4A (Expenses $ 96875527 including grants of $ 0) (Revenue $ 120541519)
City Hospital Inc. is a not-for-profit hospital located in West Virginias Eastern Panhandle that provides acute care services as well as emergency and specialty patient care. City Hospital Inc. is part of WVU Medicine University Healthcare, a regional health system serving Berkeley, Jefferson and Morgan Counties, and a member of WVU Medicine/West Virginia United Health System, the states largest healthcare network. During 2021, City Hospital documented 249,438 ancillary tests, and 2,418 observation visits.

4B (Expenses $ 22256312 including grants of $ 0) (Revenue $ 34344739)
City Hospital, Inc. operates a 24- hour, physician staffed emergency department with a Level III Trauma Center designation. During 2021, City Hospital documented 46,539 emergency visits.

4C (Expenses $ 25000102 including grants of $ 0) (Revenue $ 27145508)
As part of the WVU Cancer Institute, the WVU Medicine University Healthcare Regional Cancer Center provides cancer care in the Eastern Panhandle of West Virginia. Our cancer program, based at City Hospital, has been accredited by the American College of Surgeons Commission on Cancer since 1992 and is a recipient of their Outstanding Achievement Award. We are proud to be among the 25 of hospitals in the country with an ACOS accredited cancer program. Quality, Compassion, Collaboration. Our comprehensive cancer program includes the Outpatient Cancer and Infusion Center, a dedicated Inpatient Oncology Unit with all private rooms, Board Certified Radiation and Medical Oncologists, Patient Navigators, Radiation Therapy, and Clinical Trials. We partner with the American Cancer Society to offer education and support to patients and their families affected by cancer. A Resource Room, located on the 1st floor of the McCormack Center on City Hospitals Campus, provides free information on various programs and services available to cancer patients and their loved ones.

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The 2019 Community Health Needs Assessment was prepared by Thomas Bias, Christiaan Abildso and Emily Sarkees of the West Virginia University Health Research Center. The Community Health Needs Assessment CHNA process began with a thorough review of the previous cycles needs assessment report and implementation plan. The CHNA also involved collecting both primary and secondary data. According to the CHNA, primary data was comprised of a survey of community members perceptions of health issues followed by a community event focused on reviewing survey data, discussing community resources and assets that impact population health in the area, and working as a group to outline possible implementation strategies for each area of concern. Secondary data included US census data and County Health Rankings Data. The stakeholders represent the broad interests of the communities served by University Healthcare WVUH-East. According to the CHNA, a community meeting was held in Martinsburg to get more input from the public, especially from organizations who provide social services to individuals within the service area of University Healthcare. Representatives from these organizations held discussions in small groups to compile a working list of existing resources, programs, policies, and ideas to address each area of concern, in addition to raising questions and providing information and perspective during overall discussion of the survey data results. The CHNA stated that they also worked in their small groups and as a part of a larger discussion to formulate some new suggestions to address each health area. The organizations represented at this community meeting included American Cancer Society, Berkeley County Chamber of Commerce, Berkeley County Development Authority, Berkeley County Health Department, Berkeley County Schools, Catholic Charities, City of Martinsburg, EPIC, Jefferson County Chamber of Commerce, Jefferson County Development Authority, Jefferson County Health Department, Jefferson County Sherriffs Department, Martinsburg Parks and Recreation, Panhandle Home Health, Shenandoah Community Health, United Methodist Church, United Way and WVU Medicine officials. The CHNA can be found here https//wvumedicine.org/wp-content/uploads/2020/11/BMCJMC-CHNA-Report-2019.pdf.

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In addition to the community meeting, a public survey was also utilized. The public survey was developed by the WVU SPH with the leadership team following an iterative process. Survey topics included questions about perceptions of overall health of the community, quality of life, access to healthcare and medical needs, personal behaviors and habits, and demographic information including age, education and income. The survey was collected both online and through hard copies from residents who are 18 or older. The survey link was distributed through email lists, patient charts, social media, and made available as hard copies in the community.

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The Community Health Needs Assessment CHNA was undertaken jointly with Jefferson Memorial Hospital. You can access the full report at this website https//wvumedicine.org/about/leadership-and-more/chna/ or by going to wvumedicine.org and type Community Health Needs Assessment in the Search tool.

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According to the CHNA, following the community meeting, the leadership team discussed the totality of information collected through the survey and community event, working to identify priority areas for developing implementation strategies. With leadership and the community meeting group, the WVU SPH reviewed summarized survey data, including overall responses to the three most important health problems or issues. Health problems pertains to mainly clinical items such as health and disease topics however, when creating the survey tool, the hospital leadership saw value in asking about factors affecting health outcomes. For this reason, according to the CHNA, topics were grouped into three questions clinical health and disease items e.g. heart disease, addiction, cancer, quality of life and built or natural environmental factors e.g. air quality, availability of sidewalks, cost of medications, as well as things seen as personal choices or behaviors e.g. vaping, distracted driving, poor eating choices. This allowed the leadership team to cross-reference clinical items with their life factors and personal choices for a deeper understanding of the common themes, and a snapshot perspective of where in life the hospital might be able to implement strategies that will impact many. The CHNA survey results for health and disease included 1. Drug addiction/dependence, 2. Obesity and chronic disease 3. Mental health problems. CHNA survey results for quality of life and environmental included 1. Cost of care/medications 2. Low income 3. Lack of access to recreation spaces for all ages. CHNA survey results for personal choices and risky behaviors included 1. Drug abuse 2. Alcohol abuse 3. Bad eating choices.

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According to the CHNA, during the prioritization process that followed the community meeting, leadership team members revisited common priority areas within the context of discussions and feedback from the morning. Utilizing a prioritization matrix to guide discussion, the group considered the degree to which the hospitals can realistically affect health outcomes for each priority health concern, endeavors already underway for each, as well as level of importance relative to the reach of their impact. The list of top health concerns was pared down and reconfigured to the three that will be the focus moving forward with implementation planning. These included substance use and abuse, obesity and chronic disease and mental health.

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The top health concerns identified by the stakeholders are being addressed by University Healthcare in the following ways according to the most recent CHNA. For substance abuse, hospital leadership plans to get more MAT-trained providers in place, support for the potential Quick Response Team being developed in Jefferson County, and the importance of work to reduce stigma and use of negative terminology surrounding addiction. Potential strategies to combat obesity include further addressing and utilizing current partnerships and programming University Healthcare already has in place to help aid in the prevention of obesity and other chronic diseases. Efforts include a Diabetes Coalition and the Chronic Disease and Chronic Pain Self-Mangement Programs. Lastly, hospital leadership discussed recent hospital efforts to address the issue of mental health. These efforts include four psychiatrists, a new clinic in Ranson, recent surveying of all physicians regarding burnout, etc. Some initial strategy ideas included child and adolescent services to address existing school-based issues, initiatives addressing patients via MyChart, a need for addressing stigma and for addressing increasing suicide rates in the area.

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Hospital leadership did take the time to discuss some of the issues beyond the top three identified at the community meeting. Aging problems, low income, employment access, and transportation, for example, are something that the hospital recognizes as a community and statewide concern. However, the team agrees that these are larger problems that cannot be addressed with the resources and tools available to the hospitals right now. Similarly, cost of care and health insurance appear repeatedly in the community data, but the leadership team acknowledges that these are also in many ways systemic issues over which they have little control. Leadership has not discounted these other issues, however, and will revisit at a later time, recognizing that potential collaborations with future partners could change the scope of their impact.

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City Hospital offers discounted care only to individuals who qualify for free care. City Hospital offers a Prompt - Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount, the patient/guarantor must meet certain requirements.

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All patients are charged an amount equal to gross charges regardless of payment method. Once FAP eligibility is confirmed, charge amounts are moved to Charity Care and no longer charged to the patient.

Part I Line 3c
City Hospital Inc CHI uses 200 Federal Poverty Guideline to determine free care eligibility. However, City Hospital does not offer discounted care to individuals who do not qualify for free care.

Part I Line 6a
City Hospital, Inc. community benefit numbers are reported in total with the other hospitals within West Virginia United Health System. The most recent amounts can be found at the following web addresshttp//wvumedicine.org/about/community-benefit/.

Part I Line 7
Row b - Medicaid and Other Means-Tested Government Health Programs. The amount of offsetting revenue show in Column d of 44,688,784 includes payments received from the Directed Payment Plan of 15,948,989. These payments are intended to help offset the cost of caring for the Medicaid population in 2020/2021. Inclusion of this amount follows IRS instructions for this calculation. If these payments has not been received total community benefit from Unreimbursed Medicaid would have been 41,497,071 and 15.19 of expense.

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Column f - Total community benefit expense for 2021 is 75,185,241 and is 27.52 of total net expenses. To calculate net expense, Provision for Doubtful Accounts - Patients 12,894,548 was deducted from total expenses of 286,084,309 as shown in Part IX line 25 of the core Form 990.

Part I Line 7
Worksheet 2 from the IRS Schedule H instructions was used to derive the cost-to-charge ratio, which was used to calculate charity care at cost, unreimbursed Medicaid and other means-tested government programs at cost.

Part II
Physical improvements and housing - City Hospital employees spent a weekday volunteering at a local social service agency on behalf of the United Way of the Eastern Panhandle for the annual Day of Caring. City Hospital also provided the kick-off breakfast for approximately 300 volunteers throughout the Eastern Panhandle.

Part II
Economic Development - In 2021, Hospital representatives participated as members of the Berkeley County Board of Health and as board members for the Martinsburg Berkeley County Chamber of Commerce and Blue Ridge Community and Technical College.

Part II
Community Support - City Hospital supports and participates in many health related community activities by providing judges for science fairs at the local schools, as COVID allows. We have teams that participate in the annual March of Dimes Walk in Berkeley County, American Cancer Society Relay for Life in Berkeley County, Alzheimers Walk and various other fundraising events for local, health related, non-profit organizations. Many employees serve as volunteer board of directors for community non-profit organizations such as Hospice of the Panhandle, Boys Girls Club of the Eastern Panhandle, , Martinsburg Berkeley County Parks Rec., Girls on the Run, Berkeley and Jefferson County Chamber of Commerce, and the United Way of the Eastern Panhandle.

Part II
Environmental Improvements - 2021 marked the sixth full year for City Hospital as a tobacco free campus, by order of the Berkeley County Health Departments Clean Air Act.

Part II
Leadership Development and Training - At least one management representative from City Hospital participates in the Chamber of Commerces Leadership Berkeley class each year. The Hospital also has representatives on the Workforce Development Committee of the Chamber of Commerce. The Education Department works closely with Blue Ridge Community and Technical College to provide leadership training programs.

Part II
Community health improvement advocacy - In 2021, City Hospital Champions continued work on addressing the top three health needs identified in their 2019 CHNA.

Part II
Workforce Development - City Hospital participates in activities sponsored by the Martinsburg Berkeley County Chambers Workforce Development Committee. City Hospital is also a major sponsor of the Womens Network, which is an organization, established by the Berkeley County Chamber, which sponsors womens professional activities, social network, professional development and womens health seminars. A representative from City Hospital also serves on the Blue Ridge Community Technical College Foundation Board. City Hospital also has agreements with area community colleges and universities to allow students to complete clinical rotations at the Hospital. City Hospital provides job shadow and summer volunteer opportunities for teens to follow health professionals and learn about careers in the health field as well as participates in school career fairs in all grade levels of the school system.

Part II
Coalition Building - City Hospital staff participates in the Health Human Services Collaborative and workgroups such as the Health Work Group and Behavioral Health Workgroup. These activities focus on improving community access to health care, human services in general, and determine ways to encourage healthy lifestyles. City Hospital also leads the community coalition, Healthy Berkeley and supports several community health events such as health fairs and screenings, as COVID allows. Staff also participate in other community coalitions such as Bridges, On Track Berkeley, Promise Neighborhood Initiative and Community Garden, Try This WV, Panhandle Senior Network, Jefferson/Berkeley Alliance, Health Grandfamilies, and Mountains of Hope Cancer coalition.

Part II
Health programs are also offered free to the community. In 2021, the Walk with Ease program was offered in-person and the Chronic Pain Self-Management Program was offered virtually.

Part III Line 2
Bad Debt Expense at cost was calculated by multiplying bad debt expense - patients of 12,894,548 by our cost-to-charge ratio of 39.73 derived from Worksheet 2 in the IRS Schedule H instructions for a total of 5,123,004.

Part III Line 3
Estimated bad debt attributable to patients eligible for charity care was calculated by running a report within our patient revenue software of all bad debt account balances greater than 25,000. The total of that report was 1,497,551 which was then multiplied by the cost-to-charge ratio of 39.73 for a total of 594,977.

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We feel that, at a minimum, the estimated bad debt attributable to patients eligible for charity care of 594,977 should be considered community benefit due to the fact that a patient with an outstanding balance of 25,000 or greater usually qualifies as catastrophic if the patient completes the application process. In our Charity Care policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year.

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The System grants credit without collateral to its patients, most of whom are local residents, and are insured under third-party payor agreements, primarily with Medicare, Medicaid and various commercial insurance companies. The System records accounts receivable net of estimated prince concessions and such amounts have historically been within managements expectations.

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The mix of accounts receivable at December 31, 2021 and 2020, from patients and third-party payors is as follows For the year-end December 31, 2021 Medicare - 31, Medicaid - 16, Blue Cross - 21, Commercial, managed care and other - 28, Patients - 4, totaling 100. For the year-end December 31, 2020, Medicare - 29, Medicaid - 17, Blue Cross - 21, Commercial, managed care and other - 28, Patients - 5, totaling 100.

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City Hospital, Inc doing business as Berkeley Medical Centers financial statements are prepared on a consolidated basis as a member of the WV United Health System. The footnote for Accounts Receivable is as follows Patient accounts receivable are reported at net realizable value. For accounts receivable associated with services provided to patients who have third-party coverage, the System estimates net realizable value based on the estimated contractual reimbursement percentage, which in turn is based on current contract provisions and historical paid claims by payor. For self-pay accounts, including uninsured and patient responsibility accounts, the net realizable value is determined using historical collection experience, adjusted for estimated conversions of patient responsibility portions, expected recoveries and changes in trends to estimate implicit price concessions. Management continually reviews the estimated net realizable value of accounts receivable by monitoring cash collections, economic conditions and trends, changes in payor mix, changes in federal or state healthcare coverage and other matters.

Part III Line 8
Part III Line 6 was calculated using total cost from the Medicare Cost Report less Medicare reimbursement of direct GME. City Hospitals shortfall of 29,251,853 on Medicare program should be considered a community benefit because we are relieving a government burden by providing care in excess of our cost to these patients.

Part III Line 9b
City Hospital does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy.

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City Hospital, Inc. is a part of WVU Hospitals - East, a healthcare delivery system serving the Eastern Panhandle of WV. The WVUH-East marketing department considers several components in assessing how the organization determines the need of the communities it serves. Through outside consultants to collaborating with various departments, a needs assessment takes into account several factors including physicians to population rations, physician availability in the entire service area, and general health risks for our community. The Primary Service Area PSA for WVUH - East includes Berkeley County, WV, Jefferson County, WV and Morgan County, WV. This data is then analyzed to provide general estimates to where WVUH - East entities could better care for residents of the West Virginia Eastern Panhandle.

Part VI Line 3
City Hospital employs 2 patient account representatives to meet with patients to discuss financial eligibility for our charity care program. City Hospital has the qualification requirements, as well as, applications for charity care available at all registration areas. Patients that do not qualify for state or federally funded programs can apply for the charity care program at City Hospital.

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City Hospital is a non-profit acute care hospital located in Berkeley County, WV in the city of Martinsburg, WV. Martinsburg is the largest city in the Eastern Panhandle. City Hospital along with Jefferson Memorial Hospital located in Ranson, West Virginia makes up the eastern region of WVU Medicine, which is a part of the West Virginia United Health System.

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WVU Medicine provides a majority of inpatient services for the population in our Primary Service Area PSA. For Berkeley Medical Center, the PSA consists of Berkeley County, WV, Jefferson County, WV and Morgan County, WV. The 2020 inpatient market share for Berkeley Medical Centers Primary Service Area is 57.0 with 25.1 of those patients covered by Medicaid and 2.0 uninsured. Jefferson Medical Center, a non-profit critical access hospital under common management, is located within the Primary Service Area and War Memorial Hospital, a non-profit critical access hospital, operated by Valley Health System, is located in the extended service area of Morgan County, WV.

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Berkeley County has a population of 126,069, a median household income of 65,286, an employment rate of 67, 10.0 living in poverty and 7.8 of individuals without healthcare coverage. Jefferson Countys population is 58,370 with a median household income of 82,551, an employment rate of 65, 7.8 living in poverty and 7.1 of individuals without healthcare coverage. Morgan County has a population of 17,221 with a median household income of 57,116, an employment rate of 57, 11.0 living in poverty and 9.9 of individuals without healthcare coverage. Population and demographic information was obtained from the United States Census Bureau https//data.census.gov/cedsci/.

Part VI Line 5
City Hospital board of directors is a community board, with fourteen of the fifteen members living in or around Martinsburg, WV. The remaining board member lives in Morgantown, WV and has connections with CHI through the West Virginia United Health System. Having members living outside our PSA allows us to be more aware of the healthcare needs in other areas of West Virginia. None of the board members are employees or contractors of the filing organization, or family members thereof.

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City Hospital extends privileges to all qualified medical staff in Berkley County and surrounding communities to meet its healthcare needs.

Part VI Line 5
City Hospital allocates available funding to capital purchases and expanded services to improve patient care, support medical education in Berkeley County and surrounding counties in West Virginia and bordering states.

Part VI Line 5
In 2009, City Hospital began offering discounted screening in response to a struggling economy. Recognizing that individuals were putting off scheduling routine, preventive testing such as mammograms and blood work, City Hospital offered Discounted Mammogram Clinics in May 2021 and then again in October 2021 cash, no insurance. The clinics were successful in serving over 80 patients at City Hospital. In 2021, The Rotary Health Fairs were held in April and September. The screening provided a full blood work-up at cost. Nearly 600 individuals took advantage of these screenings.

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City Hospitals Mini-Medical School Program, which is held multiple times per year in Berkeley County, is a community health education program featuring local physicians and topics that address health needs in our communities. The program is jointly sponsored by WVU Medicine East and the WVU Robert C. Byrd Health Sciences Center Eastern Division. It is offered free to the community virtually on our Facebook page with an average of 550 views.

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City Hospital, Inc is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery team. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its service areas, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves.

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System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include West Virginia University Hospitals, Inc. in Morgantown, WV, United Hospital Center in Bridgeport, WV, Camden-Clark Memorial Hospital in Parkersburg, WV, Jefferson Memorial Hospital in Ranson, WV, Potomac Valley Hospital in Keyser, WV, Reynolds Memorial Hospital, in Glen Dale, WV, West Virginia Health Care Cooperative, doing business as, Summersville Regional Medical Center in Summersville, WV, Braxton County Memorial Hospital in Gassaway, WV, Community Health Association, doing business as, Jackson General Hospital in Ripley, WV, St. Josephs Hospital of Buckhannon in Buckhannon, WV, Wetzel County Hospital, Inc. in New Martinsville, WV, Barnesville Hospital Assocation in Barnesville, OH, Uniontown Hospital in Uniontown, PA, Wheeling Hospital, Inc. in Wheeling, WV and Harrison Community Hospital, Inc. in Cadiz, OH.

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In addition to the above mentioned hospitals, the System includes physician practices of United Physicians Care, Inc., Camden-Clark Physician Corp, and Fayette Physician Network dba WVUHS Medical Group that operate in conjunction with the System hospitals along with United Summit Center, Inc. a behavioral health center located in Clarksburg, WV. The System also includes, WVUH-East, Inc. and Camden-Clark Health Services, Inc. which operate as management companies for their respective hospitals. University Healthcare Foundation, Inc. in Martinsburg, WV, United Health Foundation, Inc. in Bridgeport, WV, Camden-Clark Foundation, Inc. in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc. in Buckhannon, WV, Reynolds Memorial Foundation, Inc. in Glen Dale, WV, Barnesville Hospital Foundation in Barnesville, OH, and Harrison Community Hospital Foundation in Cadiz, OH which perform various fundraising activities for their respective hospitals. In 2020, the System formed WVUHS Home Care, LLC to provide Home Health and Hospice services to our service areas, supporting System hospitals by providing continuous care to our patients. Wheeling Hospital Ambulatory Surgical Center, LLC a surgical center located in Bridgeport, OH was acquired in 2021.