4A (Expenses $ 147363215 including grants of $ 306081) (Revenue $ 197741342)
Community Hospital provides inpatient, outpatient, emergency, urgent, and primary health care services to communities in western Colorado which have been identified as a physician shortage area. During the tax year ended December 2020, Community Hospital had 8,275 patient days, 15,522 emergency room visits, 11,061 urgent care visits, 49,928 primary care visits, 5,407 oncology infusions and performed 3,836 surgeries. Continuted on Sch O.

Part V, Section B, Line 5:
Community Hospital was an active participant in the CHNA collaboration with the Mesa County Community Health Department and a number of other local hospitals and organizations in Mesa County. A Community Hospital representative worked with the CHNA planning committee and the Mesa County Community Transformation Group to determine what data needed to be gathered. Community Hospital provided aggregate health screening reports for its contracted employer groups to Mesa County Health Department. The healthcare partners of our community met regularly to put together a timeline and action plan to implement the Strategy Report and ensure no duplication of efforts. Community Hospital utilized previous assessments to guide interventions and collaborations. Primary data was collected from subject matter experts and community members through focus groups, informal interviews, and electronic surveys.

Part V, Section B, Line 6a:
The CHNA was conducted with the following other hospital facilities: Family Health West Hospital, St. Mary's Hospital & Regional Medical Center, Mind Springs Hospital, Inc.

Part V, Section B, Line 6b:
Mesa County Public Health, Hilltop, Marillac Clinic

Part V, Section B, Line 7d:
Hospital Website: https://yourcommunityhospital.com/Community_Health_Needs_Assessment.cfm Other Website: http://health.mesacounty.us/services/community/data-reports/ Implementation Strategy: https://yourcommunityhospital.com/Community_Health_Needs_Assessment.cfm

Part V, Section B, Line 11:
"Community Hospital was an active participant in the CHNA in collaboration with the Mesa County Public Health and a number of other local hospitals and organizations in Mesa County. This collaborative approach enabled the group to identify areas where the various organizations might work together to achieve needed improvements. Community Hospital has been utilizing this assessment as a guide for providing programs to address identified community health needs in support of the collaborators and with the mission of our organization ""to improve the health and quality of life of the individuals and communities we serve."" While Community Hospital actively supports many of the health needs that have been identified by the CHNA, we have made the decision not to address social inequities at this time. We believe that our current resources are best used to impact health needs in the other areas of inequity. Additionally, other community entities are better suited to wholeheartedly address social inequities in Mesa County."

Community Hospital's Implementation Strategies:
Community Hospital is committed to enhancing its understanding about how best to develop and implement effective strategies to address community health needs. Community Hospital also recognizes that good health outcomes cannot be achieved without joint planning and partnerships with community stakeholders and leaders. As such, Community Hospital will continue to work in partnership with other local entities to refine its goals and strategies over time. With this approach, Community Hospital will most effectively address the needs identified. Community Hospital's implementation strategies address five of the six areas identified in the CHNA. For each area, the plan outlines the following: the goals and objectives designed to guide improvement efforts, Community Hospital's role or action in addressing the areas of concern, expected outcomes, and measures which may be used to determine the action(s)' effectiveness. 1. Institutional Inequities Community Hospital has recruited and employed over 15 new primary care providers to the Grand Valley since 2018. One additional primary care provider location was opened in 2019, one new location with be opened in 2020, and at least one more is in the planning phase for 2021. Community Hospital has also expedited the new patient process (paperwork) to improve accessibility and patient experience. Community Hospital's Diversity Council utilizes the Equity in Care Toolkit, developed by the American Hospital Association, as a framework to determine how patient demographic data collected upon admissions can be used to reduce inequity in health care delivery. 2. Living Conditions Community Hospital continues to work with local employer groups to reduce barriers to care, utilizing the near-site clinic model. This model provides all employees,/dependents access to care in a cost-effective setting 24/7. Additionally, these employees and their dependents have access to free Virtual Urgent Care through the University of Utah. These resources encourage primary care utilization and decrease emergency room utilization (for primary care needs). 3. Risk Behaviors Community Hospital supports the efforts of the Mesa County Health Department to address issues such as suicide and tobacco/vaping utilization. Community Hospital offers a 16-week Lifestyle Medicine program to address risk-factors such as overweight and obesity and encourage healthy behaviors. Lastly, Community Hospital provides no-cost flu vaccines through the Community Health Partnership annual health screenings for employer groups. Flu vaccines are offered at all primary care locations and Canyon View Pharmacy. 4. Disease and Injury See above efforts to address suicide and overweight/obesity. With regards to lung cancer, in 2018 Community Hospital created a comprehensive lung cancer care team, which is made up of pulmonologists, radiation oncologists, a thoracic and vascular surgeon, medical oncologists, and a diagnostic radiologist. IN addition to state-of-the-art technology, this care team serves to threat the whole patient through comprehensive and coordinated efforts; Community Hospital believes that this approach is likely to lead to both better outcomes and improved care quality for lung cancer patients in Mesa County. This model was duplicated in 2019 when a breast cancer care team and head/neck cancer care team were also created. 5. Mortality By providing service for the entire health spectrum-from outpatient clinics to the intensive care unit - Community Hospital is aiding in reducing mortality from all causes in Mesa County.

Part V, Section B, Line 13h:
Community Hospital may make a presumption of eligibility on the basis of individual life circumstances that may include homelessness, patient deceased with no known estate, and other circumstances. The facility may use outside agencies in determining estimated income amounts for presumptive charity care eligibility.

Part V, Section B, Line 16j:

Part V, Line 16a FAP:
https://yourcommunityhospital.com/Billing.cfm

Part V, Line 16b: FAP Application:
https://yourcommunityhospital.com/PDFs/Financial%20Application%20Website.p df

Part V, Line 16c FAP Plain Language Summary:
https://yourcommunityhospital.com/Billing.cfm

Part V, Section B, Line 24:
The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy.

Part I, Line 3c:
In addition to FPL, the organization used an asset test in determining eligibility for financial assistance. The organization also took insurance status and medical indigency into consideration. Community Hospital may make a presumption of eligibility on the basis of individual life circumstances that may include homelessness, patient deceased with no known estate, and other circumstances. The facility may use outside agencies in determining estimated income amounts for presumptive charity care eligibility.

Part I, Line 7:
Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Line 7b and 7c were determined using the overall cost to charge ratio. Line 7i is actual expenses from the general ledger.

Part III, Line 2:
Allowance for bad debts is determined monthly by review of contractuals by payor using historical activity and expected collection rates. The amount is reviewed by the CFO and Board. Part III, Line 4: Footnote from Financial Statement: Please see Note 2, Financial Statement, Patient Service Revenue on page 17.

Part III, Line 8:
The Medicare cost report was used to determine the amount of the Medicare shortfall. IRS Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with government health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. This implies that treating Medicare patients is a community benefit. The organization estimates 100% should be considered a community benefit. If these individuals did not qualify for Medicare, they would qualify for financial assistance, based on the demographics of the community in which we operate.

Part III, Line 9b:
For patients who qualify for charity and who are cooperating in good faith to resolve their discounted hospital bills, Community Hospital may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts. Community Hospital will not impose extraordinary collections actions such as wage garnishments, liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for charity care under this financial assistance policy.

Part VI, Line 2:
Community Hospital develops its strategic plan both internally and supported by Quorum Health Resources to assess the healthcare needs of the community it serves. This plan includes market assessment of the service area and local demographic characteristics, clinical service line utilization and projections for inpatient, ambulatory, and provider practices. Clinical foci resulting form the same diabetes, obesity, and primary care access.

Part VI, Line 3:
Part of the Hospital's written financial assistance and charity care policy provides for financial counselors to meet with all uninsured patients prior to discharge. The Hospital's billing team may also inform patients of the Hospital's financial assistance and charity care program.

Part IV, Line 4:
The Hospital's primary service area is Western Colorado and the residents of Mesa County. Mesa County's population is approximately 150,000 with 15% of the population being over the age of 65. Community Hospital captures 15.9% of the area's healthcare market for those patients requiring inpatient stays.

Part VI, Line 5:
The Hospital is governed by a 12-member Board of Trustees composed of seven Mesa County, Colorado, community members and five community medical staff members who are all committed to fulfilling the following mission statement: Community Hospital will improve the health and quality of life of the individuals and communities we serve. The community members use their unique experience and abilities to lead the Hospital in directions that support the needs of the community.