4A (Expenses $ 256336717 including grants of $ 1209987) (Revenue $ 315098629)
SINCE ITS FOUNDING IN 1889, OUR PRIVATE, NOT-FOR-PROFIT FACILITY HAS GROWN INTO A DIVERSE CLINICAL ENTERPRISE THAT IS CONSISTENTLY RECOGNIZED NATIONALLY FOR CLINICAL EXCELLENCE BY HEALTHGRADES, TRUVEN, AND OTHER COMPARATIVE QUALITY DATA ORGANIZATIONS. HOSPITAL SERVICES ARE PROVIDED TO INPATIENTS AND OUTPATIENTS, INCLUDING CHARITY CARE TO THE INDIGENT AND OTHER PATIENTS. PLEASE SEE SCHEDULE H FOR DETAILS ON COMMUNITY BENEFITS.

FLAGLER HOSPITAL
"PART V, SECTION B, LINE 5: THE YEAR-LONG PROCESS FOR THE 2020 COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZED A COMMUNITY-WIDE STRATEGIC PLANNING PROCESS CALLED ""MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS OR ""MAPP"", WHICH WAS DEVELOPED BY THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS PLANNED BY THE HEALTH LEADERSHIP COUNCIL AS A COLLECTION OF DATA GATHERED TO IDENTIFY AND ANALYZE HEALTH STATUS, HEALTH FACTORS AND HEALTH OUTCOMES WITHIN THE COMMUNITY. USING MAPP GUIDELINES, FOCUS GROUPS WERE FORMED TO DETERMINE HOW RESIDENTS FELT ABOUT THE QUALITY OF LIFE IN ST. JOHNS COUNTY. THESE FOCUS GROUPS WERE FACILITATED BY LEADERS OF THE HEALTH LEADERSHIP COUNCIL WITH THE INTENT OF COVERING A VARIETY OF GEOGRAPHIC AND DEMOGRAPHIC SECTORS OF THE COUNTY. SECOND, A SURVEY WAS DISPERSED COUNTY-WIDE AND MADE AVAILABLE ONLINE. THIS DATA AND DATA FROM THE NATIONAL AND STATE COUNTY HEALTH RANKINGS AND HEALTHY PEOPLE 2020, SERVED AS A BASIS FOR THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). NOTE: THE COMPLETE ""COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN"" IS PUBLISHED AND AVAILABLE ON THE FLAGLER HOSPITAL WEBSITE: HTTPS://WWW.FLAGLERHEALTH.ORG/PATIENTS-VISITORS.ASPX.IN TOTAL, FLAGLER HOSPITAL AND THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL FACILITATED 8 COMMUNTIY FOCUS GROUPS WITH A TOTAL OF 50 PARTICIPANTS TO GAIN A BETTER UNDERSTANDING OF PERCEPTIONS OF COMMUNTIY STRENGTHS, NEEDS AND HEALTH CONCERNS. A COMMUNITY-WIDE SURVEY WAS USED TO GATHER RESIDENTS' THOUGHTS AND CONCERNS ABOUT THE QUALITY OF LIFE AND HEALTHCARE SERVICES IN ST. JOHNS COUNTY. THE SURVEY WAS MADE WIDELY AVAILABLE THROUGH WEB-BASED SURVEYS WHICH WERE EMAILED AND PROMOTED ON SOCIAL MEDIA SOURCES THROUGH THE FLAGLER HEALTH+/FLAGLER HOSPITAL SOCIAL MEDIA OUTLETS. 517 SURVEYS WERE COMPLETED. THE FOCUS ON COVID-19 BY BOTH THE HOSPITAL AND THE DEPARTMENT OF HEALTH RESULTED IN FEWER RESOURCES WITH THE ABILITY TO DEVOTE TIME AND PERSONNEL TO GATHER INFORMATION IN PERSON. FURTHERMORE, THE PUBLIC GATHERINGS FOR FOCUS GROUPS ARE NOT ENCOURAGED AT THIS TIME. IN ADDITION TO THE COMMUNITY SURVEY, AGGREGATE DATA FROM CARE CONNECT+ IS USED TO DETERMINE COMMUNITY NEEDS AND GAPS IN SERVICES BASED ON THE NEEDS AND GOALS VOICED BY COMMUNITY CLIENTS.SURVEY RESPONDENTS REPRESENTED ALL ST. JOHNS COUNTY, FL ZIP CODES. THE HIGHEST PROPORTION OF SURVEYS WERE COMPLETED BY RESIDENTS OF THE 32084 (25%) AND 32086 (25%) ZIP CODES OF THE COUNTY. RESPONDENTS WERE MOSTLY HOME OWNERS (83%) AND THE MAJORITY HAD LIVED IN ST. JOHNS COUNTY FOR MORE THAN 10 YEARS (58%). THERE WERE NO SURVEY RESPONDENTS THAT REPORTED BEING HOMELESS HOWEVER 4 DID NOT ANSWER THE QUESTION, AND 6 ANSWERED ""PREFER NOT TO ANSWER"". USING MOSTLY A DIGITAL SURVEY, HINDERED OUR ABILITY TO REACH THE HOMELESS POPULATION, ALTHOUGH ATTEMPTS WERE MADE TO USE THE FREE CLINIC TO REACH THOSE WHO ARE UNDERSERVED. RESPONDENTS WERE OVERWHELMINGLY FEMALE (85%) AND MARRIED OR IN A DOMESTIC PARTNERSHIP (70%). AS MENTIONED ABOVE, ST JOHNS COUNTY IS NOT VERY RACIALLY DIVERSE. ABOUT 83% OF ST JOHNS COUNTY RESIDENTS ARE WHITE AND THE SURVEY REFLECTED ABOUT 92% OF RESPONDENTS ARE WHITE. ATTEMPTS WERE MADE TO SHARE THE SURVEY THROUGH SOCIAL MEDIA TO ALL MEMBERS OF THE COMMUNITY AND TO OBTAIN A DIVERSE OUTLOOK BUT DUE TO CONSTRAINTS WITH RESOURCES DUE TO COVID-19, THE RACIAL DIVERSITY OF SURVEY RESPONDENTS WAS LESS THAN IDEAL. INFORMATION GATHERED THROUGH CARE CONNECT+ PROVIDES A MORE DIVERSE ANALYSIS OF COMMUNITY NEEDS. ALSO REFLECTING THE COMMUNITY AT LARGE, ABOUT 60% OF RESPONDENTS ARE 18-64 (COMPARED TO POPULATION OF 58% 18-64). THE MEDIAN HOUSEHOLD INCOME OF ST. JOHNS COUNTY IS $82,252 WHICH IS REFLECTED IN OUR RESPONDENTS WHO MOSTLY MAKE OVER $50,000 (60%). 73% OF SURVEY RESPONDENTS REPORTED DEGREE FROM HIGHER EDUCATION (ASSOCIATES OR HIGHER) AND ABOUT 45% OF RESIDENTS OVER 25 HAVE A BACHELOR'S OR HIGHER. A NEW SURVEY AND RESULTING REPORT WERE CREATED IN DECEMBER OF 2020 WHICH WILL BE SHOWN IN TAX YEAR 2021. THE WEBSITE FOR THIS REPORT IS SHOWN HERE FOR REFERENCE: HTTPS://WWW.FLAGLERHEALTH.ORG/COMMUNITY-HEALTH-IMPROVEMENT/COMMUNITY-BENEFIT-PLANNING/ST-JOHNS-COUNTY-HEALTH-NEEDS-ASSESSMENT/."

FLAGLER HOSPITAL
PART V, SECTION B, LINE 6B: ANASTASIA MOSQUITO CONTROL DISTRICT- SJCAZALEA HEALTHBETTY GRIFFIN CENTERCHILDREN'S HOME SOCIETY OF FLORIDACLINTON HEALTH MATTERS INITIATIVECOMMUNITY HOSPICE AND PALLIATIVE CARECOMMUNITY MANAGEMENT & CONSULTINGEPIC BEHAVIORAL HEALTHCAREFLAGLER HOSPITALFLORIDA ARMY RESERVE NATIONAL GUARDFLORIDA DEPARTMENT OF HEALTH IN ST. JOHNS COUNTYGOOD SAMARITAN HEALTH CENTERS/WILDFLOWER CLINICHEALTH PLANNING COUNCIL OF NORTHEAST FLORIDAST JOHNS RIVER RURAL HEALTH NETWORKNEW MT. MORIAH CHRISTIAN MINISTRYNORTHEAST FLORIDA HEALTHY START COALITIONPACT PREVENTION COALITION OF ST. JOHNS COUNTYST. JOHNS COUNTY HEALTH AND HUMAN SERVICESST. AUGUSTINE BEACH POLICE DEPARTMENTST. AUGUSTINE YOUTH SERVICESST. JOHNS COUNTY ADMINISTRATIONST. JOHNS COUNTY BOARD OF COUNTY COMMISSIONERSST. JOHNS COUNTY COUNCIL ON AGINGST. JOHNS COUNTY EMERGENCY MANAGEMENTSJC HEALTH AND HUMAN SERVICES ADVISORY COUNCILST. JOHNS COUNTY MEDICAL SOCIETYST. JOHNS COUNTY SCHOOL DISTRICTSJC HEAD START PROGRAM/EARLY CHILDHOOD SERVICESST. JOHNS COUNTY SHERIFF'S OFFICEST. JOHNS RIVER STATE COLLEGEST. VINCENT'S MOBILE HEALTH OUTREACH MINISTRYSTEWART MARCHMAN - ACT BEHAVIORAL HEALTHCARETHE SONTAG FOUNDATIONTOBACCO FREE ST. JOHNSYMCA OF FLORIDA'S FIRST COAST

FLAGLER HOSPITAL
PART V, SECTION B, LINE 7D: FLAGLER HOSPITAL UTILIZED A VARIETY OF APPROACHES TO INFORM THE COMMUNITY ON THE RESULTS OF THE 2017 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. FLAGLER HOSPITAL INVESTED IN PRINTING 300 HARD COPIES OF THE 147-PAGE PUBLICATION. THESE COPIES WERE PROVIDED TO ALL ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL MEMBERS AND DISPLAYED ON-SITE AT EACH MEMBER AGENCY. FLAGLER HOSPITAL ALSO PRINTED 50 LARGE-FONT VERSIONS OF THE CHNA FOR VISUALLY IMPAIRED COMMUNITY MEMBERS THAT WERE DISTRIBUTED TO THE ST. JOHNS COUNTY COUNCIL ON AGING AND LOCAL LIBRARIES.

FLAGLER HOSPITAL
"PART V, SECTION B, LINE 11: REDUCE CHRONIC DISEASE MORBIDITY AND MORTALITYCANCER IS THE LEADING CAUSE OF DEATH IN ST. JOHNS COUNTY, WITH BREAST, COLON AND LUNG CANCER IDENTIFIED AS BEING THE MOST COMMON TYPES AMONG RESIDENTS. AMONG SURVEY RESPONDENTS, CANCER WAS GIVEN HIGH PRIORITY IN PERCEPTION OF CONCERN.TO RAISE AWARENESS ABOUT THE BENEFITS OF PREVENTION AND EARLY DETECTION OF CANCER, FLAGLER HOSPITAL PARTICIPATED IN OVER 25 HEALTH FAIRS, PROVIDING ST. JOHNS COUNTY RESIDENTS WITH UP-TO-DATE SCREENING GUIDELINES AND THE BENEFITS OF A HEALTHY LIFESTYLE. CANCER PREVENTION PROGRAMS INCLUDED PRESENTATIONS FOR LOCAL CHURCHES AND CIVIC GROUPS, LUNG CANCER AWARENESS EVENTS, COLORECTAL CANCER PREVENTION AND AWARENESS EVENTS AND A SKIN CANCER PREVENTION PROGRAM. IN ADDITION, FLAGLER HOSPITAL PARTNERED WITH OTHER COMMUNITY ORGANIZATIONS SUCH AS GOOD SAMARITAN, WILDFLOWER CLINIC, AMERICAN CANCER SOCIETY, LUNG CANCER ALLIANCE, PINK-UP THE PACE AND UNITY OUTREACH TO PROMOTE CANCER AWARENESS AND EARLY DETECTION THROUGHOUT THE COMMUNITY.BREAST CANCER PROGRAM:AS A NAPBC-ACCREDITED CENTER, FLAGLER HOSPITAL IS COMMITTED TO MAINTAINING LEVELS OF EXCELLENCE IN THE DELIVERY OF COMPREHENSIVE, PATIENT-CENTERED, MULTIDISCIPLINARY CARE RESULTING IN HIGH-QUALITY CARE FOR PATIENTS WITH BREAST DISEASE. PATIENTS CAN BE CONFIDENT THAT THEIR BREAST CARE TEAM INCLUDES HEALTH CARE PROFESSIONALS FROM A VARIETY OF DISCIPLINES WHO ARE COMMITTED TO WORKING TOGETHER TO PROVIDE THE BEST CARE AVAILABLE THROUGH THEIR ENTIRE COURSE OF TREATMENT. PATIENTS RECEIVING CARE AT A NAPBC-ACCREDITED CENTER ALSO HAVE ACCESS TO INFORMATION ON CLINICAL TRIALS AND NEW TREATMENT OPTIONS, GENETIC COUNSELING, AND PATIENT-CENTERED SERVICES INCLUDING PSYCHOSOCIAL SUPPORT, REHABILITATION SERVICES AND SURVIVORSHIP CARE. TO ASSIST PATIENTS THROUGH THEIR JOURNEY, THE FLAGLER BREAST CARE PROGRAM HAS AN ONCOLOGY NURSE NAVIGATOR WHO HELPS PATIENTS FROM THE TIME THERE IS A SUSPICION OF BREAST CANCER UNTIL TREATMENT IS CONCLUDED AND BEYOND TO SURVIVORSHIP. THE NAVIGATOR IS DEDICATED TO PROVIDING PATIENTS WITH KNOWLEDGEABLE AND COMPASSIONATE SUPPORT; FACILITATING COMMUNICATION BETWEEN THE PATIENT AND PHYSICIANS IN ORDER TO DECREASE FRAGMENTATION OF CARE; AND PROVIDING PATIENTS AND FAMILY MEMBERS WITH INFORMATION ON COMMUNITY-BASED RESOURCES. THE NAVIGATOR ALSO PARTICIPATES IN COMMUNITY EVENTS, EDUCATING WOMEN ON THE BENEFITS OF EARLY DETECTION AND PREVENTION. IN 2022 THE ONCOLOGY NURSE NAVIGATOR FOLLOWED 224 BREAST CANCER PATIENTS.CANCER PROGRAM:THE CANCER PROGRAM AT FLAGLER HOSPITAL IS ACCREDITED BY THE COMMISSION ON CANCER (COC), A QUALITY PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS (ACS). TO EARN VOLUNTARY COC ACCREDITATION, A CANCER PROGRAM MUST MEET COC QUALITY CARE STANDARDS, BE EVALUATED EVERY THREE YEARS THROUGH A SURVEY PROCESS, AND MAINTAIN LEVELS OF EXCELLENCE IN THE DELIVERY OF COMPREHENSIVE PATIENT-CENTERED CARE. THE COC ACCREDITATION PROGRAM PROVIDES THE FRAMEWORK FOR FLAGLER HOSPITAL TO IMPROVE ITS QUALITY OF PATIENT CARE THROUGH VARIOUS CANCER-RELATED PROGRAMS THAT FOCUS ON THE FULL SPECTRUM OF CANCER CARE INCLUDING PREVENTION, EARLY DIAGNOSIS, CANCER STAGING, OPTIMAL TREATMENT, REHABILITATION, LIFE-LONG FOLLOW-UP FOR RECURRENT DISEASE, AND END-OF-LIFE CARE. WHEN PATIENTS RECEIVE CARE AT A COC FACILITY, THEY ALSO HAVE ACCESS TO INFORMATION ON CLINICAL TRIALS AND NEW TREATMENTS, GENETIC COUNSELING, AND PATIENT-CENTERED SERVICES INCLUDING PSYCHOSOCIAL SUPPORT, REHABILITATION SERVICES AND SURVIVORSHIP CARE. TO HELP GUIDE PATIENTS THROUGH THEIR JOURNEY FLAGLER HOSPITAL HAS ONCOLOGY NURSE NAVIGATORS THAT FOLLOW PATIENTS WITH LUNG CANCER, BREAST CANCER, PROSTATE CANCER, ESOPHAGEAL CANCER AND HEAD & NECK CANCERS. IN 2021 THE ONCOLOGY NURSE NAVIGATORS SUPPORTED 473 PATIENTS IN OUR COMMUNITY. FLAGLER HOSPITAL MAINTAINS A CANCER RESOURCE CENTER, OPEN TO ALL IN THE COMMUNITY, ALONG WITH A WIG AND PROSTHESIS CLOSET. THERE IS A FREE COMPUTER KIOSK FOR THE DISSEMINATION OF HEALTH INFORMATION. IT IS STAFFED BY OUR CANCER EDUCATION AND SUPPORT COORDINATOR AND VOLUNTEERS EACH WEEKDAY FROM 8:00 UNTIL 4:00. THE CANCER RESOURCE CENTER IS ALSO UTILIZED BY VARIOUS CANCER SUPPORT GROUPS. LUNG CANCER: RREALIZING THAT CIGARETTE SMOKING IS THE NUMBER ONE RISK FACTOR FOR LUNG CANCER, FLAGLER HOSPITAL CONTINUES TO MAINTAIN A SMOKE FREE FACILITY, INCLUDING PARKING LOTS AND LEASED PROPERTIES. FLAGLER HOSPITAL ALSO IMPLEMENTED A TOBACCO SCREENING PROTOCOL THROUGHOUT THE HOSPITAL. UPON ADMISSION, EACH PATIENT IS ASKED IF THEY SMOKE OR USE TOBACCO IN ANY OTHER FORM. THIS INFORMATION IS USED TO TRIGGER A CONSULTATION FROM THE CARDIOPULMONARY DEPARTMENT, FROM A MEMBER OF THE ""QUIT TEAM"". QUIT TEAM MEMBERS VERIFY THE PATIENTS WHO USE TOBACCO AND PROVIDE COUNSELING ON TOBACCO CESSATION. IF THE PATIENT IS INTERESTED IN QUITTING, THEY ARE GIVEN INFORMATION ON FREE TOBACCO CESSATION PROGRAMS OFFERED THROUGH FLAGLER HOSPITAL. THE QUIT TEAM ALSO EDUCATED FLAGLER STAFF AND MEDICAL PERSONNEL ON THE IMPORTANCE OF THE MESSAGE THAT CESSATION OPPORTUNITIES ARE BOTH VALUABLE AND EFFICACIOUS.FLAGLER HOSPITAL PARTNERS WITH NORTHEAST FLORIDA AREA HEALTH EDUCATION CENTER TO PROVIDE ACCESS TO THE ""QUIT SMOKING NOW"" SMOKING CESSATION PROGRAM. QUIT SMOKING NOW IS A FREE COURSE THAT CONSISTS OF GROUP SESSIONS FACILITATED BY THE CARDIOPULMONARY DEPARTMENT AND HELD IN THE FLAGLER HOSPITAL WELLNESS CENTER. CLASSES TAKE PLACE ONCE PER WEEK FOR ONE HOUR, OVER A FOUR-WEEK PERIOD.DURING 2021 THE TOOLS TO QUIT CLASS AT FLAGLER WAS ABLE TO SEE OVER 10 PARTICIPANTS WHO WERE PROVIDED WITH CESSATION EDUCATION COMBINED WITH SUPPORTIVE MEASURES TO STOP SMOKING. LOZENGES, PATCHES, AND GUMS ARE SOME OF THE THERAPIES PROVIDED IN ADDITION TO STRESS MANAGEMENT TECHNIQUES, EDUCATION REGARDING TRIGGERS TO USE, AND PERCEPTION EDUCATION TO SMOKING CESSATION.THE HOSPITAL PARTNERS WITH TOBACCO FREE ST. JOHNS, A COMMUNITY-WIDE LOCALLY ORGANIZED GROUP COLLECTIVELY WORKING TOWARDS ELIMINATING INITIATION AND USE OF TOBACCO AMONG ST. JOHNS COUNTY RESIDENTS, SUPPORTING POLICY CHANGE AND EDUCATING DECISION MAKERS ABOUT THE IMPACT OF TOBACCO ON THE LIVES OF ST. JOHNS COUNTY RESIDENTS AND VISITORS.SEE LATER PART OF SCHEDULE H, PART V FOR CONTINUATION."

FLAGLER HOSPITAL
PART V, SECTION B, LINE 15E: CONTACT INFORMATION IS IN THE PLAIN LANGUAGE SUMMARY LOCATED ON THE HOSPITAL WEBSITE: HTTPS://WWW.FLAGLERHOSPITAL.ORG/FINANCIAL-SERVICES/FAP-PLAIN-LANGUAGE-SUMMARY.ASPX: THERE ARE MANY WAYS TO FIND INFORMATION ABOUT THE FAP APPLICATION PROCESS, OR GET COPIES OF THE FAP OR FAP APPLICATION FORM. TO APPLY FOR FINANCIAL ASSISTANCE YOU MAY: DOWNLOAD THE INFORMATION ONLINE AT FLAGLERHOSPITAL.ORG, KEY WORDS FINANCIAL ASSISTANCE REQUEST THE INFORMATION IN WRITING BY MAIL OR BY VISITING THE FLAGLER HOSPITAL BUSINESS OFFICE AT 100 WHETSTONE PLACE, SUITE 100 ST. AUGUSTINE, FL 32086 REQUEST THE INFORMATION BY CALLING (904) 819-4539 AVAILABILITY OF TRANSLATIONSTHE FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, AND THE PLAIN LANGUAGE SUMMARY ARE OFFERED IN ENGLISH AND SPANISH. FLAGLER HOSPITAL MAY ELECT TO FURNISH TRANSLATION AIDS, TRANSLATION GUIDES, OR PROVIDE ASSISTANCE THROUGH USE OF QUALIFIED BILINGUAL INTERPRETER BY REQUEST. FOR INFORMATION ABOUT FLAGLER HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND TRANSLATION SERVICES, PLEASE CALL A REPRESENTATIVE AT (904) 819-4539.

PART V, SECTION B, LINE 11 CONTINUED:
REDUCE SUBSTANCE ABUSE:FLAGLER HOSPITAL MAINTAINS A CANCER RESOURCE CENTER, OPEN TO ALL IN THE COMMUNITY, ALONG WITH A WIG AND PROSTHESIS CLOSET. THERE IS A FREE COMPUTER KIOSK FOR THE DISSEMINATION OF HEALTH INFORMATION. IT IS STAFFED BY OUR CANCER EDUCATION AND SUPPORT COORDINATOR AND VOLUNTEERS EACH WEEKDAY FROM 8:00 UNTIL 4:00. THE CANCER RESOURCE CENTER IS ALSO UTILIZED BY VARIOUS CANCER SUPPORT GROUPS.JUST AS WAS FOUND IN THE 2014 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT, THE ISSUE OF SUBSTANCE ABUSE WAS LISTED AS THE #1 IMPORTANT HEALTH PROBLEMS BY SURVEY RESPONDENTS IN THE 2020 CHNA. THIS INCLUDES BINGE DRINKING, UNDERAGE DRINKING, CIGARETTE AND MARIJUANA AND OTHER DRUG USE. FLAGLER HOSPITAL'S DIRECTOR OF BEHAVIORAL HEALTH SERVICES WORKS CLOSELY WITH EPIC COMMUNITY SERVICES (EPIC WAS CREATED TO PROVIDE SUBSTANCE ABUSE PREVENTION, INTERVENTION, OUTPATIENT TREATMENT AND AFTERCARE SERVICES), PACT, (PREVENTION, ACTION, CHOICES AND TEAMWORK) PREVENTION SERVICES (WHICH ADVOCATES FOR PREVENTION FOR YOUTH), TOBACCO FREE ST. JOHNS AND OTHER GROUPS SUCH AS LAW ENFORCEMENT ON THIS ISSUE. ST. JOHNS COUNTY CONTINUES TO RANK IN THE TOP 5 COUNTIES IN FLORIDA FOR BINGE DRINKING. THE ST. JOHNS COUNTY BEHAVIORAL HEALTH CONSORTIUM CONTINUES TO WORK TOWARDS FINDING A WAY TO GET THESE IMPORTANT HEALTH SERVICES AVAILABLE FOR REFERRAL IN OUR SERVICE AREA. FLAGLER HOSPITAL CONTINUES TO PROVIDE A YEARLY $150,000 DONATION IN SUPPORT OF EPIC BEHAVIORAL HEALTHCARE'S 26-BED RECOVERY CENTER.THE EPIC RECOVERY CENTER (ERC) OPENED IN JANUARY 2014, FILLING THE NEED FOR AN INPATIENT TREATMENT CENTER IN ST. JOHNS COUNTY. THE ERC OFFERS SEVERAL TYPES OF SUBSTANCE USE DISORDER TREATMENT SERVICES INCLUDING DETOXIFICATION, OUTPATIENT THERAPY, RESIDENTIAL TREATMENT, AND THE MARS (MEDICALLY-ASSISTED RECOVERY SERVICES) PROGRAM. IN THE PAST 7.5 YEARS, THE ERC HAS HAD 6,763 ADMISSIONS AND IN THE PAST FEW YEARS, 38% OF ALL DETOX ADMISSIONS WERE RELATED TO OPIATE USE.THE MAJORITY OF EPIC RECOVERY CENTER'S PATIENTS LIVE IN POVERTY (84%), HAVE NO INSURANCE, OR INSURANCE WITH POOR BEHAVIORAL HEALTH BENEFITS, WHICH MAKES FLAGLER HOSPITAL'S SUPPORT ESSENTIAL TO PROVIDING THIS MUCH NEEDED SERVICE TO THE COMMUNITY.DISCHARGE/TRANSITION PLANS ARE DEVELOPED WITH EACH INDIVIDUAL IN THE INPATIENT UNIT THAT INCLUDES REFERRAL TO OUTPATIENT TREATMENT, REFERRAL FOR PRIMARY CARE MEDICAL SERVICES, SOBER LIVING OR OTHER HOUSING PLACEMENT, CARE COORDINATION REGARDING VARIOUS SOCIAL DETERMINATES OF HEALTH MATTERS, AND ONGOING PEER RECOVERY SUPPORT SERVICES.THE EPIC RECOVERY CENTER HAS BECOME THE CORNERSTONE OF THE ADDICTION TREATMENT SYSTEM OF CARE IN ST. JOHNS COUNTY SERVING SOME OF THE MOST VULNERABLE FLORIDIANS UNINSURED, HOMELESS, THOSE INVOLVED IN THE CHILD WELFARE SYSTEM, CRIMINALLY JUSTICE INVOLVED, AND/OR SUFFERING FROM MULTIPLE CHRONIC HEALTH CONDITIONS.INCREASE ACCESS TO DENTAL CARE:ACCESS TO DENTAL CARE HAS LONG BEEN AN ISSUE IN ST. JOHNS COUNTY, AS IT IS ACROSS THE STATE. RESPONDENTS OF THE 2020 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT REPORTED DENTAL/ORAL CARE AS ONE OF THE TOP HEALTH SERVICES THAT IS DIFFICULT TO OBTAIN. A MAJOR THEME OF ALL FOCUS GROUPS WAS A NEED FOR IMPROVED ACCESS TO DENTAL CARE. TO ADDRESS THIS NEED, FLAGLER HOSPITAL, THE WILDFLOWER CLINIC, AND THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL WORKED TOGETHER TO PROVIDE SOLUTIONS. DURING THE ASSESSMENT YEAR 640 DENTAL CASES CAME TO THE FLAGLER HOSPITAL EMERGENCY DEPARTMENT FOR DENTAL CARE, HIGHLIGHTING THE NEED. THE GOOD SAMARITAN WILDFLOWER CLINIC IS THE ONLY CLINIC OFFERING BOTH FREE DENTAL AND FREE HEALTH CARE IN ST. JOHNS COUNTY. FLAGLER CONTINUES TO BE A MAJOR CORPORATE SPONSOR OF THE WILDFLOWER CLINIC AND WORKS CLOSELY WITH THE CLINIC TO SHORTEN THE TIME BETWEEN THE INITIAL CRISES (FLAGLER ER VISIT) AND FOLLOW UP CARE. WITH THE HELP OF GRANTS FROM FLAGLER HOSPITAL, AND OTHER COMMUNITY ORGANIZATIONS, THE WILDFLOWER CLINIC STAFF HAS BEGUN OFFERING REGULARLY SCHEDULED DENTAL APPOINTMENTS IN ADDITION TO DENTAL WALK-IN CLINICS EVERY WEEK.WITH CONTINUED COLLABORATION BETWEEN THE WILDFLOWER CLINIC AND FLAGLER HOSPITAL'S EMERGENCY DEPARTMENT ON COORDINATING CARE BETWEEN UNINSURED ST. JOHNS COUNTY RESIDENTS, FLAGLER HOSPITAL EMERGENCY ROOM VISITS FOR DENTAL EMERGENCIES HAVE CONTINUED TO DROP BY OVER 10% EACH FISCAL YEAR. DURING 2022, WILDFLOWER CLINIC SAW 1,028 DENTAL PATIENTS. BUILDING ON THIS SUCCESSFUL PARTNERSHIP, FH+ AND WILDFLOWER CONTINUE TO OPTIMIZE THIS TRANSITION AND FOLLOW-UP PROCESS FROM THE HOSPITAL EMERGENCY ROOM TO THE WILDFLOWER DENTAL CLINIC.FLAGLER HOSPITAL HAS ALSO PLACED MEDICAL TELEHEALTH KIOSKS IN TWO OF ST. JOHNS COUNTY'S ELEMENTARY SCHOOLS THAT ARE IN TRADITIONALLY UNDERSERVED NEIGHBORHOODS. SOUTH WOODS ELEMENTARY AND THE WEBSTER SCHOOL HAVE A LARGE NEED FOR MEDICAL SERVICES TO BE EMBEDDED IN THE SCHOOLS, WHICH ARE SEEN AS THE HUBS OF THOSE COMMUNITIES. FLAGLER HOSPITAL PURCHASED THE KIOSKS AND FULLY STAFFS THEM WITH A WELLNESS COORDINATOR TO ALLOW FOR THE COMMUNITY TO USE THE KIOSK FREE OF CHARGE. MANY OF THE APPOINTMENTS THAT ARE SEEN AT THE KIOSKS ARE DUE TO DENTAL ISSUES, IN WHICH FLAGLER HOSPITAL DOCTORS CAN PRESCRIBE THE NECESSARY MEDICATION FOR AT THE KIOSK OR MAKE A REFERRAL TO A SPECIALIST. THE WELLNESS COORDINATORS THAT THE HOSPITAL PROVIDES HELP TO CLOSE ANY GAPS IN SERVICES, WHICH FREQUENTLY INVOLVES CONNECTING FAMILIES TO DENTAL SERVICES.INCREASE ACCESS TO MENTAL HEALTH CARE:WITH DEPRESSION AND ANXIETY RANKED AS THE #2 HEALTH PROBLEMS IN ST. JOHNS COUNTY, THE 2020 CHNA REVEALED THAT ACCESS TO MENTAL HEALTH SERVICES CONTINUES TO BE AN ISSUE. IN ADDITION, MENTAL HEALTH COUNSELING WAS REPORTED TO BE THE #1 MOST DIFFICULT TO OBTAIN SERVICE BY SURVEY RESPONDENTS.IN RESPONSE TO AN IDENTIFIED CRITICAL NEED FOR OUTPATIENT MENTAL HEALTH SERVICES IN ST. JOHNS COUNTY, FLAGLER HOSPITAL INTRODUCED AN INTENSIVE OUTPATIENT PROGRAM. THIS PROGRAM WAS SPECIFICALLY DESIGNED TO SUPPORT PATIENTS AFTER BEING RELEASED FROM INPATIENT CARE. THE PROGRAM'S PRIMARY GOAL OF IMPROVING QUALITY OF LIFE AND REDUCING SYMPTOMS TO PREVENT RELAPSE IS ACCOMPLISHED THROUGH GROUP THERAPY, MEDICATION AND SYMPTOM MANAGEMENT AND INDIVIDUAL PSYCHOTHERAPY.ALL NEW PATIENTS PARTICIPATE IN A FORMAL CLINICAL EVALUATION PERFORMED BY A MULTI-DISCIPLINARY TEAM. THIS EVALUATION HELPS THE TEAM DEVELOP A TREATMENT PLAN THAT REFLECTS EACH PATIENT'S INDIVIDUAL STRENGTHS, LIMITATIONS AND GOALS FOR TREATMENT. EVERY PATIENT'S GOALS ARE REVIEWED AND UPDATED WEEKLY IN TEAM MEETINGS AND INDIVIDUAL SESSIONS. MEDICAL STAFF FROM THE INTENSIVE OUTPATIENT PROGRAM ATTEND COMMUNITY EVENTS TO RAISE AWARENESS ABOUT MENTAL HEALTH AND TO INFORM THE COMMUNITY ABOUT AVAILABLE RESOURCES. A SCHOLARSHIP IS AVAILABLE FOR EACH SESSION, TO ENSURE THAT ACCESS TO MENTAL HEALTH SERVICES IS NEVER DEPENDENT UPON A PATIENT'S ABILITY TO PAY.FLAGLER HOSPITAL IS COMMITTED TO COLLABORATION WITH COMMUNITY PARTNERS TO ADDRESS EACH NEED IDENTIFIED DURING THE 2020 CHNA. TO INCREASE ACCESS TO MENTAL HEALTH CARE, THIS COLLABORATION CENTERS ON COORDINATION AND LINKAGE OF MENTAL HEALTH SERVICES BETWEEN FLAGLER HOSPITAL AND COMMUNITY OUTPATIENT PROVIDERS.FLAGLER HOSPITAL CONTINUES TO WORK WITH ST. AUGUSTINE YOUTH SERVICES (SAYS) TO SUPPORT THE COUNTY-WIDE MOBILE RESPONSE TEAM (MRT). THE MOBILE RESPONSE TEAM PROVIDES 24 HOUR/7 DAYS PER WEEK CRISIS SUPPORT FOR ANYONE AGED 6 TO 25 NEEDING A BEHAVIORAL HEALTH INTERVENTION/ASSESSMENT. AFTER EACH ASSESSMENT, FOLLOW-UP IS PROVIDED TO ENSURE THE YOUTH OR YOUNG ADULT HAS ACCESS TO NEEDED SERVICES. SAYS PARTNERS WITH FLAGLER HEALTH TO ASSIST IN THESE FOLLOW UP EFFORTS WHENEVER NEEDED.THE TEAM'S MISSION IS TO PROVIDE AN ASSESSMENT AT THE FIRST SIGNS OF CHILD BEHAVIORAL RISK TO PREVENT SERIOUS MENTAL ISSUES FROM DEVELOPING. THE TEAM ALSO PROVIDES IMMEDIATE ACCESS TO MENTAL HEALTH SERVICES AND ALLOWS THE OPPORTUNITY FOR FAMILIES TO SELECT A SOLUTION THAT WORKS BEST FOR THEM.THE ULTIMATE GOAL OF THE MOBILE CRISIS RESPONSE TEAM PROGRAM IS TO DIVERT CHILDREN FROM COSTLY EMERGENCY SERVICES AND ESTABLISH GREATER COORDINATION OF CARE THAT WILL SERVE THE FAMILY BEYOND THE INITIAL CRISIS. DURING FY 2022 MRT COMPLETED 491 ASSESSMENTS. OF THOSE 491 ASSESSMENTS, 79 RESULTED IN BAKER ACTS. WITH 84% OF POTENTIAL BAKER ACTS DIVERTED, COSTING APPROXIMATELY $3,900 EACH STAY, THAT MEANS A TOTAL OF $ 1,608,516 IN POTENTIAL SPENDING ON BAKER ACTS WAS SAVED IN FY 2022.IN MAY OF 2022, FLAGLER HOSPITAL OPENED THE CAIR (CRISIS, ASSESSMENT, INTERVENTION AND REFERRAL) CENTER IN RESPONSE TO AN IDENTIFIED NEED IN THE COMMUNITY FOR A LOW BARRIER ENTRY POINT FOR MENTAL HEALTH SERVICES. WORKING WITH PARTNERS IN THE COMMUNITY, THE CAIR CENTER AIMS TO REDUCE UNNECESSARY BAKER ACT ADMISSIONS, INCREASE DIVERSION FROM THE CRIMINAL JUSTICE SYSTEM, AND REDUCE RECIDIVISM TO HOSPITALS WHILE PROVIDING THOSE IN MENTAL HEALTH CRISIS A SUPPORTIVE AND APPROACHABLE ENVIRONMENT TO RECE

PART V, SECTION B, LINE 11 CONTINUED:
"INCREASE USE OF AVAILABLE TRANSPORTATION:FROM THE FOCUSES GROUPS CONDUCTED AS PART OF THE 2020 COMMUNITY HEALTH NEEDS ASSESSMENT, LACK OF TRANSPORTATION WAS IDENTIFIED AS A DIRECT BARRIER TO HEALTHCARE. FURTHERMORE, SURVEY RESULTS SHOWED A NEGATIVE INCREASE IN THE PERCENTAGE OF RESPONDENTS THAT RANKED TRANSPORTATION AS A BARRIER TO CARE, FROM 12.2% IN 2017 TO 10.69% IN 2020. TRANSPORTATION HAS BEEN A FOCUS IN ST. JOHNS COUNTY FOR OVER 15 YEARS. THE 2005 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED IMPROVING ACCESS TO HEALTH SERVICES IN OUTLYING AREAS OF ST. JOHNS COUNTY THROUGH COORDINATION OF PUBLIC TRANSPORTATION AS A HIGH-PRIORITY COMMUNITY NEED. SINCE THAT TIME, A COMMUNITY-WIDE EFFORT TO IMPROVE PUBLIC TRANSPORTATION IN ST. JOHNS COUNTY HAS PICKED UP MOMENTUM. THE ST. JOHNS COUNTY COUNCIL ON AGING, INC. (COA) SERVES AS THE COMMUNITY TRANSPORTATION COORDINATOR FOR ST. JOHNS COUNTY. THE COA PROVIDES DOOR-TO-DOOR NON-EMERGENCY MEDICAL TRANSPORTATION SERVICES TO AMBULATORY, AND WHEELCHAIR BOUND CLIENTS WITHIN THE ST. JOHNS COUNTY SERVICE AREA. THE SUNSHINE BUS COMPANY (A DIVISION OF THE COA) IS ST. JOHNS COUNTY'S PUBLIC BUS SERVICE. SINCE ITS INCEPTION IN 2006, THE SUNSHINE BUS COMPANY HAS CONTINUED TO EXPAND ITS SERVICES TO BETTER SERVE THE COMMUNITY, WITH THE ADDITION OF NEW ROUTES AND AN INCREASED NUMBER OF DAILY TRIPS. THE 2020 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT FEEDBACK SHOWED THE CONTINUED NEED FOR A FOCUS ON TRANSPORTATION. IN 2019, FLAGLER HOSPITAL SUPPORTED THE STRATEGIC OBJECTIVE OF ""INCREASE USE OF AVAILABLE TRANSPORTATION OPTIONS"" BY PARTNERING WITH THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL TO PROVIDE TRANSPORTATION TRAINING TO 14 COMMUNITY ORGANIZATIONS. THIS EDUCATION IS OFFERED TO COMMUNITY MEMBERS AND HEALTHCARE PROVIDERS TO RAISE AWARENESS AND INCREASE UTILIZATION. IN ADDITION TO SUPPORTING PUBLIC TRANSPORTATION INITIATIVES, FLAGLER HEALTH+ HAS ALSO PARTNERED WITH UBER HEALTH TO PROVIDE TRANSPORTATION TO AND FROM DOCTORS' APPOINTMENTS. THIS SERVICE IS AVAILABLE TO COMMUNITY RESIDENTS, REGARDLESS OF WHETHER OR NOT THE DOCTOR IS AFFILIATED WITH FLAGLER HEALTH+. IN FY22, CARE CONNECT PAID FOR OVER $28,000 IN UBER OR TAXI RIDES TO MEDICAL APPOINTMENTS FOR THE COMMUNITY.INCREASE ACCESS TO TAILORED PHYSICAL AND NUTRITIONAL EDUCATION:ADULT OBESITY IS THE THIRD LARGEST CONCERN ACCORDING TO RESPONDENTS OF THE 2020 COMMUNITY HEALTH ASSESSMENT. ALTHOUGH ST. JOHNS COUNTY RANKS IN THE TOP OF FLORIDA'S HEALTHIEST COUNTIES, THE NEED IS STILL PERCEIVED BY THE COMMUNITY, AS WELL AS DESIRED GIVEN A GROWING POPULATION. 56% OF ST. JOHNS COUNTY RESIDENTS ARE BETWEEN THE AGES OF 20-64, WHILE 19% ARE OVER THE AGE OF 65. FOR THIS REASON, ST. JOHNS COUNTY SHOWED PROMISE IN BENEFITING FROM TAILORED FITNESS COURSES MADE AVAILABLE AT FLAGLER HOSPITAL. CURRENTLY, BEGINNER'S TAI-CHI, YOGA FOR YOUNG ONES, CHAIR YOGA, AND RESTORATIVE YOGA ARE ALL OFFERED TO COMMUNITY MEMBERS. IN ADDITION, FLAGLER HAS PROVIDED MANY OTHER EDUCATIONAL OPPORTUNITIES IN THE FORM OF COOKING DEMONSTRATIONS, DIABETES EDUCATION, AND NUTRITION WORKSHOPS.SINCE 2020, ST. JOHNS COUNTY HAS INCREASED TO RANK SECOND HIGHEST IN THE STATE FOR HEALTH BEHAVIORS AS WELL AS SHOWN IMPROVEMENT IN PHYSICAL ENVIRONMENT. CARE CONNECT - CONNECTING PEOPLE TO RESOURCES:CARE CONNECT+ IS A PROGRAM OF THE HOSPITAL THAT WAS STARTED IN 2017. THIS COMMUNITY ALLIANCE WAS ESTABLISHED TO CONNECT AREA RESIDENTS IN NEED WITH AVAILABLE SERVICE AND ADDRESS SOCIAL DETERMINANTS OF HEALTH IN A COORDINATED WAY THROUGHOUT ALL OF ST JOHNS COUNTY. BY ALIGNING COMMUNITY RESOURCES INTO A SINGLE ACCESS POINT, CARE CONNECT INCREASES COORDINATION AND ACCESS OF AVAILABLE RESOURCES. THE PROGRAM HELPS CONNECT PEOPLE TO PRIMARY CARE SERVICE, DENTAL SERVICE, PRESCRIPTION ASSISTANCE, RENTAL AND UTILITY ASSISTANCE, TRANSPORTATION ASSISTANCE, HOMELESS PREVENTION SERVICES, ACCESS TO LOCAL FOOD BANKS AND COMMUNITY RESOURCE NAVIGATION AND CASE MANAGEMENT SERVICES. RATHER THAN SIMPLY REFER PEOPLE TO SERVICES, CARE CONNECT COMMUNITY HEALTH ASSOCIATES, FOLLOW EACH CLIENT UNTIL ALL NEEDS HAVE BEEN MET. IF SERVICES ARE NOT AVAILABLE IN THE COMMUNITY, CARE CONNECT TRACKS GAPS IN SERVICE TO DEVELOP THOSE SERVICES WITH COMMUNITY PARTNERS. CARE CONNECT INCREASES ACCESS TO HEALTH PROVIDERS, DENTAL PROVIDERS, MENTAL HEALTH PROVIDERS, SOCIAL SERVICES AND TRANSPORTATION THROUGH A COORDINATED HUB. IN FISCAL YEAR 2022, 5,924 CLIENTS WERE PART OF THE CARE CONNECT HUB AND WERE MATCHED WITH SERVICES, WHILE 7,517 SERVICES WERE PROVIDED IN TOTAL. IN SEPTEMBER OF 2019, FLAGLER HEALTH+ IMPLEMENTED AN INNOVATIVE MODEL TO INCREASE ACCESS TO BEHAVIORAL HEALTH PROVIDERS FOR STUDENTS ACROSS ST. JOHNS COUNTY THROUGH A PARTNERSHIP WITH THE ST. JOHNS COUNTY SCHOOL DISTRICT. THE B.R.A.V.E. PROGRAM STANDS FOR BEING RESILIENT AND VOICING EMOTIONS. THROUGH BRAVE, CARE CONNECT+ SERVES AS THE HUB FOR STUDENT HEALTH REFERRALS FOR THE ST JOHNS, CLAY, NASSAU AND PUTNAM SCHOOL DISTRICTS. DURING FY 2022, THERE WAS A 66% DECREASE IN THE LENGTH OF TIME FROM REFERRAL TO FIRST APPOINTMENT AND A 157% INCREASE IN THE NUMBER OF STUDENTS CONNECTED TO A BEHAVIORAL HEALTH PROVIDER. DURING THE SPRING AND SUMMER MONTHS OF 2020, WHEN THE COVID PANDEMIC AFFECTED IN-PERSON PROVIDER APPOINTMENTS, CARE CONNECT FINANCIALLY AND ADMINISTRATIVELY SUPPORTED THE LAUNCH OF A TELEMEDICINE PLATFORM WITH PROVIDERS TO MAINTAIN STUDENT AND ADULT MENTAL HEALTH APPOINTMENTS. CARE CONNECT HAS CONTINUED THIS INITIATIVE THROUGH THE YEAR 2022.PLUS BUS:FLAGLER HOSPITAL HAS ALSO MADE IT POSSIBLE TO REACH UNDERSERVED POPULATIONS WITHIN THE COMMUNITY WHO DO NOT NECESSARILY HAVE ACCESS TO CARE. THROUGH THE USE OF THEIR MOBILE HEALTH UNIT, OR PLUS BUS, A NUMBER OF PATIENTS WHO WOULD NOT HAVE BEEN SEEN WERE PROVIDED WITH A WIDE ARRAY OF SERVICES THAT ADDRESSED DIFFERENT ASPECTS OF THEIR HEALTH. IN ADDITION, THESE INDIVIDUALS WERE OFFERED CARE COORDINATION SUCH AS TRANSPORTATION ASSISTANCE. THE PLUS BUS HAS OPERATED IN PARTNERSHIP WITH OTHER COMMUNITY AGENCIES, AS WELL AS INDEPENDENTLY SEEKING OPPORTUNITIES TO AID PATIENTS WHO ARE LOW INCOME, AT HIGH-RISK, HOMELESS, OR THOSE WHO DO NOT HAVE ADEQUATE ACCESS TO CARE. WITH THIS DEMOGRAPHIC IN MIND, THE FOLLOWING CLINICS WERE PUT IN PLACE ON A MONTHLY ROTATING SCHEDULE:DINING WITH DIGNITY FLORIDA IS HOME TO THE THIRD LARGEST HOMELESS POPULATION IN THE UNITED STATES PER THE FLORIDA COALITION TO END HOMELESSNESS. ACCORDING TO THE CONTINUUM OF CARE, HOMELESSNESS IN ST. JOHNS COUNTY IS UP 2% SINCE 2018. MANY OF THESE INDIVIDUALS (ABOUT 14%) ARE ALSO EXPERIENCING LONG-TERM DISABILITY AND NEED ACCESS TO MEDICAL CARE. FOR THIS REASON, THE PLUS BUS VISITED DINING WITH DIGNITY EACH MONTH. IN PARTNERSHIP WITH WILDFLOWER CLINIC AND HOME AGAIN, HOMELESS INDIVIDUALS ARE FED HOT MEALS AND SEEN ONCE A MONTH ON THE BUS FOR PRIMARY CARE. RESOURCE COORDINATION IS PROVIDED AS WELL. HASTINGS FOOD BANK THE PLUS BUS AT FLAGLER HOSPITAL HAS ALSO TEAMED UP WITH WILDFLOWER CLINIC TO PROVIDE WEEKLY WALK-UP SERVICES IN HASTINGS, FL. THIS SERVICE IS PROVIDED IN COMBINATION WITH A LOCAL FOOD DISTRIBUTION PROGRAM AND PROVIDES PRIMARY CARE FOR UNDERINSURED PATIENTS IN THE MOST RURAL PARTS OF ST. JOHNS COUNTY. EPIC CURE FOOD DISTRIBUTION - DURING THE 2021-2022 YEAR, THE PLUS BUS (MOBILE HEALTH CLINIC) STAFF IDENTIFIED A NEED AT THE EPICCURE FOOD RESCUE PROGRAM IN ST. AUGUSTINE. HEALTH SCREENINGS WHICH INCLUDE BLOOD PRESSURE MONITORING, LIPID PANELS, AND GLUCOSE MONITORING WERE PROVIDED TO PATRONS WHO WERE PRESENT TWICE A MONTH TO RECEIVE FOOD AT EPICCURE'S WAREHOUSE.FAMILY WORSHIP CENTER - THE FOOD INSECURITY RATE IN ST. JOHNS COUNTY IS AT 20.6% FOR CHILDREN AND 13.5% OVERALL ACCORDING TO FEEDING NORTHEAST FLORIDA. FOR THIS REASON, THE PLUS BUS COMBINED PRIMARY HEALTH WITH A LARGE FOOD DISTRIBUTION AT FAMILY WORSHIP CENTER IN ST. AUGUSTINE, FL. THIS CLINIC WAS HELD MONTHLY. WILDFLOWER CLINIC TREATED WALK-ONS AND SCHEDULED PATIENTS. IN TOTAL, THE PLUS BUS TREATED OVER 300 PATIENTS DURING 2022 FOR PRIMARY CARE IN COMBINATION WITH WILDFLOWER CLINIC. A VAST MAJORITY OF THESE PATIENTS WERE UNDERINSURED, WERE HOMELESS, WERE AT HIGH RISK FOR HOMELESSNESS, LOW SOCIOECONOMIC STATUS, OR EXPERIENCE CHRONIC DISEASE. SOME OF THESE PATIENTS WERE SEEN MULTIPLE TIMES ON THE PLUS BUS, WHICH MAINTAINED ITS GOAL OF THWARTING UNNECESSARY USE OF THE ER AS PRIMARY CARE."

PART V, SECTION B, LINE 11 CONTINUED:
INCREASE ACCESS TO MENTAL HEALTH CARE:WITH DEPRESSION AND ANXIETY RANKED AS THE #2 HEALTH PROBLEMS IN ST. JOHNS COUNTY, THE 2020 CHNA REVEALED THAT ACCESS TO MENTAL HEALTH SERVICES CONTINUES TO BE AN ISSUE. IN ADDITION, MENTAL HEALTH COUNSELING WAS REPORTED TO BE THE #1 MOST DIFFICULT TO OBTAIN SERVICE BY SURVEY RESPONDENTS.IN RESPONSE TO AN IDENTIFIED CRITICAL NEED FOR OUTPATIENT MENTAL HEALTH SERVICES IN ST. JOHNS COUNTY, FLAGLER HOSPITAL INTRODUCED AN INTENSIVE OUTPATIENT PROGRAM. THIS PROGRAM WAS SPECIFICALLY DESIGNED TO SUPPORT PATIENTS AFTER BEING RELEASED FROM INPATIENT CARE. THE PROGRAM'S PRIMARY GOAL OF IMPROVING QUALITY OF LIFE AND REDUCING SYMPTOMS TO PREVENT RELAPSE IS ACCOMPLISHED THROUGH GROUP THERAPY, MEDICATION AND SYMPTOM MANAGEMENT AND INDIVIDUAL PSYCHOTHERAPY.ALL NEW PATIENTS PARTICIPATE IN A FORMAL CLINICAL EVALUATION PERFORMED BY A MULTI-DISCIPLINARY TEAM. THIS EVALUATION HELPS THE TEAM DEVELOP A TREATMENT PLAN THAT REFLECTS EACH PATIENT'S INDIVIDUAL STRENGTHS, LIMITATIONS AND GOALS FOR TREATMENT. EVERY PATIENT'S GOALS ARE REVIEWED AND UPDATED WEEKLY IN TEAM MEETINGS AND INDIVIDUAL SESSIONS. MEDICAL STAFF FROM THE INTENSIVE OUTPATIENT PROGRAM ATTEND COMMUNITY EVENTS TO RAISE AWARENESS ABOUT MENTAL HEALTH AND TO INFORM THE COMMUNITY ABOUT AVAILABLE RESOURCES. A SCHOLARSHIP IS AVAILABLE FOR EACH SESSION, TO ENSURE THAT ACCESS TO MENTAL HEALTH SERVICES IS NEVER DEPENDENT UPON A PATIENT'S ABILITY TO PAY.FLAGLER HOSPITAL IS COMMITTED TO COLLABORATION WITH COMMUNITY PARTNERS TO ADDRESS EACH NEED IDENTIFIED DURING THE 2020 CHNA. TO INCREASE ACCESS TO MENTAL HEALTH CARE, THIS COLLABORATION CENTERS ON COORDINATION AND LINKAGE OF MENTAL HEALTH SERVICES BETWEEN FLAGLER HOSPITAL AND COMMUNITY OUTPATIENT PROVIDERS.FLAGLER HOSPITAL CONTINUES TO WORK WITH ST. AUGUSTINE YOUTH SERVICES (SAYS) TO SUPPORT THE COUNTY-WIDE MOBILE RESPONSE TEAM (MRT). THE MOBILE RESPONSE TEAM PROVIDES 24 HOUR/7 DAYS PER WEEK CRISIS SUPPORT FOR ANYONE AGED 6 TO 25 NEEDING A BEHAVIORAL HEALTH INTERVENTION/ASSESSMENT. AFTER EACH ASSESSMENT, FOLLOW-UP IS PROVIDED TO ENSURE THE YOUTH OR YOUNG ADULT HAS ACCESS TO NEEDED SERVICES. SAYS PARTNERS WITH FLAGLER HEALTH TO ASSIST IN THESE FOLLOW UP EFFORTS WHENEVER NEEDED.THE TEAM'S MISSION IS TO PROVIDE AN ASSESSMENT AT THE FIRST SIGNS OF CHILD BEHAVIORAL RISK TO PREVENT SERIOUS MENTAL ISSUES FROM DEVELOPING. THE TEAM ALSO PROVIDES IMMEDIATE ACCESS TO MENTAL HEALTH SERVICES AND ALLOWS THE OPPORTUNITY FOR FAMILIES TO SELECT A SOLUTION THAT WORKS BEST FOR THEM.THE ULTIMATE GOAL OF THE MOBILE CRISIS RESPONSE TEAM PROGRAM IS TO DIVERT CHILDREN FROM COSTLY EMERGENCY SERVICES AND ESTABLISH GREATER COORDINATION OF CARE THAT WILL SERVE THE FAMILY BEYOND THE INITIAL CRISIS. DURING FY 2022 MRT COMPLETED 491 ASSESSMENTS. OF THOSE 491 ASSESSMENTS, 79 RESULTED IN BAKER ACTS. WITH 84% OF POTENTIAL BAKER ACTS DIVERTED, COSTING APPROXIMATELY $3,900 EACH STAY, THAT MEANS A TOTAL OF $ 1,608,516 IN POTENTIAL SPENDING ON BAKER ACTS WAS SAVED IN FY 2022.IN MAY OF 2022, FLAGLER HOSPITAL OPENED THE CAIR (CRISIS, ASSESSMENT, INTERVENTION AND REFERRAL) CENTER IN RESPONSE TO AN IDENTIFIED NEED IN THE COMMUNITY FOR A LOW BARRIER ENTRY POINT FOR MENTAL HEALTH SERVICES. WORKING WITH PARTNERS IN THE COMMUNITY, THE CAIR CENTER AIMS TO REDUCE UNNECESSARY BAKER ACT ADMISSIONS, INCREASE DIVERSION FROM THE CRIMINAL JUSTICE SYSTEM, AND REDUCE RECIDIVISM TO HOSPITALS WHILE PROVIDING THOSE IN MENTAL HEALTH CRISIS A SUPPORTIVE AND APPROACHABLE ENVIRONMENT TO RECEIVE SUPPORT.

PART V, SECTION B, LINE 7A:
HTTPS://WWW.FLAGLERHEALTH.ORG/PATIENTS-VISITORS/

PART V, SECTION B, LINE 7B:
HTTPS://WWW.FLAGLERHEALTH.ORG/COMMUNITY-HEALTH-IMPROVEMENT/COMMUNITY-BENEFIT-PLANNING/ST-JOHNS-COUNTY-HEALTH-NEEDS-ASSESSMENT/

PART V, SECTION B, LINE 10A
HTTPS://WWW.FLAGLERHEALTH.ORG/PATIENTS-VISITORS/

PART V, SECTION B, LINE 16A:
HTTPS://WWW.FLAGLERHEALTH.ORG/FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE-POLICY-APPLICATION/

PART V, SECTION B, LINE 16B:
HTTPS://WWW.FLAGLERHEALTH.ORG/FINANCIAL-SERVICES/FINANCIAL-COUNSELING-FINANCIAL-ASSISTANCE-POLICY/

PART V, SECTION B, LINE 16C:
HTTPS://WWW.FLAGLERHEALTH.ORG/FINANCIAL-SERVICES/FAP-PLAIN-LANGUAGE-SUMMARY/

PART I, LINE 7:
EXPENSES WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2.

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $12,680,217. OF THIS TOTAL, FLAGLER HOSPITAL'S PORTION OF BAD DEBT EXPENSE IS $12,680,217 AND OUTPATIENT SURGERY CENTER OF ST. AUGUSTINE, LLC'S PORTION OF BAD DEBT EXPENSE IS $0.

PART III, LINE 3:
BASED ON COMPILED HOSPITAL BAD DEBT DATA FOR THE FISCAL YEAR, WE ARE ESTIMATING THAT 50% OF THE TOTAL CHARGES FOR PATIENT ACCOUNTS THAT WENT TO BAD DEBT AND SCORED BETWEEN 201% - 400% (OR THAT WERE NOT SCORED) WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE IF PATIENT WOULD HAVE COMPLIED WITH THE HOSPITALS FINANCIAL ASSISTANCE POLICY OR HAD BEEN ABLE TO BE PRESUMPTIVELY SCORED. 50% OF THE CHARGES MULTIPLIED BY THE AVERAGE AGB (24%) EQUAL THE ESTIMATED COST.

PART II, COMMUNITY BUILDING ACTIVITIES
COMMUNITY HEALTH IMPROVEMENT SERVICES:IN ADDITION TO NEEDS ASSESSED BY THE HEALTH LEADERSHIP COUNCIL, FLAGLER HOSPITAL IS IN A POSITION TO KNOW THE OTHER HEALTH ISSUES WHICH COST THE COMMUNITY AND ITS CITIZENS THE MOST TIME AND MONEY. WHILE DEATH FROM DIABETES IS ON THE DECLINE, INCIDENCE OF DIABETES IS RISING, DUE TO OBESITY CAUSED BY DIET AND LIFESTYLE. FLAGLER HOSPITAL CONTINUED TO PARTNER WITH THE WILDFLOWER CLINIC, A NON-PROFIT DEDICATED TO PROVIDING FREE MEDICAL AND DENTAL CARE TO QUALIFYING ST. JOHNS COUNTY RESIDENTS, TO ESTABLISH WILDFLOWER CHRONIC CARE CLINIC (CCC). THE CHRONIC CARE CLINIC PROVIDES INVALUABLE CARE TO UNINSURED, CHRONICALLY ILL, LOW-INCOME RESIDENTS OF ST. JOHNS COUNTY. THE FLAGLER CCC FOCUSES ON CHRONIC DISEASE MANAGEMENT, WITH AN EMPHASIS ON DIABETES MANAGEMENT. THIS CLINIC IS AVAILABLE TO ANY PATIENT WITH AN UNMANAGED, CHRONIC CONDITION WHO MEETS THE GOOD SAMARITAN HEALTH CENTERS PATIENT QUALIFICATIONS. PATIENTS RECEIVE SERVICES FREE OF CHARGE.THE CHRONIC CARE CLINIC IS STAFFED WITH A NURSE PRACTITIONER, WHO IS AVAILABLE BY PHONE, PAGER, AND EMAIL, 24 HOURS A DAY/7 DAYS A WEEK. ALL CHRONIC CARE CLINIC PATIENTS ARE PROVIDED WITH HER CONTACT INFORMATION AND INSTRUCTED TO CONTACT HER DIRECTLY IF THEY HAVE ANY QUESTIONS OR CONCERNS BETWEEN VISITS, ESPECIALLY IF THEY ARE NOT FEELING WELL. THROUGH TELEMEDICINE OR ADDITIONAL VISITS BETWEEN SCHEDULED APPOINTMENTS, THE NURSE PRACTITIONER CAN ADD OR ADJUST MEDICATIONS, ORDER LAB WORK, AND MANAGE ANY SITUATIONS FOR WHICH A PATIENT MAY HAVE OTHERWISE RESORTED TO THE FLAGLER HOSPITAL EMERGENCY CARE CENTER FOR A NON-EMERGENT VISIT. BY PAIRING 24-HOUR ACCESS TO A NURSE PRACTITIONER WITH ACCESS TO MEDICATIONS THAT WOULD BE OTHERWISE UNAFFORDABLE AND EDUCATION ABOUT THEIR CHRONIC ILLNESSES, THE WILDFLOWER CHRONIC CARE CLINIC HAS EFFECTIVELY KEPT COUNTLESS PATIENTS FROM SEEKING CARE IN THE FLAGLER HOSPITAL EMERGENCY CARE CENTER. IN ADDITION, PER THE 2020 COMMUNITY HEALTH ASSESSMENT, ACCESS TO CARE ON EVENING AND WEEKEND WAS LISTED AS THE SECOND HIGHEST BARRIER TO CARE. WILDFLOWER CONDUCTS CLINICS DURING BOTH WEEKEND AND EVENING HOURS TO ADDRESS THIS ISSUE. IN 2022 WILDFLOWER CLINIC HAS PROVIDED WELL OVER 4,000 DIFFERENT INTERACTIONS IN THE FORM OF MEDICAL SERVICES TO ITS PATIENTS. SERVICES INCLUDE PLUS BUS CLINICS, CARDIOLOGY SERVICES, LABORATORY SERVICES, PATHOLOGY, MAMMOGRAPHY, PHARMACEUTICAL, PATHOLOGY, THERAPY, AND RADIOLOGY SERVICES COMBINED. DURING THE LAST FISCAL YEAR, FLAGLER HOSPITAL HAS PROVIDED THE WILDFLOWER CLINIC WITH $855,725 IN FREE LABORATORY SERVICES.THE HEART CENTER AT FLAGLER HOSPITAL PROVIDES A CRITICAL SERVICE TO RESIDENTS OF ST. JOHNS COUNTY AND THE SURROUNDING AREAS. FLAGLER HOSPITAL'S STATE-OF-THE-ART HEALTHCARE ENCOMPASSES THE ENTIRE CONTINUUM OF CARE FOR HEART PATIENTS, INCLUDING CLOSE COLLABORATION WITH ST. JOHNS COUNTY FIRE RESCUE, WITH TRANSMISSION OF EKGS DIRECTLY FROM AMBULANCE TO HOSPITAL, CARDIAC CATHETER LABS, WORLD-CLASS PHYSICIANS AND STAFF, QUALITY ASSURANCE PLANS, AND COMMUNITY OUTREACH AND EDUCATION PROGRAMS. ONCE A PATIENT IS DISCHARGED WITH A DIAGNOSIS OF HEART FAILURE, A NURSE CARE COORDINATOR FOLLOWS UP WITH THE PATIENT TO REVIEW DISCHARGE MEDICATIONS, VITAL SIGNS, THE IMPORTANCE OF WEIGHT MANAGEMENT AND FLUID RESTRICTIONS. ONCE IN THE HOME, THE NURSE PRACTITIONER REVIEWS THE FOODS THAT ARE IN THE PATIENT'S HOMES AND DISCUSSES HOW THAT FOOD SHOULD BE USED IN THE DIET OR NOT USED AT ALL. SHE USES CUPS THAT ARE ALREADY IN THE PATIENT'S HOME TO SHOW HOW MUCH FLUID SHOULD GO IN AND HOW MANY A DAY SHOULD BE USED. THIS OFFERS THE PATIENT A PRACTICAL APPROACH TO CARING FOR THEMSELVES AT HOME. THIS SERVICE COMES AT NO CHARGE TO THE PATIENT AND HELPS THEM UNDERSTAND WHAT THE DOCTOR EXPECTS FROM THEM. THIS SERVICE GOES BEYOND HOSPITAL EDUCATION AND IS TRUE COMMUNITY/HOME EDUCATION.FLAGLER HOSPITAL ALSO PARTNERED WITH THE CITY OF ST. AUGUSTINE AND BOLT TO LAUNCH AN E-BIKER SERVICE IN DOWNTOWN ST. AUGUSTINE DURING 2021. IN AN EFFORT TO ADVANCE PHYSICAL HEALTH AND ECONOMIC HEALTH, FLAGLER HELPED PURCHASE 110 ELECTRIC BIKES THAT CAN BE RENTED BY VISITORS AND RESIDENTS ALIKE. THE PROGRAM ALSO ASSISTS WITH THE HEAVY MOBILITY PROBLEMS ASSOCIATED WITH ST. AUGUSTINE.

PART III, LINE 4:
SEE AUDITED FINANCIAL STATEMENTS PAGE 11

PART VI, LINE 6:
THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

PART II, COMMUNITY BUILDING ACTIVITIES:
HEALTH PROFESSIONS EDUCATIONFLAGLER HOSPITAL DONATED PAID STAFF HOURS IN ONE-ON-ONE PROGRAMS TO PRECEPT NURSING STUDENTS AND ARNP STUDENTS FROM ST. JOHNS RIVER STATE COLLEGE, FIRST COAST TECHNICAL COLLEGE, JACKSONVILLE UNIVERSITY, UNIVERSITY OF ST. AUGUSTINE, UNIVERSITY OF NORTH FLORIDA, AND UNIFORMED SERVICES UNIVERSITY.ADDITIONALLY, STUDENTS IN THE FIELDS OF EMT AND PARAMEDIC TRAINING, PHYSICAL THERAPY, LAB SCIENCES, SOCIAL WORK, HEALTH ADMINISTRATION, PUBLIC HEALTH, RADIOLOGY, RESPIRATORY, SPEECH PATHOLOGY, AMERICAN SIGN LANGUAGE, AND DIETARY WERE TRAINED WITH ONE-ON-ONE CONTACT WITH STAFF AT FLAGLER HOSPITAL.FLAGLER HOSPITAL HAS TWO FULL TIME STAFF MEMBERS DEDICATED TO OFFERING CONTINUING MEDICAL EDUCATION (CME) TO ALL PHYSICIANS AND CLINICAL PROVIDERS IN THE ST. JOHNS COUNTY COMMUNITY, REGARDLESS OF THEIR AFFILIATION WITH THE HOSPITAL. THIS HELPS ENSURE THAT OUR LOCAL RESIDENTS HAVE ACCESS TO PHYSICIANS AND CLINICAL PROVIDERS WHO ARE UP TO DATE ON THE LATEST ADVANCEMENTS IN MEDICAL CARE. THE CME COORDINATOR FACILITATED 51 PROGRAMS CONSISTING OF GRAND ROUNDS, WEBCASTS AND ONLINE COMPUTER ACTIVITIES FOR PHYSICIANS AND CLINICAL PROVIDERS DURING THIS FISCAL YEAR.RESEARCHFLAGLER HOSPITAL EMPLOYS TWO FULL-TIME EMPLOYEES TO MANAGE A CANCER PATIENT DATABASE, LOG INFORMATION THAT CAN BE USED TO DETECT CANCER EARLIER, IMPROVE TREATMENTS AND ULTIMATELY, INCREASE CANCER SURVIVAL RATE. REGISTRARS DETERMINE A PATIENT'S ELIGIBILITY FOR THE CANCER REGISTRY, RECORD THE PATIENT'S DIAGNOSIS, AND TRACK THEIR TREATMENT PLAN. BY COLLECTING, TRACKING AND EVALUATING THIS DATA, WE ARE ABLE TO ADVANCE OUR KNOWLEDGE ON RISK FACTORS FOR CERTAIN CANCERS. BECAUSE DATA ENTERED IN THE CANCER REGISTRY IS AVAILABLE TO THE PUBLIC, OUTCOMES AND TREATMENT PLANS FOR PATIENTS IN ST. JOHNS COUNTY HAVE AN IMPACT NATION-WIDE.FINANCIAL AND IN-KIND CONTRIBUTIONSFLAGLER HOSPITAL MADE FINANCIAL AND IN-KIND CONTRIBUTIONS TO MANY AREA NON-PROFIT ORGANIZATIONS THAT FOCUS ON PROVIDING HEALTH PROGRAMS TARGETING COMMUNITY HEALTH NEEDS THAT WERE IDENTIFIED THROUGH THE ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT.ONE OF THE BIGGEST DETERMINANTS OF HEALTH THAT COMMUNITY ORGANIZATIONS HAVE INFLUENCE ON IS ACCESS TO HEALTHCARE. DURING THIS LAST FISCAL YEAR, FLAGLER HOSPITAL GAVE A $50,000 GRANT TO THE ST. JOHNS COUNCIL ON AGING TO PROVIDE STAFF TO ASSIST SENIOR CITIZENS IN ST. JOHNS COUNTY IN APPLYING FOR FREE OR REDUCED RATE PRESCRIPTION DRUGS FROM PHARMACEUTICAL COMPANIES. THIS PROGRAM CONTINUES TO SERVE OVER 275 SENIORS. BECAUSE THE GRANT PROVIDED PAID STAFF TO RUN THIS PROGRAM, COUNCIL ON AGING VOLUNTEERS WERE ABLE TO FOCUS VOLUNTEER HOURS ON COUNSELING, CLIENT NOTIFICATION AND DOCTOR'S OFFICE VISITS TO HELP EXPEDITE PAPERWORK. COA WAS ALSO ABLE TO UTILIZE GRANT MONEY TO FUND THEIR MEALS ON WHEELS PROGRAM AND PRESCRIPTION DRUG PROGRAM FOR THE YEARS OF 2021 AND 2022.FLAGLER HOSPITAL ALSO DONATED MEETING ROOMS AND IN SOME CASES FOOD/CATERING CHARGES FOR VARIOUS NON-PROFIT, SUPPORT AND SELF-HELP GROUPS IN THE COMMUNITY. THIS TOTALED OVER $8,000 USING A $3/HOUR CHARGE FOR EACH MEETING SPACE, A FIGURE BASED ON SQUARE FOOTAGE.COMMUNITY BUILDING ACTIVITIESFLAGLER HOSPITAL DONATED PAID STAFF TIME FOR EMPLOYEES WHO SERVED ON VARIOUS BOARDS FOR COMMUNITY EVENTS AND COMMITTEES WHICH OFFERED COMMUNITY SUPPORT, COALITION BUILDING WITH OTHER AGENCIES AND HEALTH AND WELFARE PROVIDERS, AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY.THROUGH A PARTNERSHIP WITH THE HOSPITAL, THE ST. JOHNS COUNTY SCHOOL DISTRICT CREATED THE FLAGLER HOSPITAL ACADEMY OF MEDICAL AND HEALTH CAREERS AT PEDRO MENENDEZ HIGH SCHOOL IN 2007-2008. IT IS OPEN TO STUDENTS THROUGHOUT THE SCHOOL SYSTEM. IT FOCUSES ON PROVIDING SKILLS AND EXPERIENCE NECESSARY TO ATTAIN ENTRY LEVEL JOBS IN HEALTH, MEDICAL AND RELATED FIELDS, AND PROVIDES ACADEMIC PREPARATION TO CONTINUE TRAINING THROUGH CLINICAL EXPERIENCE, COMMUNITY COLLEGE AND UNIVERSITY PROGRAMS. THE ACADEMY HAD OVER 250 STUDENTS WITH OVER 75 FOURTH YEAR STUDENTS ROTATING THROUGH VARIOUS DEPARTMENTS AT THE HOSPITAL FOR TRAINING. THE LIFE INSTITUTE WORKS CLOSELY WITH THE SCHOOL DISTRICT TO ADMINISTER THE ACADEMY. A SCHOLARSHIP WAS DONATED TO A STUDENT IN THE PROGRAM FOR FURTHER EDUCATION, GIVEN WITH NO EXPECTATION OF THE STUDENT HAVING TO WORK FOR FLAGLER HOSPITAL UPON COMPLETION OF SCHOOL. COMMUNITY SUPPORTCARE CONNECT+ VOLUNTEERS IS A PROGRAM THAT IS NOW HOUSED WITHIN THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT. IN JUNE 2019, THE NON-PROFIT STATUS WAS DISSOLVED AND THE PROGRAM WAS ABSORBED BY FLAGLER HOSPITAL. CARE CONNECT+ VOLUNTEERS HOSTS A WEBSITE THAT CONNECTS VOLUNTEERS TO NON-PROFIT VOLUNTEER OPPORTUNITIES IN THE COUNTY. CARE CONNECT+ VOLUNTEERS HAS 93 NONPROFIT PARTNERS, 3,744 USERS AND OVER 150 VOLUNTEER OPPORTUNITIES.IN ADDITION, FLAGLER HOSPITAL DEDICATES A ROOM NEAR THE EMERGENCY DEPARTMENT AVAILABLE 24/7/365 ONLY FOR RAPE VICTIMS AND CHILD PROTECTION CASE INTERVIEW, STAFFED BY BETTY GRIFFIN CENTER. EXAMS ARE PROVIDED BY SEXUAL ASSAULT NURSE EXAMINERS, TRAINED IN THE FORENSIC COLLECTION OF EVIDENCE WHILE PROVIDING COMPASSIONATE MEDICAL CARE TO RAPE VICTIMS. THIS INITIATIVE INVOLVED MEMBERS OF THE ST. JOHNS COUNTY TASK FORCE AGAINST DOMESTIC AND SEXUAL VIOLENCE, INCLUDING FLAGLER HOSPITAL, ST. JOHNS COUNTY SHERIFF'S OFFICE, ST. AUGUSTINE POLICE DEPARTMENT, ST. AUGUSTINE BEACH POLICE DEPT., FL SCHOOL OF THE DEAF AND BLIND POLICE DEPARTMENT, 7TH JUDICIAL CIRCUIT STATE ATTORNEY'S OFFICE AND BETTY GRIFFIN CENTER, A PUBLIC/PRIVATE PARTNERSHIP.ALONG WITH THE PLUS BUS, THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT AND ITS OUTREACH STAFF CONTINUED VACCINATION PROGRAMS AT VARIOUS LOCATIONS THROUGHOUT 2022. THESE CLINICS INCLUDED VACCINE BOOSTERS. VACCINATION CLINICS WERE CONDUCTED AT BOTH MT. MORIAH BAPTIST CHURCH AND FOR EMPLOYEES OF NORTHRUP GRUMMAN IN ST. AUGUSTINE. COMMUNITY BENEFIT OPERATIONSFLAGLER HOSPITAL HAS A FULL TIME EXECUTIVE DIRECTOR OF CARE CONNECT+ THAT OVERSEES THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT, AND A MANAGER OF CONTRACTS AND GRANTS TO HELP COORDINATE HOSPITAL-WIDE COMMUNITY BENEFIT FUNCTIONS IN ACCORDANCE WITH NATIONAL STANDARDS AND PUBLIC REPORTING REQUIREMENTS. THE EXECUTIVE DIRECTOR OF CARE CONNECT+ AND THE MANAGER OF CONTRACTS AND GRANTS USE CBISA SOFTWARE TO TRACK AND REPORT COMMUNITY BENEFIT ACTIVITIES AND PROVIDE AN ANNUAL REPORT ON COMMUNITY BENEFIT NUMBERS TO THE DIRECTOR OF ACCOUNTING FOR THE HOSPITAL'S 990 SCHEDULE H.

PART III, LINE 8:
THE MEDICARE REVENUE AND ALLOWABLE COSTS ON LINES 5 AND 6, RESPECTIVELY, WERE TAKEN FROM THE MEDICARE COST REPORT. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE REIMBURSEMENT ALLOWED, BEFORE REDUCTION OF CO-PAY AMOUNTS, LESS SEQUESTRATION AND ANY OTHER REDUCTIONS ASSOCIATED WITH VALUE BASED PURCHASING REDUCTIONS AS PER THE COST REPORT WORKSHEETS E PART A AND B. MEDICARE ALLOWABLE COSTS RELATING TO PAYMENTS ARE TAKEN FROM THE PART A AND PART B EXPENSES AS DETERMINED BY THE COST REPORT STEP DOWN AND COST APPORTIONMENT METHODOLOGY ON WORKSHEETS D-1 AND D PART V, PLUS THE 65% REDUCTION APPLIED TO MEDICARE BAD DEBTS. THE ENTIRE SHORTFALL IS REPORTED AS COMMUNITY BENEFIT. WE DO NOT RECEIVE ENOUGH IN MEDICARE REIMBURSEMENTS TO COVER OUR COSTS ASSOCIATED WITH THE PROVISION OF THESE SERVICES, YET WE CONTINUE TO PROVIDE MEDICARE SERVICES TO OUR COMMUNITY REGARDLESS OF THE REIMBURSEMENT LEVELS. THEREFORE, WE FEEL JUSTIFIED IN REPORTING THIS AS PART OF OUR COMMUNITY BENEFIT.

PART III, LINE 9B:
1.) FLAGLER HOSPITAL BUSINESS OFFICE STAFF REVIEW UNPAID PATIENT ACCOUNTS ON A REGULAR BASIS TO IDENTIFY THOSE ACCOUNTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ATTEMPTS TO CLASSIFY THESE PARTICULAR INDIVIDUALS START AT THE TIME THAT THEY ARE STILL IN-HOUSE. PATIENTS ARE ALSO CONTACTED AFTER DISCHARGE THROUGH PHONE CALLS OR MAIL. COMPLIANT INDIVIDUALS WHO MEET THE HOSPITAL'S FINANCIAL ASSISTANCE GUIDELINES ARE GRANTED THE APPROPRIATE DISCOUNT BASED ON WHERE THEY FALL IN RELATION TO THE FEDERAL POVERTY GUIDELINES. MANY PATIENTS DUE TO FAILURE TO PRODUCE THE APPROPRIATE DOCUMENTATION RECEIVE A REDUCED NON-COMPLIANT HOSPITAL ADJUSTMENT. THESE PARTICULAR INDIVIDUALS MAY HAVE RECEIVED A HIGHER WRITE-OFF IF THEY WERE IN FACT COMPLIANT. 2.) REGARDLESS OF THE PATIENTS' FINANCIAL CLASS OR STATUS, IF A BILL REMAINS UNPAID FOR MORE THAN 120 DAYS FROM THE DATE IT WAS FIRST MAILED TO THE PATIENT, AND REASONABLE COLLECTION ATTEMPTS HAVE FAILED, THE DEBT IS SENT TO A PRIMARY BAD DEBT COLLECTION AGENCY FOR FURTHER COLLECTION EFFORTS.

PART VI, LINE 2:
"ST. JOHNS COUNTY IS FORTUNATE TO HAVE STRONG AND PROACTIVE LEADERSHIP WITHIN ITS PUBLIC HEALTH SYSTEM, AND A HISTORY OF SUCCESSFUL COLLABORATION. CHAMPIONED BY FLAGLER HOSPITAL AND THE FLORIDA DEPARTMENT OF HEALTH IN ST. JOHNS COUNTY, THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL WAS ESTABLISHED IN 2010 FOR THE SPECIFIC PURPOSE OF BRINGING TOGETHER KEY LEADERS FROM THE LOCAL COMMUNITY TO ASSESS AND ADDRESS THE HEALTH NEEDS OF OUR RESIDENTS. IN MAY 2014, THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL ACHIEVED NATIONAL ROLE MODEL STATUS, WHEN IT WAS SELECTED BY THE UNIVERSITY OF KENTUCKY (UK) COLLEGE OF PUBLIC HEALTH TO BE INCLUDED IN A NATION-WIDE STUDY OF HIGHLY SUCCESSFUL PUBLIC HEALTH COLLABORATIVE. THE PURPOSE OF THE UK STUDY WAS TO IDENTIFY, COMPARE AND CONTRAST EXCEPTIONAL MODELS OF COLLABORATION INVOLVING COMMUNITY HOSPITALS, PUBLIC HEALTH DEPARTMENTS AND OTHER STAKEHOLDERS, WHO SHARE A COMMITMENT TO IMPROVING COMMUNITY HEALTH, AND TO DETERMINE THE KEY LESSONS LEARNED FROM THEIR EXPERIENCES. THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL WAS ONE OF ONLY TWELVE COLLABORATIVES SELECTED BY THE UK STUDY TEAM FROM OVER 150 NATIONAL APPLICATIONS. FLAGLER HOSPITAL'S CEO, VP OF MARKETING AND STRATEGY, AND ADMINISTRATOR OF COMMUNITY HEALTH IMPROVEMENT, ALONG WITH REPRESENTATIVES FROM 41 OTHER AGENCIES PARTICIPATED IN THIS HIGHLY COLLABORATIVE EFFORT WITH FLAGLER HOSPITAL IN THE FOREFRONT OF EVERY PHASE FROM DEVELOPING SURVEY QUESTIONS, CREATING SURVEY TOOLS, IDENTIFYING FOCUS GROUPS, ANALYZING DATA, ESTABLISHING ACTION PLANS AND REVIEWING RESULTS. SEE NARRATIVE ON PART V FOR PART V, SECTION B, LINE 6B FOR A LISTING OF THE MEMBERSHIP ORGANIZATIONS AND REPRESENTATIVES.TO IMPLEMENT THE FINDINGS AND GOALS DETERMINED THROUGH THE CHNA, THE MAPP PROCESS USES A THREE YEAR CYCLE WITH EACH IDENTIFIED NEED HAVING AN ""OWNER"" TO TRACK PROGRESS. WHILE VARIOUS MEMBERS OF THE HEALTH LEADERSHIP COUNCIL TOOK ""OWNERSHIP"" OF VARIOUS ASPECTS OF THE HEALTH NEEDS ASSESSMENT'S IMPLEMENTATION, FLAGLER HOSPITAL PARTICIPATES IN EACH PART OF IMPLEMENTATION. THE SHARED VISION AND COMMON VALUES OF MEMBERS PROVIDE A FRAMEWORK FOR PURSUING THE LONG RANGE GOALS, SO FLAGLER HOSPITAL IS PROUD TO PARTNER WITH MANY MEMBERS OF THE HEALTH LEADERSHIP COUNCIL, IN ORDER TO BROADEN COMMUNITY PARTICIPATION. FLAGLER HOSPITAL ACKNOWLEDGES AND AGREES WITH THE SPECIFIED GOALS OF THE CHNA. A COMMUNITY BALANCED SCORECARD WAS CREATED TO TRACK AND EVALUATE EACH OF THE STRATEGIC OBJECTIVES AND ACTS AS THE COMMUNITY HEALTH IMPROVEMENT PLAN. THE CRITERIA AND RATIONALE FOR EACH OF THE OBJECTIVES AND GOALS IS CONTAINED ON PAGE 21 OF THE PUBLISHED ""2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN""."

PART VI, LINE 3:
THE HOSPITAL COMMUNICATES ITS CHARITY CARE POLICY, OR PATIENT-FRIENDLY SUMMARY THEREOF, IN THE FOLLOWING WAYS:- POSTED ON THE FLAGLER HOSPITAL WEBSITE - POSTED AT THE RECEPTION DESKS IN ALL REGISTRATION AREAS - POSTED AT ALL FINANCIAL COUNSELORS' DESKSWHEN UNINSURED OR UNDERINSURED PATIENTS ARE ADMITTED TO THE HOSPITAL, THEY ARE SCREENED FOR FINANCIAL ASSISTANCE. AT THE TIME OF SCREENING, THE PATIENT IS PROVIDED A FINANCIAL ASSISTANCE APPLICATION TO COMPLETE. THEY ARE THEN ASKED TO SUBMIT THE REQUIRED FINANCIAL DOCUMENTS (I.E., BANK STATEMENTS, PAY STUBS, TAX RETURNS, ETC.). THOSE PATIENTS DISCHARGED PRIOR TO SCREENING ARE CALLED BY THE BUSINESS OFFICE AND ARE SCREENED OVER THE PHONE. THE PATIENT IS INFORMED OF THE ELIGIBILITY REQUIREMENTS AND THE FINANCIAL DOCUMENTS NEEDED FOR VERIFICATION. UNINSURED PATIENTS TREATED IN THE EMERGENCY DEPARTMENT WHO MEET CERTAIN CRITERIA ARE SCREENED BY PHONE BY THE BUSINESS OFFICE. THE PATIENT IS INFORMED OF THE ELIGIBILITY REQUIREMENTS AND THE FINANCIAL DOCUMENTS NEEDED. A SEPARATE SCREENING IS PERFORMED TO DETERMINE ELIGIBILITY FOR COUNTY PROGRAMS AND MEDICAID. IN ADDITION, THE HOSPITAL UTILIZES A THIRD-PARTY VENDOR TO SCREEN SELF-PAY PATIENTS FOR POSSIBLE DISCOUNTS AND FINANCIAL ASSISTANCE OPTIONS. FOR DETAILS, PLEASE SEE THE RESPONSE TO PART I, LINE 3C ABOVE.

PART VI, LINE 4:
"ST. JOHNS COUNTY IS PART OF THE JACKSONVILLE METROPOLITAN AREA AND ENCOMPASSES APPROXIMATELY 680 SQUARE MILES OF LAND IN NORTHEAST FLORIDA, SITUATED BETWEEN THE ST. JOHNS RIVER AND MORE THAN 40 MILES OF BEACHES ALONG THE ATLANTIC COAST. AT THE TIME OF PUBLICATION FOR THIS REPORT, THE U.S. CENSUS BUREAU 2019 POPULATION ESTIMATE FOR ST. JOHNS COUNTY, FL IS 264,762. SINCE 2010, ST. JOHNS COUNTY IS ASCRIBED AS THE HEALTHIEST COUNTY OF 67 COUNTIES IN FLORIDA FOR OVERALL HEALTH FACTORS AND HEALTH OUTCOMES IN THE 2020 COUNTY HEALTH RANKINGS REPORT. ST. JOHNS COUNTY SCHOOL DISTRICT RANKS FIRST OF 67 DISTRICTS IN FLORIDA IN TOTAL FLORIDA COMPREHENSIVE ASSESSMENT TEST POINTS. THE CITY OF ST. AUGUSTINE, THE COUNTY SEAT AND NATION'S ""OLDEST CITY,"" ATTRACTED ABOUT 6.3 MILLION VISITORS TO THE COUNTY IN 2017.POPULATION AND AGE DISTRIBUTIONST. JOHNS COUNTY'S POPULATION NEARLY TRIPLED BETWEEN THE YEARS 1990 AND 2016, THIS BEING A POPULATION INCREASE OF OVER 180%. GROWTH FOR ST. JOHNS COUNTY IS OCCURRING AT A RATE THREE TIMES FASTER THAN FLORIDA AND ALMOST SIX TIMES FASTER THAN THE NATION. THE U.S. CENSUS BUREAU ESTIMATES ST. JOHNS COUNTY'S POPULATION FOR 2016 TO BE 235,087 (51.2% FEMALE), AN ESTIMATED 3.7% HIGHER THAN THE 2015 ESTIMATE. ST. JOHNS COUNTY, FL WAS ASCRIBED THE 15TH FASTEST GROWING COUNTY AMONG THE 100 FASTEST GROWING COUNTIES WITH 10,000 OR MORE POPULATION IN THE NATION BETWEEN 2010 AND 2016. USING 2016 ESTIMATES, THE U.S. BUREAU OF ECONOMIC AND BUSINESS RESEARCH PROJECTS ST. JOHNS COUNTY'S POPULATION WILL GROW TO 287,027 BY 2025.ST. JOHNS COUNTY AND FLORIDA HAVE SIMILAR POPULATION AGE DISTRIBUTIONS. HOWEVER, WHEN COMPARED TO THE STATE, ST. JOHNS COUNTY HAS A SLIGHTLY HIGHER PROPORTION OF PEOPLE WITHIN THE GROUP OF PEOPLE FROM 10 YEARS OF AGE TO 19 YEARS OF AGE AND THE ALSO WITHIN THE GROUP OF PEOPLE FROM 35 YEARS OF AGE TO 69 YEARS OF AGE. COMPARING THE 2010 AND 2016 POPULATION AGE DISTRIBUTION ESTIMATES REVEALS AN AGING POPULATION; BETWEEN 2010 AND 2016, ST. JOHNS COUNTY EXPERIENCED HIGHEST POPULATION GROWTH AMONG PEOPLE 65 YEARS OF AGE TO 69 YEARS OF AGE (2.4%), FOLLOWED BY PEOPLE 50 YEARS OF AGE TO 54 YEARS OF AGE (1.1%) AND 40 YEARS OF AGE TO 44 YEARS OF AGE (1.0%). ACCORDING TO THE U.S. CENSUS BUREAU, APPROXIMATELY 19.3% OF ST. JOHNS COUNTY'S POPULATION WAS 65 YEARS OF AGE OR OLDER IN 2016, A SLIGHTLY LOWER PROPORTION THAN THE STATE (19.9%) BUT HIGHER THAN THE NATION (15.2%).VULNERABLE POPULATIONS PERSONS WITH ACCESS AND FUNCTIONAL NEEDS INCLUDE PERSONS WITH PHYSICAL, COGNITIVE, OR DEVELOPMENTAL DISABILITIES, PERSONS WITH LIMITED ENGLISH PROFICIENCY, GEOGRAPHICALLY OR CULTURALLY ISOLATED PERSONS, AND MEDICALLY OR CHEMICALLY DEPENDENT PERSONS. RECENT DISASTERS HAVE SHOWN THE NEED TO BETTER DEVELOP STRATEGIES FOR MEETING THE NEEDS OF MOST AT-RISK POPULATIONS TO PREVENT ADVERSE HEALTH OUTCOMES DURING OR FOLLOWING A DISASTER."