4A (Expenses $ 499449026 including grants of $ 282001) (Revenue $ 738428146)
See Schedule O.

Schedule H, Part V, Section B. Facility Reporting Group A:
Part V, Section B, Line 7a:The Hospital Facility's Website Where The CHNA Report Is Available:https://www.yumaregional.org/community/community-health-needs-assessment

Schedule H, Part V, Section B. Facility Reporting Group B:
Part V, Section B, Line 7a:The Hospital Facility's Website Where The CHNA Report Is Available:https://encompasshealth.com/-/media/healthsouth/project/healthsouth/locations/yumarehab-03016500/2022-prc-chna-report-sept-2022---yuma-county-az-pdf.pdf?la=en&hash=CE5D8D61F6BA97AC9490CBDDD1215D34D626B4DA

Schedule H, Part V, Section B. Facility Reporting Group B:
Part V, Section B, Line 7b:Other Website Where The CHNA Report Is Available:https://www.yumaregional.org/community/community-health-needs-assessment

Schedule H, Part V, Section B. Facility Reporting Group A:
Part V, Section B, Line 10:The Hospital's Most Recently Adopted Implementation Strategy:https://www.yumaregional.org/wp-content/uploads/2023/03/CHIP-2022-23.pdf

Schedule H, Part V, Section B. Facility Reporting Group B:
Part V, Section B, Line 10:The Hospital's Most Recently Adopted Implementation Strategy:https://encompasshealth.com/-/media/healthsouth/project/healthsouth/locations/yumarehab-03016500/yuma-rehabilitation-hospital-chip-pdf.pdf?la=en&hash=55AD1903F0938A360F24F5C0075532FE01DF1A98

Schedule H, Part V, Section B. Facility Reporting Group A:
Part V, line 16a, FAP website:https://www.yumaregional.org/patients-and-visitors/patient-resources/patient-financial-services/

Schedule H, Part V, Section B. Facility Reporting Group B:
Part V, line 16a, FAP website:https://encompasshealth.com/locations/yumarehab/financial-assistance

Schedule H, Part V, Section B. Facility Reporting Group A:
Part V, line 16b FAP Application Website:https://www.yumaregional.org/patients-and-visitors/patient-resources/patient-financial-services/

Schedule H, Part V, Section B. Facility Reporting Group B:
Part V, line 16b FAP Application Website:https://encompasshealth.com/-/media/healthsouth/project/healthsouth/files/financial-assistance/instructions_applications/yuma-instructions-and-application.pdf?la=en&hash=4D6F409109401A5E28CC153B20C84171057E1923

Schedule H, Part V, Section B. Facility Reporting Group A;
Part V, line 16c FAP Plain Language Summary Website:https://www.yumaregional.org/patients-and-visitors/patient-resources/patient-financial-services/

Schedule H, Part V, Section B. Facility Reporting Group B:
Part V, line 16c FAP Plain Language Summary Website:https://encompasshealth.com/-/media/healthsouth/project/healthsouth/files/financial-assistance/plain_language/yuma-plain-language-summary.pdf?la=en&hash=56CCC3813DA31D8F0C11FEEF53C7CF54D3982EF6

Part V, Section B
Facility Reporting Group A

Facility Reporting Group A consists of:
- Facility 1: Yuma Regional Medical Center, - Facility 2: Yuma Regional Medical Center - Foothills, - Facility 3: Yuma Regional Medical Plaza, - Facility 4: Yuma Regional Cancer Center

Yuma Regional Medical Center Part V, Section B, line 5:
"Significant health needs of the community for Yuma Medical Center and Yuma Rehab Hospital:""Areas of Opportunity"" were identified that represent the significant health needs of the community based on the information gathered through this Community Health Needs Assessment. From these data, it was noted that opportunities for health improvement exist in the area with regard to a variety of health issues. The Areas of Opportunity were determined after consideration of various criteria, including: standing in comparison with benchmark data (particularly national data); identified trends; the preponderance of -significant findings within topic areas; the magnitude of the issue in terms of the number of persons affected; and the potential health impact of a given issue. The selected opportunities also take into account those issues of greatest concern to the community stakeholders (key informants) giving input to this process.Based on two criteria - (1) scope and severity and (2) ability to impact the stakeholder group identified a list of top needs that were then shared with the participants during the Community Town Hall event with opportunity to provide feedback and ask questions:1. Mental health 2. Substance abuse 3. Diabetes 4. Nutrition, physical activity & weight 5. Access to healthcare services 6. Heart disease & stroke 7. Potentially disabling conditions 8. Tobacco use 9. Cancer 10. Oral health 11. Respiratory disease 12. Injury & violence 13. Infant health & family planning On September 30, 2022, Yuma Regional Medical Center convened over 90 community stakeholders (representing a cross-section of community-based agencies and organizations) and internal team members to evaluate and discuss findings of the Community Health Needs Assessment (CHNA). Professional Research Consultants, Inc. (PRC) began the meeting with a presentation of key findings from the CHNA, highlighting the significant health issues identified from the research. Based on the Town Hall inputs and evaluation of resources and existing services, Yuma Regional Medical Center adopted the below listed community health priorities as a working plan and vision for addressing top health concerns within our defined service area. Community health improvement plan prioritized needs:1. Mental health2. Substance use / abuse3. Access to healthcare services 4. Diabetes5. Cancer"

Yuma Regional Medical Center Part V, Section B, line 6a:
Yuma Rehabilitation Hospital

Yuma Regional Medical Center Part V, Section B, line 11:
"Yuma Regional Medical Center and Yuma Rehabilitation Hospital leaders, along with leaders and partners from various community stakeholder groups, have continued to address needs from the most recent 2019 CHNA. The following community health improvement plan results are shared:Priority Area: Mental HealthHigh incidence of those who reported fair or poor mental health. Symptoms of chronic depression. Suicide deaths (particularly in young adults), ratio of mental health providers. Of note, key informants rated mental health as a top concern. Goals:- Increase availability/access to behavioral health providers in community- Improve ratio of providers to community population- Increase awareness among teens and reduce/eliminate teen suicide Results and Impact: YRMC has added new behavioral health providers to shorten the six-month wait time for an initial psychiatric care visit. The wait time has significantly decreased and is now down to five weeks. YRMC began offering behavioral health in 2015 with recruitment of a psychiatrist. Since 2019, YRMC added two additional psychiatrists, a psychiatric nurse practitioner, a licensed professional counselor and two medical assistants. These additions resulted in expanded access to care locally with an estimated 10,000 patient visits annually. Strategy #1 : Partner to host behavioral health Community Town Hall to build community awareness and support. Target Population(s): Community leaders, key stakeholders, social services, law enforcement and those directly impacted (families/patients).Strategy was implemented? Yes. In the fall of 2019 and again in 2022, YRMC served as host in partnership with the Southwest Arizona Town Hall and Arizona Town Hall of a live (2019) and virtual (2022) event to engage leaders and explore solutions. Partnering Organizations: Southwest Arizona Town Hall, Arizona Town Hall, local businesses, schools, law enforcement, social service agencies and more. Results and Impact: - Fall 2019 local town hall event brought together over 100 local leaders/partners. The full day event created an opportunity for leaders to engage, learn and explore real community solutions. The YRMC CHNA served as the research document for the session. - March 2022, YRMC hosted a second (virtual) town hall event where over 65 leaders, social service agencies, non-profit organizations, business owners, elected officials and others gathered to learn more about the current state needs for behavioral health in our community. Patients shared personal stories and joined the conversation to finding real solutions. Those ideas have led to current programs now actively being implemented. These include local inpatient crisis care, intensive therapy and more. Results of the session serve as a tool for continued improvements to behavioral health in our area. Yuma Regional Medical Center utilized this input in alignment with our CHNA goals and organizational strategic plan. - In June 2022, YRMC, along with Southwest Arizona Town Hall and the Arizona Town Hall again collaborated to host over 60 people for a town hall plenary session on the topic of ""substance use in our community."" During the session, attendees, representing a diverse group of community participants, learned about our current state services and needs. Participants then worked in groups to gather input and explore collaborative solutions. The final report from the session has been shared with the community. Yuma Regional Medical Center then utilized this input in alignment with our CHNA goals and organizational strategic plan. Strategy #2: Expand facilities/resources to support added behavioral health services Target Population(s): Yuma County (service areas). Patients and families seeking services. Strategy was implemented? Yes Partnering Organizations: NoneResults and Impact: In 2019, YRMC expanded behavioral health with the addition of a dedicated clinic space that would allow for an expanded number of providers. Dedicated clinic space for behavioral health afforded a location for additional providers and resulted in a significant increase in patients served. Since 2019, there has been a 194% increase in patient visits. Strategy #3: Develop inpatient and intensive outpatient behavioral health services Target Population(s): Yuma County (service area) Strategy was implemented? Yes. In 2019, YRMC Board of Directors approved expanding YRMC's complement of behavioral health services. Partnering Organizations: YRMC & Horizon Health Results and Impact: In early 2022, YRMC partnered with Horizon Health to develop and provide inpatient behavioral health services in Yuma. Construction of a 24-bed inpatient psychiatric facility was completed in June 2022 - recruitment for that facility is currently underway with a projected opening date of Winter 2022. Based on a demographics bed analysis, the new facility is expected to serve 1,386 patients during phase one, with projected growth to serve 2,773 patients annually when open at full capacity.Priority Area: Access to Health Care ServicesBarriers to access attributed to: inconvenient office hours, lack of available appointments and long wait times, primary care physician ratio well below national standard. Emergency department utilization included high volumes of non-acute care. Goals: - Expand availability of appointments - Expand availability of primary care across community - Minimize trend to use emergency department for minor health needs - Improve physician ratio Strategy #1: Expand Family & Community Medicine residency program (growing our own) Results and Impact: When our Family & Community Medicine residency class size expanded from six incoming doctors per year to eight in 2020, our capacity to provide more high-quality primary care also magnified. With 24 residents now providing crucial primary care in our community, we have curtailed the wait for a first-time primary care visit. In 2016, the clinic saw 19,745 patient visits compared to 31,299 in 2021. Forty-three physicians have completed the residency program since 2013 and more than 30 percent of graduates have chosen to stay in Yuma to practice medicine. Strategy #2: Expand clinic hours and location to serve more people Results and Impact: Pediatric care: in May 2020, an initiative to increase access to primary pediatrics appointments went into effect. Both YRMC primary pediatric locations have new standard hours of operations to include evening appointments. One location offers appointments Monday-Friday from 8:00am to 6:00pm. A second location is Mon/Wed/Fri 8:00am to 8:00pm, as well as Saturday morning appointments. These changes have opened up an additional 70 plus pediatric specific appointments per week.Strategy #3: Recruit and retain additional providers to meet community need Results and Impact: Since 2019, Yuma Regional Medical Center has continued to expand primary care services by hiring 19 providers. We also expanded walk-in care hours and services in two YRMC clinics. Thanks to our Transitional Care Clinic, patients discharged from the hospital now have immediate access to primary care especially if they did not have an established internal medicine or family practice provider. Adding three nurse practitioners to our transitional care team has proven extremely valuable to providing the complex care recently discharged patients need. In the specialty care realm, we have successfully recruited physicians and advanced practice providers crucial to our community needs. We are pleased to see the benefits of fellowship-trained specialists treating our patients. In 2020, we welcomed a general surgeon who also completed a trauma fellowship, another who completed a colorectal surgery fellowship and a third who completed fellowship training in cancer care. A fellowship-trained arthroplasty orthopedist joined our ranks, as did a surgeon with that extra year of shoulder and elbow training. They are a boon to clinical excellence in Yuma County. Other specialists who have joined or will join our team by the end of 2022 include: two endocrinologists, two neurologists, three pediatricians and one pediatric nurse practitioner, two cardiovascular surgeons, an interventional cardiologist, a pediatric emergency doctor, five gastroenterology advanced practice providers, two ENTs, a pain management physician, a pediatric cardiologist, three pulmonologists, two non-surgical sports medicine doctors, a urologist and urology nurse practitioner, two hematology-oncology physicians, and a radiation oncologist. Yuma Regional Medical Center's annual turnover rate is 12% for employed providers, which is below the 15% national average."

Part V, Section B
Facility Reporting Group B

Facility Reporting Group B consists of:
- Facility 5: Yuma Rehabilitation Hospital

Yuma Rehabilitation Hospital Part V, Section B, line 5:
Please see the narrative response for Yuma Regional Medical Center (Reporting Group A)

Yuma Rehabilitation Hospital Part V, Section B, line 6a:
Yuma Regional Medical Center

Yuma Rehabilitation Hospital Part V, Section B, line 11:
Please see the narrative response for Yuma Regional Medical Center (Reporting Group A) For Yuma Rehabilitation Hospital (YRH):Priority Area: Potentially Disabling Conditions Approximately 36.8% of county residents report having three or more chronic health conditions. People with disabilities are less likely to get preventive health care services. Goals: -Increase independence in populations with chronic conditions.-Decrease risk for injuries related to chronic conditions Strategy 1: Educate community and partners on self and rapid admission program to help support individuals with chronic conditions being referred to YRH for inpatient rehabilitation Target Population(s): Yuma County service area Strategy 2: Yuma Rehabilitation Hospital therapy department education on fall prevention strategies for patients and community outreach Target Population(s): YRH patient population and Yuma County service area

Yuma Rehabilitation Hospital Part V, Section B, line 16j:
The FAP, FAP application form and plain language summary of the FAP were translated into the primary language(s) spoken by Limited English Proficiency (LEP) populations.

Part V, Section B, Line 11, Continued:
"Strategy #4: Decrease cancer patients accessing the emergency department unnecessarilyResults and Impact: For cancer patients, infection control concerns and complication risks arise anytime they walk through emergency room doors. They also incur significant costs. In 2019, the YRMC Cancer Center set up a new process to reduce the odds their cancer patients would need to visit the emergency department. It all started with prompting patients to call the cancer center, 24/7/365, when they developed symptoms that concerned them. The on-call physician or nurse practitioner would assess the patient's symptoms over the phone to direct the patient to the right place, for the right level of care. This caused the number of patients who sought care from the YRMC emergency department to trend to the lower end of national average statistics. Priority Area: DiabetesHigh incidence of deaths attributed to diabetes. Overall prevalence of diabetes is high among adults. Key informants ranked diabetes as a top concern. Goals: - Reduce incidence through diabetes education (inpatient & outpatient) - Enhance programs aimed at early intervention (children/families services) - Recruit additional providers to include pediatric endocrinology Strategy #1: Expand availability of diabetes support/education (inpatient & outpatient) Target Population(s): Patients diagnosed as diabetic or borderlineResults and Impact: - Diabetic patients are very vulnerable to blood sugar management challenges during their inpatient-to-outpatient transition. They also happen to be very open to education about improving their diabetes care during this time. Our Transitional Care Clinic brings recently discharged patients in for a one-hour face-to-face diabetes-care encounter. There, they start their diabetes-care program, focusing on insulin management, diet, and medication management. Follow-up education is provided with six additional biweekly phone calls. We have had wonderful outcomes including impressive HBA1C improvements as well as less blood-sugar fluctuation.- One additional certified diabetes educator was added to the inpatient team this year. In addition, a 2022 upgrade to the Healthtouch Patient Nutrition Management System is helping our nurses and registered dieticians support patients with ever better carbohydrate counting and blood sugar management. - And yet, with all of our improvements to help patients with Type 1 and Type 2 diabetes, we also made gestational diabetes a priority. The nutrition services department collaborated with our Women's Health Clinic to author a reference booklet that addresses the specific nuances of soon-to-be mothers who live with this significant challenge. It is published in both English and Spanish. - Screening our diabetic patients for neuropathy, kidney-related complications, and statin use has increased in our primary care clinics. Closing these care gaps is one of our concentrations right now because we know it can do so much good. - Finally, it was gratifying to reach a milestone in Yuma County diabetes reversal by performing our 1,000th weight loss surgery procedure in 2019. In 2022, YRMC again achieved accreditation by the American College of Surgeons as a comprehensive center for metabolic and bariatric surgery. The hospital-wide credential is the highest designation available and comes from the American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Strategy #2: Recruit pediatric endocrinologist and develop local peds-specific programs Partnering Organizations: Phoenix Children's Hospital Results and Impact: Our community needed excellent pediatric diabetes care. Starting in 2021, a strong partnership with Phoenix Children's Hospital has enabled YRMC Pediatric Subspecialty Clinics to offer endocrine services, which includes diabetic evaluation and treatment to all community pediatric patients. In-person and virtual encounters are provided. Moreover, we are currently working toward onboarding a second pediatric endocrine provider to fill the high needs of the pediatric community. Strategy #3: Recruit additional specialists (adult endocrinology) Results and Impact: Yuma County's benefit from our single YRMC-employed endocrinologist was vast. With his mature practice only able to accept a small proportion of the patients who needed him, recruiting new endocrinologists became one of our most urgent imperatives. Fortunately, we added a second endocrinologist in 2019 and a third joined YRMC in 2021. Patient visits have increased by 62% since 2019.Priority Area: Substance UseHigh incidence of cirrhosis/liver disease deaths and unintentional drug-related deaths. Key informants ranked substance use as a top concern. Barriers to access attributed to: inconvenient office hours, lack of available appointments (wait time to get an appointment), primary care physician ratio well below national standard. Emergency department utilization high volume of non-acute care. Goals: - Reduce number of patients having to travel out of town for substance detox and treatment- Expand awareness/education among students and parents Strategy #1: Develop medical detox and treatment facility/services in Yuma County Results and Impact: The need for effective, caring drug and alcohol rehabilitation care has never been more urgent in Yuma County. Nevertheless, experience and the medical literature increasingly demonstrate that detoxification and safeguarding from further substance abuse should not stand alone from the mental and medical health continuum of care. They are complex and intertwined. As a result, YRMC's new Behavioral Health Center will also deliver a drug and alcohol rehabilitation program. Our new services will soon offer inpatient beds in place along with options for outpatient substance abuse recovery care. Strategy #2: Partner with community leaders, schools and families to enhance awareness through outreach and education Partnering Organizations: Yuma Union High School District, Yellow Ribbon Suicide Awareness Coalition, and Foundation of YRMC Results and Impact: YRMC and Foundation of YRMC sponsored yellow ribbon training for local high schools. Each year, students, teachers, parents and healthcare providers are provided with education and awareness training. Over 5,000 students/parents/teachers have received training.Priority Area: Heart Disease and StrokeHeart disease and stroke are among the leading causes of deaths in Yuma County. Prevalence of heart disease and stroke are high. High blood pressure and high blood cholesterol are also prevalent. Overall cardiovascular risk is high. Goals:- Increase awareness in community about risk of heart disease and stroke - Improve outcomes and earn stroke center of excellence Strategy #1: Expand community patient/education of risk factors for heart disease and stroke Results and Impact: We have reached a large proportion of Yuma County residents with multiple educational messages about heart disease prevention, stroke prevention and stroke symptom recognition. From a Facebook live event with one of our neurologists, to his appearance on a popular local radio show, and recent newspaper feature, our doctors are educating the community. Our stroke coordinator and nurse educators have attended health fairs and community events to perform screening and education. Strategy #2: Implement YRMC stroke team Partnering Organizations: Local first responder teams and ambulance crews, DNV-GL, American Heart Association, American Stroke Association, and local news organizations Results and Impact: Since 2017, the in-hospital program has improved stroke care at YRMC by promoting consistent adherence to optimal clinical practices. Shortly after pursuing a higher level of stroke care, the hospital qualified for its first American Heart Association's ""Get With The Guidelines Stroke"" quality achievement award. Between 2019 and 2022, we have made vast improvements in stroke care. Now, we are not only holding those gains. We are on the verge of another leap in our stroke care abilities. In 2019, YRMC was infusing alteplase into patients who met the criteria in less than 60 minutes of their arrival, on average. In 2022 we are approaching an average door-to-infusion time of 45 minutes. In stroke care, speed is vital. YRMC's processes are achieving that speed."

Part V, Section B, Line 11, Continued:
Priority Area: Nutrition, Physical Activity and WeightLow fruit and vegetable consumption and growing number of those with reported food insecurity. High incidence of overweight/obesity. Access to recreation and fitness facilities. Key informants ranked nutrition, physical activity and weight as a top health concern. Goals: -Reduce incidence of obesity among children through expanded education -Partner with local community to increase consumption of fruits and vegetables-Reduce incidence of malnutrition among YRMC patients through screening and dietary early intervention. The team is comprised of a pediatrician, nationally certified in Obesity Medicine (ABOM), a social worker, and a nutritionist. Internal referrals to cardiology, endocrinology and or gastroenterology are utilized if required. Focus is on a family engagement for healthy living, including 1:1 with the provider and 1:1 with the nutritionist, and social work referrals to meet the needs of families. Planet Fitness provides free access to the gym. Strategy #1: Provide children/families healthy eating/lifestyle programResults and Impact: August 2021, Pediatric Subspecialty Clinics initiated a Pediatric 'Metabolic' Clinic (PMC). The metabolic clinic provides a comprehensive team-approach to pediatric patients who have high BMIs and often an associated diagnosis that puts pediatric patients at risk for chronic diseases. Strategy #2: Partner with local community to increase consumption of fruits and vegetables Strategy was implemented? Yes (COVID-19 minimized outreach efforts) Partnering Organizations: Yuma Community Food Bank and local schools Results and Impact: Over 400 families received Healthy Recipe Cards designed to guide the community about how to prepare locally grown fruits and vegetables. Yuma County is the leafy green capital of the world growing over 80% of the world's leafy greens right here in our community.Strategy #3: Provide malnutrition screening/assessment for YRMC in-patients with follow-up and nutrition care plan/support by a Registered Dietician Results and Impact: PMC assessments completed on a minimum of 30% of average daily census. Of those, we found that 30-50% of all inpatients are malnourished. Intervention provided by a Registered Dietician through education and diet modification. Priority Area: Cancer CareCancer is a leading cause of death in Yuma County. Identified high prevalence of cancer (non-skin) in Yuma County. Goals: - Improve lung cancer early detection/reduce deaths (lung cancer) - Reduce need for emergency department by cancer patients Strategy #1: Implement LDCT lung screening program Target Population(s): Yuma County service area; those with history of smoking, all patients referred that meet the CMS/USPFTS screening guidelines Strategy was implemented? Yes Internal Partners: oncology, radiology, pulmonary, primary care, cardio-thoracic, transitional care, and organization development External: ACS, AHD Arizona Community Health Workers (AZCHOW) Results and Impact: Conducted 10 interviews with Yuma leadership, physicians, and sponsors to gain perspective and shared realities on effectively implementing a lung-screening program and the needs of the population. In addition, several calls held with community partners (American Cancer Society, Arizona and Yuma Health Department, Arizona Southern University, Arizona Community Health Workers (AZCHOW)) to discuss regional outreach and engagement. Program leadership established to include a physician lead, multi-specialty governance committee to include primary care, community physicians, senior leadership and a dedicated lung coordinator. The program, launched on February 14, 2022, focused on internal engagement with an extremely positive response. The program superseded its annual goal of 100 completed screenings within the first five months with the following activity year to date: 358 referrals processed with 148 (41%) completed. Bi-weekly multispecialty tumor conferences held to discuss LDCT scan results for recommendations and follow up. Keeping in line with the national ratio of screening to cancer diagnosis using 1:200, the Yuma LDCT screening program has diagnosed one cancer, with two other highly suspicious cases, currently under work-up. Pending, is acceptance of an application to participate in the National Lung-Screening Registry and startup of the Pulmonary Nodule Clinic. Next steps: extend invitation to community partners for governance participation and expanding outreach to the Yuma community and surrounding cities and counties.Strategy #2: Develop after-hours phone line for cancer patients to reduce need to seek treatment in the Emergency Department Target Population(s): YRMC Cancer Center patients and families Results and Impact: As mentioned in the Access to Health Care Services section, the on-call doctor or nurse practitioner started triaging and treating patients on the phone. This caused the number of patients who sought care from the YRMC Emergency Department to trend to the lower end of national average statistics. Strategy #3: Address environmental contributors: tobacco and smoking cessation counseling Target Population(s): Patients with history of smoking Partnering Organization(s) Internal: YRMC Transitional Care provides back up for all referring providers to ensure compliance to SDM and smoking cessation. All providers are encouraged to provide the counseling visits; however, patients may be scheduled in the Transitional Care Clinic for SDM and smoking cessation counseling. External: Referrals to Ashline for non-smoking coaching sessions (offers six free 1:1 sessions and nicotine replacement products) Results and Impact: The lung-screening program follows the Medicare criteria for eligibility. Smoking cessation counseling is one of the criteria for participation in the lung-screening program. Each participant requires a documented counseling visit. Through the lung-screening program, 100% of participants received counseling with a documented visit. For patients interested in cutting back or desiring to quit smoking, the referring provider or the lung coordinator places referrals to Ashline. We collaborate with Ashline to provide one-on-one coaching and nicotine replacement products. Ashline offers six free coaching sessions and two weeks of products. After two weeks, the primary care provider can write prescriptions. Referrals are provider, coordinator, or self-driven based on patient agreement. Ashline provides YRCC (Yuma Regional Cancer Center) with a feedback report on participants. Strategy #4: Increase access to cancer care/services Strategy was implemented? Yes Target Population(s): Cancer patients within our service area Results and Impact: Patients are able to make an appointment within five working days, improving the turnaround time of referral to scheduling. The navigator assessment occurs by the second visit to proactively identify and manage patient barriers as evidenced by: compliance to clinic visits, medication compliance, and frequency of ER visits. Patient resources are made available through collaborations with the Cancer Resources Center, Foundation of Yuma Regional Medical Center, pharmaceutical foundations, American Cancer Association grants, and other community partners. The Center also provides improved phone access and startup of a physician-led, genetic screening program as a preventive measure, closing the gap for the region with no other existing genetic program.Our outcomes include: -Nurse assessments performed at 90% -Visit compliance clinic 95.9%, infusion 99.8%, and radiation 99.9% -Oral chemotherapy funding support year to date: assisted 54 patients for an estimated $2.7m (funding up 94% over previous year) -ER visit frequency average 9%, 64% below the goal of 25% -Phone abandonment rate 4.22%, in person connection at 95.7% -Genetic screening: 52 patients seen, 42 tested (80%), and 15 (36%) demonstrating pathogenic genes, indicating an increased risk for cancer. Patients counseled on care options and recommendations on lifestyle.

Part V, Section B, Line 11, Continued:
Strategy #5: Cancer research Strategy was implemented? Yes Target Population(s): Oncology patients seen at YRCC Partnering Organization(s): Internal: institutional research, legal, compliance External: WCG IRB, University of Arizona, Mayo Community Research Academic and Community Cancer Research United (ACCRU), Optimal Research, Tempus Time Trial program, PCORI grant - MD Anderson, SUNY - Buffalo Results and Impact: Cancer research at the YRMC cancer center has increased enrollment of patients in cancer clinical trials from 33 in 2015 to 121 in 2021. In addition, YRMC has been successful at increasing the participation of minorities in clinical trials resulting in 39.2% LatinX representation in all oncology trials. Other highlights include: - We garnered national attention and our best practices have been quoted by American Society of Clinical Oncology (ASCO) and Association of Community Cancer Centers (ACCC) -In partnership with Tempus Labs, we leveraged machine learning technology to efficiently identify and match patients for precision oncology clinical trials. This publication was accepted as e-poster at 2021 ASCO annual meeting citation - Journal of Clinical Oncology 2021 39:15_suppl, e13588-e13588 - Our Just-in-Time (JIT) model of clinical trials enrollment led to enrollment of minorities in oncology clinical trials. This was presented as a poster at the 2021 annual meeting of by American Society of Clinical Oncology (ASCO). Citation - Journal of Clinical Oncology 2021 39:15_suppl, 1563-1563 - Since 2016, the Cancer Center has published over 21 peer reviewed publications and about 15 posters in national and international conferences. These publications have garnered more than 1,000 citations by other peer-reviewed journals.

Part I, Line 7:
Utilizing the worksheets included in the instructions for Schedule H, cost-to-charge ratios were calculated and used to determine amounts reported in the table.

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 $57,686,954.

Part II, Community Building Activities:
"Economic development:Leader/executive participation in greater Yuma economic development, chamber of commerce, Yuma Visitors Bureau, and Arizona Western College collaborative. In those activities, Yuma Regional Medical Center (YRMC) leadership plays an active role in supporting the business and economic drivers and workforce needs.Yuma Regional Medical Center actively supports tourism as a major economic driver for the community. With approximately 100,000 annual winter visitors, YRMC has actively partnered with the local Yuma Visitors Bureau (YVB) to ensure the medical needs of a high volume of visitors. YRMC leader Shay Andres serves on the YVB board of directors, contributing approximately 3-4 hours per month in professional leadership support. Tourism is a major industry for both Arizona and Yuma County. With proximity to California and Mexico, the area attracts large numbers of travelers and international shoppers. During the winter, Yuma's influx of seasonal visitors positively impacts the economy.Community Support:Yuma Regional Medical Center is involved in several community building activities that address the root causes of health problems. Through these activities, YRMC supports community assets by offering the expertise and resources of our healthcare organization. We encourage employees to be involved in the community through community boards, health advocacy programs, and physical improvement projects to continuously improve the quality of life for the community we serve. Community building activities include the following:Coalition Building:Hospital representation to community coalitions related to community health such as:- Yuma Community Food Bank- Food for Life- Salvation Army Christmas Angels ProgramCommunity Health Improvement Advocacy:Local, state, and national advocacy in areas such as access to healthcare, public health, transportation, and housing:- Crossroads Mission - help the homeless shelter by providing bedding & financial support for drug/detox program- School health / sports physicals- Healthy Kids Program (teaches family wellness, nutrition, exercise, etc.)- Amberly's Place - support and assistance for victims of sexual abuse- In 2022, YRMC, in partnership with Southwest Town Hall, hosted a community town hall on the topics of ""mental health, substance use, and homelessness"""

Part III, Line 2:
Note 4: Patients who are covered by third-party payors are responsible for related deductibles and coinsurance, which vary in amount. The Medical Center also provides services to uninsured patients and offers those uninsured patients a discount, either by policy or law, from standard charges. The Medical Center estimates the transaction price for patients with deductibles and coinsurance and from those who are uninsured based on historical experience and current market conditions. The initial estimate of the transaction price is determined by reducing the standard charge by any contractual adjustments, discounts, and implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. For the years ended September 30, 2022 and 2021, additional revenue of approximately $ 3,219,000 and $11,986,000, respectively, was recognized due to changes in its estimates of implicit price concessions, discounts, and contractual adjustments for performance obligations satisfied in prior years. For the year ended September 30, 2021, the Medical Center recognized an additional change in estimate of approximately $4,300,000 as a result of a settlement on accounts aged greater than 365 days with two third-party payors. There was no similar additional change in estimate for the year ended September 30, 2022.

Part III, Line 4:
"YRMC periodically reviews its collection rates for all self-pay accounts and estimates the anticipated collections on all outstanding self-pay balances. A reserve is established to estimate those account balances that are not expected to be collected based on those historical collection rates.See Note 2 on page 10 of the attached financial statements for the footnote ""patient accounts receivable, net and Note 4 on page 16 for the footnote ""net patient service revenue."""

Part III, Line 8:
The organization provides acute medical care to all in need without regard to the patient's ability to pay and without regard to their payor source. The community benefits from the prompt provision of acute care services and, to the extent YRMC incurs a shortfall providing such services, this is clearly a benefit to the community.The organization utilizes the step-down method of cost allocation, as prescribed by CMS in the Medicare Cost Report.

Part III, Line 9b:
Patients may be eligible for full financial assistance or partial assistance. If partial, the remaining balance on the account will be subject to YRMC'S normal collection process and payment arrangements will be made. The balance will be turned over to a collection agency if any of the following events occur:1. Mail returned - not able to locate patient. Account goes to a collection agency after two consecutive mail returns.2. No telephone listing or disconnected.3. Regular sequence of statements and collection notices sent, including a final notice, with no response.

Part VI, Line 5:
YRMC is involved in several community building activities that address the root causes of health problems. Through these activities, YRMC supports community assets by offering the expertise and resources of our healthcare organization. YRMC encourages employees to be involved in the community through community boards, health advocacy programs and physical improvement projects to continuously improve the quality of life for the communities we serve.See also community-building activities listed for Schedule H, Part II above.

Part VI, Line 6:
N/A

Part VI, Line 7, Reports Filed With States
AZ

Part VI, Line 2:
Yuma Regional Medical Center (YRMC) has proactively developed several mechanisms for continuous evaluation of community health needs. YRMC has led the collective efforts and formation of the Alliance for Healthy Communities (AHC). The AHC (started in 1996) is a representation of people who care about the future health needs of our residents. Membership in the alliance is about partnering to improve the overall health of the community through collaboration. Membership includes organizations from throughout Yuma county such as local schools/colleges, health providers, public health, law enforcement, media, military, business and more. In FY13, the group collectively conducted a comprehensive Community Health Needs Assessment, funded by YRMC. The findings of that survey were shared during a Yuma county leadership plenary session designed for community feedback and community health needs. More recently, YRMC has conducted Community Health Needs Assessments in 2016, 2019 and 2022, as outlined in Part V of this Schedule H.Periodically, the YRMC board of directors conducts a comprehensive physician manpower review, then prepares a medical staff development plan (MSDP). YRMC then implements the plan to recruit those providers needed into the community.

Part VI, Line 3:
As each patient is registered for services, request for insurance information or payment is completed. If a patient states that they have no insurance, we will request payment in full or a deposit. If a balance remains, we will interview the patient and complete YRMC financial assistance forms. At this time the patient is given information about the AHCCCS application process, and the application is completed if the patient is eligible (based on residency and income, for example). The application process is an online web-based application called Health-E-AZ. This online process provides a tentative approval pending verification of information to determine if the patient might potentially qualify for AHCCCS. Once it is determined that the patient will not qualify for any government programs, then the financial counselor will visit with the patient and explain the financial assistance program and, if the patient wishes to apply, will retrieve all of the necessary proof of income to complete the financial assistance process. The completion of this process may continue after the patient leaves the hospital until the financial assistance process is completed by the staff in the patient accounting department.If the patient is an emergency room (ER) patient and does not qualify for completing an AHCCCS application, the patient is given a sheet of instructions explaining the financial assistance process, documents that are needed to complete the application, and phone numbers to call to make an appointment to complete the financial assistance process.The financial assistance process involves the collaboration of front-end registrars, financial counselors, med-assist employees, cashiers, and the patient accounting department.

Part VI, Line 4:
YRMC is the only hospital in Yuma County and also serves surrounding areas (towns on the California/Arizona border) and residents of Mexican border towns. The county has been designated as a medically underserved area.In Yuma County, approximately 65 percent of the population is Hispanic or Latino and, in the city of San Luis and the city of Somerton (both in Yuma County), over 90 percent of the population is Hispanic or Latino. Yuma County's population is about 208,000 and is expected to grow by 5-6 percent in the next five years.Over 75 percent of the population in Yuma County has a GED or high school diploma; 16 percent have a bachelor's degree or higher. Approximately five percent have a master's degree.The main industries in Yuma County are agriculture, tourism, and the military. There are two military bases here - Marine Corps Air Station Yuma and Yuma Proving Grounds (US Army).Approximately 17 percent of the population is below the poverty line.