4A (Expenses $ 548808062 including grants of $ 377716) (Revenue $ 680676039)
"PIEDMONT ATHENS REGIONAL MEDICAL CENTER (""PAR"") IS A 360-BED FACILITY LOCATED IN THE CITY OF ATHENS IN CLARKE COUNTY, GEORGIA. OVER 500 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN ATHENS AND THE SURROUNDING NORTHEAST GEORGIA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE FISCAL YEAR ENDED JUNE 30, 2022, THE HOSPITAL HAD 21,513 PATIENT ADMISSIONS WITH A TOTAL OF 101,409 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 81,178 OUTPATIENT VISITS TOTALED 276,811. SURGICAL SERVICES WERE PROVIDED TO 15,435 PATIENTS."

SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATION
AS A PART OF OUR PROCESS, WE INTERVIEWED NEARLY 245 STAKEHOLDERS, POLICY MAKERS AND LAWMAKERS REPRESENTING PUBLIC HEALTH, LOW-INCOME POPULATIONS, MINORITIES, CHRONIC CONDITIONS, OLDER ADULTS, AND OUR COMMUNITIES. THESE INCLUDED 12 STAKEHOLDERS WITHIN THE PIEDMONT ATHENS COMMUNITY, WHO GAVE THEIR PERSPECTIVES ON COMMUNITY HEALTH THROUGH THE LENS OF THEIR ROLE WITHIN THE COMMUNITY. THESE INTERVIEWS WERE CONDUCTED FOR PEOPLE REPRESENTING THE ENTIRE REGION. SPECIFICALLY, WE INTERVIEWED REPRESENTATIVES OF LOCAL AND REGIONAL PUBLIC HEALTH ENTITIES, MINORITY POPULATIONS, FAITH-BASED COMMUNITIES, LOCAL BUSINESS OWNERS, THE PHILANTHROPIC COMMUNITY, MENTAL HEALTH AGENCIES, ELECTED OFFICIALS AND INDIVIDUALS REPRESENTING OUR MOST VULNERABLE PATIENTS. THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS AND LEADERSHIP FROM ALL 19 HOSPITALS WERE ACTIVELY INFORMED AND ENGAGED THROUGHOUT THIS PROCESS.

SCHEDULE H, PART V, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE
https://www.piedmont.org/media/file/Community-Benefit-Needs-Assessment-PAR .pdf

SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA
IN ADDITION TO MAKING ITS CHNA REPORTS AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT ATHENS REGIONAL MEDICAL CENTER SENT COPIES TO EACH PARTICIPANT IN THE CHNA PROCESS, DISTRIBUTED THE ASSESSMENTS TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT COPIES TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENTS TO OTHER PIEDMONT HEALTHCARE HOSPITALS.

SCHEDULE H, PART V, LINE 10A: IMPLEMENTATION STRATEGIES WEBSITE
THE BOARD OF DIRECTORS FOR PIEDMONT ATHENS REGIONAL MEDICAL CENTER APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE-YEAR PERIOD BEGINNING WITH FY23 ON OCTOBER 27, 2022, WITHIN THE GRACE PERIOD FOLLOWING THE APPROVAL OF THE NEW COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING LINK IS FOR THE IMPLEMENTATION STRATEGY EFFECTIVE THROUGH JUNE 30, 2025. https://www.piedmont.org/media/file/Community-Benefit-Implementation-Strat egy-PAR.pdf

SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS
DURING FY22, PIEDMONT ATHENS REGIONAL MEDICAL CENTER CONDUCTED ITS FOURTH CHNA, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT ATHENS REGIONAL MEDICAL CENTER DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. ALL PRIORITIES ARE VIEWED THROUGH THE LENS OF HEALTH DISPARITIES, WITH PARTICULAR ATTENTION PAID TO IMPROVING OUTCOMES FOR THOSE MOST VULNERABLE DUE TO INCOME AND RACE. BASED ON THE CHNA, PIEDMONT ATHENS REGIONAL MEDICAL CENTER IS CURRENTLY FOCUSING ON: (1) ENSURING AFFORDABLE ACCESS TO HEALTH, MENTAL, AND DENTAL CARE (2) REDUCING PREVENTABLE INSTANCES OF, AND DEATHS FROM, CANCER (3) PROMOTING HEALTHY BEHAVIORS TO REDUCE PREVENTABLE CONDITIONS, DISEASES, AND ADDICTION (4) REDUCING PREVENTABLE INSTANCES OF, AND DEATHS FROM, HEART DISEASE

SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITES
FINANCIAL ASSISTANCE POLICY - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-POLICY.PDF FINANCIAL ASSISTANCE APPLICATION - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-APPLICATION.PDF FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SU MMARY-ENGLISH.PDF

SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS
SCHEDULE H, PART I, LINE 6A We regularly report to the community our community benefit activities in several ways. Each year, we prepare a systemwide community benefit report that is available to the public through publication on our website. We also make available our IRS Form 990 Schedule H on our website and provide copies to anyone upon request. We also provide information on community benefit programming to local, state, and federal lawmakers through our government affairs office and online at piedmont.org.

SCHEDULE H, PART I, LINE 7(F)
PERCENT OF TOTAL EXPENSE THE DENOMINATOR USED FOR THE CALCULATION OF COLUMN (F), PERCENT OF TOTAL EXPENSE, WAS THE AMOUNT OF TOTAL FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A) OF $599,461,818, LESS BAD DEBT EXPENSE OF $32,986,650 FROM FORM 990, PART IX, LINE 24(B).

SCHEDULE H, PART I, LINE 7
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST A RATIO OF PATIENT CARE COST TO CHARGES, CONSISTENT WITH WORKSHEET 2, WAS USED TO REPORT THE AMOUNTS IN PART I, LINES 7A-7D. FOR AMOUNTS ON LINES 7E-7K, ACTUAL EXPENSES FOR EACH COMMUNITY BENEFIT ACTIVITY ARE TRACED AND REPORTED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM.

SCHEDULE H, PART III, LINES 2-4
BAD DEBT EXPENSE CALCULATION AND FOOTNOTE The provision for bad debts is based upon leadership's assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Periodically, leadership assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category. The results of the review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible receivables. THE AMOUNT REPORTED ON PART III, LINE 3, WAS DETERMINED BY TAKING THE AVERAGE ACCEPTANCE RATE FOR ALL CHARITY CARE APPLICATIONS RECEIVED DURING THE YEAR MULTIPLIED BY THE NUMBER OF DENIALS THAT WERE ATTRIBUTABLE TO INSUFFICIENT INFORMATION. THAT TOTAL WAS THEN ADJUSTED DOWNWARD FOR THE ORGANIZATION'S USE OF PRESUMPTIVE ELIGIBILITY WHEN DETERMINING ITS COMMUNITY BENEFITS. BAD DEBT EXPENSE FOOTNOTE FROM CONSOLIDATED, AUDITED FINANCIAL STATEMENTS: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBT TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PIEDMONT ATHENS REGIONAL MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE.

SCHEDULE H, PART III, LINE 8
MEDICARE SHORTFALLS AS COMMUNITY BENEFIT The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions by utilizing our allowable Medicare cost as reported in the Medicare cost report, which is based on a cost to charge ratio. However, the allowable costs in the Medicare cost report do not reflect the actual cost of providing care to patients since the Medicare cost report excludes many direct patient care costs that are essential to provide quality healthcare for Medicare patients. For example, certain coverage fees to physicians, cost of Medicare C and D, and other similar direct patient care expenses are specifically excluded from allowable cost in the Medicare Cost Report. IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health insurance, such as Medicare, is an indication we operate to promote health in the community. Our policy is to treat Medicare patients, regardless of the extent to which Medicare pays for the treatment. For many services, Medicare's reimbursement is less than the cost of the care provided, resulting in shortfalls that are to be absorbed by us in honor of our commitment to treat elderly patients. Many of these patients live on a low, fixed income, and would qualify for financial assistance or other means-tested programs, absent from their enrollment in Medicare.

SCHEDULE H, PART III, LINE 9(B)
COLLECTION PRACTICES INITIAL SCREENINGS OF ALL INPATIENT, EMERGENCY, AND SURGERY ENCOUNTERS, AS WELL AS MOST OUTPATIENT VISITS, ARE CONDUCTED BY FINANCIAL COUNSELORS IN ORDER TO IDENTIFY ANY AVAILABLE INSURANCE OR OTHER COVERAGE FOR EACH PATIENT. COUNSELORS CONTACT PATIENTS AND THEIR FAMILIES DIRECTLY, EITHER IN PERSON OR BY LETTER, TO ASSIST THE FAMILY IN IDENTIFYING ANY PROGRAMS

SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT
We are not required to file a community benefit report; however, we are required to file with the Georgia Department of Community Health information on our indigent and charity care, as well as our Medicaid and Medicare shortfalls.

SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT
As a designated 501(c)(3) nonprofit hospital, we are required by the Internal Revenue System to conduct a triennial community health needs assessment (CHNA), in accordance with regulations put forth by the IRS following the 2010 Patient Protection and Affordable Care Act (ACA). Through this assessment, we hope to better understand local health challenges, identify health trends in our community, determine gaps in the current health delivery system and craft a plan to address those gaps and the identified health needs. In FY22, we conducted our fourth triennial CHNA. FY22 also marked the third year of our FY19 Implementation Strategy. The CHNA was led by the Piedmont Healthcare community benefits team and consulting organization Public Goods Group, with input and direction from Piedmont leadership and Piedmont Healthcare's Department of External Affairs. Process The CHNA started with a definition of our community, which is our home county due to the impact of our tax-exempt status. Property taxes make up the largest segment of a hospital's tax exemption, which impacts county revenues. Because of this, we aim to ensure that we are providing ample benefit to our county and its residents. Additionally, we take into consideration patient origin, especially that of our lower-income patients such as those who qualify for financial assistance or receive insurance coverage through Medicaid. Our secondary communities are considered the areas in which we have the highest concentration of patients fitting that criterion, including ones from nearby communities. Once we established our primary and secondary communities, we then conducted an analysis of available public health data. This included resources from: US Census, US Health and Human Services' Community Health Status Indicators, US Department of Agriculture, Economic Research Service, National Center for Education Statistics, Kaiser Family Foundation's State Health Facts, American Heart Association, County Health Rankings and Georgia Online Analytical Statistical Information System (OASIS). All figures within the CHNA were for 2017, unless otherwise noted. Health indicators are estimates provided by County Health Rankings and hospital data were internally sourced. We then interviewed key stakeholders who have a particular expertise or knowledge of our communities. Specifically, we interviewed representatives of local and regional public health entities, minority populations, faith-based communities, local business owners, the philanthropic community, mental health agencies, elected officials and individuals representing our most vulnerable patients. An internal survey was also conducted throughout the healthcare system for both clinical and non-clinical employees. Information was gathered on knowledge and understanding of community benefit and current programs, as well as suggestions for how we can better serve our patients and communities. Approximately 1,053 employees spanning the system responded. Additionally, we conducted a community-based survey that was widely advertised to the community. Once both qualitative and quantitative data was gathered, we authored the preliminary report, which was then vetted and reviewed by hospital and health system leadership. In this report, we identified several key community health needs that emerged during the assessment process. The chosen priorities were recommended by the community benefit department with sign-off from hospital and board leadership. The following criteria were used to establish the priorities: - The number of persons affected; - The seriousness of the issue; - Whether the health need particularly affected persons living in poverty or reflected health disparities; and, - Availability of community and/or hospital resources to address the need. All priorities are viewed through the lens of health disparities, with particular attention paid to improving outcomes for those most vulnerable due to income and race. The priorities we chose reflected a collective agreement on what hospital leadership, staff and the community felt was most important and within our ability to positively impact the issue. Once priorities were approved by the board of directors, we then authored the CHNA and presented our findings and recommendations to the hospital's board of directors for their input and approval. Our priorities A key component of the CHNA is to identify the top health priorities we will address over fiscal years 2023, 2024, and 2025. These priorities will guide our community benefit work. They are, in no order: - Ensure affordable access to health, mental, and dental care - Reduce preventable instances of and deaths from cancer - Promote healthy behaviors to reduce preventable conditions, diseases, and addiction - Reduce preventable instances of and deaths from heart disease With each priority, we work to achieve greater health equity by reducing the impact of poverty and other socioeconomic indicators. This means that health equity is built into each priority, which is demonstrated through our implementation strategies. Our subsequent implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities in our FY22 community health needs assessment. The implementation strategy was designed to be executed over a three-year period and included specific metrics by which we would be able to evaluate our work and its impact. The implementation strategy was developed by utilizing community feedback from the assessment in partnership with the system community benefits department, our leadership, and our board of directors. We included proven and successful interventions and programming, investing further in work we felt was successful in addressing unmet health needs.

SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY
We understand that not everyone can pay their hospital bill due to their insurance status or a limited income, and because of this, we offer financial assistance to qualifying patients. Notification about financial assistance includes, but is not limited to, a dedicated contact number, notices in patient bills, and posted notices in key areas of the hospital. These locations are the emergency room, admitting and registration departments, our business office, and patient financial services offices that are located on site. We also publish and widely publicize a plain language summary of this financial assistance care policy on our website, as well as the full policy. Referral of patients for financial assistance may be made by any staff or medical staff member at the hospital, including physicians, nurses, financial counselors, social workers, case managers, chaplains, and religious sponsors. A request for financial assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. Additionally, we provide copies of our financial assistance policy to our partner clinics and others who work closely with low-income populations. We help our partners in understanding the policy, how it relates to their populations, and receive feedback in ways our financial assistance programming could be improved.

SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH
We actively promote the health of our community through clinic-hospital partnerships, community-based health screenings, educational activities, community-building activities, the operation of a 24-hour emergency department available to the entire community, the operation of an emergency room open to all members of the community without regard to ability to pay, a governance board composed of community members, use of surplus revenue for facilities improvement, patient care, and medical training, education, and research, the provision of inpatient hospital care for all persons in the community able to pay, including those covered by Medicare and Medicaid, and an open medical staff with privileges available to all qualifying physicians. It's important to note that COVID-19 continued to have a significant impact on our proactive community benefit programs. We have maintained some programming responsive to the pandemic, including our migration to online platforms for vital community-based programming. We prioritized increasing access points for affordable health and mental care by providing free-of-charge lab services to partner clinic Mercy Health Center. We provided $28,933 in lab services to Mercy Health Center. We provided $1.8 million in funding to the Community Care Clinic to provide specialty services to all patients, particularly low-income, high-need patients. Additionally, we supported education to build the health workforce. We provided $250,000 to Athens Technical College to support supporting education for 75 residents and 1,158 students and interns whose specialties included nursing, physician assistants, pharmacy, respiratory, rehabilitation, social work, paramedic, surg/tech, and radiology. We also provided free parking to patients who qualify for financial assistance or Medicaid and receive, which totaled $697,316 in FY22. We provided funding for support prescription access for low-income patients at our charitable clinic partners. This included providing for a pharmacist ($102,000) and a pharmacy buyer ($40,000) at the Community Care Clinic, and an additional $36,000 provided for pharmaceutical support to Mercy Health Center. We also provided place-based prevention education, chronic disease management education, screenings, and health and social services referrals. The total costs for health education supplies totaled $893 to conduct 137 in-person education sessions with 2,502 participants; 515 participants in the online platforms; phone coaching for 782 heart failure patients post-discharge; 13 self-study programs offered to local night shift workers with 88 participants; and two email coaching programs offered to 59 local night shift workers. We continued to provide stroke awareness educational materials and blood pressure screenings at health fairs and community events to achieve and maintain stroke certification. In FY22, we provided comprehensive, evidence-based psychosocial support for cancer patients and their families, spending $28,000 to assist 2,260 community members dealing with cancer. We also provided an additional $14,361 in prescription assistance, as well as nearly $2,000 to support transportation to radiation for patients. We also increased local awareness of and local opportunities for lung cancer screening. In November, we held a Lung Screen Day to screen Community Care Clinic patients who meet necessary criteria and uninsured status. Eleven exams were completed at a cost of $3,300. All 11 were referred to appropriate follow-up care and screenings. We prioritized promoting healthy weight and behavior to prevent diseases by offering family programs to instill healthy behavior changes, which totaled $950 with 132 family encounters. We also provided ongoing education, training, and support for community members on weight management. We canceled most programs related to weight management due to COVID-19, though YMCA provided 291 phone coaching sessions, with our support.

SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION
While Piedmont Athens serves patients from all over northeast Georgia, we consider our community to be Athens-Clarke County. We do this in consideration of our relationship with the Hospital Authority of Clarke County and in recognition of the direct impact of our tax-exempt status on county residents. In Athens-Clarke County, an average 126,176 people lived in the 119.22 square mile area each year between 2015 and 2019.The population density for this area, estimated at 1,058.36 persons per square mile, is greater than the national average population density of 91.93 persons per square mile. Athens-Clarke is almost entirely urban -- 94 percent of community members live within an urban setting. The median age of people living within the county was 28, much lower than state and national averages. About 17 percent of the population were 18 or younger, 11 percent were over the age of 65, and 72 percent were between ages of 18-64. Ten percent identified as being born outside of the US and seven percent do not possess US citizenship status. The Hispanic population within the community is growing, and now represents approximately 11 percent of the community. About 4.41 percent of county residents were veterans in 2020, with the highest concentration living in the ZIP code 30622 (Bogart). The majority are between the ages of 25 and 64. Nearly 12 percent of the county population lived with a disability in 2020, and most were over the age of 65. In Athens-Clarke County, black populations were more likely to be disabled than any other race. In 2020, more than 13 percent of the county's population was uninsured. Being uninsured is generally a marker of low income, and the overwhelming majority. Adults aged 18 to 64 are most likely to be uninsured, and that's true in Athens-Clarke County. In 2020, 19.4 percent of the population was uninsured. The majority of those that were uninsured lived in the northern part of the county, and minorities were much more likely to be uninsured. According to the 2015-2019 American Community Survey, of the 106,427 working age population, 64,813 are included in the labor force. The labor force participation rate is 60.90 percent. Total unemployment in the county in January 2022 equaled 1,975, or 3.2 percent of the civilian non-institutionalized population age 16 and older. Of the 48,844 total occupied households in Athens-Clarke County, 20,299 -- about 42 percent -- of the population live in cost burdened households, in which housing costs are 30 percent or more of total household income. Eighty percent of these households were occupied by renters. Approximately 23 percent of households had costs that exceeded 50 percent of the household income, which places the household in significant financial strain. In Athens-Clarke County, in 2019, 13 of the county's 17 census tracts were food deserts. About 52,000 people lived within these census tracts. These tracts almost directly correspond with census tracts demonstrating retailers who are authorized to take SNAP benefits. In Athens-Clarke County, like in most of the state, those retailers tend to be convenience and discount stores that carry limited, if any, healthy foods. Low food access is defined as living more than 0.5 mile from the nearest supermarket, supercenter, or large grocery store. This indicator is relevant because it highlights populations and geographies facing food insecurity. According to the 2021 Food Access Research Atlas database, 40 percent of the total population in the county have low food access, meaning about 46,700 county residents may struggle to access healthy foods. In Athens-Clarke County, in 2020, 13.46 percent of the population were uninsured, a figure in the middle of state and national rates, which were 16 percent and 8.84 percent, respectively. When looking only at adults aged 18-64, the uninsured rate jumps to nearly 20 percent. Uninsured populations are statistically far less likely to have a primary care physician, receive specialty care and maintain control of chronic conditions. In 2019, only 75.2 percent of adults aged 18 or older saw a doctor for a routine check-up the previous year, a measure that is likely over-reported and is lower than both state and national averages. For Medicare recipients, this number jumps to 88.13 percent of adult beneficiaries, which is above both state and national averages. Routine check-ups are a critical component to maintaining good health and identifying conditions that can be treated affordably in a community-based setting. Absent that, even simple-to-treat conditions can escalate to deeper issues, eventually requiring more intensive care, later stage diagnoses, or reduced life expectancy. Heart disease is the leading cause of death for both women and men in Athens-Clarke County, with a disproportionate impact on black populations. In 2020, the age-adjusted death rate was 233.6 deaths for every 100,000 people, an increase since our last CHNA, when the date rate was 221.4 deaths per every 100,000 people. There are similar disparities when looking at other areas of heart and cerebrovascular disease deaths. For example, in 2020, the death rate for stroke for African Americans was 87.3 per every 100,000 people, as compared to the death rate for whites, which was 33.8 per every 100,000 people. The hospitalization rates for heart disease and stroke among Medicare recipients have steadily decreased over the last five years. The cardiovascular disease hospitalization rate in 2018 was 10.9 hospitalizations per every 1,000 Medicare beneficiaries, which is below the state and national rates of 12.2 and 11.8, respectively. The hospitalization rate for stroke, though, is above state and national rates, with 9.7 hospitalizations per every 1,000 Medicare beneficiaries versus the state rate of 9.3 and the national rate of 8.4. Although heart disease leads in county deaths, cancer remains a critical issue within the community. When broken down by cancer site, though, the breast cancer incidence rate is much higher than state and national rates, which are 128.4 and 126.8 diagnoses per every 100,000 people, on average each year. Other diagnosed cancer sites are below state and national averages. In 2019, 8,150 of adults aged 20 and older had diabetes, equaling 7.7 percent of the county's population, which was lower than the state rate of 9.8 percent. Diabetes is a prevalent problem in the US, often indicating an unhealthy lifestyle and puts individuals at risk for further health issues. This figure has steadily increased year over year. Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. Kidneys filter wastes and excess fluids from your blood, which are then removed in your urine. Advanced chronic kidney disease can cause dangerous levels of fluid, electrolytes, and wastes to build up in your body. In 2019, 3 percent of the county's population had a diagnosis of kidney disease, a rate better than the state and national percentages of 3.22 percent and 3.1 percent, respectively. In 2019, 33.9 percent of adults 18 and older reported having high cholesterol of the total population. Too much cholesterol puts you at risk for heart disease and stroke, two of the main causes of death within the county. In 2019, 36.2 percent of adults 18 and older had a diagnosis of high blood pressure. High blood pressure can damage your arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease.

SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM
We are part of Piedmont Healthcare, a regional not-for-profit organization, and the parent company of 19 hospitals, the Piedmont Physicians Group, the Piedmont Heart Institute, the Piedmont Clinic and the Piedmont Healthcare Foundation. Our community relations team works directly with the community. Our community benefit department oversees the community benefit activities on behalf of all hospitals throughout the system, and this includes conducting the triennial CHNA and subsequent implementation strategy, ensuring the financial assistance policy is communicated to the community, maintaining the community benefit webpage, authoring the community benefit annual report, preparing board materials, developing and executing the community benefit grants program and compiling all community benefit figures. Each hospital and certain departments of Piedmont Healthcare execute community benefit programming, such as our revenue department, which oversees the financial assistance program.