4A (Expenses $ 199308453 including grants of $ 0) (Revenue $ 224368593)
"PIEDMONT ROCKDALE HOSPITAL (""PRH"") IS A 161-BED, NON-PROFIT HOSPITAL LOCATED IN THE CITY OF CONYERS IN ROCKDALE COUNTY, GEORGIA. OVER 250 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN ROCKDALE COUNTY AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2022, THE HOSPITAL HAD 9,905 IN-PATIENT ADMISSIONS WITH A TOTAL OF 51,464 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 44,153 AND OUTPATIENT VISITS TOTALED 55,928. SURGICAL SERVICES WERE PROVIDED TO 4,910 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 7 STAKEHOLDERS WITHIN THE PIEDMONT ROCKDALE 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-PRH .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 ROCKDALE HOSPITAL 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 ROCKDALE HOSPITAL APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE-YEAR PERIOD BEGINNING WITH FY23 ON OCTOBER 20, 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-PRH.pdf

SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS
DURING FY22, PIEDMONT ROCKDALE HOSPITAL 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 ROCKDALE HOSPITAL 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 ROCKDALE HOSPITAL 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 HEALTH 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
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 PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT 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 $234,137,012, LESS BAD DEBT EXPENSE OF $21,880,441 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. PRH 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 FOR WHICH THE PATIENT/SERVICE MAY QUALIFY (INCLUDING MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM (""SCHIP""), PRIVATE OR GOVERNMENT INSURANCE COVERAGE, AND CHARITY ASSISTANCE). IF THE FAMILY CANNOT BE TIMELY LOCATED OR IS UNCOOPERATIVE, RELATED ACCOUNTS ARE TRANSFERRED TO AN INTERNAL COLLECTION DEPARTMENT FOR FURTHER ATTEMPTS TO OBTAIN PAYMENT OR, IF THE PATIENT MAY QUALIFY FOR ASSISTANCE, TO SECURE A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION'S DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF A PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY."

SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION
While Piedmont Rockdale serves patients from all over northeast Georgia, we consider our community to be Rockdale County. We do this in recognition of the direct impact of our tax-exempt status on county residents. In Rockdale County, 90,155 people lived in the 129.82 square mile area in 2020. The population density for this area, estimated at 694 persons per square mile, is much greater than the state average population density of 182 persons per square mile. Rockdale County is mostly urban, as 85 percent lived in an urban setting in 2020, and ZIP code 30294 had the highest concentration of urban dwellers. The median age of people living within the county was 39, a little older than state and national averages. About a quarter of the population were 18 or younger, 14 percent were over the age of 65, and the rest were between ages of 18-64. Ten percent of the population identified as being born outside of the US and four percent of the total population do not possess US citizenship status. About ten percent of county residents were veterans in 2020, with the highest concentration living in the ZIP code 30094 (Conyers). The majority were between the ages of 35 and 54. About 11 percent of the county population lived with a disability in 2020, and most were over the age of 65. The community is growing, and about 8,355 people moved into Rockdale County between 2010 and 2020, representing ten percent growth. With this growth comes increased diversity, as white populations decreased and all other race and ethnicities increased. Specifically, there was a 30 percent decrease in white populations, a 38 percent increase in black or African American populations, a 3 percent increase in Asian populations, and an 18 percent increase in Hispanic or Latino populations. In 2020, nearly 14 percent of the county's population was uninsured. Being uninsured is generally a marker of low income, and the overwhelming majority of those that are uninsured are also within certain ranges of the Federal Poverty Level (FPL). This means these populations are also likely to face the myriad of other social determinants of health (SDH), like housing and food insecurity. Adults aged 18 to 64 are most likely to be uninsured, and that's true in Rockdale County. In 2020, 19 percent of the population was uninsured. Minorities were much more likely to be uninsured. Additionally, nearly 22 percent of the county's population were covered through Medicaid, the state-federal public health insurance program for low-income children and adults. The highest concentration of Medicaid beneficiaries was in ZIP code 30058 (Lithonia), where 31 percent of the population received Medicaid benefits in 2020. Most of these recipients were low-income children. In 2020, the median household income was $62,505, which is between the state and national median incomes, which are $61,224 and $64,994, respectively. When broken down by the four dominant races in the community, income disparities are evident among Hispanic/Latino populations. Of employers in the community, in 2020, the largest sector by employment size was retail trade, which employed 5,845 people at an average wage of $30,422. Health care and social assistance was the next largest sector, employing 5,120 people at an average wage of $49,831. Government and government enterprises was the third largest sector, employing 4,809 people at an average wage of $63,853. In 2020, of the 70,582 working age population, 44,123 were included in the labor force, and the labor force participation rate was 62.51 percent. Total unemployment in the county in April 2022 equaled 1,429, or 3.8 percent of the civilian non-institutionalized population age 16 and older. In Rockdale County, nearly 3,870 households received SNAP benefits in December 2020, representing 12.31 percent of the total population. The median income of a household receiving SNAP benefits was $33,348, though there is variation among ZIP codes. Of the 32,094 total occupied households in Rockdale County, 8,311 -- about 32 percent -- of the population lived in cost burdened households in 2020, meaning their housing costs are 30 percent or more of total household income. Forty-seven percent were occupied by renters. Approximately 13 percent of households had costs that exceeded 50 percent of the household income, which places the household in significant financial strain. The county has a food insecurity rate of 16.2 percent, as about 14,350 community members were unsure as to how they will access adequate food at some point over the last year. Unfortunately, many of these community members are ineligible for public assistance via SNAP, WIC (Special Supplemental Nutrition Program for Women, Infants and Children), free or reduced cost school meals, the Commodity Supplemental Food Program (CSFP), or The Emergency Food Assistance Program (TEFAP). In 2020, of the 4,520 food insecure children in the county, only 30 percent were ineligible for public assistance programs. 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 33,760 county residents may struggle to access healthy foods. In Rockdale County, in 2020, 14 percent of the population were uninsured, a figure between state and national rates, which were 16 percent and 8.84 percent, respectively. When looking only at adults aged 18-64, the uninsured rate increased to more than 19 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, 80 percent of adults aged 18 or older saw a doctor for a routine check-up the previous year, a measure that is on par with both state and national averages. For Medicare recipients, this number increases to 83 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 in Rockdale County. Between 2016 and 2020, the age-adjusted death rate was 163.6 deaths for every 100,000 people, which is better than both state and national averages, and is a rate that has steadily decreased over the last ten years. Broken down by ZIP code, we see higher death rates in ZIP code 30281, which could indicate higher rates of poverty and higher rates of uninsurance. We see similar trends with stroke deaths. Between 2016 and 2020, there were 204 deaths due to stroke, resulting in an age-adjusted death rate of 43.5 deaths per every 100,000 people. This is worse than the state and national rates of 43.2 and 37.6 deaths, respectively. Like with heart disease, we see higher rates of stroke death in community members living in ZIP code 30281. The hospitalization rates for heart disease and stroke among Medicare recipients have steadily decreased over the last five years, though they are still high. The cardiovascular disease hospitalization rate in 2018 was 10.9 hospitalizations per every 1,000 Medicare beneficiaries, which is better than the state and national rates of 12.2 and 11.8, respectively. The hospitalization rate for stroke is on par with state and national rates, at 9.3 hospitalizations per every 1,000 Medicare beneficiaries, versus the state rate of 9.3 and the national rate of 8.4. In 2019, 7,790 of the county's adults aged 20 and older had diabetes, equaling 10.3 percent of the county's population, which was higher 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. In 2019, 3.6 percent of the county's population had a diagnosis of kidney disease, a rate higher than the state and national percentages of 3.22 percent and 3.1 percent, respectively. That same year, 34 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, 42 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 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, 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 still significantly impacts our proactive community benefit programs. While we have created programming responsive to the pandemic, including our migration to online platforms for vital community-based programming, many activities remain on hold. In FY22, we worked to ensure patients at not-for-profit charitable clinic Mercy Heart have access to necessary health care. Many staff members volunteer time at the clinic. Additionally, hospital leadership and Mercy Heart leadership are in frequent communication to ensure strong working relationships. This includes the supplying of access to Epic for patient health records and hospital staff-led educational courses to patients at Mercy Heart. An example of our courses in action was our diabetes educator donating time to teach healthy eating to diabetes patients at Mercy Heart. We created a patient and family advisory council to provide meaningful input on critical areas of care. Despite challenges faced by COVID-19, we met quarterly by WebEx and created ways to enhance communication with patients, family members, and the care team when needing to limit or restrict visitors. We purchased iPads for the Patient Experience Team to help allow the parties to communicate via facetime. Our commitment to combating substance abuse further expands through our role in the Stepping Up Initiative, which seeks to reduce the number of people in jails with mental health and substance use challenges. Through this, there is an effort to create a facility to house patients who do not belong in jail and do not belong in the hospital, until they can find an adequate housing and treatment location for them. We also donated hospital beds to this facility, with an estimated value of $60,000. In partnership with the Kim Atkins Foundation, we gave vouchers to women for all testing and diagnostic services, up to the diagnosis of breast cancer. Approximately 29 people used this service in FY21. Although the Kim Atkins Foundation disbanded in March 2022, the group gave us $75,000 and thus the ability to establish a fund. Through this fund, we continued to provide these services to underserved and/or underinsured women. We reduced cultural barriers to cancer prevention and education for the Hispanic/Latino community. One way this was achieved was through the promotion of our Spanish-speaking providers, including participating in events sponsored by the Latino Association. Spanish-speaking staff and providers also attended health fairs, where screenings were completed. Furthermore, we had English reading materials translated into Spanish; from signage to patient forms to results. We made promoting healthy weight and behaviors to decrease preventable instances of heart disease and diabetes a priority by building and engaging community-based partnerships to identify and eliminate potential barriers to healthy weight and behaviors. We encouraged and promoted events in the community for physical activity and being outside and social in a fun way by being a founding member of the collaborative group known as the Live Well Rockdale effort. The group held monthly Webex meetings with businesses and community members to promote healthy eating and an active lifestyle. We are also aware of the role food security plays in healthy eating. In FY22, we hosted a farmer's market for hospital staff, patients, and visitors. Food banks were also made readily available throughout the community. To further support a healthy eating campaign, we promoted classes hosted by the extension office, such as ""Eating a Rainbow"", Growing a Garden, Canning, Healthy Snacks, Children's Cooking Time, and others. The support of education is an area of immense engagement for us. In FY22, we donated hospital beds to Georgia Piedmont Technical College at an estimated value of $60,000; and to Rockdale Career Academy at an estimated value of $40,000. Additionally, we donated crash carts to Rockdale Career Academy, at an estimated value of $3,000. Beyond donations, talks were given to Leadership Rockdale school children, and press releases were submitted to the newspaper. Employees held drives to donate items to the community, coat drive, school supply drive, book drive and clothing drive. Additionally, we donated office furniture to UNIDOS Latino Association, Kim Atkins Foundation, Hills Academy Boys Prep School, Mercy Heart, and Rockdale Career Academy."

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.