4A (Expenses $ 266018549 including grants of $ 0) (Revenue $ 289833328)
PIEDMONT MACON HOSPITAL, INC. IS A 310-BED FACILITY LOCATED IN THE CITY OF MACON IN BIBB COUNTY, GEORGIA. OUR PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN MACON AND THE SURROUNDING MIDDLE GEORGIA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2022, THE HOSPITAL HAD 10,715 IN-PATIENT ADMISSIONS WITH A TOTAL OF 57,975 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 35,705 AND OUTPAITENT VISITS TOTALED 26,225. SURGICAL SERVICES WERE PROVIDED TO 4,510 PATIENTS.

SCHEDULE H, PART V, SECTION B, LINES 1 AND 2: NEW HOSPITAL ENTITY
"Piedmont Macon Hospital, Inc. (""PMM"") was created as a new entity on May 24, 2021 and is the 501(c)(3) tax-exempt parent of Coliseum Medical Center LLC, a disregarded entity, which was acquired from HCA Healthcare, a for-profit company. Piedmont filed the PMM Form 1023 application for recognition of exemption under Section 501(c)(3) of the Internal Revenue Code on July 27, 2021, and received its IRS Determination Letter reflecting PMM's status as a 501(c)(3) organization with public charity status 170(b)(1)(A)(iii) on March 21, 2022. The IRS 501(c)(3) status per the Determination Letter is retroactive with an effective date of exemption of May 24, 2021. SCHEDULE H, PART V, SECTION B, 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 MACON-BIBB COUNTY 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, SECTION B, LINE 6A: COMMUNITY HEALTH NEEDS ASSESSMENT
THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED FOR BOTH PIEDMONT MACON HOSPITAL, INC. (EIN: 87-1006981) AND PIEDMONT MACON NORTH HOSPITAL, INC. (EIN: 87-1031034).

SCHEDULE H, PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT
https://www.piedmont.org/media/file/Community-Benefit-Needs-Assessment-PMM .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 MACON 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 MACON HOSPITAL APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE-YEAR PERIOD BEGINNING WITH FY23 ON SEPTEMBER 26, 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-PMM.pdf

SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS
DURING FY22, PIEDMONT MACON 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 MACON 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 MACON 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 HEALTHY BEHAVIORS TO REDUCE PREVENTABLE CONDITIONS, DISEASES, AND ADDICTION, AND (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 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 $293,277,729, LESS BAD DEBT EXPENSE OF $86,324,380 FROM FORM 990, PART IX, LINE 24(A). 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 DOUBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYER 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. PMAH 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 PATIENTS 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. WE BELIEVE OUR MEDICARE SHORTFALL REPORTED ON PART III, LINE 7 OF SCHEDULE H, SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO ELDERLY AND MEDICARE PATIENTS. 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 Macon serves patients from all over middle Georgia, for purposes of this CHNA, we consider our community to be Macon-Bibb County. We do this in recognition of the direct impact of our tax-exempt status on county residents. In Macon-Bibb County, in 2020, 153,200 people lived in the 249 square mile area. The population density for this area, estimated at 614 persons per square mile, is much greater than the state average population density of 181 people per square mile and the average national population density of 92 persons per square mile. The ZIP code with the highest concentration of people was 31210, where 22 percent of the county's population lived. Macon-Bibb County is mostly urban, as 86 percent of community members live within an urban setting. The ZIP code with the highest concentration of the rural population was 31066 and, like in most of Georgia, rural populations in Macon-Bibb are overwhelmingly white. About 8 percent of the population were veterans in 2020, and the majority were aged 65 and older. Sixteen percent of the population - about 23,500 people - lived with a disability. Most of that population was between the ages of 18 and 64. About 25 percent of the population were 17 or younger, 15.7 percent were over the age of 65, and the remaining population were between the ages of 18-64. Between 2015 and 2019, about 38 percent of all Macon-Bibb County residents were white, 54 percent were African American, 3.25 percent were Hispanic/Latino, 2 percent were Asian, and the remaining 3 percent were comprised of other races. About 3.33 percent identified as being born outside of the US and 1.55 percent of the total population does not have citizenship status. In 2020, 13 percent of the population had no form of insurance. Insurance status and health are inextricably linked. Adults aged 18 to 64 are most likely to be uninsured. In 2020, 19.33 percent of non-elderly adults were uninsured, as compared to 5.6 percent of those under age 18 and 1 percent for those 65 and older. As with other indicators, race matters. Approximately 33 percent of Hispanic/Latino populations were uninsured, 15.6 percent of blacks were uninsured, and 13 percent of whites were uninsured. Between 2015 and 2019, the median household income was $41,334, which is much lower than state and national levels, which are $58,700 and $62,843, respectively. When broken down by the four dominant races in the community, income disparities are evident. Of employers in the community, the largest sector by employment size is health care and social assistance, which employed 19,016 community members at an average annual wage of $59,121 in 2019, according to the US Department of Commerce. Retail trade was the second largest sector, with 12,013 people employed at an average annual wage of $32,290. Finance and insurance were the third largest sector, with 11,764 people employed at an average annual wage of $59,634. According to the 2015-2019 American Community Survey, 68,412 people in the community were part of the labor force, and only 57 percent participated. Approximately 4 percent of the population were unemployed as of March 2022, a rate higher than state and national averages. This figure has steadily decreased since last year, when in March 2021, 5.6 percent of the labor force was unemployed. When looking back further, the rate is nearly three times less than the unemployment rate in 2012. In 2020, 25 percent of the county lived at or below the Federal Poverty Level (FPL), a startlingly high number. By far, the poorest ZIP code within Macon-Bibb County is 31201, where 43 percent of the population lived in poverty in 2020. In Macon-Bibb County, like most of the state, minorities are more likely to live in poverty. For example, in 2020, 34 percent of blacks and 37 percent of Hispanic/Latino populations lived at or below poverty, as compared to 12 percent of whites. In Macon-Bibb County, nearly 20 percent of households received SNAP benefits in December 2020, representing about 11,500 households. Black populations are far more likely to receive SNAP benefits than any other demographic. Only 6 percent of SNAP beneficiaries are white, and the remaining 94 percent are minority households. The ZIP code with the highest amount of SNAP recipients was 31206, where more than a third of residents received SNAP benefits. Of the 58,116 total occupied households in Macon-Bibb County in 2019, about 34 percent lived in cost burdened households, in which housing costs are 30 percent or more of total household income. Approximately 17 percent of households had costs that exceeded 50 percent of the household income, which places the household in significant financial strain. In Macon-Bibb County, in 2019, 15 of the county's 44 census tracts were food deserts, as shown in the map to the right. About 47,059 people lived within these census tracts. These tracts almost directly correspond with census tracts demonstrating retailers who are authorized to take SNAP benefits. In Macon-Bibb County, like with 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, nearly a third of the total population in the county have low food access, meaning about 50,000 county residents may struggle to access healthy foods. This is worse than the state and national rates of 30.89 percent and 22.22 percent, respectively. ZIP code 31066 has the worst rate of low food access at 81 percent. In 2019, about 80 percent of adults aged 18 or older saw a doctor for a routine check-up the previous year, a measure that is slightly higher than both state and national averages. For Medicare recipients, this number jumps to 87 percent of adult beneficiaries, which is above both state and national averages. Heart disease is a leading cause of death for both women and men in Macon-Bibb County. In 2020, the age-adjusted death rate was 273 deaths for every 100,000 people, which is far worse than both state and national rates, which were 72.4 and 91.5 heart-related deaths per 100,000 people, respectively. Between 2016 and 2020, there were 393 deaths due to stroke, representing an age-adjusted death rate of 44 deaths per every 100,000 people. Men are more likely to die from stroke than women, as are black populations. 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 16 hospitalizations per every 1,000 Medicare beneficiaries, which is higher than the state and national rates of 12.2 and 11.8, respectively. The hospitalization rate for stroke, though, is on par with state and national rates, with 8.9 hospitalizations per every 1,000 Medicare beneficiaries, as compared to 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. The cancer incidence rate for Macon-Bibb County each year, on average between 2014 and 2018, was 496.5 per every 100,000, which equates to a diagnosis rate of an average 879 new cases each year. In 2019, 13 percent of adults aged 20 and older had diabetes, which is 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. Diabetes itself is often a killer, and leads in causes of deaths for minorities, particularly Hispanic/Latino populations. In 2019, 4 percent of the county's population had a diagnosis of kidney disease, a rate worse than the state and national percentages of 3.22 percent and 3.1 percent, respectively. In 2019, 33.3 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, 27.7 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 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.

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 1,050 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; and, - 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 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.