4A (Expenses $ 367673196 including grants of $ 847810) (Revenue $ 460638489)
YAVAPAI COMMUNITY HOSPITAL ASSOCIATION DBA YAVAPAI REGIONAL MEDICAL CENTER (YRMC) IS HONORED TO SERVE THE ENTIRE COMMUNITY OF WESTERN YAVAPAI COUNTY. WE CARE FOR PEOPLE LIVING IN OUR REGION THROUGH HIGH QUALITY INPATIENT AND OUTPATIENT SERVICES AS WELL AS A WIDE RANGE OF VALUABLE COMMUNITY OUTREACH AND HEALTH EDUCATION PROGRAMS. YRMC SERVES THE HEALTHCARE NEEDS OF PEOPLE OF ALL AGES AND FROM ALL WALKS OF LIFE. WE'RE PLEASED TO MEET THOSE NEEDS 24 HOURS A DAY, 365 DAYS A YEAR.YRMC HAS TWO HOSPITALS; ONE IN PRESCOTT, YRMC WEST, AND ONE IN PRESCOTT VALLEY, YRMC EAST. BETWEEN JUNE 2021 AND JULY 2022, YRMC EMBRACED ITS NOT-FOR-PROFIT MISSION BY INVESTING IN COMMUNITY BENEFIT FOR THE PEOPLE OF WESTERN YAVAPAI COUNTY. THIS INCLUDES DIRECT HEALTHCARE SERVICES AS WELL AS PROGRAMS THAT IMPROVE HEALTH AND PREVENT ILLNESS. DURING THIS TIME PERIOD, YRMC SERVED MANY RESIDENTS IN OUR SERVICE AREA THROUGH OUR COMMUNITY BENEFIT AND HEALTH EDUCATION EFFORTS. IN SPITE OF THE CHALLENGES PRESENTED BY COVID-19 YRMC WAS STILL ABLE TO PROVIDE 8 COMMUNITY PRESENTATIONS ON HEALTH TOPICS WITH THE HELP OF VIDEO FOR REMOTE PROGRAMS PEOPLE COULD VIEW FROM THEIR HOMES. THERE WERE 1,076 VERIFIED VIEWS OF OUR HEALTHY CONVERSATIONS PRESENTATIONS AND VIDEOS IN FISCAL YEAR 2022.YRMC ALSO OFFERS A PATIENT ASSISTANCE PROGRAM TO HELP PEOPLE WHO HAVE NO INSURANCE OR WHO HAVE LIMITED INSURANCE COVERAGE.FISCAL YEAR 2022 WAS ANOTHER YEAR OF PROVIDING PERSONALIZED CARE TO MANY THOUSANDS OF PEOPLE. FOR EXAMPLE, 959 BABIES WERE BORN BETWEEN JUNE 2021 AND JULY 2022 AT YRMC'S OBSTETRICS DEPARTMENT. BIRTHING AND BREASTFEEDING CLASSES HOSTED 140 EXPECTANT PARENTS WITH MOST OF THEM PARTICIPATING ONLINE DURING THIS SAME TIME FRAME.YRMC PROVIDES FAMILY RESOURCE CENTER SERVICES THAT INCLUDE FREE PARENTING EDUCATION, COUNSELING SERVICES AND COORDINATION WITH OTHER COMMUNITY RESOURCES THAT CAN HELP SUPPORT YOUNG FAMILIES IN NEED. THESE PROGRAMS FOCUS ON ELIMINATING CHILD ABUSE AND NEGLECT AMONG PARTICIPATING FAMILIES. THESE PROGRAMS HAVE ALSO PROVIDED BASIC NECESSITIES FOR NEW FAMILIES SUCH AS BABY FORMULA AND DIAPERS. THE FAMILY RESOURCE CENTER PROVIDED PARENTS WITH 1,653 VISITS ON HOW TO CARE FOR THEIR CHILDREN BETWEEN JUNE 2021 AND JULY 2022. WITH THE COVID-19 RESTRICTIONS NEW TELEHEALTH OPTIONS MADE IT POSSIBLE TO NEARLY DOUBLE THE NUMBER OF VISITS FROM THE PRIOR YEAR. THIS IS ANOTHER EXAMPLE OF HOW YRMC WAS ABLE TO ADAPT TO THE UNIQUE CHALLENGES OF COVID-19.YRMC ALSO OFFERS THE PARTNERS FOR HEALTHY STUDENTS PROGRAM, ANOTHER EFFORT TO FILL GAPS IN THE NATIONAL POLICY REGARDING THE PROVISION OF HEALTHCARE SERVICES FOR THE UNDERSERVED. THIS IS A SCHOOL-BASED HEALTH PROGRAM FOR CHILDREN WHO ARE UNINSURED OR UNDERINSURED. THE PROGRAM IS LED BY TWO PEDIATRIC NURSE PRACTITIONERS (PNPS) WHO WORK IN CONJUNCTION WITH A LOCAL PEDIATRICIAN. SCHOOL-AGE CHILDREN AND THEIR YOUNGER SIBLINGS ARE DIAGNOSED AND TREATED FOR A WIDE VARIETY OF HEALTH PROBLEMS. A SPECIALLY-EQUIPPED MEDICAL VAN IS SENT TO LOCAL SCHOOLS. THE PNPS ALSO WORK COLLABORATIVELY WITH DENTISTS TO GET THESE CHILDREN THE HELP THEY NEED FOR DENTAL PROBLEMS.IN FISCAL YEAR 2022, 736 STUDENTS RECEIVED FREE HEALTHCARE SERVICES THROUGH PARTNERS FOR HEALTHY STUDENTS. YRMC IS PROUD TO PROVIDE THESE SERVICES AT NO CHARGE FOR THOSE IN NEED.YRMC'S POPULAR GO NOODLE ONLINE FITNESS PROGRAM FOR AREA SCHOOLS AND FAMILIES CONTINUED THROUGH FISCAL YEAR 2022. THIS FREE PROGRAM SERVED 800 FAMLIES WITH 26,000 MINUTES OF GO NOODLE FUN EXERCISES AT HOME. IN ADDITION, YRMC PROVIDED MORE THAN 312 MEALS FOR A LOCAL HOUSING SHELTER DURING FISCAL YEAR 2022. YRMC ALSO HELPED FINANCIALLY SUPPORT THE HUNGRY KIDS PROGRAM TO FEED CHILDREN FROM UNDERSERVED HOMES YEAR-ROUND.THE JAMES FAMILY HEART CENTER AT YRMC PERFORMS HUNDREDS OF CARDIAC AND THORACIC CASES AND HAS ALSO PERFECTED A BLOOD MANAGEMENT PROGRAM WHICH GREATLY BENEFITS PATIENTS. IN FISCAL YEAR 2022, YRMC PROVIDED 141 OPEN HEART AND THORACIC SURGERIES. IN ADDITION, 3,775 CARDIAC CATHETERIZATION, ELECTROPHYSIOLOGY, INTERVENTIONAL CARDIOLOGY AND INTERVENTIONAL RADIOLOGY PROCEDURES WERE PROVIDED. YRMC SURGEONS ALSO PROVIDED 117 TRANSCATHETER AORTIC VALVE REPLACEMENTS (TAVR) AND TRANSCATHETER MITRAL VALVE REPLACEMENTS (TMVR).YRMC'S COMMUNITY OUTREACH PROGRAM REACHED THOUSANDS OF PEOPLE IN OUR LOCAL COMMUNITY WITH COMPLIMENTARY, CURRENT HEALTH INFORMATION. THIS INCLUDES A SPEAKERS' - BUREAU SERVICE, PROVIDING 8 PRESENTATIONS FROM YRMC HEALTH PROFESSIONALS ABOUT HEALTH-RELATED TOPICS FOR THE COMMUNITY. DUE TO COVID RESTRICTIONS, MOST OF THOSE WERE PRESENTED ONLINE.YRMC IS HONORED TO SERVE THE ENTIRE COMMUNITY OF WESTERN YAVAPAI COUNTY. WE CARE FOR PEOPLE LIVING IN OUR REGION THROUGH HIGH QUALITY INPATIENT AND OUTPATIENT SERVICES AS WELL AS A WIDE RANGE OF VALUABLE COMMUNITY OUTREACH AND HEALTH EDUCATION PROGRAMS. YRMC SERVES THE HEALTHCARE NEEDS OF PEOPLE OF ALL AGES AND FROM ALL WALKS OF LIFE. WE'RE PLEASED TO MEET THOSE NEEDS 24 HOURS A DAY, 365 DAYS A YEAR.YRMC'S HEALTHCARE TEAM - NURSES, PHYSICIANS AND OTHER MEDICAL PROFESSIONALS CARED FOR 12,306 INPATIENTS IN FISCAL YEAR 2022. DURING THE SAME TIME PERIOD, NEARLY 70,089 PEOPLE RECEIVED CARE IN YRMC'S EMERGENCY DEPARTMENTS. WE FREQUENTLY SEE MENTAL HEALTH PATIENTS BROUGHT TO THE ED WITH SUICIDAL IDEATION - NOT MEDICAL CONDITIONS. THOSE PATIENTS RANGE FROM VERY YOUNG CHILDREN TO PEOPLE WHO ARE MORE THAN 90 YEARS OLD. YRMC HAS COLLABORATED CLOSELY WITH SEVERAL BEHAVIORAL HEALTH ORGANIZATIONS IN AN EFFORT TO HELP THE COMMUNITY AS A TEAM. WE HAVE ALSO PROVIDED FINANCIAL SUPPORT FOR LOCAL NON-PROFIT PROVIDERS. MENTAL HEALTH HAS CONSISTENTLY BEEN A COMMUNITY NEED AND, UNFORTUNATELY, YAVAPAI COUNTY HAS ONE OF THE HIGHEST SUICIDE RATES IN THE STATE. WE CONTINUE TO WORK WITH OTHER COMMUNITY AGENCIES TO ADDRESS THIS CHALLENGE.YRMC'S SOCIAL MEDIA ENGAGEMENT WAS STRONG IN FISCAL YEAR 2022. PEOPLE ENGAGED IN YRMC'S BLOG, YRMC HEALTHCONNECT AND YRMC'S FACEBOOK COMMUNITY. BOTH YRMC'S YOUR HEALTHY KITCHEN COMMUNITY AND TWITTER COMMUNITY HAD ENGAGEMENTS IN 2022. WEBSITE TRAFFIC TO YRMC.ORG EXCEEDED 500,000 PAGE VIEWS WITH OVER 150,000 VISITORS. ALL THESE VENUES PROVIDE VALUABLE HEALTH INFORMATION.

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: YAVAPAI REGIONAL MEDICAL CENTER WEST, - FACILITY 2: YAVAPAI REGIONAL MEDICAL CENTER EAST

FACILITY REPORTING GROUP A PART V, SECTION B, LINE 5:
IN CONDUCTING THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT IN TY19, YAVAPAI REGIONAL MEDICAL CENTER (YRMC) CONDUCTED A COMMUNITY HEALTH NEEDS SURVEY COMPLETED BY 61 STAKEHOLDERS, AND ANALYZED QUANTITATIVE DATA ON COMMUNITY DEMOGRAPHICS, MORBIDITY AND MORTALITY, AND HEALTH OUTCOMES AND FACTORS. PRIMARY DATA COLLECTION INCLUDED A WEB BASED SURVEY PROCESS AND PERSONAL INTERVIEWS WITH LOCAL ORGANIZATIONS, INCLUDING INDIVIDUALS WITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. SURVEY RECIPIENTS WERE CHOSEN BASED ON THE CRITERIA OF BEING PROFESSIONALS SERVING THE HEALTH NEEDS OF THE COMMUNITY AND THE SURVEYS WERE DISTRIBUTED ELECTRONICALLY DURING THE YEAR. PERSONAL INTERVIEWS WERE CONDUCTED BY STAFF AT YAVAPAI REGIONAL MEDICAL CENTER. YRMC CONDUCTED LIVE MEETINGS WITH KEY LOCAL ORGANIZATIONS, THE COUNTY HEALTH DEPARTMENT AND THE YAVAPAI PRESCOTT TRIBE. LOCAL ORGANIZATIONS INCLUDED SOCIAL SERVICE AGENCIES, SCHOOL SYSTEMS AND UNIVERSITIES, ELECTED OFFICIALS AND GOVERNMENT AGENCIES, BUSINESSES, AND OTHER MEDICAL PROVIDERS.

FACILITY REPORTING GROUP A PART V, SECTION B, LINE 6A:
YRMC OPERATES TWO HOSPITAL FACILITIES, THE WEST CAMPUS AND THE EAST CAMPUS. BOTH HOSPITALS WERE INCLUDED IN THE CHNA.

FACILITY REPORTING GROUP A PART V, SECTION B, LINE 11:
THE IMPLEMENTATION STRATEGY OUTLINES THE TOP COMMUNITY HEALTH NEEDS DESCRIBED IN THE 2019 CHNA THAT YRMC PLANS TO ADDRESS IN WHOLE OR IN PART IN FULFILLMENT OF ITS MISSION. YRMC HAS SELECTED THE TOP FIVE PRIORITIES OF THE TWELVE HEALTH NEEDS THAT WERE IDENTIFIED IN THE CHNA. THE SELECTION WAS BASED ON PRIORITY RANKING AS WELL AS RESOURCE AVAILABILITY AND APPROPRIATENESS TO YRMC'S AREAS OF EXPERTISE. THIS IMPLEMENTATION STRATEGY MAY BE MODIFIED AS CONDITIONS CHANGE AND AS APPROPRIATE.FOR EACH HEALTH NEED THAT YRMC PLANS TO ADDRESS, THE STRATEGY DESCRIBES:- ACTIONS YRMC INTENDS TO TAKE, INCLUDING PROGRAMS AND RESOURCES IT PLANS TO COMMIT- ANTICIPATED IMPACT OF THESE ACTIONS- PLANNED COLLABORATION BETWEEN YRMC AND OTHER ORGANIZATIONS1. HEALTHY BEHAVIORS/LIFESTYLE CHANGESYRMC HAS SUCCESSFULLY PROVIDED WELLNESS AND HEALTH PROMOTION PROGRAMS FOR DECADES. THESE POPULAR PROGRAMS WILL PROVIDE THE FOUNDATION FOR COMMUNITY OUTREACH IN THE AREA OF HEALTHY BEHAVIORS AND LIFESTYLES. WE ANTICIPATE AN INCREASE IN THE NUMBER OF COMMUNITY MEMBERS WHO ACTIVELY MAKE HEALTHIER CHOICES.- SOCIAL MEDIA WILL CONTINUE TO EXPAND TO HELP MEET INFORMATION NEEDS SURROUNDING GOOD HEALTH CHOICES.- EDUCATIONAL RESOURCES FOR HEALTHY LIVING CHOICES (E.G. EXERCISE PROGRAMS, NUTRITIOUS RECIPES, MENTAL HEALTH SELF-CARE)- ACCESS TO LATEST HEALTH INFORMATION (E.G. SURGERY PREPARATION, COVID-19 RESOURCES, BREAST HEALTH) TO RESULT IN HIGHER POSITIVE HEALTH OUTCOMES- LIBRARY OF SEARCHABLE HEALTH INFORMATION ARCHIVES TO INCREASE AND ENABLE HEALTH LITERACY SKILLS- TRACKING REPORTS ARE RUN MONTHLY TO GAUGE TRAFFIC TO VARIOUS SOCIAL MEDIA PAGES- CONTINUE PENDLETON CENTERS' PROGRAMS ON THE WEST CAMPUS AND THE EAST CAMPUS THAT ADAPT EXERCISE SUITABLE FOR THE AGE AND PHYSICAL CONDITION OF INDIVIDUAL PARTICIPANTS, E.G., CHAIR EXERCISES FOR THOSE WITH LIMITED PHYSICAL CAPACITY. THROUGHOUT 2020 THE COVID-19 PANDEMIC GREATLY REDUCED PARTICIPATION FOR ALL IN-PERSON PROGRAMS BUT THESE PROGRAMS STILL EXIST DEPENDING ON COVID AND DIGNITY-COMMONSPIRIT GUIDELINES.- PHYSICAL EXERCISE PROGRAMS TAILORED TO SPECIFIC PATIENT HEALTH NEEDS- CUSTOMIZATION OF TECHNIQUES AND ACCOMMODATIONS FOR PATIENTS WITH LIMITED MOBILITY TO FACILITATE GREATER COMPLIANCE AND PROFICIENCY IN PHYSICAL EXERCISE- EXPLORE COLLABORATION WITH YAVAPAI COUNTY COMMUNITY HEALTH SERVICES AND LOCAL SCHOOLS FOR IN-SCHOOL PROGRAMS TO PROMOTE HEALTHY BEHAVIORS AND EDUCATE CHILDREN ON THE IMPORTANCE OF MAINTAINING THEIR HEALTH. IN-SCHOOL PROGRAMS HAVE BEEN LIMITED DUE TO COVID RESTRICTIONS BUT WE CONTINUED TO PROVIDE PARTNERS FOR HEALTHY STUDENTS FREE PRIMARY HEALTHCARE FOR UNDERSERVED CHILDREN.- HEALTH EDUCATION TOOLS FOR TEACHERS AND STUDENTS TO BUILD HEALTHY HABITS AND CULTIVATE SUPPORTIVE PEER AND TEACHER/STUDENT RELATIONSHIPS (E.G., GO NOODLE WEB-BASED EXERCISE PROGRAM THAT INCREASES PHYSICAL ACTIVITY AND TEACHES RELAXATION/STRESS MANAGEMENT TECHNIQUES AND SKILLS, SMOKING PREVENTION, OTHER FITNESS RESOURCES)- IN COLLABORATION WITH SUBJECT MATTER EXPERTS (SME), CONTINUE THE UTILIZATION OF THE WIDELY POPULAR YRMC SPEAKERS BUREAU TO INCLUDE THE TOPIC OF HEALTHY BEHAVIORS. DUE TO COVID RESTRICTIONS THESE WERE ONLY OFFERED VIA WEB PORTALS.- SEEK OUT CONNECTIONS WITH LOCAL CHAMBERS, PEO GROUPS, CIVIC GROUPS, ETC., FOR OPPORTUNITIES TO PRESENT HEALTH INFORMATION IN THEIR NEWSLETTERS OR CONNECT THEM TO WEB-BASED RESOURCES.- EXPLORE COLLABORATION WITH LOCAL RETIREMENT CENTERS AND ASSISTED LIVING FACILITIES TO PROVIDE HEALTH INFORMATION AND SOCIAL MEDIA CONTACT.- COVID-19 PANDEMIC HAS RAISED SIGNIFICANT CHALLENGES FOR SUCH FACILITIES TO ENABLE CONTACT AMONG RESIDENTS, INHIBITING THE SOCIAL CONNECTION THAT IS ESPECIALLY IMPORTANT DURING CHALLENGING TIMES TO MINIMIZE ISOLATION, MAINTAIN HEALTH AND CULTIVATE WELL-BEING OF RESIDENTS.- WORKING WITH LOCAL FACILITIES TO PROVIDE EDUCATION ON ALTERNATIVE FORMS OF CONTACT THROUGH TECHNOLOGY (E.G. WEB-BASED MEETINGS, CELL PHONE VIDEO CHAT SESSIONS, ONLINE FORUMS) TO SHARE INFORMATION ABOUT BENEFICIAL FOODS, EXERCISE AND OTHER HEALTHY HABITS. THIS EDUCATION ENHANCES RESIDENTS' PROFICIENCY IN HEALTH BEHAVIORS.2. LACK OF PRIMARY CARE PHYSICIANSTHE 2019 CHNA PLAN IDENTIFIED A NEED FOR SPECIALISTS AS WELL AS PRIMARY CARE. WE STILL SEE A NEED FOR PRIMARY CARE AND PLAN TO ADDRESS THIS NEED ACCORDINGLY. IT IS ANTICIPATED THAT MORE PRIMARY CARE PROVIDERS WILL BE AVAILABLE FOR OUR COMMUNITY. WE ARE HOPEFUL THAT ADDITIONAL RESOURCES FROM DIGNITY-COMMONSPIRIT WILL HELP AUGMENT THE PHYSICIAN SHORTAGES IN OUR COMMUNITY.- YRMC WILL USE ADVANCED PRACTICE PROVIDERS (NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS) TO AUGMENT THE NEED FOR PRIMARY CARE.- NEEDS FOR SUITABLE OFFICE SPACE TO ACCOMMODATE ADDITIONAL PHYSICIANS WILL BE MET BASED PRIMARILY ON DIGNITY HEALTH'S MASTER FACILITIES PLAN FOR OUR COMMUNITY AND TAKING ADVANTAGE OF SPACE IN OUR COMMUNITIES THAT MAY BECOME AVAILABLE.- EXPLORE FEASIBILITY OF OPTIONS SUCH AS WALK-IN CLINICS, SATELLITE OFFICES, AND EXTENDED HOURS FOR YRMG CLINICS, ETC. - COVID-19 HAS DRAMATICALLY INCREASED USE OF TELEMEDICINE OPTIONS, RESULTING IN GREATER FAMILIARITY AND EASE OF USE AMONG PROVIDERS. THESE TECHNIQUES WILL BE USED TO EXPAND ACCESS TO PATIENTS WITH MOBILITY ISSUES OR LIMITED AVAILABILITY.- IN COLLABORATION WITH LOCAL SCHOOLS, YRMC WILL CONTINUE TO PROVIDE FREE PRIMARY CARE TO UNINSURED AND UNDERINSURED SCHOOL CHILDREN AND THEIR YOUNGER SIBLINGS THROUGH THE PARTNERS FOR HEALTHY STUDENTS PROGRAM, STAFFED BY NURSE PRACTITIONERS AND LED BY A MEDICAL DIRECTOR.- THE ECONOMIC IMPACT OF COVID-19 HAS BEEN PARTICULARLY DEVASTATING DUE TO TEMPORARY LAYOFFS RESULTING IN MORE CHILDREN WITHOUT INSURANCE COVERAGE AND IN NEED OF CARE. AS OF MAY 2020, AN ESTIMATED 17% (ONE IN SIX) WORKING ADULTS ARE RECEIVING UNEMPLOYMENT BENEFITS. TO ADDRESS THIS ISSUE, YRMC APPROVED THE EXTENSION OF PHS SERVICES BEYOND THE TRADITIONAL SCHOOL YEAR AND THROUGH THE SUMMER OF 2020.- YRMC WILL CONTINUE TO COLLABORATE WITH THE ARIZONA SONSHINE ORGANIZATION THAT PROVIDES FREE HEALTHCARE IN OUR REGION FOR SEVERAL DAYS ANNUALLY TO HELP MEET THE NEEDS OF THE UNDERSERVED.- DUE TO THE COVID-19 PANDEMIC, THE ARIZONA SONSHINE 2020 EVENT HAS BEEN CANCELED. THE ARIZONA SONSHINE ORGANIZATION IS CURRENTLY INVESTIGATING THE FEASIBILITY OF SETTING UP MOBILE MEDICAL UNITS IN SELECT AREAS IF THE CRISIS CONTINUES LONG-TERM, TO BE STAFFED BY VOLUNTEERS.3. LACK OF HEALTH KNOWLEDGEHEALTH LITERACY IS DEFINED AS A PERSON'S ABILITY TO READ, UNDERSTAND, EVALUATE AND ACT UPON HEALTH INFORMATION. LOW HEALTH LITERACY IS LINKED TO POORER HEALTH STATUS AND MORE EMERGENCY ROOM VISITS AND HOSPITALIZATIONS. YRMC'S EFFORTS ARE EXPECTED TO IMPROVE HEALTH LITERACY IN OUR COMMUNITY.- YRMC WILL CONTINUE TO USE SOCIAL MEDIA AND OTHER ELECTRONIC METHODS OF REACHING OUT TO THE COMMUNITY AND EDUCATING PEOPLE ABOUT HEALTH AND HEALTHCARE.- YRMC HEALTHCONNECT LIBRARY OF SEARCHABLE HEALTH INFORMATION ARCHIVES TO INCREASE AND ENABLE HEALTH LITERACY SKILLS.- INFORMATIVE ARTICLES ON HEALTHCONNECT TO EDUCATE READERS ON VARIOUS BODY MECHANISMS, PROCEDURES, AND MEDICAL DEVELOPMENTS.- EXPLORE UTILIZING THE YRMC SPEAKERS BUREAU FOR PROVIDING HEALTH INFORMATION FOR THE COMMUNITY.- PARTICIPANTS ATTEND VIRTUAL SESSIONS AND CAN REVIEW RESOURCE MATERIALS AT THEIR OWN PACE.- EXPLORE OTHER HEALTH LITERACY PROGRAMS AVAILABLE WITHIN THE DIGNITY-COMMONSPIRIT SYSTEM AND, IF FEASIBLE, ADAPT ONE OR MORE OF THESE PROGRAMS TO THE YRMC MARKET. THESE PROGRAMS HELP INCREASE UNDERSTANDING AND COMPLIANCE WITH HEALTH ADVICE AND RECOMMENDATIONS.

FACILITY REPORTING GROUP A PART V, SECTION B, LINE 13H:
THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. IF APPLICABLE, PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION.PATIENT COOPERATION STANDARDS - A PATIENT MUST COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS.

SCHEDULE H, PART V, SECTION B, LINE 11: (CONTINUATION)
"4. PHYSICAL INACTIVITYCARDIOVASCULAR DISEASE IS THE LEADING CAUSE OF DEATH IN THE U.S. (SOURCE: AMERICAN FAMILY PHYSICIAN, 2016). THIRTY-FIVE PERCENT OF CARDIOVASCULAR DISEASE IS DUE TO PHYSICAL INACTIVITY. APPROXIMATELY 60% OF AMERICANS 18 YEARS AND OLDER REPORT PHYSICAL INACTIVITY. THE AMERICAN HEART ASSOCIATION RECOMMENDS 30-60 MINUTES OF AEROBIC EXERCISE THREE TO FOUR TIMES A WEEK. OUR LOCAL DEMOGRAPHICS AND ECONOMIC REALITIES POSE CHALLENGES IN HELPING OUR COMMUNITY RECOGNIZE THE ISSUE AND, MOST IMPORTANTLY, MAKE EFFORTS TO IMPROVE THEIR ACTIVITY LEVELS.- COLLABORATE WITH YAVAPAI COUNTY COMMUNITY HEALTH SERVICES AND YRMC'S OWN EMPLOYEE HEALTH PROGRAM, IF APPROPRIATE, TO CREATE MORE EDUCATION ABOUT THE IMPORTANCE OF PHYSICAL ACTIVITY.- COLLABORATE WITH LOCAL SCHOOLS (MANY OF WHOM NO LONGER OFFER FREE PHYSICAL EDUCATION CLASSES OR SPORTS OPPORTUNITIES) TO INCLUDE PROGRAM IDEAS FOR BRIEF PHYSICAL ACTIVITY WITHIN THE CLASSROOM THROUGHOUT THE DAY AS BREAKS FOR CHILDREN.- EXPLORE YRMC SPONSORED HIKES/WALKS FOR THE COMMUNITY AND PROMOTE THEM ACCORDINGLY.- PROMOTE THROUGH YRMC HEALTH CONNECT PROGRAM THE MANY OPPORTUNITIES TO ENGAGE IN LOCAL HIKING PROGRAMS (E.G. HIGHLANDS CENTER FOR NATURAL HISTORY, PRESCOTT HIKING CLUB).- EDUCATE THE COMMUNITY ABOUT THE HEALTH BENEFITS OF DOMESTIC ACTIVITIES SUCH AS GARDENING, ETC.- PROMOTE THROUGH YRMC HEALTH CONNECT PROGRAM THE MANY LOW-COST OPPORTUNITIES TO ENGAGE IN HOME-BASED PHYSICAL ACTIVITY (YAVAPAI COLLEGE MASTER GARDENING PROGRAM, PRESCOTT COMMUNITY GARDENS) TO ENABLE MORE PEOPLE TO ENGAGE IN PHYSICAL ACTIVITY IN NEW AND CREATIVE WAYS NOT PREVIOUSLY CONSIDERED.- EXPLORE FURTHER COLLABORATION WITH GROUPS SUCH AS SILVER SNEAKERS FOR THE PENDLETON CENTERS FOR HEALTH AND WELLNESS AND PROMOTE SUCH PROGRAMS AND THEIR BENEFITS.- EXPLORE THE VALUE OF PARTICIPANTS FROM THE PENDLETON PROGRAMS TO PROVIDE TESTIMONIALS ON SOCIAL MEDIA AND OTHER OUTLETS REGARDING HOW STAYING PHYSICALLY ACTIVE HAS IMPROVED THEIR LIVES.5. LACK OF MENTAL HEALTH PROVIDERSYRMC WORKS CLOSELY WITH LOCAL MENTAL HEALTH PROVIDERS. SEVERAL LOCAL MENTAL HEALTH PROVIDERS REGULARLY COME TO ASSESS PATIENTS IN YRMC'S EMERGENCY DEPARTMENTS TO DETERMINE MENTAL HEALTH STATUS. BECAUSE OF THE PROLIFERATION OF MENTAL HEALTH AND SUBSTANCE ABUSE PROBLEMS IN OUR COMMUNITY, YRMC ALSO COLLABORATES CLOSELY WITH LOCAL LAW ENFORCEMENT AGENCIES. MANY PATIENTS ARE BROUGHT INTO THE EMERGENCY DEPARTMENTS BY LAW ENFORCEMENT, ESPECIALLY THOSE EXHIBITING COMBATIVE, VIOLENT BEHAVIOR AND/OR THOSE WHO ARE HOMELESS OR OTHERWISE WITHOUT FAMILY SUPPORT. ACCORDING TO HEALTH DEPARTMENTS IN THE STATE OF ARIZONA, THE COVID-19 PANDEMIC HAS RESULTED IN AN INCREASED INCIDENCE OF SUICIDES AND DOMESTIC VIOLENCE INCIDENTS.- CONTINUE COLLABORATING WITH LOCAL BEHAVIORAL HEALTH PROVIDERS IN COMMUNITY PRESENTATIONS TO HELP EDUCATE THE PUBLIC ABOUT MENTAL HEALTH AND THE FACT THAT IT DOES NOT DESERVE TO BE STIGMATIZED.- COVID-19 HAS DRAMATICALLY INCREASED THE USE OF TELEMEDICINE OPTIONS, RESULTING IN GREATER FAMILIARITY AND EASE OF USE AMONG PROVIDERS. THESE TECHNIQUES CAN BE USED TO EXPAND ACCESS TO PATIENTS WITH ANXIETY ISSUES OR LIMITED AVAILABILITY DUE TO FAMILY DEMANDS.- TRACKING TO BE CONDUCTED PERIODICALLY TO GAUGE USAGE AND TOPICS IN HIGHEST DEMAND.- CONTINUE THE COLLABORATION WITH POLARA HEALTH (FORMERLY KNOWN AS WEST YAVAPAI GUIDANCE CLINIC) AND OTHER MENTAL HEALTH PROVIDERS IN CREATION OF NEW PROGRAMS FOR MENTAL HEALTH TOPICS. INCREASED SUPPORT PROVIDED FOR THE POLARA HEALTH CRISIS STABILIZATION UNIT (CSU). HOWEVER, COVID HAS CAUSED A CLOSURE OF THE CSU FOR THE TIME BEING.- EVALUATE ADDITIONAL PARTNERSHIP OPPORTUNITIES WITH MENTAL HEALTH PROVIDERS AS THEY BECOME AVAILABLE.- A LOCAL GROUP OF PSYCHOLOGISTS HAS OFFERED FREE MENTAL HEALTH SERVICES FOR YRMC STAFF TO ASSIST WITH ISSUES RESULTING FROM THE COVID-19 AND ECONOMIC CRISES.- EXPLORE WITH LOCAL LAW ENFORCEMENT AND MENTAL HEALTH PROVIDERS POSSIBLE ALTERNATIVES TO YRMC'S EDS AS A ""HOLDING"" RESOURCE WHEN NO MEDICAL NEED IS APPARENT. SUCH ALTERNATIVES SUPPORT LAW ENFORCEMENT'S EFFORTS FOR BEHAVIORAL HEALTH HOUSING WITHIN DETENTION CENTERS IN THE COMMUNITY.- FURTHER PROMOTE PHILANTHROPICALLY SUPPORTED PROGRAMS TO ENHANCE BEHAVIORAL HEALTH SERVICES. FOR EXAMPLE, YRMC'S PARTNERS FOR HEALTHY STUDENTS (PHS) PROGRAM LAUNCHED ADOLESCENT BEHAVIORAL HEALTH SERVICES IN 2019 MADE POSSIBLE BY COMMUNITY SUPPORT AND GENEROSITY. PHS COLLABORATES WITH SOUTHWEST BEHAVIORAL HEALTH, SPECTRUM HEALTH, POLARA HEALTH AND OTHER PROVIDERS.- EXPLORE OPPORTUNITIES TO COLLABORATE WITH YRMC'S PALLIATIVE MEDICINE DEPARTMENT AND MEMORY CARE SERVICES IN THE AREA, ESPECIALLY GIVEN OUR COMMUNITY NEED FOR SUCH CARE AND INFORMATION ABOUT THESE SERVICES. - EXPLORE A HEALTHY AGING SERVICE LINE WITH A GERIATRIC ASSESSMENT CLINIC FOR OUR LOCAL COMMUNITY IN COLLABORATION WITH YRMC PALLIATIVE MEDICINE PROGRAM TO INCREASE AVAILABILITY OF MENTAL HEALTH SERVICES FOR THE SENIOR POPULATION IN WESTERN YAVAPAI COUNTY. MORE THAN ONE-THIRD OF THE POPULATION OF YRMC'S SERVICE AREA IS OVER THE AGE OF 65.THE FOLLOWING NEEDS WERE NOT SELECTED TO BE ADDRESSED IN THE CHNA: LIMITED ACCESS TO HEALTHY FOODS. THIS WILL NOT BE ADDRESSED BY YRMC BECAUSE THERE ARE A NUMBER OF COMMUNITY ORGANIZATIONS THAT WORK ON THIS ISSUE THAT ARE BETTER SUITED TO MEET THIS NEED. HOWEVER, WE DO FINANCIALLY SUPPORT LOCAL FOOD BANKS.-TRANSPORTATION: PEOPLE WHO CARE IS ONE OF THE LOCAL ORGANIZATIONS THAT PROVIDE TRANSPORTATION FOR THOSE IN NEED.-AGING POPULATION: THE GREATER PRESCOTT AREA HAS MORE THAN 35% OF PEOPLE OVER 65, WHICH IS NEARLY DOUBLE THAT OF THE REST OF ARIZONA AND THE NATION. YRMC CARES FOR ALL PEOPLE IN ALL AGE GROUPS IN OUR SERVICE AREA BUT THIS WAS NOT A SELECTED NEED FOR THE CHNA IMPLEMENTATION PLAN. -HIGH COST OF HEALTHCARE: THIS ISSUE IS BEYOND THE SCOPE OF YRMC TO ADDRESS AND IS MORE APPROPRIATE AS AN ISSUE THAT INCLUDES ALL ASPECTS OF HEALTHCARE, NOT JUST HOSPITALS.-POVERTY/CHILDREN IN POVERTY/LACK OF FINANCIAL RESOURCES: IN YRMC'S SERVICE AREA 38% OF THE LOCAL WORKFORCE IS CONSIDERED WORKING POOR AND 25% OF CHILDREN LIVE AT OR BELOW THE POVERTY LEVEL. YRMC CARES FOR ALL PEOPLE REGARDLESS OF ABILITY TO PAY. -UNINSURED AND UNDERINSURED: YRMC PROVIDES CARE TO THE UNINSURED AND UNDERINSURED PEOPLE IN OUR SERVICE AREA."

SCHEDULE H, PART V, SECTION B, LINE 16I:
TRANSLATION OF FAP INTO PRIMARY LANGUAGE SPOKEN BY LEP POPULATIONS:YRMC HAS TRANSLATED THE FAP INTO SPANISH AND WOULD CONSIDER TRANSLATING INTO ANOTHER LANGUAGE WHEN IT IS KNOWN THAT PATIENTS WILL NEED THE TRANSLATION AND ARE NOT SERVED BY THE CURRENT FORMS AND STATEMENTS. YRMC USES DEMOGRAPHIC DATA FROM THEIR SYSTEM AND THE COUNTIES TO DETERMINE IF A PATIENT POPULATION EXISTS THAT IS OVER 1,000 INDIVIDUALS THAT DO NOT SPEAK ENGLISH OR SPANISH.

PART I, LINE 3C:
UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: - THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.- THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED IN SCHEDULE H, PART V, SECTION B, LINE 13H, 3RD PARAGRAPH.- THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:- RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS;- HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS OR FREE CARE CLINIC;- PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);- FOOD STAMP ELIGIBILITY;- ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);- LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR- PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE.

PART I, LINE 7:
FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, YRMC USES A COST-TO CHARGE RATIO FOR LINE 7A-7C & 7G. THE COST TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE ORGANIZATION USED A COST ACCOUNTING AMOUNT FOR THE OTHER MEANS TESTED PROGRAMS ON LINE 7C THAT RELATED TO THE JOINT VENTURES. THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS.PART I, LINE 7B, COLUMN (F):THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.

PART I, LINE 7G:
THE SUBSIDIZED SERVICES ON LINE 7G INCLUDE PHYSICIAN CLINICS IN PRESCOTT AND PRESCOTT VALLEY. THE CLINICS IMPROVE COMMUNITY ACCESS TO HEALTHCARE SERVICES SUCH AS CARDIOLOGY AND NEUROSURGERY. WITHOUT THE CARDIOLOGY CLINICS, THE COMMUNITY WOULD BE UNDERSERVED, AS THIS WOULD CAUSE A SHORTAGE OF ACCESS FOR THIS TYPE OF CARE. THE DEMOGRAPHICS ARE MAINLY THAT OF THE MEDICARE POPULATION, AND ADDITIONAL TRAVEL TIME FOR RESIDENTS TO OBTAIN SIMILAR CARE IN OTHER AREAS WOULD BE DIFFICULT FOR RESIDENTS. THE NEUROSURGERY CLINIC IS THE ONLY CENTER AVAILABLE IN THE CITY OF PRESCOTT.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE HOSPITAL IS DEDICATED TO PROMOTING THE GENERAL HEALTH OF THE POPULATION. THE ACTIVITIES IN PART II CONTRIBUTE TO THE VITALITY OF THE COMMUNITY WHICH IS ONE OF MANY FACTORS THAT IMPACT THE HEALTH OF THE COMMUNITY AND PROVIDE A BENEFIT FOR OUR COMMUNITY.

PART III, LINE 2:
THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE PART 1, LINE 7 DISCLOSURE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS THAT FALL INTO THE FOLLOWING CATEGORIES, UP TO 200% OR 201%-400% OF THE FEDERAL POVERTY LEVEL. YRMC ALSO PROVIDES PATIENTS OPTIONS FOR UNINSURED PATIENT DISCOUNT AND SELF-PAY DISCOUNTS. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE.

PART III, LINE 3:
THE DIGNITY HEALTH FINANCIAL ASSISTANCE POLICY WAS UPDATED AND RENAMED AS COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. DIGNITY COMMUNITY CARE HOSPITALS FOLLOW THIS POLICY.THE FILING ORGANIZATION MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS,HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. COMMONSPIRIT HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, DIGNITY COMMUNITY CARE DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE.

PART VI, LINE 4:
YRMC SERVES THE RURAL COMMUNITIES IN THE WESTERN PORTION OF YAVAPAI COUNTY IN NORTHERN ARIZONA. YRMC SERVES APPROXIMATELY 150,000 MEN, WOMEN AND CHILDREN LIVING IN AN AREA LARGER THAN THE STATE OF NEW JERSEY. THE COMMUNITIES IN WHICH THE TOP 75 PERCENT OF YRMC'S PATIENTS RESIDE HAS THE FOLLOWING CHARACTERISTICS: TOTAL POPULATION: 155,304WHITE - NON-HISPANIC: 77.2%BLACK/AFRICAN AMERICAN: 0.7%HISPANIC OR LATINO: 14.6%ASIAN/PACIFIC ISLANDER: 1.6%ALL OTHERS: 5.9%% BELOW POVERTY: 6.4%UNEMPLOYMENT: 4.7%NO HIGH SCHOOL DIPLOMA: 8.2%MEDICAID (HOUSEHOLD): 22.9%UNINSURED (HOUSEHOLD): 9.5%

PART VI, LINE 6:
AFFILIATES OF YRMC ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN CALIFORNIA, ARIZONA, AND NEVADA AND IN 18 ADDITIONAL STATES THROUGH THE ALLIANCE WITHIN COMMONSPIRIT HEALTH SYSTEM. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE NET OF OFFSETTING REVENUE FOR COMMONSPIRIT HEALTH AND ITS AFFILIATED CORPORATIONS, WHICH INCLUDES YRMC, FOR THE YEAR ENDED JUNE 30, 2022, IS $3.2 BILLION. A SUMMARY OF COMMONSPIRIT'S COMMUNITY BENEFITS CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT HEALTH CONSOLIDATED FINANCIAL STATEMENTS ON PAGE 44.

SCHEDULE H, PART VI, LINE 7:
YRMC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE.

PART III, LINE 4:
THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT HEALTH CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13.PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES.

PART III, LINE 8:
COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS.COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. YRMC'S SHORTFALL INCLUDES $16.7 MILLION REPORTED ON PART III, SECTION B, LINE 7.

PART III, LINE 9B:
YRMC ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. YRMC ALSO FOLLOWS COMMONSPIRIT HEALTH'S COLLECTION POLICY. YRMC'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF YRMC OR THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER YRMC 'S PATIENT FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, YRMC WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT.ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, YRMC REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.

PART VI, LINE 2:
YRMC USES SEVERAL MEASURES BY WHICH TO ASSESS COMMUNITY HEALTH NEEDS. ONE MEASURE IS OUR MIGRATION BY SERVICE. AS AN EXAMPLE, PRIOR TO OPENING OUR CARDIOVASCULAR SURGERY PROGRAM IN 2007, WE SAW MANY HUNDREDS OF PEOPLE LEAVING OUR COMMUNITY TO GO TO PHOENIX - 100 MILES AWAY - FOR OPEN HEART SURGERY. THIS WAS AN INDICATION OF A NEED IN OUR COMMUNITY THAT REQUIRED YRMC'S FOCUSED ATTENTION AND EFFORTS THAT CULMINATED IN THE HEART CENTER AT YRMC. YRMC CONSTANTLY MONITORS VOLUME AND UTILIZATION DATA IN ITS SERVICE LINES TO HELP DETERMINE LEVEL OF NEED IN THE COMMUNITY FOR EACH SERVICE LINE. ONE OF THE MOST PROMINENT REASONS FOR PEOPLE LEAVING THE AREA FOR HEALTHCARE IS THE SHORTAGE OF AVAILABLE PHYSICIANS AND SPECIALISTS. IT IS HOPED THAT ADDITIONAL RESOURCES FROM COMMONSPIRIT WILL HELP ALLEVIATE THAT SHORTAGE FOR THIS COMMUNITY.YRMC ALSO SPENDS A GREAT DEAL OF TIME LISTENING TO THE COMMUNITY BY WAY OF COMMUNITY INVOLVEMENT BY SENIOR MANAGEMENT, PATIENT SURVEY FEEDBACK, AND COMMUNITY OUTREACH EFFORTS. COMMUNITY MEMBERS FEEL VERY COMFORTABLE IN SHARING THEIR PERCEPTIONS AND PERSPECTIVES. YRMC ALSO ENGAGED BKD AUDITING FIRM TO CONDUCT COMMUNITY NEEDS ASSESSMENT RESEARCH. THE STUDY OBJECTIVES INCLUDED THE FOLLOWING:A. MEASURE AND EVALUATE HEALTH STATUS AND HEALTHCARE UTILIZATION WITHIN THE COMMUNITY.B. IDENTIFY THE PREVALENCE OF CHRONIC CONDITIONS WITHIN VARIOUS DEMOGRAPHIC SEGMENTS WITHIN THE COMMUNITY.C. PROFILE HIGH-RISK POPULATIONS.D. IDENTIFY GAPS IN CARE AND PREVENTIVE HEALTH BEHAVIORS AMONG VARIOUS DEMOGRAPHIC SEGMENTS WITHIN THE COMMUNITY.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC:INFORMATION ABOUT PATIENT FINANCIAL ASSISTANCE AVAILABLE FROM YRMC, INCLUDING A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS THE HOSPITAL FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES YRMC SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES.IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRES THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.

PART VI, LINE 5:
YAVAPAI REGIONAL MEDICAL CENTER PROUDLY SERVES A 5,500 SQUARE MILE AREA OF WESTERN YAVAPAI COUNTY. YRMC IS DEEPLY COMMITTED TO SUPPORTING THE LOCAL COMMUNITY IN MULTIPLE WAYS, MANY OF WHICH ARE PROVIDED AT NO COST OR AT A FINANCIAL LOSS TO BENEFIT OUR COMMUNITY. WE PROVIDE RESOURCES FOR PEOPLE WHO ARE IN SEARCH OF MORE INFORMATION ABOUT THEIR HEALTH AND HOW TO IMPROVE THEIR QUALITY OF LIFE, AND WE ALSO OFFER ASSISTANCE TO THOSE WHO ARE VULNERABLE.FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE. OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS. ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS.