2022-05-16T13:12:21-05:00 2021-06-30 366055558 GRANT THORNTON LLP 1000 WILSON BOULEVARD SUITE 1400 ARLINGTON VA 22209 990 2020-07-01 520591628 TIDALHEALTH PENINSULA REGIONAL INC TIDA 4105466400 100 EAST CARROLL STREET SALISBURY MD 21801 BRUCE I RITCHIE CFO 4105466400 2022-05-16 1 BRUCE RITCHIE 999009999 MARY TORRETTA P00847851 7038477500 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X STEVEN LEONARD 100 EAST CARROLL STREET SALISBURY MD 21801 838663742 0 X WWW.TIDALHEALTH.ORG X 1897 MD IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 13 5 4212 11 26811975 4083976 17202254 15455550 473954597 481772126 28672909 49458683 1047978 1038998 520877738 547725357 0 0 0 0 252919271 208869116 0 0 720437 248158482 235750420 501077753 444619536 19799985 103105821 860332244 933173174 312831733 278664179 547500511 654508995 X IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 0 0 396400984 455221819 SEE SCHEDULE OTIDALHEALTH PENINSULA REGIONAL IS A NOT-FOR-PROFIT 501(C)(3) NON-STOCK CORPORATION FOUNDED IN 1897 TO SERVE THE HEALTH CARE NEEDS OF THE COMMUNITY. THE HOSPITAL'S PRIMARY PURPOSE IS TO PROVIDE THE HIGHEST PRIMARY, SECONDARY, AND SELECTED TERTIARY HEALTH CARE SERVICES TO RESIDENTS OF AND VISITORS TO THE MID-DELMARVA PENINSULA IN A COMPETENT, COMPASSIONATE, AND COST-EFFECTIVE MANNER DESIGNED TO ELICIT A HIGH DEGREE OF CUSTOMER SATISFACTION. THE HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE BY PROVIDING QUALITY MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR AGE. IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, EFFORTS WILL BE TAKEN TO ASSURE CARE AT AN AFFORDABLE COST, OR OBTAINED ASSISTANCE THROUGH APPROPRIATE AGENCIES ON THE PATIENT'S BEHALF. EMERGENCY SERVICES CARE WILL BE PROVIDED TO EVERYONE REGARDLESS OF ABILITY TO PAY.TIDALHEALTH PENINSULA REGIONAL SERVED OVER 15,000 INPATIENTS AND PROVIDED MORE THAN 450,000 OUTPATIENT SERVICES DURING FISCAL 2021. FOOD SERVICE PROVIDED MORE THAN 450,000 MEALS TO PATIENTS AND EMPLOYEES. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF TIDALHEALTH PENINSULA REGIONAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES. THE HOSPITAL, IN KEEPING WITH THE COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, DURING FISCAL 2021 PROVIDED:CHARITY AND OTHER ALLOWANCES TOTALING $45,185,259DISCOUNTS TO THIRD PARTY PAYORS INCLUDING PROGRAMS SUCH AS MEDICARE AND MEDICAID $43,492,074WRITE-OFF OF UNCOLLECTIBLE ACCOUNTS $5,833,942THE TOTAL UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS IS $95,511,275ALSO PROVIDED ARE MANY WELLNESS PROGRAMS, COMMUNITY EDUCATION AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES THAT TIDALHEALTH PENINSULA REGIONAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. SOME OF THE PROGRAMS ARE AS FOLLOWS: - A VARIETY OF BROCHURES ARE DISPLAYED IN ALL HOSPITAL WAITING AREAS TO EDUCATE MEMBERS OF THE COMMUNITY REGARDING PROGRAMS AND SERVICES.- WE PROVIDE CHILDBIRTH PREPARATION CLASSES, EXERCISE CLASSES FOR PRENATAL AND POSTPARTUM WOMEN AND CPR CLASSES.- WE PROVIDE ASSISTANCE TO EDUCATORS THROUGH OUR WORK WITH STUDENT NURSES, RADIOLOGY, RESPIRATORY AND LABORATORY TECHNICIANS.PROGRAM ACTIVITYDURING FY 2021, TIDALHEALTH PENINSULA REGIONAL PERFORMED COMMUNITY OUTREACH ACTIVITIES ASSOCIATED WITH COVID-19 TESTING AND VACCINATION CLINICS, FLU CLINICS AND A MOBILE HEALTH INITIATIVE AIMED TO REDUCE UNNECESSARY USE OF THE 911 EMS SYSTEM AND EMERGENCY DEPARTMENT. SPECIFIC EXAMPLES OF EDUCATION AND OUTREACH PROGRAMS, SUPPORT GROUPS, COMMUNITY HEALTH SCREENINGS, AND FITNESS AND WELLNESS ACTIVITIES SUPPORTED BY TIDALHEALTH PENINSULA REGIONAL ARE AS FOLLOWS: COMMUNITY EDUCATIONAL AND OUTREACH PROGRAMS- CPR - CHILDBIRTH PREPARATION CLASSES - REFRESHER COURSE - CHILDBIRTH - INFANT CARE CLASSES - SAFE SITTER PROGRAM - WOMEN'S HEALTH EDUCATION SUPPORT GROUPS- DIABETES SUPPORT GROUP - HEAD AND NECK CANCER SUPPORT GROUP- CAREGIVER SUPPORT GROUP EVENTS: - COMMUNITY SCREENINGS - HEIGHT/WEIGHT, BLOOD PRESSURE - SKIN CANCER SCREENINGS- ORAL, HEAD AND NECK CANCER SCREENINGS- HEARING SCREENINGS- FLU CLINIC - EDUCATIONAL EXHIBITS TO PROMOTE HEALTHY LIFESTYLES BENEFITS:- UNITED WAY FITNESS/EXERCISE PROGRAMMING:- CARDIAC REHABILITATION- EXERCISES FOR STRENGTH AND ENDURANCE - STEPPING ON FALLS PREVENTION PROGRAM 396400984 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 1 0 1 169 0 1 4212 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 13 5 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA MD X DEAN A SWINGLE - DIRECTOR OF FINANCE 3025365203 100 EAST CARROLL ST SALISBURY MD 21801 STEVEN LEONARD PRESIDENT/CEO 40.00 3.00 X X 1037091 0 166821 JAMES TODD MD PHYSICIAN 40.00 0.00 X 1067325 0 102384 ZACHARY BAKER MD PHYSICIAN 40.00 0.00 X 948367 0 34208 FAWAD KHAN MD PHYSICIAN 40.00 0.00 X 908251 0 34945 BRUCE I RITCHIE CFO 40.00 2.00 X 730288 0 158256 KARIM ARANOUT MD PHYSICIAN 40.00 0.00 X 802496 0 35039 DANIEL DANIELS MD PHYSICIAN 40.00 0.00 X 781073 0 32945 LURA LUNSFORD V.P. OPERATIONS 40.00 2.00 X 688448 0 60818 CHARLES SILVIA JR MD V.P. CHIEF MEDICAL OFFICER 40.00 1.00 X 609393 0 69659 KARIN DIBARI MD V.P. TH MEDICAL PARTNERS 40.00 0.00 X 542576 0 82295 TIMOTHY FEIST V.P. CHIEF COMPLIANCE OFFICER 40.00 0.00 X 337070 0 106089 SARAH SCOTT V.P. PEOPLE & ORGANIZATON DEV 40.00 0.00 X 371361 0 53695 JAMES TRUMBLE MD V.P. CLINICAL INTEGRATION 40.00 1.00 X 393699 0 30108 KATHRYN FIDDLER V.P. POPULATION HEALTH 40.00 1.00 X 298432 0 37544 SARAH ARNETT CHIEF NURSING OFFICER 40.00 1.00 X 305526 0 30360 DEBORAH ABBOTT BOARD MEMBER 1.00 6.00 X 30000 0 0 MEMO DIRIKER CHAIRPERSON 5.00 1.00 X X 0 0 0 JULIUS ZANT MD SECRETARY 2.00 0.00 X X 0 0 0 JAMES HARTSTEIN BOARD MEMBER 1.00 3.00 X 0 0 0 SUSAN WILLGUS-MURPHY BOARD MEMBER 1.00 1.00 X 0 0 0 KAREN POISKER BOARD MEMBER 1.00 1.00 X 0 0 0 MARK EDNEY MD BOARD MEMBER 1.00 0.00 X 0 0 0 VEL NATESAN MD BOARD MEMBER 1.00 0.00 X 0 0 0 RONDALL ALLEN PHARMD BOARD MEMBER 1.00 0.00 X 0 0 0 MARY DIBARTOLO BOARD MEMBER 1.00 0.00 X 0 0 0 JANELLE BEILER BOARD MEMBER 1.00 0.00 X 0 0 0 PERCY J PURNELL BOARD MEMBER 1.00 0.00 X 0 0 0 9851396 0 1035166 393 0 1 0 SHERIDAN ANESTHESIA OF MD PO BOX 744883 ATLANTA GA 303744883 ANESTHESIA SERVICES 6888473 INTERMED GROUP 13301 N W HWY 441 ALACHUA FL 326158512 BIOMEDICAL SERVICES 6320456 FOCUSONE SOLUTIONS LLC PO BOX 310861 DES MOINES IA 503310861 TEMP LABOR SERVICES 6268116 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE WI 532880314 TECHNICAL SERVICES 4603751 SLEEP WAVES INC 873 E BALTIMORE PIKE STE 345 KENNETT SQUARE PA 19348 SLEEP LAB SERVICES 2843600 99 355550 15100000 15455550 NET PATIENT SERVICES 623000 471049199 455221819 15827380 AMBULATORY PHARMACY 900099 10722927 10722927 481772126 7669273 -7999 7677272 223510 331659 -108149 -108149 -108149 332052642 343494 290280790 325936 41771852 17558 41789410 41789410 CAFETERIA 722514 867613 867613 MANAGEMENT FEES 561000 200000 200000 LIFELINE 532283 69667 69667 9867 9867 1147147 547725357 455221819 26811975 50236013 X 6198045 5440069 740857 17119 180459 107681 72778 162685151 142933408 19301899 449844 9942694 8726774 1188458 27462 18335374 16042473 2241114 51787 11527393 10316117 1184496 26780 1309195 94991 1214204 227740 227740 9049 9049 1863765 1863765 61834191 51070854 10676842 86495 401793 401793 73427758 73423938 -49951 53771 1519517 1499879 15340 4298 4760397 4646144 114253 180540 136983 41349 2208 11850 11850 5783339 5783339 27294197 27232825 61372 4250319 -256399 4506718 MEDICAL SUPPLIES 42805708 42805708 BAD DEBT 5833942 5833942 LOSS ON EXTINGUISHMENT 3659576 3659576 DUES 577544 139566 437305 673 444619536 396400984 47498115 720437 X 101915420 4443372 29158658 107949829 45372126 44027408 10182805 10737135 7887429 8016842 614181826 414531354 208313700 199650472 346155047 424195999 111347059 134152117 860332244 933173174 22171628 17315540 0 0 130687640 8876644 122215000 159972465 130256995 312831733 278664179 X 494771186 597373374 52729325 57135621 547500511 654508995 860332244 933173174 X 103105821 55365494 -51462831 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9049 9049 0 PART II-B, LINE 1: OTHER ACTIVITIES: TIDALHEALTH PENINSULA REGIONAL DOES NOT ENGAGE IN ANY DIRECT LOBBYING ACTIVITIES. THE ORGANIZATION PAYS MEMBERSHIP DUES TO MARYLAND HOSPITAL ASSOCIATION (MHA). MHA ENGAGES IN MANY SUPPORT ACTIVITIES INCLUDING LOBBYING AND ADVOCATING FOR ITS MEMBER HOSPITALS. THE MHA REPORTED THAT 2.93% OF MEMBER DUES WERE USED FOR LOBBYING PURPOSES AND SUCH, THE ORGANIZATION HAS REPORTED THIS AMOUNT ON SCHEDULE C PART IV AS LOBBYING ACTIVITIES. 79165301 23584799 92960 410928 102246212 71424439 8133343 5217 387264 79165301 64583287 7263806 9245 413409 71424439 56672686 257832 8059133 900 405464 64583287 49801243 250000 6985039 363596 56672686 0.47660 0.08450 0.43890 0 1 1 12378600 12378600 285377414 145993096 139384318 304474136 260444645 44029491 11951676 8093613 3858063 199650472 DONOR RESTRICTED FUND 53515264 BOARD DESIGNATED INVESTMENTS 48732959 PENSION ASSET 16374668 SELF INSURANCE FUND 7384245 INTERCOMPANY RECEIVABLES 404589 INVESTMENT IN PARTNERSHIPS 8069 SECTION 457(F) PLAN INVESTMENTS 2913041 RIGHT OF USE ASSETS 4819282 134152117 ADVANCES FROM THIRD PARTY PAYORS 100762533 EMPLOYEE COMP RELATED PAYROLL TAXES 20345818 ACCRUED SELF INSURANCE LIABILITY 3551212 SECTION 457 PLAN DEFERRED COMPENSATION 1864202 LONG-TERM LEASE LIABILITY 3733230 130256995 X PART V, LINE 4: INTENDED USE OF ENDOWMENT FUNDS THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR CAPITAL, PATIENT SERVICES OR EDUCATIONAL PURPOSES. PART X, LINE 2: LIABILITY FOR UNCERTAIN TAX POSITION (ASC 740) THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TIDALHEALTH, INC. THE RELEVANT TEXT OF THE INCOME TAX FOOTNOTE FROM THOSE FINANCIALS IS: THE HEALTH SYSTEM HAS DETERMINED THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2021 AND 2020. 1 1 1 X 1 X 1 1 1 0 1 1 13233221 13233221 0.03020 13233221 13233221 0.03020 1991760 64218 1927542 0.00440 5024703 0 5024703 0.01150 23574697 12694920 10879777 0.02480 45751 45751 0.00010 393315 242596 150719 0.00030 31030226 13001734 18028492 0.04110 44263447 13001734 31261713 0.07130 8947 8947 0.00000 103995 103995 0.00020 428583 428583 0.00100 3715468 1164000 2551468 0.00570 1113 1113 0.00000 17014 17014 0.00000 29641 29641 0.00010 4304761 1164000 3140761 0.00700 1 5833942 264276656 173471197 90805459 X 1 1 1 1 TIDALHEALTH PENINSULA REGIONAL INC 100 E CARROLL STREET SALISBURY MD 21801 WWW.TIDALHEALTH.ORG 210019 X X X TIDALHEALTH PENINSULA REGIONAL INC 1 0 0 1 X X X X X X 19 1 0 1 1 X SEE SUPPLEMENTAL INFORMATION X X 1 19 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFO X X X X X X 1 X 0 X X X X 1 X 0 0 TIDALHEALTH PENINSULA REGIONAL INC: PART V, SECTION B, LINE 5: CONSULTING REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITALCONDUENT HEALTHY COMMUNITIES INSTITUTE (HCI), A XEROX COMPANY, WAS RETAINED BY TIDALHEALTH PENINSULA REGIONAL (THPR) TO CONDUCT THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IN 2021, TIDALHEALTH IS PREPARING TO CONDUCT A NEW COMMUNITY HEALTH NEEDS ASSESSMENT THAT WILL COVER THE MD CBSA OF SOMERSET, WICOMICO AND WORCESTER COUNTIES AND A NEW AREA OF SUSSEX COUNTY, DELAWARE. EFFECTIVE JANUARY 1, 2020, TIDALHEALTH NANTICOKE (THN) AND TIDALHEALTH PHYSICIAN NETWORK, INC. (THPN), LOCATED IN SEAFORD, DELAWARE, JOINED TIDALHEALTH. NANTICOKE HAS 139 LICENSED ACUTE CARE BEDS ( 99 CURRENTLY OPERATED ) AND PRIMARILY SERVES THE WESTERN SUSSEX COUNTY, DELAWARE PORTION OF THE HEALTH SYSTEM'S PRIMARY SERVICE AREA. NANTICOKE PHYSICIAN NETWORK PROVIDES OUTPATIENT MEDICAL SERVICES IN WESTERN SUSSEX COUNTY AND FEDERALSBURG, MD. EFFECTIVE MARCH 1, 2020, MCCREADY FOUNDATION, INC., WHICH CONSISTED OF A THREE BED HOSPITAL, ALICE BYRD TAWES NURSING HOME, A 76-LICENSED BED SKILLED NURSING HOME AND CHESAPEAKE COVE ASSISTED LIVING CENTER IN CRISFIELD, MD, BECAME PART OF TIDALHEALTH. THE MCCREADY HOSPITAL DIVISION WAS MERGED INTO TIDALHEALTH PENINSULA REGIONAL AND LIMITED ITS FUNCTIONS TO THOSE CONSISTENT WITH STATUS AS A FREE-STANDING MEDICAL CENTER. HCI AND PRHS HAVE COLLABORATED SINCE 2012 TO DEVELOP THE TIDALHEALTH CREATING HEALTHY COMMUNITIES PLATFORM. HCI CONSULTANTS CONDUCTED KEY INFORMANT INTERVIEWS IN ORDER TO COLLECT COMMUNITY INPUT. KEY INFORMANT INTERVIEWS WERE CONDUCTED BETWEEN 07/26/2018 AND 08/30/2018. INTERVIEWEES WHO WERE ASKED TO PARTICIPATE WERE RECOGNIZED AS HAVING EXPERTISE IN PUBLIC HEALTH, SPECIAL KNOWLEDGE OF COMMUNITY HEALTH NEEDS AND/OR REPRESENTED THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HEALTH SYSTEM, AND/OR COULD SPEAK TO THE NEEDS OF THE MEDICALLY UNDERSERVED OR VULNERABLE POPULATIONS.THE FOLLOWING ORGANIZATIONS ARE REPRESENTATIVE OF THE INDIVIDUALS WHO PARTICIPATED IN THE INTERVIEWS:CHESAPEAKE HEALTH CENTER, CORELIFE, DEER'S HEAD HOSPITAL CENTER, HOPE, INC. (HEALTH AND OUTREACH POINT OF ENTRY), LOWER SHORE CLINIC, LOWER SHORE ENTERPRISES, MAC, INC. (MAINTAINING ACTIVE CITIZENS), SALISBURY REHABILITATION AND SKILLED NURSING CENTER - GENESIS HEALTHCARE, SALISBURY UNIVERSITY, TGM GROUP LLC, WICOMICO COUNTY EXECUTIVE, WICOMICO COUNTY HEALTH DEPARTMENT, TIDALHEALTH PENINSULA REGIONAL, AND THE SOMERSET COUNTY HEALTH DEPARTMENT.THERE WERE ALSO THREE FOCUS GROUPS THAT WERE ORGANIZED AND FACILITATED BY TIDALHEALTH PENINSULA REGIONAL, WICOMICO COUNTY HEALTH DEPARTMENT, AND SOMERSET COUNTY HEALTH DEPARTMENT. THE FOCUS GROUPS CONVENED ON 08/23/2018, 08/29/2018, AND 09/14/2018. THE AUGUST 23RD FOCUS GROUP CONSISTED OF PROFESSIONALS AND PROVIDERS FROM VARIOUS DISCIPLINES IN THE TRI-COUNTY AREA AND WAS HELD AT THPR. THE AUGUST 29TH FOCUS GROUP WAS HELD IN SALISBURY AT THE SALVATION ARMY AND INCLUDED MEMBERS OF THE GREATER SALISBURY COMMUNITY. THE SEPTEMBER 14TH FOCUS GROUP WAS HELD IN POCOMOKE CITY IN WORCESTER COUNTY AT THE POCOMOKE LIBRARY AND INCLUDED MEMBERS OF THE GREATER POCOMOKE AREA.A COMMUNITY SURVEY WAS AVAILABLE USING SURVEY MONKEY, AN ONLINE SURVEY TOOL, AND A PAPER VERSION OF THE SURVEY. THE SURVEY WAS DISTRIBUTED ACROSS THPR'S ENTIRE SERVICE AREA FROM 07/23/2018 TO 09/10/2018. A TOTAL OF 584 RESPONSES WERE COLLECTED AND A REPORT WAS CREATED. TIDALHEALTH PENINSULA REGIONAL INC: PART V, SECTION B, LINE 6B: CHNA CONDUCTED WITH ONE OR MORE ORGANIZATIONS OTHER THAN HOSPITAL FACILITIESTHE HOSPITAL FACILITY'S CHNA IS CONDUCTED WITH ONE OR MORE ORGANIZATIONS OTHER THAN THE HOSPITAL. THESE ORGANIZATIONS WE PARTNERED WITH INCLUDE THE WICOMICO COUNTY HEALTH DEPARTMENT (WICHD) AND THE SOMERSET COUNTY HEALTH DEPARTMENT (SCHD).A PARTNERSHIP WAS FORMED BETWEEN THPR, WICHD, AND SCHD TO COLLABORATE FOR THE BENEFIT OF THE COMMUNITY. THESE ORGANIZATIONS HAVE BEEN PARTNERING TOGETHER ON LOCAL ASSESSMENT EFFORTS SINCE 1995. TWO OF THE ORGANIZATIONS ARE REQUIRED TO COMPLETE A CHNA; THPR IS A NON-PROFIT HOSPITAL AND WICHD AS AN ACCREDITED HEALTH DEPARTMENT. SCHD IS IN THE EARLY PHASE OF PUBLIC HEALTH ACCREDITATION. IN DECEMBER 2018, THPR, SCHD, AND WICHD PUBLISHED THEIR 2019 CHNA. THE CHNA REPORT PROVIDES AN OVERVIEW OF SIGNIFICANT HEALTH NEEDS IN THE TRI-COUNTY SERVICE AREA. THIS CHNA REPORT WAS DEVELOPED TO PROVIDE AN OVERVIEW OF THE HEALTH NEEDS IN THE TRI-COUNTY SERVICE AREA, INCLUDING SOMERSET, WICOMICO, AND WORCESTER COUNTIES IN MARYLAND. THPR, SCHD, AND WICHD PARTNERED WITH CONDUENT HEALTHY COMMUNITIES INSTITUTE (HCI) TO CONDUCT THE CHNA. THE GOAL OF THIS REPORT IS TO OFFER A MEANINGFUL UNDERSTANDING OF THE GREATEST HEALTH NEEDS ACROSS THE TRI-COUNTY SERVICE AREA, AS WELL AS TO GUIDE PLANNING EFFORTS TO ADDRESS THOSE NEEDS. SPECIAL ATTENTION HAS BEEN GIVEN TO IDENTIFY HEALTH DISPARITIES, NEEDS OF THE VULNERABLE POPULATIONS, UNMET HEALTH NEEDS OR GAPS IN SERVICES, AND INPUT FROM THE COMMUNITY. CHNA ON HOSPITAL FACILITY'S WEBSITE SCHEDULE H, PART V, LINE 7AHTTPS://WWW.TIDALHEALTH.ORG/PUBLICATIONS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2019 TIDALHEALTH PENINSULA REGIONAL INC: PART V, SECTION B, LINE 7D: OTHER WAYS THE HOSPITAL MAKES ITS CHNA REPORT AVAILABLE TO THE PUBLICPENINSULA REGIONAL'S COMPREHENSIVE CHNA REPORT IS MADE AVAILABLE TO THE PUBLIC ONLINE AT HTTPS://WWW.TIDALHEALTH.ORG/PUBLICATIONS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2019 AND A PAPER COPY IS MADE AVAILABLE TO THE PUBLIC AT SEVERAL LOCATIONS WITHIN THE HOSPITAL FOR PUBLIC INSPECTION. IN ADDITION, THE REPORT HAS BEEN TRANSLATED INTO SPANISH AND THE HOSPITAL IS LOOKING INTO A FURTHER TRANSLATION TO CREOLE. WE PARTNER WITH CONDUENT HEALTHY COMMUNITIES INSTITUTE TO DISCOVER WHAT THE MOST PRESSING HEALTH CHALLENGES ARE IN SOMERSET, WORCESTER AND WICOMICO COUNTIES. THE PUBLIC CAN VIEW THE RESULTS OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE, AS WELL AS OUR ACTION PLAN OF STEPS WE PLAN TO TAKE BASED ON THE INFORMATION GATHERED IN THE ASSESSMENT. IN ADDITION, A COMMUNITY HEALTH DATA AND RESOURCES SECTION CAN BE ACCESSED BY THE PUBLIC. AS PART OF THIS CREATING HEALTHY COMMUNITIES, A MODULE IS AVAILABLE TO THE PUBLIC IN WHICH THEY CAN EXPLORE MULTIPLE DASHBOARDS THAT PROVIDE A GAUGE TO THE HEALTH OF THE COMMUNITIES SERVED, SOCIO-DEMOGRAPHICS AND PROMISING PRACTICES. THE DASHBOARDS INCLUDE FEATURES SUCH AS A CHNA GUIDE, HEALTH DATA, DEMOGRAPHIC DATA, HEALTH DISPARITIES, SOCIO NEEDS INDEXES, FINDING GRANTS, INDICATOR COMPARISONS, AND PROGRESS TRACKING. IMPLEMENTATION STRATEGY ON HOSPITAL FACILITY'S WEBSITE SCHEDULE H, PART V, LINE 10AHTTPS://WWW.TIDALHEALTH.ORG/PUBLICATIONS/IMPLEMENTATION-STRATEGY-COMMUNITY-BENEFIT-2019 TIDALHEALTH PENINSULA REGIONAL INC: PART V, SECTION B, LINE 11: HOW NEEDS IDENTIFIED IN THE CHNA ARE ADDRESSEDTIDALHEALTH PENINSULA REGIONAL HAS A FIXED VALUE OF RESOURCES AVAILABLE, AND THE HOSPITAL FOCUSES THOSE RESOURCES TO THE AREAS WITH THE GREATEST IMPACT, THEREFORE NOT ALL NEEDS, TO DATE, IDENTIFIED IN THE CHNA WERE ABLE TO BE ADDRESSED. NON-PRIORITIZED NEEDS INCLUDED ACCESS TO HEALTH SERVICES, OLDER ADULTS & AGING, AND ORAL HEALTH. THESE NEEDS WERE NOT SELECTED BECAUSE THEY DID NOT MEET THE PRIORITIZATION CRITERIA AS STRONGLY AS THE SELECTED TOPICS. EVEN THOUGH NOT ALL IDENTIFIED NEEDS ARE ADDRESSED SPECIFICALLY IN THE "IMPLEMENTATION STRATEGY COMMUNITY BENEFITS" PLAN, THERE ARE POPULATION HEALTH INITIATIVES ADOPTED THROUGH THE HEALTH SYSTEM'S 2020 STRATEGIC PLAN THAT PROMOTE HEALTH AND WELL-BEING WITHIN THE COMMUNITY, AND ADDRESS NEEDS WITHIN THE CHNA.BASED ON THE SIGNIFICANT NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE FOLLOWING IMPLEMENTATION INITIATIVES WERE DEVELOPED AND OUTLINED IN OUR 2019-2021 IMPLEMENTATION STRATEGY PLAN FOR TIDALHEALTH PENINSULA REGIONAL, AND ALSO IN THE COMMUNITY HEALTH IMPROVEMENT PLAN FOR SOMERSET COUNTY HEALTH DEPARTMENT AND WICOMICO COUNTY HEALTH DEPARTMENT. THIS BOOKLET CAN BE FOUND AT HTTPS://WWW.TIDALHEALTH.ORG/PUBLICATIONS/IMPLEMENTATION-STRATEGY-COMMUNITY-BENEFIT-2019 IN ADDITION TO WHERE THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN ALSO BE FOUND. AFTER A THOROUGH REVIEW OF THE HEALTH STATUS IN OUR COMMUNITY THROUGH THE CHNA, WE IDENTIFIED AREAS THAT WE COULD ADDRESS USING OUR RESOURCES, EXPERTISE AND COMMUNITY PARTNERS. THE FOLLOWING ARE THE PRIORITIZED HEALTH NEEDS THAT WILL BE ADDRESSED:- BEHAVIORAL HEALTH (MENTAL HEALTH AND MENTAL DISORDERS AS WELL AS SUBSTANCE ABUSE) - DIABETES - CANCER (FOCUS AREAS: BREAST, COLORECTAL, CERVICAL, LUNG, SKIN)PRIORITY AREAS IDENTIFIEDBEHAVIORAL HEALTHGOALS:- ADDRESS BEHAVIORAL ISSUES IN THE TRI-COUNTY SERVICE AREA BY REDUCING THE INSTANCES OF OPIOID RELATED DEATHS.- ADDRESS BEHAVIORAL ISSUES IN THE TRI-COUNTY SERVICE AREA BY TARGETING SENIORS SUFFERING WITH MINOR TO MAJOR DEPRESSION.STRATEGIES:- COLLABORATIVELY ADDRESS THE OPIOID CRISIS IN THE TRI-COUNTY SERVICE AREA WITH AN EMPHASIS ON PREVENTION, TREATMENT, RESOURCES AND ENFORCEMENT. - PROVIDE PEER SUPPORT FOR PEOPLE WHO HAVE OVERDOSED OR SOUGHT HELP FOR OPIOID ADDICTION ISSUES.- ADDRESS DEPRESSION IN ADULTS 50 YEARS OR OLDER THROUGH SKILL BUILDING, PROBLEM SOLVING AND SOCIALIZATION ACTIVITIES.OBJECTIVES AND ANTICIPATED IMPACT:- WORK COLLABORATIVELY TO ADDRESS POLICY, DEVELOP EDUCATION AND RAISE COMMUNITY AWARENESS IN THE FIGHT AGAINST OPIOID USE, AND CONTINUE TO REDUCE INSTANCES OF HEROIN OVERDOSE EACH YEAR.- UTILIZING THE COMMUNITY OUTREACH ADDICTIONS TEAM (COAT), CONTACT AND PROVIDE LINKAGE TO TREATMENT AND OTHER SUPPORT SERVICES TO COMMUNITY MEMBERS DEALING WITH SUBSTANCE ABUSE ISSUES.- REDUCE THE INSTANCES OF DEPRESSION IN OLDER ADULTS THROUGH OUTREACH AND ACCESS TO AN EVIDENCE-BASED INTERVENTION PROGRAM. INCREASE PERCENT OF PROGRAM PARTICIPANTS WITH A SIGNIFICANT REDUCTION OF DEPRESSION ABOVE THE 2018 BASELINE OF 50%.1. TIDALHEALTH PENINSULA REGIONAL TO COLLABORATE WITH WICOMICO COUNTY OPIOID INTERVENTION TEAM AND SOMERSET COUNTY OPIOID UNITED TEAM ACTIVITIES:- BRING AWARENESS, EDUCATION AND RESOURCES TO THE COMMUNITY TO WORK TOWARD ELIMINATING OPIOID ABUSE. - TARGET AWARENESS ACTIVITIES AND CAMPAIGNS TO THE COMMUNITY AND SCHOOLS. - PARTICIPATION IN DRUG AWARENESS COALITIONS.- NARCAN TRAINING FOR COMMUNITY MEMBERS.- DEVELOP AND IMPLEMENT AN OPIOID INTERVENTION TEAM EDUCATIONAL TRAILER FOR PARENTS, GUARDIANS AND ADULTS. THIS IS A MOCK TEENAGE BEDROOM SET UP TO SHOW POSSIBLE RED FLAGS FOR UNHEALTHY BEHAVIOR AND/OR SUBSTANCE USE.- COORDINATE AND HOST FIRST RESPONDER DINNER TO HELP ADDRESS COMPASSION FATIGUE.- WORK WITH COMMUNITY PARTNERS TO COORDINATE THE GO PURPLE AWARENESS CAMPAIGN PROGRAM. 2. PROGRAM TO ENCOURAGE ACTIVE AND REWARDING LIVES (PEARLS)ACTIVITIES:- RAISE AWARENESS OF THIS FREE PROGRAM THROUGH TARGETED OUTREACH TO CLINICIANS CARING FOR OLDER ADULTS, AS WELL AS SENIOR CENTERS AND OTHER LOCAL ORGANIZATIONS SERVING OLDER COMMUNITY MEMBERS.- PROVIDE ENGAGING AND IMPACTFUL CURRICULUM IN AN EASY-TO-LEARN APPROACH THROUGH FLEXIBLE ONE-ON-ONE VISITS AT LOCATIONS CONVENIENT FOR THE COMMUNITY MEMBER BEING SERVED. 3. ER UTILIZATION REDUCTION AND ACCESS IMPROVEMENT ACTIVITIES: - SWIFT, A MOBILE INTEGRATED HEALTH TEAM, MAKES HOME-BASED VISITS TO INDIVIDUALS UTILIZING 911 AT LEAST FIVE TIMES OVER A SIX-MONTH PERIOD FOR NON-LIFE-THREATENING MEDICAL REASONS. THE TEAM PROVIDES PHYSICAL, MENTAL AND SAFETY ASSESSMENTS AND SCREENS FOR SOCIAL DETERMINANTS OF HEALTH. BASED ON THEIR ASSESSMENT, PATIENTS ARE REFERRED, AS NECESSARY, FOR APPROPRIATE CARE INTERVENTIONS SUCH AS PRIMARY CARE PROVIDERS, MEDICAL SPECIALISTS, IN HOME PROVIDERS, FINANCIAL AND SOCIAL RESOURCES, AS WELL AS OTHER COMMUNITY RESOURCES. ALIGNMENT OPPORTUNITIES: - THPR, AS PART OF A REGIONAL PARTNERSHIP WITH ATLANTIC GENERAL HOSPITAL IN WORCESTER COUNTY, SCHD AND WICHD, IS COLLABORATING WITH THE MARYLAND HEALTH SERVICE COST REVIEW COMMISSION TO DEVELOP A REGIONAL APPROACH TO BEHAVIORAL HEALTH FOR FY 2021. WORK IN THESE THREE AREAS WILL BE INCORPORATED INTO THIS TRI-COUNTY REGIONAL PARTNERSHIP AND UPDATED IN THIS DOCUMENT IN 2021.- WICHD STRATEGIC PLAN 2017-2022, PRIORITY #1: IMPROVE COMMUNITY HEALTH AND WELLNESS BY FOCUSING ON PRIORITY AREAS IDENTIFIED IN COLLABORATION WITH THE LOCAL HEALTH IMPROVEMENT COALITION: CHRONIC DISEASE AND BEHAVIORAL HEALTH. THPR AND WICHD WILL BUILD OFF THE SUCCESSFUL EFFORTS THAT WERE INCLUDED FOR THIS PROGRAM IN THEIR 2016 IMPLEMENTATION STRATEGY PLAN.COLLABORATIVE ACTIVITIES:- TRAIN PEER SUPPORT SPECIALISTS.- PROVIDE PHONE AND IN-PERSON SUPPORT FOR PEOPLE WHO HAVE OVERDOSED OR WHO STRUGGLE WITH OPIOID ADDICTION, AS WELL AS OTHER SUBSTANCE ABUSE ISSUES.- PROVIDE CONNECTIONS TO RESOURCES INCLUDING TREATMENT OPTIONS.- PROVIDE PEER OUTREACH TO HIGH-RISK AREAS OF THE COMMUNITY.- MAINTAIN ONGOING COMMUNICATIONS ABOUT METRICS BETWEEN THPR AND COAT TEAM. - EVALUATE EXPANSION TO SOMERSET COUNTY. DIABETESGOAL: IMPROVE HEALTH OF PEOPLE WITH DIABETES OR PRE-DIABETES IN THE TRI-COUNTY SERVICE AREA.STRATEGIES:- OFFER EVIDENCE-BASED CHRONIC DISEASE SELF-MANAGEMENT CLASSES (CDSM) THROUGHOUT THE TRI-COUNTY SERVICE AREA.- EXPAND ACCESS TO DIABETES SCREENING, EDUCATION AND RESOURCES THROUGHOUT THE TRI-COUNTY SERVICE AREA WITH THE WAGNER WELLNESS VAN MOBILE CLINIC SERVICES.- PROVIDE A FREE EVIDENCE-BASED WEIGHT LOSS, NUTRITION AND PHYSICAL ACTIVITY PROGRAM FOR WOMEN AND CHILDREN IN WICOMICO AND SOMERSET COUNTIES.OBJECTIVES AND ANTICIPATED IMPACT:- BY DECEMBER 2020, INCREASE THE NUMBER OF SIX-WEEK EDUCATIONAL CLASSES WITH IDENTIFIED DIABETES PATIENTS AND THEIR SUPPORTING CAREGIVERS FROM 26 TO 52 PER YEAR.- BY PARTNERING WITH OTHER COMMUNITY STAKEHOLDERS, THE COMMUNITY WELLNESS PROGRAM WILL INCREASE ACCESS TO DIABETES SCREENING, EDUCATION AND CONNECTION TO COMMUNITY RESOURCES. THIS PROGRAM, WHICH INCLUDES THE WAGNER WELLNESS VAN OUTREACH, PROVIDES HEALTH OUTREACH EVENTS THAT ARE BOTH LARGE-SCALE AND SMALL-SCALE, AND CAN BE AIMED TOWARD THE PUBLIC OR A TARGETED POPULATION OR GEOGRAPHIC AREA.- STARTING IN SEPTEMBER 2019 AND ENDING IN JUNE 2021, SCALE'S EXPECTED OUTCOMES INCLUDE: 80% OF ADULT PARTICIPANTS WILL REPORT WEIGHT LOSS OF AT LEAST 5% OF THEIR TOTAL BODY WEIGHT FROM BASELINE; 20% OF ADULT PARTICIPANTS WILL REPORT A DROP-IN HEMOGLOBIN A1C BY 0.2 POINTS OR MORE; 20% OF ADULT PARTICIPANTS WILL REPORT A DECREASE IN BLOOD PRESSURE (DIASTOLIC AND SYSTOLIC) BY 5 POINTS OR MORE; DEMONSTRATED BEHAVIOR CHANGE AND IMPROVED HEALTH STATUS. 1. CHRONIC DISEASE SELF-MANAGEMENT (CDSM) CLASSES THPR WILL BUILD OFF THE SUCCESSFUL EFFORTS THAT WERE INCLUDED FOR THIS PROGRAM IN ITS 2016 IMPLEMENTATION STRATEGY PLAN ACTIVITIES.ACTIVITIES:- TARGET AND IDENTIFY PATIENTS WHO HAVE DIABETES AND THEIR CAREGIVERS THROUGH SELF-REFERRAL OR PROVIDER REFERRAL.- TRAIN COMMUNITY PEER TRAINERS AND THPR COMMUNITY HEALTH WORKERS TO CONDUCT CLASSES.- OFFER CLASSES IN ENGLISH, SPANISH AND AMERICAN SIGN LANGUAGE.- EXPLORE THE POSSIBILITY TO OFFER CLASSES IN HAITIAN-CREOLE, KOREAN AND MANDARIN LANGUAGES, BASED ON AVAILABILITY OF PEER TRAINERS IN THESE LANGUAGES. - OFFER SIX-WEEK CLASSES AT LEAST ONCE WEEKLY.- EDUCATE PARTICIPANTS ON DIABETES SELF-MANAGEMENT AND HAVE THEM SET AND TRACK WEEKLY PERSONAL GOALS AND SHARE THOSE WITH THEIR PROVIDERS.- PARTNER WITH MAC, INC. TO COLLECT DATA ON PRE AND POST A1C VALUES.- CONNECT WITH THE STATEWIDE HEALTH INFORMATION EXCHANGE TO MAKE REFERRALS BETWEEN PROVIDER OFFICES AND MAC, INC. FOR ALL CDSM CLASSES.2. WAGNER WELLNESS VAN EXPANSIONTHPR AND WICHD WILL BUILD OFF THE SUCCESSFUL EFFORTS THAT WERE INCLUDED FOR THIS PROGRAM IN ITS 2016 IMPLEMENTATION STRATEGY PLAN.ACTIVITIES:- OUTREACH TO COMMUNITIES UTILIZING A NURSE PRACTITIONER (NP) TO PROVIDE PRIMARY CARE SERVICES. - PROVIDE SCREENINGS FOR DIABETES (OTHER SCREENINGS PROVIDED AS WELL).- IDENTIFY NEED FOR AND MAKE REFERRALS TO COMMUNITY RESOURCES FOR HEALTH EDUCATION PROGRAMS. - ENSURE THOSE PEOPLE IDENTIFIED AS DIABETIC OR PRE-DIABETIC ARE REFERRED FOR PRIMARY CARE FOLLOW UP. - TRACK RATE OF SUCCESSFUL PCP FOLLOW UP FOR ALL REFERRALS.- IDENTIFY BARRIERS TO ACCESSING PCP FOLLOW UP AND WORK TOWARDS FUTURE SOLUTIONS.3. SUSTAINABLE CHANGE AND LIFESTYLE ENHANCEMENT (SCALE)ACTIVITIES:- TARGET OUTREACH TO OVERWEIGHT WOMEN OF CHILD-BEARING AGE (UP TO AGE 55) AND OVERWEIGHT CHILDREN AGES 7 - 17. - OFFER EDUCATION AND ACTIVITIES TO ENCOURAGE HEALTHIER EATING AND PHYSICAL ACTIVITY. - PROVIDE SUPPORT THROUGH COOKING DEMONSTRATIONS, GROCERY STORE TOURS, WALKS AND BETTER ACCESS TO FRESH, HEALTHY FOOD. CANCERGOAL: - IMPROVE CANCER PREVENTION, EARLY DETECTION AND INTERVENTION/TREATMENT OF CANCER TO PROVIDE THE BEST POSSIBLE OUTCOMES IN THE TRI-COUNTY AREA FOR COLORECTAL, BREAST, CERVICAL, LUNG AND SKIN CANCERS.STRATEGIES:- PARTNER WITH WICHD AND SCHD TO EXPAND CANCER SCREENING.- UTILIZE CANCER RATE DATA TO IDENTIFY NEIGHBORHOODS WITH HIGH CANCER INCIDENCE RATES FOR TARGETED EDUCATION AND SCREENING ACTIVITIES.- COLLABORATE WITH LOCAL SCHOOL DISTRICT(S) AND COLLEGES/UNIVERSITIES TO INTEGRATE SKIN CANCER PREVENTION EDUCATION WITHIN STUDENT HEALTH CURRICULA.OBJECTIVES AND ANTICIPATED IMPACT:- WORKING IN PARTNERSHIP WITH THE WICHD AND SCHD, OFFER ADDITIONAL CANCER PREVENTION PROGRAMS AND SCREENING OPTIONS FOR LOW-INCOME COMMUNITY MEMBERS, AND CONNECT THOSE WHO NEED TREATMENT.- INCREASE KNOWLEDGE OF AT-RISK ACTIVITIES FOR CANCER, IMPORTANCE OF HEALTHY BEHAVIORS IN PREVENTION OF CANCER AND IMPORTANCE OF SCREENING ACTIVITIES.1. WAGNER WELLNESS VAN EXPANSION ACTIVITIES:- CLINICAL BREAST EXAMS - SKIN CANCER SCREENING - EDUCATION - REFERRAL FOR CANCER SCREENINGS TIDALHEALTH PENINSULA REGIONAL INC: PART V, SECTION B, LINE 13B: ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCETIDALHEALTH PENINSULA REGIONAL OFFERS FINANCIAL ASSISTANCE TO PATIENTS WHOSE INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. THPR ALSO PROVIDES FINANCIAL ASSISTANCE BASED UPON SEVERAL SPECIAL SITUATIONS:1) FINANCIAL ASSISTANCE WILL BE CONSIDERED IF PATIENT IS OVER INCOME CRITERION, BUT HAS A FINANCIAL HARDSHIP. A FINANCIAL HARDSHIP EXISTS WHEN THE AMOUNT OF MEDICAL DEBT AT TIDALHEALTH PENINSULA REGIONAL EXCEEDS 25% OF THE FAMILY'S INCOME IN A YEAR. 2) A PATIENT THAT HAS QUALIFIED FOR MARYLAND MEDICAL ASSISTANCE IS DEEMED TO AUTOMATICALLY QUALIFY FOR THPR'S FINANCIAL ASSISTANCE PROGRAM. THE AMOUNT DUE FROM A PATIENT ON THESE ACCOUNTS MAY BE WRITTEN OFF TO FINANCIAL ASSISTANCE WITH VERIFICATION OF MEDICAID ELIGIBILITY. NORMAL DOCUMENTATION REQUIREMENTS ARE WAIVED FOR FINANCIAL ASSISTANCE GRANTED UPON THE BASIS OF MARYLAND MEDICAL ASSISTANCE ELIGIBILITY.3) PATIENTS WHO ARE BENEFICIARIES/RECIPIENTS OF CERTAIN MEANS-TESTED SOCIAL SERVICES PROGRAMS ADMINISTERED BY THE STATE OF MARYLAND ARE DEEMED TO HAVE PRESUMPTIVE ELIGIBILITY FOR THPR'S FINANCIAL ASSISTANCE PROGRAM. THE AMOUNT DUE FROM A PATIENT ON THESE ACCOUNTS MAY BE WRITTEN OFF TO FINANCIAL ASSISTANCE WITH VERIFICATION OF ELIGIBILITY FOR ONE OF THESE PROGRAMS. NORMAL DOCUMENTATION REQUIREMENTS ARE WAIVED FOR FINANCIAL ASSISTANCE GRANTED UPON THE BASIS OF PRESUMPTIVE ELIGIBILITY. IT IS THE RESPONSIBILITY OF PATIENTS TO NOTIFY THE HOSPITAL THEY ARE IN A MEANS TESTED PROGRAM AND PROVIDE THE DOCUMENTATION, BUT THPR STAFF DOES INQUIRE AS TO THIS STATUS DURING THE INTAKE PROCESS AND AT OTHER POINTS DURING THE FINANCIAL ASSISTANCE DETERMINATION PROCESS.TIDALHEALTH PENINSULA REGIONAL INC:PART V, SECTION B, LINE 13H: SEE DISCLOSURE FOR SCHEDULE H, PART V, LINE 13B TIDALHEALTH PENINSULA REGIONAL INC: PART V, SECTION B, LINE 15E: PUBLICIZING THE FINANCIAL ASSISTANCE POLICYIF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, ALL EFFORTS WILL BE MADE TO HELP THE PATIENT OBTAIN ASSISTANCE THROUGH APPROPRIATE AGENCIES. IN THE EVENT THAT THE PATIENT HAS APPLIED FOR AND KEPT ALL NECESSARY APPOINTMENTS AND THIRD PARTY ASSISTANCE IS NOT AVAILABLE, TIDALHEALTH PENINSULA REGIONAL WILL PROVIDE CARE AT REDUCED OR ZERO COST.WHEN NO THIRD PARTY ASSISTANCE IS AVAILABLE TO COVER THE TOTAL BILL AND THE PATIENT INDICATES THAT THEY HAVE INSUFFICIENT FUNDS, THE FOLLOWING PROCEDURE WILL OCCUR:1) THE MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION SHOULD BE REVIEWED BY STAFF, IN CONSULTATION WITH THE PATIENT, TO MAKE INITIAL ASSESSMENT OF ELIGIBILITY.2) COMPARE PATIENT'S INCOME TO CURRENT FEDERAL POVERTY GUIDELINES. 3) IF PRELIMINARILY ELIGIBLE PER GUIDELINES, SEND MARYLAND STATE UNIFORM FINANCIAL ASSISTANCE APPLICATION TO PATIENT/GUARANTOR FOR COMPLETION AND SIGNATURE. PATIENT SHOULD ATTACH APPROPRIATE DOCUMENTATION AND RETURN TO REPRESENTATIVE WITHIN 10 DAYS.UPON RECEIPT OF THE FINANCIAL ASSISTANCE REQUEST, THE REPRESENTATIVE WILL REVIEW INCOME AND ALL DOCUMENTATION. THE PATIENT MUST BE NOTIFIED WITHIN TWO BUSINESS DAYS OF THEIR PROBABLE ELIGIBILITY AND INFORMED THAT THE FINAL DETERMINATION WILL BE MADE ONCE THE COMPLETED FORM AND ALL SUPPORTING DOCUMENTS ARE RECEIVED, REVIEWED, AND THE INFORMATION VERIFIED. INCOME INFORMATION WILL BE VERIFIED USING THE DOCUMENTATION PROVIDED BY THE PATIENT AND EXTERNAL RESOURCES WHEN AVAILABLE. A FINANCIAL ASSISTANCE DISCOUNT WILL BE APPLIED TO THE PATIENT'S RESPONSIBILITY ACCORDINGLY. 4) IF INELIGIBLE, THE REPRESENTATIVE WILL NOTIFY THE PATIENT AND RESUME NORMAL DUNNING PROCESS AND FILE DENIAL WITH THE ACCOUNT. THE DENIALS WILL BE KEPT ON FILE IN THE COLLECTION OFFICE. ALL DENIALS WILL BE REVIEWED BY THE COLLECTION COORDINATOR LEVEL OR ABOVE.THE PATIENT MAY REQUEST RECONSIDERATION BY SUBMITTING A LETTER TO THE DIRECTOR OF PATIENT FINANCIAL SERVICES INDICATING THE REASON FOR THE REQUEST.ONLY INCOME AND FAMILY SIZE WILL BE CONSIDERED IN APPROVING APPLICATIONS FOR FINANCIAL ASSISTANCE UNLESS ONE OF THE FOLLOWING THREE SCENARIOS OCCURS: - THE AMOUNT REQUESTED IS GREATER THAN $50,000.- THE TAX RETURN SHOWS A SIGNIFICANT AMOUNT OF INTEREST INCOME, OR THE PATIENT STATES THEY HAVE BEEN LIVING OFF OF THEIR SAVINGS ACCOUNTS.- DOCUMENTATION INDICATES SIGNIFICANT WEALTH.IF ONE OF THE ABOVE THREE SCENARIOS ARE APPLICABLE IN THE APPLICATION, LIQUID ASSETS MAY BE CONSIDERED INCLUDING: CHECKING AND SAVINGS ACCOUNTS, STOCKS, BONDS, CERTIFICATES OF DEPOSIT, MONEY MARKET OR ANY OTHER ACCOUNTS FOR THE PAST THREE MONTHS ALONG WITH THE PAST YEAR'S TAX RETURN, AND A CREDIT REPORT MAY BE REVIEWED. THE FOLLOWING ASSETS ARE EXCLUDED:- THE FIRST $10,000 OF MONETARY ASSETS.- UP TO $150,000 IN A PRIMARY RESIDENCE.CERTAIN RETIREMENT BENEFITS (SUCH AS A 401-K WHERE THE IRS HAS GRANTED PREFERENTIAL TAX TREATMENT AS A RETIREMENT ACCOUNT INCLUDING BUT NOT LIMITED TO DEFERRED-COMPENSATION PLANS QUALIFIED UNDER THE INTERNAL REVENUE CODE, OR NONQUALIFIED DEFERRED-COMPENSATION PLANS) WHERE THE PATIENT POTENTIALLY COULD PAY TAXES AND/OR PENALTIES BY CASHING IN THE BENEFIT.IF THE BALANCE DUE IS SUFFICIENT TO WARRANT IT AND THE ASSETS ARE SUITABLE, A LIEN WILL BE PLACED ON THE ASSETS FOR THE AMOUNT OF THE BILL. COLLECTION EFFORTS WILL CONSIST OF PLACEMENT OF THE LIEN WHICH WILL RESULT IN PAYMENT TO THE HOSPITAL UPON SALE OR TRANSFER OF THE ASSET. 5) COLLECTION COORDINATOR WILL REVIEW DOCUMENTATION.IF ELIGIBLE, THE ACCOUNT WILL BE WRITTEN OFF TO FINANCIAL ASSISTANCE AND THE "REQUEST FOR FINANCIAL ASSISTANCE" FORM FINALIZED. A COPY IS RETAINED IN THE PATIENT'S FILE. THE REPRESENTATIVE WILL CALL THE PATIENT AND NOTIFY HIM/HER OF THE FINAL DETERMINATION OF ELIGIBILITY.6) TIDALHEALTH PENINSULA REGIONAL WILL REVIEW ONLY THOSE ACCOUNTS WHERE THE PATIENT OR GUARANTOR INQUIRE ABOUT FINANCIAL ASSISTANCE, MAILS IN AN APPLICATION, OR IN THE NORMAL WORKING OF THE ACCOUNT THERE IS INDICATION THAT THE PATIENT MAY BE ELIGIBLE. ANY PATIENT/CUSTOMER SERVICE REPRESENTATIVE, FINANCIAL COUNSELOR, OR COLLECTION REPRESENTATIVE MAY BEGIN THE REQUEST PROCESS.PRE-PLANNED SERVICE MAY ONLY BE CONSIDERED FOR FINANCIAL ASSISTANCE WHEN THE SERVICE IS MEDICALLY NECESSARY. FOR EXAMPLE, NO COSMETIC SURGERY WILL BE ELIGIBLE. INPATIENT, OUTPATIENT, EMERGENCY, AND PENINSULA REGIONAL MEDICAL GROUP PHYSICIAN CHARGES ARE ALL ELIGIBLE. FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, PLAIN LANGUAGE SUMMARY AVAILABLE ON THE HOSPITAL'S WEBSITESCHEDULE H, PART V, LINES 16A, 16B & 16CWWW.TIDALHEALTH.ORG/MEDICAL-CARE/FINANCIAL-ADMIN-SERVICES/BILLING/TIDALHEALTH-FINANCIAL-ASSISTANCE MAXIMUM CHARGE AMOUNTS FOR FAP-ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, LINE 22DTIDALHEALTH PENINSULA REGIONAL IS A MARYLAND HOSPITAL. AS SUCH PATIENTS AND ALL INSURANCE COMPANIES, INCLUDING MEDICARE & MEDICAID, PAY THE SAME RATE. THIS RATE IS DETERMINED BY THE STATE AGENCY, THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION. PART I, LINE 3C: OTHER METHOD USED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCEN/A - TIDALHEALTH PENINSULA REGIONAL USES THE FPG IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS ALSO CONSIDERED IF A PATIENT IS OVER INCOME CRITERION BUT HAS FINANCIAL HARDSHIP BASED ON MEDICAL DEBT. PATIENTS WHO ARE BENEFICIARIES/RECIPIENTS OF CERTAIN MEANS-TESTED SOCIAL SERVICES PROGRAM ADMINISTERED BY THE STATE OF THE PATIENT'S RESIDENCE ARE DEEMED TO HAVE PRESUMPTIVE ELIGIBILITY FOR THPR'S FA PROGRAM. PART I, LINE 6A: COMMUNITY BENEFIT REPORTTIDALHEALTH PENINSULA REGIONAL FILES ANNUALLY A COMMUNITY BENEFIT REPORT WITH THE STATE OF MARYLAND. THE REPORT IS FILED WITH THE HSCRC (HEALTH SERVICES COST REVIEW COMMISSION). SCHEDULE H, PART I, LINE 7, COLUMN (F) FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COSTTHE AMOUNT OF BAD DEBT EXPENSE EXCLUDED FROM THE DENOMINATOR IN THE COLUMN (F) PERCENTAGES IS $5,833,942.LINE 7B COLUMN (C) & (F)- MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAKOUT ANY DIRECTED OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. COMMUNITY BENEFIT EXPENSES ARE EQUAL TO MEDICAID REVENUES IN MARYLAND, AS SUCH, THE NET EFFECT IS ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM.THE COST METHODOLOGY FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS IS THE COST-TO-CHARGE RATIO USED FOR THE CHARITY CARE PROGRAMS AND DIRECT COST METHOD FOR THE OTHER BENEFITS/PROGRAMS. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIESTIDALHEALTH PENINSULA REGIONAL FUNDS A VARIETY OF PROGRAMS THAT WORK TO PROMOTE THE HEALTH AND SAFETY OF OUR COMMUNITY. THESE PROGRAMS INCLUDE ACTIVITIES IN THE AREAS OF HOUSING, ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT, ENVIRONMENTAL IMPROVEMENTS, COALITION BUILDING, AND WORKFORCE DEVELOPMENT.THE NUMBER OF PERSONS SERVED BY THE COMMUNITY BUILDING ACTIVITIES WERE NOT TRACKED FOR ALL PROGRAMS THROUGHOUT THE COURSE OF THE YEAR. COALITION BUILDINGHISTORICALLY TIDALHEALTH PENINSULA REGIONAL HAS FACILITATED INVOLVEMENT WITH HEALTH IMPROVEMENT ORGANIZATIONS TO IDENTIFY, ASSESS, AND CREATE AGGREGATE ACTION PLANS TO ADDRESS LOCAL EMERGING AND CHRONIC COMMUNITY BENEFIT SERVICE AREA HEALTHCARE ISSUES. KATHRYN FIDDLER (EXECUTIVE DIRECTOR OF POPULATION HEALTH) AND KATHERINE RODGERS (COMMUNITY INITIATIVES DIRECTOR) ATTEND THE FOLLOWING LOCAL HEALTH IMPROVEMENT COALITION'S INCLUDING SOME OF THE FRONT-LINE CARE MANAGEMENT COORDINATORS AND PHYSICIANS.- WICOMICO COUNTY LHIC- WORCESTER COUNTY HRSA- HEALTHY SOMERSET COALITION- WORCESTER COUNTY LHIC- TRI COUNTY HEALTH IMPROVEMENT PLANNING- TRI COUNTY ALLIANCE FOR THE HOMELESS- PROJECT LIVING WELL ADVISORY COMMITTEE MAC (MAINTAINING ACTIVE CITIZENS)PHYSICIAN RECRUITING TIDALHEALTH PENINSULA REGIONAL FEELS IT IS IMPORTANT TO CONTINUALLY MONITOR SPECIALTIES WHERE A SIGNIFICANT AMOUNT OF PATIENT CARE WITHIN THE SERVICE AREA IS PROVIDED BY OLDER PHYSICIANS, AS A SUDDEN OR UNEXPECTED LOSS OF COVERAGE COULD HAVE AN ADVERSE EFFECT ON THE PROVISION OF MEDICAL SERVICES TO THE COMMUNITY. SUCCESSION PLANNING AND RECRUITMENT GO HAND-IN-HAND, AS DOES SOCIO-DEMOGRAPHICS AND GOVERNMENTAL INITIATIVES ALL OF WHICH MUST BE CONSIDERED TO ASSESS APPROPRIATE PHYSICIAN RECRUITMENT. KEY FINDINGS, ACCORDING TO THE MOST RECENT MEDICAL STAFF DEVELOPMENT PLAN, INDICATE AN IMMEDIATE NEED FOR RECRUITMENT OF PRIMARY CARE PHYSICIANS TO ENGAGE IN CHRONIC DISEASE MANAGEMENT AS PART OF OUR POPULATION HEALTH INITIATIVES. SUCCESSION PLANNING IS A KEY OBJECTIVE AS TEN PRIMARY CARE PHYSICIANS ARE ABOVE THE AGE OF 55 WHICH WILL LEAVE A VOID IN AN ALREADY UNDERSERVED AREA. DEMOGRAPHICS ALSO PLAY A KEY ROLE AS THE MEDICARE POPULATION IS GROWING AT A FASTER RATE THAN THE STATE OF MARYLAND AND THE NATION. AS A GROWING RETIREMENT COMMUNITY, THERE IS AN INCREASED NEED FOR ADDITIONAL PRIMARY CARE PHYSICIANS AND CERTAIN SPECIALTIES. THERE WILL BE A 22.7% GROWTH OF THOSE BETWEEN THE AGES OF 65 TO 74 OVER THE NEXT 5 YEARS. DEFICIENCIES AND SURPLUSES IN THE CURRENT SUPPLY OF PHYSICIANS WERE DETERMINED BY REVIEWING PHYSICIAN TO-POPULATION RATIOS, PHYSICIAN PATIENT VOLUMES, POPULATION DATA, AND OTHER DATA. MANAGEMENT CONSULTANTS RECOMMEND EVALUATING POTENTIAL RECRUITMENT OF PRIMARY CARE FAMILY MEDICINE, PRIMARY CARE INTERNAL MEDICINE AND PRIMARY CARE PEDIATRICS OVER THE NEXT SEVERAL YEARS. MEDICAL SPECIALTY NEEDS ARE DRIVEN BY THE OVERALL MARKET SUPPLY, WAIT TIMES FOR NEW PATIENT APPOINTMENTS, AND CALL COVERAGE AND INPATIENT CONSULTATION NEEDS. CURRENT MEDICAL SPECIALTY RECOMMENDATIONS INCLUDE RECRUITMENT OF THE FOLLOWING PHYSICIAN SPECIALTIES DUE TO COMMUNITY NEEDS ASSESSMENT, MARKET DEMAND AND RETIREMENT: ALLERGY/IMMUNOLOGY, DERMATOLOGY, ENDOCRINOLOGY, INFECTIOUS DISEASE, NEUROLOGY, OB/GYN, PAIN MANAGEMENT, PSYCHIATRY AND RHEUMATOLOGY. OF THE MEDICAL STAFF, 32% IS EITHER AT OR ABOVE THE AGE OF 55, WHICH POSES SUCCESSION RISK. PENINSULA REGIONAL A RURAL HOSPITAL, AND OTHER LIKE-KIND RURAL COMMUNITIES ARE TYPICALLY CHALLENGED IN BOTH RECRUITMENT AND RETENTION OF PHYSICIANS DUE TO NUMEROUS FACTORS. SOME OF THESE CHALLENGES ARE DUE TO THE LOCATION AND GEOGRAPHY OF THE AREA AND AVAILABILITY OF HEALTHCARE RESOURCES. RETAINING AND RECRUITING RESOURCES IN SUB-SPECIALTIES CAN BE HARD FOR REGIONAL RURAL HOSPITALS AND TIDALHEALTH PENINSULA REGIONAL IS NO EXCEPTION. TO ADDRESS SPECIFIC COMMUNITY HEALTHCARE NEEDS THE MEDICAL CENTER HAS HAD TO RECRUIT, RETAIN, EMPLOY AND SUBSIDIZE SOME OF THE FOLLOWING SUBSPECIALTIES; PULMONARY, NEURO-HOSPITALIST, NEUROSURGERY, MEDICAL ONCOLOGY & HEMATOLOGY, GASTROENTEROLOGY, PEDIATRIC SPECIALTIES, ENDOCRINOLOGY, CARDIOLOGY, CARDIOVASCULAR SURGERY, AND PAIN MANAGEMENT. RURAL COMMUNITIES LACK THE CULTURAL AND EDUCATIONAL RESOURCES THAT LARGER URBAN CENTERS PROVIDE MAKING IT HARDER TO RETAIN AND RECRUIT THESE PHYSICIANS. LOW POPULATION PATTERNS BY GEOGRAPHY MAKE IT MORE COSTLY AND HARDER FOR COMMUNITIES AND BUSINESSES TO PROVIDE VARIOUS TYPES OF SERVICES ESPECIALLY SPECIALTY PHYSICIAN SERVICES. OVERALL, OUR LOCAL ECONOMY IS NOT AS ROBUST AS THE URBAN CENTERS AS INDICATED BY OUR LOW AVERAGE HOUSEHOLD INCOME IN THE TRI-COUNTY AREA.DISASTER READINESSTIDALHEALTH PENINSULA REGIONAL IS A MEMBER OF DRHMAG (DELMARVA REGIONAL HEALTH MUTUAL AID GROUP) WHICH IS A COALITION OF LOCAL HEALTH DEPARTMENTS, HOSPITALS AND NURSING HOMES. THEY MEET QUARTERLY TO DISCUSS ISSUES OF DISASTER PREPAREDNESS IN THE DELMARVA REGION. THPR HAS AN INTERNAL EMERGENCY MANAGEMENT COMMITTEE THAT MEETS MONTHLY WHOSE MEMBERS INCLUDE THE SAFETY COORDINATOR, CHIEF OF SECURITY, EMERGENCY DEPARTMENT RN, RISK MANAGEMENT, INFECTION PREVENTION, EXECUTIVE TEAM REPRESENTATIVE, PHARMACIST, EMERGENCY MANAGEMENT COORDINATOR, FIREFIGHTER, AND A COUNTY HEALTH DEPARTMENT REPRESENTATIVE. THPR ALSO MEETS QUARTERLY WITH OUR LOCAL PARTNERS THAT INCLUDE FIRE, POLICE, EMERGENCY MEDICAL SERVICES, AND WICOMICO COUNTY EMERGENCY MANAGEMENT TO FACILITATE DISASTER PLANNING AND MOCK DRILLS WITHIN THE COMMUNITY. SCHEDULE H, PART III, LINES 2 AND 3 SEE RESPONSE BELOW TO LINE 4 REGARDING THE METHODOLOGY USED BY THE ORGANIZATION REGARDING BAD DEBT.SCHEDULE H, PART III, LINE 4BAD DEBT FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTSA RECEIVABLE IS RECOGNIZED WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS, WHICH HAVE THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS, ARE RECORDED AS RECEIVABLES SINCE THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE RECORDED AS A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE.DISCOUNTS RANGING FROM 2.0% TO 7.7% OF CHARGES ARE GIVEN TO MEDICARE, MEDICAID, AND CERTAIN APPROVED COMMERCIAL HEALTH INSURANCE AND HEALTH MAINTENANCE ORGANIZATION PROGRAMS FOR REGULATED SERVICES. DISCOUNTS IN VARYING PERCENTAGES ARE GIVEN FOR CERTAIN UNREGULATED SERVICES. SCHEDULE H, PART III, LINE 8 MEDICARE COSTING METHODOLOGYMEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. TIDALHEALTH PENINSULA REGIONAL PROVIDES QUALITY MEDICAL SERVICES TO ALL PATIENTS REGARDLESS OF WHAT INSURANCE THEY HAVE. APPROXIMATELY, 52.9% OF THE MEDICAL CENTER'S REVENUE IS ATTRIBUTABLE TO MEDICARE PATIENTS DURING THE YEAR ENDED JUNE 30, 2021.SCHEDULE H, PART III, LINE 9BCOLLECTION POLICYTHE TIDALHEALTH PENINSULA REGIONAL COLLECTION POLICY INCLUDES INFORMATION ABOUT OUR FINANCIAL ASSISTANCE POLICY (FAP) AND HOW TO FIND THE FAP. THE DEBT COLLECTION POLICY APPLIES TO ALL PATIENTS. ADDITIONALLY, OUR COLLECTION POLICY INSTRUCTS THAT EXTRAORDINARY COLLECTION ACTIONS (ECA) WILL BE SUSPENDED WHEN A PATIENT REQUESTS INFORMATION ON OUR FAP OR SUBMITS A FINANCIAL ASSISTANCE APPLICATION WITHIN 240 DAYS OF THE FIRST POST-DISCHARGE BILLING STATEMENT. OUR POLICY DESCRIBES WHAT TO DO IF THE FINANCIAL ASSISTANCE APPLICATION IS INCOMPLETE AND WHAT IS REQUIRED TO BE REFUNDED (AMOUNTS OVER $5) IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE AFTER MAKING A PAYMENT. WE INCLUDE CLARIFICATION OF WHAT DATES OF SERVICES ARE INCLUDED IN THE FINANCIAL ASSISTANCE SO THAT WE UNDERSTAND WHEN NORMAL COLLECTION EFFORTS ARE APPROPRIATE.WITHIN OUR COLLECTION POLICY WE DESCRIBE THAT A PATIENT DENIED FINANCIAL ASSISTANCE MAY REQUEST A RECONSIDERATION. FOR DATES OF SERVICES APPROVED FOR FINANCIAL ASSISTANCE COLLECTIONS PROCESSES ARE HALTED AS THE ACCOUNT IS ADJUSTED TO ZERO DUE FROM PATIENT. THE POLICY STATES HOW TO PROCESS THE PATIENT BALANCE WHEN ONLY A PORTION OF THE CHARGE QUALIFIED FOR FINANCIAL ASSISTANCE; COLLECTIONS WILL ONLY BE PURSUED ON THE AMOUNT THAT DID NOT QUALIFY FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: NEEDS ASSESSMENTTIDALHEALTH PENINSULA REGIONAL ASSESSES COMMUNITY HEALTH NEEDS IN PARTNERSHIP WITH THE LOCAL COUNTY HEALTH DEPARTMENTS (WICOMICO, WORCESTER, SOMERSET). WE MEET ON A REGULAR BASIS TO DISCUSS AND FORMULATE STRATEGIES AND ACTION PLANS IN WHICH WE COLLABORATE WITH EACH OTHER AND LOCAL ENTITIES TO ADDRESS RESIDENTS' MOST UNDERSERVED AND CRITICAL HEALTHCARE AND SOCIAL NEEDS. DEVELOPING RELATIONSHIPS WITH COMMUNITY PARTNERS IS CRITICAL TO CONTINUED IDENTIFICATION OF UNDERSERVED NEEDS AND POPULATION HEALTH MANAGEMENT SUCCESS; A CORNERSTONE OF TIDALHEALTH PENINSULA REGIONAL STRATEGY. THE FOLLOWING LOCAL RELATIONSHIPS, PARTNERSHIPS AND MEMBERSHIPS HAS CREATED SYNERGY PRODUCING LOCAL HEALTHCARE DIVIDENDS, EXAMPLES OF THESE RELATIONSHIPS INCLUDE THE FOLLOWING: TRI-COUNTY DIABETES ALLIANCE, SWIFT (SALISBURY WICOMICO INTEGRATED FIRSTCARE TEAM), FEDERALLY QUALIFIED HEALTH CENTERS, YMCA, PATIENT CARE ADVISORY COUNCIL, LOCAL SNFS, FAITH BASED ENTITIES, MAC (MAINTAINING ACTIVE CITIZENS), SHELTERS (HALO, HOPE), LOCAL COLLEGES & HIGH SCHOOLS. WORKING TOGETHER WITH DIVERSE AND DISPARATE LOCAL ENTITIES FOR THE UNITED BUT COMMON GOAL OF MEETING RESIDENTS' UNDERSERVED NEEDS- PLANNING TOGETHER, APPLYING RESOURCES OUR GOAL IS A HEALTHIER COMMUNITY.IN ADDITION TO THE CHNA, TIDALHEALTH PENINSULA REGIONAL HAS EMBARKED ON IDENTIFYING AND TARGETING "SUPER UTILIZERS" WITHIN OUR CBSA (COMMUNITY BENEFIT SERVICE AREA); THESE RESIDENTS WILL BE IDENTIFIED, AND TARGETED FOR POPULATION HEALTH MANAGEMENT. - DEMOGRAPHICS (BLOCK GROUPS, ZIP CODES)- RACE/ETHNICITY- AGE-COHORTS- CHRONIC CONDITIONSTHE TARGET POPULATION INCLUDES PATIENTS THAT HAVE CHRONIC CONDITIONS WHO HAVE DEMONSTRATED TO HAVE BEEN HIGH UTILIZERS AT THPR, OR ARE IDENTIFIED AS BEING AT RISK OF HIGH UTILIZATION BASED ON HIS/HER CHRONIC CONDITIONS AND PATTERNS OF CARE. CURRENT DATA INDICATES AN "OVERRELIANCE" BY LOCAL RESIDENTS ON TIDALHEALTH PENINSULA REGIONAL'S EMERGENCY ROOM FOR PRIMARY AND CHRONIC CONDITION NEEDS. IN RESPONSE, THPR HAS INTRODUCED INTERVENTIONS, CARE MANAGEMENT PROGRAMS, EDUCATION, AND FOLLOW-UP WITH MEASUREMENT AND OUTCOMES. BASED UPON A CURRENT ASSESSMENT THERE ARE APPROXIMATELY 1,000+ RESIDENTS THAT MEET THE CRITERIA OF "SUPER UTILIZERS" STRATIFIED BY SOCIO-DEMOGRAPHICS AND CHRONIC DISEASE.TIDALHEALTH PENINSULA REGIONAL IS TARGETING CBSA ZIP CODES BASED UPON SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH TO INCLUDE THE UNINSURED, INDIGENT POPULATION, RESIDENTS WHO LACK TRANSPORTATION, LACK OF EDUCATION AND AVAILABILITY OF HEALTHY FOODS. TARGETING THIS BY CLUSTER AND BLOCK GROUPS, WE SEEK TO IMPACT THE HEALTH BY PROVIDING PRIMARY HEALTH SERVICES, EDUCATION, ACCESS AND MORE IMPORTANTLY BY FOSTERING RELATIONSHIPS WITHIN THE COMMUNITY WE SERVE. FOR EXAMPLE, OUR WAGNER WELLNESS VAN TRAVELS LOCALLY TO BLOCK GROUPS WHERE THERE WAS AN IDENTIFIED NEED FOR BASIC HEALTH SERVICES, IN ADDITION TO PROVIDING HEALTH SERVICES AND EDUCATION TO LOCAL ETHNIC CHURCHES AND CIVIC ORGANIZATIONS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETIDALHEALTH PENINSULA REGIONAL MAKES AVAILABLE TO ALL PATIENTS THE HIGHEST QUALITY OF MEDICAL CARE POSSIBLE WITHIN THE RESOURCES AVAILABLE.IF A PATIENT IS UNABLE TO PAY DUE TO FINANCIAL RESOURCES, ALL EFFORTS WILL BE MADE TO HELP THE PATIENT OBTAIN ASSISTANCE THROUGH APPROPRIATE AGENCIES, OR, IF HELP IS NOT AVAILABLE, TO PROVIDE CARE AT REDUCED OR ZERO COST. ONE OF TIDALHEALTH PENINSULA REGIONAL'S OVERALL GUIDING PRINCIPLES IS THAT CONCERN OVER A HOSPITAL BILL SHOULD NEVER PREVENT ANY INDIVIDUAL FROM RECEIVING EMERGENCY HEALTH SERVICES. THE MEDICAL CENTER WILL COMMUNICATE THIS MESSAGE CLEARLY TO PROSPECTIVE PATIENTS AND TO LOCAL COMMUNITY SERVICE AGENCIES AND MAKE IT CLEAR THAT EMERGENCY SERVICES WILL BE PROVIDED WITHOUT REGARD TO ABILITY TO PAY. THE MEDICAL CENTER WILL ENSURE THAT AN EMERGENCY ADMISSION OR TREATMENT IS NOT DELAYED OR DENIED PENDING DETERMINATION OF COVERAGE OR REQUIREMENT FOR PREPAYMENT OR DEPOSIT. THE MEDICAL CENTER WILL POST ADEQUATE NOTICE OF THE AVAILABILITY OF MEDICAL SERVICES, AND THE GENERAL OBLIGATION OF THE HOSPITAL TO PROVIDE CHARITY CARE. TIDALHEALTH PENINSULA REGIONAL'S "FINANCIAL ASSISTANCE POLICY" INCLUDES THE REQUIRED LANGUAGE OF DETERMINATION OF PROBABLE ELIGIBILITY WITHIN TWO BUSINESS DAYS. ON PAGE 2, THE "FINANCIAL ASSISTANCE POLICY" STATES THAT UPON RECEIPT OF THE FINANCIAL ASSISTANCE REQUEST, THE REPRESENTATIVE WILL REVIEW INCOME AND ALL DOCUMENTATION. THE PATIENT MUST BE NOTIFIED WITHIN TWO BUSINESS DAYS OF THEIR PROBABLE ELIGIBILITY. IN ACCORDANCE WITH SECTION 1, 2 AND 3, TIDALHEALTH PENINSULA REGIONAL PROVIDES PUBLIC NOTICE AND INFORMATION REGARDING ITS CHARITY CARE POLICY IN DELMARVA'S LARGEST PAPER "THE DAILY TIMES", POSTED SIGNS IN THE ADMISSION, BUSINESS OFFICE EMERGENCY ROOM AND OTHER MAJOR SERVICE AREAS OF THE MEDICAL CENTER; ADDITIONALLY INDIVIDUAL NOTICE IS PROVIDED TO EACH SELF-PAY ACCOUNT WHO SEEKS SERVICES IN THE MEDICAL CENTER AT THE TIME OF PRE-ADMISSION, ADMISSION, OR UPON REQUEST.A COPY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED DURING INTAKE AND DISCHARGE PROCESS UPON REQUEST, AND A FINANCIAL ASSISTANCE INFORMATION BROCHURE IS PROVIDED TO ALL SELFPAY PATIENTS DURING INTAKE. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS PRINTED ON BILLING STATEMENTS SENT TO PATIENTS. THPR NOTIFIES THE PATIENT OR POTENTIAL PATIENT OF GOVERNMENT PROGRAMS, INCLUDING PROVIDING THEM WITH INITIAL ASSISTANCE TO APPLY FOR SUCH PROGRAMS.PART VI, LINE 4:COMMUNITY INFORMATIONTIDALHEALTH PENINSULA REGIONAL AT 266 LICENSED BEDS FUNCTIONS AS THE PRIMARY HOSPITAL PROVIDER FOR THE RURAL SOUTHERNMOST THREE COUNTIES OF THE EASTERN SHORE OF MARYLAND, WHICH INCLUDES WICOMICO, WORCESTER AND SOMERSET COUNTIES. APPROXIMATELY 78% OF THE PATIENTS DISCHARGED FROM THE MEDICAL CENTER ARE RESIDENTS OF THE PRIMARY SERVICE AREA, WHICH HAS AN ESTIMATED POPULATION OF APPROXIMATELY 181,350 IN 2019, AND IS EXPECTED TO INCREASE TO 185,357 OR BY 2.2% BY 2024. THE MEDICAL CENTER ALSO SERVICES DORCHESTER COUNTY, MARYLAND, THE SOUTHERN PORTION OF SUSSEX COUNTY, DELAWARE AND THE NORTHERN PORTION OF ACCOMACK COUNTY, VIRGINIA.TIDALHEALTH PENINSULA REGIONAL'S CBSA (COMMUNITY BENEFITS SERVICE AREA) CONSISTS OF THOSE ZIP CODES WITHIN OUR PRIMARY SERVICE AREA. MOST OF THE POPULATION RESIDES IN WICOMICO COUNTY (105,103) WITH SALISBURY SERVING AS THE CAPITAL OF THE EASTERN SHORE. SALISBURY IS LOCATED ON THE HEADWATERS OF THE WICOMICO RIVER AND IT IS LOCATED AT THE CROSSROADS OF THE BAY AND THE OCEAN. THE REGION IS UNIQUE; THE CITY OF SALISBURY HAS SIMILAR SOCIO-ECONOMIC AND DEMOGRAPHIC CHARACTERISTICS OF A LARGE CITY, HOWEVER, THE AREA SURROUNDING SALISBURY IS RURAL AND HAS LIKE-KIND CHARACTERISTICS OF SMALL-TOWN AMERICA. DUE TO THIS DICHOTOMY, SERVING BOTH SOMETIMES PRESENTS A CHALLENGE IN DELIVERING HEALTHCARE. THE TWO OTHER COUNTIES IN TIDALHEALTH PENINSULA REGIONAL'S CBSA INCLUDE WORCESTER COUNTY, WITH A POPULATION OF 52,030 AND SOMERSET COUNTY WITH A POPULATION OF 24,217. THE GREATER "METROPOLITAN" SALISBURY AREA (ZIP CODES 21801, 21804) HAS A HIGHER POPULATION DENSITY THAN THE SURROUNDING RURAL AREAS. THIS AREA HAS A VULNERABLE POPULATION THAT INCLUDES THE INDIGENT AND A HIGHER MEDICAID MIX. MOVING EAST TOWARDS THE BEACH, LOCATED IN WORCESTER COUNTY ARE SEVERAL LARGER TOWNS, LIKE BERLIN (21811) AND OCEAN CITY (21842) THAT HAVE A HIGH POPULATION DENSITY. SOUTH OF SALISBURY, LOCATED IN SOMERSET COUNTY, ARE THE LARGER TOWNS OF PRINCESS ANNE (21853) AND CRISFIELD (21817). EXCLUDING THE GREATER SALISBURY AREA, THE LANDSCAPE AND ENVIRONMENT IS CONSIDERED RURAL, MADE UP OF SMALL BUSINESSES AND AGRICULTURE. ALL THREE COUNTIES CAN BE CLASSIFIED AS RURAL WITH A HISTORIC ECONOMIC FOUNDATION IN AGRICULTURE, POULTRY AND TOURISM. WATERMEN AND FARMERS HAVE ALWAYS COMPRISED A LARGE PERCENTAGE OF THE PENINSULA POPULATION, HOWEVER, THEIR NUMBERS HAVE BEEN DECLINING WITH A GROWTH IN THE POPULATION AND EXPANSION OF OTHER SMALL BUSINESSES. OCEAN CITY, MD LOCATED IN WORCESTER COUNTY, IS A MAJOR TOURIST DESTINATION. DURING THE SUMMER WEEKENDS, THE CITY HOSTS BETWEEN 320,000 AND 345,000 VACATIONERS, AND UP TO 8 MILLION VISITORS ANNUALLY.THE THREE COUNTIES HAVE A DIVERSIFIED ECONOMIC BASE; HOWEVER, IT IS PREDOMINATELY MADE UP OF SMALL EMPLOYERS (COMPANIES WITH LESS THAN 50 EMPLOYEES). MAJOR EMPLOYERS INCLUDE LOCAL HOSPITALS, THE POULTRY INDUSTRY, LOCAL COLLEGES AND TEACHING INSTITUTIONS. THE MEDIAN INCOME OF $55,681 IN OUR COMMUNITY BENEFITS SERVICE AREA IS CONSIDERABLY LESS THAN MARYLAND'S MEDIAN INCOME OF $85,459. IN ADDITION, SEPTEMBER 2019 UNEMPLOYMENT RATES WERE HIGHER FOR MARYLAND'S MOST EASTERN SHORE COUNTIES. THE UNEMPLOYMENT RATE IN MARYLAND WAS 3.7%, THE NATION 3.6% COMPARED TO WICOMICO 4.1%; WORCESTER 4.7% AND SOMERSET 5.4%. RESEARCH INDICATES LOWER MEDIAN INCOMES AND HIGHER UNEMPLOYMENT RATES CONTRIBUTE TO A DISPARITY IN ACCESS TO MEDICAL CARE AND A PREVALENCE OF UNTREATED CHRONIC DISEASE.THE BABY BOOMER POPULATION (THOSE AGED 55+) REPRESENT A GREATER PORTION OF THE TOTAL POPULATION IN TIDALHEALTH PENINSULA REGIONAL'S CBSA AS COMPARED TO THE NATION. THE EASTERN SHORE OF MARYLAND IS BECOMING A POPULAR RETIREMENT DESTINATION AND THE TREND IS LIKELY TO CONTINUE. THE CHRONIC CONDITIONS OF THIS AGE GROUPING CONSUME HEALTHCARE RESOURCES AT MUCH HIGHER RATES THAN SOME OF THE OTHER YOUNGER AGE-COHORTS. MEDICARE POPULATION %-----------------------------WICOMICO 17.4%WORCESTER 29.3%SOMERSET 18.3%-----------------------------MARYLAND 17.0%UNITED STATES 17.2%SOURCE: ESRI/ARCGIS 2021TIDALHEALTH PENINSULA REGIONAL'S PRIMARY SERVICE AREA (WICOMICO, WORCESTER, SOMERSET) REPRESENT SOME OF THE NEEDIEST COUNTIES IN THE STATE OF MARYLAND (WWW.COUNTYHEALTHRANKINGS.ORG/MARYLAND), BASED UPON A SOCIONEEDS INDEX INCOME, POVERTY, UNEMPLOYMENT, OCCUPATION, EDUCATIONAL ATTAINMENT AND LINGUISTIC BARRIERS THAT ARE ASSOCIATED WITH POOR HEALTH OUTCOMES, INCLUDING PREVENTABLE HOSPITALIZATIONS AND PREMATURE DEATH. PENINSULA REGIONAL HAS ZIP CODES IN EACH OF ITS PRIMARY SERVICE AREA COUNTIES WITH HIGH SOCIONEEDS INDEX LEVELS. DEPLOYMENT OF RESOURCES IS KEY IN THESE COMMUNITIES WITH HIGH SOCIOECONOMIC NEEDS AS WE FOCUS AND TARGET PREVENTION AND OUTREACH SERVICES. TO MEET ITS MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES, TIDALHEALTH PENINSULA REGIONAL HAS DEVELOPED A POPULATION HEALTH DIVISION AND HAS ENGAGED IN POPULATION HEALTH STRATEGIES TO SUPPORT THE MARYLAND TOTAL COST OF CARE MODEL, WHICH AIMS TO IMPROVE OUTCOMES, IMPROVE THE PATIENT EXPERIENCE AND REDUCE THE TOTAL COST OF CARE. THE HOSPITAL IS COORDINATING CARE, INCLUDING MENTAL HEALTH AND POST-ACUTE CARE, ACROSS HOSPITAL AND NON-HOSPITAL SETTINGS. THE POPULATION HEALTH DIVISION INCORPORATES A MULTIDISCIPLINARY TEAM OF NURSES, SOCIAL WORKERS AND COMMUNITY HEALTH WORKERS SUPPORTING THE COMMUNITY WITH A BROAD RANGE OF PRIMARY CARE SERVICES. THE DIVISION ALSO FOSTERS COMMUNITY PARTNERSHIPS WITH LOCAL HOSPITALS ATLANTIC GENERAL AND MCCREADY HEALTH IN ADDITION TO COMMUNITY-BASED ORGANIZATIONS INCLUDING LOCAL HEALTH DEPARTMENTS, FIRE DEPARTMENTS, THE MARYLAND STATE AREA AGENCY ON AGING AND OTHER AGENCIES TO PROVIDE PATIENT SUPPORT ALIGNED WITH SOCIAL DETERMINANTS OF HEALTH. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTIDALHEALTH PENINSULA REGIONAL IS COMMITTED TO THE HEALTH OF THE RURAL COMMUNITIES IT SERVES. IN FY 2021, THE HOSPITAL'S CHARITY CARE WAS $13,412,694; COMBINED CHARITY AND BAD DEBT FOR FY 2021 WAS $19,246,636. AS PART OF TIDALHEALTH PENINSULA REGIONAL'S ONGOING COMMITMENT AND MISSION STATEMENT "TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE," WE CONTINUE TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY THROUGH BUILDING RELATIONSHIPS AND COLLABORATIONS WITH ORGANIZATIONS THAT ARE ADDRESSING UNMET HEALTH NEEDS.THE WAGNER WELLNESS VAN IS A MOBILE CLINIC THAT VISITS LOCAL SHELTERS, CHURCHES AND OTHER AREAS IN THPR'S COMMUNITY BENEFITS SERVICE AREA WHERE UNDERSERVED RESIDENTS CAN RECEIVE NON-EMERGENCY MEDICAL CARE, CHRONIC CARE MANAGEMENT AND HEALTHY LIFESTYLES EDUCATION. THE VAN VISITS AREAS WHERE THE SOCIAL DETERMINANTS OF HEALTH INDICATE THE GREATEST AMOUNT OF NEED. IT PROVIDES CARE IN AREAS WITH A HIGHER PREVALENCE OF ER VISITS, LOWER MEDIAN INCOMES, INDIGENT POPULATION, ACCESS ISSUES, COMMUNICATION BARRIERS AND OVERALL POOR HEALTH OUTCOMES. THERE HAS BEEN IMPROVED CONTROL OF DIABETES AND HYPERTENSION. THE WAGNER WELLNESS VAN STRIVES TO EDUCATE PATIENTS BY PROVIDING NUTRITIONAL AND HEALTHY LIFESTYLE COUNSELING, IN ADDITION TO MEDICATION COMPLIANCE TO CONTROL DIABETES AND HYPERTENSION. HEALTH SCREENINGS ARE PERFORMED ON RESIDENTS TO HELP DETERMINE APPROPRIATE EDUCATION, SELF-MANAGEMENT CLASS INFORMATION OR REFERRALS TO COMMUNITY RESOURCES AND SERVICES. THESE SCREENINGS INCLUDE PRE-DIABETES, HYPERTENSION AND OBESITY. WHEN WARRANTED, DRUG AND ALCOHOL MISUSE SCREENINGS ARE ALSO CONDUCTED, AND COUNSELING IS AVAILABLE. IF A RESIDENT IS AT RISK FOR DIABETES, AN A1C SCREENING IS PERFORMED TO FURTHER ASSIST WITH DIAGNOSIS AND TREATMENT.SMITH ISLAND TELEHEALTH- SMITH ISLAND IS KNOWN FOR ITS WATERMEN, SMITH ISLAND CAKE, EXCEPTIONAL SEAFOOD AND BEING ISOLATED WITH LIMITED CONTACT FROM MAINLAND VISITORS. FOR THIS REASON, TIDALHEALTH PENINSULA REGIONAL CREATED A PARTNERSHIP WITH MCCREADY HEALTH, MAC AREA AGENCY ON AGING, SOMERSET COUNTY HEALTH DEPARTMENT AND THE CRISFIELD CLINIC. THE GOAL OF THE PARTNERSHIP IS TO IMPROVE THE HEALTH OF SMITH ISLAND RESIDENTS, WITH THE TARGET OF EFFECTIVELY REDUCING POTENTIALLY AVOIDABLE ED UTILIZATION. THE PROGRAM WAS LED BY THE SMITH ISLAND COMMUNITY HEALTH STAFF, WHICH PROVIDES CHRONIC DISEASE EDUCATION, MANAGEMENT AND CONNECTS 250 RESIDENTS OF SMITH ISLAND VIA TELEHEALTH FOR PRIMARY CARE PHYSICIAN VISITS. COMMUNITY HEALTH WORKERS PLAY AN INTEGRAL ROLE IN CHANGING ISLAND RESIDENTS' HEALTH BEHAVIORS AND ACTIONS; THESE EMBEDDED HEALTH FACILITATORS ARE ABLE TO EFFECTIVELY BRIDGE RELATIONSHIPS WITH THE RESIDENTS OF SMITH ISLAND. THESE FACILITATORS ARE ESSENTIALLY A PERSONAL HEALTH COACH THAT ASSISTS RESIDENTS WITH MEDICATION MANAGEMENT, TIMELY COMPLIANCE AND ULTIMATELY HELPING GUIDE RESIDENTS THROUGH PRESCRIBED HEALTHCARE PLANS. FLU SHOTS WERE ADMINISTERED ENSURING THE RESIDENTS OF SMITH ISLAND WERE PROTECTED DURING THE FLU SEASON, EFFECTIVELY REDUCING ED VISITS. SINCE INCEPTION, THE PARTNERSHIP HAS HAD GREAT SUCCESSES. FOR EXAMPLE, THERE HAS BEEN SUBSTANTIAL REDUCTIONS IN A1C LEVELS IN RESIDENTS DIAGNOSED WITH DIABETES; A PRIME EXAMPLE OF THE "TRIPLE AIM" IMPROVING HEALTH, PROVIDING ACCESS, CHRONIC DISEASE EDUCATION, AND REDUCING THE PROBABILITY OF A FUTURE EMERGENCY DEPARTMENT VISIT. RESIDENTS ARE LEARNING HOW TO SELF-MANAGE THEIR CHRONIC DISEASES AND ARE BEING EXPOSED TO THE PRINCIPLES OF LEADING HEALTHY LIFESTYLES. TO EXPAND OUR "HEALTHY LIVING" MESSAGE, TIDALHEALTH PENINSULA REGIONAL SPONSORS AND PARTICIPATES IN MANY COMMUNITY-BASED HEALTH FAIRS PROVIDING NUTRITION EDUCATION, WEIGHT LOSS, DIABETES ASSESSMENT, MULTIPLE SCREENINGS AND HEALTH LITERACY. PARTICIPATION IN HEALTH FAIRS INCLUDE UNDERSERVED AREAS LIKE SMITH ISLAND, AN ISLAND ON THE CHESAPEAKE BAY WITH A POPULATION OF ONLY 250, A HAITIAN CREOLE HEALTH FAIR, HEALTHFEST AND SCREENINGS AT THE GOVERNOR'S BASKETBALL CHALLENGE AT THE CIVIC CENTER IN WICOMICO COUNTY. TRANSFORMING THE CULTURE THROUGH PARTICIPATION AND SPONSORSHIP OF HEALTHY LIFESTYLES AND SCREENINGS, MEETING RESIDENTS AT COMMUNITY EVENTS LOCATED THROUGHOUT THE TRI-COUNTY AREA. HEALTH ASSESSMENTS- CHOLESTEROL, HDL, TRIGLYCERIDES - RESTING 12-LEAD EKG - BODY FAT / MASS INDEX - BLOOD PRESSURE TESTING - PULSE OXIMETRY TESTING - 10-YEAR RISK ANALYSIS - REVIEW CURRENT MEDICATIONS - FOLLOW-UP CARE PLAN - EXERCISE/NUTRITION WALKWICOMICO PROMOTES WALKING TRAILS, PERSONAL CHALLENGES, AND AVENUES TO ENJOY THE OUTDOORS- THE PRIMARY OBJECTIVE IS TO INCREASE AWARENESS OF AND ENGAGEMENT IN HEALTHY LIFESTYLE BEHAVIORS PROMOTING EXERCISE TO HELP WITH WEIGHT LOSS, INCREASE ENERGY, REDUCE RISK OF CHRONIC DISEASE AND MAKE PEOPLE FEEL HAPPIER. WALKWICOMICO IS PRIMARILY TARGETING THOSE THAT RESIDE IN THE COUNTY (POP. 100,000+); HOWEVER, IT WOULD ALSO BE AN ATTRACTION FOR ADJACENT COUNTIES INCLUDING VISITORS. TIDALHEALTH PENINSULA REGIONAL, AS A PARTICIPANT, HAS A COMMON GOAL TO TRANSFORM THE COMMUNITY'S CULTURE BY PROVIDING EDUCATION, GUIDANCE AND RESOURCES TOWARDS PROMOTING EXERCISE THROUGH WALKABILITY AS AN INTEGRAL PART OF A HEALTHY LIFESTYLE. THE COALITION'S INITIATIVES INCLUDED CREATING A WEBSITE AND PHONE APP SPECIFIC TO WALKING IN WICOMICO COUNTY; COMMUNICATING WITH THE COMMUNITY VIA SOCIAL MEDIA; WORKING WITH CIVIC ORGANIZATIONS, CHURCHES, LOCAL BUSINESSES, TOWNS, COUNTY HEALTH DEPARTMENTS AND OTHER GROUPS TO ENCOURAGE LOCAL WALKABILITY. WALKWICOMICO HAS MARKED WALKING ROUTES, INCREASED THE NUMBER OF WALKING ROUTES, PARTICIPATED IN AND LAUNCHED WALKING EVENTS, AND IS ENGAGED WITH DECISION MAKERS THROUGH INPUT AND FEEDBACK ABOUT MAKING WALKING SAFER EASIER AND MORE ACCESSIBLE. TIDALHEALTH PENINSULA REGIONAL PARTICIPATES WITH MANY PARTNERS THAT MAKE IT POSSIBLE TO CREATE AND DELIVER POPULATION PROGRAMS THAT IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. THESE PARTNERS HAVE PROVIDED EXPERTISE AND ALLOCATED RESOURCES TO MEET THOSE URGENT HEALTHCARE NEEDS WITHIN OUR COMMUNITY. SOME OF THESE PARTNERS INCLUDE: WICOMICO COUNTY HEALTH DEPARTMENT, SOMERSET COUNTY HEALTH DEPARTMENT, WORCESTER COUNTY HEALTH DEPARTMENT, WICOMICO COUNTY LOCAL HEALTH IMPROVEMENT COALITION, THE CITY OF SALISBURY, YMCA, CRISFIELD CLINIC, CHESAPEAKE HEALTH CARE, SWIFT, SALISBURY FIRE DEPARTMENT/EMS, ATLANTIC GENERAL HOSPITAL, FAITH BASED ORGANIZATIONS, MCCREADY MEMORIAL HOSPITAL, MAC (MAINTAINING ACTIVE CITIZENS), LOCAL COLLEGES/ AND SCHOOLS, C.O.A.T., NATIONAL KIDNEY FOUNDATION, PENINSULA REGIONAL EMPLOYEES, POST-ACUTE CARE FACILITIES, HALO, WALKWICOMICO (COALITION), LOWER SHORE CLINIC, WICOMICO COUNTY SHERIFF'S OFFICE, RESOURCE AND RECOVERY CENTER AND OTHERS. SHERIFF'S OFFICE, RESOURCE AND RECOVERY CENTER AND OTHERS.PART VI, LINE 6:AFFILIATED HEALTH CARE SYSTEM ROLESTIDALHEALTH PENINSULA REGIONAL IS PART OF TIDALHEALTH. THE SYSTEM INCLUDES A FOUNDATION AND FOR-PROFIT ENTITIES WITH INTERESTS IN VARIOUS HEALTH CARE JOINT VENTURES. IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY THE MEDICAL CENTER, THE HEALTH SYSTEM EVALUATES THE NEEDS OF THE COMMUNITY AND WILL PARTICIPATE IN COMMUNITY BENEFIT PROGRAMS AS NEEDED.PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT:MD X 1 1 X X X X X 0 1 0 0 0 1 1 1 0 STEVEN LEONARD PRESIDENT/CEO 737498 0 228713 0 70880 0 145657 0 21164 0 1203912 0 0 0 JAMES TODD MD PHYSICIAN 853347 0 67409 0 146569 0 88171 0 14213 0 1169709 0 145351 0 ZACHARY BAKER MD PHYSICIAN 843743 0 67406 0 37218 0 14899 0 19309 0 982575 0 0 0 FAWAD KHAN MD PHYSICIAN 839624 0 67409 0 1218 0 14564 0 20381 0 943196 0 0 0 BRUCE I RITCHIE CFO 540191 0 147591 0 42506 0 142856 0 15400 0 888544 0 0 0 KARIM ARANOUT MD PHYSICIAN 613768 0 170851 0 17877 0 18447 0 16592 0 837535 0 0 0 DANIEL DANIELS MD PHYSICIAN 512259 0 254080 0 14734 0 24972 0 7973 0 814018 0 0 0 LURA LUNSFORD V.P. OPERATIONS 534203 0 113351 0 40894 0 54269 0 6549 0 749266 0 0 0 CHARLES SILVIA JR MD V.P. CHIEF MEDICAL OFFICER 483326 0 87929 0 38138 0 57815 0 11844 0 679052 0 0 0 KARIN DIBARI MD V.P. TH MEDICAL PARTNERS 451777 0 82394 0 8405 0 64037 0 18258 0 624871 0 0 0 TIMOTHY FEIST V.P. CHIEF COMPLIANCE OFFICER 285312 0 50540 0 1218 0 94027 0 12062 0 443159 0 0 0 SARAH SCOTT V.P. PEOPLE & ORGANIZATON DEV 294933 0 52803 0 23625 0 53695 0 0 0 425056 0 0 0 JAMES TRUMBLE MD V.P. CLINICAL INTEGRATION 333982 0 59717 0 0 0 14127 0 15981 0 423807 0 0 0 KATHRYN FIDDLER V.P. POPULATION HEALTH 247084 0 43645 0 7703 0 36234 0 1310 0 335976 0 0 0 SARAH ARNETT CHIEF NURSING OFFICER 244011 0 53383 0 8132 0 26638 0 3722 0 335886 0 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS TIDALHEALTH PENINSULA REGIONAL PROVIDES TRAVEL FOR COMPANIONS OF BOARD MEMBERS AND REPORTS THE VALUE OF THE COMPENSATION PROVIDED AS TAXABLE TO THE RECIPIENT. THIS POLICY HAS BEEN APPROVED BY THE BOARD. PART I, LINE 3 PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION USES A COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. THE CEO OF THE ORGANIZATION HAS A WRITTEN EMPLOYMENT CONTRACT. THE COMPENSATION COMMITTEE USES AN INDEPENDENT CONSULTANT, COMPENSATION SURVEYS AND OTHER ORGANIZATION'S FORM 990 IN THE DETERMINATION PROCESS. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TPR HAS A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (UNDER SECTION 457 (F)). THIS PLAN WAS APPROVED BY THE COMPENSATION COMMITTEE OF THE TPR BOARD OF DIRECTORS TO SUPPLEMENT THE EXECUTIVE'S RETIREMENT INCOME. THE SUPPLEMENTAL RETIREMENT PLAN WAS DEVELOPED BASED ON AN INDEPENDENT CONSULTANT REPORT ON MARKET-BASED PRACTICES FOR SUPPLEMENTAL RETIREMENT PLANS. THE PERCENTAGE OF FINAL AVERAGE PAY, THE REQUIREMENTS FOR VESTING, PARTICIPANTS, AND PAY-OUT PROVISIONS WERE ESTABLISHED, REVIEWED, AND APPROVED BY THE COMPENSATION COMMITTEE. THE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN C OR IN SCHEDULE J, PART II, COLUMN B(III) AS PART OF DEFERRED COMPENSATION. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THIS SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: STEVEN LEONARD BRUCE RITCHIE KARIN DIBARI JAMES TODD ZACHARY BAKER TPR PROVIDED THE FOLLOWING FUNDING AMOUNTS DURING 2020: STEVEN LEONARD $90,625 BRUCE RITCHIE $200,000 KARIN DIBARI $250,000 JAMES TODD $50,000 JAMES TODD RECEIVED A PARTIAL DISTRIBUTON OF $145,351 DURING 2020 BASED ON HIS PLAN'S VESTING DATES. PART I, LINE 6A, 6B AND 7 CONTINGENT COMPENSATION AND NON-FIXED PAYMENTS OFFICERS AND KEY EMPLOYEES OF TIDALHEALTH PENINSULA REGIONAL ARE PAID COMPENSATION DETERMINED BY A NUMBER OF VARIABLES INCLUDING BUT NOT LIMITED TO INDIVIDUAL GOALS AS WELL AS ORGANIZATION OPERATIONAL ACHIEVEMENTS IN SERVICE, QUALITY, SAFETY, EMPLOYEE SATISFACTION, AND COST. THE FINAL DETERMINATION OF THE CONTINGENT COMPENSATION AMOUNT IS DETERMINED AND APPROVED BY THE BOARD AS PART OF THE OVERALL COMPENSATION REVIEW OF OFFICERS AND KEY EMPLOYEES. VARIABLE COMPENSATION PAYMENTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN B(II) AND REFLECT ATTAINMENT OF CERTAIN GOALS. ALSO INCLUDED IN THAT COLUMN ARE PRODUCTIVITY PAYMENTS OF $223,330 (DANIELS) AND $167,993 (ARNAOUT). MARK EDNEY MD TRUSTEE 159302 MEDICAL STAFF FEES 0 MARK EDNEY MD TRUSTEE 275920 CHESAPEAKE UROLOGY 0 REV JANELLE BEILER TRUSTEE 102917 COASTAL HOSPICE PALLIATIVE CARE PROGRAM FEES 0 VEL NATESAN MD TRUSTEE 93913 MEDICAL DIRECTOR/RENTAL PROPERTY FEES 0 KIRSTIE SILVIA FAMILY MEMBER OF OFFICER CHARLES SILVIA, JR. 72444 EMPLOYEE COMPENSATION 0 BRIAN RITCHIE FAMILY MEMBER OF OFFICER BRUCE I. RITCHIE 54698 EMPLOYEE COMPENSATION 0 FRANCES DIBARI FAMILY MEMBER OF KEY EMPLOYEE KARIN DIBARI, M.D. 18080 EMPLOYEE COMPENSATION 0 RONDALL ALLEN PHARMD TRUSTEE 251125 UMES SCHOOL OF PHARMACY 0 MARY DIBARTOLO PHD TRUSTEE 15721 SALISBURY UNIVERSITY 0 ASHLEE PARKER FAMILY MEMBER OF TRUSTEE JAMES HARTSTEIN 35237 EMPLOYEE COMPENSATION 0 ABIGAIL SUMMERVILLE FAMILY MEMBER OF KEY EMPLOYEE 28998 EMPLOYEE COMPENSATION 0 MEMO DIRIKER PHD TRUSTEE 15721 SALISBURY UNIVERSITY 0 SCHEDULE L, PART IV DESCRIPTION OF TRANSACTIONS WITH INTERESTED PERSONSEACH OF THE ABOVE-NAMED TRUSTEES ARE OWNERS OF BUSINESSES WHICH PROVIDE SERVICES TO TIDALHEALTH PENINSULA REGIONAL. THE SERVICES PROVIDED WERE APPROVED BY INDEPENDENT MEMBERS OF THE GOVERNING BODY AND ARE CHARGED AT FAIR MARKET VALUE RATES. CHARLES SILVIA JR., BRUCE I. RITCHIE AND KARIN DIBARI HAVE FAMILY MEMBERS WHO ARE EMPLOYED BY THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS STEVEN LEONARD AND MEMO DIRIKER ARE MEMBERS OF THE BOARD OF DIRECTORS OF PENINSULA HEALTH VENTURES, A WHOLLY-OWNED TAXABLE SUBSIDIARY OF TIDALHEALTH, INC. BRUCE I. RITCHIE, TPR'S CFO, ALSO SERVES AS SECRETARY/TREASURER OF PENINSULA HEALTH VENTURES. FORM 990, PART VI, SECTION A, LINE 4 CHANGES TO GOVERNING DOCUMENTS AS OF JULY 29, 2020, PENINSULA REGIONAL MEDICAL CENTER WAS RENAMED TO TIDALHEALTH PENINSULA REGIONAL, INC. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS TIDALHEALTH, INC. IS THE SOLE CORPORATE MEMBER OF TIDALHEALTH PENINSULA REGIONAL, INC. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS OF GOVERNING BODY IN ITS CAPACITY AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, TIDALHEALTH, INC. HAS THE ABILITY TO ELECT MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL AS THE SOLE CORPORATE MEMBER, TIDALHEALTH, INC. HAS THE ABILITY TO APPROVE MAJOR EXPENDITURES AND LONG TERM BORROWINGS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS OVERSIGHT OF THE COMPLETION OF THE ORGANIZATION'S FORM 990 HAS BEEN DELEGATED TO THE CHIEF FINANCIAL OFFICER OF TIDALHEALTH, INC. BY THE PRESIDENT OF THE ORGANIZATION. ONCE THE FORM 990 AND ALL SCHEDULES HAVE BEEN PREPARED BY THE ORGANIZATION'S INDEPENDENT TAX SERVICES PROVIDER, THEY ARE REVIEWED BY THE PRESIDENT PRIOR TO FILING. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO THE FILING WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY MONITORING & ENFORCEMENT THE BOARD OF TRUSTEES ARE REQUIRED TO DISCLOSE ANNUALLY, IN WRITING, ANY AND ALL INTEREST WHICH THEY OR ANY IMMEDIATE MEMBER OF THEIR FAMILY MAY HAVE IN ANY BUSINESS ENTITY WHICH HAS OR SEEKS A CONTRACTUAL OR COMPETITIVE RELATIONSHIP WITH THE ORGANIZATION. THE BOARD HAS THE AUTHORITY TO DETERMINE IF A VIOLATION HAS OCCURRED AND WHETHER ANY INTEREST WHICH SHOULD BE DISCLOSED SHOULD DISQUALIFY A DIRECTOR FROM PARTICIPATING IN ANY SPECIFIC BOARD DISCUSSION OR BOARD MEMBERSHIP. ALL DISCLOSURES ARE REVIEWED BY THE ORGANIZATION'S CHIEF COMPLIANCE OFFICER. ANY CONFLICTS ARE PRESENTED TO THE BOARD. IF A PERSON IS CONFLICTED, THEY WILL RECUSE THEMSELVES FROM ALL DISCUSSIONS AND DELIBERATIONS TO WHICH THEY WOULD APPEAR TO BE CONFLICTED. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION USES A COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. THE CEO OF THE ORGANIZATION HAS A WRITTEN EMPLOYMENT CONTRACT. THE COMPENSATION COMMITTEE USES AN INDEPENDENT CONSULTANT, COMPENSATION SURVEYS AND OTHER ORGANIZATION'S FORM 990 IN THE DETERMINATION PROCESS. THE MEMBERS OF THE COMPENSATION COMMITTEE ARE INDEPENDENT AND RELY ON THIS COMPARABILITY DATA WHEN THEY DISCUSS AND DETERMINE THE INDIVIDUAL'S COMPENSATION. CONTEMPORANEOUS MINUTES OF SUCH DISCUSSIONS ARE KEPT AND MAINTAINED IN THE ORGANIZATION'S FILES. FORM 990, PART VI, SECTION C, LINE 19 HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE PUBLIC INFORMATION OFFICE OF TIDALHEALTH PENINSULA REGIONAL AT 100 EAST CARROLL STREET, SALISBURY, MD 21801. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 51,070,854. MANAGEMENT AND GENERAL EXPENSES 10,676,842. FUNDRAISING EXPENSES 86,495. TOTAL EXPENSES 61,834,191. FORM 990, PART X, LINE 20: TAX EXEMPT BONDS IN FEBRUARY 2015 MARYLAND HEALTH AND HIGHER EDUCATIONAL FACILITIES AUTHORITY ("MHHEFA") AUTHORIZED THE ISSUANCE OF $126,665,000 AGGREGATE PRINCIPAL AMOUNT OF REVENUE BONDS (SERIES 2015 REVENUE BONDS) AT A PREMIUM OF $20,770,000. IN MAY 2020, MHHEFA AUTHORIZED THE ISSUANCE OF $95,995,000 AGGREGATE PRINCIPAL AMOUNT OF REVENUE BONDS (SERIES 2020A REVENUE BONDS) AT A PREMIUM OF $5,944,000. THE OBLIGATED GROUP FOR THE 2020A AND 2015 BONDS (COLLECTIVELY THE "BONDS") CONSISTS OF TIDALHEALTH, INC., TPR, TN AND TPN AND THE OBLIGATED GROUP FOR THE SERIES 2021A AND B TAXABLE NOTES (COLLECTIVELY THE "TAXABLE NOTES"), CONSISTS OF TIDALHEALTH, TPR, TMP, TN, TPN AND MCCREADY FOUNDATION, INC. SUPPLEMENTAL INFORMATION ON TAX-EXEMPT BONDS REPORTED ON SCHEDULE K OF FORM 990 FOR TIDALHEALTH INC., THE PARENT ORGANIZATION. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT 40,027,954. NET ASSETS RELEASED FROM RESTRICTION -7,609,953. CHANGE IN ENDOWMENT -92,960. DECREASE IN CAPITAL -83,914,606. PARTNERSHIP INCOME - TAX ADJUSTMENT 126,734. TIDALHEALTH INC 100 EAST CARROLL STREET SALISBURY MD 21801 522132761 PARENT MD 501(C)(3) LINE 12C, III-FI N/A 0 TIDALHEALTH FOUNDATION INC 100 EAST CARROLL STREET SALISBURY MD 21801 521851935 FUNDRAISING MD 501(C)(3) LINE 7 TIDALHEALTH INC 0 TIDALHEALTH PHYSICIAN NETWORK 801 MIDDLEFORD ROAD SEAFORD DE 19973 510224470 HEALTH SERVICES DE 501(C)(3) LINE 10 TIDALHEALTH INC 0 TIDALHEALTH NANTICOKE INC 801 MIDDLEFORD ROAD SEAFORD DE 19973 510069243 HOSPITAL DE 501(C)(3) LINE 3 TIDALHEALTH INC 0 DELMARVA PENINSULA INSURANCE COMPANY PO BOX 1159 KY1-1102 GRAND CAYMAN CJ 981110617 INSURANCE CJ 501(C)(3) TIDALHEALTH INC 0 PENINSULA GENERAL HOSPITAL INS TRUST 100 EAST CARROLL STREET SALISBURY MD 21801 526321234 INSURANCE MD 501(C)(3) LINE 12C, III-FI TIDALHEALTH INC 0 MCCREADY FOUNDATION INC 201 HALL HIGHWAY CRISFIELD MD 21817 520607921 FUNDRAISING MD 501(C)(3) LINE 10 TIDALHEALTH INC 0 DELMARVA SURG CTR 641 S SALISBURY SALISBURY MD 21801 522251436 HEALTH CARE MD N/A 0 0 DELMARVA ENDOSC CTR 11103 CATHAGE ROAD BERLIN MD 21801 831509115 HEALTH CARE MD N/A 0 0 PENINSULA HEALTH VENTURES (PHV) 100 EAST CARROLL STREET SALISBURY MD 21801 522250012 P'SHIP INVESTMENT MD N/A C 0 PRLTC INC 100 EAST CARROLL STREET SALISBURY MD 21801 522190588 LONG TERM CARE MD N/A C 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 1 1 DELMARVA PENINSULA INSURANCE COMPANY R 6968392 CASH