2024-05-13T10:33:08-05:00 2023-06-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 462045108 990 2022-07-01 310537122 BETHESDA HOSPITAL INC BETH 5135696575 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 MICHAEL CROFTON VP FINANCE 5135696577 2024-05-13 1 MICHAEL CROFTON 999009999 1 SHAWNA M JANSONS P01222873 3174648600 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARK CLEMENT 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 942359430 0 X WWW.TRIHEALTH.COM X 1896 OH TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. 13 10 3584 486 1849966 0 1507882 21717015 789376335 864074245 786125 6456696 43391715 4257525 835062057 896505481 302056 382755 0 0 323261206 335679252 0 0 0 408472044 441933754 732035306 777995761 103026751 118509720 1276495484 1303230765 684395825 694073589 592099659 609157176 TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED BY PROVIDING A FULL RANGE OF HEALTH RELATED SERVICES INCLUDING PREVENTION, WELLNESS AND EDUCATION. 0 0 653403553 382755 864555201 SEE SCHEDULE H 653403553 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 390 0 1 3584 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 1 0 X MICHAEL CROFTON - VP FINANCE 5135696577 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 SR SALLY DUFFY SECRETARY 1.00 3.00 X X 0 0 0 RALPH MICHAEL VICE CHAIR 1.00 3.00 X X 0 0 0 ROBERT COLLINS MD TRUSTEE 1.00 3.00 X 0 0 0 MARK CLEMENT PRESIDENT/CEO 25.00 35.00 X X 0 2238265 79463 PHILLIP CASTELLINI TRUSTEE 1.00 3.00 X 0 0 0 KATHY KELLY CHAIR 1.00 3.00 X X 0 0 0 THEODORE TORBECK TREASURER 1.00 3.00 X X 0 0 0 PHILIP FOSTER TRUSTEE 1.00 3.00 X 0 0 0 QUINT STUDER TRUSTEE 1.00 3.00 X 0 0 0 RANCE DUKE TRUSTEE 1.00 3.00 X 0 0 0 CYNTHIA BOOTH TRUSTEE 1.00 3.00 X 0 0 0 KRISTIN COPPAGE MD MED STAFF PRESIDENT-GOOD SAM 1.00 60.00 X 0 940721 97227 LORRAINE STEPHENS MD MED STAFF PRESIDENT-BETHESDA 60.00 3.00 X 244008 0 74007 ANDREW DEVOE ASST TREASURER/EVP CFO 25.00 35.00 X 0 1284173 95684 STEVE GRACEY ASST SECRETARY/SVP LEGAL 25.00 35.00 X 0 675796 84250 DAVID COOK SVP-CHIEF HR OFFICER (END 9/22) 25.00 35.00 X 0 592888 136807 JENNY SKINNER SVP-CHIEF NURSING EXECUTIVE 25.00 35.00 X 0 555853 67157 JOHN WARD SVP-BETHESDA REGION 55.00 5.00 X 0 775177 89387 HELEN KOSELKA MD CHIEF MEDICAL OFFICER 25.00 35.00 X 0 770817 100206 TERRI HANLON-BREMER CHIEF OPERATING OFFICER 25.00 35.00 X 0 830439 79566 JAIME EASTERLING PRES. & COO-BETHESDA (END 5/23) 60.00 0.00 X 0 495552 77367 SUSAN MACY CNO-BETHESDA 60.00 0.00 X 0 357891 54349 JEREMIAH KIRKLAND PRES. & COO-BUTLER (START 7/22) 30.00 30.00 X 0 466839 89478 JOHN HUTSON MD PRES. & COO-BETHESDA (START 6/23) 60.00 0.00 X 0 512892 202788 RICAHRD OKRAGLY MD PHYSICIAN 60.00 0.00 X 264965 0 67547 ROBERT KUNKEL MD PHYSICIAN 60.00 0.00 X 248108 0 62069 ELIZABETH BEITER MD PHYSICIAN 60.00 0.00 X 239679 0 59543 SCOTT WOODS MD PHYSICIAN 60.00 0.00 X 279007 0 49821 MICHAEL WEBB MD PHYSICIAN 60.00 0.00 X 241079 0 65000 WILL GRONEMAN FORMER KEY EMPLOYEE 0.00 60.00 X 0 408837 77563 GAIL DONOVAN FORMER KEY EMPLOYEE 0.00 0.00 X 0 582038 0 KEVIN JOSEPH MD FORMER KEY EMPLOYEE 0.00 0.00 X 0 660175 46579 REBECCA BAUTE FORMER KEY EMPLOYEE 0.00 0.00 X 0 329199 50034 MICHAEL EVERETT FORMER KEY EMPLOYEE 0.00 60.00 X 0 396854 69497 LONDON QUICCI FORMER KEY EMPLOYEE 0.00 0.00 X 0 270047 19741 1516846 13144453 1895130 488 1 1 0 AMERICAN NURSING CARE 6281 TRI-RIDGE BLVD LOVELAND OH 45140 STAFFING 16341616 PREFERRED LAB PARTNERS LLC 1 MEDICAL VILLAGE DRIVE SUITE B EDGEWOOD KY 41017 LABORATORY 15967812 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 CLINICAL MAINTENANCE 7108104 SEVEN HILLS ANESTHESIA 4030 SMITH ROAD SUITE 325 CINCINNATI OH 45209 ANESTHESIA 3466469 BEACON ORTHOPEDICS & SPORTS MEDICINE 500 E BUSINESS WAY CINCINNATI OH 45241 REHABILITATION 2309231 83 21447523 56873 212619 21717015 PATIENT REVENUE 621990 752573895 751462912 1110983 PHARMACY 621990 69248063 69248063 JOA REVENUE SHARE 621990 25169264 25169264 AFFILIATED ORG. RENTAL 532000 15585286 15585286 MEDICAL RESEARCH 541700 433963 433963 1063774 324791 738983 864074245 4526253 4526253 1130598 0 1130598 1130598 1130598 47770577 13815 45853949 0 1916628 13815 1930443 1930443 9804 0 9804 9804 CAFETERIA 621990 2645971 2645971 LAB SERVICES 621990 240673 240673 MEDICAL RECORDS 621990 13133 13133 217346 217346 3117123 896505481 777871886 1849966 95066614 382755 382755 5497586 318015 5179571 1359406 1359406 257191465 211107627 46083838 13486448 10828190 2658258 38317476 28099822 10217654 19826871 16001073 3825798 16656231 16656231 1715383 15412 1699971 389758 389758 719340 719340 52934422 39262981 13671441 5657687 292133 5365554 13737274 8630714 5106560 12133088 1518642 10614446 21775503 19252493 2523010 430438 173196 257242 292691 179945 112746 19829625 19683610 146015 47720375 36451527 11268848 5239477 3001758 2237719 MEDICAL/DIETARY SUPPLY 206539419 206347774 191645 OHIO HOSPITAL FEE 20297708 20297708 0 EQUIPMENT & REPAIRS 13753997 13267645 486352 DUES AND SUBSCRIPTIONS 626750 626750 0 1484588 1007552 477036 777995761 653403553 124592208 0 61949 23845 88700864 94873305 15881787 18493940 99700 99700 1005162451 493517687 478099245 511644764 328795715 322122275 53677764 61228268 221654741 205822896 26248281 22498527 63275438 66423245 1276495484 1303230765 78227412 72228915 234560 148933 558528109 551644021 9156879 6919494 38248865 63132226 684395825 694073589 X 560384524 594546352 31715135 14610824 592099659 609157176 1276495484 1303230765 X 118509720 18331255 -119783458 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12763 12763 0 PART II-B, LINE 1: 1I) DURING THE TAX YEAR, BETHESDA HOSPITAL, INC. ("HOSPITAL") PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS, A PORTION ($115) OF WHICH RELATED TO LOBBYING ACTIVITIES. IN ADDITION, TRIHEALTH, INC., A RELATED ORGANIZATION OF HOSPITAL, WHICH PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO HOSPITAL, PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS A PORTION OF WHICH RELATED TO LOBBYING ACTIVITIES. A PORTION OF THE AFOREMENTIONED ADMINISTRATIVE SUPPORT SERVICES ARE ALLOCATED TO HOSPITAL AND $12,648 OF THE AMOUNT SHOWN ON LINE 1I REPRESENTS HOSPITAL'S SHARE OF THESE LOBBYING EXPENSES. 4431716 3025 -213494 0 4221247 5556021 12907 -242245 894967 4431716 3742157 1000130 813734 0 5556021 3720610 375 93665 72493 3742157 3726463 324903 17126 347882 3720610 1.00000 0.00000 0 1 1 5358750 5358750 596883759 238408192 358475567 3887655 2398156 1489499 307330423 248553728 58776695 91701864 4157611 87544253 511644764 INVESTMENT IN JOINT VENTURES 205822896 C 205822896 DUE FROM RELATED ORGANIZATIONS 54319388 RIGHT OF USE ASSET - OPERATING LEASE 6816088 INVESTMENT IN OUTSIDE ENTITIES 2214377 MALPRACTICE INSURANCE ASSET 3073392 66423245 THIRD PARTY SETTLEMENTS 4523619 MALPRACTICE INSURANCE/WORKERS COMP LIABILITY 3073392 DUE TO RELATED ORGANIZATIONS 55535215 63132226 X PART V, LINE 4: INVESTMENT PROCEEDS FROM ENDOWMENT FUNDS ARE USED TO SUPPORT BETHESDA HOSPITAL, INC. PROGRAMS. PART X, LINE 2: THE FINANCIAL STATEMENTS OF BETHESDA HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED COMBINED FINANCIAL STATEMENTS OF TRIHEALTH THAT REPORTS ITS AND ITS SUBSIDIARIES AND AFFILIATES LIABILITY, IF APPLICABLE, FOR UNCERTAIN TAX POSITIONS UNDER ASC 740-10-25: TRIHEALTH COMPLETED AN ANALYSIS OF UNCERTAIN TAX POSITIONS AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS AT JUNE 30, 2023 OR 2022. IN ADDITION, THE FINANCIAL STATEMENTS OF BETHESDA HOSPITAL, INC. ARE AUDITED AS PART OF ITS PARENT, BETHESDA, INC. FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF BETHESDA, INC. ("COMPANY") THAT REPORTS ITS AND ITS SUBSIDIARIES LIABILITY, IF APPLICABLE, FOR UNCERTAIN TAX POSITIONS UNDER ASC 740-10-25: THE COMPANY COMPLETED AN ANALYSIS OF UNCERTAIN TAX POSITIONS AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED ON THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2023 OR 2022. 1 1 X 1 X 1 X 1 1 0 1 1 8549403 5229086 3320317 0.00430 116137752 86417379 29720373 0.03820 0 0 124687155 91646465 33040690 0.04250 14060943 11338881 2722062 0.00350 2232556 0 2232556 0.00290 13022 0 13022 0.00000 2944091 0 2944091 0.00380 321250 0 321250 0.00040 19571862 11338881 8232981 0.01060 144259017 102985346 41273671 0.05310 40402 0 40402 0.00010 40402 40402 0.00010 0 43989192 0 125895692 149761079 -23865387 X 1 1 2 1 BETHESDA NORTH HOSPITAL 10500 MONTGOMERY ROAD CINCINNATI OH 45242 WWW.TRIHEALTH.COM 1024 X X X X X 2 BETHESDA BUTLER HOSPITAL 3125 HAMILTON-MASON ROAD HAMILTON OH 45011 WWW.TRIHEALTH.COM 1457 X X X BETHESDA NORTH HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE URL IN QUESTION 10A BELOW. X 1 21 1 WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/FULFILLING-OUR-MISSION-AND-VALUES 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 BETHESDA BUTLER HOSPITAL 2 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE URL IN QUESTION 10A BELOW. X 1 21 1 WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/FULFILLING-OUR-MISSION-AND-VALUES 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 5: THE REGIONAL CHNA METHODOLOGY AND RESULTS WERE GENERATED THROUGH AN INCLUSIVE, COMPREHENSIVE, AND BALANCED DATA COLLECTION STRATEGY.COMPREHENSIVE DATA COLLECTION THE NEEDS ASSESSMENT UTILIZED A MIXED-METHOD APPROACH TO DATA COLLECTION INCLUDING SECONDARY QUANTITATIVE DATA AND PRIMARY QUANTITATIVE (REGIONAL CHNA COMMUNITY AND PROVIDER SURVEYS) AND QUALITATIVE (FOCUS GROUPS AND INTERVIEWS) DATA. SECONDARY DATA COLLECTION, WHICH BEGAN IN JANUARY OF 2021, SOUGHT TO UNDERSTAND THE GREATEST HEALTH CONDITIONS OF THE REGION, INCLUDING PREVALENCE AND IMPACT ON COMMUNITY MEMBERS. THESE RESULTS INFORMED THE CREATION OF SURVEY ITEMS THAT WERE ORGANIZED AROUND A SET OF CO-CREATED RESEARCH QUESTIONS. EACH DATA COLLECTION STRATEGY ADHERED TO A RECRUITMENT PLAN TO ENSURE A REPRESENTATIVE SAMPLE OF COMMUNITY MEMBERS, VOICES OF MARGINALIZED POPULATIONS, AND PROVIDERS ACROSS THE HEALTH AND SOCIAL SERVICES SECTORS WERE CAPTURED.OVERALL, THE SCOPE OF DATA COLLECTION WAS ROBUST AND INFORMED THE RESULTS OF THIS REGIONAL CHNA. THIS INCLUDES:8,321 COMMUNITY SURVEYS AVAILABLE APRIL, 2021 THROUGH JUNE, 2021, IN FIVE LANGUAGES. WITHIN THIS SAMPLE, REPRESENTATION WAS SEEN ACROSS 26 COUNTIES, MALES, FEMALES, AGES 18-65+, BLACK/AFRICAN AMERICAN, MULTIRACIAL, ASIAN, AMERICAN INDIAN, ALASKAN NATIVE, WHITE, AND HISPANIC/LATINO POPULATIONS. 859 PROVIDER SURVEYS, AVAILABLE APRIL, 2021 THROUGH MAY, 2021, INCLUSIVE OF BEHAVIORAL HEALTH, EDUCATION, EMERGENCY MEDICAL SERVICES, FAITH-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, JUSTICE/CORRECTIONS, MEDICAL CARE (ADULT, GERIATRIC, PEDIATRIC) ORAL HEALTH, ORGANIZATIONS ADDRESSING HEALTH RELATED SOCIAL NEEDS AND SOCIAL DETERMINANTS OF HEALTH, PHARMACEUTICAL, AND PUBLIC HEALTH DEPARTMENTS. - PROVIDERS ALSO REPRESENTED ADMINISTRATION, DIRECT PATIENT CARE, ACADEMIC, SUPPORT STAFF, AND SUPERVISORS/MANAGEMENT. - PROVIDERS REPORTED SERVING A VARIETY OF POPULATIONS INCLUDING CHILDREN/YOUTH, PEOPLE WITH DISABILITIES, ETHNIC MINORITIES, PEOPLE EXPERIENCING HOMELESSNESS, PEOPLE IN THE JUSTICE SYSTEM, VETERANS, YOUNG ADULTS, LOW-INCOME POPULATIONS, AND LGBTQ+ POPULATIONS. 51 FOCUS GROUPS WITH 234 PEOPLE WERE HELD FROM MAY, 2021 THROUGH JULY, 2021, REPRESENTING ALL THREE MSAS. SPECIFICALLY, RECRUITMENT FOR THESE FOCUS GROUPS WERE BASED ON ADVISORY COMMITTEE IDENTIFICATION OF POPULATIONS WHO ARE TRADITIONALLY UNDERREPRESENTED, MARGINALIZED, OR EXPERIENCE GREATEST HEALTH DISPARITIES. - POPULATIONS REPRESENTED IN THESE FOCUS GROUPS INCLUDE ADULT MEN, THOSE EXPERIENCING FOSTER CARE OR FOSTER PARENTING, YOUTH AND ADULTS WITH DISABILITIES, ETHNIC, CULTURAL AND LANGUAGE MINORITIES, FIRST AND SECOND-GENERATION IMMIGRANTS, PEOPLE EXPERIENCING HOMELESSNESS, THOSE INVOLVED IN THE JUSTICE SYSTEM, LOW-INCOME FAMILIES AND INDIVIDUALS, PARENTS, VETERANS, OLDER ADULTS, COMMUNITY MEMBERS WITH LIVED EXPERIENCE OF MENTAL HEALTH AND/OR ADDICTION, AND FIRST RESPONDERS. 38 STAKEHOLDER INTERVIEWS WERE HELD SEPTEMBER 27, 2021 THROUGH OCTOBER 31, 2021, ACROSS HEALTH AND SOCIAL SERVICE PROVIDERS, SPECIFICALLY WITH THE FOLLOWING BEING REPRESENTED: MENTAL HEALTH AND SUBSTANCE USE DISORDER (SUD), PUBLIC HEALTH, HOSPITAL SYSTEMS, FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS), TRANSPORTATION, HOUSING, FOOD ACCESS, HEALTHCARE ACCESS AND POLICY, SCHOOL-BASED HEALTH AND CHILDREN'S HEALTH CARE, MATERNAL AND INFANT CARE, LGBTQ+ HEALTH CARE, PHARMACY ACCESS, AND HEALTHCARE WORKFORCE DEVELOPMENT. DUE TO CHARACTER LIMITATION IN THE SOFTWARE, THESE DATA SOURCES COULD NOT BE INCLUDED IN THIS EXPLANATION. HOWEVER, APPENDIX C OF THE CHNA CONTAINS A DETAILED DESCRIPTION OF EACH DATA COLLECTION STRATEGY INCLUDING THE SAMPLING OR RECRUITMENT STRATEGY, AND ANALYSIS. THIS CAN BE FOUND ON PAGES 59 THROUGH 69 OF THE CHNA POSTED ON TRIHEALTH'S WEBSITE.DATA COLLECTION WAS ALSO COMPREHENSIVE IN THAT COMMUNITY MEMBERS, SOCIAL SERVICE PROVIDERS AND HEALTHCARE PROFESSIONALS WERE NOT ONLY ASKED "WHAT COULD BE BETTER," BUT ALSO "WHAT IS WORKING." AS A RESULT, THIS REGIONAL CHNA INCLUDES A COLLECTION OF ASSETS AND RECOMMENDED POLICY AND PRACTICE INITIATIVES IDENTIFIED BY THE COMMUNITY THAT DIRECTLY TIE TO SYSTEM BARRIERS. THE SYMBOL (TO THE LEFT) CAN BE FOUND THROUGHOUT THIS REPORT. THIS SYMBOL IDENTIFIES A POLICY OR PRACTICE THAT ADDRESSES THE HEALTH NEED DISCUSSED IN THAT SECTION. NO DATA INFORMATION GAPS WERE IDENTIFIED WHILE CONDUCTING THE CHNA.CO-CREATED RESEARCH QUESTIONS TO CREATE THE GUIDING RESEARCH QUESTIONS, THE HEALTHCARE PROVIDERS PARTICIPATED IN A GROUP PROCESS, FACILITATED BY MEASUREMENT RESOURCES COMPANY (MRC), TO IDENTIFY THE EMERGING CURIOSITIES RELATED TO COMMUNITY HEALTH. THE EXERCISE FOCUSED ON MOVING BEYOND WHAT IS KNOWN THROUGH SECONDARY DATA AND ASKING QUESTIONS THAT CAN LEAD TO ACTION. THE FOLLOWING RESEARCH QUESTIONS WERE CO-CREATED BY THE ADVISORY COMMITTEE. 1. WHAT ARE THE GREATEST HEALTH NEEDS IN THE COMMUNITY? 2. HOW DO THE GREATEST HEALTH NEEDS DIFFER ACROSS COMMUNITIES AND COMMUNITY MEMBERS? 3. WHAT SOCIAL DETERMINANTS OF HEALTH (SDOH) DRIVE THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 4. WHAT ARE THE SYSTEMIC BARRIERS OF THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 5. WHAT ARE THE STRUCTURAL BARRIERS PROVIDERS FACE IN MEETING THE NEEDS OF THE COMMUNITY? 6. WHAT SPECIFIC ACTION STEPS CAN BE TAKEN BY VARIOUS PARTNERS TO ADDRESS THE ROOT CAUSES AND ACHIEVE MORE EQUITABLE HEALTH OUTCOMES? A. WHAT COMMUNITY-BASED EXPERTISE SHOULD BE LEVERAGED? B. WHAT BEST PRACTICES ARE BEING IMPLEMENTED? TO ANSWER THESE RESEARCH QUESTIONS, A FRAMEWORK WAS DEVELOPED FOR CENTERING EQUITY AND A COMPREHENSIVE UNDERSTANDING OF THE DRIVERS OF HEALTH CONDITIONS. FROM THIS FRAMEWORK, MRC AND THE ADVISORY COMMITTEE CO-CREATED A MIXED-METHOD DATA COLLECTION STRATEGY.EQUITY-CENTERED FRAMEWORK HEALTH EQUITY MEANS EVERYONE HAS A FAIR AND JUST OPPORTUNITY TO BE AS HEALTHY AS POSSIBLE. TO ACHIEVE AN UNDERSTANDING OF HEALTH EQUITY, EACH DATA COLLECTION STRATEGY INCLUDED MECHANISMS TO:1. HEAR THE VOICES OF COMMUNITY MEMBERS AND BE INTENTIONAL ABOUT ENGAGING COMMUNITY MEMBERS WHO ARE HISTORICALLY UNDERREPRESENTED IN COMMUNITY DATA. 2. ASK QUESTIONS ABOUT HEALTH EXPERIENCES, OUTCOMES, BARRIERS, AND SOLUTIONS. 3. DISAGGREGATE THE DATA BY REGION, AGE, RACE, AND GENDER AND OTHER CHARACTERISTICS WITH SUFFICIENT SAMPLE SIZES. 4. USE THE DATA TO CLEARLY IDENTIFY THE UNIQUE EXPERIENCES OF COMMUNITY MEMBERS. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 5: THE REGIONAL CHNA METHODOLOGY AND RESULTS WERE GENERATED THROUGH AN INCLUSIVE, COMPREHENSIVE, AND BALANCED DATA COLLECTION STRATEGY.COMPREHENSIVE DATA COLLECTION THE NEEDS ASSESSMENT UTILIZED A MIXED-METHOD APPROACH TO DATA COLLECTION INCLUDING SECONDARY QUANTITATIVE DATA AND PRIMARY QUANTITATIVE (REGIONAL CHNA COMMUNITY AND PROVIDER SURVEYS) AND QUALITATIVE (FOCUS GROUPS AND INTERVIEWS) DATA. SECONDARY DATA COLLECTION, WHICH BEGAN IN JANUARY OF 2021, SOUGHT TO UNDERSTAND THE GREATEST HEALTH CONDITIONS OF THE REGION, INCLUDING PREVALENCE AND IMPACT ON COMMUNITY MEMBERS. THESE RESULTS INFORMED THE CREATION OF SURVEY ITEMS THAT WERE ORGANIZED AROUND A SET OF CO-CREATED RESEARCH QUESTIONS. EACH DATA COLLECTION STRATEGY ADHERED TO A RECRUITMENT PLAN TO ENSURE A REPRESENTATIVE SAMPLE OF COMMUNITY MEMBERS, VOICES OF MARGINALIZED POPULATIONS, AND PROVIDERS ACROSS THE HEALTH AND SOCIAL SERVICES SECTORS WERE CAPTURED.OVERALL, THE SCOPE OF DATA COLLECTION WAS ROBUST AND INFORMED THE RESULTS OF THIS REGIONAL CHNA. THIS INCLUDES:8,321 COMMUNITY SURVEYS AVAILABLE APRIL, 2021 THROUGH JUNE, 2021, IN FIVE LANGUAGES. WITHIN THIS SAMPLE, REPRESENTATION WAS SEEN ACROSS 26 COUNTIES, MALES, FEMALES, AGES 18-65+, BLACK/AFRICAN AMERICAN, MULTIRACIAL, ASIAN, AMERICAN INDIAN, ALASKAN NATIVE, WHITE, AND HISPANIC/LATINO POPULATIONS. 859 PROVIDER SURVEYS, AVAILABLE APRIL, 2021 THROUGH MAY, 2021, INCLUSIVE OF BEHAVIORAL HEALTH, EDUCATION, EMERGENCY MEDICAL SERVICES, FAITH-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, JUSTICE/CORRECTIONS, MEDICAL CARE (ADULT, GERIATRIC, PEDIATRIC) ORAL HEALTH, ORGANIZATIONS ADDRESSING HEALTH RELATED SOCIAL NEEDS AND SOCIAL DETERMINANTS OF HEALTH, PHARMACEUTICAL, AND PUBLIC HEALTH DEPARTMENTS. - PROVIDERS ALSO REPRESENTED ADMINISTRATION, DIRECT PATIENT CARE, ACADEMIC, SUPPORT STAFF, AND SUPERVISORS/MANAGEMENT. - PROVIDERS REPORTED SERVING A VARIETY OF POPULATIONS INCLUDING CHILDREN/YOUTH, PEOPLE WITH DISABILITIES, ETHNIC MINORITIES, PEOPLE EXPERIENCING HOMELESSNESS, PEOPLE IN THE JUSTICE SYSTEM, VETERANS, YOUNG ADULTS, LOW-INCOME POPULATIONS, AND LGBTQ+ POPULATIONS. 51 FOCUS GROUPS WITH 234 PEOPLE WERE HELD FROM MAY, 2021 THROUGH JULY, 2021, REPRESENTING ALL THREE MSAS. SPECIFICALLY, RECRUITMENT FOR THESE FOCUS GROUPS WERE BASED ON ADVISORY COMMITTEE IDENTIFICATION OF POPULATIONS WHO ARE TRADITIONALLY UNDERREPRESENTED, MARGINALIZED, OR EXPERIENCE GREATEST HEALTH DISPARITIES. - POPULATIONS REPRESENTED IN THESE FOCUS GROUPS INCLUDE ADULT MEN, THOSE EXPERIENCING FOSTER CARE OR FOSTER PARENTING, YOUTH AND ADULTS WITH DISABILITIES, ETHNIC, CULTURAL AND LANGUAGE MINORITIES, FIRST AND SECOND-GENERATION IMMIGRANTS, PEOPLE EXPERIENCING HOMELESSNESS, THOSE INVOLVED IN THE JUSTICE SYSTEM, LOW-INCOME FAMILIES AND INDIVIDUALS, PARENTS, VETERANS, OLDER ADULTS, COMMUNITY MEMBERS WITH LIVED EXPERIENCE OF MENTAL HEALTH AND/OR ADDICTION, AND FIRST RESPONDERS. 38 STAKEHOLDER INTERVIEWS WERE HELD SEPTEMBER 27, 2021 THROUGH OCTOBER 31, 2021, ACROSS HEALTH AND SOCIAL SERVICE PROVIDERS, SPECIFICALLY WITH THE FOLLOWING BEING REPRESENTED: MENTAL HEALTH AND SUBSTANCE USE DISORDER (SUD), PUBLIC HEALTH, HOSPITAL SYSTEMS, FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS), TRANSPORTATION, HOUSING, FOOD ACCESS, HEALTHCARE ACCESS AND POLICY, SCHOOL-BASED HEALTH AND CHILDREN'S HEALTH CARE, MATERNAL AND INFANT CARE, LGBTQ+ HEALTH CARE, PHARMACY ACCESS, AND HEALTHCARE WORKFORCE DEVELOPMENT. DUE TO CHARACTER LIMITATION IN THE SOFTWARE, THESE DATA SOURCES COULD NOT BE INCLUDED IN THIS EXPLANATION. HOWEVER, APPENDIX C OF THE CHNA CONTAINS A DETAILED DESCRIPTION OF EACH DATA COLLECTION STRATEGY INCLUDING THE SAMPLING OR RECRUITMENT STRATEGY, AND ANALYSIS. THIS CAN BE FOUND ON PAGES 59 THROUGH 69 OF THE CHNA POSTED ON TRIHEALTH'S WEBSITE.DATA COLLECTION WAS ALSO COMPREHENSIVE IN THAT COMMUNITY MEMBERS, SOCIAL SERVICE PROVIDERS AND HEALTHCARE PROFESSIONALS WERE NOT ONLY ASKED "WHAT COULD BE BETTER," BUT ALSO "WHAT IS WORKING." AS A RESULT, THIS REGIONAL CHNA INCLUDES A COLLECTION OF ASSETS AND RECOMMENDED POLICY AND PRACTICE INITIATIVES IDENTIFIED BY THE COMMUNITY THAT DIRECTLY TIE TO SYSTEM BARRIERS. THE SYMBOL (TO THE LEFT) CAN BE FOUND THROUGHOUT THIS REPORT. THIS SYMBOL IDENTIFIES A POLICY OR PRACTICE THAT ADDRESSES THE HEALTH NEED DISCUSSED IN THAT SECTION. NO DATA INFORMATION GAPS WERE IDENTIFIED WHILE CONDUCTING THE CHNA.CO-CREATED RESEARCH QUESTIONS TO CREATE THE GUIDING RESEARCH QUESTIONS, THE HEALTHCARE PROVIDERS PARTICIPATED IN A GROUP PROCESS, FACILITATED BY MEASUREMENT RESOURCES COMPANY (MRC), TO IDENTIFY THE EMERGING CURIOSITIES RELATED TO COMMUNITY HEALTH. THE EXERCISE FOCUSED ON MOVING BEYOND WHAT IS KNOWN THROUGH SECONDARY DATA AND ASKING QUESTIONS THAT CAN LEAD TO ACTION. THE FOLLOWING RESEARCH QUESTIONS WERE CO-CREATED BY THE ADVISORY COMMITTEE. 1. WHAT ARE THE GREATEST HEALTH NEEDS IN THE COMMUNITY? 2. HOW DO THE GREATEST HEALTH NEEDS DIFFER ACROSS COMMUNITIES AND COMMUNITY MEMBERS? 3. WHAT SOCIAL DETERMINANTS OF HEALTH (SDOH) DRIVE THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 4. WHAT ARE THE SYSTEMIC BARRIERS OF THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 5. WHAT ARE THE STRUCTURAL BARRIERS PROVIDERS FACE IN MEETING THE NEEDS OF THE COMMUNITY? 6. WHAT SPECIFIC ACTION STEPS CAN BE TAKEN BY VARIOUS PARTNERS TO ADDRESS THE ROOT CAUSES AND ACHIEVE MORE EQUITABLE HEALTH OUTCOMES? A. WHAT COMMUNITY-BASED EXPERTISE SHOULD BE LEVERAGED? B. WHAT BEST PRACTICES ARE BEING IMPLEMENTED? TO ANSWER THESE RESEARCH QUESTIONS, A FRAMEWORK WAS DEVELOPED FOR CENTERING EQUITY AND A COMPREHENSIVE UNDERSTANDING OF THE DRIVERS OF HEALTH CONDITIONS. FROM THIS FRAMEWORK, MRC AND THE ADVISORY COMMITTEE CO-CREATED A MIXED-METHOD DATA COLLECTION STRATEGY.EQUITY-CENTERED FRAMEWORK HEALTH EQUITY MEANS EVERYONE HAS A FAIR AND JUST OPPORTUNITY TO BE AS HEALTHY AS POSSIBLE. TO ACHIEVE AN UNDERSTANDING OF HEALTH EQUITY, EACH DATA COLLECTION STRATEGY INCLUDED MECHANISMS TO:1. HEAR THE VOICES OF COMMUNITY MEMBERS AND BE INTENTIONAL ABOUT ENGAGING COMMUNITY MEMBERS WHO ARE HISTORICALLY UNDERREPRESENTED IN COMMUNITY DATA. 2. ASK QUESTIONS ABOUT HEALTH EXPERIENCES, OUTCOMES, BARRIERS, AND SOLUTIONS. 3. DISAGGREGATE THE DATA BY REGION, AGE, RACE, AND GENDER AND OTHER CHARACTERISTICS WITH SUFFICIENT SAMPLE SIZES. 4. USE THE DATA TO CLEARLY IDENTIFY THE UNIQUE EXPERIENCES OF COMMUNITY MEMBERS. BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 6A: * THE CHRIST HOSPITAL MT. AUBURN, * CINCINNATI CHILDREN'S HOSPITAL (CINCINNATI CHILDREN'S BURNET CAMPUS, CINCINNATI CHILDREN'S LIBERTY CAMPUS, CINCINNATI CHILDREN'S COLLEGE HILL CAMPUS)* ADAMS COUNTY REGIONAL MEDICAL CENTER,* MARGARET MARY HEALTH, * KETTERING HEALTH NETWORK (FORT HAMILTON HOSPITAL, GRANDVIEW MEDICAL CENTER, GREENE MEMORIAL HOSPITAL, KETTERING BEHAVIORAL MEDICINE CENTER, KETTERING MEDICAL CENTER, SOIN MEDICAL CENTER, SOUTHVIEW MEDICAL CENTER, SYCAMORE MEDICAL CENTER)* THE C&F LINDNER CENTER OF HOPE* BON SECOURS MERCY HEALTH (BON SECOURS MERCY HEALTH-ANDERSON HOSPITAL, BON SECOURS MERCY HEALTH-CLERMONT HOSPITAL, BON SECOURS MERCY HEALTH-FAIRFIELD HOSPITAL, BON SECOURS MERCY HEALTH-WEST HOSPITAL, BON SECOURS JEWISH HOSPITAL)* MERCY HEALTH URBANA HOSPITAL* MERCY HEALTH SPRINGFIELD REGIONAL MEDICAL CENTER* PREMIER HEALTH (ATRIUM MEDICAL CENTER, MIAMI VALLEY HOSPITAL, MIAMI VALLEY HOSPITAL NORTH, MIAMI VALLEY HOSPITAL SOUTH, UPPER VALLEY MEDICAL CENTER)* TRIHEALTH (TRIHEALTH BETHESDA BUTLER HOSPITAL, TRIHEALTH BETHESDA NORTH HOSPITAL, TRIHEALTH GOOD SAMARITAN HOSPITAL, TRIHEALTH MCCULLOUGH-HYDE MEMORIAL HOSPITAL, TRIHEALTH GOOD SAMARITAN EVENDALE HOSPITAL)* UC HEALTH (UC HEALTH DRAKE CENTER FOR POST-ACUTE CARE, UC HEALTH UNIVERSITY OF CINCINNATI MEDICAL CENTER, UC HEALTH WEST CHESTER HOSPITAL)* WILSON MEMORIAL HEALTH* WAYNE HEALTHCARE BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 6A: * THE CHRIST HOSPITAL MT. AUBURN, * CINCINNATI CHILDREN'S HOSPITAL (CINCINNATI CHILDREN'S BURNET CAMPUS, CINCINNATI CHILDREN'S LIBERTY CAMPUS, CINCINNATI CHILDREN'S COLLEGE HILL CAMPUS)* ADAMS COUNTY REGIONAL MEDICAL CENTER,* MARGARET MARY HEALTH, * KETTERING HEALTH NETWORK (FORT HAMILTON HOSPITAL, GRANDVIEW MEDICAL CENTER, GREENE MEMORIAL HOSPITAL, KETTERING BEHAVIORAL MEDICINE CENTER, KETTERING MEDICAL CENTER, SOIN MEDICAL CENTER, SOUTHVIEW MEDICAL CENTER, SYCAMORE MEDICAL CENTER)* THE C&F LINDNER CENTER OF HOPE* BON SECOURS MERCY HEALTH (BON SECOURS MERCY HEALTH-ANDERSON HOSPITAL, BON SECOURS MERCY HEALTH-CLERMONT HOSPITAL, BON SECOURS MERCY HEALTH-FAIRFIELD HOSPITAL, BON SECOURS MERCY HEALTH-WEST HOSPITAL, BON SECOURS JEWISH HOSPITAL)* MERCY HEALTH URBANA HOSPITAL* MERCY HEALTH SPRINGFIELD REGIONAL MEDICAL CENTER* PREMIER HEALTH (ATRIUM MEDICAL CENTER, MIAMI VALLEY HOSPITAL, MIAMI VALLEY HOSPITAL NORTH, MIAMI VALLEY HOSPITAL SOUTH, UPPER VALLEY MEDICAL CENTER)* TRIHEALTH (TRIHEALTH BETHESDA BUTLER HOSPITAL, TRIHEALTH BETHESDA NORTH HOSPITAL, TRIHEALTH GOOD SAMARITAN HOSPITAL, TRIHEALTH MCCULLOUGH-HYDE MEMORIAL HOSPITAL, TRIHEALTH GOOD SAMARITAN EVENDALE HOSPITAL)* UC HEALTH (UC HEALTH DRAKE CENTER FOR POST-ACUTE CARE, UC HEALTH UNIVERSITY OF CINCINNATI MEDICAL CENTER, UC HEALTH WEST CHESTER HOSPITAL)* WILSON MEMORIAL HEALTH* WAYNE HEALTHCARE BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 6B: * THE HEALTH COLLABORATIVE* GREATER DAYTON AREA HOSPITAL ASSOCIATION* ADAMS COUNTY HEALTH DEPARTMENT* AUGLAIZE COUNTY HEALTH DEPARTMENT* BROWN COUNTY HEALTH DEPARTMENT* BUTLER COUNTY HEALTH DEPARTMENT* CHAMPAIGN COUNTY HEALTH DEPARTMENT* CITY OF CINCINNATI HEALTH DEPARTMENT* CITY OF HAMILTON HEALTH DEPARTMENT* CLARK COUNTY HEALTH DEPARTMENT* CLERMONT COUNTY HEALTH DEPARTMENT* CLINTON COUNTY HEALTH DEPARTMENT* DARKE COUNTY HEALTH DEPARTMENT* FAYETTE COUNTY HEALTH DEPARTMENT* GREENE COUNTY HEALTH DEPARTMENT* HAMILTON COUNTY HEALTH DEPARTMENT* HIGHLAND COUNTY HEALTH DEPARTMENT* MIAMI COUNTY HEALTH DEPARTMENT* MONTGOMERY COUNTY HEALTH DEPARTMENT* CITY OF NORWOOD HEALTH DEPARTMENT* CITY OF PIQUA HEALTH DEPARTMENT* PREBLE COUNTY HEALTH DEPARTMENT* SHELBY COUNTY HEALTH DEPARTMENT* SPRINGDALE HEALTH DEPARTMENT* WARREN COUNTY COMBINED HEALTH DISTRICT BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 6B: * THE HEALTH COLLABORATIVE* GREATER DAYTON AREA HOSPITAL ASSOCIATION* ADAMS COUNTY HEALTH DEPARTMENT* AUGLAIZE COUNTY HEALTH DEPARTMENT* BROWN COUNTY HEALTH DEPARTMENT* BUTLER COUNTY HEALTH DEPARTMENT* CHAMPAIGN COUNTY HEALTH DEPARTMENT* CITY OF CINCINNATI HEALTH DEPARTMENT* CITY OF HAMILTON HEALTH DEPARTMENT* CLARK COUNTY HEALTH DEPARTMENT* CLERMONT COUNTY HEALTH DEPARTMENT* CLINTON COUNTY HEALTH DEPARTMENT* DARKE COUNTY HEALTH DEPARTMENT* FAYETTE COUNTY HEALTH DEPARTMENT* GREENE COUNTY HEALTH DEPARTMENT* HAMILTON COUNTY HEALTH DEPARTMENT* HIGHLAND COUNTY HEALTH DEPARTMENT* MIAMI COUNTY HEALTH DEPARTMENT* MONTGOMERY COUNTY HEALTH DEPARTMENT* CITY OF NORWOOD HEALTH DEPARTMENT* CITY OF PIQUA HEALTH DEPARTMENT* PREBLE COUNTY HEALTH DEPARTMENT* SHELBY COUNTY HEALTH DEPARTMENT* SPRINGDALE HEALTH DEPARTMENT* WARREN COUNTY COMBINED HEALTH DISTRICT BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 7D: COPY AVAILABLE WITHOUT CHARGE.PLEASE CONTACT TRIHEALTH MISSION AND CULTURE BY EITHER TELEPHONE (513-569-6248), E-MAIL (FRANK_NATION@TRIHEALTH.COM) OR MAIL (625 EDEN PARK DRIVE, 9TH FLOOR, CINCINNATI, OHIO 45202). BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 7D: COPY AVAILABLE WITHOUT CHARGE.PLEASE CONTACT TRIHEALTH MISSION AND CULTURE BY EITHER TELEPHONE (513-569-6248), E-MAIL (FRANK_NATION@TRIHEALTH.COM) OR MAIL (625 EDEN PARK DRIVE, 9TH FLOOR, CINCINNATI, OHIO 45202). BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 11: 1. SUBSTANCE ABUSE/MENTAL HEALTH - GIVEN THE HIGH PREVALENCE OF SUBSTANCE ABUSE IN THIS AREA, PARTICULARLY OPIOID ABUSE, THE FACT THAT CURRENT WORK IS NOT COMPLETED AND THERE ARE MANY COMMUNITY PARTNERS THAT ARE ENGAGING ALONG WITH TRIHEALTH, SUBSTANCE ABUSE REMAINS ONE OF THE TOP PRIORITY COMMUNITY NEEDS FOR TRIHEALTH AND BETHESDA NORTH HOSPITAL ("BNH"). THE GOAL IS TO IMPROVE EARLY IDENTIFICATION AND TREATMENT, AS WELL AS EDUCATION, TO THOSE IN OUR COMMUNITY WHO NEED THE RIGHT CARE, IN THE RIGHT SETTING, AT THE RIGHT TIME REGARDING SUBSTANCE ABUSE AND MENTAL HEALTH TO IMPROVE HEALTH OUTCOMES. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:SUBSTANCE ABUSE TREATMENT COORDINATORS - PROVIDE RN/SOCIAL WORKER WITH SPECIFIC SUBSTANCE USE TRAINING AND/OR CERTIFICATION AT INPATIENT SERVICES AND EMERGENCY DEPARTMENT LOCATIONS TO ENGAGE, ASSESS, AND PROVIDE APPOINTMENTS TO TREATMENT WITHIN 24-48 HOURS AFTER DISCHARGE. OUTPATIENT ALCOHOL AND TREATMENT PROGRAM - OFFER SUPPORT AND TREATMENT TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, IN A STRUCTURED, OUTPATIENT SETTING. INTEGRATED BEHAVIORAL HEALTH MODEL - DEVELOP A BEHAVIORAL HEALTH CARE MODEL OVER THE NEXT 18 MONTHS TO PROACTIVELY IDENTIFY PATIENT NEEDS USING A COMPREHENSIVE BEHAVIORAL HEALTH ASSESSMENT AND PROVIDE TREATMENT AS INDICATED. BEHAVIORAL HEALTH INTAKE PROGRAM - REFER PATIENTS FROM THE EMERGENCY DEPARTMENT TO THE APPROPRIATE TREATMENT SETTING AND LOCATION. BNH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING REGISTERED NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC CASH GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, ADDICTION SERVICES COUNCIL, BRIGHTVIEW, TALBERT HOUSE, NAMI OF SOUTHWEST OHIO, URBAN HEALTH PROJECT, CENTER FOR ADDICTION TREATMENT, GOOD SAMARITAN FREE HEALTH CLINIC. 2. MATERNAL/CHILD HEALTH - GIVEN THE HIGH PREVALENCE IN CERTAIN GEOGRAPHIC AREAS, THE FACT THAT CURRENT WORK IS BEING EFFECTIVE AND IS NOT COMPLETED AND THERE ARE MANY COMMUNITY PARTNERS THAT ARE ENGAGING ALONG WITH TRIHEALTH. THE GOAL IS TO REDUCE INFANT MORTALITY RATES IN OUR SERVICE AREA, AS WELL AS IMPROVE OUTCOMES FOR MATERNAL HEALTH WITH EMPHASIS ON EDUCATION, CLINICAL CARE, AND COMMUNITY OUTREACH. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:OB GYN CENTER - THE CENTER WILL PROVIDE OBSTETRICS AND GYNECOLOGICAL SERVICES TO ALL, WITH SPECIAL ATTENTION TO HEALTH DISPARITIES AND THE UNDERSERVED, IMPROVING INFANT MORTALITY OUTCOMES AND WOMEN'S HEALTH. WOMAN CENTERED MEDICAL HOME MODEL - PROGRAM WILL PROVIDE A COMPLEX NETWORK OF CARE, DELIVERED BY DEDICATED CASE MANAGERS, SOCIAL WORKERS, LACTATION CONSULTANTS, BEHAVIORAL HEALTH CONSULTANTS, COMMUNITY HEALTH WORKERS, FINANCIAL COUNSELORS, AND LEGAL AID CONSULTANTS TO PROVIDE EXCELLENT CARE WHILE ADDRESSING SOCIAL DETERMINANTS OF HEALTH. HOPE PROGRAM - PROGRAM WILL PROVIDE PATIENT-CENTERED CARE TO CHEMICALLY DEPENDENT PREGNANT WOMEN IMPROVING BIRTH OUTCOMES AND MATERNAL SUBSTANCE-FREE OUTCOMES. BNH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING RNS, DEDICATED CASE MANAGER, LACTATION EDUCATOR, BEHAVIORAL HEALTH SOCIAL WORKER, DIETICIANS, GENETIC COUNSELORS AND ASSISTANCE WITH TRANSPORTATION, FOOD PANTRY, HOME FURNISHINGS AND BABY ITEMS. IT WILL DO SO IN PARTNERSHIP WITH CRADLE CINCINNATI, URBAN HEALTH PROJECT, MARCH OF DIMES, TALBERT HOUSE FATHERHOOD PROJECT, SWEET CHEEKS DIAPER BANK, START STRONG, THINK FIRST FOR YOUR BABY, HEALTHY BEGINNINGS, HEALTHY MOMS AND BABES, GS FREE CLINIC, EVERY CHILD SUCCEEDS, CRIBS FOR KIDS, CHILDBIRTH EDUCATION ASSOCIATION. 3. ACCESS TO CARE CONTINUING THE WORK OF TRIHEALTH/BETHESDA CLINICS AND THE FREE HEALTH CENTER IS ESSENTIAL TO SUSTAINED GAINS IN IMPROVING ACCESS FOR UN- AND UNDERINSURED PEOPLE. THERE IS AN OPPORTUNITY TO BUILD ON CURRENT SIMILAR WORK THAT FUNDS PATIENTS' ACCESS TO HEALTH CARE VIA RIDES TO APPOINTMENTS, HOME FROM THE EMERGENCY DEPARTMENT AND SO FORTH.THE GOAL IS TO IMPROVE ACCESS TO CARE FOR THE UNDERSERVED POPULATIONS WITH EMPHASIS ON EDUCATION, ASSESSMENT, CARE DELIVERY AND CONNECTION TO RESOURCES WITHIN BNH, TRIHEALTH AND/OR COMMUNITY ORGANIZATIONS AND PROGRAMS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:GOOD SAMARITAN FREE CLINIC A RELATED TAX-EXEMPT ORGANIZATION TO BNH, IT IS THE ONLY FREE HEALTH CENTER IN SOUTHWEST OHIO OPEN SIX DAYS PER WEEK. IT PROVIDES ACCESS TO COMPREHENSIVE, PERSONALIZED HEALTHCARE SERVICES TO MORE THAN 1500 UNINSURED PATIENTS ANNUALLY. FACULTY MEDICAL CENTER - PROGRAM WILL PROVIDE A COMPLEX NETWORK OF CARE, DELIVERED BY PROVIDERS FROM OUR GRADUATE MEDICAL EDUCATION PROGRAM WHO ARE DEDICATED TO PROVIDING EXCELLENT CLINICAL PRIMARY CARE TO THE UNDERSERVED WHILE ADDRESSING SOCIAL DETERMINANTS OF HEALTH.TRIHEALTH OUTREACH PROGRAMS COORDINATION - IMPROVE COORDINATION OF PROGRAMS DIRECTLY TO THE UNDERSERVED COMMUNITY WITH CONNECTION TO TRIHEALTH AND COMMUNITY ORGANIZATIONS. PROGRAM COORDINATION TO INCLUDE MOBILE MAMMOGRAPHY, FREE HEALTH SCREENINGS, SENIORITY, THINK FIRST EDUCATION, PHARMACY ASSISTANCE, FOOD PROGRAMS, LEGAL AID, ADVOCACY, AND HOUSING REPAIR.BNH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING MAMMOGRAPHY VAN, NURSES, SOCIAL WORKERS, PHYSICIANS, ASSISTANCE WITH FOOD, TRANSPORTATION, LEGAL AID, SPACE AND RESOURCES FOR CLINICS, COMMUNITY WORKERS, MENTAL HEALTH SPECIALISTS. IT WILL DO SO IN PARTNERSHIP WITH PEOPLE WORKING COLLABORATIVELY, LEGAL AID OF GREATER CINCINNATI, FREE STORE FOODBANK, GREATER CINCINNATI FOUNDATION, UNITED WAY, HEALTH COLLABORATIVE, SVDP CHARITABLE PHARMACY, AND VARIOUS COMMUNITY ORGANIZATION EVENTS.4. DISEASE MANAGEMENT - SEVERAL SPECIFIC CHRONIC HEALTH ISSUES HYPERTENSION, DEPRESSION, DIABETES AND CANCERS RESULTING FROM POSTPONED SCREENINGS ALL ARE AFFECTING BLACK MALES IN THE COMMUNITY DISPROPORTIONALLY, SO WERE COMBINED INTO "DISEASE MANAGEMENT". THE GOAL IS TO IMPROVE EDUCATION, DATA COLLECTION, ASSESSMENTS, INTERVENTIONS, CULTURALLY COMPETENT CARE AND CARE MANAGEMENT, BNH WILL ADDRESS AND IMPROVE SPECIFIC CHRONIC HEALTH ISSUES THAT ARE IMPACTED BY DISPARITIES, SUCH AS HYPERTENSION, DEPRESSION, DIABETES, AND CANCERS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:HEALTH DISPARITIES DATA COLLECTION - IMPLEMENT A NEW GRANT FUNDED PROGRAM TO COLLECT HEALTH DISPARITY DATA REGARDING CHRONIC DISEASE TO ASSESS SOCIAL DETERMINANTS OF HEALTH ASSIST WITH INTERVENTIONS AND TRACK OUTCOMES. COORDINATE EXISTING (AND NEW) CHRONIC HEALTH PROGRAMS WITH AN EMPHASIS ON HEALTH DISPARITIES - COORDINATE AND ASSIMILATE CURRENT (AND FUTURE) PROGRAMS THAT ADDRESS CHRONIC DISEASE IN AREAS OF CRITICAL NEED BASED ON ZIP CODES, ETHNICITY, GENDER, AND OTHER SOCIAL DETERMINANTS OF HEALTH. DIVERSITY, EQUITY, AND INCLUSION (DEI) CARE STRATEGY - IMPROVE THE DEI CARE STRATEGY TO FOCUS ON ACCURATE DEI DOCUMENTATION IN EPIC, CULTURALLY COMPETENT CARE MODEL EDUCATION, WORKFORCE DIVERSITY, BOLD PROGRAM, GRADUATE MEDICAL EDUCATION DIVERSITY INITIATIVES, SCHOOL TO WORK PROGRAM, AND SYSTEM DEI TRAINING. TRIHEALTH (OF WHICH BNH IS A PART) PLANS TO ADDRESS THESE INITIATIVES BY CREATING A POSITION OF DIRECTOR OF HEALTH EQUITIES WITHIN THE SYSTEM, CHRONIC HEALTH OUTREACH PROGRAMS AND A COMMUNITY HEALTH NEEDS COMMITTEE AS WELL AS THE UTILIZATION OF NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, MEHARRY MEDICAL COLLEGE (HBCU), VINCENT BROWN CONSULTING, HEALTH COLLABORATIVE, INTERACT FOR HEALTH, UNITED WAY, LUMERIS, AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION, NAMI, RIDECINCINNATI.IN ITS IMPLEMENTATION PLAN, BNH PROVIDED A LIST OF COMMUNITY RESOURCES AND OTHER TRIHEALTH SYSTEM PROGRAMS AVAILABLE TO HELP ADDRESS THESE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IT SERVES. HOWEVER, DUE TO SOFTWARE CONSTRAINTS, THEY ARE NOT IDENTIFIED HERE. THIS LIST CAN BE FOUND ON PAGES 10-12 OF THE PLAN FOUND AT THE FOLLOWING URL (HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/HEALTH-NEEDS-ASSESSMENT).PLEASE NOTE THAT ALL OF THE ABOVE NEEDS BEING ADDRESSED ARE IN LINE WITH THE STATE HEALTH IMPROVEMENT PLAN (SHIP) 2020-2022. THE SIGNIFICANT HEALTH NEEDS FROM THE 2022 CHNA THAT BNH WILL NOT ADDRESS ARE AS FOLLOWS: ARTHRITIS OR OSTEOPOROSIS, LUNG/RESPIRATORY RELATED CONDITIONS, INCLUDING ASTHMA, AND ORAL/DENTAL DISEASE.THESE NEEDS ARE NOT CURRENTLY BEING ADDRESSED BY BNH AS THEY ARE DEEMED TO BE NOT PARTICULARLY ACUTE WITHIN BETHESDA HOSPITAL'S FOUR-COUNTY COMMUNITY SERVED (HAMILTON, BUTLER, CLERMONT AND WARREN COUNTIES, OHIO) BASED ON THE CRITERIA/RESEARCH USED IN THE DECISION-MAKING PROCESS. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 11: 1. SUBSTANCE ABUSE/MENTAL HEALTH - GIVEN THE HIGH PREVALENCE OF SUBSTANCE ABUSE IN THIS AREA, PARTICULARLY OPIOID ABUSE, THE FACT THAT CURRENT WORK IS NOT COMPLETED AND THERE ARE MANY COMMUNITY PARTNERS THAT ARE ENGAGING ALONG WITH TRIHEALTH, SUBSTANCE ABUSE REMAINS ONE OF THE TOP PRIORITY COMMUNITY NEEDS FOR TRIHEALTH AND BETHESDA BUTLER HOSPITAL ("BBH"). THE GOAL IS TO IMPROVE EARLY IDENTIFICATION AND TREATMENT, AS WELL AS EDUCATION, TO THOSE IN OUR COMMUNITY WHO NEED THE RIGHT CARE, IN THE RIGHT SETTING, AT THE RIGHT TIME REGARDING SUBSTANCE ABUSE AND MENTAL HEALTH TO IMPROVE HEALTH OUTCOMES. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:SUBSTANCE ABUSE TREATMENT COORDINATORS - PROVIDE RN/SOCIAL WORKER WITH SPECIFIC SUBSTANCE USE TRAINING AND/OR CERTIFICATION AT INPATIENT SERVICES AND EMERGENCY DEPARTMENT LOCATIONS TO ENGAGE, ASSESS, AND PROVIDE APPOINTMENTS TO TREATMENT WITHIN 24-48 HOURS AFTER DISCHARGE. OUTPATIENT ALCOHOL AND TREATMENT PROGRAM - OFFER SUPPORT AND TREATMENT TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, IN A STRUCTURED, OUTPATIENT SETTING. INTEGRATED BEHAVIORAL HEALTH MODEL - DEVELOP A BEHAVIORAL HEALTH CARE MODEL OVER THE NEXT 18 MONTHS TO PROACTIVELY IDENTIFY PATIENT NEEDS USING A COMPREHENSIVE BEHAVIORAL HEALTH ASSESSMENT AND PROVIDE TREATMENT AS INDICATED. BEHAVIORAL HEALTH INTAKE PROGRAM - REFER PATIENTS FROM THE EMERGENCY DEPARTMENT TO THE APPROPRIATE TREATMENT SETTING AND LOCATION. BBH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING REGISTERED NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC CASH GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, ADDICTION SERVICES COUNCIL, BRIGHTVIEW, TALBERT HOUSE, NAMI OF SOUTHWEST OHIO, URBAN HEALTH PROJECT, CENTER FOR ADDICTION TREATMENT, GOOD SAMARITAN FREE HEALTH CLINIC. 2. ACCESS TO CARE CONTINUING THE WORK OF TRIHEALTH/BETHESDA CLINICS AND THE FREE HEALTH CENTER IS ESSENTIAL TO SUSTAINED GAINS IN IMPROVING ACCESS FOR UN- AND UNDERINSURED PEOPLE. THERE IS AN OPPORTUNITY TO BUILD ON CURRENT SIMILAR WORK THAT FUNDS PATIENTS' ACCESS TO HEALTH CARE VIA RIDES TO APPOINTMENTS, HOME FROM THE EMERGENCY DEPARTMENT AND SO FORTH.THE GOAL IS TO IMPROVE ACCESS TO CARE FOR THE UNDERSERVED POPULATIONS WITH EMPHASIS ON EDUCATION, ASSESSMENT, CARE DELIVERY AND CONNECTION TO RESOURCES WITHIN BBH, TRIHEALTH AND/OR COMMUNITY ORGANIZATIONS AND PROGRAMS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:GOOD SAMARITAN FREE CLINIC A RELATED TAX-EXEMPT ORGANIZATION TO BBH, IT IS THE ONLY FREE HEALTH CENTER IN SOUTHWEST OHIO OPEN SIX DAYS PER WEEK. IT PROVIDES ACCESS TO COMPREHENSIVE, PERSONALIZED HEALTHCARE SERVICES TO MORE THAN 1500 UNINSURED PATIENTS ANNUALLY. FACULTY MEDICAL CENTER - PROGRAM WILL PROVIDE A COMPLEX NETWORK OF CARE, DELIVERED BY PROVIDERS FROM OUR GRADUATE MEDICAL EDUCATION PROGRAM WHO ARE DEDICATED TO PROVIDING EXCELLENT CLINICAL PRIMARY CARE TO THE UNDERSERVED WHILE ADDRESSING SOCIAL DETERMINANTS OF HEALTH.TRIHEALTH OUTREACH PROGRAMS COORDINATION - IMPROVE COORDINATION OF PROGRAMS DIRECTLY TO THE UNDERSERVED COMMUNITY WITH CONNECTION TO TRIHEALTH AND COMMUNITY ORGANIZATIONS. PROGRAM COORDINATION TO INCLUDE MOBILE MAMMOGRAPHY, FREE HEALTH SCREENINGS, SENIORITY, THINK FIRST EDUCATION, PHARMACY ASSISTANCE, FOOD PROGRAMS, LEGAL AID, ADVOCACY, AND HOUSING REPAIR.BBH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING MAMMOGRAPHY VAN, NURSES, SOCIAL WORKERS, PHYSICIANS, ASSISTANCE WITH FOOD, TRANSPORTATION, LEGAL AID, SPACE AND RESOURCES FOR CLINICS, COMMUNITY WORKERS, MENTAL HEALTH SPECIALISTS. IT WILL DO SO IN PARTNERSHIP WITH PEOPLE WORKING COLLABORATIVELY, LEGAL AID OF GREATER CINCINNATI, FREE STORE FOODBANK, GREATER CINCINNATI FOUNDATION, UNITED WAY, HEALTH COLLABORATIVE, SVDP CHARITABLE PHARMACY, AND VARIOUS COMMUNITY ORGANIZATION EVENTS.3. DISEASE MANAGEMENT - SEVERAL SPECIFIC CHRONIC HEALTH ISSUES HYPERTENSION, DEPRESSION, DIABETES AND CANCERS RESULTING FROM POSTPONED SCREENINGS ALL ARE AFFECTING BLACK MALES IN THE COMMUNITY DISPROPORTIONALLY, SO WERE COMBINED INTO "DISEASE MANAGEMENT". THE GOAL IS TO IMPROVE EDUCATION, DATA COLLECTION, ASSESSMENTS, INTERVENTIONS, CULTURALLY COMPETENT CARE AND CARE MANAGEMENT, BBH WILL ADDRESS AND IMPROVE SPECIFIC CHRONIC HEALTH ISSUES THAT ARE IMPACTED BY DISPARITIES, SUCH AS HYPERTENSION, DEPRESSION, DIABETES, AND CANCERS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:HEALTH DISPARITIES DATA COLLECTION - IMPLEMENT A NEW GRANT FUNDED PROGRAM TO COLLECT HEALTH DISPARITY DATA REGARDING CHRONIC DISEASE TO ASSESS SOCIAL DETERMINANTS OF HEALTH ASSIST WITH INTERVENTIONS AND TRACK OUTCOMES. COORDINATE EXISTING (AND NEW) CHRONIC HEALTH PROGRAMS WITH AN EMPHASIS ON HEALTH DISPARITIES - COORDINATE AND ASSIMILATE CURRENT (AND FUTURE) PROGRAMS THAT ADDRESS CHRONIC DISEASE IN AREAS OF CRITICAL NEED BASED ON ZIP CODES, ETHNICITY, GENDER, AND OTHER SOCIAL DETERMINANTS OF HEALTH. DIVERSITY, EQUITY, AND INCLUSION (DEI) CARE STRATEGY - IMPROVE THE DEI CARE STRATEGY TO FOCUS ON ACCURATE DEI DOCUMENTATION IN EPIC, CULTURALLY COMPETENT CARE MODEL EDUCATION, WORKFORCE DIVERSITY, BOLD PROGRAM, GRADUATE MEDICAL EDUCATION DIVERSITY INITIATIVES, SCHOOL TO WORK PROGRAM, AND SYSTEM DEI TRAINING. TRIHEALTH (OF WHICH BBH IS A PART) PLANS TO ADDRESS THESE INITIATIVES BY CREATING A POSITION OF DIRECTOR OF HEALTH EQUITIES WITHIN THE SYSTEM, CHRONIC HEALTH OUTREACH PROGRAMS AND A COMMUNITY HEALTH NEEDS COMMITTEE AS WELL AS THE UTILIZATION OF NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, MEHARRY MEDICAL COLLEGE (HBCU), VINCENT BROWN CONSULTING, HEALTH COLLABORATIVE, INTERACT FOR HEALTH, UNITED WAY, LUMERIS, AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION, NAMI, RIDECINCINNATI.IN ITS IMPLEMENTATION PLAN, BBH PROVIDED A LIST OF COMMUNITY RESOURCES AND OTHER TRIHEALTH SYSTEM PROGRAMS AVAILABLE TO HELP ADDRESS THESE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IT SERVES. HOWEVER, DUE TO SOFTWARE CONSTRAINTS, THEY ARE NOT IDENTIFIED HERE. THIS LIST CAN BE FOUND ON PAGES 10 THROUGH 12 OF THE PLAN FOUND AT THE FOLLOWING URL (HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/HEALTH-NEEDS-ASSESSMENT).PLEASE NOTE THAT ALL OF THE ABOVE NEEDS BEING ADDRESSED ARE IN LINE WITH THE STATE HEALTH IMPROVEMENT PLAN (SHIP) 2020-2022. THE SIGNIFICANT HEALTH NEEDS FROM THE 2022 CHNA THAT BBH WILL NOT ADDRESS ARE AS FOLLOWS: ARTHRITIS OR OSTEOPOROSIS, LUNG/RESPIRATORY RELATED CONDITIONS, INCLUDING ASTHMA, AND ORAL/DENTAL DISEASE.THESE NEEDS ARE NOT CURRENTLY BEING ADDRESSED BY BBH AS THEY ARE DEEMED TO BE NOT PARTICULARLY ACUTE WITHIN BBH'S COMMUNITY SERVED OF BUTLER COUNTY, OHIO BASED ON THE CRITERIA/RESEARCH USED IN THE DECISION-MAKING PROCESS.AS FOR THE REASON AS TO WHY THE MATERNAL HEALTH COMPLICATIONS PRIORITY IS NOT BEING ADDRESSED, IT IS DUE TO THIS PRIORITY BEING ADDRESSED BY OTHER TRIHEALTH HOSPITALS (SEE THE SCHEDULE H FOR BETHESDA NORTH HOSPITAL WITH THIS FORM 990 AS WELL AS THE SCHEDULE H FOR GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO (EIN 31-0537486)) AS WELL AS OTHER TRIHEALTH PARTNERS. BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE TO PART I, LINE 3C. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE TO PART I, LINE 3C. BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE TO PART I, LINE 3C. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE TO PART I, LINE 3C. 18 1 - BETHESDA MEDICAL CENTER-ARROW SPRINGS 100 ARROW SPRINGS BLVD LEBANON OH 45036 24-HOUR EMERGENCY ROOM AND COMPREHENSIVE OUTPATIENT SERVICES 2 - BETHESDA OBGYN CENTER RESIDENT CLINIC 10495 MONTGOMERY ROAD CINCINNATI OH 45242 WOMEN'S HEALTH 3 - TRIHEALTH SLEEP MEDICINE 10475 MONTGOMERY ROAD CINCINNATI OH 45242 SLEEP CENTER 4 - B NORTH MINIMALLY INVASIVE SURGERY CTR 10506 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT SURGICAL CENTER 5 - BETHESDA HAND REHABILITATION 10700 MONTGOMERY ROAD CINCINNATI OH 45242 PHYSICAL THERAPY 6 - BETHESDA LOVELAND PHYSICAL THERAPY 10675 LOVELAND-MADERIA ROAD LOVELAND OH 45140 PHYSICAL THERAPY 7 - BETHESDA FAMILY PRACTICE CENTER 1775 LEXINGTON AVE CINCINNATI OH 45212 FAMILY MEDICINE CLINIC 8 - BETHESDA ALCOHOLDRUG TREATMENT 4410 CARVER WOODS DRIVE CINCINNATI OH 45242 OUTPATIENT ALCOHOL AND DRUG TREATMENT 9 - BETHESDA BUTLER PHYSICAL THERAPY 3055 HAMILTON-MASON ROAD HAMILTON OH 45011 PHYSICAL THERAPY 10 - BETHESDA BUTLER IMAGING CENTER 3075 HAMILTON-MASON ROAD HAMILTON OH 45011 MEDICAL IMAGING 11 - TRIHEALTH SLEEP MEDICINE 3055 HAMILTON-MASON ROAD HAMILTON OH 45011 SLEEP MEDICINE CENTER 12 - BETHESDA SURGERY CENTER 10615 MONTGOMERY ROAD 300 CINCINNATI OH 45242 OUTPATIENT SURGICAL CENTER 13 - BETHESDA MONTGOMERY CARDIAC TESTING 10525 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT CARDIAC TESTING 14 - BETHESDA MONTGOMERY SLEEP CENTER 10535 MONTGOMERY ROAD CINCINNATI OH 45242 SLEEP CENTER 15 - BETHESDA MRI KENWOOD 8311 MOTGOMERY ROAD CINCINNATI OH 45236 MEDICAL IMAGING 16 - TRIHEALTH KENWOOD 8240 NORTHCREEK DRIVE CINCINNATI OH 45236 INTEGRATED OUTPATIENT CENTER 17 - THOMAS COMPREHENSIVE CARE CENTER 10506A MONTGOMERY RD CINCINNATI OH 45242 SPECIALTY SERVICES 18 - TRIHEALTH PHARMACY SOLUTIONS 4623 WESLEY AVE SUITE N CINCINNATI OH 45212 SPECIALTY PHARMACY PART I, LINE 3C: BETHESDA HOSPITAL, INC. UTILIZES THE FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING CHARITY CARE ELIGIBILITY. SEE THE RESPONSES TO PART I, LINES 3A AND 3B.AN INDIVIDUAL'S INCOME UNDER FPG IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR CHARITY CARE. ADDITIONALLY, AN INDIVIDUAL'S INCOME IN RELATION TO HIS/HER MEDICAL EXPENSES IS ALSO TAKEN INTO ACCOUNT AND SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. PART I, LINE 6A: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. THE COMMUNITY BENEFIT PROVIDED BY BETHESDA HOSPITAL, INC. IS TRACKED ON A STANDALONE BASIS; HOWEVER, ITS COMMUNITY BENEFIT IS REPORTED IN A REPORT PREPARED BY TRIHEALTH IN COMBINATION WITH ITS RELATED HOSPITALS - THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND MCCULLOUGH-HYDE MEMORIAL HOSPITAL. PART I, LINE 7: FOR THE AMOUNTS REPORTED AT COST, IN PART I, LINE 7, BETHESDA HOSPITAL, INC. UTILIZED WORKSHEET 2 - RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H, TO CALCULATE THE COST-TO-CHARGE RATIO. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES COMMUNITY BENEFIT AMOUNT REPORTED IN PART I, LINE 7(G) DOES NOT INCLUDE COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25. IT IS PRESENTED ON FORM 990, PART VIII, LINE 2 AS A DEDUCTION FROM PATIENT SERVICE REVENUE WHICH CORRESPONDS TO ITS FINANCIAL STATEMENT PRESENTATION. SEE RESPONSE TO PART III, LINE 4. THEREFORE, NO ADJUSTMENT TO TOTAL EXPENSES SHOWN ON FORM 990, PART IX, LINE 25 IS NECESSARY. PART II, COMMUNITY BUILDING ACTIVITIES: BETHESDA HOSPITAL, INC. PROVIDED CASH DONATIONS THROUGH TRIHEALTH TO VARIOUS CHARITABLE ORGANIZATIONS WITHIN THE COMMUNITY TO ADDRESS HOMELESSNESS, TO INCREASE EDUCATIONAL OPPORTUNITIES AND TO BUILD AN ECONOMIC INFRASTRUCTURE.IN ADDITION, DURING THE TAX YEAR, BETHESDA HOSPITAL, INC. HELD A SERVE DAY WHERE 85 TEAM MEMBERS DONATED A TOTAL OF 341 HOURS AND ASSISTED THREE (3) LOCAL ORGANIZATIONS WITH VARIOUS COMMUNITY SERVICE PROJECTS. PART III, LINE 2: SEE PART VI RESPONSE TO PART III, LINE 4. PART III, LINE 3: SEE PART VI RESPONSE TO PART III, LINE 4. PART III, LINE 4: BETHESDA HOSPITAL, INC.'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF THE TRIHEALTH AUDIT REPORT.PLEASE NOTE THAT UNDER ACCOUNTING STANDARDS UPDATE NO. 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606), WHICH THE TRIHEALTH SYSTEM ADOPTED DURING THE TAX YEAR 2019 (FISCAL YEAR ENDED JUNE 30, 2020), BAD DEBT IS CONSIDERED AN "IMPLICIT PRICE CONCESSION AND IS NOT DISTINGUISHED FROM A CONTRACTUAL ADJUSTMENT UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND THEREFORE THERE IS NO LONGER A SPECIFIC DISCLOSURE FOR BAD DEBT IN THE CURRENT YEAR AUDIT REPORT.SEE PATIENT SERVICE REVENUE (PART OF FOOTNOTE B - PAGES 18-22) FOR ADDITIONAL DETAIL REGARDING THE ABOVE-MENTIONED STANDARD AS WELL AS HOW THE TRIHEALTH SYSTEM ACCOUNTS FOR PATIENT SERVICE REVENUE.AS FOR THE AMOUNT OF BAD DEBT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, BETHESDA HOSPITAL, INC. DOES NOT REPORT ACTUAL BAD DEBT EXPENSE AS COMMUNITY BENEFIT. IF UPON FURTHER RESEARCH, IT IS ULTIMATELY DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER TRIHEALTH'S CHARITY CARE POLICY, THOSE COSTS WOULD BE RECLASSIFIED, AS APPROPRIATE, TO COMMUNITY BENEFIT AT THAT TIME.PLEASE NOTE THAT BAD DEBT EXPENSE IS NOT DETERMINED UNTIL AFTER ALL DISCOUNTS AND ANY ASSOCIATED PAYMENTS ARE TAKEN INTO ACCOUNT. IF ANY PAYMENTS ARE RECEIVED AFTER A PATIENT ACCOUNT IS DETERMINED TO BE BAD DEBT, THE ACCOUNT WILL BE ADJUSTED ACCORDINGLY AT THAT TIME. PART III, LINE 8: BETHESDA HOSPITAL, INC. USES THE "STEPDOWN METHODOLOGY" IN DETERMINING THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THIS METHOD OF COST FINDING PROVIDES FOR THE ALLOCATION OF THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS WHICH UTILIZE SUCH SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. BETHESDA HOSPITAL, INC. DID NOT REPORT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT IN PART III, LINE 7 OF THIS SCHEDULE. PART III, LINE 9B: AS OF THE FILING OF THIS RETURN, BETHESDA HOSPITAL, INC., AS PART OF TRIHEALTH, INC., MAINTAINS A WRITTEN DEBT COLLECTION POLICY. TRIHEALTH, INC., WHO PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS, WILL NOT INITIATE COLLECTION PRACTICES ON PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BEFORE COLLECTION ACTIONS ARE TAKEN, TRIHEALTH, INC. WILL MAKE REASONABLE EFFORTS, GENERALLY AS EARLY IN THE BILLING PROCESS AS POSSIBLE, TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. AFTER SUCH EFFORTS HAVE BEEN MADE AND A BALANCE REMAINS THAT IS THE RESPONSIBILITY OF THE PATIENT OR GUARANTOR, TRIHEALTH, INC. MAY PURSUE, IN ITS SOLE DISCRETION, WHATEVER ACTIONS IT MAY BE ENTITLED TO TAKE UNDER LAW. PART VI, LINE 2: IN 1896, BETHESDA HOSPITAL, INC. ("BETHESDA") BEGAN AS A HOME VISITING MINISTRY OF THE METHODIST DEACONESSES TO SERVE THE HEALTH NEEDS OF THE GERMAN IMMIGRANTS LIVING IN CINCINNATI. NOW THAT MINISTRY, ONCE LED BY DEACONESS LOUISE GOLDER AND HER BROTHER REV. CHRISTIAN GOLDER, HAS GROWN INTO SEVERAL HEALTH SERVICES FOR GREATER CINCINNATI. IN 1995, BETHESDA, INC. AND GOOD SAMARITAN HOSPITAL FORMED A PARTNERSHIP TO CREATE A LOCAL HEALTH SYSTEM: TRIHEALTH, INC. ("TRIHEALTH"). THE MISSION OF TRIHEALTH IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY THROUGH A FULL RANGE OF HEALTH RELATED SERVICES-PREVENTION, WELLNESS AND EDUCATION AND THUS EXEMPLIFY THE FOUNDING SPIRIT OF THE BETHESDA DEACONESSES.THE SERVICES DESCRIBED BELOW, AND OTHERS NOT LISTED, PROMOTE COMMUNITY HEALTH IN ACUTE ILLNESS, IN MANAGEMENT OF CHRONIC DISEASE, AND IN EDUCATION AND PREVENTION MEASURES. PROGRAMS SEEK TO REDUCE THE BURDENS ON THE GOVERNMENT. FOR EXAMPLE, IF BETHESDA DID NOT ADDRESS THE ROOT CAUSES OF LOW BIRTH WEIGHT AND PREMATURITY, THE BURDEN TO GOVERNMENT MEDICAL PROGRAMS SUCH AS MEDICAID WOULD BE EVEN GREATER. CHNAAS A FOLLOW UP TO THE 2018 CHNA, TRIHEALTH, INC. AND ITS HOSPITALS JOINED THIRTY-ONE (31) OTHER HOSPITALS AND TWENTY-TWO (22) HEALTH DEPARTMENTS IN THE GREATER CINCINNATI-DAYTON REGION TO SPONSOR AND FUND A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT FOR 2021. THE COMPREHENSIVE CHNA SPANS TWENTY-SIX (26) COUNTIES. THE REGIONAL CHNA REPORT COVERS GREATER DAYTON AND GREATER CINCINNATI, WHICH INCLUDES NORTHERN KENTUCKY AND SOUTHEASTERN INDIANA. IN THIS REGIONAL CHNA, HEALTH ENCOMPASSES PHYSICAL, MENTAL, AND SOCIAL CONDITIONS. HEALTH CARE IS INCLUSIVE OF HOSPITALS AND EMERGENCY ROOMS, PRIMARY CARE, BEHAVIORAL HEALTH, SPECIALTY CARE (I.E., VISION, DENTAL, CHIROPRACTIC, ETC.) AND SOCIAL SERVICES THAT SUPPORT HEALTH OR LINK COMMUNITY MEMBERS TO HEALTH CARE. THE 2021 CHNA REPORT SHARES DATA FOR THE WHOLE REGION AS WELL AS DETAILED COUNTY-LEVEL DATA. ALSO, THIS REGIONAL CHNA INCLUDES A COMPREHENSIVE DATA-DRIVEN APPROACH TO DEFINE THE CURRENT STATE OF HEALTH AND HEALTH EQUITY WITH THE GOAL OF INFORMING A COLLECTIVE, PRIORITIZE AN ACTIONABLE AGENDA FOR IMPROVING HEALTH OUTCOMES ACROSS THE REGION OVER THE NEXT THREE YEARS. LIKE THE STATEWIDE HEALTH IMPROVEMENT PLAN (SHIP) FOR OHIO, THIS REGIONAL CHNA EXPLORES THE PRIORITY FACTORS THAT INFLUENCE HEALTH INCLUDING PERCEPTIONS OF HEALTHCARE QUALITY AND ACCESS, HEALTH BEHAVIORS AND COMMUNITY CONDITIONS (I.E., SOCIAL DETERMINANTS OF HEALTH). GUIDED BY THE SHIP, THE REGIONAL CHNA FOCUSES ON THE PRIORITY HEALTH OUTCOMES RELATED TO CHRONIC DISEASE, MENTAL HEALTH AND ADDICTION, AND MATERNAL AND INFANT HEALTH. THE RECOMMENDATIONS PUT FORTH IN THIS NEEDS ASSESSMENT SUPPORT THE PRIORITIES OF THE SHIP AND PROVIDE A FRAMEWORK FOR WORKING COLLABORATIVELY IN ADDRESSING DISPARITIES AND BARRIERS TO A HEALTHIER COMMUNITY. A COPY OF THE REGIONAL CHNA CAN BE FOUND AT THE FOLLOWING URL (HTTPS://HEALTHCOLLAB.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/).FROM THIS LARGER REPORT, TRIHEALTH DEVELOPED A CHNA AND ASSOCIATED IMPLEMENTATION STRATEGY FOR EACH OF ITS FACILITIES BASED ON THE COUNTY BREAKDOWN AND DISCUSSION WITH TRIHEALTH LEADERS WITH EXPERTISE IN THE AREAS WHICH NEED TO BE ADDRESSED. THE FULL TEXT OF THESE CHNAS ARE AVAILABLE ON TRIHEALTH'S WEBSITE. SEE SCHEDULE H, PART V, LINE 7A FOR THE URL.PROGRAM SERVICE ACCOMPLISHMENTSFREE AND DISCOUNTED SERVICES ARE PROVIDED FOR THOSE UNABLE TO PAY AND MEETING ELIGIBILITY CRITERIA. THROUGH THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP), BETHESDA SERVES PATIENTS MEETING CRITERIA SET FORTH BY THE OHIO DEPARTMENT OF JOBS AND FAMILY SERVICES. BETHESDA POLICY IS TO PROVIDE CHARITY CARE ON A SLIDING SCALE DISCOUNTING WHEN THE FAMILY INCOME IS UP TO 300 PERCENT OF THE ANNUALLY ESTABLISHED FEDERAL POVERTY GUIDELINE. IT OFFERS AN UNINSURED DISCOUNT FOR MEDICALLY NECESSARY SERVICES FOR THOSE WHO HAVE NO INSURANCE AND WHO DO NOT QUALIFY FOR OTHER FINANCIAL ASSISTANCE OPTIONS. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION WHICH IS AVAILABLE ON TRIHEALTH'S WEBSITE AND BROCHURES ABOUT FINANCIAL ASSISTANCE ARE VISIBLE AND AVAILABLE IN HOSPITAL REGISTRATION AND ADMITTING AREAS.DURING THE YEAR, BETHESDA PROVIDED COMMUNITY BENEFIT (INCLUDING UNCOMPENSATED CARE) AS SHOWN ON PART I, LINE 7A. THE AMOUNT OF BENEFIT FOR BOTH TRADITIONAL CHARITY CARE AND FOR THE UNPAID COST OF MEDICAID IS ONE MANIFESTATION OF THE RISING RATES OF PERSONS WITHOUT HEALTH INSURANCE. THE MEDICAID PUBLIC PROGRAM REIMBURSES HOSPITALS FOR SERVICES BUT PAYMENTS MAY NOT ALWAYS COVER THE TOTAL COST OF CARE AND MEDICATIONS. THE UNPAID COST OF MEDICARE IS NOT INCLUDED IN TOTAL COMMUNITY BENEFIT. BETHESDA IS COMMITTED TO FULFILLING THE MISSION OF COMPASSION TO THE VULNERABLE MEMBERS OF THE COMMUNITIES THEY SERVE.BETHESDA PARTICIPATES IN THE REGIONAL TRAUMA SYSTEM THUS PROVIDING THE COMMUNITY WITH ACCESS TO TRAUMA CARE. THE TWO EMERGENCY ROOMS OF BETHESDA PROVIDE 24-HOUR EMERGENCY CARE TO COMMUNITY MEMBERS LIVING IN THE NORTHEAST CORRIDOR OF CINCINNATI AS WELL AS WARREN, BUTLER, AND CLERMONT COUNTIES. BETHESDA IS A LEVEL III TRAUMA CENTER AS VERIFIED BY THE COMMITTEE ON TRAUMA OF THE AMERICAN COLLEGE OF SURGEONS. ONE EXAMPLE OF ONGOING EFFORTS BY BETHESDA TO IMPROVE THE HEALTH OF THE BROADER COMMUNITY ARE PROGRAMS TO ADDRESS THE IDENTIFIED HEALTH NEED OF DIABETES. DIABETES EDUCATORS EXTEND THE EDUCATION TO THE COMMUNITY BY PROVIDING CLASSES TO A DIVERSE POPULATION, FROM AREA INDUSTRIES AND FIREHOUSE GROUPS TO RETIREMENT CENTERS. A DIABETES SUPPORT GROUP MEETS FOR CONTINUED EDUCATION IN CHRONIC DISEASE MANAGEMENT. IN ADDITION, WOMEN NEEDING PREGNANCY AND GYNECOLOGIC CARE CAN ACCESS THIS SERVICE AT THE OB/GYN CENTER AT BETHESDA NORTH HOSPITAL. CARE IS PROVIDED BY THE MEDICAL RESIDENTS IN OBSTETRICS AND GYNECOLOGY, SUPERVISED BY FACULTY PHYSICIANS. FINANCIAL COUNSELORS AND CARE COORDINATORS ASSIST IN FINDING APPROPRIATE COVERAGE, PAYMENT PLANS AND FINANCIAL AID. AS MANY OF THE WOMEN SERVED BY THE OB/GYN CENTER AT BETHESDA NORTH HOSPITAL HAVE LIMITED PROFICIENCY IN ENGLISH, QUALIFIED BILINGUAL STAFF ASSIST IN LANGUAGE INTERPRETATION. THE TRIHEALTH THINK FIRST PROGRAM IS AN ESTABLISHED BETHESDA SERVICE FOCUSED ON INJURY PREVENTION. THE THINK FIRST PROGRAM STAFF WORKS WITH COMMUNITY PARTNERS TO PROVIDE INJURY PREVENTION PROGRAMS AND COMMUNITY AWARENESS EVENTS. COLLABORATING WITH THE EDUCATORS, THE MEDIA, CIVIC CLUBS AND CORPORATIONS, THINK FIRST TEACHES INJURY PREVENTION TO ALL AGE GROUPS. BETHESDA CONTINUES A COMMITMENT TO EDUCATING THE NEXT GENERATION OF HEALTH CARE PROVIDERS--PHYSICIANS AND ALLIED HEALTH PROFESSIONALS. COST IN EXCESS OF GOVERNMENTAL SUPPORT FOR MEDICAL EDUCATION PROGRAMS AS SHOWN ON PART I, LINE 7H.THE BETHESDA PARAMEDIC TRAINING PROGRAM IS A HOSPITAL-BASED PROGRAM ACCREDITED BY THE OHIO DEPARTMENT OF TRANSPORTATION. THROUGH THIS TRAINING PROGRAM, CERTIFIED EMERGENCY MEDICAL TECHNICIANS CAN ADVANCE TO THE PARAMEDIC LEVEL. EDUCATION IS COMPRISED OF DIDACTIC SESSIONS, WITH LAB, FIELD, AND HOSPITAL CLINICAL ROTATIONS. BETHESDA, AS A PART OF TRIHEALTH, COLLABORATES WITH LOCAL AND REGIONAL COLLEGES, UNIVERSITIES AND TRAINING CENTERS TO PROVIDE MENTORING, INTERNSHIPS, CLERKSHIPS, SUPERVISED EDUCATION AND CLINICAL ROTATIONS TO STUDENTS IN HEALTH FIELDS. THESE PARTNERSHIPS HELP STUDENTS LEARN ABOUT AND PREPARE FOR PROFESSIONS IN NURSE PRACTITIONER, RESPIRATORY THERAPY, RADIOLOGY TECHNOLOGY, STERILE PROCESSING, PHLEBOTOMY, MEDICAL LABORATORY, PHARMACY, SPEECH, AUDIOLOGY, PHYSICAL THERAPY, AND OCCUPATIONAL THERAPY. IN CONCLUSION, ASIDE FROM THE CHARITY CARE AND UNPAID COST OF MEDICARE PROGRAMS, BETHESDA PROVIDES THE COMMUNITY WITH HEALTH CARE SERVICES AND PROGRAMS, MEDICAL EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS FOR THE POOR AND THE BROADER COMMUNITY. THIS COMMITMENT TO COMMUNITY HEALTH REVEALS BETHESDA'S FOUNDING SPIRIT OF CONCERN FOR THE VULNERABLE. IT ALSO REFLECTS THE ONGOING, TANGIBLE EFFORTS AND CONTRIBUTIONS OF COUNTLESS EMPLOYEES, PHYSICIANS AND LEADERS LIVING THE CORE VALUES OF STEWARDSHIP AND RESPONSE TO COMMUNITY NEEDS. PART VI, LINE 3: TRIHEALTH, INC. PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS INCLUDING BETHESDA HOSPITAL, INC. BROCHURES/APPLICATIONS, PROVIDED IN MULTIPLE LANGUAGES, ARE VISIBLE AND AVAILABLE IN THE REGISTRATION AND ADMITTING AREAS OF ALL TRIHEALTH AFFILIATED HOSPITALS. IN ADDITION, THE APPLICATION IS PRINTED ON THE REVERSE SIDE OF A PATIENT'S BILL WITH INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION AS WELL AS HOW TO RETURN IT. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. FINALLY, TRIHEALTH INC.'S WEBSITE CONTAINS INFORMATION REGARDING ITS CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS WITH DIRECTIONS ON HOW TO CONTACT THE APPROPRIATE PERSONNEL TO INITIATE AN APPLICATION OR ASK QUESTIONS ABOUT THE PROCESS. PART VI, LINE 4: WITH BETHESDA NORTH HOSPITAL LOCATED IN MONTGOMERY, OHIO, A SUBURB OF CINCINNATI, AND BETHESDA BUTLER HOSPITAL LOCATED NEAR HAMILTON, OHIO, BETHESDA HOSPITAL, INC. AND THE TRIHEALTH SYSTEM SERVE PRIMARILY HAMILTON, BUTLER, WARREN AND CLERMONT COUNTIES IN OHIO AS WELL AS SOME PERSONS FROM INDIANA AND KENTUCKY. BETHESDA NORTH HOSPITALHAMILTON COUNTY IS THE MOST POPULATED COUNTY IN THE REGION AND IS HOME TO THE LARGEST CITY, CINCINNATI. THE ESTIMATED POPULATION OF THE COUNTY IS 825,000 WITH APPROXIMATELY 13% IN POVERTY AND APPROXIMATELY 8% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. HAMILTON COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $59,000 WITH 92% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (39% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 16% OF THE POPULATION IS 65 YEARS AND OLDER, 64% IS WHITE, 27% IS AFRICAN-AMERICAN, 4% IS HISPANIC, 3% ASIAN AND 2% OTHER.CLERMONT COUNTY IS A LARGE COUNTY WHICH WAS ONCE MOSTLY RURAL BUT HAS BECOME MORE SUBURBAN AND IS ONE OF OHIO'S APPALACHIAN COUNTIES. THE ESTIMATED POPULATION OF THE COUNTY IS 210,000 WITH APPROXIMATELY 9% IN POVERTY AND APPROXIMATELY 7% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. CLERMONT COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $70,000 WITH 90% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (29% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 18% OF THE POPULATION IS 65 YEARS AND OLDER, 93% IS WHITE, 2% IS AFRICAN-AMERICAN, 2% IS HISPANIC, 1.5% ASIAN AND 1.5% OTHER.WARREN COUNTY IS ONE OF THE FASTEST GROWING COUNTIES IN OHIO, BOTH IN RESIDENTIAL AND COMMERCIAL GROWTH. THE ESTIMATED POPULATION OF THE COUNTY IS 247,000 WITH APPROXIMATELY 5% IN POVERTY AND APPROXIMATELY 5% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. WARREN COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $89,500 WITH 94% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (44% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 3.5%. APPROXIMATELY 15% OF THE POPULATION IS 65 YEARS AND OLDER, 84% IS WHITE, 7% ASIAN, 4% IS AFRICAN-AMERICAN, 3% IS HISPANIC, AND 2% OTHER.BETHESDA BUTLERBUTLER COUNTY IS ONE OF THE MOST POPULATED COUNTIES IN THE REGION AND INCLUDES THE CITIES OF HAMILTON, MIDDLETOWN AND OXFORD. THE ESTIMATED POPULATION OF THE COUNTY IS 390,000 WITH APPROXIMATELY 10% IN POVERTY AND APPROXIMATELY 8% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. BUTLER COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $69,000 WITH 92% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (31% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 16% OF THE POPULATION IS 65 YEARS AND OLDER, 78% IS WHITE, 10% IS AFRICAN-AMERICAN, 5% IS HISPANIC, 4% ASIAN AND 3% OTHER. PART VI, LINE 5: BETHESDA HOSPITAL, INC. IS COMPRISED OF VARIOUS MEDICAL SERVICES INCLUDING BETHESDA NORTH HOSPITAL ("NORTH"), BETHESDA MEDICAL CENTER AT ARROW SPRINGS ("ARROW SPRINGS") AND BETHESDA BUTLER HOSPITAL ("HOSPITAL"). ITS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. NORTH IS A 458-BED ACUTE TERTIARY TEACHING HOSPITAL. NORTH PROVIDES A 24-HOUR EMERGENCY DEPARTMENT, INTENSIVE CARE UNITS AND A LEVEL II SPECIAL CARE NURSERY. SERVICES ARE OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. IN ADDITION, NORTH HAS AN OPEN MEDICAL STAFF AND A HISTORY OF TRAINING AND EDUCATING MEDICAL RESIDENTS AND HEALTH CARE PROFESSIONALS. FINALLY IN CONCERT WITH THE HATTON INSTITUTE AT THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, AN AFFILIATED HOSPITAL, NORTH CONDUCTS MEDICAL AND SCIENTIFIC RESEARCH PROGRAMS INCLUDING STUDIES THAT ARE NOT COMMERCIALLY SPONSORED. NORTH PARTICIPATES IN MEDICARE AND MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS, AND HAS AN ACTIVE CHARITY CARE PROGRAM.ARROW SPRINGS COMPRISES A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT, PRIMARY CARE AND SPECIALIST PHYSICIANS, DIAGNOSTIC SERVICES, OCCUPATIONAL MEDICINE, PHYSICAL THERAPY AND A PHARMACY. IT PROVIDES THE SAME HIGH-QUALITY, PATIENT-CENTERED CARE AND SERVICES THAT IS PROVIDED BY NORTH. BUTLER IS AN OVER 50-BED SURGICAL HOSPITAL LOCATED NEAR HAMILTON, OHIO. IT PROVIDES EVERYTHING FROM SURGERY, CARDIOLOGY AND IMAGING TO PHYSICAL THERAPY AND SLEEP STUDIES. WITH EIGHT OPERATING ROOMS, THREE ENDOSCOPY SUITES, TWO PROCEDURE ROOMS AND A FULL-SERVICE 24-HOUR EMERGENCY DEPARTMENT, THE HOSPITAL IS COMPLEMENTED BY ADDITIONAL SERVICES AND PHYSICIAN OFFICES FOR PRIMARY CARE, PEDIATRICS AND SPECIALTY CARE ON CAMPUS.THE BETHESDA HOSPITAL, INC. SERVICES DESCRIBED ABOVE, AND OTHERS NOT LISTED, PROMOTE COMMUNITY HEALTH IN ACUTE ILLNESS, IN MANAGEMENT OF CHRONIC DISEASE, AND IN EDUCATION AND PREVENTION MEASURES WHICH SEEK TO REDUCE THE BURDENS ON THE GOVERNMENT.BETHESDA HOSPITAL, INC. SERVES ALMOST 620,000 PEOPLE ANNUALLY. THIS INCLUDES ALMOST 24,000 ADMISSIONS, APPROXIMATELY 85,000 EMERGENCY ROOM VISITS, MORE THAN 485,000 OUTPATIENT VISITS, AND ALMOST 3,700 NEW BABIES EACH YEAR.SEE RESPONSE TO PART VI, LINE 2 FOR ADDITIONAL INFORMATION. PART VI, LINE 6: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH IN ORDER TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.THROUGH FIVE (4) HOSPITALS, FIVE (13) AMBULATORY LOCATIONS AND OVER 125 SITES OF CARE (EMPLOYING OVER 600 PHYSICIANS INCLUDING RESIDENTS), TRIHEALTH PROVIDES A WIDE RANGE OF CLINICAL, EDUCATIONAL, PREVENTIVE AND SOCIAL PROGRAMS. TRIHEALTH'S NON-HOSPITAL SERVICES INCLUDE PHYSICIAN PRACTICE MANAGEMENT, FITNESS CENTERS AND FITNESS CENTER MANAGEMENT, OCCUPATIONAL HEALTH CENTERS, HOME HEALTH AND HOSPICE CARE.HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/ 1 CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER 3333 BURNET AVE CINCINNATI OH 45229 310833936 501(C)(3) 242250 0 CRADLE CINCINNATI PROGRAM SUPPORT UPTOWN CONSORTIUM INC 3440 BURNET AVE SUITE 130 CINCINNATI OH 45229 200688727 501(C)(3) 70253 0 GENERAL SUPPORT HEALTHY MOMS & BABES INC 2270 BANNING ROAD NO 200 CINCINNATI OH 45239 311155292 501(C)(3) 48450 0 GENERAL SUPPORT FRIAR'S CLUB INC 4300 VINE STREET CINCINNATI OH 45217 310537485 501(C)(3) 9690 0 GENERAL SUPPORT 4 0 PART I, LINE 2: BETHESDA HOSPITAL, INC. ("HOSPITAL") PROVIDES GRANTS TO OTHER ORGANIZATIONS DIRECTLY ON A VERY LIMITED BASIS. IN THOSE INSTANCES, THE DEPARTMENT GRANTING THE FUNDS IS RESPONSIBLE FOR OBTAINING AND STORING ALL NECESSARY INFORMATION FROM THE OTHER ORGANIZATION RELATIVE TO HOW THE FUNDS WILL BE SPENT. GENERALLY, GRANTS ARE PROVIDED, ON BEHALF OF HOSPITAL THROUGH TRIHEALTH, INC. ("TRIHEALTH"), A SUPPORTING ORGANIZATION OF HOSPITAL, WHICH PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO HOSPITAL. AS SUCH, TRIHEALTH IS RESPONSIBLE FOR MONITORING THE USE OF HOW THE FUNDS WILL BE SPENT. 1 1 0 0 0 0 0 0 0 MARK CLEMENT PRESIDENT/CEO 0 1519500 0 527124 0 191641 0 55675 0 23788 0 2317728 0 0 ANDREW DEVOE ASST TREASURER/EVP CFO 0 738138 0 488508 0 57527 0 58175 0 37509 0 1379857 0 0 KRISTIN COPPAGE MD MED STAFF PRESIDENT-GOOD SAM 0 886848 0 6251 0 47622 0 60135 0 37092 0 1037948 0 0 TERRI HANLON-BREMER CHIEF OPERATING OFFICER 0 594629 0 164565 0 71245 0 58558 0 21008 0 910005 0 0 HELEN KOSELKA MD CHIEF MEDICAL OFFICER 0 575564 0 148657 0 46596 0 62752 0 37454 0 871023 0 0 JOHN WARD SVP-BETHESDA REGION 0 586982 0 152196 0 35999 0 58486 0 30901 0 864564 0 0 STEVE GRACEY ASST SECRETARY/SVP LEGAL 0 500083 0 140225 0 35488 0 47484 0 36766 0 760046 0 0 DAVID COOK SVP-CHIEF HR OFFICER (END 9/22) 0 369091 0 124174 0 99623 0 117733 0 19074 0 729695 0 0 JOHN HUTSON MD PRES. & COO-BETHESDA (START 6/23) 0 393798 0 117108 0 1986 0 170883 0 31905 0 715680 0 0 KEVIN JOSEPH MD FORMER KEY EMPLOYEE 0 28084 0 0 0 632091 0 37234 0 9345 0 706754 0 0 JENNY SKINNER SVP-CHIEF NURSING EXECUTIVE 0 411320 0 106058 0 38475 0 43403 0 23754 0 623010 0 0 GAIL DONOVAN FORMER KEY EMPLOYEE 0 0 0 0 0 582038 0 0 0 0 0 582038 0 582038 JAIME EASTERLING PRES. & COO-BETHESDA (END 5/23) 0 378549 0 81712 0 35291 0 55176 0 22191 0 572919 0 0 JEREMIAH KIRKLAND PRES. & COO-BUTLER (START 7/22) 0 359294 0 86254 0 21291 0 57766 0 31712 0 556317 0 0 WILL GRONEMAN FORMER KEY EMPLOYEE 0 251279 0 0 0 157558 0 54235 0 23328 0 486400 0 55510 MICHAEL EVERETT FORMER KEY EMPLOYEE 0 305487 0 76013 0 15354 0 37675 0 31822 0 466351 0 0 SUSAN MACY CNO-BETHESDA 0 285757 0 60206 0 11928 0 37500 0 16849 0 412240 0 0 REBECCA BAUTE FORMER KEY EMPLOYEE 0 65431 0 0 0 263768 0 36417 0 13617 0 379233 0 0 RICAHRD OKRAGLY MD PHYSICIAN 249208 0 0 0 15757 0 31656 0 35891 0 332512 0 0 0 SCOTT WOODS MD PHYSICIAN 260386 0 0 0 18621 0 17430 0 32391 0 328828 0 0 0 LORRAINE STEPHENS MD MED STAFF PRESIDENT-BETHESDA 186842 0 6037 0 51129 0 36849 0 37158 0 318015 0 0 0 ROBERT KUNKEL MD PHYSICIAN 228485 0 0 0 19623 0 31094 0 30975 0 310177 0 0 0 MICHAEL WEBB MD PHYSICIAN 232349 0 0 0 8730 0 42274 0 22726 0 306079 0 0 0 ELIZABETH BEITER MD PHYSICIAN 230677 0 0 0 9002 0 28862 0 30681 0 299222 0 0 0 LONDON QUICCI FORMER KEY EMPLOYEE 0 0 0 0 0 270047 0 0 0 19741 0 289788 0 0 PART I, LINES 4A-B ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENTS AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUAL(S) LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.: GAIL DONOVAN - $582,038 WILL GRONEMAN - $55,510 PART I, LINE 3: TRIHEALTH, INC., A RELATED ORGANIZATION OF BETHESDA HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINE 4A: THE REPORTABLE INDIVIDUALS OF BETHESDA HOSPITAL, INC. ARE PAID BY TRIHEALTH, INC., A RELATED ORGANIZATION, RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). TRIHEALTH, INC. HAS A STANDARD EMPLOYEE SEVERANCE PACKAGE. GENERAL SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. IN ADDITION, NOTICE PAY, IF APPLICABLE UNDER TRIHEALTH, INC. POLICY, MAY BE ADDED TO THE SEVERANCE PACKAGE AND THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH, INC. POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. DURING THE 2022 CALENDAR YEAR, THE FOLLOWING REPORTABLE INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM TRIHEALTH, INC.: KEVIN JOSEPH, MD - $572,594 LONDON QUICCI - $220,784 REBECCA BAUTE - $218,335 WILL GRONEMAN - $89,632 A COUNTY OF HAMILTON OHIO (LINE A) 316000063 407272V59 2017-04-12 316011223 BUILDINGS AND STRUCTURES 0 0 0 B COUNTY OF HAMILTON OHIO (LINE B) 316000063 000000000 2020-05-14 148454656 BUILDINGS, STRUCTURES & REFUND OF TAXABLE & TAX-EXEMPT BONDS ISSUED 9/29/15 0 0 0 C COUNTY OF HAMILTON OHIO (LINE C) 316000063 4072722B8 2021-05-27 100000000 BUILDINGS, STRUCTURES, EQUIPMENT, REFUND OF TAX-EXEMPT BONDS ISSUED 4/12/17 0 0 0 A 3125000 318817614 3974594 314505586 337434 2020 0 0 0 1 B 154550819 1811516 67820350 36938431 47980522 1 1 0 1 C 600000 100765319 1011750 16786101 82902020 65448 1 0 0 1 A 0 1 1 1 0 0.01510 0.01510 0 0 1 B 0 1 1 1 0 0 0 1 C 0 1 1 1 0 0.01970 0.01970 0 0 1 A 0 0 0 1 0 0 0 1 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COUNTY OF HAMILTON, OHIO (LINE A) DATE THE REBATE COMPUTATION WAS PERFORMED: 04/12/2022 PART II, LINE 3, COLUMN A, COLUMN B AND COLUMN C TOTAL PROCEEDS SHOWN ARE NOT IDENTICAL TO THE ISSUE PRICE LISTED IN PART I, COLUMN (E) DUE TO THE INVESTMENT EARNINGS. PART II, LINE 11, COLUMN A THE REMAINING UNSPENT FUNDS WAS DEPOSITED TO THE CREDIT OF THE BOND FUNDS AND APPLIED AS A CREDIT AGAINST BASIC RENT WITH RESPECT TO PRINCIPAL ON THE BONDS PURSUANT TO SECTION 2.24 OF THE SUBLEASE. PART II, LINE 11, COLUMN B THE AMOUNT SHOWN HERE CONSISTS OF $36,646,925 SPENT TO RETIRE PRINCIPAL AND INTEREST OF PRIOR BONDS, PLUS $291,506 FOR A SWAP TERMINATION FEE PAID WITH RESPECT TO THE RETIRED TAX-EXEMPT DEBT. THE REFUNDING CONSISTED OF PRIOR TAX-EXEMPT BONDS ($9,324,915) AND PRIOR TAXABLE BONDS ($27,322,010) OF MCCULLOUGH-HYDE MEMORIAL HOSPITAL, A RELATED IRC SECTION 501(C)(3) ORGANIZATION OF BETHESDA HOSPITAL, INC. PART II, LINE 11, COLUMN C THE AMOUNT SHOWN HERE WAS SPENT TO RETIRE PRINCIPAL AND INTEREST OF PRIOR TAX-EXEMPT BONDS HELD BY THE TAXPAYER. PART IV, LINE 6, COLUMN A SUCH AMOUNT WAS APPROPRIATELY YIELD RESTRICTED. FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS, DIRECTORS AND TRUSTEES OF BETHESDA HOSPITAL, INC. LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARDS OF TRIHEALTH, INC., TRIHEALTH HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, ALL AFFILIATED ENTITIES OF BETHESDA HOSPITAL, INC. MICHAEL EVERETT, HELEN KOSELKA, MD, MARK CLEMENT, JOHN WARD AND STEVE GRACEY HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF EITHER SITTING ON THE BOARD OF OR BEING A KEY EMPLOYEE OF THE MCCULLOUGH-HYDE MEMORIAL HOSPITAL, AN AFFILIATED ENTITY OF BETHESDA HOSPITAL, INC. KATHY KELLY, RANCE DUKE, CYNTHIA BOOTH, BOB COLLINS, MD AND QUINT STUDER HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA, INC., THE SINGLE CORPORATE MEMBER OF BETHESDA HOSPITAL, INC. MARK CLEMENT AND JENNY SKINNER HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE, A RELATED ENTITY. MARK CLEMENT, TERRI HANLON-BREMER, ANDREW DEVOE, JOHN WARD, STEVE GRACEY, JENNIFER SKINNER, DAVID COOK, HELEN KOSELKA, MD, KRISTIN COPPAGE, MD, LORRAINE STEPHENS, MD, JAMIE EASTERLING, SUSAN MACY, JEREMIAH KIRKLAND, AND JOHN HUTSON, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED ENTITY BOARDS OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES AS WELL AS BEING EMPLOYED BY TRIHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 6 BETHESDA HOSPITAL, INC. HAS TWO CORPORATE MEMBERS - BETHESDA, INC. (VOTING MEMBER) AND TRIHEALTH, INC. (NON-VOTING MEMBER). FORM 990, PART VI, SECTION A, LINE 7A BETHESDA, INC. HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF BETHESDA HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B BETHESDA, INC. MUST APPROVE CERTAIN FINANCIAL TRANSACTIONS, AMENDMENTS TO BETHESDA HOSPITAL, INC.'S GOVERNING DOCUMENTS AND THOSE MATTERS RESERVED BY OHIO LAW. FORM 990, PART VI, SECTION B, LINE 11B MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF THIS FORM 990 PRIOR TO FILING AFTER REVIEW BY THE FINANCE AND AUDIT COMMITTEE OF THE BOARD, ALONG WITH THE COMMITTEE'S SUMMARY OF THE FORM 990. HOWEVER, FOR THE PROTECTION OF DONOR PRIVACY, SCHEDULE B - SCHEDULE OF CONTRIBUTORS WAS REMOVED FROM THE COPY PROVIDED TO THE BOARD. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURN MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH NON-SUBSTANTIVE CHANGES ARE NOT SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE CERTAIN FINANCIAL INTERESTS AND FIDUCIARY RELATIONSHIPS. THE EXECUTIVE COMMITTEE AND CORPORATE COUNSEL REVIEW RESPONSES, CONDUCT FURTHER INVESTIGATION (IF NECESSARY), AND DETERMINE WHEN A CONFLICT EXISTS WITH RESPECT TO A CERTAIN TRANSACTION. IF A CONFLICT EXISTS, THE TRANSACTION IS NOT TO BE ENTERED INTO UNLESS ALTERNATIVES ARE FULLY INVESTIGATED, AND IN THEIR ABSENCE, THE BOARD, WITHOUT THE PARTICIPATION OF THE INTERESTED MEMBER(S), DETERMINES THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. PLANS TO MANAGE THE CONFLICT DURING THE RELATIONSHIP ARE IMPLEMENTED. ALL DISCUSSIONS ARE APPROPRIATELY DOCUMENTED. ALL DIRECTORS AND MANAGERS, WHICH INCLUDE OFFICERS AND KEY EMPLOYEES, ARE REQUIRED TO ANNUALLY DISCLOSE ANY CIRCUMSTANCES, INCLUDING FAMILY AND BUSINESS RELATIONSHIPS, THAT MAY CREATE A CONFLICT OF INTEREST FOR THE ORGANIZATION. THESE RESPONSES ARE REVIEWED AND ACTED UPON BY A CONFLICT OF INTEREST COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 BETHESDA HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CONTRIBUTED CAPITAL TO PARENT -10,000,000. LOSS ON UNCONSOLIDATED ORGANIZATIONS -90,710,603. CHANGE IN PENSION PLAN/SERP FUNDED STATUS -5,056,845. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS HELD AT FOUNDATION -17,010,078. NET SPECIAL FUNDS ACTIVITY -94,233. ADJUSTMENT TO TRUE UP INVESTMENT IN TRIHEALTH, INC. 3,088,301. FORM 990, PART I, LINE 6 DURING THE TAX YEAR, BETHESDA HOSPITAL, INC. WAS ASSISTED BY 486 VOLUNTEERS WHO DONATED APPROXIMATELY 50,100 HOURS. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF TRUSTEES OF BETHESDA HOSPITAL, INC. ("THE CORPORATION"), ESTABLISHED AN EXECUTIVE COMMITTEE WHICH MAY EXERCISE SUCH POWER AND AUTHORITY OF THE BOARD OF TRUSTEES IN INTERVALS BETWEEN MEETINGS OF THE BOARD AS AUTHORIZED BY THE BOARD. THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT & CEO, THE SECRETARY AND TWO OTHER BOARD MEMBERS ALL IN ACCORDANCE WITH THE NETWORK AFFILIATION AGREEMENT. FORM 990, PART XII, LINE 2C THE FINANCIAL STATEMENTS OF BETHESDA HOSPITAL, INC. ("HOSPITAL") ARE AUDITED AS PART OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). TRIHEALTH HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES AND AFFILIATES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. IN ADDITION, HOSPITAL'S FINANCIAL STATEMENTS ARE AUDITED WITH BETHESDA, INC., THE PARENT ORGANIZATION OF HOSPITAL. BETHESDA, INC. HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. DURING THE TAX YEAR, THERE WAS NOT A CHANGE IN THE PROCESS OF AUDIT OVERSIGHT AND/OR SELECTION OF AN INDEPENDENT AUDITOR BY EITHER TRIHEALTH OR BETHESDA, INC. FORM 990, PART VI, SECTION B, LINE 16B DURING THE YEAR, BETHESDA HOSPITAL, INC. PARTICIPATED IN A JOINT VENTURE WITH ONE OR MORE TAXABLE PERSONS AND/OR ORGANIZATIONS. AS OF THE END OF THE FISCAL YEAR, BETHESDA HOSPITAL, INC. HAD NOT ADOPTED A WRITTEN POLICY OR PROCEDURE THAT REQUIRES THE ORGANIZATION TO NEGOTIATE, IN ITS TRANSACTIONS AND ARRANGEMENTS WITH OTHER MEMBERS OF THE VENTURE OR ARRANGEMENT, SUCH TERMS AND SAFEGUARDS AS ARE ADEQUATE TO ENSURE THAT THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED. HOWEVER, ALL JOINT VENTURES, WHEN ENTERED INTO, HAVE OUTSIDE LEGAL COUNSEL REVIEW OF THE OPERATING AGREEMENT OR OTHER ORGANIZATIONAL DOCUMENTS TO ENSURE THAT THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED PRIOR TO THE COMMENCEMENT OF THE JOINT VENTURE. ONCE THE JOINT VENTURE COMMENCES, BETHESDA HOSPITAL, INC. PERSONNEL MONITORS ITS ACTIVITIES TO ENSURE THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED. FORM 990, PART VII, SECTION A - AVERAGE HOURS PER WEEK THE OFFICERS AND DIRECTORS FOR BETHESDA HOSPITAL, INC. THAT SHOW AT LEAST 60 HOURS PER WEEK PROVIDE SERVICES TO TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) AND ITS SUBSIDIARIES/AFFILIATES ("TRIHEALTH") AS AN ENTIRE SYSTEM. HOURS WORKED, INCLUDING THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION, ARE NOT TRACKED ON AN ENTITY BY ENTITY BASIS, THUS THE AVERAGE HOURS PER WEEK DISCLOSED ARE ESTIMATES TO SHOW THAT THE TIME SPENT BY THESE INDIVIDUALS RELATE TO THEM FULFILLING THEIR DUTIES AS FULL-TIME, 60 HOURS-PER-WEEK EMPLOYEES OF TRIHEALTH VERSUS THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION. IN ADDITION, THE COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS IN FULFILLMENT OF THEIR DUTIES AS EMPLOYEES OF TRIHEALTH. DIRECTORS (AS NOTED WITH A "MED STAFF PRES" REFERENCE) FOR BETHESDA HOSPITAL, INC. SERVE ON THE BOARD IN THEIR CAPACITY AS MEDICAL STAFF PRESIDENT FOR EITHER BETHESDA HOSPITAL, INC. OR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. IN ADDITION, THESE INDIVIDUALS PROVIDE SERVICES AS EMPLOYEES OF VARIOUS RELATED ENTITIES FOR WHICH THEY RECEIVE COMPENSATION. NONE OF THE COMPENSATION SHOWN IS FOR SERVING AS A DIRECTOR. 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