SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
CHAMBERSBURG HOSPITAL
 
Employer identification number

23-0465970
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		1 1,578 3,280,143   3,280,143 0.850 %
b Medicaid (from Worksheet 3, column a) . . . . .   22,777 50,476,683 31,243,913 19,232,770 5.000 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . . 1 24,355 53,756,826 31,243,913 22,512,913 5.850 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 11 17,666 35,041 550 34,491 0.010 %
f Health professions education (from Worksheet 5) . . . 3 100 115,978   115,978 0.030 %
g Subsidized health services (from Worksheet 6) . . . . 2   3,272,803   3,272,803 0.850 %
h Research (from Worksheet 7) . 1   164,575   164,575 0.040 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 5   2,438,774   2,438,774 0.630 %
j Total. Other Benefits . . 22 17,766 6,027,171 550 6,026,621 1.560 %
k Total. Add lines 7d and 7j . 23 42,121 59,783,997 31,244,463 28,539,534 7.410 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 1   3,362   3,362  
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy 1 40 1,360   1,360  
8 Workforce development            
9 Other            
10 Total 2 40 4,722   4,722  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
6,713,493
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
106,073
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
147,144,115
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
176,387,704
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-29,243,589
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 WellSpan Chambersburg Hospital
112 North Seventh Street
Chambersburg,PA17201
www.wellspan.org
036001 		X X         X      
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
WellSpan Chambersburg Hospital
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.wellspan.org
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
WellSpan Chambersburg Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.wellspan.org
b
www.wellspan.org
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 6
Part VFacility Information (continued)

Billing and Collections
WellSpan Chambersburg Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
WellSpan Chambersburg Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Facility: WellSpan Chambersburg Hospital - Part V, Section B, Line 5 The Summit Health Management Team, the Summit Health Community Services Team, the Healthy Franklin County Leadership Advisory Committee, and the Center for Opinion Research at Franklin and Marshall College, led by Berwood Yost, contributed to the development of the Community Health Needs Assessment (CHNA) and the Community Health Improvement Plan (CHIP). The Healthy Franklin County Leadership Advisory Committee, composed of a cross-section of stakeholders in Franklin County, brought significant insight and meaningful engagement to the CHNA process. The Community Services team coordinated and/or facilitated a series of seven focus groups with community members in the Summit Health Service area. The goal of these focus groups was to gather information about Franklin County's top community health needs from the perspective of targeted community informants that included schools, low-income, minority and senior populations. Focus groups were held with Franklin County school nurses and Chambersburg and Waynesboro area school counselors, respectively. Additionally, Dr. Jose Ricardo-Osorio, a professor at Shippensburg University and a member of Healthy Franklin County Leadership team, led a focus group of Spanish-speaking Hispanic community members. Dr. Annette Searfoss, the President and CEO of First Start Partnerships for Children and Families (formerly Franklin County Head Start) and a member of Healthy Franklin County Leadership team, also led focus groups with a group of currently enrolled First Start families in Chambersburg while Education and Family Services staff led a second group with the same target population in Waynesboro. Last, Dr. Annette Searfoss later facilitated a focus group in Chambersburg with working adults of retirement age who must continue to work because they do not have enough savings or a retirement fund to support themselves. The goal of each of these focus groups was to gather information about Franklin Countys top community health needs from the perspective of targeted community informants.A second tool was a survey of 51 veterans conducted by the Community Services team at Summit Health. This survey was designed to closely mirror the community behavioral risk factor survey and provide more details about the health conditions, risks, and behaviors of this population.In addition to the focus groups and veterans survey, Summit Health hosted a stakeholder forum on April 15, 2019, with members of the Healthy Franklin County Leadership Advisory Group. The three primary goals of the forum were to: (1) explain the CHNA process and the role of community stakeholders; (2) present the analytic framework and preliminary community health data included in the summary; and (3) gather input from these community stakeholders who have public health expertise or serve medically underserved, low income, and minority populations in Franklin County, about community health needs and community resources.
Facility: WellSpan Chambersburg Hospital - Part V, Section B, Line 6a Waynesboro Hospital.
Facility: WellSpan Chambersburg Hospital - Part V, Section B, Line 7d A printed copy of the report may be obtained upon request to: WellSpan Summit Health, Ann Spottswood, Director of Community Services, mail to: [email protected] each iteration of the CHNA process, WellSpan- Summit and its community partners continue to refine and enhance the system by which it obtains data, share it with key community, hospital and system leaders, and integrate it into the system-wide and entity-level planning processes. The key findings from the CHNA and the selected community health priorities were presented at an open community forum: BUILDING A CULTURE OF HEALTH IN FRANKLIN COUNTY, on June 5, 2019. 120 community members were given an opportunity to discuss the priorities identified and give input about how to address them through a health equity lens.The 2018 CHNA results, and related priorities identified by Healthy Franklin County Leadership Advisory Group were then shared with Summit Health Management, Waynesboro Hospital, Chambersburg Hospital, and Summit Health Boards.
Facility: WellSpan Chambersburg Hospital - Part V, Section B, Line 11 The Community Health Needs Assessment process encourages communities to reflect on the initiatives that they have undertaken and their successes in addressing the health priorities they have established. Since 2015, Summit Health's Community Services team engaged with the community to establish specific activities targeted to improving community health in seven priority areas. The community priorities, goals, and activities resulting from the 2015 Community Health Needs Assessment process are fully described in Appendix I of the 2018-2019 Summit Health Community Health Needs Assessment.The seven priority areas established in 2015 include access to primary care services, nutrition, physical activity, mental heal and substance use and prevention, education and community-based education, early childhood education, and adolescent health. Table 8 of the 2018-2019 Summit Health Community Health Needs Assessment shows the number of initiatives implemented and health indicators related to each. The community, led by Summit Health and the Healthy Franklin County Leadership Group, created many community interventions, with the most effort dedicated to nutrition, followed by mental health and substance use and prevention, physical activity, and access to care. Unfortunately, all of these activities have not yet produced much community-level change. Access to care has remained virtually unchanged, with the exception of a higher rate of dental visits. Indicators related to nutrition and physical activity have gotten worse. Mental health indicators have also declined. Education and community-based education indicators have remained virtually unchanged. Access to early childhood education has improved as have teen birth rates and teen chlamydia rates. These results are reminders of at least two important truths about improving public health. First, effecting change will require more than three or four years. Most of the public health problems in our communities have emerged over long periods of time and it will require a long-term and sustained investment to produce change. Second, most of the indicators used here are trailing indicators that reflect at least in part social and structural contexts that are likely to move once those underlying conditions begin to change. Put simply, time and social change are necessary conditions for improving the health of a community. The priorities and impacts established by the 2015 Community Health Needs Assessment (CHNA) provide a summary of the work implemented guided by the results of the previous CHNA regarding the seven priority areas indicated above. To access progress towards these goals, community indicators from the 2015 CHNA and 2019 CHNA were compared in the categories of organizational indicators and presented in a table in the CHNA assessment report. Access to care has remained virtually unchanged with the exception of higher rates of dentist visits.Nutrition and physical activity have gotten worse for all indicators, despite the many activities completed at an organizational level to address these issues. Mental health indicators have also declined. Education and community-based education indicators have remained virtually unchanged. Access to early childhood education has improved. Teen birth rate and teen chlamydia rates have gone down, while the chlamydia rate for young adults has increased. These results should be viewed while considering one important point - it takes time in order to see changes at the community level. Simply because an indicator has not changed or has declined does not mean that the intervention has failed - there may be more reasons why a positive changed has not occurred.See attached 2019 WellSpan Summit Health Community Health Improvement Plan, also available online at www.wellspan.org in Community Benefits section.
Facility: WellSpan Chambersburg Hospital - Part V, Section B, Line 13h WellSpan Health is committed to caring for all the members of its communities, regardless of their ability to pay. In recent years, overall charity care has decreased slightly as more people have obtained health insurance coverage through the Affordable Care Act and the expansion of Pennsylvanias Medical Assistance (Medicaid) program. WellSpan is proud to be a leading partner in the Healthy Community Network, which works to address the needs of uninsured and underinsured individuals in our community. In addition, the health system recently enhanced its financial assistance policy and the discounts that it provides on services. For example, if a patients income is less than 300 percent of the federal poverty level, that patient would be eligible for a 100 percent discount on the services provided. Additionally, significant discounts are available for patients whose income is between 300 percent and 350 percent of the federal poverty level. For more information on WellSpans Financial Assistance program, visit www.WellSpan.org/FinancialAssistance.
Facility: WellSpan Chambersburg Hospital - Part V, Section B, Line 16j In an effort to make patients, families and others in our communities aware of the newly expanded Financial Assistance Policy, WellSpan broadly publicized its policy via promotional signage and the distribution of easy-to-read informational materials at registration sites throughout our communities. WellSpan provided information on the Financial Assistance Policy on its billing statements and included information in patient discharge materials. In addition, the materials and information are easily accessible via WellSpans website at www.WellSpan.org/FinancialAssistance. The site reflects WellSpans newly enhanced policy, as well as informational and application materials. It was also publicized via WellSpans on-hold phone messaging system and in its direct-to-consumer community newsletter/magazine, which is distributed by mail, email and on-line. In addition, WellSpan placed posters and signage at its various sites of care to publicize its Financial Assistance Policy. Printed copies of WellSpan Healths entire financial assistance policy and the plain language summary of the policy, both of which are available in English and Spanish, may be obtained at no cost by visiting or calling one of the WellSpan patient financial services offices.The Financial Assistance Policy, Financial Assistance Application and Financial Assistance Policy Plain Language Summary are all available in Spanish.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1 WellSpan Chambersburg Hospital Outpatient Psych Unit
176 S Coldbrook Ave Unit 2
Chambersburg,PA17201 		Hospital Outpatient Psychiatric Unit
2 WellSpan Imaging
12 St Paul Dr Ste 102
Chambersburg,PA17201 		Outpatient Radiology Facilities
3 WellSpan Rhonda Brake Shreiner Womens Center
12 St Paul Dr Ste 103
Chambersburg,PA17201 		Outpatient Radiology facilities
4 WellSpan Rehabilitation & Results Fitness
1600 Orchard Dr
Chambersburg,PA17201 		Outpatient Rehabilitation Facilities
5 WellSpan Cardiology Testing
22 St Paul Dr Ste 203
Chambersburg,PA17201 		Outpatient Radiology Facilities
6 WellSpan Center for Dizziness & Balance Disorders
59 N 7th St
Chambersburg,PA17201 		Outpatient Rehabilitation Facilities
7 WellSpan Lab Services
761 5th Ave
Chambersburg,PA17201 		Outpatient Laboratory Services
8 WellSpan Lab & Imaging Services
50 Eastern Ave
Greencastle,PA17225 		Outpatient Laboratory Services and Radiology Facilities
9 WellSpan Lab Services
2 Keefer Dr
Mercersburg,PA17236 		Outpatient Laboratory Services
10 WellSpan Lab ServicesImaging & Rehab
46 Walnut Bottom Rd
Shippensburg,PA17257 		Laboratory Services, Imaging, Outpatient Rehabilitation
11 CH Outpatient Sleep Center & Imaging
97 Progress Blvd Ste 3
Shippensburg,PA17257 		Outpatient Sleep Lab Facility and Outpatient Radiology
12 WellSpan Rehabilitation
24 Antrim Commons Dr
Greencastle,PA17225 		Outpatient Rehabilitation Facilities
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) Patients 401% of poverty level and greater do not qualify for financial assistance. Patients/guarantors who complete an application for Financial Assistance whose gross income falls between 351-400% of the FPL level and meet all other Financial Assistance qualifications (MAP 118) will be eligible for a 40% discount of self-pay balances.
Part I, Line 6a - Related Organization Community Benefit Report Community Benefit Information is included in the Community Benefit Report for WellSpan Health.
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The number was calculated using the cost to charge ratio factor applied against actual patient bad debt write-offs. These numbers are included after all efforts have been exhausted to determine if the patient meets our charity care write-off policy based on federal poverty levels.
Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit The estimate of bad debt attributable to charity care policy was calculated by dividing the bad debt amount that was originally coded bad debt but later found to qualify as charity care by the amount coded to the charity care write-off codes. This ratio is applied to the bad debt cost factor expense.
Part III, Line 4 - Bad Debt Expense The Company provides an allowance for doubtful accounts for estimated losses resulting from the unwillingness or inability of patients to make payments for services. The allowance is determined by analyzing specific amounts and historical data and trends. Patient accounts receivable are charged off against the allowance for doubtful accounts when management determines that recovery is unlikely and the Company ceases collection efforts. Losses have been consistent with management's expectations in all material respects.
Part III, Line 8 - Explanation Of Shortfall As Community Benefit Chambersburg Hospital maintains records to identify and monitor the level of charity care and community service it provides. These records include the amount of charges forgone based on established rates for services and supplies furnished under its charity care and community service policies and the estimated cost of those services. Payments from Medicare are generally less than Chambersburg Hospital's costs of providing the service.
Part VI, Line 2 - Needs Assessment WellSpan Summit Health and its entities have a long history of working to better understand and respond to the health and healthcare needs of our communities and the populations we serve. Throughout the last two decades, Summit Health has made great changes to programs and services based on the findings of the CHNAs conducted in 2008, 2012, 2015 and 2018. The data played a large role in the overall strategic planning process for Summit Health.The Patient Protection and Affordable Care Act of 2010 required non-profit hospitals to conduct community health needs assessments every three years. Summit Health, and its affiliates, Chambersburg Hospital and Waynesboro Hospital, completed a CHNA report and CHIP in 2015. The 2015 CHNA report identified community health priorities of access to care; obesity, nutrition, and physical activity; mental health, substance use, and prevention; educational and community- based engagement; early childhood education; and adolescent health. Based on the data, plans were created to address the identified needs by developing education, screenings, recruitment, partnerships, and needed infrastructure.The programs helped community members gain access to needed prescriptions, primary care providers and specialists. New facilities were constructed to offer the care the community needed. Free screenings, camps and classes were put into motion and awareness was created through advertising, speaking events, health fairs, and social media. Several grants were awarded to community non- profits through Summit Endowment whose projects address key health priorities of Franklin County. While many of the goals were accomplished, others went unmet. It became clear, to be more effective, Summit Health needed to further work with community partners to determine the health needs and key priorities of the community and to work together to develop strategies to address them, a process that is constantly evolving The 2018 CHNA was developed utilizing consulting support and guidance through a contract with the Floyd Institute for Public Policy at Franklin and Marshall College. Dr. Berwood Yost, Institute Director and Project Lead has an extensive background conducting and analyzing community and corporate surveys and was integral to the prior CHNA conducted in 2015. The Summit Health Community Services team facilitated planning and collaboration with community stakeholders who determined the survey questions to be asked of the community; discussed data collection methodology, including sample size and method of obtaining data; reviewed the raw data and supporting charts/ graphs; identified potential community health priorities, and developed the process by which the results and priorities were to be shared with the community. The telephone survey was conducted by staff of the Floyd Institute for Public Policy at Franklin and Marshall College with 506 adult residents throughout Franklin County completing responses.WellSpan Health held a meeting of the Healthy Franklin County leadership team on April 15, 2019. The three primary goals of the forum were to explain the CHNA process and the role of community stakeholders, present the analytic framework and preliminary community health data included in this summary, and gather input from community stakeholders, particularly those with public health expertise and individuals and organizations serving medically underserved, low-income, and minority populations in Franklin County, about community health needs and community resources. After a brief presentation of community health data, including demographics, social determinants such as education and income, health behaviors, and health outcomes, attendees answered three specific questions: what are the most important health needs in our community? How important is addressing this need to our communitys overall health and well-being? How likely is it that our community could implement the changes needed to address this problem?Four working groups then created a final list of 35 distinct health needs, which were ranked. Based on scope, severity, and community perceptions of severity and potential impact, and considering the community initiatives taken since 2015, Franklin Countys most significant needs focus on two social determinants and two behavioral health priorities: Establishing and maintaining the basic conditions that support health, including, access to care, family-sustaining incomes, accessible transportation, reduced stress, and affordable and quality housingEstablishing and maintaining systems that assure that children and families have access to high quality educational opportunities throughout the lifespanSupporting improved mental health including reducing and treating substance useSupporting active living, healthy eating, and less obesityThe identified priorities and associated data were subsequently presented to the WellSpan-Chambersburg and Waynesboro Hospital Boards for their adoption. Board members discussed the data and identified priorities within the context of existing staffing and financial resources, current and future entity initiatives, and community partnership opportunities to address systemic community change. The final CHNA report, along with the WellSpan Summit Community Health Improvement Plan (CHIP) was presented in September 2019 to the Summit Health Board for their review and approval. This information is included in the 2018 Community Health Needs Assessment Summary Report available at www.wellspan.org.
Part VI, Line 5 - Promotion of Community Health As a charitable, community-based healthcare organization, our commitment to improving the lives and well-being of the people and communities we serve is carried out every day. Our Community Health Improvement Plan framework is constructed with Healthy People 2020 Leading Health Indicators and objectives. Further, our work at the local level aligns with similar goals and objectives in the 2017 Pennsylvania Department of Healths State Health Improvement Plan. Over the last three years, WellSpan Summit Health provided over $101 million of charity care to the community. Continuing our commitment to support the work of non-profit community organizations, between 2018 --2021, the Summit Endowment awarded more than $1.2 million in the form of 42 grants to address key issues and health priorities as outlined in our Community Health Improvement Plan.Below are a few examples of the work accomplished in the various priority areas in fiscal year 2021:In 2021, WellSpan Health encouraged community members, local employers and employees, and WellSpan staff and patients to engage in the 8th annual 10 Pound Throwdown. The 10 pound Throwdown is a 10-week community challenge that encourages participants to lose or maintain a healthy weight through healthier eating and increased physical activity. The initiative was created in 2013 to address the growing issue of adult overweight/obesity and utilizes a core website (www.10poundthrowdown.com) to encourage team participation and to offer an online weight tracker, badges to encourage healthier choices, and diverse health education resources. The 10 Pound Throwdown engaged 7,200 community members across five southcentral Pennsylvania countiesAdams, Lancaster, Lebanon, York and Franklin.A series of health improvement workshops, titled Winter STREAK, were held between January--March 2021. More than 250 individuals participated in virtual sessions that included timely information around Relaxation, Eating Healthy, Trekking, and Physical Activity.In 2021, WellSpan expanded its GO (Get Outdoors) program into Franklin County. 28 individuals participated in this initiative with the aim of helping families increase physical activity by getting outdoors. The program utilized an adaptation of letterboxing, an international hobby where participants use written clues to find items hidden in various places. Offering financial support for youth who wish to pursue careers in healthcare is essential to maintaining quality healthcare services. The Greencastle -Antrim Endowment, a component of Summit Health Endowment, is a funding mechanism which offers scholarships that ultimately impact the CHNA priority of Access to Care. From 2017-2021, $136,000 was awarded via 74 college scholarships to Greencastle-Antrim high school students pursuing a career in healthcare. 16 pre-med students participated in a summer work experience at Summit Health and 12 medical students participated in a resident internship in the Emergency Room at Summit Health. Summit Physician Services established a work group, created a plan and received funding from Summit Endowment to establish a community health worker program in 2017 to serve vulnerable, low-resourced seniors. Funding supports two Community Health Workers, who serve as liaisons between health and social services, and the community, to facilitate access to services. In 2018, the workers focused on targeted populations in the community, specifically residents of the Towers of Falling Spring in Chambersburg and diabetic patients with HgA1C greater than 9 percent. In 2019, the program expanded services to the Cottages, a senior-living apartment complex in Shippensburg.In 2021 one of the Community Health Workers expanded services to better understand and support the needs of the Latino community.Both Keystone Health and Summit Health providers are using health risk assessments to collect data to better understand and act on their patients social determinants of health. Keystone Health adopted and implemented a plan to reach linguistically isolated individuals which is reviewed annually.Summit Community Services supports Healthy Communities Partnership of Greater Franklin County in their coordination of Chambersburg Cares, a community-wide effort to engage community members and aligns resources, to promote healthy youth behaviors and reduce risk factors. Chambersburg Cares uses a data-driven process and the Communities That Care model. The group determines risks and root causes, working together to target the prioritized risks through evidence-based programs in schools and other community organizations. Our Community Services team continues to support the Franklin County Overdose Prevention Task Force. Led by our District Attorney, team members provide guidance in communication methods, website updates, data analysis, prevention and strategic planning.The Healthy Franklin County Leadership committee formed an ad hoc diversity, inclusion, and discrimination committee in the fall of 2017, due to heightened racial tensions occurring nationally which also emerged locally. The ad hoc committee conducted an environmental scan to see how these issues were being addressed in the community and to gain a better understanding of what the committees role could be in addressing them. The research done by the committee uncovered the connection between the Social Determinants of Health (SDOH) and health equity. As a result, the Healthy Franklin County Leadership committee determined that it and its partners should take steps to address the SDOH more intentionally with their work. During the same time, several grass roots groups have emerged in the community to champion the need for more diversity and inclusion training, increase the awareness and acceptance of the LGBTQ+ and the importance of racial reconciliation. Our Community Services team has continued to engage in various activities that raise awareness and honors diversity, including co-hosting MLK Day events in both 2020 and 2021. Community Services team members continue to support the Be The Village collaborative, a school-based Prenatal3rd grade initiative that supports families in their parenting role. Through ongoing efforts to strengthen standardized readiness assessment staff has implemented the KEI, Kindergarten Entry Inventory, to better assess the childs developmental status. In June 2021, 40 school nurses attended a virtual training that included presentations around diversity and inclusion, the culture of trauma informed care, and the health impact of vaping upon youth. 100% of attendees that completed evaluations stated that they have a better understanding of how to define and implement strategies and interventions to support individuals in the school setting.In 2021, The Healthy Franklin County Nutrition, Physical Activity and Weight Status Task force coordinated a virtual Community Garden Workshop where 45 individuals learned about various topics including foraging, herb spirals, honeybees, food scaping and Panel Wrap up. In 2021, more than 350 families received boxes of school supplies, hand sanitizer and masks during the Shippensburg Family Fund Day/Back to School Drive. In addition, 400 families benefited during United Ways Learn and Play Day. 300 bags were distributed in conjunction with a virtual education series aimed to support childrens emotional well-being.In 2021, 65 individuals attended two virtual yoga sessions. Of the more than 75% of individuals completing evaluations, 75% of individuals reported feeling less stressed and more relaxed after the yoga session and more than 90% agreed that they had a better understanding of how chronic stress can affect heart health. An evidenced-based, Center for Disease Control (CDC) Recognized Lifestyle Change Program, Prevent T2 was implemented by Summit Health in 2016 to help those with prediabetes make changes that can cut the risk of developing Type 2 diabetes by more than half. In 2021, three series of this year-long evidence-based model were implemented and served 24 individuals.From 2016-2021, a total of 277 adults across Franklin County in Chambersburg and Waynesboro have participated in Summit Healths Get Fit Now program. This five-week healthy lifestyle program uses a combination of Fit Bit technology and supportive group sessions to help participants learn strategies to improve health by tracking physical activity, developing personal health goals, learning healthier ways to shop for and prepare food, and understanding how stress influences how they eat and move. Additional examples of how WellSpan-Chambersburg Hospital fulfilled its community mission in Franklin County may be found in the 2021 WellSpan Community Benefit Report available online at www.wellspan.org.
Part VI, Line 6 - Affilated Health Care System WellSpan Health is an integrated health system serving the communities of southcentral Pennsylvania and northern Maryland. As a community-based, not-for-profit organization, WellSpan is dedicated to improving the health and well-being of the people it serves. WellSpan will assume a leadership role and develop partnerships with other organizations to improve access to coordinated, high-quality, cost-effective health care services, educate the health care providers of tomorrow, promote healthy lifestyles and lifelong wellness, and make its local communities healthier, more desirable places to live, work, and play. WellSpan Gettysburg Hospital works with other parts of the system to provide a comprehensive approach to meeting community needs.WellSpan Health includes: WellSpan Gettysburg Hospital, WellSpan York Hospital, WellSpan Surgery and Rehabilitation Hospital, WellSpan Ephrata Community Hospital, WellSpan The Good Samaritan Hospital of Lebanon Pennsylvania, WellSpan Philhaven, Chambersburg Hospital, Waynesboro Hospital, Apple Hill Surgical Center, Summit Surgery Center, WellSpan VNA Home Health, WellSpan Medical Group, Northern Lancaster County Medical Group, Physician Specialists of Northern Lancaster County Medical Group, Good Samaritan Physician Services, Summit Physician Services, Chambersburg Health Services, WellSpan Population Health Services, WellSpan Pharmacy, Gettysburg Hospital Foundation, York Health Foundation, Ephrata Community Health Foundation, Good Samaritan Health Services Foundation, Summit Health Foundation, WellSpan Summit Health, WellSpan Provider Network, GSH Services, and WellSpan Medical Equipment.Chambersburg Hospital's community benefit report is contained in a report prepared by their parent organization, WellSpan Health. See WellSpan Health - 2021 Community Benefit Report at www.wellspan.org
Part VI, Line 7 - States Filing of Community Benefit Report PA
Schedule H (Form 990) 2020
Additional Data


Software ID: 20011551
Software Version: 2020v4.0