SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Medium right arrow Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow Attach to Form 990.
Medium right arrow Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
FAYETTE COMMUNITY HOSPITAL INC
 
Employer identification number

58-2322328
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
 
 
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) . . .
    8,979,824   8,979,824 2.030 %
b Medicaid (from Worksheet 3, column a) . . . . .     12,240,702 11,023,539 1,217,163 0.270 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     9,328,467 8,194,626 1,133,841 0.260 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     30,548,993 19,218,165 11,330,828 2.560 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     30,563   30,563 0.010 %
f Health professions education (from Worksheet 5) . . .     2,145,594   2,145,594 0.490 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .     302,910   302,910 0.070 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     30,500   30,500 0.010 %
j Total. Other Benefits . .     2,509,567   2,509,567 0.580 %
k Total. Add lines 7d and 7j .     33,058,560 19,218,165 13,840,395 3.140 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
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     7,985   7,985  
3 Community support     11,010   11,010  
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     18,995   18,995  
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
5,365,639
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
 
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
78,838,822
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
75,465,489
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
3,373,333
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) 2022
Schedule H (Form 990) 2022
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 and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Piedmont Fayette Hospital
1255 Highway 54 West
Fayetteville,GA30214
www.piedmontfayette.com
056-550
X X         X      
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
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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)
Piedmont Fayette 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 21
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   No
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   No
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 22
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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) 2022
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Schedule H (Form 990) 2022
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Piedmont Fayette 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
SEE PART V
b
SEE PART V
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
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Part VFacility Information (continued)

Billing and Collections
Piedmont Fayette 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) 2022
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Schedule H (Form 990) 2022
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Piedmont Fayette 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) 2022
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Schedule H (Form 990) 2022
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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
SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATION AS A PART OF OUR PROCESS, WE INTERVIEWED NEARLY 245 STAKEHOLDERS, POLICY MAKERS AND LAWMAKERS REPRESENTING PUBLIC HEALTH, LOW-INCOME POPULATIONS, MINORITIES, CHRONIC CONDITIONS, OLDER ADULTS, AND OUR COMMUNITIES. THESE INCLUDED 13 STAKEHOLDERS WITHIN THE FAYETTE COMMUNITY, WHO GAVE THEIR PERSPECTIVES ON COMMUNITY HEALTH THROUGH THE LENS OF THEIR ROLE WITHIN THE COMMUNITY. THESE INTERVIEWS WERE CONDUCTED FOR PEOPLE REPRESENTING THE ENTIRE REGION. SPECIFICALLY, WE INTERVIEWED REPRESENTATIVES OF LOCAL AND REGIONAL PUBLIC HEALTH ENTITIES, MINORITY POPULATIONS, FAITH-BASED COMMUNITIES, LOCAL BUSINESS OWNERS, THE PHILANTHROPIC COMMUNITY, MENTAL HEALTH AGENCIES, ELECTED OFFICIALS AND INDIVIDUALS REPRESENTING OUR MOST VULNERABLE PATIENTS. THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS AND LEADERSHIP FROM ALL 19 HOSPITALS WERE ACTIVELY INFORMED AND ENGAGED THROUGHOUT THIS PROCESS.
SCHEDULE H, PART V, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT https://www.piedmont.org/media/file/Community-Benefit-Needs-Assessment-PFH .pdf
SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA REPORTS AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT FAYETTE HOSPITAL SENT COPIES TO EACH PARTICIPANT IN THE CHNA PROCESS, DISTRIBUTED THE ASSESSMENTS TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT COPIES TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENTS TO OTHER PIEDMONT HEALTHCARE HOSPITALS.
SCHEDULE H, PART V, LINE 10A: IMPLEMENTATION STRATEGIES WEBSITE THE BOARD OF DIRECTORS FOR PIEDMONT FAYETTE HOSPITAL APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE-YEAR PERIOD BEGINNING WITH FY23 ON SEPTEMBER 14, 2022, WITHIN THE GRACE PERIOD FOLLOWING THE APPROVAL OF THE NEW COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING LINK IS FOR THE IMPLEMENTATION STRATEGY EFFECTIVE THROUGH JUNE 30, 2025. https://www.piedmont.org/media/file/Community-Benefit-Implementation-Strat egy-PFH.pdf
SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS PIEDMONT FAYETTE HOSPITAL CONDUCTED ITS FOURTH CHNA DURING FY22, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT FAYETTE HOSPITAL DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. ALL PRIORITIES ARE VIEWED THROUGH THE LENS OF HEALTH DISPARITIES, WITH PARTICULAR ATTENTION PAID TO IMPROVING OUTCOMES FOR THOSE MOST VULNERABLE DUE TO INCOME AND RACE. BASED ON THE CHNA, PIEDMONT FAYETTE HOSPITAL IS CURRENTLY FOCUSING ON: (1) ENSURING AFFORDABLE ACCESS TO HEALTH, MENTAL, AND DENTAL CARE (2) REDUCING PREVENTABLE INSTANCES OF, AND DEATHS FROM, CANCER (3) REDUCING PREVENTABLE INSTANCES OF, AND DEATHS FROM, HEART DISEASE (4) REDUCING PREVENTABLE INSTANCES OF DIABETES AND ICREASING ACCESS TO CARE FOR THOSE LIVING WITH THE DISEASE (5) REDUCING RATES OF OBESITY AND INCREASING ACCESS TO HEALTHY FOODS AND RECREATIONAL ACTIVITIES
SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITES FINANCIAL ASSISTANCE POLICY - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-POLICY.PDF FINANCIAL ASSISTANCE APPLICATION - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-APPLICATION.PDF FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SU MMARY-ENGLISH.PDF
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
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
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
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
SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS SCHEDULE H, PART I, LINE 6A PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT We regularly report to the community our community benefit activities in several ways. Each year, we prepare a systemwide community benefit report that is available to the public through publication on our website. We also make available our IRS Form 990 Schedule H on our website and provide copies to anyone upon request. We also provide information on community benefit programming to local, state, and federal lawmakers through our government affairs office and online at piedmont.org.
SCHEDULE H, PART I, LINE 7(F) PERCENT OF TOTAL EXPENSE THE DENOMINATOR USED FOR THE CALCULATION OF COLUMN (F), PERCENT OF TOTAL EXPENSE, WAS THE AMOUNT OF TOTAL FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A) OF $536,308,338, LESS BAD DEBT EXPENSE OF $95,022,067 FROM FORM 990, PART IX, LINE 24(B).
SCHEDULE H, PART I, LINE 7 FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST A RATIO OF PATIENT CARE COST TO CHARGES, CONSISTENT WITH WORKSHEET 2, WAS USED TO REPORT THE AMOUNTS IN PART I, LINES 7A-7D. FOR AMOUNTS ON LINES 7E-7K, ACTUAL EXPENSES FOR EACH COMMUNITY BENEFIT ACTIVITY ARE TRACED AND REPORTED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM.
SCHEDULE H, PART III, LINES 2-4 BAD DEBT EXPENSE CALCULATION AND FOOTNOTE The provision for bad debts is based upon leadership's assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Periodically, leadership assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category. The results of the review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible receivables. THE AMOUNT REPORTED ON PART III, LINE 3, WAS DETERMINED BY TAKING THE AVERAGE ACCEPTANCE RATE FOR ALL CHARITY CARE APPLICATIONS RECEIVED DURING THE YEAR MULTIPLIED BY THE NUMBER OF DENIALS THAT WERE ATTRIBUTABLE TO INSUFFICIENT INFORMATION. THAT TOTAL WAS THEN ADJUSTED DOWNWARD FOR THE ORGANIZATION'S USE OF PRESUMPTIVE ELIGIBILITY WHEN DETERMINING ITS COMMUNITY BENEFITS. BAD DEBT EXPENSE FOOTNOTE FROM CONSOLIDATED, AUDITED FINANCIAL STATEMENTS: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBT TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PFH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE.
SCHEDULE H, PART III, LINE 8 MEDICARE SHORTFALLS AS COMMUNITY BENEFIT The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions by utilizing our allowable Medicare cost as reported in the Medicare cost report, which is based on a cost to charge ratio. However, the allowable costs in the Medicare cost report do not reflect the actual cost of providing care to patients since the Medicare cost report excludes many direct patient care costs that are essential to provide quality healthcare for Medicare patients. For example, certain coverage fees to physicians, cost of Medicare C and D, and other similar direct patient care expenses are specifically excluded from allowable cost in the Medicare Cost Report. We believe our Medicare shortfall reported on Part III, Line 7 of Schedule H, should be considered a community benefit as the IRS community benefit standard includes the provision of care to elderly and Medicare patients. IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health insurance, such as Medicare, is an indication we operate to promote health in the community. Our policy is to treat Medicare patients, regardless of the extent to which Medicare pays for the treatment. For many services, Medicare's reimbursement is less than the cost of the care provided, resulting in shortfalls that are to be absorbed by us in honor of our commitment to treat elderly patients. Many of these patients live on a low, fixed income, and would qualify for financial assistance or other means-tested programs, absent from their enrollment in Medicare.
SCHEDULE H, PART III, LINE 9(B) COLLECTION PRACTICES INITIAL SCREENINGS OF ALL INPATIENT, EMERGENCY, AND SURGERY ENCOUNTERS, AS WELL AS MOST OUTPATIENT VISITS, ARE CONDUCTED BY FINANCIAL COUNSELORS IN ORDER TO IDENTIFY ANY AVAILABLE INSURANCE OR OTHER COVERAGE FOR EACH PATIENT. COUNSELORS CONTACT PATIENTS AND THEIR FAMILIES DIRECTLY, EITHER IN PERSON OR BY LETTER, TO ASSIST THE FAMILY IN IDENTIFYING ANY PROGRAMS FOR WHICH THE PATIENT/SERVICE MAY QUALIFY (INCLUDING MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM ("SCHIP"), PRIVATE OR GOVERNMENT INSURANCE COVERAGE, AND CHARITY ASSISTANCE). IF THE FAMILY CANNOT BE TIMELY LOCATED OR IS UNCOOPERATIVE, RELATED ACCOUNTS ARE TRANSFERRED TO AN INTERNAL COLLECTION DEPARTMENT FOR FURTHER ATTEMPTS TO OBTAIN PAYMENT OR, IF THE PATIENT MAY QUALIFY FOR ASSISTANCE, TO SECURE A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION'S DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF A PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY.
SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT As a designated 501(c)(3) nonprofit hospital, we are required by the Internal Revenue System to conduct a triennial community health needs assessment (CHNA), in accordance with regulations put forth by the IRS following the 2010 Patient Protection and Affordable Care Act (ACA). Through this assessment, we hope to better understand local health challenges, identify health trends in our community, determine gaps in the current health delivery system and craft a plan to address those gaps and the identified health needs. In FY22, we conducted our fourth triennial CHNA and FY23 was the first year for activities outlined in its subsequent Implementation Strategy. The CHNA was led by the Piedmont Healthcare community benefits team and consulting organization Public Goods Group, with input and direction from Piedmont leadership and Piedmont Healthcare's Department of External Affairs. Process The CHNA started with a definition of our community, which is our home county due to the impact of our tax-exempt status. Property taxes make up the largest segment of a hospital's tax exemption, which impacts county revenues. Because of this, we aim to ensure that we are providing ample benefit to our county and its residents. Additionally, we take into consideration patient origin, especially that of our lower-income patients such as those who qualify for financial assistance or receive insurance coverage through Medicaid. Our secondary communities are considered the areas in which we have the highest concentration of patients fitting that criterion, including ones from nearby communities. Once we established our primary and secondary communities, we then conducted an analysis of available public health data. This included resources from: US Census, US Health and Human Services' Community Health Status Indicators, US Department of Agriculture, Economic Research Service, National Center for Education Statistics, Kaiser Family Foundation's State Health Facts, American Heart Association, County Health Rankings and Georgia Online Analytical Statistical Information System (OASIS). All figures within the CHNA were for 2020, unless otherwise noted. Health indicators are estimates provided by County Health Rankings and hospital data were internally sourced. We then interviewed key stakeholders who have a particular expertise or knowledge of our communities. Specifically, we interviewed representatives of local and regional public health entities, minority populations, faith-based communities, local business owners, the philanthropic community, mental health agencies, elected officials and individuals representing our most vulnerable patients. An internal survey was also conducted throughout the healthcare system for both clinical and non-clinical employees. Information was gathered on knowledge and understanding of community benefit and current programs, as well as suggestions for how we can better serve our patients and communities. Approximately 1,053 employees spanning the system responded. Additionally, we conducted a community-based survey that was widely advertised to the community. Once both qualitative and quantitative data was gathered, we authored the preliminary report, which was then vetted and reviewed by hospital and health system leadership. In this report, we identified several key community health needs that emerged during the assessment process. The chosen priorities were recommended by the community benefit department with sign-off from hospital and board leadership. The following criteria were used to establish the priorities: - The number of persons affected; - The seriousness of the issue; - Whether the health need particularly affected persons living in poverty or reflected health disparities; and, - Availability of community and/or hospital resources to address the need. All priorities are viewed through the lens of health disparities, with particular attention paid to improving outcomes for those most vulnerable due to income and race. The priorities we chose reflected a collective agreement on what hospital leadership, staff and the community felt was most important and within our ability to positively impact the issue. Once priorities were approved by the board of directors, we then authored the CHNA and presented our findings and recommendations to the hospital's board of directors for their input and approval. Our priorities A key component of the CHNA is to identify the top health priorities we will address over fiscal years 2023, 2024, and 2025. These priorities will guide our community benefit work. They are, in no order: - Ensure affordable access to health, mental, and dental care - Reduce preventable instances of and deaths from cancer - Reduce preventable instances of and deaths from heart disease - Reduce preventable instances of diabetes and increase access to care for those living with the disease - Reduce rates of obesity and increase access to healthy foods and recreational activities With each priority, we work to achieve greater health equity by reducing the impact of poverty and other socioeconomic indicators. This means that health equity is built into each priority, which is demonstrated through our implementation strategies. Our subsequent implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities in our FY22 community health needs assessment. The implementation strategy was designed to be executed over a three-year period and included specific metrics by which we would be able to evaluate our work and its impact. The implementation strategy was developed by utilizing community feedback from the assessment in partnership with the system community benefits department, our leadership, and our board of directors. We included proven and successful interventions and programming, investing further in work we felt was successful in addressing unmet health needs.
SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY We understand that not everyone can pay their hospital bill due to their insurance status or a limited income, and because of this, we offer financial assistance to qualifying patients. Notification about financial assistance includes, but is not limited to, a dedicated contact number, notices in patient bills, and posted notices in key areas of the hospital. These locations are the emergency room, admitting and registration departments, our business office, and patient financial services offices that are located on site. We also publish and widely publicize a plain language summary of this financial assistance care policy on our website, as well as the full policy. Referral of patients for financial assistance may be made by any staff or medical staff member at the hospital, including physicians, nurses, financial counselors, social workers, case managers, chaplains, and religious sponsors. A request for financial assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. Additionally, we provide copies of our financial assistance policy to our partner clinics and others who work closely with low-income populations. We help our partners in understanding the policy, how it relates to their populations, and receive feedback in ways our financial assistance programming could be improved.
SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION While Piedmont Fayette serves patients throughout Georgia, we consider our community to be Fayette County. We do this in recognition of the direct impact of our tax-exempt status on county residents. In Fayette County, an average of approximately 117,800 people lived in the 195-square-mile area each year from 2017 to 2021. The population density for this area, estimated at nearly 610 people per square mile, is more than the national average population density of 93 people per square mile. Fayette County is mostly urban, as 82 percent were living in an urban setting in 2020. The median age of people living within the county from 2017 to 2021 was 43, a little older than state and national averages. About 23 percent of the population were 17 or younger, 18 percent were over the age of 65, and the rest were between the ages of 18 and 64. Eleven percent of the population identified as being born outside of the US, and five percent did not possess US citizenship status. The Hispanic population within the community is growing and now represents approximately eight percent of the community. An average of about 12 percent of county residents were veterans each year from 2017 to 2021, with the highest concentration living in the ZIP code 30214 (Fayetteville). The majority were over the age of 65. About 11 percent of the county population lived with a disability, and most were over the age of 65. The community is growing, and about 12,600 people moved into Fayette County between 2010 and 2020, representing a 12 percent growth rate. With this growth comes increased diversity, as white populations decreased and those of all other races and ethnicities increased. Specifically, there was a six percent decrease in white populations, a 38 percent increase in Black or African American populations, a 55 percent increase in Asian populations, and a 40 percent increase in Hispanic or Latino populations. Between 2017 and 2021, the median household income was $96,084, which is significantly higher than the state and national median incomes of $65,030 and $69,021, respectively. When broken down by the four dominant races in the community, income disparities are evident. Of employers in the community, the largest sector by number of employees was retail trade, which employed about 8,500 people at an average wage of $25,828 in 2019. Health care and social assistance was the next largest sector, employing 8,300 people at an average wage of $54,790. Accommodation and food services was the third largest sector, employing nearly 6,800 people at an average wage of $22,552. According to the 2017-2021 American Community Survey, of the more than 94,200 working-age adults in the county, approximately 57,400 were part of the labor force, yielding a labor force participation rate of approximately 61 percent. Total unemployment in the county in July 2023 equaled about 1,800 people, or three percent of the civilian non-institutionalized population aged 16 and older. Low food access is defined as living more than one mile (urban) or 10 miles (rural) from the nearest supermarket, supercenter, or large grocery store. This indicator is relevant because it highlights populations and geographies facing food insecurity. According to the 2019 Food Access Research Atlas database, 37 percent of the total population in the county have low food access, meaning about 39,100 county residents may struggle to access healthy foods. In 2020, the county had a food insecurity rate of about seven percent, meaning more than 7,300 people had been unsure how they would access adequate food at some point during the year. Unfortunately, many of these community members are ineligible for public assistance via SNAP, WIC (Special Supplemental Nutrition Program for Women, Infants and Children), free or reduced-cost school meals, the Commodity Supplemental Food Program (CSFP), or The Emergency Food Assistance Program (TEFAP). In 2020, of the 1,540 food-insecure children in the county, 24 percent were ineligible for public assistance programs. In 2021, nearly 78 percent of adults aged 18 or older saw a doctor for a routine check-up the previous year, a measure that is higher than both state and national averages. For Medicare recipients, this number jumps to 88 percent of adult beneficiaries, which is also above both state and national averages. Routine check-ups are a critical component to maintaining good health and identifying conditions that can be treated affordably in a community-based setting. Absent that, even simple-to-treat conditions can escalate to deeper issues, eventually requiring more intensive care, later stage diagnoses, or reduced life expectancy. Heart disease is the leading cause of death in Fayette County. Between 2016 and 2020, the age-adjusted death rate was 132 deaths for every 100,000 people, which is better than both state and national averages, and a number that has decreased steadily over the last 10 years. Broken down by ZIP code, we see higher death rates in both 30215 (Fayetteville) and 30238 (Jonesboro), which could indicate higher rates of poverty and uninsurance. We see similar trends with stroke deaths. Between 2016 and 2020, there were nearly 250 deaths due to stroke, resulting in an age-adjusted death rate of 34 deaths per every 100,000 people. This is better than the state and national rates of about 43 and 38 deaths, respectively. Like with heart disease, we see higher rates of stroke death in community members living in ZIP codes 30215 (Fayetteville) and 30238 (Jonesboro). The hospitalization rates for heart disease and stroke among Medicare recipients have been decreasing steadily over the past five years. On average each year from 2017 to 2019, there were approximately nine hospitalizations for cardiovascular disease for every 1,000 Medicare beneficiaries. This rate is lower than both the state and national averages, which were about 12 and 11 hospitalizations per 1,000 beneficiaries, respectively. Furthermore, the hospitalization rate for stroke is also lower than the state average, with eight hospitalizations per 1,000 Medicare beneficiaries, compared to the state average of nine. While heart disease remains the leading cause of death in the county, cancer remains a critical issue within the community. The cancer incidence rate for Fayette County averaged more than 464 cases per 100,000 people annually between 2016 and 2020, resulting in a total of 713 new cases. When broken down by cancer site, the breast cancer incidence rate stood at 145 diagnoses per 100,000 females, which was notably lower than both the state and national averages of 129 and 127, respectively. Additionally, other diagnosed cancer sites either fell below or were on par with state and national averages. In 2019, a total of about 8,150 adults aged 20 and older had diabetes, equaling approximately eight percent of the county's population. This rate is lower than the state average of 10 percent. Diabetes is a prevalent issue in the US, often linked to an unhealthy lifestyle, and it poses risks for various health problems. This figure has fluctuated over the last five years. In 2021, about three percent of the county's population had a diagnosis of kidney disease, a rate on par with state and national percentages. That same year, 34 percent of the county's total population of adults 18 and older reported having high cholesterol. Too much cholesterol puts one at risk for heart disease and stroke, two of the main causes of death within the county. High blood pressure can damage the arteries by making them less elastic, which decreases the flow of blood and oxygen to the heart and leads to heart disease. In 2021, 33 percent of adults 18 and older in Fayette County had a diagnosis of high blood pressure.
SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH We actively promote the health of our community through clinic-hospital partnerships, community-based health screenings, educational activities, community-building activities, the operation of a 24-hour emergency department available to the entire community, the operation of an emergency room open to all members of the community without regard to ability to pay, a governance board composed of community members, use of surplus revenue for facilities improvement, patient care, and medical training, education, and research, the provision of inpatient hospital care for all persons in the community able to pay, including those covered by Medicare and Medicaid, and an open medical staff with privileges available to all qualifying physicians. In FY23, Piedmont Healthcare launched the Empowering You platform to connect community members and patients with resources to address social determinant of health issues. Powered by FindHelp.org, Piedmont clinicians and case managers can search and refer patients to supporting organizations. In FY23, we worked collaboratively and on an ongoing basis with community support groups to provide input on the importance of the mental health within our community. For the first year, as a source of action, the hospital began planning a team to support the National Association for Mental Illness (NAMI). The hospital planning committee worked in collaboration with a local judge and hospital board member to plan fundraising and awareness activities. In addition, Spiritual Care Services (SCS), a continued source for patients and families in the hospital and community to connect with mental health resources that meet their needs, provided short-term grief counseling, and helped connect people to support groups and counselors in the community. SCS extended beyond mental health needs. SCS also served as a resource to surrounding hospices through the provision of training and education regarding chaplain roles and services, as well as provided clinical pastoral education to chaplains upon request. SCS also continued to support nonprofit and support group efforts for families suffering the loss of a baby during pregnancy or shortly after birth. Aiding in the combating of such grief, SCS held once-a-month Zoom support sessions and an annual memorial service at the hospital for all families who lost a child. SCS held intermittent meetings for faith-based community leaders to learn about hospital initiatives and information to communicate with parishioners. Spiritual Care Services also had a presence in the community as a provider of advance directive documents and instruction, with an emphasis on the importance of these documents throughout a person's lifetime, and not just at an end-of-life stage. This work continued through the year, with the SCS office open to help with the completion of forms and steps for Medical Records inclusion. Piedmont Fayette engaged in many community partnerships in FY23. The hospital continued support of the American Red Cross through the donation of space for and participation recurring blood drives, resulting in 63 pints of donated blood. This support came at a cost of $36,000 to the hospital in FY23. In collaboration with other Piedmont hospitals, Piedmont Fayette donated funds for Rachel's Gift Angel Dash. Rachel's Gift provides bereavement services and care for families suffering infant loss. In partnership with Southern Crescent Habitat for Humanity, Piedmont Fayette donated funds for the project, and nine hospital directors and managers completed a day of service working on the build program for a family in Henry County. Piedmont Fayette worked to improve access to care for underserved communities in FY23. Continuing its success of last year, we held a series of Walk with a Doc events, providing monthly opportunities for any community member to walk and talk with Piedmont physicians to discuss health topics, screenings, and healthy lifestyle choices. Piedmont Fayette also provided health and wellness education and resources to the Hispanic community at the annual health fair at Holy Trinity Catholic Church. Reaching out to businesses employing primarily low-wage workers hospital employees participated in health fairs at City of Peachtree City, Fayette County Government, Coweta Fayette EMC and Rinnai Corporation, sharing information on stroke awareness, importance of health screenings, cardiology and diabetes education. We also provided health screenings, consultations, and information at Union City's Back 2 School Bash & Community Health Day. Finally, at a local church, a community relations representative presented the hospital's FY23 Community Health Needs Assessment and hospital priorities to address gaps in community healthcare to the members of North Fayette Community Association and the Rotary Club of Peachtree City. Piedmont Fayette prioritized women's health with diverse programs in FY23. We actively participated in a PTC Moms Health and Wellness Fair and a Hearthside Lafayette GO Red Day, offering resources for women's health and wellness in the local community. Transitioning to virtual platforms, we provided a ZOOM presentation regarding Women's GYN Cancer Awareness, led by Dr. Mitzie-Ann Davis. Piedmont Fayette sponsored the Joseph Sams School Dinner Dance, which brought awareness and educational support for disabled and differently abled children. More than 500 community members were served through this support. We conducted program sessions for Fayette Senior Services, addressing topics such as heart health, navigating medical bills and insurance, advanced directives, diabetes prevention and management, nutrition to prevent disease, orthopedic health, dementia, and fitness walks through Piedmont Wellness Center. This initiative not only provided valuable information but also fostered important socialization for isolated seniors, as Fayette Senior Services facilitated transportation for their attendance. Piedmont Fayette neurologist Dr. Evan Johnson educated members of Fayette Senior Services and SunCity Peachtree residents about Parkinson's disease and movement disorders. Other expert-led presentations included a program on women's issues and breast cancer awareness at multiple senior living facilities in the community, including The Oaks and Hearthside Lafayette, senior living facility. Piedmont Fayette also supported the Parkinson's Foundation Moving Day event, providing education, awareness, and resources for Parkinson's patients and their loved ones. The day was filled with movement, exercise, dance, and boxing. Cancer care and wellness were another primary focus of our community benefit work. Our Spiritual Care Services promoted Cancer Wellness to patients and faith-based community members in several ways. While providing Spiritual Care Services to cancer patients on units, staff members handed out Cancer Wellness information to emphasize all Cancer Wellness offerings and support services. Piedmont Fayette also held a significant number of community-facing cancer awareness events. In June, we sponsored the Harts of Teal 5K Color Run to bring awareness to the risks and signs of ovarian and other GYN cancers, serving 800 community members. The hospital hosted a Zoom-based event featuring hospital pulmonologist Dr. Arvind Ponnambalam, and attendees asked questions on lung cancer and signed up for screenings, if they qualified. This event was promoted heavily throughout the southside area. Dr. Mio Yanigisawa participated in a panel conversation to raise awareness about breast cancer risk factors and the importance of mammograms. Piedmont Fayette's Women's Imaging Department held its annual Ladies' Night event for Fayette County Government employees. This event allowed the employees to get their annual screening mammograms while enjoying a fun and supportive atmosphere. Piedmont Fayette's Oncology and Cancer Wellness team joined 26 other local organizations in volunteering with Clothes Less Traveled. They sorted donations and set the thrift shop up for success. Piedmont Healthcare launched the Empowering You platform to connect community members and patients with resources to address social determinant of health issues. Powered by FindHelp.org, Piedmont clinicians and case managers can search and refer patients to supporting organizations. We work collaboratively and on an ongoing basis with community support groups to give input on the importance of the mental health of our community, including youth and veteran groups. As a source of action, mental health facility partner Riverwoods Behavioral Health System receives referrals for mental health screenings, reporting more than 1,375 mental health screenings in FY23. Our director of case management serves as a member of the district 4 Department of Public Health Board, overseeing and providing guidance regarding mental health issues for the community. We are an ongoing partner and resource to Drug Free Fayette (DFF), a
SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM We are part of Piedmont Healthcare, a regional not-for-profit organization and the parent company of 19 hospitals, the Piedmont Physicians Group, the Piedmont Heart Institute, the Piedmont Clinic and the Piedmont Healthcare Foundation. Our community relations team works directly with the community. Our community benefit department oversees the community benefit activities on behalf of all hospitals throughout the system, and this includes conducting the triennial CHNA and subsequent implementation strategy, ensuring the financial assistance policy is communicated to the community, maintaining the community benefit webpage, authoring the community benefit annual report, preparing board materials, developing and executing the community benefit grants program and compiling all community benefit figures. Each hospital and certain departments of Piedmont Healthcare execute community benefit programming, such as our revenue department, which oversees the financial assistance program.
SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT We are not required to file a community benefit report; however, we are required to file with the Georgia Department of Community Health information on our indigent and charity care, as well as our Medicaid and Medicare shortfalls.
Schedule H (Form 990) 2022
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