WellSpan Health Manual of Administrative Policy Page 1 of 18 Policy #118 - WellSpan Health Financial Assistance

WellSpan Health adopts the following policy and procedure for the following specifically named entities

☒ Apple Hill Surgical Center ☒ VNA Home Health and Services ☒ WellSpan Medical Equipment ☒ WellSpan Medical Group ☒ WellSpan Pharmacy ☒ WellSpan Philhaven ☒ WellSpan and Rehabilitation ☒ WellSpan Ephrata Community Hospital ☒ WellSpan Gettysburg Hospital ☒ WellSpan Good Samaritan Hospital ☒ WellSpan York Hospital ☒ Good Samaritan Physician Services ☒ WellSpan Health System Corporate Locations ☒ Chambersburg Hospital ☒ Waynesboro Hospital ☒ WellSpan Summit Physician Services ☒ Summit Himelfarb Surgery Center ☒ WellSpan Radiation Oncology ☒ WellSpan Medical Oncology and Hematology

NOTE: This policy applies to the above-named entities and all providers employed by WellSpan. Independent providers and entities providing services within WellSpan are not required to adopt this policy. All providers of medically necessary care in WellSpan facilities who are not employed by such facilities are listed on Attachment B. None of the providers listed in Attachment B are covered by the FAP and do not apply the same discounts for services provided.

PURPOSE Consistent with its charitable mission of “working as one to improve health through exceptional care for all, lifelong wellness and healthy communities,” WellSpan Health provides financial assistance to eligible patients who are in need. The Financial Assistance Policy will be fair, efficient and accessible to all patients and will be consistently applied across all WellSpan Health entities.

POLICY AND PROCEDURE I. SCOPE AND GUIDING PRINCIPLES A. WellSpan Health will provide essential care to patients regardless of their ability to pay.

B. WellSpan Health will provide discounts to patients according to the patient’s financial status.

C. WellSpan Health determines financial eligibility based upon income, disposable assets and other forms of health insurance.

D. WellSpan Health’s ability to provide discounted services to patients may vary depending on its own financial status.

E. WellSpan Health provides assistance for the Medical Assistance application process.

F. WellSpan Health provides patients the opportunity to enter into payment plans for patient balances.

G. The HealthyCare Card Program is also available to provide financial assistance to those individuals with long-term, ongoing chronic health conditions, or to those requiring financial assistance to help with the cost of pharmaceuticals. Information regarding this program can be found at www.healthycommunitynetwork.org.

H. The requirements for grants for certain populations may supersede WellSpan Health’s financial assistance policy guidelines, including grantee community partner provider organizations approved by WellSpan Health.

I. WellSpan Health will develop and distribute easy-to-understand financial assistance materials through Customer Service, Patient Financial Services, hospital and office registration areas, internal postings and through the website, www.wellspan.org. Staff will be trained to answer

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financial assistance questions or direct such inquiries to an appropriate department in a timely manner.

II. ELIGIBILITY DETERMINATION AND APPLICATION PROCESS A. A written or verbal request for WellSpan financial assistance may be made at any time. In the event of a verbal request, a signature may not be required.

B. WellSpan Health will provide assistance to all patients whose income falls within 350 percent of the federal poverty guidelines and within the asset limits listed on Attachment A. Those patients qualifying for financial assistance will receive a discount not to exceed the amount generally billed (AGB), which is established based on the lowest WellSpan hospital AGB applied to all hospitals to enable consistent discounts. The AGB is calculated by the look- back method, in accordance with IRS Regulation 501(r). This is based on payments received from Medicare and all private payors, in the most recently completed 12 months. WellSpan calculated the AGB for each WellSpan hospital facility and applies (a percentage below) the lowest calculated AGB of 32.4% to all hospitals. WellSpan will not charge FAP-eligible individuals more than AGB for medically necessary care.

C. Additional discounts from charges for services for uninsured patients and patients with income above 350% of FPL are covered in a separate policy. (WellSpan Billing and Collections Policy)

D. The patient must accurately complete, in writing or verbally, the WellSpan Financial Assistance Application, provide documentation and return it to the designated patient financial representative. The patient must sign the last page of the application, unless it is determined that acquiring a signature will be a hardship. WellSpan also uses publicly available information to screen for Financial Assistance eligibility and qualifies patients presumptively.

E. All patients applying for WellSpan financial assistance must provide proof of income for all dependents claimed on IRS Form 1040 with the completed application. Proof of income includes current pay stubs for the last 30 days, Social Security, disability, unemployment or workers’ compensation income, pension, investment income, real estate income and all other sources of income. Additional financial information regarding a household’s expenditures may be requested to clarify an applicant’s financial position. Three (3) consecutive months bank statements (all pages) will be required for all accounts. Six (6) consecutive months bank statements (all pages) will be required for any self-employed applicants. Tax returns (all schedules) may be requested for all applicants but are required for any self-employed applicants. In the absence of these documents, patients may be required to provide other evidence of income. If the patient has no income, the patient and the person supporting the patient will complete the “Statement of Zero Income” form.

F. Patients must be prescreened for Medical Assistance prior to being accepted for financial assistance. Additionally, patients who fail to comply with reasonable insurance requirements, such as obtaining authorizations or referrals, may not be provided financial assistance.

G. Liquid assets (cash, savings, checking accounts, PayPal accounts, CDs, HSA funds, annuities, stocks, bonds or Christmas/Vacation Club) may need to be “spent down” depending on possible level of approval before financial assistance is considered (See Liquid Asset Guidelines on Attachment A). In general, non-liquid assets (residence, automobile and other personal property), as well as retirement or life insurance funds (401(k), 403(b), IRA or Rollover IRA) need not be considered. If retirement account is being accessed or drawn from, the full value of the resource will be considered in determining eligibility. Additionally, if a patient is of an age that no penalty is assessed if drawn upon, the full value of the retirement fund would be considered a liquid resource.

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H. Household size will be the number of individuals eligible to be claimed as dependents on the patient’s latest Federal Income Tax return. Students living away from home while attending school who are dependent on their parents for financial support (i.e., claimed as a dependent on their Federal income tax form) are considered part of their parent’s household for purpose of eligibility determination. I. Eligibility for WellSpan financial assistance will be maintained for one (1) year from date of determination. Eligibility may be backdated for one year. Account balances in bad debt should be reclassified as charity if date of service is in the year prior to date of determination. Financial Assistance may be discontinued if patient’s primary insurance coverage was voluntarily terminated.

J. Patients/responsible parties will be notified of the available options for financial assistance prior to an account referral to a third-party collection agency, per IRS regulation 501(r). Methods of notification include but are not limited to:

i. Posting of legible signage ii. Development of a plain language summary iii. Distributing informational brochures at hospital and office registration areas iv. Distributing informational brochures throughout its communities v. A copy of the Financial Assistance Policy plain language summary offered during the registration/discharge process vi. Conspicuous notice regarding the Financial Assistance Policy printed on all account statements vii. Copy of the Financial Assistance Policy plain language summary provided with last billing statement (at least 30 days prior to taking third-party collection action)

K. In the event of non-payment, accounts will be referred for third-party collection action, which generally includes extraordinary collection actions.

III. ELIBILITY DETERMINATIONS

A. If a patient is unable to provide all required documentation for obvious reasons (e.g., homeless) WellSpan may categorize write-offs associated with the patient’s account(s) as charity consistent with internal facility procedures and must document the rationale for the decision.

B. Where no insurance information is available, third- party information sources used for determining financial assistance eligibility will be used. These sources provide a patient account scoring mechanism, which uses patient demographic data to estimate the financial status of patients by accessing numerous publicly available databases. These sources provide an estimate of the patient’s household income and size to estimate the patient’s income per Federal Poverty Guidelines. This estimate, along with other information received from the database, such as overall charity score, may be used to provide financial assistance. When third-party information is used and the discount provided is not at the highest level available, the patient/responsible party will be given an opportunity to provide additional financial information to increase the amount of financial assistance.

C. In cases where the patient is non-responsive and/or other sources of information are readily available to perform an individual assessment of financial need, i.e. existing eligibility for Medical Assistance or scoring, these sources of information can be used to support and/or validate the decision for qualifying a patient for a full or partial financial assistance write-off.

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IV. ELIGIBLE SERVICES

A. WellSpan Health offers financial assistance for all medically necessary and emergency care services. Medically necessary is generally defined as the need for an item(s) or service(s) to be reasonable and necessary for the diagnosis or treatment of disease, injury or defect. All WellSpan entities’ services are eligible (unless excluded below). Financial assistance may not be available to individuals who reside outside of WellSpan Health’s primary service areas. B. Dental services are eligible under separate policy – see WellSpan Billing and Collection Policy.

V. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE

A. Professional fees for diagnostic services, when physicians are not employed by WellSpan entities (some non-WellSpan entities may honor WellSpan’s financial policy) – see Attachment B. B. Cosmetic procedures C. Infertility services D. Power lift chairs and power mobility equipment (e.g., scooters, van lifts and power wheelchairs) E. Check-up for lock up F. Bariatric-related services – (see section VI) G. Genetic testing H. Reference labs and handling fees I. Flat rate services under arrangements J. Services for which the patient “opted out” or for which the patient assumed financial responsibility via signed waiver K. Services received by patients with a Non-Par insurance that requires patients to utilize participating providers (redirect plans) (exception: emergent services in Emergency department) L. Pharmacy Prescription co-pays M. Services resulting from criminal/illegal activity

VI. SERVICES DEEMED NON-COVERED BY INSURANCE A. Bariatric – patients will be offered the self-pay package pricing when it is determined that the service is medically necessary, but their insurance plan will not cover the service. This is required to be paid prior to services.

VII. PLAIN COMMUNITY HARDSHIP AID DISCOUNT PROGRAM A. Due to religious beliefs, Plain Community members have difference qualifications for financial assistance and are not subject to requirements of this policy.

SCOPE: This policy applies to all entities governed by WellSpan Health.

ATTACHMENTS: Attachment A: WellSpan Financial Assistance Policy Guidelines Attachment B: Financial Assistance Policy: Non-participating Providers

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APPROVED BY: Senior Leadership Team

POLICY CROSS REFERENCES Billing and Collection Policy Payment Plan Policy Financial Assistance Plain Language Summary Emergency Medical Care Policy (EMTALA)

CREATED DATE: 07/13/04

REVIEW/REVISE DATES: 10/04; 3/05; 4/06; 8/06; 3/07; 8/07; 4/7/08; 4/23/08; 7/9/08; 7/10; 8/10; 2/11; 7/11; 4/12; 6/12, 4/1/3, 3/14, 7/16, 9/16, 6/18, 2/19, 10/19, 03/20, 03/21

SEARCH KEYWORDS: MAP, Free Care, Uncompensated Care, Indigent Care. Financial Assistance, Charity

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Attachment A

Category I: Write-off of all charges for patients whose income is less than or equal to 300% of Federal Poverty Guideline (100% discount) Category II: Patients between 301% and 350% of poverty level receive a 70% discount on services.

Poverty Guidelines 2021

# of Family 2021 Federal Poverty Up to 300% of Poverty 301% and 350% Members Guidelines Level (100% Reduction) (70% Reduction)

1 $12,880 $38,640 $45,080 2 $17,420 $52,260 $60,970 3 $21,960 $65,880 $76,860 4 $26,500 $79,500 $92,750 5 $31,040 $93,120 $108,640 6 $35,580 $106,740 $124,530 7 $40,120 $120,360 $140,420

8 $44,660 $133,980 $156,310

For families with more than eight members, add $4,480 for each additional member.

Liquid Asset Guidelines

1 individual - $25,000 asset limit Couple - $30,000 asset limit

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Attachment B Non-Participating Providers Updated: 03/2021 All providers of medically necessary care in WellSpan facilities who are not employed by such facilities are listed below. None of the providers listed in Attachment B are covered by the FAP and do not apply the same discounts for services provided. Group Name A Physical Therapist Inc. AC Consulting Inc Active Life Chiropractic, LLC Adams County Chiropractic Adams County Physical Therapy Adams Hanover ENT Adult Medicine & Aesthetics Advanced Chiropractic Care Advanced Eye Specialists LLC Advanced Otolaryngology & Allergy LLC Advanced Pain Care, PC Advanced Physical Therapy and Fitness Advanced Vein and Laser Center, Inc. Agape Physical Therapy & Sports Rehabilitation Air Rites Center - Wilmer Clinic Alan L Robin MD PA Alcove Counseling Services, Inc Allcare Family Health, PC Allergy & Asthma Center Allergy & Asthma Consultants Allergy & Asthma Specialists of Harrisburg Allergy and Asthma Center Alliance Rehabilitation Services Andersen Family Chiropractic Anesthesia & Pain Associates of Northern Lancaster County Anesthesia Associates of Lancaster Ltd Anesthesia Associates of York PA, Inc Antietam Eye Associates AO Orthopedics Inc. Apple Hill Gynecology Apple Hill Podiatry Apple Ridge Family Medicine April L Murphy, LCSW Armesto Eye Associates Arrow Counseling Services Aspire Urgent Care and Family Medicine Associated Otolaryngologists of PA, Inc Associates in Family Medicine Associates in Oral & Maxillofacial Surgery Atlantic Foot and Ankle Specialist Azizkhan Internal Medicine Associates BACA Pediatrics BACA Pediatrics Bakare & Associates Balhara Internal Medicine Barbara A. Klatchko, M.D., LTD Baxter Drew Wellmon, II, DO, PC Beaudry Oral Surgery Beech Tree Podiatry Behavioral Healthcare Consultants PC Bette A Landis, LCSW Big Spring Physical Therapy & Sports Medicine Birth Care & Family Health Services Blessed Touch Therapeutic Massage

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Blue Mountain Anesthesia Associates, PC Blue Mountain Family Practice Boshinski Eye Clinic Bouquet Mulligan Demaio Eye Professionals, PC Bowman and Associates Bowmansdale Family Practice Boyer Chiropractic Breast Center at Memorial Hospital Brian D Becker, DC Brownstone Dermatology Associates Buckley Chiropractic Center, P.C. C Brian Peffer, DPM Calcagno and Rossi Vein Treatment Center Cancer Care Associates of York, Inc Capital Anesthesia Capital Arthritis and Rheumatology Associates, LLC Cardin & Miller Physical Therapy CareExpress Carlisle Dermatology Group LLC Carlisle Digestive Disease Associates, LTD Carlisle Ear, Nose, & Throat Associates Carlisle Medical Pathology, PC Carlisle Neurocare Inc. Carlisle Pediatric Associates Center for Heart Care Center for Kidney Disease & Hypertension Central Maryland Radiation Oncology Central PA Eye Institute Central PA Rehabilitation Services Central PA Surgical Associates, LTD. Chambersburg Gastroenterology Associates, LTD Chambersburg Medical Associates Charan’s Family Medicine LLC Charles S Yeager DPM Cherry Tree Foot and Ankle Specialists, PC Children’s Resource Center Chiro - Dynamics Chiropractic Athletic Center Chiropractic Health Center of Shrewsbury Chiropractic Healthcare Center Christianne Schoedel, MD Christopher A. Seda, D.P.M. Circle of Life Massage & Wellness Cleona Chiropractic PC Cognitive Health Solutions, LLC Colonial Park Family Practice Complete Family Foot Care Center Conforti Physical Therapy Cornerstone Counseling Center Cornerstone Dermatology Cornerstone Surgical, LLC Cosmetic Plastic Surgery and Laser Center Craig Lahar, DMD Crawford Chiropractic Center Cumberland Franklin Counseling Services Cumberland Orthopedic & Spine Physical Therapy Inc Cumberland Valley Counseling Associates Cumberland Valley Foot & Ankle Specialists, PC Cumberland Valley Nephrology Cumberland Valley Neurosurgical Consultants Cumberland Valley Obstetrics & Gynecology Cumberland Valley Pain Management Cumberland Valley Retina Consultants Cumberland Valley Rheumatology PC

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Cummings Associates, PC Dailey Eye Associates Dallastown Medical Associates Davenshire Medical Center David E. Zickafoose, MD David J. Bene, MD David L Streisfeld MD PC de Ramon Plastic Surgery Institute, PC Dermatology & Skin Surgery Center of York Dermatology Associates of Lebanon Ltd Dermatology Associates of York Dillsburg Chiropractic Center Inc Ditzler Physical Therapy LLC Donald DeLorenzo, M.D. Drayer Physical Therapy Institute Drs. May-Grant Associates East Baltimore Medical Center East Berlin Chiropractic East Berlin Family Care Center East Berlin Foot and Ankle Center, PC East York Chiropractic Center Edwin A. Aquino, M.D. Elaine Lovelace, PhD ELANCO Chiropractic Inc Electrodiagnostic Medicine Group, Ltd Elena R Farrell DO Elizabeth Revell, Ph.D. Ellis D Berkowitz, MSW Elmwood Eye Center EMG Center Inc Endocrinology of Central PA LLC Engle Chiropractic Center ENT Surgery Group, PC Eye Consultants of Pennsylvania PC Eyes of York Cataract and Laser Ctr PC Facchina Eye Center Family Center for Allergy and Asthma Family Eye Care Family First Health Family Health Associates Family Health Associates Family Medicine Associates of York LLC Family Practice Center PC Family Tree Chiropractic LLC Family-Child Resources Farrell Plastic Surgery, PC Fava & Maria Eye Associates FC Select LLC dba Select Physical Therapy FHL Blood & Cancer Specialists Fifth Avenue Medical Group,LLC Fitterer Chiropractic Foot & Ankle Center Forbes Family Chiropractic, PC Forti & Consevage, PC Franco Psychological Associates PC Franklin Family Services Gastroenterology Associates of Central Pa Gastroenterology Associates of York, PC Geisinger Holy Spirit Critical Care Medicine Geisinger Holy Spirit Dermatology Geisinger Holy Spirit Emergency Medicine Geisinger Holy Spirit Hospitalist Geisinger Holy Spirit Neurology Geisinger Holy Spirit Radiology

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Geisinger Holy Spirit Silver Creek Gene P Otto, III, M.D. Gentile Hand Clinic George M.Kosco III, DO & Associates, PC Geriatric and Adult Medicine Gettysburg Cancer Center Gettysburg Chiropractic Gettysburg Diagnostic Imaging, PC Gettysburg Family Practice Gettysburg Ophthalmology Associates, P.C. Gettysburg Pediatrics Giesswein Plastic Surgery LLC Gillaspy Chiropractic Center for Neck & Back Pain Goldman Associates Good Hope Family Physicians Good Samaritan Professional Building Graham Family Chiropractic Graham Medical Clinic Grand Oaks Green Hill Family Health Center Greencastle Family Practice H. Fred Martin, MD Hampden Physician Assoc. Hand Therapy Associates Hanover Anesthesiology & Pain Medicine Hanover Area YMCA Hanover Family Practice Associates Hanover Pathology Associates Hanover Pediatric Associates, PC Hanover Women’s Health Care Harberger Speech Therapy LLC Harrisburg Foot & Ankle Center Harrisburg Gastro. Ltd. Hartzell Rupp Ophthalmology PC HCC of Carlisle, P.C. DBA Holcomb Chiropractic Center Healthy Starts Pediatrics, PC Hearing Health PA LLC Hearing Solutions of Central PA Hematology & Oncology Consultants of PA Hemler Family Eye Care Heritage Behavioral Health Heritage Family Medicine Heritage First ENT Heritage Hills Chiropractic Center Heritage Pediatrics Hershey Counseling Center Hershey Kidney Specialists, Inc. Hershey Oral Surgery Associates Hershey Orthopedic & Spine Rehab LLC Hershey Pediatric Ophthalmology Associates PC. Hershner-Decker Chiropractic, LLC Hillside Foot & Ankle Hillside Gastroenterology & Nutrition Hillside Internal Medicine Hillside Medical Practice Hillside Pain Management, PC Holtz Family Chiropractic, LLC Holy Spirit Cancer Center Holy Spirit Holy Spirit Cardiothoracic Surgery Holy Spirit Endocrinology Holy Spirit Family Medicine – Carlisle Holy Spirit Family Medicine - Dillsburg

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Holy Spirit Family Medicine - Duncannon Holy Spirit Family Medicine - Marysville Holy Spirit Family Medicine - Mechanicsburg Holy Spirit Family Medicine - New Cumberland Holy Spirit Family Medicine - Newberry Holy Spirit Family Medicine - Progress Holy Spirit Family Medicine - Yellow Breeches Holy Spirit Internal Medicine Holy Spirit Neurology Holy Spirit Ob/Gyn Holy Spirit Orthopedic Surgery Holy Spirit Pediatrics Horizon Eye Care Group Houcks Road Family Practice, PC Howard County Emergency Medical Services Howard County General Hospital Howard County General Hospital Healthcare and Surgery Howard W Burkett, DPM HSMG Family Practice - Enola HSMG Holy Spirit Carlisle Center HSMG Palliative Care HSMG Vascular Surgery Hunters Hill Eye Care, LLC Hypertension & Kidney Specialists Inspire Chiropractic & Physical Therapy Inspired Physical Therapy LLC Integrative Medicine and Digestive Disease Center Internal Medicine Consultants of York Jackson Siegelbaum Gastroenterology Jacobus Medical Center James J Sullivan DO Jatto Internal Medicine and Wellness Practice JDC Pediatrics Jeffrey A Frey, MD Jeffrey A Marks, DPM Jeffrey M. Witman, DPM Jewish Family Service of Greater Harrisburg JHCP @ Howard Country General Hospital JHCP Remington Internal Medicine JHCP Remington OB/GYN JHCP Remington Pediatrics JHU KIPP School Health Center John C. Baer, MD, LLC - dba South Penn Eye Care John E Muscalus, DO John Farmer, DO John Ramirez, PhD John Salahub DPM Podiatric Medicine & Surgery LLC John T Hower, PhD Johns Hopkins Asthma and Allergy Center Johns Hopkins at Green Spring Station Johns Hopkins at Howard County General Hospital Johns Hopkins at Suburban Hospital Johns Hopkins at White Marsh Johns Hopkins Bayview Medical Center Johns Hopkins Bayview Medical Center - Asthma and Allergy Johns Hopkins Cardiology at Columbia Johns Hopkins Cardiology at Greater Baltimore Medi Johns Hopkins Children’s Center, The Charlotte R Bloomberg Children’s Center Johns Hopkins Community Physicians - Ballston Medical Center Johns Hopkins Community Physicians - Columbia Medical Center Johns Hopkins Community Physicians - Heart Care Johns Hopkins Community Physicians - Suburban Hospital

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Johns Hopkins Community Physicians at Bowie Johns Hopkins Community Physicians at Canton Cross Johns Hopkins Community Physicians at Charles County Johns Hopkins Community Physicians at Frederick Johns Hopkins Community Physicians at Fulton Johns Hopkins Community Physicians at Germantown Johns Hopkins Community Physicians at Glen Burnie Johns Hopkins Community Physicians at Greater Dundalk Johns Hopkins Community Physicians at Green Spring Johns Hopkins Community Physicians at Howard Count Johns Hopkins Community Physicians at Laurel Johns Hopkins Community Physicians at Montgomery Johns Hopkins Community Physicians at Odenton Medical Pavilion Johns Hopkins Community Physicians at Sibley Medical Center Johns Hopkins Community Physicians at Sibley Memorial Johns Hopkins Community Physicians at Westminster Johns Hopkins Community Physicians at White Marsh Johns Hopkins Community Physicians at Wyman Park Johns Hopkins Community Physicians General Surgery Johns Hopkins Community Physicians Orthopedic and Johns Hopkins Heart and Vascular Institute at Columbia Johns Hopkins Integrative Medicine Center Johns Hopkins Medical Imaging at Columbia Johns Hopkins Medicine - Howard County General Hospital Johns Hopkins Medicine Integrative Medicine and Digestive Center Johns Hopkins Medicine University Health Services Johns Hopkins Medicine- White Marsh Johns Hopkins Orthopedic Surgery Johns Hopkins Otolaryngology at Green Spring Station Johns Hopkins Outpatient Center Johns Hopkins Rockland Physician Practice and Rese Johns Hopkins Sidney Kimmel Comprehensive Cancer Center Johns Hopkins Wilmer Eye Institute - Belair Johns Hopkins Wilmer Eye Institute - Columbia Jonestown Chiropractic Joseph P. Cardinale, DO, PC Joseph T Wunderlich DC Just Wellness LLC Kanagasabapathy Arumugarajah, MD Karen K. Stabley, MCAT AT Kathryn A. Kurdt, PhD MS Keystone Audiology and Speech Keystone Behavioral Health Keystone Chiropractic Services Keystone Eye Care Group Keystone Family Medicine Keystone Foot and Ankle Center Chambersburg Keystone Foot and Ankle Center Waynesboro Keystone Hearing Institute Keystone Infectious Disease Keystone Internal Medicine Keystone Over the Rainbow Keystone Pediatric Developmental Center Keystone Pediatrics Keystone Rehabilitation Systems Inc Keystone State Family Chiropractic, LLC Keystone Urgent Care Keystone Women’s Care Kilmore Eye Associates King and Associates Physical Therapy, Inc

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Kirk W. Davis, DPM Kirn Family Eye Care, Inc Kondner Chiropractic Center, PC KPMA, PC, d/b/a Biglerville Foot & Ankle Center KPMA, PC, d/b/a Londonderry Foot & Ankle Center KPMA, PC, d/b/a Paxtonia Foot & Ankle KPMA, PC, d/b/a West Shore Foot & Ankle Center Kristen L. Keeports, PsyD Kruba Chiropractic Center Kurt K. Thomas DO LLC Lancaster County Podiatry Lancaster Orthopedic Group Lawrence A. Filak, Jr., O.D. Lawrence Counseling Lawrence L Altaker, MD, FAPA Leader Heights Eye Center Leader Heights Spine Joint & Nerve Assc PC Leader Surgical Associates Lebanon Anesthesia Associates Lebanon Imaging Associates PC Lebanon Internal Medicine Associates, PC Lebanon Pathology Associates Lebanon Valley Family Medicine Lebanon Valley Midwifery & Women’s Health Leedy/Abbey Counseling Services Leg Up Farm, Inc. Lemoyne Primary Care PC Leslie Packer, M.D. Linda K Collevecchio, PhD, LLC Lisa H Plotkin, LSW Little Patuxent Specialty Care Center Loretta K. Schmidgall, OD, PC Ludwick Eye Center Lung Asthma & Sleep Assoc PC M. Nazeeri, M.D. MacGregor Behavioral Health Marc A. Hirsh, MD Marcos A. Ugarte, MD Mark A. Swartz, M.D., Family Practice Martin Foot and Ankle Maryland Vascular Specialists Masland Associates, Inc. Mechanicsburg Chiropractic, P.C. MedExpress Urgent Care Lebanon Medical Arts Allergy, PC Melnick, Moffitt, & Mesaros ENT Associates Mid Penn Oral & Maxillofacial Surgery, PC Mid-Atlantic Eye, LLC, dba Mid-Atlantic Cornea Consultants Mitchell Family Chiropractic LLC Mock Mays Associates Mohammad S. Haq, M.D. Morganstein De Falcis Rehabilitation Institute Morrison Associates Optometry Mulhollem Chiropractic Clinic Myerstown Family Practice PC MyEyeDr Nasreen Khan, D.O., Ophthalmology Naresh S. Maingi, MD Nephrology Associates of Central PA Nephrology Associates of York New Passages Inc Newport Counseling Center

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Newport Family Practice Occupational & Hand Therapy Specialists, Inc Onsite Neonatal Partners Inc Ophthalmology Associates of York, LLP OPTN, LLC Oral and Maxillofacial Surgery Innovations Orthopedic and Spine Physical Therapy Orthopedic Institute of PA OSS Health Osteopathic Primary Care Center Osterberg Chiropractic Centre, P.C. Otolaryngology Physicians of Lancaster Pain Institute of Central PA PC Palliative Medicine Consultants Parkway Neuroscience & Spine Institute Parris Castoro Eye Care Center Partners in Women’s Healthcare, PC Patapsco Eye Pathology Associates of Central PA Pathway Data Services Paul Dalbey, DPM Pediatric Gastroenterology Associates Pediatric Specialists of Franklin County Pediatric Therapy Associates Pediatric Urgent Care of Franklin County Penn Mar Anesthesia Penn Rehabilitation Associates, PC Penn State Health Medical Group - All About Children Penn State Health Medical Group - Andrews Patel Hematology Oncology Penn State Health Medical Group - Hospitalists Penn State Health Medical Group - Lancaster Specialties Penn State Health Medical Group - Lime Spring Penn State Health Medical Group - Post Acute Care Penn State Health Medical Group - Prospect Penn State Health Medical Group - Pulmonary & Critical Care Medicine Penn State Health Medical Group - Radiology Penn State Health Medical Group - Schuylkill Valley Penn State Health Medical Group - Walk -In Clinic Penn State Medical Group - Cocoa Penn State Medical Group - Cornerstone Penn State Medical Group - Eastbrook Penn State Medical Group - Kissel Hill Penn State Medical Group - Manor Penn State Medical Group - South Lancaster Penn State Medical Group - White Rose Pennsylvania Counseling Services Pennsylvania Eye Associates Pennsylvania Gastroenterology Consultants, PC Pennsylvania Institute of Endocrinology, LLC Pennsylvania Retina Specialists, PC Pennsylvania Toxicologists Perry Pediatrics, PC Perry Physicians PC Peter J. Sakol MD, LLC PHCVI-Pinnacle Health Cardiovascular and Thoracic Surgery PHS Physical Therapy LLC dba Select Physical Therapy Physical Therapy and Sports Injury Center, Inc. Physical Therapy, etc. Pine Street Podiatry Pinker & Associates Pinnacle Health Children’s & Teen Center Pinnacle Health CRNAs Pinnacle Health Emergency Department Services LLC Pinnacle Health Family Care of Camp Hill

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Pinnacle Health Family Care of Dillsburg Pinnacle Health Family Care of Millersburg Pinnacle Health Family Care Silver Spring Pinnacle Health Hospitalist Services LLC Pinnacle Health Maternal Fetal Medicine Pinnacle Health Pediatric Surgery Assoc Pinnacle Health Transplant Services Pinnacle Health Annville Family Medicine Pinnacle Health Breast Care Center Pinnacle Health Cardiovascular Institute Inc Pinnacle Health Cardiovascular Services Pinnacle Health Endocrinology Associates Pinnacle Health Express Pinnacle Health Family Care of Lower Paxton Pinnacle Health Family Care of Mechanicsburg Pinnacle Health Family Care of Middletown Pinnacle Health Family Care of Newport Pinnacle Health Family Care of West Hanover Pinnacle Health FASTCARE Pinnacle Health Hematology/Oncology Associates Pinnacle Health Imaging Tristan Radiology Specialist Pinnacle Health Infectious Disease Associates Pinnacle Health Internal Medicine Associates Pinnacle Health Internal Medicine Residency Program Pinnacle Health Neurosurgery Pinnacle Health Neurosurgery and Neurosciences Inst Pinnacle Health Observation Services, LLC Pinnacle Health Obstetrics and Gynecology Specialist Pinnacle Health Palliative Care Pinnacle Health Pediatric Associates Pinnacle Health Psychological Associates Pinnacle Health Radiation Oncology Pinnacle Health REACCH Program Pinnacle Health Rheumatology Associates Pinnacle Health SNF-Post Acute Care Pinnacle Health Sports Medicine Center Pinnacle Health Surgical Associates Pinnacle Health Weight Loss Center Pinnacle Health Women’s Cancer Center Pinnacle Health Women’s Outpatient Health Center Pinnacle Health Wound and Hyperbaric Center Planned Parenthood Keystone Plastic and Reconstructive Surgery Plastic Surgery of York Poloni and Associates Poplar Church Anesthesia, Inc. Premier Ankle & Foot Specialists, PC Premier Eye Care Group Premier Vein Specialists LLC Pressley Ridge Psychological Associates of Pennsylvania, PC Pulmonary Consultants of Hagerstown Quantum Imaging & Therapeutic Asc Queen Street Chiropractic R. Lynn Magargle, M.D. Rajesh Bajaj, MD Raymond L Ruberg, DO Red Lion Chiropractic, Inc Red Lion Health Care Regional GI Retina Care Center Richard E Carlson, PhD

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Richards Orthopedic Clinic and Sports Medicine LLC Riegler, Shienvold & Associates Rising Sun Eye Care Rivera Physical Therapy, PC Robina Santaniello, MD Ronald S. Czop, DC Aqua Massage and Chiropractic Center Rost and Associates Russell E. Grove Jr., O.D. Russell Macaluso, MD Ruthanne R. Wentz, LPC S Eye Care, P.C. Sackett Family Chiropractic Salman Ali, MD LLC Sanford Roumm Acharya Rheumatology, LLC Sans Pareil Eye Care LLP Sarah A. Banks DPM Saye, Gette & Diamond Dermatology Associates, PC Schaefferstown Family Practice Inc. Schein Ernst Mishra Eye PC Scott M Cherry, MD Security Family Medicine, LLC Seitz Oral & Maxillofacial Surgery Associates LLC Shepherdstown Family Practice Shippensburg Physical Therapy & Sports Medicine Shrewsbury Chiropractic Shrewsbury Vision Care Sidney Kimmel Comprehensive Care Cancer Center Sigafoose & Jackson Chiropractic Sisson-Boyer Eyecare LLC South Hills Therapeutic Inc South Penn Foot and Ankle Specialist Southern Family Medicine, LLC SpiriTrust Lutheran Counseling Services Spring Garden Family Practice Spring Grove Family Care Center Spring Road Wellness & Chiropractic Center Springdale Internal Medicine Spry Chiropractic Stanton S Lebouitz, MD Steelton Family Practice and Wellness Center Stoken Wagner Ophthalmic Associates Suburban Hospital Radiation Oncology Surgical Anesthesia of Gettysburg, LLC Surgical Specialists of York Susquehanna Internal Medicine Associates Susquehanna Oral and Maxillofacial Surgery Suzanne D. Burton, NCC, LPC Swank Chiropractic, LLC Tan & Garcia Pediatrics, P.C. The Center for Creative Arts & Play Therapy LLC The Family Health Center The Fertility Center, LLC The Foot & Body Works The Hetrick Center, PC The The Johns Hopkins Hospital - David Rubenstein Prof The Johns Hopkins Hospital at Bethesda The May Eye Care Center The Rehab Center The Well Red Lion Psychology The Wilmer Eye Institute at Bel Air

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The Wilmer Eye institute of Columbia Therapeutic Massage Works Thomas W Clark DPM TLC Cancer Clinic Todd M Pelleschi, DPM Todd R Fisher MD Family Medicine Tracy M Richards, LMFT, LCSW Treichler Sports & Family Chiropractic TrueNorth Wellness Services Twin Rose Family Medicine Union Deposit Anesthesia Urology Associates of Lebanon, PA, PC Urology of Central PA Vicki R Wheeler LPC Victor Cohen, DPM Vision Rehab & Development Center of PA Vision Therapy Associates of York Walker Chiropractic Walnut Bottom Family Practice LLC Walter J. Zimmerman, DC Walter M Kraiewski, DO Walters Chiropractic, PC Waltz Center for Oral Surgery and Implantology, PC Watkin Nipple Assoc Wayne H Senft, DO Waynesboro Family Medical Associates Waynesboro Internal Medical Associates Waynesboro Medical Associates, LLC Waynesboro PT & Sports Medicine Weaver Eye Associates West Shore Anesthesia Associates, LTD West Shore Family Practice, PC Wetzel Family Medicine Women First, Obstetrics & Gynecology, PC Women’s Health Center of Lebanon, Ltd. Women’s Outpatient Health Center Wood &Myers Oral & Maxillofacial Surgery PC Woodward & Associates Wound Specialists LLC Wyntre Brooke Eye Assoc. Inc York Dermatology York ENT Associates York Eye Associates of East York York Eye Associates of Red Lion and Dallastown York Rehabilitation Associates, PC Yorktowne Chiropractic Yorktowne Urology, PC

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