The Economic Impact of Community Health Center of the North Country Community Health Center of the North Country In 2013, Community Health Center of the North Country provided 38,560 PATIENT ENCOUNTERS to10,899 PATIENTS UNINSURED10% MEDICAID 38% MEDICARE 19% Community Health Center of the North Country directly generated and supported an additional and contributed approximately saving the system $14 MILLION ANNUAL COST SAVINGS 94TOTAL JOBS $8,604,296 TOTAL ECONOMIC IMPACT 72 22 $0.4 MILLION $0.7 MILLION Federal Tax Revenue $1.1 MILLION TOTAL TAX IMPACT $6,092,163 Direct $2,512,133 Non-direct Under 200% poverty97% Under 100% poverty34% State & Local Tax Revenue COMMUNITY IMPACT TAXIMPACT ECONOMICIMPACT COMMUNITY IMPACT Community health centers provide high quality, cost-effective, patient-centered care to vulnerable populations. CHCs serve 1 in 7 Medicaid beneficiaries, almost 1 in 3 individuals in poverty, and 1 in 5 low-income, uninsured persons. Nationally, two-thirds of health center patients are members of racial or ethnic minorities, which places CHCs at the center of the national effort to reduce racial disparities in health care.1 Recent studies show that, on average, each patient receiving care at a CHC saved the health care system 24%, annually.4 With 10,899 patients served by Community Health Center of the North Country in 2013, the estimated annual savings is $14 million at $1,263 saved per patient.5 ECONOMIC IMPACT As Community Health Center of the North Country continues to expand, their expenditures and corresponding economic impact also grow.It is estimated at about $9 million dollars in 2013 alone. The table to the right summarizes the 2013 economic impact of Community Health Health Center of the North Country. Community Health Center of the North Country Distribution of Population CHC Population 1981642 2, 3 Under 100% Poverty34%20% Under 200% Poverty97%40% Uninsured10%15% Medicaid38%16% Medicare19%16% Summary of 2013 Total Economic Activity Stimulated by Current Operations of Community Health Center of the North Country Economic Impact(incl. Value-Added) Value-Added (incl. personal income) Employment (# of FTEs) Direct$6,092,163$3,374,94872.4 Indirect$ 802,757$ 453,783 7.0 Induced$1,709,376$1,024,90115.0 Total$8,604,296$4,853,63294.4 Direct # of FTEs (employment) based on HRSA 2013 UDS data provided by the health center. Communty HeaIth Center of the North Country ECONOMIC IMPACT DEFINITION OF TERMS This analysis applies the multiplier effect, using an integrated economic modeling and planning tool called IMPLAN (IMpact analysis for PLANning) to capture the direct, indirect, and induced economic effects of an organizations business operations. IMPLAN was developed by the U.S. Department of Agriculture and the Minnesota IMPLAN Group (MIG) and employs multipliers, specific to each county and each industrial sector, to determine total output, employment, and earnings. This analysis was conducted using Implan Version 3, Trade Flows Model. Output Multiplier: measures the increase in total output generated in a defined regional economy for each dollar spent by a given industry. Value-added (Earnings) Multiplier: measures the earnings (purchasing power) that an industry generates, through payroll and the multiplier effect, for households employed by all industries within a defined area. Employment Multiplier: measures the number of jobs generated across all industries by the activity within a given industry. The multiplier produces an estimate of the total number of new jobs that a local economy can support in all industries due to the dollars being injected into the community by the organization. IMPLANs output, earnings, and employment figures are aggregated based on:Direct effects: represents the response for a given industry (in this case Total Operating Expenditures of health centers). Indirect effects: represents the response by all local industries caused by the iteration of industries purchasing. Induced effects: represents the response by all local industries to the expenditures of new household income generated by the direct and indirect effects. REFERENCES 1.NACHC, ASketchofCommunityHealthCenters, 2013. Includes patients of federally-funded health centers, non federally-funded health centers, and expected patient growth for 2013.2.Based on Bureau of Primary Health Care, HRSA, DHHS, 2012 Uniform Data System. U.S.: Kaiser Family Foundation, State Health Facts Online, www.statehealthfacts.org. Based on Census Bureau's March 2012 and 2013 Current Population Survey (CPS: Annual Social and Economic Supplements). 3.Based on Centers for Medicare & Medicaid Services: www.cms.gov. Medicare Enrollment All Beneficiaries: as of JULY 2012 4.Richard et al. CostSavingsAssociatedwiththeUseofCommunityHealthCenters. Journal of Ambulatory Care Management, Vol. 35, No. 1, pp. 5059, January/March 2012. 5.Ku et al. StrengtheningPrimaryCaretoBendtheCostCurve:TheExpansionofCommunityHealthCentersThroughHealthReform. Geiger Gibson/RCHN. Community Health Foundation Research Collaborative. Policy Research Brief No. 19. June 30, 2010. ABOUT CAPITAL LINK Capital Link is a non-profit organization that has worked with hundreds of health centers and Primary Care Associations over the past 15 years to plan capital projects, finance growth and identify ways to improve performance. We provide innovative advisory services and extensive technical assistance with the goal of supporting and expanding community-based health care. Established in the late 1990s as a joint effort of the National Association of Community Health Centers (NACHC), several state-based Primary Care Associations (PCAs), and the Bureau of Primary Health Care, Capital Link grew out of the community health center family and continues to support it through our activities.For more information visit www.caplink.org. 2014, Capital Link, Inc. All Rights Reserved. www.caplink.org

For nearly 50 years, U.S. health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay, becoming one of the largest safety net systems in the country. North Country Family Health Center, Inc. has been no exception. In 2014, North Country Family Health Center, Inc. provided care to many of the most underserved members of its community. In addition to providing quality care, North Country Family Health Center, Inc. generated positive economic impacts, including jobs, tax revenues and savings to the health care system.ANNUALLY ANNUALLY ANNUALLY COMMUNITY IMPACT Community health centers provide high quality, cost-effective, patient-centered care to vulnerable populations. Health centers serve 1 in 7 Medicaid beneficiaries, almost 1 in 3 individuals in poverty, and 1 in 5 low-income, uninsured persons. Nationally, two-thirds of health center patients are members of racial or ethnic minorities, which places health centers at the center of the national effort to reduce racial disparities in health care.1 Recent studies show that, on average, each patient receiving care at a health center saved the health care system 24%, annually.4 With 8,201 patients served by North Country Family Health Center, Inc. in 2014, the estimated annual savings is $10.4 million at $1,263 saved per patient.5 Distribution of Population CHC Population National Population 2, 3 Under 100% Poverty54%20% Under 200% Poverty88%40% Uninsured25%15% Medicaid46%16% Medicare 3%16% Privately Insured22%55% Summary of 2014 Total Economic Activity Stimulated by Current Operations of North Country Family Health Center, Inc. Economic ImpactEmployment (# of FTEs*) Direct$ 4,762,921 59 Non-Direct { Indirect$541,6075 Induced$ 1,387,616 11 Total$ 6,692,144 75 Direct # of FTEs (employment) based on HRSA 2014 UDS state level data for FQHCs. Summary of 2014 Tax Revenue FederalState/Local Direct $463,650$169,370 Non-Direct { Indirect$39,296$31,766 Induced$99,314$113,385 Total$602,260$314,521 Total Tax Impact$916,781 *Full-time Equivalent (FTE) of 1.0 means that the person is equivalent to a full-time worker. In an organization that has a 40 hour work week, a person who works 20 hours per week (i.e. 50 percent time) is reported as 0.5 FTE. FTE is also based on the number of months the employee works. An employee who works full time for four months out of the year would be reported as 0.33 FTE (4 months/12 months). 2015, Capital Link, Inc. All Rights Reserved. www.caplink.org ECONOMIC IMPACT As health centers expand, their expenditures and corresponding economic impact also grow.In 2014 alone, North Country Family Health Center, Inc. contributed about $6.7 million dollars. The table to the right summarizes economic impact and employment. The tax impacts of North Country Family Health Center, Inc. are divided into state/local governments and Federal government agencies. Tax revenue is generated through employee compensation, proprietor income, indirect business taxes, households, and corporations based on the modeled impact. HOW ECONOMIC IMPACT IS MEASUREDUsing IMPLAN, integrated economic modeling software, this analysis applies the multiplier effect to capture the direct, indirect, and induced economic effects of health center business operations and capital project plans. IMPLAN generates multipliers by geographic region and by industry combined with a county/state database. It is widely used by economists, state and city planners, universities and others to estimate the impact of projects and expenditures on the local economy. This analysis was conducted using IMPLAN Version 3, Trade Flows Model. WHAT ARE DIRECT, INDIRECT AND INDUCED IMPACTS? 2015, Capital Link, Inc. All Rights Reserved. www.caplink.org REFERENCES 1.NACHC, A Sketch of Community Health Centers, 2013. Includes patients of federally-funded health centers, non-federally funded health centers, and expected patient growth for 2013.2.Based on Bureau of Primary Health Care, HRSA, DHHS, 2012 Uniform Data System. U.S.: Kaiser Family Foundation, State Health Facts Online, www.statehealthfacts.org. Based on Census Bureau's March 2012 and 2013 Current Population Survey (CPS: Annual Social and Economic Supplements). 3.Based on Centers for Medicare & Medicaid Services: www.cms.gov. Medicare Enrollment All Beneficiaries: as of July 2012. 4.Richard et al. Cost Savings Associated with the Use of Community Health Centers. Journal of Ambulatory Care Management, Vol. 35, No. 1, pp. 5059, January/March 2012. 5.Ku et al. Strengthening Primary Care to Bend the Cost Curve: The Expansion of Community Health Centers Through Health Reform. Geiger Gibson/RCHN. Community Health Foundation Research Collaborative. Policy Research Brief No. 19. June 30, 2010. ABOUT CAPITAL LINK Capital Link is a non-profit organization that has worked with hundreds of health centers and Primary Care Associations for over 15 years to plan capital projects, finance growth and identify ways to improve performance. We provide innovative consulting services and extensive technical assistance with the goal of supporting and expanding community-based health care. For more information, visit us online at www.caplink.org. SOURCES This report was created with the 2014 the UDS report from North Country Family Health Center, Inc. in cooperation with CHCANYS. 2015, Capital Link, Inc. All Rights Reserved. www.caplink.org