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K e y s t o n e R u r a l H e a l t h C e n t e r A n n u a l R e p o r t – M a y 2 0 2 2 – C h a m b e r s b u r g , PADr. Irakli Mania,Medical Director and Psychiatrist,Keystone Behavioral Health2021AND BEYOND

KEYSTONE HEALTHAT A GLANCE» SERV ICES20 Primary Care Services: Family Medicine Speech/Language Therapy Occupational Therapy Audiology Behavioral Health Chiropractic Crisis Intervention Urgent Care Pediatrics - Chambersburg Pediatrics - Waynesboro Pediatrics Clinic at CASHS Pediatric Dentistry Women’s Care Internal Medicine Infectious Diseases HIV/AIDS Foot and Ankle STD/Family Planning/Healthy Woman Dental Chambersburg Seasonal Farmworkers» SERVES 58,003 patient through 248,761 visits(222,702 in person visits, 26,059 virtual visits), regardless of ability to pay» WE ARE ACCOUNTABLE TO THE COMMUNITY THROUGHA PATIENT-DIRECTED BOARD OF DIRECTORS» EMPLOYS over 550 employees(doctors, other primary care providers, nurses, and support staff)» PRESENTLY OWNS820 Fifth Avenue - Family Medicine830 Fifth Avenue - Pediatrics Chambersburg including Pediatric Walk In,Pharmacy, Women’s Care, Internal Medicine767 Fifth Avenue - General Dentistry and Foot and Ankle110 Chambers Hill Drive - Behavioral Health and Drug and Alcohol Services111 Chambers Hill Drive - Urgent Care, Infectious Disease/HIV and STD,Pediatric Occupational Therapy, Speech Therapy and Audiology, PediatricDentistry, Administration, Centralized Medical Records, CommunityOutreach, STD/Family Planning Clinic ServicesAncillary Services 1 Keystone-owned Pharmacy 25 Contracted Pharmacies Navigator programMAKING A DIFFERENCE IN THE LIVES OF PATIENTS EVERY DAY!Keystone Rural Health Center, also known as Keystone Health, is a 501 (c)(3) not-for-profitFederally Qualified Health Center that has been serving Franklin County and the surrounding areas since 1986.2021 PRESIDENT’S MESSAGEUnfortunately,2021 was acontinuation of2020 regardingCOVID-19.We saw peaksand valleys inJoanne Cochranthe numberPresident & CEOof communitymembers getting tested and inpositivity rates. However, therewas one significant change—wenow have a vaccine to combatwww.keystonehealth.orgthis pandemic. In January,vaccination began for those whoqualified as “phase 1A healthcareworkers”. Keystone took onthe responsibility to vaccinateall health care workers in thecommunity.February brought some goodnews. The 7- day trend for COVIDwas down in the county, and casesstarted to level off for the timebeing. Around this time, Keystone2and the county began to shift fromtesting to vaccinating. “Tier 1A”vaccination began for individuals65 and older and those with bodymass index 30. We were nowvaccinating our own employees,other healthcare and essentialworkers, vulnerable populations,and eligible patients. Keystonealso began vaccinating residents inhousing developments, especiallylow-income areas.(continued on next page)

MESSAGE FROM THE PRESIDENT & CEO (continued from page 2)March saw falling numbers inCOVID cases, both nationallyand locally, and we began to openvaccinations to the community.Also in March, as the CEOand President of KeystoneHealth, I expressed interest incommissioning a committee toaddress inclusion and diversity.This committee now meetsevery other month and has beenworking diligently to ensureKeystone’s mission of healthequity and inclusion to all ismaintained.In April, vaccination efforts werecentralized at the 111 ChambersHill site to increase our efficiency.The Keystone Navigators Programexpanded its scope, and ournavigators were now able toapprove dual eligible Medicaid/Medicare individuals for thisbenefit. Keystone Pharmacy beganto deliver medications to ourpatients.May brought good news withthe US seeing new cases againtrending downward. Keystoneperformed 17,500 vaccinations todate, which was now 25% of allvaccinations in the county.August brought a resurgence ofCOVID-19 related to the Deltavariant. Testing and positivity ratesincreased. Also this month, our340B program underwent a HRSAaudit and successfully met all thestandards.September brought in the Fifthwave of COVID. New cases startedto peak nationally and locally.Deaths were fewer than earlierwaves, likely due to the loweraverage age of those infected.Franklin County had the highestincidence in the region, with ourpositivity rate at 15%. We beganseeing an uptick in vaccinations atthis time as well.In November, a booster COVIDvaccination was now beingrecommended by the CDC forhigh risk and over 65 populations;so, Keystone began organizing toprovide a third (booster) dose tothose special populations. Alsoin November, Keystone beganoffering monoclonal antibodytherapy for those infected byCOVID. This IV therapy had beenshown to reduce hospital rates inadults by 50%. Keystone was theonly provider of this IV therapy inChambersburg.June arrived, which broughtthe retirement of Sam King, thechairman of the Keystone Healthboard of directors. Sam spentnearly 30 years on Keystone’sboard, most of those years spent asChair of the BoardDecember of 2021 started withidentification of a new variant ofthe COVID virus, Omicron, whichvery quickly became the dominantvariant throughout the world, theUSA, and our community.In July, Keystone’s minimum wagewas approved to be raised to 15per hour.2021 was another year toremember. Keystone experiencedmany difficult times over the pastyear, but through all of the trials,3stress, overwhelming demand, andat times even tears, the KeystoneHealth family never gave up. I amso thankful for each and everyemployee that continues to showup for our patients daily. I thankthem from the bottom of my heartfor their dedication to Keystoneand most importantly, to ourpatients. Their hard work andsacrifice surely saved many lives.I also want to thank our Boardof Directors for their hardwork and dedication to ensureKeystone continues to serve ourcommunity through providing anexcellent quality of healthcare,caring for all of our patients andespecially those who need itmost, contributing to high patientsatisfaction, and continuingto work toward performanceimprovement and embracingfinancial accountability.As we enter Keystone’s 36thyear of providing services, Iam hopeful that the world andKeystone can begin getting backto a sense of normalcy. As in yearspast, we want our focus to beon providing the very best careto our patients, working towardreducing disparities, and findingnew ways to meet the needs ofthose in our community. With allof the changes and obstacles 2021brought us, I have no doubt thatthe Keystone Health family canmeet any future challenges thatcome our way.

2021 QUALITY INITIATIVESIn 2021, theCOVID-19pandemic ragedinto its secondyear with wearyAmericanssuffering a greaterdeath toll thanDr. Michael Collithe year before. The Delta Variantswept through our nation in theFall, bringing a more contagiousstrain with higher hospitalizationrates. Terminology like “PPE”,“variants”, and “quarantine periods”became part of our permanentEnglish vernacular, as we, as asociety, struggled to keep up witheverchanging CDC guidelines onmanaging the COVID-19 pandemic.Keystone Health, serving a key rolein our local public health safetynetwork, transitioned from solelytesting for COVID-19 in 2020 tovaccinating our population againstit. Deputized by the Departmentof Health as a primary COVID-19vaccine provider in our area,we developed partnerships withmultiple local employers, as wellas homeless shelters and the localhousing authority, to improveaccess to the vaccine for the mostvulnerable of populations. Alltold, Keystone Health administeredaround 30,000 COVID vaccinationsin 2021, the majority to patientswho had no previous connection toKeystone.However, 2021 also offered upsomething novel and refreshing:Hope. In a true miracle of modernscience, a safe and extremelyeffective COVID-19 vaccine wasbrought to market within 12 monthsof identifying the first case ofcoronavirus in Wuhan, China. Whatwould typically take years, if notdecades, to perfect, was developedwithin weeks, trialed within months,and made widely available to theAmerican public by February 2021.As the year wound down, theDelta wave metamorphosizedinto the even more deadly andcontagious Omicron wave. Hospitalsystems throughout South CentralPennsylvania became overrun withpatients. Patients were boarding inthe emergency rooms for days onend, waiting for beds to becomeavailable on inpatient units. Withthe health systems reaching acritical mass, in November of 2021,Keystone once again fulfilled itspublic health role and embarkedon a Monoclonal Antibody infusionprogram at our new infusioncenter at our Infectious Diseaselocation. Monoclonal antibodies,administered to high-risk, sick, butnot-yet-hospitalized patients, werefound to be extremely effectiveat staving off serious illness andkeeping patients out of the hospital.Millions of Americans rolled up theirsleeves, so they could take off theirmasks. Instead of living in fear ofthe virus, the vaccine allowed usto coexist with the virus, knowingthat after inoculation we wouldbe immune from the deadliestoutcomes. By summer, the vaccinebecame available for children asyoung as age 5, meaning that nearlyevery American who desired theadditional protection could receive itand schools and workplaces alike reopened to some sense of normalcy.www.keystonehealth.orgThrough our ambitious and highlysuccessful COVID-19 vaccinationand Monoclonal Antibody infusionprograms, we likely prevented4thousands of illnesses, hundredsof hospitalizations, and dozensof deaths. In its darkest hours,our community turned to us tobe a trusted partner in COVID-19prevention, just as it had earlier withtesting.As the world learned to coexist withthe virus, we saw patients returnin droves to our practices in 2021to begin receiving long neglectedpreventative care. We had over18,000 more patient visits in 2021,an 8% increase over 2020. Wealso saw tremendous year-to-yearincreases in our breast, cervicaland colorectal cancer screeningrates, suggesting that patients wereinterested in focusing on healthcareissues other than COVID-19.Operations that had been greatlyimpacted by the pandemic in 2020,inched closer to normalcy in 2021.Our School Based Health Centerfully re-opened, our AgriculturalWorker Program saw recordfarmworker registrations, andour Dental practice expanded itsprovider base.As we move into 2022, we knowthat the challenges of COVID-19are not behind us. Specifically, themental health of our communitymembers remains at risk, with theAmerican Academy of Pediatricsdeclaring a Mental HealthEmergency for our nation’s youth inlate 2021. Yet, as mask mandates,travel restrictions, and globalCOVID-19 precautions are beinglifted, we can now allow ourselvesto imagine a healthcare world nolonger dominated by the pandemic.And there is comfort in knowing wewill enter that new world together.