Community Benefit Insight - Tax-exempt hospital

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Stewart Memorial Community Hospital

Stewart Memorial Hospital

1200 West Monroe
Lake City, IA 51449

Bed count	25	Medicare provider number	161350	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 420860039

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

2.43%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 245,143 0.82 %
Medicaid as % of operating expenses	$ 256,250 0.85 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 127,620 0.43 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 82,112 0.27 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 18,757 0.06 %
Community building* as % of operating expenses	$ 5,640 0.02 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	2
Physical improvements and housing	0
Economic development	1
Community support	1
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 5,640 0.02 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 3,585 63.56 %
Community support as % of community building expenses	$ 2,055 36.44 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 614,114 2.05 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 16501576 including grants of $ 0) (Revenue $ 15110006)
STEWART MEMORIAL COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL THAT ALSO OPERATES 4 RURAL HEALTH CLINICS. STEWART MEMORIAL EMPLOYS 11 FAMILY PRACTICE PROVIDERS, 1 BEHAVIORAL HEALTH PROVIDER, 2 GENERAL SURGEONS AND 2 CRNAS. BESIDES OFFERING 24/7 EMERGENCY ROOM SERVICES, STEWART MEMORIAL ALSO PROVIDES GENERAL RADIOLOGY, CT SCANS, ULTRASOUND, MOBILE MRI, NUCLEAR SCANS, LABORATORY, BLOOD ADMINISTRATION, CARDIAC REHABILITATION, EKGS, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, OPERATING ROOM, PHARMACY, INFUSIONS AND OBSTETRICS. DURING 2021, STEWART MEMORIAL HAD 1,036 ACUTE PATIENT DAYS, 2,241 EMERGENCY ROOM VISITS, 1,267 OPERATING ROOM PROCEDURES AND 35,176 CLINIC ENCOUNTERS.

4B (Expenses $ 6276898 including grants of $ 0) (Revenue $ 6472774)
STEWART MEMORIAL COMMUNITY HOSPITAL OWNS AND OPERATES RURAL HEALTH CLINICS IN THE COMMUNITIES OF LAKE CITY, GOWRIE, LAKE VIEW AND ROCKWELL CITY. WE EMPLOY 14 PROVIDERS WHICH ARE COMPOSED OF PHYSICIANS, PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS, THEY PROVIDE MEDICAL PROFESSIONAL SERVICES TO MEMBERS OF THESE COMMUNITIES AND SURROUNDING AREAS IN A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA.

4C (Expenses $ 2263265 including grants of $ 0) (Revenue $ 4421239)
THE LABORATORY DEPARTMENT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY TESTING FOR PATIENTS OF STEWART MEMORIAL COMMUNITY HOSPITAL. IT ALSO PROVIDE SERVICES TO THE MCCRARY-ROST CLINIC IN LAKE CITY. REAGENT AND SALARY COSTS OF PERSONNEL ACCOUNT FOR THE MAJORITY OF THE DEPARTMENT'S EXPENSES.

4D (Expenses $ 1159529 including grants of $ 0) (Revenue $ 2227950)
THE OPERATING AND RECOVERY ROOMS DEPARTMENT PROVIDE GENERAL SURGICAL AND ORTHOPEDIC PROCEDURES ALONG WITH PROCEDURES FOR ENT, CATARACT AND PODIATRY. THE SUPPLIES USED IN SUCH PROCEDURES ACCOUNT FOR A LARGE PORTION OF EXPENSES.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

STEWART MEMORIAL COMMUNITY HOSPITAL
PART V, SECTION B, LINE 5: STEWART MEMORIAL COMMUNITY HOSPITAL, IN CONJUNCTION WITH CALHOUN COUNTY PUBLIC HEALTH DEVELOPED A SURVEY MONKEY QUESTIONNAIRE TO GET INPUT FROM COMMUNITY MEMBERS. THE QUESTIONNAIRE WAS DISTRIBUTED THROUGHOUT THE SMCH SERVICE AREA TO VARIOUS ORGANIZATIONS INCLUDING PUBLIC HEALTH, SCHOOLS, OTHER HEALTH CARE PROVIDERS AND LOCAL BUSINESSES ALONG WITH EMPLOYEES OF THE HOSPITAL AND ITS AUXILIARY.

STEWART MEMORIAL COMMUNITY HOSPITAL
PART V, SECTION B, LINE 6B: CALHOUN COUNTY PUBLIC HEALTH

STEWART MEMORIAL COMMUNITY HOSPITAL
PART V, SECTION B, LINE 7D: A HARD COPY OF THE SURVEY WAS PRINTED AND DISTRIBUTED THROUGHOUT OUR SERVICE AREA INCLUDING THE LOCAL LIBRARY.

STEWART MEMORIAL COMMUNITY HOSPITAL
PART V, SECTION B, LINE 11: FOUR TOPICS WERE IDENTIFIED IN THE ASSESSMENT - 1) IMPROVE ACCESS TO QUALITY HEALTH SERVICES & SUPPORTS; 2) HEALTH EDUCATION AND INFORMATION RESOURCES; 3) HEALTHY LIVING; 4) HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH. THE FIRST TOPIC HAD 6 GOALS AND A FEW OBJECTIVES UNDER EACH. THE GOALS ARE TO REDUCE THE RATE OF CANCER DIAGNOSIS IN CALHOUN COUNTY, INCREASE THE USE OF CARE COORDINATION TO ASSIST WITH NAVIGATION THROUGH HEALTH CARE INFORMATION AND SERVICES, INCREASE ACCESS AND REFERRALS TO SHELTER SERVICES FOR VICTIMS OF ABUSE, VIOLENCE, OR SEX; INCLUDING INDIVIDUALS WITH DISABILITIES, REDUCE THE NUMBER OF REPORTED POOR MENTAL HEALTH DAYS TO IMPROVE QUALITY OF LIFE FOR CALHOUN COUNTY INDIVIDUALS AND FAMILIES, INCREASE AVAILABLE AND AFFORDABLE TRANSPORTATION SERVICES IN CALHOUN COUNTY, INCREASE THE AVAILABILITY OF SUBSTANCE ABUSE SUPPORT GROUPS FOR INDIVIDUALS AND FAMILIES. THE FIRST GOAL, REDUCE THE RATE OF CANCER DIAGNOSIS IN CALHOUN COUNTY, HAS 1 OBJECTIVE. THE OBJECTIVE IS TO INCREASE PREVENTATIVE BEHAVIORS IN PERSONS AT HIGH RISK FOR CANCER TO REDUCE CANCER RELATED DEATHS FROM 25 IN 2020 TO 15 IN 2025THE SECOND GOAL, INCREASE THE USE OF CARE COORDINATION TO ASSIST WITH NAVIGATION THROUGH HEALTH CARE INFORMATION AND SERVICES HAS 2 OBJECTIVES - INCREASE IDENTIFICATION OF INDIVIDUALS WITH MULTIPLE CARE CONDITIONS NEEDING REFERRAL FOR CARE COORDINATION TO INCREASE ACCESS AND FOLLOW UP FOR NEEDED SERVICES FROM CARE COORDINATION REFERRALS AND TO DEVELOP A TOOL TO TRACK HOME CARE REFERRALS AND FOLLOW UP. THE TARGET VALUE OF THE 1ST OBJECTIVE IS 50 INDIVIDUALS. THE 2ND OBJECTIVE IS TO DEVELOP A TOOL TO TRACK HOME CARE REFERRALS AND FOLLOW UP FROM THE BASELINE VALUE OF 0% TO 100%.THE 3RD GOAL, INCREASE ACCESS AND REFERRALS TO SHELTER SERVICES FOR VICTIMS OF ABUSE, VIOLENCE OR SEX; INCLUDING INDIVIDUALS WITH DISABILITIES HAS ONE OBJECTIVE AND ONE STRATEGY. THE OBJECTIVE IS TO INCREASE THE IDENTIFICATION OF VICTIMS OF INTIMATE PARTNER VIOLENCE WITH REFERRALS TO COMMUNITY SERVICES. CURRENT VALUE IS 46 WITH A TARGET OF 60 BY 2025.THE 4TH GOAL, REDUCE THE NUMBER OF REPORTED POOR MENTAL HEALTH DAYS TO IMPROVE QUALITY OF LIFE FOR CALHOUN COUNTY INDIVIDUALS HAS 1 OBJECTIVE. THE OBJECTIVE IS TO INCREASE KNOWLEDGE AND THE BENEFITS OF MENTAL HEALTH SERVICES FOR INDIVIDUALS WITH MENTAL HEALTH ISSUES AND THEIR FAMILIES SO THEY CAN MANAGE THEIR MENTAL HEALTH ON A DAILY BASIS AND RECEIVE APPROPRIATE SUPPORT DECREASING THE NUMBER OF REPORTED POOR MENTAL HEALTH DAYS. CURRENT BASELINE VALUE IS 3.6 DAYS, AND THE TARGET IS <3 DAYS BY 2025.THE FIFTH GOAL, INCREASE AVAILABLE AND AFFORDABLE TRANSPORTATION SERVICES IN CALHOUN COUNTY HAS ONE OBJECTIVE. THE OBJECTIVE IS TO INCREASE THE NUMBER OF RESOURCES FROM 2 (MIDAS AND MCO MEDICAL TRANSPORTATION) TO A MINIMUM OF 3 RESOURCES BY 2025. THE SIXTH GOAL FOR IMPROVE ACCESS TO QUALITY HEALTH SERVICES AND SUPPORTS IS TO INCREASE THE AVAILABILITY OF SUBSTANCE ABUSE SUPPORT GROUPS FOR INDIVIDUALS AND FAMILIES. THE OBJECTIVE IS TO INCREASE THE NUMBER OF AA/ALANON/NA GROUPS FROM 2 IN 2020 TO 4 IN 2025. THE SECOND TOPIC, HEALTH EDUCATION AND INFORMATION RESOURCES HAS 4 GOALS. THE GOALS ARE TO REDUCE THE STD RATES IN CALHOUN COUNTY, INCREASE THE NUMBER OF FAMILIES RECEIVING FAMILY FOUNDATION SERVICES, IMPROVE ACCESS TO QUALITY HEALTH SERVICES AND SUPPORTS AND TO DECREASE THE PERCENTAGE OF FOOD INSECURITY IN CALHOUN COUNTY.THE OBJECTIVE OF THE FIRST GOAL, REDUCE STD RATES IN CALHOUN COUNTY, IS TO INCREASE KNOWLEDGE OF PREVENTATIVE BEHAVIORS RELATED TO SEXUALLY TRANSMITTED INFECTIONS TO REDUCE THE NUMBER OF INFECTIONS FROM 236 IN 2020 TO 200 IN 2025. THE 2ND GOAL, INCREASE THE NUMBER OF FAMILIES RECEIVING FAMILY FOUNDATION SERVICES HAS ONE OBJECTIVE WITH FIVE STRATEGIES. THE OBJECTIVE IS TO INCREASE THE NUMBER OF FAMILIES AT 125% OF THE POVERTY RATE OR HIGHER. THE BASELINE VALUE IS 68% WITH A TARGET VALUE OF 78%. THE THIRD GOAL, IMPROVE ACCESS TO QUALITY HEALTH SERVICE AND SUPPORTS, HAS 1 OBJECTIVE. THE OBJECTIVE IS TO REDUCE THE NUMBER OF PERSONS THAT ARE UNABLE TO OBTAIN OR DELAY OBTAINING NECESSARY PRIMARY CARE OR MENTAL HEALTH CARE BY 5% BY 2025 FROM THE BASELINE VALUE OF 24%. THE FINAL GOAL IN THIS TOPIC, DECREASE THE PERCENTAGE OF FOOD INSECURITY IN CALHOUN COUNTY, ALSO HAS 1 OBJECTIVE. THE OBJECTIVE IS TO DISSEMINATE INFORMATION TO COMMUNITIES HOW TO ACCESS EMERGENCY FEEDING SITES/FOOD AND NUTRITION SITES TO REDUCE FOOD INSECURITY. THE CURRENT BASELINE VALUE IS 12% WITH A TARGET VALUE OF 6% BY 2025. THE THIRD TOPIC, HEALTHY LIVING, HAS 2 GOALS AND 2 OBJECTIVES. THE GOALS ARE TO REDUCE ADULT OBESITY RATES IN CALHOUN COUNTY AND INCREASE ACCESS TO EXERCISE OPPORTUNITIES IN CALHOUN COUNTY.THE OBJECTIVE OF GOAL 1, REDUCE ADULT OBESITY RATES IN CALHOUN COUNTY, IS TO INCREASE EDUCATIONAL AND SUPPORT PROGRAMS AVAILABLE IN CALHOUN COUNTY TO ADDRESS ADULT OBESITY AND REDUCE THE RATE. THERE IS A TARGET VALUE OF 30% FOR THIS OBJECTIVE. THE SECOND GOAL, INCREASE ACCESS TO EXERCISE OPPORTUNITIES IN CALHOUN COUNTY, HAS 1 OBJECTIVE. THE OBJECTIVE IS TO INCREASE ACCESS TO LOCATIONS OR PROGRAMS THAT SUPPORT INCREASE PHYSICAL ACTIVITY FOR CALHOUN COUNTY RESIDENTS. THE FOURTH AND FINAL TOPIC, HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH, HAS 2 GOALS. THESE GOALS ARE TO IMPROVE INCOME AND INCOME DISTRIBUTION AND TO IMPROVE HOUSING OPTIONS IN CALHOUN COUNTY.THE FIRST GOAL, IMPROVE INCOME AND INCOME DISTRIBUTION, HAS 1 OBJECTIVE - TO DECREASE INCOME INEQUALITY. BASED ON THE 2020 BASELINE YEAR, THE BASELINE VALUE IS 0.45 (GINI INDEX) WITH A TARGET VALUE OF 0.3 IN 2025. THE SECOND GOAL, IMPROVE HOUSING OPTIONS IN CALHOUN COUNTY, HAS 1 OBJECTIVE, THE OBJECTIVE IS TO DECREASE THE PERCENTAGE OF INDIVIDUALS LIVING IN INADEQUATE HOUSING. THE GOAL IS TO DECREASE TO A VALUE OF 15%.

STEWART MEMORIAL COMMUNITY HOSPITAL
PART V, SECTION B, LINE 13H: STEWART MEMORIAL COMMUNITY HOSPITAL IS COMMITTED TO PROVIDING NECESSARY HOSPITAL CARE AND TREATMENT TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ANY PATIENT WHO HAS RECEIVED SERVICES AND WHO FALLS BELOW CERTAIN INCOME AND ASSET LIMITS MAY BE ELIGIBLE FOR HOSPITAL CARE FREE OF CHARGE, OR AT A REDUCTION OF OUR ESTABLISHED CHARGES.THE HOSPITAL USES THE POVERTY INCOME GUIDELINES ISSUED BY THE COMMUNITY SERVICE ADMINISTRATION AS A BASIS FOR ELIGIBILITY CRITERIA FOR DISCOUNTED CARE. THESE GUIDELINES ARE ADJUSTED ANNUALLY BASED ON INCREASES IN THE CONSUMER PRICE INDEX. SUPPORT TO GRANT FINANCIAL ASSISTANCE MUST BE FULLY DOCUMENTED IN OUR FILES. SMCH HAS A SPREADSHEET BASED ON THE FEDERAL POVERTY GUIDELINES TO DETERMINE DISCOUNTED CARE. THE SPREADSHEET ALSO ACCOUNTS FOR THE FAMILY SIZE IN DETERMINING ELIGIBILITY. FOR THOSE APPLYING, IF THEIR INCOME FALLS BETWEEN 225-250% OF THE GUIDELINES, 75% OF THE PATIENT'S BILL IS FORGIVEN; IF THE INCOME IS BETWEEN 300-400% OF THE GUIDELINES, 50% IS FORGIVEN; IF THE INCOME AT 450% OF THE GUIDELINES, 35% IS FORGIVEN; IF THE INCOME IS AT 500% OF THE GUIDELINES, 25% IS FORGIVEN. THE NEW 501(R) REGULATIONS AND POLICIES THAT TOOK EFFECT JANUARY 1, 2016 WILL BE MADE AVAILABLE TO EVERY PATIENT AND ALSO MADE AVAILABLE ON OUR WEBSITE.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
NOT APPLICABLE

PART I, LINE 6A:
STEWART MEMORIAL COMMUNITY HOSPITAL'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION.

PART I, LINE 7:
STEWART MEMORIAL COMMUNITY HOSPITAL USED THE WORKSHEETS PROVIDED IN THE IRS INSTRUCTIONS FOR SCHEDULE H IN ADDITION TO THE INTERNAL COST ACCOUNTING SYSTEM.

PART I, LINE 7G:
THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G.

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $614,114.

PART II, COMMUNITY BUILDING ACTIVITIES:
ONE MEMBER OF THE ORGANIZATION IS A VOLUNTEER MEMBER ON THE LOCAL BETTERMENT ORGANIZATION. AT THE MONTHLY MEETINGS, THEY USE THEIR TIME TO PROMOTE THE SERVICES AND WELLNESS ACTIVITIES THE HOSPITAL PROVIDES. CURRENT AND PROSPECTIVE BUSINESSES UNDERSTAND THE VARIOUS HEALTH SERVICES THAT ARE MADE AVAILABLE TO THEM AND THEIR EMPLOYEES. OTHER STAFF MEMBERS SERVE ON VARIOUS PROJECT TEAMS IN OUR SURROUNDING COMMUNITIES TO REPRESENT THE HOSPITAL AND BUILD COMMUNITY AWARENESS. THE COO AND AN EMPLOYED PHYSICIAN ARE MEMBERS OF THE CALHOUN COUNTY BOARD OF HEALTH. STEWART MEMORIAL COMMUNITY HOSPITAL WORKED IN CONJUNCTION WITH CALHOUN COUNTY PUBLIC HEALTH TO COMPLETE A COMMUNITY NEEDS ASSESSMENT AND DEVELOP A HEALTH IMPROVEMENT PROGRAM.

PART III, LINE 2:
IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND ESTIMATES A PERCENTAGE OF THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON HISTORICAL ANALYSIS. THE ESTIMATED PERCENTAGE OF THOSE TRANSITION ACCOUNTS ARE ADDED TO RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

PART III, LINE 4:
"THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8 THROUGH 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED ""PATIENT RECEIVABLES"" ""PATIENT SERVICE REVENUE, AND ""CHARITY CARE."""

PART III, LINE 8:
SINCE THERE IS NO MEDICARE SHORTFALL CALCULATED FOR 2021, THERE IS NO SHORTFALL THAT IS TREATED AS COMMUNITY BENEFIT. THE 2021 FILED MEDICARE COST REPORT WAS USED TO DETERMINE THE ALLOWABLE COSTS.

PART III, LINE 9B:
COLLECTION POLICY:PATIENTS ARE ADMITTED INTO THE HOSPITAL COMPUTER SYSTEM WITH APPROPRIATE FINANCIAL INFORMATION INCLUDING INSURANCE INFORMATION AND ARE ASSIGNED A FINANCIAL CLASS (F/C) USED TO SEGREGATE ACCOUNTS IN ACCOUNTS RECEIVABLE (A/R) BY PAYER TYPE. PATIENTS WHO ARE MINORS ARE ADMITTED WITH THE PARENT WHO CARRIES THE INSURANCE COVERAGE AS THE RESPONSIBLE PARTY OR IF NO INSURANCE, THE PARENT WHO BROUGHT THE CHILD IN FOR CARE IS LISTED AS GUARANTOR.THE BUSINESS OFFICE WILL SEND AN ITEMIZED STATEMENT OF CHARGES TO ALL PATIENTS WHO REQUEST A COPY. INSURANCE COMPANIES ARE BILLED ELECTRONICALLY THROUGH THE USE OF EMDEON SOFTWARE WHENEVER POSSIBLE. ONCE THE INSURANCE COMPANY HAS PROCESSED THE CLAIM AND PAID ITS ENTIRE SHARE OR IF THE PATIENT DOESN'T HAVE INSURANCE, THEY WILL BE ASSIGNED A FINANCIAL CLASS OF SELF-PAY. SMCH ALLOWS PATIENTS TO SET UP PAYMENT ARRANGEMENTS FOLLOWING THIS SCHEDULE USING CHECK, MONEY ORDER, MASTERCARD OR VISA:BALANCE IS: MINIMUM PAYMENT:UNDER $250 $ 25.00 $251-$500 $ 50.00$501-$1000 $ 100.00$1001 - ABOVE $ 150.00THESE LIMITS ARE SET TO INSURE BALANCES ARE PAID IN FULL WITH 18 MONTHS IF AT ALL POSSIBLE. WHEN THE PATIENT IS ASSIGNED A FINANCIAL CLASS OF P, THE ACCOUNT IS SENT TO MED-PLAN FOR EARLY OUT PRE-COLLECT PROCESSING. THE FIRST STATEMENT FROM MED-PLAN IS MAILED OUT ON DAY 1 WHEN THEY RECEIVE THE ACCOUNT AND THEN AGAIN AT 30 DAYS. ACCOUNTS THAT DO NOT MAKE PAYMENT ARRANGEMENTS OR MAKE PAYMENTS FROM THE LETTER CAMPAIGN AFTER 45 DAYS ARE MOVED INTO A TELEPHONE CAMPAIGN. THE TELEPHONE CAMPAIGN MAKES 3 ATTEMPTS OVER 15 DAYS TO SECURE PAYMENT IN FULL OR A SCHEDULED PAYMENT PLAN. IF RESOLUTION ATTEMPTS FAIL AND MED-PLAN IS UNABLE TO RESOLVE AN ACCOUNT BECAUSE (1) IT IS IMPOSSIBLE TO REACH A PATIENT BY TELEPHONE, OR (2) THE PATIENT HAS FAILED TO COOPERATE IN ESTABLISHING A PAYMENT PLAN, OR (3) THE PATIENT HAS FAILED TO HONOR AN ESTABLISHED PLAN BY NOT MAKING SATISFACTORY PAYMENT WITHIN 60-90 DAYS, A FINAL NOTICE WILL BE SENT TO THE PATIENT. ACCOUNTS UNPAID OR ARRANGEMENTS NOT MADE AT THIS POINT IN THE BILLING PROCESS ARE DETERMINED UNCOLLECTIBLE. IF NO PAYMENT IN ALLOWABLE TIME IS RECEIVED, ACCOUNTS ARE ELECTRONICALLY SENT TO A COLLECTION AGENCY. IN THE EVENT OF PARTIAL PAYMENT, A DETERMINATION ON AN INDIVIDUAL BASIS IS MADE AS TO STOP OR PROCEED WITH THE COLLECTION AGENCY.

PART VI, LINE 2:
SMCH COLLABORATES WITH THE COUNTY HEALTH DEPARTMENT IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES THEY SERVE. SMCH ALSO EVALUATES USAGE DATA THROUGH THE IOWA HOSPITAL ASSOCIATION TO SEE THE PRIMARY MEDICAL DIAGNOSIS IN THEIR COMMUNITIES.

PART VI, LINE 3:
SMCH HAS A PATIENT ACCOUNTS MANAGER AS WELL AS A SOCIAL WORKER ON STAFF THAT IDENTIFY PATIENTS THAT MAY BE ELIGIBLE FOR ASSISTANCE OR QUALIFY FOR CHARITY CARE. THEY ASSIST THE PATIENT WITH AVAILABLE OPTIONS AND/OR THE NECESSARY PAPERWORK.

PART VI, LINE 4:
THE SERVICE AREA IS A 35 MILE RADIUS SURROUNDING THE SMCH COMMUNITY. THIS AREA CONSISTS OF MANY SMALL, RURAL COMMUNITIES THAT ARE AGRICULTURAL BASED. THE PATIENT BASE CONSISTS OF A LARGE MEDICARE POPULATION.

PART VI, LINE 5:
"SMCH PROVIDES THE COMMUNITIES WITH LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS ON PROMOTING HEALTHY LIFESTYLES. THEY PROVIDE CARE TO THE INDIGENT REGARDLESS OF THEIR ABILITY TO PAY. THE BOARD OF DIRECTORS ARE REPRESENTED BY THE VARIOUS COMMUNITIES THEY SERVE.THE HOSPITAL HAS ALSO JOINED WITH THE COUNTY DEPARTMENT OF HEALTH IN ESTABLISHING A PROGRAM CALLED ""CARING HANDS CLOSET."" CARING HANDS CLOSET IS A PROGRAM FOR EXPECTING MOTHERS AND NEW MOTHERS TO EARN POINTS TOWARDS BABY ITEMS BY ATTENDING THEIR DOCTOR APPOINTMENTS AND/OR EDUCATIONAL PROGRAMS. SMCH PROVIDES MONTHLY LABORATORY WELLNESS TESTING AND EDUCATIONAL PROGRAMS BI-MONTHLY."

PART VI, LINE 6:
SMCH IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

PART VI, LINE 7, REPORTS FILED WITH STATES
IA

Operating expenses	$ 30,022,817
Total amount spent on community benefits as % of operating expenses	$ 729,882 2.43 %