Community Benefit Insight - Tax-exempt hospital

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Knoxville Community Hospital Inc

Knoxville Community Hospital Inc

1002 South Lincoln
Knoxville, IA 50138

Bed count	25	Medicare provider number	161355	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 421087612

Display data for year:

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

4.06%

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	$ 99,742 0.22 %
Medicaid as % of operating expenses	$ 1,409,076 3.14 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 249,727 0.56 %
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.	$ 2,903 0.01 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 57,885 0.13 %
Community building* as % of operating expenses	$ 15,737 0.04 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (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
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	$ 15,737 0.04 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 282 1.79 %
Community support as % of community building expenses	$ 1,380 8.77 %
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	$ 266 1.69 %
Community health improvement advocacy as % of community building expenses	$ 4,212 26.76 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 9,597 60.98 %
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	$ 3,343,873 7.45 %
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 $ 40220324 including grants of $ 26926) (Revenue $ 47261547)
KNOXVILLE COMMUNITY HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE BEDS. THE HOSPITAL PROVIDES ACUTE AND ANCILLARY SERVICES TO INDIVIDUALS IN BOTH INPATIENT AND OUTPATIENT SETTINGS. DURING FISCAL YEAR 2022, THE HOSPITAL PROVIDED 568 DAYS OF SKILLED NURSING CARE AND 200,006 OUTPATIENT OCCASIONS OF SERVICE.

Facility Information

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

KNOXVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 3J: THE TOP FOUR HEALTH NEEDS IDENTIFIED FROM THE 2021 CHNA REPORT WERE MENTAL HEALTH, AFFORDABLE HOUSING, TRANSPORTATION AND NUTRITION. THESE TOP FOUR NEEDS WERE DETERMINED BY PRIMARY DATA (SURVEY) AND SECONDARY DATA INCLUDING COUNTY HEALTH RANKINGS, IOWA HOSPITAL ASSOCIATION INPATIENT AND OUTPATIENT DATABASES, CITY DATA, AND VITAL STATISTICS. OTHER HEALTH NEEDS IDENTIFIED WERE OBESITY, SUBSTANCE MISUSE, DOMESTIC ABUSE, SUICIDE PREVENTION AND SUPPORT AND POVERTY.

KNOXVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 5: RESEARCH WAS DONE AND DATA WAS COLLECTED TO ENSURE PROPER TOWN HALL REPRESENTATION AND TO DETERMINE THE PRIMARY SERVICE AREA. A PUBLIC RELATIONS STORY WAS PREPARED AND POSTED ON SOCIAL MEDIA, AS WELL AS SENT TO THE LOCAL MEDIA TO PUBLISH AND ANNOUNCE UPCOMING CHNA WORK AND REQUEST PUBLIC SURVEY PARTICIPATION. A PAPER SURVEY AS WELL AS AN ONLINE LINK TO THE SURVEY WAS MADE AVAILABLE FOR THE PUBLIC TO RESPOND. KHC STAFF ALSO VISITED WITH MANY LOCAL GROUPS SUCH AS ROTARY ABOUT THE CHNA PROCESS AND REQUESTED COMPLETION OF SURVEYS FOR THOSE PRESENT AT THAT MEETING. A PAPER SURVEY WAS USED WITH AN ONLINE LINK TO PSA RESIDENTS. THE SURVEY WAS SENT TO 1,000 PARTICIPANTS WITH THE ANTICIPATION OF RECEIVING 250 RETURNS. WE PREPARED AND PUBLISHED A TOWN HALL INVITATION TO THE PUBLIC AND COLLABORATING PARTIES SUCH AS PUBLIC HEALTH, SCHOOL LEADERS, FAITH-BASED LEADERS, PHYSICIANS AND OTHER CARE PROVIDERS, AS WELL AS THE MENTAL HEALTH PROVIDER COMMUNITY, FREE CLINICS, LOCAL RESIDENTS, COMMUNITY LEADER, BUSINESS LEADERS, LOCAL GOVERNMENT, PEOPLE WITH CHRONIC CONDITIONS, AND UNINSURED COMMUNITY MEMBERS, LOW INCOME RESIDENTS, AND MINORITY GROUPS ALONG WITH KNOXVILLE HOSPITAL & CLINICS. WE PREPARED A BRIEF OF GOALS, OBJECTIVE, PURPOSE, OUTCOMES, ROLES, AND COMMUNITY INVOLVEMENT AND HELD A KICK-OFF MEETING. COMMUNITY HEALTH FACTS AND PRACTICE DATA WERE COLLECTED AND PUBLISHED. COMMUNITY OPINIONS WERE COLLECTED ON HEALTH NEEDS, AND NEEDS IDENTIFIED. COMMUNITY OPINIONS WERE ALSO COLLECTED ON HEALTH NEEDS, PRACTICES, AND PHYSICIAN AND CARE PROVIDER AVAILABILITY. THE COMMUNITY HEALTH NEEDS REPORT WAS THEN PREPARED AND PRESENTED TO THE COMMUNITY WITH RECOMMENDED ACTIONS. THE TOWN HALL MEETING INCLUDED DISCUSSION ON PURPOSE, ROLES, REVIEW OF HISTORICAL DATA, PARTICIPANT DISCUSSIONS TALLY AND RANKING OF HEALTH CONCERNS, AND REFLECTION ON THE HEALTH NEEDS OF THE COMMUNITY. THE MEETING CONCLUDED WITH INFORMATION ABOUT THE NEXT STEPS. THE COMMUNITY WAS ENCOURAGED TO CONTINUE TO PARTICIPATE BY CONTRIBUTING IDEAS TO THE HOSPITAL AND PUBLIC HEALTH DEPARTMENT VIA EMAIL OR PERSONAL CONVERSATION. IN ADDITION, OTHER MEETINGS, INTERVIEWS, AND FOCUS GROUPS WERE HELD.

KNOXVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 11: 1. MENTAL HEALTH INCREASE THE PROVIDED AND BREATH OF SERVICES FOR MENTAL HEALTH NEEDS IN THE COMMUNITIES.A. SINCE NOVEMBER OF 2019, MOST OF THESE EFFORTS HAVE BEEN CONCENTRATED ON STATEWIDE AND COUNTYWIDE INITIATIVES. MOST HOURS WERE SPENT IN COLLABORATION WITH THE MARION COUNTY SHERIFF'S OFFICE AND THE LEADERS OF THE COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA ACCESS CENTER LOCATED IN OSCEOLA, IA. THE ACCESS CENTER WAS CREATED IN THIS REGION OF IOWA AND IN OTHER REGIONS AROUND THE STATE. REFERRALS ARE MADE TO THE ACCESS CENTER FOR PATIENTS EXPERIENCING A MENTAL HEALTH CRISIS. THE ACCESS CENTER HAS PROVIDED SOME RELIEF FOR AREA HOSPITALS BUT, FOR SEVERAL REASONS, SOME MENTAL HEALTH PATIENTS DO NOT QUALIFY FOR THESE SERVICES OR REQUIRE INTENSIVE INPATIENT PSYCHIATRIC CARE, SO KHC CONTINUES TO HOLD SOME MENTAL HEALTH PATIENTS IN THE EMERGENCY ROOM FOR A SIGNIFICANT NUMBER OF DAYS.B. KHC CONTINUES TO UTILIZE VIRTUAL VISITS TO ADDRESS (NON-CRISIS) MENTAL HEALTH CONCERNS FOR PATIENTS IDENTIFIED VIA AN ANNUAL DEPRESSION SCREEN AT THE MEDICAL CLINICS. CLINIC PROVIDER TIMELY ASSESSMENTS TO IDENTIFY ISSUES AND INTERVENTIONS INCLUDING A REFERRAL TO VARIOUS RESOURCES ASSIST IN THE PREVENTION OF A CRISIS. ALSO, THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT CONTINUES TO UTILIZE TELE-PSYCH TO IMPROVE ACCESS TO MENTAL HEALTH PROVIDERS IN THE EMERGENCY DEPARTMENT. THE TELE-PSYCH SYSTEM IS UTILIZED FOR ALMOST ALL OUTPATIENT MENTAL HEALTH PATIENTS THAT PRESENT TO THE EMERGENCY ROOM. ALSO, KHC HAS AN AGREEMENT WITH CENTRAL IOWA JUVENILE DETENTION CENTER WHICH PROVIDES TRANSPORT FOR MEDICALLY STABLE PATIENTS IN A SECURE CAR. THIS SERVICE IS NECESSARY BECAUSE OF THE LIMITED AVAILABILITY OF LOCAL EMS CREWS TO TRANSPORT THESE PATIENTS.C. KEVIN KINCAID CONTINUES TO LOBBY FOR IMPROVEMENTS IN INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES FOR MEMBERS OF THE COMMUNITY. IN FEBRUARY OF 2021 A NEW 100 BED MENTAL HEALTH HOSPITAL WILL OPEN IN CLIVE, IOWA THROUGH A PARTNERSHIP BETWEEN MERCYONE AND UHS IN CLIVE, IOWA. KNOXVILLE HOSPITAL & CLINICS AS AN AFFILIATE OF MERCYONE MAY BENEFIT WITH A FASTER REFERRAL PROCESS TO THIS ORGANIZATION FOR MEMBERS OF THE COMMUNITY IN NEED OF INPATIENT MENTAL HEALTH SERVICES.2. SUBSTANCE ABUSE REDUCE THE CONCERN FOR AND PRESENCE OF SUBSTANCE ABUSE RELATED HEALTH/SAFETY ISSUES.A. KNOXVILLE HOSPITAL & CLINICS APPLIED AND RECEIVED THE RURAL COMMUNITIES OPIOID RESPONSE PROGRAM (RCORP) THIS IS A MULTI-YEAR HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) INITIATIVE AIMED AT REDUCING THE MORBIDITY AND MORTALITY OF SUBSTANCE USE DISORDER (SUD), INCLUDING OPIOID USE DISORDER (OUD) IN HIGH-RISK RURAL COMMUNITIES. THE GRANT IS A COLLABORATION OF MULTIPLE COMMUNITY GROUPS IN MARION COUNTY INCLUDING MARION COUNTY PUBLIC HEALTH, THE WELL RESOURCE CENTER, UCS HEALTHCARE, CROSS MENTAL HEALTH REGION, KNOXVILLE COMMUNITY SCHOOL DISTRICT, PELLA REGIONAL HEALTH CENTER AND KNOXVILLE HOSPITAL & CLINICS. INITIATIVES HAVE INCLUDED PROVIDING EDUCATION, PARTICIPATION IN NATIONAL TAKE BACK DAY, PROVIDING SAFE MEDICATION DISPOSAL BAGS FOR FREE TO PATIENTS, AND COLLABORATING WITH OTHER ENTITIES TO ADVANCE THE GOALS OF THE PROGRAM. THE WORK WILL CONTINUE THROUGH 2024. B. KNOXVILLE PROVIDERS HAVE AND WILL CONTINUE TO REFER PATIENTS TO UCS AS NEEDED. PROVIDERS HAVE MATERIALS REGARDING UCS AND THOSE MATERIALS ARE SHARED WITH PATIENTS AS NEEDED. ALSO, OTHER COMMUNITY PARTNERS SUCH AS THE WELL, LAW ENFORCEMENT, AND SCHOOLS ARE AWARE OF THE SERVICES UCS PROVIDERS AND PASS THAT INFORMATION ON TO PEOPLE IN NEED OF THE SERVICES.C. KHC CONTINUES TO PARTNER WITH UCS, DHS, LAW ENFORCEMENT, AND MC3 TO EXPLORE TRANSPORTATION SERVICES WITHIN THE COMMUNITY. THE HIRTA SYSTEM IS STILL AVAILABLE IN MARION COUNTY BUT, SERVICES CONTINUE TO BE QUITE LIMITED.3. CHRONIC DISEASE MANAGEMENT REDUCE IMPACT OF CHRONIC DISEASE ON PHYSICAL AND MENTAL HEALTH FOR RESIDENTS IN THE COMMUNITIES.A. KNOXVILLE HOSPITAL & CLINICS LAUNCHED #HEALTHYKNOXVILLE, A MONTHLY COMMUNITY WELLNESS CHALLENGE DESIGNED TO INSPIRE COMMUNITY MEMBERS TO LIVE A HEALTHIER LIFESTYLE PHYSICALLY, MENTALLY, EMOTIONALLY, SPIRITUALLY, INTELLECTUALLY, AND FINANCIALLY. KNOXVILLE HOSPITAL & CLINICS TOGETHER WITH OUR PARTNERS THE KNOXVILLE WELLNESS COALITION, KNOXVILLE COMMUNITY SCHOOL DISTRICT, KNOXVILLE CHAMBER OF COMMERCE, AND THE CITY OF KNOXVILLE PROVIDE FUN CHALLENGES TO HELP INDIVIDUALS ASPIRE TO BE THE BEST VERSION OF THEMSELVES. THE PROGRAM AVERAGES ABOUT 15 PARTICIPANTS EACH MONTH. KNOXVILLE HOSPITAL & CLINICS LEADERS ARE WORKING WITH THE SCHOOLS TO ENCOURAGE ELEMENTARY TEACHERS TO DO IT AS A CLASS ACTIVITY AS WELL.B. IN LATE 2018 KNOXVILLE HOSPITAL & CLINICS AND 21ST CENTURY REHABILITATION SERVICES OPENED A MEDICALLY ORIENTED GYM (MOG). A MOG IS A REVOLUTIONIZING THE WAY PEOPLE IMPROVE AND MAINTAIN THEIR HEALTH. THE MOG IS STAFFED BY PHYSICAL THERAPISTS, PHYSICAL THERAPIST ASSISTANTS, AND CERTIFIED ATHLETIC TRAINERS WHO WORK CLOSELY WITH YOUR DOCTOR AND OTHER HEALTHCARE PROVIDERS TO HELP YOU ACHIEVE AND MAINTAIN AN EXCEPTIONAL QUALITY OF LIFE BY FOCUSING ON ALL ASPECTS OF YOUR HEALTH. THE PRIMARY GOAL OF THE MOG IS TO DECREASE DEPENDENCY ON MEDICINE, ADOPT EXERCISE AS A LIFESTYLE, AND REDUCE THE IMPACTS OF CHRONIC DISEASE. MOG ON AVERAGE CARES FOR BETWEEN 25 TO 35 MEMBERS A MONTH WHICH IS AN INCREASE OF ABOUT 10 MEMBERS PER MONTH OVER THE LAST YEAR. C. KHC HAS CONTINUED TO REACH OUT TO PATIENTS/COMMUNITY MEMBERS WITH DIETARY COUNSELING NEEDS THROUGH OUR INTENSIVE BEHAVIOR THERAPY FOR OBESITY. FOLLOWING OUR PATIENT-CENTERED MEDICAL HOME MODEL, PROVIDERS SEND REFERRALS TO NUTRITION SERVICES, WHERE OUR STAFF OF TWO LICENSED AND REGISTERED DIETITIANS (RDS) PROVIDE AN INDIVIDUALIZED AND EVIDENCED-BASED WEIGHT MANAGEMENT PROGRAM. CHANGING BEHAVIORS TAKES TIME AND THE JOURNEY IS DIFFERENT FOR EVERYONE, WHICH THIS SERVICE ADDRESSES BY MEETING THE PARTICIPANT WHERE HE/SHE IS AT, AND THEN COLLABORATIVELY, WITH THE RD UTILIZING MOTIVATIONAL INTERVIEWING, SHE AND THE PATIENT IDENTIFY SMART GOAL(S) TO WORK TOWARDS. FOR PATIENTS NOT INTERESTED IN A 'IBT-LIKE' PROGRAM, OUR RDS COLLABORATE WITH OUR HEALTH COACH (A REGISTERED NURSE) TO DETERMINE THE BEST PATH FORWARD. KHC DIETITIANS CONTINUE TO WORK WITH PATIENTS/COMMUNITY MEMBERS WITH DIETARY COUNSELING NEEDS FOR VARIOUS CHRONIC DISEASE STATES THROUGH NUTRITION MANAGEMENT. ALSO, DIABETES SUPPORT GROUPS HAVE RESTARTED WHICH ENCOURAGE ATTENDANCE FROM CURRENT PATIENTS AS WELL AS COMMUNITY MEMBERS. DAY AND EVENING OPTIONS ARE AVAILABLE TO REACH A WIDER RANGE OF INDIVIDUALS. TOPICS RANGE FROM DIABETES-FRIENDLY COOKING DEMONSTRATIONS, CURRENT ADVANCES IN DIABETES TECHNOLOGY, AND PRESENTATIONS FROM LOCAL SPECIALISTS IN DIABETES-RELATED AREAS.UPON REQUEST, KHC DIETITIANS' PARTNER WITH THE LOCAL HIGH SCHOOL TO PROVIDE NUTRITION EDUCATION TO ATHLETES AND STUDENTS. D. CARDIOPULMONARY REHAB HAS PARTICIPATED IN COMMUNITY HEALTH INITIATIVES AS A PREVENTION MEASURE OF HEART AND LUNG DISEASE. THIS PAST YEAR THE OPPORTUNITY OCCURRED WITH WOMEN'S HEALTH INITIATIVE OFFERED OCTOBER 6, 2022. IN ADDITION, THE CARDIOPULMONARY REHAB PROGRAM CONTINUES TO OFFER FREE SMOKING CESSATION EDUCATION TO ANYONE IN THE COMMUNITY THAT NEEDS SUPPORT. 4. TRANSPORTATION MAKE ACCESSIBLE (EASY) FOR INDIVIDUALS TO USE WITH REASONABLE ACCESS & AFFORDABILITY.A. KHC HAS UTILIZED HOME INSTEAD FOR PRIVATE-PAY CARE AND TRANSPORTATION FOR INDIVIDUALS UNDERGOING ANESTHESIA FOR PROCEDURES AT KHC. KNOXVILLE CURRENTLY HAS TWO TAXI SERVICES IN KNOXVILLE: STANTON TAXI AND LYDIA'S TAXI THAT HAVE BEEN UTILIZED TO TRANSPORT PATIENTS IN NEED. ALSO, EVERY STEP SENIOR COMPANION PROGRAM AND HIRTA PSVP PARTNER WITH INDIVIDUAL VOLUNTEERS WHO ARE TO PROVIDE TRANSPORTATION AS WELL AS COMPANIONSHIP AND LIGHT HOUSEKEEPING.B. KHC IS EXPLORING THE UTILIZATION OF UBER/HEALTHCARE AS AN OPTION FOR PATIENT TRANSPORTATION IN THE COMMUNITY. C. KHC IS DEVELOPING A PLAN TO PROVIDE TRANSPORTATION TO PATIENTS IN NEED TO ENSURE THEY MAKE APPOINTMENTS FOR DOCTOR VISITS AND NECESSARY PROCEDURES. FOCUS ON PATIENTS WITH THE GREATEST NEED IN THE COMMUNITY. ALSO, EXPLORING AN ORGANIZED VOLUNTEER SYSTEM THAT WOULD MINIMIZE PHONE CALLS AND PROVIDE AN OPPORTUNITY FOR VOLUNTEERS TO BE EASILY CONNECTED WITH SERVICES OPPORTUNITIES, INCLUDING ONE-TIME NEEDS.

KNOXVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 13H: THE HOSPITAL CONSIDERED FAMILY SIZE IN ADDITION TO THE CRITERIA ABOVE.

KNOXVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 15E: A LETTER IS SENT PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY.

KNOXVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 16J: A LETTER IS SENT, AND IN MANY CASES TWO, PRIOR TO COLLECTION DETAILING THE PAYMENT PLANS AND FINANCIAL ASSISTANCE AVAILABLE TO THOSE WHO QUALIFY.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE OR DISCOUNTED CARE TO LOW INCOME INDIVIDUALS.

PART I, LINE 6A:
THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED PARTY.

PART I, LINE 7:
THE COST TO CHARGE RATIO AS FOLLOWS WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST: (TOTAL EXPENSES - BAD DEBT) / (GROSS PATIENT SERVICE REVENUE + OTHER REVENUE) = PERCENTAGE OF COST TO CHARGE. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST BASED ON KNOXVILLE COMMUNITY HOSPITAL INC.'S INTERNAL ACCOUNTING RECORDS.

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 $3,343,873.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY SERVICE: THE HOSPITAL PROVIDES MEETING ROOM SPACE TO A NUMBER OF COMMUNITY ORGANIZATIONS AT NO COST. THE HOSPITAL PROVIDES SUPPORT TO THE LOCAL CHAMBER WITH MONETARY AND TIME DONATIONS. A FIRST AID TENT INCLUDING LABOR AND SUPPLIES FOR MEDICAL TREATMENT IS PROVIDED DURING KNOXVILLE NATIONALS AND CHAMBER EVENTS. THE HOSPITAL HOSTS AN ANGEL TREE EVERY YEAR TO HELP FAMILIES IN NEED AT CHRISTMAS. WE SUPPORT THE ANNUAL CHRISTMAS LIGHT SHOW AT MARION COUNTY PARK. THE PROCEEDS GO TO THE LOCAL HISTORICAL SOCIETY. THE HOSPITAL OFFERS HEALTH FAIRS ANNUALLY TO MEN, WOMEN AND CHILDREN. THE HOSPITAL MAINTAINS A STRONG RELATIONSHIP WITH THE LOCAL SCHOOL SYSTEM, PROVIDING ATHLETIC TRAINING CARE AT EVENTS AND FREE SPORT PHYSICALS. WE HELD A BREAST CANCER SUPPORT EVENT ON THE SQUARE WITH HEALTH INFORMATION VENDORS.ECONOMIC DEVELOPMENT: THE HOSPITAL PROVIDES LEADERSHIP DEVELOPMENT TRAINING QUARTERLY TO DEPARTMENT LEADERS. ROTATIONS AND PRECEPTORSHIPS ARE MADE AVAILABLE IN VARIOUS SPECIALTIES FOR STUDENTS GOING INTO THE MEDICAL FIELD. THE HOSPITAL IS A MEMBER OF THE LOCAL CHAMBER AND ROTARY CLUB, WITH EMPLOYEES PARTICIPATING IN BOTH. THE HOSPITAL'S ADMISSIONS DIRECTOR IS ON THE LOCAL DAY CARE BOARD. THE HOSPITAL DONATES TO LOCAL PROJECTS ON A REGULAR BASIS. THE HOSPITAL HAS EMPLOYEES ATTENDING CAREER FAIRS IN THE AREA, AND IS PART OF THE LOCAL THRIVE PROGRAM.COMMUNITY SUPPORT: MONETARY AND IN-KIND DONATIONS ARE GIVEN TO MANY COMMUNITY ORGANIZATIONS AND SCHOOL GROUPS. THE HOSPITAL SUPPORTS CANCER FUND RAISERS, PROM SAFETY EVENTS, SPORTING TEAMS, AND OTHER EVENTS. THE HOSPITAL PARTICIPATES IN LOCAL PARADES AND STRONGLY SUPPORTS LOCAL CHAMBER EVENTS AS WELL AS THE THRIVE PROGRAM. HOSPITAL EMPLOYEES SERVE ON LOCAL COMMUNITY BOARDS; SPEAK AT SCHOOL HEALTH AND CAREER EVENTS; TEACH SUNDAY SCHOOL; PROVIDE COACHING FOR AREA SPORTS TEAMS; AND DONATE TIME TO HABITAT FOR HUMANITY, 4H CLUBS, AND THE HISTORICAL SOCIETY. THE HOSPITAL OFFERED A WELCOME TO MEDICARE CLASS. THE HOSPITAL DONATES TO THE LOCAL THRIVE ORGANIZATION.ECONOMIC IMPROVEMENTS: THE HOSPITAL AGGRESSIVELY RECRUITS FOR NEW PROVIDERS IN AN EFFORT TO SUSTAIN AND GROW. THE HOSPITAL IS PLANNING AN EXTENSIVE REMODEL TO EXPAND ITS EMERGENCY ROOM AND SURGERY AREA. THE HOSPITAL CONTINUOUSLY LOOKS FOR NEW WAYS TO IMPROVE THE HEALTH OFFERINGS PROVIDED TO THE COMMUNITY. THE HOSPITAL HAS EXPANDED COMMUNITY INVOLVEMENT IN IMPROVEMENT AND EXPANSION OF HOSPITAL SPACES. THE HOSPITAL HAS A RELATIONSHIP WITH AREA SCHOOLS, OFFERING FREE SPORTS PHYSICALS. THE HOSPITAL IS CURRENTLY WORKING ON PLANS FOR A NEW PROVIDER CLINIC AND RELOCATION OF CONTRACTED SPECIALISTS TO A BIGGER SPACE AS WELL AS A NEW INFUSION CENTER.COALITION BUILDING: THE HOSPITAL PROVIDES STAFF MEMBERS FOR THE MARION COUNTY HEALTH COALITION TEAM, WHICH INCLUDES A NUMBER OF NURSES EMPLOYED BY THE HOSPITAL. OUR ER COORDINATOR IS INVOLVED IN SERVICE AREA COALITION AND IS ON THE REGIONAL MASS CASUALTY TASK FORCE. HOSPITAL EMPLOYEES WORK WITH THE LOCAL PUBLIC HEALTH DEPARTMENT. THE HOSPITAL ALSO PERFORMS THE COMMUNITY HEALTH NEEDS ASSESSMENT IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENT AND MAINTAINS A PRESENCE IN THE COMMUNITY MENTAL HEALTH TEAM. THE HOSPITAL, IN CONJUNCTION WITH OTHER LOCAL AGENCIES, MAINTAINS A SUICIDE PREVENTION TASK FORCE. THE HOSPITAL PARTICIPATES IN AND SUPPORTS THE LOCAL BACK TO SCHOOL EVENTS. EMPLOYEES SERVE ON A LOCAL DAY CARE BOARD.COMMUNITY HEALTH IMPROVEMENT: THE HOSPITAL IS DESIGNATED AS A PATIENT CENTERED MEDICAL HOME BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE. THE HOSPITAL HOSTS, PARTICIPATES IN, OR PROVIDES SUPPORT FOR A VARIETY OF COMMUNITY PROGRAMS AND EVENTS INCLUDING PICK A BETTER SNACK SCHOOL PROGRAM, LOCAL HEALTH FAIRS, GIRLS NIGHT OUT, LOVE YOUR HEART DAY, SPORTS PHYSICALS, SPORTING EVENTS, DIABETES EDUCATION, CPR AND BLS CLASSES, FLU SHOT CLINICS, AND MORE. OUR PHYSICAL THERAPY DEPARTMENT OFFERS A VARIETY OF CLASSES ON PATIENTS PHYSICAL HEALTH IMPROVEMENT. PHYSICIANS PARTICIPATE IN LOCAL HEALTH BOARDS AND CONSULT FREE OF CHARGE TO THE OTHER ORGANIZATIONS. THE HOSPITAL HAS ACUTE CARE FROM 7AM TO 7PM FOR QUICKER ACCESS FOR PATIENTS WHO DON'T HAVE APPOINTMENTS. THE HOSPITAL CEO IS NOW ON OTHER ORGANIZATIONS' BOARDS, AND CONTINUES TO WORK ON A PLAN TO IMPROVE ACCESS TO MENTAL HEALTH CARE TO PATIENTS IN OUR AREA. THE HOSPITAL OFFERS VIRTUAL CARE VISITS. THE HOSPITAL SURVEYS ITS PATIENTS REGULARLY AND USES THE DATA TO IMPROVE CARE. IN 2021, THE HOSPITAL CREATED A PERMANENT COVID CLINIC SPACE AND IS IN THE PLANNING STAGES FOR A TRAVELING MOBILE CLINIC.OTHER: THE HOSPITAL PROVIDES CAB FARE FROM THE EMERGENCY ROOM FOR INDIGENTS AND USE OF OUR ROOMS FOR LOCAL CLUBS AND COMMUNITY MEETINGS. ADMINISTRATIVE ASSISTANCE IS OFFERED TO VARIOUS ORGANIZATIONS. ONE OF OUR DOCTORS IS PRESIDENT OF THE IOWA PHYSICIANS SOCIETY AND PHYSICIAN CHAMPION FOR THE ACO HEALTH GRANT. THE HOSPITAL NOW OFFERS TELEHEALTH TO HELP PROVIDE ACCESS TO MENTAL HEALTH PROFESSIONALS TO OUR AREA PATIENTS, AND WE PAY FOR PATIENT TRANSPORTATION TO FACILITIES THAT CAN PROVIDE MENTAL HEALTH SERVICES WE DO NOT PROVIDE.

PART III, LINE 2:
THE HOSPITAL DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE HOSPITAL'S POLICY, AND OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE HOSPITAL DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS.

PART III, LINE 3:
THE HOSPITAL PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO FOR THE HOSPITAL. THE COSTS OF CARING FOR PATIENTS WHO QUALIFY UNDER THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE POLICY FOR THE YEAR ENDED JUNE 30, 2022 WERE $205,000.

PART III, LINE 4:
"THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 11 AND 12 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED ""PATIENT RECEIVABLES"" ""PATIENT SERVICE REVENUE AND ""PATIENT FINANCIAL ASSISTANCE""."

PART III, LINE 8:
"THERE IS NO SHORTFALL REPORTED DURING THE YEAR, THEREFORE NO AMOUNT IS TREATED AS A COMMUNITY BENEFIT. ""MEDICARE ALLOWABLE COSTS OF CARE"" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT D & E WORKSHEETS, OR PS&R."

PART III, LINE 9B:
THE CHARITY CARE POLICY ALLOWS FOR PROACTIVE WRITE OFF TO ALLOWANCE FOR CHARITY CARE OF ANY BALANCE OWED BY A PATIENT KNOWN TO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. COLLECTION PROCEDURES DO NOT ENSUE ON ANY ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE.

PART VI, LINE 2:
DURING TAX YEAR 2021, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS, IN COLLABORATION WITH MARION COUNTY PUBLIC HEALTH, HELD TOWN HALL MEETINGS BY SENDING OUT SURVEYS TO DEVELOP A COMMUNITY HEALTH NEEDS ASSESSMENT TO SET HEALTH GOALS AND PROGRAMS TO ADDRESS THE HEALTH NEEDS AND DESIRES OF THE COMMUNITY CAPTURED IN THE HOSPITAL'S ANNUAL COMMUNITY BENEFIT REPORT. ALSO, THE HOSPITAL ALWAYS UTILIZES INPUT FROM MEDICAL STAFF, THE BOARD OF DIRECTORS AND VARIOUS HOSPITAL ADMINISTRATIVE STAFF WHO REGULARLY REVIEW THE TREATMENT OF PATIENTS TO ENSURE MEDICAL NECESSITY AND APPROPRIATE LEVELS OF CARE ARE CONSISTENTLY PROVIDED TO THE PATIENTS OF THE HOSPITAL.

PART VI, LINE 3:
CUSTOMER SERVICE AND BILLING STAFF CONTINUALLY MONITOR BALANCES WITHOUT ACTIVITY AND THEN CONTACT THE PATIENTS TO OFFER FINANCIAL ASSISTANCE OR ARRANGE PAYMENT PLANS. THE HOSPITAL ALSO OFFERS THE ABILITY TO MAKE PAYMENTS VIA A WEB-BASED PORTAL. THE PORTAL CONTAINS INFORMATION ON THE HOSPITAL'S FINANCIAL ASSISTANCE AND PAYMENT PLAN POLICIES.

PART VI, LINE 4:
THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE FOLLOWING CITIES IN MARION COUNTY: KNOXVILLE (POP. 11,583), PLEASANTVILLE (POP. 2,954), AND MELCHER/DALLAS (POP. 1,625). THE KNOXVILLE COMMUNITY IS 40 MILES SOUTHEAST OF DES MOINES, IOWA.

PART VI, LINE 5:
KNOXVILLE COMMUNITY HOSPITAL, INC. AND THE CLINICS PROVIDE NUMEROUS OUTPATIENT SPECIALTY PROVIDER CLINICS SUCH AS PODIATRY, ORTHOPEDICS, CARDIOLOGY, UROLOGY, DERMATOLOGY, SLEEP STUDY, ONCOLOGY, AUDIOLOGY, NEPHROLOGY, RHEUMATOLOGY AND EMG TESTING AND OBGYN. PROVIDERS AND STAFF PROVIDE VARIOUS FREE EDUCATIONAL/WELLNESS PROGRAMS FOR THE COMMUNITY/SCHOOLS. THE HOSPITAL IS ADDING TO ITS SPECIALTIES YEARLY, HOSTING ANNUAL PUBLIC EVENTS INCLUDING FREE SKIN CANCER SCREENING. THESE ARE PUBLISHED IN LOCAL NEWSPAPERS.

PART VI, LINE 6:
DURING TAX YEAR 2021, KNOXVILLE COMMUNITY HOSPITAL, INC. AND CLINICS WERE AFFILIATED MEMBERS OF THE MERCY HEALTH NETWORK - CENTRAL IOWA THROUGH MERCY HOSPITAL - DES MOINES, IOWA. MERCY HEALTH NETWORK - CENTRAL IOWA INCLUDES 17 CAH/TWEENER HOSPITALS ALL LOCATED IN CENTRAL IOWA. BENEFITS OF THE AFFILIATION ARE NUMEROUS AND INCLUDE: A. SHARING OF BEST PRACTICES B. SAVINGS ON GROUP PURCHASING AGREEMENTS C. SAVINGS THROUGH GROUP CONTRACTING FOR NUMEROUS SERVICES D. ACCESS TO NUMEROUS HEALTH CARE EXPERTS E. ACCESS TO PROVIDERS OF ALL TYPES AND SPECIALTIES F. ACCESS TO COMPARATIVE REPORTING G. SUPPORT FOR HUMAN RESOURCES, MEDICAL CLINICS, PURCHASING, FINANCE, NUTRITION, MEDICAL SURGERY, AND ANCILLARY AREAS.

PART VI, LINE 7, REPORTS FILED WITH STATES
IA

Operating expenses	$ 44,856,300
Total amount spent on community benefits as % of operating expenses	$ 1,819,333 4.06 %