Community Benefit Insight - Tax-exempt hospital

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Salina Regional Health Center Inc

Salina Regional Health Center

400 S Santa Fe
Salina, KS 67401

Bed count	353	Medicare provider number	170012	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

EIN: 481169103

Display data for year:

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

13.22%

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	$ 2,467,752 0.77 %
Medicaid as % of operating expenses	$ 10,312,653 3.23 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 845,626 0.26 %
Subsidized health services as % of operating expenses	$ 28,420,745 8.90 %
Research as % of operating expenses	$ 2,953 0.00 %
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.	$ 134,742 0.04 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 29,500 0.01 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
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	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 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	$ 24,213,034 7.58 %
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 $ 259447219 including grants of $ 34500) (Revenue $ 297442853)
Salina Regional Health Center, Inc. provides hospital and health related services to the people of Saline County, Kansas. During the fiscal year Salina Regional Health Center, Inc. discharged 8,136 inpatients resulting in 33,582 patient days, treated outpatients in 430,989 visits and generated 277 million in net patient service revenue. Charges of $9 million were provided in charity care assistance during the year.

Facility Information

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

Salina Regional Health Center, Inc.
Part V, Section B, Line 5: The Community Health Assessment Core group was made up of 78 key informed representatives from the community, including doctors, attorneys, business owners and leaders of several not for profit entities. This group partnered to conduct an assessment of the health status and needs of our community. Several tools and frameworks have been developed to guide communities through the CHNA process. The framework that was selected by the CHNA Core Group is the Institute of Medicine Community Health Improvement Process. An important initial step in the process is the preparation, analysis and interpretation of data describing the community: the Community Profile. The Community Profile describes the factors that contribute to the health and the health status of the community. Data Sources - There are numerous publicly available sources for valid, reliable data. The Kansas State Department of Health and Environment (KDHE) collects information that includes pregnancy outcomes, births, deaths, cancer incidence, reportable diseases, and more. Kansas community specific data are accessible on the KDHE website. In 2011 The Kansas Partnership for Improving Community Health (KanPICH) launched the Kansas Health Matters web site to assist communities with the CHNA/CHIP process. The measures compiled in this report come from multiple sources that use scientifically sound data collection and analysis methods. More information about the methods used to produce these data is available from each source.

Salina Regional Health Center, Inc.
Part V, Section B, Line 6a: Salina Surgical Center

Salina Regional Health Center, Inc.
Part V, Section B, Line 6b: Salina Saline County Health DepartmentUnited Way of SalinaSalina Surgical HospitalDVACKNorth Central KS Area on AgingCentral Kansas Mental HealthCentral Kansas Foundation

Salina Regional Health Center, Inc.
Part V, Section B, Line 11: In the CHNA conducted for FY2022, the following needs were identified and prioritized in the following order:Depression/mental health, heart disease related indicators, aging population, cancer, drug poisoning, smoking, stroke, Covid-19, diabetes, domestic violence, immunizations, overweight/obesity including child obesity, trauma/falls, sexually transmitted disease rate, and pregnancy related indicators.The organization will not directly address the following needs identified for the reasons listed:Sexually transmitted disease rate Saline County Health Department is focused on addressing this.Domestic Violence - DVACK is the expert in this area. SRH Foundation may provide financial support to DVACK and other organizations specializing in domestic violence.In the year ended September 30, 2022, the facility has taken the following actions to address the identified needs: SRHC provides funding to Salina Regional Health Foundation, Inc. (SRH Foundation). The Foundation, in turn, supports the identified needs of SRHC by making distributions to tax-exempt organizations, including the Health Center and other causes and institutions related to, affiliated with, or cooperating in the achievement of its exempt purposes. The Foundation is a corporate member of SRHC.Depression/Mental HealthSRHC addressed this need through services offered by our behavioral health department, Veridian Behavioral Health. Many of Veridian's services are geared toward individuals and families who are struggling with common life problems such as depression, anxiety, marital problems, parent-child conflicts or grief and loss. Our services are provided in a convenient and comfortable, private office setting.Veridian psychiatrists provide direct care in an office setting while actively serving in various settings, such as intensive outpatient care, inpatient care in SRHC and in nursing homes.SRHC has worked with SRH Foundation to provide funding to organizations working to remove the stigma of depression and mental health, and provide counseling, therapy and treatment for individuals suffering from these health issues.Heart Disease Related IndicatorsSRHC addressed this need through its Salina Regional Health Center Chest Pain Center which has received the Primary PCI Accreditation from the American College of Cardiology. Striving for this national accreditation demonstrates Salina Regional Health Center's commitment to always being ready to treat patients with heart attacks. We are able to treat many of our heart attack patients without emergency surgery with a procedure called percutaneous coronary intervention (PCI). Aging PopulationSRHC addressed this need through its Meds to Bed program, providing enhanced education on medication at discharge. SRHC takes a very active role in several area nursing schools through contributions made through its Foundation.Saline County Department of Senior Services grant for $10,000 from SRH Foundation. The grant money was used for the Senior Centers Health Fair to benefit Meals on Wheels and healthcare for pets.Cloud County Community College (CCCC) grant for $250,000 from SRH Foundation. The requested funds were used toward the building of a Technical Education and Innovation Center to house academic programs of Renewable Energy, Nursing and Allied Health, and Agriculture and Industrial Technology. The CCCC Technical Education and Innovation Center positively influences the number of workers in Kansas by providing the needed education and skills to support occupational groups expected to grow employment from 2019-2029. One of the targeted outcomes for the center is increasing enrollment in Nursing and Allied Health, and addressing workforce needs for talent retention and attraction to handle the increased needs as the region's population ages. CancerSRHC addressed this need by maintaining Oncology and Radiation Oncology services, plus support services including Nutrition Counseling, Appearance Center, Spiritual support, and Cancer Registry.The Tammy Walker Cancer Center had several Cancer screening events throughout the year (Prostate, Skin, Breast and Colon). Our Foundation provides grants to Rolling Hills Zoo for Dream Night at the Zoo, a free evening at Rolling Hills Zoo for children with cancer or other chronic illnesses. Our comprehensive cancer program holds the prestigious cancer program approval by the American College of Surgeons Commission on Cancer and the American College of Radiation Oncology. In addition, the Tammy Walker Cancer Center is affiliated with the renowned Midwest Cancer Alliance, increasing access to the latest cancer treatment discoveries through a wide variety of clinical research studies.Death Rate Due to Drug PoisoningSalina Rescue Mission grant for $40,000 grant from SRH Foundation. The funds hired an Addictions Recovery Professional that has training and experience in working with those in substance abuse recovery. This person will help Mission develop classes and resources that are open to all of its residents, regardless of which program they are in. This staff person also taught relapse prevention skills, helped guests develop recovery plans and started support meetings within the Mission.Obesity (Child and Adult)School Marathon Foundation grant for $40,000 from SRH Foundation. The funds used for the Fall 2022 School Marathon, a 26.2-mile group running event for children. The School Marathon inspires lifelong habits for healthy living through a program that allows children to achieve the challenging goal of completing the marathon. The targeted population includes all Salina public and private elementary students in grades K-6. The program is all-encompassing and includes special needs populations. St. John's Missionary Baptist Church for $14,261 grant from SRH Foundation. The requested funds assisted in the completion of the church's Kid Kare Preschool Playground Project. The funds purchased a playset for the playground, specifically designed for children, ages 3-5.Smoking, Percentage of Adults Who Currently SmokeContinue with smoking cessation classes.StrokeSRHC addressed this need by continuing to provide exceptional stroke care and maintaining its designation as a Primary Stroke Center. A dedicated stroke response team is called to the Emergency Department whenever stroke is suspected. Members of the team include emergency room physicians, nurses, radiology staff, pharmacists and lab personnel who all have received specialized training to provide stroke care. The stroke team can be activated from the field by emergency responders to ensure that the team is ready to receive and treat the patient the moment they arrive at Salina Regional Health Center.Public education also is key to improving stroke outcomes. As an initiative to educate the public on stroke recognition and how to respond, the acronym FAST is often used: Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services. Salina Regional has distributed educational cards in the past and plans to continue educating the public on stroke recognition.North Central-Flint Hills Area Agency on Aging, Inc., for $18,000 grant from SRH Foundation. The funds are to be used to support the 2022 Sunflower Fair and Regional Outreach Initiative. This is the area's premier health and wellness fair geared toward older adults and individuals with disabilities. They provide outreach and education related to Heart Disease, Stroke, Depression/Mental Health, Trauma/Falls, and general wellness of older adults. Continued in Part VI

Salina Regional Health Center, Inc.
Part V, Section B, Line 13h: Presumptive eligibility may be utilized if a patient qualifies under the eligibility screening done by Salina Family Healthcare Clinic, a Community Clinic.

Salina Regional Health Center, Inc.
Part V, Section B, Line 20e: On the back of the patient statement is information on how to obtain a FAP. SRHC also hires a third party to help uninsured patients verify eligibility for public benefits or the FAP.

Salina Regional Health Center, Inc.
Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy.

Part V, Section B, Line 7a and 10a
https://www.srhc.com/about-us/community-benefit-report.php

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive eligibility may be utilized if a patient qualifies under the eligibility screening done by Salina Family Healthcare Clinic, a Community Clinic.

Part I, Line 6a:
The Community Benefit report is available upon request.

Part I, Line 7:
Amounts reported on Lines 7a and 7b are from the organization's cost accounting system taking all patient segments into account. Amounts on lines 7e, 7f, 7i are from the actual general ledger. Subsidized health services on line 7g were calculated utilizing IRS Worksheet 6.

Part I, Line 7g:
Subsidized health services includes expense in excess of revenue of $31,952,662 attributable to physician clinics.

Part III, Line 2:
The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients.

Part III, Line 4:
The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement on pages 15 and 16.

Part III, Line 8:
The payments are compared to the actual cost of providing the service as arrived at through the cost accounting system. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community.

Part III, Line 9b:
If a patient qualifies for financial assistance, the account is adjusted according to our policy. Any remaining balance after adjustment is collected under the billing and collection policies. Our billing and collection policies are the same for all patients. Patients who have qualifed for financial assistance are considered approved for a period of six months from the date of approval. After six months, patients need to reapply for financial assistance.

Part V, Section B, Line 11
"continued...Covid-19 Salina Regional Health Center continued to serve and play a significant role on the Salina County COVID-19 task force. SRHC continued full COVID screening of every patient and visitor that entered any of our facilities. Our clinics employed special screeners while the hospital used employed Information desk staff along with two staff from various departments working one-hour shifts for screening.SRHC maintained signage and posters throughout facilities with most up to date Covid 19 requirements and precautions from the CDC. We also maintained a COVID-19 webpage with all the latest CDC information. SRHC Urgent Care maintained our COVID Testing Site for our entire heath system using both PRC and Antigen testing. SRHC kept the public informed of the Hospital and region's COVID 19 status with Salina Regional's Chief Medical Officer appearing on SRHC's video news magazine The Pulse quarterly and continued to send press releases and social media updates on COVID 19 status. DiabetesSRHC addressed this need through Salina Regional Endocrinology Clinic, led by a board-certified endocrinologist, certified in Internal Medicine/Endocrinology.SRHC continued the diabetes support group program with Pharmacy, Dietary, and Organizational Development. Due to the pandemic the Diabetes Support group moved to a virtual format. With the producing of videos of each month's meetings participation actually increased and meetings will continue to be available online even when they go back to in person meetings in the future. ImmunizationsTammy Walker Cancer Center, a department of SRHC, continues to focus on HPV vaccinations. Saline County Health Dept. is focused heavily on immunizations.Trauma/FallsSRHC addresses this need by providing specialized care for patients with serious or life-threatening injuries through its Level III Trauma Center.Salina Regional Health Center plays an integral role in the region and statewide trauma councils.SRHC works with Cloud County Health Center in Concordia, KS in their efforts toward a Level IV Trauma Center designation.Pregnancy Related IndicatorsSRHC continued the ""Becoming a Mom Program"" which is a joint effort between SRHC and the Saline County Health Department. The Birth Center at Salina Regional Health Center has been named one of Kansas' ""Best of the Best in Metabolic and Newborn Screening."" Salina Regional was one of 12 facilities across the state to receive the ""Best of the Best"" designation."

Part VI, Line 2:
In addition to the community health needs assessment, SRHC analyzes hospital discharge data for all counties in the region. The Kansas Hospital Association inpatient discharge database includes data for all reporting hospitals. From this we determine usage trends that help us plan needed services.

Part VI, Line 3:
At registration, the patient is informed of their rights for financial assistance if unable to produce valid insurance coverage. The patient is referred to a third-party vendor to determine eligibility for governmental programs and if it is determined they do not qualify, they are screened under our financial assistance guidelines. We post our guidelines on our website as well.

Part VI, Line 4:
Salina Regional Health Center, Inc. is a rural community hospital serving a primary service area of Saline County, three immediately adjacent counties are its secondary service area, and has a 14-county referral area although certain specialties draw statewide. For purposes of community health needs assessment, the principal community of SRHC is Saline County.The primary service area (Saline County) has a population of 53,596. Between 2020 and 2022 the population of Saline County, KS declined from 54,301 to 53,596. When compared to the national population, this area is represented by an older population with a lower educational level and lower median income.The Challenge of the Aging PopulationAs members of the baby boom generation get older and reach retirement age, they present an increasing challenge and opportunity for health care. The growth in the number of elderly patients from the boomer generation coupled with a loss of boomer-age providers will pressure an already-stressed health care system. A big unknown is how well Medicare will digest the 75 million baby boomers amid the federal government's attempt to transform how care is provided and paid for in the program.Saline County has a higher percentage in the 65+ age-group of 19.8% compared to 17.2% for the rest of the state. This percentage is projected to continue to rise until the year 2035 before it starts to decline. Cancer, high cholesterol, COPD, arthritis, Alzheimer's, and depression for Medicare aged residents all currently have higher rates than the rest of the state. These indicators coupled with an increase in residents in this age group will be an issue for years to come.The service area is less ethnically diverse compared to the U.S. overall. The majority of residents are Caucasian (79.0%) followed by Hispanic (12.4%) and Black (3.5%). Spanish patient education materials are available at SRHC and the hospital translates via Certified Languages International and Stratus.Recognizing the relatively lower educational level in the community, the hospital writes patient information at a 4th to 6th grade reading level.Median household income in the primary service area from 2017-2021 was $55,175 compared to a Kansas median of $64,521, and national median of $69,021. A lack of available resources to the indigent is a challenge in this environment, so in addition to providing charity care, the hospital has and continues to support the Salina Family Healthcare Center, which provides care to the indigent.

Part VI, Line 5:
The governing board of Salina Regional Health Center, Inc., is comprised of volunteers intentionally selected to promote the betterment of the region we serve. Salina Regional Health Center, Inc., administrators and governing board members assist the Foundation by participating in the CHIP committee.Salina Regional Health Center, Inc. is a member of the Sunflower Health Network (SHN) along with 15 critical access hospitals (CAHS) distributed across 14 counties. A Kansas Hospital Association administrator led SHN strategic planning that resulted in regional health priorities, including providing access to specialist physician care, optimizing timeliness and safety of patient transfers, and sustaining the number of quality nurses in the region. As a result of this process, Salina Regional Health Center, Inc. was verified by the American College of Surgeons as a level III trauma center, the only designated level III trauma center in the North Central Kansas Region. Salina Regional also provides access to computerized patient simulators and other nursing education modalities to strengthen the quality of nurses in regional communities.In an effort to attract and train professional nurses in rural Kansas the University of Kansas School of Nursing and Salina Regional Health Center announced a partnership that opened a new campus location in Salina this fall. The campus will offer students a Bachelor of Science in Nursing, which accepts students who have already completed the first two years of their undergraduate education at any regionally-accredited college or university. The school is sharing existing facilities with the University of Kansas School of Medicine in Salina and accepted 12 students in its first class. The program will join medical students at a new campus in downtown Salina.

Operating expenses	$ 319,323,671
Total amount spent on community benefits as % of operating expenses	$ 42,213,971 13.22 %