Community Benefit Insight - Tax-exempt hospital

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Mt Graham Regional Medical Center Inc

Mt Graham Regional Medical Center

1600 Twentieth Avenue
Safford, AZ 85548

Bed count	25	Medicare provider number	031319	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 237094247

Display data for year:

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

4.52%

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

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2021-2021

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	$ 364,000 0.46 %
Medicaid as % of operating expenses	$ 0 0 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 2,784,174 3.52 %
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.	$ 424,344 0.54 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 66,784 0.08 %

* = 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	$ 66,784 0.08 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 0 0 %
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	$ 66,784 100 %
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	$ 5,474,849 6.93 %
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	$ 832,177 15.20 %

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 $ 62548888 including grants of $ 0) (Revenue $ 84553077)
Mt. Graham Regional Medical Center, Inc. is a 25-bed acute care hospital located in Graham County, Arizona. We are a nonprofit, community-owned and governed facility providing extensive medical services for Graham and Greenlee counties of Arizona. Our services include medical/surgical services, intensive care, obstetrics, emergency services, infusion therapy, chemotherapy, respiratory therapy, laboratory services, radiology, digital mammography, ultrasound, CT scans, MRI scans, and nuclear medicine. (Continued on Schedule O.)In addition to the services provided by the Medical Center, each month the following specialty care clinics are provided on the hospital campus: allergy and immunology; Otolaryngologist (Ear Nose Throat) ; cardiology; dermatology; oncology; orthopedics; pediatric cardiology; pediatric endocrinology; pediatric pulmonary; kidney, disability; endocrinology; and urology.In 2021, the Medical Center had 6,059 total inpatient days and 81,873 outpatient visits.The Medical Center provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less that established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was approximately $364,000 for the year ended December 31, 2021, calculated by multiplying the ratio of cost to gross charges for the Medical Center by the gross uncompensated charges associated with providing charity care to its patients.

Facility Information

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

Mt. Graham Regional Medical Center, Inc.
Part V, Section B, Line 5: As part of the process for evaluating community need, a CHNA steering committee was formed. This committee, which was commissioned to guide the CHNA process, was comprised of professionals from a variety of disciplines across the organization and from the community. This steering committee has provided guidance in all aspects of the CHNA process. The Steering Committee members included: *Mt. Graham Regional Medical Center (MGRMC) President and CEO *MGRMC Director of Marketing and Development *Eastern Arizona College Director of Nursing *Graham County Department of Health Services Director *MGRMC Emergency Department Director *MGRMC Rural Health Clinic Medical Director *MGRMC Director of Clinics *MGRMC Social WorkerAssessment Process:The CHNA process started with an overview of our primary service area. The service area was defined as the market where at least 80 percent of inpatient admissions originated. The steering committee then met to build a survey designed to identify gaps in health services available or gaps in access to health services available in MGRMC's service area. This survey was administered online and was also made available through physician offices, the county health department and through community outreach sessions conducted by members of the steering committee.

Mt. Graham Regional Medical Center, Inc.
Part V, Section B, Line 11: A Community Health Needs Assessment was conducted in 2019. The following statements includes the needs identified and the 2021 actions taken to address the needs.Improved Treatment and Services for Substance Abuse MGRMC continues to provide financial support to the Graham County Substance Abuse Coalition in their efforts to combat opioid abuse and response in the Gila Valley. The hospital continues to collaborate with a local pain management clinic located on the hospital's campus. MGRMC is diligent to ensure appropriate referrals to substance abuse treatment services and includes coverage for such services in its employee benefits program. Improved Treatment and Services Associated with Mental Health MGRMC continues to collaborate with a variety of providers of mental health services to offer in-person and tele-psych services in the hospital and hospital clinics. The hospital's Employee Assistance Program provides easy access to mental health and related services to hospital employees and their families. MGRMC's Case Management Department partners with local programs that specialize in mental health to make sure all patients have access to the mental healthcare that they are needing. The hospital works closely with mental health providers both in the community and in the Phoenix and Tucson metropolitan areas to ensure the appropriate referral of patients for needed care. Improve Services for Diabetes MGRMC employs a dietician that oversees Diabetes Family Support Group Services that includes individual nutrition counseling, diabetes education, and group support meetings. The dietician works on expanding diabetes knowledge through school visits and community health fairs. The hospital continues to support and participate in the Gila Valley Diabetes Coalition, which exists to increase awareness of and response to diabetes.Improved Opportunities for WellnessThe hospital's Copper Mountain Clinic, a federally designated rural health clinic, provides access to primary care services to include wellness visits, immunizations, illness care, health education, etc. The hospital provides a financial incentive to employees for membership in local fitness facilities. MGRMC is also part of a food coalition with local partners to provide nutritional food and items to underserved communities in food deserts. The hospital will continue to promote wellness through community health fairs, sponsoring health-related community events, and work with local clubs, organizations and wellness facilities to promote wellness activities. The hospital and it's foundation also provide support for runs, golf outings, and other sports and wellness related events.Additional Specialty Services Provided Locally MGRMC added a second general surgeon to our general surgery clinic. We supported a local clinic in the recruitment of family practice and obstetric physicians to the Gila Valley. MGRMC has recruited a full-service cardiology group to provide in-hospital consults, diagnostic reads and soon to provide clinical office services on our campus. We are pursuing clinical initiatives to expand our wound care and outpatient nursing services as well as starting inpatient dialysis services. We are in continuous pursuit of additional specialty services to provide care to our community through our Specialty Clinic that leases space to visiting providers to include oncology, urology, pediatrics, nephology to name a few. Additionally, some of the specialists are offering tele-medicine to increase their presence in the community. Covid Drive-Thru Clinic provided through the Rural Health Clinic from Covid Grant funds, partnership with United Way, MGRMC, and the Health Department. MGRMC opened a free drive-thru clinic that tested for Covid and flu-variants during the Covid Surge.

Mt. Graham Regional Medical Center, Inc.
Part V, Section B, Line 16j: A summary, including contact information, was included in our emergency rooms, waiting rooms, admissions offices, and provided to patients on admission to the hospital facility.

Mt. Graham Regional Medical Center, Inc.
Part V, Section B, Line 24: All individuals eligible under the Medical Center's financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures.

Part V, Section B, Line 7a:
Community Health Needs assessment www.mtgraham.org/about-mgrmc/community-health-needs-assessment

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
Charity care was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Community health improvement services community benefit expense is reported based on the actual cost in the general ledger. The cost for subsidized health services was determined using the Medicare Cost Report.

Part I, Line 7, Column (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 $ 5,474,849.

Part II, Community Building Activities:
The Hospital employs a financial counselor to assist patients with enrollment in AHCCCS/Cope as part of the charity care and financial assistance.

Part III, Line 2:
Accounts are not written off to bad debt until all payments, discounts, and contractual allowances are applied. When a payment is received on an account previously written off to bad debt, the payment reduces the current year's bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements.

Part III, Line 3:
The amount of bad debt expense attributable to patients eligible for charity care is based on the 15.2% of individuals living below the federal poverty level.

Part III, Line 4:
The footnote to the Organization's financial statements can be found on page 16 of the attached audited financial statements.

Part III, Line 8:
The entire Medicare shortfall is considered a community benefit. Services are provided to patients under the Medicare program even though the hospital knows they will not recover all of the costs from providing the services. This program is considered subsidized by the hospital and other payors. Patients rely on these services for their health and well-being and are essential for their access to healthcare. The costs associated with Medicare were taken from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.

Part III, Line 9b:
The Hospital must determine whether an individual is FAP-eligible or provide required notices during a notification period ending 120 days after the date of the first billing statement. Although the Hospital may use extraordinary collection efforts after the 120-day notification period, we must still accept and process a FAP application for an additional 120 days. The total period during which we must accept and process FAP applications is 240 days from the date of the first billing statement. If the hospital receives a FAP application during the application period, we must suspend any extraordinary collection efforts started until the application is processed, and if the individual is FAP-eligible, must seek to reverse the extraordinary collection efforts and promptly refund any overpaid amounts. Debts may be referred to third parties to assist with collection efforts, they may not be sold to third parties during the notification period until an eligibility determination has been made.

Part VI, Line 2:
Throughout the year, the hospital works closely with community clinics on recruiting, scheduling, and services review. The hospital also continues to expand its charity care program.

Part VI, Line 3:
Mt. Graham Regional Medical Center provides brochures for charity care at time of admission. Patients are given additional information with contact information at time of inpatient admission and discharge. Brochures with information about charity care are located in admission areas and other areas of the organization in which eligible patients are likely to be present. Charity care brochures are also provided to local physicians to provide information to their patients who may need services at Mt. Graham Regional Medical Center. When patients are contacted by phone for collection purposes, patients are given additional information regarding our charity care program. Mt. Graham Regional Medical Center has contracted HPS (Hospital Patient Services) to assist patients with government benefits such as Medicaid.

Part VI, Line 4:
Mt. Graham Regional Medical Center is an acute care hospital located in Safford which is in Graham County, Arizona. Graham County is a rural area with a population of approximately 39,050. MGRMC serves Graham, Greenlee and northern Cochise counties. The median household income is $55,693, and 15.2% of Graham County is below poverty level. The median age of population in Graham County is 33.7 with 46.2% female and 53.8% male. The two facilities closest to our facility are approximately 50-75 miles away, and both are critical access facilities. In its rural setting, the hospital serves the population with general surgery and orthopedic surgery. Other specialists come to the hospital on a weekly or monthly basis to provide service to community members.

Part VI, Line 5:
The majority of MGRMC's governing body is comprised of persons who reside in the Organization's primary service area. MGRMC extends medical staff privileges to all qualified physicians in the community. MGRMC provides emergency room services regardless of ability to pay.Mt. Graham Regional Medical Center (MGRMC) is a facility dedicated to promoting the health of the community. MGRMC provides services through our Community Health Department and Rural Health such as diabetes education and Annual Gila Valley Health Fair. The amount reported as community health improvement services represents the excess of costs for these events over the funds received from government agencies to put on the events. MGRMC supports the education and training of healthcare professionals. MGRMC offers volunteer opportunities to the community through our auxiliary.

Operating expenses	$ 79,017,371
Total amount spent on community benefits as % of operating expenses	$ 3,572,518 4.52 %