4A (Expenses $ 26673176 including grants of $ 6400) (Revenue $ 29477138)
ANDERSON COUNTY HOSPITAL HAS BEEN DESIGNATED BY THE STATE OF KANSAS AND MEDICARE AS A CRITICAL ACCESS HOSPITAL. ALL PROGRAM SERVICE EXPENSES WERE INCURRED IN FURTHERANCE OF OUR MISSION, WHICH IS TO ENSURE HIGH QUALITY HEALTHCARE IN A CARING ENVIRONMENT FOR THE COMMUNITIES WE SERVE. IN 2021, THERE WERE OVER 9,200 PATIENT DAYS, 10,200 RURAL HEALTH CLINIC VISITS, 3,100 EMERGENCY ROOM VISITS, 28,200 OUTPATIENT VISITS AND 1,100 AMBULANCE CALLS. WE PROVIDED UN-INSURED OR INDIGENT AREA CHILDREN WITH OVER 130 VACCINATIONS. AS A NONPROFIT, RURAL CRITICAL ACCESS HOSPITAL, SAINT LUKE'S HOSPITAL OF GARNETT IS COMMITTED TO SERVING ALL WHO SEEK OUR SERVICES REGARDLESS OF THEIR SOCIOECONOMIC STATUS. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS A FINANCIAL ASSISTANCE POLICY FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. THE HOSPITAL ALSO PROVIDES HEALTH RELATED ACTIVITIES AND SERVICES IN SUPPORT OF THE COMMUNITY INCLUDING PROVIDING AN ANNUAL BREAST CANCER AWARENESS CAMPAIGN AND CLINIC AND COMMUNITY WIDE HEALTH, WEIGHT, FIRST AID AND CPR CLASSES. IN ADDITION, WE PROVIDE A HEALTH CAREERS CLASS AT THE HIGH SCHOOL AND ARE A WORK STUDY SITE FOR HIGH SCHOOL STUDENTS INTERESTED IN HEALTH RELATED CAREERS. The hospital collaborated with other Saint Luke's Health System entities, the Missouri and Kansas Hospital Associations, and Mid-America Regional council to implement initiatives for establishing COVID testing sites, vaccine distribution, expanding virtual visits, and post-discharge follow-up for COVID-19 patients in addition to expanding coverage for the increase in hospitalized patients. The health system realigned its care and services to continue to treat and care for COVID-19 patients while protecting its employees.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SAINT LUKES HOSPITAL OF GARNETT INC. Input from persons representing the broad interests of the community was taken into account through key informant interviews (6 participants) and community meetings (24 participants). Stakeholders included: individuals with special knowledge of or expertise in public health; local public health departments; hospital staff and providers; representatives of social service organizations; and leaders, representatives, and members of medically underserved, low-income, and minority populations. Interviewee Organizations include Anderson County Hospital, Kansas Dept of Health & Environment, Saint Luke's Critical Access Region Affiliates and SEK Multi-County Health Department. Individuals from the Garnett Area Chamber of Commerce, Anderson County Hospital Board of Directors, Garnett School District, Southeast Kansas Mental Health Center, Anderson County Hospital and Anderson County Hospital Foundation participated in the community meetings.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - SAINT LUKES HOSPITAL OF GARNETT INC. THE HOSPITAL IS ADDRESSING THE FOLLOWING SIGNIFICANT NEEDS AS IDENTIFIED IN THE CHNA: *Access to Care (Including Access to COVID-19 Treatment and Testing Services) To address this need, ACH will implement the following initiatives: 1. Support SLHS advocacy efforts to expand Medicaid eligibility in Kansas. 2. Provide assistance to patients with the Medicaid application process. 3. Help patients enroll in general insurance programs including Medicare. 4. Expand virtual visit options for all community members including low-income communities. 5. Support SLHS efforts to update the Financial Assistance Policy and include coverage for Telehealth (virtual visit) services. 6. Enhance the existing pool of funds set aside to help patients pay for transportation after discharge. 7. Continue providing access to Wellness Clinic services for members of the Unified School District (USD-365 Garnett). 8. Continue providing vaccine and immunization services for adults and children and support providing flu vaccines in area schools. 9. Continue providing (and expanding access to) physicals for students in K-12 schools. 10.Conduct community blood drives. 11.Continue helping patients apply for Medication Assistance Access Programs offered by pharmaceutical companies. 12. Develop and implement a medication history program (with medication history technicians) to provide accurate information across SLHS. 13.Continue screening patients for transportation needs and making referrals for those in need to appropriate community resources. 14.Continue providing staff to address COVID-19 vaccine safety and benefits, social distancing strategies, masking and PPE, and patient education during discharge planning. 15.Continue providing access to COVID-19 vaccines at primary care clinics. 16.Continue providing pandemic-related community health education through social media and marketing initiatives. 17. Provide community health education for prevention and recognition of cardiac illness. 18. Provide CPR training in off-site settings. *Mental Health and Access to Mental Health Services To address this need, ACH will implement the following initiatives: 1. Continue connecting patients with Senior Life Solutions, a group counseling (mental health services) program for seniors. 2. Actively recruit mental health providers to serve diverse populations. 3. Support expansion of Crittenton Children's Center Trauma Smart program into area schools. 4. Explore partnership opportunities with the Southeast Kansas Mental Health Center 5. Screen students for mental health issues and risks when conducting physicals. 6. Collect unused medications through community-based drop boxes and a collections service. *Obesity and Physical Inactivity To address this need, ACH will implement the following initiatives: 1. Continue screening patients for food insecurity and providing referrals to appropriate community resources. 2. Continue participating in health fairs that help identify and manage risks associated with obesity and associated chronic conditions. 3. Continue providing support for on-site community outdoor fitness area. 4. Provide Eating Healthy During Pregnancy nutrition education. 5. Expand access to (and better promote) SLHS online support groups, including Gilda's Club. 6. Begin offering free or sliding fee scale group exercise (""Stay in Shape"") programs for children and teens. ACH plans to address the following significant community health needs as part the above strategic initiatives that focus on access to care, mental health, and obesity and physical inactivity: * Health Education and Preventive Health * Substance Use Disorders No hospital organization can address all of the health needs present in its community. ACH is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a wide range of community benefits. ACH does not intend to address two of the significant community health needs identified through its 2021 CHNA, namely: 1. Needs of Growing Senior Population. ACH and SLHS recognize that significant growth is projected for the population aged 65 years and older. The committee charged with developing this implementation strategy concluded that based on the criteria described above, the hospital's implementation strategy should focus on other, higher priority types of community health needs. 2.Poverty. While the hospital's 2021 CHNA identified poverty and affordable housing as significant community health needs, the committee charged with developing this implementation strategy identified other needs as higher priorities for the 2022-2024 implementation strategy. The hospital's Financial Assistance Policy provides discounts for eligible, low-income households and for those with catastrophic medical bills. The hospital also is a major employer and recognizes its role in enhancing the area's economy. This implementation strategy includes several initiatives designed to ensure that community members living in poverty have access to preventive services and efforts to collaborate with community organizations that assist low income residents."

Schedule H, Part I, Line 3c ASSISTANCE ELIGIBILITY
THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. IN ADDITION, MEDICAL INDIGENCY MAY BE DETERMINED ON AN INDIVIDUAL BASIS FOR INCOME ABOVE THE FEDERAL POVERTY LEVEL WHEN A SINGLE ILLNESS OR INJURY CAUSES HARDSHIP.

Schedule H, Part I, Line 7g Subsidized Health Services
SUBSIDIZED HEALTH SERVICES ARE FOR THE EMERGENCY DEPARTMENT, RURAL HEALTH CLINIC AND AMBULANCE SERVICES PROVIDED TO THE COMMUNITY. THE COSTS ATTRIBUTABLE TO THE PHYSICIAN RURAL HEALTH CLINIC INCLUDED IN COLUMN C ARE $2,456,132.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
1551799

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
COST OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO FROM THE HOSPITAL'S COST REPORT.

Schedule H, Part II Community Building Activities
ANDERSON COUNTY HOSPITAL'S COMMUNITY BUILDING ACTIVITIES ARE DIVERSE. THE HOSPITAL TAKES THE LEAD IN MANY COMMUNITY ENDEAVORS. WE PROVIDE MEETING SPACE, REFRESHMENTS AND SPEAKERS FOR MANY COMMUNITY PROJECTS. WE ASSIST WITH COALITION BUILDING IN OUR COMMUNITY AND BRING TOGETHER OTHER HEALTH AND SOCIAL SERVICE ORGANIZATIONS TO PLAN FOR THE BENEFIT OF THE COMMUNITY. WE PROVIDE FOR WORKFORCE DEVELOPMENT INCLUDING EMT, NURSE AID AND MEDICATION AID CLASSES THAT ARE OPEN TO THE COMMUNITY. WE PARTICIPATE IN THE ELEMENTARY AND HIGH SCHOOL BY OFFERING HEALTH RELATED CLASSES TO ALL AGE GROUPS. WE OFFER HEALTH CAREER ASSISTANCE AND CLASSES TO THE HIGH SCHOOL AND PARTICIPATE IN THE SCHOOL'S WORK STUDY PROGRAM WHICH OFFERS STUDENTS AN OPPORTUNITY TO SHADOW IN THE HEALTH CARE WORK ENVIRONMENT.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Performance obligations are identified based on the nature of the services provided. Revenue associated with performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected {or actual) charges. Performance obligations satisfied over time relate to patients in the Hospital receiving inpatient acute care or long-term care services. The Hospital measures the performance obligation from admission into the Hospital to the point when there are no further services required for the patient, which is generally at the time of discharge. For outpatient and rural health clinic services, the performance obligation is satisfied as the patient simultaneously receives and consumes the benefits provided as the services are performed. In the case of outpatient and rural health clinic services, recognition of the obligation over time yields the same results as recognizing the obligation at a point in time. The Hospital believes that this method provides a faithful depiction of the transfer of services over the term of the performance obligations based on the inputs needed to satisfy the obligations. As the majority of the Hospital's performance obligations relate to contracts with a duration of less than one year, the Hospital has applied the optional exemption provided in FASB ASC 606-10-50-14{a) and, therefore, is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above primarily relate to inpatient acute care and long-term care unit services at the end of the reporting period. The performance obligations for the inpatient acute care contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. The performance obligations for long-term care unit contracts are generally completed when the patients are discharged, which generally is longer than a year from the end of the reporting period. The consideration to be received from the long-term care patients in future periods will directly correspond to the value of the services received by the patients. The Hospital uses a portfolio approach to account for categories of patient contracts as a collective group rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenues and types of services provided for outpatient revenues. Based on historical collection trends and analyses, the Hospital believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if the individual contract approach were used. The Hospital determines the transaction price, which involves significant estimates and judgment, based on standard charges for goods and services provided, reduced by explicit and implicit price concessions, including contractual adjustments provided to third-party payors, discounts provided to uninsured and underinsured patients in accordance with the Hospital's policy, and implicit price concessions based on the historical collection experience of patient accounts. The Hospital determines the transaction price associated with services provided to patients who have third-party coverage based on reimbursement terms per contractual agreements, discount policies, and historical experience. Generally, patients who are covered by third-party payers are responsible for related deductibles and coinsurance, which vary in amount. For those patients and for uninsured patients who do not qualify for charity care, the Hospital determines the transaction price associated with services on the basis of charges, reduced by implicit price concessions. Implicit price concessions included in the estimate of the transaction price are based on historical collection experience for applicable patient portfolios. Patients who meet the Hospital's criteria for charity care are provided care without charge or at amounts less than established rates, and such amounts are not reported as revenue. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. THE AMOUNT OF BAD DEBT REPORTED IN THIS FORM 990 IS CONSISTENT WITH THE FINANCIAL STATEMENTS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
See footnote provided above in the explanation for Part III, Line 2.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
THE DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF THE PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FOR ANY REMAINING BALANCES DUE, THE SAME COLLECTION POLICY AND PROCEDURES ARE APPLIED EQUALLY TO ALL PATIENT TYPES. ALTHOUGH WE ARE NOT LEGALLY BOUND BY THE FAIR DEBT COLLECTION PRACTICES ACT, THE PRINCIPLES ADDRESSED ARE GENERALLY FOLLOWED.

Schedule H, Part V, Section B, Line 16a FAP website
- SAINT LUKE'S HOSPITAL OF GARNETT: Line 16a URL: www.saintlukeskc.org/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- SAINT LUKE'S HOSPITAL OF GARNETT: Line 16b URL: www.saintlukeskc.org/financial-assistance;

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
MEDICARE ALLOWABLE COSTS WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM THE MEDICARE COST REPORT. ANDERSON COUNTY HOSPITAL IS A CRITICAL ACCESS HOSPITAL IN A FEDERALLY DESIGNATED LOW INCOME HEALTH PROFESSIONALS SHORTAGE AREA(HPSA), LOCATED IN THE SECOND LOWEST INCOME COUNTY IN THE STATE OF KANSAS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. WE PROVIDE SERVICES TO THE MOST NEEDY CONSTITUENCIES IN OUR AREA. THESE INCLUDE BOTH MEDICAID AND MEDICARE POPULATIONS. THE ENTIRE LOSS ON MEDICARE SHOULD BE TREATED AS COMMUNITY BENEFIT. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS, INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD.

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- SAINT LUKE'S HOSPITAL OF GARNETT: Line 16c URL: www.saintlukeskc.org/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
IN ADDITION TO ITS CHNA, THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING ITS COMPREHENSIVE DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. THE HOSPITAL ALSO HAS A NUMBER OF COMMUNITY ADVISORY BOARDS REPRESENTING DIFFERENT CONSTITUENCIES THAT MEET AT LEAST ANNUALLY TO ASSIST IN PLANNING FOR THE HEALTH CARE NEEDS OF THE COMMUNITY. WE PARTICIPATE MONTHLY IN THE COMMUNITY WIDE HEALTH COALITION MADE UP OF OTHER HEALTH PROVIDERS WITHIN OUR AREA. FROM TIME TO TIME WE HAVE COMMUNITY FOCUS GROUPS TO ASSIST US IN UNDERSTANDING THE HEALTHCARE NEEDS IN OUR COMMUNITY.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
ANDERSON COUNTY HOSPITAL INFORMED AND EDUCATED PATIENTS WHO MAY BE BILLED FOR PATIENT CARE ABOUT ELIGIBILITY FOR ASSISTANCE BY POSTING SIGNS THROUGHOUT THE FACILITY AND ON HOSPITAL SPECIFIC LITERATURE GIVEN OUT TO EACH PATIENT WHO SEEKS SERVICES AS WELL AS ON OUR PATIENT BILLING STATEMENTS. WE COORDINATE IDENTIFICATION OF NEED WITH OUR PHYSICIAN OFFICE AND WITH OTHER ENTITIES WITHIN OUR HEALTH SYSTEM. WE HAVE FINANCIAL AND SOCIAL SERVICE COUNSELORS WHO WORK WITH FAMILIES AND INDIVIDUALS IN NEED. SINCE ANDERSON COUNTY IS A LOW-INCOME HPSA WE UNDERSTAND THAT A LARGE PART OF OUR POPULATION NEEDS ASSISTANCE. THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT COMPANIES TO SCREEN ALL UNINSURED PATIENTS, ANY PATIENTS IDENTIFIED BY OUR SOCIAL WORKER OR CASE MANAGEMENT TEAMS, AND ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. THE ELIGIBILITY ENROLLMENT SERVICE ALSO PROVIDES PATIENTS WITH INFORMATION ON FINANCIAL ASSISTANCE.

Schedule H, Part VI, Line 4 Community information
ANDERSON COUNTY HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN GARNETT, A RURAL COMMUNITY SOUTHWEST OF KANSAS CITY. THE SERVICE AREA ENCOMPASSES ALL OF ANDERSON COUNTY AND PORTIONS OF FRANKLIN, LINN, COFFEY, AND ALLEN COUNTIES. THE CURRENT COUNTY POPULATION IS 7,877 (2020) AND THE EXTENDED SERVICE AREA POPULATION IS 12,000 PEOPLE. THE GARNETT AREA IS MAINLY A FARMING COMMUNITY. THE COUNTY IS FEDERALLY DESIGNATED AS A LOW-INCOME HEALTH PROFESSIONALS SHORTAGE AREA.

Schedule H, Part VI, Line 5 Promotion of community health
THE BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS, MOST OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA, PLUS TWO REPRESENTATIVES OF SAINT LUKE'S HEALTH SYSTEM. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.

Schedule H, Part VI, Line 6 Affiliated health care system
THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSIST OF 16 AREA HOSPITAL FACILITIES, AND SEVERAL PRIMARY AND SPECIALTY CARE PRACTICES, AND PROVIDES A RANGE OF INPATIENT, OUTPATIENT, AND HOME CARE SERVICES. FOUNDED AS A FAITH-BASED, NOT-FOR-PROFIT ORGANIZATION, OUR MISSION INCLUDES A COMMITMENT TO THE HIGHEST LEVELS OF EXCELLENCE IN HEALTH CARE AND THE ADVANCEMENT OF MEDICAL RESEARCH AND EDUCATION. THE HEALTH SYSTEM IS AN ALIGNED ORGANIZATION IN WHICH THE PHYSICIANS AND HOSPITALS ASSUME RESPONSIBILITY FOR ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF PEOPLE IN THE METROPOLITAN KANSAS CITY AREA AND THE SURROUNDING REGION.