Community Benefit Insight - Tax-exempt hospital

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Lindsborg Community Hospital Association

Lindsborg Community Hospital

605 West Lincoln
Lindsborg, KS 64756

Bed count	21	Medicare provider number	171358	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 480545183

Display data for year:

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

27.1%

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	$ 43,000 0.33 %
Medicaid as % of operating expenses	$ 195,855 1.51 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 2,650 0.02 %
Subsidized health services as % of operating expenses	$ 3,181,699 24.54 %
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.	$ 33,624 0.26 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 57,456 0.44 %
Community building* as % of operating expenses	$ 13,339 0.10 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	1
Physical improvements and housing	0
Economic development	0
Community support	1
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	5,252
Physical improvements and housing	0
Economic development	0
Community support	5,252
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	$ 13,339 0.10 %
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	$ 13,339 100 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

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

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 288,736 2.23 %
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 $ 9530400 including grants of $ 32072) (Revenue $ 14690703)
Lindsborg Community Hospital (LCH) operates a critical access hospital in a community qualifying for such designation under federal law. The facilities are adequate for treatment or care of individuals suffering from mental or physical illness, disease, injury or deformity in an acute care, skilled nursing care, outpatient or emergency room setting. LCH cares for residents of the Smoky Valley with the operation of a 24/7 emergency room. 1,662 emergency room patients were seen in the 2022 fiscal year. 4,002 urgent care visits and 138 cardiac rehab visits improved the health of community members. 10,105 visits were made in the Family Health Care Clinic to provide acute treatment, manage chronic conditions, or provide preventive care. 4,876 meals on wheels and 2,424 frozen meals were supplied to community members. Education was provided to the Smoky Valley Community through print, digital forums and on-site in 2022. Employees of the LCH partner with community groups such as Lindsborg Ad-Hoc and Strategic Alliance to enhance the Lindsborg experience. Staff also provide leadership with the Sunflower Health Network, KHA Board of Directors, and the Sunflower (Kansas) HFMA Chapter.

Facility Information

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

Lindsborg Community Hospital
Part V, Section B, Line 5: The leadership of McPherson Hospital in McPherson, Lindsborg Community Hospital in Lindsborg, Mercy Hospital in Moundridge, and the McPherson County Health Department collaborated to create an electronic survey which was made available to the public in May 2022. A group receiving specific invitation to complete the survey was STEP (Steps to End Poverty) MC. STEP MC advocates for and meets regularly with the medically underserved and low income populations in the county.

Lindsborg Community Hospital
Part V, Section B, Line 6a: McPherson Hospital, McPherson, Kansas Mercy Hospital, Moundridge, Kansas

Lindsborg Community Hospital
Part V, Section B, Line 6b: McPherson County Public Health Department

Lindsborg Community Hospital
"Part V, Section B, Line 11: In the FY2022 CHNA the following needs were identified; obesity, drug abuse, aging issues, high blood pressure and mental health issues. While the most recent survey results from the public surveys indicated that cancer was slightly more significant than drug abuse as a priority health need, the focus group felt that drug abuse was still significant enough to warrant continued focus. The organization will not address the need of mental health issues beyond our work with Prairie View and referrals to Veridian, CKF Addiction Treatment, and other mental health and/or substance abuse treatment centers as needed. A further action plan in this area is not developed at this time as resources are limited across the healthcare spectrum, even with the known need. Lindsborg Community Hospital completed a new CHNA in the current tax year and did not have time to start addressing the needs identified in the new CHNA due to timing. The facility did in the current tax year address the following needs identified in the prior CHNA. To address the Barriers to Access we have expanded the availability of our Rheumatologist to two days per month. We have referral relationships with larger facilities for specialties not available in our community. Availability with a General Surgeon has been improved as he has a ""fast track"" available to see appropriate patients for consultation in conjunction with procedures. We continue to advocate for expansion of Medicaid within the State of Kansas. To address the risky behaviors/health problems of drug and alcohol abuse we continue alcohol and drug screenings in the clinic and in the emergency department with referrals as needed for treatment. We have expanded our access to the rheumatologist for patients to receive Suboxone treatment for opioid dependency. To address the behavior of poor eating habits we have a Registered Dietician available for consultation with patients experiencing new onset diabetes or uncontrolled diabetes. Additionally, two PA-C's continue to provide medically supervised weight management services. Health Problems:LCH continues to utilize the services of Prairie View Mental Health services for emergency screening through telemedicine. By using an iPad on a secure application, the mental health screening can be performed from a distance, thus saving the time of a screener to drive to Lindsborg. LCH will continue to utilize their relationships with Prairie View Mental Health and Veridian Behavioral Health to provide mental health care to its patients. Central Kansas Foundation is also utilized to assist those benefitting from a referral for alcohol or drug treatment. Throughout 2021, our educational offerings were limited. We were able to resume our CNA classes and a Safe Sitter Class all off-site. We were able to resume fall prevention class offsite in September 2022."

Lindsborg Community Hospital
Part V, Section B, Line 13h: 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 charity care may be applied in situations where all other avenues have been exhausted.

Lindsborg Community Hospital
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.

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 charity care may be applied in situations where all other avenues have been exhausted.

Part I, Line 7:
Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Amounts on lines 7e, 7f, and 7i are from the actual general ledger. Lines 7b and 7g were calculated utilizing the cost reports.

Part I, Line 7g:
Two provider based clinics are included in subsidized health services. Net revenues of $426,442 and costs of $2,202,636 were included for a net community benefit of $1,776,194.

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 report 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 Medicare cost reports. 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:
LCH will not engage in extraordinary collection activities prior to making reasonable efforts to determine if a patient is eligible for financial assistance. The notification period for reasonable efforts starts with the date care is provided and ends 120 days after the date of the first statement. Statements and a final notice during the 120 days meet the reasonable efforts standard. Extraordinary collections activities may include referral to a collection agency and/or legal action. Collection/legal action may be used to collect amounts due if the responsible party refuses to cooperate in the financial assistance determination process and make and follow suitable payment arrangements. Failure to cooperate includes failure to submit required data and/or failure to submit required data within the specified time period. In addition, collection/legal action may be used to collect amounts due that remain after financial assistance determinations have been made and the responsible person fails to make and follow suitable payment arrangements.

Part VI, Line 2:
In addition to the CHNA process, LCHA participates in Strategic Alliance meetings which are held every 1-2 months. The Alliance consists of businesses and organizations in Lindsborg with the purpose of discussing strategic needs of the community and identifying where synergies can be developed. LCHA also participates in weekly meetings called the Ad Hoc RoundTable. This group meets to discuss activities and needs in the community. LCHA participates in a county Behavioral Health Task Force that meets every 2-3 months. The task force members include McPherson hospital administration and physicians, Prairie View Behavioral Health staff, law enforcement, the McPherson mayor and McPherson County Attorney, the Lindsborg Chief of Police, and LCHA's administrator.Medical Staff meets monthly to discuss clinical management of LCHA. Clinic providers and management meet monthly to discuss the operations of the Family Health Care Clinic. In both meetings, issues concerning needs of the community are discussed and addressed or at least brought to the attention of administration for development of an action plan.LCHA has a Patient and Family Advisory Council (PFAC) which is made up primarily of community members who are patients or family members of patients. The group meets monthly to discuss quality and other projects that LCHA is performing. As a part of the regular agenda, community members are given an opportunity to voice comments and concerns about needs of the community.

Part VI, Line 3:
The Hospital's charity care policy is posted in patient waiting rooms in a three-ring note book. Hospital employees have been instructed to direct anyone with questions regarding assistance to the Hospital's business office. Patients are educated by the financial services staff and social services staff who are able to provide assistance upon request and through policies posted to our website.

Part VI, Line 4:
The Organization serves the Smoky Valley Area including Lindsborg, Marquette, Falun, Roxbury, Gypsum, Assaria and other areas including McPherson, Salina, Smolan, Canton, and Galva. Approximately 8% of the Hospital's patients are uninsured or Medicaid patients. The community served by the Hospital is also served by two other hospitals, plus a Federally Qualified Health Center in Salina.

Part VI, Line 6:
Lindsborg Community Hospital is an affiliate of Salina Regional Health Center. The hospital has a management and operating agreement. SRHC provides marketing services which reach the community members of the Smoky Valley, our service area. This may include marketing the hospital's services as well as those offered by SRHC and marketing the hospital's providers as well as SRHC providers.

Part VI, Line 5:
The organization's governing body is comprised of individuals who reside within the Smoky Valley service area with members from Assaria, Lindsborg, Marquette, and Galva.Medical Staff privileges are extended to all qualified physicians in the community who apply. Surplus funds are utilized to provide home health services, health and education through the Lindsborg News-Record and the Marquette Tribune, Stepping On classes, Safe Sitter classes and frozen meals for purchase. The organization's governing body is comprised primarily of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization nor family members thereof. The organization extends medical staff privileges to qualified physicians in its community for some or all of its departments. Surplus funds of the organization are returned to the organization to improve patient care through updated equipment and technology and care team member education. The organization operates an emergency room that is available 24/7 regardless of ability to pay. Through the assistance of a donor, the organization has trained 936 CNA students over the last 19 years through a partnership with Bethany Home and The Cedars. The students receive the training at no cost. The organization makes available to the surrounding area a wellness center open seven days a week without fees.

Operating expenses	$ 12,966,244
Total amount spent on community benefits as % of operating expenses	$ 3,514,284 27.10 %