4A (Expenses $ 4355758 including grants of $ 0) (Revenue $ 5868647)
THREE RURAL HEALTH CLINICS WITH A TOTAL OF 18,956 OFFICE VISITS.

4B (Expenses $ 5121677 including grants of $ 0) (Revenue $ 10795124)
ACUTE ADULT, PEDIATRIC AND INFANT INPATIENT CARE, SWING BED, LABOR AND DELIVERY AND OBSERVATION CARE. 3,780 DAYS OF CARE PROVIDED.

4C (Expenses $ 2989250 including grants of $ 0) (Revenue $ 3514990)
24 HR EMERGENCY ROOM SERVICES - 3,134 VISITS, DURABLE MEDICAL EQUIPMENT SALES, AND HOME HEALTH SERVICES - 5,750 VISITS

SCHEDULE H, PART V, SECTION B, LINE 5
A TARGETED SURVEY WAS SENT TO MEMBERS OF THE LOCAL SCHOOL SYSTEM, RELIGIOUS ORGANIZATIONS, GOVERNMENTAL AGENCIES, NON-PROFITS, AND OTHER PUBLIC HEALTH AGENCIES, REGIONAL MENTAL HEALTH PROVIDERS, AND BUSINESS LEADERS.

SCHEDULE H, PART V, SECTION B, LINE 7A
THE COMPLETE CHNA CAN BE FOUND AT: HTTP://WWW.CMHCARE.ORG/DOCS/FINAL_CHNA_REPORT%2C_2019.PDF

SCHEDULE H, PART V, SECTION B, LINE 10A
THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.CMHCARE.ORG/DOCS/IMPLEMENTATION_STRATEGY_2020-2022_FINAL.PDF

SCHEDULE H, PART V, SECTION B, LINE 11
OUR 2019 HEALTH NEEDS ASSESSMENT WAS SUMMARIZED AND PRIORITIZED INTO 6 ISSUES WHICH DID NOT VARY SIGNIFICANTLY FROM OUR PREVIOUS CHNA. ISSUES INCLUDE MENTAL HEALTH, OBESITY, AGING POPULATION, POVERTY, AND ACCESS TO CARE. TO ASSIST OUR AGING COMMUNITY MEMBERS, WE CONDUCT MONTHLY HEALTH TOPIC LUNCHEONS GEARED TOWARDS OUR OLDER POPULATION WHEN COVID RESRICTIONS ALLOW. WE PROVIDE SWING-BED, HOME HEALTH, AND DME SERVICES TO ASSIST OUR POPULATION AS THEY AGE BUT HAVE INTRODUCED NO NEW PROGRAMS BASED ON THIS CHNA. FINANCIAL CONSTRAINTS AND INSURANCE OPTIONS ARE OUTSIDE OF OUR CONTROL, BUT WE DO INFORM ALL PATIENTS OF OUR FINANCIAL ASSISTANCE OPTION THAT IS GRANTED TO THOSE DEMONSTRATING FINANCIAL NEEDS BASED UPON OUR ESTABLISHED CRITERIA. ADDITIONALLY, WE HAVE A RESOURCE WITHIN OUR PHARMACY THAT WORKS WITH INSURANCE AND PHARMACEUTICAL COMPANIES TO ASSIST LOW-INCOME PATIENTS OBTAIN FREE AND REDUCED MEDICATIONS WHICH IS CURRENTLY ASSISTING 7 OF OUR MOST VULNERABLE PATIENTS OBTAIN MEDICATION WORTH NEARLY $12,000 PER YEAR. WHEN COVID RESTRICTION AND NECESSARY SUPPLIES ALLOW, WE CONDUCT A HEALTH FAIR EACH YEAR WHICH PROVIDES (NEARLY 500 PEOPLE) A COMPREHENSIVE LAB PANEL FOR A FLAT $30 FEE CASH PRICE AND ANNUAL SPORTS PHYSICALS FOR $27.50 FEE CASH PRICE TO PROVIDE LOW-COST OPTIONS FOR ANNUAL DIAGNOSTIC SERVICES. TO ASSIST WITH COMMUNITY OBESITY WE PROVIDE DAILY, LOW-COST, PREPARED FOODS FOR THE RESIDENTS OF LOCAL DISABILITY HOUSING. WE DO NOT PROVIDE STRUCTURED MENTAL HEALTH SERVICES LOCALLY, BUT PARTNER WITH A REGIONAL PROVIDER TO ALLOW CONSULTATION VIA WEB-CAM AND REFERRALS TO THEIR OFFICES. WE CONTINUE TO HAVE A WIDE VARIETY OF SPECIALIST SERVICES PROVIDED ON-SITE WITH PHYSICIANS WHO DRIVE FROM MORE THAN 70 MILES AWAY TO CONDUCT WEEKLY OR MONTHLY CLINIC SCHEDULES. WE PROVIDE SPACE TO A DIALYSIS PROVIDER TO CONDUCT TREATMENTS ON-SITE RATHER THAN REQUIRING PATIENT AND CAREGIVERS TO TRAVEL 70 MILES EACH WAY SEVERAL TIMES EACH WEEK FOR TREATMENTS.

SCHEDULE H, PART V, SECTION B, LINE 13a
ELIGIBILITY FOR DISCOUNTED CARE FAP applications are compared against 150% of the FPL for a complete charity discount. Any applicant whose income exceeds 150% of the FPL, may be eligible for a partial charity discount. 50% of income over the FPL is compared against outstanding medical bills, those bills in excess of that calculation are eligible for a partial charity discount. Applicants with higher income may still be eligible for partial charity if the amount of their medical debt is proportionally higher than their income regardless of level.

SCHEDULE H, PART V, SECTION B, LINE 16A
THE FAP CAN BE FOUND AT: https://www.cmhcare.org/docs/2022_Financial_Assistance_Policy.pdf

SCHEDULE H, PART V, SECTION B, LINE 16B
THE FAP APPLICATION CAN BE FOUND AT: https://www.cmhcare.org/docs/FINANCIALASSISTANCEAPP2016.PDF

SCHEDULE H, PART V, SECTION B, LINE 16C
THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: https://www.cmhcare.org/docs/2018_fap_PLAIN_LANGUAGE.PDF

SCHEDULE H, PART I, LINE 3B
FAP applications are compared against 150% of the FPL for a complete charity discount. Any applicant whose income exceeds 150% of the FPL, may be eligible for a partial charity discount. 50% of income over the FPL is compared against outstanding medical bills, those bills in excess of that calculation are eligible for a partial charity discount. Applicants with higher income may still be eligible for partial charity if the amount of their medical debt is proportionally higher than their income regardless of level.

SCHEDULE H, PART 1, LINE 3C
FAP PROVIDES DISCOUNTS FOR INCOME LEVELS ABOVE 150% OF FPG. 50% OF INCOME ABOVE FPG APPLIED TO OUTSTANDING BALANCE AND DIFFERENCE IS ELIGIBLE FOR DISCOUNT IF NO OTHER ASSETS ARE IDENTIFIED. THIS ALLOWS DISCOUNTS TO APPLY IN CATASTROPHIC SITUATIONS EVEN WHEN THE PATIENT WOULD NOT OTHERWISE HAVE QUALIFIED FOR CHARITY CONSIDERATION.

SCHEDULE H, PART I, LINE 7
THE COST-TO-CHARGE RATIO WAS USED AS THE COSTING METHODOLOGY TO REPORT CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.

SCHEDULE H, PART I, LINE 7, COLUMN F
THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), SUBTRACTED FOR PURPOSES OF CALCULATING SHCEDULE H, PART I, LINE 7 IS $1,367,270.

SCHEDULE H, PART III, SECTION A, LINE 2
A PAYER SPECIFIC RESERVE IS CALCULATED EACH MONTH BASED ON TOTAL RECEIPTS AS A PERCENTAGE OF HISTORICAL GROSS AR. THIS IS SEPARATED INTO CONTRACT ADJUSTMENTS AND UNCOLLECTED BALANCES. AS ACCOUNTS ARE DEEMED NONCOLLECTABLE, AND IF ANY AMOUNTS ARE LATER RECEIVED, THESE ARE APPLIED TO THE RESERVE AND THE DIFFERENCE IS REPORTED AS MONTHLY BAD DEBT EXPENSE. UNDER GAAP STANDARDS IN 2021 GROSS AR, CONTRACT ADJ, AND UNCOLLECTED AMOUNTS ARE COMBINED INTO A SINGLE NET REVENUE LINE ON THE AUDIT FINANCIALS.

SCHEDULE H, PART III, SECTION A, LINE 3
MARSHALL COUNTY KS HAS APPROXIMATELY 10% OF THE POPULATION BELOW THE POVERTY LINE, WHILE WE USE 150% OF THE FPG AS OUR CHARITY ELIGIBILITY. PATIENTS WITH NO INSURANCE OR HIGH DEDUCTIBLE PLANS COMPOSE A DISPROPORTIONATE AMOUNT OF OUR BAD DEBT. THE CULTURE IN OUR COMMUNITY DISCOURAGES ASKING FOR CHARITY AND MANY WHO WE ARE CONFIDENT WOULD QUALIFY WILL NOT APPLY, EVEN WHEN SUGGESTED TO THEM. BASED ON THESE FACTORS WE ESTIMATE AT LEAST 25% OF OUR BAD DEBT WOULD BE CHARITY ELIGIBLE IF THEY WOULD APPLY.

SCHEDULE H, PART III, SECTION A, LINE 4
SEE NUMBERED PAGES 12 THROUGH 16 OF AUDIT REPORT FOR DESCRIPTION OF THIS TOPIC. SPECIFIC NOTE 2 STARTS AT THE BOTTOM OF PAGE 14. GAAP REPORTING CHANGES HAVE ELIMINATED THE SEPARATE BAD DEBT LINE REPLACED BY A NET PATIENT SERVICES REVENUE LINE INCLUDING WHAT WAS PREVIOUSLY CLASSIFIED AS BAD DEBT AS A COMPONENT.

SCHEDULE H, PART III, SECTION B, LINE 8
THE NUMBERS WERE DERIVED FROM THE MEDICARE COST REPORT. ALLOWABLE EXPENSES LESS THE BAD DEBT REDUCTION AND SEQUESTRATION REDUCTIONS. THESE COSTS ARE ALLOWABLE PER MEDICARE BUT WERE STATUTORILY REDUCED BY AN ARBITRARY PERCENTAGE REDUCTION TO ARRIVE AT FINAL REIMBURSEMENT. BY DEFINITION THE DIFFERENCE IS LEGITIMATE COSTS OF DOING BUSINESS THAT ARE NONETHELESS NOT PAID BY MEDICARE.

SCHEDULE H, PART III, SECTION C, LINE 9B
PATIENTS ARE INFORMED OF OUR FINANCIAL ASSISTANCE POLICY AT THE TIME OF SERVICES. IF REQUESTED, THEY ARE GIVEN THE APPLICATION AT TIME OF SERVICE OR PRIOR TO DISMISSAL. FINANCIAL ASSISTANCE IS OFFERED AT TIME LETTERS ARE SENT OUT REQUESTING PAYMENT AGREEMENTS AND AGAIN BEFORE ACCOUNTS ARE SENT TO COLLECTION.

SCHEDULE H, PART VI, LINE 2
COMMUNITY MEMORIAL HEALTHCARE REVIEWED OUR PRIOR CHNA AND THOSE OF SURROUNDING COMMUNITIES, REVIEWED DEMOGRAPHIC INFORMATION OF HISTORICAL PATIENT ENCOUNTERS, AND UTILIZED PUBLICLY AVAILABLE CDC AND HEALTH RANKING DATA ON HEALTH FACTORS, OUTCOMES, AND MARKETSHARE; COMPARING LOCAL AND NATIONAL RESULTS. WE THEN SURVEYED KEY STAKEHOLDERS IN OUR COMMUNITY TO DETERMINE ANY NEW OR CONTINUING AREAS OF CONCERN IN OUR SPECIFIC COMMUNITY. THIS INFORMATION WAS AGGREGATED AND COMPARED TO CAPABILITIES OF CMH AND OF OTHER COMMUNITY RESOURCES AVAILABLE IN OUR AREA.

SCHEDULE H, PART VI, LINE 3
THE INSURANCE OFFICE PERSONNEL EXPLAIN ELIGIBILITY TO PATIENTS AND WILL ASSIST WITH PAPERWORK. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED THROUGHOUT THE BUILDING (I.E. THE BUSINESS OFFICE, THE CLINICS, EMERGENCY DEPARTMENT) AND ON OUR WEBSITE. PATIENTS WHO ARE IDENTIFIED EITHER BEFORE SERVICES ARE RENDERED OR PRIOR TO DISCHARGE ARE CONTACTED BY THE BUSINESS OFFICE PERSONNEL TO ASSESS QUALIFICATION FOR MEDICAID OR FINANCIAL ASSISTANCE. BUSINESS OFFICE PERSONNEL ATTEMPT TO CONTACT PATIENTS VIA PHONE AND MAIL REGARDING THEIR BILL. PART OF THE CHARITY CARE PROGRAM IS TO ATTEMPT ENROLLMENT INTO THE MEDICAID PROGRAM.

SCHEDULE H, PART VI, LINE 6
NOT APPLICABLE

SCHEDULE H, PART VI, LINE 7
NOT APPLICABLE

SCHEDULE H, PART VI, LINE 4
COMMUNITY MEMORIAL HEALTHCARE, INC. IS A NOT-FOR-PROFIT MEMBERSHIP CORPORATION WHICH OWNS AND OPERATES A GENERAL ACUTE CARE HOSPITAL, THREE RURAL HEALTH CLINICS, AND A HOME HEALTH AGENCY. 80% OF THE POPULATION WE SERVE ARE RESIDENTS OF MARSHALL COUNTY KS, 13% LIVE IN NEIGHBORING WASHINGTON COUNTY, 4% LIVE IN GAGE COUNTY NE, AND 3% LIVE ELSEWHERE DUE TO OUR PROXIMITY TO A MULTI-STATE EAST/WEST HIGHWAY. MARSHALL COUNTY HAS AN ESTIMATED POPULATION OF JUST UNDER 10,000. 50% OF OUR RESIDENTS ARE 45 YEARS OR OLDER AND 71% LIVE OUTSIDE OF CITY BOUNDARIES. HOUSEHOLD INCOME IS 20% LOWER THAN THE NATIONAL AVERAGE AND OUR POVERTY LEVEL IS 9%. THE CLOSEST TERTIARY HOSPITALS ARE MORE THAN 80 MILES IN ANY DIRECTION. WITHIN THAT GEOGRAPHIC CIRCLE ARE A HANDFUL OF ACUTE PRIMARY HOSPITALS OF SIMILAR SIZE AND CAPABILITIES TO CMH.

SCHEDULE H, PART VI, LINE 5
AS THE COVID PANDEMIC CONTINUED INTO ITS SECOND YEAR, MUCH OF OUR USUAL COMMUNITY BENEFIT PROGRAMMING CONTINUED TO BE SUSPENDED. EACH YEAR FOR OVER A DECADE, CMH HAS CONDUCTED A HEALTH FAIR IN APRIL WHICH OFFERED A SCREENING BLOOD TEST FOR A SMALL FLAT FEE AND HAD GROWN TO A RATE OF OVER 500 TESTS IN A COUPLE OF HOURS. WITH 2020 SOCIAL DISTANCE REQUIREMENTS, WE CANCELED THE PROGRAM. IN 2021 WE CHANGED OUR SCHEDULE TO FALL INSTEAD OF SPRING TO ALLOW VACCINATION RATES TO LOWER SOCIAL DISTANCING RISKS. WORLDWIDE SUPPLY CHAIN ISSUES MEANT THAT WE COULD NOT PROCURE THE NECESSARY SUPPLIES AND THE PROGRAM WAS SUSPENDED FOR A SECOND YEAR. OVER THE PAST SEVERAL YEARS WE HAVE CONDUCTED A MONTHLY HEALTH EDUCATION PROGRAM FOR OUR ELDERLY POPULATION. THE COVID VUNERABILITY OF THIS HIGH-RISK GROUP MEANT THAT THE PROGRAMMING REMAINED SUSPENDED FOR 2021. PROGRAMS THAT WE WERE ABLE TO CONTINUE IN 2021 INCLUDE BREAST CANCER AWARENESS ACTIVITIES HELD EACH OCTOBER FOR THE STAFF AND PUBLIC, INCLUDING AN AFTER-HOURS CONVENIENCE MAMMOGRAM CLINIC, AN IN-MEMORIAM PINK BALLOON LAUNCH, AND EDUCATIONAL SPEAKERS. CMH IS THE LEAD SPONSOR OF THE PONY EXPRESS HALF MARATHON & 5K AND ALSO SUPPORTS THE PONY EXPRESS GRAVEL DASH BICYCLE RACE BY DONATING BOTTLED WATER AND REFRESHMENTS TO PARTICIPANTS AND STAFFING A FIRST AID TENT. CMH ALSO PROVIDES A FIRST AID TENT AND MEDICAL STAFF AT OTHER COMMUNITY EVENTS, INCLUDING BIG BLUE RIVER DAYS AND THE MARSHALL COUNTY ART COOPERATIVE'S OUTDOOR MUSIC FESTIVALS. THE CMH CONFERENCE ROOM IS SHARED WITH THE OUTSIDE COMMUNITY AND NON-PROFITS FOR EDUCATIONAL PURPOSES AND SEVERAL SUPPORT GROUPS USE THE CONFERENCE SPACE FOR MONTHLY MEETINGS, INCLUDING TWO GRIEF SUPPORT GROUPS, BREASTFEEDING SUPPORT, SUPPORT FOR PARKINSON'S DISEASE PATIENTS AND THEIR CARETAKERS, AND ALZHEIMER'S PATIENTS AND THEIR CARETAKERS. CMH PROVIDES DAILY MEALS AT COST TO THE LOCAL RESIDENTIAL CARE FACILITY POPULATION. THE CMH MEDICAL STAFF PARTICIPATE ON SEVERAL COMMUNITY BOARDS, SERVE AS MEDICAL DIRECTORS FOR LOCAL NURSING HOME AND HOSPICE ORGANIZATIONS, FUNCTION AS THE COUNTY PUBLIC HEALTH OFFICER, AND ALL PHYSICIAN STAFF FUNCTION AS DEPUTY COUNTY CORONERS AND SEVERAL PROVIDE MEDICAL SUPPORT AT SCHOOL ATHLETIC EVENTS. CMH STAFF MEMBERS PARTICIPATE IN VARIOUS FUNDRAISERS FOR THE COMMUNITY INCLUDING ADOPT-A-FAMILY, TOYS FOR TOTS BAKE SALES, CASUAL FOR A CAUSE JEANS DAYS, AND MORE. CMH STAFF MEMBERS DONATE CASES OF FACIAL TISSUES TO AREA SCHOOLS TO PREVENT THE SPREAD OF GERMS THROUGHOUT THE SCHOOL YEAR. CMH CLINICAL AND MEDICAL STAFF OFFER A JOB SHADOWING PROGRAM PROVIDING INTERNSHIP OPPORTUNITIES FOR TEENS, UNDERGRADUATE COLLEGE STUDENTS, AND MEDICAL STUDENTS. THE HOSPITAL WORKS WITH COLLEGES AND UNIVERSITIES TO SERVE AS A TRAINING SITE FOR NURSING AND OTHER HEALTHCARE-RELATED JOBS. OTHER ANNUAL PROGRAMS THAT REMAINED SUSPENDED DUE TO COVID RESTRICTIONS INCLUDE: 1) CMH STAFF HOSTS A SAFE BABYSITTING CLASS FOR 5TH & 6TH GRADE STUDENTS TO LEARN CPR/INFANT CPR, GENERIC FIRST AID, DIAPER CHANGING, BOTTLE MAKING, AND OTHER BASICS 2) CMH HOSTS KINDERGARTNERS FROM AREA SCHOOLS TO BECOME FAMILIAR WITH THE HOSPITAL, MEET EMERGENCY ROOM AND OTHER MEDICAL STAFF, LEARN ABOUT COMMON CHILDHOOD HEALTH CONCERNS SUCH AS A BROKEN BONE, AND LEARN ABOUT CAREERS IN HEALTHCARE.