4A (Expenses $ 205985506 including grants of $ 0) (Revenue $ 232065449)
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER IS A LEADING HEALTH CARE PROVIDER IN KENTUCKY. CARRYING ON THE INNOVATIVE AND TRANSFORMATIONAL CARE EMBODIED BY OUR NAMESAKE, DR. EPHRAIM MCDOWELL, THE REGIONAL MEDICAL CENTER HAS BEEN NAMED AS ONE OF THE 100 GREATEST COMMUNITY HOSPITALS IN AMERICA. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.

SCHEDULE H, PART V, SECTION B, LINE 5
COMMUNITY INPUT --------------- THROUGH THE FOCUS GROUP AND ONLINE SURVEY, PARTICIPATION AND INPUT WAS GATHERED FROM REPRESENTATIVES OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY (INCLUDING HISPANIC, AFRICAN AMERICAN), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (SPECIFICALLY, THE ELDERLY, DISABLED, YOUNG ADULTS, LGBT COMMUNITY, THE MENTALLY ILL, INMATES, HEARING IMPAIRED, MEDICAID RECIPIENTS, AND THE UNINSURED).

SCHEDULE H, PART V, SECTION B, LINE 7 AND 10
CHNA / IMPLEMENTATION STRATEGY ------------------------------ THE CHNA REPORT AND THE IMPLEMENTATION STRATEGY CAN BE OBTAINED AT: HTTP://EMHEALTH.ORG/INDEX.PHP/SERVICES/COMMUNITY-SERVICES

SCHEDULE H, PART V, SECTION B, LINE 11
ADDRESSING THE NEEDS OF THE COMMUNITY ------------------------------------- THE INTERNAL STAKEHOLDERS OF EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER DETERMINED THE FOLLOWING TO BE THE TOP HEALTH PRIORITIES FOR THE HOSPITAL TO ADDRESS IN THE COMMUNITY FOR THE COMING YEARS: - CARDIOVASCULAR DISEASE (CVD) RELATED RISK FACTORS (E.G., HYPERTENSION, BMI, GLUCOSE, TOBACCO USE, PHYSICAL ACTIVITY, NUTRITION) - CANCER EARLY DETECTION AND PREVENTION - CHILDHOOD OBESITY - ACCESS TO HEALTH SERVICES - DEMENTIAS, INCLUDING ALZHEIMER'S DISEASE - MENTAL HEALTH & MENTAL DISORDERS THESE PRIORITY AREAS, AND PLANS TO ADDRESS THESE, WILL BE INTEGRATED INTO THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE RATIONALE FOR SELECTING THESE AREAS IS AN UNDERSTANDING THAT IMPACTING THESE WOULD ALSO IMPACT MANY OTHER AREAS OF NEED IDENTIFIED IN THE ASSESSMENT, SUCH AS DIABETES, DEMENTIA, MENTAL HEALTH, SENSORY IMPAIRMENT, KIDNEY DISEASE, RESPIRATORY DISEASE, AND DISABILITY. THESE AREAS ALSO REPRESENT A CONTINUATION OF EXISTING WORK AND ALLOW THE HOSPITAL TO BUILD ON PAST SUCCESSES. THERE ARE ADDITIONAL NEEDS IDENTIFIED WITHIN THE CHNA REPORT THAT ARE NOT SPECIFICALLY ADDRESSED BY EMRMC, DUE TO NO EXPERTISE OR LIMITED RESOURCES, BUT ARE BEING ADDRESSED BY OTHER AGENCIES WITHIN THE COMMUNITY. DEFERRED NEEDS FROM THE CHNA OF BOYLE AND THE SURROUNDING COUNTIES BASED UPON RESOURCES AND/OR EXPERTISE INCLUDED THE FOLLOWING: SUBSTANCE ABUSE IS AN ISSUE IN THE STATE AND REGION. ADDICTION SERVICES ARE OFFERED BY PRIVATE PROVIDERS, COMPREHENSIVE CARE, AND SELF-REFINED IN THE REGION. EMRMC BEHAVIORAL MEDICINE UNIT DOES TREAT DUAL DIAGNOSIS PATIENTS AND THE PSYCHIATRISTS AND COUNSELORS TREAT OUT PATIENTS. THERE IS AN ACTIVE ALCOHOLICS ANONYMOUS CHAPTER. CELEBRATE RECOVERY IS OFFERED AT VARIOUS SITES IN THE SERVICE AREA. SUBSTANCE ABUSE TASK FORCE RESOURCES AND COMMITTEES ARE IN THE SURROUNDING SERVICE AREA, AND COLLABORATION OCCURS AS NEEDED. DUE TO LACK OF EXPERTISE AND RESOURCES, ADDICTION WILL BE DEFERRED AS PART OF THE WORK PLAN BY EMRMC. CHRONIC KIDNEY DISEASE AND END STAGE RENAL FAILURE LINKS TO DIABETES. FREE SCREENINGS WILL PROVIDE EARLY DETECTION AND POSSIBLY PREVENTION WHEN ADDRESSING NUTRITION, BODY MASS INDEX AND EXERCISE. SOME FAITH COMMUNITY NURSES IN CONGREGATIONS ASSESS BLOOD PRESSURES AND MEDICATION ADHERENCE AS WELL AS PROVIDE EDUCATION. RENAL SPECIALISTS AND DIALYSIS CENTERS SERVE THIS POPULATION AS WELL. DEMENTIA LINKS TO CV HEALTH AND STROKE INCIDENCE AND VASCULAR ISSUES. IT ALSO LINKS TO THE AGING OF THE POPULATION IN THE REGION. THERE IS AN ALZHEIMER'S SUPPORT GROUP IN BOYLE AND MERCER COUNTIES. ALSO, MENTAL EVALUATION AND MEDICATION MANAGEMENT IS AVAILABLE BY A PSYCHIATRIST AT THE MEDICAL CENTER. DANVILLE HEALTH & REHABILITATION CENTER AS WELL AS MORNING POINT HAS AN ALZHEIMER'S LONG-TERM CARE UNIT. THE SANDERS BROWN CENTER AT THE UNIVERSITY OF KENTUCKY HAS ON-GOING ALZHEIMER'S RELATED RESEARCH AND SERVES AS A REFERRAL CENTER FOR THE REGION. BIRTHS TO TEENAGERS AND UNWED MOTHERS, AND LOW BIRTH-WEIGHT BIRTHS ARE BEING ADDRESSED BY THE HEALTH DEPARTMENTS AND THE SCHOOL HEALTH COALITIONS. THE HAVEN CARE CENTER PROVIDES PREGNANCY RESOURCES AND SUPPORTS ALL SIX COUNTIES. CHRONIC LUNG/RESPIRATORY DISEASE IS BEING ADDRESSED WITH TOBACCO EDUCATION, STOP SMOKING CLASSES AT THE HEALTH DEPARTMENTS, PULMONARY REHAB AT EPHRAIM MCDOWELL SPECIALTY CENTER AND THROUGH PUBLIC POLICY. THE COMMUNITY SERVICE DEPARTMENT SCREENS FOR TOBACCO USE AT ALL VENUES AND REFERS CLIENTS TO THE HEALTH DEPARTMENTS. THE HEALTH DEPARTMENT OFFERS FREEDOM FROM SMOKING CLASSES TO HELP RESIDENTS STOP SMOKING. THE HEALTH DEPARTMENTS ALSO CONDUCT TOBACCO EDUCATION IN THE SCHOOL SYSTEMS. IN THE AREAS OF INFECTIOUS DISEASE, THE COUNTY HEALTH DEPARTMENTS WILL CONTINUE TO ADDRESS HIV EDUCATION AND TESTING. HEPATITIS C VACCINE IS AVAILABLE AT THE HEALTH DEPARTMENTS. EMRMC WILL DEFER DUE TO RESOURCE ALLOCATION - BOTH PERSONNEL AND TIME. INJURY AND VIOLENCE EDUCATION IS IN THE HEALTH DEPARTMENTS, COUNTY EXTENSION OFFICES, SCHOOL RESOURCE CENTERS, FAMILY COURT, AND LAW ENFORCEMENT IN ALL COUNTIES. EMRMC AND EMFLH OFFER THE SERVICES OF A SANE NURSE FOR RAPE VICTIMS. THE RAPE CRISIS CENTER SERVES THE REGION. EMRMC WILL DEFER FOCUS ON INJURY AND VIOLENCE AT THIS TIME DUE TO OTHER AGENCIES COVERING ALL ASPECTS, HAVING GREATER EXPERTISE AND DEPARTMENTAL RESOURCE LIMITATIONS. ORAL HEALTH INCLUDING REGULAR DENTAL CARE AND DENTAL INSURANCE IS A REGIONAL ISSUE. EPHRAIM MCDOWELL HEALTH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION.

SCHEDULE H, PART V, SECTION B, LINE 16
PUBLICATION OF FAP -------------------- HTTPS://WWW.EMHEALTH.ORG/FOR-PATIENTS/GOING-HOME/BILLING-INSURANCE/

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY -------------------- THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEET 1. COST COMPUTED ON IRS WORKSHEET 3 WAS COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT STEP-DOWN PROCESS.

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE ----------------------- TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990.

SCHEDULE H, PART III, LINE 2
BAD DEBT EXPENSE --------------- THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. A DETAILED REVIEW OF PATIENT ACCOUNTS WAS PERFORMED AND THIS AMOUNT REFLECTS ACTUAL WRITE-OFFS OF BAD DEBT EXPENSE DURING THE PERIOD.

SCHEDULE H, PART III, LINE 3
BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE ---------------------------------------------- BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS REPORTED PER THE MEDICARE COST REPORT WORKSHEET S-10. THIS AMOUNT IS THE RESULT OF A DETAILED REVIEW OF PATIENT ACCOUNTS AND ACTUAL WRITE-OFFS OF BAD DEBT EXPENSE DURING THE PERIOD.

SCHEDULE H, PART III, LINE 4
BAD DEBT EXPENSE ---------------- THE CORPORATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE CORPORATION PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE CORPORATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.

SCHEDULE H, PART III, LINE 8
MEDICARE SHORTFALL ------------------ AMOUNTS REPORTED ON LINES 5 AND 6 WERE BASED ON THE CORPORATION'S MEDICARE COST REPORT.

SCHEDULE H, PART III, LINE 9B
WRITTEN DEBT COLLECTION POLICY AND FINANCIAL ASSISTANCE ------------------------------------------------------- IF IT IS DETERMINED THAT A PATIENT OR RESPONSIBLE PARTY IS ELIGIBLE FOR FINANCIAL ASSISTANCE, EMH WILL: - SEND WRITTEN NOTIFICATION TO THE RESPONSIBLE INDIVIDUAL OF THE ASSISTANCE DETERMINATION, AND - IF THE DISCOUNT IS LESS THAN 100%, EMH WILL: * PROVIDE THE RESPONSIBLE INDIVIDUAL WITH A BILLING STATEMENT SHOWING THE AMOUNT OWED, HOW THE AMOUNT WAS DETERMINED, AND DESCRIBE HOW THE INDIVIDUAL CAN LEARN MORE ABOUT HOW THE HOSPITAL CALCULATES AGB; * ISSUE REFUNDS TO THE RESPONSIBLE INDIVIDUAL IF HE OR SHE PREVIOUSLY PAID AN AMOUNT TO EMH EXCEEDING WHAT HE OR SHE IS PERSONALLY RESPONSIBLE TO PAY; AND * TAKE ALL REASONABLE MEASURES TO REVERSE ANY ECAS (WITH THE EXCEPTION OF A SALE OF A DEBT OR DEFERRING OR DENYING CARE FOR NON-PAYMENT OF AMOUNTS FOR PREVIOUS CARE) TAKEN AGAINST THE RESPONSIBLE INDIVIDUAL TO THE EXTENT POSSIBLE. IF A PATIENT CANNOT SATISFY STANDARD PAYMENT EXPECTATIONS, A FINANCIAL ASSISTANCE SCREENING PROCESS FOR ALTERNATIVE SOURCES OF BALANCE RESOLUTION IS COMPLETED. THOSE RESOLUTIONS MAY INCLUDE A DISCOUNT ON CHARGES, MEDICAID ENROLLMENT OR APPLICATION FOR CHARITY CARE.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT ----------------- IN 2020, PROFESSIONAL RESEARCH CONSULTANTS (PRC) WAS ENGAGED TO CONDUCT A NEEDS ASSESSMENT OF EMRMC'S COMMUNITY, WHICH IS DEFINED AS THE PRINCIPAL RESIDENTIAL ZIP CODES IN BOYLE, CASEY, GARRARD, LINCOLN, MERCER, AND WASHINGTON COUNTIES IN KENTUCKY. A SURVEY AND A COMMUNITY FOCUS GROUP WERE COMPLETED TO OBTAIN PRIMARY DATA FROM INDIVIDUALS WITHIN THE COMMUNITY. THE FOCUS GROUP WAS COMPRISED OF REPRESENTATIVES FROM PUBLIC HEALTH, SOCIAL SERVICE PROVIDERS, EMPLOYERS, AND OTHER COMMUNITY LEADERS. SELF REPORT DATA, MORTALITY, MORBIDITY, LIFESTYLE, INCIDENCE OF CHRONIC DISEASE, INJURY DATA, AND DISABILITY DATA ARE PART OF THE ASSESSMENT PROCESS. THE BENCHMARK IS ESTABLISHED USING HEALTHY PEOPLE 2020 DATA.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ----------------------------------------------- EMRMC'S CHARITY CARE POLICY IS POSTED ON THE WWW.EMHEALTH.ORG WEBSITE. AT REGISTRATION OF SELF-PAY CLIENTS, INFORMATION IS GIVEN ON REDUCED FEE, CHARITY APPLICATION, AND A REFERRAL TO A FINANCIAL COUNSELOR. THE FREE COMMUNITY SCREENINGS ARE POSTED ON THE WEBSITE AND IN AREA NEWSPAPERS IF THE HOSTING ORGANIZATION INVITES COMMUNITY PARTICIPATION. SOME EVENTS ARE DISCUSSED ON LOCAL RADIO. INFORMATION REGARDING THE FREE CLINIC IS ALSO GIVEN BY HEALTHCARE PROVIDERS, FAITH COMMUNITY NURSES, CASE WORKERS AND OTHER MEDICAL PROFESSIONALS.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION -------------------------- THE HEALTH SYSTEM SERVES BOYLE, MERCER, CASEY, LINCOLN, GARRARD, AND WASHINGTON COUNTIES, WHICH HAVE A RURAL POPULATION OF APPROXIMATELY 124,000. ACCESS IS AN ISSUE, DUE TO TRAVEL BARRIERS SUCH AS OUT-OF-DATE HIGHWAYS AND LACK OF PUBLIC TRANSPORTATION. THESE ACCESS ISSUES INFLUENCED THE DECISIONS TO SERVE WITH FREE SCREENINGS AT KEY GATHERING PLACES SUCH AS CHURCHES AND SCHOOLS, ETC. INSURANCE COVERAGE IS ANOTHER ISSUE. THE NUMBERS OF UNINSURED CONTINUES TO EXCEED THE NATIONAL AVERAGE AND THE UNDERINSURED IN THIS SERVICE AREA CONTINUES TO INCREASE POST ACA.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH ------------------------------ EMRMC LEADERS HOLD BOTH MEMBERSHIP AND LEADERSHIP POSITIONS WITHIN VARIOUS SERVICE ORGANIZATIONS IN THE COMMUNITY, ROLE MODELING GOOD CITIZENSHIP. EMRMC STAFF VOLUNTEERED IN AREA CHURCHES AND CHILDREN'S MINISTRY PROGRAMS WITHIN THE SERVICE AREA THAT FOCUSED ON SPIRITUAL DEVELOPMENT AND WELL-BEING, APPROXIMATELY 800 CHILDREN WERE SERVED. OTHER SERVICES INCLUDE VOLUNTEER FAITH COMMUNITY NURSES SERVING WITHIN MANY OF THE LOCAL CONGREGATIONS. THE RESULT BEING BLOOD PRESSURE SCREENING, COORDINATION OF CARE, REFERRALS, AND EDUCATION RELATED TO HEALTH RISK, MEDICATIONS, MENTAL HEALTH, STROKE RISK EDUCATION, AND OTHER ISSUES. OTHERS SERVED IN MUSIC MINISTRY, VISITATION, OR CHURCH BASED COMMITTEES. MANY SERVED IN YOUTH SPORT LEAGUES AS VOLUNTEERS, EITHER COACHING OR RAISING FUNDS. OTHERS VOLUNTEERED WITH THE SCHOOL SYSTEM SERVING AS ROOM SPONSORS, BOOSTERS, PTA OFFICERS, MENTORING STUDENTS, OR OTHER NEEDED FUNCTIONS. EMRMC ASSOCIATES VOLUNTEERED AT THE LOCAL FESTIVALS INCLUDING, BUT NOT LIMITED TO: HARVEST FEST ON MAIN, KENTUCKY STATE BBQ FESTIVAL, GREAT AMERICAN BRASS BAND FESTIVAL, SOUL ON SECOND STREET, DANVILLE'S LAWN CHAIR THEATRE, APPLE FESTIVAL IN CASEY COUNTY, BEEF FESTIVAL IN MERCER COUNTY, PARTY ON THE SQUARE IN GARRARD COUNTY, FORKLAND HERITAGE FESTIVAL AND REVUE, BATTLE OF PERRYVILLE COMMEMORATION, CRUISE, BLUES & BAR-B-QUE, AND RAILROAD DAYS. THESE HOURS WERE NOT PAID HOURS, THEREFORE NOT INCLUDED IN THE COMMUNITY BENEFIT CALCULATIONS. NEVERTHELESS, THIS INVESTMENT OF TIME AND LABOR CONTRIBUTED SIGNIFICANTLY TO THE QUALITY OF LIFE IN THE REGION - IMPACTING PHYSICAL, MENTAL, AND ECONOMIC WELL-BEING OF THE POPULACE OF THE SIX COUNTY SERVICE AREAS. STAFF HAS ALSO GIVEN TESTIMONY AT LOCAL, STATE, AND FEDERAL LEVELS RELATED TO OUR SERVICE AREA'S HEALTH, EDUCATION, AND ECONOMIC ISSUES.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM ----------------------------- EMRMC IS A 222 LICENSED BED ACUTE CARE HOSPITAL SERVING THE COMMUNITY FOR NEARLY A CENTURY AS PART OF EPHRAIM MCDOWELL HEALTH (EMH). EMH IS A COMPREHENSIVE, INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES 124,000 RESIDENTS FROM SIX COUNTIES IN SOUTH CENTRAL KENTUCKY. THE EMH BOARD IS COMPRISED OF COMMUNITY MEMBERS AND REPRESENTATION FROM FT LOGAN HOSPITAL, JAMES B. HAGGIN MEMORIAL HOSPITAL, MEDICAL STAFF, AND EMRMC LEADERSHIP. FT LOGAN HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN LINCOLN COUNTY. HEALTH RESOURCE IS COMPRISED OF CLINICS, AN EARLY CHILDHOOD DEVELOPMENT CENTER, ASSISTED LIVING FACULTY, AND DURABLE MEDICAL EQUIPMENT OUTLETS. THERE ARE REPRESENTATIVES FROM OUR SIX COUNTIES, MEDICAL STAFF, AND LEADERSHIP ON THE COMMUNITY BOARD THAT OVERSEES AND COORDINATES THE SERVICES OF EPHRAIM MCDOWELL HEALTH. ON DECEMBER 1, 2017, EMH ACQUIRED JAMES B. HAGGIN HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN MERCER COUNTY.