4A (Expenses $ 10592036 including grants of $ 0) (Revenue $ 11918628)
PROVIDED ACUTE, OUTPATIENT, EMERGENCY, AMBULANCE, AND OTHER HEALTH SERVICES TO THE RESIDENTS OF CRITTENDEN COUNTY AND SURROUNDING COUNTIES, INCLUDING APPROXIMATELY $443,000 OF CHARITY CARE.

SCHEDULE H, PART V, SECTION B, LINE 5
CHNA INPUT ----------- THE HOSPITAL CONTRACTED WITH THE COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY (CEDIK) TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT IN ACCORDANCE WITH THE AFFORDABLE CARE ACT.

SCHEDULE H, PART V, LINE 11
ADDRESSING THE NEEDS OF THE COMMUNITY -------------------------------------- THE HOSPITAL IS ACTIVE IN THE SPEAKER'S BUREAU AND OFFERS COMMUNITY EDUCATION CLASSES. PARTICIPATION IN EACH OF THESE GROUPS ASSISTS THE HOSPITAL IN CONTINUALLY ASSESSING THE NEEDS OF THE COMMUNITY. IN ADDITION, NEEDS ASSESSMENTS ARE ON-GOING THROUGH THE VARIOUS PROGRAMS AND SERVICES PROVIDED TO THE COMMUNITY BY THE HOSPITAL AS FOLLOWS: 1. EXPANDED ACCESS WITHIN THE COMMUNITY (PRIMARY CARE, GENERAL SURGERY, ENT, CARDIOLOGY, ONCOLOGY, & DIETARY) 2. INCREASED COMMUNICATION INCLUDING SOCIAL MEDIA, NEWSPAPER CAMPAIGN, RADIO SPOTS AND FACILITY SIGNAGE 3. BETTER PATIENT CARE WITH PRIORITY REGISTRATION AND PRIVATE EXIT DRIVE. 4. ENGAGING THE COMMUNITY THROUGH PARENTING AND LIFE SKILLS CLASSES, CPR PROGRAMS, 5K EVENTS, YOUTH TRIATHALON, AND HEALTH FAIRS.

SCHEDULE H, PART V, LINE 16
FINANCIAL ASSISTANCE POLICY ---------------------------- HTTP://WWW.CRITTENDEN-HEALTH.ORG/DOCS/FINANCIAL_ASSISTANCE_POLICY http://www.crittenden-health.org/docs/Financial_Assistance_Policy_051817.p df

SCHEDULE H, PART I, LINE 3C
CHARITY CARE ------------ THE HOSPITAL USED A COST TO CHARGE RATIO AS CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, INCLUDED IN THE SCHEDULE H INSTRUCTIONS TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I OF SCHEDULE H. ASSET LEVELS, MEDICAL INDIGENCY AND UNDERINSURANCE ARE ALSO USED TO DETERMINE ELIGIBILITY.

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY -------------------- THE AMOUNTS REPORTED ON LINE 7 ARE DETERMINED BY MULTIPLYING REVENUE BY THE MEDICARE COST TO CHARGE RATIO. COST OF FINANCIAL ASSISTANCE WAS CALCULATED WITH A COST TO CHARGE RATIO USING WORKSHEET 2. THE COSTS RELATED TO MEDICAID PATIENTS WERE DETERMINED USING THE HOSPITAL'S COST ACCOUNTING SYSTEM. THE COSTS RELATED TO MEDICAID PATIENTS WAS DETERMINED USING THE HOSPITAL'S COST ACCOUNTING SYSTEM. HOSPITAL'S COST ACCOUNTING SYSTEM. HOSPITAL'S COST ACCOUNTING SYSTEM. COSTS FOR FINANCIAL ASSISTANCE AND BAD DEBT ACCOUNTS ARE DEDUCTED USING A RATIO OF COST TO CHARGE SPECIFIC TO THAT SUBSIDIZED SERVICE. COSTS FOR OTHER PROGRAMS REFLECT THE DIRECT AND INDIRECT COSTS OF PROVIDING THOSE PROGRAMS.

SCHEDULE H, PART I, LINE 7, COLUMN (F)
% OF TOTAL EXPENSE CALCULATION -------------------------------- THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE IS $131,343.

SCHEDULE H, PART III, LINE 2
BAD DEBT EXPENSE ----------------- THE BAD DEBT EXPENSE LISTED ON LINE 2 IS THE BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS.

SCHEDULE H, PART III, LINE 3
BAD DEBT ATTRIBUTABLE TO CHARITY CARE -------------------------------------- THE BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS ESTIAMTED PER HISTORICAL DATA.

SCHEDULE H, PART III, LINE 4
BAD DEBTS --------- PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT ONLY AFTER ALL COLLECTION PROCEDURES HAVE BEEN EXHAUSTED. THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE THAT SPECIFICALLY ADDRESSES BAD DEBTS. HOWEVER, THE PROVISION FOR BAD DEBTS IS INCLUDED IN THE NET PATIENT SERVICE REVENUE. THE PROVISION FOR BAD DEBTS REPRESENTS UNCOMPENSATED CARE FOR PATIENTS OF WHICH A MAJORITY ARE UNINSURED OR UNDERINSURED, BUT NOT APPLY OR QUALIFY FOR CHARITY CARE. THE HOSPITAL ESTIMATED THAT APPROXIMATELY 50% OF BAD DEBT EXPENSE MAY ACTUALLY QUALIFY FOR CHARITY CARE BASED ON THE FINANCIAL COLLECTOR'S KNOWLEDGE AND EXPERIENCE. APPROXIMATELY 25% OF THE CHARITY APPLICATIONS SENT OUT DO NOT RESPOND AND APPROXIMATELY 25% THAT DO RESPOND ARE UNCOOPERATIVE AND OFTEN DO NOT BRING IN ALL DOCUMENTATION REQUIRED TO SUPPORT QUALIFICATION BASED ON THE CHARITY CARE POLICY.

SCHEDULE H, PART III, LINE 8
MEDICARE -------- FISCAL YEAR 2018 MEDICARE COST REPORT WAS USED TO DETERMINE THE UNPAID COST OF MEDICARE. UNPAID COST OF MEDICARE REPRESENTS THE COST OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF PAYMENTS FOR THOSE SERVICES. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT ---------------- CRITTENDEN COUNTY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH SEVERAL AVENEUS, INVOLVING HOSPITAL EMPLOYEES FROM VARIOUS DEPARTMENTS OF THE HOSPITAL. THE MISSION IS TO PROVIDE ONGOING ASSESSMENTS OF THE HEALTHCARE NEEDS OF CRITTENDEN COUNTY AND THE SURROUNDING COMMUNITIES AND STRIVE TO MEET THE NEEDS IDENTIFIED. IN 2016, THE HOSPITAL WENT THROUGH A COMMUNITY HEALTH ASSESSMENT IN CONJUCTION WITH THE COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY (CEDIK) AT THE UNIVERSITY OF KENTUCKY.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ----------------------------------------------- PATIENT EDUCATION REGARDING ELIGIBILITY FOR ASSISTANCE PROVIDED IN THE FOLLOWING MEDIUMS: DHS APPS ARE SIGNED IN ADMITTING AND FORWARDED TO DMC TO QUALIFY - POSTED IN ADMITTING - PATIENTS ARE CONTACTED BY A PATIENT ACCOUNTS REPRESENTATIVE DURING THEIR HOSPITAL STAY REGARDING ELIGIBILITY FOR ASSISTANCE.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION --------------------- CRITTENDEN COUNTY IS A RURAL AREA WITH A REPORTED POPULATION OF 8,915. THE MEDIAN INCOME FOR A HOUSEHOLD INCOME IN 2011 WAS $37,372. THE PERCENT OF POPULATION UNDER 18 YEARS IS 22.4% IN CRITTENDEN COUNTY, WHILE THE PERCENT OF POPULATION 65 YEARS AND OLDER IS 19%. ADJACENT COUNTIES INCLUDE UNION, WEBSTER, CALDWELL, LYON, LIVINGSTON, AND HARDIN COUNTY, ILLINOIS. OF THESE COUNTIES, UNION, CALDWELL, AND LIVINGSTON ALL HAVE ONLY A CRITICAL ACCESS HOSPITAL. THE OTHER THREE, WEBSTER, LYON, AND HARDIN COUNTY, ILLINOIS, DO NOT HAVE A HOSPITAL WITHIN THE COUNTY (SOURCES: US CENSUS BUREAU).

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM ------------------------------ NOT APPLICABLE FOR CRITTENDEN COUNTY HOSPITAL.

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT ----------------------------------------- NOT APPLICABLE FOR CRITTENDEN COUNTY HOSPITAL.

SCHEDULE H, PART III, LINE 9B
COLLECTION PRACTICES -------------------- CRITTENDEN COUNTY HOSPITAL APPLIES ITS COLLECTION PRACTICES EQUALLY TO ALL PATIENTS, BOTH CHARITY CARE ELIGIBLE AND NON-CHARITY CARE PATIENTS. THE PROCEDURES FOR COLLECTION ON PATIENT ACCOUNTS ARE AS FOLLOWS: POLICY: CHS WILL REQUEST DEPOSITS AND/OR PAYMENT ARRANGEMENTS FOR PATIENT SERVICES NOT COVERED BY INSURANCE OR OTHER PAYMENT SOURCES. IMPLEMENTATION: PATIENTS CONTACTED FOR CENTRALIZED SCHEDULING. THE SCHEDULER IS NOTIFIED OF PATIENTS WITHOUT INSURANCE UNLESS CLINICALLY NECESSARY TO DO SO. OTHERWISE, SELF-PAY PATIENTS SHOULD BE SCHEDULED A FEW EXTRA DAYS OUT TO PROVIDE EXTRA TIME TO CONTACT THEM FOR PRE-SERVICE COLLECTION. PROCESS: THOSE PATIENTS WILL BE CONTACTED, AND THEN BE INFORMED OF THE NECESSARY INFORMATION FOR FINANCIAL SCREENING (PROOF OF INCOME, EMPLOYMENT INFORMATION, ETC), REQUESTED TO COME IN EARLY ON THE DAY OF SERVICES, AND REQUESTED TO BRING SOME METHOD OF PAYMENT (CASH,CHECK,CREDIT CARD,ETC.) ON THAT DAY. ER PATIENTS: PATIENTS SHOULD RECEIVE THE REQUIRED MEDICAL SCREENING AFTER THE BASIC PATIENT INFORMATION IS OBTAINED (NAME, DATE OF BIRTH AND SOCIAL SECURITY NUMBER SHOULD BE OBTAINED IF THE PATIENT'S MEDICAL CONDITION PERMITS). IF A PATIENT IS WAITING TO RECEIVE MEDICAL CARE, THE PATIENT MAY BE REGISTERED, HOWEVER THE PATIENT'S MEDICAL SCREENING SHOULD NEVER BE DELAYED FOR THE REGISTRATION PROCESS. SEE BELOW FOR NEXT STEPS. ER PATIENTS DEEMED URGENT AFTER MEDICAL SCREENING - PATIENTS DEEMED URGENT FOR ADDITIONAL CARE AFTER THE MEDICAL SCREENING WILL BE DETERMINED BY THE PROFESSIONAL JUDGEMENT OF THE PHYSICIAN OR PA COVERING THE ER. HOSPITAL STAFF WILL PROVIDE NECESSARY CARE TO MEDICALLY STABILIZE THE PATIENT AND THE PATIENT WILL BE REGISTERED WHENEVER POSSIBLE. AFTER THE PATIENT IS MEDICALLY STABILIZED THE PATIENT WILL BE ASKED FOR A DEPOSIT AND/OR PAYMENTS ON OLD ACCOUNTS, ASKED TO SET UP PAYMENT ARRANGEMENTS FOR ANY BALANCES, AND SELF-PAY PATIENTS WILL BE SCREENED FOR CHARITY AND POSSIBLE MEDICAID ELIGIBILITY AS SOON AS PRACTICAL. PHYSICIAN REFERRALS (INCLUDING THOSE VIA CENTRALIZED SCHEDULING) OR PATIENTS WITHOUT EMERGENCY MEDICAL CONDITIONS AFTER MEDICAL SCREENING - THE PATIENT WILL BE REGISTERED. AFTER REGISTRATION THE FOLLOWING SHOULD OCCUR: CHECK FOR PRIOR ACCOUNT BALANCES. PATIENTS WITH UNPAID BALANCES MORE THAN 90 DAYS OLD WILL BE REQUIRED TO MAKE A DEPOSIT AND SET UP PAYMENT ARRANGEMENTS ON THOSE OLD ACCOUNTS PRIOR TO RECEIVING ANY ADDITIONAL SERVICE FOR NON-EMERGENCY MEDICAL CONDITIONS. CHARITY SCREENING PAPERWORK: ALL SELF-PAY PATIENTS SHOULD BE SCREENED FOR CHARITY AND MEDICAID CRITERIA BASED ON THE RESPONSIBLE PARTY'S INCOME COMPARED TO THE GUIDELINES IN THE CHARITY POLICY. ALL OR PART OF THE PATIENT'S CHARGES MAY BE WRITTEN OFF. PATIENTS REFUSING TO COMPLETE CHARITY SCREENING PAPERWORK WILL BE CONSIDERED TO NOT QUALIFY. PATIENTS NOT MEETING CHARITY CRITERIA WILL BE REQUIRED TO MAKE A DEPOSIT FOR SERVICES (ACCORDING TO THE ESTABLISHED SCHEDULE) AND AGREE TO PAYMENT ARRANGEMENTS FOR THE BALANCE. CHS EMPLOYEES: EMPLOYEES OF CHS SHOULD SIGN A PAYROLL DEDUCTION AUTHORIZATION TO PAY FOR ANY COSTS NOT COVERED BY INSURANCE. PATIENTS WITHOUT NECESSARY FUNDS FOR REQUIRED DEPOSIT, NOT REQUIRING EMERGENCY SERVICES, WILL BE ASKED TO CONTACT POSSIBLE PAYMENT SOURCES (FRIENDS, RELATIVES, ETC) ON AN EXCEPTION BASIS APPROVED BY THE CEO OR CFO. IF ADEQUATE FUNDS WILL NOT BE AVAILABLE FOR THE REQUIRED DEPOSIT, THE PATIENT WILL BE ASKED TO SIGN AN AGREEMENT TO MAKE MONTHLY PAYMENTS, WHICH WILL INCLUDE AN AGREEMENT WHICH CAN BE SUBMITTED TO THEIR EMPLOYER (OR THE EMPLOYER OF THE SPOUSE OR GUARANTOR) WHERE THEY WILL AGREE TO MAKE MINIMUM MONTHLY PAYMENTS TO CHS, WHICH WILL BE SUBMITTED TO THE EMPLOYER IF THE MONTHLY PAYMENTS ARE NOT DIRECTLY SUBMITTED TO CHS. NOTE, PATIENTS WITHOUT SOME FORM OF EMPLOYMENT (FOR THEM OR GUARANTOR) WOULD GENERALLY QUALIFY FOR CHARITY. INDIVIDUALS WHO WILL NOT MAKE THE DEPOSIT OR AGREE TO PAYMENTS FROM THEIR EMPLOYER WILL BE ASKED TO RETURN FOR NON-EMERGENCY SERVICES WHEN THEY ARE WILLING TO PROVIDE ONE OF THESE PAYMENTS SOURCES. PATIENTS WHO ARE REFUSED SERVICES: THESE ARE PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE AND WHO DO NOT PROVIDE A DEPOSIT AND/OR AGREE TO THE ABOVE. NOTED PAYMENT ARRANGEMENTS: PHYSICIAN'S OFFICE WILL BE NOTIFIED AS SOON AS POSSIBLE IF A PATIENT REFERRAL IS TURNED AWAY DUE TO LACK OF PAYMENT. IF PHYSICIAN REQUESTS THE SERVICES BE PROVIDED DESPITE LACK OF PAYMENT THE ADMINISTRATOR ON CALL WILL BE NOTIFIED AND SERVICES WILL BE PROVIDED. THE DEPOSIT SCHEDULE WILL BE UPDATED AT LEAST ANNUALLY AS APPROVED BY THE CEO AND CFO, WITHIN THE TERMS OF THE POLICY. GENERALLY FOR SERVICES PROVIDED SOLELY BY CHS THE REQUIRED DEPOSIT WILL BE BETWEEN 20% AND 50% OF EXPECTED NORMAL CHARGES. FOR SERVICES PROVIDED BY EXTERNAL SOURCES, WHICH CHS HAS TO PAY A FEE PER SERVICE,THE DEPOSIT WILL BE AT LEAST THE AMOUNT CHARGED TO CHS BY THE OUTSIDE VENDOR (THIS INCLUDES SLEEP LAB AND NUCLEAR MEDICINE). PAYMENT BASED ON POVERTY LEVEL GUIDELINES: AS NOTED IN THE CHARITY POLICY, EXCEPTIONS TO THE DEPOSIT REQUIREMENTS ARE AS FOLLOWS BASED ON INCOME COMPARED TO THE MOST RECENT FEDERAL POVERTY LEVELS 0-100% ALL CHARGES TO BE FORGIVEN, NO DEPOSIT REQUIRED 101-200% NO DEPOSIT REQUIRED AT THE TIME OF SERVICES

SCHEDULE H, PART VI, LINE 5
COMMUNITY BUILDING ACTIVITIES ----------------------------- CRITTENDEN COUNTY HOSPITAL PROVIDES ACTIVITIES AND SERVICES FOR WHICH NO PATIENT BILL EXISTS. THESE SERVICES ARE NOT EXPECTED TO BE FINANCIALLY SELF-SUPPORTING, ALTHOUGH SOME MAY BE SUPPORTED BY OUTSIDE GRANTS OR FUNDING. THE HOSPITAL EMPLOYEES ALSO COLLECT MONEY OR FOOD ON AN ANNUAL BASIS FOR THE LOCAL COMMUNITY CHRISTMAS WHERE THEY ALSO PROVIDE PRESENTS FOR FAMILIES PARTICIPATING IN THE CHRISTMAS ANGEL PROGRAM. THE HOSPITAL OFFERS A HEALTH FAIR FOR THE COMMUNITY, PROVIDING FREE OR REDUCED PRICING SCREENINGS (BLOOD PRESSURE, CHILD ID, LIPID PROFILE, BLOOD GLUCOSE) AND HEALTH INFORMATION. THE HOSPITAL PROVIDES A HEALTH FAIR FOR PAR 4 (MANUFACTURING COMPANY) EMPLOYEES, CRITTENDEN COUNTY HOSPITAL AMERICAN CANCER SOCIETY, SPECIAL OLYMPICS, AND CYSTIC FIBROSIS. THE HOSPITAL OFFERS DISCOUNTED MAMMOGRAMS DURING THE MONTH OF OCTOBER IN HONOR OF BREAST CANCER AWARENESS MONTH. THE HOSPITAL ALSO PROVIDES VOLUNTEER WORKERS FOR THE CRITTENDEN COUNTY YOUTH TRIATHALON. THE HOSPITAL SUPPLIES A REGISTERED NURSE FOR 4-H CAMP FOR AREA SCHOOL CHILDREN. THE REGISTERED NURSE MAINTAINS A FIRST AID STATION THROUGHOUT THE CAMP. HOSPITAL EMPLOYEES ARE ALSO INVOLVED IN NUMEROUS BOARDS THROUGHOUT THE COMMUNITY. CRITTENDEN COUNTY HAS A CHARITY CARE PROGRAM FOR HOSPITAL CLIENTELE. THE HOSPITAL HAS WRITTEN OFF $131,343 IN UNCOLLECTABLE ACCOUNTS IN FISCAL YEAR 2018 FOR PATIENTS IT DEEMS UNABLE TO PAY FOR HEALTHCARE SERVICES UNDER ITS CHARITY CARE POLICY. CRITTENDEN COUNTY HOSPITAL ACCEPTS PATIENTS WITHOUT REGARD FOR THEIR ABILITY TO PAY FOR CARE. UNDER ITS CHARITY CARE POLICY. CRITTENDEN COUNTY HOSPITAL ACCEPTS PATIENTS WITHOUT REGARD FOR THEIR ABILITY TO PAY FOR CARE.