Community Benefit Insight - Tax-exempt hospital

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Monroe Medical Foundation Inc

Monroe County Medical Center

529 Capp Harlan Road
Tompkinsville, KY 42178

Bed count	49	Medicare provider number	180105	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 310949874

Display data for year:

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

2.41%

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	$ 444,136 2.07 %
Medicaid as % of operating expenses	$ 31,514 0.15 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 20,405 0.10 %
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.	$ 19,616 0.09 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	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
Persons served (optional)	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
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 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	$ 644,814 3.01 %
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	$ 128,963 20.00 %

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 $ 19759003 including grants of $ 14700) (Revenue $ 23507917)
Inpatient Care - Monroe Medical Foundation, Inc. operates a 49 bed acute care hospital. The hospital admitted 1,155 patients, treated 5,802 patients in the emergency room, treated 25,478 patients as patient referrals and made 2,296 ambulance runs in FYE 2-28-22. The patients admitted to the hospital as regular inpatients consisted of approximately 65% Medicare patients and 23% Medicaid patients. Approximately 2% of patients admitted did not have Medicare or Medicaid, and did not have any type of insurance. The hospital also began providing Swing Bed services in December 2014. We admitted 19 patients to the swing bed status during the fiscal year, and we had 138 swing bed patient days. (Grants included 6 high school graduates' scholarships and 2 individuals in RN school and 1 individual in LPN school).

Facility Information

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

Schedule H, Part V, Section B, Line 5-Monroe County Medical Center
In conducting the CHNA, the hospital facility took into account input from persons who represent broad interests of the community served by the hospital facility. It included 9 local expert advisors from the county. They include representatives from the Board of Education, Health Department, Housing Authority, Nursing Home, EMS Service, Banker, Extension Board Member, Audubon Area Community Services, Monroe County Medical Center, Community and Economic Development Initiative of Kentucky at the University of Kentucky and other individuals in the community who completed the CHNA surveys.

Schedule H, Part V, Section B, Line 6b-Monroe County Medical Center
The hospital facility's CHNA was conducted with various organizations other than hospital facilities. It was conducted in conjunction with leaders and experts from the local county and the Community and Economic Development Initiative of Kentucky at the University of Kentucky. It included 9 local expert advisors from the county. They included representatives from the Board of Education, the Health Department, Housing Authority, Local Nursing Home, Monroe County Medical Center, EMS Service, Banker, Extension Board Member, Audubon Area Community Services and other individuals of the Community.

Schedule H, Part V, Section B, Line 11-Monroe County Medical Center
"The following are the needs identified and the plan to address those needs although some of the plans have been delayed due to the COVID-19 Pandemic. 1. Obesity/Diabetes - The hospital has a Certified Diabetes Educator on staff for community education and free inpatient consultations. The hospital will evaluate participation in the Medicare Diabetes Prevention Program and the Kentucky Diabetes Learning Collaborative. The hospital will sponsor and facilitate monthly Diabetes Support Group Meetings; however, they have been put on hold during the pandemic. The hospital will participate in the Annual Diabetes Health Fair and provide free HbbA1C testing - sponsored by the Monroe County Health Department. The hospital will participate in the Community-Wide Health Fair with free screens and education, but it is on hold during the pandemic. We will provide education for ""smart shopping"" with local teen - 4-H teen club. The hospital will use the Economic Development Center kitchen for diabetes education and cooking classes. We will develop the Extension Club - weight loss program and health choices. We will promote the state-wide walking initiative - go365. Our physical Therapy department has sponsored a 5k event with free t-shirts with proceeds going to charity. In FYE 2-28-22, the hospital was chosen as the only hospital to participate in the Kentucky Diabetes Learning Collaborative. This collaboration will allow us to use best practices to work closely with local physician practices to assist in education of diabetic patients with an A1C greater than 9 to promote timely A1C testing, dietary education and compliance, diabetic foot checks and various other factors that are important in managing these effects of diabetes. Therapy staff participated in Senior Day at the Clay County Fair offering education on exercise and evaluation using the balance machine. 2. Respiratory Illnesses - COPD, Lung Cancer and Asthma - The hospital will evaluate the development of a Cardiac/Respiratory Rehab program. We will assist in Smoking Cessation Classes with the Health Department. We will reinstate ""Lunch and Learn"" quarterly meetings with the community after the pandemic ends. Cardiopulmonary director will participate in the radio programs. In FYE 2-28-22, due to the ongoing PHE, in-person educational classes have continued to be on hold. 3. Education on resources currently available in the community - The hospital will update the community resource book. We will develop a list of resources and post links on our website. In FYE 2-28-22, a listing of community resources including food banks, blessing boxes, clothes closets, public transportation, homeless shelters, utility resources, governmental entities, assistance programs, and medical resources have been made available to the public on the hospital facility's website. 4. Speciality Medical Services available locally - the hospital will evaluate Outpatient Psych and Telepsych via a larger hospital or contract service. The hospital will recruit specialists to conduct clinics in our clinic area. We will be recruiting specialists to conduct clinics in Pulmonology, Orthapedics, Urology, Allergist, Dermatology and Wound Care. We have previously had most of these, but we do not have them now due to various reasons such as physicians retiring or just leaving their practices. We currently have 2 specialty services offered, outpatient scopes and cardiology. The hospital continuously assesses the need for specialists and actively recruits those for which there is enough demand to justify the expense. Some are not financially feasible simply because the county isn't populous enough to support them. However, the hospital will continue to evaluate future specialists that match our community's expressed needs and will recruit those specialists in an effort to meet those needs. In FYE 2-28-22, the hospital has engaged in conversations with area tertiary hospitals about the availability of specialists to either staff an onsite specialty clinic or to offer services via telehealth."

Schedule H, Part V, Section B, Line 24-Monroe County Medical Center
All patients are initially charged the same rates. If the patient meets the financial assistance policy provisions, the charges are discounted according to the provisions of the Financial Assistance policy.

Supplemental Information

Schedule H (Form 990) Part VI

Schedule H, Part I, Line 7
Ratio of Patient Care Cost to Charges was used as the costing methodology.

Schedule H, Part I, Line 7g
There were no costs attributable to a physician clinic included as subsidized health services in line 7(g).

Schedule H, Part III, Section A, Line 4
The notes in the financial statements that describe bad debt expense are located on pages 10 and 11 of the Audit Report. The costing methodology used to determine the amounts reported on Part III, Section A, Line 2 is based on the ratio of Patient Care Cost to Charges applied to the gross amounts written off as bad debts.

Schedule H, Part III, Section B, Line 8
There is no shortfall on Medicare patients. The costing methodology used is the Ratio of Patient Care Cost to Charges applied to the gross charges.

Schedule H, Part III, Section C, Line 9b
Upon registration, financial information is gathered, when possible, to determine if they qualify for charity or financial assistance. If they are not able to provide the information at that time, they are given a financial information form to complete later. If they are admitted to the hospital, the patient financial counselor goes to the patient room and discusses the charity and financial assistance information with the patient. If we are unable to obtain the necessary information from the patient at that time, we send the information to a contracted company to obtain the necessary information. They assist them in obtaining the information and financial assistance they quality for.

Schedule H, Part VI, Line 2
The hospital also has suggestion boxes for patients, visitors and employees to obtain suggestions for new or better health services. In addition, the hospital obtains input from the physicians, visitors and employees at the annual Board/Medical Staff planning retreat.

Schedule H, Part VI, Line 3
The Financial Assistance Policy Plain Language Summary is posted on the wall in the registration offices. There are also copies of the Financial Assistance Applications in the registration areas available for the patients. In addition, the Financial Policy Plain Language Summary is posted in the exam rooms in the emergency department and in various ancillary outpatient waiting areas. If the patients do not have Medicare, Medicaid or any other type of insurance, the patient information is provided to a contracted company to follow up with patients to help them obtain medical cards and assist them in getting the necessary information to qualify for financial assistance. If the patient is admitted, the Patient Financial Counselor visits the patient in the patient room and discusses their financial options. The hospital's Financial Assistance policy is also posted on the hospital's web site.

Schedule H, Part VI, Line 4
The Monroe County Medical Center is located in Monroe County, Kentucky which is a rural area of Kentucky. The hospital primarily serves the citizens of Monroe County and parts of the joining counties. The population of Monroe County is approximately 11,233. Only approximately 14.8% persons age 25 and above have a bachelor's degree or higher compared to 33.7% for the national average. The Median household income is approximately $39,334 compared to the national median household income of $69,021. Approximately 22.0% of the persons in Monroe County live below the poverty level compared to 11.6% for the national average. The unemployment rate for Monroe County was 3.5% as of February 28, 2022. It went as high as 12.8% in April 2020 due to the COVID-19 Pandemic. The national rate for February 2022 was 3.8%. The primary industries in Monroe County are a concrete plant manufacturer, a utility lines construction company, lumber and agriculture.

Schedule H, Part VI, Line 5
The Monroe County Medical Center has an open medical staff to promote patient care for the citizens of our community. The Board of Directors of the Monroe Medical Foundation, Inc. is made up of nine individuals. All of them reside in Monroe County, and serve on the Board with no pay for providing those services. They serve because they are interested in the Community and want to give something back to the Community by helping assure that good medical services are provided to the citizens of Monroe and surrounding counties. The current Board is made up of a retired local businessman, a pharmacist, a retired banker, a retired banker and farmer, a retired school teacher, a dentist, an optometrist, the Chief of the Medical Staff and the Vice Chief of the Medical Staff. Any surplus funds of the Monroe Medical Foundation, Inc. are used to upgrade the building, purchase updated equipment and provide other wellness services and quality healthcare for our community.

Operating expenses	$ 21,419,342
Total amount spent on community benefits as % of operating expenses	$ 515,671 2.41 %