Community Benefit Insight - Tax-exempt hospital

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Marshall County Hospital District

Marshall County Hospital

615 Old Symsonia Rd
Benton, KY 42025

Bed count	25	Medicare provider number	181327	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 610601267

Display data for year:

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

4.92%

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	$ 0 0 %
Medicaid as % of operating expenses	$ 1,305,991 4.91 %
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	$ 0 0 %
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.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 2,500 0.01 %
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	$ 1,082,572 4.07 %
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 $ 23252903 including grants of $ 0) (Revenue $ 25585353)
MARSHALL COUNTY HOSPITAL DISTRICT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN MARSHALL COUNTY AND SURROUNDING COUNTIES IN KENTUCKY. IN 2021, THE HOSPITAL HAD 1,336 ACUTE DAYS, 428 ICU DAYS, AND 278 SWING DAYS.

Facility Information

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

MARSHALL COUNTY HOSPITAL DISTRICT
PART V, SECTION B, LINE 5: THE MARSHALL COUNTY HOSPITAL AND THE MARSHALL COUNTY HEALTH DEPARTMENT JOINT-VENTURED AND UTILIZED A COMMUNITY HEALTH ASSESSMENT PROCESS BASED ON MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). MAPP IS A COMMUNITY-DRIVEN STRATEGIC PLANNING PROCESS WHICH HELPS COMMUNITIES APPLY STRATEGIC THINKING TO PRIORITIZE PUBLIC HEALTH ISSUES AND IDENTIFY RESOURCES TO ADDRESS THEM. MAPP IS NOT AN AGENCY-FOCUSED ASSESSMENT PROCESS; RATHER, IT IS AN INTERACTIVE PROCESS THAT CAN IMPROVE THE EFFICIENCY, EFFECTIVENESS, AND ULTIMATELY THE PERFORMANCE OF LOCAL PUBLIC HEALTH SYSTEMS. THE ASSESSMENTS USED IN THE MAPP PROCESS INCLUDE COMMUNITY HEALTH STATUS ASSESSMENT, COMMUNITY STRENGTHS AND RISKS ASSESSMENT, FORCES OF CHANGE ASSESSMENT, AND THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT.THE MARSHALL COUNTY HEALTH DEPARTMENT AUGMENTED THE MAPP PROCESS WITH A THREE PERSPECTIVE APPROACH TO GATHERING INFORMATION. DATA GATHERED IN CONJUNCTION WITH THE COMMUNITY HEALTH STATUS ASSESSMENT PROVIDED A DATA PERSPECTIVE ON THE HEALTH OF EACH COMMUNITY. INFORMATION GATHERED DURING COMMUNITY FORUMS, PRIMARILY ATTENDED BY REPRESENTATIVES OF COMMUNITY PARTNER ORGANIZATIONS, PROVIDED THE ORGANIZATIONAL PERSPECTIVE. IN AN EFFORT TO ADD THE PERSPECTIVE OF INDIVIDUAL CITIZENS OF EACH COUNTY, BOTH PAPER AND ELECTRONIC SURVEYS WERE DISTRIBUTED. INFORMATION FROM THESE SURVEYS PROVIDED THE INDIVIDUAL PERSPECTIVE. IN ADDITION, THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT WAS COMPLETED UTILIZING AN ASSET MAPPING APPROACH.THE MARSHALL COUNTY HEALTH COALITION HELD A COMMUNITY FORUM FOR THE PURPOSE OF VISION STATEMENT DISCUSSION, COALITION ACCOMPLISHMENT CELEBRATION AND COMMUNITY HEALTH ASSESSMENT DATA UPDATES. THESE DISCUSSIONS PROVIDED THE FOUNDATION FOR THE 2019-2022 COMMUNITY HEALTH IMPROVEMENT PLAN.AREA BUSINESS LEADERS, COUNTY AND CITY OFFICIALS, LAW ENFORCEMENT, INTERESTED CITIZENS, FAITH-BASED ORGANIZATIONS, HEALTHCARE PROVIDERS AND THE GENERAL PUBLIC WERE INVITED TO PARTICIPATE. IT WAS ARRANGED FOR A FACILITATOR FROM THE UNIVERSITY OF KENTUCKY, DR. ANGIE CARMAN TO LEAD THE GROUP IN DISCUSSING HEALTH CONCERNS FOR MARSHALL COUNTY CITIZENS.

MARSHALL COUNTY HOSPITAL DISTRICT
PART V, SECTION B, LINE 6B: THE HOSPITAL PARTNERED WITH MARSHALL COUNTY HEALTH DEPARTMENT TO CONDUCT THE CHNA. SEE ADDITIONAL INFORMATION UNDER LINE 5 ABOVE.

MARSHALL COUNTY HOSPITAL DISTRICT
PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, EXECUTION OF THE IMPLEMENTATION STRATEGY, PARTICIPATION IN THE EXECUTION OF A COMMUNITY-WIDE PLAN, ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA, PRIORITIZATION OF HEALTH NEEDS IN THE COMMUNITY, AND PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN THE COMMUNITY.

PART V, SECTION B
INDIVIDUALS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY ARE NOT CHARGED ANYTHING.

Supplemental Information

Schedule H (Form 990) Part VI

PART II, COMMUNITY BUILDING ACTIVITIES:
THE ORGANIZATION DOES NOT HAVE ANY COMMUNITY BUILDING ACTIVITIES TO REPORT.

PART III, LINE 2:
THE HOSPITAL HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SOME OF THE ANALYTICAL TOOLS THAT THE HOSPITAL UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE BY PAYOR, REVENUE TRENDS BY PAYOR CLASSIFICATION AND AGED ACCOUNTS FROM DATE OF SERVICE BY PAYOR. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HOSPITAL'S POLICIES.

PART III, LINE 3:
THE HOSPITAL DOES NOT HAVE BAD DEBT EXPENSES RELATED TO THE PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY.

PART III, LINE 4:
THE AMOUNTS REPRESENT UNPAID MEDICARE DEDUCTIBLES AND COINSURANCE AND ALL SELF-PAY ACCOUNTS THAT WERE UNPAID. THE HOSPITAL HAS BOTH INTERNAL AND EXTERNAL COLLECTION EFFORTS. BAD DEBT TREATMENT IS COVERED IN FOOTNOTE 4 OF THE FINANCIAL STATEMENTS.

PART III, LINE 8:
THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL. LINE 6 COSTS REPRESENT MEDICARE CHARGES MULTIPLIED BY A CALCULATED COST-TO-CHARGE RATIO FOR ANCILLARY SERVICES AND MEDICARE DAYS MULTIPLIED BY A CALCULATED PER DIEM AMOUNT FOR ROUTINE SERVICES. LINE 5 REVENUES REPRESENT 101% OF MEDICARE COSTS, LESS 2% SEQUESTRATION, WHICH IS MEDICARE'S REIMBURSEMENT METHODOLOGY FOR CRITICAL ACCESS HOSPITALS. CMS ELIMINATED THE SEQUESTRATION ADJUSTMENT DURING THE COVID PANDEMIC AND IT IS CURRENTLY STILL ELIMINATED THROUGH DECEMBER 31, 2021.

PART III, LINE 9B:
AT ADMISSION, ALL PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE FILL OUT A DISPROPORTIONATE SHARE HOSPITAL (DSH) FORM, WHICH IS MAILED BI-WEEKLY TO THE DISABILITY MEDICAL CONSULTANTS (DMC). A PATIENT WHO APPLIES FOR FREE CARE COVERAGE (DSH) OF HIS/HER HOSPITAL SERVICES WILL, UPON REQUEST, RECEIVE A WRITTEN NOTICE OF THE HOSPITAL'S DECISION ON THE REQUEST WITHIN TWO MONTHS OF SUBMISSION OF A COMPLETED APPLICATION AND OTHER REQUIRED INFORMATION. DETERMINATION FOR FREE CARE IS MADE ON AN ACCOUNT BY ACCOUNT BASIS. WITHIN 180 DAYS OF THE DETERMINATION OF THE PATIENT'S INABILITY TO PAY FOR SERVICES, THE HOSPITAL WILL SEND THE PATIENT, HIS/HER GUARANTOR OR OTHER FINANCIALLY RESPONSIBLE PARTY AN INITIAL STATEMENT OF CHARGES CLEARLY STATING THE AMOUNT FOR WHICH THE PATIENT, GUARANTOR OR OTHER FIANCIALLY RESPONSIBLE PARTY IS RESPONSIBLE. AN ITEMIZED BILL WILL BE SENT UPON REQUEST OF THE PATIENT, AND IF NO RESPONSE, A SECOND AND THIRD STATEMENT WILL BE SENT TO THE RESPONSIBLE PARTY. FINALLY, A LETTER IS SENT STATING THAT COLLECTION AGENCY ACTION WILL BE TAKEN. THEREAFTER, IF THE ACCOUNT IS EQUAL TO OR EXCEEDS $1,000, THE HOSPITAL WILL AGAIN INVESTIGATE ALL POTENTIAL PAYMENT SOURCES BEFORE TURNING THE ACCOUNT OVER TO COLLECTIONS. THIS INCLUDES SENDING ANOTHER LETTER THROUGH THE DSH PROGRAM. IF THE AMOUNT IS LESS THAN $1,000 THE HOSPITAL WILL WRITE THE ACCOUNT OFF TO BAD DEBT AND SEND TO A COLLECTION AGENCY.

PART VI, LINE 2:
THE HOSPITAL CONTINUES TO BE PART OF THE MARSHALL COUNTY HEALTH COALITION, MADE UP OF BUSINESS LEADERS, OFFICIALS, LAW ENFORCEMENT, INTERESTED CITIZENS, FAITH-BASED ORGANIZATIONS, AND OTHER HEALTHCARE PROVIDERS. THE COMMITTEE ASSESSES THE NEEDS OF MARSHALL COUNTY RESIDENTS REGARDING HEALTH CARE, SECURITY, AND BOTH ENVIRONMENTAL AND EDUCATIONAL CONCERNS. MARSHALL COUNTY HOSPITAL ASSISTED THE LOCAL HEALTH DEPARTMENT AND OTHER MEMBERS OF THE COALITION IN THE COMPLETION OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. THE MAPP PROCESS WAS UTILIZED, WITH A THREE-PERSPECTIVE APPROACH TO GATHERING INFORMATION (DATA PERSPECTIVE, ORGANIZATIONAL PERSPECTIVE, AND INDIVIDUAL PERSPECTIVE). COMPLETION OF THE 2019 NEEDS ASSESSMENT RESULTED IN THE MCH COMMUNITY HEALTH NEEDS ASSESSMENT IMPROVEMENT PLAN, ADDRESSING THOSE CONCERNS IDENTIFIED.

PART VI, LINE 3:
DURING THE ADMISSIONS PROCESS, THE ADMISSIONS CLERK INFORMS ANY PATIENTS WITHOUT INSURANCE COVERAGE ABOUT THE AVAILABLITY OF FREE CARE COVERAGE UNDER THE DISPROPORTIONATE SHARE HOSPITAL PROGRAM (DSH) AND PROVIDES THEM WITH THE FORM TO DETERMINE ELIGIBILTY FOR BOTH THE DSH PROGRAM AND MEDICAID. THE HOSPITAL WILL PROVIDE REASONABLE ASSISTANCE IN COMPLETING THIS FORM. THE HOSPITAL WILL ALSO ADVISE PATIENTS ABOUT ELIGIBILITY FOR AND OBTAINING PUBLIC ASSISTANCE. THE COMPLETED FORM IS MAILED OUT BI-WEEKLY TO DISABILITY MEDICAL CONSULTANTS (DMC), WHO DETERMINE THOSE ELIGIBLE FOR THE DSH PROGRAM. IN ADDITION, THE FINANCIAL COUNSELOR WILL PERSONALLY SPEAK WITH ALL UNINSURED INPATIENTS WHEN FEASIBLE. UPON REQUEST, THE PATIENT WILL RECEIVE WRITTEN NOTICE OF HIS ELIGIBILITY FOR THE DSH PROGRAM WITHIN TWO MONTHS OF SUBMITTING THE COMPLETED APPLICATION AND ANY OTHER REQUIRED INFORMATION.IF THE PATIENT IS A RESIDENT OF KENTUCKY, DOES NOT HAVE HEALTH INSURANCE, MEETS THE INCOME GUIDELINES AND HAS BEEN DENIED MEDICAL CARE BY MEDICAID, THE PATIENT'S BILL WILL BE COVERED UNDER THIS PROGRAM.

PART VI, LINE 5:
"MARSHALL COUNTY HOSPITAL IS ACTIVE IN EDUCATING THE COMMUNITY. THE HOSPITAL HAS VISITED SENIOR CITIZENS, RESIDENTS OF THE LOCAL ASSISTED LIVING FACILITY, HOSTED NUMEROUS ""LUNCH AND LEARNS"" WITH VARIOUS SPEAKERS, AND REPRESENTED THE HOSPITAL AT ALL AREA FAIRS WITH EDUCATIONAL INFORMATION, AS WELL AS FREE SCREENINGS TO THE PUBLIC. THE HOSPITAL ALSO PUBLISHES EDUCATIONAL MATERIAL IN THE LOCAL NEWSPAPERS, RADIO, ON-LINE PRODUCTIONS AND THE EMPLOYEE NEWSLETTER."

PART VI, LINE 6:
THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

PART VI, LINE 4:
MARSHALL COUNTY, NESTLED ON THE SHORES OF ONE OF THE LARGEST MANMADE LAKES IN THE EASTERN UNITED STATES, HAS AN UNSURPASSED QUALITY OF LIFE. THE SMALL TOWN ATMOSPHERE, COMBINED WITH THE ACCESS TO LARGER METROPOLITAN AREAS, THE LAND BETWEEN THE LAKES NATIONAL RECREATION AREA, THE HIGHLY RATED SCHOOL SYSTEM, AND ABUNDANCE OF JOB OPPORTUNITIES, MAKES THIS AN IDEAL PLACE TO LIVE, WORK AND SUCCEED. MARSHALL COUNTY HAS A POPULATION OF APPROXIMATELY 31,748 PEOPLE WITH A MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $57,348. PER THE 2021 CENSUS, THE COUNTY IS COMPRISED OF 50.3% FEMALE AND 49.7% MALE AND IS APPROXIMATELY 97.7% CAUCASIAN. THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IS APPROXIMATELY 10.3%. APPROXIMATELY 2% OF THE EMPLOYED POPULATION RECEIVES PUBLIC ASSISTANCE INCOME. APPROXIMATELY 54% OF THE HOSPITAL'S NET PATIENT SERVICE REVENUE IS COMPRISED OF PARTICIPANTS IN MEDICARE AND MEDICAID PROGRAMS.

Operating expenses	$ 26,595,952
Total amount spent on community benefits as % of operating expenses	$ 1,308,491 4.92 %