4A (Expenses $ 19999933 including grants of $ 0) (Revenue $ 19731859)
NMMC-Hamilton serves Marion county Alabama and the surrounding area. In fiscal year 2022, there were 439 inpatient admissions, 7,145 emergency department visits, 41,660 outpatient visits, 23,229 rural health clinic visits, and 568 hospital based clinic visits. NMMC-Hamilton uses Press Ganey, the largest patient satisfaction survey company in the nation, that works with more than 7,000 healthcare facilities. Randomly selected patients are asked about their experience with inpatient, outpatient, ER, and long term care services. The four-bed Intensive Care Unit offers invasive and non-invasive monitoring for medical and surgical patients. The hospital also has 10 certified swing beds for patients who need extended care. NMMC-Hamilton offers 24-hour emergency services. The Emergency Room is staffed by well-equipped, highly qualified nurses and physicians. Emergency air ambulance services are readily available for critical care transport when needed. Outpatient services include same-day surgery, physical therapy, speech therapy, occupational therapy, laboratory and cardiac monitoring. Cardiac stress tests and holter monitoring are also offered. NMMC-Hamilton is the recipient of the VHA Leadership Award, honoring the hospital for meeting or exceeding national performance standards for clinical care and quality. VHA serves more than 1,400 not-for-profit hospitals and more than 24,000 non-acute health care organizations nationwide. NMMC-Hamilton was one of only 38 VHA member organizations to receive a 2009 Leadership Award for Clinical Excellence.

4B (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
One of the primary ways NMMC-Hamilton serves the community is by providing care to various populations for which it receives no compensation or receives compensation at rates significantly less than established rates. The board of directors of NMMC-Hamilton has established a policy under which the hospital provides care, without charge, to needy members of its community. THE FINANCIAL ASSISTANCE POLICY STATES THAT NMMC-HAMILTON WILL PROVIDE EMERGENCY AND MEDICALLY NECESSARY INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO PATIENTS FREE OF CHARGE WITH HOUSEHOLD INCOME LEVELS AT OR BELOW 150% OF THE FEDERAL POVERTY LEVEL. The policy applies to individuals who reside in Marion County. Patients from outside the county may also be granted charity care based on the judgment of NMMC-Hamilton management depending on their individual circumstances. The policy also requires the patient to cooperate fully with NMMC-Hamilton's request for information with which to verify the patient's eligibility. Following that policy, the hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy. Charges forgone, based on established rates, totaled approximately $1,611,301 in fiscal year 2022. Based on the gross charges provided to charity patients compared to total hospital gross charges, 4.73% of all services in fiscal year 2022 were provided on a charity basis. The net cost of charity care provided by NMMC-Hamilton was approximately $1,010,974 in fiscal year 2022. The total cost estimate is based on the ratio of costs to charges for NMMC-Hamilton. All of the forgone charges mentioned above are netted against patient service revenue to arrive at net patient service revenue as reflected as program service revenue on Part VIII on Form 990 in order to be consistent with financial statement reporting and are not reported as functional expenses on the tax return.

FORM 990, SCHEDULE H, PART V, SECTION B, LINE 5
INPUT FROM THE COMMUNITY WAS RECEIVED VIA INFORMANT INTERVIEWS, STANDARDIZED ELECTRONIC SURVEYS FROM KEY ORGANIZATIONS/STAKEHOLDERS, HEALTHCARE ADVOCATES/LEADERS, AND INTERESTED COMMUNITY PARTNERS RESIDING IN THE SERVICE AREAS SERVED BY NORTH MISSISSIPPI MEDICAL CENTER-HAMILTON AND THE HEALTH SYSTEM. ADDITIONAL INPUT WAS SOLICITED FROM COMMUNITY RESIDENTS WHO REPRESENT BROADLY DIVERSE INTERESTS OF THE SERVICE AREA RANGING FROM NONPROFIT COMMUNITY VOLUNTEERS TO RETIRED EDUCATORS, BANKERS, AND PRIVATE BUSINESS LEADERS.

FORM 990, SCHEDULE H, PART V, SECTION B, LINE 6A:
MARION REGIONAL MEDICAL CENTER IS PART OF THE NORTH MISSISSIPPI HEALTH SERVICES' DIVERSIFIED REGIONAL HEALTHCARE SYSTEM. NORTH MISSISSIPPI HEALTH SERVICES OPERATES SIX COMMUNITY HOSPITALS IN ADDITION TO MARION REGIONAL MEDICAL CENTER. THE CHNA INCLUDED MARION REGIONAL MEDICAL CENTER, CLAY COUNTY MEDICAL CORPORATION, PONTOTOC HEALTH SERVICES, WEBSTER HEALTH SERVICES, TISHOMINGO HEALTH SERVICES, MONROE HEALTH SERVICES AND NORTH MISSISSIPPI MEDICAL CENTER.

FORM 990 SCHEDULE H, PART V, SECTION B, LINE 7B & 10A
WWW.NMHS.NET/ABOUT-US/COMMUNITY-BENEFIT/

FORM 990 SCHEDULE H, PART V, SECTION B, LINE 11:
"THE NEEDS OF THE COMMUNITY GO BEYOND THE RESOURCES OF THE ORGANIZATION WITH THE NON-EXPANSION OF MEDICAID IN THE STATE AND THE REDUCTION IN MEDICAID PAYMENTS AS WELL AS A SIGNIFICANT INCREASE IN UNINSURED. THE ORGANIZATION FOCUSES ON PROVIDING ACCESS TO BASIC HEALTHCARE NEEDS INCLUDING: A. INCREASE ACCESS TO PREVENTIVE SERVICE - EXPAND VIRTUAL/TELEHEALTH OFFERINGS - COLLABORATE TO EXPLORE TRANSPORTATION NEEDS - INITIATE INNOVATIVE LISTEN-TO-LEARN COMMUNITY SESSIONS - UTILIZE PARTNERS TO ASSIST THOSE WITH LIMITED OR NO INSURANCE - INCREASE AFFORDABLE AFTER-HOURS CARE - IMPROVE ACCESS TO SPECIALTY CARE B. INCREASE PHYSICAL ACTIVITY AND PROMOTE EXERCISE AS MEDICINE - PARTNER WITH LOCAL WELLNESS CENTERS & GYMS - DEVELOP PARTNERSHIPS WITH LOCAL PARKS/RECREATION FACILITIES - UTILIZE EXERCISE ""PRESCRIPTIONS"" - ORGANIZE WALKING CLUBS - PROMOTE CORPORATE WELLNESS PROGRAMS - IDENTIFY COMMUNITY RESOURCES, E.G. TRAILS, WALKINGS TRACKS, ETC. C. DEVELOP A NUTRITIONALLY AWARE COMMUNITY CULTURE - SCREEN FOR AND CREATE ACCESS TO NUTRITIOUS FOODS - DEVELOP CULTURALLY-APPROPRIATE EDUCATIONAL PROGRAMS - DEVELOP COMMUNITY COALITIONS TO PROVIDE FRESH FOOD/PROMOTE COMMUNITY GARDENS - TEACH FOOD PRESERVATION SKILLS - UTILIZE ESTABLISHED NETWORKS TO PROMOTE NUTRITION D. DEVELOP PARTNERSHIPS WITH PUBLIC ENTITIES - PUBLIC HEALTH -- STATE AND REGIONAL OFFICES - EDUCATIONAL INSTITUTIONS -- EARLY CHILDHOOD, PRIMARY, SECONDARY, AND POST-SECONDARY - GOVERNMENT -- STATE, REGIONAL, AND LOCAL"

FORM 990 SCHEDULE H, PART V, SECTION B, LINE 13h:
THE FAP DOES NOT COVER CHARGES FOR PATIENTS OR TREATMENTS WITH THE FOLLOWING CONDTIONS: I. THE PATIENT HAS ANY THIRD-PARTY INSURANCE COVERAGE. A DISCRETIONARY EXCEPTION MAY BE MADE FOR INSURED PATIENTS IS THE PROVISOIN FOR THE MEDICALLY UNDER-INSURED. II. THE PATIENTS PRIMARY RESIDENCE IS OUTSIDE THE SERVICE AREA III. THE PATIENT IS CURRENTLY IN CUSTODY OF A CORRECTIONAL FACILITY IV. THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER ANOTHER CITY, COUNTY, STATE, FEDERAL OR OTHER ASSISTANCE PROGRAM WHICH SUPERSEDES THE FAP. V. IF PATIENTS CHARGES RESULTED FROM A WORK-RELATED ACCIDENT, PATIENTS ARE NOT ELIGIBLE TO APPLY UNLESS THEY CAN PROVIDE PROOF OF NO THIRD-PARTY COVERAGE. VI. IF PATIENT CHARGES RESULTED FROM AN AUTO ACCIDENT, PATIENTS ARE NOT ELIGIBLE TO APPLY UNLESS THEY CAN PROVIDE PROOF OF NO THIRD-PARTY COVERAGE. THE FINANCIAL ASSISTANCE POLICY IS NOT APPLICABLE TO PHYSICIANS OR THEIR IMMEDIATE FAMILY MEMBERS.

FORM 990 SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, & 16C
WWW.NMHS.NET/PATIENT-FAMILY-INFORMATION/FINANCIAL-ASSISTANCE/

FORM 990, SCHEDULE H, Part I, Line 3C
MARION REGIONAL MEDICAL CENTER, INC. USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. IF THE PATIENT'S INCOME LEVEL IS 0-150% OF THE FEDERAL POVERTY LEVEL (FPL), AN ADJUSTMENT OF 100% OF THE HOSPITAL'S STATED CHARGES WILL BE MADE. FOR PATIENTS WHOSE FAMILY GROSS INCOME IS EQUAL TO OR GREATER THAN 200% OF THE FPL, THE HOSPITAL MAY OFFER DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE.

FORM 990, SCHEDULE H, Part I, Line 6A
Marion Regional Medical Center's community benefit information is included in the community benefit report of its parent company, North Mississippi Health Services, Inc. North Mississippi Health Services (NMHS) is a diversified regional health care organization, which serves 24 counties in north Mississippi and northwest Alabama from headquarters in Tupelo, MS. The NMHS organization covers a broad range of acute diagnostic and therapeutic services, offered through North Mississippi Medical Center in Tupelo; a community hospital system with locations in Eupora, Iuka, Pontotoc, West Point, Amory, MS, and Hamilton AL; North Mississippi Medical Clinics, a regional network of 27 primary and specialty clinics; and nursing homes. NMHS offers a comprehensive portfolio of managed care plans.

FORM 990, SCHEDULE H, Part I, Line 7
A cost to charge ratio was used for the amounts reported in the table for Line 7. The cost to charge ratio for Line 7 was calculated using Worksheet 2.

FORM 990, SCHEDULE H, Part III, Line 2-4
"Marion Regional Medical Center's financial statements do not include a footnote specifically concerning bad debt. Bad debt is shown as a separate line item on the face of the income statement. The amount of bad debt booked each year is based on a review of outstanding receivables and their age from date of service. The older the account, the higher the reserve percentage used to estimate bad debt. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluations and specific circumstances of the account. Marion Regional Medical Center (MRMC) follows the Catholic Health Association guidelines and does not include bad debt in any community benefit amounts. MRMC believes that some portion of bad debt results from patients who could qualify for charity care but has no way of making an estimate of the amount and therefore has answered ""zero"" for Part III Line 3. 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."

FORM 990, SCHEDULE H, Part III, Line 8
The ratio of cost to charges used in the calculation of costs for Medicare was taken from the Medicare Cost Report. Lines 5, 6, & 7 do not include certain Medicare programs and costs and thus do not reflect all of the organization's revenues and costs associated with its participation in Medicare programs. Additional revenues and costs not reported on Lines 5, 6, & 7 include those associated with the organization's Medicare outpatient lab, ambulance and therapy services. Total revenues from these activities were $401,505 and total costs were $873,216 for a net shortfall of $471,711. When combined with the shortfall reported on Line 7, the net shortfall from all Medicare programs is $619,084.

FORM 990, SCHEDULE H, Part III, Line 9b
Marion Regional Medical Center does not pursue collection of amounts determined to qualify as charity care. For patients who qualify for charity care or financial assistance and who are cooperating in good faith to resolve their discounted hospital bills, the hospitals may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts.

FORM 990, SCHEDULE H, Part VI, Line 2
Needs Assessment Marion Regional Medical Center utilizes varied but complimentary methods to assess the health care needs of the community it serves. Marion Regional Medical Center and Marion County are included in the North Mississippi Health Services Community Health Assessment which is performed every three years and provides information on health status, utilization of health services, healthy beliefs and satisfaction with health care services. The North Mississippi Health Services Community Health Assessment covers the 24 county service area including Marion County and provides information by county. In addition, the North Mississippi Health Services Community Relations Facilitator conducts routine visits with our internal and external stakeholders across the entire service area including Marion County. The information gathered through several qualitative survey questions is used to determine our community's needs for the entire service area as well as the local service area for each hospital such as Marion Regional Medical Center.

FORM 990, SCHEDULE H, Part VI, Line 3
Patient Education of Eligibility for Assistance Explanations of the Marion Regional Medical Center charity care policy are communicated in a variety of forms including signage at all admission and registration areas, on the web site, on bills and statements, and in admission packets. Financial counselors assist the patient and responsible parties with determining eligibility for government programs, primarily Medicaid, and charity care status. The patient can apply for charity care at any time from the date of service through the collection process and once qualified and approved all collection efforts are stopped.

FORM 990, SCHEDULE H, Part VI, Line 7
State Filing of Community Benefit Report Marion Regional Medical Center does not file a community benefit report with the state of Mississippi as there is no requirement to do so.

FORM 990, SCHEDULE H, Part VI, Line 4
Community Information Marion Regional Medical Center serves more than 29,000 people in Marion County, Alabama and the surrounding area. The population for the service area is projected to remain essentially flat over the next five years. According to the U.S. CENSUS BUREAU, age demographics for the service area show that approximately 22% of the population is under 18 years of age, approximately 60% is between 18 and 64 years of age and that 18% is 65 or older. Caucasians make up 92% of the service area's population while African Americans make up 4% and Hispanics and others make up approximately 4%. The median household income was $44,333 for the service area, which is below the overall average for Alabama and significantly less than the nationwide average. The patient population for Marion Regional Medical Center THAT is uninsured IS 13.1%.

FORM 990, SCHEDULE H, Part VI, Line 5
Promotion of Community Health Marion Regional Medical Center has a commitment to a wide variety of community health outreach activities, which are coordinated by the community health coordinator and are staffed by Marion Regional Medical Center employees who volunteer their time to help with these events and activities. The community health coordinator assists in educating the community on health-related issues by organizing and presenting various health fairs and seminars. These events are held at local businesses, schools and community organizations and address a variety of health-related topics. In addition, the hospital sponsors cholesterol, blood pressure, vision, memory, and heart-risk screening events, through which tests are made available to the public for a nominal fee or at no charge with the majority of the costs incurred absorbed by the hospital.

FORM 990, SCHEDULE H, Part VI, Line 6
Affiliated Health Care System As noted above, Marion Regional Medical Center (MRMC) is part of North Mississippi Health Services (NMHS). NMHS operates North Mississippi Medical Center and five other community hospitals in addition to MRMC, as well as, North Mississippi Medical Clinics, which operates more than 36 medical clinics. Some of these facilities operate at an ongoing financial loss and NMHS provides operating funds in the form of working capital loans that have no set repayment date. These working capital loans have historically been converted to capital transfers in many cases, and therefore, the loans are forgiven such that the facility never makes repayment. NMHS does this in order to provide access to a variety of services across the service area and is an intentional part of its business model. The Community Health department that is part of NMMC coordinates a variety of community health activities across the service area as well.