4A (Expenses $ 22304975 including grants of $ 0) (Revenue $ 0)
SEE SCHEDULE O

Facility: SPRINGHILL MEDICAL SERVICES - Part V, Section B, Line 5
"PART V, SECTION B, LINE 3 - EXPLANATION OF HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY AND THE IDENTITY OF THE PERSONS THE HOSPITAL CONSULTED: SPRINGHILL MEDICAL CENTER ESTABLISHED A STEERING COMMITTEE TO ASSIST IN THE DEVELOPMENT OF THE CHNA. THE STEERING COMMITTEE CONSISTED OF THE FOLLOWING REPRESENTATIVES FROM SENIOR MANAGEMENT: MIKE PATRONIS (CHIEF EXECUTIVE OFFICER), DANA JONES (COO), KRISTEN COLE(CHIEF NURSING OFFICER), DAVID SANDERS (CHIEF FINANCIAL OFFICER), AND DEREK MELANCON (HUMAN RESOURCES/MARKETING). THE STEERING COMMITTEE SERVED FOUR PRIMARY PURPOSES: TO IDENTIFY AND INVITE KEY COMMUNITY STAKEHOLDERS TO SERVE AS CHNA COMMITTEE MEMBERS, TO SCHEDULE, ORGANIZE, AND FACILITATE CHNA COMMITTEE MEETINGS, TO COMPILE STATISTICAL DATA FOR CONSIDERATION BY THE CHNA COMMITTEE, AND TO PREPARE THE FINAL REPORT FOR THE ORGANIZATION. THE STEERING COMMITTEE CONSCIENTIOUSLY TOOK INTO ACCOUNT THE HOSPITAL'S SERVICE AREA WHEN SELECTING THE GROUP OF INDIVIDUALS TO SERVE ON THE CHNA COMMITTEE. IN SELECTING COMMUNITY PARTICIPANTS, THE STEERING COMMITTEE CONSIDERED EACH RESIDENT'S INVOLVEMENT IN THE COMMUNITY AND ENSURED THERE WAS ADEQUATE DIVERSITY FROM THE SERVICE AREA. THE FOLLOWING COMMUNITY MEMBERS PARTICIPATED: RAY HUDDLESTON (MAYOR OF SPRINGHILL), RONNIE DEES (COUNCIL MEMBER/BUSINESSMAN), D. NICOLE FRAZIER (COUNCIL MEMBER), STACY WILLARD (COUNCIL MEMBER), RONNIE HEARNSBERGER (COUNCIL MEMBER/BUSINESSMAN), RHONDA TAYLOR (CHAMBER MANAGER), MARGERT EDENS (SCHOOL BOARD MEMBER), LISA SMITH (COUNSELOR), KINDLE MASTERS (CHAMBER PRESIDENT), AMBER COBB (MAIN STREET MANAGER), LAURA TUCKER, (PRACTICE MANAGER HOMER), BRIDGETT SALISBURY (NEW VISIONS MARKETER), BRUCE BLANTON (POLICE JUROR), WAYNE KING (RETIRED EDUCATOR), AND TIM MOUSER (MAYOR OF SHONGALOO). KRISTIN DICKINSON, (FNP/BC), DR. SAMUEL ABHSIRE, AND DONNA MORRIS (BUS DEVELOPMENT SMC)ALSO SERVED ON THE CHNA COMMITTEE. THE CHNA COMMITTEE UTILIZED A SURVEY PROCESS TO GATHER COMMUNITY INPUT. THERE WERE 214 SURVEYS COLLECTED FROM PAPER AND ONLINE SOURCES. THE SUMMARY OF SURVEY RESULTS BEGIN ON PAGE 13 OF THE ATTACHED 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. ALSO, INCLUDED IN THE CHNA ARE SEVERAL CHARTS OF INDICATORS, MORTALITIES, CHNA COMMITTEE RECOMMENDATIONS OF PRIORITIES AND STRATEGIC IMPLEMENTATION PROCESSES. FURTHERMORE, SPRINGHILL MEDICAL CENTER'S GOAL IS TO ADDRESS ""ALL"" OUR COMMUNITY'S HEALTHCARE NEEDS THAT FALL WITHIN OUR SCOPE OF AVAILABLE SERVICES AND TO ASSIST THEM IN RECEIVING SPECIALIZED HEALTHCARE BY A PROVIDER OF THEIR CHOICE."

Facility: SPRINGHILL MEDICAL SERVICES - Part V, Section B, Line 6a
PART I, LINE 6a - COMMUNITY BENEFIT REPORT: SEE ATTACHED CHNA.

Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)
100% to 200% FPG Discounted

Part I, Line 7 - Explanation of Costing Methodology
SPRINGHILL MEDICAL SERVICES, INC. (SMC) USED A CALCULATED COST TO CHARGE RATIO PER WORKSHEET 2 IN THE INSTRUCTIONS FOR FORM 990 SCHEDLE H PUBLISHED BY THE INTERNAL REVENUE SERVICE FOR (A), (B), (C), AND (G). ACTUAL COST INCURRED WAS USED FOR (E) AND (F).

Part I, Line 7, Column F - Explanation of Bad Debt Expense
"The Hospital adopted ASC 606 during fiscal year 2020. As a result of that adoption, estimated uncollectible amounts due from these patients are generally considered implicit price concessions, presented as a direct reduction to patient service revenue, and not presented separately as provision for bad debts. The provision for bad debts is determined considering historical experience, trends in health coverage, geographical data, and other collection indicators. THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT IS RELATED TO BAD DEBT STATES ""The Hospital also provides services to uninsured patients, and offers those uninsured patients a discount, either by policy or law, from standard charges. The Hospital estimates the transaction price for patients with deductibles and coinsurance and from those who are uninsured based on historical experience and current market conditions. The initial estimate of the transaction price is determined by reducing the standard charge by any contractual adjustments, discounts, and implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenue in the period of the change. For 2021 and 2020, adjustments were recognized due to changes in the Hospitals estimates of implicit price concessions, discounts, and contractual adjustments for performance obligations satisfied in prior years were not significant. Subsequent changes that are significant and determined to be the result of an adverse change in the patients ability to pay, determined on a portfolio basis, are recorded as bad debt expense.Consistent with the Hospitals mission, care is provided to patients regardless of their ability to pay. Therefore, the Hospital has determined it has provided implicit price concessions to uninsured patients and patients with other uninsured balances (for example, copays and deductibles). The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts the Hospital expects to collect based on its collection history with those patients.""THE RATIONALE FOR INCLUDING ANY PORTION OF BAD DEBT AS COMMUNITY BENEFIT IS PRIMARILY DUE TO SMC'S RURAL LOCATION AND PROVIDING ACCESS TO PATIENTS EVEN THOUGH THEY ARE UNWILLING TO PAY OR THEY ARE UNABLE TO PAY BUT ARE UNWILLING TO FOLLOW OUR FINANCIAL ASSISTANCE PROGRAM. BY NOT BLOCKING ACCESS TO CARE, SMC KEEP THE COMMUNITY HEALTHY."

Part III, Line 4 - Bad Debt Expense
NOTE 11 NET PATIENT SERVICE REVENUE

Part III, Line 8 - Explanation Of Shortfall As Community Benefit
TREATING MEDICARE PATIENTS AND FUNDING THE ASSOCIATED SHORTFALLS ARE CONSIDERED PART OF THE FINANCIAL OBLIGATION OF SMC. COSTS OF TREATING MEDICARE PATIENTS AND THE RELATED COMMUNITY BENEFIT ARE DETERMINED BASED ON REIMBURSEMENT REPORTS FILED WITH MEDICARE.

Part VI, Line 2 - Needs Assessment
SMS,INC. ASSESSES THE NEEDS OF THE COMMUNITY THROUGH A COLLABORATION BETWEEN PHYSICIANS, CASE MANAGERS, AND OUTREACH COORDINATORS WHO SPEND TIME IN THE COMMUNITY PROVIDING EDUCATION, WELLNESS TESTS, AND ASSESSMENTS OF PATIENTS WITH CERTAIN DIAGNOSES. NEEDS ASSESSMENT IS ALSO ACCOMPLISHED THROUGH PARTICIPATON IN SPRINGHILL COMMUNITY NETWORK AND THE SENIIOR FRIENDS 50+ COMMUNITY GROUP.

Part VI, Line 3 - Patient Education of Eligibility for Assistance
SMS,INC. D/B/A SMC STRIVES TO INFORM AND EDUCATE ALL OUR UNINSURED PATIENTS THAT PRESENT TO OUR FACILITIES ABOUT OUR FINANCIAL ASSISTANCE POLICY. UNINSURED PATEINTS ARE EDUCATED ON MEDICAID AND OUR CHARITY CARE PROGRAM WHEN THEY PRESENT TO OUR FACILITY AS EMERGENCY, OUTPATIENT, OR INPATIENT. WE HAVE SEVERAL MEDICAID APPLICATION REPRESENTATIVES AT OUR FACILITY THAT CAN TAKE APPLICATIONS FOR MEDICAID AND PATIENTS ARE GIVEN INFORMATION ON HOW TO APPLY. PATIENTS ARE ALSO GIVEN A FINANCIAL ASSISTANCE APPLICATION THAT CONTAINS INSTRUCTIONS AND CONTACT INFORMATION. ALL OF OUR INITIAL BILLING STATEMENTS INFORM THE PATIENTS THAT IF THEY FEEL THEY MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE TO CONTACT THE BUSINESS OFFICE. THE FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE ON OUR WEBSITE WWW.SMCCARE.COM ALONG WITH AN APPLICATION AND PLAIN LANGUAGE FA POLICY.

Part VI, Line 4 - Community Information
SMS, INC. D/B/A SMC SERVES THE RURAL COMMUNITY OF NORTH WEBSTER PARISH IN LOUISIANA AND SOUTH COLUMBIA COUNTY IN ARKANSAS. THE POPULATION OF THE COMMUNITY IS APPROXIMATELY 36,000. THE AVERAGE INCOME IS APPROXIMATELY $30,000 PER YEAR AND ABOUT 19.7% OF THE COMMUNITY HAS INCOME BELOW THE FEDERAL POVERTY GUIDELINES. THE PATIENT MIX OF UNINSURED AND MEDICAID IS 2% AND 29%.

Part VI, Line 4 - Community Building Activities
THROUGH THE CLEANUP AND MAINTENANCE OF COMMUNITY PARKS, SMC MAKES ENVIRONMENTAL IMPROVEMENTS BY REMOVING TRASH AS WELL AS PROMOTING PHYSICAL ACTIVITY.

Part VI - Additional Information
PART 1, LINE 6A: COMMUNITY BENEFIT REPORT: SEE ATTACHED CHNAPART III, LINE 2: THE COST OF THE BAD DEBT REPORTED WAS CALCULATED BY APPLYING THE COST TO CHARGE RATIO FROM WORKSHEET 2 TO BAD DEBT GROSS CHARGES THAT HAVE BEEN DEEMED UNCOLLECTIBLE AFTER REASONABLE COLLECTION EFFORTS.PART III, LINE 3: THE AMOUNT CALCULATED AS BAD DEBT ATTRIBUTABLE TO FAP-ELIGIBLE PATIENTS WAS DETERMINED USING STATISTICAL DATA BASED UPON THE PERCENT OF APPROVED FAP APPLICATIONS TO RETURNED FAP APPLICATIONS.PART III, LINE 4: THE FOOTNOTE IN THE ORGANIZATON'S FINANCIAL STATEMENTS RELATED TO BAD DEBT IS NOTE 11 ON PAGE 8.PART III, LINE 8: THE AMOUNT REPORTED IN PART III, LINE 6 COMES DIRECTLY FROM THE MOST RECENTLY FILED MEDICARE COST REPORT.PART III, LINE 9B: THE COLLECTION PRACTICE FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FAP IS TO ASSIST THEM WITH AN APPLICATION TO THE STATE MEDICAID PROGRAM AND IF THE PATIENT IS NOT ELIGIBLE THEN THEIR CHARGES ARE REDUCED BY A PERCENTAGE USING INCOME AND THE FEDERAL POVERTY GUIDELINES.PART VI #2: NEEDS ASSESSMENTS OTHER THAN THROUGH A CHNA INCLUDE A COLLABORATION BETWEEN PHYSICIANS, CASE MANAGERS, AND OUTREACH COORDINATORS WHO SPEND TIME IN THE COMMUNITY PROVIDING EDUCATION AND WELLNESS TESTS. PART VI #4: SEE ATTACHED CHNA.