4A (Expenses $ 64537752 including grants of $ 12023229) (Revenue $ 63505383)
"SAINT LUKE'S HOSPITAL OF CHILLICOTHE D/B/A/ HEDRICK MEDICAL CENTER (""HMC"") IS A LICENSED CRITICAL ACCESS HOSPITAL PROVIDING BOTH INPATIENT AND OUTPATIENT SERVICES. HMC IS LOCATED IN CHILLICOTHE (LIVINGSTON COUNTY), MISSOURI, APPROXIMATELY 90 MILES NORTHEAST OF KANSAS CITY. HEDRICK MEDICAL CENTER IS A FAITH-BASED, NOT-FOR-PROFIT COMMUNITY HOSPITAL COMMITTED TO THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE AND HEALTH RELATED SERVICES IN A CARING ENVIRONMENT. AS A MEMBER OF SAINT LUKE'S HEALTH SYSTEM, HMC IS DEDICATED TO ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF THE COMMUNITIES SERVED. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS FINANCIAL ASSISTANCE POLICIES FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. IN ADDITION TO THE ACTIVE MEDICAL STAFF, HMC'S SPECIALTY CLINICS HOST MORE THAN 30 VISITING SPECIALISTS. THE HOSPITAL ALSO PROVIDES HEALTH RELATED ACTIVITIES AND SERVICES IN SUPPORT OF THE COMMUNITY, INCLUDING BUT NOT LIMITED TO SOCIAL WORK SERVICES, SPIRITUAL SERVICES, AND COMMUNITY EDUCATION/HEALTH FAIRS. The hospital collaborated with other Saint Luke's Health System entities, the Missouri and Kansas Hospital Associations, and Mid-America Regional council to implement initiatives for establishing COVID testing sites, vaccine distribution, expanding virtual visits, and post-discharge follow-up for COVID-19 patients in addition to expanding coverage for the increase in hospitalized patients. The health system realigned its care and services to continue to treat and care for COVID-19 patients while protecting its employees."

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - HEDRICK MEDICAL CENTER. Input from persons representing the broad interests of the community was taken into account through key informant interviews (6 participants) and community meetings (16 participants). Stakeholders included: individuals with special knowledge of or expertise in public health; local public health departments; hospital staff and providers; representatives of social service organizations; and leaders, representatives, and members of medically underserved, low-income, and minority populations. Individuals from the following organizations were interviewed: Community Action Partnership of North Central Missouri, Community Resource Center, Hedrick Family Care, Hedrick Medical Center, Livingston County Health Center, and Saint Luke's Critical Access Region. Individuals from the Bank Midwest - Chillicothe, Chillicothe City Council, Chillicothe R-2 School District, Hedrick Medical Center, and Main Street Chillicothe participated in the community meetings.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - HEDRICK MEDICAL CENTER. The hospital's CHNA identified the following significant health needs in the community served by Hedrick Medical Center: *Access to Care and Health Insurance (Including Transportation and Access to COVID-19 Treatment and Testing Services) To address this need, HMC will implement the following initiatives: 1. Continue to accept Missouri Medicaid. 2. Expand efforts to enroll community members in Medicaid (via Centauri). 3. Provide assistance to patients with the Medicaid application process. 4. Continue efforts to recruit primary care physicians and specialists into the community. 5. Continue helping patients apply for pharmaceutical company Medication Assistance Access Programs. 6. Continue providing staff to address COVID-19 vaccine safety and benefits, social distancing strategies, masking and PPE, and patient education during discharge planning. 7. Continue operating Rural Health Clinics. 8. Provide COVID-19 vaccinations at Rural Health Clinics. 9. Expand virtual visit options for all community members including low-income communities. 10. Support SLHS efforts to update the Financial Assistance Policy and include coverage for Telehealth (virtual visit) services. 11.Continue conducting ""Lunch & Learn"" sessions. 12.Continue supporting the Livingston County Healthy Baby Shower for Expectant Mothers. 13.Continue participating in the Livingston County Breastfeeding Taskforce. 14. Provide staffing to health departments to support community-based health promotion events. 15.Enhance partnerships with area FQHCs. 16.Continue providing flu vaccinations in area schools. 17.Continue providing Head Start and sports physicals for area schools. 18.Explore providing Wellness Clinic services for staff of local school districts. 19.Explore providing health services for area schools using telehealth resources. 20.Continue conducting Community Blood Center Drives. 21.Continue screening patients for transportation needs and making referrals for those in need to appropriate community resources, including OATS Transit. 22.Conduct community health education through social media and marketing. 23. Provide hands-only CPR training. *Mental Health and Access to Mental Health Services To address this need, HMC will implement the following initiatives: 1. Actively recruit mental health providers to serve diverse populations. 2. Continue screening patients for social isolation risks and make referrals to appropriate community resources. 3. Continue connecting patients with Senior Life Solutions, a group counseling (mental health services) program for seniors. 4. Explore providing virtual access to social workers in the emergency room. 5. Expand D.A.R.E. programs (currently in Chillicothe schools R-2) to other area schools. 6. Support restoring/expanding Crittenton Children's Center Trauma Smart program into area schools. 7. Explore partnership opportunities with North Central Missouri Mental Health and with Preferred Family Healthcare: a. Patient referrals. b. Crisis intervention (in area schools and elsewhere). c. QPR Training (Question, Persuade, Refer). d. Mental health first aid training. e. Advocacy for state support of mental health services. f. Other services. 8. Continue participation in Green Hills Regional Crisis Intervention Team Council. 9. Provide community mental health education (e.g., for first responders and others having contact with those experiencing mental health crises). 10. Screen students for mental health issues and risks when conducting Head Start and sports physicals. 11.Collaborate with the HMC Foundation in support of D.A.R.E. programs. *Obesity, Physical Inactivity, and Chronic Conditions To address this need, HMC will implement the following initiatives: 1. Expand efforts to screen patients for food insecurity and providing referrals to appropriate community resources. 2. Continue maintaining community walking trails. 3. Establish partnership with Walk Chillicothe. 4. Restart the hospital's fall prevention program, in partnership with the Livingston County Health Center. 5. Re-establish (chronic disease management) weight reduction programs for adults and for children. 6. Establish a stroke support group (either in-person or virtual). 7. Expand partnerships (e.g., with MU Extension) and programs (e.g., Speaker's Bureau) designed to promote healthy eating. 8. Conduct community health events in collaboration with the health departments intended to enhance Women's Heart Health. 9. Consider participating in Trenton R-9 School District Fit-Tastic programs. No hospital organization can address all of the health needs present in its community. HMC is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a wide range of community benefits. HMC plans to address the Substance Use Disorders and Overdoses community health need as part the above strategic initiatives that focus on mental health. HMC does not intend to address two of the other significant community health needs identified through its 2021 CHNA, namely: 1. Poverty. While the hospital's 2021 CHNA identified poverty as a significant community health need, the committee charged with developing this implementation strategy identified other needs as higher priorities for the 2022-2024 HMC implementation strategy. The hospital's Financial Assistance Policy provides discounts for eligible, low-income households and for those with catastrophic medical bills. The hospital also is a major employer in the county and recognizes its role in enhancing the area's economy. This implementation strategy also includes several initiatives designed to ensure that community members living in poverty have access to preventive services and efforts to collaborate with community organizations that assist lowincome residents. 2. Smoking and Tobacco Use. While the hospital's 2021 CHNA identified smoking and tobacco use as a significant community health need, the committee charged with developing this implementation strategy identified three needs as higher priorities for the 2022-2024 HMC implementation strategy. During the course of providing health services, the hospital will be counseling patients who smoke or use tobacco to seek cessation services and will be making referrals to available resources. The hospital's planned support of D.A.R.E. programs is another way that smoking and tobacco use risks will be addressed."

Schedule H, Part I, Line 3c ASSISTANCE ELIGIBILITY
THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. IN ADDITION, MEDICAL INDIGENCY MAY BE DETERMINED ON AN INDIVIDUAL BASIS FOR INCOME ABOVE THE FEDERAL POVERTY LEVEL WHEN A SINGLE ILLNESS OR INJURY CAUSES HARDSHIP.

Schedule H, Part I, Line 7g Subsidized Health Services
SUBSIDIZED HEALTH SERVICES IS FOR THE RURAL HEALTH CLINIC PROVIDED TO THE COMMUNITY. THE COSTS ATTRIBUTABLE TO THE PHYSICIAN RURAL HEALTH CLINIC INCLUDED IN COLUMN C ARE $5,533,675.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
4185305

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
COST OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO FROM THE HOSPITAL'S COST REPORT.

Schedule H, Part II Community Building Activities
THE ORGANIZATION IS INVOLVED IN SEVERAL COMMUNITY ORGANIZATIONS THAT ARE DEDICATED TO THE IMPROVEMENT OF LIFE IN THE COMMUNITY THROUGH PHYSICAL IMPROVEMENTS AND HOUSING. THE ORGANIZATION HELPS SUPPORT HABITAT FOR HUMANITY THROUGH DONATIONS OF TIME BY EMPLOYEES. MANY OF THE EMPLOYEES PARTICIPATE IN LOCAL ORGANIZATIONS AND CHURCH GROUPS THAT ARE WORKING TO HELP THE COMMUNITY GROW AND BE SUCCESSFUL.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Performance obligations are identified based on the nature of the services provided. Revenue associated with performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected (or actual) charges. Performance obligations satisfied over time relate to patients in the Medical Center receiving inpatient acute care services. The Medical Center measures the performance obligation from admission into the Medical Center, to the point when there are no further services required for the patient, which is generally at the time of discharge. For outpatient and physician clinic services, the performance obligation is satisfied as the patient simultaneously receives and consumes the benefits provided as the services are performed. In the case of outpatient and physician clinic services, recognition of the obligation over time yields the same results as recognizing the obligation at a point in time. The Medical Center believes that this method provides a faithful depiction of the transfer of services over the term of the performance obligations based on the inputs needed to satisfy the obligations. As the Medical Center's performance obligations relate to contracts with a duration of less than one year, the Medical Center has applied the optional exemption provided in FASB ASC 606-10-50-14(a) and, therefore, is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above primarily relate to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. The Medical Center uses a portfolio approach to account for categories of patient contracts as a collective group rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenues and types of services provided for outpatient revenues. Based on historical collection trends and analyses, the Medical Center believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if the individual contract approach were used. The Medical Center determines the transaction price, which involves significant estimates and judgment, based on standard charges for goods and services provided, reduced by explicit and implicit price concessions, including contractual adjustments provided to third-party payers, discounts provided to uninsured and underinsured patients in accordance with the Medical Center's policy and implicit price concessions based on the historical collection experience of patient accounts. The Medical Center determines the transaction price associated with services provided to patients who have third-party coverage based on reimbursement terms per contractual agreements, discount policies, and historical experience. Generally, patients who are covered by third-party payers are responsible for related deductibles and coinsurance, which vary in amount. For those patients and for uninsured patients who do not qualify for charity care, the Medical Center determines the transaction price associated with services on the basis of charges, reduced by implicit price concessions. Implicit price concessions included in the estimate of the transaction price are based on historical collection experience for applicable patient portfolios. Patients who meet the Medical Center's criteria for charity care are provided care without charge or at amounts less than established rates and such amounts are not reported as revenue. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. THE AMOUNT OF BAD DEBT REPORTED IN THIS FORM 990 IS CONSISTENT WITH THE FINANCIAL STATEMENTS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
See footnote provided above in the explanation for Part III, Line 2.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
THE DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF THE PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FOR ANY REMAINING BALANCES DUE, THE SAME COLLECTION POLICY AND PROCEDURES ARE APPLIED EQUALLY TO ALL PATIENT TYPES. ALTHOUGH WE ARE NOT LEGALLY BOUND BY THE FAIR DEBT COLLECTION PRACTICES ACT, THE PRINCIPLES ADDRESSED ARE GENERALLY FOLLOWED.

Schedule H, Part V, Section B, Line 16a FAP website
- HEDRICK MEDICAL CENTER: Line 16a URL: www.saintlukeskc.org/financial-assistance/policy;

Schedule H, Part V, Section B, Line 16b FAP Application website
- HEDRICK MEDICAL CENTER: Line 16b URL: www.saintlukeskc.org/financial-assistance/policy;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- HEDRICK MEDICAL CENTER: Line 16c URL: www.saintlukeskc.org/financial-assistance/policy;

Schedule H, Part VI, Line 2 Needs assessment
THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. WE INVITE COMMUNITY FEEDBACK. WE ALSO SEND PATIENT SATISFACTION SURVEYS TO OUR PATIENTS TO MEASURE HOW WE ARE MEETING THEIR NEEDS.

Schedule H, Part VI, Line 4 Community information
HEDRICK MEDICAL CENTER IS LOCATED IN CHILLICOTHE, MISSOURI, A RURAL COMMUNITY. THE HOSPITAL IS WITHIN A 90 MILE DRIVE OF THE KANSAS CITY METROPOLITAN AREA. THE CITY OF CHILLICOTHE POPULATION IS 9,106, WHILE LIVINGSTON COUNTY (THE COUNTY WHERE THE HOSPITAL IS LOCATED) POPULATION IS 14,969 (2020). The community was defined by considering the geographic origins of the hospital's inpatient discharges and emergency room visits in calendar year 2020. Livingston and Linn counties accounted for approximately 60 percent of the hospital's 2020 inpatient discharges and 78 percent of emergency room cases. The total population of the HMC community in 2019 was 27,239.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO DIRECTLY FROM THE MEDICARE COST REPORT. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN WHAT IT COSTS TO PROVIDE THE CARE AND SERVICES. WE ACCEPT ALL MEDICARE PATIENTS KNOWING THE COST OF PROVIDING THE CARE MAY EXCEED THE FUNDS WE RECEIVE FROM MEDICARE FOR THE SERVICE. OUR SHORTFALL IS CONSIDERED TO BE COMMUNITY BENEFIT. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS, INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR FINANCIAL ASSISTANCE, PATIENT BILLING AND COLLECTION. IN ADDITION TO THESE POLICIES, THE HOSPITAL PROVIDES EDUCATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES THROUGH MANY SOURCES INCLUDING THE SLHS WEBSITE, INFORMATION ON BILLING STATEMENTS, INFORMATION UPON CHECK-IN LOCATED IN THE ADMITTING PATIENT PACKETS, ON OUR B-131 RELEASE TO TREAT FORMS SIGNED BY ALL PATIENTS REQUESTING SERVICES, VISITS WITH INPATIENTS BY SOCIAL WORKER TEAMS, AND FOLLOW-UP CALLS TO PATIENTS AFTER DISCHARGE. FINANCIAL ASSISTANCE APPLICATIONS OR MEDICAID APPLICATIONS ARE REQUESTED ON ALL UNINSURED INPATIENTS PRIOR TO DISCHARGE. THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT COMPANIES TO SCREEN ALL UNINSURED PATIENTS, ANY PATIENTS IDENTIFIED BY OUR SOCIAL WORKER OR CASE MANAGEMENT TEAMS, AND ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. THE ELIGIBILITY ENROLLMENT SERVICE ALSO PROVIDES PATIENTS WITH INFORMATION ON FINANCIAL ASSISTANCE.

Schedule H, Part VI, Line 5 Promotion of community health
THE BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROGRESSIONALS, ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA, PLUS TWO REPRESENTATIVES OF SAINT LUKE'S HEALTH SYSTEM. MEDICAL STAFF PRIVELEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.

Schedule H, Part VI, Line 6 Affiliated health care system
THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSIST OF 16 AREA HOSPITAL FACILITIES, AND SEVERAL PRIMARY AND SPECIALTY CARE PRACTICES, AND PROVIDES A RANGE OF INPATIENT, OUTPATIENT, AND HOME CARE SERVICES. FOUNDED AS A FAITH-BASED, NOT-FOR-PROFIT ORGANIZATION, OUR MISSION INCLUDES A COMMITMENT TO THE HIGHEST LEVELS OF EXCELLENCE IN HEALTH CARE AND THE ADVANCEMENT OF MEDICAL RESEARCH AND EDUCATION. THE HEALTH SYSTEM IS AN ALIGNED ORGANIZATION IN WHICH THE PHYSICIANS AND HOSPITALS ASSUME RESPONSIBILITY FOR ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF PEOPLE IN THE METROPOLITAN KANSAS CITY AREA AND THE SURROUNDING REGION.