Community Benefit Insight - Tax-exempt hospital

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Providence Medical Center

Providence Medical Center

1200 Providence Road
Wayne, NE 68787

Bed count	25	Medicare provider number	281345	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 470566524

Display data for year:

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

2.64%

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	$ 305,066 1.14 %
Medicaid as % of operating expenses	$ 201,913 0.75 %
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	$ 202,419 0.75 %
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	$ 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	$ 545,077 2.03 %
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	$ 342,118 62.77 %

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 $ 21692969 including grants of $ 10493) (Revenue $ 27225898)
PROVIDENCE MEDICAL CENTER IS A NOT-FOR-PROFIT, 21 BED, CRITICAL ACCESS HOSPITAL LOCATED IN WAYNE, NEBRASKA. PROVIDENCE SERVES OVER 15,000 AREA RESIDENTS IN NORTHEAST NEBRASKA AND EMPLOYS OVER 200 PEOPLE. PROVIDENCE OFFERS ACUTE, SKILLED, AND OBSTETRICAL CARE ALONG WITH 24 HOURS A DAY, SEVEN DAYS A WEEK EMERGENCY CARE AND AMBULANCE SERVICES. THE HOSPITAL ALSO PROVIDES DIAGNOSTIC IMAGING, SURGICAL, THERAPY, LABORATORY, ONCOLOGY, RESPIRATORY, HOME HEALTH, BEHAVIORAL HEALTH AND MANY OTHER HEALTH AND WELLNESS SERVICES. THERE ARE OVER 23 SPECIALTY CLINIC DOCTORS OF DIFFERENT SPECIALTIES THAT CONDUCT CLINICS AT THE HOSPITAL IN ORDER TO BRING SPECIALIZED CARE TO THE COMMUNITY.

Facility Information

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

PROVIDENCE MEDICAL CENTER
PART V, SECTION B, LINE 5: THE HEALTH OF THE COMMUNITY IS INFLUENCED BY MANY DIFFERENT AGENCIES AND COMMUNITY SECTORS AND NOT JUST THE PUBLIC HEALTH DEPARTMENT. THE 45 PARTICIPANTS WHO ATTENDED THE MAY 21ST, 2019 INITIAL CHIP MEETING HELD VIRTUALLY ON ADOBE CONNECT WERE ASKED TO RECORD WHAT COMMUNITY SECTOR THEY REPRESENTED WITHIN THE PUBLIC HEALTH SYSTEM. THE FOLLOWING COMMUNITY SECTORS WERE PRESENT AT THE MEETING. HOSPITALS HEALTH CARE PROVIDERS FEDERALLY QUALIFIED HEALTH CENTER LOCAL PUBLIC HEALTH DEPARTMENT FAITH COMMUNITY ACADEMIC INSTITUTION SCHOOL COMMUNITY NOT FOR PROFIT CIVIC GROUP / CLUB CHAMBER OF COMMERCE LOCAL BUSINESS LAW ENFORCEMENT EMS FOUNDATION / PHILANTHROPISTS BEHAVIORAL HEALTH PRIVATE CITIZEN HISPANIC POPULATION

PROVIDENCE MEDICAL CENTER
PART V, SECTION B, LINE 6A: PENDER COMMUNITY HOSPITAL

PROVIDENCE MEDICAL CENTER
PART V, SECTION B, LINE 6B: NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT PROVIDENCE MEDICAL CENTER:PART V, SECTION B, LINE 7A: HTTPS://PROVIDENCEMEDICAL.COM/WP-CONTENT/UPLOADS/2021/02/2019-NNPHD-CHA-COMMUNITY-HEALTH-ASSESSMENT-FINAL1.PDFPROVIDENCE MEDICAL CENTER:PART V, SECTION B, LINE 10A: HTTPS://PROVIDENCEMEDICAL.COM/WP-CONTENT/UPLOADS/2021/02/2020-2022-PMC-CHNA-ACTION-PLAN.PDF

PROVIDENCE MEDICAL CENTER
PART V, SECTION B, LINE 11: WITH THE COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IN CONJUNCTION WITH NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT (NNPHD), PENDER COMMUNITY HOSPITAL, AND COMMUNITY FOCUS GROUPS, THE HEALTH CONCERNS WERE PRIORITIZED, AND STRATEGIES DEVELOPED BY A CORE GROUP OF HOSPITAL ADMINISTRATIVE MEMBERS AND COMMUNITY PARTNERS. THE IMPLEMENTATION STRATEGIES WERE BROUGHT BEFORE THE PROVIDENCE MEDICAL CENTER BOARD OF DIRECTORS FOR APPROVAL AND ADOPTION. PRIORITIZED LIST OF SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNATHROUGH THE DISCUSSION AND CONSENSUS VOTING, THE FOLLOWING COMMUNITY HEALTH PRIORITY AREAS WERE FINALIZED:PRIORITY 1: BEHAVIORAL HEALTH PRIORITY 2: OVERWEIGHT/OBESITYPRIORITY 3: CHRONIC DISEASE DETECTION AND MANAGEMENTTHE IMPACT OF ADDRESSING THESE CONCERNS WOULD OFFER THE FOLLOWING: IMPROVE ACCESS TO CARE MANAGEMENT ENHANCE POPULATION HEALTH OF THE COMMUNITY ADVANCE KNOWLEDGE OF DISEASE PROCESS AND MENTAL WELLNESSADDRESSING THESE NEEDS WILL BENEFIT OUR COMMUNITY AND RESULT IN MEASURABLE EXPENSE TO PROVIDENCE MEDICAL CENTER.RESOURCES COMMITTED WILL INVOLVE FINANCIAL SUPPORT OF ORGANIZATIONAL/ACTIVITY EXPENSE, EMPLOYEE WAGE, USE OF MEDICAL EQUIPMENT AND CLERICAL ITEMS.

PROVIDENCE MEDICAL CENTER
PART V, SECTION B, LINE 15E: PROVIDENCE MEDICAL CENTER MAY ASSIST PATIENTS IN APPLYING FOR MEDICARE, MEDICAID, AND OTHER GOVERNMENTAL MEDICAL ASSISTANCE PROGRAMS.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
UNINSURED, UNDERINSURED, AND INDIGENT BY DESIGN PATIENTS WHOSE INCOME/FAMILY INCOME IS GREATER THAN 400% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR DISCOUNTED CARE BASED ON THEIR PARTICULAR CIRCUMSTANCES. SUCH DISCOUNTS ARE AT THE DISCRETION OF THE ORGANIZATION AND WILL NOT BE COUNTED AS CHARITY CARE.

PART I, LINE 7:
THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.

PART III, LINE 2:
THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.

PART III, LINE 4:
IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.

PART III, LINE 8:
THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSEPROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONSAND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TOPROVIDE MEDICAL CARE IN THIS COMMUNITY.THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.

PART III, LINE 9B:
PROVIDENCE MEDICAL CENTER HAS A STRONG COMMITMENT TO THE COMMUNITY AND TO THE PATIENTS THAT WE SERVE. MEDICAL TREATMENT IS PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN DOING SO, WE SHALL: INFORM THE PUBLIC OF THE AVAILABILITY OF ALTERNATIVE PAYMENT ARRANGEMENTS, INCLUDING PAYMENT PLANS AND FINANCIAL ASSISTANCE PROGRAMS; PROVIDE FINANCIAL COUNSELING TO PATIENTS ABOUT THEIR HOSPITAL BILLS; RESPOND PROMPTLY TO PATIENTS' QUESTIONS ABOUT THEIR BILLS AND REQUESTS FOR FINANCIAL HELP THROUGH AN ACCEPTABLE PAYMENT PLAN AND/OR THROUGH FINANCIAL ASSISTANCE; AND PURSUE COLLECTION OF ACCOUNTS FAIRLY AND CONSISTENTLY AND WITHIN OUR WRITTEN GUIDELINES AND ENSURE THAT AGENCIES ACTING ON OUR BEHALF IN THE COLLECTION OF DEBT ALSO ACT IN ACCORDANCE WITH OUR MISSION AND GUIDELINES.

PART VI, LINE 2:
"PMC WORKS WITH THE STATE OF NEBRASKA AND THE NEBRASKA HOSPITAL ASSOCIATION TO REVIEW PATIENT DATA AND OUTCOMES. ONE OF THE PRODUCTS USED IS COMS (CLINICAL OUTCOMES MEASUREMENT SYSTEM) WHICH GIVES OUTCOME DATA FOR MORBIDITY AND MORTALITY FOR THE STATE OF NEBRASKA AND OUR SERVICE AREA. PMC ALSO HAS WORKED WITH THE NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT WITH MAPP WHICH IS ""MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP,"" WHICH IDENTIFIES PUBLIC HEALTH ISSUES AND FINDS RESOURCES TO ADDRESS THEM."

PART VI, LINE 3:
PAYMENT POLICIES AND FINANCIAL ASSISTANCE INSTRUCTIONS ARE GIVEN WITH ADMISSION DOCUMENTS, INCLUDED WITH EACH BILL, UPLOADED ON PMC'S WEBSITE, AND POSTED THROUGHOUT PMC'S FACILITIES.

PART VI, LINE 4:
THE HEALTHCARE FACILITY IS LOCATED IN WAYNE, NEBRASKA WHERE IT SERVES RESIDENTS OF NORTHEASTERN NEBRASKA. THE POPULATION BASE FROM THE NEARBY COMMUNITIES IS APPROXIMATELY 9,600 WITH AN AVERAGE INCOME OF APPROXIMATELY $45,000.

PART VI, LINE 5:
THE HOSPITAL HAS A COMMUNITY BOARD WITH MEMBERS THAT REPRESENT DIFFERENT TOWNS IN OUR SERVICE AREA. WE STRIVE TO INVEST OUR FUNDS IN BANKS WITHIN OUR SERVICE AREA. ALSO THE HOSPITAL'S ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA.

PART VI, LINE 6:
THE HOSPITAL IS NOT AFFILIATED WITH ANY OTHER HEALTH SYSTEMS.

PART VI, LINE 7, REPORTS FILED WITH STATES
NE

Operating expenses	$ 26,825,547
Total amount spent on community benefits as % of operating expenses	$ 709,398 2.64 %