4A (Expenses $ 93480442 including grants of $ 0) (Revenue $ 111475838)
INPATIENT HEALTHCARE SERVICES - THERE WERE 3,018 ADMISSIONS TO THE HOSPITAL IN 2021, REPRESENTING 8,102 PATIENT DAYS OF CARE. THERE WERE 322 INPATIENT SURGERIES PERFORMED DURING 2021. OUTPATIENT HEALTHCARE SERVICES - THERE WERE 103,613 OUTPATIENT REGISTRATIONS RECORDED IN 2021.SAME DAY SURGERY - THERE WERE 3,559 OUTPATIENT SURGERIES PERFORMED AT THE HOSPITAL IN 2021. EMERGENCY SERVICES 18,106; HOME HEALTH VISITS 23,533; HOSPICE 6,545; OCCUPATIONAL HEALTH VISITS 15,061; WILSON HEALTH MEDICAL GROUP OFFICE VISITS 117,615 HEALTH CARE SERVICES RELATED TO IMPROVING THE HEALTH OF THE COMMUNITY FOR BOTH INPATIENT AND OUTPATIENT PROGRAMS.

THE SHELBY COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: THIRTY-FIVE HOSPITALS CAME TOGETHER TO CONDUCT A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR SOUTHWEST OHIO, ORGANIZED BY THE HEALTH COLLABORATIVE IN CINCINNATI, OHIO AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION IN DAYTON, OHIO. THE HEALTH COLLABORATIVE ASSEMBLED A HIGHLY-QUALIFIED TEAM WHICH INCLUDED A CONSULTANT WITH PRIOR CHNA EXPERIENCE.

THE SHELBY COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 6A: THE 35 HOSPITALS SERVED 25 COUNTIES IN OHIO, KENTUCKY, AND INDIANA. FOR THIS CYCLE, 28 LOCAL HEALTH DEPARTMENTS ALSO COLLABORATED TO SHAPE THE PROCESS AND SHARE DATA. CONSISTENT SOURCES OF COMPARABLE DATA WERE AVAILABLE ONLY AT THE STATE AND COUNTY LEVEL, AND THEREFORE EACH PARTICIPATING HOSPITAL IDENTIFIED WHICH COUNTIES CONTAINED THEIR SERVICES AREAS. RESULTS IN THE CHNA REPORT INCLUDE DATA FROM A STRUCTURED SURVEY, QUALITATIVE DATA FROM MULTIPLE FOCUS GROUPS,AN ANALYSIS OF AVAILABLE SECONDARY DATA, AND FINDINGS FROM HEALTH DEPARTMENTS.

THE SHELBY COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 6B: FOR THIS CYCLE, 28 LOCAL HEALTH DEPARTMENTS ALSO COLLABORATED TO SHAPE THE PROCESS AND SHARE DATA.

THE SHELBY COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: DRUG DETOX:-COMMUNITY NEEDS ADDRESSED: SUBSTANCE ABUSE, MENTAL HEALTH, AND ACCESS TO CARE-GOAL: TO INCREASE THE RESOURCES AVAILABLE FOR PEOPLE SUFFERING FROM ADDICTION, ESPECIALLY OPIOID.-STRATEGY/ACTION: CREATE A PARTNERSHIP TO DEVELOP AN INPATIENT DETOX PROGRAM.-BACKGROUND: AS WITH MANY COMMUNITIES IN SOUTHWEST OHIO, SHELBY COUNTY IS EXPERIENCING AN INCREASE IN DRUG OVERDOSE DEATHS. THERE WERE 20 DRUG OVERDOSE DEATHS PER 100,000 RESIDENTS, COMPARED TO 17 FOR THE STATE OF OHIO. OTHER RISKY BEHAVIORS ARE ALSO INCREASING, WITH A RESULTANT RISE IN THE RATES OF SEXUALLY TRANSMITTED DISEASES. IT WAS A TOP CONCERN EXPRESSED AT THE COMMUNITY MEETING, IN RESIDENT SURVEYS, BY NONPROFIT AGENCIES, AND BY THE SIDNEY-SHELBY COUNTY HEALTH DEPARTMENT. THE MEETING PARTICIPANTS AND THE HEALTH DEPARTMENT SPECIFICALLY MENTIONED THE CRISIS OF OPIOID ADDICTION.TELEHEALTH:-COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE AND CHRONIC DISEASE-GOAL: TO INCREASE ACCESS TO PRIMARY CARE.-STRATEGY/ACTION: IMPLEMENT TELEHEALTH SERVICES ACCESSIBLE TO PATIENTS THROUGHOUT THE WILSON HEALTH HEALTHCARE SYSTEM-BACKGROUND: TELEHEALTH IS AN IMPORTANT RESOURCE IN A COUNTY THAT IS 51 % RURAL. RATES OF BREAST, LUNG CANCER, AND OVERALL CANCER ARE HIGHER HERE THAN FOR THE UNITED STATES OR THE STATE OF OHIO. THERE ARE ALSO FEWER PRIMARY CARE PROVIDERS PER CAPITA. ACCESS TO CARE WAS A PRIORITY AT THE COMMUNITY MEETINGS, IN AGENCY SURVEYS, AND FROM THE LOCAL HEALTH DEPARTMENT. HEALTH CLINICS:-COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE AND CHRONIC DISEASE-GOAL: TO INCREASE ACCESS TO PRIMARY CARE.-STRATEGY/ACTION: CREATE 3 COMMUNITY-BASED CLINICS, WITH THE COLLABORATION OF LOCAL EMPLOYERS, TO ESTABLISH ON-SITE AND/OR NEAR-SITE FOR MORE RESIDENTS TO ACCESS.-BACKGROUND: THERE ARE FEWER PRIMARY CARE PROVIDERS PER CAPITA IN SHELBY COUNTY THAN IN OHIO OR THE UNITED STATES. ACCESS TO CARE WAS A PRIORITY AT THE COMMUNITY MEETINGS, IN AGENCY SURVEYS, AND FROM THE LOCAL HEALTH DEPARTMENT. RATES OF BREAST, LUNG CANCER, AND OVERALL CANCER ARE HIGHER HERE THAN FOR THE UNITED STATES OR THE STATE OF OHIO. LUNG CANCER AND HEART DISEASE ARE THE LEADING CAUSES OF DEATH.CHRONIC DISEASE MANAGEMENT & PREVENTION:-COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE AND CHRONIC DISEASE-GOAL: INCREASE KNOWLEDGE ABOUT CHRONIC DISEASES IN GENERAL, INCLUDING PREVENTION AND DISEASE MANAGEMENT-STRATEGY/ACTION: COMMUNITY ENGAGEMENT TO PROVIDE EDUCATION, SCREENING AND SUPPORT TO PREVENT AND/OR MANAGE CHRONIC DISEASES-BACKGROUND: ACCESS TO CARE WAS A PRIORITY AT THE COMMUNITY MEETINGS, IN AGENCY SURVEYS, AND FROM THE LOCAL HEALTH DEPARTMENT. RATES OF BREAST, LUNG CANCER, AND OVERALL CANCER ARE HIGHER HERE THAN FOR THE UNITED STATES OR THE STATE OF OHIO. LUNG CANCER AND HEART DISEASE ARE THE LEADING CAUSES OF DEATH. IN ADDITION, THE PERCENTAGE OF THE POPULATION AGE 65 AND OLDER IS INCREASING AND EXCEEDS THE STATE PERCENTAGE.3-D MAMMOGRAPHY SCREENING:-COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE, CHRONIC DISEASE AND HEALTHY BEHAVIORS-GOAL: TO INCREASE THE NUMBER OF WOMEN WHO RECEIVE 3-D MAMMOGRAMS.-STRATEGY/ACTION: CONTINUE AND EXPAND SCREENING FOR BREAST CANCER WITH 3-D MAMMOGRAPHY.-BACKGROUND: 3-D MAMMOGRAPHY HAS THE FOLLOWING ADVANTAGES: EARLY DETECTION OF BREAST CANCER IN THE ABSENCE OF ANY SIGNS OR SYMPTOMS; LESS NEED FOR FOLLOW-UP IMAGING; IDENTIFIES MORE CANCERS; AND IMPROVES DETECTION OF CANCER IN DENSE BREAST TISSUE.CHRONIC WOUND MANAGEMENT CLINIC:-COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE AND CHRONIC DISEASE-GOAL: TO SPEED THE RECOVERY FROM NON-HEALING WOUNDS AND AVOID FURTHER COMPLICATIONS.-STRATEGY/ACTION: CREATE A CLINIC DEDICATED TO CHRONIC WOUND MANAGEMENT.-BACKGROUND: NON-HEALING WOUNDS CAN BE LIFE-THREATENING IF UNTREATED AND ADVERSELY IMPACT QUALITY OF LIFE. WOUNDS CAN RESULT FROM POOR BLOOD CIRCULATION, DIABETES, BURNS, ULCERS, INFECTIONS, SURGERY, MALIGNANCY, AND LACERATIONS. IN SHELBY COUNTY, 11% OF THE POPULATION HAVE DIABETES.

THE SHELBY COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 16J: SIGNS AT REGISTRATION AS WELL AS INFORMATION ADDED TO THE FRONT OF THE STATEMENT TO MAKE THOSE UTILIZING SERVICES AWARE.

THE SHELBY COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 20E: NOTIFIED PATIENTS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSIONNOTIFIED PATIENTS OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE

THE SHELBY COUNTY MEMORIAL HOSPITAL
"PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE GROSS AMOUNT AND A DISCOUNT IS APPLIED FOR THOSE THAT QUALIFY. WILSON HEALTH LIMITS THE AMOUNTS CHARGED FOR EMERGENCY AND MEDICALLY NECESSARY SERVICES PROVIDED TO INDIVIDUALS ELIGIBLE FOR ASSISTANCE UNDER THIS POLICY TO NOT MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE FOR SUCH CARE. THE AGB IS DERIVED BY DIVIDING (1) THE SUM OF ALL CLAIMS FOR MEDICALLY NECESSARY SERVICES PROVIDED AT WILSON HEALTH AND PAID DURING THE RELEVANT PERIOD BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYERS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBLES, BY (2) THE CHARGES SET FORTH IN THE WILSON HEALTH CHARGEMASTER AT THE TIME THE SERVICES ARE RENDERED. WILSON HEALTH-SPECIFIC AGB PERCENTAGE SHALL BE CALCULATED ANNUALLY FOR A TWELVE (12) MONTH PERIOD FROM JANUARY 1 TO DECEMBER 31 AND ALLOWS 120 DAYS FOR SUCH CALCULATION TO BE MADE AND UPDATED IN THE FAP. THE CALCULATION OF THE HOSPITAL-SPECIFIC AGB PERCENTAGE SHALL COMPLY WITH THE ""LOOK-BACK METHOD"" DESCRIBED IN THE IRS REGULATION 501(R)-5(B)(1)(B)."

THE SHELBY COUNTY MEMORIAL HOSPITAL:
SCHEDULE H, PART V, LINE 22:IN FULFILLING WILSON MEMORIAL HOSPITAL'S MISSION, WE RECOGNIZE THAT WE WILL NOT RECEIVE PAYMENT FROM CERTAIN INDIVIDUALS FOR CARE THAT HAS BEEN RENDERED, AND A CERTAIN DEGREE OF JUDGMENT WILL BE REQUIRED IN DETERMINING CHARITY CARE LEVELS OF THE PATIENTS.POLICYWILSON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT ENTITY ESTABLISHED TO MEET THE HEALTH CARE NEEDS OF ALL CITIZENS OF SIDNEY AND SURROUNDING COMMUNITIES. WILSON MEMORIAL HOSPITAL WILL PROVIDE CHARITABLE CARE FOR THOSE INDIVIDUALS WHO CAN DEMONSTRATE THE INABILITY TO PAY BASED ON THEIR FINANCIAL STATUS AS IT RELATES TO HOSPITAL AND FEDERAL POVERTY LEVEL GUIDELINES.RESPONSIBILITYTHE HOSPITAL HAS A LEGAL AND MORAL OBLIGATION TO PROVIDE EMERGENCY, TRAUMA AND OBSTETRICAL CARE BEFORE DETERMINING THE SOURCE OF PAYMENT.ELIGIBILITY REQUIREMENTSI. ALL WILSON MEMORIAL HOSPITAL PATIENTS WHO ARE UNABLE TO PAY FOR HOSPITAL SERVICES WILL BE ELIGIBLE TO APPLY FOR CHARITY ASSISTANCE.II. CHARITY ASSISTANCE MAY BE APPROVED ON TOTAL OR PARTIAL PATIENT RESPONSIBILITY. DOLLAR AMOUNTS ARE BASED ON FINANCIAL INFORMATION SUPPLIED BY THE PATIENT.III. PATIENTS WILL BE ELIGIBLE FOR TOTAL CHARITY ASSISTANCE IF:A. THE PATIENT IS INELIGIBLE FOR PUBLIC ASSISTANCE (MEDICAID, GENERAL ASSISTANCE, ETC.).B. THE PATIENT COMPLETES A FINANCIAL STATEMENT INDICATING CURRENT EARNINGS, EXPENSES AND PERSONAL/FAMILY INFORMATION. WE WILL ACCEPT THE PATIENT'S DECLARATION OF INCOME.C. THE PATIENTS AND/OR FAMILY INCOME DOES NOT EXCEED 1.25 TIMES THE POVERTY GUIDELINES AS ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.IV. PATIENTS WILL BE ELIGIBLE FOR PARTIAL CHARITY ASSISTANCE IF:A. THE PATIENT IS INELIGIBLE FOR PUBLIC ASSISTANCE (MEDICAID, GENERAL ASSISTANCE, ETC.) EITHER OR PARTIAL COVERAGE.B. THE PATIENT COMPLETES A FINANCIAL STATEMENT INDICATING CURRENT EARNINGS, EXPENSES AND PERSONAL/FAMILY INFORMATION. WE WILL ACCEPT THE PATIENT'S DECLARATION OF INCOME.C. THE PATIENTS AND/OR FAMILY INCOME DOES NOT EXCEED THREE TIMES THE POVERTY GUIDELINES AS ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.D. THE PATIENT AND/OR FAMILY INCOME EXCEEDS THREE TIMES THE INCOME POVERTY/GUIDELINES, DETERMINATION OF ELIGIBILITY AND AMOUNT OF CHARITY CARE WILL BE BASED ON FINANCIAL STATEMENT FROM PATIENT ON AN ACCOUNT BY ACCOUNT BASIS.V. PATIENTS MAY NOT BE ELIGIBLE FOR CHARITY CARE ASSISTANCE IF THE PROCEDURE PROVIDED IS ELECTIVE. EACH INSTANCE WILL BE REVIEWED ON A CASE BY CASE BASIS WITH MEDICAL STAFF AND MANAGEMENT INPUT.

THE SHELBY COUNTY MEMORIAL HOSPITAL:
SCHEDULE H, PART V, LINE 16A: HTTPS://WWW.WILSONHEALTH.ORG/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16B: HTTPS://WWW.WILSONHEALTH.ORG/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16C: HTTPS://WWW.WILSONHEALTH.ORG/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCE

PART I, LINE 3C:
IN ADDITION TO THE FPG, THE ORGANIZATION CONSIDERS MEDICAL INDIGENCY WHEN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY.

PART I, LINE 7:
THE SHELBY COUNTY MEMORIAL HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES.

PART I, LINE 7, COMMUNITY BENEFITS:
IN RESPONSE TO THE COVID PANDEMIC, WILSON HEALTH PROVIDED EXTENSIVE OUTREACH TO ITS EMPLOYEES AND THE COMMUNITY INCLUDING CLINICS TO ADMINISTER THE VACCINATION AND NUMEROUS COVID EDUCATIONAL PROGRAMS BOTH ON CAMPUS AND THROUGHOUT THE COMMUNITY WE SERVE.

PART III, LINE 2:
ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE HOSPITAL'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, 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 ORATION 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 DOUBTFUL ACCOUNTS.

PART III, LINE 3:
"THE SHELBY COUNTY MEMORIAL HOSPITAL DOES NOT ATTRIBUTE ANY BAD DEBT EXPENSE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP), THEREFORE NO PORTION OF BAD DEBT ATTRIBUTABLE TO FAP-ELIGIBLE INDIVIDUALS IS CONSIDERED A COMMUNITY BENEFIT."""

PART III, LINE 4:
FOR FOOTNOTE, SEE PAGE 15 OF THE 12/31/21 AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
THE ELDERLY ARE OFTEN AN UNDERSERVED POPULATION THAT EXPERIENCE ISSUES REGARDING ACCESS TO HEALTHCARE SERVICES. MEDICARE IS OUR LARGEST PAYER, AND HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY HAVE A SURPLUS OR DEFICIT FROM PROVIDING THESE SERVICES. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A COMMUNITY BENEFIT. IF TAX EXEMPT HOSPITALS DID NOT PROVIDE MEDICARE SERVICES, THE FEDERAL GOVERNMENT WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE MEDICARE ELIGIBLE. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 12/31/21 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST.

PART VI, LINE 2:
THE ANNUAL STRATEGIC PLANNING PROCESS UTILIZES MARKET DATA WHICH SHOWS SERVICES THAT SHELBY COUNTY RESIDENTS LEAVE TO OBTAIN ELSEWHERE. INPUT IS PROVIDED BY COMMUNITY MEMBERS WHO SIT ON HOSPITAL BOARD.

PART VI, LINE 3:
INCOME ELIGIBILITY GUIDELINES ARE CONSPICUOUSLY POSTED AT ALL REGISTRATION POINTS. IN ADDITION, THE GUIDELINES ARE PRINTED ON PATIENT STATEMENTS AND BILLS. THE HOSPITAL EMPLOYS FINANCIAL COUNSELORS WHO MEET PERSONALLY AND BY PHONE WITH PATIENTS TO ASSIST THEM IN COMPLETING FORMS TO DETERMINE THE EXTENT OF THEIR ELIGIBILITY FOR ANY FINANCIAL ASSISTANCE.

PART VI, LINE 4:
THE PRIMARY SERVICE AREA IS SHELBY AND SURROUNDING COUNTIES. WITH THE EXCEPTION OF MIAMI COUNTY TO THE SOUTH, ALL OF THE SERVICE AREA IS CONSIDERED RURAL. SHELBY COUNTY IS A RURAL NON-APPALACHIAN COUNTY WITH A POPULATION OF 47,977. SHELBY COUNTY HAD APPROXIMATELY 118.3 RESIDENTS PER SQUARE MILE. 24.7% OF THE POPULATION IS BELOW THE AGE OF 18, AND 17.4% OF THE POPULATION IS 65 AND OLDER. THE PERCENTAGE OF CHILDREN IN POVERTY IS 13%. THE POPULATION IS MADE UP OF 2.4% AFRICAN AMERICAN AND 1.6% HISPANIC INDIVIDUALS.

PART VI, LINE 5:
"THE SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION'S BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS FROM OUR COMMUNITY. THE MAJORITY OF OUR BOARD MEMBERS LIVE AND WORK WITHIN THE COMMUNITY AND ARE ACTIVELY INVOLVED WITH OTHER NON-PROFIT AGENCIES. THE MAJORITY OF OUR SENIOR MANAGERS AND STAFF ALSO LIVE IN OUR PRIMARY SERVICE AREA AND MANY SIT ON OTHER COMMUNITY BASED GOVERNANCE BOARDS. THE ""SPIRIT"" OF COMMUNITY BASED HEALTHCARE RESIDES IN OUR BOARD OF TRUSTEES AND HOSPITAL STAFF AND IS FURTHER EVIDENCED BY OUR OPEN MEDICAL STAFF."

PART III, LINE 9B:
"IN ORDER FOR THE HOSPITAL TO CONTINUE OPERATING EFFICIENTLY, THE FOLLOWING COLLECTION POLICY HAS BEEN ADOPTED.A. EACH PATIENT/GUARANTOR IS INDIVIDUALLY RESPONSIBLE FOR PAYMENT OF ALL CHARGES UNLESS HIS/HER THIRD-PARTY PAYER HAS A CONTRACT WITH THE HOSPITAL.B. THE HOSPITAL WILL ACCEPT ASSIGNMENT OF HEALTH INSURANCE BENEFITS FOR MEDICARE, MEDICAID, TRICARE, AND OTHERS PER INDIVIDUAL CONTRACT.1. DEDUCTIBLE, CO-INSURANCE, OR NON-COVERED SERVICES ARE PAYABLE AT THE TIME OF SERVICE UNLESS FINANCIAL ARRANGEMENTS HAVE BEEN MADE WITH THE FINANCIAL ADVISOR.2. ANY BALANCE AFTER THE APPLICATION OF HEALTH INSURANCE PAYMENTS TO THE PATIENT'S ACCOUNT IS TO BE PAID WITHIN THIRTY (30) DAYS FOLLOWING NOTIFICATION. IF PAID WITHIN 30 DAYS OF RECEIPT OF FIRST STATEMENT, PATIENT IS ELIGIBLE FOR A 10% DISCOUNT ON THE BALANCE OF THE BILL.3. THE HOSPITAL WILL ACCEPT MASTER CARD, VISA, AND DISCOVER CHARGE CARDS FOR PAYMENTS ON PATIENT ACCOUNTS.4. PAYMENTS OR ARRANGEMENT FOR PAYMENT PLANS ARE TO COMMENCE WITHIN THIRTY (30) DAYS OF BILL DATE. 5. PATIENTS ARE ASKED TO ""PAY IN FULL"" HOWEVER, IF THE PATIENT/GUARANTOR INDICATES AN INABILITY TO MAKE PAYMENT IN FULL, THE PATIENT/GUARANTOR WILL BE GIVEN THE OPTION TO ESTABLISH A CONTRACT ACCOUNT WITH WILSON MEMORIAL HOSPITAL.A MONTHLY CONTRACT ACCOUNT CAN BE ESTABLISHED. THE MONTHLY AGREEMENT MUST BE SET UP SO THAT THE ENTIRE AMOUNT WILL BE PAID OFF IN TWELVE MONTHS, UNLESS OTHERWISE APPROVED BY DIRECTOR OF PATIENT FINANCIAL SERVICES. NO MONTHLY PAYMENT WILL BE LESS THAN $25.00.IF THE PATIENT OR ANY FAMILY MEMBER OF THE RESPONSIBLE PARTY OR GUARANTOR'S FAMILY IS CURRENTLY PAYING ON A BILL AND HAS NEED OF THE HOSPITAL'S SERVICES AGAIN, THE PAYMENT MUST THEN BE ADJUSTED UPWARDS TO REFLECT THE NEXT BALANCE DUE.WILSON MEMORIAL HOSPITAL EMPLOYEES, ALONG WITH THEIR SPOUSE AND CHILDREN UNDER THE AGE OF EIGHTEEN, WHO INDICATE DIFFICULTY IN MEETING PAYMENT OBLIGATIONS ON THEIR ACCOUNT ARE GIVEN THE OPTION TO MAKE MONTHLY PAYMENTS, OR HAVE PAYMENTS DEDUCTED FROM THEIR PAY CHECK. (PAYROLL DEDUCTION PROGRAM).PAYMENT ON THE ACCOUNTS NOT RECEIVED ACCORDING TO THE ABOVE PROVISION WILL BE SUBJECT TO BECOMING A ""DELINQUENT ACCOUNT"". ACTIONS TAKEN BY THE HOSPITAL TOWARD SUCH ACCOUNTS WILL BE AT THE HOSPITAL'S DISCRETION.THE HOSPITAL RETAINS THE RIGHT TO REFER THE PATIENT'S DELINQUENT ACCOUNTS TO A PROFESSIONAL COLLECTION AGENCY.THE FIRST STATEMENT A PATIENT RECEIVES WILL BE SENT OUT BY WILSON HOSPITAL. IF WITHIN 30 DAYS THERE HAS BEEN NO PAYMENT ON THE ACCOUNT, IT WILL BE SENT TO OUR EARLY OUT PROGRAM. THEY WILL ACT AS A WILSON MEMORIAL FINANCIAL ADVISOR AND RECEIVE A PERCENTAGE OF THE ACCOUNT IF ANY PAYMENT IS MADE TO THEM. IF THE EARLY OUT AGENCY CANNOT COLLECT ON THE ACCOUNTS, THEY ARE SENT BACK TO THE HOSPITAL TO BE SENT TO COLLECTION AGENCIES.DIRECTOR OF PATIENT FINANCIAL SERVICES MUST APPROVE ALL ACCOUNTS SENT TO THE COLLECTION AGENCY AND MUST APPROVE ANY LEGAL ACTION THAT IS SUGGESTED BY THE COLLECTION AGENCY.WILSON MEMORIAL HOSPITAL IS REQUIRED BY LAW TO GIVE ""FREE CARE"" TO THOSE PERSONS WHO ARE ELIGIBLE BASED ON STATE STATUTES. WILSON MEMORIAL HOSPITAL HAS A CHARITY CARE POLICY FOR THOSE ELIGIBLE WHO CANNOT AFFORD TO PAY FOR CARE. THE CURRENT FEDERAL POVERTY INCOME GUIDELINES WILL BE USED TO DETERMINE ELIGIBILITY OF THE PATIENT.ANY HOSPITAL SERVICES RESULTING FROM AN ACCIDENT OR OTHER CAUSES INVOLVING A DISPUTE AS TO LIABILITY BETWEEN THE PATIENT AND OTHERS, DOES NOT INVOLVE THE HOSPITAL. THE HOSPITAL WILL EXPECT PAYMENT IN THE SAME MANNER AS ALL OTHER SERVICES. THE HOSPITAL WILL ACCEPT A LETTER OF PROTECTION FOR A DURATION OF 90 DAYS. AFTER 90 DAYS THE HOSPITAL WILL ACTIVELY PURSUE THE PATIENT OR GUARANTOR FOR PAYMENT OF RENDERED SERVICES.EXCEPTIONS TO THE ABOVE ITEMS CAN BE MADE WITH THE APPROVAL OF THE DIRECTOR OF PATIENT FINANCIAL SERVICES. ALL UNUSUAL ARRANGEMENTS AND CIRCUMSTANCES ARE REVIEWED AND APPROVED BY THE VICE PRESIDENT OF FINANCE."