4A (Expenses $ 3545434031 including grants of $ 39074948) (Revenue $ 4709685364)
"IHC HEALTH SERVICES, INC. (""HEALTH SERVICES"") PROVIDED HIGH QUALITY HEALTHCARE THROUGH ITS SYSTEM OF 22 HOSPITALS (2,688 LICENSED BEDS) AND MORE THAN 350 CLINICS LOCATED IN UTAH AND IDAHO. IN ADDITION TO THE 133,000 INPATIENT ADMISSIONS, 488,000 EMERGENCY ROOM VISITS AND 3.1 MILLION CLINIC VISITS, HEALTH SERVICES PROVIDED MORE THAN $145.1 MILLION IN CHARITY CARE (AT COST) THROUGH 268,235 CASES. FOR A MORE DETAILED EXPLANATION OF THE ORGANIZATION'S PROGRAM SERVICE ACCOMPLISHMENTS IN 2014, SEE SCHEDULE O."

PART V, SECTION B, LINES 5 AND 11
"THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA), SIGNED INTO LAW IN MARCH 2010, REQUIRES EACH NONPROFIT HOSPITAL TO PERFORM A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS AND DEVELOP A THREE-YEAR IMPLEMENTATION STRATEGY TO ADDRESS IDENTIFIED COMMUNITY NEEDS. HEALTH SERVICES' COMMUNITY BENEFIT DEPARTMENT CREATED A SYSTEM-WIDE PROCESS TO BE USED BY EACH OF ITS 21 OWNED HOSPITALS IN CONDUCTING THE FOLLOWING COMPONENTS OF THE CHNA: 1) ASKING FOR COMMUNITY INPUT REGARDING LOCAL HEALTHCARE NEEDS; 2) QUANTITATIVE DATA COLLECTION; 3) DEVELOPING IMPLEMENTATION STRATEGIES; AND 4) MAKING THE CHNA RESULTS PUBLICLY AVAILABLE. LOCAL HOSPITAL LEADERS IMPLEMENTED THE PROCESS IN EACH COMMUNITY SERVED BY A HEALTH SERVICES HOSPITAL. EACH OF HEALTH SERVICES' CHNAS INCLUDED:- DEFINITION OF THE COMMUNITY SERVED BY THE HOSPITAL- DEMOGRAPHICS OF THE COMMUNITY- EXISTING HEALTHCARE FACILITIES- EXPLANATION OF HOW THE DATA WAS OBTAINED- HEALTH NEEDS OF THE COMMUNITY- PRIMARY AND CHRONIC DISEASE NEEDS AND OTHER HEALTH ISSUES OF UNINSURED, LOW-INCOME AND MINORITY POPULATIONS- DESCRIPTION OF THE PROCESS USED TO IDENTIFY AND PRIORITIZE NEEDS- DESCRIPTION OF THE PROCESS FOR CONSULTING WITH PEOPLE REPRESENTING BROAD INTERESTS OF THE COMMUNITY- IDENTIFIED GAPS THAT LIMITED THE ABILITY TO ASSESS COMMUNITY HEALTH NEEDSTHE 2013 CHNA COMBINED A REVIEW OF THE DATA DESCRIBING THE HEALTH NEEDS WITH INPUT FROM MEMBERS OF THE COMMUNITY REPRESENTING BROAD INTERESTS OF RESIDENTS, INCLUDING THOSE WITH AN EXPERTISE IN PUBLIC HEALTH AND HEALTHCARE NEEDS OF MEDICALLY UNDERSERVED AND LOW-INCOME POPULATIONS. COMMUNITY INPUT MEETINGS INCLUDED OPEN-ENDED QUESTIONS ABOUT LOCAL HEALTH NEEDS AS WELL AS DISCUSSION ON SYSTEM-WIDE COMMUNITY HEALTH PRIORITIES. HEALTH SERVICES FIRST ESTABLISHED SYSTEM COMMUNITY HEALTH PRIORITIES IN 2009; CLINICAL STAFF DETERMINED TO USE SIMILAR HEALTH PRIORITIES IDENTIFIED IN A PREVIOUS HEALTH STATUS REPORT FOR THE 2013 QUANTITATIVE DATA COLLECTION TO IDENTIFY ANY CHANGES IN THE HEALTH INDICATORS OVER THE PAST FEW YEARS. THE FOLLOWING FOUR BROAD CATEGORIES ORIGINALLY IDENTIFIED IN 2009 REMAIN SIGNIFICANT HEALTH ISSUES FOR THE COMMUNITIES SERVED BY EACH OF HEALTH SERVICES' HOSPITALS: 1) IMPROVE THE PREVENTION, DETECTION, AND TREATMENT OF CHRONIC DISEASES ASSOCIATED WITH WEIGHT AND UNHEALTHY BEHAVIORS;2) IMPROVE ACCESS TO COMPREHENSIVE, HIGH-QUALITY HEALTHCARE SERVICES FOR LOW-INCOME POPULATIONS;3) IMPROVE ACCESS TO APPROPRIATE BEHAVIORAL HEALTH SERVICES FOR LOW-INCOME POPULATIONS; AND4) IMPROVE ACCIDENT AND INJURY PREVENTION FOR CHILDREN AND ADOLESCENTS. (PRIMARY CHILDREN'S HOSPITAL ONLY)CHNA PART ONE: COMMUNITY INPUT MEETINGSCOMMUNITY INPUT MEETINGS WERE CONVENED BY EACH HOSPITAL TO SOLICIT OBSERVATIONS AND COMMENTS ABOUT HEALTHCARE NEEDS IN THE LOCAL COMMUNITY. PARTICIPANTS WERE IDENTIFIED BY HOSPITAL STAFF WITH CONSULTATION FROM THE CENTRAL OFFICE COMMUNITY BENEFIT DEPARTMENT STAFF. PARTICIPANTS REPRESENTED THE BROAD COMMUNITY INCLUDING:- BEHAVIORAL HEALTH PROVIDER AGENCY STAFF- COUNTY OR STATE HEALTH DEPARTMENT STAFF- HIGHER EDUCATION FACULTY AND/OR STAFF- HOSPITAL GOVERNING BOARD MEMBERS- HOSPITAL STAFF- HUMAN SERVICES AGENCY STAFF- LOCAL SCHOOL DISTRICT STAFF - LOW-INCOME ADVOCATES- RESIDENTS OF THE HOSPITAL NEIGHBORHOOD- RETIRED BUSINESS PEOPLE- SAFETY-NET CLINIC STAFF- SMALL BUSINESS OWNERSCHNA PART TWO: HEALTH INDICATOR DATA COLLECTIONHEALTH SERVICES' CLINICAL LEADERS IDENTIFIED HEALTH INDICATORS FOR EACH OF THE FOUR HEALTH PRIORITIES IDENTIFIED IN THE CHNA. HEALTH SERVICES' PLANNING STAFF PROVIDED THE ZIP CODES THAT DEFINE THE PRIMARY MARKET AREA FOR EACH OF ITS 21 HOSPITALS, WHICH WERE USED TO CLEARLY DELINEATE EACH HOSPITAL'S ""COMMUNITY."" RESEARCH DEPARTMENT STAFF COLLABORATED WITH THE UTAH DEPARTMENT OF HEALTH AND THE IDAHO DEPARTMENT OF HEALTH AND WELFARE TO ASSEMBLE AVAILABLE DATA FOR HEALTH INDICATORS FOR EACH HOSPITALS' COMMUNITIES. DATA WERE DRAWN FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, VITAL RECORDS STATISTICS, AND STATE HOSPITAL DISCHARGE DATA. TWO OR THREE YEARS OF DATA WERE AGGREGATED TOGETHER FOR EACH INDICATOR TO ACHIEVE A LARGE ENOUGH SAMPLE SIZE TO CREATE HEALTH INDICATORS IN EACH HOSPITAL'S COMMUNITY. A REPORT CONTAINING SCORES ON EACH HEALTH INDICATOR FOR EACH COMMUNITY AND A SUMMARY OF THE COMMUNITY INPUT MEETINGS WERE PRESENTED TO HOSPITAL ADMINISTRATION AND THEIR COMMUNITY BENEFIT LEADERSHIP, WHICH WERE USED FOR THE NEXT STEP, IMPLEMENTATION PLANNING BASED ON THE CHNA RESULTS.IMPLEMENTATION STRATEGIES AND COMMUNITY HEALTH INITIATIVES RESULTS OF THE TWO-PART CHNA WERE USED TO DEVELOP THREE-YEAR IMPLEMENTATION PLANS WITH COMMUNITY BENEFIT AND HOSPITAL LEADERS, PLANNERS, ADMINISTRATORS, GOVERNING BOARD MEMBERS, AND COMMUNITY MEMBERS WITH AN EXPERTISE IN HEALTH. EACH HOSPITAL TEAM IDENTIFIED LOCAL HEALTH NEEDS THAT ALIGNED WITH HOSPITAL-SPECIFIC PROGRAMS, RESOURCES AND PRIORITIES, AND OPPORTUNITIES TO MAKE MEASURABLE HEALTH IMPROVEMENTS IN THE COMMUNITY. EACH PLANNING TEAM IDENTIFIED POTENTIAL COLLABORATIVE PARTNERSHIPS WITH COUNTY AND/OR STATE HEALTH DEPARTMENTS, SCHOOLS, HEALTH COALITIONS, AND OTHER ADVOCACY AGENCIES ENGAGED IN HEALTH INITIATIVES FOCUSED ON ONE OF THE FOUR HEALTH PRIORITIES. THE IMPLEMENTATION PLANS INCLUDE EVIDENCE-BASED STRATEGIES FOR ADDRESSING HEALTH NEEDS; EACH PLAN INCLUDES AN OUTLINE OF STRATEGIES AND OUTCOME MEASURES BEGINNING IN 2013 THROUGH 2015. OF THE 21 IMPLEMENTATION STRATEGIES CREATED BY HEALTH SERVICES, 19 FOCUS ON THE PREVENTION, IDENTIFICATION, AND TREATMENT OF CHRONIC DISEASE IN A WIDE VARIETY OF EVIDENCE-BASED COMMUNITY HEALTH IMPROVEMENT STRATEGIES RANGING FROM PRESCRIBING EXERCISE IN SAFETY-NET CLINICS TO COMPREHENSIVE INTENSIVE BEHAVIOR MODIFICATION TREATMENT FOR FAMILIES AT RISK FOR OBESITY. PARK CITY MEDICAL CENTER IS WORKING TO IMPROVE ACCESS TO COMPREHENSIVE HEALTHCARE THROUGH COMMUNITY INSURANCE ENROLLMENT OUTREACH. PRIMARY CHILDREN'S HOSPITAL IS LEADING SYSTEM-WIDE EFFORTS TO IMPROVE ACCIDENT AND INJURY PREVENTION FOR CHILDREN AND ADOLESCENTS. HOSPITAL IMPLEMENTATION PLANS WERE REVIEWED BY THE HOSPITAL GOVERNING BOARD AND SIGNED BY 1) THE EMPLOYEE ACCOUNTABLE FOR THE IMPLEMENTATION PLAN, 2) THE HOSPITAL ADMINISTRATOR (ALSO ACCOUNTABLE FOR ACHIEVING THE GOALS OVER THE NEXT THREE YEARS), AND 3) THE GOVERNING BOARD CHAIR.IN ADDITION TO HEALTHCARE NEEDS ADDRESSED IN EACH IMPLEMENTATION STRATEGY SET BY HEALTH SERVICES' 21 HOSPITALS, SYSTEM-WIDE COMMUNITY BENEFIT INITIATIVES ADDRESS THE HEALTH PRIORITIES OF IMPROVING PREVENTION OF CHRONIC DISEASE; ACCESS TO HIGH QUALITY, COMPREHENSIVE MEDICAL CARE; AND ACCESS TO BEHAVIORAL HEALTH. THESE CENTRALLY-LED EFFORTS IMPACT MANY OF THE 21 HOSPITAL COMMUNITIES AND ENSURE THAT HEALTH SERVICES CONTINUES TO ADDRESS THE HEALTH NEEDS.HEALTH SERVICES' STAFF IDENTIFIED TWO SIGNIFICANT GAPS IN THE QUANTITATIVE ANALYSIS PORTION OF THE CHNA. FIRST, SIGNIFICANT HEALTH INDICATORS WERE NOT AVAILABLE FOR RECENT DEPRESSION AND OTHER BEHAVIORAL HEALTH DIAGNOSTIC CATEGORIES FROM THE UTAH DEPARTMENT OF HEALTH. SECOND, CURRENT MEDICAID ENROLLMENT AND ELIGIBILITY DATA AND INFORMATION ON THE NUMBER OF HEALTHCARE PROVIDERS ACCEPTING MEDICAID IN LOCAL COMMUNITIES WAS UNAVAILABLE TO HEALTH SERVICES.NEEDS IDENTIFIED AND NOT ADDRESSED IN HOSPITAL IMPLEMENTATION PLANS:HEALTH SERVICES IS ADDRESSING THE IDENTIFIED HEALTH PRIORITIES CONCURRENT WITH THE IMPLEMENTATION PLANS (ESTABLISHED BY EACH OF ITS 21 HOSPITALS) AS A SYSTEM. IN ADDITION, HEALTH SERVICES PROVIDES FUNDING THROUGH GRANTS, IN-KIND CONTRIBUTIONS, AND OTHER CASH CONTRIBUTIONS TO HELP SUPPORT ACCESS TO HEALTHCARE. BECAUSE APPROPRIATE ACCESS TO BEHAVIORAL HEALTH SERVICES IS A CHALLENGE TO LOW-INCOME POPULATIONS IN MANY GEOGRAPHIC AREAS, HEALTH SERVICES PARTNERED WITH COMMUNITIES TO ESTABLISH MENTAL HEALTH NETWORKS THAT SIGNIFICANTLY IMPROVE ACCESS TO DETOXIFICATION, COUNSELING, MEDICATION MANAGEMENT AND PEER SUPPORT SERVICES, THUS REDUCING LONG WAITS AND FREQUENT EMERGENCY DEPARTMENT VISITS AND INPATIENT TREATMENT. CURRENTLY, COMMUNITY NETWORKS ARE SERVING OR ARE IN DEVELOPMENT IN FOUR URBAN GEOGRAPHIC AREAS."

PART V, SECTION B, LINE 7A AND 10A
INTERMOUNTAINHEALTHCARE.ORG/ABOUT/PAGES/CHNA-REPORTS

PART V, SECTION B, LINE 13H
CATASTROPHIC ASSISTANCE. HEALTH SERVICES ATTEMPTS TO LIMIT AN INDIVIDUAL'S FINANCIAL RESPONSIBILITY WHEN ALL OUTSTANDING MEDICAL DEBT, INCLUDING DEBT OWED TO OTHER PROVIDERS, EXCEEDS 35% OF THE INDIVIDUAL'S GROSS HOUSEHOLD ANNUAL INCOME.EXTENUATING CIRCUMSTANCES. SINCE EACH INDIVIDUAL'S PERSONAL CIRCUMSTANCES VARY, HEALTH SERVICES ALLOWS FOR EXTENUATING CIRCUMSTANCES NOT DIRECTLY ADDRESSED IN THE FINANCIAL ASSISTANCE POLICIES AND PROCEDURES TO BE CONSIDERED WHEN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE.ASSISTANCE BASED ON INCOME. HEALTH SERVICES EVALUATES AN INDIVIDUAL'S HOUSEHOLD INCOME COMPARED TO THE HHS FEDERAL POVERTY INCOME GUIDELINES AND OFFERS THE MAXIMUM AVAILABLE ASSISTANCE TO QUALIFYING INDIVIDUALS UNDER 150% OF THOSE GUIDELINES. HEALTH SERVICES APPLIES AN EVALUATIVE MODEL TO ESTIMATE A REASONABLE AMOUNT AN INDIVIDUAL COULD PAY WHEN INCOME FALLS BETWEEN 150% AND 500% OF THE POVERTY GUIDELINES AND THEN OFFERS ASSISTANCE TOWARDS MEDICAL BILLS IN EXCESS OF THAT ESTIMATED PAYMENT AMOUNT.

PART V, SECTION B, LINES 15E, 16I AND 20E
"SPECIFIC INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAM CAN BE FOUND ON HEALTH SERVICES' WEBSITE IN BOTH ENGLISH AND SPANISH. DETAILS INCLUDE AN EXPLANATION OF THE PROGRAM, FREQUENTLY ASKED QUESTIONS, AN ""800"" NUMBER, AND A LINK TO THE APPLICATION. BROCHURES, IN ENGLISH AND SPANISH, ARE ALSO AVAILABLE THROUGHOUT THE PUBLIC RECEPTION AND REGISTRATION AREAS OF THE HOSPITALS AND CLINICS. THE BROCHURES DESCRIBE THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY.ELIGIBILITY COUNSELORS ARE AVAILABLE TO ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION BEFORE, DURING, OR AFTER THE TIME OF SERVICE. THE PROCESS OFTEN BEGINS WITH THE PRE-REGISTRATION OF PATIENTS PRIOR TO SERVICE. HEALTH SERVICES ALSO CONTRIBUTES TO THE SALARIES OF UTAH STATE DEPARTMENT OF WORKFORCE SERVICES STAFF WHO WORK ONSITE IN SEVERAL HOSPITALS TO ASSIST PATIENTS IN APPLYING FOR MEDICAID, CHIP, OR OTHER GOVERNMENT ASSISTANCE PROGRAMS.SIGNS ARE POSTED AT PUBLIC REGISTRATION AREAS, IN PRIVATE REGISTRATION ROOMS AND IN PATIENT CARE AREAS IN BOTH ENGLISH AND SPANISH, WHICH STATE THE FOLLOWING: ""WE BELIEVE MEDICALLY NECESSARY HEALTHCARE SERVICES SHOULD BE ACCESSIBLE TO RESIDENTS IN THE COMMUNITIES WE SERVE REGARDLESS OF ABILITY TO PAY. IF YOU DON'T HAVE INSURANCE OR IF YOU NEED HELP IN PAYING FOR CARE, ASK TO SPEAK WITH ONE OF OUR ELIGIBILITY COUNSELORS ABOUT [HEALTH SERVICES'] FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE IS AVAILABLE FOR QUALIFYING PATIENTS."" BILLING ENVELOPES ALSO INCLUDE A STATEMENT ON THE BACK THAT STATES IN BOTH ENGLISH AND SPANISH: ""NEED HELP IN PAYING YOUR BILL? CONTACT THIS FACILITY, OR FOR GENERAL QUESTIONS, CALL OUR FINANCIAL ASSISTANCE HOTLINE."" A TOLL-FREE NUMBER IS INCLUDED."

PART V, SECTION B, LINE 22D
HEALTH SERVICES PROVIDES AN AUTOMATIC DISCOUNT OF 25% TO UNINSURED PATIENTS, INCLUDING THOSE WHO QUALIFY UNDER THE FINANCIAL ASSISTANCE PROGRAM. THIS DISCOUNT APPROXIMATES THE AVERAGE NEGOTIATED RATES CHARGED TO COMMERCIAL INSURANCE COMPANIES. AN ADDITIONAL 15% DISCOUNT IS AVAILABLE TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE IF PAYMENT IS MADE IN FULL AT THE TIME OF SERVICE. FINAL AMOUNTS BILLED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE BASED ON THE PATIENT'S ABILITY TO PAY AS DETERMINED UNDER HEALTH SERVICES' FINANCIAL ASSISTANCE POLICY. THE FILING ORGANIZATION BELIEVES IT IS IN COMPLIANCE WITH THE LANGUAGE OF IRC SECTION 501(R) AND WILL COMPLY WITH THE FINAL REGULATIONS EFFECTIVE 1/1/2016.

PART V, SECTION B, LINE 16B AND 16C
HTTP://INTERMOUNTAINHEALTHCARE.ORG/PATIENT-TOOLS/FINANCIAL-ASSISTANCE/

PART I, LINE 3C:
"MAXIMUM FINANCIAL ASSISTANCE IS PROVIDED TO INDIVIDUALS AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (""FPG""). APPLICANTS EQUAL TO OR BELOW THIS THRESHOLD ARE RESPONSIBLE FOR ONLY A MINUMUM CO-PAY. EVIDENCE HAS SHOWN THAT PATIENTS WHO PAY SOMETHING, EVEN VERY SMALL AMOUNTS, ARE MORE LIKELY TO FOLLOW THE MEDICAL RECOMMENDATIONS GIVEN TO THEM BY PROVIDERS. PATIENTS WHO ARE NOT ABLE TO CONTRIBUTE ANYTHING ARE NOT REQUIRED TO CONTRIBUTE AND WILL STILL RECEIVE CARE.A SLIDING SCALE IS USED FOR PATIENTS BETWEEN 150% AND 500% OF FPG.TO DETERMINE ELIGIBILITY FOR PROVIDING FREE OR DISCOUNTED CARE, HEALTH SERVICES USES A VARIETY OF FACTORS, INCLUDING INCOME AND ASSET LEVELS, MEDICAL INDIGENCE, INSURANCE STATUS, AND MEDICARE AND MEDICAID ELIGIBILITY.HEALTH SERVICES ALSO LIMITS CHARGES WHEN ALL OUTSTANDING MEDICAL DEBT, INCLUDING DEBT OWED TO OTHER PROVIDERS, EXCEEDS 35% OF THE INDIVIDUAL'S GROSS ANNUAL HOUSEHOLD INCOME.SINCE EACH INDIVIDUAL'S CIRCUMSTANCES VARY, HEALTH SERVICES ALLOWS FOR EXTENUATING CIRCUMSTANCES NOT DIRECTLY ADDRESSED IN THE FINANCIAL ASSISTANCE POLICIES TO BE CONSIDERED WHEN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE."

PART I, LINE 7:
THE FINANCIAL ASSISTANCE AT COST (LINE 7A) WAS CALCULATED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE UNREIMBURSED MEDICAID (LINE 7B) WAS PRINCIPALLY CALCULATED USING THE FILING ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM. THE EXPENSES REPORTED FOR COMMUNITY HEALTH IMPROVEMENT (LINE 7E), HEALTH PROFESSIONS EDUCATION (LINE 7F), AND THE CASH AND IN-KIND CONTRIBUTIONS (LINE 7I) INCLUDE ONLY THE DIRECT EXPENSES ASSOCIATED WITH EACH ACTIVITY. THE INDIRECT EXPENSES ASSOCIATED WITH THESE ACTIVITIES WERE NOT REPORTED. THE EXPENSES ASSOCIATED WITH RESEARCH (LINE 7H) WERE CALCULATED USING THE SAME METHODOLOGY USED FOR GRANT PROGRESS REPORTING TO THE FEDERAL GOVERNMENT.PART I, LINE 7, COLUMN (F):THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25A, BUT EXCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN, IS $152,773,537.

PART II, COMMUNITY BUILDING ACTIVITIES:
HEALTH SERVICES' COALITION BUILDING PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY NETWORKING WITH OTHER COMMUNITY AGENCIES TO ADDRESS THE HEALTH AND SAFETY ISSUES OF THE COMMUNITY. HEALTH SERVICES PARTICIPATES IN STATEWIDE SAFEKIDS COALITIONS TO PROMOTE AWARENESS AND USE OF CHILD SEAT BELTS AND TRAFFIC AND BICYCLE SAFETY, DIABETES-RELATED COALITIONS TO HELP REDUCE THE INCIDENCE OF DIABETES IN CHILDREN AND ADULTS, VARIOUS MENTAL HEALTH/SUICIDE PREVENTION EFFORTS, AND OTHER COALITIONS THAT ADDRESS HEALTHCARE ISSUES IN THE COMMUNITY. HEALTH SERVICES EMPLOYEES UTILIZE THEIR CLINICAL EXPERTISE TO COLLABORATE WITH OTHER COMMUNITY AGENCIES AND COUNTY AND STATE HEALTH DEPARTMENTS TO PROVIDE EDUCATION AND OTHER INITIATIVES. HEALTH SERVICES ALSO RECRUITS PHYSICIANS TO MEDICALLY UNDERSERVED AREAS IN RURAL SETTINGS TO MEET THE HEALTHCARE NEEDS OF RESIDENTS IN RURAL SETTINGS, THEREBY HELPING REDUCE BARRIERS TO ACCESSING CARE. WORKFORCE DEVELOPMENT ACTIVITIES INCLUDE CURRICULUM DEVELOPMENT ACTIVITIES FOR HIGH SCHOOL STUDENTS FOR WHICH THEY RECEIVE SCHOOL CREDIT FOR HEALTH CAREERS TRAINING THAT LEADS TO COLLEGE-LEVEL EDUCATION.

PART III, LINE 2:
MANAGEMENT ESTIMATES THE PROVISION FOR BAD DEBTS BY ASSESSING THE COLLECTIBILITY, TIMING AND AMOUNT OF PATIENT SERVICES REVENEUS BY CONSIDERING HISTORICAL COLLECTIONS RATES FOR EACH MAJOR PAYOR SOURCE, GENERAL ECONOMIC TRENDS AND OTHER INDICATORS.

PART III, LINE 3:
WHEN A PATIENT OR RESPONSIBLE PARTY IS UNINSURED OR UNDER-INSURED AND EXPRESSES EITHER CONCERN ABOUT THEIR ABILITY TO PAY OR INTEREST IN APPLYING FOR FINANCIAL ASSISTANCE, HEALTH SERVICES' STAFF ARE EDUCATED TO GIVE THE PATIENT AN APPLICATION FOR FINANCIAL ASSISTANCE AND INSTRUCTIONS FOR COMPLETING AND RETURNING THE APPLICATION. IN SITUATIONS WHERE THE PATIENT FAILS TO RETURN THE APPLICATION AND THE ACCOUNT PROGRESSES THROUGH THE COLLECTION CYCLE TO BAD DEBT, THE ACCOUNT WILL BE WRITTEN OFF AS A BAD DEBT. HEALTH SERVICES ALSO UTILIZES DATA SOURCES TO IDENTIFY UNRESPONSIVE INDIVIDUALS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS BELONGING TO QUALIFYING INDIVIDUALS ARE ADJUSTED TO CHARITY CARE RATHER THAN BAD DEBTS AT THE END OF THE COLLECTIONS CYCLE. THE CHARITY CARE AMOUNTS INCLUDED IN THE FINANCIAL STATEMENTS ARE SEPARATE AND DISTINCT FROM BAD DEBT EXPENSE, WHICH GENERALLY REPRESENTS PATIENT SERVICES REVENUES THAT ARE NOT COLLECTIBLE DUE TO EITHER AN UNWILLINGNESS TO PAY BY THOSE RESPONSIBLE FOR PAYMENT, OR AN INABILITY BY HEALTH SERVICES TO OBTAIN DOCUMENTATION FROM THOSE RESPONSIBLE FOR PAYMENT THAT WOULD SUBSTANTIATE THE PATIENT'S QUALIFICATION FOR CHARITY CONSIDERATION. BAD DEBT EXPENSE IS REFLECTED IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS AND WAS $231.4 MILLION AND $152.8 MILLION FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2014, RESPECTIVELY.PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE AT ANY POINT OF THE REGISTRATION, BILLING OR COLLECTION PROCESSES.

PART III, LINE 4:
"BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE COMPANY'S UNINSURED AND UNDERINSURED PATIENTS ARE UNWILLING TO PAY FOR THE SERVICES PROVIDED. ACCORDINGLY, THE COMPANY RECORDS AN ESTIMATED PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE RENDERED.MANAGEMENT ESTIMATES THE PROVISION FOR BAD DEBTS BY ASSESSING THE COLLECTABILITY, TIMING AND AMOUNT OF PATIENT SERVICES REVENUES BY CONSIDERING HISTORICAL COLLECTION RATES FOR EACH MAJOR PAYER SOURCE, GENERAL ECONOMIC TRENDS AND OTHER INDICATORS. MANAGEMENT ALSO ASSESSES THE ADEQUACY OF ALLOWANCES FOR BAD DEBTS BASED ON HISTORICAL WRITE-OFFS, ACCOUNTS RECEIVABLE AGING AND OTHER FACTORS.PART III, LINES 5-7THE MEDICARE ALLOWABLE COSTS ON PART III, LINE 6 ARE BASED ON THE ORGANIZATION'S MEDICARE COST REPORTS, WHICH ARE SIGNIFICANTLY DIFFERENT FROM TOTAL FINANCIAL STATEMENT EXPENSES. MEDICARE'S ""ALLOWABLE COSTS"" EXCLUDE COMMONLY INCURRED BUSINESS EXPENSES SUCH AS INTEREST, RESEARCH, PUBLIC RELATIONS, ETC. IN ADDITION, THE AMOUNTS DO NOT FULLY REFLECT THE FILING ORGANIZATION'S PARTICIPATION IN MEDICARE PROGRAMS. FOR EXAMPLE, THE FOLLOWING IS A PARTIAL LIST OF ACTIVITIES THAT ARE NOT CURRENTLY INCLUDED IN THE SCHEDULE H CALCULATION: - PHYSICIAN SERVICES BILLED BY THE FILING ORGANIZATION - MEDICARE PARTS C AND D (MEDICARE ADVANTAGE AND PRESCRIPTION DRUG COVERAGE)- FEE SCHEDULE SERVICES (E.G., OUTPATIENT CLINICAL LABORATORY AND THERAPY SERVICES) - DURABLE MEDICAL EQUIPMENT AND HOME IV THERAPY SERVICES INCLUSION OF ALL EXPENSES ASSOCIATED WITH MEDICARE ACTIVITIES WOULD MAKE A SIGNIFICANT DIFFERENCE IN THE FILING ORGANIZATION'S CALCULATION. IF THE ADDITIONAL ACTIVITIES WERE REPORTABLE ON SCHEDULE H, IT IS ESTIMATED THAT THE FILING ORGANIZATION'S MEDICARE SHORTFALL WOULD TOTAL APPROXIMATELY $106.9 MILLION, A DIFFERENCE OF $85.8 MILLION FROM THE AMOUNT DISCLOSED ON PART III OF THE SCHEDULE H."

PART III, LINE 8:
TOTAL DIRECT AND OVERHEAD COSTS FOR EACH COST CENTER ARE DIVIDED BY THE CORRESPONDING TOTAL PATIENT REVENUE TO DETERMINE COST/CHARGE RATIOS. THE COST/CHARGE RATIOS ARE MULTIPLIED BY THE APPLICABLE MEDICARE CHARGES TO DETERMINE MEDICARE COSTS. ALLOWABLE COSTS FOR ROUTINE AREAS ARE CALCULATED BASED ON PER DIEM COSTS (I.E., (TOTAL COSTS / TOTAL DAYS) X MEDICARE DAYS). THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL OF THE ASSOCIATED COSTS INCURRED BY HEALTH SERVICES' HOSPITALS FOR THE SERVICES PROVIDED AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT PROVIDED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B IS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORTS (USING THE MEDICARE COST REPORT STEP-DOWN METHODOLOGY). MEDICARE SHORTFALLS SHOULD BE TREATED AND REPORTED ON SCHEDULE H AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, BURDENS BORNE BY GOVERNMENTS ARE RELIEVED; (3) A SIGNIFICANT POSSIBILITY EXISTS THAT CONTINUED REDUCTION IN MEDICARE REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE REPORTED MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS.

PART III, LINE 9B:
HEALTH SERVICES RECOGNIZES ITS RESPONSIBILITY TO MANAGE THE COST OF HEALTHCARE BY ASKING THOSE WHO CAN PAY TO DO SO AND IS COMMITTED TO ASSISTING PATIENTS BY PROVIDING VARIOUS OPTIONS FOR RESOLVING THEIR FINANCIAL OBLIGATION, INCLUDING DISCOUNTS FOR THE UNINSURED, PAYMENT PLANS, AND REDUCED OR WAIVED RESPONSIBILITY THROUGH FINANCIAL ASSISTANCE. HEALTH SERVICES ALSO ASSISTS PATIENTS WHO ARE POTENTIALLY ELIGIBLE FOR GOVERNMENT ASSISTANCE PROGRAMS TO APPLY FOR SUCH ASSISTANCE. DELINQUENT ACCOUNTS MAY BE REFERRED TO EXTERNAL COLLECTION AGENCIES ONLY AFTER REASONABLE ATTEMPTS ARE MADE TO CONTACT THE RESPONSIBLE PARTY AND NO ARRANGEMENT HAS BEEN MADE TO PAY THE ACCOUNT BALANCE. SUCH AGENCIES ARE EXPECTED TO TREAT PATIENTS WITH THE SAME RESPECT AND DIGNITY THAT HEALTH SERVICES AFFORDS ITS PATIENTS. FOR EXAMPLE, CONTACTS BY THE AGENCIES WILL INCLUDE FINANCIAL ASSISTANCE OPTIONS TO PATIENTS UNABLE TO PAY. AGENCIES ARE RESTRICTED TO LEGAL PROCEEDINGS TO COLLECT DEBTS IN LIMITED CIRCUMSTANCES AND MAY ONLY DO SO UPON APPROVAL BY HEALTH SERVICES. STRONGER MEASURES SUCH AS THE COURTS ARE NOT USED UNLESS THERE IS EVIDENCE OF FRAUD OR A CLEAR ABILITY TO PAY ACCOMPANIED BY A REFUSAL TO PAY.

PART VI, LINE 3:
"BY POLICY, HEALTH SERVICES PROVIDES HEALTHCARE SERVICES TO RESIDENTS IN THE COMMUNITY ON THE BASIS OF MEDICAL NEED WITHOUT REGARD TO RACE, RELIGION, GENDER, AGE, OR ABILITY TO PAY. AN UNINSURED, LOW-INCOME PERSON WILL RECEIVE THOSE SERVICES GENERALLY AVAILABLE FOR NO CHARGE OR A REDUCED CHARGE BASED UPON SUCH PERSON'S ABILITY TO PAY, IF IN THE JUDGMENT OF THE ADMITTING PHYSICIAN THE SERVICES ARE MEDICALLY NECESSARY AND GENERALLY AVAILABLE AT THE HOSPITALS AND CLINICS AND THE PERSON REQUIRES THAT SERVICE. SPECIFIC INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAM CAN BE FOUND ON HEALTH SERVICES' WEBSITE IN BOTH ENGLISH AND SPANISH. DETAILS INCLUDE AN EXPLANATION OF THE PROGRAM, FREQUENTLY ASKED QUESTIONS, AN ""800"" NUMBER, AND A LINK TO THE APPLICATION. BROCHURES, IN ENGLISH AND SPANISH, ARE ALSO AVAILABLE THROUGHOUT THE PUBLIC RECEPTION AND REGISTRATION AREAS OF HOSPITALS AND CLINICS. THE BROCHURES DESCRIBE THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY.ELIGIBILITY COUNSELORS ARE AVAILABLE TO ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION BEFORE, DURING AND AFTER THE TIME OF SERVICE. THE PROCESS OFTEN BEGINS WITH THE PATIENT'S PRE-REGISTRATION PRIOR TO SERVICE. HEALTH SERVICES ALSO CONTRIBUTES TO THE SALARIES OF UTAH STATE DEPARTMENT OF WORKFORCE SERVICES STAFF WHO WORK ONSITE IN SEVERAL HOSPITALS TO ASSIST PATIENTS IN APPLYING FOR MEDICAID, CHIP, OR OTHER GOVERNMENT ASSISTANCE PROGRAMS.SIGNS ARE POSTED AT PUBLIC REGISTRATION AREAS, IN PRIVATE REGISTRATION ROOMS AND IN PATIENT CARE AREAS IN BOTH ENGLISH AND SPANISH, WHICH STATE THE FOLLOWING: ""WE BELIEVE MEDICALLY NECESSARY HEALTHCARE SERVICES SHOULD BE ACCESSIBLE TO RESIDENTS IN THE COMMUNITIES WE SERVE REGARDLESS OF ABILITY TO PAY. IF YOU DON'T HAVE INSURANCE OR IF YOU NEED HELP IN PAYING FOR CARE, ASK TO SPEAK WITH ONE OF OUR ELIGIBILITY COUNSELORS ABOUT [HEALTH SERVICES'] FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE IS AVAILABLE FOR QUALIFYING PATIENTS."" BILLING ENVELOPES ALSO INCLUDE A STATEMENT ON THE BACK THAT STATES IN BOTH ENGLISH AND SPANISH: ""NEED HELP IN PAYING YOUR BILL? CONTACT THIS FACILITY, OR FOR GENERAL QUESTIONS, CALL OUR FINANCIAL ASSISTANCE HOTLINE."" A TOLL-FREE NUMBER IS INCLUDED."

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HEALTH SERVICES OPERATES 22 HOSPITALS (21 OWNED AND ONE, GARFIELD MEMORIAL HOSPITAL, MANAGED BY HEALTH SERVICES) AND MORE THAN 350 CLINICS THROUGHOUT UTAH AND SOUTHERN IDAHO. THE HOSPITALS AND CLINICS VARY IN SIZE AND SERVICES BASED ON THE INDIVIDUAL NEEDS OF EACH COMMUNITY RANGING FROM URBAN SETTINGS TO RURAL AREAS IN UTAH AND SOUTHERN IDAHO. FIVE HOSPITALS ARE CRITICAL ACCESS HOSPITALS: CASSIA REGIONAL MEDICAL CENTER IN BURLEY, IDAHO; DELTA COMMUNITY MEDICAL CENTER IN DELTA, UTAH; FILLMORE COMMUNITY MEDICAL CENTER IN FILLMORE, UTAH; HEBER VALLEY MEDICAL CENTER IN HEBER, UTAH; AND SANPETE VALLEY HOSPITAL IN MOUNT PLEASANT, UTAH.BASED ON 2013 ESTIMATES, HEALTH SERVICES SERVES A POPULATION OF APPROXIMATELY 2.9 MILLION INDIVIDUALS, 2.1 MILLION OF WHICH LIVE ALONG THE WASATCH FRONT ENCOMPASSING THE OGDEN TO PROVO METROPOLITAN AREA. THE AREA REPRESENTS A RELATIVELY YOUNGER POPULATION THAN THE NATIONAL AVERAGE (31% OF THE POPULATION IS UNDER 18 YEARS OLD WHILE ONLY 9.5% IS 65 YEARS AND OLDER). EDUCATION LEVELS ARE SLIGHTLY HIGHER THAN THE NATIONAL AVERAGE (90% OF THE POPULATION ARE HIGH SCHOOL GRADUATES AND 30% HAVE A BACHELOR'S DEGREE OR HIGHER). THE 2013 MEDIAN HOUSEHOLD INCOME FOR THE AREA WAS APPROXIMATELY $58,821. IN 2013 ABOUT 13% OF THE POPULATION LIVED AT OR BELOW THE FEDERAL POVERTY LEVEL; ABOUT 10% OF THE POPULATION WAS ENROLLED IN MEDICAID (OVER HALF OF WHICH WERE CHILDREN); 9% WAS ENROLLED IN MEDICARE; AND 58% WAS ENROLLED IN EMPLOYER-SPONSORED HEALTH INSURANCE. ABOUT 14% OF THE POPULATION DID NOT HAVE HEALTH INSURANCE.AS OF JULY 2012, FOUR OF UTAH'S COUNTIES WERE DESIGNATED AS FULL COUNTY MEDICALLY UNDERSERVED POPULATIONS. NINE COUNTIES WERE DESIGNATED AS FULL COUNTY MEDICALLY UNDERSERVED AREAS. AN ADDITIONAL SIX COUNTIES WERE LISTED AS PARTIAL COUNTY MEDICALLY UNDERSERVED AREAS OR POPULATIONS. NINE OF THE COUNTIES WERE DESIGNATED AS FULL OR PARTIAL COUNTY HEALTH PROFESSIONAL SHORTAGE AREAS. THERE ARE 47 HOSPITALS IN THE SERVICE AREA.

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HEALTH SERVICES PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PARTICIPATION IN VARIOUS COALITIONS AND SERVICES THAT ADDRESS DOCUMENTED HEALTH NEEDS TO IMPROVE HEALTH. THE MAJORITY OF HEALTH SERVICES' GOVERNING BODY IS COMPRISED OF PEOPLE WHO RESIDE IN ITS SERVICE AREA, REPRESENTING BROAD COMMUNITY PERSPECTIVES. HEALTH SERVICES DIRECTLY OPERATES FIVE CLINICS AND HELPS FINANCIALLY SUPPORT 29 INDEPENDENTLY OWNED COMMUNITY CLINICS SERVING AS A SAFETY NET FOR LOW-INCOME PEOPLE IN MEDICALLY UNDERSERVED COMMUNITIES. SUCH SUPPORT INCREASES ACCESS TO HEALTHCARE SERVICES BY PROVIDING ONGOING CONSULTATIONS TO IMPROVE OPERATIONS AND BY MAKING GRANTS AND CASH AND IN-KIND CONTRIBUTIONS.HEALTH SERVICES EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITIES SERVED.AS AN ORGANIZATION EXEMPT UNDER IRS SEC 501(C)(3), SURPLUS FUNDS OF HEALTH SERVICES ARE REINVESTED BACK INTO THE COMMUNITY TO IMPROVE PATIENT CARE BY UPGRADING FACILITIES AND EQUIPMENT AND BY PROVIDING FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT ACTIVITIES THAT IMPROVE THE HEALTH OF THE PEOPLE IN COMMUNITIES SERVED.

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"THE PARENT ORGANIZATION, INTERMOUNTAIN HEALTH CARE, INC., IS A SECTION 501(C)(3) ORGANIZATION THAT PROMOTES COMMUNITY HEALTHCARE THROUGH COORDINATING THE ACTIVITIES OF AND PROVIDING SUPPORT TO HEALTH SERVICES AND ITS OTHER AFFILIATED SUBSIDIARIES. MEDICAL SERVICES FOR THE COMMUNITIES SERVED ARE PROVIDED THROUGH THE HOSPITALS AND CLINICS OF HEALTH SERVICES. ITS MISSION IS ""HELPING PEOPLE LIVE THE HEALTHIEST LIVES POSSIBLE."" A MORE DETAILED ACCOUNT OF HEALTH SERVICES' ACTIVITIES IS AVAILABLE ON FORM 990, PART III AND SCHEDULE O. INTERMOUNTAIN HEALTHCARE FOUNDATION, INC. SUPPORTS THE HEALTHCARE ACTIVITIES OF IHC HEALTH SERVICES, INC. BY ENHANCING AND STRENGTHENING RELATIONSHIPS WITH COMMUNITY LEADERS AND BY DEVELOPING FINANCIAL AND CHARITABLE SUPPORT.INTERMOUNTAIN COMMUNITY CARE FOUNDATION, INC. MAKES GRANTS TO LOCAL NONPROFIT AGENCIES THAT PROVIDE DIRECT MEDICAL, DENTAL, AND MENTAL HEALTH SERVICES FOR LOW-INCOME, UNINSURED OR MEDICALLY-UNDERSERVED POPULATIONS. HEALTH SERVICES HAS PARTNERED WITH QUALIFIED PHYSICIANS TO FORM THE MCKAY-DEE SURGICAL CENTER, LLC, AN ORGANIZATION THAT PROVIDES SURGICAL SERVICES ON AN OUTPATIENT BASIS IN THE OGDEN, UTAH AREA.SELECTHEALTH, INC. HAS AS ITS PURPOSE THE DEVELOPMENT AND OPERATION OF ALTERNATIVE HEALTHCARE DELIVERY PLANS AND FINANCING SYSTEMS TO PROVIDE COST EFFECTIVE AND HIGH QUALITY CARE TO PARTICIPATING EMPLOYER GROUPS AND INDIVIDUALS AS WELL AS CONDUCTING RESEARCH AND EDUCATIONAL DEMONSTRATION PROJECTS. THE HEALTHCARE CAPTIVE INSURANCE COMPANY IS ENGAGED IN UNDERWRITING THE LIABILITIES OF INTERMOUNTAIN HEALTH CARE, INC. AND CERTAIN AFFILIATES IN EXCESS OF THEIR SELF-INSURED LIMITS."

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"HEALTH SERVICES FILES COMMUNITY BENEFIT REPORTS (OR ""CHARITY PLANS"") WITH EACH COUNTY IN UTAH WHERE HOSPITALS ARE LOCATED AS REQUIRED BY THE UTAH NONPROFIT HOSPITAL AND NURSING HOME PROPERTY TAX EXEMPTION STANDARDS. HEALTH SERVICES HAS ONE HOSPITAL IN IDAHO, CASSIA REGIONAL MEDICAL CENTER; IDAHO CURRENTLY DOES NOT HAVE STATE NONPROFIT HOSPITAL COMMUNITY BENEFIT REPORTING REQUIREMENTS."