Community Benefit Insight - Tax-exempt hospital

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Our Lady of Lourdes Hospital at Pasco

520 North 4th Avenue

Pasco, WA 99301

EIN: 910349750

The hospital that you have selected is part of a multi-facility organization that reports community benefit expenditures in the aggregate and not by individual hospital. The data shown below are for the multi-facility organization. We encourage you to contact the individual hospital directly if you would like community benefit information on the hospital.Learn more

Individual Facility Details: Lourdes Medical Center

520 North Fourth Street
Pasco, WA 99301

1 hospital in organization:
(click a facility name to update Individual Facility Details panel)

Lourdes Medical Center

Bed count	35	Medicare provider number	501337	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

Our Lady of Lourdes Hospital at PascoDisplay data for year:

Community Benefit Spending- 2018
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

9.14%

Spending by Community Benefit Category- 2018
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2018

Additional data

Community Benefit Expenditures: 2018

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	$ 418,995 1.58 %
Medicaid as % of operating expenses	$ 1,871,632 7.04 %
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	$ 0 0 %
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.	$ 107,760 0.41 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 30,568 0.12 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	NO
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: 2018

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	$ 317,365 1.19 %
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	$ 0 0 %

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: 2018

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?	NO
Did the CHNA define the community served by the tax-exempt hospital?	Not available
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	Not available
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	Not available
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	Not available

Supplemental Information: 2018

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 $ 22011767 including grants of $ 249) (Revenue $ 23620068)
OUR LADY OF LOURDES HOSPITAL AT PASCO is a 57-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2019, OUR LADY OF LOURDES HOSPITAL AT PASCO treated 592 adults and children for a total of 2,547 patient days of service. The hospital also provided services for 66,357 outpatient visits, which included 389 outpatient surgeries and 3,875 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.

Facility Information

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

Schedule H, Part V, Section B, Line 3E
To better target community resources on the service area's most pressing health needs, the hospital participated in a group discussion with organizational decision makers and community leaders to prioritize the significant community health needs while considering several criteria: alignment with Ascension Health strategies of healthcare that leaves no one behind; care for the poor and vulnerable; opportunities for partnership; availability of existing programs and resources; opportunities for partnership; addressing disparities of subgroups; availability of evidence-based practices; and community input. The significant health needs are a prioritized description of the significant health needs of the community as identified through the CHNA. See Schedule H, Part V, Line 7 for the link to the CHNA and Schedule H, Part V, Line 11 for how those needs are being addressed.

Supplemental Information

Schedule H (Form 990) Part VI

Schedule H, Part V, Section B, Line 3 COMMUNITY HEALTH NEEDS ASSESSMENT
DUE TO THE FACT THAT Lourdes was only operational as a NON-RROFIT hospital through August 31, 2019, NO NEW COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED.

Schedule H, Part V, Section B, Line 16 FAP WEBSITE
The website provided was the site where the FAP, FAP application and plain language summary were posted during the time that Lourdes was operating as a NON-RROFIT hospital. The site is no longer operational.

Schedule H, Part I, Line 3c factors other than fpg
"Patients with demonstrated financial needs with income greater than 400% of the FPG may be eligible for consideration under a ""Means Test"" for some discount of their charges for services from the Organization based on a substantive assessment of their ability to pay. Consideration for the ""Means Test"" includes, but is not limited to, income, medical bill obligations, mortgage payments, utilities, family size and disability. A patient eligible for the ""Means Test"" discount will not be charged more than the calculated AGB charges."

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"The cost of providing charity care, means-tested government programs, and other community benefit programs was estimated using internal cost data, and was calculated in compliance with Catholic Health Association (""CHA"") guidelines. The organization used a cost accounting system that addressed all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied."

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient had been exhausted, the Corporation followed established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable were written off after collection efforts had been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2019 was $893,280 at charges, ($294,782 at cost).

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
OUR LADY OF LOURDES HOSPITAL AT PASCO HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 21.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
A COST TO CHARGE RATIO WAS APPLIED TO THE ORGANIZATION'S MEDICARE EXPENSE TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
OUR LADY OF LOURDES HOSPITAL AT PASCO FOLLOWED THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT COULD APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYINGDOCUMENTATION WAS RECEIVED THE PATIENT'S ACCOUNT WAS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO HAVE BEEN CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIED FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY WAS SUSPENDED.

Schedule H, Part V, Section B, Line 16a FAP website
A - Lourdes Medical Center: Line 16a URL: http://www.yourlourdes.com/billing-financial-assistance/;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - Lourdes Medical Center: Line 16b URL: http://www.yourlourdes.com/billing-financial-assistance/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - Lourdes Medical Center: Line 16c URL: http://www.yourlourdes.com/billing-financial-assistance/;

Schedule H, Part VI, Line 2 Needs assessment
"Our Lady of Lourdes Hospital at Pasco (""Lourdes"") was a collaborative community partner. During year ended June 30, 2019, Lourdes was only operational as a non-profit hospital through August 31, 2019. Therefore, there was minimal additional assessment of the health needs of the community."

Schedule H, Part VI, Line 7 State filing of community benefit report
WA

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Financial counselors were trained to discuss the financial assistance policy and assist those needing assistance with the application. In addition, they had knowledge of other assistance programs that patients may have qualified for and assisted patients in finding that information. During the pre-registration, registration, admission and discharge processes, Lourdes attempted to identify patients who may be eligible for charity or discounted care via the charity care policy. A financial counselor was provided to all patients. Lourdes charity care policy was posted in all admitting areas, the emergency room and the information desk with information about our financial assistance program and how to access it if needed. On the website the full application was available for download as well as information about the policy. A written summary and contact information was provided in all communications with patients regarding bills and account status.

Schedule H, Part VI, Line 4 Community information
"OUR LADY OF LOURDES HOSPITAL AT PASCO (""LOURDES"") PRIMARILY SERVED THOSE RESIDING IN FRANKLIN AND BENTON COUNTIES. LOURDES OFFERED THE ONLY ACUTE HOSPITAL IN FRANKLIN COUNTY. LOURDES ALSO OFFERS THE REGION'S ONLY INPATIENT MENTAL HEALTH HOSPITAL IN BENTON ' FRANKLIN COUNTIES. THE DEMOGRAPHIC MAKEUP OF THE COMMUNITY WE SERVED, PER THE UNITED STATES CENSUS BUREAU, WAS AS FOLLOWS: FRANKLIN COUNTY - TOTAL POPULATION (EST. AS OF 2016) - 90,160 - 73.6% ARE HIGH SCHOOL EDUCATED OR ABOVE - 15.6% OF INDIVIDUALS LIVING IN POVERTY - 53.0% HISPANIC OR LATINO BENTON COUNTY - TOTAL POPULATION (EST. AS OF 2016) - 193,686 - 88.9% ARE HIGH SCHOOL EDUCATED OR ABOVE - 14.2% OF INDIVIDUALS LIVING IN POVERTY - 21.4% HISPANIC OR LATINO THE HEALTH STATUS OF THE MID-COLUMBIA REGION TRENDS WITH THE HEALTH OF THE NATION. HOWEVER, OUR AREA HAS A HIGHER PREVALENCE OF CHILDHOOD OBESITY AND DIABETES, WHICH THEN ADDS TO OTHER ISSUES SUCH AS HEART DISEASE AND STROKE. OTHER AREAS RATED UNFAVORABLE COMPARED TO PEER COUNTIES INCLUDE : - BIRTHS TO WOMEN UNDER 18 - BIRTHS TO UNMARRIED WOMEN - NO CARE IN FIRST TRIMESTER - MORTALITY - HOMICIDE - LUNG CANCER - STROKE - SUICIDE - COLON CANCER LOURDES HEALTH NETWORK WORKED DILIGENTLY TO PROVIDE HEALTHY LIFESTYLE EDUCATION TO THE COMMUNITY IN MULTIPLE WAYS SUCH AS A COMMUNITY NEWSLETTER, A WEB-BASED HEALTH INFORMATION LIBRARY, COMMUNITY EVENTS, EDUCATIONAL FORUMS AND FORMALIZED RELATIONSHIPS WITH SCHOOLS."

Schedule H, Part VI, Line 5 Promotion of community health
"Our Lady of Lourdes Hospital at Pasco (""Lourdes"") sought to improve the physical, mental, social, and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, Our Lady of Lourdes Hospital at Pasco developed programs to help achieve its mission. Lourdes has provided significant support in the form of job shadow hours for classes at a local college, an employment service, and other organizations with the purpose of creating new employment opportunities for members of the community. Lourdes also participated in other community-building coalitions in an effort to address health and safety concerns in the community. Lourdes allowed educated staff with specific expertise to provide community education. For instance, the Infection Control nurse provided hand hygiene education to schools, at community events, and to teachers. Lourdes' board- certified child psychiatrist provided education to local teachers about signs and symptoms of children's common mental health issues. Certified dieticians provided education to school children and through the YMCA about healthy after- school snacks and overall healthy eating habits. It was estimated that over 2,000 school children and staff have attended sessions in the last year. - Other Non-profits: American Cancer Society, American Diabetes Association, American Red Cross, Boys and Girls Clubs YMCA."

Schedule H, Part VI, Line 6 Affiliated health care system
"OUR LADY OF LOURDES HOSPITAL AT PASCO, (""HEALTH NETWORK"") WAS PART OF THE ASCENSION HEALTH ALLIANCE (""THE SYSTEM""). ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION iS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN MORE THAN 20 STATES AND THE DISTRICT OF COLUMBIA. ASCENSION AND ITS MEMBER ORGANIZATIONS ARE HEREAFTER REFERRED TO COLLECTIVELY AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ORGANIZATIONS/ENTITIES OF ASCENSION SPONSOR ARE: THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. OUR LADY OF LOURDES HOSPITAL AT PASCO D/B/A LOURDES HEALTH NETWORK, LOCATED IN PASCO WASHINGTON, WAS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE HEALTH NETWORK CONSISTED OF TWO SEPARATELY LICENSED NOT-FOR-PROFIT HEALTH CARE PROVIDERS AND A FOUNDATION: LOURDES MEDICAL CENTER (""MEDICAL CENTER"") LOCATED IN PASCO, WASHINGTON; LOURDES COUNSELING CENTER (""COUNSELING CENTER"") IN RICHLAND, WASHINGTON; AND LOURDES FOUNDATION (""FOUNDATION""). THE MEDICAL CENTER AND COUNSELING CENTER PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF PASCO AND ITS SURROUNDING COMMUNITIES. ADMITTING PHYSICIANS WERE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. THE FOUNDATION SUPPORTED THE MEDICAL CENTER AND THE COUNSELING CENTER. THE HEALTH NETWORK WAS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF ASCENSION HEALTH ARE RELATED TO PROVIDING HEALTH CARE SERVICES. THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING, AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDER-INSURED - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS. - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS VICTIMS OF CHILD ABUSE AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF EACH ENTITY'S TOTAL OPERATING EXPENSES TO THE ENTITY'S BILLED CHARGES FOR PATIENT CARE. CERTAIN COSTS SUCH AS GRADUATE MEDICAL EDUCATION AND CERTAIN OTHER ACTIVITIES ARE EXCLUDED FROM TOTAL OPERATING EXPENSES FOR PURPOSES OF THIS COMPUTATION."