Community Benefit Insight - Tax-exempt hospital

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Charleston Hospital Inc dba St Francis Hospital

St Francis Hospital

333 Laidley Street
Charleston, WV 25301

Bed count	155	Medicare provider number	510031	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 611272692

Display data for year:

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

11.6%

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	$ 0 0 %
Medicaid as % of operating expenses	$ 5,051,790 11.57 %
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.	$ 13,281 0.03 %
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	$ 2,972,849 6.81 %
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: 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 $ 29801813 including grants of $ 0) (Revenue $ 62473013)
Services provided by the hospital include 9,597 inpatient days, 47,109 outpatient visits, 12,392 ambulatory surgeries and 281 observation visits. The hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Charges forgone for charity amounted to $74,653.

Facility Information

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

St. Francis Hospital
Part V, Section B, Line 5: The Kanawha Coalition for Community Health Improvement (KCCHI) facilitated primary datacollection through community surveys, focus groups, telephone calls, and key informant interviews to identify key areas for health improvement/health need within the communities served. Individuals with the knowledge, information, and expertise relevant to the health needs of the community were consulted. These individuals included representatives from county public health departments as well as leaders, representatives, or members of medically underserved, low-income, and minority populations. Additionally, where applicable, other individuals with expertise of local health needs were consulted.

St. Francis Hospital
Part V, Section B, Line 6a: Charleston Area Medical Center

St. Francis Hospital
Part V, Section B, Line 6b: Kanawha Coalition for Community Health Improvement

St. Francis Hospital
Part V, Section B, Line 11: Saint Francis identifies the following as health priorities that it intends to address: 1. Engaging in sustainable and equitable partnerships with community leaders to address the COVID19 pandemic, in terms of prevention and treatment; 2. Effectively distributing COVID-19 vaccines to targeted populations, and phasing such distribution to enable the general public to readily obtain COVID-19 vaccines; 3. Pandemic fallout: addressing overlay of mental health, drug abuse, and domestic violence; 4. Addressing a lack of access to health promotion and chronic disease prevention and education; and 5. Addressing social determinants of health to prevent unnecessary emergency room visits as well as hospital admission and readmissions.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
The cost of charity care and unreimbursed Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The cost of community health improvement services and community benefit operations was calculated based on lab tests that were captured in the hospital's clinical system. Direct expenses were calculated based on the hospital's accounting records.The amount of cash and in-kind contributions to community groups was obtained from the hospital's accounting records.

Part I, Line 7, Column (f):
The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 2,972,849.

Part III, Line 2:
The bad debt expense was obtained from the hospital's accounting records.

Part III, Line 4:
"Bad debt expense is described in the consolidated financial statements as follows: ""Patient accounts receivable are carried at net realizable value based on certain assumptions determined by each payor. In evaluating accounts receivable, the System analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the net realizable value. 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 System determines implicit price concessions based on its past historical collection experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. Management reviews troubled, aged accounts to determine collection potential. Accounts are written off when all reasonable internal and external collection efforts have been exhausted."

Part III, Line 8:
Medicare costs were obtained from the hospital's Medicare cost report.

Part III, Line 9b:
"Once Thomas Health System determines that a patient is eligible for Financial Assistance, that patient shall not receive any future bills based on undiscounted gross charges. The amount charged for emergency or other medically necessary care to a Financial Assistance eligible individual will not be more than the amounts generally billed to (received by either THS Physician Partners, Thomas Memorial or Saint Francis Hospital ) Medicare fee-for-service and commercially insured patients. The amounts generally billed are calculated using the ""look-back"" method based on actual past claims paid to THS Physician Partners, Thomas Memorial Hospital or Saint Francis Hospital, as applicable, in the prior fiscal year by Medicare fee-for-service together with all private health insurers. The amounts generally billed will be recalculated annually. If it is not known that a patient is eligible for Financial Assistance, usual charges will be billed and if it is later determined that the individual is eligible, any excess payments will be refunded."

Part VI, Line 2:
The hospital is a member of the Kanawha Coalition for Community Health Improvement. The Coalition conducts a survey every three years to assess health care needs of the community. Results of the survey are presented in a meeting of community leaders and other interested persons, and are conveyed to the general public by local media. Results of the most recent survey were released in April, 2020. Additionally, the hospital reviewed the most recent Putnam County Community Need Assessment (2018-2019) in identifying needs and defining the plan of SFH.

Part VI, Line 3:
The hospital informs and educates patients about their eligibility for assistance by: (1) providing a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (2) including the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and (3) discussing with the patient the availability of various government benefits, such as Medicaid or state programs, and assisting the patient with qualification for such programs, where applicable. For those patients who come into our office after they receive a bill, we explain this same process to them. We also employ an outside agency, Advanced Patient Advocacy (APA), to speak with patients regarding Medicaid and other state and federal funding options. APA may speak with the patient during a stay or visit or after discharge. Hospital also has a DHHR employee on campus to help with getting the employees enrolled into Medicaid.

Part VI, Line 4:
The organization's geographic service area includes approximately 470,000 persons in a 12 county area of south-central West Virginia. Heart disease, cancer and pulmonary disease have been and continue to be the leading causes of death in the service area. Patients in the service area are typical of West Virginia as a whole. The population served is 48% male, 52% female. Approximately 22% of residents in the area have are on Medicaid or uninsured with no family doctor or other healthcare provider. Except for the area within the Charleston, WV city limits, all of the counties in the organization's geographic service area are federally-designated Medically Underserved and Health Manpower Shortage Areas.

Part VI, Line 5:
The hospital's Board of Directors is comprised of individuals who are members of the local community. The hospital will extend medical staff privileges to qualified physicians in the community who meet specific credentialing criteria. The hospital's budget is structured to ensure cash flow to fund capital improvements to the facility to enhance and/or improve patient care. The hospital provides specialized services that are not available elsewhere. Its Spine and Nerve Center and Retinal program are state of the art programs that have a patient base across the Tri-State area. The hospital attracts charitable support through its volunteer program, auxiliary and Volunteen programs.

Part VI, Line 6:
The hospital, along with Thomas Memorial Hospital, is part of Thomas Health System, Inc. The health system was formed to forge a partnership based on the strength of the two established hospitals. Bringing the two hospitals under the umbrella of the Thomas Health System allows them to provide innovative and cost-effective health care to the Kanawha Valley and surrounding areas. Economies of scale have allowed for cost reductions in numerous areas, while providing advanced technology to a larger community, with access to the highest quality of physicians, nurses and support staff in our service area. The system provides a wide range of services that serves the entire community. In addition to our acute care and outpatient services, our Prime of Life program reflects the services we feel are important to the public health. Saint Francis Hospital is also a faith-based institution which provides spiritual care for its patients. This is the unique difference between Saint Francis and other hospitals in the service area.

Operating expenses	$ 43,672,520
Total amount spent on community benefits as % of operating expenses	$ 5,065,071 11.60 %