Community Benefit Insight - Tax-exempt hospital

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Southwest Health System Inc

Southwest Memorial Hospital

1311 North Mildred Road
Cortez, CO 81321

Bed count	25	Medicare provider number	061327	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 841337350

Display data for year:

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

14.01%

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	$ 3,306,327 4.60 %
Medicaid as % of operating expenses	$ 5,668,800 7.89 %
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	$ 1,090,069 1.52 %
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	$ 3,944,773 5.49 %
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 $ 67687904 including grants of $ 0) (Revenue $ 69381341)
DURING 2021, SOUTHWEST HEALTH SYSTEMS SERVED APPROXIMATELY 51,323 INPATIENTS AND OUTPATIENTS, 54,836 PATIENTS WERE SERVED THROUGH OUR PHYSICIAN CLINICS, AND 12,606 PATIENTS WERE SEEN IN OUR EMERGENCY ROOM.

Facility Information

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

SOUTHWEST MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: SHS WORKED WITH CHC CONSULTING IN THE DEVELOPMENT OF ITS CHNA. SHS PROVIDED ESSENTIAL DATA AND RESOURCES NECESSARY TO INITIATE AND COMPLETE THE PROCESS, INCLUDING THE DEFINITION OF THE HOSPITAL'S STUDY AREA AND THE IDENTIFICATION OF KEY COMMUNITY STAKEHOLDERS TO BE INTERVIEWED.CHC CONSULTING CONDUCTED THE FOLLOWING RESEARCH: A DEMOGRAPHIC ANALYSIS OF THE STUDY AREA, UTILIZING DEMOGRAPHIC DATA FROM THE IBM WATSON HEALTH MARKET EXPERT TOOL. A STUDY OF THE MOST RECENT HEALTH DATA AVAILABLE. CONDUCTED ONEONONE PHONE INTERVIEWS WITH INDIVIDUALS WHO HAVE SPECIAL KNOWLEDGE OF THECOMMUNITIES, AND ANALYZED RESULTS. FACILITATED THE PRIORITIZATION PROCESS DURING THE CHNA TEAM MEETING ON AUGUST 13, 2019. THE CHNA TEAMINCLUDED: THE METHODOLOGY FOR EACH COMPONENT OF THIS STUDY IS SUMMARIZED IN THE FOLLOWING SECTION. IN CERTAIN CASES METHODOLOGY IS ELABORATED IN THE BODY OF THE REPORT. ANTHONY SUDDUTH, CHIEF EXECUTIVE OFFICER BRIDGETT JABOUR, EXECUTIVE ASSISTANT LIESL UNGNADE, QUALITY IMPROVEMENT/RISK MANAGEMENT COORDINATOR RHONDA HATFIELD, PATIENT FINANCIAL COORDINATOR SHERRI WILBURN, CASE MANAGER KAREN LABONTE, CHIEF NURSING OFFICER KERRI WHITE, SR. CLINICAL OPERATIONS SARA BARRETT, SOCIAL WORKER

SOUTHWEST MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: THE FOUR MOST SIGNIFICANT NEEDS, AS DISCUSSED DURING THE AUGUST 13TH PRIORITIZATION MEETING, ARE LISTED BELOW: 1. CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION 2. ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS 3. ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS 4. PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES.PRIORITY #1: CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTIONMONTEZUMA COUNTY HAS A LOWER PERCENTAGE OF ADULTS WITH A PERSONAL DOCTOR THAN THE STATE. ADDITIONALLY, MONTEZUMA COUNTY HAS A LOWER RATE OF DENTISTS PER 100,000 POPULATION THAN THE STATE AND IN A RECENTLY COMPLETED MEDICAL STAFF DEVELOPMENT PLAN CONDUCTED FOR SHS, DATA INDICATES A NEED FOR ADDITIONAL PRIMARY CARE PROVIDERS WITHIN THE COMMUNITY.DURING THE MAY 2019 HOSPITAL TRANSFORMATION PROJECT COMMUNITY MEETING, STAKEHOLDERS DISCUSSED A NEED FOR AFTER HOUR CLINICS IN THE COMMUNITY. ADDITIONALLY, STAKEHOLDERS DISCUSSED A LACK OF CERTAIN SPECIALTY SERVICES IN THE COMMUNITY. ORTHOPEDIC SERVICES WERE MENTIONED AS AN INCREASING NEED DUE TO THE AGING COMMUNITY AND RETIRING BABY BOOMERS. STAKEHOLDERS DISCUSSED THE LIMITED DEPTH IN RESPIRATORY CARE, AS WELL AS THE OUTMIGRATION OF CANCER PATIENTS TO DURANGO FOR ONCOLOGY SERVICES. STAKEHOLDERS ALSO MENTIONED A NEED FOR A PAIN CLINIC TO CUT DOWN ON THE NUMBER OF EMERGENCY DEPARTMENT VISITS BY CHRONIC PAIN PATIENTS, AND DISCUSSED THE OUTMIGRATION OF CHRONIC PAIN PATIENTS TO GRAND JUNCTION FOR CARE. STAKEHOLDERS DISCUSSED POTENTIAL OPPORTUNITIES TO REDUCE BARRIERS TO ACCESSING CARE, SUCH AS IMPROVING FRONTEND TRIAGE IN THE EMERGENCY DEPARTMENT, REDUCING WAIT TIMES AND EXPANDING HOURS OF OPERATION IN THE LOCAL WALKIN CLINIC, IMPROVING ACCESS TO PRIMARY CARE PROVIDERS, CONNECTING HIGH EMERGENCY DEPARTMENT UTILIZERS WITH PRIMARY CARE PROVIDERS AND IMPLEMENTING A PAIN CLINIC.PRIORITY #2: ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONSTHE MEDIAN HOUSEHOLD INCOME IN MONTEZUMA COUNTY IS SIGNIFICANTLY LOWER THAN THE MEDIAN HOUSEHOLD INCOME IN THE STATE. MONTEZUMA COUNTY HAS A HIGHER UNEMPLOYMENT RATE THAN THE STATE, AND A HIGHER RATE OF FAMILIES LIVING BELOW POVERTY. THE PERCENTAGE OF CHILDREN LIVING BELOW POVERTY IN MONTEZUMA COUNTY IS HIGHER THAN THE STATE, AND THE COUNTY ALSO HAS A HIGHER RATE OF STUDENTS ELIGIBLE FOR FREE OR REDUCED PRICE LUNCH. MONTEZUMA COUNTY ALSO HAS A HIGHER RATE OF BOTH OVERALL AND CHILD FOOD INSECURITY THAN COLORADO. ADDITIONALLY, MONTEZUMA COUNTY HAS SEVERAL HEALTH PROFESSIONAL SHORTAGE AREA DESIGNATIONS AND CENSUS TRACTBASED MEDICALLY UNDERSERVED AREA/POPULATION DESIGNATIONS, AS DEFINED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND A HIGHER RATE OF UNINSURED ADULTS THAN THE STATE.DURING THE MAY 2019 HOSPITAL TRANSFORMATION PROJECT COMMUNITY MEETING, STAKEHOLDERS DISCUSSED TRANSPORTATION BARRIERS TO AND FROM PROVIDER APPOINTMENTS IN MONTEZUMA COUNTY THAT MAY CAUSE PATIENTS TO DELAY OR FOREGO CARE. IT WAS ALSO MENTIONED THAT SOCIOECONOMIC STATUS MAY DETERMINE THE FREQUENCY OF VISITS TO THE EMERGENCY DEPARTMENT, WITH THE LOW INCOME POPULATION AS THE MOST FREQUENT UTILIZERS OFTHHE EMERGENCY ROOM. STAKEHOLDERS DISCUSSED A NEED TO ADDRESS CULTURAL CHALLENGES IN THE COMMUNITY AND SPECIFICALLY NOTED A LACK OF NAVAJO SPEAKING PROVIDERS IN MONTEZUMA COUNTY. IT WAS ALSO MENTIONED THAT THERE IS A LACK OF FOCUS ON SOCIAL DETERMINANTS IN THE COMMUNITY AND AN ASSOCIATED NEED TO BETTER ADDRESS POVERTY AND THE WORKING POOR.PRIORITY #3: ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERSMONTEZUMA COUNTY HAS A LOWER RATE OF MENTAL AND BEHAVIORAL HEALTH CARE PROVIDERS PER 100,000 POPULATION THAN THE STATE. ADDITIONALLY, THE PERCENT OF ADULTS WHO EXPERIENCED 14 OR MORE DAYS OF POOR MENTAL HEALTH IN MONTEZUMA COUNTY IS HIGHER THAN THE STATE. DURING THE MAY 2019 HOSPITAL TRANSFORMATION PROJECT COMMUNITY MEETING, STAKEHOLDERS DISCUSSED A LACK OF MENTAL AND BEHAVIORAL HEALTH CARE RESOURCES AND PROVIDERS IN THE COMMUNITY. IT WAS NOTED THAT THE PROVIDERS AT AXIS INTEGRATED HEALTH MAY BE OVERWHELMED, AND STAKEHOLDERS DISCUSSED THE POTENTIAL BENEFIT OF HAVING ADDITIONAL PSYCHIATRISTS AND COUNSELORS AVAILABLE IN ADDITION TO WHAT IS CURRENTLY PROVIDED. A LACK OF DETOX CENTERS AND THE INABILITY TO SUPPORT SUBSTANCE ABUSE PATIENTS WERE SPECIFICALLY MENTIONED, AND CONCERN WAS RAISED SURROUNDING THE SIGNIFICANT RATE OF BEHAVIORAL HEALTHRELATED ALCOHOL AND SUBSTANCE ABUSE ISSUES. STAKEHOLDERS DISCUSSED THE PREVALENCE OF DEPRESSION, DEPRESSION RELATED TO CHRONIC ILLNESS, ANXIETY AND PANIC ATTACKS IN THE EMERGENCY ROOM AND MENTAL ILLNESS WITH DEMENTIA AS A SECONDARY DIAGNOSIS. A NEED FOR SUICIDAL IDEATION PLANS FOR PATIENTS WAS ALSO EMPHASIZED, AND STAKEHOLDERS ALSO DISCUSSED THE NECESSITY OF A SOCIAL WORKER IN THE EMERGENCY DEPARTMENT. STAKEHOLDERS DISCUSSED POTENTIAL OPPORTUNITIES TO REDUCE BARRIERS TO ACCESSING MENTAL AND BEHAVIORAL HEALTH CARE, SUCH AS MORE PSYCHOSOCIAL SUPPORT IN THE EMERGENCY DEPARTMENT (I.E., PROVIDING A SOCIAL WORKER IN THE HOSPITAL), STAFFING A HOSPITAL MENTAL HEALTH PROVIDER, PURSUING GRANT FUNDING FOR SOBER LIVING HOUSING, MARIJUANA TAX REVENUE FOR DETOX AND REHABILITATION PROGRAMS AND PROVIDING FUNDING FOR A PHYSICIAN IN THE DETENTION CENTER.PRIORITY #4: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLECONDITIONS AND UNHEALTHY LIFESTYLESDATA SUGGESTS THAT HIGHER RATES OF SPECIFIC MORTALITY CAUSES AND UNHEALTHY BEHAVIORS WARRANTS A NEED FOR INCREASED PREVENTIVE EDUCATION AND SERVICES TO IMPROVE THE HEALTH OF THE COMMUNITY. CANCER AND HEART DISEASE ARE THE TWO LEADING CAUSES OF DEATH IN MONTEZUMA COUNTY AND THE STATE. MONTEZUMA COUNTY HAS HIGHER MORTALITY RATES THAN COLORADO FOR MALIGNANT NEOPLASMS; CHRONIC LIVER DISEASE AND CIRRHOSIS; ACCIDENTS; SUICIDE; DIABETES MELLITUS; NEPHRITIS, NEPHROSIS, NEPHROTIC SYNDROME; PROSTATE CANCER; LUNG AND BRONCHUS CANCER AND COLON AND RECTUM CANCER. MONTEZUMA COUNTY HAS HIGHER RATES OF COMMUNICABLE DISEASES, SUCH AS CHLAMYDIA AND GONORRHEA, THAN THE STATE. MONTEZUMA COUNTY HAS HIGHER RATES OF CHRONIC CONDITIONS AND UNHEALTHY LIFESTYLE BEHAVIORS SUCH AS DIABETES (ADULT), OBESITY, ASTHMA, ARTHRITIS, PHYSICAL INACTIVITY, SMOKING AND MARIJUANA USE THAN THE STATE. DATA ALSO SUGGESTS THAT RESIDENTS MAY NOT BE SEEKING NECESSARY PREVENTIVE CARE SERVICES, SUCH AS MAMMOGRAMS. WITH REGARDS TO MATERNAL AND CHILD HEALTH, SPECIFICALLY, MONTEZUMA COUNTY HAS HIGHER PERCENTAGES OF INADEQUATE PRENATAL CARE, MOTHERS WHO SMOKED DURING PREGNANCY AND LOW BIRTH WEIGHT BIRTHS THAN THE STATE. DATA ALSO SUGGESTS THAT MONTEZUMA COUNTY ADULTS MAY NOT BE SEEKING PREVENTIVE CARE SERVICES IN AN APPROPRIATE MANNER, SUCH AS MAMMOGRAMS, PROSTATE CANCER SCREENINGS, PAP TEST SCREENINGS, COLORECTAL CANCER SCREENINGS AND THE INFLUENZA VACCINE. DURING THE MAY 2019 HOSPITAL TRANSFORMATION PROJECT COMMUNITY MEETING, STAKEHOLDERS DISCUSSED THE LACK OF PUBLIC KNOWLEDGE REGARDING WHERE TO GO FOR DIFFERENT TYPES OF CARE AND THE NEED FOR MORE ADVERTISING OF HOSPITAL SERVICES. IT WAS ALSO MENTIONED THAT THERE IS A NEED FORMORE SUPPORT GROUPS OF ALL TYPES TO BENEFIT SUBPOPULATIONS ACROSS THE COMMUNITY. AREAS OF CONCERN THAT WERE DISCUSSED INCLUDE HIGH RATES OF DIABETES, HEART DISEASE, URINARY TRACT INFECTIONS AND CHRONIC DISEASES WITHIN THE ELDERLY POPULATION. STAKEHOLDERS DISCUSSED THE OPPORTUNITY FOR THE CLINIC TO ENSURE CONSISTENT CARE AND PREVENT FURTHER DIABETIC COMPLICATIONS THROUGH THE TEACHING CURRENTLY IN PLACE, AND ALSO DISCUSSED THE ISSUES ASSOCIATED WITH HEART DISEASE IN THE COMMUNITY SUCH AS LACK OF PHYSICAL CARE, OBESITY, DIABETES AND OTHER RELATED CONDITIONS. URINARY TRACT INFECTIONS AND CHRONIC DISEASES OF THE ELDERLY WITH A HIGH NUMBER OF COMORBIDITIES WERE ALSO MENTIONED DURING THE MEETING. STAKEHOLDERS DISCUSSED POTENTIAL OPPORTUNITIES TO EDUCATE THE COMMUNITY, SUCH AS HOSPITAL EDUCATION CLASSES FOR THE PUBLIC, FURTHER EDUCATION ON WHERE TO GO FOR CARE FOR INDIVIDUALS AND LOCAL AGENCIES/COMMUNITY PARTNERS AND OUTREACH TO THE LOCAL SENIOR CENTER AND VETERANS IN THE COMMUNITY.

SOUTHWEST MEMORIAL HOSPITAL
PART V, SECTION B, LINE 16J: POLICY COMMUNICATION IS INCLUDED IN THE QUARTERLY NEWSLETTER.

Supplemental Information

Schedule H (Form 990) Part VI

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

PART I, LINE 7:
THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A. UNREIMBURSED MEDICAID AND SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING THE COST REPORT AND ANALYZING THE MEDICARE RATIO OF COST TO CHARGE FOR THE RESPECTIVE COST CENTERS. THE INFORMATION FOR LINES 7E AND 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS.

PART I, LINE 7G:
THE AMOUNTS REPORTED IN SUBSIDIZED HEALTH SERVICES INCLUDES COSTS FOR A RURAL HEALTH CLINIC.

PART III, LINE 2:
THE BAD DEBT ON LINE 2 IS REPORTED AT CHARGES. THE HEALTH SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYERS, PATIENTS, AND OTHERS. THE HEALTH SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS.

PART III, LINE 4:
THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES CAN BE FOUND ON PAGE 21-24 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
ONE HUNDRED PERCENT OF ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. A FACILITY MUST BE ABLE TO RECOVER ITS COSTS IN ORDER TO CONTINUE TO PROVIDE QUALITY CARE TO MEDICARE PATIENTS AND THE COMMUNITY AS A WHOLE. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THAT NOT ALL COSTS ASSOCIATED WITH ROVIDING THESE SERVICES WILL BE RECOVERED. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. THEREFORE, THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.

PART III, LINE 9B:
THE ORGANIZATION REFRAINS FROM SENDING PATIENT ACCOUNTS TO COLLECTION UNTIL 120 DAYS AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. IF A PATIENT APPLIES FOR FINANCIAL ASSISTANCE WITHIN 240 DAYS OF THE DATE OF THE FIRST POST-DISCHARGE BILLINGS STATEMENT THE ORGANIZATION WILL PULL THE ACCOUNTS FROM COLLECTIONS.

PART VI, LINE 2:
IN ADDITION TO THE CHNA DATA COLLECTION AND ANALYSIS, INPUT IS RECEIVED FROM MEDICAL STAFF, HOSPITAL LEADERSHIP, AND THE BOARD. THE HOSPITAL ALSO REVIEWS NEEDS AS PART OF THE COLORADO MANDATED HOSPITAL TRANSFORMATION PROJECT, AND IS A PARTICIPANT IN COLORADO'S REGIONAL ACCOUNTABLE ENTITIES (RAE).

PART VI, LINE 3:
PATIENTS ARE SENT LETTERS DESCRIBING THE PROGRAMS AVAILABLE TO ASSIST WITH THEIR MEDICAL BILLS. THE LETTER EXPLAINS THE PROCESS AND THE DOCUMENTS NEEDED TO COMPLETE THE ASSISTANCE APPLICATIONS(S). THE LETTER ALSO ENCOURAGES THE PATIENT TO CHECK THEIR ELIGIBILITY WITH THEIR STATE MEDICAID OFFICE. FOLLOW-UP APPOINTMENTS ARE SCHEDULED WITH FINANCIAL COUNSELORS TO COMPLETE THE ASSISTANCE APPLICATIONS.

PART VI, LINE 4:
GEOGRAPHICALLY, THE PRIMARY SERVICE AREA (PSA) OF SWMH IS COMPRISED OF SEVEN ZIP CODES WITHIN AND AROUND MONTEZUMA COUNTY IN SOUTHWEST COLORADO. SOUTHWEST HEALTH SYSTEM INC 84-1337350. THE PSA IS SITUATED BETWEEN THE MOUNTAINS TO THE EAST AND DESERTS TO THE WEST. MONTEZUMA COUNTY IS RURAL AND HEAVILY AGRICULTURAL AND VERY DEPENDENT UPON TOURISM. ACCORDING TO A 2019 REPORT OF 2018 DATA, THE MEDIAN AGE IN MONTEZUMA COUNTY IS EXPECTED TO SLIGHTLY DECREASE OVER THE NEXT FIVE YEARS, WHILE THE MEDIAN AGE IN THE STATE IS EXPECTED TO INCREASE (2019-2024). MONTEZUMA COUNTY (43.3 YEARS) HAS A CONSISTENT MEDIAN AGE WITH COLORADO (43.0 YEARS) (2019). THE MEDIAN HOUSEHOLD INCOME IN MONTEZUMA COUNTY IS EXPECTED TO DECREASE SLIGHTLY OVER THE NEXT FIVE YEARS, WHILE THE MEDIAN HOUSEHOLD INCOME IN THE STATE IS EXPECTED TO INCREASE (2019-2024).-MONTEZUMA COUNTY ($42,017) HAS A LOWER MEDIAN HOUSEHOLD INCOME THAN COLORADO ($57,268) (2019).-MONTEZUMA COUNTY (27.0%) HAS A LOWER PERCENTAGE OF RESIDENTS WITH A BACHELOR OR ADVANCED DEGREE THAN THE STATE (39.5%) (2019). UNEMPLOYMENT RATES IN MONTEZUMA COUNTY AND THE STATE REMAINED RELATIVELY STEADY BETWEEN 2016 AND 2018.-IN 2018, MONTEZUMA COUNTY (4.7%) HAD A HIGHER UNEMPLOYMENT RATE THAN THE STATE (3.3%).-BETWEEN 2014 AND 2016, THE PERCENT OF CHILDREN (<18 YEARS) LIVING BELOW POVERTY IN MONTEZUMA COUNTY AND COLORADO DECREASED.-MONTEZUMA COUNTY (24.8%) HAS HIGHER PERCENTAGE OF CHILDREN (<18 YEARS) LIVING BELOW POVERTY THAN COLORADO (13.4%) (2016).THE COUNTY HEALTH RANKINGS RANK 60 COUNTIES IN COLORADO (1 BEING THE BEST, 60 BEING THE WORST).-MANY FACTORS GO INTO THESE RANKINGS, INCLUDING PHYSICAL ENVIRONMENT AIR POLLUTION - PARTICULATE MATTER DRINKING WATER VIOLATIONS SEVERE HOUSING PROBLEMS DRIVING ALONE TO WORK-HEALTH BEHAVIORS: ADULT SMOKING ADULT OBESITY SEXUALLY TRANSMITTED INFECTIONS TEEN BIRTHS

PART VI, LINE 5:
SHS'S BOARD OF DIRECTORS IS CURRENTLY COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA (PSA) AND ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF SHS, WITH THE EXCEPTION OF ONE MEMBER WHO IS AN INDEPENDENT CONTRACTOR AS A CRNA. MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL QUALIFIED PHYSICIANS. SURPLUS FUNDS ARE USED TO IMPROVE THE CARE OF PATIENTS. SHS HOLDS EDUCATION HEALTH SEMINARS, OPEN AT NO CHARGE TO COMMUNITY MEMBERS, AND PARTICIPATES IN HEALTH FAIRS WITH FREE AND LOW COST SCREENING EXAMS.

Operating expenses	$ 71,823,222
Total amount spent on community benefits as % of operating expenses	$ 10,065,196 14.01 %