4A (Expenses $ 162237393 including grants of $ 0) (Revenue $ 171997869)
HOSPITAL SERVICES SHORT TERM CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR DOUGLAS AND COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER (CRMC) SERVED 5,168 PATIENTS FOR A TOTAL OF 20,907 INPATIENT DAYS IN 2021. NURSERY DAYS WERE 911 IN 2021. COFFEE REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY $23,359,371 OF INDIGENT AND CHARITY SERVICES IN 2021.

COFFEE REGIONAL MEDICAL CENTER INC
PART V, SECTION B, LINE 5: WE, ALONG WITH PYA, DEVELOPED SURVEYS THAT WERE SENT OUT TO ALL COMMUNITY MEMBERS. WE REACHED OUT TO INDEPENDENT MEDICAL PROFESSIONALS AS WELL AS INDIVIDUALS WITH THE LOCAL HEALTH DEPARTMENT .

COFFEE REGIONAL MEDICAL CENTER INC
PART V, SECTION B, LINE 6A: INDIRECTLY, MOST NOTABLY THE RELATIONSHIP WITH COMMUNITY BUSINESSES INVOLVING THE DELIVERY OF HEALTHCARE AND CRMC'S CRITICAL ACCESS PARTNER HOSPITALS.

COFFEE REGIONAL MEDICAL CENTER INC
PART V, SECTION B, LINE 11: CRMC HAS PREVIOUSLY AND CONTINUES TO IMPLEMENT AND INCORPORATE STRATEGIC INITIATIVES TO ADDRESS AREA IDENTIFIES IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AS WELL AS ON-GOING FEEDBACK FROM OUR MEDICAL STAFF, OUR PATIENTS, OUR COMMUNITY AND OUR BUSINESS PARTNERS

PART I, LN 7 COL(F):
THERE IS $22,784,553 OF BAD DEBT EXPENSE WHICH IS INCLUDED IN FORM 990, PART IX, LINE 24(A). THIS AMOUNT WAS REMOVED IN THE CALCULATION OF THE PERCENT OF TOTAL EXPENSE ON SCHEDULE H LINE 7F.

PART III, LINE 2:
AMOUNTS ON PART III, LINES 2 AND 3 REPRESENT CHARGES WRITTEN OFF AS UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT AND WRITTEN OFF TO BAD DEBT EXPENSE. LINE 3 IS ESTIMATED AT 75% OF THE AMOUNT ON LINE 2.

PART III, LINE 3:
IMPLICIT PRICE CONCESSIONS FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE ARE ESTIMATED BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT. FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM RECOGNIZES REVENUE ON THE BASIS OF ESTABLISHED RATES, DISCOUNTED ACCORDING TO POLICY FOR SERVICES RENDERED. HISTORICAL EXPERIENCE HAS SHOWN A SIGNIFICANT PROPORTION OF THE SYSTEM'S UNINSURED PATIENTS, IN ADDITION TO A GROWING PROPORTION OF THE SYSTEM'S INSURED PATIENTS, WILL BE UNABLE OR UNWILLING TO PAY FOR THEIR RESPONSIBLE AMOUNTS FOR THE SERVICES PROVIDED. IN ORDER TO ESTIMATE THE NET REALIZABLE VALUE OF THE REVENUES AND ACCOUNTS RECEIVABLE ASSOCIATED WITH THIRD-PARTY PAYORS AND UNINSURED PATIENTS, MANAGEMENT REGULARLY ASSESSES THEIR VALUATION BASED UPON BUSINESS AND ECONOMIC CONSIDERATIONS, TRENDS IN HEALTHCARE COVERAGE, HISTORICAL WRITE-OFF EXPERIENCE AND OTHER COLLECTION TRENDS.

PART III, LINE 4:
IMPLICIT PRICE CONCESSIONS FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE ARE ESTIMATED BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT. FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM RECOGNIZES REVENUE ON THE BASIS OF ESTABLISHED RATES, DISCOUNTED ACCORDING TO POLICY FOR SERVICES RENDERED. HISTORICAL EXPERIENCE HAS SHOWN A SIGNIFICANT PROPORTION OF THE SYSTEM'S UNINSURED PATIENTS, IN ADDITION TO A GROWING PROPORTION OF THE SYSTEM'S INSURED PATIENTS, WILL BE UNABLE OR UNWILLING TO PAY FOR THEIR RESPONSIBLE AMOUNTS FOR THE SERVICES PROVIDED. IN ORDER TO ESTIMATE THE NET REALIZABLE VALUE OF THE REVENUES AND ACCOUNTS RECEIVABLE ASSOCIATED WITH THIRD-PARTY PAYORS AND UNINSURED PATIENTS, MANAGEMENT REGULARLY ASSESSES THEIR VALUATION BASED UPON BUSINESS AND ECONOMIC CONSIDERATIONS, TRENDS IN HEALTHCARE COVERAGE, HISTORICAL WRITE-OFF EXPERIENCE AND OTHER COLLECTION TRENDS.

PART III, LINE 8:
MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS.

PART III, LINE 9B:
THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES THAT QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS AGAINST THOSE BALANCES.

PART VI, LINE 2:
EVERY THREE YEARS, WE SURVEY KEY STAKEHOLDERS THROUGHOUT THE COMMUNITY AND DEVELOP STRATEGIC INITIATIVES FOCUSED ON THE RESPONSES. WE ALSO PERFORM MARKET SHARE ANALYSIS TO UNDERSTAND WHAT SERVICES OUT COMMUNITY IS SEEKING THAT WE CURRENTLY DO NOT OFFER, AND POTENTIALLY WHAT SERVICES THAT WE MAY BE ABLE TO OFFER, IN THE FUTURE.

PART VI, LINE 4:
THE TOTAL SERVICE AREA FOR CRMC IS APPROXIMATELY 73,000 INDIVIDUALS. APPROXIMATELY 48% OF THE POPULATION IS FEMALE AND 52$ IS MALE. 69% OF THE POPULATION IS WHITE, 29% BLACK, AND 3% IS OTHER. 12% OF THE POPULATION IS O HISPANIC OR LATINO ORIGIN AND 29% OF INDIVIDUALS ARE BELOW THE POVERTY LEVEL, COMPARED TO 14% FOR THE STATE OF GEORGIA. THE MEDIAN HOUSEHOLD INCOME IS $36,500 AND THE HIGH SCHOOL . GRADUATION RATE IS 78%. IN 2018, 19.4% OF INDIVIDUALS WERE UNINSURED, COMPARED TO 15.7% FOR THE STATE OF GEORGIA.

PART VI, LINE 5:
COFFEE REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS CONSISTING OF 13 MEMBERS. CRH HEALTHCARE, INC., THE SOLE MEMBER, ELECTS THE BOARD MEMBERS OF CRMC. THE CRMC BOARD IS MADE UP OF 9 COMMUNITY MEMBERS REFLECTING THE DIVERSITY OF THE COMMUNITY. TWO ADDITIONAL MEMBERS ARE THE CHIEF OF STAFF OF CRMC AND THE CHIEF OF STAFF ELECT. ONE ADDITIONAL MEMBER IS THE SITTING CHAIRMAN OF THE COFFEE COUNTY BOARD OF COMMISSIONERS. THE REMAINING BOARD MEMBER, WHO SERVES AS A NON-VOTING MEMBER, IS THE INDIVIDUAL HOLDING THE OFFICE OF COUNTY ADMINISTRATOR OF COFFEE COUNTY. IT IS THE PHILOSOPHY OF CRMC TO ASSURE THE CONTINUATION AND ENHANCEMENT OF PATIENT CARE BY REINVESTING EXCESS FUNDS BACK INTO THE OPERATIONS OF THE FACILITY. THIS INCLUDES GREATER ACCESSIBILITY OF CARE THROUGH THE CREATION OF A RURAL HEALTH CENTER, IMPLEMENTATION OF A TELEMEDICINE PROGRAM AND RECRUITMENT OF PHYSICIANS TO THE UNDERSERVED ENVIRONMENT. ENHANCEMENT OF TECHNOLOGY IS ALSO IMPERATIVE TO ASSURE APPROPRIATE DIAGNOSTIC AND THERAPEUTIC OPTIONS FOR THE COMMUNITY. UPDATING THE AMBULANCE FLEET IS CONSISTENTLY HIGH ON THE FUNDING PRIORITY LIST TO ASSURE SERVICE TO THE MOST REMOTE AREAS OF THE COUNTY, WHICH IN SQUARE MILES IS THE SECOND LARGEST COUNTY IN THE STATE OF GEORGIA. CRMC HAS AN OPEN MEDICAL STAFF POLICY EXTENDING PRIVILEGES TO PROFESSIONALLY COMPETENT PRACTITIONERS WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS AND REQUIREMENTS OF CRMC.

PART II, COMMUNITY BUILDING ACTIVITIES:
"2021 CRMC OUTREACH ACTIVITIESCOFFEE REGIONAL MEDICAL CENTER TAKES GREAT PRIDE IN PROVIDING VARIOUS OUTREACH AND EDUCATIONAL ACTIVITIES FOR OUR SERVICE AREA TO HELP SUPPORT OUR MISSION ""TO PROVIDE EXCEPTIONAL CARE AND WELLNESS CLOSE TO HOME"".THE COVID-19 PANDEMIC, WHICH BEGAN IN MARCH OF 2020, HAS NEGATIVELY IMPACTED ON OUR ABILITY TO CONDUCT SOME OF OUR NORMAL EVENTS. AS A RESULT, MANY OF OUR SCHEDULED EVENTS AND ACTIVITIES HAD TO BE CANCELED OR SCALED BACK DURING 2020 AND 2021. BELOW ARE EVENTS WE WERE ABLE TO HOST DURING 2021.COVID-19 VACCINE CLINICDURING 2021, CRMC PROVIDED COVID-19 VACCINES TO THE PUBLIC, FREE OF CHARGE. THE CLINIC WAS STAFFED AND SUPERVISED BY CRMC PERSONNEL FOR THE ENTIRE YEAR. CRMC STAFF ALSO UPDATED PATIENT'S IMMUNIZATION RECORDS IN THE GEORGIA REGISTRY OF IMMUNIZATION TRANSACTIONS AND SERVICES (GRITS) DATABASE. A TOTAL OF 11,363 VACCINES WERE ADMINISTERED TO THE PUBLIC DURING 2021. OPERATING THE CLINIC REQUIRED APPROXIMATELY 16-MAN HOURS EACH WEEK AT A TOTAL ANNUAL COST TO CRMC OF OVER $20,000.COMMUNITY HEALTH AND WELLNESS FAIR THE ANNUAL COMMUNITY HEALTH & WELLNESS FAIR WAS HELD OCTOBER 6, 2021 AT COFFEE REGIONAL MEDICAL CENTER'S MAIN CAMPUS, WITH OVER 500 COMMUNITY MEMBERS VISITING THE FAIR THAT DAY. CRMC STAFF, ALONG WITH OUTSIDE VENDORS, PROVIDED FREE SCREENINGS ON BLOOD PRESSURE, SUGAR LEVELS, HEART RATE, OXYGEN RATE AND RESPIRATORY WELLNESS. EDUCATIONAL MATERIAL RELATED TO CANCER, STROKE, HEART DISEASE, DIABETES TREATMENT AND PREVENTION, FIRE AND HOME SAFETY, NUTRITION AND ELDERLY SUPPORT WAS PROVIDED TO PARTICIPANTS. IN ADDITION, BIOCHEMICAL BLOOD PROFILES WERE OFFERED BY CRMC'S LAB TO PARTICIPANTS AT A REDUCED FEE OF $35. THE NORMAL COST FOR THESE TESTS IS $800, WHICH RESULTED IN A SAVINGS TO THE COMMUNITY OF $144,000. HEART 2 HEART RUN EVENTCOFFEE REGIONAL'S ANNUAL HEART 2 HEART 5K RUN/FUN WALK WAS HELD A GENERAL COFFEE STATE PARK ON MARCH 6, 2021. THE FOCUS OF THIS EVENT WAS TO RAISE AWARENESS OF HEART DISEASE. THE EVENT INCLUDED A FUN RUN, 1.5 MILE WALK, 5K RACE AND 10K RACE, ALONG WITH ARTS, CRAFTS AND GAMES. OVER 200 COMMUNITY RESIDENTS ATTENDED THE EVENT. PARTICIPANT REGISTRATION FEES FOR THE EVENT GENERATED $9,700, WHICH WILL BE USED TO ASSIST PATIENTS, MANY OF WHOM ARE UNINSURED, WITH THE COST OF REHABILITATIVE TREATMENTS AFTER A CARDIAC EVENT.APPROXIMATELY 30 CRMC EMPLOYEES ASSISTED WITH PREPARATION AND HOSTING OF THE EVENT, WHICH REQUIRED OVER 80-MAN HOURS OF WORK. THE ESTIMATED COST TO CRMC FOR HOSTING THIS EVENT WAS $3,600. VOLUNTEERS FROM THE COMMUNITY AND SEVERAL SCHOOL CLUBS ALSO ASSISTED WITH HOSTING THE EVENT.WEAR RED CAMPAIGN CRMC'S ANNUAL WEAR RED CAMPAIGN TOOK PLACE DURING FEBRUARY, WHICH IS RECOGNIZED AS HEART DISEASE AWARENESS MONTH. THE WEAR RED CAMPAIGN CONSISTED OF T-SHIRT SALES, FLOWER SALES AND VARIOUS EDUCATIONAL EVENTS, PROVIDED TO THE COMMUNITY AT NO COST. THESE EVENTS ARE DESIGNED TO RAISE AWARENESS OF HEART DISEASE AND PREVENTION. THESE FUNDRAISER SALES GENERATED APPROXIMATELY $3,900, WHICH WILL BE USED TO ASSIST PATIENTS, MANY OF WHOM ARE UNINSURED, WITH THE COST OF REHABILITATIVE TREATMENTS AFTER SUFFERING A CARDIAC EVENT. THE CAMPAIGN ENDED ON THE LAST DAY OF THE MONTH WHEN CRMC EMPLOYEES AND COMMUNITY MEMBERS WERE ENCOURAGED TO WEAR RED IN RECOGNITION OF HEART DISEASE AND PREVENTION. OPEN ARMS CLINIC THE OPEN ARMS CLINIC IS AN OUTREACH PROJECT OF COFFEE REGIONAL MEDICAL CENTER, THE GOAL OF WHICH IS TO REDUCE HEALTH DISPARITIES WITHIN OUR COMMUNITY. THE CLINIC SERVES UNINSURED PATIENTS WHO RESIDE IN COFFEE OR ATKINSON COUNTY AND HAVE NON-EMERGENT HEALTHCARE NEEDS. ONE GOAL OF THE OPEN ARMS CLINIC IS THE PREVENTION OF CHRONIC DISEASE THROUGH THE TREATMENT OF ILLNESSES SUCH AS HYPERTENSION, DIABETES, AND HEART DISEASE. DURING 2021, THE CLINIC TREATED 219 PATIENTS. ACTUAL NON-SALARY EXPENSES OF OPERATING THE CLINIC WERE APPROXIMATELY $16,226. PHYSICIANS AND SUPPORT STAFF DONATE THEIR TIME TO THE CLINIC.PROJECT SEARCH PROJECT SEARCH IS A SCHOOL-TO-WORK TRANSITION PROGRAM SERVING STUDENTS WITH SIGNIFICANT INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. THE PROJECT SEARCH PROGRAM AT COFFEE HIGH SCHOOL, IN CONJUNCTION WITH COFFEE REGIONAL MEDICAL CENTER, HAS BEEN HELPING YOUNG PEOPLE WITH SIGNIFICANT DISABILITIES FIND FULFILLMENT, LEARN NEW SKILLS, AND GAIN EMPLOYMENT SINCE AUGUST 2008. THE PROGRAM TAKES PLACE ENTIRELY AT THE WORKPLACE AND THE GOAL FOR EACH PROGRAM PARTICIPANT IS COMPETITIVE EMPLOYMENT. TO REACH THAT GOAL, THE PROGRAM PROVIDES REAL-LIFE WORK EXPERIENCE COMBINED WITH TRAINING IN EMPLOYABILITY AND INDEPENDENT-LIVING SKILLS TO HELP THE PARTICIPANTS MAKE SUCCESSFUL TRANSITIONS TO PRODUCTIVE ADULT LIFE. THE PROJECT SEARCH MODEL INVOLVES AN EXTENSIVE PERIOD OF SKILLS TRAINING AND CAREER EXPLORATION, INNOVATIVE ADAPTATIONS, LONG-TERM JOB COACHING, AND CONTINUOUS FEEDBACK FROM TEACHERS, SKILLS TRAINERS, AND EMPLOYERS. AS A RESULT, AT THE COMPLETION OF THE TRAINING PROGRAM, STUDENTS WITH SIGNIFICANT INTELLECTUAL DISABILITIES ARE EMPLOYED IN NONTRADITIONAL, COMPLEX AND REWARDING JOBS. DURING THE 2020-2021 SCHOOL TERM, THE PROJECT SEARCH PROGRAM AT COFFEE REGIONAL MEDICAL CENTER HAD 6 PARTICIPANTS. VARIOUS DEPARTMENTS WITHIN THE HOSPITAL PROVIDED TRAINING OPPORTUNITIES TO THE PARTICIPANTS INCLUDING DIETARY, ENVIRONMENTAL, ENGINEERING, PATIENT ACCESS, AND MATERIALS MANAGEMENT. EACH PARTICIPANT SPENT 10 WEEKS IN THEIR GIVEN DEPARTMENT, THEN ROTATED TO A NEW DEPARTMENT. DURING THIS TIME, PARTICIPANTS WERE TAUGHT MANY SKILLS WHILE WORKING WITH A MENTOR IN EACH DEPARTMENT. EACH YEAR CRMC DONATES CLASSROOM SPACE FOR THE PROGRAM, ONE MEAL A DAY TO BOTH PARTICIPANTS AND INSTRUCTORS AND APPROXIMATELY 60 CRMC STAFF HOURS OF TRAINING, MENTORING AND EDUCATION. THE TOTAL ESTIMATED COST FOR THESE SERVICES IS APPROXIMATELY $13,300 ANNUALLY.SCHOOL SPORTS PHYSICALS ATHLETIC PHYSICALS ARE REQUIRED BY BOTH THE GEORGIA HIGH SCHOOL ASSOCIATION AND THE GEORGIA INDEPENDENT SCHOOL ASSOCIATION FOR STUDENTS PARTICIPATING IN SCHOOL ATHLETIC PROGRAMS. EACH YEAR COFFEE REGIONAL MEDICAL CENTER PROVIDES SPORTS PHYSICALS TO LOCAL SCHOOL STUDENTS PLANNING TO PARTICIPATE IN INTERSCHOLASTIC SPORTS AT NO COST. IN 2021, COFFEE REGIONAL PROVIDED 563 SPORTS PHYSICALS, AT NO COST, TO LOCAL AREA STUDENTS. THE PHYSICALS EVENT WAS STAFFED BY 10 HEALTHCARE PROVIDERS AND 18 NURSES AND STAFF MEMBERS. SPORTS PHYSICALS NORMALLY COST $32, BUT WERE PERFORMED FREE OF CHARGE THROUGH THIS PROGRAM, RESULTING IN A COST SAVINGS TO THE COMMUNITY OF $18,000. APPROXIMATELY 140 MAN-HOURS WERE REQUIRED TO HOST THIS EVENT, RESULTING IN A TOTAL PERSONNEL COST TO COFFEE REGIONAL OF APPROXIMATELY $6,800.SIDLEINE SERVICE CRMC PROVIDES SIDELINE EMERGENCY MEDICAL SERVICES FOR EACH VARSITY HIGH SCHOOL FOOTBALL GAME FOR THE COFFEE COUNTY SCHOOL SYSTEM. A FULLY EQUIPPED AMBULANCE STAFFED BY AN EMT AND A PARAMEDIC ARE PROVIDED FREE OF CHARGE FOR EACH HOME GAME. THE ESTIMATED COST OF THIS SERVICE TO CRMC EACH YEAR IS APPROXIMATELY $1,250.BREAST CANCER SCREENINGSTHE CRH ONCOLOGY GROUP SPONSORS A BREAST CANCER SCREENING EVENT EACH YEAR WITH THE GOAL OF PROMOTING AWARENESS OF BREAST CANCER AND THE IMPORTANCE OF EARLY DETECTION. IN 2021, TWO SESSIONS OF THE BREAST CANCER SCREENING EVENT WERE HELD. PARTICIPANTS WERE PROVIDED EDUCATIONAL INFORMATION ON DETECTING A LUMP AND OVERALL BREAST HEALTH. THE EVENT WAS PROMOTED THROUGH VARIOUS MARKETING EFFORTS AND FLYERS AS WELL AS SOCIAL MEDIA TO ENCOURAGE WOMEN, ESPECIALLY THOSE WITHOUT INSURANCE TO PARTICIPATE AND RECEIVE A FREE SCREENING. SEVEN CRMC HEALTHCARE PROVIDERS AND 24 STAFF MEMBERS WORKED THE EVENT. IN ADDITION, CRMC MAMMOGRAPHY, COFFEE COUNTY HEALTH DEPARTMENT, CRMC AUXILIARY AND THE LOCAL BEST SIGMA PHI ORGANIZATION PROVIDED SUPPORT FOR THE EVENT AND RESOURCES TO THE PARTICIPANTS.A TOTAL OF 75 COMMUNITY RESIDENTS TOOK ADVANTAGE OF THIS OPPORTUNITY AND RECEIVED A FREE BREAST CANCER SCREENING. THE VALUE OF THOSE FREE SCREENINGS TO THE COMMUNITY WAS $11,250. THE COST TO CRMC FOR SPONSORING THIS YEAR'S EVENT WAS APPROXIMATELY $3,000 AND REPRESENTED APPROXIMATELY 65-MAN HOURS."

PART VI, LINE 3:
THE FINANCIAL COUNSELING DEPARTMENT WILL PROVIDE INFORMATION AND APPLICATIONS TO ALL PATIENTS OR GUARANTORS SEEKING FINANCIAL ASSISTANCE FOR SERVICES RENDERED AT COFFEE REGIONAL MEDICAL CENTER THAT ARE DEEMED MEDICALLY NECESSARY. FINANCIAL COUNSELORS WILL DISCUSS ELIGIBILITY FOR MEDICAL ASSISTANCE PROGRAMS THROUGH THE DEPARTMENT OF FAMILY & CHILDREN SERVICES AND THE SOCIAL SECURITY ADMINISTRATION. IF ELIGIBILITY IS NOT MET FOR ANY MEDICAL ASSISTANCE PROGRAM, THE FINANCIAL COUNSELING DEPARTMENT WILL SEEK ELIGIBILITY THROUGH COFFEE REGIONAL MEDICAL CENTER'S INDIGENT CARE TRUST FUND PROGRAM. PATIENTS OR GUARANTORS REQUESTING FINANCIAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS (FC) OR THE BENEFIT SPECIALISTS CONTACT THE PATIENT AT THE TIME OF REGISTRATION FOR OUTPATIENT SERVICES OR IN THE EMERGENCY DEPARTMENT (AFTER MEDICAL SCREENING HAS BEEN COMPLETED). THE FC WILL ALSO CONTACT AN INDIVIDUAL IF THERE IS A REQUEST FROM SOCIAL SERVICES, A PHYSICIAN OFFICE, OR THE PATIENT FINANCIAL SERVICES DEPARTMENT. PATIENTS ADMITTED FOR INPATIENT OR OBSERVATION SERVICES MAY BE VISITED BY THE FC AFTER THE PATIENT HAS BEEN PLACED IN A ROOM AND STABILIZED. THE FC WILL DISCUSS WITH THE PATIENT OR GUARANTOR THE INDIGENT CARE TRUST FUND PROGRAM REQUIREMENTS AND APPLICATION PROCESS. THE PATIENT OR GUARANTOR WILL BE REQUIRED TO COMPLETE AN INDIGENT APPLICATION, PROVIDE PROOF OF IDENTITY, PROVIDE BIRTH CERTIFICATES OR PROOF OF DEPENDENCY FOR CHILDREN WITH NO IDENTITY, AND PROVIDE VERIFICATION OF INCOME (I.E. W2'S, FEDERAL TAX RETURN, PAY STUBS, ETC.). IF VERIFICATION IS NOT PROVIDED AT THE TIME OF THE INTERVIEW, THE PATIENT OR GUARANTOR WILL BE REQUIRED TO PROVIDE WITHIN 30 DAYS. APPLICATIONS MADE ON BEHALF OF DECEASED PATIENTS MUST HAVE VERIFICATION OF INCOME AND INFORMATION CONCERNING THE VALUE OF THE PATIENT'S ESTATE. PATIENTS WHO CHOOSE NOT TO UTILIZE CURRENT BENEFITS THEY ARE ELIGIBLE FOR (I.E. VETERANS BENEFITS, MEDICARE, AND COMMERCIAL INSURANCE) WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM. UPON RECEIPT OF THE COMPLETED APPLICATION INCLUDING NECESSARY DOCUMENTATION, CALCULATION OF THE HOUSEHOLD SIZE AND ANNUAL HOUSEHOLD INCOME IS COMPUTED AND COMPARED TO THE FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE THE PERCENTAGE OF ASSISTANCE A PATIENT OR GUARANTOR IS ELIGIBLE TO RECEIVE. PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW THE GROSS INCOME CEILING FOR POTENTIAL MEDICAID ELIGIBILITY ARE REQUIRED TO APPLY FOR MEDICAID. ASSISTANCE IS PROVIDED TO PATIENTS IN FILING FOR OTHER BENEFITS AND COMPLETING MEDICAID APPLICATIONS. PATIENTS WHO CHOOSE NOT TO APPLY FOR OTHER BENEFITS TO WHICH THEY MAY BE ENTITLED (I.E. MEDICAID) WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM. PATIENTS WHO CHOOSE TO APPLY COFFEE REGIONAL MEDICAL CENTER'S ACCOUNTS FOR THE PURPOSE OF MEETING MEDICALLY NEEDY SPEND DOWN TO RECEIVE ONGOING MEDICAID WILL NOT BE ALLOWED TO APPLY FOR THE INDIGENT PROGRAM FOR THAT ACCOUNT. PATIENTS OR GUARANTORS OVER 18 YEARS OF AGE BUT CLASSIFIED AS DEPENDENTS FOR TAX PURPOSES DUE TO STUDENT ELIGIBILITY WILL HAVE A TOTAL HOUSEHOLD SIZE THAT INCLUDES PARENTS AND SUBSEQUENT INCOME. PATIENTS OR GUARANTORS NOT ELIGIBLE FOR OTHER MEDICAL ASSISTANCE PROGRAMS WILL BE PROCESSED UNDER THE INDIGENT CARE TRUST FUND GUIDELINES USING THE FOLLOWING CATEGORIES: - INDIGENT FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW 125% OF THE FPG, THE APPLICABLE ACCOUNTS WILL BE ADJUSTED TO ZERO BALANCES. CHARITY - FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN OR EQUAL TO 125% BUT NOT GREATER THAN 200% OF THE FPG, THE APPLICABLE ACCOUNTS WILL BE ADJUSTED BY THE APPROPRIATE PERCENTAGES. AN ADJUSTMENT OF 85% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 125% AND 150% OF FPG AN ADJUSTMENT OF 70% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 150% AND 175% OF FPG AN ADJUSTMENT OF 62% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 175% AND 200% OF FPG CATASTROPHIC PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN 200% FPG MAY QUALIFY FOR CHARITY ADJUSTMENTS ON APPLICABLE ACCOUNTS, IF CONSIDERATION OF THE CRMC PATIENT OBLIGATIONS REDUCES THE ANNUAL HOUSEHOLD INCOME TO THE APPROPRIATE FPG. NOTIFICATION OF STATUS OF COMPLETED APPLICATION IS PROVIDED TO THE PATIENT OR GUARANTOR WITHIN 5 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION. APPROVED APPLICATIONS ARE VALID FOR 180 DAYS FROM DATE OF SIGNATURE. INCOMPLETE APPLICATIONS ARE HELD FOR 30 DAYS. IF NO DOCUMENTATION IS PROVIDED TO COMPLETE THE APPLICATION, A DENIAL LETTER IS SENT TO THE PATIENT OR GUARANTOR. THE APPLICATION MAY BE COMPLETED IF THE PATIENT OR GUARANTOR PROVIDES THE REQUESTED INFORMATION WITHIN 15 WORKING DAYS OF THE DENIAL. NOTIFICATION OF STATUS OF COMPLETED APPLICATION WILL BE MAILED WITHIN 15 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION. THE APPLICATION AND DOCUMENTATION WILL BECOME PROPERTY OF COFFEE REGIONAL MEDICAL CENTER AND IS TO BE KEPT CONFIDENTIAL IN THE SAME MANNER AS MEDICAL RECORDS. HOWEVER, THIS INFORMATION WILL BE USED FOR AGGREGATE REPORTING PURPOSES ONLY.