4A (Expenses $ 30473630 including grants of $ 119532) (Revenue $ 0)
DONALSONVILLE HOSPITAL PROVIDES PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE COUNTY AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. DURING THE FISCAL YEAR 2021, INPATIENT DAYS TOTALED 2,667 WITH 546 DISCHARGES; PSYCHIATRIC DAYS NUMBERED 5,286 WITH 685 DISCHARGES, AND THE SKILLED NURSING FACILITY HAD 20,968 RESIDENT DAYS.

FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 3E
THE SERVICE PRIORITIES OF THE HOSPITAL IN 2023 AND FORWARD WILL BE: 1. EMERGENCY CENTER 2. DIAGNOSTIC 3. INPATIENT SURGERY, OUTPATIENT SURGERY, AND ENDOSCOPY 4. INPATIENT ACUTE AND CHRONIC CARE 5. INPATIENT MENTAL HEALTH CARE 6. HEALTH EDUCATION AND ILLNESS PREVENTION 7. OBSTETRICS

FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 5
THE CHNA PANEL WAS SELECTED, STARTING WITH FIVE HOSPITAL BOARD MEMBERS. THE BOARD MEMBERS HAVE A BROAD RANGE OF COMMUNITY INVOLVEMENT AND LEADERSHIP ROLES, INCLUDING ONE WHO IS INVOLVED WITH LOCAL COUNTY AND CITY GOVERNMENTS; THREE WHO ARE ACTIVE WITH OTHER NONPROFIT ORGANIZATIONS AND ARE COMMUNITY LEADERS; AND ONE WITH A VAST KNOWLEDGE AND EXPERIENCE IN THE AGRICULTURAL AREA, A MAJOR INDUSTRY OF SEMINOLE COUNTY. THE CHNA PANEL INCLUDED ALL FIVE MEMBERS OF THE BOARD PLUS TWO ADDITIONAL MEMBERS - A LOCAL COUNTY COMMISSIONER WHO ALSO SERVES AS CO-PASTOR IN A LOCAL MINISTRY, AND THE LOCAL HEALTH DEPARTMENT DIRECTOR. THE DONALSONVILLE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT PANEL REVIEWED AND DISCUSSED DATA GATHERED FROM OUTSIDE SOURCES, INPUT FROM LOCAL MEDICAL STAFF, EMPLOYEE MEETINGS, INPUT FROM LOCAL GOVERNMENT, INPUT FROM LOCAL BUSINESSES AS WELL AS INTERNAL DATA. IN UTILIZING THESE SOURCES, THE PANEL ESTABLISHED THE SPECIFIC NEEDS OF THE COMMUNITY BASED ON THE FOLLOWING CRITERIA: SEVERITY, OF CASES, IMPACT ON COMMUNITY AND THE ORGANIZATION'S ABILITY TO IMPLEMENT A SOLUTION TO IMPROVE THE NEED.

FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 11
AFTER LOOKING AT ALL OF THE DATA GATHERED AND CONSISTENT WITH THE PREVIOUS CHNA, THE 2022 CHNA PANEL DETERMINED THAT THE HEALTH NEEDS THAT COULD BE IMPROVED BY THE HOSPITAL INPUT WERE AS FOLLOWS: 1. DIABETES/HYPERTENSION DISEASE 2. OBESITY IN ADULTS 3. CANCER 4. MENTAL HEALTH BOTH 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE 2019 CHNA IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE ORGANIZATION'S WEBSITE AND CAN BE FOUND AT HTTPS://WWW.DONALSONVILLEHOSPITAL.ORG/DOCS/DHICHNA2022.PDF AND HTTPS://WWW.DONALSONVILLEHOSPITAL.ORG/DOCS/5B_2020_COMMUNITY_HEALTH_NEEDS_I MPLEMENTATION.PDF, RESPECTIVELY.

FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 13H
ALL PATIENTS ARE CHARGED EQUALLY REGARDLESS OF ANY OF THE ABOVE. THOSE INDIVIDUALS WITHOUT THIRD PARTY COVERAGE ARE GIVEN A 15% DISCOUNT IF THEY DO NOT QUALIFY FOR FREE CARE. THEY ARE ALSO GIVEN THE OPPORTUNITY TO RECEIVE A 50% DISCOUNT IF BILL IS PAID WITHIN 1 YEAR OF DISCHARGE. ALSO, FREE CARE IS OFFERED FOR PATIENTS MEETING CHARITY GUIDELINES - RANGING FROM 125% TO 200% OF FEDERAL POVERTY GUIDELINES.

SCHEDULE H, PART I, LINE 7, COLUMN (F)
IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 35,962,319 ADD: EXPENSES REPORTED IN PART VIII 137,947 DENOMINATOR FOR COLUMN (F) 36,100,266

SCHEDULE H, PART I, LINE 7
COSTS FOR PART I, LINE 7A, 7B AND 7C WERE COMPUTED USING THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATED ON WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS.

SCHEDULE H, PART III, LINE 2
AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE.

SCHEDULE H, PART III, LINE 3
THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 5%) BASED ON AN ANALYSIS OF SELF PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT.

SCHEDULE H, PART III, LINE 4
SEE PAGE 14-17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DISCUSSION ON UNINSURED PATIENTS, PRICE CONCESSIONS AND BAD DEBTS.

SCHEDULE H, 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.

SCHEDULE H, PART III, LINE 9B
OUR PATIENT FINANCIAL SERVICES DEPARTMENT VISITS PATIENTS WHO HAVE NO INSURANCE TO DISCUSS ASSISTANCE AND REFER THOSE PATIENTS TO OUR LOCAL DFCS OFFICE TO OBTAIN ASSISTANCE WITH APPLYING FOR MEDICAID OR OTHER FINANCIAL ASSISTANCE. OUR PATIENT FINANCIAL SERVICES DEPARTMENT, WHICH DOES SELF-PAY BILLING AND COLLECTION, INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN COMPLETING AN APPLICATION. BILLING STATEMENTS PROVIDE A MESSAGE AND TELEPHONE NUMBER TO CALL IF THE PATIENT IS HAVING DIFFICULTIES MAKING PAYMENTS. FOR PATIENTS WHO QUALIFY AS INDIGENT OR CHARITY PATIENTS, THERE IS NO FINANCIAL OBLIGATION. THOSE PATIENTS WHO DO NOT QUALIFY AS INDIGENT OR CHARITY ARE SENT MULTIPLE STATEMENTS FOR 30, 60, AND 90 DAYS PAST DUE. THOSE PATIENTS WILL ALSO BE SENT TWO LETTERS REGARDING PAST DUE ACCOUNTS. ONCE AN ACCOUNT HAS NO ACTIVITY FOR 180 DAYS, IT WILL BE SENT TO AN OUTSIDE COLLECTION AGENCY.

SCHEDULE H, PART VI, LINE 2
A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN FISCAL YEAR 2019. INFORMATION WAS SOLICITED FROM VARIOUS INDIVIDUALS REPRESENTING THE INTERESTS OF THE COMMUNITY BY MEANS OF FOCUS GROUPS, EXTERNAL STATISTICS, AND INTERNAL DATA. THE ORGANIZATION CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITY'S NEEDS FOR HEALTH SERVICES AND COLLABORATES WITH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TO IDENTIFY THE NEEDS OF THE COMMUNITY. COMMUNITY RESEARCH HAS SHOWN THAT THE SERVICES FOR WHICH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TURN TO THE ORGANIZATION ARE EMERGENCY SERVICES, DIAGNOSTIC TESTS AND X-RAYS, AND ALSO GENERAL MEDICAL CARE. OTHER SERVICES FOR WHICH THEY TURN TO US AS A MAJOR PROVIDER ARE MINOR SURGERY, PEDIATRIC CARE, GENERAL SURGERY, AND OBSTETRICAL CARE. THIS INFORMATION, COMBINED WITH OUR EXTENSIVE COLLABORATIONS AND OUR ROLE AS A LEADER IN THE COMMUNITY, PROVIDES US THE MEANS TO UNDERSTAND AND ADDRESS THE COMMUNITY'S NEEDS AND ENSURES OUR OUTREACH PROGRAMS ARE FOCUSED ON THE POPULATIONS WHO NEED OUR SERVICES THE MOST. OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY.

SCHEDULE H, PART VI, LINE 3
THE BOARD HAS CLEARLY WRITTEN INDIGENT AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND FINANCIAL AID. PATIENT EDUCATION ON THE ORGANIZATIONS INDIGENT/CHARITY AND FINANCIAL AID PROGRAMS ARE CONDUCTED DURING PRE-REGISTRATION, THROUGH OUR PATIENT FINANCIAL SERVICES DEPARTMENT FOR PATIENTS THAT DO NOT HAVE ANY 3RD PARTY COVERAGE. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES INFORMATION TO THE BUSINESS OFFICE MANAGERS OF OUR LOCAL PHYSICIAN'S PRACTICES. PHONE CALLS AND LETTERS ARE SENT TO ALL PATIENTS THAT ARE NOT INTERVIEWED AT THE TIME OF ADMISSION EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAMS. OUR EMERGENCY DEPARTMENT IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY.

SCHEDULE H, PART VI, LINE 4
THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA IN SEMINOLE COUNTY, IN ITS BROADEST BOUNDARIES. DONALSONVILLE IS THE ECONOMIC AND MEDICAL HUB FOR THE REGION, AND THE ORGANIZATION DRAWS FROM A POPULATION OF APPROXIMATELY 9,000 RESIDENTS FOR MAJOR HEALTH CARE SERVICES. THE REGION IS MARKED BY VAST DICHOTOMIES OF WEALTH, EDUCATION, AND HEALTH STATUS. THE ORGANIZATION SERVES A POPULATION THAT HAS A HIGH PROPORTION OF LOW-INCOME INDIVIDUALS. ABOUT 25.2% OF FAMILIES AND 25.49% OF THE POPULATION WERE BELOW THE POVERTY LINE.

SCHEDULE H, PART VI, LINE 5
OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. WE HAVE PARTICIPATED IN VARIOUS LOCAL HEALTH FAIRS TO PROMOTE GOOD HEALTH AND PROVIDE SCREENING MECHANISMS FOR DETECTING HIGH BLOOD PRESSURE, ABNORMAL BLOOD SUGAR LEVELS AND HIGH CHOLESTEROL. THESE ARE THE MOST PRESSING AND PREVENTABLE DISEASES IN OUR COMMUNITY. WE WORK CLOSELY WITH THE LOCAL HEALTH DEPARTMENT TO ASSIST THEM WITH THE PROGRAMS THAT THEY FACILITATE THROUGHOUT THE YEAR. OUR BOARD HAS HAD IN PLACE FOR MORE THAN 20 YEARS, A SCHOLARSHIP PROGRAM FOR PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS. WE HAVE BEEN FORTUNATE TO HAVE MANY OF OUR LOCAL RESIDENTS FINISH MEDICAL SCHOOL, NURSING SCHOOL AND OTHER PROFESSIONAL CERTIFICATIONS, AND COME BACK TO DONALSONVILLE TO PRACTICE AND WORK IN OUR LOCAL HEALTHCARE COMMUNITY. THE PHYSICIAN SCHOLARSHIP PROGRAM HAS PRODUCED 9 OF OUR CURRENT 14 MEMBER MEDICAL STAFF. WE ALSO HAVE 3 IN THE PROGRAM THAT ARE SCHEDULED TO COME BACK TO OUR COMMUNITY OVER THE NEXT FEW YEARS. THIS TYPE OF PROGRAM HAS HELPED KEEP HEALTHCARE AVAILABLE AND ACCESSIBLE TO OUR RURAL COMMUNITY. IT HAS ENABLED US TO START NEW SERVICES THAT WOULD NOT HAVE EXISTED OTHERWISE. OUR BOARD IS DEDICATED TO PLANNING AND PREPARING FOR THIS RURAL COMMUNITY TO HAVE EASILY ACCESSIBLE HEALTHCARE FOR MANY YEARS TO COME.