Community Benefit Insight - Tax-exempt hospital

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St Luke's McCall Ltd

St Lukes Mccall

1000 State Street
Mccall, ID 83638

Bed count	15	Medicare provider number	131312	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 273311774

Display data for year:

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

4.95%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2012-2021

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	$ 547,040 1.20 %
Medicaid as % of operating expenses	$ 1,163,549 2.56 %
Costs of other means-tested government programs as % of operating expenses	$ 28,199 0.06 %
Health professions education as % of operating expenses	$ 189,944 0.42 %
Subsidized health services as % of operating expenses	$ 8,178 0.02 %
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.	$ 288,080 0.63 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 29,955 0.07 %
Community building* as % of operating expenses	$ 29,910 0.07 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
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	$ 29,910 0.07 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 11,950 39.95 %
Community support as % of community building expenses	$ 6,636 22.19 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 11,324 37.86 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 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	$ 708,855 1.56 %
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 $ 36624133 including grants of $ 0) (Revenue $ 42758578)
Medical SurgicalIn 2010, McCall Memorial Hospital integrated with St. Luke's Health System and became St. Luke's McCall. This 15-bed critical access hospital, founded in 1956, is located in the central Idaho mountains about 100 miles north of Boise. The hospital provides 24-hour emergency services, inpatient and outpatient care, surgical care, maternal and childbirth services, hospice care and more. Its providers and staff have long been on the leading edge of prevention and wellness initiatives and integrative therapies.During Fiscal Year 2022, St. Luke's McCall provided patient care for 529 admissions covering 1,385 patient days. They also provided patient care associated with 31,279 outpatient visits.

4B (Expenses $ 5498538 including grants of $ 0) (Revenue $ 6419529)
Physician ServicesSt. Luke's McCall has two physician clinics:(1) Payette Lakes Medical Clinic has 10 family medicine physicians, and seven family medicine P.A.s and N.P.s who collectively completed 31,469 clinic visits in fiscal year 2022.(2) McCall Medical Clinic has two internal medicine physicians, one general surgeon, two orthopedic surgeons and four P.A.s and N.P.s who collectively completed 14,678 clinic visits in Fiscal Year 2022.

Facility Information

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

St. Luke's McCall
Part V, Section B, Line 5: A series of interviews with people representing the broad interests of our community are conducted in order to assist in defining, prioritizing, and understanding our most important community health needs. Many of the representatives participating in the process have devoted decades to helping others lead healthier lives. We sincerely appreciate the time, thought, and valuable input they provide during our CHNA process. The openness of the community representatives allow us to better explore a broad range of health needs and issues. The representatives we interview have significant knowledge of our community. To ensure they come from distinct and varied backgrounds, we include multiple representatives from each of the following categories:Category I: Persons with special knowledge of public health. This includes persons from state, local, and/or regional governmental public health departments with knowledge, information, or expertise relevant to the health needs of our community. Category II: Individuals or organizations serving or representing the interests of the medically underserved, low-income, and minority populations in our community. Medically underserved populations include populations experiencing health disparities or at risk populations not receiving adequate medical care as a result of being uninsured or underinsured or due to geographic, language, financial, or other barriers. Category III: Additional people located in or serving our community including, but not limited to, health care advocates, nonprofit and community-based organizations, health care providers, community health centers, local school districts, and private businesses. Each potential need is scored by the community representatives on a scale from negative six (-6) to six (6). A high score signifies the representative believes the health need is both important and needs to be addressed with additional resources. Lower scores typically mean the representative believes the need is relatively less important or that it is already being addressed effectively with the current set of programs and services available.Representatives from the following organizations were contacted and interviewed:1) Affiliation: Blue Cross of Idaho Foundation2) Affiliation: Cascade Medical Center3) Affiliation: Central District Health4) Affiliation: Central District Health Community Partner5) Affiliation: Council Area (Trident Holdings employee)6) Affiliation: Idaho Department of Health and Welfare7) Affiliation: Idaho Department of Health and Welfare, Region IV Mental Health8) Affiliation: Idaho Division of Public Health9) Affiliation: Idaho Food Bank10) Affiliation: Idaho Office of the Governor11) Affiliation: Local Government12) Affiliation: McCall Donnelly School District13) Affiliation: McCall Fire & EMS14) Affiliation: Southwest District Health15) Affiliation: Southwest Idaho Area Agency on Aging16) Affiliation: St. Luke's Health Partners17) Affiliation: St. Luke's Health System18) Affiliation: St. Luke's Health System19) Affiliation: St. Luke's McCall20) Affiliation: The Speedy Foundation21) Affiliation: Treasure Valley YMCA22) Affiliation: United Way of Treasure Valley23) Affiliation: WICAP Head Start

St. Luke's McCall
"Part V, Section B, Line 11: The following health needs received the highest score within each category, signifying the importance of addressing these needs to improve community health.Significant Health Needs(1) Health Behaviors - Nutrition Programs/Education/Opportunities(2) Clinical Care - Availability of Behavioral Health Services(3) Social and Economic Factors - Housing Stability(4) Physical Environment - Accessible Modes of TransportationThe following implementation plan illustrates the strategies St. Luke's and its community partners will employ in fiscal year 2023 to address the most significant health needs identified in our 2022 Community Health Needs Assessment for the McCall area.(1) Health Behaviors - Nutrition Programs/Education/OpportunitiesMost Americans today do not have a healthy diet. The role of nutrition in chronic disease prevention and management is particularly crucial as diet is a modifiable risk factor for most chronic conditions.Improve availability and access to healthy foods.- Support community health workers and cultural liaisons within local foodbanks.- SNAP and WIC promotion and outreach.Improve understanding, education and skills to utilize healthy foods.- Deliver and support healthy eating as well as nutrition education and skill building.Support sustainable systems to lessen instances and duration of food insecurity- Identify and implement advocacy opportunities to address food/nutrition insecurity.- Explore value-based-care payment models and benefits designed for nutrition supports. (2) Clinical Care - Availability of Behavioral Health ServicesAccording to the National Alliance on Mental Illness, nearly a quarter of Idahoans are living with a mental illness. Substance Abuse and Mental Health Services Administration reports that all Idaho counties have shortages of mental health professionals.Awareness, education and skill building.- Support delivery of gatekeeper trainings.- Provide and promote mental and behavioral health education.- Implement Aging in Place survey recommendations.Population identification and intervention.- Support the community-school model.Increase access to mental and behavioral health services.- Participate and appropriately contribute to Governor's Behavioral Health Council.- Support implementation of Community Health Worker, Community Health EMS and Center for Community Health models.- Build suicide prevention and postvention strategies. (3) Social and Economic Factors - Housing StabilityAccess to stable housing leads to better physical and mental health outcomes for all. According to a report published by the Idaho Asset Building Network, ""In communities with enough affordable homes, primary care visits go up by 20%, emergency room visits go down by 18%, and accumulated medical expenses go down by 12%.""Prevention, identification and outreach.- Support development and implementation of social determinantsof health screening tool in the electronic medical record (EPIC) to assess the housing needs of patients.- Participate in local housing discussions.Increase housing availability.- Identify and engage in advocacy opportunities to address housing stability.Increase support services to help people secure and maintain safe, stable housing.- Support quality early learning programs.(4) Physical Environment - Accessible Modes of TransportationPeople facing the biggest transportation challenges are often economically and/or socially marginalized, and include lower income families, children and older adults. Ensuring access to transportation also improves access to healthier food options, medical care and employment. Create and maintain safe walking/biking paths and programs.- Support local healthy transportation opportunities.Support infrastructure for public transportation and shared ridership models.- Promote the Connecting-U McCall to Riggins bus program.- Support local transportation discussions to expand the Mountain Valley Transit route."

St. Luke's McCall
Part V, Section B, Line 13b: Financial Care: Eligible applicants will receive the following assistance:1. Full Discount: The full amount for eligible services will be covered under the Financial Care Policy for any patient or guarantor whose income is at or below 200 percent of the federal poverty level.2. Partial Discount: A sliding fee schedule will be used to determine the amount eligible for financial care assistance for any uninsured or underinsured patient or guarantor. For such applicants, assistance will be provided based on a combination of household income and assets. Partial discounts will be provided if the combination of income and assets is greater than 200 percent but equal to or less than 400 percent of the FPL. Assistance is granted only after all third-party reimbursement possibilities available to the applicant have been exhausted.3. Uninsured and underinsured individuals deemed medically indigent may qualify for a highly discounted rate.4. If the patient balance exceeds 30 percent of household income, patients will qualify for a one-time reduction.5. Assets for evaluation include, but are not limited to:a. home equity;b. IRAs, 403(b) accounts, 401k accounts, stocks/bonds;c. savings/money market accounts; andd. other investments (rental properties, etc.).WWW.STLUKESONLINE.ORG/RESOURCES/BEFORE-YOUR-VISIT/FINANCIAL-CARE

St. Luke's McCall
Part V, Section B, Line 16j: A Financial Care application is provided to the patient which contains Patient Financial Advocate contact information.

Part V, Section B, Line 7a:
https://www.stlukesonline.org/about-st-lukes/supporting-the-community/community-health-needs-assessments

Part V, Section B, Line 10a:
https://www.stlukesonline.org/about-st-lukes/supporting-the-community/community-health-needs-assessments

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
Please refer to the disclosure for Part V, Section B, Line 13b - which describes methods used to determine eligibility for financial assistance.

Part I, Line 7:
The cost to charge ratio was used to calculate the financial assistance provided to the community. Other Community benefits come from a data repository maintained by St. Luke's Employees that tracks community benefit costs and hours.

Part 1, Line 6a:
St. Luke's McCall, Ltd. is not required under Idaho law to file a community benefit report, since its total licensed beds are less than the minimum 150 bed requirement threshold. (McCall has 15 licensed beds.) Moreover, the activity of St. Luke's McCall, Ltd. is not included in the community benefit report within any of its related organizations within the St. Luke's Health System.

Part 1, Line 7i, Cash and in-kind contributions for community benefit:
During the fiscal year 2022, St. Luke's administrated and dispensed the majority of community grants, cash, and in-kind donations at the system level. Those grants and donations were still awarded and continued to support health initiatives through all the communities we serve and were reported on form 990 for St. Luke's Health System.

Part 1, Line 5a, Discounted Care:
Financial assistance is provided to any qualifying patients, regardless of budget.

Part II, Community Building Activities:
St. Luke's is an active participant in the community, and provides support to address public health issues, and works with coalitions to address local health needs. St. Luke's takes on initiatives as need arises to help the long term development of the community particularly to shape and improve public health and access to medical services.

Part III, Line 2:
The Cost to Charge ratio method was used to calculate bad debt expense at cost.

Part III, Line 3:
St. Luke's has a very robust financial assistance program, therefore, no estimate is made for bad debt attributable to patients eligible under the financial assistance policy.

Part III, Line 4:
Per the audited financial statements in footnote three, St. Luke's grants credit without collateral to its patients, most of whom are local residents and many of whom are insured under third-party agreements. The allowance for estimated uncollectible amounts is determined by analyzing both historical information (write-offs by payor classification), as well as current economic conditions.

Part III, Line 8:
The source of the information is the Medicare Cost Report for fiscal year 2022. The amount is calculated by comparing the total Medicare apportioned costs (allowable costs) to payments (including IME and GME) received during FY'22.St. Luke's provides medical care to all patients eligible for Medicare regardless of the shortfall and thereby relieves the Federal Government of the burden for paying the full cost of Medicare.

Part III, Line 9b:
All subsidiaries within the St. Luke's Health System have policies in place to provide financial assistance to those who meet established criteria and need assistance in paying for the amounts billed for their provided health care services. In addition, the collection policies and practices in place within the St. Luke's Health System provide guidance to patients on how to apply for this assistance. Collection of amounts due may be pursued in cases where the patient is unable to qualify for charity care or financial assistance and the patient has the financial resources to pay for the billed amounts.

Part VI, Line 2:
"A Community Health Needs Assessment (CHNA) was conducted for the fiscal year ending 9/30/2022. Information related to the CHNA is shown in the responses to questions 3 and 7 of ""Part V, Section B, Facility Policies and Practices"".A complete copy of the CHNA assessments for all of the hospitals operating within the St. Luke's Health System can be found at the following website:https://www.stlukesonline.org/about-st-lukes/supporting-the-community/community-health-needs-assessments"

Part VI, Line 3:
(A) St. Luke's provides notice of the availability of financial assistance via: 1. Signage 2. Patient brochure 3. Billing Statement 4. Written collection action letter 5. Online at www.stlukesonline.org/billing (B) Financial assistance policy is translated into the following language: Spanish (C) St. Luke's provides individual notice of the availability of financial assistance to a patient expected to incur charges that may not be paid in full by third party coverage, along with an estimate of the patient's liability. (D) For cases in which St. Luke's independently determines patient eligibility for financial assistance, St. Luke's provides written notice of determination that the patient is or is not eligible within 10 business days of receiving a completed application and the required supporting documentation.

Part VI, Line 4:
Adams and Valley counties represent the geographic area used to define the community we serve, also referred to here as our primary service area or service area. The criteria we use in selecting the service area is the identification of what counties our hospitalized patients reside in. Those counties that make up 70% or greater of the inpatient hospitalizations are identified as our service area. The residents of Adams and Valley counties comprise about 80% of our inpatients with approximately 61% of our inpatients living in Valley County and 19% in Adams County.Both Idaho and our service area territory are comprised of about a 97% white population while the nation, as a whole, is 76% white. The Hispanic population in Idaho represents 13% of the overall population and about 4% of our defined service area. Adams County is approximately 4% Hispanic, and Valley County is 5% Hispanic.Idaho experienced a 14% increase in population from 2010 to 2019, ranking it as one of fastest growing states in the country. Adams and Valley Counties have followed that trend, experiencing a 13% increase in population within that timeframe. St. Luke's McCall isworking to manage the volume and scope of services to meet the needs of a growing population.Over the past 10 years the 65 plus year old age group has been the fastest growing segment of our service area. Currently, about 27% of the people in our service area are over the age of 65. According to the U.S. Census, about 16% of the people in the U.S. are over age 65.The official United States poverty rate has been decreasing since 2012. The poverty rate in Valley County is currently well below the national average at 9% but above the national average in Adams County at 13%. The poverty rate in our service area for children under the age of 18 is again below the national average for Valley County at 12% and above the national average for Adams County at 20%.Median income in the United States has risen steadily since 2009. Median income in Idaho remains below the national average but continues to grow. Median income in Adams County is well below the national median and lower than Idaho's median income. Median income in Valley County is slightly below than the national median income.

Part VI, Line 5:
The people who serve on the various boards for subsidiaries within the St. Luke's Health System are local citizens who have a vested interest in the health of their communities. These committed leaders volunteer on our boards because they are dedicated to ensuring that the people of southern Idaho and the surrounding area have access to the most advanced, most comprehensive health care possible. St. Luke's believes that locally owned and governed hospitals can take the best measure of community health care needs. We are grateful to our board leadership for giving generously of their time and talents and bringing to the table their unique perspectives and intimate knowledge of their communities. St. Luke's would not be the organization it is today without our volunteer board members. The vision of dedicated community leaders has guided St. Luke's for many decades, and will continue to guide us well into the future. As a not-for-profit organization,100% of St. Luke's revenue after expenses is reinvested in the organization to serve the community in the form of staff, buildings, or new technology. Also, St. Luke's McCall, Ltd. maintains an open medical staff. Any physician can apply for practicing privileges as long as they meet the standards for St. Luke's McCall, Ltd.

Part VI, Line 6:
"As the only Idaho-based not-for-profit health system, St. Luke's Health System is part of the communities we serve, with local physicians and boards who further our organization's mission ""To improve the health of people in the communities we serve."" Working together, we share resources, skills, and knowledge to provide the best possible care, no matter which of our hospitals provide that care. Each St. Luke's Health System hospital is nationally recognized for excellence in patient care, with prestigious awards and designations reflecting the exceptional care that is synonymous with the St. Luke's name. St. Luke's Health System provides facilities and services across the region, covering a 150-mile radius that encompasses southern and central Idaho, northern Nevada, and eastern Oregon-bringing care close to home and family. The following entities are part of the St. Luke's Health System: (1) St. Luke's Regional Medical Center, Ltd. with the following locations: --St. Luke's Boise Hospital --St. Luke's Meridian Hospital --St. Luke's Children's Hospital --St. Luke's Boise/Meridian/Caldwell/Fruitland Physician Clinics --St. Luke's Eagle Urgent Care --St. Luke's Elmore Hospital with physician clinic --St. Luke's Fruitland Emergency Department/Urgent Care (2) St. Luke's Wood River Medical Center, Ltd. which consists of a critical access hospital located in Ketchum, Idaho as well as various physician clinics (3) St. Luke's Magic Valley Regional Medical Center, Ltd. which consists of the following: --St. Luke's Magic Valley Hospital-Twin Falls, Idaho --Various St. Luke's Physician Clinics in Twin Falls --Canyon View-(Behavioral Health) --St. Luke's Jerome Hospital-Jerome, Idaho --Various Physician clinics in Jerome (4) St. Luke's McCall, Ltd. which consists of a critical access hospital located in McCall, Idaho as well as various physician clinics. (5) St. Luke's Nampa Medical Center, Ltd. which consists of a critical access hospital located in Nampa, Idaho as well as various physician clinics. St. Luke's physician clinics and services are provided in partnership with area physicians and other health care professionals. These include: Cardiovascular; Child Abuse and Neglect Evaluation; Endocrinology; Ear, Nose, and Throat; Family Medicine; Gastroenterology; General Surgery; Hypertensive Disease; Internal Medicine; Maternal/Fetal Medicine; Medical Imaging; Metabolic and Bariatric Surgery; Nephrology; Neurology; Neurosurgery; Obstetrics/Gynecology; Occupational Medicine; Orthopedics; Outpatient Rehabilitation; Plastic Surgery; Psychiatry and Addiction; Pulmonary Medicine; Sleep Disorders; and Urology. In addition, St. Luke's works with other regional facilities, including Weiser Memorial Hospital and Salmon River Clinic, through a combination of management and other contracts for select specified services."

Operating expenses	$ 45,530,484
Total amount spent on community benefits as % of operating expenses	$ 2,254,945 4.95 %