Community Benefit Insight - Tax-exempt hospital

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St Margaret's Health-Peru

St Margarets Health - Peru

925 West Street
Peru, IL 61354

Bed count	65	Medicare provider number	140234	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 362852553

Display data for year:

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

10.79%

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

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2013-2021

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	$ 17,243 0.08 %
Medicaid as % of operating expenses	$ 1,271,189 6.09 %
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	$ 965,933 4.62 %
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	$ 1,290,848 6.18 %
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	$ 129,085 10.00 %

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 $ 19057816 including grants of $ 400) (Revenue $ 19971559)
St. Margaret's Health-Peru is a 49-bed acute care hospital located in Peru, Illinois. The Hospital also operates a network of primary and specialty care physician clinics in Peru and the surrounding area. Services range from employed physicians and mid-levels in the specialties of Family Medicine, Internal Medicine, Obstetrics/Gynecology, Orthopedics, Otorhinolaryngology, and Sleep Medicine. (Continued on Sch. O)In addition to these physician practices, the Hospital also offers the Care Today Clinic which provides a lower-cost, convenient alternative to emergency room care. Contracted physician services are provided for Emergency Medicine, Anesthesiology, Pathology and Hospitalists' services. Inpatient hospital services provided include medical and surgical services, ICU, Obstetrics, Swing Beds, Diagnostic, Rehab and Treatment Services. Outpatient services include Surgery, Emergency Room, Laboratory, Diagnostic Imaging, Rehab Services, Pain Management, Sleep Therapy, Wound Management, Respiratory Care, EKG, other diagnostic and therapeutic services. Hospice services are also provided. St. Margaret's Health - Peru is a Medicare dependent Hospital and qualifies for disproportionate share payments. The Hospital is committed to providing the highest quality of health services to all patients, regardless of their financial status or ability to pay. Statistics:- inpatient admissions: 405- inpatient days: 1,319- newborn deliveries: 91- inpatient surgeries: 88- outpatient surgeries: 834- outpatient visits: 32,930- emergency room visits: 3,049- clinic visits: 16,876

Facility Information

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

St. Margaret's Health-Peru
Part V, Section B, Line 3j: Industry data related to projected growth in need for various services specific to the population of this area.

St. Margaret's Health-Peru
Part V, Section B, Line 5: The Community Health Needs Assessment (CHNA) stakeholders working group, comprised of members representing the broad interests of the communities served, was responsible for the CHNA process. The stakeholder group included members from St. Margaret's Health - Peru, IVCH Medical Group, La Salle County Health Dept, Alternatives for the Older Adult, North Central Behavioral Health Services, Oglesby Public Schools and Illinois Valley United Way. The working group developed a survey instrument, evaluated survey responses, collected and evaluated secondary data, synthesized the primary and secondary data, and identified and prioritized community health needs. Primary data for this assessment came from a survey developed, distributed and analyzed by the stakeholders working group specifically for CHNA.

St. Margaret's Health-Peru
Part V, Section B, Line 11: The community health needs assessment includes a description of the actions taken to meet needs that were identified in the community health needs assessment. The areas of concern that have been identified in the new 2018 community health needs assessment, relate to cost and quality of healthcare, access to specialists and specialized treatments, and mental health and substance abuse.Regarding cost and quality of care, St. Margaret's Health - Peru has implemented a palliative care program to reduce patient and overall cost of care while enhancing care and service to patients; promoted and provided annual wellness visits to proactively manage the health of patients; and educated and assisted patients to understand available insurance and coverages provided by Medicare and Medicaid.Regarding access to specialists and specialized care, St. Margaret's Health - Peru conducted analysis to determine more specifically what the community is seeking, and augmented a medical staff development plan to recruit orthopedic surgeon, OB/GYN physicians and neurologist.Regarding mental health and substance abuse, St. Margaret's Health - Peru has increased access to mental health treatment by providing telepsychiatry services in primary care clinics; continued focus on pediatric mental health through services offered at the hygienic institute; and increased awareness of current medication assisted therapy treatment options offered through the IVCH Medical Group.

Form 990, Sch H, Part V, Section B, Line 7 and 10:
CHNA:https://aboutsmh.org/community-health-needs-assessments/Implementation Strategy:https://aboutsmh.org/community-health-needs-assessments/

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare cost report.

Part III, Line 2:
The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.

Part III, Line 3:
An estimated 10% of implicit price concessions are assumed to be attributable to patients that would have qualified for the organization's financial assistance policy.

Part III, Line 4:
The financial statement footnote regarding implicit price concessions may be found on page 13 of the audited financial statements.

Part III, Line 8:
St. Margaret's Health-Peru provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.

Part III, Line 9b:
When a patient is in the process of applying for financial assistance the account is placed on hold and no further collection efforts are made until the request for assistance has been resolved. The application process includes facilitating the patient's application for various assistance programs, and identifying where the patient falls in the discount scale of the organization based on income level and size of family. If there is a balance remaining after charity care or other financial assistance has been applied, a mutually agreen upon payment plan is developed and the account follows the same collection procedures as all other self-pay accounts. Monthly payments are required and balances are typically expected to be paid in full within one year. Extensions may be approved for unexpected changes in ability to meet the payment schedule. Collection procedures include statements, past due notices, phone calls, and, if agreed upon payment arrangements cannot be met, the account is referred to a collection agency.

Part VI, Line 2:
The determination of current and future health care needs of the communities served by St. Margaret's Health-Peru is based on a combination of the following factors: existence or non-existence of appropriate services, demonstrated need, voice of the customer, collaboration with community organizations, government agencies and other health care providers, benchmarking market research, customer surveys, physician input and monitoring of state and federal guidelines. This information is reviewed and analyzed by the hospital's administrative team and incorporated into the hospital's strategic planning process.

Part VI, Line 3:
Documentation is provided at the time of registration informing patients that financial assistance is available and providing contact information for the patient financial services department. Basic information and contact information is also available at aboutsmh.org by selecting the home page's financial assistance button. When contacted by a patient, financial counselors work individually with each applicant to determine eligibility for charity or financial assistance. Notices about financial assistance programs are posted in the registration areas and information is also included on the patient statements. The social services department notifies each inpatient of financial assistance programs available at St. Margaret's Health-Peru as well as local, state, and federal programs they may be eligible for.

Part VI, Line 4:
St. Margaret's Health-Peru serves the residents of rural communities located in LaSalle, Bureau and Putnam counties, in north central Illinois. The hospital is located near the junction of interstates 80 and 39 and is 62 miles west of Joliet and 64 miles north of Bloomington. The primary service area of the hospital has a population of about 35,000 people. No population growth is projected for the area. The largest area employers are involved in transportation, warehousing, agriculture, light industry, and retail services. The service area race and ethnicity is composed of 85% White, 3% African American, 10% Hispanic, and 1% Asian. According to the Illinois department of employment security, the 2021 unemployment rate in LaSalle county was 6.0%, which was slightly lower than the state of Illinois (6.1%) and higher than the United States (5.3%). The median household income is LaSalle ($60,069), Bureau ($55,549) and Putnam ($64,694) counties were below the state of Illinois figure of $68,428. The proportion of LaSalle county residents living below the federal poverty level of 11.4% is more than the state average of 11.0%. St. Margaret's Health-Peru serves patients without regard to age, gender, income, ethnic origin, insurance coverage, or ability to pay.

Part VI, Line 5:
The board of directors of St. Margaret's Health-Peru have regular input on strategic planning, new services, technology, and physician recruitment. St. Margaret's Health-Peru maintains an open medical staff and is constantly recruiting new physicians to meet identified needs. All available cash flow generated by the organization is reinvested back into the hospital through the purchase of property and equipment to provide services that meet the needs of the service area. The community outreach department offers a wide variety of health and wellness programming, including Tai Chi classes, free blood pressure and glucose screenings, hemoglobin A1C screenings, lipid profile screenings, healthy heart screenings, prostate cancer screenings, smoking cessation classes, babysitting clinics, CPR instruction, and first aid.

Operating expenses	$ 20,889,888
Total amount spent on community benefits as % of operating expenses	$ 2,254,365 10.79 %