Community Benefit Insight - Tax-exempt hospital

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Southeast Iowa Regional Medical Center Inc

Southeast Iowa Regional Medical Ctr

1221 South Gear Avenue
West Burlington, IA 52655

Bed count	173	Medicare provider number	160057	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 420680407

Display data for year:

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

5.22%

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	$ 5,153,882 1.00 %
Medicaid as % of operating expenses	$ 17,759,066 3.44 %
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	$ 3,841,548 0.74 %
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.	$ 123,802 0.02 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 76,599 0.01 %
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	$ 4,581,840 0.89 %
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 $ 505475989 including grants of $ 168393959) (Revenue $ 307879344)
SOUTHEAST IOWA REGIONAL MEDICAL CENTER (SIRMC) IS A TWO CAMPUS HOSPITAL. ONE IS LOCATED IN FORT MADISON, IOWA, A 50 BED HOSPTIAL AND THE OTHER IS LOCATED IN WEST BURLINGTON, IOWA, IS A 378-BED REGIONAL MEDICAL CENTER OFFERING ACUTE AND INTERMEDIATE CARE TO RESIDENTS OF SOUTHEAST IOWA, WEST CENTRAL ILLINOIS AND NORTHEAST MISSOURI. THE HOSPITAL OFFERS COMPREHENSIVE MEDICAL, EXTENSIVE SURGICAL, AND EMERGENCY CARE SERVICES. DURING FISCAL YEAR ENDING 6/30/22, SIRMC HAD 7,359 PATIENT ADMISSIONS AND 66,483 PATIENT DAYS OF MEDICAL CARE. SIRMC ALSO HAD 187,801 OUTPATIENT VISITS, 44,384 EMERGENCY ROOM VISITS AND 12,393 HOME HEALTH-CARE VISITS. SIRMC PROVIDES MEDICAL SERVICES REGARDLESS OF ABILITY TO PAY AND ACCEPTS MEDICARE AND MEDICAID.THE HOSPITAL'S 160-BED KLEIN CENTER OFFERS LONG-TERM AND SKILLED CARE ON THE HOSPITAL'S CAMPUS. THE CANCER CENTER, WHICH PROVIDES MEDICAL AND RADIATION THERAPY SERVICES FOR THE TREATMENT OF VARIOUS FORMS OF CANCER AND BLOOD DISEASES, OFFERS THE LATEST THREE-DIMENSIONAL TREATMENT-PLANNING COMPUTER TECHNOLOGY AVAILABLE IN ONLY A FEW HEALTH-CARE CENTERS IN THE STATE. THE WELLNESS PLAZA IS HOME TO ONE OF THE STATE'S PREMIER REHABILITATION AND FITNESS PROGRAMS.

Facility Information

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

SOUTHEAST IOWA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: SOUTHEAST IOWA REGIONAL MEDICAL CENTER, PART OF GREAT RIVER HEALTH SYSTEM, CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT TO DISTINGUISH THE UNMET MEDICAL AND PUBLIC HEALTH NEEDS IN DES MOINES AND LEE COUNTIES. THE STUDY HAS THREE OBJECTIVES:1. TO CONDUCT AN ASSESSMENT THAT PROVIDES A FOUNDATION FOR SOUTHEAST IOWA REGIONAL MEDICAL CENTER AND ITS PARTNERS TO BUILD A CONSENSUS ABOUT THE AREA'S MOST CRITICAL HEALTH CARE NEEDS.2. TO MEET STATE AND FEDERAL REQUIREMENTS FOR HOSPITALS THAT MUST CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY 3 YEARS.3. TO DEVELOP ACTION PLANS FOR INTERVENTIONS TO ADDRESS CONCERNS HIGHLIGHTED BY THE COMMUNITY AND HEALTH DATA.INFORMATION WAS COLLECTED THROUGH VIRTUAL MEETINGS, PAPER AND ONLINE SURVEYS, KEY INFORMANT QUESTIONNAIRES, AND A REVIEW AND ANALYSIS OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS. THE SURVEY WAS MADE AVAILABLE AT SEVERAL LOCATIONS IN THE STUDY AREA. LOCATIONS WERE CHOSEN BASED ON EASE OF ACCESS AND TRAFFIC BUT WERE RESTRICTED BY COVID-19. THE SURVEY WAS DESIGNED TO ELICIT PUBLIC RESPONSES ABOUT HEALTH NEEDS IN DES MOINES AND LEE COUNTIES. THE SURVEY INCLUDED MULTIPLE CHOICE, OPEN-ENDED AND SCALED QUESTIONS THAT ASKED PEOPLE WHAT THEY PERCEIVED TO BE THE GREATEST AREAS OF COMMUNITY NEED. A TOTAL OF 1,204 SURVEYS WERE RETURNED AND ANALYZED, A DECREASE OF 46 PERCENT FROM THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. DECREASES IN RESPONSES WERE TO BE EXPECTED DUE TO A SHORTENED SURVEY WINDOW AND REDUCED OPPORTUNITIES FOR DISBURSEMENT.INTERVIEWS WERE CONDUCTED WITH LOCAL PROFESSIONALS AND KEY INFORMANTS, INCLUDING PROFESSIONALS IN EDUCATION, LAW ENFORCEMENT, PUBLIC HEALTH AND SOCIAL SERVICES, AND OTHER PROFESSIONALS REPRESENTING UNDERSERVED POPULATIONS IN THE SERVICE AREA. PARTICIPANTS WERE ASKED TO IDENTIFY THE LARGEST HEALTH CONCERNS IN THE COMMUNITY AND TO SUGGEST WAYS TO IMPROVE UNMET HEALTH NEEDS. THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE FOR DES MOINES AND LEE COUNTIES WERE INVESTIGATED BY FOCUSING ON THE PROBLEMS INDICATED FROM THE INTERVIEWS AND COMMUNITY SURVEY. UTILIZING A STATISTICAL RANKING METHOD TO INCORPORATE INFORMATION FROM COLLABORATIVE MEETINGS, SURVEYS, AND THE INTERVIEWS, THE FOLLOWING FOUR UNMET HEALTH NEEDS WERE CHOSEN: MENTAL HEALTH SUBSTANCE MISUSE POVERTY AND EQUITY OBESITY AND OVERWEIGHTTHESE FOUR NEEDS WILL BE THE FOCUS OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER AND GREAT RIVER HEALTH SYSTEM'S EFFORTS TO IMPROVE THE HEALTH OF DES MOINES AND LEE COUNTIES.

SOUTHEAST IOWA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 6B: SOUTHEAST IOWA REGIONAL MEDICAL CENTER CONTINUALLY WORKS WITH PARTNERS AND STAKEHOLDERS OUTSIDE THE HOSPITAL TO MEET THE HEALTH NEEDS OF THE COMMUNITY. SOUTHEAST IOWA REGIONAL MEDICAL CENTER COLLABORATED WITH DES MOINES COUNTY DEPARTMENT OF PUBLIC HEALTH, COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, BLESSING HEALTH KEOKUK, AND LEE COUNTY HEALTH DEPARTMENT ON A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT.

SOUTHEAST IOWA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: SOUTHEAST IOWA REGIONAL MEDICAL CENTER WORKED WITH DES MOINES AND LEE COUNTIES RESPECTIVE PARTNERS TO REVIEW THE DATA AND INFORMATION GATHERED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. AFTER REVIEWING THE DATA FROM THE SURVEY, VIRTUAL TOWN HALL MEETINGS, AND COMMENTS FROM THE KEY INFORMANT QUESTIONNAIRE, THE FOLLOWING HIGH PRIORITY HEALTH CONCERNS WERE SELECTED: MENTAL HEALTH SUBSTANCE MISUSE POVERTY AND EQUITY OBESITY AND OVERWEIGHTLEADERS AT SOUTHEAST IOWA REGIONAL MEDICAL CENTER HIGHLIGHTED THE FOLLOWING IMPLEMENTATION STRATEGIES, POTENTIAL IMPACTS, AND RESOURCES NEEDED FOR EACH FOCUS AREA.MENTAL HEALTH- EXPAND EXISTING PROGRAMS- GERIATRIC INPATIENT UNIT- RECRUITMENTSUBSTANCE MISUSE-OPIOID MANAGEMENT IMPROVEMENTS-PEER RECOVERY GROUP-SUPPORT AND PARTICIPATION IN COMMUNITY BASED INITIATIVES-FITNESS VOUCHER PILOT PROGRAMOBESITY/OVERWEIGHT -POPULATION HEALTH PLATFORM-LIVE HEALTHY LEE COUNTY-HEALTHY LIVING COMMUNITY EDUCATIONPOVERTY AND EQUITY-RURAL PUBLIC HEALTH WORKFORCE TRAINING NETWORK PROGRAM-SOCIAL DETERMINANTS OF HEALTH ASSESSMENT WORKFLOW-GOOD FAITH ESTIMATES-GREAT RIVER HEALTH FOUNDATION PARTNERSHIP WITH SOUTHEASTERN COMMUNITY COLLEGE

SOUTHEAST IOWA REGIONAL MEDICAL CENTER
"PART V, SECTION B, LINE 13H: SIRMC MAY USE PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY:THERE ARE INSTANCES WHEN A PATIENT/INDIVIDUAL MAY APPEAR TO BE ELIGIBLE FOR CHARITY-CARE DISCOUNTS, BUT THERE IS NO COMPLETED FINANCIAL ASSISTANCE FORM ON FILE BECAUSE OF A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER RESOURCES THAT COULD PROVIDE SUFFICIENT EVIDENCE TO DETERMINE ELIGIBILITY.1. INFORMATION IS PROVIDED WEEKLY TO AN OUTSIDE SOURCE. OUTSIDE SOURCE RETURNS RESULTS TO SOUTHEAST IOWA REGIONAL MEDICAL CENTER ABOUT PATIENT QUALIFICATIONS BASED ON OUR FINANCIAL ASSISTANCE POLICY.2. OUTSIDE SOURCE USES DEMOGRAPHIC AND HOUSEHOLD INFORMATION, AND CREDIT-SCORING TECHNOLOGY TO DETERMINE THE PERCENTAGE OF ASSISTANCE FOR WHICH A PATIENT MAY BE ELIGIBLE.3. SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL ATTEMPT TO CONTACT PATIENTS BASED ON THEIR PRESUMPTIVE ASSISTANCE QUALIFICATION TO ALLOW THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE.4. PATIENTS WILL NOT BE DISQUALIFIED FROM FINANCIAL ASSISTANCE BASED ON PRESUMPTIVE ASSISTANCE RESULTS.5. IF THE ACCOUNT IS PAST DUE AND THERE IS NO COMPLETED FINANCIAL ASSISTANCE APPLICATION OR SUPPORTING DOCUMENTATION, THE PATIENT'S ACCOUNT COULD BE CONSIDERED FOR FINANCIAL ASSISTANCE BASED ON OUTSIDE SOURCE'S RESULTS.6. PRESUMPTIVE ELIGIBILITY ALSO CAN BE DETERMINED BASED ON LIFE CIRCUMSTANCES INCLUDING: -ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED -FOOD STAMP ELIGIBILITY -HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC -LOW INCOME/SUBSIDIZED HOUSING PROVIDED AS A VALID ADDRESS -PARTICIPATION IN THE WOMEN INFANTS AND CHILDREN (WIC) PROGRAM -PATIENT IS DECEASED WITH NO KNOWN ESTATE -STATE-FUNDED PRESCRIPTION PROGRAMS -SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY7. IT ALSO IS ACCEPTABLE TO USE PROXY INFORMATION TO DETERMINE ELIGIBILITY WHEN INCOME LEVELS CANNOT BE DIRECTLY DETERMINED. SUCH INFORMATION COULD INCLUDE STATEMENTS LIKE ""STAYS WITH FRIENDS OR ""OCCASIONALLY WORKS.""8. PATIENTS WHO MEET PRESUMPTIVE-CARE GUIDELINES MAY QUALIFY FOR FINANCIAL ASSISTANCE DISCOUNTS. THIS DETERMINATION IS AT THE DISCRETION OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER.9. IN A SITUATION, WHERE PRESUMPTIVE ELIGIBILITY IS GIVEN TO A PATIENT AND A FINANCIAL ASSISTANCE APPLICATION IS OBTAINED LATER, THE UPDATED ELIGIBILITY WILL BE BASED ON THE FINANCIAL ASSISTANCE APPLICATION WITH SUPPORTING DOCUMENTATION. IN THIS CASE, SOUTHEAST IOWA REGIONAL MEDICAL CENTER COULD ADJUST FINANCIAL ASSISTANCE UP TO THREE MONTHS BEFORE THE APPLICATION DATE."

SOUTHEAST IOWA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 20E: SIRMC USES AN OUTSIDE SOURCE TO SCREEN PATIENTS TO SEE IF THEY COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL GETS NOTIFICATION BACK AS TO HOW MUCH OF A FINANCIAL ASSISTANCE DISCOUNT THEY WOULD BE ELIGIBLE FOR. IF THE PATIENT DOESN'T RESPOND TO PHONE CALLS REGARDING THE FINANCIAL ASSISTANCE APPLICATION OR THEY DON'T COMPLETE THE APPLICATION, THE HOSPITAL MAY STILL DISCOUNT THE PATIENT'S CHARGES UNDER THEIR PRESUMPTIVE CHARITY POLICY. THE HOSPITAL'S PRESUMPTIVE CHARITY PROGRAM GIVES THE HOSPITAL THE OPPORTUNITY TO DISCOUNT PATIENT ACCOUNTS BASED ON INFORMATION IT MAY HAVE REGARDING A PATIENT BEING HOMELESS OR UNEMPLOYED.

PART V, SECTION B, LINES 7A AND 10A:
SIRMC'S COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT: HTTPS://WWW.GREATRIVERHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

PART V, SECTION B, LINE 16:
SIRMC'S FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT:HTTPS://WWW.GREATRIVERHEALTH.ORG/PATIENTS-VISITORS/BILLING-FINANCIAL-SERVICES/

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
SOUTHEAST IOWA REGIONAL MEDICAL CENTER (SIRMC) USES THE FPG TO DETERMINE FREE OR DISCOUNTED CARE. INDIVIDUALS WHO ARE BELOW 200% OF THE FPG QUALIFY FOR FREE CARE. IN MOST INSTANCES, THEY HAVE TO PROVIDE FINANCIAL DOCUMENTATION AND FILL OUT A CHARITY CARE APPLICATION. THE HOSPITAL ALSO USES A PRESUMPTIVE CHARITY CARE PROGRAM THAT ANALYZES PUBLIC AND PRIVATE DATABASES TO HELP DETERMINE ELIGIBILITY FOR CHARITY CARE. THESE INDIVIDUALS DO NOT HAVE ANY OTHER DOCUMENTATION TO PROVIDE. THIS PROGRAM IS USED AFTER COLLECTION ATTEMPTS HAVE BEEN DISCONTINUED. EXTRAORDINARY ASSETS ARE TAKEN INTO CONSIDERATION WHEN DETERMINING CHARITY CARE ELIGIBILITY. MEDICALLY INDIGENT INDIVIDUALS ARE COVERED UNDER THE SAME CHARITY CARE POLICY. INDIVIDUALS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LIMITS ARE GRANTED CHARITY ON A SLIDING SCALE.

PART I, LINE 7:
THE AMOUNTS INCLUDED IN PART I, LINES 7A-7D WERE CALCULATED USING COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. PART I, LINES 7E-7J ARE ACTUAL COSTS.

PART I, LINE 7G:
THE SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G IS MENTAL HEALTH SERVICES PROVIDED BY SIRMC.

PART I, LN 7 COL(F):
BAD DEBT EXPENSES OF $4,581,840 WERE SUBTRACTED FROM THE TOTAL EXPENSES IN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F.

PART III, LINE 2:
MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENTS' FINANCIAL HISOTRY, CREDIT HISTORY, AND CURRENT ECONOMIC CONDITIONS.

PART III, LINE 3:
SOUTHEAST IOWA REGIONAL MEDICAL CENTER CONTRACTS WITH AN EXTERNAL ORGANIZATION. THE ORGANIZATION RECEIVES WEEKLY LISTINGS OF PATIENT RECEIVABLES FROM SIRMC'S PATIENT FINANCIAL SERVICES STAFF. THEY RETURN RESULTS TO SIRMC IDENTIFYING INDIVIDUALS WHO COULD QUALIFY FOR THE FINANCIAL ASSISTANCE PROGRAM. THE DATA IS BASED ON PATIENT INCOME AS WELL AS THEIR CREDIT REPORTING. THE RESULTS ARE APPLIED TO SIRMC'S FINANCIAL ASSISTANCE MATRIX TO IDENTIFY IF AN INDIVIDUAL WOULD QUALIFY AND FOR WHAT PERCENTAGE. SIRMC'S PATIENT FINANCIAL SERVICES STAFF THEN CONTACT THE PATIENT TO ACQUIRE A FINANCIAL ASSISTANCE APPLICATION.

PART III, LINE 4:
"SEE THE ""PATIENTS RECEIVABLES"" PARAGRAPH IN NOTE 1 ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DESCRIPTION OF BAD DEBT EXPENSE."

PART III, LINE 8:
THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT ARE (A) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (B) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; AND (C) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.

PART III, LINE 9B:
AN EXCERPT FROM SIRMC'S FINANCIAL ASSISTANCE PROGRAM WRITTEN POLICY, RELATIONSHIP OF FINANCIAL ASSISTANCE PROGRAM TO COLLECTION POLICIES: SOUTHEAST IOWA REGIONAL MEDICAL CENTER MANAGEMENT HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, WHICH INCLUDES COLLECTION ACTION AND REPORTING TO CREDIT AGENCIES) THAT TAKE INTO ACCOUNT THE FOLLOWING: A) THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY; B) PATIENT'S GOOD FAITH EFFORT TO APPLY FOR GOVERNMENTAL PROGRAMS; C) PATIENT'S GOOD FAITH EFFORT TO APPLY FOR SOUTHEAST IOWA REGIONAL MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM; D) PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH PAYMENT AGREEMENTS MADE WITH SOUTHEAST IOWA REGIONAL MEDICAL CENTER. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL DO THE FOLLOWING: A) MAY OFFER EXTENDED PAYMENT PLANS; B) WILL NOT SEND UNPAID BALANCES TO OUTSIDE COLLECTION AGENCIES; C) WILL CEASE ALL COLLECTION EFFORTS WITH OUTSIDE COLLECTION AGENCIES. SOUTHEAST IOWA REGIONAL MEDICAL CENTER AND AGENCIES ACTING ON ITS BEHALF WILL NOT IMPOSE EXTRAORDINARY COLLECTION ACTIONS WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. REASONABLE EFFORTS SHALL INCLUDE: A) VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; B) DOCUMENTATION THAT SOUTHEAST IOWA REGIONAL MEDICAL CENTER HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WIHT THE HOSPITAL'S APPLICATION REQUIREMENTS; C) DOCUMENTATION THAT THE PATIENT HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL NOT SEND OUTSTANDING BALANCES TO AN OUTSIDE COLLECTION AGENCY UNTIL 120 DAYS FROM THE DATE THE BALANCE BECAME THE PATIENT'S RESPONSIBILITY. AN OUTSIDE AGENCY ACTING ON THE BEHALF OF SOUTHEAST IOWA REGIONAL MEDICAL CENTER WILL NOT TAKE EXTRAORDINARY COLLECTION AGENCY UNTIL AN ADDITIONAL 120 DAYS HAVE BEEN EXHAUSTED. EXTRAORDINARY COLLECTION ACTION INCLUDES BUT IS NOT LIMITED TO THE FOLLOWING: A) SELLING DEBT TO A THIRD PARTY OTHER THAN A COLLECTION AGENCY; B) REPORTING ADVERSE INFORMATION TO A CONSUMER CREDIT REPORTING AGENCY OR CREDIT BUREAU; C) FILING A CLAIM FOR UNPAID DEBT THROUGH THE COURT SYSTEM.

PART III, SECTION A, LINE 1:
THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HFMA STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.

PART VI, LINE 2:
SIRMC'S BOARD OF DIRECTORS IS COMMUNITY BASED. REPRESENTATIVES FROM VARIOUS SEGMENTS OF THE COMMUNITY MAKE UP THE BOARD. IN ADDITION, BOARD MEMBERS ARE SELECTED IN OUTLYING COMMUNITIES THAT SIRMC SERVES. THESE BOARD MEMBERS CONSTANTLY PROVIDE INPUT TO THE HEALTHCARE NEEDS OF OUR COMMUNITY THROUGH THE ANNUAL STRATEGIC PLANNING PROCESS.

PART VI, LINE 7:
SIRMC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF IOWA. HOWEVER, COMMUNITY BENEFIT INFORMATION IS PROVIDED TO THE IOWA HOSPITAL ASSOCIATION.

PART VI, LINE 3:
NOTIFICATION ABOUT GOVERNMENT PROGRAM AND/OR FINANCIAL ASSISTANCE FROM SIRMC IS DISSEMINATED BY VARIOUS MEANS AT SIRMC, WHICH INCLUDES - PUBLICATION OF NOTICES IN PATIENT BILLS AND POSTED NOTICES IN THE EMERGENCY ROOMS, ADMISSION FORMS, ADMITTING AND REGISTRATION DEPARTMENT, HOSPITAL BUSINESS OFFICES, AND THE FINANCIAL SERVICES OFFICE ON THE FACILITY CAMPUS. SIRMC ALSO POSTS AT THE LOCAL DEPARTMENT OF HEALTH SERVICES OFFICE. SIRMC ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THE ASSISTANCE OPTIONS ON THE FACILITY WEBSITE AND IN BROCHURES AVAILABLE IN PATIENT ACCESS SITES. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE SIRMC STAFF. ALSO REQUESTS FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. FINANCIAL COUNSELORS MEET WITH PATIENTS TO ASSIST IN COMPLETING A QUESTIONNAIRE THAT HELPS THEM DETERMINE IF THE PATIENT QUALIFIES FOR A GOVERNMENT PROGRAM.

PART VI, LINE 4:
A REVIEW WAS CONDUCTED BY SIRMC TO ANALYZE THE ORIGIN OF PATIENTS UTILIZING THE SERVICES PROVIDED BY THE MEDICAL CENTER. THE REVIEW INDICATED THAT DES MOINES COUNTY COMPRISES THE MEDICAL CENTER'S PRIMARY SERVICE AREA AND THAT THE SECONDARY SERVICE AREA OF THE MEDICAL CENTER CONSISTS OF HENRY, LEE, AND LOUISA COUNTIES IN IOWA AND HANCOCK AND HENDERSON COUNTIES IN ILLINOIS. BASED ON THE US CENSUS BUREAU STATISTICAL ESTIMATES FOR 2020, THE PRIMARY SERVICE AREA POPULATION IS ESTIMATED AT 38,910 RESIDENTS. THE SECONDARY SERVICE AREA POPULATIONS ARE ESTIMATED TO TOTAL 68,399 RESIDENTS. OVER AGE 65 GROUP IS CURRENTLY 21.3% OF THE PRIMARY SERVICE AREA POPULATION, AS COMPARED TO 17.7% OF THE STATE OF IOWA POPULATION AND 16.8% OF THE UNITED STATES POPULATION. THE MEDIAN HOUSEHOLD INCOME IN THE PRIMARY SERVICE AREA IS $54,318 COMPARED TO THE STATE AND NATIONAL AVERAGES OF $65,429 AND $69,021, RESPECTIVELY. THE PRIMARY SERVICE AREA POPULATION BELOW POVERTY LEVEL IS 13.2% AS COMPARED TO THE STATE AND NATIONAL AVERAGES OF 11.1% AND 11.6%, RESPECTIVELY.SOUTHEAST IOWA REGIONAL MEDICAL CENTER IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA AND THE LARGEST SERVICE PROVIDER, INCLUDING THE BROADEST SCOPE OF SERVICES, IN THE PRIMARY AND SECONDARY SERVICE AREAS.

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SOUTHEAST IOWA REGIONAL MEDICAL CENTER FURTHERS ITS EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITY BY ENSURING THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY COMPRISES MEMBERS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH.SOUTHEAST IOWA REGIONAL MEDICAL CENTER PROVIDES MEMBERSHIP TO ALL PHYSICIANS WHO MEET MEMBERSHIP AND CLINICAL REQUIREMENTS.SOUTHEAST IOWA REGIONAL MEDICAL CENTER RECRUITS PHYSICIANS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, AND OTHER HEALTH PROFESSIONALS TO IMPROVE ACCESS TO HEALTH CARE IN THE HOSPITAL'S SERVICE AREA. IT ALSO PROMOTES HEALTH CAREER EDUCATION BY WORKING CLOSELY WITH SOUTHEASTERN COMMUNITY COLLEGE'S NURSING AND OTHER PROGRAMS.SOUTHEAST IOWA REGIONAL MEDICAL CENTER PARTICIPATES IN COMMUNITY BENEFIT ACTIVITIES SUCH AS PARTNERING WITH LOCAL SCHOOLS, COMMUNITY EDUCATION, COMMUNITY INITIATIVE EVENTS, PRENATAL EDUCATION CLASSES, A PARTICIPATING IN HEALTH FAIRS.SOUTHEAST IOWA REGIONAL MEDICAL CENTER MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY. IT IS OPEN TO ALL, REGARDLESS OF ABILITY TO PAY.SURPLUS FUNDS OF THE HOSPITAL ARE INVESTED IN IMPROVING AND UPDATING CAPITAL EQUIPMENT, AND INCREASING THE SERVICES OFFERED TO ALLOW FOR BETTER CARE OF THE PATIENTS THAT ARE SERVED.

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SOUTHEAST IOWA REGIONAL MEDICAL CENTER IS PART OF GREAT RIVER HEALTH SYSTEM.GREAT RIVER HEALTH SYSTEM CONSISTS OF TWO HOSPITALS, A HOSPICE HOUSE, HOME HEALTH SERVICES, AMBULANCE SERVICES, THREE PHARMACIES, A DURABLE MEDICAL EQUIPMENT COMPANY, A LONG-TERM CARE NURSING HOME, ABOUT 25 PRIMARY-CARE AND SPECIALTY PHYSICIAN CLINICS, AND IS AFFILIATED WITH AN OUTPATIENT RENAL DIALYSIS CENTER.THE NON-HOSPITAL HEALTH CARE FACILITIES THAT ARE OPERATED BY ORGANIZATIONS RELATED TO THE HOSPITAL ARE: GREAT RIVER HEALTH SYSTEM-ANESTHESIA; GREAT RIVER HEALTH SYSTEM-AUDIOLOGY; GREAT RIVER HEALTH SYSTEM-BUSINESS HEALTH; GREAT RIVER HEALTH SYSTEM-CANCER CENTER; GREAT RIVER HEALTH SYSTEM-CARDIOLOGY; GREAT RIVER HEALTH SYSTEM-DIABETIC FOOT CLINIC; GREAT RIVER HEALTH SYSTEM-EYE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE; GREAT RIVER HEALTH SYSTEM-FAMILY MEDICINE, MERCY PLAZA; GREAT RIVER HEALTH SYSTEM-GASTROENTEROLOGY; GREAT RIVER HEALTH SYSTEM-HEALTHY LIVING; GREAT RIVER HEALTH SYSTEM-HERITAGE FAMILY PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE MEDICAL EQUIPMENT AND SUPPLIES; GREAT RIVER HEALTH SYSTEM-HERITAGE PARK PHARMACY; GREAT RIVER HEALTH SYSTEM-HERITAGE PARTNERS PHARMACY; GREAT RIVER HEALTH SYSTEM-KEOKUK; GREAT RIVER HEALTH SYSTEM-MEDIAPOLIS; GREAT RIVER HEALTH SYSTEM-MEDICINE SPECIALISTS; GREAT RIVER HEALTH SYSTEM-MENTAL HEALTH; GREAT RIVER HEALTH SYSTEM-NEPHROLOGY; GREAT RIVER HEALTH SYSTEM-ORTHOPAEDIC SPECIALISTS; GREAT RIVER HEALTH SYSTEM-PULMONOLOGY; GREAT RIVER HEALTH SYSTEM-QUICK CARE; GREAT RIVER HEALTH SYSTEM-SURGEONS; GREAT RIVER HEALTH SYSTEM-UROLOGY; GREAT RIVER HEALTH SYSTEM-WAPELLO; GREAT RIVER HEALTH SYSTEM-WEST POINT; GREAT RIVER HEALTH SYSTEM-WOMEN'S HEALTH; GREAT RIVER HEALTH SYSTEM-WOUND AND HYPERBARIC; SOUTHEASTERN RENAL DIALYSIS.

Operating expenses	$ 516,694,156
Total amount spent on community benefits as % of operating expenses	$ 26,954,897 5.22 %