efile Public Visual Render
ObjectId: 201411349349300816 - Submission: 2014-05-14
TIN: 56-2276994
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public Inspection
Name of the organization
DAVIE COUNTY EMERGENCY HEALTH CORPORATION
Employer identification number
56-2276994
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a
...
1a
Yes
b
If "Yes," was it a written policy?
.......................
1b
Yes
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
Applied uniformly to all hospital facilities
Applied uniformly to most hospital facilities
Generally tailored to individual hospital facilities
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines
(FPG)
as a factor in determining eligibility for providing
free
care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for
free
care:
3a
Yes
100%
150%
200%
Other
%
b
Did the organization use FPG as a factor in determining eligibility for providing
discounted
care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care:
.........
3b
Yes
200%
250%
300%
350%
400%
Other
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based
criteria for determining eligibility for free or discounted care. Include in the description whether the organization
used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or
discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"?
..............
4
Yes
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year?
............................
5a
Yes
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?
......
5b
Yes
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?
..............
5c
No
6a
Did the organization prepare a community benefit report during the tax year?
..........
6a
Yes
b
If "Yes," did the organization make it available to the public?
..............
6b
Yes
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a)
Number of activities or programs (optional)
(b)
Persons served (optional)
(c)
Total community benefit expense
(d)
Direct offsetting revenue
(e)
Net community benefit expense
(f)
Percent of total expense
a
Financial Assistance at cost
(from Worksheet 1)
..
337,099
337,099
3.430 %
b
Medicaid (from Worksheet 3,
column a)
....
1,452,576
906,646
545,930
5.560 %
c
Costs of other means-tested
government programs (from
Worksheet 3, column b)
.
d
Total
Financial Assistance
and Means-Tested
Government Programs
.
1,789,675
906,646
883,029
8.990 %
Other Benefits
1,587
1,587
0.020 %
e
Community health
improvement services and
community benefit operations
(from Worksheet 4)
..
f
Health professions education
(from Worksheet 5)
..
g
Subsidized health services
(from Worksheet 6)
..
h
Research (from Worksheet 7)
i
Cash and in-kind
contributions for community
benefit (from Worksheet 8)
100
100
0 %
j
Total.
Other Benefits
..
1,687
1,687
0.020 %
k
Total.
Add lines 7d and 7j
.
1,791,362
906,646
884,716
9.010 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50192T
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities
Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a)
Number of activities or programs (optional)
(b)
Persons served (optional)
(c)
Total community building expense
(d)
Direct offsetting
revenue
(e)
Net community building expense
(f)
Percent of total expense
1
Physical improvements and housing
2
Economic development
3
Community support
4
Environmental improvements
5
Leadership development and training for community members
6
Coalition building
7
Community health improvement advocacy
8
Workforce development
9
Other
10
Total
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15?
..........................
1
Yes
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount.
......
2
1,372,418
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit.
......
3
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME)
.....
5
2,628,166
6
Enter Medicare allowable costs of care relating to payments on line 5
.....
6
2,424,933
7
Subtract line 6 from line 5. This is the surplus (or shortfall)
........
7
203,233
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Cost accounting system
Cost to charge ratio
Other
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year?
..........
9a
Yes
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI
.......................
9b
Yes
Part IV
Management Companies and Joint Ventures
(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a)
Name of entity
(b)
Description of primary
activity of entity
(c)
Organization's
profit % or stock
ownership %
(d)
Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e)
Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part V
Facility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?
1
Name, address, and primary website address
Other (Describe)
Facility reporting group
1
WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA
223 HOSPITAL STREET
MOCKSVILLE
,
NC
27028
WWW.WAKEHEALTH.EDU/DAVIE-HOSPITAL
X
X
X
X
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part V
Facility Information
(continued)
Section B. Facility Policies and Practices
(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA
Name of hospital facility or facility reporting group
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)
1
Yes
No
Community Health Needs Assessment
(Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1
During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.
...................
1
Yes
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
A definition of the community served by the hospital facility
b
Demographics of the community
c
Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d
How data was obtained
e
The health needs of the community
f
Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g
The process for identifying and prioritizing community health needs and services to meet the community health needs
h
The process for consulting with persons representing the community’s interests
i
Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j
Other (describe in Part VI)
2
Indicate the tax year the hospital facility last conducted a CHNA: 20
12
3
In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted
....................
3
Yes
4
Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI
................................
4
No
5
Did the hospital facility make its CHNA report widely available to the public?
.............
5
Yes
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
Hospital facility’s website
b
Available upon request from the hospital facility
c
Other (describe in Part VI)
6
If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA
b
Execution of the implementation strategy
c
Participation in the development of a community-wide plan
d
Participation in the execution of a community-wide plan
e
Inclusion of a community benefit section in operational plans
f
Adoption of a budget for provision of services that address the needs identified in the CHNA
g
Prioritization of health needs in its community
h
Prioritization of services that the hospital facility will undertake to meet health needs in its community
i
Other (describe in Part VI)
7
Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs
........
7
Yes
8a
Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?
...........................
8a
No
b
If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax?
......
8b
c
If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part V
Facility Information
(continued)
Financial Assistance Policy
Yes
No
9
Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?
9
Yes
10
Used federal poverty guidelines (FPG) to determine eligibility for providing
free
care?
...........
10
Yes
If "Yes," indicate the FPG family income limit for eligibility for free care:
200.000000000000
%
If "No," explain in Part VI the criteria the hospital facility used.
11
Used FPG to determine eligibility for providing
discounted
care?
.................
11
Yes
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:
400.000000000000
%
If "No," explain in Part VI the criteria the hospital facility used.
12
Explained the basis for calculating amounts charged to patients?
.................
12
Yes
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
Income level
b
Asset level
c
Medical indigency
d
Insurance status
e
Uninsured discount
f
Medicaid/Medicare
g
State regulation
h
Other (describe in Part VI)
13
Explained the method for applying for financial assistance?
...................
13
Yes
14
Included measures to publicize the policy within the community served by the hospital facility?
.......
14
Yes
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
The policy was posted on the hospital facility’s website
b
The policy was attached to billing invoices
c
The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d
The policy was posted in the hospital facility’s admissions offices
e
The policy was provided, in writing, to patients on admission to the hospital facility
f
The policy was available upon request
g
Other (describe in Part VI)
Billing and Collections
15
Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?
.......
15
Yes
16
Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
Reporting to credit agency
b
Lawsuits
c
Liens on residences
d
Body attachments
e
Other similar actions (describe in Part VI)
17
Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?
..........
17
No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
Reporting to credit agency
b
Lawsuits
c
Liens on residences
d
Body attachments
e
Other similar actions (describe in Part VI)
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part V
Facility Information
(continued)
18
Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
Notified individuals of the financial assistance policy on admission
b
Notified individuals of the financial assistance policy prior to discharge
c
Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills
d
Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e
Other (describe in Part VI)
Policy Relating to Emergency Medical Care
Yes
No
19
Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?
..........
19
Yes
If “No,” indicate why:
a
The hospital facility did not provide care for any emergency medical conditions
b
The hospital facility’s policy was not in writing
c
The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d
Other (describe in Part VI)
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20
Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b
The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c
The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d
Other (describe in Part VI)
21
During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?
............................
21
No
If “Yes,” explain in Part VI.
22
During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual?
.........................
22
No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part V
Facility Information
(continued)
Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?
Name and address
Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1
Required descriptions.
Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2
Needs assessment.
Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3
Patient education of eligibility for assistance.
Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4
Community information.
Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5
Promotion of community health.
Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6
Affiliated health care system.
If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7
State filing of community benefit report.
If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8
Facility reporting group(s).
If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier
ReturnReference
Explanation
PART I, LINE 3C: THE ORGANIZATION ALSO EVALUATES CERTAIN CREDIT FILE DATA ELEMENTS TO INDENTIFY POTENTIAL SOURCES OF HIDDEN INCOME TO MORE ACCURATELY INFORM CHARITY CARE ELIGIBILITY ASSESSMENTS. PATIENTS WITH ESTIMATED HOUSEHOLD INCOME BELOW 200% OF FPG, WHO ARE IDENTIFIED AS HAVING COMMERICAL CREDIT ACCOUNTS THAT ARE BEING SERVICED IN A MANNER THAT SUGGESTS ADDITIONAL SOURCES OF INCOME, ARE NOT AUTOMATICALLY GRANTED PRESUMPTIVE CHARITY CARE.
PART I, LINE 7: THE ORGANIZATION USED THE WORKSHEETS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H TO COMPUTE ITS COST TO CHARGE RATIO FOR PURPOSES OF THE 2012 SCHEDULE H.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2538012.
PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A DISCRETE FOOTNOTE EXPLAINING BAD DEBT EXPENSE. BAD DEBT HAS NOT BEEN INCLUDED IN THE COMPUTATION OF COMMUNITY BENEFIT ON PART I, LINE 7. THE ORGANIZATION HAS A THOROUGH PROCESS OF EVALUATING BAD DEBT ACCOUNTS AS INFORMATION BECOMES AVAILABLE AND RECLASSIFIES BAD DEBT ACCOUNTS AS CHARITY CARE AS PROVIDED BY THE CHARITY CARE POLICY. AMOUNTS USED TO COMPUTE CHARITY CARE AND BAD DEBT ON SCHEDULE H USE THE MOST CURRENT DATA AVAILABLE AT THE TIME OF FILING. THE ORGANIZATION USED WORKSHEET 2 OF THE 2012 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST TO CHARGES RATIO USED TO CALCULATE BAD DEBT AT COST.
PART III, LINE 8: DAVIE HOSPITAL IS A CRITIAL ACCESS HOSPITAL AND IS REIMBURSED 100% TO 101% OF MEDICARE COSTS.
PART III, LINE 9B: PATIENT FINANCIAL RESOURCES SERVICES WORKS WITH THE PATIENT FOR ANY PATIENT LIABILITY. OUR MAIN FOCUS IS PRIOR TO SERVICES AND/OR DISCHARGE; HOWEVER, WE DO WORK WITH PATIENTS AFTER SERVICES HAVE BEEN RECEIVED AND BILLED. PATIENT FINANCIAL RESOURCES SERVICES IS REALLY TWO AREAS IN ONE--THE RESOURCE RECOVERY SPECIALIST/RRS (FORMERLY FINANCIAL COUNSELING) AND THE MEDICAID ELIGIBILITY TEAM/MPS. THESE TWO AREAS WORK TOGETHER TO FIND A RESOLUTION TO PATIENT LIABILITY, SELF PAY OR INSURED. THE RRS WORKS TO NOTIFY THE PATIENT OF ANY PATIENT LIABILITY AND ASK FOR PAYMENT FOR THAT LIABILITY. IF THE PATIENT INDICATES THAT HE/SHE NEEDS ASSISTANCE, THEN THE RRS WILL COMPLETE A FINANCIAL STATEMENT ON THE PATIENT. WHILE TAKING THAT FINANCIAL STATEMENT THE RRS IS LOOKING FOR INFORMATION THAT COULD QUALIFY THE PATIENT FOR MEDICAID OR FOR OTHER AGENCY PROGRAMS THAT ARE AVAILABLE TO THE MEDICAL CENTER. WHEN THAT INFORMATION IS IDENTIFIED THE RRS WILL LET THE PATIENT KNOW THAT A REFERRAL WILL BE MADE FOR MEDICAID OR OTHER ASSISTANCE AND A MPS WILL BE IN TOUCH WITH HIM/HER. THE RRS ALSO EXPLAINS TO THE PATIENT OR FAMILY THAT CHARITY CARE IS A LAST RESORT AND THEY MUST COOPERATE WITH ANY OTHER ASSISTANCE PROGRAMS THAT WE HAVE IDENTIFIED AND BE FOUND INELIGIBLE BEFORE CHARITY CARE WILL BE APPROVED/APPLIED. IT IS ALSO COMMUNICATED WITH THE PATIENT OR FAMILY IS INFORMED IF ANY SUPPORTING DOCUMENTATION IS NEEDED FOR ANY ASSISTANCE, WHETHER THAT BE CHARITY, MEDICAID, OR OTHER PROGRAMS.
WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA
PART V, SECTION B, LINE 3: THE COMMUNITY'S PERSPECTIVE WAS OBTAINED THROUGH A THIRTY QUESTION COMMUNITY SURVEY DISTRIBUTED TO DAVIE COUNTY RESIDENTS VIA SURVEY MONKEY. OVER 500 RESPONSES WERE RECEIVED, INCLUDING THOSE FROM A STOREHOUSE FOR JESUS (SHFJ). SHFJ SERVES WORKING POOR FAMILIES, FAMILIES WITHOUT INCOME, SINGLE PARENT FAMILIES, FAMILES AFFECTED BY ILLNESS, ELDERLY, DOMESTIC VIOLENCE FAMILIES AND THE HOMELESS/TRANSIENT POPULATION OF DAVIE COUNTY. THE HOSPITAL ALSO WORKED WITH PUBLIC HEALTH EXPERTS FROM THE DAVIE COUNTY HEALTH DEPARTMENT TO CONDUCT THE CHNA.
WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA
PART V, SECTION B, LINE 5C: THE HOSPITAL'S CHNA AND CHNA IMPLEMENTATION STRATEGY CAN BE FOUND AT WWW.WAKEHEALTH.EDU/DAVIE-MEDICAL-CENTER/ABOUT/COMMUNITY-BENEFITS/COMMUNITY-BENEFITS.HTM.
WAKE FOREST BAPTIST HEALTH-DAVIE HOSPITA
PART V, SECTION B, LINE 14G: IF PATIENTS WERE IDENTIFIED AS A "STOREHOUSE FOR JESUS" PATIENT, THE FINANCE DEPARTMENT WOULD MAIL AN APPLICATION TO THE PATIENT IF THERE WAS NO APPLICATION ON FILE.
PART VI, LINE 2: THE BOARD OF TRUSTEES APPROVED THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT ON MAY 7, 2013. A COMMUNITY WIDE TEAM COMPRISED OF THE DAVIE COUNTY HEALTH DEPARTMENT, THE HOSPITAL, UNITED WAY, STOREHOUSE FOR JESUS, THE YMCA AND OTHER COMMUNITY GROUPS, THE DAVIE COUNTY GOVERNMENT AND OTHERS CONVENED TO CONDUCT A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT WITH INPUT FROM COUNTY HEALTH EXPERTS, KEY COMMUNITY LEADERS AND THE PUBLIC (THROUGH SURVEYS). THE HOSPITAL ALSO PARTICIPATES IN A WIDE VARIETY OF LOCAL COALITIONS, INCLUDING SEVERAL SPONSORED BY THE DAVIE COUNTY HEALTH DEPARTMENT - CHRONIC DISEASE COMMITTEE AND THE COUNTY WELLNESS COMMITTEE, AS WELL AS PARTNERSHIPS AND SPONSORSHIPS WITH MANY COMMUNITY BASED ORGANIZATIONS.
PART VI, LINE 3: THE ORGANIZATION USES A VARIETY OF MEANS TO EDUCATE AND INFORM PATIENTS OF THEIR CHARITY CARE OPTIONS, INCLUDING INFORMATION ON A WEBSITE, BILLING PAMPHLETS AVAILABLE IN CLINICAL OFFICES AND THE BUSINESS OFFICE, SIGNS IN CHECK-IN AREAS, INFORMATION ON PATIENT BILL STATEMENTS, AND FROM STAFF MEMBERS DURING CONVERSATIONS CONCERNING A PATIENT'S LIABILITY FOR SERVICES. THE HOSPITAL EMPLOYS A ROBUST PRE-SERVICE FINANCIAL CLEARANCE PROCESS THAT SCREENS PATIENTS PRIOR TO SERVICE DELIVERY FOR EXISTING OR AVAILABLE PAYER SOURCES AS A MEANS OF AVOIDING BAD DEBT AND INAPPROPRIATE BILLING TO PATIENTS WITHOUT THE MEANS TO PAY. IF A PAYER SOURCE IS IDENTIFIED, HOSPITAL STAFF ASSIST THE PATIENT WITH ENROLLMENT.
PART VI, LINE 4: DAVIE HOSPITAL IS A CRITICAL ACCESS HOSPITAL SERVING DAVIE COUNTY, NORTH CAROLINA AND THE SURROUNDING AREAS. THE HOSPITAL IS THE ONLY ONE LOCATED IN THE COUNTY. THE POPULATION OF DAVIE COUNTY IS APPROXIMATELY 42,000 ACCORDING TO THE U.S. CENSUS BUREAU. 11.7 % OF THE POPULATION IS AT OR BELOW THE POVERTY LEVEL. 87.5% OF THE POPULATION IS WHITE, 6.3% IS AFRICAN AMERICAN, AND 6.2% IS OTHER DEMOGRAPHICS. THE UNEMPLOYMENT RATE IN MARCH 2011 WAS 9.7%. THE MEDIAN INCOME IS $59,503. THE GROWTH RATE OF THE COMMUNITY IS 1.9%.
PART VI, LINE 5: HOSPITAL REPRESENTATIVES ATTEND NUMEROUS HEALTH FAIRS AND PERFORM CHOLESTROL SCREENING CHECKS. THE HOSPITAL ALSO INVITES THE COMMUNITY TO ATTEND ITS LADIES' NIGHT OUT EVENT TO PROMOTE BREAST HEALTH AND BREAST CANCER AWARENESS. THE HOSPITAL IS INVOLVED WITH THE LOCAL SENIOR CENTER AND PROVIDES HEALTH EDUCATION ON VARIOUS TOPICS THROUGH OUT THE YEAR. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO ALL OF ITS DEPARTMENTS.
PART VI, LINE 6: THE MEMBER OF THE ORGANIZATION IS NORTH CAROLINA BAPTIST HOSPITAL.
REPORTS FILED WITH STATES
PART VI, LINE 7
NC
Schedule H (Form 990) 2012
Additional Data
Software ID:
Software Version: