SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MARTHA JEFFERSON HOSPITAL
 
Employer identification number

54-0261840
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.
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
 
%
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
 
%
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 discountedcare 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) . . .
    7,259,952   7,259,952 3.110 %
b Medicaid (from Worksheet 3, column a) . . . . .     9,679,026 7,252,137 2,426,889 1.040 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     16,938,978 7,252,137 9,686,841 4.150 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     1,087,069   1,087,069 0.470 %
f Health professions education (from Worksheet 5) . . .     607,942 195,922 412,020 0.180 %
g Subsidized health services (from Worksheet 6) . . . .     21,522,464 12,150,711 9,371,753 4.020 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     211,937   211,937 0.090 %
j Total. Other Benefits . .     23,429,412 12,346,633 11,082,779 4.760 %
k Total. Add lines 7d and 7j .     40,368,390 19,598,770 20,769,620 8.910 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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     2,521   2,521 0 %
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     2,521   2,521  
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
9,448,638
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
3,140,108
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
67,470,634
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
81,565,617
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-14,094,983
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:
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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility 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, primary website address, and state license number
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 MARTHA JEFFERSON HOSPITAL
500 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE,VA22911
H1872
X X         X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility 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)
MARTHA JEFFERSON HOSPITAL
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility 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
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests 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 Yes  
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
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
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   No
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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility 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: 300.000000000000%
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
b
c
d
e
f
g
h
i
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
b
c
d
e
f
g
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 individual’s eligibility under the facility’s FAP:
a
b
c
d
e
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 individual’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
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility 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
b
c
d
e
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
b
c
d
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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual 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 individual an amount equal to the gross charge for any service provided to that individual?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 3: MARTHA JEFFERSON HOSPITAL (MJH) PARTICIPATED WITH THE THOMAS JEFFERSON HEALTH DEPARTMENT IN A COLLABORATIVE EFFORT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT OF THE SIX LOCALITIES (CHARLOTTESVILLE/ALBEMARLE, FLUVANNA, GREENE, LOUISA, NELSON) IN THE HEALTH DISTRICT. THESE LOCALITIES ARE CONSIDERED MJH'S SERVICE AREA, ACCOUNTING FOR APPROXIMATELY 84% OF MJH'S INPATIENTS. OTHER PARTICIPANTS IN THIS PROCESS INCLUDED THE UNIVERSITY OF VIRGINIA HEALTH SYSTEM, THE UNIVERSITY OF VIRGINIA SCHOOL OF PUBLIC HEALTH, THE AREA AGENCY ON AGING, THE UNITED WAY, THE AREA FREE CLINIC, THE PLANNING DISTRICT COMMISSION, THE COOPERATIVE EXTENSION SERVICE, ETC. REGIONAL COUNTY INTERAGENCY COUNCILS WITH MJH REPRESENTATION WERE USED TO COLLECT EXISTING HEALTH DATA, COMMUNITY MEMBER SURVEYS, AND KEY STAKEHOLDER FOCUS GROUPS TO CREATE THE ASSESSMENT AND PLAN. THE PROCESS TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.
MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 4: THE CHNA OF MARTHA JEFFERSON HOSPITAL WAS CONDUCTED WITH UNIVERSITY OF VIRGINIA HEALTH SYSTEM/MEDICAL CENTER.
MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 5D: A COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT THE HOSPITAL FACILITY.A LINK TO THE HOSPITAL FACILITY'S COMMUNITY HEALTH NEEDS ASSESSMENT IS ON THE HOSPITAL FACILITY'S WEBSITE: HTTP://WWW.MARTHAJEFFERSON.ORG/MJH/ABOUT-OUTREACH-REPORTS.ASPXA LINK TO THE HOSPITAL FACILITY'S COMMUNITY HEALTH NEEDS ASSESSMENT IS ALSO ON THE SENTARA HEALTHCARE WEBSITE: HTTP://WWW.SENTARA.COM/SENTARA-HEALTCARE/ABOUT/PAGES/COMMUNITY-HEALTH- NEEDS-ASSESSMENT.ASPX#.UYX4QYXDWTA
MARTHA JEFFERSON HOSPITAL PART V, SECTION B, LINE 7: TO SELECT COMMUNITY HEALTH NEEDS ASSESSMENT PRIORITIES, THE HANLON MODEL WAS USED TO RATE THE MAGNITUDE AND SERIOUSNESS OF THE HEALTH ISSUES AND THE FEASIBILITY OF ADDRESSING THEM AT THE LOCAL LEVEL. HOSPITAL AND OTHER PARTICIPANTS RECOGNIZED THAT RESOURCES NEEDED TO BE DIRECTED TO THE HIGHEST PRIORITY HEALTH PROBLEMS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. 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?21
Name and address Type of Facility (describe)
1 MARTHA JEFFERSON OUTPATIENT CARE CENTER
595 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE,VA22911
DIAGNOSTIC CENTER
2 MARTHA JEFFERSON HEALTH SERVICES
3263 PROFFIT ROAD
CHARLOTTESVILLE,VA22902
DIAGNOSTIC CENTER
3 MJ SURGICAL ASSOCIATES
500 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE,VA22911
PHYSICIAN CLINIC
4 MARTHA JEFFERSON SLEEP CENTER
1793 RICHMOND ROAD
CHARLOTTESVILLE,VA22911
DIAGNOSTIC CENTER
5 FOREST LAKES FAMILY MEDICINE
3263 PROFFIT ROAD SUITE 101
CHARLOTTESVILLE,VA22911
PHYSICIAN CLINIC
6 MJ ORTHOPAEDICS
590 PETER JEFFERSON PARKWAY SUITE
100
CHARLOTTESVILLE,VA229034896
PHYSICIAN CLINIC
7 GREENE FAMILY MEDICINE
140 STONERIDGE DRIVE S SUITE 100
RUCKERSVILLE,VA229683096
PHYSICIAN CLINIC
8 PALMYRA MEDICAL ASSOCIATES
17 CENTRE COURT
PALMYRA,VA229632330
PHYSICIAN CLINIC
9 CROZET FAMILY MEDICINE
1646 PARK RIDGE DRIVE
CROZET,VA229323155
PHYSICIAN CLINIC
10 BLUE RIDGE INTERNAL MEDICINE
310 OLD IVY WAY SUITE 201
CHARLOTTESVILLE,VA229034896
PHYSICIAN CLINIC
11 MJ INTERNAL MEDICINE
590 PETER JEFFERSON PARKWAY SUITE
100
CHARLOTTESVILLE,VA22911
PHYSICIAN CLINIC
12 AFTON FAMILY MEDICINE
10950 ROCKFISH VALLEY HWY
AFTON,VA229203203
PHYSICIAN CLINIC
13 MJ AESTHETIC & RECONSTRUCTIVE SURGERY
600 PETER JEFFERSON PARKWAY
CHARLOTTESVILLE,VA229118837
PHYSICIAN CLINIC
14 BUCKINGHAM FAMILY MEDICINE
65 BRICKYARD ROAD
DILLWYN,VA229360030
PHYSICIAN CLINIC
15 MJ MEDICAL ONCOLOGY ASSOCIATES
500 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE,VA22911
PHYSICIAN CLINIC
16 MADISON FAMILY MEDICINE
2503 SOUTH SEMINOLE TRAIL
MADISON,VA227272690
PHYSICIAN CLINIC
17 MARTHA JEFFERSON NEUROSCIENCES
595 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE,VA22911
PHYSICIAN CLINIC
18 WOUND CARE AT MARTHA JEFFERSON
1490 PANTOPS MOUNTAIN PLACE
CHARLOTTESVILLE,VA22911
WOUND CENTER
19 MJ SPRING CREEK
29 JEFFERSON COURT
GORDONSVILLE,VA22942
PHYSICIAN CLINIC
20 MJH IVF LAB
595 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE,VA22911
FERTILITY LABORATORY
21 THE SOMETHING SPECIAL SHOP
500 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE,VA22911
DME
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT WAS CONTAINED IN A SYSTEM-WIDE REPORT PREPARED BY SENTARA HEALTHCARE, EIN 52-1271901, THE ORGANIZATION'S 501(C)(3) SOLE MEMBER.
PART I, LINE 7: A COMBINATION OF A RATIO OF COSTS TO CHARGES AND A COST ACCOUNTING PROCESS WHICH ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICARE, MEDICAID, UNINSURED AND SELF PAY) WAS USED TO DETERMINE ALL AMOUNTS REPORTED ON LINE 7.
PART I, LINE 7G: INCLUDES PRIMARY CARE PRACTICES COSTS OF $9,371,753.
PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE SUBTRACTED FROM THE DENOMINATOR WHEN CALCULATING COLUMN F PERCENTAGES IS $9,448,638.
PART II, COMMUNITY BUILDING ACTIVITIES: WE OFFER A VARIETY OF COMMUNITY BUILDING ACTIVITIES INCLUDING THOSE DESIGNED TO HELP MEET THE BASIC NEEDS OF OUR COMMUNITY SUCH AS FOOD DRIVES AND OUR SHOES FOR THE HOMELESS ANNUAL CAMPAIGN. WE OFFER AN ANNUAL CELEBRATION OF LIFE EVENT FOR CANCER SURVIVORS TO GIVE THEM THE OPPORTUNITY TO INTERACT WITH THE PHYSICIANS AND STAFF WHO WERE RESPONSIBLE FOR THEIR CARE. OVER THE PAST SEVERAL YEARS, WE HAVE HAD ANNUAL UNWANTED MEDICATION AND SHARPS DROP-OFF EVENTS. WE HAVE STEADILY INCREASED THE AMOUNT OF MEDICATIONS AND SHARPS WE ARE TAKING OUT OF HOMES IN OUR COMMUNITY AT EACH EVENT.
PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AT ESTABLISHED RATES IN ACCORDANCE WITH THE ORGANIZATION'S BOOKS AND RECORDS. BAD DEBT EXPENSE IS REPORTED NET OF ANY DISCOUNTS OR COLLECTIONS ON ACCOUNTS THAT WERE PREVIOUSLY WRITTENOFF (I.E.: BAD DEBT WRITE-OFFS MINUS DISCOUNTS MINUS PAYMENTS RECEIVED.)
PART III, LINE 3: IN COMPUTING LINE 3, THE ORGANIZATION REVIEWED ALL ACCOUNTS WRITTEN-OFF TO BAD DEBT FOR EMPLOYMENT HISTORY, PREVIOUS ELIGIBILITY FOR MEDICAID, INSURANCE PAYMENTS, REGISTRATION WITH INSURANCE, BANKRUPTCY AND COMPLIANCE TO INTERNAL CHARITY POLICIES.
PART III, LINE 4: SEE PAGE 17 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTE WHICH DISCUSSES BAD DEBT.
PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE THE MEDICARE COSTS REPORTED ON LINE 6. MEDICARE MARGINS HAVE BEEN DECLINING AT THE SAME TIME THAT HOSPITALS HAVE BEEN ENGAGED IN CONCERTED EFFORTS TO IMPROVE EFFICIENCY, WHICH POINTS TO THE FACT THAT THE LOSSES ARE MOST LIKELY THE RESULT OF INADEQUATE REIMBURSEMENT BY THE FEDERAL GOVERNMENT, THUS, SHOULD BE INCLUDED IN COMMUNITY BENEFIT.
PART III, LINE 9B: COLLECTION PRACTICES ARE GEARED TOWARDS PATIENTS THAT HAVE A HIGH PROBABILITY OF BEING ABLE TO PAY FOR SERVICES BASED ON INCOME LEVEL AND INELIGIBILITY FOR CHARITY PROGRAMS. IT IS THE POLICY OF MARTHA JEFFERSON HOSPITAL TO REVIEW ACCOUNTS TO ENSURE ALL POSSIBLE METHODS OF PAYMENT HAVE BEEN EXHAUSTED, I.E. MEDICAL ASSISTANCE, FINANCIAL ASSISTANCE, PAYMENT PLANS AND SELF-PAY DISCOUNTS, PRIOR TO AN ACCOUNT BEING DEEMED AS "BAD DEBT". THE ORGANIZATION PERFORMS INTERNAL BAD DEBT COLLECTION FUNCTIONS AND USES OUTSIDE COLLECTION AGENCIES ON A SECOND PLACEMENT BASIS. THE ORGANIZATION DETERMINES WHICH PATIENTS ARE SENT TO OUTSIDE AGENCIES AND GUIDES THE AGENCIES IN PERFORMING REASONABLE COLLECTION EFFORTS.
PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF ITS COMMUNITIES THROUGH THESE MEANS:- ANALYSIS OF AREA SOCIODEMOGRAPHIC AND HEALTH STATUS DATA: THE ANALYSIS FOCUSES ON IDENTIFICATION OF HEALTH CARE NEEDS FOR PLANNING AND DEVELOPMENT OF HEALTH SERVICES AND PROGRAMS. THIS ANALYSIS IS UTILIZED FOR EDUCATION OF BOARD MEMBERS AND SENIOR HOSPITAL AND MEDICAL STAFF LEADERS AND IS INCORPORATED INTO THE ORGANIZATION'S STRATEGIC PLANS.- OBTAINING INPUT FROM KEY STAKEHOLDERS AND THE PUBLIC HEALTH COMMUNTIY: IN ADDITION TO THE ANALYSIS OF SOCIODEMOGRAPHIC AND HEALTH STATUS DATA, ADDITIONAL INFORMATION IS OBTAINED AND ANALYZED. THIS INCLUDES SURVEYS OF KEY COMMUNITY STAKEHOLDERS, INPUT FROM THE LOCAL PUBLIC HEALTH COMMUNITY, AND OTHER INFORMATION - ANLAYSIS OF HEALTH CARE UTILIZATION PATTERNS AND TRENDS, FOR EXAMPLE. - REVIEW OF HEALTH CARE NEEDS ASSESSMENTS AND DATA DEVELOPED BY COMMUNITY PARTNERS (SUCH AS STATE HEALTH DEPARTMENTS AND LOCAL HEALTH DISTRICTS), REGIONAL AGENCIES (SUCH AS THE PLANNING COUNCIL OR PLANNING DISTRICT COMMISSION), NATIONAL ORGANIZATIONS WHICH REPORT ON A LOCAL BASIS (SUCH AS COUNTY HEALTH RANKINGS), AND INFORMATION REPORTED IN LOCAL MEDIA: THIS INFORMATION IS STUDIED AND INCORPORATED INTO THE ORGANIZATION'S PLANS.- DEVELOPMENT OF COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION PLANS: INCORPORATING THE INFORMATION DESCRIBED ABOVE, THE HOSPITAL UNDERTAKES A REVIEW AND PRIORITIZATION PROCESS TO IDENTIFY KEY HEALTH PROBLEMS AND TO DEVELOP IMPLEMENTATION STRATEGIES.- PARTICIPATION IN COLLABORATIVE HEALTH PLANNING AND NEEDS ASSESSMENT ACTIVITIES SUCH AS THOSE SPONSORED BY LOCAL HEALTH DISTRICTS (MAPP - MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) AND OTHER ORGRANIZATIONS SUCH AS UNITED WAY AND ACCESS PARTNERSHIP: INFORMATION GATHERED THROUGH THESE ACTIVITIES IS INCORPORATED INTO THE ORGANIZATION'S PLANNING.- INFORMATION AND INPUT FROM PATIENTS AND CARE PROVIDERS: PATIENT CHARACTERISTICS AND TRENDS ARE REVIEWED TO ASSIST IN IDENTIFYING NEW COMMUNITY NEEDS. INPUT FROM PATIENTS AND CARE PROVDIERS IS SOUGHT AND CYCLED INTO THE ASSESSMENT PHASE OF PROJECTS.
PART VI, LINE 3: THE HOSPITAL PROVIDES PAMPHLETS AT REGISTRATION AREAS, PAYMENT AREAS AND WAITING ROOMS DESCRIBING THE HOSPITAL'S BILLING PROCESS AND FINANCIAL ASSISTANCE. IN ADDITION, INFORMATION IS AVAILABLE ON THE HOSPITAL'S WEBSITE DISCUSSING ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE, THE FULL FINANCIAL ASSISTANCE POLICY, AS WELL AS INFORMATION ON THE APPLICATION PROCESS. FINANCIAL COUNSELORS AT THE HOSPITAL MAY REACH OUT TO PATIENTS TO DETERMINE IF THEY WOULD LIKE TO APPLY FOR ASSISTANCE, WHICH APPLICATION MAY BE MADE PRIOR TO, DURING OR SUBSEQUENT TO RECEIVING SERVICES.
PART VI, LINE 4: MARTHA JEFFERSON HOSPITAL SERVES THE THOMAS JEFFERSON AREA PLANNING DISTRICT (PD10), INCLUDING THE CITY OF CHARLOTTESVILLE, AND THE COUNTIES OF ALBEMARLE, FLUVANNA, GREENE, LOUISA, AND NELSON, ALL OF WHICH ARE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS. THIS DISTRICT INCLUDES URBAN, RURAL AND SUBURBAN GEOGRAPHIC AREAS. PD10 CONSISTS OF APPROXIMATELY 230,000 PEOPLE (U.S. CENSUS BUREAU 2009), WITH ALBEMARLE COUNTY BY FAR THE MOST HIGHLY POPULATED AREA, DISTANTLY FOLLOWED BY THE CITY OF CHARLOTTESVILLE AND THE OTHER COUNTIES. IN GENERAL, THE PLANNING DISTRICT IS GROWING IN POPULATION, WITH AN INCREASE OF OVER 30,000 PEOPLE FROM 2000-2009 (U.S. CENSUS BUREAU 2009). APPROXIMATELY 75 PERCENT OF CITY RESIDENTS AND 90 PERCENT OF ALBEMARLE COUNTY RESIDENTS LIVE ABOVE THE FEDERAL POVERTY LEVEL, WITH CHILDREN BEING THE MOST AFFECTED GROUP BY AGE OF PERSONS LIVING IN POVERTY. WHILE ABOUT 10 PERCENT OF CITY HOUSEHOLDS RECEIVE ASSISTANCE THROUGH FOOD STAMPS, OVER 50 PERCENT OF CITY SCHOOL CHILDREN QUALIFY FOR FREE OR REDUCED-COST LUNCH PROGRAMS (2008 CITY OF CHARLOTTESVILLE/ALBEMARLE COUNTY COMMUNITY HEALTH STATUS ASSESSMENT). MEDICAID AND SELF PAY PATIENTS COMPRISE APPROXIMATELY 10% OF THE HOSPITAL'S PATIENTS. THE COMMUNITY IS SERVED BY TWO HOSPITALS.
PART VI, LINE 5: MARTHA JEFFERSON FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH WORKPLACE HEALTHY INITIATIVES, AN OPEN MEDICAL STAFF, BOARDS OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS, CHARITY CARE POLICIES AND OUTREACH, AND USE OF SURPLUS FUND DISPERSAL. WORKFORCE DEVELOPMENT PROGRAMS CONTINUE AS DOES OUR SUPPORT OF ORGANIZATIONS CHAMPIONING CHILD DENTAL, INDIGENT PRESCRIPTION DRUG, COMMUNITY MENTAL HEALTH SERVICES AND FREE CLINIC ACCESS EFFORTS.MARTHA JEFFERSON HOSPITAL STAFF SERVE ON COMMITTEES AND BOARDS RELATED TO COMMUNITY HEALTH INCLUDING THE CHARLOTTESVILLE FREE CLINIC, JEFFERSON AREA BOARD FOR AGING, THE SENIOR CENTER, THE CHARLOTTESVILLE OBESITY TASK FORCE, HOSPICE OF THE PIEDMONT, AND THE WOMEN'S INITIATIVE. PARTNERSHIPS ARE IMPORTANT TO US. WE PARTNER WITH ORGANIZATIONS THAT HAVE A TRACK RECORD OF IMPROVING HEALTH IN OUR COMMUNITY INCLUDING BUT NOT LIMITED TO THE CHARLOTTESVILLE FREE CLINIC, GREENE FREE CLINIC, CHARLOTTESVILLE/ALBEMARLE RESCUE SQUAD, THE UNITED WAY, AND THE WOMEN'S INITIATIVE (MENTAL HEALTH SERVICES). WE MAXIMIZE OUR REACH THROUGH FINANCIAL AND IN-KIND DONATIONS TO ORGANIZATIONS SUCH AS THE CHARLOTTESVILLE CITY SCHOOLS, HOSPICE OF THE PIEDMONT, JEFFERSON AREA BOARD FOR AGING AND HEAD START PROGRAMS IN SEVERAL SURROUNDING COUNTIES. OUR PARTNERSHIPS HELP BUILD AND STRENGTHEN EXISTING PROGRAMS, AS WELL AS LEADING TO THE DEVELOPMENT OF NEW PROGRAMS. OUR PARTNERSHIPS WITH OTHER NON-PROFITS IN THE COMMUNITY ALSO HELP US STAY ABREAST OF COMMUNITY NEEDS.MARTHA JEFFERSON HOSPITAL WELCOMES AND ENCOURAGES SIGNIFICANT COMMUNITY INVOLVEMENT THROUGH THE ESTABLISHMENT OF NUMEROUS GOVERNING COMMITTEES AND A COMMUNITY LEADERSHIP COUNCIL. THERE ARE 100 COMMUNITY MEMBERS ANNUALLY INVOLVED DIRECTLY WITH THESE COMMITTEES.MARTHA JEFFERSON HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF TO ALL WHO SEEK PRIVILEGES HERE. THERE ARE OVER 450 PHYSICIANS AND ALLIED STAFF ON THE MARTHA JEFFERSON HOSPITAL MEDICAL STAFF.MARTHA JEFFERSON HOSPITAL UTILIZES SURPLUS FUNDS TO PURCHASE MEDICAL EQUIPMENT AND FACILITIES DESIGNED TO MEET THE NEEDS OF THE COMMUNITY IT SERVES.
PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM ("SENTARA"). SENTARA, A NOT-FOR-PROFIT HEALTH SYSTEM, OPERATES MORE THAN 100 SITES OF CARE SERVING RESIDENTS ACROSS VIRGINIA AND NORTHEASTERN NORTH CAROLINA. THE SYSTEM IS COMPRISED OF 11 ACUTE CARE HOSPITALS, INCLUDING SEVEN IN HAMPTON ROADS, ONE IN NORTHERN VIRGINIA, TWO IN THE BLUE RIDGE REGION, AND ONE IN SOUTH CENTRAL VIRGINIA, ADVANCED IMAGING CENTERS, NURSING AND ASSISTED LIVING CENTERS, OUTPATIENT CAMPUSES, TWO HOME HEALTH AND HOSPICE AGENCIES, A 3,800-PROVIDER MEDICAL STAFF, AND FOUR MEDICAL GROUPS WITH OVER 600 PROVIDERS.THE ORGANIZATION'S AFFILIATION WITH SENTARA ENHANCES ITS ABILITY TO ACHIEVE BEST PRACTICES IN HEALTHCARE DELIVERY; ACQUIRE CUTTING EDGE TECHNOLOGY AND INTEGRATED INFORMATION SYSTEMS, AND PROVIDE A HIGHER LEVEL OF MEDICAL CARE TO VIRGINIA'S BLUE RIDGE REGION COMMUNITY. COMBINED, THESE ATTRIBUTES BETTER POSITION THE ORGANIZATION TO ADDRESS HEALTH CARE REFORM AND OTHER PROFOUND CHANGES AFFECTING THE HEALTHCARE ENVIRONMENT.
Schedule H (Form 990) 2013
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