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
ST VINCENT HEALTHCARE
 
Employer identification number

81-0232124
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
 
No
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
 
 
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) . . . 		    6,447,422   6,447,422 1.760 %
b Medicaid (from Worksheet 3, column a) . . . . .     30,278,682 22,579,223 7,699,459 2.100 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     36,726,104 22,579,223 14,146,881 3.860 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     2,241,950   2,241,950 0.610 %
f Health professions education (from Worksheet 5) . . .     186,380   186,380 0.050 %
g Subsidized health services (from Worksheet 6) . . . .     12,185,543 5,719,893 6,465,650 1.760 %
h Research (from Worksheet 7) .     134,259   134,259 0.040 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     3,728,971   3,728,971 1.020 %
j Total. Other Benefits . .     18,477,103 5,719,893 12,757,210 3.480 %
k Total. Add lines 7d and 7j .     55,203,207 28,299,116 26,904,091 7.340 %
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     0   0 0 %
2 Economic development     0   0 0 %
3 Community support     256,227   256,227 0.070 %
4 Environmental improvements     1,276   1,276 0 %
5 Leadership development and
training for community members		     0   0 0 %
6 Coalition building     2,474   2,474 0 %
7 Community health improvement advocacy     45,667   45,667 0.010 %
8 Workforce development     198   198 0 %
9 Other     0   0 0 %
10 Total     305,842   305,842 0.080 %
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
19,840,994
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
83,365,097
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
92,282,362
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-8,917,265
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 %
1ROCKY MTN HEALTH NET
  		PHO - PROVIDE ADMIN SERVICES 50.000 %   50.000 %
2ATHL MED & PERFORM
  		ATHLETIC MEDICINE/PERFORMANCE 33.330 %   47.410 %
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 St Vincent Healthcare
1233 N 30th Street
Billings,MT59107
www.svh-mt.org
13258 		X X   X     X   Durable Medical Eqp Outpatient Phy Clin  
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)
St Vincent Healthcare
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 11
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.%
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.%
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
FORM 990, SCHEDULE H, PART V, LINE 3 ST. VINCENT HEALTHCARE'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WAS RELEASED TO THE PUBLIC IN 2011. THE ASSESSMENT WAS SPONSORED BY THE ALLIANCE, AN AFFILIATED PARTNERSHIP CONSISTING OF THE CHIEF EXECUTIVE OFFICERS AND THEIR DESIGNEES FROM BILLINGS CLINIC, YELLOWSTONE CITY COUNTY HEALTH DEPARTMENT DBA RIVERSTONE HEALTH, AND ST. VINCENT HEALTHCARE. THE ALLIANCE WORKS COLLABORATIVELY ON COMMUNITY AND REGIONAL HEALTH INITIATIVES WITH THE MISSION OF IDENTIFYING COMMUNITY HEALTH NEEDS AND THEN DEFINING AND IMPLEMENTING EFFICIENT AND EFFECTIVE COMMUNITY SOLUTIONS THROUGH INTEGRATED ACTIONS. THEIR VISION STATES, 'TOGETHER WE IMPROVE THE HEALTH OF OUR COMMUNITY, ESPECIALLY THOSE WHO ARE UNDERSERVED AND MOST VULNERABLE, IN WAYS THAT SURPASS OUR INDIVIDUAL CAPACITY.' THE 2011 CHNA WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS, INC., AND INCLUDED FOCUS GROUPS WITH COMMUNITY LEADERS AND SURVEYS OF 400 COMMUNITY MEMBERS IN YELLOWNSTONE COUNTY USING THE RANDOM-DIGIT-DIALING METHOD. THE RESULTS OF THE SURVEY AND SUBSEQUENT COMMUNITY HEALTH IMPROVEMENT PLAN CAN BE ACCESSED AT WWW.HEALTHYBYDESIGNYELLOWSTONE.ORG. A NEW CHNA IS BEING COMPLETED FOR 2014.
Form 990, Schedule H, Part V, Line 4 THE ASSESSMENT WAS SPONSORED BY THE ALLIANCE, AN AFFILIATED PARTNERSHIP CONSISTING OF BILLINGS CLINIC, YELLOWSTONE CITY COUNTY HEALTH DEPARTMENT (DB A RIVERSTONE HEALTH), AND ST. VINCENT HEALTHCARE.
Form 990, Schedule H, Part V, Line 7 Following receipt of community feedback, three areas were chosen as the priority community health needs: a. Mental Health-- Trends that were identified as significant in mental health included suicide rates. The average number of suicides was 18.6 (per 100,000) in Yellowstone County compared to the U.S. average of 10.9 and the HP 2010 average of 5.0. b. Access to Healthcare Services-- The percent of Yellowstone County residents who had a routine medical checkup in the past year was 62.9% which does not meet the HP 2010 goal of 65.2%. c. Healthy Weight-- The third area of improvement was identified as healthy weight, concerning areas of nutrition, physical activity, and prevalence of overweight residents in Yellowstone County. The percentage of individuals with a healthy weight markedly decreased from 2005 to 2011. Overall, more than 7 in 10 Yellowstone County Adults (72.9%) are overweight. 26.0% of adults are obese, which fails to meet the HP 2010 target of 15% or less. Further study shows that respondents with lower incomes are more likely to be obese. Also of note is that only 15.6% of adults have been given advice about their weight by a doctor, nurse, or other health professional in the past year. This is lower than the national average. THE REMAINDER OF NEEDS IDENTIFIED IN THE 2011 CHNA IS IMPORTANT TO ST. VINCENT SO DUE TO LIMITED EXPERTISE AT THE HOSPITAL AND THE AVAILABILITY OF COMMUNITY ORGANIZATIONS, WHO ARE ALREADY ADDRESSING THE OTHER NEEDS, ST. VINCENT COLLABORATES WITH ITS COMMUNITY PARTNERS IDENTIFIED UNDER THE COMMUNITY ALLIANCE TO ENSURE ALL NEEDS AND HEALTH INDICATORS ARE BEING ADDRESSED.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
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?38
Name and address Type of Facility (describe)
1 INTERNAL MEDICINE ASSOCIATES
2900 12TH AVENUE NORTH SUITE 310 W
BILLINGS,MT591017588 		AMBULATORY CARE CLINIC
2 INTERNAL MEDICINE AND DIABETES
2019 BROADWATER AVENUE
BILLINGS,MT591024810 		AMBULATORY CARE CLINIC
3 WEST GRAND FAMILY MEDICINE
2750 GRAND AVENUE
BILLINGS,MT591022629 		AMBULATORY CARE CLINIC
4 YELLOWSTONE IMAGING AND BREAST CENTER
2900 12TH AVENUE NORTH SUITE 210 W
BILLINGS,MT59101 		AMBULATORY RADIOLOGY
5 HOME OXYGEN AND MEDICAL EQUIPMENT
1124 16TH STREET WEST
BILLINGS,MT591024152 		DURABLE MEDICAL EQUIPMENT
6 CARDIOVASCULAR AND THORACIC SURGERY
2900 12TH AVENUE NORTH SUITE 502E
BILLINGS,MT591017504 		AMBULATORY CARE OF PRE-POST OP CARDIAC, THORACIC, VASCULAR
7 LAUREL MEDICAL CENTER
1035 1ST AVENUE
LAUREL,MT590442119 		AMBULATORY CARE
8 OUTPATIENT REHABILITATION
2900 12TH AVENUE NORTH
BILLINGS,MT59101 		OUTPATIENT THERAPIES
9 HEIGHTS FAMILY PRACTICE
32 WICKS LANE
BILLINGS,MT59105 		AMBULATORY CARE
10 HARDIN MEDICAL CLINIC
16 NORTH MILES AVENUE
HARDIN,MT590342356 		AMBULATORY CARE
11 VASCULAR CLINIC
2900 12TH AVENUE NORTHSUITE 502E
BILLINGS,MT591017504 		VASCULAR CLINIC
12 YELLOWSTONE HEART CENTER
2900 12TH AVENUE NORTH SUITE 307W
BILLINGS,MT59101 		CARDIOLOGY CARE
13 NORTHERN ROCKIES REGIONAL PAIN CENTER
2900 12TH AVENUE NORTH SUITE 401 E
BILLINGS,MT591017506 		AMBULATORY PAIN MGMT AND CARE SERVICES
14 NEUROSCIENCE CENTER
2900 12TH AVENUE NORTH SUITE 400E
BILLINGS,MT591010136 		AMBULATORY CARE AND INFUSION SERVICES
15 SVH NEUROSURGERY
2900 12TH AVENUE NORTH SUITE 315 W
BILLINGS,MT59101 		AMBULATORY PRE AND POST OPERATIVE NEUROSURGICAL CARE
16 CENTER FOR HEALTHY LIVING
2223 MISSION WAY
BILLINGS,MT591020160 		AMBULATORY CARE
17 OCCUPATIONAL HEALTH
1027 NORTH 27TH STREET
BILLINGS,MT591010701 		AMBULATORY OCCUPATIONAL HEALTH
18 BROADWATER WALKIN CLINIC
2019 BROADWATER AVENUE
BILLINGS,MT591024810 		AMBULATORY CARE
19 PHYSICAL MEDICINE CLINIC
2900 12TH AVENUE NORTH SUITE 400 E
BILLINGS,MT591010136 		PHYSICAL MEDICINE REHAB
20 CANCER THERAPY CLINIC
1041 NORTH 29TH STREET
BILLINGS,MT591010700 		CANCER THERAPY CARE
21 ELIZABETH SETON PRENATAL CLINIC
1230 NORTH 30TH ST SUITE 100
BILLINGS,MT591010128 		PRENATAL CARE
22 SVH GASTROINTESTINAL CLINIC
1144 NORTH 28TH STREET SUITE C
BILLINGS,MT59101 		GASTROINTESTINAL CARE
23 MOUNTAIN VIEW CLINIC
10 ROBINSON LANE
RED LODGE,MT590680070 		AMBULATORY CARE
24 HOME HEALTH SPECIALITIES
2600 WILSON STREET
MILES CITY,MT59301 		DURABLE MEDICAL EQUIPMENT
25 BEHAVIORAL HEALTH ASSOCIATES
1101 NORTH 27TH STREET SUITE 201
BILLINGS,MT591010100 		AMBULATORY PYSCH AND COUNSELING SERVICES
26 WEIGHT MANAGEMENT CLINIC
1101 NORTH 27TH STREET SUITE 101
BILLINGS,MT591010100 		AMBULATORY CARE SERVICES RELATED TO WEIGHT LOSS
27 SISTER JOANNA BRUNER CLINIC
720 LINDSAY LANE SUITE A
CODY,WY824144103 		AMBULATORY CARE
28 ABSAROKEE MEDICAL CLINIC
55 NORTH MONTANA AVENUE
ABSAROKEE,MT590010425 		AMBULATORY CARE
29 PHYSICAL THERAPY WEST
14 AVANTA WAY
BILLINGS,MT59102 		PHYSICAL THERAPY CARE
30 SVH TRAUMATIC BRAIN INJURY
2900 12TH AVE NORTH SUITE 10W
BILLINGS,MT291010127 		TRAUMATIC BRAIN INJURY CARE
31 SVH NEUROLOGY
1233 NORTH 30 ST
BILLINGS,MT591010127 		NEUROLOGY CARE
32 RONALD MCDONALD CLINIC
1233 NORTH 30TH STREET
BILLINGS,MT591075200 		DENTAL AND MEDICAL CARE FOR LOW-INCOME PATIENTS
33 SVH PEDIATRIC SPECIALITY CLINICS
1230 NORTH 30TH STREET SUITE 100
BILLINGS,MT591020128 		AMBULATORY CARE
34 MATERNAL FETAL CLINIC
2900 12TH AVENUE NORTH SUITE 130W
BILLINGS,MT59101 		PERINATOLOGIST CARE
35 BIG HORN BASIN RADIATION ONCOLOGY CENTER
1025 9TH STREET
CODY,WY824143441 		RADIATION ONCOLOGY CARE
36 Ortho Trauma
1233 N 30th Street
billings,MT59101 		TRAUMA SERVICES
37 MOUNTAIN VIEW CLINIC
10 Robinson Ln
RED LODGE,MT59068 		AMBULATORY CARE
38 HARDIN CLINIC
16 N Miles Ave Ste 101
HARDIN,MT59034 		AMBULATORY CARE
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 7: THE COST TO CHARGE RATIO USED TO REPORT AMOUNTS IN FORM 990, SCHEDULE H, PART I, LINE 7 WERE DERIVED FROM WORKSHEET 2, IN THE SCHEDULE H, FORM 990 INSTRUCTIONS. 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 ON SCHEDULE H, PART I, LINE 7 COLUMN (F) IS $48,259,481. PART II: COMMUNITY BUILDING ACTIVITIES, THOSE THAT ENHANCE EXISTING EFFORTS OR FILL GAPS OF COMMUNITY NEED, INCLUDE PROGRAMS THAT SUPPORT THOSE IN THE COMMUNITY WHO ARE LIVING AT OR BELOW POVERTY. ST. VINCENT HEALTHCARE ADMINISTRATIVE LEADERSHIP AND ITS EMPLOYEES PERFORMED CIVIC ACTIVITIES IN WHICH THE HEALTH OF THE COMMUNITY WAS ADVOCATED AS A PRIORITY BY THE HOSPITAL. IN 2013, ST. VINCENT CONTRIBUTED FUNDING AND RESOURCED TO NON-HEALTH RELATED NOT FOR PROFITS THAT SERVE POOR AND VULNERABLE POPULATIONS. THEY PROVIDED SUPPORT TO THE FOSTER GRANDPARENT PROGRAM FOR LOW-INCOME SENIORS, BROADWATER SCHOOL FOUNDATION - PARTNERS IN EDUCATION, THE SUMMER STUDENT VOLUNTEER MENTOR PROGRAM, ADOPT A HIGHWAY CLEAN UP, POLLUTION REDUCTION EFFORTS, COMMUNITY COALITION HEALTHCARE ALLIANCE WORK, HEALTH CARE ADVOCACY IN COLLABORATION WITH BILLINGS CLINIC AND YCCHD TO IMPROVE HEALTH CONDITIONS AND EVS DOCUMENTATION OF USING GREEN PRODUCTS MACHINE OPERATIONS TO CREATE A REDUCTION IN MEDICAL WASTE GOING TO LANDFILL- ESTIMATED AT 60% REDUCTION IN WASTE VOLUME. PART III, LINE 1: THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE TO HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) STATEMENT NO. 15 TO THE EXTENT THAT HFMA STATEMENT NO. 15 FOLLOWS THE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) FOR THE REPORTING OF BAD DEBT. PART III, LINE 2: THE ALLOWANCE FOR BAD DEBT IS BASED UPON THE ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS. THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS AT COST. THE COST TO CHARGE RATIO USED TO CALCULATE BAD DEBT AT COST WAS DERIVED FROM WORKSHEET 2, IN THE SCHEDULE H, FORM 990 INSTRUCTIONS. PART III, LINE 4: THE ALLOWANCE FOR BAD DEBT IS BASED UPON THE ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS. THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE ORGANIZATIONS FINANCIAL STATEMENTS THAT DESCRIBE THE BAD DEBT ALLOWANCE AND BAD DEBT EXPENSE: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING THE BUSINESS AND GENERAL ECONOMIC CONDITION IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL COLLECTION EXPERIENCE BY PAYOR CATEGORY AND OTHER FACTORS. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS INCLUDES A RESERVE FOR BOTH UNINSURED PATIENTS AND BALANCE AFTER INSURANCE ACCOUNTS RECEIVABLE. THE ORGANIZATION HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES PATIENTS OPPORTUNITIES TO APPLY FOR FREE OR DISCOUNTED CARE OR TO BE ENROLLED IN A GOVERNMENT SPONSORED MEDICAL CARE PROGRAM. THE PROCESS INCLUDES IDENTIFYING PATIENTS WITH A FINANCIAL CONCERN AND PROVIDING FINANCIAL COUNSELING AND ASSISTANCE IN APPLYING FOR THE ORGANIZATION'S CHARITY CARE AND OTHER FINANCIAL ASSISTANCE PROGRAMS. CERTAIN PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT BECAUSE THE ORGANIZATION DOES NOT HAVE SUFFICIENT INFORMATION TO DETERMINE IF THE PATIENT WOULD QUALIFY FOR FREE CARE OR FINANCIAL AID. THEREFORE, IT IS POSSIBLE THAT SOME BAD DEBT IS ACTUALLY CHARITY CARE. HOWEVER, IF A PATIENT ACCOUNT IS WRITTEN OFF TO BAD DEBT AND THE COLLECTION AGENCY LATER DETERMINES THAT THE PATIENT WOULD HAVE QUALIFIED FOR FREE CARE OR FINANCIAL AID, THEN THE BAD DEBT EXPENSE IS RECLASSIFIED TO CHARITY CARE. PART III, LINE 8: THE ORGANIZATION BELIEVES THAT AT LEAST SOME PORTION OF THE COSTS WE INCUR IN EXCESS OF PAYMENTS RECEIVED FROM THE FEDERAL GOVERNMENT FOR PROVIDING MEDICAL SERVICES TO MEDICARE ENROLLEES AND BENEFICIARIES UNDER THE FEDERAL MEDICARE PROGRAM (SHORTFALL OR MEDICARE SHORTFALL) CONSTITUTES A COMMUNITY BENEFIT. PROVIDING THESE SERVICES CLEARLY LESSENS THE BURDENS OF THE GOVERNMENT BY ALLEVIATING THE FEDERAL GOVERNMENT FROM HAVING TO DIRECTLY PROVIDE THESE MEDICAL SERVICES. AS DEMONSTRATED AND CALCULATED ON FORM 990, SCHEDULE H, PART III, LINES 5, 6 AND 7, OUR MEDICARE "ALLOWABLE COSTS" CLEARLY EXCEED THE PAYMENTS WE RECEIVE FOR PROVIDING THESE MEDICAL SERVICES UNDER THE MEDICARE PROGRAM. BY ABSORBING THE MEDICARE SHORTFALL COSTS WE ARE PROVIDING A COMMUNITY BENEFIT AS WELL AS EASING THE BURDEN OF THE FEDERAL GOVERNMENT HAVING TO COVER THESE COSTS. TO ARRIVE AT THE FORM 990, SCHEDULE H, PART III, LINE 6 AMOUNT WE USED ACTUAL MEDICARE CHARGES FROM INTERNAL RECORDS AND APPLIED AN ESTIMATED COST TO CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. THE ESTIMATED MEDICARE COST TO CHARGE RATIO IS THE PRIOR PERIOD MEDICARE COST REPORT COST TO CHARGE RATIO. PART III, LINE 9B AN INTEGRAL COMPONENT OF OUR MISSION IS TO BE GOOD FINANCIAL STEWARDS. THIS REQUIRES US TO DETERMINE WHICH PATIENTS ARE IN NEED OF CHARITY CARE AND WHICH ARE ABLE TO CONTRIBUTE SOME PAYMENT FOR CARE RECEIVED. WE MAINTAIN A BALANCE THAT ENABLES US TO CONTINUE TO PROVIDE CHARITY CARE TO THOSE WHO NEED IT MOST, AND TO ENSURE THAT WE MANAGE OUR RESOURCES SO THAT WE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. THE ORGANIZATION NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION, DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED. PART VI, LINE 2 NEEDS ASSESSMENT Since 1994, Billings Clinic, RiverStone Health and St. Vincent Healthcare have been working together as The Alliance, creating and sustaining innovative programs that address complex community-wide health issues. The Alliance sees this research as a community asset, information that will assist many organizations in strengthening the impact and effectiveness of their services toward improving health in our community. The 2011 Community Health NEEDS Assessment (CHNA) for Yellowstone County WAS a systematic, data-driven approach to determining the health status, behaviors and needs of our population. There are three components that are essential in rendering a complete picture of the health of Yellowstone County: (1) the community health survey [primary quantitative data]; (2) existing data [secondary quantitative data]; and (3) focus group data [primary qualitative data]. The SURVEY developed for this study gives us a complete and timely view of the health status and behaviors of area residents through a randomized telephone survey of 400 Yellowstone County adults. The sample drawn for this survey WAS representative of the adult Yellowstone County population in terms of demographic and socioeconomic characteristics, as well as geographical location. The maximum error rate associated with the total sample of 400 residents is 4.9% at the 95 percent level of confidence. Existing vital statistics and other data WERE incorporated into this assessment for Yellowstone County. Comparisons WERE also made, where available, to state and national benchmarks. Furthermore, wherever possible, health promotion goals outlined in Healthy People 2020 WERE included. To further gain perspective from community members and local organizations, five focus groups were conducted in the area, including groups among: Physicians and Other Health Professionals; Legislators; Social Service Providers; Educators; and Employers. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION,PRIOR TO DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILL
Schedule H (Form 990) 2013
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