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 FRANCIS MEDICAL CENTER
 
Employer identification number

72-0408970
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) . . .
    5,946,663   5,946,663 2.090 %
b Medicaid (from Worksheet 3, column a) . . . . .     42,951,364 23,943,169 19,008,196 6.680 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     785,392 614,770 170,622 0.060 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     49,683,419 24,557,939 25,125,481 8.830 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     629,326 124,848 504,478 0.180 %
f Health professions education (from Worksheet 5) . . .     321,340   321,340 0.110 %
g Subsidized health services (from Worksheet 6) . . . .     1,776,435 306,941 1,469,494 0.520 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     67,328   67,328 0.020 %
j Total. Other Benefits . .     2,794,429 431,789 2,362,640 0.830 %
k Total. Add lines 7d and 7j .     52,477,848 24,989,728 27,488,121 9.660 %
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     43,095   43,095 0.020 %
2 Economic development            
3 Community support     180,411   180,411 0.060 %
4 Environmental improvements            
5 Leadership development and
training for community members
    5,368   5,368  
6 Coalition building            
7 Community health improvement advocacy     184,992 172,734 12,258  
8 Workforce development     3,894   3,894  
9 Other            
10 Total     417,760 172,734 245,026 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
 
No
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
14,254,694
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
103,338,282
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
145,729,081
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-42,390,799
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 %
1P&S Surgical Hospita
 
MEDICAL SERVICES 50.000 % 2.640 % 44.680 %
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?3
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 FRANCIS MEDICAL CENTER
PO BOX 1901
MONROE,LA71210
www.fmolhs.org/stfran
License: 157
X X         X      
2 P&S SURGERY CENTER LLC
312 GRAMMONT STREET
MONROE,LA71201
www.pssurgery.com
License: 490
X X                
3 ST FRANCIS NORTH HOSPITAL
PO BOX 1901
MONROE,LA71201
www.fmolhs.org/stfran
License:157-I
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)
ST FRANCIS MEDICAL CENTER
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 12
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   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
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: 300.%
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 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)
P&S SURGERY CENTER LLC
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)
2
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 12
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: 150.%
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: 262.%
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 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 FRANCIS NORTH 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)
3
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 12
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: 300.%
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
PART V, SECTION B, LINE 3 ST. FRANCIS MEDICAL CENTER, ST. FRANCIS NORTH HOSPITAL AND P&S SURGICAL HOSPITAL: THE ORGANIZATIONS ENGAGED KEY COMMUNITY PARTNERS THROUGH PERSONAL INTERVIEWS. SFMC TOOK INTO ACCOUNT INPUT FROM THOSE WITH SPECIALIZED KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH BY INTERVIEWING SHELLEY JONES, MD, MPH, WHO IS THE REGIONAL MEDICAL DIRECTOR WITH DHH/LOUISIANA OFFICE OF PUBLIC HEALTH. SFMC ALSO TOOK INTO ACCOUNT INPUT FROM THOSE WHO REPRESENT A BROAD INTEREST OF THE COMMUNITY BY INTERVIEWING LINDSEY MURRAY, HEALTHCARE DIRECTOR AT THE CHILDREN'S COALITION OF NORTHEAST LOUISIANA, DR. JAN CORDER PZYNER, FORMER EXECUTIVE DIRECTOR OF THE LIVING WELL FOUNDATION, RENE STANSBURY, THE TOBACCO CONTROL COORDINATOR AT SOUTHWEST LOUISIANA AREA HEALTH EDUCATION CENTER AND JENNIFER HANELINE, REGION VIII TFL COORDINATOR AT TOBACCO FREE LIVING.
PART V, SECTION B, LINE 4 P&S SURGICAL HOSPITAL AND ST. FRANCIS NORTH FORMALLY ADOPTED THE COMMUNITY HEALTH NEEDS ASSESSMENT OF ST. FRANCIS MEDICAL CENTER, AN AFFILIATED ENTITY. ST. FRANCIS MEDICAL CENTER, P&S SURGICAL HOSPITAL, AND ST. FRANCIS NORTH ALL SHARE THE SAME DEMOGRAPHIC COMMUNITY SO P&S SURGICAL HOSPITAL AND ST. FRANCIS NORTH FELT THAT THE NEEDS IDENTIFIED BY ST. FRANCIS MEDICAL CENTER WERE REPRESENTATIVE OF ITS COMMUNITY'S NEEDS AS WELL.
PART V, SECTION B, LINE 7 ST. FRANCIS MEDICAL CENTER (SFMC): ALTHOUGH ST. FRANCIS MEDICAL CENTER IDENTIFIED 11 HEALTH NEEDS OF THE COMMUNITY, THE IMPLEMENTATION STRATEGY FOCUSED ON THE 5 HIGHEST NEED AREAS SINCE THEY POSED THE HIGHEST RISK TO THE COMMUNITY. THE IDENTIFIED NEEDS NOT CHOSEN AS AN AREA OF FOCUS INCLUDED ADOLESCENT HEALTH, IMMUNIZATIONS, PREMATURE BIRTH, DOMESTIC VIOLENCE, MENTAL HEALTH AND LACK OF A MEDICAL HOME/BARRIERS TO CARE. WHILE NOT CHOSEN AS AN AREA OF FOCUS, SFMC CURRENTLY CONDUCTS AND WILL CONTINUE TO CONDUCT PROGRAMS AND/OR PROVIDE SERVICES THAT HELP ADDRESS THOSE NEEDS. P&S SURGICAL HOSPITAL (P&S): ALTHOUGH P&S SURGICAL HOSPITAL IDENTIFIED 11 HEALTH NEEDS OF THE COMMUNITY, THE IMPLEMENTATION STRATEGY FOCUSED ON THE 2 HIGHEST NEED AREAS SINCE THEY POSED THE HIGHEST RISK TO THE COMMUNITY. IT CHOSE NOT TO ADDRESS DIABETES, TOBACCO USE, ASTHMA, ISSUES RELATED TO CARE FOR THE AGING, OBESITY, AND MENTAL HEALTH BECAUSE ST FRANCIS HOSPITAL OR ST FRANCIS NORTH (AFFILIATED ENTITEIS) AND OTHERS HAVE SELECTED THESE ISSUES TO ADDRESS. P&S WILL ASSIST OTHER LOCAL HOSPITALS AND ORGANIZATIONS IN THE COMMUNITY IF REQUESTED AND WHERE APPROPRIATE. P&S ALSO CHOSE NOT TO ADDRESS PREMATURE BIRTHS, DOMESTIC VIOLENCE, AND LACK OF A MEDICAL HOME/BARRIERS TO CARE BECAUSE P&S IS A SPECIALTY HOSPITAL NOT EQUIPPED TO ADDRESS SUCH ISSUES. ST. FRANCIS NORTH HOSPITAL (SFN): ALTHOUGH ST. FRANCIS MEDICAL CENTER IDENTIFIED 11 HEALTH NEEDS OF THE COMMUNITY, THE IMPLEMENTATION STRATEGY FOCUSED ON THE 2 HIGHEST NEED AREAS SINCE THEY POSED THE HIGHEST RISK TO THE COMMUNITY. THE IDENTIFIED NEEDS NOT CHOSEN AS AN AREA OF FOCUS INCLUDED OBESITY, DIABETES, TOBACCO USE, ASTHMA, ISSUES RELATED TO CARE FOR THE AGING, IMMUNIZATIONS, PREMATURE BIRTH, DOMESTIC VIOLENCE AND LACK OF A MEDICAL HOME/BARRIERS TO CARE. WHILE NOT CHOSEN AS AN AREA OF FOCUS, SFN CURRENTLY CONDUCTS AND WILL CONTINUE TO CONDUCT PROGRAMS AND/OR PROVIDE SERVICES THAT HELP ADDRESS THOSE NEEDS.
PART V, SECTION B, LINE 5 ST. FRANCIS MEDICAL CENTER, ST. FRANCIS MEDICAL CENTER - NORTH & P&S SURGICAL HOSPITAL: THE CHNA CAN BE FOUND AT HTTPS://FMOLHS.ORG/STFRAN/PAGES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX ST. FRANCIS NORTH HOSPITAL
PART V, LINE 14G ST. FRANCIS MEDICAL CENTER, ST. FRANCIS NORTH HOSPITAL AND P&S SURGICAL HOSPITAL: REGISTRATION PERSONNEL REFER PATIENTS THAT MAY HAVE DIFFICULTY PAYING FOR THEIR MEDICAL CARE TO FINANCIAL COUNSELORS TO DISCUSS QUALIFICATION FOR FREE OR DISCOUNTED CARE.
PART V, QUESTION 20D ST. FRANCIS MEDICAL CENTER, ST. FRANCIS NORTH HOSPITAL AND P&S SURGICAL HOSPITAL: THE HOSPITAL OFFERS VARIOUS LEVELS OF DISCOUNTS WHICH ARE BASED ON A SLIDING SCALE USING THE FEDERAL POVERTY GUIDELINE FAMILY INCOME LEVELS AND OTHER FACTORS. SUCH OTHER FACTORS INCLUDE ASSET LEVELS, INCOME LEVELS, MEDICAL INDIGENCY, AND A PATIENT'S QUALIFICATION FOR MEDICARE OR MEDICAID. TOGETHER THESE CRITERIA ARE USED TO SET THE MAXIMUM AMOUNT CHARGED. THE SLIDING SCALE IS DESIGNED SO THAT THE DISCOUNTS APPLIED BRING PATIENT CHARGES TO "BELOW THE AMOUNT" GENERALLY BILLED TO INDIVIDUALS WHO HAD INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY SERVICES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
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?5
Name and address Type of Facility (describe)
1 COMMUNITY HEALTH CENTER
920 OLIVER ROAD
MONROE,LA71201
VARIOUS OUTPATIENT SERVICES
2 NORTHEAST LA CANCER INSTITUTE
411 CALYPSO STREET
MONROE,LA71210
CANCER TREATMENT AND IMAGING CENTER
3 Monroe MRI Center
501 Catalpa Street
Monroe,LA71201
MRI SERVICES
4 ST FRANCIS PET IMAGING OF MONROE
PO BOX 1851
Monroe,LA71201
PET IMAGING SERVICES
5 ST FRANCIS PEDIATRIC AFTER HOURS
PO BOX 207
MONROE,LA71201
AFTER HOURS CLINIC FOR CHILDREN
6
7
8
9
10
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 3C FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULL AND PARTIAL DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS AND IS AVAILABLE IF MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: 1) PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL; 2) STATE-FUNDED PRESCRIPTION PROGRAMS; 3) HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT; 4) PATIENT'S CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCE PROGRAMS; 5) PATIENT ELIGIBLE FOR FOOD STAMPS; 6) MEDICAID ELIGIBLE PATIENT; 7) PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY; 8) PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY.
PART I, LINE 7G ST. FRANCIS MEDICAL CENTER PROVIDES SUBSIDIZED HEALTH SERVICES, INCLUDING SERVICES THAT PROVIDE PEDIATRIC NEUROLOGY, PEDIATRIC NEUROSURGERY, AND ADULT NEUROLOGY. THESE SPECIALIZED SERVICES ARE SUBSIDIZED BY ST. FRANCIS MEDICAL CENTER SINCE THESE ARE UNDER-SERVED SPECIALTY AREAS.
PART I, LINE 7 THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-7D AND IS BASED ON THE JUNE 30, 2014 MEDICARE COST REPORT DATA. FOR PART I LINES 7E, 7F, 7G, 7H AND 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENT AND THE MEDICARE COST REPORT WHERE APPLICABLE.
PART III, LINE 4 THE BAD DEBT FOOTNOTE IS ON PAGE 15 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8 THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. THE ORGANIZATION CURRENTLY DOES NOT BELIEVE THAT ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT.
PART III, LINE 9B PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE FULLY DISCOUNTED BASED ON A PRESUMPTIVE CHARITY SCORING SYSTEM WHICH IS SIMILAR TO CREDIT SCORING. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY. THESE PROCESSES HELP IDENTIFY (EARLY IN THE PROCESS) PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THIS HELPS KEEP QUALIFYING PATIENTS OUT OF THE HOSPITAL'S COLLECTION PROCESSES BECAUSE AMOUNTS COVERED BY FINANCIAL ASSISTANCE ARE NOT SUBJECT TO THE HOSPITAL'S COLLECTION PRACTICES. HOWEVER, IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE DISCOUNTED AMOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS.
PART VI, LINE 2 NEEDS ASSESSMENT: Responding to the health needs of our community, especially to those most in need, is primary to the hospital's mission. As such, St. Francis Medical Center, Inc. works to conduct health care needs assessments. They work closely with Families helping Families, The Wellspring, The Children's Coalition, YMCA and many other organizations to define community needs and to consolidate efforts to meet those community needs. For example, a school-based health center and a diabetes and nutrition center was initiated after a health care assessment identified the need. The hospital conducted a formal community based needs assessment in 2011 and will continue to use community based data to support decisions for outreach in the community.
PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: Patients are informed through a patient handbook that contains information on the financial policies of St. Francis Medical Center. Additionally, signs are posted in the Admissions areas that Financial Counseling is available upon request. Systems and tools are utilized to conduct high level financial screening to assist in identifying patients eligible for financial assistance. Financial counselors work closely with patients to assist with enrollment for those who are eligible for Medicaid as well as assist those who are eligible for HOSPITAL FINANCIAL ASSISTANCE in determining eligibility.
PART VI, LINE 4 COMMUNITY INFORMATION: ST. FRANCIS MEDICAL CENTER (SFMC) IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN MONROE, LOUISIANA THAT SERVES OUACHITA PARISH AND PORTIONS OF THE SURROUNDING PARISHES. PURSUANT TO THE HOSPITAL'S LAST CHNA, SFMC'S PRIMARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 150,862 AND THE SENIOR POPULATION COMPRISES ABOUT 12.6% OF THE TOTAL POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $37,298 AND 20.8% OF THE PARISH'S RESIDENTS LIVE BELOW THE POVERTY LEVEL. ST. FRANCIS MEDICAL CENTER PRIMARY SERVICE AREA INCLUDES THE FOLLOWING PARISH: OUACHITA PARISH ST. FRANCIS MEDICAL CENTER SECONDARY SERVICE AREA INCLUDES THE FOLLOWING PARISHES: CALDWELL PARISH EAST CARROLL PARISH FRANKLIN PARISH JACKSON PARISH LINCOLN PARISH MADISON PARISH MOREHOUSE PARISH RICHLAND PARISH TENSAS PARISH UNION PARISH WEST CARROLL PARISH
PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: St. Francis Medical Center participates in community improvement activities because it understands that improvements to a community have a direct link to the improved health of community residents. Community improvement activities include the following: SFMC provides occupancy and utilities free of charge to St. Vincent DePaul charitable pharmacy so that the poorest individuals in the community have access to prescription drugs. SFMC also provides occupancy free of charge to a primary health care clinic located in one of the poorest areas of Monroe. These activities allow the recipient organizations to spend their available funds on activities that have more direct impact on those in need. SFMC provides management oversight of community programs and activities, including Meals on Wheels, taxi and medication provided to the needy, and community benefit salary dollars. SMFC proudly serves as the designated regional hospital for Region 8 and provides leadership and coordination for emergency preparedness activities. SFMC provides leadership development and training for Roman Catholic Priests to serve in the SFMC Community. SFMC improves access to public health through its financial support of an adult day health care facility and a school based health center. SFMC has many programs designed to promote leadership development and provide exposure to various careers in heatlh care. Such programs include health information management, sports medicine program, AHEC (area health education center) program, Carroll High School Housekeeping Program and the Jr. Volunteer Program. A majority of the governing body of SFMC is comprised of individuals from a broad cross-section of the community who reside in the primary service area and who are neither employees nor contractors of the organization. SFMC extends medical staff privileges to all qualified physicians in the community for some or all of the departments, as needed. SFMC applies surplus funds to improvements in patient care through investment in clinical technology, medical information technology, and continued training of clinical staff.
PART VI, LINE 6 St. Francis Medical Center is a not-for-profit hospital, non-stock member corporation of which Franciscan Missionaries of Our Lady Health System, Inc. (FMOL Health System) is the sole member. St. Francis Medical Center is part of the FMOL Health System which includes several hospitals and tax-exempt affiliates throughout the state of Louisiana. St. Francis Medical Center serves the community in Northeastern Louisiana and Southern Arkansas. Other related hospitals in Louisiana include: Our Lady of Lourdes Regional Medical Center Our Lady of the Lake Hospital St. Elizabeth Hospital Our Lady of the Lake Assumption Hospital OUR LADY OF THE ANGELS HOSPITAL
PART III, SECTION A, LINE 2 THE HOSPITAL ACCOUNTS FOR BAD DEBTS BASED ON THE AGING OF THE ACCOUNTS AND BASED ON THE HISTORICAL COLLECTION ASSOCIATED WITH THE VARIOUS AGING CATEGORIES. ON A PERIODIC BASIS, THE ORGANIZATION CONDUCTS A RETROSPECTIVE REVIEW TO DETERMINE THE APPROPRIATENESS OF THE COLLECTION PERCENTAGES UTILIZED IN ESTIMATED BAD DEBT EXPENSE. CHARITY AND DISCOUNTS ARE NOT INCLUDED IN BAD DEBT EXPENSE. PAYMENTS RECEIVED ON ACCOUNTS SUBSEQUENT TO BEING CONSIDERED BAD DEBT ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE.
PART I, LINE 7F FOR THE PURPOSE OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F, FUNCTIONAL EXPENSES WERE USED WHICH DID NOT INCLUDE BAD DEBT EXPENSE.
Schedule H (Form 990) 2013
Additional Data


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