efile Public Visual Render
ObjectId: 201543149349300954 - Submission: 2015-11-10
TIN: 15-0532245
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
Attach to Form 990.
Information about Schedule H (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
ST ELIZABETH MEDICAL CENTER
Employer identification number
15-0532245
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a
.
.
.
.
1a
Yes
b
If "Yes," was it a written policy?
.......................
1b
Yes
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
Applied uniformly to all hospital facilities
Applied uniformly to most hospital facilities
Generally tailored to individual hospital facilities
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines
(FPG)
as a factor in determining eligibility for providing
free
care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for
free
care:
3a
Yes
100%
150%
200%
Other
%
b
Did the organization use FPG as a factor in determining eligibility for providing
discounted
care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care:
.
.
.
.
.
.
.
.
3b
Yes
200%
250%
300%
350%
400%
Other
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria
used 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 discounted
care 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)
.
.
.
1,967,712
932,435
1,035,277
0.510 %
b
Medicaid (from Worksheet 3, column a) .
.
.
.
.
40,942,495
31,384,073
9,558,422
4.670 %
c
Costs of other means-tested government programs (from Worksheet 3, column b)
.
.
985,912
526,040
459,872
0.220 %
d
Total
Financial Assistance and Means-Tested Government Programs .
.
.
.
.
43,896,119
32,842,548
11,053,571
5.400 %
Other Benefits
e
Community health improvement services and community benefit operations (from Worksheet 4).
466,168
100,782
365,386
0.180 %
f
Health professions education (from Worksheet 5)
.
.
.
7,266,478
4,776,934
2,489,544
1.220 %
g
Subsidized health services (from Worksheet 6)
.
.
.
.
3,369,872
2,982,809
387,063
0.190 %
h
Research (from Worksheet 7)
.
145,288
39,913
105,375
0.050 %
i
Cash and in-kind contributions for community benefit (from Worksheet 8)
.
.
.
.
j
Total.
Other Benefits
.
.
11,247,806
7,900,438
3,347,368
1.640 %
k
Total.
Add lines 7d and 7j
.
55,143,925
40,742,986
14,400,939
7.040 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50192T
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities
Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a)
Number of activities or programs (optional)
(b)
Persons served (optional)
(c)
Total community building expense
(d)
Direct offsetting
revenue
(e)
Net community building expense
(f)
Percent of total expense
1
Physical improvements and housing
2
Economic development
3
Community support
4
Environmental improvements
5
Leadership development and training for community members
6
Coalition building
7
Community health improvement advocacy
8
Workforce development
9
Other
10
Total
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15?
..........................
1
Yes
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount.
......
2
3,838,092
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
458,000
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
51,474,916
6
Enter Medicare allowable costs of care relating to payments on line 5
.....
6
54,999,639
7
Subtract line 6 from line 5. This is the surplus (or shortfall)
........
7
-3,524,723
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Cost accounting system
Cost to charge ratio
Other
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year?
..........
9a
Yes
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI
.........................
9b
Yes
Part IV
Management Companies and Joint Ventures
(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a)
Name of entity
(b)
Description of primary
activity of entity
(c)
Organization's
profit % or stock
ownership %
(d)
Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e)
Physicians'
profit % or stock
ownership %
1
1 MVHI
CARDIAC SERVICES
70.000 %
0 %
0 %
2
2 MVEC
GASTROENTEROLOGY SERVICES
20.000 %
0 %
0 %
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?
1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Other (Describe)
Facility reporting group
1
ST ELIZABETH MEDICAL CENTER
2209 GENESEE STREET
UTICA
,
NY
13501
X
X
TEACHING HOSPITAL AND 24 HOUR ER
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
Section B. Facility Policies and Practices
(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
ST ELIZABETH MEDICAL CENTER
Name of hospital facility or letter of facility reporting group
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes
No
Community Health Needs Assessment
1
Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.
.........................
1
No
2
Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.
..............
2
No
3
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 12.
.....................
3
Yes
If "Yes," indicate what the CHNA report describes (check all that apply):
a
A definition of the community served by the hospital facility
b
Demographics of the community
c
Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d
How data was obtained
e
The significant health needs of the community
f
Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g
The process for identifying and prioritizing community health needs and services to meet the community health needs
h
The process for consulting with persons representing the community’s interests
i
Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j
Other (describe in Section C)
4
Indicate the tax year the hospital facility last conducted a CHNA: 20
13
5
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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted
.................
5
Yes
6a
Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C
..................................
6a
Yes
b
Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C.
.............................
6b
Yes
7
Did the hospital facility make its CHNA report widely available to the public?
..............
7
Yes
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
Hospital facility’s website (list url):
WWW.STEMC.ORG
b
Other website (list url):
c
Made a paper copy available for public inspection without charge at the hospital facility
d
Other (describe in Section C)
8
Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11.
..............
8
Yes
9
Indicate the tax year the hospital facility last adopted an implementation strategy: 20
13
10
Is the hospital facility's most recently adopted implementation strategy posted on a website?
.........
10
Yes
a
If "Yes" (list url):
WWW.STEMC.ORG
b
If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return?
......
10b
No
11
Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a
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)?
...............................
12a
No
b
If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?
........
12b
c
If "Yes" to line 12b, 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) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
ST ELIZABETH MEDICAL CENTER
Name of hospital facility or letter of facility reporting group
Financial Assistance Policy (FAP)
Yes
No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13
Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?
13
Yes
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of
200.000000000000
%
and FPG family income limit for eligibility for discounted care of
300.000000000000
%
b
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance discount
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
.................
14
Yes
15
Explained the method for applying for financial assistance?
...................
15
Yes
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of his or her application.
b
Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.
c
Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.
d
Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.
e
Other (describe in Section C)
16
Included measures to publicize the policy within the community served by the hospital facility?
........
16
Yes
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)
e
The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)
g
Notice of availability of the FAP was conspicuously displayed throughout the hospital facility
h
Notified members of the community who are most likely to require financial assistance about availability of the FAP
i
Other (describe in Section C)
Billing and Collections
17
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 all of the actions the hospital facility or other authorized party may take upon non-payment?
..................................
17
Yes
18
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
Reporting to credit agency(ies)
b
Selling an individual’s debt to another party
c
Actions that require a legal or judicial process
d
Other similar actions (describe in Section C)
e
None of these actions or other similar actions were permitted
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
ST ELIZABETH MEDICAL CENTER
Name of hospital facility or letter of facility reporting group
Financial Assistance Policy (FAP)
Yes
No
19
Did the hospital facility or other 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?
............
19
No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
Reporting to credit agency(ies)
b
Selling an individual’s debt to another party
c
Actions that require a legal or judicial process
d
Other similar actions (describe in Section C)
20
Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
Notified individuals of the financial assistance policy on admission
b
Notified individuals of the financial assistance policy prior to discharge
c
Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills
d
Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy
e
Other (describe in Section C)
f
None of these efforts were made
Policy Relating to Emergency Medical Care
21
Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?
..................
21
Yes
If "No," indicate why:
a
The hospital facility did not provide care for any emergency medical conditions
b
The hospital facility’s policy was not in writing
c
The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)
d
Other (describe in Section C)
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22
Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged
b
The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c
The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d
Other (describe in Section C)
23
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?
...............................
23
No
If "Yes," explain in Section C.
24
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?
...........................
24
Yes
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
Section C. Supplemental Information for Part V, Section B.
Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference
Explanation
ST ELIZABETH MEDICAL CENTER
PART V, SECTION B, LINE 5: A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), HELD ON MAY 20, 2013, MARKED THE FORMAL LAUNCH OF THE CHA PROCESS. THE PARTICIPANTS WORKED IN SMALL GROUPS TO IDENTIFY AND PRIORITIZE KEY HEALTH SYSTEM ISSUES. IDENTIFIED WERE PROVIDER SHORTAGES-COST OF CARE. THE TOP TWO HEALTH STATUS ISSUES IDENTIFIED WERE LIFESTYLES-CHRONIC DISEASE AND ORAL HEALTH-BEHAVORIAL HEALTH. PARTICIPANTS WERE ALSO ASKED TO DESCRIBE THE ATTRIBUTES OF A HEALTH COMMUNITY AND DRAW A PICTURE OF A HEALTH ONEIDA COUNTY (THESE DRAWINGS ARE INCORPORATED IN APPENDIX 1 OF THE CHNA REPORT). THE RESULTS OF THE FORUM HELPED TO FRAME THE KEY ISSUES TO EXAMINE DURING THE COURSE OF THE PROCESS. THIS COLLABORATIVE PROCESS ENSURED BROAD PARTICIPATION IN THE ANALYSIS OF DATA AND SELECTION OF PRIORITY AREAS.
ST ELIZABETH MEDICAL CENTER
PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH FAXTION ST LUKE'S HEALTHCARE AND ROME MEMORIAL HOSPITAL FACILITIES.
ST ELIZABETH MEDICAL CENTER
PART V, SECTION B, LINE 24: INITIALLY, ALL PATIENTS WITHOUT INSURANCE RECEIVE A SUBSTANTIAL DISCOUNT OFF OF THE GROSS CHARGES. OUR FACILITY HAS CHARGED SOME OF ITS FAP ELIGIBLE PATIENTS AN AMOUNT EQUAL TO THE GROSS CHARGES FOR SERVICES PROVIDED. IF A PATIENT CHOSE NOT TO PAY THE DISCOUNTED RATES, THE DISCOUNTED CHARGES ARE GROSSED UP AND ACCOUNT IS THEN SENT INTO A COLLECTION AGENCY AT THE GROSS AMOUNT.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility 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?
17
Name and address
Type of Facility (describe)
1
MEDICAL ARTS
4401 MIDDLE SETTLEMENT ROAD
NEW HARTFORD
,
NY
13413
OUTPATIENT LAB/X-RAY
2
SEMC AT FAMILY PRACTICE CENTER
120 HOBART STREET
UTICA
,
NY
13501
OUTPATIENT PHYSICIAN CLINIC
3
WOUND CARE SERVICES
4401 MIDDLE SETTLEMENT ROAD
NEW HARTFORD
,
NY
13413
OUTPATIENT PHYSICIAN CLINIC
4
WOMEN & CHILDREN'S FAMILY HEALTH CENTER
2212 GENESEE STREET
UTICA
,
NY
13501
OUTPATIENT PHYSICIAN CLINIC
5
COMMUNITY MEDICINE AT EAST UTICA
1256 CULVER AVENUE
UTICA
,
NY
13501
OUTPATIENT PHYSICIAN CLINIC
6
FAMILY PRACTICE NEW HARTFORD
4401 MIDDLE SETTLEMENT ROAD
NEW HARTFORD
,
NY
13413
OUTPATIENT PHYSICIAN CLINIC
7
MARIAN MEDICAL IMAGING
2211 GENESEE STREET
UTICA
,
NY
13501
OUTPATIENT LAB/X-RAY
8
SAUQUOIT COMMUNITY MEDICINE
2888 ONEIDA STREET
SAUQUOIT
,
NY
13456
OUTPATIENT PHYSICIAN CLINIC
9
CLINTON FAMILY HEALTH CENTER
101 COLLEGE STREET
CLINTON
,
NY
13323
OUTPATIENT PHYSICIAN CLINIC
10
LITTLE FALLS FAMILY PRACTICE
500 EAST MAIN STREET
LITTLE FALLS
,
NY
13365
OUTPATIENT PHYSICIAN CLINIC
11
WATERVILLE FAMILY HEALTH CENTER
117 WEST MAIN STREET
WATERVILLE
,
NY
13480
OUTPATIENT PHYSICIAN CLINIC
12
NORTH UTICA COMMUNITY HEALTH CENTER
417 TRENTON ROAD
UTICA
,
NY
13502
OUTPATIENT PHYSICIAN CLINIC
13
COMMUNITY MEDICAL SERVICES - MOHAWK
5 ANN STREET
MOHAWK
,
NY
13407
OUTPATIENT PHYSICIAN CLINIC
14
TOWN OF WEBB HEALTH CENTER
114 SOUTH SHORE ROAD
OLD FORGE
,
NY
13420
OUTPATIENT PHYSICIAN CLINIC
15
COMMUNITY MEDICAL SERVICES SOUTH UTICA
6 HAMPDEN PLACE
UTICA
,
NY
13501
OUTPATIENT PHYSICIAN CLINIC
16
ADIRONDACK SPORTS MEDICINE
4401 MIDDLE SETTLEMENT ROAD
NEW HARTFORD
,
NY
13413
OUTPATIENT REHAB SERVICES
17
KERNAN ELEMENTARY SCHOOL
926 YORK STREET
UTICA
,
NY
13502
SCHOOL BASED HEALTH CENTER
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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:
COSTING METHODOLOGYCHARITY CARE THE COST TO CHARGE RATIO THAT WAS USED TO COMPLETE THE CHART FOR LINE 7 WAS DERIVED FROM THE WORKSHEET 2 CALCULATION.
PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 8,547,041.
PART III, LINE 4:
THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE MEDICAL CENTER'S POLICY IS NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE; THEREFORE, THESE AMOUNTS ARE NOT REPORTED IN NET PATIENT SERVICE REVENUE. DURING 2014 AND 2013, COSTS INCURRED BY THE MEDICAL CENTER IN THE PROVISION OF CHARITY CARE WERE BASED ON THE RATIO OF THE MEDICAL CENTER'S COSTS TO GROSS CHARGES AND APPROXIMATED $458,000 AND $863,000 FOR THE YEARS ENDED DECEMBER 31, 2014 AND 2013, RESPECTIVELY.THE MEDICAL CENTER GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY AGREEMENTS. ADDITIONS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR DOUBTFUL ACCOUNTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE AND SUBSEQUENT RECOVERIES ARE ADDED. THE AMOUNT OF THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENT HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. SERVICES RENDERED TO INDIVIDUALS WHEN PAYMENT IS EXPECTED AND ULTIMATELY NOT RECEIVED ARE WRITTEN OFF TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:
THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS COST TO CHARGE RATIO. THE SHORTFALL REPORTED IS COMMUNITY BENEFIT EXPENSE BECAUSE THIS AMOUNT REPRESENTS THE UNREIMBURSED COSTS TO THE MEDICAL CENTER FOR PROVIDING CARE FOR THE COMMUNITY'S ELDERLY AND DISABLED.
PART III, LINE 9B:
COLLECTION POLICY PROVISIONS PATIENTS THAT QUALIFY FOR THE MEDICAL CENTER'S CHARITY CARE PROGRAM HAVE THE CHARGES ON THEIR ACCOUNTS FORGIVEN AS THEY ARE PLACED IN CHARITY CARE AND THE BALANCES ARE WRITTEN OFF. THE MEDICAL CENTER'S CHARITY CARE PROGRAM USED THE FEDERAL POVERTY GUIDELINES (FPG) AS A GUIDE WITH HIGH-END LIMITS AT 300% OF THE FPG. IN THOSE SITUATIONS WHERE THE PATIENT'S INCOME IS BETWEEN 200% - 300% OF THE FPG, A SMALL COST SHARE WOULD BE THE ONLY AMOUNT NOT INCLUDED IN CHARITY CARE. ADDITIONALLY THIS SMALL COST SHARE WOULD BE THE ONLY AMOUNT TURNED OVER TO COLLECTION WITH THE OPPORTUNITY OF EVENTUALLY BEING WRITTEN OF TO BAD DEBT IF NOT PAID.
PART VI, LINE 2:
NEEDS ASSESSMENTTHE MEDICAL CENTER ASSESSES HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES BY COLLABORATING WITH ONEIDA AND HERKIMER COUNTIES' DEPARTMENTS OF HEALTH ON COMMUNITY HEALTH ASSESSMENTS. DATA WAS COLLECTED IN 2013 THROUGH A MAPP PROCESS, AROUND THE NYS PREVENTION AGENDA ISSUES. FIVE RESULTING PRIORITY WORK GROUPS THAT CONTAIN MEDICAL CENTER EMPLOYEES CONTINUE TO ASSESS CHANGES AND ADDRESS PRIORITY AREAS. THESE WORK GROUPS ALSO REPORT TO THE SEMC COMMUNITY DESIGN TEAM, WHICH REGULARLY HEARS ABOUT HEALTHCARE NEEDS THROUGH THOSE IN AREA COMMUNITIES.
PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THIS IS COMMUNICATED THROUGH SEMC'S FACILITATED ENROLLMENT PROGRAM AND THE MOTHER BERNARDINA CHARITY CARE PROGRAM. INFORMATION IS INCLUDED IN THE PATIENT INFORMATION GUIDES PRESENTED TO INPATIENTS AND OUTPATIENTS, AND IS AVAILABLE ON THE HOSPITAL'S WEBSITE. ST ELIZABETH MEDICAL CENTER RECOGNIZES THAT PROVIDING EXCEPTIONAL HEALTHCARE SERVICE TO THE COMMUNITY IS A VITAL COMMUNITY RESOURCE. OUR ACHIEVEMENTS ARE NOT OURS ALONE, BUT ARE OBTAINED BY COLLABORATIVE EFFORTS WITH OUR COMMUNITY AND GOVERNMENT LEADERS WORKING TOGETHER TO IMPROVE THE "HEALTH" OF THE COMMUNITY.SEMC'S FACILITATED ENROLLMENT PROGRAM IN 2000, ST ELIZABETH MEDICAL CENTER DEVELOPED AND IMPLEMENTED THE FACILITATED ENROLLMENT PROGRAM AS A RESULT OF THE UNIQUE COLLABORATION THAT WAS FORGED BETWEEN ST ELIZABETH MEDICAL CENTER AND ONEIDA COUNTY SOCIAL SERVICE DEPARTMENT. THIS PROGRAM ALLOWS SEMC STAFF, PATIENT ACCOUNT REPRESENTATIVES, TO ACT AS AN AUTHORIZED REPRESENTATIVE OF THE PATIENT AT THE ONIEDA COUNTY DEPARTMENT OF SOCIAL SERVICES AND SUBMIT THE APPLICATION FOR BENEFITS. THIS SUCCESSFUL PROGRAM HAS EXPANDED THROUGHOUT THE PAST SEVERAL YEARS TO INCLUDE OUTPATIENTS AND EMERGENCY DEPARTMENT PATIENTS.SEMC'S MOTHER BERNARDINA CHARITY CARE PROGRAMTO SUPPORT OUR MISSION, THE ST ELIZABETH MEDICAL CENTER HAS DEVELOPED THE MOTHER BERNARDINA CHARITY CARE PROGRAM. THE MEDICAL CENTER WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED SERVICES TO ELIGIBLE PERSONS.
PART VI, LINE 4:
COMMUNITY INFORMATION ST ELIZABETH MEDICAL CENTER'S PRIMARY SERVICE AREA (PSA) CONSISTS OF THE ZIP CODES IN WHICH 80% OF ITS PATIENTS LIVE (MOSTLY ONEIDA COUNTY AND SOME WITHIN HERKIMER COUNTY). ITS SECONDARY SERVICE AREA (SSA) CONSISTS OF ZIP CODES IN WHICH THE REMIANING 10+% OF ITS PATIENTS LIVE (MOSTLY OUTLYING REGIONS OF ONEIDA AND HERKIMER COUNTIES, PLUS SOME ZIP CODES IN MADISON AND LEWIS COUNTIES). METHODS USED TO DETERMINE THE SERVICE AREA ARE ANALYSIS OF PATIENT ORIGIN, BASED ON HOME ZIP CODE. IT IS AN ETHNICALLY AND ECONOMICALLY DIVERSE REGION, WITH MANY IMMIGRANTS AND AN OLDER POPULATION THAN THE NATIONAL AVERAGE.
PART VI, LINE 5:
PROMOTION OF COMMUNITY HEALTHTHESE ACTIONS REPRESENT THE MEDICAL CENTER'S EMPLOYEE OUTREACH BEYOND THE HOSPITAL AND MEDICAL GROUP OFFICES INTO AREA COMMUNITIES, AND THEY SPAN A WIDE REACH OF EVENTS AND SITES. ALONG WITH HOSPITALS ACROSS THE STATE AND NATION, ST ELIZABETH NOW MONITORS HOW OUR FAITHFULNESS TO THE REGIONAL POPULATION MEETS OUR LOCAL COMMUNITIES' UNIQUE HEALTH NEEDS.THEREFORE, COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. OUR CATHOLIC TRADITION AND MEDICAL CENTER MISSION TEACH US TO PUT THE NEEDS OF THE POOR AND VULNERABLE FIRST. AMONG OUR COMMUNITY BENEFIT ACTIVITIES ARE:-CHARITY CARE FOR PEOPLE UNABLE TO AFFORD SERVICE-HEALTH EDUCATION AND ILLNESS PREVENTION-HEALTHCARE INITIATIVES FOR AT-RISK YOUTHS-FREE OR LOW-COST CLINICS AND-INITIATIVES TO RAISE AWARENESS AND RECEIVE PUBLIC INPUTMANY OF THESE ACTIVITIES ARE ADVANCED IN COLLABORATION WITH COMMUNITY MEMBERS AND OTHER ORGANIZATIONS TO IMPROVE HEALTH AND QUALITY OF LIFE. THE MEDICAL CENTER FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH AN OPEN MEDICAL STAFF AND A COMMUNITY BOARD. SEMC FURTHER PROMOTES THE HEALTH OF THE COMMUNITY BY USING ITS SURPLUS FOR TRAINING AND EDUCATION OF ITS EMPLOYEES AND BY INVESTING IN HEALTHCARE TECHNOLOGY.PART VII, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT NEW YORK STATE
LINE 6
ST ELIZABETH MEDICAL CENTER (SEMC) AND FAXTON ST LUKE'S HEALTHCARE (FSLH) AFFILIATED UNDER THE MOHAWK VALLEY HEALTH SYSTEM (MVHS) ON MARCH 6, 2014. THE TWO ORGANIZATIONS ARE NOW GOVERNED BY A SINGLE, 18-MEMBER MVHS BOARD OF DIRECTORS AND A SINGLE MANAGEMENT TEAM. AS THE ORGANIZATIONS MOVE FORWARD, THEY WILL CONTINUE TO WORK COLLABORATIVELY TO MEET THEIR RESPECTIVE 2013 COMMUNITY SERVICE PLAN GOALS.IN MAY 2014, FSLH WAS RECOGNIZED BY THE NYSDOH AS AN EMERGING PERFORMING PROVIDER SYSTEM (PPS). IN DECEMBER 2014, FSLH JOINED WITH AUBURN COMMUNITY HOSPITAL, ST JOSEPH'S HOSPITAL HEALTH CENTER AND SUNY UPSTATE UNIVERSITY HOSPITAL AS A SINGLE PPS UNDER THE NAME CENTRAL NEW YORK CARE COLLABORATIVE (CNYCC). THE CNYCC WILL COLLABORATE TO MEET THE HEALTHCARE NEEDS OF PEOPLE LIVING IN CAYUGA, LEWIS, MADISON, ONEIDA, ONONDAGA AND OSWEGO COUNTIES. THE COMBINED DSRIP APPLICATION INCLUDES TWO PROJECTS THAT ARE TIED TO THE FLSH AND SEMC COMMUNITY SERVICE PLANS. ONE IS TO ADDRESS TOBACCO USE IN PREGNANT WOMEN TO HELP PREVENT PREMATURE BIRTHS. THE SECOND IS IMPLEMENTING EVIDENCE-BASED STRATEGIES FOR DISEASE MANAGEMENT IN HIGH RISK/AFFECTED POPULATIONS, SPECIFICALLY CARDIOVASCULAR, BY ADOPTING STRATEGIES FROM THE MILLION HEARTS CAMPAIGN THAT FOCUSES ON ABCS (ASPIRIN, BLOOD PRESSURE, CHOLESTEROL AND SMOKING). THE ELECTRONIC MEDICAL RECORD (EMR) AT BOTH HOSPITALS WILL PROMPT PROVIDERS TO COMPLETE THE 5 AS: ASK, ASSESS, ADVISE, ASSIST, AND ARRANGE (FOLLOW-UP) OF TOBACCO CONTROL.
Schedule H (Form 990) 2014
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