efile Public Visual Render
ObjectId: 201601379349308895 - Submission: 2016-05-16
TIN: 94-0545320
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
HEBREW HOME FOR AGED DISABLED
DBA JEWISH HOME OF SAN FRANCISCO
Employer identification number
94-0545320
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)
.
.
.
352,093
352,093
0.450 %
b
Medicaid (from Worksheet 3, column a) .
.
.
.
.
59,449,026
58,526,916
922,110
1.190 %
c
Costs of other means-tested government programs (from Worksheet 3, column b)
.
.
d
Total
Financial Assistance and Means-Tested Government Programs .
.
.
.
.
59,801,119
58,526,916
1,274,203
1.640 %
Other Benefits
e
Community health improvement services and community benefit operations (from Worksheet 4).
f
Health professions education (from Worksheet 5)
.
.
.
g
Subsidized health services (from Worksheet 6)
.
.
.
.
h
Research (from Worksheet 7)
.
43,284
43,284
0.060 %
i
Cash and in-kind contributions for community benefit (from Worksheet 8)
.
.
.
.
j
Total.
Other Benefits
.
.
43,284
43,284
0.060 %
k
Total.
Add lines 7d and 7j
.
59,844,403
58,526,916
1,317,487
1.700 %
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
403,270
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
41,717
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
16,722,450
6
Enter Medicare allowable costs of care relating to payments on line 5
.....
6
14,522,988
7
Subtract line 6 from line 5. This is the surplus (or shortfall)
........
7
2,199,462
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Cost accounting system
Cost to charge ratio
Other
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year?
..........
9a
Yes
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI
.........................
9b
Yes
Part IV
Management Companies and Joint Ventures
(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a)
Name of entity
(b)
Description of primary
activity of entity
(c)
Organization's
profit % or stock
ownership %
(d)
Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e)
Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 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
ACUTE PSYCHIATRIC HOSPITAL
302 SILVER AVENUE
SAN FRANCISCO
,
CA
94112
X
NONE
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)
ACUTE PSYCHIATRIC HOSPITAL
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
No
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):
HTTP://JHSF.ORG/ABOUT-COMMUNITY-BENEFIT.HTM
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
No
a
If "Yes" (list url):
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)
ACUTE PSYCHIATRIC HOSPITAL
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
100.000000000000
%
and FPG family income limit for eligibility for discounted care of
350.000000000000
%
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):
HTTP://JHSF.ORG/ABOUT-CHARITABLE.HTM
b
The FAP application form was widely available on a website (list url):
HTTP://JHSF.ORG/ABOUT-CHARITABLE.HTM
c
A plain language summary of the FAP was widely available on a website (list url):
HTTP://JHSF.ORG/ABOUT-CHARITABLE.HTM
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)
ACUTE PSYCHIATRIC HOSPITAL
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
Yes
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
No
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
No
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
ACUTE PSYCHIATRIC HOSPITAL
PART V, SECTION B, LINE 5: NEEDS ASSESSMENTTHE ORGANIZATION IS A MEMBER OF BUILDING A HEALTHIER SAN FRANCISCO (BHSF), A COLLABORATION OF SAN FRANCISCO HOSPITALS, THE DEPARTMENT OF PUBLIC HEALTH, UNITED WAY, HUMAN SERVICES PROVIDERS, PHILANTHROPIC FOUNDATIONS, AND NUMEROUS COMMUNITY-BASED ORGANIZATIONS. BHSF IS COMMITTED TO WORKING TOWARD IMPROVING THE HEALTH STATUS OF ALL PEOPLE IN SAN FRANCISCO. TO THAT END, BHSF NEEDS ASSESSMENT PROCESS UTILIZES THE BEST SECONDARY DATA AVAILABLE ON SELECTED INDICATORS OF THE HEALTH OR CONDITIONS AFFECTING THE WELL-BEING OF SAN FRANCISCO'S POPULATION AND SUBPOPULATIONS, AND SEEKS FEEDBACK AND INPUT FROM THE COMMUNITY TO GUIDE THE ASSESSMENT AND DIRECT THE CALL TO ACTION. THE ONGOING RESULTS OF THIS ONGOING ASSESSMENT ARE AVAILABLE AT THEIR WEBSITE: HTTP://WWW.SFHIP.ORG/INDEX.PHP?MODULE=ARTICLE&FUNC=COLLECTION&CID=3
ACUTE PSYCHIATRIC HOSPITAL
PART V, SECTION B, LINE 6A: THE JEWISH HOME HAS PARTNERED WITH THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA AND OTHER HOSPITAL FACILITIES IN CONDUCTING ITS MOST RECENT CHNA. THESE OTHER HOSPITAL FACILITIES ARE AS FOLLOWS:CALIFORNIA PACIFIC MEDICAL CENTERCHINESE HOSPITAL OF SAN FRANCISCOKAISER PERMANENTE HOSPITALLAGUNA HONDA HOSPITAL AND REHABILITATION CENTERSAINT FRANCIS MEMORIAL HOSPITALST. MARY'S MEDICAL CENTERUCSF MEDICAL CENTERVA MEDICAL CENTER SAN FRANCISCOFURTHER INFORMATION ON THESE FACILITIES MAY BE FOUND ON THE WEBSITEHTTP://WWW.SFHIP.ORG/ AND SELECTING THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA FROM THE LIST OF SPONSORS.
ACUTE PSYCHIATRIC HOSPITAL
PART V, SECTION B, LINE 11: THE JEWISH HOME HAS A 140-PLUS-YEAR HISTORY OF COMMUNITY BENEFIT TO THE ELDERLY POPULATION OF THE BAY AREA. OBJECTIVES TO CONTINUE THIS HISTORY OF SERVICE ARE A PRINCIPAL PART OF THE HOME'S ORGANIZATIONAL PHILOSOPHY AND STRATEGIC PLANNING INITIATIVES. SPECIFIC ACTIVITIES TO ADDRESS COMMUNITY BENEFITS INCLUDE:-PLANNING TO REVITALIZE THE JEWISH HOME'S CAMPUS INTO A MODEL OF CARE THAT WILL BENEFIT MORE OLDER ADULTS IN THE BAY AREA (INCLUDING THE FRAIL AND VULNERABLE), ADDRESS URGENT SOCIETAL CHALLENGES (SUCH AS THE HUGE WAVE OF BABY BOOMERS REACHING RETIREMENT AGE), AND HELP SUSTAIN THE JEWISH HOME'S CHARITABLE MISSION BY BEING FINANCIALLY VIABLE. THIS DEVELOPMENT OF FINANCIALLY SUSTAINABLE FACILITIES, SERVICES, AND PROGRAMS WILL SERVE AND SUPPORT A BROADER CROSS-SECTION OF OLDER ADULTS RESIDING ON THE JEWISH HOME'S CAMPUS, OR IN THEIR OWN HOMES AND THE COMMUNITY.-EXPLORING COLLABORATIONS WITH ORGANIZATIONS WHOSE MISSIONS ARE SIMILAR TO THAT OF THE JEWISH HOME'S, WITH THE INTENT OF EXTENDING THE BREADTH OF CARE, PROGRAMS, AND SERVICES SO AS TO BETTER SERVE CONSTITUENT MEMBERS.-CONTINUING FUNDRAISING INITIATIVES TO ENSURE CONTINUED ABILITY TO SERVE THE FRAIL AND INDIGENT ELDERLY IN THE FUTURE.-COORDINATING WITH NEW AND ESTABLISHED RESIDENTIAL CARE FACILITIES AND PROGRAMS THROUGHOUT THE BAY AREA.-COORDINATING SERVICES AMONG OTHER JEWISH-SPONSORED ORGANIZATIONS.-DEVELOPING PROGRAMS AS THE NEEDS OF RESIDENTS CHANGE.-AS PART OF THE JEWISH SENIOR LIVING GROUP NETWORK, WORKING COLLABORATIVELY TO FURTHER DEVELOP A BROAD AND INTEGRATED NETWORK OF SENIOR LIVING COMMUNITIES, PROGRAMS, AND SERVICES IN THE BAY AREA.THE BOARD OF TRUSTEES OF THE JEWISH HOME IS COMMITTED TO ITS LONG TRADITION OF SERVICE TO THE ENTIRE COMMUNITY AND, IN PARTICULAR, THE UNDERSERVED. IT WILL CONTINUE TO IDENTIFY AND PLAN FOR NEEDS AS THE AGES AND DEMOGRAPHICS OF BOTH MEMBERS OF THE COMMUNITY AND THE HOME'S POPULATION UNDERGO GROWTH AND CHANGE.
ACUTE PSYCHIATRIC HOSPITAL
PART V, SECTION B, LINE 13B: MEDICAID/MEDICARE, STATE REGULATION
ACUTE PSYCHIATRIC HOSPITAL
PART V, SECTION B, LINE 18D: PHONE CALLS, EMAILS, LETTERS
ACUTE PSYCHIATRIC HOSPITAL
PART V, SECTION B, LINE 19D: PHONE CALLS, EMAILS, LETTERS
ACUTE PSYCHIATRIC HOSPITAL
PART V, SECTION B, LINE 22D: MEDI-CAL STATE RATE
PART V, SECTION B, LINE 16
FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
ACUTE PSYCHIATRIC HOSPITAL PART V, SECTION B, LINE 16A WEBSITE:
HTTP://JHSF.ORG/ABOUT-CHARITABLE.HTM
ACUTE PSYCHIATRIC HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:
HTTP://JHSF.ORG/ABOUT-CHARITABLE.HTM
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?
Name and address
Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
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:
COST TO CHARGE RATIOTHE COST TO CHARGE RATIO AS DETERMINED BY WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNTS REPORTED ON LINE 7A AND 7B. THE COSTING METHODOLOGY USED ON LINE 7H WAS CALCULATED BASED ON ACTUAL COSTS FROM THE ORGANIZATION'S GENERAL LEDGER.
PART I, LN 7 COL(F):
BAD DEBT EXPENSE IS REPORTED AS A NET ADJUSTMENT TO PATIENT CHARGES AND THEREFORE NOT INCLUDED AS PART OF TOTAL EXPENSES FROM PART IX, LINE 25, COLUMN A.
PART III, LINE 2:
UNCOLLECTED RESIDENT ACCOUNTS ARE ANALYZED BASED ON STANDARD PROCEDURES FOR ALL RESIDENT ACCOUNTS. THE RESULT OF THE ANALYSIS IS WHAT IS RECOGNIZED AS BAD DEBT EXPENSE. THE ORGANIZATION FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE.
PART III, LINE 3:
COST-TO-CHARGE RATIO METHOD WAS USED.
PART III, LINE 4:
THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE AUDITED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE DESCRIBING PATIENT SERVICE REVENUES AND CHARITY CARE WHICH READS AS FOLLOWS: PATIENT SERVICE REVENUES ARE RECORDED ON THE ACCRUAL BASIS IN THE PERIOD SERVICES ARE PROVIDED AT ESTABLISHED RATES REGARDLESS OF WHETHER COLLECTION IN FULL IS ANTICIPATED. CONTRACTUAL ALLOWANCES AND THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS ARE REPORTED AS DEDUCTIONS FROM PATIENT SERVICE REVENUES. CONTRACTUAL ALLOWANCES INCLUDE DIFFERENCES BETWEEN ESTABLISHED BILLING RATES AND AMOUNTS ESTIMATED BY MANAGEMENT AS PAYABLE UNDER VARIOUS CONTRACTUAL ARRANGEMENTS IN EFFECT, INCLUDING THOSE WITH THE MEDICARE AND MEDI-CAL PROGRAMS. ESTIMATION DIFFERENCES BETWEEN FINAL SETTLEMENTS AND AMOUNTS ACCRUED IN PREVIOUS YEARS ARE REPORTED AS ADJUSTMENTS TO THE CURRENT YEAR'S CONTRACTUAL ALLOWANCES. THE ORGANIZATION ACCEPTS RESIDENTS OF THE SAN FRANCISCO BAY AREA WHO MEET CERTAIN HEALTHCARE REQUIREMENTS REGARDLESS OF THEIR ABILITY TO PAY. A RESIDENT IS CLASSIFIED AS A CHARITY RESIDENT BY REFERENCE TO ESTABLISHED POLICIES OF THE ORGANIZATION. THE ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE BASED ON THESE ESTABLISHED POLICIES. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH LESSER OR NO PAYMENT IS ANTICIPATED. CHARITY CARE IS INCLUDED IN GROSS PATIENT SERVICE REVENUE AND A CORRESPONDING ALLOWANCE IS REFLECTED IN DETERMINING NET PATIENT SERVICE REVENUE. THE AMOUNT OF CHARITY CARE PROVIDED, DETERMINED ON THE BASIS OF COST, WAS $41,718 AND $20,940 FOR THE YEARS ENDED JUNE 30, 2015 AND 2014. THE ORGANIZATION ESTIMATES THE COST OF PROVIDING CHARITY CARE USING THE RATIO OF AVERAGE PATIENT CARE COST TO GROSS CHARGES, AND THEN APPLYING THAT RATIO TO THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE.
PART III, LINE 8:
MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. THE AMOUNTS REPORTED IN LINES 5, 6 AND 7 COME FROM THE HOSPITAL'S FILED MEDICARE COST REPORT. THE TOTAL REVENUE EQUATES TO MEDICARE PAYMENTS AND THE MEDICARE ALLOWABLE COSTS ARE DETERMINED ON THE MEDICARE COST REPORT THAT UTILIZED COST TO CHARGE RATIOS APPLIED TO COVERED MEDICARE REVENUES.
PART III, LINE 9B:
UNCOLLECTED RESIDENT ACCOUNTS ARE ANALYZED BASED ON STANDARD PROCEDURES FOR ALL RESIDENT ACCOUNTS. THE RESULT OF THE ANALYSIS IS WHAT IS RECOGNIZED AS BAD DEBT EXPENSE. THE ORGANIZATION FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE AUDITED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE DESCRIBING PATIENT SERVICE REVENUES AND CHARITY CARE WHICH READS AS FOLLOWS: PATIENT SERVICE REVENUES ARE RECORDED ON THE ACCRUAL BASIS IN THE PERIOD SERVICES ARE PROVIDED AT ESTABLISHED RATES REGARDLESS OF WHETHER COLLECTION IN FULL IS ANTICIPATED. CONTRACTUAL ALLOWANCES AND THE PROVISION FOR UNCOLLECTIBLE_ ACCOUNTS ARE REPORTED AS DEDUCTIONS FROM PATIENT SERVICE REVENUES. CONTRACTUAL ALLOWANCES INCLUDE DIFFERENCES BETWEEN ESTABLISHED BILLING RATES AND AMOUNTS ESTIMATED BY MANAGEMENT AS PAYABLE UNDER VARIOUS CONTRACTUAL ARRANGEMENTS IN EFFECT, INCLUDING THOSE WITH THE MEDICARE AND MEDI-CAL PROGRAMS. ESTIMATION DIFFERENCES BETWEEN FINAL SETTLEMENTS AND AMOUNTS ACCRUED IN PREVIOUS YEARS ARE REPORTED AS ADJUSTMENTS TO THE CURRENT YEAR'S CONTRACTUAL ALLOWANCES. THE HOME ACCEPTS RESIDENTS OF THE SAN FRANCISCO BAY AREA WHO MEET CERTAIN REQUIREMENTS REGARDLESS OF THEIR ABILITY TO PAY. A RESIDENT IS CLASSIFIED AS A CHARITY RESIDENT BY REFERENCE TO ESTABLISHED POLICIES OF THE HOME. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH LESSER PAYMENT IS ANTICIPATED. CHARITY CARE IS INCLUDED IN GROSS PATIENT SERVICE REVENUE AND A CORRESPONDING ALLOWANCE IS REFLECTED IN DETERMINING NET PATIENT SERVICE REVENUE.
PART VI, LINE 2:
NEEDS ASSESSMENTTHE ORGANIZATION IS A MEMBER OF BUILDING A HEALTHIER SAN FRANCISCO (BHSF), A COLLABORATION OF SAN FRANCISCO HOSPITALS, THE DEPARTMENT OF PUBLIC HEALTH, UNITED WAY, HUMAN SERVICES PROVIDERS, PHILANTHROPIC FOUNDATIONS, AND NUMEROUS COMMUNITY-BASED ORGANIZATIONS. BHSF IS COMMITTED TO WORKING TOWARD IMPROVING THE HEALTH STATUS OF ALL PEOPLE IN SAN FRANCISCO. TO THAT END, BHSF NEEDS-ASSESSMENT PROCESS UTILIZES THE BEST SECONDARY DATA AVAILABLE ON SELECTED INDICATORS OF THE HEALTH OR CONDITIONS AFFECTING THE WELL-BEING OF SAN FRANCISCO'S POPULATION AND SUBPOPULATIONS, AND SEEKS FEEDBACK AND INPUT FROM THE COMMUNITY TO GUIDE THE ASSESSMENT AND DIRECT THE CALL TO ACTION. THE ONGOING RESULTS OF THIS ONGOING ASSESSMENT ARE AVAILABLE AT THEIR WEBSITE: HTTP://WWW.SFHIP.ORG/INDEX.PHP? MODULE=ARTICLE&FUNC=COLLECTION&CID=3
PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEA RESIDENT SERVICES COORDINATOR STAFF IS AVAILABLE TO ASSIST RESIDENTS AND/OR THEIR FAMILY MEMBERS OR LEGAL REPRESENTATIVES THROUGH THE PROCESS OF DETERMINING THEIR ELIGIBILITY FOR ALL GOVERNMENT PROGRAMS AND ASSIST THEM IN THE APPLICATION PROCESS.
PART VI, LINE 4:
COMMUNITY INFORMATIONTHE ORGANIZATION SERVES THE MOST MEDICALLY/COGNITIVELY FRAIL, AS WELL AS FINANCIALLY INDIGENT ELDERS (82 PERCENT OF THE ORGANIZATION RESIDENTS ARE INDIGENT AND/OR MEDI-CAL RECIPIENTS WHO DO NOT PAY THE FULL COST OF CARE), WITH AN AVERAGE AGE OF 87. IT PROVIDES PROFESSIONAL AND COMPREHENSIVE PROGRAMS THAT INCLUDE PERSONAL AND HEALTH CARE TO THE ELDERLY WHO PRIMARILY RESIDE IN THE GREATER SAN FRANCISCO BAY AREA.
PART VI, LINE 5:
PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES TO PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITIES IT SERVES AS WELL AS TO PROVIDE TRAINING AND INTERNSHIP OPPORTUNITIES TO THE FUTURE CARETAKERS AND LEADERS OF THE COMMUNITIES. FOLLOWING IS A LIST OF SOME OF THOSE ACTIVITIES: THE ORGANIZATION'S STAFF ATTENDED AND PRESENTED IN CONFERENCES RELATED TO ISSUES ON THE CARE FOR THE ELDERLY. OVER THE PAST 39 YEARS, THE ORGANIZATION HAS PARTNERED WITH SAN FRANCISCO CITY COLLEGE IN OFFERING SEVERAL ADULT EDUCATION CLASSES TO THE GENERAL COMMUNITY. APPROXIMATELY 20 TO 25 STUDENTS ENROLL EACH SEMESTER IN THE CREATIVE ARTS CLASS. THE ORGANIZATION PARTNERS WITH LOCAL HIGH SCHOOLS THAT AIM TO INVOLVE YOUTH IN THEIR COMMUNITY BY ENCOURAGING THEM TO FULFILL NEEDS IN THEIR RESPECTIVE MILIEUS. MUTUAL GOALS INCLUDE THE PROMOTION OF CIVIC RESPONSIBILITY AND THE DEVELOPMENT OF LEADERSHIP SKILLS. STUDENTS FROM UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, SAMUEL MERRITT COLLEGE, DOMINICAN UNIVERSITY, SAN JOSE STATE UNIVERSITY, AND SAN FRANCISCO STATE UNIVERSITY CONTINUE TO INTERN WITH THE ORGANIZATION'S PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPISTS. THE ORGANIZATION REGULARLY OPENS ITS DOORS TO PROFESSIONAL ORGANIZATIONS AND COMMUNITY GROUPS, OFFERING THEM FREE MEETING SPACE, AND CONTINUING EDUCATION CREDITS. THE ORGANIZATION PARTNERS WITH LOCAL ORGANIZATIONS, FOSTERING DIALOGUE, COLLABORATIONS, AND ONGOING COMMUNICATIONS WITH ITS NEIGHBORS. GERIATRIC FELLOWS FROM THE HEBREW UNION COLLEGE - JEWISH INSTITUTE OF RELIGION IN LOS ANGELES, CALIF. (IN COOPERATION WITH THE KALSMAN INSTITUTE ON JUDAISM AND HEALTH), AND HEBREW UNION COLLEGE- JEWISH INSTITUTE OF RELIGION (HUC-JIR) IN NEW YORK RECEIVE TRAINING AT THE ORGANIZATION. FOURTH-YEAR PHARMACY STUDENTS AT UCSF SPEND 12 HOURS A WEEK, IN 12-WEEK ROTATIONS, IN THE ORGANIZATION'S PHARMACY DEPARTMENT. THROUGH ITS AFFILIATION WITH THE ORGANIZATION, SIX TO SEVEN TOURO UNIVERSITY SCHOOL OF PHARMACY STUDENTS PER ACADEMIC YEAR RECEIVE A SIX-WEEK TRAINING IN LONG-TERM CARE PHARMACY. THEY LEARN HOW THE GERIATRIC PATIENT PROCESSES DRUGS DIFFERENTLY FROM A YOUNGER POPULATION, ARE EXPOSED TO HOW DRUGS ARE DISPENSED AND UTILIZED, AND GAIN AN UNDERSTANDING OF THIRD-PARTY PAYERS. THE ORGANIZATION COLLABORATES WITH THE SAN FRANCISCO JEWISH COMMUNITY CENTER TO PROVIDE HOT, NUTRITIOUS MEALS TO JEWISH SENIORS.
PART VI, LINE 7, REPORTS FILED WITH STATES
CA
Schedule H (Form 990) 2014
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