SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
LICKING MEMORIAL HOSPITAL
 
Employer identification number

31-4379519
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 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 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) . . .
  9,755 3,549,624 3,943,195 0 0 %
b Medicaid (from Worksheet 3, column a) . . . . .   35,013 34,909,561 16,057,199 18,852,362 11.540 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .   44,768 38,459,185 20,000,394 18,852,362 11.540 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   19,181 2,831,402 148,365 2,683,037 1.640 %
f Health professions education (from Worksheet 5) . . .   1,003 682,876 15,420 667,456 0.410 %
g Subsidized health services (from Worksheet 6) . . . .     165,795   165,795 0.100 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .   3,315 589,093   589,093 0.360 %
j Total. Other Benefits . .   23,499 4,269,166 163,785 4,105,381 2.510 %
k Total. Add lines 7d and 7j .   68,267 42,728,351 20,164,179 22,957,743 14.050 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
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     52,789   52,789 0.030 %
2 Economic development   43 56,384   56,384 0.030 %
3 Community support   389 132,539   132,539 0.080 %
4 Environmental improvements            
5 Leadership development and
training for community members
    1,000   1,000 0 %
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development   762 29,747   29,747 0.020 %
9 Other            
10 Total   1,194 272,459   272,459 0.160 %
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
20,294,009
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
5,012,620
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
35,070,859
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
39,407,766
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,336,907
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 LICKING MEMORIAL HOSPITAL
1320 WEST MAIN STREET
NEWARK,OH43055
X X         X      
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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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)
LICKING MEMORIAL 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
b
c
d
e
f
g
h
i
j
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  
6 a 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   No
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
b
c
d
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.LMHEALTH.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" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2015
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Schedule H (Form 990) 2015
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
LICKING MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
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
b
c
d
e
f
g
h
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
b
c
d
e
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
WWW.LMHEALTH.ORG
b
WWW.LMHEALTH.ORG
c
d
e
f
g
h
i
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
b
c
d
e
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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Part VFacility Information (continued)

LICKING MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized 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
b
c
d
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 19. (check all that apply):
a
b
c
d
e
f
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
b
c
d
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
b
c
d
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) 2015
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Schedule H (Form 990) 2015
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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
LICKING MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: REPRESENTATIVES FROM LICKING MEMORIAL HOSPITAL PARTICIPATE IN A COLLABORATIVE COMMITTEE WITH THE LICKING COUNTY HEALTH DEPARTMENT KNOWN AS THE LICKING COUNTY COMMUNITY HEALTH IMPROVEMENT COMMITTEE. THIS COMMITTEE WAS CONVENED TO PRIORITIZE PUBLIC HEALTH ISSUES AND TO IDENTIFY RESOURCES TO ADDRESS THEM. THE COMMITTEE MEETS QUARTERLY ON AN ONGOING BASIS, BEGINNING IN APRIL 2010. MEMBERS OF THE COMMITTEE REPRESENT A VARIETY OF LOCAL PUBLIC HEALTH SYSTEM AGENCIES THAT ARE INTERESTED IN IMPROVING THE HEALTH OF LICKING COUNTY RESIDENTS. PARTICIPATING AGENCIES OF THE COMMITTEE INCLUDE, LICKING COUNTY HEALTH DEPARTMENT, LICKING COUNTY BOARD OF HEALTH, LICKING MEMORIAL HEALTH SYSTEMS, LICKING COUNTY UNITED WAY, FAMILY HEALTH SERVICES OF EAST CENTRAL OHIO, COMMUNITY HEALTH CLINIC, AMERICAN RED CROSS OF LICKING COUNTY, OHIO STATE UNIVERSITY EXTENSION - LICKING COUNTY, PATHWAYS OF CENTRAL OHIO, COMMUNITY MENTAL HEALTH AND RECOVERY BOARD, MENTAL HEALTH AMERICA OF LICKING COUNTY, LICKING COUNTY FIRE CHIEFS ASSOCIATION, LICKING COUNTY AGING PROGRAM, GRANVILLE SCHOOL DISTRICT, HOSPICE OF CENTRAL OHIO, CENTER FOR THE VISUALLY IMPAIRED, LICKING COUNTY AREA TRANSPORTATION, DENISON UNIVERSITY, LICKING COUNTY BOARD OF DEVELOPMENTAL DISABILITIES, MANY OF WHICH REPRESENT PERSONS WHO ARE THE MEMBERS OF THE MEDICALLY UNDERSERVED GROUPS AND THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.
LICKING MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: THE LICKING COUNTY HEALTH DEPARTMENT BROUGHT TOGETHER THE LICKING COUNTY COMMUNITY HEALTH IMPROVEMENT COMMITTEE, COMPRISED OF REPRESENTATIVES FROM OVER 20 AGENCIES FROM THE PUBLIC HEALTH SYSTEM IN LICKING COUNTY, TO IDENTIFY COMMUNITY NEEDS AND DEVELOP A COMMUNITY HEALTH IMPROVEMENT PLAN THAT ADDRESSES THE TOP FOUR PUBLIC HEALTH PRIORITIES IN THE COUNTY. REPRESENTATIVES FROM LICKING MEMORIAL HOSPITAL PARTICIPATED IN THIS COMMITTEE WHICH PROVIDED AN OPPORTUNITY TO BROADEN THE IMPACT OF ITS PROGRAMS.
LICKING MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: AFTER COMPLETING THE COMMUNITY HEALTH NEEDS ASSESSMENT, LICKING MEMORIAL HEALTH SYSTEMS PRIORITIZED FIVE NEEDS TO ADDRESS. BELOW ARE EACH OF THOSE NEEDS AND OUR PLANS TO ADDRESS THEM: REDUCE TOBACCO USAGE A - PROVIDE A QUIT FOR YOUR HEALTH PROGRAM THAT PROVIDES COUNSELING AND SMOKING CESSATION SUPPORT, INCLUDING NICOTINE REPLACEMENT THERAPY, TO ALL INTERESTED COMMUNITY MEMBERS FREE OF CHARGE. WE WILL ALSO ADDRESS ANY NEED FOR ADDITIONAL ADVERTISING OF THE QUIT FOR YOUR HEALTH PROGRAM. B - ENCOURAGE EMPLOYERS TO ADOPT SMOKE-FREE WORKPLACE POLICIES AND OFFER INCENTIVES TO THEIR STAFF TO STOP SMOKING. WE WILL CONSIDER DEVELOPMENT OF BUSINESS WELLNESS TOOLKITS THAT COUNTY EMPLOYERS CAN UTILIZE FOR STAFF EDUCATION. C - CONDUCT FOCUS STUDIES WITH YOUTH GROUPS TO GAUGE TOBACCO USAGE HABITS IN THE YOUTH POPULATION AND LEVERAGE THE INFORMATION FOR TOBACCO CESSATION AND PREVENTION EDUCATION. COLLABORATE WITH THE OUR FUTURES IN LICKING COUNTY INITIATIVE ON YOUTH SMOKING AND ALCOHOL EDUCATION. REDUCE OBESITY A - CONTINUE OUR ACTIVE FIT YOUTH WELLNESS PROGRAM PROMOTING HEALTHY LIFESTYLES, EXERCISE, AND DIET CHOICES AMONG THE YOUTH OF LICKING COUNTY, IN CONJUNCTION WITH OTHER COMMUNITY HEALTH LEADERS. B - PROMOTE MEMBERSHIP IN THE LICKING COUNTY WELLNESS COALITION. C - INCREASE AWARENESS AND PROVIDE DIABETES EDUCATION WITHIN THE COMMUNITY, INCLUDING INTENSIVE ONE-ON-ONE EDUCATION WITH LICENSED DIABETES EDUCATORS AND COMPLIMENTARY COMMUNITY EDUCATION PROGRAMMING. D - PROVIDE FREE DIABETES SCREENINGS AT COMMUNITY EVENTS. E - PROVIDE COMMUNITY EDUCATION PROGRAMMING FOCUSED ON HEALTHIER FOOD CHOICES, EXERCISE AND GOOD LIFESTYLE HABITS. DECREASE BREAST CANCER MORTALITY A - PROVIDE ROUTINE COMMUNITY EDUCATION ON THE IDENTIFICATION AND TREATMENT OF BREAST CANCER, FOCUSING ON SELF-EXAMINATION, PATHOLOGY AND EARLY DETECTION. PROGRAMS WILL INCLUDE FREE BREAST CANCER EXAMS FOR ATTENDEES. B - PROVIDE MAMMOGRAM DAYS IN WHICH UNDERSERVED OR UNINSURED COMMUNITY MEMBERS MAY RECEIVE MAMMOGRAMS FREE OF CHARGE. DECREASE COLON CANCER MORTALITY A - INCREASE COLON CANCER SCREENINGS THROUGH PRIMARY CARE PRACTICES/OFFICES. B - ADD ADDITIONAL GASTROENTEROLOGIST PHYSICIAN COVERAGE TO INCREASE PATIENT ACCESS TO AVAILABLE APPOINTMENTS AND INCREASE OPPORTUNITIES FOR COLON CANCER SCREENINGS. C - EVALUATE THE USE OF SEPTIN 9 BIOMARKERS FOR USE IN PATIENTS WHO ARE AVERSE TO COLONOSCOPY. D - PROVIDE FREE COMMUNITY EDUCATION PROGRAMMING WITH FOCUS ON REGULAR SCREENING, SYMPTOMS/PATHOLOGY AND EARLY DIAGNOSIS. MOBILIZE PARTNERSHIPS AND DEVELOP STRATEGIES TO ADDRESS COMMUNITY HEALTH OBJECTIVES WITHIN THE COMMUNITY HEALTH IMPROVEMENT COMMITTEE. A - EVALUATE EXISTING PROGRAMS AND DEVELOP NEW INITIATIVES DESIGNED TO REDUCE CANCER RISKS, PROVIDE EARLY DETECTION, ENHANCE TREATMENT, AND IMPROVE SURVIVOR QUALITY OF LIFE. KEY MEMBERS OF LICKING MEMORIAL HEALTH SYSTEMS WILL SERVE AS ADVISORS OR ON THIS COMMITTEE. B - FOCUS ON IMPROVING COLONOSCOPY RATES WITHIN THE COUNTY. C - PROVIDE EDUCATIONAL SESSIONS ON PRESCRIPTION DRUG ABUSE IN LICKING COUNTY. D - HOLD PRESCRIPTION DRUG "TAKE BACK" EVENTS.
LICKING MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY IN PLACE THAT DISCOUNTS CARE TO THOSE APPLYING FOR AND MEETING THE INCOME LIMITS FOR DISCOUNTED CARE AT A RATE THAT IS GREATER THAN THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 8
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?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 9
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY LICKING MEMORIAL HEALTH SYSTEMS AND INCLUDES LICKING MEMORIAL HEALTH SYSTEMS, LICKING MEMORIAL HOSPITAL, LICKING MEMORIAL PROFESSIONAL CORPORATION, LICKING MEMORIAL HEALTH FOUNDATION.
PART I, LINE 7: THE ORGANIZATION USED THE CBISA SOFTWARE TO DETERMINE THE COST ACCOUNTING METHODOLOGY.
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 $ 20,294,010.
PART II, COMMUNITY BUILDING ACTIVITIES: IT IS IMPORTANT TO NOTE THAT ALL ACTIVITIES ASSOCIATED WITH LICKING MEMORIAL HEALTH SYSTEMS (LMHS) REFLECT AND FURTHER THE MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY". WE DEFINE THE HEALTH OF THE COMMUNITY IN A BROAD SENSE IN ORDER TO INCLUDE ACTIVITIES THAT ARE NOT NECESSARILY HEALTH AND MEDICALLY RELATED, BUT WHICH ARE CRITICAL TO SUSTAINING A HEALTHY COMMUNITY, SUCH AS STRONG SCHOOL SYSTEMS, YOUTH PROGRAMS AND ARTS. TO PROMOTE HEALTH EDUCATION TO THE COMMUNITY, WE PUBLISH THE COMMUNITY CONNECTION, A BI-MONTHLY MAGAZINE MAILED TO APPROXIMATELY 44,000 HOUSEHOLDS THAT HIGHLIGHTS ALL OF THE COMMUNITY BUILDING ACTIVITES THROUGHOUT THE YEAR. ADVOCACY FOR THE HEALTH OF THE COMMUNITY IS NOT ONLY EVIDENT THROUGH THE COMMUNITY CONNECTION PUBLICATIONS, BUT THROUGH VARIOUS HEALTH-RELATED EVENTS AND CLASSES INCLUDING HEALTH FAIRS, SCHOOL PRESENTATIONS, HEALTH IMPROVEMENT SCREENINGS, AND WORKSHOPS THAT AID IN OVERALL HEALTH EDUCATION OF THE COMMUNITY. LMHS REGULARLY WELCOMES COMMUNITY MEMBERS TO ATTEND FREE EDUCATIONAL PROGRAMS AT THE HOSPITAL. PROGRAMS ARE DESIGNED TO EMPOWER COMMUNITY MEMBERS WITH THE INFORMATION NEEDED TO IMPROVE THEIR HEALTH AND THE HEALTH OF THEIR FAMILIES. TO FURTHER "IMPROVE THE HEALTH OF THE COMMUNITY", LMHS SUSTAINS ECONOMIC DEVELOPMENT BY EXISTING AS THE COUNTY'S LARGEST EMPLOYER.
PART III, LINE 2: THE ORGANIZATION USES THE CBISA SOFTWARE FOR COSTING METHODOLOGY, A SOFTWARE PROGRAM ENDORSED BY BOTH THE OHIO HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION.
PART III, LINE 3: THE ORGANIZATION EMPLOYED A PATIENT SCORING METHODOLOGY WHICH COMBINES NUMEROUS FINANCIAL INDICATORS TO ARRIVE AT A NUMERIC CREDIT SCORE. THIS SCORE INCLUDES THE PATIENT'S ABILITY TO PAY BASED ON THE ESTIMATED HOUSEHOLD INCOME AS WELL AS THE PROBABILITY OF PAYMENT BEING MADE BASED ON HISTORICAL CREDIT INFORMATION.
PART III, LINE 4: SEE PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8: THE MEDICARE SHORTFALL REPRESENTS AN UNDERPAYMENT OF OUR COSTS FOR PROVIDING SERVICES TO TRADITIONAL MEDICARE PATIENTS, OUR LARGEST PAYER. SINCE THIS SHORTFALL RELATES TO SUCH A LARGE PORTION OF OUR COMMUNITY, WE FEEL THE COST SHORTFALL IS A RELEVANT FACTOR WHEN CONSIDERING COMMUNITY BENEFIT.WE USE THE MEDICARE COST REPORT FOR COSTING METHODOLOGY FOR CALCULATING THE MEDICARE SHORTFALL.IN ADDITION TO TRADITIONAL MEDICARE SHORTFALLS, THE HOSPITAL PROVIDES SERVICES TO MEDICARE HMO PATIENTS AT OR BELOW COST AS A FURTHER BENEFIT TO OUR COMMUNITY. BY ADOPTING THE SAME METHODOLOGY FOR TRADITIONAL MEDICARE ABOVE, THE MEDICARE HMO SHORTFALL AMOUNTED TO $4,669,161ALONG THAT SAME LINE, LICKING MEMORIAL PROFESSIONAL CORPORATION, ANOTHER LMHS SUBSIDIARY, PROVIDED SERVICES TO MEDICARE (TRADITIONAL AND HMO) BENEFICIARIES AT A COST SHORTFALL OF $7,597,910 USING A CBISA SOFTWARE COSTING METHOD. THE CBISA SOFTWARE IS ENDORSED BY BOTH THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION AS A COSTING METHOD UTILIZED FOR DETERMINING SHORTFALLS.
PART III, LINE 9B: THE PATIENT ACCOUNTING DEPARTMENT IS RESPONSIBLE FOR THE COLLECTION OF PATIENTS' ACCOUNTS. THE OBJECTIVE OF THE DEPARTMENT IS TO COLLECT ACCOUNTS DUE THE HOSPITAL WHILE MAINTAINING POSITIVE GUEST RELATIONS.-PRIOR TO OR UPON ADMISSION, PATIENT INFORMATION IS OBTAINED BY THE REGISTRATION DEPARTMENT. THIS INFORMATION IS FORWARDED TO THE PATIENT ACCOUNT REPRESENTATIVE FOR MEDASSIST, INC. UPON ADMISSION.-WHENEVER POSSIBLE, SELF-PAY INPATIENTS ARE INTERVIEWED BY THE PATIENT ACCOUNT REPRESENTATIVE PRIOR TO DISCHARGE. PATIENTS WILL BE SCREENED FOR POSSIBLE STATE OR FEDERAL PROGRAM ELIGIBILITY, SUCH AS MEDICAID ORSOCIAL SECURITY DISABILITY. IF PATIENTS DO NOT MEET THE CRITERIA FOR THESE PROGRAMS, THEY WILL BE INFORMED OF THE UNCOMPENSATED CARE PROGRAMS AVAILABLE.- ALL STATEMENTS CONTAIN INFORMATION AND GUIDELINES FOR UNCOMPENSATED CARE.
PART VI, LINE 2: WITH A MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY", LMHS CONTINUOUSLY MONITORS AND ASSESSES THE NEEDS OF OUR COMMUNITY IN A VARIETY OF METHODS. OUR ENTIRE LEADERSHIP TEAM IS VERY ACTIVE IN THE COMMUNITY, SERVING ON LOCAL, NOT-FOR-PROFIT BOARDS AND IN SERVICE CLUBS SUCH AS ROTARY AND KIWANIS. AS THE LARGEST EMPLOYER IN LICKING COUNTY, THE COMMUNITY LOOKS TO OUR MANAGEMENT STAFF FOR SUPPORT AND INVOLVEMENT IN MOST, IF NOT ALL, MAJOR INITIATIVES. THIS COMMUNITY INVOLVEMENT PROVIDES THE OPPORTUNITY TO COLLECT INFORMATION REGARDING THE NEEDS OF THE DIFFERENT ORGANIZATIONS. SENIOR MANAGEMENT IS VERY RESPONSIVE IN PROVIDING ASSISTANCE WHERE NEEDED AS THE INFORMATION BECOMES AVAILABLE.THE BOARDS OF DIRECTORS FOR LICKING MEMORIAL HOSPITAL (LMH) AND THE HEALTH SYSTEMS ARE VERY INTERESTED AND ACTIVELY ENGAGED IN THE COMMUNITY; THEREFORE, THEY ARE A GREAT RESOURCE IN MAKING ADMINISTRATION AWARE OF NEEDS. IN ADDITION, THE BOARD RECEIVES A MONTHLY REPORT AT EACH BOARD MEETING, HIGHLIGHTING ALL OF THE COMMUNITY ACTIVITIES SUPPORTED BY THE HOSPITAL INCLUDING DONATIONS MADE DURING THAT MONTH, HEALTH FAIRS, HEALTH SCREENINGS, MANAGEMENT AND PHYSICIANS SPEAKING IN THE COMMUNITY, ETC. PROVIDING ALL OF THIS INFORMATION TO THE BOARD ALLOWS THEM TO BE SUPPORTIVE AS ADMINISTRATION RECOMMENDS IMPLEMENTING NEW SERVICES OR ENHANCING EXISTING OFFERINGS.ORGANIZED UNDER THE HOSPITAL CORPORATION IS A 75 MEMBER DEVELOPMENT COUNCIL WHOSE PURPOSE IS TO EDUCATE THE COMMUNITY ABOUT THE HOSPITAL AND TO COMPLETE FUNDRAISING ACTIVITIES IN SUPPORT OF THE ORGANIZATION. THE MEMBERS OF THE LMH DEVELOPMENT COUNCIL ARE COMMUNITY LEADERS REPRESENTING ALL AREAS OF BUSINESS, INDUSTRY AND EDUCATION IN THE COMMUNITY. THESE ARE INDIVIDUALS WHO HAVE THEIR "FINGERS ON THE PULSE" OF THE COMMUNITY, AND ONE OF THEIR RESPONSIBILITIES AS AMBASSADORS IS TO MAKE THE ADMINISTRATION AWARE OF NEEDS IN THE COMMUNITY ESPECIALLY PERTAINING TO HEALTH CARE. AMONG MANY OUTREACH ACTIVITIES OF THE DEVELOPMENT COUNCIL, PROBABLY THE MOST PRODUCTIVE ARE THE COMMUNITY LEADER ROUNDTABLES THAT ARE SPONSORED BY THIS GROUP. THESE ARE LUNCHEONS SCHEDULED MONTHLY WITH THE HEALTH SYSTEMS PRESIDENT & CEO. DEVELOPMENT COUNCIL MEMBERS SERVE AS HOSTS, AND THEY INVITE 20-25 PEOPLE WITH SIMILAR INTERESTS. SOME EXAMPLES OF RECENT ROUNDTABLE GROUPS INCLUDE SCHOOL NURSES, SCHOOL ATHLETIC DIRECTORS AND COACHES, REALTORS, FIRE CHIEFS, LOCAL POLITICIANS, ETC. THESE FORUMS ARE ALWAYS VERY INFORMATIVE FOR BOTH ATTENDEES AND THE ADMINISTRATION AS WE SHARE INFORMATION ABOUT THE HOSPITAL AND THEN ASK FOR FEEDBACK FROM THE COMMUNITY LEADERS WHO ARE PRESENT. MANY TIMES, IDEAS FOR HOSPITAL INITIATIVES COME FROM THESE EVENTS.ANOTHER ACTIVITY OF THE DEVELOPMENT COUNCIL IS A QUARTERLY CORPORATE BREAKFAST. THESE EDUCATIONAL SESSIONS NORMALLY DRAW 100-125 ATTENDEES FOR BREAKFAST AND PROVIDE AN OPPORTUNITY TO EDUCATE THE COMMUNITY LEADERSHIP REGARDING HOSPITAL ACTIVITIES AND TO PROVIDE AN OPEN FORUM TO DISCUSS HEALTH CARE AND OTHER NEEDS WITHIN THE COMMUNITY. SPEAKERS AT THESE EVENTS HAVE INCLUDED PHYSICIANS SPEAKING ABOUT OPHTHALMOLOGY, UROLOGICAL SERVICES, HEART ATTACK AWARENESS, REHABILITATION SERVICES, AND OTOLARYNGOLOGY. IN ADDITION, NEW PHYSICIANS ARE INTRODUCED TO THE COMMUNITY LEADERS IN ATTENDENCE AT THE CORPORATE BREAKFAST EVENTS.THE HEALTH SYSTEMS' WEBSITE PROVIDES DETAILED INFORMATION ON THE VARIOUS PROGRAMS AVAILABLE AND PROVIDES A MECHANISM FOR COMMUNITY FEEDBACK. ALL REQUESTS COMING THROUGH THE WEBSITE RECEIVE CAREFUL CONSIDERATION AND A DETAILED RESPONSE.AN AFFILIATED PHYSICIAN GROUP, KNOWN AS THE LICKING MEMORIAL PROFESSIONAL CORPORATION, PROVIDES PHYSICIAN INPUT REGARDING THE NEEDS THEY IDENTIFY IN THEIR DAILY PRACTICE AND COMMUNITY INVOLVEMENT. THESE OBSERVATIONS ARE DISCUSSED WITH ADMINISTRATION FOR DEVELOPMENT OF PROGRAMS AND SERVICES TO ADDRESS SUCH NEEDS.
PART VI, LINE 3: LMHS PROVIDES ASSISTANCE TO THOSE WHO ARE ABOVE THE FEDERAL POVERTY LEVEL BY OFFERING DISCOUNTED CARE BASED UPON A SLIDING SCALE UP TO 250% OF THE FEDERAL POVERTY LEVEL. IN ADDITION, THE ORGANIZATION PROVIDES FREE OR DISCOUNTED CARE FOR THOSE WHO ARE CONSIDERED MEDICALLY INDIGENT. IN 2015, LMHS PROVIDED $27.6 MILLION OF UNCOMPENSATED CARE AT STANDARD CHARGES, INCLUDING $4.6 MILLION OF CHARITY CARE.HOWEVER, LMHS PROVIDES CARE TO THE ENTIRE COMMUNITY, REGARDLESS OF INCOME LEVELS. THAT MESSAGE IS SHARED WITH THE COMMUNITY IN A VARIETY OF WAYS. THE HEALTH SYSTEMS' WEBSITE PROVIDES INFORMATION ON ASSISTANCE FOR PAYING HOSPITAL BILLS THROUGH THE HOSPITAL CARE ASSURANCE PROGRAM/ COMMUNITY ASSISTANCE PROGRAM. THIS IS ALSO COMMUNICATED THROUGH BROCHURES AND APPLICATIONS WHICH HIGHLIGHT THE INCOME LEVEL-BASED NEEDS FOR THE PATIENT. IN ADDITION, THE BILLING STATEMENT SENT TO THE PATIENT OR GUARANTOR PROVIDES INSTRUCTIONS FOR ACCESSING CHARITY CARE. THIS INFORMATION ALSO CAN BE ACCESSED THROUGH THE BILLING OFFICE. FURTHERMORE, THE HEALTH SYSTEMS CONTRACTS WITH AN ELIGIBILITY COMPANY TO SCREEN AND IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR ASSISTANCE, AND EMPLOYS USE OF EARLY-OUT AGENCIES TO PERFORM SELF-PAY BILLING SERVICES. THESE AGENCIES ROUTINELY IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR ASSISTANCE AND PROVIDE APPLICATIONS FOR COMPLETION. THE LMH DEVELOPMENT COUNCIL HAS BEEN EDUCATED ABOUT OUR COMMITMENT TO PROVIDE CARE FOR THE ENTIRE COMMUNITY - THAT MESSAGE IS SHARED IN THE COMMUNITY THROUGH THEIR GRASS ROOTS EFFORTS.
PART VI, LINE 4: LICKING MEMORIAL HOSPITAL IS LOCATED IN NEWARK, OHIO THIRTY MILES EAST OF COLUMBUS. THE CITY OF NEWARK HAS A POPULATION OF ABOUT 48,000 PEOPLE WITH A MEDIAN INCOME OF APPROXIMATELY $37,000. THE HOSPITAL SERVES THE COMMUNITY OF NEWARK AND LICKING COUNTY. LICKING COUNTY HAS A POPULATION OF APPROXIMATELY 170,000 (PER US CENSUS BUREAU), A PER CAPITA INCOME OF APPROXIMATELY $27,000 AND AN UNEMPLOYMENT RATE OF 4.3%.
PART VI, LINE 5: THROUGH THE MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY", LMHS PROMOTES HEALTH EDUCATION AND WELLNESS IN VARIOUS WAYS. LMHS PROVIDES SERVICES, WHICH INCLUDE PARTICIPATION IN MANY COMMUNITY HEALTH FAIRS THROUGHOUT THE COUNTY TO ENCOURAGE AND ADVANCE HEALTHCARE EDUCATION IN AREA SCHOOLS, CHURCHES, AND BUSINESSES; PROVIDED MANY FREE CLASSES REGARDING TOPICS SUCH AS CHILDBIRTH, INFANT AND CHILD CPR, BREASTFEEDING, SIBLING PREPARATION, DIABETES, NEWBORN BASICS, AND TOBACCO CESSATION; PROVIDED SUPPORT GROUPS FOR VICTIMS AND FAMILIES OF CANCER, DIABETES, CHEMICAL DEPENDENCY, AND HEART DISEASE; PROVIDED ASSISTANCE TO EDUCATORS THROUGH COALITIONS WITH STUDENT NURSES, OCCUPATIONAL THERAPY, AND PHYSICAL THERAPY INTERNS; PROVIDED SPEAKERS TO SCHOOLS, BUSINESSES, AND VARIOUS ORGANIZATIONS ON TOPICS SUCH AS TOBACCO CESSATION, LEADING AN ACTIVE AND HEALTHY LIFESTYLE, AND DIABETES EDUCATION. THE SCHEDULE IS FOUND ONLINE OR PRINTED THROUGH OUR BI-MONTHLY COMMUNITY CONNECTION PUBLICATION FOR THE COMMUNITY TO ACKNOWLEDGE. LMHS ALSO PROMOTES HEALTH AND WELLNESS TO THE COMMUNITY THROUGH A VARIETY OF INITIATIVES. IN 2012, THE HEALTH SYSTEMS CREATED THE ACTIVE-FIT YOUTH WELLNESS PROGRAM, TARGETING YOUTH AGES 6-12. THE PROGRAM OFFERS A FREE ONLINE GOAL-ORIENTED WELLNESS ACTIVITY PLAN WITH INCENTIVES FOR THOSE WHO COMPLETE THEIR GOALS. THE PROGRAM ALSO FEATURES UNIQUE COMMUNITY EVENTS TO HELP THE PARTICIPANTS STAY ACTIVE AND LEARN HOW TO BETTER CARE FOR THEIR PERSONAL HEALTH. THE PROGRAM HAS BEEN PROMOTED DIRECTLY TO THE YOUTH WITH SCHOOL ASSEMBLY PRESENTATIONS AND THROUGH AN AGGRESSIVE ADVERTISING AND MARKETING CAMPAIGN TO THE COMMUNITY.THE HEALTH SYSTEMS ALSO EMPHASIZES THE NEED FOR EXCELLENT PERSONAL HEALTH TO A VARIETY OF DEMOGRAPHICS THROUGH SPECIAL EVENTS. FOR EXAMPLE, LMHS INVITES COMMUNITY MEMBERS EACH YEAR TO A RED DRESS GALA EVENT FEATURING SPEAKER PRESENTATIONS, DEMONSTRATIONS, HEALTH SCREENINGS AND HEART-HEALTHY FOODS. EACH SUMMER, LMHS OFFERS THE HEART TO PLAY PROGRAM TO LICKING COUNTY JUNIOR- AND HIGH SCHOOL STUDENTS. THE PROGRAM FEATURES HEALTH REVIEW EVENTS THROUGHOUT THE SUMMER MONTHS WITH AN EKG HEART SCREENING, IN ADDITION TO A HEALTH AND CONCUSSION SCREENING.THE HEALTH SYSTEMS ALSO DEVOTES RESOURCES TO A HEALTH-RELATED COMMUNITY BENEFIT PROJECT EACH YEAR. IN 2013, THE HEALTH SYSTEMS BEGAN UPGRADING THE 12-LEAD EKGS FOR THE LOCAL EMS PROVIDERS. THIS IS A MULTI YEAR PROJECT TO BE CARRIED OUT FROM 2013 THROUGH 2016 FOR A TOTAL CONTRIBUTION OF $845,000.
PART VI, LINE 6: LICKING MEMORIAL HEALTH SYSTEMS (THE SYSTEM) IS A NONPROFIT CORPORATION ORGANIZED UNDER THE LAWS OF THE STATE OF OHIO TO PROVIDE AND PROMOTE HEALTH CARE SERVICES IN CENTRAL OHIO.THE SYSTEM IS THE PARENT ORGANIZATION AND SOLE CORPORATE MEMBER OF LICKING MEMORIAL HOSPITAL (LMH), LICKING MEMORIAL HEALTH FOUNDATION (LMHF), AND LICKING MEMORIAL PROFESSIONAL CORPORATION (LMPC).LMPC EMPLOYS A STAFF OF PHYSICIANS AND SUPPORT PERSONNEL TO FURTHER THE HEALTH SYSTEM'S CHARITABLE PURPOSE. LMPC HAS A SOLE PHYSICIAN SHAREHOLDER, WHO, UNDER A SHARED CONTROL AGREEMENT, ASSIGNED THE VOTING RIGHTS OF THE STOCK TO LMHS.
Schedule H (Form 990) 2015
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