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 Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
HALIFAX REGIONAL HOSPITAL INC
 
Employer identification number

54-0648699
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) . . . 		    2,239,350   2,239,350 2.690 %
b Medicaid (from Worksheet 3, column a) . . . . .     6,973,816 8,110,776 0 0 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     9,213,166 8,110,776 2,239,350 2.690 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     315,213   315,213 0.380 %
f Health professions education (from Worksheet 5) . . .     110,426   110,426 0.130 %
g Subsidized health services (from Worksheet 6) . . . .     12,065,114   12,065,114 14.500 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     130,464   130,464 0.160 %
j Total. Other Benefits . .     12,621,217   12,621,217 15.170 %
k Total. Add lines 7d and 7j .     21,834,383 8,110,776 14,860,567 17.860 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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     6,692   6,692 0.010 %
3 Community support     1,512   1,512 0 %
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy     9,591   9,591 0.010 %
8 Workforce development     1,297,452   1,297,452 1.560 %
9 Other            
10 Total     1,315,247   1,315,247 1.580 %
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
8,053,153
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
36,545,407
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
45,350,783
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-8,805,376
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 %
11 HALIFAX PHO INC
  		MANAGED CARE 50.000 %   50.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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?1Name, 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 HALIFAX REGIONAL HOSPITAL INC
2204 WILBORN AVENUE
SOUTH BOSTON,VA24592
WWW.SENTARA.COM
H1853 		X X         X   HOME HEALTH HOSPICE  
Schedule H (Form 990) 2017
Page 4
Schedule H (Form 990) 2017
Page 4
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)
HALIFAX REGIONAL HOSPITAL INC
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 15
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   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
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 15
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 Yes  
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) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
HALIFAX REGIONAL HOSPITAL INC
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 Was widely publicized 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.SENTARA.COM/FINANCIALASSISTANCE
b
WWW.SENTARA.COM/FINANCIALASSISTANCE
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
Page 6
Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
HALIFAX REGIONAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
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
e
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
Schedule H (Form 990) 2017
Page 7
Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
HALIFAX REGIONAL HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2017
Page 8
Schedule H (Form 990) 2017
Page 8
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, 16j, 18e, 19e, 20e, 21c, 21d, 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
HALIFAX REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 5: IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), SENTARA HALIFAX REGIONAL HOSPITAL (SHRH) TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING REPRESENTATIVES OF THE LOCAL PUBLIC HEALTH DEPARTMENTS AND ORGANIZATIONS SERVING THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS THROUGH: 1) SURVEYING KEY COMMUNITY STAKEHOLDERS BY USE OF AN ONLINE SURVEY TO IDENTIFY SIGNIFICANT HEALTH PROBLEMS AND SERVICE GAPS; 2) REVIEW OF ASSESSMENTS AND OTHER PLANNING DOCUMENTS PREPARED BY COMMUNITY ORGANIZATIONS SUCH AS THE LOCAL HEALTH DEPARTMENT; AND 3) DIRECT COMMUNICATION WITH COMMUNITY STAKEHOLDERS THROUGH INTERVIEWS AND A FOCUS GROUP.1) SHRH IDENTIFIED ITS SENIOR LEADERSHIP TEAM TO SERVE AS THE CHNA STEERING COMMITTEE RESPONSIBLE FOR OVERSEEING THE ASSESSMENT, INCLUDING THE SURVEY. THE SURVEY DISTRIBUTION LIST WAS REVIEWED TO ENSURE BROAD REPRESENTATION, INCLUDING REPRESENTATIVES OF THE LOCAL HEALTH DEPARTMENTS, COMMUNITY SERVICES BOARDS (MENTAL HEALTH AND SUBSTANCE ABUSE), SOCIAL SERVICES DEPARTMENTS, EDUCATIONAL INSTITUTIONS, PROVIDERS (MEDICAL, DENTAL, ETC.), BUSINESSES, VOLUNTARY HEALTH AGENCIES, AREA AGENCIES ON AGING, CIVIC LEAGUES, THE FAITH COMMUNITY AND OTHER HEALTH AND HUMAN SERVICES ORGANIZATIONS AND GROUPS. DURING THE SURVEY PROCESS, THE RESPONSE RATE WAS MONITORED AND FOLLOW UP WAS MADE TO ENSURE GOOD AND BROADLY REPRESENTATIVE PARTICIPATION.2) HEALTH-RELATED ASSESSMENTS AND PLANS DEVELOPED BY OTHER ORGANIZATIONS WERE IDENTIFIED AND REVIEWED. THESE FINDINGS WERE TAKEN INTO ACCOUNT IN THE IDENTIFICATION OF SIGNIFICANT HEALTH ISSUES AND IN THE DEVELOPMENT OF THE HOSPITAL'S IMPLEMENTATION STRATEGIES.3) DIRECT COMMUNICATION WITH COMMUNITY STAKEHOLDERS WAS ALSO AN IMPORTANT PART OF THE PROCESS. MEMBERS OF THE STEERING COMMITTEE PROVIDED INPUT BASED UPON THEIR INVOLVEMENT IN COMMUNITY COALITIONS AND COMMUNITY HEALTH INITIATIVES AND THEIR COMMUNICATIONS WITH INDIVIDUALS IN THE COMMUNITY. IN ADDITION, HOSPITAL STAFF CONDUCTED KEY INFORMANT INTERVIEWS AND A FOCUS GROUP TO RECEIVE BROADER INPUT.
HALIFAX REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 7D: COPIES OF THE ASSESSMENT HAVE BEEN MADE AVAILABLE TO COMMUNITY ORGANIZATIONS.A LINK TO THE HOSPITAL FACILITY'S COMMUNITY HEALTH NEEDS ASSESSMENT IS ALSO ON THE SENTARA HEALTHCARE WEBSITE:HTTP://WWW.SENTARA.COM/ASSETS/PDF/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/SHRH-2015-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF
HALIFAX REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE SHRH COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED NUMEROUS HEALTH ISSUES. DURING THE CHNA PROCESS, THE HOSPITAL UNDERWENT A PRIORITIZATION PROCESS TO IDENTIFY THE SIGNIFICANT HEALTH NEEDS FOR WHICH IMPLEMENTATION STRATEGIES SHOULD BE DEVELOPED. THE PROCESS CONSIDERED FACTORS SUCH AS SIZE AND SCOPE OF THE HEALTH PROBLEM, THE INTENSITY AND SEVERITY OF THE ISSUE, THE POTENTIAL TO EFFECTIVELY ADDRESS THE PROBLEM AND THE AVAILABILITY OF COMMUNITY RESOURCES, IMPACT ON HEALTH DISPARITIES, THE IMPORTANCE TO THE COMMUNITY, AND SENTARA'S MISSION "TO IMPROVE HEALTH EVERYDAY". FOR THE SIGNIFICANT HEALTH NEEDS, IN ADDITION TO EXECUTION OF THE IMPLEMENTATION STRATEGIES, THE HOSPITAL IS PARTICIPATING IN A VARIETY OF LOCAL INITIATIVES. SOME OF THE AREA NEEDS WHICH ARE NOT SPECIFICALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY WERE IDENTIFIED AS LOWER PRIORITY BECAUSE THEY DID NOT RANK HIGH WITH THE PRIORITIZATION FACTORS.
HALIFAX REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 16J: QUARTERLY ARTICLES WERE PLACED IN LOCAL NEWSPAPERS TO INFORM THE PUBLIC ABOUT THE FINANCIAL ASSISTANCE POLICY.
HALIFAX REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 20E: THE HOSPITAL USES AN OUTSIDE VENDOR THAT SCREENS ALL PATIENTS WITHOUT INSURANCE FOR ELIGIBILITY FOR GOVERNMENT PROGRAMS, AND A FINANCIAL COUNSELOR WHO SCREENS THOSE THAT ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAMS TO DETERMINE WHETHER THEY MEET CRITERIA FOR CHARITY CARE.
HALIFAX REGIONAL HOSPITAL, INC.: PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS PRESENTED IN THE CHNA ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED BY COMMUNITY MEMBERS VIA MULTIPLE METHODS. IN ADDITION TO A KEY STAKEHOLDER SURVEY CONDUCTED ONLINE, FOCUS GROUPS ARE CONDUCTED, WITH ADDITIONAL INTERVIEWS WITH POLICY MAKERS AND REPRESENTATIVES OF INDEPENDENT COMMUNITY ORGANIZATIONS. SENTARA ENSURES THAT RESPONDENTS TO REQUESTS FOR INPUT REPRESENT MANY TYPES OF COMMUNITY ACTORS: POLICY MAKERS, SERVICE PROVIDERS, REPRESENTATIVES OF PUBLIC HEALTH ORGANIZATIONS, REPRESENTATIVES OF UNDERSERVED POPULATIONS, SOCIAL SERVICE PROVIDERS AND GOVERNMENT FUNCTIONS SUCH AS SCHOOLS, AND THE BUSINESS AND LARGER COMMUNITIES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
Page 9
Schedule H (Form 990) 2017
Page 9
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?1
Name and address Type of Facility (describe)
1 1 - CENTER FOR BEHAVIORAL HEALTH
504 WILBORN AVENUE
SOUTH BOSTON,VA24592 		REHABILITATION CENTER
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2017
Page 10
Schedule H (Form 990) 2017
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 3C: THE ORGANIZATION USES A MULTI-FACETED REVIEW OF AN APPLICANT'S SITUATION TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. AN APPLICANT'S HOUSEHOLD INCOME IS EVALUATED IN LIGHT OF RELEVANT FACTS AND CIRCUMSTANCES, SUCH AS REPORTED INCOME, ASSETS, LIABILITIES, EXPENSES, AND OTHER RESOURCES AVAILABLE TO THE APPLICANT OR THE APPLICANT'S RESPONSIBLE PARTY, WHEN DETERMINING THE LEVEL OF FINANCIAL ASSISTANCE THAT AN APPLICANT QUALIFIES FOR UNDER THE FINANCIAL ASSISTANCE POLICY.
PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT WAS CONTAINED IN A SYSTEM-WIDE REPORT PREPARED BY SENTARA HEALTHCARE, EIN 52-1271901, THE ORGANIZATION'S 501(C)(3) SOLE MEMBER.
PART I, LINE 7: EXCEPT FOR SUBSIDIZED HEALTH SERVICES, THE ORGANIZATION USED A COST-TO-CHARGES RATIO FROM WORKSHEET 2 TO DETERMINE THE AMOUNTS REPORTED IN PART I, LINE 7. COST METHOD WAS USED FOR SUBSIDIZED HEALTH SERVICES (7G).
PART I, LINE 7G: $12,065,114 OF THE AMOUNT REPORTED IN COLUMN (E) WAS ATTRIBUTABLE TO PHYSICIAN CLINICS.
PART I, LN 7 COL(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 $8,053,153.
PART II, COMMUNITY BUILDING ACTIVITIES: EMPLOYEES DONATE HUNDREDS OF HOURS AND SHARE THEIR TALENTS AND EXPERTISE AS MEMBERS OF VARIOUS CIVIC AND RELIGIOUS ORGANIZATIONS IN THEIR COMMUNITIES, AS WELL AS SERVING ON RESCUE SQUADS AND FIRE DEPARTMENTS. THE HOSPITAL ALLOWS AND ENCOURAGES EMPLOYEES TO PROVIDE SERVICE TO THE COMMUNITY DURING WORKING HOURS ALSO. EMPLOYEES SERVE IN VARIOUS CAPACITIES INCLUDING ON BOARDS AND ADVISORY COMMITTEES OF A NUMBER OF COMMUNITY GROUPS AND STATE ORGANIZATIONS ADVANCING COMMUNITY HEALTH AND WELLNESS AND WORKFORCE DEVELOPMENT INCLUDING THE FOLLOWING: HALIFAX COUNTY CHAMBER OF COMMERCE; CHARLOTTE COUNTY CHAMBER OF COMMERCE; CLARKSVILLE CHAMBER OF COMMERCE; MECKLENBURG COUNTY BUSINESS EDUCATION PARTNERSHIP; HALIFAX ADVOCATES FOR SUBSTANCE ABUSE PREVENTION; SOUTHSIDE HEALTH COALITION, HALIFAX VOCATIONAL EDUCATION FOUNDATION; SOUTHSIDE VIRGINIA COMMUNITY COLLEGE SCHOOL OF NURSING ADVISORY COUNCIL; COMMITTEE FOR THE CENTER FOR NURSING EXCELLENCE; SOUTHERN VIRGINIA HIGHER EDUCATION CENTER; VIRGINIA COMMUNITY COLLEGE SYSTEM; VIRGINIA FOUNDATION FOR COMMUNITY COLLEGES; HALIFAX EDUCATION FOUNDATION; HALIFAX COUNTY PUBLIC SCHOOLS EDUCATION FOUNDATION; VIRGINIA ADVANCED STUDY ON STRATEGIES BOARD; ECONOMIC DEVELOPMENT COMMITTEE; WORKFORCE INVESTMENT BOARD; HALIFAX COUNTY UNITED WAY; TRI-COUNTY COMMUNITY ACTION AGENCY BOARD; HEALTHY FAMILIES TRI-COUNTY ADVISORY COUNCIL; DIXIE YOUTH SOFTBALL BOARD; MENTOR ROLE MODEL PROGRAM AND THE HALIFAX AND MECKLENBURG COUNTY YMCAS.HALIFAX REGIONAL HOSPITAL CONTINUES TO PARTICIPATE IN REGIONAL AND LOCAL EXERCISES TO TEST THE EMERGENCY OPERATIONS PLAN AND TO CONDUCT INTERNAL EXERCISES. THESE INITIATIVES HELP HALIFAX REGIONAL HOSPITAL PREPARE FOR AND COORDINATE CRISIS RESPONSE AND RECOVERY OPERATIONS WITH STATE, LOCAL AND FEDERAL AGENCIES IN THE EVENT OF A BIOTERRORIST EVENT/DISASTER. OUTSIDE THE REALM OF THE GRANT FUNDING, HALIFAX REGIONAL HOSPITAL SUPPLIED THE EMPLOYEE TIME INVOLVED IN TRAINING FOR COMMUNITY EMERGENCY PREPAREDNESS AS WELL AS FOR COMMUNITY DISASTER TRAINING DRILLS. OUR FOCUS CONTINUES TO BE ON PREPARING THE HOSPITAL STAFF AND THE COMMUNITY FOR "ALL HAZARDS."
PART III, LINE 2: AMOUNT REPORTED ON LINE 2 INCLUDES ACTUAL BAD DEBT WRITE OFFS NET OF RECOVERIES PLUS CHANGES IN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCOUNTS RECEIVABLE. SEE ALSO THE FOOTNOTE ON PAGES 15-16 OF THE ATTACHED FINANCIAL STATEMENTS WHICH DISCUSSES BAD DEBT.
PART III, LINE 4: SEE PAGES 15-16 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTE WHICH DISCUSSES BAD DEBT.
PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE AND RELATED REIMBURSEMENT WERE OBTAINED FROM THE 2017 MEDICARE COST REPORT INCLUDING DSH AND BAD DEBT REIMBURSEMENT. THE MEDICARE ALLOWABLE COST AS REPORTED ON THE MEDICARE COST REPORT REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS IN COMPLIANCE WITH FEDERAL MEDICARE REGULATIONS REGARDING THE CALCULATION OF MEDICARE ALLOWABLE COST.
PART III, LINE 9B: HALIFAX REGIONAL HOSPITAL HAS AN "ACCOUNT FOLLOW UP" POLICY OUTLINING STATEMENT INTERVALS. THE POLICY APPLIES TO ALL PATIENTS. THE HOSPITAL FACILITY ALSO HAS A "FINANCIAL POLICY" OUTLINING ITS STATEMENT SERIES. . IF THE PATIENT QUALIFIES FOR FREE CARE BASED ON 200% OF FEDERAL POVERTY GUIDELINES, THE ENTIRE BALANCE IS WRITTEN OFF TO CHARITY AND NO COLLECTION EFFORTS ARE MADE. A NOTICE IS SENT TO THE PATIENT ADVISING THAT CHARITY QUALIFICATIONS HAVE BEEN MET. UNINSURED PATIENTS MAY RECEIVE A 75% DISCOUNT IF THEIR INCOME IS BETWEEN 201-400% OF THE FEDERAL POVERTY GUIDELINES AND A 30% DISCOUNT IF THEIR INCOME IS ABOVE 400% OF FEDERAL POVERTY GUIDELINES. IF THE PATIENT QUALIFIES FOR DISCOUNTED CARE, THE APPROPRIATE DISCOUNT IS APPLIED TO THE BALANCE. A NOTICE IS SENT TO THE PATIENT ADVISING THAT CHARITY QUALIFICATIONS HAVE BEEN MET AND THE PATIENT IS REQUESTED TO CONTACT THE HOSPITAL FACILITY TO SET UP THE REMAINING BALANCE ON A PAYMENT PLAN. THE HOSPITAL FACILITY DID NOT IMPOSE COLLECTION ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT WAS ELIGIBLE FOR FINANCIAL ASSISTANCE.
PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF ITS COMMUNITIES THROUGH THESE MEANS:-ANALYSIS OF AREA SOCIODEMOGRAPHIC, HEALTH STATUS, AND OTHER DATA: THE ANALYSIS FOCUSES ON IDENTIFICATION OF HEALTH CARE NEEDS FOR PLANNING AND DEVELOPMENT OF HEALTH SERVICES AND PROGRAMS. THIS ANALYSIS IS UTILIZED IN THE DEVELOPMENT OF ORGANIZATIONAL PLANS.-OBTAINING INPUT FROM KEY STAKEHOLDERS AND THE PUBLIC HEALTH COMMUNITY: IN ADDITION TO THE ANALYSIS OF SOCIODEMOGRAPHIC, HEALTH STATUS, AND OTHER DATA, ADDITIONAL INFORMATION IS OBTAINED AND ANALYZED. THIS INCLUDES INPUT FROM KEY STAKEHOLDERS INCLUDING THE LOCAL PUBLIC HEALTH COMMUNITY.-REVIEW OF HEALTH CARE NEEDS ASSESSMENTS AND DATA DEVELOPED BY COMMUNITY PARTNERS (SUCH AS STATE HEALTH DEPARTMENTS AND LOCAL HEALTH DISTRICTS), REGIONAL AGENCIES (SUCH AS THE PLANNING COUNCIL OR PLANNING DISTRICT COMMISSION), NATIONAL ORGANIZATIONS WHICH REPORT ON A LOCAL BASIS (SUCH AS COUNTY HEALTH RANKINGS), AND INFORMATION REPORTED IN LOCAL MEDIA: THIS INFORMATION IS STUDIED, INCORPORATED INTO THE ORGANIZATION'S PLANS, AND SHARED WITH ORGANIZATIONAL DECISION MAKERS.-PARTICIPATION IN COLLABORATIVE HEALTH PLANNING AND NEEDS ASSESSMENT ACTIVITIES SUCH AS THOSE SPONSORED BY THE LOCAL HEALTH DISTRICTS AND OTHER ORGANIZATIONS. INFORMATION GATHERED THROUGH THESE ACTIVITIES IS INCORPORATED INTO THE ORGANIZATION'S PLANNING.-INFORMATION AND INPUT FROM PATIENTS AND CARE PROVIDERS: PATIENT CHARACTERISTICS AND TRENDS ARE REVIEWED TO ASSIST IN IDENTIFYING NEW COMMUNITY NEEDS. INPUT FROM PATIENTS AND CARE PROVIDERS IS SOUGHT AND CYCLED INTO THE ASSESSMENT PHASE OF PROJECTS.
PART VI, LINE 3: WHEN A PATIENT IS REGISTERED AT THE ORGANIZATION'S HOSPITAL FACILITY, S/HE IS OFFERED FINANCIAL ASSISTANCE BROCHURE AND APPLICATION WHICH INCLUDES CONTACT INFORMATION FOR ADDITIONAL INFORMATION. FRAMED COPIES OF THE NOTICE ARE LOCATED IN REGISTRATION AREAS AND KEY PUBLIC AREAS OF THE FACILITY. THE FACILITY'S TELEPHONE SYSTEM OFFERS "ON HOLD" MESSAGING THAT IS UTILIZED TO INFORM INCOMING CALLERS OF FINANCIAL ASSISTANCE INFORMATION EVERY THIRD MONTH. QUARTERLY ARTICLES ARE PLACED IN AREA NEWSPAPERS AS A CUSTOMER SERVICE TOOL TO REMIND PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE INFORMATION, ALONG WITH AN APPLICATION FOR FINANCIAL ASSISTANCE, IS LOCATED ON THE FACILITY'S WEBSITE. A NOTICE REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS PRINTED ON PATIENT BILLS AND INCLUDES CONTACT INFORMATION FOR ADDITIONAL INFORMATION. ALL INDIVIDUALS RECEIVE A FINANCIAL ASSISTANCE APPLICATION ENCLOSED WITH THE SECOND BILLING STATEMENT WHICH INCLUDES DETAILED INFORMATION.THE ORGANIZATION HAS PARTNERED WITH FIRSTSOURCE TO AID UNINSURED EMERGENCY DEPARTMENT PATIENTS, UNINSURED AND UNDERINSURED INPATIENTS, OUTPATIENT SURGERY, AND OBSERVATION PATIENTS IN APPLYING FOR MEDICAL ASSISTANCE THROUGH GOVERNMENT PROGRAMS. FIRSTSOURCE ASSISTS PATIENTS THROUGHOUT THE ENTIRE APPLICATION PROCESS TO ENSURE ALL DOCUMENTATION IS COMPLETE.FIRSTSOURCE ALSO HELPS PATIENTS COMPLETE FINANCIAL ASSISTANCE APPLICATIONS IF THEY MAY NOT QUALIFY FOR GOVERNMENT ASSISTANCE.
PART VI, LINE 4: SENTARA HALIFAX REGIONAL HOSPITAL SERVES RESIDENTS OF HALIFAX, MECKLENBURG, AND CHARLOTTE COUNTIES.THE 2017 POPULATION OF THE AREA IS 79,530 AND THE POPULATION IS PROJECTED TO DECLINE BY 0.8% OVER THE NEXT FIVE YEARS COMPARED TO A PROJECTED U.S. GROWTH RATE OF 3.8%. 23.7% OF THE POPULATION ARE AGE 65+ COMPARED TO THE U.S. AT 15.5%. EDUCATION-WISE, 20.6% HAVE LESS THAN A HIGH SCHOOL EDUCATION, COMPARED TO 13.5% FOR THE U.S. INCOME-WISE, THE AVERAGE HOUSEHOLD INCOME IS $51,514 COMPARED TO $80,853 FOR THE U.S. AND 34.2% OF THE HOUSEHOLDS HAVE AN ANNUAL INCOME OF LESS THAN $25,000, COMPARED TO 21.9% FOR THE U.S. THE RACE AND ETHNICITY COMPOSITION IS AS FOLLOWS: 61.2% FOR WHITE NON-HISPANIC, 33.4% FOR BLACK NON-HISPANIC, 2.7% FOR HISPANIC, 0.7% FOR ASIAN AND PACIFIC ISLANDERS NON-HISPANIC, AND 1.9% FOR ALL OTHERS. THIS COMPARES TO THE U.S. COMPOSITION OF 60.8% FOR WHITE NON-HISPANIC, 12.4% FOR BLACK NON-HISPANIC, 18% FOR HISPANIC, 5.7% FOR ASIAN AND PACIFIC ISLANDERS NON-HISPANIC, AND 3.2% FOR ALL OTHERS.
PART VI, LINE 5: THE ORGANIZATION'S GOVERNING BODY IS A COMMUNITY-BASED BOARD COMPRISED OF A MAJORITY OF MEMBERS WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION OR ITS AFFILIATES, NOR FAMILY MEMBERS THEREOF. GENERALLY, MEDICAL STAFF MEMBERSHIP IS OPEN TO ALL CARE PROVIDERS WHO MEET CREDENTIALING REQUIREMENTS. THE ORGANIZATION'S SURPLUS FUNDS ARE USED FOR IMPROVEMENTS IN PATIENT CARE, PROVISION OF SERVICES TO THE UNINSURED AND UNDERINSURED, MEDICAL EDUCATION, AND COMMUNITY PROGRAMS.
PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM ("SENTARA"). SENTARA, A NOT FOR PROFIT HEALTH SYSTEM, OPERATES MORE THAN 300 SITES OF CARE SERVING RESIDENTS ACROSS VIRGINIA AND NORTHEASTERN NORTH CAROLINA. THE SYSTEM IS COMPRISED OF 12 ACUTE CARE HOSPITALS INCLUDING SEVEN IN HAMPTON ROADS, ONE IN NORTHERN VIRGINIA, TWO IN THE BLUE RIDGE REGIONS, ONE IN SOUTH CENTRAL VIRGINIA, AND ONE IN NORTHEASTERN NORTH CAROLINA; ADVANCED IMAGING CENTERS; NURSING AND ASSISTED-LIVING CENTERS; OUT PATIENT CAMPUSES; HOME HEALTH AND HOSPICE CARE; A 3,800-PROVIDER MEDICAL STAFF; AND FOUR MEDICAL GROUPS. ITS AFFILIATION WITH SENTARA ENHANCES THE ORGANIZATION'S ABILITY TO ACHIEVE BEST PRACTICES IN HEALTHCARE DELIVERY; ACQUIRE CUTTING EDGE TECHNOLOGY AND INTEGRATED INFORMATION SYSTEMS; AND PROVIDE A HIGHER LEVEL OF MEDICAL CARE TO VIRGINIA'S SOUTH CENTRAL COMMUNITY. THESE ATTRIBUTES BETTER POSITION THE ORGANIZATION TO ADDRESS HEALTH CARE REFORM AND OTHER PROFOUND CHANGES AFFECTING THE HEALTHCARE ENVIRONMENT.
Schedule H (Form 990) 2017
Additional Data


Software ID:  
Software Version: