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/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
MARY RUTAN HOSPITAL
 
Employer identification number

34-1407259
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) . . .
    2,740,971 3,445,923 0 0 %
b Medicaid (from Worksheet 3, column a) . . . . .     19,932,818 10,373,988 9,558,830 9.600 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     22,673,789 13,819,911 9,558,830 9.600 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 12 164,936 478,275 52,900 425,375 0.430 %
f Health professions education (from Worksheet 5) . . . 2 16 134,987 0 134,987 0.140 %
g Subsidized health services (from Worksheet 6) . . . . 1 97 23,969 0 23,969 0.020 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 3 3,133 127,029 0 127,029 0.130 %
j Total. Other Benefits . . 18 168,182 764,260 52,900 711,360 0.720 %
k Total. Add lines 7d and 7j . 18 168,182 23,438,049 13,872,811 10,270,190 10.320 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
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 1 0 40,022   40,022 0.040 %
3 Community support 1 1,885 1,195   1,195 0 %
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy 1 947 39,287   39,287 0.040 %
8 Workforce development            
9 Other            
10 Total 3 2,832 80,504   80,504 0.080 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,950,621
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
23,688
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
17,148,119
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
21,695,002
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,546,883
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) 2018
Schedule H (Form 990) 2018
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 MARY RUTAN HOSPITAL
205 PALMER AVE
BELLEFONTAINE,OH43311
X X         X      
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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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)
MARY RUTAN 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 18
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 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://FOUNDATION.MARYRUTAN.ORG/NEEDS-ASSESSMENT/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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) 2018
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Schedule H (Form 990) 2018
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MARY RUTAN 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 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
HTTPS://WWW.MARYRUTAN.ORG/PATIENTS-AND-VISITORS/BILLING-INFORMATION/FINANCI
b
HTTPS://WWW.MARYRUTAN.ORG/PATIENTS-AND-VISITORS/BILLING-INFORMATION/FINANCI
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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Part VFacility Information (continued)

Billing and Collections
MARY RUTAN HOSPITAL
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) 2018
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Schedule H (Form 990) 2018
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MARY RUTAN HOSPITAL
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 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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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, 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
MARY RUTAN HOSPITAL PART V, SECTION B, LINE 5: MARY RUTAN HOSPITAL, ALONG WITH SEVERAL COMMUNITY HEALTH AND HUMAN SERVICE ORGANIZATIONS, FORMED A COLLABORATIVE TEAM TO IMPLEMENT A SURVEY FOCUSED ON IDENTIFYING AND DEFINING OUR LOCAL HEALTH ISSUES, COMMUNITY CONCERNS, AREA RISKS AND NEEDS. THE TEAM WORKED TOGETHER FOR MORE THAN A YEAR TO GATHER AND ANALYZE DATA, AND PROVIDE DIRECTION FOR THE FULL REPORT. SPONSORING ORGANIZATIONS INCLUDE: MARY RUTAN HOSPITAL, MARY RUTAN FOUNDATION, LOGAN COUNTY HEALTH DISTRICT, UNITED WAY OF LOGAN COUNTY, MENTAL HEALTH, DRUG AND ALCOHOL SERVICES BOARD OF LOGAN AND CHAMPAIGN COUNTIES, COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY. FIFTY PERCENT (10,426) OF THE HOUSEHOLDS WERE SURVEYED TO GATHER INFORMATION ABOUT HEALTHCARE, QUALITY OF LIFE, WELLNESS, ENVIRONMENT, SAFETY, PARENTING, AND SOCIAL DEMOGRAPHICS. 12.9% OF LOGAN COUNTY HOUSEHOLDS RESPONDED TO THE ANONYMOUS SURVEY. CALLED A BEHAVIORAL RISK FACTOR SURVEY, THESE SURVEYS ARE THE ONLY SOURCE OF COUNTY SPECIFIC ESTIMATES THAT QUANTIFY THE PREVALENCE OF VARIOUS BEHAVIORS, MEDICAL CONDITIONS, AND PREVENTATIVE HEALTH CARE PRACTICES AMONG LOGAN COUNTY ADULTS. AS A PART OF THE ASSESSMENT PROCESS COMMUNITY FOCUS GROUPS TARGETED AT THE LOW RESPONSE POPULATIONS OF YOUNG ADULT, MINORITY, INDIAN LAKE AND AMISH COMMUNITIES, WERE HELD TO DISCUSS PERCEPTIONS OF NEEDS, ACCESS TO AVAILABLE HEALTH CARE PROGRAMS, AND PRIORITIES AS ONE ON ONE INTERVIEWS WITH A KEY INFORMANTS IN THE COMMUNITY AND WELL AS THE GATHERING OF SECONDARY DATA TO FURTHER VALIDATE AND IDENTIFY AREAS OF CONCERN AND NEED. MORE THAN 35 HEALTH AND HUMAN SERVICE PROVIDERS AND PROFESSIONALS FROM ACROSS THE COUNTY CAME TOGETHER FOR THE PURPOSE OF THIS SURVEY. THESE COMMUNITY PARTNERS INCLUDED PROFESSIONALS IN THE AREAS OF HOSPITAL ADMINISTRATION, PUBLIC HEALTH, MENTAL HEALTH, FQHC, HEALTH AND HUMAN SERVICES, INDUSTRY, COUNSELING, EDUCATION, CHILDREN'S DEVELOPMENT, AGING, LAW ENFORCEMENT, AND LOCAL GOVERNMENT. MARY RUTAN HOSPITAL AND EACH PARTICIPATING ORGANIZATION WILL UTILIZE THIS INFORMATION ACCORDING TO COMMUNITY NEEDS AND THEIR OWN UNIQUE STRENGTHS. EFFORTS ARE BEING COORDINATED ACROSS THE COUNTY TO HELP ENSURE ADEQUATE AVAILABILITY OF NEEDED SERVICES AND EFFORTS TO IMPROVE AT RISK FINDINGS. EIGHT ACTION GROUPS HAVE BEEN FORMED AND ARE WORKING COLLABORATIVELY TO ADDRESS THESE ISSUES. THOSE GROUPS INCLUDE: HEALTHY LIVING COALITION, COALITION FOR OPIATE RELIEF EFFORTS, MENTAL HEALTH & SUICIDE COALITION, ACCESS AND RESOURCES COALITION, SAFE AND SUPPORTIVE FAMILIES AND CHILDREN COALITION, HOUSING AND HOMELESSNESS COALTION, WORKFORCE DEVELOPMENT COMMITTEE AND THE LOGAN COUNTY COALITION ADVISORY BOARD THAT PROVIDES OVERSIGHT AND DIRECTION FOR THE COALITIONS. THE COMPLETE ACTION PLAN, INCLUDING NEEDS IDENTIFIED, STRATEGIES FOR ADDRESSING THOSE NEEDS, ACTIVITIES UNDERTAKEN, AND MEASUREMENT OF OUTCOMES, CAN BE VIEWED AND/OR DOWNLOADED FROM THE HOSPITAL WEBSITE AT WWW.MARYRUTAN.ORG. THESE SAME COMMUNITY PARTNERS CAME TOGETHER FOR THE CREATION, FACILITATION AND IMPLEMENTATION OF THE CURRENT YEAR NEEDS ASSESSMENT. IN ADDITION, A COMMUNITY CALL TO ACTION MEETING WAS HELD WHERE OVER 80 COMMUNITY MEMBERS CAME TOGETHER TO REVIEW AND PRIORITIZE AREAS OF RISK AND NEED. MARY RUTAN HOSPITAL, THE LOGAN COUNTY HEALTH DISTRICT AND DRUG, ALCOHOL AND MENTAL HEALTH BOARD OF LOGAN AND CHAMPAIGN COUNTIES, COMMUNITY HEALTH AND WELLNESS PARTNERS AND UNITED WAY OF LOGAN COUNTY WERE THE LEAD ORGANIZATIONS FOR THIS CONTINUED REPORT.
MARY RUTAN HOSPITAL PART V, SECTION B, LINE 6B: MARY RUTAN FOUNDATION, LOGAN COUNTY HEALTH DISTRICT, UNITED WAY OF LOGAN COUNTY, MENTAL HEALTH, DRUG AND ALCOHOL SERVICES BOARD OF LOGAN AND CHAMPAIGN COUNTIES, COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY ACTED AT THE LEAD ORGANIZATION AND FUNDING PARTNERS FOR THE ASSESSMENT. OTHERS INVOLVED IN THE PROCESS INCLUDE: LOGAN COUNTY CHILDREN'S SERVICES, LOGAN COUNTY BOARD OF DEVELOPMENTAL DISABILIITIES, LOGAN COUNTY COMMISSIONERS, LOGAN COUNTY FAMILY COURT, LOGAN COUNTY JOB & FAMILY SERVICES, LOGAN COUNTY SHERIFF'S DEPARTMENT, BELLEFONTAINE CITY POLICE DEPARMENT, AREA EMS, THE OHIO STATE UNIVERSITY EXTENSION OFFICE OF LOGAN COUNTY, COUNCIL OF RUAL SERVICES, LOGAN COUNTY EDUCATIONAL SERVICES CENTER, AND INDIAN LAKE LOCAL SCHOOLS.
MARY RUTAN HOSPITAL PART V, SECTION B, LINE 7D: AREA MEDIA COMMUNICATION IN PRINT AND RADIO, SPEAKING ENGAGEMENTS AT AREA SERVICE CLUBS AND ORGANIZATIONS, ELECTRONIC COMMUNICATION AND SOCIAL MEDIA.
MARY RUTAN HOSPITAL PART V, SECTION B, LINE 11: THE CHNA ACTION PLAN CAN BE ACCESSED AT WWW.MARYRUTAN.ORG. TWO NEEDS WERE IDENDTIFIED BY THE 2018 COMMUNITY HEALTH RISK AND NEEDS ASSESSMENT, BUT WERE NOT ADDRESSED BY THE ACTION PLAN AT THIS TIME: WORKFORCE DEVELOPMENT AND HOUSING AND HOMELESSNESS . WHILE WE WILL FOCUS THE MAJORITY OF OUR EFFORTS ON THE IDENTIFIED NEEDS, WE WILL SUPPORT COMMUNITY EFFORTS IN THESE AREAS THROUGH PARTICIPATION AND FINANCIAL SUPPORT TO THE LOGAN COUNTY CHAMBER OF COMMERCE AND THE HOUSING AND HOMELESSNESS COALITION. THESE TOPICS ARE NOT ADDRESSED IN MARY RUTAN HOSPITAL'S PLAN OF ACTION DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE PRIORITY HEALTH NEEDS SPECIFICALLY IDENTIFIED.
MARY RUTAN HOSPITAL PART V, SECTION B, LINE 13H: MARY RUTAN ALSO HAS A CATASTROPHIC CHARITY POLICY IN PLACE FOR PATIENTS WHO DO NOT QUALIFY FOR OTHER PROGRAMS, WHO HAVE AN ACCUMULATED BALANCE ABOVE $50,000, AND WHOSE INCOME IN BETWEEN 200 AND 400% OF THE FPL. THIS IS A PARTIAL DISCOUNT DEPENDENT UPON % OF FPL, RANGING FROM 50% DISCOUNT TO 90% DISCOUNT.
MARY RUTAN HOSPITAL PART V, SECTION B, LINE 15E: PATIENTS CAN COMPLETE A DIGITAL VERSION OF THE FAP APPLICATION ONLINE, WHICH IS IDENTICAL TO THE PAPER FORM AND USED FOR PROCESSING, THOUGH THEY STILL WOULD ULTIMATELY HAVE TO SIGN OFF ON A PRINTED COPY.
MARY RUTAN HOSPITAL PART V, SECTION B, LINE 24: AS STATED IN THE FAP, THE FAP APPLIES TO ONLY SERVICES THAT ARE URGENT AND MEDICALLY NECESSARY. NON-FAP ELIGIBLE PATIENTS RECEIVING MEDICALLY NECESSARY SERVICES, SUCH AS OUT OF STATE PATIENTS, RECEIVE AT LEAST A NOMINAL DISCOUNT FROM CHARGE. ELECTIVE SERVICES ARE EXCLUDED FROM THE FAP AS THOSE ARE NOT DEEMED URGENT OR MEDICALLY NECESSARY. RETAIL SERVICES, SUCH AS OUR DIRECT ACCESS LAB, ARE EXEMPT FROM OUR ASSISTANCE PROGRAM AS THEY ARE CONSIDERED NEITHER URGENT NOR MEDICALLY NECESSARY BY THE NATURE OF THEIR RETAIL STATUS (RETAIL IN THIS CASE MEANING NOT SUBMITTED TO THRID PARTY PAYERS AND THAT THEY ALLOW PATIENTS TO SELF-ORDER/SELF-REFER). PRICES FOR THESE SERVICES ARE LOW, FIXED (NON-NEGOTIATED WITH PAYERS), AND ARE STANDARDIZED REGARDLESS OF SETTING OR INSURANCE STATUS. AN INDIVIDUAL WHO MIGHT OTHERWISE QUALIFY FOR FAP COULD THEREFORE RECEIVE THESE ELECTIVE SERVICES AND PAY THE GROSS CHARGE AMOUNT DUE TO THE EXCLUSION OF THESE ELECTIVE SERVICES, DESPITE BEING OTHERWISE ELIGIBLE UNDER THE FAP.
PART V, SECTION B, LINE 16I THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY WERE NOT TRANSLATED FOR OTHER FOREIGN SPEAKING POPULATIONS BECAUSE NONE OF THE FOREIGN SPEAKING POPULATIONS IN THE COMMUNITY EXCEEDED FIVE PERCENT OF THE COMMUNITY IN WHICH THE MARY RUTAN HOSPITAL SERVES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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 7: THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO REPORT FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID AS COMMUNITY BENEFITS.
PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE RELATED TO PATIENT CARE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), (BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN) IS $3,950,621.
PART II, COMMUNITY BUILDING ACTIVITIES: MARY RUTAN HOSPITAL AND FOUNDATION ARE COMMITTED TO PROVIDING PROFESSIONAL ASSISTANCE TO THE LOGAN COUNTY COMMUNITY THORUGH THE VOLUNTEERING OF TIME AND RESOURCES FOR ECONOMIC DEVELOPMENT TO THE LOGAN COUNTY GREATER AREA CHAMBER OF COMMERCE, THE LOGAN COUNTY COMMUNITY IMPROVEMENT CORPORATION AND INDIAN LAKE CHAMBER OF COMMERCE. IN ADDITION, ADMINISTRATIVE TEAM MEMBERS VOLUNTEER PROFESSIONAL SERVICES AND RESOURCES TO THE UNITED WAY OF LOGAN COUNTY, HILLIKER YMCA, LOGAN COUNTY HEALTH DISTRICT, LOGAN COUNTY MENTAL HEALTH BOARD, LOGAN COUNTY COALITION OF OPIATE RELIEF EFFORTS, LOGAN COUNTY FAMILY AND CHILDREN FIRST COUNCIL, LOGAN COUNTY HEALTHIER LIVING COALITION, LOGAN COUNTY TRANSPORTATION ADVISORY GROUP, LOGAN COUNTY COALITION ADVISORY BOARD, FQHC BOARD-COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY AND LUTHERAN COMMUNITY SERVICES PROMOTING AND ESTABLISHING HEALTH, WELLNESS AND NUTRITIONAL SERVICES FOR THOSE IN NEED IN AND AT-RISK AREAS OF THE COMMUNITY.
PART III, LINE 2: BAD DEBT IS PRESENTED AT GROSS CHARGES. FOR RECEIVABLES ASSOCIATED WITH SELF PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.
PART III, LINE 3: THE ESTIMATE OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS BASED ON AN ESTIMATED PERCENTAGE OF BAD DEBT WRITE OFFS. THE PERCENTAGE IS DERIVED FROM A HISTORICAL REVIEW OF PATIENTS THAT QUALIFIED FOR CHARITY AFTER THEY WERE PLACED IN COLLECTIONS.
PART III, LINE 4: BAD DEBT FOOTNOTE: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. FOR RECEIVABLES ASSOCIATED WITH SELF PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENECE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. ADDITIONAL INFORMATION: THE HOSPITAL GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE COMPOSITION OF RECEIVABLES FROM PATIENTS AND THIRD-PARTY PAYORS WAS AS FOLLOWS IN 2018: 19% MEDICARE, 69% COMMERCIAL INSURANCE AND HMOS, 7% MEDICAID, AND 5% SELF PAY.
PART III, LINE 8: MEDICARE COSTS HAVE BEEN PULLED FROM THE 2018 MEDICARE COST REPORT, UTILIZING A COST TO CHARGE RATIO. BASED ON 2010 US CENSUS BUREAU ESTIMATES, 14.7% OF THE LOGAN COUNTY, OHIO POPULATION IS OVER AGE 65. SERVICES PROVIDED TO MEDICARE PATIENTS ACCOUNTED FOR APPROXIMATELY 39% OF PATIENT SERVICE REVENUE IN 2018. WE HAVE INCLUDED MEDICARE SHORTFALLS IN OUR 2018 COMMUNITY BENEFIT REPORT. THE ONGOING CARE OF OUR AGING POPULATION CERTAINLY MEETS A SIGNIFICANT NEED OF THE COMMUNITY. EQUIVALENT HOSPITAL BASED CARE IS NOT AVAILABLE FROM ANY OTHER LOCAL SOURCE. PROVIDING EFFICIENT, COST EFFECTIVE CARE IS ALWAYS A GOAL, BUT SHORTFALLS CAN AND DO OCCUR. THOSE SHORTFALLS ARE ABSORBED BY THE HOSPITAL AND ARE CONSIDERED TO BE A COST OF OUR MISSION TO ACCEPT RESPONSIBILITY FOR MEETING THE HEALTHCARE NEEDS OF OUR COMMUNITY.
PART III, LINE 9B: MARY RUTAN HOSPITAL COMPLIES WITH THE FAIR DEBT COLLECTION PRACTICES ACT AT ALL TIMES. A SELF PAY ACCOUNT IS MANAGED BY AN DEDICATED TEAM AT THE TIME PATIENT LIABILITY IS DETERMINED POST-SERVICE. THE TYPICAL PROCESS IS A SERIES OF LETTERS AND PHONE CALLS . THE TIMELINESS AND STEPS ARE OUTLINED IN MRH'S BAD DEBT & COLLECTIONS POLICY (WHICH IS POSTED IN FULL ONLINE FOR PATIENT REVIEW, ALONG WITH A PLAIN LANGUARY SUMMARY). IF THERE IS NO RESPONSE TO THE TEAM'S STATEMENTS AND CALLS, THEN THE ACCOUNT IS PULLED FOR REVIEW, REVIEWED TO VALIDATE THAT IT BALANCES ARE CORRECT, WRITTEN OFF TO BAD DEBT, AND SENT TO A COLLECTION AGENCY. WHEN A PATIENT HAS INITIATED THE CHARITY APPLICATION PROCESS AND HAS APPLIED FOR ONE OF OUR PROGRAMS, THAT PATIENT REMAINS IN THAT STATUS WITHOUT ANY COLLECTION EFFORTS OF ANY KIND UNTIL FINAL ELIGIBILITY FOR ASSISTANCE CAN BE DETERMINED. APPLICABLE ASSISTANCE/DISCOUNTS ARE APPLIED TO THE ACCOUNT BALANCE IF QUALIFIED. PATIENTS WHO DO NOT QUALIFY ARE NOTIFIED AND NORMAL COLLECTION EFFORTS BEGIN/RESUME AT THAT TIME.
PART VI, LINE 2: COLLABORATION WITH LOCAL HUMAN SERVICE ORGANIZATIONS IS KEY IN IDENTIFYING NEEDS ON AN ONGOING BASIS. MARY RUTAN HOSPITAL AND MARY RUTAN FOUNDATION PROGRAMS ARE TARGETED TOWARD SPECIFIC POPULATIONS IN NEED, AS WELL AS DESIGNATED AT-RISK AREAS. GENERAL HEALTH AND WELLNESS PROMOTIONS EDUCATE THE COMMUNITY ABOUT PREVENTATIVE MEASURES AGAINST CHRONIC ILLNESSES. HEALTH AND WELLNESS EDUCATION, AS WELL AS FREE SCREENING, ARE PROVIDED MONTHLY AT SUBSIDIZED SENIOR HOUSING UNITS AND AT FOOD PANTRIES. OTHER EXAMPLES INCLUDE POWER-UP 4 FITNESS, FIELD TO FORK AND BILLY BONES, WHICH ARE PROGRAMS EDUCATING STUDENTS ON THE IMPORTANCE OF EXCERCISE AND PROPER NUTRITION IN THE FIGHT AGAINST CHILDHOOD OBESITY. THIS PROGRAM IS DONE IN COLLABORATION WITH ALL AREA SCHOOLS. IN ADDITION, MARY RUTAN HOSPITAL UTILIZES THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE COUNTY HEALTH RANKINGS REPORT. MRH FACILITATES CREATING A HEALTHIER ME AND MATTER OF BALANCE COURSES TARGETED FOR THE ADULT POPULATION ADDRESSING PROPER NUTRITION, DIET AND EXCERCISE. MRH LEADS OTHER COMMUNITY PARTNERS ON THE HEALTHY LIVING COALITION REVIEWING AT-RISK AREAS IN THE COMMUNITY AND ESTABLISHING EDUCATIONAL PROGRAMS AND RESOURCES TO ADDRESS THOSE NEEDS. MARY RUTAN HOSPITAL ALSO SERVICES AS AN ACTIVE MEMBER OF THE LOGAN COUNTY FAMILY AND CHILDREN FIRST COUNCIL TO PROVIDE ORGANIZATION UPDATES REGARDING ONGOING PROJECTS AND TO DISCUSS AND IDENTIFY COMMUNITY NEEDS. THIS COUNCIL IS COMPRISED OF SENIOR LEADERS OF THE HOSPITAL, HEALTH DEPARTMENT, CHILDREN'S SERVICES, JOB AND FAMILY SERVICES, AND MENTAL HEALTH BOARD AS WELL AS OTHER HEALTH AND HUMAN SERVICE AGENCIES, LAW ENFORCEMENT, AND AREA SCHOOL DISTRICTS. MRH IS ALSO AN ACTIVE MEMBER OF THE LOGAN COUNTY COALITION FOR OPIATE RELIEF EFFORTS, IMPLEMENTING PROGRAMS AND SERVICES TO COMBAT THE HEROIN AND OPIATE ABUSE ISSUES IN LOGAN COUNTY. IN ADDITION, MRH SENIOR LEADERSHP SERVES ON THE LOGAN COUNTY COALTION ADVISORY BOARD CREATED TO ASSIST AND BE A RESOURCE FOR AT RISK FINDINGS OF THE NEEDS ASSESSMENT OF OBESITY, CHRONIC DISEASE, DRUG ABUSE, MENTAL HEALTH, ACCESS TO SERVICES, HOUSING AND HOMELESSNESS AND WORKFORCE DEVELOPMENT.
PART VI, LINE 3: A VARIETY OF MEANS IS USED TO PROVIDE INFORMATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO ALL PATIENTS. NOTICES ARE POSTED AT ALL POINTS OF REGISTRATION, IN OUR CLINICS, AND IN OUR OFF-SITE BUSINESS OFFICE LOCATION. HANDOUTS AND APPLICATIONS FOR HCAP/CHARITY CARE ARE ALSO AVAILABLE AT REGISTRATION. FINANCIAL ASSISTANCE INFORMATION IS INCLUDED IN PATIENT BILLING BROCHURES, ON THE MARY RUTAN HOSPITAL WEBSITE, ON BILLING STATEMENTS, AND IN A SEPARATE LETTER INCLUDED WITH ALL SELF PAY ACCOUNT BILLING STATEMENTS. MRH REPRESENTATIVES ALSO ATTEMPT TO EDUCATE PATIENTS PRIOR TO AND CONCURRENT WITH SERVICE ABOUT OUR ASSISTANCE PROGRAMS.
PART VI, LINE 4: MARY RUTAN HOSPITAL'S PRIMARY SERVICE AREA IS RURAL LOGAN COUNTY. ALTHOUGH MARY RUTAN HOSPITAL DOES SERVE SOME INDIVIDUALS FROM ADJOINING COUNTIES (INCLUDING HARDIN, CHAMPAIGN, SHELBY AND UNION), INPATIENT VOLUMES EQUAL 26% AND OUTPATIENT SERVICE VOLUMES EQUAL 55% OF LOGAN COUNTY RESDIENTS. THE LOGAN COUNTY POPULATION IS APPROXIMATELY 45,358 AND, BASED ON 2018 US CENSUS BUREAU ESTIMATES, MEDIAN HOUSEHOLD INCOME IS $53,051. AN ESTIMATED 11.1% OF THE COUNTY POPULATION IS BELOW THE FEDERAL POVERTY LEVEL.
PART VI, LINE 5: THE HOSPITAL FAMILY INCLUDES PARENT CORPORATION, MARY RUTAN HEALTH ASSOCIATION, AND SUBSIDIARIES MARY RUTAN HOSPITAL, MARY RUTAN FOUNDATION, LOGAN VIEW, INC., AND LOGAN COUNTY CANCER SOCIETY. THERE IS A COORDINATED EFFORT TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY. DOLLARS ARE BUDGETED ANNUALLY THROUGH MARY RUTAN FOUNDATION TO SUPPORT COMMUNITY HEALTH ACTIVITIES ORGANIZED AND SPONSORED BY MARY RUTAN FOUNDATION. THE GOVERNING BODIES OF EACH CORPORATION ARE MADE UP OF RESIDENTS OF OUR COMMUNITY WHO ARE FAMILIAR WITH THE HEALTH AND WELLNESS ISSUES FACING LOGAN COUNTY AND THE SURROUNDING AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. IN ADDITION, ANNUALLY MARY RUTAN FOUNDATION AWARDS COMMUNITY HEALTH AND WELLNESS GRANTS TO AREA SCHOOLS, SOCIAL SERVICE AND NOT FOR PROFIT ORGANIZATIONS FOCUSED ON THE AREAS OF RISK AND NEED IDENTIFIED IN THE COMMUNITY TO EXPAND OUTREACH EFFORTS PAST THE PROGRAMS AND SERVICES PROVIDED BY THE HOSPITAL AND FOUNDATION. DUE TO LACK OF FUNDING BY AREA SCHOOLS AND INABILITY TO EMPLOYEE ATHLETIC TRAINERS, MARY RUTAN HOSPITAL FUNDS AND PROVIDES ATHLETIC TRAINERS AT EACH (6) AREA HIGH SCHOOL FOR THE HEALTH, WELLBEING AND SAFETY OF AREA STUDENT ATHLETES.
PART VI, LINE 6: MARY RUTAN HEALTH ASSOCIATION IS THE PARENT CORPORATION. THE HEALTH ASSOCIATION OPERATES CARDIAC REHAB AND CORPORATE HEALTH CLINICS, PROVIDES MANAGEMENT SERVICES TO THE HOSPITAL AND PARTICIPATES IN VARIOUS HEALTH FAIRS AND SCREENINGS THROUGHOUT THE COMMUNITY EACH YEAR. MARY RUTAN FOUNDATION'S MISSION IS TO CREATE PHILANTHROPIC RELATIONSHIPS TO SUPPORT PATIENT CARE SERVICES, AWARD MEDICAL SCHOLARSHIPS, PURCHASE NEEDED MEDICAL EQUIPMENT AND DEVELOP CAPITAL, WHILE PROMOTING HEALTH AND WELLNESS THROUGH EDUCATIONAL PROGRAMS AND SERVICES. LOGAN COUNTY CANCER SOCIETY PROVIDES FINANCIAL ASSISTANCE TO RESIDENTS OF LOGAN COUNTY WHO HAVE CANCER OR CANCER RELATED ILLNESSES, WHILE PROMOTING EDUCATION IN THE DETECTION AND TREATMENT OF CANCER. OPERATION AND FACILITATION OF ALL SERVICES PROVIDED BY THE LOGAN COUNTY CANCER SOCIETY ARE PROVIDED BY EMPLOYEES OF MARY RUTAN HOSPITAL AND MARY RUTAN HEALTH ASSOCIATION AND NO SALARIES OR BENEFITS ARE CHARGED TO THE ORGANIZATION FOR THIS SERVICE. LOGAN VIEW LLC ALSO SPONSORS A VARIETY OF HEALTH AND WELLNESS PROGRAMS IN THE COMMUNITY.
Schedule H (Form 990) 2018
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