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
MERCY HOSPITAL INC
 
Employer identification number

48-0663711
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
 
No
%
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) . . . 		    50,884 1,770 49,114 1.420 %
b Medicaid (from Worksheet 3, column a) . . . . .     135,153 70,282 64,871 1.880 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     186,037 72,052 113,985 3.300 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     672   672 0.020 %
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .     466,304 213,718 252,586 7.300 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     466,976 213,718 253,258 7.320 %
k Total. Add lines 7d and 7j .     653,013 285,770 367,243 10.620 %
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            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
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
112,509
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
48,000
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
1,055,507
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
1,563,481
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-507,974
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 MERCY HOSPITAL INC
218 E PACK STREET
MOUNDRIDGE,KS67107
WWW.MERCYH.ORG
H059003 		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)
MERCY 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 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 Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
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): SEE SCHEDULE H, PART V, SECTION C
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)
MERCY 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
SEE SCHEDULE H, PART V, SECTION C
b
SEE SCHEDULE H, PART V, SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
MERCY 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) 2018
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Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MERCY 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) 2018
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Schedule H (Form 990) 2018
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
SCHEDULE H, PART V, SECTION B, LINE 5 SURVEYS WERE DISTRIBUTED TO THE GENERAL PUBLIC THROUGH A SURVEY PLATFORM, AND ALSO MADE AVAILABLE IN PAPER FORM AT PUBLIC LOCATIONS SUCH AS THE SENIOR CENTER, THE HOSPITAL, AND THE LOCAL CLINICS. SURVEYS WERE ALSO LINKED ON THE HOSPITAL WEBSITE FOR ANY MEMBER OF THE COMMUNITY TO ACCESS. FOLLOWING THE INITIAL COMMUNITY SURVEY, A FOLLOW-UP WORKGROUP WAS HELD, HOSTED BY THE MCPHERSON COUNTY HEALTH DEPARTMENT AND MCPHERSON HOSPITAL. PHYSICIANS FROM THE CONTRIBUTING HOSPITALS, AS WELL AS THE COUNTY HEALTH DIRECTOR WERE IN ATTENDENCE, AND PROVIDED THEIR INSIGHT AND EXPERTISE. MEMBERS OF THE COMMUNITY, INCLUDING REPRESENTATIVES FROM COUNTY EMERGENCY SERVICES, AS WELL AS OTHER INDIVIDUALS WERE ALSO IN ATTENDENCE AND CONTRIBUTED THEIR INPUT.
SCHEDULE H, PART V, SECTION B, LINE 6A MCPHERSON HOSPITAL, LINDSBORG COMMUNITY HOSPITAL
SCHEDULE H, PART V, SECTION B, LINE 6B MCPHERSON COUNTY HEALTH DEPARTMENT SCHEDULE H, PART V, SECTION B, LINE 7A WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 10A WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
SCHEDULE H, PART V, SECTION B, LINE 11 MERCY HOSPITAL IS PROVIDING FREE BLOOD PRESSURE SCREENINGS AT THE LOCAL SENIOR CENTER, AND IS WORKING TO PROVIDE FURTHER HEALTH SERVICES AND EDUCATION TO THIS SEGMENT OF THE POPULATION. MERCY HOSPITAL HAS SIGNED THE KANSAS HOSPITAL ASSOCIATION'S HEALTHY KANSAS HOSPITALS PLEDGE, DEMONSTRATING MERCY'S DESIRE TO TAKE THE LEAD IN PROVIDING HEALTHY EATING, ACTIVITY, AND LIFESTYLE GUIDANCE. MERCY HOSPITAL IS COMMITTED TO PROMOTING A HEALTHY LIFESTYLE FOR OUR STAFF AND COMMUNITY. THE HOSPITAL HAS CONTINUED TO ACTIVELY ENGAGE COMMUNITY PARTNERS TO IMPROVE TRANSFER AGREEMENTS AND DISCHARGE PATHWAYS FOR MENTAL HEALTH PATIENTS AND THOSE WITH RELATED DIAGNOSES SUCH AS SUBSTANCE USE DISORDER. MERCY HOSPITAL IS COMMITTED TO FOCUSING OUR RESOURCES AND EFFORTS ON ADDRESSING THESE PRIORITIES IN 2020 AND BEYOND, TO MEET THE COMMUNITY'S HEALTH NEEDS. WE ARE WORKING TO BEGIN OFFERING A FREE NEWSLETTER TO OUR COMMUNITY WHICH WOULD BE MADE AVAILABLE IN PRINT AND DIGITAL VERSIONS. CONTENT FOR THIS PUBLICATION WOULD PROVIDE RESOURCES AND EDUCATION FOR OUR COMMUNITY MEMBERS, TO ENGAGE THEM AND RAISE THE OVERALL HEALTH OF OUR PATIENT POPULATION.
SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, AND 16C WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Page 9
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
Page 10
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
SCHEDULE H, PART I, LINE 3C IN ADDITION TO FPG CONSIDERATIONS, THE HOSPITAL ALSO USES ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS TO DETERMINE WHETHER INDIVIDUALS ARE FAP ELIGIBLE. HOSPITAL ONLY PROVIDES 100% CHARITY CARE TO ELIGIBLE INDIVIDUALS. NO SLIDING SCALE IS USED TO DETERMINE DISCOUNTED CARE. ALL FAP ELIGIBLE INDIVIDUALS RECEIVE 100% FREE CARE. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H IS THE COST TO CHARGE RATIO FROM THE ORGANIZATION'S 9/30/2019 MEDICARE COST REPORT.
SCHEDULE H, PART III, SECTION A, LINE 2 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNT REPORTED IS THE INCREASE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS, BASED ON THE EXPENSES INCURRED IN TAX YEAR 2019.
SCHEDULE H, PART III, SECTION A, LINE 3 THE AMOUNT OF CHARITY CARE PROVIDED BY THE HOSPITAL, BASED ON ACTUAL COSTS FROM THE COST REPORT, WAS APPROXIMATELY 20% HIGHER THAN THE AMOUNT FROM TAX YEAR 2018. THIS IS BASED ON THOSE WHO ACTUALLY COMPLETED THE FORMS AS REQUESTED AND QUALIFIED FOR FINANCIAL ASSISTANCE. THE HOSPITAL BELIEVES IT IS REASONABLE TO ASSUME THAT THE INCREASE IN BAD DEBT-RELATED EXPENSES ALSO INCLUDES A SUBSTANTIAL AND REASONABLY COMPARATIVE NUMBER OF INDIVIDUALS WHO WOULD HAVE QUALIFIED BASED ON THEIR INCOME LEVEL, BUT DID NOT MAKE THE EFFORT TO COMPLETE THE FORMS.
SCHEDULE H, PART III, SECTION A, LINE 4 THE FOOTNOTE ABOUT BAD DEBT AND ALLOWANCE FOR DOUBTFUL ACCOUNTS APPEARS ON PAGE 7 AND 8 OF THE FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION B, LINE 8 WE PROVIDE OUTPATIENT AND SKILLED NURSING CARE AS A BENEFIT TO OUR COMMUNITY, ALLOWING MANY OF OUR LOCAL CITIZENS TO CONTINUE TO RECOVER CLOSE TO HOME, AND WHERE FAMILY AND FRIENDS ARE ABLE TO VISIT, AND MOST IMPORTANTLY THEY CAN BE SEEN BY THEIR PRIMARY CARE PHYSICIAN. THESE FACTORS CONTRIBUTE TO GREATER CONTINUITY OF CARE AND HELP TO AVOID OVER-UTILIZATION OF RESOURCES AND UNNECESSARY IN-PATIENT HOSPITALIZATION COSTS. THE OUTPATIENT AND SKILLED NURSING CARE WE PROVIDE IS REIMBURSED AT WELL BELOW COST FROM MEDICARE. THE COST TO CHARGE RATIO FROM THE MOST-RECENTLY FILED MEDICARE COST REPORT WAS USED TO DETERMINE MEDICARE ALLOWABLE COSTS FOR THE ASSOCIATED PAYMENTS, LESS AMOUNTS REPORTED AS COMMUNITY BENEFIT UNDER PART I SECTION 7.
SCHEDULE H, PART III, SECTION C, LINE 9B ANY SELF-PAY ACCOUNT THAT HAS BEEN SELF-PAY FOR 90 DAYS WITH NO ACTION SHALL BE CONSIDERED DELINQUENT. THESE ACCOUNTS WITH BALANCES OVER $50.00 ARE PASSED ON TO OUR INTERNAL COLLECTIONS DEPARTMENT, TO ATTEMPT CONTACT WITH THE GUARANTOR TO ESTABLISH A PAYMENT PLAN. THIS METHOD INCLUDES MAILINGS AND PHONE CALLS. BANKRUPTCIES WILL HAVE ALL COLLECTIONS EFFORTS STOPPED UPON RECEIPT OF BANKRUPTCY NOTICE. ALL ACCOUNTS BEING WORKED BY OUR INTERNAL COLLECTIONS DEPARTMENT ARE OFFERED THE HOSPITAL'S ESTABLISHED FINANCIAL ASSISTANCE POLICY AND APPLICATION. ANY PATIENT ACCOUNTS WHICH QUALIFY ARE HANDLED ACCORDING TO THAT POLICY. FUTURE ACCOUNTS FOR A GUARANTOR WHO IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE MAY BE AWARDED CHARITY CARE BASED ON ADMINISTRATIVE DECISION. ALL FINANCIAL ASSISTANCE APPLICATIONS ARE SUBJECT TO PERIODIC AND ANNUAL REVIEW TO ENSURE THE GUARANTOR'S CURRENT FINANCIAL SITUATION IS TAKEN INTO CONSIDERATION.
SCHEDULE H, PART VI, LINE 2 IN 2019, A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS PERFORMED WITH TWO OTHER AREA HOSPITALS, IN CONJUNCTION WITH THE COUNTY HEALTH DEPARTMENT. RESIDENTS WERE SURVEYED, AND AFTER INITIAL HEALTH ISSUES WERE IDENTIFIED, A WORKGROUP WAS FORMED, REPRESENTING A CROSS SECTION OF SURVEY RESPONDENTS. THIS WORKGROUP WORKED TO PRIORITIZE THE ISSUES AFFECTING THE COMMUNITY AND TO IDENTIFY SOLUTIONS. MERCY HOSPITAL HAS COMPILED A FACILITY-SPECIFIC CHNA IMPLEMENTATION PLAN, WHICH IS BEING CARRIED OUT STARTING IN 2020 THROUGH THE NEXT THREE YEARS.
SCHEDULE H, PART VI, LINE 3 COMMUNICATION OF THE FINANCIAL ASSISTANCE AVAILABLE FROM MERCY HOSPITAL, INC. SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN EMERGENCY ROOMS, REGISTRATION, PATIENT FINANCIAL SERVICES AND AT OTHER PUBLIC PLACES AS MERCY HOSPITAL, INC. MAY ELECT. INFORMATION SHALL ALSO BE INCLUDED ON THE FACILITY WEBSITE AND IN THE CONDITIONS OF ADMISSION FORM. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE MERCY HOSPITAL, INC. STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL SERVICES STAFF, SOCIAL WORKER AND CASE MANAGER. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.
SCHEDULE H, PART VI, LINE 4 MERCY HOSPITAL IS LOCATED IN MOUNDRIDGE, KS AND SERVES AN URBAN/RURAL MIX OF INDIVIDUALS FROM FOUR SURROUNDING COMMUNITIES. MOUNDRIDGE HAS A POPULATION OF APPROXIMATELY 4,500 PEOPLE. BENEFICIARIES ARE FROM FARMING AND SOME MANUFACTURING ORGANIZATIONS IN THE APPROXIMATE 30 MILE RADIUS OF THE HOSPITAL. THERE ARE TWO OTHER HOSPITALS WITHIN A 20 MILE RADIUS ALSO SERVING THE AREA.
SCHEDULE H, PART VI, LINE 5 THE HOSPITAL MEDICAL STAFF IS COMPOSED OF COURTESY AND CONSULTING PHYSICIANS WHO MEET QUARTERLY. TOPICS RELATING TO COMMUNITY HEALTH MAY BE DISCUSSED IN MEDICAL STAFF MEETINGS. THE HOSPITAL'S BOARD IS COMPRISED OF 12 VOLUNTEER MEMBERS FROM VARIOUS REGIONS OF THE SERVICE AREA.
SCHEDULE H, PART VI, LINE 6 N/A
SCHEDULE H, PART VI, LINE 7 N/A
Schedule H (Form 990) 2018
Additional Data


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