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
GEISINGER-BLOOMSBURG HOSPITAL
 
Employer identification number

23-2193572
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
Yes
 
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
 
No
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) . . .
    608,351   608,351 1.160 %
b Medicaid (from Worksheet 3, column a) . . . . .     10,301,904 5,823,824 4,478,080 8.550 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     251,694 133,062 118,632 0.230 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     11,161,949 5,956,886 5,205,063 9.940 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     176,323 2,950 173,373 0.330 %
f Health professions education (from Worksheet 5) . . .     884,346 87,965 796,381 1.520 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     1,017   1,017  
j Total. Other Benefits . .     1,061,686 90,915 970,771 1.850 %
k Total. Add lines 7d and 7j .     12,223,635 6,047,801 6,175,834 11.800 %
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
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
2,235,062
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
218,813
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
6,203,648
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
7,958,984
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-1,755,336
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 GEISINGER-BLOOMSBURG HOSPITAL
549 FAIR STREET
BLOOMSBURG,PA17815
WWW.GEISINGER.ORG
025001
X X   X     X   TRAUMA SERVICES  
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)
GEISINGER-BLOOMSBURG 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 Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
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 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.GEISINGER.ORG
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
GEISINGER-BLOOMSBURG 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
WWW.GEISINGER.ORG - REFER TO SECTION C
b
WWW.GEISINGER.ORG - REFER TO SECTION C
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
GEISINGER-BLOOMSBURG 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)
GEISINGER-BLOOMSBURG 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   No
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
FACILITY 1, GEISINGER-BLOOMSBURG HOSPITAL - PART V, LINE 5 SECTION B., COMMUNITY HEALTH NEEDS ASSESSMENT, LINES 3, 5 AND 6A: A COLLABORATIVE APPROACH TO COMMUNITY HEALTH IMPROVEMENT THE GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 19 COUNTIES ACROSS CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA WHICH REPRESENT THE COLLECTIVE SERVICE AREAS OF THE COLLABORATING HOSPITALS. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS AND FOSTER COOPERATION WITH LOCAL COMMUNITY PARTNERS TO IMPACT HEALTH NEEDS, REGIONAL RESEARCH AND LOCAL REPORTING WAS DEVELOPED. THE COLLABORATING HEALTH SYSTEMS AGREED THAT BY COORDINATING EFFORTS TO IDENTIFY COMMUNITY HEALTH NEEDS ACROSS THE REGION, THE HEALTH SYSTEMS WOULD CONSERVE COMMUNITY RESOURCES WHILE DEMONSTRATING LEADERSHIP IN CONVENING LOCAL COMMUNITY PARTNERS TO ADDRESS COMMON PRIORITY NEEDS. BEST PRACTICES IN COMMUNITY HEALTH IMPROVEMENT DEMONSTRATE THAT FOSTERING "COLLECTIVE IMPACT" IS AMONG THE MOST SUCCESSFUL WAYS TO AFFECT THE HEALTH OF A COMMUNITY. COLLECTIVE IMPACT IS ACHIEVED BY COMMITTING A DIVERSE GROUP OF STAKEHOLDERS TOWARD A COMMON GOAL OR ACTION, PARTICULARLY TO IMPACT DEEP ROOTED SOCIAL OR HEALTH NEEDS. BY TAKING A COLLABORATIVE APPROACH TO THE CHNA, GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL ARE LEADING THE WAY TO IMPROVE THE HEALTH OF COMMUNITIES IN CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA. CHNA LEADERSHIP THE CHNA WAS OVERSEEN BY A PLANNING COMMITTEE OF REPRESENTATIVES FROM EACH HEALTH SYSTEM, AS WELL AS A REGIONAL ADVISORY COMMITTEE OF REPRESENTATIVES FROM EACH HOSPITAL. COMMUNITY ENGAGEMENT COMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE CHNA. WEBINARS WERE HELD IN OCTOBER AND NOVEMBER 2017 TO ANNOUNCE THE ONSET OF THE CHNA AND ENCOURAGE BROAD PARTICIPATION ACROSS THE REGION. THROUGHOUT OCTOBER AND NOVEMBER 2017, A KEY INFORMANT SURVEY WAS SENT TO APPROXIMATELY 1,000 REPRESENTATIVES OF HEALTH AND HUMAN SERVICE ORGANIZATIONS, RELIGIOUS INSTITUTIONS, CIVIC ASSOCIATIONS, BUSINESSES, ELECTED OFFICIALS AND OTHER COMMUNITY REPRESENTATIVES. PARTNER FORUMS WERE HELD THROUGHOUT THE REGION IN JANUARY 2018 TO BRING TOGETHER THESE PARTNERS TO REVIEW RESEARCH FINDINGS AND PROVIDE FEEDBACK ON THE MOST PRESSING COMMUNITY HEALTH NEEDS. IN MARCH AND APRIL 2018, FOCUS GROUPS WITH SENIORS WERE HELD TO BETTER UNDERSTAND CHALLENGES AND OPPORTUNITIES TO IMPROVING HEALTH AMONG HIGH RISK POPULATIONS. COMMUNITY FORUMS WERE HELD IN FALL 2018 TO PRESENT CHNA FINDINGS AND IMPLEMENTATION PLANS TO COMMUNITY RESIDENTS AND PROVIDE A FORUM FOR DIALOGUE ABOUT ADDRESSING COMMUNITY HEALTH NEEDS. CHNA METHODOLOGY THE CHNA WAS CONDUCTED FROM SEPTEMBER 2017 TO APRIL 2018 AND USED BOTH PRIMARY AND SECONDARY RESEARCH TO ILLUSTRATE AND COMPARE HEALTH TRENDS AND DISPARITIES ACROSS THE REGION. PRIMARY RESEARCH WAS USED TO SOLICIT INPUT FROM KEY COMMUNITY STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. FOCUS GROUPS AND INTERVIEWS WERE USED TO COLLECT IN-DEPTH INSIGHT FROM HEALTH CONSUMERS REPRESENTING MEDICALLY UNDERSERVED OR HIGH RISK POPULATIONS. EXISTING DATA SOURCES, INCLUDING PUBLIC HEALTH STATISTICS, DEMOGRAPHIC AND SOCIAL MEASURES, AND HEALTHCARE UTILIZATION, WERE COLLECTED AND ANALYZED TO IDENTIFY HEALTH TRENDS ACROSS HOSPITAL SERVICE AREAS. SPECIFIC RESEARCH METHODS INCLUDED: AN ANALYSIS OF STATISTICAL HEALTH AND SOCIOECONOMIC INDICATORS FROM ACROSS THE REGION AN ANALYSIS AND COMPARISON OF ACUTE HOSPITAL UTILIZATION DATA A KEY INFORMANT SURVEY WITH 113 COMMUNITY LEADERS AND REPRESENTATIVES SIX REGIONAL PARTNER FORUMS WITH COMMUNITY BASED ORGANIZATIONS TO IDENTIFY COMMUNITY HEALTH PRIORITIES AND FACILITATE COLLABORATION TOWARD COMMUNITY HEALTH IMPROVEMENT TWELVE FOCUS GROUPS WITH SENIORS TO EXAMINE PREFERENCES, CHALLENGES, AND OPPORTUNITIES TO ACCESSING AND RECEIVING HEALTHCARE PRIORITIZATION OF COMMUNITY HEALTH NEEDS TO DETERMINE THE MOST PRESSING HEALTH ISSUES ON WHICH TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS THE CHNA BUILT UPON THE HOSPITALS' PREVIOUS CHNAS AND SUBSEQUENT IMPLEMENTATION PLANS. THE RESEARCH FINDINGS WILL BE USED TO GUIDE COMMUNITY BENEFIT INITIATIVES FOR THE HOSPITALS AND ENGAGE LOCAL PARTNERS TO COLLECTIVELY ADDRESS IDENTIFIED HEALTH NEEDS. PRIORITIZED COMMUNITY HEALTH NEEDS IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY, GEISINGER AND ITS CHNA PARTNERS SOLICITED AND RECEIVED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY EACH HOSPITAL, INCLUDING THOSE WITH EXPERTISE IN PUBLIC HEALTH, REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND OTHER COMMUNITY STAKEHOLDERS WHO BROUGHT WIDE PERSPECTIVES ON COMMUNITY HEALTH NEEDS, EXISTING COMMUNITY RESOURCES TO MEET THOSE NEEDS, AND GAPS IN THE CURRENT SERVICE DELIVERY SYSTEM. THROUGH FACILITATED DIALOGUE AND A SERIES OF CRITERIA-BASED VOTING EXERCISES, THE FOLLOWING HEALTH ISSUES WERE PRIORITIZED AS THE MOST SIGNIFICANT HEALTH NEEDS ACROSS THE REGION ON WHICH TO FOCUS HEALTH IMPROVEMENT EFFORTS OVER THE COMING THREE-YEAR CYCLE. ACCESS TO CARE BEHAVIORAL HEALTH (TO INCLUDE SUBSTANCE ABUSE AND MENTAL HEALTH STRATEGIES) CHRONIC DISEASE PREVENTION AND MANAGEMENT (WITH A FOCUS ON INCREASING HEALTHY HABITS) TO DIRECT COMMUNITY BENEFIT AND HEALTH IMPROVEMENT ACTIVITIES, GEISINGER AND ITS CHNA PARTNERS CREATED INDIVIDUAL IMPLEMENTATION PLANS FOR EACH HOSPITAL TO DETAIL THE RESOURCES AND SERVICES THAT WILL BE USED TO ADDRESS THESE IDENTIFIED HEALTH PRIORITIES. BOARD APPROVAL THE GEISINGER CHNA FINAL REPORTS WERE REVIEWED AND APPROVED BY THE GEISINGER HEALTH AFFILIATE BOARDS ON JUNE 20, 2018 AND THE GEISINGER HEALTH BOARD OF DIRECTORS ON JUNE 21, 2018. FOLLOWING THE BOARDS' APPROVAL, ALL CHNA REPORTS WERE MADE AVAILABLE TO THE PUBLIC VIA THE GEISINGER WEBSITE AT HTTPS://WWW.GEISINGER.ORG/ABOUT-GEISINGER/IN-OUR-COMMUNITY/CHNA. RESEARCH PARTNER BAKER TILLY WAS ENGAGED AS OUR CHNA RESEARCH PARTNER. BAKER TILLY ASSISTED IN ALL PHASES OF THE CHNA INCLUDING PROJECT MANAGEMENT, QUANTITATIVE AND QUALITATIVE DATA COLLECTION, SMALL AND LARGE GROUP FACILITATION AND REPORT WRITING. THE BAKER TILLY TEAM HAS WORKED WITH MORE THAN 100 HOSPITALS AND THOUSANDS OF THEIR COMMUNITY PARTNERS ACROSS THE NATION TO ASSESS HEALTH NEEDS AND DEVELOP ACTIONABLE PLANS FOR COMMUNITY HEALTH IMPROVEMENT. THROUGHOUT THIS DOCUMENT THE TERMS "SYSTEM- OR "GEISINGER" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH ("GH") AS PARENT AND ALL SUBSIDIARY ENTITIES COMPRISING THE SYSTEM.
FACILITY 1, GEISINGER-BLOOMSBURG HOSPITAL - PART V, LINE 6A ALLIED SERVICES REHABILITATION HOSPITAL, JOHN HEINZ REHABILITATION HOSPITAL, EVANGELICAL COMMUNITY HOSPITAL, GEISINGER MEDICAL CENTER (INCLUDES GEISINGER-SHAMOKIN AREA COMMUNITY HOSPITAL), GEISINGER ENCOMPASS HEALTH LIMITED LIABILITY COMPANY (DBA GEISINGER ENCOMPASS HEALTH REHABILITATION HOSPITAL), GEISINGER WYOMING VALLEY MEDICAL CENTER (INCLUDES GEISINGER SOUTH WILKES-BARRE), GEISINGER-BLOOMSBURG HOSPITAL, COMMUNITY MEDICAL CENTER (DBA GEISINGER COMMUNITY MEDICAL CENTER), GEISINGER JERSEY SHORE HOSPITAL, GEISINGER-LEWISTOWN HOSPITAL, AND HOLY SPIRIT HOSPITAL (DBA GEISINGER HOLY SPIRIT).
FACILITY 1, GEISINGER-BLOOMSBURG HOSPITAL - PART V, LINE 11 FIVE PRIORITY AREAS WERE IDENTIFIED WITHIN OUR CURRENT CHNA: ACCESS TO CARE, BEHAVIORAL HEALTH, CHRONIC DISEASE, MATERNAL/INFANT HEALTH, AND SENIOR HEALTH. IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY, GEISINGER AND ITS CHNA PARTNERS SOLICITED AND RECEIVED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY EACH HOSPITAL, INCLUDING THOSE WITH EXPERTISE IN PUBLIC HEALTH, REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND OTHER COMMUNITY STAKEHOLDERS WHO BROUGHT WIDE PERSPECTIVES ON COMMUNITY HEALTH NEEDS, EXISTING COMMUNITY RESOURCES TO MEET THOSE NEEDS, AND GAPS IN THE CURRENT SERVICE DELIVERY SYSTEM. THROUGH FACILITATED DIALOGUE AND A SERIES OF CRITERIA-BASED VOTING EXERCISES, THE FOLLOWING HEALTH ISSUES WERE PRIORITIZED AS THE MOST SIGNIFICANT HEALTH NEEDS ACROSS THE REGION ON WHICH TO FOCUS HEALTH IMPROVEMENT EFFORTS OVER THE COMING THREE-YEAR CYCLE: ACCESS TO CARE, BEHAVIORAL HEALTH, AND CHRONIC DISEASE. PROGRAMMING AND CLINICAL SERVICES WITHIN THESE PRIORITY AREAS IMPACT THE POPULATIONS OF MATERIAL/INFANT HEALTH AND SENIOR HEALTH AND ARE THEREBY SERVED THROUGH ALL APPROPRIATE HEALTH IMPROVEMENT EFFORTS. BELOW ARE SYSTEMWIDE PROGRAMS OFFERED BY GEISINGER TO FULFILL COMMUNITY NEEDS THAT WERE IDENTIFIED IN THE HOSPITAL'S MOST RECENT CHNA. SOME PROGRAMS ARE COMPLETELY OPERATED OR FUNDED BY GEISINGER AND SOME ARE OFFERED IN COOPERATION WITH LOCAL HEALTH AND HUMAN SERVICE AGENCIES. FOR MORE SPECIFIC NEEDS FOUND IN OUR LOCAL COMMUNITIES, WE OFFER PROGRAMS TO SERVE PATIENTS CLOSE TO HOME. THE TOP THREE NEEDS IDENTIFIED IN THE MOST RECENT AND/OR PAST CHNA SURVEYS FALL INTO ONE OF THREE COMMUNITY NEED CATEGORIES: 1)IMPROVING ACCESS TO HEALTHCARE: THE MOST SIGNIFICANT NEED IDENTIFIED WAS FOR BETTER, FASTER, MORE CONVENIENT AND LESS COSTLY ACCESS TO HEALTHCARE SERVICES. GEISINGER IS TAKING INNOVATIVE STEPS TO ADDRESS BARRIERS TO HEALTHCARE BY: INCREASING THE NUMBER OF RESIDENTS WHO HAVE A REGULAR PRIMARY CARE PROVIDER, INCREASING ACCESS TO PRIMARY AND SPECIALTY CARE PROVIDERS PRACTICING IN MEDICALLY UNDERSERVED AREAS (MUAS) AND HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS), REDUCING BARRIERS TO RECEIVING CARE FOR RESIDENTS WITHOUT TRANSPORTATION, PROMOTING AWARENESS OF AVAILABLE OPTIONS FOR ASSISTANCE TO PAY FOR HEALTHCARE NEEDS AND FOSTERING THE PURSUIT OF HEALTH CAREERS AND ONGOING TRAINING OF HEALTH PROFESSIONALS. 2)ADDRESSING BEHAVIORAL HEALTH AND SUBSTANCE ABUSE: GEISINGER IS COMMITTED TO HELPING PATIENTS FIND HEALTHCARE SERVICES WHEN THEY ARE FACING BEHAVIORAL HEALTH CHALLENGES OR STRUGGLING WITH ADDICTION. WE ADVANCE DIALOGUE AT THE LOCAL AND STATE LEVEL TO ADDRESS BEHAVIORAL HEALTH NEEDS. WE FOSTER INTEGRATION OF BEHAVIOR AND PRIMARY HEALTH CARE. WE PROVIDE EDUCATION TO INCREASE RESIDENTS' AWARENESS OF BEHAVIORAL HEALTH ISSUES AND REDUCE THE STIGMA ASSOCIATED WITH BEHAVIORAL HEALTH CONDITIONS. AND WE STRIVE TO INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES. 3)MANAGING CHRONIC CONDITIONS: GEISINGER HAS NUMEROUS PROGRAMS TO HELP PATIENTS PREVENT AND MANAGE CHRONIC CONDITIONS. EFFORTS INCLUDE ENCOURAGING COMMUNITY INITIATIVES THAT SUPPORT ACCESS TO AND AVAILABILITY OF HEALTHY LIFESTYLE CHOICES, INITIATING EARLY-STAGE INTERVENTIONS FOR INDIVIDUALS AT HIGH RISK FOR CHRONIC DISEASE, AND DEVELOPING INTEGRATIVE CARE MODELS TO IMPROVE OUTCOMES FOR PATIENTS WITH CHRONIC DISEASE. ACCESS TO CARE: GEISINGER BLOOMSBURG HOSPITAL IS COMMITTED TO INCREASING THE NUMBER OF RESIDENTS WHO HAVE A REGULAR PRIMARY CARE PROVIDER. ONE OF THE WAYS WE ARE MAKING THIS HAPPEN IS BY SCREENING PATIENTS WHO ACCESS SERVICES AT THE EMERGENCY DEPARTMENT TO DETERMINE IF THEY HAVE A MEDICAL HOME AND ASSIST THOSE WHO DO NOT IN FINDING A PRIMARY CARE PROVIDER. THIS APPROACH HAS NOT ONLY INCREASED THE NUMBER OF RESIDENTS WHO REPORT HAVING A MEDICAL HOME, IT HAS ALSO INCREASED THE NUMBER OF RESIDENTS WHO RECEIVE PREVENTIVE CARE AND REDUCED THE NUMBER OF NON-EMERGENT VISITS TO THE EMERGENCY DEPARTMENT. WE'RE ALSO IMPROVING ACCESS TO CARE BY FOSTERING THE PURSUIT OF HEALTH CAREERS AND PROVIDING ONGOING TRAINING TO HEALTH PROFESSIONALS, INCLUDING NURSING AND ALLIED HEALTH STUDENTS. AT THE SAME TIME, WE CONTINUE TO ENCOURAGE HIGH SCHOOL AND COLLEGE STUDENTS TO ENTER THE HEALTHCARE FIELD BY PROVIDING HIGH SCHOOL STEM AND CAREER TOURS OF GEISINGER BLOOMSBURG HOSPITAL, PARTICIPATING IN COLLEGE ORIENTATIONS AND HEALTH SYMPOSIUMS AND PROVIDING OPPORTUNITIES FOR VOLUNTEERING. BEHAVIORAL HEALTH: GEISINGER BLOOMSBURG HOSPITAL IS COMMITTED TO ADVANCING LOCAL AND STATE DIALOGUE TO ADDRESS BEHAVIORAL HEALTH NEEDS. WE PARTICIPATE IN AND ARE WELL REPRESENTED ON THE BOARD OF THE COALITION FOR SOCIAL EQUITY, AN ORGANIZATION THAT PROMOTES EQUALITY FOR ALL PERSONS IN BLOOMSBURG AND THE SURROUNDING AREAS THROUGH COMMUNITY EVENTS, TRAININGS AND POLICY CHANGES. THERE ARE NUMEROUS PRIMARY CARE LOCATIONS WHICH ALSO OFFER BEHAVIORAL HEALTH SERVICES. AN INTEGRATED PRIMARY CARE SITE IN BLOOMSBURG TREATS BOTH PEDIATRIC AND ADULT PATIENTS AND TELEPSYCHIATRY SERVICES ARE ALSO PROVIDED. A GEROPSYCHIATRY CLINIC IS IN PLACE AT THE BEHAVIORAL HEALTH OUTPATIENT CLINIC ON FIRST STREET IN BLOOMSBURG, WITH NEUROPSYCHOLOGY SERVICES PROVIDED AT THE SAME LOCATION. GEISINGER BLOOMSBURG HOSPITAL IS INCREASING ACCESS TO BEHAVIORAL HEALTH SERVICES BY OFFERING THE SEXUAL ABUSE PROGRAM WITH TRAINED SEXUAL ASSAULT NURSE EXAMINERS (SANE) IN THE HOSPITAL EMERGENCY DEPARTMENT. THE APPROACH INCREASES AWARENESS OF SEXUAL ABUSE AMONG EMERGENCY DEPARTMENT STAFF AND COMMUNITY MEMBERS, INCREASES OUR CAPACITY TO PROVIDE COMPREHENSIVE CARE TO VICTIMS OF SEXUAL ABUSE AND IMPROVES OUTCOMES FOR PATIENTS WHO ARE TREATED BY SANE PROVIDERS. CHRONIC DISEASE MANAGEMENT AND PREVENTION: GEISINGER BLOOMSBURG HOSPITAL ENCOURAGES COMMUNITY INITIATIVES THAT SUPPORT ACCESS TO AND AVAILABILITY OF HEALTHY LIFESTYLE CHOICES. WE ARE ALSO INSTRUMENTAL IN DEVELOPING INTEGRATIVE CARE MODELS TO IMPROVE OUTCOMES FOR PATIENTS WITH CHRONIC DISEASE. BOTH GOALS ARE SUPPORTED THROUGH OUR PRESENCE ON THE BOARD OF DIRECTORS FOR THE COLUMBIA CHILD DEVELOPMENT PROGRAM TO PROVIDE QUALITY, INCLUSIVE SERVICES FOR CHILDREN AND FAMILIES. WE ALSO PARTICIPATE IN FREE COMMUNITY EVENTS, INCLUDING HEALTH AND WELLNESS EDUCATIONAL PROGRAMS AND HEALTH FAIRS. WE PROVIDE SUPPORT GROUPS, INCLUDING THE BETTER BREATHERS' CLUB, FOR PATIENTS WITH ASTHMA, COPD AND OTHER BREATHING ISSUES, AND THEIR CAREGIVERS. THESE GROUPS IMPROVE CLINICAL MEASURES AMONG PARTICIPANTS AND INCREASE COPING SKILLS TO HELP THEM BETTER MANAGE DISEASE. KNOWLEDGE LEVELS PRE-AND POST-PARTICIPATION ARE MEASURED AND RECORDED TO MAKE SURE WE ARE COMMUNICATING EFFECTIVELY.
FACILITY 1, GEISINGER-BLOOMSBURG HOSPITAL - PART V, LINE 13B RECENT WAGE STATEMENTS, UNEMPLOYMENT OR OTHER DOCUMENTATION OF BENEFITS OR COMPENSATION RECEIVED MAY BE CONSIDERED IN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY.
FACILITY 1, GEISINGER-BLOOMSBURG HOSPITAL - PART V, LINE 16J THE FAP, FAP APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FAP ARE WIDELY AVAILABLE AT HTTPS://WWW.GEISINGER.ORG/PATIENT-CARE/PATIENTS-AND- VISITORS/BILLING-AND-INSURANCE/NEED-HELP. IN ADDITION, REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
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 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE SUPPORTING DOCUMENTATION FOR ELIGIBILITY MAY CONSIST OF INCOME AND ASSET INFORMATION, INCLUSIVE BUT NOT LIMITED TO: FEDERAL INCOME TAX FORM 1040 FROM THE PRIOR YEAR, PAY STUB COPIES (FROM FOUR PRIOR PAY PERIODS), WRITTEN VERIFICATION OF ANY OTHER INCOME RECEIVED (I.E. SOCIAL SECURITY, ADC, CHILD SUPPORT, ALIMONY, ETC.), CURRENT CREDIT REPORTS AND ASSET VERIFICATION. THE HOSPITAL MAY ALSO UTILIZE INDUSTRY TESTED EXTERNAL ANALYTICAL TOOLS TO QUALIFY PATIENTS FOR UNCOMPENSATED CARE (AKA PRESUMPTIVE CHARITY). GEISINGER PROVIDERS, WITHOUT DISCRIMINATION, CARE FOR ALL EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR FINANCIAL ASSISTANCE ELIGIBILITY OR ABILITY TO PAY. IT IS THE POLICY OF GEISINGER HOSPITAL FACILITIES TO COMPLY WITH THE STANDARDS OF THE FEDERAL EMERGENCY MEDICAL TREATEMENT AND ACTIVE LABOR TRANSPORT ACT NOF 1986 ("EMTLA") AND REGULATIONS IN PROVIDING MEDICAL SCREENING EXAMINATION AND SUCH FURTHER TREATMENT AS MAY BE NECESSARY TO STABILIZE AN EMERGENCY MEDICAL CONDITION FOR ANY INDIVIDUAL PRESENTING TO THE EMERGENCY DEPARTMENT SEEKING TREATMENT.
PART I, LINE 6A - RELATED ORGANIZATION INFORMATION COMMUNITY BENEFIT REPORT: A SUMMARY OF THE COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL AND ITS RELATED CHARITABLE ORGANIZATIONS IS INCLUDED IN GEISINGER'S ANNUAL REPORT AND IS AVAILABLE AT GEISINGER.ORG AND MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE REPORT CAN BE FOUND AT: HTTPS://WWW.GEISINGER.ORG/ABOUT- GEISINGER/NEWS-AND-MEDIA/FOR-MEDIA/ANNUAL-REPORTS
PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED IN SUBSIDIZED HEALTH SERVICES.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION A COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COSTS REPORTED ON LINE 7 AND ADDRESSED PATIENT SEGMENTS BY PAYOR (E.G. MEDICARE, MEDICAID, COMMERCIAL PAYERS, SELF-PAY, ETC.). A COST TO CHARGE RATIO, CALCULATED PURSUANT TO WORKSHEET 2 OF THE FORM 990 INSTRUCTIONS, WAS USED TO CALCULATE THE COST OF CHARITY CARE.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY REFER TO THE RESPONSE FOR PART III, LINE 4.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE PATIENTS' ACCOUNTS ARE MONITORED THROUGHOUT THE BILLING PROCESS AND ARE RECLASSIFIED TO CHARITY CARE (100% DISCOUNTED CARE) WHENEVER A PATIENT BECOMES ELIGIBLE UNDER THE HOSPITAL'S UNCOMPENSATED OR CHARITY CARE POLICIES. THE HOSPITAL ESTIMATES THAT APPROXIMATELY 7% OF THE BAD DEBT ACCOUNTS ARE SUBSEQUENTLY RECLASSIFIED TO UNCOMPENSATED OR CHARITY CARE.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS PART III, LINES 2 AND 4: GEISINGER HEALTH AND ITS AFFILIATES ("GEISINGER"), THAT INCLUDES THE HOSPITAL, PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. GEISINGER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS (BAD DEBT EXPENSE) METHODOLOGY AND CHARITY CARE POLICIES ARE CONSISTENTLY APPLIED ACROSS ALL CHARITABLE AFFILIATES. SEE FOOTNOTE 3: SUMMARY OF SIGNIFICANT ACCOUNTING BEGINNING ON PAGE 8 OF THE ATTACHED GEISINGER CONSOLIDATED FINANCIAL STATEMENTS, JUNE 30, 2019 AND JUNE 30, 2018. SEE PAGE 13 FOR THE DISCUSSION REGARDING NET PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE.
PART III, LINE 8 - MEDICARE EXPLANATION PART III, LINE 3 - BAD DEBT: MEDICARE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM. THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND THE COST OF BAD DEBT ARE COMMUNITY BENEFIT AND SHOULD BE INCLUDED ON FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW, THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON- DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND IS CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER THE INTERNAL REVENUE CODE ("IRC") 501(C)(3). SATISFYING THE "COMMUNITY BENEFIT STANDARD," AS ARTICULATED BY THE INTERNAL REVENUE SERVICE (IRS) IN REVENUE RULING 69-545, IS CURRENTLY REQUIRED FOR A HOSPITAL TO BE RECOGNIZED AS A CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE (IRC) 501(C)(3). THIS RULING REMOVED THE PREVIOUS REQUIREMENT OF REVENUE RULING 56-185, KNOWN AS THE "CHARITY CARE STANDARD," THAT IN ORDER TO BE A CHARITABLE ORGANIZATION, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR THEIR CARE. THIS EARLIER RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT MEAN THAT A HOSPITAL WAS CHARITABLE SINCE THAT LEVEL COULD REFLECT THE HOSPITAL'S FINANCIAL ABILITY TO PROVIDE SUCH CARE. REVENUE RULING 56-185 ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT IMPACT A HOSPITAL'S CHARITABLE STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. AS DEVELOPED IN REVENUE RULING 69-545, UNDER THE COMMUNITY BENEFIT STANDARD, HOSPITALS WERE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THIS RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED THOSE WHO COULD PAY FOR THE SERVICES EITHER BY THEMSELVES, THROUGH PRIVATE INSURANCE OR PUBLIC PROGRAMS SUCH AS MEDICARE. IN ADDITION, THE HOSPITAL OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL WAS CHARITABLE BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM CHARITABLE, AS REQUIRED BY TREASURY REGULATION SECTION 1.501 (C)(3)-1(D)(2). THE IRS RULED THAT THE PROMOTION OF HEALTH, LIKE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES OF THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO THOSE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER FACTORS THAT DEMONSTRATED COMMUNITY BENEFIT INCLUDED: SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND FACILITIES AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; AND IT WAS CONTROLLED BY A BOARD OF DIRECTORS THAT CONSISTED OF INDEPENDENT CIVIC LEADERS. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALLS) AND BAD DEBT SHOULD BE REPORTED AS COMMUNITY BENEFIT ON FORM 990, SCHEDULE H, PART I, LINE 7. THIS ORGANIZATION AGREES WITH THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 RESPONDING TO A DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA ARGUED THAT MEDICARE UNDERPAYMENTS (SHORTFALLS) IS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: -PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS REMAINS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. -MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES ONLY 92 CENTS FOR EVERY DOLLAR HOSPITALS SPEND TO CARE FOR MEDICARE PATIENTS. -MANY MEDICARE PATIENTS, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46% OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200% OF THE FEDERAL POVERTY LEVEL. MANY ARE ALSO ELIGIBLE FOR MEDICAID, SO CALLED -DUAL ELIGIBLES". PENNSYLVANIA REQUIRES NON-PROFIT HOSPITALS TO PROVIDE A MINIMUM LEVEL OF COMMUNITY BENEFIT TO RETAIN EXEMPTION FROM STATE AND LOCAL TAXES. ACCORDING TO STATE GUIDANCE AND CASE LAW, THE UNREIMBURSED COST OF MEDICARE AND BAD DEBT IS CONSIDERED TO BE COMMUNITY BENEFIT FOR STATE TAX EXEMPTION PURPOSES. PART III, LINE 6 ONLY INCLUDES THOSE COSTS THAT ARE PERMITTED TO BE REPORTED IN THE HOSPITAL'S MEDICARE COST REPORT THAT IS REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT. THE HOSPITAL CONSIDERS THE TOTAL MEDICARE UNDERPAYMENTS (SHORTFALL) OF 3,075,433 SHOULD BE REPORTED AS COMMUNITY BENEFIT ON THE FORM 990, SCHEDULE H, PART I, LINE 7. ALONG WITH PROVIDING CARE TO MEDICAID PATIENTS AND PROVIDING FREE OR DISCOUNTED CARE TO OTHER LOW-INCOME PATIENTS, THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. LIKE MEDICAID, MEDICARE DOES NOT PAY THE FULL COST OF PROVIDING CARE TO THESE PATIENTS, FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE SHORTFALL. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THE MEDICARE SHORTFALL AND IS THEREBY PROVIDING ACCESS TO MEDICAL SERVICES FOR THE ELDERLY AND RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR PROVIDING CARE TO MEDICARE PATIENTS. ABSENT THE MEDICARE PROGRAM, IT IS LIKELY THAT MANY MEDICARE PATIENTS WOULD BE ELIGIBLE FOR CHARITY CARE OR OTHER NEED-BASED GOVERNMENT PROGRAMS. THE AMOUNT EXPENDED TO COVER THE SHORTFALL IS MONEY NOT AVAILABLE FOR FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. BOTH THE HOSPITAL AND THE AHA BELIEVE THAT PATIENT BAD DEBT BE REPORTED AS A COMMUNITY BENEFIT ON FORM 990, SCHEDULE H, PART I, LINE 7. LIKE MEDICARE UNDERPAYMENTS (SHORTFALLS), BAD DEBT SHOULD BE REPORTED AS COMMUNITY BENEFIT BECAUSE: -A SIGNIFICANT PORTION OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO FOR MANY REASONS DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY UNDER THE HOSPITAL'S CHARITY CARE OR FINANCIAL ASSISTANCE POLICY (FAP). A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO"), "NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFIT", CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." -THE CBO REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF THE BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR CHARITABLE MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THE EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ACCORDING TO THE CBO REPORT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. (IN FY 2019, APPROXIMATELY 7% OF THE HOSPITAL'S BAD DEBT WAS SUBSEQUENTLY RECLASSIFIED TO CHARITY CARE.) THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE (BAD DEBT AND CHARITY CARE) AS A MEASURE OF COMMUNITY BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZED NATIONALLY. THE EXPERIENCE OF HOSPITALS NATIONWIDE REINFORCE THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE CHARITABLE MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS' BEAR IN SERVING ALL PATIENTS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. IN ADDITION, THE HOSPITAL INVESTS SIGNIFICANT RESOURCES IN SYSTEMS AND STAFF TRAINING TO ASSIST PATIENTS THAT ARE IN NEED OF FINANCIAL ASSISTANCE. FOR FISCAL YEAR ENDED 6/30/2019 THE HOSPITAL'S COST OF PROVIDING PATIENT CARE FOR SERVICES ACCOUNTED FOR AS BAD DEBT WAS 381,342.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE HOSPITAL IS COMMITTED TO PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND THE HOSPITAL'S COLLECTION ACTIONS ARE CONSISTENTLY APPLIED TO ALL PATIENTS. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND COUNSELING TO PATIENTS WITH LIMITED FINANCIAL MEANS. A PATIENT MAY BECOME ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING AND COLLECTION PROCESS. IN ANY STAGE OF THE BILLING PROCESS, COLLECTION ACTIONS ARE NOT PURSUED WHENEVER A PATIENT APPLIES AND IS BEING EVALUATED FOR FINANCIAL ASSISTANCE. UNDER NO CIRCUMSTANCES WILL THE HOSPITAL FREEZE OR ATTACH BANK ACCOUNTS OF A PATIENT, ENFORCE LIENS, ACTIVELY PURSUE ASSETS FROM A PRIOR JUDGMENT OR GARNISH THE WAGES OF A PATIENT AND/OR FAMILY MEMBER BEFORE DETERMINING IF THE PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. GEISINGER MANAGEMENT HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR GOVERNMENTAL PROGRAMS OR FINANCIAL ASSISTANCE FROM GEISINGER AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY HIS OR HER PAYMENT AGREEMENTS. BILLING AND COLLECTION POLICY: THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN ACCORDANCE WITH THE MISSION AND VALUES OF THE HOSPITAL AS WELL AS FEDERAL AND STATE LAW. THE POLICY IS DESIGNED TO PROMOTE APPROPRIATE ACCESS TO MEDICAL CARE FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY WHILE MAINTAINING GEISINGER'S FISCAL RESPONSIBILITY TO MAXIMIZE REIMBURSEMENT AND MINIMIZE BAD DEBT. THE ORGANIZATION'S BILLING AND COLLECTION POLICY IS INTENDED TO TAKE INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. THE ORGANIZATION MAKES SURE THAT PATIENTS ARE ASSISTED IN OBTAINING HEALTH INSURANCE COVERAGE FROM PRIVATELY AND PUBLICLY FUNDED SOURCES, WHENEVER POSSIBLE. ALL BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT REPRESENTATIVES ARE EDUCATED ON ALL ASPECTS OF THE BILLING AND COLLECTION POLICY AND ARE EXPECTED TO ADMINISTER THE POLICY ON A REGULAR AND CONSISTENT BASIS. BUSINESS OFFICE CUSTOMER SERVICE REPRESENTATIVES ARE HELD ACCOUNTABLE TO TREAT ALL PATIENTS WITH COURTESY, RESPECT, CONFIDENTIALITY AND CULTURAL SENSITIVITY. THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN CONJUNCTION WITH THE PROCEDURES OUTLINED IN INTERNAL ADMINISTRATIVE POLICIES. THE GEISINGER EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND VICE PRESIDENT, CHIEF REVENUE OFFICER HAVE OVERALL RESPONSIBILITY FOR THE BILLING AND COLLECTION ACTIVITIES OF THE HOSPITAL. THE BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT STAFF IS RESPONSIBLE FOR THE DAY-TO-DAY ENFORCEMENT OF APPROVED POLICIES AND PROCEDURES. GEISINGER MAY OFFER EXTENDED PAYMENT PLANS TO PATIENTS WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS. EMERGENCY & MEDICALLY NECESSARY SERVICES: GEISINGER DOES NOT ENGAGE IN ANY ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE. THE ORGANIZATION WILL NEVER DEMAND THAT AN EMERGENCY DEPARTMENT PATIENT PAY BEFORE RECEIVING TREATMENT FOR EMERGENCY MEDICAL CONDITIONS. ADDITIONALLY, GEISINGER DOES NOT PERMIT DEBT COLLECTION ACTIVITIES IN THE EMERGENCY DEPARTMENT OR OTHER AREAS WHERE SUCH ACTIVITIES COULD INTERFERE WITH THE PROVISION OF EMERGENCY CARE ON A NONDISCRIMINATORY BASIS. ALL MEDICALLY NECESSARY HOSPITAL SERVICES ARE PROVIDED WITHOUT CONSIDERATION OF ABILITY TO PAY AND ARE NOT DELAYED PENDING APPLICATION OR APPROVAL OF MEDICAL ASSISTANCE OR THE GEISINGER FINANCIAL ASSISTANCE PROGRAM. ADVANCE PAYMENT IS NOT REQUIRED FOR ANY MEDICALLY NECESSARY SERVICES. COMPLIANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(6): GEISINGER DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS ("ECAS") AS DEFINED BY INTERNAL REVENUE CODE SECTION 501(R)(6) PRIOR TO THE EXPIRATION OF THE NOTIFICATION PERIOD. THE NOTIFICATION PERIOD IS DEFINED AS A 120-DAY PERIOD OR GREATER, WHICH BEGINS ON THE DATE OF THE 1ST POST-DISCHARGE BILLING STATEMENT, IN WHICH NO ECAS ARE INITIATED AGAINST THE PATIENT. SUBSEQUENT TO THE NOTIFICATION PERIOD GEISINGER, OR ANY THIRD PARTIES ACTING ON ITS BEHALF, MAY INITIATE THE FOLLOWING ECAS AGAINST A PATIENT FOR AN UNPAID BALANCE IF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION HAS NOT BEEN MADE OR IF AN INDIVIDUAL IS INELIGIBLE FOR FINANCIAL ASSISTANCE. GEISINGER MAY AUTHORIZE THIRD PARTIES TO REPORT ADVERSE INFORMATION ABOUT THE INDIVIDUAL TO CONSUMER CREDIT REPORTING AGENCIES OR CREDIT BUREAUS ON DELINQUENT PATIENT ACCOUNTS AFTER THE NOTIFICATION PERIOD. THE ORGANIZATION ENSURES REASONABLE EFFORTS HAVE BEEN TAKEN TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY AND ENSURES THE FOLLOWING ACTIONS ARE TAKEN AT LEAST 30 DAYS PRIOR TO INITIATING ANY ECA: 1) THE PATIENT IS PROVIDED WITH WRITTEN NOTICE WHICH: INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE PATIENTS; IDENTIFIES THE ECA(S) THAT GEISINGER INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE; AND STATES A DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. 2) THE PATIENT IS PROVIDED WITH A COPY OF THE PLAIN LANGUAGE SUMMARY; AND 3) REASONABLE EFFORTS ARE MADE TO ORALLY NOTIFY THE PATIENT ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. GEISINGER PROCESSES ALL APPLICATIONS FOR FINANCIAL ASSISTANCE SUBMITTED DURING THE APPLICATION PERIOD. THE APPLICATION PERIOD BEGINS ON THE DATE THE CARE IS PROVIDED AND ENDS ON THE 240TH DAY AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT.
PART VI, LINE 2 - NEEDS ASSESSMENT THE GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 19 COUNTIES ACROSS CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA WHICH REPRESENT THE COLLECTIVE SERVICE AREAS OF THE COLLABORATING HOSPITALS. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS AND FOSTER COOPERATION WITH LOCAL COMMUNITY PARTNERS TO IMPACT HEALTH NEEDS, REGIONAL RESEARCH AND LOCAL REPORTING WAS DEVELOPED. THE COLLABORATING HEALTH SYSTEMS AGREED THAT BY COORDINATING EFFORTS TO IDENTIFY COMMUNITY HEALTH NEEDS ACROSS THE REGION, THE HEALTH SYSTEMS WOULD CONSERVE COMMUNITY RESOURCES WHILE DEMONSTRATING LEADERSHIP IN CONVENING LOCAL COMMUNITY PARTNERS TO ADDRESS COMMON PRIORITY NEEDS. BEST PRACTICES IN COMMUNITY HEALTH IMPROVEMENT DEMONSTRATE THAT FOSTERING "COLLECTIVE IMPACT" IS AMONG THE MOST SUCCESSFUL WAYS TO AFFECT THE HEALTH OF A COMMUNITY. COLLECTIVE IMPACT IS ACHIEVED BY COMMITTING A DIVERSE GROUP OF STAKEHOLDERS TOWARD A COMMON GOAL OR ACTION, PARTICULARLY TO IMPACT DEEP ROOTED SOCIAL OR HEALTH NEEDS. BY TAKING A COLLABORATIVE APPROACH TO THE CHNA, GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL ARE LEADING THE WAY TO IMPROVE THE HEALTH OF COMMUNITIES IN CENTRAL, NORTHEASTERN, AND SOUTH CENTRAL PENNSYLVANIA. THE FOLLOWING PAGES DESCRIBE THE PROCESS AND RESEARCH METHODS USED IN THE FY2019 CHNA AND THE FINDINGS THAT PORTRAY THE HEALTH STATUS OF THE COMMUNITIES WE SERVE AND OUTLINE OPPORTUNITIES TO WORK WITH OUR COMMUNITY PARTNERS TO ADVANCE HEALTH AMONG ALL RESIDENTS ACROSS OUR SERVICE AREAS. SEE ALSO THE DISCUSSION RELATED TO THE RESPONSE TO PART V, LINE 5.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FOR URGENT AND EMERGENT SERVICES, PATIENTS ARE PROVIDED CARE REGARDLESS OF THEIR ABILITY TO PAY. IN THE EVENT A PATIENT HAS AN EMERGENCY MEDICAL CONDITION; TREATMENT IS NOT DELAYED TO PERMIT AN INQUIRY REGARDING A PATIENT'S METHOD OF PAYMENT OR INSURANCE STATUS. FOR OTHER THAN URGENT AND EMERGENT SERVICES, THE HOSPITAL PROVIDES UNCOMPENSATED CARE, FREE OF CHARGE, OR ON A 100% DISCOUNTED BASIS, TO THOSE PATIENTS WHO DEMONSTRATE AN INABILITY TO PAY. DEPENDING UPON FAMILY SIZE AND INCOME, FREE OR 100% DISCOUNTED SERVICES ARE AVAILABLE TO A PATIENT WITH FAMILY INCOME OF 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND FINANCIAL COUNSELING TO PATIENTS OF LIMITED MEANS. A PATIENT MAY BECOME ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING PROCESS. INFORMATION (SIGNS, BROCHURES, ETC.) REGARDING THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES ARE PROVIDED AT THE EMERGENCY ROOM, REGISTRATION AND VARIOUS ACCESS POINTS THROUGHOUT THE HOSPITAL. REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. NOTICE OF THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES CAN ALSO BE FOUND ON THE GEISINGER WEB SITE AT WWW.GEISINGER.ORG. PATIENTS ARE ALSO PROVIDED INFORMATION ON THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES WITH EACH PATIENT BILL. THE FINANCIAL ASSISTANCE POLICY ("FAP"), THE FAP APPLICATION AND PLAIN LANGUAGE SUMMARY ("PLS") ARE AVAILABLE ON-LINE. PAPER COPIES ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL OR ARE AVAILABLE AT REGISTRATION AREAS WHICH INCLUDES EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL-BASED CLINICS AND PATIENT FINANCIAL SERVICES DEPARTMENTS. ALL FAP DOCUMENTS ARE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGE OF POPULATIONS WITH LIMITED ENGLISH PROFICIENCY ("LEP") THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE HOSPITAL'S SERVICE AREA. SIGNS OR DISPLAYS ARE CONSPICUOUSLY POSTED IN PUBLIC HOSPITAL LOCATIONS INCLUDING THE EMERGENCY DEPARTMENT, ADMISSIONS DEPARTMENT AND REGISTRATION DEPARTMENT THAT INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. ALL PATIENTS ARE OFFERED A COPY OF THE PLS AS PART OF THE INTAKE AND DISCHARGE PROCESSES. ADDITIONALLY, FINANCIAL COUNSELORS AND CUSTOMER SERVICE REPRESENTATIVES ARE AVAILABLE TO ASSIST PATIENTS WITH CONCERNS.
PART VI, LINE 4 - COMMUNITY INFORMATION GEISINGER BLOOMSBURG HOSPITAL PRIMARILY SERVES RESIDENTS IN 15 ZIP CODES SPANNING COLUMBIA, LUZERNE, MONTOUR, AND NORTHUMBERLAND COUNTIES IN PENNSYLVANIA. THE 2017 POPULATION OF THE SERVICE AREA WAS 164,250 AND PROJECTED TO DECREASE 0.4% BY 2022. ZIP CODE OF RESIDENCE IS ONE OF THE MOST IMPORTANT PREDICTORS OF HEALTH DISPARITY; WHERE RESIDENTS LIVE MATTERS IN DETERMINING THEIR HEALTH. THE COMMUNITY NEED INDEX (CNI) WAS DEVELOPED BY DIGNITY HEALTH AND TRUVEN HEALTH ANALYTICS TO ILLUSTRATE THE POTENTIAL FOR HEALTH DISPARITY AT THE ZIP CODE LEVEL. THE CNI SCORES ZIP CODES ON A SCALE OF 1.0 (LOW NEED) TO 5.0 (HIGH NEED) BASED ON 2015 DATA INDICATORS FOR FIVE SOCIO-ECONOMIC BARRIERS: INCOME: POVERTY AMONG ELDERLY HOUSEHOLDS, FAMILIES WITH CHILDREN, AND SINGLE FEMALE HEADED FAMILIES WITH CHILDREN CULTURE/LANGUAGE: MINORITY POPULATIONS AND ENGLISH LANGUAGE BARRIERS EDUCATION: POPULATION OVER 25 YEARS WITHOUT A HIGH SCHOOL DIPLOMA INSURANCE COVERAGE: UNEMPLOYMENT RATE AMONG POPULATION 16 YEARS OR OVER AND POPULATION WITHOUT HEALTH INSURANCE HOUSING STATUS: HOUSEHOLDERS RENTING THEIR HOME THE WEIGHTED AVERAGE CNI SCORE FOR GEISINGER BLOOMSBURG HOSPITAL'S 15 ZIP CODE SERVICE AREA IS 3.1, INDICATING MODERATE OVERALL COMMUNITY NEED. THE CENTRAL REGION POPULATION IS PRIMARILY WHITE, BUT DIVERSITY IS INCREASING. THE WHITE POPULATION AS A PERCENTAGE OF THE TOTAL POPULATION IS DECLINING IN ALL COUNTIES, WHILE BLACK/AFRICAN AMERICAN AND HISPANIC/LATINO POPULATIONS ARE GROWING. THE DEMOGRAPHIC SHIFT IS A STATEWIDE TREND. MINORITY POPULATIONS ARE THE ONLY GROWING DEMOGRAPHIC IN PENNSYLVANIA. THE HISPANIC/LATINO POPULATION IS ONE OF THE FASTEST GROWING DEMOGRAPHIC GROUPS. MONTOUR, NORTHUMBERLAND AND SCHUYLKILL COUNTIES ARE PROJECTED TO EXPERIENCE THE GREATEST INCREASE IN THE HISPANIC/LATINO POPULATION. PENNSYLVANIA FARES BETTER THAN THE NATION ON MOST ECONOMIC INDICATORS. PENNSYLVANIA RESIDENTS ARE LESS LIKELY TO LIVE IN POVERTY, HAVE A SIMILAR UNEMPLOYMENT RATE AS THE NATION'S AVERAGE, AND ARE MORE LIKELY TO HAVE ATTAINED AT LEAST A HIGH SCHOOL DIPLOMA. WITHIN THE CENTRAL REGION, RESIDENTS HAVE A LOWER MEDIAN HOUSEHOLD INCOME WHEN COMPARED TO THE STATE AND THE NATION. RESIDENTS IN CLINTON, COLUMBIA AND LYCOMING HAVE HIGHER POVERTY RATES THAN THE STATE AND THE NATION. SIMILARLY, EDUCATION ATTAINMENT IS LOWER AMONG MOST CENTRAL REGION COUNTIES, EXCEPTING MONTOUR, SNYDER, AND SULLIVAN. RACIAL AND ETHNIC MINORITY GROUPS LIKE BLACK/AFRICAN AMERICAN OR HISPANIC/LATINO RESIDENTS ARE MORE LIKELY TO BE IMPACTED BY ADVERSE SOCIOECONOMIC FACTORS, INCLUDING POVERTY, UNEMPLOYMENT, OR EDUCATION ATTAINMENT. POVERTY IS ONE OF THE BIGGEST DRIVERS OF DISPARITY IN THE CENTRAL REGION. POVERTY RATES AMONG MINORITY POPULATIONS ARE DOUBLE THE RATES AMONG WHITES. SOCIOECONOMIC DISPARITY CONTRIBUTES TO WORSE HEALTH OUTCOMES. BECAUSE POPULATION COUNTS FOR MINORITY RESIDENTS ACROSS THE REGION ARE LOW, HEALTH DISPARITIES ARE PRIMARILY EVIDENCED BY STATE AND NATIONAL TRENDS. THE 2017 POPULATION OF THE CENTRAL REGION IS 577,141. LYCOMING AND SCHUYLKILL COUNTIES COMPRISE THE MAJORITY OF THE POPULATION (46%). COUNTIES WITH SOME OF THE SMALLEST POPULATION COUNTS (CLINTON, MONTOUR, AND SNYDER) ARE EXPECTED TO HAVE THE LARGEST GROWTH BY 2022. THE CENTRAL REGION POPULATION IS PRIMARILY WHITE, BUT BECOMING MORE DIVERSE. THE PERCENTAGE OF WHITE RESIDENTS DECREASED ABOUT 1 PERCENTAGE POINT FROM 2010 TO 2017, WHILE THE PERCENTAGES OF BLACK/AFRICAN AMERICAN AND/OR HISPANIC/LATINO INCREASED SLIGHTLY SINCE 2010. THESE TRENDS ARE EXPECTED TO CONTINUE THROUGH 2022. CONSISTENT WITH THE DEMOGRAPHICS OF THE AREA, RESIDENTS ARE MORE LIKELY TO SPEAK ENGLISH AS THEIR PRIMARY LANGUAGE. PENNSYLVANIA HAS A HIGHER MEDIAN AGE THAN THE NATION. THE MEDIAN AGE OF LYCOMING, MONTOUR, NORTHUMBERLAND, SCHUYLKILL, AND SULLIVAN COUNTIES EXCEEDS THE STATE. SULLIVAN COUNTY HAS THE HIGHEST MEDIAN AGE, EXCEEDING THE STATE BY 11 POINTS. ALL COUNTIES WITHIN THE CENTRAL REGION HAVE A LOWER MEDIAN HOUSEHOLD INCOME THAN THE STATE AND THE NATION. SULLIVAN COUNTY HAS THE LOWEST MEDIAN HOUSEHOLD INCOME, BUT SIMILAR POVERTY RATES TO THE STATE. CLINTON, COLUMBIA, AND LYCOMING COUNTIES HAVE THE HIGHEST POVERTY RATES AMONG ALL RESIDENTS AND/OR CHILDREN. APPROXIMATELY 22% TO 25% OF CHILDREN IN CLINTON AND LYCOMING COUNTIES LIVE IN POVERTY. MONTOUR COUNTY HAS THE HIGHEST MEDIAN HOUSEHOLD INCOME AND THE LOWEST POVERTY RATES. ALL CENTRAL REGION COUNTIES EXCEPT MONTOUR HAVE A HIGHER PERCENTAGE OF BLUE COLLAR WORKERS WHEN COMPARED TO THE STATE AND THE NATION. THE UNEMPLOYMENT RATE FOR ALL COUNTIES IS SIMILAR TO OR LOWER THAN THE STATE UNEMPLOYMENT RATE, RANGING FROM 3% TO 6%. HOMEOWNERSHIP IS A MEASURE OF HOUSING AFFORDABILITY AND ECONOMIC STABILITY. ALL COUNTIES HAVE A LOWER MEDIAN HOME VALUE WHEN COMPARED TO THE STATE, BUT ONLY HOUSEHOLDERS IN MONTOUR, SCHUYLKILL, AND SNYDER COUNTIES ARE MORE LIKELY TO OWN THEIR HOME. ALL THREE COUNTIES HAVE SOME OF THE LOWEST POVERTY RATES IN THE REGION. EDUCATION IS THE LARGEST PREDICTOR OF POVERTY AND ONE OF THE MOST EFFECTIVE MEANS OF REDUCING INEQUALITIES. A HIGHER PERCENTAGE OF RESIDENTS IN ALL COUNTIES EXCEPT MONTOUR CONCLUDE THEIR EDUCATION WITH A HIGH SCHOOL DIPLOMA WHEN COMPARED TO THE STATE. MONTOUR COUNTY RESIDENTS ARE MORE LIKELY TO HAVE A BACHELOR'S DEGREE OR HIGHER WHEN COMPARED TO PEER COUNTIES.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART I IN ADDITION TO THE NET COMMUNITY BENEFIT COSTS INCURRED BY THE ORGANIZATION AS REPORTED IN SCHEDULE H, PART I, LINE 7; PLEASE REFER TO SCHEDULE O OF THIS FORM 990 FOR THE ORGANIZATION'S NARRATIVE COMMUNITY BENEFIT STATEMENT FOR ADDITIONAL INFORMATION ON HOW THE ORGANIZATION PROMOTES HEALTH AND PROVIDES HEALTHCARE SERVICES TO THE COMMUNITY REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY IN FURTHERANCE OF ITS CHARITABLE TAX EXEMPT PURPOSE.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM THE HOSPITAL IS AN AFFILIATE WITHIN GEISINGER, AN INTEGRATED HEALTH SERVICES ORGANIZATION THAT INCLUDES 13 HOSPITAL CAMPUSES, A NEARLY 600,000 -MEMBER HEALTH PLAN, TWO RESEARCH CENTERS, THE GEISINGER LEWISTOWN HOSPITAL SCHOOL OF NURSING AND THE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE. AND GEISINGER'S MYCODE COMMUNITY HEALTH INITIATIVE, THE LARGEST HEALTHCARE SYSTEM-BASED PRECISION HEALTH PROJECT IN THE WORLD, WITH NEARLY 200,000 VOLUNTEERS ENROLLED, IS CONDUCTING EXTENSIVE RESEARCH AND RETURNING MEDICALLY ACTIONABLE RESULTS TO PARTICIPANTS. HISTORY. GEISINGER HAD ITS BEGINNINGS IN THE SMALL COMMUNITY OF DANVILLE, WHICH IS LOCATED IN CENTRAL PENNSYLVANIA ON THE NORTHERN BRANCH OF THE SUSQUEHANNA RIVER. THERE, IN 1915, ABIGAIL A. GEISINGER FOUNDED THE GEORGE F. GEISINGER MEMORIAL HOSPITAL IN MEMORY OF HER HUSBAND. FROM THE BEGINNING, THE NEW HOSPITAL WAS DESIGNED AS A COMPREHENSIVE HEALTHCARE INSTITUTION THAT WOULD OFFER SPECIALIZED MEDICAL CARE TO PEOPLE IN THE RURAL AREAS OF CENTRAL AND NORTHEASTERN PENNSYLVANIA. UNLIKE MOST HEALTHCARE SYSTEMS, WHICH EVOLVED WITH A HOSPITAL FOCUS, GEISINGER'S HISTORY AND TRADITION IS THAT OF A PHYSICIAN-LED AND PHYSICIAN-DRIVEN HEALTHCARE ORGANIZATION. THIS TRADITION BEGAN WHEN MRS. GEISINGER BROUGHT DR. HAROLD FOSS, A MAYO CLINIC TRAINED PHYSICIAN, TO BE HER HOSPITAL'S FIRST CHIEF OF STAFF. TODAY, GEISINGER IS REGARDED AS A NATIONAL MODEL OF HEALTHCARE DELIVERY CENTERED ON A SOPHISTICATED MULTISPECIALTY GROUP PRACTICE. SINCE THE 1970S, GEISINGER'S STRATEGY OF INTEGRATING PHYSICIANS AND HOSPITALS EXPANDED TO INCLUDE THE MANAGEMENT OF HEALTH AND THE FINANCING OF HEALTHCARE SERVICES THROUGH ITS WHOLLY CONTROLLED HEALTH MAINTENANCE ORGANIZATION, GEISINGER HEALTH PLAN. TWO INDEMNITY HEALTH INSURERS, GEISINGER INDEMNITY INSURANCE COMPANY AND GEISINGER QUALITY OPTIONS, INC. HAVE BEEN ADDED IN RECENT YEARS. CORPORATE STRUCTURE. THE ORGANIZATIONAL STRUCTURE OF THE SYSTEM REFLECTS THE STRATEGIC GOAL OF OPERATING AS A FULLY INTEGRATED HEALTHCARE SYSTEM WHOSE CORPORATE COMPONENTS SHARE THE COMMON GOALS OF MANAGING AND IMPROVING THE HEALTHCARE OF ITS PATIENTS AND MEMBERS, WHILE RECOGNIZING AND RESPECTING THE CORPORATE IDENTITY OF EACH ENTITY. THIS INTEGRATION LINKS THE AREAS OF PHYSICIANS, HOSPITALS/CLINICS, AND HEALTHCARE INSURANCE. SEE SCHEDULE R FOR A LIST OF THE AFFILIATED ORGANIZATIONS COMPRISING GEISINGER.
ADDITIONAL INFORMATION PART VI, LINE 7: FORM 990, SCHEDULE H, PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: AT THIS TIME, THE HOSPITAL AND ITS AFFILIATES ARE NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE.
Schedule H (Form 990) 2018
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