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
2021
Open to Public Inspection
Name of the organization
SOUTH LYON HEALTH CENTER INC
DBA SOUTH LYON MEDICAL CENTER
Employer identification number

88-0256932
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
 
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
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
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) . . .
    159,630   159,630 1.110 %
b Medicaid (from Worksheet 3, column a) . . . . .     2,190,558 1,314,780 875,778 6.060 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     2,350,188 1,314,780 1,035,408 7.170 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .            
k Total. Add lines 7d and 7j .     2,350,188 1,314,780 1,035,408 7.170 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 Healthcare 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
559,172
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
260,195
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
1,266,571
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
2,073,396
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-806,825
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) 2021
Schedule H (Form 990) 2021
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 and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 SOUTH LYON MEDICAL CENTER
PO BOX 940
YERINGTON,NV89447
WWW.SLMCNV.ORG
660RUH-19
X X         X   RURAL  
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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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)
SOUTH LYON MEDICAL CENTER
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 21
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C, LINE 7D
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) 2021
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Schedule H (Form 990) 2021
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
SOUTH LYON MEDICAL CENTER
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 PART V, SECTION C
b
SEE PART V, SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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Part VFacility Information (continued)

Billing and Collections
SOUTH LYON MEDICAL CENTER
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) 2021
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Schedule H (Form 990) 2021
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
SOUTH LYON MEDICAL CENTER
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) 2021
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Schedule H (Form 990) 2021
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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, 20a, 20b, 20c, 20d, 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
SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 5: INFORMATION WAS COLLECTED FROM PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY UNMET HEALTH NEEDS WITHIN THE COMMUNITY. INFORMATION FROM THESE SOURCES WAS SUMMARIZED INTO THEMES THAT REPRESENT THE COMMUNITY'S UNMET HEALTH NEEDS, WHICH SERVE AS THE BASIS OF THE CHNA.PRIMARY DATA:PRIMARY DATA REPRESENTS INFORMATION COLLECTED FIRSTHAND FROM STAKEHOLDERS WITHIN SLMC'S COMMUNITY. THIS DATA WAS COLLECTED TO VALIDATE SECONDARY DATA FINDINGS THAT PERTAIN TO SLMC'S SERVICE AREA, IDENTIFY ISSUES THAT WERE NOT REPRESENTED IN THE SECONDARY DATA, AND UNDERSTAND WHAT SPECIFIC SUBGROUPS OF THE COMMUNITY MAY FACE ADDITIONAL CHALLENGES OR DISPARITIES.INTERVIEWS WERE CONDUCTED WITH COMMUNITY STAKEHOLDERS WHO BEST REPRESENTED THE BROAD INTERESTS, EXPERIENCES, AND NEEDS OF SLMC'S COMMUNITY, PARTICULARLY PEOPLE WHO REPRESENT MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS. A COMMUNITY HEALTH SURVEY WAS ALSO DISTRIBUTED TO ENSURE THAT EACH PERSON HAD THE OPPORTUNITY TO PARTICIPATE AND BE HEARD IN THIS PROCESS. A COMPLETE LIST OF THE COMMUNITY STAKEHOLDERS CAN BE FOUND IN THE REFERENCES AND ACKNOWLEDGMENTS.THE INTERVIEWS AND SURVEYS WERE DESIGNED TO SOLICIT INFORMATION PERTAINING TO THE FOLLOWING TOPICS:- SIGNIFICANT HEALTHCARE ISSUES OR NEEDS- SOCIAL, BEHAVIORAL, AND ENVIRONMENTAL FACTORS THAT CONTRIBUTE TO HEALTH NEEDS- BARRIERS TO CARE WITHIN THE COMMUNITY- VULNERABLE POPULATIONS WHO EXPERIENCE DISPARITIES- SUGGESTIONS OR IDEAS TO ADDRESS THE COMMUNITY'S NEEDS- POTENTIAL RESOURCES OR INFRASTRUCTURE TO SUPPORT HEALTH, SOCIAL, BEHAVIORAL, OR ENVIRONMENTAL NEEDS- AREAS FOR COLLABORATION TO ADDRESS HEALTH NEEDSSECONDARY DATA:SECONDARY DATA WAS COLLECTED FROM STATISTICAL DATA SOURCES AVAILABLE AT THE LOCAL, REGIONAL, STATE, AND NATIONAL LEVEL. THIS DATA PROVIDES A PROFILE OF THE DEMOGRAPHIC, SOCIAL, ECONOMIC, AND HEALTH CHARACTERISTICS OF SLMC'S COMMUNITY. TO THE EXTENT POSSIBLE DATA WAS COLLECTED AT THE LOCAL LEVEL, AND COMPARED TO REGIONAL, STATE, OR NATIONAL BENCHMARKS WHEN DETERMINING HEALTH NEEDS.SOURCES OF SECONDARY DATA INCLUDE:- AMERICAN COMMUNITY SURVEY- BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM- CENTER FOR DISEASE CONTROL AND PREVENTION- COUNTY HEALTH RANKINGS- ESRI BUSINESS INFORMATION SOLUTIONS- HEALTHIEST COMMUNITIES, A COLLABORATION BETWEEN U.S. NEWS AND THE UNIVERSITY OF MISSOURI EXTENSION CENTER FOR APPLIED RESEARCH AND ENGAGEMENT SYSTEMS- U.S. CENSUS BUREAU
SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 7D: PART V, SECTION B, LINES 7A & 10A:HTTPS://SLMCNV.ORG/COMMUNITY-NEEDS-ASSESSMENT/
SOUTH LYON MEDICAL CENTER PART V, SECTION B, LINE 11: CHNA IMPLEMENTATION PLAN:IN COLLABORATION WITH WIPFLI AND THE ADVISORY COMMITTEE, SLMC DEVELOPED AN IMPLEMENTATION PLAN TO ADDRESS THE PRIORITIZED HEALTH NEEDS. SLMC WILL EXPLORE THE FOLLOWING STRATEGIC OBJECTIVES AND TACTICS TO ADDRESS THE PRIORITIZED HEALTH NEEDS:ACCESS TO PRIMARY CAREACCESS TO SPECIALTY CARESTRATEGIC OBJECTIVES:- REDUCE APPOINTMENT WAIT TIMES TO CREATE BETTER ACCESSIBILITY FOR PATIENTS- IMPROVE PROVIDER PRODUCTIVITY TO CREATE BETTER ACCESSIBILITY FOR PATIENTS- IMPROVE ACCESSIBILITY FOR SPANISH-SPEAKING PATIENTS- RIGHT-SIZE NUMBER OF PROVIDERS EMPLOYED BY SLMC TO ALIGN SUPPLY WITH DEMANDTACTICS:- IMPLEMENT AND ADVERTISE A TWO-WEEK APPOINTMENT GUARANTEE WITHIN THE COMMUNITY- DEVELOP AN ADVERTISEMENT STRATEGY TO REACH THE HISPANIC POPULATION AND INCREASE RECRUITMENT OF BI-LINGUAL EMPLOYEES- CONDUCT A CLINICAL OPERATIONAL ASSESSMENT TO ANALYZE PROVIDER THROUGHPUT AND PRODUCTIVITY AND OTHER FACTORS IMPACTING THE PATIENT EXPERIENCE AT SLMC- EXPLORE IMPLEMENTING PRODUCTIVITY-BASED COMPENSATION AGREEMENTS TO IMPROVE PROVIDER PRODUCTIVITY- CONDUCT AN ASSESSMENT TO DETERMINE NUMBER OF PRIMARY CARE PROVIDERS NEEDED TO SUPPORT COMMUNITY DEMAND- CONTINUE SUPPORTING PARTNERSHIPS/AFFILIATIONS WITH RURAL RESIDENT TRAINING PROGRAMS TO RECRUIT MORE PRIMARY CARE PROVIDERS COMMITTED TO RURAL HEALTH TO SLMCSTRATEGIC OBJECTIVES:- EXPLORE FEASIBILITY OF OFFERING NEW SPECIALTY SERVICES AT SLMC- RIGHT-SIZE NUMBER OF PROVIDERS EMPLOYED OR CONTRACTED BY SLMC TO ALIGN SUPPLY WITH DEMAND- IMPROVE ADVERTISEMENT OF SERVICES AVAILABLE AT SLMC, INCLUDING DIAGNOSTIC AND OUTREACH/VISITING SPECIALTY SERVICES- REDUCE TRANSPORTATION BARRIERS FOR PATIENTS WHO NEED TO ACCESS SPECIALTY SERVICESTACTICS:- EXPLORE FEASIBILITY OF IMPLEMENTING A CARDIAC ECHO PROGRAM TO SUPPORT PATIENTS WITH HEART DISEASE- IMPLEMENT PROVIDER EDUCATION FOR TELEHEALTH SPECIALTY REFERRALS- HIRE A SOCIAL MEDIA COORDINATOR TO IMPROVE SOCIAL MEDIA PRESENCE AND IMPROVE ADVERTISEMENT OF SERVICES WITHIN THE COMMUNITY, INCLUDING THE HISPANIC POPULATION- EXPLORE COLLABORATION WITH HELPING HANDS TO PROVIDE FINANCIAL/OPERATIONAL SUPPORTMENTAL HEALTH AND SUBSTANCE USE:STRATEGIC OBJECTIVES:- IMPROVE ACCESSIBILITY TO MENTAL HEALTH AND SUBSTANCE USE SERVICES AT SLMC- RECRUIT OR CONTRACT WITH MORE BEHAVIORAL HEALTH PROVIDERS TO IMPROVE OUTPATIENT AND EMERGENCY RESPONSE SERVICES- IMPROVE ADVERTISEMENT OF BEHAVIORAL HEALTH SERVICES AVAILABLE AT SLMCTACTICS:- CONTINUE PROVIDING ACCESSIBILITY TO TELE-MENTAL HEALTH SERVICES WITH RENOWN, AND EXPLORE VIRTUAL PRESCRIBING CAPABILITIES FOR MEDICATION-ASSISTED TREATMENT- EXPLORE NEED FOR AND BARRIERS TO TELE-MENTAL HEALTH ADOPTION AND UTILIZATION IN SLMC PATIENTS- EXPLORE CONTRACTING WITH BEHAVIORAL HEALTH SOLUTIONS TO PROVIDE BEHAVIORAL HEALTH SERVICES TO PATIENTS- EXPLORE CONTRACTING WITH A LICENSED CLINICAL SOCIAL WORKER TO PROVIDE EMERGENCY BEHAVIORAL HEALTH CASE MANAGEMENT SERVICES
PART V, SECTION B, LINE 16 (A-C): HTTPS://SLMCNV.ORG/FINANCIAL-SERVICES/
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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?4
Name and address Type of Facility (describe)
1 1 - LONG TERM CARE
213 S WHITACRE STREET
YERINGTON,NV89447
LONG TERM CARE
2 2 - PHYSICIAN'S CLINIC
311 SURPRISE STREET
YERINGTON,NV89447
RURAL HEALTH CLINIC
3 3 - BARNETT CLINIC
213 S WHITACRE STREET
YERINGTON,NV89447
RURAL HEALTH CLINIC
4 4 - SMITH VALLEY CLINIC
445 STATE HWY 338
WELLINGTON,NV89444
RURAL HEALTH CLINIC
5
6
7
8
9
10
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 7: THE COSTING METHODOLOGY IS THE COST TO CHARGES RATIO. THE COST-TO-CHARGES RATIO IS USED FOR ALL PATIENT SEGMENT LINE INPATIENT, OUTPATIENT, AND EMERGENCY ROOM.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 781,367.
SCHEDULE H, PART I, LINE 5: THE ORGANIZATION BUDGETS FOR THEIR PROVISION FOR BAD DEBT AND CHARITY CARE ANNUALLY. THIS IS REPRESENTED IN A TOTAL OF THE TWO, NOT SEPARATELY. THE ORGANIZATION DOES COMPARE BUDGET TO ACTUAL FOR THIS LINE ITEM BUT NOT SEPARATELY SO THERE IS NO COMMENT ON WHETHER OR NOT THE ORGANIZATION EXCEEDED THE BUDGETED AMOUNT FOR DISCOUNTED OR FREE CARE UNDER THE FAP.
PART II, COMMUNITY BUILDING ACTIVITIES: THERE ARE A VARIETY OF ACTIVITIES THAT SLMC DOES TO SUPPORT AND PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS WEDNESDAY (OFFERING REDUCED COST FOR SERVICES), PROVIDING SPACE FOR SPECIALISTS FOR LOCAL VISITS, PROVIDING FREE MEETING ACCESS TO COMMUNITY SUPPORT ORGANIZATIONS, PROVIDING DIABETIC EDUCATION TO PATIENTS, THEIR FAMILIES, AND THE COMMUNITY. SLMC ALSO PROVIDES TRAVELING FLU VACCINATION CLINICS TO AREA BUSINESSES. MANY OF THESE PROGRAMS ARE NOT EASY OR COST EFFECTIVE TO TRACK IN OUR ACCOUNTING SYSTEM AND THEREFORE ARE NOT REPORTED.
PART III, LINE 2: THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO.
PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY IS DETERMINED BY THE ORGANIZATION USING INFORMATION AVAILABLE TO MAKE AN EDUCATED ESTIMATE.
PART III, LINE 4: THE ORGANIZATION DOES NOT HAVE A SEPARATE BAD DEBT FOOTNOTE. THE FOOTNOTE INCLUDED HERE IS THE PATIENT RECEIVABLES AND CREDIT POLICY NOTE.PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT AND RESIDENT ACCOUNTS RECEIVABLE.IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.
PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORTED IN THE MEDICARE COST REPORT IS THE COST TO CHARGE RATIO.
PART III, LINE 9B: EMERGENCY ROOM PATIENTS WITHOUT A PAYMENT SOURCE MAY BE CLASSIFIED AS CHARITY IF THEY DO NOT HAVE A JOB, MAILING ADDRESS, RESIDENCE, OR INSURANCE. CONSIDERATION MUST ALSO BE GIVEN TO CLASSIFYING EMERGENCY ROOM ONLY PATIENTS WHO DO NOT PROVIDE ADEQUATE INFORMATION AS TO THEIR FINANCIAL STATUS. IN MANY INSTANCES, THESE PATIENTS ARE HOMELESS AND HAVE FEW RESOURCES TO COVER THE COST OF THEIR CARE.IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE HOSPITAL'S CHARITY CARE ELIGIBILITY CRITERIA, THEIR PATIENT ACCOUNT MAY BE CONSIDERED CHARITY CARE, EVEN IF THEY WERE ORIGINALLY CLASSIFIED AS A BAD DEBT. COLLECTION AGENCY PATIENT ACCOUNTS MEETING CHARITY CARE CRITERIA SHOULD BE RETURNED TO THE HOSPITAL BILLING OFFICE AND REVIEWED FOR CHARITY CARE ELIGIBILITY.
PART VI, LINE 2: SOUTH LYON MEDICAL CENTER (SLMC) CONDUCTS WELLNESS WEDNESDAY WEEKLY OFFERING REDUCED LAB TESTING TO ACCESS PATIENT HEALTH. SLMC WILL MEET WITH LOCAL ORGANIZATIONS (I.E., ROTARY, SOROPTIMISTS, ETC.) UPON REQUEST. SLMC IS ALSO DEVELOPING A COMMUNITY WELLNESS PROGRAM WITH A FOCUS ON DIABETES IN ENGLISH AND SPANISH. THE ORGANIZATION PROVIDES COMMENT BOXES, HCAPHS SURVEYS AND PATIENT COMPLAINT/CONCERNS SURVEYS TO GATHER INFORMATION ON COMMUNITY NEEDS.
PART VI, LINE 3: PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE THROUGH THE CHARITY CARE POLICY ARE MADE THROUGH EACH OF THE FOLLOWING MEANS:1. POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMITTING OFFICES, AND HOSPITAL OUTPATIENT SERVICE SETTINGS.2. INCLUDING INFORMATION IN THE BILLS SENT TO UNINSURED PATIENTS STATEMENTS INDICATING:A) IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS, THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR FOR FINANCIAL ASSISTANCE FROM THE HOSPITAL.B) A HOSPITAL PHONE NUMBER THAT PATIENTS MAY CALL FOR FURTHER INFORMATION.3. POSTING NOTICE OF THE AVAILABILITY OF ASSISTANCE AND A CONTACT PHONE NUMBER ON THE SLMC WEB SITE.4. PROVIDING UNINSURED PATIENTS INFORMATION OUTLINING THE TYPES OF FINANCIAL ASSISTANCE AVAILABLE.POSTED NOTICES (AS LISTED ABOVE) SHALL BE IN THE PRIMARY LANGUAGE(S) OF SLMC'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. POSTED NOTICES SHALL CONTAIN THE FOLLOWING INFORMATION:1. A STATEMENT INDICATING THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS WHO MAY NOT BE ABLE TO PAY THEIR BILL AND THAT THIS POLICY PROVIDES FOR FULL OR PARTIAL CHARITY CARE WRITE-OFF.2. IDENTIFICATION OF A HOSPITAL CONTACT PHONE NUMBER THAT THE PATIENT CAN CALL TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND ABOUT HOW TO APPLY FOR ASSISTANCE.
PART VI, LINE 4: AS OF 2021, THE POPULATION OF THE PSA IS 8,897, WITH PROJECTIONS ESTIMATING THAT THE PSA IS ANTICIPATED TO GROW BY 3% OVER THE NEXT FIVE YEARS, OR BY ABOUT 286 PEOPLE.THE AGE DISTRIBUTION OF THE POPULATION ALSO IMPACTS THE NEED FOR HEALTHCARE SERVICES. THE COMMUNITY SERVED BY SLMC TRENDS SIGNIFICANTLY OLDER THAN STATE AND NATIONAL BENCHMARKS, WITH 30% OF THE POPULATION CONSISTING OF PEOPLE OVER THE AGE OF 65. THIS AGE COHORT IS ANTICIPATED TO CONTRIBUTE TO A MAJORITY OF THE GROWTH PROJECTED IN THE PSA OVER THE NEXT FIVE YEARS (321 PEOPLE) SLMC'S PSA IS PREDOMINANTLY WHITE, WITH 64% OF THE POPULATION CONSISTING OF INDIVIDUALS WHO IDENTIFY AS WHITE, NON-HISPANIC. APPROXIMATELY 26% OF THE POPULATION IDENTIFIES AS HISPANIC, HIGHER THAN THE NATIONAL BENCHMARK OF 19%. INCOME IS ONE OF THE MOST IMPORTANT SOCIAL DETERMINANTS OF HEALTH, IMPACTING NOT ONLY EDUCATION AND LIVING CONDITIONS, BUT ALSO PHYSICAL HEALTH, MENTAL HEALTH, AND HEALTH-RELATED BEHAVIORS SUCH AS DIET AND EXERCISE. HOUSEHOLD INCOME IN THE PSA TRENDS SIGNIFICANTLY LOWER THAN COUNTY, STATE, AND NATIONAL BENCHMARKS, WITH 38% OF HOUSEHOLDS IN THE PSA REPORTING A HOUSEHOLD INCOME BELOW $35,000, COMPARED TO 29% OF HOUSEHOLDS IN LYON COUNTY. THIS INDICATES THAT SLMC'S PSA IS SIGNIFICANTLY LESS AFFLUENT.
PART VI, LINE 5: SOUTH LYON MEDICAL CENTER HAS A COMMUNITY-BASED BOARD OF DIRECTORS; AN OPEN MEDICAL STAFF AND USES SURPLUS FUNDS TO PAY FOR COMMUNITY SERVICES SUCH AS HEALTH FAIRS, SPACE FOR MEDICAL SPECIALISTS FOR LOCAL VISITS.
Schedule H (Form 990) 2021
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