PART I, LINE 3C:
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TO QUALIFY FOR FINANCIAL ASSISTANCE, (A) HOUSEHOLD INCOME MUST BE LESS THAN 300% OF FEDERAL POVERTY GUIDELINES, (B) THE VALUE OF ASSETS HELD MUST BE LESS THAN $25,000 FOR AN INDIVIDUAL OR $50,000 FOR A FAMILY, (C) THE INDIVIDUAL MUST RECEIVE MEDICALLY NECESSARY CARE, (D) LIVE IN ST. LUKE'S PRIMARY OR SECONDARY SERVICE AREA (UNLESS THEY PRESENT WITH AN URGENT, EMERGENT, OR LIFE-THREATENING MEDICAL CONDITION), AND (E) COMPLETE A FINANCIAL ASSISTANCE APPLICATION, INCLUDING REQUIRED SUPPORTING DOCUMENTS.
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PART I, LINE 7:
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ST. LUKE'S USED COST-TO-CHARGE RATIOS DERIVED FROM THE MOST RECENT COMPLETED MEDICARE COST REPORT FOR FINANCIAL ASSISTANCE AND GOVERNMENT PROGRAM; AND ACTUAL COSTS FOR OTHER COMMUNITY BENEFITS.
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PART I, LINE 7G:
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ST. LUKE'S INCLUDED SUBSIDIZED HEALTH SERVICES FROM MENTAL HEALTH SERVICES, WOMEN AND CHILDREN SERVICES, AND HOMECARE/HOSPICE SERVICES.
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PART I, LINE 7, COLUMN (F):
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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 $ 6,922,726.
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PART II, COMMUNITY BUILDING ACTIVITIES:
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ST. LUKE'S COMMUNITY-BUILDING ACTIVITIES INCLUDE CASH, IN-KIND DONATIONS, AND OTHER EXPENDITURES FOR THE DEVELOPMENT OF THE COMMUNITY HEALTH PROGRAMS AND PARTNERSHIPS SUCH AS: ECONOMIC DEVELOPMENT EVENTS, MEETINGS, AND MEMBERSHIP WITH AREA CHAMBERS OF COMMERCE, CITY COUNSEL, AND ST. LOUIS COUNTY; COMMUNITY SUPPORT OF LOCAL FUNDRAISERS, ORGANIZATIONS AND EVENTS; LEADERSHIP DEVELOPMENT, TRAINING, AND EDUCATION; COALITION BUILDING WITH AREA ASSOCIATIONS TO PROMOTE COLLABORATION ON WELLNESS INITIATIVES; COMMUNITY HEALTH IMPROVEMENT ADVOCACY IN PARTNERSHIP WITH LOCAL ORGANIZATIONS, EVENTS, AND SERVICES; AND WORKFORCE DEVELOPMENT VIA EDUCATION, MENTORSHIP, PANEL PRESENTATIONS, AND OTHER STUDENT PROGRAMS.
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PART III, LINE 2:
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BAD DEBT ACCOUNTS WILL MEET AT ALL OF THE FOLLOWING CRITERIA:I. ATTEMPTS HAVE BEEN MADE TO CONTACT THE PATIENT OR GUARANTOR BY MAIL AND TELEPHONE.II. PATIENT OR GUARANTOR HAS NOT RESPONDED DURING THE COLLECTION CYCLE IN A TIMELY AND RESPONSIBLE MANNER OR HAS DEFAULTED ON A PAYMENT ASSESSMENT.III. THERE ARE NO KNOWN CIRCUMSTANCES WHICH WOULD JUSTIFY RECONSIDERATION FOR FINANCIAL ASSISTANCE.APPROVAL FOR BAD DEBT WRITE-OFFS ARE AS FOLLOWS:$0 TO $2,499 - PATIENT ACCOUNTS MANAGER OR CBO MANAGER$2,500 TO $9,999 - BUSINESS SERVICES DIRECTOR OR CBO MANAGER$10,000 AND OVER - CHIEF FINANCIAL OFFICER
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PART III, LINE 3:
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ST. LUKE'S HOSPITAL OF DULUTH CANNOT REASONABLY ESTIMATE THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION.
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PART III, LINE 4:
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SEE THE "PATIENT RECEIVABLES NOTE ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
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PART III, LINE 8:
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THE MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THE INDIVIDUALS WHO PARTICIPATE IN THE MEDICARE PROGRAM ARE FREQUENTLY UNABLE TO AFFORD MEDICAL CARE WITHOUT THIS PROGRAM AND ST. LUKE'S HOSPITAL PARTICIPATES IN THE MEDICARE PROGRAM TO ASSIST THESE INDIVIDUALS DESPITE THE SIGNIFICANT FINANCIAL COST/LOSS TO THE HOSPITAL. THE COST-TO-CHARGE RATIO WAS THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED ON SCHEDULE H, PART III, LINE 6.
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PART III, LINE 9B:
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ST. LUKE'S 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 AND THE PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH THEIR PAYMENT AGREEMENTS.IN THE EVENT THAT A PATIENT FAILS OR REFUSES TO FULFILL THEIR FINANCIAL OBLIGATION, ST. LUKE'S MAY ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS, INCLUDING:A. REFERRAL OF UNPAID BALANCES TO EXTERNAL COLLECTION AGENCIES;B. ACTIONS THAT REQUIRE A LEGAL OR JUDICIAL PROCESS SUCH AS A LIEN ON PROPERTY OR GARNISHMENT OF WAGES.PRIOR TO INITIATING ECA'S, ST. LUKE'S WILL FOLLOW ALL APPLICABLE REGULATIONS AND MAKE REASONABLE EFFORTS TO DETERMINE WHETHER AN INDIVIDUAL WHO HAS AN UNPAID ACCOUNT IS ELIGIBLE FOR FAP. ST. LUKE'S WILL REFRAIN FROM ANY ECA'S FOR AT LEAST 120 DAYS AFTER SENDING THE FIRST POST-DISCHARGE BILLING STATEMENT AND ALLOWING AT LEAST 240 DAYS TO APPLY FOR FINANCIAL ASSISTANCE.THE BILLING AND COLLECTIONS POLICY IS AVAILABLE TO THE PUBLIC ONLINE AT HTTPS://WWW.SLHDULUTH.COM/PATIENTS-VISITORS/FINANCIAL-SERVICES/ST-LUKES-FINANCIAL-ASSISTANCE-PROGRAM/ AND PAPER COPIES OF THE POLICY ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE BY MAIL, IN THE EMERGENCY ROOM, AND IN ALL ADMISSIONS AREAS.
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PART VI, LINE 2:
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ST. LUKE'S HAS A LONG HISTORY OF PARTICIPATING IN SUCCESSFUL, SUSTAINABLE COLLABORATIVE INITIATIVES ON LOCAL, REGIONAL, AND NATIONAL LEVELS. 1) ST. LUKE'S RESEARCH DEPARTMENT, THE WHITESIDE INSTITUTE FOR CLINICAL RESEARCH, WAS FORMED IN 1996 AS THE RESULT OF A PARTNERSHIP WITH THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH (UMMSD), AND CONTINUES TO PROVIDE SERVICES TO ST. LUKE'S PATIENTS IN ACCESS TO LOCAL, NATIONAL, AND MULTI-NATIONAL CLINICAL STUDIES AS WELL AS TO ST. LUKE'S STAFF IN DEVELOPMENT OF RESEARCH STUDIES, REFERRAL TO UM COLLABORATORS, AND GRANT WRITING RESOURCES. 2) ST. LUKE'S HAS COLLABORATED WITH THE MULTI-STATE CONSORTIUM OF ABOUT 64 SUPPORTING ORGANIZATIONS INCLUDING COUNTY PUBLIC HEALTH DEPARTMENTS, HOSPITALS, AND CLINICS TO FUND THE BRIDGE TO HEALTH SURVEY. THIS PROJECT COLLECTED POPULATION-BASED, HEALTH STATUS DATA ON ADULTS (AGED 18+) IN THE REGION USING A SURVEY FORMAT AND WAS CONDUCTED IN 1995, 2000, 2005, 2010, 2015 AND 2020. TO ADDRESS A NEED THAT BECAME APPARENT AS A RESULT OF THE BRIDGE TO HEALTH SURVEY, ST. LUKE'S JOINED WITH OTHER HEALTHCARE PROVIDERS IN THE COMMUNITY TO DEVELOP TWO PROGRAMS: SHARECARE, WHICH ESTABLISHED SLIDING FEE SCALES FOR CLINIC AND OUTPATIENT SERVICES TO DIMINISH THE FINANCIAL BARRIER TO PREVENTIVE, MENTAL HEALTH, AND PRIMARY CARE SERVICES; AND HEALTHSHARE, WHICH IS A COVERAGE MODEL FOR SMALL BUSINESSES FUNDED COLLABORATIVELY BY THE EMPLOYERS, EMPLOYEES, AND THE COMMUNITY. THIS COVERAGE MODEL PROVIDES A CONTINUUM OF HEALTH CARE SERVICES FOR EMPLOYEES WITHIN A DEFINED NETWORK OF COMMUNITY PROVIDERS. 3) ST. LUKE'S WAS A LEAD PARTICIPANT IN THE WILDERNESS COALITION PHARMACY SERVICES PROJECT FUNDED BY THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY. THIS 3-YEAR PROJECT SUCCESSFULLY IMPLEMENTED 24/7 PROFESSIONAL PHARMACY SERVICES FOR 10 RURAL HOSPITALS IN NORTHEASTERN MINNESOTA USING ST. LUKE'S 24-HOUR PHARMACY, AN ITV-BASED SYSTEM OF CONTINUING EDUCATION FOR SITES, PHARMACY POLICIES AND PROCEDURES ADAPTABLE FOR INDIVIDUAL SITES, AS WELL AS BEDSIDE VERIFICATION OF MEDICATION ADMINISTRATION AND MEDICATION BAR CODING AT SOME LOCATIONS. THOUGH PROJECT FUNDING HAS ENDED, THE SERVICES REMAIN AND THE PROGRAM IS NOW SELF-SUSTAINING.
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PART VI, LINE 3:
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ST. LUKE'S INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT ELIGIBILITY FOR ASSISTANCE THE FOLLOWING WAYS:- INFORMATION IS INCLUDED ON THE ST. LUKE'S WEBSITE (WWW.SLHDULUTH.COM) REGARDING WHO PATIENTS SHOULD CONTACT FOR INFORMATION OR FINANCIAL ASSISTANCE.- THERE ARE POSTINGS IN ALL REGISTRATION AREAS WITH CONTACT INFORMATION AND PHONE NUMBERS REGARDING HOW PATIENTS CAN OBTAIN ASSISTANCE (BOTH FROM ST. LUKE'S AND EXTERNAL ORGANIZATIONS).- ALL ST. LUKE'S EXTERNAL BILLING AND COLLECTION VENDORS HAVE BEEN INSTRUCTED TO REFER ANY PATIENT INDICATING THEY LACK THE FINANCIAL WHEREWITHAL TO MEET THEIR FINANCIAL OBLIGATIONS TO ST. LUKE'S FINANCIAL COUNSELORS. AS REQUIRED UNDER A BILLING AND COLLECTION AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL, ST. LUKE'S PERFORMS AN ANNUAL AUDIT OF ALL EXTERNAL VENDORS TO ENSURE COMPLIANCE WITH THIS INSTRUCTION AND ALL OTHER ST. LUKE'S POLICIES AND PROCEDURES.- ST. LUKE'S FINANCIAL COUNSELORS' BUSINESS CARDS ARE PROMINENTLY DISPLAYED AND AVAILABLE AT ALL REGISTRATION AREAS (INCLUDING THE EMERGENCY/URGENT CARE AREA) WITH THEIR CONTACT INFORMATION AND PHONE NUMBERS. PATIENTS ARE ENCOURAGED TO CONTACT FINANCIAL COUNSELORS.- THE ST. LUKE'S FINANCIAL COUNSELORS' PHONE NUMBER IS LISTED PROMINENTLY ON THE PATIENT BILLING STATEMENTS.- THE FINANCIAL COUNSELORS ARE AVAILABLE WEEKDAYS BY PHONE OR IN PERSON TO DISCUSS AND APPLY FOR FINANCIAL ASSISTANCE PROGRAMS.- ST. LUKE'S HAS ENGAGED AN EXTERNAL VENDOR TO MEET WITH PATIENTS AT BEDSIDE TO DISCUSS ELIGIBILITY FOR ASSISTANCE WITH GOVERNMENTAL ASSISTANCE PROGRAMS OR ST. LUKE'S FINANCIAL ASSISTANCE PROGRAM.- ST. LUKE'S INPATIENT BOOKLET CONTAINS INFORMATION REGARDING FINANCIAL ASSISTANCE AND CONTACT INFORMATION.- AT LEAST ANNUALLY, THE ST. LUKE'S AND MEDICAL STAFF NEWSLETTERS CONTAIN ARTICLES REGARDING PATIENT FINANCIAL ASSISTANCE. HOSPITAL AND MEDICAL STAFF MEMBERS ARE INFORMED THAT THEY HAVE THE RESPONSIBILITY TO LISTEN FOR FINANCIAL CONCERNS EXPRESSED BY PATIENTS AND TO PROACTIVELY REFER THOSE PATIENTS TO ST. LUKE'S FINANCIAL COUNSELORS.
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PART VI, LINE 4:
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ST. LUKE'S SERVICE AREA CONSISTS OF A 17-COUNTY REGION OF NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN, AND THE WESTERN UPPER PENINSULA OF MICHIGAN WITH A POPULATION OF APPROXIMATELY 500,000. THE PRIMARY MARKET CONSISTS OF DULUTH, CLOQUET, AND TWO HARBORS, MINNESOTA, AND SUPERIOR, WISCONSIN. THIS PRIMARY MARKET SERVES URBAN AND SUBURBAN AREAS WITH A POPULATION OF APPROXIMATELY 166,000.DEMOGRAPHICS OF THE COMMUNITY OR COMMUNITIES (PRIMARY MARKET) PER MOST RECENT CENSUS:POPULATIONS - DULUTH, MN (86,697); SUPERIOR, WI (26,751)MEDIAN HOUSEHOLD INCOME - DULUTH, MN ($54,084); SUPERIOR, WI ($48,830)% OF INDIVIDUALS BELOW FPG - DULUTH, MN (17.7%); SUPERIOR, WI (14.0%)HOSPITALS SERVING THE COMMUNITY OR COMMUNITIES (PRIMARY MARKET):ST. LUKE'S HOSPITAL OF DULUTHLAKE VIEW MEMORIAL HOSPITALCLOQUET COMMUNITY MEMORIAL HOSPITALESSENTIA HEALTH SMDC MEDICAL CENTER (FORMERLY MILLER DAWN)ESSENTIA HEALTH ST. MARY'S HOSPITAL OF SUPERIORESSENTIA HEALTH ST. MARY'S MEDICAL CENTERFEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS PRESENT IN THE COMMUNITY:MUA/P - DULUTH, MN (11); SUPERIOR, WI (7)
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PART VI, LINE 5:
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ST. LUKE'S HAS BUILT A REPUTATION OF PROVIDING QUALITY CARE AND PUTTING THE PATIENT FIRST. SINCE OPENING IN 1881, ST. LUKE'S HAS GROWN INTO A NATIONALLY RECOGNIZED HEALTH CARE SYSTEM SERVING 17 COUNTIES THROUGHOUT NORTHEASTERN MINNESOTA, NORTHWESTERN WISCONSIN, AND THE UPPER PENINSULA OF MICHIGAN. ST. LUKE'S HOSPITAL, ALONG WITH ITS PRIMARY AND SPECIALTY CARE CLINICS, OFFERS A COMPREHENSIVE CONTINUUM OF CARE THAT INCLUDES TRAUMA, MEDICAL, SURGICAL, DIAGNOSTIC, THERAPEUTIC, AND REHAB SERVICES. MORE THAN 2,000 HEALTHCARE PROFESSIONALS MAKE UP ST. LUKE'S STAFF, INCLUDING A MEDICAL STAFF OF 959, WITH 463 PHYSICIANS AND ADVANCED PRACTICE CLINICIANS. ST. LUKE'S 13 PRIMARY CARE CLINICS ARE LOCATED IN DULUTH AND ACROSS MINNESOTA IN SILVER BAY, HIBBING, MOUNTAIN IRON, AND HERMANTOWN, MN; AS WELL AS IN ASHLAND AND SUPERIOR, WI. AN ADDITIONAL 7 URGENT CARE CLINICS, 2 PHARMACIES, 3 REGIONAL CENTERS IN TRAUMA, HEART & VASCULAR AND CANCER; AND 30 SPECIALTY CLINICS LOCATED PRIMARILY ON THE ST. LUKE'S CAMPUS PROVIDE EXPERTISE IN MANY AREAS OF HEALTH CARE INCLUDING: CANCER CARE, CARDIAC CARE, HOME CARE AND HOSPICE, ADULT PSYCHIATRY, PLASTIC SURGERY, ALLERGY, ENDOCRINOLOGY, DERMATOLOGY, GASTROENTEROLOGY, INFECTIOUS DISEASE, PHYSICAL MEDICINE AND REHAB, UROLOGY, RHEUMATOLOGY, NEUROSURGERY, AND PULMONARY MEDICINE.
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PART VI, LINE 7, REPORTS FILED WITH STATES
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MN
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