Community Benefit Insight - Tax-exempt hospital

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Brattleboro Memorial Hospital

Brattleboro Memorial Hospital

17 Belmont Ave
Brattleboro, VT 05301

Bed count	104	Medicare provider number	470011	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 030107300

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

28.88%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 409,667 0.39 %
Medicaid as % of operating expenses	$ 9,594,531 9.14 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 20,184,892 19.22 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 121,337 0.12 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 17,000 0.02 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 2,094,939 1.99 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 1,047,469 50.00 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 89184753 including grants of $ 18950) (Revenue $ 96379210)
Provision of Hospital Care, both inpatient and outpatient services, on a region-wide basis. BMH provided healthcare services to approximately 2,493 inpatients and 139,172 outpatients throughout the year.Brattleboro Memorial Hospital is a modern, well-equipped and professionally staffed community hospital which has been serving greater Brattleboro and the tri-state area since 1904. Throughout our more than a century of caring for our community, BMH has kept up with medical technology which, in turn, has drawn excellent physicians to our facility. The BMH Medical Staff boasts more than 100 board-certified physicians, active in both primary care and many specialties.

4B (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
Charity Care:The Hospital's charity care program is designed to assist those patients who are either uninsured, underinsured or have limited financial resources that impact their ability to fully pay for their hospital care. Before completing an application for charity care, patients are first asked to investigate whether or not they may be eligible for Medicare, Medicaid, Veteran's Benefits or other governmental or public assistance programs.The Hospital's qualifications for charity care are as follows:1. Charity care is limited to medically necessary services. Patients receiving certain elective services, such as those considered cosmetic, investigational or experimental, are expected to make payment arrangements in advance, as these types of services are not covered by the charity care program.2. The patient's family income must be at or below 250% of the current Federal Poverty Income Guidelines for their applicable family size.The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy, the estimated cost of those services and supplies and equivalent service statistics. The following information measures the level of the charity care provided during the year ended September 30, 2022:Equivalent percentage of charity care services to all services 1.48%In addition, the Hospital incurs a payment shortfall in the treatment of Medicaid patients. This government program reimburses for medical services at less than the costs incurred to provide those services. In September 30, 2022 and 2021, the Hospital incurred a shortfall of approximately $9,594,531 and $8,192,978, respectively, related to treating Medicaid patients.The Hospital also provided other community benefits upon which no monetary value has been placed.-Offers free smoking cessation classes.-Collaborates with other community agencies in publishing a community wellness calendar twice a year.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Brattleboro Memorial Hospital
Part V, Section B, Line 5: BMH conducted a collaborative CHNA in partnership with Grace Cottage Family Health & Hospital and the Brattleboro Retreat. In October 2020, the Windham County Community Health Needs Assessment Steering Committee formed and began meeting. The Steering Committee was comprised of representatives from BMH, the Brattleboro Retreat, Grace Cottage Family Health & Hospital, and the Brattleboro Office of the VDH, the Agency of Human Services District Director and the BMH Health Equity Coordinator. The group met multiple times over that year to develop the various sections of the CHNA. The data collection process took place from March 2021 through May 2021. The Community Health Needs Assessment was approved by the Board in December 14, 2021.

Brattleboro Memorial Hospital
Part V, Section B, Line 6a: The Hospital's CHNA was conducted in partnership with Grace Cottage Hospital and The Brattleboro Retreat.

Brattleboro Memorial Hospital
Part V, Section B, Line 11: Brattleboro Memorial Hospital (BMH) completed a Community Health Needs Assessment (CHNA) in 2021. The CHNA revealed five areas of need. They are as follows: Mental Health (including Depression and Anxiety), Healthy Aging (including physical fitness, obesity and arthritis), Chronic Conditions (Diabetes, Hypertension, Substance Use Disorder and COPD), Cancer, and Health Equity and Affordability. BMH continues to support various programs around addressing the needs identified in the Community Health Needs Assessment such as Healthworks, a collaboration between several community agencies addressing the needs of people who are unhoused and suffer from Substance Use disorder and who have various mental health and physical health needs. BMH also continues to participate in the Regional Psychiatric Strategy committee. The Community Health Team continues to be supported by the hospital addressing various wellness activities and tobacco cessation classes. Various Quality initiatives have been developed to address chronic health conditions such as COPD, reducing HgA1C's and controlling hypertension. The hospital is also looking at expanding and addressing Health Equity by establishing a committee and looking at health disparities in the region.

Brattleboro Memorial Hospital
Part V, Section B, Line 13h: The Hospital's charity care program is designed to assist those patients who are either uninsured, underinsured or have limited financial resources that impact their ability to fully pay for their hospital care. Before completing an application for charity care, patients are first asked to investigate whether or not they may be eligible for Medicare, Medicaid, Veteran's Benefits or other governmental or public assistance programs. The Hospital's qualifications for charity care are as follows: 1. Charity care is limited to medically necessary services. Patients receiving certain elective services, such as those considered cosmetic, investigational or experimental, are expected to make payment arrangements in advance, as these types of services are not covered by the charity care program. 2. The patient's family income must be below 300% of the current Federal Poverty Income Guidelines for their applicable family size. The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy, the estimated cost of those services and supplies and equivalent service statistics. The following information measures the level of the charity care provided during the year ended September 30, 2020: Equivalent percentage of charity care services to all services 1.48%. In addition, the Hospital incurs a payment shortfall in the treatment of Medicaid patients. This government program reimburses for medical services at less than the costs incurred to provide those services. In September 30, 2022 and 2021, the Hospital incurred a shortfall of approximately $9,594,531 and $8,192,978, respectively, related to treating Medicaid patients. The Hospital also provided other community benefits upon which no monetary value has been placed. -Offers free smoking cessation classes. -Collaborates with other community agencies in publishing a community wellness calendar twice a year.

Part V, line 7a, CHNA report website:
https://www.bmhvt.org/practice/community-initiatives/community-health-needs-assessment/

Part V, line 10a, Implementation Strategy website:
https://www.bmhvt.org/practice/community-initiatives/community-health-needs-assessment/

Part V, line 16a, FAP website:
https://www.bmhvt.org/patients-visitors/patient-information/pfs/charityfree_care/

Part V, line 16b, FAP Application website:
https://www.bmhvt.org/patients-visitors/patient-information/pfs/charityfree_care/

Part V, line 16c, FAP Plain Language Summary website:
https://www.bmhvt.org/patients-visitors/patient-information/pfs/charityfree_care/

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
Brattleboro Memorial Hospital's Free Care program is designed to assist those patients who are either uninsured, underinsured or have limited financial resources that impact their ability to fully pay for their hospital care. When making application for Free Care, patients are first asked to investigate whether or not they may be eligible for Medicare, Medicaid, Veterans' Benefits or other governmental or public assistance programs. Free Care should always be the payor of last resort.A. Qualifications for Free Care:1. Free Care is limited to medically necessary services. Patients receiving certain elective services, such as those considered cosmetic, investigational or experimental, are expected to make payment arrangements in advance, as these types of services are not covered by Free Care;2. Patients' family income must be at or below 250% of the current Federal Poverty Income Guidelines for their family size;3. Patients or their guarantors must complete a Free Care application and provide the hospital with verification of income. Responsible parties may be asked to disclose the identity and amounts of any assets that could be used to pay for medical expenses.NOTE: Income verification may be waived at the discretion of the Director of Patient Financial Services, particularly in those instances in which patients have subsequently qualified for Medicaid, or are deceased, with no estate;4. Free Care applications will be processed within two weeks of the date of their receipt in our Business Office;5. Free Care applies only to those patient accounts still in active Accounts Receivable; no Free Care allowance may be applied against accounts that have been forwarded to a collection agency as Bad Debt.B. Patients will be notified in writing of their approval or denial status within 30 days of the date of receipt of the application and any required supporting documentation. All accounts written off to Free Care must be approved by the Vice President of Revenue Cycle or the Chird Financial Officer.

Part I, Line 7:
A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used.

Part II, Community Building Activities:
The director of Community Initiatives is involved with several community coalitions and programming such as the Accountable Community for Health, Community Health Team, Healthworks, Tobacco prevention and cessation programing and the NAACP Health Justice Committee. The Accountable Communities for Health brings approx. 30-50 community partners together to discuss current programs and concerns around Mental Health and overall health of the community. The Community Health team supports people with nutrition support, care coordination and mental health supports. Healthworks is a collaboration of several community partners assisting folks who are unhoused with case management, therapy, primary care, nursing and substance use disorder. The Tobacco prevention and cessation programing addresses the spectrum of tobacco use. The NAACP Health Justice committee address health related needs of our BIPOC community. 2. Our Director of Nutrition Services supports local agriculture & has been recognized for BMH's level of support. 550 BMH employees benefit from local foods & healthy choices on our breakfast, lunch & dinner menus daily.

Part III, Line 2:
The Hospital utilized Worksheet 2 from IRS Schedule H Instructions/guidance to determine the ratio of patient care costs to charge ratio (43.43% for fiscal year 2022) and multiplied this ratio by the Hospital's total bad debt expense of $4,824,020 to determine Part II, Line 2 bad debt expense of $2,094,939.

Part III, Line 3:
The estimated bad debt that may be eligible for our charity care policy was based on a 50% eligibility rate.

Part III, Line 4:
Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectibility of accounts receivable, the Hospital 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 in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. Any changes resulted from trends experienced in the collection of amounts from self-pay patients with and without insurance. Any changes in the allowance was a result of actual write-offs of self-pay balances deemed uncollectibles.

Part III, Line 8:
The Medicare shortfall should be considered a community benefit in its entirety. The Medicare shortfall presented is based upon the IRS instuctions to only include the Medicare cost report claims data. The Medicare shortfall is significantly more due to physician and fee schedule data not being included. A cost-to-charge ratio was used.

Part III, Line 9b:
Patients or their guarantors must complete a Free Care application and provide the hospital with verification of income. Responsible parties may be asked to disclose the identity and amounts of any assets that could be used to pay for medical expenses.NOTE: Income verification may be waived at the discretion of the Director of Patient Financial Services, particularly in those instances in which patients have subsequently qualified for Medicaid, or are deceased, with no estate.

Part VI, Line 2:
BMH conducted the 2021 Community Health Needs Assessment. The needs assessment addressed health and wellness in Windham County, inclusive of lifestyle, access to care, maternal & child health, illness & death, and injury. Methodology included data analysis, on-line surveys, survey questionnaire distribution at various locations and COVID vaccine sites. Highest priority issues about healthcare & healthcare access were identified.

Part VI, Line 4:
BMH serves a total service area that includes:- 22 towns- A population of 42,869- Compared to VT/US, residents of the service area tend to be: a. Older b. Similarly well off, especially in the secondary service area c. Less at risk for obesityThe 65+ population will be the fastest growing segment, while the 0-17 and 18-44 age cohorts drop. VT is the second oldest state in the country (after Maine). Median age in the PSA & SSA is higher than Vermont overall & significantly higher than the US median.

Operating expenses	$ 105,011,898
Total amount spent on community benefits as % of operating expenses	$ 30,327,427 28.88 %