Welcome! 2013 Healthcare Leadership & Education Summit June 13, 2013 Greensboro, GA

1. Welcome! 2013 Healthcare Leadership & Education Summit June 13, 2013Greensboro, GA Speaker: Trina S. Hackensmith Vice President, Lyon Software

3. Introduction

4. Community Benefit Why are we talking about Community Benefit? IRS 990H requirements Heightened tax-exempt scrutiny Ensuring fulfillment of mission PR/marketing efforts Lyon Software 2013

5. Community Benefit IRS 990H Requirements Lyon Software 2013

6. Community Benefit Heightened Tax-Exempt Scrutiny …accountability and transparency… • distrust of hospitals • inconsistency in reporting • how much is enough Lyon Software 2013

7. Community Benefit Ensuring Fulfillment of Mission “Mission-driven organizations do not provide community benefit because of external pressures…They do it because it is right…” Source: A Guide for Planning & Reporting Community Benefit, CHA 2012 Edition, page 16 “Our organizations were established not for economic opportunity but to address the need for health services in our communities. Our facilities were born out of community need, a tradition that continues today.” Sr. Carol Keehan, DC President and CEO Catholic Health Association Lyon Software 2013

8. Community Benefit PR/Marketing Efforts: Telling Your Story “The responsibility rests with hospital and health system marketers to put all the pieces of community benefit together to create a consistent, ongoing message that demonstrates the organization’s commitment to improving the community’s health status.” Patsy Matheny A Marketer’s Guide to Community Benefit Reporting and IRS Form 990H, HCPro, Inc. 2009 Lyon Software 2013

9. What is Community Benefit and What Counts? The information provided in this presentation does not constitute legal or tax advice. The material is provided for informational/educational purposes only.

10. What is Community Benefit? Community benefit programs or activities provide treatment and/or promote health and healing as a response to identified community needs. • For a program to “count”: • It must address a documented community need, and • It must have at least one of these community benefit objectives • Improve access to health care services • Enhance health of the community • Advance medical or health care knowledge • Relieve/reduce the burden of government/other community efforts Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

11. What is Community Benefit? It must address a documented community need • A community health needs assessment developed or accessed by the organization • Documentation that demonstrated community need or a request from a public agency or community group was the basis for initiating or continuing the activity or program • The involvement of unrelated, collaborative tax-exempt or government organizations as partners in the activity or program. Source: IRS 990H Instructions, 2012

12. What is Community Benefit? • 2. It must have at least one of these community benefit objectives • a) Improve access to health care services • The program is available broadly to the public • The program participants include vulnerable or underserved persons • A barrier to access is reduced or eliminated • If the program ceased to exist, the community would lose access to a needed service Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

13. What is Community Benefit? • 2. It must have at least one of these community benefit objectives • b) Enhance health of the community • The program is designed around public health goals and principles • The program yields measurable improvements to health status • The community’s health status would decline if the program ceased to exist • A public health agency provides comparable services • The program is operated in collaboration with public health partners Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

14. What is Community Benefit? • 2. It must have at least one of these community benefit objectives • c) Advance medical or health care knowledge • The program trains health professionals/students as they advance toward health profession degrees or other credentials • The organization does not require trainees to join the staff • Health professional continuing education programs are open to professionals in the community • The program involves research, with findings available broadly to the public within a reasonable period of time Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

15. What is Community Benefit? • 2. It must have at least one of these community benefit objectives • d) Relieve/reduce the burden of gov’t/other community efforts • The program relieves a government financial or programmatic burden • Government provides the same or a similar service • Government provides support of the activity • If the program were closed, cost to government or another tax-exempt organization would increase • The program receives philanthropic support through community volunteers or contributions Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

16. What is NOT Community Benefit • A program does not count as community benefit, if: • The program is primarily for marketing purposes • The program benefits the organization more than the community • An objective “prudent layperson” would question whether the program truly benefits the community • The program or donation is unrelated to health or the hospital’s mission • The program represents a community benefit provided by another entity or individual • Access to the program is restricted to employees or physicians affiliated with the hospital • The activity represents a normal “cost of doing business” or is associated with the current standard of care Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

17. What Qualifies (Counts) as a Community Benefit? Community Health Improvement Health Professions Education Subsidized Health Services Research Financial & In-kind Contributions Community Building Activities Community Benefit Operations Financial Assistance Medicaid Other Means-tested Government Programs Community Benefit Services Categories A-G

18. Categories of Community Benefit Community Health Improvement Services (category A) “Community health improvement services” means activities or programs, subsidized by the health care organization, carried out or supported for the express purpose of improving community health. Such services do not generate inpatient or outpatient bills, although there may be a nominal patient fee or sliding scale fee for these services. Health Fairs Screenings Ask a Nurse Source: 2012 IRS 990H Instructions Lead Removal A1: Community Health Education A2: Community-Based Clinical Services A3: Health Care Support Services A4: Social and Environmental Improvement Activities Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

19. Categories of Community Benefit Health Professions Education (category B) Educational programs that result in a degree, certificate, or training necessary to be licensed to practice as a health professional, as required by state law, or continuing education necessary to retain state license or certification by a board in the individual's health profession specialty. Source: 2012 IRS 990H Instructions B1: Physicians/Medical Students B2: Nurses/Nursing Students B3: Other Health Professions Education B4: Scholarships/Funding for Health Professions Education Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

20. Categories of Community Benefit Subsidized Health Services (category C) “Subsidized health services” means clinical services provided despite a financial loss to the organization. The financial loss is measured after removing losses associated with bad debt, financial assistance, Medicaid, and other means-tested government programs. Source: 2012 IRS 990H Instructions C1: Emergency and Trauma Services C2: Neonatal Intensive Care C3: Hospital Outpatient Services C4: Burn Units C5: Women’s and Children’s Services C6: Renal Dialysis Services C7: Subsidized Continuing Care C8: Behavioral Health Services C9: Palliative Care Examples of Subsidized Services Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

21. Categories of Community Benefit Research (category D) “Research” means any study or investigation the goal of which is to generate increased generalizable knowledge made available to the public Source: 2012 IRS 990H Instructions D1: Clinical Research D2: Community Health Research Source: A Guide for Planning & Reporting Community Benefit 2012 Edition Where is the money coming from to fund the research? Self? Not for profit? Government? NOT a for profit

22. Categories of Community Benefit Financial and In-Kind Contributions (category E) “Cash and in-kind contributions” means contributions made by the organization to health care organizations and other community groups restricted to one or more of the community benefit activities described in the table in Part I, line 7 Source: 2012 IRS 990H Instructions E1: Cash Donations Don’t count employee-donated funds Send a “restricted use” letter E2: Grants What constitutes a grant? E3: In-Kind Donations Meeting room space Employee time Actual not opportunity cost Where is the money going? Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

23. Categories of Community Benefit Community Building Activities(category F) Report in this part the costs of the organization's activities that it engaged in during the tax year to protect or improve the community's health or safety, and that are not reportable in Part I of this schedule. Source: 2012 IRS 990H Instructions F1: Physical Improvements and Housing F2: Economic Development F3: Community Support F4: Environmental Improvements F5: Leadership Development/Training for Community Members F6: Coalition Building F7: Advocacy for Community Health Improvements and Safety F8: Workforce Development Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

24. Categories of Community Benefit Community Building Activities(category F continued) Some community building activities may also meet the definition of community benefit… An organization that reports information in this Part II must describe in Part VI how its community building activities promote the health of the communities it serves. Source: 2012 IRS 990H Instructions Direct link to health = Category A Indirect (or less direct) link to health = Category F

25. Categories of Community Benefit Community Benefit Operations (category G) • “Community benefit operations” means: • activities associated with community health needs assessments, • community benefit program administration, and • the organization's activities associated with fundraising or grant-writing for community benefit programs. Source: 2012 IRS 990H Instructions Consider including costs of training, program evaluation, and CBISA™!

26. IRS Form 990 Schedule H

27. IRS 990H Part I: FAP, Medicaid, Means-tested, Categories A, B, C, D, E, & G

28. IRS 990H Part II: Community Building Activities (F)

29. IRS 9990H Part III: A (Bad Debt), B (Medicare), and C (Collection Practices)

30. IRS 9990H Part VI: Supplemental Information www.irs.gov/form990

31. Telling Your Story: A Marketer’s Responsibility The information provided in this presentation does not constitute legal or tax advice. The material is provided for informational/educational purposes only.

32. Telling Your Story Communicating the core values of nonprofits Source: Listening Post Communiqué No. 22 December 2012

33. Telling Your Story Creating a consistent, ongoing message • How is the hospital demonstrating it’s commitment to improving the health of the community? • Are you helping to tell the story of good • stewardship of resources? Source: Patsy Matheny, A Marketer’s Guide to Community Benefit Reporting and IRS Form 990H, HCPro, Inc. 2009 “Tell your story – Tell your story – Tell your story!” Con Kelly Social Accountability Task Force

34. Telling Your Story Helping to prepare the IRS 990 Schedule H • Two fundamental tasks for the marketer… • Contribute to the open-ended questions in Part VI (the “essay questions”) • Prepare yourself and others on how to respond to media and other inquiries on the information submitted on the Schedule. Source: Patsy Matheny, A Marketer’s Guide to Community Benefit Reporting and IRS Form 990H, HCPro, Inc. 2009

35. Telling Your Story Identifying key internal and external audiences Source: A Guide for Planning & Reporting Community Benefit 2012 Edition

36. Resources

37. Resources Written by: Patsy Matheny, LLC Available at Amazon.com and HealthLeaders Media

38. Resources www.chausa.org

39. Resources http://www.chausa.org/communitybenefit/printed-resources

40. Resources www.thecommunityguide.org www.healthypeople.gov www.countyhealthrankings.org

41. Resources 419-885-4593 9:00 am – 5:00 pm (EST) support@ lyonsoftware.com www.lyonsoftware.com

42. Lyon Software…striving to make social accountability reporting a streamlined process…