Community Benefit Insight - Tax-exempt hospital

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Sumner Community Club

Community Mem Hospt Summer

909 West 1st Street
Sumner, IA 50674

Bed count	25	Medicare provider number	161320	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 420670596

Display data for year:

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

4.11%

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	$ 13,631 0.09 %
Medicaid as % of operating expenses	$ 521,142 3.34 %
Costs of other means-tested government programs as % of operating expenses	$ 1,588 0.01 %
Health professions education as % of operating expenses	$ 35,519 0.23 %
Subsidized health services as % of operating expenses	$ 35,863 0.23 %
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.	$ 11,461 0.07 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 21,829 0.14 %
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	$ 47,078 0.30 %
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 2021 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	$ 13,700 29.10 %

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 $ 9907382 including grants of $ 0) (Revenue $ 7645504)
REVENUE AND EXPENSES RELATING TO OUTPATIENT DEPARTMENTS THAT OPERATE WITHIN COMMUNITY MEMORIAL HOSPITAL. THESE DEPARTMENTS INCLUDE, BUT ARE NOT LIMITED TO, LABORATORY, RADIOLOGY, OPERATING AND RECOVERY ROOM, AND PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES. EACH OF THESE OUTPATIENT DEPARTMENTS PROVIDES STATISTICAL INFORMATION BASED ON VOLUME RELATED TO THE SPECIFIC SERVICE AREA AND WORKS IN CONJUNCTION WITH SERVICES PROVIDED IN THE CMH MEDICAL CLINIC, EMERGENCY DEPARTMENT AND ACUTE NURSING SERVICES.

4B (Expenses $ 1958170 including grants of $ 0) (Revenue $ 4199436)
COMMUNITY MEMORIAL HOSPITAL (CMH) MEDICAL CLINIC CONTINUED TO SERVE SUMNER, IA AND THE SURROUNDING AREA IN THE YEAR 2021. CMH CLINIC WAS STAFFED WITH 4 PROVIDERS. THE CMH CLINIC HAS TWO NURSE PRACTITIONERS AND TWO PHYSICIANS. PATIENTS WERE SERVED IN MANY CAPACITIES INCLUDING, BUT NOT LIMITED TO, WELL CHILD VISITS, ANNUAL WELLNESS VISITS, IMMUNIZATIONS, ROUTINE PEDIATRIC CARE, SHARED MATERNITY CARE, WOUND CARE, THERAPEUTIC INJECTIONS AND MANIPULATION TREATMENTS. PATIENTS RANGED FROM NEWBORN TO GERIATRIC. A 50-MILE RADIUS OF SUMNER WAS SERVED WITH A TOTAL PATIENT VOLUME OF 14,241 FOR 2021. IN ADDITION TO CLINIC VISITS, OUR PROVIDERS CONTINUE THEIR SERVICE TO SURROUNDING NURSING HOMES AND ASSISTED LIVING FACILITIES WITH PATIENTS SEEN MONTHLY AT HILLCREST HOME IN SUMNER, MAPLECREST MANOR IN FAYETTE, TRIPOLI NURSING & REHAB IN TRIPOLI, AND COBBLESTONE ASSISTED LIVING IN SUMNER. OTHER SERVICES TO THE COMMUNITY WERE PHYSICALS FOR AREA FIREFIGHTERS AND EMS AGENCIES AND POST-JOB OFFER PHYSICALS FOR FIVE LOCAL BUSINESSES. PROVIDERS CONTINUE TO TAKE CALL FOR THE EMERGENCY DEPARTMENT ON A REGULAR SCHEDULED BASIS IN THE EVENING AND ON WEEKENDS THROUGHOUT EACH MONTH. INDIVIDUALS FROM THE COMMUNITY ARE ALLOWED TO WALK INTO THE CLINIC FOR FREE BLOOD PRESSURE CHECKS WHENEVER NEEDED. PROVIDERS AVIDLY PRECEPT FOR STUDENT'S VARIOUS PROGRAMS WITH DES MOINES UNIVERSITY IN DES MOINES, IA, ALLEN COLLEGE IN WATERLOO, IA, UNIVERSITY OF IOWA, IOWA CITY AND UPPER IOWA UNIVERSITY, FAYETTE, IA TAKING ADVANTAGE OF THIS IN 2021. THE CLINIC HOURS CONTINUE TO BE MONDAY THROUGH THURSDAY 7 AM TO 8 PM AND FRIDAY ARE 7 AM TO 5 PM THROUGH 10/31/21. EFFECTIVE 11/1/21 CLINIC HOURS WERE CHANGED TO MONDAY THROUGH FRIDAY 7 AM TO 5 PM. DURING HEIGHTENED COVID-19 PRECAUTIONS AND CLOSURES, THE EVENING CLINIC WAS CLOSED.

4C (Expenses $ 1282068 including grants of $ 0) (Revenue $ 1575626)
THE CMH EMERGENCY DEPARTMENT SERVED 1,566 PATIENTS IN 2021. THIS IS AN INCREASE OF 195 PATIENT VISITS FROM 1,371 VISITS IN 2020. THE NUMBER OF PHYSICIAN HOURS SPENT IN THE EMERGENCY DEPARTMENT INCREASED FROM 3,463 IN 2020 TO 4,146 IN 2021.THE EDUCATIONAL FOCUS FOR 2021 CENTERED AROUND MOCK CODES COMPLETED BY THE EMERGENCY DEPARTMENT LEAD. THE SUBJECTS EDUCATED ON WERE THE DELIVERY AND CARE OF A BABY, COVID PATIENT PRIORITIZATION, ACUTE MYOCARDIAL INFARCTION (CHEST PAIN AND SHORTNESS OF BREATH), ANHYDROUS AMMONIA EXPOSURE, ANAPHYLAXIS, HEAT STROKE, STROKES AND STROKE ALERTS, CODE BLUE, AND NECK INJURIES ON A FOOTBALL PLAYER WEARING A HELMET ON PRESENTATION.EDUCATION PRESENTED AT THE NURSES' MEETINGS IN 2021 INCLUDE: EMERGENCY DEPARTMENT DOCUMENTATION, VAPOTHERM, TRANSFERS VIA AIR (HELICOPTERS), HOW/WHEN TO OVERRIDE MEDICATIONS FROM THE PYXIS, DYSPHAGIA DIETS, CRITICAL DRIPS (EXAMPLES INCLUDE PROPOFOL AND VERSED), BI-PAP, INTEROSSEOUS INSERTION, PEDIATRIC ASSESSMENTS, EMAIL PHISHING, RAPID SEQUENCE INTUBATION KITS, TRACTION SPLINTS, AND MALIGNANT HYPERTHERMIA. A GUEST SPEAKER FROM IOWA DONOR NETWORK PRESENTED INFORMATION AS WELL.COMMUNITY MEMORIAL HOSPITAL HAS A WEEK IN MARCH WHERE THERE ARE MANY EDUCATION TOPICS PRESENTED, KNOWN TO THE STAFF AS MARCH MADNESS. IN 2021 THE TOPICS WERE ENCOURAGE/COUGH ASSIST, VAPOTHERM, CARE PLANS AND EDUCATION, CAPNOGRAPHY, BI-PAP, NASAL ATOMIZER, THE PHYSICAL IMPACT OF COVID, COVID THERAPIES, HOW TO CARE FOR INPATIENT SURGICAL PATIENTS, POST PROCEDURE SEDATION, AND CHEST TUBES.2021 CONTINUOUS IMPROVEMENT PROGRAM PROJECTS IN THE EMERGENCY DEPARTMENT WERE HAVING ALL VITAL SIGNS OBTAINED IN THE FIRST 15 MINUTES UPON ARRIVAL IN THE EMERGENCY DEPARTMENT, PLACING A URINARY CATHETER WHEN A PATIENT HAS A PELVIC FRACTURE, AND HAVING TWO IV'S IN PLACE WHEN THERE IS A CODE THREE TRANSFER.NURSING INITIAL OR RECERTIFICATIONS INCLUDED: CPI, HAZMAT, ACLS, BLS, TNCC, NRP, AND PALS.

4D (Expenses $ 1181836 including grants of $ 0) (Revenue $ 1318539)
ACUTE NURSING HAD 73 ADMISSIONS IN 2021. CMH UTILIZES A COMPANY CALLED MCKESSON'S CHANGE HEALTHCARE FOR QUALIFYING PATIENTS TO DETERMINE IF THEY MEET INPATIENT ADMISSION CRITERIA. THE AVERAGE LENGTH OF STAY FOR ACUTE WAS 66.42 HOURS. THIS IS WELL BELOW THE 96 HOURS THRESHOLD FOR CRITICAL ACCESS. THERE WAS A TOTAL OF 238 ACUTE PATIENT DAYS AND 412 SWING BED DAYS IN 2021.

Facility Information

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

COMMUNITY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: THE 27-QUESTION SURVEY OPPORTUNITY WAS PUBLICIZED IN AREA NEWSPAPERS AND ONLINE. THE MEDIA RELEASE WAS SENT OUT TO PRINT, RADIO, CABLE AND TELEVISION CONTACTS. IN ADDITION, EMAILS WERE SENT WITH A LINK TO THE SURVEY (OR HARD COPY WAS MADE AVAILABLE) TO AREA CHURCHES, AREA SCHOOL CONTACTS, AND ORGANIZATIONS. THERE WERE 198 INDIVIDUALS THAT RESPONDED TO THE NEEDS ASSESSMENT SURVEY THAT WAS CONDUCTED. THIS SURVEY SAMPLE REPRESENTED A SMALL CROSS-SECTION OF THE POPULATION AREAS IN THE COMMUNITIES INCLUDED IN THE ASSESSMENT. THE SERVICE AREA THAT WAS SURVEYED INCLUDED 3 COUNTIES THAT ARE ALL SERVED BY THE HOSPITALS AND AGENCIES THAT COLLABORATED IN THE NEEDS ASSESSMENT PROCESS.

COMMUNITY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 6A: WAVERLY HEALTH CENTER, WAVERLY, IA

COMMUNITY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: THE BOARD OF DIRECTORS REVIEWED THE LIST OF NEEDS IDENTIFIED BY REVIEWING THE NUMBER OF RESPONSES RECEIVED FOR EACH INDIVIDUAL NEED. THIS PROCESS IDENTIFIED THE TOP 4 NEEDS THAT WERE RECOGNIZED BY COMMUNITY MEMORIAL HOSPITAL BOARD OF DIRECTORS TO DEVELOP A PLAN AND CREATE AN IMPLEMENTATION PLAN. THE NEEDS THAT HAVE BEEN CHOSEN TO ADDRESS INCLUDE: ACCESS TO HEALTHCARE, CHRONIC DISEASE MANAGEMENT, WELLNESS INITIATIVES, AND ACCESS TO MENTAL HEALTH SERVICES. THE BOARD OF DIRECTORS HAS ACKNOWLEDGED THAT THESE NEEDS FALL WITHIN THE SCOPE OF THE MISSION AND EACH COVERS A BROAD SPECTRUM AND OFFER ONGOING OPPORTUNITIES FOR IMPROVEMENT. THE BOARD OF DIRECTORS IS COMMITTED TO THE SUCCESS AND SUSTAINABILITY OF QUALITY LOCAL HEALTHCARE AND PLACING A FOCUS ON THESE NEEDS HELPS ACHIEVE THIS. COMMUNITY MEMORIAL HOSPITAL HAS INCLUDED FUNDS IN THE OPERATING BUDGET TO CONTINUE TO SUPPORT THE NEEDS ASSESSMENT MOVING FORWARD.THE MAJORITY OF THE NEEDS IDENTIFIED IN THIS NEEDS ASSESSMENT FALLS UNDER THESE BROADER CATEGORIES. THE HOSPITAL WILL CONTINUE TO MAKE EVERY EFFORT TO PROVIDE EDUCATIONAL OPPORTUNITIES FOR THE COMMUNITY IN THE AREAS THAT WERE ADDRESSED IN PREVIOUS YEARS. IT IS NOT TO SAY THAT THESE NEEDS WILL NOT BE ADDRESSED OR FOLLOWED BY THE HOSPITAL, BUT INSTEAD ARE NOT INCLUDED IN THE CHNA IMPLEMENTATION STRATEGY. THE HOSPITAL WILL MONITOR THE OVERALL NEEDS OF THE COMMUNITY SERVED AND REASSESS AS WE MOVE FORWARD. IN ADDITION, THERE ARE SERVICES, ORGANIZATIONS AND BUSINESSES WITHIN THE SERVICE AREA THAT ARE IDENTIFIED TO FOCUS ON THESE NEEDS CURRENTLY.

COMMUNITY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 15E: COMMUNITY MEMORIAL HOSPITAL PATIENT STATEMENTS INCLUDES INFORMATION ON HOW TO MAKE APPLICATION FOR FINANCIAL ASSISTANCE. IN ADDITION TO THE STANDARD INFORMATION, COMMUNITY MEMORIAL HOSPITAL ALSO HAS A DESIGNATED STAFF MEMBER THAT MONITORS PATIENT ACCOUNTS THAT ARE RECEIVING A SECOND OR THIRD STATEMENTS. THIS STAFF MEMBER MAKES CONTACT WITH THE INDIVIDUAL PATIENTS TO DETERMINE IF A FINANCIAL ASSISTANCE APPLICATION SHOULD BE MAILED OUT FOR COMPLETION. THE FINANCIAL ASSISTANCE APPLICATION PROVIDES A LISTING OF THE INFORMATION THAT WILL BE NEEDED IN ORDER TO PROCEED WITH ITS REVIEW.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
NOT APPLICABLE

PART I, LINE 6A:
THE REPORT IS PREPARED BY THE STAFF OF COMMUNITY MEMORIAL HOSPITAL.

PART I, LINE 7:
"THE COST TO CHARGE RATIO PER IRS WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNTS IN THE UPPER PORTION OF THE TABLE. COSTING OF THE ""OTHER BENEFITS"" PORTION OF THE TABLE WAS CALCULATED PER GUIDANCE PROVIDED BY THE IOWA HOSPITAL ASSOCIATION IN TERMS OF PROPER REPORTING OF COMMUNITY BENEFITS."

PART I, LINE 7G:
NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS WERE INCLUDED.

PART I, LN 7 COL(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 $47,078.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY MEMORIAL HOSPITAL DID NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES IN PART II OF SCHEDULE H.

PART III, LINE 2:
THE ALLOWANCES REFLECT MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED IN THE FUTURE AND ARE BASED ON REVIEWS OF PATIENT BALANCES BY PAYER CLASSES. PERCENTAGES ARE APPLIED TO EACH PAYER CLASS BASED ON CONTRACTUAL AGREEMENTS AND HISTORICAL COLLECTION AND RECOVERY INFORMATION TO DETERMINE THAT NET REALIZABLE VALUE OF THE PATIENT RECEIVABLES.

PART III, LINE 3:
THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. PATIENTS WHO QUALIFY FOR CHARITY CARE ARE GIVEN A PERCENTAGE DISCOUNT FROM ESTABLISHED CHARGES BASED ON A SLIDING SCALE USING POVERTY GUIDELINES. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN NET OPERATING REVENUE OR IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO FOR THE HOSPITAL.

PART III, LINE 4:
"THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10, AND 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED ""PATIENT RECEIVABLES"" ""PATIENT SERVICE REVENUE"", AND ""PATIENT FINANCIAL ASSISTANCE""."

PART III, LINE 8:
THERE IS NO SHORTFALL REPORTED IN THE CURRENT YEAR.

PART III, LINE 9B:
"COMMUNITY MEMORIAL HOSPITAL'S COLLECTIONS POLICY STATES THAT THE HOSPITAL WILL ""REFRAIN FROM INITIATING EXTRAORDINARY COLLECTION ACTIONS FOR 120 DAYS FROM THE DATE OF THE PATIENT'S FIRST POST DISCHARGE BILLING STATEMENT"" IF ELIGIBILITY FOR FINANCIAL ASSISTANCE IS UNDETERMINED. IN ADDITION, ""IF THE PATIENT SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION AT ANY TIME WITHIN THE APPLICATION PERIOD, THE HOSPITAL MUST SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS, DETERMINE THE ELIGIBILITY, AND NOTIFY THE PATIENT"". ONCE A DECISION IS MADE ON THE FINANCIAL ASSISTANCE APPLICATION, COLLECTION EFFORTS WILL STOP IF IT IS APPROVED OR CONTINUE WHERE THE EFFORTS LEFT OFF IF THE APPLICATION IS DECLINED."

PART VI, LINE 2:
COMMUNITY MEMORIAL HOSPITAL COMPLETED THE CHNA PROCESS IN 2019. THE CHNA IS CURRENTLY POSTED ON THE HOSPITAL WEBSITE. THE FOUR AREAS OF FOCUS CHOSEN BY COMMUNITY MEMORIAL HOSPITAL FROM THE CHNA INCLUDE: ACCESS TO HEALTHCARE, CHRONIC DISEASE MANAGEMENT, WELLNESS INITIATIVES, INCLUDING OBESITY, AFFORDABLE WELLNESS AND FITNESS, HEALTHY BEHAVIOR LIFESTYLES AND EMPLOYEE WELLNESS, AND ACCESS TO MENTAL HEALTH SERVICES. MANY OF THE BOARD OF DIRECTORS ARE INVOLVED IN VARIOUS GROUPS AND BUSINESSES IN THE COMMUNITY AND RECEIVE INPUT FROM COMMUNITY MEMBERS. THIS COMMUNITY INVOLVEMENT IS INCREASED WITH ANOTHER GROUP OF INDIVIDUALS WHO ARE INVOLVED IN THE HOSPITAL AUXILIARY AND FOUNDATION. IN A SMALLER TOWN, PEOPLE ARE AWARE OF WHO SERVES ON THE HOSPITAL BOARD AND FOUNDATION BOARDS, IN THE AUXILIARY AND HOSPITAL ADMINISTRATION. COMMUNITY MEMBERS FEEL COMFORTABLE APPROACHING THEM WITH THE NEEDS THAT THEY SEE AS A BENEFIT TO THE COMMUNITY, SUCH AS, IMPROVING ACCESS TO SPECIALIST SERVICES WITH INCREASED OFFERINGS OF OUTPATIENT CLINICS WITHIN THE HOSPITAL.THE HOSPITAL SEES ITS ROLE AS CARE OF ILLNESS BUT ALSO IMPROVEMENT OF HEALTH AND WELLNESS. IN REGARD TO THESE GOALS, ALMOST MONTHLY THERE ARE OPPORTUNITIES FOR EDUCATION ON VARIOUS HEALTH TOPICS OFFERED IN THE COMMUNITY. THE HOSPITAL ADDITIONALLY SPONSORS LOCAL INDUSTRY-HOSTED HEALTH FAIRS AND COMMUNITY WELLNESS TESTING. THE WELLNESS TESTING OFFERINGS HAVE SEEN INCREASING PARTICIPATION BY COMMUNITY MEMBERS AND PRESENT THE OPPORTUNITY FOR ADDITIONAL COMMUNITY INPUT.AS THE HOSPITAL PLANNED FOR THE NEW REPLACEMENT FACILITY, A GREAT DEAL OF PREPARATION WORK WAS DONE TO BE SURE TO BUILD FOR THE PRESENT NEEDS AS TO HEALTH SERVICES BUT TO ALSO MAKE SURE THAT WE CAN ADDRESS FUTURE NEEDS. WE KNEW THAT DIAGNOSTIC SERVICES WOULD BE AN INCREASING FOCUS AS TO STANDARDS OF CARE. THE IMPLEMENTATION STRATEGY FOR THE CHNA IS ALSO LOCATED WITHIN THE CHNA REPORT LOCATED ON THE HOSPITAL'S WEBSITE. THIS STRATEGY WAS ALSO IMPLEMENTED IN 2019.

PART VI, LINE 3:
CMH HAS A PAYMENT BROCHURE THAT IS LOCATED AT THE REGISTRATION DESK FOR ALL PATIENTS TO TAKE WITH THEM EXPLAINING OUR PAYMENT TERMS AND THE AVAILABILITY OF FINANCIAL ASSISTANCE. THERE IS ALSO AN AREA ON THE STATEMENTS SENT TO PATIENTS THAT ALLOWS FOR MESSAGES TO BE PRINTED. THE MESSAGE INDICATES THE AVAILABILITY FOR ASSISTANCE FOR THOSE WHO QUALIFY. IN ADDITION, A DESIGNATED STAFF MEMBER WORKS DIRECTLY WITH PATIENTS WITH OPEN ACCOUNT BALANCES TO PROVIDE PAYMENT PLANS, FINANCIAL ASSISTANCE APPLICATIONS OR ADDITIONAL INSURANCE COVERAGE POSSIBILITIES.

PART VI, LINE 4:
CMH'S PRIMARY SERVICE AREA CONSISTS OF CITIES FROM THE FOLLOWING SEVEN ZIP CODES, WHICH INCLUDE SUMNER (50674), FREDERICKSBURG (50630), TRIPOLI (50676), HAWKEYE (52147), WESTGATE (50681), FAYETTE (52142) AND FAIRBANK (50629). THE COMMUNITIES THAT ARE INCLUDED IN THE CMH SERVICE AREA PRIMARILY CONSIST OF FARMING BACKGROUNDS AND RURAL AREAS. THE PRIMARY POPULATION IS LOCATED IN A RURAL SETTING WITH SUMNER BEING THE LARGEST CITY WITH A POPULATION OF APPROXIMATELY 2,000.

PART VI, LINE 6:
COMMUNITY MEMORIAL HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

PART VI, LINE 7, REPORTS FILED WITH STATES
IA

PART VI, LINE 5:
"COMMUNITY MEMORIAL HOSPITAL (CMH) IS A PILLAR IN THE COMMUNITY AND STRIVES TO BE A STRONG COMMUNITY PARTNER. CMH CONTINUES TO REACH OUT AND PARTNER WITH THE COMMUNITY IN MANY AREAS. CMH HELPS TO PROMOTE HEALTH AND WELLNESS BY SUPPORTING COMMUNITY GROUPS AND INITIATIVES AND CONSISTENTLY OFFERS ""HEALTH HIGHLIGHTS,"" WHICH PROVIDE FREE EDUCATION ON VARIOUS HEALTH-RELATED TOPICS. CMH CONTINUES TO HELP COORDINATE AND PLAN PREPAREDNESS TRAINING AND DRILLS FOR THE COMMUNITY, WORKING WITH SEVERAL LOCAL AND COUNTY AGENCIES. THE RELATIONSHIPS AND COLLABORATION CREATED IS BENEFICIAL FOR ALL INVOLVED AND THE RESIDENTS WE SERVE. LASTLY, CRITICAL INCIDENT STRESS DEBRIEFING (CISD) TRAINED STAFF HAVE BEEN UTILIZED ON MULTIPLE OCCASIONS TO LEAD DEBRIEFINGS FOR AREA EMERGENCY RESPONSE AGENCIES FOLLOWING FIRES, DEATHS, ETC."

Operating expenses	$ 15,611,347
Total amount spent on community benefits as % of operating expenses	$ 641,033 4.11 %