Community Benefit Insight - Tax-exempt hospital

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Virginia Gay Hospital Inc

Virginia Gay Hospital

502 N 9th Street
Vinton, IA 52349

Bed count	83	Medicare provider number	161349	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 421231996

Display data for year:

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

2.06%

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	$ 81,000 0.24 %
Medicaid as % of operating expenses	$ 0 0 %
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	$ 623,535 1.82 %
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.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
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	$ 554,194 1.62 %
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	$ 158,433 28.59 %

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 $ 29600874 including grants of $ 12500) (Revenue $ 34020155)
Virginia Gay Hospital is a 25-bed acute care hospital and a 40-bed long-term care facility located in Vinton, Iowa. The Hospital leads delivery of healthcare to its region through over 300 associates (including 18 providers) who coordinate care to deliver patient care as an integrated unit. Virginia Gay Hospital and its affiliates also work seamlessly to meet the needs of the communities they serve. The Hospital provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amounts of charges foregone for services provided under the Hospital's charity care policy were $158,433 for the year ended June 30, 2022. Total direct and indirect costs related to these charges foregone were approximately $81,000 at June 30, 2022, based on an average ratio of cost to gross charges.In addition, the Hospital provides services to other patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided.The Hospital also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable.Virginia Gay Hospital also makes medical care accessible to the entire community it serves. The Hospital operates a full-time emergency room and provides emergency care regardless of ability to pay. The Hospital provides clinical services needed to operate the emergency room and provides on-site emergency medical care and medical transportation services through an area ambulance service, van service, and an onsite helipad.The Hospital had 38,641 outpatient visits and the rural health clinics had 40,481 visits.

Facility Information

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

Virginia Gay Hospital, Inc.
Part V, Section B, Line 5: A strategic planning session for fiscal year 2022 was held on 2/18/22. Key members of VGH including but not limited to senior management, members of the VGH Board of Directors, and medical providers discussed the future needs and actions of the organization to ensure our service area's health needs continued to be met.Senior management meets twice monthly to discuss the current and future needs for our service area and the actions necessary to meet the needs of our communities served. The most recent meeting was held on 8/1/22. Obtaining input from key stakeholders was another crucial step in the assessment process. These stakeholders were drawn from private and public organizations that serve people in the Benton County area and were invited to identify the top health issues confronting the populations they served. The health issues these various groups and individuals identified reflected the overarching theme of social determinants/health equity. Analysis of the input received was completed to help determine the priority health needs. Meetings were held to discuss the following Public Health topics to help assess and prioritize the community health needs: Promotion of Healthy Living Prevent Injuries/Violence Protect Against Environmental Hazards Prevent Epidemics/Spread of Disease Prepare for Respond to/Recover from Public Health Emergencies Strengthen the Health Infrastructure. Discussions, correspondence, strategizing, and implementation continue amongst members of the above groups to address the identified health needs and concerns.VGH engaged several tactics to ensure different members of our community were contacted, including those knowledgeable of health care needs of vulnerable populations. This was completed through personal interviews, emails, surveys, and meetings that occurred between the Fall of 2020 to Spring of 2022. The following community partners were involved in the CHNA process: Virginia Gay Hospital, Clinics, Home Health, and Nursing & Rehab VGH Board of Directors Benton County Board of Supervisors Benton County Board of Health Benton County Public Health Benton County Environmental Health Benton County Emergency Management Benton County Disaster Recovery Coalition Benton County Coalition Benton County Social Services Benton County Department of Human Services Benton County TransportationBenton County School Districts Benton County Development Group Benton County Wellness CoalitionRegion 6 Emergency Preparedness CoalitionVinton Unlimited Above the Influence Coalition (Substance Abuse) Iowa State Benton County Extension Office Benton County Police DepartmentsBenton County School DistrictsBetter Tomorrows (Early Childhood Iowa) Benton-Iowa Decategorization Hawkeye Area Community Action Programs (HACAP)Area Substance Abuse Council (ASAC)Vinton Parks & Recreation DepartmentAbbe Center for Community Mental Health

Virginia Gay Hospital, Inc.
"Part V, Section B, Line 11: Highest Priority Health NeedsA survey was conducted March 2022 resulting in 118 completed surveys. The surveys were from anonymous participants. The goal of this survey was to better help us understand the health concerns and needs in Benton County.Following the collection of statistical data and community input, each health indicator was analyzed by comparing it to the state rates to determine our county's priority health concerns.It was determined that Mental Health 78.81%, Obesity 64.41% along with Chronic Health conditions 53.35% and Substance abuse 38.14% were the top health priorities in Benton County. We will continue our current goals for Mental Health, Substance Abuse and have added Health Prevention as our top three priorities. Health prevention will encompass our previous objectives on obesity while including other chronic illness needs as identified from the Benton County 2022 CHNA survey data.1.Preventive HealthGoal 1: Promote current Health programs and provide education to residents of Benton CountyActions: *Community events held to provide information, resources, and support in relation to preventive health. *Quarterly education per provider, in-person and/or recorded. Spotlight services/monthly awareness. VGH promotion through news articles and local media. *Promote current services; Diabetes program, Gifts of Hope, PT, Yoga, Childcare, Health Fair, Financial navigator/SHIP, 3D Mammograms *VGH Diabetes prevention program 2019-present. *Benton County Food pantry Flier distributions monthly. HACAP partnership, Feeding America: 10/2022 *The City and Vinton Park and Recreation Department have been working on plans for a new Wellness Center that would be located adjacent to the high school and combine, indoor/outdoor pool areas, gym, walking track, meeting rooms and exercise. This is a partnership that will benefit the community as well as allow Virginia Gay to provide services: diabetes prevention/weight loss/cooking demos/ CPR-first Aide/Baby-sitting/ Coordination support groups/Mental Health peer support/ Grieving/Ministerial services *Daycare partnership in progress *Cancer Screening clinics in collaboration with Mercy HPCCGoal 2: Increase Health prevention services to the residents of Benton CountyActions:*PH clinics: Sexual Health Clinic 8/22 (quarterly), SHIP program 9/22, BP clinics 9/22, Vaccine clinics *Promotion of services events2.Mental HealthGoal 1: Reduce intentional injuries among Benton County residents; reduce percent of Benton County students who have in the past 12 months seriously considered suicide by 1%. Actions: *Community events held to provide information, resources, and support in relation to suicide prevention. *VGH depression screenings on every patient that is 12 years or older. *HACAP 1st Five program offered the ACES training. ASAC, ACES training *Benton County Community School Districts Opportunity for ACES training and Mental health first aide to all teachers and administrators along with suicide awareness. *Depression Screenings at WIC clinics. *Benton County Rural Access promotionGoal 2: Increase mental health services for Benton County residentsActions: *Actively recruiting/hiring behavioral health specialist at Vinton Family Medical Clinic. *Promotion of the mental health services available in Benton County. *Second VGH Full time ARNP hired for Behavioral Health 11/2020. *Promoting and support of The Benton County CISM (Critical Incident Stress Management) Team established 2020.3.Substance AbuseGoal 1: Decrease substance abuse among Benton County Youth; Decrease the percentage of 11th graders who reported it was ""easy/very easy"" to have access to alcohol by 3%.Actions: *ASAC, Benton County Schools: ""What you cannot see"" trailer, Upcoming Community Speaker ""Steered Straight"" *Above the Influence Core Measurement Survey-Benton County Data collection monitoring Iowa Youth Survey Data review and monitoring *Community events held to provide information, resources, and support in relation to substance abuse and prevention.Goal 2: Decrease prescription drug abuse among Benton County residents; increase the number of pounds of prescription medications collected through drop boxes by 50 pounds. Actions: *Provide information to the community on Count, Lock-Up, Dispose campaign through various forms of media and sustainable locations. Example: Benton County Health Fair, Community events. *Posters/fliers distributed to the health care locations throughout the county, including medical clinics and pharmacies. *Promote Take Back Days for prescription medications. *Benton County Above the Influence Coalition. ASAC; Generation Rx and drug drop box materials distributed at 6 locations 9/2021 *Continue to work with Benton County Above the Influence Coalition subcommittees for Substance prevention, Mental HealthResults: *2021: 187 pounds"

Virginia Gay Hospital, Inc.
Part V, Section B, Line 16j: A summary of the policy and financial assistance information is posted in the emergency, admitting and waiting rooms, admissions and business offices, included with patient bills and information is available on our website.

Schedule H, Part V, Section B, Line 7a and 10a:
CHNA and Implementation Strategy:https://myvgh.org/community-health-needs-assessment/

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 6a:
The community benefit report is available upon request.

Part I, Line 7:
Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio which addresses all patient segments. The cost for subsidized health services on line 7g was determined using the Medicare cost report.

Part III, Line 2:
The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients.

Part III, Line 3:
Virginia Gay Hospital used the percentage of applications denied due to lack of information.

Part III, Line 4:
The footnote to the Organization's financial statements can be found on pages 10 and 11 of the attached audited financial statements.

Part III, Line 8:
There was a Medicare shortfall for the fiscal year. Even at a loss the Hospital continues to provide services to these patients because access to healthcare and individual's health is important. Therefore, the Hospital considers the Medicare shortfall a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $324,350.Medicare fee schedule revenue $ 187,938Medicare estimated costs of care relating to payments (560,595)Net (Shortage) $ (372,657)

Part III, Line 9b:
Statements are sent out every 30 days. Up to four statements are sent. Accounts are sent to collections at 121 days, with all collection practices adhering to 501(r) guidelines. If an approved application is received between 122-240 days the account is cancelled from the collection agency.

Part VI, Line 2:
The Hospital provides staff to attend Community Coalitions and Advisory Committees which are focused on specific populations and/or community health issues. Examples of the committees include but are not limited to the Benton County (Provider) Coalition, the Benton County Disaster Recovery Coalition, Above the Influence (substance abuse) Coalition and the Benton County Wellness Coalition. These coalitions meet regularly throughout the year, gather/assess data to identify problems, and work towards resolution of the identified problems. Virginia Gay Hospital's staff participates in the community needs assessment process for public health. The target area for the 2022 Community Health Needs Assessment (CHNA) is Benton County, Iowa. Special attention was paid to recruiting diverse subsets of the population to help accurately identify the most critical issues in the area. Following the collection of all the statistical data, each health indicator was analyzed by comparing it regionally, to the state average rate, and national rates to determine the community's priority health concerns. Preventive Health, Mental Health, and Substance Abuse were identified as the highest priority health needs in Benton County. The CHNA and implementation strategy are posted on our website and can be viewed in their entirety at www.myvghinc.org .

Part VI, Line 3:
Virginia Gay Hospital is committed to providing charity care to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care based on their individual financial situation. Virginia Gay Hospital strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. Patients are expected to cooperate with Virginia Gay Hospital's procedures for obtaining charity care or other forms of payment of financial assistance, to contribute to the cost of their care based on their individual ability to pay. The charity care policy includes all departments of the facility, including Vinton Family Medical Clinic, Urbana Family Medical Clinic, Van Horne Family Medical Clinic, Atkins Family Medical Clinic and the Nursing and Rehab. The Virginia Gay Hospital Home Health Agency has a separate financial assistance procedure, due to their Public Health role in the community. VGH has a commitment to establish/maintain effective partnerships throughout the county and work with all entities that influence community health. To improve and strengthen the local planning process multiple community partners have been involved in the CHNA process. Notification about charity care is available by the publication of notices in patient bills, posting of notices in the emergency rooms, admitting and registration departments, the Business Office, and other public places the Hospital may elect. Information is also included on the facility website, and in the patient information packets. A request for charity may be made by the patient or a family member, close friend or associate of the patient, subject to the applicable privacy laws

Part VI, Line 4:
The community VGH serves, as defined for the CHNA, is based on the primary service area of our hospital. The major service area is Benton County, serving an estimated population of nearly 26,000 with an area of 716.27 square miles. VGH also services several other counties and states. Per the Iowa Hospital Association Dimensions Program (2020) 82.70% of the 26,070 outpatient visits, were from residents of Benton County and of the 288 VGH inpatient discharges, 82.70% were Benton County residents.Unique to Benton County population is the presence of an AmeriCorps National Civilian Community Corps (NCCC) training campus. AmeriCorps NCCC strengthens communities and develops leaders through direct, team-based national and community service. In partnership with non-profitssecular and faith basedlocal municipalities, state governments, federal government, national and state parks, Indian tribes, and schools, members complete service projects throughout the region they are assigned. AmeriCorps NCCC is a full-time, team-based residential program for men and women ages 18-24.The closest hospitals are located 37 miles away in Cedar Rapids, Iowa. Virginia Gay Hospital currently operates four separate clinics; one clinic is located on the hospital campus in Vinton, another located in the rural town of Van Horne, Iowa which is 15 miles from Vinton, another located in the rural community of Urbana, 13 miles from Vinton, and the other located in the rural community of Atkins which is 19 miles from Vinton. The Hospital and clinics serve a large number of Medicare and Medicaid patients. The median household income for Benton County was $67,729. The 2022 unemployment rate was 5.0%.

Part VI, Line 5:
Virginia Gay Hospital is proudly recognized as having one of the lowest costs per stay rates in the state of Iowa. The Hospital offers twenty-five beds in an acute care setting with state of the art technology and professional services. Virginia Gay Hospital also offers 24 hour acute care, short term skilled nursing services, radiology, respiratory care, cardio-pulmonary rehabilitation, physical therapy, occupational therapy, speech therapy, laboratory services, surgical services, outpatient clinics and emergency care. In addition, our staff has contributed multiple hours providing uncompensated time in areas such as family/parenting/sibling education, medical expertise for the schools' athletic teams, health fairs, information and referrals to community services, safety classes, sports physicals and many other uncompensated services.Requirements of the IRS community benefit standard for tax-exempt organizations are integral to the Hospital's larger charitable mission of improving health and quality of life. Specifically, Virginia Gay Hospital is governed by an independent board including community leaders, physicians, consumer representatives, business experts and clinical healthcare experts who reside in our primary service area. The Board has a history of commitment to acting with the highest integrity and has been proactively evaluating opportunities to voluntarily adopt governance best practices to ensure the organization continues to operate with the highest of integrity for the benefit of the community.To meet the needs of our community, the Hospital extends privileges to medical staff that are qualified through licensure in the state of Iowa.Excess funds are reinvested and used for patient care and facility upgrades.Virginia Gay's Home Health Agency offers a variety of services to all ages in the rural population of Benton County, Including Skilled nursing, Home Care Aide and Homemaking services. The Hospital also offers such services as skilled and non-skilled service home care, blood pressure checks, and group teaching classes such as cardiopulmonary resuscitation (CPR), Advanced Life Support (ALS) and Pediatric Advanced Life Support (PALS).In addition, Virginia Gay Hospital, through its integrated network of providers, provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare and Medicaid and by offering assistance through their Financial assistance program.Virginia Gay Hospital's Financial Assistance Policy provides discounted and free services to patients who lack the resources to be fully responsible for the health care they receive. The Financial Assistance Policy is designed to ensure the entire community served by the Hospital has access to needed healthcare services.Virginia Gay Hospital takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad health needs of the community. It strives to identify community needs beyond basic healthcare, respond to them, aiming to make a positive, life-enhancing difference in the community.Contributing to Community Education: The nursing staff and Home Health Agency nurses participate in several county wide events and community health fairs. These events provide information and guidelines to those in need of medical information.Preventive Care is a Priority: The Hospital has taken steps to enhance preventive care for people of all ages by ensuring that those who come here for preventive care receive the screenings and recommendations appropriate to their personal and family history.

Operating expenses	$ 34,205,704
Total amount spent on community benefits as % of operating expenses	$ 704,535 2.06 %