Community Benefit Insight - Tax-exempt hospital

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Cloud County Health Center Inc

Cloud County Health Center

1100 Highland Drive
Concordia, KS 66901

Bed count	25	Medicare provider number	171349	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 480545923

Display data for year:

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

23.1%

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	$ 140,000 0.76 %
Medicaid as % of operating expenses	$ 1,151,740 6.29 %
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	$ 2,939,410 16.05 %
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	$ 900,579 4.92 %
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	$ 0 0 %

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 $ 14278930 including grants of $ 2500) (Revenue $ 18821707)
Cloud County Health Center (Health Center) is a nonprofit acute care hospital located in Concordia Kansas. The Health Center provides inpatient, outpatient, rural healht clinic and emergency care services to residents of Cloud County and the surrounding area. Health Center had a total of 253 discharges and 1,613 patient days. The hospital had a total of 275 surgeries, 2,639 ED visits and 22,190 OP visits and the Family Care Center had 15,121 visits. In addition to providing Inpatient and Outpatient services, the hospital provides the following ancillary services; Lab, Imaging, Pharmacy, Respiratory Therapy, Rehab services and Sleep Lab services. Imaging services include all of the following areas; General X-ray, CT Scan, Nuclear Medicine, Ultrasound, Bone Density and Mammography services. MRI services are provided on Sundays with a Mobile Unit.

Facility Information

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

Cloud County Health Center
Part V, Section B, Line 5: On April 28, 2022, the Community Health Needs Assessment Committee met and discussed ways to involve the community in addressing the most important health needs of Cloud County. The group decided to survey the community, asking for their input on priority of the following areas:- Obesity- Depression/Mental Health- Diabetes- Heart Disease- Tobacco Use Including vaping and chewing- Stroke- Trauma/Falls- Hypertension (high blood pressure)- High cholesterol- Substance Abuse- Transportation to Medical ServicesThe survey was launched through all forms of media for a period of six weeks. 118 surveys were received and tabulated. The Community Health Needs Assessment Committee met in July to review the results and discuss an implementation plan. The Committee consists of 25 members from various organizations in the community.

Cloud County Health Center
Part V, Section B, Line 7d: Can contact the Hospital or Health Department to obtain a copy.

Cloud County Health Center
Part V, Section B, Line 11: The following community health priority areas were identified in the most recent CHNA.1) Obesity2) Depression/Mental Health3) Diabetes4) Heart Disease5) Tobacco Use6) Stroke7) Trauma/Falls8) Hypertension9) High Cholesterol10) Substance Abuse11) Transportation to Medical ServicesAlthough all of the above are important and will be addressed as part of our regular operations, the hospital will focus on Obesity (including trauma/falls), Depression/Mental Health, and Substance Abuse, including Tobacco Use during fiscal years ending in 2023-2025. With assistance from other organizations, we will address the issues through the following steps:#1 - Provide Opportunities to Stabilize Mental HealthA) Publicize a new hotline number for suicide prevention and provide information in schools, libraries, the hospital, major employers, and ag industry companies.B) Develop more access to telehealth#2 - Provide ways to decrease Obesity in the Community and include Education of Health issues leading to ObesityA) Start Weight Watchers program in the communityB) Offer Community classes on weight managementC) Stepping On Program Provide classes at the hospital to help prevent falls/trauma injuriesD) Community exercise activities - Develop bike trails/walking trails in the community#3 - Develop ways to decrease Substance abuse and Tobacco useA) Promote Great American Smokeout Day annuallyB) Utilize health fairs to publicize dangers of substance abuseDue to timing, the hospital focused on the needs identified in the prior CHNA during fiscal year ended 2022, as follows:#1 - Accessibility and Availability to Healthcare - A new state-of-the-art facility will open in November 2022. The Hospital received approval from USDA on funding for the new replacement facility and broke ground in March 2021. We continued to offer increased the hours in our Family Care Clinic and walk-in clinic hours until 6:00 p.m., Monday thru Friday. Each day we have a dedicated provider scheduled for walk-in patients. The clinic continued its relationship with the high school USD 333 and the community college to provide annual physicals for their student athletes. Tele-health services were also available and increased during the fiscal year for the Clinic.#2 - Promoting Healthier Lifestyles - We continued to promote awareness of heart disease through increased advertising in our community in the newspaper, on the radio and our website. We participated in Wear RED Day in February to help raise awareness of heart disease as the leading cause of death among Americans. We promoted increased community activity of the bike trails, walking trails in the city of Concordia and made our Physical Therapy equipment available after hours in the hospital.#3 - Received funding for a fixed MRI at our new facility when it opens in November 2022. The hospital will now have MRI services scheduled 5 days a week and emergency services on weekends instead of the mobile MRI truck one day per week on Sundays. We provided increased services in the community to treat patients with trauma, stroke, hypertension, high cholesterol, etc.

Cloud County Health Center
Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy.

Part V, Section B, Line 7a
nckmed.com/about/community-health-needs

Part V, Section B, Line 10a
nckmed.com/about/community-health-needs

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size, medical indigency, insurance and underinsurance status. Presumptive eligibility may be used if the other options are not available.

Part I, Line 7:
Charity care expense was converted to cost on line 7A based on an overall cost-to-charge ratio addressing all patient segments. Line 7B, Medicaid, was determined based on the costing methods used to prepare the cost reports. Line 7G was obtained from the Medicare Cost Report.

Part I, Line 7g:
Rural health clinic revenue of $1,727,645 and expense of $3,682,373 are included on line 7g. The net cost of rural health clinic subsidized services is $1,954,728.

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 4:
The footnote to the organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 11-12.

Part III, Line 8:
The payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community.

Part III, Line 9b:
Collection practices do not apply to patients who have an approved payment plan in effect provided payments are kept current. Patients who have qualified for 100% financial assistance would not go to collection as their account balance would be reduced to zero prior to getting to the collection stage. Patients who qualify for less than 100% assistance may go to collection if their balance is not paid according to an agreed upon schedule. Accounts that are deemed to qualify for financial assistance while in collections will be removed from collections and returned to the business office.

Part VI, Line 2:
The hospital has an 18 member CHNA committee that meets quarterly at the hospital to discuss the healthcare needs in the community. Members include staff from the hospital, health department representatives, city and county government officials, school leaders and city business leaders.

Part VI, Line 3:
The hospital does the following to educate patients on the financial assistance offered at CCHC; (1) posts its financial assistance policy and financial assistance contact information on its website, in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (4) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable.

Part VI, Line 4:
CCHC is located in Concordia, KS. Concordia is the county seat of Cloud County. It is a rural community with an estimated population of 5,111 per the 2020 Census data. Concordia is home to Cloud County Community College located just off highway 81 in Concordia. Concordia is surrounded by Healthcare facilities in all directions. To the north in Belleville, KS is Republic County Hospital located 18 miles from Concordia, KS. To the east is Clay County which has Clay County Medical Center approx. 45 miles from Concordia, KS. To the south is Ottawa County approx. 33 miles from Concordia, KS. Ottawa County has a facility in Minneapolis, KS. Then to the west is Mitchell County approx. 32 miles from Concordia, KS. Mitchell County has a facility in Beloit, KS. CCHC gets about 80% of its patients from Concordia, 6% from Clyde, 5% from Jamestown, 2% from Glasco and 1% from both Aurora and Miltonvale. Also, the hospital sees about 4% of its patients from Belleville and Beloit combined. The median income for a household is $44,185. The per capita income for the city is $22,715. About 13.6% of the population were below the poverty line.

Part VI, Line 5:
The hospital has a Rural Health Clinic within the hospital and provides services Monday through Friday from 8:30 am. till 6:00 pm. Monday thru Friday. The Clinic has outreach locations in Clyde and Jamestown. The physicians see patients in Clyde on Wednesday and Thursday mornings and every other Tuesday morning in Jamestown. The hospital has a total of 7 providers of which 3 are physicians and 4 are mid-level providers. The hospital operates an emergency department 24 hours per day, 7 days per week.The hospital's Board of Trustees is made up of members from all parts of the county, including local business leaders and retired individuals from Concordia and the surrounding communities.The services offered at CCHC include the following:IP Acute servicesIP ICU servicesIP swing bed services - patients requiring Therapy services or IV antibiotic servicesED services FCC Family Care Clinic Specialty Clinic ServicesAncillary services including the following:Physical Therapy, Occupational Therapy and Speech Pathology services,Radiology services including ultrasound, nuclear medicine, CT scan and mobile MRI servicesLaboratoryRespiratory TherapyCardiac Rehab ServicesSleep Lab servicesOperating Room OP proceduresAnti Coag ClinicOutpatient Services Including IV Therapy and Blood Transfusions

Part VI, Line 6:
CCHC has been part of an affiliation with Salina Regional Health Center (SRHC) since May 2016. CCHC staff are employees of SRHC and adhere to the same polices as SRHC staff. CCHC is on the same EMR system as SRHC which helps to provide a continuity of care for our patients in our communities. Contracts and purchasing agreements are beneficial for both organizations in the areas of pricing and terms of the agreements. SRHC helps support our community by sending specialists to our clinic monthly. They also provide subject matter experts that CCHC can call upon with questions.

Operating expenses	$ 18,319,628
Total amount spent on community benefits as % of operating expenses	$ 4,231,150 23.10 %