4A (Expenses $ 54885932 including grants of $ 0) (Revenue $ 57876168)
RIVERVIEW HEALTHCARE DIRECTLY PROVIDES OR SUPPORTS THE PROVISION OF A CONTINUUM OF QUALITY, ACCESSIBLE AND COST-EFFECTIVE SERVICES FOCUSED ON THE NEEDS OF INDIVIDUALS. RIVERVIEW STRIVES TO MEET AREA MEDICAL NEEDS AND IMPROVE THE PHYSICAL AND MENTAL WELLBEING FOR PEOPLE OF THE AREA. THE HOSPITAL IS A MODERN 25-BED ACUTE CARE CRITICAL ACCESS HOSPITAL. FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2022, THE HOSPITAL HAD 758 ADMISSIONS, 1,698 PATIENT DAYS, 48,845 OUTPATIENT VISITS, 1,622 SURGERIES, AND 6,098 ER PATIENT VISITS. THE CLINICS PROVIDE A WIDE RANGE OF SERVICES INCLUDING FAMILY PRACTICE DOCTORS AND SPECIALTY DOCTORS. FOR THE YEAR ENDED SEPTEMBER 30, 2022, CLINIC PAITIENT VISITS WERE 32,202.

4B (Expenses $ 3930329 including grants of $ 0) (Revenue $ 4144457)
RIVERVIEW CARE CENTER PROVIDES STIMULATING DAILY ACTIVITIES FOR ITS RESIDENT IN AN ENJOYABLE ENVIRONMENT AND A CARING ATMOSPHERE WHERE ALL RESIDENTS ARE TREATED WITH THE UTMOST DIGNITY. THE MEMORY CARE UNIT PROMOTES A CALM AND THERAPEUTIC ATMOSPHERE. RIVERVIEW CARE CENTER IS A 24-BED FACILITY, FOR THE YEAR ENDING SEPTEMBER 30, 2022, THERE WERE 6 NURSING HOME ADMISSIONS AND 7,359 RESIDENT DAYSRIVERVIEW HOME CARE IS A FULL SERVICE HOME CARE AGENCY PROVIDING 24-HOUR ACCESS TO ON CALL NURSES, ROUTINE SERVICE ON WEEKENDS AND HOLIDAYS, AND A FULL RANGE OF THERAPY SERVICES. FOR THE YEAR ENDING SEPTEMBER 30, 2022, THERE WERE 1,330 HOME CARE PAITENTS AND 13,676 PATIENT VISITS. (CONTINUED IN SCHEDULE O)RIVERVIEW ASSISTED LIVING PROVIDES SERVICE TO RESIDENTS IN CROOKSTON. ASSISTANCE FOR THOSE UNABLE TO LIVE ALONE WITHOUT AID INCLUDES HOUSEKEEPING, HELP DRESSING, BATHING, PREPARING MEALS, MEDICATION SET-UP AND MANY OTHER SERVICES. FOR THE YEAR ENDING SEPTEMBER 30, 2022, THERE WERE 196 ASSISTED LIVING PATIENTS AND 5,482 PATIENT VISITS.

4C (Expenses $ 1471593 including grants of $ 0) (Revenue $ 1551767)
RIVERVIEW RECOVERY CENTER PROVIDES A DAY TREATMENT AND OUTPATIENT TREATMENT PROGRAM EFFECTIVE FOR THE ADULT WHO IS ABUSING OR DEPENDENT ON ONE OR MORE MOOD-ALTERING CHECMICALS. THE RECOVERY CENTER OPERATES CLINICS IN CROOKSTON, EAST GRAND FORKS, THIEF RIVER FALLS, AND ROSEAU, MINNESOTA. FOR THE YEAR ENDING SEPTEMBER 30, 2022, RECOVERY CENTER HAD 1,240 OUTPATIENT VISITS.

RIVERVIEW HOSPITAL
PART V, SECTION B, LINE 5: RIVERVIEW CONTRACTED WITH CLIFTONLARSONALLEN, LLP TO CONDUCT COMMUNITY INTERVIEWS AND TO ASSIST IN PREPARING THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY.THE INFORMATION WAS GATHERED THROUGH ONE-ON-ONE AND SMALL GROUP INTERVIEWS WITH KEY COMMMUNITY STAKEHOLDERS. THE INFORMATION WAS GATHERED FROM PEOPLE IN PUBLIC HEALTH, GOVERNMENT HEALTH AND OTHER GOVERNMENT AGENCIES, LEADERS OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS.THE FOLLOWING AGENCIES, ORGANIZATIONS, AND BUSINESSES PARTICIPATED IN THE COMMUNITY HEALTH NEEDS ASESSMENT PROCESS BY CONTRIBUTING THEIR PERSPECTIVES, OPINIONS, AND OBERVATIONS. WE THANK THEM FOR THEIR PAST AND CONTINUED ASSISTANCE. - POLK COUNTY PUBLIC HEALTH DEPARTMENT- POLK COUNTY SHERIFF'S DEPARTMENT- RIVERVIEW HEALTH- TRI-VALLEY OPPORTUNITY COUNCIL- NORTHWEST MENTAL HEALTH - CROOKSTON PUBLIC SCHOOL DISTRICT- INTER-COUNTY NURSING SERVICE

RIVERVIEW HOSPITAL
PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ON OUR WEBSITE AT: HTTPS://WWW.RIVERVIEWHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

RIVERVIEW HOSPITAL
PART V, SECTION B, LINE 11: IN THE 2013 CHNA REPORT, RIVERVIEW HEALTH IDENTIFIED OBESITY, JOINT OR BACK PAIN, AND HIGH BLOOD PRESSURE AS THE PRIMARY COMMUNITY HEALTH NEEDS. BASED ON THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, RIVERVIEW HEALTH HAS TAKEN THE FOLLOWING STEPS SINCE 2013 TO IMPROVE THE HEALTH OF OUR COMMUNITY:1. RIVERVIEW HEALTH HAS ROLE MODELED AN EMPLOYEE WELLNESS PROGRAM THAT ENCOURAGES HEALTHY EATING CHOICES AND PHYSICAL ACTIVITY AS A MEANS OF MANAGING WEIGHT AND OVERALL HEALTH.2. RIVERVIEW HEALTH HIRED A REGISTERED DIETICIAN THAT SPECIALIZES IN EDUCATION AND PLANNING FOR HEALTHY DIET AND WEIGHT MANAGEMENT, BOTH IN INPATIENT AND OUTPATIENT SETTINGS.3. RIVERVIEW HEALTH IMPLEMENTED A BMI (BODY MASS INDEX) TRACKING SYSTEM AND TARGETED PATIENTS WITH HIGH RISK FACTORS FOR SUPPORT AND EDUCATION.IN JUNE 2016 RIVERVIEW HEALTH PUBLISHED ITS SECOND CHNA REPORT. BASED ON THAT COMMUNITY HEALTH NEEDS ASSESSMENT, RIVERVIEW HEALTH IDENTIFIED OBESITY AND DIABETES AS THE PRIMARY SIGNIFICANT COMMUNITY HEALTH NEED AND SUBSTANCE ABUSE AND MENTAL HEALTH AS THE SECONDARY SIGNIFICANT COMMUNITY HEALTH NEEDS.OBESITY AND DIABETES:RIVERVIEW HEALTH OFFERS INITIATIVES TO ENHANCE THE EDUCATION AND TREATMENT OF OBESITY AND DIABETES IN THE COMMUNITY. IN ADDITION TO HIRING A REGISTERED DIETICIAN THAT SPECIALIZES IN EDUCATION AND PLANNING FOR HEALTHY DIET AND WEIGHT MANAGEMENT, RIVERVIEW HAS HIRED A HEALTH COACH TO OFFER A TEAM BASED APPROACH TO CHRONIC DISEASE MANAGEMENT AND OBESITY. THIS POSITION WORKS COLLABORATIVELY WITH CLINICIANS, PATIENTS AND OTHER SERVICE PROVIDERS TO BETTER MANAGE CHRONIC CONDITIONS IN THE COMMUNITY INCLUDING DIABETES AND OBESITY.RIVERVIEW HEALTH HAS ALSO INCREASED EDUCATIONAL OPPORTUNITIES FOR THOSE SEEKING EDUCATION IN DIABETES AND NUTRITION BY OFFERING A TYPE 2 DIABETES SUPPORT GROUP.RIVERVIEW HEALTH ALSO OFFERS TYPE 2 DIABETES PREVENTION CLASSES IN AN EFFORT TO PREVENT OR REDUCE THE ONSET OF TYPE 2 DIABETES.SUBSTANCE ABUSE AND MENTAL HEALTH:RIVERVIEW HEALTH ALREADY OFFERS OUTPATIENT ADDICTION SERVICE THROUGH ITS RIVERVIEW RECOVERY CENTER.RIVERVIEW RECOVERY CENTER OFFERS AN EXTENSIVE LIST OF OUTPATIENT PROGRAMS THAT ALLOW PATIENTS THE ABILITY TO RECEIVE HIGH-CALIBER CLINICAL CARE WHILE MAINTAINING COMMITMENTS TO WORK, FAMILY AND HOME.OUTPATIENT SERVICES ARE OFFERED AT RIVERVIEW RECOVERY'S LOCATIONS: CROOKSTON, EAST GRAND FORKS, ROSEAU AND THIEF RIVER FALLS.TREATMENTS INCLUDE: - RULE 25 CHEMICAL DEPENDENCY ASSESSMENT: A COMPREHENSIVE CHEMICAL HEALTH ASSESSMENT. - INDIVIDUAL COUNSELING SESSIONS: PROVIDED FOR INDIVIDUALS THAT HAVE COMPLETED TREATMENT AND ARE STRUGGLING WITH THOUGHTS OF USING. - INTENSIVE OUTPATIENT TREATMENT: THIS INCLUDES THREE GROUP COUNSELING MEETINGS PER WEEK, ONE WEEKLY INDIVIDUAL COUNSELING SESSION AND REGULAR URINE DRUG AND ALCOHOL SCREENING FOR INDIVIDUALS STRUGGLING WITH ADDICTION THAT DO NOT MEET CRITERIA FOR RESIDENTIAL TREATMENT. - RELAPSE PREVENTION: RELAPSE PREVENTION INCLUDES ONE INDIVIDUAL COUNSELING SESSION PER WEEK AS WELL AS REGULAR URINE DRUG AND ALCOHOL SCREENING TESTS FOR INDIVIDUALS THAT HAVE COMPLETED TREATMENT, INPATIENT OR INTENSIVE OUTPATIENT, IN THE LAST THREE YEARS AND ARE STRUGGLING WITH ADDICTION. RELAPSE PREVENTION IS INTENDED FOR INDIVIDUALS THAT ARE NOT USING DAILY, BUT WANT TO STOP THE CYCLE. - DRIVING WITH CARE 1: FOR THE FIRST TIME DWI OFFENDER WITH A BLOOD ALCOHOL LEVEL OF LESS THAN .15 AT THE TIME OF ARREST. DRIVING WITH CARE 1 IS A GROUP EDUCATION AND TRAINING PROGRAM THAT HAS PROVEN TO REDUCE RECURRENCE OF DWI. NEW CLASSES BEGIN QUARTERLY. - DRIVING WITH CARE 2: FOR THE FIRST TIME DWI OFFENDER WITH A BLOOD ALCOHOL LEVEL OF MORE THAN .15 AT THE TIME OF ARREST, OR MULTIPLE DWI OFFENCES. DRIVING WITH CARE 2 IS A GROUP EDUCATION AND TRAINING PROGRAM THAT HAS PROVEN TO REDUCE RECURRENCE OF DWI. NEW CLASSES BEGIN QUARTERLY.RATHER THAN EXPAND THE SCOPE OF MENTAL HEALTH SERVICES, RIVERVIEW WILL CONTINUE TO WORK WITH COMMUNITY PARTNERS SUCH AS THE NORTHWESTERN MENTAL HEALTH CENTER TO ENSURE THE COMMUNITY HAS ADEQUATE ACCESS TO MENTAL HEALTH SERVICES.IN 2019 RIVERVIEW HEALTH PUBLISHED ITS THIRD CHNA REPORT. BASED ON THAT COMMUNITY HEALTH NEEDS ASSESSMENT, RIVERVIEW HEALTH IDENTIFIED OBESITY, INCLUDING JOINT/BACK PAIN AND HIGH BLOOD PRESSURE AS THE PRIMARY SIGNIFICANT COMMUNITY HEALTH NEED AND SUBSTANCE ABUSE AND MENTAL HEALTH AS THE SECONDARY SIGNIFICANT COMMUNITY HEALTH NEEDS.BETWEEN OCTOBER 2019 AND SEPTEMBER 2022, RIVERVIEW HEALTH TOOK THE FOLLOWING ACTIONS TO ADDRESS THE PREVIOUSLY IDENTIFIED COMMUNITY HEALTH NEEDS: OBESITY:RIVERVIEW HEALTH CONTINUES TO EMPLOY A LICENSED REGISTERED DIETICIAN (LRD) THAT FOCUSES ON THE HEALTHY EATING HABITS OF THE PATIENTS IN OUR COMMUNITY. THIS POSITION SERVED IN A CAPACITY FOR 1:1 CARE PLAN DEVELOPMENT AND GROUP EDUCATION AS WELL AS COMMUNITY PRESENTATIONS RELATING TO HEALTHY INTAKE AND WEIGHT/METABOLIC CONTROL. FREQUENCY OF REFERRALS FROM PROVIDERS FOR 1:1 COUNSELING WITH THE REGISTERED DIETICIAN HAS MORE THAN DOUBLED IN THE PAST THREE YEARS. AS AN INTEGRAL PART OF THE TEAM THE DIETICIAN WORKS WITH PROVIDERS AND HEALTH COACHES TO MANAGE THE HEALTH OF PATIENTS. RIVERVIEW HAS WORKED TOWARD IMPROVING PATIENTS THAT STRUGGLE WITH EATING HABITS AND WEIGHT CONTROL. THIS IMPROVEMENT IS SPECIFICALLY MEASURED THROUGH A GOAL THAT STATES: RIVERVIEW WILL IMPROVE OVERALL CONTROL OF ADULT DIABETIC PATIENT BLOOD SUGAR LEVELS TO AT LEAST 80% OF PATIENTS HAVING A HGBA1C MEASUREMENT OF LESS THAN 8%. RIVERVIEW HAS MET THE GOAL IN EACH YEAR SINCE INCEPTION. IN ADDITION TO EMPLOYING A REGISTERED DIETICIAN RIVERVIEW SPONSORS COMMUNITY EVENTS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. THE FOLLOWING LIST INCLUDES EXAMPLES:THE POWER OF PRODUCE: FOR THE PAST THREE YEARS RIVERVIEW HAS SPONSORED THE POWER OF PRODUCE TO PROVIDE FREE WHOLE FRUITS AND VEGETABLES TO KIDS AND SENIOR CITIZENS AT THE LOCAL FARMERS MARKET. RIVERVIEW 2K WALK AND ROLL: AN EVENT FOCUSED ON PROMOTING AND ENCOURAGING ACTIVITY AND MOVEMENT DIABETES SUPPORT GROUP: PEER GROUP THAT SUPPORTS AND PROMOTES HEALTHY ACTIVITIES AND HABITS. HEALTH HABITS COOKING VIDEOS: EXAMPLE - HTTPS://YOUTU.BE/UND3QJQZZFS MEDICAL MINUTE VIDEOS: EXAMPLE - HTTPS://YOUTU.BE/5R-ER6KCRZA SUBSTANCE ABUSE:RIVERVIEW CONTINUES TO OFFER SUBSTANCE ABUSE TREATMENT. TO INCREASE ACCESS TO TREATMENT, RIVERVIEW RECOVERY CENTER STARTED OFFERING ELECTRONIC OPTIONS FOR SERVICES. WITH THE USE OF A SMART PHONE OR TABLET CLIENTS CAN CONNECT WITH COUNSELORS FOR A VARIETY OF ASSESSMENT AND TREATMENT OPTIONS. THIS STRATEGY HAS DECREASED THE AMOUNT OF NO SHOWS FOR TREATMENT APPOINTMENTS AND ALLOWS THE CLIENT FLEXIBILITY FOR TREATMENT. TREATMENTS INCLUDE: COMPREHENSIVE HEALTH ASSESSMENTS: A COMPREHENSIVE CHEMICAL HEALTH ASSESSMENT. INDIVIDUAL COUNSELING SESSIONS: PROVIDED FOR INDIVIDUALS THAT HAVE COMPLETED TREATMENT AND ARE STRUGGLING WITH THOUGHTS OF USING. INTENSIVE OUTPATIENT TREATMENT: INTENSIVE OUTPATIENT THERAPY INCLUDES THREE GROUP COUNSELING MEETINGS PER WEEK. ONE WEEKLY INDIVIDUAL COUNSELING SESSION AND REGULAR URINE DRUG AND ALCOHOL SCREENING FOR INDIVIDUALS STRUGGLING WITH ADDICTION THAT DO NOT MEET THE CRITERIA FOR RESIDENTIAL TREATMENT. RELAPSE PREVENTION: RELAPSE PREVENTION INCLUDES ONE INDIVIDUAL COUNSELING SESSION PER WEEK AS WELL AS REGULAR URINE DRUG AND ALCOHOL SCREENING TESTS FOR INDIVIDUALS THAT HAVE COMPLETED TREATMENT, INPATIENT OR INTENSIVE OUTPATIENT, IN THE LAST THREE YEARS AND ARE STRUGGLING WITH ADDICTION. RELAPSE PREVENTION IS INTENDED FOR INDIVIDUALS THAT ARE NOT USING DAILY BUT WANT TO STOP THE CYCLE.DRIVING WITH CARE 1: FOR THE FIRST TIME DWI OFFENDER WITH A BLOOD ALCOHOL LEVEL OF LESS THAN .15 AT THE TIME OF ARREST. DRIVING WITH CARE 1 IS A GROUP EDUCATION AND TRAINING PROGRAM THAT HAS PROVEN TO REDUCE THE RECURRENCE OF DWI. NEW CLASSES BEGIN QUARTERLY. DRIVING WITH CARE 2: FOR THE FIRST TIME DWI OFFENDER WITH A BLOOD-ALCOHOL LEVEL OF MORE THAN .15 AT THE TIME OF ARREST, OR MULTIPLE DWI OFFENSES. DRIVING WITH CARE 2 IS A GROUP EDUCATION AND TRAINING PROGRAM THAT HAS PROVEN TO REDUCE THE RECURRENCE OF DWI. NEW CLASSES BEGIN QUARTERLY. MENTAL HEALTH:RIVERVIEW CONTINUES TO PARTNER WITH ALLUMA (FORMERLY NORTHWESTERN MENTAL HEALTH) TO ENSURE THE COMMUNITY HAS ADEQUATE ACCESS TO MENTAL HEALTH SERVICES. SOME OF THE COLLABORATIONS WITH ALLUMA INCLUDE: SUICIDE PREVENTION RIVERVIEW HEALTH FOCUSES ON SUICIDE PREVENTION, MENTAL HEALTH, AND MENTAL WELLNESS. RIVERVIEW HEALTH HAS A SUICIDE PREVENTION STEERING COMMITTEE UTILIZING THE ZERO SUICIDE INITIATIVE. RIVERVIEW PARTNERS WITH THE MINNESOTA DEPARTMENT OF HEALTH AND ALLUMA WITH THE ZERO SUICIDE INITIATIVE ACTION PLAN. CRISIS TEAM ALLUMA HAS A CRISIS RESPONSE TEAM THAT WILL RESPOND TO OUR EMERGENCY DEPARTMENT IF A NEED ARISES. THE CRISIS RESPONSE TEAM ALLOWS FOR GREATER CARE COORDINATION AND ENSURES THE PATIENTS HAVE ACCESS TO THE SERVICES THEY NEED.

RIVERVIEW HOSPITAL
PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTNACE POLICY IS AVAILABLE AT:HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/RIVERVIEW-HEALTH-SITE-275/MEDIA/3D66C20A22744620A988C9626281EC69/2023-COMMUNITY-CARE-APPLICATION-FULL.PDFTHE FINANCIAL ASSISTANCE POLICY APPLICATION IS AVAILABLE AT:HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/RIVERVIEW-HEALTH-SITE-275/MEDIA/3D66C20A22744620A988C9626281EC69/2023-COMMUNITY-CARE-APPLICATION-FULL.PDFTHE FINANCIAL ASSITANCE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/RIVERVIEW-HEALTH-SITE-275/MEDIA/3D66C20A22744620A988C9626281EC69/2023-COMMUNITY-CARE-APPLICATION-FULL.PDF

PART I, LINE 3C:
ELIGIBILITY FOR CHARITY CARE IS BASED ON HOUSEHOLD INCOME COMPARED TO FEDERAL POVERTY GUIDELINES FOR THE INDIVIDUAL'S FAMILY SIZE. TO QUALIFY FOR CHARITY CARE, A PERSON MUST RECEIVE MEDICALLY NECESSARY CARE AT RIVERVIEW HOSPITAL AND CLINICS, BE A RESIDENT OF EITHER MINNESOTA OR NORTH DAKOTA, SUBMIT A COMPLETE CHARITY CARE APPLICATION INCLUDING REQUIRED DOCUMENTATION, AND SUBMIT EVIDENCE OF APPLICATION FOR GOVERNMENT MEDICAL ASSISTANCE.

PART I, LINE 7:
COSTS INCLUDED ON LINES 7A AND 7B ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. THE COSTS REPORTED ON LINES 7E-7I ARE DIRECT COSTS TO THE FACILITIES FOR THE PROGRAMS DESCRIBED BELOW. PART 1, LINE 7E COSTS: COMMUNITY HEALTH SERVICES IS THE TOTAL COST OF ACTIVITIES TO IMPROVE COMMUNITY HEALTH IN THE FOLLOWING AREAS: (1)PROVIDING COMMUNITY HEALTH EDUCATION WITH HEALTH LECTURES AND WORKSHOPS TO COMMUNITIY GROUPS, HEALTH AND CAREER DAY FAIRS, FAMILY AND FRIENDS CPR CLASSES AND BY PROVIDING SPECIFIC DIAGNOSES (AUTISM) SUPPORT GROUPS; (2) PROVIDING CLINICAL SERVICES SUCH AS FREE BLOOD PRESSURE AND CHOLESTEROL SCREENING AT HEALTH FAIRS; AND (3) PROVIDING SUPPORT SERVICES LIKE ENROLLMENT ASSISTANCE IN PUBLIC PROGRAMS, MENTAL HEALTH SERVICE HOT-LINES AND BUS TRANSPORTATION VOUCHERS TO ENHANCE PATIENT ACCESS TO CARE.PART I, LINE 7F COSTS: HEALTH PROFESSIONS EDUCATION IS THE COST OF OPERATING PROFESSIONAL EDUCATION AND TRAINING PROGRAMS FOR MEDICAL STUDENTS, NURSING STUDENTS, AND TECHNICIANS. SCHOLARSHIPS ARE ALSO OFFERED TO NON-EMPLOYEES FOR NURSING AND OTHER PROFESSIONAL EDUCATION.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES INCLUDE COSTS FOR BILLED SERVICES THAT ARE SUBSIDIZED BY THE HEALTH CARE ORGANIZATION. CLINICAL PATIENT CARE SERVICES ARE PROVIDED DESPITE A NEGATIVE MARGIN BECAUSE THEY ARE NEEDED BY THE COMMUNITY THE HOSPITAL'S SUBSIDIZED HEALTH SERVICES INCLUDE THE HOSPITAL OPERATED CLINIC.

PART I, LINE 7, COLUMN (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 $ 1,353,743.

PART III, LINE 2:
PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ASSOCIATION ANALYZES ITS PAST HISTORY 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 OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ASSOCIATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ASSOCIATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

PART III, LINE 3:
ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANT POLICY WAS DETERMINED BY TAKING THE BAD DEBT EXPENSE AND MULTIPLYING IT BY THE RATIO OF THE ORGANIZATION'S MEDICAID CONTRACTUAL ADJUSTMENTS TO THE TOTAL PATIENT SERVICE REVENUE AMOUNTS FROM THE HAR REPORT.

PART III, LINE 4:
"SEE THE ""PATIENT AND RESIDENT RECEIVABLES, NET NOTE ON PAGE 10 OF THE ATTACHED FINANCIAL STATEMENTS."

PART III, LINE 8:
THE MEDICARE ALLOWABLE COSTS REPORTED ON PART III, LINE 6 WERE DERIVED FROM THE 2021 FILED MEDICARE COST REPORT.

PART III, LINE 9B:
THROUGHOUT THE PAYMENT AND COLLECTION PROCESS, STAFF ATTEMPTS TO IDENTIFY TO THE EXTENT POSSIBLE, PATIENTS WHICH ARE WORTHY AND APPROPRIATE FOR CHARITY CONSIDERATION. THOSE ACCOUNTS TO BE CONSIDERED FOR CHARITY REDUCTIONS ARE ASKED TO COMPLETE A FINANCIAL DISCLOSURE FORM, WHICH WILL PROVIDE PERTINENT PATIENT FINANCIAL INFORMATION NECESSARY TO DETERMINE FINANCIAL NEED. REVIEW OF POTENTIAL CHARITY REQUESTS ARE PERFORMED DAILY BY THE FINANCIAL COORDINATOR AND CERTAIN RECOMMENDATIONS ARE FORWARDED TO THE CFO FOR SIGNATURE AND APPROVAL. ALL MINNESOTA RESIDENTS, UPON REQUEST, WHO ARE UNINSURED WILL RECEIVE A PRIVATE PAY DISCOUNT DETERMINED BY THE INSURANCE COMPANY WITH WHICH RIVERVIEW HEALTH DOES THE GREATEST VOLUME. THE SOCIAL SERVICES DEPARTMENT OF RIVERVIEW HEALTHCARE WORKS CLOSELY WITH THE STATE MEDICAID ELIGIBILITY PROGRAM TO ENSURE PATIENTS HAVE ACCESS TO AVAILABLE PROGRAMS. NON-INSURED PATIENTS ARE REFERRED TO THE STATE MEDICAID ELIGIBILITY PROGRAM FOR A PROBABILITY OF ELIGIBILITY ASSESSMENT.

PART VI, LINE 2:
THE HOSPITAL PERFORMED PATIENT SURVEYS AND HIRED CONSULTANTS THAT PERFORM SURVEYS AND STUDIES TO DETERMINE HEALTH CARE NEEDS OF THE COMMUNITY.

PART VI, LINE 3:
CHARITY CARE FORMS ARE HANDED OUT IN ADMITTING AND ALSO PLACED IN COLLECTION LETTERS. MEDICAID SERVICES INFORMATION IS AVAILABLE TO PATIENTS AT REGISTRATION. THE MULTI-DISCIPLINARY DISCHARGE PLANNING COMMITTEE MEETS DAILY AND PLANS THE DISCHARGE OF PATIENTS, INCLUDING FINNANCIAL PLANNING. REFER TO APPROPRIATE AGENCIES AND PROGRAMS FOR FINANCIAL AID WHEN THE PATIENT HAS NO HOSPITAL INSURANCE OR WHEN PATIENT/FAMILY RESOURCES ARE LIMITED OR DEPLETED.

PART VI, LINE 4:
RIVERVIEW HEALTH PRIMARY SERVICE AREA CONSISTS OF POLK & RED LAKE COUNTY WITH A POPULATION OF APPROXIMATELY 34,700. THE UNEMPLOYMENT RATE IS BELOW THE STATE LEVEL. THE MAJORITY OF WORKERS ARE EMPLOYED IN HEALTHCARE, MANUFACTURING OR FARMING.POLK AND RED LAKE COUNTIES HAVE A LARGER-THAN-AVERAGE PROPORTION OF ELDERLY INDIVIDUALS POLK AND RED LAKE COUNTIES HAVE A MEDIAN INCOME BELOW STATE AVERAGE.

PART VI, LINE 5:
COMMUNITY BUILDING ACTIVITIES ARE PROGRAMS AND ACTIVITIES THAT ARE DESIGNED TO ADDRESS ROOT CAUSES OF HEALTH PROBLEMS IN THE COMMUNITY. DISASTER READINESS, REDUCING THE AIR ENVIRONMENTAL HAZARDS, SHARPS DISPOSAL AND COMMUNITY LEADERSHIP DEVELOPMENT ARE SOME PROGRAMS. RECRUITMENT OF PHYSICIANS TO THIS RURAL COMMUNITY AND PROVIDING PROGRAMS TO DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE ARE TWO OTHER ACTIVITIES.

PART VI, LINE 7, REPORTS FILED WITH STATES
MN