Community Benefit Insight - Tax-exempt hospital

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Trinity Health & Affiliates

PO Box 5020

Minot, ND 58702

EIN: 331007002

The hospital that you have selected is part of a multi-facility organization that reports community benefit expenditures in the aggregate and not by individual hospital. The data shown below are for the multi-facility organization. We encourage you to contact the individual hospital directly if you would like community benefit information on the hospital.Learn more

Individual Facility Details: Trinity Hospitals/St Joes

One Burdick Expressway West
Minot, ND 58702

2 hospitals in organization:
(click a facility name to update Individual Facility Details panel)

Trinity Hospitals/St Joes

Kenmare Community Hospital

Bed count	416	Medicare provider number	350006	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

Trinity Health & AffiliatesDisplay data for year:

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

1.31%

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	$ 2,574,871 0.75 %
Medicaid as % of operating expenses	$ 246,035 0.07 %
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	$ 0 0 %
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.	$ 1,663,539 0.48 %
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	$ 15,779,080 4.59 %
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 $ 248898238 including grants of $ 278922) (Revenue $ 351899590)
TRINITY HEALTH & AFFILIATES PROVIDES HOSPITAL SERVICES TO CENTRAL AND NORTHWEST NORTH DAKOTA AND NORTHEASTERN MONTANA. TRINITY HOSPITALS IS THE LARGEST HOSPITAL PROVIDER IN NORTHWEST NORTH DAKOTA, WITH AN ACUTE CARE FACILITY THAT IS VERIFIED BY THE AMERICAN COLLEGE OF SURGEONS AS A LEVEL 2 TRAUMA CENTER. TRINITY SERVES AS A REFERRAL CENTER FOR THE FOLLOWING SERVICES: HEART, NEURO, GENERAL AND ROBOTIC SURGERY, CANCER AND CARDIAC CARE, OPHTHALMOLOGY AND RETINAL SURGERY, ADVANCED DIAGNOSTICS, NEWBORN INTENSIVE CARE, ORTHOPEDICS, SPORTS MEDICINE, INPATIENT REHABILITATION, BEHAVIORAL HEALTH, KIDNEY DIALYSIS AND LITHOTRIPSY. TRINITY HOSPITAL INCLUDES A JOINT REPLACEMENT AND GERIATRIC CENTER, CARDIAC CENTER, STROKE CENTER AND NEUROSURGERY CENTER. (SEE SCHEDULE O)TRINITY HOSPITAL - ST. JOSEPH'S INCLUDES AN INPATIENT REHABILITATION UNIT, KIDNEY DYALISIS UNIT, INPATIENT MENTAL HEALTH, OUTPATIENT BEHAVIORAL HEALTH, AND BOTH INPATIENT AND OUTPATIENT CHEMICAL DEPENDENCY UNITS. TRINITY'S NORTHSTAR CRITICAIR HELICOPTER PROVIDES CRITICAL CARE TRANSPORT WITHIN A 150-MILE RADIUS OF TRINITY HOSPITAL. TRINITY ALSO PROVIDES GROUND AMBULANCE SERVICES TO THE CITY OF MINOT AND THE SURROUNDING AREA THROUGH COMMUNITY AMBULANCE SERVICE OF MINOT, INC.

4B (Expenses $ 19667093 including grants of $ 0) (Revenue $ 19103183)
TRINITY HOMES IS A 161-BED HOSPITAL-BASED SKILLED NURSING FACILITY PARTICIPATING IN THE MEDICARE AND MEDICAID PROGRAMS. TRINITY HOMES INCLUDES AN ALZHEIMER'S SPECIAL CARE UNIT AND 13 RETIREMENT APARTMENTS. RESIDENTS OF TRINITY HOMES, UNDER THE DIRECTION OF THEIR PHYSICIAN, ARE ABLE TO RECEIVE SKILLED NURSING CARE, PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, DIETETIC SERVICES, SOCIAL SERVICES, AND ACTIVITIES OF DAILY LIVING ASSISTANCE, SPIRITUAL CARE AND RECREATIONAL ACTIVITIES.

Facility Information

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

TRINITY HOSPITAL
"PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") PROCESS PRIMARILY INVOLVED INTERVIEWS IN SPRING 2022 WITH VARIOUS COMMUNITY LEADERS, MEDICAL PROFESSIONALS, AND CITY AND COUNTY GOVERNMENT OFFICIALS. PARTICIPANTS INCLUDED THE CITY OF MINOT, FIRST DISTRICT HEALTH UNIT, MINOT AIR FORCE BASE, MINOT COMMISSION ON AGING, MINOT PUBLIC SCHOOL DISTRICT, WARD COUNTY JAIL, WARD COUNTY SHERIFF'S DEPARTMENT, AND WARD COUNTY SOCIAL SERVICES."

TRINITY HOSPITAL ST. JOSEPH'S
"PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") PROCESS PRIMARILY INVOLVED INTERVIEWS IN SPRING 2022 WITH VARIOUS COMMUNITY LEADERS, MEDICAL PROFESSIONALS, AND CITY AND COUNTY GOVERNMENT OFFICIALS. PARTICIPANTS INCLUDED THE CITY OF MINOT, FIRST DISTRICT HEALTH UNIT, MINOT AIR FORCE BASE, MINOT COMMISSION ON AGING, MINOT PUBLIC SCHOOL DISTRICT, WARD COUNTY JAIL, WARD COUNTY SHERIFF'S DEPARTMENT, AND WARD COUNTY SOCIAL SERVICES."

TRINITY KENMARE HOSPITAL
"PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") PROCESS PRIMARILY INVOLVED INTERVIEWS IN SPRING 2022 WITH VARIOUS COMMUNITY LEADERS, MEDICAL PROFESSIONALS, AND CITY AND COUNTY GOVERNMENT OFFICIALS. PARTICIPANTS INCLUDED THE CITY OF KENMARE, FIRST DISTRICT HEALTH UNIT, MINOT COMMISSION ON AGING, AND WARD COUNTY SOCIAL SERVICES."

TRINITY HOSPITAL
PART V, SECTION B, LINE 6A: TRINITY HOSPITAL CONDUCTED ITS CHNA IN COLLABORATION WITH TRINITY HOSPITAL-ST. JOSEPH'S AND TRINITY KENMARE HOSPITAL. BECAUSE OF THEIR IDENTICAL COMMUNITIES AND RELATIONSHIP WITHIN TRINITY HEALTH, TRINITY HOSPITAL AND TRINITY HOSPITAL-ST. JOSEPH'S PRODUCED A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT.

TRINITY HOSPITAL ST. JOSEPH'S
PART V, SECTION B, LINE 6A: TRINITY HOSPITAL-ST. JOSEPH'S CONDUCTED ITS CHNA IN COLLABORATION WITH TRINITY HOSPITAL AND TRINITY KENMARE HOSPITAL. BECAUSE OF THEIR IDENTICAL COMMUNITIES AND RELATIONSHIP WITHIN TRINITY HEALTH, TRINITY HOSPITAL AND TRINITY HOSPITAL-ST. JOSEPH'S PRODUCED A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT REPORT.

TRINITY KENMARE HOSPITAL
PART V, SECTION B, LINE 6A: TRINITY KENMARE HOSPITAL CONDUCTED ITS CHNA IN COLLABORATION WITH TRINITY HOSPITAL AND TRINITY HOSPITAL-ST. JOSEPH'S.

TRINITY HOSPITAL
PART V, SECTION B, LINE 11: IN TRINITY HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, THE IDENTIFIED SIGNIFICANT COMMUNITY HEALTH NEEDS WERE ACCESS TO CARE, SUBSTANCE ABUSE, MENTAL HEALTH, AND OBESITY. HOWEVER, TRINITY HOSPITAL'S EFFORTS DURING THE FISCAL YEAR WERE ENTIRELY DEDICATED TO PROVIDING AN EFFECTIVE RESPONSE TO THE COVID PANDEMIC.

TRINITY HOSPITAL ST. JOSEPH'S
PART V, SECTION B, LINE 11: IN TRINITY HOSPITAL - ST. JOSEPH'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, THE IDENTIFIED SIGNIFICANT COMMUNITY HEALTH NEEDS WERE ACCESS TO CARE, SUBSTANCE ABUSE AND MENTAL HEALTH. HOWEVER, TRINITY HOSPITAL - ST. JOSEPH'S EFFORTS DURING THE FISCAL YEAR WERE ENTIRELY DEDICATED TO PROVIDING AN EFFECTIVE RESPONSE TO THE COVID PANDEMIC.

TRINITY KENMARE HOSPITAL
PART V, SECTION B, LINE 11: IN TRINITY KENMARE HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, THE IDENTIFIED SIGNIFICANT COMMUNITY HEALTH NEEDS WERE ACCESS TO HEALTH CARE CARE SERVICES, SUBSTANCE ABUSE, MENTAL HEALTH, AND OBESITY. HOWEVER, TRINITY KENMARE HOSPITAL'S EFFORTS DURING THE FISCAL YEAR WERE ENTIRELY DEDICATED TO PROVIDING AN EFFECTIVE RESPONSE TO THE COVID PANDEMIC.

TRINITY HOSPITAL
PART V, SECTION B, LINE 13H: OTHER CRITERIA USED BY TRINITY HOSPITAL TO DETERMINE ELIGIBILITY UNDER THEIR FAP: 1. ELIGIBILITY FOR MEDICARE OR MEDICAID IS ALSO CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE.2. TRINITY HOSPITAL MAY PRESUMPTIVELY DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR CHARITY CARE UNDER THIS POLICY WITHOUT A COMPLETED APPLICATION IF THE HOSPITAL IS ABLE TO VERFIY INCOME FROM A RELIABLE THIRD PARTY, I.E. SOCIAL SECURITY, MEDICAID, ETC.

TRINITY HOSPITAL ST. JOSEPH'S
PART V, SECTION B, LINE 13H: OTHER CRITERIA USED BY TRINITY HOSPITAL TO DETERMINE ELIGIBILITY UNDER THEIR FAP: 1. ELIGIBILITY FOR MEDICARE OR MEDICAID IS ALSO CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE.2. TRINITY HOSPITAL MAY PRESUMPTIVELY DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR CHARITY CARE UNDER THIS POLICY WITHOUT A COMPLETED APPLICATION IF THE HOSPITAL IS ABLE TO VERFIY INCOME FROM A RELIABLE THIRD PARTY, I.E. SOCIAL SECURITY, MEDICAID, ETC.

TRINITY KENMARE HOSPITAL
PART V, SECTION B, LINE 13H: OTHER CRITERIA USED BY TRINITY HOSPITAL TO DETERMINE ELIGIBILITY UNDER THEIR FAP: 1. ELIGIBILITY FOR MEDICARE OR MEDICAID IS ALSO CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE.2. TRINITY HOSPITAL MAY PRESUMPTIVELY DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR CHARITY CARE UNDER THIS POLICY WITHOUT A COMPLETED APPLICATION IF THE HOSPITAL IS ABLE TO VERFIY INCOME FROM A RELIABLE THIRD PARTY, I.E. SOCIAL SECURITY, MEDICAID, ETC.

TRINITY HOSPITAL
PART V, SECTION B, LINE 16J: PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR.

TRINITY HOSPITAL ST. JOSEPH'S
PART V, SECTION B, LINE 16J: PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO BE COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR.

TRINITY KENMARE HOSPITAL
PART V, SECTION B, LINE 16J: PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO BE COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
TO BE ELIGIBLE FOR FREE CARE UNDER TRINITY HEALTH'S FINANCIAL ASSISTANCE POLICY, THE SERVICES MUST BE MEDICALLY NECESSARY, THE PERSON'S HOUSEHOLD INCOME MUST BE BELOW 250% OF FEDERAL POVERTY GUIDELINES, THEY MUST RESIDE WITHIN TRINITY HEALTH'S SERVICE AREA, THEY MUST EXHAUST OTHER FINANCIAL ASSISTANCE OPPORTUNITIES (E.G.: MEDICARE, MEDICAID), AND THEY MUST PROVIDE A COMPLETE FINANCIAL ASSISTANCE APPLICATION. SPECIAL CONSIDERATION IS GIVEN WHEN INCOME LEVELS EXCEED THE INCOME GUIDELINES FOR CHARITY CARE AND THE HEALTHCARE EXPENSES EXCEED A SIGNIFICANT MULTIPLE OF THE HOUSEHOLD'S ANNUAL INCOME.

PART I, LINE 7:
TRINITY'S COMMUNITY BENEFIT EXPENSES AND REVENUES WERE CALCULATED USING THE IRS WORKSHEETS PROVIDED IN THE INSTRUCTIONS TO THE 2021 FORM 990, SCHEDULE H.

PART I, LN 7 COL(F):
$15,779,080 OF BAD DEBT EXPENSE WAS EXCLUDED IN CALCULATING THE PERCENTAGES REPORTED IN PART I, LINE 7, COLUMN F.IN FURTHERANCE OF ITS CHARITABLE PURPOSE, TRINITY PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY-BASED SERVICE PROGRAMS SUCH AS FREE CLINICS, HEALTH SCREENINGS, IN-HOME CAREGIVER SERVICES, SOCIAL SERVICE AND SUPPORT COUNSELING FOR PATIENTS AND FAMILIES, PASTORAL CARE, CRISIS INTERVENTION, TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUSES, AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY, A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, TELEPHONE INFORMATION SERVICES, AND COSTS RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. THE COST OF PROVIDING THE ABOVE SERVICES IS NOT INCLUDED IN TRINITY'S CHARITY CARE AMOUNT.

PART III, LINE 2:
TRINITY PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED CHARGE TO RESIDENTS OF ITS COMMUNITY THROUGH THE PROVISION OF CHARITY CARE. INCLUDED IN TRINITY'S DEFINITION OF CHARITY CARE ARE THE FOLLOWING: (A) SERVICES PROVIDED TO THE UNINSURED OR UNDERINSURED AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED TO BE UNABLE TO PAY BECAUSE OF SOCIOECONOMIC FACTORS.TRINITY MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THOSE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR CHARITY CARE.AMOUNTS DO NOT INCLUDE THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS OR THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES. TRINITY USES THE COST-TO-CHARGE RATIO TO DETERMINE THE AMOUNTS REPORTED IN LINE 2.

PART III, LINE 3:
TRINITY IS REPORTING $0 ON LINE 3 BECAUSE THE ORGANIZATION DOES NOT HAVE A RELIABLE ESTIMATE OF THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO INDIVIDUALS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION.

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

PART III, LINE 8:
THE MEDICARE ALLOWABLE COSTS REPORTED ON PART III, LINE 6 WAS DERIVED USING TRINITY HOSPITALS AND KENMARE'S 2022 MEDICARE COST REPORTS.

PART III, LINE 9B:
IT IS THE POLICY OF TRINITY TO PROVIDE MEDICAL SERVICES TO THE COMMUNITY AND REGION REGARDLESS OF THE CUSTOMER'S ABILITY TO PAY THROUGH CONSISTENT BILLING PRACTICES. ACCOUNTS WILL BE MONITORED TO ENSURE THAT CUSTOMERS ARE BILLED FOR ONLY THOSE SERVICES PROVIDED. TRINITY, THROUGH VERIFICATION OF INFORMATION, IS REQUIRED TO PROVIDE TIMELY AND ACCURATE BILLING, COLLECTION, AND PATIENT ACCOUNT MAINTENANCE. INFORMATION REGARDING TRINITY'S BILLING AND PAYMENT GUIDELINES, WHICH INCLUDES FINANCIAL ASSISTANCE PROGRAMS, ARE AVAILABLE AT REGISTRATION AND BUSINESS SERVICES LOCATIONS. THIS INFORMATION IS COMMUNICATED VERBALLY OR THROUGH THE USE OF THE TRINITY BILLING & PAYMENT GUIDELINES BROCHURE. TO ENHANCE VERBAL COMMUNICATIONS, INTERPRETERS ARE PROVIDED AS NECESSARY.

PART VI, LINE 2:
TRINITY HEALTH COMPLETES A THOROUGH COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS, IN COMPLIANCE WITH SECTION 501(R). TRINITY'S FIRST COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE YEAR ENDED JUNE 30, 2013. THE SECOND WAS COMPLETED DURING THE YEAR ENDED JUNE 30, 2016, THE THIRD WAS COMPLETED DURING THE YEAR ENDED JUNE 30, 2019, AND THE FOURTH WAS COMPLETED DURING THE YEAR END JUNE 30, 2022. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT FOR BOTH YEARS IS AVAILABLE ONLINE AT HTTP://WWW.TRINITYHEALTH.ORG/PATIENTS-VISITORS/.

PART VI, LINE 3:
TRINITY HEALTH'S HOSPITALS WIDELY PUBLICIZE FINANCIAL ASSISTANCE INFORMATION IN ALL OF THE METHODS REQUIRED UNDER SECTION 501(R) AND RELATED REGULATIONS. EXAMPLES INCLUDE INFORMATION ON BILLING STATEMENTS, INFORMATION POSTED IN ADMISSIONS AREAS AND EMERGENCY ROOMS, AND INFORMATION PROVIDED AT ADMISSION. IN ADDITION, PATIENT ACCESS AND BUSINESS OFFICE STAFF ATTEMPT TO IDENTIFY ALL CASES THAT WILL QUALIFY FOR FINANCIAL ASSISTANCE AT THE TIME OF ADMISSION. PATIENTS IDENTIFIED AS POSSIBLE FINANCIAL ASSISTANCE CASES ARE ASKED TO COMPLETE A FINANCIAL ASSISTANCE FORM AND ARE REFERRED TO THE APPROPRIATE COUNSELOR.

PART VI, LINE 5:
IN FURTHERANCE OF ITS CHARITABLE PURPOSE, TRINITY PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY-BASED SERVICE PROGRAMS SUCH AS FREE CLINICS, HEALTH SCREENINGS, IN-HOME CAREGIVER SERVICES, SOCIAL SERVICE AND SUPPORT COUNSELING FOR PATIENTS AND FAMILIES, PASTORAL CARE, CRISIS INTERVENTION, TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUSES, AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY, A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, TELEPHONE INFORMATION SERVICES, AND COSTS RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY.

PART VI, LINE 6:
THIS FORM 990 INCLUDES TRINITY HOSPITAL, TRINITY HOSPITAL-ST. JOSEPH'S, AND TRINITY KENMARE HOSPITAL. THESE THREE HOSPITALS ARE PART OF TRINITY HEALTH SYSTEM. TRINITY HEALTH IS THE PARENT ORGANIZATION. THE SYSTEM ALSO INCLUDES TRINITY HEALTH FOUNDATION, TRINITY HOMES, AND COMMUNITY AMBULANCE SERVICE OF MINOT, ALL OF WHICH ARE TAX-EXEMPT 501(C)(3) ORGANIZATIONS, AS WELL AS MEDICAL ARTS OUTPATIENT SERVICES INC. AND B&B DRUG INC., BOTH OF WHICH ARE FOR-PROFIT C CORPORATIONS.

PART VI, LINE 7, REPORTS FILED WITH STATES
ND

PART VI, LINE 4:
"ALTHOUGH TRINITY HOSPITAL AND TRINITY HOSPITAL - ST. JOSEPH'S ARE LOCATED IN MINOT, NORTH DAKOTA, WE HAVE HISTORICALLY DEFINED OUR ""COMMUNITY"" AS A BROADER AREA THAT INCLUDES NORTHWESTERN NORTH DAKOTA AS WELL AS A PORTION OF NORTHEASTERN MONTANA. WITHIN THIS BROADER COMMUNITY, APPROXIMATELY TWO-THIRDS OF OUR INPATIENTS AND OUTPATIENTS RESIDE WITHIN IN AND IMMEDIATELY AROUND THE CITY OF MINOT AND WARD COUNTY. UNDERSTANDING OUR COMMUNITY REQUIRES AN UNDERSTANDING OF NORTH DAKOTA'S OIL RESERVES. UNDERLYING NORTHWESTERN NORTH DAKOTA IS A MASSIVE ROCK FORMATION, REFERRED TO AS THE BAKKEN SHALE, WHICH HOLDS AN ESTIMATED 18 BILLION BARRELS OF CRUDE OIL. WHEN THIS RESOURCE WAS FIRST DISCOVERED IN 1951, RECOVERING IT WAS FINANCIALLY UNFEASIBLE BECAUSE THE OIL WAS EMBEDDED IN THE STONE. THEN, AROUND 2008, EVERYTHING CHANGED. NEW DRILLING TECHNOLOGY CALLED HYDRAULIC FRACTURING, OR 'FRACKING', BECAME WIDESPREAD, AND OIL PRODUCTION TOOK OFF. AS OF 2013, THERE ARE MORE THAN 200 ACTIVE OIL RIGS IN NORTH DAKOTA, PRODUCING ABOUT 20 MILLION BARRELS OF OIL EVERY MONTH. THE RIGS AND SUPPORT SYSTEMS HAVE RESCULPTED THE LANDSCAPE, MILLIONS OF DOLLARS HAVE BEEN INVESTED ON INFRASTRUCTURE UPGRADES ACROSS THE AREA.AS THE PRICE OF OIL PEAKED IN 2015, THEN DROPPED, ALONG WITH SIGNIFICANT OUTFLOWS OF OIL FIELD WORKERS, THE PRICE HAS STABILIZED AND LEASES ARE NEARING RENEWAL, OIL FIELD WORKERS ARE NOW INFLOWING ONCE AGAIN. MAJOR OIL COMPANIES ARE ON THE REHIRE TRACE ONCE AGAIN (FOR APPROXIMATELY 800 WORKERS). ALTHOUGH MUCH OF THE OIL FIELD ACTIVITY OCCURS TO THE WEST OF MINOT, OUR COMMUNITY HAS BEEN SIGNIFICANTLY IMPACTED BY THE FLUCTUATION OF PEOPLE INTO AND OUT OF OUR COMMUNITY. DEMAND FOR ALMOST EVERY GOOD, FROM HOUSING TO CLOTHING TO FOOD, TO HUMAN CAPITAL HAS FLUCTUATED, AND OUR COMMUNITY HAS STRUGGLED WITH THESE FLUCTUATIONS."