Community Benefit Insight - Tax-exempt hospital

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St Andrew's Hospital

St Andrews Health Center

316 Ohmer St
Bottineau, ND 58318

Bed count	25	Medicare provider number	351307	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 450226426

Display data for year:

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

3.85%

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	$ 48,000 0.29 %
Medicaid as % of operating expenses	$ 74,381 0.44 %
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	$ 526,141 3.13 %
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	$ 203,846 1.21 %
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	$ 22,831 11.20 %

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 $ 14744680 including grants of $ 0) (Revenue $ 16537311)
"SMP Health - St. Andrew's (Health Center), formerly doing business as St. Andrew's Health Center, is a 25-bed acute care hospital and a senior apartment facility located in Bottineau, North Dakota. SMP Health - St. Andrew's has been a part of the community since 1913. Our mission is to provide services to all who come to us for care; this is something that we are very proud of. Our ability to better the lives of those most in need is the core of our beliefs and knowing that we can make a difference in the lives of those we serve. In addition, we believe that through our leadership and presence in the community that we have been and will continue to be an essential part of the healthcare delivery team. Statement continued on Schedule O.St. Andrew's Hospital is designated as a Critical Access Hospital and has had the designation since July 2001. There were 355 acute patient days and 4,588 swing-bed days. The percent of occupancy was 54.2%.We continue to utilize ""The Guide for Planning and Reporting Community Benefit"" book that was prepared by the Catholic Health Care Association to help determine what qualifies as a community benefit. We attend a variety of educational opportunities throughout the year to provide direction in reporting on our benefits to the community.The Hospital provides healthcare services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Health Center does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was $48,000 for the year ended September 30, 2022, calculated by multiplying the ratio of cost to gross charges for the Health Center by the gross uncompensated charges associated with providing charity care to its patients.St. Andrew's 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."

Facility Information

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

St. Andrew's Hospital
Part V, Section B, Line 5: Throughout the CHNA process Rolette County Public Health was involved. The qualitative primary research methodology consisted of stakeholder interviews and focus group discussions with key community stakeholders, policymakers, and residents. In total, ten one-on-one virtual phone interviews were conducted.

St. Andrew's Hospital
Part V, Section B, Line 6b: Bottineau County Public Health

St. Andrew's Hospital
Part V, Section B, Line 11: A number of needs were identified in the 2018 CHNA process conducted by the UND Center for Rural Health. During the final community group meeting, public health and other community leaders narrowed the list down to two top needs:1. Not enough jobs with livable wages.2. Depression and anxiety.Not enough jobs with livable wagesSt. Andrew's Executive Team and Board of Directors approved substantial changes to the wage scale for the 2022 budget. St. Andrew's continues to experience substantial inflation in the market for Human Resources. As such, the wage scale will be re-evaluated to ensure St. Andrew's can be competitive in the market for talent. This evaluation will take into account competitors outside of the healthcare space.Depression and AnxietyThe Rural Mental Health Consortium is no longer functional. St. Andrew's continues to provide mental health services in its Rural Health Clinic. The feasibility of a MAT program continues to be evaluated. The Hospital is working to bring mental health to patients via telemedicine with a Psychiatry Network.The 2021 CHNA was completed in fiscal year 2022. The following needs were identified and will be addressed over the next 3 years.1. Increase the number of mental health providers for adults2. Increase the number of mental health providers for children and youth3. Increase the number of prescribing mental health providers (i.e., psychiatrists)4. Improve school-based mental health support for children and youth5. Improve drug and other substance abuse early intervention and prevention services6. Increase availability of resources to help seniors stay in their homes (e.g., home health, senior meals)7. Improve care coordination between the hospital and other clinics, private doctors, or other health service providers8. Increase drug and other substance abuse treatment services 9. Increase or promote opportunities for physical fitness10. More intentionally engage the Native American community in health and wellness initiatives11. Increase access to affordable quality childcare12. Increase access to affordable rental housing13. Increase access to specialty health care providers in the community (i.e., neurologists, endocrinologists)14. Increase awareness of services or programs to help people learn about, and enroll in, programs that provide financial support for people needing health care15. Increase case management services for people with complex chronic health conditionsThe Hospital will not address increase access to affordable quality childcare and affordable rental housing as the needs are out of the hospital's purview and would be better addressed by other community partners.

St. Andrew's Hospital
Part V, Section B, Line 13h: In addition to using 200% of the federal poverty guidelines to determine eligibility for providing discounted care to low income individuals, St. Andrew's Hospital also uses a sliding fee schedule based on income and family size. Depending on income and family size a patient could have 20%, 40%, 60%, 80% or 100% written off to charity care.Individuals with medical expenses in excess of 30% of their gross income who would otherwise not qualify for the Caring Program based on their earnings can qualify for catastrophic charity care and receive a reduction in the cost of their medical services.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
In addition to using 200% of the federal poverty guidelines to determine eligibility for providing discounted care to low-income individuals, St. Andrew's Hospital also uses a sliding fee schedule based on income and family size. Depending on income and family size a patient could have 20%, 40%, 60%, 80% or 100% written off to charity care.Individuals with medical expenses in excess of 30% of their gross income who would otherwise not qualify for the Caring Program based on their earnings can qualify for catastrophic charity care and receive a reduction in the cost of their medical services.Part I, Line 6b:St. Andrew's Hospital makes its community benefit report available to the public by posting it on an internal bulletin board.

Part I, Line 7:
Charity care expense on line 7a was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b and subsidized health services line 7g was calculated using the costing methods to prepare the cost reports.

Part III, Line 2:
The amount on line 2 represents implicit price concessions and bad debts. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Bad debt reflects amounts that will not be paid by patients based on an adverse change in the patient's ability to pay.

Part III, Line 3:
The estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy is based on 11.2% of individuals living below the federal poverty level (per the U.S. Census Bureau for Bottineau County).

Part III, Line 4:
The footnote to the Organization's financial statements can be found on pages 12 and 13 of the attached audited financial statements.

Part III, Line 8:
St. Andrew's Hospital provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Fiscal year 2022 had a Medicare surplus. Any year there is a Medicare shortfall that would be considered a community benefit.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 $184,270.Medicare fee schedule revenue $ 82,347Medicare estimated costs of care relating to payments (266,617)Net (Shortage) $ (184,270)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 Centers for Medicaid and Medicare Services.

Part III, Line 9b:
The Hospital does not pursue extraordinary collection activities for 120 days from the date of service while the patient is applying for financial assistance. A 30-day notice is provided to the patient before any collection activities begin. A patient has a total of 240 days to apply for financial assistance. Individuals provided with charity discounts, financial assistance, or are on payment plans are not referred to a collection agency. After a determination of charity care, any personal portion due would follow the same collection procedures as other types of patients.

Part VI, Line 2:
In addition to the CHNA, the Hospital receives regular feedback on community needs from board members, other community organizations such as Economic Development Corporation and Chamber of Commerce, and from interested community members.

Part VI, Line 3:
Extensive signage is posted throughout the facility in the ER, waiting rooms, and the admissions/registration area. Patient statements include language regarding opportunity for financial assistance. The financial assistance policy and application for charity care/financial assistance are on the website. All collection related notices include encouragement to patients to explore financial assistance. The facility employs a Community Resource Coordinator (CRC), who offers an array of services in searching for medical/dental coverage for those that are underinsured or uninsured. The number of uninsured and underserved is growing in Bottineau County. We are seeing an increase in the individual's out of pocket costs that remain following payments provided by their insurance carriers. With the rise in health care premiums and aging population, families have to make some difficult decisions. The lack of insurance or underinsured has a devastating effect on the people of our community. We are committed to the Catholic Healthcare Initiative on working towards insurance coverage issues for the uninsured and underinsured.

Part VI, Line 4:
St. Andrew's Hospital is a 25-bed acute care hospital and a senior apartment facility located in Bottineau, North Dakota. St. Andrew's Hospital serves approximately 7,500 individuals, encompassing a large part of Bottineau County. Bottineau County is located in rural, North Central North Dakota, next to the Canadian border. Our main patient base is of senior-citizen age, as the percentage of individuals over the age of 65 in Bottineau County is 24.3%. 11.2% of our population base is living below the poverty level and the 2021 estimated median household income was $68,095. Unemployment in 2022 was 2.4% compared to 2.3% in North Dakota. The most common industries are retail trade, health care and social assistance and construction.

Part VI, Line 5:
SMP Health - St. Andrew's board is comprised of eight members: Christopher Albertson, CEO, two sisters from the Sisters of Mary of the Presentation, and five community members otherwise unaffiliated with the facility or Sisters of Mary of the Presentation. To meet the needs of our community, the Hospital extends privileges to medical staff that are qualified and licensed. In addition to regular planning for systematic replacement/enhancement of patient care equipment like CT scanners and patient beds, the organization periodically assesses additional needs for equipment and utilizes surplus funds as well as community donations to help meet those needs.SMP Health - St. Andrew's and its team of co-workers strive to increase their level of community involvement. Many of the employees of the Hospital serve on multiple local and regional committees working to improve the health and lives of the members of Bottineau County. SMP Health - St. Andrew's operates an emergency room available 24 hours a day and accepts all patients, regardless of ability to pay. We are the sole provider of emergency and inpatient services in our county. The Hospital operates a separate foundation which conducts fundraising activities and solicits funds that are utilized to further the programs of the Hospital. The Foundation makes regular contributions to the Hospital for items that directly improve patient care (minor and capital). St. Andrew's also works with the school system to provide volunteer opportunities for students to work in the Health Care Center.Beyond Charity CareIn addition to our free charity care, the Hospital has provided many other services to meet the needs of those in Bottineau County and service area: we provide access to clinical practice to the Bottineau and Minot region.A number of students job shadow in various departments as part of their education requirements. Over the past year we have had students job shadowing or completing internship hours for Lab technician. We have the school of nursing students from Dakota College Bottineau at the facility completing practicals during the college school year. We are happy to be a clinical site to Dakota College-Bottineau for the ADN/PN nursing program and UND for the NP program; we have a number of students that utilize SMP Health - St. Andrew's for their clinicals on a day-to-day basis. St. Andrew's Hospital allows for time to educate high school students about potential career opportunities in health care and provides job shadowing opportunities for those interested. The Hospital works closely with the Health and Sciences Instructor from the local high school to provide health career access to the students. The Hospital has provided presentations to members of the community and the surrounding areas/groups to educate them about the health and wellness issues. A regular Healthbeat article is printed in the local newspaper. There is also a weekly radio spot to discuss current healthcare related issues. Services were expanded to offer blood pressure checks and wellness profiles to the community of Bottineau. SMP Health - St. Andrew's participates in a number of community events/activities that pertain to healthcare and direct relations to the community; including wellness committee, bio terrorism group, disaster preparedness, co-sponsor a blood drive, blood pressures are offered during a variety of community events such as North Central Electric's annual meeting held in June, and our annual Hospital week celebration, just to name a few. Blood pressure screenings are offerred every Tuesday. This helps monitor the vascular health of 20 to 30 patients each week. Annually, approximately 1,000 people are impacted. Throughout the year food pantry drives were held and funds collected to give to the school system for children in need of money for milk at snack time. The Community Resource Coordinator (CRC) offers assistance to those in need. The CRC offers an array of services in searching for medical/dental coverage for those that are underinsured or uninsured. The CRC maintains the blanket hugs program and provided approximately 70 free blankets for pediatric patients in need of comforting. The CRC also helps individuals complete Caring Program paperwork. In total, the CRC provides resources to approximately 100 people in the community and service area. Without the resource, many of these individuals would go with needs unmet.

Part VI, Line 6:
We are an affiliate of the Sisters of Mary of the Presentation Health System dba SMP Health. SMP Health St. Andrew's operates in accordance with the mission, vision, and values of the SMP Health. Our annual budgeting process includes an assessment of how our budget demonstrates a commitment to the values of the system and the system works to ensure we are always mindful of our duty to care for the poor and those in need. SMP Health St. Andrew's has a Strategic Plan developed from themes set forth by the Health System for all affiliates. The strategic plan is an active document which SMP Health St. Andrew's works on continuously and reports back to the health system on our progress toward established goals which again, align with the mission, vision, and values of the organization.

Operating expenses	$ 16,827,295
Total amount spent on community benefits as % of operating expenses	$ 648,522 3.85 %