Community Benefit Insight - Tax-exempt hospital

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Hazen Memorial Hospital Association

Sakakawea Medical Center

510 J8th Ave Ne
Hazen, ND 58545

Bed count	13	Medicare provider number	351310	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 450308379

Display data for year:

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

1.5%

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	$ 69,000 0.41 %
Medicaid as % of operating expenses	$ 53,518 0.32 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 17,074 0.10 %
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.	$ 113,408 0.67 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 36,156 0.21 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	18
Physical improvements and housing	0
Economic development	0
Community support	8
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	10
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	$ 36,156 0.21 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 17,159 47.46 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 18,997 52.54 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 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	$ 311,478 1.84 %
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	$ 24,918 8.00 %

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 $ 12942842 including grants of $ 1050) (Revenue $ 15496268)
Sakakawea Medical Center (SMC) is a 13-bed critical access hospital providing services in the following areas - acute care, observation, surgery, intermediate and skilled swing bed, emergency room with trauma level V certification, Saturday urgent care, and hospice. Services provided by the ancillary departments include physical therapy, occupational therapy, radiology, 3D mammography, bone density, ultrasound, CT, nuclear med, MRI, laboratory, respiratory therapy, cardiac rehab, EKG, Holter Monitor, and thallium stress tests. Based on charges foregone Sakakawea Medical Center provided $81,588 in charity care. Also available to all self-pay patients, regardless of financial status, is a 30% discount policy for timely payments. SMC is a participating provider for Medicare, Medicaid, Blue Cross Blue Shield and other insurances.Sakakawea Medical Center reaches out to the communities in the service area through programs such as falls prevention classes, CPR education, ACLS classes, PALS classes, grief support groups, smoking cessation classes, occupational health, free blood pressure checks, a Christmas giving tree project, a Community Care nurse and health career presentations to high schools. SMC sponsors several community events that promote good health and wellness education including Women's World of Wellness and Mammography Marathon. Wellness screenings are provided to area schools and businesses. SMC provides community education programs on requested topics free of charge. It is important for Sakakawea Medical Center to serve our communities by providing all of their health care needs.

4B (Expenses $ 1125588 including grants of $ 0) (Revenue $ 922221)
"Senior Suites is a basic care facility that was completed in April 1997. It is adjacent to Sakakawea Medical Center. Senior Suites can accommodate 34 residents with single or double rooms. It features a licensed beauty shop, activity room, spacious commons areas and an enclosed nurse's station. The rooms are set up like suites, hence the name ""Senior Suites."" The facility is available to those in the senior population that require a minimal amount of supervision, but do not require 24 hour services. The residents are provided with assistance for daily living and medication administration. Resident care census days totaled 5,707 this year."

Facility Information

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

Hazen Memorial Hospital Association
Part V, Section B, Line 5: SMC worked closely with all of its partners, including Custer Health and Southwestern District Health Unit. SMC also used a survey soliciting feedback from area residents. Community leaders took part in one-on-one key informant interviews. In addition, a community group convened to discuss area health needs and the needs assessment process. During this process, a wide range of secondary sources of data were examined, which provided information on a multitude of measures, including demographics, health conditions, indicators, outcomes, rates of preventive measures, rates of disease and at-risk behaviors.

Hazen Memorial Hospital Association
Part V, Section B, Line 6b: Organizations participating include Sakakawea Medical Center, Coal Country Community Health Center, Knife River Care Center, Custer Health, Southwestern District Health Unit, and Mercer County Ambulance.

Hazen Memorial Hospital Association
Part V, Section B, Line 11: In the most recent CHNA conducted the following needs were identified:1) Substance Use (Alcohol and Drug Use/Misuse) - All Ages2) Depression and Anxiety - All Ages3) Availability of Resources to Help the Elderly Stay in their Homes4) Attracting and Retaining Young FamiliesAll four of these needs will be addressed by SMC throughout the implementation process.SMC just implemented a new CHNA during the tax year and were not able to address each need specifically during the year. However, the needs identified are similar to those identified in the prior CHNA. During the fiscal year, SMC was able to address attracting and retaining young families. SMC was able to assist in implementing a new certified nursing assistant program at Knife River Care Center, and to collaborate with local realtor groups on welcome packets for new families. There are also several officers and employees that continue to participate on various community boards, of which they are able to assist with community organizations that are also addressing these needs.

Hazen Memorial Hospital Association
Part V, Section B, Line 13h: Sakakawea Medical Center offers two separate programs for discounted care. The self-pay discount policy is available for uninsured patients regardless of income. A discount of 30% is allowed if regular monthly payments are remitted in a specified time frame. The charity care program provides discounted care to patients based on family income according to FPG guidelines. The sliding fee scale allows discounts from 30% to 100% of charges. The program is available for uninsured patients as well as co-pays and deductibles for insured patients.The self-pay discounts program cannot be combined with the charity care program. However, the Hospital counsels all self-pay individuals to determine if their potential charity care discount would result in a better discount if they apply for charity care. The patients that use the self-pay discount are typically the patients that do not want to submit their financial information or patients that would not qualify under the charity care policy.

Hazen Memorial Hospital Association
Part V, Section B, Line 15e: An individual must complete an application and submit supporting documentation such as check stubs or an income tax return. All of the staff in the Business Office billing department are able to assist individuals with any questions they have regarding the application process.

Hazen Memorial Hospital Association
Part V, Section B, Line 16j: In addition to the full FAP being available upon request, information referencing the FAP is attached to the billing invoices, as well as posted in the admissions office, emergency rooms and waiting rooms.

Schedule H, Part V, Line 7a/b, Line 10 & Line 16a/b/c URL Links:
Line 7a:https://www.smcnd.org/assets/docs/CHNA-hazen-22%20062922%20_1_.pdfLine 10:https://www.smcnd.org/assets/docs/chna-implementation-plan-2022.pdf

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
Sakakawea Medical Center offers two separate programs for discounted care. The self pay discount policy is available for uninsured patients regardless of income. A discount of 30% is allowed if regular monthly payments are remitted in a specified time frame. This program cannot be combined with the Charity Care program.The charity care program provides discounted care to patients based on family income according to FPG guidelines. The sliding fee scale allows discounts from 30% to 100% of charges. The program is available for uninsured patients as well as co-pays and deductibles for insured patients.

Part I, Line 7:
Charity care is based on the total direct and indirect costs related to providing services to patients and based on average ratios of cost to charges. Unreimbursed Medicaid was converted to cost using the cost-to-charge ratio derived from the relevant cost center on the Medicare cost report. Community health improvement services, and health professionals education for community benefit reflect actual expenses recorded to the general ledger.

Part II, Community Building Activities:
The CEO, Brian Williams serves on 5 boards for community health improvement - CHAD, BCBS Rural, NDHA, NDLTC and Energy Capital Health Network, and he is a Mentor for the NRHA CEO Program. He also serves on three community support boards - Energy capital Childcare Cooperative, Vision West and Mercer County Ambulance. The CFO, DON, HR and public relations all serve on committees of the Energy Capital Health Network board. The Surgeon and OR Nurse Coordinator serve on the Mercer County Ambulance Board. The Surgeon also serves on the Wing and Riverdale Ambulance Board. The Director of Rehab Services serves on the Riverdale Ambulance Board. The HIM Director serves on the Dakota Central Social Service Board. The Environmental Services/Safety Coordinator participates in NDESA, NDLTC and Mercer County LEPC.

Part III, Line 2:
The amount reported on line 2 represents implicit price concessions. The Medical Center determines its estimate of implicit price concessions based on its historical collection experience with this class of patients and residents.

Part III, Line 3:
There are most likely some patients in implicit price concessions who would qualify for charity care, but they have not completed the application and remitted the required paperwork. We applied the 8% of Mercer County population that is under the Federal Poverty Guidelines to the total implicit price concessions to estimate the amount of implicit price concessions that are attributable to patients eligible under the organization's financial assistance policy.

Part III, Line 4:
The financial statement footnote regarding implicit price concessions may be found on page 13-14 of the audited financial statements.

Part III, Line 8:
Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare & Medicaid Services. The costs themselves are a community benefit as the community would not receive these services if we did not provide them.

Part III, Line 9b:
If a patient has applied for charity care previously, an application is sent with the monthly statement. Once it is determined that the patient is eligible, the charity care discount portion is written off. The organization does not send patient accounts to collections within the first 120 days of the date of the first invoice for a service. The organization allows the patient up to 240 days from the date of the first invoice for that service to complete the charity care application. If the patient account is with the collection agency within the 240 days of the first invoice and it is determined they qualify for charity care, the organization will notify the collection agency of the amount of charity care that applies to the account. The remaining patient portion then falls under the same collection practices of all other accounts. Our policy requires a new charity care application every six months.

Part VI, Line 2:
Sakakawea Medical Center consults with local physicians to identify community healthcare needs. The SMC staff participates in local and regional organizations and activities including Chamber of Commerce and economic development boards. The CEO routinely attends city council and county commission meetings to solicit input and engage in dialogue relating to healthcare needs and services.Sakakawea Medical Center has collaborated with other local providers to conduct a community health needs assessment which will inventory service delivery assets, identify needs and create a foundation for undertaking strategic initiatives.

Part VI, Line 3:
Charity care information is sent with the monthly statements to all uninsured patients as well as to patients that are not making adequate monthly payments. Approximately 100 notices are sent out per month with the statements. Inpatients and surgical patients are informed at the time of admission about charity care. A social worker visits with all self-pay inpatients to inform them about the charity care, Medicaid (state program), and self-pay discount policies. Brochures have been printed that describe our charity care and discount policies. The brochures are available in waiting rooms, ER, the clinics and admitting offices. In addition to these efforts, the financial assistance policy is also available on the website.

Part VI, Line 4:
Hazen Memorial Hospital Association serves the communities in Mercer County and the surrounding area, including the towns of Hazen, Beulah, Stanton, Zap, Golden Valley, Center and Pick City. Sakakawea Medical Center, located in Hazen, is the only hospital in the county. The nearest hospital is located more than 60 miles away. Attached to the hospital is Senior Suites, a basic care facility. The combined total population of the county is approximately 8,323. The average per capita income in Mercer County is $37,725. The current unemployment rate is 3.4%. The percentage of persons in poverty in Mercer County is 8%. Sakakawea Medical Center's payer mix for this fiscal year included 2% uninsured patients and 3% Medicaid patients. All patients presenting to the facility are cared for regardless of their ability to pay.

Part VI, Line 5:
As a critical access hospital, Sakakawea Medical Center provides a variety of health and wellness services to our service area. The organization subsidizes home care services to ensure those residents who are homebound have the health care they need. The emergency room is staffed 24 hours a day and is available to all regardless of ability to pay. The Board of Directors is comprised of county-wide volunteers; three are from Hazen, five from Beulah, two are from Stanton and one from Golden Valley. The directors have various occupations including power plant manager, bank president, accounting supervisor, engineer, chiropractor, speech pathologist, publisher, marketing executive, and business owner. The directors are not employed by SMC.Medical privileges are extended to all physicians in the county.Sakakawea Medical Center's Hospice staff is assisted by 27 volunteers from the area communities. The staff at Senior Suites, the basic care facility, is served by 22 community volunteers. Surplus funds are invested back into the facility through equipment purchases and facility improvements. This past year, SMC upgraded the negative pressure room sensors. A new Omnicell system was purchased to provide the most up to date technology and features for our patients and staff. SMC also purchased upgrades with a new call light and fire alarm system for Senior Suites. A new van was also purchased for Senior Suites to help transport residents. Future surplus funds will be used to meet debt service requirements and any needed equipment additions or replacements. In addition, more continuing education is being offered to the staff by means of webinars and workshops. An employee assistance program is available for staff and family members which provides free confidential assessments, counseling, or referral services by trained professionals.Sakakawea Medical Center is investing in the future of healthcare professionals by implementing a nursing program. We are partnering with other health care providers in the county, a community health center and a nursing home, to offer Interactive Video Network (IVN) classes in our facility. Hands-on skill work and clinicals are taught by registered nurses employed by our organization. Upon completion of an 11 month program, students will receive a certificate in practical nursing. An additional 9 month program enables the students to receive an Associate Degree in Nursing and become eligible to test for their registered nurse license. Sakakawea Medical Center also supports state universities and high schools by offering rural medical experiences to area students. Throughout the year, students are provided with practice opportunities in nursing, lab, PT, or the emergency room.

Operating expenses	$ 16,898,470
Total amount spent on community benefits as % of operating expenses	$ 253,000 1.50 %