Community Benefit Insight - Tax-exempt hospital

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Wishek Hospital Clinic Association

Wishek Community Hospital

1007 4th Avenue South
Wishek, ND 58495

Bed count	24	Medicare provider number	351321	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 450358986

Display data for year:

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

2.4%

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	$ 98,992 1.15 %
Medicaid as % of operating expenses	$ 106,962 1.25 %
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.	$ 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	$ 12,072 0.14 %
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 $ 5364864 including grants of $ 0) (Revenue $ 6092182)
ACUTE HEALTHCARE/OUTPATIENT SERVICES/EMERGENCY DEPARTMENT/SKILLED SWINGBED.

4B (Expenses $ 1704495 including grants of $ 0) (Revenue $ 1770603)
HEALTHCARE SERVICES PROVIDED TO FOUR COMMUNITIES WITHIN OUR SERVICE AREA OF RURAL ND. FOUR RURAL HEALTH CLINICS.

Facility Information

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

PART V, SECTION B
FACILITY REPORTING GROUP A

WISHEK COMMUNITY HOSPITAL PART V, SECTION B, LINE 5:
THROUGH A JOINT EFFORT, PROFESSIONALS FROM WISHEK HOSPITAL AND CLINICS AND CENTRAL VALLEY HEALTH DISTRICT, WITH THE ASSISTANCE OF THE CENTER FOR RURAL HEALTH AT THE UNIVERSITY OF ND SCHOOL OF MEDICINE AND HEALTH SCIENCES CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2020. A COMMUNITY GROUP CONSISTING OF 25 COMMUNITY MEMBERS ALONG WITH AFOREMENTIONED PROFESSIONALS SERVED AS A FOCUS GROUP THAT IDENTIFIED THE GENERAL HEALTH NEEDS OF THE COMMUNITIES OF THE THREE COUNTIES THEY SERVE. A SURVEY WAS DISTRIBUTED TO RESIDENTS IN LAMOURE, LOGAN, AND MCINTOSH COUNTY AND THE RESULTS OF THIS SURVEY WERE SHARED WITH THE FOCUS GROUP AND PRIORITY HEALTH NEEDS WERE DETERMINED.

WISHEK COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B:
THE OTHER FACILITY INCLUDED IN WISHEK'S 2020 CHNA WAS CENTRAL VALLEY HEALTH DISTRICT.

WISHEK COMMUNITY HOSPITAL PART V, SECTION B, LINE 11:
IN ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED BY OUR 2020 CHNA, WE SOUGHT OUT TELEHEALTH MENTAL HEALTH SERVICES.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
WISHEK HOSPITAL CLINIC ASSOCIATION (WHCA) USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PROVIDING FREE OR DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. WHCA USES 200% AS THE FAMILY INCOME LIMIT.

PART I, LINE 7:
A COST TO CHARGE RATIO WAS USED FOR THE FIGURES REPORTED IN THE TABLE USING WORKSHEET 2.

PART III, LINE 3:
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 FINANICAL ASSISTANCE BUT DID NOT COMPLETE THE APPLICATION

PART III, LINE 4:
THE AMOUNTS WERE DETERMINED BASED UPON THE COST TO CHARGE RATIO USING WORKSHEET A. THE HOSPITAL ALSO HAS A POLICY FOR COLLECTIONS AND BAD DEBTS. WHCA FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. A PORTION CAN BE LOCATED IN PATIENT RECEIVABLES SECTION ON PAGE 10 OF THE PRIOR YEAR AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
THE AMOUNTS WERE DETERMINED BASED UPON THE COST TO CHARGE RATIO FROM THE COST REPORT THAT WAS FILED FOR THE YEAR.

PART III, LINE 9B:
ALL PATIENTS ARE NOTIFIED ON THEIR MONTHLY STATEMENT THAT THE ORGANIZATION OFFERS AN UNCOMPENSATED CARE PROGRAM FOR ANYONE UNABLE TO MEET THEIR PRIVATE PAY POLICY AND THAT THEY ARE TO CONTACT THE ACCOUNTS RECEIVABLE DEPARTMENT. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING WITH THE ORGANIZATION IN GOOD FAITH TO RESOLVE THEIR BILLS, THE ORGANIZATION WILL OFFER EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS, REDUCE THE BILL BY THE APPROPRIATE AMOUNTS, WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES AND WILL CEASE ALL COLLECTION EFFORTS.

PART III, LINE 2
THE BAD DEBT EXPENSE IS CALCULATED BY THE ESTIMATED CHANGE IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ALONG WITH THE ACTUAL AMOUNT OF ACCOUNTS WRITTEN OFF. SEE THE NOTE TO THE FINANCIAL STATEMENTS REGARDING PATIENT RECEIVABLES ON PAGE 10 OF THE PRIOR YEAR FINANCIAL STATEMENTS FOR THE METHODOLOGY USED TO ESTIMATE THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

PART VI, LINE 2:
"THE MEDICAL STAFF TEAM MEETS MONTHLY TO DISCUSS CURRENT OR MOST RECENT CASES THAT THEY HAVE ENCOUNTERED. UNIQUE CASES, AS WELL AS THE ROUTINE CASES ARE DISCUSSED. EVERY OTHER MONTH, SUPPORT STAFF, WHICH INCLUDE THE DIRECTORS OF NURSING, HEALTH INFORMATION MANAGEMENT, LABORATORY/RADIOLOGY, PHARMACY, DISCHARGE PLANNING AND ADMINISTRATION, ARE INVITED TO THESE MEETINGS FOR SIMILAR DISCUSSIONS, IN ADDITION TO UNIFYING THE APPROACH IN VARIOUS MATTERS SUCH AS STANDARDS OF CARE, QUALITY ASSURANCE STUDY REVIEW, MEDICARE/MEDICAID OR 3RD PARTY GUIDELINES ON STANDARDS OF CARE AND/OR REIMBURSEMENT. THE ORGANIZATION HAS ALSO ESTABLISHED A ""CALL-BACK"" SYSTEM. ALL PATIENT DISCHARGED FROM THE HOSPITAL ARE FOLLOWED UP WITH A CALL AND/QUESTIONNAIRES ASKING ABOUT HOW THEY ARE DOING, IF THERE ARE ANY QUESTIONS, ADDITIONAL AREAS OF NEED OR SERVICES THAT WE MAY NEED TO GET IN PLACE FOR THEM. WE HAVE A SYSTEM IN OUR ORGANIZATION THAT ALSO ALLOWS FOR OUR STAFF TO REVIEW THE PATIENT'S CHART PRIOR TO A CLINIC VISIT TO IDENTIFY ANY NEEDS SUCH AS MAMMOGRAMS, BONE DENSITY, PSA, CHOLESTEROL, PAP, COLONOSCOPE OR ANY OTHER IDENTIFIED FOLLOW-UP SCREENING OR TEST. A SHEET IS PLACED ON THE FRONT OF THE CHART TO ASSIST THE MEDICAL STAFF IN CUEING INTO THESE NEEDS. ONCE THE VISIT IS COMPLETE THE CHART IS THEN RE-ROUTED BACK INTO THE CALL-BACK OFFICE FOR PLACING INTO THE SYSTEM THE NEXT DATE OF SCREENING SERVICES OR TO SCHEDULE FOLLOW-UP OR REFERRAL APPOINTMENTS FOR THAT PATIENT NEEDS. MESSAGES ARE ALSO SENT TO PATIENTS IN RELATION TO THE ROUTINE FOLLOW-UPS FOR MEDICATION REFILLS OR MONITORING OF CHRONIC MEDICAL CONDITIONS SUCH AS DIABETES, HEART DISEASE, KIDNEY OR LIVER DISEASE PROCESS, OSTEOPOROSIS OR ANY OTHER IDENTIFIED DISEASE PROCESS/ABNORMALITY.THE MANAGEMENT TEAM AND THE BOARD OF DIRECTORS ALSO MEETS MONTHLY TO BRING TO THE TABLE THE CURRENT OPERATIONS AND DISCUSSION OF CURRENT HAPPENINGS AND FEEDBACK. DUE TO THE FACT WE REPRESENT DIFFERENT AREAS THAT COME TOGETHER AS A TEAM TO ENSURE ACCESS TO HEALTHCARE AT A LOW COST HIGH QUALITY MANNER IS IN PLACE - THIS OPPORTUNITY ALLOWS VARIABLE DISCUSSION TO COMMUNITY NEEDS AND HOW WE CAN ADDRESS THEM IN AN INTERDISCIPLINARY TEAM APPROACH.UTILIZATION IS MONITORED IN RELATION TO THE CURRENT PROGRAMS IN PLACE. SUCH PROGRAMS INCLUDE THE CARDIAC REHAB PROGRAM, WOMEN'S WAY PROGRAM, CHARITY CARE OR UNCOMPENSATED CARE PROGRAM, HOME HEALTH AND EXTENDED CARE PROGRAMS.TO EXPAND A BIT ON HOW FAR OUR COMMUNITY REACHES AND ITS REPRESENTATION - WE HAVE ESTABLISHED FOUR RURAL HEALTH CLINICS IN SURROUNDING COMMUNITIES WHICH REACH AS FAR OUT AS 45 MILES FOR THE CLINIC LOCATION, HOWEVER COMMUNITY CITIZEN EXPANSION REACHES BEYOND THE 45 MILE RADIUS. REPRESENTATION ON THE MEDICAL STAFF AND BOARD OF DIRECTORS REACHES INTO THESE AREAS, AS WE HAVE BOTH DESIGNATED PROFESSIONALS FROM THOSE AREAS ON OUR TEAMS FOR ENSURING ACCESS TO HEALTHCARE AND ADDRESSING THOSE NEEDS OF THE POPULATION IN THE AREA."

PART VI, LINE 5:
THE WHCA GOVERNING BOARD IS COMPOSED OF MEMBERS FROM THE COMMUNITIES IT SERVES AND ARE NOT EMPLOYEES, CONTRACTORS, NOR FAMILY MEMBERS. THE SURPLUS OF FUNDS IS USED TO UPDATE THE AGING FACILITY AS WELL AS UPDATED TECHNOLOGICALLY MEDICAL EQUIPMENT AND COMPUTER SYSTEMS TO MEET THE ELECTRONIC MEDICAL RECORDS REQUIREMENTS TO SERVICE OUR PATIENT POPULATION. HAVING UPDATED MEDICAL EQUIPMENT NOT ONLY KEEPS THE SERVICES IN TO OUR RURAL AREA, BUT ALSO ALLOWS US TO PROVIDE FOR OUR PATIENTS.

PART VI, LINE 3:
AS PATIENTS ENTER INTO THE HOSPITAL THE BUSINESS OFFICE DIRECTOR AND SOCIAL WORKER PAY CLOSE ATTENTION TO THE PATIENT'S FINANCIAL CLASS (TYPE OF PAYOR). IF PATIENTS ARE PRIVATE PAY, WE GO EDUCATE AND SPEAK TO THAT PATIENT ABOUT PROGRAMS THEY WOULD BE ELIGIBLE FOR. IF PATIENTS HAVE LOW ASSETS/LOW INCOME, THEY COULD BE ELIGIBLE FOR MEDICAID THROUGH THE COUNTY SOCIAL SERVICES OR THEY ARE ELIGIBLE FOR THE HOSPITAL'S UNCOMPENSATED CARE. THE UNCOMPENSATED CARE (CHARITY CARE) FOLLOWS THE FEDERAL GUIDELINES REGARDING INCOME ASSET LEVELS. IF PATIENTS NEED ASSISTANCE WITH THE APPLICATION, WE WOULD ASSIST THEM. THE CHARITY CARE GUIDELINES ARE PRINTED ON THE BACK OF EVERY PATIENT'S MONTHLY STATEMENT. THE BUSINESS OFFICE DIRECTOR AND SOCIAL WORKER AT OUR FACILITY ARE THE RESPONSIBLE PARTIES FOR INFORMING PATIENTS WITH EDUCATION ABOUT PROGRAMS THEY MAY BE ELIGIBLE FOR WHETHER IT IS THE HOSPITAL'S CHARITY CARE OR OTHER STATE/FEDERAL FUNDED PROGRAMS.

PART VI, LINE 4:
WISHEK HOSPITAL CLINIC ASSOCIATION (WHCA) IS A 24-BED NON-PROFIT CRITICAL ACCESS HOSPITAL (CAH) LOCATED IN SOUTH CENTRAL NORTH DAKOTA. OUR ORGANIZATION PROVIDES SUCH SERVICES AS 24-HOUR EMERGENCY CARE, CLINIC, AMBULANCE, OUTPATIENT HOSPITAL AND ANCILLARY SERVICES, INPATIENT AND SWINGBED, AND OUTPATIENT SURGERY. WHCA HAS FOUR RURAL HEALTH CLINICS LOCATED IN WISHEK, KULM, NAPOLEON, AND GACKLE AND OF THE FOUR; THREE ARE LOCATED MORE THAN 30 MILES AWAY. OUR AMBULANCE PROVIDES CPR TRAINING TO THOSE INTERESTED AND IS ON STANDBY CALL AT LOCAL FOOTBALL GAMES AS A COURTESY TO THE COMMUNITY. WHCA SERVES THE COUNTIES OF MCINTOSH, LOGAN, AND WESTERN LAMOURE, WHICH INCLUDES A GEOGRAPHIC AREA OF OVER 2,000 SQUARE MILES AND APPROXIMATELY 6,800 RESIDENTS ACCORDING TO THE U.S. CENSUS BUREAU, CENSUS 2010 REPORT. STATISTICS IN RELATION TO THIS POPULATION INCLUDE A MAJORITY OF THE POPULATION OF AGE 65 OR OLDER WITH MCINTOSH AT 37.2%, LOGAN 28.2%, AND LAMOURE 24.6%. THE CASE MIX FOR THE HOSPITAL IS 71% MEDICARE, 19% BCBS, 3% MEDICAID AND 7% OTHER. THE CASE MIX FOR OUR FOUR CLINICS IS 50% MEDICARE, 35% BCBS, 3% MEDICAID, AND 12% OTHER. THE MEDIAN AGE OF RESIDENTS OF MCINTOSH COUNTY IS 51 YEARS OF AGE. WITH THIS STATISTIC, THE MAIN AREA WHICH WHCA SERVES INDICATES MCINTOSH COUNTY IS THE OLDEST COUNTY OF THE 53 COUNTIES IN NORTH DAKOTA. FURTHERMORE, MCINTOSH COUNTY IS THE FIFTH OLDEST MEDIAN AGE OF ALL COUNTIES IN THE NATION. THE STATE MEDIAN AGE IS 37 YEARS AND THE NATIONAL MEDIAN AGE IS 37.2. FIGURES ARE ACCORDING TO THE 2010 CENSUS. THE PERCENT OF NORTH DAKOTA RESIDENTS LIVING IN POVERTY WAS ESTIMATED IN 2009 TO BE 11.7%. MCINTOSH COUNTY WAS ESTIMATED TO BE 14%, LOGAN COUNTY 13.2%, AND LAMOURE COUNTY 10.9%.THE COMMUNITY OF WISHEK POSSESSES A 60-BED NURSING HOME (WISHEK LIVING CENTER), WHICH IS INDEPENDENT OF THE HOSPITAL. THE COMMUNITY OF NAPOLEON, WHICH IS LOCATED IN LOGAN COUNTY, HAS A 44-BED NURSING HOME (NAPOLEON CARE CENTER) AND WE PROVIDE THE MAJORITY OF HEALTH CARE IN THESE TWO SKILLED FACILITIES. WE ALSO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS OF THE GACKLE CARE CENTER'S BASIC CARE RESIDENTS IN GACKLE, ND.WHCA IS LOCATED IN A DESIGNATED MEDICALLY UNDERSERVED AREA AND IN A HEALTH PROFESSIONAL SHORTAGE AREA IN NORTH DAKOTA.

Operating expenses	$ 8,589,048
Total amount spent on community benefits as % of operating expenses	$ 205,954 2.40 %