Community Benefit Insight - Tax-exempt hospital

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Cavalier County Memorial Hospital Association

Cavalier County Memorial Hospital

909 Second Street
Langdon, ND 58249

Bed count	20	Medicare provider number	351323	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 450306787

Display data for year:

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

18.71%

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	$ 26,441 0.21 %
Medicaid as % of operating expenses	$ 98,128 0.77 %
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	$ 2,265,440 17.73 %
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	$ 178,562 1.40 %
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 $ 9463536 including grants of $ 2110) (Revenue $ 13202121)
PROVIDE PATIENT HEALTHCARE SERVICES INCLUDING HOSPITAL AND CLINIC TO SURROUNDING COMMUNITY. THE ORGANIZATION PROVIDED APPROXIMATELY $27,006 OF CHARITY CARE DURING THE YEAR ENDED 06/30/2022.

Facility Information

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

CAVALIER COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: THE METHODOLOGY TO CONDUCT THIS ASSESSMENT TAKES A COMPREHENSIVE APPROACH TO ASSESS COMMUNITY HEALTH NEEDS, PERFORM SEVERAL INDEPENDENT DATA ANALYSES BASED ON SECONDARY SOURCE DATA, AUGMENT THIS WITH LOCAL EXPERT ADVISOR OPINIONS, AND RESOLVE ANY DATA INCONSISTENCY OR DISCREPANCIES BY REVIEWING THE COMBINED OPINIONS FORMED FROM LOCAL EXPERT ADVISORS. THE HOSPITAL RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS. LOCAL EXPERT AREA RESIDENTS WERE ASKED TO NOTE IF THEY PERCEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES EXISTED IN THEIR PORTION OF THE COUNTY. INPUT WAS OBTAINED FROM THE REQUIRED THREE MINIMUM SOURCES AND EXPANDED TO INCLUDE OTHER REPRESENTATIVE GROUPS. THE HOSPITAL ASKED ALL THOSE PARTICIPATING IN THE WRITTEN COMMENT SOLICITATION PROCESS TO SELF-IDENTIFY INTO ANY OF THE FOLLOWING REPRESENTATIVE CLASSIFICATIONS, WHICH ARE DETAILED IN AN APPENDIX TO THIS REPORT.

CAVALIER COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 6B: CAVALIER COUNTY MEMORIAL HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WITH QHR HEALTH.PART V, LINE 7A:HTTPS://WWW.LPH.HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPART V, LINE 10:HTTPS://WWW.LPH.HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

CAVALIER COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: THE 2021 SIGNIFICANT HEALTH NEEDS IDENTIFIED FOR CAVALIER COUNTY ARE:1. BEHAVIORAL HEALTH:A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: BEHAVIORAL MENTAL HEALTH TASK FORCE A LOCAL GROUP THAT CONSISTS OF REPRESENTATIVES FROM PUBLIC HEALTH, LAW ENFORCEMENT, SOCIAL SERVICES, THE BOARD OF EDUCATION, AND LPH; DEPRESSION SCREENINGS ARE PERFORMED DURING EVERY VISIT AT THE PRIMARY CARE CLINIC; TELE-PSYCHIATRY OFFERINGS.B. IMPACT OF ACTIONS TAKEN SINCE THE IMMEDIATE PRECEDING CHNA: ALCOHOLICS ANONYMOUS (AA) SERVICES ARE NOW PROVIDED AT WALHALLA CLINIC; LPH HAS A PROVIDER TRAINED IN CHILD BEHAVIORAL HEALTH; WALHALLA CLINIC OFFERS A ROBUST MEDICAL MARIJUANA PROGRAM TO LIMIT OPIOID USE AMONG CHRONIC PAIN PATIENTS.C. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: ADD ALCOHOLICS ANONYMOUS/NARCOTICS ANONYMOUS (AA/NA) SERVICES; INCREASE EDUCATION AND AWARENESS ON MENTAL HEALTH IN THE COMMUNITY; WORK WITH ADDICTION COUNSELORS IN THE AREA TO CONNECT AA/NA PARTICIPANTS WITH THEIR SERVICES; EXPLORE POTENTIAL SCREENING PROTOCOLS FOR DRUG/SUBSTANCE/ALCOHOL USE; INCREASE EDUCATION FOR PHYSICIANS TO BE AWARE OF COUNSELORS THAT THEY CAN REFER PATIENTS TO; CONTINUE WORK WITH THE BEHAVIORAL MENTAL HEALTH TASK FORCE; EXPLORE THE DEVELOPMENT OF A SUBOXONE TREATMENT PROGRAM THROUGH A CERTIFIED PROVIDER; DEVELOP AND SUPPORT PROVIDERS WHO ARE INTERESTED IN BEHAVIORAL HEALTH.2. CHRONIC DISEASE MANAGEMENT:A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: CARAVAN HEALTH COLLABORATIVE LPH ACCOUNTABLE CARE ORGANIZATION (ACO); COMPREHENSIVE PRIMARY CARE SERVICES; CHRONIC CARE MANAGEMENT SERVICES CHRONIC DISEASE PATIENTS RECEIVE PHONE CALLS EVERY OTHER WEEK FROM HEALTHCARE PROFESSIONALS TO REVIEW HOW THEIR CARE IS GOING; TRANSITIONAL CARE MANAGEMENT SERVICES PATIENTS DISCHARGED FROM THE HOSPITAL WITH A CHRONIC CONDITION RECEIVE A CALL TO ENSURE A FOLLOW-UP APPOINTMENT IS SCHEDULED AT THE CLINIC; LPH PROVIDERS CONDUCT ANNUAL WELLNESS VISITS; POPULATION HEALTH NURSE AVAILABLE ON STAFF; LPH CONDUCTS AN ANNUAL HEALTH FAIR WITH OVER 30 DIFFERENT VENDORS; LPH CONDUCTS WOMEN'S HEALTH DAY AND MEN'S HEALTH DAY TO PROVIDE SCREENING SERVICES; COVID-19 PREVENTION AND EDUCATION SERVICES; TELEMEDICINE APPOINTMENTS ARE AVAILABLE ACROSS A RANGE OF SERVICE LINES; CAVALIER COUNTY SENIOR MEALS AND SERVICES AND THE FOUNDATION PROVIDE FREE MEALS FOR TWO WEEKS AFTER DISCHARGE TO MEDICARE PATIENTS; SCREENING SERVICES: BLOOD PRESSURE MONITORING; BONE DENSITY TESTING; COLONOSCOPIES; DIABETES MANAGEMENT; DOT YEARLY PHYSICALS; LAB TESTING; MAMMOGRAPHY; SPORTS PHYSICALS; WELLNESS CHECK-UPS; VISITING OUTREACH PROVIDERS; CARDIOLOGY; DERMATOLOGY; OB/GYN; ONCOLOGY; ORTHOPEDICS; PAIN MANAGEMENT; GI.B. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: WORK WITH COMMERCIAL INSURANCES TO BROADEN CHRONIC CARE MANAGEMENT SERVICES TO ALL PATIENTS; INCREASE EDUCATION AND AWARENESS AROUND CHRONIC DISEASES ON SOCIAL MEDIA; INITIATE COMMUNITY PARAMEDIC PROGRAM, INCLUDING DISEASE MONITORING AND MEDICATION MANAGEMENT FOR CHF AND COPD; EXPLORE POTENTIAL PROGRAMS TO PROVIDE CARE IN A PATIENT'S HOME AS AN ALTERNATIVE TO LONG-TERM CARE; EVALUATE THE POTENTIAL OF INCREASING SPECIALTY ROTATIONS FOR SERVICES THAT ARE HEAVILY UTILIZED.3. ACCESS TO HEALTHCARE SERVICES: A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: WEEKEND CLINIC HOURS; 24-HOUR EMERGENCY CARE AND SWING BED SERVICES; TELEMEDICINE APPOINTMENTS ARE AVAILABLE ACROSS A RANGE OF SERVICE LINES; VISITING OUTREACH PROVIDERS; CARDIOLOGY; DERMATOLOGY; OB/GYN; ONCOLOGY; ORTHOPEDICS; PAIN MANAGEMENT; GI; FINANCIAL ASSISTANCE POLICY FOR PATIENTS UP TO 200% OF THE FEDERAL POVERTY LINE; PRICE TRANSPARENCY PRICE ESTIMATOR TOOL AVAILABLE ON THE HOSPITAL'S WEBSITE; SCREENING FOR FINANCIAL ASSISTANCE POLICY IS INCLUDED ON ALL STATEMENTS AND APPLICATIONS ARE INCLUDED WITH PATIENT PACKETS; BILLING SUPPORT STAFF AVAILABLE ONSITE AT LPH; SOCIAL WORKER ON STAFF TO HELP CONNECT PATIENTS TO AVAILABLE RESOURCES; HOSPITAL-BACKED LOANS FOR PATIENTS THROUGH CHOICE FINANCIAL BANK; FREE HEALTH SCREENINGS FOR EMPLOYEES DURING HEALTHCARE WORKER APPRECIATION WEEK; OUTREACH CLINIC IN WALHALLA; LPH CONDUCTS AN ANNUAL HEALTH FAIR WHERE FREE HEALTH SCREENINGS ARE PROVIDED; AGREEMENT WITH THE UNIVERSITY OF NORTH DAKOTA TO TRAIN AND RECRUIT MEDICAL, NURSING, AND PHYSICIAN ASSISTANT STUDENTS; ON THE HORIZON: LPH'S COMMUNITY MAGAZINE PROVIDES STORIES FROM PATIENTS AND FEATURES INFORMATION ABOUT HOSPITAL SERVICES AND HEALTH TIPS.B. IMPACT OF ACTIONS TAKEN SINCE THE IMMEDIATELY PRECEDING CHNA: UPDATED FINANCIAL ASSISTANCE POLICY; OPTIMIZED HOSPITAL WEBSITE TO BE MORE USER-FRIENDLY AND TO PROVIDE CLEAR INFORMATION ON SERVICES AVAILABLE; IMPROVED HOSPITAL SIGNAGE TO SUPPORT COMMUNITY AWARENESS AND WAYFINDING.C. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: ADD EARLY AND LATE WEEKDAY HOURS AT THE CLINIC; CONTINUE TO EXPAND TELEMEDICINE OFFERINGS; CONTINUE TO IMPROVE BILLING PROCESSES AT THE HOSPITAL; CONTINUE TO INVEST IN THE LOCAL COMMUNITY FOR NURSING STAFF.

CAVALIER COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 13H: PATIENTS WHO HAVE DIED AND HAVE NO ESTATE ARE DEEMED BY CCMH TO HAVE NO INCOME FOR THE PURPOSE OF DETERMINING CHARITY CARE ELIGIBILITY.

CAVALIER COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 16J: THE ORGANIZATION DID NOT TRANSLATE THE FAP INTO ANY OTHER LANGUAGE THAN THE ENGLISH. THERE IS LESS THAN 4% NON-ENGLISH SPEAKING POPULATION IN THE AREA THE HOSPITAL SERVES AND THERE IS NOT A REQUIREMENT TO TRANSLATE THE FAP.PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCEPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCEPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCE

CAVALIER COUNTY MEMORIAL HOSPITAL
PART V, SECTION B, LINE 20E: ALL PATIENTS RECEIVE LETTERS AFTER NONPAYMENT THAT INCLUDE A PLAIN LANGUAGE SUMMARY OF OUR FINANCIAL ASSISTANCE PLAN.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
"THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES (""FPG"") AS THE PRIMARY BASIS FOR THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL ALSO USES THE PATIENT'S ADJUSTED GROSS INCOME FIGURE FROM THEIR INCOME TAX RETURN AND CHECK IT WITH THE FPG. THE HOSPITAL DOES NOT USE AN ASSET TEST. THE HOSPITAL REQUIRES APPLICANTS TO SUBMIT A MEDICAID DENIAL, THE PRIOR YEAR'S TAX FILING, AND 3 MONTHS OF INCOME VERIFICATION AS PART OF THE FINANCIAL ASSISTANCE APPLICATION PROCESS."

PART I, LINE 7:
COST TO CHARGE RATIO WAS DERIVED USING WORKSHEET 2 FROM THE IRS TO CALCULATED THE AMOUNTS INCLUDED IN SCHEDULE H, PART I, LINE 7A & 7B COMMUNITY HEALTH IMPROVEMENTS SERVICES & COMMUNITY BENEFIT OPERATIONS (LINE 7E) AND HEALTH PROFESSIONAL EDUCATION ARE REPORTED AT COST.

PART I, LINE 7G:
THE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO IP/OP OBSERVATION BEDS, THE AMOUNTS ARE DETERMINED USING A COMPLETED COST REPORT. THE UNIT REPORTED COSTS OF $3,511,394 WITH OFFSETTING REVENUE OF $1,245,945.

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24E, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $182,379.

PART III, LINE 2:
THE ORGANIZATION'S BAD DEBT EXPENSE IS THE BAD DEBT EXPENSE LESS BAD DEBT RECOVERIES AS REPORTED ON THE FINANCIAL STATEMENTS MULTIPLIED BY THE COST TO CHARGE RATIO.

PART III, LINE 3:
THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS.

PART III, LINE 4:
THE TEXT REGARDING THE ORGANIZATION'S BAD DEBT IS FOUND ON PAGE 12 OF THEIR ACCOMPANING FINANCIAL STATEMENTS. A PORTION OF THAT TEXT IS BELOW: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THE YEARS ENDED JUNE 30, 2022 AND 2021, WAS NOT SIGNIFICANT. CONSISTENT WITH THE HOSPITAL'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE HOSPITAL HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (I.E., COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN THE AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE HOSPITAL EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. THE HOSPITAL'S POLICY IS TO PROVIDE DISCOUNTS RANGING FROM 40 TO 100 PERCENT UNDER A SLIDING FEE SCHEDULE THAT IS BASED ON FAMILY SIZE AND INCOME IN RELATION TO FEDERAL POVERTY GUIDELINES. THIS POLICY DID NOT CHANGE IN 2022 AND 2021.

PART III, LINE 8:
CAVALIER COUNTY MEMORIAL HOSPITAL ASSOCIATION IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. BASED ON THE INSTRUCTIONS, THE TOTAL MEDICARE REVENUE SHOWN ON THIS FORM 990 INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE THAT IS ACTUALLY RECEIVED BY THE HOSPITAL FROM THE MEDICARE PROGRAM. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THE RECIPIENTS ARE TYPICALLY ELDERLY AND/OR DISABLED MEMBERS OF THE COMMUNITY AND ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.

PART III, LINE 9B:
IF A PATIENT QUALIFIES FOR CHARITY CARE, A PERCENTAGE OF THEIR BILL IS WRITTEN OFF DEPENDING ON THEIR INCOME LEVEL. THE BALANCE THAT REMAINS IS SUBJECT TO OUR COLLECTION POLICY. IF A PAYMENT HAS NOT BEEN MADE FOR 2 MONTHS, A 1ST LETTER IS SENT STATING THAT THEY HAVE A MONTH TO MAKE A PAYMENT. IF A PAYMENT HAS NOT BEEN MADE AFTER THAT MONTH, A 2ND LETTER IS SENT OUT STATING THEY HAVE ANOTHER MONTH TO MAKE A PAYMENT. IF A PAYMENT HAS STILL NOT BEEN MADE, THEN THEY GET TURNED OVER TO OUR COLLECTION AGENCY.

PART VI, LINE 2:
LANGDON PRAIRIE HEALTH ACTIVELY ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY BY EVALUATING THE PROGRESS AND SUCCESS OF PREVIOUS COMMUNITY NEEDS ASSESSMENTS, EVALUATING QUALITY METRICS, PATIENT SATISFACTION SURVEYS, AND ACO RESULTS. ALL DEPARTMENTS PARTICIPATE IN LPH'S QUALITY ASSURANCE PROGRAM WHICH MEASURES PATIENT SATISFACTION AND THE QUALITY OF THE SERVICES PROVIDED AND PROVIDES AN OPPORTUNITY FOR IMPROVING PROCESSES RESULTING IN IMPROVED HEALTHCARE FOR OUR COMMUNITY.

PART VI, LINE 3:
LANGDON PRAIRIE HEALTH OFFERS ASSISTANCE TO ALL PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. OUR WEBSITE, FACEBOOK PAGE, BILLING STATEMENTS COMMUNITY CALENDAR AND PATIENT HANDBOOK INDICATE WHO TO CONTACT IN ORDER TO APPLY. BUSINESS OFFICE STAFF ALSO MONITOR PATIENT ACCOUNTS THAT ARE DORMANT AND IN JEOPARDY OF COLLECTIONS, CONTACT THOSE PATIENTS AND OFFER ASSISTNCE IN THE APPLICATIONS PROCESS AS WELL.

PART VI, LINE 4:
CAVALIER COUNTY IS LOCATED IN THE STATE OF NORTH DAKOTA AND ACCORDING TO THE US CENSUS 2022 HAS A POPULATION OF APPROXIMATELY 3,362. PERSONS 65 YEARS AND OLDER MAKE UP 27.2% AND PERSONS UNDER 18% MAKE UP 29%. THE WHITE RACE MAKES UP APPROXIMATELY 96% WHILE THE HISPANIC OR LATINO MAKES UP 2.5%. OF THE 1,153 HOUSEHOLDS THERE WERE 2.34 PERSONS LIVING IN EACH HOUSEHOLD. THE MEDIAN HOUSEHOLD INCOME WAS $60,284 AND 8% WERE CONSIDERED TO BE IN POVERTY. THE POPULATION PER SQUARE MILE IS 2.5 IN AN AREA OF 1,489. 6.3% PERSONS SUFFER FROM A DISABILITY AND 7.1% ARE UNINSURED. THE COUNTY WAS FOUNDED IN 1879 AND THE COUNTY SEAT IS LOCATED IN LANGDON.

PART VI, LINE 5:
LPH AND CLINICS FURTHER THEIR EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY BY OFFERING SEVERAL PROGRAMS FOR FINANCIAL ASSISTANCE, OFFERING HEALTH FAIRS AND FREE AND REDUCED HEALTH ASSESSMENTS AND TESTING. CHARITY CARE IS OFFERED AND EMERGENCY SERVICES ARE PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY. ANY CONTRIBUTIONS MADE TO THE ORGANIZATION ARE TAX DEDUCTIBLE AND APPLIES FOR GRANTS TO PURCHASE NEEDED EQUIPMENT AND PROVIDE ADVANCED MEDICAL TRAINING.

PART VI, LINE 7, REPORTS FILED WITH STATES
ND

Operating expenses	$ 12,776,302
Total amount spent on community benefits as % of operating expenses	$ 2,390,009 18.71 %