Community Benefit Insight - Tax-exempt hospital

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St Aloisius Hospital

St Aloisius Medical Center

325 East Brewster Street
Harvey, ND 58341

Bed count	25	Medicare provider number	351327	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 450226729

Display data for year:

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

3.29%

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	$ 25,000 0.11 %
Medicaid as % of operating expenses	$ 81,879 0.36 %
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	$ 344,820 1.52 %
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.	$ 285,074 1.26 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 10,488 0.05 %
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	$ 759,440 3.35 %
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	$ 66,831 8.80 %

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 $ 19897658 including grants of $ 11488) (Revenue $ 22319017)
CRITICAL ACCESS HOSPITAL DESIGNATIONSMP Health - St. Aloisius is a 25-bed acute care hospital and 70-bed nursing facility located in Harvey, North Dakota. The Hospital was designated as a Critical Access Hospital in 2002. As a critical access hospital, our role is vital to the health and welfare of the community we serve. The patient and resident days for FY 2022 were as follows: 909 acute days and 1,503 swing-bed days.(Continued on Schedule O) RESPONDING TO THE NEEDS OF THE POOR The Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the years ended September 30, 2022 was $13,000.In addition, the Medical Center provides services to other medically indigent patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Medical Center 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.SMP Health - St. Aloisius provides a Senior Living Facility. This consists of 16 apartment units. Two of the one-bedroom apartments are handicap accessible. A noon meal is optional but is served 7 days per week. There is also a 24-hour emergency call system.SMP Health - St. Aloisius Long Term Care is a 70-bed skilled nursing facility licensed by the State of North Dakota. The facility provides occupational, physical and speech therapy and other activities offered 7 days per week. St. Aloisius Long Term Care facility had 22,953 patient days for FY 2022.SMP Health - St. Aloisius Clinic had 9,960 visits in FY 2022.

Facility Information

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

St. Aloisius Hospital
Part V, Section B, Line 5: A community group consisting of 18 community members was convened and first met on June 14, 2022. During this first community group meeting, group members were introduced to the needs assessment process, reviewed basic demographic information about the community, and served as a focus group. Focus group topics included community assets and challenges and the general health needs of the community. The focus group included the following members: Nursing Administrator and Prevention Coordinator from the Wells County District Health Unit, 911 Communications/Sheriff's Office in Wells County, Suicide Prevention volunteer, North Dakota EMS President, and other businesses and community members. The community group met again on August 17, 2022. At this second meeting the community group was presented with survey results, findings from key informant interviews and the focus group, and a wide range of secondary data relating to the general health of the population in Wells County. The group was then tasked with identifying and prioritizing the community's health needs.

St. Aloisius Hospital
Part V, Section B, Line 6b: A Community Health Needs Assessment was performed in the summer of 2022 in collaboration with the Center for Rural Health to determine the most pressing health needs of Harvey area.

St. Aloisius Hospital
"Part V, Section B, Line 11: A Community Health Needs Assessment (""CHNA"") was performed in the summer of 2019 in collaboration with Wells County District Health to determine the most pressing health needs of Harvey area. The FY2022 accomplishments are below.1. Increase the access of mental health and addiction providers within our service area and address adult alcohol use and abuse.2. Develop a resilient community and environmental health care approach for the community at large.Mental Health Services and alcohol and drug useDepression and anxiety, emotional abuse, bullying and cyberbullying, and alcohol and drug use and abuse are all related to mental health and having access to these services. As a result of the specific needs identified, stakeholders discussed increasing the access of mental health and addiction providers within the service area and how to develop a resilient prevention approach for the community at large. The implementation strategies included the implementation of the Community Mental Health Services to add counselors for adult mental health and addiction needs. The Hospital collaborated on a regular basis with Rural Mental Health (RMHC) FNP-Psych and Village Family services to increase awareness of services and the full plan for the community's mental health and addiction needs. Mental health providers met with SMP Health St. Aloisius staff to discuss needs and how to increase awareness of mental health services. The objective was to increase the number of practicing mental health primary care providers over a 3-year period. (FY19- FY21). RMHC provided rural mental health services at SMP Health - St. Aloisius providing a counselor once a week. A counselor from The Village in Minot provided counseling for children and adults and continues to serve the Harvey area at the Harvey Public School. She and her husband have opened a business in Harvey to provide counseling services. RMHC closed during 2022, but a mental health counselor continues to attend to the mental health needs at SMP Health - St. Aloisius.The Harvey Area Community Cares Coalition has existed for the past several years and has developed a strong collaboration with Harvey Public school, City of Harvey, faith communities, SMP Health - St. Aloisius, Wells County District Health Unit (WCDHU), Village Family Services, Harvey business community, community members, Harvey Police and WC sheriff office. This group will continue to lead the efforts to address mental health concerns of the communities.The area Interagency Committee met monthly and were informed of mental health services and plans as developed. Members include the Central Prairie Human Service Zone, HAV-IT, City of Harvey, Wells County District Health Unit, SMP Health - St. Aloisius, SAAF, Options, Harvey Chamber, Alzheimer's Association, local mental health counselor, and Village. Wells County District Health Unit acquired a SOARS grant from the North Dakota Department of Health for addiction and recovery. F5 agency currently comes to Harvey providing PEER SUPPORT services. The Community Care's Coalition continues to sponsor educational events where mental health services are shared with participants.Community and Environmental Health ConcernsCommunity and environmental health concerns identified were attracting and retaining young families, creating a community health program, and strengthening relationships between school, health services and community leaders. The key objectives were: joint development agreement with the City of Harvey and WCDHU and SMP Health - St. Aloisius to coordinate on job openings in the community. Community health was addressed with Governor Burgum's Main Street Initiative. One step to achieve objectives was to hire a human resources director. Another step was to post positions on Facebook, Indeed, SMP Health - St. Aloisius website, Jobs ND, 3RNET, local and out of town newspapers, and working with an offsite recruitment company. The Hospital will not address the following health needs identified in the CHNA as part of this Implementation Plan due to limited resources and the need to allocate significant resources to the two priority health needs identified above. 1. Senior population health concerns including the cost of long-term care and nursing homes and the availability of services to assist the elderly to remain in their home.2. Threat concerns such as illegal drug use, child abuse, healthy eating education and health food choices and youth alcohol.A Community Health Needs Assessment was completed in 2022. The following needs were identified and will be addressed over the next 3 years.1. Depression/anxiety for all ages 2. Assisted living options 3. Smoking and tobacco use, exposure to second-hand smoke, juuling/vaping 4. Attracting and retaining young families"

St. Aloisius Hospital
Part V, Section B, Line 16j: A note is printed on monthly statements providing information regarding financial assistance. The financial assistance policy is provided to all patients upon registration at the Hospital. The Uncompensated Care & Service Application and information regarding the financial assistance policy is available on our website and available upon request.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
In addition to income, assets and liabilities may also be used to determine eligibility.

Part I, Line 6a:
The Hospital's community benefit report is available upon request.

Part I, Line 7:
Charity care expense was converted to cost on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Community health improvement services and cash and in-kind contributions are reported based on actual expenses recorded in the Organization's general ledger. The cost for subsidized health services was determined using the Medicare cost report.

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

Part III, Line 3:
The Hospital reasonably estimates the portion of implicit price concessions that could have qualified for charity care. An estimated 8.8% of implicit price concessions in 2021 are attributable to patients living below the federal poverty level in Wells County.

Part III, Line 4:
The footnote to the Organization's financial statements can be found on pages 10 and 11 of the attached audited financial statements.

Part III, Line 8:
SMP Health - St. Aloisius provides services to patients under the Medicare program regardless of a shortfall or surplus. The Hospital knows 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. 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 $82,164.Medicare fee schedule revenue $ 96,151Medicare estimated costs of care relating to payments (178,314)Net (Shortage) $ (82,164)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 the Centers for Medicaid and Medicare Services.

Part III, Line 9b:
Patients that are in the process of applying for charity care or have been approved for charity care will not have collection procedures brought on them. If a patient does not complete the Caring Program application within 120 days the account will follow the same collection procedure as other accounts. Accounts turned over to collections may be eligible for the Caring Program if the patient completes an application and is approved within an additional 120 days. After a determination of charity care, any personal portion due would follow the same collection procedures as other patients. Persons that have been granted bankruptcy by the courts are transferred to the Caring Program and written off as charity care. No collection procedures are pursued.

Part VI, Line 2:
"SMP Health - St. Aloisius addresses needs throughout the community in addition to completing the CHNA. The Hospital employs a marketing/public relations individual and provides feedback on needs in the community. A community care program, named ""Community Cares Coalition"" was formed to address and assist with suicide prevention and is still active in 2022. The Hospital has other activities to assist families in need throughout the community."

Part VI, Line 3:
SMP Health - St. Aloisius has a Revenue Cycle Manager, RCM, who works in conjunction with the business office staff on reviewing patient accounts both with insurance and those who are self-pay. Our monthly billing statements include information regarding financial assistance. The financial assistance policy is provided to self-pay patients upon registration at the Hospital and Clinic. It is not provided to all patients. The application for Uncompensated Care and Services and information regarding the financial assistance policy is available on our website and available upon request.The hospital nurses ask the patient if they have any financial concerns about their hospital stay and if they do, the nurse calls the RCM or CFO to notify them that the patient has financial questions. The RCM or CFO will then follow up with the patient about their concerns.

Part VI, Line 4:
SMP Health - St. Aloisius is a non-profit Critical Access Hospital located in central North Dakota. We serve more than 15 rural communities including Harvey where we are located. Our area of service is approximately 90 miles in diameter. Local doctors have clinics in Harvey. Some of the same community demographics issues still exist, however, these community needs are still being addressed in the current year. Obesity continues to be an issue in all areas as is excessive drinking, drug use, diabetes etc. In 2021, 36% of adults in Wells County were considered obese compared to 36% in North Dakota and 30% nationally. This is a increase from 2019 of 32% in North Dakota. Adult smokers by percent of population in Wells County is 21% compared to 20% in North Dakota and 15% in the US. Excessive drinking was 23% in Wells County, 24% in North Dakota and 15% in the US. Injury Deaths were more prevalent in Wells County (66 deaths per 100,000 residents) than in the state overall (72 per 100,000 residents) and the top 10% of US Counties (61 per 100,000 residents). In Wells County, 50% of households have one or more seniors (60 and older). Unemployment in Wells County in 2021 was 4.4% and in North Dakota 2021 was 4.0%. The estimated median household income in Wells County for 2021 was $63,665. The estimated median household income for North Dakota was $89,504.. Also, 8.8% of residents had income below the poverty level, which is a decrease from 11.5% of 2020.Services offered include acute care, swing bed, surgery, clinic, senior housing and long-term care services. Our average acute/swing bed daily census is 5.5 patients. Our average clinic visits per month in FY22 was 830. Long term care average daily census was 63.69, up from 63.35 last year. SMP Health St. Aloisius has provided services in Harvey since 1938 with the Sisters of Mary of the Presentation Health System. With a special mission to serve the poor, the Sisters' have offered healing hospitality to all who come to us for care.The closest critical access hospitals are Heart of America Medical Center located in Rugby, ND approximately 42 miles away and Carrington Health Center located in Carrington, ND approximately 54 miles away.

Part VI, Line 6:
We are an affiliate of SMP Health. SMP Health - St. Aloisius operates in accordance with the mission, vision, and values of the Sisters of Mary of the Presentation Health Corporation. 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. Aloisius 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. Aloisius 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.

Part VI, Line 5:
"The Organization's governing body is composed of representatives from Harvey and surrounding local communities in addition to representatives from the Sisters of Mary of the Presentation. The group is diverse, as it includes lay people, religious representatives and businessmen and women. This diversity represents the rural population we serve. This facility extends medical staff privileges to those qualified practitioners based on an established credentialing process. We are not a research facility. Any excess funds are reinvested into funded depreciation for future capital projects for the facility. As a critical access facility, there have not been many years with excess funds, but when there is, the facility has made improvements in building infrastructure to increase quality and efficiency for our patients and residents we serve. We have hired additional staff in our therapy department and the dry needling this past year and lymphedema treatments in FY2022. We now have our own Ultrasound Radiology Technologist to handle the Ultrasound outpatientsSMP Health - St. Aloisius is very supportive of community organizations. The following are examples of services St. Aloisius has provided to the community at large for a total of $321,707.1. The facility has a 24/7 emergency room available to patients regardless of ability to pay.2. Sponsored weekly Healthy Hints radio spots where health issues are addressed3. 24/7 Pastoral Care services.4. Provided lab services to patients (including free wellness for employees) during our spring and fall Wellness Days.5. We provided sports physicals to area athletes and their payments for the physicals were donated to Wells County Booster club.6. Diabetes education is provided by hospital staff who is certified in Diabetes Education7. Provided donations to local school projects and other community groups, memorial services, child protection referrals.8. Presented bi-weekly ""Did You Know"" health information in the local newspaper. 9. Provided office space (in kind) for Hearing Aid Services and Mental Health Counselor staff/clients in our hospital building. There were many patients served weekly by the Rural Mental Health staff.10. Provided cable television, internet and phone to our patients and residents which is non-reimbursable on our cost report.11. Sent outdated supplies to local missionaries for distribution"

Operating expenses	$ 22,697,026
Total amount spent on community benefits as % of operating expenses	$ 747,261 3.29 %