Community Benefit Insight - Tax-exempt hospital

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Towner County Medical Center Inc

Towner County Medical Center

Hwy 281 North
Cando, ND 58324

Bed count	20	Medicare provider number	351331	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 450425948

Display data for year:

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

1.1%

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	$ 4,000 0.03 %
Medicaid as % of operating expenses	$ 27,021 0.18 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 19,600 0.13 %
Subsidized health services as % of operating expenses	$ 97,826 0.64 %
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.	$ 20,100 0.13 %
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	$ 211,954 1.39 %
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	$ 20,771 9.80 %

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 $ 13015267 including grants of $ 2975417) (Revenue $ 12612537)
I. IntroductionTowner County Medical Center was acquired from the Sisters of St. Francis, a Catholic religious order, in 1992. The community of Cando wanted to ensure itself that there would continue to be health care services available to not only the residents of Cando, but to the areas surrounding the community as well.Service to the community and the surrounding area is a hallmark of how we are here. The Medical Center provides diagnostic and therapeutic treatment to all, regardless of race, sex, religion, financial ability to pay, or any other area that could be deemed to be discriminatory. In addition to the core medical services, we are continually reaching out to surrounding communities assisting them in promoting a healthier community as well.II. Uncompensated CareTowner County Medical Center provides uncompensated care to those in need of services, who either have limited resources or who may have fallen on hard times and are in need of relief in order to get back on their feet. The amount of traditional uncompensated care for the year ended June 30, 2022 was $220,988, which includes charity care and implicit price concessions. In many cases, we believe that the bad debt is in fact charity care, but individuals are too proud to come in and request charity. New policies and procedures have been developed in an effort to allow us to better identify these individuals, and to be able to classify them as they should be. In addition to uncompensated care, Towner County Medical Center also provides discounts to the Medicare and Medicaid programs. For the year ended June 30, 2022 those discounts totaled $4,351,646.

Facility Information

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

Towner County Medical Center
Part V, Section B, Line 5: A survey was used to solicit feedback from area residents for the CHNA. This went out in December of 2021 and it was available for 4 months to complete. Community leaders, representing the broad interests of the community, took part in one-on-one key informant interviews. A community group, comprised of community leaders and area residents, was convened to discuss area health needs and inform of the assessment process. The first meeting was held in November of 2021 and various meetings, and one-on-one sessions were held over the next 6 months with an implementation plan brought to the community in July. The Center for Rural Health provided input as well as Towner County Public Health on the medically underserved, low-income and minority populations.

Towner County Medical Center
Part V, Section B, Line 6b: Towner County Public Health District

Towner County Medical Center
Part V, Section B, Line 11: The following needs were identified in the most recently completed CHNA:1. Mental Health Services2. Retaining Young Families3. Cost of Healthcare4. ChildcareTowner County Medical Center has been working to address each of these needs as follows:1. Mental Health Services: We are working together with Public Health, Law enforcement, and local schools to identify the specific needs for the area concerning mental and emotional health. 2. Retaining Young Families: TCMC strives to offer employment with competitive wages and benefits to try to prevent the relocation of young families to larger centers3. Cost of Healthcare: We continue to provide preventative healthcare procedures and expand healthcare screening to area residents. Outreach professionals continue to bring healthcare to TCMC on a regular basis, allowing patients to stay close to home for the care they need. We will continue to look at ways to expand these services. 4. Childcare: TCMC daycare is certified Step 4 with the Bright and Early program of North Dakota. Our Director continues to apply for grants to reduce the cost of labor so we are able to continue to provide affordable, high quality daycare in the area.

Towner County Medical Center
Part V, Section B, Line 16j: The financial assistance policy and application are available on the website and upon request. The financial assistance policy is provided in summary form with the third billing invoice. Towner County Medical Center also has a credit collection policy brochure posted at the clinic reception desk where patients check in.

Part V, Line 20d:
An application is required to be filled out and on file prior to a patient receiving financial assistance.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
Charity care expense was converted to cost on Line 7a based on an overall cost-to-charge ratio addressing all patient segments.Part I, Line 7b: The Medicaid cost report was used to calculate the amount of unreimbursed Medicaid.Part I, line 7e and 7f: Costs reported on line 7e and 7f come from the general ledger accounts.

Part I, Line 7g:
Towner County Medical Center operates the only emergency room in their service area. The cost for subsidizing health services was determined using the Medicare Cost Report.

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

Part III, Line 3:
The methodology for determining the amount of the Organization's implicit price concessions attributable to patients that would be eligible under the Organization's charity care policy was calculated by taking the percentage of individuals below the poverty level times implicit price concessions. 9.8 percent of individuals are below the poverty level and so the organization is estimating that 9.8 percent of implicit price concessions is attributable to individuals eligible for charity care.

Part III, Line 4:
Footnote from organization's financial statements: The footnote that describes implicit price concessions is found on page 10-11 of the attached audit report.

Part III, Line 8:
Medicare allowable cost is based on the Medicare cost report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Towner County Medical Center provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services.

Part III, Line 9b:
After a patient receives two statements without making a payment, TCMC will call the patient to discuss their past due account. After the third statement is sent out the patient also receives a written notice saying they are being sent to collections. This notice also provides a number for them to contact TCMC about their past due account. If the patient does get in contact with TCMC they will offer the patient charity care at that time and the patient will need to complete the steps to see if they qualify for charity care. If an individual submits an incomplete financial assistance application, they are contacted regarding the missing information. They are not sent to collections until all of the information has been received and it is determined they do not meet the qualifications for financial assistance. If a person submits a financial assistance application after they have been sent to collections, and it is determined they are eligible for financial assistance, the accounts that qualify will be removed from collections. It is documented on the application submitted if a patient is eligible or ineligible for financial assistance.

Part VI, Line 2:
We completed a market analysis study that provided us with areas of concern as well as possible areas of growth. This will now be used for strategic planning in regards to what services may be feasible for Towner County Medical Center to pursue going forward.We are currently in the process of building a new hospital/clinic/nursing home project to better align with data obtained in past market analysis information that was compiled. The goal is to have this new campus completed by the year 2024.

Part VI, Line 3:
Towner County Medical Center posts its charity care policy, or a summary thereof, financial assistance application and financial assistance contact information on their website and in admissions areas; includes the policy, or a summary thereof, along with financial assistance contact information in the patient's third billing invoice; and/or discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable.

Part VI, Line 4:
The community Towner County Medical Center (TCMC) serves is rural with an estimated population of 2,162 people, 25.3% of this is senior population aged 65 and older. The median household income is $52,300 and the average household size is 2.07. Of this population, 9.8% live below the poverty level. There are two hospitals within 40-55 miles of Towner County Medical Center. One is in Rolla, which is within 10 miles from the Turtle Mountain Indian Reservation. The other is in Devils Lake which is within 10 miles from the Spirit Lake Indian Reservation.

Part VI, Line 5:
Towner County Medical Center's Board of Directors is comprised of volunteers that reside in the community. TCMC would extend medical privileges to all qualified physicians in the hospital to practice, although there are currently no other physicians in the community. Any surplus funds, if available, are used to improve patient care and add additional patient services. Recent additional services added have been CT and Outpatient Chemotherapy services.TCMC provides specialty cardiac rehab, cancer outpatient services, and operates an emergency room regardless of ability to pay. TCMC is the sole community provider of healthcare services in this community.Community outreach with Public Entities:Towner County was the last county in the state of North Dakota to not have a county public health office. In conjunction with the county, Towner County Medical Center took on the responsibility of starting up the public health office. The program, which is funded by Towner County and through grants, provides many services such as immunizations, baby checks, car seats and other services to those in need. It is through cooperation, such as this, that Towner County Medical Center is able to reach out and provide services to those most in need, who may not otherwise be able to receive these types of preventative services.Community Outreach for the Broader Community:Towner County Medical Center offers a number of services to individuals in the region aimed at providing preventative services, educational services and chronic care management services.Senior Meals/Senior Center - Towner County Medical Center provides senior meals. Seniors either come to the medical center to eat their lunches or they are taken out to them through the use of volunteers. In addition to the meals, Towner County Medical Center also offers its conference room as a gathering place for the seniors in the community and area to come socialize, play cards or to have other events. The use of the space is weekly and there is no cost to the seniors for the use of this space.Medical Education - Towner County Medical Center serves as an active participant in the University of North Dakota Medical School training program. Serving as a site for various medical students, we also serve as a clinical site for nurses in training, certified nursing assistant in training, and for other fields in which we have appropriately trained staff and facilities to assist in the training process.Other - We encourage physicians and other staff to be active participants in the community. We have staff actively involved in economic development, in youth sports, in the fine arts, and in community leadership positions. It is through this active partnership that Towner County Medical Center is able to contribute to the community to make it a better place to live and an area that people desire to move to.

Operating expenses	$ 15,286,390
Total amount spent on community benefits as % of operating expenses	$ 168,547 1.10 %