Community Benefit Insight - Tax-exempt hospital

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Good Samaritan Hospital Association

Heart Of America Medical Center

800 Main Avenue South
Rugby, ND 58368

Bed count	25	Medicare provider number	351332	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 450226419

Display data for year:

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

10.24%

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	$ 164,000 0.60 %
Medicaid as % of operating expenses	$ 75,247 0.28 %
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	$ 2,538,802 9.35 %
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.	$ 897 0.00 %
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	$ 513,044 1.89 %
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	$ 128,261 25 %

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 $ 23384620 including grants of $ 50000) (Revenue $ 26886234)
Good Samaritan Hospital Association (GSHA) is a nonprofit health care organization, owned by 21 area churches representing all the local denominations of the Christian faith. The area churches at an annual meeting every year elect a board of trustees. This board is the legal governing body that is responsible for the Association. GSHA's primary focus is healthcare within and around the community of Rugby, ND. GSHA has 25 licensed acute/swing beds as a critical access hospital, 3 rural health clinics, along with a surgical clinic/pain clinic, 45 Medicare skilled nursing home beds (2 in layaway), 60 basic care beds, and 37 assisted living apartments. We also service the community through a robust hospital-based hospice program. GHSA was impacted by COVID in many ways such that many activities and volunteer work were cancelled due to infection control risks and CDC guidance. Additionally, we continued to see increased charity care due to patients being impacted with industries shutting down during COVID waves. COVID testing was provided to the community. And our infection control nurse was working with public health to improve the community's awareness. GSHA provides numerous community and social programs including, but not limited to the following: Charity Care - the estimated cost of providing charity care services was $164,000 during the year ended March 31, 2022 (calculated by multiplying the ratio of cost to gross charges for the Organization by the gross uncompensated charges associated with providing charity care to patients), reduced fee flu shot clinics, diabetic education program, chronic care management, public healthcare educational and informational notices, testing and information during health shows and community events, ambulance volunteers, provides EMT courses for ambulances, educational outreach for school system, provides senior citizen meals, free blood pressure checks, community education, physical therapy, provides meeting room for various organizations and churches, CPR training, wellness programs, affiliated with LPN/RN school program through consortium of facilities and colleges. Through CRH's CHNA process, we were able to determine the base needs of our community that we can work towards completing: more daycare, increased mental health services, and attracting and attaining young families.

Facility Information

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

Heart of America Medical Center
Part V, Section B, Line 5: Our initial task force involved public health, city government, local school, pastoral and HAMC representation. Our community meetings involved those areas along with agricultural, business owners, first responders, and social services representation from our service area. We collaborated with Lake Region District Health Unit for conducting our CHNA. The representative from our local office attended task force meetings, distributed surveys to patients, was involved in press releases and participated in community meetings. Surveys were available online as well as paper in several locations. Throughout the process, task force and community meetings were held intermittently from September 2021 through January 2022. CRH conducted community interviews for informational purposes.

Heart of America Medical Center
Part V, Section B, Line 6b: Lake Region District Health Unit & UND Center for Rural Health

Heart of America Medical Center
Part V, Section B, Line 11: During the current fiscal year, the organization completed a new CHNA. The latest CHNA completed identified the following needs in our Community:-Attaining and Retaining Young Families: The organization plans to address this need by recruiting to the organization and introducing the families to the culture of Rugby and the surrounding areas. Focusing on what the community and surrounding areas have to offer in our rural communities such as hiking, fishing, county fair, and a great school district.-Availability of mental health services: The organization plans to address this need by informing the patients and public that mental health services are available through their provider in the clinic. -Not enough healthcare staff in general: HAMC is working to recruit more staff back to healthcare through advertising, job fairs, and working with the schools. -Having enough daycare services: HR is working on an analysis to determine if the organization has capacity to take in community children into the daycare. In addition, during the fiscal year, the organization also took steps to address the needs from the prior CHNA. Some of the needs identified in the prior CHNA were similar to those identified in the most recent CHNA.Needs identified in our prior CHNA included:-Attaining and Retaining Young Families-Availability of resources to help the elderly stay in their homes-Depression/Anxiety Youth-Cost of Health Care InsuranceIn the current year, the facility took the following actions to address these needs as follows from the prior completed CHNA:Attracting and Retaining Young Families: As the largest employer in our service area, we realize the important part we play in impacting this need. We restructured our benefits and increased the employer contribution to make benefits more affordable and attractive to new employees. We adjusted wages based on salary surveys to be competitive in the market and will review annually salary and benefits to remain competitive. In addition, we have increased our marketing of services offered and career opportunities available. Daycare is available to employees as a fringe benefit. We designed an education reimbursement program for staff development and growth. Availability of resources to help the elderly stay in their homes: We have added home visits in several areas such as PT and RT and recently started offering telehealth visits in our clinics. If a needed service is not offered at HAMC at this time but is available in our service area, we communicate that to our patients. We also research the viability of adding that service in the future.Cost of Health Care Insurance: Although we may not be able to affect our entire service area's cost of health insurance, as the largest employer, reducing our employees' health insurance costs will have a significant impact in itself. We were able to join the NDHA Health Trust and save the staff with a reduction in health benefit expenses and avoided an increase that was proposed by Sanford had we not switched.The organization may not address the following needs identified as extensively due to limited resources and the need to allocate significant resources to the priority needs identified above, however the following actions have been taken:Depression/Anxiety in Youth: We were unable to successfully recruit a mental health provider due to the high demand for this specialty. We are working with a telehealth provider and made the staff aware of the benefit offered from our carrier. Talks have been ongoing to share these services with our school, county social services and the county prison but no movement at this time due to limited available mental health providers.

Heart of America Medical Center
Part V, Section B, Line 15e: As part of the application the patient will provide name demographic information, occupation, employer, spouse demographic and employment information, dependent information and insurance information.As part of the application patient may provide paystubs, or itemized income and expenses, or verification from welfare agencies, verification from unemployment or workers compensation, or income tax returns as supporting documentation.

Part V, Line 7b:
Other Website:https://ruralhealth.und.edu/projects/community-health-needs-assessment/reports

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. Community Health Improvement Services, line 7e, reflects actual expenses recorded to the general ledger. Medicaid, line 7b, and Subsidized health services, line 7g, were calculated based on information from the 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.

Part III, Line 3:
The Organization estimated the implicit price concessions attributable to patients who likely would qualify for financial assistance by applying the percentage of financial assistance applications sent out but not received back or not completed.

Part III, Line 4:
The footnote to the Organization's financial statements related to implicit price concessions can be found on page 13-14 of the attached audited financial statements.

Part III, Line 8:
Medicare allowable costs were obtained from 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.

Part III, Line 9b:
Our accounts are worked effectively and thoroughly with self-pay statements printed monthly once insurances have met their obligations. The goal is to obtain payment in full, establish acceptable payment arrangements, and look at other appropriate agencies or low income programs, or offer the charity care program if needed. In the collection process, the bill guarantor is reminded they may qualify for our charity care program and are given information on how to apply. Our third party collection company also offers charity care during collection calls. The statements explain who to call for a charity care application. Our charity program is income based and patients have 120 days to submit a financial assistance application, and uses 200% of the Federal poverty guidelines. If they qualify, the bill is written off 100% to charity care. Once approved they qualify for assistance for 6 months before and 6 months after of the approval date. After 120 days in collections, the account is written to bad debt. At least 30 days before we take extraordinary collection action we send notification. Up to 240 days we accept application and stop collection actions and reverse the collection effort.

Part VI, Line 2:
Heart of America Medical Center and its associated facilities serves a smaller community where providers know their patients. GSHA board members live in the communities we serve. We expect board members to bring back concerns of their communities so we can prioritize the needs. We also receive valuable community feedback from the HAMC Auxiliary Board and dozens of volunteers who contribute thousands of hours to the hospital and our long-term care and basic care facilities.

Part VI, Line 3:
Good Samaritan Hospital Association, doing business as Heart of America Medical Center, provides medical care regardless of patients' ability to pay. We provide information on federal, state and local payment assistance programs prior to the rendering of services or, in emergency situations, as soon as is appropriate. HAMC Community (Charity) Care is available for inpatient and outpatient hospital services, clinic services and swing bed care. Social work staff provide patients with this information. Patients can also find Community Care information on our website and it's also included with information on our Prompt Payment Discount program. Staff members processing self-pay bills encourage patients to apply for Community Care and our third-party collection company encourages patients to apply for Community Care if they are experiencing financial hardships.

Part VI, Line 4:
Heart of America Medical Center is a 25 bed Critical Access Hospital Designated Level V trauma center, Chemotherapy/infusion suite, surgical suite, pharmacy, lab, and radiology (including MRI on site). Outpatient services include wellness center, sports medicine, pain clinic, and diabetes education. Also, located in Rugby, N.D is the LTC nursing home and the separate campus at Haaland Estates which includes 60 basic care beds with a memory care unit and a 37-bed assisted living apartment building. Heart of America Johnson Clinics are in Rugby, Dunseith, and Maddock, N.D., serving people within a 50-mile radius of Rugby. The closest tertiary facility is 65 miles to the west. Our primary service area is Pierce County and portions of Benson, McHenry, Rolette, Wells, Towner, Sheridan, and Bottineau counties. According to the Fiscal Year 2022 CHNA, HAMC is providing crucial medical services to more than 13,000 people in their service area. Roughly 300 employees make HAMC the largest employer in the region. HAMC has a significant economic impact on the region with the annual payroll utilized in the region which also leads to additional jobs and income for the region as they interact with other sectors of the local economy. The population in Pierce County is 3,945, of which the majority have insurance via employers 71%, 13% Medicare, 12% self-insured, 6% Indian Health Services (IHS), 4% Medicaid, 3% Veterans Choice, 3% No insurance, 6% Other. Major employers in Rugby and Pierce County are the HAMC, Rugby Manufacturing, and the public schools.

Part VI, Line 6:
GSHA is not part of an affiliated healthcare system, however, as a Critical Access Hospital we provide and promote high-quality care for our patients via rural health network agreements with Trinity Medical Center in Minot and MedCenter One in Bismarck, N.D. These agreements enhance our patients' continuity of care by identifying and forming processes that facilitate patient referrals and easy transfer between facilities and enhance communication between providers. GSHA piggy-backs on Altru's Epic system and is an Accountable Care Organization.

Part VI, Line 5:
Good Samaritan Hospital Association is sponsored by 14 member churches located throughout our service area. The GSHA board of directors reside in our primary service area, are engaged in various occupations and activities and are elected by GSHA member churches. Through Heart of America Johnson Clinics, Heart of America Medical Center has a presence Rugby, Dunseith and Maddock, N.D., providing our patients with health care services close to home. We make specialty services in ophthalmology, podiatry, audiology and mental health available to our patients through partnerships with specialty clinics and providers. We offer state-of-the-art cancer treatment in our chemotherapy suite and recently added life-saving 3D mammography equipment to our radiology department. Heart of America Hospice provides personalized, holistic end-of-life care and services for local hospice patients and their families in a 60-mile radius of Rugby. Without GSHA, there will be no hospital, no emergency room, no rural health clinics, no surgical clinic, no skilled nursing care facility, no basic case facility, no assisted living facility, no wellness/fitness center in our service area. We operate most of these programs at a loss, but we continue to offer them to serve the needs of the people who live here. For those providers that apply to HAMC they have privileges in our community once approved by board of directors as presented by the medical staff.Surplus funds, if available, are used to improve the facility for patient care and upgrade the medical equipment.

Operating expenses	$ 27,141,309
Total amount spent on community benefits as % of operating expenses	$ 2,778,946 10.24 %