Community Benefit Insight - Tax-exempt hospital

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Dimmit Regional Hospital

Dimmit Regional Hospital District

70440 Spiral Drive
Carrizo Springs, TX 78834

Bed count	25	Medicare provider number	451390	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 263091251

Display data for year:

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

11.32%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2017-2021

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	$ 3,542,829 11.30 %
Medicaid as % of operating expenses	$ 0 0 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 7,386 0.02 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 5,572,939 17.77 %
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 $ 19167815 including grants of $ 0) (Revenue $ 19687848)
PROVIDED MEDICAL CARE TO RESIDENTS IN THE DIMMIT COUNTY AREA, INCLUDING 217 OPERATIONS; 9,513 EMERGENCY ROOM VISITS; 492 OBSERVATIONS VISITS AND 2,282 PATIENT DAYS.

4B (Expenses $ 4791955 including grants of $ 0) (Revenue $ 6313632)
WE ACHIEVED OUR GOAL TO PROVIDE A COMFORTABLE STAY FOR PATIENTS WHICH INCREASED OUR PATIENT DAYS. OUR SWING BED PROGRAM ALSO DID WELL AND WE WERE ABLE TO PROVIDE MORE REHAB SERVICES TO THE SWING BED PATIENTS THROUGH PHYSICAL THERAPY, SPEECH THERAPY AND OCCUPATIONAL THERAPY. WE ALSO INSTALLED A CUDDLES SECURITY SYSTEM FOR OUR LABOR & DELIVERY AND NURSERY. WE ALSO REPLACED 10 PATIENT BEDS, A BIRTHING BED, AND ADDED a WIRELESS FETAL MONITOR. WE REPLACED 8 STRETCHERS AND AN ANESTHESIA MACHINE AND PURCHASED BLOOD GAS ANALYZER AND A MICROBOLOGY ANALYZER TO PROVIDE ADDITIONAL TESTS TO PATIENTS SO THEY WOULD NOT HAVE TO TRAVEL OUT OF TOWN FOR THEM.

4C (Expenses $ 2177032 including grants of $ 0) (Revenue $ 5052603)
THE ACQUISITON OF A PHYSICIAN PRACTICE HAS ALLOWED US TO SET UP A PROVIDER BASED RURAL HEALTH CLINIC TO PROVIDE HEALTHCARE SERVICES TO OUR RURAL COMMUNITY. WE ADDED ANOTHER NURSE PRACTITIONER TO THE CLINIC. THE CLINIC DOORS HAVE ALSO BEEN UPGRADED TO PROVIDE A SECURE SETTING FOR PATIENTS. THE ER BAY DOORS WERE ALSO REPLACED. WE ARE ALSO PROVIDING PHYSICAL THERAPY AND SPEECH THERAPY TO OUR SWING BED PATIENTS AND ARE IN THE PROCESS OF ADDING OCCUPATIONAL THERAPY. WHEELCHAIRS WERE ALSO PURCHASED FOR THE HOSPITAL AND CLINIC.

Facility Information

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

SCHEDULE H, PART V, SECTION B, LINE 5
INPUT FROM THE COMMUNITY: THE ORGANIZATION CONDUCTED INTERVIEWS IN ELEVEN FORMAL FOCUS GROUPS WITH COMMUNITY HEALTH PROFESSIONALS, COUNTY/CITY GOVERNMENTAL OFFICIALS, EDUCATORS, AND GENERAL BUSINESS LEADERS, PUBLIC CITIZENS, AND COMMUNITY NON-PROFITS.

SCHEDULE H, PART V, SECTION B, LINE 11
IDENTIFIED NEEDS ADDRESSED AND NOT ADDRESSED: THE CURRENT IMPLEMENTATION STRATEGY COVERS THE 2022 FISCAL YEAR. HOWEVER, THE MAJOR PRIORITIES IDENTIFIED IN THE 2014, 2016, 2019 AND THE RECENT 2022 ASSESSMENTS ARE NOT SIGNIFICANTLY DIFFERENT. THIS DOES NOT MEAN THAT THERE HAS NOT BEEN PROGRESS MADE BUT SIMPLY SHOWS THE SAME ISSUES ARE STILL CONSIDERED TO BE IMPORTANT BY THE COMMUNITY, AND THE HOSPITAL'S FOCUS SHOULD CONTINUE TO BE ON THOSE ISSUES. THE NEXT IMPLEMENTATION PLAN WILL ADDRESS THE FOLLOWING NEEDS IDENTIFIED IN THE MOST RECENT CHNA: 1. AFFORDABLE HEALTHCARE: MANY PARTICIPANTS IN THE FOCUS GROUPS STATED THAT DUE TO THE LACK OF INSURANCE OR NOT HAVING ADEQUATE INSURANCE, SOME RESIDENTS DELAYED IN SEEKING MEDICAL CARE FOR CHRONIC DISEASES AND OTHER HEALTH ISSUES BECAUSE THEY CANNOT AFFORD THE CARE. HOSPITAL LEADERSHIP IS INVESTIGATING EVERY POSSIBLE AVENUE TO CONTINUE TO OFFER CASH DISCOUNTS, SLIDING SCALES AND EVEN OFFER BOUTIQUE PAYMENT PLANS TO OFFER CITIZENS EVERY POSSIBLE ALTERNATIVE FOR PAYMENT OF HOSPITAL SERVICE. 2. CHRONIC DISEASES AND HEALTHY LIVING: THERE IS A CONCERN IN THE COMMUNITY FOR ADDRESSING CHRONIC DISEASES IN CARRIZO SPRINGS, INCLUDING DIABETES, HEART DISEASE, CANCER, HYPERTENSION AND MENTAL HEALTH. DRH WILL LOOK INTO PARTNERING WITH OTHER AGENCIES TO CONTINUE TO OFFER SEVERAL HEALTH FAIRS AND HEALTH SCREENINGS THROUGHOUT THE YEAR AS WELL AS EDUCATION PRESENTATIONS IN A REGIONAL AGENCY WIDE EDUCATIONAL FORUM. 3. MENTAL HEALTH NEEDS: ALL FOCUS GROUP PARTICIPANTS MENTIONED THE ISSUES OF MENTAL HEALTH CONCERNS WITHIN THE COMMUNITY. WHILE THIS A MAJOR HEALTH ISSUE FACING ALL COMMUNITIES AND TOP NUMBER ONE HEALTH ISSUE AMONG TEXANS, IT IS BEYOND THE HOSPITAL'S CURRENT RESOURCES OR CAPABILITIES. THE HOSPITAL MAY LOOK TO PARTNER WITH OTHER ORGANIZATIONS TO HELP ADDRESS THIS NEED IN THE FUTURE. 4. ALCOHOL AND SUBSTANCE ABUSE: PARTICIPANTS OF DIMMIT COUNTY FELT THAT THERE IS AN ALCOHOL AND SUBSTANCE ABUSE PROBLEM SIMILAR TO OTHER COMMUNITIES. FOCUS GROUPS MENTIONED THE NEED FOR EDUCATION ABOUT ALCOHOL AND DRUG ABUSE FOR ADULTS AND TEENS. THERE WAS A CONSENSUS THAT THE SCHOOL AND HOSPITAL SHOULD WORK CLOSELY ON CREATING A DRUG ABUSE SCHOOL PROGRAM THAT WOULD EDUCATE BOTH THE STUDENTS AND PARENTS OR SENIORS IN THE COMMUNITY ABOUT ALCOHOL AND DRUG ABUSE.

SCHEDULE H, PART V, SECTION B, LINE 7A & 10A
THE CHNA AND IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST OR AT THE FOLLOWING ADDRESS: WWW.DIMMITREGIONALHOSPITAL.COM/GETPAGE.PHP?NAME=COMMUNITY_HEALTH_NE EDS_ASSESSMENT&SUB=COMMUNITY+HEALTH+NEEDS+ASSESSMENT

SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C
AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM POLICY: THE FAP, FAP APPLICATION, AND FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST OR AT THE FOLLOWING ADDRESS: https://www.dimmitregionalhospital.com/docs/Financial_Assistance_Plain_Lan guage_Summary.pdf

SCHEDULE H, PART V, SECTION B, LINES 18, 19, & 20
BILLING AND COLLECTIONS: NEITHER DIMMIT REGIONAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY DIMMIT REGIONAL HOSPITAL, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY.

Supplemental Information

Schedule H (Form 990) Part VI

SCHEDULE H, PART III, SECTION A, LINE 2
METHODOLOGY TO ESTIMATE BAD DEBT EXPENSE: WHEN A PATIENT COMES IN THEIR ACCOUNT IS SET UP WITH A COLLECTION CODE. THERE ARE 4 BILLING CYCLES WHERE FOUR STATEMENTS ARE SENT TO THE PATIENT AND THEN A COLLECTION LETTER IS SENT BASED ON THE COLLECTION CODE. ACCOUNTS ARE THEN REVIEWED AFTER THE SYSTEM FLAGS THEM BASED ON THE COLLECTION CODE BEFORE THE ACCOUNTS ARE WRITTEN OFF TO BAD DEBT. THE AMOUNT ON LINE 2 IS BASED ON THIS INTERNAL METHODOLOGY.

SCHEDULE H, PART III, SECTION A, LINE 3
BAD DEBT AS A COMMUNITY BENEFIT: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT FOOTNOTE: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS.

SCHEDULE H, PART III, SECTION B, LINE 8
COSTING METHODOLOGY: THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT.

SCHEDULE H, PART III, SECTION C, LINE 9B
COLLECTION PRACTICES: THE HOSPITAL HAS AMENDED THEIR COLLECTIONS POLICY TO INCLUDE THE PRACTICES TO BE FOLLOWED FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ONLY COLLECTIONS NEEDED ARE THE CO-INSURANCE AND DEDUCTIBLE AMOUNT. ALL OTHER COLLECTIONS WILL CEASE. THIS POLICY IS ON THE WEBSITE ALONG WITH THE OTHER FINANCIAL ASSISTANCE DOCUMENTS.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: THE HOSPITAL HAS A COMMITTEE STAFFED BY EMPLOYEES RESPONSIBLE FOR REACHING OUT AND MEETING WITH COMMUNITY MEMBERS ON REGULAR BASIS. THESE MEETINGS ARE USED TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS GIVEN TO ALL PATIENTS. CHARITY CARE APPLICATIONS ARE GIVEN TO E.R. PATIENTS THAT ARE SELF PAY. A LETTER IS MAILED WITH A CHARITY CARE APPLICATION TO THESE PATIENTS. FOLLOW-UP CALLS ARE THEN MADE TO THE PATIENTS RECEIVING APPLICATIONS TO EXPLAIN AND ASK IF THEY NEED HELP IN COMPLETING THEM. AT REGISTRATION OR ADMISSION, CHARITY CARE APPLICATIONS ARE GIVEN TO INPATIENTS AND OUTPATIENTS THAT ARE SELF PAY. WE ALSO HAVE AN HFAP COORDINATOR, MONDAY THRU FRIDAY, 8AM TO 5PM, THAT WILL TALK TO THESE PATIENTS AND EXPLAIN WHAT ASSISTANCE WE HAVE AVAILABLE. IF AN APPLICATION IS REQUESTED AT A LATER DATE, IT IS SENT TO THE PATIENT.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: DIMMIT COUNTY ESTIMATED POPULATION IS 8,615 WITH A TOTAL SERVICE AREA OF 12,542 PEOPLE. THE GENDER COMPOSITION IS 49.30% MALE AND 50.70% FEMALE. THE POVERTY RATE IS 25.70% AND THE MEDIAN INCOME PER HOUSEHOLD IS $25,000.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH: A SPECIALTY CLINIC WAS STARTED AND CURRENTLY SERVICES PODIATRY, DENTAL SERVICES AND CARDIOLOGY. DIMMIT REGIONAL HOSPITAL HAS RECRUITED AN ORTHOPEDIC SURGEON AND RECRUITING AN ENT AND ONCOLOGY. THIS WILL HELP ALLEVIATE FINANCIAL STRAIN FOR PATIENTS WHO NEED SPECIALTY CARE AND HAVE TO TRAVEL TO OBTAIN IT. EDUCATION PROGRAMS ARE ALSO PROVIDED TO PROMOTE HEALTHCARE HABITS. ADDITIONALLY, HEALTH FAIRS ARE ALSO HELD. DRH ALSO HAS A TELEMEDICINE PROJECT WITH METHODIST HOSPITAL IN SAN ANTONIO TO PROVIDE STROKE ALERT SERVICES IN THE EMERGENCY ROOM. A COMMUNITY HEALTH SURVEY WAS CONDUCTED TO FIND OUT WHAT ARE THE COMMUNITY'S HEALTH PRIORITY CONCERNS. THE HOSPITAL HAS BEEN DESIGNATED AS A RURAL HEALTH CLINIC. DRH HAS ALSO EMPLOYED A GENERAL SURGEON, WHO IS SHARED WITH FRIO REGIONAL HOSPITAL.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM: N/A

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS

SCHEDULE H, PART I, LINE 3C
FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: - MEDICAL INDIGENCY - INSURANCE STATUS - UNDERINSURANCE STATUS - RESIDENCY

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE, TOTALING $5,572,939.

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION COST ON IRS WORKSHEETS 1 AND 3. COSTS COMPUTED ON WORKSHEET 5 WERE COMPUTED USING STATE SUPPLEMENTAL COST REPORTS.

Operating expenses	$ 31,357,465
Total amount spent on community benefits as % of operating expenses	$ 3,550,215 11.32 %