4A (Expenses $ 96863527 including grants of $ 7800) (Revenue $ 109728516)
THE HOSPITAL PROVIDED 4,579 DAYS OF CARE TO 1,093 PATIENTS IN 2021. IN ADDITION, THE HOSPITAL PROVIDED APPROXIMATELY 324,484 OUTPATIENT VISITS IN THE EMERGENCY ROOM, RENTAL DIALYSIS, SURGICAL, AND OTHER PATIENT SERVICE CENTERS. THE HOSPITAL PROVIDED APPROXIMATELY $1,397,000 IN CHARITABLE SERVICES TO PATIENTS UNABLE TO PAY FOR HEALTHCARE SERVICES.

TRI-STATE MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: THE CHNA WAS PREPARED IN PARTICIPATION AND SUPPORT WITH THE SE WASHINGTON HEALTH PARTNERSHIP AND THE GREATER COLUMBIA ACCOUNTABLE COMMUNITIES OF HEALTH. THEIR FINDINGS AND PRIORITIES INFORMED OUR OWN PROCESS. OTHER ORGANIZATIONS THAT CONTRIBUTED THEIR TIME AND PERSPECTIVES THE THIS CHNA THROUGH KEY INFORMATION SURVEYS INCLUDE: CITY OF CLARKSTON, CITY OF LEWISTON, THE ASOTIN COUNTY HEALTH DISTRICT, LOCAL SCHOOL DISTRICTS, TWIN COUNTY UNITED WAY, THE SALVATION ARMY-LEWISTON, NORTHWEST CHILDREN'S HOME, THE YWCA, TSMH FAMILY PRACTICE, LEWIS-CLARK VALLEY CHAMBER OF COMMERCE, THE LOCAL BEHAVIORAL HEALTH AND AGING AND DISABILITY PROVIDERS AS WELL AS OTHER KEY EMPLOYERS AND CIVIC LEADERS IN THE LEWIS-CLARK VALLEY COMMUNITY.

TRI-STATE MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: TSMH HAS ELECTED TO CONTINUE TO BUILD OFF THE PREVIOUS CHNA PRIORITIES. WE HAVE SELECTED AS OUR OVERALL PRIORITY SUPPORT INDIVIDUALS AND FAMILIES THROUGH ACCESS TO CARE AND COMPREHENSIVE PRIMARY-CARE BASED PREVENTIVE WELLNESS PROGRAMMING. SPECIFIC STRATEGIES THAT CONTINUE INCLUDE RECRUIT ADDITIONAL PRIMARY CARE PROVIDERS, CONTINUE GROWTH OF BEHAVIORAL HEALTH SERVICES, DEVELOP AND OFFER LOWER COST MEANS OF ACCESSING CARE (I.E. VIRTUAL CARE), PARTNER WITH COMMUNITY ORGANIZATIONS TO EDUCATE, INFORM AND SUPPORT YOUTH AND ADULTS AROUND HEALTHY LIVING. STRATEGIES BEING CONSIDERED INCLUDE ENHANCED MENTAL/BEHAVIORAL HEALTH STRATEGIES: RECRUIT ADDITIONAL MENTAL HEALTH CARE PROVIDERS, INCLUDING MID-LEVEL PROVIDERS IMPROVE RATE OF SCREENING FOR MENTAL HEALTH AND SUBSTANCE ABUSE DISORDERS IN PRIMARY CARE, AND RATE OF REFERRALS FOR MENTAL HEALTH/SUBSTANCE ABUSE DISORDERS PARTNER WITH LOCAL ORGANIZATIONS TO IMPLEMENT COMMUNITY-BASED SUICIDE PREVENTION STRATEGIESCHILDREN AND YOUTH WORK WITH PARTNERS TO IMPLEMENT STRATEGIES TO REDUCE CHILDHOOD FOOD INSECURITY, INCLUDING FOOD BACKPACKS IN SCHOOLS AND IN-KIND DONATIONS TO LOCAL FOOD BANKS WORK WITH SCHOOLS AND LOCAL BUSINESSES TO IMPLEMENT AND EVALUATE ANTI-VAPING CAMPAIGNS AND TOOLKITS

PART I, LINE 7:
THE COST-TO-CHARGE RATIO USED WAS DERIVED BASED ON THE FILED 2020 MEDICARE COST REPORT.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,743,768.

PART II, COMMUNITY BUILDING ACTIVITIES:
TRI-STATE MEMORIAL HOSPITAL HELPS PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES BY PROVIDING SUPPORT AMONGST A NUMBER OF LOCAL CHARITIES, FOOD BANKS AND OTHER AGENCIES. IN 2021 TRI-STATE HOSPITAL CONTRIBUTED $7,500 TO THE BOYS AND GIRLS CLUBS OF THE LEWIS-CLARK VALLEY WHICH THEY USED FOR THE PARTNERSHIP FOR KIDS, THE ANNUAL CAMPAIGN, THE GRILLED CHEESE PROGRAM AND MEDICAL SUPPLIES/FIRST AID DONATIONS. THE WORLD SERIES OF NAIA BASEBALL IS PLAYED IN LEWISTON AND TRI-STATE MEMORIAL HOSPITAL SPONSORED THAT EVENT AND SPONSORED THE MEDICAL TENT AND REFRESHMENTS FOR ALL MEDICAL VOLUNTEERS FOR THIS EVENT. ADDITIONALLY, TRI-STATE MEMORIAL HOSPITAL GAVE DONATIONS TO THE WASHINGTON POISON CONTROL, VALLEY VISION, AND FIELD OF DREAMS. TRI-STATE MEMORIAL HOSPITAL CONTINUES TO FIND WAYS TO SUPPORT THE COMMUNITIES IT SERVES IN BROAD AND EXPANDING WAYS, TRYING TO REACH ALL PATIENTS FROM ADOLESCENCE TO ADULTHOOD.

PART III, LINE 2:
THE ORGANIZATION'S BAD DEBT EXPENSE AT COST WAS ESTIMATED BY MULTIPLYING THE BAD DEBT EXPENSE BY THE ORGANIZATION'S COST-TO-CHARGE RATIO.

PART III, LINE 3:
THE FACILITY REPORTS BAD DEBT EXPENSE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NUMBER 15, SO NONE OF THE BAD DEBT EXPENSE REPORTED ON SCHEDULE H, PART III, LINE 2 IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FACILITY'S FINANCIAL ASSISTANCE POLICY.

PART III, LINE 4:
WHILE THE FACILITY DOES NOT HAVE A NOTE REGARDING BAD DEBT EXPENSE IN ITS FINANCIAL STATEMENTS, THE AMOUNT OF BAD DEBT EXPENSE FOR EACH YEAR IS DISCLOSED ON THE FACILITY'S STATEMENTS OF REVENUE AND EXPENSES. THE AMOUNT OF BAD DEBT EXPENSE REPORTED WAS $1,743,768 FOR THE YEAR ENDED DECEMBER 31, 2021. THE COSTING METHODOLOGY USED TO DETERMINE THE COST OF BAD DEBT IS BASED ON THE FACILITY'S CALCULATED COST-TO-CHARGE RATIO.

PART III, LINE 8:
THE FACILITY IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED BY MEDICARE AT APPROXIMATELY 99% OF MEDICARE'S COSTS.THE TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FACILITY'S FILED 2021 MEDICARE COST REPORT.

PART III, LINE 9B:
"THE FULL PATIENT BALANCE FOR THOSE KNOWN TO QUALIFY FOR CHARITY CARE WILL BE EVALUATED FOR FINANCIAL ASSISTANCE ELIGIBILITY AS FOLLOWS: THEY QUALIFY FOR A 100% DISCOUNT IF THE PATIENT'S GROSS FAMILY INCOME IS AT OR BELOW 100% OF THE CURRENT FEDERAL POVERTY GUIDELINES, THEY QUALIFY FOR A 75% DISCOUNT IF THE PATIENT'S GROSS FAMILY INCOME IS AT OR BETWEEN 101% TO 200% OF THE CURRENT FEDERAL POVERTY GUIDELINES, AND THEY QUALIFY FOR A 35% DISCOUNT IF THE PATIENT'S GROSS FAMILY INCOME IS AT OR BETWEEN 201% TO 300% OF THE CURRENT FEDERAL POVERTY GUIDELINES.THE HOSPITAL MAY CHOOSE TO GRANT FINANCIAL ASSISTANCE BASED SOLELY UPON THE INITIAL DETERMINATION OF THE PATIENT. ANY PATIENTS WHO ARE ON STATE ASSISTANCE, ARE UNEMPLOYED, DISABLED, TRANSIENT OR INCOMPETENT MAY BE VALID ""PRIMA-FACIE"" CANDIDATES. IN SUCH CASES, THE HOSPITAL MAY NOT COMPLETE FULL VERIFICATION OR DOCUMENTATION OF ANY REQUESTS.UNINSURED AND UNDERINSURED WASHINGTON AND IDAHO PATIENTS MAY QUALIFY FOR A DISCOUNT. DETERMINATION WILL BE MADE BY TSMH ADMINISTRATION UPON PATIENT'S COMPLETION OF THE SPECIAL CONSIDERATION FINANCIAL ASSISTANCE APPLICATION AND THE SPECIFIED SUPPORTING DOCUMENTATION AS PROOF OF SEVERE FINANCIAL HARDSHIP OF PERSONAL LOSS FROM TIME OF REQUEST BASED ON ECONOMIC SITUATION. THE COLLECTION PRACTICE FOR PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE IS AS FOLLOWS: 75% OF THE PATIENT'S BILL IS ADJUSTED OFF IF THE PERSON IS BETWEEN 101-200% OF THE FPL TO CHARITY CARE AND THE REMAINING 25% IS THE PATIENT'S RESPONSIBILITY. IF THE PATIENT IS UP TO 100% OF THE FPL THEN 100% OF THE PATIENT'S BILL IS ADJUSTED OFF AS CHARITY CARE. THIS POLICY IS APPLIED TO ALL PATIENTS THAT HAVE COMPLETED A FINANCIAL ASSISTANCE APPLICATION AND WHOSE INCOMES LEVELS HAVE BEEN VERIFIED. PATIENTS ARE ALSO IDENTIFIED WHO MAY BE ELIGIBLE FOR ASSISTANCE BEYOND THE HOSPITAL THROUGH MEDICAID OR COUNTY AID."

PART VI, LINE 2:
IN 2019 THE CHNA WAS PREPARED IN PARTICIPATION AND SUPPORT WITH THE SE WASHINGTON HEALTH PARTNERSHIP AND THE GREATER COLUMBIA ACCOUNTABLE COMMUNITIES OF HEALTH. THEIR FINDINGS AND PRIORITIES INFORMED OUR OWN PROCESS. OTHER ORGANIZATIONS THAT CONTRIBUTED THEIR TIME AND PERSPECTIVES THE THIS CHNA THROUGH KEY INFORMATION SURVEYS INCLUDE: CITY OF CLARKSTON, CITY OF LEWISTON, THE ASOTIN COUNTY HEALTH DISTRICT, LOCAL SCHOOL DISTRICTS, TWIN COUNTY UNITED WAY, THE SALVATION ARMY-LEWISTON, NORTHWEST CHILDREN'S HOME, THE YWCA, TSMH FAMILY PRACTICE, LEWIS-CLARK VALLEY CHAMBER OF COMMERCE, THE LOCAL BEHAVIORAL HEALTH AND AGING AND DISABILITY PROVIDERS AS WELL AS OTHER KEY EMPLOYERS AND CIVIC LEADERS IN THE LEWIS-CLARK VALLEY COMMUNITY.

PART VI, LINE 3:
FINANCIAL BROCHURES ARE SENT WITH ITEMIZED STATEMENTS TO ALL UNINSURED PATIENTS. AT THE TIME PATIENT MAKES CONTACT, THE PATIENT FINANCIAL COUNSELOR WILL:1. DISCUSS THE HOSPITAL GUIDELINE FOR REIMBURSEMENT OF HOSPITAL SERVICES.2. THE 10% DISCOUNT IS OFFERED TO UNINSURED PATIENTS WHEN BALANCE IS PAID IN FULL. 3. ESTABLISH A PAYMENT CONTRACT IN ORDER TO RESOLVE THE ACCOUNT BALANCE WITHIN APPLICABLE GUIDELINES. THE MINIMUM ACCEPTABLE PAYMENT IS $50 OR 5% (WHICHEVER IS GREATER).4. IDENTIFY A PATIENT WHO MAY BE ELIGIBLE FOR ASSISTANCE TO INCLUDE BUT NOT LIMITED TO MEDICAID OR COUNTY AID FOR THE STATE THE PATIENT RESIDES.5. DETERMINE IF HOUSEHOLD INCOME MEETS OR FALLS BELOW THE CURRENT YEAR'S POVERTY GUIDELINES THEN EXPLAIN TSMH FINANCIAL ASSISTANCE PROGRAM.

PART VI, LINE 4:
TSMH IS LOCATED IN THE LEWIS-CLARK VALLEY (THE VALLEY), AT THE CONFLUENCE OF THE SNAKE AND CLEARWATER RIVERS IN THE SOUTHEASTERN MOST CORNER OF WASHINGTON STATE. THE CITY OF CLARKSTON IS CONTIGUOUS TO THE CITY OF LEWISTON IN NEIGHBORING NEZ PERCE COUNTY IN IDAHO. TSMH SERVES RESIDENTS OF BOTH ASOTIN COUNTY AND ADJOINING NEZ PERCE COUNTY. COLLECTIVELY, THESE TWO COUNTIES ACCOUNT FOR CLOSE TO 80% OF TSMH'S PATIENTS AND ARE CONSIDERED THE SERVICE AREA COMMUNITY (COMMUNITY).

PART VI, LINE 5:
THE HOSPITAL PERFORMS SURGERIES REQUIRING INPATIENT STAYS AND ALSO SAME DAY OPERATIONS, NOT REQUIRING A HOSPITAL STAY. OUTPATIENT SERVICES INCLUDE RENAL DIALYSIS CENTERS IN CLARKSTON, WA, WOUND HEALING & HYPERBARIC CENTER, SLEEP DIAGNOSTIC CENTER, AND A 24 HOUR PHYSICIAN STAFFED EMERGENCY DEPARTMENT. OTHER OUTPATIENT SERVICES INCLUDE A NEPHROLOGY CENTER, PRIMARY CARE CLINIC, INTERNAL MEDICINE CLINIC, GENERAL SURGERY CLINIC, UROLOGY CLINIC, RHEUMATOLOGY CLINIC, AND PAIN CLINIC. THE HOSPITAL OPERATES WITH OVER 657 FULL AND PART-TIME EMPLOYEES, 41 VOLUNTEERS AND 325 PHYSICIANS ON STAFF. TRI-STATE HOSPITAL FOUNDATION IS A NON-PROFIT ORGANIZATION WHICH BENEFITS THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL. GIFTS TO THE FOUNDATION ARE USED TO PURCHASE SPECIALIZED EQUIPMENT THAT HELP EXPAND SERVICES PROVIDED BY THE HOSPITAL TO THE COMMUNITY.