Community Benefit Insight - Tax-exempt hospital

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Ivinson Memorial Hospital

Ivinson Memorial Hospital

255 N 30th St
Laramie, WY 82072

Bed count	99	Medicare provider number	530025	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 300975387

Display data for year:

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

4.04%

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	$ 841,118 0.74 %
Medicaid as % of operating expenses	$ 3,774,064 3.30 %
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	$ 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	$ 9,391,095 8.22 %
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	$ 1,662,224 17.70 %

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 $ 104339309 including grants of $ 1929829) (Revenue $ 124545308)
IVINSON MEMORIAL HOSPITAL SERVES THE RESIDENTS OF ALBANY COUNTY, WYOMING AND THE SURROUNDING AREA. LARAMIE IS THE LARGEST CITY IN THE SERVICE AREA WITH A POPULATION OF APPROXIMATELY 32,000. THE SERVICES PROVIDED TO THE COMMUNITY ARE BEHAVIORAL HEALTH (INPATIENT), CARDIAC REHAB, CARDIOPULMONARY, CHAPLAIN, DIALYSIS, DISCHARGE PLANNING / SOCIAL SERVICES, EMERGENCY SERVICES, INFECTION CONTROL, INPATIENT ACUTE CARE, INTENSIVE CARE UNIT, IVINSON MEDICAL GROUP, LAB (ANATOMIC / CLINICAL), NUTRITIONAL COUNSELING, OB/GYN, ONCOLOGY, PEDIATRICS, PHARMACY, RADIATION THERAPY, RADIOLOGY / DIAGNOSTIC IMAGING, RADIOLOGY - MRI, RADIOLOGY - CT, RADIOLOGY - NUCLEAR MEDICINE, RADIOLOGY - MAMMOGRAPHY, REHAB - PHYSICAL / OCCUPATIONAL THERAPY, SLEEP LAB, SPEECH PATHOLOGY - INPATIENT (INCLUDING SWING BEDS)/ OUTPATIENT, SURGERY SERVICES, AND ULTRASOUND.FOR THE YEAR ENDED JUNE 30, 2022, IMH HAD THE FOLLOWING STATISTICS:ADMISSIONS 1,653EMERGENCY VISITS 12,191OUTPATIENT VISITS 83,822CLINIC VISITS 39,977IMH ALSO PROVIDED $1,929,829 IN CHARITY CARE FOR THE YEAR ENDED JUNE 30, 2022.IN 2022, CHARTIS RECOGNIZED IMH AS A TOP 100 RURAL FACILITY. THE CHARTIS CENTER BASES THEIR TOP 100 LIST ON THE HOSPITAL STRENGTH INDEX, AN ASSESSMENT OF A HOSPITAL'S PERFORMANCE IN INPATIENT/OUTPATIENT MARKET SHARE, QUALITY, OUTCOMES, PATIENT PERSPECTIVE, COST, CHARGE AND FINANCIAL EFFICIENCY. THIS IS THE FIFTH YEAR IN A ROW THAT IMH HAS BEEN RECOGNIZED AS A TOP 100 RURAL FACILITY. IN 2022, IMH ALSO RECEIVED AN A GRADE FROM THE LEAPFROG GROUP.

Facility Information

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

IVINSON MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: IVINSON MEMORIAL HOSPITAL REACHED OUT TO AN EXPANSIVE AND HIGHLY DIVERSE GROUP OF INDIVIDUALS TO PARTICIPATE IN ITS CHNA LEADERSHIP TEAM AND TO CONTRIBUTE INSIGHT FROM COMMUNITY SERVICE ORGANIZATIONS. EACH MEMBER PROVIDED PROJECT INSIGHT, FEEDBACK REGARDING PERCEPTIONS OF AREA HEALTH NEEDS, DATA EVALUATION, AND OTHER GUIDANCE DURING THE CHNA PROCESS. THESE INDIVIDUALS HAD A BREADTH OF COMMUNITY HEALTH VISION, KNOWLEDGE, AND POWER TO IMPACT THE WELL-BEING OF THE SERVICE AREA.IMH SOUGHT INPUT FROM THE COMMUNITY THROUGH A SURVEY THAT WAS DISSEMINATED THROUGH THE IMH WEBSITE, OUTREACH FROM IMH AND AFFILIATED (AND NON-AFFILIATED) COMMUNITY PARTNERS, AND OTHERS. THE SURVEY WAS OPEN FOR APPROXIMATELY 60 DAYS IN ORDER TO MAXIMIZE COMMUNITY INVOLVEMENT AND ANALYSIS OF RESULTS.

IVINSON MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: IN 2019, IVINSON MEMORIAL HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WORKING WITH COMMUNITY LEADERS, UNDERSERVED POPULATIONS RECEIVING SERVICES IN THE COMMUNITY AND OTHERS TO COMPLETE OUR CHNA AND IDENTIFY COMMUNITY HEALTH-RELATED NEEDS. FROM THAT ASSESSMENT, WE CREATED AN IMPLEMENTATION PLAN THAT IDENTIFIED THE FOLLOWING PRIORITIZED NEEDS: 1. BEHAVIORAL HEALTH AND SUBSTANCE USE SERVICES.2. AWARENESS OF AVAILABLE SERVICES ESPECIALLY IN WEST LARAMIE.3. EXPANSION OF, OR BETTER ACCESS TO, SERVICES IN WEST LARAMIE.4. CARE COORDINATION FOR HIGHER-NEED PATIENTS.IN 2020, THIS PLAN WAS UPDATED TO REFLECT THE CURRENT NEEDS OF THE COMMUNITY AS IMPACTED BY COVID-19. THE ADJUSTED IMPLANTATION PLAN IDENTIFIED THE FOLLOWING: 1. BEHAVIORAL HEALTH SERVICES.2. COVID-19 COMMUNITY HEALTH. - TESTING AND VACCINATIONS. - TELEHEALTH EXPANSION.3. CARE COORDINATION FOR HIGHER NEEDS PATIENTS.IN 2020 AND INTO 2021, IVINSON FOCUSED ON THE NEEDS OF OUR COMMUNITY SURROUNDING THE COVID-19 PANDEMIC. IN RESPONSE TO COMMUNITY NEEDS, IVINSON ENACTED THE FOLLOWING: - INITIATING COVID-19 DRIVE-UP TESTING: COVID-19 TESTING WAS MOVED INTO THE PARKING GARAGE AND TESTS WERE PERFORMED FROM PATIENT CARS. DRIVE-UP TESTING WAS AVAILABLE 5 DAYS A WEEK AND LATER DECREASED AS THE NEED FOR COMMUNITY TESTING DECREASED. MEMBERS OF THE WYOMING NATIONAL GUARD WERE SENT IN RESPONSE TO THE GREATER STAFFING NEEDS DUE TO THE PANDEMIC. - PARTNERING WITH THE UNIVERSITY OF WYOMING TO HOST A MOBILE TRAILER TRAVEL ON CAMPUS AND HAVE STAFF AVAILABLE TO TEST STUDENTS, STAFF AND ATHLETES FOR COVID-19. - OPENING AN URGENT CARE CLINIC TO TEST, TREAT AND VACCINATE AGAINST COVID-19. - PARTNERING WITH ALBANY COUNTY PUBLIC HEALTH AND THE UNIVERSITY OF WYOMING TO IMPLEMENT THE ALBANY COUNTY VACCINE CLINIC TO VACCINATE PATIENTS AGAINST COVID-19. - JOINING THE CITY OF LARAMIE AND OTHER LOCAL PARTNERS IN IMPLEMENTING A COVID-19 VACCINE INCENTIVE PROGRAM TO ENCOURAGE VACCINATION. - HOSTING OFF-SITE VACCINATION CLINICS. IN ADDITION, WE HAVE BEEN WORKING ON THE BEHAVIORAL NEEDS OF THE COMMUNITY AS NOTED BELOW: - WORKING WITH UCH TO USE TELEHEALTH WITH MENTAL HEALTH EXAMINERS AND IMH ER. - WORKING WITH ALBANY COUNTY MENTAL HEALTH BOARD TO CREATE A MENTAL HEALTH CRISIS RESPONSE TEAM, AND WORKING WITH LAW ENFORCEMENT ON CIT TRAINING (CRISIS INTERVENTION TEAM). - WORKING WITH ALBANY COUNTY ATTORNEY'S OFFICE ON EMERGENCY DETENTIONS AND THE GATEKEEPING PROGRAM.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
TO QUALIFY FOR ASSISTANCE UNDER IVINSON MEMORIAL HOSPITAL'S FINANCIAL ASSISTANCE POLICY, AN INDIVIDUAL MUST BE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND UNABLE TO PAY FOR EMERGENCY TREATMENT OR MEDICALLY NECESSARY CARE. THE FOLLOWING FACTORS ARE CONSIDERED IN DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE GRANTED:1. INDIVIDUAL OR FAMILY INCOME AND NET WORTH;2. EMPLOYMENT STATUS AND EARNING CAPACITY;3. FAMILY SIZE;4. OTHER FINANCIAL OBLIGATIONS; AND5. OTHER SOURCES OF PAYMENT FOR THE SERVICES RENDERED.

PART I, LINE 7:
THE COMMUNITY BENEFIT EXPENSES WERE CALCULATED USING THE SCHEDULE H INSTRUCTIONS' WORKSHEETS TO CALCULATE A COST-TO-CHARGE RATIO, WHICH WAS THEN APPLIED TO TOTAL EXPENSES.

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 $ 9,391,095.

PART III, LINE 2:
IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.

PART III, LINE 3:
THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE WAS ESTIMATED USING THE PERCENTAGE OF THE SERVICE AREA IDENTIFIED AS LIVING BELOW THE FEDERAL POVERTY LEVEL BASED ON THE MOST RECENT U.S. CENSUS DATA. ACCORDING TO THE U.S. CENSUS BUREAU, 17.7% OF ALBANY COUNTY RESIDENTS LIVED BELOW THE FEDERAL POVERTY LEVEL AS OF JULY 1, 2022.

PART III, LINE 4:
"SEE THE ""PATIENT ACCOUNTS RECEIVABLE, NET"" PARAGRAPHS ON PAGES 8-9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF IVINSON MEMORIAL HOSPITAL'S BAD DEBT EXPENSE."

PART III, LINE 8:
THE MEDICARE REVENUES AND ALLOWABLE COSTS OF CARE WERE CALCULATED USING THE JUNE 30, 2022 MEDICARE COST REPORT. THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE IVINSON MEMORIAL HOSPITAL PROVIDES THESE SERVICES TO THE ELDERLY INDIVIDUALS IN OUR COMMUNITY WHO WOULD LIKELY HAVE DIFFICULTY OBTAINING SUFFICIENT MEDICAL CARE WITHOUT THE MEDICARE PROGRAM.

PART III, LINE 9B:
IVINSON MEMORIAL HOSPITAL BILLS OUT ANY INSURANCE PRIOR TO BILLING THE PATIENT. THESE BILLS NORMALLY GO OUT WITHIN 7 DAYS OF THE SERVICE DATE. AFTER THE INSURANCE COMPANY HAS PAID ITS SHARE OF THE MEDICAL BILL, THE ACCOUNT IS POSTED FOR PAYMENTS AND ADJUSTMENTS AND THEN THE FIRST BILL IS SUBMITTED TO THE PATIENT. THREE STATEMENT CYCLES (MONTHLY) ARE SENT TO THE GUARANTOR FOR UNPAID ACCOUNTS BEFORE ANY REFERRAL TO AN OUTSIDE COLLECTION AGENCY IS MADE. EACH ACCOUNT IS INDIVIDUALLY REVIEWED PRIOR TO BEING SENT TO COLLECTION. IF THE PATIENT REQUESTS FINANCIAL ASSISTANCE, ALL BILLING/COLLECTION ACTIVITY IS SUSPENDED UNTIL A DETERMINATION IS MADE REGARDING THE PATIENT'S REQUEST FOR ASSISTANCE. EACH REQUEST IS REVIEWED BY THE BUSINESS OFFICE STAFF FOR COMPLETENESS AND QUALIFICATION AND THEN FURTHER REVIEWED BY THE PATIENT FINANCIAL SERVICES DIRECTOR AND CFO. THE PATIENT THEN RECEIVES A CALL AND A LETTER EXPLAINING THE DETERMINATION.

PART VI, LINE 2:
IN 2016, ALBANY COUNTY HOSPITAL DISTRICT PARTNERED WITH ALBANY COUNTY TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. THIS DOCUMENT WAS USED TO HELP SET STRATEGY FOR THE HOSPITAL DISTRICT, WHICH WAS TRANSFERRED TO IVINSON MEMORIAL HOSPITAL ON JANUARY 1, 2018. THAT COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED PHYSICIAN AVAILABILITY AS ONE OF THE SIGNIFICANT ISSUES, SO IMH HAS BEEN WORKING TO IMPROVE THIS SINCE 2016.

PART VI, LINE 3:
IVINSON MEMORIAL HOSPITAL EDUCATES THE PUBLIC ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH THE FOLLOWING PROCESSES:1. INFORMATION ON BILLING STATEMENTS AND PATIENT CONSENT FORMS;2. INFORMATION POSTED IN EMERGENCY ROOMS, ADMITTING LOCATIONS, WAITING ROOMS, THE BUSINESS OFFICE, AND OTHER PUBLIC PLACES;3. PUBLICATION ON THE HOSPITAL'S WEBSITE;4. PUBLICATION ON BROCHURES AVAILABLE IN PATIENT ACCESS SITES AND OTHER LOCATIONS IN THE COMMUNITY; AND5. REFERRALS GIVEN TO SPECIFIC PATIENTS BY HOSPITAL STAFF.

PART VI, LINE 4:
THE HOSPITAL'S PRIMARY SERVICE AREA IS ALBANY COUNTY, WYOMING. THE LARGEST CITY IN THE COUNTY IS LARAMIE. THE SECONDARY SERVICE AREA INCLUDES SEVERAL ADDITIONAL COUNTIES IN WYOMING AND PARTS OF NORTHERN COLORADO.

PART VI, LINE 6:
IVINSON MEMORIAL HOSPITAL AFFILIATED WITH UCH AS THEY PROVIDE IVINSON MEMORIAL HOSPITAL A CEO BUT IVINSON MEMORIAL HOSPITAL IS INDEPENDENT AND IS OPERATED BY A FULLY INDEPENDENT BOARD OF DIRECTORS.

Operating expenses	$ 114,215,879
Total amount spent on community benefits as % of operating expenses	$ 4,615,182 4.04 %