Community Benefit Insight - Tax-exempt hospital

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Hot Springs County Hospital Dist

Hot Springs County Memorial

150 East Arapahoe
Thermopolis, WY 82443

Bed count	25	Medicare provider number	531304	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 836000182

Display data for year:

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

5.9%

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	$ 350,026 1.01 %
Medicaid as % of operating expenses	$ 797,392 2.31 %
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	$ 686,104 1.98 %
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.	$ 208,511 0.60 %
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	$ 1,619,817 4.68 %
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	$ 485,945 30.00 %

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 $ 30959231 including grants of $ 0) (Revenue $ 33103388)
Hot Springs County Hospital District (the Hospital), a not for profit and governmental hospital, provides compassionate medical care for all, regardless of their ability to pay. The Hospital offers 24/7 emergency care (2,504 visits), inpatient services (1,186 patient days), outpatient services (18,242 visits), HSH-Basin Clinic (4,013 visits), HSH-Thermopolis Clinic (12,407 visits), HSH-Worland Clinic (6,946 visits), HSH-Surgical Clinic (1,302 visits), HSH-Riverton Clinic (1,490 visits), and HSH-Shoshoni Clinic (803 visits).The Hospital has a financial assistance program under which services are provided for free or at a reduced rate. Charity Care awarded under the financial assistance program totaled $510,987. The cost of charity care for the year ended June 30, 2022 based on direct and indirect cost of providing charity care services was $350,026.Many employees are teachers in the education programs open to the public such as Certified Nursing Assistant and CardioPulmonary Resuscitation. An agreement with the University of Wyoming, Central Wyoming College and Northeastern Wyoming College encourages nursing, pharmacy, and social services students to intern at the Hospital. Health information links are available on the Hospital website.Comfort carts and free meals are available for families during stressful conditions. HSH-Clinics provide reduced or free exams for school athletics, medicine assistance, blood pressure screening and community education seminars. The Hospital offers scholarships to qualifying candidates wanting to advance their education to the betterment of the Hospital and Community. Community Resource Training for High School Students and the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) medical education program, which promotes medical education in Western States, are two long-time programs in which the Hospital participates.

Facility Information

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

Hot Springs County Hospital District
Part V, Section B, Line 5: The community health needs assessment steering committee is comprised of the following hospital representatives: CEO, RNs and Chief Nursing Officer. The steering committee also comprised of the following community represenatives: BSW Social Worker, Hot Springs County Public Health, Public Health Officer and Hot Springs County Community Prevention Program Coordinator. In addition, members of the Hot Springs County Prevention Coalition provided input for the development of the community health needs assessment. The members included, an RN, Public Health Officer, Coordinator, Hot Springs County Community Prevention Program, Wellspring Counseling, Assistant County Attorney, Executive Director Thermopolis Chamber of Commerce, Hot Springs County Victim Witness Program, Wyoming Pioneer Home Administrator, Public Health Response Coordinator, Hot Springs County Sheriff Department, Wisdom Tree Counseling, Executive Director Wellspring Counseling Services, Executive Director Hope Agency, Executive Director Childrens Resource Center, Administrative Assistant Hot Springs County Commissioners, Hot Springs County Youth Alternatives, Supervisor Department of Family Services, Hot Springs County School District Counselor, and Head Start.

Hot Springs County Hospital District
Part V, Section B, Line 11: The community health needs were prioritized based on the following five criteria:1. Magnitude/scale of the problem2. Severity of the problem3. Health disparities4. Importance to the community5. Ability to leverage the three priority community health needs chosen were behavioral health, poverty, and opioidsThe needs identified in the 2019 CHNA were behavior health, poverty and use of opiods. All three were addressed in the tax year.The goal for behavioral health is to have more access to behavioral health services. Poverty goals included decreasing poverty and increasing services. The opioid goals include reduction in use and education. The community partners for these three initiatives include Hot Springs County Prevention Coalition, Hot Springs County School District 1, Wellspring Counseling Center, law enforcement, the county attorney's office, Hope Agency, Wisdom Tree Counseling, Youth Alternatives Program, Help Center, Yellowstone Community Assistance Network, Department of Family Services, Hot Springs County Public Health, Ministerial Alliance, River of Life Fellowship, Hot Springs County Senior Center, Messiah's Mall.During the current tax year the following actions were taken to address the identified needs:Behavioral Health:-Expanded access to mental health counselors through recruitment and retention for practices and possible telemedicine program provided for the community-Expanded services for children with a variety of behavioral health needs including developmental delays and behavioral issues through the school system-Created more community awareness on suicide, alcohol/drugs/tobacco use and abuse, and mental health crisisPoverty:-Educated the community on lower cost preventative services-Established people in the community willing to help with insurance applications-Educated the front-line workers on resources available in the community -Provided programs to assist with financial empowerment (budgeting and sensible nutrition)Opioid Crisis:-HSH-Thermopolis Clinic closely monitors the pain contracts. Contract medications are reviewed and attempts are made to decrease when able.-HSH-Thermopolis Clinic and Hospital Providers complete education on every patient with opioids.

Hot Springs County Hospital District
Part V, Section B, Line 13b: See Part V, line 13h

Hot Springs County Hospital District
Part V, Section B, Line 13h: The facility's criteria for eligibility for free or discounted care is based on the federal poverty guidelines, family size, and the patient's equity resources (assets less medical debt). In addition, the patient and family members must receive a denial from Medicaid or other public assistance programs. Extenuating circumstances (death, acts of nature, etc.) are considered in determining eligibility for financial assistance.

Part V, line 20d, No Presumtive Eligibility Determination:
The Hospital does not make presumptive eligibility determinations. A patient needs to apply for financial assistance based on most current circumstances to be considered eligible.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
The facility's criteria for eligibility for free or discounted care is based on the federal poverty guidelines, family size, and the patient's equity resources (assets less medical debt). In addition, the patient and family members must receive a denial from Medicaid or other public assistance programs. Extenuating circumstances (death, acts of nature, etc.) are considered in determining eligibility for financial assistance.

Part I, Line 7:
Line 7a Financial Assistance at cost was calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Line 7b, Medicaid was calculated using Worksheet 3. Line 7g, Subsideized Health Services, was calculated using Worksheet 6. Line 7e was calcuated based on actual cost.

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 $ 1,619,817.

Part III, Line 2:
The organization determines its estimate of bad debt provisions based on its historical write off and recovery information.

Part III, Line 3:
The estimated dollar amount of the organization's bad debt expense that reasonably is attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy, but for whom insufficient information was obtained to determine their eligibility, was estimated to be 30%.

Part III, Line 4:
The footnote to the Organization's financial statements can be found on page 16 of the attached audited financial statements.

Part III, Line 8:
The hospital is licensed by the Centers for Medicare and Medicaid Services as a critical access hospital. As a critical access hospital, it is reimbursed on 101% of costs less the 2% sequestration adjustment. The hospital utilized the annual cost report for fiscal year June 30, 2022, which it is required to submit to the Centers for Medicare and Medicaid Services as the source to determine the Medicare allowable costs of care in connection with the revenue received from Medicare.The Hospital 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. Therefore, the entire Medicare shortfall, if any, is considered a community benefit. The Organization reported only those allowable costs and Medicare reimbursements reported in the Medicare cost report for the year.

Part III, Line 9b:
The hospital makes every effort to complete a financial evaluation at the earliest possible point in the revenue cycle for all patients indicating an inability to meet their financial obligations. A financial assistance program application is completed once all other options for reimbursements have been exhausted. The hospital policy indicates it will send a notice to the patient within 30 days of services to notify the patient that financial assistance is available. The hospital policy does not send patient accounts to collections until after 120 days after the date of the first invoice of the service. If a patient submits a financial assistance application within 240 days after the date of the first invoice of the services, the hospital removes the patient account from collections.

Part VI, Line 2:
HSH utilized both quantitative and qualitive methods in assessing community health care needs. From a qualitative standpoint, a variety of sources were used to identify community health trends and health disparities from various sources, such as Hot Springs County Public Health, Center for Disease Control, etc. Every effort was made to obtain the most current data. Data was analyzed for comparison purposes with the state, other counties within the state, and local data collected by the Hot Springs County Prevention Coalition. Qualitative data collection included interviews with key stakeholders, a community survey and four focus groups. In addition to patient surveys, the Hot Springs County Prevention Coalition meets once a month to discuss the needs and ways to address these needs.

Part VI, Line 3:
We inform our patients of the Financial Assistance program through various means, such as signage in the admissions area and Emergency Department and all statements have verbiage for Financial Assistance availability and contact information. Financial assistance information and application are also available on our website.

Part VI, Line 4:
Hot Springs Health is located in the rural community in the Central Wyoming. Being one of the smallest counties in the state, Hot Springs County is largely an agricultural and ranching community. According to the 2017 census, there were approximately 4,696 residents in the county. Hot Springs County population of persons under the age of five is 5.3%, persons under age of eighteen is 21.3%, persons over age sixty-five is 25.5%. The percent of females in the county is $49.3%. Veterans from years 2013-2017 totaled 612 individuals, ranking above the Wyoming average with 12.71% of the residents having a veteran status.The median household income in HS County for 2017 was $48,403, mean household income was $64,864, and per capita income in the past 12 months of 2017 was $30,939. For Wyoming the median household income is $60,938 and the mean household income is $76,731. The median earning for workers in Wyoming was $32,205 and in HS County was $30,775. The median earnings for males working full-time in Wyoming was $53,727 and in HS County was $49,038. The median earnings for females working full-time in Wyoming was $37,915 and in HS County $41,220.HS County exceeds the state average in relation to poverty level at 12.1% vs state average of 11.3%. Hot Springs County School District is a Title 1 School. Free and reduced meals are provided to 53.5% of elementary school families and 39.68% of the entire district. Single family homes equal 265 of our population. More than one quarter of our population is age 65 or older. Of those aged 60 years and older, 20% receive food stamps.

Part VI, Line 5:
The Board of Directors is comprised of residents of Hot Springs County representing various backgrounds. They are not employees of HSH, nor contractors, nor family members. Any surplus funds are directed towards patient care by investing into modern equipment and technology and providing medical education to our clinical personnel to provide the best care to our community.HSH extends medical staff privileges to all qualified physicians in the community.HSH is the only Critical Access Hospital in the Hot Springs County.HSH provides chemotherapy and biotherapy services, immunotherapy, and blood transfusions, thus allowing patients to receive treatments right here, at home, without having to travel long distances. Holistic pain management is available to our community at our Specialty Clinic. Rehabilitation services provided at HSH include physical therapy, speech/language pathology and occupational therapy. HSH provides a 24-hour Emergency room that is available to all regardless of ability to pay.HSH participates in the HRSA Rural Residency Planning and Development Program offering a Rural Residency Training Track to medical residents who have an interest in working in rural hospitals.

Operating expenses	$ 34,593,484
Total amount spent on community benefits as % of operating expenses	$ 2,042,033 5.90 %