4A (Expenses $ 19355967 including grants of $ 0) (Revenue $ 24658217)
Rio Grande Hospital (RGH) is a licensed 17 bed critical access hospital located in Del Norte, Colorado. Rio Grande Hospital is a Level IV Trauma Center in the State of Colorado. Rio Grande Hospital has been a Level IV Trauma Center since 1999. We are actively involved with the San Luis Valley RETAC. Del Norte is located in the southwestern area of the state 225 miles southwest of Denver and 45 minutes west of Alamosa, Colorado in the San Luis Valley.

Rio Grande Hospital
Part V, Section B, Line 5: Three methods were used to collect primary data: three community meetings, a smaller community focus group meeting, and an online survey between the September 2021 and December 2021. Over 170 community members and agencies were emailed and/or mailed invitations to the community meetings. These individuals were chosen based on their involvement with other hospital work, past participation, or representation of key sectors of RGH's service population. These groups included public health, social services, behavioral health, school districts, long term care facilities, churches, non-profits, workforce centers, banks, ambulance services, fire departments, sheriff's offices, head start, agricultural cooperatives, emergency management, health educators, economic development, outdoor groups, higher education, county commissioners, veterans, and RGH and Clinic staff.

Rio Grande Hospital
Part V, Section B, Line 7d: https://riograndehospital.org/chna/

Rio Grande Hospital
Part V, Section B, Line 11: The Organization completed the most recent CHNA and Implementation Strategy in 2021. RGH identified the following in 20211) Improve referral system for patients needing specialist2) Create a reminder system for preventative and wellness visits3) Provide community education on ALTO (alternatives to opiods)4) Continue to expand Telehealth services5) Explore other potential specialty services6) Expand medical tourismThe Organization was not able to address all the needs identified due to the CHNA being completed in December of 2021. Actions will be delivered in the upcoming years. The following the needs were identified in the 2018 CHNA: 1) Poor nutrition and lack of physical activity2) Promoting health education on disease prevention3) Difficulty navigating insurances and healthcare in general4) Providing additional specialty services5) Get out into the community and use community Partners6) Stronger partnership with mental healthThe hospital during 2021 focused on addressing the needs raised during the 2018 CHNA. Although Covid has changed communication and in-person meetings, RGH restarted and expanded collaboration. It invested in equipment to facilitate remote meetings. In responding to community collaboration, RGH re-established the Health and Wellness community meeting with all the county service organizations that provide social services, public health services, employment services, transportation and public services. RGH re-established the patient family advisory council to receive community input on direct patient care. In 2021 RGH developed its Telehealth programs for remote direct primary care in all of its clinical providers as a patient option. It expanded its MAT (Medication Assisted Treatment) program through collaboration with Valley Wide Health Systems. It expanded outpatient services of surgery, pain management and dermatology with collaboration of Heart of the Rockies, another hospital. In 2021 RGH enhanced it relationship with San Luis Valley Behavior Health Group allowing patients to connect to alternative organizations for mental health services.In 2021 RGH began planning to expand on annual wellness visits at all of it clinics. The hospital outreached to the local school systems for youth wellness which started with School Health physicals. In 2021 RGH began community meetings to look at a wellness village discussion for the 2021-2023 CHNA cycle. This project involves the healthy nutrition, exercise, education and housing identified in the 2018 CHNA.In 2021 RGH began exploring Medicare alternatives for the Community with the Western Health Care Alliance.In 2021 RGH began exploring additional patient navigators in both the hospital and clinics.

Rio Grande Hospital
Part V, Section B, Line 13b: The Rio Grande Hospital has two specific policies that affect patients who qualify for charity care. The first policy is the State's Colorado Indigent Care Program (CICP) which has specific rules the State requires for participation. The second is a policy which offers discounts for patients who do not qualify for the State's CICP program listed above.The Colorado Indigent Care Program offers a sliding fee scale to residents of the State of Colorado based upon 250% of the federal poverty guidelines. The program requirements can be seen at any admission desk of the Rio Grande Hospital and on the website for Colorado Indigent Care Program. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital offers an additional charity care program for those not qualifying for the State's program based upon 200% of the federal poverty guidelines with a sliding scale which offers up to 100% discount on services provided. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital's complete charity care policy is posted at all locations within the Hospital that provide services.

Rio Grande Hospital
Part V, Section B, Line 16j: See Website, Available in both English and Spanish. Paper copies available at all hospital and clinic admission offices.

Part I, Line 3c:
The Rio Grande Hospital has two specific policies that affect patients who qualify for charity care. The first policy is the State's Colorado Indigent Care Program (CICP) that has specific rules the State requires for participation. The second is a policy that offers discounts for patients who do not qualify for the State's CICP program listed above.The Colorado Indigent Care Program offers a sliding fee scale to residents of the State of Colorado based upon 250% of the federal poverty guidelines. The program requirements can be seen at any admission desk of the Rio Grande Hospital and on the website for Colorado Indigent Care Program. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital offers an additional charity care program for those not qualifying for the State's program based upon 200% of the federal poverty guidelines with a sliding scale that offers up to 100% discount on services provided. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital's complete charity care policy is posted at all locations within the Hospital that provide services.

Part I, Line 7:
Line 7a Financial Assistance was converted to cost based on an average ratio of costs to gross charges.Line 7g Subsidized Health Services was determined using the Medicare Cost Report.Lines 7e and 7f are based on actual expenses.

Part I, Line 7g:
Subsidized health services includes costs of $3,324,774 from rural health clinics.

Part II, Community Building Activities:
Rio Grande Hospital hosts the Health and Wellness Board for public health, employment, housing, transportation and assorted other public services. Rio Grande Hospital provided 203 school sports physicals to Monte Visa and Del Norte Schools. Rio Grande Hospital is working on encouraging both students and adults to complete Wellness Physicals. Rio Grande Hospital provided 1,013 Covid vaccines during 2021. Rio Grande Hospital also provided a Covid Hot-line to answer questions.

Part III, Line 2:
The amount reported on line 2 represents implicit price concessions. The hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.

Part III, Line 3:
The estimated amount of the organization's implicit price concessions attributable to patients that would be eligible under the organization's charity care policy was calculated as a percentage of the accounts sent to collections that were identified as being eligible for charity care if the patient would have applied for assistence. In 2021, after review of the accounts recommended for collections, 50.0% of the accounts were marked charity care assistance regardless of patients applying for assistance. The accounts included many patients who lapse their Medicaid or financial assistance programs.

Part III, Line 4:
The footnote to the Organization's financial statements that describes implicit price concessions can be found on page 16 and 17 of the attached audited financial statements.

Part III, Line 8:
Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, if there is a Medicare shortfall the entire Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by CMS.

Part III, Line 9b:
The Organization requires payment in full upon receipt of the bill. If payment in full is not plausible the patient must establish a payment plan within 120 days from the date of the invoice for the services provided or it will be released to a collection agency to recover these payments. The Hospital does not charge interest on the accounts with payment plans that extend beyond 12 months. For patients that are known to qualify for charity care or financial assistance the State of Colorado requires them to complete a form to apply under one of the two policies offered: Colorado's Indigient Care (CICP) program for state residents or the alternative policy for patients that do not qualify under the CICP program. Patients have 90 days upon the day of service to complete the application. If the remaining patient balance on accounts that qualify under these charity care policies is greater than $25 it will fall under the hospital collection policy guidelines. Balances under $25 can be written off as an administrative adjustment. The Hospital staff discusses these options with these patients, as well as the Business Office that handles the collection of payments. These policies are also posted throughout the Hospital. The Hospital has the administrative authority to write off any amounts they deem will be charity care, such as those that are medically indigent and those amounts under the $25 threshold. The policy states accounts eligible for financial assistance are to be addressed within 240 days of the first bill.

Part VI, Line 3:
Rio Grande Hospital posts signs at admissions and at all intake sites informing the patients of programs available for financial assistance. The Hospital has a Financial Counselor available during business hours Monday thru Friday to assist and educate patients in providing information and filing forms for financial assistance. The Hospital reviews patient status and contacts patients it believes are eligible for financial assistance. The Hospital offers copies of their assistance programs upon request. The Hospital offers payment programs based upon patients providing essential personal financial data.

Part VI, Line 2:
Rio Grande Hospital uses the executive team to review progress on implementation strategy. In addition, the hospital sponsors the Health and Wellness Board which meets monthly at the hospital or on-line via zoom. This is a collaboration of agencies, organizations and individuals serving our community. It includes Rio Grande County (RGC) Public Health, RGC Social Services for Rio Grande an Mineral Counties, RGC Jail Nurse, Colorado Employment Division, School Nurses, School Principals, Behavior Health, San Luis Valley Transportation. The Health and Wellness Board covers multitude of community services which include physical health, mental health, housing, jobs, schools, youth, seniors, jails, vulnerable populations, chronic diseases, and community threats such as Covid and Opioid addiction.Rio Grande Hospital continues to use the Hospital's Patient Family Advisory Committee (PFAC) on a quarterly basis. It had 3 meetings in 2021 due to Covid-19

Part VI, Line 4:
Rio Grande Hospital (RGH) is a licensed 17 bed critical access hospital located in Del Norte, Colorado. Rio Grande Hospital is a Level IV Trauma Center in the State of Colorado. Rio Grande Hospital has been a Level IV Trauma Center since 1999. We are actively involved with the San Luis Valley RETAC.Del Norte is located in the southwestern area of the state 225 miles southwest of Denver and 45 minutes west of Alamosa, Colorado in the San Luis Valley. Rio Grande Hospital serves a catchment area of approximately 100 miles with elevations ranging from 7,814 feet in Del Norte to 11,800 feet at the Summitville Mines to 9,800 feet at Brown Lakes above Creede, Colorado. Our economy thrives from agriculture and tourism. The San Luis Valley is known for farming of potatoes, wheat, barley and canola which increases the risk of job related trauma. The nearest Level IV Trauma Center is Pagosa Springs Medical Center 1.25 hours west of Del Norte. The closest Level II Trauma Center is located in Pueblo. The closest Level III Trauma Center is located in San Luis Valley Regional Medical Center in Alamosa, which is approximately 45 minutes east of Del Norte. The population base for Rio Grande County is 11,736. Creede has a population of 698 residents. During the months of June, July, and August the population of this area increases by three times. Rio Grande County has 64% of residents living below 250% of the federal poverty level.Rio Grande Hospital sees tourists who have been hunting, skiing, hiking, fishing, camping, and riding ATVs in the mountains. They also treat tourists who visit the San Luis Valley for the warm summer temperatures. With the San Juan Mountains of the Continental Divide bordering the San Luis Valley on the west side, tourism is an all year round industry. RGH has a five bed Emergency Department and had 5,710 emergency department visits during 2021. Medical emergencies consist of chest pain, acute myocardial infractions, shortness of breath, nausea, vomiting, dehydration, and altitude illnesses.Rio Grande Hospital has four satellite clinics located in Monte Vista, Del Norte, South Fork and Creede.

Part VI, Line 5:
The Organization's governing body is comprised of persons who reside in the Organization's primary service area who are neither employees nor contractors of the Organization, nor family members thereof. We note one exception, a physician serving on the board. The Organization also extends medical staff privileges to other qualified physicians in the community. Due to the nature of the long term debt agreements being federally insured by the USDA, the Organization is required to apply any surplus funds into a reserve account. Surplus funds used to improve the facilities and equipment to improve patient care are subject to approval from USDA. Rio Grande Hospital is involved in a number of community health activities. The Hospital is a major provider in the annual health fair offering multiple health tests at discounts to the general public. It annually provides flu shots to the general public for a discounted price. The Hospital provides a women's workshop on reducing risk factors for heart disease and breast cancer at South Fork. The RGH is instrumental in providing health fair services in Del Norte, South Fork and assisting in Center, Creede and the Rural Electric Cooperative. The Hospital offers school physicals free or at a reduced cost to all the kids at schools in the Hospital service area. The discount is dependent upon school programs. It serves Del Norte, Monte Vista, and Creede High Schools and Grade Schools.The Rio Grande Hospital would not exist or be able to operate without the assistance of grants and donations. The Hospital, through volunteer hours of the Board and employees, annually puts on a dinner and fund raising night. This event did not occur in 2021 due to COVID. In addition we receive support from the South Fork Ladies Golf Association, the South Fork Kiwanis Club, and multiple smaller organizations and church groups. The Hospital provides four clinics in four communities. These clinics are unable to operate without the support subsidies provided by the Hospital. The Hospital utilizes the key staff from the Hospital to support each clinic. The key supporting staff include technical staff from nursing, radiology and laboratory in addition to the administrative support staff of billing and accounting. The clinics are up to 45 miles in distance from the main campus. Our primary clinic is located on our main campus. The clinics offer open house days annually to allow the community to meet the staff and examine the facilities.The Hospital and its staff are involved in many community events including the Monte Vista Stampede Parade, the Del Norte Covered Wagon Parade and Parade of Lights.The Hospital is in its fourth year of the Wound Care services which include the hyperbaric chamber for advance wound care. The Hospital is in its third year for Cardiac Rehab. Rio Grande Hospital has been a community partner in testing and providing vaccine to the communities it serves. The Hospital has been offering wound care services, cardiac rehab services, and is advancing towards community dermatology services and pain management services. We additionally offer Physical Therapy staff to schools for their sport programs.