Community Benefit Insight - Tax-exempt hospital

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Hills & Dales General Hospital Inc

Hills & Dales General Hospital

4675 Hill Street
Cass City, MI 48726

Bed count	25	Medicare provider number	231316	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 381619577

Display data for year:

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

9.86%

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	$ 59,000 0.15 %
Medicaid as % of operating expenses	$ 3,940,266 9.70 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 573 0.00 %
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.	$ 7,039 0.02 %
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	$ 1,683,095 4.14 %
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 2022 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	$ 336,619 20 %

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 $ 33201826 including grants of $ 0) (Revenue $ 43848219)
The organization provided nursing and professional services for acute & swing bed patients, emergency and outpatients. During fiscal year 2022, this included over 2,160 inpatient days, 7,176 emergency room visits, over 49,883 physician visits, 49,670 distinct patients for a total of over 108,889 registrations. During the year, over 56.9% of the services provided were to governmental programs, which reimburse below actual costs. In addition, the hospital provided approximately $59,000 in charity care and was unable to collect from uninsured and underinsured patients. Community benefits are also provided through free programs such as, health fairs, public service announcements, education on specific disease conditions, lectures, blood pressure screening, TB training. The hospital also provided reduce fee services.

Facility Information

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

Hills & Dales General Hospital Inc.
Part V, Section B, Line 5: The hospital outsourced the data collection process to Thumb Community Health Partnership of which the hospital is a member. The hospital's process included a community survey in addition to review of assessments by the Thumb Community Health Partnership and Michigan Thumb Public Health Alliance.

Hills & Dales General Hospital Inc.
Part V, Section B, Line 6a: The hospital completed the assessment on their own but relied on an assessment completed by Thumb Community Health Partnership. The partnership includes the following hospitals: Deckerville Community Hospital, Harbor Beach Community Hospital, Marlette Regional Hospital, McKenzie Health Systems, McLaren Caro Region, McLaren Lapeer Region, McLaren Thumb Region, Scheurer Health.

Hills & Dales General Hospital Inc.
Part V, Section B, Line 6b: The hospital completed the assessment on their own but relied on an assessment completed by Thumb Community Health Partnership. The partnership includes the following other organizations: Great Lakes Bay Health Centers, Human Development Commission, Huron Behavioral Health, Great Start Collaborative, Huron County Health Department, Lapeer County Health Department, Lapeer County Community Mental Health, List Psychological, MDHHS, Get Connected. Get Help, Sanilac County Community Foundation, Sanilac Community Mental Health, Sanilac Great Start Collaborative, Sanilac County Health Department, Tuscola Behavioral Health Systems, Tuscola County Health Department, Tuscola Great Start Collaborative, Thumb Community Health Partnership.

Hills & Dales General Hospital Inc.
"Part V, Section B, Line 11: Based on all of the information reviewed including the Thumb Community Health Partnership assessment and the strategies already in place to address many of the needs identified, the following priorities were identified: Access to ServicesCancerBehavioral HealthThe following actions were identified to address the identified needs:Access to services: --Develop and implement a marketing plan to increase awareness of those service lines below the 50% awareness level as measured by the community survey--Systematically advocate with governmental and social services to attempt to improve transportation services in Tuscola County. --Provide resources and support to ensure that individuals have health insurance to meet their personal needs and in the event of unplanned medical needs. --Develop and implement an expanded primary care market in the Caro, MI areaAttempted to develop a collaborative solution to substance abuse through the Covenant Rural Thumb Network Cancer: Establish a medical oncology & infusion clinic at Hills & Dales to improve cancer care access in our communityBehavioral Health: Research and propose a ""thumb"" area patient-centered addiction treatment facility for men and women to encourage a positive and long-lasting recovery. The following actions were taken during the tax year related to the 2019 needs identified:Decrease rate of obesity: There was a 10% increase in diabetes self-management services referrals. Improve mental health: These activities progressed with the addition of a tele-medicine cart, an operating agreement with Covenant Healthcare to provide tele-psychiatry, and 2 additional providers certified in MAT. Tele-psychiatry program is no longer in process. The organization is investigating other sources of support for psychiatry consultations. Hills and Dales Healthcare is a participating partner in the Thumb Opioid Response Consortium, which is a multiagency partnership that addresses opioid and substance use in the rural areas of the thumb region of Michigan. Decrease indicent of senior injuries: Many of the planned activities continued, albeit with lesser activity, considering the pandemic and increased risk for seniors. More efforts were focused on tele-medicine office visits, COVID 19 testing, and vaccination preparedness. The Matter of Balance class and driver safety have not resumed, as there are no instructors currently available. The organization is actively pursuing recognition as an Age-Friendly Health System through the Institute for Healthcare Improvement."

Schedule H, Part V, Line 7a and 10a:
https://hdhlth.org/community-health-needs-assessment/

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost reports. The community health improvement services and community benefit operations, health professional education, and cash and in-kind contributions for community benefit are all based on actual cost.

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

Part III, Line 3:
The amount of implicit price concessions that could be reasonably attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy was an estimate. This amount was calculated by multiplying the implicit price concessions by 20%. This estimate was based on local unemployment rates and other related factors.

Part III, Line 4:
The footnote to the Organization's financial statements can be found on page 12-13 of the attached audited financial statements.

Part III, Line 8:
As Critical Access Hospital, Medicare reimburses the hospital based on costs incurred. Not all of the costs incurred are eligible for reimbursement via the Medicare cost report.The numbers used to determine the surplus came from the filed Medicare Cost Report for this fiscal year.

Part III, Line 9b:
The organization recommends accounts for collection and treatment as bad debt once the account hits 120 days. The account must have received at least 2 calls, received at least 3 statements, and also have no recent payment in the last 45 days. Additionally, the patient or account holder must be informed and encouraged to complete an application for charity care and be given at least 30 days to complete said application. The accounts that are set up on a payment plan and current will not receive any calls until the payment plan goes into default status. For accounts of those known to qualify for financial assistance, the collection actions are stopped during the time the person is completing the application.

Part VI, Line 2:
Hills & Dales General Hospital conducts a regular Community Health Needs Assessment through a systematic process to identify key community health concerns. Data was collected and analyzed from the following sources: Community Survey (online and on paper) and 2021 Thumb regional Health Assessment conducted by the Thumb Community Health Partnership. From the data collected, prioritization of needs and an implementation plan was identified by the organization's senior team and Board of Trustees. Results of all community health needs assessments and implementation plans are available on the organization's website, www.hdghmi.org. The hospital is part of the Thumb Community Health Partnership which is a coordinated regional effort to identify key issues and establish a coordinated response to regional community needs.

Part VI, Line 3:
The Hospital has packets available to patients at the time of registration that notes the financial assistance policy and procedures. This packet is offered to a patient and/or a representative of the patient if the patient asks about the price of the services about to be received. A financial assistance packet is offered to individuals that express concern over being able to afford the services about to be rendered. The process applies to hospital services and physician offices owned and operated by the hospital.

Part VI, Line 4:
Hills & Dales General Hospital is a critical access hospital located in Cass City, Michigan within Tuscola County. Area of services include southwest portion of Huron County, northwest portion of Sanilac County and eastern half of Tuscola County. The unemployment and uninsured numbers for these counties were higher than the state and national average. The median household income was below the state and national average.

Part VI, Line 5:
The Hospital is governed by the Community Board and has an open medical staff. It also participates in free or reduced health screenings and fairs that are available to the general public which include screening and education to help improve the health status of our community.

Part VI, Line 6:
Hills & Dales General Hospital's affiliation with Covenant in Saginaw. The primary purpose of the affiliation is to meet Critical Access Hospital (CAH) requirements to have an agreement with a tertiary hospital. This is no share governance Hills & Dales General Hospital has an independent Board, Tax ID number, medical staff, etc. Covenant has offered some resources to Hills & Dales General Hospital including Educational Classes, Job Skill enhancement, co-marketing and medical staff development. Hills & Dales General Hospital also participates in group purchasing through Covenant with VHA.

Operating expenses	$ 40,631,855
Total amount spent on community benefits as % of operating expenses	$ 4,006,878 9.86 %