4A (Expenses $ 15255695 including grants of $ 2244) (Revenue $ 17125427)
"KITTSON MEMORIAL HEALTHCARE CENTER (KMHC) PROVIDES SERVICE TO EMERGENCY, ACUTE, AND CLINIC PATIENTS. ALL PATIENTS ARE TREATED IN AN EMERGENCY SETTING REGARDLESS OF ABILITY TO PAY OR FINANCIAL CLASS STATUS. KMHC HOME HEALTH PROVIDES MEDICAL AND PERSONAL ASSISTANCE TO THOSE PATIENTS WHO ARE HOME BOUND. THIS VALUED SERVICE PROVIDES AREA RESIDENTS WITH THE ASSISTANCE THEY NEED TO LIVE INDEPENDENTLY WHETHER IT BE HOUSEKEEPING SERVICES, MEDICATION DISPENSATION, OR DAILY DRESSING CHANGES. KMHC'S ASSISTED LIVING COMPLEX PROVIDES THOSE AREA RESIDENTS WITH OPTIONS TO ASSIST IN THEIR TRANSGRESSION FROM LIVING INDEPENDENTLY TO CONGREGATE DINING WITH OTHER ASSISTED LIVING RESIDENTS, MEDICATION DISPENSATION ASSISTANCE, AND ACCESS TO ACTIVITIES IN THE NURSING HOME. RESIDENTS ARE ALSO ABLE TO ""COME AND GO"" AS THEY PLEASE WITH ACCESS TO THEIR OWN TRANSPORTATION OR TRANSPORTATION MAY BE ARRANGED."

KITTSON MEMORIAL HEALTHCARE CENTER
"PART V, SECTION B, LINE 5: IN THE 2018 ASSESSMENT, COMPLETED BY SEPTEMBER 2019, WE REVIEWED OUR ASSESSMENT AND IMPLEMENTATION PLAN FROM 2016 AND REVIEWED THE CURRENT DATA FOR HEALTH TRENDS FOR OUR COUNTY. WE ALSO DID A SELECTED MAILING OF ""QUALITY OF LIFE"" SURVEYS TO A TARGETED AUDIENCE THROUGHOUT THE COUNTY. THE TARGET LIST OF INDIVIDUALS INCLUDED VARIOUS CITY LEADERS, SENIOR CENTERS, SCHOOL PERSONNEL, PUBLIC HEALTH AND HOME HEALTH STAFF, HEALTHCARE PROVIDERS, HOSPITAL BOARD MEMBERS, COUNTY EMPLOYEES, SOCIAL SERVICES STAFF, BUSINESS OWNERS, AND YOUNG FAMILIES IN OUR COUNTY. WE REQUESTED THEIR OPINIONS ON IMPORTANT SERVICES THAT THEY WOULD LIKE TO SEE ADDED TO OUR FACILITY OR MAINTAINED BY OUR FACILITY."

KITTSON MEMORIAL HEALTHCARE CENTER
"PART V, SECTION B, LINE 11: KITTSON HEALTHCARE IS A 15-BED CRITICAL ACCESS HOSPITAL LOCATED IN THE FAR NORTHWEST CORNER OF MINNESOTA. THE FACILITY ALSO OPERATES A 60-BED NURSING HOME, 8-UNIT ASSISTED LIVING COMPLEX, TWO RURAL HEALTH CLINICS, AND HOME HEALTH/PUBLIC HEALTH SERVICES. THE COUNTY BORDERS CANADA AND NORTH DAKOTA. THE COMMUNITY OF KITTSON COUNTY STRONGLY DESIRES THE MAINTENANCE OF THIS FACILITY WITH THEIR EXPRESSED DESIRE FOR THE CONTINUATION OF THE EMERGENCY ROOM, CLINICAL SERVICES, ACUTE CARE AND PHARMACY SERVICES. IN AUGUST 2019, KITTSON HEALTHCARE OPENED A PHARMACY NEXT TO THE MEDICAL CLINIC AND WILL CONTINUE TO OFFER PHARMACY SERVICES TO THE RESIDENTS OF THIS SERVICE AREA UPON THE RETIREMENT OF OUR LONE PHARMACIST IN THE COUNTY AFTER NEARLY 60 YEARS OF SERVICE. RETAIL PHARMACY SERVICES WILL CONTINUE TO BE OFFERED TO THE RESIDENTS OF KITTSON COUNTY. TWO PHARMACISTS AND ONE PHARMACY TECHNICIAN ARE EMPLOYED BY KH TO PROVIDE THESE SERVICES.IN PROMOTING HEALTHY BEHAVIORS AND LIFESTYLES, TWO OF OUR PUBLIC HEALTH NURSES HAVE BEEN TRAINED IN THE CDC'S EVIDENCE-BASED CURRICULUM, ""I CAN PREVENT DIABETES"". THE FIRST YEAR LONG COURSE HAS BEEN COMPLETED WITH COMPLEMENTING DIETITIAN CONSULTING SERVICES OFFERED THROUGH KITTSON HEALTHCARE ONCE A MONTH (AS A BILLABLE SERVICE). LOCAL EDUCATION CLASSES WILL CONTINUE TO BE OFFERED TO AREA CITIZENS. KH PROVIDES CONTINUED EDUCATION ON DIABETES, OBESITY, SMOKING/TOBACCO USE, HEART DISEASE, ETC. THE ADDITION OF DR. COOK TO KH MEDICAL STAFF HAS ALLOWED MORE DEDICATED PATIENT EDUCATION AND DEDICATED RESOURCES TO THESE SERVICES.WE WILL CONTINUE TO EDUCATE AND ADDRESS SMOKING AND TOBACCO USE IN OUR AREA AS WELL AS DISSEMINATE AND EDUCATE OUR PATIENTS ON HEART DISEASE AND CANCER.IN THE 2016 MINNESOTA STUDENT SURVEY, WHEN THE STUDENTS WERE ASKED ABOUT THEIR SEAT BELT USE, 60% OF 11TH GRADE STUDENTS SAID THEY USED THEIR SEATBELTS ALWAYS, WHILE 32% OF 9TH GRADE STUDENTS SAID THEY USED THEIR SEATBELTS ALWAYS. THIS IS A MARKED IMPROVEMENT FROM THE 2010 MINNESOTA STUDENT SURVEY FOR KITTSON COUNTY, 28% OF 12 AND 9TH GRADE STUDENTS SAID THAT THEY WORE THEY ALWAYS WORE A SEATBELT.THE CURRENTLY ADOPTED CHNA IDENTIFIED THE FOLLOWING ISSUES: TRANSPORTATION AND ACCESS TO HEALTHCARE SERVICES - KITTSON HEALTHCARE HAS SUBMITTED AN APPLICATION FOR A GRANT TO PURCHASE A TRANSPORTATION VAN. ALSO, A REASSIGNMENT OF DUTIES FOR STAFF MEMBERS AND A POLICY HAS BEEN DEVELOPED FOR DESIGNATED STAFF TO PROVIDE TRAVEL ARRANGEMENTS FOR NURSING HOME RESIDENTS. MENTAL HEALTH SERVICES - SEE BELOW. VAPING/TOBACCO USE - SEE BELOW. OBESITY - SEE BELOW. CONTINUED ACCESS TO HEALTHCARE SERVICES IN THE ""COMMUNITY"" OF KITTSON COUNTY INCREASE SPECIALTY SERVICES IN OUR CLINICS - INCREASED AVAILABILITY OF SPECIALTY SERVICES TO INCLUDE CARDIOLOGY, DERMATOLOGY, ENDOSCOPY, MENTAL HEALTH, PODIATRY, OPHTHALMOLOGY, AND ORTHOPEDICS. IN FISCAL YEAR 2021, ALTRU OBGYN WERE ADDED TO THE VISITING SPECIALIST ROTATION. ELDER CARE AND SERVICES NEEDED TO ""AGE IN PLACE"" OPIOID ABUSE SOCIAL MEDIA EDUCATION TO STUDENTS AND PARENTS (BULLYING, TRAFFICKING) CONTAINMENT OF HEALTHCARE COSTS - ADOPTION OF PRICING TRANSPARENCY COMPLIANCE, ADDITIONAL EDUCATION ON FINANCIAL ASSISTANCE POLICIES, AND REFINED INTERNAL COLLECTION PROCESSES. PREPARATION FOR THE NO SURPRISE ACT HAS ALSO BEEN INITIATED.UPON REVIEW OF THE 10 TOP ISSUES IDENTIFIED, KITTSON HEALTHCARE WILL THE FOLLOWING PRIORITY AREAS TO WORK ON OVER THE NEXT 3 YEARS.PRIORITY 1: MENTAL HEALTH SERVICESGOAL: INCREASE MENTAL HEALTH SERVICES TO OUR SERVICE AREA TO INCLUDE BOTH ADULTS AND YOUTH SERVICES.GOAL: INCREASE PHQ-9 ASSESSMENTS ON BOTH ADULTS AND YOUTH IN OUR MEDICAL CLINICS TO HELP IDENTIFY MENTAL HEALTH CONCERNS.TIMEFRAME: FALL/SPRING, 2019-2020 AND ONGOINGUPDATE: IN 2019, AMBER DEERE, PMHNP BC WAS ADDED TO THE MEDICAL STAFF IN HALLOCK AND KARLSTAD CLINICS. AMBER'S GOAL IS TO IMPROVE PATIENT'S QUALITY OF LIFE AND REDUCE THE NEGATIVE STIGMA ASSOCIATED WITH MENTAL HEALTH. HER ROLE IS TO EVALUATE, TREAT AND DIAGNOSE PSYCHIATRIC PATIENTS AGES 6 AND OLDER. HER APPROACH IS TO PROVIDE HOLISTIC INDIVIDUALIZED CARE, BASED ON EACH PERSON'S NEEDS.PRIORITY 2: SUICIDE PREVENTION AND EDUCATIONGOAL: PROVIDE SUICIDE EDUCATION AND SUPPORT TO OUR PROVIDERS, FRONTLINE NURSING STAFF AND TO OUR COMMUNITY.TIMEFRAME: FALL/SPRING OF 2019-2020UPDATE: WHILE RECRUITMENT EFFORTS ARE IN PLACE TO HIRE AN ADVANCED PRACTICE PROVIDER OF MENTAL HEALTH, FUTURE INTENTIONS ARE TO PARTNER WITH THE PUBLIC HEALTH DEPARTMENT IN EDUCATION, PREVENTION, AND TREATMENT OF SUICIDE. THE ADDITION OF BEHAVIORAL HEALTH SERVICES WILL BE AN AIDED PREVENTION METHOD WHICH IS CURRENTLY BEING RESEARCHED WITH AN IMPLEMENTATION DATE OF MAY 2022.PRIORITY 3: VAPING AND TOBACCO USEGOAL: PROVIDE EDUCATION AND SUPPORT TO SCHOOLS' STAFF AND STUDENTS (INCLUDING PARENTS AND COMMUNITY) REGARDING THE DANGERS AND LONG-TERM EFFECTS OF VAPING AND TOBACCO USE.GOAL: PROVIDE SMOKING CESSATION SUPPORT THROUGH OUR MEDICAL CLINICS IN HALLOCK AND KARLSTAD.TIMEFRAME: FALL/SPRING, 2019-2020 AND ONGOINGUPDATE: PUBLIC HEALTH STAFF COMPLETED THE INTERVENTION FOR NICOTINE DEPENDENCE: EDUCATION AND AN ALTERNATIVE TO SUSPENSION FROM THE AMERICAN LUNG ASSOCIATION (INDEPTH) COURSE AND PROMOTED ADOPTION OF THIS INTERVENTION TO KITTSON CENTRAL, LANCASTER, AND TRI-COUNTY SCHOOL DISTRICT LEADERSHIP AS WELL AS THE KITTSON COUNTY CENTRAL ATHLETIC DIRECTORS.PRIORITY 4: OBESITYGOAL: PROMOTE HEALTHY LIFESTYLES THROUGH PUBLIC EDUCATION.GOAL: COLLABORATE WITH THE SCHOOLS TO ENCOURAGE HEALTHY LIFE STYLES IN OUR YOUTH.GOAL: COLLABORATE WITH WORKPLACES TO ENCOURAGE AND EDUCATE EMPLOYEES ABOUT THE BENEFITS OF HEALTHY BEHAVIORS AND LIFESTYLES.TIMEFRAME: FALL/SPRING, 2019-2020 AND ONGOINGUPDATE: PUBLIC HEALTH PROMOTED HEALTHY LIFESTYLES, MENTAL HEALTH AND WELLNESS TO KITTSON CENTRAL, LANCASTER AND TRI-COUNTY SCHOOL DISTRICT STAFF DURING THEIR WORKSHOP EDUCATION AND THROUGHOUT THE YEAR FROM THE MINNESOTA DEPARTMENT OF HEALTH MENTAL WELL-BEING AND RESILIENCE LEARNING COMMUNITY. THESE TOOLKITS WERE CALLED THE MENTAL WELL-BEING AND COVID-19 COMMUNICATIONS TOOLKIT AND THE #STAYCONNECTEDMN TOOLKIT.PUBLIC INPUT IS ALWAYS WELCOME.COVID-19 AND THE PUBLIC HEALTH EMERGENCY CHANGED THE FOCUS AND ABILITY TO DELIVER SERVICES THROUGHOUT THE FISCAL YEAR. KITTSON HEALTHCARE'S FOCUS CONTINUES TO BE ON STAFF AND COMMUNITY EDUCATION, TESTING, PREVENTION, AND STRONG EFFORTS ON VACCINATION. MULTIPLE PUBLIC (FREE) VACCINE CLINICS WERE HELD THROUGHOUT THE COUNTY DUE TO SECURED GRANT FUNDS."

PART I, LINE 3C:
TO QUALIFY FOR FINANCIAL ASSISTANCE, AN INDIVIDUAL MUST:(A) RECEIVE EMERGENCY MEDICAL CARE OR MEDICALLY NECESSARY CARE AT THE HOSPITAL;(B) HAVE TOTAL INCOME LESS THAN OR EQUAL TO 200 PERCENT OF FEDERAL POVERTY GUIDELINES;(C) APPLY FOR MEDICAID; AND(D) SUBMIT A COMPLETE COMMUNITY CARE (FINANCIAL ASSISTANCE) APPLICATION, INCLUDING REQUIRED DOCUMENTATION.

PART I, LINE 6A:
THE ANNUAL COMMUNITY BENEFIT REPORT IS MADE AVAILABLE UPON REQUEST.

PART I, LINE 7:
THE ORGANIZATION USED THE COST TO CHARGE RATIO FROM WORKSHEET 2 FROM THE IRS TO CALCULATE THE AMOUNTS IN LINE 7B AND USED ACTUAL COSTS TO CALCULATE THE AMOUNTS IN LINES 7G AND 7I.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES INCLUDED IN PART I, LINE 7G INCLUDE COSTS AND REVENUES ASSOCIATED WITH HALLOCK RURAL HEALTH CLINIC, KARLSTAD RURAL HEALTH CLINIC, EMERGENCY ROOM SERVICES, CARDIAC REHABILIATION SERVICES, THE SKILLED NURSING FACILITY, ADULTS & PEDIATRICS, MEDICAL SUPPLIES, AND OBSERVATION BEDS.

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 $ 68,766.

PART III, LINE 2:
IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE CENTER ANALYZES ITS COLLECTION 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. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). 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 CENTER RECORDS A SIGNIFICANT 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 ORGANIZATION HAS NOT IDENTIFIED A METHOD TO REASONABLY ESTIMATE THE PORTION OF OUR BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY.

PART III, LINE 4:
"SEE THE ""PATIENT AND RESIDENT RECEIVABLES"" SECTION IN NOTE 1 (PAGE 9) TO THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBT EXPENSE."

PART III, LINE 8:
THE MEDICARE SHORTFALL REPORTED IN PART III, LINE 7 IS DUE TO THE NON-ALLOWABLE/NON-REIMBURASABLE COSTS PER THE MEDICARE COST REPORT AND WOULDN'T NECESSARILY BE CONSIDERED COMMUNITY BENEFIT IN NATURE.THE MEDICARE ALLOWABLE COSTS REPORTED IN PART III, LINE 6 WERE DERIVED USING THE FY 2021 FILED MEDICARE COST REPORT.

PART III, LINE 9B:
COLLECTION EFFORTS ARE MADE BY CONTACTING THE PATIENT THROUGH WRITTEN CORRESPONDENCE AND PHONE CALLS. IF, THROUGHOUT THESE CONVERSATIONS, THE COLLECTOR AND PATIENT DISCUSS THAT THE PATIENT IS NOT ABLE TO AFFORD PAYMENTS AS REQUIRED BY OUR POLICY, THE PATIENT IS ENCOURAGED TO APPLY FOR COMMUNITY CARE. AN APPLICATION, PLAIN LANGUAGE SUMMARY, AND FAP ARE SENT TO THE PATIENT TO REVIEW AND COMPLETE. ACCORDING TO FEDERAL POVERTY GUIDELINES, THE PATIENT MAY QUALIFY FOR ALL OR A PERCENT OF CHARGES WRITTEN OFF THEIR ACCOUNT. PATIENTS MUST APPLY FOR MEDICAID PRIOR TO QUALIFYING FOR COMMUNITY CARE. ADDITIONAL INFORMATION IS OFFERED TO HELP THEM APPLY FOR STATE FUNDED PROGRAMS.

PART VI, LINE 2:
PUBLIC HEALTH CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS INFORMATION IS THEN SHARED WITH FACILITY MANAGEMENT AND THE BOARD OF DIRECTORS. GOING FORWARD, A CHNA WILL BE CONDUCTED EVERY THREE YEARS TO MAKE THIS ASSESSMENT.IN ADDITION TO CONDUCTING THE CHNA EVERY THREE YEARS, KITTSON INFORMALLY LISTENS TO THE PUBLIC'S REQUEST FOR SERVICES. THROUGH OUR PUBLIC HEALTH AND SCHOOL HEALTH WORK, WE ARE CONTINUALLY ASSESSING THE HEALTH NEEDS OF THE COMMUNITY AND MEETING THE NEEDS AT THE TIME. FOR EXAMPLE, KITTSON HELD PUBLIC MEETINGS WITH COUNSELORS WHEN THE COMMUNITY HAD A NEED FOR ADDITIONAL SUPPORT AND INFORMATION REGARDING SUICIDE.

PART VI, LINE 3:
IF A PATIENT IS UNABLE TO PAY THEIR BILL, THE PATIENT IS ENCOURAGED TO APPLY FOR COMMUNITY CARE. AN APPLICATION IS SUBSEQUENTLY SENT TO COMPLETE, ALONG WITH A COPY OF OUR FAP AND PLAIN LANGUAGE SUMMARY (A NOTICE IS INCLUDED IN THEIR MONTHLY STATEMENT TO CONTACT US REGARDING COMMUNITY CARE IF THEY ARE UNABLE TO PAY THEIR BILL). WE ARE ADDITIONALY ABLE TO PROVIDE PATIENTS WITH CONTACT INFORMATION AT THE COUNTY FOR QUALIFICATION/APPLICATION INFORMATION REGARDING GOVERNMENTAL FINANCIAL ASSISTANCE. INFORMATION REGARDING COMMUNITY CARE IS ALSO AVAILABLE IN THE ADMISSION AREA OF THE CLINIC.

PART VI, LINE 4:
KMHC PRIMARILY SERVES THE RESIDENTS OF KITTSON COUNTY, WHICH IS LOCATED IN NORTHWEST MINNESOTA, WITH A POPULATION OF APPROXIMATELY 4,300. THIS IS A VERY RURAL AREA WITH 4.1 PERSONS PER SQUARE MILE. THE MEDIAN HOUSEHOLD INCOME IS $55,410 WITH 10.3% OF THE POPULATION BELOW POVERTY LEVELS.

PART VI, LINE 7, REPORTS FILED WITH STATES
MN

PART VI, LINE 5:
"KITTSON MANAGERS DELIVER COMMUNITY MEALS ON WHEELS FOR ONE MONTH EACH YEAR; SUPPORT A VIRTUAL ""RELAY FOR LIFE"" EVENT; PROVIDE AMBULANCE STAND-BY SERVICES AT LOCAL PUBLIC HIGH SCHOOL SPORTING VENTS AS WELL AS THE COUNTY FAIR; PROVIDE FREE BLOOD PRESSURE CHECKS AT VARIOUS AREA EVENTS THROUGHOUT THE YEAR; PROVIDE FINANCIAL CONTRIBUTIONS TO HELP FUND TWO AREA PUBLIC SCHOOLS' ""AFTER PROM PARTY"" EVENTS; PROVIDE TO AREA CHARITIES FOR THEIR FUNDRAISING EVENTS, LAB TESTING CERTIFICATES AS DOOR OR RAFFLE PRIZES; FREE AND REDUCED CARE; HEALTH INFORMATION BOOTH AT FOUR DAY COUNTY FAIR. KITTSON HEALTHCARE ALSO PROVIDES SERVICES THAT OTHER PRIVATE ENTITITES TYPICALLY WON'T CONSIDER PROVIDING SUCH AS ASSISTED LIVING SERVICES, NURSING HOME SERVICES, ELDERLY WAIVERED SERVICES, COMMUNITY FITNESS, AMBULANCE SERVICES, ETC. AS THERE IS LITTLE VOLUME AND MINIMAL FINANCIAL RETURN. HOWEVER, KITTSON HEALTHCARE'S GOVERNING BOARD VIEWS THESE SERVICES AS ESSENTIAL IN MEETING THE NEEDS AND SERVING THE RESIDENTS OF KITTSON COUNTY."