Community Benefit Insight - Tax-exempt hospital

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LifeCare Medical Center

Lifecare Medical Center

715 Delmore Drive
Roseau, MN 56751

Bed count	15	Medicare provider number	241344	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 411804205

Display data for year:

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

12.08%

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	$ 100,000 0.18 %
Medicaid as % of operating expenses	$ 782,564 1.43 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 174,694 0.32 %
Subsidized health services as % of operating expenses	$ 5,208,554 9.54 %
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.	$ 223,159 0.41 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 103,556 0.19 %
Community building* as % of operating expenses	$ 601,061 1.10 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
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	$ 601,061 1.10 %
Physical improvements and housing as % of community building expenses	$ 24,241 4.03 %
Economic development as % of community building expenses	$ 6,110 1.02 %
Community support as % of community building expenses	$ 61,020 10.15 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 13,068 2.17 %
Community health improvement advocacy as % of community building expenses	$ 126,269 21.01 %
Workforce development as % of community building expenses	$ 370,353 61.62 %
Other as % of community building expenses	$ 0 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	$ 1,158,317 2.12 %
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	$ 84,557 7.30 %

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 $ 45805514 including grants of $ 60250) (Revenue $ 54523154)
LifeCare Medical Center operates a 25-bed critical access hospital, including a 50-bed nursing facility, home health, hospice, and public health in Roseau, Minnesota. The organization also operates a 40-bed nursing home and 12 apartments of assisted living in Greenbush, Minnesota. The purpose of the organization is to own, maintain, and operate a hospital, nursing homes, furnish medical and surgical care to the sick, infirmed, or injured.Acute Care Hospital (Inpatient and Outpatient)Inpatient days: 2,903 (1,695 IP and 1,208 SWB)Continued on Schedule O...Long Term CareLifeCare Roseau Manor Resident Days: 13,002LifeCare Greenbush Manor Resident Days: 10,307Home Health/Public Health Visits: 6,128Hospice Clients Served: 30To fulfill its mission of community service, LifeCare Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The amount of charges foregone, based on established rates, was $154,962 for the year ended September 30, 2022.LifeCare Medical Center was selected by The National Rural Health Association's Rural Health Policy Institute, iVantage Health Analytics and The Chartis Center for Rural Health as one of the top 100 Critical Access Hospitals in the country based on quality, customer surveys, and financial indicators. We are very proud of our staff in being selected in 2018, 2020, and 2021 for this honor.

Facility Information

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

LifeCare Medical Center
Part V, Section B, Line 5: LifeCare Community Relations and LifeCare Public Health collected community input on the health needs of Roseau County through a series of meetings with targeted individuals and groups, which represented all age and geographic levels of our service area. There were 13 meetings in total, which occurred between March 2022 through May 2022. These meetings included the 3 largest employers in our service area: Marvin Windows & Doors, Central Boiler, and Polaris. Meetings also included the Warroad, Badger, Greenbush and Roseau schools, Roseau County, Roseau Police Department, Roseau Ministerial Association, and Roseau City Council. In addition, those who serve low-income and minority populations were represented by Roseau County Social Services, LifeCare Public Health, and NW Community Action. Everyone participating in the interviews was given a list of specific health indicators/needs based on past responses from previous needs assessments and asked the following open-ended questions on community health needs: 1. What do you believe are the 2-3 most important issues that should be addressed to improve the quality of life for people in our community? 2. After reviewing the Health Indicators List, what items do you think are the most pressing health concerns for our citizens and why? Are there any not on the list that you believe are a concern? 3. What (if anything) is holding our community back from doing what needs to be done to improve health and quality of life for residents? 4. If you could create the healthiest community what would that look like to you? 5. Please share a few things our community could do better to enhance the health of our residents: The responses from these individual meetings were then forwarded on to Garth Kruger, EvaluationGroup, LLC and he compiled them into a comprehensive list of community health needs and suggestions.

LifeCare Medical Center
"Part V, Section B, Line 11: The health needs identified in our prior CHNA were Mental Health, Healthy Eating, Alcohol Use, Technology Addiction, Drug Use, Physical Activity, Vaping, Parenting, Isolation, Obesity, Daycare, Housing, Health Insurance, Tobacco Use, Transportation and Social Media.LifeCare does not have the expertise or resources to work toward solutions for all of the items identified in prior CHNA. As a result, priority was not given to the following needs: Lack of Daycare Providers, Health Insurance, Housing, Social Media, Parenting, Transportation, or Technology Addiction. LifeCare Medical Center did complete a new CHNA in the current tax year. We continued to address the Mental Health needs identified in the prior Community Health Needs Assessment as identified below. The needs identified in the new CHNA will be similar to these other than we have decided to change the name to Chronic Disease Management vs. Obesity/Healthy Eating/Physical Activity.1. MENTAL HEALTH *Our Integrative Behavioral Health Committee continues to meet at least monthly to review and plan mental health related activities for staff and community. *LifeCare Behavioral Health has added the services of a Psychiatric Mental Health Nurse Practitioner 2 days a week. A Registered Nurse position was also created to facilitate this addition and help with patient care & education, triage, and support. *Paula Hedlund, Behavioral Health RN, attends monthly meetings as a Board member of the MAX Foundation which is a local suicide prevention group. The mission of this group is to support programs, projects and activities that facilitate mental wellness amongst youth. *The MAX Foundation has helped 5 Minnesota schools, including 3 of the 4 in our service area, implement Project 11, a mental health & wellness curriculum for grades K-12. *LifeCare continues to have staff members attend the monthly H.O.P.E. coalition meetings. This coalition is committed to ending death by suicide in NW MN through Help, Outreach, Prevention and Education. * LifeCare continues to share mental health messaging and education with our community partners. *Participated in ""Be The Voice"" events in Thief River Falls, MN and Warroad, MN. These events included a Mental Health Expo and Suicide Awareness Speakers for the community. The Thief River Falls event had 300 attendees and the Warroad event had over 600 people attend.*LifeCare and the Max Foundation partnered to have Tim Denney offer QPR training to high school coaches in our service area and beyond. *Wellness speaker event, featuring Amy Dee, was held at the Roseau School Theater for the community. *We continue to post mental health resources and positive messaging via our social media accounts. *Motivational Speaker, Hunter Pinke, presented to Roseau High School and Elementary students. This was sponsored by the Max Foundation. Plans are underway to offer this in the Warroad and Greenbush Schools in the near future. *Partnered with Roseau County to promote positive mental health messaging and resources at the Roseau County Fair. ""Be The Voice"" was the theme. *Presented an ""Embracing Hope"", a community-focused event that featured inspirational speakers addressing life challenges, terminal illness, grief, and finding healing through faith and support. *LifeCare participated in a covid recovery group with the County to address the mental health challenges that we are facing today due to the impacts of covid.2. OBESITY/HEALTHY EATING/PHYSICAL ACTIVITY *The 24-hour onsite wellness/fitness centers were available for use in Roseau, Warroad and Greenbush. *LifeCare continued to provide an online portal, Wellbeats, for employees to use as a resource for online exercise programming and education for themselves and their families. *May Walk Run was held in person during May of 2022 for the first time in a few years. *LifeCare continues to have a Registered Dietician available through Rehab services for nutrition consolation. *Social Media continues to be used for communicating education on healthy living. *Tai Ji Quan & Matter of Balance classes were offered but attendance was low and we had to cancel. We felt attendance may have been affected due to people not being ready to participate in group events after covid. *Participated in Marvin & Central Boiler Health Fairs. *Work continues on the new Warroad Wellness Center which will house Behavioral Health and Rehab services, along with a new fitness center and community room for exercise classes and social programming. LifeCare staff have been part of the planning group for this new facility. *Provided health education at the Roseau Elementary 2nd grade Health Fair. *Power Sports camps and youth fitness training was held through our Rehab department. *In the process of implementing personal training.3. TOBACCO USE/VAPING/DRUG USE/ALCOHOL USE *We continue to work with Team EPIC and Roseau County youth to decrease the use of Alcohol, Tobacco and Drugs. Meetings are held monthly. *Drug Take Back events were held in Greenbush, Roseau and Warroad. *We continue to offer Cessation resources on our website and social media accounts. *We continue to provide education on these topics via social media and discharge planning packets. *Public Health is planning to resume Tobacco Compliance Checks."

LifeCare Medical Center
Part V, Section B, Line 16j: In addition to providing the full policy upon request, the Hospital also summarizes the policy on its website, billing invoices, as well as brochures summarizing the policy in the emergency rooms and admissions office.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
In addition to the Federal Poverty Guidelines, the Medical Center also used an asset test of $15,000.

Part I, Line 7:
Charity care was converted to cost by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients. Community health improvements and cash and in-kind contributions are calculated at actual costs recorded in the general ledger. Health professionals Education costs are e based on estimated time and wages to manage students and interns at the facilities. Subsidized health services and Medicaid are converted to cost according to costs allocated to the relevant cost centers on the Medicare Cost Report.

Part II, Community Building Activities:
Community support includes donations to local community organizations and employee staff time donated to local community committees, as well as employee staff time spent on disaster preparedness beyond legal requirements.Coalition building includes EMT and CPR training for area First Responders and Fire Departments, as well as time donated to the Roseau Area Diabetes Center.Community health improvement advocacy includes staff time on healthcare related boards that advocate for healthcare, as well as time spent on discussions on proper prescription drug disposals, med alerts, chronic disease management, time spent in local correctional facilities on prescription drug abuse and on the Roseau County Committee on Aging. By being involved in the community through the above activities, we are able to increase health awareness.Roseau County is considered a Health Professional Shortage Area and therefore is including the costs of recruitment in workforce development. This promotes better care for our patients. The costs include physician recruitment, career fairs and workforce development committees.

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 estimated amount of implicit price concessions is attributable to patients eligible under the organization's charity care policy is calculated by using the estimated percentage of community population that is under the Federal Poverty Guidelines. The organization has estimated 7.3% of the implicit price concessions would be charity care.

Part III, Line 4:
The financial statement footnote regarding implicit price concessions may be found on page 11 of the 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 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 Centers for Medicare and Medicaid Services.

Part III, Line 9b:
Before engaging in ECAs to obtain payment for care, LifeCare Medical Center must make certain reasonable efforts to determine whether an individual is eligible for financial assistance under our financial assistance policy: a) ECAs may begin only when 120 days have passed since the first post discharge statement was provided (an exception is the account with no delivery information and those can go directly to collections). b) However, at least 30 days before initiating ECAs to obtain payment, LifeCare Medical Center shall do the following: i. Provide the individual with a written notice that indicates the availability of financial assistance, lists potential ECAs that may be taken to obtain payment for care, and gives a deadline after which ECAs may be initiated (no sooner than 120 days after the first post discharge billing statement and 30 days after the written notice) ii. Provide a plain-language summary of the FAP along with the notice described above iii. Attempt to notify the individual orally about the FAP and how he or she may get assistance with the application process.After making reasonable efforts to determine financial assistance eligibility as outlined above, LifeCare Medical Center (or its authorized business partners) may take any of the following ECAs to obtain payment for care: a) Report adverse information to credit reporting agencies and/or credit bureaus b) Take action to foreclose property c) Garnish wages d) Place a lien on property. If a patient has an outstanding balance for previously provided care, LifeCare Medical Center may engage in the ECA of deferring, denying, or requiring payment before providing additional medically necessary (but non-emergent) care only when the following steps are taken:a) LifeCare Medical Center provides the patient with an FAP application and a plain language summary of the FAP b) LifeCare Medical Center provides a written notice indicating the availability of financial assistance and specifying any deadline after which a completed application for assistance for the previous care episode will no longer be accepted. This deadline must be at least 30 days after the notice date or 240 days after the post-discharge billing statement for prior care whichever is later. c) LifeCare Medical Center makes a reasonable effort to orally notify the individual about the financial assistance policy and explain how to receive assistance with the application process. d) LifeCare Medical Center processes on an expedited basis any FAP applications for previous care received with the stated deadline.

Part VI, Line 2:
LifeCare Medical Center provides the Public Health functions for Roseau County.

Part VI, Line 3:
We have financial counselors who have phone conversations with patients during our collections process. We guide patients to other financial programs as well as our own charity care program. Brochures are available in the admitting area which is in the same location as the Emergency Room. Information is also sent to our patients via patient bills. Our website has the charity care application and brochure, as well as the contact information for our financial counselors, available to patients.

Part VI, Line 4:
Roseau County is a rural area with a population of approximately 15,331 people. We are the sole hospital located in Roseau County and the nearest tertiary hospital is two hours away. We are a federally-designated medically underserved area. In 2022, approximately 18.1% of the population was age 65 or older. The average median household income is $62,304 and approximately 7.3% of the population is below the federal poverty level.

Part VI, Line 5:
The organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay.As a not-for-profit organization LifeCare Medical Center has made a promise to give back to its community. As a regional healthcare leader, LifeCare strives to respond to healthcare needs by partnering with local leaders, educators, government officials and others.The community benefit report summarizes how this leadership role has made a difference to the people of the area. Included are highlights describing how LifeCare has played an integral role in enhancing the health and overall well-being of the community.Trusted PartnershipsLifeCare's commitment to quality care extends beyond its walls and into the community where strong partnerships have been built to maintain and improve the health and overall well-being of its neighbors. LifeCare EMS personnel are proud of their trusted relationships with regional emergency response groups. Area fire fighters, police, and others participate in disaster training sessions where a disaster is staged and responded to as if it were a real life situation. This type of training helps prepare all groups involved.Education for a Healthy FuturePart of LifeCare's mission is to help educate the next generation of health care professionals. LifeCare Directors work closely with many regional high school and post-secondary educational facilities to bring students into our organization through job shadowing, internships, rural scholar and other programs. Through these programs, students get a firsthand look at specific health care careers as they learn from our staff for a day, week, month or several months based on their program. Students often times focus on rural healthcare employment opportunities that may be available to them once they have completed their education.Charity CareLifeCare recognizes that circumstances arise where a patient is simply unable to pay a hospital bill. In these situations, LifeCare offers a program called Charity Care, in which LifeCare forgives the bills of deserving families and individuals who meet set income guidelines. Great appreciation has been voiced by many who received a helping hand from this program. In fiscal year 2022, LifeCare granted $154,962 in Charity Care based on charges foregone.A Healthy Awareness and Community OutreachLifeCare employees know the importance of educating the public about a healthy lifestyle. And sometimes the best way to provide awareness is to venture outside the facility. That's why LifeCare is involved with many initiatives throughout our communities. By reaching out to the public through nutrition and exercise programs, civic projects, health and safety awareness, health fairs, and other methods, they are able to educate and strengthen the community.Fifth grade tours have become a favorite for students throughout Roseau County. A hospital tour is coupled with a mini health fair where students learn their blood type. The goal of this program is to influence young students into making healthy lifestyle decisions, in addition to introducing them to careers in healthcare.Funding Essential ServicesLifeCare's commitment to community needs is exemplified by its contribution to subsidized services. In fiscal year 2022, LifeCare absorbed over $5,200,000 in costs in order to sustain services that rely on funding from other sources, in particular the Medicaid program. These departments include respiratory therapy, home health care, hospice, public health, ambulance, clinic space, behavioral health, OB, and the two nursing homes.LifeCare Medical Center distributed approximately $7.3 million based on cost in Community Benefits in fiscal year 2022 as reported on Schedule H Part I, II and III.

Operating expenses	$ 54,578,646
Total amount spent on community benefits as % of operating expenses	$ 6,592,527 12.08 %