4A (Expenses $ 162609224 including grants of $ 330198) (Revenue $ 175391452)
AS A COMMUNITY-BASED HOSPITAL AND HEALTH CARE PROVIDER, CRMC'S MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITY AND PROVIDE QUALITY HEALTH CARE SERVICES FOR ALL CITIZENS, REGARDLESS OF ABILITY TO PAY. EACH YEAR, CRMC GIVES BACK TO THE COMMUNITY THROUGH EDUCATION, HEALTH SERVICES, DONATIONS, AND FREE AND REDUCED COST HEALTH CARE TO ENSURE THAT FINANCIAL ISSUES DO NOT PREVENT PATIENTS FROM SEEKING OR RECEIVING CARE. CRMC MAKES SIGNIFICANT EFFORTS TO ENSURE CHARITY CARE IS GRANTED TO ALL PATIENTS WHO QUALIFY. IN FY22 A TOTAL OF $362,758 IN SERVICES WERE PROVIDED TO LOW-INCOME PATIENTS AT FREE OR REDUCED PRICES AND WAS PROVIDED TO THOSE WHO HAVE EXHAUSTED THIRD PARTY RESOURCES, DO NOT QUALIFY FOR MEDICAID, OR HAVE INSUFFICIENT INCOMES. CRMC ALSO EXPERIENCED A LOSS OF $2,919,303 IN THE UNPAID COSTS OF MEDICAID FOR LOW-INCOME INDIVIDUALS. THE CUYUNA LAKES AREA HAS A HIGH NEED FOR SEVERAL HEALTH CARE SERVICES THAT DO NOT GENERATE SUFFICIENT REVENUE TO COVER THE COST OF PROVIDING THEM. CRMC SUBSIDIZED A TOTAL OF $2,328,143 IN SERVICES IN FY22 TO ENSURE THEIR AVAILABILITY TO OUR COMMUNITY. THE ORGANIZATION ALSO PROVIDES HEALTH-RELATED EDUCATION TO THE COMMUNITY THROUGH EVENTS, CLASSES, LECTURES, AND WELLNESS SCREENINGS COMPLETELY FREE-OF-CHARGE TO THE COMMUNITY. CRMC'S HEALTH AND WELLNESS EVENTS IN 2022 WERE ATTENDED BY 11,859. IN FY22, 4,601 LUNCHES WERE PROVIDED FOR YOUTH IN THE CUYUNA LAKES LUNCH BUNCH FREE SUMMER LUNCH PROGRAM. IN ADDITION, CASH DONATIONS WERE MADE TO THE CUYUNA AND EMILY FOOD BANKS, AND THE CROSBY FARMER'S MARKET AND ITS POWER OF PRODUCE PROGRAM WERE SUPPORTED. CRMC OFFERS YEAR-ROUND COURSES ON FIRST AID, CPR, CHILDBIRTH, AND WEIGHT MANAGEMENT TOGETHER WITH SUPPORT GROUPS ON MENTAL HEALTH, CANCER, AND WEIGHT LOSS. THE VALUE OF CRMC'S COMMUNITY EDUCATION AND SUPPORT IN FY22 TOTALED $497,864. CRMC ALSO SUPPORTS OTHER ORGANIZATIONS AND INITIATIVES THAT SHARE ITS GOAL TO IMPROVE THE HEALTH OF OUR COMMUNITY. IN FY22, THAT INCLUDED $180,198 IN CASH AND IN-KIND DONATIONS TO ORGANIZATIONS FOCUSED ON THE HEALTH, SOCIAL, CULTURAL, AND EDUCATIONAL NEEDS OF THE AREA. IN ADDITION, CRMC STAFF DONATES TIME, MATERIALS, AND LEADERSHIP TO MORE THAN 20 COMMUNITY GROUPS INCLUDING VARIOUS SCHOOLS; CUYUNA LAKES, BRAINERD LAKES AND NISSWA CHAMBERS OF COMMERCE; HALLETT COMMUNITY CENTER; CROSBY-IRONTON, BRAINERD, NISSWA AND PEQUOT LAKES SCHOOLS; NORTHLAND ARBORETUM; AREA CHURCHES; UNITED WAY; KINSHIP PARTNERS; CROSBY, IRONTON, CUYUNA AND DEERWOOD FIRE DEPARTMENTS AND OTHERS. BECAUSE FOOD INSECURITY IS A GREAT NEED FOR THE AREA, CRMC ANNUALLY INVESTS ABOUT $20,000 TOWARDS FREE SUMMER LUNCH AND HOLIDAY BREAK MEALS FOR STUDENTS, HEALTHY FOOD AT COMMUNITY EVENTS, AND STOCKING AREA FOOD SHELVES. CRMC ALSO INVESTS APPROXIMATELY $5 MILLION PER YEAR IN CAPITAL IMPROVEMENTS SUCH AS NEW EQUIPMENT, FACILITIES, AND TECHNOLOGY INFRASTRUCTURE.

CUYUNA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: CRMC UTILIZED INFORMATION FROM RESULTS OF THE 2020-2022 CHNA DEVELOPED BY ESSENTIA HEALTH/ST. JOSEPH'S MEDICAL CENTER AS WELL AS THE 2021 CROW WING COUNTY COMMUNITY HEALTH SURVEY. DATA FROM CRMC'S CLINIC AND HOSPITAL PATIENT RECORDS, THE U.S. CENSUS, STATE OF MINNESOTA, AND AREA PUBLIC SCHOOLS WAS ALSO INCLUDED.

CUYUNA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 6A: ESSENTIA HEALTH/ST. JOSEPH'S MEDICAL CENTER IN BRAINERD, DATA FROM ITS 2020-2022 CHNA WAS UTILIZED.

CUYUNA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 6B: CROW WING COUNTY HEALTH DEPARTMENT AND SHERIFF, HALLETT COMMUNITY CENTER, CENTRAL LAKES COLLEGE, LAKES AREA FOOD SHELF, CROSBY-IRONTON SCHOOL DISTRICT, PEQUOT LAKES SCHOOL DISTRICT, UPLIFTED WELLNESS STUDIO, CONSOLIDATED TELECOMMUNICATIONS COMPANY, GREAT RIVER EYE CLINIC, CUYUNA LAKES CHAMBER OF COMMERCE, BRAINERD LAKES AREA CHAMBER OF COMMERCE, NISSWA CHAMBER OF COMMERCE AND SMILES FOR JAKE.

CUYUNA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: MENTAL HEALTH - RECRUITED A PSYCHIATRIST TO SERVE THE COMMUNITY. PARTNERED WITH SMILES FOR JAKE SUICIDE PREVENTION COALITION TO PROVIDE COMMUNITY EDUCATION AND EVENTS ON BULLYING, ANXIETY, AND HOPELESSNESS. PROVIDED TRAINING TO CRMC PROVIDERS, LEADERSHIP, AND STAFF. CONTINUED TO PARTNER WITH COMMUNITY ORGANIZATIONS IN PROVIDING EDUCATION TO STAFF AND PROVIDERS. CONTINUE TO OFFER UNLIMITED EAP VISITS FOR STAFF AND THEIR FAMILY MEMBERS. SCREEN ALL CLINIC PATIENTS FOR DEPRESSION AND OFFER ASSISTANCE TO THOSE WITH POSITIVE RESULTS. THROUGH WELLNESS PROGRAM, OFFERED EDUCATION, T-SHIRTS WITH POSITIVE MESSAGES, SOCIAL ACTIVITIES. OFFERED THE PUBLIC THE OPPORTUNITY TO CREATE SMILE BOXES AND PAINT ROCKS WITH POSITIVE MESSAGES AT COMMUNITY EVENTS. PROVIDED 3 GOOD THINGS EDUCATION AND NOTEBOOKS TO NUMEROUS STUDENTS. PARTNERED WITH SMILES FOR JAKE TO COORDINATE A CUYUNA CHRISTMAS, A FREE, POSITIVE HOLIDAY CELEBRATION FOR THE COMMUNITY. SUPPORTED NEW MENTAL HEALTH SUPPORT GROUP FOR THE COMMUNITY BY PROVIDING MEETING SPACE AND PUBLICITY. PHYSICAL ACTIVITY - OFFER WELLBEATS ON-DEMAND FITNESS PROGRAM FOR STAFF. SUPPORT CUYUNA STATE RECREATION AREA TRAIL MAINTENANCE. PROVIDE BIKES FOR STAFF TO RIDE ON BREAKS AND AFTER WORK. ENCOURAGE STAFF TO PARTICIPATE IN GROUP BIKE RIDES, RUNS, AND KICKBALL GAMES. PROVIDED BIKE HELMETS TO AREA STUDENTS. SPONSOR HALLETT CENTER ICE SKATING RINK. PROVIDE ATHLETIC TRAINER FOR CROSBY-IRONTON SCHOOL AND PEQUOT LAKES SCHOOL ATHLETES. SUPPORTED LOCAL COMMUNITY SKATING RINKS, YOUTH HOCKEY ASSOCIATIONS, SPORTS BOOSTERS, BASEBALL TEAMS, AND RANGERETTES DANCE TEAM. INCORPORATE PHYSICAL ACTIVITES INTO COMMUNITY EVENTS, E.G., REINDEER RACES AT CUYUNA CHRISTMAS; BEAN BAG TOSS, GIANT RING TOSS, BEAR BONG, AND VEGGIE/FRUIT WALK; AND HOST BIKE HELMET FITTINGS. NUTRITION- INCLUDE NUTRITION INFORMATION TO CRMC CULINARY MENUS. FINANCIALLY SUPPORT CROSBY, LAKES AREA, AND EMILY FOOD BANKS. OFFERED DIABETES EDUCATION AND SUPPORT GROUPS. OFFER MEDICAL WEIGHT MANAGEMENT PROGRAM AND INTENSIVE BEHAVIORAL THERAPY PROGRAMS FOR OVERWEIGHT INDIVIDUALS. SPONSOR CUYUNA FARMER'S MARKET AND ITS POWER OF PRODUCE PROGRAM ENCOURAGING YOUTH AND SENIORS TO EAT MORE FRUITS AND VEGETABLES. STARTED NEW LIVING WELL: WEIGHT LOSS SERIES CLASS. OFFER MONTHLY VIRTUAL WEIGHT LOSS SUPPORT GROUPS AND SEMINARS. FINANCIALLY SPONSORED FISHING TO END HUNGER FISHING TOURNAMENT BENEFITTING COMMUNITY OUTREACH. HOLD VEGGIE/FRUIT WALK ACTIVITY AT COMMUNITY EVENTS.

PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE
HTTPS://WWW.CUYUNAMED.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE:
HTTPS://WWW.CUYUNAMED.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

PART I, LINE 7:
COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED MEDICARE COST REPORT.

PART I, LN 7 COL(F):
IMPLICIT PRICE CONCESSIONS THAT WERE SUBTRACTED FROM TOTAL EXPENSE TO OBTAIN THE % OF COMMUNITY BENEFIT TO TOTAL EXPENSE AMOUNTED TO $6,009,748.

PART II, COMMUNITY BUILDING ACTIVITIES:
CRMC PROMOTED THE HEALTH OF THE COMMUNITIES IT SERVES THROUGH THE FOLLOWING COMMUNITY BUILDING PROJECTS. CRMC FINANCIALLY SUPPORTED THE BRAINERD LAKES AREA ECONOMIC DEVELOPMENT CORPORATION TO HELP FOSTER THE CREATION OF NEW JOBS, ATTRACT NEW INDUSTRY TO THE REGION AND ASSIST AREA BUSINESSES. IT ALSO SUPPORTS THE BRAINERD LAKES, CUYUNA LAKES, PEQUOT LAKES, AND NISSWA CHAMBER OF COMMERCES AND THEIR COMMUNITY EVENTS TO ASSIST IN BUILDING HEALTHY AND SUCCESSFUL BUSINESS COMMUNITIES. HEALTH OF THE COMMUNITY WAS IMPROVED THROUGH NUMEROUS VIRTUAL AND IN-PERSON HEALTH AND WELLNESS EDUCATIONAL CLASSES AND SUPPORT GROUPS. FOOD WAS ALSO PROVIDED TO ECONOMICALLY INSECURE FAMILIES THROUGH THE CUYUNA LAKES LUNCH BUNCH PROGRAM WHERE LUNCHES ARE GIVEN TO YOUTH IN THE SUMMER AND SCHOOL FREE LUNCHES ARE NOT AVAILABLE. FINANCIAL DONATIONS WERE MADE TO THE CUYUNA LAKES, EMILY, AND LAKES AREA FOOD SHELVES AS WELL AS THE OUTREACH PROGRAM. TO ENCOURAGE STUDENTS TO SEEK A HEALTH CARE CAREER, CRMC SUPPORTED BRIDGES ACADEMY CAREER DAY, AN EVENT WHERE AREA HIGH SCHOOL STUDENTS COME TO THE LOCAL COMMUNITY COLLEGE TO HEAR FROM PROFESSIONALS ABOUT THEIR SPECIFIC JOBS. SEVERAL FIELD TRIPS TO THE FACILITIES ARE HOSTED BY THE HOSPITAL'S VARIOUS DEPARTMENTS AND EMERGENCY MEDICAL SERVICES PROVIDED NUMEROUS CPR/FIRST AID TRAINING CLASSES AND DEMONSTRATIONS. CRMC ALSO SUPPORTED CROSBY-IRONTON HIGH SCHOOL'S NEW RANGER MADE PROGRAM WHICH TEACHES STUDENTS MANUFACTURING, DRAFTING, WOODWORKING, METAL WORKS, AND AUTO SKILLS.

PART III, LINE 2:
REVENUES GENERALLY RELATE TO CONTRACTS WITH PATIENTS IN WHICH THE PERFORMANCE OBLIGATIONS ARE TO PROVIDE HEALTH CARE SERVICES TO THE PATIENTS. REVENUES ARE RECORDED DURING THE PERIOD THE PERFORMANCE OBLIGATIONS TO PROVIDE HEALTH CARE SERVICES ARE SATISFIED. THE CENTER'S PERFORMANCE OBLIGATIONS FOR INPATIENT SERVICES ARE GENERALLY SATISFIED OVER PERIODS THAT AVERAGE APPROXIMATELY THREE DAYS, AND REVENUES ARE RECOGNIZED BASED ON CHARGES INCURRED IN RELATION TO TOTAL EXPECTED CHARGES. PERFORMANCE OBLIGATIONS FOR OUTPATIENT SERVICES ARE GENERALLY SATISFIED OVER A PERIOD OF LESS THAN ONE DAY.REVENUES ARE BASED UPON THE ESTIMATED AMOUNTS THE CENTER EXPECTS TO BE ENTITLED TO RECEIVE FROM PATIENTS, INCLUDING PAYMENTS MADE BY THIRD-PARTY PAYORS ON BEHALF OF PATIENTS. ESTIMATES OF CONTRACTUAL ALLOWANCES UNDER MANAGED CARE AND COMMERCIAL INSURANCE PLANS ARE BASED UPON THE PAYMENT TERMS SPECIFIED IN THE RELATED CONTRACTUAL AGREEMENTS. REVENUES RELATED TO UNINSURED PATIENTS AND UNINSURED COPAYMENTS AND DEDUCTIBLE AMOUNTS FOR PATIENTS WHO HAVE HEALTH CARE COVERAGE MAY HAVE DISCOUNTS APPLIED (UNINSURED DISCOUNTS AND CONTRACTUAL DISCOUNTS). THE CENTER ALSO RECORDS ESTIMATED IMPLICIT PRICE CONCESSIONS (BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE) RELATED TO UNINSURED ACCOUNTS TO RECORD SELF-PAY REVENUES AT THE ESTIMATED AMOUNTS THE CENTER EXPECTS TO COLLECT. UNDER THE PROVISIONS OF ACCOUNTING STANDARDS UPDATE (ASU) NO. 2014-09, WHICH WAS ADOPTED APRIL 1, 2019, WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THE CENTER HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE RECEIVABLES IF THE CENTER'S RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE SUBSEQUENT TO THE ADOPTION OF ASU 2014-09, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE CENTER DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THANINDIVIDUALLY. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH.THE PRIMARY COLLECTIONS RISKS RELATE TO UNINSURED PATIENT ACCOUNTS, INCLUDING PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE CARRIER HAS PAID THE AMOUNTS COVERED BY THE APPLICABLE AGREEMENT, BUT THE PATIENT RESPONSIBILITY AMOUNTS (DEDUCTIBLES AND COPAYMENTS) REMAIN OUTSTANDING. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO AMOUNTS DUE DIRECTLY FROM PATIENTS. ESTIMATED IMPLICIT PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, REGARDLESS OF THE AGING OF THOSE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED.

PART III, LINE 3:
AT CUYUNA REGIONAL MEDICAL CENTER IMPLICIT PRICE CONCESSIONS ARE CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE ARE INABILITY TO PAY.

PART III, LINE 4:
SEE FOOTNOTE 1 ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:WE PROVIDE A COURTESY PHONE CALL AFTER THE FIRST STATEMENT. AT THAT TIME THE FINANCIAL ASSISTANCE POLICY IS DISCUSSED. WE ALSO HAVE FINANCIAL ADVISORS AVAILABLE DURING NORMAL BUSINESS HOURS IN THE FACILITY. WE ALSO MAIL OUT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION PRIOR TO SENDING A PATIENT TO COLLECTIONS. THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE THROUGHOUT OUR FACILITIES AND ONLINE AT: HTTPS://WWW.CUYUNAMED.ORG/PATIENT-INFORMATION/BILLING.

PART VI, LINE 6:
AFFILIATED HEALTH CARE SYSTEM:N/A

PART VI, LINE 7, REPORTS FILED WITH STATES
MN

PART III, LINE 8:
THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6:THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6.

PART III, LINE 9B:
IT IS OUR GOAL TO PROVIDE AFFORDABLE HEALTHCARE SERVICES TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY AND ASSIST UNINSURED OR UNDERINSURED PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE.WE ALLOW PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE TO PAY WHAT THEY ARE WILLING AND ABLE TO PAY BUT WE DO NOT REQUEST PAYMENT. PATIENT ASSISTANCE IS NOT CONSIDERED TO BE A SUBSTITUTE FOR PERSONAL RESPONSIBILITY. PATIENTS MUST COOPERATE WITH CRMC PROCEDURES FOR OBTAINING FINANCIAL ASSISTANCE. PATIENTS ARE EXPECTED TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR ABILITY TO PAY. INDIVIDUALS WITH THE FINANCIAL MEANS TO PURCHASE HEALTH INSURANCE SHALL BE URGED TO DO SO. THIS ASSURES ACCESS TO HEALTH CARE SERVICES AND PROTECTS THEIR ASSETS.CUYUNA REGIONAL MEDICAL CENTER'S PAYMENT AND COLLECTION POLICY STATES:PURPOSE: CRMC HAS ESTABLISHED A STRONG MISSION OF MEETING THE MEDICAL NEEDS OF THE COMMUNITIES IT SERVES. A SOUND PAYMENT AND COLLECTION POLICY IS A FUNDAMENTAL COMPONENT OF THIS MISSION. CRMC WILL MAINTAIN A POLICY OF COMMUNICATING FINANCIAL RESPONSIBILITY TO OUR PATIENTS WITH THE EXPECTATION OF PAYMENT AT TIME OF SERVICE. CRMC WILL ASSIST PATIENTS IN ALIGNING THEM WITH RESOURCES NEEDED TO FACILITATE THE PROMPT PAYMENT OF ANY PATIENT BALANCE. THE POLICY WILL KEEP IN MIND THE PATIENT'S UNIQUE FINANCIAL SITUATION AND PRESERVE THE DIGNITY OF THOSE INVOLVED.RESPONSIBILITY: CFO, DIRECTOR OF REVENUE CYCLE AND DESIGNATED PERSONNEL ARE RESPONSIBLE FOR THE CREATION, REVISION AND ENFORCEMENT OF THIS POLICY.DEFINITIONS: 1. PATIENT FINANCING OPTIONS: CUYUNA REGIONAL MEDICAL CENTER WILL PROVIDE THE FOLLOWING PAYMENT OPTIONS:A. CASH PAYMENTSI. THE EXPECTATION OF CRMC IS SELF PAY BALANCES WILL BE PAID ON DATE OF SERVICE OR PRIOR TO SERVICE. INQUIRIES INTO PROCEDURE COSTS AND PAYMENT ARRANGEMENTS ARE DIRECTED TO THE DIRECTOR OF REVENUE CYCLE OR REPRESENTATIVE. SELF PAY BALANCES SHOULD BE PAID WITHIN 15 DAYS OF RECEIPT OF FIRST STATEMENT.B. CREDIT CARDSI. CRMC WILL ACCEPT CREDIT CARD PAYMENTS FOR PATIENT'S SELF-PAY PORTION OF BALANCES. MOST MAJOR CREDIT CARDS ARE ACCEPTED.C. MEDICAID ELIGIBILITY & OTHER FUNDING SOURCESI. THE BUSINESS OFFICE OF CRMC WORKS CLOSELY WITH THE STATE MEDICAID ELIGIBILITY PROGRAM TO ENSURE PATIENTS HAVE ACCESS TO AVAILABLE PROGRAMS. NON-INSURED PATIENTS ARE REFERRED TO THE STATE MEDICAID PROGRAM FOR A PROBABILITY OF ELIGIBILITY ASSESSMENT. APPLICATIONS ARE AVAILABLE FROM THE BUSINESS OFFICE. SERVICE ITEMIZATIONS ARE AVAILABLE UPON REQUEST FOR SUBMISSION TO FLEX ACCOUNTS OR HSA'S.D. UNCOMPENSATED CAREI. APPLICATIONS ARE AVAILABLE FROM THE BUSINESS OFFICE. DOCUMENTATION OF INCOME AND MEDICAID ELIGIBILITY MAY BE REQUIRED. FEDERAL POVERTY GUIDELINES MAY BE UTILIZED IN DETERMINING UNCOMPENSATED CARE REDUCTIONS.2. SELF PAY DISCOUNTS: A. CRMC IN COOPERATION WITH THE MN ATTORNEY GENERAL AGREEMENT HAS AGREED TO INITIATE A DISCOUNT EQUAL TO ITS LARGEST COMMERCIAL PAYER TO ANY PATIENT WITHOUT HEALTH INSURANCE. A PAYMENT IN FULL DISCOUNT MAY BE OFFERED TO PATIENTS WITH A SELF-PAY ACCOUNT BALANCE ABOVE $500 WHEN PAID WITHIN THE FIRST BILLING CYCLE. SERVICES EXCLUDED FROM THESE DISCOUNTS MAY INCLUDE: LONG TERM CARE, HOME CARE SPEND DOWNS, ASSISTED LIVING SERVICES, LIFE LINE, AND OTHER CONTRACTED ANCILLARY SERVICES. 3. COLLECTION OF CO-PAYS, DEDUCTIBLES AND CO-INSURANCE:A. COLLECTION OF CO-PAYS, DEDUCTIBLES, AND CO-INSURANCE MAY BE COLLECTED FROM PATIENTS AT THE TIME OF SERVICE OR PRIOR TO SERVICE WHEN THE BENEFIT LEVELS HAVE BEEN VERIFIED. 4. PAYMENT CONTRACTS:A. PATIENTS THAT CANNOT PAY THEIR BALANCE IN FULL MAY ESTABLISH A PAYMENT CONTRACT. CRMC PROMOTES ACHIEVING PATIENT BALANCES AT ZERO WITHIN 6 MONTHS FROM DATE OF SERVICE. IN THE EVENT THAT EXTENDED ARRANGEMENTS NEED TO BE MADE, CONSULTATION WITH THE DIRECTOR OF REVENUE CYCLE OR REPRESENTATIVE WILL BE REQUIRED. CRMC WILL ESTABLISH REASONABLE PAYMENT ARRANGEMENTS BUT NO LESS THAN A MINIMAL PAYMENT OF 4% OF PATIENT'S BALANCE OR $20 PER MONTH WHICHEVER IS GREATER FOR A MAXIMUM PAYMENT CONTRACT OF 24 MONTHS PER ACCOUNT BALANCE. CRMC WILL NOT PROMOTE CONSOLIDATING ACCOUNTS AND WILL WORK WITH PATIENTS TO ENSURE UNDERSTANDING OF ACCOUNTS BALANCES DUE.5. BILLING CONCERNS:A. OUR BUSINESS OFFICE IS OPEN MONDAY THROUGH FRIDAY FROM 7:30 AM UNTIL 4:30 PM TO ANSWER ANY BILLING QUESTIONS. PLEASE HAVE YOUR ACCOUNT NUMBER AVAILABLE WHEN REQUESTING ACCOUNT INFORMATION.6. ESTIMATES:A. PROCEDURE ESTIMATES MAY BE OBTAINED BY CONTACTING THE DIRECTOR OF MANAGED CONTRACTS.POLICY STATEMENT: CUYUNA REGIONAL MEDICAL CENTER'S (CRMC) PAYMENT AND COLLECTION POLICY IS THAT PAYMENT IS DUE WHEN SERVICES ARE RENDERED. HOWEVER, AS A COURTESY, CRMC WILL SUBMIT THIRD PARTY CLAIMS FOR OUR PATIENTS. ANY SELF-PAY PORTION IS DUE AT THE TIME OF SERVICE UNLESS PRIOR ARRANGEMENTS HAVE BEEN MADE WITH THE BUSINESS OFFICE. FOR THE PURPOSES OF THIS POLICY, SELF-PAY PORTION IS DEFINED AS CO-PAYMENTS, DEDUCTIBLES, AND NON COVERED SERVICES (IF KNOWN AT THE TIME OF SERVICE.) SELF-PAY PORTION ALSO REFERS TO AMOUNTS OWED BY INDIVIDUALS WITHOUT INSURANCE.

PART VI, LINE 2:
NEEDS ASSESSMENT:EVERY THREE YEARS, CUYUNA REGIONAL MEDICAL CENTER CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO SYSTEMATICALLY IDENTIFY, ANALYZE AND PRIORITIZE COMMUNITY HEALTH NEEDS. THE PROCESS IS CONDUCTED IN COLLABORATION WITH MANY COMMUNITY PARTNERS INCLUDING ESSENTIAL HEALTH, THE CROW WING COUNTY HEALTH DEPARTMENT, AND ORGANIZATIONS OR INDIVIDUALS THAT REPRESENT BROAD INTERESTS IN THE COMMUNITY. CRMC UTILIZES EXISTING INFORMATION FROM THE ESSENTIA HEALTH/ST. JOSEPH'S MEDICAL CENTER CHNA, CROW WING COUNTY HEALTH RANKINGS, AND MINNESOTA DEPARTMENT OF EDUCATION STUDENT SURVEYS. THE ORGANIZATION ALSO SURVEYS COMMUNITY MEMBERS AT PUBLIC EVENTS AND REVIEWS THE HEALTH STATISTICS OF THE PATIENTS IT SERVES. TO UNDERSTAND THE SOCIAL, ECONOMIC, AND HEALTH STATUS OF AREA RESIDENTS, STATISTICS WERE ALSO COLLECTED FROM STATE, COUNTY, AND LOCAL SOURCES. FOLLOWING ANALYSIS OF ALL DATA SOURCES, CRMC TOGETHER WITH COMMUNITY STAKEHOLDERS IDENTIFIES ITS TOP THREE PRIORITY AREAS TO ADDRESS. CRMC THEN PARTNERS WITH OTHER ORGANIZATIONS TO COORDINATE ACTION PLANS, POOL RESOURCES, AND JOINTLY ADDRESS THE PRIORITIES OF THE ASSESSMENT.

PART VI, LINE 4:
COMMUNITY INFORMATION:A COMMUNITY-BUILT FACILITY, CUYUNA REGIONAL MEDICAL CENTER SERVES APPROXIMATELY 60,000 PEOPLE IN THE BRAINERD LAKES, AN AREA KNOWN AS MINNESOTA'S VACATION DESTINATION BECAUSE OF ITS BEAUTIFUL LAKES AND WOODLANDS OFFERING A VARIETY OF OUTDOOR RECREATION OPPORTUNITIES. WITH AN AVERAGE DAILY CENSUS OF 15 PATIENTS, CRMC SERVES APPROXIMATELY 1,400 INPATIENTS AND 170,000 OUTPATIENTS ANNUALLY AND HAS OVER 8,000 ER VISITS AND ABOUT 200 BIRTHS. THE MAJORITY OF CRMC'S PATIENTS, 65 PERCENT, RESIDE IN BRAINERD, BAXTER, LONGVIILLE, AITKIN, ONAMIA AND THEIR SURROUNDING AREAS. ANOTHER 35 PERCENT OF ITS PATIENTS LIVE IN THE HOSPITAL DISTRICTS OF BAY LAKE, CROSBY, CUYUNA, DEAN LAKE, DEERFIELD, DEERWOOD, EMILY, FAIRFIELD, FIFTY LAKES, LITTLE PINE, RABBIT LAKE, RIVERTON, TROMMALD, AND WOLFORD. THE MAJORITY OF THE RESIDENTS, 95%, ARE WHITE. ABOUT HALF ARE MALE AND THE OTHER HALF FEMALE. MORE THAN 60% OF THE POPULATION RESIDE IN RURAL AREAS. A TOTAL OF 22% OF RESIDENTS ARE UNDER AGE 18 AND 22% ARE 65 YEARS AND OLDER. THE MEDIAN HOUSEHOLD INCOME IS $53,500. ABOUT 85% OF THE RESIDENTS ARE HIGH SCHOOL GRADUATES AND 71% HAVE SOME COLLEGE EDUCATION. THIRTY PERCENT OF THE CHILDREN LIVE IN SINGLE-PARENT HOUSEHOLDS, 17% OF CHILDREN LIVE IN POVERTY, AND 37% ARE ELIGIBLE FOR FREE OR REDUCED-PRICE LUNCH.

PART VI, LINE 5:
CRMC ALSO FURTHERS ITS MISSION BY PROMOTING THE HEALTH OF THE COMMUNITY THROUGH PROGRAMS AND ACTIVITIES THAT FOSTER HEALTH, HEALING, AND WELLNESS. CRMC KNOWS THAT MUCH OF WHAT INFLUENCES HEALTH HAPPENS OUTSIDE OF THE HOSPITAL OR DOCTOR'S OFFICE IN OUR SCHOOLS, WORKPLACES AND NEIGHBORHOODS. JUST AS ITS CARE TEAMS DEVOTE THEMSELVES TO MEETING THE NEEDS OF PATIENTS, CRMC IS DRIVEN TO ADDRESS ITS SPECIFIC COMMUNITY HEALTH NEEDS WITH WELLNESS SCREENINGS, HEALTH EDUCATION CLASSES AND EVENTS, HEALTH FAIRS, AND OTHER COMMUNITY OUTREACH. CRMC PRO-ACTIVELY RECRUITS THE PHYSICIANS AND SPECIALISTS NEEDED TO MEET THE COMMUNITY'S HEALTHCARE NEEDS AND WORKS HARD TO RETAIN ITS MEDICAL STAFF. CRMC STRIVES TO KNOW WHAT KIND OF PHYSICIANS ARE GOING TO BE NEEDED AND THEN PLANS AND ALLOCATES RESOURCES ACCORDINGLY. THE ORGANIZATION ALSO ASSESSES THE DEMOGRAPHICS AND PRACTICE PATTERNS OF CURRENT STAFF TO SHOW POTENTIAL RECRUITING CANDIDATES THAT THERE IS A NEED FOR THEIR SERVICES. CRMC PROVIDED OVER $60,000 IN FINANCIAL ASSISTANCE TO AREA CANCER PATIENTS NEEDING SOME ASSISTANCE DURING TREATMENT. IN ADDITION OUR STAFF ANNUALLY VOLUNTEER APPROXIMATELY 500 HOURS OF THEIR TIME TO HELP OTHERS IN OUR COMMUNITY. CRMC IS GOVERNED BY A NINE-MEMBER, NON-PROFIT BOARD OF DIRECTORS CONSISTING OF FOUR LEADERS WHO LIVE IN AREAS GEOGRAPHICALLY REPRESENTATIVE OF CRMC'S SERVICE AREA, TWO DISTRICT BOARD MEMBERS, TWO MEDICAL STAFF AND THE CEO. THE BOARD'S PRIMARY RESPONSIBILITY IS TO ASSURE THE SERVICES PROVIDED BY CRMC MEET COMMUNITY STANDARDS, PROMOTE PATIENT SAFETY AND ENSURE THE HOSPITAL IS PROVIDING THE HIGHEST QUALITY OF HEALTH CARE SERVICES TO THE COMMUNITIES CRMC SERVES. CRMC ALSO HAS AN 18-MEMBER GOVERNING BOARD ELECTED BY RESIDENTS OF ITS COMMUNITIES. MEMBERS OF THIS GROUP ASSURE THAT PAYMENT ON THE OUTSTANDING DEBT AND OTHER OBLIGATIONS OF CRMC ARE SATISFIED. CRMC INVESTS APPROXIMATELY $5 MILLION PER YEAR IN CAPITAL IMPROVEMENTS TO ENSURE ITS STAFF CAN CONTINUE TO PROVIDE COMPASSIONATE, PATIENT-CENTERED CARE UTILIZING THE MOST ADVANCED TREATMENTS AND TECHNOLOGIES AVAILABLE.