4A (Expenses $ 63147845 including grants of $ 57114) (Revenue $ 77249774)
"TRI COUNTY HOSPITAL (TCH) LEADS DELIVERY OF HEALTHCARE TO ITS SERVICE AREA THROUGH THE EFFORTS OF 541 EMPLOYEES WHO COORDINATE THESE EFFORTS TO DELIVER QUALITY PATIENT CARE. ALL OF THE TCH FACILITIES OPERATE IN FEDERALLY DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS. OUR SERVICE AREAS GENERALLY RANK AMONGST THE MOST ECONOMICALLY AND SOCIALLY CHALLENGED IN THE STATE OF MINNESOTA. THE ACCOMPLISHMENTS WHICH FOLLOW HIGHLIGHT THE COMMITMENT OF TCH TO ITS COMMUNITIES. REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT ORGANIZATIONS ARE INTEGRAL TO TCH'S LARGER CHARITABLE MISSION OF ""IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE."" TCH IS GOVERNED BY AN INDEPENDENT BOARD INCLUDING COMMUNITY LEADERS, BUSINESS EXPERTS, AND CLINICAL HEALTHCARE EXPERTS AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO VOLUNTARILY ADOPT GOVERNANCE BEST PRACTICES TO ENSURE THE ORGANIZATION CONTINUES TO OPERATE WITH THE HIGHEST INTEGRITY FOR THE BENEFIT OF THE COMMUNITY. TRI COUNTY HOSPITAL, A CERTIFIED CRITICAL ACCESS HOSPITAL, OPERATES 25 BEDS AND PROVIDES NEEDED MEDICAL SERVICES AND PATIENT CARE TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. SERVICES INCLUDE INPATIENT, OUTPATIENT, EMERGENCY, SURGICAL, INTENSIVE, OBSTETRICAL, AND PEDIATRIC NURSING CARE. ANCILLARY SERVICES INCLUDE LABORATORY, RADIOLOGICAL, THERAPY SERVICES, CHIROPRACTIC, REHABILITATIVE, AND PHARMACY. TRI-COUNTY HOSPITAL IS THE LARGEST EMPLOYER IN THE COMMUNITY, EMPLOYING 541 STAFF DURING 2021. TRI COUNTY HOSPITAL'S UNCOMPENSATED CARE (CHARITY CARE) PROGRAM PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTH CARE THEY RECEIVE. THE UNCOMPENSATED CARE PROGRAM IS DESIGNED TO ENSURE THE ENTIRE COMMUNITY SERVED BY TCH HAS ACCESS TO NEEDED HEALTHCARE SERVICES. IN 2021, $1,143,644 OF REVENUES WAS DESIGNATED AS CHARITABLE SERVICES. TRI-COUNTY HOSPITAL CARED FOR 923 INPATIENTS FOR A TOTAL 2,539 DAYS OF CARE. ADDITIONALLY, TRI-COUNTY HOSPITAL OPERATES SIX CERTIFIED RURAL HEALTH CLINICS IN AREAS IDENTIFIED BY STATE AND FEDERAL AGENCIES AS HEALTH PROFESSIONAL SHORTAGE AREAS. THESE CLINICS EXAMINED AND/OR TREATED 55,918 PATIENTS IN 2021. TOTAL OUTPATIENT ENCOUNTERS FOR 2021 (INCLUDING THE CLINICS) WERE 158,149. TRI-COUNTY HOSPITAL OPERATES A FULL TIME EMERGENCY DEPARTMENT AND ACCEPTS ALL PATIENTS WHO PRESENT THEMSELVES FOR EMERGENCY SERVICES AT THE FACILITY, SEEING 5,342 PATIENTS IN THE EMERGENCY DEPARTMENT IN 2021. TRI-COUNTY HOSPITAL OPERATES AN AMBULANCE SERVICE WHERE PATIENTS RECEIVE EMERGENT CARE AND TRANSPORTATION BY EMERGENCY MEDICAL TECHNICIANS THAT PROVIDE ADVANCED LIFE SUPPORT SERVICES. TCH ALSO OFFERS EMS EDUCATION COURSES FOR THE PURPOSE OF INCREASING SURVIVAL, IMPROVING COMMUNITY AWARENESS, AND INCREASING INDIVIDUAL CONFIDENCE AS A PART OF ITS CHARITABLE MISSION. COURSES OFFERED INCLUDE EMERGENCY MEDICAL TECHNICIAN BASIC, FIRST RESPONDER, CPR, AND FIRST AID. TRI-COUNTY HOSPITAL PROVIDES A COMMUNITY PARAMEDIC PROGRAM. COMMUNITY PARAMEDIC IS A PROVISION OF OUTREACH TO PATIENTS AT RISK FOR USING THE EMERGENCY MEDICAL OR INPATIENT HEALTHCARE SYSTEM FOR PRIMARY CARE SERVICES, AND HELPING THEM FIND MORE APPROPRIATE RESOURCES FOR THEIR MEDICAL NEEDS. THE COMMUNITY PARAMEDIC PROGRAM HAD 369 VISITS DURING 2021. TCH ALSO PROVIDES OR PARTICIPATES IN OTHER PROGRAMS WHICH CONTRIBUTE TO ITS CHARITABLE MISSION. EDUCATIONAL PROGRAMMING IS A PRIORITY INCLUDING BUT NOT LIMITED TO THE HIGH SCHOOL SUMMER INTERNSHIP PROGRAM; PROVIDING A CLINICAL ROTATION SITE FOR NURSING STUDENTS AND FOR RADIOLOGY AND LABORATORY TECHNICIANS FROM AREA TECHNICAL COLLEGES, PARTICIPATING AS PRECEPTOR SITES FOR MEDICAL SCHOOLS INCLUDING THE RURAL PHYSICIAN ASSOCIATE PROGRAM AND SUMMER INTERNSHIP IN MEDICINE AS WELL AS PROVIDING CAMPUS-BASED PRECEPTOR PHYSICIANS TO THE UNIVERSITY OF MINNESOTA-DULUTH AND ST. CLOUD RESIDENCY PROGRAMS, AND HEALTH FAIRS WITH SCREENING OPPORTUNITIES IN ITS SERVICE AREA. TRI-COUNTY HOSPITAL ALSO OPERATES AN ADJUNCT ORGANIZATION (TRI COUNTY HOSPITAL FOUNDATION) WHICH HAS DEVELOPED A LOCAL SCHOLARSHIP FUND AND GRANT DOLLARS FOR WORTHY CAUSES, AND PROVIDES COMMUNITY HEALTH EDUCATION PROGRAMS, WHICH ARE CONSISTENT WITH IMPROVING THE COMMUNITIES' HEALTH STATUS. TCH ALSO PROVIDES ORGANIZATIONAL AND ADMINISTRATIVE SUPPORT TO VARIOUS COMMUNITY BASED GROUPS OFFERING PEER SUPPORT PROGRAMS. THESE INCLUDE AREAS SUCH AS CANCER, BREAST CANCER, ARTHRITIS, DIABETES, AND OTHERS. TCH PROVIDES SEVERAL AVENUES FOR LOCAL INDIVIDUALS TO CONTRIBUTE TO THE COMMUNITY THROUGH OUR VOLUNTEER PROGRAMS. INCLUDED ARE THE HOSPITAL INPATIENT AND OUTPATIENT VOLUNTEER SUPPORT PROGRAM, AND VARIOUS ADVISORY COMMITTEES. WE ARE CONTINUALLY THANKED BY THESE INDIVIDUALS FOR THE OPPORTUNITY FOR THEM TO FEEL NEEDED AND OFFER A PRODUCTIVE OUTLET FOR THEIR TALENTS.DURING 2021, 78 VOLUNTEERS PROVIDED SERVICE TO TCH."

TRI-COUNTY HOSPITAL, INC.
"PART V, SECTION B, LINE 5: TRI-COUNTY HEALTH CARE CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE COLLABORATION OF TODD, WADENA AND MORRISON COUNTY PUBLIC HEALTH AGENCIES; CENTRACARE HEALTH SYSTEM; CHI ST. GABRIEL'S HOSPITAL; AND LAKEWOOD HEALTH SYSTEM TO ENSURE THE MOST COMPREHENSIVE ASSESSMENT OF THE SERVICE AREA COMMUNITY. THE MAPP PROCESS (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) WAS USED AS A ""COMMUNITY-DRIVEN STRATEGIC PLANNING PROCESS FOR IMPROVING COMMUNITY HEALTH AND PROVIDED THE FRAMEWORK FOR DATA COLLECTION AND PRIORITIZING PUBLIC HEALTH NEEDS. DATA WAS COLLECTED FROM A VARIETY OF SOURCES INCLUDING INFORMATION FROM QUESTIONNAIRES FOR KEY STAKEHOLDERS, A COMMUNITY HEALTH SURVEY, AND QUANTITATIVE STATISTICS FROM LOCAL, COUNTY, AND STATE PUBLIC HEALTH SOURCES. THE COMMUNITY HEALTH SURVEY WAS DISSEMINATED AND ANALYZED DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IN THE TRI-COUNTY HEALTH CARE SERVICE AREA. SURVEYS WERE SENT OUT IN JANUARY 2019 TO A RANDOM SAMPLE OF 6,400 HOUSEHOLDS. COMPLETED SURVEYS WERE RECEIVED FROM 1,553 ADULT RESIDENTS OF THE THREE COUNTIES."

TRI-COUNTY HOSPITAL, INC.
PART V, SECTION B, LINE 6A: TRI-COUNTY HEALTH CARE CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE COLLABORATION OF CENTRACARE HEALTH SYSTEM, CHI ST. GABRIEL'S HOSPITAL, AND LAKEWOOD HEALTH SYSTEM.

TRI-COUNTY HOSPITAL, INC.
PART V, SECTION B, LINE 6B: TRI-COUNTY HEALTH CARE CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE COLLABORATION OF TODD, WADENA, AND MORRISON COUNTY PUBLIC HEALTH AGENCIES.

TRI-COUNTY HOSPITAL, INC.
"PART V, SECTION B, LINE 11: IN 2016, TCHC CONDUCTED A CHNA THAT PRIORITIZED UNHEALTHY BEHAVIORS, OBESITY, CHRONIC DISEASE, AND MENTAL HEALTH. TCHC HAS ADDRESSED THESE ISSUES AS FOLLOWS:UNHEALTHY BEHAVIORS - THIS ITEM WAS IDENTIFIED AS A FIRST PRIORITY AS SUCCESSFUL RESULTS IN THIS AREA MAY ALSO HAVE POSITIVE IMPACTS ON OTHER SIGNIFICANT HEALTH ISSUES INCLUDING OBESITY, HEART DISEASE, STROKE, DIABETES, HIGH CHOLESTEROL, HIGH BLOOD PRESSURE, CANCER, ETC. HEALTHY BEHAVIOR PROMOTION ADDRESSES EXERCISE, DIET, SMOKING, ALCOHOL USE, DRUG USE, AND HEALTH CARE COMPLIANCE. AS PART OF THE MASLOWSKI RESEARCH STUDY, TCHC IS PARTNERING WITH WADENA REGIONAL WELLNESS CENTER, CITY OF WADENA, JOLENE JOHANNES STATE FARM AGENCY, TODD WADENA ELECTRIC ASSOCIATION, WADENA DEER CREEK SCHOOLS, WADENA STATE BANK, AND WEST CENTRAL TELEPHONE WITH PLANS TO EXPAND SEVERAL OTHER KEY COMMUNITY EMPLOYER GROUPS TO CREATE A RESULTS-ORIENTED WELLNESS INITIATIVE FOR THE WADENA COMMUNITY AND SURROUNDING AREA. WITH THE AID OF THE FRANK AND ELEANOR MASLOWSKI CHARITABLE TRUST AND THE WADENA REGIONAL WELLNESS CENTER, TCHC IS CONDUCTING A RESEARCH STUDY TO IDENTIFY FACTORS THAT MAY BE PREDICTIVE OR EXPLANATORY OF HEALTH RISK STATUS IN THE TCHC SERVICE AREA POPULATION. THE FIRST PHASE OF THE RESEARCH STUDY BEGAN IN 2013 WITH TCHC COMPILING BASELINE HEALTH CARE DATA FROM THE TCHC EMPLOYEE GROUP AND HAS EXPANDED THIS TO THE EMPLOYER GROUPS IDENTIFIED IN THE PREVIOUS PARAGRAPH. THE NEXT PHASE OF THIS PROJECT IS TO CONDUCT THIS SAME ACTIVITY WITH GROUPS FROM WADENA AND BERTHA COMMUNITIES. HEALTH CARE COMPLIANCE AND PREVENTION WILL BE ADDRESSED THROUGH OUR CARE COORDINATION PROGRAM. OBESITY - THIS CAN BE ADDRESSED WITH THE INITIATIVES BEING UNDERTAKEN FOR UNHEALTHY BEHAVIORS.CHRONIC DISEASE - INCLUDES DIABETES, HEART DISEASE, STROKE, HIGH CHOLESTEROL, HIGH BLOOD PRESSURE, CANCER, ETC. IN ADDITION TO THE WELLNESS INITIATIVES BEING UNDERTAKEN FOR UNHEALTHY BEHAVIORS, TCHC HAS IMPLEMENTED A MEDICAL HOME PROGRAM IN PARTNERSHIP WITH COMMUNITY PARAMEDICS TO AID PERSONS WITH CHRONIC ILLNESSES AND HELP THEM MANAGE THESE CONDITIONS TO REMAIN COMPLIANT WITH THEIR CARE AND ACHIEVE POSITIVE OUTCOMES. TCHC HAS ALSO IMPLEMENTED CARE COORDINATION PROGRAM TO IDENTIFY AND MONITOR PATIENTS DUE FOR PREVENTIVE CARE AND CONTACTING THOSE PATIENTS IN AN EFFORT TO IDENTIFY PATIENTS AT RISK EARLIER IN THE DISEASE PROCESS. TCHC WILL CONTINUE TO OFFER THE DIABETIC EDUCATION AND DIABETIC SUPPORT GROUP.MENTAL HEALTH - IN 2012, TCHC HIRED DR. AARON LARSON, PSYCHIATRIST, AND IN 2019, TRACI JONES TO PROVIDE FULL-TIME PSYCHIATRIC SERVICES IN THE WADENA CLINIC. TCHC IS CONTINUING TO RECRUIT PROVIDERS TO MEET INCREASING DEMANDS FOR PSYCHIATRIC SERVICES. IN 2019, TCHC CONDUCTED A NEW CHNA THAT CONTINUED TO IDENTIFY THOSE SAME NEEDS, BUT ALSO IDENTIFIED SOCIAL DETERMINANTS OF HEALTH, COMMUNITY INFRASTRUCTURE, DRUG ADDICTION, CANCER, ACCESS TO HEALTH CARE SERVICES, PHI DATA EXCHANGE AND DECREASED FUNDING. TCHC HAS ADDRESSED THESE ISSUES AS FOLLOWS:SOCIAL DETERMINANTS OF HEALTH - INCLUDES HEALTH EQUITY, HOUSING, EMPLOYMENT, ENVIRONMENT AND TRANSPORTATION. TCHC LACKS RESOURCES TO FULLY ADDRESS THIS ISSUE BUT PLANS TO PARTNER WITH LOCAL GOVERNMENT AND BUSINESS LEADERS TO COLLABORATE ON COMMUNITY BUILDING IN AN EFFORT TO INCREASE POPULATION, IMPROVE SOCIO-ECONOMIC STATUS AND BUILD/ENHANCE THE COMMUNITY REPUTATION. TCHC WILL CONTINUE TO PROVIDE UNCOMPENSATED CARE FOR THOSE WHO LACK THE ABILITY TO PAY FOR HEALTH CARE SERVICES. TCHC ALSO PARTICIPATES IN HELPING PAY FOR CAR SEATS AND BIKE HELMETS FOR SAFE TRANSPORTATION OF INFANTS AND CHILDREN. TCHC WILL CONTINUE TO SUBSIDIZE FARES FOR INDIVIDUALS UTILIZING FRIENDLY RIDER PUBLIC TRANSPORTATION SERVICES TO GET TO THEIR APPOINTMENTS AT TCHC. TCHC ENTERED INTO AN AGREEMENT WITH THE STATE OF MINNESOTA AS PART OF THEIR INTEGRATED HEALTHCARE PARTNERSHIP IN 2018. AS PART OF THIS PROGRAM, THE HEALTH EQUITY GOAL IS TO ADDRESS ISSUES WITH OPIOID ADDICTION. THE ORGANIZATION HAS IMPLEMENTED AN OPIOID PROGRAM TO ASSIST WITH ADDICTION MANAGEMENT AND PROVIDE MEDICATION-ASSISTED TREATMENT. THE ORGANIZATION INTENDS TO CONTINUE THIS PROGRAM WITH ANOTHER THREE-YEAR AGREEMENT, BEGINNING IN 2022, WITH THE STATE TO ADDRESS THIS ISSUE.CANCER - TCHC'S INITIATIVES TO INCREASE PREVENTIVE VISITS AND DIAGNOSTIC SCREENING EXAMS WILL AID WITH EARLY DETECTION OF CANCER. IN ADDITION, TCHC'S PARTNERSHIP WITH LAKE REGION HEALTH CARE IN FERGUS FALLS, MN, ALLOWS US TO PROVIDE ONCOLOGY SERVICES FOR CANCER PATIENTS IN ADDITION TO OFFERING OUTPATIENT CHEMOTHERAPY SERVICES. ACCESS TO HEALTH CARE - TCHC OFFERS AN UNCOMPENSATED CARE PLAN FOR PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY. THIS PLAN IS OFFERED TO PERSONS WITH ANNUAL INCOME AT 200% PERCENT OF FEDERAL POVERTY GUIDELINES. TCHC IS LOCATED IN A HEALTH CARE PROFESSIONAL SHORTAGE AREA WHERE ACCESS TO A PROVIDER MAY BE LIMITED AT TIMES AND RECRUITING PROVIDERS TO RURAL AREAS CONTINUES TO BE A CHALLENGE. IN ADDITION, TCHC HAS DEVELOPED A MODEL THAT UTILIZES NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS TO PRACTICE ALONGSIDE THE PHYSICIAN TO PROVIDE NECESSARY SERVICES IN A MORE COST-EFFECTIVE MANNER. IN AN EFFORT TO IMPROVE ACCESS TO HEALTH CARE, TCHC HAS IMPLEMENTED A WALK-IN CLINIC EXTENDING HOURS MONDAY THROUGH THURSDAY AND SATURDAY MORNINGS. AS PART OF OUR CARE COORDINATION PLAN, TCHC IS COLLABORATING WITH PAYOR PLANS TO IMPLEMENT NECESSARY HEALTH SCREENINGS FOR SPECIFIC DISEASES IN AN EFFORT TO PREVENT/DETECT SPECIFIC ISSUES SUCH AS DIABETES, CANCER SCREENINGS, ETC. WITH THE COVID PANDEMIC, THE ORGANIZATION HAS EXPANDED SERVICES TO INCLUDE TELEHEALTH VISITS. THE ORGANIZATION PROVIDED COVID VACCINES TO PATIENTS IN THE COMMUNITY AT NO CHARGE. POPULATION HEALTH INFRASTRUCTURE - TCHC HAS BEEN ESTABLISHING RELATIONSHIPS AND PARTNERING WITH OTHER FACILITIES AND PROVIDERS TO ESTABLISH A MODEL FOR MANAGING POPULATION HEALTH. CURRENTLY, TCHC IS PARTNERING WITH CENTRACARE HOSPITALS AND SEVERAL OTHER AFFILIATES INCLUDING DOUGLAS COUNTY HOSPITAL AND RICE MEMORIAL HOSPITAL ON A CLINICALLY INTEGRATED NETWORK. TCHC, ALONG WITH THESE FACILITIES, UTILIZES THE EPIC ELECTRONIC MEDICAL RECORDS SYSTEM WITH A GOAL TO IMPLEMENT THE ""HEALTHY PLANET"" MODULE AS A TOOL TO AID WITH POPULATION HEALTH MANAGEMENT. DATA EXCHANGE - TCHC'S PARTNERSHIP WITH CENTRACARE HOSPITALS AND OTHER CENTRACARE AFFILIATES AS PART OF THE EPIC ELECTRONIC MEDICAL RECORDS SYSTEM ALLOWS US TO MEET FEDERAL MEANINGFUL USE REQUIREMENTS. THIS SYSTEM ALLOWS COMMUNICATION BETWEEN HOSPITALS BY UTILIZING THE ""CARE EVERYWHERE"" FEATURE OF THIS SYSTEM. DECREASED FUNDING - THIS IS A CONTINUED CHALLENGE FOR OUR ORGANIZATION AS THE FUNDS FOR HEALTH CARE DECREASE WHILE THE DEMAND CONTINUES TO RISE. TCHC COLLABORATES WITH THE MINNESOTA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION FOR ADVOCACY EFFORTS FOR RURAL HEALTH CARE."

TRI-COUNTY HOSPITAL, INC.
PART V, SECTION B, LINE 20E: THE ORGANIZATION WRITES OFF SELF ADMINISTERED DRUGS FOR MEDICARE PATIENTS AS APPROVED BY THE OIG.

PART I, LINE 3C:
TRI-COUNTY HOSPITAL DETERMINES ELIGIBILITY BASED ON AN INDIVIDUAL'S INCOME, NET ASSETS, INSURANCE COVERAGE, AND APPLICATION FOR FEDERAL AND/OR STATE-PROVIDED ASSISTANCE. SEE OUR WEBSITE, WWW.TCHC.ORG/PATIENTS-AND-VISITORS/BILLING-AND-FINANCIAL-INFORMATION, FOR DETAILED INFORMATION ABOUT ELIGIBILITY CRITERIA.

PART I, LINE 7:
IN ORDER TO DETERMINE THE AMOUNTS INCLUDED IN PART I, LINE 7, TCH GENERALLY USES THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS FORM 990 INSTRUCTIONS. TO CALCULATE THE COSTS OF COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFITS OPERATIONS, HEALTH PROFESSIONS EDUCATION, AND SUBSIDIZED HEALTH SERVICES, TCH USES THE COST-TO-CHARGE RATIO SPECIFIC TO THOSE SERVICES.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES INCLUDE REVENUES AND COSTS ASSOCIATED WITH ER AND THE FOLLOWING SIX PROVIDER-BASED CLINICS:- TRI-COUNTY HEALTH CARE - WADENDA CLINIC- TRI-COUNTY HEALTH CARE - BERTHA CLINIC- TRI-COUNTY HEALTH CARE - HENNING CLINIC- TRI-COUNTY HEALTH CARE - OTTERTAIL CLINIC- TRI-COUNTY HEALTH CARE - SEBEKA CLINIC- TRI-COUNTY HEALTH CARE - VERNDALE CLINICCOMMUNITY BENEFIT EXPENSES RELATED TO THESE CLINICS IS $15,170,492.

PART II, COMMUNITY BUILDING ACTIVITIES:
THROUGH OUR HOSPITAL AND FOUNDATION, COMMUNITY EDUCATION, COMMUNITY SUPPORT AND MANY OTHER EFFORTS, WE ARE ABLE TO SUPPORT SEVERAL HEALTH INITIATIVES THROUGHOUT THE COMMUNITIES WE SERVE SUCH AS CONTINUING HEALTH EDUCATION, HEALTH EQUIPMENT IN THE SCHOOLS, PRENATAL EDUCATION, CONTINUING COMMUNITY HEALTH EDUCATION, CAR SEAT SAFETY EDUCATION, HEALTH CARE SCHOLARSHIPS, ETC.

PART III, LINE 3:
IN 2014, TRI-COUNTY HOSPITAL ADDED THE PRESUMPTIVE UNCOMPENSATED CARE POLICY. IF AN ACCOUNT IS READY TO BE SENT TO BAD DEBT BUT HAS MEDICAID NOW OR THERE IS OTHER PROOF THAT THE PATIENT WOULD QUALIFY, THE AMOUNT IS WRITTEN OFF AS UNCOMPENSATED CARE. THEREFORE, ACCOUNTS ARE NOT BEING SENT TO COLLECTIONS THAT MEET THIS NEW UNCOMPENSATED CARE GUIDELINE.

PART III, LINE 4:
SEE THE 'PATIENT RECEIVABLES, NET' PARAGRAPH ON PAGE 11 OF THE ATTACHED FINANCIAL STATEMENTS FOR INFORMATION ABOUT BAD DEBT EXPENSE.

PART III, LINE 8:
THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2021 FILED MEDICARE COST REPORT. AS A CRITICAL ACCESS HOSPITAL, TRI-COUNTY HOSPITALIS REIMBUSED AT 101% (LESS SEQUESTRATION WHEN IN EFFECT) OF COST WHEN SERVING MEDICARE BENEFICIARIES, RESULTING IN A SURPLUS.

PART III, LINE 9B:
IT IS THE EXPECTATION THAT ALL PATIENTS RECEIVING SERVICES ARE FINANCIALLY RESPONSIBLE FOR THE TIMELY PAYMENT OF ALL CHARGES INCURRED. HOWEVER, NO PATIENT WILL BE REFUSED NECESSARY OR EMERGENCY CARE IF UNABLE TO MEET THE FINANCIAL REQUIREMENTS. INFORMATION GATHERED AT REGISTRATION IS THE KEY TO SUCCESSFUL COLLECTION EFFORTS. ACCURATE NAME, ADDRESS, PHONE NUMBERS, EMPLOYMENT AND CONTACT NAMES ARE REQUIRED. ALL CLIENTS PROVIDE A COPY OF THEIR DRIVER'S LICENSE AS IDENTIFICATION. IF THE PATIENT IS UNABLE TO PAY THE TOTAL AMOUNT, A PAYMENT PLAN WILL BE SET UP ACCORDING TO THE ATTACHED PAYMENT SCHEDULE. OTHER MEANS TO RESOLVE THE DEBT SUCH AS ASSISTANCE WITH MEDICAID FORMS AND UNCOMPENSATED CARE WILL BE DISCUSSED WITH THE PATIENT. ACCOUNT REPRESENTATIVES ARE RESPONSIBLE FOR PATIENT AND INSURANCE CONTACTS NECESSARY TO SECURE PAYMENT FOR SERVICES. IF PAYMENT HAS NOT BEEN RECEIVED AT THE TIME OF SERVICE, THE FOLLOWING INTERNAL COLLECTION GUIDELINE WILL BEGIN. SOME STEPS IN THE POLICY COULD BE ELIMINATED, OR TIMING CHANGED, DUE TO THE STATUS OF PREVIOUS ACCOUNTS FOR GUARANTOR.- 1ST STATEMENT - AFTER ALL INSURANCE AND ADJUSTMENTS ARE PROCESSED ON AN ACCOUNT, AND THE ACCOUNT IS SELF-PAY, THE FIRST STATEMENT WILL BE PRODUCED AND SENT TO THE PATIENT.- 2ND STATEMENT - A 2ND INVOICE IS GENERATED IF THE ACCOUNT HAS NOT BEEN PAID IN FULL. THIS IS APPROXIMATELY 30 DAYS FROM THE 1ST INVOICE DATE, BUT DOES VARY BASED ON THE TIMING OF STATEMENT CYCLES. - A TCHC CREDIT POLICY LETTER IS MAILED TO THE PATIENT AFTER THE 2ND STATEMENT IS GENERATED.- 3RD STATEMENT - A 3RD INVOICE IS GENERATED IF THE ACCOUNT HAS NOT BEEN PAID IN FULL. THIS IS APPROXIMATELY 30 DAYS FROM THE 2ND INVOICE DATE. AT THIS TIME A PATIENT RESOURCE REPRESENTATIVE FOLLOWS UP WITH A PHONE CALL AND A PAST DUE LETTER #1 IS MAILED TO THE PATIENT.- 4TH STATEMENT - A 4TH INVOICE IS GENERATED IF THE ACCOUNT HAS NOT BEEN PAID IN FULL. THIS IS APPROXIMATELY 30 DAYS FROM THE 3RD INVOICE DATE. AT THIS TIME A PAST DUE LETTER #2 IS MAILED TO THE PATIENT ALONG WITH A PLAIN LANGUAGE SUMMARY OF TCHC'S UNCOMPENSATED CARE POLICY.- 5TH STATEMENT - A 5TH INVOICE IS GENERATED IF THE ACCOUNT HAS NOT BEEN PAID IN FULL. THIS IS APPROXIMATELY 30 DAYS FROM THE 4TH INVOICE DATE. AT THIS TIME A PATIENT RESOURCE REPRESENTATIVE FOLLOWS UP WITH A PHONE CALL AND A FINAL DEMAND NOTICE IS MAILED TO THE PATIENT.- 30 DAYS AFTER FINAL NOTICE HAS BEEN GIVEN, ACCOUNTS ARE REVIEWED BY PATIENT RESOURCES STAFF FOR SUBMISSION TO THIRD-PARTY COLLECTION AGENCIES. PATIENTS MAY ALSO RECEIVE A 6TH INVOICE DEPENDING ON THE TIMING OF STATEMENT CYCLES.- MISSED PAYMENT LETTERS ARE SENT WHEN A PAYMENT IS NOT RECEIVED FROM A PATIENT WHO HAS SET UP A PAYMENT PLAN AND HAS MADE PRIOR INSTALLMENTS ON TIME.

PART VI, LINE 3:
WE MAKE INFORMATION AVAILABLE REGARDING OUR UNCOMPENSATED CARE PROGRAM ON OUR WEBSITE, IN BROCHURES, AND DURING COLLECTION CONTACTS WITH PATIENTS.

PART VI, LINE 4:
THE TRI-COUNTY HEALTH CARE COMMUNITY IS LOCATED IN WEST CENTRAL MINNESOTA AND INCLUDES EASTERN/CENTRAL OTTER TAIL, TODD, AND WADENA COUNTIES. THE TOTAL POPULATION OF ALL THREE COUNTIES IS ESTIMATED AT 95,839; THE PRIMARY SERVICE AREA POPULATION OF TCHC IS ESTIMATED AT 38,184 BECAUSE IT MORE SPECIFICALLY FOCUSES ON THE CITIES OF WADENDA, SEBEKA, NEW YORK MILLS, BERTHA, DEER CREEK, HEWITT, ALDRICH, VERNDALE, BLUFFTON, HENNING, MENAHGA AND OTTERTAIL. THE TRI-COUNTY HEALTH CARE SERVICE AREA CONSISTS OF PRIMARILY WHITE/CAUCASIANS AT 95.7 PERCENT WITH 4.3 PERCENT MINORITY. THE STATE OF MINNESOTA IS ALSO PRIMARILY WHITE/CAUCASIANS AT 83.7 PERCENT BUT HAS A GREATER MINORITY POPULATION OF 16.3 PERCENT.

PART VI, LINE 6:
TRI-COUNTY HOSPITAL IS PART OF AN INTEGRATED HEALTH SYSTEM (TRI-COUNTY HEALTH CARE). THE SYSTEM OPERATES A 25-BED CRITICAL ACCESS HOSPITAL (TRI-COUNTY HOSPITAL) AND ALSO OPERATES SEVERAL CLINICS IN THE SURROUNDING AREA.

PART VI, LINE 7, REPORTS FILED WITH STATES
MN

PART VI, LINE 2:
TRI-COUNTY HEALTH CARE (TCHC) ANTICIPATES THE NEEDS OF THE COMMUNITY BY USING BOTH INTERNAL AND EXTERNAL DATA. FOR INTERNAL MEANS, TCHC CAN GAUGE THE NEEDS OF THE COMMUNITY BASED ON WHAT IS PRESENTING IN OUR E/R, EMS CALLS, AND IDENTIFIED HEALTH PROBLEMS FOR OUR CLINIC PATIENTS. FOR EXTERNAL SOURCES OF DATA, TCHC ALSO WORKS CLOSELY WITH LOCAL LAW ENFORCEMENT, SOCIAL SERVICES, AND OTHER PUBLIC AGENCIES TO ASSESS THE NEEDS OF THE COMMUNITY. TCHC IS INVOLVED WITH THE CHILD PROTECTION TEAM, TCHC LEADERSHIP IS INVOLVED WITH OTHER CIVIC GROUPS TO HELP IDENTIFY NEEDS, AND TCHC CLINIC ADVISORY GROUPS INCLUDE COMMUNITY LEADERS AND SCHOOL OFFICIALS TO PROVIDE INPUT TO IDENTIFY HEALTH NEEDS IN ALL SIX OF THE COMMUNITIES WHERE TCHC HAS A CLINIC. THE ORGANIZATION ALSO PROVIDES FREE EDUCATIONAL OPPORTUNITIES FOR COMMUNITY MEMBERS THROUGH COMMUNITY EVENTS WHICH INCLUDE FREE LAB SCREENINGS FOR ALL WHO WISH TO ATTEND. THESE EVENTS ARE NOT LIMITED TO TCHC PATIENTS AND LAB RESULTS ARE FORWARDED TO THE PATIENT'S DESIGNATED PROVIDER.

PART VI, LINE 5:
TRI COUNTY HOSPITAL'S UNCOMPENSATED CARE (CHARITY CARE) PROGRAM PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTH CARE THEY RECEIVE. THE UNCOMPENSATED CARE PROGRAM IS DESIGNED TO ENSURE THE ENTIRE COMMUNITY SERVED BY TCH HAS ACCESS TO NEEDED HEALTHCARE SERVICES. TRI-COUNTY HOSPITAL OPERATES A FULL-TIME EMERGENCY ROOM AND ACCEPTS ALL PATIENTS WHO PRESENT THEMSELVES FOR EMERGENCY SERVICES AT THE FACILITY. TCH ALSO PROVIDES OR PARTICIPATES IN OTHER PROGRAMS WHICH CONTRIBUTE TO ITS CHARITABLE MISSION, INCLUDING THE HIGH SCHOOL SUMMER INTERNSHIP PROGRAM AND PROVIDES A CLINICAL ROTATION SITE FOR LPN/LVN NURSING STUDENTS FROM THE LOCAL TECHNICAL COLLEGE. TRI-COUNTY HOSPITAL ALSO OPERATES AN ADJUNCT ORGANIZATION (TRI COUNTY HOSPITAL FOUNDATION) WHICH HAS DEVELOPED A LOCAL SCHOLARSHIP FUND AND GRANT DOLLARS FOR WORTHY CAUSES, AND PROVIDES COMMUNITY HEALTH EDUCATION PROGRAMS, WHICH ARE CONSISTENT WITH IMPROVING THE COMMUNITIES' HEALTH STATUS. TCH ALSO PROVIDES ORGANIZATIONAL AND ADMINISTRATIVE SUPPORT TO VARIOUS COMMUNITY BASED GROUPS OFFERING PEER SUPPORT PROGRAMS. THESE INCLUDE AREAS SUCH AS CANCER, BREAST CANCER, ARTHRITIS, DIABETES, AND OTHERS. TCH PROVIDES SEVERAL AVENUES FOR LOCAL INDIVIDUALS TO CONTRIBUTE TO THE COMMUNITY THROUGH OUR VOLUNTEER PROGRAMS. INCLUDED ARE THE HOSPITAL INPATIENT AND OUTPATIENT VOLUNTEER SUPPORT PROGRAM, VOLUNTEER PROGRAMS. HOSPICE VOLUNTEERS, VOLUNTEERS, AND VARIOUS ADVISORY COMMITTEES. WE ARE CONTINUALLY THANKED BY THESE INDIVIDUALS FOR THE OPPORTUNITY FOR THEM TO FEEL NEEDED AND OFFER A PRODUCTIVE OUTLET FOR THEIR TALENTS.