4A (Expenses $ 66819871 including grants of $ 20955) (Revenue $ 68862089)
CMH IS A CRITICAL ACCESS HOSPITAL LOCATED IN CLOQUET, MN WHICH RESIDES IN CARLTON COUNTY. CMH SERVES PRIMARILY AN ELEVEN ZIP CODE AREA WITH A POPULATION OF APPROXIMATELY 35,000 RESIDENTS. CMH OFFERS THE COMMUNITY A ROBUST SERVICE LINE OFFERING WHICH INCLUDES INPATIENT & OUTPATIENT SERVICES ALONG WITH A 44 BED SKILLED NURSING FACILITY. CMH PROVIDES A NEWLY CONSTRUCTED STATE OF THE ART INPATIENT FACILITY HOUSING MED/SURG, ICU, OB, AND SWING BED SERVICES. CMH PROVIDES A FULL ARRAY OF OUTPATIENT SERVICES WHICH INCLUDE: A 24 HOUR E/R, A FULL SPECTRUM OF IMAGING SERVICES, LAB, SURGERY, CHEMO/INFUSION, PHARMACY, R.T., CARDIAC REHAB, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, DIABETIC EDUCATION, SLEEP STUDIES, AND A NUMBER OF OTHER MEDICAL SERVICES NEEDED BY OUR COMMUNITY. CMH OPERATES A 44 BED SKILLED NURSING FACILITY THAT MAINTAINS A HIGH OCCUPANCY RATE. CMH ALSO EMPLOYS A NUMBER OF PHYSICIANS IN SPECIALTIES THAT ARE IN HIGH DEMAND IN OUR SERVICE AREA. THESE INCLUDE GENERAL SURGEONS, ORTHOPEDIC SURGEONS, AND OB/GYN. CMH HAS GROWN AT A FAST PACE TO MEET THE NEEDS OF OUR COMMUNITY. IN THE TAX YEAR ENDING SEPTEMBER 30, 2022, CMH PROVIDED 3,975 INPATIENT DAYS, 2,059 SURGERIES, 11,111 EMERGENCY ROOM VISITS, 14,415 LTC RESIDENT DAYS AND 48,876 OUTPATIENT VISITS. IN ADDITION, CMH REACHES OUT TO THE COMMUNITY TO ENHANCE THE HEALTH AND WELL BEING OF OUR SERVICE AREA BY OFFERING NUMEROUS EDUCATIONAL OPPORTUNITIES, HEALTH SCREENINGS, AND SUPPORT GROUPS.

COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
PART V, SECTION B, LINE 5: WE MET WITH OUR HEALTH PARTNERS AT CARLTON COUNTY PUBLIC HEALTH AND HUMAN SERVICES TO REVIEW EXISTING DATA AND CONCLUSIONS DRAWN FROM THE DATA. WE ALSO WORKED WITH THEM AND A LARGER GROUP OF PARTNERS TO DEVELOP ADDITIONAL DATA SOURCES, WHERE WE RECEIVED FEEDBACK AND INPUT FROM MEMBERS AS TO THE VALIDITY OF OUR ASSESSMENT. MEMBERS OF THAT COMMITTEE SPAN ACROSS VARIOUS AGENCIES OF PUBLIC HEALTH, AS WELL AS INVOLVING COMMUNITY VOLUNTEERS, SOCIAL SERVICES AGENCIES, AND HEALTH EDUCATION PERSONNEL FROM CLOQUET AND THE REGION.

COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
PART V, SECTION B, LINE 6B: BECAUSE WE WERE THE ONLY ENTITY REQUIRED TO COMPLETE A CHNA IN 2022 AND OUR PARTNERING ENTITIES ARE REQUIRED TO PERFORM A CHNA IN 2023, NONE OF THOSE ENTITIES HAD THE SAME TIMEFRAME FOR COMPLETING THE PROCESS AS US. THAT BEING SAID, WE OBTAINED DATA FROM THOSE GROUPS AND SOUGHT INPUT AND FEEDBACK ON THE FINDINGS WE COMPILED INTERNALLY AS PART OF OUR PROCESS. WE SPECIFICALLY FOCUSED ON A SHARED AGENDA THAT WOULD ANSWER OUR NEEDS AND GIVE THEM DATA THAT COULD BE USED WITHIN THEIR PROCESS. THOSE PARTNERS INCLUDE REPRESENTATIVES FROM THE FOLLOWING AGENCIES THAT WERE EITHER CONTACTED INDIVIDUALLY OR THROUGH GROUPS SUCH AS THE CARLTON COUNTY PUBLIC HEALTH ADVISORY COMMITTEE: CARLTON COUNTY PUBLIC HEALTH, CARLTON COUNTY CHILDREN & FAMILY SERVICES, FOND DU LAC TRIBAL & COMMUNITY COLLEGE, STATEWIDE HEALTH IMPROVEMENT PROGRAM (SHIP) COMMUNITY LEADERSHIP TEAM, ARROWHEAD AGENCY ON AGING, AND COMMUNITY HEALTH BOARD REPRESENTATIVES.

COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
PART V, SECTION B, LINE 11: EACH OF THESE NEEDS REQUIRES WORK BEYOND THE WALLS OF CMH. WE WILL PARTNER WITH OTHER COUNTY GROUPS AND TASK FORCES ALREADY IN PLACE TO ADDRESS, OR IN SOME CASES CONTINUE TO ADDRESS THE NEEDS NOTED. MENTAL HEALTH -THESE EFFORTS WILL FOCUS MORE IN THE SCHOOLS AND COMMUNITIES AT LARGE. WE INTEND TO PARTNER WITH OTHER AGENCIES TO IMPLEMENT SCHOOL CURRICULUM AND POLICIES THAT SUPPORT MENTAL WELLBEING. WE WILL ALSO INCREASE TRAINING OPPORTUNITIES WITHIN THE COMMUNITY TO UNDERSTAND AND SUPPORT MENTAL HEALTH. FINALLY, WE WILL RESEARCH THE FEASIBILITY OF SUPPORTING THE CREATION OF A PUBLIC HEALTH COMMUNITY NAVIGATOR POSITION TO FIND AND PROMOTE EXISTING GROUPS, REPLICATE EXISTING PROGRAMS, PROVIDE EDUCATION TO SPECIFIC POPULATIONS ON HOW PROCESSES WORK IN THE COMMUNITY, AND ORGANIZE VOLUNTEER OPPORTUNITIES.SUBSTANCE USE -AGAIN, MOST OF THIS WORK WILL TAKE PLACE OUTSIDE OF CMH ITSELF. WE INTEND TO PROMOTE POSITIVE WELL-BEING RESOURCES AND MAKE IT EASIER FOR COMMUNITY MEMBERS TO SHARE RESOURCES. WE SEEK TO EXPAND POSITIVE COMMUNITY NORMS AND STIGMA REDUCTION CAMPAIGNS THROUGH THE COUNTY ACROSS ALL AGES. WE ALSO WILL WORK TO INCREASE COLLABORATION FOR DRUG DROP BOXES, GROWING THE PROGRAM BEYOND LOCAL POLICE DEPARTMENTS.OBESITY -THIS WORK WILL REQUIRE STRONG PARTNERSHIPS ACROSS THE COMMUNITY. WE WANT TO INCREASE ACCESS TO HEALTHY FOODS AND PRODUCE. WE WILL WORK TO CREATE A CULTURE OF HEALTHY BEHAVIORS - HEALTHY EATING, ACTIVE LIVING. WE WILL SUPPORT ACTIVE TRANSPORTATION INITIATIVES, AND WE WILL EXPAND BREAST FEEDING PROMOTION PROGRAMS.CMH WILL NOT BE ADDRESSING OTHER NEEDS IDENTIFIED IN THE FIELDS OF HOUSING AND AGING. THESE ARE BROAD TOPICS, AND OUR EFFORTS WILL BE FOCUSED IN THE AREAS ALREADY LISTED. OUR ONGOING OPERATIONS DO SUPPORT HEALTHY AGING THROUGH MANY OF THE SERVICES WE ALREADY OFFER, BUT WE SIMPLY DO NOT HAVE THE ORGANIZATIONAL BANDWIDTH TO TACKLE ANY OF THE OTHER PRIORITY AREAS IDENTIFIED AT THIS TIME.

PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE:
HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2023/05/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FY2022.PDF

PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE:
HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2023/05/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FY2022.PDF

PART V, LINE 16A, FAP WEBSITE:
HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2022/06/PFS-COMMUNITY-CARE-PROGRAM.PDF

PART V, LINE 16B, FAP APPLICATION FORM WEBSITE:
HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2023/01/COMMUNITY-CARE-APPLICATION-2023.PDF

PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:
HTTPS://CLOQUETHOSPITAL.COM/WP-CONTENT/UPLOADS/2022/06/FAP-PLAIN-LANGUAGE-SUMMARY-2022.PDF

PART I, LINE 7:
COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2022 MEDICARE COST REPORT (LINES 7A, 7B, 7C). LINE 7I IS LISTED AS ACTUAL WITH THE EXCEPTION OF AN ESTIMATE FOR SPACE UTILIZATION FOR VARIOUS COMMUNITY PROGRAMS.

PART I, LN 7 COL(F):
IMPLICIT PRICE CONCESSIONS FROM FINANCIAL STATEMENTS ARE $2,104,950.

PART II, COMMUNITY BUILDING ACTIVITIES:
N/A

PART III, LINE 2:
THE HOSPITAL GENERALLY ESTIMATES THE AMOUNT OF IMPLICIT PRICE CONCESSIONS FOR THE CURRENT YEAR BY USING THE PERCENTAGE OF REVENUE AS SHOWN AS IMPLICIT PRICE CONCESSIONS IN SUPPLEMENTAL INFORMATION TO THE AUDITED FINANCIAL STATEMENT FROM THE PRIOR YEAR.

PART III, LINE 3:
AT COMMUNITY MEMORIAL HOSPITAL, IMPLICIT PRICE CONCESSIONS ARE CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE REFLECT AN INABILITY TO PAY.

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

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 VI, LINE 2:
NEEDS ASSESSMENT:WE ARE A SPONSOR OF THE BRIDGE TO HEALTH SURVEY INSTRUMENT. THE SURVEY IS DESIGNED TO GATHER POPULATION-BASED HEALTH STATUS DATA ON RESIDENTS IN A NINE-COUNTY REGION IN NORTHEASTERN MINNESOTA AND NORTHWESTERN WISCONSIN. THE SURVEY IS A COLLABORATIVE EFFORT INVOLVING REPRESENTATIVES FROM OVER 60 HEALTH-RELATED ORGANIZATIONS. WE UTILIZE THE INFORMATION GATHERED FROM THIS SURVEY BROKEN DOWN TO OUR SPECIFIC SERVICE AREA TO IDENTIFY UNMET NEEDS AND OPPORTUNITIES FOR COMMUNITY HEALTH IMPROVEMENT.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:SELF PAY PATIENTS ARE INFORMED AT THE TIME OF SERVICE THAT WE CAN PROVIDE COMMUNITY CARE SERVICES AND PROVIDE A FORM. WE ADVISE THE PATIENT TO APPLY FOR MEDICAL ASSISTANCE TO THE MINNESOTA COUNTY HUMAN SERVICES OFFICE WHERE THEY RESIDE SO THAT THEY CAN APPLY FOR ASSISTANCE. COMMUNITY CARE (CHARITY CARE) APPLICATIONS ARE PROVIDED IN OUR REGISTRATION OFFICES, WAITING ROOMS AND ON OUR WEBSITE. THE ORGANIZATION ALSO SENDS INFORMATION TO PATIENTS WITH THEIR ITEMIZED BILLS. WE REQUEST THAT PATIENTS CALL US WITH QUESTIONS OR FOR HELP REGARDING MEDICAL ASSISTANCE OR OUR COMMUNITY CARE PROGRAM.

PART VI, LINE 4:
COMMUNITY INFORMATION:COMMUMITY MEMORIAL HOSPITAL (CMH) MEETS THE STATE OF MINNESOTA'S CRITERIA OF A RURAL HOSPITAL AND HAS BEEN GRANTED NECESSARY PROVIDER STATUS AS A CRITICAL ACCESS HOSPITAL. CMH IS LOCATED IN CLOQUET, MINNESOTA, WHICH IS IN CARLTON COUNTY, A NORTHEASTERN COUNTY IN MINNESOTA, APPROXIMATELY 25 MILES FROM DULUTH, MINNESOTA AND LAKE SUPERIOR. CMH SERVES PRIMARILY AN ELEVEN ZIP CODE AREA WITH 85% OF ITS PATIENTS RESIDING IN CARLTON COUNTY. CARLTON COUNTY'S 2020 CENSUS ESTIMATED THE POPULATION AT 36,207. GROWTH IS PROJECTED OVER THE NEXT FIVE PLUS YEARS. MEDIAN HOUSEHOLD INCOME FOR THE AREA IS $68,579 WHICH IS 12% LOWER THAN THE MINNESOTA AVERAGE. THE ECONOMY OF THE SERVICE AREA IS MIXED AND INCLUDES MANUFACTURING, EDUCATIONAL SERVICES, RECREATIONAL CASINO-RESORT AND HEALTHCARE SERVICES. THIS MIX HAS HAD A STABILIZING EFFECT ON UNEMPLOYMENT. WHILE BEING GENERALLY HIGHER THAN THE MINNESOTA AVERAGE, THIS MEASURE HAS NOT SEEN LARGE SWINGS THAT THE NATION HAS SEEN.

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

PART VI, LINE 7, REPORTS FILED WITH STATES
MN

PART III, LINE 9B:
COMMUNITY MEMORIAL HOSPITAL HAS BOTH SELF-PAY COLLECTIONS AND COMMUNITY CARE PROGRAM (CHARITY CARE) POLICIES THAT ARE UTILIZED AND APPLIED FLUIDLY. SELF-PAY (MINNESOTA ATTORNEY GENERAL) DISCOUNTS ARE APPLIED IMMEDIATELY TO A SELF-PAY PATIENTS' LIABILITY. ALL INPATIENT AND OUTPATIENT ACCOUNTS ARE ELIGIBLE FOR CHARITY CARE. ALL PATIENTS ARE ADVISED OF THIS PROGRAM AND APPLICATIONS ARE MADE READILY AVAILABLE. ELIGIBILITY IS DETERMINED BY THE APPLICANTS INCOME (FEDERAL TAX RETURN AND OTHER FINANCIAL DISCLOSURES) COMPARED TO THE FEDERAL POVERTY GUIDELINES. QUALIFYING PATIENTS CAN RECEIVE A PARTIAL SLIDING SCALE REDUCTION UP TO 100%. PATIENTS WHO MAY QUALIFY BUT DO NOT COMPLETE THE COMMUNITY CARE APPLICATION WOULD BE MOVED TO OUR SELF-PAY COLLECTION POLICY. THIS POLICY OUTLINES THE SERIES OF STATEMENT MAILINGS, 30-60-90 DAY LETTERS, COURTESY CALLS AS WELL AS THE AVAILABILITY OF COMMUNITY CARE. THIS CYCLE IS PURSUED RATHER THAN THE ACCOUNT BEING CONSIDERED FOR BAD DEBT COLLECTION.COMMUNITY MEMORIAL HOSPITAL ASSOCIATION'S BILLING AND COLLECTIONS POLICY STATES:I. PURPOSE: THE COLLECTION OF PATIENT BALANCES IS INTENDED TO PRESERVE A SOUND FINANCIAL BASIS FOR OPERATIONS IN ORDER THAT VITAL ESSENTIAL SERVICES CONTINUE TO BE PROVIDED.II. POLICY: SELF-PAY BALANCES ARE DUE UPON RECEIPT OF AN ITEMIZED BILL OR STATEMENT WHEN THE ACCOUNT BALANCE IS DETERMINED TO BE THE PATIENT'S RESPONSIBILITY (AFTER THIRD-PARTY BENEFITS ARE EXHAUSTED). CMH IS OBLIGATED TO COLLECT FOR SERVICES PROVIDED FROM PATIENTS THAT HAVE THE ABILITY TO PAY. PATIENTS UNABLE TO PAY BALANCES IN FULL MAY MAKE MINIMUM MONTHLY PAYMENTS. CMH WILL ASSIST PATIENTS IN OBTAINING PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE.PRIOR TO ASSIGNING AN ACCOUNT TO A COLLECTION AGENCY FOR NON-PAYMENT OR INSUFFICIENT PAYMENT, THE BILLING CYCLE WILL BE FOLLOWED AND THE EVENTS AND ALL PATIENT/GUARANTOR COMMUNICATION MUST BE CLEARLY DOCUMENTED IN THE ACCOUNT NOTES.III. DEFINITIONS/SPECIAL CONSIDERATIONSA BAD DEBT IS AN ACCOUNT RECEIVABLE BASED ON SERVICES FURNISHED TO A PATIENT THAT IS REGARDED AS UNCOLLECTABLE FOLLOWING REASONABLE COLLECTION EFFORTS. ACCOUNTS WILL BE TRANSFERRED TO A COLLECTION AGENCY AS AUTHORIZED BY ADMINISTRATION.A GUARANTOR IS THE PERSON RESPONSIBLE FOR THE PAYMENT OF THE MEDICAL DEBT. THE GUARANTOR IS TYPICALLY THE SAME AS THE ADULT PATIENT. THE GUARANTOR FOR A MINOR CHILD IS TYPICALLY THE PARENT OR LEGAL GUARDIAN THAT BRINGS THE CHILD IN FOR SERVICES.PAYMENTS MAY BE MADE BY CASH, CHECK OR CREDIT CARD (VISA, MASTERCARD OR DISCOVER). CHECKS RETURNED BY A FINANCIAL INSTITUTION WILL INCUR A $30 RETURN CHECK FEE.IV. PROCEDURE1. SELF-PAY/UNINSURED AT TIME OF SERVICE:A. SCHEDULED SURGICAL PROCEDURES REQUIRE A MINIMUM $500 PREPAYMENT ON OR BEFORE THE DATE OF SERVICE IF THE PATIENT/GUARANTOR DOES NOT QUALIFY FOR ANY OTHER PROGRAM. OTHER SCHEDULED OUTPATIENT SERVICES REQUIRE A MINIMUM 10% PREPAYMENT.B. AN ITEMIZED BILL IS MAILED APPROXIMATELY 7 - 10 DAYS AFTER SERVICE/DISCHARGE DATE ALONG WITH A SELF- PAY LETTER (NEWSP) REQUESTING ANY POSSIBLE HEALTH PLAN COVERAGE INFORMATION AND INFORMING THE GUARANTOR ABOUT THE SELF-PAY DISCOUNTS AND COMMUNITY CARE PROGRAM (POLICY BUS-2002). THE SELF PAY DISCOUNT FOR UNINSURED (POLICY BUS-2005) IS APPLIED TO THE ACCOUNT IF APPROPRIATE.C. FIRST STATEMENT PRINTS APPROXIMATELY 14 DAYS LATER. A PROMPT PAY DISCOUNT (10%) IS OFFERED ON BALANCES OVER $50 IF PAID IN FULL WITHIN 30 DAYS. A COMMUNITY CARE APPLICATION WILL BE MAILED FOR ACCOUNT BALANCES OVER $1,500.D. SECOND STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH PAST DUE MESSAGE IF THERE HAS BEEN NO PAYMENT MADE OR NO CONTRACT FOR PAYMENT ESTABLISHED.E. THIRD STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH FIRST COLLECTION LETTER (#55) IF NO PAYMENT OR CONTRACT.F. FOURTH STATEMENT PRINTS APPROXIMATELY 30 DAYS LATER WITH SECOND/LAST COLLECTION LETTER (#25) STATING THEY HAVE 1O DAYS TO RESPOND OR THE ACCOUNT WILL BE PLACED WITH A PROFESSIONAL COLLECTION AGENCY IF NO PAYMENT IS RECEIVED OR CONTRACT ESTABLISHED.G. APPROXIMATELY 10 -30 DAYS LATER THE ACCOUNT IS REVIEWED FOR PLACEMENT WITH AN AGENCY.A. ROUTINE REVIEWS INCLUDE BUT ARE NOT LIMITED TO:I. CHECKING MN-ITS FOR MEDICAID ELIGIBILITYII. CHECKING IF ALL THIRD PARTY PAYER PAYMENTS HAVE BEEN RECEIVED OR IF DENIED PENDING INFORMATION FROM PATIENT, INSURED OR PROVIDERIII. CHECKING FOR RECENT PAYMENTS ON ALL ACCOUNTS WITH THE SAME PATIENT/GUARANTORIV. DETERMINING IF PATIENT MAY QUALIFY FOR CONTRACT HEALTH SERVICE (PHS) COVERAGEV. CHECKING IF A COMMUNITY CARE APPLICATION IS PENDINGVI. NEWBORNS CHECKED IF THEY ARE ENROLLED ON PARENT(S) HEALTH PLAN OR STATE MEDICAIDVII. REVIEW ACCOUNT COMMENTS/NOTES FOR RECENT PATIENT COMMUNICATION2. SELF-PAY BALANCE AFTER THIRD PARTY PAYERS:A. FIRST SELF-PAY STATEMENT PRINTS APPROXIMATELY 3 DAYS AFTER FINAL THIRD PARTY PAYMENT IS POSTED TO ACCOUNT. PROMPT PAY DISCOUNT (10%) IS OFFERED ON BALANCES OVER $50 IF PAID IN FULL WITHIN 30 DAYS.B. SUBSEQUENT STATEMENTS AND LETTERS FOLLOW THE SAME PROCESS AS ABOVE IF NO PAYMENT OR CONTRACT IS ESTABLISHED.3. PLACEMENT OF BAD DEBT ACCOUNTS WITH AN AGENCY OR OTHER RESOLUTION:A. THE DECISION TO ADVANCE A DEBT TO AN AGENCY FOR COLLECTION WILL BE BASED ON SUCH FACTORS AS LACK OF PAYMENT, INSUFFICIENT PAYMENTS, FAILURE TO APPLY FOR AVAILABLE PROGRAMS, FAILURE TO RESPOND TO PROVIDER OR PAYER REQUESTS FOR INFORMATION, OR FAILURE TO CONTACT THE BUSINESS OFFICE AS REQUESTED.B. AN ACCOUNT MAY BE DETERMINED UNCOLLECTIBLE AND TRANSFERRED TO AN AGENCY IF MAIL HAS BEEN RETURNED FOR A BAD ADDRESS AND ATTEMPTS WERE UNSUCCESSFUL TO FIND A CURRENT ADDRESS FOLLOWING THE RETURNED MAIL PROCEDURE.C. MINIMUM PAYMENT GUIDELINES WERE ESTABLISHED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY THEIR ACCOUNT BALANCE IN FULL. A LETTER (INSUF) WILL BE SENT TO PATIENTS THAT ARE NOT MAKING MINIMUM PAYMENTS ACCORDING TO CMH GUIDELINES WHICH ARE PRINTED ON THE BACK OF STATEMENTS.A. IF MINIMUM PAYMENTS ARE NOT SUBSEQUENTLY RECEIVED, INFORMATION MUST BE PROVIDED JUSTIFYING WHY THE MINIMUM PAYMENT CANNOT BE MADE AND WHY THEY ARE NOT ELIGIBLE FOR OTHER PROGRAMS SUCH AS MEDICAID AND COMMUNITY CARE. IF A FINANCIAL HARDSHIP IS INDICATED, A REDUCED PAYMENT PLAN MAY BE ESTABLISHED WITH PERIODIC REVIEW IN SIX TO NINE MONTHS. FINANCIAL HARDSHIP WILL BE DETERMINED UPON REVIEW OF SUPPORTING DOCUMENTATION.B. IF THE PATIENT/GUARANTOR DOES NOT RESPOND TO THE INSUFFICIENT PAYMENT LETTER, CONTINUED COLLECTION ACTIVITY WILL BE PURSUED.C. IF THE PATIENT/GUARANTOR DOES NOT RESPOND TO ANY ATTEMPTS TO DISCUSS THE INSUFFICIENT PAYMENT PLAN, THE ACCOUNT MAY BE TURNED OVER TO AN AGENCY.D. TRANSFERRING SELF-PAY BALANCES ONTO ONE ACCOUNT MAY ONLY BE DONE IF THE MINIMUM PAYMENT IS MADE ON THE NEW COMBINED BALANCE.D. PATIENTS KNOWN OR REPORTED TO HAVE EXPIRED, WITHOUT AN ESTATE OR PROBATE FILED, WILL NOT BE TRANSFERRED TO AN AGENCY IF THERE IS NO INDICATION THAT THE ACCOUNT WILL BE PAID. BALANCES WILL BE A WRITE-OFF ADJUSTMENT WHEN DEEMED APPROPRIATE.E. ACCOUNT BALANCES LESS THAN $25 WILL FOLLOW NORMAL COLLECTION PROCEDURES BUT WILL NOT BE TRANSFERRED TO AN AGENCY. IF THERE IS NO OTHER PATIENT OR GUARANTOR ACCOUNT BALANCES TO COMBINE WITH, THE BALANCE MAY BE A WRITE-OFF ADJUSTMENT.F. SMALL BALANCE WRITE-OFF ADJUSTMENTS WILL BE DONE MONTHLY ON ACCOUNT BALANCES LESS THAN $4.99 IF THERE IS NOT OTHER SELF-PAY ACCOUNT BALANCES TO COMBINE WITH. STATEMENTS ARE NOT SENT OUT FOR BALANCES UNDER $3.00.G. COLLECTION AGENCIES ARE DIRECTED TO RETURN ANY UNCOLLECTIBLE ACCOUNTS WITHIN NINE MONTHS OF TRANSFER IF NO PAYMENTS HAVE BEEN MADE OR PROVIDE INFORMATION TO CMH THAT WARRANTS RETAINING SUCH ACCOUNTS.

PART VI, LINE 5:
"PROMOTION OF COMMUNITY HEALTH:COMMUNITY MEMORIAL HOSPITAL (CMH) CONTINUES TO HAVE A STRONG ECONOMIC IMPACT ON OUR SERVICE REGION. WE KNOW WE COULD NOT BE SUCCESSFUL WITHOUT THE SUPPORT OF OUR COMMUNITY. OUR BOARD OF DIRECTORS ARE COMPRISED OF COMMUNITY MEMBERS WITH DIVERSE BACKGROUNDS AND INTERESTS. WE HAVE AN OPEN MEDICAL STAFF POLICY THAT SHARES OUR INTEREST OF PROVIDING QUALITY HEALTH CARE LOCALLY. WE TAKE ""COMMUNITY"" IN OUR NAME SERIOUSLY. CMH REACHES OUT BY OFFERING SCREENINGS, EDUCATION GROUPS AND OTHER CONNECTIONS TO IMPROVE THE HEALTH OF OUR CITIZENS. EDUCATIONAL SEMINARS INCLUDE: DIZZINESS, DIABETES, CHILDBIRTH AND URINARY INCONTINENCE. ONGOING STROKE AND GRIEF SUPPORT GROUPS HELP FAMILIES DEALING WITH THESE ISSUES. CMH HOSTS EXERCISE PROGRAMS IN ARTHRITIS CARE AND PILATES. MANY CONSULTING SERVICES ARE OFFERED THROUGH OUR OCCUPATIONAL THERAPY DEPARTMENT. WE CAN ASSIST IN DESIGNING AND PERFORMING EMPLOYMENT SCREENINGS, FUNCTIONAL JOB DESCRIPTIONS, WORK-SITE EVALUATIONS, WORKER EDUCATION, ETC. COMMUNITY MEMORIAL HOSPITAL GOES OUT INTO THE AREA TO CONDUCT HEALTH FAIRS AND EXPOS PROVIDING SCREENINGS FOR VISION, BLOOD GLUCOSE, BLOOD PRESSURE, GRIP STRENGTH AS WELL AS BODY FAT ANALYSIS. COMMUNITY MEMORIAL HOSPITAL WILL CONTINUE TO GROW THE PROMOTION OF HEALTH IN THE COMMUNITY AND FURTHER ITS PURPOSE AS A EXEMPT ORGANIZATION."