Community Benefit Insight - Tax-exempt hospital

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Northwestern Medical Center

Northwestern Medical Center

133 Fairfield Street
Saint Albans, VT 05478

Bed count	70	Medicare provider number	470024	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 030266986

Display data for year:

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

13.36%

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	$ 799,035 0.63 %
Medicaid as % of operating expenses	$ 15,595,116 12.26 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 541,294 0.43 %
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.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 62,169 0.05 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
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	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 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	$ 0 0 %
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	$ 0 0 %

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 $ 84221710 including grants of $ 62169) (Revenue $ 121838654)
Providing inpatient and outpatient services to the general public in a full-service 70-bed hospital. The Hospital publishes an annual report. Please refer to the annual report for additional explanation of the Hospital's programs and achievements.

4B (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
Charity Care - The Hospital provides care to patients who meet certain criteria under its charity care policy. Because the Hospital does not pursue collection or amounts determined to qualify as charity care they are not reported in revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. The records include the amount of charges foregone for services and supplies furnished under its charity care policy, the estimated cost of those services and supplies and equivalent service statistics. The following information measures the level of charity care provided during the year ended September 30, 2022.See continuation on Schedule O. Estimated costs and expenses incurred to provide charity care: $913,094Number of charity care patients served: 1,168The Hospital provides health care services to residents of St. Albans, Vermont, and the surrounding area, without regard to the individual's ability to pay for their services.

Facility Information

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

Northwestern Medical Center
Part V, Section B, Line 5: As part of our 2021/2022 (FY'22) Community Health Needs Assessment, NMC gathered input in a variety of ways including interviews with physicians, providers, and community partners; perspectives from staff and volunteers; discussions with the Incorporators from throughout our service area; patient satisfaction insights; and utilization trend analysis. Significant input, perspective, and prioritization were received through a local group of experts who were asked to validate the direction and findings of the assessment and to establish priority among various identified issues. The composition of this group of community members aligns with the Federal regulations for involvement of community leaders with specified skills or representing specified constituencies and allows for them to use their connections to their neighbors and clientele and insights there in to assist in refining and prioritizing the community health needs.

Northwestern Medical Center
Part V, Section B, Line 6b: Center for Rural Studies at the University of VermontAbenaki Nation of MissisquoiChamplain Valley Office of Economic OpportunityFranklin County Home Health AssociationNorthwest Counseling and Support ServicesNorthwest Regional Planning CommissionNorthern Tier Center for HealthUnited Way of Northwest VermontVermont Department of Health

Northwestern Medical Center
Part V, Section B, Line 7d: In addition to making the Community Health Needs Assessment widely available via the hospital website and in response to requests, Northwestern Medical Center provided overviews of the Community Health Needs Assessment to members of the community through presentations at groups such as the NMC Incorporators (150 local members who elect the hospital Board); the Boards of Directors of Northwestern Medical Center, Franklin County Home Health Agency; Northwestern Counseling & Support Services, NOTCH (Northern Tier Centers for Health Federally Qualified Health Centers); and the St. Albans Rotary comprised of business and civic leaders from across the region; and via Health Beat, NMC's public access television show. The priorities of the Community Health Needs Assessment are frequently referenced in other hospital documents, plans, publications, and presentations as we work to integrate these findings into our efforts to care for our community.

Northwestern Medical Center
"Part V, Section B, Line 11: NMC is addressing the significant needs identified in its most recently conducted CHNA through a variety of initiatives including: Access to healthcare (continuing to increase access to local specialty care services in our community, including cardiology, midwifery, physician medicine & rehab services, inpatient pediatrics, tele-neurology, urology, etc.), Affordability of services and cost of living (continuing to work with our community in implementing the State's value-based care model to reduce health care costs, improving patient experience, increasing equity and improving population health), Safety and Belonging (exploring opportunities for continued alignment and partnership with local public transportation providers; engaging in opportunities to promote community activities and resources that bring people together, foster belonging, and improve the overall quality of life) and Community Gathering and Connectedness (creating safe spaces by having opportunities for modeling our differences as staff, medical staff, and administration drawing guidance from our DEI work, which could include encouraging pronoun usage in our communications, showing support through intentional actions, posting ""welcome"" in different languages etc.). The Community Health Improvement Plan was developed by recognizing NMC's role as a community hospital in addressing the health needs of the population, as well as developing an understanding of what other organizations are doing to address the needs of the populations we serve. In addition, we restructured our Accountable Community for Health to specifically address systematic issues that are creating barriers to health. NMC's most recent CHNA also addressed several additional items that NMC is working with other community partners to lead the CAIRES Accountable for Health (ACH). The mission of the CAIRES ACH is to design health and service systems together with communities to be equitable, responsibe, and adaptable. Our vision is that Grand Isle and Franklin Counties will be inclusive, self-determined, health communities where everyone is well, safe, nurtured, and respected. To encourage collaboration and reduce the impact hierarchies of systemic oppression have on communities. The structure of the ACH de-centralizes decision making. The ACH is made of three group types with specific purposes and decision-making powers.-The CAIRES Circle is focused on the ongoing sustainability of the ACH and supports collaboration across workgroups.-Workgroups are formed around specific areas of focus and make decisions related to workgroup goals.-The Production Team provides organization and administrative support across the ACH to support the shared vision and mission of the ACH.NMC's Director of Population Health serves on the Production Team and attends the CAIRES Circle with members of NMC's senior leadership team. Members of NMC's Department of Population Health are leading and serving on workgroups, including:1. A Regional Transportation Workgroup2. The Transitions of Care Workgroup3. Youth Health Workgroup4. Outpatient Service Medical Workgroup5. Homeless Healthcare Workgroup"

Part V, line 10a, Hospital facility's website:
https://www.northwesternmedicalcenter.org/about-nmc/hospital-data/community-assessments/

Part V, line 17a, Hospital facility's website:
https://www.northwesternmedicalcenter.org/about-nmc/hospital-data/community-assessments/

Part V, line 16a, FAP website:
https://www.northwesternmedicalcenter.org/patients-visitors/pay-an-nmc-bill/free-care-discount-policy/

Part V, line 16b, FAP Application website:
https://www.northwesternmedicalcenter.org/patients-visitors/pay-an-nmc-bill/free-care-discount-policy/

Part V, line 16c, FAP Plain Language Summary website:
https://www.northwesternmedicalcenter.org/patients-visitors/pay-an-nmc-bill/free-care-discount-policy/

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
Determining eligibility for free care and/or discounted care is not solely determined by Federal Poverty Guidelines (FPG). Other considerations, such as net worth, other financial obligations, and outstanding medical bills are reviewed in addition to income.

Part I, Line 7g:
Subsidized health services includes the Medicare shortfall from physician practices that are not included in the Hospital's cost reporting reflected on Part III, Line 7.

Part III, Line 4:
See pages 8-12 of the attached audited financial statements.

Part III, Line 8:
The cost was determined using the cost to charge ratio.The Medicare shortfall of $16,005,494 reported on line 7 of Part III, does not represent all Medicare services provided by the Hospital, as required by IRS instructions. When taking all Medicare services into account, the Hospital calculated a different Medicare shortfall using an internal costing methodology.

Part III, Line 9b:
During the collection process, financial assistance, a payment plan or a discount may be offered to the patient, if appropriate, and in accordance with established hospital policy.

Part VI, Line 2:
In alignment with the Federal mandate, Northwestern Medical Center conducted a comprehensive Community Health Needs Assessment in 2022. This document was formally approved by the Hospital's Board of Directors at their May 6, 2022 meeting, placing it in the Hospital's 2022 Fiscal Year. This document replaces the previous Community Health Needs Assessment which was approved in the Hospital's 2019 Fiscal Year.Five top priorities were identified: BIPOC; Healthy & affordable food; Affordability of Healthcare; Reliable Transportation and Environmental, Physical and Emotional Safety - and action plans have been created to help address each of these priorities. The current (and previous) assessment is available free of charge on the Hospital website and the Hospital's Community Relations Office is available to provide free printed copies as requested.

Part VI, Line 3:
The Hospital uses a variety of methods of communication to inform and educate patients about its financial assistance program. For example, information related to financial assistance and charity care is available on the Hospital's website and patient portal, included on the back of patient statements, posted on signs at registration areas, and patients may speak on the phone with a collection specialist. The Hospital's financial assistance program is also widely publicized within the community, including published information regularly placed in the local newspaper and information brochures displayed at local United Way and Department of Health offices.

Part VI, Line 4:
The Hospital serves the greater Franklin and Grand Isle counties in northwestern Vermont. The service area consists of approximately 56,000 people and the area is primarily rural and agricultural in nature with some light industry.

Part VI, Line 5:
The Hospital maintains an open medical staff and a community based Board of Directors. The Hospital's Board of Directors is elected by the Hospital's Board of Incorporators, which consists of approximately 150 local residents. The Hospital created and funds a program known as The Center for Health and Wellness, which is committed to a collaborative approach to community health improvement.

Operating expenses	$ 127,236,585
Total amount spent on community benefits as % of operating expenses	$ 16,997,614 13.36 %