SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Graceville Health Center
 
Employer identification number

41-0726173
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    23,757   23,757 0.270 %
b Medicaid (from Worksheet 3, column a) . . . . .     2,147,246 2,245,937 -98,691 1.130 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     2,171,003 2,245,937 -74,934 0.860 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     2,159   2,159 0.020 %
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     2,159   2,159 0.020 %
k Total. Add lines 7d and 7j .     2,173,162 2,245,937 -72,775 0.840 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
43,912
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
100
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
2,069,840
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
2,049,347
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
20,493
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Essentia Health Holy Trinity Hospital
115 West 2nd Street
Graceville,MN56240
www.essentiahealth.org
365536 		X X     X   X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Essentia Health Holy Trinity Hospital
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI.................................. 		4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 160.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 310.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?........ 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual?.......................... 22   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
Part V, Line 1j The Community Health Needs Assessment also includes a Community Health Profile. The profile is based on data from the Behavioral Risk Factors Surveillance System and the University of Wisconsin Population Health Institute County Health Rankings. Part V, Line 3 A Community/Patient Focus Group was held for community members to identify and prioritize their community health needs. In addition, persons were consulted at Town Hall Meetings, which was designed to address each prioritized health need. During the Town Hall Meeting, intervention options for meeting the health need were presented, and participants selected the option best suited to their community. Individuals from the following organizations attended the Town Hall Meeting (names and titles available upon request): Big Stone Chiropractic Health Center, Big Stone Therapies, Blue Cross Blue Shield, Chokio-Alberta School, City of Graceville, Community/Patient Focus Group, Countryside Public Health, Main Street Fitness, Northern Star Newspaper, Stevens Traverse Grant Public Health, University of Minnesota Agronomy and Plant Genetics, and University of Minnesota Extension. See the CHNA posted on the website listed in Part V, Line 5a for a list of organizations that were invited to, but did not attend the town hall meetings. According to the 2012 UWPHI County Health Rankings data, the majority of Essentia Health Holy Trinity Hospitals service area is rural (percent rural): Big Stone County (100%), Stevens County (51.6%), Traverse County (100%). Given the known health disparities of rural populations, all attendees of the Community/Patient Focus Group and Town Hall Meetings are representatives and/or members of medically-underserved and low income populations, as well as populations with chronic disease needs. Community/Patient Focus Group participants were specifically instructed to consider themselves as representatives of the community-at-large. Participants at the Town Hall Meetings served more formal leadership or representative roles. An elected official of the City of Graceville (name and title available upon request) attended the Town Hall Meeting, as well as the Community/Patient Focus Group. In Big Stone, Stevens, and Traverse Counties, 90.0% or more of the residents are Caucasian. However, as attendees at the Community/Patient Focus Group were instructed to act as representatives of the entire community, and data stratified by race/ethnicity were presented, health needs of minority populations were considered. As city elected officials represent the entire electorate, including minorities, minority populations were represented by the elected official of the City of Graceville as well. Part V, Line 4 Essentia Health Holy Trinity Hospital is affiliated with Essentia Health. In the interest of efficiency, cost effectiveness, and alignment with Essentia Health population health strategies, the hospital facilitys CHNA was conducted in a coordinated process with fourteen other Essentia Health hospital facilities. While still allowing for tailoring to each particular hospital facility, procedures were standardized across hospital facilities. The hospital facilities included in this coordinated process are: Essentia Health Ada in Ada, MN; Clearwater Valley Hospital and Clinics, Inc. in Orofino, ID; Essentia Health Deer River in Deer River, MN; Essentia Health Virginia in Virginia, MN; Essentia Health Holy Trinity Hospital in Graceville, MN; Essentia Health West in Fargo, ND; Minnesota Valley Health Center, Inc. in Le Sueur, MN; Essentia Health Northern Pines in Aurora, MN; Essentia Health Sandstone in Sandstone, MN; Essentia Health Duluth in Duluth, MN; Essentia Health St. Josephs Medical Center in Brainerd, MN; Essentia Health St. Marys Hospital-Superior in Superior, WI; St. Marys Hospital, Inc. in Cottonwood, ID; Essentia Health St. Marys Medical Center in Duluth, MN; and Essentia Health St. Marys-Detroit Lakes in Detroit Lakes, MN. Since Essentia Health West joined the collaborative effort on February 1, 2013, not all aspects of the Essentia Health West CHNA are coordinated with those of the other hospital facilities. The hospital facility did not collaborate with any other hospital facility outside of the Essentia Health System. Part V, Line 5a The CHNA is posted under the Community Benefit/CHNA tab on the hospital facility's homepage at: http://www.essentiahealth.org/HolyTrinityHospital/Find-a-Clinic/Essentia-H ealthHoly-Trinity-Hospital-Graceville-96.aspx Part V, Line 5d Links to the report were emailed to the Minnesota Hospital Association (MHA) to catalog the assessments and make them available on their website to help members meet IRS requirements for wide dissemination of reports. The MHA will also analyze the assessments to identify common themes, issues and needs on a statewide and regional basis. Finally, the MHA will use the catalog as a vehicle for connecting hospitals with similar community needs with one another to explore joint implementation strategies, information sharing, or resources for making their community benefit activities as influential as possible. Part V, Line 6i This box was not checked, so not applicable. Part V, Line 7 Seven health needs were identified through the CHNA. Of those health needs, the highest priority health need has and will continue to be addressed over the next three years as a part of the hospital facilitys implementation strategy. The hospital facility will not directly meet the six unprioritized health needs due to resource constraints. Rather than inadequately addressing all health needs, the hospital facility will focus resources, financial and otherwise, on optimizing the first intervention for the communitys highest priority health need while the Health System collectively builds the necessary resources and capacity for population health improvement in order to foster success in meeting the health need. Despite not directly meeting the unprioritized needs, interventions addressing the highest prioritized health need may partially address the unprioritized health needs that overlap with the prioritized health need. If the unprioritized health needs remain in the next CHNA cycle, they may be directly addressed at that time. The six unprioritized health needs are as follows: Tobacco use Immunizations Preventative care Access to healthcare Reduction of excessive/binge drinking Secondary prevention/screening Part V, Line 10 Checked "Yes", so not applicable. Part V, Line 11 Checked "Yes", so not applicable. Part V, Line 12i This box was not checked, so not applicable. Part V, Line 14g This box was not checked, so not applicable. Part V, Line 16e This box was not checked, so not applicable. Part V, Line 17e This box was not checked, so not applicable. Part V, Line 18e This box was not checked, so not applicable. Part V, Line 19c This box was not checked, so not applicable. Part V, Line 19d This box was not checked, so not applicable. Part V, Line 20d For patients known to qualify for the financial assistance program, they are charged the same as their most common insurance payor. Part V, Line 21 Checked "No", so not applicable. Part V, Line 22 Checked "No", so not applicable.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address Type of Facility (describe)
1 Essentia Health Grace Home
116 West 2nd Street
Graceville,MN56240 		Skilled Nursing Facility
2 Essentia Health Grace Village
114 West 2nd Street
Graceville,MN56240 		Assisted Living Apartments
3 Essentia Health Graceville Clinic
115 West 2nd Street
Graceville,MN56240 		Multi-Specialty Clinic
4 Essentia Health Chokio Clinic
101 Main Street
Chokio,MN56221 		Primary Care Clinic
5 Essentia Health Graceville Home Health
115 West 2nd Street
Graceville,MN56240 		Home Health
6
7
8
9
10
Schedule H (Form 990) 2013
Page 12
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part VI, Line 1 Provide the description required for Part I, lines 3c, 6a, 7g, 7, column (f), 7; Part II; Part III, lines 2, 3, 4, 8, 9b: Part I, line 3c Assets will be considered along with the patients income to determine eligibility for the Financial Assistance Program. To be eligible, reportable assets may not exceed $15,000 for a household of one (1), or $25,000 for a household of two (2) or more. Assets may include, but are not limited to, such items as checking and savings accounts, IRAs, 401(k)s; value of additional cars that exceed the number of working members in the household, equity in recreational vehicles and additional property, etc. Part I, line 6a Essentia Health Holy Trinity Hospitals community benefit information is consolidated into the Essentia Health community benefit information which is included in the Essentia Health annual report. The annual report is made available to the public at http://www.essentiahealth.org/Main/Annual-Report.aspx. Essentia Health, headquartered in Duluth, Minn., is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho and is Essentia Health Holy Trinity Hospitals parent corporation. Part 1, line 7g not applicable. Part I, line 7, column (f) Bad debt expense that was subtracted from total expense to obtain the % of community benefit to total expense amounted to $43,912. Part I, line 7 The cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate the costs for the following community benefits: Charity Care and Unreimbursed Medicaid. Actual costs were used for the remainder of the community benefits reported. Part II not applicable, no community building activities. Part III, line 2 Discounts, charity care, and bad debt expense are accounted for as reductions to revenue. Bad debt expense on patient accounts would be identified as any balance on the account, less any previous payments and discounts, that has aged and is absent of any payments. If, during the collection process, it becomes known that the patient qualifies for charity care, the amounts included within bad debt expense would be reclassified to charity care. Part III, Line 3 Essentia Health Holy Trinity Hospital is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the cost of bad debt as a community benefit. As a tax exempt hospital, we must provide the necessary services regardless of the patients ability to pay for that care. In doing so, Essentia Health makes quality patient care available to all in our community, regardless of their economic means. Part III, line 3 Essentia Health Holy Trinity Hospital applied a high-level, conservative analytic review by multiplying the ratio of charitable allowances to gross patient revenue against bad debt expense to arrive at an approximation of charity care that resides in bad debt. Part III, line 4 Page 12 of the audit contains the footnote describing the organizations bad debt expense. Part III, line 8 The methodology used in determining the reported Medicare Allowable Costs begins with the hospital's general ledger system. The costs are obtained from the general ledger and then adjusted and reported in accordance with Centers for Medicare Services (CMS) "cost finding" guidelines as published in their Provider Reimbursement Manual. Once the Medicare allowable costs are determined from the hospital's cost report, any costs attributed to subsidized health services, and Medical Education, are removed and reported separately. Part III, line 8 Not Applicable Part III, line 8 Essentia Health Holy Trinity Hospital is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the full value of the Medicare shortfall as a community benefit. The rationale for the organization's opinion is providing care for the elderly and serving Medicare patients is an essential part of the community benefit standard. Medicare, like Medicaid, does not pay the full cost of care and it is likely to get worse. Many Medicare beneficiaries are poor and are eligible for Medicaid in addition to Medicare. Medicare underpayment must be shouldered by the hospital in order to continue treating the communitys elderly and poor. These underpayments represent a real cost of serving the community. Part III, line 9b The policies and procedures for internal and external collection practices take into account the extent to which the patient qualifies for the Financial Assistance Policy (FAP) and financial assistance, a patients good faith effort to apply for a governmental program or for financial assistance from Essentia Health Holy Trinity Hospital and the patients good faith effort to comply with his/her payment agreements. Essentia Health Holy Trinity Hospital offers extended payment plans to eligible patients and will not impose liens on primary residences nor will we report patients to a credit rating agency for outstanding patient bills. Essentia Health Holy Trinity Hospital will not charge a patient gross amount of charges for any uninsured treatment. Uninsured discounts will be applied to the gross charges prior to any FAP or other discounts. At any time Essentia Health Holy Trinity Hospital recognizes that a patient may be eligible for State or Federal programs, a representative will assist the patient in obtaining information about those programs or provide contact information for those programs. Essentia Health Holy Trinity Hospital contracts with an outside patient advocacy agency, which may provide assistance to the uninsured patient in applying to certain State and Federal programs. At any stage of the patient experience and up through the collection process, the patient may express a concern that they are unable to pay their bill in full or meet the payment plan requirements. At that time, the patient will be given every opportunity to complete and submit an application for financial assistance. Essentia Health Holy Trinity Hospital trains its outside debt collection agencies and attorneys about the Financial Assistance Policy and how a patient may obtain more information about the FAP or submit an application for financial assistance. Essentia Health Holy Trinity Hospital requires its outside collection agencies and attorneys to refer patients who may be eligible for financial assistance to Essentia Health Holy Trinity Hospital. If a patient has submitted an application for financial assistance after an account has been referred for collection activity, Essentia Health Holy Trinity Hospital and its outside debt collection agencies suspend all collection activity until the patients financial assistance application has been processed and Essentia Health Holy Trinity Hospital has notified the patient of its decision.
Part VI, line 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B: We continue to use patient feedback surveys from Professional Research Consultants (PRC) to gauge community needs. Providers and clinic staff offer patient education classes based on feedback from patients. We monitor our Quality Initiative matrices and focus on those scores indicating additional attention to patient needs and desires. Currently we are able to assess our community in the following ways: listening to our customer feedback on PRC surveys, analyzing outcomes from our various community education and support group programs and school sponsored functions promoting health education and prevention. The small, rural size of our service area allows us to have a close relationship with the needs of our customers and within economic reason (and affordability) we try to provide and service those needs.
Part VI, line 3 Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's charity care policy: Essentia Health Holy Trinity Hospital makes information on its Financial Assistance Policy (FAP) readily available to the patient. Information about financial assistance programs is available on the Essentia Health (parent company) website (www.essentiahealth.org) where the Information and application is easily accessible to be viewed, downloaded and printed at no charge to the patient. Notices on the availability of financial assistance are conspicuously posted in emergency room departments. Financial assistance information is available during the pre-admission financial screening, at the time of registration and prior to a hospital discharge. Information about the FAP is in all collection letters and patient statements. FAP information and/or applications are made available to appropriate community health services agencies and other organizations that assist people in need. Essentia Health Holy Trinity Hospital educates staff members who work closely with patients providing direct patient treatment and who work in admissions, billing and collections, about the existence of the FAP and how a patient may obtain more information. Annual education/awareness of the FAP is provided to ensure all employees with patient contact are aware of the program and how patients can obtain additional information. Clinical and hospital staff who provide direct patient care have knowledge of the FAP and know to direct patients to a Registration Interviewer or Business Office Representative. Registration staff have an understanding of the policy, knowledge of where the related documents are located and where to direct the patient for more information on the FAP. Designated employees (Financial Counselors; Patient Accounts Representatives) have a thorough understanding of the FAP and offer the information on the FAP to those patients who make an inquiry about the program or are determined through a financial screening that the patient may be eligible for this program. Patient advocacy services also inform the patient about the availability of assistance. A request for financial assistance may be made by the patient, a patients guarantor, a family member, close friend, or associate of the patient, subject to applicable privacy laws. Essentia Health Holy Trinity Hospital responds to any oral or written requests for more general information on the FAP made by a patient or any interested party.
Part VI, line 4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: Essentia Health Holy Trinity Hospital is located in Graceville, MN. Essentia Health Holy Trinity Hospital is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Essentia Health Holy Trinity Hospital operates 1 hospital, 2 clinics, a skilled nursing facility, an assisted living facility, and home health that serves the communities of far west and central Minnesota. The community served by Holy Trinity Hospital also extends into eastern South Dakota. The overall community is classified as Rural. Essentia Health Holy Trinity Hospital and its related facilities cover a service region of approximately 6,000 people. The service region age distribution is 20.7% under the age of 18; 54.1% between the ages of 18 and 65; and 25.2% over the age of 65. The racial makeup of the service region is 94.2% Caucasian; 0.2% Black or African American; 0.1% Asian;1.1% Hispanic; and 4.4% other, predominantly Native American. The gender split ratio is 53.5% women and 46.5% men. The average income for the service area is approximately $52,000. Approximately 8.7% of the population falls below the federal poverty guidelines. Essentia Health Holy Trinity Hospital, along with Essentia Health is committed to serve patients regardless of their ability to pay. 8.8% gross revenue dollars were from self pay patients. In addition, approximately 23.3% of their gross revenue dollars were Medicaid recipients. As mentioned above, Essentia Health Holy Trinity Hospital is part of a larger system, Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There are no other hospitals outside of the Essentia Health umbrella that service the community.
Part VI, line 5 Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting the health of the community: All board members reside in and around the community of Graceville with the exception of one member from Duluth who is there to ensure its dedication to its Catholic faith mission and leadership. Board members and management positions are vetted through the Conflict of Interest process done by the corporate office each year. Volunteerism and providing faith-based care are part of the daily culture and mission of Essentia Health Holy Trinity Hospital. The organization extends medical staff privileges to all qualified physicians in the community. In part due to the size and location of the organization, it is not always easy to recruit physicians to practice here and as a result, physician and advanced practice clinicians are at a premium for our service area. While no research is conducted at the facility, all available funds are invested back into the hospital as evidenced by the commitment to invest significant dollars in upgraded technology (EMR) and new equipment for patient and quality services. As a community benefit Essentia Health Holy Trinity Hospital provides space for community meetings such as EMT classes, Alcohol Anonymous, diabetes education, foundation board and general health/wellness classes. Other uses for boy- scout, girl- scout, 4-H meetings, Alzheimers support group, and other community outreach activities also take place. Essentia Health Holy Trinity Hospital sponsors an annual health fair. They invite the public into the facility for health education, blood pressure screens, glucose and cholesterol lab testing. Essentia Health Holy Trinity Hospital provided masks for area schools and local businesses. Education for current public health concerns such as Ebola are also being made available to the community via local experts and through in-home education from home health nursing. Essentia Health Holy Trinity Hospital sponsored two cancer walks, a summer medical intern program, a memory screen clinic, a Medicare D education seminar, a Cancer Care speaker, a fit testing for the city, a womens health night, a Go Red lab day, and a health care booth at the county fair. Part I, line 7e reflects the financial aspect of the community benefit from these activities. Essentia Health Holy Trinity Hospital is a part of Essentia Health, a fully integrated health system with facilities in Minnesota, Wisconsin, North Dakota and Idaho. As a non-profit organization, Essentia Health reinvests surplus revenues into medical training, programs and technology that improve patient care. Essentia provides services predominantly in rural communities and is committed to eliminating geographic barriers to care. We strive to provide high-quality, patient-centered care close to home for the communities we serve. We continue to upgrade facilities and technology, such as MRIs, CT scanners and surgery suites, to ensure patients in rural communities have nearby access to these services. In addition, we have embarked on several major construction projects, which include a new $50 million wing for our Fargo hospital. Essentia Health was one of the first Accountable Care Organizations in the country to receive the highest level of accreditation from the National Committee for Quality Assurance (NCQA). As an ACO, Essentia is committed to meeting the Triple Aim of improving care and population health, while reducing the overall costs for patients and society as a whole. The formation of our ACO, along with ongoing management and process improvement, represents a significant investment for Essentia. Since a majority of healthcare costs are directly related to caring for patients who have chronic conditions, Essentia has developed medical homes, which are designed to improve health outcomes for patients, especially those with chronic diseases. Much of this work is not fully reimbursed by state or federal programs. Essentia supports the health of our communities through active research and clinical trials through the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Various Essentia Health organizations contributed approximately $4.25 million in support to the Institute during the past year. The Essentia Institute of Rural Health also coordinates our community health needs assessment program. Across our system, Essentia offers community members the opportunity to take part in a National Diabetes Prevention Program, which was designed by the Centers for Disease Control and Prevention. Participants receive the year-long program at no cost, and learn valuable information and skills for making important lifestyle changes. These new healthy habits help participants lose weight and become more active, which is vital in the prevention of diabetes and other chronic diseases.
Part VI, line 6 If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served: Essentia Health Holy Trinity Hospital is part of Essentia Health, an integrated health system with 16 hospitals, 66 clinics, eight long-term care facilities, two assisted living facilities, five independent living facilities, five ambulance services and one research institute in four states: Minnesota, Wisconsin, North Dakota and Idaho. The health system serves a predominantly rural population whose median incomes generally fall below averages of the states where they live. The presence of our clinics and hospitals ensures that people with few economic resources dont have to drive an hour or more to receive basic (and in some cases life-saving) medical care. In addition to staffing hospitals and clinics in federally recognized underserved areas, we support the health of our communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into our smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or faced with other challenges that make it difficult to travel long distances for care. Our size and integrated structure allow us to offer patients services often found only in larger urban settings. Services ranging from chemotherapy to congestive heart failure management and hospice are available to patients in many of the rural communities we serve. Essentia Health also supports the health of our rural communities through active research and clinical trials by the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Essentia Health is also serving patients through the use of our electronic health record (EHR). The vast majority of Essentias hospitals and clinics are using a fully-integrated EHR for patient care. Technology like the electronic health record and Essentias telehealth program allows health clinicians to share test results and consult with colleagues in real time across great distances. Medical information is no longer lost in the shuffle of paper records an important consideration in a region where patients must often be transferred to a larger Essentia facility for complex surgeries or medical care. Essentia is also actively working with government agencies and insurers to develop innovative and cost-effective approaches to care that will improve health outcomes while reducing overall costs to patients and insurers. This innovation can be found in our use of remote home monitors for patients with congestive heart failure and our focus on using a team-based approach to helping patients manage chronic diseases. Essentia Health is committed to helping patients and their families lead active and fulfilling lives in the small and large communities where they live. We hope to become a model of healthcare delivery, particularly in rural areas, in the years to come.
Part VI, line 7 If applicable, identify all states with which the organization, or a related organization, files a community benefit report: Essentia Health Holy Trinity Hospital files a community benefit report in Minnesota.
Schedule H (Form 990) 2013
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