efile Public Visual Render
ObjectId: 201543139349300329 - Submission: 2015-11-09
TIN: 41-0726171
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
Attach to Form 990.
Information about Schedule H (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Employer identification number
41-0726171
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.
Applied uniformly to all hospital facilities
Applied uniformly to most hospital facilities
Generally tailored to individual hospital facilities
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
100%
150%
200%
Other
%
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
200%
250%
300%
350%
400%
Other
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria
used 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
No
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 discounted
care 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)
.
.
.
137,890
137,890
0.580 %
b
Medicaid (from Worksheet 3, column a) .
.
.
.
.
5,392,960
3,416,382
1,976,578
8.260 %
c
Costs of other means-tested government programs (from Worksheet 3, column b)
.
.
d
Total
Financial Assistance and Means-Tested Government Programs .
.
.
.
.
5,530,850
3,416,382
2,114,468
8.840 %
Other Benefits
e
Community health improvement services and community benefit operations (from Worksheet 4).
8,106
8,106
0.030 %
f
Health professions education (from Worksheet 5)
.
.
.
13,971
13,971
0.060 %
g
Subsidized health services (from Worksheet 6)
.
.
.
.
h
Research (from Worksheet 7)
.
i
Cash and in-kind contributions for community benefit (from Worksheet 8)
.
.
.
.
4,410
4,410
0.020 %
j
Total.
Other Benefits
.
.
26,487
26,487
0.110 %
k
Total.
Add lines 7d and 7j
.
5,557,337
3,416,382
2,140,955
8.950 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50192T
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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
142
142
0 %
3
Community support
3,284
3,284
0.010 %
4
Environmental improvements
26,200
26,200
0.110 %
5
Leadership development and training for community members
6
Coalition building
7
Community health improvement advocacy
8
Workforce development
9
Other
10
Total
29,626
29,626
0.120 %
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
858,484
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
110,000
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
8,306,411
6
Enter Medicare allowable costs of care relating to payments on line 5
.....
6
8,353,140
7
Subtract line 6 from line 5. This is the surplus (or shortfall)
........
7
-46,729
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:
Cost accounting system
Cost to charge ratio
Other
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) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility 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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Other (Describe)
Facility reporting group
1
RAINY LAKE MEDICAL CENTER
1400 HIGHWAY 71
INTERNATIONAL FALLS
,
MN
56649
WWW.RAINYLAKEMEDICAL.COM
365894
X
X
X
X
RURAL HEALTH CLINIC AND SPECIALTY PROVIDER-BASED CLINIC
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility 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)
RAINY LAKE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes
No
Community Health Needs Assessment
1
Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.
.........................
1
No
2
Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.
..............
2
No
3
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 12.
.....................
3
Yes
If "Yes," indicate what the CHNA report describes (check all that apply):
a
A definition of the community served by the hospital facility
b
Demographics of the community
c
Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d
How data was obtained
e
The significant health needs of the community
f
Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g
The process for identifying and prioritizing community health needs and services to meet the community health needs
h
The process for consulting with persons representing the community’s interests
i
Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j
Other (describe in Section C)
4
Indicate the tax year the hospital facility last conducted a CHNA: 20
13
5
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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted
.................
5
Yes
6a
Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C
..................................
6a
No
b
Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C.
.............................
6b
Yes
7
Did the hospital facility make its CHNA report widely available to the public?
..............
7
Yes
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
Hospital facility’s website (list url):
RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2013/12/HEALTH-NEEDS-ASSESSMENT.PDF
b
Other website (list url):
c
Made a paper copy available for public inspection without charge at the hospital facility
d
Other (describe in Section C)
8
Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11.
..............
8
Yes
9
Indicate the tax year the hospital facility last adopted an implementation strategy: 20
13
10
Is the hospital facility's most recently adopted implementation strategy posted on a website?
.........
10
Yes
a
If "Yes" (list url):
RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2014/01/IMPLEMENTATION-STRATEGY-1
b
If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return?
......
10b
No
11
Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a
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)?
...............................
12a
No
b
If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?
........
12b
c
If "Yes" to line 12b, 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) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
RAINY LAKE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group
Financial Assistance Policy (FAP)
Yes
No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13
Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?
13
Yes
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of
200.000000000000
%
and FPG family income limit for eligibility for discounted care of
300.000000000000
%
b
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance discount
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
.................
14
Yes
15
Explained the method for applying for financial assistance?
...................
15
Yes
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of his or her application.
b
Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.
c
Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.
d
Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.
e
Other (describe in Section C)
16
Included measures to publicize the policy within the community served by the hospital facility?
........
16
Yes
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)
e
The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)
g
Notice of availability of the FAP was conspicuously displayed throughout the hospital facility
h
Notified members of the community who are most likely to require financial assistance about availability of the FAP
i
Other (describe in Section C)
Billing and Collections
17
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 all of the actions the hospital facility or other authorized party may take upon non-payment?
..................................
17
Yes
18
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
Reporting to credit agency(ies)
b
Selling an individual’s debt to another party
c
Actions that require a legal or judicial process
d
Other similar actions (describe in Section C)
e
None of these actions or other similar actions were permitted
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
RAINY LAKE MEDICAL CENTER
Name of hospital facility or letter of facility reporting group
Financial Assistance Policy (FAP)
Yes
No
19
Did the hospital facility or other 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?
............
19
No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
Reporting to credit agency(ies)
b
Selling an individual’s debt to another party
c
Actions that require a legal or judicial process
d
Other similar actions (describe in Section C)
20
Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
Notified individuals of the financial assistance policy on admission
b
Notified individuals of the financial assistance policy prior to discharge
c
Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills
d
Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy
e
Other (describe in Section C)
f
None of these efforts were made
Policy Relating to Emergency Medical Care
21
Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?
..................
21
Yes
If "No," indicate why:
a
The hospital facility did not provide care for any emergency medical conditions
b
The hospital facility’s policy was not in writing
c
The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)
d
Other (describe in Section C)
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22
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
The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged
b
The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c
The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d
Other (describe in Section C)
23
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?
...............................
23
No
If "Yes," explain in Section C.
24
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?
...........................
24
No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
Section C. Supplemental Information for Part V, Section B.
Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference
Explanation
RAINY LAKE MEDICAL CENTER
PART V, SECTION B, LINE 5: RLMC WORKED WITH THE KOOCHICHING COUNTY HEALTH DEPARTMENT TO COMPLETE ITS COMMUNITY HEALTH NEEDS ASSESSMENT. A REPRESENTATIVE OF RLMC AND THE DIRECTOR OF THE KOOCHICHING COUNTY HEALTH DEPARTMENT MET WITH 34 KEY COMMUNITY STAKEHOLDERS REPRESENTING A BROAD SECTION OF THE COMMUNITY INCLUDING LOCAL SERVICE PROVIDERS, MEMBERS OF THE RELIGIOUS COMMUNITY, BUSINESS OWNERS, AND CITIZENS FROM INTERNATIONAL FALLS AND THE GREATER COUNTY. THE AGENCIES REPRESENTED INCLUDED THOSE SERVING THE MEDICALLY UNDERSERVED AND LOW-INCOME POPULATIONS OF INTERNATIONAL FALLS AND KOOCHICHING COUNTY. RLMC ALSO CONDUCTED KEY STAKEHOLDER MEETINGS THROUGHOUT ITS SERVICE AREA, INTERVIEWING GROUPS OF INDIVIDUALS IDENTIFIED AS INFORMAL COMMUNITY LEADERS AND INTERESTED CITIZENRY.
RAINY LAKE MEDICAL CENTER
PART V, SECTION B, LINE 11: ACCESS TO CARE FOR THE COMMUNITY HAS BEEN INCREASED WITH THE OPENING OF THE RURAL HEALTH CLINIC IN FEBRUARY 2014 WITH THREE FAMILY-PRACTICE PROVIDERS. AN INTERNIST HAS BEEN HIRED, AS WELL AS A SURGEON AND ORTHOPEDIC PA. THIS HAS ALLOWED EXPANDED SPECIALTY SERVICES TO BE OFFERED LOCALLY, REDUCING THE NEED FOR RESIDENTS TO TRAVEL. TELEMEDICINE SERVICES HAVE ALSO BEEN INSTALLED IN THE ER; A BENEFIT OF WHICH IS A LESSER NEED TO TRANSFER PATIENTS, MEANING THEY CAN REMAIN CLOSER TO HOME. THE FOLLOWING ARE COMMUNITY NEEDS THAT WERE IDENTIFIED BUT NOT ADDRESSED BY RLMC: A) THE HIGH COST OF HEALTHCARE AND LACK OF HEALTH INSURANCE (OUTSIDE OF RLMC'S MISSION). B) LACK OF MENTAL HEALTH PRACTITIONERS (OUTSIDE OF RLMC'S MISSION). C) TRANSPORTATION (OUTSIDE OF RLMC'S MISSION). D) ACCESS TO HEALTH-RELATED SERVICES SUCH AS MEAL PROGRAMS, HOME CARE AND ALZHEIMER SUPPORT PROGRAMS (DUPLICATION OF EFFORT WITH LOCAL COUNTY HEALTH DEPARTMENT). E) SMOKING RATES AMONG TEENS (DUPLICATION OF EFFORT WITH LOCAL COUNTY HEALTH DEPARTMENT). F) OVERUSE OF ALCOHOL (OUTSIDE OF RLMC'S MISSION). G) DRUG ABUSE (OUTSIDE OF RLMC'S MISSION). H) THE IMPACT OF GEOGRAPHIC ISOLATION ON MENTAL HEALTH AND THE DESIRE TO BE HEALTHY (OUTSIDE OF RLMC'S MISSION). I) ACCESS TO LOCAL MENTAL HEALTH PROVIDERS AS WELL AS REGIONAL TREATMENT FACILITIES (LIMITED RESOURCES).
RAINY LAKE MEDICAL CENTER
PART V, SECTION B, LINE 22D: WE FOLLOW THE MINNESOTA ATTORNEY GENERAL AGREEMENT FOR THE MOST FAVORABLE NON-GOVERNMENTAL THIRD PARTY PAYOR THAT PROVIDED THE MOST REVENUE TO THE PROVIDER DURING THE PREVIOUS YEAR.
PART V, SECTION B, LINE 16
FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
RAINY LAKE MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE:
HTTP://RAINYLAKEMEDICAL.COM/PATIENT-RESOURCES/COMMUNITY-CARE
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility 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?
Name and address
Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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
PART I, LINE 6A:
RLMC MAKES ITS COMMUNITY BENEFIT REPORT AVAILABLE TO THE PUBLIC BY INCLUDING IT IN THEIR FINANCIAL STATEMENTS AND THROUGH THE MINNESOTA HOSPITAL ASSOCIATION ANNUAL REPORT.
PART I, LINE 7:
COSTING METHODOLOGY USED WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 FOR LINES A AND B. ACTUAL COSTS WERE USED TO DERIVE AMOUNTS ON LINES E, F, AND I.
PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 858,484.
PART II, COMMUNITY BUILDING ACTIVITIES:
RLMC INVESTS RESOURCES TOWARDS EMERGENCY PREPAREDNESS, PARTICULARLY A "DECONTAMINATION TEAM" THAT CONDUCTS DRILLS THROUGHOUT THE YEAR. THE TEAM IS SKILLED IN SETTING UP A PORTABLE DECONTAMINATION TENT, DRESSING IN AN APPROPRIATE LEVEL OF PPE AND PRACTICING DECONTAMINATING PATIENTS.
PART III, LINE 2:
BAD DEBT EXPENSE IS ESTIMATED BASED ON ANALYZING HISTORICAL DATA AS WELL AS THE CURRENT ECONOMIC ENVIRONMENT AS WELL AS REVIEWING THOSE ACCOUNTS ON PAYMNET PLANS.
PART III, LINE 3:
WE TRACKED ACCOUNTS THAT WENT TO BAD DEBT DURING THE YEAR, WHERE THE PATIENT HAD RECEIVED THE COMMUNITY CARE APPLICATION BUT DID NOT COMPLETE IT.
PART III, LINE 4:
SEE THE "PATIENT ACCOUNTS RECEIVABLE, NET" SECTION ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBT EXPENSE.
PART III, LINE 8:
THERE WAS A SHORTFALL CALCULATED OF $46,729 IN 2014. THE AMOUNTS INCLUDED IN PART III, LINES 6-8 WERE DERIVED USING THE 2014 FILED MEDICARE COST REPORT. CERTAIN EXPENSES ARE CONSIDERED NON-ALLOWABLE BY MEDICARE BUT ARE SPENT ON THINGS THAT BENEFIT THE COMMUNITY, SUCH AS COMMUNITY SUPPORT GROUPS, ECONOMIC DEVELOPMENT THROUGH THE CHAMBER OF COMMERCE, SPONSORSHIPS/DONATIONS TO EVENTS SUCH AS THE AMERICAN CANCER SOCIETY RELAY FOR LIFE.
PART III, LINE 9B:
RLMC WILL NOT REFER AN ACCOUNT TO A THIRD PARTY DEBT COLLECTION AGENCY UNLESS RLMC HAS GIVEN THE PATIENT REASONABLE OPPORTUNITY TO SUBMIT A COMMUNITY CARE APPLICATION IF THE FACTS AND CIRCUMSTANCES SUGGEST THE PATIENT MAY BE ELIGIBLE FOR COMMUNITY CARE, INCLUDING FOR EXAMPLE, IF THE PATIENT IS UNINSURED OR IS ON MINNESOTA CARE, MEDICAL ASSISTANCE, OR OTHER RELIEF BASED ON NEED. IF A PATIENT SUBMITS AN APPLICATION FOR COMMUNITY CARE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, RLMC WILL SUSPEND ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S APPLICATION HAS BEEN PROCESSED AND THE PATIENT HAS BEEN NOTIFIED OF THE DECISION.
PART VI, LINE 2:
IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY FORUMS ARE HELD AS WELL AS HEALTH FAIRS. BOTH GIVE COMMUNITY MEMBERS THE CHANCE TO PROVIDE FEEDBACK ON THEIR HEALTH CARE NEEDS.
PART VI, LINE 3:
RLMC HAS STAFF THAT ARE MINNESOTA COMMUNITY APPLICATION AGENT (MNCAA) CERTIFIED, WHICH ENABLES US TO ASSIST OUR PATIENTS WITH THE MINNESOTA CARE APPLICATION PROCESS. RLMC COMMUNICATES TO PATIENTS OUR COMMUNITY CARE PROGRAM (CHARITY CARE) IN THE FOLLOWING MANNER:1. PATIENTS ARE GIVEN A COMMUNITY CARE BROCHURE WITH A MINNESOTA CARE INSERT AT TIME OF SERVICE.2. STATEMENTS AND LETTERS SENT TO PATIENTS OFFERING COMMUNITY CARE.3. PHONE CALLS ARE MADE TO PATIENTS TO DISCUSS AND OFFER COMMUNITY CARE AND ASSISTANCE WITH THE MINNESOTA CARE APPLICATION PROCESS.4. ALL EMPLOYEES ARE EDUCATED ANNUALLY ABOUT OUR COMMUNITY CARE PROGRAM AND THREE EMPLOYEES ARE EDUCATED TO COMPLETE AND SUBMIT MINNESOTA CARE APPLICATIONS TO THE STATE FOR PROCESSING.5. UPON REQUEST, COMMUNITY CARE PACKETS WITH APPLICATIONS FOR BOTH OUR COMMUNITY CARE PROGRAM AND THE MINNESOTA CARE INSURANCE ARE SENT OR GIVEN TO PATIENTS.6. THE RLMC WEBSITE DISPLAYS PAYMENT OPTIONS WHERE OUR COMMUNITY CARE PROGRAM IS DISCUSSED.7. ONE OF THE REQUIREMENTS FOR RLMC COMMUNITY CARE IS A DENIAL FROM THE COUNTY IN REGARDS TO FINANCIAL ASSISTANCE UNLESS THEY ARE ENROLLED IN THE MN SENIOR PROGRAM. WE OFFER TO ASSIST THEM WITH THEIR MEDICAL ASSISTANCE APPLICATION.
PART VI, LINE 4:
RLMC PRIMARILY SERVES THE POPULATION OF KOOCHINCHING COUNTY, MINNESOTA. THE COUNTY IS LARGE AND SPARSELY POPULATED WITH INTERNATIONAL FALLS AS THE MAIN POPULATION CENTER. OTHER NEARBY SMALLER COMMUNITIES INCLUDE LITTLEFORK, BIG FALLS, RANIER, BIRCHDALE AND LOMAN. COLLECTIVELY THESE COMMUNITIES MAKE UP THE PRIMARY SERVICE AREA (PSA). THE PSA HAS AN ESTIMATED POPULATION OF AROUND 12,000 AND IS PROJECTED TO CONTINUALLY DECLINE. THE AVERAGE DISPOSABLE HOUSEHOLD INCOME IS AROUND $49,000 WHICH IS 6% LOWER THAN THE U.S. AVERAGE. APPROXIMATELY 19% OF THE POPULATION IS OVER THE AGE OF 65.
PART VI, LINE 5:
REPRESENTATION ON THE BOARD IS PREDOMINANTLY LOCAL AS THE BYLAWS STATE THAT NO MORE THAN 4 TRUSTEES MAY RESIDE OUTSIDE OF THE SERVICE AREA. RLMC HAS IN PLACE AN OPEN MEDICAL STAFF MODEL.
Schedule H (Form 990) 2014
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