SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
ALTRU HEALTH SYSTEM
 
Employer identification number

45-0310462
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 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

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
Yes
 
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
 
No
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) . . . 		    2,119,706   2,119,706 0.380 %
b Medicaid (from Worksheet 3, column a) . . . . .     19,447,748   19,447,748 3.440 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     896,723   896,723 0.160 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     22,464,177   22,464,177 3.980 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     1,159,720   1,159,720 0.210 %
f Health professions education (from Worksheet 5) . . .     608,719   608,719 0.110 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .     78,498   78,498 0.010 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     147,000   147,000 0.030 %
j Total. Other Benefits . .     1,993,937   1,993,937 0.360 %
k Total. Add lines 7d and 7j .     24,458,114   24,458,114 4.340 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
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
9,480,521
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
0
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
130,670,289
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
394,057,285
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-263,386,996
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) 2017
Schedule H (Form 990) 2017
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?3Name, 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) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 ALTRU HOSPITAL
1200 S COLUMBIA RD
GRAND FORKS,ND582066002 		X X         X      
2 ALTRU REHABILITATION CENTER
1300 S COLUMBIA RD
GRAND FORKS,ND582066002 		X                  
3 ALTRU SPECIALTY CENTER
4500 S WASHINGTON ST
GRAND FORKS,ND58201 		X X                
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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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)
ALTRU HOSPITAL
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
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
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  
6 a 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 Yes  
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
b
c
d
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 17
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.ALTRU.ORG
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2017
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Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
ALTRU HOSPITAL
Name of hospital facility or letter of facility reporting group  
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
b
c
d
e
f
g
h
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
b
c
d
e
16 Was widely publicized 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
WWW.ALTRU.ORG
b
WWW.ALTRU.ORG
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
ALTRU HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
b
c
d
e
f
19 Did the hospital facility or other authorized 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 Yes  
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
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 19. (check all that apply):
a
b
c
d
e
f
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
b
c
d
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
ALTRU HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
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
b
c
d
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 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
Page 4
Schedule H (Form 990) 2017
Page 4
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)
ALTRU REHABILITATION 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): 		2
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
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
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  
6 a 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 Yes  
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
b
c
d
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   No
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
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" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
ALTRU REHABILITATION CENTER
Name of hospital facility or letter of facility reporting group  
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
b
c
d
e
f
g
h
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
b
c
d
e
16 Was widely publicized 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
WWW.ALTRU.ORG
b
WWW.ALTRU.ORG
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
Page 6
Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
ALTRU REHABILITATION CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
b
c
d
e
f
19 Did the hospital facility or other authorized 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 Yes  
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
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 19. (check all that apply):
a
b
c
d
e
f
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
b
c
d
Schedule H (Form 990) 2017
Page 7
Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
ALTRU REHABILITATION CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
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
b
c
d
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 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
Page 8
Schedule H (Form 990) 2017
Page 8
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, 16j, 18e, 19e, 20e, 21c, 21d, 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
ALTRU HOSPITAL PART V, SECTION B, LINE 5: ALTRU HEALTH SYSTEM AND THE GRAND FORKS PUBLIC HEALTH DEPARTMENT ENGAGED MULTIPLE PARTNERS TO CONDUCT SURVEYS AND FOCUS GROUPS WITH COMMUNITY LEADERS TO GET THEIR INSIGHT ABOUT THE HEALTH OF THE COMMUNITY AND HOW IT CAN BE IMPROVED. IT WAS AGREED TO USE THE PROCESS FROM THE ASSOCIATION FOR COMMUNITY HEALTH IMPROVEMENT (SIX STEP COMMUNITY HEALTH ASSESSMENT PROCESS).A COMMUNITY-BASED ADVISORY COMMITTEE WAS FORMED TO WORK WITH ALTRU AND GRAND FORKS PUBLIC HEALTH ON THE ASSESSMENT. LEADERSHIP FROM ALTRU AND GRAND FORKS PUBLIC HEALTH SERVED ON THE ADVISORY COMMITTEE, ALONG WITH INDIVIDUALS REPRESENTING THE FOLLOWING AGENCIES/ORGANIZATIONS:COMMUNITY VIOLENCE INTERVENTION CENTERUNITED WAYGRAND FORKS PUBLIC SCHOOLSUNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINEUNIVERSITY OF NORTH DAKOTANORTHEAST HUMAN SERVICE CENTERGRAND FORKS POLICE DEPARTMENTGRAND FORKS FIRE DEPARTMENTALTRU FAMILY YMCAGRAND FORKS PARK DISTRICTGRAND FORKS AIR FORCE BASELIPP, CARLSON, WITUCKI & ASSOCIATESGRAND FORKS SENIOR CENTERTHIRD STREET CLINICGRAND FORKS CITY COUNCILFAITH COMMUNITYGLOBAL FRIENDS COALITIONVALLEY COMMUNITY HEALTH CENTERPOLK COUNTY PUBLIC HEALTHGRAND FORKS COUNTY COMMISSIONTHE ADVISORY COMMITTEE ENGAGED STUDENTS FROM THE UNIVERSITY OF NORTH DAKOTA'S MASTER OF PUBLIC HEALTH PROGRAM WITH THE ASSISTANCE OF DR. RAYMOND GOLDSTEEN, PROFESSOR AND DIRECTOR OF THE DEPARTMENT OF POPULATION HEALTH. THE STUDENT TEAM CONDUCTED A COMMUNITY SURVEY ALONG WITH FOCUS GROUPS WITH COMMUNITY LEADERS TO GET THEIR INSIGHT ABOUT THE HEALTH OF GRAND FORKS AND POLK COUNTY COMMUNITIES AND HOW IT CAN BE IMPROVED.
ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 5: ALTRU HEALTH SYSTEM AND THE GRAND FORKS PUBLIC HEALTH DEPARTMENT ENGAGED MULTIPLE PARTNERS TO CONDUCT SURVEYS AND FOCUS GROUPS WITH COMMUNITY LEADERS TO GET THEIR INSIGHT ABOUT THE HEALTH OF THE COMMUNITY AND HOW IT CAN BE IMPROVED. IT WAS AGREED TO USE THE PROCESS FROM THE ASSOCIATION FOR COMMUNITY HEALTH IMPROVEMENT (SIX STEP COMMUNITY HEALTH ASSESSMENT PROCESS).A COMMUNITY-BASED ADVISORY COMMITTEE WAS FORMED TO WORK WITH ALTRU AND GRAND FORKS PUBLIC HEALTH ON THE ASSESSMENT. LEADERSHIP FROM ALTRU AND GRAND FORKS PUBLIC HEALTH SERVED ON THE ADVISORY COMMITTEE, ALONG WITH INDIVIDUALS REPRESENTING THE FOLLOWING AGENCIES/ORGANIZATIONS:COMMUNITY VIOLENCE INTERVENTION CENTERUNITED WAYGRAND FORKS PUBLIC SCHOOLSUNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINEUNIVERSITY OF NORTH DAKOTANORTHEAST HUMAN SERVICE CENTERGRAND FORKS POLICE DEPARTMENTGRAND FORKS FIRE DEPARTMENTALTRU FAMILY YMCAGRAND FORKS PARK DISTRICTGRAND FORKS AIR FORCE BASELIPP, CARLSON, WITUCKI & ASSOCIATESGRAND FORKS SENIOR CENTERTHIRD STREET CLINICGRAND FORKS CITY COUNCILFAITH COMMUNITYGLOBAL FRIENDS COALITIONVALLEY COMMUNITY HEALTH CENTERPOLK COUNTY PUBLIC HEALTHGRAND FORKS COUNTY COMMISSIONTHE ADVISORY COMMITTEE ENGAGED STUDENTS FROM THE UNIVERSITY OF NORTH DAKOTA'S MASTER OF PUBLIC HEALTH PROGRAM WITH THE ASSISTANCE OF DR. RAYMOND GOLDSTEEN, PROFESSOR AND DIRECTOR OF THE DEPARTMENT OF POPULATION HEALTH. THE STUDENT TEAM CONDUCTED A COMMUNITY SURVEY ALONG WITH FOCUS GROUPS WITH COMMUNITY LEADERS TO GET THEIR INSIGHT ABOUT THE HEALTH OF GRAND FORKS AND POLK COUNTY COMMUNITIES AND HOW IT CAN BE IMPROVED.
ALTRU HOSPITAL PART V, SECTION B, LINE 6A: ALTRU REHABILITATION CENTER
ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 6A: ALTRU HEALTH SYSTEM
ALTRU HOSPITAL PART V, SECTION B, LINE 6B: GRAND FORKS PUBLIC HEALTH
ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 6B: GRAND FORKS PUBLIC HEALTH
ALTRU HOSPITAL PART V, SECTION B, LINE 11: ALTRU HEALTH SYSTEM DEVELOPED A LIST OF APPROXIMATELY SIXTY SIGNIFICANT ISSUES/NEEDS WITH THE INPUT OF THE ADVISORY COMMITTEE. FROM THIS LIST, THE HEALTH ISSUES WERE RANKED BY PRIORITY, AND THE TOP 5 AREAS WERE IDENTIFIED FOR AREAS OF IMPROVEMENT. THE ADVISORY COMMITTEE AND A SMALLER COMMITTEE COMPRISED OF INDIVIDUALS FROM ALTRU HEALTH SYSTEM, GRAND FORKS PUBLIC HEALTH DEPARTMENT, GRAND FORKS SUBSTANCE ABUSE PREVENTION COALITION, POLK COUNTY PUBLIC HEALTH, AND QUALITY HEALTH ASSOCIATES OF NORTH DAKOTA ARE WORKING ON THE ONGOING IMPROVEMENT PLANNING / IMPLEMENTATION STRATEGY DEVELOPMENT. THE COMMITTEE WILL BE CONDUCTING IMPLEMENTATION ACTIVITIES AND PROVIDING UPDATES ANNUALLY TO KEY STAKEHOLDERS TO DOCUMENT PROGRESS. LIMITED FINANCIAL, COMMUNITY, AND PERSONNEL RESOURCES DID NOT ALLOW ALTRU HEALTH SYSTEM TO ADDRESS ALL OF THE IDENTIFIED NEEDS FOR THE 2016 CHNA.
ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 11: ALTRU HEALTH SYSTEM DEVELOPED A LIST OF APPROXIMATELY SIXTY SIGNIFICANT ISSUES/NEEDS WITH THE INPUT OF THE ADVISORY COMMITTEE. FROM THIS LIST, THE HEALTH ISSUES WERE RANKED BY PRIORITY, AND THE TOP 5 AREAS WERE IDENTIFIED FOR AREAS OF IMPROVEMENT. THE ADVISORY COMMITTEE AND A SMALLER COMMITTEE COMPRISED OF INDIVIDUALS FROM ALTRU HEALTH SYSTEM, GRAND FORKS PUBLIC HEALTH DEPARTMENT, GRAND FORKS SUBSTANCE ABUSE PREVENTION COALITION, POLK COUNTY PUBLIC HEALTH, AND QUALITY HEALTH ASSOCIATES OF NORTH DAKOTA ARE WORKING ON THE ONGOING IMPROVEMENT PLANNING / IMPLEMENTATION STRATEGY DEVELOPMENT. THE COMMITTEE WILL BE CONDUCTING IMPLEMENTATION ACTIVITIES AND PROVIDING UPDATES ANNUALLY TO KEY STAKEHOLDERS TO DOCUMENT PROGRESS. LIMITED FINANCIAL, COMMUNITY, AND PERSONNEL RESOURCES DID NOT ALLOW ALTRU HEALTH SYSTEM TO ADDRESS ALL OF THE IDENTIFIED NEEDS FOR THE 2016 CHNA.
ALTRU HOSPITAL PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE GROSS CHARGE REGARDLESS OF INSURANCE STATUS. ADJUSTMENTS MAY BE APPLIED PROVIDING THE PATIENTS APPLY FOR AND QUALIFY FOR CHARITY CARE.
ALTRU REHABILITATION CENTER PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE GROSS CHARGE REGARDLESS OF INSURANCE STATUS. ADJUSTMENTS MAY BE APPLIED PROVIDING THE PATIENTS APPLY FOR AND QUALIFY FOR CHARITY CARE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
Page 9
Schedule H (Form 990) 2017
Page 9
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?54
Name and address Type of Facility (describe)
1 2 - ALTRU CANCER CENTER
960 S COLUMBIA RD
GRAND FORKS,ND582066003 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
2 3 - TRUYU AESTHETIC CENTER
3165 DEMERS AVE
GRAND FORKS,ND582066003 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
3 4 - ALTRU FAMILY MEDICINE CENTER
1380 S COLUMBIA RD
GRAND FORKS,ND582066003 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
4 5 - ALTRU FAMILY MEDICINE RESIDENCY
725 HAMLINE STREET
GRAND FORKS,ND58203 		OUTPATIENT CLINIC
5 6 - ALTRU FAMILY MEDICINE RESIDENCY PHARMACY
725 HAMLINE STREET
GRAND FORKS,ND58203 		OUTPATIENT PHARMACY
6 7 - ALTRU CLINIC - DRAYTON
1003 N MAIN
DRAYTON,ND582254650 		OUTPATIENT CLINIC/THERAPY
7 8 - ALTRU PSYCHIATRY CENTER
860 S COLUMBIA RD
GRAND FORKS,ND582066002 		OUTPATIENT DEPARTMENT - PSYCH SERVICES
8 10 - ALTRU OUTPATIENT CENTER
411 2ND ST NW
EAST GRAND FORKS,MN56721 		OUTPATIENT THERAPY
9 11 - ALTRU CLINIC - CAVALIER
201 E 3RD AVE S
CAVALIER,ND582200040 		OUTPATIENT CLINIC
10 12 - ALTRU CLINIC - DEVILS LAKE
1001 7TH STREET NE
DEVILS LAKE,ND583012719 		OUTPATIENT CLINIC
11 13 - ALTRU CLINIC - CROOKSTON
400 SOUTH MINNESOTA
CROOKSTON,MN567160606 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
12 14 - ALTRU CLINIC - RED LAKE FALLS
312 INTERNATIONAL DRIVE
RED LAKE FALLS,MN567504662 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
13 15 - ALTRU CLINIC - ERSKINE
23076 347TH ST SE
ERSKINE,MN565354201 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
14 16 - ALTRU CLINIC - FERTILE
MILL STREET MAIN
FERTILE,MN565404215 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
15 17 - ALTRU CLINIC - ROSEAU
711 DELMORE DRIVE
ROSEAU,MN567511534 		OUTPATIENT CLINIC
16 18 - ALTRU CLINIC - WARROAD
412 MAIN AVE NE
WARROAD,MN567632342 		OUTPATIENT CLINIC
17 19 - ALTRU CLINIC - GREENBUSH
19120 200TH ST
GREENBUSH,MN567269280 		OUTPATIENT CLINIC
18 20 - UNITY MEDICAL CENTER
164 WEST 13TH STREET
GRAFTON,ND58237 		HOME HEALTH/HOSPICE
19 21 - FIRST CARE HEALTH CENTER
PO BOX I
PARK RIVER,ND58270 		HOME HEALTH/HOSPICE/THERAPY
20 22 - NELSON COUNTY HEALTH SYSTEM
BOX 367
MCVILLE,ND58254 		HOME HEALTH/HOSPICE
21 23 - CO CAVALIER CLINIC
201 E 3RD AVE S
CAVALIER,ND58220 		HOME HEALTH/HOSPICE
22 24 - ALTRU HOME SVCS-NORTH VALLEY HOME HEALTH
109 S MINNESOTA ST
WARREN,MN56762 		HOME HEALTH/HOSPICE
23 25 - ANETA PARKVIEW HEALTH CENTER
BOX 287
ANETA,ND58212 		OUTREACH CLINIC
24 26 - CAVALIER COUNTY MEMORIAL
909 2ND ST
LANGDON,ND58249 		OUTREACH CLINIC
25 27 - CENTRAL BOILER
20502 160TH ST
GREENBUSH,MN56726 		OUTREACH CLINIC
26 28 - COOPERSTOWN MEDICAL CENTER
1200 ROBERTS ST
COOPERSTOWN,ND58425 		OUTREACH CLINIC
27 29 - DEVILS LAKE GOOD SAMARITAN
302 7TH AVE
DEVILS LAKE,ND58301 		OUTREACH CLINIC
28 30 - FIRST CARE HEALTH CENTER
115 VIVIAN ST
PARK RIVER,ND58270 		OUTREACH CLINIC
29 31 - FRIENDSHIP
554 W 12TH ST
GRAFTON,ND58327 		OUTREACH CLINIC
30 32 - 4TH CORP
120 11TH ST
NEW ROCKFORD,ND58356 		OUTREACH CLINIC
31 33 - GRIGGS COUNTY HOSPITAL
1200 ROBERTS AVE NE
COOPERSTOWN,ND58425 		OUTREACH CLINIC
32 34 - HATTON PRAIRIE VILLAGE
930 DAKOTA AVE
HATTON,ND58240 		OUTREACH CLINIC
33 35 - HEARTLAND CARE CENTER
620 14TH AVE NE
DEVILS LAKE,ND58301 		OUTREACH CLINIC
34 36 - KARLSTAD HEALTH CARE
304 WASHINGTON AVE W
KARLSTAD,MN56732 		OUTREACH CLINIC
35 37 - KITTSON MEMORIAL HEALTH CARE CENTER
1010 S BIRCH
HALLOCK,MN56728 		OUTREACH CLINIC
36 38 - KITTSON MEMORIAL CLINIC OF KARLSTAD
1ST AND ROOSEVELT
KARLSTAD,MN56732 		OUTREACH CLINIC
37 39 - LAKE REGION CORP
224 3TH ST NW
DEVILS LAKE,ND583012908 		OUTREACH CLINIC
38 40 - LAKOTA GOOD SAMARITAN
608 4TH AVE SW HWY 2
LAKOTA,ND583447500 		OUTREACH CLINIC
39 41 - MAPLE MANOR CARE CENTER
1116 9TH AVE
LANGDON,ND58249 		OUTREACH CLINIC
40 42 - MCINTOSH MANOR NURSING HOME
600 RIVERSIDE AVE NE
MCINTOSH,MN56556 		OUTREACH CLINIC
41 43 - NELSON COUNTY CARE CENTER
108 E NYHUS AVE
MCVILLE,ND58254 		OUTREACH CLINIC
42 44 - NELSON COUNTY HEALTH SYSTEM
200 NORTH MAIN
MCVILLE,ND58254 		OUTREACH CLINIC
43 45 - NORTHWOOD DEACONESS
4 N PART ST
NORTHWOOD,ND58267 		OUTREACH CLINIC
44 46 - OAKLAND PARK COMMUNITIES INC
123 BAKEN STREET
THIEF RIVER FALLS,MN56701 		OUTREACH CLINIC
45 47 - PEMBILIER NURSING CENTER
500 DELANO AVE
WALHALLA,ND58282 		OUTREACH CLINIC
46 48 - PEMBINA COUNTY MEMORIAL HOSPITAL
301 MOUNTAIN STREET E
CAVALIER,ND58220 		OUTREACH CLINIC
47 49 - PIONEER MEMORIAL CARE CENTER
23028 347TH ST SE
ERSKINE,MN565359466 		OUTREACH CLINIC
48 50 - REM-GRAFTON
817 HILL AVE
GRAFTON,ND58327 		OUTREACH CLINIC
49 51 - VALLEY 4000
4004 24TH AVE SOUTH
GRAND FORKS,ND58201 		OUTREACH CLINIC
50 52 - VALLEY MEMORIAL HOMES
2900 14TH AVE SOUTH
GRAND FORKS,ND58201 		OUTREACH CLINIC
51 53 - WEDGEWOOD MANOR
804 MAIN STREET WEST
CAVALIER,ND58220 		OUTREACH CLINIC
52 54 - CENTER FOR PREVENTION & GENETICS
4401 S 11TH ST
GRAND FORKS,ND58201 		OUTREACH CLINIC
53 55 - ALTRU CLINIC - EAST GRAND FORKS
607 DEMERS AVE
EAST GRAND FORKS,MN56721 		OUTPATIENT DEPT OF ALTRU HOSP - CLINIC
54 56 - ALTRU PROFESSIONAL CENTER
4440 S WASHINGTON ST
GRAND FORKS,ND58201 		OUTPATIENT CLINIC
Schedule H (Form 990) 2017
Page 10
Schedule H (Form 990) 2017
Page 10
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: PREPARATION OF ANNUAL COMMUNITY BENEFIT REPORT: ALTRU HEALTH SYSTEM PREPARES ANNUALLY A COMMUNITY BENEFIT REPORT BASED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION. ONCE ALL REPORTING FORMS HAVE BEEN COMPILED FOR THE YEAR, THE CATHOLIC HEALTH ORGANIZATION'S REFERENCE GUIDE FROM "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT" IS USED TO DETERMINE WHAT ITEMS SHOULD BE REPORTED INTO WHAT CATEGORY. THE COMMUNITY BENEFIT REPORT IS PUBLISHED AS A PART OF THE CORPORATION'S ANNUAL REPORT, WHICH IS PLACED ON OUR WEB SITE FOR PUBLIC ACCESS.
PART I, LINE 7: COLUMN (F) - PERCENT OF TOTAL EXPENSES: IN DETERMINING THE DENOMINATOR FOR THE PERCENT OF TOTAL EXPENSE CALCULATION, THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WAS REDUCED BY BAD DEBTS EXPENSE OF $9,480,521CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: THE METHODOLOGY USED TO DETERMINE THE REPORTED AMOUNTS FOR THE CHARITY CARE IS A COST-TO-CHARGE RATIO BASED ON GROSS CHARGES WRITTEN OFF PURSUANT TO OUR CHARITY CARE AND MEANS-TESTED PROGRAMS ELIGIBILITY CRITERIA. OTHER COMMUNITY BENEFIT IS DETERMINED FROM INFORMATION THAT WAS COMPILED ON FORMS DESIGNED BY THE CATHOLIC HEALTH ORGANIZATION AND USING THEIR REFERENCE GUIDE, "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT," TO DETERMINE WHICH CATEGORY THE AMOUNTS ARE PROPERLY REPORTED UNDER.
PART II, COMMUNITY BUILDING ACTIVITIES: NONE DOCUMENTED ON FORM 990.
PART III, LINE 4: FOOTNOTE DISCLOSURE REGARDING BAD DEBTS EXPENSE: NOTES 1 AND 13 TO THE AUDITED FINANCIAL STATEMENTS REPORT ON BAD DEBT EXPENSE. NOTE 1 - ACCOUNTS RECEIVABLE: "PATIENT RECEIVABLES ARE UNCOLLATERALIZED PATIENT AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS ON PATIENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED IN THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM.PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, ALTRU HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, ALTRU RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.ALTRU'S PROCESS FOR CALCULATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS HAS NOT SIGNIFICANTLY CHANGED FROM DECEMBER 31, 2016 TO DECEMBER 31, 2017. ALTRU DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE OFFS FROM THIRD-PARTY PAYORS. ALTRU HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2016 OR 2017.NOTE 13 - "...NEITHER THE CHARITY CARE NOR THE UNCOMPENSATED CARE AMOUNTS INCLUDE BAD DEBTS AS SHOWN IN THE STATEMENT OF OPERATIONS."
PART III, LINE 8: NONE OF THE SHORTFALL SHOWN ON PART III, LINE 7 OF $263,386,996 HAS BEEN TREATED AS COMMUNITY BENEFIT AS REPORTED ON SCHEDULE H. THE SOURCE OF THE AMOUNT SHOWN ON PART III, LINE 6 COMES FROM THE MEDICARE ALLOWABLE COSTS REPORTED IN ALTRU'S MEDICARE COST REPORT SUBMITTED FOR THE FISCAL YEAR ENDING DECEMBER 31, 2017, UTILIZING THE FOLLOWING WORKSHEETS: WORKSHEETS B PART I, H-7 PARTS 1&2, I-4, AND K-6.
PART III, LINE 9B: PROVISION FOR COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE FOUND IN ALTRU'S POLICIES 2611 "DEDUCTIONS FROM REVENUES AND 2614 "CHARITY CARE." ALTRU'S COMMUNITY CARE PROGRAM IS DESIGNED TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO HAVE NO INSURANCE AND/OR LIMITED MEANS TO PAY FOR THEIR MEDICAL SERVICES AND DO NOT QUALIFY FOR OTHER PROGRAMS. IN ADDITION TO QUALITY HEALTHCARE, PATIENTS OF ALTRU HEALTH SYSTEM ARE PROVIDED FINANCIAL COUNSELING REGARDING THEIR MEDICAL BILLS, BY SOMEONE WHO CAN UNDERSTAND AND OFFER POSSIBLE SOLUTIONS FOR THOSE WHO CANNOT PAY IN FULL. PROGRAMS ARE ALSO AVAILABLE FOR UNINSURED PATIENTS, AND FOR THOSE FOUND TO BE IN MEDICAL HARDSHIP.
PART VI, LINE 2: NEEDS ASSESSMENT: ALTRU HEALTH SYSTEM'S MISSION - IMPROVING HEALTH, ENRICHING LIFE - CONFIRMS THAT OUR RESPONSIBILITY TO THE REGION GOES BEYOND PROVIDING QUALITY HEALTHCARE SERVICES. ALL OF OUR RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. AT ALTRU, GOOD HEALTH MEANS THAT EVERY INDIVIDUAL SHOULD ENJOY THE BEST ACHIEVABLE AND SO SHOULD OUR COMMUNITIES. ALTRU'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS APPROVED BY THE BOARD OF DIRECTORS ON SEPTEMBER 26, 2016. AS A RESULT OF THE ASSESSMENT, ALTRU PRIORITIZED AND IS FOCUSING ON THE FOLLOWING FIVE ISSUES: 1) ACCESS TO BEHAVIORAL HEALTH SERVICES, INCLUDING ADDICTION TREATMENT AND COUNSELING; 2) PRESCRIPTION AND ILLEGAL DRUG ABUSE; 3) RATE OF OBESITY; 4) BINGE DRINKING/EXCESSIVE DRINKING; AND 5) CARE COORDINATION AND ACCESS TO HEALTH CARE.
PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:ALTRU HAS SEVERAL AVENUES IN WHICH INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS COMMUNICATED TO PATIENTS. UNINSURED AND SELF-PAY PATIENTS IN THE HOSPITAL RECEIVE A VISIT FROM PATIENT REPRESENTATIVES AFTER INTAKE. DURING THIS MEETING, THEY ARE INFORMED OF VARIOUS FEDERAL, STATE AND COMMUNITY-BASED PROGRAMS THAT MAY PROVIDE ASSISTANCE. UNINSURED OR SELF-PAY PATIENTS FROM OUTPATIENTS RECEIVE CONTACT FROM PATIENT REPRESENTATIVES BY PHONE OR EMAIL INFORMING THEM OF POTENTIAL SOURCES OF FINANCIAL ASSISTANCE. BOTH SETS OF PATIENTS ARE ALSO PROVIDED INFORMATION ON HOW TO MOVE FORWARD IN APPLYING FOR THE PROGRAMS. IF PATIENTS ARE FOUND TO BE STRUGGLING WITH MEDICAL EXPENSES, OUR CREDIT AND COLLECTIONS REPRESENTATIVES UTILIZE LETTERS AND PHONE CALLS TO INFORM THEM OF VARIOUS RESOURCES THAT MAY PROVIDE ASSISTANCE.FINANCIAL ASSISTANCE INFORMATION IS ALSO AVAILABLE TO THE PUBLIC AS A WHOLE. ALTRU'S WEBSITE, ALTRU.ORG, INCLUDES FINANCIAL ASSISTANCE CONTACT INFORMATION AND ELIGIBILITY GUIDELINES. PATIENTS MAY REVIEW THIS ON THEIR OWN AND CONTACT AGENCIES THAT MAY PROVIDE ASSISTANCE BASED ON THEIR CIRCUMSTANCES. ALSO, ALTRU DISTRIBUTES BROCHURES FEATURING OUR COMMUNITY CARE PROGRAM AND OTHER FEDERAL AND STATE PROGRAMS. THESE BROCHURES ARE AVAILABLE TO BOTH PATIENTS AND VISITORS IN WAITING ROOMS OF OUR INPATIENT AND OUTPATIENT FACILITIES AS WELL AS IN ALL BUSINESS OFFICE LOCATIONS.
PART VI, LINE 4: COMMUNITY INFORMATION:ALTRU HEALTH SYSTEM SERVES A 17-COUNTY AREA THAT IS DIVIDED INTO THREE DISTINCT SERVICE AREAS (PRIMARY, SECONDARY, AND REFERRAL) AND HAS A POPULATION OF APPROXIMATELY 224,000 PERSONS (2017 ESTIMATE) WHO RESIDE IN A DIVERSE AREA OF AGRICULTURE AND INDUSTRY. THE SERVICE AREA STRETCHES 265 MILES EAST AND WEST AND 120 MILES NORTH AND SOUTH. GRAND FORKS SITS IN THE MIDDLE OF THE RED RIVER VALLEY, ONE OF THE WORLD'S RICHEST AGRICULTURAL AREAS. PRINCIPAL CROPS INCLUDE SUGAR BEETS, POTATOES, EDIBLE BEANS, AND SMALL GRAINS SUCH AS WHEAT AND BARLEY. MUCH OF THE INDUSTRY IN THE AREA IS RELATED TO AGRICULTURE AND FOOD PROCESSING.THE PRIMARY SERVICE AREA, COMPRISED OF GRAND FORKS COUNTY (NORTH DAKOTA) AND POLK COUNTY (MINNESOTA), IS HOME TO 103,172 PEOPLE (2017 ESTIMATE). LOCATED IN THIS MARKET ARE ALTRU HOSPITAL, ALTRU REHABILITATION CENTER, ALTRU CANCER CENTER, AND 13 OTHER LOCATIONS THAT ARE HOME TO OUR PROVIDERS' CLINIC PRACTICES AND OTHER SERVICES OFFERED BY ALTRU. ALTRU HOSPITAL SERVES AS THE MAJOR REFERRAL CENTER FOR THE PEOPLE OF THE REGION. AS SUCH, IT PROVIDES A BROAD SPECTRUM OF PROGRAMS AND SERVICES. A FULL RANGE OF SERVICES ARE AVAILABLE FOR PATIENTS SUFFERING FROM CANCER, HEART DISEASE, END-STAGE RENAL DISEASE, NEUROLOGICAL DISORDERS, ALCOHOL OR CHEMICAL DEPENDENCY, HIGH RISK OBSTETRICAL COMPLICATIONS, AND PSYCHIATRIC DISORDERS. ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN 2017 FOR OUR PRIMARY MARKET WAS 76 PERCENT BASED ON CLAIMS DATA FROM THE MINNESOTA HOSPITAL ASSOCIATION (MHA). ABOUT 80 PERCENT OF THE PHYSICIANS IN THE PRIMARY AREA ARE EMPLOYED BY ALTRU HEALTH SYSTEM. ALSO LOCATED IN GRAND FORKS COUNTY IS NORTHWOOD COMMUNITY HEALTH CENTER (IN NORTHWOOD, ND). A COUPLE NOTABLE POPULATIONS ALTRU SERVES THAT ARE LOCATED IN OUR PRIMARY SERVICE AREA INCLUDE THE UNIVERSITY OF NORTH DAKOTA AND GRAND FORKS AIR FORCE BASE. THE UNIVERSITY OF NORTH DAKOTA IS THE STATE'S OLDEST INSTITUTION OF HIGHER LEARNING WITH AN ENROLLMENT OF ABOUT 15,000 STUDENTS (FALL 2017). THE NUMBER OF RESIDENTS AT GRAND FORKS AIR FORCE BASE WAS COUNTED AT 2,367 IN THE 2010 CENSUS.WITH A POPULATION OF 35,058 (2017 ESTIMATE), THE SECONDARY SERVICE AREA IS COMPRISED OF FIVE COUNTIES TO THE WEST, NORTH, AND EAST OF GRAND FORKS COUNTY: NELSON, WALSH, AND PEMBINA COUNTIES IN NORTH DAKOTA, AND MARSHALL AND KITTSON COUNTIES IN MINNESOTA; THIS AREA IS LARGELY RURAL AND AGRICULTURAL. WITHIN THIS AREA, ALTRU HAS FIVE REGIONAL CLINIC LOCATIONS; IT IS ALSO HOME TO SEVERAL SMALL HOSPITALS AS LISTED BELOW.SECONDARY SERVICE AREA HOSPITALS: LOCATIONUNITY MEDICAL CENTER: GRAFTON, NDFIRST CARE HEALTH CENTER: PARK RIVER, NDPEMBINA COUNTY MEMORIAL HOSPITAL: CAVALIER, NDNELSON COUNTY HEALTH SYSTEM: MCVILLE, NDKITTSON MEMORIAL HOSPITAL: HALLOCK, MNNORTH VALLEY HEALTH CENTER: WARREN, MNIN 2017, ALTRU'S HOSPITAL INPATIENT MARKET SHARE IN THIS SERVICE AREA WAS AROUND 64 PERCENT ACCORDING TO CLAIMS PROVIDED BY MHA. THE SYSTEM EMPLOYS MANY OF THE PHYSICIANS IN THE SECONDARY SERVICE AREA. ALL OF THESE PHYSICIANS ARE ON MEDICAL STAFFS OF COMMUNITY HOSPITALS THROUGHOUT THE REGION, AND REFER PATIENTS TO GRAND FORKS AND ELSEWHERE FOR SPECIALTY CARE.THE SYSTEM'S REFERRAL AREA IS COMPRISED OF TEN COUNTIES ENCIRCLING THE PRIMARY AND SECONDARY SERVICE AREAS (ROLETTE, TOWNER, BENSON, RAMSEY, CAVALIER, AND TRAILL COUNTIES IN NORTH DAKOTA AND ROSEAU, LAKE OF THE WOODS, PENNINGTON, AND RED LAKE COUNTIES IN MINNESOTA.) THIS REGION IS ALSO MOSTLY RURAL AND AGRICULTURAL AND INCLUDES SEVERAL SMALLER HOSPITALS AS LISTED SERVING THE PRIMARY CARE NEEDS OF THEIR COMMUNITIES. ALTRU HAS SIX REGIONAL CLINICS IN THIS SERVICE AREA AND ALTRU HOSPITAL'S INPATIENT MARKET SHARE IN THIS REGION IS ABOUT 31 PERCENT ACCORDING TO 2017 CLAIMS DATA PROVIDED BY MHA. ALTRU, ONCE AGAIN, EMPLOYS MANY OF THE PHYSICIANS IN THIS AREA, AND THESE PHYSICIANS HAVE PRACTICE PATTERNS SIMILAR TO THOSE OF THE PHYSICIANS IN OUR SECONDARY SERVICE AREA.REFERRAL SERVICE AREA HOSPITALS: LOCATIONCAVALIER COUNTY MEMORIAL HOSPITAL: LANGDON, NDHILLSBORO MEDICAL CENTER: HILLSBORO, NDLAKEWOOD HEALTH CENTER: BAUDETTE, MNMERCY HOSPITAL: DEVILS LAKE, NDSANFORD-THIEF RIVER FALLS MEDICAL CENTER: THIEF RIVER FALLS, MNPRESENTATION MEDICAL CENTER: ROLLA, NDTOWNER COUNTY MEDICAL CENTER: CANDO, NDSANFORD MAYVILLE MEDICAL CENTER: MAYVILLE, NDLIFECARE MEDICAL CENTER: ROSEAU, MNQUENTIN N. BURDICK MEMORIAL HOSPITAL: BELCOURT, NDAS PREVIOUSLY MENTIONED, ALTRU'S 17-COUNTY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 224,000 (2017 ESTIMATE). USING DATA FROM SG2(A VENDOR SPECIALIZING IN HEALTH CARE PLANNING INFORMATION), THE INSURANCE COVERAGE FOR COMMUNITIES IN OUR SERVICE AREA IS ESTIMATED TO BE AS FOLLOWS: 2017 PROJECTIONS AS A PERCENTMEDICAID 16,324 16%MEDICARE 16,099 16%MEDICARE-ADVANTAGE 6,785 7%COMMERCIAL 56,776 55%SELF-PAY (UNINSURED) 5,057 5%VETERANS 2,532 2%A PERCENTAGE BREAKDOWN OF INPATIENT UTILIZATION FOR ALTRU HOSPITAL BASED ON DISCHARGES BY TYPE OF PAYER PER 2017 PROJECTION SHOWS APPROXIMATELY 16 PERCENT OF DISCHARGES WERE FOR MEDICAID AND 5 PERCENT WERE SELF PAY (UNINSURED). ALSO FROM SG2, OUR TOTAL SERVICE AREA'S INCOME BY HOUSEHOLD IS AS FOLLOWS:INCOME RANGE 2017 HOUSEHOLDS$ < $ 9,999 9,985 $ 10,000 - $ 14,999 7,588$ 15,000 - $ 19,999 7,187$ 20,000 - $ 24,999 6,816$ 25,000 - $ 29,999 6,277$ 30,000 - $ 39,999 6,438$ 35,000 - $ 39,999 6,326$ 40,000 - $ 44,999 6,143$ 45,000 - $ 49,999 5,836$ 50,000 - $ 59,999 10,240$ 60,000 - $ 74,999 13,573$ 75,000 - $ 99,999 16,495$100,000 - $124,999 10,478$125,000 - $149,999 5,665$150,000 - $199,999 4,074$ > $200,000 4,084ACCORDING TO THE WEBSITE FOR HEALTH RESOURCES AND SERVICES ADMINISTRATION, THE FOLLOWING AREAS IN OUR SERVICE AREA ARE MUA'S:NORTH DAKOTA:BENSON COUNTY: BENSON SERVICE AREACAVALIER COUNTY: CAVALIER SERVICE AREAGRAND FORKS COUNTY: NORTHWOOD SERVICE AREA, GRAND FORKS SERVICE AREANELSON COUNTY: NELSON SERVICE AREAPEMBINA COUNTY: WALHALLA SERVICE AREAROLETTE COUNTY: ROLETTE SERVICE AREATOWNER COUNTY: CANDO CITY SERVICE AREATRAILL COUNTY: TRAILL SERVICE AREAWALSH COUNTY: PARK RIVER CITY SERVICE AREAMINNESOTA:KITTSON COUNTY: KITTSON SERVICE AREAMARSHALL COUNTY: MARSHALL SERVICE AREAPOLK COUNTY: POLK SERVICE AREARED LAKE COUNTY: RED LAKE SERVICE AREAROSEAU COUNTY: ROSEAU SERVICE AREA
PART VI, LINE 5: ALL OF ALTRU'S RESOURCES ARE DEVOTED TO IMPROVING HEALTH IN THE COMMUNITIES WE SERVE. TO DO SO, WE KNOW THAT NOT ALL MEDICAL SERVICES WILL COME FROM STAFF EMPLOYED BY ALTRU HEALTH SYSTEM. ALTRU EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR NEARLY ALL DEPARTMENTS. ALSO, OUR BOARD OF DIRECTORS IS MADE UP OF INDIVIDUALS FROM OUTSIDE ALTRU HEALTH SYSTEM. THESE PEOPLE ARE VOLUNTEERS WHO HAVE THE SAME DEDICATION AND FOCUS ON ALTRU'S MISSION AS OUR OWN STAFF.
PART VI, LINE 6: ALTRU HEALTH SYSTEM IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. IN SEPTEMBER 2011, ALTRU HEALTH SYSTEM BECAME THE FIRST MEMBER OF THE MAYO CLINIC CARE NETWORK. THIS IS A NON-OWNERSHIP RELATIONSHIP THAT BENFITS THE ORGANIZATION'S PHYSICIANS AND PATIENTS FROM ENHANCED ACCESS TO MAYO PHYSICIANS AND CLINICAL RESOURCES. MORE SPECIFICALLY, PHYSICIANS HAVE ACCESS TO MAYO CLINIC'S EVIDENCE-BASED DISEASE MANAGEMENT PROTOCOLS, CLINIC CARE GUIDELINES, AND TREATMENT RECOMMENDATIONS AND REFERENCE MATERIALS FOR COMPLEX MEDICAL CONDITIONS.PART VI, LINE 7: ALTRU HEALTH SYSTEM IS NOT REQUIRED TO FILE OUR COMMUNITY BENEFIT REPORT WITH ANY OUTSIDE ORGANIZATIONS BUT HAS MADE OUR REPORT AVAILABLE TO ANYONE ON OUR WEB SITE.
Schedule H (Form 990) 2017
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