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 Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
AMERY REGIONAL MEDICAL CENTER INC
 
Employer identification number

39-0908320
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
 
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
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
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) . . .
    279,576 0 279,576 0.410 %
b Medicaid (from Worksheet 3, column a) . . . . .     9,840,271 7,620,302 2,219,969 3.290 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     10,119,847 7,620,302 2,499,545 3.700 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 13 678 112,337 0 112,337 0.170 %
f Health professions education (from Worksheet 5) . . . 7 17 278,964 0 278,964 0.410 %
g Subsidized health services (from Worksheet 6) . . . . 2   2,630,389 0 2,630,389 3.900 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 6   135,581 4,970 130,611 0.190 %
j Total. Other Benefits . . 28 695 3,157,271 4,970 3,152,301 4.670 %
k Total. Add lines 7d and 7j . 28 695 13,277,118 7,625,272 5,651,846 8.370 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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 1     2,742 0 0 %
3 Community support            
4 Environmental improvements 1     3,805 0 0 %
5 Leadership development and
training for community members
           
6 Coalition building 4     7,416 0 0 %
7 Community health improvement advocacy            
8 Workforce development 1     944 0 0 %
9 Other            
10 Total 7     14,907 0 0 %
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 Healthcare 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
829,228
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
 
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
23,131,249
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
23,131,249
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
 
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) 2021
Schedule H (Form 990) 2021
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?1Name, 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 and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 AMERY REGIONAL MEDICAL CENTER
265 GRIFFIN STREET EAST
AMERY,WI54001
WWW.AMERYMEDICALCENTER.ORG
CAH CERT LICENSE 1010
X X     X   X      
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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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)
AMERY REGIONAL MEDICAL CENTER INC
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 21
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   No
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 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/AMERY/ABOUT/COMMUNITY
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) 2021
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Schedule H (Form 990) 2021
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
AMERY REGIONAL MEDICAL CENTER INC
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
SEE NOTES
b
SEE NOTES
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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Part VFacility Information (continued)

Billing and Collections
AMERY REGIONAL MEDICAL CENTER INC
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   No
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) 2021
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Schedule H (Form 990) 2021
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
AMERY REGIONAL MEDICAL CENTER INC
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   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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, 20a, 20b, 20c, 20d, 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
AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: TO COMPREHENSIVELY UNDERSTAND AND DESCRIBE THE NEEDS OF THE COMMUNITIES HEALTHPARTNERS SERVES, WE SYSTEMATICALLY IDENTIFIED A LIST OF PUBLICLY AVAILABLE DATA SOURCES AND A LIST OF INTERNALLY AVAILABLE HEALTHPARTNERS DATA SOURCES. WITH THE CHNA WORKGROUP THAT HAD EXPERTISE FROM PUBLIC HEALTH, HEALTHCARE AND EPIDEMIOLOGY, WE CAREFULLY REVIEWED THE LIST TO IDENTIFY OPPORTUNITIES WITH A SPECIFIC LENS TOWARDS INCLUDING MEMBERS WITH UNIQUE INSIGHT INTO NEEDS OF OUR UNDERSERVED COMMUNITIES WHERE HEALTH AND OTHER DISPARITIES EXIST. TO FURTHER ROUND OUT UNDERSTANDING, WE SOUGHT ADDITIONAL DATA SOURCES TOGETHER WITH OUR COMMUNITY PARTNERS. WHERE OPPORTUNITIES STILL REMAIN FOR BETTER UNDERSTANDING DUE TO LACK OF CURRENTLY AVAILABLE DATA, WE HAVE NOTED IN THE REPORT. FOR EXAMPLE, WE IDENTIFIED SPECIFIC GAPS IN DATA AVAILABLE TO UNDERSTAND THE COVID-19 PANDEMIC CONTEXT AND THE INFLUENCE OF STRUCTURAL RACISM ON THE NEEDS AREAS. THUS, WE SPECIFICALLY DESIGNED OUR QUALITATIVE COMMUNITY CONVERSATIONS AND OUR QUANTITATIVE HEALTHPARTNERS PROVIDER SURVEYS TO FILL THESE GAPS. HEALTHPARTNERS PROVIDER SURVEYS: SELECT HEALTHPARTNERS STAFF WHO PROVIDE DIRECT CARE FOR OUR PATIENTS WERE INVITED BY HOSPITAL LEADERS AND THE CHNA EXPERT PANEL MEMBERS TO COMPLETE A BRIEF WEB SURVEY ABOUT THE NEEDS OF THE PATIENTS THEY SERVE. THE SURVEY WAS DEVELOPED BY AN EXPERT SURVEY METHODOLOGIST WITH INPUT FROM THE CHNA WORKGROUP. OVERALL, 444 PROVIDERS INCLUDING DOCTORS, CARE COORDINATORS, PHARMACISTS, PHYSICAL OR OCCUPATIONAL THERAPISTS, DIETITIANS, NURSES, AND SOCIAL WORKERS COMPLETED SURVEYS ACROSS ALL HEALTHPARTNERS HOSPITALS. DESCRIPTIVE STATISTICS AND A THEMATIC ANALYSIS WERE COMPLETED AND INCLUDED IN THE NEEDS AREA SUMMARIES BELOW.COMMUNITY CONVERSATIONS: A TOTAL OF 41 COMMUNITY CONVERSATIONS WERE HELD OR ATTENDED BY HEALTHPARTNERS WORKGROUP MEMBERS. RESULTS WERE SUMMARIZED AND KEY THEMES AND QUOTES WERE ADDED TO THE NEEDS AREA SUMMARIES THROUGHOUT. ADDITIONAL DETAILS ABOUT THE COMMUNITY CONVERSATIONS CAN BE FOUND IN THE APPENDIX OF THE AMERY'S 2021CHNA AT HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/AMERY/ABOUT/COMMUNITY
AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: HEALTHPARTNERS COLLABORATED ACROSS EIGHT HOSPITALS WITHIN ITS FAMILY OF CARE FOR THE 2021 CHNA: AMERY HOSPITAL & CLINIC (AMERY, WI) HUDSON HOSPITAL & CLINIC (HUDSON, WI) HUTCHINSON HEALTH (HUTCHINSON, MN) LAKEVIEW HOSPITAL (STILLWATER, MN) OLIVIA HOSPITAL AND CLINIC (OLIVIA, MN) PARK NICOLLET HEALTH SERVICES INCLUDING PARK NICOLLET METHODIST HOSPITAL (ST. LOUIS PARK, MN) REGIONS HOSPITAL (ST. PAUL, MN) WESTFIELDS HOSPITAL & CLINIC (NEW RICHMOND, WI)
AMERY REGIONAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: IN 2021, SEVERAL TACTICS WERE IMPLEMENTED TO HELP ADDRESS THE NEEDS IDENTIFIED IN OUR CHNA AND DESCRIBED IN OUR IMPLEMENTATION PLAN. HIGHLIGHTS OF THE 2021 ACTIVITIES AND RESULTS ARE INCLUDED BELOW.ACCESS TO CARE GOAL: IMPROVE ACCESS TO CARE THAT IS APPROPRIATE, AFFORDABLE, AND CONVENIENT. -CONTINUED TO INCREASE WEBSITE ACCESS TO PATIENT AND COMMUNITY ACCESS TO HEALTH INFORMATION AND APPOINTMENT SCHEDULING. -IMPROVED GEOGRAPHIC ACCESS OF CARE FOR PATIENTS THROUGH COORDINATION OF APPOINTMENT SCHEDULING BETWEEN FIVE SITES IN THE ST. CROIX VALLEY AREA. -SIGNIFICANTLY INCREASED TELEMEDICINE FOR PRIMARY, SPECIALTY AND BEHAVIORAL HEALTH SERVICES IN A VERY SHORT TIME FRAME TO INCREASE ACCESS DURING PANDEMIC RESTRICTIONS. ACCESS TO HEALTH GOAL: STRENGTHEN EXISTING AND EXPLORE NEW COMMUNITY PARTNERSHIPS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH, PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT, AND PROMOTE SUSTAINABLE OPERATIONS TO POSITIVELY IMPACT THE COMMUNITY.- DUE TO COVID-19 PANDEMIC, NEW PARTNERSHIPS WERE ESTABLISHED, AND EXISTING PARTNERSHIPS WERE STRENGTHENED TO MEET SHIFTING AND EMERGING COMMUNITY NEEDS. - UPDATED COMMUNITY RESOURCE LIST TO INCLUDE NEW RESOURCES AND SUPPORT DURING COVID PANDEMIC; AVAILABLE TO PATIENTS, STAFF AND COMMUNITY MEMBERS. - CONTINUED TO SERVE ON CORE LEADERSHIP TEAM FOR SUPERSHELF FOOD SHELF TRANSFORMATIONS AND MAKE ADAPTATIONS IN DELIVERY METHODS FOR COVID-19. - DISTRIBUTED BOOKS TO CHILDREN IN CLINICS THROUGH REACH OUT AND READ. LITTLE MOMENTS COUNT OFFERED VIRTUAL TRAINING AND RESOURCES TO CONTINUE MOMENTUM OF COLLABORATION TO PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT. - INCREASED RECYCLING AND PURCHASES OF SUSTAINABLY PRODUCED AND LOCAL FOODS AND BEVERAGES. - REDUCED WASTE TO LANDFILLS, MEAT PURCHASES, SINGLE USE PLASTIC BOTTLES, ELECTRICITY, NATURAL GAS AND WATER USE AND TOTAL GREENHOUSE EMISSIONS. INCREASED USE OF ENVIRONMENTALLY PREFERRED AND RECYCLED PAPER AND OFFICE SUPPLIES. MENTAL HEALTH AND WELL-BEING GOAL: REDUCE THE STIGMA SURROUNDING MENTAL ILLNESS, INCREASE ACCESS TO EDUCATION AND RESOURCES AROUND MENTAL HEALTH AND WELL-BEING AND IMPROVE ACCESS TO MENTAL HEALTH SERVICES.IN 2021, THE REACH OF THE MAKE IT OK CAMPAIGN EXPANDED THROUGH TRAINING LOCAL AMBASSADORS, PROMOTION, AND PARTNERSHIPS WITH LOCAL AGENCIES AND PUBLIC HEALTH. DESPITE THE CHALLENGE OF COVID-19, MAKE IT OK MADE PROGRESS IN REDUCING THE STIGMA OF MENTAL ILLNESS WITH THE FOLLOWING IMPACT: - RECEIVED 81,349 WEBSITE VISITS WITH 62,780 UNIQUE VISITORS IN 2021. THE MAKE IT OK TOOLS AND RESOURCES WERE DOWNLOADED MORE THAN 500 TIMES BY PEOPLE IN 250 US CITIES AND 25 MINNESOTA COUNTIES. - HELD 11 AMBASSADOR TRAININGS BOTH IN PERSON AND VIRTUALLY, MOBILIZING AN ADDITIONAL 200 AMBASSADORS. - REACHED MORE THAN 2,000 PEOPLE THROUGH COMMUNITY PRESENTATIONS, EVENTS AND TABLING. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS. -MORE THAN 500 AMBASSADORS ARE NOW TRAINED IN THE ST. CROIX VALLEY AREA. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS. -OFFERED BEATING THE BLUES AND RESILIENCY RESOURCES AT NO CHARGE TO MEMBERS, PATIENTS AND EMPLOYEES. MENTAL HEALTH RESOURCES PROMOTED AS KEY PART OF EMPLOYEE WELL-BEING PROGRAM. HOSPITAL CONVENES AND PARTICIPATES IN MULTIPLE COLLABORATIVES FOCUSING ON MENTAL HEALTH. - INCREASED VALLEY-WIDE USE OF BEHAVIORAL HEALTH TELEHEALTH (BHTV) PROGRAM FOR PATIENTS ACCESSING EMERGENCY DEPARTMENT CARE DURING A MENTAL HEALTH CRISIS.NUTRITION AND PHYSICAL ACTIVITY GOALS: PROMOTE AND SUPPORT PHYSICAL ACTIVITY AND NUTRITION AND SUPPORT AND ENCOURAGE HEALTHY FOOD AND PHYSICAL ACTIVITY ENVIRONMENT CHANGE. POWERUP: SINCE 2015, THE HOSPITAL HAS SUPPORTED POWERUP, A COMMUNITYWIDE HEALTH INITIATIVE THAT INSPIRES AND ENGAGES THE ENTIRE COMMUNITY TO PROMOTE BETTER EATING AND PHYSICAL ACTIVITIES SO YOUTH CAN REACH THEIR FULL POTENTIAL. OUR WORK WITH HUNDREDS OF PARTNERS ACROSS THE REGION HAS RESULTED IN A HIGH LEVEL OF COMMUNITY AND SCHOOL ENGAGEMENT, STRONGER SCHOOL WELLNESS POLICIES AND PRACTICES; MORE FREE AND LOW-COST OPTIONS FOR PHYSICAL ACTIVITY INCLUDING OPEN GYMS; PARTNERSHIPS WITH STATE AND LOCAL PARKS; TRANSFORMED FOOD PANTRIES, CAFETERIAS AND CONCESSIONS; AND COMMUNITY MOMENTUM TO CREATE CHANGE. SUBSTANCE USE GOAL: REDUCED OPIOID PRESCRIPTIONS, DOSES, AND PATIENTS MEETING CHRONIC OPIOID USE CRITERIA. THROUGH COLLABORATIVE EFFORTS WITH PHARMACY, PRESCRIBERS AND PAIN CLINICS, ACHIEVED SIGNIFICANT REDUCTION IN OPIOID PRESCRIBING IN OUR CARE SYSTEM AND COMMUNITY. VALLEY-WIDE, SINCE 2016, THERE HAS BEEN A 68% AND 52% REDUCTION IN OPIOIDS PRESCRIBED AT DISCHARGE IN HOSPITALS AND EMERGENCY DEPARTMENTS, RESPECTIVELY.
PART V, SECTION B, LINE 3E AMERY ADDRESSES THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY THROUGH OUR CHNA.
SCHEDULE H, PART V, LINE 20A AMERY DOES NOT PERFORM ANY ECAS (EXTRAORDINARY COLLECTION ACTIONS), THEREFORE WE WOULD NOT GIVE A PATIENT A WRITTEN NOTICE OF DOING SO.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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?6
Name and address Type of Facility (describe)
1 1 - ARMC REHAB SERVICES
220 N KELLER AVENUE
AMERY,WI54001
REHABILITATION
2 2 - LUCK MEDICAL CLINIC
137 FIRST AVENUE
LUCK,WI54853
RURAL HEALTH CLINIC
3 3 - TURTLE LAKE MEDICAL CLINIC
550 MARTIN AVENUE
TURTLE LAKE,WI54889
RURAL HEALTH CLINIC
4 4 - CLEAR LAKE CLINIC
357 THIRD AVENUE
CLEAR LAKE,WI54005
RURAL HEALTH CLINIC
5 5 - LUCK PT & FITNESS
2547 STATE ROAD 35 SUITE 5
LUCK,WI54853
PHYSICAL THERAPY
6 6 - AMERY REGIONAL MEDICAL CENTER WEST
230 DERONDA STREET
AMERY,WI54001
10 BED INPATIENT DPU OF AMERY
7
8
9
10
Schedule H (Form 990) 2021
Page 10
Schedule H (Form 990) 2021
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 7: AMERY REGIONAL MEDICAL CENTER (AMERY) USES THE COST-TO-CHARGE RATIO METHOD WHEN CALCULATING THE AMOUNTS REPORTED ON PART I. LINE 7. THE COST-TO-CHARGE RATIO WAS DERIVED USING WORKSHEET 2, RATIO OF PATIENT CARE-COST-TO-CHARGE, FROM THE SCHEDULE H INSTRUCTIONS
PART III, LINE 2: AMERY USES THE COST TO CHARGE METHODOLOGY TO DETERMINE AMOUNT REPORTED AS BAD DEBT. AMERY BELIEVES THAT MANY OF THE ACCOUNTS IN BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY IF THE GUARANTORS WOULD HAVE COMPLETED THE FINANCIAL ASSISTANCE PAPERWORK. AMERY IS PROVIDING SERVICES TO INDIVIDUALS/FAMILIES IN ITS SERVICE AREA THAT ARE UNABLE/UNWILLING TO PAY FOR THESE SERVICES. THIS IS COMPARABLE TO PROVIDING CHARITY CARE WHICH AMERY ALSO INCLUDES AS A COMMUNITY BENEFIT.
PART III, LINE 4: SEE THE ORGANIZATION'S FOOTNOTES 1.O AND 1.Q, ON PAGE 25 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENT.
PART III, LINE 8: AMERYS MEDICARE COST IS DERIVED BASED ON THE RATIO OF MEDICARE FFS CHARGES TO TOTAL CHARGES MULTIPLIED BY TOTAL EXPENSES (LESS CHARITY CARE & BAD DEBT). NONE OF THE MEDICARE FFS LOSS REPORTED ON SCHEDULE H, PART III, LINE 7 IS TREATED AS COMMUNITY BENEFIT ON SCHEDULE H, PART I, LINE 7A.
PART III, LINE 9B: COLLECTIONS PRACTICESAMERY'S DEBT COLLECTION POLICY CONTAINS PROVISIONS ON COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE. AMERY WILL NOT REFER ANY ACCOUNT TO A THIRD PARTY DEBT COLLECTION AGENCY UNLESS IT HAS CONFIRMED THAT:- THERE IS REASONABLE BASIS TO BELIEVE THAT THE PATIENT OWES THE DEBT.- ALL KNOWN THIRD-PARTY PAYERS HAVE BEEN PROPERLY BILLED, AND THE PATIENT IS RESPONSIBLE FOR THE REMAINING DEBT.- IF THE PATIENT HAS INDICATED AN INABILITY TO PAY THE FULL AMOUNT, THE PATIENT HAS BEEN OFFERED A REASONABLE PAYMENT PLAN. AMERY WILL NOT REFER PATIENTS TO DEBT COLLECTION AGENCIES WHO ARE PERFORMING AS SPECIFIED IN THEIR PAYMENT PLANS.- THE PATIENT HAS BEEN GIVEN AN OPPORTUNITY TO SUBMIT A CHARITY CARE (FINANCIAL ASSISTANCE) APPLICATION. IF THE PATIENT HAS SUBMITTED AN APPLICATION FOR CHARITY CARE, ALL COLLECTION ACTIVITY WILL BE SUSPENDED UNTIL THE APPLICATION HAS BEEN PROCESSED.
PART VI, LINE 2: TO COMPREHENSIVELY UNDERSTAND AND DESCRIBE THE NEEDS OF THE COMMUNITIES HEALTHPARTNERS SERVES, WE SYSTEMATICALLY IDENTIFIED A LIST OF PUBLICLY AVAILABLE DATA SOURCES AND A LIST OF INTERNALLY AVAILABLE HEALTHPARTNERS DATA SOURCES. WITH THE CHNA WORKGROUP THAT HAD EXPERTISE FROM PUBLIC HEALTH, HEALTHCARE AND EPIDEMIOLOGY, WE CAREFULLY REVIEWED THE LIST TO IDENTIFY OPPORTUNITIES WITH A SPECIFIC LENS TOWARDS INCLUDING MEMBERS WITH UNIQUE INSIGHT INTO NEEDS OF OUR UNDERSERVED COMMUNITIES WHERE HEALTH AND OTHER DISPARITIES EXIST. TO FURTHER ROUND OUT UNDERSTANDING, WE SOUGHT ADDITIONAL DATA SOURCES TOGETHER WITH OUR COMMUNITY PARTNERS. WHERE OPPORTUNITIES STILL REMAIN FOR BETTER UNDERSTANDING DUE TO LACK OF CURRENTLY AVAILABLE DATA, WE HAVE NOTED IN THE REPORT. FOR EXAMPLE, WE IDENTIFIED SPECIFIC GAPS IN DATA AVAILABLE TO UNDERSTAND THE COVID-19 PANDEMIC CONTEXT AND THE INFLUENCE OF STRUCTURAL RACISM ON THE NEEDS AREAS. THUS, WE SPECIFICALLY DESIGNED OUR QUALITATIVE COMMUNITY CONVERSATIONS AND OUR QUANTITATIVE HEALTHPARTNERS PROVIDER SURVEYS TO FILL THESE GAPS. HEALTHPARTNERS PROVIDER SURVEYS: SELECT HEALTHPARTNERS STAFF WHO PROVIDE DIRECT CARE FOR OUR PATIENTS WERE INVITED BY HOSPITAL LEADERS AND THE CHNA EXPERT PANEL MEMBERS TO COMPLETE A BRIEF WEB SURVEY ABOUT THE NEEDS OF THE PATIENTS THEY SERVE. THE SURVEY WAS DEVELOPED BY AN EXPERT SURVEY METHODOLOGIST WITH INPUT FROM THE CHNA WORKGROUP. OVERALL, 444 PROVIDERS INCLUDING DOCTORS, CARE COORDINATORS, PHARMACISTS, PHYSICAL OR OCCUPATIONAL THERAPISTS, DIETITIANS, NURSES, AND SOCIAL WORKERS COMPLETED SURVEYS ACROSS ALL HEALTHPARTNERS HOSPITALS. DESCRIPTIVE STATISTICS AND A THEMATIC ANALYSIS WERE COMPLETED AND INCLUDED IN THE NEEDS AREA SUMMARIES BELOW.COMMUNITY CONVERSATIONS: A TOTAL OF 41 COMMUNITY CONVERSATIONS WERE HELD OR ATTENDED BY HEALTHPARTNERS WORKGROUP MEMBERS. RESULTS WERE SUMMARIZED AND KEY THEMES AND QUOTES WERE ADDED TO THE NEEDS AREA SUMMARIES THROUGHOUT. ADDITIONAL DETAILS ABOUT THE COMMUNITY CONVERSATIONS CAN BE FOUND IN THE APPENDIX OF THE AMERY'S 2021CHNA AT HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/AMERY/ABOUT/COMMUNITY
PART VI, LINE 3: AMERY'S PATIENT FINANCIAL SERVICES DEPARTMENT WORKS WITH EACH PATIENT REGARDING ACCOUNT BALANCES LEFT TO PATIENT RESPONSIBILITY. PATIENTS WHO ARE NOT ALREADY ON GOVERNMENT ASSISTANCE OR HAVE LIMITED ASSISTANCE ARE REFERRED TO AMERY'S HEALTH BENEFITS COUNSELOR, WHO WORKS WITH THEM TO EVALUATE ASSISTANCE OPTIONS AND ASSISTS IN GETTING APPLICATIONS OR CONTACTS WITH THE APPROPRIATE PROGRAMS. IF ADDITIONAL ASSISTANCE IS NEEDED, THE COUNSELOR WILL WORK WITH THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITH AMERY AND HELPS THEM THROUGH THE PROCESS. THE FINANCIAL ASSISTANCE PROGRAM AND APPLICATION ARE LOCATED ON AMERY'S INTERNET SITE TO ALLOW PATIENTS DIRECT ACCESS TO THIS INFORMATION.
PART VI, LINE 4: THE AMERY REGIONAL MEDICAL CENTER (AMERY) SERVICE AREA INCLUDED 15 DIFFERENT ZIP CODES IN NORTHWEST WISCONSIN THAT PRIMARILY REPRESENT POLK COUNTY. IT INCLUDES THREE RURAL HEALTH CLINICS IN LUCK, TURTLE LAKE, AND CLEAR LAKE, WHICH ARE ALL MEDICALLY UNDERSERVED AREAS. THE AMERY COMMUNITY IS ALSO CONSIDERED A MENTAL HEALTH MEDICALLY UNDERSERVED AREA. THE WOUND CENTER & INPATIENT PSYCH SERVICE DRAWS FROM OUTSIDE AMERY'S NORMAL SERVICE AREA.
PART VI, LINE 5: TEN OF AMERY'S THIRTEEN BOARD MEMBERS LIVE IN AMERY'S SERVICE AREA. AMERY HAS AN OPEN MEDICAL STAFF WHICH INCLUDES PROVIDERS FROM THE COMMUNITY, AND OTHER COMMUNITIES AS WELL AS THE TWIN CITIES. ANY SURPLUS FUNDS GENERATED ARE USED TO PURCHASE EQUIPMENT, BUILD NEW FACILITIES, AND EXPAND SERVICES AVAILABLE IN AMERY'S COMMUNITY.
PART VI, LINE 6: HEALTHPARTNERS AND AMERY HAVE HAD A LONG-STANDING RELATIONSHIP, WITH HEALTHPARTNERS EMPLOYING AND SOURCING PHYSICIANS AND MID-LEVEL PRACTITIONERS TO AMERY FOR AMERY'S PRIMARY CARE CLINICS. IN 2014, AMERY BECAME PART OF THE HEALTHPARTNERS FAMILY OF MISSION-DRIVEN NON-PROFIT ORGANIZATIONS. AS PART OF HEALTHPARTNERS, AMERY USES HEALTHPARTNERS' INTEGRATED ELECTRONIC HEALTH RECORD SYSTEM, PARTICIPATES IN COORDINATED CHNA PROCESSES AND IMPLEMENTATION STRATEGIES, AND ACCESSES CENTRALIZED SUPPORT SERVICES IN FINANCE, LEGAL, IS&T, AND QUALITY. THE FOUR HEALTHPARTNERS HOSPITALS IN THE ST. CROIX VALLEY - STILLWATER MN AND HUDSON, NEW RICHMOND, AND AMERY WI - WORK TOGETHER TO ESTABLISH ACCESSIBLE AND COORDINATED SPECIALTY SERVICES FOR VALLEY RESIDENTS. EXAMPLES OF THESE SERVICES INCLUDE RADIATION THERAPY ON THE NEW RICHMOND CAMPUS, BREAST DIAGNOSTICS ON THE STILLWATER CAMPUS, AND GERIATRIC BEHAVIORAL HEALTH SERVICES ON THE ARMC CAMPUS. HEALTHPARTNERS INCLUDES INSURANCE AND HMO (HEALTH MAINTENANCE ORGANIZATION) ENTITIES THAT PROVIDE CARE COORDINATION, DISEASE MANAGEMENT, ON-LINE CARE OF BASIC CONDITIONS, A 24-HOUR/7-DAY PER WEEK NURSE LINE, AND OTHER SERVICES THAT ENHANCE CARE OF MEMBERS, PATIENTS AND THE COMMUNITY.
PART VI, LINE 7, REPORTS FILED WITH STATES WI
Schedule H (Form 990) 2021
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