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
TRINITY HOSPITAL TWIN CITY
 
Employer identification number

27-5401105
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
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) . . . 		    684,199 1,023,986 0 0 %
b Medicaid (from Worksheet 3, column a) . . . . .   14,768 6,688,285 2,171,449 4,516,836 17.090 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .   0 0 0    
d Total Financial Assistance and Means-Tested Government Programs . . . . .   14,768 7,372,484 3,195,435 4,516,836 17.090 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 3 417 0 0    
f Health professions education (from Worksheet 5) . . . 0 0 0 0    
g Subsidized health services (from Worksheet 6) . . . . 0 0 10 0 10 0 %
h Research (from Worksheet 7) . 0 0 0 0    
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 1 13 8,135 0 8,135 0.030 %
j Total. Other Benefits . . 4 430 8,145   8,145 0.030 %
k Total. Add lines 7d and 7j . 4 15,198 7,380,629 3,195,435 4,524,981 17.120 %
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            
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 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
2,787,641
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
8,262,197
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
7,885,663
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
376,534
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 TRINITY HOSPITAL TWIN CITY
819 NORTH FIRST STREET
DENNISON,OH44621
HTTPS://WWW.TRINITYTWINCITY.ORG/
2001194 		X       X   X     A
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)
FACILITY REPORTING GROUP - A
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): 		 
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 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 22
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SCHEDULE H, PART V SUPPLEMENTAL INFORMATION
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)
FACILITY REPORTING GROUP - A
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 PART V, SECTION C
b
SEE PART V, SECTION C
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
FACILITY REPORTING GROUP - A
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
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
FACILITY REPORTING GROUP - A
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
PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.
PART V, SECTION B, LINE 7B: ACCESS TUSCARAWAS: WWW.ACCESSTUSC.ORGHOSPITAL COUNCIL OF NORTHWEST OHIO: HTTPS://WWW.HCNO.ORG/COMMUNITY-SERVICES/COMMUNITY-HEALTH-ASSESSMENTS/NEW PHILADELPHIA CITY HEALTH DEPARTMENT: HTTP://WWW.NEWPHILAOH.COM/HEALTH-DEPARTMENTTUSCARAWAS COUNTY HEALTH DEPARTMENT: WWW.TCHDNOW.ORG
PART V, SECTION B, LINE 7A HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
PART V, SECTION B, LINE 10A HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
PART V, SECTION B FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: TRINITY HOSPITAL TWIN CITY
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: THIS COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS WAS COMMISSIONED BY HEALTHY TUSC. HEALTHY TUSC HAS BEEN IN EXISTENCE SINCE 2009 WITH APPROXIMATELY 29 MEMBER ORGANIZATIONS. MULTIPLE SECTORS, INCLUDING THE GENERAL PUBLIC, WERE ASKED THROUGH RADIO AND PRINT MEDIA, AND THROUGH OUTREACH TO EMPLOYERS TO PARTICIPATE IN THE PROCESS, INCLUDING DEFINING THE SCOPE OF THE PROJECT, CHOOSING QUESTIONS FOR THE SURVEYS, REVIEWING INITIAL DATA, PLANNING A COMMUNITY RELEASE, AND IDENTIFYING AND PRIORITIZING NEEDS. TWENTY-NINE COMMUNITY ORGANIZATIONS WORKED TOGETHER TO CREATE ONE COMPREHENSIVE ASSESSMENT AND PLAN, WITH MORE THAN 250 OF COMMUNITY MEMBERS VIEWING THE ONLINE VIDEO RELEASE AND PROVIDING QUALITATIVE FEEDBACK. PUBLIC HEALTH PARTICIPANTS INCLUDED TUSCARAWAS COUNTY HEALTH DEPARTMENT AND THE NEW PHILADELPHIA CITY HEALTH DEPARTMENT. DATA FOR THE 2021 CHNA WERE OBTAINED BY INDEPENDENT RESEARCHERS FROM THE TOLEDO-BASED HOSPITAL COUNCIL OF NORTHWEST OHIO AND THEIR PARTNERS AT THE UNIVERSITY OF TOLEDO, WHO ADMINISTERED SURVEYS TO A CROSS-SECTIONAL, RANDOMIZED SAMPLE OF TUSCARAWAS COUNTY RESIDENTS AS FOLLOWS: ADULTS AGED 19 YEARS AND OLDER. THE SURVEY INSTRUMENT CONTAINED BOTH CUSTOMIZED QUESTIONS AND A SET OF CORE QUESTIONS TAKEN FROM THE CENTER FOR DISEASE CONTROL AND PREVENTION'S BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM. THE NUMBER OF SURVEYS COMPLETED AND ANALYZED MET THE THRESHOLD FOR STATISTICAL SIGNIFICANCE AT THE 95% CONFIDENCE LEVEL, WITH A 6% MARGIN OF ERROR. WHEREVER POSSIBLE, LOCAL FINDINGS HAVE BEEN COMPARED TO OTHER LOCAL, REGIONAL, STATE, AND NATIONAL DATA. AS WE MOVE FORWARD WITH PLANNING STRATEGIES, WE CONTINUE TO COMMIT TO SERVING THOSE IN OUR COUNTY WHO EXPERIENCE HEALTH AND BASIC NEEDS DISPARITIES. FINALLY, ADDITIONAL INFORMATION WAS COLLECTED FROM SECONDARY DATA SOURCES (I.E., VITAL STATISTICS, OHIO DISEASE REPORTING SYSTEM, ETC.) TO SUPPLEMENT FINDINGS FROM THE ADULT SURVEY. DETAILED DATA COLLECTION METHODS ARE DESCRIBED LATER IN THIS SECTION.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A: CLEVELAND CLINIC-UNION HOSPITAL
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B: THE CHNA WAS MADE POSSIBLE THROUGH THE WORK OF 38 PROFESSIONALS REPRESENTING THE FOLLOWING ORGANIZATIONS: ACCESS TUSC ; ADAMHS BOARD ; AULTMAN HEALTH FOUNDATION ; CLEVELAND CLINIC FOUNDATION ; CLEVELAND CLINIC UNION HOSPITAL ; COMMUNITY HOSPICE ; COMMUNITY VOLUNTEER ; COMPASS ; EAST CENTRAL OHIO EDUCATIONAL SERVICE CENTER ; FRIENDS OF THE HOMELESS OF TUSCARAWAS COUNTY ; NEW PHILADELPHIA CITY HEALTH DEPARTMENT ; OHIO GUIDESTONE, EMPOWER TUSC ; OHIO MID-EASTERN GOVERNMENT ASSOCIATION ; OHIO RISE/AETNA ; PROVIA ; PUENTES GROUP ; SPRINGVALE HEALTH CENTER ; TRINITY HEALTH SYSTEM TWIN CITY MEDICAL CENTER ; TWIN CITY MEDICAL CENTER VIBRANT LIVING ; TUSCARAWAS CLINIC FOR THE WORKING UNINSURED ; TUSCARAWAS COUNTY ADDICTION TASK FORCE ; TUSCARAWAS COUNTY COMMISSIONERS ; TUSCARAWAS COUNTY ECONOMIC DEVELOPMENT COUNCIL ; TUSCARAWAS COUNTY EMERGENCY MANAGEMENT AGENCY ; TUSCARAWAS COUNTY HEALTH DEPARTMENT ; TUSCARAWAS COUNTY SENIOR CENTER ; TUSCARAWAS COUNTY SENIOR CENTER MOBILITY MANAGEMENT ; TUSCARAWAS COUNTY CONVENTION AND VISITORS BUREAU ; TUSCARAWAS COUNTY COUNCIL FOR CHURCH & COMMUNITY ; TUSCARAWAS COUNTY FAMILY & CHILDREN FIRST COUNCIL ; TUSCARAWAS VALLEY FARMERS MARKET ; TUSCO DISPLAY ; UNITED WAY OF TUSCARAWAS COUNTY ; YMCA.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11: THE HOSPITAL IS DEDICATED TO IMPROVING COMMUNITY HEALTH AND DELIVERING COMMUNITY BENEFITS WITH THE ENGAGEMENT OF ITS MANAGEMENT TEAM, BOARD, CLINICIANS AND STAFF, AND IN COLLABORATION WITH COMMUNITY PARTNERS. HOSPITAL AND HEALTH SYSTEM PARTICIPANTS INCLUDED PRESIDENT, DWAYNE RICHARDSON; SENIOR TEAM MEMBERS, OTHER LEADERSHIP TEAM MEMBERS AND THE EXECUTIVE ASSISTANT. COMMUNITY INPUT OR CONTRIBUTIONS TO THIS IMPLEMENTATION STRATEGY INCLUDED COLLABORATION WITH THE HEALTHY TUSC COMMITTEE WHICH IS A LOCAL COLLABORATIVE AGENCY MADE UP OF OTHER HEALTHCARE FACILITIES AND NONPROFIT ORGANIZATIONS WHO WORK TOGETHER TO CREATE A HEALTHIER COMMUNITY FOR OUR CITIZENS. HEALTHY TUSC COMPRISES MORE THAN 20 LOCAL ORGANIZATIONS WITH THE SAME GOAL OF IMPROVING THE HEALTH OUTCOMES IN OUR COMMUNITY. PRIORITY #1 - HEALTH BEHAVIORS:PHYSICAL ACTIVITY/NUTRITION STRATEGIES: CREATE A COMMUNITY-WIDE PHYSICAL ACTIVITY CAMPAIGN. RECRUIT AT LEAST FIVE AGENCIES WHO ARE WORKING TO IMPROVE AND PROMOTE TUSCARAWAS COUNTY'S PHYSICAL ACTIVITY OPPORTUNITIES. DETERMINE THE GOALS AND OBJECTIVES OF THE PHYSICAL ACTIVITY CAMPAIGN. ENGAGE COMMUNITY AGENCIES THAT COORDINATE A UNIFIED MESSAGE TO INCREASE AWARENESS OF TUSCARAWAS COUNTY PHYSICAL ACTIVITY OPPORTUNITIES AND CREATE A CULTURE OF HEALTH. BRAND THE CAMPAIGN AND EXPLORE THE FEASIBILITY OF CREATING A COUNTY PHYSICAL ACTIVITY RESOURCE THAT HOUSES INFORMATION ABOUT ALL PHYSICAL ACTIVITY OPPORTUNITIES. TOBACCO STRATEGIES: SMOKE FREE ENVIRONMENTS: CONDUCT POLICY SCAN. IDENTIFY AREAS NOT 100% SMOKE FREE. WORK WITH STAKEHOLDERS TO PASS ORDINANCE OR CREATE POLICY TO BE SMOKE FREE. TOBACCO STRATEGIES: ACCESS TO CESSATION: QUIT LINE REFERRALS/QUIT ATTEMPTS. HEALTH CARE PROVIDER REMINDER SYSTEMS. CONDUCT OUTREACH WITH COMMUNITY MEMBERS, AGENCIES, GROUPS, ORGANIZATIONS THIS CAN BE DONE VIA TRAININGS, PRESENTATIONS, OR COMMUNITY EVENTS. TOBACCO STRATEGIES: LICENSURE FOR RETAILERS: GROUNDWORK FOR TOBACCO RETAILER LICENSE (TRL): SWOT ANALYSIS; IDENTIFY DECISION MAKERS AND GATHER INFORMATION ON PROBABLE POSITIONS OF POTENTIAL DECISION MAKERS; CREATE IMPLEMENTATION PLAN; COMPILE LIST OF RETAILERS.PRIORITY #2 ACCESS TO CAREACCESS TO CARE - SCHOOL-BASED HEALTH CENTERS: GATHER COMMUNITY LEADERS, STAKEHOLDERS, LOCAL QUALIFIED HEALTHCARE PROVIDERS (SUCH AS NURSE PRACTITIONERS), AND MENTAL HEALTH PROVIDERS TO DISCUSS AND ASSESS THE NEED FOR A SCHOOL-BASED HEALTH CENTER AND DETERMINE THE TYPE OF SERVICES IT WILL BE PROVIDE TO THE STUDENTS THAT FOLLOW STATE STANDARDS. RESEARCH AND SECURE FUNDING THROUGH THE STATE, COUNTY HEALTH DEPARTMENT, FEDERALLY QUALIFIED HEATH CENTERS (FQHC), LOCAL BUSINESSES, COMMUNITY PROVIDERS, GRANTS, AND ANOTHER FUNDRAISING. OPEN 2 SCHOOL-BASED HEALTH CLINICS IN TUSCARAWAS COUNTY. ACCESS TO CARE - COMMUNITY RESOURCE GUIDE: REVIEW OLD COMMUNITY RESOURCE GUIDE AND UPDATE INFORMATION AS NEEDED. PROMOTE/SHARE GUIDE THROUGH VARIOUS OUTLETS (I.E., SOCIAL MEDIA, NEWSPAPER, BULLETINS, AND RADIO) AND PROVIDE PRINT COPIES THROUGHOUT THE COUNTY. ACCESS TO CARE - EXPAND BROADBAND INTERNET ACCESS TO RURAL AREAS: COLLECT BASELINE DATA ON THE NUMBER OF COMMUNITY MEMBERS WHO LACK ACCESS TO INTERNET IN RURAL AREAS. SHARE INFORMATION WITH VARIOUS COMMUNITY STAKEHOLDERS AND REVIEW CURRENT CONTRACT(S) WITH BROADBAND COMPANY(IES). WORK WITH STAKEHOLDERS AND BROADBAND COMPANY(IES) TO CREATE A PLAN FOR EXTENDING SERVICES TO RURAL AREAS. ACCESS TO CARE COMMUNITY HEALTH WORKERS: INCREASE NUMBER OF COMMUNITY HEALTH WORKERS (CHW) AND/OR IMPROVE CHW COMMUNITY ENGAGEMENT.PRIORITY #3 MENTAL HEALTH AND ADDICTION:MENTAL HEALTH AND ADDICTION - UNIVERSAL SCHOOL-BASED SUICIDE AWARENESS AND EDUCATION PROGRAMS: INTRODUCE SCHOOL-BASED SUICIDE AWARENESS AND EDUCATION PROGRAM (I.E., SIGNS OF SUICIDE (SOS), QUESTION, PERSUADE, REFER (QPR), HOPE SQUAD PEER SUPPORT, AND MENTAL HEALTH FIRST AID) ALONG WITH SUPPORTING DATA, TO ALL SCHOOL DISTRICTS AND ENGAGE INTERESTING DISTRICTS IN A PLANNING PROCESS.MENTAL HEALTH AND ADDICTION COLLABORATE WITH SCHOOLS TO SUPPORT THE IMPLEMENTATION OF SOCIAL EMOTIONAL LEARNING STANDARDS AND ONGOING BEHAVIORAL HEALTH SUPPORT: WORK WITH SCHOOLS TO DETERMINE AREAS OF NEED AS WELL AS OPPORTUNITIES TO PARTNER BEHAVIORAL HEALTH RESOURCES AND TRAININGS IN DISTRICTS THAT ARE WILLING. MENTAL HEALTH AND ADDICTION MENTAL HEALTH FIRST AID: OBTAIN BASELINE DATA ON THE NUMBER OF MENTAL HEALTH FIRST AID (MHFA) TRAININGS THAT HAVE TAKEN PLACE IN THE TUSCARAWAS COUNTY. MARKET THE TRAINING TO LOCAL CHURCHES, SCHOOLS, ROTARY CLUBS, LAW ENFORCEMENT, CHAMBERS OF COMMERCE, CITY COUNCILS, COLLEGE STUDENTS, ETC. PROVIDE AT LEAST TWO MHFA TRAININGS.MENTAL HEALTH AND ADDICTION INCREASE COUNTY AWARENESS OF SIGNS AND SYMPTOMS OF ALCOHOL ADDICTION AND LOCAL RESOURCES: REVIEW EXISTING AWARENESS CAMPAIGNS RELATED TO ALCOHOL ADDICTION AND DETERMINE WHICH WOULD HAVE THE MOST IMPACT IN THE COUNTY. ENSURE CAMPAIGN INCLUDES CONNECTION TO LOCAL RESOURCES AS WELL AS EASE OF ENGAGEMENT IN SERVICES. DEVELOP A ROLL-OUT PLAN FOR CAMPAIGN.THE HOSPITAL WILL NOT BE ADDRESSING THE FOLLOWING HEALTH NEEDS: YOUTH MENTAL HEALTH/DRUG USE AND YOUTH SMOKING. ANY NEEDS IN THIS REPORT THAT THE HOSPITAL ITSELF DOES NOT INTEND TO ADDRESS ARE DUE TO OTHER LOCAL AGENCIES COMPLETING THESE PROJECTS OR THESE PROJECTS FALLING UNDER ANOTHER AGENCY'S EXPERTISE. THE HOSPITAL COLLABORATES WITH ALL INITIATIVES IDENTIFIED IN THIS CHIP AND ADVOCATES FOR ALL INITIATIVES IDENTIFIED, EVEN IF THE HOSPITAL IS NOT NOTED AS THE RESPONSIBLE ORGANIZATION ON THE SPECIFIC STRATEGY.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PATIENT COOPERATION STANDARDS - A PATIENT MUST COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS.
PART V, SECTION B, LINE 16A HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/FINANCIAL-ASSISTANCE-SERVICES-2
PART V, SECTION B, LINE 16B HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/FINANCIAL-ASSISTANCE-SERVICES-2
PART V, SECTION B, LINE 16C HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/FINANCIAL-ASSISTANCE-SERVICES-2
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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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?  
Name and address Type of Facility (describe)
1
2
3
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6
7
8
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Schedule H (Form 990) 2021
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Schedule H (Form 990) 2021
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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 3C: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE:-THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.-THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS.-THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:-RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS;-HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS OR FREE CARE CLINIC;-PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);-FOOD STAMP ELIGIBILITY;-ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);-LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR-PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE.
PART I, LINE 7: COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY ("CBISA") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS.
PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE.
PART III, LINE 4: TRINITY HOSPITAL TWIN CITY DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13."PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES."
PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. TRINITY HOSPITAL TWIN CITY'S SURPLUS, AS REPORTED ON PART III, SECTION B, LINE 7, OF $376,534 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS.
PART III, LINE 9B: COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.
PART III, LINE 3: TRINITY HOSPITAL TWIN CITY MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. TRINITY HOSPITAL TWIN CITY'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. TRINITY HOSPITAL TWIN CITY ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, TRINITY HOSPITAL TWIN CITY DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE.
PART VI, LINE 2: PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE SHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS- NEEDED BASIS. THE HEALTHY TUSC TASK FORCE WILL MEET AT LEAST QUARTERLY TO REPORT PROGRESS AND WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE HEALTHY TUSC TASK FORCE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY. TUSCARAWAS COUNTY WILL CONTINUE FACILITATING CHAS EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS.PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND SECONDARY DATA WILL BE ANALYZED FOR YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN TUSCARAWAS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. INDICATORS HAVE ALREADY BEEN DEFINED THROUGHOUT THIS REPORT AND ARE IDENTIFIED WITH THE ICON.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE HEALTHY TUSC TASK FORCE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY). FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES.
PART VI, LINE 3: INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.
PART VI, LINE 4: THE COMMUNITY HAS BEEN DEFINED AS TUSCARAWAS COUNTY. MOST OF CLEVELAND CLINIC UNION HOSPITAL'S AND TWIN CITY MEDICAL CENTER'S DISCHARGES WERE RESIDENTS OF TUSCARAWAS COUNTY. IN ADDITION, CLEVELAND CLINIC UNION HOSPITAL AND TWIN CITY MEDICAL CENTER COLLABORATE WITH MULTIPLE STAKEHOLDERS, MOST OF WHOM PROVIDE SERVICES AT THE COUNTY-LEVEL. TUSCARAWAS COUNTY IS AN APPALACHIAN COUNTY LOCATED IN EAST CENTRAL OHIO. THE COUNTY HAS A POPULATION OF 92,335, AND ITS LARGEST CITY NEW PHILADELPHIA HAS A POPULATION OF 17,446. THE POPULATION IS ALMOST ENTIRELY WHITE (98.4%). 2.8% ARE HISPANIC OR LATINO (OF ANY RACE). A HIGH SCHOOL DIPLOMA IS THE HIGHEST EDUCATIONAL ATTAINMENT FOR 44.7% OF THE POPULATION. MEDIAN HOUSEHOLD INCOME IS $53,616, THE POVERTY RATE (ALL INDIVIDUALS) IS 11.7%, AND THE UNEMPLOYMENT RATE IS 3.3%. THIRTEEN PERCENT ARE UNINSURED. TUSCARAWAS COUNTY IS FEDERALLY DESIGNATED AS A PRIMARY MEDICAL, MENTAL HEALTH CARE, AND DENTAL CARE HEALTH PROFESSIONAL SHORTAGE AREA (HPSA).
PART VI, LINE 5: FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS.ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS.
PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN - BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY.
PART VI, LINE 7: OH
Schedule H (Form 990) 2021
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