2022-11-11T09:09:39-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2021-01-01 451257972 THREE RIVERS HEALTH SYSTEM INC THRE 2692781145 701 S HEALTH PARKWAY THREE RIVERS MI 49093 JEFFREY P COSTELLO CFO 2692781145 2022-11-09 1 JEFFREY COSTELLO 999009999 DAVID LOWENTHAL P00378651 2695674500 2022-11-03 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z THREE RIVERS HEALTH JEFFREY P COSTELLO 701 S HEALTH PARKWAY THREE RIVERS MI 49093 77792636 0 X WWW.THREERIVERSHEALTH.ORG X 2011 MI SEE SCHEDULE O. 6 6 590 75 0 0 9249878 7424607 65768316 70102988 48772 34929 311528 211174 75378494 77773698 0 0 0 0 31282425 37132323 0 0 0 38987958 36351425 70270383 73483748 5108111 4289950 40789143 44921544 28259783 18271326 12529360 26650218 X WE DELIVER OUTSTANDING CARE, INSPIRE HEALTH, AND CONNECT WITH HEART. 0 0 65027746 0 70102988 IN 2021, ONCOLOGY SERVICES DIPPED TO 2,275 FROM 3,000, PARTLY DUE TO COVID AND THE CHANGES IN PROVIDERS OVER THE COURSE OF THE YEAR. THE RELATIONSHIP BETWEEN ASCENSION BORGESS CANCER CENTER CONTINUED THROUGH THE YEAR. THE COVERAGE CONTINUED AT THREE DAYS PER WEEK AUGMENTED BY ADVANCED PRACTICE PROVIDERS. THE COMMUNITY CONTINUES TO RELY ON LOCAL ONCOLOGY CARE, AS THIS IS A NECESSARY SERVICE LINE IN THE COUNTY. WOUND CARE CONTINUED TO BE A SERVICE OFFERED IN THE COMMUNITY AS WELL, PROVIDING HBO THERAPY CLOSE TO HOME AND WOUND DEBRIDEMENT. SOME OF THESE PATIENTS RECEIVED WOUND CARE THREE TIMES PER WEEK, WHICH WOULD BE DIFFICULT AS MANY DO NOT HAVE THE FINANCIAL RESOURCES AVAILABLE OR ABILITY TO TRAVEL. THREE RIVERS HEALTH OFFERS INPATIENT DETOXIFICATION TREATMENT WHICH INCURS THREE-TO-FIVE-DAY LENGTH OF STAYS WITH MEDICAL STABILIZATION DURING THE WITHDRAWAL PHASE, OUTPATIENT SERVICES ARE ARRANGED FOR CONTINUED SUCCESS WITH THE PROGRAM. THIS SERVICE LINE DOES NOT PRODUCE A MARGIN FOR THE FACILITY BUT IS RECOGNIZED AS A COMMUNITY NEED. OUTPATIENT INFUSION SERVICES WERE ALSO RENDERED DURING 2021 THROUGH THE MANAGEMENT OF A CONTRACT SERVICE PARTNERSHIP WHILE CARE WAS DELIVERED ONSITE AT THE FACILITY WITH HOSPITAL STAFF. THESE SERVICES MAY NOT PROVIDE STRONG REVENUES, IF ANY, BUT WITHOUT THEM THE COMMUNITY WOULD SUFFER GREATLY. THE GOAL OF KEEPING HIGH QUALITY CARE CLOSE TO HOME AND AT REASONABLE COST IS MEETING THE NEEDS OF THE COMMUNITIES WE SERVE. 65027746 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 29 0 1 590 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X JEFFREY P COSTELLO 5746473460 701 S HEALTH PARKWAY THREE RIVERS MI 49093 LAURIE HINES CHAIR 2.00 0.00 X X 0 0 0 RAYMOND L BENDURE PHD TREASURER/VICE CHAIR 2.00 0.00 X X 0 0 0 RICK CORDES SECRETARY 2.00 0.00 X X 0 0 0 ADAM GOFF OD DIRECTOR 2.00 0.00 X 0 0 0 JENNIFER PLATZ DIRECTOR 2.00 0.00 X 0 0 0 JIM STUCK DIRECTOR 2.00 0.00 X 0 0 0 DAVE SHANNON PRESIDENT 40.00 10.00 X 848741 0 75412 STEVE ANDREWS CFO 40.00 10.00 X 769588 0 49312 KREG GRUBER CEO 2.00 50.00 X 0 1487125 206853 JEFF COSTELLO CFO 2.00 50.00 X 0 952112 130897 HOPE BAILEY VP NURSING 40.00 10.00 X 288363 0 36057 LYNETTE BURKETT AUDIOLOGIST 40.00 0.00 X 155109 0 32729 DAVID PARKS DIRECTOR IT 40.00 5.00 X 139072 0 35975 KATERINE GAJ MANAGER OPPT 40.00 0.00 X 141700 0 13817 ANDREA SMITH PHARMACIST 40.00 0.00 X 133393 0 32681 KARLEEN KINKER PHARMACIST 40.00 0.00 X 135328 0 12248 2611294 2439237 625981 38 0 1 0 AMERCIAN PHYSCIAN PARTNERS 5121 MARYLAND WAY STE 300 BRENTWOOD TN 37027 EMERGENCY ROOM PHYSICIANS 978701 WEST MICHIGAN ENT 3850 GLENKERRY COURT PORTAGE MI 49024 PHYSICIAN SERVICES 940033 COMPHEALTH MEDICAL STAFFING PO BOX 972651 DALLAS TX 75397 NURSING TEMPORARY STAFFING 627788 KALAMAZOO FOOT & ANKLE 12057 WEST INDIAN LAKE DR VICKSBURG MI 49097 PHYSICIAN SERVICES 546350 RAGHURAM ELLURU MD 1446 BURLINGTON DR HICKORY CORNERS MI 49060 PHYSICIAN SERVICES 406435 29 7177241 247366 7424607 NET PATIENT REVENUE 621110 69908123 69908123 OTHER PROGRAM REVENUE 621110 194865 194865 70102988 33619 33619 119160 18938 100222 100222 100222 1310 0 1310 1310 1310 CAFETERIA/VENDING 900099 83951 83951 REBATES 900099 27001 27001 110952 77773698 70102988 0 246103 X 2067473 1845217 222256 28478886 25417408 3061478 543422 485004 58418 4477541 3996205 481336 1565001 1396763 168238 562163 562163 214740 214740 144149 144149 2431 2170 261 61357 61357 12656092 11151639 1504453 161150 143826 17324 847481 756377 91104 269538 240563 28975 228493 203930 24563 1973064 1760960 212104 630086 562352 67734 MEDICAL SUPPLIES 10685906 9537171 1148735 BAD DEBT EXPENSE 4318366 4318366 PROF. DUES & DEVELOPMEN 2045066 1825221 219845 EQUIP RENTAL AND MAINTE 1551343 1384574 166769 73483748 65027746 8456002 0 10525079 5813463 15409160 15445146 3321088 4906469 1078685 871809 916217 1126035 17328219 712352 7301581 16615867 133595 130861 41258 11894 2062480 0 40789143 44921544 9247281 5237875 1843441 3676696 4689877 4051368 5402898 5305387 7076286 0 28259783 18271326 X 12529360 26650218 12529360 26650218 40789143 44921544 4289950 9830908 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2431 2431 0 PART II-B, LINE 1: 14.56% OF MHA MEMBERSHIP DUES ARE FOR LOBBYING ACTIVITIES. 5690000 5690000 7372004 154597 7217407 954855 47743 907112 3163029 510012 2653017 148331 148331 16615867 1 1 X 1 X 1 X 1 1 1 0 1 1 17297077 9827526 7469551 0.10800 17297077 9827526 7469551 0.10800 154252 154252 0.00220 1073842 1073842 0.01550 12508503 7871683 4636820 0.06700 13736597 7871683 5864914 0.08470 31033674 17699209 13334465 0.19270 1 4318366 777306 9959985 14262735 -4302750 X 1 1 1 1 THREE RIVERS HEALTH 701 S HEALTH PARKWAY THREE RIVERS MI 49093 1060000006 X X X THREE RIVERS HEALTH 1 0 0 1 X X X X X X X X X X 19 1 0 1 1 X HTTPS://IMPACT.BEACONHEALTHSYSTEM.ORG/CHNA X X 1 19 1 HTTPS://IMPACT.BEACONHEALTHSYSTEM.ORG/CHNA 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.BEACONHEALTHSYSTEM.ORG/PAY-YOUR-BILL/?_GA=2.92349909.XXX-XX-XXXX. X HTTPS://WWW.BEACONHEALTHSYSTEM.ORG/PAY-YOUR-BILL/?_GA=2.92349909.XXX-XX-XXXX. X HTTPS://WWW.BEACONHEALTHSYSTEM.ORG/PAY-YOUR-BILL/?_GA=2.92349909.XXX-XX-XXXX. X X X X X X 1 X 0 X X X X 1 X 0 0 THREE RIVERS HEALTH PART V, SECTION B, LINE 3J: THE CHNA CONTENT INCLUDED THE PROJECT OBJECTIVES, AN OVERVIEW OF THE ASSESSMENT, AS WELL AS THE FINANCIAL OPPORTUNITY SUMMARY. THE REPORT SUMMARIZED THE APPROACH AND ITS FINDINGS. IT ALSO COMPARED HOW THE COMMUNITY COMPARED TO ITS PEERS, AND SUMMARIZED KEY CONCLUSIONS AND OBSERVATIONS. FINALLY, IT RANKED THE NEEDS OF THE COMMUNITY, AND IDENTIFIED AN ACTION PLAN TO HELP IMPLEMENT THE IMPROVEMENT IN COMMUNITY HEALTH OVERALL. THREE RIVERS HEALTH PART V, SECTION B, LINE 5: INITIALLY, WE DEPLOYED A NEEDS ASSESSMENT SURVEY WITHIN THE LOCAL POPULATION FOR ANY RESIDENT TO COMPLETE. WE RECEIVED INPUT FROM 620 AREA RESIDENTS. IT WAS AN INTERNET-BASED SURVEY THAT WAS PROMOTED VIA ADVERTISING, AND THROUGH LOCAL CIVIC AND HEALTH ORGANIZATIONS. PRELIMINARY CONCLUSIONS WERE THEN PRESENTED TO A LOCAL GROUP OF EXPERTS, WHO WERE ASKED TO VALIDATE PRIOR ASSESSMENTS, AND TO ESTABLISH PRIORITY AMONG VARIOUS IDENTIFIED HEALTH AND MEDICAL ISSUES. WHEN THE FINAL ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL GROUP OF EXPERTS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. SOME OF THE OTHER LOCAL ORGANIZATIONS THAT HELPED WITH THIS PROCESS WAS COVERED BRIDGE FQHC, COMMUNITY MENTAL HEALTH DEPARTMENT, BRANCH HILLSDALE- ST. JOSEPH COMMUNITY HEALTH AGENCY, AND ST. JOSEPH COUNTY COMMISSION ON AGING. THREE RIVERS HEALTH PART V, SECTION B, LINE 6B: COMMUNITY MENTAL HEALTH DEPARTMENT THREE RIVERS HEALTH PART V, SECTION B, LINE 7D: ACCESS VIA THE WEBSITE WAS THE PRIMARY MEANS, AND BY WORD OF MOUTH REPRESENTATION FROM OUR BOARD MEMBERS. A SUMMARY OF THE ASSESSMENT WAS ALSO SENT OUT AS A MAILER TO THE RESIDENTS OF THE COUNTY. THREE RIVERS HEALTH PART V, SECTION B, LINE 11: THE HOSPITAL AND ITS BOARD CHOSE FIVE AREAS TO FOCUS ON: DIABETES, EDUCATION AND PREVENTION, ACCESS TO HEALTHCARE SERVICES, MENTAL HEALTH AND SUICIDE, OBESITY AND PHYSICAL INACTIVITY, AND SUBSTANCE ABUSE. DIETICIANS AT THREE RIVERS HEALTH LAID THE FOUNDATION FOR THE PRE-DIABETES PROGRAM TITLED, "MINDSET 365" FOR EMPLOYEES AND THE COMMUNITY. EDUCATION AND PREVENTION IS ADDRESSED THROUGH SKIN AND PROSTATE CANCER SCREENING TO COMMUNITY MEMBERS. PHYSICIAN SERVICES; PRIMARY CARE, ORTHOPEDICS, AND SPECIALIST RECRUITMENT EFFORTS WERE MADE. MENTAL HEALTH AND SUICIDE; WORKED THROUGH CON FOR SERVICES BUT THREE RIVERS HEALTH DID NOT PROCEED DUE TO FINANCIAL CONSTRAINTS AND THE INABILITY TO RECRUIT A PSYCHIATRIST. OBESITY AND PHYSICAL INACTIVITY IS ADDRESSED THROUGH TWO SCHOOL BASED CLINICS THAT IS AN OUTREACH TO CHILDREN WITH THESE ISSUES. THE HOSPITAL HEALTH FACILITY IS OPEN TO THE COMMUNITY AND PASSES ARE DONATED TO CHILDREN WITH THESE SPECIFIC ISSUES. 20 1 - THREE RIVERS HEALTH CENTER FOR WOUND HEA 721 S HEALTH PARKWAY THREE RIVERS MI 49093 WOUND CARE 2 - THREE RIVERS HEALTH FAMILY INTERNAL MEDI 711 S HEALTH PARKWAY THREE RIVERS MI 49093 RURAL HEALTH CLINIC - INTERNAL MEDICINE, FAMILY CARE & WOMEN'S SERVICES 3 - WEST MI EAR NOSE AND THROAT 3850 GLENKERRY CT PORTAGE MI 49024 EAR, NOSE, AND THROAT CARE 4 - THREE RIVERS HEALTH SPECIALTY CLINIC 711 S HEALTH PARKWAY THREE RIVERS MI 49093 OTHER OUTPATIENT CLINIC 5 - THREE RIVERS HEALTH FAMILY CARE 721 6TH AVENUE SUITE B THREE RIVERS MI 49093 RURAL HEALTH CLINIC 6 - THREE RIVERS BONE AND JOINT 1021 HILL STREET SUITE 300 THREE RIVERS MI 49093 BONE AND JOINT FACILITY 7 - THREE RIVERS HEALTH ORTHOPEDICS 1021 HILL STREET SUITE 300 THREE RIVERS MI 49093 ORTHOPEDICS 8 - THREE RIVERS HEALTH HOMECARE 711 S HEALTH PARKWAY THREE RIVERS MI 49093 HOMECARE 9 - THREE RIVERS HEALTH SURGICAL SERVICES 715 S HEALTH PARKWAY THREE RIVERS MI 49093 SURGICAL SERVICES 10 - THREE RIVERS HEALTH FAMILY CARE 601 E CHICAGO RD PO BOX 295 WHITE PIGEON MI 49099 RURAL HEALTH CLINIC 11 - THREE RIVERS HEALTH IMED 16587 ENTERPRISE DR THREE RIVERS MI 49093 URGENT CARE CENTER 12 - THREE RIVERS HEALTH HOSPICE 711 S HEALTH PARKWAY THREE RIVERS MI 49093 HOSPICE CARE 13 - THREE RIVERS HEALTH CENTER FOR FAMILY ME 850 S HEALTH PARKWAY THREE RIVERS MI 49093 OTHER OUTPATIENT CLINIC 14 - VEERA PATEL MD - INTERNAL MEDICINE 1021 HILL STREET SUITE 100 THREE RIVERS MI 49093 INTERNAL MEDICINE 15 - KALAMAZOO FOOT AND ANKLE SPECIALISTS 7971 MOORSBRIDGE RD PORTAGE MI 49024 FOOT AND ANKLE CARE 16 - HAND AND PLASTICS 1021 HILL STREET SUITE 100 THREE RIVERS MI 49093 HAND AND PLASTICS CARE 17 - THREE RIVERS HEALTH FAMILY CARE 110 EAST MAIN ST MARCELLUS MI 49067 OTHER OUTPATIENT CLINIC 18 - HEALTH TRAC - WELLNESS PAVILLION 501 S HEALTH PARKWAY THREE RIVERS MI 49093 WELLNESS CENTER 19 - THREE RIVERS HEALTH SLEEP CLINIC 701 S HEALTH PARKWAY THREE RIVERS MI 49093 OTHER OUTPATIENT CLINIC 20 - RHC PAWS CLINIC 721 6TH AVENUE SUITE A THREE RIVERS MI 49093 PEDIATRIC CLINIC PART I, LINE 7: LINES 7A THROUGH 7C ARE REPORTED USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2. LINES 7E THROUGH 7G ARE REPORTED USING DIRECT COSTS FOR CLINIC OPERATIONS. A COST ACCOUNTING SYSTEM WAS USED FOR HOSPITAL OPERATIONS. PART I, LINE 7G: OTHER SUBSIDIZED HEALTH SERVICES INCLUDES GROSS CLINIC COSTS OF $13,197,068. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4,318,366. PART III, LINE 2: BAD DEBT EXPENSE ARE DOLLARS THAT ARE WRITTEN OFF OR RESERVED FOR PATIENTS THAT HAVE AVAILABLE RESOURCES, BUT WOULD NOT PAY FOR SERVICES. THE EXCEPTION TO THIS RULE WOULD BE CHARITY CARE ACCOUNTS THAT ARE INCLUDED IN BAD DEBT BECAUSE OF A LACK OF INFORMATION PROVIDED, OR THE TIMING OF RECEIVING THAT INFORMATION. PAYMENTS ON ACCOUNTS THAT HAVE BEEN WRITTEN OFF WOULD REDUCE THE OVERALL BAD DEBT EXPENSE. DISCOUNTS ON CHARGES ARE NOT INCLUDED IN BAD DEBT EXPENSE. PART III, LINE 3: SEE ABOVE FOR METHODOLOGY. WITH REGARDS TO CHARITY CARE, THE HOSPITAL ESTIMATES THAT APPROXIMATELY $777,306 OF CHARITY CARE IS INCLUDED IN BAD DEBT EXPENSE DUE TO NOT RECEIVING INFORMATION FROM PATIENTS TO HELP DETERMINE ELIGIBILITY, OR NOT RECEIVING THE INFORMATION IN A TIMELY MANNER, THUS WE BELIEVE THE $777,306 SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 4: PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH BHS EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. BHS HAS AGREEMENTS WITH VARIOUS THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO BHS AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. THIRD PARTIES INCLUDE MEDICARE, MEDICAID, MANAGED HEALTH CARE PLANS, AND OTHER COMMERCIAL PLANS. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. THESE AMOUNTS INCLUDE ESTIMATED ADJUSTMENTS UNDER CERTAIN REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS, WHICH ARE SUBJECT TO AUDIT BY THE APPLICABLE ADMINISTERING AGENCY. THESE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS AND ARE ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED (SEE NOTE 4). THE HOSPITALS PROVIDE CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHARITY CARE PROVIDED IS EXCLUDED FROM PATIENT SERVICE REVENUE (SEE NOTE 5). PART III, LINE 8: MEDICARE IS OUR LARGEST PAYOR, THUS PAYMENTS FOR THIS POPULATION CREATE A FINANCIAL BURDEN ON THE HOSPITAL AS PAYMENTS DO NOT COVER COSTS. MOST OF THE MEDICARE PATIENTS LIVE ON FIXED INCOMES. WE USED THE COST TO CHARGE RATIO TO DETERMINE COSTS. AS MEDICARE IS OUR LARGEST PAYOR, THE SHORTFALL IN COVERING COSTS IS EXTREME, THUS THIS WOULD SEEM TO QUALIFY AS A BENEFIT TO OUR COMMUNITY. PART III, LINE 9B: THE HOSPITAL'S CURRENT COLLECTION PROCESS APPLIES TO ALL PATIENTS. IF NO INSURANCE IS AVAILABLE FOR SERVICES, AND THEY DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, WE WILL MAKE THEM AWARE OF THEIR OPTIONS. DISCOUNTS ARE OFFERED WHICH ARE TIED TO COMMERICAL MANAGED CARE CONTRACTS. PAYMENT ARRANGEMENTS CAN BE MADE FOR A SPECIFIC PERIOD OF TIME, WITH NO INTEREST CHARGED. ONCE ARRANGEMENTS ARE MADE, THE ACCOUNT FOLLOWS THE STANDARD COLLECTION PROCESS OF LETTERS AND PHONE CALLS. AFTER 120 DAYS, IF NO PAYMENT HAS BEEN MADE OR IF PAYMENT ARRANGEMENTS ARE NOT KEPT, THE ACCOUNT WILL BE REFERRED TO A COLLECTION AGENCY. PART VI, LINE 2: THE HOSPITAL CURRENTLY REVIEWS THE HEALTH INDICATORS OF THE COUNTY AND WILL FROM TIME TO TIME COMPLETE COMMUNITY SURVEYS. WE ASSESS WHETHER WE HAVE A SHORTAGE OF PHYSICIANS IN THE AREA ANNUALLY AS WELL. WE REVIEW TRENDS OF OUR PATIENT ACTIVITY BY SERVICE AND TYPE OF PATIENT TO SEE IF ADJUSTMENTS IN SERVICE OR RESOURCE ALLOCATION NEED TO BE MADE. WE REVIEW OUR PATIENT SATISFACTION SURVEYS PERIODICALLY TO IDENTIFY ANY POTENTIAL GAPS IN SERVICES. WE PARTNER WITH THE LOCAL SCHOOLS AND COMMUNITY MENTAL HEALTH ON SPECIFIC HEALTH INITIATIVE THROUGHOUT THE YEAR. OUR MOST RECENT NEEDS ASSESSMENT WAS COMPLETED IN 2019. WE ALSO PARTNER WITH A LOCAL FQHC ("COVERED BRIDGE"). WE ARE ALSO A PART OF AN ACO THAT HELPS US MONITOR QUALITY INDICATORS OF OUR PATIENTS AND HAS ALSO HELPED US PROMOTE ANNUAL WELLNESS VISITS. WE HAVE 2 FULL TIME CARE COORDINATOR THAT HELPS WITH TRANSITION OF CARE BETWEEN PROVIDERS AS WELL. WE ARE PLANNING ON ADDING MORE STAFF TO HELP WITH THESE INITIATIVES. PART VI, LINE 3: UPON IDENTIFYING PATIENTS WHO HAVE NO COVERAGE, WE WILL SEND THEM TO OUR PATIENT ASSISTANCE REPRESENTATIVE. THIS PERSON WILL THEN REVIEW THE OPTIONS THAT ARE AVAILABLE FOR THIS INDIVIDUAL. IF MEDICAID IS A POSSIBILITY, WE THEN SEND THIS PERSON TO OUR MEDICAID SPECIALIST, WHO WILL HELP THEM WITH THE PROCESS, AS WELL AS ANY FORMS. WE HAVE A FORMAL FINANCIAL ASSISTANCE PROGRAM THAT IS ADVERTISED HOSPITAL WIDE AND ON OUR WEBSITE. IF THEY QUALIFY FOR FINANCIAL ASSISTANCE, WE WILL EDUCATE THEM AND ASSIST THEM WITH THE PROCESS. PART VI, LINE 4: THE HOSPITAL PRESENTLY SERVES ST. JOSEPH COUNTY, ALONG WITH OTHER PROVIDERS AS WELL. THE ESTIMATED POPULATION OF THE TOTAL MARKET IS AROUND 62,000. THE COMMUNITY WAS HEAVILY DEPENDENT ON THE AUTO INDUSTRY AND THUS THE ECONOMY HAS STRUGGLED IN RECENT YEARS. WHILE THE OVERALL ECONOMY IN THE STATE HAS REBOUNDED SOMEWHAT, THE LOCAL COUNTY HAS LAGGED IN THE RECOVERY. THE UNEMPLOYMENT RATE CONTINUES TO BE HIGH, AND THE MEDICAID POPULATION IN THE COMMUNITY IS EXTREMELY HIGH. ADDITIONALLY, PEOPLE WITH COVERAGE HAS ALSO INCREASED. BECAUSE OF THIS, MANY PEOPLE USE THE ER AS THEIR PRIMARY CARE PROVIDER. WHILE THE COMMUNITY IS RURAL, IT IS CLOSE TO URBAN AREAS. MANY PEOPLE IN THE COMMUNITY DO NOT HAVE ADEQUATE TRAVEL ARRANGEMENTS, AS CAN BE EVIDENCED BY HIGH NO SHOW RATES FOR PRIMARY CARE APPOINTMENTS DUE TO TRAVEL ISSUES. WE ARE CURRENTLY EVALUATING OPPORTUNITIES WITH THE COUNTY TO HELP WITH THE TRAVEL ISSUES. PART VI, LINE 5: THE HOSPITAL HAS A BOARD THAT RESIDES ENTIRELY IN THE COMMUNITY IT SERVES. THE HOSPITAL HAS EXTENDED PRIVILEGES TO ALL QUALIFIED STAFF IN THE COMMUNITY, AND AS MENTIONED ABOVE, HAS SET UP ARRANGEMENTS WITH TERTIARY HOSPITALS TO ARRANGE FOR SPECIALISTS TO PROVIDE CARE IN THE COMMUNITY ON AN AS NEEDED BASIS. THIS IS CRITICAL, AS THIS MEANS THE LOCAL POPULATION DOES NOT HAVE TO TRAVEL EXTENSIVELY FOR THIS SPECIALTY CARE. IF SURPLUS FUNDS ARE AVAILABLE, THESE FUNDS ARE INVESTED BACK INTO THE COMMUNITY, BY ALLOCATING DOLLARS FOR MEDICAL EQUIPMENT REPLACEMENT, PHYSICIAN RECRUITING, AND OTHER COMMUNITY INITIATIVES. THE HOSPITAL ALSO CONTINUES TO ESTABLISH RURAL HEALTH CLINICS IN COMMUNITIES SURROUNDING ITS SERVICE AREA. THE HOSPITAL IS ALSO A MEMBER OF AN ACO, AND THE HOSPITAL HAS HIRED A CARE COORDINATOR TO HELP WITH CHRONIC CARE PATIENTS AND TO HELP PROMOTE ANNUAL WELLNESS VISTS AS WELL. PART VI, LINE 7, REPORTS FILED WITH STATES MI X X 1 0 0 0 0 0 0 1 0 KREG GRUBER CEO 0 947095 0 389336 0 150694 0 187021 0 19832 0 1693978 0 84167 JEFF COSTELLO CFO 0 575796 0 193976 0 182340 0 115848 0 15049 0 1083009 0 74414 DAVE SHANNON PRESIDENT 332366 0 181250 0 335125 0 0 0 75412 0 924153 0 0 0 STEVE ANDREWS CFO 254222 0 148800 0 366566 0 0 0 49312 0 818900 0 0 0 HOPE BAILEY VP NURSING 177004 0 110499 0 860 0 3703 0 32354 0 324420 0 0 0 LYNETTE BURKETT AUDIOLOGIST 67102 0 87972 0 35 0 3254 0 29475 0 187838 0 0 0 DAVID PARKS DIRECTOR IT 122980 0 12859 0 3233 0 2939 0 33036 0 175047 0 0 0 ANDREA SMITH PHARMACIST 128898 0 0 0 4495 0 2821 0 29860 0 166074 0 0 0 KATERINE GAJ MANAGER OPPT 131814 0 8767 0 1119 0 2537 0 11280 0 155517 0 0 0 PART I, LINE 4A STEVE ANDREWS RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $366,000. DAVE SHANNON RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $325,000. BOTH AMOUNTS WERE PAID OUT LUMP SUM IN OCTOBER 2021. PART I, LINE 7 EXECUTIVES RECEIVED A BONUS BASED ON FINANCIAL PERFORMANCE AND PERFORMANCE MEASURES OF THE ORGANIZATION. MANAGERS RECEIVED A BONUS BASED ON FINANCIAL PERFORMANCE AND PERFORMANCE MEASURES OF THE ORGANIZATION, AS WELL AS PERSONAL GOALS. THIS BONUS PROCESS WAS APPROVED BY THE COMPENSATION COMMITTEE WHICH IS COMPRISED OF MEMBERS OF THE BOARD. FORM 990, PART I, LINE 1: THREE RIVERS HEALTH EXISTS TO PROVIDE COST EFFECTIVE HEALTHCARE TO ITS COMMUNITY, AND TO PROVIDE ACCESS TO QUALITY HEALTHCARE PROVIDERS, WHICH IN TURN HELPS IMPROVE THE WELLNESS OF OUR COMMUNITIES. ST. JOE COUNTY CONTINUES TO HAVE ECONOMIC ISSUES, WHICH IN TURN PROVIDES CHALLENGES FOR PEOPLE TO ACCESS AND PAY FOR HEALTH CARE. WE HAVE A HIGH POPULATION OF MEDICAID PATIENTS, AND BECAUSE OF THIS WE CONTINUE TO PROVIDE SERVICES THAT ENHANCE THE OPPORTUNITIES FOR THOSE PATIENTS, AS WELL AS ALL PATIENTS. WE EMPLOY 90% OF THE PROVIDERS IN THE COMMUNITY, AND WE CONTINUE TO ENSURE THAT OUR CUSTOMERS HAVE ADEQUATE ACCESS TO PRIMARY CARE AND SPECIALISTS. WE HAVE 4 RURAL HEALTH CLINICS AND MAY ADD ANOTHER IN 2022. WE STARTED RECRUITING OTHER PRIMARY CARE PHYSICIANS IN 2017 AND ADDED MORE PROVIDERS IN THE COMMUNITY IN 2018. THE HOSPITAL CONTINUES TO PROVIDE A FULL RANGE OF SERVICES SUCH AS OB, WOUND CARE, HOME CARE AND HOSPICE, AS WELL AS A WELLNESS FACILITY. MANY OF THESE SERVICES ARE HEAVILY SUBSIDIZED. THE HOSPITAL CONTINUES TO PROVIDE SUPPORT SERVICES FOR PEOPLE THAT DO NOT HAVE INSURANCE COVERAGE, AND IN MANY CASES HELPS THEM NAVIGATE THE PROCESS WHICH IN MANY CASES RESULTS IN SOME INSURANCE COVERAGE. THE HOSPITAL OVER THE PAST FEW YEARS HAS EXPANDED ITS ORTHOPEDIC SERVICES, AND AS A RESULT THE COMMUNITY HAS ACCESS TO MULTIPLE PROVIDERS FOR THESE SERVICES, AS WELL AS ENT SERVICES, THUS RESULTING IN PEOPLE BEING ABLE TO RECEIVE THESE SERVICES LOCALLY, RATHER THAN TRAVEL TO RECEIVE THESE SERVICES. THE HOSPITAL CONTINUES TO EXPLORE PARTNERSHIPS WITH OTHER ENTITIES TO ENSURE THAT LOCAL HEALTHCARE REMAINS AVAILABLE AND COST EFFECTIVE. THE HOSPITAL CONTINUES TO ADD SERVICES IN THE COMMUNITY, AS EXPANDED INFUSION SERVICES WERE ADDED IN 2019, AND A SHORT STAY VOLUNTARY DETOX UNIT WAS ADDED IN 2020. THE HOSPITAL ALSO PARTNERED WITH A COMPANY TO KEEP PAIN MANAGEMENT SERVICES IN THE COMMUNITY IN 2018. IN 2020 THE HOSPITAL TOOK OVER THE OPERATIONS OF A LOCAL URGENT CARE CENTER. FORM 990, PART VI, SECTION A, LINE 3 UNTIL 10/1/2021, THE HOSPITAL USED A MANAGEMENT COMPANY TO MANAGE OPERATIONS. THEY ALSO EMPLOYED THE CEO AND CFO. FORM 990, PART VI, SECTION A, LINE 4 THE GOVERNING DOCUMENTS WERE UPDATED TO REFLECT BEACON HEALTH BECOMING THE SOLE MEMBER OF THREE RIVERS HEALTH SYSTEM AS OF 10/1/2021. FORM 990, PART VI, SECTION A, LINE 6 AS OF 10/1/2021, BEACON HEALTH SYSTEM, INC. BECAME THE SOLE CORPORATE MEMBER OF THREE RIVERS HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A BEACON HEALTH, THE SOLE CORPORATE MEMBER, HAS THE POWER TO NOMINATE, ELECT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE BOARD OF DIRECTORS MUST BE APPROVED BY BEACON HEALTH SYSTEM, THE SOLE MEMBER OF THREE RIVERS HEALTH SYSTEM. THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF BEACON HEALTH SYSTEM'S BOARD: 1. SELECTION AND RETENTION OF AUDITORS 2. APPROVAL OF ALL CONTRACTS, POLICIES, OR PROGRAMS OF INSURANCE ESTABLISHING THE TYPES OF INSURANCE COVERAGE REQUIRED AS WELL AS THE COVERAGE LEVELS 3. OTHER MATTERS AS DETERMINED FROM TIME TO TIME BY THE MEMBER, OR AS PROVIDED IN THE BYLAWS OR OTHER GOVERNING DOCUMENTS FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PRESENTED AT THE BOARD MEETING AND REVIEWED BY OFFICERS AND MEMBERS DURING THE MEETING BEFORE THE RETURN FILING. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICE REQUIRES ANNUAL DISCLOSURE, AND COMMUNICATES TO BOARD PERIODICALLY. IF A CONFLICT OF INTEREST ARISES, THE INDIVIDUAL IS REQUIRED TO LEAVE THE ROOM WHEN DISCUSSIONS TAKE PLACE. FORM 990, PART VI, SECTION B, LINE 15 THREE RIVERS HEALTH SYSTEMS, INC'S PARENT, BEACON HEATLH SYSTEM, INC. HAS AN EXTENSIVE EXAMINATION THAT IS CONDUCTED, FOR VICE PRESIDENT AND HIGHER, USING COMPARABLE MARKET DATA THAT IS THEN REVIEWED BY AN INDEPENDENT CONSULTANT HIRED BY, AND REPORTING TO, THE BOARD OF DIRECTORS. HUMAN RESOURCES CONDUCTS THE ANALYSIS AND MAKES RECOMMENDATIONS TO THE CEO WHO THEN MAKES THE RECOMMENDATIONS FOR ALL OTHER EXECUTIVES/OFFICERS TO THE BOARD FOR APPROVAL. THE INDEPENDENT CONSULTING GROUP SEPARATELY MAKES THE RECOMMENDATIONS REGARDING THE CEO'S COMPENSATION TO THE BOARD FOR APPROVAL. RECOMMENDATIONS ARE PRESENTED TO THE COMPENSATION COMMITTEE OF THE BEACON HEALTH SYSTEM, INC. BOARD FOR DELIBERATION AND FINAL DECISION. DELIBERATION AND FINAL DECISION ARE PERFORMED BY THE INDEPENDENT MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE DISTRIBUTED QUARTERLY TO THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE AS PART OF THE CONTINUING DISCLOSURES FOR THE BEACON HEALTH SYSTEM, INC. BONDS. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,044,865. MANAGEMENT AND GENERAL EXPENSES 648,455. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,693,320. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 3,162,376. MANAGEMENT AND GENERAL EXPENSES 380,902. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,543,278. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 3,944,398. MANAGEMENT AND GENERAL EXPENSES 475,096. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,419,494. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. 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