2019-11-15T14:07:50-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2018-01-01 451257972 THREE RIVERS HEALTH SYSTEM INC THRE 2692781145 701 S HEALTH PARKWAY THREE RIVERS MI 49093 STEVE ANDREWS CFO 2692781145 2019-11-13 1 DAVID LOWENTHAL P00378651 2695674500 2019-11-12 23.122.254.12 2019-11-13 13:51:34 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 58F74DC53CB874483B207ADF23CD6921384352E9 2018 2020-03-31 21:24:44Z THREE RIVERS HEALTH STEVE ANDREWS 701 S HEALTH PARKWAY THREE RIVERS MI 49093 65570288 0 X WWW.THREERIVERSHEALTH.ORG X 2011 MI SEE SCHEDULE O. 10 8 552 105 0 0 21736 270785 61728995 65207073 2503 22093 188011 47200 61941245 65547151 0 0 0 0 28993826 29152325 0 0 0 34337724 36197490 63331550 65349815 -1390305 197336 18465591 19696346 14532282 15565701 3933309 4130645 X THREE RIVERS HEALTH IS COMMITTED TO THE SUSTAINED WELL BEING OF OUR PATIENTS, FAMILIES, AND COMMUNITIES THROUGH HIGH QUALITY, LOW COST, DYNAMIC HEALTHCARE. 1 0 56778117 65207073 IN 2018 THE HOSPITAL AGAIN CONTINUED TO OFFER A WIDE RANGE OF SERVICES, WHILE ALSO EXPANDING THE NUMBER OF AVAILABLE PROVIDERS. ONE OF THE HOSPITAL'S LARGEST SERVICE LINES ONCOLOGY CONTINUES TO GROW, AS THE HOSPITAL CONTINUES TO PARTNER WITH A LARGER CANCER FACILITY NORTH OF THE HOSPITAL. THIS IS AN EXTREMELY HIGH COST SERVICE, AND THE HOSPITAL CONTINUES TO ADD PHYSICIAN HOURS TO COVER THIS SERVICE, WHICH ENABLES THE PATIENTS IN OUR COMMUNITY TO HAVE THIS SERVICE LOCALLY, RATHER THAN HAVING TO TRAVEL FOR THESE SERVICES. WE HAD 2,600 VISITS TO THIS CLINIC IN 2018. ADDITIONALLY, WE CONTINUE TO OFFER WOUND CARE SERVICES TO THE COMMUNITY, AND HAVE BEEN DOING THIS FOR OVER 6 YEARS, DESPITE THIS SERVICE PRODUCING REVENUES ANNUALLY THAT WERE $275,000 LESS THAN THE COST TO RUN THE SERVICE. ONCE AGAIN, HAVING THIS SERVICE ENABLES ACCESS TO THIS SERVICE THAT ORDINARILY WOULD NOT BE AN OPTION FOR CERTAIN INDIVIDUALS DUE TO TRAVEL CONSTRAINTS. LASTLY, WE PARTNERED WITH A COMPANY TO PROVIDE PAIN MANAGEMENT SERVICES IN THE COMMUNITY AFTER WE LEARNED THAT THIS SERVICE WOULD BE DISCONTINUED IN THE COUNTY DUE TO A CONTRACT ISSUE. WHILE THIS SERVICE PRESENTLY DOES NOT PRODUCE A MARGIN, THE HOSPITAL FELT THAT THE MISSION OF THE HOSPITAL WOULD BE FURTHER MET BY MAINTAINING THIS SERVICE IN THE COMMUNITY. 56778117 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 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 37 0 1 552 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 MI X STEVEN T ANDREWS 2692739604 701 S HEALTH PARKWAY THREE RIVERS MI 49093 LAURIE HINES BOARD CHAIR 6.00 0.00 X X 0 0 0 RAY BENDURE TREASURER/VICE CHAIR 6.00 4.10 X X 0 0 0 MARY BETH FLEURY SECRETARY 4.00 0.00 X X 0 0 0 LARRY CLARK BOARD CHAIR - PART YEAR 6.00 4.10 X X 0 0 0 RICK CORDES BOARD MEMBER 4.00 4.00 X 0 0 0 ADAM GOFF BOARD MEMBER 4.00 0.00 X 0 0 0 JANELL HART BOARD MEMBER 4.00 0.00 X 0 0 0 JAMES MACDONALD DO BOARD MEMBER 40.00 0.00 X 0 291649 53720 JENNIFER PLATZ BOARD MEMBER 4.00 0.00 X 0 0 0 JESSICA PUCKETT DO CHIEF OF STAFF 40.00 4.00 X 0 338552 31950 JIM STUCK BOARD MEMBER 4.00 0.00 X 0 0 0 JOHN TOUSE BOARD MEMBER - PART YEAR 4.00 0.00 X 0 0 0 DAVE SHANNON PRESIDENT/CEO 40.00 11.00 X 242742 0 72621 STEVE ANDREWS CFO 40.00 9.00 X 218194 0 63038 WILLIAM RUSSELL PRESIDENT/CEO - PART YEAR 40.00 11.00 X 91874 0 3654 HOPE BAILEY CHIEF CLINICAL OFFICER 40.00 3.00 X 163854 0 38826 CAMERON YAU MD PHYSICIAN 40.00 0.00 X 0 657498 33290 RAMON URREA MD PHYSICIAN 40.00 0.00 X 0 378965 47959 AMBER NASH-GUIFORD MD PHYSICIAN 40.00 0.00 X 0 323936 46818 ANIL PATEL MD PHYSICIAN 40.00 0.00 X 0 300735 52716 CAROLINE GREENIDGE MD PHYSICIAN 40.00 0.00 X 0 289917 25960 716664 2581252 470552 19 0 1 0 KALAMAZOO FOOT & ANKLE 12057 WEST INDIAN LAKE DR VICKSBURG MI 49097 PHYSICIAN SERVICES 1465961 BORGESS MEDICAL CENTER 1521 GULL ROAD KALAMAZOO MI 49048 PHYSICIAN, IT SERVICES, LAUNDRY 1229062 WEST MICHIGAN ENT 3850 GLENKERRY COURT PORTAGE MI 49024 PHYSICIAN SERVICES 1035095 QHR 1573 MALLORY LANE BRENTWOOD TN 37027 HOSPITAL MANAGEMENT 1015815 ATHENA HEALTH 311 ARSENAL ST WATERTOWN MA 02472 REVENUE CYCLE SERVICES 742220 27 258617 12168 270785 NET PATIENT REVENUE 621110 64963533 64963533 OTHER PROGRAM REVENUE 621110 243540 243540 65207073 21968 21968 203660 23137 180523 180523 180523 125 0 125 125 125 CAFETERIA/VENDING 900099 116861 116861 MISCELLANEOUS 900099 -250184 -250184 -133323 65547151 65207073 0 69293 X 894803 187969 706834 22292783 19641975 2650808 256977 237933 19044 4156029 3764770 391259 1551733 1365918 185815 790313 592735 197578 151061 113296 37765 130963 98222 32741 9149 6862 2287 22792 17094 5698 10121273 8001978 2119295 2762 2072 690 134344 107475 26869 1242052 968800 273252 234063 187250 46813 427792 368053 59739 1845201 1439257 405944 727611 691230 36381 MEDICAL SUPPLIES 7921823 7515787 406036 BAD DEBT EXPENSE 5083188 5083188 PHYSICIAN FEES 5037699 4533929 503770 EQUIP RENTAL AND MAINTE 2156437 1725150 431287 158967 127174 31793 65349815 56778117 8571698 0 1977703 1694851 5197164 4920101 38566 49677 1010696 1018441 774697 769392 53886608 45135384 9297902 8751224 120159 121480 48704 2371180 18465591 19696346 6782144 6918484 5974890 5728657 1775248 2918560 14532282 15565701 X 3933309 4130645 3933309 4130645 18465591 19696346 197336 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 9149 9149 0 PART II-B, LINE 1: A PORTION OF MHA DUES IS ALLOCATED TO LOBBYING EXPENSE. 219500 219500 21399645 17051132 4348513 1491773 1458379 33394 30762840 26625873 4136967 12850 12850 8751224 MALPRACTICE INSURANCE RECEIVABLE 2000000 COST REPORT SETTLEMENTS RECEIVABLE 371180 2371180 COST REPORT SETTLEMENTS PAYABLE 918560 MALPRACTICE INSURANCE PAYABLE 2000000 2918560 1 1 X 1 X 1 X 1 1 1 0 0 75931 75931 0.00130 15583817 10818206 4765611 0.07910 15659748 10818206 4841542 0.08040 193607 193607 0.00320 517119 517119 0.00860 13856438 9495140 4361298 0.07240 14567164 9495140 5072024 0.08420 30226912 20313346 9913566 0.16460 1 5083188 914974 9086742 9862837 -776095 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 16 1 1 1 1 X FULL WEBSITE LISTED IN "OTHER" X X 1 16 1 HTTP://WWW.THREERIVERSHEALTH.ORG/WP-CONTENT/UPLOADS/2016-CHNA-1.PDF 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.THREERIVERSHEALTH.ORG/FINANCIAL-ASSISTANCE/ X HTTP://WWW.THREERIVERSHEALTH.ORG/FINANCIAL-ASSISTANCE/ X HTTP://WWW.THREERIVERSHEALTH.ORG/FINANCIAL-ASSISTANCE/ 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 WERE STURGIS HOSPITAL, 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 6A: STURGIS HOSPITAL THREE RIVERS HEALTH PART V, SECTION B, LINE 6B: COMMUNITY MENTAL HEALTH THREE RIVERS HEALTH PART V, SECTION B, LINE 7D: FROM LINE 7A: HTTP://WWW.THREERIVERSHEALTH.ORG/WP-CONTENT/UPLOADS/2016-CHNA-1.PDF THREE RIVERS HEALTH PART V, SECTION B, LINE 11: THE HOSPITAL AND ITS BOARD CHOSE FIVE AREAS TO FOCUS ON: DIABETES, EDUCATION AND PREVENTION, PHYSICIAN SERVICES, MENTAL HEALTH AND SUICIDE, OBESITY AND PHYSICAL INACTIVITY. 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 A SCHOOL BASED CLINIC 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. 18 1 - THREE RIVERS HEALTH CENTER FOR FAMILY MEDI 850 S HEALTH PARKWAY THREE RIVERS MI 49093 REHABILITATION AND OTHER OUTPATIENT CLINICS 2 - THREE RIVERS HEALTH HOSPICE 711 S HEALTH PARKWAY THREE RIVERS MI 49093 HOSPICE CARE 3 - THREE RIVERS HEALTH HOMECARE 711 S HEALTH PARKWAY THREE RIVERS MI 49093 HOMECARE 4 - THREE RIVERS HEALTH FAMILY CARE 721 6TH AVENUE SUITE B THREE RIVERS MI 49093 RURAL HEALTH CLINIC - THREE RIVERS 5 - THREE RIVERS HEALTH FAMILY CARE 601 E CHICAGO RD PO BOX 295 WHITE PIGEON MI 49099 RURAL HEALTH CLINIC - WHITE PIGEON 6 - THREE RIVERS HEALTH FAMILY INTERNAL MEDICI 711 S HEALTH PARKWAY THREE RIVERS MI 49093 RURAL HEALTH CLINIC - INTERNAL MEDICINE, FAMILY CARE & WOMEN'S SERVICES 7 - THREE RIVERS HEALTH ORTHOPEDICS 1021 HILL STREET SUITE 300 THREE RIVERS MI 49093 ORTHOPEDICS 8 - THREE RIVERS BONE AND JOINT 1021 HILL STREET SUITE 300 THREE RIVERS MI 49093 BONE AND JOINT FACILITY 9 - THREE RIVERS HEALTH SURGICAL SERVICES 715 S HEALTH PARKWAY THREE RIVERS MI 49093 SURGICAL SERVICES 10 - VEERA PATEL MD - INTERNAL MEDICINE 1021 HILL STREET SUITE 100 THREE RIVERS MI 49093 INTERNAL MEDICINE 11 - THREE RIVERS HEALTH FAMILY CARE 110 EAST MAIN ST MARCELLUS MI 49067 RURAL HEALTH CLINIC - MARCELLUS 12 - THREE RIVERS HEALTH CENTER FOR WOUND HEALI 721 S HEALTH PARKWAY THREE RIVERS MI 49093 WOUND CARE 13 - THREE RIVERS HEALTH SLEEP CLINIC 701 S HEALTH PARKWAY THREE RIVERS MI 49093 REHABILITATION AND OTHER OUTPATIENT CLINICS 14 - KALAMAZOO FOOT AND ANKLE SPECIALISTS 7971 MOORSBRIDGE RD PORTAGE MI 49024 FOOT AND ANKLE CARE 15 - WEST MI EAR NOSE AND THROAT 3850 GLENKERRY CT PORTAGE MI 49024 EAR, NOSE, AND THROAT CARE 16 - FAMILY WELLNESS OF THREE RIVERS 655 S ERIE ST THREE RIVERS MI 49093 REHABILITATION AND OTHER OUTPATIENT CLINICS 17 - THREE RIVERS HEALTH SPECIALTY CLINIC 711 S HEALTH PARKWAY THREE RIVERS MI 49093 REHABILITATION AND OTHER OUTPATIENT CLINICS 18 - HEALTH TRAC - WELLNESS PAVILLION 501 S HEALTH PARKWAY THREE RIVERS MI 49093 WELLNESS CENTER 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 $12,835,182. 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 $ 5,083,188. 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. 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 $914,974 OF CHARITY CARE IS INCLUDED IN BAD DEBT EXPENSE DUE TO NOT RECEIVING INFORMATION FROM PATIENTS TO HELP DETERMINE ELIGIBILITY, THUS WE BELIEVE THE $914,974 SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE ORGANIZATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. 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 2016. WE ALSO PARTNER WITH THE OTHER HOSPITAL IN THE COUNTY - STURGIS HOSPITAL. 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. 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. X X 1 0 0 0 0 0 0 0 0 JAMES MACDONALD DO BOARD MEMBER 0 291649 0 0 0 0 0 23346 0 30374 0 345369 0 0 JESSICA PUCKETT DO CHIEF OF STAFF 0 332502 0 50 0 6000 0 17500 0 14450 0 370502 0 0 DAVE SHANNON PRESIDENT/CEO 241688 0 0 0 1054 0 0 0 72621 0 315363 0 0 0 STEVE ANDREWS CFO 193481 0 21619 0 3094 0 4500 0 58538 0 281232 0 0 0 HOPE BAILEY CHIEF CLINICAL OFFICER 150604 0 13250 0 0 0 15325 0 23501 0 202680 0 0 0 CAMERON YAU MD PHYSICIAN 0 607498 0 0 0 50000 0 18500 0 14790 0 690788 0 0 RAMON URREA MD PHYSICIAN 0 46685 0 0 0 332280 0 17700 0 30259 0 426924 0 0 AMBER NASH-GUIFORD MD PHYSICIAN 0 323936 0 0 0 0 0 18374 0 28444 0 370754 0 0 ANIL PATEL MD PHYSICIAN 0 186877 0 103998 0 9860 0 23120 0 29596 0 353451 0 0 CAROLINE GREENIDGE MD PHYSICIAN 0 286155 0 0 0 3762 0 0 0 25960 0 315877 0 0 PART I, LINE 4A WILLIAM RUSSELL RECEIVED A SEVERANCE PAYMENT OF $62,680 DURING THE YEAR. 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 3 RURAL HEALTH CLINICS AND ARE LOOKING AT EXPANDING THE RHC'S. 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 WILL BE ADDED IN 2019, AND A SHORT STAY VOLUNTARY DETOX UNIT WILL BE ADDED IN LATE 2019. THE HOSPITAL ALSO PARTNERED WITH A COMPANY TO KEEP PAIN MANAGEMENT SERVICES IN THE COMMUNITY IN 2018. FORM 990, PART III, LINE 2 WE NOW PROVIDE A COMPLETE PAIN MANAGEMENT PROGRAM THAT IS A JOINT VENTURE. THIS NEW SERVICE ENABLES PEOPLE IN THE COMMUNITY TO HAVE ACCESS TO NECESSARY PAIN MANAGEMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL USES A MANAGEMENT COMPANY TO MANAGE OPERATIONS. THEY ALSO EMPLOY THE CEO AND CFO. 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 AFTER THE RETURN IS FILED. 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 THE HOSPITAL USES DATA FROM MHA TO DETERMINE THE SALARY STRUCTURE FOR EMPLOYEES. FOR THE CEO AND CFO, QHR IS THE PRIMARY SOURCE FOR COMPENSATION, WHICH MUST BE APPROVED BY THE BOARD. THE SALARY PLAN IS PRESENTED TO THE FINANCE COMMITTEE AS WELL. ALL DECISIONS ARE DOCUMENTED IN THE BOARD MINUTES. THIS PROCESS TOOK PLACE IN 2018 AGAIN. FORM 990, PART VI, SECTION C, LINE 19 POLICIES AND STATEMENTS ARE REVIEWED AT BOARD MEETINGS. IF ADDITIONAL REQUESTS ARE MADE, THIS INFORMATION IS PROVIDED AS REQUESTED. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,535,836. MANAGEMENT AND GENERAL EXPENSES 1,845,279. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,381,115. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 2,466,142. MANAGEMENT AND GENERAL EXPENSES 274,016. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,740,158. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. THREE RIVERS HEALTH FOUNDATION 701 S HEALTH PARKWAY THREE RIVERS MI 49093 201384776 FOUNDATION TO HOSPITAL MI 501(C)(3) LINE 12A, I THREE RIVERS HEALTH SYSTEM INC 1 TRAH PROPERTIES INC 701 S HEALTH PARKWAY THREE RIVERS MI 49093 383366344 PROPERTY MANAGEMENT MI 501(C)(3) LINE 12A, I THREE RIVERS HEALTH SYSTEM INC 1 THREE RIVERS HEALTH AUTHORITY 701 S HEALTH PARKWAY THREE RIVERS MI 49093 382317300 HOSPITAL MI 501(C)(3) LINE 3 N/A 0 THREE RIVERS HEALTH NETWORK 701 S HEALTH PARKWAY THREE RIVERS MI 49093 383330974 MEDICAL DATA PROCESSING MI N/A C 0 INTEGRATED HEALTH SYSTEMS INC 701 S HEALTH PARKWAY THREE RIVERS MI 49093 383134384 PERSONNEL MANAGEMENT MI THREE RIVERS HEALTH SYSTEM INC C 5522111 3078 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 TRAH PROPERTIES INC K 245277 RENT PAID INTEGRATED HEALTH SYSTEMS INC O 5522111 FMV