2025-11-14T13:48:39-06:00 2024-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2024-01-01 451257972 Three Rivers Health System Inc THRE 2692781145 701 S Health Parkway Three Rivers MI 49093 Jeffrey Costello CFO 2692781145 2025-11-07 1 1 Rebekuh Eley P01247672 3126343400 2025-11-07 2024 2025-03-06 01:10:19Z Three Rivers Health Maria Behr 701 S Health Parkway Three Rivers MI 49093 80259416 0 X www.beaconhealthsystem.org X 2011 MI We deliver outstanding care, inspire health, and connect with heart. 8 7 525 40 0 0 761266 516931 71858061 77774134 305817 684943 882982 1274967 73808126 80250975 7792 32769 0 0 33346399 36742366 0 0 0 40566733 36915776 73920924 73690911 -112798 6560064 54102951 62993423 10524344 11694299 43578607 51299124 X We deliver outstanding care, inspire health, and connect with heart. 0 0 57546631 32769 78786420 In 2024, The Center for Wound Healing continues to serve this community well offering hyperbaric oxygen therapy and an average healing rate above the state and national average. Having this service line available has proven to allow patients to keep limbs when otherwise travel would be difficult, and treatment may not be possible. Podiatry and Internal Medicine have continued to play an integral role at the Center with regards to wound debridement and offering an interdisciplinary approach to healing and limb retention. Oncology services remained down. This service line is viewed as a community need; therefore, we persevered through low volumes serving all those who were able. We have had provider changes and are making plans to have a system Oncology Service line. Outpatient infusions continue to be a service need provided on a 24/7 basis. Outpatient therapies (PT, OT and speech) along with Cardiac Rehab are all located on the campus that allow for local care to an underserved community. Three Rivers Health continues to offer many services that would otherwise be impossible for some of the community due to lack of resources and support. These services may or may not be strong revenue stream, but are rendered as part of the organization's mission to deliver outstanding care, inspire health and connect with heart. We continue to work to provide high-quality, close to home, and at reasonable cost healthcare; striving to meet the needs of the communities we serve. 57546631 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 59 0 1 525 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jeffrey Costello 5746473549 615 N Michigan Street South Bend IN 46601 Linda Evans MD Director, Physician 40.00 0.00 X 208381 0 27723 Adam Goff OD Director 2.00 0.00 X 1016 0 0 Laurie A Hines Chair 2.00 0.00 X X 200 0 0 Raymond L Bendure PhD Vice Chair 2.00 0.00 X X 200 0 0 Rick Cordes Secretary 2.00 0.00 X X 200 0 0 Jennifer Platz Director 2.00 0.00 X 200 0 0 Jim Stuck Director 2.00 0.00 X 200 0 0 Ed Reed Director 2.00 0.00 X 200 0 0 Kreg R Gruber CEO 2.00 50.00 X 0 1848714 287708 Jeffrey P Costello CFO 2.00 50.00 X 0 1077612 188598 Maria A Behr President 40.00 0.00 X 0 379565 102861 Erika L Dearing Employed Physician 40.00 0.00 X 372909 0 63720 Jessica Puckett Employed Physician 40.00 0.00 X 369923 0 49643 Alyssa Erskine Employed Physician 40.00 0.00 X 340560 0 59545 James MacDonald Employed Physician 40.00 0.00 X 324689 0 68220 Todd M Ozdych Employed Physician 40.00 0.00 X 328932 0 57291 Hope Bailey Former VP Nursing 0.00 0.00 X 258447 0 55905 2206057 3305891 961214 61 1 1 0 Clinical Colleagues Inc 1765 E Nine Mile Rd Pensacola FL 32514 Anesthesia Services 2329988 Kalamazoo Foot & Ankle Specialists PLC 12057 West Indian Lake Dr Vicksburg MI 49097 Physician Services 2081204 Elite Emergency Physicians Inc 600 East Blvd Elkhart IN 46514 Physician Services 738666 West Michigan Ear Nose & Throat 3850 Glenkerry Court Portage MI 49024 Physician Services 661248 Panamerican Hospitalists PLLC 50755 Brookside Drive Granger IN 46530 Physician Services 562843 27 2130 514801 516931 Net Patient Revenue 622110 76872159 76872159 iMed Shared Service 622110 563064 563064 Affiliated Rental Revenue 532000 300000 300000 Pharmacy Sales 456110 35571 35571 Medical Services to Affiliates 622110 3340 3340 77774134 689743 689743 264822 2141 262681 262681 262681 1500 6300 -4800 -4800 -4800 340B 456110 662345 662345 Quality Incentive 622110 179370 179370 Cafeteria Sales 622110 104752 104752 65819 65819 1012286 80250975 78786420 0 947624 X 32769 32769 484643 484643 550455 550455 29970543 25684755 4285788 546596 468433 78163 3314667 2840670 473997 1875462 1607271 268191 572397 572397 14012 14012 -9719 -9719 2230 1911 319 141238 141238 7409826 6350273 1059553 1822 1561 261 1310607 1123192 187415 395 339 56 1471489 1262847 208642 95327 81695 13632 61111 52372 8739 53737 46053 7684 2046746 1754061 292685 568208 486954 81254 Medical Supplies 7168820 7168820 Management Fees 6789322 6789322 Bad Debt Expense 4773776 4773776 Dues & Subscriptions 3954049 3388620 565429 490383 420259 70124 73690911 57546631 16144280 0 935 1035 19054651 20505970 138791 126066 8055134 12961816 495 0 1031334 1027007 217204 211145 29841214 6403872 21682114 23437342 3922293 4723042 54102951 62993423 5580863 6374738 32889 -17458 2933947 2583733 1976645 2753286 10524344 11694299 X 43578607 51299124 43578607 51299124 54102951 62993423 X 6560064 2628 1157825 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2230 2230 0 Part II-B, Line 1: Three Rivers Health paid dues to the following organizations for which the amount or percentage listed was attributed to lobbying: ACOG (American College of Obstetricians and Gynecologists) - 20% MHA (Michigan Health & Hospital Association) - 10% ACEND (Academy of Nutrition and Dietetics) - 10% MAHC (Michigan Home Care Hospice Association) - 20% ASHT (American Society of Hand Therapists) - 20% AOTA (American Occupational Therapy Association) - 20% AASM (American Academy of Sleep Medicine) - 20% ACHE (American College of Healthcare Executives) - 1% When unable to ascertain allocation of dues attributed to lobbying, a conservative estimate of 20% is applied. 42456771 9625097 2320861 4428203 49974526 38758960 2440358 2682416 1424963 42456771 0 46675184 -4645969 3270255 38758960 0.67190 0.00000 0.32810 0 1 1 6502266 6502266 13359826 1830518 11529308 9979122 4573354 5405768 23437342 Other Receivables 468347 Third Party Receivables 4254695 4723042 Third Party Payables 2753286 2753286 X Part V, Line 4: Net assets with donor restrictions consist of assets whose use is limited by donor imposed, time and/or purpose restrictions. In accordance with the restriction, a majority of the investment income and investment gains or losses from these net assets are restricted by the donor for a specific purpose. A specified portion of income earned by the net assets is released from restriction and used for operations each year and, therefore, is included in the consolidated statements of operations and changes in net assets as other revenue. The board has discretion to utilize each year the incomes, revenues and profits arising and accruing from the endowments in defraying costs associated with the trust and the remainder for support, betterment, improvement, upkeep, expansion and replacement of Beacon Health System, Inc. and its corporate affiliates. Part X, Line 2: ASC 740, Income Taxes, requires that realization of an uncertain income tax position is more likely than not (i.e., greater than 50% likelihood of receiving a benefit) before it is recognized in the consolidated financial statements as the amount most likely to be realized assuming a review by tax authorities having all relevant information and applying current conventions. This interpretation also clarifies the financial statement classification of tax-related penalties and interest and sets forth new disclosures regarding unrecognized tax benefits. No amount was recorded for the years ended December 31, 2024 or 2023. 1 1 X 1 X 1 X 1 1 1 0 1 1 3913662 0 3913662 0.05680 17328249 19712554 0 0.00000 21241911 19712554 3913662 0.05680 633000 0 633000 0.00920 9426261 5420122 4006139 0.05810 32450 0 32450 0.00050 10091711 5420122 4671589 0.06780 31333622 25132676 8585251 0.12460 1 4773776 1524888 2075149 6447166 -4372017 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 24 1 1 0 1 X https://impact.beaconhealthsystem.org/chna/ X X 1 22 1 https://impact.beaconhealthsystem.org/chna/ 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X https://www.beaconhealthsystem.org/patients-and-visitors/ X https://www.beaconhealthsystem.org/patients-and-visitors/ X https://www.beaconhealthsystem.org/patients-and-visitors/ 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 5: Beacon Health System's 2024 Community Health Needs Assessment (CHNA) represents more than just a regulatory requirement for non-profit hospitals. The organization views it as a valuable opportunity to engage with communities across their four-county service area (St. Joseph County IN, Elkhart County, Marshall County, and St. Joseph County MI) to understand health and social needs of community members. The assessment follows the MAPP 2.0 framework (Mobilizing for Action through Planning and Partnerships) developed by the National Association of County & City Health Officials. This community-driven assessment and planning process is designed to support health equity while focusing on strategic, prioritized needs. The framework helps recognize and align resources across integrated sectors by emphasizing diverse and inclusive assessment activities. The CHNA is structured around three primary assessment components: Community Status Assessment (CSA) - Provides a foundation of secondary research data about demographics, health status, health inequities, and social drivers of health. This helps identify communities at greater risk of poor health outcomes and understand which groups may need more services. Community Partner Assessment (CPA) - Reviews existing resources, systems, processes, and capacities, both individually and collectively as a network of community partners. This component recognizes that community partnerships form the required network of support for public health improvement, as rarely can a single agency address all interrelated needs. Community Context Assessment (CCA) - Collects and analyzes qualitative data through community engagement. This component captures the lived experiences of community members, providing insights about helpful resources, organizational strengths, cultural nuances, and priorities. The assessment methodology employed a mixed methods approach between January and September 2024, including secondary research, community surveying, resource guide reviews, access audits, qualitative interviews, focus groups, and a needs prioritization process. Throughout the process, Beacon utilized: A Multi-Sector Health Advisory Council with a total of 23 representatives from across the four-county service area who received MAPP 2.0 training and met monthly throughout the project. Eight Equity Champions representing diverse communities helped ensure the needs of underrepresented or historically marginalized communities were understood. Beacon Health System is dedicated to understanding health equity and disparities within the communities it serves. Equity Champions participated in a stakeholder interview, participated in a focus group or helped host and recruit community members for a focus group, and participated in the prioritization process. The Equity Champions met regularly throughout the CHNA process. The research engaged many participants throughout the four-county region. 150 participants were for the focus groups and stakeholder interviews. We had 1,513 individuals complete our community survey. 49 partners completed the partner survey. We completed an access audit/mystery shopper with 25 facilities across the region. Community members participated in focus groups that explored local health needs and how these intersect with individual health experiences. Meanwhile, professionals and community leaders contributed their expertise through both focus groups and stakeholder interviews to provide insights into the broader health landscape. The participants represented diverse sectors that influence community health, including healthcare professionals, government representatives, faith-based organizations, community-based organizations, educational institutions, and social service providers. This multi-sector approach ensured a well-rounded understanding of health needs from various perspectives, combining both personal experiences and professional knowledge.Collectively with the health advisory council, health equity champions, the community survey, key informant interviews, and focus groups who took into account input received from persons who represent the broad interests of the community served. Secondary data provides an essential framework from which to better understand the fabric of the community. This analysis highlights sociodemographic factors, social drivers of health (SDOH), behavioral health risk factors, and other key indicators to further guide the development of effective strategies to meet evolving needs. In addition to collecting key demographic secondary data, research also focused on the SDOH. The SDOH includes a wide range of factors, including, but not limited to, income, education, job security, food security, housing, basic amenities, the environment, social inclusion and non-discrimination, and access to quality affordable health care. The top priority was identified through the modified delphi technique with our advisory council and internal leaders. The assessment identified 49 community needs, with "Access to Providers" emerging as the top priority area. This includes several subcategories:- Shortages of various provider types (primary care, specialists like endocrinology, OBGYN, pediatrics, rheumatology, neurology, podiatry) - Need for community health workers and peer support specialists - Improving cultural competency of providers - Addressing community mistrust of providers The report defines "providers" broadly to include anyone within the health system who interacts with patients or community members (nurses, front desk staff, cafeteria workers, environmental services). Three Rivers Health Part V, Section B, Line 6a: Three Rivers Health (TRH) developed the 2024 St. Joseph County CHNA in partnership with Elkhart General Hospital, Community Hospital of Bremen, and Memorial Hospital South Bend, Beacon Health System (BHS) care partners. Three Rivers Health Part V, Section B, Line 7d: The Community Health Needs Assessment (CHNA) was made widely available to the community through posting on the Beacon Health System website at https://impact.beaconhealthsystem.org/chna/ and through email transmission upon request. Hospital staff were also available to discuss the results of the CHNA and implementation strategies in requested community forums. Three Rivers Health Part V, Section B, Line 11: In partnership with the Branch-Hillsdale-St. Joseph Department of Health and other community partners, there is a focus on maternal and child health and mental health. For the mental health objectives in the CHIP, raising awareness about Pivotal, the Certified Community Behavioral Health Clinic (CCHBC) in St. Joseph, Michigan, needs improvement. Pivotal states they have not launched an awareness campaign before due to a lack of funding. Beacon funded a marketing campaign to help raise awareness that all residents can access behavioral health services at Pivotal, which will in turn increase mental health care access for St. Joseph County residents. The other priority area, maternal and child health, seeks to improve knowledge and use of the Women, Infant and Children's (WIC) program in St. Joseph County, Michigan. The work plan below provides detail on we will increase knowledge through sharing information with new birth parents, developing a marketing campaign to strengthen awareness of WIC, provide incentives when currently enrolled families need to recertify in the program, and promoting breastfeeding with support groups and items that support breastfeeding. A USDA 2023 report showed that only about 51% of those eligible actually participate in WIC, a program that is vital to the health and well-being of nearly half our nation's babies along with millions of young children up to age 5 and their mothers. Mental Health Metrics % of the population with frequent mental health distress % of the population with two or more trusted support people Healthcare Access Metrics % of the population with health insurance (adults < 65 and children) % of adults who reported their healthcare providers always involved them in decisions about their care, as much as they wanted. Beacon Community Impact provided community resources to 59,738 individuals across our service area Elkhart, Marshall, and St. Joseph, IN Counties and St Jospeh County, Michigan in 2024. Within Beacon Health System, the Beacon Community Impact Department leads efforts impact our priority areas of mental health and healthcare access using a combination of internal programs and collaborative partnerships. Our implementation strategy incorporates a three-pronged approach: We provide direct services to clients through Beacon's Early Childhood Services and Community Health Services teams. Early Childhood Services include the St. Joseph County (Ind.) WIC program, two sickle cell programs and our Family & Infants Support Program. These programs focus on the health status of women, infants and young families, particularly the most vulnerable in Beacon's service area. Our Community Health Services team focuses on prevention through community health educators with school curricula delivered throughout middle and high schools in the three Indiana counties we serve. Summer programming shifts to health-related day camps and participation at community health fairs. Though it may not be their primary focus, these community health teams screen for and provide referrals for clients experiencing mental health challenges. Likewise, they emphasize the importance of trusted adults as protective factors for youth. We fund local community organizations with expertise in their service areas. These organizations are community nonprofits with boots-on-the-ground services in the most vulnerable neighborhoods and more diverse populations. Each of the funded partners addresses the top two health priorities and reports on the number of participants and on an outcome metric for either mental health or healthcare access. In addition, Beacon partnered with the local health department in Three Rivers, Michigan, to support building out their Community Health Worker Program to increase services addressing healthcare access and mental health. Participating organizations Community partners - Center for Healing and Hope - diabetes support program - Child and Parent Services, Inc. (CAPS) - maternal and infant health support - Healthy Beginnings (Elkhart County Health Department) - maternal and infant health support - Mental Health Awareness of Michiana (MHAM) - behavioral and mental health - United Health Services - healthcare navigation - La Casa de Amistad - social service support - Maple City Health Care - maternal infant health support - Transformation Ministries - youth advocacy and support - Gentleman and Scholars, Inc. - youth advocacy and support - Imani Unidad - health literacy and case management - Horizon Education Alliance - health literacy and case management - Branch-Hillsdale-St. Joseph Community Health Agency, Health Department Beacon Community Impact Programs - Beacon Health Navigator - Family and Infant Support Program (FISP) - Health and Wellness Programs - Sickle Cell Infant Screening - Sickle Cell Broadscope - Women, Infants and Children (WIC) Clinic. Three Rivers Health Part V, Section B, Line 13h: The policy allows for patients to qualify for assistance by two means: financial or catastrophic. The financial assistance program also allows for partial assistance or full assistance based on eligibility criteria in this policy.Financial assistance1. A patient qualifying for financial assistance is a person who is uninsured or underinsured, receives care and unable to pay their bill.2. To be eligible for assistance under the financial assistance guidelines, a person's income shall be at or below a percentage of the federal poverty level (FPL) as determined by federal poverty guidelines. Household size and income determines the % of FPL. Three Rivers Health System, or its designee, may consider other financial assets and liabilities of the person when determining eligibility.3. Three Rivers Health System will use the most current poverty income guidelines issued by the U.S. Department of Health and Human Services to determine an individual's eligibility for financial assistance. The poverty income guidelines are published annually in the federal register and for the purposes of this policy will become effective the first day of the month following the month of publication.4. To qualify under the financial assistance portion of this policy, a completed, signed financial assistance application must be submitted and proof of income, proof of no income, proof of lack of financial assets and other required documents must accompany the application. 15 1 - Three Rivers Health Center for Wound 721 S Health Parkway Three Rivers MI 49093 Wound Care 2 - Three Rivers Health Family Internal Med 711 S Health Parkway Three Rivers MI 49093 Rural Health Clinic - Internal Medicine, Family Care, and 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 Health Orthopedics 1021 Hill Street Suite 300 Three Rivers MI 49093 Orthopedics 7 - Three Rivers Health Homecare 711 S Health Parkway Three Rivers MI 49093 Homecare 8 - Three Rivers Health Surgical Services 715 S Health Parkway Three Rivers MI 49093 Surgical Services 9 - Three Rivers Health Family Care 601 E Chicago Rd PO Box 295 White Pigeon MI 49099 Rural Health Clinic 10 - Three Rivers Health iMed 16587 Enterprise Dr Three Rivers MI 49093 Urgent Care Center 11 - Three Rivers Health Hospice 711 S Health Parkway Three Rivers MI 49093 Hospice Care 12 - Three Rivers Health Center for Family 850 S Health Parkway Three Rivers MI 49093 Other Outpatient Clinic 13 - Three Rivers Health Family Care 110 East Main St Marcellus MI 49067 Other Outpatient Clinic 14 - Three Rivers Health Sleep Clinic 701 S Health Parkway Three Rivers MI 49093 Other Outpatient Clinic 15 - RHC Paws Clinic 721 6th Avenue Suite A Three Rivers MI 49093 Pediatric Clinic Part I, Line 3c: Household size and incomeThe following factors may be considered in determining the eligibility of the patient for assistance and must be provided by all income earning residents in the countable household unit unless they are not dependents based on IRS guidelines for determining whether a household member can be considered a dependent.1. Indiana workforce wage report for last 2 quarters (unemployment income).2. Last 3 pay stubs or a letter or printout from employer(s) providing verification of gross income if currently employed. This documentation should not be more than 30 days old from date of issue and include year-to-date information.3. Last 3 bank statements (including explanations of regular deposits not explained by pay stubs).4. Social Security award or entitlement letter or other proof of gross monthly award.5. Retirement income.6. Investment income.7. Statement from person(s) that are providing direct support.8. Number of dependents.9. Most recent tax return (including W2 and all supporting schedules).10. Other financial obligations.11. The amount and frequency of hospital/medical bills.12. Other financial resources that produce income.13. If self-employed, gross income less cost of goods sold and employeesalaries.Financial capacity1. Individuals with the financial capacity to purchase health insurance coverage through the health insurance marketplace may be required to purchase and will be provided access to meet with an Indiana certified navigator as a means of assuring access to healthcare services, for their overall personal health, and for the protection of their individual assets.2. Individuals found to be ineligible for Medicaid or other affordable health care coverage must provide proof of denial.3. Food stamps or supplemental nutrition assistance program (SNAP) will not be counted as income.4. Cosmetic services are not eligible for any type of assistance and cannot be included in the amount of hospital/medical bills owed. Part I, Line 6a: Beacon Health System (EIN: 45-3864076) prepared the annual community benefit report. Part I, Line 7: The costing method used to calculate financial assistance reported on Lines 7 a through d was the cost-to-charge ratio as derived on tax form 990, Schedule H, worksheet 2. All other community benefits were calcualted using direct costs. 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 $ 4,773,776. Schedule H, Part I In 2024, TRH received a large Medicaid Quality Assurance Assessment Payment (QAAP) that included payments related to prior years. The total QAAP payment received as approximately $1,790,000 related to years prior to 2024. Without the QAAP payments related to prior years, the Net Community Benefit Expense would have been $(594,002), -.86% of total expense. Part II, Community Building Activities: The St. Joseph County Human Services established itself as the multi-purpose collaborative body for St. Joseph County, ensuring that resources are used cooperatively and efficiently by all residents. The TRH Vice President of Operations attends meetings regularly. The mission of the St. Joseph County Human Services Commission is to coordinate and leverage collaborative efforts to improve the quality of life for all citizens. Collaboration benefits the community and fosters innovation, which are tracked and evaluated with outcome measures. Coordination ensures that clients needing services from multiple agencies receive them as efficiently and effectively as possible, and all residents should have access to opportunities that improve their quality of life. 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 $192,801 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 $192,801 should be considered a community benefit. Part III, Line 4: The provision for bad debts is based upon management's assessment of historical and expected net collections taking into consideration the trends in health care coverage, historical economic trends, and other collection indicators. Management assesses the adequacy of the allowances periodically throughout the year based upon historical write-off experience by major payor category. The results of the review are then utilized to make modifications, as necessary, to the provision for bad debts to provide for an appropriate allowance for uncollectible accounts. A significant portion of the corporation's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the corporation records a significant provision for bad debts related to uninsured patients in the period the services are provided. 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 commercial 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: TRH reviews the health indicators of the county and completes community surveys. TRH assesses whether we have a shortage of physicians in the area annually as well. TRH reviews trends of our patient activity by service and type of patient to see if adjustments in service or resource allocation need to be made. TRH also reviews satisfaction surveys periodically to identify any potential gaps in services. TRH partners with the local schools and community mental health on specific health initiatives throughout the year. Beacon Community Impact formed the first Community Health Advisory Council in 2016. Still operating on an as needed basis today the Council consists of representation from Community Hospital of Bremen, Elkhart General Hospital, Memorial Hospital of South Bend, and Three Rivers Health. The council is made up of individuals from Beacon Health System and community stakeholders (i.e. Council at Large, Public School Systems, other Health Care entities, Indiana University South Bend, University of Notre Dame, Ivy Tech Community College, community organizations, local churches, community persons, etc.). The Advisory Council met monthly in 2024 following the MAPP 2.0 training during the Community Health Needs Assessment (CHNA) procedures and will meet 2-4 times per year to learn about community health, the CHNA process, and to review local hospital and community data collected regarding health in our community; there are periodic email communications as well. The Advisory Council provides input on the health priority areas, offers best practices, identifies areas of opportunities, and monitors progress on addressing health needs. 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: Three Rivers Health presently serves St. Joseph County, along with other providers. As stated by the U.S. Census Bureau, the county's total population is 60,878 (year 2023). 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 County is approximately 521 square miles in size. US 12 and US 131 are two major highways that run through St. Joseph, MI. It is approximately 20 miles south of Kalamazoo, MI. The unemployment rate continues to be high (5.3%), and the population with Medicaid in the community is high (20%). Additionally, people with coverage have also increased. According to the Michigan Department of Health, St. Joseph County ranks 61st out of 83 counties in the state for health status. While the community is classified as rural and 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 alongside collaborating with the local health department to address the social drivers of health. Elkhart, Marshall and St. Joseph Counties are all located in Northern Indiana. They have a total of 6 cities and 16 towns with a combined population of 525,609. St. Joseph is the largest and Marshall the smallest, which is classified as rural. St. Joseph County, Michigan borders Elkhart County, Indiana and is similar in rural classification as Marshall County. Although each varies in population density, they are closer in geographic size (SJC, IN-457 square miles, Elkhart-463, Marshall-443, SJC, MI-521). The median household income (2018-2022) is comparable across Beacon's service area counties, with Marshall County leading at $66,016, followed by Elkhart County at $63,978, St. Joseph County, MI at $62,281, and St. Joseph County, IN at $61,877 - all below the U.S. median of $75,149. Poverty rates vary, with St. Joseph County, IN experiencing the highest rate at 14.4%, followed by St. Joseph County, MI at 12.9%, Elkhart County at 12.0%, and Marshall County with the lowest at 10.8%. Elkhart County remains the "RV Capital of the World," with the industry generating over $32.4 billion in annual economic impact nationwide and supporting over 18,000 local jobs. Marshall County continues as one of Indiana's agricultural leaders, with over 219,000 acres of farmland generating $171 million in agricultural products. St. Joseph County, IN serves as the regional center for higher education, home to institutions like Notre Dame, Indiana University South Bend, and Saint Mary's College, which have helped transform the local economy from manufacturing to health, education, and service sectors. St. Joseph County, MI maintains its natural beauty with numerous lakes and woodlands, including over 42 lakes and Sturgeon Lake, which spans 220 acres. Part VI, Line 5: In partnership with Beacon Health System (BHS), the mission of Three Rivers Health (TRH) is to deliver outstanding care, inspire health and connect with heart. BHS is committed to clinical excellence, compassionate care, and the ongoing improvement of quality of life. Our commitment will lead BHS to be the community's provider of outstanding quality, superior value and comprehensive health care services. Both BHS and TRH consistently invest funds to improve the quality of life for our communities. BHS values reflect an unwavering commitment to the communities we serve. TRH has as its values: Patients are at the center - Patient needs, care and safety are our top priority. - Trust - Our actions will firmly demonstrate our integrity, abilities and our character. - Respect - We will treat our patients, community members, and each other with the highest level of regard, demonstrating an understanding of different perspectives, cultures, interests and needs of others. - Integrity - We will continually do the right thing for patients, associates, and communities we serve. - Compassion - We will appropriately demonstrate empathy and sympathy, and express the desire to help. TRH seeks to promote the health and well-being of St. Joseph (SJC) residents, with specific focus on the most vulnerable populations, by providing education to aid in early detection and prevention of disease and to improve the health status of the community as a whole. Beacon Health System welcomed Three Rivers Health in Three Rivers, Michigan, to the Beacon family in September 2021. In 2023, Community Impact established a working relationship with the local health department, Branch-Hillsdale-St. Joseph Community Health Agency, to address the top needs in the community. Beacon Health System employs a comprehensive approach to health promotion across its four-county service area, focusing on two priority areas: healthcare access and mental health. This integrated strategy works through community partnerships and internal programs to address social determinants of health and build healthier communities. Part VI, Line 6: In 2011, MHSB affiliated with Elkhart General Hospital of Elkhart, Indiana, under the name of Beacon Health System. In 2018, Beacon Health System affiliated with Community Hospital of Bremen. In October 2021, Beacon Health System affiliated with Three Rivers Health System. All organizations continue as full-care providers for their respective Counties, and they are committed to promoting the health of the communities they serve. The Three Rivers Health board of directors consists of 8 voting board members. The Beacon Health System Board of Directors consists of 14 voting board members. Part VI, Line 7, Reports Filed With States MI Schedule H, Part VI, Line 7 Three Rivers Health Hospital prepares a community benefit report both for the state of Michigan and for the annual report, which is posted at www.beaconhealthsystem.org/chna. 1 Branch-Hillsdale-St Joseph Community Health Agency 570 Marshall Rd Coldwater MI 49036 383411829 501(c)(3) 20000 0 General support 1 0 Part I, Line 2: Donations and grants given to organizations that improve the health and well-being of our community are monitored through outcome measurement reports that are provided to Three Rivers Health by the various organizations. These reports inform us of how the donations and grants were used. X 1 1 0 1 0 0 0 0 0 1 0 Kreg R Gruber CEO 0 1081233 0 557131 0 210350 0 259693 0 28015 0 2136422 0 64523 Jeffrey P Costello CFO 0 626239 0 261724 0 189649 0 166583 0 22015 0 1266210 0 61622 Maria A Behr President 0 260753 0 108933 0 9879 0 93556 0 9305 0 482426 0 0 Erika L Dearing Employed Physician 334237 0 15714 0 22958 0 36800 0 26920 0 436629 0 0 0 Jessica Puckett Employed Physician 348046 0 20422 0 1455 0 36800 0 12843 0 419566 0 0 0 Alyssa Erskine Employed Physician 309368 0 15714 0 15478 0 36262 0 23283 0 400105 0 0 0 James MacDonald Employed Physician 319052 0 714 0 4923 0 43724 0 24496 0 392909 0 0 0 Todd M Ozdych Employed Physician 323652 0 357 0 4923 0 43702 0 13589 0 386223 0 0 0 Hope Bailey Former VP Nursing 202257 0 55049 0 1141 0 39795 0 16110 0 314352 0 0 0 Linda Evans MD Director, Physician 203623 0 714 0 4044 0 16683 0 11040 0 236104 0 0 0 Part I, Line 1a Three Rivers Health System, Inc. offers complimentary health club membership to Beacon Health System's Health and Lifestyle Center, a related party. Health or social club dues for the following individuals was included in taxable compensation: Adam Goff Part I, Line 3 Three Rivers Health System, Inc. uses a related organization's (Beacon Health System, Inc.) compensation review process. This review process includes an extensive examination using comparable market data that is then reviewed by an independent consultant hired by, and reported to, the board of directors. Recommendations are presented to the board for deliberation and final decision. Part I, Line 4b Beacon Health System implemented an executive retention plan to attract and retain key employees by providing additional deferred compensation. The Chief Executive Officer will participate in the plan and will select other participants pursuant to the guidelines set by the employer's board of directors. The employer may make contributions under the plan and has sole discretion over whether to make a contribution. Vesting occurs on January 1 of the fifth year for which such contributions are made for participants who have been continuously employed. The plan also allows vesting to occur if the participant attains the age of 62. The following individuals received vested payments in 2024, reflected in column (b)(iii): -Kreg Gruber, $198,816 -Jeffrey Costello, $130,545 The following individuals received deferred payments in 2024 that will vest in future years, which are reflected in column c: -Kreg Gruber, $215,393 -Jeffrey Costello, $122,283 -Maria Behr, $49,256 Part I, Line 7 The Organization has three incentive plans (employee, management, and executive which have a net operating income to budget measurement for the payout threshold. The employee plan shares the excess over budget net operating income with the non-management employees for Beacon Health System, Inc. and the affiliated entities. The employee incentive has a maximum cap of $4,500,000. The payout and amount of the payout for the employee incentive plan is made at the discretion of the board. The management incentive plan is funded when operating income is equal to or greater than 50% of the budgeted net operating income. Reward amounts are based on a balanced score card methodology utilizing Beacon's strategic imperatives and measured using selected metrics set on a sliding scale defined as threshold 50%, target 100%, and maximum 150%. The strategic imperatives are clinical excellence, great workplace, customer-driven culture, smart growth, and financial sustainability. Each imperative carries a default weight of 20%. The payout of the management incentive is made at the discretion of the board. Executives are covered under the Beacon Health System Executive Short-Term Incentive Plan (ESTIP). The ESTIP is funded when operating income is equal to or greater than 50% of the budgeted net operating income. Reward amounts are based on a balanced score card methodology utilizing Beacon's strategic imperatives and measured using selected metrics set on a sliding scale defined as threshold 50%, target 100%, and maximum 150%. The strategic imperatives are clinical excellence, great workplace, customer-driven culture, smart growth, and financial sustainability. Each imperative carries a default weight of 20%. The payout of the ESTIP is made at the discretion of the board. Form 990, Part VI, Section A, line 6 Beacon Health System, Inc. is 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 organization incorporates numerous parties in the production and review of the form 990 and associated schedules. Senior accounting staff and management complete information for the form 990 and related schedules. Some forms and schedules are reviewed by the controller. Subsequent to those steps, the organization engaged RSM to prepare form 990 and appropriate schedules. Prior to filing the return, the CFO, the audit committee of the organization, and the CEO, conduct a general overview of the form 990, including applicable compensation schedules. In addition, each board member receives notification of the IRS form 990 placement on the Organization's board portals which allows for board member review prior to filing the return. Form 990, Part VI, Section B, line 12c There are three separate forms that are sent out through the internal audit department to key employees or board members regarding conflict of interest. They are as follows: 1. The first is a conflict of interest statement that is sent to senior level administration, management, and select staff such as purchasing department employees. The purpose of the statement is to require these employees to disclose any potential conflict of interests they may have. The statements are sent in January of each year for the previous year activities we pursue the replies to get a 100% response rate. In the current year we sent out 372 statements and are working to achieve a 100% response rate. Each response is reviewed by the director of internal audit and the results are reported to the CEO of Beacon Health System, the audit committee chairman, as well as the audit committee of the board of directors. 2. The second statement is the board duality of interest statement that is sent to current board members, former board members from the last five years, and other key employees. The duality of interest statement is sent using a web based survey tool provided by RSM. The replies are reviewed by the director of internal audit. The results of the surveys are summarized using the web based tool and are reviewed by RSM in completing the 990. The results are reported to the CEO of Beacon Health System, the audit committee chairman, and the audit committee of the board of directors. 3. The third statement is entitled "Code of Ethics for Senior Financial Officers". The statement requires an acknowledgement form to be signed by Beacon Health System's key financial employees that Beacon's financial information is to the best of their knowledge true and accurate. This statement was sent out on March 4, 2025 and the signed acknowledgements are kept by the director of internal audit. In 2024, 31 designated employees were requested to sign the form and we had a 100% compliance rate. Any potential conflicts of interests are reviewed by independent parties both internal and external to the organization, and if necessary, corrective action would be taken to resolve a true conflict. The individual with the potential conflict of interest would be excluded from all review proceedings. Form 990, Part VI, Section B, line 15 Three Rivers Health Systems, Inc.'s parent, Beacon Health System, Inc. has a comprehensive process in place for reviewing and approving compensation of the executive leadership team. This review compares the total compensation provided to each executive to that provided to functionally similar positions in similarly situated organizations. This review is conducted regularly by the board compensation committee in consultation with an independent compensation advisor who is hired by and reports to the board compensation committee. Based on the advice of the compensation advisor and comparable and appropriate market data reported in third-party compensation surveys, and applying the organization's executive compensation philosophy, the board compensation committee makes compensation recommendations regarding the CEO's compensation to the board of directors for approval and the CEO makes compensation recommendation regarding all other members of the executive leadership team to the board compensation committee for approval. Deliberations and final decisions are contemporaneously documented. The annual compensation review was completed by the board compensation committee in March 2025 and the independent compensation advisor provided a statement of reasonableness of the compensation provided to the CEO and executive leadership team members. 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 Professional Fees & Purch. Srvcs: Program service expenses 6,350,273. Management and general expenses 1,059,553. Fundraising expenses 0. Total expenses 7,409,826. Form 990, Part XI, line 9: Write-off Intercompany Balances 1,157,825. Beacon Medical Group Inc 615 N Michigan St South Bend IN 46601 351536132 Physician Practices IN 501(c)(3) Line 10 Beacon Health System Inc 1 Beacon Health Foundation Inc 615 N Michigan St South Bend IN 46601 351536129 Financial Support IN 501(c)(3) Line 7 Beacon Health System Inc 1 Elkhart General Hospital Inc 600 East Blvd Elkhart IN 46514 350877574 Hospital IN 501(c)(3) Line 3 Beacon Health System Inc 1 Community Hospital of Bremen Inc 1020 High Road Bremen IN 46506 350835006 Hospital IN 501(c)(3) Line 3 Beacon Health System Inc 1 Memorial Hospital of South Bend 615 N Michigan St South Bend IN 46601 350868132 Hospital IN 501(c)(3) Line 3 Beacon 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 12c, III-FI N/A 0 Beacon Health System Inc 615 N Michigan St South Bend IN 46601 453864076 Parent Organization IN 501(c)(3) Line 12c, III-FI N/A 0 South Bend Specialty Surgery Center LLC 335 Florence Ave 1B Granger IN 46530 460571418 Ambulatory Surgery Center IN N/A 0 0 Beacon Health Ventures Inc 615 N Michigan St South Bend IN 46601 351901068 Home Medical IN N/A C 0 Beacon Health Ventures Michigan Inc 615 N Michigan St South Bend IN 46601 208259773 Home Medical MI N/A C 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 Beacon Medical Group Inc P 1330762 Actual Charges Memorial Hospital of South Bend Inc P 65954 Actual Charges Beacon Medical Group Inc Q 159978 Actual Charges Beacon Medical Group Inc R 214001 Cash Beacon Medical Group Inc S 956784 Cash Memorial Hospital of South Bend Inc S 61929 Cash