2016-11-14T15:25:36-07:00 2016-03-31 990 2015-04-01 382007629 HAYES GREEN BEACH MEMORIAL HOSPITAL HAYE 5175431050 321 East Harris Street Charlotte MI 48813 Kim Capps Chief Financial Officer 5175431050 2016-11-01 2015 2017-02-10 21:41:12Z Matthew Rush President and CEO 321 East Harris Street Charlotte MI 48813 51069192 0 X www.hgbhealth.com X 1972 MI Hayes Green Beach Memorial Hospital provides needed medical care to the community regardless of the individuals ability to pay. These services are provided to hospital inpatients and outpatients in addition to 24 hour emergency room and ambulance services. 13 11 552 132 0 0 347410 337364 47017449 48870306 348048 304760 1548238 1412571 49261145 50925001 0 0 0 0 25360165 25227986 0 0 263150 24522882 25873967 49883047 51101953 -621902 -176952 71978013 69976653 39103923 37797995 32874090 32178658 To enhance the overall health and vitality of the people and communities we serve. 0 0 3523255 0 5967879 Inpatient care: Hayes Green Beach Memorial Hospital offers inpatient acute care services with admissions of 668 providing 1,746 days of care. 24666606 0 35333204 Outpatient care: which includes laboratory, radiology, physical therapy, respiratory therapy, urgent care and 24 hour emergency care to 83,472 out patients. These included 12,139 emergency room visits, 13,720 urgent care visits, 30,546 radiology procedures, 131,718 laboratory tests and 48,993 therapy procedures. In addition 4,792 ambulance runs were provided. 8518577 0 7569223 Physician practice visits of 55,918 were provided in family practice, internal medicine, orthopedics, general surgery and pain management. 0 0 0 36708438 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 105 0 1 552 1 0 0 0 0 0 0 X 13 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X Kim Capps 5175431050 321 E Harris Street Charlotte MI 48813 Thomas Eveland Secretary 1 0 X X 0 0 0 Fred Darin OD Trustee, Chairmen of the Board 1 0 X X 0 0 0 Charles Grundstrom Vice Chair 1 0 X X 0 0 0 Denise Wheaton Trustee,Treasurer 1 0 X X 0 0 0 Leonore Pray Trustee 1 0 X 0 0 0 Ed Dobbs Trustee 1 0 X 0 0 0 Martin Latchaw Trustee 1 0 X 0 0 0 Sharon Kubica Trustee 1 0 X 0 0 0 Dennis Swan Trustee 1 0 X 0 0 0 Eileen Fhaner Trustee 1 0 X 0 0 0 David Reece Trustee 1 0 X 0 0 0 Barrett Zink DO Trustee/Physician 40 0 X 126438 0 13705 Matthew Rush Trustee/President/CEO 40 0 X X 332332 0 66134 Kim Capps Chief Financial Officer 40 0 X 172625 0 20000 Kimberly Friar Physician 40 0 X 383677 0 15080 Scot Randall Physician 40 0 X 595559 0 15681 Erica Magers Physician 40 0 X 500710 0 15220 Todd Otten Physician 40 0 X 407234 0 15090 Jeremy Pascotto Physician 40 0 X 600497 0 5437 3119072 0 166347 25 0 1 1 EPMG of Michigan PC 2000 Green Road Suite 300 Ann Arbor MI 48105 Emergency Department Physicians 708658 AHNI Leasing Company LLC 100 Bayview Circle Ste 400 Newport Beach CA 92660 Equipment Leasing 689866 Lansing Surgical Associates PLLC 2720 S Washington Ave Lansing MI 48910 General Surgeon Surgical Services 262420 Leidos Health LLC 705 East Main Street Westfield IN 46074 IT Consulting Services 240778 Charles E Viele Jr Charles Viele Construction 1295 Battle Creek Road Charlotte MI 48813 Construction Services 233561 16 0 0 0 0 0 337364 0 337364 Services to Inpatients 622110 5967879 5967879 0 0 Services to Outpatients 622110 35333204 35333204 0 0 Physician Practice Services 622110 7569223 7569223 0 0 0 0 0 0 48870306 304760 0 0 304760 0 0 0 0 0 0 0 0 223552 0 133639 0 89913 0 89913 0 0 89913 0 0 27986 0 10552 17434 0 17434 Cafeteria Revenue 900099 100016 0 0 100016 1205208 0 0 1205208 1305224 50925001 48870306 0 1717331 X 0 0 0 0 0 0 0 0 505273 0 505273 0 0 0 0 0 20649315 17011685 3506913 130717 172574 142134 29346 1094 2595556 2137736 441368 16452 1305268 1075037 221958 8273 0 0 0 0 111387 0 111387 0 65360 0 65360 0 2990 0 2990 0 0 0 35000 0 35000 0 7279123 5374167 1819571 85385 161234 161234 0 2445944 1376196 1069365 383 0 0 0 0 0 0 0 0 1002098 0 1002098 0 111606 42188 69418 0 0 0 0 0 0 0 0 1697522 0 1697522 0 0 0 0 0 3258031 722554 2525359 10118 860903 138045 722858 0 Medicaid QAAP/Uncompensated Care 1263871 1263871 0 0 Medical Supplies 5508077 5508077 0 0 Recruitment 1524 1524 0 0 Bad Debt Expense 1801679 1801679 0 0 267618 113545 143345 10728 51101953 36708438 14130365 263150 2966785 2765731 6570579 4241000 587360 429961 6416115 6158740 304323 640715 1148435 1141800 3985739 3732544 81156207 42460015 39478276 38696192 10485121 11954701 35280 215269 71978013 69976653 3987636 3697289 34155072 33272430 961215 828276 39103923 37797995 X 31105655 30643014 673983 499329 1094452 1036315 32874090 32178658 71978013 69976653 X -176952 -672551 0 0 0 154071 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 2990 2990 0 Schedule C, Part II-B, Line 1 Portion of Michigan Hospital and American Hospital Association's annual dues spent on lobbying. 1094452 0 -58137 0 0 0 1036315 1066079 0 28373 0 0 0 1094452 969976 0 96103 0 0 0 1066079 933302 0 36674 0 0 0 969976 901683 0 31619 0 0 0 933302 0 1 0 1 0 0 2673036 2673036 0 54504733 24497535 30007198 0 0 0 0 0 23902768 17962480 5940288 0 75670 0 75670 38696192 0 Estimated Third-Party Payor Settlements 828276 828276 X 48450771 -672551 0 0 0 -672551 49123322 0 1801679 1801679 50925001 49300274 0 0 0 0 0 49300274 0 1801679 1801679 51101953 Schedule D, Part V, Line 4 Permanent endowment funds, donor restricted, with the stipulation that the principal must be invested and kept intact, only the income generated each year from the funds is used for operations by Hayes Green Beach Memorial Hospital. Schedule D, Part X, Line 2 The Hospital is a nonprofit, tax exempt organization and, accordingly, no tax provision is reflected in the financial statements. The accounting standard that refers to accounting for uncertainty in income taxes addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded on the financial statements. Organizations must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The standard also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods, and requires increased disclosure. The evaluated potential exposure related to uncertain tax position was found to be immaterial. Schedule D, Part XI, Line 4b Provision for Bad Debt included as a revenue deduction on audited financial statements and included as an expense on Form 990. Schedule D, Part XII, Line 4b Provision for Bad Debt included as a revenue deduction on audited financial statements and included as an expense on Form 990. 2015 GALA 27986 0 27986 0 0 0 0 0 10552 0 0 27986 0 27986 0 0 0 0 0 10552 10552 17434 1 1 X 1 X 1 X 2.25 1 1 0 1 1 0 0 306341 0 306341 0.01 0 0 7442859 5431130 2011729 0.04 0 0 0 0 0 0 0 0 7749200 5431130 2318070 0.05 0 0 145476 0 145476 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 145476 0 145476 0.00 0 0 7894676 5431130 2463546 0.05 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21078 0 21078 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21078 0 21078 0 1 1801679 90084 9244029 9157987 86042 X 1 1 1 1 Hayes Green Beach Memorial Hospital 321 East Harris Street Charlotte MI 48813 www.hgbhealth.com 1060000163 X X X Physician practices, Internal Medicine, Family Practice, Pain Management and General Surgery. Hayes Green Beach Memorial Hospital 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X www.hgbhealth.com 1 16 1 www.hgbhealth.com 0 0 1 X 1.5 2.25 X X X X 1 1 X X X 1 X http://www.hgbhealth.com/patients-visitors/patients/questions-about-your-bill X http://www.hgbhealth.com/patients-visitors/patients/questions-about-your-bill X http://www.hgbhealth.com/patients-visitors/patients/questions-about-your-bill X X X X X 1 X 1 X X X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Hayes Green Beach Memorial Hospital The primary method of determining the health needs of the region was through focus groups and community dialogue sessions hosted in numerous communities including Charlotte and Eaton Rapids. Upon completing the assessment, HGB, as well as other participating hospitals, validated these findings by conducting both a written and electronic survey listing all key priority areas identified. This validation process provided an opportunity for HGB physicians, employees and Board of Trustees to provide input on determining the top three priorities. Schedule H, Part V, Section B, Line 6a-Hayes Green Beach Memorial Hospital The hospital facility's Community Health Needs Assessment was conducted in collaboration with Eaton Rapids Medical Center, McLaren Great Lansing and Sparrow Health System. Schedule H, Part V, Section B, Line 6b-Hayes Green Beach Memorial Hospital The hospital facility's Community Health Needs Assessment was conducted in collaboration with Barry Eaton Health Department. Schedule H, Part V, Section B, Line 11-Hayes Green Beach Memorial Hospital The hospital's Community Health Needs Assessment is a three year plan and therefore resources will be allocated over that time period so not all community needs identified have been addressed to date. In addition, some of the communities needs will be addressed in collaboration with other agencies. Schedule H, Part I, Line 7 Used Worksheet 2 provided in Schedule H instructions to calculate cost to charge ratio related to patient care. Schedule H, Part I, Line 7, Column f The denominator is based on the total expenses shown on Part IX less bad debt expense of $1,801,679. Schedule H, Part II Hayes Green Beach Memorial Hospital takes an active role in supporting community organizations and activities that can positively impact community health and prevention as well as economic development efforts that will foster support for resources needed by healthy communities. Some examples include providing staff resources and rooms for participation in the local economic organization CAN DO as well as providing leadership for several regional health initiatives. Schedule H, Part III, Section A, Line 4 Accounts receivable for patients, insurance companies and governmental agencies are based on gross charges. 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 Hospital'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. An allowance for contractual adjustments is based on expected payment rates from payors based on current reimbursement methodologies. This amount also includes amounts received as interim payments against unpaid by certain payors. Bad Debt - For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances for which third-party coverage exists, the Hospital 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 exhauster is charged off against the allowance for doubtful accounts in the period they are determined to be uncollectible. Bad debt expense reported on Line 2 is the bad debt expense reported on the audited financial statements and on Form 990 part XI. The amount reported on Line 3 is a conservative estimate of 5% based on Patient Accounting experience. Schedule H, Part III, Section B, Line 8 No Medicare shortfall calculated in the current year. Medicare allowable costs and Medicare reimbursement from the Medicare cost report were used to arrive at the amounts on line 5 & 6. Schedule H, Part III, Section C, Line 9b If a patient qualifies for financial assistance the amount they owe will not exceed 115% of the amount allowed by Medicare. Additionally patients may be eligible for charity care in which up to 100% of the balance will be written off to charity care. Schedule H, Part VI, Line 2 Hayes Green Beach Memorial Hospital has assessed the health care needs of the community through the development of the Community Health Needs Assessment that was compiled in collaboration with four hospital systems and local health departments. In addition, Hayes Green Beach Memorial Hospital also assesses the health care needs of the communities we serve by utilizing data collected both internally and from a variety of external sources including the Michigan Hospital Association, Michigan Department of Community Health, Barry-Eaton Health department, local social service agencies, and our payors. The Barry-Eaton Health Department completed a behavioral risk Factor Survey which sought to measure the health status, risk behaviors, clinical preventative care practices and chronic disease rates of Barry and Eaton County residents. The survey provided crucial data to identify priority health issues in our community. The results of the survey have been used in planning efforts and effective targeting of resources to support intervention programs. In addition, the Hospital utilized the health statistics and reports published by the Michigan Department of Community Health (MDCH). These reports show state, county and community level data for such statistics as infant mortality, cancer incidence and mortality, communicable disease and leading hospitalizations. This information is useful to identify emerging health issues and hospital trends so that health programs can be targeted. Schedule H, Part VI, Line 3 Hayes Green Beach Memorial Hospital strives to inform and educate our patients or guarantors regarding eligibility for assistance under federal, state or local government programs or under the hospital's charity care policy. We employ a full time Patient Account Representative who is responsible for addressing payment questions from patients and assisting with payment arrangements, completing paperwork to qualify for charity care or completing forms for government assistance. Our billing statements also encourage patients who are unable to pay the amount due to call and discuss payment arrangements or other financial assistance including charity care. Our website also references the number to call for payment assistance. In addition, we have a Patient Rights and Responsibilities brochure that is given to every inpatient and made available to outpatients. It states that "you are entitled to receive and examine an explanation of your bill and to receive, upon request, information relating to financial assistance available through the hospital". Schedule H, Part VI, Line 4 Hayes Green Beach Memorial Hospital is located in central Michigan approximately 22 miles southwest of Lansing. HGB is also in close proximity to Michigan State University and General Motors assembly facility. Charlotte is county seat for Eaton County and is the primary service area for the hospital. There are over 108,000 people in the county with 20,000 in the hospital's primary service area. The median household income for Eaton County is $55,223 and for Charlotte it is $43,163. 9.8% of people in Eaton County are below the poverty level compared to 15.8% in Michigan. Schedule H, Part VI, Line 5 The mission of Hayes Green Beach Memorial Hospital is to enhance the overall health and vitality of the people and communities we serve. The hospital has a long and successful history of reinvesting surplus funds in expanding its services to meet the current and anticipated health care demands of the community. In 2000, the Hospital constructed a 20,000 square foot replacement medical office building designed to not only provide state of the art facilities, but to also recruit new physicians and provide new services for the community such as dialysis. Thereafter, in 2005, HGB completed a 45,000 square foot addition to relocate beds, as well as the radiology and emergency departments. Most recently the Hospital purchased an abandoned grocery store which was an eye sore in the community and has revitalized it into a Health park which includes outpatient rehabilitation, a walking path and gym for community use. In FY 2016 178,964 people visited our Health park and 15,576 are L!NK cardholders - 50% of which reside outside of the facility's zip code. The Hospital is governed by a thirteen member Board of Trustees with varying backgrounds and eleven are neither employees or contractors of the organization. The organization extends medical staff privileges to all qualified physicians in its community. The medical staff of HGB consists of active staff members in specialties including emergency medicine, family practice, internal medicine, orthopedics, general surgery, urgent care, anesthesia, OB/GYN, pathology and radiology. Schedule H, Part VI, Line 6 N/A Schedule H, Part VI, Line 7 N/A X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Matthew Rush Trustee/President/CEO 332332 0 0 0 0 0 0 0 66134 0 398466 0 0 0 Kim Capps Chief Financial Officer 172625 0 0 0 0 0 700 0 20000 0 193325 0 0 0 Kimberly Friar Physician 182998 0 200679 0 0 0 700 0 15080 0 399457 0 0 0 Scot Randall Physician 182998 0 412561 0 0 0 0 0 15681 0 611240 0 0 0 Erica Magers Physician 182998 0 317712 0 0 0 0 0 15220 0 515930 0 0 0 Todd Otten Physician 183019 0 224215 0 0 0 700 0 15090 0 423024 0 0 0 Jeremy Pascotto Physician 600497 0 0 0 0 0 0 0 5437 0 605934 0 0 0 Schedule J, Part I, Line 1a Local Country Club dues of $344 paid for Matthew Rush per employment contract. These dues are not added to Matthew Rush's taxable income. The Country Club is used for business purposed only. Schedule J, Part I, Line 3 Annually Quorum Health Resources engages the Hospital Board of Trustees to individually evaluate the CEO. This data is then shared with the Board as a whole. Salary for the CEO is based on both national and regional surveys based on revenue size, length of service and performance. Quorum Health Resources recommends to the Board a salary range. However the final decision is ultimately the Board of Trustees decision. Form 990, Part VI, Section A, Line 3 Hayes Green Beach Memorial Hospital's CEO, Matthew Rush is employed by Quorum Health Resources. Quorum Health Resources was paid a total of $725,335 in FY 2014, 398,466 was CEO salary and benefits and $326,869 was for management services. Form 990, Part VI, Section B, Line 11b Form 990 is prepared by the Hospital's Finance Department. A copy is given to each Board member via a secure e-mail and a hard copy is made available upon request. Form 990, Part VI, Section B, Line 12c Conflict of interest policy is regularly and consistently monitored and enforced through annual review of policy and orientation of new trustees to organization policies. In addition to annual review of policy, trustees and persons in leadership roles are required to disclose annually interests that could give rise to conflicts of interest. The conflict of interest policy covers all trustee and persons in leadership roles in the organization. Any trustee with a potential conflict of interest is not allowed to vote on any matters in which the conflict comes into play. In addition, prior to decision making or deliberation session, management attempts to identify any potential conflict issues and ensure appropriate actions are taken. The organization also has an active compliance officer and compliance committee to assure hospital policies is followed. Form 990, Part VI, Section B, Line 15 In 2013 Quorum Health Resources engaged the hospital Board of Trustee to individually evaluate the CEO. This data was than shared with the Board as a whole. The Board of Trustees set the compensation for the CEO based on both national and regional surveys based on revenue size, length of service and performance. Quorum Health Resource recommends to the Board a salary range. However the final decision is ultimately the Board of Trustees. In 2016 regional and health compensation studies were completed for all job classifications. Compensation adjustments were made for classifications that were not comparable to other areas. Other Executive compensation is based on market share information from Michigan Hospital Association. Form 990, Part VI, Section C, Line 19 Governance documents and conflict of interest policy made available upon advice of attorneys. Financial statements made available upon request. Form 990, Part IX, Line 11g Contract Ed Physician $708,658; Laboratory reference fees $515,027; Pharmacy management fees $270,594; Hospitalist fees $203,807; orthopedic resident fees $167,854; MRI equipment and staff fees $729,233; Respiratory therapy professional fees $255,511; collection fees $427,675; med/surg contract labor $65,444; Emergency room contract labor $130,482; Laundry and linen $103,357; Medical Record contract labor $214,007; Payments to Independent Providers $1,110,763; Audit and finance consulting fees $225,031; and Other fees $246,724. Form 990, Part XI, Line 9 Temporarily restricted contributions = $166,496, net loss in fair value of perpetual trust = ($58,137) and other adjustments = $45,712.