2014-11-17T15:56:41-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2013-01-01 451257972 THREE RIVERS HEALTH SYSTEM INC THRE 2692781145 701 S HEALTH PARKWAY THREE RIVERS MI 49093 STEVE ANDREWS CFO 2692781145 2014-11-17 1 CAROL LALONDE CPA P00181637 2695674500 2013 2015-11-30 17:44:51Z THREE RIVERS HEALTH STEVE ANDREWS 701 S HEALTH PARKWAY THREE RIVERS MI 49093 41769580 0 X WWW.THREERIVERSHEALTH.ORG X 2011 MI SEE SCHEDULE O. 11 11 544 87 0 0 0 581 0 41855486 0 -9259 0 -77228 0 41769580 0 0 0 0 0 18516711 0 0 0 0 25877430 0 44394141 0 -2624561 0 19329742 0 12421418 0 6908324 X THE HOSPITAL'S MISSION IS TO PROVIDE ACCESS TO HIGH QUALITY HEALTHCARE TO OUR COMMUNITY. 1 0 36965076 41855486 GENERAL ACUTE SERVICES FOR COMMUNITY INPATIENT AND OUTPATIENT SERVICES. 36965076 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 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 31 0 1 544 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MI X STEVEN T ANDREWS 2692739604 701 S HEALTH PARKWAY THREE RIVERS MI 49093 LAURIE HINES VICE CHAIR 3.00 0.00 X X 0 0 0 LARRY CLARK BOARD CHAIR 3.00 1.00 X X 0 0 0 SUE POTTS TREASURER 3.00 0.00 X X 0 0 0 ANDY GOLDBERGER BOARD MEMBER 3.00 0.00 X 0 0 0 DIANA DEGRAAF BOARD MEMBER 3.00 0.00 X 0 0 0 PAT HENDERSON BOARD MEMBER 3.00 1.00 X 0 0 0 GARRETT HALL BOARD MEMBER 3.00 0.00 X 0 0 0 RAY BENDURE BOARD MEMBER 3.00 0.00 X 0 0 0 JOHN TOUSE BOARD MEMBER 3.00 0.00 X 0 0 0 JACKIE BOWEN BOARD MEMBER 3.00 0.00 X 0 0 0 HENRI'ETTA TOLBERT BOARD MEMBER 3.00 0.00 X 0 0 0 LINDA EVANS MD CHEIF OF STAFF 0.00 40.00 X 0 196506 38968 WILLIAM RUSSELL PRESIDENT/CEO 40.00 4.00 X 238103 0 72946 STEVE ANDREWS CHIEF FINANCIAL OFFICER 40.00 4.00 X 171938 0 57689 HOPE BAILEY VICE PRESIDENT 40.00 3.00 X 104633 36427 34864 MIKE PULFORD CRNA 40.00 0.00 X 128973 48448 38574 LEONARD DARLING PHARMACY MANAGER 40.00 0.00 X 92127 36764 28121 DOUG ZEHNER PHARMACIST 40.00 0.00 X 84642 31834 29620 DAVE PARKS IT MANAGER 40.00 0.00 X 75482 27462 30417 KATHARINE GAJ OP PT MANAGER 40.00 0.00 X 74902 27464 34123 970800 404905 365322 6 0 1 0 BORGESS MEDICAL CENTER 1521 GULL ROAD KALAMAZOO MI 49048 LAB, LAUNDRY, IT SERVICES 1001809 QHR 105 CONTINENTAL PLACE BRENTWOOD TN 37027 MANAGEMENT SERVICES, SALARIES 835554 REHAB CARE GROUP PO BOX 502096 ST LOUIS MO 63150 REHAB MANAGEMENT SERVICES 579253 LABATORY CORPORATION PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 222024 PLANTE & MORAN LLC 1111 MICHIGAN AVE SUITE 100 EAST LANSING MI 48823 ACCOUTING SERVICES 153395 10 581 581 NET PATIENT REVENUE 621110 37348665 37348665 OTHER PROGRAM REVENUE 621110 4506821 4506821 41855486 -11365 -11365 -141429 0 -141429 -141429 -141429 2106 0 2106 2106 2106 CAFETERIA/VENDING 900099 37736 37736 MISCELLANEOUS 900099 26465 26465 64201 41769580 41855486 0 -86487 X 175923 175923 13900784 11648534 2252250 139624 125662 13962 3265996 2939396 326600 1034384 930946 103438 819179 245754 573425 204751 204751 64956 12991 51965 4183 4183 12304 12304 6017341 3434496 2582845 11670 3925 7745 57431 57431 628005 628005 119549 119549 128004 128004 2029242 2029242 468777 46794 421983 BAD DEBT EXPENSE 5602100 5602100 MEDICAL SUPPLIES 4129841 4016529 113312 PHYSICIAN FEES 3566112 3566112 EQUIP RENTAL AND MAINTE 1933204 1393952 539252 80781 80781 44394141 36965076 7429065 0 0 781794 0 5674266 0 1099853 0 1028661 46361131 36231087 0 10130044 0 481865 0 117626 0 15633 0 19329742 0 6861393 0 4791422 0 0 768603 0 12421418 X 0 0 0 0 0 6908324 0 6908324 0 19329742 X -2624561 9532885 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 6177 6177 0 PART II-B, LINE 1: A PORTION OF MHA DUES IS ALLOCATED TO LOBBYING EXPENSE. 219500 219500 21220968 14969041 6251927 24920663 21262046 3658617 10130044 COST REPORT SETTLEMENTS PAYABLE 768603 768603 X PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL, TRAH PROPERTIES, AND THREE RIVERS HEALTH FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. IHS AND PHO ARE DEEMED CORPORATIONS AND FILE 1120S WITH NO TAX DUE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGRANIZATION AND HAS CONCLUDED THAT AS OF DECEMEBER 31, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMEBER 31, 2010. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 0 559142 559142 0.01440 9372980 5190043 4182937 0.10780 9932122 5190043 4742079 0.12220 65635 65635 0.00170 139732 139732 0.00360 3096949 2832135 264814 0.00680 3302316 2832135 470181 0.01210 13234438 8022178 5212260 0.13430 1 5602100 900000 8143956 9673313 -1529357 X 1 1 1 1 THREE RIVERS HEALTH 701 S HEALTH PARKWAY THREE RIVERS MI 49093 X X X THREE RIVERS HEALTH 1 1 X X X X X X X X X 12 1 1 1 X WWW.THREERIVERSHEALTH.ORG X X X X X X X X 0 0 1 1 250.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 THREE RIVERS HEALTH PART V, SECTION B, LINE 1J: 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 3: INITIALLY, WE DEPLOYED A NEEDS ASSESSMENT SURVEY WITHIN THE LOCAL POPULATION FOR ANY RESIDENT TO COMPLETE. WE RECEIVED INPUT FROM 620 AREA RESIDENTS. IT WAS AN INTERNET BASED SURVEY THAT WAS PROMOTED VIA ADVERTISING, AND THROUGH LOCAL CIVIC AND HEALTH ORGANIZATIONS. PRELIMINARY CONCLUSIONS WERE THEN PRESENTED TO A LOCAL GROUP OF EXPERTS, WHO WERE ASKED TO VALIDATE PRIOR ASSESSMENTS, AND TO ESTABLISH PRIORITY AMONG VARIOUS IDENTIFIED HEALTH AND MEDICAL ISSUES. WHEN THE FINAL ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL GROUP OF EXPERTS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. SOME OF THE OTHER LOCAL ORGANIZATIONS THAT HELPED WITH THIS PROCESS WAS 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 4: STURGIS HOSPITAL THREE RIVERS HEALTH PART V, SECTION B, LINE 5D: ACCESS VIA THE WEBSITE WAS THE PRIMARY MEANS, AND BY WORD OF MOUTH REPRESENTATION FORM OUR BOARD MEMBERS. THREE RIVERS HEALTH PART V, SECTION B, LINE 6I: THE HOSPITAL'S BOARD OF DIRECTORS HAS ADOPTED THE CARVER MODEL OF GOVERNANCE, WHICH HELPS THE BOARD FOCUS MORE ON OUTCOMES, RATHER THAN ON DAY TO DAY OPERATIONS. THIS MODEL HAS ENABLED THE BOARD TO FOCUS ON COMMUNITY HEALTH INITIATIVES EXTENSIVELY FOR THE LAST 6-8 YEARS. THE CHNA ONLY FURTHER EMPHASIZES THE MISSION OF THE LOCAL HOSPITAL, AND ALSO THE REASON FOR THE EXISTENCE OF THE ORGANIZATION. THREE RIVERS HEALTH PART V, SECTION B, LINE 7: THE SURVEY IDENTIFIED 23 AREAS THAT WERE PROBLEMS. THESE WERE RANKED ACCORDING TO PRIORITY, AND IMPLEMENTATION STRATEGY. THERE WERE 7 CATEGORIES THAT RANKED AS A LOW PRIORITY, AND LOW IMPLEMENTATION RESPONSIBILITY. THE FOLLOWING SEVEN AREAS WERE: PALLIATIVE CARE, DRINKING, MOTOR VEHICLE DEATHS, PREMATURE DEATHS, SELF DESCRIBES HEALTH STATUS, PHYSICAL ENVIRONMENT FACTORS, AND UNINTENTIONAL INJURY. THE OTHER 16 AREAS WILL BE ADDRESSED FIRST, WHILE THESE SEVEN AREAS WILL NOT BE ADDRESSED INITIALLY. THREE RIVERS HEALTH PART V, SECTION B, LINE 10: THE HOSPITAL CONTINUES TO PROVIDE FREE CARE AND USES THE FPG, AS WELL AS ASSETS AVAILABLE TO DETERMINE FREE CAR. THREE RIVERS HEALTH PART V, SECTION B, LINE 11: FPG ARE USED. THREE RIVERS HEALTH PART V, SECTION B, LINE 12I: ASSET LEVELS ARE USED. THREE RIVERS HEALTH PART V, SECTION B, LINE 14G: PUBLICIZED ON WEBSITE AND THROUGHOUT ALL OF OUR FACILITIES. THREE RIVERS HEALTH PART V, SECTION B, LINE 16E: NO COLLECTION EFFORTS ARE STARTED UNTIL ELIGIBILITY FOR FINANCIAL ASSISTANCE IS DETERMINE. THREE RIVERS HEALTH PART V, SECTION B, LINE 20D: FOR PEOPLE THAT ARE NOT ELIGIBLE FOR A FULL DISCOUNT, WE USE THE AVERAGE DISCOUNT THAT MEDICARE AND COMMERCIAL PAYERS GIVE. 3 THREE RIVERS HEALTH FAMILY CARE 677 E MAIN STREET PO BOX 310 CENTREVILLE MI 49032 RURAL HEALTH CLINIC - CENTREVILLE THREE RIVERS HEALTH FAMILY CARE 721 6TH AVENUE STE B THREE RIVERS MI 49093 RURAL HEALTH CLINIC - THREE RIVERS THREE RIVERS HEALTH FAMILY CARE 119 S KALAMAZOO STREET PO BOX 295 CENTREVILLE MI 49032 RURAL HEALTH CLINIC -WHITE PIGEON PART I, LINE 7: COSTING METHODOLOGY IS A COST TO CHARGE RATIO AS DEFINED BY THE IRS INSTRUCTIONS. PART I, LINE 7G: OTHER SUBSIDIZED HEALTH SERVICES INCLUDES GROSS CLINIC COSTS OF $5,806,373. PART I, LN 7 COL(F): 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 A LACK OF INFORMATION PROVIDED, OR THE TIMING OF THE INFORMATION BEING RECEIVED. 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 II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL PRESENTLY INVESTS RESOURCES EVERY YEAR TO RECRUIT AN ADEQUATE NUMBER OF PHYSICIANS TO SERVE ITS COMMUNITY. MOST OF THESE PROVIDERS ARE EMPLOYEES OF THE HOSPITAL, AND THE HOSPITALS PROVIDE HEAVY SUBSIDIES TO THESE PRACTICES. THE HOSPITAL CONTINUES TO HAVE ANNUAL HEALTH FAIRS, AND HAS SPECIFIC SCHOLARSHIP FUNDS FOR SELECT SERVICES SUCH AS DIABETES AND CARDIAC REHAB. THE HOSPITAL ALSO PARTNERS WITH TERTIARY HOSPITALS IN KALAMAZOO TO PROMOTE HEALTHY LIVING, AND ALSO PROVIDES ACCESS TO SPECIALISTS FROM URBAN AREAS ON OUR CAMPUS. THE HOSPITAL ADDITIONALLY THROUGH ITS WELLNESS FACILITY OFFERS WELLNESS PROGRAMS TO THE COMMUNITY. PART III, LINE 4: THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZED AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS FO ITS STANDARD RATES FOR SERVICES PROVIDED(OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PATIENT SERVICE REVENUE, NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS (BUT BEFORE PROVISION FOR BAD DEBTS), RECOGNIZED IN THE PERIOD FROM THESE MAJOR PAYOR SOURCES IN TOTAL WAS $36,842,730 DURING 2013. THIS AMOUNT IS MADE UP OF AMOUNTS FROM THIRD-PARTY PAYORS OF $31,808,765 AND AMOUNTS FROM SELF-PAY PAYORS OF $5,033,965. RETROACTIVELY CALCULATED ADJUSTMENTS ARISING UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARY PAYORS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED.LAWS AND REGULATIONS GOVERNING THE MEDICARE AND MEDICAID PROGRAMS ARE COMPLEX AND SUBJECT TO INTERPRETATION. MANAGEMENT BELIEVES THAT IT IS IN COMPLIANCE WITH ALL APPLICABLE LAWS AND REGULATIONS. FINAL DETERMINATION OF COMPLIANCE OF SUCH LAWS AND REGULATIONS IS SUBJECT TO FUTURE GOVERNMENT REVIEW AND INTERPRETATION. VIOLATIONS MAY RESULT IN SIGNIFICANT REGULATORY ACTION INCLUDING FINES, PENALTIES, AND EXCLUSION FROM THE MEDICARE AND MEDICAID PROGRAMS.BAD DEBT EXPENSES CONSISTS OF DOLLARS THAT ARE WRITTEN OFF OR RESERVED FOR THAT PERTAINS TO PATIENTS THAT HAD AVILABLE RESOURCES, BUT WOULD NOT PAY FOR THEIR SERVICES. THE EXCEPTION TO THIS RULE APPLIES TO CHARITY CARE ACCOUNTS THAT ACTUALLY ARE INCLUDED IN BAD DEBT BECAUSE OF LACK OF INFORMATION PROVIDED, OR BECAUSE OF THE TIMING OF DETERMINATION FOR CHARITY CARE. WE ESTIMATE THAT AT THE END OF 2013, APPROXIMATELY $900,000 INCLUDED IN BAD DEBT SHOULD ACTUALLY CONSIDERED CHARITY CARE. BECAUSE OF THIS WE BELIEVE THIS SHOULD ALSO BE INCLUDED IN OUR COMMUNITY BENEFIT CALCULATION. 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 INCOME. WE USED THE COST TO CHARGE RATIO TO DETERMINE COST. AS MEDICARE IS OUR LARGEST PAYOR, THE SHORTFALL IS IN COVERING COSTS IS EXTREME, THUS THIS WOULD SEEM TO QUALIFY AS A BENEFIT TO OUR COMMUNITY. PART III, LINE 9B: THE HOSPITALS CURRENT COLLECTION PRACTICES APPLY 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 RVIEW OUR PATIENT SATISFACTION SURVEYS PERIODICALLY TO IDENTIFY AND 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 2012. WE ARE IN THE PROCESS OF PLANNING FOR ANOTHER ASSESSMENT TO BE COMPLETED IN 2015. PART VI, LINE 3: ONCE WE IDENTIFY A PATIENT WHO HAS NO COVERAGE, WE WILL SEND THEM TO OUR PATIENT ASSISTANCE REPRESENTATIVE. THIS REPRESENTATIVE WILL THEN REVIEW THE OPTIONS THAT ARE AVAILABLE FOR THAT INDIVIDUAL. IF MEDICAID IS A POSSIBILITY, WE THEN SEND THE INDIVIDUAL 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 ASSTSTANCE, WE WILL EDUCATE THEM AND ASSEST THEM WITH THE PROCESS. PART VI, LINE 4: THE HOSPITAL PRESENTLY SERVES ST.JOSEPH COUNTY, ALONG WITH OTHER PROVIDERS IN THE COMMUNITY. THE POPULATION OF THIS COMMUNITY IS APPROXIMATELY 62,000. THE COMMUNITY, AN AREA THAT WAS HEAVILY DEPENDENT ON THE AUTO INDUSTRY, IS PRESENTLY ECONOMICALLY DEPRESSED. 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 HGIH 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 SPECIALIST 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 EXENSIVELY FOR THIS SPECIALTY CARE. IF SURPLUS FUNDS ARE AVAILABE, 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. PART VI, LINE 7, REPORTS FILED WITH STATES MI X X 0 0 0 0 0 0 0 0 0 LINDA EVANS MD CHEIF OF STAFF 0 191006 0 0 0 5500 0 22750 0 16218 0 235474 0 0 WILLIAM RUSSELL PRESIDENT/CEO 238103 0 0 0 0 0 0 0 72946 0 311049 0 0 0 STEVE ANDREWS CHIEF FINANCIAL OFFICER 171938 0 0 0 0 0 3488 0 54201 0 229627 0 0 0 HOPE BAILEY VICE PRESIDENT 104633 36427 0 0 0 0 6097 2186 19897 6684 130627 45297 0 0 MIKE PULFORD CRNA 128973 48448 0 0 0 0 10107 5329 17264 5874 156344 59651 0 0 LEONARD DARLING PHARMACY MANAGER 92127 36764 0 0 0 0 1843 665 19191 6422 113161 43851 0 0 FORM 990, PART I, LINE 1: THE HOSPITAL'S MISSION IS TO PROVIDE ACCESS TO HIGH QUALITY HEALTHCARE TO OUR COMMUNITY. WE SERVE A COMMUNITY THAT HAS ONE OF THE HIGHEST UNEMPLOYMENT RATES IN THE STATE. WE EMPLOY 80% OF THE PHYSICIANS IN THE COMMUNITY, THUS PROVIDING ADEQUATE ACCESS TO OUR COMMUNITY, SPECIFICALLY MEDICAID ELIGIBLE PATIENTS. WE OPERATE 4 RURAL HEALTH CLINICS, AND WILL HAVE ONE MORE OPERATIONAL IN 2014, WHICH GREATLY ENHANCES ACCESS TO CARE. WE PROVIDE A FULL RANGE OF OB SERVICES TO THE COMMUNITY, OF WHICH OVER 60% IS MEDICAID. WE ALSO PROVIDE WELLNESS AND DIABETIC EDUCATION SERVICES TO THE COMMUNITY, AS WELL AS HOMECARE AND HOSPICE, ALL SERVICES THAT ARE HEAVILY SUBSIDIZED. IN ADDITION, THE HOSPITAL ALSO HAS A IP REHABILITATION UNIT ON CAMPUS AS WELL. WE HAVE STARTED AN EMPLOYEE WELLNESS PROGRAM INTERNALLY, AND PLAN TO WORK WITH LOCAL EMPLOYERS TO OFFER THIS SERVICE AS WELL. FUTURE PLANS INCLUDE OFFERING MENTAL SERVICES, AND WOUND CARE SERVICES TO THE COMMUNITY. ADDITIONALLY, WE ARE ADDING RESOURCES TO HELP THE UNINSURED NAVIGATE THE REQUIREMENTS FOR OBTAINING INSURANCE COVERAGE FOR THEIR PROBLEMS. THE WOUND CARE PROGRAM BECAME OPERATIONAL IN THE FALL OF 2013. FORM 990, PART III, LINE 2 OPERATION OF AN ACUTE CARE HOSPITAL FOR INPATIENT AND OUTPATIENT 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 11 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 2013 AGAIN. FORM 990, PART VI, SECTION C, LINE 19 POLICIES AND STATEMENTS ARE REVIEWED AT BOARD MEETINGS. THE LOCAL PRESS ALSO RECEIVES THIS INFORMATION. IF ADDITIONAL REQUESTS ARE MADE, THIS INFORMATION IS PROVIDED AS REQUESTED. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,667,757. MANAGEMENT AND GENERAL EXPENSES 2,582,845. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,250,602. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 766,739. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 766,739. FORM 990, PART XI, LINE 9: TRANSFER 9,532,885. 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) 11 TYPE 1 THREE RIVERS HEALTH AUTHORITY 1 TRAH PROPERTIES INC 701 S HEALTH PARKWAY THREE RIVERS MI 49093 383366344 PROPERTY MANAGEMENT MI 501(C)(3) 11 TYPE 1 THREE RIVERS HEALTH AUTHORITY 1 THREE RIVERS HEALTH AUTHORITY 701 S HEALTH PARKWAY THREE RIVERS MI 49093 382317300 HOSPITAL MI 501(C)(3) 3 N/A 0 THREE RIVERS HEALTH NETWORK 701 S HEALTH PARKWAY THREE RIVERS MI 49093 383330974 MEDICAL DATA PROCESSING MI THREE RIVERS HEALTH AUTHORITY C 13840 1.00000 1 INTEGRATED HEALTH SYSTEMS INC 701 S HEALTH PARKWAY THREE RIVERS MI 49093 383134384 PERSONNEL MANAGEMENT MI N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 0 1 0 0 0 TRAH PROPERTIES INC K 102199 RENT PAID INTEGRATED HEALTH SYSTEMS INC P 4959457 FMV THREE RIVERS HEALTH AUTHORITY C 9532885 NBV