2023-11-09T08:31:10-06:00 2022-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-10-01 381619577 Hills & Dales General Hospital Inc HILL 9898722121 4675 Hill Street Cass City MI 48726 Andrew Daniels President and CEO 9898722121 2023-11-08 1 Andrew Daniels 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Andrew Daniels 4675 Hill Street Cass City MI 48726 15397579 0 X www.hdghmi.org X 1960 MI To be recognized as the leading healthcare organization in the communities we serve. 7 7 515 41 0 0 1443280 2797996 43848219 12551882 12035 21990 -20355 5507 45283179 15377375 0 0 0 0 23825386 7620487 0 0 0 16806469 4624539 40631855 12245026 4651324 3132349 29245599 32706755 9106638 7046113 20138961 25660642 X To be the provider of choice and the employer of choice in our primary market 0 0 10278786 0 12551882 The organization provided nursing and professional services for acute & swing bed patients, emergency and outpatients. During the short period October 1, 2022 to December 31, 2022, HDGH provided care including 694 inpatient days, 1,943 emergency room visits, over 13,620 physician visits, 11,172 distinct patient visits for over a total of 27,429 registrations. During the year, over 67.3% of the services provided were to governmental programs, which reimburse below the actual costs. In addition, the hospital provided $21,589.96 in charity care and was unable to collect from uninsured and underinsured patients. Community benefits are also provided through free programs such as, health fairs, public service announcements, education on specific disease conditions, lectures, blood pressure screening, TB training. The hospital also provided reduce fee services. 10278786 1 1 0 0 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 25 0 1 515 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X Renee Henry Director of Finance 9898722121 4675 Hill Street Cass City MI 48726 Patrick Curtis Chair 4.00 7.00 X X 0 0 0 Danny Haag Vice Chair 4.00 7.00 X X 0 0 0 Judy Brown Secretary/Treasurer 4.00 7.00 X X 0 0 0 Carol Starling OD Trustee 2.00 5.00 X 0 0 0 Jim Luth Trustee 2.00 5.00 X 0 0 0 Faith Fahrner RN Trustee 2.00 5.00 X 0 0 0 Rachel Estelle Trustee 2.00 5.00 X 0 0 0 Andrew Daniels President and CEO 40.00 6.00 X 376487 0 21365 Kurt Sargent VP of Finance/CFO 40.00 6.00 X 174340 0 8624 Dr Eric Shoemaker Family Physician 40.00 X 429432 0 26036 John Bitner Family Physician 40.00 X 396625 0 37816 Richard Moyer Orthopedic Surgeon 40.00 X 298393 0 28100 David Komasara Emergency Room Physician 40.00 X 447630 0 26728 Craig Mizes General Surgeon 40.00 X 375670 0 24934 2498577 0 173603 39 0 1 0 Dr Melanie Harrington MD 6700 McAlpine Road Kingston MI 48741 Medical Services 528020 Covenant Medical Center 700 Cooper Avenue Saginaw MI 48602 EPIC/Physician Coverage 499121 Covenant Healthcare Lab 700 Cooper Avenue Saginaw MI 48602 Lab Services 461330 Dr Steven L Jensen MD 25 Hunters Ridge Saginaw MI 48606 Medical Services 324000 Huron Anesthesia Services 1803 Clem Street Ubly MI 48475 Medical Services 264850 11 54954 2743042 2797996 Patient Service Revenue 621110 11789085 11789085 Pharmacy Revenue 456110 519240 519240 Management Fees 900099 187925 187925 Cafeteria 900099 34053 34053 Fitness Center Revenue 900099 4934 4934 16645 16645 12551882 22707 22707 24994 19487 5507 5507 5507 717 -717 -717 -717 15377375 12551882 0 27497 X 248228 248228 5726174 5650612 75562 230526 201926 28600 1015976 943616 72360 399583 376721 22862 29094 29094 8896 8896 1764711 1019587 745124 139333 11258 128075 258127 207751 50376 135829 49692 86137 268830 182358 86472 19122 18795 327 17095 14845 2250 2522 2522 227884 131456 96428 118972 99611 19361 Medical Supplies 885801 885801 Repairs and Maintenance 240360 214845 25515 Tax Assessment 201451 201451 Food 53050 44607 8443 253462 21332 232130 12245026 10278786 1966240 0 15314849 9571406 5886808 6731975 175218 301771 518516 488639 18174474 8786245 6392591 9388229 4297490 1119171 957617 808074 29245599 32706755 3938006 5215668 2846330 1500 2322302 1828945 9106638 7046113 X 20138961 25660642 20138961 25660642 29245599 32706755 X 3132349 78504 2310828 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 46421 8352 85265 -30492 612088 612088 9419285 5121744 4297541 6858239 3130914 3727325 1284862 533587 751275 9388229 Capital Lease 357048 Estimated Third-Party Payor Settlements 1267977 Related Party Payable 203920 1828945 X Part IV, Line 1b: The Auxiliary uses the Hospital EIN for their activity. Part X, Line 2: The Organization believes it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 0 1 1 0 1 1 2000 2000 0.00020 2000 2000 0.00020 1762 1762 0.00010 80 80 0.00000 1842 1842 0.00010 3842 3842 0.00030 0 1911334 1901469 9865 X 1 1 1 1 Hills & Dales General Hospital Inc 4675 Hill Street Cass City MI 48726 www.hdghmi.org 1060000144 X X X Hills & Dales General Hospital Inc 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X See Supplemental Info 1 21 1 See Supplemental Info 0 1 X 100.000000000000 300.000000000000 X X X 1 1 X X X X 1 X https://hdhlth.org/billing/financial-assistance/ X https://hdhlth.org/billing/financial-assistance/ X https://hdhlth.org/billing/financial-assistance/ X X X X X 1 X 0 X X X X 1 X 0 0 Hills & Dales General Hospital Inc. Part V, Section B, Line 5: The hospital outsourced the data collection process to Thumb Community Health Partnership of which the hospital is a member. The hospital's process included a community survey in addition to review of assessments by the Thumb Community Health Partnership and Michigan Thumb Public Health Alliance. Hills & Dales General Hospital Inc. Part V, Section B, Line 6a: The hospital completed the assessment on their own but relied on an assessment completed by Thumb Community Health Partnership. The partnership includes the following hospitals: Deckerville Community Hospital, Harbor Beach Community Hospital, Marlette Regional Hospital, McKenzie Health Systems, McLaren Caro Region, McLaren Lapeer Region, McLaren Thumb Region, Scheurer Health. Hills & Dales General Hospital Inc. Part V, Section B, Line 6b: The hospital completed the assessment on their own but relied on an assessment completed by Thumb Community Health Partnership. The partnership includes the following other organizations: Great Lakes Bay Health Centers, Human Development Commission, Huron Behavioral Health, Great Start Collaborative, Huron County Health Department, Lapeer County Health Department, Lapeer County Community Mental Health, List Psychological, MDHHS, Get Connected. Get Help, Sanilac County Community Foundation, Sanilac Community Mental Health, Sanilac Great Start Collaborative, Sanilac County Health Department, Tuscola Behavioral Health Systems, Tuscola County Health Department, Tuscola Great Start Collaborative, Thumb Community Health Partnership. Hills & Dales General Hospital Inc. Part V, Section B, Line 11: Based on all of the information reviewed including the Thumb Community Health Partnership assessment and the strategies already in place to address many of the needs identified, the following priorities were identified: Access to ServicesCancerBehavioral HealthThe following actions were identified to address the identified needs:Access to services: --Develop and implement a marketing plan to increase awareness of those service lines below the 50% awareness level as measured by the community survey--Systematically advocate with governmental and social services to attempt to improve transportation services in Tuscola County. --Provide resources and support to ensure that individuals have health insurance to meet their personal needs and in the event of unplanned medical needs. --Develop and implement an expanded primary care market in the Caro, MI areaAttempted to develop a collaborative solution to substance abuse through the Covenant Rural Thumb Network Cancer: Establish a medical oncology & infusion clinic at Hills & Dales to improve cancer care access in our communityBehavioral Health: Research and propose a "thumb" area patient-centered addiction treatment facility for men and women to encourage a positive and long-lasting recovery. The following actions were taken during the tax year related to the 2019 needs identified:Decrease rate of obesity: There was a 10% increase in diabetes self-management services referrals. Improve mental health: These activities progressed with the addition of a tele-medicine cart, an operating agreement with Covenant Healthcare to provide tele-psychiatry, and 2 additional providers certified in MAT. Tele-psychiatry program is no longer in process. The organization is investigating other sources of support for psychiatry consultations. Hills and Dales Healthcare is a participating partner in the Thumb Opioid Response Consortium, which is a multiagency partnership that addresses opioid and substance use in the rural areas of the thumb region of Michigan. Decrease indicent of senior injuries: Many of the planned activities continued, albeit with lesser activity, considering the pandemic and increased risk for seniors. More efforts were focused on tele-medicine office visits, COVID 19 testing, and vaccination preparedness. The Matter of Balance class and driver safety have not resumed, as there are no instructors currently available. The organization is actively pursuing recognition as an Age-Friendly Health System through the Institute for Healthcare Improvement. Schedule H, Part V, Line 7a and 10a: https://hdhlth.org/community-health-needs-assessment/ Part I, Line 7: Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. The community health improvement services and community benefit operations and health professional education are based on actual cost. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: The amount of implicit price concessions that could be reasonably attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy was an estimate. This amount was calculated by multiplying the implicit price concessions by 20%. This estimate was based on local unemployment rates and other related factors. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 12-13 of the attached audited financial statements. Part III, Line 8: As Critical Access Hospital, Medicare reimburses the hospital based on costs incurred. Not all of the costs incurred are eligible for reimbursement via the Medicare cost report.The numbers used to determine the surplus came from the filed Medicare Cost Report for this fiscal year. Part III, Line 9b: The organization recommends accounts for collection and treatment as bad debt once the account hits 120 days. The account must have received at least 2 calls, received at least 3 statements, and also have no recent payment in the last 45 days. Additionally, the patient or account holder must be informed and encouraged to complete an application for charity care and be given at least 30 days to complete said application. The accounts that are set up on a payment plan and current will not receive any calls until the payment plan goes into default status. For accounts of those known to qualify for financial assistance, the collection actions are stopped during the time the person is completing the application. Part VI, Line 2: Hills & Dales General Hospital conducts a regular Community Health Needs Assessment through a systematic process to identify key community health concerns. Data was collected and analyzed from the following sources: Community Survey (online and on paper) and 2021 Thumb regional Health Assessment conducted by the Thumb Community Health Partnership. From the data collected, prioritization of needs and an implementation plan was identified by the organization's senior team and Board of Trustees. Results of all community health needs assessments and implementation plans are available on the organization's website, www.hdghmi.org. The hospital is part of the Thumb Community Health Partnership which is a coordinated regional effort to identify key issues and establish a coordinated response to regional community needs. Part VI, Line 3: The Hospital has packets available to patients at the time of registration that notes the financial assistance policy and procedures. This packet is offered to a patient and/or a representative of the patient if the patient asks about the price of the services about to be received. A financial assistance packet is offered to individuals that express concern over being able to afford the services about to be rendered. The process applies to hospital services and physician offices owned and operated by the hospital. Part VI, Line 4: Hills & Dales General Hospital is a critical access hospital located in Cass City, Michigan within Tuscola County. Area of services include southwest portion of Huron County, northwest portion of Sanilac County and eastern half of Tuscola County. The unemployment and uninsured numbers for these counties were higher than the state and national average. The median household income was below the state and national average. Part VI, Line 5: The Hospital is governed by the Community Board and has an open medical staff. It also participates in free or reduced health screenings and fairs that are available to the general public which include screening and education to help improve the health status of our community. Part VI, Line 6: Hills & Dales General Hospital's affiliation with Covenant in Saginaw. The primary purpose of the affiliation is to meet Critical Access Hospital (CAH) requirements to have an agreement with a tertiary hospital. There is no shared governance. Hills & Dales General Hospital has an independent Board, Tax ID number, medical staff, etc. Covenant has offered some resources to Hills & Dales General Hospital including Educational Classes, Job Skill enhancement, co-marketing and medical staff development. Hills & Dales General Hospital also participates in group purchasing through Covenant with VHA. X X X X 0 0 0 0 0 0 0 0 0 David Komasara Emergency Room Physician 437630 0 10000 0 0 0 12200 0 14528 0 474358 0 0 0 Dr Eric Shoemaker Family Physician 359406 0 70026 0 0 0 12200 0 13836 0 455468 0 0 0 John Bitner Family Physician 387425 0 9200 0 0 0 11809 0 26007 0 434441 0 0 0 Craig Mizes General Surgeon 365670 0 10000 0 0 0 12200 0 12734 0 400604 0 0 0 Andrew Daniels President and CEO 293987 0 82500 0 0 0 11422 0 9943 0 397852 0 0 0 Richard Moyer Orthopedic Surgeon 298093 0 300 0 0 0 5955 0 22144 0 326492 0 0 0 Kurt Sargent VP of Finance/CFO 134007 0 40333 0 0 0 5728 0 2895 0 182963 0 0 0 Form 990, Part VI, Section A, line 1a There shall be an Executive Committee of the Board, consisting of the Chair, Vice Chair, Secretary, Treasurer, the President/CEO, ex-officio without vote, and such other number of Directors who may be nominated by the Chair and approved by the Board of Directors: Provided, however, that in no event shall the Executive Committee constitue a majority of the Board of Directors. The Executive Committee shall meet at the call of the Chair, and exercise such functions and powers as the Board of Directors may provide. The Executive Committee shall keep records of its proceedings, and shall report on its actions to the Board of Directors as its next meeting. The Executive Committee shall possess and exercise all of the powers and authority of the Board of Directors, to the extent permitted by law, and shall manage the affairs of the Corporation between meetings of the Board of Directors. Notwithstanding anything which may be expressed in, or implied from this Section, the Executive Committee shall not have the power or authority to: A. Amend the Articles of Incorporation; B. Adopt an agreement of merger or consolidation; C. Approve the sale, lease, or exchange of all or substantially all of the Hospital's property and assets; D. Approve a dissolution of the Corporation or revocation of a dissolution; E. Amend these Bylaws; F. Fill vacancies on the Board and/or appoint officers; G. Modify the purpose of the Corporation; or H. Approve the incurrence of any long-term debt, or the capital and/or operating budgets of the Corporation. Form 990, Part VI, Section A, line 6 Hills and Dales Healthcare Corporation is the sole member. Form 990, Part VI, Section A, line 7a The number of directors is at least three and no more than eight persons and all directors are appointed by Hills and Dales Healthcare Corporation. Form 990, Part VI, Section A, line 7b The following actions may be taken by the organization only upon written approval of the Board of Trustees of Hills & Dales Healthcare Corporation: A: Adoption, amendment, or other modification of the Bylaw or Articles of Incorporation; B: Any mergers, consolidation, reorganization, other change in the corporate structure or the creation of any corporate subsidiary; C: Participation in any partnership, limited partnership, corporation, association or other form of joint venture or shared service with any other party; D: Creation, incurrence, or assumption of indebtedness, commitments, or any contractual obligations with respect to borrowed money, guarantees, endorsements, leases, or other type of direct contingent liabilities, in excess of $150,000 for any one item; E: Creation, incurrence, or assumption of any mortgage, pledge, security agreement, encumbrance, or other lien of any kind in any property or assets of the organization; F: Acquisitions, by purchase, lease or by any other method of real estate, capital improvements, or equipment in excess of value of $150,000 for any such item; G: Any change in the services of programs of the organization, including the termination of existing services, the addition of new services, or any major expansion or contraction of existing services or programs; H: Adoption, amendment or modification of the annual operating and capital budgets of the corporations; or I: Adoption, amendment or modification of the mission and goals of the corporation, and its long-range and short-range strategic plans. J. Appointment of persons to serve, or removal of persons serving on, the Board of Trustees of the Corporation K. Setting the total number of Trustees to serve on the Board of Trustees of the Corporation L The appointment and/or removal of the President and Chief Executive Officer of the Corporation. Provisions J, K and L were added with the change in bylaws in May 2022. Form 990, Part VI, Section B, line 11b The 990 was reviewed by the Director of Finance. A copy was then provided to the Trustees for review at the next board meeting. Form 990, Part VI, Section B, line 12c The conflict of interest form is completed annually and monitored for compliance by the CEO and the Chairman of the Board. When a conflict exists, the Board member notifies the rest of the Board of the Conflict. The Board member is allowed to discuss the matter at hand, however, the member with the conflict is not allowed to vote on any conflicted issue. This policy covers all Board members, officers, administrative staff members and Medical Staff members with administrative responsibilities. Form 990, Part VI, Section B, line 15 The salaries of the CEO, officers, and key employees are determined by three independent Board members from the Hills & Dales General Hospital, Inc. Board of Trustees using market data and outside surveys. Compensation is reviewed annually. Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, and financial statements available to the general public. Form 990, Part IX, line 11g Professional Fees: Program service expenses 283,862. Management and general expenses 0. Fundraising expenses 0. Total expenses 283,862. Contracted Services: Program service expenses 155,625. Management and general expenses 654,549. Fundraising expenses 0. Total expenses 810,174. Other Fees: Program service expenses 146,153. Management and general expenses 90,575. Fundraising expenses 0. Total expenses 236,728. Contracted Physicians: Program service expenses 433,947. Management and general expenses 0. Fundraising expenses 0. Total expenses 433,947. Form 990, Part XI, line 9: Transfer from Thumb Area Enterprises 2,310,828. Hills & Dales Healthcare Corp 4675 Hill Street Cass City MI 48726 382622537 Manage excess funds on behalf of subsidiaries MI 501(c)(3) Line 12b, II N/A 0 Thumb Area Enterprise 6086 Beechwood Drive Cass City MI 48726 382628943 Care of residents with dementia MI 501(c)(3) Line 10 Hills & Dales Healthcare Corp 1 Hills & Dales Foundation 4675 Hill Street Cass City MI 48726 352368240 Solicit funds on behalf of hospital MI 501(c)(3) Line 12a, I Hills & Dales Healthcare Corp 1 Northeast Tuscola Healthcare 4675 Hill Street Cass City MI 48726 475387652 Rental of building to hospital MI 501(c)(3) Line 12b, II Hills & Dales General Hospital Inc 1 Selad Corporation 4675 Hill Street Cass City MI 48726 382680346 Retail pharmacy MI N/A C 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 Northeast Tuscola Healthcare K 149293 Accrual