2024-02-27T08:59:10-06:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 381415390 DECKERVILLE COMMUNITY HOSPITAL INC DECK 8103762835 3559 PINE STREET DECKERVILLE MI 484270126 ANGELA MCCONNACHIE COO/CEO 8103762835 2024-02-13 1 ANGELA MCCONNACHIE XXX-XX-XXXX 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-02-12 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ANGELA MCCONNACHIE 3559 PINE STREET DECKERVILLE MI 484270126 9841699 0 X WWW.DECKERVILLEHOSP.ORG X 1952 MI TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES, CLOSE TO HOME, IN A PATIENT-CENTERED ENVIRONMENT AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO TO WORK CLOSELY WITH THE LOCAL COMMUNITY TO SUPPORT THE HEALTH AND WELLNESS OF THE COMMUNITY AS A WHOLE. 12 11 92 14 0 0 612938 984013 8490437 8797882 -9361 15738 41514 44066 9135528 9841699 0 0 0 0 4447387 4666695 0 0 0 4345949 4684400 8793336 9351095 342192 490604 5907147 6396722 2185271 2110337 3721876 4286385 X TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES, CLOSE TO HOME, IN A PATIENT-CENTERED ENVIRONMENT AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO TO WORK CLOSELY WITH THE LOCAL COMMUNITY TO SUPPORT THE HEALTH AND WELLNESS OF THE COMMUNITY AS A WHOLE. 0 0 7281382 0 8797882 TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES, CLOSE TO HOME, IN A PATIENT-CENTERED ENVIRONMENT AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO TO WORK CLOSELY WITH THE LOCAL COMMUNITY TO SUPPORT THE HEALTH AND WELLNESS OF THE COMMUNITY AS A WHOLE.DECKERVILLE OFFERS, AS PART OF ITS MISSION, NECESSARY MEDICAL CARE TO THOSE INDIVIDUALS NOT COVERED UNDER A THIRD PARTY INSURER OR GOVERNMENT PROGRAM OR WHO DO NOT HAVE RESOURCES TO PAY ALL OR A PORTION OF THEIR BILLS.DURING THE FISCAL YEAR ENDED JUNE 30, 2023, THE HOSPITAL SERVICED 40 INPATIENT DAYS, 1,991 EMERGENCY ROOM VISITS, AND 17,079 OUTPATIENTS THROUGH ITS CLINICS, OFFICE PRACTICES, AND ANCILLARY DEPARTMENTS. 7281382 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 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 23 0 92 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X KIMBERLY GENTNER 8103767024 3559 PINE STREET DECKERVILLE MI 484270126 ANGELA MCCONNACHIE COO/CEO 4.00 36.00 X X 111026 0 7537 DANIEL BABCOCK CEO (THRU DEC 2022) 4.00 36.00 X X 0 203316 26806 GAIL DENTON CHARIMAN 1.00 1.00 X X 0 0 0 JUSTIN FABER VICE CHAIRMAN 1.00 1.00 X X 0 0 0 VICTORIA MEIBURG SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 CHRISTOPHER CLARK DIRECTOR (THRU MAY 2023) 1.00 1.00 X 0 0 0 SUE COOK DIRECTOR 1.00 1.00 X 0 0 0 STEVE ELLIS DIRECTOR 1.00 1.00 X 0 0 0 IRENE COLE DIRECTOR 1.00 1.00 X 0 0 0 CURTIS LANDRITH DIRECTOR 1.00 1.00 X 0 0 0 ALEXANDER MESSING DIRECTOR 1.00 1.00 X 0 0 0 DAVID MESSING DIRECTOR 1.00 1.00 X 0 0 0 SCOTT ORR DIRECTOR 1.00 1.00 X 0 0 0 PAUL ROHLING DIRECTOR 1.00 1.00 X 0 0 0 DAVID WEST DIRECTOR (THRU MAY 2023) 1.00 1.00 X 0 0 0 KIMBERLY GENTNER CFO 4.00 36.00 X 103570 0 0 MALORIE MCVITTIE PHYSICIAN 40.00 X 241808 0 7560 ROBERTA WEISS NURSE PRACTIONER 40.00 X 116436 0 10225 CARRIE EUGSTER NURSE PRACTIONER 36.00 X 121426 0 0 KEITH DAVIDSON NURSE PRACTIONER 40.00 X 118166 0 0 812432 203316 52128 6 0 1 0 RASHID ALSABEH 3546 CEDAR BROOK DR ROCHESTER HILLS MI 48309 ER PHYSICIAN 255055 SCOTT GREIB 3337 SLATTERY RD ATTICA MI 48412 ER PHYSICIAN 225468 CHRISTOPHER KREINER 3088 PAINT CREEK DR OAKLAND MI 48363 ER PHYSICIAN 214750 NICK BUTTAR 8445 WEARWICK GROVES CRT GRAND BLANC MI 48439 PROVIDER OVERSIGHT & ER PHYSICIAN 205445 4 946689 37324 984013 NET PATIENT SERVICE RE 621500 6743290 6743290 CLINIC REVENUE 621110 1719573 1719573 PHARMACY 456110 292835 292835 CLINICAL SPACE 621110 6535 6535 35649 35649 8797882 15738 15738 6900 0 6900 6900 6900 37166 37166 37166 9841699 8797882 0 59804 X 301643 301643 3521000 3073268 447732 522233 378411 143822 321819 231252 90567 1275 1275 85155 21250 63905 718 718 2134979 1980078 154901 29543 29543 33561 22977 10584 343199 343199 151539 24563 126976 26610 10061 16549 9735 9735 383952 381326 2626 99381 32319 67062 MEDICAL SUPPLIES 406907 376217 30690 DRUG EXPENSE 234490 234490 MAINTENANCE AND REPAIRS 212634 178494 34140 PROVISION FOR BAD DEBTS 184013 184013 346709 142928 203781 9351095 7281382 2069713 0 1527624 1067965 756055 185 0 250000 967237 1544175 72508 70781 384587 97204 6498628 4096326 2152780 2402302 46356 964110 5907147 6396722 834517 561293 429789 0 189690 95728 731275 1453316 2185271 2110337 X 3675520 4233312 46356 53073 3721876 4286385 5907147 6396722 X 490604 6717 67188 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 718 718 0 PART II-B, LINE 1: THE ORGANIZATION PAYS ANNUAL DUES TO MICHIGAN HEALTH AND HOSPITAL ASSOCIATION (MHA) AND A PORTION OF THOSE DUES GOES TOWARD LOBBYING. THE MHA WORKS WITH ITS MEMBER HOSPITAL AND HEALTH SYSTEMS TO INFORM DECISION-MAKERS ABOUT THE IMPACT OF HOSPITALS ON LOCAL HEALTH AND HEALTHCARE DELIVERY, AND ON CREATING THRIVING COMMUNITIES. THEY SPEND TIME IN MICHIGAN AND WASHINGTON DC TO ADVOCATE ON BEHALF OF THE INTERESTS OF ITS MEMBERS. 46356 7813 1096 53073 61330 -13900 1074 46356 50416 11930 1016 61330 51035 412 1031 50416 49565 3497 1863 164 51035 0.00000 0.00000 1.00000 1 0 58668 58668 1535820 1424327 111493 4645319 2671999 1973320 258821 258821 2402302 BENEFICIAL INTEREST IN ASSETS HELD BY FOUNDATION 53073 INVESTMENT IN UNCONSOLIDATED AFFILIATE 911037 964110 DUE TO RELATED PARTIES 743849 ESTIMATED THIRD-PARTY PAYOR SETTLEMEMTS 709467 1453316 9484248 6717 6717 9477531 364168 364168 9841699 9167082 0 9167082 184013 184013 9351095 PART V, LINE 4: THE HOSPITAL HAS ENTERED INTO AN AGREEMENT WITH THE SANILAC COUNTY COMMUNITY FOUNDATION TO CREATE A DONOR-RESTRICTED ENDOWMENT, THE DECKERVILLE COMMUNITY HOSPITAL ENDOWMENT FUND, FOR THE PURPOSE OF PROVIDING SUPPORT TO THE HOSPITAL TO CARRY OUT ITS ROLE AND MISSION AS DESIRED BY ITS GOVERNING DOCUMENTS. THE FOUNDATION HAS ALL POWERS NECESSARY TO CARRY OUT THE PURPOSE OF THE FUND, INCLUDING POWERS TO INVEST AND REINVEST THE FUND AND THE POWER TO COMINGLE THE ASSETS OF THE FUND WITH THOSE OF OTHER FUNDS FOR INVESTMENT PURPOSES. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 184,013. CHANGE IN INVESTMENT OF UNCONSOLIDATED AFFILIATES 180,155. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 184,013. 1 1 X 1 X 1 X 1 1 0 0 312 312 0.00000 2382003 1856170 525833 0.05740 2382315 1856170 526145 0.05740 2204035 2708232 0 0.00000 2204035 2708232 0 0.00000 4586350 4564402 526145 0.05740 0 154633 61853 2411993 2431722 -19729 X 1 1 1 1 DECKERVILLE COMMUNITY HOSPITAL INC 3559 PINE STREET DECKERVILLE MI 48427 WWW.DECKERVILLEHOSP.ORG 1060000118 X X X DECKERVILLE COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X HTTPS://DECKERVILLEHOSP.ORG/RESOURCES/ X 1 21 1 HTTPS://DECKERVILLEHOSP.ORG/RESOURCES/ 0 1 X 100.000000000000 250.000000000000 X X X 1 1 X X X 1 X HTTPS://DECKERVILLEHOSP.ORG/BILLING/ X HTTPS://DECKERVILLEHOSP.ORG/BILLING/ X HTTPS://DECKERVILLEHOSP.ORG/BILLING/ X X X X X X 1 X 0 X X X X X 1 X 0 0 DECKERVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 5: THE FOCUS GROUP INCLUDED THE DECKERVILLE VILLAGE COUNCIL, DECKERVILLE HOSPITAL AUXILIARY MEETING, AND THE DECKERVILLE COMMUNITY DEVELOPMENT COMMISSION MEMBERS. THE PURPOSE OF THE FOCUS GROUPS WERE TO OBTAIN FEEDBACK FROM COMMUNITY LEADERS ON PRIORITIES IDENTIFIED FROM THE ASSESSMENT AND ADDITIONAL FEED BACK FROM A COMMUNITY HEALTH SURVEY. THESE SURVEYS WERE DISTRIBUTED AND COLLECTED AT MONTHLY MEETINGS. THE FOCUS GROUP REPRESENTED THE GEOGRAPHIC SERVICE AREA OF DECKERVILLE COMMUNITY HOSPITAL DECKERVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 6A: THERE WERE MULTIPLE HOSPITAL FACILITIES IN THE FOUR COUNTIES OF HURON, LAPEER, SANILAC, AND TUSCOLA THAT RECEIVED SUPPORT FROM THE MICHIGAN CENTER FOR RURAL HEALTH AND MICHIGAN THUMB PUBLIC HEALTH ALLIANCE (HURON, LAPEER, SANILAC, AND TUSCOLA). DECKERVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 6B: THERE WERE MULTIPLE HOSPITAL FACILITIES THAT RECEIVED SUPPORT FROM THE MICHIGAN CENTER FOR RURAL HEALTH AND MICHIGAN THUMB PUBLIC HEALTH ALLIANCE (HURON, LAPEER, SANILAC, AND TUSCOLA). DECKERVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 11: DECKERVILLE IDENTIFIED THE FOLLOWING FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED IN TAX YEAR 2021 AS TOP CONCERNS AND AREAS. THE BOARD HAS APPROVED THE ORGANIZATION FOCUS ITS EFFORTS ON THE FOLLOWING IN TAX YEAR 2022:DECKERVILLE COMMUNITY HOSPITAL UTILIZED THE REGIONAL WORK COMPLETED BY THE THUMB COMMUNITY HEALTH PARTNERSHIP TO IDENTIFY LOCAL PRIORITIES. AS INDICATED IN STEP 4 OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, PRIORITIES MUST BE SELECTED TO ENSURE THAT LIMITED RESOURCES HAVE THE GREATEST IMPACT. SELECTION OF PRIORITIES WILL OFTEN RESULT IN MORE COMPLEX AND EFFECTIVE IMPLEMENTATION STRATEGIES. IDENTIFYING A LIMITED NUMBER OF PRIORITIES ON WHICH TO FOCUS ALSO ALLOWS COMMUNITY INITIATIVES TO BE DEVELOPED WITH COLLABORATING ORGANIZATIONS. EVALUATION AND PROGRESS CAN BE MORE EFFECTIVELY MANAGED WHEN THE PRIORITIES ARE FEWER IN NUMBER. IN REVIEW OF EXISTING EFFORTS, THE TEAM DETERMINED THAT DECKERVILLE COMMUNITY HOSPITAL WOULD HAVE THE GREATEST IMPACT ON COMMUNITY HEALTH BY TARGETING SEVEN FOCUS AREAS. DATA THAT LED TO THESE PRIORITIES IS INCLUDED IN THE FOLLOWING SECTION.1. CANCER- DCH PARTNERS WITH P.C.U.P.S FOUNDATION TO RAISE FUNDS AND CREATE A HIGHER AWARENESS IN THE FIGHT AGAINST PROSTATE CANCER. P.C.U.P.S. STANDS FOR PROSTATE CANCER UNDERSTANDING, PREVENTION AND SCREENINGS.- DCH PARTICIPATES IN THE ACS "GO RED" CAMPAIGN.- PARTNERED WITH THE HEALTH DEPARTMENT FOR UNDER INSURED PATIENTS FOR SCREENING EXAMS.- IN FEBRUARY OF 2022, THE HOSPITAL BECAME A PART OWNER OF THE CRTN CANCER CENTER LOCATED IN MARLETTE, MI WHICH IS ALSO LOCATED IN SANILAC COUNTY.2. CHRONIC DISEASE- SPECIALIST OPTIONS EITHER ON-SITE OR THROUGH TELE-HEALTH, UTILIZING CRTN NETWORK.- INCREASE TELEHEALTH UTILIZATION- AWARENESS OF SERVICES-UTILIZE SOCIAL MEDIA TO INCREASE AWARENESS OF SERVICE LINES- UTILIZING THE ACO POPULATION MANAGEMENT DASHBOARD, PREVENTION AND SCREENING MEASUREMENTS, AND MONTHLY HEALTH MONTH AWARENESS CAMPAIGNS TO IDENTIFY THOSE INDIVIDUALS WHO NEED THOSE SCREENINGS AND NOTIFY THEM, "IT'S TIME FOR YOUR YEARLY SCREENING."3. SUBSTANCE USE/MENTAL HEALTH- PHYSICIAN OFFICES AND EMERGENCY DEPARTMENT CONTINUE TO ABIDE BY STRICT GUIDELINES IN THE PRESCRIBING AND ADMINISTRATION OF OPIOIDS AND NARCOTICS.- MEMBER OF THUMB OPIOID RESPONSE CONSORTIUM (TORC) TO REDUCE THE HARM OF SUBSTANCE USE DISORDERS BY WORKING TOGETHER AS A REGION (HURON, SANILAC, TUSCOLA, AND THE RURAL TRACKS OF LAPEER COUNTY) TO ENSURE THAT PREVENTION, TREATMENT, AND RECOVERY SERVICES ARE ALIGNED WITH THE NEEDS OF THE COMMUNITY.- PREVIOUSLY COMPLETED SBIRT TRAINING THROUGH THE TORC.- MEMBER OF THUMB COMMUNITY HEALTH PARTNERSHIP TO PROVIDE MAN THERAPY.4. TOBACCO USE & VAPING- DCH PARTICIPATES IN "IDENTIFYING EVERY DAY DANGERS IN THE LIVES OF YOUTH" EVENT TARGETING TOBACCO USE AND VAPING.- MEMBER OF THE THUMB OPIOID RESPONSE CONSORTIUM (TORC) TO REDUCE THE HARM OF SUBSTANCE USE DISORDERS BY WORKING TOGETHER AS A REGION (HURON, SANILAC, TUSCOLA, AND THE RURAL TRACKS OF LAPEER COUNTY) TO ENSURE THAT PREVENTION, TREATMENT, AND RECOVERY SERVICES ARE ALIGNED WITH THE NEEDS OF THE COMMUNITY.5. PRENATAL AND INFANT HEALTH- OFFER COMMUNITY EDUCATION ON PRENATAL AND INFANT HEALTH ISSUES.- REFER PATIENTS TO THE SCHD FOR THESE SERVICES.- EMPLOY A PEDIATRICIAN THAT SEES PATIENTS AT BOTH DCH AND MRH TO MEET A LARGER POPULATION OF INFANTS. 6. VETERAN'S SERVICES- IDENTIFYING WHAT SERVICES CAN BE PERFORMED AND PARTNERS.- HELPED WORK WITH OUR PARTNERING HOSPITAL TO BECOME A VA ELIGIBLE SITE, WHICH JUST BROADENS ACCESS TO HEALTHCARE ACROSS OUR COUNTY. 7. ACCESS TO THE INTERNET- LOCATING A POTENTIAL LOCATION FOR OUR REFERRED PATIENTS TO UTILIZE TELEHEALTH SERVICES IF THEY DO NOT HAVE ADEQUATE INTERNET AT HOME.OUTSIDE OF THE ABOVE WE ALSO DID THE FOLLOWING THIS PAST YEAR:-POSTED THE "FUNTASTIC FAMILY FUN FAIR" WHERE WE GAVE AWAY FREE: LIFE JACKETS, BACK PACKS, MEDICATION LOCK BOXES, BIKE REFLECTORS, FIRE BLANKETS, SMOKE DETECTORS, FOOD THERMOMETERS, FIRST AID KITS, AND DID EDUCATION ON: PERSONAL BODY SAFETY, DRIVING SAFETY, KINDNESS MATTERS, WATER AND SUN SAFETY, FIRST AID SAFETY, NIGHT BIKE SAFETY, GUN SAFETY.-PLANNED A COMMUNITY HEALTH FAIR WHERE WE DID FREE BLOOD PRESSURE SCREENING: HGB SCREENING, LIPID PANEL COUPON -PARTNERED WITH THE AGRISCIENCE CLASS TO PROVIDE A COMMUNITY GARDEN.-EXPANDED WALK IN CLINIC HOURS IN JUNE TO INCLUDE MONDAYS AND FRIDAYS.-PARTNERED WITH THE TUSCOLA AND SANILAC SENIOR FAIR AND THUMB FESTIVAL'S KIDS DAY-PROVIDE EDUCATION AND SERVICE LINE INFORMATION IN JUNE.-IN MARCH WE PARTNERED WITH TCHP FOR A PERSONAL CARE DRIVE THAT WERE DISTRIBUTED TO THOSE IN NEED. -IN MARCH WE PARTNERED WITH COVENANT TO PROVIDE ADVANCED CARE PLANNING CLASSES FREE TO THE COMMUNITY. DECKERVILLE COMMUNITY HOSPITAL, INC. PART V, SECTION B, LINE 20E: WHEN A PATIENT IS ADMITTED TO THE HOSPITAL WITHOUT INSURANCE AND THE PATIENT FINANCIAL LIAISON IS AVAILABLE, SHE WILL PHYSICALLY MEET WITH THE PATIENT TO DISCUSS PAYMENT OPTIONS INCLUDING FAP. THIS WOULD BE PRIOR TO DISCHARGE. HER SCHEDULED HOURS ARE MONDAY - FRIDAY 7:00 AM - 3:30 PM. FOR PATIENTS THAT ARE ADMITTED OUTSIDE OF HER SCHEDULED HOURS FAP INFORMATION IS POSTED IN ALL ER ROOMS AND PATIENT ROOMS FOR DISPLAY. FINANCIAL ASSISTANCE AVAILABILITY IS NOTATED ON ALL PATIENT STATEMENTS AND A LETTER DETAILING THE FAP IS SENT TO A PATIENT PRIOR TO ECA. THE PATIENT IS CALLED SEVERAL TIMES TO IDENTIFY THEIR ELIGIBILITY FOR FAP PRIOR TO INITIATING ECA. 2 1 - DECKERVILLE HEALTHCARE SERVICES CLINIC 2433 BLACK RIVER STREET DECKERVILLE MI 48427 RHC CLINIC 2 - DECKERVILLE WALK-IN CLINIC 3559 PINE STREET DECKERVILLE MI 48427 CLINIC PART I, LINE 7: THE ORGANIZATION USES THE COST TO CHARGE RATIO RECOMMENDED BY WORKSHEET 2 OF THE IRS FORM 990, SCHEDULE H INSTRUCTIONS. PART I, LINE 7G: THE ORGANIZATION IS REPORTING THE FOLLOWING SERVICE LINES AS SUBSIDIZED ON SCHEDULE H, PART I, LINE 7G: EMERGENCY ROOM, HOSPITAL CLINIC, RURAL HEALTH CLINIC. 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 $ 184,013. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 4: THE ORGANIZATION DOES NOT HAVE A SPECIFIC BAD DEBT FOOTNOTE IN THEIR FINANCIAL STATEMENTS. ACCOUNTS RECEIVABLE AND CREDIT POLICY:ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS, WHICH REFLECT MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. THE HOSPITAL DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE AMOUNT OF MEDICARE ALLOWABLE COST WAS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNT LISTED FOR MEDICARE REVENUE DOES NOT INCLUDE PHYSICIAN SERVICES PROVIDED AT THE HOSPITAL, OUTLYING CLINIC LOCATIONS. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARE FOR PATIENTS. PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AN ADDITIONAL COMMUNITY BENEFIT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COST METHOD USED ABOVE FOR IRS 990 COMPLIANCES REPORTING IS BASED ON THE OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY THE HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED BASED ON MEDICARE REGULATIONS. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR. PART III, LINE 9B: IF A PATIENT PRESENTS WITHOUT INSURANCE FOR OUTPATIENT SERVICES, THE FRONT DESK INFORMS THE PATIENT OF THE AVAILABILITY OF FINANCIAL ASSISTANCE VIA A FORM THAT THE PATIENT RECEIVES PRIOR TO SERVICES. THE PATIENTS SEEN IN THE EMERGENCY ROOM DEPARTMENT IF STILL IN THE HOSPITAL DURING FINANCIAL SERVICES REGULAR BUSINESS HOURS, THE PATIENT IS APPROACHED TO OFFER THE OPPORTUNITY FOR FINANCIAL ASSISTANCE. THERE IS SIGNAGE IN THE EMERGENCY ROOMS AND WAITING ROOM AREAS INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. THERE IS VERBIAGE ON THE PATIENT STATEMENTS INDICATING AVAILABILITY OF THE PROGRAM AS WELL. EACH PATIENT PRIOR TO BAD DEBT COLLECTIONS RECEIVES A LETTER FROM THE FINANCIAL LIAISON AND A PHONE CALL FOR OUTREACH AS WELL. PART VI, LINE 2: THE ORGANIZATION USES STATISTICS FROM THE MICHIGAN THUMB PUBLIC HEALTH ALLIANCE, ONGOING PATIENT SATISFACTION SURVEYS, PATIENT QUESTIONNAIRES AT THE HEALTHCARE CLINIC RELATED TO SOCIOECONOMIC SITUATIONS OF THE PATIENT, AND AN ANNUAL PROGRAM EVALUATION COMPLETED BY THE CEO/CFO FOR THE HOSPITAL AND RHC AND REPORTED AT THE ANNUAL MEETINGS. DCH IS A MEMBER OF THE CRTN (COVENANT RURAL THUMB NETWORK) WHICH ALSO LOOKS AT DATA TO SEE WHERE NEEDS ARE LACKING. ALSO, THE RELATIONSHIP BUILT UNDER UNITED HEALTHCARE PARTNERS WITH MARLETTE REGIONAL HOSPITAL HAS ALSO BEEN A GOOD RESOURCE OF INFORMATION ON WHAT PATIENTS IN THE COUNTY ARE LOOKING FOR AS WELL. PART VI, LINE 3: WHEN A PATIENT IS ADMITTED TO THE HOSPITAL WITHOUT INSURANCE AND THE PATIENT FINANCIAL LIAISON IS AVAILABLE, SHE WILL PHYSICALLY MEET WITH THE PATIENT TO DISCUSS PAYMENT OPTIONS INCLUDING THE FAP APPLICATION PROCESS AND ELIGIBILITY PRIOR TO THE PATIENT DISCHARGE. THE FINANCIAL LIAISON REVIEWS PATIENT LISTS TO IDENTIFY UN-INSURED PATIENTS THAT WERE SEEN AT THE HOSPITAL AND CONTACTS THEM VIA PHONE TO ASSIST THE PATIENT. ADDITIONALLY, FOR PATIENTS THAT ARE ADMITTED OUTSIDE OF THE AVAILABLE HOURS OF THE FINANCIAL LIAISON, THE FAP AVAILABILITY NOTICE IS POSTED IN THE EMERGENCY ROOMS AND DISPLAYED IN THE WAITING AREAS THROUGHOUT THE HOSPITAL. THE PATIENT STATEMENTS INDICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND PATIENTS RECEIVE A LETTER NOTICE WITH A COPY OF A PLAIN LANGUAGE SUMMARY PRIOR TO INITIATING EXTRAORDINARY COLLECTION EFFORTS. PART VI, LINE 4: DECKERVILLE COMMUNITY HOSPITAL SERVES RURAL COMMUNITIES IN SANILAC COUNTY AND PORTIONS OF HURON COUNTY. THE HOSPITAL'S SERVICE AREA INCLUDES NUMEROUS MUNICIPALITIES: APPLEGATE, CARSONVILLE, CROSWELL, DECKERVILLE, HARBOR BEACH, MINDEN CITY, PORT SANILAC, RUTH, SANDUSKY, SNOVER, AND PALMS. BASED ON CENSUS DATA FOR THESE MUNICIPALITIES, APPROXIMATELY 27,077 PEOPLE LIVE IN THE SERVICE AREA. (CENSUS-AMERICAN COMMUNITY SURVEY 5-YEAR AVERAGE-2020). TWENTY-TWO PERCENT OF THE POPULATION IS OVER THE AGE OF 65 AND ONLY 20.6% ARE UNDER THE AGE OF 18. THE POPULATION HAS LIMITED RACIAL DIVERSITY WITH 97.7% OF THE POPULATION WHITE. THE SERVICE AREA HAS A COLLEGE DEGREE RATE OF 14.45% COMPARED TO MICHIGAN'S 30.5% AND THE UNITED STATES' 32.9%. AVERAGE HOUSEHOLD INCOME IN THE SERVICE AREA IS $65,155 AS COMPARED TO MICHIGAN'S AVERAGE INCOME OF $80,803 AND THE UNITED STATES AVERAGE INCOME OF $91,547. UNEMPLOYMENT IN THE SERVICE AREA RANGED FROM 1 TO 3.7% COMPARED TO MICHIGAN AT 6% AND THE U.S. AT 5.4%. OF THE CIVILIAN NONINSTITUTIONALIZED POPULATION 6.3% HAVE NO HEALTH INSURANCE COVERAGE COMPARED TO MICHIGAN AT 5.4% AND THE U.S. AT 8.7%. THE PERCENTAGE OF PEOPLE WHO HAD INCOMES BELOW POVERTY IN THE PAST 12 MONTHS WAS 12.3% BUT RANGED BY THE MUNICIPALITY FROM 7.1% TO 19.3%. PART VI, LINE 5: IN FY23 THERE WERE NO NEW SERVICES LINES ADDED TO THE HOSPITAL. HOWEVER, AT THE END OF THE FISCAL YEAR THE HOSPITAL HAD A COMMITMENT TO PURCHASE A CLINIC BUILDING IN PORT SANILAC, MI AS WELL AS RE-OPEN OUR MAIN STREET CLINIC. THE GOAL IS TO INCREASE OUR PRIMARY CARE SERVICES TO REACH MORE PATIENTS. PART VI, LINE 6: DECKERVILLE COMMUNITY HOSPITAL IS WORKING TOGETHER WITH MARLETTE REGIONAL HOSPITAL AND UNITED HEALTHCARE PARTNERS TO BETTER SERVE THE COMMUNITY AND CREATE MORE EFFICIENT PATIENT CARE PROGRAMS THROUGHOUT THE TWO ORGANIZATIONS. DURING THE END OF FY'20 BOTH ORGANIZATIONS COMBINED THEIR ADMINISTRATIVE TEAMS TO HAVE ONE CEO, COO, AND CFO OVER BOTH FACILITIES TO CREATE AN EVEN BETTER FLOW OF EFFICIENCIES BETWEEN THE TWO HOSPITALS. THIS PAST YEAR THERE HAS BEEN A MORE INCREASED EFFORT TO SHARE AND UTILIZE RESOURCES TOGETHER AS MORE STAFF IS BEING SHARED BETWEEN THE TWO ORGANIZATIONS. WE HAVE AN EIGHT PERSON LEADERSHIP TEAM THAT HELPS TO OVERSEE BOTH FACILITIES. THE HOSPITAL IS ABLE TO UTILIZE RESOURCES FROM EACH FACILITY TO ENHANCE THE PATIENT EXPERIENCE. DURING THIS PAST YEAR UHP FULLY OPEN A COMMUNITY CENTER IN MARLETTE, MI THAT HAS 20 INDEPENDENT VILLAS, 20 ASSISTED LIVING ROOMS, AND 12 MEMORY CARE ROOMS. THE HOSPITAL IS ALSO A MEMBER OF CRTN (COVENANT REGIONAL THUMB NETWORK), WHICH IS A 6 MEMBER GROUP OF HOSPITALS THAT WORKS TOGETHER TO SEE HOW THEY CAN INCREASE CARE IN THE THUMB AREA. 0 0 0 0 0 0 0 0 0 MALORIE MCVITTIE PHYSICIAN 241760 0 0 0 48 0 0 0 7560 0 249368 0 0 0 DANIEL BABCOCK CEO (THRU DEC 2022) 0 191441 0 5329 0 6546 0 4090 0 22716 0 230122 0 0 SCHEDULE J, PART I, LINE 3 THE CEO FOR THE ORGANIZATION IS COMPENSATED BY A RELATED PARTY, REPORTED IN SCHEDULE R. THE RELATED PARTY HAS SELECTED WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY AND STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7A THE HOSPITAL HAS ONLY 1 MEMBER, WHICH IS BLUEWATER HEALTHCARE NETWORK WHICH MAY APPOINT ONE OR MORE OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE SINGLE MEMBER HAS THE RIGHT TO APPOINT AN OFFICER OR DIRECTOR OR ANYONE ELSE TO ACT ON ITS BEHALF IN THE CAPACITY OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS PREPARED BY OUTSIDE PROFESSIONALS AND REVIEWED BY THE HOSPITAL ADMINISTRATION AND THEN A FINAL APPROVAL IS DONE BY THE HOSPITAL BOARD. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF DIRECTORS - PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS OF INTEREST SHALL FILE FORMAL STATEMENTS DISCLOSING ACTUAL OR POTENTIAL CONFLICTS WHENEVER AN ACTUAL OR POTENTIAL CONFLICT ARISES; BEFORE ANY TRANSACTIONS CONSTITUTING A CONFLICT OR POTENTIAL CONFLICT IS CONSUMMATED; AND ONCE EACH CALENDAR YEAR SO LONG AS THE CONFLICT OR POTENTIAL CONFLICT CONTINUES TO EXIST. THE DISCLOSURE STATEMENT SHALL INCLUDE A DESCRIPTION OF THE RELATIONSHIP OR INTEREST CAUSING THE CONFLICT OR POTENTIAL CONFLICT, THE ROLE IN THE RELATIONSHIP OR TRANSACTION PLAYED BY THE PERSON HAVING THE CONFLICT, AND THE BENEFITS AND DETERMENTS ACCRUING TO THE HOSPITAL AND TO THE PERSON HAVING THE CONFLICT AS A RESULT OF THE CONTRACT, TRANSACTION, OR RELATIONSHIP. ANY MEMBER OF THE BOARD OF DIRECTORS HAVING AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST ON ANY MATTER SHALL NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER CONSTITUTING A CONFLICT. THE INTERESTED DIRECTOR MAY, HOWEVER, BE COUNTED FOR THE PURPOSE OF DETERMINING WHETHER A QUORUM OF THE BOARD, OR OF A COMMITTEE OF THE BOARD, EXISTS. THE MATTER CONSTITUTING THE CONFLICT SHALL BE APPROVED IF IT IS APPROVED BY A MAJORITY OF DISINTERESTED DIRECTORS VOTING ON THE MATTER. THE CONFLICT OF INTEREST POLICY SHALL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF THE BOARD OF DIRECTORS AND THAT ANY NEW MEMBERS OF THE SAID BOARD OF DIRECTORS BE ADVISED OF THE POLICY UPON ENTERING ON THE DUTIES OF HIS/HER OFFICE. IN ADDITION TO THE BOARD OF DIRECTORS BEING HELD TO THE CONFLICT OF INTEREST POLICY, COPIES OF THE POLICY ARE AVAILABLE TO ALL MANAGEMENT EMPLOYEES. CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED ANNUALLY BY ALL DIRECTORS, OFFICERS, MANAGING EMPLOYEES, AND EMPLOYED MEDICAL STAFF. THE COMPLETED FORMS ARE KEPT ON FILE BY THE HOSPITAL'S COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT'S SALARIES ARE COMPARED TO A WAGE SURVEY FROM HOSPITAL COUNCIL OF EAST CENTRAL MICHIGAN AS A GUIDE. THE BOARD AND OTHER OFFICERS HAVE FINAL DETERMINATION OF THE WAGES. THE OFFICERS OR KEY EMPLOYEE'S SALARIES ARE REVIEWED BY THE BOARD OF DIRECTORS, THESE ARE COMPARED TO THE SALARIES OF SOMEONE IN A SIMILAR POSITION ON THE HCEM WAGE SURVEY. FORM 990, PART VI, SECTION C, LINE 19 THE ENTITY MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G EMERGENCY ROOM FEES & SERVICES: PROGRAM SERVICE EXPENSES 1,208,505. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,208,505. RHC FEES & SERVICES: PROGRAM SERVICE EXPENSES 41,804. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,804. MARLETTE CLINIC: PROGRAM SERVICE EXPENSES 15,536. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,536. DHCS FEES & SERVICES: PROGRAM SERVICE EXPENSES 38,421. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,421. OTHER FEES & SERVICES: PROGRAM SERVICE EXPENSES 675,812. MANAGEMENT AND GENERAL EXPENSES 154,901. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 830,713. FORM 990, PART XI, LINE 9: EQUITY TRANSFER FROM UNITED HEALTHCARE PARTNERS 247,343. CHANGE IN INVESTMENT IN UNCONSOLIDATED AFFILIATE -180,155. MARLETTE REGIONAL HOSPITAL 2770 MAIN STREET MARLETTE MI 48453 381507302 CRITICAL ACCESS HOSPITAL MI 501(C)(3) LINE 12B, II BLUEWATER HEALTHCARE NETWORK 1 BLUEWATER HEALTHCARE NETWORK 2770 MAIN STREET MARLETTE MI 48453 465444203 PARENT COMPANY MI 501(C)(3) LINE 3 N/A 0 MARLETTE SENIOR LIVING 6305 BLUEWATER MARLETTE MI 48453 843210271 SENIOR LIVING MI 501(C)(3) LINE 10 BLUEWATER HEALTHCARE NETWORK 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 MARLETTE REGIONAL HOSPITAL E 543849 COST MARLETTE REGIONAL HOSPITAL O 347173 COST MARLETTE REGIONAL HOSPITAL P 54539 COST