2025-05-14T09:39:47+00:00 2024-06-30 440160260 Forvis Mazars LLP 111 E Wayne Street Suite 600 Fort Wayne IN 46802 990 2023-07-01 386005550 HILLSDALE COMMUNITY HEALTH CENTER HILL 5174374451 168 SOUTH HOWELL STREET HILLSDALE MI 49242 JEREMIAH J HODSHIRE OFFICER 2025-05-14 true true Lauren Denton P01571860 2604604000 2025-05-14 2023 2025-03-06 01:10:19Z HILLSDALE HOSPITAL JEREMIAH J HODSHIRE 168 SOUTH HOWELL STREET HILLSDALE MI 49242 107848711 false X WWW.HILLSDALEHOSPITAL.COM X 1950 MI SHORT-TERM, ACUTE CARE HOSPITAL FACILITY 10 10 671 43 26506 14265 1264575 995772 78152031 90139783 716542 2654741 3819 8993 80136967 93799289 0 0 0 0 38027387 38302066 40000 0 3000 46358507 52413908 84425894 90715974 -4288927 3083315 60765502 63579298 25415565 23928676 35349937 39650622 HILLSDALE HOSPITAL IS A GUARDIAN OF EXCEPTIONAL HEALTH SERVICES FOR OUR COMMUNITY, ENSURING THAT FAMILIES HAVE ACCESS TO HIGH-QUALITY CARE WHEN AND WHERE THEY NEED IT. LARGE ENOUGH TO BE OF SERVICE... SMALL ENOUGH TO CARE. false false 77294501 90139783 HILLSDALE HOSPITAL IS A SHORT-TERM, ACUTE CARE HOSPITAL FACILITY INCLUDING A SKILLED NURSING UNIT, A PSYCHIATRIC UNIT, AND A HOME HEALTH CARE DEPARTMENT, WHICH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO THE HILLSDALE COUNTY, MICHIGAN AREA. THE HOSPITAL ALSO SUPPORTS UNPROFITABLE/SUBSIDIZED HEALTH SERVICES, INCLUDING BEHAVIORAL HEALTH, OBSTETRICS, AND EMERGENCY SERVICES. HILLSDALE HOSPITAL SAW 2,197 INPATIENT ADMISSIONS IN FY 2024, 152,140 OUTPATIENT VISITS, AND 19,095 EMERGENCY DEPARTMENT VISITS. DURING FY 2024 APPROXIMATELY 45.7% OF SERVICES RENDERED WERE TO ELDERLY PATIENTS UNDER THE MEDICARE PROGRAM, APPROXIMATELY 22.3% OF SERVICES PROVIDED WERE TO PATIENTS DEEMED INDIGENT UNDER STATE GUIDELINES AND APPROXIMATELY 2.3% OF SERVICES PROVIDED WERE TO INDIVIDUALS WITHOUT ANY HEALTHCARE COVERAGE. THE HOSPITAL STRIVES TO MINIMIZE THE FINANCIAL BARRIERS TO HEALTHCARE THAT EXIST FOR CERTAIN MEMBERS OF OUR COMMUNITY, AND IN FY 2024 PROVIDED APPROXIMATELY $1,100,000 IN CHARITY CARE AND RECORDED A PROVISION FOR BAD DEBT OF $4.5 MILLION. A COMPLETE LIST OF SERVICES OFFERED IS AVAILABLE AT WWW.HILLSDALEHOSPITAL.COM, ALONG WITH THE INFORMATION REGARDING APPLYING FOR FINANCIAL ASSISTANCE. HILLSDALE HOSPITAL GIVES BACK TO THE COMMUNITY IN MANY WAYS, INCLUDING SUPPORTING THE FREE HEALTH CLINIC AND PROVIDING HIGHER EDUCATION LOANS FOR ALLIED HEALTH PROFESSIONS. 77294501 true true false true false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false true true true false false false false true true false false false true X 61 0 671 true false true CJ false false false false false false false false false false X 10 10 false false false false true true true true true false false true true true true true true true true false MI X MARK GROSS 5174375232 168 S HOWELL STREET HILLSDALE MI 49242 David Gossage Vice Chair 1.5 X X 0 0 0 Gregory Bailey Chair 1.5 X X 0 0 0 Richard Moore Treasurer 1.5 X X 0 0 0 Robert Henthorne SECRETARY 10.0 X X 24000 0 0 Craig Connor Board Member 1.5 X 0 0 0 Diane Philipp Board Member 1.5 X 0 0 0 Karlye Horton Board Member 1.5 X 0 0 0 Kimberly Blythe Board Member 1.5 X 0 0 0 Shea Dow Board Member 1.5 X 0 0 0 Susan Smith Board Member 1.5 X 0 0 0 Jeremiah J Hodshire President/CEO 40.0 X 602813 0 54975 Mark Gross Vice President/CFO 40.0 X 461500 0 58425 Nichole Ellis Chief of Staff (Ex Oficio) 1.5 X 0 0 0 Brian Sinischo OBGYN 40.0 X 510869 0 18101 John Anderson Orthopedic Surgeon 40.0 X 567453 0 12472 Norris March General Suregon 40.0 X 599360 0 15542 Parthiv Patel Orthopedic Surgeon 40.0 X 845775 0 19925 Sarah Spencer OBGYN 40.0 X 401354 0 6297 4013124 0 185737 33 false true false MI Emergency Physicians LLP PO Box 677979 Dallas TX 752677979 Emergency Physicians 2191078 Healthpro Heritage LLC PO Box 69268 Baltimore MD 212649268 Therapy Services 1830447 Anesthesia Staffing Consultants PO Box 226804 Dallas TX 752226804 Anesthesia Services 1486698 Sparrow Hospital 1322 E Michigan Ave Lansing MI 48912 Reference Lab 1229968 Forvis PO Box 200870 Dallas TX 753200870 Consulting 1010598 31 995772 32289 995772 NET PATIENT REVENUE 621110 90211774 90211774 CAFETERIA SALES 621110 143991 143991 EMPLOYEE PRESCRIPTIONS 621110 67554 67554 OTHER INCOME 621110 -283536 -283536 0 0 0 0 90139783 1065433 26506 1038927 68947 59954 8993 0 8993 8993 15575267 3509 13989468 0 1585799 3509 1589308 1589308 0 0 0 0 0 93799289 90139783 26506 2637228 X 0 0 1481843 1215111 266732 29699376 24353488 5345888 540005 442804 97201 4481617 3674926 806691 2099225 1721365 377860 183520 183520 110938 110938 3000 3000 156129 156129 24117816 19776608 4341208 0 262617 215346 47271 563316 461919 101397 672761 551664 121097 2132286 1748475 383811 148205 121528 26677 9356 7672 1684 2036095 1669598 366497 966519 792546 173973 MEDICAL SUPPLIES 13970848 13970848 PROVISION FOR DOUBTFUL ACCOUNTS 4247727 4247727 RENT TO HHF 1334624 1094392 240232 REPAIR & MAINTENANCE 1302846 1068334 234512 195305 160150 35155 0 90715974 77294501 13418473 3000 473359 171786 7032934 10486165 0 0 11624924 13851149 0 0 0 0 581825 566442 1540688 1599472 1069949 1053186 16088393 8015488 8765376 8072905 24213777 21887045 0 0 0 0 5462670 5891148 60765502 63579298 11837808 13226236 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13577757 10702440 25415565 23928676 X 35256872 39299495 93065 351127 35349937 39650622 60765502 63579298 X 3083315 591382 625988 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 3000 false false 3000 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY HILLSDALE COMMUNITY HEALTH CENTER PAID MEMBERSHIP DUES TO THE MICHIGAN HOSPITAL ASSOCIATION, WHICH INCLUDED A PERCENTAGE THAT WAS ATTRIBUTED TO LOBBYING EXPENSES. 95000 95000 5336880 508591 4828289 19790 19790 10529295 7506897 3022398 107428 107428 8072905 OTHER 2092042 ASSETS LIMITED AS TO USE 2461556 DUE FROM THIRD PARTY PAYER 859834 RIGHT OF USE ASSETS 477716 5891148 COST REPORT SETTLEMENTS 10702440 10702440 X 90046769 591382 59954 651336 89395433 156129 4247727 4403856 93799289 86372072 59954 59954 86312118 156129 4247727 4403856 90715974 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 RENTAL EXPENSES - 59954 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements PROVISION FOR UNCOLLECTIBLE ACCOUNTS - 4247727 Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990 RENTAL EXPENSES - 59954 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements PROVISION FOR UNCOLLECTIBLE ACCOUNTS - 4247727 true true X true X true X true true true false true true 442912 0 442912 0.0051 19761091 23009716 0 0.0 14393816 9187507 5206309 0.0602 0 0 34597819 32197223 5649221 0.0653 3 435 5694 0 5694 0.0001 137160 15689 121471 0.0014 0 0 0 0.0 0 0 0 0.0 43726 5000 38726 0.0004 3 435 186580 20689 165891 0.0019 3 435 34784399 32217912 5815112 0.0673 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 0.0 true 4247727 1518859 25936076 32738731 -6802655 X true true 1 1 Hillsdale Community Health Center 168 S Howell St Hillsdale MI 49242 www.hillsdalehospital.com X X X Inpatient Psych Unit; Skilled Nursing Facility Hillsdale Community Health Center 1 false false true X X X X X X X X X 22 true false true true X WWW.HILLSDALEHOSPITAL.COM true 22 true WWW.HILLSDALEHOSPITAL.COM false true X 100.0 300.0 X X X X X X true true X X X true X www.hillsdalehospital.com X www.hillsdalehospital.com X www.hillsdalehospital.com X X X true X false X X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Hillsdale Community Health Center. THE PRIMARY DATA FOR THE ASSESSMENT CONSISTED OF A HEALTH SURVEY OF THE GENERAL COUNTY POPULATION AND AN OPEN FORUM OF HUMAN SERVICES NETWORK MEMBERS. THE HEALTH SURVEY QUESTIONNAIRE WAS DESIGNED TO CREATE A PROFILE OF THE RESPONDENTS, THEIR HEALTH NEEDS, AND VIEWS ON COMMUNITY HEALTH-RELATED ISSUES. ALL RESIDENTS OF THE COUNTY WERE INVITED TO PARTICIPATE IN THE SURVEY THROUGH A WIDE-REACHING INFORMATION CAMPAIGN THAT CONSISTED OF INFORMATIONAL ADS IN THE LOCAL NEWSPAPER, THE LOCAL RADIO STATION, PAPER MAILINGS, THE HOSPITAL WEBSITE, AND PERSONAL REQUESTS BY HOSPITAL VOLUNTEERS. AS A RESULT OF THE CAMPAIGN, 723 INDIVIDUALS COMPLETED THE HEALTH SURVEY QUESTIONNAIRE (1,200 IN 2019). SECONDARY DATA WAS COLLECTED FROM A VARIETY OF COUNTY, STATE, AND FEDERAL SOURCES SUCH AS THE US CENSUS BUREAU, MICHIGAN LABOR AND EDUCATION DEPARTMENTS, MICHIGAN DEPARTMENT OF VITAL STATISTICS, MICHIGAN BEHAVIOR RISK FACTOR SURVEY, AND KIDS COUNT IN MICHIGAN. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Hillsdale Community Health Center. HILLSDALE HOSPITAL PARTNERED WITH THE HILLSDALE COUNTY HUMAN SERVICES NETWORK TO CREATE A COMPREHENSIVE COMMUNITY BASED HEALTH NEEDS ASSESSMENT. HILLSDALE HOSPITAL HIRED AN INDEPENDENT CONTRACTOR TO HELP DESIGN THE SURVEY, ANALYZE THE DATA, FACILITATE DISCUSSIONS, AND CREATE THE FINAL REPORT. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HILLSDALE COMMUNITY HEALTH CENTER. 1. Recommendation from Human Services Network (HSN): Recruiting more professionals in the fields of cardiology, oncology, geriatrics and ENT. Background: Health Professional Shortage Areas (HPSA) designations identify areas, population groups, or facilities within the United States that are experiencing a shortage of health care professionals. Geographic HPSAs have a shortage of services for the entire population within an established geographic area. Hillsdale County has such a determination for the entire county. Hillsdale is designated as a Health Professional Shortage Area by the Federal government for Primary Care, Dental Care and Behavioral Health. Hillsdale Hospital was able to recruit an ENT several years ago, but this provider subsequently left Hillsdale due to lack of sufficient demand (2012-14). In addition, Hillsdale Hospital had oncology service with Dr. Shen for several years, but Dr. Shen subsequently left and his role has been difficult if not impossible to fill. The hospital has looked at several contractual alternatives since his departure, but has not yet been successful in bringing this much needed service back to the county. The leading causes of death in Hillsdale County (reported as a 2018 to 2020 three year average) was heart disease - greater than the next 7 leading causes, combined. Hillsdale County has always had a shortage of cardiology services and that continues. The Hospital has had a collaborative relationship with Ascension Borgess Hospital for cardiology services and we will continue to attempt to bolster this service to meet the demands of our community. We currently have one Cardiology provider for Hillsdale (Dr. Owusu). It will be the intention of the Hospital to actively recruit for this service line in an attempt to fill this important need within the County going forward. There are opportunities to accomplish this via both staffed as well as tele-health alternatives. In addition to the shortage of Primary Care and specialty care in Hillsdale County, the number of geriatricians per 10,000 adults older than 65 years of age has decreased steadily since 2000. Action Plan - Cardiology: The Hospital has had a collaborative relationship with Ascension Borgess Hospital for cardiology services and we will continue to attempt to bolster this service to meet the demands of our community. We currently have one Cardiology provider for Hillsdale (Dr. Owusu). It will be the intention of the Hospital to actively recruit for this service line i-n an attempt to fill this important need within the County going forward. There are opportunities to accomplish this via both staffed as well as tele-health alternatives. Oncology - Hillsdale Hospital currently has a NDA with West Michigan Cancer Center and an affiliation agreement for Oncology services with Ascension Borgess. Unfortunately, there are no oncologist to recruit to Michigan and Ascension is down 4, limiting their ability to come to Hillsdale at this time. Right now, the relationship is going to be a virtual option (telehealth) at our Three Meadows facility until we can get one here very part-time. Gerontology: Geriatricians are fully trained medical doctors. After graduating from medical school, completing residency requirements, and becoming state-licensed to practice medicine, doctors who want to specialize in geriatric medicine must become board-certified in internal medicine or family medicine. Attracting and retaining such specialists in today's market is increasingly difficult. Hillsdale County is extremely fortunate to have 2 such specialist residing and working in our community at this point in time. Fortunate in that, by most estimates, a population the size of Hillsdale County, with a senior population currently at about 20%, we are projected to need between 1.4 and 1.6 FTE gerontology specialists to serve our community. So while we currently appear to have sufficient specialty care in this area, we have two issues of concern. First, the senior population is growing and is currently 4% larger, by percentage, than the senior population in Michigan. In addition, the median age of Hillsdale County residents is nearly 3 years older than that of Michigan, so as time marches on, there will be a larger and larger percentage of seniors who will need care. In addition, providers, believe it or not, are subject to the hands of time as well. We already know we will need to replace one of our two Geriatric specialists within the next 3-5 years. Hillsdale Hospital will be actively seeking providers with this specialty in the coming years so we can 1. Recruit the necessary skills and 2. Attract and retain these professionals as our population will demand it in the coming years. Second, and perhaps as important, it was noted during our community session for this current CHNA, there were many/most of the membership of the Human Service Network that were NOT aware we had Gerontology specialists in our community. The hospital is also firmly committed to engage in a marketing campaign, so that providers as well as our community are fully aware that we have this specialty available for referral and will work hard to maintain and even grow this capacity. ENT - Hillsdale Hospital is proud to announce that at the time of the presenting of this Action Plan to the Board, we will already have and be utilizing the services of an ENT. She will be beginning to service patients in Hillsdale beginning June 9, 2022 on a limited basis, with a potential for increasing availability if demand warrants it. Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - HILLSDALE COMMUNITY HEALTH CENTER. 2. Recommendation from HSN: Encourage physicians to take more Medicaid patients, especially in the pediatric field. Background: Hillsdale County has a large number of people living at or near poverty level, and the number is growing. A complete look at the various types of health insurance used by Hillsdale County citizens can be seen using U.S. Census data (below). In addition, hospital data shows that 23% of patients pay for Hospital services utilizing Medicaid. It is a significant payment source in Hillsdale County given the level of poverty within the county. Medicaid also the payment source for approximately 48% of all births within the County. Having sufficient providers who accept Medicaid as a source of payment for patients is critical in providing quality healthcare to our citizens. As such, it was discussed that many providers only accept a small percentage of patients within their panel of patients who are insured by Medicaid. The Collaborative strongly encouraged the Hospital to encourage all providers increase this percentage so that more patients can have access to care. Insurance Types - % of Hillsdale County (Source: US Census) Medicare 15% VA 2% Uninsured 6% Employer based 45% Medicaid 20% Other 12% A poverty level of 100% in the U.S. was defined in 2021 as an annual income of: - $14,097 for one person under age 65. - $12,996 for one person aged 65 or older. - $27,479 for a family of two adults and two children. Hillsdale County has a higher percentage of people below poverty level than Michigan or the United States. Our Survey showed a high degree of concern among those responding to the issue of respondents in the 2022 CHNA survey were asked if they were very concerned, moderately concerned, or not at all concerned about poverty in the community. Of the 683 people who answered this question: - 324 (47.4%) said they were very concerned. - 290 (42.5%) were moderately concerned. A recent study by researchers from the US Bureau of Economic Analysis, the University of Chicago, and the Federal Reserve Bank in San Francisco found providers run into more obstacles when trying to bill Medicaid than they do with other insurers, and that these administrative hurdles explain the access problems experienced by Medicaid patients as much as the program's payment rates. Medicaid payment rates, the amount doctors receive for providing services, are on average lower than Medicare or private coverage. This has typically been used to explain why many physicians are reluctant to take Medicaid and why some Medicaid recipients still struggle to access care. That is on top of the other health challenges that people with lower incomes face. Usually, the access problem is seen as caused by the prices paid by Medicaid. And Medicaid does pay less than the other major insurers: Based on its own data, the average initial claim filed is $98 for Medicaid patients, whereas Medicare averages $137 and private insurers average $180. Action Plan: For many low-income people in the US, getting insured isn't enough to get health access to health care: Patients with Medicaid can struggle to find a doctor willing to take their health insurance. And this happens in large part because, for doctors and providers, billing Medicaid is a challenge. The Hospital can assist the community in the area, as we have Rural Health Centers who take all patients regardless of their ability to pay, and all Hospital owned PCP's also take Medicaid as payment in full. As for our community providers, the Hospital is fully aware that doctors' offices are businesses in addition to healthcare providers, and it's not surprising that they would make participation decisions based not only on how much they get paid, but also on the hassle of doing business with different insurers. They need to make sufficient margin to stay in business. The existing 'rule of thumb' for providers is 80/20, for Medicaid vs. other forms of insurance. Hopefully with the Hospital providing more primary care than ever, and the potential for that to increase over time, there will be sufficient provider capacity to serve this population and this gap. It is the intention of the hospital to provide access to care for as many patients as we serve, providing a variety of options (RHC, Walk in care, PCP care, multiple clinics, ER care). Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - HILLSDALE COMMUNITY HEALTH CENTER. 3. Recommendation from HSN: Coordinate the existing pain clinic with Prevention Works. Background: According to the Centers for Disease Control and Prevention, "In 2019, nearly 50,000 people in the United States died from opioid-involved overdoses. The misuse of and addiction to opioids-including prescription pain relievers, heroin, and synthetic opioids such as fentanyl-is a serious national crisis." Opioids work in the nervous system or on specific receptors in the brain to reduce the intensity of pain. Overdose deaths from opioids include those from prescription opioids, heroin, and synthetic opioids like fentanyl. Although prescriptions for opioids account for only some of the drug overdose deaths, the Centers for Disease Control and Prevention has been tracking the prescription dispensing rate per 100 persons over the past years. The rate has been much higher in Michigan than the United States for the years 2018-20 but Hillsdale County rates are lower than both Michigan and the United States rates for 2019 & 2020. The HSN members pointed out that physicians are often "hamstrung" by the government in prescribing pain management drugs. There is a large amount of paperwork needed to be filed on a regular basis for providers to continue to write prescriptions for opioids. Many providers would prefer to refer patients needing opioids for pain management to certified pain management clinics. Pain management clinics should include a mental health component since behavioral modifications can sometimes reduce the need for medications. The HSN members recommended a coordination between Hillsdale Hospital and Prevention Works. Action Plan: The Prevention Works Coalition has been operational in Hillsdale County since the summer of 2007, and currently has seventeen (17) active members. There is representation from law enforcement, human service providers, government, media, SUD treatment, and concerned citizens. Coalition members provide strong linkages across the county and region, with members serving on the local multi-purpose collaborative body (Human Services Network - HSN), CAN council (Child Abuse Prevention and Awareness - CAPA), Family Treatment Court advisory council, 4H groups, and many service clubs, churches, and other organizations. The Coalition staff are active on Tobacco Reduction Action Coalition (TRAC), Coordinated School Health Council, HSN and the HSN Indicators workgroup, C3 (domestic violence community coalition), Hillsdale Community Schools board of education, and the Alpha-Omega Women's Care Center board. This involvement in multiple sectors of the community helps the Coalition to network. Prevention Works seeks to partner with others to continue to expand our prevention efforts in Hillsdale County. That said, Hillsdale Hospital will reach out to Prevention Works to attempt to coordinate our efforts with our existing pain clinic and other services that could benefit or be synergized by collaboration with Prevention Works. The hospital will actively participate with Prevention Works over the next 3 years to assure services are maximized for our patients and coordinated with other providers of care within the County. Schedule H, Part V, Section B, Line 11 Facility , 4 Facility , 4 - HILLSDALE COMMUNITY HEALTH CENTER. 4. Recommendation from HSN: Address the issue of inadequate prenatal care by creating partnerships with the Branch-Hillsdale-St. Joseph Community Health Agency's WIC program as well as the prenatal care initiatives headed by Great Start. Background: Prenatal care is reported based on the Kessner Index (The Kessner Index is a classification of prenatal care based on the month of pregnancy in which prenatal care began, the number of prenatal visits and the length of pregnancy; i.e. for shorter pregnancies, fewer prenatal visits constitute adequate care). Among the 1,501 births to Hillsdale County residents between 2018-20: - 53.3% of the mothers received adequate prenatal care compared to 67.8% in Michigan. - 35.9% of mothers received intermediate care compared to 23.4% in Michigan. - 10.8% had inadequate care compared to 8.8% in Michigan. Hillsdale Hospital offers a fully equipped birthing center. Not all births to Hillsdale County residents occurred at Hillsdale Hospital, but some out-of-county residents also used the hospital facility. The HSN members were very concerned about the lack of adequate pre-natal care for area moms. One member said the county was the second county in the state of Michigan for inadequate care last year. Several factors that prohibited adequate pre-natal care were discussed including: - Transportation issues, especially for teen moms. - Cultural issues. Some said their moms didn't need early pre-natal care and therefore they did not feel the need for it. - Drug use. Moms using drugs may be reluctant to seek care, concerned about being reported to protective services for abuse of their unborn child. The law in Michigan currently prohibits protective services to intervene until and unless the child is born with drug addiction problems, so this concern may be less than expectant mothers believe. The Branch-Hillsdale-St. Joseph Community Health Agency oversees the WIC Program in Hillsdale County. They have found that younger moms may not be aware of the availability of this program and the requirements necessary to access services. Linking moms on WIC to adequate pre-natal care is sometimes a challenge but HSN members recommended better coordination between the Agency and the OB/GYN area providers. Members also recommended the OB/GYN providers collaborate with Great Start on linking new moms and mother's to be with WIC and other pre-natal and early childhood programs. Action Plan: Actions plans on this longstanding issue in Hillsdale County will come from two sources. First, OB Nursing Management will actively reach out to both the Branch-Hillsdale-St. Joseph Community Health Agency to seek opportunities to collaborate and expand the services provided by WIC for women in Hillsdale County. Additionally, OB Nursing Management will reach out to the Great Start Collaborative to increase the Hospital's presence with this organization to attempt to better serve our patients and their families. Great Start, whose mission is to assure a coordinated system of community resources to assist all Hillsdale County families in providing a great start for their children prenatal through third grade, will be an excellent opportunity for the Hospital to collaborate in this endeavor to assure we are providing the best, coordinated care possible for Hillsdale County moms. In addition to reaching out to community groups to better coordinate care and services, our physician providers here at the Hospital have committed to the following initiatives: 1. Education- improving our patients understanding of risks of obesity, smoking, diabetes etc. Coordinating programs and/or education material will assist in increasing the quality of care we can provide. 2. Centering pregnancy- this is a preset program that groups patients by gestational age and allows them to go through their pregnancy together. Dr. Sinischo (OB/GYN) truly believe this would be an amazing opportunity for our community to access this initiative. The Hospital may need to explore sources of funding and possible grants to afford this. This program gives patients control of their health and educates in important ways. This program has been shown to decrease morbidity and mortality proven through proven research. 3. Providing Mental health professional for needed out-patient care. The hospital is currently positioning to begin the process of providing limited outpatient mental health services in the coming months. This is a great step and we will have many patients, in desperate need, to refer if this program can become a reality. Schedule H, Part V, Section B, Line 11 Facility , 5 Facility , 5 - HILLSDALE COMMUNITY HEALTH CENTER. 5. Recommendation from HSN: Create (or incorporate) a weight clinic with a program that includes both dietary and behavioral health modifications to address the obesity issue. Background: Obesity is a major factor in the control of diabetes, heart disease and other chronic conditions. Weight control is a problem for many area residents. When asked in the 2022 CHNA survey if they were concerned about their weight, 702 respondents answered the question. Of these: - 334 (47.6%) said they were. - 368 (52.4%) said they were not. When asked how they would best describe their weight, 681 respondents answeredthe question. Of these: - 18 (2.6%) said they were under weight. - 245 (36.0%) said they were average weight. - 350 (51.4%)) said they were overweight. - 68 (10.0%) said they were obese. These results were similar to what was found in the CHNA previous surveys. - 50.5% said they were overweight and 8.6% said they were obese in 2019. - 51.1% said they were overweight and 7.7% said they were obese in 2016. These results indicate little progress has been made in this area. Hillsdale Hospital currently offers a multidisciplinary approach to treat obesity. 1. The hospital has a resident dietician. Area doctors can refer overweight or obese patients to the dietician for consultation on diets and diet modification. 2. Regular seminars are conducted for those interested in weight loss surgery to explain procedures and expected outcomes. 3. The hospital offers several surgical procedures in conjunction with the Hillsdale Surgical Group for those interested in surgical intervention. Surgical options include laparoscopic gastric sleeve resection and laparoscopic adjustable banding. The HSN members commented that some areas have created weight clinics associated with their hospital. The clinics provide dietary programs plus supportive help for patients to make the behavioral modifications needed to reduce their weight. Providers refer for individual counseling - our Hospital Dietician see patients 1-3 visits, depending on insurance mix. 50% of insurance, including Medicare, does not pay for weight management. New preventative codes exist, however, that could include nutrition, that we may be able to use. Hospital Administration is exploring the feasibility of this becoming a reality. Due to limited reimbursement, Hospital Dietary staff typically see patients once, which is not enough to help a person with obesity change their entire life and lose weight. If insurance does not pay, or patients do not want to pay in deductible, the Hospital offers a monthly group nutrition class 1 hours in length for $30. Again, not enough to truly help someone. Action Plan: Pre-Covid: - The Hospital had a group 10-12-week weight management program going right before covid-we had 12 participants and it was going very well. Then we shut down due to covid. We offered it free to employees and charged public $50; it was a pilot program. - Obese patients have many needs that need to be met: food insecurity, disordered eating, h/o misinformation causing yo-yo weight cycles that causes shifts in metabolism that making weight loss very difficult, emotional factors and mobility factors, family issues, etc. Moving Forward: The Hospital will seek to offer a comprehensive weight management program which would address the following, the most important in the order listed: - Behavior change, mental health, disordered eating patterns - Meal planning, cooking and meal prep classes, eating on a budget - Mindful and intuitive eating - Nutrition - Movement and activity This program should include an exercise specialist (I have one from the college), and behavior health specialist and obviously a Registered Dietician. The exercise piece is important but the latest obesity research is showing that the quality of food and eating patterns contribute to weight management more than exercise. Basically, you may be very active and if you are not eating correctly, you will not lose weight; however, movement does assist in disease prevention, quality of life and calorie burning on a daily basis. Schedule H, Part V, Section B, Line 11 Facility , 6 Facility , 6 - HILLSDALE COMMUNITY HEALTH CENTER. 6. Recommendation from HSN: Refer psychiatric discharge patients to Lifeways for outpatient follow up care when appropriate (they now take all patients regardless of ability to pay). Background: Not all hospitalizations of county residents are at Hillsdale Hospital. But a study of the hospital discharge data shows that the leading causes of hospitalization at Hillsdale Hospital were psychiatric disorders, and obstetrics. Covid 19 discharges in the past year were also significant. There was an active discussion about meeting the mental health needs in the county. Members pointed out that Hillsdale Hospital's psychiatric unit draws residents from the neighboring counties who lack such a facility so the discharge numbers would be less if you just considered county residents. Lifeways has become a Certified Behavioral Mental Health Clinic and currently accepts people with all types of insurance, even if they can only refer them to other resources. The lack of understanding of the services available to county residents suffering mental health issues and the stigma some attach to people seeking mental health treatment is one of the main reasons people do not seek help. The use of telehealth services for psychiatric patients may help to bridge some of the gap due to the lack of area psychiatrists. The HSN recommended a better communication between the hospital discharge personnel and Lifeways for follow up services. Action Plan: Hillsdale Hospital's Behavioral Health Unit currently discharges about 35 patient per month to their home setting. These patients often will need assistance with medication management, and access to follow up Outpatient services to assure they don't return to an inpatient setting. LifeWays of Hillsdale County is the public agency serving people in Jackson and Hillsdale counties. LifeWays, as a Certified Community Behavioral Health Clinic grantee, provides a comprehensive set of services used to increase access to care, support people in crisis, and provide treatment for those with the most serious and complex behavioral health needs regardless of their insurance coverage. Hillsdale Hospital Behavioral Health Unit will refer to Lifeways, to provide a 'medical home' for as many of our discharged patients who this appropriately serves. In Addition, Hillsdale Hospital is exploring providing Outpatient services as well through the addition of a Behavioral Health Outpatient clinic that will be exploring over the next few months. We are optimistic, that with our own Outpatient clinic and through services provided by LifeWays that we can meet the needs of our Behavioral Health patients in the Outpatient setting in Hillsdale County, a service that has been lacking for some time in the Hillsdale community. Schedule H, Part V, Section B, Line 11 Facility , 7 Facility , 7 - HILLSDALE COMMUNITY HEALTH CENTER. 7. Recommendation from HSN: Encourage discharge planners to become more aware of, and coordinate with, existing programs offered by the various community agencies for improved follow up care. (e.g., MACES). Background: Hospitalizations account for nearly one-third of the total $2 trillion spent on health care in the United States. In the majority of cases, hospitalization is necessary and appropriate. However, a substantial fraction of all hospitalizations are patients returning to the hospital soon after their previous stay. These rehospitalizations are costly, potentially harmful, and often avoidable. Evidence suggests that the rate of avoidable rehospitalization can be reduced by improving core discharge planning and transition processes out of the hospital; improving transitions and care coordination at the interfaces between care settings; and enhancing coaching, education, and support for patient self-management. Validated risk assessment tools such as the Hospital Score and LACE index have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. Hospitals are monitored for the number of patients re-admitted for the same illness within a short period following discharge. Although in some cases this is unavoidable due to the nature of the illness or the actions of the patient following discharge, premature release of patients from a facility or lack of follow-up outpatient monitoring or service coordination and follow-up care can contribute to the likelihood of re-admittance. However, the HSN members recommended there could be better identification of patients at risk, and more coordination between the hospital discharge personnel and area agencies to prevent otherwise avoidable readmissions. Patients being discharged were sometimes not referred to outside agencies that could provide additional follow up services or care. Action Plan: Proper identification of patients 'at-risk' of readmission to the hospital is the best proactive step we can take to begin to tackle this issue. LACE is an indexed scoring tool to identify patients at risk for readmission or death within 30 days of discharge. The LACE index comprises four parameters: length of stay. type of admission (acuity), comorbidities using the Charlson Comorbidity Index, and number of ED visits. Hillsdale Hospital will begin implementation of the utilization of this tool in the coming months, assessing all patients for their level of risk to better identify those patients who need extra attention prior to and during the discharge process. In addition, Case Management Services has been looking into the addition of a transition of care RN. This position would be charged with assessing patient likelihood of readmission, establishing links to resources in the community and assisting patients in obtaining the necessary assistance they will need to transition back to their home or to the next level of care post-discharge. These services will also be coordinated with existing OP clinic services and our ACO Patient Coordinator to avoid duplication of effort and provide seamless assistance to patients during this transition. Many patients discharged from the hospital do not have a primary care physician, so establishing this relationship with providers in the community or one of our hospital-based clinics will be critical. Schedule H, Part V, Section B, Line 11 Facility , 8 Facility , 8 - HILLSDALE COMMUNITY HEALTH CENTER. 8. Recommendation from HSN: Continue making telehealth services available because of its appeal to the younger population segment. Background: The rise of technology has given rise to many improvements in the health care system. In previous years, the HSN suggested that the development of a telemedicine system would benefit the community. During the Covid 19 epidemic, the use of telemedicine seemed like a viable and desirable option. A telehealth service became available in early 2021 in the Hillsdale County area through nearly all of the health clinics. Respondents in the 2022 CHNA survey were asked about it. The survey asked respondents if they had tried telehealth. Of the 672 who answered this question: - 134 (19.9%) said they had tried it. - 538 (80.1%) had not. A follow up question asked respondents who had not tried telehealth why they had not. Of the 279 who answered this question: - 48 (17.2%) said they did not have a computer or smart phone. - 197 (70.6%) felt it was not personal. - 34 (12.2%) said they had safety concerns. The HSN members pointed out that the 2022 CHNA had a predominately older population than the general county and senior citizens might be less likely to use telehealth services. Younger residents who are use to texting and more experienced in computer use might embrace telehealth, especially if the cost is less, since the lack of medical insurance could be a problem for them. Telehealth may actually be preferred as this generation ages. Action Plan: Hillsdale Hospital has technology in all of our outpatient clinics (Orthopedics, OB/GYN, Reading, Litchfield, Hillsdale Health and Wellness, Hillsdale Surgical) to support the ability of tele-health services for patients. We are lacking, however, in some areas in terms of technology and will need to address these issues. In the coming months we will be upgrading that technology and holding staff meetings with clinical staff (both providers and clinic staff) to discuss making tele-health an equal choice for all patients when scheduling appointments. This will be a cultural shift with some of our clinic staff as well as some clinicians. We also intend to launch a county wide advertising campaign, letting our community know that, if they choose, we are ready and able to provide nearly all of our patient visits in a virtual environment. The hospital will make the necessary upgrades at each of our offices to make this as efficient and pleasant an experience as possible for both the providers of care as well as the patients. It is our intention to increase the percentage of visits provided via tele-health significantly over the next 1-3 years. The population we see within our OP clinical setting is significantly younger than in the Hospital setting and this population is increasingly more technology savvy and looking for the same level of sophistication from our clinics and our providers. This is a cultural change that has already left the station and we need to get on board before our patients look for better solutions elsewhere. This was pointed out by several members of our Human Services Network and felt that the hospital needed to make this a priority or be left behind in the marketplace. Creating this tech-friendly environment as an equal option for our patients will be a central focus in our Outpatient clinics over the coming months and years. Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - Hillsdale Community Health Center. AFTER INSURANCE PAYMENTS, THE SELF PAY PORTION IS BILLED TO THE PATIENT ON A MONTHLY STATEMENT. THE STATEMENT INCLUDES INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND HOW TO APPLY. THE GUARANTOR RECEIVES FOUR STATEMENTS. IF THE AMOUNT IS STILL NOT PAID, THE GUARANTOR CONTINUES TO RECEIVE LETTERS UNTIL THE ACCOUNT IS WRITTEN OFF TO THE COLLECTION AGENCY. DURING THE TIME THE GUARANTOR IS RECEIVING THE STATEMENTS AND LETTERS, SEVERAL TELEPHONE CALLS ARE PLACED TO THE GUARANTOR TO TRY TO DISCUSS THE PAYMENT OR OTHER OPTIONS AVAILABLE TO THE GUARANTOR SUCH AS A PAYMENT PLAN OR FINANCIAL ASSISTANCE. 6 HILLSDALE HOME CARE 1711 S HILLSDALE RD HILLSDALE MI 49242 HOME CARE HILLSDALE HOME OXYGEN 49 E CARLETON RD HILLSDALE MI 49242 DME READING HEALTH CLINIC 143 S MAIN ST READING MI 49274 RURAL HEALTH CLINIC LITCHFIELD HEALTH CLINIC 535 MARSHALL ST LITCHFIELD MI 49252 RURAL HEALTH CLINIC QUINCY WORK HEALTH 181 E CHICAGO ST QUINCY MI 49082 OCCUPATIONAL HEALTH HILLSDALE HEALTH & WELLNESS 240 W CARLETON RD HILLSDALE MI 49242 RURAL HEALTH CLINIC Schedule H, Part V, Section B, Line 21 Policy Relating to Emergency Medical Care ALL PATIENTS ARE BILLED THE SAME AMOUNT REGARDLESS OF TYPE OF INSURANCE OR LACK OF INSURANCE. DISCOUNTS OFF BILLED CHARGES ARE PROVIDED THROUGH THE CHARITY APPLICATION PROCESS OR PROMPT PAYMENT DISCOUNTS. Schedule H, Part II COMMUNITY BUILDING ACTIVITIES HILLSDALE COMMUNITY HEALTH CENTER PROVIDES NUMEROUS COMMUNITY ACTIVITIES IN SUPPORT OF THE RESIDENTS OF HILLSDALE COUNTY, INCLUDING SENIOR SUNDAY WHERE LUNCH IS SERVED TO THE SENIOR COMMUNITY MEMBERS AND A SPEAKER DISCUSSES HEALTH ISSUES AND OTHER TOPICS RELATING TO THIS AGE GROUP. IN ADDITION, THERE ARE SEVERAL SUPPORT GROUPS AND CLASSES, INCLUDING THE BREAST CANCER SUPPORT GROUP, BREAST FEEDING CLASSES, BIRTHING CLASSES, NUTRITION EDUCATION AND DIABETES EDUCATION CLASSES. THERE ARE PERIODIC HEALTH SCREENINGS SUCH AS VARICOSE VEIN, FOOT PAIN, CHOLESTEROL, AND COPD SCREENINGS. HILLSDALE COMMUNITY HEALTH CENTER ALSO PROVIDES FREE SUPPORT TO ST. PETER'S FREE CLINIC AND PARTICIPATES IN THE LOCAL ALLIED HEALTH STUDENT PROGRAM. NUMEROUS HIGH SCHOOL AND COMMUNITY LOANS HAVE BEEN GRANTED FOR FULL TUITION FOR ALLIED HEALTH DEGREES. REPAYMENT OF LOANS IS FULFILLED THROUGH A TIME COMMITMENT TO THE HILLSDALE COMMUNITY HEALTH CENTER. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 4247727 Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount 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 RATE FACTORS APPLIED TO UNPAID ACCOUNTS STRATIFIED BY PAYOR AND NUMBER OF DAYS THE ACCOUNTS ARE OUTSTANDING. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology HILLSDALE HOSPITAL SAW $1,518,859 OF ACCOUNTS WRITTEN OFF TO BAD DEBT THAT WERE ATTRIBUTED TO PATIENTS WITH NO INSURANCE COVERAGE. THE AVERAGE DISCOUNT APPLIED TO ACCOUNTS THROUGH OUR FINANCIAL ASSISTANCE PROGRAM WAS 94.6%. WE APPLIED THAT PERCENTAGE TO THOSE ACCOUNTS WRITTEN OFF WITH NO INSURANCE. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HILLSDALE COMMUNITY HEALTH CENTER PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HILLSDALE COMMUNITY HEALTH CENTER BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS IS AT 54 PERCENT OF TOTAL ACCOUNTS RECEIVABLE AT JUNE 30, 2024. IN ADDITION, THE HOSPITAL'S BAD DEBT WRITE-OFFS INCREASED FROM APPROXIMATELY $4,500,000 FOR THE YEAR ENDED JUNE 30, 2023, TO APPROXIMATELY $4,530,000 FOR THE YEAR ENDED JUNE 30, 2024. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE COST TO CHARGE RATIO IS USED TO DETERMINE MEDICARE SURPLUS OR SHORTFALL AT COST. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT AS THIS IS THE EXTENT TO WHICH COSTS RELATED TO MEDICARE SERVICES GO UNPAID. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance AFTER INSURANCE PAYMENTS, THE SELF PAY PORTION IS BILLED TO THE PATIENT ON A MONTHLY STATEMENT. THE STATEMENT INCLUDES INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND HOW TO APPLY. THE GUARANTOR RECEIVES FOUR STATEMENTS. IF THE AMOUNT IS STILL NOT PAID, THE GUARANTOR CONTINUES TO RECEIVE LETTERS UNTIL THE ACCOUNT IS WRITTEN OFF TO THE COLLECTION AGENCY. DURING THE TIME THE GUARANTOR IS RECEIVING THE STATEMENTS AND LETTERS, SEVERAL TELEPHONE CALLS ARE PLACED TO THE GUARANTOR TO TRY TO DISCUSS THE PAYMENT OR OTHER OPTIONS AVAILABLE TO THE GUARANTOR SUCH AS A PAYMENT PLAN OR FINANCIAL ASSISTANCE. Schedule H, Part V, Section B, Line 16a FAP website - Hillsdale Community Health Center: Line 16a URL: www.hillsdalehospital.com; Schedule H, Part V, Section B, Line 16b FAP Application website - Hillsdale Community Health Center: Line 16b URL: www.hillsdalehospital.com; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Hillsdale Community Health Center: Line 16c URL: www.hillsdalehospital.com; Schedule H, Part VI, Line 2 Needs assessment HCHC PARTNERED WITH THE HUMAN SERVICES NETWORK, A COMMUNITY COLLABORATIVE BODY MADE UP OF A MAJORITY OF THE COUNTY'S HUMAN SERVICE, EDUCATIONAL, FAITH BASED, AND NON-PROFIT ORGANIZATIONS WITHIN HILLSDALE COUNTY. THIS GROUP SERVED AS THE STEERING GROUP FOR THE PROJECT, ALONG WITH ITS EXECUTIVE COMMITTEE. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance IF A PATIENT PRESENTS TO HCHC FOR SERVICES AND INDICATES THEY HAVE NO INSURANCE, THEY ARE PROVIDED A COPY OF THE FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY ALONG WITH A LISTING OF THOSE ORGANIZATIONS THAT ARE AVAILABLE TO PROVIDE ADDITIONAL HELP AND SERVICES. WE ALSO HAVE A STATE MEDICAID CASE WORKER ON SITE WHO IS AVAILABLE TO WORK WITH THE PATIENTS TO DETERMINE THEIR ELIGIBILITY FOR MEDICAID OR OTHER SERVICES. EACH STATEMENT MAILED TO THE GUARANTOR INCLUDES A STATEMENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO APPLY OR GET ADDITIONAL INFORMATION. AS COLLECTION CALLS ARE MADE TO THE GUARANTOR THEY ALSO INFORM THEM ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. THERE ARE INFORMATIONAL POSTERS IN THE PATIENT WAITING ROOMS, AND FINANCIAL ASSISTANCE POLICY INFORMATION IS INCLUDED IN EACH DISCHARGE PACKET PROVIDED TO ADMITTED PATIENTS. THE COMPLETE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY IS PROVIDED ON THE HOSPITAL WEBSITE. Schedule H, Part VI, Line 4 Community information HILLSDALE, MICHIGAN IS THE COUNTY SEAT OF HILLSDALE COUNTY. ITS POPULATION IS 7,998 (AS OF 2023) WITH A HOUSEHOLD MEDIAN INCOME OF $47,817 (AS OF 2023). AS OF DECEMBER 2023, THE CURRENT UNEMPLOYMENT RATE IS 3.5% FOR HILLSDALE COUNTY. THE COUNTY IS BOUNDED ON THE NORTH BY CALHOUN AND JACKSON COUNTIES, ON THE EAST BY LENAWEE COUNTY, ON THE WEST BY BRANCH COUNTY, AND ON THE SOUTH BY STEUBEN COUNTY INDIANA AND WILLIAMS COUNTY OHIO. THE EXTREME SOUTHWEST CORNER OF HILLSDALE COUNTY IS WHERE THREE STATES OF MICHIGAN, OHIO AND INDIANA MEET. ON MAPS, THE COUNTY IS SITUATED AT 42 NORTH LATITUDE AND 8430' WEST LONGITUDE, AND COMPRISES ABOUT 617 SQUARE MILES, OR 394,880 ACRES. THE LAND LIES AN AVERAGE OF 630 FEET ABOVE LAKE ERIE AND 616 FEET ABOVE LAKE MICHIGAN. Schedule H, Part VI, Line 5 Promotion of community health HCHC FACILITATES SEVERAL EDUCATIONAL CLASSES INCLUDING BREAST FEEDING, BIRTHING, NUTRITION, AND DIABETES EDUCATION, AS WELL AS SEVERAL PERIODIC HEALTH SCREENINGS INCLUDING VARICOSE VEIN, FOOT PAIN, ACID REFLUX, CHOLESTEROL, AND COPD SCREENINGS, AS WELL AS PROVIDES FREE FLU SHOTS AND COVID-19 VACCINES TO THE MEMBERS OF THE COMMUNITY. HCHC OWNS AND OPERATES THREE RURAL HEALTH CLINICS IN READING, LITCHFIELD, AND HILLSDALE, MICHIGAN THAT PROVIDE HEALTHCARE SERVICES TO THE MEDICAID AND SELF INSURED POPULATION. HCHC ALSO PROVIDES FREE SUPPORT TO ST. PETER'S FREE CLINIC AND PARTICIPATES IN THE LOCAL ALLIED HEALTH STUDENT PROGRAM. X X X true true X X X X X X false true false false false false false false false Jeremiah J Hodshire President/CEO 390861 0 170063 0 41889 0 47400 0 7575 0 657788 0 0 0 Mark Gross Vice President/CFO 275928 0 143750 0 41822 0 47400 0 11025 0 519925 0 0 0 Parthiv Patel Orthopedic Surgeon 559828 0 285922 0 25 0 9900 0 10025 0 865700 0 0 0 Norris March General Suregon 343973 0 232862 0 22525 0 9900 0 5642 0 614902 0 0 0 John Anderson Orthopedic Surgeon 564212 0 0 0 3241 0 9900 0 2572 0 579925 0 0 0 Brian Sinischo OBGYN 310809 0 200035 0 25 0 9900 0 8201 0 528970 0 0 0 Sarah Spencer OBGYN 386329 0 15000 0 25 0 1724 0 4573 0 407651 0 0 0 Schedule J, Part I, Line 1a Travel for companions Annually, the spouses of the CEO and CFO accompany them on a business trip. The cost of the spouse's travel is treated as taxable compensation. Schedule J, Part I, Line 1a Tax indemnification and gross-up payments Taxable spouse travel and reimbursement for dues is grossed up. Schedule J, Part I, Line 1a Housing allowance or residence for personal use THE CFO RESIDES IN A HOUSE OWNED BY THE HOSPITAL. HOUSING COSTS OF $6,000 ARE INCLUDED IN THE CFO'S TAXABLE INCOME PER YEAR. THIS IS DONE THROUGH PAYROLL AT $500 PER MONTH. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan DURING THE YEAR ENDED 6/30/2024, MARK GROSS AND JEREMIAH HODSHIRE PARTICIPATED IN A 457F PLAN. CONTRIBUTIONS TO THE PLAN WERE $37,500 FOR MARK GROSS AND $37,500 FOR JEREMIAH HODSHIRE. DISTRIBUTIONS TO THE PLAN WERE $37,500 FOR MARK GROSS AND $37,500 FOR JEREMIAH HODSHIRE. THE CONTRIBUTIONS WERE FULLY VESTED AND THEREFORE WERE INCLUDED IN TAXABLE WAGES AND ARE REPORTED ON SCHEDULE J, PART II, COLUMN B III. The Pediatric Place Of Hillsdae SEE STATEMENT 125630 Pediatric Coverage false Schedule L, Part IV BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS NICHOLE ELLIS, HILLSDALE CHIEF OF STAFF, IS A GREATER THAN 35% OWNER OF THE PEDIATRIC PLACE OF HILLSDALE. X 3 23813 Market value X 1 8476 Market value false true false Schedule M, Part I COLUMN B THE AMOUNTS LISTED IN PART I, COLUMN B ARE BASED ON THE NUMBER OF CONTRIBUTORS FOR EACH TYPE OF PROPERTY CONTRIBUTED. Form 990, Part VI, Line 15 THERE IS A SEPARATE COMPENSATION COMMITTEE OF THE GOVERNING BODY WHICH CONSULTS WITH THE COMPANY'S LEGAL FIRM FOR COMPARABILITY DATA. THERE IS A WRITTEN EMPLOYMENT CONTRACT THAT IS APPROVED BY THE COMPENSATION COMMITTEE. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS FISCAL YEAR 2021. Form 990, Part VI, Line 6 Classes of members or stockholders MEMBERS OF THE CORPORATION SHALL BE APPOINTED FOR A TERM OF THREE (3) YEARS. ALL MEMBERS OF THE CORPORATION SHALL BE NOMINATED PURSUANT TO SECTION 5.1, AND SHALL BE APPOINTED BY THE MEMBERS AT AN ANNUAL OR SPECIAL MEETING OF MEMBERS. EVERY ATTEMPT SHALL BE MADE IN THE SELECTION OF CANDIDATES FOR MEMBERSHIP TO SECURE THE BROADEST DIVERSITY OF REPRESENTATION OF THE COMMUNITY AND ITS INTERESTS AS POSSIBLE, INCLUDING THE CONSIDERATION OF SUCH FACTORS AS AREAS OF EXPERTISE, BACKGROUND AND AREAS OF RESIDENCY. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE CORPORATION MEMBERS ELECT THE BOARD OF TRUSTEES. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE CORPORATION MEMBERS APPROVE ANY PROPOSED CHANGE IN THE PURPOSE OR PHILOSOPHY OF THE CORPORATION, AND APPROVE A PLAN OF MERGER, CONSOLIDATION, SALE, OR DISSOLUTION OF THE CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. IN ADDITION, THE FORM 990 IS REVIEWED BY THE CFO AND CEO FOR ACCURACY. THE RETURN IS ALSO REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. Form 990, Part VI, Line 12c Conflict of interest policy BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST ANNUALLY. THE BOARD OF TRUSTEES SHALL DETERMINE WHETHER A CONFLICT EXISTS BY MAJORITY VOTE. IF A CONFLICT OF INTEREST IS DEEMED TO EXIST, THE TRUSTEE OR OFFICER SHALL NOT PARTICIPIATE IN DELIBERATIONS OR DISCUSSIONS REGARDING THE TRANSACTION AND ARE NOT ALLOWED TO VOTE ON THE MATTER AT HAND. Form 990, Part VI, Line 19 Required documents available to the public DOCUMENTS ARE AVAILABLE ON REQUEST. Form 990, Part IX, Line 11g Other Fees SPEECH THERAPIST - Total Expense: 21304, Program Service Expense: 17469, Management and General Expenses: 3835, Fundraising Expenses: ; COLLECTION SERVICES - Total Expense: 184754, Program Service Expense: 151498, Management and General Expenses: 33256, Fundraising Expenses: ; PSYCH - Total Expense: 262229, Program Service Expense: 215028, Management and General Expenses: 47201, Fundraising Expenses: ; E/R - Total Expense: 852484, Program Service Expense: 699037, Management and General Expenses: 153447, Fundraising Expenses: ; MAT MANAGEMENT - Total Expense: 169072, Program Service Expense: 138639, Management and General Expenses: 30433, Fundraising Expenses: ; PHARMACY - Total Expense: 953311, Program Service Expense: 781715, Management and General Expenses: 171596, Fundraising Expenses: ; ANESTHESIOLOGIST - Total Expense: 2047187, Program Service Expense: 1678693, Management and General Expenses: 368494, Fundraising Expenses: ; PHYSICAL THERAPY - Total Expense: 771776, Program Service Expense: 632856, Management and General Expenses: 138920, Fundraising Expenses: ; OCCUPATIONAL THERAPY - Total Expense: 210705, Program Service Expense: 172778, Management and General Expenses: 37927, Fundraising Expenses: ; SLEEP STUDY - Total Expense: 255860, Program Service Expense: 209805, Management and General Expenses: 46055, Fundraising Expenses: ; HOME CARE - Total Expense: 687735, Program Service Expense: 563943, Management and General Expenses: 123792, Fundraising Expenses: ; HOSPITALIST - Total Expense: 1445424, Program Service Expense: 1185248, Management and General Expenses: 260176, Fundraising Expenses: ; PULM CLINIC - Total Expense: 758499, Program Service Expense: 621969, Management and General Expenses: 136530, Fundraising Expenses: ; QUALITY - Total Expense: 213517, Program Service Expense: 175084, Management and General Expenses: 38433, Fundraising Expenses: ; MED RECS - Total Expense: 22402, Program Service Expense: 18370, Management and General Expenses: 4032, Fundraising Expenses: ; PATHOLOGY - Total Expense: 489359, Program Service Expense: 401274, Management and General Expenses: 88085, Fundraising Expenses: ; ADMINISTRATION - Total Expense: 1804979, Program Service Expense: 1480083, Management and General Expenses: 324896, Fundraising Expenses: ; INFORMATIONAL TECHNOLOGY - Total Expense: 520186, Program Service Expense: 426553, Management and General Expenses: 93633, Fundraising Expenses: ; QAAP FEE - Total Expense: 3498846, Program Service Expense: 2869054, Management and General Expenses: 629792, Fundraising Expenses: ; LAB SERVICE - Total Expense: 1239819, Program Service Expense: 1016652, Management and General Expenses: 223167, Fundraising Expenses: ; OTHER PURCHASED SERVICES - Total Expense: 7708368, Program Service Expense: 6320860, Management and General Expenses: 1387508, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances NET ASSETS RELEASED FROM RESTRICTIONS - 625988; Headwaters Health Foundation 168 S Howell St Hillsdale MI 49242 811509725 Support MI 501(c)(3) Type I HH true HALLETT ST PROFESSIONAL DEVELOPMENT 451 HIDDEN MEADOWS DR HILLSDALE MI 49242 383497750 PROFESSIONAL BUILDING MI NA Related 279324 1145008 false true 0.375 HCHC Assurance Co LTD 300548721 Financial CJ HCHC C Corporation 652251 1999916 1 true false false true false false false false false true false false false false false false true false false HALLETT ST PROFESSIONAL DEVELOPMENT D 316393 FMV HALLETT ST PROFESSIONAL DEVELOPMENT Q 232851 FMV