2025-11-05T08:49:34-06:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2024-01-01 381619577 HILLS & DALES GENERAL HOSPITAL INC HILL 9898722121 4675 HILL STREET CASS CITY MI 48726 ANGELA MCCONNACHIE CEO 9898722121 2025-11-04 1 0 ANN NEIL P01817922 6123764500 2025-11-04 2024 2025-03-06 01:10:19Z ANDREW DANIELS 4675 HILL STREET CASS CITY MI 48726 96903534 0 X WWW.ASPIRERHS.ORG X 1960 MI TO BE RECOGNIZED AS THE LEADING HEALTHCARE ORGANIZATION IN THE COMMUNITIES WE SERVE. 11 11 556 50 0 0 395397 58509 72286959 93949189 380091 987090 3534035 1662946 76596482 96657734 9782 10434 0 0 37241972 42740754 0 0 0 30530258 45011197 67782012 87762385 8814470 8895349 51076690 54392188 15745118 22224690 35331572 32167498 X TO BE THE PROVIDER OF CHOICE AND THE EMPLOYER OF CHOICE IN OUR PRIMARY MARKET. 0 0 78857628 10434 93949189 THE ORGANIZAION PROVIDED NURSING AND PROFESSIONAL SERVICES FOR ACUTE & SWING BED PATIENTS, EMERGENCY, AND OUTPATIENTS. DURING THE PERIOD JANUARY 1, 2024 TO DECEMBER 31, 2024, HDGH PROVIDED CARE INCLUDING 1,182 INPATIENT DAYS, 1,931 SWING BED DAYS, 8,220 EMERGENCY ROOM VISITS, OVER 86,376 PHYSICIAN VISITS, FOR A TOTAL REGISTRATIONS OF 164,702 . DURING THE YEAR, 68.7% OF THE SERVICES PROVIDED WERE TO GOVERNMENTAL PROGRAMS, WHICH REIMBURSE BELOW ACTUAL COSTS. IN ADDITION, THE HOSPITAL PROVIDED APPROXIMATELY $385,506 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. 78857628 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 85 0 1 556 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X RENEE HENRY 9898722121 6667 MAIN STREET CASS CITY MI 48726 PAT CURTIS CHAIRMAN 1.00 1.00 X 0 0 0 GAIL DENTON VICE-CHAIRMAN 1.00 1.00 X 0 0 0 DAVID MESSING SECRETARY/TREASURER 1.00 1.00 X 0 0 0 CAROL STARLING DIRECTOR 1.00 1.00 X 0 0 0 ERIK TAMLYN DIRECTOR 1.00 1.00 X 0 0 0 FAITH FAHRNER RN DIRECTOR 1.00 1.00 X 0 0 0 JUDY BROWN DIRECTOR 1.00 1.00 X 0 0 0 PAUL ROHLING DIRECTOR 1.00 1.00 X 0 0 0 SCOTT ORR DIRECTOR 1.00 1.00 X 0 0 0 STEVE ELLIS DIRECTOR 1.00 1.00 X 0 0 0 VICTORIA MEIBURG DIRECTOR 1.00 1.00 X 0 0 0 ANDREW DANIELS PRESIDENT AND CO-CEO 13.00 27.00 X 318986 71506 41883 ANGELA MCCONNACHIE CO-CEO 13.00 27.00 X 127046 241799 6523 KIMBERLY GENTNER CFO 13.00 27.00 X 94688 164954 11091 JIAB SULEIMAN PHYSICIAN 40.00 0.00 X 1224906 0 44464 DAVID KOMASARA PHYSICIAN 39.00 1.00 X 532936 7178 28749 ADAM TURNER PHYSICIAN 40.00 0.00 X 532918 0 25455 ERIC SHOEMAKER PHYSICIAN 40.00 0.00 X 518874 0 48771 FARAAZ AHMED PHYSICIAN 23.00 17.00 X 281284 209314 29635 3631638 694751 236571 67 0 1 0 THUMB MRI CENTER LLC PO BOX 67 CASS CITY MI 48726 MEDICAL SERVICES 3605361 MICHIGAN RURAL MEDICAL SERVICES PLLC 2573 GINGER COURT BLOOMFIELD HILLS MI 48304 MEDICAL SERVICES 1916000 NET REVENUE ASSOCIATES LLC 1330 CORPORATE DRIVE SUITE 100 HUDSON OH 44236 CONSULTING SERVICES 1240375 TAP STAFFING 295 W EDDY ROAD SANDUSKY MI 48471 STAFFING AGENCY 1225050 COVENANT HEALTHCARE LABORATORY 1447 N HARRISON SAGINAW MI 48602 LAB SERVICES 924859 17 44888 13621 58509 PATIENT SERVICE REVENUE 621110 90417367 90417367 PHARMACY REVENUE 456110 3531822 3531822 93949189 530825 530825 58887 229264 -170377 -170377 -170377 472801 0 16536 472801 -16536 456265 456265 MISCELLANEOUS REVENUE 900099 1635334 1635334 CAFETERIA REVENUE 900099 182440 182440 FITNESS REVENUE 900099 10734 10734 4815 4815 1833323 96657734 93949189 0 2650036 X 10434 10434 33422608 28492765 4929843 1162083 1139934 22149 5923553 5848501 75052 2232510 2192591 39919 79243 79243 148924 148924 16277343 15023528 1253815 376665 26006 350659 1800013 1310135 489878 1907000 999098 907902 983166 979469 3697 123437 82898 40539 113070 67099 45971 499954 491357 8597 2284170 2203722 80448 493443 413582 79861 MEDICAL SUPPLIES 13051077 13051077 0 BAD DEBT 3957669 3892508 65161 TAX ASSESSMENT 1486833 1486833 REPAIRS AND MAINTENANCE 999973 951805 48168 429217 194286 234931 87762385 78857628 8904757 0 3404594 7525215 4308938 3094804 15255871 14677485 638270 1059230 414855 353688 24971501 9199348 17674700 15772153 4944165 1779938 625707 832688 3809590 9296987 51076690 54392188 6454376 8693171 11900 309760 9278842 13221759 15745118 22224690 X 35331572 32167498 35331572 32167498 51076690 54392188 X 8895349 -129246 -11930177 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3764 3764 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO AHA AND MHA OF WHICH A PORTION GOES TOWARD LOBBYING. 1 26538 124721 95448 55811 0 489088 489088 13246260 4039479 9206781 1136485 604571 531914 9061448 4555298 4506150 1038220 1038220 15772153 DUE FROM RELATED PARTY 1099562 RIGHT-OF-USE ASSETS 8197425 9296987 CAPITAL LEASE 12040167 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1179736 RELATED PARTY PAYABLE 1856 13221759 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 RELTAED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSES IF SUCH INTEREST AND PENALTIES ARE INCURRED. 1 1 X 1 X 1 X 0 1 1 0 1 1 173509 173509 0.00210 13323058 5538886 7784172 0.09290 13496567 5538886 7957681 0.09500 2315 2315 0.00000 2315 2315 0.00000 13498882 5538886 7959996 0.09500 0 3957669 589513 12311146 12356175 -45029 X 1 1 1 1 HILLS & DALES GENERAL HOSPITAL INC 4675 HILL STREET CASS CITY MI 48726 WWW.ASPIREHS.ORG 381619577 X X X HILLS & DALES GENERAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE PART V, LINE 7D X 1 22 1 SEE PART V, LINE 7D 0 1 X 100.000000000000 300.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION B, LINE 16J X SEE PART V, SECTION B, LINE 16J X SEE PART V, LINE 16J X X 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 BEHAVORIAL HEALTH SYSTEMS, TUSCOLA COUNTY HEALTH DEPARTMENT, TUSCOLA GREAT START COLLABORATIVE, THUMB COMMUNITY HEALTH PARTNERSHIP. HILLS & DALES GENERAL HOSPITAL INC. PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ON OUR WEBSITE AT: HTTPS://ASPIRERHS.ORG/COMMUNITY-RESOURCES/DIRECT LINK:HTTPS://ASPIRERHS.ORG/WP-CONTENT/UPLOADS/2024/09/2022%20CHNA%20REPORT-HD-FINAL%20(002).PDFIF A READER USES THIS INFORMATION TO ACCESS THE FORM ONLINE, BE SURE TO FORMAT THE URL WITH LOWERCASE LETTERS WHEN COPYING AND PASTING THE DIRECT LINKS. HILLS & DALES GENERAL HOSPITAL INC. PART V, SECTION B, LINE 11: BASED ON ALL INFORMATION REVIEWED, INCLUDING THE THUMB COMMUNITY HEALTH PARTNERSHIP ASSESSMENT AND THE STRATEGIES ALREADY IN PLACE TO ADDRESS COMMUNITY NEEDS, THE FOLLOWING PRIORITIES WERE IDENTIFIED:- ACCESS TO SERVICES- CANCER- BEHAVIORAL HEALTHTHE FOLLOWING ACTIONS WERE IDENTIFIED TO ADDRESS THE NEEDS:ACCESS TO SERVICESHILLS AND DALES OFFER VARIOUS LOW-COST AND FREE SCREENINGS TO COMMUNITY MEMBERS TO INCREASE ACCESS TO VALUABLE HEALTH SCREENINGS, ESPECIALLY FOR THOSE WHO DO NOT HAVE INSURANCE. SOME OF THESE INCLUDE KNOW YOUR NUMBERS, BREAST CANCER SCREENINGS AND PROSTATE CANCER SCREENINGS THROUGH THE BREAST CANCER UNDERSTANDING PREVENTION AND SCREENING (B.C.U.P.S.) AND PROSTATE CANCER UNDERSTANDING PREVENTION AND SCREENING (P.C.U.P.S.) PROGRAMS. IN 2024, DISCUSSIONS BEGAN REGARDING THE HIRING OF A COMMUNITY HEALTH WORKER. THE PURPOSE OF THE COMMUNITY HEALTH WORKER WOULD BE TO FACILITATE ACCESS TO SERVICES TO COMMUNITY MEMBERS. WITH A COMMUNITY HEALTH WORKER, THE ROLE FILLS GAPS IN THE COMMUNITY THAT EXIST DUE TO A LACK OF ACCESS, AWARENESS, OR KNOWLEDGE OF COMMUNITY PROGRAMS. A COMMUNITY HEALTH WORKER CAN ELIMINATE THESE GAPS AND INCREASE ACCESS TO SERVICES BY CONNECTING COMMUNITY MEMBERS TO THE SERVICES THEY NEED, WHETHER IT IS IN THE HOSPITAL SYSTEM OR OTHER ORGANIZATIONS.HILLS AND DALES ALSO HAVE FINANCIAL AND INSURANCE NAVIGATORS AND CARE MANAGERS WHO GUIDE PATIENTS THROUGH COMMON SETBACKS THAT PREVENT THEM FROM RECEIVING CARE. THIS INCLUDES FINANCIAL MANAGEMENT OF CARE, INSURANCE ASSISTANCE, AND NAVIGATING THE VARIOUS SERVICES THAT A PATIENT MAY NEED DURING THEIR CARE. COMMUNICATION TOOLS AND ONLINE RESOURCES WERE STREAMLINED TO EFFECTIVELY COMMUNICATE WITH THE COMMUNITY AND PATIENTS. STREAMLINING COMMUNICATIONS INCLUDED ONE SYSTEM-WIDE WEBSITE AND ONE SYSTEM-WIDE FACEBOOK PAGE FOR ASPIRE PARTNER HOSPITALS. MARKETING HAS INCREASED ITS REACH IN 2024 TO INCLUDE MORE ZIP CODES THAT WERE PREVIOUSLY NOT ADVERTISED OR HAD AWARENESS CAMPAIGNS DIRECTED TO. THIS EXPANDED REACH INCLUDED DIRECT MAILERS, BILLBOARDS, ADVERTISEMENTS, AND MORE. HILLS AND DALES ALSO EXPANDED SERVICES INTO A NEW MARKET IN 2024. THE BAD AXE CLINIC OPENED WITH EXPANDED SERVICES, INCLUDING LAB, RADIOLOGY, PODIATRY, FAMILY HEALTHCARE AND PEDIATRICS, AND RAPID CARE. CANCER:HILLS AND DALES IS A MEMBER OF THE COVENANT REGIONAL THUMB NETWORK (CRTN), WHICH IS A NETWORK OF LOCAL HOSPITALS AND COVENANT HEALTHCARE THAT WORK TOGETHER TO OPERATE THE COVENANT CANCER CARE CENTER AT ASPIRE MARLETTE. THIS FACILITY IS A ONE-STOP FACILITY SERVING CANCER PATIENTS LIVING IN MICHIGAN'S THUMB AREA, WHICH IS AN EXTENSION OF THE COVENANT CANCER CARE CENTER IN SAGINAW, MICHIGAN. CRTN AND THE CANCER CARE CENTER WORK TOGETHER TO PROVIDE MORE COMPREHENSIVE CANCER SERVICES CLOSE TO HOME. PARTNER WITH CRTN AND PROVIDE GREATER ACCESS TO CANCER SERVICESIN 2024, HILLS AND DALES EXPANDED INFUSION SERVICES. 2024 ALSO MARKED THE ADOPTION OF THE BREAST CANCER UNDERSTANDING PREVENTION AND SCREENING (B.C.U.P.S.) AND PROSTATE CANCER UNDERSTANDING PREVENTION AND SCREENING (P.C.U.P.S.) PROGRAMS INTO THE ASPIRE RURAL HEALTH SYSTEM FOUNDATION. PREVIOUSLY, THESE PROGRAMS WERE MANAGED BY OTHER LOCAL ORGANIZATIONS BUT TRANSITIONED TO THE FOUNDATION, WHICH DEVELOPED A MORE DIRECT LINE TO PATIENTS ACCESSING THESE RESOURCES. ONE RESOURCE OFFERED THROUGH THE B.C.U.P.S. AND P.C.U.P.S. IS GRANT PROGRAMS. THE GRANT PROGRAMS OFFER $500 IN FINANCIAL ASSISTANCE FOR THOSE UNDERGOING TREATMENT FOR BREAST CANCER OR PROSTATE CANCER, AND PATIENTS ARE ELIGIBLE TO REAPPLY FOR FUNDING EVERY 6 MONTHS. HILLS AND DALES DEVELOPED VARIOUS CANCER AWARENESS CAMPAIGNS, SUCH AS BREAST AND COLORECTAL CANCER CAMPAIGNS, THAT ARE SPREAD THROUGH SOCIAL MEDIA CHANNELS. BEHAVIORAL HEALTH:THROUGHOUT 2024, HILLS AND DALES BEGAN THE RECRUITMENT PROCESS FOR NEW PSYCHIATRY PROVIDERS AND PROJECT DEVELOPMENT FOR A NEW PSYCHIATRY CLINIC, WHICH WOULD LATER OPEN IN 2025. PARTNERSHIP OPPORTUNITIES WITH THUMB AREA PSYCHOLOGICAL SERVICES WERE EXPLORED AS WELL.HILLS AND DALES ALSO HELD AWARENESS CAMPAIGNS REGARDING MENTAL HEALTH THAT WERE COMPLETE WITH COMMUNITY MENTAL HEALTH RESOURCE INFORMATION FOR COMMUNITY MEMBERS TO UTILIZE.AN IMPACT REPORT WAS COMPILED TO IDENTIFY GAPS AND THE VALUE OF A POTENTIAL MEDICATION-ASSISTED TREATMENT (MAT) CLINIC. FINDINGS OF THIS REPORT INCLUDED SHORT-TERM AND LONG-TERM OUTCOMES. SHORT-TERM OUTCOMES WOULD BE CREATING A DIRECT ER TO CLINIC PIPELINE THAT MINIMIZES RELIANCE ON ER TREATMENT, HIGH PATIENT SATISFACTION, AND REDUCED OPIOID USE AND OVERDOSE. LONG-TERM OUTCOMES WOULD BE IMPROVED TREATMENT RETENTION, LOWERING THE NUMBER OF RESPONDENTS WHO LIST SUD TREATMENT AS A COMMUNITY NEED ON COMMUNITY HEALTH SURVEYS, AND INCREASED SERVICE LINES TO MAT AND OTHER SUD TREATMENT. IN 2025, A MAT PROGRAM WAS OPENED AS A RESULT OF THESE 2024 FINDINGS.HILLS AND DALES IS AN ACTIVE PARTNER IN THE THUMB OPIOID RESPONSE CONSORTIUM (TORC).AS A PART OF ASPIRE RURAL HEALTH SYSTEM, HILLS AND DALES OFFER VARIOUS BENEFITS, EVENTS, AND CHALLENGES AIMED AT ENCOURAGING EMPLOYEES, PATIENTS, AND THE COMMUNITY TO MAKE BEHAVIORAL CHANGES TOWARDS MORE ACTIVE AND HEALTHY LIFESTYLES. SUCH PROGRAMS INCLUDE EMPLOYEE WALKING AND WATER CHALLENGES, EMPLOYEE DISCOUNTS TO LOCAL GYMS AND FITNESS CENTERS, AND ASPIRE-WIDE FREE COMMUNITY FITNESS CLASSES AT THE HEARTLANDS MARLETTE SENIOR LIVING. HILLS AND DALES ALSO PUTS ON A COMMUNITY 5K EACH YEAR. THE ORGANIZATION ALSO OFFERS MATTER OF BALANCE AND SMART DRIVERS CLASSES. HILLS AND DALES ALSO HAS MEDICAL NUTRITION THERAPY FOR NUTRITION COUNSELING WHILE PATIENTS ARE RECEIVING INPATIENT CARE. DIABETES SELF-MANAGEMENT EDUCATION IS ALSO AVAILABLE IN AN OUTPATIENT SETTING. HILLS & DALES GENERAL HOSPITAL INC. PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT:HTTPS://ASPIRERHS.ORG/BILLING/.DIRECT LINK: HTTPS://ASPIRERHS.ORG/BILLING/THE FINANCIAL ASSISTANCE POLICY APPLICATION IS AVAILABLE AT: HTTPS://ASPIRERHS.ORG/BILLING/DIRECT LINK: HTTPS://ASPIRERHS.ORG/WP-CONTENT/UPLOADS/2025/01/PA-102-FAP-APPLICATION.PDFTHE FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT: HTTPS://ASPIRERHS.ORG/BILLING/DIRECT LINK: HTTPS://ASPIRERHS.ORG/WP-CONTENT/UPLOADS/2025/10/ASPIRE-FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SUMMARY-1.DOCXIF A READER USES THIS INFORMATION TO ACCESS THE FORM ONLINE, BE SURE TO FORMAT THE URL WITH LOWERCASE LETTERS WHEN COPYING AND PASTING THE DIRECT LINKS. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONAL EDUCATION, AND CASH AND IN KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT ARE ALL BASED ON ACTUAL COST.COST TO CHARGE RATIO WAS DERIVED USING WORKSHEET 2 FROM THE IRS TO CALCULATE THE AMOUNTS INCLUDED IN SCHEDULE H, PART I, LINE 7A & 7B. COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS (LINE 7E) AND HEALTH PROFESSIONAL EDUCATION ARE REPORTED AT COST 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 $ 3,957,669. 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 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: FOR INFORMATION ABOUT BAD DEBT EXPENSE, SEE THE "PATIENT SERVICE REVENUE" SECTION OF NOTE 1 PAGES 16-19 OF THE ATTACHED 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 MEIDCARE COST REPORT. THE NUMBERS USED TO DETERMINE THE SURPLUS CAME FROM THE FILED MEDICARE COST REPORT FOR THE 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 ORGANIZATIONS' WEBSITE, WWW.ASPIRERHS.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 HEALTHTRUST. 1 CASS CITY CHAMBER OF COMMERCE 6506 MAIN STREET CASS CITY MI 48726 386090272 501(C)(6) 10000 0 N/A N/A GENERAL OPERATING SUPPORT 0 1 PART I, LINE 2: ASPIRE'S FINANCE DEPARTMENT IS COMPRISED OF TALENTED TEAM MEMBERS WITH EXTENSIVE EXPERIENCE IN NON-PROFIT ACCOUNTING AND AUDITING. KEY PRACTICES ARE TO UPHOLD ETHICS, STEWARDSHIP, TRANSPARENCY, AND CONFIDENTIALITY. UPON RECEIVING A GRANT AWARD, CARE WILL BE TAKEN TO REVIEW THE SPECIFIC TERMS, RESTRICTIONS, CONDITIONS, REPORTING REQUIREMENTS, AND DEADLINES. THE DETAILS OF THE GRANT WILL BE COMMUNICATED TO TEAM MEMBERS DIRECTLY ASSOCIATED WITH ITS IMPLEMENTATION. FINANCE USES A COMPREHENSIVE CLOUD ERP SOLUTION DESIGNED TO FACILITATE COMPLEX ACCOUNTING TASKS. DETAILED TRANSACTIONS, SUPPORTING DOCUMENTATION, AND DESIGNATION WILL BE THE BASIS OF COMPLIANCE FOR RECOGNIZING REVENUE, MONITORING ALLOWABLE EXPENSES, AND CONDUCTING INTERNAL REVIEWS. FINANCE PRACTICES STRONG INTERNAL CONTROLS SUCH AS SEGREGATION OF DUTIES, PERIODIC RECONCILIATION, AND INTERNAL REVIEWS WITH ASPIRE'S GRANT WRITER. ASPIRE'S PROCESS IS DESIGNED TO MEET EXTERNAL REVIEWS THAT ADD ANOTHER LAYER OF PREPARATION AND AUDIT TRAILS. AT THE END OF A GRANT PERIOD, A COMPLETE REVIEW WILL BE CONDUCTED TO ENSURE FUNDS WERE SPENT ACCORDINGLY AND ANY FUNDS REMAINING SHALL BE RETURNED TO THE GRANTOR BY THE SPECIFIED DEADLINE. 0 0 0 0 0 0 0 0 0 JIAB SULEIMAN PHYSICIAN 720000 0 504906 0 0 0 34055 0 10409 0 1269370 0 0 0 DAVID KOMASARA PHYSICIAN 478401 6443 54535 735 0 0 22551 304 5816 78 561303 7560 0 0 ERIC SHOEMAKER PHYSICIAN 421800 0 97074 0 0 0 41162 0 7609 0 567645 0 0 0 ADAM TURNER PHYSICIAN 532918 0 0 0 0 0 23000 0 2455 0 558373 0 0 0 FARAAZ AHMED PHYSICIAN 260804 194075 6146 4573 14334 10666 13187 9813 3804 2831 298275 221958 0 0 ANDREW DANIELS PRESIDENT AND CO-CEO 238323 53424 71497 16027 9166 2055 26335 5903 7879 1766 353200 79175 0 0 ANGELA MCCONNACHIE CO-CEO 98629 187715 28417 54084 0 0 0 0 2247 4276 129293 246075 0 0 KIMBERLY GENTNER CFO 79371 138271 15317 26683 0 0 4045 7046 0 0 98733 172000 0 0 PART I, LINE 3 THE ORGANIZATION'S COMPENSATION IS DETERMINED BY BLUEWATER HEALTHCARE NETWORK DBA ASPIRE RURAL HEALTH, A RELATED ORGANIZATION. THE FOLLOWING WERE USED IN DETERMINING THE COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE 3. WRITTEN EMPLOYEMENT CONTRACT FORM 990, PART V, LINE 1A: FORM 1099/1096 FILING - VENDORS FOR THE FILING ORGANIZATION ARE PAID BY BLUEWATER HEALTHCARE NETWORK (EIN 46-5444203) A OF 04/15/2024. AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE BLUEWATER HEALTHCARE NETWORK (WITH LIMITED EXCEPTIONS) UNDER THE BLUEWATER HEALTHCARE NETWORK (EIN 46-5444203). FORM 990, PART V, LINE 2A: W-3 FILING - EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT AS OF 04/15/2024. AS SUCH, REQUIRED PAYROLL FILINGS (INCLUDING W-2 AND W-3S) AFTER 04/15/2024 ARE REPORTED UNDER THE RELATED ORGANIZATION, BLUEWATER HEALTHCARE NETWORK (EIN 46-5444203). 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 & 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 & 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 BLUEWATER HEALTHCARE NETWORK DBA ASPIRE RURAL HEALTH: 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 COMPLIED BY THE CORPORATE CONTROLLER AND THEN REVIEWED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST FORM IS COMPLETED ANNUALLY AND MONITORED FOR COMPLIANCE BY THE CEO, THE COMPLIANCE OFFICER, 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, OFFICERES 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 IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 6,802,131. MANAGEMENT AND GENERAL EXPENSES 9,250. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,811,381. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 8,217,397. MANAGEMENT AND GENERAL EXPENSES 1,244,565. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,461,962. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 4,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,000. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS -10,128,276. LOSS ON EQUITY METHOD INVESTMENTS 759,420. TRANSFER NET ASSETS OF NORTHWOOD MEADOWS -2,561,321. ASPIRE RURAL HEALTH SYSTEM FOUNDATION 4675 HILL STREET CASS CITY MI 48726 352368240 SOLICIT FUNDS ON BEHALF OF HOSPITAL MI 501(C)(3) LINE 12A, I BLUEWATER HEALTHCARE NETWORK 0 HILLS & DALES HEALTHCARE CORPORATION 4675 HILL STREET CASS CITY MI 48726 382622537 MANAGE EXCESS FUNDS ON BEHALF OF SUBSIDIARIES MI 501(C)(3) LINE 3 BLUEWATER HEALTHCARE NETWORK 0 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 HEALTHCARE CORPORATION 0 NSB LAND HOLDING INC 4675 HILL STREET CASS CITY MI 48726 883867204 LAND HOLDING MI 501(C)(3) LINE 12A, I HILLS & DALES HEALTHCARE CORPORATION 0 DECKERVILLE COMMUNITY HOSPITAL 3559 PINE STREET DECKERVILLE MI 48427 381415390 HOSPITAL MI 501(C)(3) LINE 3 BLUEWATER HEALTHCARE NETWORK 0 MARLETTE REGIONAL HOSPITAL 2770 MAIN STREET MARLETTE MI 48453 381507302 HOSPITAL MI 501(C)(3) LINE 12B, II BLUEWATER HEALTHCARE NETWORK 0 MARLETTE SENIOR LIVING 6305 BLUEWATER COURT MARLETTE MI 48453 843210271 SENIOR LIVING MI 501(C)(3) LINE 10 BLUEWATER HEALTHCARE NETWORK 0 BLUEWATER HEALTHCARE NETWORK 2770 MAIN STREET MARLETTE MI 48453 465444203 PARENT MI 501(C)(3) LINE 12A, I N/A 0 THUMB MRI LLC 6320 VAN DYKE ROAD CASS CITY MI 48726 364107673 IMAGING MI N/A 0 0 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 1