2020-07-09T09:06:37-05:00 2019-06-30 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2018-07-01 386005550 HILLSDALE COMMUNITY HEALTH CENTER % LEYA VANDEUSEN HILL 5174374451 168 SOUTH HOWELL STREET HILLSDALE MI 49242 DUKE ANDERSON PRESIDENT/CEO 5174374451 2020-05-15 true Lauren R Denton P01571860 2604604000 167.68.126.162 35027420201915000006 2020-07-09 P 1DB21BA5E43097C511A7D1ADC50EBB96669EB973 4054C3EF14AA7DF352A59B9CFDC0CB34D463127C 2018 2021-01-29 14:40:06Z HILLSDALE HOSPITAL DUKE ANDERSON 168 SOUTH HOWELL STREET HILLSDALE MI 49242 70623706 false X WWW.HILLSDALEHOSPITAL.COM X 1950 MI SHORT-TERM, ACUTE CARE HOSPITAL FACILITY. 12 8 542 97 0 238735 217049 61192819 69164975 863692 708859 57876 68824 62353122 70159707 0 0 0 0 28143697 30404096 0 0 0 35781167 36883441 63924864 67287537 -1571742 2872170 39871181 45665008 14370409 16137813 25500772 29527195 X HILLSDALE COMMUNITY HEALTH CENTER IS AN INDEPENDENT, PROGRESSIVE HEALTH CARE TEAM. WE WILL CONTINUE TO UTILIZE THE LATEST TECHNOLOGY AND EXPERTISE WHILE DELIVERING COMPASSIONATE, QUALITY CARE. WE ARE LARGE ENOUGH TO BE OF SERVICE... SMALL ENOUGH TO CARE. false false 57480847 69164975 HILLSDALE HOSPITAL IS A SHORT-TERM, ACUTE CARE HOSPITAL FACILITY INCLUDING A SKILLED NURSING UNIT, A PSYCHIATRIC UNIT, AND HOME HEALTH CARE DEPARTMENT WHICH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO THE HILLSDALE, MICHIGAN AREA. THE HOSPITAL ALSO SUPPORTS UNPROFITABLE/SUBSIDIZED HEALTH SERVICES, INCLUDING BEHAVIORAL HEALTH, OBSTETRICS, AND EMERGENCY SERVICES. HILLSDALE HOSPITAL SAW 2,383 INPATIENT ADMISSIONS IN FY 2019, 96,816 OUTPATIENT VISITS, AND 21,786 EMERGENCY DEPARTMENT VISITS. DURING FY 2019 APPROXIMATELY 44% OF SERVICES RENDERED WERE TO ELDERLY PATIENTS UNDER THE MEDICARE PROGRAM, APPROXIMATELY 24.6% OF SERVICES PROVIDED WERE TO PATIENTS DEEMED INDIGENT UNDER STATE GUIDELINES AND APPROXIMATELY 3.6% 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 2019 PROVIDED APPROXIMATELY $415,000 IN CHARITY CARE AND RECORDED A PROVISION FOR BAD DEBT OF $4 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 HIGH SCHOOL AND COMMUNITY LOANS FOR ALLIED HEALTH PROFESSIONS FOR HIGHER EDUCATION. 57480847 true true false false false false false false false false true false false false true true false true false false false false false false true false true true false false true false false false false false false true true false false false false false true true false false false true 79 0 542 true false true CJ false false false false false false false false false false X 12 8 false false false false true true true true true false false true true true true true true true true false MI X LEYA VANDEUSEN 5174375234 168 S HOWELL STREET HILLSDALE MI 49242 GREGORY BAILEY BOARD CHAIRMAN 1.5 1.0 X X 0 0 0 ALFRED BEDIAKO MD BOARD MEMEBER 1.5 0.0 X 0 0 0 CRAIG CONNOR BOARD MEMBER 1.5 0.0 X 0 0 0 DAVID GOSSAGE BOARD VICE CHAIRMAN 1.5 0.0 X X 24290 0 0 DIANE PHILIPP BOARD MEMBER 1.5 0.0 X 0 0 0 KIMBERLY BLYTHE BOARD MEMBER 1.5 0.0 X 0 0 0 LEANNE RUMLER BOARD MEMBER 1.5 0.0 X 0 0 0 RICHARD MOORE BOARD TREASURER 1.5 1.0 X X 0 0 0 DALE MCCRIRIE EX OFFICIO/PHYSICIAN 40.0 0.0 X 294834 0 32093 KARLYE HORTON BOARD MEMBER 1.5 0.0 X 0 0 0 ROBERT HENTHORNE BOARD MEMBER 1.5 0.0 X 17920 0 0 NICHOLE ELLIS DO EX OFFICIO/CHIEF OF STAFF 1.5 0.0 X 3009 0 0 DUKE ANDERSON PRESIDENT/CEO 40.0 0.0 X 402284 0 30241 MARK GROSS CFO (STARTED 4/2018) 40.0 0.0 X 174242 0 17911 PARTHIV PATEL PHYSICIAN 40.0 0.0 X 605860 0 30006 CHRISTOPHER HOGG PHYSICIAN 40.0 0.0 X 522862 0 23684 NORRIS MARCH PHYSICIAN 40.0 0.0 X 350116 0 16683 BRIAN SINISCHO PHYSICIAN 40.0 0.0 X 323234 0 17374 RAVINDER SHARMA PHYSICIAN 40.0 0.0 X 303737 0 32093 3022388 0 200085 20 false true false HEALTHPRO HERITAGE LLC 536 OLD HOWELL RD GREENVILLE SC 29615 THERAPY SERVICES 1699383 MI EMERGENCY PHYSICIANS PO BOX 677979 DALLAS TX 75267 EMERGENCY PHYSICIANS 1050201 ANES STAFFING CONSULTANTS 6225 N STATE HWY 161 IRVING TX 75038 CRNA 525907 UNIV OF TOLEDO 3355 GLENDALE AVE TOLEDO OH 43614 ORTHO PHYSICIANS 379550 FOULKE CONSTRUCTION 149 LEWIS STREET HILLSDALE MI 49242 CONSTRUCTION 344740 25 217049 217049 NET PATIENT REVENUE 621110 68499557 68499557 CAFETERIA SALES 621110 150608 150608 EMPLOYEE PRESCRIPTION 621110 87474 87474 OTHER INCOME 621110 427336 427336 69164975 474564 474564 0 0 124132 77142 46990 0 46990 46990 616790 217648 164847 399142 -164847 234295 234295 26196 4362 21834 21834 0 0 0 0 0 0 0 70159707 69164975 777683 0 0 0 0 692812 568106 124706 0 23406385 19193236 4213149 408577 335033 73544 4249104 3484265 764839 1647218 1350719 296499 0 252732 252732 52500 52500 0 0 113970 113970 13361726 10956615 2405111 221674 181773 39901 386395 316844 69551 0 0 2465977 2022101 443876 216870 177833 39037 0 0 36909 30265 6644 0 912311 748095 164216 1221057 1001267 219790 MEDICAL SUPPLIES 10740254 10740254 PROVISION FOR DOUBTFUL 3975369 3975369 REPAIR AND MAINTENANCE 1492884 1224165 268719 RENT TO HHF 1334628 1094395 240233 98185 80512 17673 67287537 57480847 9806690 0 768323 355738 6400755 6075476 0 0 8215023 8531510 0 0 0 0 1605283 1558344 382914 735467 937994 976745 6136028 1301883 1509649 4834145 18496218 20518267 0 0 0 0 0 0 1555022 2079316 39871181 45665008 10077444 10702260 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4292965 5435553 14370409 16137813 X 25454677 29479549 46095 47646 0 0 25500772 29527195 39871181 45665008 X 2872170 412467 741786 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3200 3200 2085041 82606 2002435 3652932 1219277 2433655 394855 394855 4834145 0 COST REPORT SETTLEMENTS 5435553 5435553 66678309 412467 81504 493971 66184338 3975369 3975369 70159707 63393672 81504 81504 63312168 3975369 3975369 67287537 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. PART XI, LINE 2D - OTHER ADJUSTMENTS SPECIAL EVENTS EXPENSES $4,362 RENTAL EXPENSES $77,142 TOTAL: $81,504 PART XI, LINE 4B - OTHER ADJUSTMENTS PROVISION FOR UNCOLLECTIBLE ACCOUNTS $3,975,369 PART XII, LINE 2D - OTHER ADJUSTMENTS SPECIAL EVENTS EXPENSES $4,362 RENTAL EXPENSES $77,142 TOTAL: $81,504 PART XII, LINE 4B - OTHER ADJUSTMENTS PROVISION FOR UNCOLLECTIBLE ACCOUNTS $3,975,369 GOLF OUTING 26196 26196 680 3282 400 0 26196 26196 680 3282 400 4362 21834 true true X true X true X true true false true true 167260 167260 0.00270 13909898 10793583 3116315 0.04980 14077158 10793583 3283575 0.05250 25 1230 17848 17848 0.00030 35 212276 343396 -131121 0.00210 8105586 6342864 1762722 0.02810 6 25725 25725 0.00040 31 1265 8361435 6686260 1675174 0.02670 31 1265 22438593 17479843 4958749 0.07920 true 3975369 2615837 16864328 19618164 -2753836 X true true 1 1 HILLSDALE COMMUNITY HEALTH CENTER 168 S HOWELL STREET HILLSDALE MI 49242 X X X X INPATIENT PSYCH UNIT HILLSDALE COMMUNITY HEALTH CENTER 1 false false true X X X X X X X X X 19 true false true true X WWW.HILLSDALEHOSPITAL.COM X true 16 true WWW.HILLSDALEHOSPITAL.COM false true X 100 300. 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 X true X false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 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, 1,110 INDIVIDUALS COMPLETED THE HEALTH SURVEY QUESTIONNAIRE (983 IN 2013). 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 HILLSDALE HOSPITAL PARTNERED WITH THE HILLSDALE COUNTY HUMAN SERVICES NETWORK TO CREATE A COMPREHENSIVE COMMUNITY BASED HEALTH NEEDS ASSESSMENT. THE HUMAN SERVICES NETWORK 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 Issue 1: Smoking while pregnant. Background and Action Plan This has been a longstanding problem/issue with pregnant mothers in Hillsdale County. Hillsdale County has historically had a higher rate of overall population who smoke, and a much higher of women who report smoking while pregnant. Hillsdale County reports 27.6% of pregnant women report smoking while pregnant in the latest 3 year data set, compared to 16.2% of women in Michigan. This is a huge disparity and a risk factor that cannot be ignored. Smoking during pregnancy increases the risk of health problems for developing babies, including preterm birth, low birth weight, and birth defects of the mouth and lip. Smoking during and after pregnancy also increases the risk of sudden infant death syndrome (SIDS), all associated with higher rates or mortality and increased cost to patients and the overall health system within the county. There are several evidence based interventions that can be explored for possible implementation with patients, with the assistance of local providers; they include: The Baby & Me-Tobacco Free ProgramTM is an evidenced-based program used by many clinicians to help pregnant women stop smoking. The program is set up to provide education and resources for women to quit smoking. Follow-up visits consist of exhaled carbon monoxide measurements to ensure quit. The positive reinforcement is diaper vouchers that can be used post-partum. Another evidence-based program is Smoking Cessation and Reduction in Pregnancy TreatmentTM (SCRIPT). This program provides a comprehensive guide for purchase in English and Spanish, as well as video format. Some states provide quit-lines specific for pregnant smokers and other states link pregnant smokers to the regular quit-line. This is a resource currently available in Michigan,. The quit-line tobacco cessation program uses clinically proven methods to achieve some of the highest quit rates in the country. We help nearly 450 people a day in their journey to quit tobacco. What the Program Offers Participants: - Participants enroll online or by telephone. They then have access to these program offerings: - Coaching by phone and additional support via email, text, or instant message. Participants work with a coach to prepare a quit plan, set a quit date, understand tobacco triggers, manage cravings and address relapses. Coaches are available 24/7. - A robust pharmacotherapy program that varies by client is offered. - Planning and educational materials to help participants map out their road to quitting tobacco. - Membership in an online community of others who are working to become tobacco free. Recommendation: Hillsdale Hospital will investigate potential implementation of all 4 of these opportunities. The Hospital will work with members of the local OB/GYN community as well as appropriate local providers to assure these evidence based opportunities are readily available to pregnant mothers within the County. A goal of reducing smoking while pregnant in Hillsdale by 10% over the next 3 years will be established and tracked over time. Issue 2: Inadequate Prenatal Care Background and Action Plan Stemming from a request by the US Congress, the Government Accounting Office (GAO) investigated the extent to which Medicaid beneficiaries and uninsured women experience difficulties in obtaining access to prenatal care to determine the: (1) timing and number of their prenatal care visits; and (2) barriers they perceived as preventing them from obtaining care earlier or more often. The GAO found some of the following barriers exist throughout the system of care: Women less likely to obtain prenatal care are more likely to be poorly educated, uninsured, lack of money to pay for care, lack of transportation and unawareness of services available. Many of these same issues were identified within this report (less educated than the general populace, poor, lack of transportation) were all either identified within the secondary data or during the discussion with the Human Services Network who acted as a proxy for the Community. Given that a large number of women of childbearing age within Hillsdale County are on Medicaid as their primary source of insurance, this data speaks directly to action plans that need to be put in place to address this issue. Inadequate prenatal care (PNC) is defined as when no care was received or if care began during the third trimester. It is also inadequate if care began during the first or second trimester but less than five visits occurred. Inadequate PNC data for Hillsdale County shows a dramatic lack of adequate care for pregnant mothers within the county. Data for 2017 shows adequate PNC for Hillsdale pregnant mothers at 64.9%, and the rate for the State of Michigan at 72.2%. Clearly, given these data, this is a significant need to be addressed within the county. Discussion at the Human Services Network designated this as an issue that the Hospital could have a significant impact, as one of the OB/GYN practices within the county is owned by the Hospital and the other has a provider who is a Board member of the Hospital. The major issue identified by the group was transportation. A significant number of these pregnant moms are either working poor or young moms with little or no means. Transportation is a barrier for many of these women, but some solutions have been identified that can assist in this area. This will require coordination between the Department of Human Services (of which we co-employ one of their staff), the hospital and the OB/GYN offices in the county. In speaking with our partners in the Department of Health and Human Services (DHHS), there are many opportunities to better educate patients and caregivers about the services available. Not only are there accelerated Medicaid approvals available for pregnant moms, there is also travel assistance programs offering travel to and from appointments. There are also materials that can be made available to better educate our county on the importance of early prenatal care. All of these opportunities will be investigated and implemented as appropriate over the next three year cycle. Recommendation: The Hospital will work with our in-house DHHS representative, as well as our partners at the Branch-Hillsdale-St. Joseph Community Health Agency to make as many of these resources available to both our hospital OB/GYNs as well as the non-hospital OB/GYN office. We will establish a 3 year goal of increasing the number of women in Hillsdale County with adequate PNC to 70%. We will strive to meet this goal by 6/30 of 2022. Issue 3: Opioid Use / Abuse Background and Action Plan Prescription drug misuse is a serious problem in Michigan and Hillsdale County is not exempt from this issue. Drug overdose deaths are on the rise across the state. Two types of prescription drugs are the leading cause of misuse - painkillers (opioids) and tranquilizers (benzodiazepines). Opioids include both illegal drugs, such as heroin, and prescription pain medicine. Common opioids used to treat pain include oxycodone, hydrocodone, morphine, methadone, and codeine. Synthetic opioids are contributing to the crisis, too. Synthetic opioids that are appearing across Michigan include Fentanyl and Carfentanil. These drugs are far more powerful and deadly than other opioids and are frequently mixed with heroin, often times without the user knowing. Hillsdale Hospital can be on the forefront of this issue in the county as nearly all surgical procedures, chronic pain prescriptions and ER visits fall under the purview of the hospital. Researchers found that among the 7 surgeries studied - TKA, THA, rotator cuff surgery, hysterectomy, hernia surgery, colectomy, and sleeve gastrectomy - the average number of opioid pills prescribed dropped, but only slightly, from 85 pills per patient to 82. Authors of the report speculate that the slow progress could be due in part to the level of pressure surgeons feel to prescribe more opioids then they feel are necessary - a pressure reported by 66% of surgeons surveyed. Hillsdale hospital currently participates in the Michigan Surgical Quality Collaborative and a major emphasis has been placed on reducing the over use of opioids being used, and better restricting to newly established best practice dosing guidelines. This requires both a change in historic practice patterns and better patient education. Both of these issues will be addressed as we moved quickly to curb this growing problem in our industry. Emergency Departments too, are not exempt from this epidemic. Non-opioid therapies should be used as first line therapy and educating our ED providers on current best practice prescribing guidelines will be first and foremost in the strategies we employ. New guidance is available and needs to be explored and implemented within our facility. The list below are many of the current recommendations that will be reviewed. - Lost or stolen prescriptions sho do not have, but that there are still some shortages that they wish could be addressed. OB/GYN continues to be an issue as there are only 2 offices with 3 providers and a Nurse Midwife. The hospital recently constructed a new OB wing for the hospital and providing sufficient OB coverage continues to be a top priority. Utilizing some of the Federal incentives available as a result of Hillsdale Countys designation may be critical in obtaining additional funding as well as additional health provider resources. The hospital will continue to use any and all of these opportunities to fill gaps in care and service within our service area. To start the next 3 year cycle, we have developed the following tentative list; secure in the knowledge that once we make it, it will be subject to change due to need or unforeseen circumstances. Organization wide current top targeted needs for healthcare professionals at this time (5/10/2019) 1) OB/GYN Advanced Practice Provider 2) Advanced Practice Provider 3) Chief Nursing Officer 4) Director of Home Care 5) Medical Records Manager or Revenue Cycle Director 6) Director of Marketing 7) Scrub Tech 8) RNs for Emergency 9) RNs for OB 10) Medical Assistants for Clinics Recommendation: Hillsdale Hospital will continue to work to recruit as well as retain high quality professionals in these areas of service. The hospital is also recruiting (and has tentatively secured) an OB/GYN as well as a Urologist. Item 5: Transportation for medical services Background and Action Plan Transportation is an important social determinant of health in rural communities. The availability of reliable transportation impacts a persons ability to access appropriate and well-coordinated healthcare, purchase nutritious food, and otherwise care for him or herself. Rural populations most likely to need transportation services to maintain their health and well-being include: - The elderly - People with disabilities - Low-income individuals and families - Veterans and people with special healthcare needs, who often must travel long distances to access care Accessible transportation options can make the difference between healthcare access and no access for many people in rural areas. Often elderly individuals and individuals with disabilities have greater healthcare needs than other rural residents, and living in rural areas isolated from healthcare providers causes them additional difficulties. Distance to healthcare can have a significant impact on their quality of life, their health, and their safety. Distance and available transportation go hand in hand when it comes to preventing the elderly and people with disabilities from receiving the healthcare that they need. According to a 2010 study from the Upper Great Plains Transportation Institute, some of the negative impacts due to distance and lack of transportation include: - Increase in delayed or missed trips to receive healthcare services - Disruption in ongoing treatments and services for chronically ill patients - Travel distance to health services and the related costs affect patients healthcare decisions - Travel time spent to access healthcare can affect patients physically and cause stress - Use of some medications, like insulin, declines as patients live farther from their source of care Studies have shown that providing transportation for medical treatment to low-income, elderly and the disabled patients is cost-effective and improves the quality of life. A study by the Transit Cooperative Research Program, Cost Benefit Analysis of Providing Non-Emergency Medical Transportation, showed the differences between the cost of poorly-managed and well-managed care, as well as the differences in quality of life. They found that reduction in healthcare costs and improvement in quality of life would more than offset the costs required to provide non-emergency medical transportation. Missing a routine or preventive care service because of transportation can lead to poorly managed care, a need for emergency care, and preventable hospitalizations. Providing effective transportation options to healthcare services for low-income, elderly, and disabled residents keeps them out of hospitals and nursing homes, allowing them to remain contributing members of the community and lead healthier lives while keeping health costs down. Currently, Hillsdale Hospital has a transportation program set up by the Hospital with Key Opportunities and the DOT supplemented by grant funds. Drivers are available for transportation for patients in need, but limited to 1 driver for all hospital services. The driver does service all hospital units (SNF, BHU, ED, Inpatient). This funding is scheduled to end in 2019 and does not appear to be renewable. Other opportunities such as this will be explored moving forward. While this transportation issue is not a problem that can be solved for our population at large, there are segments of our consumer base who could be helped if they were aware of transportation services that are available through many insurers (Medicaid, BCBS-M, AETNA, HMOs). Some ever provide transportation for prescription pickup if you do not have a working car or a drivers license While Medicare does NOT provide transportation services, there are a growing percentage of Medicare eligible citizens who also have Medicaid. Currently, Medicaid is the payer of 23% of our total patient population. In addition, some private insurance carriers also offer this service to their covered lives, and as a results, we could impact upwards of 50% to 55% of our patients with this type of assistance. Recommendation: Hillsdale Hospital will work with local providers as well as our own Case Management staff to assure that patients are aware of the benefits and services that are available to them to assure the opportunity for the best healthcare possible. The goal is to provide information regarding resources, to all patients served within the Hillsdale Hospital service market, including physician offices within the hospital family. This includes advertising, brochures, and discharge education and coordination of services with our partners at DHHS. In addition, we will continue to seek additional grant opportunities as they become available. We will also keep an eye on Uber, Lift and other similar service providers for their potential penetration into our service market. Item 6: Increase low/no cost screenings for low income patients Background and Action Plan The health of people with low incomes often suffers because they cant afford adequate housing, food, or child care. Such living conditions, and the stress they cause, can lead to higher rates of tobacco and alcohol use and increase the risk of health problems developing or worsening over time. In addition, partly because they are more likely to be unable to afford care, people with low-incomes use fewer preventive care services. As a result, there are fewer opportunities for practitioners to assess and educate these patients about their health risks. Even when low-income people do see health care providers, the social needs like poor housing that may affect their health and complicate treatment are rarely addressed. If health plans and providers can better meet the needs of these patients, such improvement might spur higher quality improvements throughout the system. Compared to their higher-income counterparts, relatively healthy low-income people are more likely to: Have poorer self-reported health and greater health risks. One-fifth of low-income adults report their health as fair or poor, compared to only 5 percent of higher-income adults. Rates of obesity are also higher among low-income adults (36%) compared to higher-income adults (28%). Low-income adults are also much more likely to be smokers (25%). Have more mental health problems. Based on a widely used screening tool for identifying symptoms of depression and anxiety (the K6 distress scale), low-income people are much more likely to be in serious psychological distress (7%) compared to higher-income people (1%). Low-income people also report more difficulty sleeping (18%) than higher-income people (14%). Have more limited access to care. Although research has shown that the Affordable Care Act significantly narrowed income disparities in insurance coverage and access to care, such disparities persist. Lower-income people are still much more likely to be uninsured (26%) compared to higher-income people (4%). In addition, almost one-quarter (23%) of low-income adults lack a usual source of care. They are also much more likely to report delaying care, not being able to afford prescription medications, and experiencing problems paying medical bills relative to higher-income people. Recommendation: Provide half priced Bone Mineral Density Scan (DEXA), Osteoporosis/fracture risk - normally $228.60 for select months over the next three year cycle. This will benefit patients, as DEXA helps evaluate if they have poor bone density which puts them at risk for osteoporosis an SCHEDULE H, PART V, SECTION B, LINE 20E 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 21 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. 3 HILLSDALE HOME CARE 451 HIDDEN MEADOWS DRIVE HILLSDALE MI 49242 HOME CARE READING HEALTH CLINIC 143 S MAIN STREET READING MI 49274 RURAL HEALTH CLINIC HILLSDALE HOME OXYGEN 451 HIDDEN MEADOWS DRIVE HILLSDALE MI 49242 OXYGEN DME SCHEDULE H, PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,975,369. 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 III, SECTION A, LINE 2 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, SECTION A, LINE 3 HILLSDALE HOSPITAL SAW $2,615,837 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 73.33%. WE APPLIED THAT PERCENTAGE TO THOSE ACCOUNTS WRITTEN OFF WITH NO INSURANCE. SCHEDULE H, PART III, SECTION A, LINE 4 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 patients 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 Hospitals allowance for doubtful accounts for self-pay patients remained at 74 percent of selfpay accounts receivable at June 30, 2019. In addition, the Hospitals write-offs increased approximately $860,000 from approximately $4,052,000 for the year ended June 30, 2018, to approximately $4,912,000 for the year ended June 30, 2019. These changes were caused by shifts toward non-private pay patients in the current year, as well as slightly lower volumes in 2019. SCHEDULE H, PART III, SECTION B, LINE 8 THE COST TO CHARGE RATIO IS USED TO DETERMINE MEDICARE SURPLUS AT COST. THE MEDICARE ALLOWABLE COSTS REPORTED DO NOT INCLUDE ALL MEDICARE CHARGES. HAD ALL CHARGES BEEN INCLUDABLE THE RESULT WOULD BE A SHORTFALL. 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, SECTION C, LINE 9B 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 VI, LINE 2 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 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 HILLSDALE MICHIGAN IS THE COUNTY SEAT OF HILLSDALE COUNTY. ITS POPULATION IS 8,200 WITH A HOUSEHOLD MEDIAN INCOME OF $32,022. THE CURRENT UNEMPLOYMENT RATE IS 7.5% FOR THE CITY OF HILLSDALE, AND 4.9% 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 GRANCH 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 HCHC FACILITATES MANY DIFFERENT SUPPORT GROUPS INCLUDING THE BREAST CANCER SUPPORT GROUP, COPD SUPPORT GROUP, AND THE BARIATRIC SUPPORT GROUP. WE ALSO OFFER 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 TO THE MEMBERS OF THE COMMUNITY. HCHC OWNS AND OPERATES A RURAL HEALTH CLINIC IN READING, MICHIGAN THAT PROVIDES 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 true true X X X X X X false false false false false false false false false DUKE ANDERSON PRESIDENT/CEO 401492 0 0 0 792 0 8250 0 21991 0 432525 0 MARK GROSS CFO (STARTED 4/2018) 173924 0 0 0 318 0 0 0 17911 0 192153 0 DALE MCCRIRIE EX OFFICIO/PHYSICIAN 294042 0 0 0 792 0 8250 0 23843 0 326927 0 PARTHIV PATEL PHYSICIAN 605354 0 0 0 506 0 8250 0 21756 0 635866 0 CHRISTOPHER HOGG PHYSICIAN 521630 0 0 0 1232 0 0 0 23684 0 546546 0 NORRIS MARCH PHYSICIAN 349840 0 0 0 276 0 8250 0 8433 0 366799 0 BRIAN SINISCHO PHYSICIAN 322977 0 0 0 257 0 0 0 17374 0 340608 0 RAVINDER SHARMA PHYSICIAN 302945 0 0 0 792 0 8250 0 23843 0 335830 0 SCHEDULE J, PART I, LINE 1A ANNUALLY, THE CEO'S SPOUSE ACCOMPANIES THE CEO ON A BUSINESS TRIP. THE SPOUSE'S TRAVEL COSTS ARE INCLUDED IN THE CEO'S COMPENSATION. THE CFO LIVES IN A HOSPITAL OWNED HOUSE FOR $500 INCLUDED IN HIS TAXABLE INCOME. GARBAGE, UTILITIES, CLEANING, ETC ARE INCLUDED. KAREN LUPARELLO WIFE OF DAVID GOSSAGE 76655 COMPENSATED EMPLOYEE false ARROW SWIFT PRINTING BOARD MEMBERS PART OWNER 212154 PRINTING COMPANY false SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS LEANNE RUMLER, HILLSDALE BOARD MEMBER, IS A GREATER THAN 35% OWNER OF ARROW SWIFT. FORM 990, PART VI, SECTION A, LINE 7A AS OF 6/30/2019, DAVID GOSSAGE AND DALE MCCRIRIE ARE CONSIDERED NON-INDEPENDENT BOARD MEMBERS BECAUSE THEY ARE PAID EMPLOYEES OF THE FILING ORGANIZATION. ROBERT HENTHORNE RECEIVED COMPENSATION FROM THE ORGANIZATION AND THEREFORE IS CONSIDERED A NON-INDEPENDENT BOARD MEMBER. DAVID GOSSAGE AND LEANNE RUMLER ARE ALSO CONSIDERED NON-INDEPENDENT BOARD MEMBERS DUE TO THE TRANSACTIONS LISTED ON SCHEDULE L. FORM 990, PART VI, SECTION A, LINE 6 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, SECTION A, LINE 7A THE CORPORATION MEMBERS ELECT THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B 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, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES FOR THEIR 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, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO DISCLOSE OF 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, SECTION B, LINE 15A & 15B 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 2019. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: SPEECH THERAPIST 56,823 COLLECTION SERVICES 193,525 OTHER PURCHASED SERVICES: PSYCH 330,183 E/R 587,695 BACTERIA SERVICES 226,387 MAT MANAGEMENT 88,012 CONTRACT PHYSICIANS 49,233 PHARMACY 928,545 ANESTHESIOLOGIST 422,922 PHYSICAL THERAPY 662,066 OCCUPATIONAL THERAPY 252,186 SLEEP STUDY 197,200 HOME CARE 600,792 HOSPITALIST 1,078,201 PULM CLINIC 255,496 QUALITY 62,941 MED RECS 60,410 PATHOLOGY 337,640 ADMINISTRATION 1,269,845 INFORMATIONAL TECHNOLOGY 483,115 QAAP FEE 2,133,887 LAB SERVICE 155,598 OTHER PURCHASED SERVICES 2,929,024 TOTAL EXPENSES 13,361,726 FORM 990, PART XI, LINE 9 TRANSFER OF ASSETS FROM HEADWATERS HEALTH FOUNDATION 741,786 HEADWATERS HEALTH FOUNDATION 168 S HOWELL SREET HILLSDALE MI 49242 811509725 SUPPORT MI 501 (c) (3) 12A HH true HCHC ASSURANCE CO LTD PO BOX 1051 GRAND CAYMAN CAYMAN CJ KY1-1102 300548721 FINANCIAL CJ HCHC C CORP 237679 1575671 1.00000 true true false false false false false false false false false false false false false false false false true false HEADWATERS HEALTH FOUNDATION A 1334628 FMV HEADWATERS HEALTH FOUNDATION R 741786 FMV