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Three Rivers Health System Inc

Three Rivers Health
701 S Health Parkway
Three Rivers, MI 49093
Bed count60Medicare provider number230015Member of the Council of Teaching HospitalsNOChildren's hospitalNO
EIN: 451257972
Display data for year:
Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
18.15%
Spending by Community Benefit Category- 2021
(as % of total functional expenses)
* = CBI denoted preventative categories
Community Benefit Spending Compared to Functional Expenses, 2010-2021
Additional data

Community Benefit Expenditures: 2021

  • All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.

    • Operating expenses$ 73,483,748
      Total amount spent on community benefits
      as % of operating expenses
      $ 13,334,465
      18.15 %
  • Amount spent in the following IRS community benefit categories:
      • Financial Assistance at cost
        as % of operating expenses
        $ 0
        0 %
        Medicaid
        as % of operating expenses
        $ 7,469,551
        10.16 %
        Costs of other means-tested government programs
        as % of operating expenses
        $ 0
        0 %
        Health professions education
        as % of operating expenses
        $ 1,073,842
        1.46 %
        Subsidized health services
        as % of operating expenses
        $ 4,636,820
        6.31 %
        Research
        as % of operating expenses
        $ 0
        0 %
        Community health improvement services and community benefit operations*
        as % of operating expenses
        Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.
        $ 154,252
        0.21 %
        Cash and in-kind contributions for community benefit*
        as % of operating expenses
        $ 0
        0 %
        Community building*
        as % of operating expenses
        $ 0
        0 %
    • * = CBI denoted preventative categories
    • Community building activities details:
        • Did tax-exempt hospital report community building activities?Not available
          Number of activities or programs (optional)0
          Physical improvements and housing0
          Economic development0
          Community support0
          Environmental improvements0
          Leadership development and training for community members0
          Coalition building0
          Community health improvement advocacy0
          Workforce development0
          Other0
          Persons served (optional)0
          Physical improvements and housing0
          Economic development0
          Community support0
          Environmental improvements0
          Leadership development and training for community members0
          Coalition building0
          Community health improvement advocacy0
          Workforce development0
          Other0
          Community building expense
          as % of operating expenses
          $ 0
          0 %
          Physical improvements and housing
          as % of community building expenses
          $ 0
          Economic development
          as % of community building expenses
          $ 0
          Community support
          as % of community building expenses
          $ 0
          Environmental improvements
          as % of community building expenses
          $ 0
          Leadership development and training for community members
          as % of community building expenses
          $ 0
          Coalition building
          as % of community building expenses
          $ 0
          Community health improvement advocacy
          as % of community building expenses
          $ 0
          Workforce development
          as % of community building expenses
          $ 0
          Other
          as % of community building expenses
          $ 0
          Direct offsetting revenue$ 0
          Physical improvements and housing$ 0
          Economic development$ 0
          Community support$ 0
          Environmental improvements$ 0
          Leadership development and training for community members$ 0
          Coalition building$ 0
          Community health improvement advocacy$ 0
          Workforce development$ 0
          Other$ 0

    Other Useful Tax-exempt Hospital Information: 2021

    • In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

      • Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt
        as % of operating expenses
        $ 4,318,366
        5.88 %
        Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?NO
    • Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy

      The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

      • Does the organization have a written financial assistance (charity care) policy?YES
        Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?YES
        Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy
        as % of operating expenses
        $ 777,306
        18.00 %
    • Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
      • Reported to credit agencyNot available
    • Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.

      • After enactment of the ACA, has the state in which this tax-exempt hospital is located expanded Medicaid?YES
    • The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.

      • If not, is the state's Medicaid threshold for working parents at or below 76% of the federal poverty guidelines?Not available
    • In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

      • Does the state in which the tax-exempt hospital is located have a mandatory community benefit reporting statute?NO

    Community Health Needs Assessment Activities: 2021

    • The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

      • Did the tax-exempt hospital report that they had conducted a CHNA?YES
        Did the CHNA define the community served by the tax-exempt hospital?YES
        Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?YES
        Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?YES
        Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?YES

    Supplemental Information: 2021

    This section presents qualitative information submitted by the hospital, verbatim from the 990H record.
    • Statement of Program Service Accomplishments
      Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
    • 4A (Expenses $ 65027746 including grants of $ 0) (Revenue $ 70102988)
      IN 2021, ONCOLOGY SERVICES DIPPED TO 2,275 FROM 3,000, PARTLY DUE TO COVID AND THE CHANGES IN PROVIDERS OVER THE COURSE OF THE YEAR. THE RELATIONSHIP BETWEEN ASCENSION BORGESS CANCER CENTER CONTINUED THROUGH THE YEAR. THE COVERAGE CONTINUED AT THREE DAYS PER WEEK AUGMENTED BY ADVANCED PRACTICE PROVIDERS. THE COMMUNITY CONTINUES TO RELY ON LOCAL ONCOLOGY CARE, AS THIS IS A NECESSARY SERVICE LINE IN THE COUNTY. WOUND CARE CONTINUED TO BE A SERVICE OFFERED IN THE COMMUNITY AS WELL, PROVIDING HBO THERAPY CLOSE TO HOME AND WOUND DEBRIDEMENT. SOME OF THESE PATIENTS RECEIVED WOUND CARE THREE TIMES PER WEEK, WHICH WOULD BE DIFFICULT AS MANY DO NOT HAVE THE FINANCIAL RESOURCES AVAILABLE OR ABILITY TO TRAVEL. THREE RIVERS HEALTH OFFERS INPATIENT DETOXIFICATION TREATMENT WHICH INCURS THREE-TO-FIVE-DAY LENGTH OF STAYS WITH MEDICAL STABILIZATION DURING THE WITHDRAWAL PHASE, OUTPATIENT SERVICES ARE ARRANGED FOR CONTINUED SUCCESS WITH THE PROGRAM. THIS SERVICE LINE DOES NOT PRODUCE A MARGIN FOR THE FACILITY BUT IS RECOGNIZED AS A COMMUNITY NEED. OUTPATIENT INFUSION SERVICES WERE ALSO RENDERED DURING 2021 THROUGH THE MANAGEMENT OF A CONTRACT SERVICE PARTNERSHIP WHILE CARE WAS DELIVERED ONSITE AT THE FACILITY WITH HOSPITAL STAFF. THESE SERVICES MAY NOT PROVIDE STRONG REVENUES, IF ANY, BUT WITHOUT THEM THE COMMUNITY WOULD SUFFER GREATLY. THE GOAL OF KEEPING HIGH QUALITY CARE CLOSE TO HOME AND AT REASONABLE COST IS MEETING THE NEEDS OF THE COMMUNITIES WE SERVE.
      Facility Information
      Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.
      THREE RIVERS HEALTH
      PART V, SECTION B, LINE 3J: THE CHNA CONTENT INCLUDED THE PROJECT OBJECTIVES, AN OVERVIEW OF THE ASSESSMENT, AS WELL AS THE FINANCIAL OPPORTUNITY SUMMARY. THE REPORT SUMMARIZED THE APPROACH AND ITS FINDINGS. IT ALSO COMPARED HOW THE COMMUNITY COMPARED TO ITS PEERS, AND SUMMARIZED KEY CONCLUSIONS AND OBSERVATIONS. FINALLY, IT RANKED THE NEEDS OF THE COMMUNITY, AND IDENTIFIED AN ACTION PLAN TO HELP IMPLEMENT THE IMPROVEMENT IN COMMUNITY HEALTH OVERALL.
      THREE RIVERS HEALTH
      PART V, SECTION B, LINE 5: INITIALLY, WE DEPLOYED A NEEDS ASSESSMENT SURVEY WITHIN THE LOCAL POPULATION FOR ANY RESIDENT TO COMPLETE. WE RECEIVED INPUT FROM 620 AREA RESIDENTS. IT WAS AN INTERNET-BASED SURVEY THAT WAS PROMOTED VIA ADVERTISING, AND THROUGH LOCAL CIVIC AND HEALTH ORGANIZATIONS. PRELIMINARY CONCLUSIONS WERE THEN PRESENTED TO A LOCAL GROUP OF EXPERTS, WHO WERE ASKED TO VALIDATE PRIOR ASSESSMENTS, AND TO ESTABLISH PRIORITY AMONG VARIOUS IDENTIFIED HEALTH AND MEDICAL ISSUES. WHEN THE FINAL ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL GROUP OF EXPERTS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. SOME OF THE OTHER LOCAL ORGANIZATIONS THAT HELPED WITH THIS PROCESS WAS COVERED BRIDGE FQHC, COMMUNITY MENTAL HEALTH DEPARTMENT, BRANCH HILLSDALE- ST. JOSEPH COMMUNITY HEALTH AGENCY, AND ST. JOSEPH COUNTY COMMISSION ON AGING.
      THREE RIVERS HEALTH
      PART V, SECTION B, LINE 6B: COMMUNITY MENTAL HEALTH DEPARTMENT
      THREE RIVERS HEALTH
      PART V, SECTION B, LINE 7D: ACCESS VIA THE WEBSITE WAS THE PRIMARY MEANS, AND BY WORD OF MOUTH REPRESENTATION FROM OUR BOARD MEMBERS. A SUMMARY OF THE ASSESSMENT WAS ALSO SENT OUT AS A MAILER TO THE RESIDENTS OF THE COUNTY.
      THREE RIVERS HEALTH
      "PART V, SECTION B, LINE 11: THE HOSPITAL AND ITS BOARD CHOSE FIVE AREAS TO FOCUS ON: DIABETES, EDUCATION AND PREVENTION, ACCESS TO HEALTHCARE SERVICES, MENTAL HEALTH AND SUICIDE, OBESITY AND PHYSICAL INACTIVITY, AND SUBSTANCE ABUSE. DIETICIANS AT THREE RIVERS HEALTH LAID THE FOUNDATION FOR THE PRE-DIABETES PROGRAM TITLED, ""MINDSET 365"" FOR EMPLOYEES AND THE COMMUNITY. EDUCATION AND PREVENTION IS ADDRESSED THROUGH SKIN AND PROSTATE CANCER SCREENING TO COMMUNITY MEMBERS. PHYSICIAN SERVICES; PRIMARY CARE, ORTHOPEDICS, AND SPECIALIST RECRUITMENT EFFORTS WERE MADE. MENTAL HEALTH AND SUICIDE; WORKED THROUGH CON FOR SERVICES BUT THREE RIVERS HEALTH DID NOT PROCEED DUE TO FINANCIAL CONSTRAINTS AND THE INABILITY TO RECRUIT A PSYCHIATRIST. OBESITY AND PHYSICAL INACTIVITY IS ADDRESSED THROUGH TWO SCHOOL BASED CLINICS THAT IS AN OUTREACH TO CHILDREN WITH THESE ISSUES. THE HOSPITAL HEALTH FACILITY IS OPEN TO THE COMMUNITY AND PASSES ARE DONATED TO CHILDREN WITH THESE SPECIFIC ISSUES."
      Supplemental Information
      Schedule H (Form 990) Part VI
      PART I, LINE 7:
      LINES 7A THROUGH 7C ARE REPORTED USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2. LINES 7E THROUGH 7G ARE REPORTED USING DIRECT COSTS FOR CLINIC OPERATIONS. A COST ACCOUNTING SYSTEM WAS USED FOR HOSPITAL OPERATIONS.
      PART I, LINE 7G:
      OTHER SUBSIDIZED HEALTH SERVICES INCLUDES GROSS CLINIC COSTS OF $13,197,068.
      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 $ 4,318,366.
      PART III, LINE 2:
      BAD DEBT EXPENSE ARE DOLLARS THAT ARE WRITTEN OFF OR RESERVED FOR PATIENTS THAT HAVE AVAILABLE RESOURCES, BUT WOULD NOT PAY FOR SERVICES. THE EXCEPTION TO THIS RULE WOULD BE CHARITY CARE ACCOUNTS THAT ARE INCLUDED IN BAD DEBT BECAUSE OF A LACK OF INFORMATION PROVIDED, OR THE TIMING OF RECEIVING THAT INFORMATION. PAYMENTS ON ACCOUNTS THAT HAVE BEEN WRITTEN OFF WOULD REDUCE THE OVERALL BAD DEBT EXPENSE. DISCOUNTS ON CHARGES ARE NOT INCLUDED IN BAD DEBT EXPENSE.
      PART III, LINE 3:
      SEE ABOVE FOR METHODOLOGY. WITH REGARDS TO CHARITY CARE, THE HOSPITAL ESTIMATES THAT APPROXIMATELY $777,306 OF CHARITY CARE IS INCLUDED IN BAD DEBT EXPENSE DUE TO NOT RECEIVING INFORMATION FROM PATIENTS TO HELP DETERMINE ELIGIBILITY, OR NOT RECEIVING THE INFORMATION IN A TIMELY MANNER, THUS WE BELIEVE THE $777,306 SHOULD BE CONSIDERED A COMMUNITY BENEFIT.
      PART III, LINE 4:
      PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH BHS EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. BHS HAS AGREEMENTS WITH VARIOUS THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO BHS AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. THIRD PARTIES INCLUDE MEDICARE, MEDICAID, MANAGED HEALTH CARE PLANS, AND OTHER COMMERCIAL PLANS. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. THESE AMOUNTS INCLUDE ESTIMATED ADJUSTMENTS UNDER CERTAIN REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS, WHICH ARE SUBJECT TO AUDIT BY THE APPLICABLE ADMINISTERING AGENCY. THESE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS AND ARE ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED (SEE NOTE 4). THE HOSPITALS PROVIDE CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHARITY CARE PROVIDED IS EXCLUDED FROM PATIENT SERVICE REVENUE (SEE NOTE 5).
      PART III, LINE 8:
      MEDICARE IS OUR LARGEST PAYOR, THUS PAYMENTS FOR THIS POPULATION CREATE A FINANCIAL BURDEN ON THE HOSPITAL AS PAYMENTS DO NOT COVER COSTS. MOST OF THE MEDICARE PATIENTS LIVE ON FIXED INCOMES. WE USED THE COST TO CHARGE RATIO TO DETERMINE COSTS. AS MEDICARE IS OUR LARGEST PAYOR, THE SHORTFALL IN COVERING COSTS IS EXTREME, THUS THIS WOULD SEEM TO QUALIFY AS A BENEFIT TO OUR COMMUNITY.
      PART III, LINE 9B:
      THE HOSPITAL'S CURRENT COLLECTION PROCESS APPLIES TO ALL PATIENTS. IF NO INSURANCE IS AVAILABLE FOR SERVICES, AND THEY DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, WE WILL MAKE THEM AWARE OF THEIR OPTIONS. DISCOUNTS ARE OFFERED WHICH ARE TIED TO COMMERICAL MANAGED CARE CONTRACTS. PAYMENT ARRANGEMENTS CAN BE MADE FOR A SPECIFIC PERIOD OF TIME, WITH NO INTEREST CHARGED. ONCE ARRANGEMENTS ARE MADE, THE ACCOUNT FOLLOWS THE STANDARD COLLECTION PROCESS OF LETTERS AND PHONE CALLS. AFTER 120 DAYS, IF NO PAYMENT HAS BEEN MADE OR IF PAYMENT ARRANGEMENTS ARE NOT KEPT, THE ACCOUNT WILL BE REFERRED TO A COLLECTION AGENCY.
      PART VI, LINE 2:
      "THE HOSPITAL CURRENTLY REVIEWS THE HEALTH INDICATORS OF THE COUNTY AND WILL FROM TIME TO TIME COMPLETE COMMUNITY SURVEYS. WE ASSESS WHETHER WE HAVE A SHORTAGE OF PHYSICIANS IN THE AREA ANNUALLY AS WELL. WE REVIEW TRENDS OF OUR PATIENT ACTIVITY BY SERVICE AND TYPE OF PATIENT TO SEE IF ADJUSTMENTS IN SERVICE OR RESOURCE ALLOCATION NEED TO BE MADE. WE REVIEW OUR PATIENT SATISFACTION SURVEYS PERIODICALLY TO IDENTIFY ANY POTENTIAL GAPS IN SERVICES. WE PARTNER WITH THE LOCAL SCHOOLS AND COMMUNITY MENTAL HEALTH ON SPECIFIC HEALTH INITIATIVE THROUGHOUT THE YEAR. OUR MOST RECENT NEEDS ASSESSMENT WAS COMPLETED IN 2019. WE ALSO PARTNER WITH A LOCAL FQHC (""COVERED BRIDGE""). WE ARE ALSO A PART OF AN ACO THAT HELPS US MONITOR QUALITY INDICATORS OF OUR PATIENTS AND HAS ALSO HELPED US PROMOTE ANNUAL WELLNESS VISITS. WE HAVE 2 FULL TIME CARE COORDINATOR THAT HELPS WITH TRANSITION OF CARE BETWEEN PROVIDERS AS WELL. WE ARE PLANNING ON ADDING MORE STAFF TO HELP WITH THESE INITIATIVES."
      PART VI, LINE 3:
      UPON IDENTIFYING PATIENTS WHO HAVE NO COVERAGE, WE WILL SEND THEM TO OUR PATIENT ASSISTANCE REPRESENTATIVE. THIS PERSON WILL THEN REVIEW THE OPTIONS THAT ARE AVAILABLE FOR THIS INDIVIDUAL. IF MEDICAID IS A POSSIBILITY, WE THEN SEND THIS PERSON TO OUR MEDICAID SPECIALIST, WHO WILL HELP THEM WITH THE PROCESS, AS WELL AS ANY FORMS. WE HAVE A FORMAL FINANCIAL ASSISTANCE PROGRAM THAT IS ADVERTISED HOSPITAL WIDE AND ON OUR WEBSITE. IF THEY QUALIFY FOR FINANCIAL ASSISTANCE, WE WILL EDUCATE THEM AND ASSIST THEM WITH THE PROCESS.
      PART VI, LINE 7, REPORTS FILED WITH STATES
      MI
      PART VI, LINE 4:
      THE HOSPITAL PRESENTLY SERVES ST. JOSEPH COUNTY, ALONG WITH OTHER PROVIDERS AS WELL. THE ESTIMATED POPULATION OF THE TOTAL MARKET IS AROUND 62,000. THE COMMUNITY WAS HEAVILY DEPENDENT ON THE AUTO INDUSTRY AND THUS THE ECONOMY HAS STRUGGLED IN RECENT YEARS. WHILE THE OVERALL ECONOMY IN THE STATE HAS REBOUNDED SOMEWHAT, THE LOCAL COUNTY HAS LAGGED IN THE RECOVERY. THE UNEMPLOYMENT RATE CONTINUES TO BE HIGH, AND THE MEDICAID POPULATION IN THE COMMUNITY IS EXTREMELY HIGH. ADDITIONALLY, PEOPLE WITH COVERAGE HAS ALSO INCREASED. BECAUSE OF THIS, MANY PEOPLE USE THE ER AS THEIR PRIMARY CARE PROVIDER. WHILE THE COMMUNITY IS RURAL, IT IS CLOSE TO URBAN AREAS. MANY PEOPLE IN THE COMMUNITY DO NOT HAVE ADEQUATE TRAVEL ARRANGEMENTS, AS CAN BE EVIDENCED BY HIGH NO SHOW RATES FOR PRIMARY CARE APPOINTMENTS DUE TO TRAVEL ISSUES. WE ARE CURRENTLY EVALUATING OPPORTUNITIES WITH THE COUNTY TO HELP WITH THE TRAVEL ISSUES.
      PART VI, LINE 5:
      THE HOSPITAL HAS A BOARD THAT RESIDES ENTIRELY IN THE COMMUNITY IT SERVES. THE HOSPITAL HAS EXTENDED PRIVILEGES TO ALL QUALIFIED STAFF IN THE COMMUNITY, AND AS MENTIONED ABOVE, HAS SET UP ARRANGEMENTS WITH TERTIARY HOSPITALS TO ARRANGE FOR SPECIALISTS TO PROVIDE CARE IN THE COMMUNITY ON AN AS NEEDED BASIS. THIS IS CRITICAL, AS THIS MEANS THE LOCAL POPULATION DOES NOT HAVE TO TRAVEL EXTENSIVELY FOR THIS SPECIALTY CARE. IF SURPLUS FUNDS ARE AVAILABLE, THESE FUNDS ARE INVESTED BACK INTO THE COMMUNITY, BY ALLOCATING DOLLARS FOR MEDICAL EQUIPMENT REPLACEMENT, PHYSICIAN RECRUITING, AND OTHER COMMUNITY INITIATIVES. THE HOSPITAL ALSO CONTINUES TO ESTABLISH RURAL HEALTH CLINICS IN COMMUNITIES SURROUNDING ITS SERVICE AREA. THE HOSPITAL IS ALSO A MEMBER OF AN ACO, AND THE HOSPITAL HAS HIRED A CARE COORDINATOR TO HELP WITH CHRONIC CARE PATIENTS AND TO HELP PROMOTE ANNUAL WELLNESS VISTS AS WELL.