Community Benefit Insight - Tax-exempt hospital

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Mymichigan Medical Center Alma

Mymichigan Medical Center-Gratiot

300 E Warwick Drive
Alma, MI 48801

Bed count	142	Medicare provider number	230030	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 381437919

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

5.66%

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.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 3,153,093 1.81 %
Medicaid as % of operating expenses	$ 4,813,231 2.76 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 1,732,308 0.99 %
Subsidized health services as % of operating expenses	$ 0 0 %
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.	$ 158,078 0.09 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 25,663 0.01 %
Community building* as % of operating expenses	$ 45,033 0.03 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	116
Physical improvements and housing	4
Economic development	1
Community support	72
Environmental improvements	0
Leadership development and training for community members	6
Coalition building	27
Community health improvement advocacy	6
Workforce development	0
Other	0
Persons served (optional)	4,328
Physical improvements and housing	0
Economic development	0
Community support	4,328
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 45,033 0.03 %
Physical improvements and housing as % of community building expenses	$ 383 0.85 %
Economic development as % of community building expenses	$ 116 0.26 %
Community support as % of community building expenses	$ 26,236 58.26 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 406 0.90 %
Coalition building as % of community building expenses	$ 16,356 36.32 %
Community health improvement advocacy as % of community building expenses	$ 1,536 3.41 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 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	$ 6,115,833 3.50 %
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	$ 305,792 5.00 %

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:
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.
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.
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.

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 $ 148606969 including grants of $ 0) (Revenue $ 169360197)
MYMICHIGAN MEDICAL CENTER ALMA PROVIDES COMPASSIONATE PATIENT CARE SERVICES OF SUPERIOR QUALITY TO GRATIOT AND ISABELLA COUNTIES. 4,254 PATIENT ADMISSIONS AND 177,178 OUTPATIENT VISITS WERE PROVIDED IN FISCAL YEAR 2022. CARE IS PROVIDED WITHOUT RESPECT TO PATIENT'S ABILITY TO PAY.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

MYMICHIGAN MEDICAL CENTER ALMA
PART V, SECTION B, LINE 5: MYMICHIGAN MEDICAL CENTER ALMA/MT. PLEASANT'S COMMUNITY EDUCATION SUPERVISOR IS A MEMBER OF THE LIVE WELL GRATIOT STEERING COMMITTEE. THIS COMMITTEE IS A SUBCOMMITTEE OF THE GRATIOT COUNTY COLLABORATIVE COUNCIL. OTHER ORGANIZATIONS WHO PARTICIPATE IN THIS COMMITTEE INCLUDE: ALMA COLLEGE; GRATIOT-ISABELLA RESD; GRATIOT INTEGRATED HEALTH NETWORK; GRATIOT COUNTY CHILD ADVOCACY; UNITED WAY OF GRATIOT AND ISABELLA COUNTIES; ST. LOUIS FARMERS MARKET; AND MID-MICHIGAN DISTRICT HEALTH DEPARTMENT. THE COMMITTEE IS RESPONSIBLE FOR DEVELOPING AND EVALUATING ASSESSMENTS OF COMMUNITY NEED AND DEVELOPING PLANS TO MEET THOSE NEEDS. ADDITIONALLY, MYMICHIGAN MEDICAL CENTER ALMA/MT. PLEASANT'S COMMUNITY EDUCATION SUPERVISOR IS ALSO A MEMBER OF THE ISABELLA COUNTY COLLABORATIVE COUNCIL, WHICH INCUDES ORGANIZATION SUCH AS TEN16 RECOVERY NETWORK, ISABELLA COUNTY CHILD ADVOCACY, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTRAL MICHIGAN COMMUNITY MENTAL HEALTH, LIFE CHOICES OF CENTRAL MICHIGAN, AND ISABELLA COUNTY COMMISSION ON AGING. REPRESENTATIVES FROM EACH OF THE AGENCIES LISTED ABOVE ASSISTED IN THE DATA COLLECTION, REVIEW AND PRIORITIZATION OVER THE COURSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS.

MYMICHIGAN MEDICAL CENTER ALMA
"PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS WERE DETERMINED AND PRIORITIZED BY REVIEWING QUANTITATIVE AND QUALITATIVE DATA, AND RANKING HEALTH ISSUES ACCORDING TO FOCUS. WE INVESTIGATED A VARIETY OF PRIMARY AND SECONDARY DATA SOURCES. A GRID OF OVER 150 INDICATORS FROM 20 DIFFERENT PRIMARY AND SECONDARY SOURCES WAS UTILIZED TO BUILD THE DATA PLATFORM. DATA OUT OF NORMAL RANGE AGAINST A BENCHMARK WAS COMPARED TO CURRENT STANDARDS, THOSE OF OUR COMMUNITY HEALTH TEAM, POPULATION HEALTH COLLABORATIVE TEAM, AND THOSE OF OUR COLLABORATIVE PARTNERS AND COMMUNITY MEMBERS. IN ORDER TO DETERMINE CAUSES OF HEALTH PROBLEMS, DATA WAS CATEGORIZED INTO FOUR AREAS: 1. DETERMINANTS OF HEALTH; 2. CARE ACCESS; 3. HEALTH BEHAVIORS AND 4. HEALTH CONDITIONS. AREAS WHERE HEALTH ISSUES EXISTED WERE REVEALED IN TWO WAYS. FIRST, WHEN COMPARISON OF LOCAL QUANTITATIVE DATA INDICATORS AGAINST STATE OF MICHIGAN BENCHMARKS RESULTED IN POOR PERFORMANCE; AND WHEN THEMES OF UNACCEPTABLE HEALTH EMERGED FROM ANALYSIS OF QUALITATIVE DATA. PRIORITIZATION OCCURRED IN STAGES; INPUT WAS SOLICITED FROM THE COMMUNITY HEALTH TEAM, MYMICHIGAN MEDICAL CENTER ALMA/MT. PLEASANT LEADERSHIP TEAM, COMMUNITY HEALTH STAFF AND RESPECTIVE COMMUNITY GROUPS. IN ORDER TO RESPOND AND IMPACT THE HEALTH CARE NEEDS THAT WERE IDENTIFIED, THE TOP PRIORITY AREAS FOR MYMICHIGAN MEDICAL CENTER ALMA/MT. PLEASANT CHOSEN BY THE COMMUNITY HEALTH TEAM AND REVIEWED BY THE MYMICHIGAN HEALTH POPULATION HEALTH COLLABORATION TEAM AND MYMICHIGAN MEDICAL CENTER ALMA/MT. PLEASANT'S BOARD ON JUNE 19, 2019 FOLLOW; ALONG WITH AN UPDATE OF STRATEGIES IMPLEMENTED:A. CHRONIC DISEASE PREVENTION. EDUCATE, ENCOURAGE AND PROVIDE OPPORTUNITY FOR IMPROVED HEALTH BEHAVIORS AND INCREASED ACCESS TO HEALTHY FOODS. PROJECTS THAT ALIGN WITH PREVENTION OF CHRONIC DISEASE FOLLOW: PRESCRIPTION FOR HEALTH PROGRAM IN PARTNERSHIP WITH MSU EXTENSION, MID MICHIGAN DISTRICT HEALTH DEPARTMENT, ST. LOUIS FARMERS MARKET, AND THE CITY OF MT. PLEASANT FARMERS MARKET, WHICH YIELDED 56 PARTICIPANTS IN GRATIOT COUNTY AND 21 PARTICIPANTS IN ISABELLA COUNTY; A ""HEALTHIER YOU"" COURSE, PROVIDED IN PARTNERSHIP BY MYMICHIGAN HEALTH CLINICAL NUTRITION SERVICES AND MYMICHIGAN HEALTH BEHAVIORAL HEALTH SERVICE LINES, WHICH YIELDED 12 PARTICIPANTS IN GRATIOT COUNTY AND 8 PARTICIPANTS IN ISABELLA COUNTY; AND HEALTHY EATING DEMONSTRATIONS AND EDUCATION AT MULTIPLE DIFFERENT COMMUNITY SITES, INCLUDING THE ST. LOUIS AND CITY OF MT. PLEASANT FARMERS MARKETS, THE STRICKLER NONPROFIT CENTER, THE GRATIOT COMMUNITY GARDEN, AND DOW CHEMICAL. B. MATERNAL/INFANT/CHILD HEALTH. PREPARE, CARE AND SUPPORT CHILDBEARING FAMILIES IN ORDER TO IMPROVE THE HEALTH AND WELL-BEING OF CHILDBEARING WOMEN AND INFANTS. PROJECTS THAT ALIGN WITH IMPROVING MATERNAL/INFANT/CHILD HEALTH FOLLOW: IMPLEMENTATION OF CENTERINGPREGNANCY, GROUP PRENATAL CARE MODEL, AT MYMICHIGAN MEDICAL CENTER MT. PLEASANT; PROVIDING VIRTUAL CHILDBIRTH EDUCATION CLASSES TO EXPECTANT FAMILIES IN PARTNERSHIP WITH BOTH HOSPITAL BASED AND COMMUNITY PRIMARY CARE AND OBSTETRIC OFFICES; PROVIDING A FREE BREASTFEEDING SUPPORT LINE FOR ALL FAMILIES WITHIN THE REGION, WHICH YIELDED 65 CALLS IN FY2022, SERVING 54 DIFFERENT FAMILIES; AND OFFERING NEWBORN AND PARENTING SUPPORT GROUPS OPTIONS IN BOTH ALMA AND MT. PLEASANT, YIELDING 30 SESSIONS IN ALMA AND 15 SESSIONS IN MT. PLEASANT, THROUGHOUT THE YEAR. C. MENTAL HEALTH AND SUBSTANCE USE. LEAD, PARTNER AND SUPPORT EFFORTS TO ENSURE A COMPREHENSIVE SYSTEM OF CARE TO MEET THE BEHAVIORAL HEALTH OF ALL AT THE RIGHT TIME, IN THE RIGHT PLACE, AND WITH THE RIGHT CARE. PROJECTS THAT ALIGN WITH ADDRESSING MENTAL HEALTH AND SUBSTANCE USE NEEDS IN THE COMMUNITY FOLLOW: IMPLEMENTING PROJECT ASSERT (ALCOHOL AND SUBSTANCE USE SERVICES, EDUCATION, AND REFERRAL TO TREATMENT), IN PARTNERSHIP WITH TEN16 RECOVERY NETWORK, IN BOTH THE ALMA AND MT. PLEASANT EMERGENCY DEPARTMENTS, YIELDING 167 SUBSTANCE USE REFERRALS IN ALMA AND 47 SUBSTANCE USE REFERRALS IN MT. PLEASANT; OFFERING A RESPONSIBLE PRESCRIBING EDUCATION SERIES, IN PARTNERSHIP WITH THE GRATIOT COUNTY SUBSTANCE ABUSE COALITION AND MID MICHIGAN DISTRICT HEALTH DEPARTMENT, WHICH YIELDED 87 PARTICIPANTS; AND PARTICIPATING IN MULTIPLE SUBSTANCE USE AND MENTAL HEALTH OUTREACH ACTIVITIES ACROSS THE COMMUNITY, INCLUDING COMMUNITY PRESCRIPTION AND SHARPS TAKE BACK EVENTS AND PROVIDING MENTAL HEALTH EDUCATION AT THE STRICKLER NONPROFIT CENTER EVENTS AND LOCAL MOBILE FOOD DISTRIBUTIONS."

PART V, SECTION B, LINES 7A AND 10A
HTTPS://WWW.MYMICHIGAN.ORG/ABOUT/COMMUNITY-BENEFITS/CHNA/

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
AS WELL AS USING THE FEDERAL POVERTY GUIDELINES, THE PATIENT'S AVAILABLE ASSETS AND ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT ARE TAKEN INTO CONSIDERATION WHEN DETERMINING FREE OR DISCOUNTED CARE. PATIENTS WHOSE FAMILY INCOME EXCEEDS 350% OF THE FPG MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE.

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 $ 6,115,833.

PART II, COMMUNITY BUILDING ACTIVITIES:
MYMICHIGAN MEDICAL CENTER ALMA/MT. PLEASANT EMPLOYEES CONTRIBUTED MANY HOURS ATTRIBUTED TO COALITION BUILDING AS MEMBERS FOR COMMUNITY BOARDS, CIVIC ORGANIZATIONS, ADVISORY COMMITTEES, COALITIONS AND WORK GROUPS. EXAMPLES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: GRATIOT INTEGRATED HEALTH NETWORK BOARD OF DIRECTORS; GRATIOT CHILD ADVOCACY BOARD OF DIRECTORS; ISABELLA HABITAT FOR HUMANITY BOARD OF DIRECTORS AND RESTORE COMMITTEE; GREAT LAKES BAY REGIONAL ALLIANCE BOARD OF DIRECTORS; AAAMG (GRATIOT COUNTY TOP EMPLOYERS) PLANNING COMMITTEE; MIDDLE MICHIGAN DEVELOPMENT CORPORATION BOARD OF DIRECTORS; UNITED WAY OF GRATIOT AND ISABELLA COUNTIES BOARD OF DIRECTORS; MT. PLEASANT AREA CHAMBER OF COMMERCE BOARD OF DIRECTORS; GRATIOT COUNTY COMMUNITY FOUNDATION BOARD AND SCHOLARSHIP COMMITTEE; GREATER GRATIOT DEVELOPMENT BOARD OF DIRECTORS; AMERICAN HOSPITAL ASSOCIATION REGIONAL POLICY BOARD OF DIRECTORS; ART REACH OF MID MICHIGAN;S BANNER SELECTION COMMITTEE; AND GIRL SCOUTS OF MICHIGAN. IN-KIND FINANCIAL SUPPORT WAS PROVIDED TO MID MICHIGAN COLLEGE, WITH A LARGE DONATION OF LAB AND MEDICAL SUPPLIES FOR STUDENT USE, AS WELL AS DONATIONS OF FURNITURE TO LUX FUNERAL HOME, ALMA HIGH SCHOOL, AND ALMA RESALE STORE, AND MEDICAL SUPPLIES DONATED TO THE UKRAINE. IN ADDITION, MYMICHIGAN MEDICAL CENTERS ALMA/MT. PLEASANT ALSO DONATED SCRAP METALS TO PINE RIVER CLEAN UP COALITION AND BUILT A LITTLE FREE FOOD PANTRY (FOR COMMUNITY USE) ON THE PROPERTY OF MYMICHIGAN MEDICAL CENTER ALMA. ADDITIONALLY, COMMUNITY HEALTH IMPROVEMENT ADVOCACY WAS ENACTED THROUGH WORK BY MYMICHIGAN MEDICAL CENTER ALMA/MT. PLEASANT STAFF FOR ORGANIZATIONS THAT FOLLOW: CASTING FOR RECOVERY PROGRAM, GREAT LAKES CHAPTER OF AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES, LEGISLATIVE BREAKFASTS, AND PROVIDING HEALTH EDUCATION AND VOLUNTEERISM AT MULTIPLE HEALTH FAIRS ACROSS THE REGION.

PART III, LINE 2:
THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX.BAD DEBT EXPENSE METHODOLOGY: OTHER UNCOMPENSATED CARE REPRESENTS THE COST OF SERVICES PROVIDED FOR WHICH PAYMENT IS EXPECTED AT THE TIME SERVICE IS PROVIDED, BUT PAYMENT IS NOT RECEIVED OR IS LESS THAN THE COST INCURRED TO PROVIDE THE SERVICE. THE FOLLOWING IS INCLUDED AS PROGRAMS AND SERVICES RELATED TO OTHER UNCOMPENSATED CARE: UNCOMPENSATED SERVICES, AT COST REPRESENTS THE COST OF SERVICES PROVIDED FOR WHICH A FEE HAS BEEN ASSESSED BUT NOT COLLECTED OR ONLY A PORTION OF THE COST OF THE RENDERED SERVICE HAS BEEN RECOVERED.

PART III, LINE 3:
THE BAD DEBT COST WAS REVIEWED BY THE HOSPITAL'S REVENUE CYCLE TEAM AND THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE QUALIFIED UNDER OUR FINANCIAL ASSISTANCE POLICY IS 5% OF TOTAL BAD DEBTS.

PART III, LINE 4:
PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS

PART III, LINE 8:
THE SOCIAL SECURITY ACT AMENDMENT TO ESTABLISH MEDICARE STATES THAT MEDICARE WILL NOT PAY THE COST TO PROVIDE CARE TO NON-BENEFICIARIES AND NON-BENEFICIARIES WILL NOT PAY THE COST OF CARE FOR BENEFICIARIES. WHEN MEDICARE DOES NOT PAY RATES THAT COVER ALL THE COST OF CARE FOR BENEFICIARIES, IT BECOMES A COMMUNITY BURDEN. THEREFORE, THE FULL AMOUNT OF SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT.THIS ORGANIZATION BELIEVES THE AUDITED FINANCIAL STATEMENT CALCULATION IS A MORE ACCURATE DETERMINATION OF COST THAN THE MEDICARE ALLOWABLE COSTS USED FOR COST REPORTS THAT ARE REQUIRED TO BE UTILIZED ON THIS SCHEDULE IN PART III, SECTION B. THE AUDITED FINANCIAL STATEMENTS INCLUDE ALL MEDICARE REVENUES AND COSTS AND ALSO USE A COST-TO-CHARGE RATIO METHOD.COSTING METHODOLOGY: AN AVERAGE COST-TO-CHARGE RATIO IS APPLIED TO THE CHARGE WRITE-OFF. THE RATIO IS CALCULATED BY REMOVING FROM TOTAL EXPENSE THE OTHER OPERATING INCOME, UNCOMPENSATED CARE EXPENSE AND THE DIRECTLY ASSIGNED MEDICAID ASSESSMENT EXPENSE, THEN DIVIDING THIS NET EXPENSE BY TOTAL GROSS PATIENT REVENUES. THIS RATIO IS MULTIPLIED WITH THE CHARITY CARE CHARGES AND UNCOMPENSATED CARE CHARGES WRITTEN OFF FOR THE RELATED EXPENSE.

PART III, LINE 9B:
"MYMICHIGAN HEALTH DOES NOT TRY TO COLLECT FROM THOSE WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. MYMICHIGAN HEALTH'S POLICY STATES THAT THE PURPOSE OF THE POLICY ""IS TO PROVIDE COST EFFECTIVE PAYMENT OPTIONS TO PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE (PER FINANCIAL AID/CHARITY CARE POLICY) AND EITHER HAVE NO INSURANCE OR HAVE A BALANCE AFTER INSURANCE WHICH IS THEIR RESPONSIBILITY TO PAY."""

PART VI, LINE 7, REPORTS FILED WITH STATES
MI

PART VI, LINE 2:
IN FY2022, MYMICHIGAN HEALTH'S FOCUS ON IMPROVING THE HEALTH OF OUR COMMUNITIES WAS REFLECTED IN OUR PURPOSE STATEMENT. WE PARTNERED WITH SCHOOLS, BUSINESSES AND HEALTH CARE AGENCIES TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITIES SERVED. OUR HOSPITAL BOARDS ARE COMPRISED OF COMMUNITY MEMBERS WHO PROVIDE INPUT INTO THE COMMUNITY ENDEAVORS WE INSTITUTE. ADDITIONALLY, WE PARTICIPATE IN COMMUNITY COLLABORATIVE PARTNERSHIPS FOR AREA NON-PROFITS WITH A FOCUS ON HEALTH LIKE THE GRATIOT COUNTY COLLABORATIVE COUNCIL, ISABELLA COUNTY COLLABORATIVE COUNCIL, LIVE WELL GRATIOT, CENTRAL MICHIGAN RURAL HEALTH NETWORK, AND THE NORTH CENTRAL COMMUNITY HEALTH INNOVATION REGION. WE ALSO PARTNER WITH THE MICHIGAN HEALTH IMPROVEMENT ALLIANCE, INC., OR MIHIA, WHICH IS A DIVERSE GROUP OF STAKEHOLDERS COLLABORATING TOGETHER AS A NON-PROFIT ORGANIZATION TO IMPROVE HEALTH AND HEALTH DELIVERY IN CENTRAL MICHIGAN THROUGH PARTICIPATION IN A REGIONAL POPULATION HEALTH TEAM AND A REGIONAL PERINATAL QUALITY COLLABORATIVE COMMITTEE. THESE COMMUNITY COLLABORATIONS HELP TO BUILD A HEALTH CARE SYSTEM WHERE CONSUMERS, PROVIDERS AND PAYERS MAKE DECISIONS FOR BEST PRACTICE IN THE AREA SERVED. ADDITIONALLY, WE PARTNER ON NEEDED HEALTH INITIATIVES, WORKING WITH LOCAL PUBLIC HEALTH DEPARTMENTS AND HEALTH AND HUMAN SERVICE AGENCIES TO UNDERSTAND THE UNIQUE HEALTH NEEDS OF EACH OF OUR COMMUNITIES. IN 2019, A COMMUNITY HEALTH SURVEY WAS CONDUCTED TO UNDERSTAND THE HEALTH AND HEALTH NEEDS OF PEOPLE LIVING IN GRATIOT AND ISABELLA COUNTIES. MYMICHIGAN HEALTH'S COMMUNITY HEALTH TEAM WORKED WITH THE GRATIOT AND ISABELLA COUNTY COLLABORATIVE COUNCILS, AS WELL AS THE LIVE WELL GRATIOT STEERING COMMITTEE, TO ADAPT THE SURVEY TO ENSURE IT MET THE NEEDS OF THE COUNTIES, AND COLLECTED DATA ON ANY HEALTH ISSUES/FACTORS EMERGING SINCE THE PREVIOUS DATA COLLECTION. THE MYMICHIGAN HEALTH COMMUNITY HEALTH TEAM AIMED TO COLLECT DATA FROM A SAMPLE ACROSS GRATIOT AND ISABELLA COUNTIES, INCLUDING A REPRESENTATIVE SAMPLE FROM THE CITIES AND OUT COUNTY AREAS. THE TEAM USED EXISTING US CENSUS DATA TO OBTAIN POPULATION ESTIMATES FOR EACH TOWNSHIP/CITY IN EACH COUNTY, TO ENSURE APPROPRIATE REPRESENTATION FROM EACH LOCATION. EFFORTS WERE ALSO MADE TO OBTAIN A SAMPLE THAT WAS REPRESENTATIVE OF EACH COUNTY'S POPULATION (AGE, RACE, EDUCATION, INCOME).

PART VI, LINE 3:
INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE IS COMMUNICATED TO THE PUBLIC THROUGH INFORMATIONAL BROCHURES AT REGISTRATION AREAS AND THROUGH PATIENT ACCOUNTING COUNSELORS. PATIENT ACCOUNTING COUNSELORS ARE TRAINED TO HELP PATIENTS OBTAIN FREE OR LOW-COST HEALTH INSURANCE OR TO WORK WITH PATIENTS TO PROVIDE CHARITY CARE OR FINANCIAL AID BASED ON THEIR FINANCIAL STATUS. MYMICHIGAN HEALTH PROVIDES FINANCIAL AID TO PATIENTS BASED ON THEIR INCOME, ASSETS, AND NEEDS. IN ADDITION, MYMICHIGAN HEALTH MAY BE ABLE TO HELP PATIENTS RECEIVE FREE OR LOW-COST HEALTH INSURANCE OR WORK WITH THE PATIENT TO ARRANGE A MANAGEABLE PAYMENT PLAN. ADDITIONALLY, SOCIAL WORKERS PROVIDE INFORMATION, BOTH WRITTEN AND VERBAL, ABOUT PROGRAMS FOR ASSISTANCE. THEY ALSO COORDINATE WITH THE MEDICAID ELIGIBILITY REPRESENTATIVE FROM DHS FOR FOLLOW-UP OR EXPEDITED APPLICATIONS. THEY PROVIDE MEDICAID APPLICATIONS, PERSONAL FINANCIAL STATEMENTS FOR HOSPITAL CHARITY CARE AND REFER TO THE PATIENT ACCOUNTING COUNSELORS. ADDITIONALLY, CONTACT INFORMATION ABOUT FINANCIAL ASSISTANCE IS AVAILABLE ON OUR WEBSITE AT HTTPS://WWW.MYMICHIGAN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE/PATIENT-NOTICE-OF-FINANCIAL-AID.

PART VI, LINE 4:
THE COMMUNITY SERVED FOCUSES ON MYMICHIGAN MEDICAL CENTER ALMA, LOCATED IN GRATIOT COUNTY, AND MYMICHIGAN MEDICAL CENTER MT. PLEASANT, LOCATED IN ISABELLA COUNTY. THE SERVICE AREA IN ISABELLA COUNTY IS COMPRISED OF ZIP CODES: 49310 (BLANCHARD), 48893 (LAKE ISABELLA), 49310 (MILLBROOK), 48804 (MT. PLEASANT), 48858 (MT. PLEASANT), 48859 (MT. PLEASANT), 48878 (SHEPHERD), 48893 (WEIDMAN), AND 48896 (WINN). THE SERVICE AREA IN GRATIOT COUNTY IS COMPRISED OF ZIP CODES: 48801 (ALMA), 48802 (ALMA), 48806 (ASHLEY), 48807 (BANNISTER), 48615 (BRECKENRIDGE), 48830 (ELM HALL), 48832 (ELWELL), 48847 (ITHACA), 48856 (MIDDLETON), 48862 (NORTH STAR), 48871 (PERRINTON), 48874 (POMPEII), 48877 (RIVERDALE), 48880 (SAINT LOUIS), 48889 (SUMNER), AND 48662 (WHEELER). ACCORDING TO COUNTY HEALTH RANKINGS THERE ARE 41,018 RESIDENTS IN GRATIOT COUNTY. OF THOSE, 20 PERCENT ARE UNDER 18 YEARS OF AGE AND 16.9 PERCENT ARE 65 AND OLDER. FEMALES MAKE UP 46.3 PERCENT OF THE POPULATION WHILE MALES MAKE UP 53.7 PERCENT. THE MEDIAN AGE IN GRATIOT COUNTY IS 39.5 YEARS OF AGE. OF THE POPULATION, 85.9 PERCENT ARE WHITE (NON-HISPANIC) AND 14.1 PERCENT ARE NON-WHITE. IN GRATIOT COUNTY, THE PERCENTAGE OF PEOPLE WHO REPORTED THEIR HEALTH TO BE FAIR OR POOR WAS 16 PERCENT. ACCORDING TO COUNTY HEALTH RANKINGS THERE ARE 71,063 RESIDENTS IN ISABELLA COUNTY. OF THOSE, 17.2 PERCENT ARE UNDER 18 YEARS OF AGE AND 12.1 PERCENT ARE 65 AND OLDER. FEMALES MAKE UP 51.4 PERCENT OF THE POPULATION WHILE MALES MAKE UP 48.6 PERCENT. THE MEDIAN AGE IN ISABELLA COUNTY IS 28.1 YEARS OF AGE. OF THE POPULATION, 85.5 PERCENT ARE WHITE (NON-HISPANIC) AND 14.5 PERCENT ARE NON-WHITE. IN ISABELLA COUNTY, THE PERCENTAGE OF PEOPLE WHO REPORTED THEIR HEALTH TO BE FAIR OR POOR WAS 19 PERCENT.

PART VI, LINE 5:
EACH MYMICHIGAN HEALTH MEMBER HOSPITAL ADDRESSES HEALTH AND WELLBEING WITHIN THE COMMUNITIES SERVED. FOUR PORTFOLIOS OF POPULATION HEALTH ARE ADDRESSED: PHYSICAL AND BEHAVIORAL HEALTH; SOCIAL AND SPIRITUAL WELL-BEING; COMMUNITY HEALTH AND WELL-BEING AND COMMUNITIES OF SOLUTIONS. PORTFOLIO ONE AIMS AT IMPROVING THE PHYSICAL AND OR MENTAL HEALTH OF INDIVIDUALS SERVED THROUGH QUALITY MEASUREMENT AND PERFORMANCE IMPROVEMENT INITIATIVES, AS WELL AS THE USE OF PATIENT CARE NAVIGATORS AND CARE MANAGERS IN PRIMARY CARE OFFICES AND INITIATIVES TO IMPROVE ACCESS TO CARE, LIKE INCREASED OPPORTUNITIES FOR TELEMEDICINE. PORTFOLIO TWO ADDRESSES SOCIAL AND SPIRITUAL DRIVERS OF HEALTH AND WELL-BEING, MANY OF WHICH ARE IDENTIFIED THROUGH SYSTEMATIC EVALUATION OF SOCIAL DETERMINANTS OF HEALTH COMPLETED AT SEVERAL POINTS OF CONTACT INCLUDING: NEW PATIENTS, EMERGENCY DEPARTMENT PATIENTS, ANNUAL PHYSICALS, POST HOSPITAL DISCHARGES, REFERRALS TO CARE MANAGERS AND PATIENTS WHO CONSISTENTLY DO NOT SHOW UP FOR APPOINTMENTS TO DETERMINE WHAT BARRIERS THEY MAY BE ENCOUNTERING. PORTFOLIO THREE ACTIVITIES AIM TO IMPROVE COMMUNITY HEALTH AND WELL-BEING BY COMMUNITY PARTNERS WORKING TOGETHER TO ASSESS DATA, DETERMINE FOCUS AREAS OF HEALTH AND POOL STAFF AND RESOURCES TO IMPLEMENT HEALTH IMPROVEMENT PROJECTS LIKE INCREASING PHYSICAL ACTIVITY, ACCESS TO HEALTHY FOODS AND REDUCING OPIOID USAGE. PORTFOLIO FOUR ADDRESSES OUR ROLE AS AN ANCHOR INSTITUTION. WE ARE THE MAJOR EMPLOYER IN EACH COMMUNITY WE SERVE AND AS SUCH, WE PROMOTE HEALTH AND WELL-BEING BY CAPITALIZING ON COMMUNITY ASSETS AND ACTIVE ENGAGEMENT WITH REGIONAL INITIATIVES. A TOTAL OF $1,961,082 IN COMMUNITY BENEFITS WAS PROVIDED BY MYMICHIGAN MEDICAL CENTERS ALMA AND MT. PLEASANT IN FY2022 THROUGH COMMUNITY EDUCATION PROGRAMS, SCREENINGS, SPECIAL EVENTS AND HEALTH EXPERTISE. IN FY 2022 4,339 PERSONS WERE REACHED WITH GENERAL COMMUNITY EDUCATION TOPICS LIKE BREASTFEEDING EDUCATION, PARENTING EDUCATION, NUTRITION AND WEIGHT MANAGEMENT, AND TOBACCO CESSATION. THERE WERE 245 PEOPLE REACHED WITH EDUCATION ON MENTAL HEALTH AND DEPRESSION AND 72 FOR DRUG AND ALCOHOL EDUCATION. ADDITIONALLY, 134 PEOPLE WERE REACHED FOR HEART DISEASE AND HEART HEALTH EDUCATION AND 449 FOR CPR AND FIRST AID EDUCATION. THERE WERE 18 INDIVIDUALS THAT PARTICIAPTED IN FREE MAMMOGRAM SCREENINGS. THESE SCREENINGS PROVIDED A MEANS FOR DETECTING POTENTIALLY SERIOUS HEALTH PROBLEMS IN THEIR EARLIEST STAGES, WHEN TREATMENT IS USUALLY MORE SUCCESSFUL, RESULTING IN LOWER MORBIDITY OR MORTALITY. ADDITIONALLY, MYMICHIGAN MEDICAL CENTER ALMA HOSTED 7 COMMUNITY BLOOD DRIVES, RESULTING IN COLLECTION OF OVER 200 PINTS OF BLOOD DONATED, WHILE MYMICHIGAN MEDICAL CENTER MT. PLEASANT HOSTED 6 COMMUNITY BLOOD DRIVES, RESULTING IN 100 PINTS OF BLOOD COLLECTED. THERE WERE 258 INDIVIDUALS WHO RECEIVED SUPPORT THROUGH MEETING GROUPS LIKE: ALZHEIMER'S, BARIATRIC, BRAIN INJURY, OSTOMY, PARENTING, AND PARKINSON'S SUPPORT GROUPS.

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THE COMMUNITY BENEFITS PROVIDED BY MYMICHIGAN MEDICAL CENTERS ALMA AND MT. PLEASANT IN FISCAL YEAR 2022 INCLUDE COMMUNITY EDUCATION PROGRAMS, SCREENINGS, SPECIAL EVENTS AND HEALTH EXPERTISE, INCLUDING INSURANCE UNDER-REIMBURSEMENTS AND SERVICES TO THOSE WHO COULD NOT PAY. OVER $132 MILLION IN COMMUNITY BENEFITS WAS PROVIDED BY MYMICHIGAN HEALTH TO THE COMMUNITIES IT SERVES. THE UNDERLYING PREMISE FOR EACH MYMICHIGAN HEALTH MEMBER IS SHARED OWNERSHIP FOR COMMUNITY HEALTH. THE PLAN REFLECTS INPUT FROM DESIGNATED INDIVIDUALS IN EACH COMMUNITY INCLUSIVE OF, BUT NOT LIMITED TO, PUBLIC HEALTH EXPERTS, REPRESENTATIVES OF LOW-INCOME AND MEDICALLY UNDERSERVED POPULATIONS AND THOSE SUFFERING FROM CHRONIC DISEASE. THE BROADENED SCOPE FROM WHICH WE FUNCTION IS INHERENT IN THE STRATEGIES WHICH INCLUDE INTERNAL HEALTH IMPROVEMENT INITIATIVES OF MYMICHIGAN MEDICAL CENTERS ALMA AND MT. PLEASANT AND MYMICHIGAN HEALTH, AS WELL AS COLLABORATIVE EFFORTS OF THE HOSPITAL WITH PUBLIC HEALTH, THE UNIVERSITY OF MICHIGAN AND OUR COMMUNITY PARTNERS.

Operating expenses	$ 174,525,613
Total amount spent on community benefits as % of operating expenses	$ 9,882,373 5.66 %