4A (Expenses $ 441226256 including grants of $ 0) (Revenue $ 0)
METRO HEALTH HOSPITAL IS A 208-BED TEACHING HOSPITAL THAT PROVIDES A COMPREHENSIVE SUITE OF INPATIENT AND OUTPATIENT HEALTHCARE SERVICES, INCLUDING FAST EMERGENCY SERVICES, CANCER AND CARDIAC CARE, ROBOTIC AND TRADITIONAL SURGERY, FAMILY PRACTICE, INTERNAL MEDICINE, SPORTS MEDICINE AND OTHERS. THE ORGANIZATION'S MISSION IS TO IMPROVE THE HEALTH AND WELL- BEING OF THE COMMUNITIES IT SERVES. TO THAT END, METRO PROVIDES EDUCATION AND SCREENING PROGRAMS FOR THE COMMUNITY, EDUCATION OPPORTUNITIES FOR FUTURE DOCTORS, NURSES AND OTHER HEALTH PROFESSIONS, FINANCIAL ASSISTANCE PROGRAMS, CARE FOR THE UNDERSERVED, AND MUCH MORE. DURING FISCAL YEAR 2022, METRO HEALTH WELCOMED 1,747 BABIES INTO OUR COMMUNITY, CARED FOR 54,222 EMERGENCY ROOM VISITS, PERFORMED 1,613,504 LABORATORY TESTS AND 42,282 DIAGNOSTIC RADIOLOGY PROCEDURES AND COUNTED 39,909 PATIENT DAYS. THE METRO HEALTH COMMUNITY CLINIC, WHICH PROVIDES MEDICAL CARE TO THE UNDERSERVED, PROVIDED CARE FOR 17,218 PATIENT VISITS. METRO HEALTH'S MEDICAL EDUCATION PROGRAM INCLUDED 120 MEDICAL STUDENTS, RESIDENTS AND FELLOWS.

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 3E
OUTLINES AND DISCUSSES ELEVEN TOP HEALTH-RELATED NEEDS OF THE COMMUNITY

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 5
"ADDITIONAL DATA COLLECTION METHODS WERE USED BY THE COMMUNITY INPUT WORKGROUP TO GATHER DATA FROM COMMUNITY MEMBERS WHOSE VOICE AND HEALTH STATUS MAY NOT BE REPRESENTED THROUGH THE LOCAL, STATE, AND NATIONAL SECONDARY DATA SOURCES. THE ADDITIONAL DATA COLLECTION METHODS INCLUDED COMMUNITY INPUT WALLS (STRATEGY INVOLVING GATHERING INPUT FROM COMMUNITY MEMBERS DIRECTLY BY POSTING LARGE SHEETS OF PAPER IN PUBLIC SPACE AND ASKING COMMUNITY MEMBERS TO ANSWER QUESTIONS ABOUT THE COMMUNITY BY WRITING THEIR THOUGHTS ON THE WALL), FOCUS GROUPS WITH COMMUNITY MEMBERS PARTICIPATING TO GENERATE COMMUNITY INPUT FROM VARIOUS POPULATIONS ABOUT THE HEALTH AND WELL-BEING OF KENT COUNTY AND INTERCEPT INTERVIEWS (METHOD DESIGNED TO ENGAGE PARTICIPANTS WHO MAY NOT BE INCLINED TO ATTEND A FOCUS GROUP OR TOWN HALL MEETING). THE INTERCEPT INTERVIEWS WERE TRANSLATED INTO SPANISH FOR THE LATINO/HISPANIC COMMUNITY AND OTHER LANGUAGES SPOKEN BY THE ASIAN COMMUNITY. THIS ASSESSMENT WAS DESIGNED TO PROVIDE A BROAD OVERVIEW OF HEALTH AND WELL BEING AND IDENTIFY CRITICAL ISSUES RELATED TO COMMUNITY HEALTH IN KENT COUNTY. HOWEVER, IT IS NOT INCLUSIVE OF EVERY HEALHT-RELATED ISSUE THAT RESIDENTS FACE AND DOES NOT REPRESENT ALL POSSIBLE POPULATIONS OF INTEREST. COVID-19 LIMITATIONS: DATA IN THIS REPORT REPRESENT THE MOST CURRENT, COUNTY-LEVEL SOURCES AT THE TIME OF PUBLICATION. HOWEVER, IT'S IMPORTANT TO NOTE THE SOURCE DATA IN RELATION TO THE COVID-19 TIMELINE. MANY INDICATORS REFLECT THE STATE OF HEALTH PRIOR TO THE PANDEMIC; HOWEVER, COMMUNITY INPUT DATA WAS COLLECTED DURING THE PANDEMIC. GATHERING COMMUNITY INPUT DATA ON LONG-TERM HEALTH NEEDS DURING THE PANDEMIC MAY HAVE INCREASED THE LIKELIHOOD OF BIAS AND/OR MEASUREMENT ERROR. COMMITTEE MEMBERS TRIED TO ACCOUNT FOR THIS BY STRATEGICALLY PHRASING SURVEY QUESTIONS SO THE DIRECT AND INDIRECT EFFECTS OF THE PANDEMIC WOULD NOT SKEW THE RESPONSES. FOR EXAMPLE, ""FEAR OR CLOSURE DUE TO COVID-19"" WAS A RESPONSE OPTION INCLUDED WHEN ASKING ABOUT BARRIERS TO ACCESSING HEALTH CARE, SO THESE COULD BE FILTERED OUT DURING ANALYSIS TO GET A MORE ACCURATE AND RELIABLE DETERMINATION OF BARRIERS THAT EXIST BEYOND THE PANDEMIC. IN CONSIDERATION OF SOME OF THESE LIMITATIONS, THE PROCESS OF PRIORITIZING HEALTH NEEDS WAS BASED ON BOTH QUANTITAVE DATA COLLECTED PRIOR TO THE STATE SHUTDOWN IN MICHIGAN, AND QUALITATIVE DATA COLLECTED AMIDST THE PANDEMIC. COMMUNITY SURVEY: ANOTHER LIMITATION IS THE CONVENIENCE SAMPLING METHODOLOGY USED TO CONDUE SURVEY (DISSEMINATION ONLINE AND VIA COMMUNITY ORGANIZATIONS). BECAUSE THE SAMPLE OF SURVEY RESPONDENTS WAS NOT RANDOMLY SELECTED, GENERALIZABILITY OF THE FINDINGS TO THE BROADER POPULATIONS IS LIMITED. COMPARED TO THE POPULATION OF KENT COUNTY, PEOPLE OF COLOR, MEN, AND YOUNGER ADULTS (AGE 25 AND YOUNGER) WERE UNDERREPRESENTED AMONGST SURVEY RESPONDENTS, AND THOSE WITH A BACHELOR'S DEGREE OR HIGHER WERE OVERREPRESENTED. DUE TO THE PANDEMIC RESTRICTIONS AND CANCELATION OF COMMUNITY EVENTS, IN-PERSON SURVEYING TECHNIQUES COULD NOT BE USED PURPOSIVELY SAMPLE UNDERREPRESENTED POPULATIONS. ADDITIONALLY, DISSEMINATION WAS PRIMARILY CONDUCTED THROUGH SOCIAL MEDIA AND PARTNER NETWORKS WHICH MAY HAVE FURTHER LIMITED THE SCOPE OF POTENTIAL RESPONDENTS AND INCREASED THE LIKELIHOOD FOR SELECTION BIAS. FOCUS GROUPS: THE GOAL OF THE FOCUS GROUPS WAS TO OBTAIN ADDITIONAL COMMUNITY INPUT FROM POPULATIONS THAT WERE UNDERREPRESENTED IN THE SURVEY RESPONSES AND GET AN IN-DEPTH PERSPECTIVE ON ISSUES FROM SPECIFIC SUB- POPULATIONS. ALTHOUGH THE FOCUS GROUPS PROVIDE VALUABLE INSIGHTS, RESULTS ARE NOT STATISTICALLY REPRESENTATIVE OF THE LARGER KENT COUNTY POPULATION DUE TO NON-RANDOM RECRUITING OF PARTICIPANTS AND A SMALL SAMPLE SIZE. ADDITIONALLY, SINCE RECRUITMENT WAS CONDUCTED BY THE COMMUNITY ORGANIZATIONS THAT HOSTED AND FACILITATED FOCUS GROUPS, MANY WHO PARTICIPATED WERE ALREADY INVOLVED IN COMMUNITY PROGRAMMING AND THE RESPONSES MAY ONLY PROVIDE ONE PERSPECTIVE ON THE ISSUES DISCUSSED."

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 6A
SPECTRUM HEALTH, MERCY HEALTH, MARY FREE BED, PINE REST CHRISTIAN MENTAL HEALTH SERVICES.

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 6B
KENT COUNTY HEALTH DEPARTMENT, YMCA, NETWORK 180

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 11
1.ACCESS TO HEALTH CARE: UMH-WEST HOSTS FREE AND LOW-COST COMMUNITY CLASSES FOCUSED ON PROMOTING HEALTHY HABITS AND THE SERVICES OUR SPECIALITY CARE OFFICES PROVIDE. EMPLOYEES SERVE ON COMMUNITY COUNCILS AIMED AT MAKING HEALTH CARE AS A WHOLE MORE ACCESSIBLE TO ALL. THROUGH COMMUNTY EVENT SPONSORSHIPS AND TABLING EVENTS, UMH-WEST PROVIDES FINANCIAL SUPORT FOR SERVICES THAT MAY NOT BE OFFERED WITHIN OUR SYSTEM, SUCH AS DENTAL CARE. UMH-WEST HAS TRANSLATION SERVICES AVAILBALE TO ENSURE WE ARE PROVIDING THE BEST CARE POSSIBLE FOR ALL WHO SEEK OUR SERVICES. 2.DISCRIMINATION AND RACIAL INEQUALITY: UMH-WEST'S DIVERSITY EQUITY AND INCLUSION DEPARTMENT PROVIDES TRAINING AND EDUCAITONAL OPPORUNITES TO EMPLOYEES TO ENUSRE THAT WE ARE TREATING ALL PATIENTS EQUITABLY. THROUGH COMMUNITY MENTORING PROGRAMS AND TASKFORCE GROUPS, WE ARE STRIVING TO CREATE A COMMUNITY WHERE ALL FEEL SAFE, WELCOMED AND FAIRLY TREATED. 3.ECONOMIC SECURITY: UMH-WEST HAS MADE DILIGENT EFFORTS TO MAKE SURE EMPLOYEES ARE RECEIVING FAIR AND COMPARABLE WAGES BY COMPLETING ANNUAL MARKET ANALYSES. LEADERS SERVE ON COMMUNITY BOARDS AND SIT IN ON FOCUS GROUPS TO ADDRESS HOW THE COMMUNITY RECOMMENDS HOW WE ADDRESS THIS NEED. 4.MENTAL HEALTH: UMH-WEST HAS EXPANDED OUR SERVICES TO INCLUDE PSYCHIATRY. WE OFFER FREE AND LOW-COST COMMUNITY STRESS MANAGEMENT CLASSES (GENTLE YOGA AND PAINTING) AND TOBACCO CESSATION CLASSES PROVIDED BY OUR PULMONARY REHABILITATION DEPARTMENT. SUPPORT GROUPS FOR BREASTFEEDING MOTHERS, PARKINSONS DISEASE, THOSE WITH EMPHASEMA, COPD OR WHO HAVE HAD OR CARE FOR SOMEONE WHO HAS HAD A STROKE PROVIDE OUR COMMUNITY MEMBERS A SAFE PLACE TO GO TO KNOW THEY ARE NOT ALONE.

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 13B
A PATIENT WHOSE HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEED 15% OF THE PERSON'S ANNUAL GROSS INCOME AS SET FORTH IN THIS POLICY AND WHO IS UNABLE TO PAY THE REMAINING BILL MAY BE CONSIDERED MEDICALLY INDIGENT AND IS ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE. OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON MAY BE CONSIDERED WHEN DETERMINING ABILITY TO PAY. A DETERMINATION OF A PATIENT'S ABILITY TO PAY THE REMAINDER OF THE BILL WILL BE BASED ON WHETHER THE PATIENT REASONABLY CAN BE EXPECTED TO PAY THE ACCOUNT IN FULL OVER A 25 METROPOLITAN HOSPITAL MONTH PERIOD. IF THE DETERMINATION IS MADE THAT A PATIENT HAS THE ABILITY TO PAY THE REMAINDER OF THE BILL, SUCH DETERMINATION DOES NOT PREVENT A REASSESSMENT OF THE PATIENT'S ABILITY TO PAY AT A LATER DATE.

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 16J
"METROPOLITAN HOSPITAL PART V, LINE 16A, FAP WEBSITE: HTTPS://METROHEALTH.NET/ABOUT-METRO-HEALTH/BILLING-PAYMENT-OPTIONS/FINANCIA METROPOLITAN HOSPITAL PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://METROHEALTH.NET/ABOUT-METRO-HEALTH/BILLING-PAYMENT-OPTIONS/FINANCIA METROPOLITAN HOSPITAL PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://METROHEALTH.NET/ABOUT-METRO-HEALTH/BILLING-PAYMENT-OPTIONS/FINANCIA PART V, SECTION B, LINE 16I: PUBLICATION/NOTICE OF FINANCIAL ASSISTANCE: IT IS THE GOAL OF METRO HEALTH HOPITAL TO COMMUNICATE TO PATIENTS AND THE PUBLIC OF THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY. THIS IS ACHIEVED THROUGH VARIOUS METHODS INCLUDING, BUT NOT LIMITED TO, ""A PATIENT'S GUIDE"", METRO HEALTH'S WEBSITE (WWW.METROHEALTH.NET), PATIENT BILLING STATEMENTS, WORD OF MOUTH AND COMMUNITY PUBLIC LOCATIONS. FINANCIAL ASSISTANCE APPLICATIONS WILL BE TRANSLATED INTO LANGUAGES APPROPRIATE TO THE HOSPITAL'S COMMUNITY."

FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 24
IN ACCORDANCE WITH MEDICARE POLICY WE CHARGE THE FULL AMOUNT BUT FOR PEOPLE WHO DID NOT HAVE INSURANCE WE DISCOUNTED THE CHARGE BY 40%. IF THEY HAD INSURANCE THE AMOUNT WAS DISCOUNTED BY THE CONTRACT PERCENTAGE.

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 20,202,770.

SCHEDULE H, PART I, LINE 7
THE INFORMATION USED TO CALCULATE LINE 7 IS ON THE PAID CLAIMS BASIS. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2.

SCHEDULE H, PART II
"ALTHOUGH MANY SUCH ACTIVITIES ARE OFTEN NOT QUANTIFIABLE, WE CONTINUE TO BUILD ON OUR STRONG RECORD OF COLLABORATION WITH COMMUNITY GROUPS, BUSINESSES ACADEMIC INSTITUTIONS, AND GOVERNMENTAL AND NON- GOVERNMENTAL ORGANIZATIONS WITH THE GOAL OF IMPROVING HEALTH OUTCOMES AND REDUCING HEALTH DISPARITIES. EMPHASIS IS PLACED ON ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH, THE HEALTH CARE DELIVERY SYSTEM AND COMMUNITY ECONOMIC DEVELOPMENT. METRO HEALTH TAKES SERIOUSLY THE OPPORTUNITY AND OBLIGATION WE HAVE TO HELP BUILD OUR COMMUNITY. ALL MEMBERS OF THE ORGANIZATIONS LEADERSHIP TEAM ARE REQUIRED TO VOLUNTEER A MINIMUM OF 12 HOURS TO COMMUNITY-BENEFIT INITIATIVES. GENERAL STAFF MEMBERS ARE ALSO ENCOURAGED TO VOLUNTEER AT COMMUNITY-BENEFIT INITIATIVES. MANY METRO EMPLOYEES PLAY AN ACTIVE ROLE ON THE BOARDS AND/OR COMMITTEES OF SEVERAL HEALTH AND HUMAN SERVICE AGENCIES IN OUR COMMUNITY, SUCH AS YMCA, GRAND RAPIDS CHAMBER OF COMMERCE HEALTH CARE COMMITTEE, ELES PLACE GRAND RAPIDS, GRAND RAPIDS AFRICAN AMERICAN HEALTH INSTITUTE, GOODWILL INDUSTRIES, MEL TROTTER MINISTRIES, COMMUNITY TRANSFORMATION GRANT COMMITTEE, KID'S FOOD BASKET, WEST MICHIGAN HISPANIC CHAMBER OF COMMERCE AND MORE. IN ADDITION, METRO LEADERS AND STAFF MEMBERS PARTICIPATE IN ONE- DAY COMMUNITY ACTIVITIES, SUCH AS PRESENTING HEALTH OR CAREER INFORMATION IN AREA SCHOOLS FROM ELEMENTARY SCHOOLS TO COLLEGES AND UNIVERSITIES. AS AN OSTEOPATHIC TEACHING HOSPITAL, WE HAVE A SIGNIFICANT PRESENCE WITH THE MICHIGAN ASSOCIATION OF OSTEOPATHIC DIRECTORS AND MEDICAL EDUCATORS. THIS ASSOCIATION HELPS TRAIN NEW PHYSICIANS AND DEVELOPS THE CURRICULUM USED FOR MEDICAL RESIDENTS AND STUDENT INTERNS THROUGHOUT OUR STATE. SEVERAL MEMBERS OF OUR STAFF ARE INVOLVED IN THIS GROUP AT THE STATE LEVEL AND SPEND A LARGE NUMBER OF HOURS EVERY YEAR SERVING IN THIS CAPACITY. METRO HEALTH IS ALSO THE EDUCATION SITE FOR OVER ONE HUNDRED MEDICAL FELLOWS, RESIDENTS AND STUDENTS. METRO ALSO PROMOTES HEALTH IN OUR COMMUNITY AND STEWARDSHIP OF NATURAL RESOURCES BY COLLABORATING WITH THE CITY OF WYOMING TO HOST TWO ""DRUG TAKE BACK DAYS"" EACH YEAR. BY WORKING TOGETHER WE ARE ABLE TO BRING THIS U.S. DEPARTMENT OF JUSTICE/DRUG ENFORCEMENT ADMINISTRATION PROGRAM TO OUR COMMUNITY. THE CITY OF WYOMING PROVIDES DISPOSAL AND LAW ENFORCEMENT PERSONNEL, WHILE METRO HEALTH PROVIDES PHARMACISTS TO ANSWER COMMUNITY MEMBER QUESTIONS AND HELP SORT DRUGS AND A CONVENIENT LOCATION FOR COMMUNITY MEMBERS TO DROP OFF UNUSED AND EXPIRED DRUGS. BY PROPERLY DISPOSING OF THE MATERIALS, WE ARE ABLE TO KEEP THESE DRUGS OUT OF THE COMMUNITYS WATER SYSTEM AND AWAY FROM CHILDREN WHO MIGHT FIND THEM IN A HOME. METRO IS CURRENTLY WORKING WITH THE CITY OF WYOMING FIRE DEPARTMENT WITH EMT TRAINING FOR THEIR STAFF."

SCHEDULE H, PART III, LINE 2
BAD DEBT IS ANY PORTION OF PATIENT ACCOUNT THAT IS DEEMED UNCOLLECTIBLE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN MADE, INCLUDING FINANCIAL ASSISTANCE. BAD DEBT DOES NOT INCLUDE CONTRACTUAL DISCOUNTS, COMMUNITY BENEFIT OR CHARITY CARE.

SCHEDULE H, PART III, LINE 8
HEALTHCARE PAYMENT REFORMS IMPLEMENTED THROUGH THE AFFORDABLE CARE ACT HAVE SHIFTED SOME OF THE EXPENSE BURDEN OF PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES FROM THE GOVERNMENT ON TO HEALTHCARE PROVIDERS THROUGH REDUCED PAYMENTS. THESE PAYMENT REDUCTIONS HAVE INCREASED THE LOSSES INCURRED BY HEALTHCARE PROVIDERS FOR TREATING MEDICARE BENEFICIARIES. BY REDUCING THE GOVERNMENTS FINANCIAL BURDEN FOR PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIS, METRO HEALTH BELIEVES THAT MEDICARE SHORTFALLS SHOULD BE TREATED AS A COMMUNITY BENEFIT.

SCHEDULE H, PART III, LINE 9B
METRO TRIES TO INFORM THE PATIENT IF THEY QUALIFY FOR CHARITY CARE AS SOON AS POSSIBLE BECAUSE THE PATIENT BENEFITS FROM KNOWING ABOUT THEIR FINANCIAL OBLIGATIONS AND THE HOSPITAL CAN AVOID A COSTLY COLLECTIONS PROCESS IF THE PATIENT HAS THE INABILITY TO PAY. EVERY PATIENT BILL HAS THE FEDERAL POVERTY GUIDELINES ON THE BACK AND ITS ON METRO'S WEBSITE. BOTH EXPLAIN THE PROCEDURES AND LIMITS FOR CHARITY CARE AND DISCOUNTING PROGRAMS. PATIENT FINANCIAL REPRESENTATIVES ARE AVAILABLE TO DISCUSS FILLING OUT THE PAPERWORK FOR GOVERNMENT MEDICAL ASSISTANCE PROGRAMS.

SCHEDULE H, PART VI, LINE 2
FOR MORE THAN 20 YEARS, HEALTHY KENT HAS ENGAGED A BROAD ARRAY OF COMMUNITY PARTNER ORGANIZATIONS TO ADDRESS DATA-DRIVEN PRIORITY AREAS, RANGING FROM INFANT MORTALITY TO VIOLENCE. DURING ITS TENURE, HEALTHY KENT HAS YIELDED MANY NOTEWORTHY COMMUNITY-BASED SUCCESSES, AND CONTINUES TO ACHIEVE RESULTS THROUGH ITS SUCCESSFUL COMMUNITY COLLABORATIONS ON TOPICS RANGING FROM MATERNAL AND CHILD HEALTH TO SUICIDE PREVENTION. IN 2013, HEALTHY KENT ALSO TOOK ON THE ROLE OF CONVENER FOR THE FISCAL YEAR END 2015 COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA) PROCESS. THIS IS THE FOURTH ITERATION OF KENT COUNTYS COMMUNITY HEALTH IMPROVEMENT EFFORTS. THE FIRST COUNTYWIDE CHNA WAS PUBLISHED IN FISCAL YEAR END 2012, FOLLOWED THE NEXT YEAR BY A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP), WHICH OUTLINED COMMUNITY PRIORITIES AS WELL AS GOALS, OBJECTIVES, AND STRATEGIES AIMED AT IMPACTING THOSE KEY PRIORITIES. MANY LESSONS WERE LEARNED FROM THE FIRST ITERATION OF THE CHNA/CHIP PROCESS WITHIN OUR COMMUNITY. AS A RESULT, SIGNIFICANT IMPROVEMENTS HAVE BEEN MADE TO THE HEALTH IMPROVEMENT PROCESS IN KENT COUNTY. SOME OF THESE IMPROVEMENTS INCLUDE A STRONGER FOCUS ON COMMUNITY INPUT, ENHANCED DATA COLLECTION AND REPORTING, AS WELL AS AN EXPANDED BREADTH OF INVOLVEMENT IN VARIOUS PHASES OF THE PROCESS BY KEY COMMUNITY AGENCIES AND ORGANIZATIONS. ADDITIONALLY, THE RESPONSIBILITY FOR COORDINATING THE CHNA/CHIP PROCESS IN OUR COMMUNITY HAS SHIFTED FROM KENT COUNTY WORKING TOGETHER FOR A HEALTHIER TOMORROW TO HEALTHY KENT.THE MISSION OF THE KENT COUNTY CHNA PROCESS WAS TO ENSURE THAT THE PEOPLE OF KENT COUNTY ARE EMPOWERED TO ACHIEVE LIFE-LONG PHYSICAL, MENTAL AND SOCIAL WELLBEING THROUGH 1) EQUAL ACCESS TO HIGH QUALITY, AFFORDABLE HEALTHCARE; 2) A COORDINATED SYSTEM OF CARE THAT IS LOCAL, PREVENTIVE, HOLISTIC AND PATIENT CENTERED; AND 3) AN ENVIRONMENT THAT SUPPORTS HEALTHY LIVING FOR ALL. FOUR PRIORITY HEALTH ISSUES THAT WERE DISCOVERED WERE 1) ACCESS TO HEALTH CARE, 2) DISCRIMINATION AND RACIAL INEQUALITY, 3) ECONOMIC SECURITY, AND 4) MENTAL HEALTH. THE 2021 CHNA IS A COMPREHENSIVE COMPILATION OF DATA THAT EXPLAINS THE CURRENT STATE OF HEALTH, WELLBEING, AND FACTORS AFFECTING HEALTH OF THOSE WHO LIVE, LEARN, AND WORK IN KENT COUNTY, MICHIGAN. THE 2021 CHNA PROCESS WAS MODELED AFTER THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) FRAMEWORK. MAPP IS A NATIONALLY-RECOGNIZED, BEST- PRACTICE FRAMEWORK FOR COMMUNITY HEALTH NEEDS ASSESMENT AND IMPROVEMENT PLANNING PROCESSES THAT WAS DEVELOPED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO). THERE ARE SIX KEY PHASES OF THE MAPP PROCESS, INCLUDING: 1) ORGANIZING FOR SUCCESS AND PARTNERSHIP DEVELOPMENT 2) VISIONING 3) THE FOUR MAPP ASSESSMENTS 4) IDENTIFYING STRATEGIC ISSUES 5) FORMULATE GOALS AND STRATEGIES 6) TAKE ACTION (ACTION CYCLE) THE 2021 CHNA REPORT INCLUDES A SUMMARY AND DESCRIPTION OF HOW KENT COUNTY HAS IMPLEMENTED THE FIRST FOUR MAPP PHASES. PHASES FIVE AND SIX WILL BE DISCUSSED AND REPORTED AS THE 2021 COMMUNITY HEALTH IMPROVEMENT PLANNING PROCESS GETS UNDERWAY AND YIELDS A FINAL REPORT.

SCHEDULE H, PART VI, LINE 3
METRO HEALTH RECOGNIZES THAT INDIVIDUALS AND FAMILIES WHO ARE FACING FINANCIAL INSTABILITY OR HARDSHIP OFTEN NEGLECT HEALTHCARE NEEDS UNTIL THEY BECOME EMERGENT CONDITIONS. THIS PRACTICE PLACES STRESS ON PATIENTS, FAMILIES AND THE HEALTHCARE SYSTEM. METRO HEALTH SEEKS TO INFORM PATIENTS OF THEIR ELIGIBILITY FOR CHARITY CARE AS SOON AS POSSIBLE IN THE HEALTHCARE PROCESS SO THAT PATIENTS KNOW THERE IS HELP FOR THEM AND SO THAT THE ORGANIZATION AVOIDS COSTLY COLLECTIONS PROCESSES. METRO HEALTH POSTS INFORMATION ON FINANCIAL ASSISTANCE ON THE ORGANIZATION WEB SITE. THERE ARE ALSO BROCHURES IN WAITING ROOMS AND AT REGISTRATION DESKS WITH INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAMS. PATIENTS WHO REPORT HAVING NO COVERAGE AT REGISTRATION ARE PROVIDED INFORMATION ABOUT OUR COMMUNITY BENEFIT DISCOUNT. THIS PROGRAM PROVIDES A 40% DISCOUNT TO ALL PATIENTS WITHOUT COVERAGE AS WELL AS AN INTEREST FREE PAYMENT PLAN (CAREPAYMENT) FOR THOSE PATIENTS WITH A BALANCE THEY ARE UNABLE TO PAY IN THE NEAR FUTURE. IN ADDITION, EVERY PATIENT BILL INCLUDES THE FEDERAL POVERTY GUIDELINES ON THE BACK AND EXPLAINS THE PROCEDURES AND LIMITS FOR CHARITY CARE AND DISCOUNTING PROGRAMS. PATIENT FINANCIAL REPRESENTATIVES ARE AVAILABLE TO DISCUSS FILLING OUT PAPERWORK FOR GOVERNMENT MEDICAL ASSISTANCE PROGRAMS. THERE IS ALSO A PHONE NUMBER LISTED ON THE APPLICATION FOR FINANCIAL ASSISTANCE WHICH PATIENTS CAN CALL IF THEY HAVE QUESTIONS.

SCHEDULE H, PART VI, LINE 4
THE FISCAL YEAR END 2022 COMMUNITY HEALTH SURVEY ASKED RESPONDENTS TO PROVIDE DATA ON A NUMBER OF DEMOGRAPHIC TOPICS, INCLUDING GENDER, RACE, AGE, RELATIONSHIP STATUS, HOME OWNERSHIP, EMPLOYMENT STATUS, EDUCATIONAL ATTAINMENT, HOUSEHOLD INCOME, GEOGRAPHIC LOCATION OF RESIDENCE, AND BMI. THE MAJORITY OF SURVEY RESPONDENTS WERE FEMALE (79%), WHITE (83.5%), AND REPORTED A HOUSEHOLD INCOME BETWEEN 50,000-74,999 PER YEAR (23.7%). MOST SURVEY RESPONDENTS FELL WITHIN THE AGE CATEGORIES OF 25 TO 34 YEARS (19.7%), 35 TO 44 YEARS (21.5%), AND 45 TO 54 YEARS (18%). OVER 89.6% REPORTED THAT THEY HAD AN EDUCATIONAL ATTAINMENT LEVEL OF AT LEAST SOME COLLEGE. ALMOST TWO IN THREE (62.5%) ADULTS ARE OVERWEIGHT OR OBESE. THE MAJORITY OF THE PARTICIPANTS OF THE SURVEY WERE FROM GRAND RAPIDS, WYOMING, AND KENTWOOD, WITH 24 OTHER CITIES, TOWNSHIPS OR VILLAGES BEING REPRESENTED IN THE RESULTS. GRAND RAPIDS REPRESENTS THE VAST MAJORITY, WITH OVER 60% OF PARTICIPANTS RESIDING IN THE CITY. KENT COUNTY, WHERE THE MAJORITY OF METRO HEALTH PATIENTS RESIDE, IS THE FOURTH LARGEST COUNTY IN MICHIGAN. AS OF 2019, THERE WAS AN ESTIMATED POPULATION OF 656,955 IN KENT COUNTY. KENT COUNTY INCLUDES A DIVERSE MIX OF DEMOGRAPHICS. ACCORDING TO THE UNITED STATES CENSUS BUREAU WEB SITE (2019 CENSUS), 89.4% OF THE POPULATION IS WHITE (NOT HISPANIC). THE HISPANIC POPULATION IS 5.1% OF RESIDENTS; THE AFRICAN AMERICAN POPULATION IS 13.8% OF THE COMMUNITY, AND ASIAN AMERICANS COMPRISE 3.1% OF THE POPULATION.

SCHEDULE H, PART VI, LINE 7
MICHIGAN

SCHEDULE H, PART VI
PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR 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 BAD DEBTS, IF NECESSARY. 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 BAD DEBTS 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) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: HEALTHCARE PAYMENT REFORMS IMPLEMENTED THROUGH THE AFFORDABLE CARE ACT HAVE SHIFTED SOME OF THE EXPENSE BURDEN OF PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES FROM THE GOVERNMENT ON TO HEALTHCARE PROVIDERS THROUGH REDUCED PAYMENTS. THESE PAYMENT REDUCTIONS HAVE INCREASED THE LOSSES INCURRED BY HEALTHCARE PROVIDERS FOR TREATING MEDICARE BENEFICIARIES. BY REDUCING THE GOVERNMENTS FINANCIAL BURDEN FOR PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIS, METRO HEALTH BELIEVES THAT MEDICARE SHORTFALLS PROVIDE A VALUABLE COMMUNITY BENEFIT.

SCHEDULE H, PART VI, LINE 5
IN FISCAL YEAR 2022, METRO HEALTH HOSPITAL CONTINUED TO PROVIDE COMMUNITY BENEFIT BY PROVIDING HIGH QUALITY, COORDINATED PATIENT CARE, EDUCATION, RESEARCH AND ADVOCACY PROGRAMS. WE PROVIDED THESE SERVICES IN KENT COUNTY, MICHIGAN AND THE SURROUNDING WEST MICHIGAN AREAS. METROS GOVERNANCE STRUCTURE, OPEN MEDICAL STAFF, AND OUTREACH PROGRAMMING CONTRIBUTE TO HOW WE PROMOTE COMMUNITY HEALTH. BOARD SERVICE IS A COMMITMENT TO HELP FURTHER THE HOSPITALS MISSION OF RELENTLESSLY ADVANCING HEALTH TO SERVE WEST MICHIGAN. MEMBERS REPRESENT A WIDE SPECTRUM OF INDUSTRIES, INCLUDING HEALTHCARE, BANKING, REAL ESTATE, MARKETING, OFFICE FURNITURE, NON-PROFIT LEADERSHIP AND MORE. WHILE THE MAJORITY OF BOARD MEMBERS ARE CAUCASIAN, MEMBERS ALSO REPRESENT THE AFRICAN AMERICAN AND LATINO COMMUNITIES. METRO HEALTH MAINTAINS AN OPEN MEDICAL STAFF, MEANING COMMUNITY PRACTITIONERS CAN HOLD PRIVILEGES AT THE HOSPITAL. THERE ARE MORE THAN 500 MEMBERS OF THE MEDICAL STAFF, REPRESENTING EMPLOYED AND INDEPENDENT PHYSICIANS AND A MIX OF PRIMARY CARE AND SPECIALTY PHYSICIANS. METRO HEALTH HOSPITAL OFFERS A VARIETY OF PROGRAMS TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR LIVE HEALTHY COMMUNITY OUTREACH PROGRAM PROVIDES FREE AND LOW-COST HEALTH EDUCATION PROMOTION EVENTS, CLASSES AND MORE TO OUR COMMUNITY. THE MAJORITY OF THESE PROGRAMS IS DESIGNED TO ADDRESS RECOGNIZED HEALTH NEEDS IN THE COMMUNITY. THESE CLASSES AND EVENTS GROW IN POPULARITY EVERY YEAR AND INCLUDE TOPICS SUCH AS LIVING WITH DIABETES, CPR CLASSES COOKING WITH THE CARDIOLOGIST AND MORE. LOW-COST EXERCISE CLASSES OFFER ACTIVITY TO BEGINNERS, AS WELL AS TO VERY FIT PARTICIPANTS. OTHER FREE OFFERINGS ARE TOBACCO CESSATION, PRE-DIABETES, NUTRITION, JOINT PAIN, INJURY AND FALL PREVENTION, CHILD SAFETY SEAT, HEALTHY COOKING CLASSES, STRESS MANAGEMENT CLASSES AND MANY MORE. WHILE ALL OF THE LIVE HEALTHY CLASSES ARE FREE OR LOW COST, IF COST IS A DETERRENT FOR PEOPLE BEING ABLE TO ATTEND, THE COMMUNITY OUTREACH DEPARTMENT WAIVES THE FEE. FREE HEALTH SCREENS ARE ALSO AN IMPORTANT COMPONENT OF THE LIVE HEALTHY PROGRAM. AS EXAMPLES, FREE BLOOD PRESSURE SCREENS ARE HELD MONTHLY IN THE HOSPITAL AND AT THREE OFFSITE PHYSICIAN OFFICES. HOLDING SCREENS AT THESE REMOTE LOCATIONS MAKES IT EASIER FOR MORE PEOPLE IN OUR SERVICE AREA TO TAKE ADVANTAGE OF THE FREE SERVICE. FOR EXAMPLE, METRO ALSO OFFERED FREE SCREENING EVENTS FOR PERIPHERAL ARTERY DISEASE (PAD) AND SUDDEN CARDIAC DEATH IN HIGH SCHOOL ATHLETES. PAD CAN RESULT AS A SIDE EFFECT OF DIABETES OR OTHER ILLNESSES; ALL PEOPLE AT RISK OF HEART DISEASE ARE AT RISK OF PAD. LEFT UNTREATED PAD CAN RESULT IN CRITICAL LIMB ISCHEMIA AND/OR AMPUTATION. BY TREATING PAD BEFORE IT ESCALATES, PHYSICIANS ARE HELPING PATIENTS AVOID COSTLY AND LIFE-CHANGING MAJOR AMPUTATIONS. OUR COMMUNITY WAS DIRECTLY AFFECTED BY THE DEATH OF A YOUNG ATHLETE ON THE BASKETBALL COURT. PARENTS AND SCHOOL ADMINISTRATORS ALIKE SOUGHT RESOURCES FOR IDENTIFYING RISKS OF SUDDEN CARDIAC DEATH. AS A RESULT, METROS SPORTS MEDICINE AND CARDIOLOGY PHYSICIANS PARTNER TO OFFER SCREENINGS TO HIGH SCHOOL STUDENTS. THE HOSPITAL ALSO HOSTS A NUMBER OF FREE SUPPORT GROUPS AND MEETINGS FOR COMMUNITY ORGANIZATIONS. SOME SUPPORT GROUPS ARE RUN BY METRO HEALTH PROFESSIONALS AND OTHERS ARE COMMUNITY-BASED GROUPS TO WHOM METRO OFFERS FREE CONFERENCE ROOM SPACE. SOME OF THE SUPPORT GROUPS MEETING AT METRO INCLUDE THOSE FOR ALZHEIMERS, BREASTFEEDING AND CANCER SERVICES. AS A TEACHING HOSPITAL, METRO ALSO OFFERS EDUCATIONAL OPPORTUNITIES TO MEDICAL RESIDENTS, NURSES, RADIOLOGY TECHS, PHLEBOTOMISTS AND EVEN HIGH SCHOOL STUDENTS WHO ARE INTERESTED IN MEDICAL PROFESSIONS. THE METRO HEALTH FARM MARKET IS ANOTHER WAY METRO SEEKS TO IMPROVE THE HEALTH OF OUR COMMUNITY. FOR TEN CONSECUTIVE YEARS NOW, OUR MARKET HAS GROWN IN POPULARITY AMONG COMMUNITY MEMBERS, PATIENTS AND EMPLOYEES. ON FARM MARKET DAYS, IT IS COMMON TO SEE OUTPATIENTS AND VISITORS MINGLE WITH COMMUNITY MEMBERS AS THEY SHOP FOR FRESH, LOCALLY GROWN AND PRODUCED FOODS. METRO CONTINUED ITS EFFORTS TO MAKE HEALTHY FOODS AVAILABLE TO OUR ENTIRE COMMUNITY BY CONTINUING TO OFFER FARM MARKET SHOPPERS ON FOOD ASSISTANCE WAYS TO USE THE ASSISTANCE AT THE MARKET. METRO ACCEPTS PROJECT FRESH COUPONS AND SNAP BENEFITS. WE ASLO ACCEPT DOUBLE UP FOOD BUCKS, SENIOR PROJECT FRESH, AND WIC. AS AN ADDED BENEFIT, METRO OFFERED FREE HEALTH SCREENS AND COOKING CLASSES AT THE MARKET SO THAT AREA RESIDENTS COULD LEARN ABOUT THEIR HEALTH AND LEARN WAYS TO COOK THE DELICIOUS, HEALTHY FOODS AVAILABLE AT THE MARKET REGARDLESS OF THEIR INCOME LEVEL. METRO HEALTH IS ALSO COMMITTED TO PROTECTING THE ENVIRONMENT THROUGH A NUMBER OF GREEN INITIATIVES. OUR HOSPITAL BUILDING IS ONE OF THE FIRST HOSPITALS IN THE NATION DESIGNED AND BUILT TO BE LEED-CERTIFIED (LEADERSHIP IN ENERGY AND ENVIRONMENTAL DESIGN), AND IT IS LOCATED IN THE METRO HEALTH VILLAGE WHICH REQUIRES ALL BUILDINGS ON THE PROPERTY TO BE DESIGNED AND BUILT FOR LEED CERTIFICATION. EMPLOYEE AND COMMUNITY PARTICIPATION IN RECYCLING AND COMPOSTING PROGRAMS AT THE HOSPITAL CONTINUES TO GROW EACH YEAR. THE HOSPITAL KITCHEN RECYCLING AND COMPOSTING IS VERY SUCCESSFUL AND WOULD NOT BE POSSIBLE WITHOUT THE BUY-IN OF THE EMPLOYEE TEAM. WE HAVE CREATED A SUSTAINABILTY COMMITTEE THAT INCLUDES EMPLOYEE LEADERSHIP THROUGHOUT THE ORGANIZATION THAT PLAY AN IMPORTANT ROLE IN OUR SUSTAINABILITY INITIATIVES. BEYOND THE WALLS OF THE HOSPITAL, METROS LEADERSHIP TEAM IS WORKING TO MAKE AN IMPACT ON THE COMMUNITY. EVERY MEMBER OF THE LEADERSHIP TEAM IS EXPECTED TO VOLUNTEER A MINIMUM OF 12 HOURS DURING THE YEAR TO COMMUNITY- BENEFIT INITIATIVES. MANY LEADERS GO WELL ABOVE THE 12-HOUR THRESHOLD AND VOLUNTEER MUCH MORE IN THE COMMUNITY. THEY ALSO ALLOW TEAM BUILDING THROUGH SERVICE TO OTHER ORGANIZATIONS. TEAMS OF METRO EMPLOYEES HAVE WORKED TOGETHER TO ASSIST AREA FOOD PROGRAMS, PROVIDE FLU SHOTS FOR AREA RESIDENTS IN NEED AND MORE.