4A (Expenses $ 9900408 including grants of $ 0) (Revenue $ 10272246)
Ascension Brighton Center for Recovery is a 70-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2022, Ascension Brighton Center for Recovery treated 1,321 adults and children for a total of 13,693 patient days of service. The hospital also provided outpatient services for 14,137. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. As part of the Ascension Catholic health ministry, the filing organization served in support of Ascension's commitment to both care for patients and communities and support caregivers and other associates through the challenges of the COVID-19 global pandemic in FY22.

Schedule H, Part V, Section B, Line 3E
TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Ascension Brighton Center for Recovery. Recognizing its vital importance in understanding the health needs and assets of the community, Ascension Southeast Michigan (SEM) hospitals (consisting of Ascension Brighton Center for Recovery, Ascension Macomb-Oakland Hospital - Warren Campus and Madison Heights Campus, Ascension St. John Hospital, Ascension Providence Hospital - Southfield Campus and Novi Campus, and Ascension River District Hospital) completed the tax year 2021 CHNA. With facilitation of the Ascension SEM Community Health Department and Ascension Michigan Community Benefit Center of Expertise, a concerted effort was made to ensure that the individuals and organizations represented the needs and perspectives of: 1) public health practice and research; 2) individuals who are medically underserved, are low-income, or considered among the minority populations served by the hospital; and 3) the broader community at large and those who represent the broad interests and needs of the community served. Multiple methods were used to gather community input, including key stakeholder focus groups and community surveys for adults and youth. These methods provided additional perspectives on how to select and address top health issues facing southeast Michigan. A summary of the process and results is outlined below: -Surveys - A survey was conducted by Ascension SEM Community Health Department to gather the perceptions, thoughts, opinions, and concerns of the community regarding healthy behaviors, mental health, physical health, substance use, Social Determinants of Health (SDoH), access to care, COVID-19 for southeast Michigan (Wayne, including city of Detroit, Oakland, Macomb, Livingston, and St. Clair counties). A total of 872 individuals participated in the survey, held between September 2021 and November 2021. The data gathered and analyzed from youth and the community provides valuable insight into the issues of importance to the community. The adult (general) community survey contained 36 questions and was distributed to adults age 18+ by email, paper surveys located in medical centers, and shared electronically through our partner organizations. 751 responses were received. The youth community survey contained 24 questions and was distributed to students in the Ascension MI school-based health centers through electronic and paper surveys. 121 responses were received. The key stakeholder survey contained 8 questions and was distributed electronically through our partner organization and during the key stakeholders focus group sessions. 23 responses were received. -Key Stakeholders Focus Groups - Key Stakeholder focus groups were conducted by Ascension SEM Community Health to gather feedback from key stakeholders on the health needs and assets of southeast Michigan (Wayne [City of Detroit], Oakland, Macomb, Livingston, and St. Clair counties). The focus groups were held between August 2021 and October 2021. Participants included stakeholders within the southeast Michigan area that works with local health departments, federally qualified health clinics, nonprofit and community organizations, mental health organizations, youth serving organizations, senior serving organizations, education leaders and local school districts, faith-based organizations, local government officials and law enforcement. In 2020, Ascension SEM Community Health established Community Advisory Committees (CAC) composed of a diverse group of key stakeholders including educators, business and faith leaders, nonprofit and public agencies serving infants, children and seniors, to establish, maintain and/or enhance its relationships with the community. The following list represents the organizations that participated in the 2021 CHNA process: *CARE of Southeastern Michigan *Catholic Charities of Southeast Michigan *Deighton Family Medicine *Family Victory Fellowship Church *Hazel Park School District *HAVEN of Oakland County *Livingston County Catholic Charities *Livingston County Health Department *National Alliance on Mental Illness *New Hope Center of Grief Support *Oak Park School District *Oakland County Health Division *The Arc Livingston County *The Family Center of Grosse Pointe/Harper Woods *The Helm Life Center *The Youth Connection *Vista Maria

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Ascension Brighton Center for Recovery. The community health needs assessment was conducted with the following facilities: 1. Ascension St. John Hospital 2. Ascension Providence Hospital-Southfield 3. Ascension Providence Hospital-Novi 4. Ascension Macomb-Oakland Hospital-Warren 5. Ascension Macomb-Oakland Hospital-Madison Heights 6. Ascension River District Hospital

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Ascension Brighton Center for Recovery. Ascension Brighton Center for Recovery (as part of Ascension Southeast Michigan [SEM] Hospitals consisting of Ascension Brighton Center for Recovery, Ascension Macomb-Oakland Hospital - Warren Campus and Madison Heights Campus, Ascension St. John Hospital, Ascension Providence Hospital - Southfield Campus and Novi Campus, and Ascension River District Hospital) tax year 2018 implementation strategy was approved by the Ascension Southeast Michigan Board of Trustees in September 2019, and applied to the following three-year cycle: July 1, 2019 to June 30, 2022. Highlights and impact made within the three (3) prioritized needs areas for the 2019 implementation strategy, which was coordinated and carried out through the Ascension SEM Community Health Department, are outlined below. It is important to note: the Public Health Emergency due to the pandemic impacted Ascension SEM hospital's ability to complete many strategies, though some areas were able to continue providing services in a virtual setting after a short period of transition. 1. Obesity reduction and Diabetes Prevention - Implemented the Center for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) and over 150 participants were served through the program. One of the DPP goals was for participants to lose at least 5% of their weight; about 70% of participants have lost at least 5% of their weight and nearly 1,000 total lbs lost across all DPP cohorts. Prior to COVID-19, the program was offered in-person; however, it swiftly transitioned to virtual. During the COVID-19 pandemic, Ascension Southeast Michigan Community Health Department applied and was granted CDC approval for Long Distance Learning status (virtual DPP classes). a. Increase wellness center hours to accommodate more participants - Status: Not met due to the public health emergency; Process Measures: Additional 2 hours added to Wellness centers, Goal: 98 hours, Results: 72/98 (75%), Transitioned to virtual exercise classes b. Maintain and increase partners to promote Wellness center exercise classes - Status: Not met due to the public health emergency; Process Measures: Maintained 6 partnerships that promoted the exercise classes in their communications to the public, 1 new partnership with a local health department, Goal: 20, Results: 6/18 (33.3%) c. Enhance Fitness exercise class, improve participants physical activity - Status: Completed; Outcome Measures: Goal: 80%, Results: 86.1% of participants self-reported a 50% improvement in their physical activity via survey d. Track referrals into DPP from AMG and hospital diabetes education, Providence Medical Ctr and physician offices - Status: Completed; Outcome Measures: Goal: 120 referrals, Result: 133. e. Schedule/implement 8 new DPP cohorts - Status: Completed; Outcome Measures: Goal: 24 cohorts, Result: 59. f. 50% of participants enrolled in a DPP cohort will decrease weight by at least 5% - Status: Completed; Outcome Measures: Goal: 50%, Result: 68% g. Retain 80% of participants after session #16 of the 16 week of DPP - Status: Not met due to the public health emergency; Outcome Measures: Goal: 80%, Result: 71% 2. Mental Health/Substance Abuse Prevention - Increased access to mental health programs/services for children and youth by adding programs/services in over 10 School Based Health Centers. a. Expansion of mental health services in 3 school-based health centers (SBHCs) - Status: Completed; Process Measures: 6 SBHCs in FY 2020, Goal:3, Result: 6 b. Expansion of telehealth mental health services to 4 school-based health centers (SBHCs) - Status: Completed; Process Measures: 8 SBHCs in FY 2021 Goal:4, Result:8 c. Convert referrals to Eastwood Behavioral Health clinics to scheduled appointments - Status: Not met due to the public health emergency; Process Measures: 40% of the auto-referrals received into the Eastwood clinics will be converted to scheduled appointments, FY 2020 & 2021 - 51% of referrals converted to schedule appointments, Goal: 40%, Result: 25.5% d. Implement the Rapid Assessment for Adolescent Preventive Services (RAAPS) as a suicide risk screening and provide mental health education, counseling and referral for youth in partner schools - Process Measures: FY 2020, 2021, FY 2022 YTD; 5,417 students screened for depression and suicide with the RAAPS screening Goal: 7,354 ; 1.004 students counseled for depression and suicide Goal: 1,550; 51 students referred to an external provider for additional support/treatment of depression and suicide Goal: 68, e. Implement Red Flags mental health education, counseling and referral for youth in partner schools (Implement the Red Flags program into 4 new SBHCs behavioral health sites.) - Process Measures: FY 2020, 2021, FY 2022 YTD, implemented program in 7 SBHCs behavioral health sites, 82 sessions completed Goal: 150, 516 students trained in the Red Flags program Goal: 1,500 Result: 516; Outcome Measures: Increase knowledge of signs, symptoms and information of mental health by 80%, In FY 2021, 92% of students increased knowledge Goal: 80%, Result: 31% 3. Improving Maternal/infant Health - Through the Maternal Infant Health Program (MIHP), 65% of women enrolled, and seen by Ascension physicians, achieved adequate prenatal care (7 to 13 prenatal care visits) a. Increase the utilization of the Maternal Infant Health Program (MIHP), which provides evidenced based services to improve awareness, knowledge and behaviors for preventing maternal mortality and infant mortality for communities, including vulnerable and at-risk communities - Status: Completed; Process Measures: Increase referrals to the MIHP program from Ascension hospitals (St John, Providence Southfield, and Macomb) by 15%, FY 2020, 2021, FY 2022 YTD; Referrals increased by 40%, Goal: 15%, Result: 40% b. Achieve Adequate Prenatal visits (65% of women seen by Ascension physicians and enrolled in MIHP will achieve adequate prenatal care (7 to 13 prenatal care visits) - Status: Completed; Process Measures: # of events, materials, participants, etc., Outcome Measures: FY 2020, 2021, FY 2022 YTD, Goal 65%, Result 67% c. Improvement of knowledge of breast feeding and safe sleep practices pre/post test - Process Measures: # of events, materials, participants, etc., Outcome Measures: % change in knowledge, behavior, health metrics, Goal 85%, Result: 100% The FY2023-FY2025 Ascension Brighton Center for Recovery Implementation Strategy for the tax year 2021 CHNA will address the following prioritized needs: 1. Mental Health (includes stress, anxiety and depression): Strategy 1.1: Increase involvement in and support of community health activities to address mental health-focused needs 2. Healthy Behaviors and Chronic Disease Issues: Strategy 2.1: Increase involvement in and support of community health activities to address chronic disease-focused needs 3. Access to Care (with emphasis on maternal and infant health): Strategy 3.1: Increase involvement in and support of community health activities to address access to care-focused needs Strategy 3.2: Provide outreach screenings for underserved populations to improve access to healthcare services in Livingston County It's important to note that all significant needs will be addressed as prioritized needs within the 3-year implementation strategy. After evaluating Ascension SEM hospital's resources, program strengths, partnerships, and capacity to make an impact, the four significant needs were modified (in title) and became the three prioritized needs, thus addressing all significant needs.

Schedule H, Part I, Line 3c FACTORS OTHER THAN FPG
"IN ADDITION TO FPG, THE ORGANIZATION USES MEDICAL INDIGENCY, ASSET TEST, INSURANCE STATUS AND RESIDENCY AS OTHER FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A Patient may not be eligible for the financial assistance if such Patient is deemed to have sufficient assets to pay pursuant to an ""Asset Test."" The Asset Test involves a substantive assessment of a Patient's ability to pay based on the categories of assets measured in the FAP Application. A Patient with such assets that exceed 250% of such Patient's FPL amount may not be eligible for financial assistance. AN ASSET TEST APPLIES IF A PATIENT HAS ELIGIBLE LIQUID ASSETS THAT EXCEED 250% OF THE PATIENT'S FPG LEVEL FOR CONSIDERATION OF FINANCIAL ASSISTANCE ELIGIBILITY. LIQUID ASSETS INCLUDE ASSETS THAT CAN BE CONVERTED TO CASH WITHIN 1 YEAR. THESE INCLUDE ITEMS SUCH AS CHECKING ACCOUNTS, SAVINGS ACCOUNTS, TRUST FUNDS AND LUXURY ITEMS SUCH AS RECREATIONAL VEHICLES, BOATS, A SECOND HOME, ETC."

Schedule H, Part I, Line 5a BUDGET AMOUNTS FOR FREE OR DISCOUNTED CARE
THE ORGANIZATION ADMINISTERS ITS FINANCIAL ASSISTANCE POLICY IN ACCORDANCE WITH THE TERMS OF THE POLICY.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (""CHA"") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED."

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2022 was $264,008 at charges, $229,687 (at cost).

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BASED ON THE ORGANIZATION'S ADMINISTRATION OF ITS FINANCIAL ASSISTANCE PROGRAM, NO ESTIMATE FOR BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS IS DEEMED APPLICABLE TO HOSPITAL OPERATIONS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION IS PART OFASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSESBAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 17-20, OF THE AUDITED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE GROSS CHARGES TO CALCULATE MEDICARE COSTS, WHICH ARE THEN COMPARED TO MEDICARE PAYMENTS RECEIVED, TO DETERMINE A MEDICARE GAIN OR LOSS. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT A MEDICARE SHORTFALL (LOSS) IS NOT TREATED AS COMMUNITY BENEFIT, EVEN THOUGH THE HOSPITAL HAS INCURRED LOSSES IN PROVIDING CARE TO MEDICARE PATIENTS. THEREFORE, NONE OF THE AMOUNT ON LINE 7 IS TREATED AS COMMUNITY BENEFIT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
ASCENSION BRIGHTON CENTER FOR RECOVERY FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED IF ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED FOR THE AMOUNTS FOR WHICH THE PATIENT QUALIFIES.

Schedule H, Part V, Section B, Line 16a FAP website
- Ascension Brighton Center for Recovery: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- Ascension Brighton Center for Recovery: Line 16b URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Ascension Brighton Center for Recovery: Line 16c URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part VI, Line 5 Promotion of community health
Ascension Brighton Center for Recovery's GOVERNING BODY IS COMPRISED OF PERSONS REPRESENTING ASCENSION MICHIGAN'S SERVICE AREAS AND INCLUDES MEMBERS WITH DIVERSE ASPECTS AND INTERESTS OF THE SERVICE AREA. MEMBERS OF THE GOVERNING BODY RESIDE IN THE ORGANIZATION'S SERVICE AREA AND ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. ASCENSION BRIGHTON CENTER FOR RECOVERY EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. ASCENSION BRIGHTON CENTER FOR RECOVERY APPLIES SURPLUS FUNDS TO FUND IMPROVEMENTS IN PATIENT CARE.

Schedule H, Part VI, Line 2 Needs assessment
Ascension Brighton Center for Recovery uses internal and external data and reports from third parties, including government sources, to assess the healthcare needs of the communities we serve. These reports provide key information about health, socioeconomic, demographic factors that identify areas of need and inform our strategies that help to meet those needs of our community. These reports include, but are not limited to: -Sg2 Healthcare Intelligence -State Datasets -Internal Data Sets Ascension Brighton Center for Recovery utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, Ascension Brighton Center for Recovery Hospital considers the health care needs of the overall community when evaluating internal financial and operational decisions.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Ascension Brighton Center for Recovery IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL, IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, Ascension Brighton Center for Recovery'S FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES; Ascension Brighton Center for Recovery PROVIDES FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 400% OF THE FEDERAL POVERTY LEVEL. Ascension Brighton Center for Recovery WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY VIA THE HOSPITAL FACILITY'S WEBSITE - https://healthcare.ascension.org/Financial-Assistance Ascension Brighton Center for Recovery MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION. THE PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. Ascension Brighton Center for Recovery INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. Ascension Brighton Center for Recovery INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 4 Community information
Ascension Brighton Center for Recovery is located in Livingston County. The total population of Livingston county is estimated to be 160,877 residents in calendar year 2023 and is estimated to increase by 3,312 residents or 2.06% over the next five years (Sg2/Claritas Pop-Facts 2023). As a substance abuse acute care hospital, Ascension Brighton Center for Recovery serves all of southeast Michigan including Livingston, Wayne, Oakland, Macomb and St. Clair counties. The population of this area is 4.26 million and is estimated to remain at that level over the next 5 years. There are an estimated 72,905 households in Livingston County and 1,692,360 households in the 5 county service area. The service area is considered urban. There is a federally designated medically underserved area in Livingston County. There are multiple medically underserved areas in the entire service area. The median household income in Livingston county is $84,274, based on the United States Census Bureau (in 2020 dollars, 2016-2020). Approximately 5.3% of the service area persons live below the poverty line in Livingston County. There is one acute care hospital located in Livingston County.

Schedule H, Part VI, Line 6 Affiliated health care system
ASCENSION BRIGHTON CENTER FOR RECOVERY IS A MEMBER OF ASCENSION. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 19 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. ASCENSION BRIGHTON CENTER FOR RECOVERY OPERATES A HOSPITAL FACILITY IN LIVINGSTON COUNTY MICHIGAN AND IS PART OF ASCENSION HEALTH. ASCENSION ALSO OPERATES HOSPITALS IN THE EASTERN PORTION OF THE STATE INCLUDING ASCENSION ST. JOHN HOSPITAL, ASCENSION RIVER DISTRICT HOSPITAL, ASCENSION MACOMB OAKLAND HOSPITAL WARREN CAMPUS, ASCENSION MACOMB OAKLAND HOSPITAL MADISON HEIGHTS CAMPUS, ASCENSION PROVIDENCE HOSPITAL SOUTHFIELD CAMPUS, ASCENSION PROVIDENCE HOSPITAL NOVI CAMPUS, ASCENSION PROVIDENCE ROCHESTER HOSPITAL, ASCENSION ST. MARY'S HOSPITAL, ASCENSION STANDISH HOSPITAL, ASCENSION ST. JOSEPH HOSPITAL AND ASCENSION GENESYS HOSPITAL. ASCENSION ALSO OWNS AND OPERATES OTHER HEALTH CARE RELATED ENTITIES IN SOUTHWEST MICHIGAN INCLUDING ASCENSION BORGESS ALLEGAN HOSPITAL, ASCENSION BORGESS PIPP HOSPITAL, ASCENSION BORGESS LEE HOSPITAL AND ASCENSION BORGESS HOSPITAL. THE HEALTH SYSTEM PROVIDES INPATIENT,AND OUTPATIENT SERVICES FOR RESIDENTS OF ASCENSION BRIGHTON CENTER FOR RECOVERY'S SERVICE AREA IN SOUTHEASTERN MICHIGAN.