4A (Expenses $ 32953033 including grants of $ 40715) (Revenue $ 34110357)
Schoolcraft Memorial Hospital (SMH), a component unit of Schoolcraft County, is organized under Public Act of 230 and is a county hospital corporation that operates a 12-bed acute care facility. SMH provides comprehensive inpatient, outpatient, emergency, medical clinic, and home health services in total. Healthcare is offered in at least 30 specialties, some of which include cardiology, neurology, general and orthopedic surgery, a 24-hour physician staffed emergency room, a walk-in clinic, physical and occupational therapy, cardiac rehabilitation, and a wide range of diagnostic services including a full-service laboratory, x-ray, mammography, CT scans, MRI's, and nuclear medicine. SMH is an equal opportunity provider and employer. During 2021 SMH had 1,417 acute and swing bed patient days, 641 inpatient and outpatient surgeries, 42,651 outpatient visits, and 373 home health admits.The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was $178,000 in 2021, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients.

4B (Expenses $ 5574658 including grants of $ 0) (Revenue $ 7240802)
SMH owns a provider based rural health clinic, which had thirteen physicians, two physician assistants, and four nurse practitioners. SMH had 24,049 RHC visits in 2021.

4C (Expenses $ 2889700 including grants of $ 0) (Revenue $ 5183030)
SMH offers 24/7 emergency services staffed with a physician who is on-site. SMH treats all patients, regardless of their ability to pay. SMH had 4,380 ER visits in 2021.

Schoolcraft Memorial Hospital
Part V, Section B, Line 5: Six Upper Peninsula health departments and 36 community partners announce the release of the latest edition of the Community Health Needs Assessment (CHNA) covering all 15 U.P. counties. The 458-page report, now available on-line to the general public, provides a wealth of information on the health status of U.P.'s 300,000 residents. The newly published CHNA is the culmination of an 18-month project led by local health departments in collaboration with hospitals, behavioral health agencies and health foundations. It includes data on health across the lifespan, access to care, community issues like drug abuse, and results from an extensive health survey conducted last August. Stakeholders will use the data to inform residents, identify priorities for community health improvement. The unique partnership of 42 organizations serving the U.P. continues to make it possible to conduct a comprehensive regional assessment of this breadth and depth.Sixteen health issues consistently identified as important by Upper Peninsula residents from a variety of data sources, including from local agency surveys of clients and providers, and several recent-year hospital and local health department led focus group meetings, were chosen for this survey. Respondents to the 2017 Health Survey of Upper Peninsula Adults were asked to rank their perceptions of each of these community health issues using a 4-point Likert-type scale. Respondents were asked to focus on the health of their community, not their individual or family health needs. Respondents to the 2021 UPCHIPS were asked to rank the same list of priorities.

Schoolcraft Memorial Hospital
Part V, Section B, Line 6a: Aspirus Iron River Hospital Munising Memorial Hospital/Baycare Medical CenterAspirus Ironwood Hospital MyMichigan Medical Center - SaultAspirus Keweenaw HospitalAspirus Ontonagon Hospital Baraga County Memorial Hospital OSF St. Francis HospitalBellin Health Hospital and Clinics Schoolcraft Memorial HospitalHelen Newberry Joy Hospital Mackinac Straits Health System U P Health Systems - BellMarshfield Clinic Health System - Dickinson U P Health Systems MarquetteU P Health Systems - PortageWar Memorial Hospital

Schoolcraft Memorial Hospital
Part V, Section B, Line 6b: Upper Peninsula Health Care SolutionsKeweenaw Bay Indian Community Upper Peninsula Health GroupLuce-Mackinac-Alger-Schoolcraft District Health DepartmentGogebic County Community Mental Health Superior Health FoundationGreat Lakes Recovery Center Upper Great Lakes Family Health CenterPathways Community Mental HealthChippewa County Health Department Portage Health FoundationCopper Country Community Mental Health Public Health of Delta & Menominee CountiesDickinson-Iron District Health Department Northern Michigan Center for Rural HealthBCBS Foundation of Michigan Northpointe Behavioral Health SystemsNorthCare NetworkUpper Peninsula Health PlanMarquette County Health Department Michigan Department of Health and Human ServicesMichigan Health Endowment Fund Western U P Health DepartmentMichigan Technological University Western U P Planning & Development Region

Schoolcraft Memorial Hospital
Part V, Section B, Line 7d: As a part of the implementation strategy, there will be hard copy binders containing the report that will be distributed to various communities within Manistique, such as the public library, etc. There have been several newsletter articles in hospital-based publications, some of which are distributed in the community, keeping the community apprised about progress on the CHNA and availability of the report & implementation strategy.

Schoolcraft Memorial Hospital
Part V, Section B, Line 11: The following describes how the needs identified in the 2018 CHNA were addressed during 2021:1. Youth Mentoring and BusinessIn 2021 SMH partnered with Manistique Area schools to mentor HOSA students entering the health field.2. Substance Use and Attitudes about Drugs, Alcohol, Tobacco, VapingSMH's therapists continued to offer substance abuse therapy and the Psychiatric Nurse Practitioner continued offering outpatient medication assisted treatment (Vivitrol). 3. Behavioral Health, Mental Health, Peer SupportRecruitment efforts for an additional Child Psych Nurse Practitioner were successful and services began in 2022. Dr. Sloane is a childhood trauma specialist and was hired through a grant. He offered free consultations with children and families through our grant period. He collborated with family practice providers, offering recommendations for medication, ongoing support, and follow up visits. Dr. Sloane continued through 2021 even after the grant period ended. Dr. Sloan particularly helps children with high ACES scores.The hospital mentored a social work student intern who was later hired as a full time therapist. This growth will allow us to offer behavior health services across a patient's lifespan.The team uses evidence-based therapies and assessments for traumatic experiences with every patient. The Patient Navigator assists patients to ensure they have access to care and connects them to vital community resources. The position was vacant for a portion of 2021, but recruitment efforts were successful in 2022. The following significant needs were identified in the 2021 CHNA: - Health Insurance is expensive or has high costs for co-pays and deductibles - Drug abuse - Unemployment, wages and economic conditions - Lack of health insurance - Lack of housing and programs for people with Alzheimer's Disease and dementia - Lack of affordable healthy foods, including year-round fresh fruits and vegetables - Lack of programs and services to help seniors maintain their health and independence - Lack of affordable facilities or programs for year-round physical activity of recreation - Childhood obesity - Shortage of mental health programs and services, or lack of affordable mental health care

Schoolcraft Memorial Hospital
Part V, Section B, Line 13h: Schoolcraft Memorial Hospital offers a self-pay discount of 41% of gross charges for uninsured patients regardless of income.

Schedule H, Part V, Section B, Line 7a:
http://www.scmh.org/community/community-health-needs-assessment/

Schedule H, Part V, Section B, Line 10a:
https://www.wupdhd.org/community-health-needs-assessment/

Schedule H, Part V, Section B, Line 7b:
https://www.wupdhd.org/2022/07/25/upchna/

Part I, Line 3c:
Schoolcraft Memorial Hospital offers a self-pay discount of 41% of gross charges for uninsured patients regardless of income. Medical indigency and underinsurance status are also used to determine eligibility.

Part I, Line 7:
Financial assistance was calculated using the cost-to-charge ratio. Unreimbursed Medicaid and subsidized health services were calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers.

Part I, Ln 7 Col(f):
The amount of bad debt expense backed out of total expenses to determine the percentage was $1,052,327.

Part III, Line 2:
The organization determines its bad debt expense based on actual charges. Self-pay discounts are applied to patient accounts before balances are deemed to be bad debt.

Part III, Line 3:
The amount listed on line 3 is an estimate of community care applications not returned. Approximately 60% of applications were not returned that may have qualified for community care.

Part III, Line 4:
The footnote to the organization's financial statements addressing implicit price concessions may be found on page 18 of the attached audited financial statements.

Part III, Line 8:
The shortfall should be considered as community benefit as this amount is not included in bad debt and no effort is made to collect this shortfall. In addition, providing services to the Medicare population is a community benefit as the elderly are a charitable class and providing them with healthcare helps the community.

Part III, Line 9b:
Schoolcraft Memorial Hospital works with patients to help them qualify for financial assistance. If a patient does not complete the financial assistance application or provide the required documentation, SCMH follows the same collection efforts as it does with other delinquent accounts. SCMH will attempt to work with the patient to set up a payment plan or make payment on the amount. If the patient does not respond the SCMH efforts, the account is referred to an external collection agency.

Part VI, Line 2:
The CHNA is the only formal assessment of broad scope that the hospital has utlilized in recent years to assess the health care needs of the community. The hospital did identify the need for COVID-19 vaccine clinics and was one of the first hospitals in the state of Michigan to roll out an organized drive through vaccine clinics to quickly administer COVID-19 vaccines. The clinics were offered weekly to meet the needs of the service area.

Part VI, Line 3:
Schoolcraft Memorial Hospital posts a summary of its charity care policy, and financial assistance contact information in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a summary of the policy, and financial assistance contact information to patients as part of the intake process; (3) includes a statement regarding the policy, along with financial assistance contact information, on patient bills; and assists the patient with qualification for charity care where applicable.

Part VI, Line 4:
Schoolcraft Memorial Hospital primarily provides services to the residents of Schoolcraft County. The county is 1,884 square miles of which 1,178 is land, and 706 is water. As of July 1, 2020 the population is estimated to be 7,912. Approximately 37.8% is estimated to be 60 years and older and 26.9% is estimated to be 65 years and older. As of 2020 the median household income in the county was $48,443. The percentage of individuals whose income was below the poverty level was 15.6% as of the 2020 census.Schoolcraft Memorial Hospital is the only hospital in the county. The nearest hospital is approximately 50 miles from Schoolcraft Memorial Hospital. Schoolcraft County is not designated as a Medically Underserved Area. It has been designated as a low-income health care professional shortage area.

Part VI, Line 5:
"SMH donates staff (board members) and health care services in the amount of $70,000/year to the low-income uninsured clients of the Medical Care Access Coalition, Schoolcraft County Office. The hospital has one staff person on the executive board of the Eastern Upper Peninsula Crisis Response team, and several additional staff who provide critical incident response interventions to first responders, schools, hospital staff, businesses, etc., throughout the region following an emotionally traumatic critical/crisis incident. The hospital has taken a leading role with the Sault Tribe Strategic Alliance for Health in planning and developing a farmers' market (the first in Manistique), as well as assisting in the planning for several miles of new sidewalk and safer intersections for the benefit of local schoolchildren and to encourage increased physical activity among all residents to fight the obesity epidemic. The hospital has a staff person who participates as a part of a local suicide & bullying prevention coalition and gives time to local awareness activities such as the annual suicide memorial vigil. The hospital has several staff who actively participate as a part of the local substance abuse prevention task force. The hospital wellness committee plans and implements activities in the schools to encourage nutritious eating habits and increase physical activity. The hospital donates staff time to the Great Start Collaborative and other early childhood programs toward the development of annual strategic plans, fundraising efforts, etc. One of the hospital's social workers is a trained Medicare/Medicaid assistance program counselor who sees about 200 people per year during the ""open window"" for Medicare Part D enrollment, and assists others throughout the year upon request. A hospital social worker is a certified child passenger safety seat technician and assists low income families that are unable to afford safety seats by providing a new seat and instructing in their safe installment. The hospital has the majority of the vendor booths and low cost or free screenings and services provided at the annual community health fair. The social workers educate and assist community members in completing advance directives. A social worker actively participates in the planning and on the day of the Walk to End Alzheimer's Diesease as well as sitting on the regional board of the Alzheimer's Association."

Part VI, Line 7, Reports Filed With States
MI