4A (Expenses $ 3239667322 including grants of $ 3575027) (Revenue $ 4031190076)
SPECTRUM HEALTH SYSTEM GROUP REFLECTS THE COMPOSITE INFORMATION AND OPERATIONS OF 23 TAX EXEMPT ENTITIES, INCLUDING 14 SEPARATELY LICENSED HOSPITALS, A SKILLED NURSING FACILITY, LONG-TERM ACUTE REHABILITATION AND HOME CARE, A MULTISPECIALTY PHYSICIAN GROUP, AND A CHARITABLE FOUNDATION. THE SPECTRUM HEALTH SYSTEM GROUP INCLUDES 150 SERVICE SITES, PHYSICIAN OFFICES AND OUTPATIENT LOCATIONS, PROVIDING CONVENIENT ACCESS TO SERVICES THROUGHOUT OUR 16-COUNTY SERVICE AREA. SEE SCHEDULE O - CONTINUED UNDER PART III, LINE 4A SPECTRUM HEALTH HOSPITAL GROUP.

4B (Expenses $ 690608624 including grants of $ 0) (Revenue $ 370038080)
SPECTRUM HEALTH MEDICAL GROUP - SEE SCHEDULE O

4C (Expenses $ 3951453 including grants of $ 1278199) (Revenue $ 0)
SPECTRUM HEALTH FOUNDATION - SEE SCHEDULE O

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - A,1 - Spectrum Health Butterworth and A,2 - Spectrum Health Blodgett. THE DATA COLLECTION PROCESS INVOLVED COMMUNITY SURVEYS, COMMUNITY-LED FOCUS GROUPS, A BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) SURVEY, LOCAL, STATE, AND NATIONAL SECONDARY SOURCES, AND PRIORITIZATION MEETINGS WITH STAKEHOLDERS. EACH OF THESE METHODS ARE DESCRIBED IN DETAIL ALONG WITH THE QUESTIONS USED IN THE KENT COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMUNITY SURVEY WAS ADMINISTERED IN AN ONLINE AND PAPER-BASED FORMAT IN BOTH ENGLISH AND SPANISH TO INDIVIDUALS WHO LIVE OR WORK IN KENT COUNTY. NEARLY 1,700 RESIDENTS RESPONDED TO THE SURVEY WHICH CONTAINED 54 QUESTIONS RELATED TO COVID-19, STRESS AND SOCIAL SUPPORT, NEIGHBORHOOD CHARACTERISTICS, AND BARRIERS TO HEALTH SERVICES. RESPONDENTS WERE ALSO ASKED TO IDENTIFY THE TOP FIVE HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH THAT HAD THE GREATEST IMPACT ON THEM. FOCUS GROUPS WERE ANOTHER METHOD OF DATA COLLECTION WHICH WAS USED TO COLLECT INPUT FROM COMMUNITY PARTNER ORGANIZATIONS. THIS PROCESS WAS INSTRUMENTAL IN DETERMINING THE KEY CHARACTERISTICS OF A HEALTHY COMMUNITY, THE MOST IMPORTANT ISSUES THAT NEEDED TO BE ADDRESSED, AND STRENGTHS AND ASSETS OF THE COMMUNITY. THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) SURVEY WAS ABLE TO COLLECT FEEDBACK FROM NEARLY 1,400 INDIVIDUALS THROUGH A STANDARDIZED SURVEY CONDUCTED VIA TELEPHONE INTERVIEWS OFFERED IN BOTH ENGLISH AND SPANISH. THE BRFSS SURVEYS WERE ESSENTIAL IN COLLECTING INFORMATION FROM A REPRESENTATIVE SAMPLE OF KENT COUNTY RESIDENTS ON SELF-REPORTED DISEASE PREVALENCE AND SELECT RISK FACTORS. A 'FORCES OF CHANGE' ASSESSMENT WAS PERFORMED IN PARTNERSHIP WITH GRAND VALLEY STATE UNIVERSITY MASTER OF PUBLIC ADMINISTRATION STUDENTS TO COLLECT INPUT ON CURRENT AND EMERGING ISSUES IN KENT COUNTY FROM LOCAL STAKEHOLDERS AND ORGANIZATIONS. THE TOP FORCES AND OTHER THEMES WERE INCLUDED IN THE CHNA DOCUMENT THROUGHOUT. INPUT ON SIGNIFICANT HEALTH NEEDS WAS GATHERED FROM 54 COMMUNITY PARTNERS IN THREE SEPARATE PRIORITIZATION MEETINGS. CRITERIA-BASED RANKING WAS USED IN THE MEETINGS FOR PARTICIPANTS TO SCORE HEALTH NEEDS AND RANK THEM BASED ON IMPORTANCE, EXISTING DISPARITIES, AND ABILITY TO ADDRESS THE NEED. PLEASE SEE APPENDIX A OF THE KENT COUNTY CHNA FOR THE PRIORITIZATION TOOL USED. ADDITIONALLY, A VARIETY OF EXISTING DATA AND INFORMATIONAL RESOURCES WERE USED TO PROVIDE ADDITIONAL CONTEXT ABOUT THE COMMUNITY INCLUDING INFORMATION FROM THE U.S. CENSUS BUREAU/AMERICAN COMMUNITY SURVEY, THE CENTERS FOR DISEASE CONTROL AND PREVENTION WONDER, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND THE MICHIGAN PROFILE FOR HEALTHY YOUTH SURVEY ALONG WITH MANY OTHERS.

Schedule H, Part V, Section B, Line 5 Facility A, 2
Facility A, 2 - A,3 - Spectrum Health United and A,9 -Spectrum Health Kelsey. DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA A PAPER SURVEY DIRECTED TOWARDS VULNERABLE AND UNDERSERVED SUB-POPULATIONS AS WELL AS A TELEPHONE SURVEY. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS AND KEY INFORMANTS, PROVIDED IN-DEPTH TELEPHONE INTERVIEWS OR COMPLETED AN ONLINE SURVEY. SECONDARY DATA WAS DERIVED FROM VARIOUS GOVERNMENT AND HEALTH SOURCES SUCH AS THE U.S. CENSUS, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY HEALTH RANKINGS, BUREAU OF LABOR STATISTICS, AND KIDS COUNT DATA CENTER. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY, KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH AND/OR HUMAN SERVICE ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUB POPULATIONS IMPACTED MOST BY ISSUES IN HEALTH/HEALTH CARE. FOR A LISTING OF THE TITLES OF INDIVIDUALS AND SOURCES CONSULTED, SEE THE CHNA APPENDIX.

Schedule H, Part V, Section B, Line 5 Facility A, 3
Facility A, 3 - A,4 - Spectrum Health Gerber Memorial. DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA A PAPER SURVEY DIRECTED TOWARDS VULNERABLE AND UNDERSERVED SUB-POPULATIONS AS WELL AS A TELEPHONE SURVEY. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS AND KEY INFORMANTS, PROVIDED IN-DEPTH TELEPHONE INTERVIEWS AND AN ONLINE SURVEY SECONDARY DATA WAS DERIVED FROM VARIOUS GOVERNMENT AND HEALTH SOURCES SUCH AS THE U.S. CENSUS, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY HEALTH RANKINGS, BUREAU OF LABOR STATISTICS, AND KIDS COUNT DATA CENTER. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY, KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH AND/OR HUMAN SERVICE ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUB POPULATIONS IMPACTED MOST BY ISSUES IN HEALTH/HEALTH CARE. FOR A LISTING OF THE TITLES OF INDIVIDUALS AND SOURCES CONSULTED, SEE THE CHNA APPENDIX.

Schedule H, Part V, Section B, Line 5 Facility A, 4
Facility A, 4 - A,7 - Spectrum Health Reed City. DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA A PAPER SURVEY DIRECTED TOWARDS VULNERABLE AND UNDERSERVED SUB-POPULATIONS AS WELL AS A TELEPHONE SURVEY. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS AND KEY INFORMANTS, PROVIDED IN-DEPTH TELEPHONE INTERVIEWS AND AN ONLINE SURVEY SECONDARY DATA WAS DERIVED FROM VARIOUS GOVERNMENT AND HEALTH SOURCES SUCH AS THE U.S. CENSUS, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY HEALTH RANKINGS, BUREAU OF LABOR STATISTICS, AND KIDS COUNT DATA CENTER. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY, KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH AND/OR HUMAN SERVICE ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUB POPULATIONS IMPACTED MOST BY ISSUES IN HEALTH/HEALTH CARE. FOR A LISTING OF THE TITLES OF INDIVIDUALS AND SOURCES CONSULTED, SEE THE CHNA APPENDIX.

Schedule H, Part V, Section B, Line 5 Facility A, 5
Facility A, 5 - A,8 - Spectrum Health Zeeland. DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA A PAPER SURVEY DIRECTED TOWARDS VULNERABLE AND UNDERSERVED SUB-POPULATIONS AS WELL AS A TELEPHONE SURVEY. NEARLY 350 RESIDENTS COMPLETED THIS SURVEY. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS AND KEY INFORMANTS, PROVIDED IN-DEPTH TELEPHONE INTERVIEWS AND AN ONLINE SURVEY. THE BEHAVIORAL RISK FACTOR SURVEILLANCE (BRFS) SURVEY WAS UTILIZED TO COLLECT FEEDBACK FROM 1,200 INDIVIDUALS THROUGH A STANDARDIZED SURVEY CONDUCTED VIA TELEPHONE INTERVIEWS OFFERED IN BOTH ENGLISH AND SPANISH. THE BRFS WAS ESSENTIAL IN COLLECTING INFORMATION FROM A REPRESENTATIVE SAMPLE OF OTTAWA COUNTY RESIDENTS ON SELF-REPORTED DISEASE PREVALENCE AND SELECT RISK FACTORS. SECONDARY DATA WAS DERIVED FROM VARIOUS GOVERNMENT AND HEALTH SOURCES SUCH AS THE U.S. CENSUS, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY HEALTH RANKINGS, BUREAU OF LABOR STATISTICS, AND KIDS COUNT DATA CENTER. MANY PUBLIC HEALTH EXPERTS WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY, KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH AND/OR HUMAN SERVICE ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUB POPULATIONS IMPACTED MOST BY ISSUES IN HEALTH/HEALTH CARE. FOR A LISTING OF THE TITLES OF INDIVIDUALS AND SOURCES CONSULTED, SEE THE CHNA APPENDIX.

Schedule H, Part V, Section B, Line 5 Facility A, 6
Facility A, 6 - A,6 - Spectrum Health Big Rapids. DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA A PAPER SURVEY DIRECTED TOWARDS VULNERABLE AND UNDERSERVED SUB-POPULATIONS AS WELL AS A TELEPHONE SURVEY. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS AND KEY INFORMANTS, PROVIDED IN-DEPTH TELEPHONE INTERVIEWS AND AN ONLINE SURVEY SECONDARY DATA WAS DERIVED FROM VARIOUS GOVERNMENT AND HEALTH SOURCES SUCH AS THE U.S. CENSUS, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY HEALTH RANKINGS, BUREAU OF LABOR STATISTICS, AND KIDS COUNT DATA CENTER. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY, KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH AND/OR HUMAN SERVICE ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUB POPULATIONS IMPACTED MOST BY ISSUES IN HEALTH/HEALTH CARE. FOR A LISTING OF THE TITLES OF INDIVIDUALS AND SOURCES CONSULTED, SEE THE CHNA APPENDIX.

Schedule H, Part V, Section B, Line 5 Facility A, 7
Facility A, 7 - A,5 - Spectrum Health Ludington. DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA A PAPER SURVEY DIRECTED TOWARDS VULNERABLE AND UNDERSERVED SUB-POPULATIONS AS WELL AS A TELEPHONE SURVEY. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS AND KEY INFORMANTS, PROVIDED IN-DEPTH TELEPHONE INTERVIEWS AND AN ONLINE SURVEY SECONDARY DATA WAS DERIVED FROM VARIOUS GOVERNMENT AND HEALTH SOURCES SUCH AS THE U.S. CENSUS, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY HEALTH RANKINGS, BUREAU OF LABOR STATISTICS, AND KIDS COUNT DATA CENTER. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY, KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH AND/OR HUMAN SERVICE ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUB POPULATIONS IMPACTED MOST BY ISSUES IN HEALTH/HEALTH CARE. FOR A LISTING OF THE TITLES OF INDIVIDUALS AND SOURCES CONSULTED, SEE THE CHNA APPENDIX.

Schedule H, Part V, Section B, Line 5 Facility A, 8
Facility A, 8 - A, 10 - Spectrum Health Pennock. DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA A PAPER SURVEY DIRECTED TOWARDS VULNERABLE AND UNDERSERVED SUB-POPULATIONS AS WELL AS A TELEPHONE SURVEY. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS AND KEY INFORMANTS, PROVIDED IN-DEPTH TELEPHONE INTERVIEWS AND AN ONLINE SURVEY. SECONDARY DATA WAS DERIVED FROM VARIOUS GOVERNMENT AND HEALTH SOURCES SUCH AS THE U.S. CENSUS, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY HEALTH RANKINGS, BUREAU OF LABOR STATISTICS, AND KIDS COUNT DATA CENTER. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY, KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH AND/OR HUMAN SERVICE ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUB POPULATIONS IMPACTED MOST BY ISSUES IN HEALTH/HEALTH CARE. FOR A LISTING OF THE TITLES OF INDIVIDUALS AND SOURCES CONSULTED, SEE CHNA APPENDIX.

Schedule H, Part V, Section B, Line 5 Facility A, 9
Facility A, 9 - A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES. THE CHNA WAS INFORMED BY DATA COLLECTED THROUGH MULTIPLE METHODS. PRIMARY SOURCE DATA (FIRSTHAND INFORMATION COLLECTED DIRECTLY FROM COMMUNITY MEMBERS) WAS COLLECTED THROUGH SURVEYS, PHOTOVOICE, AND INTERVIEWS, WITH A FOCUS ON GATHERING INPUT FROM NEIGHBORHOODS EXPERIENCING THE POOREST HEALTH OUTCOMES (I.E., HIGHEST MORTALITY RATES AND LOWEST LIFE EXPECTANCY). ADDITIONAL INFORMATION (SECONDARY DATA) WAS GATHERED THROUGH SCIENTIFIC LITERATURE, POLICY BRIEFS, AND OTHER ORGANIZATIONAL DOCUMENTS. GOVERNMENT DATASETS (E.G., EMPLOYMENT, INCOME, AGRICULTURE, HOUSING, TRANSPORTATION, HEALTHCARE RESOURCES, CIVIL ENGAGEMENT, AND RECREATION) WERE ALSO UTILIZED. THE SURVEY WAS ADMINISTERED IN ELECTRONIC AND PAPER FORMATS TO GOVERNMENT BODIES, LOCAL BUSINESSES, K-12 SCHOOLS, HIGHER EDUCATION INSTITUTIONS, AND NON-PROFIT AND OTHER COMMUNITY ORGANIZATIONS. INPUT WAS SOLICITED FROM STAKEHOLDERS WHO WERE DIVERSE BY AGE, ETHNICITY, GENDER IDENTITY, LANGUAGE PROFICIENCY, LITERACY LEVEL, PROFESSION, SEXUAL ORIENTATION, AND SOCIOECONOMIC STATUS. TO ENSURE INPUT WAS RECEIVED FROM COMMUNITY MEMBERS FACED WITH LITERACY CHALLENGES AND LANGUAGE BARRIERS, SURVEY QUESTIONS WERE ADMINISTERED VERBALLY (I.E., INTERVIEWS) AND TRANSLATED INTO SPANISH. SURVEY RESPONSES WERE RECEIVED FROM NEARLY 2,000 PEOPLE. PHOTOVOICE WAS USED TO CAPTURE RESPONSES TO THE SURVEY QUESTIONS FROM MORE THAN 100 AREA YOUTH. WHILE GATHERING COMMUNITY INPUT, EFFORTS WERE MADE TO ENSURE THAT THE DEMOGRAPHICS OF RESPONDENTS REFLECTED THE DEMOGRAPHICS OF BERRIEN COUNTY. MOREOVER, THE CHNA TEAM OVERSAMPLED IN GEOGRAPHIC AREAS WITH THE HIGHEST DEATH RATES AND LOWEST LIFE EXPECTANCIES. THUS, THE TEAM WAS ABLE TO ENSURE INPUT FROM THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AND FROM INDIVIDUALS AND ORGANIZATIONS WHO SERVE OR REPRESENT THE INTERESTS OF THESE POPULATIONS. DATA WAS ALSO COLLECTED THROUGH REVIEWS OF DOCUMENTS PUBLISHED BY THE BERRIEN COUNTY HEALTH DEPARTMENT, THE BERRIEN COUNTY MENTAL HEALTH AUTHORITY (RIVERWOOD CENTER), THE SOUTHWEST MICHIGAN PLANNING COMMISSION, AND OTHER BODIES WITH SPECIALIZED KNOWLEDGE, INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - A,11 LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES. LAKELAND HOSPITAL - NILES, LAKELAND HOSPITAL - WATERVLIET, AND LAKELAND MEDICAL CENTER, ST. JOSEPH

Schedule H, Part V, Section B, Line 6a Facility A, 2
Facility A, 2 - A,1 - SPECTRUM HEALTH BUTTERWORTH AND A,2 - SPECTRUM HEALTH BLODGETT. METRO HEALTH - UNIVERSITY OF MICHIGAN HEALTH PINE REST MARY FREE BED REHABILITATION HOSPITAL MERCY HEALTH

Schedule H, Part V, Section B, Line 6a Facility A, 3
Facility A, 3 - A,8 - SPECTRUM HEALTH ZEELAND. HOLLAND HOSPITAL NORTH OTTAWA COMMUNITY HEALTH SYSTEM

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - A,1 - Spectrum Health Butterworth and A,2 - Spectrum Health Blodgett. Kent County Health Department In addition many community organizations participated in or supported the CHNA process. A full listing of these organizations can be found in Appendix A of the CHNA: https://www.spectrumhealth.org/healthier-communities/grand-rapids-hospitals-community-health-needs-assessment

Schedule H, Part V, Section B, Line 6b Facility A, 2
Facility A, 2 - A,11 LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES. CHNA DATA WAS COLLECTED THROUGH REVIEWS OF DOCUMENTS PUBLISHED BY THE BERRIEN COUNTY HEALTH DEPARTMENT, THE BERRIEN COUNTY MENTAL HEALTH AUTHORITY (RIVERWOOD CENTER), THE SOUTHWEST MICHIGAN PLANNING COMMISSION, AND OTHER BODIES WITH SPECIALIZED KNOWLEDGE, INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY.

Schedule H, Part V, Section B, Line 6b Facility A, 3
Facility A, 3 - A,8 - SPECTRUM HEALTH ZEELAND. COMMUNITY MENTAL HEALTH - OTTAWA COUNTY OTTAWA DEPARTMENT OF PUBLIC HEALTH

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - SPECTRUM HEALTH SYSTEM REPORTING GROUP A,1 - A,10. Spectrum Health System reporting group A is addressing the significant needs identified in the most recently conducted CHNA's through adoption of an implementation strategy that addresses each of the community needs identified through the CHNA, execution of the implementation strategy, participation in the development and execution of a community-wide plan, inclusion of community benefit section in operational plans, adoption of a budget for provision of services that address the needs identified in the CHNA, prioritization of the health needs in the community and prioritization of services that the hospital facilities will undertake to meet health needs in the community. The hospital facilities are addressing many of the significant needs identified in the CHNA, however the hospital facilities will not address all significant health needs identified in the CHNA due to the limited resources and the need to allocate significant resources to the significant health needs that are being addressed. Each hospital facility's implementation plan identifies the significant needs identified in the CHNA but not addressed in the plan. The implementation plans for each hospital facility are available at: https://www.spectrumhealth.org/healthier-communities/community-health-needs-assessment

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES. IN MID-SEPTEMBER 2020, SPECTRUM HEALTH LAKELAND RECEIVED A GRANT FROM THE MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES, TO PROVIDE SERVICES IN THE BENTON HARBOR COMMUNITY, OCTOBER - DECEMBER 2020. THE GRANT ADDRESSED THE DISPARATE IMPACT OF COVID-19 EXPERIENCED BY AFRICAN AMERICANS IN THE CITY OF BENTON HARBOR WHO, ACCORDING TO THE DATA COMPILED BY THE BERRIEN COUNTY HEALTH DEPARTMENT, EXPERIENCED THE COUNTY'S HIGHEST BURDEN OF COVID INFECTIONS, HOSPITALIZATIONS, AND DEATHS. THE PROJECT ADDRESSED THE DISPARATE IMPACT BY PROVIDING, IN A CENTRALLY LOCATED AND EASILY ACCESSIBLE SITE, THE FOLLOWING FREE SERVICES: COVID TESTING; CULTURALLY RELEVANT/RESONANT COVID EDUCATION AND PUBLIC HEALTH MESSAGING; MENTAL HEALTH SERVICES; SOCIAL AND LEGAL NAVIGATION SERVICES; HEALTH SCREENINGS (FLU SHOTS, BP & CHOLESTEROL CHECKS) AND EDUCATION; PPE; WATER FILTERS; HOT SPOTS AND SCHOOL KITS FOR REMOTE LEARNING ACTIVITIES. HTTPS://WWW.SPECTRUMHEALTHLAKELAND.ORG/CENTER-FOR-BETTER-HEALTH. DURING 2021, THIS WORK CONTINUES TO PROVIDE COVID VACCINATIONS AS WELL AS SOCIAL NAVIGATION SERVICES TO HELP BENTON HARBOR RESIDENTS ACCESS FOOD, HOUSING, CLOTHING, UTILITY, AND OTHER RESOURCES CHALLENGED BY THE PANDEMIC. LEGAL NAVIGATION SERVICES HELPED BENTON HARBOR RESIDENTS' ACCESS LEGAL AID AND ATTEND COURT DATES. THE BOARD OF DIRECTORS OF SPECTRUM HEALTH LAKELAND VOTED UNANIMOUSLY TO CONTINUE TO FUND THE CENTER FOR BETTER HEALTH AND SUPPORT A HYPERTENSION CENTER. THIS IS USED TO LEVERAGE ADDITIONAL PRIVATE, STATE, AND FEDERAL FUNDS TO SUPPORT THE EVENTUAL DEVELOPMENT OF A CARDIOMETABOLIC CENTER THAT FOCUSES ON THE HEALTH CONDITIONS THAT DISPROPORTIONATELY BURDEN THE BENTON HARBOR COMMUNITY (I.E., HYPERTENSION, DIABETES, OBESITY). FURHERMORE, THIS WORK PROVIDES A FOUNDATION FOR FUTURE WORK TO ADDRESS HEALTH INEQUITIES IN BENTON HARBOR AND FOR LAKELAND TO EXECUTE ON ITS COMMITMENT TO ADVANCE HEALTH EQUITY.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - Spectrum Health System Group A,1 - A,13. Spectrum Health acknowledges that significant health events may result in catastrophic financial burden to a patient and family, as such Spectrum Health reserves the right to review catastrophic cases on an individual basis. Consideration for a reduced financial obligation will be made factoring medical bills accumulated within the last 240 days, as well as those anticipated to occur within the next 90 days. A catastrophic financial burden is one which results in a financial burden of 25% of annual household income or greater.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - Spectrum Health System Group A,1 - A,13. The organization uses FPG to determine eligibility for free care. An evaluation is not used for discounted care, as applicants that qualify for any assistance receive free care.

Schedule H, Part V, Section B, Line 16 Facility A, 1
"Facility A, 1 - Spectrum Health System Group A,1 - A,13. SPECTRUM HEALTH HAS IMPLEMENTED MEASURES TO WIDELY PUBLICIZE COMMUNICATIONS TO PATIENTS AND THE PUBLIC REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. COMMUNICATION METHODS INCLUDE BUT ARE NOT LIMITED TO SIGNAGE IN EACH HOSPITAL EMERGENCY DEPARTMENT, HOSPITAL ADMISSIONS OFFICE(S) AND OTHER PUBLIC LOCATIONS WITHIN THE HOSPITAL, INFORMATION ON THE SPECTRUM HEALTH WEBSITE, THE SPECTRUM HEALTH PATIENT HANDBOOK, VARIOUS INFORMATIONAL BROCHURES, UPON REQUEST BY ANY PATIENT, GUARANTOR OR COMMUNITY MEMBER, WORD OF MOUTH VIA FINANCIAL COUNSELORS AND OTHERS, AND THROUGH COMMUNITY PUBLICATIONS AND OUTREACH EVENTS. IN ADDITION, SPECTRUM HEALTH WILL OFFER A PLAIN LANGUAGE SUMMARY OF ITS FINANCIAL ASSISTANCE ELIGIBILITY POLICY AS PART OF THE PATIENT INTAKE AND/OR DISCHARGE PROCESS, AS WELL AS PROVIDE INDIVIDUALS WITH ASSISTANCE IN COMPLETING THE APPLICATION PROCESS. PATIENTS WILL BE NOTIFIED OF THE FINANCIAL ASSISTANCE ELIGIBILITY POLICY FOR A PERIOD OF AT LEAST 120 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. PATIENT BALANCES WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE EVALUATION FOR AT LEAST 240 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT (""APPLICATION PERIOD""). IF SPECTRUM HEALTH RECEIVES A FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD, WHETHER THE APPLICATION IS COMPLETE OR INCOMPLETE, IT WILL SUSPEND ANY COLLECTION EFFORTS UNTIL A DETERMINATION REGARDING FINANCIAL ASSISTANCE IS MADE."

Schedule H, Part V, Section B, Line 7 CHNA website address
Spectrum Health Butterworth: https://www.spectrumhealth.org/locations/spectrum-health-hospitals-butterworth-hospital/community-health-needs-assessment Spectrum Health Blodgett: https://www.spectrumhealth.org/locations/spectrum-health-hospitals-blodgett-hospital/community-health-needs-assessment Spectrum Health United: https://www.spectrumhealth.org/locations/spectrum-health-united-hospital/community/community-health-needs-assessment Spectrum Health Gerber Memorial: https://www.spectrumhealth.org/locations/spectrum-health-gerber-memorial/community-resources/community-health-needs-assessment Spectrum Health Ludington: https://www.spectrumhealth.org/locations/spectrum-health-ludington-hospital/communities/community-health-needs-assessment Spectrum Health Big Rapids: https://www.spectrumhealth.org/locations/spectrum-health-big-rapids-hospital/communities/community-health-needs-assessment Spectrum Health Reed City: https://www.spectrumhealth.org/locations/spectrum-health-reed-city-hospital/communities/community-health-needs-assessment Spectrum Health Zeeland: https://www.spectrumhealth.org/locations/spectrum-health-zeeland-community-hospital/communities/community-health-needs-assessment Spectrum Health Kelsey: https://www.spectrumhealth.org/locations/spectrum-health-kelsey-hospital/community-resources/community-health-needs-assessment Spectrum Health Pennock: https://www.spectrumhealth.org/locations/spectrum-health-pennock/communities/community-health-needs-assessment Spectrum Health Lakeland: https://www.spectrumhealthlakeland.org/population-health/get-facts/community-health-needs-assessment

Schedule H, Part V, Section B, Line 10 Implementation strategy website address
Spectrum Health Butterworth: https://www.spectrumhealth.org/locations/spectrum-health-hospitals-butterworth-hospital/community-health-needs-assessment Spectrum Health Blodgett: https://www.spectrumhealth.org/locations/spectrum-health-hospitals-blodgett-hospital/community-health-needs-assessment Spectrum Health United: https://www.spectrumhealth.org/locations/spectrum-health-united-hospital/community/community-health-needs-assessment Spectrum Health Gerber Memorial: https://www.spectrumhealth.org/locations/spectrum-health-gerber-memorial/community-resources/community-health-needs-assessment Spectrum Health Ludington: https://www.spectrumhealth.org/locations/spectrum-health-ludington-hospital/communities/community-health-needs-assessment Spectrum Health Big Rapids: https://www.spectrumhealth.org/locations/spectrum-health-big-rapids-hospital/communities/community-health-needs-assessment Spectrum Health Reed City: https://www.spectrumhealth.org/locations/spectrum-health-reed-city-hospital/communities/community-health-needs-assessment Spectrum Health Zeeland: https://www.spectrumhealth.org/locations/spectrum-health-zeeland-community-hospital/communities/community-health-needs-assessment Spectrum Health Kelsey: https://www.spectrumhealth.org/locations/spectrum-health-kelsey-hospital/community-resources/community-health-needs-assessment Spectrum Health Pennock: https://www.spectrumhealth.org/locations/spectrum-health-pennock/communities/community-health-needs-assessment Spectrum Health Lakeland: https://www.spectrumhealthlakeland.org/population-health/get-facts/community-health-needs-assessment

Schedule H, Part I, Line 6a Related Organization Information
"SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 BHSH SYSTEM PUBLISHES A CONSOLIDATED COMMUNITY BENEFIT REPORT ON ITS WEBSITE AT WWW.SPECTRUMHEALTH.ORG (CLICK ON THE LINK TITLED ""ABOUT"" THEN ""CORPORATE SOCIAL RESPONSIBILITY"" OR HTTPS://WWW.SPECTRUMHEALTH.ORG/ABOUT-US/CORPORATE-SOCIAL-RESPONSIBILITY/COMMUNITY-BENEFIT). IN ADDITION, THE HEALTH SYSTEM HOLDS AN ANNUAL MEETING, WHICH IS OPEN TO THE PUBLIC, TO DISCUSS ITS COMMUNITY COMMITMENTS. A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES AS PART OF THE 2019-2022 IMPLEMENTATION STRATEGY, SPECTRUM HEALTH LAKELAND PRESENTS THE ANNUAL COMMUNITY BENEFITS REPORT TO THE POPULATION HEALTH COMMITTEE (SUB-COMMITTEE OF THE BOARD), AND TO THE LAKELAND BOARD OF DIRECTORS. ONE OF THE ACTION ITEMS INCLUDED IN THE IMPLEMENTATION STRATEGY IS TO RE-ENGINEER COMMUNITY BENEFIT REPORTING INFRASTRUCTURE AND PROCESSES. ONE OF THE INTENDED IMPACTS OF THE AFFORDABLE CARE ACT IS TO ALIGN HEALTH SYSTEMS' ALLOCATIONS OF COMMUNITY BENEFITS WITH HEALTH NEEDS IDENTIFIED IN THE CHNA."

Schedule H, Part VI, Line 7 State Filing of Community Benefit Report
IF APPLICABLE, IDENTIFY ALL STATES WITH WHICH THE ORGANIZATION, OR A RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT: THE STATE OF MICHIGAN DOES NOT REQUIRE A COMMUNITY BENEFIT REPORT TO BE FILED WITH THE STATE HOWEVER BHSH SYSTEM VOLUNTARILY REPORTS CONSOLIDATED COMMUNITY BENEFIT INFORMATION TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION AND IN AN ANNUAL MEETING TO THE COMMUNITY. THE COMMUNITY BENEFIT REPORT IS ALSO AVAILABLE ON THE ORGANIZATION'S WEBSITE.

Schedule H, Part I, Line 7 Total Functional Expenses Used
SINCE THE AMOUNT OF TOTAL FUNCTIONAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25, COLUMN A, INCLUDES NON-HOSPITAL FACILITY EXPENSES (INCLUDING MEDICAL GROUP, SKILLED NURSING, HOSPICE, HOME CARE, AND OTHER SUCH NON-HOSPITAL FACILITY EXPENSES), AND THE COMMUNITY BENEFIT EXPENSES ON PART I, LINE 7, RELATE ONLY TO HOSPITAL FACILITIES, FOR PURPOSES OF CALCULATING TOTAL COMMUNITY BENEFIT, A TOTAL FUNCTIONAL EXPENSE AMOUNT OF $3,547,118,785 WAS USED. THIS AMOUNT REPRESENTS TOTAL FUNCTIONAL EXPENSES RELATED TO SPECTRUM HEALTH'S HOSPITAL FACILITIES ONLY, WHICH YIELDS A MORE ACCURATE AND MEANINGFUL DISCLOSURE OF SPECTRUM HEALTH'S TOTAL COMMUNITY BENEFIT PERCENTAGE.

Schedule H, Part V, Section B, Line 16a FAP AVAILABLE WEBSITE
SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 https://www.spectrumhealth.org/billing/financial-assistance A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES https://www.spectrumhealthlakeland.org/patient-visitor-guide/patient/billing/financial-assistance

Schedule H, Part V, Section B, Line 16b FAB APPLICATION FORM WEBSITE
SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 https://www.spectrumhealth.org/billing/financial-assistance A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES https://www.spectrumhealthlakeland.org/patient-visitor-guide/patient/billing/financial-assistance

Schedule H, Part V, Section B, Line 16c PLAIN LANGUAGE FAP SUMMARY WEBSITE
SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 https://www.spectrumhealth.org/billing/financial-assistance A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES https://www.spectrumhealthlakeland.org/patient-visitor-guide/patient/billing/financial-assistance

Schedule H, Part V, Section B, Line 7 LINE 7B
SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 HTTPS://WWW.SPECTRUMHEALTH.ORG/HEALTHIER-COMMUNITIES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES HTTPS://WWW.SPECTRUMHEALTHLAKELAND.ORG/POPULATION-HEALTH

Schedule H, Part VI, Line 4 COMMUNITY INFORMATION CONTINUED
SPECTRUM HEALTH SYSTEM GROUP A, 10 - SPECTRUM HEALTH PENNOCK SPECTRUM HEALTH PENNOCK IS A CRITICAL ACCESS FACILITY LOCATED IN BARRY COUNTY AND IS UNIQUELY LOCATED IN THE MIDDLE OF FOUR (4) LARGER METROPOLITAN AREAS: GRAND RAPIDS, LANSING, KALAMAZOO, AND BATTLE CREEK. THE PRIMARY SERVICE AREA IS IDENTIFIED AS BARRY COUNTY AND SUPPORTS A POPULATION OF RESIDENTS OVER 62,000. SPECTRUM HEALTH PENNOCK IS THE ONLY HOSPITAL WITHIN A 35 MILE RADIUS SERVICING RESIDENTS OF THE COMMUNITY. OTHER HEALTHCARE RESOURCES AVAILABLE IN THE COMMUNITY INCLUDE BOTH INDEPENDENT AND PENNOCK EMPLOYED PHYSICIAN OFFICES, CHERRY HEALTH - BARRY COMMUNITY HEALTH CENTER, AND PENNOCK URGENT CARE CENTER. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-PENNOCK/COMMUNITIES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES THE SYSTEM SERVES APPROXIMATELY 280,000 RESIDENTS IN BERRIEN COUNTY AND SURROUNDING AREAS. COMMUNITY SERVED. LAKELAND SERVES ALL OF BERRIEN COUNTY, AND PARTS OF VAN BUREN AND CASS COUNTIES WITH 13 TO 15 PERCENT OF THE POPULATION IN THESE COUNTIES LIVING BELOW THE POVERTY LEVEL. ALL THREE COUNTIES ARE LOCATED IN THE SOUTHWEST CORNER OF MICHIGAN. THIS SERVICE AREA IS DETERMINED BY THE LOCATION OF LAKELAND'S FACILITIES AND PATIENTS' PLACES OF RESIDENCE. THE 2021 CHNA IDENTIFIES THE HEALTH NEEDS OF BERRIEN COUNTY.

Schedule H, Part V, Section B, Line 7 LINE 7D
THE CHNA WAS PROVIDED DURING ONLINE COMMUNITY EDUCATIONAL CLASSES - PARTICIPANTS RECEIVED A LINK TO THE WEBSITE. COPIES WERE AVAILABLE AT THE CENTER FOR BETTER HEALTH HTTPS://WWW.SPECTRUMHEALTHLAKELAND.ORG/CENTER-FOR-BETTER-HEALTH. COMMUNITY MEMBERS AND REPRESENTATIVES FROM THE POPULATION HEALTH COMMITTEE, (SUBGROUP OF THE LAKELAND BOARD OF DIRECTORS), E.G., COMMUNITY LEADERS RECEIVED THE CHNA.

Schedule H, Part V, Section B, Line 4 HOSPITAL LAST CONDUCTED A CHNA
SEVERAL HOSPITALS INCLUDED IN FACILITY REPORTING GROUP A CONDUCTED A CHNA IN TAX YEAR 2021 - SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT, LAKELAND COMMUNITY HOSPITAL, WATERVLIET, LAKELAND HOSPITALS AT ST. JOSEPH, AND LAKELAND HOSPITALS AT NILES. THE REMAINING MEMBERS OF FACILITY REPORTING GROUP A WILL CONDUCT A CHNA IN TAX YEAR 2022.

Schedule H, Part V, Section B, Line 9 HOSPITAL LAST ADOPTED AN IMPLEMENTATION STRATEGY
SEVERAL HOSPITALS INCLUDED IN FACILITY REPORTING GROUP ADOPTED AN IMPLEMENTATION STRATEGY DURING TAX YEAR 2021 - SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT, LAKELAND COMMUNITY HOSPITAL, WATERVLIET, LAKELAND HOSPITALS AT ST. JOSEPH, AND LAKELAND HOSPITALS AT NILES. THE REMAINING MEMBERS OF FACILITY REPORTING GROUP A WILL ADOPT IMPLEMENTATION STRATEGIES IN TAX YEAR 2022.

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
BHSH SYSTEM 38-3382353

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
88152650

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
THE ORGANIZATION CALCULATES AN OVERALL COST-TO-CHARGE RATIO DERIVED BY USING THE IRS WORKSHEET 2 FORMAT, RATIO OF PATIENT CARE COST-TO-CHARGES. ALL PATIENT SEGMENTS AND PAYERS ARE USED IN THE CALCULATION.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ACCOUNTS RECEIVABLE, PAYER COMPOSITION AND AGING, AND HISTORICAL WRITE-OFF EXPERIENCE BY PAYER CATEGORY AND OTHER FACTORS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTED ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR THIRD-PARTY PAYERS, THE PROVISION IS DETERMINED BY ANALYZING CONTRACTUALLY DUE AMOUNTS FROM PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES. FOR SELF-PAY PATIENTS, THE PROVISION IS BASED ON AN ANALYSIS OF PAST EXPERIENCE RELATED TO PATIENTS UNWILLING TO PAY STANDARD RATES CHARGED. THE DIFFERENCE BETWEEN THAT STANDARD RATE CHARGED (LESS THE NEGOTIATED DISCOUNTED RATE) AND THE AMOUNT ACTUALLY COLLECTED AFTER THE REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ALL CHARGES ARE REPORTED AT GROSS, WHICH IS CONSISTENT WITH THE REPORTING METHODOLOGY USED IN THE ORGANIZATION'S FINANCIAL STATEMENTS.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
"THE HOSPITAL FACILITIES ARE UNABLE TO ESTIMATE ACCURATELY THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FREE SERVICES UNDER THE FINANCIAL ASSISTANCE POLICY. ALTHOUGH A PORTION OF BAD DEBT EXPENSES MAY RELATE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE, A REPORTABLE FIGURE CANNOT BE REASONABLY ESTIMATED. THE HOSPITAL FACILITIES HAVE IMPLEMENTED A ""PROPENSITY TO PAY"" EVALUATION TOOL THAT PROACTIVELY ASSESSES ONE'S ABILITY AND LIKELIHOOD TO PAY. THIS TOOL HAS PROVIDED A HIGHER DEGREE OF FOCUSED FINANCIAL COUNSELING EFFORTS, RESULTING IN A SUBSTANTIAL REDUCTION OF BAD DEBT AND HIGHER RATE OF IDENTIFICATION OF CHARITY ACCOUNTS."

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE NET PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE FOOTNOTE, WHICH CONTAINS BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ON PAGES 19-23 OF THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE ELIGIBLE FOR FREE CARE, AND THUS NO COLLECTION ACTION IS TAKEN. IF FINANCIAL ASSISTANCE ELIGIBILITY WOULD BE DISCOVERED AFTER COMMENCEMENT OF A COLLECTION ACTION, THEN SUCH COLLECTION ACTION WOULD BE SUSPENDED OR REVERSED.

Schedule H, Part V, Section B, Line 16a FAP website
A - SPECTRUM HEALTH BUTTERWORTH: Line 16a URL: SEE SUPPLEMENTAL INFORMATION IN PART VI;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - SPECTRUM HEALTH BUTTERWORTH: Line 16b URL: SEE SUPPLEMENTAL INFORMATION IN PART VI;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - SPECTRUM HEALTH BUTTERWORTH: Line 16c URL: SEE SUPPLEMENTAL INFORMATION IN PART VI;

Schedule H, Part VI, Line 4 Community information
DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES: SPECTRUM HEALTH SYSTEM GROUP, A,1 - A,9 SPECTRUM HEALTH BUTTERWORTH AND SPECTRUM HEALTH BLODGETT: SPECTRUM HEALTH BUTTERWORTH AND SPECTRUM HEALTH BLODGETT ARE LOCATED IN THE SAME COMMUNITY. THEY HAVE IDENTIFIED A PRIMARY SERVICE AREA OF ONE AND A HALF COUNTIES, INCLUDING KENT COUNTY AND PART OF EASTERN OTTAWA COUNTY. THE OVERALL SERVICE AREA TOTALS THIRTEEN COUNTIES, INCLUDING GRAND RAPIDS, MICHIGAN, THE SECOND LARGEST CITY IN THE STATE. OVERALL, THESE COUNTIES HAVE A TOTAL POPULATION OF OVER 1,600,000 RESIDENTS. KENT COUNTY IS LOCATED IN WESTERN MICHIGAN AND IS THE FOURTH LARGEST POPULATION CENTER IN THE STATE. THE COUNTY IS COMPOSED OF TWENTY-ONE TOWNSHIPS, FIVE VILLAGES, AND NINE CITIES COVERING 846 SQUARE MILES. GRAND RAPIDS IS THE COUNTY SEAT AND IS 30 MILES FROM LAKE MICHIGAN AND IS THE SECOND LARGEST CITY IN THE STATE. THE HEALTH CARE RESOURCES IN KENT COUNTY INCLUDE SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT, METRO HEALTH - UNIVERSITY OF MICHIGAN HEALTH, SAINT MARY'S HEALTH CARE, PINE REST, AND MARY FREE BED REHABILITATION HOSPITAL. IN ADDITION, THE HEALTH DEPARTMENT OPERATES FOUR PUBLIC HEALTH CLINICS THROUGHOUT THE COUNTY THAT OFFER PERSONAL HEALTH SERVICES. THE GRAND RAPIDS HOME FOR VETERANS AND THE VETERANS AFFAIRS OUTPATIENT CLINIC PROVIDE SERVICES FOR VETERANS. IN ADDITION TO MAJOR HEALTH CENTERS AND PUBLICLY FUNDED SERVICES, KENT COUNTY OFFERS NUMEROUS HEALTH-RELATED SERVICES THROUGH NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/HEALTHIER-COMMUNITIES/GRAND-RAPIDS-HOSPITALS-COMMUNITY-HEALTH-NEEDS-ASSESSMENT. SPECTRUM HEALTH UNITED: SPECTRUM HEALTH UNITED SERVES THE MEDICAL NEEDS OF THE RESIDENTS OF GREENVILLE, MI. THE PRIMARY SERVICE AREA IS COMPRISED WHERE SPECTRUM HEALTH UNITED IS LOCATED AND INCLUDES MONTCALM COUNTY AND PORTIONS OF ADJACENT COUNTIES (IONIA AND GRATIOT) SUPPORTING A POPULATION OF OVER 173,000 RESIDENTS. RESIDENTS OF KENT COUNTY MAY ALSO SEEK CARE AT SPECTRUM HEALTH UNITED. THE HEALTHCARE RESOURCES IN SPECTRUM HEALTH UNITED'S SERVICE AREA INCLUDE SPECTRUM HEALTH KELSEY, SPARROW CARSON HOSPITAL, SHERIDAN COMMUNITY HOSPITAL, THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, AND CHERRY STREET - MONTCALM AREA HEALTH CENTER. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-UNITED-HOSPITAL/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH GERBER MEMORIAL: SPECTRUM HEALTH GERBER MEMORIAL IS A CRITICAL ACCESS FACILITY THAT HAS IDENTIFIED A PRIMARY SERVICE AREA OF SEVERAL COUNTIES INCLUDING NEWAYGO COUNTY, EASTERN OCEANA COUNTY AND EASTERN MUSKEGON COUNTY AS PRIMARY AND NORTHERN KENT COUNTY AND SOUTHERN LAKE COUNTY AS SECONDARY. THE PRIMARY SERVICE AREA SUPPORTS A POPULATION OF OVER 253,000 RESIDENTS. SPECTRUM HEALTH GERBER MEMORIAL IS THE ONLY MAJOR MEDICAL FACILITY IN THE FACILITY'S PRIMARY SERVICE AREA. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-GERBER-MEMORIAL/COMMUNITY-RESOURCES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH LUDINGTON: SPECTRUM HEALTH LUDINGTON SERVES A RURAL COMMUNITY LOCATED ON THE COAST OF LAKE MICHIGAN SERVING MASON AND PORTIONS OF OCEANA AND LAKE COUNTIES. THE PRIMARY SERVICE AREA SUPPORTS A POPULATION OF OVER 68,000 RESIDENTS, HOWEVER AS THE COMMUNITY IS A SEASONAL TOURIST DESTINATION, THE POPULATION OF THE COMMUNITY SIGNIFICANTLY CHANGES WITH THE SEASONS. A SEASONAL MIGRANT POPULATION IS PRESENT DUE TO AGRICULTURAL EMPLOYMENT OPPORTUNITIES IN THE COMMUNITY. A LARGE PORTION OF THE HOSPITALS PATIENTS ARE COVERED BY EITHER MEDICARE OR MEDICAID. SPECTRUM HEALTH LUDINGTON IS THE ONLY MAJOR MEDICAL FACILITY IN THE FACILITY'S SERVICE AREA. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/LUDINGTON-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH BIG RAPIDS: SPECTRUM HEALTH BIG RAPIDS IS LOCATED IN THE MID-WESTERN PORTION OF THE STATE OF MICHIGAN. IT SERVES THE MEDICAL NEEDS OF THE RESIDENTS OF BIG RAPIDS, MI. THE PRIMARY SERVICE AREA IS COMPRISED WHERE SPECTRUM HEALTH BIG RAPIDS IS LOCATED AND INCLUDES MECOSTA COUNTY AND PORTIONS OF ADJACENT COUNTIES. THESE ADJACENT COUNTIES INCLUDE NEWAYGO, ISABELLA, OSCEOLA, AND LAKE COUNTIES. OVERALL, THESE COUNTIES HAVE A TOTAL POPULATION OF OVER 190,000 RESIDENTS. ACCORDING TO THE US CENSUS FROM 2016 TO 2020 THESE COUNTIES AVERAGED BETWEEN 12 AND 19 PERCENT OF THEIR POPULATION LIVING BELOW THE POVERTY LINE. SPECTRUM HEALTH BIG RAPIDS IS THE ONLY MAJOR MEDICAL FACILITY LOCATED IN THE FACILITY'S SERVICE AREA. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/BIG-RAPIDS-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH REED CITY: SPECTRUM HEALTH REED CITY IS A CRITICAL ACCESS FACILITY SERVES THE MEDICAL NEEDS OF THE RESIDENTS OF REED CITY, MI AND THE FAR-NORTHERN PORTION OF A PRIMARY SERVICE AREA SHARED WITH SPECTRUM HEALTH BIG RAPIDS, A RELATED ORGANIZATION. THE PRIMARY SERVICE AREA IS COMPRISED OF OSCEOLA COUNTY AND PORTIONS OF ADJACENT COUNTIES. THESE ADJACENT COUNTIES INCLUDE MECOSTA, LAKE, AND CLARE COUNTIES. OVERALL, THESE COUNTIES HAVE A TOTAL POPULATION OF OVER 106,000 RESIDENTS. OSCEOLA COUNTY IS LOCATED IN NORTHERN MICHIGAN APPROXIMATELY 80 MILES NORTH OF GRAND RAPIDS. THE RURAL COUNTY IS COMPOSED OF SIXTEEN TOWNSHIPS, FOUR VILLAGES, AND TWO CITIES COVERING 566 SQUARE MILES. REED CITY IS THE COUNTY SEAT. THE ONLY MAJOR MEDICAL FACILITY IN OSCEOLA COUNTY IS SPECTRUM HEALTH REED CITY. IN ADDITION, THE HEALTH DEPARTMENT IS A BRANCH OFFICE OF THE CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT. LOCATED WEST OF OSCEOLA COUNTY, LAKE COUNTY IS COMPOSED OF FIFTEEN TOWNSHIPS AND TWO VILLAGES COVERING 567 SQUARE MILES. BALDWIN IS THE COUNTY SEAT. THERE ARE NO MAJOR MEDICAL FACILITIES IN LAKE COUNTY. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-REED-CITY-HOSPITAL/COMMUNITIES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH ZEELAND: SPECTRUM HEALTH ZEELAND HAS IDENTIFIED A PRIMARY SERVICE AREA INCLUSIVE OF MUCH OF OTTAWA COUNTY AND THE SURROUNDING LAKESHORE REGION. OVERALL, THE SERVICE AREA OF SPECTRUM HEALTH ZEELAND HAS A POPULATION OF OVER 299,000. THE HEALTHCARE RESOURCES IN OTTAWA COUNTY INCLUDE SPECTRUM HEALTH ZEELAND, HOLLAND HOSPITAL, AND NORTH OTTAWA COMMUNITY HEALTH SYSTEM. OTTAWA COUNTY OFFERS NUMEROUS HEALTH RELATED SERVICES INCLUDING FOUR FREE MEDICAL CLINICS AND A VARIETY OF SERVICES THROUGH NON-PROFIT AGENCIES SUCH AS THE OTTAWA COUNTY HEALTH DEPARTMENT AND OTTAWA COUNTY COMMUNITY MENTAL HEALTH. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-ZEELAND-COMMUNITY-HOSPITAL/COMMUNITIES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH KELSEY: SPECTRUM HEALTH KELSEY IS A CRITICAL ACCESS FACILITY THAT SERVES THE MEDICAL NEEDS OF THE RESIDENTS OF LAKEVIEW, MI AND THE FAR-NORTHERN PORTION OF A PRIMARY SERVICE AREA SHARED WITH SPECTRUM HEALTH UNITED, A RELATED ORGANIZATION AND INCLUDES MONTCALM COUNTY AND PORTIONS OF ADJACENT COUNTIES (IONIA AND GRATIOT) SUPPORTING A POPULATION OF OVER 173,000 RESIDENTS. RESIDENTS OF KENT COUNTY MAY ALSO SEEK CARE AT SPECTRUM HEALTH KELSEY. THE HEALTHCARE RESOURCES IN SPECTRUM HEALTH KELSEY'S SERVICE AREA INCLUDE SPECTRUM HEALTH UNITED, SPARROW CARSON HOSPITAL, AND SHERIDAN COMMUNITY HOSPITAL, THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, AND CHERRY STREET - MONTCALM AREA HEALTH CENTER. FOR SPECIFIC POPULATION AND INCOME/POVERTY STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-KELSEY-HOSPITAL/COMMUNITY-RESOURCES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

Schedule H, Part I, Line 7g Subsidized Health Services
"SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 SUBSIDIZED HEALTH SERVICES OFFERED BY SPECTRUM HEALTH INCLUDE THE UNREIMBURSED COSTS OF PROVIDING FREE OR SUBSIDIZED HEALTH SERVICES AND/OR COMMUNITY CLINICS. SUBSIDIZED HEALTH SERVICES WERE PROVIDED AT THE FOLLOWING CLINICS BY SPECTRUM HEALTH: -CENTER FOR INTEGRATED MEDICINE (""CIM"") IS AN ADDICTION MEDICINE AND COMPLEX CARE CLINIC THAT EMPLOYS A NEW MODEL OF CARE TO ASSESS AND TREAT SUBSTANCE USE DISORDERS. THE CENTRAL GOAL OF THE CIM IS TO IDENTIFY, ACCURATELY DIAGNOSE AND DEVELOP A CARE PLAN FOR EACH PATIENT. PATIENTS UNDERGO COMPREHENSIVE HEALTH EXAMS, A BEHAVIORAL HEALTH ASSESSMENT, ADDICTION ASSESSMENT, AND A MEDICAL SOCIAL WORK CASE MANAGEMENT EVALUATION. -HELEN DEVOS CHILDREN'S HOSPITAL PEDIATRIC PRIMARY CARE CLINIC IS A RESIDENCY TEACHING CLINIC THAT TEAMS PEDIATRICIANS WITH MEDICAL STUDENTS AND RESIDENTS TO SERVE AS THE MEDICAL HOME FOR ITS PATIENTS. THE PROGRAM PROVIDES ROUTINE WELL-CHILD CARE, DIAGNOSIS AND TREATMENT FOR NEW PROBLEMS, MANAGEMENT OF COMPLEX CHRONIC CARE, AND PEDIATRIC CONSULTATION BY REFERRAL. -SPECTRUM HEALTH OB/GYN CLINIC HAS A DUAL MISSION OF TEACHING OB/GYN RESIDENTS AND TAKING CARE OF THE UNDERINSURED WOMEN OF ALL AGES IN THE COMMUNITY. SERVICE PROVISION INCLUDES COMPREHENSIVE OBSTETRIC AND GYNECOLOGY CARE, CENTERING PREGNANCY GROUP CARE, HIGH RISK OBSTETRICS, AND CLOSE COLLABORATION WITH SOCIAL WORK, REGISTERED DIETITIANS, AND COMMUNITY PARTNERS TO REDUCE MATERNAL AND INFANT MORTALITY. -SPECTRUM HEALTH INTERNAL MEDICINE AND FAMILY PRACTICE CLINIC OFFERS FAMILY CARE TO THE UNDERINSURED. THE CLINIC SERVES AS A TEACHING CLINIC FOR INTERNAL MEDICINE AND FAMILY PRACTICE CLINICS. -INTERNAL MEDICINE RESIDENCY PRACTICE: THE INTERNAL MEDICINE RESIDENCY CLINIC HAS A DUAL MISSION OF TEACHING INTERNAL MEDICINE RESIDENTS AND TAKING CARE OF THE UNDERINSURED IN THE COMMUNITY, INCLUDING COMPREHENSIVE INTERNAL MEDICINE SERVICES TO ADULTS. -FAMILY MEDICINE RESIDENCY CENTER: THE FAMILY MEDICINE RESIDENCY CENTER HAS A DUAL MISSION OF TEACHING FAMILY MEDICINE RESIDENTS AND TAKING CARE OF THE UNDERINSURED IN THE COMMUNITY, INCLUDING COMPREHENSIVE SERVICES TO ADULTS AND CHILDREN. OBSTETRICS SERVICES ARE OFFERED AS WELL. -ORTHOPEDIC SURGERY RESIDENCY PRACTICE: THE ORTHOPEDIC RESIDENCY CLINIC HAS A DUAL MISSION OF TEACHING ORTHOPEDIC SURGERY RESIDENTS AND TAKING CARE OF THE UNDERINSURED IN THE COMMUNITY, INCLUDING GENERAL ORTHOPEDIC SURGERY SERVICES TO ADULTS. -GENERAL SURGERY RESIDENCY PRACTICE/ GENERAL SURGERY ACADEMIC PRACTICE: THE GENERAL SURGERY RESIDENCY CLINIC HAS A DUAL MISSION OF TEACHING GENERAL SURGERY RESIDENTS AND TAKING CARE OF THE UNDERINSURED IN THE COMMUNITY, INCLUDING COMPREHENSIVE GENERAL SURGERY SERVICES TO ADULTS. -PLASTIC SURGERY RESIDENCY PRACTICE/ THE PLASTIC SURGERY RESIDENCY CLINIC HAS A DUAL MISSION OF TEACHING PLASTIC SURGERY RESIDENTS AND TAKING CARE OF THE UNDERINSURED IN THE COMMUNITY, INCLUDING COMPREHENSIVE PLASTIC SURGERY SERVICES TO ADULTS. A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES SUBSIDIZED HEALTH SERVICES OFFERED BY SPECTRUM HEALTH LAKELAND INCLUDE THE UNREIMBURSED COSTS OF PROVIDING FREE OR SUBSIDIZED HEALTH SERVICES FOR FORENSIC CARE & ADVOCACY (FORMERLY KNOWN AS SANE=SEXUAL ASSAULT NURSE EXAMINER'S PROGRAM) AT SPECTRUM HEALTH LAKELAND HAS BEEN PROVIDING SPECIALIZED MEDICAL EVALUATIONS SINCE 2009. THROUGH CRISIS INTERVENTION & EMOTIONAL SUPPORT INCLUDING CONTINUAL ADVOCACY, LEGAL ADVOCACY, & COUNSELING, WE PROVIDE CARE FOR SURVIVORS OF SEXUAL ASSAULT; PHYSICAL ASSAULT OR ABUSE; INTIMATE PARTNER VIOLENCE; CHILD & VULNERABLE ADULT ABUSE; & HUMAN TRAFFICKING. FORENSIC CARE & ADVOCACY (SANE) ADDRESSES AN IDENTIFIED COMMUNITY NEED BY OFFERING AN ESSENTIAL HEALTHCARE RESOURCE FOR SURVIVORS OF SEXUAL VIOLENCE WHO OTHERWISE WOULDN'T HAVE ACCESS TO THIS FULL SCOPE OF 24/7 SPECIALIZED, TRAUMA-INFORMED CARE CLOSE TO HOME (& REGARDLESS OF THEIR ABILITY TO PAY)."

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
SPECTRUM HEALTH SYSTEM GROUP A,1 - A,13 THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. IN DETERMINING MEDICARE SHORTFALLS, THE ORGANIZATION USES A RATIO OF COST-TO-CHARGES. IN DETERMINING THE RATIO OF COST-TO-CHARGES THE ORGANIZATION ADJUSTS FOR BAD DEBT EXPENSES, NON-PATIENT CARE ACTIVITIES, MEDICAID PROVIDER TAXES AND COMMUNITY BENEFITS ACCOUNTED FOR, AND OR REPORTED, ELSEWHERE. THE RATIO OF COST-TO-CHARGES IS APPLIED TO MEDICARE CHARGES TO DETERMINE SHORTFALLS IN MEDICARE REIMBURSEMENTS.

Schedule H, Part II Community Building Activities
SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 SPECTRUM HEALTH'S HOSPITAL FACILITIES ARE DEDICATED TO THE COMMUNITIES THEY SERVE. THE HOSPITALS WORK TO ADDRESS THE PRESSING HEALTH ISSUES OF THE COMMUNITIES THEY SERVE BY PROMOTING AND ADVOCATING FOR OVERALL COMMUNITY HEALTH IMPROVEMENT. SPECTRUM HEALTH CONTRIBUTES FUNDING AND PARTNERS WITH COMMUNITY CLINICS SUCH AS CHERRY HEALTH SERVICES, CATHERINE'S HEALTH CENTER, AND EXALTA HEALTH TO PROVIDE MEDICAL SERVICES TO IMPROVE THE HEALTH OF ADULTS MANAGING CHRONIC DISEASE, IMPROVING CHILDREN'S HEALTH, AND REDUCING INFANT MORTALITY. AS THE NEED FOR MENTAL HEALTH SERVICES AND SUBSTANCE USE DISORDERS CONTINUE TO RISE, SPECTRUM HEALTH FUNDS ORGANIZATIONS SUCH AS ARBOR CIRCLE AND THE GRAND RAPIDS RED PROJECT. AS WE RECOGNIZE THAT HEALTHCARE IS NOT THE SOLE CONTRIBUTOR TO IMPROVING HEALTH, WE ALSO SUPPORT ORGANIZATIONS THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH (THAT INCLUDE BUT ARE NOT LIMITED TO) EDUCATION, EMPLOYMENT, HOUSING, AND FOOD INSECURITY. IN THE HEALTH SCIENCES SCHOOL PARTNERSHIP, THE REGION'S PREMIER SPECIALTY HIGH SCHOOL, FOCUS IS ON PREPARING STUDENTS FOR COLLEGE AND TECHNICAL CAREER PATHWAYS IN THE WIDE-RANGING HEALTH CARE INDUSTRY. OUR FOOD INSECURITY ALLIANCE INCLUDES PARTNERING WITH ORGANIZATIONS SUCH AS ACCESS OF WEST MICHIGAN, THE COMMUNITY FOOD CLUB, URBAN ROOTS AND WELLHOUSE. TO REDUCE HOUSING INSECURITY, WE PARTNER WITH KINGDOM LIFE MINISTRIES TO HOUSE PREGNANT MOTHERS AND FAMILIES AND SUPPORT 3:11 HOUSING WHICH HOUSES HOMELESS YOUTH. SPECTRUM HEALTH IS ALSO PART OF A COLLABORATIVE PARTNERSHIP WITH THE ROBERT WOOD JOHNSON FOUNDATION AND REINVESTMENT FUND CALLED INVEST HEALTH. IT FOCUSES ON INCREASING EQUITABLE OUTCOMES BY REDUCING INFANT MORTALITY, LEAD EXPOSURES AND INCREASING FOOD SECURITY IN HISTORICALLY LOW-INCOME TARGETED CENSUS TRACT AREAS. THE INVEST HEALTH GRAND RAPIDS TEAM WILL ACHIEVE THIS THROUGH SCALING WORKFORCE MODELS AND HOUSING SUPPLY WITH ALIGNED INFANT MORTALITY, LEAD AND FOOD PROGRAMMING IN THE TARGETED CENSUS TRACTS. ADDITIONALLY, THE HOSPITALS HOST A MULTITUDE OF FREE COMMUNITY EDUCATION SEMINARS AND HEALTH SCREENINGS, HEALTH FAIRS AND SUPPORT GROUPS. A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES COMMUNITY BUILDING ACTIVITIES - PROGRAMS AND SERVICES THAT WHILE NOT DIRECTLY RELATED TO HEALTH CARE, ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS SUCH AS POVERTY, CRIME, AND ENVIRONMENTAL ISSUES. EXAMPLES ARE PHYSICAL IMPROVEMENTS, ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT, COALITION BUILDING, COMMUNITY HEALTH IMPROVEMENT ADVOCACY, AND WORKFORCE DEVELOPMENT ACTIVITIES. HTTPS://WWW.SPECTRUMHEALTHLAKELAND.ORG/HEALTHWELLNESS/COMMUNITY-HEALTH-ANDWELLNESS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT COMMUNITY BUILDING ACTIVITIES / PHYSICAL IMPROVEMENTS - DEVELOPMENT OR MAINTENANCE OF PARKS AND PLAYGROUNDS TO PROMOTE PHYSICAL ACTIVITIES LAKELAND HOSPITAL WATERVLIET PAR COURSE - IS MAINTAINED BY HOSPITAL ASSOCIATES TO PROVIDE COMMUNITY MEMBERS A SAFE AND SECURE PLACE TO EXERCISE. IT IS ALSO USED BY WATERVLIET HIGH SCHOOL STUDENTS DURING GYM CLASSES. The GROWTH (Guided Real-World Orientation and Work Training at the Hospital) internship program launched in 2020 and continued in 2021, in response to the shortage of African American and Hispanic/Latinx team members. The program creates a career pipeline between Benton Harbor area youth and Spectrum Health Lakeland and offers an inclusive culture of love and respect while helping students develop a diverse set of skills for the workforce. The program included a combination of guided real-world experience and work training at the hospital.

Schedule H, Part VI, Line 2 Needs assessment
DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED IN PART V, SECTION B: THE CHNA DATA PROVIDES A LEVEL FOUNDATION ON WHICH TO PLAN, DEVELOP, AND IMPLEMENT NEW PROGRAMS AND SERVICES TO MEET THE NEEDS OF OUR COMMUNITY. OPERATIONAL SERVICES IDENTIFIED BY THE CHNA, EXPANSION OF THE BLUE ENVELOP PROGRAM, INCREASED REFERRAL GOALS FOR THE MATERNAL INFANT HEALTH PROGRAM, SCHEDULED COUNTY DRUG TAKE BACK EVENTS, AND SUSTAINING THE COORDINATED APPROACH TO CHILDHOOD HEALTH PROGRAM. ALL HAVE BEEN BUILT INTO THE STRATEGIC PLAN AND BUDGET. ADDITIONAL AREAS OF IMPROVEMENT TO COMMUNITY HEALTH WERE IDENTIFIED AND ARE BEING ADDRESSED OUTSIDE OF THE CHNA. FOR EXAMPLE, A COMMUNITY- BASED APPROACH (INVEST HEALTH) IS ADDRESSING ITEMS SUCH AS SAFE, AFFORDABLE HOUSING, INFANT MORTALITY, IMPACT HIRING AS AN ECONOMIC ELEVATOR (RECOGNIZING THE LINK BETWEEN WEALTH CREATION AND HEALTH) AND FOOD INSECURITY. IN ADDITION, THE COVID-19 PANDEMIC LED TO COLLORATIVE EFFORTS TO INCREASE ACCESS TO COVID-19 TESTING AND VACCINES. THESE EFFORTS ALLOW SPECTRUM HEALTH TO LEVERAGE/MULTIPLY FUNDS WHILE DOING COLLABORATIVE WORK WITH COMMUNITY TO ADDRESS THESE ISSUES. THE CHNA AND IMPLEMENTATION PLANS ARE LOCATED AT: SPECTRUM HEALTH BUTTERWORTH: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-HOSPITALS-BUTTERWORTH-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH BLODGETT: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-HOSPITALS-BLODGETT-HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH UNITED: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-UNITED-HOSPITAL/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH GERBER MEMORIAL: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-GERBER-MEMORIAL/COMMUNITY-RESOURCES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH LUDINGTON: https://www.spectrumhealth.org/locations/ludington-hospital/community-health-needs-assessment SPECTRUM HEALTH BIG RAPIDS: https://www.spectrumhealth.org/locations/big-rapids-hospital/community-health-needs-assessment SPECTRUM HEALTH REED CITY: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-REED-CITY-HOSPITAL/COMMUNITIES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH ZEELAND: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-ZEELAND-COMMUNITY-HOSPITAL/COMMUNITIES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH KELSEY: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-KELSEY-HOSPITAL/COMMUNITY-RESOURCES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH PENNOCK: HTTPS://WWW.SPECTRUMHEALTH.ORG/LOCATIONS/SPECTRUM-HEALTH-PENNOCK/COMMUNITIES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH LAKELAND: HTTPS://WWW.SPECTRUMHEALTHLAKELAND.ORG/POPULATION-HEALTH/GET-FACTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY: SPECTRUM HEALTH INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY THROUGH PRODUCING INFORMATION CARDS AND BROCHURES FOR THE UNINSURED, COMMUNITY OUTREACH PROGRAMS, CONSUMER INFORMATION CLASSES, SPECTRUM HEALTH'S WEBSITE, PERSONAL FINANCIAL COUNSELING AND BY PROVIDING ASSISTANCE IN THE ACTUAL ENROLLMENT OF SUCH PROGRAMS. EACH SPECTRUM HEALTH FACILITY HAS A DEPARTMENT OF FINANCIAL COUNSELORS WHO WORK WITH PATIENTS THAT EXPRESS ANY LEVEL OF CONCERN WITH PAYING THEIR BILL. IN ADDITION, FINANCIAL COUNSELORS PROACTIVELY IDENTIFY PATIENTS WHO HAVE QUALIFYING FACTORS FOR GOVERNMENTAL ASSISTANCE. SPECTRUM HEALTH ALSO PARTNERS WITH ORGANIZATIONS THAT SPECIALIZE IN THE QUALIFICATION PROCESS. IF A PATIENT'S NEED FOR ASSISTANCE IS NOT IDENTIFIED PRIOR TO BILLING, ANY CONCERNS AS A RESULT OF RECEIVING A BILL ARE ADDRESSED BY FINANCIAL COUNSELORS AT THAT TIME. SPECTRUM HEALTH WIDELY PUBLICIZES COMMUNICATIONS TO PATIENTS AND THE PUBLIC ON THE AVAILABILITY OF FINANCIAL ASSISTANCE. THIS IS ACHIEVED THROUGH VARIOUS METHODS INCLUDING, BUT NOT LIMITED TO, THE SPECTRUM HEALTH PATIENT HANDBOOK, VARIOUS INFORMATIONAL BROCHURES, SIGNAGE IN EACH HOSPITAL EMERGENCY DEPARTMENT, ADMISSIONS OFFICES, AND OTHER PUBLIC LOCATIONS, UPON REQUEST BY ANY PATIENT, GUARANTOR OR COMMUNITY MEMBER, WORD OF MOUTH VIA FINANCIAL COUNSELORS AND OTHERS, AND THROUGH COMMUNITY PUBLICATIONS AND OUTREACH EVENTS. IN ADDITION, SPECTRUM HEALTH LISTS OPTIONS FOR THE UNINSURED AND UNDERINSURED ON ITS WEBSITE, ALONG WITH A COPY OF THE FINANCIAL ASSISTANCE ELIGIBILITY POLICY AT WWW.SPECTRUMHEALTH.ORG/AFFORDING-CARE/FINANCIAL-ASSISTANCE

Schedule H, Part VI, Line 5 Promotion of community health
SPECTRUM HEALTH SYSTEM GROUP A,1 - A,10 PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (E.G., OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.): THE COMMUNITY BOARD OF EACH FACILITY ON PART V, SECTION A IS SUBSTANTIALLY COMPOSED OF INDEPENDENT COMMUNITY MEMBERS THAT RESIDE IN THE PRIMARY SERVICE AREA OF THE HOSPITAL THEY SERVE AND PROVIDE ADVICE TO THAT HOSPITAL'S LEADERSHIP TEAM. THE HOSPITAL IS FURTHER SUPPORTED BY THE SPECTRUM HEALTH WEST MICHIGAN BOARD, WHICH IS THE GOVERNING BOARD OF THE HOSPITAL AND ALL OTHER HOSPITALS, POST-ACUTE CARE AND THE MEDICAL GROUP IN WEST MICHIGAN. ALL HOSPITALS IN BHSH SYSTEM ALSO EXTEND MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. BHSH SYSTEM INVESTS NET EARNINGS IN IMPROVING PATIENT CARE, BUILDING AND RENOVATING FACILITIES, PURCHASING NEW TECHNOLOGY, PROVIDING HEALTH EDUCATION AND FUNDING COMMUNITY PROGRAMS. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON ALL BHSH SYSTEM HOSPITAL FACILITIES TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENTS ARE STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. A,11 - LAKELAND COMMUNITY HOSPITAL, WATERVLIET, A,12 - LAKELAND HOSPITALS AT ST. JOSEPH AND A,13 - LAKELAND HOSPITALS AT NILES COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS - REPRESENTS ACTIVITIES THAT HELP IMPROVE THE HEALTH AND QUALITY OF LIFE FOR PEOPLE IN THE COMMUNITY. COMMUNITY BUILDING ACTIVITIES -PROMOTED THE HEALTH OF THE COMMUNITIES. HEALTH PROFESSIONS EDUCATION - LAKELAND PREPARES HEALTH CARE PROFESSIONALS FOR THE FUTURE BY PROVIDING A VARIETY OF TRAINING PROGRAMS AND EDUCATIONAL EXPERIENCES IN CLINICAL SETTINGS FOR UNDERGRADUATE AND GRADUATE STUDENTS, MEDICAL RESIDENTS, AND NURSING AND OTHER ALLIED HEALTH PROFESSIONALS. CASH & IN-KIND DONATIONS TO COMMUNITY GROUPS - CASH CONTRIBUTIONS AND IN-KIND DONATIONS ARE DESIGNATED FOR HEALTH CARE RELATED ACTIVITIES PROVIDED BY SOCIAL SERVICE AND COMMUNITY AGENCIES, SUCH AS MEDICAL SUPPORT FOR COMMUNITY EVENTS AND PARTNERS WHO SERVE THE MOST VULNERABLE POPULATIONS. THIS AMOUNT ALSO INCLUDES LEADERSHIP INVOLVEMENT ON COMMUNITY BOARDS THAT SUPPORT ORGANIZATIONS AND THEIR EFFORTS ON BEHALF OF VULNERABLE POPULATIONS. RESEARCH - LAKELAND IS COMMITTED TO INNOVATION BY OFFERING THE MOST ADVANCED, HIGH-QUALITY TREATMENTS AND HEALTH AND HEALING SERVICES TO THE COMMUNITY. AS A RESULT, LAKELAND SPONSORS CLINICAL AND COMMUNITY HEALTH RESEARCH, AS WELL AS STUDIES ON HEALTH CARE DELIVERY. FINANCIAL ASSISTANCE - FREE OR DISCOUNTED CARE THAT LAKELAND OFFERS TO PEOPLE WHO ARE UNABLE TO PAY FOR THEIR OWN CARE AND NOT ELIGIBLE FOR PUBLIC PROGRAMS. FINANCIAL ASSISTANCE DOES NOT INCLUDE THE BAD DEBT COST, WHICH TOTALED $23,183,788 IN CY 2021. UNREIMBURSED MEDICAID - REPRESENTS THE COST OF CARING FOR PEOPLE COVERED BY MEDICAID MINUS THE AMOUNT LAKELAND RECEIVES FROM THOSE PROGRAMS. IN ACCORDANCE WITH IRS REQUIREMENTS, BELOW IS A SUMMARY OF THE IMPACT OF THE IMPLEMENTATION STRATEGY THAT WAS UNDERTAKEN TO ADDRESS THE PRIORITY HEALTH NEEDS IDENTIFIED IN THE 2019 - 2021 CHNA. * INCREASED MENTAL HEALTH AWARENESS AND COMMUNITY CAPACITY TO ADDRESS MENTAL HEALTH CONCERNS. MENTAL HEALTH-RELATED TRAININGS WERE PROVIDED. A COMPREHENSIVE MENTAL HEALTHRELATED CURRICULUM WAS DEVELOPED AND IS BEING DELIVERED THROUGH A REGIONAL MULTISTAKEHOLDER COLLECTIVE IMPACT INITIATIVE. MENTAL ILLNESS IS LESS STIGMATIZED AS EVIDENCED BY THE SIGNIFICANT INCREASE IN THE NUMBER OF COMMUNITY MEMBERS AND ORGANIZATIONS SEEKING EDUCATION AND TRAINING.

Schedule H, Part VI, Line 6 Affiliated health care system
"IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED: SPECTRUM HEALTH IS AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM IN WEST MICHIGAN OFFERING A FULL CONTINUUM OF CARE THROUGH THE SPECTRUM HEALTH HOSPITAL GROUP, WHICH IS COMPRISED OF FOURTEEN HOSPITALS INCLUDING HELEN DEVOS CHILDREN'S HOSPITAL, A STATE-OF-THE-ART CHILDREN'S HOSPITAL AND LAKELAND REGIONAL HEALTH SYSTEM, WHICH INTEGRATED INTO THE BHSH SYSTEM IN OCTOBER 2018 AND IS INCLUDED IN THE 2021 990 GROUP RETURN FILING. THE SPECTRUM HEALTH HOSPITAL GROUP INCLUDES MORE THAN 150 AMBULATORY SERVICE SITES (INCLUDING LAKELAND REGIONAL HEALTH SYSTEM SITES); THE SPECTRUM HEALTH MEDICAL GROUP PHYSICIAN GROUP; AND PRIORITY HEALTH, A HEALTH PLAN WITH OVER 1,216,000 MEMBERS. SPECTRUM HEALTH IS WEST MICHIGAN'S LARGEST EMPLOYER WITH MORE THAN 31,000 EMPLOYEES (INCLUDING LAKELAND REGIONAL HEALTH SYSTEM) AND OVER 2,300 VOLUNTEERS. THE INTEGRATED HEALTH SYSTEM (INCLUDING LAKELAND REGIONAL HEALTH SYSTEM) PROVIDED OVER $506 MILLION IN COMMUNITY BENEFIT DURING ITS 2021 TAX YEAR COVERING JANUARY 1 - DECEMBER 31, 2021. THE $506 MILLION IN COMMUNITY BENEFIT INCLUDES COMMUNITY BENEFIT ACTIVITIES BY THE FACILITIES INCLUDED ON SCHEDULE H HOSPITALS AS WELL AS COMMUNITY BENEFIT ACTIVITIES OF OTHER ORGANIZATION ACROSS THE INTEGRATED HEALTH SYSTEM (INCLUDING LAKELAND REGIONAL HEALTH SYSTEM). EACH HOSPITAL FACILITY INCLUDED ON PART V; SECTION A IS A MEMBER OF THE AFFILIATED GROUP OF ENTITIES WITHIN SPECTRUM HEALTH. EACH HOSPITAL FACILITY IS RESPONSIBLE FOR CREATING VALUE WITHIN ITS RESPECTIVE COMMUNITY. FROM ITS INCEPTION, SPECTRUM HEALTH HAS BEEN A FAITHFUL STEWARD OF ITS COMMUNITY ASSETS. AS A WEST MICHIGAN-BASED NOT-FOR-PROFIT HEALTH SYSTEM, THE ORGANIZATION INVESTS ITS NET EARNINGS TO IMPROVE PATIENT CARE, BUILD AND RENOVATE FACILITIES, PURCHASE NEW TECHNOLOGY, PROVIDE HEALTH EDUCATION AND FUND LOCAL COMMUNITY PROGRAMS. SPECTRUM HEALTH'S MISSION - TO IMPROVE HEALTH, INSPIRE HOPE AND SAVE LIVES IS CENTRAL TO OUR STRATEGIC DISCUSSIONS AND GUIDES OUR INVESTMENTS AND THE ALLOCATION OF OUR RESOURCES. SPECTRUM HEALTH IS COMMITTED TO PROVIDING VALUE TO THE PEOPLE WE SERVE. ""VALUE"" MEANS ACCESS TO HIGH-QUALITY HEALTH CARE AT AFFORDABLE COSTS, AS WELL AS ACCESS TO THE FULL CONTINUUM OF HEALTH CARE SERVICES, FROM HEALTH INSURANCE TO OUTPATIENT CARE TO INPATIENT AND HOME CARE, AND EVERYTHING IN BETWEEN. SPECTRUM HEALTH HAS HUNDREDS OF PROGRAMS THAT SUPPORT ITS MISSION ""TO IMPROVE HEALTH, INSPIRE HOPE AND SAVE LIVES."" THESE PROGRAMS ARE BROUGHT TOGETHER UNDER TEN KEY AREAS: HEALTHIER COMMUNITIES, EDUCATION, INCLUSION AND DIVERSITY, COMMUNITY ENGAGEMENT, RESEARCH, INNOVATION, EMPLOYEE ENGAGEMENT, SUSTAINABILITY, REGIONAL RELATIONSHIPS AND COMMUNITY BENEFIT."