4A (Expenses $ 31967954 including grants of $ 34482) (Revenue $ 36771532)
DURING FISCAL YEAR 2021-2022 MARLETTE REGIONAL HOSPITAL SERVED 855 ACUTE AND 507 SWING BED INPATIENT DAYS, PROVIDED CARE TO 44,178 OUTPATIENT VISITS, 9,278 EMERGENCY DEPARTMENT VISITS, AND SERVED 27,874 VISITS IN ITS FAMILY HEALTH PRACTICES.RECOGNIZING ITS MISSION TO THE COMMUNITY, THE HOSPITAL PARTICIPATES IN THE FEDERAL GOVERNMENT'S MEDICARE PROGRAM AND NUMEROUS MEDICAID HEALTH PLANS, OFTEN PROVIDING CHARITY CARE OR SERVICE AT RATES OF REIMBURSEMENT THAT ARE BELOW THE HOSPITAL'S ACTUAL COST. IN THE LAST FISCAL YEAR, THE HOSPITAL HAD CHARITY CARE EXPENSES OF $19,482. ADDITIONALLY, THE HOSPITAL'S ALLOWANCE FOR UNCOLLECTABLE BAD DEBTS ARE ESTIMATED BY THE USE OF THE ALLOWANCE METHOD. BAD DEBTS FOR THE YEARS ENDING JUNE 30, 2022, AND 2021 AMOUNTED TO $1,072,075 AND $1,082,031, RESPECTIVELY. OTHER COMMUNITY BENEFITS ARE PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED ON ACTIVITIES AND SERVICES THAT MRH BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. A SAMPLING OF THESE COMMUNITY BENEFITS IS PROVIDED BELOW: EDUCATIONAL SERVICES/PROGRAMS:-ABUSE AND NEGLECT RECOGNITION TRAINING FOR COMMUNITY AND HOSPITAL STAFF-CAREER GUIDANCE FOR AREA SCHOOL STUDENTS-COOPERATIVE PROFESSIONAL TRAINING WITH LOCAL COLLEGES-DISEASE/CONDITION-SPECIFIC EDUCATION, E.G., DIABETES-EDUCATION/COUNSELING FOR FAMILIES OF PATIENTS-EDUCATION/COUNSELING FOR PATIENTS-EDUCATIONAL PROGRAMS FOR EMPLOYEES (ADULT EDUCATION)-ORGAN DONATION INFORMATION CAMPAIGNS-SUPPORT GROUPS FOR PATIENTS, THEIR FAMILIES AND THE COMMUNITY-TRAINING OF PUBLIC HEALTH AND SAFETY PERSONNELCOMMUNITY WELLNESS CAMPAIGNS/PROGRAMS: -HEALTH PROMOTION AND PREVENTIONS ACTIVITIES-BLOOD PRESSURE CLINICS-DISCHARGE PLANNING WITH FOLLOW-UP SUPPORT PROGRAMS-HEALTH PROMOTION/WELLNESS PROGRAMS-HEALTH SCREENING/HEALTH FAIRS-NUTRITION AND WEIGHT CONTROL-RURAL HEALTH OUTREACH SERVICES-STRESS MANAGEMENT-WORK SITE HEALTH PROMOTION SERVICE-KNOW YOUR NUMBERS LOW-COST SCREENING ON THE FIRST MONDAY OF EVERY MONTH (EXCEPT FOR HOLIDAYS), MARLETTE REGIONAL HOSPITAL OFFERS REDUCED RATE HEALTH SCREENINGS INCLUDING ACHILLES BONE DENSITY, BASIC METABOLIC PANEL, COMPLETE BLOOD COUNT, GLUCOSE, HBA1C, LIPID PROFILE, LIVER PANEL, POTASSIUM, PROSTATE-SPECIFIC ANTIGEN (PSA), MICROALBUMIN, SPIROMETRY, THYROID-STIMULATING HORMONE (TSH), AND VITAMIN D. LAB RATES RANGE FROM $8 TO $40. -BCUPS (THE BREAST CANCER UNDERSTANDING PREVENTION AND SCREENING (B.C.U.P.S.) PROGRAM IS IN PLACE TO FINANCIALLY ASSIST PATIENTS IN ACQUIRING IMPORTANT SCREENING MAMMOGRAMS AND DIAGNOSTIC TESTING SERVICES.)-MARLETTE REGIONAL HOSPITAL OFFERS $10 SPORTS PHYSICALS IN JUNE, JULY & AUGUST. MARLETTE REGIONAL HOSPITAL'S FAMILY HEALTHCARE OFFICES WILL OFFER REDUCED-PRICE SPORTS PHYSICALS TO AREA ATHLETES FOR A COST OF TEN DOLLARS IN THE MONTHS OF JUNE, JULY AND AUGUST, AND HALF OF THE PROCEEDS WILL BE DONATED BACK TO LOCAL SCHOOLS' ATHLETIC PROGRAMS.-MARLETTE ARC BLOOD DRIVE WE PROVIDE FOOD FOR THE BLOOD DRIVE. BARB PICKS UP THE FOOD FROM THE HOSPITAL AND DROPS IT OFF MONTHLY. WE ALSO HELP COORDINATE THE VOLUNTEERS.MRH SERVICES/PROGRAMS:-EMERGENCY SERVICES DEPARTMENT-ADVANCED LIFE SUPPORT AMBULANCE SERVICE-FIRE AND POLICE ASSISTANCE-HELICOPTER TRANSFER ASSISTANCE-CLINICAL SERVICES-CERTIFIED RURAL HEALTH CLINICS-CHILDHOOD & ADULT IMMUNIZATIONS-TELE-STROKE VIRTUAL MEDICINE-PRIMARY CARE SERVICES-ACUTE MEDICAL AND SURGICAL SERVICES-RESIDENTIAL AND HOME-BASED HOSPICE SERVICES-UNIQUELY-ACCREDITED HOSPITAL, LABORATORY, CARDIOPULMONARY, HOSPICE AND LONG-TERM CARE SERVICES-MOBILE PET AND BONE DENSITY TESTING TECHNOLOGY-COORDINATION OF PATIENT CARE SERVICES IN HOSPITAL-FREE OR LOW-COST SERVICES TO LOW-INCOME FAMILIES-GENERAL HEALTH SCREENING CLINICS-RESPIRATORY/PULMONARY DISEASE SERVICES-SCHOOL SPORTS PHYSICALS-SKILLED NURSING SERVICES/INTERMEDIATE CARE FACILITY-WOUND CARE CLINIC-PEDIATRIC SERVICES-NON-CLINICAL HOSPITAL SERVICES-ADVOCACY ON BEHALF OF SPECIFIC PATIENTS NEEDING INTERVENTION WITH PUBLIC AGENCIES (SOCIAL SERVICES)-FREE MEETING ROOMS FOR COMMUNITY GROUPS-GUIDANCE AND REFERRAL TO COMMUNITY SERVICES AND PUBLIC ASSISTANCE PROGRAMS, INCLUDING MEDICAID-MEALS FOR FAMILY MEMBERS-TRANSLATION OR INTERPRETER SERVICES FOR NON-ENGLISH-SPEAKING PATIENTS-SUPPORT FOR OTHER HEALTH CARE PROVIDERS-VISITING MEDICAL AND SURGICAL SPECIALISTS TO COMPLEMENT PRIMARY CARE-BEREAVEMENT GROUP MEETS AT EAST CAMPUS MONTHLY IN THE FOUNDATION CONFERENCE ROOM.-TRANSITIONS PROGRAM THIS IS A FREE SERVICE RAN THROUGH HOSPICE.- PHYSICIANS' CARE- WORK IN PARTNERSHIP CARING HEART HEALTH CLINIC-SUPPORT FOR BLOOD DRIVES-PHYSICIAN REFERRAL SERVICES-PARTNER IN REGIONAL RURAL HEALTH NETWORKS-WORKING RELATIONSHIPS WITH OTHERS-CIVIC ORGANIZATIONS SUCH AS LIONS CLUB, TOYS FOR TOTS, AMERICAN CANCER SOCIETY RESEARCH PROGRAM-AMERICAN ASSOCIATION OF RETIRED PERSONS-COMMUNITY-BASED BUSINESS GROUPS SUCH AS CHAMBERS OF COMMERCE-ECONOMIC DEVELOPMENT AGENCIES-HOME HEALTH AGENCIES-HOSPICES-LOCAL SCHOOLS AND COLLEGES-NURSING HOMES-SENIOR CITIZENS - FREE MATTER OF BALANCE PROGRAM-STATE AND LOCAL AGENCIES AND ORGANIZATIONS-CENTRAL MICHIGAN UNIVERSITY COLLEGE OF MEDICINE-COVENANT REGIONAL THUMB NETWORK (CRTN)-DECKERVILLE COMMUNITY HOSPITAL- THE HEARTLANDS, INDEPENDENT LIVING, MEMORY CARE AND ASSISTED LIVING -MICHIGAN CENTER FOR RURAL HEALTH-SANILAC COUNTY HEALTH DEPARTMENT-THUMB COMMUNITY HEALTH PARTNERSHIP (TCHP)-THUMB OPIOID RESPONSE CONSORTIUM (TORC)MARLETTE REGIONAL HOSPITAL IS COMMITTED TO SERVING OUR PATIENTS IN WAYS THAT RESPECT THE ORIGINAL VALUES OF OUR COMMUNITY - A COMPASSION FOR OUR NEIGHBORS AND A SENSE OF DUTY TO SERVE THOSE IN NEED. IN RESPECTING THESE VALUES, MARLETTE REGIONAL HOSPITAL ACKNOWLEDGES ITS OBLIGATION TO OFFER SERVICES TO PATIENTS THAT MAY NOT BE ABLE TO FULLY AFFORD THE CARE THEY NEED, WHILE ALSO SERVING THE HEALTH IMPROVEMENT NEEDS OF OUR LARGER COMMUNITY. TO THAT END, THE HOSPITAL HAS ADOPTED POLICIES THAT DESCRIBE HOW.

MARLETTE REGIONAL HOSPITAL
PART V, SECTION B, LINE 5: STAKEHOLDER MEETINGS AND SURVEYS INTENTIONALLY SOUGHT TO INCLUDE VULNERABLE POPULATIONS. THIS WAS ACHIEVED BY DISTRIBUTING SURVEYS TO INDIVIDUALS PARTICIPATING IN SERVICES FOR LOW-INCOME POPULATION AND SENIOR CITIZENS. ADDITIONALLY, SOCIAL SERVICE ORGANIZATIONS THAT SERVE VULNERABLE POPULATIONS WERE PROVIDED SURVEYS. AGENCIES INCLUDED HUMAN DEVELOPMENT COMMISSION, MENTAL HEALTH AGENCIES, THE PUBLIC HEALTH AND SOCIAL SERVICES DIVISION OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, SOCIAL WORKERS, INTERMEDIATE SCHOOL DISTRICTS, STAFF FROM HEALTH CARE SECTOR WITH FREE OR LOW COST HEALTH CLINICS, EARLY CHILDHOOD SERVICE PROVIDERS, AND LAW ENFORCEMENT

MARLETTE REGIONAL HOSPITAL
PART V, SECTION B, LINE 6B: DECKERVILLE COMMUNITY HOSPITAL

MARLETTE REGIONAL HOSPITAL
PART V, SECTION B, LINE 11: SELECTION OF PRIORITIES WILL OFTEN RESULT IN MORE COMPLEX AND EFFECTIVE IMPLEMENTATION STRATEGIES. IDENTIFYING A LIMITED NUMBER OF PRIORITIES ON WHICH TO FOCUS ALSO ALLOWS COMMUNITY INITIATIVES TO BE DEVELOPED WITH COLLABORATING ORGANIZATIONS. EVALUATION AND PROGRESS CAN BE MORE EFFECTIVELY MANAGED WHEN THE PRIORITIES ARE FEWER IN NUMBER. IN REVIEW OF EXISTING EFFORTS, THE TEAM DETERMINED THAT MARLETTE REGIONAL HOSPITAL WOULD HAVE THE GREATEST IMPACT ON COMMUNITY HEALTH BY TARGETING SIX FOCUS AREAS. DATA THAT LED TO THESE PRIORITIES IS INCLUDED IN THE FOLLOWING SECTION. 1. ACCESS TO HEALTH INSURANCE - CARE COORDINATORS PROMOTE WELLNESS SCREENINGS AND ASSIST WITH REMOVING BARRIERS TO ACCESS CARE SUCH AS COST, NAVIGATING INSURANCE, AND TRANSPORTATION. REMOVING BARRIERS TO HEALTH INSURANCE INCLUDE KNOW YOUR NUMBERS, LOW COST SCREENINGS, BCUPS, AND $10 SPORTS PHYSICALS. OFFER A POINT OF CONTACT FOR PATIENTS TO CALL WITH QUESTIONS, CONCERNS AND FEEDBACK IN REGARDS TO HEALTH INSURANCE. EXPANDING ACCESS BY INCREASING TELEHEALTH SERVICES INCLUDING INPATIENT CARE COVERAGE AND SPECIALTY CONSULTATIONS.2. SERVICE AWARENESS - PROVIDER DIRECTORY AND SERVICES OFFERED ARE POSTED ON THE MARLETTE REGIONAL HOSPITAL WEBSITE AND ALL MARLETTE REGIONAL HOSPITAL FAMILY HEALTH CARE OFFICES. SERVICE AREAS ARE HIGHLIGHTED ON SOCIAL MEDIA. MRH HAS SENT OUT A EVERY DOOR DIRECT MAILING. MRH CREATES AN ANNUAL REPORT THAT INCLUDES SERVICES OFFERED. WITH PATIENT CONSENT, MRH PROVIDES PATIENT TESTIMONIALS. WORK IN PARTNERSHIP WITH THE CRTN. THIS NETWORK ENHANCES AND STRENGTHENS HIGH-QUALITY HEALTHCARE PROVIDED BY YOUR COMMUNITY HOSPITAL WITH IMPROVED ACCESS TO MORE RESOURCES WHEN ADDITIONAL SPECIALIZED SUPPORT IS NEEDED. - PROVIDES MORE BOARD-CERTIFIED SPECIALIST COVERAGE AND SPECIALTY CLINICS RIGHT IN YOUR COMMUNITY - ENHANCES HOSPITAL ALIGNMENT WITH PROCESSES IN PLACE TO EXPEDITE PATIENT TRANSFERS WHEN NEEDED - INCREASES LOCAL ACCESS TO CARE, WHILE IMPROVING THE AFFORDABILITY OF QUALITY HEALTHCARE IN THE REGION - PRESERVES COMPLETE INDEPENDENCE OF LOCAL COMMUNITY HOSPITALS IN THE NETWORK.3. HEART DISEASE - DIABETIC EDUCATION CLASSES EXPANDED TO DECKERVILLE AND EXTENDED HOURS. OFFER COMMUNITY GARDEN PLOTS AND PLANTS FREE OF CHARGE @ MRH. DEVELOPMENT OF THE HEARTLANDS SENIOR LIVING INCLUDES EXERCISE CLASSES, FITNESS CENTER, AND WALKING TRAIL NEARBY. WALKING TRAIL SUPPORTER. OFFER 40 MILE WALK CHALLENGE. OFFER FREE OR LOW-COST EXERCISE CLASSES @ MRH. MRH HELPS COORDINATE A 5K IN BROWN CITY. EMERGENCY TELEHEALTH SERVICES FOR POSSIBLE STROKE PATIENTS BEGAN IN 2016. SPECIALTY SERVICES ADDED INCLUDE OUTPATIENT CLINIC SERVICES INCLUDING TELEPSYCHIATRY, CARDIOLOGY, ENT, ORTHOPEDICS, NEPHROLOGY, AND VASCULAR MEDICINE.4. TOBACCO USE AND VAPING - MRH DISTRIBUTES LUNG SCREENING CARDS AT COMMUNITY EVENTS AND HEALTH CARE OFFICES. SHARE RESOURCES ON TOBACCO USE OF VAPING PRODUCTS WITH THE COMMUNITY FROM MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES. LUNG CANCER SCREENING CAMPAIGN IN JUNE HIGHLIGHTS TOBACCO USE OF VAPING PRODUCTS.5. CANCER - MRH PROVIDES FINANCIAL ASSISTANCE FOR MAMMOGRAMS AND DIAGNOSTIC TESTING SERVICES THROUGH THE B.C.U.P.S. PROGRAM. MRH PARTNERS WITH P.C.U.P.S. FOUNDATION.TO RAISE FUNDS AND CREATE A HIGHER AWARENESS IN THE FIGHT AGAINST PROSTATE CANCER. FROM THIS MEETING, THE P.C.U.P.S PROGRAM WAS CREATED. P.C.U.P.S. STANDS FOR PROSTATE CANCER UNDERSTANDING, PREVENTION AND SCREENINGS. MARLETTE REGIONAL HOSPITAL CANCER CENTER DEVELOPMENT WITH COVENANT. 6. BEHAVIORAL HEALTH- PHYSICIAN OFFICES AND EMERGENCY DEPARTMENT CONTINUE TO ABIDE BY STRICT GUIDELINES IN THE PRESCRIBING AND ADMINISTRATION OF OPIOIDS AND NARCOTICS. MEMBER OF THUMB OPIOID RESPONSE CONSORTIUM (TORC) TO REDUCE THE HARM OF SUBSTANCE USE DISORDERS BY WORKING TOGETHER AS A REGION (HURON, SANILAC, TUSCOLA AND THE RURAL TRACKS OF LAPEER COUNTY) TO ENSURE THAT PREVENTION, TREATMENT, AND RECOVERY SERVICES ARE ALIGNED WITH THE NEEDS OF THE COMMUNITY. PREVIOUSLY COMPLETED SBIRT TRAINING THROUGH THE TORC. MEMBER OF THUMB COMMUNITY HEALTH PARTNERSHIP TO PROVIDE MAN THERAPY.SECONDARY PRIORITIES1. COVID 19- NOTIFY THE COMMUNITY WITH COVID-19 UPDATES. OFFERED 100 FREE COVID-19 ANTIBODY TESTS CURRENTLY OFFER $25 COVID-19 ANTIBODY TESTS. SEND OUT COMMUNICATION WITH VACCINATION AND TESTING LOCATIONS. OFFER TESTING IN THE EMERGENCY DEPARTMENT. ENFORCE RESTRICTIONS IN ALL MARLETTE REGIONAL HOSPITAL FACILITIES.2. DIABETES- POST DIABETES EDUCATION AWARENESS VIDEOS ON SOCIAL MEDIA. OFFERING EVENING CLASSES TO ACCOMMODATE MORE PATIENTS AND THEIR SCHEDULES. WITH PATIENT'S CONSENT CAPTURE TESTIMONIALS TO ENCOURAGE OTHERS IN NEED OF THE SERVICE TO CONTACT MRH. MEMBER OF THUMB COMMUNITY HEALTH PARTNERSHIP WHICH PROVIDES WOMEN TO WOMEN CHRONIC DISEASE HEALTH PROGRAM.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,010,564.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE HOSPITAL IS GOVERNED BY A COMMUNITY BOARD AND HAS AN OPEN MEDICAL STAFF. IT ALSO PARTICIPATES IN FREE OR REDUCED HEALTH SCREENINGS AND FAIRS THAT ARE AVAILABLE TO THE GENERAL PUBLIC. AT THE END OF FY2022 THE HOSPITAL PARTIALLY OPENED UP IT'S SENIOR LIVING COMMUNITY, THE HEARTLANDS, WHICH ENCOMPASSES 20 INDEPENDENT VILLAS, 20 ASSISTED LIVING, AND 12 MEMORY CARE ROOMS AND A COMMUNITY CENTER. WE HAD A HANDFUL OF INDEPENDENT VILLA RESIDENTS MOVE IN AT THE END OF THE FISCAL YEAR AND IN FY2023 WE ARE HOPING TO HAVE ALL SERVICE LINES UP AND RUNNING TO BETTER SUPPORT THIS PATIENT POPULATION.

PART III, LINE 2:
THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.

PART III, LINE 4:
THE ORGANIZATION DOES NOT HAVE A SPECIFIC BAD DEBT FOOTNOTE IN THEIR FINANCIAL STATEMENTS. ACCOUNTS RECEIVABLE AND CREDIT POLICY:ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS, WHICH REFLECT MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. THE HOSPITAL DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.

PART III, LINE 8:
THE AMOUNT OF MEDICARE ALLOWABLE COST WAS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNT LISTED FOR MEDICARE REVENUE DOES NOT INCLUDE PHYSICIAN SERVICES PROVIDED AT THE HOSPITAL, OUTLYING CLINIC LOCATIONS. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARE FOR PATIENTS. PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AN ADDITIONAL COMMUNITY BENEFIT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COST METHOD USED ABOVE FOR IRS 990 COMPLIANCES REPORTING IS BASED ON THE OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY THE HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED BASED ON MEDICARE REGULATIONS. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR.

PART VI, LINE 2:
THE HOSPITAL HAS PARTNERED WITH PRESS GANEY WHICH IS A COMPANY THAT HELPS US DO SURVEYS FOR PATIENT SATISFACTION. WE USE FEEDBACK FROM THOSE SURVEYS TO BETTER UNDERSTAND THE NEEDS OF OUR PATIENTS. ALSO, WITH WORKING CLOSELY WITH DCH WE GAIN A BETTER UNDERSTANDING OF THE NEEDS OF OUR PATIENTS IN OUR COUNTY BY ANALYZING DATA AT BOTH FACILITIES FOR POTENTIAL NEEDS.

PART VI, LINE 5:
THE HOSPITAL IS GOVERNED BY A COMMUNITY BOARD AND HAS AN OPEN MEDICAL STAFF. IT ALSO PARTICIPATES IN FREE OR REDUCED HEALTH SCREENINGS AND FAIRS THAT ARE AVAILABLE TO THE GENERAL PUBLIC. AT THE END OF FY2022 THE HOSPITAL PARTIALLY OPENED UP IT'S SENIOR LIVING COMMUNITY, THE HEARTLANDS, WHICH ENCOMPASSES 20 INDEPENDENT VILLAS, 20 ASSISTED LIVING, AND 12 MEMORY CARE ROOMS AND A COMMUNITY CENTER. WE HAD A HANDFUL OF INDEPENDENT VILLA RESIDENTS MOVE IN AT THE END OF THE FISCAL YEAR AND IN FY2023 WE ARE HOPING TO HAVE ALL SERVICE LINES UP AND RUNNING TO BETTER SUPPORT THIS PATIENT POPULATION.

PART VI, LINE 6:
THE ORGANIZATION IS WORKING WITH DECKERVILLE COMMUNITY HOSPITAL, THUMB MRI, AND THE COVENANT REGIONAL THUMB NETWORK TO BETTER SERVE THE NEEDS OF THE COMMUNITY.

PART VI, LINE 7, REPORTS FILED WITH STATES
MI

PART VI, LINE 3:
FOR INPATIENT SERVICES WE SEEK ANY INFORMATION REGARDING INSURANCE COVERAGE. IF NO COVERAGE IS AVAILABLE, WE REFER THE PATIENT TO OUR SOCIAL WORKER WHO HELPS THE PATIENT APPLY FOR GOVERNMENT ASSISTANCE IF APPLICABLE AND AVAILABLE, AND IF IT IS NOT, THEN WE HELP THEM COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. FOR OUTPATIENT SERVICES THE REGISTRATION STAFF OFFER FINANCIAL ASSISTANCE APPLICATIONS TO PATIENTS WHO CANNOT PAY THEIR UPFRONT COLLECTIONS. THE BILLING DEPARTMENT ALSO ASSISTS THE PATIENT IN APPLYING FOR GOVERNMENTAL ASSISTANCE. IF NOT APPLICABLE OR AVAILABLE, THE PATIENT IS ASSISTED IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AND APPLICATIONS TO SPECIAL ORGANIZATIONS THAT MIGHT OFFER ASSISTANCE AS WELL. NOTICES OF AVAILABILITY OF FINANCIAL ASSISTANCE ARE ALSO POSTED IN THE HOSPITAL LOBBY.

PART VI, LINE 4:
MARLETTE REGIONAL HOSPITAL SERVES RURAL COMMUNITIES IN SANILAC COUNTY AND PORTIONS OF LAPEER AND TUSCOLA COUNTIES. THE HOSPITAL'S SERVICE AREA INCLUDES NUMEROUS MUNICIPALITIES: BROWN CITY, DECKER, DEFORD, MARLETTE, MELVIN, PECK, SANDUSKY, SNOVER, FOSTORIA, KINGSTON, MAYVILLE, NORTH BRANCH, CLIFFORD, YALE, AND SILVERWOOD. BASED ON CENSUS DATA FOR MUNICIPALITIES, APPROXIMATELY 47,157 PEOPLE LIVE IN THE SERVICE AREA. THE HOSPITAL PROVIDES SERVICE TO COMMUNITIES IN WHICH THERE ARE A WIDE RANGE OF NEEDS (CENSUS-AMERICAN COMMUNITY SURVEY 5 YEAR AVERAGE(2020). EIGHTEEN AND ONE HALF PERCENT OF THE POPULATION IS OVER THE AGE OF 65 AND ONLY 23% ARE UNDER AGE 18. THE POPULATION HAS LIMITED RACIAL DIVERSITY WITH 98.5% OF THE POPULATION WHITE. THE SERVICE AREA HAS A COLLEGE DEGREE RATE OF 11.2% COMPARED TO MICHIGAN'S 30.5% AND UNITED STATES 32.9%. AVERAGE HOUSEHOLD INCOME IN THE SERVICE AREA IS $67,887 AS COMPARED TO MICHIGAN'S AVERAGE INCOME OF $80,803 AND THE UNITED STATES AVERAGE INCOME OF $91,547. UNEMPLOYMENT IN THE SERVICE AREA RANGED FROM 3.9 TO 13.4% COMPARED TO MICHIGAN AT 6% AND THE U.S. AT 5.4%. OF THE CIVILIAN NONINSTITUTIONALIZED POPULATION 8.5% HAVE NO HEALTH INSURANCE COVERAGE COMPARED TO MICHIGAN AT 5.4% AND THE U.S. AT 8.7%. THE PERCENTAGE OF PEOPLE WHO HAD INCOMES BELOW POVERTY IN PAST 12 MONTHS WAS 14.88% BUT RANGED BY MUNICIPALITY FROM 7.8% TO 28.4%.