SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
HILLSDALE COMMUNITY HEALTH CENTER
 
Employer identification number

38-6005550
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    229,416   229,416 0.370 %
b Medicaid (from Worksheet 3, column a) . . . . .     11,100,705 20,115,336    
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     11,330,121 20,115,336 229,416 0.370 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 11 1,429 17,061 3,505 13,556 0.020 %
f Health professions education (from Worksheet 5) . . . 1 36 722,499 674,642 47,857 0.080 %
g Subsidized health services (from Worksheet 6) . . . .     10,619,794 9,004,549 1,615,244 2.590 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     15,450   15,450 0.020 %
j Total. Other Benefits . . 12 1,465 11,374,804 9,682,696 1,692,107 2.710 %
k Total. Add lines 7d and 7j . 12 1,465 22,704,925 29,798,032 1,921,523 3.080 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
4,766,718
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,262,310
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
16,778,359
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
14,352,573
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
2,425,786
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 HILLSDALE COMMUNITY HEALTH CENTER
168 S HOWELL STREET
HILLSDALE,MI49242
X X   X     X   INPATIENT PSYCH UNIT  
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HILLSDALE COMMUNITY HEALTH CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.HILLSDALEHOSPITAL.COM
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
HILLSDALE COMMUNITY HEALTH CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.HILLSDALEHOSPITAL.COM
b
WWW.HILLSDALEHOSPITAL.COM
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

HILLSDALE COMMUNITY HEALTH CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 7
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, LINE 5 THE PRIMARY DATA FOR THE ASSESSMENT CONSISTED OF A HEALTH SURVEY OF THE GENERAL COUNTY POPULATION AND AN OPEN FORUM OF HSN MEMBERS. THE HEALTH SURVEY QUESTIONNAIRE WAS DESIGNED TO CREATE A PROFILE OF THE RESPONDENTS, THEIR HEALTH NEEDS, AND VIEWS ON COMMUNITY HEALTH-RELATED ISSUES. ALL RESIDENTS OF THE COUNTY WERE INVITED TO PARTICIPATE IN THE SURVEY THROUGH A WIDE-REACHING INFORMATION CAMPAIGN THAT CONSISTED OF INFORMATIONAL ADS IN THE LOCAL NEWSPAPER, THE LOCAL RADIO STATION, PAPER MAILINGS, THE HOSPITAL WEBSITE, AND PERSONAL REQUESTS BY HOSPITAL VOLUNTEERS. AS A RESULT OF THE CAMPAIGN, 1,110 INDIVIDUALS COMPLETED THE HEALTH SURVEY QUESTIONNAIRE (983 IN 2013). SECONDARY DATA WAS COLLECTED FROM A VARIETY OF COUNTY, STATE, AND FEDERAL SOURCES SUCH AS THE US CENSUS BUREAU, MICHIGAN LABOR AND EDUCATION DEPARTMENTS, MICHIGAN DEPARTMENT OF VITAL STATISTICS, MICHIGAN BEHAVIOR RISK FACTOR SURVEY, AND KIDS COUNT IN MICHIGAN. SCHEDULE H, PART V, SECTION B, LINE 6B HILLSDALE HOSPITAL PARTNERED WITH THE HILLSDALE COUNTY HUMAN SERVICES NETWORK (HSN) TO CREATE A COMPREHENSIVE COMMUNITY BASED HEALTH NEEDS ASSESSMENT. THE HSN HIRED AN INDEPENDENT CONTRACTOR TO HELP DESIGN THE SURVEY, ANALYZE THE DATA, FACILITATE DISCUSSIONS, AND CREATE THE FINAL REPORT.
SCHEDULE H, PART V, SECTION B, LINE 7D THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATIONS PLAN CAN BE FOUND ONLINE AT WWW.HILLSDALEHOSPITAL.COM.
SCHEDULE H, PART V, SECTION B, LINE 11 NEED #1 THE CHNA IDENTIFIED WAS TO PROVIDE "Access to care and more free screenings." HCHC HAS RECENTLY IMPLEMENTED THE FOLLOWING Solutions IN ORDER TO MEET THESE NEEDS: -Increase the number of health screenings for low or no cost. -increase education regarding the services currently available for a reduced price. NEED #2 IDENTIFIED WAS T0 "ENCOURAGE MORE PHYSICIANS TO ACCEPT MEDICAID." An educational campaign on the HCHC Website as well as through THE Community Newsletter, will reinforce and educate HCHC'S commitment to accepting Medicaid as well as employed physicians with THE Hospital. NEED #3 WAS TO "EMPLOY MORE SPECIALISTS." Oncology is a large unmet need in Hillsdale County and recruitment efforts are currently underway to bring a provider to the Hillsdale community to provide this service. Healthcare costs, poverty and lack of transportation are also issues for Hillsdale County, making this effort even more important, as traveling to Ann Arbor or Toledo are often cost prohibitive. NEED #4 IDENTIFIED WAS TO "Provide Physical Therapy Services for those without insurance." HCHC currently contracts with Agility Health to provide both IP and OP PT services and will work with Agility to assure that patients do not go untreated due to financial hardship. Part of this process is educating patients as to the services that are available and the assistance provideD in gaining access to payment plans and Medicaid and Medicare. NEED #5 WAS IDENTIFIED AS THE NEED TO "Provide access to mental health services specifically for depression and dementia screenings." HCHC will provide increased depression and dementia screenings through THE Neurology clinic at reduced or no cost to patients. NEED #6 WAS IDENTIFIED AS THE NEED TO "Reduce opiate prescription use by using the MAPS Program." HCMC will assure all providers and mid-level providers are trained in the appropriate use of MAPS to better serve THE patients. NEED #7 WAS IDENTIFIED AS THE NEED TO at least one detox bed or area in the hospital." When the need arises, HCHC will designate the 4 rooms closest to THE Nursing Station on THE Medical Surgical Unit for use of this process. NEED #8 WAS IDENTIFIED AS THE NEED TO "Train staff to better recognize and to be able to better referral instances of domestic violence and substance abuse." HCHC can seek training from area professionals in recognizing the symptoms and signs of domestic violence aS WELL AS make appropriate referrals and follow up for patients who ARE present at THE hospital. This will be undertaken, primarily with ED staff who have a better chance of encountering such individuals. NEED #9 WAS IDENTIFIED AS THE NEED TO "Increase access to prenatal care and provide more infant safe sleep instruction." HCHC OB department can increase educational opportunities in this area in THE prenatal education classes. NEED #10 WAS IDENTIFIED AS THE NEED TO "Help establish clinics in schools similar to the Branch County model." HCHC did not believe THEY were in a position to apply for such funding and refer this back to the Hillsdale County ISD for their consideration. NEED #11 WAS IDENTIFIED AS THE NEED TO a wellness initiative THAT partnerS with local companies." HCHC currently partners with a handful of local businesses regarding wellness initiatives. Over the next 3 year period HCHC will be expanding these opportunities to other businesses and organizations who wish to partner with the hospital to benefit their employees. THE LAST NEED IDENTIFIED WAS TO "Have a consistent presence at the monthly HSN meeting." The Hospital is committing to send the Chief Quality Officer as the sole representative from this point forward, assuring consistent attendance. SCHEDULE H, PART V, SECTION B, LINE 20E AFTER INSURANCE PAYMENTS, THE SELF PAY PORTION IS BILLED TO THE PATIENT ON A MONTHLY STATEMENT. THE STATEMENT INCLUDES INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND HOW TO APPLY. AFTER THREE CYCLES, IF THE AMOUNT IS NOT PAID, THE GUARANTOR RECEIVES THREE CYCLES OF COLLECTION LETTERS. IF THE AMOUNT IS STILL NOT PAID, THE GUARANTOR CONTINUES TO RECEIVE LETTERS UNTIL THE ACCOUNT IS WRITTEN OFF TO THE COLLECTION AGENCY. DURING THE TIME THE GUARANTOR IS RECEIVING THE STATEMENTS AND LETTERS, SEVERAL TELEPHONE CALLS ARE PLACED TO THE GUARANTOR TO TRY TO DISCUSS THE PAYMENT OR OTHER OPTIONS AVAILABLE TO THE GUARANTOR SUCH AS A PAYMENT PLAN OR FINANCIAL ASSISTANCE. SCHEDULE H, PART V, SECTION B, LINE 21 ALL PATIENTS ARE BILLED THE SAME AMOUNT REGARDLESS OF TYPE OF INSURANCE OR LACK OF INSURANCE. DISCOUNTS OFF BILLED CHARGES ARE PROVIDED THROUGH THE CHARITY APPLICATION PROCESS OR PROMPT PAYMENT DISCOUNTS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
Page 8
Schedule H (Form 990) 2015
Page 8
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address Type of Facility (describe)
1 HILLSDALE HOME CARE
451 HIDDEN MEADOWS DRIVE
HILLSDALE,MI49242
HOME CARE
2 READING HEALTH CLINIC
143 S MAIN STREET
READING,MI49274
RURAL HEALTH CLINIC
3 HILLSDALE HOME CARE
451 HIDDEN MEADOWS DRIVE
HILLSDALE,MI49242
OXYGEN DIME
4
5
6
7
8
9
10
Schedule H (Form 990) 2015
Page 9
Schedule H (Form 990) 2015
Page 9
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
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.
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.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. 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.).
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.
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.
Form and Line Reference Explanation
SCHEDULE H, PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $4,766,718. SCHEDULE H, PART II, COMMUNITY BUILDING ACTIVITIES: HILLSDALE COMMUNITY HEALTH CENTER PROVIDES NUMEROUS COMMUNITY ACTIVITIES IN SUPPORT OF THE RESIDENTS OF HILLSDALE COUNTY, INCLUDING SENIOR SUNDAY WHERE LUNCH IS SERVED TO THE SENIOR COMMUNITY MEMBERS AND A SPEAKER DISCUSSES HEALTH ISSUES AND OTHER TOPICS RELATING TO THIS AGE GROUP. IN ADDITION, THERE ARE SEVERAL SUPPORT GROUPS AND CLASSES, INCLUDING THE BREAST CANCER SUPPORT GROUP, BREAST FEEDING CLASSES, BIRTHING CLASSES, NUTRITION EDUCATION AND DIABETES EDUCATION CLASSES. THERE ARE PERIODIC HEALTH SCREENINGS SUCH AS VARICOSE VEIN, FOOT PAIN, CHOLESTEROL, AND COPD SCREENINGS. HILLSDALE COMMUNITY HEALTH CENTER ALSO PROVIDES FREE SUPPORT TO ST. PETER'S FREE CLINIC AND PARTICIPATES IN THE LOCAL ALLIED HEALTH STUDENT PROGRAM. NUMEROUS HIGH SCHOOL AND COMMUNITY LOANS HAVE BEEN GRANTED FOR FULL TUITION FOR ALLIED HEALTH DEGREES. REPAYMENT OF LOANS IS FULFILLED THROUGH A TIME COMMITMENT TO THE HILLSDALE COMMUNITY HEALTH CENTER. SCHEDULE H, PART III, SECTION A, LINE 2 ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS STRATIFIED BY PAYOR AND NUMBER OF DAYS THE ACCOUNTS ARE OUTSTANDING. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.
SCHEDULE H, PART III, SECTION A, LINE 3 HILLSDALE HOSPITAL SAW $3,351,571 OF ACCOUNTS WRITTEN OFF TO BAD DEBT THAT WERE ATTRIBUTED TO PATIENTS WITH NO INSURANCE COVERAGE. THE AVERAGE DISCOUNT APPLIED TO ACCOUNTS THROUGH OUR FINANCIAL ASSISTANCE PROGRAM WAS 67.5%. WE APPLIED THAT PERCENTAGE TO THOSE ACCOUNTS WRITTEN OFF WITH NO INSURANCE.
SCHEDULE H, PART III, SECTION A, LINE 4 The Hillsdale Community Health Center reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hillsdale Community Health Center provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Hillsdale Community Health Center bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for uncollectible accounts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Hospital's allowance for doubtful accounts for self-pay patients increased from 68% of self-pay accounts receivable at June 30, 2015, to 71% of self-pay accounts receivable at June 30, 2016. In addition, the Hospital's write-offs decreased approximately $594,000 from approximately $5,811,000 for the year ended june 30, 2015, to approximately $5,217,000 for the year ended June 30, 2016. Both changes were caused by a shift in payer mix which resulted in a decrease in private pay patients and increase in governmental payers patients in 2016 as a result of health care reform. SCHEDULE H, PART III, SECTION B, LINE 8 THE COST TO CHARGE RATIO IS USED TO DETERMINE MEDICARE SURPLUS AT COST. THE MEDICARE ALLOWABLE COSTS REPORTED DO NOT INCLUDE ALL MEDICARE CHARGES. HAD ALL CHARGES BEEN INCLUDABLE THE RESULT WOULD BE A SHORTFALL. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT AS THIS IS THE EXTENT TO WHICH COSTS RELATED TO MEDICARE SERVICES GO UNPAID.
SCHEDULE H, PART III, SECTION C, LINE 9B AFTER INSURANCE PAYMENTS, THE SELF PAY PORTION IS BILLED TO THE PATIENT ON A MONTHLY STATEMENT. THE STATEMENT INCLUDES INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND HOW TO APPLY. AFTER THREE CYCLES, IF THE AMOUNT IS NOT PAID, THE GUARANTOR RECEIVES THREE CYCLES OF COLLECTION LETTERS. IF THE AMOUNT IS STILL NOT PAID, THE GUARANTOR CONTINUES TO RECEIVE LETTERS UNTIL THE ACCOUNT IS WRITTEN OFF TO THE COLLECTION AGENCY. DURING THE TIME THE GUARANTOR IS RECEIVING THE STATEMENTS AND LETTERS, SEVERAL TELEPHONE CALLS ARE PLACED TO THE GUARANTOR TO TRY TO DISCUSS THE PAYMENT OR OTHER OPTIONS AVAILABLE TO THE GUARANTOR SUCH AS A PAYMENT PLAN OR FINANCIAL ASSISTANCE.
SCHEDULE H, PART VI, LINE 2 HCHC PARTNERED WITH THE HUMAN SERVICES NETWORK, A COMMUNITY COLLABORATIVE BODY MADE UP OF A MAJORITY OF THE COUNTY'S HUMAN SERVICE, EDUCATIONAL, FAITH BASED, AND NON-PROFIT ORGANIZATIONS WITHIN HILLSDALE COUNTY. THIS GROUP SERVED AS THE STEERING GROUP FOR THE PROJECT, ALONG WITH ITS EXECUTIVE COMMITTEE.
SCHEDULE H, PART VI, LINE 3 IF A PATIENT PRESENTS TO HCHC FOR SERVICES AND INDICATES THEY HAVE NO INSURANCE, THEY ARE PROVIDED A COPY OF THE FAP PLAIN LANGUAGE SUMMARY ALONG WITH A LISTING OF THOSE ORGANIZATIONS THAT ARE AVAILABLE TO PROVIDE ADDITIONAL HELP AND SERVICES. WE ALSO HAVE TWO STATE DSH WORKERS ON SITE WHO ARE AVAILABLE TO WORK WITH THE PATIENTS TO DETERMINE THEIR ELIGIBILITY FOR MEDICAID OR OTHER SERVICES. EACH STATEMENT MAILED TO THE GUARANTOR INCLUDES A STATEMENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO APPLY OR GET ADDITIONAL INFORMATION. AS COLLECTION CALLS ARE MADE TO THE GUARANTOR THEY ALSO INFORM THEM ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. THERE ARE INFORMATIONAL POSTERS IN THE PATIENT WAITING ROOMS, AND FAP INFORMATION IS INCLUDED IN EACH DISCHARGE PACKET PROVIDED TO ADMITTED PATIENTS. THE COMPLETE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY IS PROVIDED ON THE HOSPITAL WEBSITE.
SCHEDULE H, PART VI, LINE 4 HILLSDALE MICHIGAN IS THE COUNTY SEAT OF HILLSDALE COUNTY. ITS POPULATION IS 8,200 WITH A HOUSEHOLD MEDIAN INCOME OF $32,022. THE CURRENT UNEMPLOYMENT RATE IS 7.5% FOR THE CITY OF HILLSDALE, AND 4.9% FOR HILLSDALE COUNTY. THE COUNTY IS BOUNDED ON THE NORTH BY CALHOUN AND JACKSON COUNTIES, ON THE EAST BY LENAWEE COUNTY, ON THE WEST BY GRANCH COUNTY, AND ON THE SOUTH BY STEUBEN COUNTY INDIANA AND WILLIAMS COUNTY OHIO. THE EXTREME SOUTHWEST CORNER OF HILLSDALE COUNTY IS WHERE THREE STATES OF MICHIGAN, OHIO AND INDIANA MEET. ON MAPS, THE COUNTY IS SITUATED AT 42 NORTH LATITUDE AND 8430' WEST LONGITUDE, AND COMPRISES ABOUT 617 SQUARE MILES, OR 394,880 ACRES. THE LAND LIES AN AVERAGE OF 630 FEET ABOVE LAKE ERIE AND 616 FEET ABOVE LAKE MICHIGAN.
SCHEDULE H, PART VI, LINE 5 HCHC FACILITATES MANY DIFFERENT SUPPORT GROUPS INCLUDING THE BREAST CANCER SUPPORT GROUP, COPD SUPPORT GROUP, AND THE BARIATRIC SUPPORT GROUP. WE ALSO OFFER SEVERAL EDUCATIONAL CLASSES INCLUDING BREAST FEEDING, BIRTHING, NUTRITION, AND DIABETES EDUCATION, AS WELL AS SEVERAL PERIODIC HEALTH SCREENINGS INCLUDING VARICOSE VEIN, FOOT PAIN, ACID REFLUX, CHOLESTEROL, AND COPD SCREENINGS, AS WELL AS PROVIDES FREE FLU SHOTS TO THE MEMBERS OF THE COMMUNITY. HCHC OWNS AND OPERATES A RURAL HEALTH CLINIC IN READING, MICHIGAN THAT PROVIDES HEALTHCARE SERVICES TO THE MEDICAID AND SELF INSURED POPULATION. HCHC ALSO PROVIDES FREE SUPPORT TO ST. PETER'S FREE CLINIC AND PARTICIPATES IN THE LOCAL ALLIED HEALTH STUDENT PROGRAM.
Schedule H (Form 990) 2015
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