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
2016
Open to Public Inspection
Name of the organization
Standish Community Hospital
 
Employer identification number

38-1671120
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
 
No
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
 
 
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) . . . 		    129,314   129,314 0.61 %
b Medicaid (from Worksheet 3, column a) . . . . .     5,006,503 5,505,854 0 0 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .         0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 5,135,817 5,505,854 129,314 0.61 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     27,611 965 26,646 0.13 %
f Health professions education (from Worksheet 5) . . .     6,386   6,386 0.03 %
g Subsidized health services (from Worksheet 6) . . . .         0 0 %
h Research (from Worksheet 7) .         0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     1,075   1,075 0.01 %
j Total. Other Benefits . . 0 0 35,072 965 34,107 0.16 %
k Total. Add lines 7d and 7j . 0 0 5,170,889 5,506,819 163,421 0.77 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2016
Schedule H (Form 990) 2016
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         0 0 %
2 Economic development         0 0 %
3 Community support     4,026   4,026 0.02 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building     1,264   1,264 0.01 %
7 Community health improvement advocacy         0 0 %
8 Workforce development         0 0 %
9 Other     1,122   1,122 0.01 %
10 Total 0 0 6,412 0 6,412 0.03 %
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
 
No
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
484,148
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
214,170
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
12,866,247
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
11,077,768
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
1,788,479
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) 2016
Schedule H (Form 990) 2016
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?1Name, 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 STANDISH COMMUNITY HOSPITAL
805 W CEDAR STREET
STANDISH,MI48658
WWW.STMARYSOFMICHIGAN.ORG/STANDISH
060020 		X       X   X   SKILLED NURSING FACILITY  
Schedule H (Form 990) 2016
Page 4
Schedule H (Form 990) 2016
Page 4
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)
STANDISH COMMUNITY HOSPITAL
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 15
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 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): https://healthcare.ascension.org/Locations/Michigan/Standish-Saint-Mary/Community-Benefit-Reports
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) 2016
Page 5
Schedule H (Form 990) 2016
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
STANDISH COMMUNITY HOSPITAL
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 Was widely publicized 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
https://healthcare.ascension.org/Locations/Michigan/Standish-Saint-Mary/Financial-Assistance
b
https://healthcare.ascension.org/Locations/Michigan/Standish-Saint-Mary/Financial-Assistance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2016
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Schedule H (Form 990) 2016
Page 6
Part VFacility Information (continued)

Billing and Collections
STANDISH COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
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
e
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
Schedule H (Form 990) 2016
Page 7
Schedule H (Form 990) 2016
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
STANDISH COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2016
Page 8
Schedule H (Form 990) 2016
Page 8
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, 16j, 18e, 19e, 20e, 21c, 21d, 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 Facility , 1 Facility , 1 - Standish Community Hospital Inc. The 2016 assessment began with the collection of secondary data from various sources. This included demographic, socioeconomic characteristics and information pertaining to the health status of the county for the most recent years available. In addition to the secondary data, the Arenac County Health Advisory Committee surveyed the community to determine the health priorities of the county. Following the compilation of the survey data, the committee held focus groups to receive input from a diverse group of leaders representing the broad interests of the community, including leadership from the healthcare sector - Central Michigan District Health Department, Sterling Area Health Center, Bay Arenac Behavioral Health, and representatives from those organizations who work closely with the poor and vulnerable populations. These stakeholders provided knowledge about the community's health status, risk factors, utilization of services, community resource needs, and identified gaps and needs in healthcare.
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Standish Community Hospital Inc. The non-hospital organizations with which Standish Community Hospital conducted its most recent CHNA are: Central Michigan District Health Department Sterling Area Health Center Bay Arenac Behavioral Health Arenac County Sheriff's Department Standish-Sterling Community Schools Northeast Michigan Community Service Action Agency Michigan Works
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Standish Community Hospital Inc. The Arenac County Health Advisory Committee utilized data, a community survey, and focus groups to determine the following prioritized needs as identified the the most recent CHNA: Need: Nutrition - 33.2% of Arenac County adults are listed as having a Body Mass Index (BMI) great than 30 Goal: proper nutrition is essential to reducing obesity, as well as chronic diseases such as type 2 diabetes, heart disease, high blood pressure, and stroke. By focusing on improving nutrition, the intent is to reduce obesity levels which will correspond with lower chronic disease rates. Strategy 1: Increase the number of double up food bucks program providers in Arenac County. Strategy 1: improve redemption of project fresh and senior fresh coupons. Action: Arenac County now has a retailer who participates in the Double Up Food Bucks program (Family Fare, Standish). Prior to this, no other grocer participated in the county. Need: Behavioral Health Services - 1 in 5 Americans has a mental illness and many are reluctant to seek help or might not know where to turn for careDue to the rural environment of Arenac County, access to behavioral health services is limited. Currently, a minimal number of behavioral health providers are available and not all insurance plans are accepted. Strategy 1: Implement a mental health first aid program in Arenac County. Goal: Due to the rural environment of Arenac County, access to behavioral health services is limited. Currently, a minimal number of behavioral health providers are available and not all insurance plans are accepted. Strategy 1: Implement a mental health first aid program in Arenac County. Action: Two Mental Health First Aid classes have been offered to residents in Arenac County. Need: Physical Health / Access to Primary Care - Access to healthcare services is critical for residents who live in rural communities. According to Healthy People 2020, access to healthcare is important for: overall physical, social, and mental health status; prevention of disease; detection and treatment of illnesses; quality of life; preventable death; and life expectancy. Rural residents often experience barriers to healthcare that limit their ability to get the care they need, as well as accessing available services in a timely manner. In Arenac County, after hours/walk-in services are limited to evenings, Monday-Thursday. Those needing non-emergency medical attention outside of this timeframe either travel a distance to find a walk-in clinic or utilize the hospital's emergency department. Goal: Expand the availability of after hours clinics and weekend appointments in Arenac County. Action: Standish Family Medicine, located on the campus of St. Mary's of Michigan Standish Hospital, added a walk-in clinic which is available on Tuesday, Wednesday and Thursday evenings. The following were the Needs that were identified That Will Not Be Addressed: A need for improved transportation systems was identified during the CHNA process. Despite advocating for improved transportation, it was determined that St. Mary's of Michigan Standish Hospital, including the Arenac County Health Advisory Committee, do not have the resources available to directly impact transportation.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2016
Page 9
Schedule H (Form 990) 2016
Page 9
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?0
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2016
Page 10
Schedule H (Form 990) 2016
Page 10
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 6a COMMUNITY BENEFIT REPORT This report illustrates the significant degree to which St. Mary's of Michigan Standish Hospital contributes to the positive health status of the communities it serves. As a member of Ascension Health, the nation's largest Catholic healthcare system, St. Mary's of Michigan Standish Hospital continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of St. Mary's of Michigan Standish Hospital is to serve all persons with special attention to those who are poor and vulnerable. St. Mary's of Michigan Standish Hospital is dedicated to spiritually centered, holistic care that sustains and improves the health of individuals and communities. St. Mary's of Michigan Standish Hospital furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. St. Mary's of Michigan Standish Hospital has engaged in the following activities to ensure that our mission is accomplished: Unreimbursed Services Provided to the Elderly and the Poor St. Mary's of Michigan Standish Hospital provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2017 approximately 54.3% of the value of services rendered was to elderly patients under the Medicare program, and approximately 21.9% of the services were provided to patients who were deemed indigent under state, county, or Medical Center Guidelines. In the spirit of principles adopted by Ascension Health, St. Mary's of Michigan Standish Hospital has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2017, the estimated unreimbursed charges of services provided to the elderly, uninsured, and underinsured totaled $38,967,682. Patient Services St. Mary's of Michigan Standish Hospital provides the following in-patient and out-patient medical services to the community: - Ambulatory Care Services - Emergency Care Services - Cardiac Rehab Services - Rural Health Clinic Office - Visiting Physician Services - Rehabilitation Services - Skilled Nursing Facility Some of the services listed above operate at a loss in order to ensure that all services are available to meet community health care needs. These include our Rural Health Clinic and Speech Therapy. During the fiscal year ending June 30, 2017, our hospital treated adults and children in the community for a total of 10,854 patient days of service. The medical center also provided services to 47,200 outpatients, including 10,458 emergency visits. Community Outreach activities St. Mary's of Michigan Standish Hospital seeks to improve the physical, mental, social and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, St. Mary's of Michigan Standish Hospital has developed the following programs to help achieve its mission: - Diabetes Education - Car Seat Safety Programs - MIChild and Healthy Kids Enrollment - Chronic Obstructive Disease Education - Community Thanksgiving Dinner Summary St. Mary's of Michigan Standish Hospital furthers its charitable purposes by providing a broad array of services to meet the healthcare needs of patients and organizations in the community. We provide essential medical services to the community, train and recruit healthcare professionals to serve the needs of the broader community, provide appropriate charity services to those patients who are not able to pay for their own healthcare needs, provide services to other organizations that allow them to provide quality services to their patients or constituents, and present education information classes and activities to the community in order to improve its overall health status.
Schedule H, Part V, Section B, Line 17 Billing and Collection Policy During tax year 2017, the organization learned via verbal comments of IRS agents at public events that the IRS intends that the "readily obtainable" standard in the 501(r) regulations for the AGB calculation and billing and collection policy is only met if those items are posted to the organization's web site. The organization had interpreted that web posting standard to be a safe harbor after consulting with external counsel and tax advisors, and timely took other steps to make the information readily obtainable. Consequently, the organization does not believe its decision to not post these documents to its web site rises to the level of a failure, nor does it believe the circumstances were either willful or egregious, having otherwise timely taken the steps necessary to attain and continue to maintain compliance with the other requirements related to the billing and collection policy and the AGB, as part of its policies and procedures for ensuring compliance with all aspects of 501(r). However, the organization is making this voluntary disclosure in order to communicate to the IRS the changes it is undertaking in response to the recent IRS informal guidance on this specific point concerning the "readily obtainable" standard, and the fact that the organization has started the work necessary to post its AGB information and billing and collection policy to its web site and will complete those additional postings as soon as reasonably possible. The other web postings required under 501(r) (i.e., those related to the community health needs assessment and the financial assistance policy) were timely completed and continue to remain in place as required. The organization believes its safeguards worked as intended in this case (i.e., the organization has regular communications with a number of external law firms and tax consultants and the timely attention to the recent guidance was supported by the framework of regular access to subject matter experts). These changes are in the process of being incorporated into corporate policies and procedures that apply to the organization.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied.
Schedule H, Part II Community Building Activities RESEARCH SHOWS THAT SOCIAL DETERMINANTS AND QUALITY OF LIFE PLAY A MAJOR ROLE IN THE HEALTH STATUS OF INDIVIDUALS AND COMMUNITIES. COMMUNITY BUILDING ACTIVITIES, WHICH FOCUS ON IMPROVING THE QUALITY OF LIFE WITHIN A COMMUNITY, ULTIMATELY INFLUENCE AND IMPROVE HEALTH STATUS.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2017 was $1,200,056 at charges, ($484,148 at cost).
Schedule H, Part III, Line 3 Bad Debt Expense Methodology The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 19.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Patients are encouraged to participate in their own care by working with the financial counselor and applying for Medicaid or other public assistance programs to qualify for charity or financial assistance. Any patient that may be eligible for public assistance must make an application for such. A documented response from public assistance must be on file prior to final determination of charity care funds. The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply.
Schedule H, Part V, Section B, Line 16a FAP website - STANDISH COMMUNITY HOSPITAL: Line 16a URL: https://healthcare.ascension.org/Locations/Michigan/Standish-Saint-Mary/Financial-Assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website - STANDISH COMMUNITY HOSPITAL: Line 16b URL: https://healthcare.ascension.org/Locations/Michigan/Standish-Saint-Mary/Financial-Assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - STANDISH COMMUNITY HOSPITAL: Line 16c URL: https://healthcare.ascension.org/Locations/Michigan/Standish-Saint-Mary/Financial-Assistance;
Schedule H, Part VI, Line 2 Needs assessment St. Mary's of Michigan Standish Hospital (SMMSH) participates in Community Needs Assessments to gain information about the health care needs of the community. The Community Needs Assessments provides an assessment of Arenac County pertaining to demographics, health, safe and stable homes, and economic development. SMMSH uses this information to ensure that the organization is meeting the needs of the community.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St. Mary's of Michigan Standish Hospital informs the community about their Charity Care Program, as well as other state or local government programs, through the following ways: - A Patient Financial Consultant is available Monday through Friday to discuss and assist with sign up for state and local government programs, and/or the hospital's charity care program. - The Patient Financial Consultant or Case Manager meet with self-pay patients who have been admitted to the hospital to discuss financial assistance programs that are available. - Self-pay outpatients receive the hospital's financial assistance application, as well as other state and federal assistance program information (MI Child Central Health Plan Medicaid and others as applicable), through the mail.
Schedule H, Part VI, Line 4 Community information St. Mary's of Michigan Standish Hospital's primary service area is Arenac County, over 70 percent of its patients reside in the county. Arenac County is located on Lake Huron on Michigan's eastern coast. It is a popular resort area dubbed the "sunrise side" of Michigan. A rural, largely undeveloped county, with plenty of canoeing, hunting, and fishing attracts tourists year-round. In addition to tourism, the economic base of Arenac County consists of agriculture and manufacturing. Agriculture accounts for approximately 48% of the land use. Additionally, health services provide a great deal of local employment. Standish, the county seat, is known as a supply headquarters for those traveling to Northern Michigan. It is also the location of the county's only hospital, St, Mary's of Michigan Standish Hospital. Approximately 15,649 people reside in Arenac County, They live in widely varying economic circumstances, with 17.9% of individuals identified as living below the poverty level; somewhat higher than the state rate of 15,7%,The unemployment rate is 13.2% which is slightly higher than the state average of 10.3%. There are several medical services many of which are tied to St. Mary's of Michigan Standish Hospital, but it is considered to be a health professional shortage area according to the US Health Resources and Services Administration. Accessing health care services can often be a challenge for those living in rural settings. Additional strains and stresses on these services are presented by the transient nature of some of the population (e.g. seasonal residents tourists and summer visitors) and general economic and demographic changes (i.e. an increasing aged population) that are occurring more generally in all of Michigan and the United States (i.e. increasing numbers of unemployed, increasing numbers of the "working poor"). Total population - 15,899 Male - 8,056 Female - 7,843 Under 5 years - 754 5 to 9 years - 838 10 to 14 years - 929 15 to 19 years - 1,064 20 to 24 years - 722 25 to 34 years - 1,537 35 to 44 years - 1,731 45 to 54 years - 2 661 55 to 59 years - 1,241 60 to 64 years - 1,195 65 to 74 years - 1,892 75 to 84 years - 979 85 years and over - 356 Race & Ethnicity The following illustrates the race and ethnicity of Arenac County residents for the year 2010. White - 15,393 Black or African American - 29 American Indian or Alaska Native - 190 Asian - 29 Hispanic or Latino - 225 Native Hawaiian or Other Pacific Islander - 9 Other - 44 Unemployment Rate The unemployment rate of Arenac County is 13.2% which is slightly higher than the state average of 10.3%. Arenac County 2000 - 5.8% 2010 - 16.1% 2011 - 13.2% Michigan 2000 - 3. 7% 2010 - 12. 7% 2011 - 10.3% Poverty According to the U.S. Census Bureau, the per capita and median household income is lower in Arenac County than in Michigan. The percentage of persons below poverty is higher than the Michigan average. Arenac County Per Capita Income in Past 12 Months - $19,386 Median Household Income - $36,281 Persons below poverty level, percent - 17.9% Michigan Per Capita Income in Past 12 Months - $25,482 Median Household Income - $48,669 Persons below poverty level, percent - 15.7% Education Rate Of the population age 25 and over 18.9% have less than a high school diploma which is higher than the state rate of 11.6%. Arenac County Less than 9th Grade - 625 9th to 12th Grade, no diploma - 1,602 High School Graduate - 4,834 Some College, no degree - 2,553 Associate's Degree - 900 Bachelor's Degree - 840 Graduate or Professional Degree - 429 Michigan Less than 9th Grade - 229,079 9th to 12th Grade, no diploma - 534,231 High School Graduate - 2,041,868 Some College, no degree - 1,561,637 Associate's Degree - 540,517 Bachelor's Degree - 1,021,486 Graduate or Professional Degree - 638,046 Physical Environment A community's health is affected by the physical environment. A safe, clean environment that provides access to healthy food and recreational opportunities is important to maintaining and improving community health. Grocery Store Access The following reports the number of grocery stores per 100,000 population. This indicator provides a measure of healthy food access and environmental influences on dietary behaviors. Arenac County Total Population, 2010 Census - 15,899 Number of Establishments - 5 Establishment Rate (Per 100,000 Pop.) - 31.45 Michigan Total Population, 2010 Census - 9,883,640 Number of Establishments - 2,154 Establishment Rate (Per 100,000 Pop.) - 21.79 United States Total Population, 2010 Census - 312,471,327 Number of Establishments - 67 342 Establishment Rate (Per 100,000 Pop.) - 21.55 Recreation and Fitness Facility Access The following reports the number per 100,000 population of recreation and fitness facilities. This indicator is relevant because access to recreation and fitness facilities encourages physical activity and other healthy behaviors. Arenac County Total Population, 2010 Census - 15,899 Number of Establishments - 1 Establishment Rate (Per 100,000 Population) - 6.29 Michigan Total Population, 2010 Census - 9,883,640 Number of Establishments - 894 Establishment Rate (Per 100,000 Population) - 9.05 United States Total Population, 2010 Census - 308,745,538 Number of Establishments - 29 896 Establishment Rate (Per 100,000 Population) - 9.68 Health Behaviors Health behaviors such as poor diet, a lack of exercise and substance abuse contribute to poor health status. Physical Inactivity (Adult) The following reports the percentage of adults aged 18 and older who self-report no leisure time for activity, based on the question: "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics golf, gardening, or walking for exercise?". Current behaviors are determinants of future health and this indicator may illustrate a cause of significant health issues, such as obesity and poor cardiovascular health. Arenac County Total Population (Age 18) - 13,214 Number Physically Inactive - 3,263.86 Percent Physically Inactive - 24.70% Michigan Total Population (Age 18) - 7,531,713 Number Physically Inactive - 1,709,699 Percent Physically Inactive - 22.70% United States Total Population (Age 18) - 111,821,887 Number Physically Inactive - 27,579,949 Percent Physically Inactive - 24.66% Heavy Alcohol The following reports the percentage of adults aged 18 and older who self-report heavy alcohol consumption (defined as more than two drinks per day for men and one drink per day for women). Current behaviors are determinants of future health and this indicator may illustrate a cause of significant health issues, such as cirrhosis, cancers and untreated mental and behavioral health needs. Arenac County Total Population (Age 18) - 13,214 Number Physically Inactive - 1,572,47 Percent Physically Inactive - 11.90% Michigan Total Population (Age 18) - 7,531,713 Number Physically Inactive - 1,408,430 Percent Physically Inactive - 18.70%
Schedule H, Part VI, Line 5 Promotion of community health St. Mary's of Michigan Standish Hospital offers the following activities to focus on improving the health of the community. -Health screenings and educational materials are provided free or at a reduced cost. -Diabetes support group meetings occur on a bi-monthly basis and are available, free of charge. -Grief support group meetings are offered twice a month, free of charge. -Speakers Bureau: Associates are available to provide educational programs to civic and non-profit groups, free of charge. -Free health and safety events are hosted by the hospital.
Schedule H, Part VI, Line 6 Affiliated health care system STANDISH COMMUNITY HOSPITAL IS AN AFFILIATE OF ASCENSION MICHIGAN AND ASCENSION HEALTH. STANDISH COMMUNITY HOSPITAL'S AFFILIATES ARE LARGE MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT MINISTRIES INCLUDING HOSPITAL AND NON-HOSPITAL MINISTRIES (PHYSICIAN GROUP PRACTICES, HOSPITAL ORGANIZATIONS, RESEARCH, HOME HEALTH, DURABLE MEDICAL EQUIPMENT AND SENIOR FACILITIES). THESE MINISTRIES WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF SERVING AS A HEALING PRESENCE WITH SPECIAL CONCERN FOR OUR NEIGHBORS ESPECIALLY THOSE WHO ARE VULNERABLE. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION AND RESEARCH. THE ORGANIZATIONS WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, STATE AND NATIONAL LEVEL. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST.FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care that sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and to other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and for community benefit programs: Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured. Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and for other vulnerable persons. Cost of other programs for persons living in poverty and for other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and the other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome. Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research. Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care to persons living in poverty or in the cost of other community benefit programs. The cost of providing care to persons living in poverty and of other community benefit programs is estimated using internal cost data and is estimated by reducing charges forgone by a factor derived from the ratio of total operating expenses to billed charges for patient care.
Schedule H, Part VI, Line 7 State filing of community benefit report MI
Schedule H (Form 990) 2016
Additional Data


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