4A (Expenses $ 435861013 including grants of $ 96436) (Revenue $ 314325788)
HENRY FORD HEALTH MACOMB HOSPITAL-CLINTON TOWNSHIP (HFMH) IS RECOGNIZED FOR ITS EXCELLENCE IN PROVIDING INPATIENT CARE TO THE RESIDENTS OF MACOMB COUNTY MICHIGAN AS WELL AS OTHER COMMUNITIES LOCATED NORTHEAST OF THE CITY OF DETROIT. DURING 2021, HFMH HAD 21,725 DISCHARGES.HFMH PROVIDES COMPREHENSIVE ACUTE AND TERTIARY CARE. SPECIALTY SERVICES INCLUDE A HEART & VASCULAR INSTITUTE, HENRY FORD CANCER INSTITUTE, A WOMEN'S HEALTH CENTER, ALONG WITH A BIRTHING CENTER THAT FEATURES 19 LABOR, DELIVERY, RECOVERY AND POST-PARTUM SUITES. THE HOSPITAL ALSO HAS A 37-BED INPATIENT REHABILITATION PROGRAM, AN AMBULATORY AND MINIMALLY INVASIVE SURGERY CENTER AND LEADING DIAGNOSTIC IMAGING, ALONG WITH ADVANCED TRAUMA CAPABILITIES AND EMERGENCY SERVICES.THE CORONAVIRUS IMPACT AND RESPONSEADDRESSING THE IMPACT OF COVID 19 ON ITS COMMUNITY HAS BEEN A PRIORITY FOR THE SYSTEM, FROM THE ADMISSION OF ITS FIRST COVID 19 PATIENT IN EARLY 2020, THROUGHOUT 2021, WITH ONGOING IMPLICATIONS EXPECTED TO CONTINUE THROUGHOUT 2022. IN 2021 THE VOLUME OF COVID 19 ADMITTED PATIENTS INITIALLY SHOWED A STEADY DECREASE UNTIL A THIRD SURGE BEGAN IN MARCH AND CONTINUED THROUGH JUNE. IN THE SECOND HALF OF 2021, THE SYSTEM EXPERIENCED A STEADY INCREASE IN COVID 19 CASES ASSOCIATED WITH BOTH THE DELTA AND OMICRON VARIANTS.DRIVEN BY THE ECONOMIC IMPACT OF COVID 19, FRONT LINE CLINICAL AND SUPPORT STAFF LABOR SHORTAGES INCREASINGLY IMPACTED SYSTEM OPERATIONS IN 2021. THIS HAS REQUIRED RELIANCE UPON PREMIUM PAY PRACTICES AND USE OF HIGHER COST TEMPORARY AND CONTRACT LABOR TO MAINTAIN THESE ESSENTIAL WORKERS. LABOR DISRUPTIONS ARE EXPECTED TO PERSIST THROUGH THE DURATION OF THE PANDEMIC AND THROUGHOUT 2022.THE SYSTEM CONTINUES TO MONITOR PATIENT AND MEMBER UTILIZATION INFORMATION TO SUPPORT ESTIMATING THE IMPACT OF COVID 19 ON OPERATIONS AND FINANCIAL PERFORMANCE. WE BELIEVE THAT OUR CASH RESOURCES, BORROWING CAPACITY, AND CASH FLOWS GENERATED FROM OPERATIONS WILL CONTINUE TO BE SUFFICIENT TO WITHSTAND THE FINANCIAL IMPACT OF THE PANDEMIC, AND WILL ENABLE US TO CONTINUE TO SUPPORT OUR OPERATIONS, REGULATORY REQUIREMENTS, DEBT REPAYMENT OBLIGATIONS, AND CAPITAL EXPENDITURES FOR THE FORESEEABLE FUTURE. THE SYSTEM TOOK THE MARKET LEADING POSITION OF REQUIRING ALL TEAM MEMBERS AND MEDICAL STAFF, STUDENTS, VOLUNTEERS, AND CONTRACTORS TO BE FULLY VACCINATED BY SEPTEMBER 10, 2021. THE SYSTEM REPORTED THAT 99 PERCENT OF ITS WORKFORCE WERE COMPLIANT WITH ITS COVID 19 VACCINATION REQUIREMENT. THIS FIGURE MEANS TEAM MEMBERS WERE EITHER FULLY VACCINATED, ON THE WAY TO COMPLETING A TWO-DOSE REGIMEN, OR RECEIVED AN APPROVED MEDICAL OR RELIGIOUS EXEMPTION.THE SYSTEM BELIEVES THAT THE KNOWLEDGE GAINED REGARDING EFFECTIVE AND SAFE CLINICAL PRACTICES AND TREATMENT PROTOCOLS AND THE INCREASING LEVEL OF VACCINATION AND IMMUNITY AMONGST OUR TEAM MEMBERS AND THE COMMUNITY POSITIONED THE SYSTEM WELL TO PROTECT OUR STAFF AND PATIENTS FROM VIRUS TRANSMISSION AND TO MAINTAIN FULL SCOPE OPERATIONS.DURING 2021, THE SYSTEM SERVED AS THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ANCHOR NETWORK PARTNER FOR THE MONOCLONAL ANTIBODY (MAB) PROGRAM IN SOUTHEAST AND SOUTHCENTRAL MICHIGAN. UNDER THIS PARTNERSHIP, THE SYSTEM EXPANDED AVAILABILITY OF MAB BY OPENING AN INFUSION CENTER IN SOUTHWEST DETROIT AT COMMUNITY HEALTH AND SOCIAL SERVICES, A FEDERALLY QUALIFIED HEALTH CENTER WHOSE PHYSICIAN SERVICES ARE CONTRACTED THROUGH THE SYSTEM AND EXPANDING PROGRAMS AT THREE OF ITS HOSPITALS THAT CARE FOR PATIENTS IN UNDERSERVED COMMUNITIES.IN APRIL 2021, THE SYSTEM ESTABLISHED A SPECIALTY CLINIC TO TREAT COVID 19 AND OTHER PATIENTS WHO HAVE LINGERING COGNITIVE, EMOTIONAL, AND MENTAL HEALTH CONDITIONS AFTER BEING HOSPITALIZED IN THE INTENSIVE CARE UNIT. AS AN INCREASING NUMBER OF COVID 19 PATIENTS RECOVER AND ARE DISCHARGED FROM THE HOSPITAL, IT IS ANTICIPATED THAT MANY WILL NEED LONG TERM HELP GETTING BACK TO A NORMAL STATE OF PHYSICAL AND MENTAL WELL-BEING. THE POST ICU BRAIN HEALTH CLINIC OPENED RECENTLY AT THE NEUROPSYCHOLOGY CENTERS IN DETROIT AND WEST BLOOMFIELD. CLINIC STAFF CONDUCT EVALUATIONS, MAKE RECOMMENDATIONS FOR TREATMENT, AND PROVIDE RESOURCES FOCUSING ON PATIENTS AGED 55 AND OLDER WHO CONTINUE TO EXPERIENCE COGNITIVE, BEHAVIORAL, OR PSYCHIATRIC SYMPTOMS. IN ADDITION, SERVICES ARE OFFERED TO CAREGIVERS THAT PROVIDE NEW TOOLS AND STRATEGIES FOR CARING FOR AND SUPPORTING THEIR LOVED ONE,ALONG WITH HOME HEALTH VISITS TO ASSIST PATIENTS WITH USING TELEMEDICINE.MEDICAL EDUCATION:HENRY FORD HEALTH HOSPITAL DOCTORS TRAIN APPROXIMATELY 900 MEDICAL SCHOOL STUDENTS, 675 RESIDENTS AND FELLOWS ACROSS 50 DIFFERENT AREAS OF MEDICINE EVERY YEAR. HENRY FORD HEALTH HOSPITAL RESIDENCY AND FELLOWSHIP PROGRAMS ARE NATIONALLY ACCREDITED M.D. (DOCTORATE OF MEDICINE) TRAINING PROGRAMS.HENRY FORD HEALTH MACOMB HOSPITALS HAVE AN OSTEOPATHIC GRADUATE MEDICAL EDUCATION PROGRAM, OFFERING ROTATIONS TO RESIDENTS, INTERNS AND THIRD-AND-FOUTH-YEAR MEDICAL STUDENTS.

4B (Expenses $ 74577685 including grants of $ 0) (Revenue $ 173580570)
HFMH PROVIDES OUTPATIENT SERVICES AT MULTIPLE LOCATIONS THROUGHOUT THE NORTH EASTERN METROPOLITAN COMMUNITIES OF DETROIT. IN TOTAL THIS REPRESENTED 885,082 TOTAL OUTPATIENT FACILITY VISITS DURING 2021.

4C (Expenses $ 44604767 including grants of $ 0) (Revenue $ 60897627)
HFMH OPERATES A LEVEL II EMERGENCY FACILITY. EMERGENCY SERVICES REPRESENTED 56,252 PATIENT VISITS DURING 2021.

4D (Expenses $ 46860883 including grants of $ 0) (Revenue $ 82441163)
OTHER PROGRAM SERVICES INCLUDE ANCILLARY SERVICES LOCATED WITHIN THE MEDICAL FACILITIES.

HENRY FORD HEALTH MACOMB HOSPITAL-CLINTON TWP
PART V, SECTION B, LINE 5: OUR METHODOLOGY FOR DATA COLLECTION INVOLVED REACHING OUT TO COMMUNITY EXPERTS AND OTHER MEMBERS OF COMMUNITY AGENCIES IN MACOMB COUNTY USING FOCUS GROUPS WHICH WERE CONDUCTED MARCH AND APRIL 2019. FOCUS GROUP PARTICIPANTS INCLUDED LEADERS FROM AGENCIES SUCH AS CARE OF SOUTHEASTERN MICHIGAN, MACOMB COUNTY OFFICE OF SUBSTANCE ABUSE, MACOMB COUNTY HEALTH DEPARTMENT, EASTERSEALS MICHIGAN AND MANY OTHERS. PARTICIPANTS HAD A WIDE RANGE OF EXPERTISE. FROM THEIR SURVEY RESPONSES WE GAINED INSIGHT INTO THE KINDS OF HEALTH ISSUES FACING OUR COMMUNITIES.OUR METHODOLOGY ALSO INCLUDED A WIDE VARIETY OF SECONDARY DATA SOURCES IN ADDITION TO RESULTS OBTAINED FROM SURVEY PARTICIPANTS IN WAYNE, OAKLAND, AND JACKSON COUNTIES. ADDITIONALLY, WE LOCATED STATE HEALTH NEEDS DATA FOR HF HEALTH USING THE MICHIGAN BEHAVIORAL RISK FACTOR SURVEY AND MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES PROFILES AMONG OTHER SOURCES. DATA FROM THESE SOURCES CAN BE FOUND IN THE APPENDIX.

HENRY FORD HEALTH MACOMB HOSP-MOUNT CLEMENS
PART V, SECTION B, LINE 5: OUR METHODOLOGY FOR DATA COLLECTION INVOLVED REACHING OUT TO COMMUNITY EXPERTS AND OTHER MEMBERS OF COMMUNITY AGENCIES IN MACOMB COUNTY USING FOCUS GROUPS WHICH WERE CONDUCTED MARCH AND APRIL 2019. FOCUS GROUP PARTICIPANTS INCLUDED LEADERS FROM AGENCIES SUCH AS CARE OF SOUTHEASTERN MICHIGAN, MACOMB COUNTY OFFICE OF SUBSTANCE ABUSE, MACOMB COUNTY HEALTH DEPARTMENT, EASTERSEALS MICHIGAN AND MANY OTHERS. PARTICIPANTS HAD A WIDE RANGE OF EXPERTISE. FROM THEIR SURVEY RESPONSES WE GAINED INSIGHT INTO THE KINDS OF HEALTH ISSUES FACING OUR COMMUNITIES.OUR METHODOLOGY ALSO INCLUDED A WIDE VARIETY OF SECONDARY DATA SOURCES IN ADDITION TO RESULTS OBTAINED FROM SURVEY PARTICIPANTS IN WAYNE, OAKLAND, AND JACKSON COUNTIES. ADDITIONALLY, WE LOCATED STATE HEALTH NEEDS DATA FOR HF HEALTH USING THE MICHIGAN BEHAVIORAL RISK FACTOR SURVEY AND MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES PROFILES, AMONG OTHER SOURCES. DATA FROM THESE SOURCES CAN BE FOUND IN THE APPENDIX.

HENRY FORD HEALTH MACOMB HOSPITAL-CLINTON TWP
PART V, SECTION B, LINE 6A: HENRY FORD HEALTH HOSPITALHENRY FORD HEALTH WYANDOTTE HOSPITALHENRY FORD HEALTH WEST BLOOMFIELD HOSPITALHENRY FORD HEALTH KINGSWOOD HOSPITALHENRY FORD HEALTH JACKSON HOSPITALHENRY FORD HEALTH ALLEGIANCE SPECIALTY HOSPITALHENRY FORD HEALTH COTTAGE HOSPITAL/MEDICAL CENTER

HENRY FORD HEALTH MACOMB HOSPITAL-CLINTON TWP
PART V, SECTION B, LINE 11: THE CHNA WAS CONDUCTED IN 2019 IN PARTNERSHIP WITH THE MACOMB COUNTY HEALTH DEPARTMENT AND THEIR COMMUNITY HEALTH IMPROVEMENT PLAN WORKGROUPS. SEVERAL SIGNIFICANT HEALTH NEEDS WITHIN THE SERVICE AREA OF HENRY FORD HEALTH MACOMB HOSPITAL(HFMH) WERE IDENTIFIED. HEALTH NEEDS WERE PRIORITIZED BASED ON SEVERAL CRITERIA INCLUDING IMPORTANCE GIVEN TO HEALTH ISSUES BY FOCUS GROUP AND SURVEY PARTICIPANTS, STATISTICAL DATA FROM THE STATE OF MICHIGAN, AS WELL AS INPUT FROM HF HEALTH AND COMMUNITY LEADERS. HENRY FORD HEALTH MACOMB'S RESOURCES AND OVERALL ALIGNMENT WITH THE HENRY FORD HEALTH MISSION, VISION, GOALS AND STRATEGIC PRIORITIES WERE TAKEN INTO CONSIDERATION WHEN IDENTIFYING THE TOP THREE MOST SIGNIFICANT HEALTH ISSUES TO BE ADDRESSED: HEALTHY LIFESTYLES & DIABETES, SUBSTANCE ABUSE & MENTAL HEALTH AND HEART DISEASE. HENRY FORD HEALTH MACOMB WILL FOCUS ON DEVELOPING AND SUPPORTING INITIATIVES AND MEASURE THEIR EFFECTIVENESS TO IMPROVE THESE HEALTH NEEDS. IN TERMS OF SIGNIFICANT HEALTH NEEDS THAT WILL NOT BE ADDRESSED, HENRY FORD HEALTH MACOMB ACKNOWLEDGES THE WIDE RANGE OF HEALTH CONCERNS THAT EMERGED FROM THE CHNA PROCESS, AND DETERMINED IT COULD MOST EFFECTIVELY FOCUS ON THOSE HEALTH NEEDS THAT WERE DETERMINED TO BE MOST URGENT AND ESSENTIAL TO THE HEALTH OF THE COMMUNITY AS WELL AS WITHIN ITS ABILITY TO INFLUENCE. WHILE MOST OF THESE ADDITIONAL HEALTH ISSUES ARE CURRENTLY BEING ADDRESSED BY EXISTING PROGRAMS AND INITIATIVES OF HFMH OR A PARTNER ORGANIZATION, HFMH WILL NOT TAKE NEW OR SPECIFIC, ADDITIONAL ACTIONS RELATED TO THE FOLLOWING HEALTH NEEDS: KIDNEY DISEASE, FAMILY PLANNING, ASTHMA AND ALZHEIMER'S DISEASE.

HENRY FORD HEALTH MACOMB HOSP-MOUNT CLEMENS
PART V, SECTION B, LINE 11: THE CHNA WAS CONDUCTED IN 2019 IN PARTNERSHIP WITH THE MACOMB COUNTY HEALTH DEPARTMENT AND THEIR COMMUNITY HEALTH IMPROVEMENT PLAN WORKGROUPS. SEVERAL SIGNIFICANT HEALTH NEEDS WITHIN THE SERVICE AREA OF HENRY FORD HEALTH MACOMB HOSPITAL (HFMH) WERE IDENTIFIED. HEALTH NEEDS WERE PRIORITIZED BASED ON SEVERAL CRITERIA INCLUDING IMPORTANCE GIVEN TO HEALTH ISSUES BY FOCUS GROUP AND SURVEY PARTICIPANTS, STATISTICAL DATA FROM THE STATE OF MICHIGAN, AS WELL AS INPUT FROM HF HEALTH AND COMMUNITY LEADERS. HENRY FORD HEALTH MACOMB'S RESOURCES AND OVERALL ALIGNMENT WITH THE HENRY FORD HEALTH MISSION, VISION, GOALS AND STRATEGIC PRIORITIES WERE TAKEN INTO CONSIDERATION WHEN IDENTIFYING THE TOP THREE MOST SIGNIFICANT HEALTH ISSUES TO BE ADDRESSED: HEALTHY LIFESTYLES & DIABETES, SUBSTANCE ABUSE & MENTAL HEALTH AND HEART DISEASE. HENRY FORD HEALTH MACOMB WILL FOCUS ON DEVELOPING AND SUPPORTING INITIATIVES AND MEASURE THEIR EFFECTIVENESS TO IMPROVE THESE HEALTH NEEDS. IN TERMS OF SIGNIFICANT HEALTH NEEDS THAT WILL NOT BE ADDRESSED, HENRY FORD HEALTH MACOMB ACKNOWLEDGES THE WIDE RANGE OF HEALTH CONCERNS THAT EMERGED FROM THE CHNA PROCESS, AND DETERMINED IT COULD MOST EFFECTIVELY FOCUS ON THOSE HEALTH NEEDS THAT WERE DETERMINED TO BE MOST URGENT AND ESSENTIAL TO THE HEALTH OF THE COMMUNITY AS WELL AS WITHIN ITS ABILITY TO INFLUENCE. WHILE MOST OF THESE ADDITIONAL HEALTH ISSUES ARE CURRENTLY BEING ADDRESSED BY EXISTING PROGRAMS AND INITIATIVES OF HFMH OR A PARTNER ORGANIZATION, HFMH WILL NOT TAKE NEW OR SPECIFIC, ADDITIONAL ACTIONS RELATED TO THE FOLLOWING HEALTH NEEDS: KIDNEY DISEASE, FAMILY PLANNING, ASTHMA AND ALZHEIMER'S DISEASE.

HENRY FORD HEALTH MACOMB HOSPITAL-CLINTON TWP
PART V, SECTION B, LINE 13B: HENRY FORD HEALTH MACOMB HOSPITAL-CLINTON TOWNSHIP ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNTED RATE THAT DOES NOT EXCEED 138% OF MEDICARE PAYMENT RATES. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES.PART V, SECTION B, LINE 22A:HENRY FORD MACOMB HEALTH HOSPITAL-CLINTON TOWNSHIP ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNTED RATE THAT DOES NOT EXCEED 138% OF MEDICARE PAYMENT RATES. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES.

HENRY FORD HEALTH MACOMB HOSP-MOUNT CLEMENS
PART V, SECTION B, LINE 13B: HENRY FORD HEALTH MACOMB HOSPITAL-MOUNT CLEMENS ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNTED RATE THAT DOES NOT EXCEED 138% OF MEDICARE PAYMENT RATES. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES. PART V, SECTION B, LINE 22A:HENRY FORD HEALTH MACOMB HOSPITAL-MOUNT CLEMENS ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNTED RATE THAT DOES NOT EXCEED 138% OF MEDICARE PAYMENT RATES. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES.

PART V, LINE 10A
HTTPS://WWW.HENRYFORD.COM/ABOUT/COMMUNITY-HEALTH/NEEDS-ASSESSMENT

PART I, LN 7 COL(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 $12,962,635

PART II, COMMUNITY BUILDING ACTIVITIES:
HFMH BELIEVES THAT THE STRENGTH AND VITALITY OF A COMMUNITY HAS A SIGNIFICANT IMPACT ON THE BEHAVIORS OF ITS RESIDENTS AND THAT THERE IS DIRECT CORRELATION BETWEEN THE VIABILITY OF A COMMUNITY AND THE ATTITUDE OF ITS RESIDENTS TOWARD HEALTHIER BEHAVIORS. THEREFORE, HFMH INCLUDES IN ITS COMMITMENT TO COMMUNITY BENEFIT A FOCUS ON DIRECT INVOLVEMENT IN THE COMMUNITY TO BOTH IMPROVE THE ENVIRONMENT AND ENSURE THAT CRITICAL MESSAGES ON THE BENEFITS OF HEALTHIER BEHAVIORS ARE HEARD. HFMH LEADERS COLLABORATE WITH COMMUNITY TASK FORCES AND COALITIONS IN ADDRESSING THE NEEDS OF OUR SERVICE AREA.

PART III, LINE 2:
THE ORGANIZATION'S BAD DEBT EXPENSE IS STATED BASE UPON GROSS CHARGES.

PART III, LINE 4:
IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR 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 ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. AT SUCH POINT IN TIME THAT A BILLED SERVICE IS BELIEVED TO BE UNCOLLECTIBLE, THE RELATED RECEIVABLE IS WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ESTIMATES OF RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS ARE ACCRUED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE RECEIVED.FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE ORGANIZATION OFFERS A DISCOUNT OFF STANDARD RATES FOR SERVICES PROVIDED THAT RESULT IN NET CHARGES THAT DO NOT EXCEED 138% OF MEDICARE RATES.

PART III, LINE 9B:
"SHOULD A PATIENT BE DEEMED ELIGIBLE FOR ASSISTANCE ANY COLLECTION EFFORTS ASSOCIATED WITH THE QUALIFYING SERVICE ARE SUSPENDED. IF THE PATIENT IS DETERMINED TO QUALIFY UNDER THE ORGANIZATION'S CHARITY CARE POLICY PRIOR TO BILLING, NO BILL IS EVER GENERATED AND THEREFORE THE ELEMENTS OF THE COLLECTION POLICY ARE NEVER INVOKED. WHEN THE DETERMINATION IS NOT MADE PRIOR TO BILLING, THE ORGANIZATION'S COLLECTION POLICY WOULD APPLY. THIS POLICY READS IN PART:- ""PATIENTS WILL BE EVALUATED FOR THE SYSTEM'S PATIENT FINANCIAL ASSISTANCE PROGRAM""- ""UNINSURED PATIENTS WILL BE GIVEN A DISCOUNT""- ""UNDERINSURED PATIENTS MAY QUALIFY FOR DISCOUNTED SERVICES BASED UPON THEIR AGGREGATE HOUSEHOLD INCOME""- ""THE ORGANIZATION WILL REVIEW THE PATIENTS'S RECORD TO DETERMINE IF REASONABLE EFFORTS WERE UNDERTAKEN TO ENSURE THAT FINANCIAL ASSISTANCE WAS OFFERED AND/OR IF FINANCIAL ASSISTANCE IS REQUESTED""- ""LEGAL ACTION...MAY BE TAKEN...WHEN THERE IS EVIDENCE THAT THE PATIENT OR RESPONSIBLE PARTY HAS INCOME AND/OR ASSETS TO MEET HIS OR HER OBLIGATION""- ""THE ORGANIZATION WILL NOT FORCE THE SALE OR FORECLOSURE OF ANY PATIENT OR GUARANTOR'S PRIMARY RESIDENCE TO PAY AN OUTSTANDING MEDICAL BILL""- ""THE ORGANIZATION WILL NOT...REQUIRE THE PATIENT OR RESPONSIBLE PARTY TO APPEAR IN COURT""- ""THE ORGANIZATION WILL DIRECT THEIR COLLECTION AGENCIES TO FOLLOW THESE GUIDELINES"""

PART VI, LINE 2:
HENRY FORD HEALTH (HF HEALTH) CONSIDERS THE ONGOING ASSESSMENT OF COMMUNITY HEALTH NEEDS AS AN ESSENTIAL FUNCTION. HENRY FORD HEALTH MACOMB HOSPITAL WAS ENCOMPASSED IN THE HF HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT. IT PROVIDES KEY INFORMATION REGARDING THE DEMOGRAPHICS AND MAJOR NEEDS OF THE COMMUNITIES SERVED, IT SUPPORTS THE PRIORITIZATION OF THE SERVICES MADE AVAILABLE, AND IT HELPS TARGET POPULATIONS WITH THE MOST VULNERABILITY TO HEALTH NEEDS SUCH AS THE POOR, UNINSURED, AS WELL AS VARIOUS OTHER POPULATIONS THAT MAY HAVE BEEN OVERLOOKED. THE COMMUNITY HEALTH NEEDS ASSESSMENT ALSO PROVIDES VALUABLE INFORMATION REGARDING OTHER ORGANIZATIONS SUPPORTING THE NEEDS WITHIN THE COMMUNITY SO PROGRAMS CAN BE COORDINATED AND LEVERAGED TO ENSURE THAT EVERY DOLLAR IS INVESTED WISELY.INTERNALLY THE COMMUNITY HEALTH ANCHOR COUNCIL ENTERPRISE (CHANCE) PROVIDES EXECUTIVE OVERSIGHT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR HENRY FORD HEALTH. THE CHNA WAS COMPLETED IN SEVERAL PHASES. THE FIRST PHASE INCLUDED DATA COLLECTION FROM A VARIETY OF PUBLIC AND PROPRIETARY SOURCES THAT PROVIDED INFORMATION AROUND POPULATION DEMOGRAPHICS, SOCIOECONOMIC DATA, HEALTH STATUS INDICATORS AS WELL AS SEVERAL OTHER DATA ELEMENTS. THE SECOND PHASE INVOLVED DEVELOPING AND DISTRIBUTING A KEY STAKEHOLDER SURVEY TO CAPTURE COMMUNITY ORGANIZATION AND COALITION INPUT AS TO MAJOR HEALTH NEEDS THEY BELIEVE SHOULD BE PRIORITIZED AND ADDRESSED IN THE FOUR-COUNTY AREA. THE THIRD PHASE INCORPORATED QUANTITATIVE AND QUALITATIVE DATA COLLECTED IN THE FIRST TWO PHASES AND BASED ON THIS INFORMATION IDENTIFIED PRIORITIES FOR HENRY FORD HEALTH TO ADDRESS WITHIN THE COMMUNITIES IT SERVES. THIS ASSESSMENT WAS PREPARED JOINTLY BY THE HF HEALTH BUSINESS INTEGRITY SERVICES AND CORPORATE STRATEGIC PLANNING DEPARTMENTS, ALONG WITH THE OFFICE OF COMMUNITY HEALTH, EQUITY AND WELLNESS. RESULTS ARE BEING USED AS A FOUNDATION FOR PLANNING, DEVELOPING, AND REFINING HF HEALTH'S FUTURE COMMUNITY SERVICES IN THE FOUR-COUNTY AREAS. RESULTS OF THIS ASSESSMENT HAVE BEEN REVIEWED WITH SEVERAL HENRY FORD HEALTH LEADERS, LEADING TO STRATEGIC AND IMPLEMENTATION PLAN MODIFICATIONS TO ALIGN STRATEGY WITH IDENTIFIED NEEDS

PART VI, LINE 6:
THE SYSTEM DEMONSTRATES ITS EXEMPT PURPOSE TO BENEFIT THE COMMUNITY BY OPERATING EMERGENCY ROOMS OPEN TO THE PUBLIC 24 HOURS A DAY, 7 DAYS A WEEK; PROVIDING FACILITIES FOR THE EDUCATION AND TRAINING OF HEALTH CARE PROFESSIONALS; AND MAINTAINING RESEARCH FACILITIES FOR THE STUDY OF NEW DRUGS AND MEDICAL DEVICES THAT OFFER THE PROMISE OF IMPROVING HEALTH CARE. THE SYSTEM ALSO PROVIDES COMMUNITY HEALTH SERVICES, SUCH AS COMMUNITY EDUCATION AND OUTREACH IN THE FORM OF FREE OR LOW-COST CLINICS; HEALTH EDUCATION TELEVISION PROGRAMMING; DONATIONS FOR THE COMMUNITY; MULTIPLE HEALTH PROMOTION AND WELLNESS PROGRAMS, SUCH AS HEALTH SCREENING; AND VARIOUS COMMUNITY PROJECTS AND SUPPORT GROUPS.

PART VI, LINE 3:
HFMH HAS VARIOUS APPROACHES TO TARGET AND INFORM RESIDENTS OF ITS COMMUNITIES ABOUT THE PROGRAMS AND SERVICES IT OFFERS. PROGRAMS WHERE WE PARTNER WITH ORGANIZATIONS WITH ESTABLISHED RELATIONSHIPS WITH THE INDIVIDUALS SUCH AS THROUGH COMMUNITY HEALTH CENTERS, THE PUBLIC SCHOOLS AND FAITH-BASED ORGANIZATIONS HAVE BEEN PARTICULARLY SUCCESSFUL. HFMH FOLLOWS THE HF HEALTH PATIENT FINANCIAL ASSISTANCE POLICY. HF HEALTH HAS A SINGULAR PATIENT FINANCIAL ASSISTANCE POLICY (PFAP). INDIVIDUALS WITHOUT ADEQUATE HEALTH INSURANCE COVERAGE MOST FREQUENTLY APPEAR IN OUR EMERGENCY ROOM FOR SERVICES, ALL PATIENTS ARE SEEN WITHOUT REGARD TO ABILITY TO PAY. INTAKE STAFF IS TRAINED WITH REGARD TO HOW TO APPROACH AND ENGAGE AN INDIVIDUAL WHEN THERE IS AN APPARENT LACK OF ADEQUATE HEALTH COVERAGE. THIS INCLUDES INFORMING THEM OF THE PROGRAMS OFFERED BY HFMH AS WELL AS OTHER COMMUNITY, LOCAL, STATE AND FEDERAL PROGRAMS OFFERING POTENTIAL SUPPORT. HFMH HAS DEDICATED STAFF RESPONSIBLE TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR SUPPORTIVE PROGRAMS AND ASSIST THEM WITH THE ENROLLMENT PROCESS. THERE ARE MANY REASONS WHY A PATIENT IN NEED OF FINANCIAL ASSISTANCE WITH THEIR MEDICAL CARE MAY NOT HAVE BEEN IDENTIFIED AT THE TIME OF THE CARE DELIVERY. PATIENT FINANCIAL SERVICE AND COLLECTION STAFFS ARE TRAINED TO RECOGNIZE THESE INDIVIDUALS AND PROVIDE THEM WITH ADVICE REGARDING THE VARIOUS OPTIONS AVAILABLE TO SUPPORT THEIR CARE NEEDS.

PART VI, LINE 4:
THE FOUR-COUNTY AREA INCLUDES THE COUNTIES OF WAYNE, OAKLAND, MACOMB, AND JACKSON WHICH ARE LOCATED IN SOUTHEASTERN AND SOUTHCENTRAL MICHIGAN AND ACCOUNT FOR 41% OF THE MICHIGAN POPULATION. WAYNE, OAKLAND, AND MACOMB (IN THAT ORDER) ARE THE MOST POPULATED COUNTIES IN MICHIGAN. JACKSON COUNTY IS MUCH SMALLER. OF THE NEARLY 4 MILLION RESIDENTS, APPROXIMATELY 51% OF THE POPULATION IS FEMALE. WITH REGARD TO RACE/ETHNICITY, THE FOUR-COUNTY AREA IS 64% WHITE, COMPARED TO A NATIONAL AVERAGE OF 60%. OF NOTE, THE FOUR-COUNTY AREA IS 24% BLACK, WHICH IS TWICE THE NATIONAL PERCENTAGE OF 12%. CONVERSELY, THE HISPANIC POPULATION (5.0%) IS A LITTLE UNDER ONE THIRD THE NATIONAL PERCENTAGE OF 18%.THE NUMBER OF FOUR-COUNTY RESIDENTS IS EXPECTED TO REMAIN FLAT OVER THE NEXT SEVERAL YEARS. WHEN EXAMINING AGE DISTRIBUTION, THE FOUR-COUNTY AREA HAS A COMPARABLE POPULATION TO THAT OF THE COUNTRY WITH 17% OF THE POPULATION ABOVE THE AGE OF 65. OF PARTICULAR INTEREST TO HEALTHCARE PROVIDERS IS THE AGING POPULATION OF THE FOUR-COUNTY AREA WITH THE 65-YEARS-OLD AND ABOVE POPULATION EXPECTED TO RISE BY 15% FROM 2019 TO 2024.WITH REGARDS TO EDUCATION, THE FOUR-COUNTY AREA HAS APPROXIMATELY 11% OF RESIDENTS WHO HAVE SOME HIGH SCHOOL EDUCATION OR LESS COMPARED TO THE NATIONAL AVERAGE OF 13%. FURTHER, 29% OF RESIDENTS HAVE A BACHELOR'S DEGREE OR GREATER, WHICH IS COMPARABLE TO THE NATIONAL AVERAGE. THE FOUR-COUNTY AREA IS DIVERSE IN POPULATION, RACE/ETHNICITY, ECONOMIC GROWTH AND DEVELOPMENT. THE AUTOMOTIVE INDUSTRY REMAINS THE LARGEST EMPLOYER IN THE REGION, BUT THE HEALTH CARE SECTOR IS REPRESENTED AMONG THE TOP EMPLOYERS IN THE REGION AS WELL. THE AVERAGE MEDIAN HOUSEHOLD INCOME WITHIN THE FOUR-COUNTY AREA ($56,240) IS SLIGHTLY LESS THAN THE NATIONAL AVERAGE ($57,652). WITHIN THE FOUR-COUNTY AREA, THE MEDIAN HOUSEHOLD INCOME IN OAKLAND COUNTY ($73,369) IS SIGNIFICANTLY HIGHER THAN WAYNE COUNTY ($43,702), JACKSON COUNTY ($49,715) AND MACOMB COUNTY ($58,175). AT THE ZIP CODE LEVEL, AVERAGE HOUSEHOLD INCOMES VARY SIGNIFICANTLY.LOWER HOUSEHOLD INCOMES NEGATIVELY IMPACT PURCHASING POWER, HEALTH INSURANCE COVERAGE, AND COSTS OF BASIC NECESSITIES. AS A RESULT, THE FOUR-COUNTY AREA'S SAFETY NETS, INCLUDING HEALTHCARE SYSTEMS, ARE BEING STRETCHED TO THE LIMIT. MICHIGAN RANKS 33RD IN THE COUNTRY FOR CHILDREN UNDER 18 IN FAMILIES BELOW THE POVERTY LEVEL, AT 19.3%, A 3% IMPROVEMENT FROM 2016. UNEMPLOYMENT IN MICHIGAN HAS DROPPED TO 4.6% IN 2018, WHICH IS SIMILAR TO THE NATIONAL AVERAGE AND A DECLINE OF 0.8% SINCE 2016 IN MICHIGAN. CONVERSELY, WITHIN THE FOUR-COUNTY AREA THE UNEMPLOYMENT RATE MATCHES THE NATIONAL AVERAGE OF 4% AND RANGES FROM 3.2% IN OAKLAND COUNTY TO 5.0% IN WAYNE COUNTY.THERE ARE KEY DEMOGRAPHIC DIFFERENCES BETWEEN THE RESIDENTS OF EACH COUNTY WITHIN THE FOUR-COUNTY AREA. FOR EXAMPLE, AGE, SEX, EDUCATION, AND INCOME DISTRIBUTION DIFFER FROM COUNTY TO COUNTY. IN ORDER TO INCREASE THE UTILITY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, IT IS IMPORTANT TO ANALYZE THE PROFILE(S) OF EACH OF THESE COUNTIES AT A MORE DETAILED LEVEL, SUCH AS ZIP CODES, SO THAT CERTAIN DIFFERENCES WITHIN THE AREA BECOME EVIDENT.ONE COMMUNITY IN PARTICULAR NEED OF ATTENTION IS THE CITY OF DETROIT. WHEN EXAMINING THE CITY OF DETROIT THE AVERAGE HOUSEHOLD INCOME IS $40,314, WHICH IS SIGNIFICANTLY LESS THAN AVERAGE HOUSEHOLD INCOME OF THE OVERALL FOUR-COUNTY AREA ($68,064). REGARDING EDUCATION, 23% OF RESIDENTS HAVE LESS THAN A HIGH SCHOOL EDUCATION AND ONLY 14% HAVE A BACHELOR'S DEGREE OR HIGHER. IN TERMS OF RACE/ETHNICITY, APPROXIMATELY 91% OF DETROIT IS COMPOSED OF A MINORITY POPULATION VERSUS 37% FOR THE FOUR-COUNTY AREA AS A WHOLE. THE DETROIT UNEMPLOYMENT RATE IS 7.9% (NOVEMBER 2018), DOWN FROM 11.5% IN SEPTEMBER 2015.WHEN LOOKING OUTSIDE OF THE CITY OF DETROIT, VARIOUS OTHER ZIP CODES IN THE FOUR-COUNTY AREA INDICATE SECTIONS OF THE REGION THAT HAVE LOWER INCOMES, LESS EDUCATION, AND ARE MORE RACIALLY AND ETHNICALLY DIVERSE. THE AVERAGE HOUSEHOLD INCOME OF THESE ZIP CODES RANGES FROM $29,486-$54,251, LOWER THAN THE FOUR-COUNTY SERVICE AREA. OVERALL, 17% OF RESIDENTS IN THESE ZIP CODES HAVE LESS THAN A HIGH SCHOOL EDUCATION COMPARED TO 11% FOR THE FOUR-COUNTY AREA. THESE TWENTY ZIP CODES HAVE A SLIGHTLY DIFFERENT PERCENTAGE OF RACIAL/ETHNIC MINORITIES AS COMPARED TO THE REST OF THE FOUR-COUNTY AREA. AS A WHOLE THESE ZIP CODES ARE COMPOSED OF 40% MINORITIES COMPARED TO 36% FOR THE FOUR-COUNTY AREA.AS A RESULT, THE CITY OF DETROIT AND ABOVE TWENTY ZIP CODES ARE OF PARTICULAR INTEREST IN PLANNING COMMUNITY NEEDS INITIATIVES WITHIN THE FOUR-COUNTY AREA.

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"HENRY FORD HEALTH MACOMB HOSPITALS (HFMH) ARE PART OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH (""HF HEALTH""), ONE OF THE NATION'S LARGEST INTEGRATED HEALTH DELIVERY SYSTEMS SERVING ALL OF SOUTHEASTERN MICHIGAN. THIS TAX RETURN REFLECTS ACTIVITIES OF THE CLINTON TOWNSHIP CAMPUS OF HFMH, WHICH INCLUDES 451 INPATIENT BEDS WITH AN OPEN MEDICAL STAFF, A BEHAVIORAL HEALTH FACILITY, AS WELL AS SEVERAL OUTPATIENT LOCATIONS SERVING THE MACOMB COUNTY AREA OF MICHIGAN. HFMH IS GOVERNED BY A DEDICATED VOLUNTEER COMMUNITY BOARD AND IT PROVIDES ITS COMMUNITIES WITH A FULL RANGE OF CLINICAL SERVICES INCLUDING GENERAL MEDICINE, SURGERY, OBSTETRICS, PEDIATRICS, CARDIAC CARE, PHYSICAL AND REHABILITATION MEDICINE, AMBULATORY SURGERY, INPATIENT AND OUTPATIENT BEHAVIORAL SERVICES, AND 24 HOUR EMERGENCY CARE."