4A (Expenses $ 1767215582 including grants of $ 2154760) (Revenue $ 2168707468)
SPECTRUM HEALTH SYSTEM GROUP REFLECTS THE COMPOSITE INFORMATION AND OPERATIONS OF FIFTEEN TAX EXEMPT ENTITIES, INCLUDING 10 SEPARATELY LICENSED HOSPITALS, A SKILLED NURSING FACILITY, LONG-TERM ACUTE REHABILITATION AND HOME CARE, A MULTISPECIALTY PHYSICIAN GROUP, AND A CHARITABLE FOUNDATION. THE SPECTRUM HEALTH SYSTEM GROUP INCLUDES MORE THAN 170 SERVICES SITES, PHYSICIAN OFFICES AND OUTPATIENT LOCATIONS, PROVIDING CONVENIENT ACCESS TO SERVICES THROUGHOUT OUR 13-COUNTY SERVICE AREA. DURING THE FISCAL YEAR ENDED JUNE 30, 2014 THE SPECTRUM HEALTH INTEGRATED HEALTH SYSTEM PROVIDED $295 MILLION IN COMMUNITY BENEFIT PROGRAMS TO WEST MICHIGAN. THE COMMUNITY BENEFIT ACTIVITIES INCLUDED HEALTH CLINICS, RESEARCH, DONATIONS, CHARITY CARE, BAD DEBTS RELATED TO CARING FOR THE UNINSURED AND UNDERINSURED, COSTS FOR GOVERNMENT PROGRAM PATIENTS, COMMUNITY PARTNERSHIP PROGRAMS, AND HEALTH PROFESSION EDUCATION. SPECTRUM HEALTH HOSPITAL GROUP - SEE SCHEDULE O

4B (Expenses $ 410402009 including grants of $ 0) (Revenue $ 274641491)
SPECTRUM HEALTH MEDICAL GROUP - SEE SCHEDULE O

4C (Expenses $ 2339623 including grants of $ 1310562) (Revenue $ 0)
SPECTRUM HEALTH FOUNDATION - SEE SCHEDULE O

Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment
(1) A - SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT AND SPECTRUM HEALTH KENT COMMUNITY CAMPUS: THE QUALITATIVE DATA COLLECTION PROCESS INVOLVED CONDUCTING FOCUS GROUPS, BRIEF INTERCEPT INTERVIEWS, AND COMMUNITY INPUT WALLS WITH COMMUNITY MEMBERS. EACH OF THESE METHODS ARE DESCRIBED IN DETAIL ALONG WITH THE QUESTIONS USED IN THE KENT COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOCUS GROUPS WERE FACILITATED BY A MICHIGAN PUBLIC HEALTH INSTITUTE (MPHI) RESEARCHER TO GENERATE COMMUNITY INPUT FROM VARIOUS POPULATION GROUPS ABOUT HEALTH AND WELLBEING IN KENT COUNTY. 12 SMALL FOCUS GROUPS WERE CONDUCTED WITH 119 COMMUNITY MEMBERS PARTICIPATING. INTERVIEWERS CONDUCTED 395 INTERCEPT INTERVIEWS IN THREE LANGUAGES BY TRAINED COMMUNITY MEMBERS. MPHI PROVIDED INTERVIEWERS WITH THE INTERVIEW MATERIALS NEEDED, AS WELL AS TECHNICAL ASSISTANCE. COMPLETED INTERVIEWS WERE RETURNED TO MPHI FOR ANALYSIS. COMMUNITY INPUT WALLS WERE CONDUCTED BY GATHERING INPUT FROM COMMUNITY MEMBERS DIRECTLY BY POSTING LARGE SHEETS OF PAPER IN A PUBLIC SPACE AND ASKING COMMUNITY MEMBERS TO ANSWER QUESTIONS ABOUT COMMUNITY HEALTH BY WRITING THEIR THOUGHTS ON THE WALL. THE COMMUNITY INPUT WALL PROCESS WAS COMPLETED FOUR TIMES. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE STEERING COMMITTEE INCLUDING KENT, IONIA, AND OTTAWA COUNTY HEALTH DEPARTMENTS, MPHI, ALLIANCE FOR HEALTH, AND THE COMMUNITY RESEARCH INSTITUTE OF GRAND VALLEY STATE UNIVERSITY. FOR A LISTING OF ALL INDIVIDUALS AND SOURCES CONSULTED, SEE APPENDICES A & B OF THE KENT COUNTY CHNA. ; (2) A - SPECTRUM HEALTH UNITED AND SPECTRUM HEALTH KELSEY: PRIMARY AND SECONDARY DATA WERE IDENTIFIED, COLLECTED AND ANALYZED, WHICH INCLUDED THE DEVELOPMENT AND DISTRIBUTION OF A COMMUNITY AND HEALTH CARE PROVIDER SURVEY. THE COMMUNITY SURVEY WAS MAILED TO 500 RANDOMLY SELECTED HOUSEHOLDS WITHIN MONTCALM COUNTY WITH 424 RETURNED BY MAIL FOR ANALYSIS. AN ADDITIONAL 51 SURVEYS WERE COMPLETED AND RETURNED FROM CLIENTS OF LOCAL SERVICE AGENCIES FOR A TOTAL OF 475 SURVEYS USED FOR ANALYSIS. COUNTY SPECIFIC SECONDARY DATA FROM A VARIETY OF SOURCES WAS ALSO COLLECTED AND ANALYZED. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE STEERING COMMITTEE INCLUDING MIDMICHIGAN DISTRICT HEALTH DEPARTMENT, UNITED WAY, AND THE DEPARTMENT OF HUMAN SERVICES. FOR THE ENTIRE LISTING OF INDIVIDUALS, SEE THE MONTCALM COUNTY CHNA. ; (3) A - SPECTRUM HEALTH GERBER MEMORIAL: DATA WAS GATHERED FROM A VARIETY OF SOURCES AND USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA FOCUS GROUPS. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS OR KEY INFORMANTS, PROVIDED INPUT VIA IN-DEPTH INTERVIEWS AND AN ONLINE SURVEY. SECONDARY DATA GATHERED FROM STATE AND NATIONAL DATABASES WAS ALSO USED TO SUPPLEMENT THE OVERALL FINDINGS. LOCAL HOSPITAL UTILIZATION DATA WAS ALSO USED. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE-LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUBPOPULATIONS IMPACTED MOST BY ISSUES IN HEALTH CARE. FOR A LISTING OF ALL INDIVIDUALS AND SOURCES CONSULTED, SEE THE NEWAYGO COUNTY CHNA. ; (4) A - SPECTRUM HEALTH REED CITY: DATA WAS GATHERED FROM A VARIETY OF SOURCES AND USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS OBTAINED VIA FOCUS GROUPS. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS OR KEY INFORMANTS, PROVIDED INPUT VIA IN-DEPTH INTERVIEWS AND AN ONLINE SURVEY. SECONDARY DATA GATHERED FROM STATE AND NATIONAL DATABASES WAS ALSO USED TO SUPPLEMENT THE OVERALL FINDINGS. LOCAL HOSPITAL UTILIZATION DATA WAS ALSO USED. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE. ADDITIONALLY KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE-LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUBPOPULATIONS IMPACTED MOST BY ISSUES IN HEALTH CARE. FOR A LISTING OF ALL INDIVIDUALS AND SOURCES CONSULTED, SEE THE LAKE/OSCEOLA COUNTY CHNA. ; (5) A - SPECTRUM HEALTH ZEELAND: DATA WAS GATHERED FROM A VARIETY OF SOURCES AND USING MULTIPLE METHODOLOGIES. FEEDBACK WAS OBTAINED FROM COMMUNITY RESIDENTS INCLUDING PROVIDERS, LOW INCOME, HISPANIC, SENIOR ADULTS AND AT-HOME PARENTS VIA A BEHAVIORAL RISK FACTOR SURVEY AND FOCUS GROUPS. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS OR KEY INFORMANTS, PROVIDED INPUT VIA IN-DEPTH INTERVIEWS AND AN ONLINE SURVEY. SECONDARY DATA GATHERED FROM STATE AND NATIONAL DATABASES WAS ALSO USED TO SUPPLEMENT THE OVERALL FINDINGS. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE INCLUDING OTTAWA COUNTY HEALTH DEPARTMENT, GREATER OTTAWA COUNTY UNITED WAY, HOLLAND HOSPITAL, AND NORTH OTTAWA COMMUNITY HEALTH SYSTEM. FOR A LISTING OF ALL INDIVIDUALS AND SOURCES CONSULTED, SEE THE OTTAWA COUNTY CHNA. ADDITIONALLY KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE-LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUBPOPULATIONS IMPACTED MOST BY ISSUES IN HEALTHCARE. FOR A LISTING OF ALL INDIVIDUALS AND SOURCES CONSULTED, SEE THE OTTAWA COUNTY CHNA.; (6) A - SPECTRUM HEALTH BIG RAPIDS: DATA WAS GATHERED FROM A VARIETY OF SOURCES USING MULTIPLE METHODOLOGIES. COMMUNITY RESIDENT FEEDBACK WAS COLLECTED THROUGH 400 TELEPHONE SURVEYS OF RANDOMLY SELECTED HOUSEHOLDS. A FOCUS GROUP, AN INTERVIEW GROUP, AND TWO EMAIL SURVEY GROUPS WERE UTILIZED TO GATHER QUALITATIVE DATA FROM KEY COMMUNITY GROUPS INCLUDING: BIG RAPIDS HOUSING COMMISSION, THE SPECTRUM HEALTH BIG RAPIDS AUXILIARY, MECOSTA OSCEOLA HUMAN SERVICES COLLABORATIVE BODY AND THE BOARD OF DIRECTORS OF SPECTRUM HEALTH BIG RAPIDS.; (1) - SPECTRUM HEALTH LUDINGTON: DATA WAS GATHERED FROM A VARIETY OF SOURCES AND USING MULTIPLE METHODOLOGIES. RESIDENT FEEDBACK WAS OBTAINED VIA A BEHAVIORAL RISK FACTOR SURVEY AND FOCUS GROUPS. THIS FEEDBACK WAS OBTAINED FROM COMMUNITY RESIDENTS CHOSEN USING DISPROPORTIONATE STRATIFIED RANDOM SAMPLING. HEALTH CARE PROFESSIONALS AND OTHER COMMUNITY LEADERS, KNOWN AS KEY STAKEHOLDERS OR KEY INFORMANTS, PROVIDED INPUT VIA IN-DEPTH INTERVIEWS AND AN ONLINE SURVEY. SECONDARY DATA GATHERED FROM STATE AND NATIONAL DATABASES AND SPECTRUM HEALTH LUDINGTON UTILIZATION DATA WAS ALSO USED TO SUPPLEMENT THE OVERALL FINDINGS. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE CHNA TASK FORCE INCLUDING MASON COUNTY HEALTH DEPARTMENT, UNITED WAY OF MASON COUNTY, AND WEST SHORE COMMUNITY COLLEGE. FOR A LISTING OF ALL INDIVIDUALS AND SOURCES CONSULTED, SEE THE MASON COUNTY AND NORTHERN OCEANA COUNTY CHNA. ADDITIONALLY KEY STAKEHOLDERS WHO WERE INTERVIEWED ARE DEFINED AS EXECUTIVE-LEVEL COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES AND ARE OFTEN INVOLVED IN POLICY DECISION MAKING. KEY INFORMANTS WHO PARTICIPATED IN THE ONLINE SURVEY ARE DEFINED AS COMMUNITY LEADERS HAVING EXTENSIVE KNOWLEDGE AND EXPERTISE ON PUBLIC HEALTH ISSUES OR HAVE EXPERIENCE WITH SUBPOPULATIONS IMPACTED MOST BY ISSUES IN HEALTH CARE. FOR A LISTING OF ALL INDIVIDUALS AND SOURCES CONSULTED, SEE THE MASON COUNT AND NORTHERN OCEANA COUNTY CHNA.;

Schedule H, Part V Sec B, Line 4, Other Hospital Facilities included in Needs Assessment
(1) A - SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT, SPECTRUM HEALTH KENT COMMUNITY CAMPUS: METROPOLITAN HOSPITAL SAINT MARY'S HEALTH CARE PINE REST MARY FREE BED REHABILITATION HOSPITAL ; (2) A - SPECTRUM HEALTH UNITED AND SPECTRUM HEALTH KELSEY: CARSON CITY HOSPITAL SHERIDAN COMMUNITY HOSPITAL ; (3) A - SPECTRUM HEALTH ZEELAND: HOLLAND HOSPITAL NORTH OTTAWA COMMUNITY HEALTH SYSTEM ;

Schedule H, Part V Sec B, Line 5d, Availability of Needs Assessment
(1) A - SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT AND SPECTRUM HEALTH KENT COMMUNITY CAMPUS: THE CHNA FOR SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT AND SPECTRUM HEALTH KENT COMMUNITY CAMPUS IS AVAILABLE ON THE KENT COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE: HTTP://WWW.KENTCOUNTYCHNA.ORG/PDFS/CHNA.PDF; (2) A - SPECTRUM HEALTH UNITED AND SPECTRUM HEALTH KELSEY: THE CHNA FOR SPECTRUM HEALTH UNITED AND SPECTRUM HEALTH KELSEY IS AVAILABLE ON THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENTS WEBPAGE. HTTP://WWW.MMDHD.ORG/CHA/MONTCALM/CHA_MONTCALM_CO_PROFILE.PDF; (3) A - SPECTRUM HEALTH ZEELAND: THE CHNA FOR SPECTRUM HEALTH ZEELAND IS AVAILABLE ON THE OTTAWA COUNTY HEALTH DEPARTMENTS WEBSITE: HTTP://WWW.MIOTTAWA.ORG/HEALTH/OCHD/PDF/DATA/2011-2012_CHNA_REPORT_MEDIA.PDF;

Schedule H, Part V Sec B, Line 11, Eligibility for Discounted Care
(1) A - SPECTRUM HEALTH SYSTEM GROUP A: THE ORGANIZATION USES FPG TO DETERMINE ELIGIBILITY FOR FREE CARE. AN EVALUATION IS NOT USED FOR DISCOUNTED CARE, AS APPLICANTS THAT QUALIFY FOR ANY ASSISTANCE RECEIVE FREE CARE.;

Schedule H, Part V Sec B, Line 12i, Other factors used in determining amounts charged to patients
(1) A - SPECTRUM HEALTH SYSTEM GROUP A: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE PROVIDED FREE CARE, THEREFORE THE ORGANIZATION DOES NOT CHARGE ANY AMOUNT TO THOSE PATIENTS. ;

Schedule H, Part V Sec B, Line 14g, Other ways hospital publicized Financial Assistance Policy
"(1) A - SPECTRUM HEALTH SYSTEM GROUP A: SPECTRUM HEALTH WIDELY PUBLICIZES COMMUNICATIONS TO BOTH PATIENTS AND THE PUBLIC OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. THIS IS ACHIEVED THROUGH VARIOUS METHODS INCLUDING, BUT NOT LIMITED TO, THE SPECTRUM HEALTH PATIENT HANDBOOK, VARIOUS INFORMATIONAL BROCHURES, SIGNAGE IN EACH HOSPITAL EMERGENCY DEPARTMENT, ADMISSIONS OFFICES AND OTHER PUBLIC LOCATIONS, POSTING ON THE SPECTRUM HEALTH WEBSITE, UPON REQUEST BY ANY PATIENT, GUARANTOR OR COMMUNITY MEMBER, WORD OF MOUTH VIA FINANCIAL RESOURCE ADVISORS AND OTHERS, AND THROUGH COMMUNITY PUBLICATIONS AND OUTREACH EVENTS. IN ADDITION, SPECTRUM HEALTH WILL DISTRIBUTE A PLAIN LANGUAGE SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY AND MAKE AVAILABLE TO PATIENTS A FINANCIAL ASSISTANCE APPLICATION PRIOR TO DISCHARGE. THE PLAIN LANGUAGE SUMMARY WILL ALSO BE INCLUDED IN ALL BILLING STATEMENTS WITH NO FEWER THAN THREE BILLING STATEMENTS BEING SENT TO EACH PATIENT. PATIENTS WILL BE NOTIFIED OF THE FINANCIAL ASSISTANCE POLICY FOR A PERIOD OF 120 DAYS FROM THE DATE OF THE FIRST BILLING STATEMENT [""NOTIFICATION PERIOD""]. PATIENT BALANCES WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE EVALUATION FOR AT LEAST 240 DAYS FROM THE DATE OF THE FIRST BILLING STATEMENT [""APPLICATION PERIOD""]. SPECTRUM HEALTH WILL ACCEPT FINANCIAL ASSISTANCE APPLICATIONS ON ACCOUNTS PLACED WITH A COLLECTION AGENCY FOR A PERIOD NO LONGER THAN 240 DAYS FROM THE DATE OF THE FIRST BILLING STATEMENT. IF SPECTRUM HEALTH RECEIVES A FINANCIAL ASSISTANCE APPLICATION DURING THE 240 DAY APPLICATION PERIOD, WHETHER COMPLETE OR INCOMPLETE, IT WILL SUSPEND ANY COLLECTION EFFORTS UNTIL SUCH TIME A DETERMINATION IS MADE.;"

Schedule H, Part V Sec B, Line 20d, How amounts charged to FAP-eligible patients were determined
(1) A - SPECTRUM HEALTH SYSTEM GROUP A: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE ARE PROVIDED FREE CARE, THEREFORE THE ORGANIZATION DOES NOT CHARGE ANY AMOUNT TO THOSE PATIENTS. ; (1) - SPECTRUM HEALTH LUDINGTON: SPECTRUM HEALTH LUDINGTON FIRST ATTEMPTS TO QUALIFY THE PATIENT FOR FAP OR OTHER COMMUNITY RESOURCES FOR COVERAGE. PATIENTS ARE THEN OFFERED A DISCOUNT OF UP TO 30% OF CHARGES. THE 30% DISCOUNT IS COMPRISED OF A 20% SELF PAY DISCOUNT AND A 10% PROMPT PAY DISCOUNT. THIS 30% DISCOUNT IS OFFERED BY THE HOSPITAL TO ALL PATIENTS. PATIENTS AT 150% OF FPG QUALIFY FOR FREE CARE AND THEREFORE WILL NOT BE CHARGED.;

SCHEDULE H, PART I, LINE 2, FINANCIAL ASSISTANCE POLICY
"A UNIFORM FINANCIAL ASSISTANCE POLICY APPLIED TO ALL OF THE HOSPITAL FACILITIES LISTED IN PART V, SECTION A, WITH THE EXCEPTION OF SPECTRUM HEALTH LUDINGTON (""SHL""). DUE TO THE TIMING OF INTEGRATION INTO THE HEALTH SYSTEM, SHL APPLIED THEIR OWN FINANCIAL ASSISTANCE POLICY DURING FY14."

SCHEDULE H, PART I, LINE 3A, FEDERAL POVERTY GUIDELINES FOR FREE CARE
ALL HOSPITAL FACILITIES LISTED IN PART V, SECTION A USE 250% OF FEDERAL POVERTY GUIDELINES AS A FACTOR IN DETERMINING ELIGIBILITY FOR FREE CARE, WITH THE EXCEPTION OF SPECTRUM HEALTH LUDINGTON, WHICH USES 150% OF FEDERAL POVERTY GUIDELINES AS A FACTOR IN DETERMINING ELIGIBILITY FOR FREE CARE DURING FY14.

SCHEDULE H, PART I, LINE 3B, FEDERAL POVERTY GUIDELINES FOR DISCOUNTED CARE
SPECTRUM HEALTH LUDINGTON IS THE ONLY HOSPITAL FACILITY LISTED IN PART V, SECTION A, TO PROVIDE DISCOUNTED CARE, USING 200% OF FEDERAL POVERTY GUIDELINES AS A FACTOR IN DETERMINING ELIGIBILITY.

Schedule H, Part I, Line 3c, Eligibility criteria for free or discounted care
ALL OF THE HOSPITAL FACILITIES LISTED IN PART V, SECTION A USE FPG TO DETERMINE ELIGIBILITY FOR FREE CARE. THE HOSPITAL FACILITIES LISTED IN PART V, SECTION A, EXCEPT FOR SPECTRUM HEALTH LUDINGTON DO NOT USE AN EVALUATION FOR DISCOUNTED CARE, AS APPLICANTS THAT QUALIFY FOR ANY ASSISTANCE RECEIVE FREE CARE.

SCHEDULE H, PART I, LINE 5B, BUDGETED FINANCIAL ASSISTANCE
THE ACTUAL FINANCIAL ASSISTANCE EXPENSES EXCEEDED THE BUDGETED AMOUNTS FOR ALL HOSPITAL FACILITIES LISTED IN PART V, SECTION A WITH THE EXCEPTION OF SPECTRUM HEALTH LUDINGTON AND SPECTRUM HEALTH BIG RAPIDS. SPECTRUM HEALTH LUDINGTON'S ACTUAL FINANCIAL ASSISTANCE EXPENSES WERE 98% OF THE BUDGETED AMOUNT. SPECTRUM HEALTH BIG RAPIDS' ACTUAL FINANCIAL ASSISTANCE EXPENSES WERE 84% OF THE BUDGETED AMOUNT.

Schedule H, Part I, Line 6a, Community benefit report prepared by related organization
SPECTRUM HEALTH SYSTEM (EIN: 38-3382353)

SCHEDULE H, PART I, LINE 6A, RELATED ORGANIZATION INFORMATION
"SPECTRUM HEALTH SYSTEM PUBLISHES A CONSOLIDATED COMMUNITY BENEFIT REPORT ON ITS WEBSITE AT WWW.SPECTRUMHEALTH.ORG (CLICK THE LINK TITLED ""ABOUT US""). IN ADDITION THE HEALTH SYSTEM HOLDS AN ANNUAL MEETING, WHICH IS OPEN TO THE PUBLIC, TO DISCUSS ITS COMMUNITY COMMITMENTS."

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

Schedule H, Part I, Line 7, col(f), Bad Debt Expense excluded from financial assistance calculation
88,193,079

Schedule H, Part I, Line 7g, Subsidized Health Services
"SUBSIDIZED HEALTH SERVICES OFFERED BY SPECTRUM HEALTH BUTTERWORTH INCLUDE THE UNREIMBURSED COSTS OF PROVIDING FREE OR SUBSIDIZED HEALTH SERVICES AND/OR COMMUNITY CLINICS. SUBSIDIZED HEALTH SERVICES WERE PROVIDED AT THE FOLLOWING CLINICS BY SPECTRUM HEALTH BUTTERWORTH: -CENTER FOR INTEGRATED MEDICINE (""CIM"") IS A MULTI-SPECIALTY CLINIC THAT EMPLOYS A NEW MODEL OF CARE TO ASSESS AND TREAT HIGH-FREQUENCY PATIENTS FROM AREA EMERGENCY ROOMS. THE CENTRAL GOAL OF THE CIM IS TO IDENTIFY, ACCURATELY DIAGNOSE AND DEVELOP A CARE PLAN FOR EACH PATIENT. PATIENTS UNDERGO COMPREHENSIVE EXAMS, A BEHAVIORAL HEALTH EXAM, ADDICTION ASSESSMENT, AND A MEDICAL SOCIAL WORK CASE MANAGEMENT EVALUATION. -DEVOS CHILDREN'S PEDIATRIC CLINIC IS A RESIDENCY TEACHING CLINIC THAT TEAMS PEDIATRICIANS WITH MEDICAL STUDENTS AND RESIDENTS TO PROVIDE ROUTINE WELL-CHILD CARE, DIAGNOSIS AND TREATMENT FOR NEW PROBLEMS, AND PEDIATRIC CONSULTATION BY REFERRAL. THE CLINIC'S NEUROSURGERY TEAM USES ADVANCED TECHNOLOGY AND LEADING-EDGE PROTOCOLS TO DIAGNOSE, TREAT AND MANAGE NERVOUS SYSTEM DISORDERS. -SPECTRUM HEALTH OB/GYN CLINIC HAS A DUAL MISSION OF TEACHING OB/GYN RESIDENTS AND TAKING CARE OF THE UNDERINSURED IN THE COMMUNITY, INCLUDING COMPREHENSIVE OBSTETRIC AND GYNECOLOGY SERVICES TO WOMEN OF ALL AGES. -SPECTRUM HEALTH INTERNAL MEDICINE AND FAMILY PRACTICE CLINIC OFFERS FAMILY CARE TO THE UNDERINSURED. THE CLINIC SERVES AS A TEACHING CLINIC FOR INTERNAL MEDICINE AND FAMILY PRACTICE CLINICS."

Schedule H, Part II, Community Building Activities
SPECTRUM HEALTH'S HOSPITAL FACILITIES ARE DEDICATED TO THE COMMUNITIES THEY SERVE. THE HOSPITALS WORK TO ADDRESS MANY OF THE COMMUNITIES THEY SERVE PRESSING HEALTH ISSUES BY PROMOTING AND ADVOCATING FOR OVERALL COMMUNITY HEALTH IMPROVEMENT. SIGNIFICANT COMMUNITY BUILDING ACTIVITIES IN FY14 INCLUDE SUPPORTING FERGUSON RENAISSANCE CENTER, AN ORGANIZATION THAT PROVIDES PERMANENT SUPPORTIVE HOUSING TO PREVIOUSLY HOMELESS COMMUNITY MEMBERS; HEALTH SCIENCES SCHOOL PARTNERSHIP, THE REGION'S PREMIER SPECIALTY HIGH SCHOOL FOCUSED ON PREPARING STUDENTS FOR COLLEGE CAREER PATHWAYS IN THE WIDE-RANGING HEALTH CARE INDUSTRY; AND BELKNAP COMMONS SERVICE CENTER, PROVIDING COMPUTER, PHONE AND FAX RESOURCES, FOOD PANTRY ACCESS AND PERTINENT EDUCATION OPPORTUNITIES TO IMPROVE THE SOCIAL WELLNESS OF THE BELKNAP NEIGHBORHOOD THROUGH PARTNERSHIP, COLLABORATION, AND EMPOWERMENT. ADDITIONALLY, THE HOSPITALS HOST A MULTITUDE OF FREE COMMUNITY EDUCATION SEMINARS AND HEALTH SCREENINGS, HEALTH FAIRS AND SUPPORT GROUPS.

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

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

Schedule H, Part III, Line 4, Bad debt expense - financial statement footnote
THE NET PATIENT SERVICE REVENUE, PATIENT ACCOUNTS RECEIVABLE, AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOOTNOTE IS ON PAGES 14 TO 16 OF THE ORGANIZATIONS CONSOLIDATED FINANCIAL STATEMENT.

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

SCHEDULE H, PART III, LINE 9B, COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE
ALL OF THE HOSPITAL FACILITIES LISTED IN PART V, SECTION A, EXCEPT FOR SPECTRUM HEALTH LUDINGTON PROVIDE FREE CARE TO ALL PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE WILL NOT OWE ANYTHING, AND THUS WILL NOT BE SUBJECT TO COLLECTION ACTIVITIES. SPECTRUM HEALTH LUDINGTON'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. PATIENTS AT 150% OF FPG QUALIFY FOR FREE CARE WILL NOT OWE ANYTHING, AND THUS WILL NOT BE SUBJECT TO COLLECTION ACTIVITIES.

SCHEDULE H, PART V, SECTION B, LINE 2, COMMUNITY HEALTH NEEDS ASSESSMENT
ALL OF THE HOSPITAL FACILITIES LISTED IN PART V, SECTION A, REPORTING GROUP A, EXCEPT FOR SPECTRUM HEALTH BIG RAPIDS LAST CONDUCTED A CHNA IN TAX YEAR 2011. SPECTRUM HEALTH BIG RAPIDS LAST CONDUCTED A CHNA IN TAX YEAR 2012.

SCHEDULE H, PART V, SECTION B, LINE 5A, SPECTRUM HEALTH BUTTERWORTH FACILITY WEBSITE
SPECTRUM HEALTH BUTTERWORTH:HTTP://WWW.SPECTRUMHEALTH.ORG/BUTTERWORTH-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH BLODGETT:HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-BLODGETT-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH UNITED:HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-UNITED-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH GERBER MEMORIAL:HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-SHGM-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH BIG RAPIDS:HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-BIG-RAPIDS-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH REED CITY:HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-REED-CITY-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH ZEELAND:HTTP://WWW.SPECTRUMHEALTH.ORG/ZEELAND-COMMUNITY-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH KENT COMMUNITY CAMPUS:HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-US-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-3870 SPECTRUM HEALTH KELSEY:HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-KELSEY-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT

Schedule H, Part VI, Line 2, Needs assessment.
THE CHNA DATA PROVIDES A LEVEL FOUNDATION ON WHICH TO PLAN, DEVELOP, AND IMPLEMENT NEW PROGRAMS AND SERVICES TO MEET THE NEEDS OF OUR COMMUNITY. OPERATIONAL SERVICES IDENTIFIED BY THE CHNA, E.G. ADDITIONAL MEDICAL CLINIC LOCATIONS WITH EXTENDED HOURS OF OPERATION, AND A PHYSICIAN RECRUITMENT PLAN HAS BEEN DEVELOPED TO INCREASE ACCESS, BOTH OF WHICH HAVE BEEN BUILT INTO THE STRATEGIC PLAN AND BUDGET. THE CHNA AND IMPLEMENTATION PLANS ARE LOCATED AT: HTTP://WWW.SPECTRUMHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH ALSO PREPARES AN ANNUAL CORPORATE SOCIAL RESPONSIBILITY REPORT THAT FOCUSES ON TEN KEY AREAS: HEALTHIER COMMUNITIES, EDUCATION, INCLUSION AND DIVERSITY, COMMUNITY ENGAGEMENT, RESEARCH, INNOVATION, EMPLOYEE ENGAGEMENT, SUSTAINABILITY, REGIONAL RELATIONSHIPS AND COMMUNITY BENEFIT.

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

Schedule H, Part VI, Line 4, Community information.
SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT AND SPECTRUM HEALTH KENT COMMUNITY CAMPUS: SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT AND SPECTRUM HEALTH KENT COMMUNITY CAMPUS ARE LOCATED IN THE SAME COMMUNITY. THEY HAVE IDENTIFIED A PRIMARY SERVICE AREA OF ONE AND A HALF COUNTIES, INCLUDING KENT COUNTY AND PART OF EASTERN OTTAWA COUNTY. THE OVERALL SERVICE AREA TOTALS THIRTEEN COUNTIES, INCLUDING GRAND RAPIDS, MICHIGAN, THE SECOND LARGEST CITY IN THE STATE. OVERALL THESE COUNTIES HAVE A TOTAL POPULATION OF OVER 1,500,000 RESIDENTS. KENT COUNTY IS LOCATED IN WESTERN MICHIGAN AND IS THE FOURTH LARGEST POPULATION CENTER IN THE STATE. THE COUNTY IS COMPOSED OF TWENTY-ONE TOWNSHIPS, FIVE VILLAGES, AND NINE CITIES COVERING 864 SQUARE MILES. GRAND RAPIDS IS THE COUNTY SEAT AND IS 30 MILES FROM LAKE MICHIGAN. GRAND RAPIDS IS ALSO KNOWN FOR BEING THE HOME OF PRESIDENT GERALD R. FORD. THE HEALTH CARE RESOURCES IN KENT COUNTY INCLUDE SPECTRUM HEALTH BUTTERWORTH, SPECTRUM HEALTH BLODGETT, METROPOLITAN HEALTH, SAINT MARY'S HEALTH CARE, PINE REST, AND MARY FREE BED REHABILITATION HOSPITAL. IN ADDITION, THE HEALTH DEPARTMENT OPERATES FIVE PUBLIC HEALTH CLINICS THROUGHOUT THE COUNTY THAT OFFER PERSONAL HEALTH SERVICES. THE GRAND RAPIDS HOME FOR VETERANS AND THE VETERANS AFFAIRS OUTPATIENT CLINIC PROVIDE SERVICES FOR VETERANS. IN ADDITION TO MAJOR HEALTH CENTERS AND PUBLICLY FUNDED SERVICES, KENT COUNTY OFFERS NUMEROUS HEALTH-RELATED SERVICES THROUGH NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/DOCUMENTS/KENT_COUNTY_CHNA_REPORT_NO_COVER.PDF SPECTRUM HEALTH UNITED: SPECTRUM HEALTH UNITED HAS IDENTIFIED A PRIMARY SERVICE AREA COMPRISED OF 19 ZIP CODES SURROUNDING GREENVILLE, WHERE SPECTRUM HEALTH UNITED IS LOCATED. THE OVERALL SERVICE AREA INCLUDES MONTCALM AND PORTIONS OF ADJACENT COUNTIES THAT IN TOTAL SUPPORT A POPULATION OF OVER 100,000 RESIDENTS. THE HEALTHCARE RESOURCES IN SPECTRUM HEALTH UNITED'S SERVICE AREA INCLUDE SPECTRUM HEALTH KELSEY, CARSON CITY HOSPITAL, SHERIDAN COMMUNITY HOSPITAL, THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, AND CHERRY STREET - MONTCALM AREA HEALTH CENTER. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-UNITED-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT SPECTRUM HEALTH GERBER MEMORIAL: SPECTRUM HEALTH GERBER MEMORIAL HAS IDENTIFIED A PRIMARY SERVICE AREA OF SEVERAL COUNTIES INCLUDING NEWAYGO COUNTY, EASTERN OCEANA COUNTY AND EASTERN MUSKEGON COUNTY AS PRIMARY AND NORTHERN KENT COUNTY AND SOUTHERN LAKE COUNTY AS SECONDARY. SPECTRUM HEALTH GERBER MEMORIAL IS THE ONLY MAJOR MEDICAL FACILITY IN THE FACILITIES PRIMARY SERVICE AREA. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-SHGM-COMMUNITY-HEALTH-NEEDS-ASSESSMENT. SPECTRUM HEALTH LUDINGTON: SPECTRUM HEALTH LUDINGTON SERVES A RURAL COMMUNITY LOCATED ON THE COAST OF LAKE MICHIGAN SERVING MASON AND PORTIONS OF OCEANA AND LAKE COUNTIES . AS THE COMMUNITY IS A SEASONAL TOURIST ATTRACTION, THE POPULATION OF THE COMMUNITY SIGNIFICANTLY CHANGES WITH THE SEASONS. A SEASONAL MIGRANT POPULATION IS PRESENT DUE TO AGRICULTURAL EMPLOYMENT OPPORTUNITIES IN THE COMMUNITY. A LARGE PORTION OF THE HOSPITALS PATIENTS ARE COVERED BY EITHER MEDICARE OR MEDICAID. SPECTRUM HEALTH LUDINGTON IS THE ONLY MAJOR MEDICAL FACILITY IN THE FACILITIES SERVICE AREA. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/DOCUMENTS/LUDINGTON/MMCWM%20CHNA%20REPORT%205_16_13.PDF SPECTRUM HEALTH BIG RAPIDS: SPECTRUM HEALTH BIG RAPIDS IS LOCATED IN THE MID-WESTERN PORTION OF THE STATE OF MICHIGAN. THE HOSPITAL SERVES A FIVE COUNTY AREA SURROUNDING MECOSTA COUNTY THAT INCLUDES A LARGE POPULATION WITH LOW INCOME STATUS. ACCORDING TO THE US CENSUS FROM 2008 TO 2012 ROUGHLY 23 PERCENT OF THE POPULATION IN THIS AREA LIVES BELOW THE POVERTY LINE. SPECTRUM HEALTH BIG RAPIDS IS THE ONLY MAJOR MEDICAL FACILITY LOCATED IN THE FACILITIES SERVICE AREA. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/DOCUMENTS/BIG%20RAPIDS%20HOSPITAL/MCMC_CHNA.PDF SPECTRUM HEALTH REED CITY: SPECTRUM HEALTH REED CITY HAS IDENTIFIED A PRIMARY SERVICE AREA OF THREE COUNTIES, INCLUDING LAKE, OSCEOLA AND A PORTION OF NORTH CENTRAL MECOSTA COUNTY. OVERALL THESE COUNTIES HAVE A TOTAL POPULATION OF OVER 75,600 RESIDENTS. OSCEOLA COUNTY IS LOCATED IN NORTHERN MICHIGAN APPROXIMATELY 80 MILES NORTH OF GRAND RAPIDS. THE RURAL COUNTY IS COMPOSED OF SIXTEEN TOWNSHIPS, FOUR VILLAGES, AND TWO CITIES COVERING 573 SQUARE MILES. REED CITY IS THE COUNTY SEAT. THE ONLY MAJOR MEDICAL FACILITY IN OSCEOLA COUNTY IS SPECTRUM HEALTH REED CITY. IN ADDITION, THE HEALTH DEPARTMENT IS A BRANCH OFFICE OF THE CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT. LOCATED WEST OF OSCEOLA COUNTY, LAKE COUNTY IS COMPOSED OF FIFTEEN TOWNSHIPS AND TWO VILLAGES COVERING 575 SQUARE MILES. BALDWIN IS THE COUNTY SEAT. THERE ARE NO MAJOR MEDICAL FACILITIES IN LAKE COUNTY. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-REED-CITY-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT. SPECTRUM HEALTH ZEELAND: SPECTRUM HEALTH ZEELAND HAS IDENTIFIED A PRIMARY SERVICE AREA INCLUSIVE OF MUCH OF OTTAWA COUNTY AND THE SURROUNDING LAKESHORE REGION. OVERALL THE SERVICE AREA OF SPECTRUM HEALTH ZEELAND HAS A POPULATION OF OVER 270,000. THE HEALTHCARE RESOURCES IN OTTAWA COUNTY INCLUDE SPECTRUM HEALTH ZEELAND, HOLLAND HOSPITAL, AND NORTH OTTAWA COMMUNITY HEALTH SYSTEM. OTTAWA COUNTY OFFERS NUMEROUS HEALTH RELATED SERVICES INCLUDING TWO FREE MEDICAL CLINICS AND A VARIETY OF SERVICES THROUGH NON PROFIT AGENCIES SUCH THE OTTAWA COUNTY HEALTH DEPARTMENT AND OTTAWA COUNTY COMMUNITY MENTAL HEALTH FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-4450 SPECTRUM HEALTH KELSEY: SPECTRUM HEALTH KELSEY IS A CRITICAL ACCESS FACILITY THAT SERVES THE MEDICAL NEEDS OF THE RESIDENTS OF LAKEVIEW, MI AND THE FAR-NORTHERN PORTION OF A PRIMARY SERVICE AREA SHARED WITH SPECTRUM HEALTH UNITED, A RELATED ORGANIZATION. THE PRIMARY SERVICE AREA IS COMPRISED OF 19 ZIP CODES SURROUNDING LAKEVIEW, WHERE SPECTRUM HEALTH KELSEY IS LOCATED, AND INCLUDES MONTCALM AND PORTIONS OF ADJACENT COUNTIES THAT SUPPORT A POPULATION OF OVER 100,000 RESIDENTS. THE HEALTHCARE RESOURCES IN SPECTRUM HEALTH KELSEY'S SERVICE AREA INCLUDE SPECTRUM HEALTH UNITED, CARSON CITY HOSPITAL, AND SHERIDAN COMMUNITY HOSPITAL, THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, AND CHERRY STREET - MONTCALM AREA HEALTH CENTER. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-KELSEY-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.

Schedule H, Part VI, Line 5, Promotion of community health
THE BOARD OF DIRECTORS OF EACH FACILITY ON PART V, SECTION A ARE SUBSTANTIALLY COMPOSED OF INDEPENDENT COMMUNITY MEMBERS THAT RESIDE IN THE PRIMARY SERVICE AREA OF THE HOSPITAL. ALL HOSPITALS IN SPECTRUM HEALTH SYSTEM ALSO EXTEND MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SPECTRUM HEALTH SYSTEM INVESTS NET EARNINGS IN IMPROVING PATIENT CARE, BUILDING AND RENOVATING FACILITIES, PURCHASING NEW TECHNOLOGY, PROVIDING HEALTH EDUCATION AND FUNDING COMMUNITY PROGRAMS. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON ALL SPECTRUM HEALTH SYSTEM HOSPITAL FACILITIES TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENTS ARE STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY.

Schedule H, Part VI, Line 6, Affiliated health care system
"SPECTRUM HEALTH IS AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM IN WEST MICHIGAN OFFERING A FULL CONTINUUM OF CARE THROUGH THE SPECTRUM HEALTH HOSPITAL GROUP, WHICH IS COMPRISED OF ELEVEN HOSPITALS INCLUDING HELEN DEVOS CHILDREN'S HOSPITAL, A STATE OF THE ART CHILDREN'S HOSPITAL THAT OPENED IN JANUARY 2011, AND MORE THAN 170 SERVICE SITES; THE SPECTRUM HEALTH MEDICAL GROUP AND WEST MICHIGAN HEART, PHYSICIAN GROUPS TOTALING MORE THAN 1,000 PROVIDERS; AND PRIORITY HEALTH, A HEALTH PLAN WITH 575,000 MEMBERS. SPECTRUM HEALTH IS WEST MICHIGAN'S LARGEST EMPLOYER WITH 21,000 EMPLOYEES. THE INTEGRATED HEALTH SYSTEM PROVIDED $295 MILLION IN COMMUNITY BENEFIT DURING ITS 2014 FISCAL YEAR. THE $295 MILLION IN COMMUNITY BENEFIT INCLUDES COMMUNITY BENEFIT ACTIVITIES BY THE FACILITIES INCLUDED ON SCHEDULE H HOSPITALS AS WELL AS COMMUNITY BENEFIT ACTIVITIES OF OTHER ORGANIZATION ACROSS THE INTEGRATED HEALTH SYSTEM. EACH HOSPITAL FACILITY INCLUDED ON PART V, SECTION A IS A MEMBER OF THE AFFILIATED GROUP OF ENTITIES WITHIN SPECTRUM HEALTH. EACH HOSPITAL FACILITY IS RESPONSIBLE FOR CREATING VALUE WITHIN ITS RESPECTIVE COMMUNITY. FROM ITS INCEPTION, SPECTRUM HEALTH HAS BEEN A FAITHFUL STEWARD OF ITS COMMUNITY ASSETS. AS A WEST MICHIGAN-BASED NOT-FOR-PROFIT HEALTH SYSTEM, THE ORGANIZATION INVESTS ITS NET EARNINGS TO IMPROVE PATIENT CARE, BUILD AND RENOVATE FACILITIES, PURCHASE NEW TECHNOLOGY, PROVIDE HEALTH EDUCATION AND FUND LOCAL COMMUNITY PROGRAMS. OVER THE YEARS, OUR MISSION HAS REMAINED THE SAME-TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. WE TAKE OUR MISSION SERIOUSLY. IT IS CENTRAL TO OUR STRATEGIC DISCUSSIONS AND GUIDES OUR INVESTMENTS AND THE ALLOCATION OF OUR RESOURCES. SPECTRUM HEALTH IS COMMITTED TO PROVIDING VALUE TO THE PEOPLE WE SERVE. ""VALUE"" MEANS ACCESS TO HIGH-QUALITY HEALTH CARE AT AFFORDABLE COSTS, AS WELL AS ACCESS TO THE FULL CONTINUUM OF HEALTH CARE SERVICES, FROM HEALTH INSURANCE TO OUTPATIENT CARE TO INPATIENT AND HOME CARE, AND EVERYTHING IN BETWEEN. SPECTRUM HEALTH HAS HUNDREDS OF PROGRAMS THAT SUPPORT ITS MISSION ""TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE."" THESE PROGRAMS ARE BROUGHT TOGETHER UNDER TEN KEY AREAS: HEALTHIER COMMUNITIES, EDUCATION, INCLUSION AND DIVERSITY, COMMUNITY ENGAGEMENT, RESEARCH, INNOVATION, EMPLOYEE ENGAGEMENT, SUSTAINABILITY, REGIONAL RELATIONSHIPS AND COMMUNITY BENEFIT."

SCHEDULE H, PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT
THE STATE OF MICHIGAN DOES NOT REQUIRE A COMMUNITY BENEFIT REPORT TO BE FILED WITH THE STATE HOWEVER SPECTRUM HEALTH SYSTEM VOLUNTARILY REPORTS CONSOLIDATED COMMUNITY BENEFIT INFORMATION TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION AND IN AN ANNUAL MEETING TO THE COMMUNITY. THE COMMUNITY BENEFIT REPORT IS ALSO AVAILABLE ON THE ORGANIZATION'S WEBSITE.