TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) DAVID MILLER...................................................................... VICE CHAIR	5.00 .................	X				0	1,173,953	103,400
(2) MATTHEW SEVENSMA...................................................................... CHIEF OF STA	.................			X		960,790	0	31,140
(3) DAVID SPAHLINGER...................................................................... VICE CHAIRPE	.................				X	0	942,775	46,316
(4) AUGUSTO ELIAS...................................................................... PHYSICIAN	.................			X		947,957	0	32,836
(5) MICHAEL SUMNERS...................................................................... PHYSICIAN	.................			X		918,538	0	18,603
(6) BARBARA KARENKO...................................................................... PHYSICIAN	.................			X		876,070	0	31,438
(7) ERIC WALCHAK...................................................................... PHYSICIAN	.................			X		801,590	0	31,577
(8) PAUL KOVACK...................................................................... BOARD MEMBER	40.00 .................	X	X			793,695	0	31,438
(9) PETER HAHN...................................................................... PRESIDENT AN	40.00 .................		X			755,348	0	32,836
(10) RAKESH PAI...................................................................... PRESIDENT-ME	40.00 .................		X			559,240	0	31,438
(11) RONALD GRIFKA...................................................................... CMO	40.00 .................		X			561,494	0	18,745
(12) JEFFERY POSTLEWAITE...................................................................... VP-MEDICAL A	40.00 .................		X			450,886	0	26,003
(13) QUINTA VREEDE...................................................................... BOARD MEMBER	5.00 .................	X				0	426,961	38,291
(14) KRIS KURTZ...................................................................... CFO	40.00 .................		X			410,344	0	32,836
(15) LANCE OWENS...................................................................... CM INFO. OFF	40.00 .................		X			383,350	0	32,836
(16) LORI PRICE -PART YEAR...................................................................... COO	40.00 .................		X			390,326	0	12,420
(17) JONATHAN WILDA...................................................................... CIO	40.00 .................		X			356,707	0	31,577

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(18) JENNIFER GONZALEZ - PART YEAR........................................................................ CHRO	40.00 .......................			X	318,228	32,836
(19) STEVEN POLEGA........................................................................ CNO	40.00 .......................		X		314,173	32,398
(20) GREGORY MEYER........................................................................ CCO	40.00 .......................		X		297,133	26,569
(21) MONICA TAYLOR........................................................................ COO - MEDICA	40.00 .......................		X		295,990	25,046
(22) PENNY DEVRIES........................................................................ VP-MARKETING	40.00 .......................		X		293,006	25,337
(23) PHILIP VANLAAN........................................................................ ASSOC. GEN C	40.00 .......................		X		261,965	30,634
(24) STACIE BOMMERSBACH........................................................................ VP- QUALITY	40.00 .......................		X		267,839	13,813
(25) THOMAS FANTIN........................................................................ VP-IT	40.00 .......................		X		212,744	28,617
(26) RHAE-ANN BOOKER........................................................................ VP-DEI	40.00 .......................		X		217,206	23,140
(27) BRUCE CARRIER........................................................................ CHIEF HR OFF	40.00 .......................		X		187,874	28,906
(28) TENA HOXSIE........................................................................ VP-PATIENT F	40.00 .......................		X		172,439	21,253
(29) KATHRYN VEENSTRA........................................................................ ASSISTANT CN	40.00 .......................		X		166,159	11,277
(30) JARRETT MARTUS........................................................................ SECRETARY	40.00 .......................		X		107,610	11,064
(31) STEVE VAN ANDEL........................................................................ CHAIR	5.00 .......................	X			0	0
(32) CONNIE BOHATCH........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(33) WILLIAM BARKELEY........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(34) BRUCE COURTADE........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(35) SCOTT EPSTEIN........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(36) PATRICIA GUNTERN........................................................................ CHIEF OF STA	5.00 .......................	X	X		0	0
(37) JOHN HENDRICKSON........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(38) LAURA HOPSON........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(39) CYNTHIA MCCURREN........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(40) LARRY ROBSON........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(41) CARLOS SANCHEZ........................................................................ BOARD MEMBER	5.00 .......................	X			0	0
(42) TIMOTHY WILLIAMS........................................................................ BOARD MEMBER	5.00 .......................	X			0	0

(A) Name and business address	(B) Description of services	(C) Compensation
GREAT LAKES NEUROSURGICAL ASSOCIATE, 3350 EAGLE PARK DR NE STE 102 GRAND RAPIDS,MI49525	MEDICAL SERVICE	7,915,094
EPIC SYSTEMS CORP, PO BOX 88314 MILWAUKEE,WI53288	MEDICAL IS	3,010,211
ANESTHESIA MEDICAL CONSULTANTS, 333 EVERGREEN DR NE GRAND RAPIDS,MI49525	MEDICAL SERVICE	2,518,103
VIRTUAL RADIOLOGIC PROFESSIONALS MI, 11995 SINGLETREE LANE MINNEAPOLIS,MN55344	MEDICAL SERVICE	1,958,476
SODEXO CTM INC, PO BOX 415000 NASHVILLE,TN37241	MEDICAL EQUIP.	1,691,862
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 68

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

METROPOLITAN HOSPITAL

Employer identification number

38-0593405

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

METROPOLITAN HOSPITAL

Employer identification number

38-0593405

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization METROPOLITAN HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization METROPOLITAN HOSPITAL		Employer identification number 38-0593405

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization METROPOLITAN HOSPITAL			Employer identification number 38-0593405
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

METROPOLITAN HOSPITAL

Employer identification number

38-0593405

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	15,320,928		15,320,928
b	Buildings ....	215,352,026	102,812,617	112,539,409
c	Leasehold improvements	30,931,745	53,307,054	-22,375,309
d	Equipment ....	373,437,570	199,400,209	174,037,361
e	Other .....	36,043,320		36,043,320
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				315,565,709

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	301,048,987
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

METROPOLITAN HOSPITAL

Employer identification number

38-0593405

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other 300.0000000000 %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	3,800,544		3,800,544	0.720 %
b	Medicaid (from Worksheet 3, column a) . . . . .	85,965,245	82,791,675	3,173,570	0.600 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	89,765,789	82,791,675	6,974,114	1.320 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	609,916		609,916	0.010 %
f	Health professions education (from Worksheet 5) . . .	9,663,688	4,819,878	4,843,810	0.920 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	687,876	178,125	509,751	0.100 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	601,908		601,908	0.110 %
j	Total. Other Benefits . .	11,563,388	4,998,003	6,565,385	1.140 %
k	Total. Add lines 7d and 7j .	101,329,177	87,789,678	13,539,499	2.460 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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)
1	Physical improvements and housing
2	Economic development
3	Community support	73
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	900
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	74	900

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,187,164

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

177,795,298

Enter Medicare allowable costs of care relating to payments on line 5.....

208,546,712

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-30,751,414

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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) 2021

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)
1	METROPOLITAN HOSPITAL 5900 BYRON CENTER AVENUE SW WYOMING,MI49519	X	X	X	X

Schedule H (Form 990) 2021

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)

	METROPOLITAN 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):

Yes

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

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 .................

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..................................

Yes

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. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.METROHEALTH.NET

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.METROHEALTH.NET

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	METROPOLITAN HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, PAGE 8

The FAP application form was widely available on a website (list url):

SEE PART V, PAGE 8

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, PAGE 8

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	METROPOLITAN HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	METROPOLITAN HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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? ...............................

If "Yes," explain in Section C.

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? ...........................

Yes

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

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, 20a, 20b, 20c, 20d, 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
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 3E	OUTLINES AND DISCUSSES ELEVEN TOP HEALTH-RELATED NEEDS OF THE COMMUNITY
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 5	ADDITIONAL DATA COLLECTION METHODS WERE USED BY THE COMMUNITY INPUT WORKGROUP TO GATHER DATA FROM COMMUNITY MEMBERS WHOSE VOICE AND HEALTH STATUS MAY NOT BE REPRESENTED THROUGH THE LOCAL, STATE, AND NATIONAL SECONDARY DATA SOURCES. THE ADDITIONAL DATA COLLECTION METHODS INCLUDED COMMUNITY INPUT WALLS (STRATEGY INVOLVING GATHERING INPUT FROM COMMUNITY MEMBERS DIRECTLY BY POSTING LARGE SHEETS OF PAPER IN PUBLIC SPACE AND ASKING COMMUNITY MEMBERS TO ANSWER QUESTIONS ABOUT THE COMMUNITY BY WRITING THEIR THOUGHTS ON THE WALL), FOCUS GROUPS WITH COMMUNITY MEMBERS PARTICIPATING TO GENERATE COMMUNITY INPUT FROM VARIOUS POPULATIONS ABOUT THE HEALTH AND WELL-BEING OF KENT COUNTY AND INTERCEPT INTERVIEWS (METHOD DESIGNED TO ENGAGE PARTICIPANTS WHO MAY NOT BE INCLINED TO ATTEND A FOCUS GROUP OR TOWN HALL MEETING). THE INTERCEPT INTERVIEWS WERE TRANSLATED INTO SPANISH FOR THE LATINO/HISPANIC COMMUNITY AND OTHER LANGUAGES SPOKEN BY THE ASIAN COMMUNITY. THIS ASSESSMENT WAS DESIGNED TO PROVIDE A BROAD OVERVIEW OF HEALTH AND WELL BEING AND IDENTIFY CRITICAL ISSUES RELATED TO COMMUNITY HEALTH IN KENT COUNTY. HOWEVER, IT IS NOT INCLUSIVE OF EVERY HEALHT-RELATED ISSUE THAT RESIDENTS FACE AND DOES NOT REPRESENT ALL POSSIBLE POPULATIONS OF INTEREST. COVID-19 LIMITATIONS: DATA IN THIS REPORT REPRESENT THE MOST CURRENT, COUNTY-LEVEL SOURCES AT THE TIME OF PUBLICATION. HOWEVER, IT'S IMPORTANT TO NOTE THE SOURCE DATA IN RELATION TO THE COVID-19 TIMELINE. MANY INDICATORS REFLECT THE STATE OF HEALTH PRIOR TO THE PANDEMIC; HOWEVER, COMMUNITY INPUT DATA WAS COLLECTED DURING THE PANDEMIC. GATHERING COMMUNITY INPUT DATA ON LONG-TERM HEALTH NEEDS DURING THE PANDEMIC MAY HAVE INCREASED THE LIKELIHOOD OF BIAS AND/OR MEASUREMENT ERROR. COMMITTEE MEMBERS TRIED TO ACCOUNT FOR THIS BY STRATEGICALLY PHRASING SURVEY QUESTIONS SO THE DIRECT AND INDIRECT EFFECTS OF THE PANDEMIC WOULD NOT SKEW THE RESPONSES. FOR EXAMPLE, "FEAR OR CLOSURE DUE TO COVID-19" WAS A RESPONSE OPTION INCLUDED WHEN ASKING ABOUT BARRIERS TO ACCESSING HEALTH CARE, SO THESE COULD BE FILTERED OUT DURING ANALYSIS TO GET A MORE ACCURATE AND RELIABLE DETERMINATION OF BARRIERS THAT EXIST BEYOND THE PANDEMIC. IN CONSIDERATION OF SOME OF THESE LIMITATIONS, THE PROCESS OF PRIORITIZING HEALTH NEEDS WAS BASED ON BOTH QUANTITAVE DATA COLLECTED PRIOR TO THE STATE SHUTDOWN IN MICHIGAN, AND QUALITATIVE DATA COLLECTED AMIDST THE PANDEMIC. COMMUNITY SURVEY: ANOTHER LIMITATION IS THE CONVENIENCE SAMPLING METHODOLOGY USED TO CONDUE SURVEY (DISSEMINATION ONLINE AND VIA COMMUNITY ORGANIZATIONS). BECAUSE THE SAMPLE OF SURVEY RESPONDENTS WAS NOT RANDOMLY SELECTED, GENERALIZABILITY OF THE FINDINGS TO THE BROADER POPULATIONS IS LIMITED. COMPARED TO THE POPULATION OF KENT COUNTY, PEOPLE OF COLOR, MEN, AND YOUNGER ADULTS (AGE 25 AND YOUNGER) WERE UNDERREPRESENTED AMONGST SURVEY RESPONDENTS, AND THOSE WITH A BACHELOR'S DEGREE OR HIGHER WERE OVERREPRESENTED. DUE TO THE PANDEMIC RESTRICTIONS AND CANCELATION OF COMMUNITY EVENTS, IN-PERSON SURVEYING TECHNIQUES COULD NOT BE USED PURPOSIVELY SAMPLE UNDERREPRESENTED POPULATIONS. ADDITIONALLY, DISSEMINATION WAS PRIMARILY CONDUCTED THROUGH SOCIAL MEDIA AND PARTNER NETWORKS WHICH MAY HAVE FURTHER LIMITED THE SCOPE OF POTENTIAL RESPONDENTS AND INCREASED THE LIKELIHOOD FOR SELECTION BIAS. FOCUS GROUPS: THE GOAL OF THE FOCUS GROUPS WAS TO OBTAIN ADDITIONAL COMMUNITY INPUT FROM POPULATIONS THAT WERE UNDERREPRESENTED IN THE SURVEY RESPONSES AND GET AN IN-DEPTH PERSPECTIVE ON ISSUES FROM SPECIFIC SUB- POPULATIONS. ALTHOUGH THE FOCUS GROUPS PROVIDE VALUABLE INSIGHTS, RESULTS ARE NOT STATISTICALLY REPRESENTATIVE OF THE LARGER KENT COUNTY POPULATION DUE TO NON-RANDOM RECRUITING OF PARTICIPANTS AND A SMALL SAMPLE SIZE. ADDITIONALLY, SINCE RECRUITMENT WAS CONDUCTED BY THE COMMUNITY ORGANIZATIONS THAT HOSTED AND FACILITATED FOCUS GROUPS, MANY WHO PARTICIPATED WERE ALREADY INVOLVED IN COMMUNITY PROGRAMMING AND THE RESPONSES MAY ONLY PROVIDE ONE PERSPECTIVE ON THE ISSUES DISCUSSED.
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 6A	SPECTRUM HEALTH, MERCY HEALTH, MARY FREE BED, PINE REST CHRISTIAN MENTAL HEALTH SERVICES.
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 6B	KENT COUNTY HEALTH DEPARTMENT, YMCA, NETWORK 180
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 11	1.ACCESS TO HEALTH CARE: UMH-WEST HOSTS FREE AND LOW-COST COMMUNITY CLASSES FOCUSED ON PROMOTING HEALTHY HABITS AND THE SERVICES OUR SPECIALITY CARE OFFICES PROVIDE. EMPLOYEES SERVE ON COMMUNITY COUNCILS AIMED AT MAKING HEALTH CARE AS A WHOLE MORE ACCESSIBLE TO ALL. THROUGH COMMUNTY EVENT SPONSORSHIPS AND TABLING EVENTS, UMH-WEST PROVIDES FINANCIAL SUPORT FOR SERVICES THAT MAY NOT BE OFFERED WITHIN OUR SYSTEM, SUCH AS DENTAL CARE. UMH-WEST HAS TRANSLATION SERVICES AVAILBALE TO ENSURE WE ARE PROVIDING THE BEST CARE POSSIBLE FOR ALL WHO SEEK OUR SERVICES. 2.DISCRIMINATION AND RACIAL INEQUALITY: UMH-WEST'S DIVERSITY EQUITY AND INCLUSION DEPARTMENT PROVIDES TRAINING AND EDUCAITONAL OPPORUNITES TO EMPLOYEES TO ENUSRE THAT WE ARE TREATING ALL PATIENTS EQUITABLY. THROUGH COMMUNITY MENTORING PROGRAMS AND TASKFORCE GROUPS, WE ARE STRIVING TO CREATE A COMMUNITY WHERE ALL FEEL SAFE, WELCOMED AND FAIRLY TREATED. 3.ECONOMIC SECURITY: UMH-WEST HAS MADE DILIGENT EFFORTS TO MAKE SURE EMPLOYEES ARE RECEIVING FAIR AND COMPARABLE WAGES BY COMPLETING ANNUAL MARKET ANALYSES. LEADERS SERVE ON COMMUNITY BOARDS AND SIT IN ON FOCUS GROUPS TO ADDRESS HOW THE COMMUNITY RECOMMENDS HOW WE ADDRESS THIS NEED. 4.MENTAL HEALTH: UMH-WEST HAS EXPANDED OUR SERVICES TO INCLUDE PSYCHIATRY. WE OFFER FREE AND LOW-COST COMMUNITY STRESS MANAGEMENT CLASSES (GENTLE YOGA AND PAINTING) AND TOBACCO CESSATION CLASSES PROVIDED BY OUR PULMONARY REHABILITATION DEPARTMENT. SUPPORT GROUPS FOR BREASTFEEDING MOTHERS, PARKINSONS DISEASE, THOSE WITH EMPHASEMA, COPD OR WHO HAVE HAD OR CARE FOR SOMEONE WHO HAS HAD A STROKE PROVIDE OUR COMMUNITY MEMBERS A SAFE PLACE TO GO TO KNOW THEY ARE NOT ALONE.
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 13B	A PATIENT WHOSE HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEED 15% OF THE PERSON'S ANNUAL GROSS INCOME AS SET FORTH IN THIS POLICY AND WHO IS UNABLE TO PAY THE REMAINING BILL MAY BE CONSIDERED MEDICALLY INDIGENT AND IS ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE. OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON MAY BE CONSIDERED WHEN DETERMINING ABILITY TO PAY. A DETERMINATION OF A PATIENT'S ABILITY TO PAY THE REMAINDER OF THE BILL WILL BE BASED ON WHETHER THE PATIENT REASONABLY CAN BE EXPECTED TO PAY THE ACCOUNT IN FULL OVER A 25 METROPOLITAN HOSPITAL MONTH PERIOD. IF THE DETERMINATION IS MADE THAT A PATIENT HAS THE ABILITY TO PAY THE REMAINDER OF THE BILL, SUCH DETERMINATION DOES NOT PREVENT A REASSESSMENT OF THE PATIENT'S ABILITY TO PAY AT A LATER DATE.
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 16J	METROPOLITAN HOSPITAL PART V, LINE 16A, FAP WEBSITE: HTTPS://METROHEALTH.NET/ABOUT-METRO-HEALTH/BILLING-PAYMENT-OPTIONS/FINANCIA METROPOLITAN HOSPITAL PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://METROHEALTH.NET/ABOUT-METRO-HEALTH/BILLING-PAYMENT-OPTIONS/FINANCIA METROPOLITAN HOSPITAL PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://METROHEALTH.NET/ABOUT-METRO-HEALTH/BILLING-PAYMENT-OPTIONS/FINANCIA PART V, SECTION B, LINE 16I: PUBLICATION/NOTICE OF FINANCIAL ASSISTANCE: IT IS THE GOAL OF METRO HEALTH HOPITAL TO COMMUNICATE TO PATIENTS AND THE PUBLIC OF THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY. THIS IS ACHIEVED THROUGH VARIOUS METHODS INCLUDING, BUT NOT LIMITED TO, "A PATIENT'S GUIDE", METRO HEALTH'S WEBSITE (WWW.METROHEALTH.NET), PATIENT BILLING STATEMENTS, WORD OF MOUTH AND COMMUNITY PUBLIC LOCATIONS. FINANCIAL ASSISTANCE APPLICATIONS WILL BE TRANSLATED INTO LANGUAGES APPROPRIATE TO THE HOSPITAL'S COMMUNITY.
FACILITY 1, METROPOLITAN HOSPITAL - PART V, LINE 24	IN ACCORDANCE WITH MEDICARE POLICY WE CHARGE THE FULL AMOUNT BUT FOR PEOPLE WHO DID NOT HAVE INSURANCE WE DISCOUNTED THE CHARGE BY 40%. IF THEY HAD INSURANCE THE AMOUNT WAS DISCOUNTED BY THE CONTRACT PERCENTAGE.

Schedule H (Form 990) 2021

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?21
Name and address		Type of Facility (describe)
1	CANCER SERVICES 5950 METRO WAY WYOMING,MI49519	CANCER CENTER
2	GVSU 10383 42ND AVE STE A ALLENDALE,MI49401	FAMILY PRACTICE
3	HEALTHPARK 2093 HEALTH DRIVE WYOMING,MI49519	SLEEP LAB & ENDOSCOPY, INTERNAL MEDICINE
4	METRO HEALTH ALLENDALE 4830 BECKER DR ALLENDALE,MI49401	FAMILY PRACTICE, PT, RADIOLOGY & MAMMORG
5	METRO HEALTH CALEDONIA PLAZA 8941 NORTH RODGER COURT CALEDONIA,MI49316	FAMILY PRACTICE, PT, RADIOLOGY & MAMMOGR
6	UMHW EAST BELTLINE 1310 EAST BELTLINE AVE SE GRAND RAPIDS,MI49506	FAMILY PRACTICE, PT, RADIOLOGY & MAMMOGR
7	METRO HEALTH CEDAR SPRINGS 14211 WHITE CREEK CEDAR SPRINGS,MI49319	FAMILY PRACTICE, PT, RADIOLOGY & MAMMOG
8	METRO HEALTH COMMUNITY CLINIC 785 36TH ST SE WYOMING,MI49519	CLLNIC FOR LOW INCOME & OFFICES
9	METRO HEALTH COMSTOCK PARK 4200 N DIVISION COMSTOCK PARK,MI49321	FAMILY PRACTICE, PT, RADIOLOGY & MAMMOGR
10	METRO HEALTH GREENVILLE 1915 WEST WASHINGTON GREENVILLE,MI48838	HEART & VASCULAR
11	METRO HEALTH HUDSONVILLE 3912 32ND AVE HUDSONVILLE,MI49426	FAMILY PRACTICE, PT, RADIOLOGY & MAMMOGR
12	METRO HEALTH JENISON 7686 GEORGETOWN CENTER DR JENISON,MI49428	FAMILY PRACTICE, PT, RADIOLOGY & MAMMOGR
13	METRO HEALTH LOWELL 2550 WEST MAIN LOWELL,MI49331	FAMILY PRACTICE, PT, RADIOLOGY & MAMMOGR
14	METRO HEALTH OPHTHALMOLOGY 2221 HEALTH DRIVE SW WYOMING,MI49519	OPHTHALMOLOGY
15	METRO HEALTH PROFESSIONAL BUILDING 2122 HEALTH DRIVE SW WYOMING,MI49519	WOUND CLINIC, LAB & PULMONARY REHAB
16	METRO HEALTH ROCKFORD 4685 BELDING ROAD ROCKFORD,MI49341	FAMILY PRACTICE, DIABETES ED, PT, RADIOL
17	METRO HEALTH WAYLAND 893 E SUPERIOR WAYLAND,MI49348	FAMILY PRACTICE, RADIOLOGY, PT & MAMMOGR
18	METRO HEALTH PARK EAST 4055 CASCADE RD SE GRAND RAPIDS,MI49546	URGENT CARE, SURGERY CENTER, OB/GYN
19	METRO-HEALTH SOUTHWEST PLAZA 2215 44TH STREET SW WYOMING,MI49519	FAMILY PRACTICE, DIABETES ED, PT, RADIOL
20	METRO HEALTH GRAND RAPIDS NORTHEAST 1787 GRAND RIDGE CT NE 101 GRAND RAPIDS,MI49525	FAMILY PRACTICE
21	HUDSONVILLE II 2917 PORT SHELDON STREET HUDSONVILLE,MI49426	FAMILY PRACTICE, PEDIACTRICS

Schedule H (Form 990) 2021

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 7, COLUMN (F)	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS 20,202,770.
SCHEDULE H, PART I, LINE 7	THE INFORMATION USED TO CALCULATE LINE 7 IS ON THE PAID CLAIMS BASIS. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2.
SCHEDULE H, PART II	ALTHOUGH MANY SUCH ACTIVITIES ARE OFTEN NOT QUANTIFIABLE, WE CONTINUE TO BUILD ON OUR STRONG RECORD OF COLLABORATION WITH COMMUNITY GROUPS, BUSINESSES ACADEMIC INSTITUTIONS, AND GOVERNMENTAL AND NON- GOVERNMENTAL ORGANIZATIONS WITH THE GOAL OF IMPROVING HEALTH OUTCOMES AND REDUCING HEALTH DISPARITIES. EMPHASIS IS PLACED ON ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH, THE HEALTH CARE DELIVERY SYSTEM AND COMMUNITY ECONOMIC DEVELOPMENT. METRO HEALTH TAKES SERIOUSLY THE OPPORTUNITY AND OBLIGATION WE HAVE TO HELP BUILD OUR COMMUNITY. ALL MEMBERS OF THE ORGANIZATIONS LEADERSHIP TEAM ARE REQUIRED TO VOLUNTEER A MINIMUM OF 12 HOURS TO COMMUNITY-BENEFIT INITIATIVES. GENERAL STAFF MEMBERS ARE ALSO ENCOURAGED TO VOLUNTEER AT COMMUNITY-BENEFIT INITIATIVES. MANY METRO EMPLOYEES PLAY AN ACTIVE ROLE ON THE BOARDS AND/OR COMMITTEES OF SEVERAL HEALTH AND HUMAN SERVICE AGENCIES IN OUR COMMUNITY, SUCH AS YMCA, GRAND RAPIDS CHAMBER OF COMMERCE HEALTH CARE COMMITTEE, ELES PLACE GRAND RAPIDS, GRAND RAPIDS AFRICAN AMERICAN HEALTH INSTITUTE, GOODWILL INDUSTRIES, MEL TROTTER MINISTRIES, COMMUNITY TRANSFORMATION GRANT COMMITTEE, KID'S FOOD BASKET, WEST MICHIGAN HISPANIC CHAMBER OF COMMERCE AND MORE. IN ADDITION, METRO LEADERS AND STAFF MEMBERS PARTICIPATE IN ONE- DAY COMMUNITY ACTIVITIES, SUCH AS PRESENTING HEALTH OR CAREER INFORMATION IN AREA SCHOOLS FROM ELEMENTARY SCHOOLS TO COLLEGES AND UNIVERSITIES. AS AN OSTEOPATHIC TEACHING HOSPITAL, WE HAVE A SIGNIFICANT PRESENCE WITH THE MICHIGAN ASSOCIATION OF OSTEOPATHIC DIRECTORS AND MEDICAL EDUCATORS. THIS ASSOCIATION HELPS TRAIN NEW PHYSICIANS AND DEVELOPS THE CURRICULUM USED FOR MEDICAL RESIDENTS AND STUDENT INTERNS THROUGHOUT OUR STATE. SEVERAL MEMBERS OF OUR STAFF ARE INVOLVED IN THIS GROUP AT THE STATE LEVEL AND SPEND A LARGE NUMBER OF HOURS EVERY YEAR SERVING IN THIS CAPACITY. METRO HEALTH IS ALSO THE EDUCATION SITE FOR OVER ONE HUNDRED MEDICAL FELLOWS, RESIDENTS AND STUDENTS. METRO ALSO PROMOTES HEALTH IN OUR COMMUNITY AND STEWARDSHIP OF NATURAL RESOURCES BY COLLABORATING WITH THE CITY OF WYOMING TO HOST TWO "DRUG TAKE BACK DAYS" EACH YEAR. BY WORKING TOGETHER WE ARE ABLE TO BRING THIS U.S. DEPARTMENT OF JUSTICE/DRUG ENFORCEMENT ADMINISTRATION PROGRAM TO OUR COMMUNITY. THE CITY OF WYOMING PROVIDES DISPOSAL AND LAW ENFORCEMENT PERSONNEL, WHILE METRO HEALTH PROVIDES PHARMACISTS TO ANSWER COMMUNITY MEMBER QUESTIONS AND HELP SORT DRUGS AND A CONVENIENT LOCATION FOR COMMUNITY MEMBERS TO DROP OFF UNUSED AND EXPIRED DRUGS. BY PROPERLY DISPOSING OF THE MATERIALS, WE ARE ABLE TO KEEP THESE DRUGS OUT OF THE COMMUNITYS WATER SYSTEM AND AWAY FROM CHILDREN WHO MIGHT FIND THEM IN A HOME. METRO IS CURRENTLY WORKING WITH THE CITY OF WYOMING FIRE DEPARTMENT WITH EMT TRAINING FOR THEIR STAFF.
SCHEDULE H, PART III, LINE 2	BAD DEBT IS ANY PORTION OF PATIENT ACCOUNT THAT IS DEEMED UNCOLLECTIBLE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN MADE, INCLUDING FINANCIAL ASSISTANCE. BAD DEBT DOES NOT INCLUDE CONTRACTUAL DISCOUNTS, COMMUNITY BENEFIT OR CHARITY CARE.
SCHEDULE H, PART III, LINE 8	HEALTHCARE PAYMENT REFORMS IMPLEMENTED THROUGH THE AFFORDABLE CARE ACT HAVE SHIFTED SOME OF THE EXPENSE BURDEN OF PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES FROM THE GOVERNMENT ON TO HEALTHCARE PROVIDERS THROUGH REDUCED PAYMENTS. THESE PAYMENT REDUCTIONS HAVE INCREASED THE LOSSES INCURRED BY HEALTHCARE PROVIDERS FOR TREATING MEDICARE BENEFICIARIES. BY REDUCING THE GOVERNMENTS FINANCIAL BURDEN FOR PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIS, METRO HEALTH BELIEVES THAT MEDICARE SHORTFALLS SHOULD BE TREATED AS A COMMUNITY BENEFIT.
SCHEDULE H, PART III, LINE 9B	METRO TRIES TO INFORM THE PATIENT IF THEY QUALIFY FOR CHARITY CARE AS SOON AS POSSIBLE BECAUSE THE PATIENT BENEFITS FROM KNOWING ABOUT THEIR FINANCIAL OBLIGATIONS AND THE HOSPITAL CAN AVOID A COSTLY COLLECTIONS PROCESS IF THE PATIENT HAS THE INABILITY TO PAY. EVERY PATIENT BILL HAS THE FEDERAL POVERTY GUIDELINES ON THE BACK AND ITS ON METRO'S WEBSITE. BOTH EXPLAIN THE PROCEDURES AND LIMITS FOR CHARITY CARE AND DISCOUNTING PROGRAMS. PATIENT FINANCIAL REPRESENTATIVES ARE AVAILABLE TO DISCUSS FILLING OUT THE PAPERWORK FOR GOVERNMENT MEDICAL ASSISTANCE PROGRAMS.
SCHEDULE H, PART VI, LINE 2	FOR MORE THAN 20 YEARS, HEALTHY KENT HAS ENGAGED A BROAD ARRAY OF COMMUNITY PARTNER ORGANIZATIONS TO ADDRESS DATA-DRIVEN PRIORITY AREAS, RANGING FROM INFANT MORTALITY TO VIOLENCE. DURING ITS TENURE, HEALTHY KENT HAS YIELDED MANY NOTEWORTHY COMMUNITY-BASED SUCCESSES, AND CONTINUES TO ACHIEVE RESULTS THROUGH ITS SUCCESSFUL COMMUNITY COLLABORATIONS ON TOPICS RANGING FROM MATERNAL AND CHILD HEALTH TO SUICIDE PREVENTION. IN 2013, HEALTHY KENT ALSO TOOK ON THE ROLE OF CONVENER FOR THE FISCAL YEAR END 2015 COMMUNITY HEALTH NEEDS ASSESSMENT(CHNA) PROCESS. THIS IS THE FOURTH ITERATION OF KENT COUNTYS COMMUNITY HEALTH IMPROVEMENT EFFORTS. THE FIRST COUNTYWIDE CHNA WAS PUBLISHED IN FISCAL YEAR END 2012, FOLLOWED THE NEXT YEAR BY A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP), WHICH OUTLINED COMMUNITY PRIORITIES AS WELL AS GOALS, OBJECTIVES, AND STRATEGIES AIMED AT IMPACTING THOSE KEY PRIORITIES. MANY LESSONS WERE LEARNED FROM THE FIRST ITERATION OF THE CHNA/CHIP PROCESS WITHIN OUR COMMUNITY. AS A RESULT, SIGNIFICANT IMPROVEMENTS HAVE BEEN MADE TO THE HEALTH IMPROVEMENT PROCESS IN KENT COUNTY. SOME OF THESE IMPROVEMENTS INCLUDE A STRONGER FOCUS ON COMMUNITY INPUT, ENHANCED DATA COLLECTION AND REPORTING, AS WELL AS AN EXPANDED BREADTH OF INVOLVEMENT IN VARIOUS PHASES OF THE PROCESS BY KEY COMMUNITY AGENCIES AND ORGANIZATIONS. ADDITIONALLY, THE RESPONSIBILITY FOR COORDINATING THE CHNA/CHIP PROCESS IN OUR COMMUNITY HAS SHIFTED FROM KENT COUNTY WORKING TOGETHER FOR A HEALTHIER TOMORROW TO HEALTHY KENT.THE MISSION OF THE KENT COUNTY CHNA PROCESS WAS TO ENSURE THAT THE PEOPLE OF KENT COUNTY ARE EMPOWERED TO ACHIEVE LIFE-LONG PHYSICAL, MENTAL AND SOCIAL WELLBEING THROUGH 1) EQUAL ACCESS TO HIGH QUALITY, AFFORDABLE HEALTHCARE; 2) A COORDINATED SYSTEM OF CARE THAT IS LOCAL, PREVENTIVE, HOLISTIC AND PATIENT CENTERED; AND 3) AN ENVIRONMENT THAT SUPPORTS HEALTHY LIVING FOR ALL. FOUR PRIORITY HEALTH ISSUES THAT WERE DISCOVERED WERE 1) ACCESS TO HEALTH CARE, 2) DISCRIMINATION AND RACIAL INEQUALITY, 3) ECONOMIC SECURITY, AND 4) MENTAL HEALTH. THE 2021 CHNA IS A COMPREHENSIVE COMPILATION OF DATA THAT EXPLAINS THE CURRENT STATE OF HEALTH, WELLBEING, AND FACTORS AFFECTING HEALTH OF THOSE WHO LIVE, LEARN, AND WORK IN KENT COUNTY, MICHIGAN. THE 2021 CHNA PROCESS WAS MODELED AFTER THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) FRAMEWORK. MAPP IS A NATIONALLY-RECOGNIZED, BEST- PRACTICE FRAMEWORK FOR COMMUNITY HEALTH NEEDS ASSESMENT AND IMPROVEMENT PLANNING PROCESSES THAT WAS DEVELOPED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO). THERE ARE SIX KEY PHASES OF THE MAPP PROCESS, INCLUDING: 1) ORGANIZING FOR SUCCESS AND PARTNERSHIP DEVELOPMENT 2) VISIONING 3) THE FOUR MAPP ASSESSMENTS 4) IDENTIFYING STRATEGIC ISSUES 5) FORMULATE GOALS AND STRATEGIES 6) TAKE ACTION (ACTION CYCLE) THE 2021 CHNA REPORT INCLUDES A SUMMARY AND DESCRIPTION OF HOW KENT COUNTY HAS IMPLEMENTED THE FIRST FOUR MAPP PHASES. PHASES FIVE AND SIX WILL BE DISCUSSED AND REPORTED AS THE 2021 COMMUNITY HEALTH IMPROVEMENT PLANNING PROCESS GETS UNDERWAY AND YIELDS A FINAL REPORT.
SCHEDULE H, PART VI, LINE 3	METRO HEALTH RECOGNIZES THAT INDIVIDUALS AND FAMILIES WHO ARE FACING FINANCIAL INSTABILITY OR HARDSHIP OFTEN NEGLECT HEALTHCARE NEEDS UNTIL THEY BECOME EMERGENT CONDITIONS. THIS PRACTICE PLACES STRESS ON PATIENTS, FAMILIES AND THE HEALTHCARE SYSTEM. METRO HEALTH SEEKS TO INFORM PATIENTS OF THEIR ELIGIBILITY FOR CHARITY CARE AS SOON AS POSSIBLE IN THE HEALTHCARE PROCESS SO THAT PATIENTS KNOW THERE IS HELP FOR THEM AND SO THAT THE ORGANIZATION AVOIDS COSTLY COLLECTIONS PROCESSES. METRO HEALTH POSTS INFORMATION ON FINANCIAL ASSISTANCE ON THE ORGANIZATION WEB SITE. THERE ARE ALSO BROCHURES IN WAITING ROOMS AND AT REGISTRATION DESKS WITH INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAMS. PATIENTS WHO REPORT HAVING NO COVERAGE AT REGISTRATION ARE PROVIDED INFORMATION ABOUT OUR COMMUNITY BENEFIT DISCOUNT. THIS PROGRAM PROVIDES A 40% DISCOUNT TO ALL PATIENTS WITHOUT COVERAGE AS WELL AS AN INTEREST FREE PAYMENT PLAN (CAREPAYMENT) FOR THOSE PATIENTS WITH A BALANCE THEY ARE UNABLE TO PAY IN THE NEAR FUTURE. IN ADDITION, EVERY PATIENT BILL INCLUDES THE FEDERAL POVERTY GUIDELINES ON THE BACK AND EXPLAINS THE PROCEDURES AND LIMITS FOR CHARITY CARE AND DISCOUNTING PROGRAMS. PATIENT FINANCIAL REPRESENTATIVES ARE AVAILABLE TO DISCUSS FILLING OUT PAPERWORK FOR GOVERNMENT MEDICAL ASSISTANCE PROGRAMS. THERE IS ALSO A PHONE NUMBER LISTED ON THE APPLICATION FOR FINANCIAL ASSISTANCE WHICH PATIENTS CAN CALL IF THEY HAVE QUESTIONS.
SCHEDULE H, PART VI, LINE 4	THE FISCAL YEAR END 2022 COMMUNITY HEALTH SURVEY ASKED RESPONDENTS TO PROVIDE DATA ON A NUMBER OF DEMOGRAPHIC TOPICS, INCLUDING GENDER, RACE, AGE, RELATIONSHIP STATUS, HOME OWNERSHIP, EMPLOYMENT STATUS, EDUCATIONAL ATTAINMENT, HOUSEHOLD INCOME, GEOGRAPHIC LOCATION OF RESIDENCE, AND BMI. THE MAJORITY OF SURVEY RESPONDENTS WERE FEMALE (79%), WHITE (83.5%), AND REPORTED A HOUSEHOLD INCOME BETWEEN 50,000-74,999 PER YEAR (23.7%). MOST SURVEY RESPONDENTS FELL WITHIN THE AGE CATEGORIES OF 25 TO 34 YEARS (19.7%), 35 TO 44 YEARS (21.5%), AND 45 TO 54 YEARS (18%). OVER 89.6% REPORTED THAT THEY HAD AN EDUCATIONAL ATTAINMENT LEVEL OF AT LEAST SOME COLLEGE. ALMOST TWO IN THREE (62.5%) ADULTS ARE OVERWEIGHT OR OBESE. THE MAJORITY OF THE PARTICIPANTS OF THE SURVEY WERE FROM GRAND RAPIDS, WYOMING, AND KENTWOOD, WITH 24 OTHER CITIES, TOWNSHIPS OR VILLAGES BEING REPRESENTED IN THE RESULTS. GRAND RAPIDS REPRESENTS THE VAST MAJORITY, WITH OVER 60% OF PARTICIPANTS RESIDING IN THE CITY. KENT COUNTY, WHERE THE MAJORITY OF METRO HEALTH PATIENTS RESIDE, IS THE FOURTH LARGEST COUNTY IN MICHIGAN. AS OF 2019, THERE WAS AN ESTIMATED POPULATION OF 656,955 IN KENT COUNTY. KENT COUNTY INCLUDES A DIVERSE MIX OF DEMOGRAPHICS. ACCORDING TO THE UNITED STATES CENSUS BUREAU WEB SITE (2019 CENSUS), 89.4% OF THE POPULATION IS WHITE (NOT HISPANIC). THE HISPANIC POPULATION IS 5.1% OF RESIDENTS; THE AFRICAN AMERICAN POPULATION IS 13.8% OF THE COMMUNITY, AND ASIAN AMERICANS COMPRISE 3.1% OF THE POPULATION.
SCHEDULE H, PART VI, LINE 5	IN FISCAL YEAR 2022, METRO HEALTH HOSPITAL CONTINUED TO PROVIDE COMMUNITY BENEFIT BY PROVIDING HIGH QUALITY, COORDINATED PATIENT CARE, EDUCATION, RESEARCH AND ADVOCACY PROGRAMS. WE PROVIDED THESE SERVICES IN KENT COUNTY, MICHIGAN AND THE SURROUNDING WEST MICHIGAN AREAS. METROS GOVERNANCE STRUCTURE, OPEN MEDICAL STAFF, AND OUTREACH PROGRAMMING CONTRIBUTE TO HOW WE PROMOTE COMMUNITY HEALTH. BOARD SERVICE IS A COMMITMENT TO HELP FURTHER THE HOSPITALS MISSION OF RELENTLESSLY ADVANCING HEALTH TO SERVE WEST MICHIGAN. MEMBERS REPRESENT A WIDE SPECTRUM OF INDUSTRIES, INCLUDING HEALTHCARE, BANKING, REAL ESTATE, MARKETING, OFFICE FURNITURE, NON-PROFIT LEADERSHIP AND MORE. WHILE THE MAJORITY OF BOARD MEMBERS ARE CAUCASIAN, MEMBERS ALSO REPRESENT THE AFRICAN AMERICAN AND LATINO COMMUNITIES. METRO HEALTH MAINTAINS AN OPEN MEDICAL STAFF, MEANING COMMUNITY PRACTITIONERS CAN HOLD PRIVILEGES AT THE HOSPITAL. THERE ARE MORE THAN 500 MEMBERS OF THE MEDICAL STAFF, REPRESENTING EMPLOYED AND INDEPENDENT PHYSICIANS AND A MIX OF PRIMARY CARE AND SPECIALTY PHYSICIANS. METRO HEALTH HOSPITAL OFFERS A VARIETY OF PROGRAMS TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR LIVE HEALTHY COMMUNITY OUTREACH PROGRAM PROVIDES FREE AND LOW-COST HEALTH EDUCATION PROMOTION EVENTS, CLASSES AND MORE TO OUR COMMUNITY. THE MAJORITY OF THESE PROGRAMS IS DESIGNED TO ADDRESS RECOGNIZED HEALTH NEEDS IN THE COMMUNITY. THESE CLASSES AND EVENTS GROW IN POPULARITY EVERY YEAR AND INCLUDE TOPICS SUCH AS LIVING WITH DIABETES, CPR CLASSES COOKING WITH THE CARDIOLOGIST AND MORE. LOW-COST EXERCISE CLASSES OFFER ACTIVITY TO BEGINNERS, AS WELL AS TO VERY FIT PARTICIPANTS. OTHER FREE OFFERINGS ARE TOBACCO CESSATION, PRE-DIABETES, NUTRITION, JOINT PAIN, INJURY AND FALL PREVENTION, CHILD SAFETY SEAT, HEALTHY COOKING CLASSES, STRESS MANAGEMENT CLASSES AND MANY MORE. WHILE ALL OF THE LIVE HEALTHY CLASSES ARE FREE OR LOW COST, IF COST IS A DETERRENT FOR PEOPLE BEING ABLE TO ATTEND, THE COMMUNITY OUTREACH DEPARTMENT WAIVES THE FEE. FREE HEALTH SCREENS ARE ALSO AN IMPORTANT COMPONENT OF THE LIVE HEALTHY PROGRAM. AS EXAMPLES, FREE BLOOD PRESSURE SCREENS ARE HELD MONTHLY IN THE HOSPITAL AND AT THREE OFFSITE PHYSICIAN OFFICES. HOLDING SCREENS AT THESE REMOTE LOCATIONS MAKES IT EASIER FOR MORE PEOPLE IN OUR SERVICE AREA TO TAKE ADVANTAGE OF THE FREE SERVICE. FOR EXAMPLE, METRO ALSO OFFERED FREE SCREENING EVENTS FOR PERIPHERAL ARTERY DISEASE (PAD) AND SUDDEN CARDIAC DEATH IN HIGH SCHOOL ATHLETES. PAD CAN RESULT AS A SIDE EFFECT OF DIABETES OR OTHER ILLNESSES; ALL PEOPLE AT RISK OF HEART DISEASE ARE AT RISK OF PAD. LEFT UNTREATED PAD CAN RESULT IN CRITICAL LIMB ISCHEMIA AND/OR AMPUTATION. BY TREATING PAD BEFORE IT ESCALATES, PHYSICIANS ARE HELPING PATIENTS AVOID COSTLY AND LIFE-CHANGING MAJOR AMPUTATIONS. OUR COMMUNITY WAS DIRECTLY AFFECTED BY THE DEATH OF A YOUNG ATHLETE ON THE BASKETBALL COURT. PARENTS AND SCHOOL ADMINISTRATORS ALIKE SOUGHT RESOURCES FOR IDENTIFYING RISKS OF SUDDEN CARDIAC DEATH. AS A RESULT, METROS SPORTS MEDICINE AND CARDIOLOGY PHYSICIANS PARTNER TO OFFER SCREENINGS TO HIGH SCHOOL STUDENTS. THE HOSPITAL ALSO HOSTS A NUMBER OF FREE SUPPORT GROUPS AND MEETINGS FOR COMMUNITY ORGANIZATIONS. SOME SUPPORT GROUPS ARE RUN BY METRO HEALTH PROFESSIONALS AND OTHERS ARE COMMUNITY-BASED GROUPS TO WHOM METRO OFFERS FREE CONFERENCE ROOM SPACE. SOME OF THE SUPPORT GROUPS MEETING AT METRO INCLUDE THOSE FOR ALZHEIMERS, BREASTFEEDING AND CANCER SERVICES. AS A TEACHING HOSPITAL, METRO ALSO OFFERS EDUCATIONAL OPPORTUNITIES TO MEDICAL RESIDENTS, NURSES, RADIOLOGY TECHS, PHLEBOTOMISTS AND EVEN HIGH SCHOOL STUDENTS WHO ARE INTERESTED IN MEDICAL PROFESSIONS. THE METRO HEALTH FARM MARKET IS ANOTHER WAY METRO SEEKS TO IMPROVE THE HEALTH OF OUR COMMUNITY. FOR TEN CONSECUTIVE YEARS NOW, OUR MARKET HAS GROWN IN POPULARITY AMONG COMMUNITY MEMBERS, PATIENTS AND EMPLOYEES. ON FARM MARKET DAYS, IT IS COMMON TO SEE OUTPATIENTS AND VISITORS MINGLE WITH COMMUNITY MEMBERS AS THEY SHOP FOR FRESH, LOCALLY GROWN AND PRODUCED FOODS. METRO CONTINUED ITS EFFORTS TO MAKE HEALTHY FOODS AVAILABLE TO OUR ENTIRE COMMUNITY BY CONTINUING TO OFFER FARM MARKET SHOPPERS ON FOOD ASSISTANCE WAYS TO USE THE ASSISTANCE AT THE MARKET. METRO ACCEPTS PROJECT FRESH COUPONS AND SNAP BENEFITS. WE ASLO ACCEPT DOUBLE UP FOOD BUCKS, SENIOR PROJECT FRESH, AND WIC. AS AN ADDED BENEFIT, METRO OFFERED FREE HEALTH SCREENS AND COOKING CLASSES AT THE MARKET SO THAT AREA RESIDENTS COULD LEARN ABOUT THEIR HEALTH AND LEARN WAYS TO COOK THE DELICIOUS, HEALTHY FOODS AVAILABLE AT THE MARKET REGARDLESS OF THEIR INCOME LEVEL. METRO HEALTH IS ALSO COMMITTED TO PROTECTING THE ENVIRONMENT THROUGH A NUMBER OF GREEN INITIATIVES. OUR HOSPITAL BUILDING IS ONE OF THE FIRST HOSPITALS IN THE NATION DESIGNED AND BUILT TO BE LEED-CERTIFIED (LEADERSHIP IN ENERGY AND ENVIRONMENTAL DESIGN), AND IT IS LOCATED IN THE METRO HEALTH VILLAGE WHICH REQUIRES ALL BUILDINGS ON THE PROPERTY TO BE DESIGNED AND BUILT FOR LEED CERTIFICATION. EMPLOYEE AND COMMUNITY PARTICIPATION IN RECYCLING AND COMPOSTING PROGRAMS AT THE HOSPITAL CONTINUES TO GROW EACH YEAR. THE HOSPITAL KITCHEN RECYCLING AND COMPOSTING IS VERY SUCCESSFUL AND WOULD NOT BE POSSIBLE WITHOUT THE BUY-IN OF THE EMPLOYEE TEAM. WE HAVE CREATED A SUSTAINABILTY COMMITTEE THAT INCLUDES EMPLOYEE LEADERSHIP THROUGHOUT THE ORGANIZATION THAT PLAY AN IMPORTANT ROLE IN OUR SUSTAINABILITY INITIATIVES. BEYOND THE WALLS OF THE HOSPITAL, METROS LEADERSHIP TEAM IS WORKING TO MAKE AN IMPACT ON THE COMMUNITY. EVERY MEMBER OF THE LEADERSHIP TEAM IS EXPECTED TO VOLUNTEER A MINIMUM OF 12 HOURS DURING THE YEAR TO COMMUNITY- BENEFIT INITIATIVES. MANY LEADERS GO WELL ABOVE THE 12-HOUR THRESHOLD AND VOLUNTEER MUCH MORE IN THE COMMUNITY. THEY ALSO ALLOW TEAM BUILDING THROUGH SERVICE TO OTHER ORGANIZATIONS. TEAMS OF METRO EMPLOYEES HAVE WORKED TOGETHER TO ASSIST AREA FOOD PROGRAMS, PROVIDE FLU SHOTS FOR AREA RESIDENTS IN NEED AND MORE.
SCHEDULE H, PART VI, LINE 7	MICHIGAN
SCHEDULE H, PART VI	PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL 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 HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: HEALTHCARE PAYMENT REFORMS IMPLEMENTED THROUGH THE AFFORDABLE CARE ACT HAVE SHIFTED SOME OF THE EXPENSE BURDEN OF PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES FROM THE GOVERNMENT ON TO HEALTHCARE PROVIDERS THROUGH REDUCED PAYMENTS. THESE PAYMENT REDUCTIONS HAVE INCREASED THE LOSSES INCURRED BY HEALTHCARE PROVIDERS FOR TREATING MEDICARE BENEFICIARIES. BY REDUCING THE GOVERNMENTS FINANCIAL BURDEN FOR PROVIDING HEALTHCARE SERVICES TO MEDICARE BENEFICIARIS, METRO HEALTH BELIEVES THAT MEDICARE SHORTFALLS PROVIDE A VALUABLE COMMUNITY BENEFIT.

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

METROPOLITAN HOSPITAL

Employer identification number

38-0593405

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DAVID MILLER VICE CHAIR	(i) (ii)	------------- 1,127,593	-------------	------------- 46,360	------------- 79,000	------------- 24,400	------------- 1,277,353	-------------
2MATTHEW SEVENSMA CHIEF OF STAFF	(i) (ii)	695,465 -------------	264,335 -------------	990 -------------	11,600 -------------	19,540 -------------	991,930 -------------	-------------
3DAVID SPAHLINGER VICE CHAIRPERSON	(i) (ii)	------------- 928,276	-------------	------------- 14,499	------------- 28,999	------------- 17,317	------------- 989,091	-------------
4AUGUSTO ELIAS PHYSICIAN	(i) (ii)	946,439 -------------	-------------	1,518 -------------	11,600 -------------	21,236 -------------	980,793 -------------	-------------
5MICHAEL SUMNERS PHYSICIAN	(i) (ii)	587,244 -------------	330,634 -------------	660 -------------	11,600 -------------	7,003 -------------	937,141 -------------	-------------
6BARBARA KARENKO PHYSICIAN	(i) (ii)	659,851 -------------	215,559 -------------	660 -------------	11,600 -------------	19,838 -------------	907,508 -------------	-------------
7ERIC WALCHAK PHYSICIAN	(i) (ii)	645,316 -------------	154,756 -------------	1,518 -------------	11,600 -------------	19,977 -------------	833,167 -------------	-------------
8PAUL KOVACK BOARD MEMBER	(i) (ii)	589,448 -------------	199,891 -------------	4,356 -------------	11,600 -------------	19,838 -------------	825,133 -------------	-------------
9PETER HAHN PRESIDENT AND CEO	(i) (ii)	623,382 -------------	128,365 -------------	3,601 -------------	11,600 -------------	21,236 -------------	788,184 -------------	-------------
10RAKESH PAI PRESIDENT-MED/CPHO	(i) (ii)	460,557 -------------	97,693 -------------	990 -------------	11,600 -------------	19,838 -------------	590,678 -------------	-------------
11RONALD GRIFKA CMO	(i) (ii)	462,581 -------------	94,557 -------------	4,356 -------------	11,600 -------------	7,145 -------------	580,239 -------------	-------------
12JEFFERY POSTLEWAITE VP-MEDICAL AFFAIRS	(i) (ii)	387,408 -------------	59,122 -------------	4,356 -------------	11,600 -------------	14,403 -------------	476,889 -------------	-------------
13QUINTA VREEDE BOARD MEMBER	(i) (ii)	------------- 400,461	-------------	------------- 26,500	------------- 29,000	------------- 9,291	------------- 465,252	-------------
14KRIS KURTZ CFO	(i) (ii)	322,316 -------------	86,510 -------------	1,518 -------------	11,600 -------------	21,236 -------------	443,180 -------------	-------------
15LANCE OWENS CM INFO. OFFICER	(i) (ii)	316,330 -------------	65,502 -------------	1,518 -------------	11,600 -------------	21,236 -------------	416,186 -------------	-------------
16LORI PRICE -PART YEAR COO	(i) (ii)	307,766 -------------	80,342 -------------	2,218 -------------	-------------	12,420 -------------	402,746 -------------	-------------
17JONATHAN WILDA CIO	(i) (ii)	295,024 -------------	61,023 -------------	660 -------------	11,600 -------------	19,977 -------------	388,284 -------------	-------------
18JENNIFER GONZALEZ - PART YEAR CHRO	(i) (ii)	264,452 -------------	52,786 -------------	990 -------------	11,600 -------------	21,236 -------------	351,064 -------------	-------------
19STEVEN POLEGA CNO	(i) (ii)	258,812 -------------	53,843 -------------	1,518 -------------	11,600 -------------	20,798 -------------	346,571 -------------	-------------
20GREGORY MEYER CCO	(i) (ii)	239,106 -------------	49,645 -------------	8,382 -------------	11,600 -------------	14,969 -------------	323,702 -------------	-------------
21MONICA TAYLOR COO - MEDICAL GROUP	(i) (ii)	249,125 -------------	45,347 -------------	1,518 -------------	11,600 -------------	13,446 -------------	321,036 -------------	-------------
22PENNY DEVRIES VP-MARKETING/COMMUN.	(i) (ii)	239,208 -------------	49,442 -------------	4,356 -------------	11,600 -------------	13,737 -------------	318,343 -------------	-------------
23PHILIP VANLAAN ASSOC. GEN COUNSEL	(i) (ii)	224,290 -------------	37,081 -------------	594 -------------	10,657 -------------	19,977 -------------	292,599 -------------	-------------
24STACIE BOMMERSBACH VP- QUALITY & SAFETY	(i) (ii)	237,661 -------------	29,188 -------------	990 -------------	6,891 -------------	6,922 -------------	281,652 -------------	-------------
25THOMAS FANTIN VP-IT	(i) (ii)	181,873 -------------	30,258 -------------	613 -------------	8,683 -------------	19,934 -------------	241,361 -------------	-------------
26RHAE-ANN BOOKER VP-DEI	(i) (ii)	185,098 -------------	30,684 -------------	1,424 -------------	8,769 -------------	14,371 -------------	240,346 -------------	-------------
27BRUCE CARRIER CHIEF HR OFFICER	(i) (ii)	159,419 -------------	27,203 -------------	1,252 -------------	7,788 -------------	21,118 -------------	216,780 -------------	-------------
28TENA HOXSIE VP-PATIENT FIN EXP	(i) (ii)	150,654 -------------	18,465 -------------	3,320 -------------	6,988 -------------	14,265 -------------	193,692 -------------	-------------
29KATHRYN VEENSTRA ASSISTANT CNO	(i) (ii)	148,408 -------------	17,315 -------------	436 -------------	4,119 -------------	7,158 -------------	177,436 -------------	-------------

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PAGE 1, PART I, LINE 4	DAVID MILLER 0 50,000 0

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

METROPOLITAN HOSPITAL

Employer identification number

38-0593405

Return Reference	Explanation
FORM 990 - ORGANIZATION'S MISSION	METRO HEALTH'S MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. TO THAT END THE ORGANIZATION BELIEVES THE FOUNDATION OF GOOD HEALTH IS BASED ON EXCELLENT QUALITY PRIMARY CARE. THE ORGANIZATION IS ANCHORED BY A 208-BED, GENERAL ACUTE CARE COMMUNITY HOSPITAL. ADDITIONALLY, IT OPERATES 13 NEIGHBORHOOD OUTPATIENT CENTERS, STUDENT HEALTH FACILITIES AT GRAND VALLEY STATE UNIVERSITY AND A COMMUNITY CLINIC FOR THE UNDERSERVED. THE NEIGHBORHOOD OUTPATIENT CENTERS RING THE ORGANIZATION'S SERVICE AREA, ALLOWING PATIENTS ACCESS TO QUALITY HEALTHCARE CLOSE TO HOME; SERVICES AT THEM INCLUDE PRIMARY CARE, LAB SERVICES, MAMMOGRAPHY, X-RAY AND PHYSICAL THERAPY. IN ADDITION TO PRIMARY CARE SERVICES, THE ORGANIZATION PROVIDES SPECIALTY CARE AT ITS HEART AND VASCULAR PRACTICE, CANCER CENTER, AMBULATORY SURGERY CENTER, OPHTHALMOLOGY OFFICE, SLEEP LAB AND OTHER SITES. THE ORGANIZATION ALSO FOCUSES ON IMPROVING THE HEALTH OF THE COMMUNITY BEFORE PEOPLE NEED HEALTHCARE. IT DOES THIS THROUGH ITS LIVE HEALTHY COMMUNITY OUTREACH PROGRAM THAT OFFERS FREE AND LOW-COST CLASSES, SEMINARS AND COMMUNITY HEALTH SCREENS. IN THE PAST YEAR, SCREENS HAVE BEEN DONE FOR HIGH BLOOD PRESSURE, PERIPHERAL VASCULAR DISEASE, MEMORY ISSUES AND SUDDEN CARDIAC DEATH. METRO HEALTH IS ALSO A MAJOR PROVIDER OF OSTEOPATHIC MEDICAL EDUCATION. IN FISCAL YEAR 2021, 120 MEDICAL STUDENTS, RESIDENTS AND FELLOWS PARTICIPATED IN ITS MEDICAL EDUCATION PROGRAM. THE REGENTS OF THE UNIVERSITY OF MICHIGAN (U-M) IS THE WHOLLY-OWNED MEMBER OF UM HEALTH WHICH IS THE SOLE MEMBER OF METROPOLITAN HOSPITAL ALSO KNOWN AS UMH-WEST. IN WHICH CASE, THE HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF UM HEALTH AND U-M FOR FISCAL YEAR ENDED JUNE 30, 2022 ACCORDINGLY.
FORM 990, PAGE 2, PART III, LINE 4A	METRO HEALTH HOSPITAL IS A 208-BED TEACHING HOSPITAL THAT PROVIDES A COMPREHENSIVE SUITE OF INPATIENT AND OUTPATIENT HEALTHCARE SERVICES, INCLUDING FAST EMERGENCY SERVICES, CANCER AND CARDIAC CARE, ROBOTIC AND TRADITIONAL SURGERY, FAMILY PRACTICE, INTERNAL MEDICINE, SPORTS MEDICINE AND OTHERS. THE ORGANIZATION'S MISSION IS TO IMPROVE THE HEALTH AND WELL- BEING OF THE COMMUNITIES IT SERVES. TO THAT END, METRO PROVIDES EDUCATION AND SCREENING PROGRAMS FOR THE COMMUNITY, EDUCATION OPPORTUNITIES FOR FUTURE DOCTORS, NURSES AND OTHER HEALTH PROFESSIONS, FINANCIAL ASSISTANCE PROGRAMS, CARE FOR THE UNDERSERVED, AND MUCH MORE. DURING FISCAL YEAR 2022, METRO HEALTH WELCOMED 1,747 BABIES INTO OUR COMMUNITY, CARED FOR 54,222 EMERGENCY ROOM VISITS, PERFORMED 1,613,504 LABORATORY TESTS AND 42,282 DIAGNOSTIC RADIOLOGY PROCEDURES AND COUNTED 39,909 PATIENT DAYS. THE METRO HEALTH COMMUNITY CLINIC, WHICH PROVIDES MEDICAL CARE TO THE UNDERSERVED, PROVIDED CARE FOR 17,218 PATIENT VISITS. METRO HEALTH'S MEDICAL EDUCATION PROGRAM INCLUDED 120 MEDICAL STUDENTS, RESIDENTS AND FELLOWS.
FORM 990, PAGE 6, PART VI, LINE 6	SEE 2ND PARAGRAPH, PAGE 1 - AFFILIATION WITH THE REGENTS OF THE UNIVERSITY OF MICHIGAN VIA ITS WHOLLY-OWNED NON-PROFIT, U-M HEALTH.
FORM 990, PAGE 6, PART VI, LINE 7A	THE SOLE MEMBER, UM HEALTH, SHALL ELECT THE DIRECTORS OF METROPOLITAN HOSPITAL.
FORM 990, PAGE 6, PART VI, LINE 7B	U-M HEALTH EXERCISES CERTAIN RESERVED POWERS,INCLUDING APPROVAL OF STRATEGIC PLANS AND ANNUAL OR OTHER BUDGETS.
FORM 990, PAGE 6, PART VI, LINE 11B	THE COMPLETED FORM 990 WAS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CONTROLLER. ALSO, PRIOR TO FILING THE FORM 990, THE FULL METRO BOARD OF DIRECTORS WAS NOTIFIED THAT THE COMPLETED FORM 990 WAS AVAILABLE FOR REVIEW AT THE BOARD MEETING.
FORM 990, PAGE 6, PART VI, LINE 12C	EACH BOARD MEMBER, KEY EMPLOYED AND NON-EMPLOYED PERSONNEL IS REQUIRED ANNUALLY TO COMPLETE A CONFLICT OF INTEREST STATEMENT. THE STATEMENTS ARE COMPILED AND THE HOSPITAL'S COMPLIANCE DEPARTMENT REVIEWS THEM FOR ANY POTENTIAL CONFLICTS. ANY CONFLICTS ARE NOTED AND APPROPRIATE ACTION IS TAKEN AS REQUIRED, IE VOTING OR CONTRACTS.
FORM 990, PAGE 6, PART VI, LINE 15A	THE CEO AND OTHER EXECUTIVE COMPENSATION IS DETERMINED BY USE OF CONSULTANTS AND COMPARABILITY DATA FROM OTHER HOSPITALS OF SIMILAR SIZE. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE CEO COMPENSATION. THEIR DISCUSSION IS DOCUMENTED IN THE MINUTES OF THE MEETING.
FORM 990, PAGE 6, PART VI, LINE 15B	THE EXECUTIVE'S COMPENSATION IS DETERMINED BY USE OF CONSULTANTS AND COMPARABILITY DATA FROM OTHER HOSPITALS OF SIMILAR SIZE. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE EXECUTIVE COMPENSATION. THEIR DISCUSSION IS DOCUMENTED IN THE MINUTES OF THE MEETING. THE EXECUTIVE TEAM HAS ENTERED INTO WRITTEN COMPENSATION CONTRACTS. STUDIES BY AN INDEPENDENT FIRM WERE COMPLETED TO ENSURE THE EXECUTIVES WERE AT MARKET VALUE.
FORM 990, PAGE 6, PART VI, LINE 19	DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9	CHANGE IN EQUITY INVESTMENT -87,804 PY GASB 87 ADJUSTMENT -1,189,639 TOTAL -1,277,443

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

METROPOLITAN HOSPITAL

Employer identification number

38-0593405

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(f) Direct controlling entity
(1) LAND METRO LLC 5900 BYRON CENTER AVE SW WYOMING,MI49519 20-2863709	REAL ESTAT	MI	METRO HOS

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)METROPOLITAN FOUNDATION 5900 BYRON CENTER AVE SW WYOMING,MI49519 38-3033329	SUP HOSP	MI	501C3	7	METRO HOSP	Yes
(2)REGENTS OF THE UNIV OF MICHIGAN 5082 WOLVERINE TWR 3003 S STATE ANN ARBOR,MI48109 38-6006309	SCHOOL	MI	501C3	2	N/A		No
(3)UM HEALTH 5082 WOLVERINE TOWER 3003 S STATE ANN ARBOR,MI48109 81-4913150	SUP ORG	MI	501C3	12A	UM		No
(4)WEST MICHIGAN RADIATION ONCOLOGY 5950 METRO WAY WYOMING,MI49529 30-0501592	HOSPITAL	MI	501C3	3	NA		No
(5)MICHIGAN HEALTH CORPORATION 5082 WOLVERINE TOWER 3003 S STATE ANN ARBOR,MI48109 38-3261376	SUP ORG	MI	501C3	12A	UM		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) MICHIGAN DIALYSIS SERVICES LLC 5082 WOLVERINE TOWER 300 S STATE ANN ARBOR,MI48109 38-3472138	DIALYSIS	MI	MHC	RELATED				No			No
(2) PHYSICIAN ORGANIZATION OF MI ACO 5082 WOLVERINE TOWER 3003 S STATE ANN ARBOR,MI48109 45-4542046	HEALTHCARE	MI	MHC	RELATED				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) KENT HELATH CARE PHYSICIAN ORG 2225 MAIN STREET SW STE 110 WYOMING,MI49519 38-3404658	HEALTHCARE	MI	METRO HOSP	C CORP	-8,810	601,961		Yes

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) METROPOLITAN FOUNDATION	C	1,621,437	CASH
(2) METROPOLITAN FOUNDATION	M	563,561	ALLOCATION OF COSTS
(3) REGENTS OF THE UNIVERSITY OF MI	E	19,000,000	CASH

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: METRO HEALTH'S MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. TO THAT END THE ORGANIZATION BELIEVES THE FOUNDATION OF GOOD HEALTH IS BASED ON EXCELLENT QUALITY PRIMARY CARE. THE ORGANIZATION IS ANCHORED BY A 208-BED, GENERAL ACUTE CARE COMMUNITY HOSPITAL. ADDITIONALLY, IT OPERATES 13 NEIGHBORHOOD OUTPATIENT CENTERS, STUDENT HEALTH FACILITIES AT GRAND VALLEY STATE UNIVERSITY AND A COMMUNITY CLINIC FOR THE UNDERSERVED. THE NEIGHBORHOOD OUTPATIENT CENTERS RING THE ORGANIZATION'S SERVICE AREA, ALLOWING PATIENTS ACCESS TO QUALITY HEALTHCARE CLOSE TO HOME; SERVICES AT THEM INCLUDE PRIMARY CARE, LAB SERVICES, MAMMOGRAPHY, X-RAY AND PHYSICAL THERAPY. IN ADDITION TO PRIMARY CARE SERVICES, THE ORGANIZATION PROVIDES SPECIALTY CARE AT ITS HEART AND VASCULAR PRACTICE, CANCER CENTER, AMBULATORY SURGERY CENTER, OPHTHALMOLOGY OFFICE, SLEEP LAB AND OTHER SITES. THE ORGANIZATION ALSO FOCUSES ON IMPROVING THE HEALTH OF THE COMMUNITY BEFORE PEOPLE NEED HEALTHCARE. IT DOES THIS THROUGH
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	3,579
6	Total number of volunteers (estimate if necessary) .............	6	86
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,063,970
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,282,892	1,621,437
9	Program service revenue (Part VIII, line 2g) .........	521,128,125	539,463,197
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	338,725	379,288
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)		0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	523,749,742	541,463,922
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	236,591,817	254,253,115
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 531,241
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	268,312,553	281,632,408
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	504,904,370	535,885,523
19	Revenue less expenses. Subtract line 18 from line 12.......	18,845,372	5,578,399
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	393,317,505	438,298,116
21	Total liabilities (Part X, line 26).............	304,354,426	345,930,237
22	Net assets or fund balances. Subtract line 21 from line 20.....	88,963,079	92,367,879

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 441,226,256 including grants of $ ) (Revenue $ )
	METRO HEALTH HOSPITAL IS A 208-BED TEACHING HOSPITAL THAT PROVIDES A COMPREHENSIVE SUITE OF INPATIENT AND OUTPATIENT HEALTHCARE SERVICES, INCLUDING FAST EMERGENCY SERVICES, CANCER AND CARDIAC CARE, ROBOTIC AND TRADITIONAL SURGERY, FAMILY PRACTICE, INTERNAL MEDICINE, SPORTS MEDICINE AND OTHERS. THE ORGANIZATION'S MISSION IS TO IMPROVE THE HEALTH AND WELL- BEING OF THE COMMUNITIES IT SERVES. TO THAT END, METRO PROVIDES EDUCATION AND SCREENING PROGRAMS FOR THE COMMUNITY, EDUCATION OPPORTUNITIES FOR FUTURE DOCTORS, NURSES AND OTHER HEALTH PROFESSIONS, FINANCIAL ASSISTANCE PROGRAMS, CARE FOR THE UNDERSERVED, AND MUCH MORE. DURING FISCAL YEAR 2022, METRO HEALTH WELCOMED 1,747 BABIES INTO OUR COMMUNITY, CARED FOR 54,222 EMERGENCY ROOM VISITS, PERFORMED 1,613,504 LABORATORY TESTS AND 42,282 DIAGNOSTIC RADIOLOGY PROCEDURES AND COUNTED 39,909 PATIENT DAYS. THE METRO HEALTH COMMUNITY CLINIC, WHICH PROVIDES MEDICAL CARE TO THE UNDERSERVED, PROVIDED CARE FOR 17,218 PATIENT VISITS. METRO HEALTH'S MEDICAL EDUCATION PROGRAM INCLUDED 120 MEDICAL STUDENTS, RESIDENTS AND FELLOWS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses441,226,256

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	12,278,701	2,543,689	894,620

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,621,437

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		1,621,437

		Business Code
2a	NET PATIENT REVENUE		514,181,914	514,181,914
b	OTHER REVENUE		24,217,313	24,217,313
c	LAB TEST FOR OUTSIDE PATIENTS	541380	1,063,970		1,063,970
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		539,463,197

3 Investment income (including dividends, interest, and othersimilar amounts) ......			385,148			385,148
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	-5,860		7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	-5,860		7c
d	Net gain or (loss).........			-5,860			-5,860
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			541,463,922	538,399,227	1,063,970	379,288

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	4,650,541	3,607,189	1,037,845	5,507
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	217,453,217	173,130,418	43,932,170	390,629
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	-4,910,439		-4,910,439
9	Other employee benefits .......	22,795,394	555,197	22,240,197
10	Payroll taxes ...........	14,264,402	11,824,860	2,409,073	30,469
11	Fees for services (non-employees):
a	Management ......	2,187,319	2,184,319	3,000
b	Legal .........	822,680		822,680
c	Accounting ...........	163,448		163,448
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	50,683,607	50,499,829	182,636	1,142
12	Advertising and promotion ....	2,864,626	730,063	2,134,563
13	Office expenses .......	11,345,679	11,065,386	259,840	20,453
14	Information technology ......	12,911,958	956,078	11,955,880
15	Royalties ..
16	Occupancy ...........	16,969,818	16,280,734	689,084
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	3,325,837	2,050,763	1,207,913	67,161
20	Interest ...........	10,826,544	9,732,799	1,093,745
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	33,896,554	33,201,809	694,745
23	Insurance ...	9,460,670	1,323,112	8,137,503	55
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	106,605,717	106,299,291	306,426
b	BAD DEBT	10,479,334	10,479,334
c	OTHER	4,457,129	4,101,684	355,445
d	CONSULTING	2,341,176	915,266	1,410,085	15,825
e	All other expenses	2,290,312	2,288,125	2,187
25	Total functional expenses. Add lines 1 through 24e	535,885,523	441,226,256	94,128,026	531,241
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			19,841,979	1	9,682,402
2	Savings and temporary cash investments .........			36,870,731	2	10,434,486
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			54,840,578	4	71,777,491
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			526,399	7	707,487
8	Inventories for sale or use ............			9,356,468	8	8,778,686
9	Prepaid expenses and deferred charges ......			1,544,387	9	2,518,514
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	671,085,589
b	Less: accumulated depreciation	10b	355,519,880	251,349,518	10c	315,565,709
11	Investments—publicly traded securities .			7,772,080	11	5,368,626
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			686,256	14
15	Other assets. See Part IV, line 11 ...........			10,529,109	15	13,464,715
16	Total assets. Add lines 1 through 15 (must equal line 33)...			393,317,505	16	438,298,116

17	Accounts payable and accrued expenses .....	36,962,299	17	43,836,099
18	Grants payable ...		18
19	Deferred revenue .........	4,443,462	19	1,045,151
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	383,460	23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	262,565,205	25	301,048,987
26	Total liabilities. Add lines 17 through 25..	304,354,426	26	345,930,237

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	88,963,079	27	92,367,879
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	88,963,079	32	92,367,879
33	Total liabilities and net assets/fund balances ........	393,317,505	33	438,298,116