TY 2024 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) Linda Evans MD...................................................................... Director, Physician	40.00 ................. 0.00	X				208,381	0	27,723
(2) Adam Goff OD...................................................................... Director	2.00 ................. 0.00	X				1,016	0	0
(3) Laurie A Hines...................................................................... Chair	2.00 ................. 0.00	X	X			200	0	0
(4) Raymond L Bendure PhD...................................................................... Vice Chair	2.00 ................. 0.00	X	X			200	0	0
(5) Rick Cordes...................................................................... Secretary	2.00 ................. 0.00	X	X			200	0	0
(6) Jennifer Platz...................................................................... Director	2.00 ................. 0.00	X				200	0	0
(7) Jim Stuck...................................................................... Director	2.00 ................. 0.00	X				200	0	0
(8) Ed Reed...................................................................... Director	2.00 ................. 0.00	X				200	0	0
(9) Kreg R Gruber...................................................................... CEO	2.00 ................. 50.00		X			0	1,848,714	287,708
(10) Jeffrey P Costello...................................................................... CFO	2.00 ................. 50.00		X			0	1,077,612	188,598
(11) Maria A Behr...................................................................... President	40.00 ................. 0.00		X			0	379,565	102,861
(12) Erika L Dearing...................................................................... Employed Physician	40.00 ................. 0.00			X		372,909	0	63,720
(13) Jessica Puckett...................................................................... Employed Physician	40.00 ................. 0.00			X		369,923	0	49,643
(14) Alyssa Erskine...................................................................... Employed Physician	40.00 ................. 0.00			X		340,560	0	59,545
(15) James MacDonald...................................................................... Employed Physician	40.00 ................. 0.00			X		324,689	0	68,220
(16) Todd M Ozdych...................................................................... Employed Physician	40.00 ................. 0.00			X		328,932	0	57,291
(17) Hope Bailey...................................................................... Former VP Nursing	0.00 ................. 0.00				X	258,447	0	55,905

(A) Name and business address	(B) Description of services	(C) Compensation
Clinical Colleagues Inc 1765 E Nine Mile Rd Pensacola,FL32514	Anesthesia Services	2,329,988
Kalamazoo Foot & Ankle Specialists PLC 12057 West Indian Lake Dr Vicksburg,MI49097	Physician Services	2,081,204
Elite Emergency Physicians Inc 600 East Blvd Elkhart,IN46514	Physician Services	738,666
West Michigan Ear Nose & Throat 3850 Glenkerry Court Portage,MI49024	Physician Services	661,248
Panamerican Hospitalists PLLC 50755 Brookside Drive Granger,IN46530	Physician Services	562,843
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 27

- 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

2024

Open to Public
Inspection

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

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) 2024

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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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 2024 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2023 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2024. 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—2023. 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—2024. 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—2023. 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) 2024

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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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) 2020	(b) 2021	(c) 2022	(d) 2023	(e) 2024	(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 2024 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2023 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2024 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2023 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2024. 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—2023. 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) 2024

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) 2024

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) 2024

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) 2024

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 2024 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-2024	(iii) Distributable Amount for 2024
1 Distributable amount for 2024 from Section C, line 6
2 Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2024:
a From 2019.......
b From 2020.......
c From 2021.......
d From 2022.......
e From 2023.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2024 distributable amount
i Carryover from 2019 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2024 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2024 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2020.....
b Excess from 2021.....
c Excess from 2022.....
d Excess from 2023.....
e Excess from 2024.....

Schedule A (Form 990) (2024)

Schedule A (Form 990) 2024

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) 2024

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)
(Rev. January 2025)

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

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

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 ......... Right Arrow

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) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025) Page 2

Name of organization Three Rivers Health System Inc

Part I	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) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025)

Page 3

Name of organization Three Rivers Health System Inc		Employer identification number 45-1257972

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) (Rev. 1-2025)

Schedule B (Form 990) (Rev. 1-2025)

Page 4


Name of organization Three Rivers Health System Inc			Employer identification number 45-1257972
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) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

right arrow

Complete if the organization is described below. 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

2024

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... right arrow

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ right arrow

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... right arrow

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990) 2024

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check right arrow

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check right arrow

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2021	(b) 2022	(c) 2023	(d) 2024	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2024

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

2,230

Total. Add lines 1c through 1i ....................................................................................................

2,230

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	Three Rivers Health paid dues to the following organizations for which the amount or percentage listed was attributed to lobbying: ACOG (American College of Obstetricians and Gynecologists) - 20% MHA (Michigan Health & Hospital Association) - 10% ACEND (Academy of Nutrition and Dietetics) - 10% MAHC (Michigan Home Care Hospice Association) - 20% ASHT (American Society of Hand Therapists) - 20% AOTA (American Occupational Therapy Association) - 20% AASM (American Academy of Sleep Medicine) - 20% ACHE (American College of Healthcare Executives) - 1% When unable to ascertain allocation of dues attributed to lobbying, a conservative estimate of 20% is applied.

Return Reference

Explanation

Part II-B, Line 1:

Three Rivers Health paid dues to the following organizations for which the amount or percentage listed was attributed to lobbying: ACOG (American College of Obstetricians and Gynecologists) - 20% MHA (Michigan Health & Hospital Association) - 10% ACEND (Academy of Nutrition and Dietetics) - 10% MAHC (Michigan Home Care Hospice Association) - 20% ASHT (American Society of Hand Therapists) - 20% AOTA (American Occupational Therapy Association) - 20% AASM (American Academy of Sleep Medicine) - 20% ACHE (American College of Healthcare Executives) - 1% When unable to ascertain allocation of dues attributed to lobbying, a conservative estimate of 20% is applied.

Schedule C (Form 990) 2024

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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

Open to Public Inspection

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

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

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) (Rev. 1-2025)

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 ....	42,456,771	38,758,960	0
b	Contributions ...	9,625,097	2,440,358	46,675,184
c	Net investment earnings, gains, and losses	2,320,861	2,682,416	-4,645,969
d	Grants or scholarships ...	4,428,203	1,424,963	3,270,255
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	49,974,526	42,456,771	38,758,960

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

Board designated or quasi-endowment right arrow

67.190 %

Permanent endowment right arrow

0 %

Term endowment right arrow

32.810 %

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)

Yes

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

Yes

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 .....	6,502,266		6,502,266
b	Buildings ....	13,359,826	1,830,518	11,529,308
c	Leasehold improvements
d	Equipment ....	9,979,122	4,573,354	5,405,768
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				23,437,342

Schedule D (Form 990) (Rev. 1-2025)

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)Other Receivables				468,347
(2)Third Party Receivables				4,254,695
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				4,723,042

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
Third Party Payables	2,753,286








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,753,286
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) (Rev. 1-2025)

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

Part V, Line 4:

Net assets with donor restrictions consist of assets whose use is limited by donor imposed, time and/or purpose restrictions. In accordance with the restriction, a majority of the investment income and investment gains or losses from these net assets are restricted by the donor for a specific purpose. A specified portion of income earned by the net assets is released from restriction and used for operations each year and, therefore, is included in the consolidated statements of operations and changes in net assets as other revenue. The board has discretion to utilize each year the incomes, revenues and profits arising and accruing from the endowments in defraying costs associated with the trust and the remainder for support, betterment, improvement, upkeep, expansion and replacement of Beacon Health System, Inc. and its corporate affiliates.

Part X, Line 2:

ASC 740, Income Taxes, requires that realization of an uncertain income tax position is more likely than not (i.e., greater than 50% likelihood of receiving a benefit) before it is recognized in the consolidated financial statements as the amount most likely to be realized assuming a review by tax authorities having all relevant information and applying current conventions. This interpretation also clarifies the financial statement classification of tax-related penalties and interest and sets forth new disclosures regarding unrecognized tax benefits. No amount was recorded for the years ended December 31, 2024 or 2023.

Schedule D (Form 990) (Rev. 1-2025)

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 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2024

Open to Public Inspection

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

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 %

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? . . . . . .

Yes

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) . . .	3,913,662	0	3,913,662	5.680 %
b	Medicaid (from Worksheet 3, column a) . . . . .	17,328,249	19,712,554	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	21,241,911	19,712,554	3,913,662	5.680 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	633,000	0	633,000	0.920 %
g	Subsidized health services (from Worksheet 6) . . . .	9,426,261	5,420,122	4,006,139	5.810 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	32,450	0	32,450	0.050 %
j	Total. Other Benefits . .	10,091,711	5,420,122	4,671,589	6.780 %
k	Total. Add lines 7d and 7j .	31,333,622	25,132,676	8,585,251	12.460 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2024

Schedule H (Form 990) 2024

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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. ......

4,773,776

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. ......

1,524,888

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).....

2,075,149

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

6,447,166

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

-4,372,017

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) 2024

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	Three Rivers Health 701 S Health Parkway Three Rivers,MI49093 1060000006	X	X	X

Schedule H (Form 990) 2024

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)

	Three Rivers Health
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 24

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

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): https://impact.beaconhealthsystem.org/chna/

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 22

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

Yes

If "Yes" (list url): https://impact.beaconhealthsystem.org/chna/

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) 2024

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Three Rivers Health
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 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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):

https://www.beaconhealthsystem.org/patients-and-visitors/

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

https://www.beaconhealthsystem.org/patients-and-visitors/

A plain language summary of the FAP was widely available on a website (list url):
https://www.beaconhealthsystem.org/patients-and-visitors/

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) 2024

Page 6

Part VFacility Information (continued)

Billing and Collections

	Three Rivers Health
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) 2024

Page 7

Part VFacility Information (continued)

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

	Three Rivers Health
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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2024

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
Three Rivers Health	Part V, Section B, Line 5: Beacon Health System's 2024 Community Health Needs Assessment (CHNA) represents more than just a regulatory requirement for non-profit hospitals. The organization views it as a valuable opportunity to engage with communities across their four-county service area (St. Joseph County IN, Elkhart County, Marshall County, and St. Joseph County MI) to understand health and social needs of community members. The assessment follows the MAPP 2.0 framework (Mobilizing for Action through Planning and Partnerships) developed by the National Association of County & City Health Officials. This community-driven assessment and planning process is designed to support health equity while focusing on strategic, prioritized needs. The framework helps recognize and align resources across integrated sectors by emphasizing diverse and inclusive assessment activities. The CHNA is structured around three primary assessment components: Community Status Assessment (CSA) - Provides a foundation of secondary research data about demographics, health status, health inequities, and social drivers of health. This helps identify communities at greater risk of poor health outcomes and understand which groups may need more services. Community Partner Assessment (CPA) - Reviews existing resources, systems, processes, and capacities, both individually and collectively as a network of community partners. This component recognizes that community partnerships form the required network of support for public health improvement, as rarely can a single agency address all interrelated needs. Community Context Assessment (CCA) - Collects and analyzes qualitative data through community engagement. This component captures the lived experiences of community members, providing insights about helpful resources, organizational strengths, cultural nuances, and priorities. The assessment methodology employed a mixed methods approach between January and September 2024, including secondary research, community surveying, resource guide reviews, access audits, qualitative interviews, focus groups, and a needs prioritization process. Throughout the process, Beacon utilized: A Multi-Sector Health Advisory Council with a total of 23 representatives from across the four-county service area who received MAPP 2.0 training and met monthly throughout the project. Eight Equity Champions representing diverse communities helped ensure the needs of underrepresented or historically marginalized communities were understood. Beacon Health System is dedicated to understanding health equity and disparities within the communities it serves. Equity Champions participated in a stakeholder interview, participated in a focus group or helped host and recruit community members for a focus group, and participated in the prioritization process. The Equity Champions met regularly throughout the CHNA process. The research engaged many participants throughout the four-county region. 150 participants were for the focus groups and stakeholder interviews. We had 1,513 individuals complete our community survey. 49 partners completed the partner survey. We completed an access audit/mystery shopper with 25 facilities across the region. Community members participated in focus groups that explored local health needs and how these intersect with individual health experiences. Meanwhile, professionals and community leaders contributed their expertise through both focus groups and stakeholder interviews to provide insights into the broader health landscape. The participants represented diverse sectors that influence community health, including healthcare professionals, government representatives, faith-based organizations, community-based organizations, educational institutions, and social service providers. This multi-sector approach ensured a well-rounded understanding of health needs from various perspectives, combining both personal experiences and professional knowledge.Collectively with the health advisory council, health equity champions, the community survey, key informant interviews, and focus groups who took into account input received from persons who represent the broad interests of the community served. Secondary data provides an essential framework from which to better understand the fabric of the community. This analysis highlights sociodemographic factors, social drivers of health (SDOH), behavioral health risk factors, and other key indicators to further guide the development of effective strategies to meet evolving needs. In addition to collecting key demographic secondary data, research also focused on the SDOH. The SDOH includes a wide range of factors, including, but not limited to, income, education, job security, food security, housing, basic amenities, the environment, social inclusion and non-discrimination, and access to quality affordable health care. The top priority was identified through the modified delphi technique with our advisory council and internal leaders. The assessment identified 49 community needs, with "Access to Providers" emerging as the top priority area. This includes several subcategories:- Shortages of various provider types (primary care, specialists like endocrinology, OBGYN, pediatrics, rheumatology, neurology, podiatry) - Need for community health workers and peer support specialists - Improving cultural competency of providers - Addressing community mistrust of providers The report defines "providers" broadly to include anyone within the health system who interacts with patients or community members (nurses, front desk staff, cafeteria workers, environmental services).
Three Rivers Health	Part V, Section B, Line 6a: Three Rivers Health (TRH) developed the 2024 St. Joseph County CHNA in partnership with Elkhart General Hospital, Community Hospital of Bremen, and Memorial Hospital South Bend, Beacon Health System (BHS) care partners.
Three Rivers Health	Part V, Section B, Line 7d: The Community Health Needs Assessment (CHNA) was made widely available to the community through posting on the Beacon Health System website at https://impact.beaconhealthsystem.org/chna/ and through email transmission upon request. Hospital staff were also available to discuss the results of the CHNA and implementation strategies in requested community forums.
Three Rivers Health	Part V, Section B, Line 11: In partnership with the Branch-Hillsdale-St. Joseph Department of Health and other community partners, there is a focus on maternal and child health and mental health. For the mental health objectives in the CHIP, raising awareness about Pivotal, the Certified Community Behavioral Health Clinic (CCHBC) in St. Joseph, Michigan, needs improvement. Pivotal states they have not launched an awareness campaign before due to a lack of funding. Beacon funded a marketing campaign to help raise awareness that all residents can access behavioral health services at Pivotal, which will in turn increase mental health care access for St. Joseph County residents. The other priority area, maternal and child health, seeks to improve knowledge and use of the Women, Infant and Children's (WIC) program in St. Joseph County, Michigan. The work plan below provides detail on we will increase knowledge through sharing information with new birth parents, developing a marketing campaign to strengthen awareness of WIC, provide incentives when currently enrolled families need to recertify in the program, and promoting breastfeeding with support groups and items that support breastfeeding. A USDA 2023 report showed that only about 51% of those eligible actually participate in WIC, a program that is vital to the health and well-being of nearly half our nation's babies along with millions of young children up to age 5 and their mothers. Mental Health Metrics % of the population with frequent mental health distress % of the population with two or more trusted support people Healthcare Access Metrics % of the population with health insurance (adults < 65 and children) % of adults who reported their healthcare providers always involved them in decisions about their care, as much as they wanted. Beacon Community Impact provided community resources to 59,738 individuals across our service area Elkhart, Marshall, and St. Joseph, IN Counties and St Jospeh County, Michigan in 2024. Within Beacon Health System, the Beacon Community Impact Department leads efforts impact our priority areas of mental health and healthcare access using a combination of internal programs and collaborative partnerships. Our implementation strategy incorporates a three-pronged approach: We provide direct services to clients through Beacon's Early Childhood Services and Community Health Services teams. Early Childhood Services include the St. Joseph County (Ind.) WIC program, two sickle cell programs and our Family & Infants Support Program. These programs focus on the health status of women, infants and young families, particularly the most vulnerable in Beacon's service area. Our Community Health Services team focuses on prevention through community health educators with school curricula delivered throughout middle and high schools in the three Indiana counties we serve. Summer programming shifts to health-related day camps and participation at community health fairs. Though it may not be their primary focus, these community health teams screen for and provide referrals for clients experiencing mental health challenges. Likewise, they emphasize the importance of trusted adults as protective factors for youth. We fund local community organizations with expertise in their service areas. These organizations are community nonprofits with boots-on-the-ground services in the most vulnerable neighborhoods and more diverse populations. Each of the funded partners addresses the top two health priorities and reports on the number of participants and on an outcome metric for either mental health or healthcare access. In addition, Beacon partnered with the local health department in Three Rivers, Michigan, to support building out their Community Health Worker Program to increase services addressing healthcare access and mental health. Participating organizations Community partners - Center for Healing and Hope - diabetes support program - Child and Parent Services, Inc. (CAPS) - maternal and infant health support - Healthy Beginnings (Elkhart County Health Department) - maternal and infant health support - Mental Health Awareness of Michiana (MHAM) - behavioral and mental health - United Health Services - healthcare navigation - La Casa de Amistad - social service support - Maple City Health Care - maternal infant health support - Transformation Ministries - youth advocacy and support - Gentleman and Scholars, Inc. - youth advocacy and support - Imani Unidad - health literacy and case management - Horizon Education Alliance - health literacy and case management - Branch-Hillsdale-St. Joseph Community Health Agency, Health Department Beacon Community Impact Programs - Beacon Health Navigator - Family and Infant Support Program (FISP) - Health and Wellness Programs - Sickle Cell Infant Screening - Sickle Cell Broadscope - Women, Infants and Children (WIC) Clinic.
Three Rivers Health	Part V, Section B, Line 13h: The policy allows for patients to qualify for assistance by two means: financial or catastrophic. The financial assistance program also allows for partial assistance or full assistance based on eligibility criteria in this policy.Financial assistance1. A patient qualifying for financial assistance is a person who is uninsured or underinsured, receives care and unable to pay their bill.2. To be eligible for assistance under the financial assistance guidelines, a person's income shall be at or below a percentage of the federal poverty level (FPL) as determined by federal poverty guidelines. Household size and income determines the % of FPL. Three Rivers Health System, or its designee, may consider other financial assets and liabilities of the person when determining eligibility.3. Three Rivers Health System will use the most current poverty income guidelines issued by the U.S. Department of Health and Human Services to determine an individual's eligibility for financial assistance. The poverty income guidelines are published annually in the federal register and for the purposes of this policy will become effective the first day of the month following the month of publication.4. To qualify under the financial assistance portion of this policy, a completed, signed financial assistance application must be submitted and proof of income, proof of no income, proof of lack of financial assets and other required documents must accompany the application.

Schedule H (Form 990) 2024

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?15
Name and address		Type of Facility (describe)
1	1 - Three Rivers Health Center for Wound 721 S Health Parkway Three Rivers,MI49093	Wound Care
2	2 - Three Rivers Health Family Internal Med 711 S Health Parkway Three Rivers,MI49093	Rural Health Clinic - Internal Medicine, Family Care, and Women's Services
3	3 - West MI Ear Nose and Throat 3850 Glenkerry Ct Portage,MI49024	Ear, Nose, and Throat Care
4	4 - Three Rivers Health Specialty Clinic 711 S Health Parkway Three Rivers,MI49093	Other Outpatient Clinic
5	5 - Three Rivers Health Family Care 721 6th Avenue Suite B Three Rivers,MI49093	Rural Health Clinic
6	6 - Three Rivers Health Orthopedics 1021 Hill Street Suite 300 Three Rivers,MI49093	Orthopedics
7	7 - Three Rivers Health Homecare 711 S Health Parkway Three Rivers,MI49093	Homecare
8	8 - Three Rivers Health Surgical Services 715 S Health Parkway Three Rivers,MI49093	Surgical Services
9	9 - Three Rivers Health Family Care 601 E Chicago Rd PO Box 295 White Pigeon,MI49099	Rural Health Clinic
10	10 - Three Rivers Health iMed 16587 Enterprise Dr Three Rivers,MI49093	Urgent Care Center
11	11 - Three Rivers Health Hospice 711 S Health Parkway Three Rivers,MI49093	Hospice Care
12	12 - Three Rivers Health Center for Family 850 S Health Parkway Three Rivers,MI49093	Other Outpatient Clinic
13	13 - Three Rivers Health Family Care 110 East Main St Marcellus,MI49067	Other Outpatient Clinic
14	14 - Three Rivers Health Sleep Clinic 701 S Health Parkway Three Rivers,MI49093	Other Outpatient Clinic
15	15 - RHC Paws Clinic 721 6th Avenue Suite A Three Rivers,MI49093	Pediatric Clinic

Schedule H (Form 990) 2024

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
Part I, Line 3c:	Household size and incomeThe following factors may be considered in determining the eligibility of the patient for assistance and must be provided by all income earning residents in the countable household unit unless they are not dependents based on IRS guidelines for determining whether a household member can be considered a dependent.1. Indiana workforce wage report for last 2 quarters (unemployment income).2. Last 3 pay stubs or a letter or printout from employer(s) providing verification of gross income if currently employed. This documentation should not be more than 30 days old from date of issue and include year-to-date information.3. Last 3 bank statements (including explanations of regular deposits not explained by pay stubs).4. Social Security award or entitlement letter or other proof of gross monthly award.5. Retirement income.6. Investment income.7. Statement from person(s) that are providing direct support.8. Number of dependents.9. Most recent tax return (including W2 and all supporting schedules).10. Other financial obligations.11. The amount and frequency of hospital/medical bills.12. Other financial resources that produce income.13. If self-employed, gross income less cost of goods sold and employeesalaries.Financial capacity1. Individuals with the financial capacity to purchase health insurance coverage through the health insurance marketplace may be required to purchase and will be provided access to meet with an Indiana certified navigator as a means of assuring access to healthcare services, for their overall personal health, and for the protection of their individual assets.2. Individuals found to be ineligible for Medicaid or other affordable health care coverage must provide proof of denial.3. Food stamps or supplemental nutrition assistance program (SNAP) will not be counted as income.4. Cosmetic services are not eligible for any type of assistance and cannot be included in the amount of hospital/medical bills owed.
Part I, Line 6a:	Beacon Health System (EIN: 45-3864076) prepared the annual community benefit report.
Part I, Line 7:	The costing method used to calculate financial assistance reported on Lines 7 a through d was the cost-to-charge ratio as derived on tax form 990, Schedule H, worksheet 2. All other community benefits were calcualted using direct costs.
Part I, Line 7, Column (f):	The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 4,773,776.
Schedule H, Part I	In 2024, TRH received a large Medicaid Quality Assurance Assessment Payment (QAAP) that included payments related to prior years. The total QAAP payment received as approximately $1,790,000 related to years prior to 2024. Without the QAAP payments related to prior years, the Net Community Benefit Expense would have been $(594,002), -.86% of total expense.
Part II, Community Building Activities:	The St. Joseph County Human Services established itself as the multi-purpose collaborative body for St. Joseph County, ensuring that resources are used cooperatively and efficiently by all residents. The TRH Vice President of Operations attends meetings regularly. The mission of the St. Joseph County Human Services Commission is to coordinate and leverage collaborative efforts to improve the quality of life for all citizens. Collaboration benefits the community and fosters innovation, which are tracked and evaluated with outcome measures. Coordination ensures that clients needing services from multiple agencies receive them as efficiently and effectively as possible, and all residents should have access to opportunities that improve their quality of life.
Part III, Line 2:	Bad debt expense are dollars that are written off or reserved for patients that have available resources, but would not pay for services. The exception to this rule would be charity care accounts that are included in bad debt because of a lack of information provided, or the timing of receiving that information. Payments on accounts that have been written off would reduce the overall bad debt expense. Discounts on charges are not included in bad debt expense.
Part III, Line 3:	See above for methodology. With regards to charity care, the Hospital estimates that approximately $192,801 of charity care is included in bad debt expense due to not receiving information from patients to help determine eligibility, or not receiving the information in a timely manner, thus we believe the $192,801 should be considered a community benefit.
Part III, Line 4:	The provision for bad debts is based upon management's assessment of historical and expected net collections taking into consideration the trends in health care coverage, historical economic trends, and other collection indicators. Management assesses the adequacy of the allowances periodically throughout the year based upon historical write-off experience by major payor category. The results of the review are then utilized to make modifications, as necessary, to the provision for bad debts to provide for an appropriate allowance for uncollectible accounts. A significant portion of the corporation's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the corporation records a significant provision for bad debts related to uninsured patients in the period the services are provided.
Part III, Line 8:	Medicare is our largest payor, thus payments for this population create a financial burden on the Hospital as payments do not cover costs. Most of the Medicare patients live on fixed incomes. We used the cost-to-charge ratio to determine costs. As Medicare is our largest payor, the shortfall in covering costs is extreme, thus this would seem to qualify as a benefit to our community.
Part III, Line 9b:	The Hospital's current collection process applies to all patients. If no insurance is available for services, and they do not qualify for financial assistance, we will make them aware of their options. Discounts are offered which are tied to commercial managed care contracts. Payment arrangements can be made for a specific period of time, with no interest charged. Once arrangements are made, the account follows the standard collection process of letters and phone calls. After 120 days, if no payment has been made or if payment arrangements are not kept, the account will be referred to a collection agency.
Part VI, Line 2:	TRH reviews the health indicators of the county and completes community surveys. TRH assesses whether we have a shortage of physicians in the area annually as well. TRH reviews trends of our patient activity by service and type of patient to see if adjustments in service or resource allocation need to be made. TRH also reviews satisfaction surveys periodically to identify any potential gaps in services. TRH partners with the local schools and community mental health on specific health initiatives throughout the year. Beacon Community Impact formed the first Community Health Advisory Council in 2016. Still operating on an as needed basis today the Council consists of representation from Community Hospital of Bremen, Elkhart General Hospital, Memorial Hospital of South Bend, and Three Rivers Health. The council is made up of individuals from Beacon Health System and community stakeholders (i.e. Council at Large, Public School Systems, other Health Care entities, Indiana University South Bend, University of Notre Dame, Ivy Tech Community College, community organizations, local churches, community persons, etc.). The Advisory Council met monthly in 2024 following the MAPP 2.0 training during the Community Health Needs Assessment (CHNA) procedures and will meet 2-4 times per year to learn about community health, the CHNA process, and to review local hospital and community data collected regarding health in our community; there are periodic email communications as well. The Advisory Council provides input on the health priority areas, offers best practices, identifies areas of opportunities, and monitors progress on addressing health needs.
Part VI, Line 3:	Upon identifying patients who have no coverage, we will send them to our patient assistance representative. This person will then review the options that are available for this individual. If Medicaid is a possibility, we then send this person to our Medicaid specialist, who will help them with the process, as well as any forms. We have a formal financial assistance program that is advertised hospital wide and on our website. If they qualify for financial assistance, we will educate them and assist them with the process.
Part VI, Line 4:	Three Rivers Health presently serves St. Joseph County, along with other providers. As stated by the U.S. Census Bureau, the county's total population is 60,878 (year 2023). The community was heavily dependent on the auto industry, and thus, the economy has struggled in recent years. While the overall economy in the state has rebounded somewhat, the local county has lagged in the recovery. The County is approximately 521 square miles in size. US 12 and US 131 are two major highways that run through St. Joseph, MI. It is approximately 20 miles south of Kalamazoo, MI. The unemployment rate continues to be high (5.3%), and the population with Medicaid in the community is high (20%). Additionally, people with coverage have also increased. According to the Michigan Department of Health, St. Joseph County ranks 61st out of 83 counties in the state for health status. While the community is classified as rural and is close to urban areas, many people in the community do not have adequate travel arrangements, as can be evidenced by high no-show rates for primary care appointments due to travel issues. We are currently evaluating opportunities with the county to help with the travel issues alongside collaborating with the local health department to address the social drivers of health. Elkhart, Marshall and St. Joseph Counties are all located in Northern Indiana. They have a total of 6 cities and 16 towns with a combined population of 525,609. St. Joseph is the largest and Marshall the smallest, which is classified as rural. St. Joseph County, Michigan borders Elkhart County, Indiana and is similar in rural classification as Marshall County. Although each varies in population density, they are closer in geographic size (SJC, IN-457 square miles, Elkhart-463, Marshall-443, SJC, MI-521). The median household income (2018-2022) is comparable across Beacon's service area counties, with Marshall County leading at $66,016, followed by Elkhart County at $63,978, St. Joseph County, MI at $62,281, and St. Joseph County, IN at $61,877 - all below the U.S. median of $75,149. Poverty rates vary, with St. Joseph County, IN experiencing the highest rate at 14.4%, followed by St. Joseph County, MI at 12.9%, Elkhart County at 12.0%, and Marshall County with the lowest at 10.8%. Elkhart County remains the "RV Capital of the World," with the industry generating over $32.4 billion in annual economic impact nationwide and supporting over 18,000 local jobs. Marshall County continues as one of Indiana's agricultural leaders, with over 219,000 acres of farmland generating $171 million in agricultural products. St. Joseph County, IN serves as the regional center for higher education, home to institutions like Notre Dame, Indiana University South Bend, and Saint Mary's College, which have helped transform the local economy from manufacturing to health, education, and service sectors. St. Joseph County, MI maintains its natural beauty with numerous lakes and woodlands, including over 42 lakes and Sturgeon Lake, which spans 220 acres.
Part VI, Line 5:	In partnership with Beacon Health System (BHS), the mission of Three Rivers Health (TRH) is to deliver outstanding care, inspire health and connect with heart. BHS is committed to clinical excellence, compassionate care, and the ongoing improvement of quality of life. Our commitment will lead BHS to be the community's provider of outstanding quality, superior value and comprehensive health care services. Both BHS and TRH consistently invest funds to improve the quality of life for our communities. BHS values reflect an unwavering commitment to the communities we serve. TRH has as its values: Patients are at the center - Patient needs, care and safety are our top priority. - Trust - Our actions will firmly demonstrate our integrity, abilities and our character. - Respect - We will treat our patients, community members, and each other with the highest level of regard, demonstrating an understanding of different perspectives, cultures, interests and needs of others. - Integrity - We will continually do the right thing for patients, associates, and communities we serve. - Compassion - We will appropriately demonstrate empathy and sympathy, and express the desire to help. TRH seeks to promote the health and well-being of St. Joseph (SJC) residents, with specific focus on the most vulnerable populations, by providing education to aid in early detection and prevention of disease and to improve the health status of the community as a whole. Beacon Health System welcomed Three Rivers Health in Three Rivers, Michigan, to the Beacon family in September 2021. In 2023, Community Impact established a working relationship with the local health department, Branch-Hillsdale-St. Joseph Community Health Agency, to address the top needs in the community. Beacon Health System employs a comprehensive approach to health promotion across its four-county service area, focusing on two priority areas: healthcare access and mental health. This integrated strategy works through community partnerships and internal programs to address social determinants of health and build healthier communities.
Part VI, Line 6:	In 2011, MHSB affiliated with Elkhart General Hospital of Elkhart, Indiana, under the name of Beacon Health System. In 2018, Beacon Health System affiliated with Community Hospital of Bremen. In October 2021, Beacon Health System affiliated with Three Rivers Health System. All organizations continue as full-care providers for their respective Counties, and they are committed to promoting the health of the communities they serve. The Three Rivers Health board of directors consists of 8 voting board members. The Beacon Health System Board of Directors consists of 14 voting board members.
Part VI, Line 7, Reports Filed With States	MI
Schedule H, Part VI, Line 7	Three Rivers Health Hospital prepares a community benefit report both for the state of Michigan and for the annual report, which is posted at www.beaconhealthsystem.org/chna.

Schedule H (Form 990) 2024

Additional Data

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Schedule I
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

Open to Public
Inspection

Name of the organization
Three Rivers Health System Inc

Employer identification number
45-1257972

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Branch-Hillsdale-St Joseph Community Health Agency 570 Marshall Rd Coldwater,MI49036	38-3411829	501(c)(3)	20,000	0			General support

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) Rev. 1-2025

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
Part I, Line 2:	Donations and grants given to organizations that improve the health and well-being of our community are monitored through outcome measurement reports that are provided to Three Rivers Health by the various organizations. These reports inform us of how the donations and grants were used.

Schedule I (Form 990) Rev. 1-2025

Additional Data

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Schedule J
(Form 990)
(Rev. January 2025)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

Open to Public Inspection

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

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 .....

Yes

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? ....

Yes

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

Yes

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) (Rev. 1-2025)

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)
1Kreg R Gruber CEO	(i) (ii)	0 ------------- 1,081,233	0 ------------- 557,131	0 ------------- 210,350	0 ------------- 259,693	0 ------------- 28,015	0 ------------- 2,136,422	0 ------------- 64,523
2Jeffrey P Costello CFO	(i) (ii)	0 ------------- 626,239	0 ------------- 261,724	0 ------------- 189,649	0 ------------- 166,583	0 ------------- 22,015	0 ------------- 1,266,210	0 ------------- 61,622
3Maria A Behr President	(i) (ii)	0 ------------- 260,753	0 ------------- 108,933	0 ------------- 9,879	0 ------------- 93,556	0 ------------- 9,305	0 ------------- 482,426	0 ------------- 0
4Erika L Dearing Employed Physician	(i) (ii)	334,237 ------------- 0	15,714 ------------- 0	22,958 ------------- 0	36,800 ------------- 0	26,920 ------------- 0	436,629 ------------- 0	0 ------------- 0
5Jessica Puckett Employed Physician	(i) (ii)	348,046 ------------- 0	20,422 ------------- 0	1,455 ------------- 0	36,800 ------------- 0	12,843 ------------- 0	419,566 ------------- 0	0 ------------- 0
6Alyssa Erskine Employed Physician	(i) (ii)	309,368 ------------- 0	15,714 ------------- 0	15,478 ------------- 0	36,262 ------------- 0	23,283 ------------- 0	400,105 ------------- 0	0 ------------- 0
7James MacDonald Employed Physician	(i) (ii)	319,052 ------------- 0	714 ------------- 0	4,923 ------------- 0	43,724 ------------- 0	24,496 ------------- 0	392,909 ------------- 0	0 ------------- 0
8Todd M Ozdych Employed Physician	(i) (ii)	323,652 ------------- 0	357 ------------- 0	4,923 ------------- 0	43,702 ------------- 0	13,589 ------------- 0	386,223 ------------- 0	0 ------------- 0
9Hope Bailey Former VP Nursing	(i) (ii)	202,257 ------------- 0	55,049 ------------- 0	1,141 ------------- 0	39,795 ------------- 0	16,110 ------------- 0	314,352 ------------- 0	0 ------------- 0
10Linda Evans MD Director, Physician	(i) (ii)	203,623 ------------- 0	714 ------------- 0	4,044 ------------- 0	16,683 ------------- 0	11,040 ------------- 0	236,104 ------------- 0	0 ------------- 0

Schedule J (Form 990) (Rev. 1-2025)

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
Part I, Line 1a	Three Rivers Health System, Inc. offers complimentary health club membership to Beacon Health System's Health and Lifestyle Center, a related party. Health or social club dues for the following individuals was included in taxable compensation: Adam Goff
Part I, Line 3	Three Rivers Health System, Inc. uses a related organization's (Beacon Health System, Inc.) compensation review process. This review process includes an extensive examination using comparable market data that is then reviewed by an independent consultant hired by, and reported to, the board of directors. Recommendations are presented to the board for deliberation and final decision.
Part I, Line 4b	Beacon Health System implemented an executive retention plan to attract and retain key employees by providing additional deferred compensation. The Chief Executive Officer will participate in the plan and will select other participants pursuant to the guidelines set by the employer's board of directors. The employer may make contributions under the plan and has sole discretion over whether to make a contribution. Vesting occurs on January 1 of the fifth year for which such contributions are made for participants who have been continuously employed. The plan also allows vesting to occur if the participant attains the age of 62. The following individuals received vested payments in 2024, reflected in column (b)(iii): -Kreg Gruber, $198,816 -Jeffrey Costello, $130,545 The following individuals received deferred payments in 2024 that will vest in future years, which are reflected in column c: -Kreg Gruber, $215,393 -Jeffrey Costello, $122,283 -Maria Behr, $49,256
Part I, Line 7	The Organization has three incentive plans (employee, management, and executive which have a net operating income to budget measurement for the payout threshold. The employee plan shares the excess over budget net operating income with the non-management employees for Beacon Health System, Inc. and the affiliated entities. The employee incentive has a maximum cap of $4,500,000. The payout and amount of the payout for the employee incentive plan is made at the discretion of the board. The management incentive plan is funded when operating income is equal to or greater than 50% of the budgeted net operating income. Reward amounts are based on a balanced score card methodology utilizing Beacon's strategic imperatives and measured using selected metrics set on a sliding scale defined as threshold 50%, target 100%, and maximum 150%. The strategic imperatives are clinical excellence, great workplace, customer-driven culture, smart growth, and financial sustainability. Each imperative carries a default weight of 20%. The payout of the management incentive is made at the discretion of the board. Executives are covered under the Beacon Health System Executive Short-Term Incentive Plan (ESTIP). The ESTIP is funded when operating income is equal to or greater than 50% of the budgeted net operating income. Reward amounts are based on a balanced score card methodology utilizing Beacon's strategic imperatives and measured using selected metrics set on a sliding scale defined as threshold 50%, target 100%, and maximum 150%. The strategic imperatives are clinical excellence, great workplace, customer-driven culture, smart growth, and financial sustainability. Each imperative carries a default weight of 20%. The payout of the ESTIP is made at the discretion of the board.

Schedule J (Form 990) (Rev. 1-2025)

Additional Data

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SCHEDULE O
(Form 990)
(Rev. January 2025)
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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public
Inspection

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

Return Reference	Explanation
Form 990, Part VI, Section A, line 6	Beacon Health System, Inc. is the sole corporate member of Three Rivers Health System, Inc.
Form 990, Part VI, Section A, line 7a	Beacon Health, the sole corporate member, has the power to nominate, elect and remove members of the board of directors.
Form 990, Part VI, Section A, line 7b	Decisions of the board of directors must be approved by Beacon Health System, the sole member of Three Rivers Health System. The following matters require the approval of Beacon Health System's board: 1. Selection and retention of auditors. 2. Approval of all contracts, policies, or programs of insurance establishing the types of insurance coverage required as well as the coverage levels. 3. Other matters as determined from time to time by the member, or as provided in the bylaws or other governing documents.
Form 990, Part VI, Section B, line 11b	The organization incorporates numerous parties in the production and review of the form 990 and associated schedules. Senior accounting staff and management complete information for the form 990 and related schedules. Some forms and schedules are reviewed by the controller. Subsequent to those steps, the organization engaged RSM to prepare form 990 and appropriate schedules. Prior to filing the return, the CFO, the audit committee of the organization, and the CEO, conduct a general overview of the form 990, including applicable compensation schedules. In addition, each board member receives notification of the IRS form 990 placement on the Organization's board portals which allows for board member review prior to filing the return.
Form 990, Part VI, Section B, line 12c	There are three separate forms that are sent out through the internal audit department to key employees or board members regarding conflict of interest. They are as follows: 1. The first is a conflict of interest statement that is sent to senior level administration, management, and select staff such as purchasing department employees. The purpose of the statement is to require these employees to disclose any potential conflict of interests they may have. The statements are sent in January of each year for the previous year activities we pursue the replies to get a 100% response rate. In the current year we sent out 372 statements and are working to achieve a 100% response rate. Each response is reviewed by the director of internal audit and the results are reported to the CEO of Beacon Health System, the audit committee chairman, as well as the audit committee of the board of directors. 2. The second statement is the board duality of interest statement that is sent to current board members, former board members from the last five years, and other key employees. The duality of interest statement is sent using a web based survey tool provided by RSM. The replies are reviewed by the director of internal audit. The results of the surveys are summarized using the web based tool and are reviewed by RSM in completing the 990. The results are reported to the CEO of Beacon Health System, the audit committee chairman, and the audit committee of the board of directors. 3. The third statement is entitled "Code of Ethics for Senior Financial Officers". The statement requires an acknowledgement form to be signed by Beacon Health System's key financial employees that Beacon's financial information is to the best of their knowledge true and accurate. This statement was sent out on March 4, 2025 and the signed acknowledgements are kept by the director of internal audit. In 2024, 31 designated employees were requested to sign the form and we had a 100% compliance rate. Any potential conflicts of interests are reviewed by independent parties both internal and external to the organization, and if necessary, corrective action would be taken to resolve a true conflict. The individual with the potential conflict of interest would be excluded from all review proceedings.
Form 990, Part VI, Section B, line 15	Three Rivers Health Systems, Inc.'s parent, Beacon Health System, Inc. has a comprehensive process in place for reviewing and approving compensation of the executive leadership team. This review compares the total compensation provided to each executive to that provided to functionally similar positions in similarly situated organizations. This review is conducted regularly by the board compensation committee in consultation with an independent compensation advisor who is hired by and reports to the board compensation committee. Based on the advice of the compensation advisor and comparable and appropriate market data reported in third-party compensation surveys, and applying the organization's executive compensation philosophy, the board compensation committee makes compensation recommendations regarding the CEO's compensation to the board of directors for approval and the CEO makes compensation recommendation regarding all other members of the executive leadership team to the board compensation committee for approval. Deliberations and final decisions are contemporaneously documented. The annual compensation review was completed by the board compensation committee in March 2025 and the independent compensation advisor provided a statement of reasonableness of the compensation provided to the CEO and executive leadership team members.
Form 990, Part VI, Section C, line 19	The governing documents and conflict of interest policy are not made available to the public. The financial statements are distributed quarterly to the Electronic Municipal Market Access (EMMA) website as part of the continuing disclosures for the Beacon Health System, Inc. bonds.
Form 990, Part IX, line 11g	Professional Fees & Purch. Srvcs: Program service expenses 6,350,273. Management and general expenses 1,059,553. Fundraising expenses 0. Total expenses 7,409,826.
Form 990, Part XI, line 9:	Write-off Intercompany Balances 1,157,825.

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

Cat. No. 51056K

Schedule O (Form 990) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)
(Rev. January 2025)

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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public Inspection

Name of the organization

Three Rivers Health System Inc

Employer identification number

45-1257972

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)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

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)Beacon Medical Group Inc 615 N Michigan St South Bend,IN46601 35-1536132	Physician Practices	IN	501(c)(3)	Line 10	Beacon Health System Inc	Yes
(2)Beacon Health Foundation Inc 615 N Michigan St South Bend,IN46601 35-1536129	Financial Support	IN	501(c)(3)	Line 7	Beacon Health System Inc	Yes
(3)Elkhart General Hospital Inc 600 East Blvd Elkhart,IN46514 35-0877574	Hospital	IN	501(c)(3)	Line 3	Beacon Health System Inc	Yes
(4)Community Hospital of Bremen Inc 1020 High Road Bremen,IN46506 35-0835006	Hospital	IN	501(c)(3)	Line 3	Beacon Health System Inc	Yes
(5)Memorial Hospital of South Bend 615 N Michigan St South Bend,IN46601 35-0868132	Hospital	IN	501(c)(3)	Line 3	Beacon Health System Inc	Yes
(6)TRAH Properties Inc 701 S Health Parkway Three Rivers,MI49093 38-3366344	Property Management	MI	501(c)(3)	Line 12a, I	Three Rivers Health System Inc	Yes
(7)Three Rivers Health Authority 701 S Health Parkway Three Rivers,MI49093 38-2317300	Hospital	MI	501(c)(3)	Line 12c, III-FI	N/A		No
(8)Beacon Health System Inc 615 N Michigan St South Bend,IN46601 45-3864076	Parent Organization	IN	501(c)(3)	Line 12c, III-FI	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) (Rev. 1-2025)

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	(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) South Bend Specialty Surgery Center LLC 335 Florence Ave 1B Granger,IN46530 46-0571418	Ambulatory Surgery Center	IN	N/A				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) Beacon Health Ventures Inc 615 N Michigan St South Bend,IN46601 35-1901068	Home Medical	IN	N/A	C					No
(2) Beacon Health Ventures Michigan Inc 615 N Michigan St South Bend,IN46601 20-8259773	Home Medical	MI	N/A	C					No

Schedule R (Form 990) (Rev. 1-2025)

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) ............................

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) .......................

Yes

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) .................

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

Yes

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

Yes

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

Yes

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

Yes

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) Beacon Medical Group Inc	P	1,330,762	Actual Charges
(2) Memorial Hospital of South Bend Inc	P	65,954	Actual Charges
(3) Beacon Medical Group Inc	Q	159,978	Actual Charges
(4) Beacon Medical Group Inc	R	214,001	Cash
(5) Beacon Medical Group Inc	S	956,784	Cash
(6) Memorial Hospital of South Bend Inc	S	61,929	Cash

Schedule R (Form 990) (Rev. 1-2025)

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) (Rev. 1-2025)

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) (Rev. 1-2025)

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: We deliver outstanding care, inspire health, and connect with heart.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2024 (Part V, line 2a) ......	5	525
6	Total number of volunteers (estimate if necessary) .............	6	40
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	761,266	516,931
9	Program service revenue (Part VIII, line 2g) .........	71,858,061	77,774,134
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	305,817	684,943
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	882,982	1,274,967
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	73,808,126	80,250,975
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	7,792	32,769
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	33,346,399	36,742,366
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	40,566,733	36,915,776
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	73,920,924	73,690,911
19	Revenue less expenses. Subtract line 18 from line 12.......	-112,798	6,560,064
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	54,102,951	62,993,423
21	Total liabilities (Part X, line 26).............	10,524,344	11,694,299
22	Net assets or fund balances. Subtract line 21 from line 20.....	43,578,607	51,299,124

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 57,546,631 including grants of $ 32,769 ) (Revenue $ 78,786,420 )
	In 2024, The Center for Wound Healing continues to serve this community well offering hyperbaric oxygen therapy and an average healing rate above the state and national average. Having this service line available has proven to allow patients to keep limbs when otherwise travel would be difficult, and treatment may not be possible. Podiatry and Internal Medicine have continued to play an integral role at the Center with regards to wound debridement and offering an interdisciplinary approach to healing and limb retention. Oncology services remained down. This service line is viewed as a community need; therefore, we persevered through low volumes serving all those who were able. We have had provider changes and are making plans to have a system Oncology Service line. Outpatient infusions continue to be a service need provided on a 24/7 basis. Outpatient therapies (PT, OT and speech) along with Cardiac Rehab are all located on the campus that allow for local care to an underserved community. Three Rivers Health continues to offer many services that would otherwise be impossible for some of the community due to lack of resources and support. These services may or may not be strong revenue stream, but are rendered as part of the organization's mission to deliver outstanding care, inspire health and connect with heart. We continue to work to provide high-quality, close to home, and at reasonable cost healthcare; striving to meet the needs of the communities we serve.

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 expenses57,546,631

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	2,206,057	3,305,891	961,214

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,130
e	Government grants (contributions)		1e	514,801

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

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

h Total. Add lines 1a-1f.......		516,931

		Business Code
2a	Net Patient Revenue	622110	76,872,159	76,872,159
b	iMed Shared Service	622110	563,064	563,064
c	Affiliated Rental Revenue	532000	300,000	300,000
d	Pharmacy Sales	456110	35,571	35,571
e	Medical Services to Affiliates	622110	3,340	3,340
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		77,774,134

3 Investment income (including dividends, interest, and othersimilar amounts) ......			689,743			689,743
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	264,822
b	Less: rental expenses	6b	2,141
c	Rental income or (loss)	6c	262,681
d	Net rental income or (loss).......			262,681			262,681
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a		1,500
b	Less: cost or other basis and sales expenses	7b		6,300
c	Gain or (loss)	7c		-4,800
d	Net gain or (loss).........			-4,800			-4,800
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
11a	340B		456110	662,345	662,345
b	Quality Incentive		622110	179,370	179,370
c	Cafeteria Sales		622110	104,752	104,752
d	All other revenue ....			65,819	65,819
e	Total. Add lines 11a–11d ......			1,012,286
12	Total revenue. See instructions.....			80,250,975	78,786,420	0	947,624

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	32,769	32,769
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 ...........	484,643		484,643
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	550,455		550,455
7	Other salaries and wages........	29,970,543	25,684,755	4,285,788
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	546,596	468,433	78,163
9	Other employee benefits .......	3,314,667	2,840,670	473,997
10	Payroll taxes ...........	1,875,462	1,607,271	268,191
11	Fees for services (non-employees):
a	Management ......	572,397		572,397
b	Legal .........	14,012		14,012
c	Accounting ...........	-9,719		-9,719
d	Lobbying ...........	2,230	1,911	319
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	141,238		141,238
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	7,409,826	6,350,273	1,059,553
12	Advertising and promotion ....	1,822	1,561	261
13	Office expenses .......	1,310,607	1,123,192	187,415
14	Information technology ......	395	339	56
15	Royalties ..
16	Occupancy ...........	1,471,489	1,262,847	208,642
17	Travel ............	95,327	81,695	13,632
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	61,111	52,372	8,739
20	Interest ...........	53,737	46,053	7,684
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,046,746	1,754,061	292,685
23	Insurance ...	568,208	486,954	81,254
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	7,168,820	7,168,820
b	Management Fees	6,789,322		6,789,322
c	Bad Debt Expense	4,773,776	4,773,776
d	Dues & Subscriptions	3,954,049	3,388,620	565,429
e	All other expenses	490,383	420,259	70,124
25	Total functional expenses. Add lines 1 through 24e	73,690,911	57,546,631	16,144,280	0
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 ........			935	1	1,035
2	Savings and temporary cash investments .........			19,054,651	2	20,505,970
3	Pledges and grants receivable, net ......			138,791	3	126,066
4	Accounts receivable, net .............			8,055,134	4	12,961,816
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 ...........			495	7	0
8	Inventories for sale or use ............			1,031,334	8	1,027,007
9	Prepaid expenses and deferred charges ......			217,204	9	211,145
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	29,841,214
b	Less: accumulated depreciation	10b	6,403,872	21,682,114	10c	23,437,342
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			3,922,293	15	4,723,042
16	Total assets. Add lines 1 through 15 (must equal line 33)...			54,102,951	16	62,993,423

17	Accounts payable and accrued expenses .....	5,580,863	17	6,374,738
18	Grants payable ...		18
19	Deferred revenue .........	32,889	19	-17,458
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 ..	2,933,947	23	2,583,733
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	1,976,645	25	2,753,286
26	Total liabilities. Add lines 17 through 25..	10,524,344	26	11,694,299

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	43,578,607	27	51,299,124
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 ...........	43,578,607	32	51,299,124
33	Total liabilities and net assets/fund balances ........	54,102,951	33	62,993,423