2023-11-14T14:32:13-06:00 2022-12-31 390859910 BAKER TILLY US LLP 20 STANWIX STREET PITTSBURGH PA 15222 990 2022-01-01 381358208 MEMORIAL HOSPITAL MEMO 9897235211 826 WEST KING STREET OWOSSO MI 48867 JORRI TREMAIN CFO 9897235211 2023-11-14 1 JORRI TREMAIN 999009999 0 JEFFREY J PETRELL P00138808 4126976400 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MEMORIAL HEALTHCARE JORRI TREMAIN 826 WEST KING STREET OWOSSO MI 48867 257798587 0 X WWW.MEMORIALHEALTHCARE.ORG X 1919 MI TO PROVIDE HEALTHCARE SERVICES TO PATIENTS. 17 9 1887 73 438373 0 5780723 3337828 234338187 250920336 3587182 641750 2361379 2201249 246067471 257101163 0 0 0 0 125089880 127190886 0 0 176724 125365769 139588671 250455649 266779557 -4388178 -9678394 220221745 191179125 103605519 91371330 116616226 99807795 X TO PROMOTE HEALTH AND PROVIDE QUALITY COMPASSIONATE HEALTHCARE IN OUR REGION THROUGH A COMMITMENT TO SERVICE EXCELLENCE, TEAMWORK AND INNOVATION. 0 0 42427492 78895791 A MEDICAL AND SURGICAL HOSPITAL THAT PROVIDES INPATIENT AND OUTPATIENT SERVICES TO ALL PATIENTS.INPATIENT DISCHARGES: 3,736, PATIENT DAYS: 23,217, INPATIENT SURGERIES: 769, BIRTHS: 465 78872684 147512321 ANCILLARY SERVICES (OUTPATIENT VISITS: 258,385, OUTPATIENT SURGERIES: 3,728, PAIN MANAGEMENT VISITS: 6,759 61658734 25288957 MMA SERVICES (PHYSICIAN CLINICS, MMA RVU'S: 438,478 47147627 72038 ALL OTHER PROGRAM SERVICES 47147627 72038 230106537 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 264 0 1887 1 1 1 0 0 0 0 0 0 0 0 0 X 17 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 MI X ROSE BROWN 9897294717 826 WEST KING STREET OWOSSO MI 48867 RANY A ABURASHED DO MEMBER 40.00 X 100533 0 8756 BRIAN L LONG EXECUTIVE DIRECTOR/CEO 58.00 2.00 X X 644722 0 21838 JAMES J FAYSAL DO MEMBER 40.00 X 416816 0 27327 ANTHONY A PATSY DO MEMBER 39.00 1.00 X 335105 0 27959 MICHAEL B KRAMER DO MEMBER 40.00 X 454042 0 23320 RONALD M BISHOP DO MEMBER 40.00 X 297305 0 24241 GREGORY P BONTRAGER PRESIDENT 2.00 X X 0 0 0 TONY M YOUNG VICE PRESIDENT 2.00 X X 0 0 0 WILFRED BILL A FARRELL MEMBER 2.00 X 0 0 0 JERRY D WALDEN SECRETARY 2.00 X X 0 0 0 MICHAEL L ASH MEMBER 2.00 1.00 X 0 0 0 BARBARA BAKEROMEROD MEMBER 2.00 X 0 0 0 THOMAS E CAMPBELL MEMBER 2.00 X 0 0 0 SHANA M ESPINOZA MEMBER 2.00 X 0 0 0 MARGARET R FREY DO MEMBER 40.00 X 337786 0 28160 JOSEPH E TESTA DO MEMBER 40.00 X 602238 0 29626 BRUCE J WENZLICK MEMBER 2.00 X 0 0 0 JORRI TREMAIN CFO 40.00 X 219467 0 7546 JAMES NEMETH COO 40.00 X 395312 0 30084 JOSEPH M BUSTAMANTE DO CHIEF MEDICAL OFFICER 40.00 X 383442 0 24458 THOMAS KURTZ CIO 40.00 X 262336 0 26867 RAMY M KURDI DO PHYSICIAN 40.00 X 1238740 0 29993 TAREK R PACHA DO PHYSICIAN 40.00 X 1040093 0 24613 ASHRAF M ELBANNA MD PHYSICIAN 40.00 X 807759 0 28894 BRETT WALKER DO PHYSICIAN 40.00 X 876566 0 21347 HAZEM TABBAA DO PHYSICIAN 40.00 X 760146 0 29588 9172408 0 414617 176 0 1 0 AMERICAN HEALTHCARE STAFFING 226 E SIXTEENTH ST SUITE A TRAVERSE CITY MI 49684 STAFFING SERVICES 4033630 ALLIANCE HNI LLC PO BOX 772550 DETROIT MI 48277 RENTAL OF EQUIPMENT 2036995 ECS CENTRAL MICHIGAN PC 4100 EMBASSY DR SE STE 400 GRAND RAPIDS MI 49546 CONTRACTED EMERGECY ROOM PHYSICIANS 1248216 ACCOUNTABLE HEALTHCARE STAFFING 999 YAMATO ROAD 210 BOCA RATON FL 33431 STAFFING SERVICES 732509 LOCUMTENENS PO BOX 405547 ATLANTA GA 303845547 STAFFING SERVICES 727075 36 944671 2393157 3337828 NET PATIENT SERVICE REVENUE 900099 245999413 245999413 PHYSICIAN REVENUE 900099 4868834 4868834 BILLING SERVICE REVENUE 561000 52089 52089 250920336 1339174 1339174 900860 0 900860 900860 900860 218316 479108 -218316 -479108 -697424 -697424 CAFETERIA REVENUE 722513 914105 914105 WELLNESS CENTER 623000 386284 386284 1300389 257101163 251769107 438373 1555855 4729286 4729286 101372317 94700520 6536754 135043 1498147 1468703 29444 12967678 12613811 334047 19820 6623458 5894621 728837 359897 5300 354597 139098 139098 158945 158945 15663745 13325940 2337446 359 1351418 67881 1283537 1318602 1153261 163490 1851 368952 101081 267871 12405411 11050144 1354716 551 232246 167692 64554 95714 89044 6670 1234755 1229727 5028 8521408 284947 8236461 1197690 761194 436496 PHARMACEUTICAL EXPENSES 50879304 50824776 54528 MEDICAL SUPPLIES 20517535 19815888 701647 PROVISION FOR BAD DEBTS 9170761 1055810 8114951 QAAP TAX EXPENSE 7650871 7650871 8322319 7845326 457893 19100 266779557 230106537 36496296 176724 71556 3595270 15943164 30053 31537338 24846140 5658104 5159998 1269308 1443779 211331500 110459200 102907152 100872300 55030435 37133135 5324803 7804688 12773647 220221745 191179125 26600719 26443470 9640017 60099085 56615385 5855997 2642961 1409701 5669514 103605519 91371330 X 116616226 99807795 116616226 99807795 220221745 191179125 X -9678394 -7264637 3632 130968 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6630 6630 0 PART II-B, LINE 1: MEMORIAL HEALTHCARE PAYS DUES TO MICHIGAN HEALTH AND HOSPITAL ASSOCIATION & MICHIGAN HEALTH COUNCIL. A PORTION OF THESE DUES GO TOWARDS LOBBYING. 5649953 -682942 4967011 5665470 316175 105527 226165 5649953 5342671 7082 333532 17814 5665471 4492321 36587 826200 12437 5342671 4653008 76952 -225393 12246 4492321 0.53120 0.46880 0 1 1 5098180 5098180 113667232 43631615 70035617 912480 345186 567294 87139419 64127325 23012094 4514189 2355074 2159115 100872300 WELLS FARGO MUTUAL FUNDS 37133135 F 37133135 DUE FROM AFFILIATES 2096116 FINANCE LEASE RIGHT-OF-USE ASSETS 1136934 OPERATING LEASE RIGHT-OF-USE ASSETS 1220200 OTHER ASSETS 8150372 THIRD-PARTY PAYOR SETTLEMENTS 170025 12773647 ESTIMATED THIRD-PARTY PAYOR 1289738 FINANCE LEASE OBLIGATION 1179672 OPERATING LEASE OBLIGATION 1325959 ACCELERATED MEDICARE PAYMENTS 968709 DUE TO AFFILIATES 555103 OTHER LIABILITIES 350333 5669514 X 242726966 -7264637 2286751 -4977886 247704852 9396311 9396311 257101163 259321819 1938573 1938573 257383246 9396311 9396311 266779557 PART V, LINE 4: THERE ARE VARIOUS PERMANENT AND BOARD DESIGNATED ENDOWMENT FUNDS. THE ONLY SPECIFICALLY IDENTIFIED USES OF THE VARIOUS FUNDS ARE AS FOLLOWS: NURSING SCHOLARSHIP AWARDS AND NURSING AND HEALTHCARE FOR THE ELDERLY. PART X, LINE 2: THE ORGANIZATION AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON THEIR EXEMPT INCOME UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND A SIMILAR PROVISION OF STATE LAW. THESE ENTITIES ARE SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. DEV CORP AND ASSISTED LIVING ARE SINGLE MEMBER LIMITED LIABILITY COMPANIES, WHICH ARE CONSIDERED DISREGARDED ENTITIES FOR TAX PURPOSES. PAIN MANAGEMENT IS A LIMITED LIABILITY COMPANY AND HAS ELECTED TO HAVE ITS INCOME TAXES AS A PARTNERSHIP UNDER THE PROVISIONS OF THE IRC. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKE-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO UNCERTAIN TAX POSITIONS THAT MET THE RECOGNITION THRESHOLD IN 2022 AND 2021. PART XI, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITY - PAIN MANAGEMENT 2,286,751. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES 158,954. BAD DEBT EXPENSE 9,170,761. EXPENSES RECORDED AS REVENUE 66,596. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITY - PAIN MANAGEMENT 1,938,573. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES 158,954. BAD DEBT EXPENSE 9,170,761. EXPENSES RECORDED AS REVENUE 66,596. 1 1 X 1 X 1 X 1 1 1 0 1 1 251136 251136 0.00100 50204669 40949163 9255506 0.03590 50455805 40949163 9506642 0.03690 214244 214244 0.00080 483965 483965 0.00190 19265258 14203957 5061301 0.01960 164664 164664 0.00060 243822 243822 0.00090 20371953 14203957 6167996 0.02380 70827758 55153120 15674638 0.06070 18000 18000 0.00010 2966 2966 0.00000 68670 68670 0.00030 57948 57948 0.00020 147584 147584 0.00060 0 9170761 2751229 26423233 29828069 -3404836 X 1 1 1 1 MEMORIAL HEALTHCARE 826 WEST KING STREET OWOSSO MI 48867 MEMORIALHEALTHCARE.ORG X X X LONG-TERM CARE HOSPITAL MEMORAL HEALTHCARE 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X MEMORIALHEALTHCARE.ORG/ABOUT/REPORTS-AND-PUBLICATIONS X MEMORIALHEALTHCARE.ORG/ABOUT/REPORTS-AND-PUBLICATIONS X 1 22 1 MEMORIALHEALTHCARE.ORG/ABOUT/REPORTS-AND-PUBLICATIONS 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X MEMORIALHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-SERVICES X MEMORIALHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-SERVICES X MEMORIALHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-SERVICES X X X X X X X 1 X 0 X X X X 1 X 0 0 MEMORAL HEALTHCARE PART V, SECTION B, LINE 5: PARTICIPANTS IN THE CHNA:GREAT LAKES BAY HEALTHSAFECENTERSHIAWASSEE REGIONAL EDUCATION SERVICE DISTRICTSHIAWASSEE COUNTY HEALTH DEPARTMENTSHIAWASSEE HEALTH AND WELLNESSCATHOLIC CHARITIESMEMORIAL HEALTHCAREMEMORIAL HEALTHCARE FOUNDATIONMICHIGAN STATE UNIVERSITY EXTENSIONRESPITE VOLUNTEERS OF SHIAWASSEE COUNTYSHIAWASSEE GREAT START INITIATIVEGREATER LANSING FOOD BANKSHIAWASSEE HOPEMEMORIAL HOSPITALCOMMUNITY MEMBERSOWOSSO PUBLIC SCHOOLSSHIAWASSEE FAMILY YMCA - LIVE HEALTHYSHIAWASSEE HEALTH AND HUMAN SERVICES COUNCILSHIAWASSEE MINISTERIAL REPRESENTATIVESUNITED WAY OF GENESEE COUNTY (SHIAWASSEE)SHIAWASSEE COUNCIL ON AGINGHOMELESS ANGELSDISABILITY NETWORK CAPITAL AREABAKER PATHWAYSPARTICIPANTS IN THE IMPLEMENTATION PLANNING:BILL ARCHER, SHIAWASSEE COUNTY VASTEPHANIE ROWELL, MEMORIAL HEALTHCARE, TAYLOR LIFE CENTERDENNIS CHERNIN, SHIAWASSEE COUNTY HEALTH DEPARTMENTPENNY CORBIN, SHIAWASSEE COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (SCCMHA)GILPIN, CATHOLIC CHARITIESNICOLE GREENWAY, SHIAWASSEE COUNTY HEALTH DEPARTMENTPHIL HATHAWAY, TOWN PLANS LLC, LIVE HEALTHY COALITIONCOURTNEY HERRICK, SHIAWASSEE EDUCATION SERVICE DISTRICT (SRESS)LARRY JOHNSON, SHIAWASSEE COUNTY HEALTH DEPARTMENTJEFF MCMANUS, RESPITE VOLUNTEERS OF SHIAWASSEE COUNTYMICHAEL DEWEY, SHIAWASSEE UNITED WAYMARLA PRICE, MEMORIAL HEALTHCARE DIETICIANCATHY SPRAGUE-EMANS, CATHOLIC CHARITIESMEMORIAL HOSPITAL THOMAS TEAL, MD, MEMORIAL HEALTHCAREABBIE TIPTON. MEMORIAL HEALTHCAREJORRI TREMAIN, MEMORIAL HEALTHCAREMARLENE WEBSTER, SHIAWASSEE HOPESARA WRIGHT, GREAT LAKES BAY HEALTH CENTER SHIAWASSEE COUNTY MEMORAL HEALTHCARE PART V, SECTION B, LINE 6B: MEMORIAL WAS THE LEAD ON THE CHNA BUT THERE WAS A SHIAWASSEE COMMUNITY HEALTH NEEDS TEAM THAT CONSISTED OF THEFOLLOWING ORGANIZATIONS:A. SHIAWASSEE UNITED WAYB. SHIAWASSEE REGIONAL EDUCATION SERVICEC. SHIAWASSEE COUNTY COMMUNITY MENTAL HEALTH AUTHORITYD. SHIAWASSEE COUNTY HEALTH DEPARTMENT MEMORAL HEALTHCARE PART V, SECTION B, LINE 11: DUE TO COVID-19, MEMORIAL HEALTHCARE WILL BEGIN WORKING ON ITS IMPLEMENTATION PLAN IN JULY OF 2020. HOWEVER, THE PRIMARY NEEDS IDENTIFIED IN THE SURVEY WERE MENTAL HEALTH, OBESITY, AND SUBSTANCE ABUSE BASED ON THE RESPONSES. THESE DOMAINS WILL BE THE FOCUS OF MEMORIAL HEALTHCARE'S EFFORTS MOVING FORWARD AND WILL ENCOMPASS BOTH ADULTS AND CHILDREN.AS WITH MOST HEATH CARE FACILITIES, MEMORIAL HEALTHCARE HAS LIMITED FINANCIAL RESOURCES TO ADDRESS ALL ISSUES. MEMORAL HEALTHCARE PART V, SECTION B, LINE 16J: THE FAP POLICY IS ALSO STATED ON ALL BILLING STATEMENTS SENT FROM THE HOSPITAL. MEMORAL HEALTHCARE PART V, SECTION B, LINE 20E: SEND SELF-PAY ACCOUNTS TO ADVOMAS, A MEDICAL BILLING SERVICE, PRIOR TO SENDING TO CAREPAYMENT AND BEFORE SENDING TO BAD DEBT. 39 1 - MEMORIAL HEALTHCARE CANCER CENTER 721 N SHIAWASSEE OWOSSO MI 48867 CANCER CARE SERVICES/ONCOLOGY/ANTICOAG 2 - MEMORIAL HEALTHCARE OUT PT SERVICES 1975 W M21 STE 102 OWOSSO MI 48867 HOME HEALTH/HOSPICE 3 - MEMORIAL HEALTHCARE HEALTH PARK OFFIC 100 HEALTH PARK DRIVE OWOSSO MI 48867 MH LAB/MH RAD, MMA DR. VORENKAMP & OCC HEALTH 4 - MEMORIAL HEALTHCARE PAIN CLINIC 818 W KING ST STE 300 OWOSSO MI 48867 PAIN MGMNT 5 - MEMORIAL HEALTHCARE'S OWOSSO WOODARD 317 S ELM ST STE 116 OWOSSO MI 48867 PHYSCIAL THERAPY REHAB, SERVICES/CARDIAC REHAB 6 - MID MICHIGAN ORTHOPEDICS 819 N SHIAWASSEE ST STE 200 OWOSSO MI 48867 ORTHO ( SCHMIDT/PALAZETI,BRANCH/MIKE SMITH/WOODS/KURDI/ELBANNA/WALKER/JAUSS) 7 - MEMORIAL HEALTHCARE OBGYN 818 W KING ST LOWER LEVEL OWOSSO MI 48867 OBGYN (CHAVES/FREY/LONDON/ARLANDA SMITH) 8 - MEMORIAL OVID-ELSIE OFFICES 9480 E M-21 OWOSSO MI 48866 MMA PRIMARY CARE (THATIKONDA/HUFF/KOHORST), MH LAB, MH RAD 9 - MEMORIAL DURAND OFFICES 9099 E LANSING ROAD DURAND MI 48429 MMA FAMILY MEDICINE (GAITONDE/AKBARI/MCARTHUR/LAFFERTY), DURAND URGENT CARE 10 - MEMORIAL PERRY OFFICES 3337 W BRITTON ROAD PERRY MI 48872 MMA FAMILY MEDICINE (LIU/MANKEY/RICE/TUCZYNSKI), MH LAB, MH RAD 11 - MEMORIAL PEDIATRIC CLINIC 802 W KING ST STE M OWOSSO MI 48867 PEDS (KRAMER, PAVON, CREIGHTON, KIDWELL, GOSSAYNIE) 12 - INSTITUTE FOR NEUROSCIENCE & MULTIPLE 819 N SHIAWASSEE ST STE 100 OWOSSO MI 48867 NEUROLOGY (PACE/FREY/LEAHY/COTE/BRUNE/NOWACEK/WALCH/SAEED/PLATNER/BAINS) 13 - MEMORIAL LAINGSBURG OFFICES 317 E GRAND RIVER LAINGSBURG MI 48848 FAMILY MEDICINE (GURDEN, KING, BROOKS), MH LAB, MH RAD 14 - MEMORIAL SURGICAL ASSOCIATESWOUND CL 818 W KING ST STE 201 OWOSSO MI 48867 SURGERY (AZMEH/ FLERMOEN/ TESTA/ WEAVE/SPENCLEY/HARP), WOUND CLINIC (SPIESS) 15 - MEMORIAL CHESANING FAMILY PRACTICE 300 S CHAPMAN CHESANING MI 48616 FAMILY MEDICINE (EBERT/LIVIERATOS/FELDPAUSCH/WEGSHEID) 16 - MEMORIAL PHYSICAL REHABILITATION CENTER 8906 E LANSING ROAD DURAND MI 48429 REHAB SERVICES 17 - MMA GASTRO OFFICES 721 N SHIAWASSEE STE 202 OWOSSO MI 48867 GASTROENTEROLOGY (MEHDI/TABBAA/HUSEINI/LANDERS/SATTAZAHN/LOCUMS) 18 - MEMORIAL OUTPATIENT SERVICES - CHESANING 305 S SAGINAW STREET CHESANING MI 48616 LAB, RAD, PT SERVICES 19 - MEMORIAL STATE ROAD OFFICES 239 N STATE ROAD OWOSSO MI 48867 MH LAB, MH RAD, MMA SHIAWASSEE FAMILY MED (SOMO/JOHNSTON), MMA URGENT CARE 20 - INTERNAL MEDICINE ASSOCIATES OF OWOSS 300 HEALTH PARK DR STE 302 OWOSSO MI 48867 INTERNAL MED (MACAL/SANTIAGO/ARDELEAN) 21 - PEDIATIC & ADOLESCENT SERVICES 802 W KING ST STE J OWOSSO MI 48867 PEDS (BUDAI) 22 - MEMORIAL HEALTHCARE ENDOCRINOLOGY 802 W KING ST STE E OWOSSO MI 48867 ENDOCRINOLOGY (DAOUD/CARR) 23 - MEMORIAL UROLOGY 818 W KING ST STE 202 OWOSSO MI 48867 UROLOGY (BOOKMAN/PACHA/BYRON) 24 - MEMORIAL PHYSICAL REHAB - PERRY 3737 W LANSING ROAD PERRY MI 48872 REHAB SERVICES 25 - MEMORIAL HEALTHCARE HOSPITAL MEDICINE 826 W KING ST 3RD FLOOR OWOSSO MI 48867 HOSPITALISTS 26 - MEMORIAL HEALTHCARE PEDIATRIC GASTROE 1123 VILLA LINDE CT STE 38 FLINT MI 48532 PEDS GASTRO (JIBALY) 27 - MEMORIAL HEALTHCARE ALLERGY & IMMUNOLOGY 317 S ELM ST STE 205A OWOSSO MI 48867 ALLERGIST (NASIR) 28 - MEMORIAL HEALTHCARE INSTITUTE FOR NEURO 4600 GARFIELD RD AUBURN MI 48611 NEURO (DARDAS) 29 - MEMORIAL HEALTHCARE NUTRITION & DIABETES 317 S ELM ST STE 202 OWOSSO MI 48867 DIABETES 30 - MEMORIAL HEALTHCARE PALLIATIVE MEDICINE 802 W KING ST SUITE C OWOSSO MI 48867 PALLIATIVE CARE (LARSON) 31 - MEMORIAL HEALTHCARE PULMONOLOGY 826 W KING ST STE 200 OWOSSO MI 48867 PULMOMOLGIST (PRUITT) 32 - MEMORIAL HEALTHCARE PHYSICAL MED & REHAB 1501 WATERFORD PARKWAY STE B ST JOHNS MI 48879 PHYSCIAL MEDICINE & REHABILIATION (AZUH) 33 - MEMORIAL HEALTHCARE NEURO SAGINAW 4680 MCLEOD EAST STE 2 SAGINAW MI 48604 NEURO SAGINAW (LEE/NEWTON/IBRAHIM/NEURO SAG INPT LOCUMS) 34 - MEMORIAL HEALTHCARE COVID OFFSITE TESTIN 1637 W CHESTNUT OWOSSO MI 48867 LAB SERVICES 35 - MEMORIAL HEALTHCARE ALLERGYIMMUNOLOGY 4200 FASHION SQUARE BLVD SUITE 301 SAGINAW MI 48603 ALLERGY/IMMUNOLOGY SAGINAW (MOHSEN NASIR) 36 - MEMORIAL HEALTHCARE DERMATOLOGY 802 W KING ST SUITE G OWOSSO MI 48867 DERMATOLOGY (WASIM NASIR) 37 - FAMILY MED KING ST 818 W KING ST STE 101 OWOSSO MI 48867 FAMILY MEDICINE (PATSY/OLIVER/MARCOS IZA/QAQISH/BRETT GURDEN/PERRIN/KROKOS) 38 - ENT AND AUDIOLOGY 818 W KING ST STE 301 OWOSSO MI 48867 ENT (RADGENS/NELSON) 39 - INSTITUTE FOR NEURO PRACTICE POOL ACCOUN 2525 JOLLY RD STE 240 OKEMOS MI 48864 NEURO (MASIH/KATTELUS/SIMENSKY) PART I, LINE 7: THE COSTING METHODOLOGY USED FOR LINE 7A WAS THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 IN ADDITION TO DISCOUNTS AT COST PER THE HOSPITAL'S ACCOUNTING RECORDS. THE COSTING METHODOLOGY USED FOR LINES 7B - 7C WAS THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE COSTING METHODOLOGY USED FOR LINES 7E - 7I WERE ACTUAL COSTS PER THE HOSPITAL'S ACCOUNTING RECORDS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE EMERGENCY ROOM AND OR SERVICES. NO PHYSICIAN CLINICS ARE INCLUDED. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990 PART IX LINE 25 COLUMN A WAS SUBTRACTED FROM THE DENOMINATOR FOR PURPOSES OF CALCULATING THE PERCENT OF TOTAL EXPENSES. THE BAD DEBT EXPENSE EXCLUDED WAS $9,170,761. PART II, COMMUNITY BUILDING ACTIVITIES: MEMORIAL HEALTHCARE HAS A STRONG REPUTATION AS A COLLABORATOR AND SUPPORTER OF AGENCIES AND ORGANIZATIONS WORKING TO IMPROVE THE QUALITY OF LIFE IN OUR REGION. INCLUDED IN THESE EFFORTS IS A VIGOROUS SUPPORT BOTH FINANCIALLY AND IN-KIND OF THE ECONOMIC DEVELOPMENT EFFORTS IN OUR COUNTY. WE PLAY A LEADERSHIP ROLE IN THE HEALTH & HUMAN SERVICES COLLABORATIVE IN SHIAWASSEE COUNTY WHICH HAS MADE A DIFFERENCE IN IMPORTANT ISSUES TO OUR RESIDENTS SUCH AS: TRANSPORTATION, ACCESS TO HEALTH AND DENTAL CARE FOR THOSE ON MEDICAID OR UNINSURED, HOMELESSNESS PREVENTION, SUICIDE PREVENTION, ELDER CARE, ETC.DURING THE COVID-19 PANDEMIC, MEMORIAL PROVIDED THE COMMUNITY AS WELL AS THEIR OWN EMPLOYEES WITH TESTING SITES WHICH INCLUDED A DRIVE-THRU LOCATION WITH MINIMAL CONTACT. TO FURTHER THEIR EFFORTS TO MINIMIZE THE SPREAD OF COVID MEMORIAL ALSO EXTENDED BEYOND SHIAWASSEE COUNTY TO PROVIDE SERVICES TO WAYNE COUNTY TO PROVIDE EXCELLENT CARE IN TESTING ALL THE INMATES AND SHERIFFS. MEMORIAL WAS ALSO AMONG THE FIRST TO PROVIDE THE 1ST DOSE OF THE VACCINE TO THE COMMUNITY AND THEIR EMPLOYEES. MEMORIAL CONTINUES TO PROVIDE EXCEPTIONAL COMMUNITY SUPPORT INCLUDING ESTABLISHING ITSELF AS AN INDUSTRY LEADER IN THE CONTINUED FIGHT AGAINST THE SPREAD OF COVID-19. PART III, LINE 2: THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 3: IT HAS BEEN ESTIMATED THAT APPROXIMATELY 30 PERCENT OF EXPENSES RELATING TO BAD DEBT ARE ATTRIBUTABLE TO PATIENTS THAT MAY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. THE ESTIMATE IS BASED ON THE HOSPITALS EXPERIENCE AND REVIEW OF CHARITY CARE APPLICATIONS. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF OUR FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDE PRIMARILY TO SELF-PAY PATIENTS.ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVAN PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING MEMORIAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), MEMORIAL RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 8: MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. INPATIENT AND OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. COSTS ON STRESS, SUBACUTE AND LONG-TERM CARE ARE ALSO INCLUDED. MEDICARE REVENUE AND COSTS RELATED TO THE SUBSIDIZED HEALTH SERVICES HAVE BEEN REMOVED IN ORDER TO AVOID DUPLICATION. ANY SHORTFALLS CALCULATED HERE ARE CONSIDERED TO BE A COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS RECEIVE A STATEMENT 14 DAYS AFTER THEIR INSURANCE PAYS OR 14 DAYS AFTER SERVICE FOR SELF PAY PATIENTS. PATIENT WILL RECEIVE A PAST DUE NOTICE (2ND STATEMENT) 30 DAYS AFTER FIRST STATEMENT IF NO PAYMENT MADE OR PAYMENT ARRANGEMENT SET UP. PATIENTS WILL THEN BE REFERRED TO OUR VENDOR CAREPAYMENT TO SET UP A 25 MONTH PAYMENT PLAN. IF THE PATIENT DEFAULTS (AFTER A MINIMUM OF 90 DAYS) ON THE PAYMENT PLAN THE ACCOUNT WILL BE RETURNED TO MEMORIAL AND THEN WILL BE SENT ONTO UNITED COLLECTION BUREAU FOR COLLECTION ACTIVITY. PATIENT WILL RECEIVE NOTICE OF ANY ECA'S 30 DAYS PRIOR TO BEING SENT TO COLLECTIONS. PART VI, LINE 2: WE ASSESS THE HEALTH NEEDS OF OUR RESIDENTS THROUGH COLLABORATIONS WITH THE COUNTY HEALTH DEPARTMENT, OUR 10 SCHOOL DISTRICTS, OUR COUNCIL OF HEALTH & HUMAN SERVICE AGENCIES AND THROUGH PHYSICIAN OBSERVATION AND REQUESTS. PART VI, LINE 3: WE COMMUNICATE THIS THROUGH SEVERAL METHODS INCLUDING: POSTING AT REGISTRATION POINTS, IN THE PATIENT HANDBOOK PROVIDED TO ALL INPATIENTS, IN A GUIDE TO THE BILLING PROCESS PAMPHLET HANDED OUT AT REGISTRATION POINTS, ON THE BACK OF OUR PATIENT STATEMENTS, VERBALLY THRU OUR FINANCIAL COUNSELING STAFF WHEN PATIENTS ARE IN-HOUSE AS WELL AS THROUGH PHONE CONVERSATIONS WITH PATIENTS CONCERNING THEIR BILLS. PART VI, LINE 4: MEMORIAL HEALTHCARE SERVES SHIAWASSEE COUNTY AND THE SURROUNDING REGION, APPROXIMATELY 105,000 PEOPLE. IT IS A RURAL COUNTY WITH A CENTRAL CITY OF OWOSSO (POPULATION 15,000). THE CENTER CORE OF THE COUNTY, OWOSSO, IS KNOWN AS A "MICROPOLITAN". THERE IS LITTLE RACIAL DIVERSITY, 94% OF THE RESIDENTS ARE WHITE, 4% ARE HISPANIC, 1% IS AFRICAN AMERICAN, AND 2% ARE OTHER/2 OR MORE RACES. THE DIVERSITY IS MORE APPARENT IN THE SOCIAL ECONOMIC DISPARITIES. IN JANUARY OF 2020, THE UNEMPLOYMENT RATE FOR SHIAWASSEE COUNTY WAS 4.40% WHICH WAS SLIGHTLY HIGHER THAN THE STATE AVERAGE OF 3.8%. IN MAY OF 2020, THE UNEMPLOYMENT RATE FOR SHIAWASSEE COUNTY WAS 29.2% WHICH WAS ALSO HIGHER THAN THE STATE AVERAGE OF 21.2%. 18.3% OF CHILDREN LIVE IN POVERTY. PART VI, LINE 5: MEMORIAL HEALTHCARE DEVELOPED A COLLABORATION WITH GREAT LAKES BAY HEALTH CENTER OF SAGINAW TO SET UP A COMMUNITY HEALTH CENTER IN SHIAWASSEE COUNTY. THIS CENTER SERVES AS THE MEDICAL HOME FOR THOUSANDS WHO HAD NO ACCESS TO CARE. THROUGH A PARTNERSHIP WITH COMMUNITY MENTAL HEALTH, THIS CENTER ALSO NOW HAS A FULL TIME SOCIAL WORKER. CURRENTLY, WE ARE WORKING TO INCREASE ACCESS TO DENTAL HEALTH. PART VI, LINE 6: MEMORIAL HEALTHCARE FOUNDATION PROVIDES FUND DEVELOPMENT SERVICES TO ASSIST MEMORIAL HEALTHCARE. MEMORIAL HEALTHCARE OPERATES A SHORT-TERM, ACUTE-CARE FACILITY OFFERING INPATIENT AND OUTPATIENT HEALTHCARE, MENTAL HEALTH SERVICES, AND HOME CARE PRIMARILY TO CITIZENS OF SHIAWASSEE COUNTY, MICHIGAN. PART VI, LINE 7, REPORTS FILED WITH STATES MI X 1 1 X X X 0 0 0 0 0 0 0 1 0 RAMY M KURDI DO PHYSICIAN 1081740 0 157000 0 0 0 6100 0 23893 0 1268733 0 0 0 TAREK R PACHA DO PHYSICIAN 700001 0 340092 0 0 0 6100 0 18513 0 1064706 0 0 0 BRETT WALKER DO PHYSICIAN 875000 0 1566 0 0 0 3365 0 17982 0 897913 0 0 0 ASHRAF M ELBANNA MD PHYSICIAN 800010 0 7749 0 0 0 6100 0 22794 0 836653 0 0 0 HAZEM TABBAA DO PHYSICIAN 719231 0 40915 0 0 0 5421 0 24167 0 789734 0 0 0 BRIAN L LONG EXECUTIVE DIRECTOR/CEO 604284 0 40438 0 0 0 6100 0 15738 0 666560 0 0 0 JOSEPH E TESTA DO MEMBER 518971 0 83267 0 0 0 6100 0 23526 0 631864 0 0 0 MICHAEL B KRAMER DO MEMBER 238125 0 215917 0 0 0 5537 0 17783 0 477362 0 0 0 JAMES J FAYSAL DO MEMBER 341250 0 75566 0 0 0 6100 0 21227 0 444143 0 0 0 JAMES NEMETH COO 386205 0 9107 0 0 0 6100 0 23984 0 425396 0 0 0 JOSEPH M BUSTAMANTE DO CHIEF MEDICAL OFFICER 383248 0 194 0 0 0 6100 0 18358 0 407900 0 0 0 MARGARET R FREY DO MEMBER 330726 0 7060 0 0 0 6100 0 22060 0 365946 0 0 0 ANTHONY A PATSY DO MEMBER 260000 0 75105 0 0 0 6100 0 21859 0 363064 0 0 0 RONALD M BISHOP DO MEMBER 276117 0 21188 0 0 0 5787 0 18454 0 321546 0 0 0 THOMAS KURTZ CIO 262336 0 0 0 0 0 5247 0 21620 0 289203 0 0 0 JORRI TREMAIN CFO 210859 0 8608 0 0 0 4367 0 3179 0 227013 0 0 0 PART I, LINE 1A PHYSICIANS LISTED IN FORM 990, PART VII (AS WELL AS ALL THE PHYSICIANS ON STAFF) ARE GENERALLY ALLOWED $4,000/YEAR PER THEIR CONTRACTS. USUALLY, THIS MONEY IS USED FOR BOOKS AND CONTINUING EDUCATION. THIS IS NOT REPORTED AS TAXABLE COMPENSATION TO THE PHYSICIANS. PART I, LINE 7 MEMORIAL BONUSES ARE BASED ON OPERATING TARGETS BUT ARE PAID OUT AT THE DISCRETION AND APPROVAL OF THE BOARD OF DIRECTORS. A MICHIGAN FINANCE AUTHORITY 381358208 2015-07-29 7055000 FUND $7 MILLON OF 2015 CAPITAL BUDGET 0 0 0 B MICHIGAN FINANCE AUTHORITY 381358208 59447PXT3 2013-08-06 19369159 PAY DOWN DEBT - $12 MILLION / FUND $8 MILLION OF 2013 CAPITAL BUDGET 0 0 0 C MICHIGAN FINANCE AUTHORITY 381358208 2020-12-22 40000000 FUNDING OF A NEW BUILDING 0 0 0 D MICHIGAN FINANCE AUTHORITY 381358208 2020-06-30 10000000 FUND TEH NEW EMR PROJECT 0 0 0 A 4997292 7055000 64952 6990048 2015 1 0 1 1 B 11842858 19369159 70728 9991669 9306762 2014 1 0 1 1 C 5590284 40000000 148000 11593116 28406884 0 0 0 1 D 2148792 10000000 117484 9882516 2021 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 1 0 B 0 0 0 1 0 0 0 1 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 1 B 1 C 1 D 1 ALYSSA LAWTON ALYSSA LAWTON IS THE DAUGHTER OF BRIAN LONG THE CEO OF THE HOSPITAL 49211 ALYSSA LAWTON IS AN EMPLOYEE OF THE HOSPITAL 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT. THE CEO, CFO, AND THE FINANCE DIRECTOR ALL REVIEWED THE 990. TAX RETURNS WILL BE MADE AVAILABLE TO ALL FINANCE COMMITTEE MEMBERS AND BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS AND LEADERSHIP TEAM MEMBERS ARE COVERED BY THIS POLICY. EACH COVERED MEMBER IS REQUIRED TO COMPLETE A DISCLOSURE STATEMENT ANNUALLY. ANY POTENTIAL CONFLICT THAT ARISES DURING THE YEAR MUST BE DISCLOSED WITHIN 14 DAYS OF FIDUCIARY'S KNOWLEDGE THAT A CONFLICT MAY EXIST. THE BOARD CHAIR HAS ULTIMATE RESPONSIBILITY FOR ENFORCEMENT OF THE POLICY. IF A CONFLICT DOES EXIST, THE MEMBER WITH THE CONFLICT ABSTAINS FROM VOTING AND THE CONFLICT IS NOTED IN THE MINUTES OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT, OFFICERS AND KEY EMPLOYEES INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION UPON HIRING. THE FULL BOARD OF DIRECTORS REVIEWS THE CEO'S COMPENSATION ANNUALLY. A COMPENSATION COMMITTEE HAS BEEN FORMED AND ACTIVELY PARTICIPATES IN DECISIONS RELATED TO CEO AND EXECUTIVE PAY AND BENEFITS AS WELL AS PROVIDING INPUT AND OVERSIGHT FOR THE ORGANIZATIONS COMPENSATION PHILOSOPHY AND PROGRAM. CEO AND EXECUTIVE PAY IS REVIEWED AT LEAST ANNUALLY BY THIS COMMITTEE. THE MOST RECENT REVIEW OF CEO AND EXECUTIVE PAY WAS JULY 2022. UPDATED SALARY RANGES ARE PROVIDED BY AN OUTSIDE COMPENSATION CONSULTING COMPANY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER TO/FROM AFFILIATES -34,692. DISTRIBUTION TO NONCONTROLLING INTEREST 163,608. OTHER NET ASSET ACTIVITY 2,052. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND FOR SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MEMORIAL ASSISTED LIVING LLC 826 WEST KING STREET OWOSSO MI 48867 464831571 PROVIDE HOUSING AND SUPPORT FOR THE ELDERLY MI 61547 7119482 MEMORIAL HOSPITAL MEMORIAL HEALTHCARE FOUNDATION 826 WEST KING STREET OWOSSO MI 48867 383036586 TO PROVIDE FUND DEVELOPMENT SERVICES TO ASSIST MEMORIAL MI 501(C)(3) LINE 12A, I MEMORIAL HOSPITAL 1 MEMORIAL HEALTHCARE PAIN MANAGEMENT 826 WEST KING STREET OWOSSO MI 48867 472218456 PROVIDE OUTPATIENT PAIN MANAGEMENT SERVICES MI MEMORIAL HOSPITAL RELATED 160668 442312 0 0 0.51000 MHC DEVELOPEMENT CORPORATION 826 WEST KING STREET OWOSSO MI 48867 463742868 DEVELOPMENT OF ASSISTED LIVING PROPERTY MI MEMORIAL HOSPITAL C -26308 4618397 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 MEMORIAL HEALTHCARE FOUNDATION P 182113 ACTUAL CASH MEMORIAL HEALTHCARE FOUNDATION C 461449 ACTUAL CASH MEMORIAL HEALTHCARE PAIN MANAGEMENT P 71626 ACTUAL CASH