2022-11-11T11:05:23-06:00 2021-12-31 990 2021-01-01 237383042 HENRY FORD HEALTH SYSTEM FOUNDATION HENR 3138768704 ONE FORD PLACE - 5F DETROIT MI 48202 ROBIN DAMSCHRODER EVP FINANCE/CFO 3138768714 2022-11-11 ROBIN DAMSCHRODER 999009999 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ROBIN DAMSCHRODER ONE FORD PLACE - 5F DETROIT MI 48202 43136928 0 X N/A X 1974 MI TO IMPROVE LIFE BY SUPPORTING EXCELLENCE IN THE SCIENCE AND ART OF HEALTH CARE AND HEALING. 37 31 0 0 0 0 0 0 0 0 3172498 16688128 23070 29329 3195568 16717457 16318616 17125084 0 0 0 0 0 0 0 360561 463736 16679177 17588820 -13483609 -871363 365525098 411181841 16300000 17100000 349225098 394081841 X THE HENRY FORD HEALTH SYSTEM FOUNDATION (THE FOUNDATION) IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH" ) SERVING THE METROPOLITAN DETROIT MICHIGAN COMMUNITIES. AS AN INTEGRATED COMPONENT OF ONE OF THE NATION'S LEADING COMPREHENSIVE, INTEGRATED HEALTH SYSTEMS, THE FOUNDATION EXISTS TO ADVANCE THE GOALS AND MISSION OF HF HEALTH AND TO IMPROVE THE QUALITY OF HUMAN LIFE THROUGH ITS SUPPORT OF THE SCIENCE AND ART OF HEALTH CARE AND HEALING. THE ORGANIZATION PROVIDES FINANCING TO VARIOUS RESEARCH AND OTHER INITIATIVES OF HF HEALTH. 0 0 17588820 17125084 147094467 THE FOUNDATION'S PURPOSE IS TO MANAGE AN ENDOWMENT FUND AND BASED ON THE RESULTS OF HF HEALTH NEEDS ANALYSIS, PROVIDE FUNDING TO VARIOUS RESEARCH AND OTHER INITIATIVES OF HF HEALTH AND ITS AFFILIATES. 17588820 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 37 31 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X ROBIN DAMSCHRODER 3138768714 ONE FORD PLACE DETROIT MI 48202 THOMAS C BUHL TRUSTEE - CHAIR 2.00 0.00 X X 0 0 0 WRIGHT L LASSITER III TRUSTEE- PRESIDENT 2.00 63.00 X X 0 4247701 57276 ALFRED J FISHER III TRUSTEE 1.00 0.00 X 0 0 0 ALLEN H DEMCHIK TRUSTEE 1.00 0.00 X 0 0 0 BENSON FORD JR TRUSTEE 1.00 0.00 X 0 0 0 CALVIN R FORD TRUSTEE 1.00 0.00 X 0 0 0 CHARLOTTE A FORD TRUSTEE 1.00 0.00 X 0 0 0 DAVID M HEMPSTEAD TRUSTEE 1.00 3.00 X 0 0 0 DAVID P LARSEN TRUSTEE 1.00 0.00 X 0 0 0 FREDERICK LAVERY JR TRUSTEE 1.00 0.00 X 0 0 0 GRETCHEN GONZALES DAVIDSON TRUSTEE 1.00 0.00 X 0 0 0 HENRY W LIM MD PHYSICIAN TRUSTEE 1.00 60.00 X 0 861333 52961 IAN BURNSTEIN TRUSTEE 1.00 0.00 X 0 0 0 JEFFREY TAMAROFF TRUSTEE 1.00 0.00 X 0 0 0 KATHLEEN J WHELAN TRUSTEE 1.00 0.00 X 0 0 0 KENNETH A FRUEHAUF TRUSTEE 1.00 0.00 X 0 0 0 KYLE ANNE SASENA TRUSTEE 1.00 0.00 X 0 0 0 LEROY C RICHIE TRUSTEE 1.00 0.00 X 0 0 0 LINDA HAYMAN TRUSTEE 1.00 0.00 X 0 0 0 LYNN FORD ALANDT TRUSTEE 1.00 3.00 X 0 0 0 MANU K MALHOTRAMD PHYSICIAN TRUSTEE 1.00 59.00 X 0 579837 55665 MARY JANE VOGT TRUSTEE 1.00 60.00 X 0 556704 38687 MICHAEL E BERGER TRUSTEE 1.00 0.00 X 0 0 0 NIKOLAOS MOSCHOURIS TRUSTEE 1.00 0.00 X 0 0 0 PETER D CUMMINGS TRUSTEE 1.00 0.00 X 0 0 0 POMPILIO E D'AGOSTINI TRUSTEE 1.00 0.00 X 0 0 0 ROBERT C BOBB TRUSTEE 1.00 0.00 X 0 0 0 RONNIE J BOJI TRUSTEE 1.00 0.00 X 0 0 0 SANDRA E PIERCE TRUSTEE 1.00 0.00 X 0 0 0 SHARI E FINSILVER TRUSTEE 1.00 0.00 X 0 0 0 STEVEN N KALKANIS MD PHYSICIAN TRUSTEE 1.00 59.00 X 0 1427236 237044 TIFFANY SLEMMONS DOUGLAS TRUSTEE 1.00 0.00 X 0 0 0 TODD A WYETT TRUSTEE 1.00 0.00 X 0 0 0 VIVIAN ROGERS PICKARD TRUSTEE 1.00 0.00 X 0 0 0 VONDA GRANT TRUSTEE 1.00 0.00 X 0 0 0 WALTER E DOUGLAS TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM W O'NEILLMD PHYSICIAN TRUSTEE 1.00 59.00 X 0 2039718 48116 MARJORIE A STATEN JD ASSISTANT SECRETARY 2.00 58.00 X 0 207169 13637 MICHELLE JOHNSON TIDJANI ESQ SECRETARY 2.00 63.00 X 0 1865610 53218 ROBIN S DAMSCHRODER TREASURER 2.00 63.00 X 0 1540448 294992 CELESTE WILLIAMS MD FORMER PHYSICIAN TRUSTEE 0.00 60.00 X 0 436097 31308 TAMER A GHANEM MD FORMER PHYSICIAN TRUSTEE 0.00 60.00 X 0 373147 54594 WILLIAM A CONWAY MD FORMER PHYSICIAN TRUSTEE 0.00 60.00 X 0 160537 34939 0 14295537 972437 0 1 1 0 0 2008022 2008022 41099577 26419471 14680106 14680106 14680106 ROYALTY INCOME 523000 29329 29329 29329 16717457 14680106 0 2037351 17125084 17125084 INVESTMENT FEES 463736 463736 17588820 17588820 0 0 1638604 1646149 316876385 348090138 47005655 61443978 4454 1576 365525098 411181841 16300000 17100000 16300000 17100000 X 349225098 394081841 349225098 394081841 365525098 411181841 -871363 45728106 0 X X 0 1 X 1 0 X X 1 HENRY FORD HEALTH SYSTEM 381357020 3 1 17125084 0 1 17125084 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1.00000 0 OTHER SECURITIES 24494720 F HFHS MALPRACTICE 502269 F VENTURE CAPITAL, PARTNER 36446989 F 61443978 X PART X, LINE 2: THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2021 AND 2020 . 1 HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT MI 48202 381357020 501(C)(3) 17125084 0 RESEARCH FUNDING TO HENRY FORD HEALTH SYSTEM 1 X X X X 0 1 0 0 0 0 0 0 0 WRIGHT L LASSITER III TRUSTEE- PRESIDENT 0 1941833 0 1583203 0 722665 0 24749 0 32527 0 4304977 0 0 WILLIAM W O'NEILLMD PHYSICIAN TRUSTEE 0 1756694 0 250000 0 33024 0 26199 0 21917 0 2087834 0 0 MICHELLE JOHNSON TIDJANI ESQ SECRETARY 0 852795 0 366719 0 646096 0 24024 0 29194 0 1918828 0 466295 ROBIN S DAMSCHRODER TREASURER 0 998152 0 521554 0 20742 0 262941 0 32051 0 1835440 0 0 STEVEN N KALKANIS MD PHYSICIAN TRUSTEE 0 984364 0 420750 0 22122 0 208232 0 28812 0 1664280 0 0 HENRY W LIM MD PHYSICIAN TRUSTEE 0 608803 0 226876 0 25654 0 27649 0 25312 0 914294 0 0 MANU K MALHOTRAMD PHYSICIAN TRUSTEE 0 405944 0 126990 0 46903 0 26199 0 29466 0 635502 0 0 MARY JANE VOGT TRUSTEE 0 413193 0 137892 0 5619 0 27649 0 11038 0 595391 0 0 CELESTE WILLIAMS MD FORMER PHYSICIAN TRUSTEE 0 378010 0 32908 0 25179 0 26199 0 5109 0 467405 0 0 TAMER A GHANEM MD FORMER PHYSICIAN TRUSTEE 0 332663 0 1323 0 39161 0 24749 0 29845 0 427741 0 0 MARJORIE A STATEN JD ASSISTANT SECRETARY 0 170963 0 34667 0 1539 0 3045 0 10592 0 220806 0 0 WILLIAM A CONWAY MD FORMER PHYSICIAN TRUSTEE 0 160537 0 0 0 0 0 13911 0 21028 0 195476 0 0 PART I, LINE 4B SCH J, LINE 4B, PERSON PARTICIPATING IN HFHS NONQUALIFIED RETIREMENT PLANS SEC 457(F) - SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) VALUE OF TAXABLE REPORTABLE 2021 ACCRUAL NON VESTED 2021 DISTRIBUTIONS W-2 AMOUNTS PARTICIPANT WRIGHT L. LASSITER III 698,263 - - 698,263 MICHELLE JOHNSON TIDJANI 624,886 - - 624,886 STEVEN KALKANIS, M.D. - 182,033 - - ROBIN DAMSCHRODER - 238,192 - - CONTRIBUTIONS TO SEC 457(B)-NON-QUALIFIED DEFERRED COMPENSATION RETIREMENT PLAN EMPLOYEE EMPLOYER MEDICARE REPORTABLE 2021 CONTRIBUTIONS 2021 CONTRIBUTIONS TAX GROSS-UP W-2 AMOUNTS HENRY W. LIM, M.D. - 18,605 448 19,053 WRIGHT LASSITER III 19,500 - - 19,500 TAMER A. GHANEM, M.D. 12,350 2,664 64 15,078 ROBIN DAMSCHRODER 19,500 - - 19,500 CELESTE THOMAS WILLIAMS 13,391 5,080 122 18,593 STEVEN KALKANIS, M.D. 19,500 - - 19,500 MICHELLE JOHNSON TIDJANI 19,500 - - 19,500 MARY JANE VOGT - 4,274 103 4,377 WILLIAM O'NEIL, M.D. - 19,500 469 19,962 MANU MALHOTRA, M.D. - 5,625 135 5,760 FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIP AMONGST BOARD MEMBERS: LYNN FORD ALANDT, CHARLOTTE A. FORD AND BENSON FORD JR. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A TAX EXEMPT MEMBERSHIP CORPORATION AND THE SOLE MEMBER OF THE ORGANIZATION IS HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH"). FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF THE ORGANIZATION, HF HEALTH HOLDS THE RESERVE POWER TO APPROVE OR DISAPPROVE TRUSTEE APPOINTMENTS. FORM 990, PART VI, SECTION A, LINE 7B BASED ON THE ESTABLISHED RESERVE POWERS, CERTAIN DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH") AND THE TAX DEPARTMENT OF HF HEALTH PREPARES THE ORGANIZATION'S FORM 990. AS PART OF THE PREPARATION AND REVIEW PROCESS PRIOR TO FILING THE RETURN THE FOLLOWING REVIEW PROCESS IS CONDUCTED: - REVIEW OF THE ENTIRE RETURN WITH THE HF HEALTH SENIOR VICE PRESIDENT, FINANCIAL OPERATIONS AND CHIEF FINANCIAL OFFICER, - REVIEW OF ALL COMPENSATION MATTERS AND DISCLOSURES WITH THE HF HEALTH COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. - REVIEW OF THE RETURN WITH THE HF HEALTH AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS AND CEO - PROVIDE A COPY OF THE RETURN TO THE HF HEALTH BOARD OF DIRECTORS FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH") WHO OVERSEES THE CONFLICT OF INTEREST PROCESS WITH REGARD TO THE ORGANIZATION. HF HEALTH HAS A STANDING CONFLICT OF INTEREST COMMITTEE (THE COMMITTEE) THAT IS RESPONSIBLE FOR OVERSIGHT OF ALL CONFLICT OF INTEREST MATTERS. THE HF HEALTH CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS AND EMPLOYEES. ANNUALLY, DIRECTORS, EMPLOYEES OF A MANAGEMENT LEVEL, RESEARCHERS, AS WELL AS EMPLOYEES ASSOCIATED WITH PROCUREMENT, OR IN CERTAIN OTHER PREDEFINED ROLES MUST COMPLETE AN ANNUAL DISCLOSURE DESIGNED TO IDENTIFY ACTIVITIES AND RELATIONSHIPS THAT COULD POTENTIALLY GIVE RISE TO A CONFLICT OF INTEREST. IT IS THE RESPONSIBILITY OF THE COMMITTEE TO REVIEW THESE DISCLOSURES AND DETERMINE THE NEED FOR ANY ACTION TO MANAGE THE POTENTIAL CONFLICT. THE COMMITTEE ANNUALLY REPORTS THE RESULTS OF ITS ACTIVITIES TO THE HF HEALTH AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15B THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH (HF HEALTH) WHO HAS RESPONSIBILITY TO OVERSEE THE COMPENSATION PRACTICES OF THE ORGANIZATION. HFHS HAS A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS CONSISTING OF ALL EXTERNAL DIRECTORS. THEY MEET PERIODICALLY THROUGHOUT THE YEAR. THEY ARE CHARGED WITH APPROVAL OF THE ORGANIZATION'S OVERALL COMPENSATION AND BENEFIT PROGRAMS AS WELL AS THE SPECIFIC REVIEW AND APPROVAL OF THE COMPENSATION OF CERTAIN EMPLOYEES INCLUDING THE CHIEF EXECUTIVE OFFICER, ALL OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THEY DIRECTLY ENGAGE AN INDEPENDENT COMPENSATION ADVISOR TO ASSIST WITH THIS PROCESS. THE PROCESS INCLUDES EVALUATION OF THE INDIVIDUAL'S PERFORMANCE, UTILIZATION OF COMPENSATION STUDIES OF SIMILARLY SITUATED POSITIONS, AS WELL AS COMPARISONS TO COMPENSATION AS REPORTED BY OTHER HEALTH CARE ORGANIZATIONS. THE REASONABLENESS OF COMPENSATION IS EVALUATED BASED UPON THESE AND OTHER FACTORS. THE COMMITTEE ALSO REVIEWS THE COMPENSATION DISCLOSURES TO BE MADE ON FORM 990 IN ADVANCE OF FILING. FORM 990, PART VI, SECTION C, LINE 19 IT IS THE PRACTICE OF THE ORGANIZATION TO MAKE ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO ANY PARTY REQUESTING SUCH INFORMATION. FORM 990, PART IV, LINE 12 THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT OBTAINED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH. FORM 990, PART XII - LINE 2C HENRY FORD FOUNDATION (FUND) IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF HENRY FORD HEALTH. THE GOVERNING BODY OF HF HEALTH HAS DELEGATED THE OVERSIGHT OF THE FINANCIAL STATEMENTS, INCLUDING THE CHOICE OF INDEPENDENT AUDITORS, TO ITS AUDIT COMMITTEE. FORM 5713 - INTERNATIONAL BOYCOTT ACTIVITY: A FORM 5713, INTERNATIONAL BOYCOTT REPORT, HAS BEEN FILED ON OUR BEHALF BY HENRY FORD HEALTH (PARENT OF OUR CONTROLLED GROUP OF WHICH THE ORGANIZATION IS A MEMBER). THE ORGANIZATION DID NOT ITSELF HAVE ANY ACTIVITIES ASSOCIATED WITH AN INTERNATIONAL BOYCOTT COUNTRY. FORM 990, PART VII: AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: MANY EXECUTIVE EMPLOYEES OF HF HEALTH PROVIDE SERVICES TO MULTIPLE AFFILIATED ENTITIES. HENRY FORD HEALTH USES ESTIMATES FOR REPORTING AVERAGE HOURS PER WEEK IN ALL SECTIONS OF FORM 990. GENERALLY, 60 HOURS ARE REPORTED FOR THE HOURS ASSOCIATED FOR THE ORGANIZATION THAT THE INDIVIDUAL HAS PRINCIPAL RESPONSIBILITY FOR. HOURS ASSOCIATED WITH OTHER HOSPITAL OR LARGER ORGANIZATIONS ARE REPORTED AT 5 PER WEEK AND FOR SMALLER ORGANIZATIONS 1 HOUR PER WEEK IS REPORTED. HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT MI 48202 381357020 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 N/A 0 HENRY FORD WYANDOTTE HOSPITAL 2333 BIDDLE AVE WYANDOTTE MI 48192 382791823 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 HENRY FORD HEALTH SYSTEM 1 HEALTH ALLIANCE PLAN 2850 W GRAND BLVD DETROIT MI 48202 382242827 HEALTH MAINTENANCE ORGANIZATION MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 HFII CORPORATION ONE FORD PLACE DETROIT MI 48202 900840304 SCIENTIFIC RESEARCH MI 501(C)(3) LINE 7 HENRY FORD HEALTH SYSTEM 1 HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES ONE FORD PLACE DETROIT MI 48202 464064067 ADVOCACY SERVICES FOR HF HEALTH AND AFFILIATES MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 HENRY FORD MACOMB HOSPITAL CORPORATION ONE FORD PLACE DETROIT MI 48192 382947657 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 HENRY FORD HEALTH SYSTEM 1 HENRY FORD ALLEGIANCE HEALTH GROUP 205 N EAST AVENUE JACKSON MI 49201 382756428 EXEMPT ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD HEALTH SYSTEM 1 ALLEGIANCE HEALTH FOUNDATION 205 N EAST AVENUE JACKSON MI 49201 383607833 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD ALLEGIANCE HEALTH GROUP 1 HOSPICE OF JACKSON DBA ALLEGIANCE HOSPICE 205 N EAST AVENUE JACKSON MI 49201 382336367 HOSPICE MI 501(C)(3) LINE 7 HEALTHLINK 1 HEALTHLINK 205 N EAST AVENUE JACKSON MI 49201 382756425 HOME HEALTH CARE MI 501(C)(3) LINE 12A, I HENRY FORD ALLEGIANCE HEALTH GROUP 1 CARELINK OF JACKSON 110 NORTH ELM AVENUE JACKSON MI 49202 381218485 LONG TERM ACUTE HOSPITAL MI 501(C)(3) LINE 3 HENRY FORD ALLEGIANCE HEALTH GROUP 1 WA FOOTE MEMORIAL HOSPITAL DBA HENRY FORD HEALTH JACKSON HOSPITAL 205 N EAST AVENUE JACKSON MI 48201 382027689 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 HENRY FORD ALLEGIANCE HEALTH GROUP 1 THE CLARENCE S LIVINGOOD LECTURESHIP AND EDUCATION FUND 3031 WEST GRAND BOULEVARD NO 800 DETROIT MI 48202 382682321 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD HEALTH SYSTEM 1 HENRY FORD PHYSICIAN PARTNERS ONE FORD PLACE DETROIT MI 48202 871633901 PHYSICIAN SERVICES MI 501(C)(3) LINE 3 HENRY FORD HEALTH SYSTEM 1 NORTHWEST DETROIT DIALYSIS 30100 TELEGRAPH BINGHAM FARMS MI 48025 383232668 OPERATE DIALYSIS CLINIC MI HENRY FORD HEALTH SYSTEM N/A 0 0 MACOMB REGIONAL DIALYSIS CENTERS 16151 NINETEEN MILE RD CLINTON TOWNSHIP MI 48038 260423581 OPERATE DIALYSIS CLINIC MI HENRY FORD HEALTH SYSTEM N/A 0 0 FOOTE HEALTH CENTER ASSOCIATES 1100 E MICHIGAN AVENUE JACKSON MI 49201 383017711 LESSOR OF MEDICAL CONDOMINIUM MI HENRY FORD ALLEGIANCE HEALTH GROUP RELATED 0 0 SHA REALTY INC ONE FORD PLACE DETROIT MI 48202 381378121 REAL ESTATE HOLDING MI HENRY FORD HEALTH SYSTEM FOUNDATION C 637777 8428870 1.00000 1 FAIRLANE HEALTH SERVICES 30100 TELEGRAPH BINGHAM FARMS MI 48025 382565235 HEALTHCARE MANAGEMENT MI HENRY FORD HEALTH SYSTEM C 1 ALLIANCE HEALTH AND LIFE INSURANCE 2850 W GRAND BLVD DETROIT MI 48202 383291563 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HAP PREFERRED INC 2850 W GRAND BLVD DETROIT MI 48202 382513504 PROVIDER NETWORK LEASING MI HEALTH ALLIANCE PLAN C 1 ONIKA INSURANCE LTD FIRST CARRIBEAN HOUSE GRAND CAYMAN CAYMAN ISLANDS CJ CAPTIVE INSURANCE CJ HENRY FORD HEALTH SYSTEM C 1 HENRY FORD PHYSICIAN NETWORK ONE FORD PLACE DETROIT MI 48202 320306774 PHYSICIAN NETWORK MI HENRY FORD HEALTH SYSTEM C 1 ADMINISTRATION SYSTEMS RESEARCH CORPORATION 2850 W GRAND BLVD DETROIT MI 48202 382651185 THIRD PARTY INSURANCE ADMINISTRATOR MI HEALTH ALLIANCE PLAN C 1 HAP EMPOWERED HEALTH PLAN INC 2850 W GRAND BLVD DETROIT MI 48202 383123777 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HENRY FORD ALLEGIANCE PHARMACY 205 N EAST AVENUE JACKSON MI 49201 383370242 PHARMACY MI HENRY FORD ALLEGIANCE HEALTH GROUP C 1 HENRY FORD ELIJAH MCCOY CONDOMINIUM ASSOCIATION 1150 ELIJAH MCCOY DR DETROIT MI 48202 852144748 CONDOMINIUM ASSOCIATION MI HENRY FORD HEALTH SYSTEM S 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 HENRY FORD HEALTH SYSTEM B 17125084 CASH VALUE SCHEDULE R, PART V, LINE 1D & 1E: THE ORGANIZATION, AS A DESIGNATED AFFILIATE, IS A MEMBER OF THE HENRY FORD HEALTH SYSTEM CREDIT GROUP. MEMBERS OF THE CREDIT GROUP ARE JOINTLY AND SEVERALLY LIABLE FOR OUTSTANDING OBLIGATIONS ISSUED UNDER THE 2016 AND 2019 HFHS BOND MASTER INDENTURES.