2019-01-14T10:47:27-06:00 2018-02-28 990 2017-03-01 381218485 CARELINK OF JACKSON A COMMUNITY-OWNED SPECIALTY HOSPITAL CARE 5172054463 110 NORTH ELM AVENUE JACKSON MI 49202 DALE L FRIESEN CHIEF FINANCIAL OFFICER 5172054463 2019-01-14 150.198.17.8 2019-01-14 11:46:14 ES P A6B258DA322BB4701323A8C6F76545826E7CE75E D2F1EDA38465ECFB4A612DF41651BA0E1D69915F 2017 2019-02-21 02:37:17Z HENRY FORD ALLEGIANCE SPECIALTY HOSP Ondrea L Bates 110 NORTH ELM AVENUE JACKSON MI 49202 13323816 0 X www.henryford.com X 2003 MI TO PROVIDE LONG-TERM ACUTE HEALTHCARE TO THE RESIDENTS OF JACKSON, MI AND SURROUNDING AREAS. 6 4 144 1 0 0 4004 2088 14222577 13280401 4554 2411 101589 38916 14332724 13323816 0 0 0 0 7012326 6685210 0 0 0 8802276 8179324 15814602 14864534 -1481878 -1540718 8474568 7899704 3410260 4376114 5064308 3523590 X HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS COMMITTED TO HOLISTIC CARE OF INDIVIDUALS WITH COMPLEX MEDICAL NEEDS. 0 0 12514624 13317645 HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS A LONG-TERM ACUTE CARE HOSPITAL FULLY ACCREDITED BY THE JOINT COMMISSION.THE FACILITY IS DESIGNED AND MANAGED TO PROVIDE CARE FOR MEDICALLY COMPLEX PATIENTS REQUIRING AN AVERAGE HOSPITAL STAY IN EXCESS OF 25 DAYS. ANY PATIENT HAVING AN ACUTE CHRONIC CONDITION, COMPLICATION FROM A SURGICAL PROCEDURE OR EXPECTED TO REQUIRE A LONGER ACUTE HOSPITAL STAY MAY BE CONSIDERED FOR ADMISSION. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS A FREE-STANDING HOSPITAL WHEREBY PATIENTS ARE ACCEPTED FROM MULTIPLE SOURCES.PATIENTS ARE FREQUENTLY REFERRED TO THE FACILITY FROM OTHER ACUTE CARE HOSPITALS, SKILLED NURSING FACILITIES, PHYSICIAN OFFICES,WOUND CLINICS, DIALYSIS CENTERS AND OTHER SOURCES.DURING THE FISCAL YEAR ENDED 02/28/2018, HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL MAINTAINED AN AVERAGE DAILY CENSUS OF 22.6 PATIENTS AND PROVIDED 8,245 DAYS OF PATIENT CARE. DUE TO THE COMPLEX MEDICAL NEEDS OF PATIENTS SERVED BY THE HOSPITAL, THE AVERAGE PATIENT RESIDED AT THE FACILITY FOR 25.2 DAYS. PATIENTS WHO SATISFIED MINIMUM MEDICARE ADMISSION CRITERIA MAINTAINED AN AVERAGE LENGTH OF STAY OF 28.6 DAYS. APPROXIMATELY 74.6% OF ALL DISCHARGED PATIENTS WERE MEDICARE ELIGIBLE. 12514624 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 17 0 1 144 1 0 0 0 0 0 0 0 0 0 0 X 6 4 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X X DALE L FRIESEN 5172050475 110 NORTH ELM AVENUE JACKSON MI 49202 Ondrea Bates President 2.00 63.00 X X 0 404612 65562 Brent Ellis Chairperson 2.00 0.00 X X 0 0 0 Maryanne Fuchs Vice Chairperson (Thru Feb 6 2018) 2.00 0.00 X X 0 0 0 David K Schmidt Trustee 1.00 0.00 X 0 0 0 Bruce A Insencio Jr Trustee 1.00 0.00 X 0 0 0 Vlad Motoc MD Trustee 1.00 0.00 X 0 0 0 Gregg Patten MD Trustee 1.00 0.00 X 0 0 0 Wendy Boersma Trustee 1.00 59.00 X 0 219125 26186 J Mark Fall Chief Executive Officer 40.00 0.00 X 0 0 0 Dale L Friesen Chief Financial Officer 50.00 0.00 X 0 0 0 0 623737 91748 0 0 1 1 Independent Hospitalist Physicians PLLC PO Box 110 Royal Oak MI 48068 Physician Services 1136131 Greentree Healthcare Partners LLC 110 Johnston Farm Lane Woodstock GA 30188 Management Services 636199 Fresenius Management Services Inc 16343 Collections Center Drive Chicago IL 60693 Healthcare Services 157219 3 2088 2088 PATIENT SERVICES 621990 13280401 13280401 13280401 2411 2411 DIETARY CAFETERIA 722210 35842 35842 MEDICAL RECORDS FEES 900099 1402 1402 1672 1672 38916 13323816 13317645 0 4083 X 5491640 5006474 485166 107822 98296 9526 682636 584656 97980 403112 367499 35613 781747 781747 5118 5118 22400 22400 1984 1984 3853024 2985011 868013 744 744 1055717 1055717 24959 24959 248933 248933 37942 37942 398572 398572 36770 33093 3677 PHARMACEUTICALS 1076375 1076375 MEDICAL SUPPLIES 444100 444100 FOOD 127591 127591 BAD DEBTS 63348 63348 14864534 12514624 2349910 0 299890 502555 1140428 451530 2176441 2295523 82732 35170 5366220 751294 4775077 4614926 8474568 7899704 419798 564761 2990462 3811353 3410260 4376114 X 5064308 3523590 5064308 3523590 8474568 7899704 -1540718 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1984 1984 0 Part II-B, Line 1: HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL PAYS MEMBERSHIP DUES TO SEVERAL NON-PROFIT ADVOCACY GROUPS INCLUDING THE AMERICAN HOSPITAL ASSOCIATION, MICHIGAN HOSPITAL ASSOCIATION, AND NATIONAL ASSOCIATION OF LONG-TERM ACUTE CARE HOSPITALS (NALTH). THESE ORGANIZATIONS USE A PORTION OF MEMBERSHIP DUES TO LOBBY FOR CAUSES RELATED TO THE EXEMPT MISSION OF HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL. 150000 150000 3920076 391346 3528730 1296144 359948 936196 4614926 COST REPORT SETTLEMENTS PAYABLE 158116 ACCRUED COMPENSATION 1432546 PAYABLE TO AFFILIATE 2220691 3811353 X Part X, Line 2: THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2017 AND 2016. 1 1 X 1 X 250.000000000000 0 1 1 1 0 0 102504 102504 0.00660 1522190 670107 852083 0.05460 1624694 670107 954587 0.06120 2534 2534 0.00020 2534 2534 0.00020 1627228 670107 957121 0.06140 0 63348 15837 6505941 8279021 -1773080 X 1 1 1 1 CARELINK OF JACKSON 110 NORTH ELM AVENUE JACKSON MI 49202 WWW.CARELINKOFJACKSON.ORG 380051 X LONG-TERM ACUTE CARE HOSPITAL HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE PART V, SECTION C FOR THE FULL WEBSITE X HTTP://WWW.MYHIO.ORG X 1 16 1 SEE PART V, SECTION C FOR THE FULL WEBSITE 0 1 X 250.000000000000 X X X X X 1 1 X X X X 1 X WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE X WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE X WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 0 X X 0 0 HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL Part V, Section B, Line 5: THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL IS A COLLABORATION OF COMMUNITY STAKEHOLDERS COMMITTED TO IMPROVING THE HEALTH STATUS OF THE COMMUNITY THROUGH AN INTEGRATED HEALTH IMPROVEMENT INFRASTRUCTURE THAT ADDRESSES THE COMMUNITY'S PRIORITY HEALTH ISSUES. IN THIS MODEL, COMMUNITY STAKEHOLDERS WORK WITH PUBLIC HEALTH EXPERTS TO DEVELOP AND COMPILE A COMMUNITY HEALTH NEEDS ASSESSMENT FOR JACKSON COUNTY. MEMBERS OF THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL INCLUDED THE FOLLOWING INDIVIDUALS: AMY SCHULTZ - HENRY FORD ALLEGIANCE HEALTH; MEGAN IRENE ALBERTSON - HENRY FORD ALLEGIANCE HEALTH; BRITTANY EASTON - HENRY FORD ALLEGIANCE HEALTH; RICHARD THOUNE - HENRY FORD ALLEGIANCE HEALTH; SARAH ALLISON - HENRY FORD ALLEGIANCE HEALTH; SHAINA TINSEY - HENRY FORD ALLEGIANCE HEALTH; SHERI BUTTERS - HENRY FORD ALLEGIANCE HEALTH; TASHIA M. CARTER - HENRY FORD ALLEGIANCE HEALTH; JOSH WILLIAMS - HENRY FORD ALLEGIANCE HEALTH; KEVEN MOSLEY-KOEHLER - HENRY FORD ALLEGIANCE HEALTH; LAURIE GUSTAFSON - HENRY FORD ALLEGIANCE HEALTH; ROBERT ANDERSON - HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL; ANDREA PARSHALL - BIG BROTHERS BIG SISTERS OF JACKSON COUNTY; TONY HOLLOW - BIG BROTHERS BIG SISTERS OF JACKSON COUNTY; SARA BENEDETTO - CENTER FOR FAMILY HEALTH; MOLLY KASER - CENTER FOR FAMILY HEALTH; FREDDIE DANCY - CITY OF JACKSON; JENNIFER DARLING - COMMUNITY MEMBER; TED HILLEARY - COMMUNITY MEMBER; KATE MARTIN - COMMUNITY MEMBER; RHONDA RUDOLPH - COMMUNITY MEMBER; LAUREL MAULDIN - COMMUNITY MEMBER; TOBY BERRY - COMMUNITY ACTION AGENCY; ZOE LYONS - DHHS; KELLY SHEPARD - GREAT START COLLABORATIVE OF JACKSON COUNTY; CHRISSY BLACKWELL - GREAT START COLLABORATIVE OF JACKSON COUNTY; SHAY BRISTON - JACKSON COLLABORATIVE NETWORK; DONITA BENTLEY - JACKSON COLLABORATIVE NETWORK; MONICA MOSER - JACKSON COMMUNITY FOUNDATION; IRENE LECRONE - JACKSON COUNTY CRADLE TO CAREER EDUCATION NETWORK; KAITLYN STEIN - JACKSON COUNTY HEALTH DEPARTMENT; ANGELA ALDRICH - JACKSON COUNTY HEALTH DEPARTMENT; DON HAYDUK - JACKSON COUNTY HEALTH DEPARTMENT; AIMEE FORS - JACKSON COUNTY HEALTH DEPARTMENT; JULIE WEISBROD - JACKSON COUNTY HEALTH DEPARTMENT; MICHELLE WHITE - JACKSON COUNTY HEALTH DEPARTMENT; LIZ BREED - JACKSON DISTRICT LIBRARY; SARA TACKETT - JACKSON DISTRICT LIBRARY; WYNN HAZEN - JACKSON HEALTH NETWORK; RAY KING - JACKSON HEALTH NETWORK; COURTLAND KETEYIAN - JACKSON HEALTH NETWORK; JANELLE BUCHLER - JACKSON COUNTY ISD; LAURIE INGRAM - JACKSON HOUSING COMMISSION; SHAWNA TELLO - JACKSON YMCA; ELIZABETH KNOBLAUCH - LIFEWAYS; MARIBETH LEONARD - LIFEWAYS; TRACI FOWLER - LIFEWAYS; AMY PELLETIER - MARRIAGE MATTERS OF JACKSON; CATHY WEBB - MCLAREN HEALTH PLAN; KARA LORENZ - REGION 2 AREA AGENCY ON AGING; JULIE WETHERBY - REGION 2 AREA AGENCY ON AGING; ALLISON STONER - UNITED WAY OF JACKSON COUNTY; KEN TOLL - UNITED WAY OF JACKSON COUNTY; BETHANY STUTZMAN - UNITED WAY OF JACKSON COUNTY HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL Part V, Section B, Line 6a: W.A. FOOTE MEMORIAL HOSPITAL (DBA HENRY FORD ALLEGIANCE HEALTH) HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL Part V, Section B, Line 6b: BIG BROTHERS/BIG SISTERS OF JACKSON COUNTY; CENTER FOR FAMILY HEALTH; CITY OF JACKSON; COMMUNITY ACTION AGENCY; DHHS; GREAT START COLLABORATIVE OF JACKSON COUNTY; JACKSON COLLABORATIVE NETWORK; JACKSON COMMUNITY FOUNDATION; JACKSON COUNTY CRADLE TO CAREER EDUCATION NETWORK; JACKSON COUNTY HEALTH DEPARTMENT; JACKSON DISTRICT LIBRARY; JACKSON HEALTH NETWORK; JACKSON COUNTY ISD; JACKSON HOUSING COMMISSION; JACKSON YMCA; LIFEWAYS; MARRIAGE MATTERS OF JACKSON; MCLAREN HEALTH PLAN; REGION 2 AREA AGENCY ON AGING; UNITED WAY OF JACKSON COUNTYPART V, SECTION B, LINE 7A:A FULL COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND ON THE HOSPITALS WEBSITE AT:HTTPS://WWW.HENRYFORD.COM/LOCATIONS/ALLEGIANCE-SPECIALTY-HOSPITAL/COMMUNITY-HEALTH-ASSESSMENTPART V, SECTION B, LINE 10A:A FULL COPY OF THE IMPROVEMENT PLAN CAN BE FOUND ON THE FOLLOWING WEBSITE:HTTPS://WWW.HENRYFORD.COM/LOCATIONS/ALLEGIANCE-SPECIALTY-HOSPITAL/COMMUNITY-HEALTH-ASSESSMENT HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL Part V, Section B, Line 11: HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL COLLABORATED WITH THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL TO COMPILE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR JACKSON COUNTY. IN RESPONSE TO THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA, THE HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL BOARD OF TRUSTEE'S FORMALLY ADOPTED THE HENRY FORD SPECIALTY HOSPITAL COMMUNITY ACTION PLAN.THE ACTIONS AND STRATEGIES OUTLINED IN THE ACTION PLAN ARE SCHEDULED FOR EXECUTION BETWEEN 2017 AND 2020. SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA AND ADOPTED FOR THE PRIORITIZATION BY HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL INCLUDE:A) REDUCTION OF OBESITY RATES AMONGST JACKSON COUNTY RESIDENTS;B) REDUCTION OF TOBACCO AND SECOND-HAND SMOKE EXPOSURE AMONGST JACKSON COUNTY RESIDENTS; ANDC) REDUCTION OF SUBSTANCE ABUSE BEHAVIOR AMONGST JACKSON COUNTY RESIDENTS.IN REGARDS TO COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT SPECIFICALLY ADDRESSED WITHIN THE ORGANIZATION'S ACTION PLAN, HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL ACKNOWLEDGES THAT CERTAIN HEALTH NEEDS ARE MOST EFFECTIVELY AND EFFICIENTLY SERVED BY OTHER HEALTHCARE ORGANIZATIONS THAT POSSESS THE REQUISITE SPECIALIZATION CAPABILITIES AND RESOURCES. AS A RESULT, THE ORGANIZATIONS'S ACTION PLAN FOCUSES UPON THOSE COMMUNITY HEALTH NEEDS THAT FALL WITHIN THE SCOPE OF THE ORGANIZATION'S ABILITY TO INFLUENCE POSTIVE OUTCOMES. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL Part V, Section B, Line 13b: PATIENTS DETERMINED TO BE INELIGIBLE FOR HEALTH INSURANCE COVERAGE AND WHOSE ANNUAL AGGREGATE HOUSEHOLD INCOME IS AT OR BELOW 250% OF THE FEDERAL POVERTY LEVEL, ARE ELIGIBLE FOR A 100% DISCOUNT ON ALL MEDICALLY NECESSARY SERVICES. PATIENTS WHO OVER A 12-MONTH PERIOD HAVE ACCUMULATED A LARGE MEDICAL DEBT AS A RESULT OF A CATASTROPHIC MEDICAL SITUATION WITH OUT-OF-POCKET EXPENSES THAT EXCEED 30% OF THEIR GROSS ANNUAL HOUSEHOLD INCOME WILL BE ELIGIBLE FOR EITHER A) 100% DISCOUNT IF THEIR HOUSEHOLD INCOME IS BELOW 250% OF THE FEDERAL POVERTY LEVEL; OR B) HAVING THEIR OUTSTANDING MEDICAL DEBT ADJUSTED TO 30% OF THEIR HOUSEHOLD INCOME IF THEIR ANNUAL HOUSEHOLD INCOME EXCEEDS 250% OF THE FEDERAL POVERTY LEVEL. Part I, Line 3c: PATIENTS (WHETHER INSURED OR NOT) HAVING HOUSEHOLD INCOMES AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINE LEVEL MAY QUALIFY UNDER THE PATIENT FINANCIAL ASSISTANCE POLICY (PFAP) FOR A 100% DISCOUNT ON ALL MEDICALLY NECESSARY SERVICES. IN ADDITION, PATIENTS (WHETHER INSURED OR NOT), HAVING ACCUMULATED OVER A 12-MONTH PERIOD OUTSTANDING MEDICAL LIABILITIES OWING TO HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL AN AMOUNT EXCEEDING 30% OF THEIR HOUSEHOLD INCOME MAY QUALIFY FOR DISCOUNTS ON THEIR PERSONAL OBLIGATION. Part I, Line 7: THE ORGANIZATION'S COST TO CHARGE RATIO IS USED TO CALCULATE COMMUNITY BENEFITS (INCLUDING CHARITY CARE AND MEDICAID SHORTFALL) AT COST. THIS RATIO IS DERIVED FROM WORKSHEET 2. Part I, Ln 7 Col(f): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATION THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $63,348 PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST HISTORY AND IDENTIFIES HISTORICAL TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES FOR PURPOSES OF ESTIMATING AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. PART III, LINE 3: THE HOSPITAL DOES NOT COLLECT FROM PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. PATIENTS HAVING DIFFICULTY PAYING THE AMOUNTS FOR WHICH THEY ARE RESPONSIBLE ARE ENCOURAGED TO VISIT WITH FINANCIAL COUNSELORS. THE COUNSELORS ENCOURAGE PATIENTS TO SUBMIT PERSONAL FINANCIAL INFORMATION TO ASSESS THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, CERTAIN PATIENTS EITHER DO NOT QUALIFY FOR FINANCIAL ASSISTANCE OR ELECT NOT TO SUBMIT THE REQUISITE PERSONAL FINANCIAL INFORMATION NECESSSARY TO DETERMINE ELIGIBILITY. AS A RESULT, A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT ARE NOT GRANTED SUCH ASSISTANCE DUE TO FAILURE TO COMPLY WITH THE NECESSARY DATA REQUESTS. Part III, Line 4: THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT ISSUED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH SYSTEM.NET PATIENT SERVICE REVENUE, PATIENT CARE RECEIVABLES, AND ALLOWANCE FOR DOUBTFUL ACCOUNTS- NET PATIENTS SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS. NET PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS REPORTED ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. REIMBURSEMENT FROM MOST PAYORS FOR ACUTE INPATIENT AND OUTPATIENT SERVICES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. REIMBURSEMENTS FOR SERVICES TO CERTAIN PATIENTS INCLUDE PROSPECTIVELY DETERMINED PER DIEM RATES, FEE SCHEDULES, AND DISCOUNTS FROM ESTABLISHED CHARGES. MEDICARE, MEDICAID, AND BLUE CROSS HAVE COST-REIMBURSED ITEMS AND TENTATIVE RATES WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS AND A SUBSEQUENT AUDIT OR REVIEW PROCESS, AND REPRESENT THE MAJOR PAYORS INCLUDED IN PATIENT CARE RECEIVABLES AT DECEMBER 31, 2017 and 2016. REVENUES ASSOCIATED WITH HEALTH CARE SERVICES PROVIDED BY THE SYSTEM TO MEMBERS OF ITS HMO ARE INCLUDED IN HEALTH CARE PREMIUMS IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS.IN EVALUATIONG THE COLLECTABILTY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES IT'S HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTIONS OF THE BILL.), THE SYSTEM RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS EXPERIENCE. AT SUCH POINT IN TIME THAT A BILLED SERVICE IS BELIEVED TO BE UNCOLLECTIBLE, THE RELATED RECEIVABLE IS WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ESTIMATES OF RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS ARE ACCRUED IN THE PERIOD THAT RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE RECEIVED.THE SYSTEM ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE SYSTEM'S PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNT OFF STANDARD RATES FOR SERVICES PROVIDED THAT RESULT IN NET CHARGES THAT DO NOT EXCEED 115% OF MEDICARE PAYMENT RATES. THE ACCOUNTS RECEIVABLE FROM SELF-PAY PATIENTS REPRESENTED 12% OF TOTAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2017 AND 2016. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES. THE SYSTEM'S ALLOWANCES, WHICH ARE PRIMARILY RELATED TO SELF-PAY PATIENTS, WERE $95,521,000 AND $124,399,000 AT DECEMBER 31, 2017 AND 2016, RESPECTIVELY. THESE ALLOWANCES INCLUDE ESTIMATES RELATED TO BOTH PRESUMPTIVE ELIGIBILTY FOR CHARITY OF $15,993,000 AND $32,294,000 AN BAD DEBTS OF $79,528,000 AND $92,105,000 AT DECEMBER 31, 2017 AND 2016, RESPECTIVELY. IN 2017, THE SYSTEM ENHANCED ITS COLLECTION POLICIES INCREASING COLLECTIONS ON PREVIOUSLY RESERVED ACCOUNTS, WHICH RESULTED IN A DECREASE IN THE ALLOWANCE IN THE CURRENT YEAR. THE DECEMBER 31, 2017 ALLOWANCE REFLECTS THIS IMPROVED COLLECTION EXPERIENCE COMBINED WITH FAVORABLE PAYER MIX IN YEAR-END PATIENT CARE RECEIVABLES. Part III, Line 8: ALLOWABLE MEDICARE COSTS REPORTED ON SCHEDULE H, PART III, LINE 6 ARE DETERMINED VIA UTALIZATIONS OF THE ORGANIZATION'S CURRENT COST-TO-CHARGE RATIO. MANAGEMENT BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL REPORTED ON LINE 7 SHOULD BE DEEMED A COMMUNITY BENEFIT. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS SUBSIDIZING A GOVERNMENT PROGRAM BY VIRTUE OF SUSTAINING MATERIAL FINANCIAL LOSSED IN THE PROVISION OF HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES. Part III, Line 9b: HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL DOES NOT COLLECT FROM PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. PATIENTS HAVING DIFFICULTY PAYING THEIR PERSONAL RESPONSIBILITY ARE ENCOURAGED TO VISIT WITH FINANCIAL COUNSELORS. THE COUNSELORS REVIEW PATIENT'S PERSONAL FINANCIAL INFORMATION FOR PURPOSES OF DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. IN ADDITION, STATEMENTS SUBMITTED TO PATIENTS CONTAIN A TELEPHONE NUMBER FOR THEM TO CALL FOR POTENTIAL FINANCIAL ASSISTANCE. PART VI, LINE 2: A LOCAL HEALTH IMPROVEMENT ORGANIZATION (HIO) WAS INITIALLY ESTABLISHED BASED UPON THE PREMISE THAT LONG-TERM HEALTH IMPROVEMENT REQUIRES AN EXTENSION BEYOND ACUTE MEDICAL CARE IN ORDER TO AFFECT SOCIAL AND ENVIRONMENTAL DETERMINANTS OF HEALTH. SUBSEQUENT TO ITS FOUNDING IN 2000, THE HIO HAS EVOLVED TO BECOME A BEST PRACTICE MODEL FOR ORGANIZING POPULATION HEALTH IMPROVEMENT EFFORTS IN THE LOCAL REGION.THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL IS A COLLABORATIVE OF COMMUNITY STAKEHOLDERS, OF WHICH HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS A MEMBER. THE HIO IS COMMITTED TO IMPROVING THE HEALTH STATUS OF THE LOCAL COMMUNITY THROUGH AN INTEGREATED HEALTH IMPROVEMENT INFRASTRUCTURE THAT ADDRESSES LOCAL PRIORITY HEALTH NEEDS. IT IS RESPONSIBLE FOR PERFORMING SHARED NEEDS ASSESSMENTS, IDENTIFYING HIGH PRIORITY HEALTH ISSUES, DEVELOPING AND COORDINATING THE IMPLEMENTATION OF COLLABORATIVE ACTION PLANS AND MONITORING PROGRESS OVER TIME.IN 2016, THE HIO COMPILED AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IS ACCESSIBLE VIA THE RESPECTIVE HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL AND HIO WEBSITES. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL HAS COLLABORATED WITH THE HIO TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT WAS CONDUCTED VIA A STATISTICALLY VALID TELEPHONE SURVEY OF OVER 1,200 JACKSON COUNTY RESIDENTS AND VARIOUS FOCUS DISCUSSION GROUPS FOR PURPOSE OF GAINING INSIGHT REGARDING LOCAL HEALTH STATUS, ATTITUDES, BELIEFS, BEHAVIORS AND OPPORTUNITIES.THE HIO COORDINATING COUNCIL INCLUDED REPRESENTATION FROM LOCAL GOVERMENT, PUBLIC HEALTH, HEALTHCARE ORGANIZATIONS, SCHOOL DISTRICTS, MENTAL HEALTH, LOCAL EMPLOYERS AND OTHER HUMAN SERVICE SECTORS. THE NEEDS ASSESSMENT PROVIDES A POWERFUL TOOL TO MEASURE HEALTH INDICATORS WITHIN GEOGRAPHIC AND DEMOGRAPHIC SUBPOPULATIONS; MEASURE HEALTH STATUS AGAINST OTHER COMMUNITIES, STATES AND THE NATION; PRIORITIZING HEALTH ISSUES WITHIN THE COMMUNITY; CREATING A SYSTEM FOR SHARING THIS DATA WITH COMMUNITY ORGANIZATIONS AND RESIDENTS; AND MONITORING CHANGES OVER TIME. BASED UPON RECENT DATA, THE HIO CONTINUES TO PRIORITIZE OBESITY, SMOKING AND SUBSTANCE ABUSE AS TARGETS FOR IMPROVMENT. ACTION TEAMS ORGANIZED AROUND GOALS IN EACH OF THESE AREAS PURSUE EVIDENCE-BASED COMMUNITY STRATEGIES SUCH AS ADDRESSING NUTRITION/WEIGHT ISSUES, ANTI-TOBACCO POLICIES, AND SCREENING, INTERVENTION AND TREATMENT REFERRAL TOOLS.THE HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL COMMUNITY ACTION PLAN WAS FORMALLY APPROVED BY THE BOARD OF TRUSTEES. PART VI, LINE 3: PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ARE NOTIFIED OF POTENTIAL ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER FEDERAL AND STATE PROGRAMS AS WELL AS UNDER THE COMPANY'S CHARITY CARE POLICY. PATIENTS ARE INFORMED VIA DIRECT COMMUNICATION FROM THE PATIENT ACCOUNT COORDINATOR, CASE MANAGERS, OR VARIOUS OTHER HOSPITAL PERSONNEL. WHEN BILLED FOR MEDICAL CARE, PATIENTS ARE ENCOURAGED TO CONTACT THE BUSINESS OFFICE FOR ASSISTANCE. ADDITIONALLY, A SERIES OF LETTERS ARE MAILED TO PATIENTS TO APPRISE THEM OF VARIOUS PAYMENT AND ASSISTANCE OPTIONS. WHEN APPROPRIATE, PATIENTS RECEIVE AN APPLICATION FOR CHARITY CARE THAT IS TO BE SUBMITTED FOR REVIEW AND ELIGIBILTY DETERMINATION BY THE FINANCE DEPARTMENT. FINALLY, THE HENRY FORD ALLEGIANCE SPECIALITY HOSPITAL WEBSITE CONTAINS ADDITIONAL INFORMATION PERTAINING TO FINANCIAL ASSISTANCE POLICIES AND APPLICABLE APPLICATION FORMS. PART VI, LINE 4: THE PRIMARY COMMUNITY SERVED BY HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS DETERMINED GEOGRAPHICALLY BY THE BOUNDARIES OF JACKSON COUNTY, MI. AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, THE HOSPITAL SERVES THE HEALTH NEEDS OF MORE THAN 160,000 RESIDENTS OF JACKSON COUNTY, MI. THE GENDER DISTRIBUTION OF JACKSON COUNTY RESIDENTS IS 51% MALE AND 49% FEMALE. THE AGE DISTRIBUTION OF JACKSON COUNTY RESIDENTS IS 26% AGE 19 YEARS OF AGE AND UNDER, 18% BETWEEN 20 AND 34 YEARS, 29% BETWEEN 35 AND 54 YEARS, 13% BETWEEN 55 AND 64 YEARS; AND 14% OF RESIDENTS ARE AGE 65 AND OLDER. ACCORDING TO 2011 CENSUS DATA, THE RACIAL DISTRIBUTION OF JACKSON COUNTY RESIDENTS IS 88.0% AS CAUCASIAN, 7.9% AS AFRICAN AMERICAN, 0.7% AS ASIAN, 0.4% AS AMERICAN INDIAN OR ALASKA NATIVE, AND 3.0% AS ANOTHER RACE OR TWO OR MORE PLACES. OF MALES AGE 15 YEARS AND OLDER, 33.0% HAVE NEVER MARRIED, 50.3% ARE MARRIED, 1.5% ARE SEPARATED, 2.9% ARE WIDOWED, AND 12.3% ARE DIVORCED. OF FEMALES AGE 15 AND OVER, 25.0% HAVE NEVER MARRIED, 50.3% ARE MARRIED, 1.7% ARE SEPARATED, 9.8% ARE WIDOWED, AND 13.2% ARE DIVORCED. ACCORDING TO THE BUREAU OF LABOR STATISTICS (2013), JACKSON COUNTY ALSO EXPERIANCES A HIGH UNEMPLOYMENT RATE OF 8.8%. WITH 69,400 INDIVIDUALS IN THE CIVILIAN LABOR FORCE, 6,100 RESIDENTS ARE CURRENTLY UNEMPLOYED. OF THOSE EMPLOYED, MAJOR INDUSTRIES REPRESENTED INCLUDE EDUCATIONAL SERVICES, HEALTHCARE, AND SOCIAL ASSISTANCE (23.9%); MANUFACTURING (18.7%); RETAIL TRADE (12.1%); PROFESSIONAL, SCIENTIFIC, MANAGEMENT, ADMINSTRATIVE, AND WASTE MANAGEMENT SERVICES (7.7%); AND ARTS, ENTERTAINMENT, RECREATION, ACCOMMODATION AND FOOD SERVICES (7.5%). APPROXIMATELY 74.6% OF HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL PATIENTS WERE COVERED BY MEDICARE, WHILE 12.6% WERE INSURED BY MEDICAID. PART VI, LINE 5: HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING AND SAFEGUARDING THE HEALTH OF THE COMMUNITY IN WHICH IT IS LOCATED. A MAJORITY OF THE ORGANIZATION'S BOARD OF TRUSTEES (I.E. FOUR OF SEVEN VOTING MEMBERS) ARE APPOINTED FOR PURPOSES OF REPRESENTING THE HEALTHCARE NEEDS AND INTERESTS OF THE LOCAL COMMUNITY. NONE OF SAID COMMUNITY BOARD MEMBERS ARE: A) EMPLOYED BY THE ORGANIZATION OR ANY RELATED ENTITY; B) AN INDEPENDENT CONTRACTOR OF THE ORGANIZATION OR ANY RELATED ENTITY; OR C) A FAMILY MEMBER OF ANY ORGANIZATIONAL EMPLOYEE. ALL COMMUNITY BOARD MEMBERS ARE APPOINTED SOLELY FOR PURPOSES OF REPRESENTING THE HEALTHCARE NEEDS OF CITIZENS RESIDING WITHIN THE ORGANIZATION'S PRIMARY SERVICE AREA. FURTHER, THE ORGANIZATION MAINTAINS AN OPEN MEDICAL STAFF WHEREBY ALL LOCAL PHYSICIANS AND OTHER MEDICAL PROVIDERS ARE WELCOME TO APPLY FOR PRIVILEGES. FINALLY, THE ORGANIZATION'S FINANCIAL SURPLUS IS CONTINUALLY REINVESTED IN EQUIPMENT, STAFFING AND OTHER RESOURCES REQUIRED TO FURTHER THE HEALTH AND WELLBEING OF THE LOCAL COMMUNITY. PART VI, LINE 6: THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HENRY FORD ALLEGIANCE HEALTH GROUP, A 501(C)(3) ORGANIZATION. OTHER RELATED AFFILIATES INCLUDE A HOSPITAL WITH A 24-HOUR EMERGENCY ROOM, HOSPICE, HOME HEALTH CARE COMPANY, FOUNDATION AND A VOLUNTEER ORGANIZATION (ALL 501(C)(3) ORGANIZATIONS). IN ADDITION, THE AFFILIATED HOSPITAL MAINTAINS A CLINICALLY INTEGRATED NETWORK. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL AND THE AFFILIATED HOSPITAL, HOSPICE AND HOME HEALTH CARE ORGANIZATIONS COLLABORATE CLOSELY FOR PURPOSES OF PROVIDING MEDICALLY NECESSARY SERVICES TO THE JACKSON, MI COMMUNITY. THE AFFILIATED FOUNDATION AND VOLUNTEER ORGANIZATIONS WORK CLOSELY WITH HENRY FORD ALLEGIANCE HEALTH GROUP (PARENT ENTITY) AND THE AFFILIATED HOSPITAL TO RAISE FUNDS FOR THE PROJECTS AND SERVICES THAT BENEFIT THE OVERALL WELL-BEING OF THE COMMUNITY. PREVIOUSLY, CAMPAIGNS CONDUCTED BY THE AFFILIATED ENTITIES SUCCESSFULLY RAISED FUNDS TO EXPAND AND IMPROVE A GRADUATE MEDICAL EDUCATION PROGRAM, CANCER CARE SERVICE LINE AND TO PROVIDE FREE MEDICAL CARE TO THE INDIGENT PATIENTS. THE CLINICALLY INTEGRATED NETWORK SEEKS TO IMPROVE PATIENT CLINICAL OUTCOMES THROUGH ENCOURAGING COORDINATED CARE AND LOWERING OVERALL HEALTHCARE COSTS. PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: MI 0 1 0 0 0 0 0 0 0 Ondrea Bates President 0 282850 0 90000 0 31762 0 34742 0 30820 0 470174 0 0 Wendy Boersma Trustee 0 180090 0 22000 0 17035 0 22387 0 3799 0 245311 0 0 Part I, Line 3 HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL DOES NOT PAY COMPENSATION TO ITS CEO. RATHER, THE ORGANIZATION CONTRACTS WITH GREENTREE HEALTHCARE PARTNERS, LLC, AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY, FOR THE SERVICES OF THE CEO. THE FORM 990 FOR HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS FOR THE TWELVE MONTHS ENDED FEBRUARY 28, 2018. HOWEVER, THE COMPENSATION REPORTED ON BOTH FORM 990. PART VII AND SCHEDULE J REFLECTS THE FULL YEAR 2017 W-2'S FOR EACH CURRENT AND FORMER OFFICER, TRUSTEE, KEY EMPLOYEE AND THE (5) HIGHEST COMPENSATED EMPLOYEES. ON THE STATEMENT OF FUNCTIONAL EXPENSE IN PART IX, THE COMPENSATION REPORTED ON LINES 5 AND 7 REPRESENTS THE COMPENSATION PAID TO THESE INDIVIDUALS FOR THE FISCAL YEAR ENDED FEBRUARY 28, 2018. Part I, Line 4b THE FOLLOWING HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL TRUSTEES PARTICIPATED IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN THROUGH THEIR EMPLOYMENT AS OFFICERS OF HENRY FORD ALLEGIANCE HEALTH,A RELATED TAX-EXEMPT ORGANIZATION. THE CALENDAR YEAR 2017 CONTRIBUTION AND DISTRIBUTION AMOUNTS ARE AS FOLLOWS: Sec 457(f)-Non-Qualified Deferred Compensation Retirement Plan - W.A. Foote Memorial Hospital Participant Accrual Distribution Non-Vested Reportable W-2 Ondrea Bates 15,625 - - - Wendy Boersma 9,833 - - - Sec 457(f) - Supplemental Executive Retirement Plan (SERP) - W.A. Foote Memorial Hospital Participant Accrual Distribution Non-Vested Reportable W-2 Ondrea Bates - 7,942 - 7,942 Form 990, Part VI, Section A, line 3 OFFICERS OF THE ORGANIZATION ARE EMPLOYED BY AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY. SEE PART VII, SECTION B, INDEPENDENT CONTRACTORS. THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS OR KEY EMPLOYEES TO GREENTREE HEALTHCARE PARTNERS, LLC, AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY. GREENTREE HEALTHCARE PARTNERS, LLC ASSIGNED SPECIFIC EMPLOYEES TO SERVE IN THE CAPACITY OF CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND CHIEF OPERATING OFFICER OF THE ORGANIZATION. THE FOLLOWING OFFICERS, REPORTED ON FORM 990, PART VII, SECTION A, WERE EMPLOYED BY GREENTREE HEALTHCARE PARTNERS, LLC AND RECEIVED THE ACCOMPANYING COMPENSATION FROM THE MANAGEMENT COMPANY DURING THE CALENDAR YEAR ENDING WITHIN THE ORGANIZATION'S FISCAL YEAR. 1.) J. MARK FALL, CHIEF EXECUTIVE OFFICER: A. REGULAR COMPENSATION- $260,532 B. TRAVEL REIMBURSEMENT- $49,726 2.) DALE L. FRIESEN, CHIEF FINANCIAL OFFICER: A. REGULAR COMPENSATION- $133,000 B. TRAVEL REIMBURSEMENT- $16,943 Form 990, Part VI, Section A, line 6 THE CORPORATION IS ORGANIZED ON A MEMBERSHIP BASIS. THE SOLE CORPORATE MEMBER OF THE CORPORATION IS HENRY FORD ALLEGIANCE HEALTH GROUP, A MICHIGAN NONPROFIT CORPORATION. THE MEMBER'S SOLE MEMBER IS HENRY FORD HEALTH SYSTEM. Form 990, Part VI, Section A, line 7a THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HENRY FORD ALLEGIANCE HEALTH GROUP (MEMBER). IN TURN, THE MEMBER'S SOLE CORPORATE MEMBER IS HENRY FORD HEALTH SYSTEM (HFHS). HFHS HAS THE POWER TO APPROVE CHANGES IN THOSE PROVISIONS OF THE CORPORATION'S BYLAWS WHICH AFFECT THE SIZE, COMPOSITION AND METHOD OF SELECTION OF THE BOARD OF DIRECTORS. THE SOLE MEMBER HAS THE POWER TO ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE CORPORATION'S DIRECTORS. Form 990, Part VI, Section A, line 7b THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HENRY FORD ALLEGIANCE HEALTH GROUP (MEMBER). IN TURN, THE MEMBER'S SOLE CORPORATE MEMBER IS HENRY FORD HEALTH SYSTEM (HFHS). THE RESERVED POWERS OF HENRY FORD HEALTH SYSTEM (HFHS) INCLUDE THE FOLLOWING: -APPOINT THE BOARD OF TRUSTEES, CHAIRPERSON, AND PRESIDENT OF THE CORPORATION AND ITS SUBSIDIARIES; -REMOVE THE BOARD OF TRUSTEES, CHAIRPERSON AND PRESIDENT OF THE CORPORATION AND IT'S SUBSIDIARIES; -CHANGE THE CORPORATE MEMBER OF THE CORPORATION OR ITS SUBSIDIARIES, PROVIDED SUCH ACTION SHALL HAVE BEEN APPROVED BY A VOTE OF THE MEMBER'S BOARD OF DIRECTORS; -AMEND THESE BYLAWS, THE CORPORATION'S SUBSIDIARIES, PROVIDED HFHS FIRST CONSULTS WITH THE MEMBER'S BOARD OF DIRECTORS REGARDING THE PROPOSED AMENDMENT; -APPROVE AN AGREEMENT OF (A) MERGER OR CONSOLIDATION OF THE CORPORATION OR ITS SUBSIDIARIES, OR (B) SALE, LEASE, OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR ITS SUBSIDIARIES, PROVIDED SUCH AGREEMENT SHALL HAVE BEEN APPROVED BY VOTE OF TWO-THIRDS OF THE MEMBER'S LOCAL DIRECTORS (AS DEFINED IN THE MEMBER'S BYLAWS) AND FURTHER PROVIDED THAT APPROVAL OF THE LOCAL DIRECTORS SHALL NOT BE REQUIRED WITH RESPECT TO CERTAIN TRANSACTIONS WITH RESPECT TO HFHS'S OVERALL HEALTH SYSTEM (INCLUDING THE SYSTEM) AS DESCRIBED IN SECTION 6.8 OF THE AFFILIATION AGREEMENT DATED MARCH 4, 2016 BETWEEN THE MEMBER (THEN KNOWN AS ALLEGIANCE HEALTH SERVICES) AND HFHS, AS AMENDED FROM TIME TO TIME; -DISSOLVE THE CORPORATION OR ITS SUBSIDIARIES OR REVOKE SUCH DISSOLUTION, PROVIDED SUCH ACTION SHALL HAVE BEEN APPROVED BY A VOTE OF THE MEMBER'S BOARD OF DIRECTORS; -CAUSE THE CORPORATION AND ITS SUBSIDIARIES TO INCUR, ASSUME OR GUARANTY INDEBTNESS OR FULFILL OTHER OBLIGATIONS REQUIRED UNDER HFHS DEBT AGREEMENTS; -ENCUMBER THE ASSETS OF THE CORPORATION AND ITS SUBSIDIARIES AS SECURITY FOR DEBTS OR OTHER LAWFUL ENGAGEMENTS SECURING INDEBTEDNESS; -AUTHORIZE THE FORMATION OR ACQUISTION OF NEW SUBSIDIARIES OF THE CORPORATION FOLLOWING CONSULTATION WITH THE MEMBER'S BOARD OF DIRECTORS. AS USED HEREIN, "INDEBTEDNESS" OF A PERSON SHALL MEAN: (A) OBLIGATIONS OF SUCH PERSON RELATING TO INDEBTEDNESS FOR BORROWED MONEY; (B) OBLIGATIONS OF SUCH PERSON EVIDENCED BY BONDS, NOTES, DEBENTURES OR SIMILAR INSTRUMENTS; AND (C) OBLIGATIONS IN THE NATURE OF GUARANTEES BY, OR JOINT AND SEVERAL LIABILITY OF, SUCH PERSON WITH RESPECT TO THE OBLIGATIONS OF ANY OTHER PERSON OF THE TYPE DESCRIBED IN CLAUSES (A) AND (B) ABOVE. THE CORPORATION SHALL CAUSE THE RESERVED POWERS LISTED TO BE INCLUDED IN THE ARTICLES OF INCORPORATION, BYLAWS, OR OTHER COMPARABLE GOVERNING DOCUMENTS, OF EACH SYSTEM ENTITY OF WHICH THE CORPORATION IS DIRECTLY OR INDIRECTLY THE SOLE OWNER OR MEMBER, PROVIDED HFHS'S AUTHORITY WITH RESPECT TO THE CORPORATION AND SAID SYSTEM ENTITIES SHALL BE DELEGATED AS DESCRIBED IN THE AUTHORITY MATRIX ATTACHED TO THESE BYLAWS AS EXHIBIT 1 AND HFHS SHALL CONSULT WITH THE BOARD OF THE MEMBER BEFORE MODIFYING THE AUTHORITY MATRIX. Form 990, Part VI, Section B, line 11b THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM (HFHS) AND THE TAX DEPARTMENT OF HFHS 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 HFHS SENIOR VICE PRESIDENT OF FINANCIAL OPERATIONS AND THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. -REVIEW OF ALL COMPENSATION MATTERS AND DISCLOSURES WITH THE COMPENSATION COMMITTEE OF THE HFHS BOARD OF DIRECTORS. -PROVIDE A COPY OF THE RETURN TO THE ORGANIZATION'S BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 12c THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT ISSUED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH SYSTEM. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL HAS ADOPTED THE CONFLICT OF INTEREST POLICY MAINTAINED BY ITS SOLE CORPORATE MEMBER. THE PARAGRAPH BELOW DETAILS HOW THE POLICY REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE MEMBER'S BOARD OF TRUSTEE'S COMPLIANCE COMMITTEE HAS ULTIMATE RESPONSIBILITY OVER THE ENFORCEMENT OF THE HOSPITAL'S CONFLICT OF INTEREST POLICY. WHEN A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THE COMPLIANCE COMMITTEE IS RESPONSIBLE FOR REVIEWING THE POTENTIAL CONFLICT TO ENSURE COMPLIANCE WITH THE POLICY. ALSO, GENERAL COUNSEL ROUTINELY REVIEWS UPCOMING BOARD AND COMMITTEE MEETING AGENDAS TO ASSESS POTENTIAL CONFLICT SITUATIONS. ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. TRUSTEES, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE AND SUBMIT AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. BOARD TRUSTEES IDENTIFIED AS HAVING A CONFLICT OF INTEREST ARE PERMITTED TO DISCUSS THE POTENTIAL TRANSACTION. THEY ARE NOT, HOWEVER, ALLOWED TO DELIBERATE IN ANY DECISIONS OR VOTES RELATIVE TO THE MATTER IN QUESTION. Form 990, Part VI, Section B, line 15 HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS MANAGED BY AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY. THE MANAGEMENT CONTRACT IS REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF TRUSTEES. EMPLOYEES OF THE OUTSIDE MANAGEMENT COMPANY DO NOT HAVE A VOTE IN APPROVING THE CONTRACT. THE FORM 990 FOR HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS FOR THE TWELVE MONTHS ENDED FEBRUARY 28, 2018. HOWEVER, THE COMPENSATION REPORTED ON BOTH FORM 990, PART VII AND SCHEDULE J REFLECTS THE FULL YEAR 2017 W-2'S FOR EACH CURRENT AND FORMER OFFICER, TRUSTEE, KEY EMPLOYEE AND THE (5) HIGHEST COMPENSATED EMPLOYEES. ON THE STATEMENT OF FUNCTIONAL EXPENSE IN PART IX, THE COMPENSATION REPORTED ON LINES 5 AND 7 REPRESENTS THE COMPENSATION PAID TO THESE INDIVIDUALS FOR THE FISCAL YEAR ENDED FEBRUARY 28, 2018. Form 990, Part VI, Section C, line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND ALSO VIA THE STATE OF MICHIGAN WEBSITE. FORM 990 IS AVAILABLE UPON REQUEST. THE FORM 990 IS ALSO AVAILABLE ON THE FREE WEBSITE WWW.GUIDESTAR.ORG. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC. Form 990, Part IX, line 11g PURCHASED SERIVCES: Program service expenses 1,900,756. Management and general expenses 868,013. Fundraising expenses 0. Total expenses 2,768,769. PROVIDER SERVICES: Program service expenses 1,050,085. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,050,085. MEDICAL DIRECTOR FEES: Program service expenses 34,170. Management and general expenses 0. Fundraising expenses 0. Total expenses 34,170. FORM 990, PART XII, LINE 2C HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF HENRY FORD HEALTH SYSTEM (THE SOLE MEMBER OF HENRY FORD ALLEGIANCE HEALTH GROUP). THE GOVERNING BODY OF HENRY FORD HEALTH SYSTEM HAS DELEGATED THE OVERSIGHT OF ITS FINANCIAL STATEMENTS, INCLUDING THE CHOICE OF INDEPENDENT AUDITORS, TO THE AUDIT COMMITTEE OF HENRY FORD HEALTH SYSTEM. FORM 5713 - INTERNATIONAL BOYCOTT REPORT: A FORM 5713, INTERNATIONAL BOYCOTT REPORT,HAS BEEN FILED ON OUR BEHALF BY HENRY FORD HEALTH SYSTEM (PARENT OF OUR CONTROLLED GROUP). THE ORGANIZATION DID NOT ITSELF HAVE ANY ACTIVITIES ASSOCIATED WITH AN INTERNATIONAL BOYCOTT COUNTRY. WA FOOTE MEMORIAL HOSPITAL DBA HENRY FORD ALLEGIANCE HEALTH 205 N EAST AVENUE JACKSON MI 49201 382027689 HEALTHCARE SERVICE PROVIDER MI 501(c)(3) Line 3 HENRY FORD ALLEGIANCE HEALTH GROUP 1 HENRY FORD ALLEGIANCE HEALTH GROUP 205 N EAST AVENUE JACKSON MI 49201 382756428 HEALTHCARE SERVICE PROVIDER 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 CARE MI 501(c)(3) Line 7 HEALTHLINK 1 THE HOSPICE OF JACKSON ENDOWMENT FUND ONE JACKSON SQUARE JACKSON MI 49201 383422146 SUPPORTING ORGANIZATION MI 501(c)(3) Line 12b, II ALLEGIANCE HOSPICE 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 VOLUNTEERS OF HENRY FORD ALLEGIANCE HEALTH 205 N EAST AVENUE JACKSON MI 49201 386082835 SUPPORTING ORGANIZATION MI 501(c)(3) Line 7 HENRY FORD ALLEGIANCE HEALTH GROUP 1 HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT MI 48202 381357020 HEALTHCARE SERVICE PROVIDER MI 501(c)(3) Line 3 0 HENRY FORD MACOMB HOSPITAL ONE FORD PLACE DETROIT MI 48202 382947657 HEALTHCARE SERVICE PROVIDER MI 501(c)(3) Line 3 HENRY FORD HEALTH SYSTEM 1 HENRY FORD WYANDOTTE ONE FORD PLACE DETROIT MI 48202 382791823 HEALTHCARE SERVICE PROVIDER MI 501(c)(3) Line 3 HENRY FORD HEALTH SYSTEM 1 HENRY FORD HEALTH SYSTEM FOUNDATION ONE FORD PLACE DETROIT MI 48202 237383042 SUPPORTING ORGANIZATION MI 501(c)(3) Line 12a, I HENRY FORD HEALTH SYSTEM 1 HEALTH ALLIANCE PLAN 2850 W GRAND BLVD DETROIT MI 48202 382242827 HEALTH MAINTENANCE ORGANIZATION MI 501(c)(4) HENRY FORD HEALTH SYSTEM 1 HFHS SELF FUNDED LIABILITY ONE FORD PLACE DETROIT MI 48202 386553031 MALPRACTICE INSURANCE MI 501(c)(4) HENRY FORD HEALTH SYSTEM 1 HENRY FORD CONTINUING CARE ONE FORD PLACE DETROIT MI 48202 382433285 NURSING HOME MI 501(c)(3) Line 10 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 THE HFHS AND AFFILIATES MI 501(c)(4) 1 FOOTE HEALTH CENTER ASSOCIATES 1100 E MICHIGAN AVENUE JACKSON MI 49201 383017711 LESSOR OF MEDICAL CONDOMINIUMS MI 0 0 NORTHWEST DETROIT DIALYSIS 30100 TELEGRAPH BINGHAM FARMS MI 48025 383232668 OPERATES DIALYSIS CLINIC MI 0 0 MACOMB REGIONAL DIALYSIS 16151 NINETEEN MILE CLINTON TOWNSHIP MI 48038 260423581 OPERATES DIALYSIS CLINIC MI 0 0 VIKING HEALTH SYSTEM 205 N EAST AVENUE JACKSON MI 49201 382756161 IDLE HEALTHCARE ADMINISTRATION CORPORATION MI C 0 CASCADES INSURANCE COMPANY LTD 205 N EAST AVENUE JACKSON MI 49201 981132982 HOSPITAL MALPRACTICE INSURANCE CAPTIVE CJ C 0 SHA REALTYINC ONE FORD PLACE DETROIT MI 48202 381378121 REAL ESTATE HOLDING MI C 0 FAIRLANE HEALTH SERVICES 30100 TELEGRAPH BINGHAM FARMS MI 48025 382565235 HEALTHCARE MANAGEMENT MI C 0 ALLIANCE HEALTH AND LIFE INSURANCE 2850 W GRAND BLVD DETROIT MI 48202 383291563 HEALTH INSURANCE PROVIDER MI C 0 HAP PREFERREDINC 2850 W GRAND BLVD DETROIT MI 48202 382513504 PROVIDER NTEWORK LEASING MI C 0 HAP MIDWEST HEALTH PLANINC 2850 W GRAND BLVD DETROIT MI 48202 383123777 HEALTH INSURANCE PROVIDER MI C 0 HAP COMMUNITY ALLIANCE 2850 W GRAND BLVD DETROIT MI 48202 320306774 MANAGEMENT COMPANY MI C 0 ADMINISTRATION SYSTEMS RESEARCH CORPORATION 2850 W GRAND BLVD DETROIT MI 48202 382651185 THIRD-PARTY INSURANCE ADMINISTRATION MI C 0 ONIKA INSURANCE LTD FIRST CARRIBEAN HOUSE GRAND CAYMAN CJ CAPTIVE INSURANCE CJ C 0 HENRY FORD PHYSICIAN NETWORK ONE FORD PLACE DETROIT MI 48202 380306774 PHYSICIAN NETWORK MI C 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 HENRY FORD ALLEGIANCE HEALTH L 37736 COST HENRY FORD ALLEGIANCE HEALTH M 825611 AGREEMENT