CARELINK OF JACKSON: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CARELINK OF JACKSON (EIN 38-1218485)
- Tax period
- 2016-03-01 to 2017-02-28
- Filed
- 2018-01-15
- IRS object ID
- 201840169349300104
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-01-15T16:30:45-06:00 | ReturnTs |
| Tax Period End | 2017-02-28 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 Trade Centre Way Ste 300 | AddressLine1Txt |
| City | Portage | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-03-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381218485 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARELINK OF JACKSON | BusinessNameLine1Txt |
| Business Name Line2 | A COMMUNITY-OWNED SPECIALTY HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARE | BusinessNameControlTxt |
| Phone | 5177871440 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH ELM AVENUE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49202 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DALE L FRIESEN | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 5177964475 | PhoneNum |
| Signature | 2018-01-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carol LaLonde CPA | PreparerPersonNm |
| PTIN | P00181637 | PTIN |
| Phone | 2695674500 | PhoneNum |
| Preparation | 2018-01-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.59.56.32 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-01-15 | IPDt |
| IP Tm | 10:12:21 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | EBB51160BF2136090E0706D858221EDFD566B897 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | J MARK FALL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH ELM AVENUE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,332,724 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.carelinkofjackson.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE LONG-TERM ACUTE HEALTHCARE TO THE RESIDENTS OF JACKSON, MI AND SURROUNDING AREAS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 167 | TotalEmployeeCnt |
| Total Volunteers | 3 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $92 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,004 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,593,567 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,222,577 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$89 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,554 | CYInvestmentIncomeAmt |
| PY Other Revenue | $42,676 | PYOtherRevenueAmt |
| CY Other Revenue | $101,589 | CYOtherRevenueAmt |
| PY Total Revenue | $15,636,246 | PYTotalRevenueAmt |
| CY Total Revenue | $14,332,724 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,944,664 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,012,326 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,604,059 | PYOtherExpensesAmt |
| CY Other Expenses | $8,802,276 | CYOtherExpensesAmt |
| PY Total Expenses | $15,548,723 | PYTotalExpensesAmt |
| CY Total Expenses | $15,814,602 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $87,523 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,481,878 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,741,677 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,474,568 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,584,441 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,410,260 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,157,236 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,064,308 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS COMMITTED TO HOLISTIC CARE OF INDIVIDUALS WITH COMPLEX MEDICAL NEEDS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,395,565 | ExpenseAmt |
| Revenue | $14,321,701 | RevenueAmt |
| Desc | 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 02/28/2017, HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL MAINTAINED AN AVERAGE DAILY CENSUS OF 29 PATIENTS AND PROVIDED 10,567 DAYS OF PATIENT CARE. DUE TO THE COMPLEX MEDICAL NEEDS OF PATIENTS SERVED BY THE HOSPITAL, THE AVERAGE PATIENT RESIDED AT THE FACILITY FOR 21.8 DAYS. PATIENTS WHO SATISFIED MINIMUM MEDICARE ADMISSION CRITERIA MAINTAINED AN AVERAGE LENGTH OF STAY OF 25.3 DAYS. APPROXIMATELY 78.0% OF ALL DISCHARGED PATIENTS WERE MEDICARE ELIGIBLE. | Desc |
| Total Program Service Expenses | $13,395,565 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 167 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DALE L FRIESEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5177964475 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH ELM AVENUE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49202 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| ONDREA BATES | |||||||
| PRESIDENT | 3.00 | 57.00 | Yes (X) | Yes (X) | $0 | $329,776 | $61,880 |
| BRENT ELLIS | |||||||
| CHAIRPERSON | 5.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARYANNE FUCHS | |||||||
| VICE CHAIRPERSON | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DAVID SCHMIDT | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BRUCE A INOSENCIO JR | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| GREGG PATTEN MD | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| WENDY BOERSMA | |||||||
| TRUSTEE | 1.00 | 59.00 | Yes (X) | $0 | $192,645 | $17,273 | |
| J MARK FALL | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DALE L FRIESEN | |||||||
| CHIEF FINANCIAL OFFICER | 50.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $522,421 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $79,153 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INDEPENDENT HOSPITALIST PHYSICIANS PLLC | |||||
| PO BOX 100 | ROYAL OAK | MI | 48068 | PHYSICIAN SERVICES | $1,246,581 |
| GREENTREE HEALTHCARE PARTNERS LLC | |||||
| 110 JOHNSTON FARM LANE | WOODSTOCK | GA | 30188 | MANAGEMENT SERVICES | $782,905 |
| FRESENIUS MANAGEMENT SERVICES INC | |||||
| 16343 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | HEALTHCARE SERVICES | $166,677 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $4,004 | AllOtherContributionsAmt |
| Total Contributions | $4,004 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621990 | $14,207,071 | $14,207,071 |
| PATIENT CARE | 621990 | $11,172 | $11,172 |
| INPATIENT REHABILITATION | 621990 | $4,334 | $4,334 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,222,577 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,990 | TotalRevenueColumnAmt |
| Exclusion | $2,990 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,564 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,564 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,564 | TotalRevenueColumnAmt |
| Exclusion | $1,564 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| ENVIRONMENTAL PROJECT REIMBURSEME | 900099 | $56,058 | $56,058 |
| DIETARY CAFETERIA | 722210 | $41,364 | $41,364 |
| MEDICAL RECORDS FEES | 900099 | $1,702 | $1,702 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,465 | TotalRevenueColumnAmt |
| Exclusion | $2,465 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $101,589 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,332,724 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,321,701 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,019 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,762,405 | TotalAmt |
| Program Services | $5,231,222 | ProgramServicesAmt |
| Management And General | $531,183 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,974 | TotalAmt |
| Program Services | $88,943 | ProgramServicesAmt |
| Management And General | $9,031 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $728,138 | TotalAmt |
| Program Services | $661,018 | ProgramServicesAmt |
| Management And General | $67,120 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $423,809 | TotalAmt |
| Program Services | $384,742 | ProgramServicesAmt |
| Management And General | $39,067 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $743,238 | TotalAmt |
| Management And General | $743,238 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,027 | TotalAmt |
| Management And General | $2,027 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,800 | TotalAmt |
| Management And General | $53,800 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,993 | TotalAmt |
| Management And General | $3,993 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,176,996 | TotalAmt |
| Program Services | $3,288,294 | ProgramServicesAmt |
| Management And General | $888,702 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $497 | TotalAmt |
| Management And General | $497 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,023,773 | TotalAmt |
| Program Services | $1,000,116 | ProgramServicesAmt |
| Management And General | $23,657 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,805 | TotalAmt |
| Program Services | $27,805 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,027 | TotalAmt |
| Program Services | $237,027 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,951 | TotalAmt |
| Management And General | $52,951 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $379,540 | TotalAmt |
| Program Services | $379,540 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,711 | TotalAmt |
| Program Services | $33,940 | ProgramServicesAmt |
| Management And General | $3,771 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PHARMACEUTICALS | $1,219,658 | $1,219,658 |
| MEDICAL SUPPLIES | $490,770 | $490,770 |
| bad debt | $195,605 | $195,605 |
| FOOD | $156,885 | $156,885 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,814,602 | TotalAmt |
| Program Services | $13,395,565 | ProgramServicesAmt |
| Management And General | $2,419,037 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,020 | BOYAmt |
| EOY | $299,890 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,512,920 | BOYAmt |
| EOY | $1,140,428 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,755,166 | BOYAmt |
| EOY | $2,176,441 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,911 | BOYAmt |
| EOY | $82,732 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,128,619 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $353,542 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,092,640 | BOYAmt |
| EOY | $4,775,077 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,020 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,741,677 | BOYAmt |
| EOY | $8,474,568 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $377,454 | BOYAmt |
| EOY | $419,798 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,206,987 | BOYAmt |
| EOY | $2,990,462 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,584,441 | BOYAmt |
| EOY | $3,410,260 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,157,236 | BOYAmt |
| EOY | $5,064,308 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,157,236 | BOYAmt |
| EOY | $5,064,308 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,741,677 | BOYAmt |
| EOY | $8,474,568 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,481,878 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $2,388,950 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,993 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,993 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $150,000 | OtherCostOrOtherBasisAmt |
| Book Value | $150,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,730,193 | OtherCostOrOtherBasisAmt |
| Depreciation | $184,547 | DepreciationAmt |
| Book Value | $3,545,646 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,182,972 | OtherCostOrOtherBasisAmt |
| Depreciation | $168,995 | DepreciationAmt |
| Book Value | $1,013,977 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $65,454 | OtherCostOrOtherBasisAmt |
| Book Value | $65,454 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,775,077 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| COST REPORT SETTLEMENTS PAYABLE | $108,759 |
| ACCRUED COMPENSATION | $574,837 |
| PAYABLE TO AFFILIATE | $2,306,866 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,990,462 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT ISSUED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH SYSTEM. THE SYSTEM, EXCEPT FOR HAP, HFPN, HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES, ONIKA, HPI, ALLIANCE, MHP, AND ASR, CONSISTS OF ENTITIES DESCRIBED UNDER INTERNAL REVENUE SERVICE CODE SECTION 501(C)(3) AND, AS SUCH, ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(A) AND DO NOT HAVE A PRIVATE FOUNDATION STATUS UNDER INTERNAL REVENUE CODE SECTIONS 509(A)(1), 509(A)(2), OR 509(A)(3). HAP AND HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES ARE ENTITIES DESCRIBED UNDER INTERNAL REVENUE CODE SECTION 501(C)(4) AND, AS SUCH, ARE EXEMPT FROM FEDERAL INCOME TAXES. HFPN, HPI, ALLIANCE, MHP, AND ASR ARE TAXABLE ENTITIES. APPROXIMATELY $1,751,000 AND $19,953,000 IN RELATED TAX EXPENSE WAS RECORDED IN GENERAL AND OTHER ADMINISTRATIVE EXPENSE IN 2016 AND 2015, RESPECTIVELY. THE SYSTEM'S WHOLLY OWNED INSURANCE CAPTIVES, ONIKA AND CASCADES INSURANCE (WHICH MERGED INTO ONIKA EFFECTIVE APRIL 1, 2016), OPERATE IN THE CAYMAN ISLANDS AND ARE CURRENTLY NOT SUBJECT TO INCOME TAXES. THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2016 AND 2015. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $63,760 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $63,760 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,095,515 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,041,330 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,054,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06670 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,159,275 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,041,330 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,117,945 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07070 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,856 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,856 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,594 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,594 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,450 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,174,725 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,041,330 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,133,395 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07170 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $195,605 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $48,901 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,204,562 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,030,109 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$825,547 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARELINK OF JACKSON A COMMUNITY OWNED SPECIALTY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH ELM AVENUE | AddressLine1Txt |
| City | JACKSON | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CARELINKOFJACKSON.ORG | WebsiteAddressTxt |
| State License | 380051 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | long-term acute care hospital | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C FOR FULL WEBSITE | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | http://www.myhio.org | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C FOR FULL WEBSITE | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.allegiancehealth.org/services/long-term-acute-care-hospital/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.allegiancehealth.org/services/long-term-acute-care-hospital/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.allegiancehealth.org/services/long-term-acute-care-hospital/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | 0 | NondisEmergencyCarePolicyInd |
| No Emergency Care | Yes (X) | NoEmergencyCareInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 HEALTHMEGAN IRENE ALBERTSON - HENRY FORD ALLEGIANCE HEALTHRAY KING, MD - HENRY FORD ALLEGIANCE HEALTHBRITTANY EASTON - HENRY FORD ALLEGIANCE HEALTHRICHARD THOUNE - HENRY FORD ALLEGIANCE HEALTHSARAH ALLISON - HENRY FORD ALLEGIANCE HEALTHSHAINA TINSEY - HENRY FORD ALLEGIANCE HEALTHSHERI BUTTERS - HENRY FORD ALLEGIANCE HEALTHROBERT ANDERSON - HENRY FORD ALLEGIANCE SPECIALTY HOSPITALANDY FARMER - AARPMELISSA LAIRD - BIG BROTHERS/BIG SISTERS OF JACKSON COUNTYTONY HOLLOW - BIG BROTHERS/BIG SISTERS OF JACKSON COUNTYMOLLY KASER - CENTER FOR FAMILY HEALTHSARA BENEDETTO - CENTER FOR FAMILY HEALTHFREDDIE DANCY - CITY OF JACKSONTOBY BERRY - COMMUNITY ACTION AGENCYCHRISSY BLACKWELL - GREAT START COLLABORATIVE OF JACKSON COUNTYKELLY SHEPPARD - GREAT START COLLABORATIVE OF JACKSON COUNTYAIMEE FORS - JACKSON COUNTY HEALTH DEPARTMENTANGELA ALDRICH - JACKSON COUNTY HEALTH DEPARTMENTDON HAYDUK - JACKSON COUNTY HEALTH DEPARTMENTJULIE WEISBROD - JACKSON COUNTY HEALTH DEPARTMENTKAITLYN STEIN - JACKSON COUNTY HEALTH DEPARTMENTMICHELLE WHITE - JACKSON COUNTY HEALTH DEPARTMENTRHONDA RUDOLPH - JACKSON COUNTY HEALTH DEPARTMENTCOURTLAND KETEYIAN - JACKSON HEALTH NETWORKWYNN HAZEN - JACKSON HEALTH NETWORKCARLY COXON - JACKSON COUNTY FINANCIAL STABILITY NETWORKJANELLE BUCHLER - JACKSON COUNTY INTERMEDIATE SCHOOL DISTRICTIRENE LECRONE - JACKSON COUNTY CRADLE TO CAREER EDUCATION NETWORKLIZ BREED - JACKSON DISTRICT LIBRARYSARA TACKETT - JACKSON DISTRICT LIBRARYMELISSA QUISENBERRY - JACKSON YMCASHAWNA TELLO - JACKSON YMCAMONICA MOSER - JACKSON COMMUNITY FOUNDATIONELIZABETH KNOBLAUCH - LIFEWAYS COMMUNITY MENTAL HEALTHMARIBETH LEONARD - LIFEWAYS COMMUNITY MENTAL HEALTHTRACI FOWLER - LIFEWAYS COMMUNITY MENTAL HEALTHAMY PELLETIER - MARRIAGE MATTERS JACKSONALLISON STONER - UNITED WAY OF JACKSON COUNTYBETHANY STUTZMAN - UNITED WAY OF JACKSON COUNTYKEN TOLL - UNITED WAY OF JACKSON COUNTYJULIE WETHERBY - REGION 2 AREA AGENCY ON AGINGKATE MARTIN - COMMUNITY MEMBERLAUREL MAULDIN - COMMUNITY MEMBERTED HILLEARY - COMMUNITY MEMBER |
| 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: AARPBIG BROTHERS/BIG SISTERS OF JACKSON COUNTYCENTER FOR FAMILY HEALTHCITY OF JACKSONCOMMUNITY ACTION AGENCYGREAT START COLLABORATIVE OF JACKSON COUNTYJACKSON COUNTY HEALTH DEPARTMENTJACKSON HEALTH NETWORKJACKSON COUNTY FINANCIAL STABILITY NETWORKJACKSON COUNTY INTERMEDIATE SCHOOL DISTRICTJACKSON COUNTY CRADLE TO CAREER EDUCATION NETWORKJACKSON DISTRICT LIBRARYJACKSON YMCAJACKSON COMMUNITY FOUNDATIONLIFEWAYS COMMUNITY MENTAL HEALTHMARRIAGE MATTERS JACKSONUNITED WAY OF JACKSON COUNTYREGION 2 AREA AGENCY ON AGING |
| HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL | Part V, Section B, Line 7d: PART V, SECTION B, LINE 7A:A FULL COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND ON THE HOSPITAL'S WEBSITE AT: https://www.allegiancehealth.org/services/long-term-acute-care-hospital/financial-assistance-community-healthPART V, SECTION B, LINE 10A: A FULL COPY OF THE IMPROVEMENT PLAN CAN BE FOUND ON THE FOLLOWING WEBSITE: https://www.allegiancehealth.org/services/long-term-acute-care-hospital/financial-assistance-community-health |
| 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 TRUSTEES FORMALLY ADOPTED THE HENRY FORD ALLEGIANCE 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 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; AND C) 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 ORGANIZATION'S ACTION PLAN FOCUSES UPON THOSE COMMUNITY HEALTH NEEDS THAT FALL WITHIN THE SCOPE OF THE ORGANIZATION'S ABILITY TO INFLUENCE POSITIVE OUTCOMES. |
| HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL | Part V, Section B, Line 13b: PATIENTS WITH ANNUAL HOUSEHOLD INCOME IN EXCESS OF 250% OF THE FEDERAL POVERTY LEVEL MAY BE ELIGIBLE FOR FREE OR DISCOUNTED CARE TO THE EXTENT THAT THEIR OUTSTANDING MEDICAL DEBT EXCEEDS 30% OF THEIR HOUSEHOLD INCOME. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $195,605. |
| 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 PATIENT 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, 2016 AND 2015. 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 EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE 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 PORTION OF THE BILL), THE SYSTEM RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST 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 THE 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% AND 16% OF TOTAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2016 AND 2015, RESPECTIVELY. 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 $124,399,000 AND $137,309,000 AT DECEMBER 31, 2016 AND 2015, RESPECTIVELY. THESE ALLOWANCES INCLUDE ESTIMATES RELATED TO BOTH PRESUMPTIVE ELIGIBILITY FOR CHARITY OF $32,294,000 AND $23,344,000 AND BAD DEBTS OF $92,105,000 AND $113,965,000 AT DECEMBER 31, 2016 AND 2015, RESPECTIVELY. THE DECREASE IN THE ALLOWANCES IS DUE TO A DECREASE IN THE UNINSURED OR SELF-PAY POPULATION AS A RESULT OF HEALTH CARE REFORM, INCLUDING MEDICAID EXPANSION THAT BEGAN IN 2014. |
| Part III, Line 8: | ALLOWABLE MEDICARE COSTS REPORTED ON SCHEDULE H, PART III, LINE 6 ARE DETERMINED VIA UTILIZATION 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 LOSSES 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 PURPOSES OF GAINING INSIGHT REGARDING LOCAL HEALTH STATUS, ATTITUDES, BELIEFS, BEHAVIORS AND OPPORTUNITIES. THE HIO COORDINATING COUNCIL INCLUDES REPRESENTATION FROM LOCAL GOVERNMENT, 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 IMPROVEMENT. 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 SPECIALTY 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 RACES. 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 EXPERIENCES 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 77.7% OF HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL PATIENTS WERE COVERED BY MEDICARE, WHILE 9.2% 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; ORC) 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 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 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, Reports Filed With States | MI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ONDREA BATES | ||||||||||||||
| PRESIDENT | $0 | $301,650 | $0 | $17,793 | $0 | $10,333 | $0 | $30,425 | $0 | $31,455 | $0 | $391,656 | $0 | $0 |
| WENDY BOERSMA | ||||||||||||||
| TRUSTEE | $0 | $190,254 | $0 | $0 | $0 | $2,391 | $0 | $14,514 | $0 | $2,759 | $0 | $209,918 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2017. However, the compensation reported on both Form 990, Part VII and Schedule J reflects the full year 2016 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, 2017. |
| 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 2016 CONTRIBUTION AND DISTRIBUTION AMOUNTS ARE AS FOLLOWS: 457(F) CONTRIBUTIONS - ONDREA BATES $15,188 457(F) CONTRIBUTIONS - WENDY BOERSMA $4,838 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 - $261,335 b. Travel Reimbursement - $57,749 2.) Dale L. Friesen, Chief Financial Officer a. Regular Compensation - $130,504 b. Travel Reimbursement - $17,085 |
| Form 990, Part VI, Section A, line 6 | THE CORPORATION IS ORGANIZED ON A MEMBER BASIS. THE SOLE CORPORATE MEMBER OF THE ENTITY 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 its 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 Articles of Incorporation or the governing documents of 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 Indebtedness 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 acquisition 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 | FORM 990 IS REVIEWED BY THE ENTITY'S CHIEF FINANCIAL OFFICER AND THE DIRECTOR OF FINANCE FOR THE SOLE CORPORATE MEMBER (HENRY FORD ALLEGIANCE HEALTH GROUP). FINAL COPIES OF THE RETURN ARE DISTRIBUTED TO THE ENTITY'S BOARD OF TRUSTEES AND CHIEF EXECUTIVE OFFICER FOR REVIEW PRIOR TO FILING. |
| 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 IT'S SOLE CORPORATE MEMBER. THE PARAGRAPH BELOW DETAILS HOW THE POLICY REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE 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, 2017. However, the compensation reported on both Form 990, Part VII and Schedule J reflects the full year 2016 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, 2017. |
| 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 SERVICES: Program service expenses 2,197,211. Management and general expenses 888,702. Fundraising expenses 0. Total expenses 3,085,913. PROVIDER SERVICES: Program service expenses 1,054,123. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,054,123. MEDICAL DIRECTOR FEES: Program service expenses 36,960. Management and general expenses 0. Fundraising expenses 0. Total expenses 36,960. |
| Form 990, Part XI, line 9: | PURCHASE ACCOUNTING ADJUSTMENT 2,388,950. |
| 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 Allegiance Specialty Hospital has delegated the oversight of its financial statements, including the choice of independent auditors, to the audit committee of Henry Ford Health System. |
| PART V, LINE 4 | 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (1) | |
| HENRY FORD ALLEGIANCE HEALTH GROUP | |||||||||||
| 205 N EAST AVENUE | JACKSON | MI | 49201 | 382756428 | HEALTHCARE SERVICE PROVIDER | MI | 501(C)(3) | Line 12b, II | 0 | ||
| 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 | Yes (1) | |
| HOSPICE OF JACKSON DBA ALLEGIANCE HOSPICE | |||||||||||
| 205 N EAST AVENUE | JACKSON | MI | 49201 | 382336367 | HOSPICE CARE | MI | 501(C)(3) | Line 7 | HEALTHLINK | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| HENRY FORD HEALTH SYSTEM | |||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 381357020 | HEALTHCARE SERVICE PROVIDER | MI | 501(C)(3) | Line 3 | 0 | N/A | |
| HENRY FORD WYANDOTTE HOSPITAL | |||||||||||
| 2333 BIDDLE AVENUE | WYANDOTTE | MI | 48192 | 382791823 | HEALTHCARE SERVICE PROVIDER | MI | 501(C)(3) | Line 3 | HENRY FORD HEALTH SYSTEM | Yes (1) | |
| HENRY FORD MACOMB HOSPITAL CORPORATION | |||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 382947657 | HEALTHCARE SERVICE PROVIDER | MI | 501(C)(3) | Line 3 | HENRY FORD HEALTH SYSTEM | Yes (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 | Yes (1) | |
| HEALTH ALLIANCE PLAN | |||||||||||
| 2850 W GRAND BLVD | DETROIT | MI | 48202 | 382242827 | HEALTH MAINTENANCE ORGANIZATION | MI | 501(C)(4) | HENRY FORD HEALTH SYSTEM | Yes (1) | ||
| HFHS SELF FUNDED LIABILITY | |||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 386553031 | MALPRACTICE INSURANCE | MI | 501(C)(4) | HENRY FORD HEALTH SYSTEM | Yes (1) | ||
| HENRY FORD CONTINUING CARE | |||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 382433285 | NURSING HOMES | MI | 501(C)(3) | Line 10 | HENRY FORD HEALTH SYSTEM | Yes (1) | |
| HFII CORPORATION | |||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 900840304 | SCIENTIFIC RESEARCH | MI | 501(C)(3) | Line 7 | HENRY FORD HEALTH SYSTEM | Yes (1) | |
| HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES | |||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 464064067 | ADVOCACY SERVICES FOR HFHS AND AFFILIATES | MI | 501(C)(4) | HENRY FORD HEALTH SYSTEM | Yes (1) | ||
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| FOOTE HEALTH CENTER ASSOCIATES | |||||||
| 1100 E MICHIGAN AVENUE | JACKSON | MI | 49201 | 383017711 | LESSOR OF MEDICAL CONDOMINIUMS | MI | N/A |
| NORTHWEST DETROIT DIALYSIS | |||||||
| 30100 TELEGRAPH | BINGHAM FARMS | MI | 48025 | 383232668 | OPERATES DIALYSIS CLINIC | MI | N/A |
| MACOMB REGIONAL DIALYSIS | |||||||
| 16151 NINETEEN MILE | CLINTON TOWNSHIP | MI | 48038 | 260423581 | OPERATES DIALYSIS CLINIC | MI | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VIKING HEALTH SYSTEM INC | |||||||||||||
| 205 N EAST AVENUE | JACKSON | MI | 49201 | 382756161 | IDLE HEALTHCARE ADMINISTRATION CORPORATION | MI | N/A | C | 0 | ||||
| CASCADES INSURANCE COMPANY LTD | |||||||||||||
| 205 N EAST AVENUE | JACKSON | MI | 49201 | 981132982 | HOSPITAL MALPRACTICE INSURANCE CAPTIVE | N/A | C | 0 | CJ | ||||
| SHA REALTY INC | |||||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 381378121 | REAL ESTATE HOLDING | MI | N/A | C | 0 | ||||
| FAIRLANE HEALTH SERVICES | |||||||||||||
| 30100 TELEGRAPH | BINGHAM FARMS | MI | 48025 | 382565235 | HEALTHCARE MANAGEMENT | MI | N/A | C | 0 | ||||
| ALLIANCE HEALTH AND LIFE INSURANCE | |||||||||||||
| 2850 W GRAND BLVD | DETROIT | MI | 48202 | 383291563 | HEALTH INSURANCE PROVIDER | MI | N/A | C | 0 | ||||
| HAP PREFERRED INC | |||||||||||||
| 2850 W GRAND BLVD | DETROIT | MI | 48202 | 382513504 | PROVIDER NETWORK LEASING | MI | N/A | C | 0 | ||||
| HAP MIDWEST HEALTH PLAN INC | |||||||||||||
| 2850 W GRAND BLVD | DETROIT | MI | 48202 | 383123777 | HEALTH INSURANCE PROVIDER | MI | N/A | C | 0 | ||||
| HAP COMMUNITY ALLIANCE | |||||||||||||
| 2850 W GRAND BLVD | DETROIT | MI | 48202 | 320306774 | MANAGEMENT COMPANY | MI | N/A | C | 0 | ||||
| ADMINISTRATION SYSTEMS RESEARCH CORPORATION | |||||||||||||
| 2850 W GRAND BLVD | DETROIT | MI | 48202 | 382651185 | THIRD-PARTY INSURANCE ADMINISTRATION | MI | N/A | C | 0 | ||||
| ONIKA INSURANCE LTD | |||||||||||||
| CAPTIVE INSURANCE | N/A | C | 0 | CJ | FIRST CARRIBEAN HOUSE | GRAND CAYMAN | CJ | ||||||
| HENRY FORD PHYSICIAN NETWORK | |||||||||||||
| ONE FORD PLACE | DETROIT | MI | 48202 | 380306774 | PHYSICIAN NETWORK | MI | N/A | C | 0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| HENRY FORD ALLEGIANCE HEALTH | ||
| L | $515,504 | COST |
| HENRY FORD ALLEGIANCE HEALTH | ||
| M | $5,301,972 | AGREEMENT |
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