2018-01-15T16:30:45-06:00 2017-02-28 381357951 PLANTE & MORAN PLLC 750 Trade Centre Way Ste 300 Portage MI 49002 990 2016-03-01 381218485 CARELINK OF JACKSON A COMMUNITY-OWNED SPECIALTY HOSPITAL CARE 5177871440 110 NORTH ELM AVENUE JACKSON MI 49202 DALE L FRIESEN CHIEF FINANCIAL OFFICER 5177964475 2018-01-15 1 Carol LaLonde CPA P00181637 2695674500 2018-01-15 67.59.56.32 2018-01-15 10:12:21 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 EBB51160BF2136090E0706D858221EDFD566B897 2016 2021-01-29 14:40:06Z HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL J MARK FALL 110 NORTH ELM AVENUE JACKSON MI 49202 14332724 0 X www.carelinkofjackson.org X 2003 MI TO PROVIDE LONG-TERM ACUTE HEALTHCARE TO THE RESIDENTS OF JACKSON, MI AND SURROUNDING AREAS. 7 5 167 3 0 0 92 4004 15593567 14222577 -89 4554 42676 101589 15636246 14332724 0 0 0 0 6944664 7012326 0 0 0 8604059 8802276 15548723 15814602 87523 -1481878 7741677 8474568 3584441 3410260 4157236 5064308 X HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS COMMITTED TO HOLISTIC CARE OF INDIVIDUALS WITH COMPLEX MEDICAL NEEDS. 0 0 13395565 14321701 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. 13395565 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 13 0 1 167 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X DALE L FRIESEN 5177964475 110 NORTH ELM AVENUE JACKSON MI 49202 ONDREA BATES PRESIDENT 3.00 57.00 X X 0 329776 61880 BRENT ELLIS CHAIRPERSON 5.00 0.00 X X 0 0 0 MARYANNE FUCHS VICE CHAIRPERSON 1.00 0.00 X X 0 0 0 DAVID SCHMIDT TRUSTEE 1.00 0.00 X 0 0 0 BRUCE A INOSENCIO JR 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 192645 17273 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 522421 79153 0 0 1 1 INDEPENDENT HOSPITALIST PHYSICIANS PLLC PO BOX 100 ROYAL OAK MI 48068 PHYSICIAN SERVICES 1246581 GREENTREE HEALTHCARE PARTNERS LLC 110 JOHNSTON FARM LANE WOODSTOCK GA 30188 MANAGEMENT SERVICES 782905 FRESENIUS MANAGEMENT SERVICES INC 16343 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 HEALTHCARE SERVICES 166677 3 4004 4004 PATIENT SERVICES 621990 14207071 14207071 PATIENT CARE 621990 11172 11172 INPATIENT REHABILITATION 621990 4334 4334 14222577 2990 2990 1564 0 1564 1564 1564 ENVIRONMENTAL PROJECT REIMBURSEME 900099 56058 56058 DIETARY CAFETERIA 722210 41364 41364 MEDICAL RECORDS FEES 900099 1702 1702 2465 2465 101589 14332724 14321701 0 7019 X 5762405 5231222 531183 97974 88943 9031 728138 661018 67120 423809 384742 39067 743238 743238 2027 2027 53800 53800 3993 3993 4176996 3288294 888702 497 497 1023773 1000116 23657 27805 27805 237027 237027 52951 52951 379540 379540 37711 33940 3771 PHARMACEUTICALS 1219658 1219658 MEDICAL SUPPLIES 490770 490770 bad debt 195605 195605 FOOD 156885 156885 15814602 13395565 2419037 0 225020 299890 1512920 1140428 3755166 2176441 74911 82732 5128619 353542 2092640 4775077 81020 0 7741677 8474568 377454 419798 3206987 2990462 3584441 3410260 X 4157236 5064308 4157236 5064308 7741677 8474568 X -1481878 2388950 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 3993 3993 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 3730193 184547 3545646 1182972 168995 1013977 65454 65454 4775077 COST REPORT SETTLEMENTS PAYABLE 108759 ACCRUED COMPENSATION 574837 PAYABLE TO AFFILIATE 2306866 2990462 X Part X, Line 2: 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. 1 1 X 1 X 250.000000000000 0 1 1 0 1 1 63760 63760 0.00400 2095515 1041330 1054185 0.06670 2159275 1041330 1117945 0.07070 8856 8856 0.00060 6594 6594 0.00040 15450 15450 0.00100 2174725 1041330 1133395 0.07170 0 195605 48901 8204562 9030109 -825547 X 1 1 1 1 CARELINK OF JACKSON A COMMUNITY OWNED SPECIALTY HOSPITAL 110 NORTH ELM AVENUE JACKSON MI 49202 WWW.CARELINKOFJACKSON.ORG 380051 X long-term acute care hospital HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE PART V, SECTION C FOR FULL WEBSITE X http://www.myhio.org X 1 16 1 SEE PART V, SECTION C FOR FULL WEBSITE 0 1 X 250.000000000000 X X X X X 1 1 X X X 1 X www.allegiancehealth.org/services/long-term-acute-care-hospital/ X www.allegiancehealth.org/services/long-term-acute-care-hospital/ X www.allegiancehealth.org/services/long-term-acute-care-hospital/ 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 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. 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 0 1 0 0 0 0 0 0 0 ONDREA BATES PRESIDENT 0 301650 0 17793 0 10333 0 30425 0 31455 0 391656 0 0 WENDY BOERSMA TRUSTEE 0 190254 0 0 0 2391 0 14514 0 2759 0 209918 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, 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 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. 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 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 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 N/A 0 HENRY FORD WYANDOTTE HOSPITAL 2333 BIDDLE AVENUE WYANDOTTE MI 48192 382791823 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) Line 3 HENRY FORD HEALTH SYSTEM 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 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 HOMES 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 HFHS AND AFFILIATES MI 501(C)(4) HENRY FORD HEALTH SYSTEM 1 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 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 CJ N/A C 0 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 FIRST CARRIBEAN HOUSE GRAND CAYMAN CJ CAPTIVE INSURANCE CJ N/A C 0 HENRY FORD PHYSICIAN NETWORK ONE FORD PLACE DETROIT MI 48202 380306774 PHYSICIAN NETWORK MI N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 HENRY FORD ALLEGIANCE HEALTH L 515504 COST HENRY FORD ALLEGIANCE HEALTH M 5301972 AGREEMENT