2016-11-15T17:02:21-06:00 2015-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2015-01-01 383239057 CRITTENTON CANCER CENTER CRIT 2486525000 1101 WEST UNIVERSITY DRIVE ROCHESTER MI 48307 DONNA KOPINSKI TREASURER 2486525000 2016-11-09 1 CAROL LALONDECPA P00181637 2695674500 2015 2017-02-10 21:41:12Z MARGARET DIMOND 1101 WEST UNIVERSITY DRIVE ROCHESTER MI 48307 1652313 0 X WWW.CRITTENTON.COM X 1996 MI CRITTENTON CANCER CENTER LEASES OUT ITS BUILDING FOR ADVANCED CANCER DIAGNOSTIC, TREATMENT PLANNING AND SERVICES TO PATIENTS IN MICHIGAN'S OAKLAND AREA. IT ALSO PROVIDES CATSCAN,LABORATORY AND CLINIC SERVICES FOR ON-SITE PATIENT CONVENIENCE. 1 0 0 400 0 0 0 0 1462015 1208461 0 0 -818602 -845444 643413 363017 0 0 0 0 64965 0 0 0 0 1438133 839012 1503098 839012 -859685 -475995 19144061 18496866 18026666 18984676 1117395 -487810 NONE 0 0 697169 1208115 CRITTENTON CANCER CENTER PROVIDES LEASED SPACE/EQUIPMENT TO ST JOHN'S FOR CARE OF CANCER PATIENTS. 30171 346 CRITTENTON CANCER CENTER PROVIDED ADVANCED RADIATION ONCOLOGY SERVICES TO MICHIGAN'S TRI-COUNTY AREA. 727340 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 MI X KIM HAUSCHILD 2486525780 1101 WEST UNIVERSITY DRIVE ROCHESTER MI 48307 ROY POWELL PRESIDENT - PART YEAR 1.00 39.00 X X 0 527563 35778 MICHAEL CLARK SECRETARY - PART YEAR 1.00 39.00 X X 0 199326 36932 DONNA KOPINSKI TREASURER 1.00 39.00 X X 0 263120 41605 0 990009 114315 0 0 1 0 VARIAN MEDICAL SYSTEMS 70140 NETWORK PLACE CHICAGO IL 60673 MAINT EQPT CONTRACT 220077 1 RENTAL REVENUE 531120 1208115 1208115 TREATMENT REVENUE 621400 346 346 1208461 443852 1289296 -845444 -845444 -845444 363017 1208461 0 -845444 X 4200 4200 92039 59510 32529 11059 11059 260772 260772 450358 405018 45340 REPAIRS AND MAINTENANCE 18544 18544 RENTALS-EQUIPMENT 1129 1129 MISCELLANEOUS EXPENSE 875 875 COLLECTION EXPENSES 25 25 11 11 839012 727340 111672 0 49811 0 1849007 17238 250344 347825 14855349 336780 16994899 14518569 0 3613234 19144061 18496866 295370 72867 113546 207526 17617750 18704283 18026666 18984676 X 1117395 -487810 1117395 -487810 19144061 18496866 X -475995 -1129210 X X 0 0 0 X 5686171 3964250 1404069 1462015 1208461 13724966 5686171 3964250 1404069 1462015 1208461 13724966 0 1169009 1158546 2327555 1169009 1158546 2327555 11397411 11 333091 443852 776954 11 333091 443852 776954 5686182 3964250 1404069 1795106 1652313 14501920 0.78590 0.90920 0.05360 0.02010 X 291819 291819 12934680 110526 12824154 1628850 226254 1402596 14518569 DUE FROM CRITTENTON HOSPITAL MEDICAL CENTER 3613234 3613234 DUE TO CRITTENTON HOSPITAL MEDICAL CENTER 18704283 18704283 1 0 0 0 0 0 0 0 0 ROY POWELL PRESIDENT - PART YEAR 0 514057 0 10000 0 3506 0 18173 0 17605 0 563341 0 0 MICHAEL CLARK SECRETARY - PART YEAR 0 159670 0 20000 0 19656 0 19327 0 17605 0 236258 0 0 DONNA KOPINSKI TREASURER 0 243120 0 20000 0 0 0 24000 0 17605 0 304725 0 0 PART I, LINE 3 COMPENSATION IS DETERMINED BY A RELATED PARTY WHO USES A COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE IN ORDER TO ESTABLISH COMPENSATION FOR THE PRESIDENT. PART I, LINE 4A ROY POWELL AND MICHAEL CLARK RECEIVED $3,505 AND $18,270, RESPECTIVELY IN SEVERANCE PAYMENTS. FORM 990, PART VI, SECTION A, LINE 4 THE GOVERNING DOCUMENTS OF CRITTENTON CANCER CENTER CHANGED WITH THE ACQUISITION BY ASCENSION MICHIGAN. CRITTENTON HOSPITAL MEDICAL CENTER REMAINS THE SOLE MEMBER OF CRITTENTON CANCER CENTER ON 10/1/15. THE GOVERNING DOCUMENTS WERE AMENDED TO CONFORM WITH THIS ACQUISITION. THE PHILOSOPHY OF CRITTENTON CANCER CENTER IS THAT OF ASCENSION SPONSOR IN THAT IT WILL BE IN ACCORDANCE WITH THE OFFICIAL TEACHINGS OF THE ROMAN CATHOLIC CHURCH AND THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES, AS APPROVED. THERE ARE POWERS AND RESPONSIBILITIES RESERVED FOR ASCENSION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS CRITTENTON HOSPITAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 8A CRITTENTON CANCER CENTER DOES NOT HAVE ANY COMMITTEES SET UP THEREFORE THIS QUESTION IS NOT APPLICABLE. FORM 990, PART VI, SECTION A, LINE 8B CRITTENTON CANCER CENTER DOES NOT HAVE ANY COMMITTEES SET UP THEREFORE THIS QUESTION IS NOT APPLICABLE. FORM 990, PART VI, SECTION B, LINE 11 THE 990 RETURN WAS NOT GIVEN TO EACH OF THE BOARD MEMBERS FOR REVIEW PRIOR TO BEING FILED WITH THE IRS AS THEY ARE NO LONGER WITH THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 12C THE SECRETARY OF THE BOARD IS THE HOSPITAL'S COMPLIANCE OFFICER. THE HOSPITAL POLICY STATES THAT ALL EMPLOYEES HAVE A CONTINUOUS OBLIGATION TO DISCLOSE CONFLICTS OF INTEREST, AN ACTUAL IMPROPRIETY, AND/OR AN APPEARANCE OF IMPROPRIETY. EMPLOYEES AT THE MANAGER LEVEL AND ABOVE EACH SIGN A STATEMENT ON AN ANNUAL BASIS ACKNOWLEDGING THEIR UNDERSTANDING OF THE POLICY AND VERIFYING THEIR APPROPRIATE DISCLOSURE OF ANY CONFLICTS. ALL REPORTED CONFLICTS SHALL BE REVIEWED BY THE CEO IN CONJUNCTION WITH THE COMPLIANCE OFFICER AND DEPARTMENT OF LEGAL AFFAIRS. IF IT IS DETERMINED THAT A CONFLICT EXISTS THE EMPLOYEE SHALL DISCONTINUE ALL ACTIVITIES SURROUNDING THAT CONFLICT. THE EMPLOYEE MAY ALSO SEEK A WAIVER OF THE CONFLICT FROM THE CEO. CHMC ALSO HAS A QUESTIONNAIRE FOR INDIVIDUALS AND THEIR IMMEDIATE FAMILY MEMBERS REGARDING CONFLICTS OF INTEREST AND THIS MUST BE SIGNED BY THE INDIVIDUALS. THE QUESTIONNAIRE INCLUDES THE FOLLOWING: 1. IDENTIFY YOUR SERVICE ON ANY BOARD OF DIRECTORS OR TRUSTEES OF ANY OF THE COMPANY'S WITH WHICH CHMC OR ANY OF ITS AFFILIATES DOES BUSINESS. 2. IDENTIFY WHETHER YOU ARE ASSOCIATED DIRECTLY OR INDIRECTLY OR HOLD A POSITION OR FINANCIAL INTEREST IN ANY OUTSIDE ORGANIZATION OR CONCERN WITH WHICH CRITTENTON DOES BUSINESS. 3. IDENTIFY WHETHER YOU DIRECT, MANAGE, OR PROVIDE SERVICES OR CONSULTATION TO ANY OUTSIDE ORGANIZATION OR CONCERN THAT DOES BUSINESS WITH OR COMPETES WITH CRITTENTON. 4. IDENTIFY ANY ACTIVITIES IN WHICH YOU ARE ENGAGED THAT MIGHT BE REGARDED AS CONSTITUTING A POTENTIAL CONFLICT OF INTEREST WITH CRITTENTON. 5. DISCLOSE ANY DIRECT OR INDIRECT COMPENSATION THAT YOU RECEIVE, OR ANTICIPATE RECEIVING, FROM ANY PERSON, FIRM, CORPORATION, OR MARKET IN ANY WAY RELATED TO YOUR POSITION WITH CRITTENTON. IF AT ANY TIME THERE IS A MATTER UNDER CONSIDERATION WHICH MAY CREATE A DIRECT OR INDIRECT CONFLICT OF INTEREST, IT IS THE INDIVIDUAL'S OBLIGATION TO DISCLOSE THE FACTS SURROUNDING THE POSSIBLE CONFLICT TO THE CORPORATE COMPLIANCE OFFICER OR DEPARTMENT OF HUMAN RESOURCES AND THAT THE INDIVIDUAL AGREES TO PROMPTLY REPORT ANY NEW SITUATIONS THAT REQUIRE DISCLOSURE UNDER THIS QUESTIONNAIRE. THERE IS A SIGNED WRITTEN AGREEMENT/DOCUMENTATION FOR ANY BOARD MEMBER OR OFFICER IF A CONFLICT OF INTEREST ARISES. CURRENTLY THERE HAVE NOT BEEN ANY RESTRICTIONS PLACED ON ANY BOARD MEMBER OR OFFICER AS AN ISSUE HAS NOT ARISEN TO WARRANT THIS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF CRITTENTON CANCER CENTER'S MANAGEMENT IS PAID BY A RELATED ORGANIZATION, CRITTENTON HOSPITAL MEDICAL CENTER(CHMC). THE HUMAN RESOURCES DEPARTMENT OF CHMC CONDUCTS A BI-ANNUAL WAGE SURVEY OF SELECT POSITIONS TO DETERMINE MARKET COMPETITIVENESS. SURVEYS ARE CONDUCTED ON BEHALF OF CHMC BY A THIRD PARTY TO ASSURE COMPARABILITY OF POSITION SCOPE, SPAN OF CONTROL AND ACCOUNTABILITY WHEN OBTAINING SURVEY RESULTS FROM OTHER LOCAL AREA HEALTH CARE INSTITUTIONS. THE THIRD PARTY COMPILES SURVEY RESULTS AND SUBMITS THEM TO HUMAN RESOURCES FOR REVIEW, ANALYSIS AND RECOMMENDATIONS. HUMAN RESOURCES PREPARES SALARY RECOMMENDATIONS AND REVIEWS THEM WITH THE LEADERSHIP TEAM FOR IMPLEMENTATION SUBJECT TO FUNDING. FORM 990, PART VI, SECTION C, LINE 19 THIS INFORMATION IS SENT OUT UPON REQUEST EITHER IN HARD COPY OR ELECTRONIC FORM AS INDICATED IN EACH REQUEST. FORM 990, PART IX, LINE 11G COLLECTION FEES: PROGRAM SERVICE EXPENSES 1,709. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,709. CONTRACT SERVICES - HEALTH CARE PROF.: PROGRAM SERVICE EXPENSES 13,511. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,511. GROUNDS MAINTENANCE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 32,529. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,529. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 44,290. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,290. FORM 990, PART XI, LINE 9: FAIR MARKET VALUE ADJUSTMENT ON FIXED ASSETS -1,129,210. FORM 990, PART XII, LINE 2C: CRITTENTON HOSPITAL MEDICAL CENTER WAS PURCHASED BY ASCENSION HEALTH AS OF 10/1/15. THE COMMITTEE THAT USED TO BE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT NO LONGER EXISTS UNDER CRITTENTON. ASCENSION HEALTH NOW HANDLES THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITORS. AS PART OF ASCENSION, CRITTENTON DID NOT HAVE AN AUDIT AT 12/31/15, BUT RATHER HAD ONE COVERING 10/1/15-6/30/16. CRITTENTON HOSPITAL MEDICAL CENTER 1101 W UNIVERSITY DR ROCHESTER MI 48307 381359247 GENERAL HOSPITAL MI 501(C)(3) LINE 3 N/A 0 CRITTENTON HOSPITAL MEDICAL CENTER FOUNDATION 1101 W UNIVERSITY DR ROCHESTER MI 48307 382627336 SUPPORTING MI 501(C)(3) LINE 11A, I CRITTENTON HOSPITAL MEDICAL CENTER 1 CRITTENTON MEDICAL EQUIPMENT 161 S LIVERNOIS RD ROCHESTER HILLS MI 48307 383433794 MEDICAL EQUIPMENT SALES MI N/A HBC INFUSIONS 1101 W UNIVERSITY DR ROCHESTER MI 48307 753123093 INFUSION SERVICES MI N/A BALD MOUNTAIN SURGICAL CENTER 1375 S LAPEER RD STE 3109 LAKE ORION MI 48360 030444972 SURGICAL SERVICES MI N/A CRITTENTON DEVELOPMENT CORPORATION 2251 N SQUIRREL RD STE 310 AUBURN HILLS MI 48326 382594115 REAL ESTATE MI N/A C 0 CRITTENTON MEDICAL PHARMACY 1101 W UNIVERSITY DR ROCHESTER MI 48307 203773341 PHARMACY SALES MI N/A C 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0 CRITTENTON HOSPITAL MEDICAL CENTER K 153000 ACTUAL COST INCURRED CRITTENTON HOSPITAL MEDICAL CENTER Q 61023 ACTUAL COST INCURRED CRITTENTON HOSPITAL MEDICAL CENTER E 933533 ACTUAL COST INCURRED