2016-11-12T00:24:23-06:00 2015-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 462045108 990 2015-01-01 271302183 MONROE CANCER CENTER MONR 7342401800 800 STEWART RD MONROE MI 48162 MICHAEL P BROWNING TREASURER 7342401800 2016-11-11 1 SHAWNA M JIMENEZ P01222873 3174648600 2015 2017-02-10 21:41:12Z MICHAEL P BROWNING 1801 RICHARDS ROAD TOLEDO OH 43607 1367455 0 X WWW.PROMEDICA.ORG X 2009 MI MONROE CANCER CENTER PROVIDES ADVANCED CANCER DIAGNOSTIC, TREATMENT PLANNING AND TREATMENT SERVICES TO PATIENTS, PRIMARILY THROUGH RADIATION ONCOLOGY, IN MONROE COUNTY, MICHIGAN AND THE TOLEDO AREA IN OHIO. 1 0 0 1 0 0 0 0 13549508 1367007 1382 448 0 0 13550890 1367455 0 0 0 0 0 0 0 0 0 14045896 2700137 14045896 2700137 -495006 -1332682 1143475 1909062 123984 1122253 1019491 786809 MONROE CANCER CENTER PROVIDES ADVANCED CANCER DIAGNOSTIC, TREATMENT PLANNING AND TREATMENT SERVICES, PRIMARILY THROUGH RADIATION ONCOLOGY SERVICES, TO PATIENTS IN MICHIGAN'S MONROE COUNTY AREA AND OHIO'S TOLEDO AREA. 0 0 2604799 1367007 MONROE CANCER CENTER PROVIDES ADVANCED RADIATION/ONCOLOGY SERVICES TO MICHIGAN'S MONROE COUNTY AND OHIO'S TOLEDO AREA. 2604799 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X BRIAN HANSEN 4198918505 5901 MONCLOVA RD MAUMEE OH 43537 ANN KUJAWA VICE-CHAIR 1.00 40.00 X X 0 157948 36769 JOHN E KIBBLE CHAIRPERSON 1.00 40.00 X X 0 280576 167839 MARGARET DIMOND SECRETARY 1.00 0.00 X X 0 0 0 GARY AKENBERGER SR. VP FINANCE, PHS 0.50 45.00 X 0 415589 89075 PAMELA M JENSEN FORMER OFFICER 0.00 41.00 X 0 281184 63692 0 1135297 357375 0 1 1 0 TOLEDO RADIATION ONCOLOGY 3000 REGENCY COURT SUITE 207 TOLEDO OH 43623 BILLING SERVICES 191667 VARIAN MEDICAL SYSTEMS 70140 NETWORK PLACE CHICAGO IL 60673 EQUIPMENT REPAIRS 105093 2 NET PATIENT SERVICES 621400 1367007 1367007 1367007 448 448 1367455 1367007 0 448 X 11664 11664 62472 62472 16537 16537 1506909 1502244 4665 8683 8683 268416 268416 127452 127452 10512 10512 EQUIPMENT RENTAL 634896 634896 PERSONAL PROPERTY TAX 35588 35588 MEDICAL SUPPLIES 15735 15735 FOOD 1223 1223 50 50 2700137 2604799 95338 0 438002 106073 222946 176631 39666 33537 1257046 764225 442861 492821 1100000 1143475 1909062 123984 305521 0 816732 123984 1122253 X 1019491 786809 1019491 786809 1143475 1909062 X -1332682 1100000 X X 0 1 X 1 0 X 175 175 6911955 13271356 13235811 13549508 1367007 48335637 6911955 13271531 13235811 13549508 1367007 48335812 0 0 0 48335812 4539 3845 2513 1382 448 12727 4539 3845 2513 1382 448 12727 6916494 13275376 13238324 13550890 1367455 48348539 0.99970 0.00030 X 122265 22415 99850 1062098 710322 351776 72683 31488 41195 492821 DUE TO AFFILIATES 816732 816732 X PART X, LINE 2: MONROE CANCER CENTER IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES (PHS). THE FOLLOWING REFLECTS PHS'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740. EXCEPT AS NOTED BELOW, PHS DID NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, A TAXABLE SUBSIDIARY OF PHS RECOGNIZED A LIABILITY FOR UNCERTAIN TAX POSITIONS OF $0 AND $9,027,000, RESPECTIVELY. MONROE CANCER CENTER DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. 1 1 0 0 0 0 0 0 0 ANN KUJAWA VICE-CHAIR 0 147904 0 2750 0 7294 0 15548 0 21221 0 194717 0 0 JOHN E KIBBLE CHAIRPERSON 0 53127 0 20399 0 207050 0 167007 0 832 0 448415 0 0 GARY AKENBERGER SR. VP FINANCE, PHS 0 291582 0 84049 0 39958 0 67444 0 21631 0 504664 0 0 PAMELA M JENSEN FORMER OFFICER 0 221829 0 56031 0 3324 0 48779 0 14913 0 344876 0 0 PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF MONROE CANCER CENTER, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A: UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM PROMEDICA. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: JOHN E. KIBBLE $150,599 PART I, LINE 4B: ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE APRIL 1, 2015, MONROE CANCER CENTER AMENDED ITS ARTICLE OF INCORPORATION AND BYLAWS. THE SIGNIFICANT CHANGES ARE AS FOLLOWS: - MERCY MEMORIAL HOSPITAL CORPORATION AND EMMA L. BIXBY MEDICAL CENTER BECAME THE MEMBERS. - THE NUMBER OF THE BOARD OF DIRECTORS SHALL CONSIST OF 3 VOTING DIRECTORS WHO ARE APPOINTED BY THE MEMBERS. - A QUORUM FOR TRANSACTION OF BUSINESS IN ANY MEETING OF THE BOARD OF DIRECTORS EXISTS WHEN A MAJORITY OF THE DIRECTORS ARE PRESENT. FORM 990, PART VI, SECTION A, LINE 6 AS A MICHIGAN NON-PROFIT ORGANIZATION, THIS CORPORATION HAS 2 CORPORATE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF MERCY MEMORIAL HOSPITAL CORPORATION AND EMMA L. BIXBY MEDICAL CENTER, WHICH ARE THE MEMBERS OF MONROE CANCER CENTER. AS THE SOLE MEMBER OF MERCY MEMORIAL HOSPITAL CORPORATION AND EMMA L. BIXBY MEDICAL CENTER, PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF MONROE CANCER CENTER, AND (B) FILL ANY VACANCY OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION. FORM 990, PART VI, SECTION B, LINE 11 UNDER THE GUIDANCE OF PROMEDICA HEALTH SYSTEM, INC.'S (PHS) TAX CONSULTANTS, FORM 990S ARE PREPARED BY THE RESPECTIVE ACCOUNTING DEPARTMENT OF EACH AFFILIATE AND REVIEWED BY THE AFFILIATE'S FINANCE LEADERSHIP. AFTER AFFILIATE'S FINANCE LEADERSHIP APPROVAL, COPIES OF THE FORM 990 FOR PHS AND THEIR SUBSIDIARIES ARE PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES AND ARE REVIEWED AND SIGNED BY A PRINCIPAL OFFICER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER CERTIFICATION STATEMENT WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER CERTIFICATION STATEMENTS ARE COMPILED AND REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER CERTIFICATION STATEMENTS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO FILE THE CERTIFICATION STATEMENT, OR THE FILING OF A FALSE OR INCOMPLETE CERTIFICATION STATEMENT, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S CERTIFICATION STATEMENT OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL SALARIED EMPLOYEES AND SPECIFICALLY IDENTIFIED HOURLY EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PHYSICIANS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PHYSICIAN CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER FOR PROMEDICA PHYSICIAN GROUP (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PHYSICIAN CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PHYSICIANS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PHYSICIAN STANDARD OF CONDUCT AND THE PHYSICIAN CERTIFICATION STATEMENT WHICH THE NEW PHYSICIAN IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, CHIEF OPERATING OFFICER OR THEIR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE V.P., AUDIT & COMPLIANCE. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL BY THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER. RESULTS OF THE EMPLOYED PHYSICIAN AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. ANY ITEMS THAT MEET CRITERIA FOR PUBLIC DISCLOSURE WILL BE COMMUNICATED TO THE APPROPRIATE PHYSICIAN BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE IN ADVANCE OF THE POSTING. THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE WILL PROVIDE THE PHYSICIAN-INDUSTRY RELATIONSHIP DISCLOSURES TO THE APPLICABLE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. THE PUBLIC DISCLOSURE WILL BE POSTED ON THE PPG PHYSICIAN WEBSITE (I.E., WWW.PPGDOCS.ORG) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. FORM 990, PART VI, SECTION B, LINE 15 MONROE CANCER CENTER'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF MONROE CANCER CENTER'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASE SERVICES - PHYSICIAN: PROGRAM SERVICE EXPENSES 687,517. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 687,517. PURCHASE SERVICES - NON PHYSICIAN: PROGRAM SERVICE EXPENSES 528,897. MANAGEMENT AND GENERAL EXPENSES 4,665. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 533,562. PURCHASE SERVICES - OTHER: PROGRAM SERVICE EXPENSES 285,830. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 285,830. FORM 990, PART XI, LINE 9: WRITE-UP OF INTANGIBLE ASSET 1,100,000. FORM 990, PART XII, LINE 2C: MONROE CANCER CENTER IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES (PHS) WHICH ARE PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE PHS AUDIT/COMPLIANCE COMMITTEE WHICH PROVIDES ASSISTANCE TO THE PHS BOARDS OF TRUSTEES IN FULFILLING ITS FIDUCIARY RESPONSIBILITIES AND MAINTAINS FREE AND OPEN COMMUNICATION BETWEEN THE COMMITTEE, THE V.P. OF AUDIT/COMPLIANCE, THE INDEPENDENT AUDITORS AND MANAGEMENT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. MAJOR RESPONSIBILITIES OF THE AUDIT/COMPLIANCE COMMITTEE INCLUDE: - ANNUALLY, APPROVE THE ENGAGEMENT OF THE EXTERNAL AUDITOR, INCLUDING RELATED SCOPE, FEES AND REPORTS. - REVIEW WITH MANAGEMENT AND THE INDEPENDENT AUDITORS THE ANNUAL FINANCIAL STATEMENTS AND RESULTS OF THE AUDIT, INCLUDING REQUIRED MATTERS TO BE COMMUNICATED TO THE COMMITTEE BY THE INDEPENDENT AUDITORS UNDER GENERALLY ACCEPTED AUDITING STANDARDS. - DISCUSS WITH THE EXTERNAL AUDITORS THEIR INDEPENDENCE FROM MANAGEMENT AND THE ORGANIZATION AND THE MATTERS INCLUDED IN WRITTEN DISCLOSURE REQUIRED BY THE INDEPENDENCE STANDARDS BOARD. - OVERSEE MANAGEMENT ACTION PLANS RESULTING FROM EXTERNAL MANAGEMENT LETTER. COBRA VENTURES LLC 5901 MONCLOVA RD MAUMEE OH 43537 204671613 LAND LEASING OH 5510 94354 ST LUKE'S HOSPITAL FOUNDATION MIDWEST CARDIOVASCULAR CONSULTANTS LLC 5855 MONROE ST SYLVANIA OH 43560 611448753 EMPLOYS PHYSICIANS OH 0 535504 PROMEDICA PHYSICIAN GROUP PROMEDICA CENTRAL PHYSICIANS LLC 5855 MONROE ST SYLVANIA OH 43560 341881137 EMPLOYS PHYSICIANS OH 231170716 291204025 PROMEDICA PHYSICIAN GROUP PROMEDICA EAST PHYSICIANS LLC 5855 MONROE ST SYLVANIA OH 43560 341881145 EMPLOYS PHYSICIANS OH 7735386 -1576704 PROMEDICA PHYSICIAN GROUP PROMEDICA WEST PHYSICIANS LLC 5855 MONROE ST SYLVANIA OH 43560 341893773 EMPLOYS PHYSICIANS OH 15982568 -8068901 PROMEDICA PHYSICIAN GROUP PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS LLC 5855 MONROE ST SYLVANIA OH 43560 263888045 EMPLOYS PHYSICIANS OH 30141070 -56519329 PROMEDICA PHYSICIAN GROUP PROMEDICA CARDIOTHORACIC PHYSICIANS LLC 5855 MONROE ST SYLVANIA OH 43560 270978204 EMPLOYS PHYSICIANS OH 5936506 -9670745 PROMEDICA PHYSICIAN GROUP WELLCARE PHYSICIANS LLC 5901 MONCLOVA RD MAUMEE OH 43537 611528443 EMPLOYS PHYSICIANS OH 16368856 8878730 PROMEDICA PHYSICIAN GROUP THE PHARMACY COUNTER LLC 5855 MONROE ST SYLVANIA OH 43560 271325141 MEDICAL EQUIPMENT & PHARMACY OH 60641144 17065865 PROMEDICA PHYSICIAN GROUP WOLF CREEK ASSOCIATES LLC 901 KIMOLE LN ADRIAN MI 49221 383164818 FACILITY LEASING MI 131432 1308580 EMMA L BIXBY MEDICAL CENTER PROMEDICA MONROE CARDIOLOGY PLLC 5855 MONROE ST SYLVANIA OH 43560 272920342 EMPLOYS PHYSICIANS MI 2425382 -3059070 PROMEDICA PHYSICIAN GROUP ERIE WEST HOSPICE & PALLIATIVE CARE LLC 5855 MONROE ST SYLVANIA OH 43560 205752995 PROVIDES HOSPICE CARE OH 4709330 7039875 PROMEDICA PHYSICIANS AND CONTINUUM SERVICES PROMEDICA ANESTHESIA CONSULTANTS LLC 5855 MONROE ST SYLVANIA OH 43560 453251737 EMPLOYS PHYSICIANS OH 30303052 -44305935 PROMEDICA PHYSICIAN GROUP PROMEDICA PHYSICIANS MANAGEMENT SERVICES LLC 5855 MONROE ST SYLVANIA OH 43560 453230331 PRACTICE MANAGEMENT OH 0 -2356472 PROMEDICA PHYSICIAN GROUP PROMEDICA SURGICAL SERVICES LLC 5855 MONROE ST SYLVANIA OH 43560 EMPLOYS PHYSICIANS OH 0 0 PROMEDICA PHYSICIAN GROUP MISSION POINTE GOLF COURSE LLC 2142 NORTH COVE TOLEDO OH 43606 GOLF COURSE OH 0 391382 PROMEDICA FOUNDATION PROMEDICA INNOVATIONS LLC 1801 RICHARDS RD TOLEDO OH 43607 INVESTMENT COMPANY OH 0 0 PROMEDICA HEALTH SYSTEM INC PROMEDICA GENITO-URINARY SURGEONS LLC 5855 MONROE ST SYLVANIA OH 43560 461120436 EMPLOYS PHYSICIANS OH 11558436 -14936580 PROMEDICA PHYSICIAN GROUP PROMEDICA MONROE PHYSICIANS PLLC 5855 MONROE ST SYLVANIA OH 43560 461111822 EMPLOYS PHYSICIANS MI 27275 -757452 PROMEDICA PHYSICIAN GROUP PROMEDICA MULTI-SPECIALTY PHYSICIANS LLC 5855 MONROE ST SYLVANIA OH 43560 454976786 EMPLOYS PHYSICIANS OH 0 159481 PROMEDICA PHYSICIAN GROUP PROMEDICA HOSPITALISTS LLC 5855 MONROE ST SYLVANIA OH 43560 EMPLOYS PHYSICIANS OH 0 0 PROMEDICA PHYSICIAN GROUP PROMEDICA HOSPITALISTS PLLC 5855 MONROE ST SYLVANIA OH 43560 EMPLOYS PHYSICIANS MI 0 0 PROMEDICA PHYSICIAN GROUP MEMORIAL ANESTHESIA LTD 715 SOUTH TAFT AVE FREMONT OH 43420 205763680 EMPLOYS PHYSICIANS OH 0 0 PROMEDICA PHYSICIAN GROUP MEMORIAL PROFESSIONAL SERVICES LTD 715 SOUTH TAFT AVE FREMONT OH 43420 273763993 EMPLOYS PHYSICIANS OH 10132691 -381185 PROMEDICA PHYSICIAN GROUP PHS VENTURES LLC 1801 RICHARDS RD TOLEDO OH 43607 341880473 HEALTH CARE MANAGEMENT SERVICES DE 0 0 PROMEDICA HEALTH SYSTEM INC BAY PARK COMMUNITY HOSPITAL 2801 BAY PARK DR OREGON OH 43616 341883132 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 CARE ENTERPRISES INC 5901 MONCLOVA RD MAUMEE OH 43537 341366709 FACILITY LEASING OH 501(C)(3) 11B, II PROMEDICA HEALTH SYSTEM INC 1 DEFIANCE HOSPITAL AUXILIARY 1200 RALSTON DEFIANCE OH 43512 510173779 HOSPITAL / FOUNDATION SUPPORT OH 501(C)(3) 11D, III-O DEFIANCE HOSPITAL INC 1 DEFIANCE HOSPITAL INC 1200 RALSTON DEFIANCE OH 43512 344446484 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 EMMA L BIXBY MEDICAL CENTER 818 RIVERSIDE AVE ADRIAN MI 49221 382796005 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 EMMA L BIXBY MEDICAL CENTER AUXILIARY 818 RIVERSIDE AVE ADRIAN MI 49221 382149602 HOSPITAL / FOUNDATION SUPPORT MI 501(C)(3) 11B, II EMMA L BIXBY MEDICAL CENTER 1 FLOWER HOSPITAL 5200 HARROUN RD SYLVANIA OH 43560 344428794 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 FOSTORIA HOSPITAL ASSOCIATION 501 VAN BUREN STREET FOSTORIA OH 44830 340898745 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 FOSTORIA HOSPITAL AUXILIARY PO BOX 907 FOSTORIA OH 44830 346517634 HOSPITAL / FOUNDATION SUPPORT OH 501(C)(3) 11A, I FOSTORIA HOSPITAL ASSOCIATION 1 HERRICK MEDICAL CENTER AUXILIARY 500 E POTTAWATAMIE ST TECUMSEH MI 49286 383076105 HOSPITAL / FOUNDATION SUPPORT MI 501(C)(3) 11B, II HERRICK MEMORIAL HOSPITAL INC 1 HERRICK MEMORIAL HOSPITAL INC 500 E POTTAWATAMIE ST TECUMSEH MI 49286 383049015 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 LENAWEE LONG TERM CARE 700 LAKESHIRE TR ADRIAN MI 49221 382879330 LONG TERM CARE MI 501(C)(3) 9 EMMA L BIXBY MEDICAL CENTER 1 PROMEDICA CONTINUING CARE SERVICES CORP 5855 MONROE ST SYLVANIA OH 43560 344492440 LONG TERM AND HOME HEALTH CARE OH 501(C)(3) 9 PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 1 PROMEDICA COURIER SERVICES INC 3170 W CENTRAL AVE TOLEDO OH 43606 260324790 COURIER SERVICE OH 501(C)(3) 11B, II PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 1 PROMEDICA HEALTH SYSTEM INC 1801 RICHARDS RD TOLEDO OH 43607 341517671 PARENT COMPANY OF HEALTH SYSTEM OH 501(C)(3) 11B, II N/A 0 PROMEDICA INDEMNITY CORP ONE CHURCH ST 5TH FLOOR BURLINGTON VT 05401 341931936 PROFESSIONAL & GENERAL LIABILITY VT 501(C)(3) 11B, II PROMEDICA HEALTH SYSTEM INC 1 PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 5855 MONROE ST SYLVANIA OH 43560 341880767 PHYSICIAN MANAGEMENT SERVICES OH 501(C)(3) 11B, II PROMEDICA HEALTH SYSTEM INC 1 PROMEDICA PHYSICIAN GROUP 5855 MONROE ST SYLVANIA OH 43560 341899439 PHYSICIAN HEALTH CARE SERVICES OH 501(C)(3) 9 PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 1 ST LUKE'S HOSPITAL 5901 MONCLOVA RD MAUMEE OH 43537 344428232 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 ST LUKE'S HOSPITAL FOUNDATION 5901 MONCLOVA RD MAUMEE OH 43537 341292849 FOUNDATION OH 501(C)(3) 11B, II PROMEDICA HEALTH SYSTEM INC 1 PROMEDICA FOUNDATION 2142 N COVE BLVD TOLEDO OH 43606 341517672 FOUNDATION OH 501(C)(3) 11B, II PROMEDICA HEALTH SYSTEM INC 1 THE TOLEDO HOSPITAL 2142 N COVE BLVD TOLEDO OH 43606 344428256 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 TOLEDO DISTRICT NURSE ASSOCIATION 1946 N 13TH STREET TOLEDO OH 43624 344427949 SKILLED HOME CARE OH 501(C)(3) 9 PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 1 VISITING NURSE HOSPICE AND HEALTH CARE 5855 MONROE ST SYLVANIA OH 43560 341831624 HOSPICE HOME CARE OH 501(C)(3) 9 PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 1 KAITLYN'S COTTAGE INC 1260 RALSTON AVE DEFIANCE OH 43512 454781053 RESPITE CARE OH 501(C)(3) 9 DEFIANCE HOSPITAL INC 1 MEMORIAL HOSPITAL 715 SOUTH TAFT AVE FREMONT OH 43420 344430849 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 MONROE COMMUNITY HEALTH SERVICES 718 N MACOMB MONROE MI 48162 382934134 LONG TERM CARE MI 501(C)(3) 9 MERCY MEMORIAL HOSPITAL CORPORATION 1 MERCY MEMORIAL HOSPITAL CORPORATION 718 N MACOMB MONROE MI 48162 381984289 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 PARAMOUNT ADVANTAGE 1901 INDIAN WOOD CIR MAUMEE OH 43537 203376102 HEALTH INSURANCE OH 501(C)(3) 9 PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES 1 BIXBY MEDICAL OFFICE LIMITED PARTNERSHIP 818 RIVERSIDE AVE ADRIAN MI 49221 382972398 FACILITY LEASING MI EMMA L BIXBY MEDICAL CENTER RELATED 36791 1173776 0 1 0.64600 REYNOLDS RD SURGICAL CENTER LLC 2865 N REYNOLDS RD TOLEDO OH 43615 311569454 FREESTANDING AMBULATORY SURGICAL CENTER OH THE TOLEDO HOSPITAL RELATED 726688 2333126 0 0 0.65040 WATERVILLE MEDICAL CENTER LLC 5901 MONCLOVA RD MAUMEE OH 43537 320160784 FACILITY LEASING OH CARE ENTERPRISES INC RELATED 32184 753658 0 0 0.70000 NORTHWEST OHIO DEDICATED BREAST MRI LLC 5901 MONCLOVA RD MAUMEE OH 43537 260679898 MEDICAL DIAGNOSTICS OH THE TOLEDO HOSPITAL RELATED 211264 449126 0 0 0.50000 WEST CENTRAL SURGICAL CENTER LLC 7055 W CENTRAL TOLEDO OH 43617 200088459 AMBULATORY SURGICAL CENTER OH THE TOLEDO HOSPITAL RELATED 298291 2912457 0 1 0.50000 OHIO CARE AMBULATORY SURGICAL CENTER LLC 5959 MONCLOVA RD MAUMEE OH 43537 341863472 AMBULATORY SURGICAL CENTER OH ST LUKE'S HOSPITAL RELATED 73215 1293530 0 0 0.54680 LENAWEE PHYSICIAN HOSPITAL ORGANIZATION LLC 818 RIVERSIDE AVE ADRIAN MI 49221 383605511 PHYSICIAN MANAGEMENT SERVICES MI EMMA L BIXBY MEDICAL CENTER RELATED -23464 253470 0 1 0.50000 PROMEDICA SURGICAL SERVICES CO-MANAGEMENT CO LLC 5901 MONCLOVA RD MAUMEE OH 43537 461989695 PHYSICIAN MANAGEMENT SERVICES OH PROMEDICA HEALTH SYSTEM INC RELATED 743257 816423 0 0 0.51920 EAST-WEST HOLDINGS LTD 715 SOUTH TAFT AVE FREMONT OH 43420 204066818 REAL ESTATE OH MEMORIAL HOSPITAL RELATED 6016 306259 0 0 0.50000 SURGICAL INSTITUTE OF MONROE LLC 1051 S TELEGRAPH RD MONROE MI 48161 270843485 AMBULATORY SURGICAL CENTER MI PROMEDICA PHYSICIANS AND CONTINUUM SERVICES RELATED 4044 3684750 0 0 0.54000 PROMEDICA MASTER TENANT LLC 1801 RICHARDS RD TOLEDO OH 43607 475288490 REAL ESTATE OH PROMEDICA MANAGER MEMBER LLC RELATED 103328 0 1 0.01000 PROMEDICA DOWNTOWN CAMPUS LANDLORD LLC 1801 RICHARDS RD TOLEDO OH 43607 473163945 REAL ESTATE OH PROMEDICA MANAGER MEMBER LLC RELATED 22771216 0 1 0.90000 CARE HOLDINGS 5901 MONCLOVA RD MAUMEE OH 43537 341796790 HOLDING COMPANY OH PROMEDICA HEALTH SYSTEM INC C 1.00000 1 HERRICK MEMORIAL DEVELOPMENT CORP 500 E POTTAWATAMIE TR ADRIAN MI 49221 383146907 FACILITY LEASING MI EMMA L BIXBY MEDICAL CENTER C 906 964439 1.00000 1 LHA PHYSICIAN SERVICES CORPORATION 818 RIVERSIDE AVE ADRIAN MI 49221 611451576 PHYSICIAN BILLING MI EMMA L BIXBY MEDICAL CENTER C -44391 1.00000 1 PHYSICIANS ADVANTAGE MSO 5901 MONCLOVA RD MAUMEE OH 43537 061811760 PHYSICIAN MANAGEMENT SERVICES OH PROMEDICA HEALTH SYSTEM INC C 1.00000 1 PROMEDICA CENTRAL CORPORATION OF MICHIGAN 5855 MONROE ST SYLVANIA OH 43560 383322278 PHYSICIAN HEALTH CARE SERVICES OH PROMEDICA PHYSICIAN GROUP C -1047084 3582068 1.00000 1 PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES 1901 INDIAN WOOD CIR MAUMEE OH 43537 341570675 HEALTH CARE INSURANCE OH PROMEDICA HEALTH SYSTEM INC C 76588676 344035035 1.00000 1 PROMEDICA NORTH PHYSICIAN CORPORATION 5855 MONROE ST SYLVANIA OH 43560 383482148 PHYSICIAN HEALTH CARE SERVICES OH PROMEDICA PHYSICIAN GROUP C 203340 1.00000 1 PROMEDICA RETAIL GROUP INC 3890 MONROE ST TOLEDO OH 43606 341159928 FLORIST OH PROMEDICA PHYSICIANS AND CONTINUUM SERVICES C 485 1016984 1.00000 1 HERRICK MEMORIAL OFFICE PLAZA CONDOMINIUM ASSOCIATION 818 RIVERSIDE AVE ADRIAN MI 49221 383639616 FACILITY MANAGEMENT MI HERRICK MEMORIAL DEVELOPMENT CORP C 45 55879 0.71800 1 PROMEDICA HEALTH NETWORK INC 1801 RICHARDS RD TOLEDO OH 43607 474006496 PHYSICIAN MANAGEMENT SERVICES OH PROMEDICA HEALTH SYSTEM INC C 1.00000 1 MONROE HEALTH VENTURES 718 N MACOMB MONROE MI 48164 382704426 PHARMACY MI MERCY MEMORIAL HOSPITAL CORPORATION C 1.00000 1 PROMEDICA MANAGER MEMBER LLC 1801 RICHARDS RD TOLEDO OH 43607 475168737 REAL ESTATE OH PROMEDICA HEALTH SYSTEM INC C 9536974 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 MERCY MEMORIAL HOSPITAL CORPORATION N 351998 FMV MERCY MEMORIAL HOSPITAL CORPORATION O 402987 FMV MERCY MEMORIAL HOSPITAL CORPORATION P 52012 FMV