2015-01-13T09:57:47-06:00 2014-02-28 990 2013-03-01 381218485 CareLink of Jackson a Community-Owned Speciality Hospital CARE 5177871440 110 North Elm Avenue Jackson MI 49202 Dale L Friesen Chief Financial Officer 5177871440 2014-01-06 2013 2016-02-25 16:41:14Z J Mark Fall 110 North Elm Avenue Jackson MI 49202 16115218 0 X www.carelinkofjackson.org X 2003 MI To provide long-term acute healthcare to the residents of Jackson, MI and surrounding areas. 7 4 183 1 0 0 0 13415 16594715 15795945 -903 299 231693 257874 16825505 16067533 0 0 0 0 6928712 6905485 0 0 0 9277929 8943664 16206641 15849149 618864 218384 6921794 6551926 3230157 2641905 3691637 3910021 X CareLink of Jackson is committed to holistic care of individuals with complex medical needs. 0 0 13783494 15842154 CareLink of Jackson 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 may be expected to require a longer acute hospital stay may be considered for admission.CareLink of Jackson is a free-standing hospital whereby patients are accepted from multiple sources. Patients are frequently referred to CareLink of Jackson from other acute care hospitals, skilled nursing facilities, physician offices, wound clinics, and dialysis centers. During the fiscal year ended 02/28/14, CareLink of Jackson maintained an average daily census of 32.6 patients and provided 11,892 days of patient care. Due to the complex medical needs served by the hospital, the average patient resided at the facility for 26.1 days. Approximately 85.6% of all discharged patients were Medicare-eligible. 13783494 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 12 0 1 183 1 0 0 0 0 0 0 0 0 0 0 X 7 4 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Dale L Friesen 5177964475 110 North Elm Avenue Jackson MI 49202 Ondrea Bates Trustee 1.00 60.00 X 0 93174 0 Karen Chaprnka Trustee 1.00 60.00 X 0 416975 35339 Brent Ellis Chairman 5.00 0.00 X 0 0 0 Michael K Falahee Trustee 1.00 0.00 X 0 0 0 Maryanne Fuchs Trustee 1.00 0.00 X 0 0 0 Greg Patten MD Trustee 1.00 1.00 X 0 2000 0 David Schmidt Trustee 1.00 0.00 X 0 0 0 J Mark Fall CEO 40.00 0.00 X 0 0 0 Dale Friesen CFO 50.00 0.00 X 0 0 0 Jeremy Curtis Director Clinical Services 50.00 0.00 X 130968 0 11683 130968 512149 47022 1 0 1 0 Greentree Healthcare Partners LLC 3296 Hutton Drive Marietta GA 30066 Management Services 839492 Pulmonary Clinic of Southern Michigan 900 E Michigan Avenue Jackson MI 49201 Healthcare Services 239272 Fresenius Management Services Inc 16343 Collections Center Drive Chicago IL 60693 Healthcare Services 169803 Universal Hospital Services 6625 W 78th Street Minneapolis MN 55439 Equipment Management Services 111379 4 13415 13415 Patient Service 621990 15795945 15795945 15795945 3158 3158 256491 44826 211665 211665 211665 2859 -2859 -2859 -2859 Dietary Cafeteria 722210 43121 43121 Miscellaneous 900099 3088 3088 46209 16067533 15842154 0 211964 X 5697973 5137971 560002 80817 72735 8082 704761 634285 70476 421934 379741 42193 809388 809388 226004 226004 108390 108390 2463 2463 3765197 3765197 6783 6783 806442 625092 181350 18168 18168 283710 283710 68601 22572 46029 32 32 362983 362983 44951 40456 4495 Pharmaceuticals 1627194 1627194 Medical Supplies 678356 678356 Food 135002 135002 15849149 13783494 2065655 0 199974 199844 1877831 1158501 2261144 2677616 19861 0 87703 75801 6585315 4225847 2394751 2359468 80530 80696 6921794 6551926 638209 317699 2591948 2324206 3230157 2641905 X 3691637 3910021 3691637 3910021 6921794 6551926 218384 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2463 2463 0 Part II-B, Line 1: CareLink of Jackson pays membership dues to several non-profit advocacy groups including Michigan Hospital Association. These organizations use a portion of membership dues to lobby for causes related to CareLink of Jackson's exempt mission. 198058 198058 4640972 3087398 1553574 1612499 1138449 474050 133786 133786 2359468 Cost Report Settlement Payable 609975 Payable to Affiliate 1223890 Compensation Amounts Withheld 490341 2324206 16090216 0 16090216 -22683 -22683 16067533 15871832 22683 22683 15849149 0 15849149 Part XI, Line 4b - Other Adjustments: Revenue counted as expense in audited financial statements. Part XII, Line 2d - Other Adjustments: Revenue counted as expense in audited financial statements. Schedule D, Page 4, Part XI, Line 4b and Part XII, Line 2d Differences in audited financial and tax revenues and expenses are explained by a number of factors. These factors include but are not limited to equipment losses and rental expenses reported as expenses in the audited financial purposes. For tax returns, these amounts are moved to the revenue page of the Form 990 and netted against the appropriate revenue amount. 1 1 1 X 1 X 1 1 0 1 0 97844 97844 0.00620 97844 97844 0.00620 23563 23563 0.00150 1835 1835 0.00010 25398 25398 0.00160 123242 123242 0.00780 0 202079 10535909 11438335 -902426 X 1 1 1 1 CareLink of Jackson 110 North Elm Avenue Jackson MI 49202 www.carelinkofjackson.org X Long-Term Acute Care Hospital CareLink of Jackson 1 1 X X X X X X X X X 13 1 1 1 X X X X X X 0 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X 1 1 X 1 0 0 X X 0 0 CareLink of Jackson Part V, Section B, Line 3: Individuals contributing input for CareLink of Jackson's recent CHNAMegan Albertson, Allegiance HealthKellie Baker, LifeWaysMarilyn Bell, Michigan Purchasers Health AllianceSara Benedetto, Center for Family Health Adam Brown, Jackson County AdministrationCindy Bruner, Meridian Health PlanShelly Bullinger, Jackson County Health DepartmentKathleen Clark, YMCA Storer CampsMark Fall, CareLinkAndrew Farmer, AARP of MichiganKevin Ford, MSUTed Hilleary, Community MemberJennifer Johnson, Great Lakes IndustryDavid King, LifeWaysRay King, Allegiance HealthDavid Kirk, Allegiance HealthIrene LeCrone, United WayKatie Luke, Partnership Park Neighborhood Assoc.Katherine Martin, Community Action AgencyRebecca Mayer, AWAREPamela McCrum, Catholic Charities of Jackson Dani Meier, Jackson Public SchoolsMonica Moser, Jackson Community Foundation Wendy Murdock, United Way of Jackson CountyErin Norton, United WayAmy Pelletier, Marriage MattersRhonda Rudolph, Jackson County Health DepartmentScott Schmidt, United Way of Jackson County Amy Schultz, Allegiance HealthSteve Sukta, Intermediate School DistrictScott TenBrink, Fitness Council of Jackson Shaina Tinsey, Allegiance HealthJulie Weisbrod, Jackson County Health DepartmentTed Westmeier, Jackson County Health Department CareLink of Jackson Part V, Section B, Line 4: W.A. Foote Memorial Hospital dba Allegiance Health CareLink of Jackson Part V, Section B, Line 7: The Community Health Needs Assessment (CHNA) was presented to and formally approved by the governing body (i.e. Board of Trustees) on June 26, 2014. As such, specific programs intended to address the needs outlined in the CHNA were not yet formally implemented prior to the fiscal year-end. It is anticipated that CHNA-specific needs will be addressed beginning in the forthcoming fiscal year. CareLink of Jackson Part V, Section B, Line 20d: The hospital facility determined the maximum amounts that can be charged to FAP-eligible individuals as the commercial insurance rate of its largest contract provider. Part II, Community Building Activities: Both the organization and its affiliated healthcare entities exist for the purpose of addressing the healthcare needs of the local community. The governing bodies of the affiliated entities maintain significant representation from the local community to ensure overall community awareness, sensitivity and response. As a long-term acute care hospital, CareLink of Jackson serves as a unique discharge destination for medically complex patients upon discharge from the affiliated short-term acute care hospital (i.e. brother/sister entity). Patients admitted to CareLink of Jackson are typically not appropriate admission candidates to either skilled nursing facilities or their personal residence. Accordingly, CareLink of Jackson provides an intermediate source of specialized medical care not typically available in other communities. Part III, Line 8: The organization believes the entire shortfall reported on Line 7 should be treated as Community Benefit. CareLink of Jackson is subsidizing a government program and sustaining material losses in providing health care to Medicare recipients. Part III, Line 9b: The collection practices employed by CareLink of Jackson include telephone contact with Third-Party payors, a series of letters and telephone contacts with individual patients, and, if necessary, submission of the claim to a third-party collection agency. Part VI, Line 2: CareLink and other community partners conduct a telephone survey every three years in order to gather information on the health status of Jackson County. Through a statistically valid survey, we collect responses from over 1,000 Jackson County residents age 18 and older to a 180 question survey about their health status, insurance coverage, personal health habits and health care experiences. The specific steps involve collecting and analyzing health information for our County (including subpopulations within our County); measuring our health status against other communities, the state and the nation; prioritizing health issues within the community; creating a system for sharing this data with community organizations and residents; initiating strategic planning to address these issues through collaborative activities; and monitoring impact of health initiatives on community health outcomes. Part VI, Line 3: Patients are notified of potential eligibility for financial assistance under federal and state programs as well as the company's charity care policy. Patients are informed via direct communication with the patient account coordinator, the case manager, or various other hospital personnel. Where appropriate, patients receive an application for charity care that is to be submitted for review by the finance department. Part VI, Line 4: CareLink of Jackson population is determined geographically by the boundaries of Jackson County and various surrounding communities. As a subsidiary of Allegiance Health, a tax exempt Health System, CareLink helps serves the collective health needs of the more than 160,000 residents of Jackson County. The gender distribution of Jackson County residents is 49% female and 51% male.The age distribution of Jackson County is 26% of residents 19 years 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 65 years and older. Racial distribution of Jackson County residents according to the 2011 Census Data is 88.0% as white, 7.9% as African American, 0.7% as Asian, 0.4% as American Indian or Alaska Native, and 3.0% as some other race or two or more races. Of males aged 15 years and over, 33.0% have never married, 50.3% are married, 1.5% are separated, 2.9% are widowed, and 12.3% are divorced. Of females aged 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, health care, and social assistance (23.9%); manufacturing (18.7%); retail trade (12.1%); professional, scientific, management, administrative, and waste management services (7.7%); and arts, entertainment, recreation, accommodation, and food services (7.5%). Part VI, Line 6: The Hospital's sole corporate member is Allegiance Health Services, a 501(c)(3) organization. Other affiliates include a Hospital with a 24 hour emergency room, Foundation, a Hospice, a Volunteer Organization and a Home Health Care company, all 501(c)(3) organizations. Additionally, the hospital recently formed a clinically integrated network.The Hospital, Hospice, LTACH and Home Health Care organization work together to provide necessary medical services to the Jackson Community. The Foundation and the Volunteer Organization work closely with the Parent and the Hospital in raising funds for projects and services that would benefit the overall well-being of the community. The most recent campaign is raising funds for a Graduate Medical Education program. Previous campaigns successfully raised funds to expand and improve our cancer care service line and provided free medical care to indigent patients. The clinically integrated network works to improve patient clinical outcomes thru coordinated care and lowering overall health care costs. 0 1 0 0 0 1 0 0 0 Karen Chaprnka Trustee 0 352567 0 0 0 64408 0 22966 0 12373 0 452314 0 0 Part I, Line 3 CareLink of Jackson does not pay compensation to its CEO. CareLink contracts with Greentree Healthcare Partners for the services of the CEO. Part I, Line 4b Certain CareLink of Jackson Trustees participated in a non-qualified deferred compensation plan through their employment as officers of Allegiance Health, a related tax-exempt organization. The calendar year 2013 contribution amounts are as follows: 457(f) Contributions Ondrea Bates $5,014 Karen Chaprnka $21,054 Part I, Line 6 Greentree Healthcare Partners provides management consulting services to CareLink, including the services of the CEO, CFO, and COO, per the terms of a three-year management agreement. The agreement calls for a fixed monthly fee, plus the opportunity for Greentree to earn additional compensation that is based, in part, on the profitability of the organization. In addition to the financial measure, the additional compensation is also based on measures of quality, growth and management of the organization. Greentree Healthcare Partners LLC Contractor 809388 Reported amount is for payments made by CareLink of Jackson to Greentree Healthcare Partners for outsourced management services. J. Mark Fall, a CareLink of Jackson Officer, is a partner in Greentree Healthcare Partners. 0 Pulmonary Clinic of SO MI Contractor 241259 Reported amount is for payments CareLink of Jackson made to Pulmonary Clinic of SO MI for healthcare services. Pulmonary Clinic of SO MI is part owned by CareLink Trustee Gregg Patten. 0 Form 990, Part VI, Section A, line 3 Officers of the organization are employed by a management company. See Part VII, Section B, Independent Contractors. Form 990, Part VI, Section A, line 6 The Corporation is organized on a member basis. The sole corporate member of the Corporation is Allegiance Health Services. Form 990, Part VI, Section A, line 7a Member has the power to approve changes in those provisions of the Corporations Bylaws which affect the size, composition, and method of selection of the Board of Directors. Member has the power to elect and remove, with or without cause, the Corporation's Directors. Form 990, Part VI, Section A, line 7b Member has the power to approve any change in the Articles of Incorporation, purposes or philosophy of the Corporation; Approve plans of merger, consolidation or dissolution of the Corporation. Authorize the sale, lease, mortgage or other disposition of all or substantially all of the assets owned, held or leased by or to the Corporation. Ratify or reject operating and capital budgets developed by the Board and any non budgetary expenditures or creations of debt in excess of an amount designated by the Member from time to time. Authorize the formation or acquisition of new subsidiaries of the Corporation or the sale or other disposition of existing subsidiaries. Select the auditors for the Corporation. The Member may also take action without a meeting. Any action required or permitted to be taken at an annual or special meeting of the Member of the Corporation, may be taken without a meeting, without prior notice, and without a vote, if a consent in writing, setting forth the action so taken, is signed by the Member of the Corporation. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by CareLink's CFO and Allegiance Health's Director of Finance. Allegiance Health is a related tax exempt organization. Final copies of the return are distributed to CareLink's Board of Directors and CEO for review before the return is filed. Form 990, Part VI, Section B, line 12c CareLink of Jackson has adopted Allegiance Health's conflict of interest policy. Paragraph below details how Allegiance's policy regularly and consistently monitors and enforces compliance with the conflict of interest policy. The Board 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 review of the conflict of interest for compliance with the policy. Also, General Counsel routinely reviews upcoming Board and Committee meeting agendas to assess potential conflict situations. All employees are responsible to complete a conflict of interest statment. Trustees, directors, and key employees are required to fill out 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 allowed to deliberate in the decision or vote on the matter. Form 990, Part VI, Section B, line 15 CareLink of Jackson is managed by a third party consulting group. This contract is reviewed and approved annually by the Board of Trustees. Employees of the outside consulting group do not have a vote in approving the contract. Form 990, Part VI, Section C, line 19 The organization's governing documents are available to the public upon request and also on 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 Other Purchased Services: Program service expenses 3,765,197. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,765,197. WA Foote Memorial Hospital dba Allegiance Health 205 N East Avenue Jackson MI 49201 382027689 Exempt Hospital MI 501(c)(3) Line 3 Allegiance Health Services 1 Allegiance Health Services 205 N East Avenue Jackson MI 49201 382756428 Exempt Health System MI 501(c)(3) Line 11b, II N/A 0 Allegiance Health Foundation 205 N East Avenue Jackson MI 49201 383607833 Supports Allegiance Health MI 501(c)(3) Line 11b, II Allegiance Health Services 1 Hospice of Jackson dba Allegiance Hospice 205 N East Avenue Jackson MI 49201 382336367 Hospice Care MI 501(c)(3) Line 7 Heathlink 1 The Hospice of Jackson Endowment Fund One Jackson Square Jackson MI 49201 383422146 Raise Funds for Allegiance Hospice MI 501(c)(3) Line 11c, III-FI Allegiance Hospice 1 Healthlink 205 N East Avenue Jackson MI 49201 382756425 Home Health Care MI 501(c)(3) Line 11a, I Allegiance Health Services 1 Michigan Imaging Services 205 N East Avenue Jackson MI 49201 382895225 Medical Imaging MI 501(c)(3) Line 11a, I Allegiance Health Services 1 South Central Practice Association 205 N East Avenue Jackson MI 49201 383309805 Idle Organization MI 501(c)(3) Line 11a, I Allegiance Health Services 1 Allegiance Health Volunteers 205 N East Avenue Jackson MI 49201 386082835 Exempt Association MI 501(c)(3) Line 11d, III-O Allegiance Health Services 1 Jackson Community Medical Records 205 N East Avenue Jackson MI 49201 371502443 Electronic Medical Records MI Related 0 0 0.51000 Foote Health Center Associates 1100 E Michigan Avenue Jackson MI 49201 383017711 Lessor of Medical Condominiums MI Related 0 0 0.54430 Viking Health System Inc 205 N East Avenue Jackson MI 49201 382756161 Idle Healthcare Administration Corporation MI WA Foote Memorial Hospital C 1.00000 0 Cascades Insurance Company LTD 205 N East Avenue Jackson MI 49201 981132982 Hospital Malpractice Insurance Captive CJ WA Foote Memorial Hospital C 1.00000 0 Cascades Professional Staffing Corporation 205 N East Avenue Jackson MI 49201 383370242 Idle Staffing Corporation MI WA Foote Memorial Hospital C 1.00000 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0 0 0 WA Foote Memorial Hospital J 256491 FMV WA Foote Memorial Hospital L 707237 FMV WA Foote Memorial Hospital M 5076000 FMV