2015-05-12T09:48:24-05:00 2014-06-30 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2013-07-01 381984289 MERCY MEMORIAL HOSPITAL CORPORATION MERC 7342404520 718 N MACOMB STREET MONROE MI 48162 THOMAS W SCHILLING CFO & SR VP OF FINANCE 7342404520 2015-05-07 1 CAROL LALONDE CPA P00181637 2483522500 2013 2016-02-25 16:41:14Z THOMAS W SCHILLING 718 N MACOMB STREET MONROE MI 48162 215777616 0 X WWW.MERCYMEMORIAL.ORG X 1971 MI AS AN INDEPENDENT HEALTH CARE SYSTEM, WE PROVIDE HIGH QUALITY, COMPREHENSIVE SERVICES TO THE PEOPLE AND COMMUNITIES WE SERVE. 17 12 1831 714 5635170 -67280 1026597 2720499 163883977 159706704 5998902 11779187 -60873 -31753 170848603 174174637 11376 162673 0 0 88723092 82973526 0 0 193739 81427068 80827042 170161536 163963241 687067 10211396 193187007 202898659 90563680 87957239 102623327 114941420 X AS AN INDEPENDENT HEALTH CARE SYSTEM, WE PROVIDE HIGH QUALITY, COMPREHENSIVE SERVICES TO THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 136766684 159423 154064442 HOSPITAL BASED HEALTHCARE SERVICES -A MULTITUDE OF HEALTH CARE SERVICES WERE PROVIDED BY THE HOSPITAL TO THE PEOPLE OF MONROE COUNTY AND SURROUNDING AREAS. THESE PROGRAM SERVICES INCLUDED VARIOUS ASPECTS OF INPATIENT, OUTPATIENT, AND EMERGENCY CARE. THIS CARE WAS PROVIDED IN A MANNER THAT RESPECTED THE VALUE, PRIVACY, AND DIGNITY OF INDIVIDUAL PATIENTS AND THEIR FAMILIES. FURTHER, CONTINUOUS EFFORTS WERE MADE TO IDENTIFY AND IMPLEMENT NEW AND BETTER WAYS TO MEET THE PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL NEEDS OF PATIENTS. DURING THE YEAR THE HOSPITAL PROVIDED:[A] 36,300 DAYS OF ACUTE CARE FOR ADULT AND PEDIATRIC INPATIENTS,[B] 1,365 DAYS OF ACUTE CARE FOR NEWBORNS,[C] EMERGENCY CARE FOR 43,567 OUTPATIENT VISITS, AND[D] 1,289,432 OUTPATIENT SERVICES REGISTRATIONS. 104137 3000 105824 HOSPITAL GUILD - 100 MEMBERS RENDERED SERVICES TO THE HOSPITAL AND ITS PATIENTS BY OPERATING A GIFT SHOP, KNITTING CAPS FOR NEWBORNS, MAKING CRADLE PICTURES AVAILABLE, ASSISTING IN THE INTERNAL TRANSPORTATION OF PATIENTS AND ASSISTING IN OTHER PATIENT RELATED ACTIVITIES THROUGHOUT THE HOSPITAL. THE GIFT SHOP AND CRADLE PICTURES ARE PRIMARILY FOR THE CONVENIENCE OF EMPLOYEES, PATIENTS AND VISITORS. THE GUILD ALSO OFFERS SOME NURSING SCHOLARSHIPS. 33725 250 HOSPITAL MEDICAL STAFF - 343 MEMBERS [A] DIRECTED AND REVIEWED HOSPITAL BASED HEALTHCARE SERVICES AND [B] PARTICIPATED IN PERIODIC MEETINGS CONCERNING THE DELIVERY OF HEALTHCARE SERVICES, INCLUDING MEDICAL EDUCATION. 136904546 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 1 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 0 0 1 244 1 1 1831 1 1 1 1 CJ 0 0 0 1 1 0 0 0 0 X 17 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THOMAS W SCHILLING 7342404520 718 N MACOMB STREET MONROE MI 48162 BHURGRI MD AAMER CHIEF OF STAFF - EX OFFICIO 4.00 2.00 X 71341 22400 0 CALENDAR KAREN TRUSTEE 1.00 1.00 X 0 0 0 CHARBONEAU DO MICHAEL TRUSTEE, SURGEON 40.00 1.00 X 563524 0 17005 COMPEAN MD JOSE R TRUSTEE 1.00 1.00 X 32192 0 0 DARROW KURT L VICE CHAIR 1.00 1.00 X X 0 0 0 FRANZEN VICKI L SECRETARY 1.00 1.00 X X 0 0 0 KABIR MD ABDUL TRUSTEE 1.30 1.00 X 42793 0 0 KUBISKE DAVID TRUSTEE 1.00 1.00 X 0 0 0 KULISH BARTON TREASURER 1.00 1.00 X X 0 0 0 MCNAMEE MD KENNETH J TRUSTEE 1.00 1.00 X 8362 0 0 PHILLIPS ANNETTE S PRESIDENT & CEO - EX OFFICIO 40.00 1.00 X X 411794 0 77587 RYAN SISTER JANET TRUSTEE 1.00 1.00 X 0 0 0 SPENCER EDD DONALD A CHAIR PERSON 1.00 1.00 X X 0 0 0 WALSH ARLENE R TRUSTEE 1.00 1.00 X 0 0 0 WETZEL SUZANNE TRUSTEE 1.00 1.00 X 0 0 0 WILBURN WALTER TRUSTEE 1.00 1.00 X 0 0 0 ZWACK MATTHEW TRUSTEE 1.00 1.00 X 0 0 0 SCHILLING THOMAS W CFO SENIOR VP FINANCE 40.00 1.00 X 273225 0 43261 UBRANSKI PAM CNO 40.00 X 200000 0 26776 PROCHNOW TODD PHYSICIAN 40.00 X 511529 0 16888 DHAR RAVI PHYSICIAN 40.00 X 251331 0 401 OLENCHAK DANIEL PHYSICIAN 40.00 X 434927 0 16594 CRAIG MARVIN D PHYSICIAN 40.00 X 326191 0 11060 SHERRARD MARK CMO 40.00 X 253200 0 40423 3380409 22400 249995 59 0 1 0 AUCH GEORGE W CO 735 S PADDOCK PONTIAC MI 48341 CONSTRUCTION MGT. 2234981 MCKESSON INFORMATION SERVICES 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 SOFTWARE SERVICES 2051828 MICHIGAN CO-TENANCY LABS DEPT CH 14271 PALATINE IL 60055 LABORATORY SERVICES 1052290 ALLSCRIPTS 3 RAVINA DRIVE ATLANTA GA 30346 SOFTWARE SERVICES 867016 GE HEALTHCARE 101 CARNEGIE CENTER PRINCETON NJ 08540 EQUIPMENT SERVICES 778292 53 16700 87044 2000000 6109 610646 64525 2720499 HOSPITAL BASED HEALTHCARE SERVICE 621990 153965710 153965710 NON-PATIENT PHARMACY 446110 4215698 4215698 NON-PATIENT REF. LAB 621500 1154235 1154235 DME 446110 265237 265237 HOSPITAL GUILD 621990 105824 105824 159706704 1535688 1535688 1009352 1095754 -86402 -86402 -86402 50142705 271183 40170389 0 9972316 271183 10243499 10243499 128969 87044 171820 -42851 -42851 44200 45432 -1232 -1232 218316 119584 98732 98732 174174637 154170266 5635170 11648702 159173 159173 3500 3500 1770611 878259 892352 65291170 54605923 10579049 106198 476872 395202 80913 757 10626137 8898716 1710287 17134 4808736 3985180 815922 7634 861639 861639 398495 398495 206177 206177 20541 20541 415206 415206 15663929 10939806 4713126 10997 399619 38009 361610 1611436 839158 769184 3094 3241126 136102 3105024 3502744 3232094 270650 193621 191560 2061 396113 193047 203066 2526679 2526679 11090733 10233536 856938 259 6639 -594541 601180 HOSPITAL SUPPLIES 24366698 24365162 1536 PROVISION FOR BAD DEBTS 9434022 9434022 QAAP 5593142 5593142 DIETARY SUPPLIES 850817 850817 47666 47666 163963241 136904546 26864956 193739 192721 165649 9798063 13585691 22898993 23767114 28684 0 2588472 2868296 2297646 2347232 210109526 129486230 80626924 80623296 71881207 76845506 428576 512422 132458 88305 2313263 2095148 193187007 202898659 42542630 39132784 42886500 41915594 5134550 6908861 90563680 87957239 X 99097292 111315255 3470122 3568281 55913 57884 102623327 114941420 193187007 202898659 X 10211396 3219010 -1112313 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20541 20541 0 PART II-B, LINE 1: THE ORGANIZATION PAID DUES TO ORGANIZATIONS WHICH PERFORMED LOBBYING ACTIVITIES. 3526034 777566 88640 766075 3626165 3429748 1122390 93639 1119743 3526034 3254087 1265452 96131 2500 1183422 3429748 3106926 1263779 87576 1204194 3254087 4973922 1132367 168896 3168259 3106926 0.98000 0.02000 0 0 15571742 15571742 65321353 38880539 26440814 3976929 3464107 512822 124916963 87141584 37775379 322539 322539 80623296 X PART V, LINE 4: TRUE ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR NURSING SCHOLARSHIPS. QUASI-ENDOWMENT FUNDS HAVE BEEN DESIGNATED FOR VARIOUS USES TO FURTHER THE HOSPITAL'S MISSION TO PROVIDE QUALITY, COMPREHENSIVE HEALTH CARE SERVICES. SOME OF THESE DESIGNATIONS INCLUDE HOSPICE, CHAPLAINCY, CANCER TREATMENT ASSISTANCE, CAPITAL IMPROVEMENTS, AND PHARMACY ASSISTANCE. PART X, LINE 2: THE CORPORATION AND MCHS ARE NOT-FOR-PROFIT ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND M TRUST IS AN EXEMPTED COMPANY UNDER THE COMPANIES LAW OF THE CAYMAN ISLANDS; ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. WITH FEW EXCEPTIONS, THE CORPORATION IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE, AND LOCAL, OR NON-U.S. INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2014, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICE PAYMENTS TO FOREIGN INSURANCE COMPANY THAT PROVIDES INSURANCE TO THE HOSPITAL 1576016 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 7751781 0 0 0 0 0 0 9327797 0 9327797 1 0 1 0 0 0 FANTASY OF TREES 2013 159636 36930 122706 72465 8938 28185 1250 21709 GOLF OUTING 2014 45395 45395 3479 13451 1 10982 4719 6263 5752 3466 6263 6862 216013 87044 128969 81696 12404 47899 1250 28571 171820 -42851 44200 500 43695 1237 1 1.00000 44200 500 43695 1237 45432 -1232 MI 1 0 1 0 0.10000 0.90000 MOLLY MOORE 718 N MACOMB STREET MONROE MI 48162 0 MOLLY MOORE 3700 OVERSEES GAMING ACTIVITIES AND RECORDKEEPING X 0 1 1 X 1 X 0 1 1 1 0 1 1 3256899 3256899 0.02110 27349292 21532372 5816920 0.03760 30606191 21532372 9073819 0.05870 1026913 7599 1019314 0.00660 76 459 1070459 1070459 0.00690 263512 150 263362 0.00170 38 29155 29155 0.00020 114 459 2390039 7749 2382290 0.01540 114 459 32996230 21540121 11456109 0.07410 25337 25337 0.00020 31 2837 16957 16957 0.00010 102 102 0.00000 45053 45053 0.00040 4 355 9477 9477 0.00010 4 33 24091 24091 0.00020 39 3225 121017 121017 0.00100 1 9434022 943402 42386130 46876374 -4490244 X 1 1 1 1 MERCY MEMORIAL HOSPITAL CORPORATION 718 N MACOMB STREET MONROE MI 48162 X X X MERCY MEMORIAL HOSPITAL CORPORATION 1 1 X X X X X X X X X 13 1 0 1 X FULL WEBSITE LISTED IN PART V SECTION C X X X X X X X 0 0 1 1 200.000000000000 0 1 X X X X 1 1 X 1 0 X X X 1 X 0 0 MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 3: THE HOSPITAL CONSULTED WITH THE FOLLOWING INDIVIDUALS ON THE INDICATED AREAS: KIM COMERZAN, DIRECTOR MONROE COUNTY HEALTH DEPT AND DR. TATYANA IVANOVA, COMMUNITY HEALTH DIRECTOR MONROE COUNTY HEALTH DEPT., ON THE DEVELOPMENT OF COMMON CHNA SECONDARY DATA SET, CHN PRIORITIES, AND DESIGN OF FUTURE CHNA STUDIES AND REPORTS. ED LARKINS, EXECUTIVE DIRECTOR FAMILY MEDICAL CENTER OF MICHIGAN FEDERALLY QUALIFIED CLINIC, AND DR. SUSAN HULSEMANN, DIRECTOR FAITHWORKS MEDICAL CLINIC FOR WORKING UNINSURED, ON THE NEEDS OF UNINSURED AND UNDERINSURED. ROB WHITNEY, COMMANDER MONROE COUNTY SALVATION ARMY, AND CONNIE CARROLL, EXECUTIVE DIRECTOR MONROE COUNTY UNITED WAY, ON NEEDS OF INDIGENT AND UNINSURED.ANDREA MULHEISEN, DIRECTOR NETWORK DEVELOPMENT FOR THE AREA AGENCY ON AGING 1B, AND JEFF MCBEE, DIRECTOR MONROE COUNTY COMMISSION ON AGING, ON NEEDS OF ELDERLY. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 5D: THE CHNA IS AVILABLE AT HTTP://WWW.MERCYMEMORIAL.ORG/MAIN/COMMUNITYBENEFIT.ASPXTHE ASSOCIATED IMPLEMENTATION PLAN CAN BE ACCESSED AT HTTP://WWW.MERCYMEMORIAL.ORG/RESOURCE.ASHX?SN=CHNA_IMPLEMENTATIONPLAN THE ANNUAL SCORECARD AT HTTP://WWW.MERCYMEMORIAL.ORG/RESOURCE.ASHXSN=CHNPLANSCORECARD MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 7: THE IMPLEMENTATION PLAN INCLUDES ONLY CHNA IDENTIFIED NEEDS NOT CURRENTLY BEING ADDRESSED BY THE HOSPITAL. THE FOLLOWING NEEDS ARE, THEREFORE, NOT INCLUDED IN THE IMPLEMENTATION PLAN: SMOKING CESSATION- THE HOSPITAL CONTINUES TO IDENTIFY AND COUNSEL INPATIENTS WHO SMOKE, CONTINUES TO OFFER CESSATION CLASSES TO THE COMMUNITY, CONTINUES TO MAINTAIN A SMOKE FREE CAMPUS, AND CONTINUES TO HIRE ONLY NON-SMOKERS. MENTAL HEALTH SERVICES AND SUBSTANCE ABUSE- THE HOSPITAL CONTINUES TO OPERATE THE ONLY LICENSED INPATIENT PSYCHIATRIC UNIT IN MONROE COUNTY, CONTINUES TO PROVIDE OUTPATIENT PSYCHIATRY AND COUNSELING SERVICES, AND CONTINUES TO RECRUIT ADULT AND CHILD PSYCHIATRISTS.PREVENTION OF INJURIES- THE HOSPITAL CONTINUES TO PROVIDE AMBULANCE AND EMT COVERAGE OF COMMUNITY EVENTS, CONTINUES TO ACTIVELY PARTICIPATE IN INFANT AND CHILD SAFETY PROGRAMS OFFERED BY OTHER COMMUNITY AGENCIES, AND CONTINUES TO OFFER FIRST AID CLASSES TO THE COMMUNITY. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 11: THE FINANCIAL ASSISTANCE POLICY IS FOR FREE CARE AND THE ONLY OTHER DISCOUNTED CARE AVAILABLE IS FOR ANY PATIENT PAYING WITHIN 30 DAYS RECEIVES A 20% DISCOUNT. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 20D: FAP-ELIGIBLE INDIVIDUALS ARE NOT CHARGED AND DO NOT RECEIVE A BILL IF THEY QUALIFY UNDER THE HOSPITAL'S FAP. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 22: CHARGES ARE ENTERED FOR ALL PATIENTS WHO RECEIVE SERVICES REGARDLESS OF INSURANCE OR LACK THEREOF. IF A PATIENT QUALIFIES FOR CHARITY CARE, A CHARITY CARE ADJUSTMENT IS MADE SO THE PATIENT DOES NOT RECEIVE A BILL. 32 MMH REHAB 700 STEWART ROAD MONROE MI 48162 REHAB SERVICES DIAGNOSTIC CENTER 901 N MACOMB STREET MONROE MI 48162 DIAGNOSTIC, CARDIOPULMONARY, LAB MERCY MEMORIAL HOSPICE 1070 N MONROE STREET MONROE MI 48162 HOSPICE SERVICES HOME CARE CONNECTION 1070 N MONROE STREET STE A MONROE MI 48162 HOME CARE SERVICES WESTSIDE MEDICAL 100 POWELL DUNDEE MI 48131 DIAGNOSTIC THERAPY, LAB PHLEBOTOMY-DELISLE CENTER 1056 N MONROE STREET MONROE MI 48162 OUTREACH LAB BEHAVIORAL HEALTH 700 STEWART RD MONROE MI 48162 BEHAVIORAL HEALTH MMH OUTPATIENT SURGERY CENTER 750 STEWART ROAD MONROE MI 48162 AMBULATORY SURGERY CENTER HOME RESPIRATORY DME 1070 N MONROE STREET STE C MONROE MI 48162 HOME RESPIRATORY DME PHLEBOTOMYXRAY-DRKABIR 219 W FRONT STREET MONROE MI 48162 OUTREACH LAB NEWPORT MEDICAL 7825 NORTH DIXIE NEWPORT MI 48166 PATIENT ACCOUNTING, LAB PHLEBOTOMY-DR STEWART 811 N MONROE STREET MONROE MI 48162 OUTREACH LAB DR MICHAEL CHARBONEAU 730 N MACOMB STREET MONROE MI 48162 DOCTOR OFFICE SLEEP LAB MACOMB 717 N MACOMB STREET MONROE MI 48162 SLEEP LAB SERVICES DR AHADI OFFICE COMPLEX 55 COLE ROAD MONROE MI 48162 OUTREACH LAB PHLEBOTMY-KARPENKO 323 STEWART ROAD MONROE MI 48162 OUTREACH LAB DR KURT ROECKER 14930 LAPLAISANCE ROAD SUITE 118 MONROE MI 48162 OUTREACH LAB DR TODD PROCHNOW 730 N MACOMB STREET SUITE 419 MONROE MI 48162 DOCTOR OFFICE PHLEBOTOMY-DR DONA 7505 GRAFTON ROAD SUITE 5 MONROE MI 48162 OUTREACH LAB PHLEBOTOMY-DR QURESHI 5290 W BROOKSHIRE ROAD MONROE MI 48161 OUTREACH LAB DR DANIEL OLENCHAK 730 N MACOMB STREET SUITE 419 MONROE MI 48162 DOCTOR OFFICE DR MARVIN CRAIG 4220 LUNA PIER ROAD LUNA PIER MI 48157 DOCTOR OFFICE DR BARNETT KANTZ 100 POWELL ROAD STE 2 DUNDEE MI 48131 DOCTOR OFFICE MMH POB 730 N MACOMB STREET MONROE MI 48162 OUTPATIENT CLINIC TEMPERANCE 1715 W DEAN ROAD TEMPERANCE MI 48182 SLEEP LAB, LAB SERVICES OUTPATIENT THERAPY 214 ELM STREET MONROE MI 48162 OCCUPATIONAL THERAPY SERVICES DR JAMES DOYLE 920 N MACOMB STREET MONROE MI 48162 DOCTOR OFFICE DR BETTY RUMSCHLAG 7470 SECOR ROAD LAMBERTVILLE MI 48144 DOCTOR OFFICE DR MICHELLE CHARTIER 7825 N DIXIE HWY NEWPORT MI 48166 DOCTOR OFFICE DR KRISTA GUSTAD 730 N MACOMB STREET STE 329 MONROE MI 48162 DOCTOR OFFICE FAMILY MEDICAL RESIDENCY CENTER 650 STEWARD ROAD MONROE MI 48162 DOCTOR OFFICE MONROE CANCER CENTER 800 STEWART ROAD MONROE MI 48162 CANCER TREATMENT PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. ACTUAL COSTS FROM THE COST ACCOUNTING SYSTEM AND ACCOUNTING RECORDS ARE USED FOR LINES 7E THROUGH 7I. PART I, LINE 7G: N/A - THE HOSPITAL DID NOT LIST ANY SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $9,434,022. PART II, COMMUNITY BUILDING ACTIVITIES: PARTICIPATION IN TASK FORCES AND COMMITTEES ASSURES A MORE COORDINATED APPROACH TO SERVICES FOR AN AGING POPULATION. EMERGENCY PREPAREDNESS AND COORDINATION OF EFFORT AMONG AGENCIES PROVIDING HUMAN SERVICES. SPECIFIC AREAS OF IMPROVEMENT INCLUDE PRE-HOSPITAL AMBULANCE CARE, REFERRAL OF SENIORS TO SUPPORTIVE COMMUNITY SERVICES, SUICIDE PREVENTION, SUBSTANCE ABUSE, AND BREASTFEEDING FOR IMPROVED CHILD HEALTH. PART III, LINE 4: PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED UP ON MANAGEMENT'S ASSESSMENT OF THE HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTABLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. THE BAD DEBT AMOUNT REPORTED ON PART III LINE 2 IS BAD DEBT EXPENSE PER THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND PER FORM 990 PART IX. PART III, LINE 3: THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS ESTIMATED AT 10 PERCENT OF BAD DEBT EXPENSE. PART III, LINE 8: THE SHORTFALL SHOULD BE CONSIDERED AND INCLUDED IN THE COMMUNITY BENEFIT AS THE REIMBURSEMENT DID NOT MEET THE "COST" OF THE EXPENSE BASED ON REASONABLE COSTING METHODOLOGIES. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. PART VI, LINE 2: SECONDARY COMMUNITY HEALTH DATA ARE CONSIDERED IN THE ANNUAL REVIEW AND ADJUSTMENT OF THE HOSPITAL'S 3-YEAR STRATEGIC PLAN; HOSPITAL LEADERS SERVE ON COMMUNITY BOARDS, COMMITTEES AND TASK FORCES WHERE NEEDS MAY BE IDENTIFIED; THE HOSPITAL AND MONROE COUNTY HEALTH DEPARTMENT ARE COLLABORATING ON DEVELOPING A PRIMARY DATA ACQUISITION PROCESS DESIGNED TO ENGAGE COMMUNITY PARTNER ORGANIZATIONS, OBTAIN BROADER INPUT FROM COMMUNITY MEMBERS ON HEALTH NEEDS AND PRIORITIES, AND PROVIDE THE FOUNDATION FOR THE NEXT CHNA. PART VI, LINE 3: WHEN IT IS DETERMINED THAT A PATIENT IS UNABLE TO PAY FOR SERVICES (EITHER BEFORE OR AFTER SERVICES ARE RENDERED) A FINANCIAL COUNSELOR WILL SPEAK TO THE PATIENT TO EXPLAIN FINANCIAL ASSISTANCE. THE FIRST OPTION OFFERED IS STATE MEDICAID. THE PATIENT IS ASSESSED FOR MEDICAID QUALIFICATION AND IF IT IS DETERMINED THE PATIENT DOES NOT QUALIFY, THEY ARE OFFERED CHARITY CARE ASSISTANCE. THE PATIENT IS GIVEN A CHARITY CARE APPLICATION AND REQUESTED TO COMPLETE AND RETURN TO THE FINANCIAL COUNSELOR WITH THE APPROPRIATE DOCUMENTATION. ONCE THE APPLICATION IS RETURNED TO THE FINANCIAL COUNSELOR, IT IS ASSEMBLED AND SENT TO THE PATIENT ACCOUNTING OFFICE FOR APPROVAL. DEPENDING ON THE AMOUNT, VARYING LEVELS OF APPROVAL ARE REQUIRED. PART VI, LINE 4: WITHIN THE 549.4 SQUARE MILES OF MONROE COUNTY A MIXED URBAN AND RURAL ENVIRONMENT IS SUPPORTED BY A DIVERSE ECONOMY. URBAN AND INDUSTRIAL DEVELOPMENTS PREDOMINATE ALONG LAKE ERIE, WHILE APPROXIMATELY 1,100 WORKING FARMS OCCUPY THE WESTERN TOWNSHIPS. FROM THE 2010 CENSUS THERE WERE 152,021 PEOPLE IN THE COUNTY IN 58,888 HOUSEHOLDS. THE RACIAL MAKEUP OF THE COUNTY WAS 94.4% WHITE, 2.1% BLACK OR AFRICAN AMERICAN, 0.3% NATIVE AMERICAN, 0.6% ASIAN, 0.8% FROM OTHER RACES, AND 1.8% FROM TWO OR MORE RACES. 96.3% SPOKE ENGLISH AT HOME. ABOUT 12.1% OF THE POPULATION WAS BELOW THE FEDERAL POVERTY LEVEL, AND 15,339 INDIVIDUALS UNDER 65 YEARS WERE UNINSURED. 12.8% OF THE POPULATION WAS OVER 65 YEARS. IN 2012 DECEMBER UNEMPLOYMENT WAS 7.6%. PART VI, LINE 5: THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF; THE HOSPITAL'S BOARD OF TRUSTEES IS BROADLY REPRESENTATIVE OF THE COMMUNITY; HOSPITAL LEADERS SERVE ON COMMUNITY BOARDS, COMMITTEES AND TASKFORCES THAT ADDRESS HEALTH AND HUMAN SERVICES ISSUES. PART VI, LINE 6: N/A - NOT AFFILIATED. PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: THE HOSPITAL IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT IN MICHIGAN OR ANY OTHER STATE. 1 MONROE COMMUNITY HEALTH SERVICES 718 N MACOMB STREET MONROE MI 48164 382934134 501(C)(3) 154104 N/A N/A SUPPORT THE PURPOSE OF THE ORGANIZATION 1 PART I, LINE 2: FOR GRANTS MADE TO MONROE COMMUNITY HEALTH SERVICES, ACCOUNTS HAVE MONTHLY BUDGETED DOLLAR AMOUNTS. WHEN ACTUAL COSTS ARE RECORDED FOR THE MONTH, A COMPARISION IS MADE TO THE BUDGET AND APPROPRIATE VARIANCE ANALYSIS IS PERFORMED WHERE INDICATED TO EXAMINE THE SOURCE OF THE VARIANCE. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 CHARBONEAU DO MICHAEL TRUSTEE, SURGEON 562549 0 75 0 900 0 0 0 17005 0 580529 0 0 0 PHILLIPS ANNETTE S PRESIDENT & CEO - EX OFFICIO 406994 0 0 0 4800 0 61049 0 16538 0 489381 0 0 0 SCHILLING THOMAS W CFO SENIOR VP FINANCE 267225 0 0 0 6000 0 26723 0 16538 0 316486 0 0 0 UBRANSKI PAM CNO 200000 0 0 0 0 0 20000 0 6776 0 226776 0 0 0 PROCHNOW TODD PHYSICIAN 495231 0 75 0 16223 0 0 0 16888 0 528417 0 0 0 DHAR RAVI PHYSICIAN 249986 0 75 0 1270 0 0 0 401 0 251732 0 0 0 OLENCHAK DANIEL PHYSICIAN 417516 0 75 0 17336 0 0 0 16594 0 451521 0 0 0 CRAIG MARVIN D PHYSICIAN 325259 0 75 0 857 0 0 0 11060 0 337251 0 0 0 SHERRARD MARK CMO 248400 0 0 0 4800 0 23885 0 16538 0 293623 0 0 0 PART I, LINE 1A THE HOSPITAL MAINTAINS A MEMBERSHIP WITH A COMMUNITY GOLF / COUNTRY CLUB. THE MEMBERSHIP IS INTENDED FOR THE GENERAL USE OF THE HOSPITAL, AND IS MAINTAINED UNDER THE NAME OF THE CHIEF EXECUTIVE OFFICER (AS A REPRESENTATIVE MUST BE NAMED IN THIS INSTANCE). USE OF THE MEMBERSHIP IS MADE AVAILABLE FOR BUSINESS PURPOSES ONLY, AND PERSONAL USE IS PROHIBITED. FACILITIES AT THE COUNTRY CLUB ARE USED FOR HOSPITAL FUNCTIONS, BUSINESS MEETINGS, VOLUNTEER RECOGNITION, AND FUNDRAISING. THIS BENEFIT IS NOT TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B THE ORGANIZATION OFFERS SELECT MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES ANNUAL EMPLOYER-FUNDED CONTRIBUTIONS EQUAL TO A FIXED PERCENT OF BASE SALARY: 15% FOR CEO, 10% FOR SENIOR VICE PRESIDENTS AND 5% FOR VICE PRESIDENTS. BENEFITS ARE VESTED AFTER THREE YEARS OF SERVICE AND ARE PAID OUT IN A LUMP SUM BY MARCH 15 OF THE YEAR FOLLOWING THE YEAR IN WHICH THEY BECOME VESTED. THE FOLLOWING INDIVIDUALS REPORTED ON FORM 990, PART VII ARE PARTICIPANTS: ANNETTE PHILLIPS, THOMAS SCHILLING AND JOHN KIBBLE. A COUNTY OF MONROE HOSPITAL FINANCE AUTHORITY 386004873 610648AR8 2006-06-15 50405076 CONSTRUCTION PROJECT ADDING 58,995 SQ FT; RENOVATING 66,910 SQ FT 0 0 0 B COUNTY OF MONROE HOSPITAL FINANCE AUTHORITY 386004873 2012-03-30 3170830 CATH LAB RENOVATION AND EQUIPMENT 0 0 0 C COUNTY OF MONROE HOSPITAL FINANCE AUTHORITY 386004873 2013-12-23 3100000 MRI & CT CONSTRUCTION AND EQUIPMENT 0 0 0 A 52639779 3812411 709013 36382719 2009 1 0 1 1 B 3170830 30000 3140830 2012 0 0 1 1 C 3060500 39500 3100000 2014 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 0 B 0 0 1 0 0 0 0 0 0 C 0 0 1 0 0 0 0 0 0 A 1 B 1 C 1 SCHEDULE K, PART I, BOND ISSUES: MONROE COMMUNITY HEALTH SERVICES IS A MEMBER OF THE MERCY MEMORIAL HOSPITAL CORPORATION OBLIGATED GROUP OF WHICH MONROE COMMUNITY HEALTH SERVICES HAS BEEN ALLOCATED FUNDS FROM THIS 2006 BOND ISSUANCE. SCHEDULE K, PART I, BOND ISSUES: A- THE BOND ISSUE PRICE WAS $50,405,076.58 WITH A REDEMPTION PRICE OF $49,550,000 AT MATURITY. PROCEEDS OF THE ISSUE WERE USED FOR BOND ISSUANCE COSTS, REQUIRED RESERVE FUND, REFUND PRIOR ISSUE BONDS AND INDEBTEDNESS (02/01/1994 BONDS) AND BUILDING EXPANSION AND EQUIPMENT. B - SIEMENS PUBLIC INC. PROGRAM REVENUE NOTE ISSUE PRICE WAS $3,170,830. PROCEEDS OF THE ISSUE WERE USED FOR NOTE ISSUANCE COSTS AND CATH LAB RENOVATION EQUIPMENT. C - PNC EQUIPMENT FINANCE. LLC PROGRAM REVENUE NOTE ISSUE PRICE WAS $3,100,000. PROCEEDS OF THE ISSUE WERE USED FOR ISSUANCE COSTS AND MRI AND CT RENOVATION AND EQUIPMENT. MONROE HEALTH CENTER >35% OWNED BY BOARD MEMBER AAMER BHURGRI. 131030 LEASE OF PROPERTY 0 X 2 300 COMPARABLE SALES X 22130 COMPARABLE SALES X 1 300 COMPARABLE SALES X 1 1000 COMPARABLE SALES X AUCTION ITEMS 65 40795 COMPARABLE SALES 0 0 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS DR. KENNETH MCNAMEE, DR. AAMER BHURGRI, DR. MICHAEL CHARBONEAU, AND DR. ABDUL KABIR HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 INPUT DATA IS REVIEWED AND ANALYZED BY THE CONTROLLER AND THEN SUBMITTED TO THE CERTIFIED PUBLIC ACCOUNTING FIRM FOR PREPARATION. THE COMPLETED FORM 990 IS THEN RETURNED TO THE CFO AND THE CEO FOR FINAL REVIEW AND APPROVAL BEFORE THE BOARD MEETING. BEFORE THE RETURN IS FILED, THE FORM 990 IS REVIEW BY THE BOARD. ALL MEMBERS RECEIVE A COPY OF THE FORM 990, EVEN THOSE THAT ARE UNABLE TO ATTEND THE SCHEDULED MEETING. THE REVIEW IS PERFORMED DURING ONE OF THE MONTHLY BOARD MEETINGS, WHERE EACH MEMBER HAS A CHANCE TO ASK QUESTIONS. THIS REVIEW IS DOCUMENTED VIA MINUTES TO THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS BOARD MEMBERS, OFFICERS AND EMPLOYEES OF THE HOSPITAL. ON AN ANNUAL BASIS, THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS DISTRIBUTED TO OFFICERS, EMPLOYEES, AND TRUSTEES OF MERCY MEMORIAL HOSPITAL CORPORATION. POTENTIAL CONFLICTS OF INTEREST ARE ANALYZED BY THE HOSPITAL'S LEGAL DEPARTMENT AND ARE GIVEN RANKINGS OF LOW, MODERATE, AND SEVERE RISK. THIS ANALYSIS IS GIVEN TO THE BOARD CHAIR AND THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. ANY MEMBER WITH AN IDENTIFIED CONFLICT OF INTEREST IS EXCUSED FROM THE MEETING DURING DISCUSSIONS PERTAINING TO THE ISSUE OF CONFLICT, AND THE MEMBER IS NOT PERMITTED TO VOTE ON ANY ISSUE OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES AND APPROVES ALL COMPENSATION FOR THOSE DESIGNATED IN SENIOR LEADERSHIP POSITIONS SUCH AS THE CHIEF EXECUTIVE OFFICER & PRESIDENT, THE CHIEF MEDICAL OFFICER & VICE PRESIDENT OF MEDICAL AFFAIRS, THE CHIEF FINANCIAL OFFICER & SENIOR VICE PRESIDENT OF FINANCE, THE CHIEF NURSING OFFICER & SENIOR VICE PRESIDENT OF CLINICAL OPERATIONS, AND OTHER VICE PRESIDENTS. THE INDEPENDENT BOARD COMMITTEE RETAINS AN OUTSIDE CONSULTANT TO ANALYZE AND ASSIST IN MAKING THESE DETERMINATIONS THROUGH A VARIETY OF MARKET SURVEYS/STUDIES. THIS PROCESS IS UNDERTAKEN ANNUALLY AND WAS LAST PERFORMED IN 2014. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT -1,112,313. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT OR SELECTION PROCESS FROM THE PRIOR YEAR. FORM 926, PART III FOLLOWING IS ADDITIONAL INFORMATION AS REQUESTED BY REGULATIONS SEC. 1.6038B-1(C) AND TEMPORARY REGULATIONS SEC. 1.6038B-1T(C)(5) AND 1.6038B-1T(D). REGULATION SEC. 1.6038B-1T(C)(1): TRANSFEROR: MERCY MEMORIAL HOSPITAL SYSTEM EIN: 38-1984289 718 NORTH MACOMB STREET MONROE, MI 48162 REGULATION SEC. 1.6038B-1T(C)(2): TRANSFEREE: (I.): M TRUST ASSURANCE COMPANY, LTD. EIN: 98-0700372 P.O. BOX 1051 GRAND CAYMAN KY1-1102, CAYMAN ISLANDS INCORPORATED IN THE CAYMAN ISLANDS (II.): INSURANCE PREMIUMS RECEIVED FROM RELATED PARTIES CONSIDERED TO BE DEEMED CONTRIBUTIONS TO CAPITAL OF THE ABOVE CORPORATION OCCURRED ON VARIOUS DATES THROUGHOUT THE YEAR. THE TOTAL AMOUNT OF THESE DEEMED CONTRIBUTIONS WAS $1,708,114. REGULATION SEC. 1.6038B-1T(C)(3): CONSIDERATION RECEIVED: NOTHING WAS RECEIVED IN CONSIDERATION IN EXCHANGE FOR DEEMED CASH CONTRIBUTIONS TO CAPITAL OF $1,708,114. THE TAXPAYER OWNED 100% OF THE STOCK OF THE TRANSFEREE CORPORATION BOTH BEFORE AND AFTER THESE TRANSFERS. REGULATION SEC. 1.6038B-1T(C)(4): PROPERTY TRANSFERRED: CASH IN THE AMOUNT OF $1,708,114 (US DOLLARS) REGULATION SEC. 1.6038B-1T(C)(5): TRANSFER OF FOREIGN BRANCH WITH PREVIOUSLY DEDUCTED LOSSES: NOT APPLICABLE REGULATION SEC. 1.6038B-1T(C)(6): APPLICATION OF IRC SEC. 367(A)(5): NOT APPLICABLE MONROE COMMUNITY HEALTH SERVICES 718 N MACOMB STREET MONROE MI 48164 382934134 SKILLED NURSING AND OUTPATIENT SURGERY MI 501(C)(3) LINE 9 MERCY MEMORIAL HOSPITAL CORPORATION 1 MONROE HEALTH VENTURES 718 N MACOMB STREET MONROE MI 48164 382704426 PHARMACY MI MERCY MEMORIAL HOSPITAL CORPORATION C 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 MONROE COMMUNITY HEALTH SERVICES L 153879 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES M 222140 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES P 82476 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES Q 1540783 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES B 154104 CASH VALUE MONROE COMMUNITY HEALTH SERVICES C 2000000 CASH VALUE