2014-11-12T15:41:34-06:00 2013-12-31 990 2013-01-01 382947657 HENRY FORD MACOMB HOSPITAL CORPORATION HENR 3138768714 ONE FORD PLACE - 5F DETROIT MI 48202 EDWARD G CHADWICK EVP/CFO 3138768714 2014-11-12 2013 2015-11-30 17:44:51Z EDWARD G CHADWICK ONE FORD PLACE - 5F DETROIT MI 48202 431641727 0 X WWW.HENRYFORD.COM/HOMEPAGE_MACOMB X 1990 DE TO IMPROVE PEOPLE'S LIVES THROUGH EXCELLENCE IN THE SCIENCE AND ART OF HEALTH CARE AND HEALING.VISION: TRANSFORMING LIVES AND COMMUNITIES THROUGH HEALTH AND WELLNESS-ONE PERSON AT A TIME. 20 14 3978 768 0 0 1329527 805484 421602532 424214179 1146386 692896 4246857 5374017 428325302 431086576 0 0 0 0 202374976 207702973 0 0 128800 211297491 222065449 413672467 429768422 14652835 1318154 312555541 318636179 246655797 228509694 65899744 90126485 X HENRY FORD MACOMB HOSPITAL (HFMH) IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM SERVING THE NORTHEASTERN METROPOLITAN DETROIT MICHIGAN COMMUNITIES. AS AN INTEGRATED COMPONENT OF ONE OF THE NATION'S LEADING COMPREHENSIVE, INTEGRATED HEALTH SYSTEMS, IT IS THE MISSION OF HFMH TO IMPROVE HUMAN LIFE THROUGH THE EXCELLENCE OF THE SCIENCE AND ART OF HEALTH CARE AND HEALING. HFMH IS COMMITTED TO PROVIDING HEALTH SERVICES AND IMPROVING THE QUALITY OF LIFE OF ALL OF THE CITIZENS OF THE COMMUNITIES IT SERVES REGARDLESS OF THEIR FINANCIAL CIRCUMSTANCES. THE ORGANIZATION PROVIDES FINANCING AND HEALTH CARE DELIVERY, INCLUDING ACUTE, SPECIALTY, PRIMARY AND PREVENTATIVE CARE SERVICES BACKED BY EXCELLENCE IN RESEARCH AND EDUCATION. 0 0 258512163 292778065 HFMH IS RECOGNIZED FOR ITS EXCELLENCE IN PROVIDING INPATIENT CARE TO THE RESIDENTS OF THE MACOMB COUNTY MICHIGAN AS WELL AS ALL OF THE OTHER COMMUNITIES LOCATED NORTHEAST OF THE CITY OF DETROIT. DURING 2013 HFMH HAD 24,937 DISCHARGES, AND 111,439 PATIENT DAYS.HENRY FORD MACOMB HOSPITAL-CLINTON TOWNSHIP PROVIDES COMPREHENSIVE ACUTE AND TERTIARY CARE. SPECIALTY SERVICES INCLUDE A HEART & VASCULAR INSTITUTE, JOSEPHINE FORD CANCER CENTER, A WOMEN'S HEALTH CENTER, ALONG WITH A BIRTHING CENTER THAT FEATURES 18 LABOR, DELIVERY, RECOVERY AND POST-PARTUM SUITES. THE HOSPITAL ALSO HAS A 42-BED INPATIENT REHABILITATION PROGRAM, AN AMBULATORY AND MINIMALLY INVASIVE SURGERY CENTER AND LEADING DIAGNOSTIC IMAGING, ALONG WITH ADVANCED TRAUMA CAPABILITIES AND EMERGENCY SERVICES.HENRY FORD HOSPITAL DOCTORS TRAIN MORE THAN 600 MEDICAL SCHOOL STUDENTS, 500 RESIDENTS AND 150 FELLOWS ACROSS 46 DIFFERENT AREAS OF MEDICINE EVERY YEAR. HENRY FORD HOSPITAL RESIDENCY AND FELLOWSHIP PROGRAMS ARE NATIONALLY ACCREDITED M.D. (DOCTORATE OF MEDICINE) TRAINING PROGRAMS. HENRY FORD MACOMB HOSPITALS OFFER NATIONALLY ACCREDITED D.O. (DOCTORATE OF OSTEOPATHIC MEDICINE) AND D.P.M. (DOCTORATE OF PODIATRIC MEDICINE) TRAINING PROGRAMS, AND TRAINED 103 MEDICAL RESIDENTS DURING 2013. 80947256 88432998 HFMH PROVIDES OUTPATIENT SERVICES AT MULTIPLE LOCATIONS THROUGHOUT THE NORTH EASTERN METROPOLITAN COMMUNITIES OF DETROIT. IN TOTAL THIS REPRESENTED MORE THAN 170,000 OUTPATIENT VISITS, 15,000 OUTPATIENT SURGICAL AND ENDOSCOPY PROCEDURES, AND 49,000 URGENT CARE VISITS DURING 2013. 27530415 33146749 HFMH OPERATES A LEVEL II EMERGENCY FACILITY. EMERGENCY SERVICES REPRESENTED 64,238 PATIENT VISITS DURING 2013. 16589248 12896225 OTHER PROGRAM SERVICES INCLUDE ANCILLARY SERVICES LOCATED WITHIN THE MEDICAL FACILITIES. 16589248 12896225 383579082 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 0 1 248 16 1 3978 1 0 0 0 0 0 1 1 0 0 0 0 X 20 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X EDWARD G CHADWICK 3138768714 ONE FORD PLACE DETROIT MI 48202 PAUL D ALANDT TRUSTEE 1.00 0.00 X 0 0 0 MYRA BERGMAN RSM TRUSTEE 1.00 0.00 X 0 0 0 EDWARD D CALLAGHAN PHD TRUSTEE 1.00 4.00 X 0 0 0 DAVID F GIRODAT TRUSTEE 1.00 0.00 X 0 0 0 STEVEN D HARRINGTON MD TRUSTEE 1.00 1.00 X 0 0 0 CAROLANN K KINNER DO TRUSTEE 1.00 0.00 X 0 0 0 BRIAN G LODER DPM TRUSTEE 40.00 10.00 X 99883 30621 25037 RAYMOND C LOPE' TRUSTEE 1.00 0.00 X 0 0 0 ALI H SHAKIR MD TRUSTEE 1.00 0.00 X 2400 0 0 JAMES E THOMPSON DD TRUSTEE 1.00 0.00 X 0 0 0 ANTHONY J VIVIANO TRUSTEE 1.00 1.00 X 0 0 0 ANDREA L WULF TRUSTEE / VICE CHAIR 2.00 0.00 X X 0 0 0 ALBERT L LORENZO PHD TRUSTEE-CHAIR 2.00 0.00 X X 0 0 0 DIANE L SAYERS DO TRUSTEE 1.00 60.00 X 0 308329 55153 THOMAS B MELDRUM TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM A MORELLI SR TRUSTEE 1.00 0.00 X 0 0 0 CARL M PESTA DO TRUSTEE 1.00 0.00 X 0 0 0 RHONDA M POWELL TRUSTEE 1.00 0.00 X 0 0 0 ROSS C RICHARDSON TRUSTEE 1.00 0.00 X 0 0 0 ROBERT G RINEY TRUSTEE 1.00 63.00 X 0 1458742 53368 BARBARA W ROSSMANN PRESIDENT / TRUSTEE 60.00 1.00 X X 679206 0 76038 JAMES M CONNELLY TREASURER 1.00 65.00 X 0 1108016 45562 EDITH L EISENMANN SECRETARY 1.00 67.00 X 0 220523 38669 TERRY A GOODBALIAN ASSISTANT TREASURER/CFO 60.00 0.00 X 251282 0 53406 GARY BEAULAC CHIEF OPERATING OFFICER 60.00 0.00 X 321704 0 51569 MICHAEL CERVENAK VP-ORG STRATEGY 1.00 0.00 X 258712 0 50283 JOANNA R PEASE DO CHIEF MEDICAL OFFICER 60.00 0.00 X 332520 0 41826 ANDREW AGOSTA MD PHYSICIAN 60.00 0.00 X 585275 0 64791 MICHAEL HENDERSON MD PHYSICIAN 60.00 0.00 X 520322 0 41115 FREMONT SCOTT MD PHYSICIAN 60.00 0.00 X 521792 0 50236 RONALD LEVIN MD PHYSICIAN 60.00 0.00 X 1037190 0 47339 MARK T RYAN MD PHYSICIAN 60.00 0.00 X 725292 0 29130 STEVEN HATHAWAY FORMER CFO/TREASURER 0.00 60.00 X 0 307435 64311 5335578 3433666 787833 167 1 1 0 TRINITY INFORMATION SERVICES 20555 VICTOR PARKWAY LIVONIA MI 48152 IT SERVICES 12035492 DIVISION 6 FABRICATION & INSTALLATION LL 24201 HOOVER WARREN MI 48089 CONSTRUCTION 1140035 WELLINGTON HOME BUILDING LLC PO BOX 54 TRENTON MI 48183 CONSTRUCTION 1012530 DEMARIA BUILDING COMPANY INC 45500 GRAND RIVER AVE PO BOX 8018 NOVI MI 48376 CONSTRUCTION 964808 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 19182 EHR SERVICES 903381 61 620355 185129 109536 805484 HOSPITAL SERVICES 900099 284239012 284239012 OUTPATIENT SERVICES 621400 88432998 88432998 EMERGENCY SERVICES 900099 33146749 33146749 MEDICAL EDUCATION-GME 900099 8539053 8539053 9856367 9856367 424214179 884171 884171 1047142 0 1047142 1047142 1047142 29124 220399 -191275 -191275 -191275 182575 620355 270189 -87614 -87614 113047 64563 48484 48484 JOINT VENTURES 900099 1600667 1600667 CAFETERIA 900099 1134872 1134872 GIFT SHOP 453220 732013 732013 898453 898453 4366005 431086576 427254037 0 3027055 2241467 685903 1468454 87110 369757 369757 163177495 156488789 6688706 13475652 12805541 663031 7080 17301582 16441216 851275 9091 11137020 10583203 547965 5852 69494 15509 53985 127199 127199 33117164 29795460 3319219 2485 1884381 6075 1878306 8640147 7603695 1033706 2746 3764409 3665555 98854 11312209 10254977 1045892 11340 446653 338453 108200 285078 208587 76491 6849602 152171 6697431 15380414 14123754 1254296 2364 4235564 3816973 418591 MEDICAL SUPPLIES 70960680 70918304 42376 BAD DEBT EXPENSE 14031048 14031048 QUAAP TAX 10887877 10887877 REPAIRS & MAINTENANCE 9569317 8896755 672562 30504213 11489480 19014001 732 429768422 383579082 46060540 128800 8953 8117 73114123 71078382 476035 424268 22254315 30185973 7839163 7069416 3824250 3945500 326857436 167150616 161472538 159706820 28137690 29559204 690784 963296 98590 98590 14639100 15596613 312555541 318636179 29552774 32376445 158054214 155162999 59048809 40970250 246655797 228509694 X 58090147 84484240 5565088 3279705 2244509 2362540 65899744 90126485 312555541 318636179 X 1318154 -518593 23427180 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7809597 766354 80354 3014060 5642245 9503430 1301075 104796 3099704 7809597 7906493 3249213 -11640 1640636 9503430 7002141 1150549 41284 861779 -574298 7906493 1284494 6266095 -130441 418007 7002141 0.41870 0.58130 0 0 839256 11743199 12582455 299164 181563698 66353686 115509176 1610589 450686 1159903 123962086 100346244 23615842 6839444 6839444 159706820 MALPRACTICE LIABILITY 20276240 CORPORATE RESERVE 6613263 WORKERS COMP LIABILITY 1806461 DEFERRED COMPENSATION 4883000 POST RETIREMENT BENEFITS 6904173 OTHER LONG TERM LIABILITIES 487113 40970250 X PART V, LINE 4: EARNINGS FROM THE ORGANIZATION'S ENDOWMENTS FUNDS ARE UTILIZED BASED ON THE NATURE OF THE SPECIFIC ASSOCIATED RESTRICTION. THESE PRIMARILY RELATE TO FUNDING INITIATIVES ASSOCIATED WITH SPECIFIC DISEASE CONDITIONS AND FURTHERING MEDICAL EDUCATION AND RESEARCH INITIATIVES. PART X, LINE 2: THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2013 AND 2012. MEDALLION EVENT 304553 253289 51264 111639 AMBASSADOR CLUB 216896 173352 43544 71608 2 281481 193714 87767 86942 802930 620355 182575 270189 270189 -87614 113047 64413 150 0 113047 64413 150 64563 48484 MI 1 0 1 0 1.00000 REBECCA BLANKEN SPECIAL EVENTS DEPT ONE FORD PLACE DETROIT MI 48202 0 0 1 1 X 1 X 0 1 1 1 0 1 1 7404458 7404458 0.01780 49779572 40305296 9474276 0.02280 57184030 40305296 16878734 0.04060 2410697 10319 2400378 0.00580 13266648 8539053 4727595 0.01140 10048266 8044595 2003671 0.00480 168219 168219 0.00040 558185 558185 0.00130 26452015 16593967 9858048 0.02370 83636045 56899263 26736782 0.06430 54410 54410 0.00010 185786 185786 0.00040 2550 2550 0.00000 3500 3500 0.00000 19241 19241 0.00010 151994 151994 0.00040 417481 417481 0.00100 0 14031048 2607762 158892641 155817995 3074646 X 1 1 2 1 HENRY FORD MACOMB HOSPITAL - CLINTON 15855 19 MILE ROAD CLINTON TOWNSHIP MI 48038 X X X X 2 HENRY FORD MACOMB HOSPITAL - WARREN 13355 E TEN MILE ROAD WARREN MI 48089 X X HENRY FORD MACOMB HOSPITAL-CLINTON TWP 1 1 X X X X X X X 13 1 1 1 X WWW.HENRYFORD.COM/DOCUMENTS/COMMUNITYHEAL X X X X X X 1 0 1 1 200.000000000000 0 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 HENRY FORD MACOMB HOSPITAL-WARREN 2 0 1 1 200.000000000000 0 1 X X X X X X 1 1 X X X X 1 0 1 X 0 0 HENRY FORD MACOMB HOSPITAL-CLINTON TWP PART V, SECTION B, LINE 3: AS PART OF THE CHNA PROCESS, A COMMUNITY STAKEHOLDER SURVEY WAS DEVELOPED AND CONDUCTED BY HENRY FORD HEALTH SYSTEM, INCLUSIVE OF HENRY FORD WYANDOTTE AND HENRY FORD MACOMB HOSPITALS. THE SURVEY WAS DESIGNED TO GATHER INPUT FROM MAJOR COMMUNITY STAKEHOLDERS IN THE TRI-COUNTY AREA AND BE USED TO COMPLEMENT AND VALIDATE THE TRENDS IN DEMOGRAPHIC AND COMMUNITY HEALTH DATA IDENTIFIED WITHIN THE CHNA. THE SURVEY ALSO ASSISTED IN ACHIEVING COMPLIANCE WITH THE IRS REQUIREMENTS OF GATHERING COMMUNITY INPUT. AREAS OF SPECIFIC FOCUS IN THE SURVEY INCLUDED: PROMOTING HEALTHY BEHAVIORS, MANAGING CHRONIC DISEASE, PUBLIC HEALTH INFRASTRUCTURE/ENVIRONMENTAL HAZARDS AND ADDITIONAL OPEN ENDED QUESTIONS. KEY COMMUNITY STAKEHOLDERS THROUGHOUT THE WAYNE, MACOMB AND OAKLAND TRI-COUNTY AREA WERE INVITED TO PARTICIPATE IN THE SURVEY VIA A LINK TO THE ELECTRONIC SURVEY FROM NOVEMBER, 2011 TO DECEMBER, 2012. SEE APPENDIX 2 OF THE CHNA TO VIEW THE STAKEHOLDER SURVEY TEMPLATE. APPENDIX 3 DETAILS THE COMMUNITY STAKEHOLDERS INVITED TO PARTICIPATE AS WELL AS THE STAKEHOLDERS THAT COMPLETED THE SURVEY. HENRY FORD MACOMB HOSPITAL-CLINTON TWP PART V, SECTION B, LINE 4: HENRY FORD HOSPITALHENRY FORD MACOMB HOSPITALSHENRY FORD WYANDOTTE HOSPITALHENRY FORD WEST BLOOMFIELD HOSPITALHENRY FORD MAPLEGROVE CENTERHENRY FORD KINGSWOOD HOSPITALHENRY FORD COTTAGE HOSPITAL/MEDICAL CENTER HENRY FORD MACOMB HOSPITAL-CLINTON TWP PART V, SECTION B, LINE 11: FOR PATIENTS THAT FAILED TO QUALIFY FOR FINANCIAL ASSISTANCE, DISCOUNTS FOR MEDICALLY NECESSARY SERVICES WERE PROVIDED AT 40% OFF OF STANDARD RATES. HENRY FORD MACOMB HOSPITAL-WARREN PART V, SECTION B, LINE 11: FOR PATIENTS THAT FAILED TO QUALIFY FOR FINANCIAL ASSISTANCE, DISCOUNTS FOR MEDICALLY NECESSARY SERVICES WERE PROVIDED AT 40% OFF OF STANDARD RATES. HENRY FORD MACOMB HOSPITAL-CLINTON TWP PART V, SECTION B, LINE 14G: SUMMARIES OF THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE PROGRAM ARE AVAILABLE AT ALL SERVICE LOCATIONS AND IN THE ADMISSIONS OFFICE. SIMILAR POSTINGS HAVE BEEN PLACED IN PROMINENT LOCATIONS AT OUR FACILITIES. ADDITIONALLY, PATIENT BILLINGS PROVIDE GUIDANCE TO PATIENT ON WHO TO CONTACT TO LEARN MORE ABOUT THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE PROGRAM. HENRY FORD MACOMB HOSPITAL-WARREN PART V, SECTION B, LINE 14G: SUMMARIES OF THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE PROGRAM ARE AVAILABLE AT ALL SERVICE LOCATIONS AND IN THE ADMISSIONS OFFICE. SIMILAR POSTINGS HAVE BEEN PLACED IN PROMINENT LOCATIONS AT OUR FACILITIES. ADDITIONALLY, PATIENT BILLINGS PROVIDE GUIDANCE TO PATIENT ON WHO TO CONTACT TO LEARN MORE ABOUT THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE PROGRAM. HENRY FORD MACOMB HOSPITAL-CLINTON TWP PART V, SECTION B, LINE 19C: FOR PATIENTS THAT QUALIFY UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM WHOSE HOUSEHOLD INCOME IS AT 200%, OR LESS THAN THE FEDERAL POVERTY LEVEL, QUALIFYING SERVICES ARE PROVIDED AT NO COST. IN SITUATIONS WHERE THE QUALIFYING PATIENTS HOUSEHOLD INCOME IS GREATER THAN 200%, BUT LESS THAN 400% OF THE FEDERAL POVERTY LEVEL, SERVICES ARE PROVIDED BASED UPON A STEPPED DISCOUNT RATE. MEDICARE RATES ARE USED IN DETERMINING THIS DISCOUNT. HENRY FORD MACOMB HOSPITAL-CLINTON TWP PART V, SECTION B, LINE 20D: FOR PATIENTS THAT FAILED TO QUALIFY FOR FINANCIAL ASSISTANCE, DISCOUNTS FOR MEDICALLY NECESSARY SERVICES WERE PROVIDED AT 40% OFF OF STANDARD RATES. HENRY FORD MACOMB HOSPITAL-WARREN PART V, SECTION B, LINE 20D: FOR PATIENTS THAT FAILED TO QUALIFY FOR FINANCIAL ASSISTANCE, DISCOUNTS FOR MEDICALLY NECESSARY SERVICES WERE PROVIDED AT 40% OFF OF STANDARD RATES. 30 HENRY FORD MACOMB-BRUCE TOWNSHIP MED CTR 80650 VAN DYKE BRUCE TOWNSHIP MI 48065 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-CHESTERFIELD MED CNTR 30795 23 MILE ROAD CHESTERFIELD TOWNSHI MI 48047 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB CENTER-CLINTON TWP 16151 19 MILE ROAD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-FRASER HEALTH CENTER 15717 15 MILE ROAD FRASER MI 48035 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-RICHMOND MEDICAL CNTR 31505 32 MILE ROAD RICHMOND MI 48062 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-SLEEP MEDICINE 15945 19 MILE ROAD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-SHELBY OBGYN 49050 SCHOENHERR SHELBY TOWNSHIP MI 48316 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-WASHINGTON TWP MED CTR 12150 30 MILE ROAD WASHINGTON TOWNSHIP MI 48095 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB MEDICAL CENTER 15520 19 MILE ROAD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-CHESTERFIELD OBGYN 51086 FAIRCHILD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-MEDICAL CENTER 15400 19 MILE ROAD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-PARK PLACE PEDIATRICS 20373 HALL ROAD MACOMB MI 48044 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-SHELBY OBGYN 51221 SCHOENHERR SHELBY TOWNSHIP MI 48315 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-SHELBY FAMILY MED 49310 VAN DYKE SHELBY TOWNSHIP MI 48317 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-HARPER FAMILY MEDICINE 36539 HARPER AVENUE CLINTON TOWNSHIP MI 48035 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-MACOMB FAMILY MED 48924 HAYES ROAD MACOMB MI 48044 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-SHELBY RHEUMATOLOGY 50505 SCHOENHERR-SUITE 175 SHELBY TOWNSHIP MI 48315 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-CNTR FOR HEALTH MGMT 42850 GARFIELD ROAD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB CENTER-CLINTON TWP 43401 GARFIELD ROAD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB CENTER-CLINTON TWP 43411 GARFIELD ROAD CLINTON TOWNSHIP MI 48038 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB REHAB-STERLING HEIGHTS 44800 DELCO BLVD STERLING HEIGHTS MI 48313 REHABILITATION SERVIES HENRY FORD MACOMB REHAB-WARREN 3601 E ELEVEN MILE ROAD WARREN MI 48092 REHABILITATION SERVIES HENRY FORD MACOMB REHAB-CLINTON TWP 16301 NINETEEN NIME ROAD CLINTON TOWNSHIP MI 48308 REHABILITATION SERVIES HFMH-WARREN INTERNAL MEDICINE 25531 SCHOENHERR WARREN MI 48089 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HFMH-WARREN MEDICAL CENTER 25625 SCHOENHERR WARREN MI 48089 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HFMH-WARREN MARTIN MEDICAL CENTER 28001 SCHOENHERR WARREN MI 48088 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HFMH-WARREN FAMILY MEDICINE 30205 SCHOENHERR WARREN MI 48093 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HFMH-WARREN SLEEP MEDICINE 13251 E TEN MILE ROAD WARREN MI 48089 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HFMH-WARREN VASCULAR SURGERY 27500 HOOVER WARREN MI 48093 CLINICAL/DIAGNOSTIC MEDICAL SERVICES HENRY FORD MACOMB-FAMILY MEDICINE 21250 HALL ROAD CLINTON TOWNSHIP MI 48039 CLINICAL/DIAGNOSTIC MEDICAL SERVICES PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 14,031,048. PART II, COMMUNITY BUILDING ACTIVITIES: HFMH BELIEVES THAT THE STRENGTH AND VITALITY OF A COMMUNITY HAS A SIGNIFICANT IMPACT ON THE BEHAVIORS OF ITS RESIDENTS AND THAT THERE IS DIRECT CORRELATION BETWEEN THE VIABILITY OF A COMMUNITY AND THE ATTITUDE OF ITS RESIDENTS TOWARD HEALTHIER BEHAVIORS. THEREFORE, HFMH INCLUDES IN ITS COMMITTMENT TO COMMUNITY BENEFIT A FOCUS ON DIRECT INVOLVEMENT IN THE COMMUNITY TO BOTH IMPROVE THE ENVIRONMENT AND ENSURE THAT CRITICAL MESSAGES ON THE BENEFITS OF HEALTHIER BEHAVIORS ARE HEARD. HFMH LEADERS COLLABORATE WITH COMMUNITY TASK FORCES AND COALITIONS IN ADDRESSING THE NEEDS OF OUR SERVICE AREA. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE IS STATED IN PATIENT GROSS CHARGES. PART III, LINE 4: FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE SYSTEM'S PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNT OF UP TO 40% OF ITS STANDARD RATES FOR SERVICES PROVIDED. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THEREFORE, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. THE SYSTEM'S FINANCIAL ASSISTANCE POLICIES REMAINED CONSISTENT DURING 2012 AND 2013. THE ORGANIZATION DETERMINES THE COSTS OF SUCH UNPAID SERVICES BY APPLYING A COST-TO-CHARGE RATIO TO THE BILLED CHARGES. FOR UNINSURED PATIENTS WHO FAIL TO QUALIFY FOR ANY PROGRAM TO SUPPORT THE COST OF THEIR MEDICAL CARE, MEDICALLY NECESSARY SERVICES WILL BE PROVIDED AT A COST NOT TO EXCEED 115% OF THE STANDARD MEDICARE RATE. IN ACCORDANCE WITH THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE PROGRAM, THE COST OF CARE MAY BE FURTHER REDUCED AND IN SOME INSTANCES WILL BE PROVIDED AT NO COST. PART III, LINE 9B: IF THE PATIENT IS DETERMINED TO QUALIFY UNDER THE ORGANIZATION'S CHARITY CARE POLICY PRIOR TO BILLING, NO BILL IS EVER GENERATED AND THEREFORE THE ELEMENTS OF THE COLLECTION POLICY ARE NEVER INVOKED. WHEN THE DETERMINATION IS NOT MADE PRIOR TO BILLING, THE ORGANIZATION'S COLLECTION POLICY WOULD APPLY. THIS POLICY READS IN PART:- "PATIENTS WILL BE EVALUATED FOR THE SYSTEM'S PATIENT FINANCIAL ASSISTANCE PROGRAM"- "UNINSURED PATIENTS WILL BE GIVEN A DISCOUNT"- "UNDERINSURED PATIENTS MAY QUALIFY FOR DISCOUNTED SERVICES BASED UPON THEIR AGGREGATE HOUSEHOLD INCOME"- "THE ORGANIZATION WILL REVIEW THE PATIENTS'S RECORD TO DETERMINE IF REASONABLE EFFORTS WERE UNDERTAKEN TO ENSURE THAT FINANCIAL ASSISTANCE WAS OFFERED AND/OR IF FINANCIAL ASSISTANCE IS REQUESTED"- "LEGAL ACTION...MAY BE TAKEN...WHEN THERE IS EVIDENCE THAT THE PATIENT OR RESPONSIBLE PARTY HAS INCOME AND/OR ASSETS TO MEET HIS OR HER OBLIGATION"- "THE ORGANIZATION WILL NOT FORCE THE SALE OR FORECLOSURE OF ANY PATIENT OR GUARANTOR'S PRIMARY RESIDENCE TO PAY AN OUTSTANDING MEDICAL BILL"- "THE ORGANIZATION WILL NOT...REQUIRE THE PATIENT OR RESPONSIBLE PARTY TO APPEAR IN COURT"- "THE ORGANIZATION WILL DIRECT THEIR COLLECTION AGENCIES TO FOLLOW THESE GUIDELINES" PART VI, LINE 2: HENRY FORD HEALTH SYSTEM (HFHS) CONSIDERS THE ONGOING ASSESSMENT OF COMMUNITY HEALTH NEEDS AS AN ESSENTIAL FUNCTION. HENRY FORD MACOMB HOSPITAL WAS ENCOMPASSED IN THE HFHS COMMUNITY HEALTH NEEDS ASSESSMENT. IT PROVIDES KEY INFORMATION REGARDING THE DEMOGRAPHICS AND MAJOR NEEDS OF THE COMMUNITIES SERVED, IT SUPPORTS THE PRIORITIZATION OF THE SERVICES MADE AVAILABLE, AND IT HELPS TARGET POPULATIONS WITH THE MOST VULNERABILITY TO HEALTH NEEDS SUCH AS THE POOR, UNINSURED, AS WELL AS VARIOUS OTHER POPULATIONS THAT MAY HAVE BEEN OVERLOOKED. THE COMMUNITY HEALTH NEEDS ASSESSMENT ALSO PROVIDES VALUABLE INFORMATION REGARDING OTHER ORGANIZATIONS SUPPORTING THE NEEDS WITHIN THE COMMUNITY SO PROGRAMS CAN BE COORDINATED AND LEVERAGED TO ENSURE THAT EVERY DOLLAR IS INVESTED WISELY.THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN THREE PHASES. THE FIRST PHASE INCLUDES DATA COLLECTION FROM A VARIETY OF PUBLIC AND PROPRIETARY SOURCES THAT PROVIDED INFORMATION AROUND POPULATION DEMOGRAPHICS, SOCIOECONOMIC DATA, HEALTH STATUS INDICATORS, AS WELL AS SEVERAL OTHER DATA POINTS. SOURCES FOR THIS FIRST PHASE INCLUDED THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH (MDCH), MICHIGAN BEHAVIORAL RISK FACTOR SURVEY, CLARITAS INC. /TRUVEN HEALTH ANALYTICS, MICHIGAN STATE HOMELESS MANAGEMENT INFORMATION SYSTEM (MSHMIS), AND THE MICHIGAN INPATIENT DATABASE. THE SECOND PHASE INVOLVED DEVELOPING AND DISTRIBUTING A KEY STAKEHOLDER SURVEY TO CAPTURE THE INPUT OF OTHER COMMUNITY ORGANIZATIONS AND COALITIONS ABOUT WHAT THEY BELIEVE ARE THEMAJOR HEALTH NEEDS THAT SHOULD BE PRIORITIZED AND ADDRESSED IN THE TRI-COUNTY AREA. THE THIRD PHASE INCORPORATED THE QUANTITATIVE AND QUALITATIVE DATA THAT WAS COLLECTED IN THE FIRST TWO PHASES, AND BASED ON THIS INFORMATION IDENTIFIED PRIORITIES FOR HENRY FORD HEALTH SYSTEM TO ADDRESS WITH THE COMMUNITIES IT SERVES.THIS ASSESSMENT WAS PREPARED BY THE CORPORATE PLANNING DEPARTMENT WITHIN HENRY FORD HEALTH SYSTEM. RESULTS ARE USED AS A FOUNDATION FOR PLANNING, DEVELOPING, AND REFINING HFHS'S FUTURE COMMUNITY SERVICES IN THE TRI-COUNTY AREA. PART VI, LINE 3: HFMH HAS VARIOUS APPROACHES TO TARGET AND INFORM RESIDENTS OF ITS COMMUNITIES ABOUT THE PROGRAMS AND SERVICES IT OFFERS. PROGRAMS WHERE WE PARTNER WITH ORGANIZATIONS WITH ESTABLISHED RELATIONSHIPS WITH THE INDIVIDUALS SUCH AS THROUGH COMMUNITY HEALTH CENTERS, THE PUBLIC SCHOOLS AND FAITH-BASED ORGANIZATIONS HAVE BEEN PARTICULARLY SUCCESSFUL. HFMH FOLLOWS THE HFHS PATIENT FINANCIAL ASSISTANCE POLICY. ALL PATIENTS ARE SEEN WITHOUT REGARD TO ABILITY TO PAY. INTAKE STAFF IS TRAINED WITH REGARD TO HOW TO APPROACH AND ENGAGE AN INDIVIDUAL WHEN THERE IS AN APPARENT LACK OF ADEQUATE HEALTH COVERAGE. THIS INCLUDES INFORMING THEM OF THE PROGRAMS OFFERED BY HFMH AS WELL AS OTHER COMMUNITY, LOCAL, STATE AND FEDERAL PROGRAMS OFFERING POTENTIAL SUPPORT. HFMH HAS DEDICATED STAFF RESPONSIBLE TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR SUPPORTIVE PROGRAMS AND ASSIST THEM WITH THE ENROLLMENT PROCESS. THERE ARE MANY REASONS WHY A PATIENT IN NEED OF FINANCIAL ASSISTANCE WITH THEIR MEDICAL CARE MAY NOT HAVE BEEN IDENTIFIED AT THE TIME OF THE CARE DELIVERY. PATIENT FINANCIAL SERVICE AND COLLECTION STAFFS ARE TRAINED TO RECOGNIZE THESE INDIVIDUALS AND PROVIDE THEM WITH ADVICE REGARDING THE VARIOUS OPTIONS AVAILABLE TO SUPPORT THEIR CARE NEEDS. PART VI, LINE 4: ALTHOUGH HFHS AND ITS AFFILIATES PROVIDE SERVICES TO INDIVIDUALS RESIDING THROUGHOUT THE STATE OF MICHIGAN AND IN SOME CASES FROM AROUND THE WORLD, IT DEFINES ITS COMMUNITIES SERVED BASED ON THE AREAS GENERATING THE HIGHEST INPATIENT VOLUMES. MORE THAN 94% OF THIS VOLUME FOR HFHS ORIGINATES IN THE TRI-COUNTY AREA, INCLUDING THE CITY OF DETROIT. THE TRI-COUNTY AREA INCLUDES THE CONTIGUOUS COUNTIES OF WAYNE, OAKLAND AND MACOMB, WHICH ARE LOCATED IN SOUTHEASTERN MICHIGAN AND ACCOUNT FOR 39% OF THE MICHIGAN POPULATION. WAYNE, OAKLAND, AND MACOMB (IN THAT ORDER) ARE THE MOST POPULATED COUNTIES IN MICHIGAN. OF THE NEARLY 4 MILLION RESIDENTS, APPROXIMATELY 52% OF THE POPULATION IS FEMALE. WITH REGARD TO RACE/ETHNICITY, THE TRI-COUNTY AREA IS 65% WHITE, COMPARED TO A NATIONAL AVERAGE OF 62%. OF NOTE, THE TRI-COUNTY AREA IS 25% BLACK, WHICH IS OVER TWICE THE NATIONAL PERCENTAGE OF 12%. CONVERSELY, THE HISPANIC POPULATION (4.0%) IS LESS THAN ONE QUARTER OF THE NATIONAL PERCENTAGE OF 17%. THE NUMBER OF TRI-COUNTY RESIDENTS IS EXPECTED TO DECREASE BY 1% OVER THE NEXT SEVERAL YEARS,WHICH CONTRASTS WITH THE 3% INCREASE EXPECTED NATIONWIDE. IN ADDITION, FEMALES OF CHILD BEARING AGE (15-44), WHO MAKE UP 19% OF THE TRI-COUNTY'S POPULATION, ARE EXPECTED TO DECLINE BY 4% OVER THE NEXT SEVERAL YEARS. WHEN EXAMINING AGE DISTRIBUTION, THE TRI-COUNTY HAS A COMPARABLE POPULATION TO THAT OF THE COUNTRY AND 14% OF THE POPULATION IS ABOVE THE AGE OF 65. OF PARTICULAR INTEREST TO HEALTHCARE PROVIDERS IS THE AGING POPULATION OF THE TRI-COUNTY AREA WITH THE 55 YEARS OLD AND ABOVE POPULATION EXPECTED TO RISE BY 9% FROM 2013 TO 2018. WITH REGARDS TO EDUCATION, THE TRI-COUNTY HAS APPROXIMATELY 12% OF RESIDENTS WHO HAVE SOME HIGH SCHOOL EDUCATION OR LESS COMPARED TO THE NATIONAL AVERAGE OF 15%. FURTHER, 28% OF RESIDENTS HAVE A BACHELOR'S DEGREE OR GREATER, WHICH IS COMPARABLE TO THE NATIONAL AVERAGE.THE TRI-COUNTY AREA IS DIVERSE IN REGARDS TO POPULATION, RACIAL/ETHNIC COMPOSITION, ECONOMIC GROWTH AND DEVELOPMENT. THE AUTOMOTIVE INDUSTRY REMAINS THE LARGEST EMPLOYER IN THE REGION, BUT THE HEALTH CARE SECTOR IS ALSO REPRESENTED AMONG THE TOP EMPLOYERS IN THE REGION AS WELL (CRAIN'S DETROIT 2012 LISTINGS OF MAJOR EMPLOYERS). THE AVERAGE HOUSEHOLD INCOME WITHIN THE TRI-COUNTY AREA ($63,344) IS LESS THAN THE NATIONAL AVERAGE ($69,637). WITHIN THE TRI-COUNTY AREA, THE AVERAGE HOUSEHOLD INCOME IN OAKLAND COUNTY ($80,157) IS SIGNIFICANTLY HIGHER THAN WAYNE COUNTY ($53,355) AND MACOMB COUNTY ($58,589). AT THE ZIP CODE LEVEL, AVERAGE HOUSEHOLD INCOMES VARY SIGNIFICANTLY,RANGING FROM $25,145 TO $163,374. LOWER HOUSEHOLD INCOMES NEGATIVELY IMPACT PURCHASING POWER, HEALTH INSURANCE COVERAGE, AND COSTS OF BASIC NECESSITIES. AS A RESULT, THE TRI-COUNTY AREA'S SAFETY NETS, INCLUDING HEALTHCARE SYSTEMS, ARE BEING STRETCHED TO THE LIMIT (UNITED WAY RESEARCH INCOME DOWN ACROSS STATE: POVERTY INCREASING AND SPREADING THROUGHOUT THE TRICOUNTY 2006, HTTP://WWW.UWSEM.ORG). IN ADDITION, WITHIN THE TRI-COUNTY AREA THE UNEMPLOYMENT RATE IS SLIGHTLY HIGHER THAN THE NATIONAL AVERAGE OF 7.6% AND RANGES FROM 8.3% IN OAKLAND COUNTY TO 11% IN WAYNE COUNTY (LOCAL AREA UNEMPLOYMENT STATISTIC UPDATE MARCH 2013, OAKLAND COUNTY MICHIGAN).AS STATED PREVIOUSLY, THE TRI-COUNTY AREA IS RATHER DIVERSE THROUGHOUT ITS THREE COUNTIES. FOR EXAMPLE, AGE, SEX, EDUCATION, AND INCOME DISTRIBUTION DIFFER FROM COUNTY TO COUNTY. IN ORDER TO INCREASE THE UTILITY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, IT IS IMPORTANT TO ANALYZE THE PROFILE(S) OF EACH OF THESE COUNTIES AT A MORE DETAILED LEVEL, SUCH AS ZIP CODES, SO THAT CERTAIN DIFFERENCES WITHIN THE AREA BECOME EVIDENT.ONE COMMUNITY IN PARTICULAR NEED OF ATTENTION IS THE CITY OF DETROIT.WHEN EXAMINING THE CITY OF DETROIT THE AVERAGE HOUSEHOLD INCOME IS $36,186, WHICH IS SIGNIFICANTLY LESS THAN AVERAGE HOUSEHOLD INCOME OF THE OVERALL TRI-COUNTY AREA ($63,344). REGARDING EDUCATION, 22% OF RESIDENTS HAVE LESS THAN A HIGH SCHOOL EDUCATION AND ONLY 12% OF HAVE A BACHELOR'S DEGREE OR HIGHER. IN TERMS OF RACIAL/ETHNIC DIVERSITY, APPROXIMATELY 93% OF DETROIT IS COMPOSED OF A MINORITY POPULATION VERSUS 36% FOR THE TRI-COUNTY AREA AS A WHOLE. THE DETROIT UNEMPLOYMENT RATE IS 17.5%, WHICH IS SIGNIFICANTLY GREATER THAN THE NATIONAL AVERAGE OF 7.6% (LOCAL AREA UNEMPLOYMENT STATISTIC UPDATE MARCH 2013, OAKLAND COUNTY MICHIGAN).WHEN LOOKING OUTSIDE OF THE CITY OF DETROIT, VARIOUS ZIP CODES IN THE TRI-COUNTY AREA REPRESENT SECTIONS OF THE REGION THAT HAVE LOWER INCOMES, LESS EDUCATION, AND ARE MORE RACIALLY AND ETHNICALLY DIVERSE. OF THE ZIP CODES THAT RANK IN THE TOP 20 ZIP CODES FOR BOTH LOWEST AVERAGE HOUSEHOLD INCOME AND HIGHEST PROPORTION OF THE POPULATION WITHOUT A HIGH SCHOOL DIPLOMA IN THE TRI-COUNTY AREA, THE AVERAGE HOUSEHOLD INCOME IS $41,724, WHICH IS SIGNIFICANTLY LESS THAN THE AVERAGE HOUSEHOLD INCOME OF $63,344 FOR THE OVERALL TRI-COUNTY AREA. OVERALL, 21% OF RESIDENTS IN THESE ZIP CODES HAVE LESS THAN A HIGH SCHOOL EDUCATION COMPARED TO 12% FOR THE TRI-COUNTY AREA. THESE 20 ZIP CODES HAVE A SLIGHTLY HIGHER PERCENTAGE OF RACIAL/ETHNIC MINORITIES AS COMPARED TO THE REST OF THE TRI-COUNTY AREA. AS A WHOLE THESE ZIP CODES ARE COMPRISED OF 42% MINORITIES COMPARED TO 36% FOR THE TRI-COUNTY AREA.AS A RESULT, THE DETROIT AREA AND ABOVE 20 ZIP CODES, AS WELL AS OTHER ZIP CODES WITH SIMILAR CHARACTERISTICS, SHOULD BE OF PARTICULAR INTEREST WHEN PLANNING COMMUNITY NEEDS INITIATIVES WITHIN THE TRI-COUNTY AREA.PLEASE SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR FURTHER DETAILS. PART VI, LINE 5: HENRY FORD MACOMB HOSPITALS (HFMH) IS PART OF HENRY FORD HEALTH SYSTEM, ONE OF THE NATION'S LARGEST INTEGRATED HEALTH DELIVERY SYSTEMS SERVING ALL OF SOUTHEASTERN MICHIGAN. THIS TAX RETURN REFLECTS ACTIVITIES OF THE CLINTON TOWNSHIP CAMPUS OF HFMH, WHICH INCLUDES APPROXIMATELY 400 INPATIENT BEDS WITH AN OPEN MEDICAL STAFF, A BEHAVIORAL HEALTH FACILITY, AS WELL AS SEVERAL OUTPATIENT LOCATIONS SERVING THE MACOMB COUNTY AREA OF MICHIGAN. HFMH IS GOVERNED BY A DEDICATED VOLUNTEER COMMUNITY BOARD AND IT PROVIDES ITS COMMUNITIES WITH A FULL RANGE OF CLINICAL SERVICES INCLUDING GENERAL MEDICINE, SURGERY, OBSTETRICS, PEDIATRICS, CARDIAC CARE, PHYSICAL AND REHABILITATION MEDICINE, AMBULATORY SURGERY, INPATIENT AND OUTPATIENT BEHAVIORAL SERVICES, AND 24 HOUR EMERGENCY CARE. PART VI, LINE 6: THE SYSTEM DEMONSTRATES ITS EXEMPT PURPOSE TO BENEFIT THE COMMUNITY BY OPERATING EMERGENCY ROOMS OPEN TO THE PUBLIC 24 HOURS A DAY, 7 DAYS A WEEK; PROVIDING FACILITIES FOR THE EDUCATION AND TRAINING OF HEALTH CARE PROFESSIONALS; AND MAINTAINING RESEARCH FACILITIES FOR THE STUDY OF NEW DRUGS AND MEDICAL DEVICES THAT OFFER THE PROMISE OF IMPROVING HEALTH CARE. THE SYSTEM ALSO PROVIDES COMMUNITY HEALTH SERVICES, SUCH AS COMMUNITY EDUCATION AND OUTREACH IN THE FORM OF FREE OR LOW-COST CLINICS; HEALTH EDUCATION TELEVISION PROGRAMMING; DONATIONS FOR THE COMMUNITY; MULTIPLE HEALTH PROMOTION AND WELLNESS PROGRAMS, SUCH AS HEALTH SCREENING; AND VARIOUS COMMUNITY PROJECTS AND SUPPORT GROUPS X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 BRIAN G LODER DPM TRUSTEE 98977 30621 0 0 906 0 8651 0 16386 0 124920 30621 0 0 DIANE L SAYERS DO TRUSTEE 0 288720 0 13734 0 5875 0 31858 0 23295 0 363482 0 0 ROBERT G RINEY TRUSTEE 0 917323 0 370356 0 171063 0 31859 0 21509 0 1512110 0 0 BARBARA W ROSSMANN PRESIDENT / TRUSTEE 478283 0 146028 0 54895 0 49912 0 26126 0 755244 0 0 0 JAMES M CONNELLY TREASURER 0 662923 0 268013 0 177080 0 29308 0 16254 0 1153578 0 0 EDITH L EISENMANN SECRETARY 0 180375 0 19688 0 20460 0 25545 0 13124 0 259192 0 0 TERRY A GOODBALIAN ASSISTANT TREASURER/CFO 225239 0 18566 0 7477 0 26041 0 27365 0 304688 0 0 0 GARY BEAULAC CHIEF OPERATING OFFICER 272200 0 27063 0 22441 0 26759 0 24810 0 373273 0 0 0 MICHAEL CERVENAK VP-ORG STRATEGY 237483 0 19450 0 1779 0 29308 0 20975 0 308995 0 0 0 JOANNA R PEASE DO CHIEF MEDICAL OFFICER 303535 0 27372 0 1613 0 26758 0 15068 0 374346 0 0 0 ANDREW AGOSTA MD PHYSICIAN 415766 0 59681 0 109828 0 43282 0 21509 0 650066 0 0 0 MICHAEL HENDERSON MD PHYSICIAN 367440 0 85575 0 67307 0 29308 0 11807 0 561437 0 0 0 FREMONT SCOTT MD PHYSICIAN 498043 0 1400 0 22349 0 26758 0 23478 0 572028 0 0 0 RONALD LEVIN MD PHYSICIAN 640978 0 168517 0 227695 0 29053 0 18286 0 1084529 0 0 0 MARK T RYAN MD PHYSICIAN 573665 0 103534 0 48093 0 25483 0 3647 0 754422 0 0 0 STEVEN HATHAWAY FORMER CFO/TREASURER 0 264150 0 36869 0 6416 0 42058 0 22253 0 371746 0 0 PART I, LINE 1A IT IS THE ORGANIZATION'S POLICY TO PAY OR REIMBURSE EMPLOYEES FOR BONAFIDE BUSINESS TRAVEL BASED ON THE MOST COST EFFECTIVE MEANS AVAILABLE. GENERALLY, WHEN AIR TRAVEL IS INVOLVED THIS EQUATES TO COACH CLASS AIR FARE. UNDER CERTAIN CIRCUMSTANCES, SUCH AS WHEN COACH CLASS IS NOT AVAILABLE OR THE TRIP IS OF AN EXTENSIVE DURATION, SENIOR LEADERSHIP HAS APPROVED BUSINESS CLASS, FIRST CLASS OR CHARTER TRAVEL. IN SUCH CIRCUMSTANCES, THE TRAVEL IS CONSIDERED TO BE FOR A BONAFIDE BUSINESS PURPOSE; ACCORDINGLY NO TAXABLE INCOME IS REPORTED. NO QUALIFYING INDIVIDUALS RECEIVED PAID OR REIMBURSED FIRST CLASS TRAVEL DURING 2013. CERTAIN MEMBERS OF THE ORGANIZATION'S SENIOR LEADERSHIP TEAM PARTICIPATE IN A SUPPLEMENTAL RETIREMENT PROGRAM THAT RESULTS IN REPORTABLE TAXABLE INCOME AS THE BENEFITS ACCRUE, RATHER THAN AS THEY ARE PAID. CERTAIN MEMBERS OF THE ORGANIZATION'S SENIOR LEADERSHIP ALSO HAVE THE OPTION TO PARTICIPATE IN NON-QUALIFIED 457 BENEFIT PROGRAMS WHICH RESULTS IN REPORTABLE TAXABLE INCOME AS BENEFITS ACCRUE, RATHER THAN AS THEY ARE PAID. IT IS AN ELEMENT OF THE PLAN DESIGN TO ABSORB THE ADVANCE TAX IMPACT OF THESE PLANS FOR THE PARTICIPANTS. IN SUCH CASES THE RELATED AMOUNTS ARE REPORTED AS TAXABLE INCOME TO THE INDIVIDUAL AND INCLUDED IN THE DETERMINATION OF REASONABLE COMPENSATION. SEE Q. 4B FOR THE REQUIRED LISTING OF THE PARTICIPATING INDIVIDUALS. PART I, LINE 4B SCH J, LINE 4B, PERSONS PARTICIPATING IN NONQUALIFIED RETIREMENT PLANS SEC 457(F) - SUPPLEMENTAL HFHS EXECUTIVE RETIREMENT PLAN (SERP) TAXABLE REPORTABLE VALUE OF 2013 ACCRUAL 2013 DISTRIBUTIONS W-2 AMOUNTS PARTICIPANT JAMES CONNELLY 136,600 - 136,600 ROBERT RINEY 149,090 - 149,090 BARBARA ROSSMANN 27,148 - 27,148 CONTRIBUTIONS TO SEC 457(F)-NON-QUALIFIED DEFERRED COMPENSATION RETIREMENT PLAN EMPLOYEE EMPLOYER MEDICARE REPORTABLE 2013 CONTRIBUTIONS 2013 CONTRIBUTIONS TAX GROSS-UP W-2 AMOUNTS BARBARA ROSSMANN 3,854 13,646 328 17,828 RONALD LEVIN, M.D. - 12,446 300 12,746 ANDREW AGOSTA, M.D. 10,203 7,297 177 17,676 JAMES CONNELLY - 17,500 421 17,921 STEVEN HATHAWAY - 1,478 36 1,514 FREMONT SCOTT, MD - 9,780 236 10,016 GARY BEAULAC 15,900 1,600 39 17,539 MICHAEL HENDERSON,MD 12,936 4,564 110 17,610 JOANNA PEASE, M.D. - 1,575 38 1,613 ROBERT RINEY - 17,500 421 17,921 MARK RYAN, M.D. 7,472 10,028 241 17,741 EDITH EISENMANN 17,500 - - 17,500 SEE BELOW 0 ADVANCED CARDIO PLLC SEE BELOW 337077 SEE BELOW 0 DIAB & KINNER PC SEE BELOW 43000 SEE BELOW 0 MARTIN BEAULAC SEE BELOW 160335 SEE BELOW 0 ROSEMARY MINJEUR SEE BELOW 69791 SEE BELOW 0 RAYMOND MINJEUR SEE BELOW 59800 SEE BELOW 0 JONATHAN BEAULAC SEE BELOW 59581 SEE BELOW 0 COLLEEN HARRINGTON SEE BELOW 20250 SEE BELOW 0 SCHEDULE L, PART IV - BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: ADVANCED CARDIOTHORACIC SURGEONS, PLLC(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: OWNER/TRUSTEE(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR MEDICAL SERVICES(A) NAME OF PERSON: DIAB & KINNER INTERNAL MEDICINE, PC(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: OWNER/TRUSTEE(D) DESCRIPTION OF TRANSACTION: PAYMENT FOR MEDICAL SERVICES(A) NAME OF PERSON: MARTIN BEAULAC(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER/KEY EMPLOYEE(D) DESCRIPTION OF TRANSACTION: EMPLOYEE COMPENSATION PAID BY THE ORGANIZATION(A) NAME OF PERSON: ROSEMARY MINJEUR(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER/KEY EMPLOYEE(D) DESCRIPTION OF TRANSACTION: EMPLOYEE COMPENSATION PAID BY THE ORGANIZATION(A) NAME OF PERSON: RAYMOND MINJEUR(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER/KEY EMPLOYEE(D) DESCRIPTION OF TRANSACTION: EMPLOYEE COMPENSATION PAID BY THE ORGANIZATION(A) NAME OF PERSON: JONATHAN BEAULAC(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER/KEY EMPLOYEE(D) DESCRIPTION OF TRANSACTION: EMPLOYEE COMPENSATION PAID BY THE ORGANIZATION(A) NAME OF PERSON: COLLEEN HARRINGTON: (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER/TRUSTEE(D) DESCRIPTION OF TRANSACTION: EMPLOYEE COMPENSATION PAID BY THE ORGANIZATION X EVENT CONTRIB 100 105786 FAIR MARKET VALUE X CELL PHONES/C 1 3750 FAIR MARKET VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A TAX EXEMPT STOCK CORPORATION AND HENRY FORD HEALTH SYSTEM HOLDS ALL OF THE ISSUED AND OUTSTANDING SHARES OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE STOCK HOLDER OF THE ORGANIZATION, HFHS HOLDS THE RESERVE POWER TO APPROVE OR DISAPPROVE TRUSTEE APPOINTMENTS. FORM 990, PART VI, SECTION A, LINE 7B BASED ON THE ESTABLISHED RESERVE POWERS, CERTAIN DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM (HFHS) AND THE TAX DEPARTMENT OF HFHS PREPARES THE ORGANIZATION'S FORM 990. AS PART OF THE PREPARATION AND REVIEW PROCESS PRIOR TO FILING THE RETURN, THE FOLLOWING REVIEW PROCESS IS CONDUCTED: - REVIEW OF THE ENTIRE RETURN WITH THE HFHS AND ORGANIZATION'S CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER AND CHIEF EXECUTIVE OFFICER - REVIEW OF ALL COMPENSATION MATTERS AND DISCLOSURES WITH THE COMPENSATION COMMITTEE OF THE HFHS BOARD OF TRUSTEES - REVIEW OF THE RETURN WITH THE HFHS AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES - PROVIDE A COPY OF THE RETURN TO THE ORGANIZATION'S BOARD OF TRUSTEES FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM (HFHS) WHO OVERSEES THE CONFLICT OF INTEREST PROCESS WITH REGARD TO THE ORGANIZATION. HFHS HAS A STANDING CONFLICT OF INTEREST COMMITTEE (THE COMMITTEE) THAT IS RESPONSIBLE FOR OVERSIGHT OF ALL CONFLICT OF INTEREST MATTERS. THE HFHS CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES AND EMPLOYEES. ANNUALLY, TRUSTEES, EMPLOYEES OF A MANAGEMENT LEVEL, RESEARCHERS, AS WELL AS EMPLOYEES ASSOCIATED WITH PROCUREMENT, OR IN CERTAIN OTHER PREDEFINED ROLES MUST COMPLETE AN ANNUAL DISCLOSURE DESIGNED TO IDENTIFY ACTIVITIES AND RELATIONSHIPS THAT COULD POTENTIALLY GIVE RISE TO A CONFLICT OF INTEREST. IT IS THE RESPONSIBILITY OF THE COMMITTEE TO REVIEW THESE DISCLOSURES AND DETERMINE THE NEED FOR ANY ACTION TO MANAGE THE POTENTIAL CONFLICT. THE COMMITTEE ANNUALLY REPORTS THE RESULTS OF ITS ACTIVITIES TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE HFHS BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM (HFHS) WHO HAS RESPONSIBILITY TO OVERSEE THE COMPENSATION PRACTICES OF THE ORGANIZATION. HFHS HAS A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES CONSISTING OF ALL EXTERNAL TRUSTEES. THEY MEET PERIODICALLY THROUGHOUT THE YEAR. THEY ARE CHARGED WITH APPROVAL OF THE ORGANIZATION'S OVERALL COMPENSATION AND BENEFIT PROGRAMS AS WELL AS THE SPECIFIC REVIEW AND APPROVAL OF THE COMPENSATION OF CERTAIN EMPLOYEES INCLUDING THE CHIEF EXECUTIVE OFFICER, ALL OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THEY DIRECTLY ENGAGE AN INDEPENDENT COMPENSATION ADVISOR TO ASSIST WITH THIS PROCESS. THE PROCESS INCLUDES EVALUATION OF THE INDIVIDUAL'S PERFORMANCE, UTILIZATION OF COMPENSATION STUDIES OF SIMILARLY SITUATED POSITIONS, AS WELL AS COMPARISONS TO COMPENSATION AS REPORTED BY OTHER HEALTH CARE ORGANIZATIONS. THE REASONABLENESS OF COMPENSATION IS EVALUATED BASED UPON THESE AND OTHER FACTORS. THE COMMITTEE ALSO REVIEWS THE COMPENSATION DISCLOSURES TO BE MADE ON FORM 990 IN ADVANCE OF FILING. FORM 990, PART VI, SECTION C, LINE 19 IT IS THE PRACTICE OF THE ORGANIZATION TO MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO ANY PARTY REQUESTING SUCH INFORMATION. AS A HOLDER OF TAX EXEMPT DEBT THE FINANCIAL STATEMENTS OF THE ORGANIZATION ARE MADE AVAILABLE TO A PUBLIC CLEARING HOUSE ON A QUARTERLY BASIS. PART IV, LINE 12 THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT OBTAINED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH SYSTEM. FORM 990, PART IV, LINE 24A, TAX-EXEMPT BOND ISSUE: THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM. THE ALLOCATED TAX-EXEMPT BOND LIABILITY OF THE ORGANIZATION IS REPORTED UNDER THE FORM 990, SCHEDULE K OF ITS PARENT, HENRY FORD HEALTH SYSTEM. FORM 990, PART XI, LINE 9: MINIMUM PENSION LIABILITY ADJUSTMENT 23,427,180. FORM 990, PART XII, LINE 2C: FORM 990 - PART XII - LINE 2C: HENRY FORD WYANDOTTE HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF HENRY FORD HEALTH SYSTEM. THE GOVERNING BODY OF HFHS HAS DELEGATED THE OVERSIGHT OF THE FINANCIAL STATEMENTS, INCLUDING THE CHOICE OF INDEPENDENT AUDITORS, TO ITS AUDIT COMMITTEE. FORM 990, PART VII AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: MANY EXECUTIVE EMPLOYEES OF HFHS PROVIDE SERVICES TO MULTIPLE AFFILIATED ENTITIES. HENRY FORD HEALTH SYSTEM USES ESTIMATES FOR REPORTING AVERAGE HOURS PER WEEK IN ALL SECTIONS OF FORM 990. GENERALLY 60 HOURS ARE REPORTED FOR THE HOURS ASSOCIATED FOR THE ORGANIZATION THAT THE INDIVIDUAL HAS PRINCIPAL RESPONSIBILITY FOR. HOURS ASSOCIATED WITH OTHER HOSPITAL OR LARGER ORGANIZATIONS ARE REPORTED AT 5 PER WEEK AND FOR SMALLER ORGANIZATIONS 1 HOUR PER WEEK IS REPORTED. MERCY MOUNT CLEMENS REAL ESTATE LLC ONE FORD PLACE DETROIT MI 48202 382947657 REAL ESTATE MI 25000 0 N/A HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT MI 48202 381357020 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) 3 N/A 0 HENRY FORD WYANDOTTE HOSPITAL 2333 BIDDLE AVE WYANDOTTE MI 48192 382791823 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) 3 HENRY FORD HEALTH SYSTEM 1 HENRY FORD HEALTH SYSTEM FOUNDATION ONE FORD PLACE DETROIT MI 48202 237383042 SUPPORTING ORGANIZATION MI 501(C)(3) 11A-TYPE 1 HENRY FORD HEALTH SYSTEM 1 HEALTH ALLIANCE PLAN 2850 W GRAND BLVD DETROIT MI 48202 382242827 HEALTH MAINTENANCE ORGANIZATION MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 HFHS SELF FUNDED LIABILITY ONE FORD PLACE DETROIT MI 48202 386553031 MALPRACTICE INSURANCE MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 DOWNRIVER CENTER FOR ONCOLOGY ONE FORD PLACE DETROIT MI 48202 383193008 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) 3 HENRY FORD HEALTH SYSTEM 1 HENRY FORD CONTINUING CARE ONE FORD PLACE DETROIT MI 48202 382433285 NURSING HOMES MI 501(C)(3) 9 HENRY FORD HEALTH SYSTEM 1 HFII CORPORATION ONE FORD PLACE DETROIT MI 48202 900840304 SCIENTIFIC RESEARCH MI 501(C)(3) 7 HENRY FORD HEALTH SYSTEM 1 HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES ONE FORD PLACE DETROIT MI 48202 464064067 ADVOCACY FOR HFHS AND AFFILIATE MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 NORTHWEST DETROIT DIALYSIS 30100 TELEGRAPH BINGHAM FARMS MI 48025 383232668 OPERATE DIALYSIS CLINIC MI HENRY FORD HEALTH SYSTEM N/A 0 0 DIALYSIS PARTNERS OF NW OHIO 30100 TELEGRAPH BINGHAM FARMS MI 48025 341877956 OPERATE DIALYSIS CLINIC OH HENRY FORD HEALTH SYSTEM N/A 0 0 MACOMB REGIONAL DIALYSIS CENTERS 16151 NINETEEN MILE RD CLINTON TOWNSHIP MI 48038 260423581 OPERATE DIALYSIS CLINICS MI HENRY FORD HEALTH SYSTEM N/A 0 0 HORIZON PROPERTIES INC ONE FORD PLACE DETROIT MI 48202 382679527 REAL ESTATE - LESSOR BUILDINGS MI N/A C 313665 945910 1.00000 1 FAIRLANE HEALTH SERVICES 30100 TELEGRAPH BINGHAM FARMS MI 48025 382565235 HEALTHCARE MANAGEMENT MI HENRY FORD HEALTH SYSTEM C 1 ALLIANCE HEALTH AND LIFE INSURANCE 2850 W GRAND BLVD DETROIT MI 48202 383291563 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HAP PREFERRED INC 2850 W GRAND BLVD DETROIT MI 48202 382513504 PROVIDER NETWORK LEASING MI HEALTH ALLIANCE PLAN C 1 SHA REALTY INC ONE FORD PLACE DETROIT MI 48202 381378121 REAL ESTATE HOLDING MI HENRY FORD HEALTH SYSTEM C 1 FIRST OPTOMETRY EYE CARE CENTERS INC 655 W 13 MILE RD MADISON HEIGHTS MI 48071 382299059 FRANCHISING EYE CARE CENTERS MI HENRY FORD HEALTH SYSTEM C 1 FIRST OPTOMETRY VISION PLANS INC 655 W 13 MILE RD MADISON HEIGHTS MI 48071 382594841 VISION CARE PLANS MI HENRY FORD HEALTH SYSTEM C 1 ONIKA INSURANCE LTD FIRST CARRIBEAN HOUSE GRAND CAYMAN CJ CAPTIVE INSURANCE CJ HENRY FORD HEALTH SYSTEM C 1 HENRY FORD PHYSICIAN NETWORK ONE FORD PLACE DETROIT MI 48202 320306774 PHYSICIAN NETWORK MI HENRY FORD HEALTH SYSTEM C 1 ADMINISTRATION SYSTEMS RESEARCH CORPORATION 2850 W GRAND BLVD DETROIT MI 48202 382651185 THIRD PARTY INSURANCE ADMINISTRATOR MI HEALTH ALLIANCE PLAN C 1 MIDWEST HEALTH PLAN 4700 SHAEFER ROAD SUITE 340 DEARBORN MI 48126 383123777 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HAP COMMUNITY ALLIANCE 2850 W GRAND BLVD DETROIT MI 48202 270449055 HEALTH MAINTENANCE ORGANIZATION MI HEALTH ALLIANCE PLAN C 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 HEALTH ALLIANCE PLAN L 45301610 CASH VALUE HEALTH ALLIANCE PLAN M 20328472 CASH VALUE HFHS SELF FUNDED LIABILITY M 900000 CASH VALUE ONIKA INSURANCE LTD M 1050000 CASH VALUE