2014-11-17T11:02:42-06:00 2013-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2013-01-01 381490180 CARSON CITY HOSPITAL CARS 9895843971 406 E ELM STREET PO BOX 879 CARSON CITY MI 48811 RICHARD REID CFO 9895843971 2014-11-17 1 CAROL LALONDE P00181637 2695674500 2013 2015-11-30 17:44:51Z MATTHEW THOMPSON 406 E ELM STREET PO BOX 879 CARSON CITY MI 48811 63435119 0 X WWW.CARSONHEALTH.ORG X 1938 MI THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY & ACCESSIBLE HEALTH CARE SERVICES TO COMMUNITIES WE SERVE IN CONJUNCTION, CCH PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. 12 9 715 104 0 0 101927 0 58936320 61573854 416201 495155 712517 988025 60166965 63057034 0 0 0 0 35461383 35381239 0 0 11577 25339837 33118415 60801220 68499654 -634255 -5442620 45594758 43059007 25177381 27110571 20417377 15948436 X THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY & ACCESSIBLE HEALTH CARE SERVICES TO COMMUNITIES WE SERVE IN CONJUNCTION, CCH PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. 0 0 46950054 0 36688053 CCH IS A 77-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, D.O.. SINCE THIS TIME, CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS IN A FOUR-COUNTY AREA. CCH CURRENTLY OPERATES A SHORT-TERM, ACUTE-CARE FACILITY AND SEVERAL SATELLITE CLINICS OFFERING INPATIENT AND OUTPATIENT HEALTHCARE SERVICES, PSYCHIATRIC SERVICES, PHYSICIAN SERVICES, AND HOME HEALTH CARE, PRIMARILY TO PATIENTS IN THE CARSON CITY, MICHIGAN AREA, INCLUDING GRATIOT, MONTCALM, CLINTON, AND IONIA COUNTIES. CCH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE CCH DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. UNDER ARRANGEMENTS WITH VARIOUS GOVERNMENTAL INSURANCE PROGRAMS, CCH PROVIDES SIGNIFICANT CARE TO THE LOCAL INDIGENT POPULATION FOR WHICH REIMBURSEMENT FOR SERVICES RENDERED IS GENERALLY LESS THAN THE COST OF PROVIDING SUCH SERVICES. AS PART OF ITS OBILIAGTION TO THE LOCAL COMMUNITY, CCH ALSO PROVIDES SERVICES TO INDIGENT PATIENTS UNDER THE MEDICAID PROGRAM AT PAYMENT AMOUNTS LESS THAN THE COST OF THE SERVICES PROVIDED. FOR THE YEAR ENDED DECEMBER 31, 2013, CCH PROVIDED OVER $2 MILLION IN UNCOMPENSATED CARE. THE ESTIMATED ANNUAL TOTAL LOCAL ECONOMIC IMPACT IS $30,000,000. 1614348 1790228 ITHACA FAMILY CARE CENTER (IFCC) IS AN OFFICE WITH 2 PHYSICIANS, 1 NURSE PRACTIONER, AND 1 PHYSICIAN ASSISTANT THAT FOCUSES ON FAMILY PRACTICE FOR GRATIOT COUNTY. IFCC PROVIDES OUTPATIENT SERVICES SUCH AS AUDIOMETRY, BLOOD PRESSURECHECK, EAR EXAMINATION, EKG, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATIONS, HEALTH EDUCATION, HEMOCCULT, IMMUNIZATION, LACERATION, OFFICE VISITS, OSTEOPATHIC MAIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS AND PREMARITAL COUNSELING. THEY ALSO PROVIDE LABORATORY SERVICES SUCHA AS BLOOD SUGAR, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. 1280214 1365901 CARSON FAMILY CARE CENTER (CFCC) IS AN OFFICE WITH 2 PHYSICIANS, 1 NURSE PRACTITIONER, AND 1 PHYSICIAN ASSISTANT THAT FOCUSES ON FAMILY PRACTICE FOR MONTCALM COUNTY. CFCC PROVIES OUTPATIENT SERVICES SUCH AS ASTHMA SERVICES, AUDIOMETRY, BLOOD PRESSURE CHECKS, DISABILITY/IMPAIRMENT EVALUATIONS, DRUG AND ALCOHOL SCREENING, EAR EXAMINATION, EKG, EMPLOYEE SCREENING, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATION, HEALTH EDUCATION, IMMUNIZATION, IMMUNOTHERAPY, INJURY MANAGEMENT WORK RELATED INJURIES, LACERATION, LASER COSMETICS, OFFICE VISITS, OSTEPATHIC MANIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS, PRE-EMPLOYMENT PHYSICALS, PREMARITAL COUNSELING, SAFETY PROGRAMS AND WORK SITE VISITS. THEY ALSO PROVIDE LABORATORY SERVICES SUCH AS BLOOD SUGAR, HEMOCCULT, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. 8401971 21729672 OTHER PROGRAM SERVICES INCLUDE THE OPERATION OF THE FOLLOWING FACILITIES: ASHLEY FAMILY CARE CENTER, CARSON BEHAVIORAL CARE CENTER, CARSON CITY HOSPITAL ORTHOPEDICS AND GENERAL SURGERY PHYSICAL REHABILITATION CENTER, FOWLER FAMILY CARE CENTER, GREENVILLE FAMILY CARE, CENTER HOSPITALISTS LYONS FAMILY CARE CENTER, PEDIATRIC AND ADOLESCENT SPECIALISTS, STANTON FAMILY CARE CENTER, CARSON HOME CARE, CARSON PAIN MANAGEMENT. 8401971 21729672 58246587 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 56 0 1 715 1 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X RICHARD REID 9895843971 406 E ELM STREET CARSON CITY MI 48811 ROBERT SEALS SECRETARY/TREASURER, MED. DIRECTOR 40.00 0.00 X X 317497 0 14367 MATTHEW J THOMPSON PRESIDENT/CEO 40.00 0.20 X X 218284 0 13571 HAROLD HOUSE VICE CHAIR 2.00 0.00 X X 0 0 0 BRENT WILSON CHAIR 2.00 0.00 X X 0 0 0 GARY REETZ BOARD MEMBER 2.00 0.00 X 0 0 0 MARK BRETT BOARD MEMBER 2.00 0.00 X 0 0 0 TOM MACDONALD BOARD MEMBER 2.00 0.00 X 0 0 0 TOM OSTRANDER BOARD MEMBER 2.00 0.00 X 0 0 0 REX A RIMMEL DO BOARD MEMBER 2.00 0.00 X 0 0 0 DOUGLAS POFF DO BOARD MEMBER/PHYSICIAN 40.00 0.00 X 197930 0 5589 RODERICK COY BOARD MEMBER 2.00 0.00 X 0 0 0 CINDA KOSLOSKI BOARD MEMBER 2.00 0.00 X 0 0 0 GEORGETTE RUSSELL VP/TALENT & ORG. EFFECTIVENESS 40.00 0.00 X 137003 0 10614 RICHARD D TERRY VP/CIO 40.00 0.00 X 102811 0 6698 NANCY A WEAVER VP NURSING/CNO 40.00 0.00 X 169077 0 11223 DUANE C MILLER CFO 40.00 1.00 X 157532 0 11883 CHRISTOPHER E HERALD MD ER DIRECTOR 40.00 0.00 X 328050 0 15251 DAVID J FREESTONE MD PHYSICIAN/CHIEF OF STAFF 40.00 0.20 X 304853 0 15251 ROBERT BOORSTEIN DO PHYSICIAN 40.00 0.00 X 405816 0 15965 ADAM Z COTE PHYSICIAN 40.00 0.00 X 599233 0 8102 PARUTAPPA R BHIMALLI PHYSICIAN 40.00 0.00 X 519859 0 16542 JOSEPH B WHITE PHYSICIAN 40.00 0.00 X 612437 0 8151 RAYMOND P ALLARD PHYSICIAN 40.00 0.00 X 508100 0 9401 4578482 0 162608 79 0 1 0 PRISM HEALTHCARE PARTNERS LTD 190 S LA SALLE ST SUITE 2900 CHICAGO IL 60603 HEALTHCARE CONSULTING SERVICES 1331644 PHARMACY SYSTEMS PO BOX 71-0716 COLUMBUS OH 43271 PHARMACY CONSULTING SERVICES 256142 QUEUE ADVERTISING 410 S CEDAR LANSING MI 48912 ADVERTISING SERVICES 252596 PSI SUPPLY CHAIN SOLUTIONS LLC 5050 BRADENTON AVE DUBLIN OH 43017 SUPPLY CHAIN MANAGEMENT 212004 LIFE CARE SLEEP DIAGNOSTICS LLC 7200 W SAGINAW HWY SUITE 1 LANSING MI 48917 SLEEP STUDY CONSULTING 168700 9 NET PATIENT SERVICE REVENUE 621300 61109774 61109774 MEDICARE/MEDICAID "HITECH" REVENU 900099 464080 464080 61573854 448127 448127 502107 378085 124022 124022 124022 47028 0 47028 47028 47028 MISCELLANEOUS 900099 590489 590489 CAFETERIA/COFFEE SHOP/VENDING 722210 273514 273514 864003 63057034 61573854 0 1483180 1933037 1240954 692083 27547500 25752859 1794641 2050573 1865185 185388 2054019 1858616 195403 1796110 1644518 151592 129725 129725 85725 85725 5682714 2516145 3166569 533956 184470 349486 5093755 3896593 1188472 8690 960422 203082 754492 2848 6575627 5496080 1079547 320080 229726 90315 39 335032 335032 1707503 1687358 20145 921954 697237 224717 BAD DEBTS 3176472 3176472 RX SALES 2573624 2573624 ORTHO JOINT REPLACEMENT 1229914 1229914 IMPLANTS 843967 843967 2947945 2814755 133190 68499654 58246587 10241490 11577 4654 4704 3657966 3513798 8979500 7658136 65356 114882 1357876 1577849 2295049 1500123 47191193 25952607 22236362 21238586 5511066 5843661 239805 239804 1247124 1367464 45594758 43059007 7468462 9627418 14390157 13632780 2140214 1966218 20010 17510 1158538 1866645 25177381 27110571 X 20180658 15767354 236719 181082 20417377 15948436 45594758 43059007 X -5442620 471540 502139 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4644 4644 0 PART II-B, LINE 1: THE ORGANIZATION INDIRECTLY INFLUENCED LEGISLATION THROUGH ITS ANNUAL DUES PAID TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION; 18.82% OF DUES PAID WERE USED FOR SPECIFIC LOBBYING PURPOSES. 751643 751643 31730858 14388707 17342151 13116607 10965377 2151230 1592085 598523 993562 21238586 DEFINED BENEFIT PENSION LIABILITY 627135 COST REPORT SETTLEMENTS PAYABLE 1172010 OTHER LONG TERM LIABILITIES 67500 1866645 X 60886925 471540 -2641649 -2170109 63057034 0 63057034 65396772 73590 73590 65323182 3176472 3176472 68499654 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -3,176,472. CHANGE IN PENSION LIABILITY 534,823. PART XII, LINE 2D - OTHER ADJUSTMENTS: TRANSFER OF CAPITAL TO FUND THE FOUNDATION 73,590. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 3,176,472. 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 873189 873189 0.01270 10241629 6852014 3389615 0.04950 11114818 6852014 4262804 0.06220 21753 21753 0.00030 207602 17074 190528 0.00280 873189 873189 0.01270 1102544 17074 1085470 0.01580 12217362 6869088 5348274 0.07800 1 3176472 82588 11448044 11717897 -269853 X 1 1 1 1 CARSON CITY HOSPITAL 406 E ELM STREET CARSON CITY MI 48811 X X X X CARSON CITY HOSPITAL 1 1 X X X X X X X X 11 0 1 1 X SEE FULL WEBSITE ADDRESS IN SUPPLEMENTAL X X X X X 0 0 1 1 250.000000000000 1 250.000000000000 1 1 1 X 1 0 X X 1 X 0 0 CARSON CITY HOSPITAL PART V, SECTION B, LINE 4: SPECTRUM HEALTH KELSEY HOSPITALSHERIDAN COMMUNITY HOSPITALCHERRY STREET - MONTCALM AREA HEALTH CENTER CARSON CITY HOSPITAL PART V, SECTION B, LINE 5D: HTTP://WWW.CARSONHEALTH.ORG/ABOUT/COMMUNITY -HEALTH-ASSESSMENT-MONTCALM-AND-GRATIOT-COUNTY.HTML CARSON CITY HOSPITAL PART V, SECTION B, LINE 7: CARSON HEALTH WILL NOT BE SPECIFICALLY ADDRESSING EACH AND EVERY HEALTH NEED LISTED IN THE CHNA DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES ON THE TWO PRIORITY HEALTH NEEDS IDENTIFIED: IMPROVED ACCESS TO HEALTH CARE AND INCREASED AWARENESS OF EXISTING COMMUNITY RESOURCES. SOME OF THESE HEALTH NEEDS WILL BE INDIRECTLY IMPACTED BY FOCUSING ON THE TWO PRIORITY HEALTH NEEDS IDENTIFIED ABOVE. SEE IMPLEMENTATION STRATEGY POSTED ON THE ORGANIZATION'S WEBSITE: HTTP://WWW.CARSONHEALTH.ORG/ABOUT/CARSON-HEALTH-COMMUNITY-ASSESSMENT- IMPLEMENTATION-PLAN.HTML CARSON CITY HOSPITAL PART V, SECTION B, LINE 20D: DURING 2011, THE HOSPITAL FACILITY USED THE HIGHEST COMMERCIAL RATE WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. DURING 2012, THE HOSPITAL FACILITY HAS CHANGED ITS PRACTICE AND USES THE AVERAGE OF THE THREE HIGHEST COMMERCIAL RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AND IS CONSISTENT WITH FISCAL YEAR 2013. 14 ITHACA FAMILY CARE CENTER 114 N MAIN ST ITHACA MI 48847 GENERAL MEDICAL OUTPATIENT CLINIC CARSON FAMILY CARE CENTER 102 S THIRD ST STE 100 BOX 277 CARSON CITY MI 48811 GENERAL MEDICAL OUTPATIENT CLINIC PHYSICAL REHABILITATION CARE CENTER 602 E ELM STREET CARSON CITY MI 48811 OUTPATIENT REHABILITATION CLINIC CARSON HOME CARE 406 E ELM STREET CARSON CITY MI 48811 HOME HEALTH CARE GREENVILLE FAMILY CARE CENTER 1014 E WASHINGTON GREENVILLE MI 48838 GENERAL MEDICAL OUTPATIENT CLINIC PEDIATRIC & ADOLESCENT SPECIALISTS 245 S SECOND ST BOX 847 CARSON CITY MI 48811 GENERAL MEDICAL OUTPATIENT CLINIC STANTON FAMILY CARE CENTER 545 N STATE ST BOX 638 STANTON MI 48888 GENERAL MEDICAL OUTPATIENT CLINIC ASHLEY FAMILY CARE CENTER 320 S STERLING ST BOX 96 ASHLEY MI 48806 GENERAL MEDICAL OUTPATIENT CLINIC CARSON PAIN MANAGEMENT 102 S THIRD ST SUITE 300 CARSON CITY MI 48811 OUTPATIENT PAIN MANAGEMENT OFFICE CARSON CITY HOSPITAL ORTHOPEDICS AND GEN 102 S THIRD ST STE 400 BOX 326 CARSON CITY MI 48811 GENERAL MEDICAL/SURGICAL OUTPATIENT CLINIC HOSPITALISTS 406 E ELM STREET CARSON CITY MI 48811 GENERAL MEDICAL INPATIENT CLINIC CARSON BEHAVIORAL HEALTH CENTER 102 S THIRD ST STE 500 BOX 417 CARSON CITY MI 48811 BEHAVIORAL HEALTH CLINIC FOWLER FAMILY CARE CENTER 11017 W THIRD ST BOX 19 FOWLER MI 48835 GENERAL MEDICAL OUTPATIENT CLINIC LYONS FAMILY CARE CENTER 505 E BRIDGE ST BOX 186 LYONS MI 48851 GENERAL MEDICAL OUTPATIENT CLINIC PART I, LINE 7: THE DEFINITION OF A COMMUNITY BENEFIT IS A SERVICE OR PROGRAM THAT THE HOSPITAL PROVIDES TO PROMOTE HEALTH AND HEALING AS A RESPONSE TO COMMUNITY NEEDS. COMMUNITY BENEFITS USUALLY GENERATE A LOW OR NEGATIVE FINANCIAL RETURN, RESPOND TO PUBLIC HEALTH NEEDS, INVOLVE EDUCATION OR RESEARCH THAT IMPROVES THE OVERALL COMMUNITY HEALTH, AND RESPOND TO THE NEEDS OF SPECIAL POPULATIONS SUCH AS PERSONS LIVING IN POVERTY AND OTHER DISENFRANCHISED PERSONS. THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. PART I, LINE 7G: THE COMMUNITY BENEFITS REPORT TAKES THE WHOLE HOSPITAL, WHICH ALSO TAKES THE MEDICAL SERVICES GROUP PHYSICIAN CLINICS INTO CONSIDERATION. SOME ITEMS CAN ONLY BE DONE IN THE HOSPITAL WHILE MANY OTHERS CAN BE DONE IN A PHYSICIAN CLINIC SETTING. THE REVENUE THAT IS BROUGHT IN FROM THE PHYSICIAN CLINIC SETTING INCLUDES BLOOD PRESSURE CHECKS, CHILD IMMUNIZATIONS, AND CHOLESTEROL TESTING, AS WELL AS MANY OTHER PREVENTATIVE SERVICES IN LOW POPULATION, RURAL COMMUNITIES. PART III, LINE 2: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 3: THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY REPORTED IN PART III, LINE 3 IS DETERMINED BY USING A PERCENTAGE (2.6%) OF THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE AT COST. THIS PERCENTAGE IS DETERMINED BY ANALYZING THE HOSPITAL'S WRITE-OFFS COMPARED TO ITS TOTAL GROSS REVENUE. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. ANY SHORTFALLS THAT RESULT FROM MEDICARE ALLOWABLE COSTS EXCEEDING MEDICARE REVENUE CAN BE CONSIDERED A COMMUNITY BENEFIT IF THE ACTIVITY IS SOMETHING THAT CARSON CITY HOSPITAL IS DOING TO CREATE THE AWARENESS AND WELL-BEING OF THE HOSPITAL COMMUNITY. PART III, LINE 9B: CARSON CITY HOSPITAL INITIATES COLLECTION AT THE POINT OF SERVICE THROUGH THE PATIENT ACCESS DEPARTMENT. PATIENTS ARE ADVISED OF THEIR CO-PAY AND DEDUCTIBLE AND ASKED FOR A DEPOSIT ON THESE SELF-PAY CONTRIBUTIONS. PATIENTS WHO DO NOT HAVE INSURANCE ARE ADVISED OF ESTIMATED COST, AND ASSISTANCE PROGRAMS ARE OFFERED ALONG WITH CONTACT INFORMATION TO OBTAIN FURTHER INFORMATION. THE PATIENT'S BILL IS CHARGED, CODED, AND PROCESSED WITH THE APPROPRIATE PAYORS, IF APPLICABLE, AND AT THE POINT ALL THIRD PAYORS HAVE MADE PAYMENT, THE REMAINING BALANCE IS BILLED ON A STATEMENT TO THE PATIENT. AT THE POINT THAT THE PATIENT RECEIVES THE STATEMENT, THEY MAY CHOOSE TO MAKE PAYMENT ARRANGEMENTS THROUGH A PAYMENT PLAN, OR MAY CHOOSE TO APPLY FOR ASSISTANCE. THE PATIENT WHO DOES NOT MAKE PAYMENT ARRANGEMENTS OR DOES NOT APPLY FOR ASSISTANCE, WILL RECEIVE THREE STATEMENTS OVER A 90-DAY PERIOD. IF NO RESOLUTION IS ACHIEVED THE ACCOUNT WILL BE REFERRED TO AN OUTSIDE AGENCY FOR COLLECTION. THE PATIENT HAS 60 DAYS AT THE AGENCY BEFORE THEIR ACCOUNT IS RECORDED AS BAD DEBT. THE PATIENT STILL HAS THE OPTION OF APPLYING FOR ASSISTANCE OR MAKING PAYMENT ARRANGEMENTS WITH THE AGENCY. PART VI, LINE 2: CARSON CITY HOSPITAL RESPONDS TO THE HEALTHCARE NEEDS OF ITS ENTIRE SERVICE AREA. ITS DOORS ARE OPEN TO ALL THOSE WHO NEED HEALTHCARE SERVICES. INFORMATION ABOUT HEALTHCARE NEEDS IS RECEIVED THROUGH PARTNERSHIPS WITH LOCAL NON-PROFITS, GOVERNMENT AGENCIES AND OTHER HEALTHCARE ORGANIZATIONS, SUCH AS THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT AND THE IONIA COUNTY HEALTH DEPARTMENT - WHICH, TOGETHER, MONITOR THE MORTALITY RATES AND CAUSES IN CLINTON, GRATIOT, IONIA AND MONTCALM COUNTIES. HOSPITAL SERVICE RECORDS AND PATIENT SATISFACTION SURVEYS - MANAGED BY PRESS GANEY - ALSO PROVIDE FEEDBACK TO HOSPITAL STAFF ABOUT THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: ALTHOUGH NOT SPECIFICALLY OUTLINED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL USES THE FOLLOWING METHODS TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED: THE POLICY WAS POSTED ON THE HOSPITAL FACILITY'S WEBSITE, THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS OR WAITING ROOMS, THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICE, THE POLICY WAS AVAILABLE UPON REQUEST, PATIENTS WERE MADE AWARE OF THE POLICY UPON ADMISSION. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS CURRENTLY UNDER REVIEW, AND THE HOSPITAL IS CONSIDERING ADDING SPECIFIC INFORMATION RELATED THE METHODS USED TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED. PART VI, LINE 4: CARSON CITY HOSPITAL (CCH) IS A 77-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, DO. SINCE THIS TIME CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS OF COMMUNITIES IN A FOUR-COUNTY AREA. THE HOSPITALS GOVERNING BODY CONSISTS PRIMARILY OF VOLUNTEER MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN THE FALL OF 1996, CARSON BECAME A PART OF CARSON HEALTH NETWORK (CHN). CHN WAS INTRODUCED TO WORK AS AN UMBRELLA UNDER WHICH ALL THE INDIVIDUAL HEALTHCARE ENTITIES ARE CONTAINED. CHN INCLUDES CARSON CITY HOSPITAL, FAMILY MEDICINE PRACTICES AND SEVERAL SPECIALTY CLINICS OFFERING A WIDE VARIETY OF SERVICES. THE FAMILY MEDICINE PROFESSIONAL MEDICAL STAFF, IN COOPERATION WITH HOSPITAL BASED SPECIALISTS, SERVES PATIENTS IN ASHELY, CARSON CITY, FOWLER, GREENVILLE, ITHACA, LYONS, MAPLE RAPIDS AND STANTON. THESE OFFICES FALL INTO 4 COUNTIES WHICH INCLUDE MONTCALM, IONIA, CLINTON AND GRATIOT COUNTIES. ALL AREAS ARE DESIGNATED AS RURAL BASED WITH AN AVERAGE OF 20,210 HOUSEHOLDS WITH AN AVERAGE HOUSEHOLD SIZE OF 2.7 PEOPLE. THE AVERAGE INCOME PER HOUSEHOLD IS $42,590 WHILE 6.20% OF ALL FAMILIES ARE BELOW THE POVERTY LEVEL. ALSO INCLUDED IN THIS GEOGRAPHIC AREA ARE 5 OTHER HOSPITALS: SPARROW CLINTON HOSPITAL, SPARROW IONIA HOSPITAL, SPECTRUM HEALTH UNITED CAMPUS, SHERIDAN COMMUNITY HOSPITAL, AND MIDMICHIGAN MEDICAL CENTER GRATIOT. IN ADDITION TO ACUTE HOSPITAL CARE, CCH PROVIDES A VARIETY OF ADVANCED SERVICES, RANGING FROM AN INTENSIVE/CORONARY CARE UNIT TO A BEHAVIORAL HEALTH UNIT AND MULTIPLE OUTPATIENT SERVICES. CCH ALSO PROVIDES 24-HOUR EMERGENCY ROOM CARE. PHYSICIANS ARE AVAILABLE TO YOU ANY TIME AT THE HOSPITAL, DAY OR NIGHT FOR EMERGENCY OR NON-EMERGENCY MEDICAL ASSISTANCE. ANY SURPLUS FUNDS AVAILABLE TO THE HOSPITAL ARE USED FOR FACILITY AND EQUIPMENT IMPROVEMENTS IN ORDER TO PROVIDE BETTER PATIENT CARE. THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 INCLUDED PROVISIONS FOR IMPLEMENTING HEALTH INFORMATION TECHNOLOGY UNDER THE HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT ("HITECH"). THESE PROVISIONS WERE DESIGNED TO INCREASE THE USE OF ELECTRONIC HEALTH RECORDS("EHR") TECHNOLOGY AND ESTABLISH REQUIREMENTS FOR A MEDICARE AND MEDICAID INCENTIVE PAYMENTS PROGRAM BEGINNING IN 2011 FOR ELIGIBLE HOSPITALS AND PROVIDERS THAT ADOPT AND MEANINGFULLY USE CERTIFIED EHR TECHNOLOGY ELIGIBILITY FOR ANNUAL MEDICARE INCENTIVE PAYMENTS IS DEPENDENT ON PROVIDERS DEMONSTRATING MEANINGFUL USE OF EHR TECHNOLOGY IN EACH PERIOD OVER A FOUR-YEAR PERIOD. INITIAL MEDICAID INCENTIVE PAYMENTS ARE AVAILABLE TO PROVIDERS THAT ADOPT, IMPLEMENT, OR UPGRADE CERTIFIED EHR TECHNOLOGY, BUT PROVIDERS MUST DEMONSTRATE MEANINGFUL USE OF SUCH TECHNOLOGY IN SUBSEQUENT YEARS TO QUALIFY FOR ADDITIONAL INCENTIVE PAYMENTS. DURING 2012, CARSON CITY HOSPITAL DEMONSTRATED THE MEANINGFUL USE OF ITS CERTIFIED EHR TECHNOLOGY AND WAS ABLE TO RECOGNIZE APPROXIMATELY $1.3 MILLION IN REVENUE FOR HITECH INCENTIVES FROM MEDICARE AND MEDICAID. THESE INCENTIVE PAYMENTS ALLOW THE HOSPITAL TO PROVIDE ADDITIONAL QUALITY SERVICES TO THOSE IN THE COMMUNITY. PART VI, LINE 5: CARSON CITY HOSPITAL PROVIDES A SPEAKERS BUREAU LIST OF PHYSICIANS AND STAFF MEMBERS WHO ARE WILLING TO GO OUT INTO THE COMMUNITY AND SPEAK ON A VARIETY OF HEALTHCARE, QUALITY-OF-LIFE, AND GENERAL-INTEREST TOPICS TO SCHOOLCHILDREN, BUSINESS CLUBS, AND OTHER NON-PROFIT ORGANIZATIONS. THE HOSPITAL ALSO MAINTAINS A MONTHLY BROWN BAG LUNCH SERIES FEATURING SIMILAR TOPICS, WHICH IS HELD INSIDE THE HOSPITAL AND OPEN TO THE COMMUNITY. CARSON CITY HOSPITAL'S ACTIVITIES PROMOTE THE HEALTHCARE OF THE COMMUNITY BY EDUCATING AND PROVIDING EASY ACCESSIBLE HEALTHCARE WITH A 24-HOUR EMERGENCY DEPARTMENT. OUTSIDE PHYSICIANS CAN APPLY FOR PRIVILEGES AT CARSON CITY HOSPITAL THROUGH A PROCESS TO TREAT AND PROVIDE MEDICAL CARE AT THE HOSPITAL. IN ADDITION, CARSON CITY HOSPITAL IS COMPRISED OF SEVEN HOSPITAL-OWNED PHYSICIAN CLINICS IN A RURAL SETTING. FREE AND REDUCED RATE SPORTS PHYSICALS ARE PROVIDED AT SELECTED CLINICS. PART VI, LINE 6: IN JANUARY 1997, CHN BECAME AFFILIATED WITH THE SPARROW HEALTH SYSTEM OF LANSING, MICHIGAN. THIS AFFILIATION HAS MANY BENEFITS INCLUDING HOLDING DOWN HEALTH CARE COSTS, IMPROVED ACCESS TO SPECIALIZED SERVICES, ACCESS TO INFORMATION SYSTEMS, MANAGED CARE CONTRACTS AND NEW PHYSICIAN RECRUITMENT. CCH IS A MEMBER OF THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND THE MICHIGAN OSTEOPATHIC ASSOCIATION. X X 0 0 0 0 0 0 0 1 0 ROBERT SEALS SECRETARY/TREASURER, MED. DIRECTOR 303130 0 0 0 14367 0 7500 0 6867 0 331864 0 0 0 MATTHEW J THOMPSON PRESIDENT/CEO 204713 0 0 0 13571 0 5646 0 7925 0 231855 0 0 0 DOUGLAS POFF DO BOARD MEMBER/PHYSICIAN 192341 0 0 0 5589 0 5166 0 423 0 203519 0 0 0 NANCY A WEAVER VP NURSING/CNO 157854 0 0 0 11223 0 4385 0 6838 0 180300 0 0 0 DUANE C MILLER CFO 145648 0 0 0 11884 0 3709 0 8174 0 169415 0 0 0 CHRISTOPHER E HERALD MD ER DIRECTOR 312799 0 0 0 15251 0 7500 0 7751 0 343301 0 0 0 DAVID J FREESTONE MD PHYSICIAN/CHIEF OF STAFF 289602 0 0 0 15251 0 7500 0 7751 0 320104 0 0 0 ROBERT BOORSTEIN DO PHYSICIAN 389851 0 0 0 15965 0 7500 0 8465 0 421781 0 0 0 ADAM Z COTE PHYSICIAN 591131 0 0 0 8102 0 7500 0 602 0 607335 0 0 0 PARUTAPPA R BHIMALLI PHYSICIAN 503317 0 0 0 16542 0 7500 0 9042 0 536401 0 0 0 JOSEPH B WHITE PHYSICIAN 604286 0 0 0 8151 0 0 0 8151 0 620588 0 0 0 RAYMOND P ALLARD PHYSICIAN 498699 0 0 0 9401 0 7500 0 1901 0 517501 0 0 0 PART I, LINE 7 PHYSICIANS RECEIVED ANNUAL PRODUCTION INCENTIVE COMPENSATION, WHICH IS CALCULATED BASED ON EQUALING OR EXCEEDING CERTAIN NET PATIENT REVENUE TARGETS A MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 54965HKS4 2006-02-01 18000000 HOSPITAL EQUIPMENT LOAN PROGRAM (HELP) 0 0 1 B MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 594654HG5 2007-12-18 455937 HOSPITAL EQUIPMENT LOAN PROGRAM (HELP) 0 0 1 A 3970793 18000000 133000 14012600 3854400 2009 0 0 1 1 B 94987 455937 455937 2007 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: MICHIGAN STATE HOSPITAL FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/01/2011 ISSUER NAME: MICHIGAN STATE HOSPITAL FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/18/2012 SCHEDULE K, PART II, LINE 3 THE ORGANIZATION SPENT ITS OWN OPERATING FUNDS AND IN TURN WAS REIMBURSED WITH THE BOND PROCEEDS, THEREFORE THERE ARE NO INTEREST EARNINGS ON THE PROCEEDS. SPARROW HEALTH SYSTEM BRETT, OSTRANDER, REETZ, & KOSLOSKI ARE CCH BOARD MEMBERS/SPARROW OFFICERS 592445 MARK BRETT, TOM OSTRANDER, GARY REETZ AND CINDA KOSLOSKI, CARSON CITY HOSPITAL BOARD MEMBERS, SERVE AS THE SENIOR VICE PRESIDENT, AFFILIATE OPERATIONS; VICE PRESIDENT, PROFESSIONAL SERVICES; CONTROLLER; AND DIRECTOR OF DECISION SUPPORT, RESPECTIVELY, FOR SPARROW HEALTH SYSTEM, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2013, CARSON CITY HOSPITAL MADE PAYMENTS TO SPARROW HEALTH SYSTEM IN THE AMOUNT OF $342,445 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICALS, LABORATORY AND OTHER PATIENT CARE SERVICES, SOFTWARE SUPPORT, EQUIPMENT RENTAL, AND PHYSICIAN RECRUITING. AND CARSON CITY HOSPITAL RECEIVED PAYMENTS FROM SPARROW HEALTH SYSTEM IN THE AMOUNT OF $250,000 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICALS, OFFICE RENT, AND SUPPORT FOR PSYCHIATRIC MEDICAL EDUCATION. 0 FORM 990, PART VI, SECTION A, LINE 6 CARSON CITY HOSPITAL (CCH) IS ORGANIZED ON A MEMBERSHIP BASIS. THERE ARE TWO CLASSES OF MEMBERS: CLASS A MEMBERSHIP CONSISTS OF THE ORIGINAL DIRECTORS OF CCH, EXCLUDING THOSE DIRECTORS WHO ARE ELECTED OR APPOINTED BY THE CLASS B MEMBER; THE CLASS B MEMBER IS SPARROW HEALTH SYSTEM (SPARROW), AN UNRELATED MICHIGAN NONPROFIT CORPORATION. OTHER THAN SPARROW, THERE SHALL BE NO ADDITIONAL CLASS B MEMBERSHIP INTERESTS WITHOUT THE CONSENT OF SPARROW. FORM 990, PART VI, SECTION A, LINE 7A CLASS A MEMBERS EACH HAVE ONE VOTE FOR PURPOSES OF VOTING BY MEMBERS; THE NUMBER OF VOTES HELD BY THE CLASS B MEMBER (SPARROW) IS PROPORTIONATE TO THE SPARROW PERCENTAGE INTEREST MULTIPLIED BY THE VOTES HELD IN THE AGGREGATE BY BOTH CLASS A AND CLASS B MEMBERS. AT THE ANNUAL MEETING OF THE MEMBERS, THE CLASS A MEMBERS ELECT 9 DIRECTORS OF THE BOARD OF DIRECTORS BY MAJORITY VOTE OF THE CLASS A MEMBERS, AND THE CLASS B MEMBER (SPARROW) ELECTS A NUMBER OF DIRECTORS OF THE BOARD OF DIRECTORS THAT IS CONSISTENT WITH THE CURRENT SPARROW PERCENTAGE INTEREST. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIVITIES REQUIRE THE AFFIRMATIVE VOTE OF THE CLASS B MEMBER (SPARROW): 1. AMENDMENTS TO THE ARTICLES OF INCORPORATION AND THE BYLAWS; 2. THE DISSOLUTION, MERGER, SALE, SALE OF SUBSTANTIALLY ALL OF THE ASSETS, LEASE, OR TRANSFER OF CONTROL; 3. THE SALE OF A MAJORITY OWNERSHIP INTEREST IN CCH; 4. THE PUBLICLY RECOGNIZED "AFFILIATION" WITH ANY ORGANIZATION OTHER THAN THE CLASS B MEMBER (SPARROW); 5. APPROVAL OF CCH'S ANNUAL OPERATING BUDGET, WHEN SUCH BUDGET REFLECTS A TOTAL MARGIN OF LESS THAN 2% OF NET REVENUE; 6. APPROVAL OF CCH'S ANNUAL CAPITAL BUDGET, WHEN SUCH BUDGET ANTICIPATES AN ADDITIONAL CAPITAL CONTRIBUTION FROM THE CLASS B MEMBER (SPARROW) BEYOND ITS ORIGINAL CAPITAL CONTRIBUTION; 7. THE INCURRENCE OF ANY DEBT OBLIGATION IN THE AGGREGATE GREATER THAN $500,000; 8. THE APPROVAL OF CAPITAL EXPENDITURES IN EXCESS OF $500,000 (EXCEPT AS TO REPLACE EQUIPMENT); AND 9. ANY ACTION THAT ALLOWS OR FACILITATES THE CREATION OF A NEW CLASS OF MEMBERS OR CREATION OF A MEMBERSHIP INTEREST IN CCH. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S MANAGEMENT. A BOARD MEETING IS HELD WITH OUR TAX ADVISORS WHERE A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY FOR REVIEW BEFORE THE RETURN IS FILED WITH THE IRS. THE BOARD IS GIVEN A SUMMARY OF KEY POINTS REGARDING THE FORM 990, AND IS ALLOWED TO ASK ANY QUESTIONS THEY MAY HAVE ONCE ALL BOARD MEMBERS HAVE REVIEWED THE RETURN, IT IS THEN SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED TO ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO DETERMINE WHETHER ANY POTENTIAL CONFLICTS OF INTEREST EXIST ON AN ANNUAL BASIS. THE HOSPITAL EXECUTIVE COMMITTEE, WHICH INCLUDES THE PRESIDENT OF THE BOARD OF DIRECTORS, DISCUSSES THE CONFLICT OF INTEREST QUESTIONNAIRES TO DETERMINE WHETHER AN ACTUAL CONFLICT EXISTS. IF A CONFLICT IS DETERMINED TO EXIST, THE PERSON WITH THE CONFLICT IS RECUSED FROM TAKING PART IN ANY DECISIONS CONCERNING THE CONFLICTING ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/CEO. THE BOARD PRESIDENT/CEO IS REMOVED FORM THE BOARD DISCUSSIONS TO PREVENT HIM FROM DISCUSSING AND DETERMINING HIS OWN COMPENSATION. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR THE CEO, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. COMPENSATION FOR THE CURRENT YEAR IS DISCUSSED AND APPROVED IN THE PREVIOUS YEAR DURING THE BUDGET APPROVAL PROCESS. THE 2012 COMPENSATION WAS REVIEWED AND APPROVED DURING NOVEMBER/DECEMBER 2011 DURING THE ANNUAL BUDGETING PROCESS. THE 2013 COMPENSATION WAS REVIEWED AND APPROVED DURING NOVEMBER/DECEMBER 2012 DURING THE ANNUAL BUDGETING PROCESS. THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR ALL POSITIONS, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR ALL POSITIONS, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. THE 2013 COMPENSATION WAS REVIEWED AND APPROVED AT THE END OF 2012 DURING THE ANNUAL BUDGETING PROCESS. FORM 990, PART VI, SECTION C, LINE 19 AN ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. AS A HOSPITAL, THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS AN ATTACHMENT TO ITS FORM 990, WHICH IS A REQUIRED DISCLOSURE PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. FORM 990, PART VI, LINE 1A THE EXECUTIVE COMMITTEE OF THE BOARD SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, THE PRESIDENT, THE VICE-CHAIRPERSON, THE SECRETARY/TREASURER AND THE MEDICAL DIRECTOR A SIXTH MEMBER SHALL BE APPOINTED BY THE CHAIRPERSON AND CHOSEN FORM ONE OF THE CLASS B MEMBERS OF THE BOARD THE CHAIRPERSON SHALL APPOINT REPLACEMENTS WHEN NECESSARY A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM IT SHALL HAVE THE AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS THE COMMITTEE SHALL MAKE A FULL REPORT OF ITS ACTIONS, IF ANY, AT THE NEXT REGUALR MEETING OF THE BOARD MEETINGS OF THE COMMITTEE MAY BEHELD AT ANY TIME ON CALL BY THE CHAIRPERSO OF THE BOARD. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY 534,823. PRIOR PERIOD ADJUSTMENT 40,906. TRANSFER OF CAPITAL TO FUND THE FOUNDATION -73,590. FORM 990, PART XII, LINE 2C THE AUDIT PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. CARSON FOUNDATION INC 406 E ELM ST CARSON CITY MI 48811 460877509 ENHANCE RESOURCES FOR HIGH QUALITY AND ACCESSIBLE HEALTH CARE MI 501(C)(3) LINE 11A, I CARSON CITY HOSPITAL 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 CARSON FOUNDATION INC B 73590 ACTUAL AMOUNT