2014-07-29T16:23:27-05:00 2013-06-30 381357951 PLANTE & MORAN PLLC 600 E FRONT STREET SUITE 300 TRAVERSE CITY MI 49686 990 2012-07-01 381381288 PORTAGE HEALTH INC PORT 9064878000 500 CAMPUS DRIVE HANCOCK MI 49930 SUSAN BINKLEY 9064878000 2014-07-23 1 MICHAEL A BAKER P00053797 2319477800 2012 2015-11-30 17:44:51Z JAMES BOGAN 500 CAMPUS DRIVE HANCOCK MI 49930 94480880 0 X WWW.PORTAGEHEALTH.ORG X 1948 MI TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES. 14 8 875 107 1666764 37601 75256 55961 80662704 82209455 918391 1893096 1948956 2200123 83605307 86358635 67000 41500 0 0 44993242 47329236 0 0 0 33508930 34285409 78569172 81656145 5036135 4702490 99612010 101728636 37762680 32690463 61849330 69038173 X TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES. 0 0 22410803 35440118 OUTPATIENT SERVICES - (SURGERY, LAB, IMAGING, REHAB, INFUSIONS, ETC) 121,096 VISITS 12576040 14149290 PHYSICIAN CLINICS - 71,373 VISITS 8164175 16005501 INPATIENT ROUTINE CARE - 1,501 DISCHARGES AND 332 NEWBORN DELIVERIES 26146693 41500 16614546 ALL OTHER PROGRAM SERVICES 26146693 41500 16614546 69297711 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 94 0 1 875 1 1 1 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X SUSAN BINKLEY CFO 9064831503 500 CAMPUS DRIVE HANCOCK MI 49930 BRUCE TRUSOCK MD 40.00 0.40 X 298910 0 26530 STEVE ZUTTER 1.00 0.40 X X 0 0 0 MARTIN ISKRA 1.00 0.40 X 0 0 0 JAMES BOGAN 40.00 0.40 X X 345968 0 30690 KIRK LUFKIN MD 40.00 0.40 X 280638 0 17969 ELLEN HORSCH 1.00 0.40 X 0 0 0 DAVE MECHLIN 1.00 0.40 X 0 0 0 MIKE NEUMAN MD PHD 1.00 0.40 X X 0 0 0 TIMOTHY SEARS MD 40.00 0.40 X 446185 0 30571 KRISTINE JUKURI-WEIDNER 1.00 0.40 X X 0 0 0 WILLIAM LISTON MD 40.00 0.40 X 428736 0 17707 TIM BARONI 1.00 0.40 X X 0 0 0 DAWN NULF MD 40.00 0.40 X 366150 0 30822 JAY MARTINEAU 1.00 0.40 X 0 0 0 BRIAN DONAHUE 40.00 0.40 X 178963 0 27706 CHRISTOPHER PEER 40.00 0.00 X 607187 0 15547 KIRK KLEMME 40.00 0.00 X 438532 0 26995 JENNIFER BOW 40.00 0.00 X 500608 0 16855 WILLIAM SARAZIN 48.60 0.00 X 347098 0 30976 REBECCA BAUDOIN 36.00 0.00 X 311189 0 17582 4550164 0 289950 54 0 1 0 THOMAS J MOYLE JR INC PO BOX 399 HOUGHTON MI 49931 BUILDING CONSTRUCTION SERVICES 2086170 MARQUETTE GENERAL HOSPITAL 580 W COLLEGE AVENUE MARQUETTE MI 49855 MEDICAL & COMPUTER SERVICES 871222 MEDICAL LABS OF MARQUETTE PC 420 W MAGNETIC MARQUETTE MI 49855 PATHOLOGY SERVICES 472605 DELTA LOCUM TENENS 1755 WITTINGTON PLACE DALLAS TX 75234 PHYSICIAN LOCUM SERVICES 386056 AHSA LLC PO BOX 945 TRAVERSE CITY MI 49685 PHYSICIAN LOCUM SERVICES 292275 14 37990 8685 9286 55961 HEALTH SERVICES 622110 80734643 80734643 OTHER RELATED REVENUE 622110 1035691 1035691 EHR REVENUE 622110 439121 439121 82209455 960938 960938 184834 5311 179523 179523 179523 9042092 7000 8110976 5958 931116 1042 932158 932158 MANAGEMENT FEES 541610 1666764 1666764 CAFETERIA INCOME 722210 353836 353836 2020600 86358635 82209455 1666764 2426455 41500 41500 2520762 1636060 884702 34813998 30421128 4392870 1892644 1474790 417854 5760413 4895598 864815 2341419 1770092 571327 77728 77728 128955 128955 157553 157553 7993541 6133210 1860331 274651 12669 261982 1019655 543172 476483 271196 177021 94175 1207191 967238 239953 255063 241306 13757 285775 102759 183016 1235632 1037931 197701 3921501 3294061 627440 244188 2268 241920 MEDICAL SUPPLIES & DRUG 11903157 11699444 203713 QUALITY ASSURANCE TAXES 2127578 2127578 PROVISION FOR BAD DEBTS 1706515 1706515 AFFILIATION COSTS 546415 546415 929115 466956 462159 81656145 69297711 12358434 0 7801785 9308260 1313011 265979 750 8332620 6444557 1377623 1479656 1162751 864490 981621 375363 96664193 52151622 43367712 44512571 28504132 31480503 6770005 6997257 99612010 101728636 7437764 5872689 6000 25329900 23944900 4995016 2866874 37762680 32690463 X 61849330 69038173 61849330 69038173 99612010 101728636 X 4702490 1007862 1478491 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 10186 10186 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DUES PAID TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND HCAM. 157724 157724 59008237 25122783 33885454 1329074 848299 480775 33855369 26180540 7674829 2313789 2313789 44512571 COST REPORT SETTLEMENT RECEIVABLE 2461636 BOND ISSUE COST 382328 INVESTMENT IN JOINT VENTURES 556798 INVESTMENT IN SUBSIDIARIES 3596495 6997257 FAIR VALUE OF INTEREST RATE SWAP 2541283 COST REPORT SETTLEMENT PAYABLE 325591 2866874 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION 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 ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 449155 449155 0.00560 10200270 10190207 10063 0.00010 10649425 10190207 459218 0.00570 941 21149 163008 163008 0.00200 14 390 900087 900087 0.01130 1 16000 16000 0.00020 831 25544 394520 394520 0.00490 1787 47083 1473615 1473615 0.01840 1787 47083 12123040 10190207 1932833 0.02410 3 295 7500 7500 0.00010 8 374 9820 9820 0.00010 5 793 9823 9823 0.00010 16 1462 27143 27143 0.00030 1 1706515 145054 15559924 16290659 -730735 X 1 1 1 1 PORTAGE HEALTH INC

500 CAMPUS DRIVE HANCOCK MI 49930

WWW.PORTAGEHEALTH.ORG X X X PORTAGE HEALTH INC 1 1 X X X X X X 12 1 1 1 X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 9 PORTAGE HEALTH REHAB

MINE STREET STATION CALUMET MI 49913

OUTPATIENT REHAB PORTAGE HEALTH INC

500 CAMPUS DRIVE HANCOCK MI 49930

LONG-TERM CARE MERCY EMS

23298 AIRPARK BLVD CALUMET MI 49913

AMBULANCE SERVICE JOINT VENTURE PORTAGE HEALTH HOME CARE & HOSPICE

821 WATER STREET HANCOCK MI 49930

HOME HEALTH OFFICE PORTAGE HEALTH - UNIVERSITY CENTER

600 MACINNES DRIVE HOUGHTON MI 49931

OUTPATIENT CLINIC PORTAGE HEALTH MEDICAL GROUP

945 NINTH STREET LAKE LINDEN MI 49945

OUTPATIENT CLINIC PORTAGE HEALTH SLEEP DISORDERS CENTER

890 CAMPUS DRIVE HANCOCK MI 49930

SLEEP DISORDERS CENTER PORTAGE HEALTH - HOUGHTON

921 W SHARON AVE HOUGHTON MI 49930

EXPRESS CARE & FITNESS CENTER ONTONAGON COMMUNITY HEALTH CENTER INC

751 S SEVENTH STREET ONTONAGON MI 49953

MEDICAL CLINIC JOINT VENTURE PART I, LINE 3C: PATIENTS WHO DO NOT QUALIFY FOR MEDICAL ASSISTANCE (MEDICAID), HAVE A FAMILY NET WORTH OF LESS THAN $100,000 AND WHOSE ANNUAL FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR FREE CARE. PATIENTS WHO DO NOT QUALIFY FOR MEDICAID OR THE COMMUNITY CARE PROGRAM MAY QUALIFY FOR THE OUR DISCOUNTED CARE PROGRAM. PATIENTS WHO HAVE A FAMILY NET WORTH OF LESS THAN $100,000 AND WHOSE ANNUAL FAMILY INCOME IS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR A 30% TO 90% WRITE-OFF OF THEIR BILL. ALL SELF PAY PATIENTS AUTOMATICALLY RECEIVE A 20% DISCOUNT. PART I, LINE 6A: N/A - NO RELATED PARTIES IDENTIFIED. PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. THE HOSPITAL'S INTERNAL ACCOUNTING RECORDS/ACTUAL COSTS ARE USED FOR LINES 7E, 7F, AND 7I. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $1,706,515. PART II: PORTAGE HEALTH HAS ESTABLISHED ITSELF AS A LEADER IN PROMOTING THE HEALTH OF THE COMMUNITY. A FEW EXAMPLES OF THE MANY HEALTH PROMOTION ACTIVITIES THAT WE DO ARE MENTIONED HERE. THESE HEALTH PROMOTION ACTIVITIES TOUCH DIFFERENT AGE GROUPS. 1.MEALS ON WHEELS PROGRAM FOR THE ELDERLY IN WHICH WE PREPARE 1100 MEALS AT NOON EACH DAY. NOT ONLY DO WE PROVIDE THE MEAL, BUT MANY TIMES OUR MEAL TRANSPORTER IS THE ONLY PERSON THAT THE ELDERLY CITIZENS SEE. WE ATTEMPT TO MEET SOME OF THEIR EMOTIONAL NEEDS AS WELL AS THEIR PHYSICAL NEEDS.2.THE PROMOTION OF A SMOKE FREE CAMPUS MANY YEARS AGO HAS ESTABLISHED PORTAGE AS A LEADER IN OUR COMMUNITY TO STAMP OUT TOBACCO USE. HEALTH PROMOTION AND EARLY DETECTION OF DISEASE ARE BOTH IMPORTANT FOR US TO IMPROVE THE QUALITY OF LIFE IN THE COMMUNITY. 3. PORTAGE JOINED THE COPPER COUNTRY GREAT START COLLABORATIVE TO ASSIST IN MAKING SURE THAT EVERY CHILD IN BARAGA, HOUGHTON, AND KEWEENAW COUNTIES AND THEIR PARENTS HAS THE SERVICES THEY NEED FOR PHYSICAL HEALTH, SOCIAL AND EMOTIONAL HEALTH, QUALITY CARE AND EARLY LEARNING; AND PARENT LEADERSHIP AND SUPPORT.4. PORTAGE DONATED FUNDS TO SUPPORT THE COPPER HARBOR PLAYGROUND PROJECT. THE PROJECT PROMOTES THE VITAL DEVELOPMENT OF SOCIAL AND PHYSICAL HEALTH FOR CHILDREN OF ALL ABILITIES. THE PROJECT ALSO STRIVES TO ENRICH THE QUALITY OF LIFE FOR ALL LOCAL CITIZENS, PROVIDE ECONOMIC VALUE THROUGH FACILITIES THAT SUPPORT TOURISM, AND ENCOURAGE LONG-TERM COMMUNITY STABILITY AND GROWTH.AS SHOWN HERE, PORTAGE HEALTH HAS COMMITTED TO PROVIDING THE LEADERSHIP IN HEALTH PROMOTION IN ACTIVITIES. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION 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 ORGANIZATION 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 INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION 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.THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY IS $145,054. THE HOSPITAL'S BEST ESTIMATE, 8.50 PERCENT OF BAD DEBT EXPENSE, WAS BASED UPON REVIEW OF EXTERNAL LITERATURE.THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 8: MEDICARE SHORTFALL IS TAKEN FROM THE MEDICARE COST REPORT. THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: EACH PATIENT RECEIVES 3 SYSTEM GENERATED STATEMENTS. IF THEY DO NOT MAKE SUFFICIENT PAYMENT, THE PATIENT RECEIVES A LETTER. AFTER THE LETTER IS SENT WITH NO RESOLUTION, THE PATIENT WILL RECEIVE A FINAL NOTICE LETTER, THEN A PHONE CALL. IF NO RESOLUTION AT THAT POINT, PATIENT IS TURNED TO COLLECTIONS. COLLECTION AGENCY WORKS ALL BAD DEBT ACCOUNTS. NON-EMERGENT CARE BAD DEBT PATIENTS OWING MORE THAN $100 WILL NOT BE SCHEDULED FOR ADDITIONAL MEDICAL CARE UNTIL THEY MEET WITH THE FINANCIAL COUNSELOR AND MAKE FULL PAYMENT OR SET UP PAYMENT PLAN. THESE NON-EMERGENT CARE PATIENTS MAY ALSO APPLY TO SEE IF THEY QUALIFY FOR FINANCIAL ASSISTANCE FOR FUTURE VISITS. PATIENTS IN NEED OF URGENT CARE ARE SEEN REGARDLESS OF ABILITY TO PAY. PORTAGE HEALTH, INC. PART V, SECTION B, LINE 3: SEE THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT, LOCATED AT HTTP://WWW.PORTAGEHEALTH.ORG.THE REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY WESTERN UPPER PENINSULA HEALTH DEPARTMENT IN PARTNERSHIP WITH HEALTH CARE PROVIDERS ASPIRUS GRAND VIEW, ASPIRUS KEWEENAW, ASPIRUS ONTONAGON HOSPITAL, BARAGA COUNTY MEMORIAL HOSPITAL, COPPER COUNTRY MENTAL HEALTH SERVICES, GOGEBIC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY, AND WESTERN UPPER PENINSULA SUBSTANCE ABUSE SERVICE COORDINATING AGENCY. THE LEAD INVESTIGATOR ON THE PROJECT WAS RAY SHARP, MANAGER, COMMUNITY PLANNING & PREPAREDNESS FROM WESTERN UPPER PENINSULA HEALTH DEPARTMENT. DATA FOR THE ASSESSMENT REPORT WERE GATHERED FROM A WIDE ARRAY OF PUBLISHED SOURCES, FROM A SURVEY OF MORE THAN 2,500 LOCAL ADULTS, AND FROM HEALTH CARE PROVIDERS. PUBLISHED SOURCES INCLUDED THE U.S. CENSUS, THE AMERICAN COMMUNITY SURVEY, AND STATISTICS COMPILED BY THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, THE WISCONSIN DIVISION OF PUBLIC HEALTH, AND OTHER GOVERNMENT AND PRIVATE AGENCIES. THE LOCAL SURVEY WAS DESIGNED AND ADMINISTERED BY HEALTH DEPARTMENT STAFF. DR. ADAM WELLSTEAD, ASSISTANT PROFESSOR AT MICHIGAN TECHNOLOGICAL UNIVERSITY, ASSISTED WITH THE STATISTICAL ANALYSIS OF THE SURVEY RESPONSES. PORTAGE HEALTH, INC. PART V, SECTION B, LINE 4: THE CHNA WAS CONDUCTED WITH THE FOLLOWING OTHER HOSPITAL FACILITIES - ASPIRUS GRAND VIEW, ASPIRUS KEWEENAW, ASPIRUS ONTONAGON HOSPITAL AND BARAGA COUNTY MEMORIAL HOSPITAL. PORTAGE HEALTH, INC. PART V, SECTION B, LINE 5C: THE COMPLETE CHNA REPORT WAS MADE AVAILABLE TO ALL OF PORTAGE HEALTH STAFF. SPECIAL PRESENTATIONS ON CHNA FINDINGS WERE MADE TO THE FOLLOWING GROUPS WITHIN PORTAGE HEALTH - EXECUTIVE MANAGEMENT, PHYSICIAN AND MANAGEMENT STAFF, AND THE BOARD OF DIRECTORS. AN EIGHT PAGE PRINTED SUMMARY WAS ALSO GIVEN TO MANY GROUPS WITHIN PORTAGE HEALTH AND MADE AVAILABLE AT ALL PORTAGE HEALTH FACILITIES. PORTAGE HEALTH, INC. PART V, SECTION B, LINE 7: SEE THE HOSPITAL'S IMPLEMENTATION PLAN, LOCATED AT HTTP://WWW.PORTAGEHEALTH.ORG.PORTAGE HEALTH CREATED A WELLNESS ADVISORY COUNCIL TO REVIEW THE COMPLETED CHNA REPORT, PRIORITIZE NEEDS AND IDENTIFY IMPLEMENTATION STRATEGIES TO ADDRESS AREAS OF FOCUS. THE WELLNESS ADVISORY COUNCIL ALSO TOOK INTO CONSIDERATION CURRENT PROGRAMING AND SERVICES OFFERED IN THE COMMUNITY WHEN PRIORITIZING NEEDS. 3 AREAS OF FOCUS WERE IDENTIFIED CHILDHOOD OBESITY, COMMUNITY NUTRITION, PREVENTION/WELLNESS. AN IMPLEMENTATION PLAN INCLUDING STRATEGIES, ACTIONS, PARTNERS AND RESOURCES WAS THEN CREATED TO ADDRESS EACH AREA OF FOCUS. AVAILABILITY OF RESOURCES LIMITED ADDRESSING EVERY NEED IDENTIFIED WITHIN THE CHNA REPORT. PORTAGE HEALTH, INC. PART V, SECTION B, LINE 20D: ALL BILLS ARE GENERATED AT GROSS CHARGES FOR PROCEDURES PROVIDED. ALL SELF PAY PATIENTS AUTOMATICALLY RECEIVE A 20 PERCENT DISCOUNT. THE 20 PERCENT DISCOUNT IS BASED ON BEST PRACTICE BENCHMARKS. AFTER THE 20 PERCENT DISCOUNT IS APPLIED, THE PATIENT BILL WOULD BE LESS THAN GENERALLY CHARGED TO PATIENTS WITH INSURANCE. PART VI, LINE 2: PORTAGE HEALTH HAS PARTNERED WITH THE WESTERN U.P. HEALTH DEPARTMENT, ASPIRUS HOSPITALS, BARAGA COUNTY MEMORIAL HOSPITAL, WESTERN U.P. SUBSTANCE ABUSE SERVICE COORDINATING AGENCY, COPPER COUNTRY MENTAL HEALTH AND GOGEBIC COUNTY COMMUNITY MENTAL HEALTH TO CONDUCT A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). DATA WAS COLLECTED THROUGH MANY DIFFERENT FACETS, INCLUDING A LOCAL SURVEY OF THE COMMUNITY. THE FINALIZED CHNA REPORT WAS RELEASED IN 2013. PORTAGE HEALTH HAS A WELLNESS TASK FORCE WHICH HAS DEVELOPED INITIATIVES BASED ON THE NEEDS IDENTIFIED IN THE CHNA. THESE INITIATIVES WILL BE PRIORITIZED AND IMPLEMENTED IN FISCAL YEAR 2014. PART VI, LINE 3: SOCIAL WORKERS CHECK IN-PATIENTS FOR INSURANCE AND MEET WITH THE PATIENT TO GIVE THEM THE MEDICAID AND FINANCIAL ASSISTANCE APPLICATION; THEY OFFER TO HELP COMPLETE THE FORMS. SELF PAY PATIENTS ARE CONTACTED BY FINANCIAL COUNSELORS TO EXPLORE OPTIONS. FINANCIAL ASSISTANCE BROCHURES ARE IN THE CLINICS, THE ER AND ON PORTAGE HEALTH'S WEBSITE. DOCTORS AND NURSES REFER PATIENTS IN FINANCIAL NEED TO THE FINANCIAL COUNSELORS. PART VI, LINE 4: PORTAGE HEALTH SERVES A 4 COUNTY AREA, WITH POPULATION OF 53.461 AND COVERING A LAND AREA OF 3,768 SQUARE MILES.PORTAGE HEALTH IS A COMMUNITY BASED HEALTH CARE ORGANIZATION WHICH PROVIDES HEATH CARE SERVICES TO 28,000 PEOPLE IN A PRIMARY SERVICE AREA AND 20,000 IN A SECONDARY SERVICE AREA FOR A TOTAL OF 48,000 PEOPLE.OUR COMMUNITY IS RURAL IN NATURE BUT HAS 2 UNIVERSITIES WHICH OFFER AN ARRAY OF SERVICES WHICH ARE AVAILABLE BOTH TO THE STUDENT POPULATION AS WELL AS THE GENERAL COMMUNITY. OUR CONSTITUENTS ARE A COMBINATION OF RETIRED ELDERLY, PROFESSIONALS, TRADES, LOW INCOME PEOPLE AND STUDENTS. WE PROVIDE THE NEEDED SERVICES THAT THIS CONSTITUENCY NEEDS. WE OFFER SECONDARY CARE SERVICES WHICH INCLUDES EMERGENCY, DIAGNOSTICS, CLINICS, HOME CARE, HEALTH PROMOTION, ACUTE CARE AND REHAB. PART VI, LINE 5: WE EVALUATE THE HEALTH BEHAVIORS AND ADDRESS CHANGES IN BEHAVIOR BY OFFERING PROGRAMS TO OUR COMMUNITY WHICH AFFECT CHANGE. SOME AREAS ARE TOBACCO ABUSE, OBESITY, SLEEP DEPRIVATION AND BAD EATING HABITS. PART VI, LINE 6: AFFILIATES OF PORTAGE HEALTH INC. INCLUDE THE FOLLOWING ORGANIZATIONS, EACH OF WHICH CONTRIBUTE TO HEALTH PROMOTION IN THE MANNER INDICATED: * PORTAGE HEALTH RESOURCES, INC PROVIDES MEALS TO SENIORS IN THE COMMUNITY* PORTAGE HEALTH HOME SERVICES PROVIDES HOME HEALTH SERVICES, HOME MEDICAL EQUIPMENT AND SUPPLIES, HOSPICE SERVICES, AND PRIVATE DUTY SERVICES.* PORTAGE HEALTH FOUNDATION RAISES, MANAGES, AND DISPENSES FUNDS TO SUPPORT THE MISSION OF PORTAGE HEALTH INC. AND PROVIDE PROGRAMS THAT ENHANCE THE WELL-BEING OF THE COMMUNITY.* ONTONAGON COMMUNITY HEALTH CENTER, INC. - PROVIDES PRIMARY HEALTH CARE SERVICES AND VISITING PHYSICIAN SPECIALISTS TO ONTONAGON COMMUNITY RESIDENTS.* MERCY EMS PROVIDES EMERGENCY TRANSPORTATION SERVICES. * COPPER COUNTRY APOTHECARIES, INC. - OFFERS RETAIL PHARMACY SERVICES. REPORTS FILED WITH STATES PART VI, LINE 7 MI 1 COPPER COUNTRY GREAT START COLLABORATIVE 850 W SHARON AVENUE SUITE 6 HOUGHTON MI 49931 381718440 501(C)(3) 10000 N/A N/A COPPER COUNTRY EARLY CHILDHOOD FUND CITY OF HANCOCK 339 QUINCY STREET HANCOCK MI 49930 386004557 GOVERNMENT-ISD 11500 N/A N/A CITY BUS TRANSPORTATION SYSTEM & SESQUICENTENNIAL CELEBRATION OMEGA HOUSE 2211 MAUREEN LANE HOUGHTON MI 49931 383511814 501(C)(3) 5000 N/A N/A DEFRAY COSTS/RAISE AWARENESS TO HOSPICE CARE AT THE OMEGA HOUSE DIAL HELP INC 609 SHELDEN AVENUE HOUGHTON MI 49931 382026918 501(C)(3) 5000 N/A N/A FUND SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM PINE MOUNTAIN MUSIC FESTIVAL PO BOX 406 HANCOCK MI 49930 383029498 501(C)(3) 5000 N/A N/A SUPPORT OF CULTURAL ARTS PROGRAMS LITTLE BROTHERS FRIENDS OF THE ELDERLY 527 HANCOCK STREET HANCOCK MI 49930 382411631 501(C)(3) 5000 N/A N/A EXPANSION OF SERVICES TO THE ELDERLY IN 3 COUNTIES 5 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: N/A - ALL AMOUNTS IN THIS SCHEDULE ARE DONATIONS OR SPONSORSHIPS AND ARE NOT GRANT FUNDS. X X X X X 0 0 0 0 0 0 0 0 0 BRUCE TRUSOCK MD 147156 0 150154 0 1600 0 13628 0 12902 0 325440 0 0 0 JAMES BOGAN 286165 0 51990 0 7813 0 14813 0 15877 0 376658 0 0 0 KIRK LUFKIN MD 241171 0 31136 0 8331 0 9514 0 8455 0 298607 0 0 0 TIMOTHY SEARS MD 259190 0 185395 0 1600 0 16019 0 14552 0 476756 0 0 0 WILLIAM LISTON MD 241741 0 185395 0 1600 0 16292 0 1415 0 446443 0 0 0 DAWN NULF MD 349850 0 15000 0 1300 0 15918 0 14904 0 396972 0 0 0 BRIAN DONAHUE 158076 0 19733 0 1154 0 12873 0 14833 0 206669 0 0 0 CHRISTOPHER PEER 514887 0 92000 0 300 0 0 0 15547 0 622734 0 0 0 KIRK KLEMME 395682 0 41250 0 1600 0 16268 0 10727 0 465527 0 0 0 JENNIFER BOW 440258 0 60000 0 350 0 3651 0 13204 0 517463 0 0 0 WILLIAM SARAZIN 331998 0 12500 0 2600 0 15647 0 15329 0 378074 0 0 0 REBECCA BAUDOIN 310889 0 0 0 300 0 5000 0 12582 0 328771 0 0 0 A CITY OF HANCOCK HOSPITAL FINANCE AUTHORITY 386004557 410204AC5 2006-12-01 27920000 HOSPITAL, NURSING HOME, MEDICAL CLINIC, REFUND BONDS ISSUED 3/5/98 & 3/11/04 0 0 0 B CITY OF HANCOCK HOSPITAL FINANCE AUTHORITY 274398699 2010-12-30 4000000 RENOVATION & ADDITION TO MEDICAL CLINIC AND RADIOLOGY/ENDOSCOPY EQUIPMENT 0 0 0 A 7630100 27920000 426791 130520 5187597 22175092 2007 1 1 1 1 B 345000 4000000 80000 3920000 2012 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 1 MORGAN STANLEY 26.000000000000 0 0 0 0 0 B 0 0 0 0 1 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S AUDIT COMMITTEE AND COPIES OF THE FORM 990 ARE PROVIDED TO EACH BOARD MEMBER FOR REVIEW AFTER THE RETURN HAS BEEN FILED. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL CONFLICT OF INTEREST STATEMENT IS COMPLETED AND SIGNED BY EACH BOARD MEMBER. THE PRESIDENT AND CEO REVIEWS THE COMPLETED CONFLICT OF INTEREST FORMS. IF A CONFLICT IS IDENTIFIED, THAT BOARD MEMBER IS EXCUSED FROM ANY DICUSSION OR VOTE RELATING TO THE IDENTIFIED CONFLICT. IN ADDITION, COMPENSATION AND AUDIT ISSUES ARE ACTED ON BY INDEPENDENT BOARD MEMBERS ONLY. THE CONFLICT OF INTEREST POLICY COVERS THE FOLLOWING INDIVIDUALS: * INTERESTED PERSONS - BOARD MEMBERS, COMMITTEE MEMBERS, OFFICERS AND ADMINISTRATIVE STAFF, INCLUDING DIRECTORS, MANAGERS, COORDINATORS AND SUPERVISORS OF PORTAGE HEALTH. * ASSOCIATES - EMPLOYEES, MEDICAL STAFF, VOLUNTEERS, DIRECTORS, OFFICERS, SUPPLIERS, VENDORS, CONTRACTORS, CONSULTANTS AND AGENTS OF PORTAGE HEALTH. FORM 990, PART VI, SECTION B, LINE 15 OCCASIONALLY, AN INDEPENDENT CONSULTANT IS RETAINED TO RESEARCH THE MARKET DATA AND PERFORM COMPARISONS FOR THE CEO AND OTHER OFFICER POSITIONS. THE RESULTS OF THE COMPARISON AND MARKET DATA ARE PRESENTED TO THE COMPENSATION COMMITTEE. THIS WAS LAST PERFORMED IN 2011. IF NO OUTSIDE CONSULTANT IS RETAINED, MARKET SURVEYS ARE UTILIZED TO DETERMINE ADJUSTMENTS TO THE CEO'S AND THE OTHER OFFICERS COMPENSATION. IN EITHER CASE, THE COMPENSATION COMMITTEE RECOMMENDS ANY ADJUSTMENTS TO THE BOARD OF TRUSTEES. THE INDEPENDENT BOARD MEMBERS VOTE ON THE CEO'S COMPENSATION AMOUNT AND IF APPROVED, IT IS FORMALLY PUT INTO A WRITTEN EMPLOYMENT CONTRACT AND DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE AND OF THE BOARD OF TRUSTEES. THE OTHER OFFICERS COMPENSATION STRUCTURE AND SALARY RANGES ARE APPROVED BY THE COMPENSATION COMMITTEE VERSUS SPECIFIC DOLLAR AMOUNTS. THIS PROCESS WAS LAST UNDERTAKEN IN MARCH 2012 BASED ON 2011 DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CLEARING ACCOUNT ADJUSTMENT 627. CHANGE IN INTEREST RATE SWAP 1,241,148. SHARE OF NET ASSETS OF RELATED PARTIES 400,000. EQUITY IN LOSSES OF UNCONSOLIDATED INVESTEES -163,284. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PORTAGE HEALTH RESOURCES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383041729 SENIOR MEALS MI 501(C)(3) LINE 11A, I PORTAGE HEALTH INC 1 PORTAGE HEALTH HOME SERVICES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383565553 PRIVATE DUTY CARE MI 501(C)(3) LINE 9 PORTAGE HEALTH INC 1 PORTAGE HEALTH FOUNDATION 500 CAMPUS DRIVE HANCOCK MI 49930 383022945 FUNDRAISING MI 501(C)(3) LINE 11A, I PORTAGE HEALTH INC 1 COPPER COUNTRY APOTHECARIES INC 500 CAMPUS DRIVE HANCOCK MI 49930 302083778 RETAIL PHARMACY MI PORTAGE HEALTH INC C 570252 3349396 1.00000 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 COPPER COUNTRY APOTHECARIES INC A 85511 FMV - CONTRACT PRICE COPPER COUNTRY APOTHECARIES INC M 1666764 COST PORTAGE HEALTH RESOURCES INC M 90000 COST COPPER COUNTRY APOTHECARIES INC P 550683 FMV - CONTRACT PRICE ($/RX) PORTAGE HEALTH RESOURCES INC A 31800 FMV PORTAGE HEALTH HOME SERVICES INC A 16404 FMV PORTAGE HEALTH HOME SERVICES INC M 80150 COST PORTAGE HEALTH HOME SERVICES INC S 400000 COST COPPER COUNTRY APOTHECARIES INC S 570253 COST