2014-02-14T17:00:04-06:00 2013-06-30 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2012-07-01 381297435 SPECTRUM HEALTH KELSEY SPEC 6167747322 615 S Bower Greenville MI 488382628 RYAN K JOHNSON 2014-02-06 true Geralyn R Hurd P00933422 3128997000 2012 2015-11-30 17:44:51Z BRIAN BRASSER 615 S Bower Greenville MI 488382628 18421897 false X HTTP://WWW.SPECTRUMHEALTH.ORG/KELSEY X 1945 MI TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 14 11 177 4 0 0 121676 156141 16824168 18169952 -329 -2780 23404 85230 16968919 18408543 0 0 0 0 8930627 9478265 0 0 0 7639098 7492007 16569725 16970272 399194 1438271 5140109 6339623 1786218 1669395 3353891 4670228 TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 15777432 18164416 SPECTRUM HEALTH KELSEY (SHK) HOSPITAL IS A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL IN LAKEVIEW, MICHIGAN, WITH 16 ACUTE-CARE BEDS AND 31 SKILLED-NURSING-FACILITY BEDS. SHK IS A REGIONAL HEALTH CENTER FOR PRIMARY AND SECONDARY CARE. SERVICES INCLUDE AROUND-THE-CLOCK EMERGENCY CARE, INPATIENT ACUTE CARE, OUTPATIENT SURGICAL CARE, OUTPATIENT PHYSICAL MEDICINE AND REHABILITATION. IN FISCAL YEAR 2013 THERE WERE 237 INPATIENT ADMISSIONS, 1,028 INPATIENT DAYS, 101 REHAB & NURSING CENTER ADMISSIONS, 10,052 REHAB & NURSING CENTER PATIENT DAYS, AND 9,452 EMERGENCY ROOM VISITS. SPECTRUM HEALTH KELSEY HOSPITAL IS ACCREDITED BY THE JOINT COMMISSION. 15777432 true true false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false false true 0 0 177 true false false false false false false false false false false X 14 11 false false false false true true true true true false false true true true true true true false false false X Ryan K Johnson 6162256310 615 S Bower Greenville MI 488382628 X CHRISTINA FREESE-DECKER 2.00 48.00 X X 0 388108 107120 DAVID MACK 2.00 4.00 X X 0 18000 0 LINDA BLANCHARD 2.00 2.00 X X 0 0 0 WILLIAM HAM 2.00 4.00 X X 0 0 0 DOMENICO AUSIELLO MD 2.00 2.00 X 0 0 0 DOUGLAS APPLE MD 2.00 48.00 X 0 338648 28718 FRANZ MOGDIS 2.00 2.00 X 0 0 0 JEFFERY LOOMIS 2.00 4.00 X 0 0 0 KEVIN O'CONNOR 2.00 2.00 X 0 0 0 MARC CHIRCOP 2.00 48.00 X 0 678791 186859 MATTHEW DEKRAKER DC 2.00 2.00 X 0 0 0 PETER HAINES 2.00 2.00 X 0 0 0 STEVE BOWSER 2.00 2.00 X 0 0 0 TAD CHARLES SIMON 2.00 2.00 X 0 0 0 RYAN JOHNSON 2.00 48.00 X 0 140497 22326 BRIAN BRASSER 2.00 48.00 X 0 166465 25601 PRISCILLA MAHAR 2.00 48.00 X 0 167383 24304 VICKI JENSEN 2.00 48.00 X 0 158624 25295 LORY READ 50.00 0 X 205274 0 23017 MICHAEL BORGELD 50.00 0 X 219769 0 25298 PHILIP SCHUMACHER 50.00 0 X 243968 0 17402 TODD PRYOR 50.00 0 X 275817 0 20611 WILLIAM HEATH 50.00 0 X 126319 0 13952 DAVID OEHRING 0.00 0.00 X 0 167839 10176 MARY ANNE JONES 0.00 50.00 X 0 273228 72862 PAUL BONIS 0.00 50.00 X 0 517456 127067 1071147 3015039 730607 7 true true false HAR CONSULTING 975 SPAULDING AVE SE ADA MI 49301 PHYSICIAN SERVICES 126528 1 148325 5547 2269 156141 PATIENT SERVICE REVENUE 622110 18161823 18161823 OTHER HOSPITAL OPERATING INCOME 900099 8129 8129 0 0 0 0 0 0 0 18169952 403 403 0 0 6318 8671 -2353 0 -2353 -2353 1500 4683 0 -3183 -3183 -3183 0 0 0 CAFETERIA 722212 87583 87583 0 0 0 0 0 0 87583 18408543 18164416 0 87986 0 0 0 0 0 0 7266272 6885919 380353 251970 238781 13189 1477220 1399895 77325 482803 457531 25272 0 1608 1608 0 0 0 0 712550 681401 31149 0 3490 3381 109 367921 331877 36044 8858 8858 0 694197 676293 17904 39476 35777 3699 0 46678 29476 17202 0 0 258265 251604 6661 181761 177073 4688 BAD DEBTS 1400469 1400469 MEDICAL SUPPLIES 912472 908705 3767 MEDICAID QUALITY ASSESSMENT TAX 65549 65549 SHARED SERVICES / MANAGEMENT FEES 2720219 2176175 544044 78494 48668 29826 0 16970272 15777432 1192840 0 0 1490 955298 170000 1297314 1183816 0 0 75169 90804 44216 7132 7467699 5543079 1776189 1924620 0 0 42500 42500 1733231 2135453 5140109 6339623 59224 3035 60615 3284 0 1666379 1663076 1786218 1669395 X 3054384 4492655 299507 172858 4715 3353891 4670228 5140109 6339623 X 1438271 -121934 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 288618 288618 4025403 2976284 1049119 192585 94370 98215 2878243 2423587 454656 82850 48838 34012 1924620 BENEFICIAL INTEREST IN FOUNDATION ASSETS 177573 DUE FROM AFFILIATES 1957880 2135453 0 THIRD PARTY PAYABLE 1663076 1663076 FIN 48 (ASC 740) FOOTNOTE SCHEDULE D, PART X, LINE 2 SPECTRUM HEALTH SYSTEM CONDUCTS AN ANALYSIS ANNUALLY TO DETERMINE THE ORGANIZATION'S LIABILITY WITH RESPECT TO UNCERTAIN TAX POSITIONS. FOR THE YEAR ENDED JUNE 30, 2013 IT WAS DETERMINED THAT THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS TO DISCLOSE. AS SUCH, THERE WAS NO FOOTNOTE ADDED TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. true true X true X false true true true false true true 322004 322004 0.02070 4558451 4779891 -221440 0.00000 0 0.00000 0 0 4880455 4779891 100564 0.02070 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 0 0 4880455 4779891 100564 0.02070 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 true 1400469 0 6193650 6552148 -358498 X true false 1 1 SPECTRUM HEALTH KELSEY HOSPITAL

419 WASHINGTON AVE LAKEVIEW MI 48850

HTTP://WWW.SPECTRUMHEALTH.ORG/KELSEY X X X X SPECTRUM HEALTH KELSEY HOSPITAL 1 true X X X X X X X X X 11 true true true X X X X X X X X X X true false true true 200 false true X true true X X X true false X X X X true X false false 1 SPECTRUM HEALTH REHAB AND NURSING CENTER

418 WASHINGTON AVE LAKEVIEW MI 48850

NURSING HOME Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c THE ORGANIZATION USES FPG TO DETERMINE ELIGIBILITY FOR FREE CARE. AN EVALUATION IS NOT USED FOR DISCOUNTED CARE, AS APPLICANTS THAT QUALIFY FOR ANY ASSISTANCE RECEIVE FREE CARE. Community benefit report prepared by related organization Schedule H, Part I, Line 6a SPECTRUM HEALTH SYSTEM (EIN: 38-3382353) RELATED ORGANIZATION INFORMATION SCHEDULE H, PART I, LINE 6A THE HEALTH SYSTEM PUBLISHES A CONSOLIDATED COMMUNITY BENEFIT REPORT ON ITS WEBSITE AT WWW.SPECTRUMHEALTH.ORG (CLICK THE LINK TITLED "ABOUT US"). IN ADDITION, THE HEALTH SYSTEM HOLDS AN ANNUAL MEETING TO THE PUBLIC TO DISCUSS ITS COMMUNITY COMMITMENTS. Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 THE ORGANIZATION CALCULATES AN OVERALL COST-TO-CHARGE RATIO DERIVED BY USING THE IRS WORKSHEET 2 FORMAT, RATIO OF PATIENT CARE COST-TO-CHARGES. ALL PATIENT SEGMENTS AND PAYERS ARE USED IN THE CALCULATION. MEDICAID SCHEDULE H, PART I, LINE 7B DURING THE TAX YEAR THE ORGANIZATION RECEIVED A LARGE ALLOCATION FROM THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH'S RURAL ACCESS POOL RESULTING IN DIRECT OFFSETTING REVENUE TO EXCEED TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO MEDICAID. HOSPITALS CATEGORIZED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AS SOLE COMMUNITY HOSPITALS ARE ELIGIBLE FOR ALLOCATIONS FROM THE POOL. EACH HOSPITALS ALLOCATION FROM THE POOL IS CALCULATED AS THE UNREIMBURSED COST THE HOSPITAL INCURRED PROVIDING INPATIENT AND OUTPATIENT SERVICES TO MICHIGAN MEDICAID BENEFICIARIES DURING ITS COST PERIOD THAT ENDED DURING THE SECOND PREVIOUS FY. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 1,400,469 Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ACCOUNTS RECEIVABLE, PAYOR COMPOSITION AND AGING, AND HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY AND OTHER FACTORS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTED ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR THIRD-PARTY PAYERS, THE PROVISION IS DETERMINED BY ANALYZING CONTRACTUALLY DUE AMOUNTS FROM PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES. FOR SELF-PAY PATIENTS, THE PROVISION IS BASED ON AN ANALYSIS OF PAST EXPERIENCE RELATED TO PATIENTS UNWILLING TO PAY STANDARD RATES CHARGED. THE DIFFERENCE BETWEEN THAT STANDARD RATE CHARGED (LESS THE NEGOTIATE DISCOUNTED RATE) AND THE AMOUNT ACTUALLY COLLECTED AFTER THE REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ALL CHARGES ARE REPORTED AT GROSS, WHICH IS CONSISTENT WITH THE REPORTING METHODOLOGY USED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. Bad debt expense - methodology used to estimate amount as community benefit Schedule H, Part III, Line 3 THE ORGANIZATION IS UNABLE TO ESTIMATE ACCURATELY THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FREE OR DISCOUNTED SERVICES UNDER THE FINANCIAL ASSISTANCE POLICY. ALTHOUGH A PORTION OF BAD DEBT EXPENSES MAY RELATE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE, A REPORTABLE FIGURE CANNOT BE REASONABLY ESTIMATED. THE ORGANIZATION HAS IMPLEMENTED A "PROPENSITY TO PAY" EVALUATION TOOL THAT PROACTIVELY ASSESSES ONE'S ABILITY AND LIKELIHOOD TO PAY. WITH THIS TOOL, THE ORGANIZATION HAS BEEN ABLE TO PROVIDE A HIGHER DEGREE OF FOCUSED FINANCIAL COUNSELING EFFORTS, RESULTING IN A SUBSTANTIAL REDUCTION OF BAD DEBT AND HIGHER RATE OF IDENTIFICATION OF CHARITY ACCOUNTS. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE NET PATIENT SERVICE REVENUE, PATIENT ACCOUNTS RECEIVABLE, AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOOTNOTE IS ON PAGES 14 TO 16 OF THE ORGANIZATIONS CONSOLIDATED FINANCIAL STATEMENT. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. IN DETERMINING MEDICARE SHORTFALLS THE ORGANIZATION USES A RATIO OF COST TO CHARGES. IN DETERMINING THE RATIO OF COST TO CHARGES THE ORGANIZATION ADJUSTS FOR BAD DEBT EXPENSES, NON-PATIENT CARE ACTIVITIES, MEDICAID PROVIDER TAXES AND COMMUNITY BENEFITS ACCOUNTED FOR, AND OR REPORTED, ELSEWHERE. THE RATIO OF COST TO CHARGES IS APPLIED TO MEDICARE CHARGES TO DETERMINE SHORTFALLS IN MEDICARE REIMBURSEMENTS. COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE SCHEDULE H, PART III, LINE 9B THE ORGANIZATION PROVIDES FREE CARE TO ALL PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE WILL NOT OWE ANYTHING, AND THUS WILL NOT BE SUBJECT TO COLLECTION ACTIVITIES. Community Served by Needs Assessment Schedule H, Part V Section B, Line 3 (1) SPECTRUM HEALTH KELSEY HOSPITAL - PRIMARY AND SECONDARY DATA WERE IDENTIFIED, COLLECTED AND ANALYZED, WHICH INCLUDED THE DEVELOPMENT AND DISTRIBUTION OF A COMMUNITY AND HEALTH CARE PROVIDER SURVEY. THE COMMUNITY SURVEY WAS MAILED IN TO 1,500 RANDOMLY SELECTED HOUSEHOLDS WITHIN MONTCALM COUNTY WITH 424 RETURNED BY MAIL FOR ANALYSIS. AN ADDITIONAL 51 SURVEYS WERE COMPLETED AND RETURNED FROM CLIENTS OF LOCAL SERVICE AGENCIES FOR A TOTAL OF 475 SURVEYS USED FOR ANALYSIS. COUNTY-SPECIFIC SECONDARY DATA FROM A VARIETY OF SOURCES WAS ALSO COLLECTED AND ANALYZED. MANY EXPERTS ON PUBLIC HEALTH WERE CONSULTED AS MEMBERS OF THE STEERING COMMITTEE INCLUDING MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, UNITED WAY, AND THE DEPARTMENT OF HUMAN SERVICES. FOR THE ENTIRE LISTING OF INDIVIDUALS, SEE THE MONTCALM COUNTY CHNA.; Other Hospital Facilities included in Needs Assessment Schedule H, Part V Section B, Line 4 (1) SPECTRUM HEALTH KELSEY HOSPITAL - CARSON CITY HOSPITAL SHERIDAN COMMUNITY HOSPITAL; Used FPG to determine eligibility for providing discounted care criteria Schedule H, Part V Section B, Line 11 (1) SPECTRUM HEALTH KELSEY HOSPITAL - THE ORGANIZATION USES FPG TO DETERMINE ELIGIBILITY FOR FREE CARE. AN EVALUATION IS NOT USED FOR DISCOUNTED CARE, AS APPLICANTS THAT QUALIFY FOR ANY ASSISTANCE RECEIVE FREE CARE.; Other factors included in calculating amounts charges to patients Schedule H, Part V Section B, Line 12h (1) SPECTRUM HEALTH KELSEY HOSPITAL - THE ORGANIZATION DOES NOT CHARGE ANY AMOUNT TO PATIENTS WHO QUALIFY FOR ASSISTANCE.; Other ways hospital publicized Financial Assistance Policy Schedule H, Part V Section B, Line 14g (1) SPECTRUM HEALTH KELSEY HOSPITAL - THE ORGANIZATION PUBLICIZES THE FINANCIAL ASSISTANCE POLICY BY COMMUNICATING ITS AVAILABILITY VIA A PATIENT HANDBOOK, SIGNAGE, INFORMATIONAL BROCHURES, COMMUNITY PUBLICATIONS, AND VIA WORD OF MOUTH BY FINANCIAL COUNSELORS ASSISTING PATIENTS. REFERENCE TO THE AVAILABILITY OF THE POLICY IS PUBLICLY POSTED IN WAITING ROOMS. ; Means used to determine amounts billed Schedule H, Part V Section B, Line 20d (1) SPECTRUM HEALTH KELSEY HOSPITAL - THE ORGANIZATION DOES NOT CHARGE ANY AMOUNT TO PATIENTS WHO QUALIFY FOR ASSISTANCE.; Needs assessment. Schedule H, Part VI, Line 2 THE CHNA DATA PROVIDES A LEVEL FOUNDATION ON WHICH TO PLAN, DEVELOP, AND IMPLEMENT NEW PROGRAMS AND SERVICES TO MEET THE NEEDS OF OUR COMMUNITY. OPERATIONAL SERVICES IDENTIFIED BY THE CHNA, E.G. RETENTION OF QUALIFIED PROVIDERS, HAVE BEEN BUILT INTO THE STRATEGIC PLAN AND BUDGET, AND A RECRUITMENT PLAN HAS BEEN CREATED BASED ON CONVERSATIONS AROUND THE COMMUNITY BENEFIT DOLLARS. THE CHNA AND IMPLEMENTATION PLAN IS LOCATED AT: HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-KELSEY-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT. SPECTRUM HEALTH ALSO PREPARES AN ANNUAL CORPORATE SOCIAL RESPONSIBILITY REPORT THAT FOCUSES ON NINE KEY AREAS: HEALTHIER COMMUNITIES, EDUCATION, COMMUNITY ENGAGEMENT, RESEARCH, INNOVATION, EMPLOYEE ENGAGEMENT, SUSTAINABILITY, REGIONAL RELATIONSHIPS AND COMMUNITY BENEFIT. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY THROUGH PRODUCING INFORMATION CARDS FOR THE UNINSURED, COMMUNITY OUTREACH PROGRAMS, CONSUMER INFORMATION CLASSES, ORGANIZATION WEBSITE, PERSONAL FINANCIAL COUNSELING, AND BY PROVIDING ASSISTANCE IN THE ACTUAL ENROLLMENT OF SUCH PROGRAMS. THE ORGANIZATION HAS A DEPARTMENT OF FINANCIAL COUNSELORS WHO WORK WITH PATIENTS THAT EXPRESS ANY LEVEL OF CONCERN WITH PAYING THEIR BILL. IN ADDITION, THE ORGANIZATION ALSO PROACTIVELY IDENTIFIES PATIENTS WHO HAVE QUALIFYING FACTORS FOR GOVERNMENTAL ASSISTANCE AND PARTNERS WITH ORGANIZATIONS THAT SPECIALIZE IN THE QUALIFICATION PROCESS. IF THE NEED FOR ASSISTANCE IS NOT IDENTIFIED PRIOR TO BILLING, PATIENT CONCERNS THAT ARE RECEIVED AS A RESULT OF RECEIVING A BILL ARE ADDRESSED BY FINANCIAL COUNSELORS AT THAT TIME. THE ORGANIZATION WIDELY PUBLICIZES COMMUNICATIONS TO PATIENTS AND THE PUBLIC ON THE AVAILABILITY OF FINANCIAL ASSISTANCE. THIS IS ACHIEVED THROUGH VARIOUS METHODS INCLUDING, BUT NOT LIMITED TO, VIA THE SPECTRUM HEALTH PATIENT HANDBOOK, VARIOUS INFORMATIONAL BROCHURES, SIGNAGE IN EACH HOSPITAL DEPARTMENT, ADMISSIONS OFFICES AND OTHER PUBLIC LOCATIONS, UPON REQUEST BY ANY PATIENT, GUARANTOR OR COMMUNITY MEMBER, WORD OF MOUTH VIA FINANCIAL COUNSELORS AND OTHERS, AND THROUGH COMMUNITY PUBLICATIONS AND OUTREACH EVENTS. IN ADDITION, THE ORGANIZATION LISTS OPTIONS FOR THE UNINSURED AND UNDERINSURED ON THEIR WEBSITE, ALONG WITH A COPY OF THE FINANCIAL ASSISTANCE ELIGIBILITY POLICY (SEARCH "FINANCIAL ASSISTANCE" AT WWW.SPECTRUMHEALTH.ORG). Community information. Schedule H, Part VI, Line 4 THE TAXPAYER IS A CRITICAL ACCESS FACILITY THAT SERVES THE MEDICAL NEEDS OF THE RESIDENTS OF LAKEVIEW, MI AND THE FAR-NORTHERN PORTION OF A PRIMARY SERVICE AREA SHARED WITH UNITED MEMORIAL HOSPITAL, A RELATED ORGANIZATION. THE PRIMARY SERVICE AREA IS COMPRISED OF 19 ZIP CODES SURROUNDING LAKEVIEW, WHERE KELSEY HOSPITAL IS LOCATED, AND INCLUDES MONTCALM AND PORTIONS OF ADJACENT COUNTIES THAT SUPPORTS A POPULATION OF OVER 100,000 RESIDENTS. FOR SPECIFIC POPULATION STATISTICS SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT ACCESSIBLE AT HTTP://WWW.SPECTRUMHEALTH.ORG/ABOUT-KELSEY-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT. Promotion of community health Schedule H, Part VI, Line 5 SPECTRUM HEALTH KELSEY'S BOARD OF DIRECTORS IS COMPOSED OF MEMBERS OF WHICH SUBSTANTIALLY ALL ARE INDEPENDENT COMMUNITY MEMBERS. A MAJORITY OF THE BOARD RESIDES IN SPECTRUM HEALTH KELSEY'S PRIMARY SERVICE AREA. SPECTRUM HEALTH KELSEY ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SPECTRUM HEALTH KELSEY INVESTS NET EARNINGS IN IMPROVING PATIENT CARE, BUILDING AND RENOVATING FACILITIES, PURCHASING NEW TECHNOLOGY, PROVIDING HEALTH EDUCATION AND FUNDING COMMUNITY PROGRAMS. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON SPECTRUM HEALTH KELSEY TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED EMERGENCY CARE PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND EXPERIENCED IN EMERGENCY CARE. FURTHERMORE, NO PATIENT IS DENIED TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. Affiliated health care system Schedule H, Part VI, Line 6 SPECTRUM HEALTH IS AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM IN WEST MICHIGAN OFFERING A FULL CONTINUUM OF CARE THROUGH THE SPECTRUM HEALTH HOSPITAL GROUP, WHICH IS COMPRISED OF NINE HOSPITALS INCLUDING HELEN DEVOS CHILDREN'S HOSPITAL, A STATE OF THE ART CHILDREN'S HOSPITAL THAT OPENED IN JANUARY 2011, AND 183 SERVICE SITES; THE SPECTRUM HEALTH MEDICAL GROUP AND WEST MICHIGAN HEART, PHYSICIAN GROUPS TOTALING MORE THAN 700 PROVIDERS; AND PRIORITY HEALTH, A HEALTH PLAN WITH 600,000 MEMBERS. SPECTRUM HEALTH IS WEST MICHIGAN'S LARGEST EMPLOYER WITH 19,000 EMPLOYEES. THE ORGANIZATION PROVIDED $250 MILLION IN COMMUNITY BENEFIT DURING ITS 2012 FISCAL YEAR. SPECTRUM HEALTH KELSEY IS A MEMBER OF THE AFFILIATED GROUP OF ENTITIES WITHIN THE SPECTRUM HEALTH SYSTEM ("SPECTRUM HEALTH"). EACH MEMBER CREATES VALUE WITHIN ITS RESPECTIVE COMMUNITY AND IS RESPONSIBLE FOR THEIR ACTIONS AND THE IMPACT THESE ACTIONS HAVE. FROM ITS INCEPTION, SPECTRUM HEALTH HAS BEEN A FAITHFUL STEWARD OF ITS COMMUNITY ASSETS. AS A WEST MICHIGAN-BASED NOT-FOR-PROFIT HEALTH SYSTEM, THE ORGANIZATION INVESTS ITS NET EARNINGS TO IMPROVE PATIENT CARE, BUILD AND RENOVATE FACILITIES, PURCHASE NEW TECHNOLOGY, PROVIDE HEALTH EDUCATION AND FUND LOCAL COMMUNITY PROGRAMS. OVER THE YEARS, OUR MISSION HAS REMAINED THE SAME-TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. WE TAKE OUR MISSION SERIOUSLY. IT IS CENTRAL TO OUR STRATEGIC DISCUSSIONS AND GUIDES OUR INVESTMENTS AND THE ALLOCATION OF OUR RESOURCES. SPECTRUM HEALTH IS COMMITTED TO PROVIDING VALUE TO THE PEOPLE WE SERVE. "VALUE" MEANS ACCESS TO HIGH-QUALITY HEALTH CARE AT AFFORDABLE COSTS, AS WELL AS ACCESS TO THE FULL CONTINUUM OF HEALTH CARE SERVICES, FROM HEALTH INSURANCE TO OUTPATIENT CARE TO INPATIENT AND HOME CARE, AND EVERYTHING IN BETWEEN. SPECTRUM HEALTH HAS HUNDREDS OF PROGRAMS THAT SUPPORT ITS MISSION "TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE." THESE PROGRAMS ARE BROUGHT TOGETHER UNDER NINE KEY AREAS: HEALTHIER COMMUNITIES, EDUCATION, COMMUNITY ENGAGEMENT, RESEARCH, INNOVATION, EMPLOYEE ENGAGEMENT, SUSTAINABILITY, REGIONAL RELATIONSHIPS AND COMMUNITY BENEFIT. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 THE ORGANIZATION IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH THE STATE HOWEVER THE ORGANIZATION VOLUNTARILY REPORTS COMMUNITY BENEFIT INFORMATION TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION AND IN AN ANNUAL MEETING TO THE COMMUNITY. THE COMMUNITY BENEFIT REPORT IS ALSO AVAILABLE ON THE ORGANIZATION'S WEBSITE. true true false false false false false false false BRIAN BRASSER 0 140182 0 25268 0 1014 0 6012 0 19589 0 192065 0 0 CHRISTINA FREESE-DECKER 0 235924 0 151236 0 947 0 62349 0 44771 0 495228 0 97867 DAVID OEHRING 0 54612 0 0 0 113227 0 2500 0 7676 0 178015 0 0 DOUGLAS APPLE MD 0 287167 0 50854 0 627 0 13750 0 14968 0 367365 0 0 LORY READ 204874 0 0 0 400 0 8246 0 14771 0 228291 0 0 0 MARC CHIRCOP 0 375829 0 284273 0 18690 0 126548 0 60311 0 865650 0 173508 MARY ANNE JONES 0 240202 0 27001 0 6025 0 48317 0 24545 0 346090 0 0 MICHAEL BORGELD 216688 0 1200 0 1881 0 8598 0 16700 0 245067 0 0 0 PAUL BONIS 0 297773 0 214015 0 5669 0 76409 0 50658 0 644524 0 113828 PHILIP SCHUMACHER 241510 0 0 0 2458 0 0 0 17402 0 261370 0 0 0 PRISCILLA MAHAR 0 140937 0 24553 0 1893 0 5942 0 18362 0 191687 0 0 RYAN JOHNSON 0 127438 0 12690 0 369 0 5439 0 16887 0 162823 0 0 TODD PRYOR 274809 0 0 0 1008 0 1376 0 19236 0 296429 0 0 0 VICKI JENSEN 0 133857 0 23361 0 1406 0 7841 0 17453 0 183918 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 THE SPECTRUM HEALTH SYSTEM BOARD OF DIRECTORS (THROUGH ITS EXECUTIVE COMMITTEE) USES THE FOLLOWING PROCESS FOR DETERMINING COMPENSATION OF THE TOP MANAGEMENT OFFICIAL, OTHER OFFICERS, AND KEY EMPLOYEES AT SPECTRUM HEALTH KELSEY. LABOR MARKET DATA REFLECTING COMPARABLE ORGANIZATIONS AND JOBS (PREPARED BY INDEPENDENT FIRMS) ARE RELIED UPON. COMPETITIVE ASSESSMENT REPORTS ARE PROVIDED TO THE EXECUTIVE COMMITTEE IN ADVANCE OF MEETINGS. THE COMPETITIVE ASSESSMENT REPORT IS PREPARED BY A NATIONALLY KNOWN INDEPENDENT EXECUTIVE COMPENSATION FIRM AND, FOR FY 2013 (7/1/12-6/30/13), WAS BASED ON THE FOLLOWING INDEPENDENT SURVEYS OF HEALTH CARE EXECUTIVES AT COMPARABLE HEALTH SYSTEMS, HEALTH PLANS, AND MEDICAL GROUPS: * AMERICAN MEDICAL GROUP ASSOCIATION: 2012 MEDICAL GROUP COMPENSATION & FINANCIAL SURVEY * INTEGRATED HEALTHCARE STRATEGIES: 2012 HEALTH CARE EXECUTIVE COMPENSATION SURVEY * MERCER HUMAN RESOURCES CONSULTING: 2012 EXECUTIVE COMPENSATION SURVEY * MERCER HUMAN RESOURCES CONSULTING: 2012 INTEGRATED HEALTH NETWORKS COMPENSATION SURVEY * MEDICAL GROUP MANAGEMENT ASSOCIATION: 2012 MANAGEMENT COMPENSATION SURVEY * SULLIVAN, COTTER AND ASSOCIATES: 2012 SURVEY OF MANAGER AND EXECUTIVE COMPENSATION IN HOSPITALS AND HEALTH SYSTEMS * SULLIVAN, COTTER AND ASSOCIATES: 2012 PHYSICIAN COMPENSATION AND PRODUCTIVITY SURVEY REPORT * TOWERS WATSON: 2012/2013 HOSPITAL AND HEALTHCARE MANAGEMENT COMPENSATION REPORT * TOWERS WATSON: 2012/2013 TOP MANAGEMENT COMPENSATION REPORT * WARREN: 2012 COMPENSATION SURVEY COMPENSATION ADJUSTMENTS ARE APPROVED BY EXECUTIVE COMMITTEE MEMBERS, CONSISTENT WITH THE SPECTRUM HEALTH COMPENSATION PHILOSOPHY DESCRIBED BELOW. MINUTES OF COMMITTEE DISCUSSIONS AND DECISIONS ARE PREPARED TO MEMORIALIZE EXECUTIVE COMMITTEE DECISIONS BASED UPON THE ABOVE DATA. CASH COMPENSATION DATA RELIED UPON BY THE EXECUTIVE COMMITTEE IS NATIONAL AND REFLECTS THE COMPENSATION PAID TO EXECUTIVES IN COMPARABLE JOBS IN COMPARABLY-SIZED HEALTHCARE ORGANIZATIONS. SPECTRUM HEALTH RECRUITS NATIONALLY FOR ITS EXECUTIVES. BENEFITS DATA REFLECT NATIONAL HEALTHCARE MARKET PRACTICES. GEOGRAPHIC PAY DIFFERENTIAL AND COST OF LIVING DATA INDICATES CONSISTENCY WITH NATIONAL DATA. THIS PROCESS IS INTENDED TO ASSIST SPECTRUM HEALTH IN QUALIFYING FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS (INTERMEDIATE SANCTIONS REGULATIONS) AND COMPLYING WITH THE POTENTIAL SPECTRUM HEALTH EXCESS BENEFIT TRANSACTION POLICY FOR THOSE INDIVIDUALS IN THE GROUP WHO ARE DISQUALIFIED PERSONS. THE OPINION SUBMITTED FROM THE THIRD PARTY INDEPENDENT CONSULTING FIRM IS IN ACCORDANCE WITH THE PROVISIONS OF TREASURY REGULATIONS SECTION 53.4958-6(C)(2) AND IS ALSO INTENDED TO SATISFY THE PROFESSIONAL ADVICE REQUIREMENT OF TREASURY REGULATIONS SECTION 53.4958-1(D)(4)(III). Severance or change-of-control payment Schedule J, Part I, Line 4a $112,358 DAVID OEHRING Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b $113,828 PAUL BONIS $173,508 MARC CHIRCOP $ 97,867 CHRISTINA FREESE-DECKER SCHEDULE J, PART I, LINE 4B IS ANSWERED "YES" BECAUSE CERTAIN INDIVIDUALS, WHOSE SALARY AND BENEFITS ARE PAID BY THE REPORTING ORGANIZATION OR A RELATED ORGANIZATION, DO "PARTICIPATE IN" SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN(S). SOME INDIVIDUALS RECEIVED DISTRIBUTIONS DURING THE YEAR (AS REPORTED ON THIS LINE) WHEREAS OTHERS PARTICIPATED IN THE PLAN(S) BUT DID NOT RECEIVE DISTRIBUTIONS. DISTRIBUTIONS REPORTED ON THIS LINE ARE ALSO INCLUDED IN SCHEDULE J, PART II, COLUMN F AS COMPENSATION REPORTED IN A PRIOR YEAR. ENDOWMENT FUNDS FORM 990, PART IV, LINE 10 SPECTRUM HEALTH FOUNDATION (38-2752328) HOLDS AN UNRESTRICTED, BOARD DESIGNATED ENDOWMENT TO BE USED FOR THE BENEFIT OF SPECTRUM HEALTH UNITED (38-1358412) AND SPECTRUM HEALTH KELSEY (38-1297435). THE ENDOWMENT FUND IS PROPERLY REPORTED ON SCHEDULE D, PART V OF SPECTRUM HEALTH FOUNDATION'S FORM 990. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 THE ORGANIZATION HAS ONE MEMBER(S)/STOCKHOLDER(S) AS FOLLOWS: - SPECTRUM HEALTH UNITED (F/K/A UNITED MEMORIAL HOSPITAL ASSOCIATION) (EIN 38-1358412), A MICHIGAN NONPROFIT CORPORATION. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a THE SOLE MEMBER(S) (SEE FORM 990, PART VI, LINE 6) OF THE ORGANIZATION APPOINTS ALL MEMBERS OF THE BOARD OF DIRECTORS. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b UNLESS OTHERWISE NOTED BELOW, THE SOLE MEMBER(S) (SEE FORM 990, PART VI, LINE 6) OF THE ORGANIZATION HAS THE RESERVED POWERS SET FORTH BELOW, AND SHALL NOT BE DEEMED AUTHORIZED UNLESS AND UNTIL APPROVED BY THE SOLE MEMBER(S): -THE ADOPTION OF OR AMENDMENTS TO THE ARTICLES OF INCORPORATION AND/OR THE BYLAWS OF THE ORGANIZATION (THE "GOVERNING DOCUMENTS") OR ANY SUBSIDIARY OF THE ORGANIZATION; -THE ADOPTION OF OR AMENDMENT OF STRATEGIC PLANS, VISIONS, BUSINESS PLANS, JOINT VENTURES AND FACILITY MASTER PLANS; -THE ADOPTION OF OR AMENDMENT OF THE ANNUAL OPERATING AND CAPITAL BUDGETS; -APPROVAL OF CAPITAL EXPENDITURES PURSUANT TO GUIDELINES AS ADOPTED AND/OR REVISED BY UNITED FROM TIME TO TIME; -APPROVAL OF ALL BORROWING FOR CAPITAL OR OPERATING PURPOSES, ALL GUARANTEES OF INDEBTEDNESS, AND ALL MORTGAGES OF REAL ESTATE; -APPROVAL OF ALL PROJECTS REQUIRING A CERTIFICATE OF NEED UNDER MICHIGAN LAW; -APPROVAL OF THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF PROPERTY PURSUANT TO GUIDELINES AS ADOPTED AND/OR REVISED BY UNITED FROM TIME TO TIME; -APPROVAL OF THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, OR THE DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION OR CHANGE IN CORPORATE MEMBERSHIP OF THE ORGANIZATION OR ANY SUBSIDIARY OF THE ORGANIZATION; OR -ANY OTHER APPROVAL OF UNITED REQUIRED BY LAW OR BY THE GOVERNING DOCUMENTS. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. THE REVIEW PROCESS FOR THIS FORM 990 IS AS FOLLOWS: 1. PREPARATION OF THE RETURN IS SUPERVISED AND REVIEWED BY THE ORGANIZATION'S CORPORATE TAX MANAGER. 2. A SECOND REVIEW IS PERFORMED BY AN EXTERNAL CPA FIRM WITH EXPERTISE IN TAX-EXEMPT RETURN PREPARATION. 3. THE RETURN IS REVIEWED BY THE ORGANIZATION'S FINANCE AND LEGAL DEPARTMENTS (INCLUDING THE VICE PRESIDENT OF FINANCE OR CHIEF FINANCIAL OFFICER) AND SHARED WITH THE MEMBERS OF THE BOARD OF DIRECTORS. 4. THE ORGANIZATION'S VICE PRESIDENT OF FINANCE OR CHIEF FINANCIAL OFFICER REVIEWS COMMENTS OR QUESTIONS RECEIVED BY MEMBERS OF THE BOARD OF DIRECTORS, IF ANY, TO ADDRESS OR TO INCORPORATE, AS APPROPRIATE, INTO THE RETURN PRIOR TO FILING. Conflict of interest policy Form 990, Part VI, Section B, Line 12c BOARD OF DIRECTORS 1. CONFLICTS OF INTEREST MUST BE DISCLOSED, BOTH VIA AN ANNUAL ELECTRONIC DISCLOSURE PROCESS AS WELL AS VERBALLY AT A BOARD MEETING PRIOR TO DISCUSSION OF ANY AGENDA ITEM WITH REGARD TO WHICH A BOARD MEMBER HAS A CONFLICT. 2. A PERSON HAVING A FINANCIAL INTEREST IN A PROPOSED TRANSACTION OR ARRANGEMENT MAY MAKE A PRESENTATION AT A MEETING OF THE BOARD OF DIRECTORS OR COMMITTEE CONSIDERING THAT TRANSACTION OR ARRANGEMENT, BUT AFTER THAT PRESENTATION HE OR SHE SHALL LEAVE THE MEETING DURING DISCUSSION AND VOTING ON THAT PROPOSED TRANSACTION OR ARRANGEMENT. THE PERSON HAVING THE FINANCIAL INTEREST SHALL NOT BE COUNTED IN DETERMINING WHETHER A QUORUM IS PRESENT. 3. THE CHAIRPERSON OF THE BOARD OF DIRECTORS OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE (INCLUDING OUTSIDE ADVISORS) TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND TO ADVISE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST. 4. THE BOARD OF DIRECTORS OR COMMITTEE SHALL EXERCISE DUE DILIGENCE TO DETERMINE WHETHER THE ORGANIZATION CAN, WITH REASONABLE EFFORTS, OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. 5. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OF DIRECTORS OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS AND MEMBERS WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. 6. THE MINUTES OF THE MEETINGS OF THE BOARD OF DIRECTORS AND ALL OF THE ORGANIZATION'S COMMITTEES SHALL SET FORTH: A)THE NAMES OF THE PERSONS WHO DISCLOSED A FINANCIAL INTEREST IN A PROPOSED TRANSACTION OR ARRANGEMENT INVOLVING THE ORGANIZATION OR ANY OF ITS SUBSIDIARIES AND THE NATURE OF THE FINANCIAL INTEREST; AND B)THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO SUCH TRANSACTION OR ARRANGEMENT, INCLUDING ANY DISCUSSION OF ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THAT MATTER. THE VOTES OF INDIVIDUAL MEMBERS NEED NOT BE RECORDED UNLESS OTHERWISE DIRECTED BY THE BOARD OF DIRECTORS OR COMMITTEE. 7. THERE IS AN ONGOING REQUIREMENT THAT MEMBERS OF THE BOARD OF DIRECTORS COMPLETE ANOTHER DISCLOSURE QUESTIONNAIRE AT ANY POINT DURING HIS/HER TENURE ON THE BOARD OF DIRECTORS WHEN A NEW POTENTIAL CONFLICT OF INTEREST ARISES. IF A MEMBER OF THE BOARD OF DIRECTORS COMPLETES A DISCLOSURE QUESTIONNAIRE AS A RESULT OF A NEW POTENTIAL CONFLICT OF INTEREST, THAT DISCLOSURE QUESTIONNAIRE IS SUBMITTED TO THE LEGAL, ORGANIZATIONAL INTEGRITY, INTERNAL AUDIT, AND HUMAN RESOURCES DEPARTMENTS FOR REVIEW. MANAGEMENT 1. UPON ACCEPTANCE OF AN EMPLOYMENT OFFER, EACH MEMBER OF MANAGEMENT COMPLETES A CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE. A COPY OF THE MEMBER OF MANAGEMENT'S DISCLOSURE QUESTIONNAIRE IS SENT TO THE ORGANIZATION'S LEGAL DEPARTMENT. A COPY OF THE MEMBER OF MANAGEMENT'S DISCLOSURE IS REVIEWED BY THE ORGANIZATION'S COI COORDINATOR AND ESCALATED TO THE COI COMMITTEE IF NECESSARY. 2. ANNUALLY, EACH MEMBER OF MANAGEMENT COMPLETES AN ANNUAL CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE ELECTRONICALLY. THE DISCLOSURE QUESTIONNAIRE IS REVIEWED THE LEGAL, ORGANIZATIONAL INTEGRITY, INTERNAL AUDIT, AND HUMAN RESOURCES DEPARTMENTS. 3. THERE IS AN ONGOING REQUIREMENT THAT MEMBERS OF MANAGEMENT COMPLETE ANOTHER DISCLOSURE QUESTIONNAIRE AT ANY POINT DURING HIS/HER EMPLOYMENT WHEN A NEW POTENTIAL CONFLICT OF INTEREST ARISES. IF A MEMBER OF MANAGEMENT COMPLETES A DISCLOSURE QUESTIONNAIRE AS A RESULT OF A NEW POTENTIAL CONFLICT OF INTEREST, THAT DISCLOSURE QUESTIONNAIRE IS SUBMITTED TO THE LEGAL, ORGANIZATIONAL INTEGRITY, INTERNAL AUDIT, AND HUMAN RESOURCES DEPARTMENTS. 4. THE LEGAL, ORGANIZATIONAL INTEGRITY, INTERNAL AUDIT, AND HUMAN RESOURCES DEPARTMENTS, IN CONSULTATION WITH EXECUTIVE MANAGEMENT, DETERMINE HOW ANY REPORTED CONFLICTS SHOULD BE MANAGED. MANAGEMENT OF A CONFLICT MAY TAKE A VARIETY OF DIFFERENT FORMS FROM IMPLEMENTATION OF A MANAGEMENT PLAN TO REQUIRING THAT THE MEMBER OF MANAGEMENT CEASE THE ACTIVITY CREATING THE CONFLICT OR, IN EXTREME CASES, LEAVE THE ORGANIZATION'S EMPLOYMENT. MANAGEMENT IS DETERMINED ON AN INDIVIDUAL BASIS BASED UPON THE FACTS AND CIRCUMSTANCES SURROUNDING THE DISCLOSURE. THE PURPOSE OF CONFLICT MANAGEMENT IS TO PROVIDE TRANSPARENCY WITHIN THE ORGANIZATION AND TO ENSURE THAT THE ORGANIZATION'S EMPLOYEES ARE ALWAYS ACTING IN THE BEST INTEREST OF THE ORGANIZATION. COMPENSATION FORM 990, PART VI, LINE 15 THE ORGANIZATION DID NOT COMPENSATE A TOP MANAGEMENT OFFICIAL, OTHER OFFICERS, OR KEY EMPLOYEES FOR THEIR SERVICES TO THE ORGANIZATION. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION HAVE BEEN PROVIDED TO THE STATE OF MICHIGAN AND ARE AVAILABLE TO THE PUBLIC ON THE STATE'S WEBSITE. THE ORGANIZATION'S BYLAWS AND INTERNAL POLICIES ARE GENERALLY NOT MADE AVAILABLE TO THE PUBLIC. THE OVERALL SYSTEM CONSOLIDATED FINANCIAL STATEMENTS ARE PROVIDED AT WWW.SPECTRUMHEALTH.ORG IN THE SECTION TITLED "ABOUT US." FINANCIAL PERFORMANCE IS DISCUSSED AT AN ANNUAL PUBLIC MEETING HELD AND POSTED TO WWW.SPECTRUMHEALTH.ORG ANNUALLY (UNDER THE SECTION TITLED "ABOUT US"). COMPENSATION FORM 990, PART VII, SECTION A, LINE 1A CONSISTENT WITH PRIOR YEARS, THE COMPENSATION REPORTED FOR THESE INDIVIDUALS IS NOT FOR SERVICES IN THEIR CAPACITY AS MEMBERS OF THE BOARD OF DIRECTORS BUT FOR SERVICES AS EMPLOYEES OF THE ORGANIZATION OR A RELATED ORGANIZATION. CONSISTENT WITH PRIOR YEARS, COMPENSATION AND BENEFITS ARE REPORTED USING THE MOST RECENT CALENDAR YEAR COMPENSATION DATA. THE COMPENSATION FIGURES REPORTED IN THESE SECTIONS ARE FOR THE YEAR ENDED DECEMBER 31, 2012. INDIVIDUALS WITH COMPENSATION REPORTED IN PART VII WORK A COMBINED AVERAGE OF 50 HOURS PER WEEK FOR THE REPORTING ORGANIZATION AND/OR A RELATED TAX-EXEMPT ORGANIZATION. Other changes in net assets or fund balances Form 990 , Part XI, Line 9 CHANGE IN BENEFICIAL INTEREST IN FOUNDATION ASSETS - -121934; OVERSIGHT OF THE AUDIT FORM 990, PART XII, LINE 2C THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION WERE AUDITED BY AN INDEPENDENT AUDITOR AS PART OF THE CONSOLIDATED AUDIT OF SPECTRUM HEALTH SYSTEM (EIN 38-3382353). THE OVERSIGHT OF THAT AUDIT IS BEING ASSUMED BY SPECTRUM HEALTH SYSTEM. IRS TAX FILLINGS FORM 990, PART V, LINE 1A, 2A, AND PART VII, SECTION B, LINE 2 SPECTRUM HEALTH UNITED (38-1358412), THE SOLE MEMBER OF SPECTRUM HEALTH KELSEY, FILES ALL APPLICABLE IRS TAX FILINGS, INCLUDING FORMS 1099, 1096, W-2, AND W-3 ON BEHALF OF SPECTRUM HEALTH KELSEY. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A REPRESENTS THE THE 1099'S AND W-2'S ALLOCABLE TO THE ACTIVITIES OF SPECTRUM HEALTH KELSEY. SPECTRUM HEALTH SYSTEM 100 MICHIGAN ST NE GRAND RAPIDS MI 49503 MANAGEMENT MI 501(C)(3) 11 - Type III - FI NA false SH UNITED MEMORIAL FOUNDATION 615 S BOWER GREENVILLE MI 48838 PHILANTHROPY MI 501(C)(3) 11 - Type I SPECTRUM HEALTH UNITED false SPECTRUM HEALTH UNITED 615 S BOWER GREENVILLE MI 48838 HEALTHCARE MI 501(C)(3) 3 SPECTRUM HEALTH SYSTEM false false false true false false false false false false false false true true true true false false false false SECTION 512(B)(13) CONTROLLED ENTITY? PART II, COLUMN (G) THE ORGANIZATION IS A MEMBER OF A CONSOLIDATED HEALTH SYSTEM AND HAS A COMMON PARENT ORGANIZATION, SPECTRUM HEALTH SYSTEM.