2014-05-14T17:19:11-05:00 2013-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2012-07-01 381490190 Lee Memorial Hospital Corporation LEEM 2697828681 420 W High Street Dowagiac MI 49047 Richard Felbinger 2697828681 2014-05-14 1 Alicia M Janisch P00741382 5137847100 2014-05-12 2012 2015-11-30 17:44:51Z Borgess Lee Memorial Hospital John Ryder 420 W High Street Dowagiac MI 49047 27034571 0 0928 X www.borgesslee.com X 1954 MI To promote the health and well-being of the communities we serve. 14 9 316 35 0 0 210154 187863 28470598 25926933 129573 173059 217825 746716 29028150 27034571 0 0 0 0 15623432 16499003 0 0 0 14843682 10345204 30467114 26844207 -1438964 190364 15934657 15937948 23667915 22770767 -7733258 -6832819 X Lee Memorial Hospital is a values-based community hospital continuing the healing mission of the Sisters of St. Joseph and Borgess Health. Our Mission is to promote the health and well-being of the communities we serve respecting the dignity of human life and actively responding to the needs of the poor. Our Values-We are called to: Service of the Poor: Generosity of spirit, especially for persons most in need. Reverence: Respect and compassion for the dignity and diversity of life. Integrity: Inspiring trust through personal leadership. Wisdom: Integrating excellence and stewardship. Creativity: Courageous and innovation. Dedication: Affirming the hope and joy of our ministry. 0 0 22112758 22277964 Outpatient Revenue - Fees for providing outpatient health care services which allowed Lee Memorial Hospital to pay for supplies, salaries, and other expenses necessary to meet our mission to provide health care services to all residents in the Cass County area regardless of their ability to pay for those services. 4275614 4307623 Inpatient Revenue - Fees for providing inpatient and swing bed health care services which allowed Lee Memorial Hospital to pay for supplies, salaries, and other expenses necessary to meet our mission to provide health care services to all residents in the Cass County area regardless of their ability to pay for those services. 9388 9388 Pharmacy - Pharmacy Services are provided to all patients without consideration of their ability to pay for those services. If the patient is unable to pay for pharmacy, they can apply for charity care and the charges will be written off. 26397760 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 125 0 1 316 1 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X John Ryder 2697828681 420 W High Street Dowagiac MI 49047 Charles K Burling DDS 1.00 0.00 X X 0 0 0 William J Lawrence 1.00 0.00 X X 0 0 0 Terry Harris 1.00 0.00 X X 0 0 0 Thomas A Atkinson 1.00 0.00 X X 0 0 0 Frank Williams 1.00 0.00 X X 0 0 0 Dale Blunier 1.00 0.00 X 0 0 0 Father Kevin A Covert 1.00 0.00 X 0 0 0 Mark Daniel PhD 1.00 0.00 X 0 0 0 James Eckman 1.00 0.00 X 0 0 0 Elaine Foster PhD 1.00 0.00 X 0 0 0 Rozanne Scherr 1.00 0.00 X 0 0 0 J Scott Winchester 1.00 0.00 X 0 0 0 Robert Hill MD 5.00 35.00 X X 0 241580 41129 Mark Anthony 5.00 35.00 X X 0 321445 54784 Linda A Root 5.00 35.00 X X 0 224081 59231 John Ryder 20.00 20.00 X X 0 187470 65794 Joy A Strand 1.00 39.00 X X 0 240244 34071 Anthony F Olivia 1.00 39.00 X X 0 532227 35749 Marcus Free MD 40.00 0.00 X X 66563 0 1391 James Wierman DO 1.00 0.00 X X 0 0 0 Kenneth Holst 40.00 0.00 X 0 165549 28370 Paul A Spaude 1.00 39.00 X 0 1377283 144295 Richard Felbinger 1.00 39.00 X 0 484745 77766 Sirinivasan Dhatreecharan 40.00 0.00 X 284550 0 14363 Boonchoo Change 40.00 0.00 X 280401 0 21110 Abbas R Syed 40.00 0.00 X 209233 0 7062 Donnie Bouchard 40.00 0.00 X 208694 0 15015 Marcus Gardiner 40.00 0.00 X 158846 0 15855 1208287 3774624 615985 20 0 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Physician Services 1109230 Medical Doctor Associate 145 Technology Parkway Norcross GA 30092 Physician Services 506494 Midwest Mobile Diagnostic Image 1700 Gull Road Kalamazoo MI 49001 Mobile MRI 406653 Apogee Medical Management 2525 E Camelback Road Phoenix AZ 85016 Hospitalist Physician Services 364003 Premier Radiology 1535 Gull Road Kalamazoo MI 49048 Physician Radiology Service 334860 9 40149 142647 5067 187863 Net Patient Revenue 621990 25917545 25917545 Pharmacy Income 446110 9388 9388 25926933 173059 173059 18875 0 18875 18875 18875 Outside Svcs/Incentive 621990 668042 668042 Cafeteria/Vending 722210 53094 53094 6705 6705 727841 27034571 26594975 0 251733 12770662 12430298 340364 698128 690988 7140 2108667 2105787 2880 921546 900310 21236 1398838 1384850 13988 118698 117511 1187 171560 169844 1716 1334939 1321589 13350 134956 133606 1350 507693 503584 4109 71331 71261 70 Physician Fees 3274534 3274534 Medical Supplies 2063935 2041023 22912 Contract Labor 554396 548852 5544 Minor Eqipment 75853 75853 638471 627870 10601 26844207 26397760 446447 0 1014 1116 1473958 1446870 5401190 5190878 357605 406077 19647 6782 19058577 14093655 5123690 4964922 3557553 3921303 15934657 15937948 2481327 2982775 21186588 19787992 23667915 22770767 X -7733258 -6832819 0 0 -7733258 -6832819 15934657 15937948 X 190364 130568 579507 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 52096 52096 12035985 8063978 3972007 6826467 5885680 940787 144029 143997 32 4964922 Interest in Investments Held by Ascension Health Alliance 3921303 3921303 Due to Borgess Medical Center 15640891 Self Insurance Liability 90021 Pension Payable 3870121 Asset Retirement Obligations 100000 A/R Probable Refunds 83000 Escheats Payable 3959 19787992 1 1 1 X 1 X 1 1 1 0 1 1 1476117 1177861 298256 0.01110 6616210 4872146 1744064 0.06500 8092327 6050007 2042320 0.07610 90209 424 89785 0.00330 123376 123376 0.00460 29307 29307 0.00110 242892 424 242468 0.00900 8335219 6050431 2284788 0.08510 5416 5416 0.00020 14616 14616 0.00050 20032 20032 0.00070 0 2648256 389280 5048789 5098777 -49988 X 1 1 1 1 Borgess Lee Memorial Hospital

420 W High Street Dowagiac MI 49047

www.borgesslee.com X X X X Borgess Lee Memorial Hospital 1 1 X X X X X X X X 12 1 0 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 1 0 1 X X 0 0 Part I, Line 7: The cost of providing charity care and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association (CHA) Guidelines. The organization uses a cost accounting system that addresses all patient segments. For the information in the table, a cost-to-charge ratio was calculated and applied. Part II: The organization provides education and materials to help promote healthy living through community health fairs, diabetes education and health screenings. Part III, Line 4: From the consolidated audited financial statements of Ascension Health Alliance (which includes the activity of Lee Memorial Hospital Corporation):The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Borgess' policies. Part III, Line 8: Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Part III, Line 9b: The organization has a written debt collection policy and collection procedures will only pertain to patients that do not qualify for charity or financial assistance and who are not complying with payment arrangements that have been agreed to by the hospital and the patient. Borgess Lee Memorial Hospital Part V, Section B, Line 3: To gain the important input needed for the CHNA, a CHNA Committee was formed. This committee included Lee Memorial Hospital leadership, representatives from governmental health organizations and community agency people who are directly involved in providing services to the medically underserved, minority, and low income populations. Below is the list of the CHNA Committee members and the organizations they represent:1) Dr. Rick Johansen - Berrien, Van Buren, Cass Counties Health Department2) Kari Adams - Lee Memorial Hospital3) Beth Cripe - Lee Memorial Hospital4) Judy Drenth - Lee Memorial Hospital5) Carol Howland - Lee Memorial Hospital6) John Ryder - Lee Memorial Hospital7) Mia Willhite - Lee Memorial Hospital8) Bob Cochrane - Cass County Council on Aging9) Mary Middleton - Cass Family Clinic10) Tom Atkins - City of Dowagiac-Polic Department11) Cindy Underwood - Department of Human Services12) Suzanne Dorman - Dowagiac Union Schools13) Dr. Arthur Culpepper - Pokagon Health Center14) Jeff Elliot - Van Buren/Cass County District Health Department15) Kathy Emans - Woodlands Behavioral Healthcare NetworkThe CHNA Committee met three times over the course of two months. Members brought data to these meetings which were reviewed. Discussions and presentations helped committee members identified key community health priorities and resources available to meet them. This process provided a significant amount of data collection that covered multiple categories which related to health needs of Cass County. This data was synthesized to develop a Community Needs Scorecard, the frame work of the CHNA.Summary of Measures Collected and Reviewed:- BLMH Community Benefit Activities- BLMH Primary Care/Providers Availability- BLMH Diabetic Advisory Committee data- Borgess Diabetic Data- Borgess Obesity Data- County Rankings & Roadmaps- Leading Diagnoses for Hospitalization-Cass County- Preventable Hospitalizations and Rates-Cass County- Michigan's Health Profile Chartbook- Michigan's State Health Assessment and State Health Improvement Plan- Health Risk Behavior in The State of Michigan-2011 Behavioral Risk Factor Survey.Phases of the Assessment Process:- Community/agency/organization meetings and discussions- Information/data collection and review- Key community health needs identification/agreement- Strategy development- Community stakeholder consideration and validation- Indicator/Measurement development necessary to monitor community changes and impacts.Assessment Priorities and Health Needs Identification:To determine priorities, five priority selection criteria were set:1. Impact on the community health improvement2. Scope of the community affected3. Threat to long term quality of life4. Resources/Capacity to address identified issues5. Consequences of inactionAfter synthesizing the information and applying the priority selection criteria, the following were identified as major factors affecting the health of Cass County residents (Assessment Priorities) and were used to determine the four major focus areas (Health Needs Identification) as identified through the CHNA process:Major Factors/Focus Areas:Access to primary care:- Understanding of Physicians- Urgent care when needed- Cass County has an incredibly high patient to physician rate of 8,401:1 compared to state rate of 1,119:1 and national benchmark of 631:1Diabetes/Obesity:- 10.7% of the residents in Cass County have diabetes and the rate is growing.- 31% of the residents in Cass County are considered obese.- Obesity is Michigan's top health priority.- Both diabetes and obesity are leading causes of disease and death.Access to mental health/psychiatric care:- Mental health us a leading cause of disability in Cass County.- Nationally, it is estimated that 25% of adults endure a mental disorder during a year.Community wellness/health education:- Borgess Lee Memorial Hospital is in the position to lead a community wellness effort through screenings and other similar initiatives.- Health education is the key to reducing the diabetes and obesity rates as well as the rates for many other chronic diseases.Community Assets Identified:The CHNA Committee will continue to serve as a forum for community and healthcare stakeholders to work together in addressing the needs of the community through shared initiatives and collaboration to the four major factors/focus areas noted above. The committee represents community assets that are vital to improving the health of residents of Cass County, including: Lee Memorial Hospital and its primary care provider network, the Cass County Family Clinic, the Cass County Health Department, the Cass County Council on Aging, the Department of Human Services, the Pokagon Health Center and Woodlands Behavioral Healthcare Network. Borgess Lee Memorial Hospital Part V, Section B, Line 5c: The Hospital facility's webiste address is http://www.borgess.com/files/chna/CHNA_Borgess-Lee.pdf Borgess Lee Memorial Hospital Part V, Section B, Line 7: Lee Memorial Hospital priorities and implementation strategies were developed based on the findings established by the CHNA, BLMH strengths and capabilities, BLMH strategic direction and a review of the hospital's existing community benefit activities: The CHNA resulted in four major focus areas: - Access to primary care - Diabetes/obesity - Access to mental health/psychiatric care - Community wellness/health education Lee Memorial Hospital used the following criteria to determine implementation priorities: - Severity of the issue - Ability of the hospital to affect change - Ability to evaluate outcomes - Community and hospital resources available Based on these criteria, Lee Memorial Hospital will develop initiatives to address access to primary care including physician understaffing and urgent care. It will also develop initiatives to lessen diabetes and obesity rates. It will work in partnership with other members of the CHNA Committee to address access to mental health/psychiatric care and to implement community wellness/health education programs. Lee Memorial Hospital Objectives: - Complete 90% of planned permanent physician and mid-level replacements by 12/31/13- Implement a community-wide diabetes initiative - Convene a community task force and lead plan development to improve access to mental health and psychiatric care - Convene a community task force and help plan to implement community wellness programs Description of What Lee Memorial Hospital Will Do To Address Community Needs:Hospital Initiatives:Access to Primary Care:Access to primary including the lack of physicians was identified as a major community health need. Lee Memorial Hospital will continue to lead and spearhead initiatives to attract and retain high quality primary care physicians and mid-level providers. Access to Primary Care Action Plans: -Maintain aggressive, ongoing recruiting programs to seek out and hire permanent Physician, Nurse Practitioner and Physician Assistant providers to fill the staffing needs identified by Lee Memorial Hospital and the Borgess Lee Medical Group1) Family Practice-add new internal medicine and family practice physicians and new nurse practitioners and physician assistants 2) Pediatrics-add new nurse practitioners and physician assistants 3) Orthopedics-add a new orthopedic surgeon - Continue Internal and Recruiting Agency Initiatives Currently in Progress - Create Succession Plan for next 1-5 years Diabetes EducationCass County's diabetes rate is high and is a major catalyst contributing to a whole range of health disease and issues. Lee Memorial Hospital will use its position within the community and the clinical expertise of its people to lead county-wide diabetes awareness and education efforts. Diabetes Education Action Plans: - Develop Diabetes education business plan by 6/1/13 - Implement plan by 12/30/13 - Review plan progress during Q3 calendar year 2014 - Report progress to Lee Memorial Hospital Board by 9/1/14 Community Partnership Initiatives:Mental Health/Psychiatric Care Access Lee Memorial Hospital will seek to help establish a community partnership to address this major health need. It will participate, help implement and remained involved in actions and initiatives designed to improve access to mental health and psychiatric care. Mental Health/Psychiatric Care Access Action Plans- Identify CHNA participants who would be stakeholders in this initiative - Establish a Task Force - Develop a plan with goals for July 2013-June 2014 - Review progress during Q3 of calendar year 2014 with Board update Community Wellness Initiatives Lee Memorial Hospital is in a unique position to help convene and lead a community partnership that focuses efforts and resources on programs that help improve and maintain wellness among the residents of Cass County. Community Wellness Action PlansIdentify CHNA Participants with interest in this initiative- Establish Community Wellness Task Force - Develop Wellness Initiative Plan including Goals for CY 2014 - Review CY 2014 progress Q1 calendar year 2015 with Board updateNext Steps for Lee Memorial Priorities: For each of the priority areas; access to primary care, diabetes/obesity, access to mental health/psychiatric care and community wellness/health education, Lee Memorial Hospital will work with community partners to:- Identify initiatives and activities within the community that can be built upon - Develop measurable goals and evaluate progress - Build support within the community and among health care providers - Develop and execute detailed work plans Borgess Lee Memorial Hospital Part V, Section B, Line 14g: A summary of the financial assistance policy is posted on the hospital facility's emergency rooms or waiting rooms, admission offices and available upon request. Borgess Lee Memorial Hospital Part V, Section B, Line 18e: Question 18 is more appropriately answered as not applicable as the Billing and Collections Policy of Lee Memorial Hospital Corporation does not allow a hospital to engage in extraordinary collection actions before the organization made reasonable efforts to determine whether the individual is eligible for assistance under the financial assistance policy. Reasonable efforts taken include but are not limited to: - Notifying individuals of the financial assistance policy on admission- Notifying individuals of the financial assistance policy prior to discharge- Notifying individuals of the financial assistance policy in communications with the patients regarding the patients' billsDocumenting its determination of whether patients were eligible for financial assistance under the hospital facility's financial assistance policy. Borgess Lee Memorial Hospital Part V, Section B, Line 20d: The amounts were determined through financial assistance policy. Part VI, Line 2: See Part V, Section B, Line 3 disclosure. Part VI, Line 3: As part of the intake process the organization provides a copy of the policy and financial assistance contact information to patients. Also, available is a staff person to discuss with the patient the availability of various government benefits, such as Medicaid or state and local programs and assist the patient with qualification for such programs, where applicable. Part VI, Line 4: In 2013, a Community Health Needs Assessment (CHNA) was conducted for the approximate 52,000 residents of Cass County by Borgess-Lee Memorial Hospital (BLMH) located in Dowagiac. While BLMH is the only hospital in Cass County, there are three Michigan based health systems and three large Indiana hospitals that serve the Cass County population: Borgess Health (BLMH and Borgess Medical Center Kalamazoo); Lakeland Health (Lakeland Hospital-Niles and Lakeland Medical Center- St. Joseph); Bronson Healthcare (Bronson Lakeview Hospital-Paw Paw and Bronson Methodist Hospital-Kalamazoo); Elkhart General Hospital-Elkhart, Indiana; Memorial Hospital-South Bend, Indiana; and St. Joseph Regional Medical Center- South Bend, Indiana.Description of the Community:Cass County is located in southwest Michigan and borders the State of Indiana. It covers about 491 square miles with total population of 52,242. The area was originally inhabited by three bands of Potawatomi Indians. And during Civil War, Cass County played a major role in Underground Railroad which resulted in the settling of many Black families in the area. Both of these factors have contributed to the unique cultural diversity of the county.According to 2010 US Census Data Cass County has 20,101 households. The current unemployment rate is about 8.1%, below the state wide average. The median household income is $45,342. The per capita income is $23,045. Both are below the Michigan average. The percentage of persons with Bachelor's degrees is 16.7% much lower than the Michigan average of 25%. About 90% of the full-time residents are white, 5.4% are African-American, 3% are Hispanic and 1% is Native American. About 13.3% of the residents fall below the poverty level, which is better than the state-wide average. The overall population tends to skew slightly older and is declining somewhat.Three characteristics combine to make Cass County somewhat unique, especially as it relates top serving health needs. The first is the county's rather large, rural/agriculture base. About 60% of the Cass County is farm land ranking it 15th out of Michigan's 83 counties. Much of the farm land is used for growing seasonal fruits and vegetables which require migrant farm laborers to harvest. This results in a heavy influx of mostly Hispanic families which in turn impacts the need and delivery of health care services.The second characteristic relates to the significant recreational opportunities that abound in Cass County. It has over 250 lakes and the county's close proximity to major population centers in Indiana and Illinois makes a regional recreational "Mecca". During the summer, the population around the lakes grows significantly. Both the summer and full-time lake residents tend to be very affluent. While most of the health care needs of the summer residents are served by out-of-state providers, these people do impact the area's health care service delivery, especially emergency room and fast track primary care services.The third characteristic is the large blue-collar population in the county's two largest population centers-Dowagiac and Cassapolis. The City of Dowagiac is the county's largest city. It has about 2,400 households with a total population of 5,879. Median household income is $31,329 and per capita income $17,739. Both are well the county and state averages. Also, about 20% of the residents fall below the poverty rate. The Village of Cassapolis, the County Seat, ranks are even lower. It has about 700 households with a total population of 1,774. Median household income is $24,781 and per capita income is $15,114. Almost 30% of the Cassapolis residents fall below the poverty level. Part VI, Line 5: The organizations governing body is comprised of persons who reside in Cass County and are neither employees nor contractors of the organization. The organization is a Critical Access Hospital and provides medical services to all people in the community without regard to the patient's race, creed, national origin, economic status or ability to pay. In addition the organization participates in Medicare, Medicaid, CHAMPUS and other government sponsored health care programs. The organization provides education and materials for nutrition/weight loss management, Women's Health Fair, PSA and Flu Shot Clinics. Part VI, Line 6: Lee Memorial Hospital Corporation is a wholly owned subsidiary of Borgess Health Alliance, Inc., which is a member of Ascension Health. Ascension Health Alliance became the sole corporate member and parent organization of Ascension Health, a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. In addition to serving as the sole corporate member of Ascension Health, Ascension Health Alliance serves as the member or shareholder of various other subsidiaries. Ascension Health Alliance, its subsidiaries, and the Health Ministries are referred to collectively from time to time hereafter as the System.Ascension Health Alliance is sponsored by Ascension Health Ministries, a Public Juridic Person. The Participating Entities of Ascension Health Ministries are the Daughters of Charity of St. Vincent de Paul in the United States, St. Louise Province, the Congregation of St. Joseph, the Congregation of the Sisters of St. Joseph of Carondelet, the Congregation of Alexian Brothers of the Immaculate Conception ProvinceAmerican Province, and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of AssisiUS/Caribbean Province. Marian Health System, which was previously sponsored by the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi US/Caribbean Province, became part of Ascension Health on April 1, 2013. In addition, Alexian Brothers Health System, which was previously sponsored by the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. American Province, became part of Ascension Health on January 1, 2012.The Hospital, located in Dowagiac, Michigan, is a nonprofit critical access hospital. The Hospital provides inpatient, outpatient, and emergency care services for the residents of Dowagiac, Michigan. Admitting physicians are primarily practitioners in the local area. The Hospital is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health and its sponsored organizations are related to providing health care services.Ascension Health Alliance directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs:- Traditional charity care includes the cost of services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured.- Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons.- Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.- Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons who are poor and community benefit programs. The cost of providing care of persons who are poor and community benefit programs is estimated using internal cost data. 1 1 0 0 0 0 0 0 0 Robert Hill MD 0 217460 0 22969 0 1151 0 25086 0 16043 0 282709 0 0 Mark Anthony 0 234705 0 46922 0 39818 0 43750 0 11034 0 376229 0 0 Linda A Root 0 150090 0 65412 0 8579 0 41206 0 18025 0 283312 0 0 John Ryder 0 136583 0 42774 0 8113 0 46612 0 19182 0 253264 0 0 Joy A Strand 0 92078 0 52089 0 96077 0 24900 0 9171 0 274315 0 0 Anthony F Olivia 0 355259 0 160800 0 16168 0 16216 0 19533 0 567976 0 0 Kenneth Holst 0 146181 0 15450 0 3918 0 8517 0 19853 0 193919 0 0 Paul A Spaude 0 499198 0 833129 0 44956 0 126774 0 17521 0 1521578 0 0 Richard Felbinger 0 290265 0 155750 0 38730 0 56617 0 21149 0 562511 0 0 Sirinivasan Dhatreecharan 284550 0 0 0 0 0 0 0 14363 0 298913 0 0 0 Boonchoo Change 280401 0 0 0 0 0 0 0 21110 0 301511 0 0 0 Abbas R Syed 209233 0 0 0 0 0 0 0 7062 0 216295 0 0 0 Donnie Bouchard 208694 0 0 0 0 0 0 0 15015 0 223709 0 0 0 Marcus Gardiner 158846 0 0 0 0 0 0 0 15855 0 174701 0 0 0 Part I, Line 3 Borgess Medical Center, a related organization of Lee Memorial Hospital Corporation, uses the following to establish the compensation of the Organization's CEO: - Compensation Committee, - Written Employment Contract, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee Supplemental Information Part III Part I, Line 4a: Severance Payments: Joy A. Strand - $80,208 Part I, LIne 4b: Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Du e to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid to the executive is reported as compensation on Form 990, Part II, column B in the year paid. Borgess Medical Center (a related entity) contributed to Ascension Health's nonqualified supplemental retirement plan and the following individual received payment: Mark Anthony - $15,000 Form 990, Part VI, Section A, line 6 Lee Memorial Hospital Corporation has a single corporate member, Borgess Health Alliance, Inc. Form 990, Part VI, Section A, line 7a Lee Memorial Hospital Corporation has a single corporate member, Borgess Health Alliance, Inc., who has the ability to elect members to the governing body of Lee Memorial Hospital Corporation. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Lee Memorial Hospital Corporation financial information or corporation as a whole are subject to approval by its sole corporate member, Borgess Health Alliance, Inc. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflict of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's CEO, the process performed by Borgess Medical Center (a related organization who paid the CEO) included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Executive/Compensation Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals that worked at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the Executive Committee minutes. The individual was not present when his compensation was decided. In determining compensation of other officers of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Executive/Compensation Committee reviewed and approved the compensation. In the review of the compensation, the other officers of the organization were compared to individuals that worked at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the Executive Committee minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Deferred Pension Cost - FAS 158 579,507. Ascension Health PO Box 45998 St Louis MO 63134 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Borgess Health Alliance Inc 1521 Gull Road Kalamazoo MI 49048 382335286 Health System Parent MI Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Borgess Medical Center 1521 Gull Road Kalamazoo MI 49048 381360526 Healthcare Services MI Section 501(c)(3) Schedule A, Line 3 Borgess Health Alliance Inc 1 Borgess Ambulatory Care Corporation 1521 Gull Road Kalamazoo MI 49048 382468823 Holding Company MI Section 501(c)(3) Schedule A, Line 3 Borgess Health Alliance Inc 1 Borgess Foundation 1521 Gull Road Kalamazoo MI 49048 237222558 Fundraising MI Section 501(c)(3) Schedule A, Line 11c Borgess Health Alliance Inc 1 Borgess Nursing Home 3057 Gull Road Kalamazoo MI 490481281 382555589 Residential Care MI Section 501(c)(3) Schedule A, Line 3 Borgess Health Alliance Inc 1 Lee Memorial Foundation 420 W High Street Dowagiac MI 49047 382860459 Fundraising MI Section 501(c)(3) Schedule A, Line 11c Borgess Health Alliance Inc 1 ProMed Healthcare 1521 Gull Road Kalamazoo MI 49048 383193801 Healthcare Services MI Section 501(c)(3) Schedule A, Line 9 Borgess Health Alliance Inc 1 Visiting Nurse & Hospice Services of SW MI 348 North Burdick Kalamazoo MI 49007 381359216 Home Nursing and Rehabilitation Services MI Section 501(c)(3) Schedule A, Line 9 Borgess Health Alliance Inc 1 Visiting Nurses Home Care DBA Borgess VNA Home Care 348 North Burdick Kalamazoo MI 49007 382717691 Home Healthcare Services MI Section 501(c)(3) Schedule A, Line 9 Borgess Health Alliance Inc 1 Textile Systems Inc 817 Walbridge Kalamazoo MI 49007 382705047 Laundry Services MI N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Borgess Medical Center R 4319340 FMV