2013-05-15T14:47:08-05:00 2012-06-30 382806590 MAKELA TOUTANT HILL & NARDI PC 201 W BLUFF STREET MARQUETTE MI 49855 990 2011-07-01 381358036 MARQUETTE GENERAL HOSPITAL INC MARQ 9062253450 420 W MAGNETIC STREET MARQUETTE MI 49855 JERRY L WORDEN 9062253450 2013-05-15 1 ROBIN A RAUVALA P00070626 9062283600 2011 2016-02-25 16:41:14Z JERRY L WORDEN 420 W MAGNETIC STREET MARQUETTE MI 49855 376918578 0 X WWW.MGH.ORG X 1897 MI TO BE A REGIONAL HEALTH RESOURCE, IMPROVING THE HEALTH OF THOSE WE SERVE. 14 10 2866 517 4712344 0 736486 2957349 316269301 327845066 -576946 -1180453 17140 -11946 316445981 329610016 0 0 0 0 164687080 164135024 0 0 0 143106091 162588849 307793171 326723873 8652810 2886143 248826715 242532893 167162681 198400518 81664034 44132375 X TO BE THE REGIONAL MEDICAL CENTER OF CHOICE BY PROVIDING EFFICIENTLY DELIVERED, HIGH QUALITY, COMPASSIONATE CARE. 0 0 212244925 225635156 HOSPITAL SERVICES ENCOMPASSING 9,865 INPATIENT ADMISSIONS; 51,954 INPATIENT DAYS AND 239,851 OUTPATIENT VISITS/REGISTRATIONS. 89921084 76312087 PHYSICIAN PRACTICES WITH 166,730 PATIENTS AND 363,808 VISITS. 4708380 5440087 HOME HEALTH SERVICES COVERING SEVEN COUNTIES, SERVING 1,881 PATIENTS WITH 35,379 HOME VISITS. 4747060 12961629 INCLUDES REVENUE FROM: THE SALE OF BLOOD PRODUCTS TO OTHER HOSPITALS; SALES TO EMPLOYEES AND GUESTS AT A CAFETERIA, COFFEE SHOP AND GIFT SHOP; PHARMACEUTICAL SALES TO EMPLOYEES AND GUESTS; INDIGENT CARE AGREEMENT WITH AN UNRELATED NON-PROFIT ORGANIZATION; RENTAL OF SPACE TO OTHER UNRELATED HEALTH CARE ORGANIZATIONS; TUITION REVENUE FOR THE HOSPITAL-RUN SCHOOL OF RADIOGRAPHY AND SCHOOL OF EMT; IT SERVICES TO OTHER UNRELATED HOSPITALS AND PHYSICIAN OFFICES; TELEHEALTH SERVICES TO OTHER UNRELATED HOSPITALS AND PHYSICIAN OFFICES. 4747060 12961629 311621449 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 0 1 187 0 2866 1 1 1 0 0 0 0 0 0 0 0 0 X 14 10 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MI X JERRY L WORDEN SENIOR VPCFO 9062253450 420 W MAGNETIC STREET MARQUETTE MI 49855 TIMOTHY J LARSON 3.00 X X 0 0 0 RICHARD R SCHAEFER 3.00 X X 0 0 0 JUDITH WATSON-OLSON 3.00 X X 0 0 0 MICHAEL L VONCK 3.00 X X 0 0 0 LOIS A MICHELIN 3.00 X X 0 0 0 BRADLEY CORY 2.00 X 0 0 0 GARY LAPLANT 2.00 X 0 0 0 LARRY S LEWIS MD 50.00 X 369611 0 18165 MARYANNE SHANNON 2.00 X 0 0 0 K MICHAEL SKYTTA 2.00 X 0 0 0 NANCY DWYER 2.00 X 0 0 0 DAN GREENLEE 2.00 X 0 0 0 SCOTT HERIOUX 2.00 X 0 0 0 RICHARD BLOTTER 2.00 X 0 0 0 A GARY MULLER 50.00 X X 843584 0 35743 JERRY L WORDEN 50.00 X 348125 0 56212 DAVID S GRASER 50.00 X 322575 0 51594 THOMAS F NOREN MD 50.00 X 408029 0 22772 DAGMAR A RAICA 50.00 X 199711 0 18333 CRAIG COCCIA 50.00 X 1910498 0 26844 PAUL LAHAYE 50.00 X 939031 0 17982 RICHARD ROVIN 50.00 X 609958 0 28186 BHAVANI MEKALA 50.00 X 566043 0 16320 ANDREW JAHODA 50.00 X 549364 0 15834 FREDERICK P HOENKE MD 50.00 X 353842 0 29270 7420371 0 337255 193 1 1 0 UPIMS LLC (CARDIOLOGY JOINT VENTURE) 1414 W FAIR AVE MARQUETTE MI 49855 IMAGING SERVICES 5081802 REHAB CARE GROUP INC 7733 FORSYTH BLVD ST LOUIS MO 63105 THERAPY SERVICES 4535321 SOUND PHYSICIANS 1123 PACIFIC AVENUE TACOMA WA 98402 PHYSICIAN SERVICES 1815494 DMS IMAGING 2101 N UNIVERSITY DRIVE FARGO ND 58102 PET SCANNING 945410 MAYO COLLABORATIVE SERVICES 3050 SUPERIOR DRIVE ROCHESTOR MN 55901 LAB SERVICES 911736 39 2723052 234297 2957349 HOSPITAL SERVICES 622110 230347500 225635156 4712344 PHYSICIAN PRACTICES 621111 76312087 76312087 HOME HEALTH SERVICES 621610 5440087 5440087 BLOOD PRODUCTS 621511 1758046 1758046 EMPLOYEE & GUEST MEALS 722212 1267347 1267347 12719999 11203583 1516416 327845066 1170682 1170682 876799 876799 81113 93059 -11946 -11946 -11946 43803192 184377 43979992 3235511 -176800 -3051134 -3227934 -3227934 329610016 320348959 4712344 1591364 2715658 109466 2606192 514978 322866 192112 123621740 119913088 3708652 7378605 7157247 221358 20395295 19783436 611859 9508748 9223486 285262 8177402 6133051 2044351 1271784 317946 953838 225443 225443 72357 72357 25956723 25178021 778702 582213 564747 17466 67608790 65580526 2028264 5295592 5136724 158868 8244206 7996880 247326 2521417 2445774 75643 437912 424775 13137 2831650 2746700 84950 10335211 10025155 310056 1804726 1750584 54142 UNCOMPENSATED CARE 13475192 13475192 QUALITY ASSURANCE ASSES 6808314 6604065 204249 LEASED EQUIPMENT 1897814 1840880 56934 5042103 4890840 151263 326723873 311621449 15102424 0 28458445 33024052 881452 789976 36555737 29675909 46700 36208 8118566 8056032 2609834 3169284 294912962 205895083 91942951 89017879 59596589 57380554 12975901 14221522 7640540 7161477 248826715 242532893 39661534 38719695 61072089 61178740 476036 427029 65953022 98075054 167162681 198400518 X 78348751 41947903 3315283 1731710 452762 81664034 44132375 248826715 242532893 X 2886143 -40417802 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7494807 7494807 144621712 93446325 51175387 138653786 110250715 28403071 4142657 2198043 1944614 89017879 UP HEALTH NETWORK 11522921 C UP MEDICAL CENTER 2698601 F 14221522 INSURANCE RESERVES 5865886 ACCRUED BENEFIT OBLIGATION 3746764 ACCRUED PENSION LIABILITY 88462404 98075054 329610016 326723873 2886143 -2036821 -38380981 -40417802 -37531659 328979264 -2036821 2536880 500059 328479205 1130811 1130811 329610016 366510923 39787050 39787050 326723873 0 326723873 PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT -38,854,148. GAIN ON DISCONTINUED OPERATIONS 2,443,821. LOSS ON EXTINGUISHMENT OF DEBT -839,843. RESTRICTED CONTRIBUTIONS -1,130,811. TOTAL TO SCHEDULE D, PART XI, LINE 8: -38,380,981. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON DISCONTINUED OPERATIONS 2,443,821. RENTAL EXPENSES 93,059. PART XII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 1,130,811. PART XIII, LINE 2D - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT 38,854,148. RENTAL EXPENSES 93,059. LOSS ON EXTINGUISHMENT OF DEBT 839,843. 1 1 1 X 1 X 1 1 1 0 1 1 1 1085175 0 1085175 0.00350 1 40593226 30211398 10381828 0.03310 1 1201815 815350 386465 0.00120 3 42880216 31026748 11853468 0.03780 2141 30279 953482 213508 739974 0.00240 56 825 6625170 4675641 1949529 0.00620 1 22969587 19047024 3922563 0.01250 1 523561 56372 467189 0.00150 90 873 164269 3002 161267 0.00050 2289 31977 31236069 23995547 7240522 0.02310 2292 31977 74116285 55022295 19093990 0.06090 7 232 1213 1213 0.00000 1 74 74 0.00000 6 149 49958 49958 0.00020 14 381 51245 51245 0.00020 1 6146005 4265972 83517473 58213837 25303636 X 1 0 1 UP IMAGING MANAGEMENT SERVICES LLC OUTPATIENT NON-INVASIVE DIAGNOSTIC CARDIOVASCULAR IMAGING SERVICES 0.60000 0.40000 1 1 MARQUETTE GENERAL HOSPITAL INC

420 W MAGNETIC ST MARQUETTE MI 49855

X X X X X MARQUETTE GENERAL HOSPITAL INC 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X 1 X X X 1 X X X X X X X X 1 X 0 1 14 MARQUETTE MEDICAL CLINIC

1414 WEST FAIR AVENUE MARQUETTE MI 49855

OUTPATIENT CLINIC MARQUETTE GENERAL HEMOTOLOGYONCOLOGY

1711 SOUTH STEPHENSON AVE SUITE 315 IRON MOUNTAIN MI 49801

OUTPATIENT CLINIC CHIPPEWA MEDICAL ASSOCIATES

AVERY SQUARE 510 ASHUM SUITE 5 SAULT STE MARIE MI 49783

OUTPATIENT CLINIC MARQUETTE SPECIALTY CLINIC

800 EAST BOULEVARD KINGSFORD MI 49802

OUTPATIENT CLINIC LAKEWOOD MEDICAL ASSOCIATES

5087 US 41 SOUTH MARQUETTE MI 49855

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

2500 7TH AVE SOUTH ESCANABA MI 49829

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

405 US 41 EAST NEGAUNEE MI 49866

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

1500 W ICE LAKE RD IRON RIVER MI 49935

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

2002 MINNEAPOLIS AVE GLADSTONE MI 49837

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

500 CAMPUS DRIVE SUITE 5 HANCOCK MI 49930

OUTPATIENT CLINIC ONTONAGON COMMUNITY HEALTH CENTER

751 S 7TH ST ONTONAGON MI 49953

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

COMMUNITY BUILDING TRENARY MI 49891

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

BURT TOWNSHIP HALL GRAND MARAIS MI 49839

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

205 OSCEOLA ST LAURIUM MI 49913

OUTPATIENT CLINIC PART I, LINE 7: ROW A - CHARITY CARE: COST TO CHARGE RATIO.ROW B - MEDICAID: COST TO CHARGE RATIO USING MEDICARE COST REPORT RULES.ROW C - UNREIMBURSED COSTS: COST TO CHARGE RATIO USING MEDICARE COST REPORT RULES.ROW E TO J - OTHER BENEFITS: DIRECT CHARGE OF TIME AND COSTS. PART I, LINE 7G: THE SYSTEM PROVIDES SUBSIDIZED HEALTH SERVICES FOR BEHAVIORAL HEALTH, FAMILY PRACTICE CLINICS IN MEDICALLY UNDERSERVED AREAS, NICU, AND WOMEN'S SERVICES. COSTS OF SUBSIDIZED HEALTH SERVICES FOR PHYSICIAN CLINICS INCLUDED IN LINE 7B ARE $12,202,224. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 13475192. PART II: COMMUNITY BUILDING ACTIVITIES INCLUDE PARTICIPATION IN COLLABORATIVE PARTNERSHIPS WITH COMMUNITY GROUPS, RECRUITMENT OF PROFESSIONALS FOR AREAS IDENTIFIED AS MEDICALLY UNDERSERVED, REGIONAL ECONOMIC DEVELOPMENT GROUPS AND PROGRAMS. PART III, LINE 4: FOOTNOTE TEXT: 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 SYSTEM 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 SYSTEM 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 SYSTEM 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.COSTING METHODOLOGY: GROSS BAD DEBT EXPENSE WAS $13,475,192 WITH A COST OF $6,146,005 WHICH WAS CALCULATED USING THE ORGANIZATION'S RATIO OF PATIENT CARE COST TO CHARGES. AN ATTORNEY REVIEWED THE ACCOUNTS TO DETERMINE THE PERCENTAGE THAT WOULD HAVE QUALIFIED FOR CHARITY CARE. PART III, LINE 8: MEDICARE COSTS ARE FROM THE MEDICARE COST REPORT, WHICH UTILIZES MEDICARE ALLOWABLE COST AND THEN RATIO OF COST TO CHARGES BY HCFA LINE NUMBER. MEDICARE ALLOWABLE COST IS DETERMINED BY INCLUDING ALL DIRECT AND INDIRECT EXPENSES IN WORKSHEET A AND THEN OFFSETTING ANY NON-ALLOWABLE COSTS AND MISCELLANEOUS REVENUES. NON-ALLOWABLE COSTS INCLUDE ANY EXPENSE NOT NECESSARY FOR PATIENT CARE OR THOSE DEEMED A LUXURY OR EXCESSIVE. TYPICAL OFFSETS INCLUDE PATIENT TELEVISIONS AND TELEPHONES, PAYMENTS TO PROVIDER BASED PHYSICIANS IN EXCESS OF REASONABLE LIMITS, AND NON-PATIENT REVENUE, TO NAME A FEW. OVERHEAD IS STEPPED-DOWN TO THE REIMBURSABLE AND NON-REIMBURSABLE HCFA LINES. TOTAL COST IS THEN DETERMINED USING RATIO OF COST TO CHARGES. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 11H: CREDIT REPORT, LIVING ARRANGEMENTS/HOME LIFE, CONVERSATIONS WITH PATIENT OR PATIENT'S FAMILY. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 13G: REGISTRATION PERSONNEL REFER UNINSURED AND LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE POLICY. ALSO, A THIRD PARTY COLLECTOR WILL DISCUSS THE POLICY WITH PATIENTS HAVING PAST DUE ACCOUNTS. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 17E: REGISTRATION PERSONNEL, FINANCIAL COUNSELORS, AND THE THIRD PARTY COLLECTOR REVIEW PATIENT AND/OR ACCOUNT INFORMATION TO DETERMINE IF PATIENTS MAY QUALIFY FOR STATE OR FEDERAL ASSISTANCE. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGED THE SAME FIXED GROSS RATES FOR SERVICES. DISCOUNTS ARE APPLIED IF QUALIFICATIONS ARE MET AND THE PATIENT FOLLOWS THE FINANCIAL ASSISTANCE POLICY PROCESS. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME FIXED GROSS RATES FOR SERVICES. DISCOUNTS ARE APPLIED IF QUALIFICATIONS ARE MET AND THE PATIENT FOLLOWS THE FINANCIAL ASSISTANCE POLICY PROCESS. PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY UTILIZING NEEDS ASSESSMENTS CONDUCTED BY MULTIPLE AGENCIES PROVIDING HEALTH CARE TO THE SERVICE AREA POPULATION, AS WELL AS CONDUCTING AND DIRECTING QUALITATIVE (FOCUS GROUPS AND INDIVIDUAL, IN PERSON INTERVIEWS) AND QUANTITATIVE (PHONE SURVEYS) MARKET RESEARCH OF THE SERVICE AREA POPULATION. RESEARCH IS ALSO CONDUCTED VIA INTERVIEWS AND FOCUS GROUPS WITH PHYSICIANS AND MID-LEVELS TO DETERMINE HEALTH CARE NEEDS. PART VI, LINE 3: IN-HOUSE MEDICAL ASSISTANCE EXPERTS EXPLAIN PROGRAMS TO PATIENTS AND ASSIST WITH THE APPLICATION PROCESS. PATIENT ACCESS IDENTIFIES SELF-PAY AND UNDERINSURED PATIENTS AND REFERS THEM TO IN-HOUSE FINANCIAL COUNSELORS. FINANCIAL ASSISTANCE INFORMATION AND APPLICATIONS ARE AVAILABLE ON-LINE. PART VI, LINE 4: THE SYSTEM SERVES THE RESIDENTS OF THE UPPER PENINSULA OF MICHIGAN. PART VI, LINE 5: THE MAJORITY (10 OF 14) OF THE ORGANIZATION'S BOARD MEMBERS ARE INDEPENDENT AND RESIDE AND/OR WORK IN MARQUETTE COUNTY, THE ORGANIZATION'S PRIMARY SERVICE AREA. MANY LOCAL PHYSICIANS NOT EMPLOYED BY THE HOSPITAL HAVE PRIVILEGES AT THE HOSPITAL. X X X X X X 0 1 0 0 0 0 0 0 0 LARRY S LEWIS MD 369611 0 0 0 0 0 0 0 18354 0 387965 0 0 0 A GARY MULLER 547300 0 143081 0 153203 0 9800 0 35103 0 888487 0 128750 0 JERRY L WORDEN 308223 0 35000 0 4902 0 41240 0 22341 0 411706 0 0 0 DAVID S GRASER 283616 0 35000 0 3959 0 38622 0 14814 0 376011 0 0 0 THOMAS F NOREN MD 295477 0 70002 0 42550 0 9800 0 14729 0 432558 0 35520 0 DAGMAR A RAICA 178021 0 20000 0 1690 0 7937 0 11283 0 218931 0 0 0 CRAIG COCCIA 1864344 0 46154 0 0 0 9800 0 18004 0 1938302 0 0 0 PAUL LAHAYE 937619 0 0 0 1412 0 9800 0 9142 0 957973 0 0 0 RICHARD ROVIN 566304 0 43654 0 0 0 9800 0 19346 0 639104 0 0 0 BHAVANI MEKALA 550266 0 15777 0 0 0 0 0 17504 0 583547 0 0 0 ANDREW JAHODA 549364 0 0 0 0 0 9800 0 6994 0 566158 0 0 0 FREDERICK P HOENKE MD 252252 0 100000 0 1590 0 9800 0 20581 0 384223 0 0 0 PART I, LINE 4B PART I, LINE 4B: SUPPLEMENTAL RETIREMENT PAYMENTS MADE TO SECTION 457(F) PLAN FOR: JERRY L WORDEN $31,440 DAVID S GRASER $28,822 DISTRIBUTIONS FROM SECTION 457(F) PLAN MADE TO: A GARY MULLER $130,759 THOMAS F NOREN $36,412 MI STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HBA3 2005-05-04 29102140 BLDG IMPROVEMENTS & EQUIPMENT 0 0 0 CITY OF MARQUETTE HOSPITAL FINANCE AUTH 386004521 NONEXXXXX 2011-12-13 39550000 REFUND PRIOR ISSUE (8/23/06) 0 0 0 6855000 29600966 2238812 101094 275951 26985109 2006 0 0 1 1 39550000 304825 2161311 37083863 2007 1 0 1 1 1 0 0 0 0.00250 0.00250 1 0 0 0 0 1 0 0 0 1 SOCIETE GENERALE 28.000000000000 1 0 1 0 0 0 0 0 1 PART II, LINE 3, TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. PART II, LINE 4, COLUMN A. THE GIC WAS TERMINATED ON 3/29/2012 BHAVANI PRASAD MEKALA SIGNING BONUS X 65174 36208 0 1 1 36208 CINDY MASSIE FAMILY MEMBER OF CURRENT BOARD MEMBER, TIMOTHY J LARSON 52130 EMPLOYMENT 0 HELEN LAPLANT FAMILY MEMBER OF CURRENT BOARD MEMBER, GARY LAPLANT 25967 EMPLOYMENT 0 JESSICA BLEAU-WORDEN FAMILY MEMBER OF CURRENT OFFICER, JERRY WORDEN 52658 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED AND RESTATED ITS ARTICLES OF INCORPORATION TO CHANGE ITS ORGANIZATION FROM A MEMBERSHIP-BASED TO A DIRECTORSHIP-BASED ORGANIZATION. IN JUNE 2010 THE ARTICLES OF INCORPORATION HAD BEEN RESTATED TO CEDE CERTAIN POWERS TO ITS MEMBER, SUPERIOR HEALTH PARTNERS; HOWEVER, THE RESTATEMENT THAT OCCURRED IN FEBRUARY 2012 REINSTATED THE DIRECTORSHIP-BASED GOVERNANCE FORM AND ELIMINATED MEMBERS. AS A RESULT, LINE 6 ACKNOWLEDGES NO MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 ONCE FORM 990 HAS BEEN PREPARED, IT IS REVIEWED BY THE VP OF FINANCE, THE CFO, AND THE CEO. IT IS THEN PRESENTED TO THE FINANCE COMMITTEE. UPON APPROVAL BY THE FINANCE COMMITTEE, THE COMPLETED TAX RETURN IS PRESENTED TO THE BOARD OF TRUSTEES BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF TRUSTEES SIGNS A CONFLICT OF INTEREST STATEMENT ANNUALLY. EMPLOYEES WHO ALSO SERVE ON THE BOARD OR WHO ARE OFFICERS ARE REMINDED AT THEIR ANNUAL EVALUATIONS TO ABIDE BY THE CODE OF CONDUCT AND ALSO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 TO DETERMINE EXECUTIVE COMPENSATION FOR THE CEO, VICE PRESIDENTS AND OFFICERS OF THE CORPORATION, THE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO CONDUCT SALARY SURVEYS OF THE HEALTH CARE MARKET. THE INDEPENDENT CONSULTANT REVIEWS FINDINGS AND MAKES RECOMMENDATIONS TO THE COMPENSATION COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATION WEBSITE. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE WITHIN CONTINUING DISCLOSURES FOR BOND ISSUANCES AT WWW.FIRSTRIVER.COM. THE ORGANIZATION DOES NOT MAKE PUBLICLY AVAILABLE ITS CONFLICT OF INTEREST POLICY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,036,821. PENSION LIABILITY ADJUSTMENT -38,854,148. GAIN ON DISCONTINUED OPERATIONS 2,443,821. LOSS ON EXTINGUISHMENT OF DEBT -839,843. RESTRICTED CONTRIBUTIONS -1,130,811. TOTAL TO FORM 990, PART XI, LINE 5: -40,417,802. MATTSON MANAGEMENT GROUP LLC 420 W MAGNETIC ST MARQUETTE MI 49855 300136373 LANDHOLDING MI -2302 122433 N/A RAMPART EMERGENCY MEDICAL SERVICES INC 828 SHERIDAN ROAD ESCANABA MI 49829 382413139 EMERGENCY MEDICAL SERVICES MI 501(C)(3) 9 N/A 1 MARQUETTE GENERAL FOUNDATION 420 W MAGNETIC ST MARQUETTE MI 49855 203615349 FUNDRAISING FOR MARQUETTE GENERAL HOSPITAL MI 501(C)(3) 11A TYPE I N/A 1 UPPER PENINSULA HEALTH PLAN INC 228 W WASHINGTON ST MARQUETTE MI 49855 383379956 MEDICAID HMO MI 501(C)(4) N/A N/A 1 UPPER PENINSULA MANAGED CARE LLC 228 W WASHINGTON ST MARQUETTE MI 49855 383323620 MANAGEMENT COMPANY OF UP HEALTH PLAN MI N/A RELATED 817955 2160815 0 0 0.56270 ICE LAKE MEDICAL ARTS BUILDING 420 W MAGNETIC ST MARQUETTE MI 49855 382206384 LEASING OF BUILDING SPACE MI N/A C 2832 70376 0.66670 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 MARQUETTE GENERAL FOUNDATION C 2723052 AUDITED F/S MARQUETTE GENERAL FOUNDATION K 370062 AUDITED F/S MARQUETTE GENERAL FOUNDATION M 36366 AUDITED F/S RAMPART EMERGENCY MEDICAL SERVICES INC P 2532908 REVIEW GL DETAIL UPPER PENINSULA MANAGED CARE LLC R 856983 REVIEW GL DETAIL