2013-05-15T14:50:42-05:00 2012-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2011-07-01 381394903 BELL MEMORIAL HOSPITAL BELL 9064864431 901 LAKE SHORE DRIVE ISHPEMING MI 49849 GERALD MESSANA 9064852643 2013-05-14 1 TERRI REXRODE CPA MST P00096513 9206620016 2013-05-14 2011 2016-02-24 21:20:13Z GERALD MESSANA 901 LAKE SHORE DRIVE ISHPEMING MI 49849 47026342 0 X WWW.BELLHOSPITAL.ORG X 1951 MI IMPROVE THE LIVES OF EVERYONE WE TOUCH. 15 13 404 150 501519 0 2363282 405615 43239019 46519556 863944 92102 0 0 46466245 47017273 3918967 2570274 0 0 20814931 21514065 0 0 0 20261271 23265233 44995169 47349572 1471076 -332299 60880447 60602917 43234364 45821691 17646083 14781226 BELL HOSPITAL'S MISSION IS TO IMPROVE THE LIVES OF EVERYONE WE TOUCH. 0 0 35659462 42425042 EXPENSES WERE INCURRED IN PROVIDING HEALTHCARE SERVICES TO THE RESIDENTS OF ISHPEMING, MICHIGAN AND SURROUNDING AREAS IN FURTHERANCE OF THE HOSPITAL'S EXEMPT PURPOSE. BELL HOSPITAL IS DEDICATED TO BEING A LEADER IN PROVIDING AND PROMOTING HEALTH AND WELLNESS TO THE SURROUNDING COMMUNITY. BELL HOSPITAL IS A CONVENIENT AND COMPASSIONATE ACUTE CARE HOSPITAL OFFERING A FULL RANGE OF SERVICES. BELL HOSPITAL OFFERS KEY ANCILLARY SERVICES AND ADVANCED MEDICAL TECHNOLOGIES. JUST STEPS AWAY, THE SURGICAL CENTER PERFORMS PROCEDURES ON A DAILY BASIS. BELL HOSPITAL ALSO OFFERS REHABILITATION SERVICES, INCLUDING PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, AS WELL AS CORPORATE WELLNESS. 35659462 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 41 0 1 404 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X GERALD MESSANA 9064864431 901 LAKESHORE DRIVE ISHPEMING MI 49849 JANICE ANDERSON 4.00 X 0 0 0 REVEREND RUDY KEMPPAINEN 4.00 X X 0 0 0 ROBERT DELLANGELO 4.00 X X 0 0 0 RICHARD GRAYBILL 4.00 X X 0 0 0 MARLIN KITCHEN 4.00 X X 0 0 0 BILL STREAM 4.00 X 0 0 0 JAMES HAYWARD DDS 4.00 X 0 0 0 KEN FARLEY 4.00 X 0 0 0 DOUGLAS LABELLE MD CMO 40.00 X 288986 0 26116 TOM FLEURY 4.00 X 0 0 0 DAVID HOLLI 4.00 X 0 0 0 RON KATERS 4.00 X 0 0 0 BARBARA MEYER 4.00 X 0 0 0 RON MEYER 4.00 X 0 0 0 MICHAEL PREVOST MD COS 4.00 X 0 209624 27967 RICK AMENT 40.00 X 248840 0 24432 GERALD MESSANA 40.00 X 112089 0 22106 BARBARA LARSON 40.00 X 122497 0 14216 JUDD JOHNSTON MD 40.00 X 262825 0 34050 HAROLD HILDEBRAND MD 40.00 X 268004 0 33383 LYLE VANDERSCHAAF MD 40.00 X 290164 0 26211 MICHAEL MLSNA MD 40.00 X 240429 0 33704 RENEE KNIOLA 40.00 X 387784 0 22844 2221618 209624 265029 14 0 1 0 MARQUETTE GENERAL HEALTH SYSTEM 420 W MAGNETIC STREET MARQUETTE MI 49855 LAB AND PATHOLOGY READING 646195 SUPERIOR THERAPY SERVICES 97 SOUTH FOURTH STREET SUITE B ISHPEMING MI 49849 SPEECH, OCCUPATIONAL AND PHYSICAL THERAP 429612 CARLOS MORENO 23916 OLD 16 ROAD CENTREVILLE MI 49032 ANESTHESIOLOGIST 258697 SIGNATURE PERFORMANCE 10330 REGENCY PARKWAY DRIVE SUITE OMAHA NE 68114 REVENUE CYCLE MANAGEMENT 188957 HHA SERVICES INC PO BOX 935695 ATLANTA GA 31193 DIETARY SERVICES 169073 11 400000 5615 405615 PATIENT REVENUE 624100 42425042 42425042 QAAP REVENUE 623000 1906651 1906651 EHR INCENTIVE REVENUE 623990 799893 799893 MISCELLANEOUS 900099 641415 641415 ASSISTED LIVING 623000 501519 501519 245036 245036 46519556 100174 100174 997 9069 -8072 -8072 -8072 47017273 42425042 501519 3685097 2570274 2570274 816303 299354 516949 15840710 12656476 3184234 1364424 1064663 299761 2375232 1895065 480167 1117396 871906 245490 141287 141287 2804944 1072252 1732692 200978 200978 9894027 7212955 2681072 782555 526423 256132 60461 30870 29591 1923250 1293766 629484 2733302 1838686 894616 261655 168387 93268 BAD DEBT EXPENSE 3963508 3963508 DUES, LICENSES, & SUBSC 364978 87321 277657 MISCELLANEOUS 134288 107556 26732 47349572 35659462 11690110 0 10270679 9250049 4481493 6169751 1560414 1428171 381269 420061 57721423 17357289 42698696 40364134 933888 1048443 554008 1922308 60880447 60602917 3497078 3938394 0 820204 33243432 32379488 6493854 8683605 43234364 45821691 X 17494015 14392518 152068 388708 17646083 14781226 60880447 60602917 X -332299 -2532558 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2851 2851 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MHA AND AHA LOBBYING DUES 2194046 2194046 38615682 6663848 31951834 3524 3524 0 16906016 10689917 6216099 2155 2155 40364134 ACCRUED PROFESSIONAL AND OTHER LIABILITIES 425436 FAS 87 LIABILITY 5147026 OTHER- FMV OF INTEREST RATE SWAPS 2967264 LEASES PAYABLE 143879 8683605 47017273 47349572 -332299 114555 -2647113 -2532558 -2864857 46236460 114555 -489753 -375198 46611658 405615 405615 47017273 44775766 -5615 -5615 44781381 2568191 2568191 47349572 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN FISCAL 2012 AND 2011. FEDERAL INCOME TAX RETURNS FOR THE FISCAL YEARS ENDED 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS). PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -489,753. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS -2,394,000. CHANGE IN INTEREST OF NET ASSETS OF THE CHARITABLE FOUNDATION 236,640. TOTAL TO SCHEDULE D, PART XI, LINE 8: -2,647,113. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -489,753. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS FROM FOUNDATION 400,000. GRANT 5,615. PART XIII, LINE 2D - OTHER ADJUSTMENTS: GRANT REVENUE -5,615. PART XIII, LINE 4B - OTHER ADJUSTMENTS: TRANSFER TO AFFILIATE 2,568,191. 1 1 X 1 X 1 X 1 1 0 1 1 626712 0 626712 0.01440 4043377 3383949 659428 0.01520 3998161 1592995 2405166 0.05540 8668250 4976944 3691306 0.08500 142357 780 141577 0.00330 367000 0 367000 0.00850 58634 0 58634 0.00140 567991 780 567211 0.01320 9236241 4977724 4258517 0.09820 455 455 0.00000 3892 3892 0.00010 29969 29969 0.00070 8981 8981 0.00020 4974 4974 0.00010 3800 3800 0.00010 4551 4551 0.00010 45 45 0.00000 56667 56667 0.00130 1 1890076 0 12465720 11238231 1227489 X 1 0 1 1 BELL MEMORIAL HOSPITAL

901 LAKESHORE DRIVE ISHPEMING MI 49849

X X X X BELL MEMORIAL HOSPITAL 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 0 1 X X X 0 1 X 0 0 PART I, LINE 3C: N/A PART I, L7 COL(F): BELL MEMORIAL HOSPITAL TAKES ACTUAL GROSS CHARGES OF BAD DEBT EXPENSES AND APPLIES THE RATIO OF PATIENT CARE COST TO CHARGES. THE COST TO CHARGE RATIO METHOD WAS USED FROM WORKSHEET 2.BAD DEBT EXPENSE OF $3,963,508 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT OF TOTAL EXPENSES ON SCHEDULE H. PART II: BELL HOSPITAL'S SENIOR MANAGEMENT, DIRECTORS, MANAGERS, PHYSICIANS, AND NURSES CONTRIBUTED MORE THAN 1,500 STAFF HOURS AND A TOTAL OF $99,665 TOTAL COMMUNITY BUILDING EXPENSES WITH NO OFFSETTING REVENUE TO PROVIDE LEADERSHIP AND RESOURCES TO EQUIP COMMUNITY ORGANIZATIONS WITH THE SKILLS NEEDED TO CREATE HEALTHY COMMUNITIES. OUR STAFF PARTICIPATE ON BOARDS, ADVISORY COMMITTEES, AND COMMISSIONS. FOR EXAMPLE, OUR VICE PRESIDENT OF OPERATIONS SERVES IN TWO KIWANIS ORGANIZATIONS AND IS A MEMBER OF THE ACHIEVE COUNCIL, USING TIME THAT WOULD OTHERWISE BE ALLOCATED FOR OTHER ACTIVITIES AT BELL HOSPITAL. PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL LOSS RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD THEY ARE DEEMED TO BE UNCOLLECTIBLE. THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS 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. BELL HOSPITAL USES A COST-TO-CHARGE RATIO BASED FOR DETERMINING BAD DEBT EXPENSE AMOUNTS. FURTHER, BELL HOSPITAL USES THE KNOWLEDGE OF ITS ACCOUNTING STAFF TO HELP ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. PART III, LINE 8: AS MOST OF THE MEDICARE CLIENTELE ARE FROM MARQUETTE COUNTRY, THE COST-TO-CHARGE RATIO PERCENTAGE ON THE SHORTFALL IS BELIEVED TO BE A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED WAS THE COST-TO-CHARGE RATIO. PART III, LINE 9B: THE DEBT COLLECTION POLICY MAY APPLY TO PATIENTS WHO QUALIFY UNDER THE CHARITY CARE POLICY. FOR EXAMPLE, IF THE CHARITY CARE POLICY COVERED 80% OF THE MEDICAL COSTS UNDER THE SLIDING SCALE OF THE FEDERAL POVERTY GUIDELINES, BELL HOSPITAL WOULD USE DEBT COLLECTION PRACTICES TO COLLECT THE REMAINING 20%. BELL HOSPITAL USES THE SAME DEBT COLLECTION PRACTICES FOR ALL INDIVIDUALS. PART VI, LINE 2: BELL MEMORIAL HOSPITAL DOES NOT CONDUCT ITS OWN NEEDS ASSESSMENT. THE LOCAL COUNTY HEALTH DEPARTMENT ALONG WITH LOCAL COALITIONS HAVE CONDUCTED NEEDS ASSESSMENTS AND HAVE PUBLISHED THE INFORMATION. BELL MEMORIAL HOSPITAL USES THIS INFORMATION TO DEVELOP PROGRAMS AND INITIATIVES TO IMPROVE THE HEALTH OF THE COMMUNITY. PART VI, LINE 3: AT THE POINT OF REGISTRATION IT IS DETERMINED WHETHER A PATIENT HAS INSURANCE COVERAGE OR IS A "SELF-PAY" PATIENT. IF A "SELF-PAY" PATIENT, THEY ARE MADE AWARE OF THEIR RESPONSIBILITY FOR PAYMENT AND REFERRED TO A HOSPITAL FINANCIAL COUNSELOR TO DETERMINE ELIGIBILITY. FOR ALL INPATIENTS NOTED AS "SELF-PAY", A FINANCIAL COUNSELOR WILL MEET THEM IN PERSON WHILE AT THE HOSPITAL AND REVIEW ELIGIBILITY OPTIONS. FURTHER, A CHARITY CARE FLYER IS INSERTED IN THEIR BILLING STATEMENT, AS WELL AS, THE FINANCIAL COUNSELOR'S CONTACT INFORMATION. ALSO, EACH BILLING STATEMENT SENT TO THE INDIVIDUAL IS STAMPED WITH COUNSELOR'S PHONE NUMBER AND STATES TO CALL THEM IF UNABLE TO PAY IN 30 DAYS. PART VI, LINE 4: BELL HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL THAT HAS BEEN DEDICATED TO SERVING THE AREA'S HEALTH CARE NEEDS FOR OVER A CENTURY. BELL HOSPITAL IS THE WESTERN MOST HOSPITAL WITHIN MARQUETTE COUNTY; THEREFORE, IT RECEIVES A NUMBER OF PATIENTS WITHIN ITS AMBULANCE ROUTE, WHICH INCLUDES THE NEAREST TWO CITIES AND TEN TOWNSHIPS (ISHPEMING, ELY, TILDEN, REPUBLIC, NEGAUNEE, CHAMPION, HUMBOLDT, RICHMOND, MICHIGAMME AND SPURR). OVER 22,000 RESIDENTS LIVE IN THESE AREAS AND SEEK MEDICAL ATTENTION. PART VI, LINE 5: THE ACHIEVE PROGRAM:THE ACHIEVE CHART TEAM OF MARQUETTE COUNTY'S VISION IS TO ASSIST OUR RESIDENTS TO ACHIEVE HIGHER LEVELS OF GOOD HEALTH BY MAKING THE HEALTHY CHOICE, THE EASY CHOICE. IT DOES THIS BY: 1. PROMOTING HEALTH AND WELLNESS ACTIVITIES WITHIN THE COMMUNITY; 2. PROVIDING OR COORDINATING OPPORTUNITIES THAT EDUCATES INDIVIDUALS ABOUT HEALTHY LIFESTYLES; 3. PROMOTING ENVIRONMENTAL AND POLICY CHANGES WITHIN THE COMMUNITY THAT MAKE IT EASIER TO BE PHYSICALLY ACTIVE, PRACTICE GOOD NUTRITION, LIVE TOBACCO FREE, AND AVOID SECOND HAND SMOKE. THE PRIMARY PURPOSE OF THE ACHIEVE CHART TEAM OF MARQUETTE COUNTY IS TO COLLABORATIVELY WORK IN THE COMMUNITY TO PROMOTE THE MAINTENANCE AND IMPROVEMENT OF THE HEALTH OF MARQUETTE COUNTY RESIDENTS THROUGH ENVIRONMENTAL AND POLICY CHANGES THAT SUPPORT REGULAR PHYSICAL ACTIVITY, GOOD NUTRITION, AND TOBACCO FREE LIVING, AS WELL AS THE ELIMINATION OF SECOND HAND SMOKE.BELL HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING AN ANNUAL STRENGTH FROM WITHIN PROGRAM THAT TARGETS LOCAL YOUTHS FROM GRADES 6-8 TO PROVIDE A STRUCTURED HEALTHY LIVING PROGRAM INCLUDING EXERCISE, NUTRITION AND COMMUNITY SERVICE. THE SFW PROGRAM AWARDS A YEAR OF TUITION TO THE LOCAL UNIVERSITY.BELL HOSPITAL ALSO CONDUCTS AN ANNUAL WOMEN'S HEALTH EXPO FREE OF CHARGE. THE STAFF, MANAGEMENT AND PHYSICIANS OF BELL HOSPITAL PROVIDE HEALTH SCREENINGS, HEALTH AND WELLNESS DEMONSTRATIONS AND PHYSICIAN PRESENTATIONS ALL FREE OF CHARGE FOR THE WOMEN OF THE COMMUNITY. THE STAFF AND MANAGEMENT CONTRIBUTED OVER 200 HOURS AND RESULTED IN NEARLY $8,000 IN EXPENSES WITH NO OFFSETTING REVENUE. SINCE A MAJORITY OF THE COMMUNITY IS IN THE MINING INDUSTRY OR FAMILY OF SUCH MINERS, BELL HOSPITAL CONDUCTS AN ANNUAL CLIFFS HEALTH EXPO FREE OF CHARGE FOR EMPLOYEES AND FAMILIES OF CLIFFS NATURAL RESOURCES. THE HEALTH EXPO PROVIDED HEALTH SCREENINGS, HEALTH AND WELLNESS DEMONSTRATIONS WHICH MANAGEMENT AND STAFF CONTRIBUTED 290 HOURS OF TIME AND $8,000 IN EXPENSES WITH NO OFFSETTING REVENUE.BELL HOSPITAL SPONSORS THE WEEKLY "MEDICAL MINUTE" SERIES ON A LOCAL TELEVISION STATION. DURING THE MEDICAL MINUTE, A PHYSICIAN PROVIDES MEDICAL INFORMATION ON A VARIETY OF ISSUES EACH WEEK.THE AMBULANCE/EMS SERVICE AT BELL IS DEDICATED STAFF AT ALL LOCAL HIGH SCHOOL SPORTING EVENTS AND SERVICES OUR LIFELINE CALLS, AND EMERGENCY UNITS AT NO CHARGE. OUR SPORTS MEDICINE PROGRAM ALSO PROVIDES DEDICATED STAFF FOR LOCAL SPORTING EVENTS. THESE RESOURCES AMOUNTED TO NEARLY 1,300 STAFF HOURS AND $46,000 IN STAFF COSTS WITH NO OFFSETTING REVENUE.BELL HOSPITAL SPONSORS THE FOLLOWING LOCAL COMMUNITY EVENTS:LAKE SUPERIOR COMMUNITY PARTNERSHIP AND GREATER ISHPEMING-NEGAUNEE CHAMBER OF COMMERCESERVICE CLUB ORGANIZATIONS AND EVENTSPIGS-N-HEAT FIRE RELIEF FUNDCOMMUNITY BABY SHOWER (PROVIDES BABY ESSENTIALS FOR LOW INCOME MOMS TO BE)MUD PLUNGEANNUAL SUMMER AND WINTER COMMUNITY EVENTS PART VI, LINE 6: N/A REPORTS FILED WITH STATES PART VI, LINE 7 MI 0 BELL MEDICAL CENTER 901 LAKESHORE DRIVE ISHPEMING MI 49849 382124042 501(C)(3) 2568191 TO SUPPORT THE OPERATIONS OF BELL MEDICAL CENTER IN ITS CHARITABLE PURPOSE. 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALL OF THE GRANTS WERE GIVEN TO MEMBERS OF OUR AFFILIATED GROUP. X X X 1 0 0 0 0 0 0 0 0 DOUGLAS LABELLE MD CMO 288986 0 0 0 0 0 13025 0 13091 0 315102 0 0 0 MICHAEL PREVOST MD COS 0 159344 0 50280 0 0 0 14742 0 13225 0 237591 0 0 RICK AMENT 212317 0 0 0 36523 0 11207 0 13225 0 273272 0 0 0 JUDD JOHNSTON MD 250893 0 11932 0 0 0 20825 0 13225 0 296875 0 0 0 HAROLD HILDEBRAND MD 268004 0 0 0 0 0 20158 0 13225 0 301387 0 0 0 LYLE VANDERSCHAAF MD 290164 0 0 0 0 0 12986 0 13225 0 316375 0 0 0 MICHAEL MLSNA MD 240429 0 0 0 0 0 20479 0 13225 0 274133 0 0 0 RENEE KNIOLA 387784 0 0 0 0 0 9619 0 13225 0 410628 0 0 0 PART I, LINE 4A RICK AMENT: $36,523 ECONOMIC DEVELOPMENT CORP OF THE COUNTY OF MARQUETTE MI 382401335 57147NAC7 2007-03-29 32825000 ACQUISITION, CONTRUCTION AND EQUIPPING OF A NEW CRITICAL ACCESS HOSPITAL 0 0 0 ECONOMIC DEVELOPMENT CORP OF THE COUNTY OF MARQUETTE MI 382401335 57147NAD5 2007-08-28 3700000 CONTRUCTION OF WATER, SEWER AND UTILITY EXTENSIONS FOR NEW HOSPITAL 0 0 0 3570000 33767401 492809 432814 2008 0 0 1 1 340000 3733927 74000 46924 2008 1 0 1 1 0 0 1 0 0 0.04190 0.04190 0 0 0 0 0 0 0 1 1 CHARTER ONE BANK NA 9.800000000000 0 0 0 0 1 0 1 1 CHARTER ONE BANK NA 9.900000000000 0 0 0 0 1 FORM 990, SCHEDULE K SCHEDULE K, PART II, LINE 3, BOND ISSUE B: THE CURRENT REFUNDING ESCROW WAS EXPENDED ON NOVEMBER 7, 2007. SCHEDULE K, PART II, LINE 7, BOND ISSUE A: OF THE TOTAL COSTS OF ISSUANCE OF THE BONDS, $492,809 WAS FOR CREDIT ENHANCEMENT AND $432,814 WAS FOR COSTS OF ISSUANCE. SCHEDULE K, PART II, LINE 7, BOND ISSUE B: OF THE TOTAL COSTS OF ISSUANCE OF THE BONDS, $46,924 WAS FOR CREDIT ENHANCEMENT AND $74,000 WAS FOR COSTS OF ISSUANCE. SCHEDULE K, PART III, LINE 3A, BOND ISSUE A: THE ORGANIZATION HAS DETERMINED THAT ITS ARRANGEMENT OR SERVICE CONTRACTS MEET THE SAFE HARBOR UNDER REV PROC 97-13, 1997-1 C B 632. SCHEDULE K, PART III, LINE 7, THE ORGANIZATION WILL SEEK TO ADOPT ARRANGEMENT PRACTICES TO ENSURE POST-ISSUANCE COMPLIANCE THIS UP-COMING YEAR. SCHEDULE K, PART IV, LINE 6, BOND ISSUES A AND B: THE ORGANIZATION REASONABLY BELIEVES THAT THE BOND ISSUES QUALIFIED FOR AN EXCEPTION TO REBATE AND HAS HIRED A REBATE ANALYST TO CONFIRM. FORM 990, PART VI, SECTION A, LINE 6 SUPERIOR HEALTHCARE SYSTEM IN THE SOLE MEMBER (100% OWNER) OF BELL MEMORIAL HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A MANY OF THE BOARD MEMBERS OF SUPERIOR HEALTHCARE SYSTEM ARE ALSO BOARD MEMBERS OF BELL MEMORIAL HOSPITAL, THEREFORE IT CAN BE SAID THAT SUPERIOR HEALTHCARE SYSTEM HAS THE ABILITY TO ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B MANY OF THE BOARD MEMBERS OF SUPERIOR HEALTHCARE SYSTEM ARE ALSO BOARD MEMBERS OF BELL MEMORIAL HOSPITAL, THEREFORE IT CAN BE SAID THAT SUPERIOR HEALTHCARE SYSTEM HAS APPROVAL OVER DECISIONS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO BEING SUBMITTED TO THE IRS. QUESTIONS AND COMMENTS WERE SOLICITED FROM THE BOARD OF DIRECTORS TO ENSURE THE COMPLETENESS AND ACCURACY OF THE FORM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS REVIEW AND SIGN THE CONFLICT OF INTEREST DISCLOSURES ANNUALLY. THESE STATEMENTS ARE REVIEWED BY THE ORGANIZATION'S LEGAL COUNSEL TO ENSURE COMPLIANCE WITH THE POLICY. IF A BOARD MEMBER IS FOUND TO HAVE A CONFLICT, THEY ARE REQUIRED TO REMOVE THEMSELVES FROM ANY DISCUSSIONS OF THE MATTER. IF THE CONFLICT COULD NOT BE DEALT WITH THE BOARD WOULD HAVE TO CONSIDER WHETHER THE BOARD MEMBER SHOULD STAY A MEMBER OF THE BOARD OF DIRECTORS TO DATE, THE ORGANIZATION HAS NOT HAD ANY BOARD MEMBERS WITH CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES COMPENSATION SURVEYS AND MHA DATA TO ENSURE COMPENSATION DATA IS COMPARABLE. DETERMINATION OF THE OFFICER'S AND CHIEF OF STAFF'S COMPENSATION PACKAGES WERE LAST CONDUCTED IN 2010 USING AFOREMENTIONED DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 114,555. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -489,753. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS -2,394,000. CHANGE IN INTEREST OF NET ASSETS OF THE CHARITABLE FOUNDATION 236,640. TOTAL TO FORM 990, PART XI, LINE 5: -2,532,558. FORM 990, PART XII, LINE 2C: THE AUDIT PROCESS HAS NOT CHANGED IN THE CURRENT YEAR. SUPERIOR HEALTHCARE SYSTEMS 901 LAKESHORE DR ISHPEMING MI 49849 383040126 HEALTHCARE SERVICES MI 501(C)(3) LINE 3 N/A 0 BELL MEDICAL CENTER 901 LAKESHORE DR ISHPEMING MI 49849 382124042 HEALTHCARE SERVICES MI 501(C)(3) LINE 11B, II BELL MEMORIAL HOSPITAL 1 BELL FOUNDATION 97 S FOURTH ST ISHPEMING MI 49849 383040125 FUND RAISING MI 501(C)(3) LINE 11B, II BELL MEMORIAL HOSPITAL 1 SUPERIOR ENTERPRISES INC 97 S FOURTH ST ISHPEMING MI 49849 383112668 REHABILITATION SERVICES MI N/A C 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 BELL MEDICAL CENTER B 2568191 FMV BELL FOUNDATION C 400000 FMV BELL MEDICAL CENTER N 62073 FMV BELL FOUNDATION N 68695 FMV SUPERIOR ENTERPRISES N 16250 FMV