2013-05-15T15:26:36-05:00 2012-06-30 381357951 PLANTE & MORAN PLLC 600 E FRONT STREET SUITE 300 TRAVERSE CITY MI 49686 990 2011-07-01 381381288 PORTAGE HEALTH INC PORT 9064878000 500 CAMPUS DRIVE HANCOCK MI 49930 JAMES BOGAN 9064878000 2013-05-15 1 P00842339 2319477800 2011 2016-02-24 21:20:13Z JAMES BOGAN 500 CAMPUS DRIVE HANCOCK MI 49930 91339099 0 X WWW.PORTAGEHEALTH.ORG X 1948 MI TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES. 15 9 855 135 1468211 28988 96147 75256 72338868 80662704 2957486 918391 1912747 1948956 77305248 83605307 10000 67000 0 0 42716799 44993242 0 0 0 28594964 33508930 71321763 78569172 5983485 5036135 94170360 99612010 36168300 37762680 58002060 61849330 X TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES. 0 0 23001784 0 35852131 OUTPATIENT SERVICES - (SURGERY, LAB, IMAGING, REHAB, INFUSIONS, ETC) 121,646 VISITS 11809293 0 13244743 PHYSICIAN CLINICS - 68,615 VISITS 7367730 0 14142271 INPATIENT ROUTINE CARE - 1,469 DISCHARGES AND 339 NEWBORN DELIVERIES 23750451 67000 17423559 ALL OTHER PROGRAM SERVICES 23750451 67000 17423559 65929258 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 74 0 1 855 1 1 1 0 0 0 0 0 0 0 0 0 X 15 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X BRIAN DONAHUE CFO 9064831503 500 CAMPUS DRIVE HANCOCK MI 49930 X BRUCE TRUSOCK MD 40.00 X 349255 0 26282 STEVE ZUTTER 1.00 X X 0 0 0 MARTIN ISKRA 1.00 X 0 0 0 JAMES BOGAN 40.00 X X 333802 0 33293 KIRK LUFKIN MD 40.00 X 317690 0 31398 ELLEN HORSCH 1.00 X 0 0 0 DAVID MECHLIN 1.00 X 0 0 0 MICHAEL NEUMAN MD PHD 1.00 X X 0 0 0 TIMOTHY SEARS MD 40.00 X 440506 0 27612 KRISTINE JUKURI-WEIDNER 1.00 X X 0 0 0 WILLIAM LISTON MD 40.00 X 417437 0 14221 PETER WICKLEY 1.00 X X 0 0 0 TIM BARONI 1.00 X 0 0 0 DAWN NULF MD 40.00 X 297628 0 31553 JAY MARTINEAU 1.00 X 0 0 0 BRIAN DONAHUE 40.00 X 185585 0 17674 LARRY CARROLL MD 40.00 X 353490 0 30993 KIRK KLEMME MD 40.00 X 349958 0 26321 WILLIAM SARAZIN MD 40.00 X 341578 0 31403 MOHANNAD RAJJOUB MD 40.00 X 425825 0 16103 THOMAS MCCONNON MD 36.00 X 274210 0 29529 4086964 0 316382 49 0 1 0 MARQUETTE GENERAL HOSPITAL 580 W COLLEGE AVENUE MARQUETTE MI 49855 MEDICAL AND COMPUTER SERVICES 1032646 THOMAS J MOYLE JR INC PO BOX 399 HOUGHTON MI 49931 BUILDING CONSTRUCTION 1020571 AHSA LLC PO BOX 945 TRAVERSE CITY MI 49685 PHYSICIAN LOCUMS 659078 YALMER MATTILA CONTRACTING PO BOX 456 HOUGHTON MI 49931 BUILDING CONSTRUCTION 562695 JOHN BOWMAN MD PO BOX 5101 GYPSUM MI 81637 PHYSICIAN LOCUM 266694 11 30440 38470 6346 75256 HEALTH SERVICES 622110 79836908 79836908 OTHER RELATED REVENUE 622110 825796 825796 80662704 895429 895429 180150 31081 149069 149069 5835 143234 7722673 3000 7702711 0 19962 3000 22962 22962 MANAGEMENT FEES 541610 1462376 1462376 CAFETERIA INCOME 722210 337511 337511 1799887 83605307 80662704 1468211 1399136 67000 67000 2736480 1763605 972875 32545920 28103971 4441949 1708637 1349653 358984 5797890 4856495 941395 2204315 1652924 551391 92715 92715 170795 170795 145458 145458 8251387 6346808 1904579 237388 11926 225462 1003818 489443 514375 1169335 937023 232312 200934 176614 24320 268587 113474 155113 1266314 1044950 221364 4008228 3329127 679101 500231 2268 497963 MEDICAL SUPPLIES & DRUG 11456686 11252493 204193 QUALITY ASSURANCE TAXES 2227611 2227611 PROVISION FOR BAD DEBTS 1874895 1874895 REPAIRS 216368 93890 122478 418180 235088 183092 78569172 65929258 12639914 0 9809885 7801785 1314114 1313011 750 750 7728977 8332620 580801 1377623 909162 1162751 385920 981621 91678444 48310732 41077776 43367712 27944552 28504132 4418423 6770005 94170360 99612010 5630607 7437764 26869900 25329900 3667793 4995016 36168300 37762680 X 58002060 61849330 58002060 61849330 94170360 99612010 X 5036135 -1188865 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 8754 8754 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DUES PAID TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND HCAM. 157724 157724 55136403 23368783 31767620 1329074 783041 546033 30612616 24158908 6453708 4442627 4442627 43367712 COST REPORT SETTLEMENT RECEIVABLE 2603830 BOND ISSUE COST 410911 INVESTMENT IN JOINT VENTURES 604266 INVESTMENT IN SUBSIDIARIES 3150998 6770005 FAIR VALUE OF INTEREST RATE SWAP 3782431 COST REPORT SETTLEMENT PAYABLE 1212585 4995016 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 454349 454349 0.00590 10933921 10796746 137175 0.00180 11388270 10796746 591524 0.00770 142762 33815 108947 0.00140 748120 748120 0.00980 612008 286608 325400 0.00420 1502890 320423 1182467 0.01540 12891160 11117169 1773991 0.02310 1 10000 10000 0.00010 42 230 2635 2635 0.00000 43 2479 24748 24748 0.00030 86 2709 37383 37383 0.00040 1 1874895 160000 13526741 14154173 -627432 X 1 1 1 1 PORTAGE HEALTH INC

500 CAMPUS DRIVE HANCOCK MI 49930

X X X PORTAGE HEALTH INC 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 7 PORTAGE HEALTH - UNIVERSITY CENTER

600 MACINNES DRIVE HOUGHTON MI 49931

OUTPATIENT CLINIC PORTAGE HEALTH MEDICAL GROUP

945 NINTH STREET LAKE LINDEN MI 49945

OUTPATIENT CLINIC PORTAGE HEALTH REHAB

MINE STREET STATION CALUMET MI 49913

OUTPATIENT REHAB PORTAGE HEALTH SLEEP DISORDERS CENTER

890 CAMPUS DRIVE HANCOCK MI 49930

SLEEP DISORDERS CENTER PORTAGE HEALTH - HOUGHTON

921 W SHARON AVE HOUGHTON MI 49930

EXPRESS CARE & FITNESS CENTER PORTAGE HEALTH INC

500 CAMPUS DRIVE HANCOCK MI 49930

LONG-TERM CARE PORTAGE HEALTH HOME CARE & HOSPICE

821 WATER STREET HANCOCK MI 49930

HOME HEALTH OFFICE PART I, LINE 3C: PATIENTS WHO DO NOT QUALIFY FOR MEDICAL ASSISTANCE (MEDICAID), HAVE A FAMILY NET WORTH OF LESS THAN $100,000 AND WHOSE ANNUAL FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR FREE CARE. PATIENTS WHO DO NOT QUALIFY FOR MEDICAID OR THE COMMUNITY CARE PROGRAM MAY QUALIFY FOR THE OUR DISCOUNTED CARE PROGRAM. PATIENTS WHO HAVE A FAMILY NET WORTH OF LESS THAN $100,000 AND WHOSE ANNUAL FAMILY INCOME IS BETWEEN 200% AND 300% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR A 30% TO 90% WRITE-OFF OF THEIR BILL. ALL SELF PAY PATIENTS AUTOMATICALLY RECEIVE A 20% DISCOUNT. PART I, LINE 6A: N/A - NO RELATED PARTIES IDENTIFIED. PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. THE HOSPITAL'S INTERNAL ACCOUNTING RECORDS/ACTUAL COSTS ARE USED FOR LINES 7E, 7F, AND 7I. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $1,874,895. PART II: PORTAGE HEALTH HAS ESTABLISHED ITSELF AS A LEADER IN PROMOTING THE HEALTH OF THE COMMUNITY. A FEW EXAMPLES OF THE MANY HEALTH PROMOTION ACTIVITIES THAT WE DO ARE MENTIONED HERE. THESE HEALTH PROMOTION ACTIVITIES TOUCH DIFFERENT AGE GROUPS. 1. MEALS ON WHEELS PROGRAM FOR THE ELDERLY IN WHICH WE PREPARE 1100 MEALS AT NOON EACH DAY. NOT ONLY DO WE PROVIDE THE MEAL, BUT MANY TIMES OUR MEAL TRANSPORTER IS THE ONLY PERSON THAT THE ELDERLY CITIZENS SEE. WE ATTEMPT TO MEET SOME OF THEIR EMOTIONAL NEEDS AS WELL AS THEIR PHYSICAL NEEDS.2. THE PROMOTION OF A SMOKE FREE CAMPUS MANY YEARS AGO HAS ESTABLISHED PORTAGE AS A LEADER IN OUR COMMUNITY TO STAMP OUT TOBACCO USE. HEALTH PROMOTION AND EARLY DETECTION OF DISEASE ARE BOTH IMPORTANT FOR US TO IMPROVE THE QUALITY OF LIFE IN THE COMMUNITY. 3. PORTAGE JOINED THE COPPER COUNTRY GREAT START COLLABORATIVE TO ASSIST IN MAKING SURE THAT EVERY CHILD IN BARAGA, HOUGHTON, AND KEWEENAW COUNTIES AND THEIR PARENTS HAS THE SERVICES THEY NEED FOR PHYSICAL HEALTH, SOCIAL AND EMOTIONAL HEALTH, QUALITY CARE AND EARLY LEARNING; AND PARENT LEADERSHIP AND SUPPORT.4. PORTAGE DONATED FUNDS TO SUPPORT THE COPPER HARBOR PLAYGROUND PROJECT. THE PROJECT PROMOTES THE VITAL DEVELOPMENT OF SOCIAL AND PHYSICAL HEALTH FOR CHILDREN OF ALL ABILITIES. THE PROJECT ALSO STRIVES TO ENRICH THE QUALITY OF LIFE FOR ALL LOCAL CITIZENS, PROVIDE ECONOMIC VALUE THROUGH FACILITIES THAT SUPPORT TOURISM, AND ENCOURAGE LONG-TERM COMMUNITY STABILITY AND GROWTH.AS SHOWN HERE, PORTAGE HEALTH HAS COMMITTED TO PROVIDING THE LEADERSHIP IN HEALTH PROMOTION IN ACTIVITIES. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE: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 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 AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDED AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY IS $160,000. THE HOSPITAL'S BEST ESTIMATE, 8.50 PERCENT OF BAD DEBT EXPENSE, WAS BASED UPON REVIEW OF EXTERNAL LITERATURE.THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 8: MEDICARE SHORTFALL IS TAKEN FROM THE MEDICARE COST REPORT, WORKSHEET B, LINE 5. THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. PART III, LINE 9B: EACH PATIENT RECEIVES 3 SYSTEM GENERATED STATEMENTS. IF THEY DO NOT MAKE SUFFICIENT PAYMENT, THE PATIENT RECEIVES A LETTER. AFTER THE LETTER IS SENT WITH NO RESOLUTION, THE PATIENT WILL RECEIVE A FINAL NOTICE LETTER, THEN A PHONE CALL. IF NO RESOLUTION AT THAT POINT, PATIENT IS TURNED TO COLLECTIONS. COLLECTION AGENCY WORKS ALL BAD DEBT ACCOUNTS. NON-EMERGENT CARE BAD DEBT PATIENTS OWING MORE THAN $100 WILL NOT BE SCHEDULED FOR ADDITIONAL MEDICAL CARE UNTIL THEY MEET WITH THE FINANCIAL COUNSELOR AND MAKE FULL PAYMENT OR SET UP PAYMENT PLAN. THESE NON-EMERGENT CARE PATIENTS MAY ALSO APPLY TO SEE IF THEY QUALIFY FOR FINANCIAL ASSISTANCE FOR FUTURE VISITS. PATIENTS IN NEED OF URGENT CARE ARE SEEN REGARDLESS OF ABILITY TO PAY. AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE COSTS NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) ARE SUMMARIZED AS FOLLOWS:TOTAL COST: 5,980,464TOTAL REIMBURSEMENT: 5,533,061COST IN EXCESS OF REIMBURSEMENT: 447,404 PORTAGE HEALTH, INC. PART V, SECTION B, LINE 19D: ALL BILLS ARE GENERATED AT GROSS CHARGES FOR PROCEDURES PROVIDED. ALL SELF PAY PATIENTS AUTOMATICALLY RECEIVE A 20 PERCENT DISCOUNT. THE 20 PERCENT DISCOUNT IS BASED ON BEST PRACTICE BENCHMARKS. PART VI, LINE 2: PORTAGE HEALTH HAS PARTNERED WITH THE WESTERN U.P. HEALTH DEPARTMENT, ASPIRUS HOSPITALS, BARAGA COUNTY MEMORIAL HOSPITAL, WESTERN U.P. SUBSTANCE ABUSE SERVICE COORDINATING AGENCY, COPPER COUNTRY MENTAL HEALTH AND GOGEBIC COUNTY COMMUNITY MENTAL HEALTH TO CONDUCT A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT. WORK BEGAN IN JANUARY 2012 AND IS EXPECTED TO CONTINUE OVER THE NEXT 12 MONTHS. DATA WILL BE COLLECTED THROUGH MANY DIFFERENT FACETS, INCLUDING A LOCAL SURVEY OF THE COMMUNITY. THE FINALIZED CHNA REPORT WILL BE RELEASED IN FEBRUARY 2013. PORTAGE HEALTH HAS A WELLNESS TASK FORCE WHICH WILL DEVELOP INITIATIVES BASED ON THE NEEDS IDENTIFIED IN THE CHNA. THESE INITIATIVES WILL BE PRIORITIZED AND IMPLEMENTED IN FY14. PART VI, LINE 3: SOCIAL WORKERS CHECK IN-PATIENTS FOR INSURANCE AND MEET WITH THE PATIENT TO GIVE THEM THE MEDICAID AND FINANCIAL ASSISTANCE APPLICATION; THEY OFFER TO HELP COMPLETE THE FORMS. SELF PAY PATIENTS ARE CONTACTED BY FINANCIAL COUNSELORS TO EXPLORE OPTIONS. FINANCIAL ASSISTANCE BROCHURES ARE IN THE CLINICS, THE ER AND ON PORTAGE HEALTH'S WEBSITE. DOCTORS AND NURSES REFER PATIENTS IN FINANCIAL NEED TO THE FINANCIAL COUNSELORS. PART VI, LINE 4: PORTAGE HEALTH SERVES A 4 COUNTY AREA, WITH POPULATION OF 53.461 AND COVERING A LAND AREA OF 3,768 SQUARE MILES.PORTAGE HEALTH IS A COMMUNITY BASED HEALTH CARE ORGANIZATION WHICH PROVIDES HEATH CARE SERVICES TO 28,000 PEOPLE IN A PRIMARY SERVICE AREA AND 20,000 IN A SECONDARY SERVICE AREA FOR A TOTAL OF 48,000 PEOPLE.OUR COMMUNITY IS RURAL IN NATURE BUT HAS 2 UNIVERSITIES WHICH OFFER AN ARRAY OF SERVICES WHICH ARE AVAILABLE BOTH TO THE STUDENT POPULATION AS WELL AS THE GENERAL COMMUNITY. OUR CONSTITUENTS ARE A COMBINATION OF RETIRED ELDERLY, PROFESSIONALS, TRADES, LOW INCOME PEOPLE AND STUDENTS. WE PROVIDE THE NEEDED SERVICES THAT THIS CONSTITUENCY NEEDS. WE OFFER SECONDARY CARE SERVICES WHICH INCLUDES EMERGENCY, DIAGNOSTICS, CLINICS, HOME CARE, HEALTH PROMOTION, ACUTE CARE AND REHAB. PART VI, LINE 5: WE EVALUATE THE HEALTH BEHAVIORS AND ADDRESS CHANGES IN BEHAVIOR BY OFFERING PROGRAMS TO OUR COMMUNITY WHICH AFFECT CHANGE. SOME AREAS ARE TOBACCO ABUSE, OBESITY, SLEEP DEPRIVATION AND BAD EATING HABITS. PART VI, LINE 6: N/A - THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 MI 1 COPPER COUNTRY GREAT START COLLABORATIVE 850 W SHARON AVE SUITE 6 HOUGHTON MI 49931 381718440 501(C)(3) 10000 0 N/A N/A COPPER COUNTRY EARLY CHILDHOOD FUND MICHIGAN TECH FUND 1400 TOWNSEND DRIVE HOUGHTON MI 49931 381554664 501(C)(3) 27000 0 N/A N/A DEPARTMENT DEVELOPMENT AND STUDENT PROJECT SUPPORT KEWEENAW TRAIL ALLIANCE PO BOX 336 HOUGHTON MI 49931 381621057 NOT APPLICABLE 5000 0 N/A N/A SPONSORSHIP CITY OF HANCOCK 339 QUINCY STREET HANCOCK MI 49930 386004557 GOVERNMENT 10000 0 N/A N/A CITY BUS TRANSPORTATION SYSTEM COPPER HARBOR PLAYGROUND PO BOX 106 COPPER HARBOR MI 49918 320042815 501(C)(3) 10000 0 N/A N/A COPPER HARBOR PLAYGROUND PROJECT FINNFEST USA 2013 PO BOX 13 HANCOCK MI 49930 352409675 501(C)(3) 5000 0 N/A N/A SPONSORSHIP 5 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: N/A - ALL AMOUNTS IN THIS SCHEDULE ARE DONATIONS OR SPONSORSHIPS AND ARE NOT GRANT FUNDS. X X X X X 0 0 0 1 0 1 1 0 0 BRUCE TRUSOCK MD 132581 0 204674 0 12000 0 13686 0 12596 0 375537 0 0 0 JAMES BOGAN 259582 0 68515 0 5705 0 17850 0 15443 0 367095 0 0 0 KIRK LUFKIN MD 271385 0 45034 0 1271 0 16625 0 14773 0 349088 0 0 0 TIMOTHY SEARS MD 223467 0 217039 0 0 0 13232 0 14380 0 468118 0 0 0 WILLIAM LISTON MD 230498 0 177789 0 9150 0 13082 0 1139 0 431658 0 0 0 DAWN NULF MD 260768 0 17500 0 19360 0 17150 0 14403 0 329181 0 0 0 BRIAN DONAHUE 158635 0 26492 0 458 0 13132 0 4542 0 203259 0 0 0 LARRY CARROLL MD 348490 0 5000 0 0 0 16342 0 14651 0 384483 0 0 0 KIRK KLEMME MD 199958 0 150000 0 0 0 16489 0 9832 0 376279 0 0 0 WILLIAM SARAZIN MD 326478 0 12500 0 2600 0 17746 0 13657 0 372981 0 0 0 MOHANNAD RAJJOUB MD 311854 0 113971 0 0 0 608 0 15495 0 441928 0 0 0 THOMAS MCCONNON MD 133471 0 140739 0 0 0 15199 0 14330 0 303739 0 0 0 PART I, LINE 5 EMPLOYED PHYSICIANS ARE PAID AN INCENTIVE BONUS BASED ON THE RELATIVE VALUE UNIT OF PROCEDURES PERFORMED TO ALL PATIENTS, REGARDLESS OF THE PATIENTS' ABILITY TO PAY. ALL INCENTIVE BONUS AGREEMENTS HAVE OVERALL CAPS ON TOTAL COMPENSATION FOR WHICH THE PHYSICIAN IS ELIGIBLE IN A TWELVE MONTH TIME PERIOD. PART I, LINE 6 THE CEO AND THE VICE PRESIDENTS ARE PAID AN INCENTIVE BONUS BASED ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS AND THE CONSOLIDATED NET EARNINGS OF THE ORGANIZATION. PERFORMANCE GOALS AND PERCENTAGE OF BONUS AVAILABLE TO BE PAID ARE BOTH APPROVED BY THE BOARD OF DIRECTORS. THE PHYSICIANS ARE PAID A BONUS PAYMENT BASED ON RELATIVE VALUE UNITS (RVU'S). CITY OF HANCOCK HOSPITAL FINANCE AUTHORITY 386004557 410204AC5 2006-12-01 27920000 HOSPITAL, NURSING HOME, MEDICAL CLINIC, REFUND BONDS ISSUED 3/5/98 & 3/11/04 0 0 0 CITY OF HANCOCK HOSPITAL FINANCE AUTHORITY 274398699 2010-12-30 4000000 RENOVATION & ADDITION TO MEDICAL CLINIC AND RADIOLOGY/ENDOSCOPY EQUIPMENT 0 0 0 6460100 27920000 426791 130520 5187597 22175092 2007 1 1 1 1 130000 4000000 80000 3920000 2012 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 1 MORGAN STANLEY 26.000000000000 0 0 0 0 1 0 1 0 0 0 1 PORTAGE HEALTH IS CURRENTLY WORKING WITH LEGAL COUNSEL TO DRAFT WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES COVERING ARBITRAGE REBATE, PRIVATE BUSINESS USE, DOCUMENT RETENTION, THE REMEDIATION PROVISIONS AND VCAP. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S AUDIT COMMITTEE AND COPIES OF THE FORM 990 ARE PROVIDED TO EACH BOARD MEMBER FOR REVIEW AFTER THE RETURN HAS BEEN FILED. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL CONFLICT OF INTEREST STATEMENT IS COMPLETED AND SIGNED BY EACH BOARD MEMBER. THE PRESIDENT AND CEO REVIEWS THE COMPLETED CONFLICT OF INTEREST FORMS. IF A CONFLICT IS IDENTIFIED, THAT BOARD MEMBER IS EXCUSED FROM ANY DICUSSION OR VOTE RELATING TO THE IDENTIFIED CONFLICT. IN ADDITION, COMPENSATION AND AUDIT ISSUES ARE ACTED ON BY INDEPENDENT BOARD MEMBERS ONLY. THE CONFLICT OF INTEREST POLICY COVERS THE FOLLOWING INDIVIDUALS: * INTERESTED PERSONS - BOARD MEMBERS, COMMITTEE MEMBERS, OFFICERS AND ADMINISTRATIVE STAFF, INCLUDING DIRECTORS, MANAGERS, COORDINATORS AND SUPERVISORS OF PORTAGE HEALTH. * ASSOCIATES - EMPLOYEES, MEDICAL STAFF, VOLUNTEERS, DIRECTORS, OFFICERS, SUPPLIERS, VENDORS, CONTRACTORS, CONSULTANTS AND AGENTS OF PORTAGE HEALTH. FORM 990, PART VI, SECTION B, LINE 15 OCCASIONALLY, AN INDEPENDENT CONSULTANT IS RETAINED TO RESEARCH THE MARKET DATA AND PERFORM COMPARISONS FOR THE CEO AND OTHER OFFICER POSITIONS. THE RESULTS OF THE COMPARISON AND MARKET DATA ARE PRESENTED TO THE COMPENSATION COMMITTEE. THIS WAS LAST PERFORMED FEBRUARY/MARCH 2009. IF NO OUTSIDE CONSULTANT IS RETAINED, MARKET SURVEYS ARE UTILIZED TO DETERMINE ADJUSTMENTS TO THE CEO'S AND THE OTHER OFFICERS COMPENSATION. IN EITHER CASE, THE COMPENSATION COMMITTEE RECOMMENDS ANY ADJUSTMENTS TO THE BOARD OF TRUSTEES. THE INDEPENDENT BOARD MEMBERS VOTE ON THE CEO'S COMPENSATION AMOUNT AND IF APPROVED, IT IS FORMALLY PUT INTO A WRITTEN EMPLOYMENT CONTRACT AND DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE AND OF THE BOARD OF TRUSTEES. THE OTHER OFFICERS COMPENSATION STRUCTURE AND SALARY RANGES ARE APPROVED BY THE COMPENSATION COMMITTEE VERSUS SPECIFIC DOLLAR AMOUNTS. THIS PROCESS WAS LAST UNDERTAKEN IN MARCH 2012 BASED ON 2011 DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: THESE INDIVIDUALS DEVOTE THE FOLLOWING HOURS PER WEEK TO, RELATED ORGANIZATION, PORTAGE HEALTH FOUNDATION: JAMES BOGAN 1 HOUR BRIAN DONAHUE 1 HOUR THE REMAINING BOARD MEMBERS DEVOTE APPROXIMATELY 1 HOUR PER WEEK, IN TOTAL, TO THE RELATED ORGANIZATIONS LISTED IN SCHEDULE R. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -384,138. CLEARING ACCOUNT ADJUSTMENT -1,592. CHANGE IN INTEREST RATE SWAP -1,518,866. SHARE OF NET ASSETS OF RELATED PARTIES 715,731. TOTAL TO FORM 990, PART XI, LINE 5: -1,188,865. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PORTAGE HEALTH RESOURCES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383041729 SENIOR MEALS MI 501(C)(3) LINE 11A, I PORTAGE HEALTH INC 1 PORTAGE HEALTH HOME SERVICES INC 500 CAMPUS DRIVE HANCOCK MI 49930 383565553 PRIVATE DUTY CARE MI 501(C)(3) LINE 9 PORTAGE HEALTH INC 1 PORTAGE HEALTH FOUNDATION 500 CAMPUS DRIVE HANCOCK MI 49930 383022945 FUNDRAISING MI 501(C)(3) LINE 11A, I PORTAGE HEALTH INC 1 COPPER COUNTRY APOTHECARIES INC 500 CAMPUS DRIVE HANCOCK MI 49930 302083778 RETAIL PHARMACY MI PORTAGE HEALTH INC C 468963 2685538 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 COPPER COUNTRY APOTHECARIES INC A 83021 FMV - CONTRACT PRICE COPPER COUNTRY APOTHECARIES INC P 1462376 COST PORTAGE HEALTH RESOURCES INC P 90000 COST PORTAGE HEALTH HOME SERVICES INC P 70622 COST COPPER COUNTRY APOTHECARIES INC Q 520268 FMV - CONTRACT PRICE ($/RX) COPPER COUNTRY APOTHECARIES INC R 468963 COST PORTAGE HEALTH HOME SERVICES INC R 246768 COST PORTAGE HEALTH RESOURCES INC A 31800 FMV PORTAGE HEALTH HOME SERVICES INC A 16404 FMV