2013-06-05T07:42:58-05:00 2011-12-31 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2011-01-01 381359247 CRITTENTON HOSPITAL MEDICAL CENTER CRIT 2486525000 1101 W UNIVERSITY DRIVE ROCHESTER MI 48307 FRANK SOTTILE MD 2486525000 2013-05-31 1 SUSAN MIENCIER P00842339 2483522500 2011 2016-03-07 17:11:31Z X FRANK SOTTILE MD 1101 W UNIVERSITY DRIVE ROCHESTER MI 48307 336449120 0 X WWW.CRITTENTON.COM X 1900 MI ENHANCING THE HEALTH STATUS OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. 14 14 1888 366 3827987 0 130423 9165492 227868169 225567987 6310770 6129991 901828 1064217 235211190 241927687 0 139050 0 0 101684492 103353571 0 0 3058 134781834 135377209 236466326 238869830 -1255136 3057857 342865573 324301265 158862071 162439194 184003502 161862071 CRITTENTON HOSPITAL MEDICAL CENTER IS DEDICATED TO ENHANCING THE HEALTH STATUS OF THE INDIVIDUALS AND COMMUNITIES WE SERVE IN PARTNERSHIP WITH OUR PHYSICIANS, EMPLOYEES, AND COMMUNITY MEMBERS. 0 0 204519193 221742737 SEE SCHEDULE O PART III, LINE 4 DESCRIPTION 204519193 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 1 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 1 259 0 1 1888 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 1 1 0 1 0 X KIM HAUSCHILD 2486525780 1101 W UNIVERSITY DRIVE ROCHESTER MI 48307 X BEVERLY ALLEN 1.00 X 0 0 0 LISA ASADOORIAN 1.00 X 0 0 0 BRYAN BARNETT 1.00 X 0 0 0 MICHAEL BROWE 1.00 X 0 0 0 PETER DESTEIGER 1.00 X 0 0 0 ROBERT GOMD 1.00 X 32513 0 0 KENNETH JOHNSON 1.00 X 0 0 0 KATHRIN KUDNER 1.00 X 0 0 0 ROBERT LENIHANII 1.00 X 0 0 0 FREDERICK MAIBAUERMD 1.00 X 3100 0 0 RUSSELL SHELTON 1.00 X 0 0 0 F SCOTT MILLER 1.00 X 0 0 0 ROBERT SKANDALARIS 1.00 X 0 0 0 BRAD UPTON 1.00 X 0 0 0 LYNN ORFGEN 40.00 X 436703 0 43616 AUDRIANNE MOCERI 40.00 X 61510 0 19221 JEFFREY JENNINGSMD 1.00 X 56250 0 0 CYNTHIA LONG 40.00 X 135656 0 11649 FRANK SOTTILE 40.00 X 368369 0 51548 GREGORY PARTAMIAN 40.00 X 219289 0 49124 KATHLEEN VANWAGONER 40.00 X 158935 0 50692 MICHELLE HORNBERGER 40.00 X 140488 0 39213 DONNA KOPINSKI 40.00 X 76844 0 9029 SAMAR KAZZIHA MD 40.00 X 473497 0 27582 DOUGLAS PUGMIRE DO 40.00 X 421886 0 25299 KEVIN FLOREK DO 40.00 X 257364 0 50671 AMARBIR KHAIRA MD 40.00 X 251054 0 0 NACIANCENO V WOO MD 40.00 X 208670 0 42536 3302128 0 420180 11 0 1 0 BARTON MALOW-REWOLD LLC 26500 AMERICAN DR SOUTHFIELD MI 48034 CONSTRUCTION MANAGEMENT 6761744 UNASOURCE SURGERY CENTERLLC 4550 INVESTMENT DR STE 100 TROY MI 48098 SURGICAL SERVICES 5359814 PATRIOT MEDICAL TECHNOLOGIES MSC-410672 PO BOX 415000 NASHVILLE TN 37241 BIOMEDICAL SERVICES 2064773 HARLEY ELLIS DEVEREAUX PO BOX 674273 DETROIT MI 48267 ARCHITECTUAL SERVICES 2030554 BALD MOUNTAIN SURGICAL CENTER LLC 1375 S LAPEER RD STE 109 LAKE ORION MI 48360 SURGICAL SERVICES 1962355 60 500 9143378 21614 9165492 NET PATIENT SERVICE RE 900099 224143023 220591914 3551109 INVESTMENT IN JOINT VE 900099 665835 391694 274141 PROFESSIONAL FEES U-M 900099 250906 250906 CPR CLASSES 611600 124643 124643 KARMONOS ONCOLOGY REVE 900099 123928 123928 259652 259652 225567987 2636621 2636621 94788128 3052326 92543985 1803099 2244143 1249227 3493370 3493370 43283 500 32699 10584 10584 233540 141650 91890 91890 MEDICAL STAFF FUNCTION 900099 234114 234114 MRI AND LAND LEASE 900099 201840 201840 TV RENTAL 900099 168117 168117 357672 2737 354935 961743 241927687 221742737 3827987 7191471 139050 139050 1816444 1816444 81351816 76009983 5341833 4454939 4053104 401835 8991391 8157798 833593 6738981 6131125 607856 32500 32500 370343 3138 367205 232461 232461 55000 55000 63962 63962 40455558 36472096 3983462 1062876 26118 1036758 3760108 2311645 1447403 1060 8212126 8212126 5076960 2078356 2998604 103427 53113 50314 24801 12658 10145 1998 2359132 2359132 14770727 9565908 5204819 169618 145185 24433 MEDICAL SUPPLIES 37634118 37030716 603402 BAD DEBT 11426145 11426145 QAAP EXPENSE 5897271 5897271 MALPRACTICE 717435 585833 131602 2952641 2060819 891822 238869830 204519193 34347579 3058 12687 12685 31655509 17990817 43237642 41194946 4338541 3928146 2851118 2471594 313418675 167691167 147340385 145727508 77599045 78648873 28439 47846 14314607 11249473 21487600 23029377 342865573 324301265 25898151 28784304 101980000 98610000 2223583 1595841 147845 17500 28612492 33431549 158862071 162439194 X 183159661 161034469 843841 827602 184003502 161862071 342865573 324301265 X 3057857 -25199288 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 55000 55000 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: CRITTENTON HOSPITAL MEDICAL CENTER INDIRECTLY CONDUCTS LOBBYING ACTIVITIES THROUGHOUT THE YEAR. THE HOSPITAL HAS ENGAGED THE SERVICES OF A PROFESSIONAL LOBBYIST, WHO PERIODICALLY MEETS WITH FEDERAL, STATE, AND LOCAL LEGISLATORS TO DISCUSS ITEMS OF IMPORTANCE TO THE HOSPITAL AND HEALTH CARE INDUSTRY, AND ISSUES AFFECTING THE HEALTH CARE NEEDS OF THE COMMUNITY. THE EXPENDITURES LISTED IN PART II-B ARE FEES AND EXPENSE REIMBURSEMENTS PAID TO THE LOBBYIST DURING THE YEAR. ON RARE OCCASIONS, THE HOSPITAL ENCOURAGES ITS EMPLOYEES TO CONTACT LEGISLATORS TO CONSIDER CHANGES IN THE LAW THAT WOULD IMPROVE THE REGULATORY CLIMATE AFFECTING THE HEALTH CARE INDUSTRY AND ULTIMATELY, HEALTH CARE NEEDS OF THE COMMUNITY THE HOSPITAL SERVES. THE "GRASSROOT" LOBBYING IS INFREQUENT, AND INVOLVES NO SIGNIFICANT EXPENDITURES BY EITHER THE HOSPITAL OR ITS EMPLOYEES. NONE OF THIS ACTIVITY (DIRECT OR INDIRECT) INVOLVES POLITICAL CAMPAIGN ACTIVITY. 843841 219377 12055 243647 4025 827601 964434 167277 17908 295562 10216 843841 1026646 152319 19315 218961 14885 964434 1062921 168931 15719 203894 17031 1026646 1.00000 0 1 1 2565744 2565744 182076640 89054583 93022057 1732459 887455 845004 109889986 75576013 34313973 17153846 2173116 14980730 145727508 15000 ACCOUNTS RECEIVABLE AFFILIATES 1063796 14010 MISCELLANEOUS ACCOUNTS RECEIVABLE 1557280 14300 ACCOUNTS RECEIVABLE POWERWORKS 72336 14030 CASH RESTRICTED BY BOND COVENANTS -1867143 14090 DEBT SECURITIES 4130089 8110-18140 DEBT ISSUANCE COST 749915 18160 LONG TERM ACCOUNTS RECEIVABLE 4220006 18170 ACCOUNTS RECEIVABLE KARMANOS 585653 19010 ACCOUNTS RECEIVABLE SAAC 6287318 14400 DUE FROM THIRD PARTY 1067458 19110 PHYSICIAN LOAN FOREGIVENESS 795154 19120 PHYSICIAN LOANS 617515 19100 LOAN RECEIVABLE DOCTORS HOSPITAL 3750000 23029377 SELF FUNDED MALPRACTICE INS CLAIMS LIABILITY 3212548 POST RETIREMENT HEALTH INS LIABILITY 579986 PENSION LIABILITY 29639015 33431549 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED FOR THE GIFT SHOP, THE AUXILLIARY AND THE HOSPITAL FOR GRANTS, SCHOLARSHIPS AND OTHER EXPENSES. CENTRAL AMERICA/CARIBBEAN 0 0 PROGRAM SERVICES INSURANCE 536288 CENTRAL AMERICA/CARIBBEAN 0 0 INVESTMENT 164489 0 0 0 0 0 0 700777 0 700777 1 0 1 0 0 0 SHEET SALE 13290 13290 8842 $6 SALE 10488 10488 8565 14 20005 500 19505 15292 43783 500 43283 32699 32699 10584 1 1 X 1 X 1 X 1 1 0 1 1 544708 544708 0.00240 1 18509422 13093138 5416284 0.02380 234353 213871 20482 0.00010 1 19288483 13307009 5981474 0.02630 1480 24360 554663 0 554663 0.00240 870 3318 8184220 1502935 6681285 0.02940 1 50 72800 0 72800 0.00030 68 11915 108150 0 108150 0.00050 2419 39643 8919833 1502935 7416898 0.03260 2420 39643 28208316 14809944 13398372 0.05890 8 1533 1948 0 1948 0.00000 20 1000 21913 0 21913 0.00010 76 1555 37485 0 37485 0.00020 104 4088 61346 61346 0.00030 0 11426145 5713073 67815398 75128123 -7312725 X 1 1 1 USC LLC SURGICAL CENTER 0.28700 0.71300 1 1 CRITTENTON HOSPITAL MEDICAL CENTER

1101 W UNIVERSITY ROCHESTER MI 48307

X X X X CRITTENTON HOSPITAL MEDICAL CENTER 1 1 1 200.000000000000 1 250.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 1 X 0 0 1 USC LLC

4800 INVESTMENT DRIVE STE 370 TROY MI 48098

SURGICAL CENTER PART I, LINE 3C: CRITTENTON HOSPITAL MEDICAL CENTER USED THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILTY FOR PROVIDING BOTH 'FREE' CARE AND 'DISCOUNTED' CARE TO LOW INCOME INDIVIDUALS. THE FAMILY INCOME LIMIT USED IS 200% FOR 'FREE' CARE AND 250% FOR 'DISCOUNTED' CARE. PART I, LINE 7: THE COSTING METHOD USED FOR FINANCIAL ASSISTANCE AND MEANS TESTED GOVERNMENT PROGRAMS WAS A COST TO CHARGE RATIO FROM WORKSHEET 2 AND OTHER COMMUNITY BENEFITS WAS CALCULATED BASED UPON ACTUAL COST. PART I, LINE 7G: CRITTENTON HOSPITAL MEDICAL CENTER DOES NOT HAVE ANY SUBSIDIZED HEALTH SERVICES TO REPORT. PART I, L7 COL(F): THE BAD DEBT EXPENSE OF $11,426,145 WAS REMOVED FROM THE DENOMINATOR FOR THE CALCULATION OF THE PERCENT OF TOTAL EXPENSE. PART II: COMMUNITY HEALTH LEADERSHIP AND OTHER SENIOR LEADERS ACTIVELY PARTICIPATE ON A BROAD RANGE OF COMMUNITY COALITIONS SUCH AS THE OLDER PERSON'S COMMISSION, ROCHESTER COMMUNITY SCHOOLS, ROCHESTER/AUBURN HILLS COMMUNITY COALITION, OAKLAND COUNTY OBESITY COALITION, REGION 2 NORTH, OAKLAND COUNTY MEDICAL CONTROL AUTHORITY, MICHIGAN DEPT OF COMMUNITY HEALTH, CROSSROADS PREGNANCY CENTER AND OTHERS. THIS PROVIDES ONGOING KNOWLEDGE OF VARYING COMMUNITY NEEDS AND ADJUSTS AS ECONOMIC, ENVIRONMENTAL, AND HEALTHCARE CHANGES OCCUR IN CRITTENTON'S KEY COMMUNITIES.THE VARIOUS PROGRAMS THAT CHMC OFFERS TO THE COMMUNITY HELP TO ENHANCE THE HEALTH STATUS BY EDUCATION, EARLY DETECTION, SCREENING, AND ACCESSIBILITY TO RESOURCES. WE RECEIVE MULTIPLY STORIES EVERY YEAR STATING THAT IF THEY HAD NOT HAD ATTENDED ONE OF OUR SCREENINGS THEN THEY MAY NOT HAVE PURSUED FURTHER MEDICAL CARE OR TREATMENT. THE SCREENING OR EDUCATION IS WHAT INCREASED THEIR AWARENESS AND ENCOURAGED THEM TO SEEK CARE AND THAT SCREENING OR ACTIVITY IS WHAT HELPED TO ENHANCE THEIR HEALTH. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THE REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. THE HOSPITAL FOLLOWS THE POLICY OF PROVIDING HEALTH SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CONSEQUENTLY, THE HOSPITAL PROVIDES HEALTH SERVICES FREE OF CHARGE OR AT AMOUNTS LESS THAN ITS FULL COSTS OF PROVIDING CARE TO CERTAIN CATEGORIES OF PATIENTS. THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS CALCULATED USING THE HISTORICAL PERCENTAGE BASED ON CHARITY CARE APPLICATIONS APPROVED. PART III, LINE 8: AS A NON-PROFIT HOSPITAL, CRITTENTON HOSPITAL MEDICAL CENTER IS REQUIRED TO PROVIDE MINIMAL LEVELS OF COMMUNITY BENEFIT IN EXCHANGE FOR OUR TAX EXEMPT STATUS. THESE COMMUNITY BENEFITS INCLUDE HEALTH EDUCATION OPPORTUNITIES, CHARITY AND BAD DEBT WRITEOFFS, AND OUR LOSSES ON MEDICARE. IN KEEPING WITH OUR MISSION TO PROMOTE HEALTH IN THE COMMUNITY, WE PROVIDE CARE TO MEDICARE BENEFICIARIES AT A LOSS, THUS HELPING TO RELIEVE THE GOVERNMENT BURDEN OF TREATING THESE PATIENTS WHO MAY OTHERWISE HAVE THEIR ACCESS TO CARE LIMITED. PART III, LINE 9B: IT IS THE POLICY OF CRITTENTON HOSPITAL MEDICAL CENTER TO REQUIRE PAYMENT IN FULL FOR ALL SERVICES RENDERED, WHICH ARE PATIENT PAY, UPON RECEIPT OF THEIR FIRST STATEMENT. THE PATIENT THEN HAS THIRTY DAYS TO REMIT PAYMENT IN FULL. THE BURDEN OF PROOF OF A PATIENT'S INABILITY TO PAY IN FULL IS THE RESPONSIBILITY OF THE PATIENT. IF THE PATIENT CAN PROVE AN INABILITY TO PAY THEIR DEBT IN FULL, PARTIAL PAYMENT ARRANGEMENTS CAN BE MADE. IT IS ALSO THE POLICY OF THE HOSPITAL TO PROVIDE THE PATIENT WITH INFORMATION REGARDING THE AVAILABILITY OF WHATEVER SOCIAL SERVICES MAY BE APPLICABLE FOR THE PATIENT. IN ADDITION, A CHARITY CARE APPLICATION MAY ALSO BE PROVIDED. CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 9: THE HOSPITAL TAKES PART AND ASSISTS PATIENTS IN QUALIFYING FOR THE COUNTY INDIGENT HOSPITALIZATION PROGRAM. CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 10: FINANCIAL COUNSELORS ARE ON SITE AND CONTACTED WHENEVER A PATIENT COMES INTO THE HOSPITAL WITHOUT INSURANCE. THESE COUNSELORS ASSIST THE PATIENTS IN QUALIFYING FOR COUNTY, STATE, FEDERAL OR HOSPITAL ASSISTANCE PROGRAMS. CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 19D: CRITTENTON HOSPITAL MEDICAL CENTER BILLS BASED UPON THE EMERGENCY ROOM CHARGEMASTER, NOT ON ANY PARTICULAR PAYERS CONTRACTED REIMBURSEMENT RATE. THE HOSPITAL WILL PROVIDE A 25% DISCOUNT TO ANY EMERGENCY ROOM PATIENT THAT REQUESTS ONE. PART VI, LINE 2: THE ALLOCATION OF CRITTENTON'S RESOURCES TO IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE OF COMMUNITY RESIDENTS ARE BASED ON COMMUNITY NEEDS THAT ARE IDENTIFIED BOTH THROUGH THE STRATEGIC PLANNING PROCESS AND THROUGH A YEARLY COMPREHENSIVE REVIEW OF COUNTY, STATE AND FEDERAL HEALTHCARE DATA BY CRITTENTON'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT. COMMUNITY NEEDS INFORMATION IS GATHERED FROM BOTH THE CDC'S NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION BEHAVIORAL RISK FACTOR SURVEILLLANCE SYSTEMS AND THROUGH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH. FOR EXAMPLE, IN 2008 THE NEED FOR A SCHOOL NURSE PROGRAM WAS IDENTIFIED WITH THE ROCHESTER COMMUNITY SCHOOLS. CRITTENTON'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT DEVELOPED AND IMPLEMENTED THE PROGRAM WHICH NOW SERVES 14,000 STUDENTS AND MANAGES 450 MEDICAL MANAGEMENT PROGRAMS. IN 2009 AND AGAIN IN 2010, PARTICIPATION WITH THE ROCHESTER/AUBURN HILLS COALITION RESULTED IN CRITTENTON'S SPONSORING RACHEL'S CHALLENGE, A PROGRAM WHICH PROVIDES SUICIDE PREVENTION AND INTERVENTION AND IMPROVED PEER TO PEER CONFLICT MANAGEMENT SKILLS FOR AREA YOUTH. PART VI, LINE 3: CRITTENTON HOSPITAL MEDICAL CENTER DOES A NUMBER OF THINGS IN ORDER TO EDUCATE AND/OR ASSIST A PATIENT IN RECEIVING OUTSIDE ASSISTANCE, INCLUDING THE FOLLOWING:1. SIGNAGE IS POSTED AT REGISTRATION POINTS AROUND THE HOSPITAL REGARDING ASSISTANCE AVAILABLE TO PAY FOR SERVICES AS WELL AS OUR UNCOMPENSATED SERVICES PROGRAM, HANDOUTS ARE GIVEN TO THE PATIENTS AND THE PROGRAM IS OUTLINED ON THE BACK OF EVERY STATEMENT THAT IS SENT TO THE PATIENT.2. FINANCIAL COUNSELORS ARE ON SITE THAT ARE CONTACTED EVERY TIME A PATIENT WITHOUT INSURANCE COMES INTO THE EMERGENCY ROOM OR IS ADMITTED TO THE HOSPITAL. IN THE PAST 12 MONTHS THE FINANCIAL COUNSELORS HAVE ASSISTED OVER 600 PATIENTS IN QUALIFYING FOR COUNTY, STATE, FEDERAL, OR HOSPITAL ASSISTANCE PROGRAMS.3. TAKE PART AND ASSIST PATIENTS IN QUALIFYING FOR THE COUNTY INDIGENT HOSPITALIZATION PROGRAM WHICH IS RUN DIRECTLY THROUGH THE HOSPITAL AND PLACES VIRTUALLY NO BURDEN OF ANY TYPE ON THE PATIENT IN ORDER TO BE QUALIFIED.4. ALL MANAGERS THAT DEAL WITH THE PUBLIC ARE DIRECTLY INFORMED OF OUR UNCOMPENSATED SERVICE PROGRAMS AND VERBALLY ASSIST PATIENTS WITH SUGGESTIONS AS WELL AS OUR CASHIERS HAVING ACCESS TO THE SAME INFORMATION AND TRAINING.5. OFFER ASSISTANCE TO NEWBORN MOTHERS WITHOUT INSURANCE IN THE FORM OF ASSISTANCE IN APPLYING FOR MEDICAID AND PROVIDING MINIMAL PAYMENT OPTIONS. PART VI, LINE 4: CRITTENTON IS A 290 BED ACUTE CARE HEALTH FACILITY SERVING COMMUNITIES IN OAKLAND, MACOMB, AND LAPEER COUNTIES. THE ENTIRE SERVICE AREA ENCOMPASSES 35 ZIP CODES IN THREE REGIONS AND IS FURTHER SUBDIVIDED INTO THREE SECTORS: OUR CORE SECTOR WHICH ENCOMPASSES THE THREE ROCHESTER ZIP CODES, AND THE PRIMARY AND SECONDARY SECTORS. THE DEMOGRAPHIC SKEW FOR THE AREA IS SLIGHTLY OLDER THAN THE NORM WITH HIGHER HOUSEHOLD INCOMES. PART VI, LINE 5: CRITTENTON HOSPITAL MEDICAL CENTER DOESN'T WANT TO FORGET THE IMPORTANT ROLE THE COMMUNITY PLAYS IN ITS SUCCESS. THE HOSPITAL IS ESPECIALLY GRATEFUL THAT THEY ARE ABLE TO GIVE BACK TO THE COMMUNITY THROUGH ESSENTIOAL HEALTHCARE SERVICES AND EDUCATION TO CATER TO THE UNMET NEEDS OF SO MANY IN ITS COMMUNITY. OFFERING ADVANCED CARE AND SERVICES IN ONE OF THE MANY WAYS CRITTENTON SERVES ITS COMMUNITY. CRITTENTON HAS PARTNERED WITH PREMIER ORGANIZATIONS TO FULFILL ITS MISSION OF ENHANCING THE HEALTH STATUS OF THE COMMUNITY, I.E. UNIVERSITY OF MICHIGAN, BARBARA ANN KARMANOS CANCER INSTITUTE, WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE AND OAKLAND UNIVERSITY SCHOOL OF NURSING ARE JUST A FEW. PART VI, LINE 6: CRITTENTON HOSPITAL MEDICAL CENTER IS DEDICATED TO PROVIDING CARE TO ALL RESIDENTS OF THE COMMUNITY, REGARDLESS OF THEIR FINANCIAL STATUS. THROUGH UNCOMPENSATED CARE, GOVERNMENT SPONSORED HEALTH CARE, COMMUNITY HEALTH SERVICES AND DONATIONS THE HOSPITAL IS ABLE TO REACH OUT TO THE COMMUNITY. THE FOUNDATION IS THE FUNDRAISING ARM OF THE ORGANIZATION. THEY HAVE HOSTED EVENTS SUCH AS THE GOLF, TENNIS AND FUN WALK BENEFIT AND THE GOURMET GALA BENEFIT WHICH HAS RAISED MONEY FOR A VARIETY OF ENHANCEMENTS TO THE HOSPITAL. THE CRITTENTON VOLUNTEER AUXILIARY IS AN INTEGRAL PART OF THE HOSPITAL'S SUCCESS. THE GROUP CONTRIBUTES A GREAT DEAL OF TIME AND SERVICE TO FURTHER THE GOAL OF PROVIDING CLINICAL EXCELLENCE IN A COMFORTABLE,WELCOMING ENVIRONMENT. SOME OF THE SERVICES THAT THEY PROVIDE INCLUDE CLERICAL ASSISTANCE, ESCORTING PATIENTS AROUND THE FACILITY, AND GREETING FAMILIES AND VISITORS. THE CRITTENTON WELLNESS CENTER AND THE OLDER PERSONS COMMISSION HAVE COMBINED HEALTH, WELLNESS, EDUCATION AND ACTIVITIES ALL WITH THE OLDER PERSON IN MINDE. MEMBERSHIP IS FREE TO RESIDENTS OF ROCHESTER, ROCHESTER HILLS, AND OAKLAND TOWNSHIP WHO ARE OLDER THAN AGE FIFTY. CRITTENTON CANCER CENTER PROVIDES COMMUNITY MEMBERS WITH A NEW LOCAL RESOURCE FOR EXCEPTIONAL CANCER CARE. THE SERVICES INCLUDED AT THE CANCER CENTER ARE CHEMOTHERAPY AND INFUSION, IMAGING, AND RADIATION THERAPY. REPORTS FILED WITH STATES PART VI, LINE 7 MI 0 CRITTENTON HOSPITAL MEDICAL CENTER FOUNDATION 1101 W UNIVERSITY ROCHESTER MI 48307 382627336 501(C)3 139050 TO PROVIDE FINANCIAL SUPPORT AND FURTHER CHARITABLE ENDEAVORS. 1 X X 1 0 0 0 0 0 0 0 0 LYNN ORFGEN 410709 0 0 0 25994 0 22000 0 21616 0 480319 0 0 0 CYNTHIA LONG 63968 0 0 0 71688 0 7747 0 3902 0 147305 0 0 0 FRANK SOTTILE 364964 0 0 0 3405 0 22000 0 29548 0 419917 0 0 0 GREGORY PARTAMIAN 212785 0 0 0 6504 0 22000 0 27124 0 268413 0 0 0 KATHLEEN VANWAGONER 156752 0 0 0 2183 0 22000 0 28692 0 209627 0 0 0 MICHELLE HORNBERGER 135205 0 0 0 5283 0 15000 0 24213 0 179701 0 0 0 SAMAR KAZZIHA MD 457617 0 14000 0 1880 0 0 0 27582 0 501079 0 0 0 DOUGLAS PUGMIRE DO 421854 0 0 0 32 0 0 0 25299 0 447185 0 0 0 KEVIN FLOREK DO 253792 0 0 0 3572 0 22000 0 28671 0 308035 0 0 0 AMARBIR KHAIRA MD 251054 0 0 0 0 0 0 0 0 0 251054 0 0 0 NACIANCENO V WOO MD 206668 0 0 0 2002 0 21996 0 20540 0 251206 0 0 0 PART I, LINE 3 THE AUDIT COMMITTEE REVIEWS THE PERFORMANCE AGAINST THE GOALS SET FOR THE CEO. IN ADDITION THE AUDIT COMMITTEE PERFORMS A REVIEW OF THE TOTAL SALARY AGAINST MARKET STATISTICS. FROM THAT REVIEW, A RECOMMENDATION IS MADE TO THE EXECUTIVE COMMITTEE OF THE BOARD AND THE BOARD FOR APPROVAL. PART I, LINE 4A CYNTHIA LONG RECEIVED A SEVERANCE OF $71,424 DURING 2011. EMPLOYEE AND EMPLOYER HAVE MUTUALLY AGREED TO TERMINATE EMPLOYEE'S EMPLOYMENT, EFFECTIVE FEBRUARY 28, 2011. EMPLOYEE WILL BE PROVIDED NOTICE OF HER RIGHTS UNDER COBRA. IF EMPLOYEE ELECTS TO ACCEPT THE TERMS OF THIS AGREEMENT, THE EMPLOYER WILL PAY THE COBRA PREMIUMS THROUGH JULY 16, 2011. THE EMPLOYER AGREES TO PAY EMPLOYEE SEVERANCE PAY, TWO WEEKS FOR EVERY YEAR OF SERVICE IN THE AMOUNT MINUS NORMAL LAWFUL DEDUCTIONS FOR TAXES AND WITHHOLDING. FURTHERMORE, EMPLOYEE HAS NOT WAIVED, RELEASED OR DISCHARGED EMPLOYER FROM PROVIDING TO HER ANY VESTED RETIREMENT BENEFITS. . IN ADDITION EMPLOYER AGREES TO REIMBURSE EMPLOYEE $766.65 FOR NON-REFUNDABLE AIRFARE TO THE CAYMAN ISLANDS SCHEDULED ON BEHALF OF THE EMPLOYER. PART I, LINE 5 MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465E4Z3 2003-07-30 52400000 REFUNDED 2002B SERIES/ BUILDING EXPENSES 0 0 0 MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465E5X7 2003-12-23 21480000 REIMBURSE PRIOR CAPITAL EXPENDITURES 0 0 0 52400000 490373 14485934 2005 1 0 1 1 21480000 330699 46634 2003 1 0 1 1 0 1 0 0 0 0 0 1 1 COMERICA 5.200000000000 0 0 0 0 0 REPORTED SALARY OF OFFICER DID NOT MATCH W-2 FORM 990 - EXPLANATION OF AMENDED RETURN: THERE WAS AN ERROR OF REPORTABLE COMPENSATION FOR ONE OF THE OFFICERS. THE COMPENSATION FOR KATHLEEN VANWAGONER, CNO, DID NOT MATCH THE W-2 THAT WAS REPORTED TO THE IRS AND HAS BEEN CORRECTED ON THIS AMENDED RETURN. PART VII, PART IX, LINE 5 AND LINE 7, AND SCH. J PART II HAVE ALL BEEN AFFECTED BY THIS ERROR. FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS PREPARED BY THE FINANCE DEPARTMENT, AND THEN IS SENT TO AN OUTSIDE CERTIFIED PUBLIC ACCOUNTANTS OFFICE WHERE THE RETURN IS REVIEWED. THE RETURN IS THEN GIVEN TO THE BOARD OF DIRECTORS VIA E-MAIL FOR REVIEW. AFTER THE REVIEW, THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL POLICY STATES THAT ALL EMPLOYEES HAVE A CONTINUOUS OBLIGATION TO DISCLOSE CONFLICTS OF INTEREST, AN ACTUAL IMPROPRIETY, AND/OR AN APPEARANCE OF IMPROPRIETY. EMPLOYEES AT THE MANAGER LEVEL AND ABOVE EACH SIGN A STATEMENT ON AN ANNUAL BASIS ACKNOWLEDGING THEIR UNDERSTANDING OF THE POLICY AND VERIFYING THEIR APPROPRIATE DISCLOSURE OF ANY CONFLICTS. ALL REPORTED CONFLICTS SHALL BE REVIEWED BY THE CEO IN CONJUCTION WITH THE COMPLIANCE OFFICER AND DEPARTMENT OF LEGAL AFFAIRS. IF IT IS DETERMINED THAT A CONFLICT EXISTS THE EMPLOYEEE SHALL DISCONTINUE ALL ACTIVITIES SURROUNDING THAT CONFLICT. THE EMPLOYEE MAY ALSO SEEK A WAIVER OF THE CONFLICT FROM THE CEO. CHMC ALSO HAS A QUESTIONNAIRE FOR INDIVIDUALS AND THEIR IMMEDIATE FAMILY MEMBERS, INCLUDING BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES REGARDING CONFICTS OF INTEREST AND THIS MUST BE SIGNED BY THE INDIVIDUALS. THE QUESTIONNAIRE INCLUDES THE FOLLOWING: 1. IDENTIFY YOUR SERVICE ON ANY BOARD OF DIRECTORS OR TRUSTEES OF ANY OF THE COMPANY'S WITH WHICH CHMC OR ANY OF ITS' AFFILIATES DOES BUSINESS. 2. IDENTIFY WHETHER YOU ARE ASSOCIATED DIRECTLY OR INDIRECTLY OR HOLD A POSITION OR FINANCIAL INTEREST IN ANY OUTSIDE ORGANIZATION OR CONCERN WITH WHICH CRITTENTON DOES BUSINESS. 3. IDENTIFY WHETHER YOU DIRECT, MANAGE,OR PROVIDE SERVICES OR CONSULTATION TO ANY OUTSIDE ORGANIZATION OR CONCERN THAT DOES BUSINESS WITH OR COMPETES WITH CRITTENTON. 4. IDENTIFY ANY ACTIVITIES IN WHICH YOU ARE ENGAGED THAT MIGHT BE REGARDED AS CONSTITUTING A POTENTIAL CONFLICT OF INTEREST WITH CRITTENTON. 5. DISCLOSE ANY DIRECT OR INDIRECT COMPENSATION THAT YOU RECEIVE, OR ANTICIPATE RECEIVING, FROM ANY PERSON, FIRM, CORPORATION, OR MARKET IN ANY WAY RELATED TO YOUR POSITION WITH CRITTENTON. IF AT ANY TIME THERE IS A MATTER UNDER CONSIDERATION WHICH MAY CREATE A DIRECT OR INDIRECT CONFLICT OF INTEREST, IT IS THE INDIVIDUAL'S OBLIGATION TO DISCLOSE THE FACTS SURROUNDING THE POSSIBLE CONFLICT TO THE CORPORATE COMPLIANCE OFFICER OR DEPARTMENT OF HUMAN RESOURCES AND THAT THE INDIVIDUAL AGREES TO PROMPTLY REPORT ANY NEW SITUATIONS THAT REQUIRE DISCLOSURE UNDER THIS QUESTIONNAIRE. THERE IS A SIGNED WRITTEN AGREEMENT/DOCUMENTATION FOR ANY BOARD MEMBER OR OFFICER IF A CONFLICT OF INTEREST ARISES. CURRENTLY THERE HAVE NOT BEEN ANY RESTRICTIONS PLACED ON ANY BOARD MEMBER OR OFFICER AS AN ISSUE HAS NOT ARISEN TO WARRANT THIS. FORM 990, PART VI, SECTION B, LINE 15A THE AUDIT COMMITTEE REVIEWS THE PERFORMANCE AGAINST THE GOALS SET FOR THE CEO. IN ADDITION THE AUDIT COMMITTEE PERFORMS A REVIEW OF THE TOTAL SALARY AGAINST MARKET STATISTICS. FROM THAT REVIEW, A RECOMMENDATION IS MADE TO THE EXECUTIVE COMMITTEE OF THE BOARD AND THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST OF THE INDIVIDUAL. ESTIMATED HOURS PER WEEK OFFICERS, ETC DEVOTED TO RELATED ORGANIZATIONS PART VII-LINE 1B CYNTHIA LONG AND DONNA KOPINSKI DEVOTED APPROXIMATELY 2 HOURS PER WEEK AT FOUNDATION. FRANK SOTTILE, LYNN ORFGEN AND DONNA KOPINSKI DEVOTED APPROXIMATELY 4 HOURS PER WEEK TO THE CANCER CENTER, WHILE MICHELLE HORNBERGER DEVOTED APPROXIMATELY 13 HOURS PER WEEK TO CRITTENTON DEVELOPMENT CORPORATION. LYNN ORFGEN ALSO DEVOTED APPROXIMATELY 4 HOURS PER WEEK TO CRITTENTON DEVELOPMENT CORPORATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,775,895. PRIOR PERIOD ADJUSTMENTS: -11,223,107. PENSION LIABILITY -7,002,914. CANCER CENTER ACQUISITION -4,159,952. NET ASSETS RELEASED FROM RESTRICTIONS -37,420. TOTAL TO FORM 990, PART XI, LINE 5: -25,199,288. AUDIT OF FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT MAKE ANY SIGNIFICANT CHANGES IN THE PROCESS OF THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR. PROGRAM SERVICE ACCOMPLISHMENTS PART III, LINE 4A THE HOSPITAL WAS INVOLVED IN A LARGE NUMBER OF VARIOUS TYPES OF COMMUNITY CARE PROJECTS, EITHER AS A PARTICIPANT OR A SPONSORING ORGANIZATION. THESE INCLUDE, BUT ARE NOT LIMITED TO: HEALTHY PREGNANCY, WOMEN'S HEALTHY HEART, NUTRITION, WEIGHT LOSS, HEALTHY AGING, CHILD SAFETY, HEALTH RISK APPRAISALS, SMOKING CESSATION, MANAGING STRESS, CPR, SLEEP DISORDER AND MEN'S HEALTH CLASSES FOR THE COMMUNITY. ALSO, FREE BLOOD PRESSURE SCREENINGS ARE MADE AVAILABLE TO THE COMMUNITY. A BEREAVEMENT PROGRAM IS OFFERED THROUGH THE OBSTETRICS DEPARTMENT FOR GRIEVING PARENTS OF INFANTS. A TRAVEL MEDICINE PROGRAM IS OFFERED FOR BUSINESS AND VACATION TRAVELS THROUGH THE OCCUPATIONAL MEDICINE DEPARTMENT. ANNUALLY, VOLUNTEERS FROM THE HOSPITAL PARTICIPATE AT THE ROCHESTER ARTS AND APPLES FESTIVAL, COLLECT GIFTS FOR THE ROCHESTER NEIGHBORHOOD HOUSE, COLLECT FOOD FOR THE MICHIGAN HARVEST GATHERING, PARTICIPATE IN THE NORTH OAKLAND AMERICAN HEART WALK, THE BROOKSIE WAY AND COATS FOR COLD. A PEDIATRIC URGENT CARE PROGRAM IS OFFERED FOR AFTER HOURS MEDICAL CARE FOR CHILDREN UNDER EIGHTEEN YEARS OF AGE. ADDITIONALLY, A GEROPSYCHIATRIC PROGRAM WAS STARTED TO ASSIST OLDER ADULTS WITH HEALTH CARE CHANGES. WOUND CARE SERVICES ARE ALSO OFFERED, INCLUDING HYPERBARIC TREATMENTS. OFFICER WHO CANNOT BE REACHED AT THE ORGANIZATION'S MAILING ADDRESS PART VI SECTION A LINE 9 LYNN ORFGEN-1937 ARCHERS POINTE, ROCHESTER HILLS, MI 48306 CRITTENTON HOSPITAL MEDICAL CENTER FOUNDATION 1101 W UNIVERSITY DR ROCHESTER MI 48307 382627336 SUPPORTING MI SECTION 501(C)(3) SCHEDULE A LINE 11A CRITTENTON HOSPITAL MEDICAL CENTER 1 CRITTENTON CANCER CENTER 1901STAR BATT DR ROCHESTER HILLS MI 48309 383239057 SUPPORTING MI SECTION 501(C)(3) SCHEDULE A LINE 9 CRITTENTON HOSPITAL MEDICAL CENTER 1 CRITTENTON MEDICAL EQUIPMENT 161 S LIVERNOIS RD ROCHESTER HILLS MI 48307 383433794 MEDICAL EQUIPMENT SALES MI CRITTENTON DEVELOPMENT CORPORATION UNRELATED 0 0 HBC INFUSIONS 1101 W UNIVERSITY ROCHESTER MI 48307 753123093 INFUSION SERVICES MI CRITTENTON DEVELOPMENT CORPORATION UNRELATED 0 0 BALD MOUNTAIN SURGICAL CENTER 1375 S LAPEER RD STE 3109 LAKE ORION MI 48360 030444972 SURGICAL SERVICES MI CRITTENTON DEVELOPMENT CORPORATION UNRELATED 0 0 CRITTENTON DEVELOPMENT CORPORATION 2251 N SQUIRREL RD STE 310 AUBURN HILLS MI 48326 382594115 REAL ESTATE MI CRITTENTON HOSPITAL MEDICAL CENTER C 806168 18518665 1.00000 CRITTENTON MEDICAL PHARMACY 1101 W UNIVERSITY ROCHESTER MI 48307 203773341 PHARMACY SALES MI CRITTENTON DEVELOPMENT CORPORATION C 0 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 0 0 CRITTENTON DEVELOPMENT CORP N 164551 CASH CRITTENTON CANCER CENTER D 12269512 CASH CHMC FOUNDATION B 139050 CASH CHMC FOUNDATION C 9143378 CASH CHMC FOUNDATION K 126628 CASH CHMC FOUNDATION L 353704 CASH CHMC FOUNDATION P 480319 CASH CRITTENTON CANCER CENTER O 811535 CASH CRITTENTON CANCER CENTER P 176987 CASH