2013-01-08T08:44:17-06:00 2012-02-29 990 2011-03-01 381218485 CareLink of Jackson a Community-Owned Speciality Hospital CARE 5177871440 110 North Elm Avenue Jackson MI 49202 Dale Friesen 5177871440 2013-01-08 2011 2016-03-07 17:11:31Z J Mark Fall 15117775 0 X www.carelinkofjackson.org X 2003 MI To provide long-term acute healthcare to the residents of Jackson, MI and surrounding areas. 6 3 163 2 0 0 0 0 16148886 14865922 1319 2515 328125 198526 16478330 15066963 0 0 0 0 6188656 6688354 0 0 0 8821071 9374822 15009727 16063176 1468603 -996213 6928605 6473108 2655839 3196555 4272766 3276553 X CareLink of Jackson is committed to holistic care of individuals with complex medical needs. 0 0 13856898 14871465 CareLink of Jackson is a long-term acute care hospital fully accredited by The Joint Commission. The facility is designed to provide care for medically complex patients requiring an average hospital stay in excess of 25 days. Any patient having an acute chronic condition, complication from a surgical procedure or may be expected to require a longer acute hospital stay may be considered for admission.CareLink of Jackson is a free-standing hospital whereby patients are accepted from multiple sources. Patients are frequently referred to CareLink of Jackson from other acute care hospitals, skilled nursing facilities, physician offices, wound clinics, dialysis centers and others. During the fiscal year ended 02/29/12, CareLink of Jackson maintained an average daily census of 34.2 patients and provided 12,511 days of patient care. Due to the complex medical needs served by the hospital, the average patient resided at the facility for 26.93 days. Approximately 86% of all patients are Medicare-eligible. 13856898 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 14 0 1 163 1 0 0 0 0 0 0 0 0 0 0 X 6 3 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Dale Friesen 5177964475 110 North Elm Avenue Jackson MI 49202 Jacalyn Liebowitz 1.00 X 0 329583 64646 Karen Chaprnka 1.00 X 0 491711 71571 Robert Albertson MD 1.00 X 0 0 0 Brent Ellis 1.00 X 0 0 0 Maryanne Fuchs 1.00 X 0 0 0 David Schmidt 1.00 X 0 0 0 J Mark Fall 50.00 X 0 0 0 Dale Friesen 50.00 X 0 0 0 Jeremy Curtis 50.00 X 126442 0 16114 126442 821294 152331 1 0 1 0 Greentree Healthcare Partners LLC 3296 Hutton Walk Marietta GA 30066 Management Services 705479 Pulmonary Clinics of Southern MI 900 East Michigan Avenue Jackson MI 49201 Healthcare Services 261399 Fresenius Management Services 16343 Collections Center Drive Chicago IL 60693 Healthcare Services 145831 Jackson Community Ambulance PO Box 673985 Detroit MI 48267 Healthcare Services 127676 Optimal Staffing Solutions INC 15945 Wood Road Lansing MI 48906 Staffing Services 120989 5 Patient Revenue 621990 14865922 14865922 14865922 2515 2515 243795 50812 192983 192983 192983 Miscellaneous Income 900099 4739 4739 Medical Record Release 621990 804 804 5543 15066963 14871465 0 195498 5456567 4836422 620145 80436 71588 8848 736592 655567 81025 414759 369136 45623 752731 752731 21262 21262 30800 30800 5260 5260 3757058 3397438 359620 20241 20241 582723 434371 148352 21290 21290 300611 300611 89716 7672 82044 703 703 403621 403621 75768 67434 8334 Pharmaceuticals 1913023 1913023 Medical Supplies 659401 659401 Bad Debt 580823 580823 Food 130906 130906 28885 28885 16063176 13856898 2206278 0 200124 200538 1429143 808812 2562834 2737524 22159 23221 74975 93823 6059012 3530197 2559156 2528815 80214 80375 6928605 6473108 603980 464101 2051859 2732454 2655839 3196555 X 4272766 3276553 4272766 3276553 6928605 6473108 -996213 0 X 0 1 1 X 0 X 0 0 0 0 0 0 0 0 1 5260 5260 0 Explanation of Lobbying Activities: Part II-B, Line 1: CareLink of Jackson pays membership dues to several non-profit advocacy groups including Michigan Hospital Association, American Hospital Association and Acute-Care Long-Term Hospital Association. These organizations use a portion of membership dues to lobby for causes related to CareLink of Jackson's exempt mission. 198058 198058 4411126 2574592 1836534 1435663 955605 480058 14165 14165 2528815 Compensation Amounts Withheld 368275 Payable to Affiliate 1779418 Cost Report Settlement Payable 584761 2732454 15066963 16063176 -996213 -996213 15100397 0 15100397 -33434 -33434 15066963 16096610 33434 33434 16063176 0 16063176 Part XII, Line 4b - Other Adjustments: Revenue counted as expense in audited financial statements -33,434. Part XIII, Line 2d - Other Adjustments: Revenue counted as expense in audited financial statements 33,434. 1 1 1 X 1 X 1 1 1 0 0 152669 152669 0.00990 152669 152669 0.00990 9027 9027 0.00060 22858 22858 0.00150 31885 31885 0.00210 184554 184554 0.01200 0 221104 0 9957485 10585672 -628187 X 1 1 1 1 CareLink of Jackson

110 North Elm Avenue Jackson MI 49202

X Long-Term Acute Care Hospital CareLink of Jackson 1 1 1 200.000000000000 1 350.000000000000 1 X X X X X 1 1 X 1 0 0 X X 0 0 Part I, Line 7: The Hospital used a cost-to-charge ratio to calculate charity care at cost. 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 $ 580823. Part II: N/A Part III, Line 4: There is not a bad debt expense footnote in the organization's audited financial statements. The company's bad debt expense at cost is determined by multiplying total bad debt expense by the overall cost-to-charge ratio. Part III, Line 8: The organization believes the entire shortfall reported on Line 7 should be treated as Community Benefit. CareLink of Jackson is subsidizing a government program and sustaining material losses in providing health care to Medicare recipients. The organization's cost-to charge ratio method was used in calculating Medicare allowable costs. Part III, Line 9b: The collection practices employed by CareLink of Jackson include telephone contact with Third-Party payors, a series of letters and telephone contacts with individual patients, and, if necessary, submission of the claim to a third-party collection agency. CareLink of Jackson Part V, Section B, Line 19d: The hospital facility determined the maximum amounts that can be charged to FAP-eligible individuals as the commercial insurance rate of its largest contract provider. Part VI, Line 2: CareLink of Jackson will be joining the next community needs assessment conducted by Allegiance Health and the Jackson County Health Department. The survey conducted with input from community partners gathers information on the health status of Jackson County. Part VI, Line 3: Patients are notified of potential eligibility for financial assistance under federal and state programs as well as the company's charity care policy. Patients are informed via direct communication with the patient account coordinator, the case manager, or various other hospital personnel. Where appropriate, patients receive an application for charity care that is to be submitted for review by the finance department. Part VI, Line 4: Jackson County has a population of approximately 33,300 residents. The median resident age is 31.3 years. The estimated median household income in 2008 was $33,994 and the estimated per capita income was $16,595. The estimated median house or condo value in 2008 was $90,280. The demographic constituents of Jackson County are comprised of approximately 72.7% White/Caucasian, 19.9% African American, 3.9% Hispanic, 0.2% Asian, and 3.3% Other. The nearest city with a population of 50,000+ residents is 33.6 miles away and the nearest city with a population of $200,000+ residents is 58.6 miles away. Jackson County has one general acute care hospital located in the city of Jackson, MI. Part VI, Line 5: Representatives of the local community comprise a voting majority of the Board of Trustees. The purpose of community representation on the Board of Trustees is to facilitate organizational sensitivity and awareness to the health needs of the local community. Part VI, Line 6: Both the organization and its affiliated healthcare entities exist for the purpose of addressing the healthcare needs of the local community. The governing bodies of the affiliated entities maintain significant representation from the local community to ensure overall community awareness, sensitivity and response. As a long-term acute care hospital, CareLink of Jackson serves as a unique discharge destination for medically complex patients upon discharge from the affiliated short-term acute care hospital (i.e. brother/sister entity). Patients admitted to CareLink of Jackson are typically not appropriate admission candidates to either skilled nursing facilities or their personal residence. Accordingly, CareLink of Jackson provides an intermediate source of specialized medical care not typically available in other communities. 0 1 0 0 0 1 0 0 0 Jacalyn Liebowitz 0 203222 0 52218 0 74143 0 45328 0 19318 0 394229 0 34609 Karen Chaprnka 0 314333 0 78229 0 99149 0 60103 0 11468 0 563282 0 53228 Part I, Line 4b Certain CareLink of Jackson directors participated in a non-qualified deferred compensation plan through their employment as officers of Allegiance Health a related tax-exempt organization. The plan which began in 2005 partially vested in 2010. Payout of vested amounts resulted in an increase of salary for these directors. The calendar year 2011 contribution and payout amounts are as follows: 457(f) Contributions Karen Chaprnka $39,278, Jacalyn Liebowitz $26,953 457(f) Payouts Karen Chaprnka $53,228, Jacalyn Liebowitz $34,609 Part I, Line 6 Greentree Healthcare Partners provides management consulting services to CareLink, including the services of the CEO, CFO and Chief Operating Officer, per the terms of a three-year management agreement. The agreement calls for a fixed monthly fee, plus the opportunity for Greentree to earn additional compensation that is based, in part, on the profitability of the organization. In addition to the financial measure, the additional compensation is also based on measures of quality, growth and management of the organization Supplemental Information Part III Part I, Line 3: CareLink of Jackson does not pay compensation to its CEO. CareLink contracts with Greentree Healthcare Partners for the services of the CEO. Greentree Healthcare Partners LLC Contractor 752731 Reported amount is for payments made by CareLink of Jackson to Greentree Healthcare Partners for outsourced management services. J. Mark Fall a CareLink of Jackson Officer is a partner in Greentree Healthcare Partners. 0 Pulmonary Clinic of SO MI Contractor 260334 Reported amount is for payments CareLink of Jackson made to Pulmonary Clinic of SO MI for healthcare services. Pulmonary Clinic of SO MI is part-owned by CareLink Trustee Dr. Robert Albertson. 0 Form 990, Part VI, Section A, line 3 Officers of the organization are employed by a management company. See Part VII, Section B, Independent Contractors. Form 990, Part VI, Section A, line 6 The corporation is organized on a membership basis. The sole member of the Corporation is Allegiance Health Services. Form 990, Part VI, Section A, line 7a The member has the power to elect and remove, with or without cause, the Corporation's Trustees, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present. Form 990, Part VI, Section A, line 7b Powers reserved to the Member: In addition to doing all things required or allowed by law, the Member of the Corporation shall take the following actions, by a two-thirds majority vote of the directors then serving on the Board of the Member, unless a different majority voting requirement is otherwise specified in this Article. Approve any change in these Articles of Incorporation, purposes or philosophy of the Corporation; Approve changes in those provisions of the Corporation's Bylaws which affect the size, composition, and method of selection of the Board of Trustees, or which affect this Article; Approve plans of merger, consolidation or dissolution of the Corporation; Authorize the sale, lease, mortgage or other disposition of all or substantially all of the assets owned, held or leased by or to the Corporation, or approve any decision by the Corporation which would have the net effect of diminution of governance control of the Member, and any decision by the Corporation which would have the net effect of diminution in the Corporation's governance control over its own subsidiary. Authorize the formation or acquisition of new subsidiaries of the Corporation or the sale or other disposition of existing subsidiaries. Approve guarantees by the Corporation of the debt of others in excess of maximum limits established by the Member, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting which a quorum is present; and Ratify or reject operating and capital budgets developed by the Board and any non-budgetary expenditures or creations of debt in excess of an amount designated by the Member from time to time, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by CareLink's CFO and Allegiance Health's Director of Finance. Allegiance Health is a related organization. Final copies of the return are distributed to CareLink's CEO and Board of Trustees for review before the return is filed. Form 990, Part VI, Section B, line 12c The Board Finance Committee has ultimate responsibility over the enforcement of the Hospital's Conflict of Interest Policy. When a potential conflict of interest is identified, the Finance Committee is responsible for review of the conflict of interest for complaince with the policy. Also, General Counsel routinely reviews upcoming Board and Committee meeting agendas to assess potential conflict situations. All employees and Trustees of the organization are required to fill out an annual conflict of interest questionnaire. Board Trustees identified as having a conflict of interest are permitted to discuss the potential transaction. They are not allowed to deliberate in the decision or vote on the matter. Form 990, Part VI, Section B, line 15 CareLink of Jackson is managed by a third party consulting group. This contract is reviewed and approved annually by the board of Trustees. Employees of the outside consulting group do not have a vote in approving the contract. Form 990, Part VI, Section C, line 19 The organization's governing documents are available to the public upon request and also on the State of Michigan website. Form 990 is available upon request. The Form 990 is also available on the free website www.guidestar.org. The organization's conflict of interest policy is not available to the public. PCN LLC 205 N East Avenue Jackson MI 49201 Physician Rental Network MI 0 0 WA Foote Memorial Hospital Jackson Health Network L3C 205 N East Avenue Jackson MI 49201 453253643 Clinically Integrated Network MI 0 0 WA Foote Memorial Hospital WA Foote Memorial Hospital 205 N East Avenue Jackson MI 49201 382027689 Exempt Hospital MI 501(c)(3) Line 3 Allegiance Health Services 1 Allegiance Health Services 205 N East Avenue Jackson MI 49201 382756428 Exempt Health System MI 501(c)(3) Line 11b, II N/A 0 Allegiance Health Foundation 205 N East Avenue Jackson MI 49201 383607833 Exempt Foundation MI 501(c)(3) Line 11a, I Allegiance Health Services 1 Hospice of Jackson dba Allegiance Hospice 205 N East Avenue Jackson MI 49201 382336367 Hospice Care MI 501(c)(3) Line 7 Heathlink 1 The Hospice of Jackson Endowment Fund One Jackson Square Jackson MI 49201 383422146 Raise Funds for Allegiance Hospice MI 501(c)(3) Line 11c, III-FI Allegiance Hospice 1 Healthlink 205 N East Avenue Jackson MI 49201 382756425 Home Health Care MI 501(c)(3) Line 11a, I Allegiance Health Services 1 Physicians Health Plan of South Michigan One Jackson Square Jackson MI 49201 383311905 Exempt HMO MI 501(c)(4) Allegiance Health Services 1 Michigan Imaging Services 205 N East Avenue Jackson MI 49201 382895225 Medical Imaging MI 501(c)(3) Line 11a, I Allegiance Health Services 1 South Central Practice Association 205 N East Avenue Jackson MI 49201 383309805 Idle Organization MI 501(c)(3) Line 11a, I Allegiance Health Services 1 Allegiance Health Volunteers 205 N East Avenue Jackson MI 49201 386082835 Exempt Association MI 501(c)(3) Line 11d, III-O Allegiance Health Services 1 Jackson Community Medical Records 205 N East Avenue Jackson MI 49201 371502443 Electronic Medical Records MI WA Foote Memorial Hospital Unrelated 0 0 Foote Health Center Associates 1100 E Michigan Avenue Jackson MI 49201 383017711 Lessor of Medical Condominiums MI WA Foote Memorial Hospital Related 0 0 Physicians Choice Network Inc 205 N East Avenue Jackson MI 49201 382594857 Physician Rental Network MI N/A C Viking Health System Inc 205 N East Avenue Jackson MI 49201 382756161 Idle Healthcare Administration Corporation MI N/A C Cascades Insurance Company LTD 205 N East Avenue Jackson MI 49201 382027689 Hospital Malpractice Insurance Captive CJ N/A C Cascades Professional Staffing Corporation 205 N East Avenue Jackson MI 49201 383370242 Idle Staffing Corporation MI N/A C 0 0 0 0 1 0 0 0 1 0 1 1 0 1 0 0 0 0 WA Foote Memorial Hospital I 243795 FMV WA Foote Memorial Hospital K 518635 FMV WA Foote Memorial Hospital L 6570000 FMV WA Foote Memorial Hospital E 600000 FMV