2012-11-14T19:57:28-06:00 2011-12-31 861065772 DELOITTE TAX LLP 200 RENAISSANCE CENTER SUITE 3900 DETROIT MI 48243 990 2011-01-01 381426919 BOTSFORD GENERAL HOSPITAL BOTS 2484718157 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 REGINA DOXTADER 2484718157 2012-11-14 1 LORI BOYCE P00121981 3133963000 2011 2016-02-24 21:20:13Z BOTSFORD HOSPITAL PAUL LACASSE 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 315141593 0 X BOTSFORD.ORG X 1944 MI COMMITMENT TO EXCELLENCE AND QUALITY IN THE DELIVERY OF PERSONAL AND COMPASSIONATE HEALTH CARE. 20 17 2812 318 2179460 -540314 1121293 842254 295231767 294723615 2659029 2510925 4232373 5839308 303244462 303916102 15516427 17732329 0 0 132618263 132012867 0 0 188429 144067546 141601677 292202236 291346873 11042226 12569229 245182324 252905138 152516912 166424592 92665412 86480546 X COMMITMENT TO EXCELLENCE AND QUALITY IN THE DELIVERY OF PERSONAL AND COMPASSIONATE HEALTH CARE. 0 0 209929673 271286406 PATIENT SERVICES: THE CORPORATION OPERATES A HOSPITAL FACILITY LICENSED FOR 330 BEDS, AND PROVIDES INPATIENT HOSPITAL SERVICES AS WELL AS A WIDE RANGE OF OUTPATIENT SERVICES. THE SERVICES ARE PROVIDED AT THE HOSPITAL FACILITY AND AT VARIOUS OFF-SITE FACILITIES WITHIN A SIX MILE RADIUS OF THE MAIN CAMPUS, SERVING THE NEEDS OF RESIDENTS OF SOUTHERN OAKLAND COUNTY AND NORTHERN WAYNE COUNTY. THE CORPORATION ALSO OPERATES A NETWORK OF PRIMARY CARE AND SPECIALTY PHYSICIAN PRACTICES, KNOWN AS THE BOTSFORD CLINIC SYSTEM, AT 24 OFFICE SITES. THERE WERE 16,364 ADMISSIONS TO THE HOSPITAL FOR A TOTAL OF 78,088 PATIENT DAYS. THERE WERE 61,051 EMERGENCY ROOM VISITS AND 9,280 SURGERIES. THERE WERE 2,990,895 LABORATORY PROCEDURES AND 126,579 OUTPATIENT THERAPY UNITS PROVIDED. 21258355 CHARITY CARE AND BAD DEBT: BOTSFORD HOSPITAL PROACTIVELY ADDRESSES ISSUES THAT AFFECT ACCESSIBILITY, FINANCING, AND DELIVERY OF HEALTH CARE TO ALL PEOPLE, PARTICULARLY THE UNINSURED, UNDERINSURED, AND THE UNDERSERVED. THE HOSPITAL PROVIDED APPROXIMATELY $21.3 MILLION IN UNCOMPENSATED CARE DURING THE FISCAL YEAR ENDING 12/31/11. 16653910 16653910 15729862 MEDICAL EDUCATION: OSTEOPATHIC MEDICAL EDUCATION AND CLINICAL TRAINING IS AN IMPORTANT COMPONENT OF THE MISSION OF THE CORPORATION. THE CORPORATION IS APPROVED FOR PRE-GRADUATE AND POST-GRADUATE PHYSICIAN TRAINING. THE AMERICAN OSTEOPATHIC ASSOCIATION APPROVES THE HOSPITAL FACILITY FOR TWENTY SPECIALTY AND SUB-SPECIALTY RESIDENCY PROGRAMS. CURRENTLY, THERE ARE 164 POST GRADUATE RESIDENTS. THE MAJOR EMPHASIS IN POST-DOCTORAL TRAINING IS IN THE PRIMARY CARE AREAS, WITH RESIDENCY PROGRAMS AND TEACHING CURRICULUMS ESTABLISHED IN FAMILY MEDICINE, INTERNAL MEDICINE, AND OBSTETRICS AND GYNECOLOGY. SPECIALTY TRAINING PROGRAMS ARE ALSO CONDUCTED. 6488319 984458 9101091 INCLUDED IN OTHER PROGRAM SERVICES IS BOTSFORD CENTER FOR HEALTH IMPROVEMENT IN NOVI, MICHIGAN, AND THE BOTSFORD OUTPAIENT PHARMACY LOCATED IN FARMINGTON HILLS, MICHIGAN. 6488319 984458 9101091 254330257 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0 1 0 0 1 0 1 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 0 0 1 384 0 1 2812 1 1 1 0 0 0 0 1 1 0 0 0 0 X 20 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X REGINA DOXTADER 2484718157 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 X JOHN ANHUT 1.00 X 2400 0 0 STEVEN BARNABY 1.00 X 5900 1000 0 JEANNE CARLSON 1.00 X 2050 0 0 GERSON COOPER 1.00 X 4100 5800 0 RAYMOND DZENDZEL 1.00 X 1900 1000 0 WILLIAM HARTSOCK 1.00 X 2500 0 0 RUDOLPH HOBBS 1.00 X 1700 0 0 EDWARD HODGES 1.00 X 2700 0 0 DEBORAH LAMM 1.00 X 900 0 0 ED LONIEWSKI 1.00 X 2200 200 0 HARRIS MAINSTER 1.00 X 2500 1000 0 KEN MASSEY 1.00 X 2150 0 0 MAX MCKINNEY 1.00 X 21284 0 0 MICHAEL REBOCK 1.00 X 1600 0 0 DANIEL SCHIFFER 1.00 X 2850 1200 0 MARK SCHOSTAK 1.00 X 1500 0 0 JACQUELINE SHADKO 1.00 X 2100 0 0 DAVID SUSSER 1.00 X 2450 1000 0 JACK WAYNE 1.00 X 2900 0 0 PAUL LACASSE 40.00 X X 583164 0 37383 DAVID MARCELLINO 40.00 X 392195 0 34284 LISA VANDECAVEYE 40.00 X 316359 0 36224 MARGO GORCHOW 40.00 X 222748 0 21553 DAVID WALTERS 40.00 X 346372 0 36761 BARBARA PALMER 40.00 X 241206 0 20765 REGINA DOXTADER 40.00 X 225962 0 35486 MARGARET HASLER 40.00 X 233568 0 21124 RONALD SZUMSKI 40.00 X 223272 0 36302 WILLIAM SCHEUBER 40.00 X 183840 0 31539 ADAM COOPER 40.00 X 354049 0 35355 ANDREW CYKIERT 40.00 X 427759 0 37725 RICHARD HERMAN 40.00 X 375056 0 36027 GILBERT HERMAN 40.00 X 334293 0 34987 BEN ROSSI 40.00 X 399778 0 26001 4925305 11200 481516 124 0 1 0 ACS CONSULTANT COMPANY PO BOX 201322 DALLAS TX 75320 INFORMATION TECHNOLOGY SERVICES 13020142 SODEXHO INC PO BOX 70060 CHICAGO IL 60673 ENVIRONMENTAL & DIETARY SERVICES 11177938 CONTRACTING RESOURCES INC 403 EGRAND RIVER AVE BRIGHTON MI 48116 CONSTRUCTION SERVICES 2822132 FARMINGTON MRT INC 30000 NORTHWESTERN HWY FARMINGTON HILLS MI 48334 CANCER CENTER MGMNT & STAFFING 2593788 INTEGRATED MOBILE IMAGING 363 WBIG BEAVER RD TROY MI 48084 M.R.I. IMAGING SERVICES 1190045 84 137197 677082 27975 148885 842254 PATIENT SERVICES 621990 273465866 271286406 2179460 MEDICAL EDUCATION 621990 15729862 15729862 5527887 5527887 294723615 1868977 1868977 1489191 1621250 -132059 -132059 -132059 9276259 104996 8318437 420870 957822 -315874 641948 -7271 649219 26393 137197 127354 -100961 -100961 833358 737580 95778 95778 EMPLOYEE SERVICES 900099 1897708 1897708 MEDICAID E.M.R. INCENT 900099 1042099 1042099 CAPTIVE PREMIUM REV 900099 908458 908458 2128285 640668 1487617 5976550 303916102 296117359 2179460 4777029 984458 984458 16653910 16653910 93961 93961 3345791 18534 3266182 61075 105908404 99408732 6499672 2863170 2548221 314949 11923454 11765883 157571 7972048 6961986 1010062 559625 500000 59625 476431 476431 234612 234612 68725 68725 33360668 30780588 2580080 1721735 21556 1700179 7762298 4645453 2989491 127354 9446531 195002 9251529 6642807 5656937 985870 1488001 1161368 326633 2173170 2060296 112874 11676094 9763121 1912973 2183854 405008 1778846 MEDICAL SUPPLIES 37177600 36812966 364634 UNCOMPENSATED CARE 21258355 21258355 EQUIPMENT RENTAL & MAIN 5374610 2633922 2740688 UBI TAX (FED & STATE) -3439 -3439 291346873 254330257 36828187 188429 22019302 23676234 22341427 23406450 4878762 4138283 3900619 3635291 243503369 149693685 92642004 93809684 53040270 53943380 155877 46204063 50295816 245182324 252905138 27406959 37354439 41479041 38845127 3193468 3223222 30299133 26990706 50138311 60011098 152516912 166424592 X 92665412 86480546 92665412 86480546 245182324 252905138 X 12569229 -18754095 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 68725 68725 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DUES PAID TO MICHIGAN HOSPITAL ASSOCIATION IN THE AMOUNT OF $105,781. PER THE MICHIGAN HOSPITAL ASSOCIATION, 13.92% OF THEIR BUDGET SUPPORTS LOBBYING ACTIVITIES. TOTAL OF $14,725. PARTICIPATION FEES FOR SECTION 508 HOSPITAL COALITION WERE $54,000. 0 1 2838687 2838687 133214170 72779140 60435030 3446606 2923910 522696 99987309 71786610 28200699 4016597 2204025 1812572 93809684 CONSTRUCTION IN PROGRESS 15673107 DEBT SERVICE AND PROJECT FUND 988918 PROFESSIONAL LIABILITY FUND 11886598 INVESTMENT AND RECEIVABLES FROM AFFILIATES 1637971 FICA RECOVERY FUND 1831680 457 PLAN ASSETS 3991718 OTHER RECEIVABLES 5041943 AWUIL CAPTIVE PROF LIABILITY FUND 5650540 MISCELLANEOUS 2840565 BOND ISSUE COSTS 752776 50295816 ACCRUED PENSION COST 32131229 DUE TO AFFILIATES 188215 PROFESSIONAL LIABILITY & OTHER CLAIMS 24370318 EST.THIRD- PARTY PAYOR SETTLEMENTS 3321336 60011098 PART IV, LINE 2B: THE ORGANIZATION REFLECTS AN AMOUNT AS BOTH AN ASSET AND LIABILITY RELATING TO RESIDENT FICA RECOVERY FUNDS. SCHEDULE D, PART X: UNSECURED PAYABLES TO RELATED ORGANIZATIONS - THE FOLLOWING REFLECTS BALANCES OWED TO RELATED ORGANIZATIONS AS OF DECEMBER 31, 2011: DUE TO COMMUNITY EMERGENCY MEDICAL SERVICES, INC. - $70,933 DUE TO PARASTAR - $48,741 DUE TO ZIEGER HEALTH CARE CORPORATION - $68,541 SCHEDULE D, PART X: OTHER AMOUNTS REFLECT LIABILITIES FOR DEFINED BENEFIT AND DEFINED CONTRIBUTION PLANS, PROFESSIONAL LIABILITY CLAIMS AND ESTIMATED THIRD PARTY SETTLEMENTS. 0 CENTRAL AMERICAN AND CARRIBEAN INVESTMENT 5650540 CENTRAL AMERICAN AND CARRIBEAN 0 0 PROGRAM SERVICES HEALTH CARE SERVICES 93961 0 0 0 0 0 0 5744501 0 5744501 GUATEMALA MEDICAL MISSION ANTIGUA, GUATEMALA 2975 93961 VOLUNTEER TIME AND MEDICAL SUPPLIES. FMV 0 0 1 0 0 0 PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U.S.: SCHEDULE F, PART I, LINE 2: LINE 1: THE ORGANIZATION DOES NOT MAKE GRANTS TO FOREIGN ORGANIZATIONS, GOVERNMENTS OR INDIVIDUALS. THE DIRECTOR OF MEDICAL ADMINISTRATION OVERSEES THE ARRANGEMENTS FOR VOLUNTEERS TO TRAVEL TO GUATEMALA. EXPLANATION FOR ESTIMATED NUMBER OF RECIPIENTS: SCHEDULE F, PART III, COL (C): IN MARCH OF 2011, A GROUP OF VOLUNTEER RESIDENTS AND INTERNS FROM BOTSFORD HOSPITAL, AN OSTEOPATHIC HOSPITAL IN FARMINGTON HILLS, MI, DONATED TIME AND EFFORT TO BRING MUCH NEEDED MEDICAL CARE TO THE PEOPLE OF ANTIGUA, GUATEMALA. DURING THIS MEDICAL MISSION, MEDICAL PERSONNEL TREATED NEWBORNS, THE ELDERLY, AND EVERYONE IN BETWEEN. MEDICAL PERSONNEL ADDRESSED THEIR HEALTH ISSUES RANGING FROM SIMPLE RASHES TO LIFE-THREATENING INFECTIONS. TO MOST OF THE POPULATION, OUR MEDICAL PERSONNEL WERE THE FIRST MEDICAL PROFESSIONALS THAT THEY ENCOUNTERED IN THEIR LIVES, BUT HOPEFULLY NOT THE LAST. THIS IS AN ANNUAL PROGRAM AND INCOME FROM SPECIAL FUNDRAISING EVENTS IS USED TO PAY FOR EXPENSES. ALL EXCESS FUNDRAISING INCOME FOR THIS PROGRAM FROM A PRIOR YEAR IS USED TO OFFSET EXPENSES FOR A FUTURE YEAR. BOTSFORD MEDICAL STAFF GOLF OUTING 74057 48782 25275 2382 29663 411 GUATEMALA MEDICAL MISSION 84072 84072 93961 1 5461 4343 1118 937 163590 137197 26393 2382 29663 95309 127354 -100961 1 1 X 0 0 1 1 0 0 2643214 2643214 0.00960 39124364 27921959 11202405 0.04050 41767578 27921959 13845619 0.05010 403661 65833 337828 0.00120 17170879 10229930 6940949 0.02510 193397 193397 0.00070 17767937 10295763 7472174 0.02700 59535515 38217722 21317793 0.07710 20812 20812 0.00010 79946 79946 0.00030 100758 100758 0.00040 1 6343575 123563987 106312403 17251584 X 1 1 1 1 BOTSFORD HOSPITAL

28050 GRAND RIVER FARMINGTON HILLS MI 48336

X X X X BOTSFORD GENERAL HOSPITAL 1 1 0 0 1 X X X X X 1 1 X X 1 0 1 X 0 0 21 MIDWEST INTERNAL MEDICINE ASSOCIATES

20317 FARMINGTON LIVONIA MI 48152

PHYSICIAN CLINIC BOTSFORD PEDIATRICS

23133 ORCHARD LAKESUITE 100 FARMINGTON MI 48335

PHYSICIAN CLINIC FARMINGTON VILLAGE FAMILY PRACTICE

32754 GRAND RIVER FARMINGTON MI 48335

PHYSICIAN CLINIC BOTSFORD CENTER FOR REHAB-INFINITY

28455 HAGGERTY NOVI MI 48377

PHYSICIAN CLINIC BOTSFORD PROFESSIONAL CENTER SOUTH

28100 GRAND RIVER FARMINGTON HILLS MI 48336

OUTPATIENT PHARMACY BOTSFORD PODIATRY CLINIC & PRIMARY CARE

27031 WARREN DEARBORN HEIGHTS MI 48127

PHYSICIAN CLINIC ESSENTIAL OBGYN

35125 GRAND RIVER FARMINGTON HILLS MI 48335

PHYSICIAN CLINIC BOTSFORD MEDICAL CENTER

15540 BEECH DALY REDFORD MI 48240

PHYSICIAN CLINIC BOTSFORD WELLNESS COMPLEX

39830 GRAND RIVER NOVI MI 48377

HEALTH & REHAB CENTER BOTSFORD CENTER FOR GERIATRIC REHAB

21450 ARCHWOOD FARMINGTON HILLS MI 48336

PHYSICIAN CLINIC BOTSFORD PROFESSIONAL CENTER NORTH

28080 GRAND RIVER FARMINGTON HILLS MI 48336

GENERAL MEDICAL & SURGICAL BRENTWOOD MEDICAL CENTER

28711 W 8 MILE LIVONIA MI 48152

PHYSICIAN CLINIC COMP OBGYN- NOVI

39475 LEWIS DR SUITE 140 NOVI MI 48377

PHYSICIAN CLINIC FAIRWOOD FAMILY PRACTICE

27015 WARREN DEARBORN HEIGHTS MI 48127

PHYSICIAN CLINIC BOTSFORD FAMILY PRACTICE

28481 SEVEN MILE ROAD LIVONIA MI 48152

PHYSICIAN CLINIC SOUTH REDFORD SCHOOL BASED HEALTH CENTER

25605 ORANGELAWN REDFORD MI 48239

PHYSICIAN CLINIC BOTSFORD DERMATOLOGY RESIDENT CLINIC

21141 MIDDLEBELT FARMINGTON HILLS MI 48336

PHYSICIAN CLINIC BOTSFORD CANCER CENTER AND BREAST IMAGIN

27900 GRAND RIVER FARMINGTON HILLS MI 48336

GENERAL MEDICAL & SURGICAL CENTER FOR NEUROREACTIVE MEDICINE

39830 GRAND RIVERSUITE B-3 NOVI MI 48375

PHYSICIAN CLINIC BOTSFORD CANCER CENTER AND BREAST IMAGIN

27900 GRAND RIVER FARMINGTON HILLS MI 48336

PHYSICIAN CLINIC VALLEY HILL THERAPY CENTER

26905 GRAND RIVER REDFORD MI 48240

OUTPATIENT THERAPY PART I, LINE 3C: BOTSFORD HOSPITAL USES AN ABILITY TO PAY (ATP) MODEL TO DETERMINE FINANCIAL ASSISTANCE. VARIABLES USED IN THE ATP MODEL INCLUDE ZIP CODE, ESTIMATED HOUSEHOLD INCOME, ESTIMATED HOUSEHOLD SIZE, ESTIMATED MORTGAGE VALUE, ESTIMATED MORTGAGE BALANCE, ESTIMATED CREDIT LINES VALUE, ESTIMATED CREDIT BALANCES AND ESTIMATED MONTHLY OBLIGATIONS. THE ATP MODEL USES A POINT SCALE ON FIVE FACTORS, USING THE VARIABLES ABOVE, THAT ARE BOTH INCOME AND ASSET BASED TO CALCULATE AN OVERALL SCORE. THE OVERALL SCORE DETERMINES THE DISCOUNT TO BE APPLIED. PART I, LINE 7, COLUMN (F):$14,986,145 OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE TOTAL EXPENSE FIGURE IN CALCULATING THE COST TO CHARGE RATIO THAT IS USED TO DETERMINE THE PERCENT OF COMMUNITY BENEFIT EXPENSE ON SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II: BOTSFORD HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITIES IN WHICH IT SERVES IN A NUMBER OF DIFFERENT WAYS. THE CEO & PRESIDENT, CORPORATE VP OF MARKETING AND COMMUNITY HEALTH COORDINATOR LEAD MANY BOTSFORD EMPLOYEES IN THE PARTICIPATION AND INVOLVEMENT OF NUMEROUS COMMUNITY MEETINGS AND EVENTS. MEETINGS AND EVENTS THAT BOTSFORD STAFF HAVE ATTENDED INCLUDE: COMMISSION ON CHILDREN'S ISSUES, FARMINGTON PUBLIC SCHOOLS PARTNERSHIP, HEALTHY PARTNERS, HEALTHY COMMUNITY INITIATIVE, GREATER DETROIT AREA HEALTH COUNCIL, SAVE LIVES / SAVE DOLLARS, HEALTH CARE FORUMS AND CHAMBER OF COUNCIL MEETINGS OF FARMINGTON, FARMINGTON HILLS, REDFORD AND SOUTHFIELD. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS DETERMINED BASED ON HISTORICAL LOSS RATE FACTORS AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF IN THE PERIOD THAT THEY ARE DEEMED UNCOLLECTIBLE. PART III, LINE 8: COSTING METHODOLOGY IS COST TO CHARGE RATIO. PART III, LINE 9B: THE GUARANTOR/PATIENT'S ACCOUNT WILL AUTOMATICALLY BE REVIEWED FOR FINANCIAL ELIGIBILITY UNDER BOTSFORD'S FINANCIAL ASSISTANCE PROGRAM. THE PROGRAM IS ADMINISTERED THROUGH THE SYSTEM BUSINESS OFFICE AND AUTOMATICALLY REVIEWS EVERY SELF-PAY ACCOUNT BALANCE IN EXCESS OF AN ANNUALLY-PREDETERMINED "FAIR SHARE CONTRIBUTION" WHICH WILL REMAIN THE PATIENT'S RESPONSIBILITY. BOTSFORD'S PROGRAM ALSO ALLOWS FOR A CATASTROPHIC CAP, NOT TO EXCEED THAT OF $10,000 FOR ANY SELF-PAY PATIENT ACCOUNT BALANCE. THE PROGRAM IS AUTOMATIC, HAS EXTENSIVE USE OF CREDIT BUREAU REPORTING DATA, AND DOES NOT REQUIRE THE PATIENT TO SUPPLY ANY PERSONAL FINANCIAL INFORMATION.CHARITY CARE PROGRAM- THIS PROGRAM IS DESIGNED TO GIVE PRORATED DISCOUNTS TO QUALIFIED UNINSURED PATIENTS, BASED ON THEIR INCOME, ASSETS AND FINANCIAL NEEDS.- ALL SELF-PAY BALANCES WILL BE REVIEWED TO DETERMINE IF THE PATIENT MAY QUALIFY FOR REDUCTION OF THE BALANCE OWED, BASED ON OUR CHARITABLE PROGRAM GUIDELINES. - ALL PATIENTS WHO QUALIFY WILL BE RESPONSIBLE TO MAKE A FAIR CONTRIBUTION TOWARDS THEIR BALANCE, NOT TO EXCEED $10,000 FOR HOSPITAL ACCOUNTS THAT ARE FOUND TO BE ELIGIBLE UNDER THIS PROGRAM. TOTAL AMOUNT DUE IS BASED ON THE APPROVED CHARITY PERCENTAGE DETERMINATIONS.PART V, LINE 9 SEE DESCRIPTION FOR PART I, LINE 3C. PART V, LINE 10 SEE DESCRIPTION FOR PART I, LINE 3C.PART V, LINE 11H SEE DESCRIPTION FOR PART I, LINE 3C.PART V, LINE 13G: PATIENT REGISTRATION REPRESENTATIVES, FINANCIAL COUNSELORS, CENTRAL SCHEDULING REPRESENTATIVES, PRE-ARRIVAL REPRESENTATIVES AND CUSTOMER SERVICE REPRESENTATIVES ARE EDUCATED ON THE FINANCIAL ASSISTANCE POLICY AND COMMUNICATE INFORMATION ON THE POLICY TO PATIENTS DURING ALL CONTACTS. PART V, LINE 19D: UNDER THE FINANCIAL ASSISTANCE POLICY, ALL HOSPITAL PAY BALANCES IN EXCESS OF $10,000 (OR $1,000 FOR CLINIC AND OUTREACH LABORATORY CLAIMS) AUTOMATICALLY QUALIFY FOR A CATASTROPHIC CAP DISCOUNT, WHICH LIMITS PATIENT RESPONSIBILITY TO NO MORE THAN $10,000 PER CLAIM ($1,000 FOR CLINIC AND LAB). PART VI, LINE 2: BOTSFORD HOSPITAL SEEKS TO IMPROVE THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH STATUS OF THE COMMUNITIES IT SERVES. THE HOSPITAL BELIEVES THAT WHEN PEOPLE HAVE ACCESS TO HEALTH CARE AND ARE EDUCATED REGARDING LIFESTYLE BEHAVIORS, THEY HAVE AN IMPROVED CHANCE OF LIVING A HEALTHY LIFE. TO THAT END, THE HOSPITAL DEVELOPS AND OFFERS A WIDE-RANGE OF HEALTH SERVICES, EDUCATION AND SCREENINGS. BOTSFORD HOSPITAL ENGAGES IN PARTNERSHIPS WITH GROUPS, SYSTEMS AND AGENCIES THROUGHOUT THE COMMUNITIES IT SERVES TO ASSESS ITS IMPACT ON ACHIEVING ITS GOALS. AMONG THE CONTRIBUTIONS THE HOSPITAL CONSIDERS WHEN ASSESSING ITS NON-PROFIT STATUS ARE THE DELIVERY OF FREE AND REDUCED PATIENT CARE, CARE OF THE ELDERLY AND INDIGENT, PATIENT EDUCATION AND HEALTH AWARENESS PROGRAMS FOR THE COMMUNITY, AND MEDICAL EDUCATION. ADDITIONALLY, THE HOSPITAL DELIVERS ALL OF THESE HEALTH CARE SERVICES TO PEOPLE IN THE COMMUNITY WITHOUT REGARD TO RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS OR ABILITY TO PAY.THE OPENING OF THE BOTSFORD CANCER CENTER IN 2009 IS A SPECIFIC EXAMPLE OF HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. IN 2005, A REVIEW OF BOTSFORD'S CANCER PATIENTS INDICATED A SIGNIFICANT NEED. THE ASSESSMENT IDENTIFIED THAT CANCER IS THE SECOND LEADING CAUSE OF DEATH IN BOTSFORD'S HOME COUNTIES, AND IS MOST PREVALENT IN PEOPLE OVER 55, WHICH IS SIGNIFICANT IN LIGHT OF THE AGING POPULATION. A REVIEW OF BOTSFORD'S PATIENT STATISTICS FOR 2003 AND 2004 SHOWED ALMOST 700 NEW CANCER CASES DIAGNOSED AT BOTSFORD ANNUALLY AND OVER 2,000 VISITS BY PATIENTS WITH PRIMARY OR SECONDARY CANCER DIAGNOSES. ADDITIONALLY, WAYNE AND OAKLAND COUNTIES REPORTED DEATHS DUE TO CANCER RELATED ILLNESSES OF 4,007 AND 2,062, RESPECTIVELY IN 2004. TO ADDRESS THE NEED TO CARE FOR THESE CANCER PATIENTS, BOTSFORD'S BOARD OF DIRECTORS DECIDED TO BUILD A CANCER CENTER. THE BOTSFORD CANCER CENTER WAS OPENED IN EARLY 2009.IN 2010 BOTSFORD RECEIVED TRAUMA CENTER VERIFICATION. BOTSFORD IS ONE OF ONLY EIGHT TRAUMA LEVEL II CENTERS IN MICHIGAN, ONE OF ONLY THREE TRAUMA CENTERS IN OAKLAND COUNTY AND THE ONLY ONE IN THE WESTERN PART OF OAKLAND COUNTY. BOTSFORD RECEIVED VERIFICATION AS A LEVEL II TRAUMA CENTER FROM THE AMERICAN COLLEGE OF SURGEONS (ACS) EFFECTIVE JANUARY 26, 2010. AS A LEVEL II TRAUMA CENTER, BOTSFORD IS EXPECTED TO PROVIDE INITIAL, DEFINITIVE TRAUMA CARE, REGARDLESS OF THE SEVERITY OF INJURY. THIS NEW CLINICAL DEPARTMENT PROVIDES THE HIGHEST LEVEL OF CARE FOR CRITICALLY INJURED PATIENTS IN BOTSFORD HOSPITALS SURROUNDING COMMUNITIES. PART VI, LINE 3: BOTSFORD HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS, WHO MAY BE BILLED FOR PATIENT CARE, ABOUT THEIR ELIGIBILITY FOR ASSISTANCE IN A NUMBER OF WAYS. A FEW OF THE COMMUNICATIONS INCLUDE A BROCHURE WITHIN THE PATIENT FOLDER WHICH IS GIVEN TO EVERY PATIENT ADMITTED TO THE HOSPITAL, A TOPIC IDENTIFIED IN THE FAQS WITHIN THE WWW. BOTSFORD.ORG WEBSITE RELATING TO ONLINE PAYMENTS AND BROCHURES MADE AVAILABLE AT ALL OF THE ORGANIZATION'S PATIENT SERVICE LOCATIONS INFORMING PATIENTS ON HOW TO OBTAIN INFORMATION ON ELIGIBILITY FOR ASSISTANCE. PART VI, LINE 4: BOTSFORD HOSPITAL IS LOCATED IN OAKLAND COUNTY AND SERVES COMMUNITIES IN BOTH OAKLAND AND WAYNE COUNTY. THE 2011 UNEMPLOYMENT RATE IN MICHIGAN OVERALL (ACCORDING TO THE MI DEPARTMENT OF ENERGY, LABOR AND ECONOMIC GROWTH) IS 8.3%, WHILE WAYNE COUNTY HAS AN UNEMPLOYMENT RATE OF 10.5% AND OAKLAND COUNTY HAS AN UNEMPLOYMENT RATE OF 8.1%.BOTSFORD HOSPITAL SERVES FOUR COMMUNITIES IN ITS PRIMARY SERVICE AREA; FARMINGTON/FARMINGTON HILLS, LIVONIA, REDFORD AND SOUTHFIELD. THE FARMINGTON/FARMINGTON HILLS AREA HAS A POPULATION OF 85,272 WITH A MEDIAN AGE OF 42.8 AND A MEDIAN HOUSE-HOLD INCOME OF $69,482. THE LIVONIA AREA HAS A POPULATION OF 85,557 WITH A MEDIAN AGE OF 44.7 AND A MEDIAN HOUSE-HOLD INCOME OF $66,537. THE REDFORD AREA HAS A POPULATION OF 136,336 WITH A MEDIAN AGE OF 36.5 AND A MEDIAN HOUSE-HOLD INCOME OF $42,623. THE SOUTHFIELD AREA HAS A POPULATION OF 108,713 WITH A MEDIAN AGE OF 40.8 AND A MEDIAN HOUSE-HOLD INCOME OF $51,934. BOTSFORD HOSPITAL HAS TWO SECONDARY SERVICE AREAS. COMMUNITIES IN OUR SOUTHEAST SECONDARY AREA INCLUDE AREAS OF DETROIT, WESTLAND, GARDEN CITY AND DEARBORN HEIGHTS. IN TOTAL, THE ZIP CODES WE SERVE HAVE A POPULATION OF 459,212 WITH A MEDIAN AGE OF 36.5 AND A MEDIAN HOUSE-HOLD INCOME OF $37,749. COMMUNITIES IN OUR NORTHWEST SECONDARY AREA INCLUDE AREAS OF WIXOM, WALLED LAKE, NOVI, WEST BLOOMFIELD, CANTON, PLYMOUTH, NORTHVILLE AND NEW HUDSON. IN TOTAL, THE ZIP CODES WE SERVE HAS A POPULATION OF 287,221 WITH A MEDIAN AGE OF 39.8 AND A MEDIAN HOUSE-HOLD INCOME OF $78,607. PART VI, LINE 5: PART VI, LINE 5: BOTSFORD HOSPITAL HAS AN OPEN MEDICAL STAFF MODEL AND OUR BOARD IS COMPRISED OF MEMBERS OF THE COMMUNITY. THE HOSPITAL ALSO HAS A NATIONALLY RENOWNED MEDICAL EDUCATION (D.O.) PROGRAM OFFERING 20 DIFFERENT SPECIALTIES. BOTSFORD HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITIES IN WHICH IT SERVES THROUGH NUMEROUS OUTREACH ACTIVITIES.THESE ACTIVITIES INCLUDE: CHRONIC DISEASE MANAGEMENT AND EDUCATION THAT ADDRESSES DIABETES, CARDIAC HEALTH, HYPERTENSION, PULMONARY DISEASE AND OBESITY; COMPREHENSIVE LIFESTYLE BEHAVIOR EDUCATION AND INITIATIVES FOCUSED ON HEALTH RISK AND SUBSCRIBING TO THE HHS HEALTHY PEOPLE 2011 GOALS AND THE STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH GOALS. THIS EFFORT ALSO INCLUDES COMPREHENSIVE COLLABORATION EFFORTS WITH LOCAL SCHOOL DISTRICTS ADDRESSING AT-RISK BEHAVIORS IN THE SCHOOL-AGE POPULATION.CONSUMER HEALTH RESOURCES SERVICES PROVIDED BY A MEDICAL LIBRARY AND WEBSITE, AND A QUARTERLY MAGAZINE, HEALTHSOURCE.HEALTH SCREENINGS IN MULTIPLE PUBLIC VENUES THAT INCLUDE TESTING FOR HYPERTENSION, CHOLESTEROL, FOOT DISORDERS, SKIN CANCER, BLOOD GLUCOSE, BONE DENSITY AND BODY FAT.MATERNAL-CHILD HEALTH EDUCATION THAT INCLUDES CHILDBIRTH, BABY CARE, BREAST-FEEDING, PARENTING, GRAND-PARENTING, AND BI-LINGUAL PROGRAMS FOR JAPANESE SPEAKING COMMUNITY MEMBERS.SENIOR RESOURCE PROGRAM THAT INCLUDES EDUCATION, REFERRAL AND SOCIAL ACTIVITIES.SUPPORT GROUP SYSTEM THAT INCLUDES ADDICTIONS, ALZHEIMER'S, CARDIOLOGY, CLOSED HEAD INJURY, STROKE SURVIVORS, GRIEF SUPPORT AND CARE GIVING.WEIGHT, NUTRITION AND FITNESS PROGRAMMING.BOTSFORD ALSO PARTICIPATES IN MANY CHARITABLE PROGRAMS IN THE COMMUNITIES IS SERVES THROUGH DIRECT FINANCIAL CONTRIBUTION, IN-KIND SUPPORT, AND TIME AND RESOURCES. THE HOSPITAL PROMOTES NUMEROUS FUNDRAISING EVENTS WITH BOTSFORD STAFF OR WITH FINANCIAL SUPPORT. PART VI, LINE 6: BOTSFORD HOSPITAL IS PART OF THE BOTSFORD HEALTH CARE (BHC) SYSTEM. THE MISSION OF BHC IS TO ADVANCE HEALTH IN THE COMMUNITIES IT SERVES. THE MISSION INCORPORATES CARING, COMMUNITY INVOLVEMENT, RESEARCH, EDUCATION AND LEADERSHIP. BHC'S VISION IS TO BE A STRONG INDEPENDENT SYSTEM OF HEALTH CARE, KNOWN FOR PROVIDING EXCELLENT CUSTOMER SERVICE, SUPERIOR VALUE, AND COMMUNITY SUPPORT THROUGH A NETWORK OF HEALTH AND HEALTH-RELATED SERVICES WHICH DEMONSTRATE A DEDICATION TO OUR PHILOSOPHY AND MISSION, A COMMITMENT TO COLLABORATION, AND RESPONSIBILITY TO FUTURE GENERATIONS.THE THREE MAIN ORGANIZATIONS OF BHC INCLUDE BOTSFORD HOSPITAL, BOTSFORD CONTINUING CARE CORPORATION AND COMMUNITY EMERGENCY MEDICAL SERVICES. EACH OF THESE ORGANIZATIONS IS BRIEFLY DESCRIBED BELOW:BOTSFORD HOSPITAL IS LICENSED FOR 330 BEDS, AND PROVIDES INPATIENT HOSPITAL SERVICES AS WELL AS A WIDE RANGE OF OUTPATIENT SERVICES. THE SERVICES ARE PROVIDED AT THE HOSPITAL FACILITY AND AT VARIOUS OFF-SITE FACILITIES WITHIN A SIX MILE RADIUS OF THE MAIN CAMPUS, SERVING THE NEEDS OF RESIDENTS OF SOUTHERN OAKLAND COUNTY AND NORTHERN WAYNE COUNTY. BOTSFORD HOSPITAL ALSO OPERATES A NETWORK OF PRIMARY CARE AND SPECIALTY PHYSICIAN PRACTICES, KNOWN AS THE BOTSFORD CLINIC SYSTEM, AT 24 OFFICE SITES. OSTEOPATHIC MEDICAL EDUCATION AND CLINICAL TRAINING IS AN IMPORTANT COMPONENT OF THE MISSION OF BOTSFORD HOSPITAL. BOTSFORD HOSPITAL IS APPROVED FOR PRE-GRADUATE AND POST-GRADUATE PHYSICIAN TRAINING. THE AMERICAN OSTEOPATHIC ASSOCIATION APPROVES THE HOSPITAL FACILITY FOR TWENTY SPECIALTY AND SUB-SPECIALTY RESIDENCY PROGRAMS.BOTSFORD CONTINUING CARE CORPORATION IS MADE UP OF THREE MAIN SERVICES. THE FIRST IS A SKILLED NURSING FACILITY WITH 179 BEDS LOCATED IN FARMINGTON HILLS, MICHIGAN. THE SECOND SERVICE IS AN ASSISTED LIVING FACILITY WITH 63 BEDS ALSO LOCATED IN FARMINGTON HILLS, MICHIGAN. IT IS A SAFE AND SUPPORTIVE ENVIRONMENT FOR OLDER ADULTS NEEDING SOME ASSISTANCE WITH THEIR DAILY ROUTINE. EACH RESIDENTS' CARE IS CUSTOMIZED TO HIS OR HER INDIVIDUAL NEEDS TO PROVIDE SUPPORT AND ASSISTANCE WHILE MAINTAINING AND PROVIDING INDEPENDENCE. THE THIRD SERVICE IS AN INDEPENDENT LIVING APARTMENT WITH 51 UNITS ALSO LOCATED IN FARMINGTON HILLS, MICHIGAN. EACH APARTMENT IS WHEELCHAIR ACCESSIBLE, HAS 24 HOUR SECURITY SERVICES, ILLUMINATED THERMOSTATS AND INCLUDES EMERGENCY CALL SERVICE. ALL OF THESE SERVICES ARE BENEFICIAL TO THE ELDERLY POPULATION THAT WE SERVE.COMMUNITY EMERGENCY MEDICAL SERVICE (CEMS) PROVIDES AN ARRAY OF SERVICES FROM AMBULANCE SERVICE TO TRAINING AND EDUCATIONAL PROGRAMS FOR THE PUBLIC. CEMS PROVIDES MEDICAL DIRECTION AND TRANSPORTATION SUCH AS MOBILE INTENSIVE CARE UNITS, TRANSPORTING CRITICALLY ILL PATIENTS, NON-EMERGENCY VAN SERVICE, AND PROVIDING MEDICAL DIRECTION FOR 911 CALLERS. CEMS, THROUGH THE LIFE SUPPORT TRAINING INSTITUTE (LSTI), IS COMMITTED TO COMMUNITY INVOLVEMENT AND EDUCATION. LSTI PROVIDES TRAINING AND CERTIFICATION FOR PERSONS WHO WISH TO BECOME BASIC EMTS OR PARAMEDICS. THIS SERVICE IS PROVIDED TO MEMBERS OF THE GENERAL PUBLIC AND TO PERSONS WHO ARE EMPLOYED WITH A FIRE DEPARTMENT. LSTI IS ALSO AN AMERICAN HEART ASSOCIATION SITE THAT PROVIDES CPR TRAINING AND CERTIFICATION TO MEMBERS OF THE GENERAL PUBLIC. 1 FARMINGTON HILLS POLICE BENEVOLENT ASSOCIATION 31655 WEST ELEVEN MILE FARMINGTON HILLS MI 48336 383245831 501(C)(3) 5000 THE GRANT IS TO ASSIST THE FAMILIES OF FALLEN POLICE OFFICERS IN OUR COMMUNITY. BOTSFORD BELIEVES THAT WE SHOULD SUPPORT OUR LOCAL ORGANIZATIONS THAT NEED ASSISTANCE. THE ORGANIZATION RECEIVING THIS GRANT IS MONITORED THROUGH ACTIVE INVOLVEMENT OF BOTSFORD STAFF WITHIN THE FARMINGTON HILLS COMMUNITY. REDFORD CHILDREN'S ISSUES COMMISSION 12121 HEMINGWAY REDFORD MI 48239 383169773 501(C)(3) 6000 THE COMMISSION ON CHILDREN'S ISSUES HOSTS A VARIETY OF PROGRAMS AND SERVICES TO DETER JUVENILE DELINQUENCY WITHIN REDFORD TOWNSHIP. BOTSFORD BELIEVES THAT WE SHOULD SUPPORT OUR LOCAL ORGANIZATIONS THAT NEED ASSISTANCE. THE ORGANIZATION RECEIVING THIS GRANT IS MONITORED THROUGH ACTIVE INVOLVEMENT OF BOTSFORD STAFF WITHIN THE REDFORD COMMUNITY. ZIEGER HEALTH CARE CORPORATION 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 382500428 501(C)(3) 456651 FMV PAYMENT OF EXPENSES THIS IS AN INTERNAL GRANT GIVEN TO A RELATED 501C(3) ORGANIZATION. TO HELP SUPPORT THE MISSION OF THE BOTSFORD FOUNDATION THROUGH CASH AND PAYMENT OF EXPENSES. ZIEGER HEALTH CARE CORPORATION 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 382500428 501(C)(3) 126807 THIS IS AN INTERNAL GRANT GIVEN TO A RELATED 501C(3) ORGANIZATION TO HELP SUPPORT THE BOTSFORD FOUNDATION. BOTSFORD CONTINUING CARE CORPORATION 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 382549505 501(C)(3) 390000 THIS IS AN INTERNAL GRANT GIVEN TO A RELATED 501C(3) ORGANIZATION. TO HELP SUPPORT THE MISSION OF THE BOTSFORD CONTINUING CARE CORPORATION. 4 RESIDENT STIPENDS 170 16653910 SCHEDULE I, PART III: RESIDENT STIPENDS: OSTEOPATHIC MEDICAL EDUCATION AND CLINICAL TRAINING IS AN IMPORTANT COMPONENT OF THE MISSION OF THE CORPORATION. THE CORPORATION IS APPROVED FOR PRE-GRADUATE AND POST-GRADUATE PHYSICIAN TRAINING. THE AMERICAN OSTEOPATHIC ASSOCIATION APPROVES THE HOSPITAL FACILITY FOR TWENTY SPECIALTY AND SUB-SPECIALTY RESIDENCY PROGRAMS. CURRENTLY, THERE ARE 170 POST GRADUATE RESIDENTS. THE MAJOR EMPHASIS IN POST-DOCTORAL TRAINING IS IN THE PRIMARY CARE AREAS, WITH RESIDENCY PROGRAMS AND TEACHING CURRICULUMS ESTABLISHED IN FAMILY MEDICINE, INTERNAL MEDICINE, AND OBSTETRICS AND GYNECOLOGY. SPECIALTY TRAINING PROGRAMS ARE ALSO CONDUCTED. X X X X X 0 0 0 0 0 0 0 1 0 PAUL LACASSE 459628 0 81374 0 42162 0 14700 0 22683 0 620547 0 0 0 DAVID MARCELLINO 305435 0 56340 0 30420 0 14700 0 19584 0 426479 0 0 0 LISA VANDECAVEYE 240701 0 48085 0 27573 0 14604 0 21620 0 352583 0 0 0 MARGO GORCHOW 174567 0 30780 0 17401 0 11659 0 9894 0 244301 0 0 0 DAVID WALTERS 270032 0 48600 0 27740 0 14700 0 22061 0 383133 0 0 0 BARBARA PALMER 172920 0 32654 0 35632 0 12509 0 8256 0 261971 0 0 0 REGINA DOXTADER 163863 0 32720 0 29379 0 12326 0 23160 0 261448 0 0 0 MARGARET HASLER 113608 0 24040 0 95920 0 12780 0 8344 0 254692 0 0 0 RONALD SZUMSKI 184147 0 30336 0 8789 0 12335 0 23967 0 259574 0 0 0 WILLIAM SCHEUBER 166550 0 17290 0 0 0 10660 0 20879 0 215379 0 0 0 ADAM COOPER 339372 0 0 0 14677 0 14700 0 20655 0 389404 0 0 0 ANDREW CYKIERT 265740 0 144580 0 17439 0 14700 0 23025 0 465484 0 0 0 RICHARD HERMAN 359825 0 0 0 15231 0 14700 0 21327 0 411083 0 0 0 GILBERT HERMAN 312930 0 0 0 21363 0 14700 0 20287 0 369280 0 0 0 BEN ROSSI 227195 0 146103 0 26480 0 5096 0 20905 0 425779 0 0 0 PART I, LINE 7 NON-FIXED PAYMENTS ARE PAID ONLY UPON APPROVAL OF THE BOTSFORD HOSPITAL COMPENSATION COMMITTEE AND ARE BASED UPON ESTABLISHED METRICS. CITY OF FARMINGTON HILLS HOSPITAL FINANCE AUTHORITY 521719468 311166BJ0 2008-04-03 11835179 CANCER CENTER CONSTRUCTION COSTS,EQUIPT. & REFINANCE BONDS ISSUED 12/18/91 0 0 0 1210991 11901948 236704 16278 11407495 241472 2008 1 0 1 1 0 0 1 0 0 0.00000 0.00000 1 0 1 0 0 0 1 SCHEDULE K SUPPLENTAL INFORMATION THE BOND ISSUED 04/03/08 WAS ISSUED TO THE ZIEGER HEALTH CARE CORPORATION OBLIGATED GROUP IN THE AMOUNT OF $16,370,000. THE OBLIGATED GROUP CONSISTS OF ZIEGER HEALTH CARE CORPORATION, BOTSFORD GENERAL HOSPITAL, BOTSFORD CONTINUING CARE CORPORATION AND COMMUNITY EMERGENCY MEDICAL SERVICES. EACH ENTITY OF THE OBLIGATED GROUP WAS ALLOCATED A PORTION OF THIS DEBT AND THAT AMOUNT IS REFLECTED ON SCHEDULE K, PART 1 AND ON SCHEDULE K, PART II. PART V- BOTSFORD GENERAL HOSPITAL COMPLIANCE PROCEDURES CONDUCTED ON AN AS NEEDED BASIS; WRITTEN DOCUMENTATION OF SUCH COMPLIANCE PROCEDURES WAS FORMALLY ADOPTED SUBSEQUENT TO YEAR END. PART VI- THE DIFFERENCE BETWEEN THE ISSUE PRICE (PART I, COLUMN (E)) AND TOTAL PROCEEDS OF THE ISSUE (PART II, LINE 3) IS DUE TO INVESTMENT EARNINGS. ADAM COOPER MD FAM MBR IS A BD MBR 389404 COMPENSATIONCOMPENSATION PAID 0 CARDIOVASCULAR CLINICAL ASSOCIATES BD MBR / >5% INTEREST IN VENDOR THAT PROVIDES SERVICES TO BH 313900 SERVICESVENDOR PROVIDES CARE TO BOTSFORD PATIENTS AS WELL AS INTERPRETING VARIOUS PROCEDURES SUCH AS ECHOCARDIOGRAMS, STRESS TESTS AND EKGS. THE VENDOR RECEIVES A MONTHLY PAYMENT FOR PERFORMING THESE SERVICES. 0 MICHAEL SCHEUBER FATHER IS A KEY EMPLOYEE 12000 COMPENSATIONSON RECEIVED COMPENSATION FROM BOTSFORD HOSPITAL FOR SERVICES AS A PROJECT INTERN IN THE CLINICAL PROCESS IMPROVEMENT DEPARTMENT. 0 ANNETTE LACASSE FAM MBR IS A BD MBR 15000 COMPENSATIONPROVIDES PHYSICIAN SERVICES AS DERMATOLOGY PROGRAM DIRECTOR. 0 X EQUIPMENT 10 148885 PURCHASE PRICE OF EQUIPMENT 0 1 1 THIRD PARTY USE: PART I, LINE 32B: BOTSFORD HOSPITAL USES ZIEGER HEALTH CARE CORPORATION TO SOLICIT, PROCESS AND SELL NON-CASH CONTRIBUTIONS. ADDITIONALLY, ZIEGER HEALTH CARE CORPORATION PURCHASES EQUIPMENT FOR THE BENEFIT OF BOTSFORD HOSPITAL. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE BOARD MEMBERS OR SHARED OFFICERS ON TWO OR MORE ENTITIES WITHIN THE BOTSFORD HEALTH CARE SYSTEM. GERSON COOPER RAYMOND DZENDZEL PAUL LACASSE DAVID MARCELLINO LISA VANDECAVEYE REGINA DOXTADER FORM 990, PART VI, SECTION A, LINE 6 ZIEGER HEALTH CARE CORPORATION IS THE SOLE CORPORATE MEMBER OF BOTSFORD HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER, ZIEGER HEALTH CARE CORPORATION APPROVED/ELECTS THE GOVERNING BODY OF BOTSFORD HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER, ZIEGER HEALTH CARE CORPORATION HAS CERTAIN RESERVED POWERS OVER OPERATIONS AND CAPITAL OF BOTSFORD HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND ALL RELATED SCHEDULES WERE PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT AND REVIEWED BY AN OUTSIDE TAX FIRM. A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE OF THE CONFLICT OF INTEREST POLICY BY REVIEW OF THE POLICY ANNUALLY AT THE BOARD MEETING AND MANDATORY SUBMISSION OF CONFLICTS TO THE ASSISTANT SECRETARY OF THE ORGANIZATION PER THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION, BENEFITS AND RETIREMENT COMMITTEE (COMMITTEE) OF BOTSFORD HEALTH CARE WILL REVIEW AND MAKE RECOMMENDATIONS TO THE BOARD OF DIRECTORS WITH RESPECT TO ALL ASPECTS OF COMPENSATION AND OTHER BENEFITS, INCLUDING, WITHOUT LIMITATIONS, COMPENSATION OF THE CORPORATION'S DIRECTORS, OFFICERS, PHYSICIANS, EMPLOYEES AND CONTRACTORS. THE COMMITTEE RETAINS AN INDEPENDENT COMPENSATION CONSULTANT EACH YEAR TO ASSESS THE COMPETITIVENESS AND REASONABLENESS OF THE TOTAL COMPENSATION PROVIDED TO EXECUTIVES, DIRECTORS AND PHYSICIANS. THE COMPENSATION CONSULTANT ABSTRACTS BASE SALARY, TOTAL CASH COMPENSATION AND BENEFITS DATA FROM MAJOR SURVEYS FOR HEALTHCARE AND OTHER APPROPRIATE INDUSTRIES. THE FAIR MARKET REVIEW IS FOR COMPARABLE POSITIONS IN COMPARABLE ORGANIZATIONS BASED UPON SIZE, TOTAL REVENUES AND OTHER RELEVANT FACTORS. YEARLY, THE CONSULTANT WILL PRESENT A SUMMARY OF FINDINGS AND RECOMMENDATIONS INTENDED TO HELP THE COMMITTEE ESTABLISH THE "REBUTTABLE PRESUMPTION OF REASONABLENESS FOR EXECUTIVES, DIRECTORS AND PHYSICIANS." THE COMMITTEE WILL MAKE RECOMMENDATIONS TO THE VARIOUS BOARDS FOR APPROVAL. NO MEMBER OF THE COMMITTEE WILL EVALUATE ANY COMPENSATION ARRANGEMENT WITH RESPECT TO WHICH HE OR SHE HAS A CONFLICT OF INTEREST. YEARLY, THE COMMITTEE MEMBERS WILL SIGN A CONFLICT OF INTEREST POLICY. ALL COMMITTEE RECOMMENDATIONS AND ACTIONS ARE ADEQUATELY DOCUMENTED IN COMMITTEE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS THAT ARE REQUIRED TO BE MADE AVAILABLE TO THE PUBLIC WILL BE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII, COLUMN B HOURS WORKED FOR RELATED ORGANIZATIONS OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF BOTSFORD HOSPITAL PROVIDE SERVICES TO BOTSFORD HOSPITAL AND AFFILIATES. HOURS WORKED ARE NOT TRACKED SEPARATELY FOR EACH ENTITY. THEREFORE, HOURS FOR ALL INDIVIDUALS REPORTED ON FORM 990, PART VII, COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS REPRESENT AGGREGATE HOURS WORKED PER WEEK FOR ALL ENTITIES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,307,029. ADDITIONAL MINIMUM PENSION LIABILITY ADJUSTMENT -18,109,651. SECURITY GRANT - EQUIPMENT REIMBURSEMENT 69,646. DEFERRED REVENUE - CAFETERIA RENOVATIONS 122,449. MEDICAL EQUIPMENT GRANT 470,490. TOTAL TO FORM 990, PART XI, LINE 5: -18,754,095. AUDIT COMMITTEE PROCESS FORM 990, PART XII, LINE 2C THE ORGANIZATION'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THE PROCESS THAT THE AUDIT COMMITTEE FOLLOWS FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR HAS NOT CHANGED FROM THE PRIOR YEAR. ZIEGER HEALTHCARE CORPORATION 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 382500428 CENTRALIZED GOVERNANCE & MGMT MI 501 (C) (3) 9 1 BOTSFORD CONTINUING CARE CORPORATION 28050 GRAND RIVER AVENUE FARMINGTON HILLS MI 48336 382549505 LONG TERM NURSING CARE MI 501 (C) (3) 9 ZIEGER HEALTHCARE CORPORATION 1 COMMUNITY EMERGENCY MEDICAL SERVICE INC 25400 W EIGHT MILE ROAD SOUTHFIELD MI 48034 382410823 AMBULANCE SERVICES MI 501 (C) (3) 9 ZIEGER HEALTHCARE CORPORATION 1 BOTSFORD COMMONS PROPERTY ASSOCIATION 21400 ARCHWOOD CIRCLE FARMINGTON HILLS MI 48336 383203663 PROPERTY MANAGEMENT MI BOTSFORD CONTINUING CARE CORPORATION C PARASTAR MEDICAL SERVICES 25250 W EIGHT MILE ROAD SOUTHFIELD MI 48034 382755982 MANAGEMENT & DISPATCH SERVICES MI COMMUNITY EMERGENCY MEDICAL SERVICES C BGH PHYSICIAN PORTFOLIO (CAPTIVE) PO BOX 1109 68 WEST BAY ROAD GEORGETOWN GRAND CAYMAN CJ KY1-1102 381426919 CAPTIVE INSURANCE (CELL) CJ BOTSFORD HOSPITAL C 5673986 1.00000 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 BOTSFORD CONTINUING CARE CORPORATION N 424477 COST BOTSFORD CONTINUING CARE CORPORATION P 3394648 COST COMMUNITY EMERGENCY MEDICAL SERVICES N 453300 COST COMMUNITY EMERGENCY MEDICAL SERVICES P 1319970 COST PARASTAR N 820721 COST PARASTAR P 332776 COST COMMUNITY EMERGENCY MEDICAL SERVICES L 634462 COST ZIEGER HEALTHCARE CORPORATION C 677082 COST ZIEGER HEALTHCARE CORPORATION B 583458 COST BOTSFORD CONTINUING CARE CORPORATION J 123188 COST ZIEGER HEALTHCARE CORPORATION O 1109882 COST BOTSFORD CONTINUING CARE CORPORATION O 390000 COST