2012-05-15T09:17:38-05:00 2011-06-30 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2010-07-01 382335286 Borgess Health Alliance Inc BORG 2692268301 1521 Gull Road Kalamazoo MI 490481640 Richard Felbinger 2692268301 2012-05-15 1 Matt Montgomery 5137847100 2010 2016-02-24 21:20:13Z Paul Spaude 1521 Gull Road Kalamazoo MI 490481640 3216264 0 0928 X www.borgess.com X 1980 MI Serving more than 1 million people through a network of hospitals & healthcare facilities. 14 13 0 13 0 0 0 0 1722985 3090710 0 0 62136 102607 1785121 3193317 0 0 0 0 0 0 0 0 44375 597791 2222736 597791 2222736 1187330 970581 6245937 5422209 1988266 1602734 4257671 3819475 X The purpose of Borgess Health is to be a values-based health system continuing the healing mission of the Sisters of St. Joseph and responding to the needs of those we serve. Our commitment to those we serve respects the dignity of human life and actively responds to the needs of the poor. 0 0 802153 57617 Borgess Health Alliance, Inc. hosts information seminars to educate the public regarding changes foreseen in the healthcare industry. Additionally, Borgess Health Alliance, Inc. provides office space to other healthcare services providers. 1376208 3090710 Borgess Health Alliance, Inc. manages healthcare joint ventures related to providing care to the community. Corporate office expense allocations. 2178361 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 X Richard Felbinger 2692265499 1521 Gull Road Kalamazoo MI 49024 Larry D Lueth 1.00 X 0 0 0 Daniel E Stewart MD 1.00 X 0 0 0 Joni L Knapper 1.00 X 0 0 0 Susan Pozo PhD 1.00 X 0 0 0 Michael L Chojnowski end 1210 1.00 X 0 0 0 James McLaren MD 1.00 X 0 0 0 Sanjay Dalal MD 1.00 X 0 0 0 Gary Druskovich MD 1.00 X 0 0 0 Mary Ellen Gondeck CSJ 1.00 X 0 0 0 Doyle A Hayes 1.00 X 0 0 0 Kevin Holleman MD 1.00 X 0 0 0 Albert Little 1.00 X 0 0 0 William M Harrison 1.00 X 0 0 0 James F Hettinger 1.00 X 0 0 0 Paul A Spaude Sch O 40.00 X X 0 827613 87785 Richard Felbinger Sch O 40.00 X 0 340884 102690 0 1168497 190475 0 0 1 0 0 Investment in JVs 532000 3090710 3090710 3090710 67937 22947 44990 44990 44990 Other Refunds 621990 50492 50492 Seminar Income 621990 7125 7125 57617 3193317 3148327 0 44990 1420583 1420583 1140 1140 1000 1000 2292 2292 292294 292294 38543 38543 20934 20934 Contract Service 400410 400410 Donation Expense 44375 44375 Minor Equipment 955 955 Dues 210 210 2222736 2178361 0 44375 90000 63806 1826406 1598522 1380014 259388 1164507 1120626 3015024 2639255 150000 6245937 5422209 161860 4212 1826406 1598522 1988266 1602734 X 4257671 3819475 4257671 3819475 6245937 5422209 X 970581 -1408777 X 0 1 1 X 0 X X 0 0 0 Borgess Medical Center 381360526 3 - Hospital 1 1 1 825101 1 825101 197000 197000 1183014 259388 923626 1120626 Woodbridge Center, LLC 828069 C MMDI, LLC 871975 C SMIC, LLC 939211 C 2639255 Due to Borgess Medical Center 1598522 1598522 0 1 0 0 0 0 0 0 0 Paul A Spaude Sch O 0 411545 0 298813 0 117255 0 67578 0 20207 0 915398 0 0 Richard Felbinger Sch O 0 259825 0 27277 0 53782 0 76725 0 25965 0 443574 0 0 Supplemental Information Part III Part I, Line 3: Borgess Medical Center, a related organization of Borgess Health Alliance, Inc., uses the following to establish the compensation of the organization's CEO: - Compensation Committee, - Written Employment Contract, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee Part I, Line 4b: Eligible Executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon to facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The related organization that paid the salaries of the individuals listed in Schedule J, Part II, contributed to the Supplemental Nonqualified Retirement Plan in the amounts as noted: Paul A. Spaude - $49,992 Form 990, Part VI, Section A, line 6 Borgess Health Alliance, Inc. has a single corporate member, Ascension Health. Form 990, Part VI, Section A, line 7a Borgess Health Alliance, Inc. has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of the Borgess Health Alliance, Inc. Form 990, Part VI, Section A, line 7b Ascension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining the compensation of the organization's CEO, the process performed by Borgess Medical Center, a related organization, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The executive/compensation committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at other organizations in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the executive committee minutes. The individual was not present when his compensation was decided. In determining the compensation of the other officer of the organization, the process performed by Borgess Medical Center, a related organization, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The executive/compensation committee reviewed and approved the compensation. In the review of the compensation, the other officer of the organization was compared to other organizations' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the executive committee minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfer to Borgess Properties -1,408,777. Total to Form 990, Part XI, Line 5: -1,408,777. Explanation of Hours for Officers: Form 990, Part VII, Section A: Certain officers for Borgess Health Alliance, Inc. provide services to Borgess Health Alliance, Inc. and its subsidiaries. Hours worked are not tracked on an enitity by entity basis. Therefore, where noted with a "(Sch O)" reference, officers' hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees represent aggregate hours worked per week for all entities. Ascension Health PO Box 45998 St Louis MO 63134 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Borgess Medical Center 1521 Gull Road Kalamazoo MI 49048 381360526 Healthcare Services MI Section 501(c)(3) Schedule A, Line 3 Borgess Health Alliance Inc 1 Borgess Ambulatory Care Corporation 1521 Gull Road Kalamazoo MI 49048 382468823 Holding Company MI Section 501(c)(3) Schedule A, Line 3 Borgess Health Alliance Inc 1 Borgess Foundation 1521 Gull Road Kalamazoo MI 49048 237222558 Fundraising MI Section 501(c)(3) Schedule A, Line 11c Borgess Health Alliance Inc 1 Borgess Nursing Home 537 Chicago Avenue Kalamazoo MI 49048 382555589 Residential Care MI Section 501(c)(3) Schedule A, Line 3 Borgess Health Alliance Inc 1 Lee Memorial Hospital Corporation 420 W High Street Dowagiac MI 49047 381490190 Healthcare Services MI Section 501(c)(3) Schedule A, Line 3 Borgess Health Alliance Inc 1 Lee Memorial Foundation 420 W High Street Dowagiac MI 49047 382860459 Fundraising MI Section 501(c)(3) Schedule A, Line 11c Borgess Health Alliance Inc 1 ProMed Healthcare 1521 Gull Road Kalamazoo MI 49048 383193801 Healthcare Services MI Section 501(c)(3) Schedule A, Line 9 Borgess Health Alliance Inc 1 Visiting Nurse & Hospice Services of SW MI 348 North Burdick Kalamazoo MI 49007 381359216 Home Nursing and Rehabilitation Services MI Section 501(c)(3) Schedule A, Line 9 Borgess Health Alliance Inc 1 Visiting Nurses Home Care DBA Borgess VNA Home Care 348 North Burdick Kalamazoo MI 49007 382717691 Home Healthcare Services MI Section 501(c)(3) Schedule A, Line 9 Borgess Health Alliance Inc 1 Textile Systems Inc 817 Walbridge Kalamazoo MI 49007 382705047 Laundry Services MI N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 Borgess Medical Center P 736845 Fair Value Borgess Medical Center Q 3511317 Fair Value