2012-05-15T13:24:52-05:00 2011-06-30 MAKELA TOUTANT HILL & NARDI PC 201 W BLUFF STREET MARQUETTE MI 49855 990 2010-07-01 381358036 MARQUETTE GENERAL HOSPITAL INC MARQ 9062253450 420 W MAGNETIC STREET MARQUETTE MI 49855 JERRY L WORDEN 9062253450 2012-05-15 1 ROBIN A RAUVALA 9062283600 2010 2016-02-24 21:20:13Z JERRY L WORDEN 420 W MAGNETIC STREET MARQUETTE MI 49855 332944962 0 X WWW.MGH.ORG X 1897 MI TO BE A REGIONAL HEALTH RESOURCE, IMPROVING THE HEALTH OF THOSE WE SERVE. 15 11 2867 534 7405347 0 664278 736486 323220852 316269301 752096 -576946 817 17140 324638043 316445981 0 0 0 0 155517337 164687080 0 0 0 161525504 143106091 317042841 307793171 7595202 8652810 266525060 248826715 192888879 167162681 73636181 81664034 X TO BE THE REGIONAL MEDICAL CENTER OF CHOICE BY PROVIDING EFFICIENTLY DELIVERED, HIGH QUALITY, COMPASSIONATE CARE. 0 0 202032086 227297577 HOSPITAL SERVICES ENCOMPASSING 10,535 INPATIENT ADMISSIONS; 55,511 INPATIENT DAYS AND 268,628 OUTPATIENT VISITS/REGISTRATIONS. 74523361 67909667 PHYSICIAN PRACTICES WITH 164,107 PATIENTS AND 351,030 VISITS. 5204232 6510575 HOME HEALTH SERVICES COVERING EIGHT COUNTIES, SERVING 1,906 PATIENTS WITH 38,777 HOME VISITS. 14200633 14551482 INCLUDES REVENUE FROM: THE SALE OF BLOOD PRODUCTS TO OTHER HOSPITALS; SALES TO EMPLOYEES AND GUESTS AT A CAFETERIA, COFFEE SHOP AND GIFT SHOP; PHARMACEUTICAL SALES TO EMPLOYEES AND GUESTS; INDIGENT CARE AGREEMENT WITH AN UNRELATED NON-PROFIT ORGANIZATION; RENTAL OF SPACE TO OTHER UNRELATED HEALTH CARE ORGANIZATIONS; TUITION REVENUE FOR THE HOSPITAL-RUN SCHOOL OF RADIOGRAPHY AND SCHOOL OF EMT; IT SERVICES TO OTHER UNRELATED HOSPITALS AND PHYSICIAN OFFICES; TELEHEALTH SERVICES TO OTHER UNRELATED HOSPITALS AND PHYSICIAN OFFICES. 14200633 14551482 295960312 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 0 1 187 0 2867 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MI X JERRY L WORDEN SENIOR VPCFO 9062253450 420 W MAGNETIC STREET MARQUETTE MI 49855 TIMOTHY J LARSON 3.00 X X 0 0 0 RICHARD R SCHAEFER 3.00 X X 0 0 0 JUDITH WATSON-OLSON 3.00 X X 0 0 0 MICHAEL L VONCK 3.00 X X 0 0 0 LOIS A MICHELIN 3.00 X X 0 0 0 BRADLEY CORY 2.00 X 0 0 0 GARY LAPLANT 2.00 X 0 0 0 LARRY S LEWIS MD 50.00 X 331904 0 15620 JOHN P BARTLETT MD 5.00 X 20004 0 0 MARYANNE SHANNON 2.00 X 0 0 0 K MICHAEL SKYTTA 2.00 X 0 0 0 NANCY DWYER 2.00 X 0 0 0 DAN GREENLEE 2.00 X 0 0 0 SCOTT HERIOUX 2.00 X 0 0 0 RICHARD BLOTTER 2.00 X 0 0 0 A GARY MULLER 50.00 X X 569487 0 112274 JERRY L WORDEN 50.00 X 327257 0 54277 DAVID S GRASER 50.00 X 266953 0 46784 THOMAS F NOREN MD 50.00 X 290185 0 44477 DAGMAR A RAICA 50.00 X 176177 0 14854 CRAIG COCCIA 50.00 X 2049647 0 24320 PAUL LAHAYE 50.00 X 1204178 0 24320 RICHARD ROVIN 50.00 X 686952 0 29410 ANDREW JAHODA 50.00 X 578111 0 15265 MARIANNE ANANICH 50.00 X 567852 0 8181 MICHAEL J BECKSTROM 50.00 X 158986 0 15726 THOMAS A MOSER 50.00 X 185997 0 5460 DENNIS D BOE 50.00 X 159029 0 20981 FREDERICK P HOENKE MD 50.00 X 369200 0 40343 7941919 0 472292 179 1 1 0 REHAB CARE GROUP INC 7733 FORSYTH BLVD ST LOUIS MO 63105 THERAPY SERVICES 5283257 UPIMS LLC (CARDIOLOGY JOINT VENTURE) 1414 W FAIR AVE MARQUETTE MI 49855 IMAGING SERVICES 3198183 SOUND PHYSICIANS 1123 PACIFIC AVENUE TACOMA WA 98402 PHYSICIAN SERVICES 1829032 MAYO COLLABORATIVE SERVICES 3050 SUPERIOR DRIVE ROCHESTOR MN 55901 LAB SERVICES 1051685 DMS IMAGING 2101 N UNIVERSITY DR FARGO ND 58102 PET SCANNING 911090 39 436507 299979 736486 HOSPITAL SERVICES 622110 227297577 219892230 7405347 PHYSICIAN PRACTICES 621111 67909667 67909667 HOME HEALTH SERVICES 621610 6510575 6510575 BLOOD PRODUCTS 621511 1602703 1602703 EMPLOYEE & GUEST MEALS 722212 1220370 1220370 11728409 10222505 1505904 316269301 822645 822645 286555 286555 114631 97491 17140 17140 17140 14547416 167928 15836965 564525 -1289549 -396597 -1686146 -1686146 316445981 306137680 7405347 2166468 2576887 461934 2114953 1064604 779299 285305 123322244 119622307 3699937 8675109 8414856 260253 20662884 20042997 619887 8385352 8133791 251561 292348 29235 263113 743382 371691 371691 118191 118191 55096 53443 1653 28704175 27843050 861125 778610 755252 23358 68686167 66625582 2060585 3844982 3729633 115349 7425494 7202729 222765 2340369 2270158 70211 475809 461535 14274 3486480 3381886 104594 11017283 10686765 330518 1202039 1165978 36061 UNCOMPENSATED CARE 13686490 13686490 QUALITY ASSURANCE ASSES 6543990 6347670 196320 MAINTENANCE CONTRACTS 3959109 3840336 118773 LEASED EQUIPMENT 1783823 1730308 53515 PENSION CURTAILMENT -16054262 -15572634 -481628 4016516 3896021 120495 307793171 295960312 11832859 0 36710985 28458445 49943474 36555737 143572 46700 8490577 8118566 2447369 2609834 311931594 219988643 100913805 91942951 39372126 59596589 19066010 12975901 9437142 8521992 266525060 248826715 44238277 39661534 63426933 61072089 4457289 476036 80766380 65953022 192888879 167162681 X 70934334 78348751 2701847 3315283 73636181 81664034 266525060 248826715 X 8652810 -624957 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7494807 7494807 147582699 93674075 53908624 152507826 124122069 28385757 4346262 2192499 2153763 91942951 INVESTMENT IN UP HEALTH NETWORK 10263645 C INVESTMENT IN UP MEDICAL CENTER 2712256 F 12975901 PROFESSIONAL LIAB AND W/C RESERVES 5480036 ACCRUED LT EMPLOYEE COMP AND BENE 3686809 ACCRUED LT PENSION LIABILITY 51837385 INTEREST RATE SWAP AGREEMENT 4948792 65953022 316445981 307793171 8652810 2145587 -2770544 -624957 8027853 319025791 2145587 336732 2482319 316543472 -97491 -97491 316445981 311611374 3818203 3818203 307793171 0 307793171 PART XI, LINE 8 - OTHER ADJUSTMENTS: CONTRIBUTION RECEIVED - RESTRICTED PROPERTY 131,204. PENSION LIABILITY ADJUSTMENT -1,738,697. INCREASE IN TEMPORARILY RESTRICTED NET ASSETS 613,436. NET ASSETS RELEASED FROM RESTRICTIONS 205,528. TRANSFER TO AFFILIATE (SHP) -1,982,015. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONTRIBUTION RECEIVED - RESTRICTED 131,204. NET ASSETS RELEASED FROM RESTRICTIONS 205,528. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE -97,491. PART XIII, LINE 2D - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT 1,738,697. TRANSFER TO AFFILIATE (SHP) 1,982,015. RENT 97,491. 1 1 1 X 1 X 1 1 1 0 1 1 1127934 1127934 0.00380 42673688 30161229 12512459 0.04250 1125301 624015 501286 0.00170 44926923 30785244 14141679 0.04800 1026308 144004 882304 0.00300 6903041 4900646 2002395 0.00680 27220157 22016515 5203642 0.01770 432258 26435 405823 0.00140 207857 207857 0.00070 35789621 27087600 8702021 0.02960 80716544 57872844 22843700 0.07760 80 80 0.00000 1610 1610 0.00000 367 367 0.00000 36711 36711 0.00010 38768 38768 0.00010 1 5562819 3687535 88040813 70709890 17330923 X 1 0 1 UP IMAGING MANAGEMENT SERVICES LLC OUTPATIENT NON-INVASIVE DIAGNOSTIC CARDIOVASCULAR IMAGING SERVICES 0.60000 0.40000 1 1 MARQUETTE GENERAL HOSPITAL INC

420 W MAGNETIC ST MARQUETTE MI 49855

X X X X X MARQUETTE GENERAL HOSPITAL INC 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X 1 X X X 1 X X X X X X X X 1 X 0 1 14 MARQUETTE MEDICAL CLINIC

1414 WEST FAIR AVENUE MARQUETTE MI 49855

OUTPATIENT CLINIC MARQUETTE GENERAL HEMOTOLOGYONCOLOGY

1711 SOUTH STEPHENSON AVE SUITE 315 IRON MOUNTAIN MI 49801

OUTPATIENT CLINIC CHIPPEWA MEDICAL ASSOCIATES

AVERY SQUARE 510 ASHUM SUITE 5 SAULT STE MARIE MI 49783

OUTPATIENT CLINIC MARQUETTE SPECIALTY CLINIC

800 EAST BOULEVARD KINGSFORD MI 49802

OUTPATIENT CLINIC LAKEWOOD MEDICAL ASSOCIATES

5087 US 41 SOUTH MARQUETTE MI 49855

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

2500 7TH AVE SOUTH ESCANABA MI 49829

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

405 US 41 EAST NEGAUNEE MI 49866

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

1500 W ICE LAKE RD IRON RIVER MI 49935

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

2002 MINNEAPOLIS AVE GLADSTONE MI 49837

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

500 CAMPUS DRIVE SUITE 5 HANCOCK MI 49930

OUTPATIENT CLINIC ONTONAGON COMMUNITY HEALTH CENTER

751 S 7TH ST ONTONAGON MI 49953

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

COMMUNITY BUILDING TRENARY MI 49891

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

BURT TOWNSHIP HALL GRAND MARAIS MI 49839

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

205 OSCEOLA ST LAURIUM MI 49913

OUTPATIENT CLINIC PART I, LINE 7: ROW A - CHARITY CARE: COST TO CHARGE RATIO.ROW B - MEDICAID: COST TO CHARGE RATIO USING MEDICARE COST REPORT RULES.ROW C - UNREIMBURSED COSTS: COST TO CHARGE RATIO USING MEDICARE COST REPORT RULES.ROW E TO J - OTHER BENEFITS: DIRECT CHARGE OF TIME AND COSTS. PART I, LINE 7G: THE SYSTEM PROVIDES SUBSIDIZED HEALTH SERVICES FOR BEHAVIORAL HEALTH, FAMILY PRACTICE CLINICS IN MEDICALLY UNDERSERVED AREAS, NICU, AND WOMEN'S SERVICES. COSTS OF SUBSIDIZED HEALTH SERVICES FOR PHYSICIAN CLINICS INCLUDED IN LINE 7B ARE $11,914,302. 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 $ 13686490. PART II: COMMUNITY BUILDING ACTIVITIES INCLUDE PARTICIPATION IN COLLABORATIVE PARTNERSHIPS WITH COMMUNITY GROUPS, RECRUITMENT OF PROFESSIONALS FOR AREAS IDENTIFIED AS MEDICALLY UNDERSERVED, REGIONAL ECONOMIC DEVELOPMENT GROUPS AND PROGRAMS. PART III, LINE 4: FOOTNOTE TEXT: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.COSTING METHODOLOGY: GROSS BAD DEBT EXPENSE WAS $13,686,490 WITH A COST OF $5,562,819 WHICH WAS CALCULATED USING THE ORGANIZATION'S RATIO OF PATIENT CARE COST TO CHARGES. AN ATTORNEY REVIEWED THE ACCOUNTS TO DETERMINE THE PERCENTAGE THAT WOULD HAVE QUALIFIED FOR CHARITY CARE. PART III, LINE 8: MEDICARE COSTS ARE FROM THE MEDICARE COST REPORT, WHICH UTILIZES MEDICARE ALLOWABLE COST AND THEN RATIO OF COST TO CHARGES BY HCFA LINE NUMBER. MEDICARE ALLOWABLE COST IS DETERMINED BY INCLUDING ALL DIRECT AND INDIRECT EXPENSES IN WORKSHEET A AND THEN OFFSETTING ANY NON-ALLOWABLE COSTS AND MISCELLANEOUS REVENUES. NON-ALLOWABLE COSTS INCLUDE ANY EXPENSE NOT NECESSARY FOR PATIENT CARE OR THOSE DEEMED A LUXURY OR EXCESSIVE. TYPICAL OFFSETS INCLUDE PATIENT TELEVISIONS AND TELEPHONES, PAYMENTS TO PROVIDER BASED PHYSICIANS IN EXCESS OF REASONABLE LIMITS, AND NON-PATIENT REVENUE, TO NAME A FEW. OVERHEAD IS STEPPED-DOWN TO THE REIMBURSABLE AND NON-REIMBURSABLE HCFA LINES. TOTAL COST IS THEN DETERMINED USING RATIO OF COST TO CHARGES. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 11H: CREDIT REPORT, LIVING ARRANGEMENTS/HOME LIFE, CONVERSATIONS WITH PATIENT OR PATIENT'S FAMILY. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 13G: REGISTRATION PERSONNEL REFER UNINSURED AND LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE POLICY. ALSO, A THIRD PARTY COLLECTOR WILL DISCUSS THE POLICY WITH PATIENTS HAVING PAST DUE ACCOUNTS. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 17E: REGISTRATION PERSONNEL, FINANCIAL COUNSELORS, AND THE THIRD PARTY COLLECTOR REVIEW PATIENT AND/OR ACCOUNT INFORMATION TO DETERMINE IF PATIENTS MAY QUALIFY FOR STATE OR FEDERAL ASSISTANCE. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGED THE SAME FIXED GROSS RATES FOR SERVICES. DISCOUNTS ARE APPLIED IF QUALIFICATIONS ARE MET AND THE PATIENT FOLLOWS THE FINANCIAL ASSISTANCE POLICY PROCESS. MARQUETTE GENERAL HOSPITAL INC PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME FIXED GROSS RATES FOR SERVICES. DISCOUNTS ARE APPLIED IF QUALIFICATIONS ARE MET AND THE PATIENT FOLLOWS THE FINANCIAL ASSISTANCE POLICY PROCESS. PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY UTILIZING NEEDS ASSESSMENTS CONDUCTED BY MULTIPLE AGENCIES PROVIDING HEALTH CARE TO THE SERVICE AREA POPULATION, AS WELL AS CONDUCTING AND DIRECTING QUALITATIVE (FOCUS GROUPS AND INDIVIDUAL, IN PERSON INTERVIEWS) AND QUANTITATIVE (PHONE SURVEYS) MARKET RESEARCH OF THE SERVICE AREA POPULATION. RESEARCH IS ALSO CONDUCTED VIA INTERVIEWS AND FOCUS GROUPS WITH PHYSICIANS AND MID-LEVELS TO DETERMINE HEALTH CARE NEEDS. PART VI, LINE 3: IN-HOUSE MEDICAL ASSISTANCE EXPERTS EXPLAIN PROGRAMS TO PATIENTS AND ASSIST WITH THE APPLICATION PROCESS. PATIENT ACCESS IDENTIFIES SELF-PAY AND UNDERINSURED PATIENTS AND REFERS THEM TO IN-HOUSE FINANCIAL COUNSELORS. FINANCIAL ASSISTANCE INFORMATION AND APPLICATIONS ARE AVAILABLE ON-LINE. PART VI, LINE 4: THE SYSTEM SERVES THE RESIDENTS OF THE UPPER PENINSULA OF MICHIGAN. PART VI, LINE 6: THE MAJORITY (11 OF 15) OF THE ORGANIZATION'S BOARD MEMBERS ARE INDEPENDENT AND RESIDE AND/OR WORK IN MARQUETTE COUNTY, THE ORGANIZATION'S PRIMARY SERVICE AREA. MANY LOCAL PHYSICIANS NOT EMPLOYED BY THE HOSPITAL HAVE PRIVILEGES AT THE HOSPITAL. X X X X X X 1 1 0 0 0 0 0 0 0 LARRY S LEWIS MD 331904 0 0 0 0 0 0 0 15881 0 347785 0 0 0 A GARY MULLER 543434 0 0 0 26053 0 88550 0 33544 0 691581 0 0 0 JERRY L WORDEN 322173 0 0 0 5084 0 41240 0 22363 0 390860 0 0 0 DAVID S GRASER 263122 0 0 0 3831 0 35307 0 15411 0 317671 0 0 0 THOMAS F NOREN MD 283820 0 0 0 6365 0 33000 0 15720 0 338905 0 0 0 DAGMAR A RAICA 174461 0 0 0 1716 0 10442 0 6647 0 193266 0 0 0 CRAIG COCCIA 1999801 0 49846 0 0 0 9800 0 16530 0 2075977 0 0 0 PAUL LAHAYE 1164608 0 15216 0 24354 0 9800 0 16736 0 1230714 0 0 0 RICHARD ROVIN 639806 0 47146 0 0 0 9800 0 21630 0 718382 0 0 0 ANDREW JAHODA 566660 0 11451 0 0 0 9800 0 7475 0 595386 0 0 0 MARIANNE ANANICH 567852 0 0 0 0 0 0 0 11115 0 578967 0 0 0 MICHAEL J BECKSTROM 137609 0 0 0 21377 0 1206 0 16380 0 176572 0 0 0 THOMAS A MOSER 61254 0 0 0 124743 0 2470 0 3195 0 191662 0 0 0 DENNIS D BOE 157291 0 0 0 1738 0 9669 0 14890 0 183588 0 0 0 FREDERICK P HOENKE MD 268184 0 100000 0 1016 0 19715 0 23700 0 412615 0 0 0 PART I, LINES 4A-B PART I, LINES 4A-B: SEVERANCE PAYMENT MADE TO: THOMAS A MOSER $117,692 SUPPLEMENTAL RETIREMENT PAYMENTS MADE FOR: A GARY MULLER $78,750 JERRY L WORDEN $31,440 DAVID S GRASER $25,507 THOMAS F NOREN $27,500 MI STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HBA3 2005-05-04 29102140 FACILITY IMPROV & EQUIP 0 0 0 MI STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HDX1 2006-08-23 37000000 FACILITY IMPROV & EQUIP 0 0 0 4460000 29613931 2251777 101094 275951 26985109 2006 0 0 1 1 37211671 4020680 50434 484965 995420 31887507 2007 0 0 1 1 1 0 0 0 1 0.00250 0.00250 1 0 0 0 0 1 1 0 0 0 1 SOCIETE GENERALE 28.000000000000 1 0 1 0 1 1 SEE PART V 0 0 1 SOCIETE GENERALE 15.700000000000 1 0 1 PART II, LINE 3, TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. PART IV, COLUMN B, LINE 3B: DEUTSCHE BANK (SWAP), JP MORGAN (RATE LOCK AGREEMENT TERMINATED ON 8/23/06 ISSUE DATE) PART IV, COLUMN B, LINE 3C: 15.8 YEARS (SWAP), 13.1 YEARS (RATE LOCK AGREEMENT TERMINATED ON 8/23/06 ISSUE DATE) CRAIG COCCIA SIGNING BONUS X 240000 24000 0 1 1 RICHARD ROVIN SIGNING BONUS X 227000 22700 0 1 1 46700 CINDY MASSIE FAMILY MEMBER OF CURRENT BOARD MEMBER, TIMOTHY J LARSON 49750 EMPLOYMENT 0 HELEN LAPLANT FAMILY MEMBER OF CURRENT BOARD MEMBER, GARY LAPLANT 21235 EMPLOYMENT 0 JESSICA BLEAU-WORDEN FAMILY MEMBER OF CURRENT OFFICER, JERRY WORDEN 55650 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 UNDER THE CURRENT ARTICLES OF INCORPORATION, THE GOVERNING BODY MEMBERS (BOARD OF TRUSTEES) ARE THE ONLY MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 ONCE FORM 990 HAS BEEN PREPARED, IT IS REVIEWED BY THE VP OF FINANCE, THE CFO, AND THE CEO. IT IS THEN PRESENTED TO THE FINANCE COMMITTEE. UPON APPROVAL BY THE FINANCE COMMITTEE, THE COMPLETED TAX RETURN IS PRESENTED TO THE BOARD OF TRUSTEES BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF TRUSTEES SIGNS A CONFLICT OF INTEREST STATEMENT ANNUALLY. EMPLOYEES WHO ALSO SERVE ON THE BOARD OR WHO ARE OFFICERS ARE REMINDED AT THEIR ANNUAL EVALUATIONS TO ABIDE BY THE CODE OF CONDUCT AND ALSO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 TO DETERMINE EXECUTIVE COMPENSATION FOR THE CEO, VICE PRESIDENTS AND OFFICERS OF THE CORPORATION, THE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO CONDUCT SALARY SURVEYS OF THE HEALTH CARE MARKET. THE INDEPENDENT CONSULTANT REVIEWS FINDINGS AND MAKES RECOMMENDATIONS TO THE COMPENSATION COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATION WEBSITE. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE WITHIN CONTINUING DISCLOSURES FOR BOND ISSUANCES AT WWW.FIRSTRIVER.COM. THE ORGANIZATION DOES NOT MAKE PUBLICLY AVAILABLE ITS CONFLICT OF INTEREST POLICY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,145,587. CONTRIBUTION RECEIVED - RESTRICTED PROPERTY 131,204. PENSION LIABILITY ADJUSTMENT -1,738,697. INCREASE IN TEMPORARILY RESTRICTED NET ASSETS 613,436. NET ASSETS RELEASED FROM RESTRICTIONS 205,528. TRANSFER TO AFFILIATE (SHP) -1,982,015. TOTAL TO FORM 990, PART XI, LINE 5: -624,957. SECTION 409A DOCUMENT CORRECTION UNDER SECTION IX OF NOTICE 2010-6 1. NAME OF EACH SERVICE PROVIDER AFFECTED BY THE DOCUMENT FAILURE: A. DAVID S GRASER B. A GARY MULLER C. THOMAS NOREN D. JERRY L WORDEN 2. NAME OF THE NONQUALIFIED DEFERRED COMPENSATION PLAN WITH RESPECT TO WHICH THE DOCUMENT FAILURE OCCURRED: MARQUETTE GENERAL HOSPITAL INC 457(F) SUPPLEMENTAL RETIREMENT PLAN. 3. REQUIRED STATEMENTS FOR THE DOCUMENT FAILURE - PLAN PROVISIONS PROVIDING FOR IMPERMISSIBLE INITIAL DEFERRAL ELECTION. A. THE DOCUMENT FAILURE IS ELIGIBLE FOR CORRECTION UNDER NOTICE 2010-6. B. THE SECTION OF NOTICE 2010-6 UNDER WHICH THE DOCUMENT FAILURE IS CORRECTED IS SECTION IX. C. MARQUETTE GENERAL HEALTH SYSTEM HAS TAKEN ALL ACTIONS REQUIRED AND HAS OTHERWISE MET ALL REQUIREMENTS FOR THE PROPOSED CORRECTION AS OF THE LAST DAY OF MARQUETTE GENERAL HEALTH SYSTEM'S TAXABLE YEAR IN WHICH THE CORRECTION IS MADE (2010). D. THE DATE OF CORRECTION WAS OCTOBER 19, 2010. E. THE AMOUNT INVOLVED IN THE DOCUMENT FAILURE WAS $0, SINCE THE PLAN PROVISION PROVIDING FOR AN IMPERMISSIBLE INITIAL DEFERRAL ELECTION WAS NOT APPLIED. F. NO AMOUNT WAS REPORTED BY MARQUETTE GENERAL HEALTH SYSTEM AS INCLUDIBLE IN INCOME UNDER SECTION 409(A) AS PART OF THE CORRECTION. MATTSON MANAGEMENT GROUP LLC 420 W MAGNETIC ST MARQUETTE MI 49855 300136373 LANDHOLDING MI 0 124735 N/A RAMPART EMERGENCY MEDICAL SERVICES INC 828 SHERIDAN ROAD ESCANABA MI 49829 382413139 EMERGENCY MEDICAL SERVICES MI 501(C)(3) 9 N/A 1 MARQUETTE GENERAL FOUNDATION 420 W MAGNETIC ST MARQUETTE MI 49855 203615349 FUNDRAISING FOR MARQUETTE GENERAL HOSPITAL MI 501(C)(3) 11A TYPE I N/A 1 UPPER PENINSULA HEALTH PLAN INC 228 W WASHINGTON ST MARQUETTE MI 49855 383379956 MEDICAID HMO MI 501(C)(4) N/A N/A 1 UPPER PENINSULA MANAGED CARE LLC 228 W WASHINGTON ST MARQUETTE MI 49855 383323620 MANAGEMENT COMPANY OF UP HEALTH PLAN MI N/A RELATED 1185066 1917851 0 0 0.56270 ICE LAKE MEDICAL ARTS BUILDING 420 W MAGNETIC ST MARQUETTE MI 49855 382206384 LEASING OF BUILDING SPACE MI N/A C 5560 69504 0.66670 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 MARQUETTE GENERAL FOUNDATION C 436507 AUDITED F/S MARQUETTE GENERAL FOUNDATION K 459359 AUDITED F/S MARQUETTE GENERAL FOUNDATION M 42825 AUDITED F/S RAMPART EMERGENCY MEDICAL SERVICES INC P 968961 REVIEW GL DETAIL UPPER PENINSULA MANAGED CARE LLC R 799290 REVIEW GL DETAIL UPPER PENINSULA HEALTH PLAN INC R 7918031 REVIEW GL DETAIL