2012-11-01T13:56:54-05:00 2011-12-31 381357951 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2011-01-01 382602147 CHIPPEWA CNTY WAR MEMORIAL HOSPITAL INC CHIP 9066354460 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 KEVIN KALCHIK 9066354460 2012-10-29 1 P00053797 2319477800 2011 2016-02-24 21:20:13Z WAR MEMORIAL HOSPITAL DAVID JAHN CEO 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 95843902 0 X WWW.WARMEMORIALHOSPITAL.ORG X 1985 MI TO PROVIDE HEALTH CARE SERVICES AND ACCESS TO THE RESIDENTS OF SAULT STE. MARIE AND THE EASTERN UPPER PENINSULA. OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. 10 8 953 90 0 0 101848 153499 83026437 89034515 102786 937587 511463 347575 83742534 90473176 0 0 0 0 42687012 44910390 0 0 0 41242688 43230725 83929700 88141115 -187166 2332061 43532934 59779002 22366219 36557356 21166715 23221646 X OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. 0 0 53770839 0 72233941 OUTPATIENT ANCILLARY AND PROFESSIONAL SERVICES - THE PROGRAM HAD 149,006 OUTPATIENT VISITS IN 2011. SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. 13319458 0 12424779 INPATIENT ACUTE SERVICES - THE PROGRAM HAD 2,827 ADMISSIONS WITH A TOTAL OF 11,546 PATIENT DAYS IN 2011. SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. 2778396 0 2104965 BEHAVIORAL HEALTH CLINIC - THE PROGRAM HAD 387 ADMISSIONS WITH A TOTAL OF 3,921 PATIENT DAYS IN 2011. SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. 3456825 0 2301407 1. WAR MEMORIAL HOSPITAL PROVIDED INPATIENT CARE TO 2,827 PATIENTS IN FISCAL YEAR 2011. OUR 51 BED LONG TERM CARE UNIT (HOSPITAL-ATTACHED NURSING HOME) HAD AN AVERAGE OCCUPANCY RATE OF 95% DURING THE YEAR. OUR OBSTETRICS/NURSERY UNIT REPORTED 339 BIRTHS AND OUR SURGICAL SERVICES DEPARTMENT PROVIDED SURGICAL CARE FOR 5,175 PATIENTS. THE HOSPITAL'S TWENTY FOUR HOUR EMERGENCY DEPARTMENT AND THE COMMUNITY CARE CLINIC (WALK-IN URGENT CARE CENTER) RECORDED 18,248 VISITS AND 11,688 VISITS RESPECTIVELY. IN FISCAL YEAR 2011, THERE WERE OVER 148,999 PATIENT REGISTRATIONS FOR THE HOSPITAL'S MULTIPLE OUTPATIENT SERVICE DEPARTMENTS (LAB, RADIOLOGY, CARDIOPULMONARY, REHABILITATION). THE REHABILITATION DEPARTMENT CONTINUED IT EXPANSION OF SERVICES IN CONTRACTING TO PROVIDE REHABILITATION SERVICES WITH MULTIPLE ORGANIZATIONS IN THE REGION; INCLUDING, BUT NOT LIMITED TO, AREA SCHOOLS, HOSPITALS, AND HOME HEALTH AGENCIES. NEARLY 357,633 REHABILITATION TREATMENTS WERE REPORTED.2. WAR MEMORIAL HOSPITAL CONTINUES TO PARTNER WITH TERTIARY FACILITIES TO PROVIDE CONSISTENT ACCESS TO PROVIDERS OF CARDIOLOGY, INTERNAL MEDICINE, ONCOLOGY, AND NEPHROLOGY. DUE TO THE HOSPITAL'S GEOGRAPHIC LOCATION AND COMMUNITY SIZE, THE HOSPITAL HAS CONTINUED TO INDEPENDENTLY RECRUIT OTHER SPECIALISTS TO ENSURE ACCESS TO PROVIDERS. THE HOSPITAL CONTINUES ITS EFFORTS IN PROVIDING PRIMARY CARE IN OUTREACH AREAS OF THE EASTERN UPPER PENINSULA. SIGNIFICANT PROVIDER ADDITIONS IN THE PAST COUPLE OF YEARS INCLUDE GASTROENTEROLOGY, NEUROLOGY, BARIATRIC, PAIN MANAGEMENT, AND ENHANCING IT MEDICAL STAFF WITH ADDITIONAL PROVIDERS TO ENSURE ACCESS AND COVERAGE. WITH THESE EFFORTS AND PARTNERSHIPS THE HOSPITAL HAS BEEN SUCCESSFUL IN MAINTAINING ALL OTHER SERVICES.3. WAR MEMORIAL HOSPITAL CONTINUED ITS LEADERSHIP AND INVOLVEMENT IN COMMUNITY AND HEALTHCARE PROVIDER EDUCATION AND TRAINING. EXAMPLES OF COMMUNITY EDUCATION AND/OR HEALTH SCREENINGS INCLUDED A COMMUNITY BABY SHOWER, SENIOR HEALTH FAIR, EARLY PRE-NATAL EDUCATION AND CHILDBIRTH CLASSES. THE HOSPITAL'S INVOLVEMENT IN HEALTHCARE PROVIDER EDUCATION AND TRAINING INCLUDED NURSE AIDE TRAINING PROGRAMS AND SERVING AS CLINICAL INTERNSHIP SITE FOR MANY COLLEGE AND UNIVERSITY TRAINING PROGRAMS FOR STUDENTS IN REGISTERED NURSING, PHARMACY, MEDICAL TECHNOLOGY, HEALTH INFORMATION MANAGEMENT, AND PHYSICIAN ASSISTANT PROGRAMS. THE HOSPITAL IS ALSO DESIGNATED AS A COMMUNITY TRAINING CENTER OFFERING TRAINING TO AREA PHYSICIANS AND STAFF ON PEDIATRIC ADVANCED LIFE SUPPORT, ADVANCED CARDIAC LIFE SUPPORT AND BASIC LIFE SUPPORT. THE HOSPITAL IS ALSO CERTIFIED TO PROVIDE CONTINUING MEDICAL EDUCATION TO AREA PHYSICIANS AND STAFF AND CONDUCTS MORE THAN 25 ON-SITE PROGRAMS PER YEAR. VIDEO CONFERENCING CAPABILITIES ALSO PROVIDE ACCESS TO COMMUNITY AND HEALTHCARE PROVIDER TRAINING THROUGHOUT THE YEAR.4. WAR MEMORIAL HOSPITAL EMPLOYEES HAVE EMPLOYMENT BENEFITS WHICH INCLUDE PAYMENT FOR EXPENSES FOR THE COMPLETION OF A BACHELOR OF SCIENCE IN NURSING FOR CURRENT REGISTERED NURSES ON STAFF. ADDITIONALLY, OTHER EMPLOYEES HAVE ANNUAL EDUCATION BENEFITS FOR CONTINUING/ADVANCING THEIR EDUCATION IN A HEALTHCARE FIELD. THE HOSPITAL ALSO OFFERS AN EDUCATIONAL LOAN PROGRAM WITH A PERIOD OF NO-INTEREST LOANS WHILE ENROLLED IN AN EDUCATIONAL PROGRAM. FOR NEWLY HIRED EMPLOYEES IN JOB SHORTAGE CLASSIFICATIONS, EMPLOYEES CAN RECEIVE FUNDS FOR STUDENT LOAN REPAYMENT FOR A COMMITMENT TO SERVE WAR MEMORIAL HOSPITAL FOR A SPECIFIED NUMBER OF YEARS.5. WAR MEMORIAL HOSPITAL IS ONE OF THE TOP TEN LARGEST EMPLOYERS IN OUR REGION. WE EMPLOY APPROXIMATELY 854 PEOPLE AND HAVE AN ANNUAL PAYROLL OF APPROXIMATELY $35.7 MILLION; PROVIDING A POSITIVE ECONOMIC IMPACT IN THE COMMUNITY. 6. WAR MEMORIAL HOSPITAL PROVIDES CARE TO PATIENTS COVERED BY GOVERNMENTAL PROGRAMS AT REIMBURSEMENTS AT LESS THAN WHAT IS NEEDED IN ORDER TO PROVIDE STABILITY OF OPERATIONS. THE UN-REIMBURSED VALUE OF PROVIDING CARE TO MEDICAID PATIENTS IS APPROXIMATELY $2,665,997. AS THE NUMBER OF UNINSURED OR UNDERINSURED CITIZENS CONTINUES TO INCREASE, THE HOSPITAL'S ABILITY TO COLLECT REIMBURSEMENTS FOR SERVICES PROVIDED CONTINUES TO BE A CHALLENGE. THEREFORE, HOSPITAL LEADERS HAVE SERVED IN LEADERSHIP CAPACITIES IN THE DEVELOPMENT OF A COMMUNITY HEALTH ACCESS COALITION WHICH HAS A MISSION TO PROVIDE ACCESS TO QUALITY HEALTH CARE FOR THE UNINSURED RESIDENTS OF CHIPPEWA, LUCE, AND MACKINAC COUNTIES BY COORDINATING SERVICES OF VARIOUS HEALTH CARE PROVIDERS TO OFFER AN AFFORDABLE, DIGNIFIED AND ENHANCED CONTINUUM OF CARE. THE HOSPITAL AS WELL AS LOCAL PHYSICIANS AGREE TO PROVIDE CARE THAT IS UNCOMPENSATED OR AT A REDUCED FEE. 3456825 2301407 73325518 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 108 0 1 953 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X KEVIN KALCHIK CFO 9066354456 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 RONALD CALERY 1.50 X X 6435 0 0 SCOTT SHACKLETON 1.50 X 6885 0 0 JOHN JORGENSON SR 1.50 X 6570 0 0 WW LAJOIE 1.50 X X 5400 0 0 TED POSTULA 1.50 X 5940 0 0 GARY MCDOWELL 1.50 X 5985 0 0 FRANK SASSO 1.50 X X 7530 0 0 FREDERICK LUDWIG 40.00 X 103293 0 8955 ELIZABETH DEMARAY 1.50 X X 6390 0 0 TIMOTHY O'CONNOR 1.50 X 25350 0 0 SUSAN TETZLAFF 40.00 X 137910 0 31791 DAVID JAHN 40.00 X 250117 0 58364 KEVIN KALCHIK 40.00 X 132215 0 31507 MARLA BUNKER 40.00 X 110318 0 30411 JAMES HAGLUND 40.00 X 161922 0 20944 WALEED DOGHMI 40.00 X 623993 0 32146 RICHARD GANZHORN 40.00 X 827700 0 32146 JAMIE ADAIR 40.00 X 461463 0 32146 JOHN GALEY 40.00 X 663647 0 32059 PAULA RECHNER 40.00 X 449780 0 32146 3998843 0 342615 28 0 1 0 EUPEP PO BOX 2870 WHITEHOUSE OH 43571 E.R. PHYSICIAN COVERAGE 1875324 DEVERE CONSTRUCTION COMPANY 1030 DEVERE DRIVE ALPENA MI 49707 CONTRACTOR 1005243 MAXIT HEALTHCARE LLC PO BOX 2589 FORT WAYNE IN 46801 INFORMATION SYSTEMS 575176 WILLIAM GOOD MD 2625 KITCHEN ROAD CHEBOYGAN MI 49721 ANESTHESIOLOGIST 536719 HORIZON HEALTH PO BOX 840839 DALLAS TX 75284 MANAGEMENT FEE 478112 24 28128 69454 55917 153499 PATIENT SERVICE REVENU 622110 88774969 88774969 OTHER RELATED REVENUE 622110 259546 259546 89034515 878272 878272 238705 208128 30577 30577 30577 5193986 11192 5145863 0 48123 11192 59315 59315 10724 28128 16735 -6011 -6011 CAFETERIA REVENUE 722210 444502 444502 EXTINGUISHMENT OF DEBT 900099 -121493 -121493 323009 90473176 89065092 0 1254585 1154232 323595 830637 34761527 30462854 4298673 6696444 5950331 746113 2298187 1986392 311795 607545 607545 156985 156985 8496928 7305849 1191079 163136 7202 155934 1433906 985269 448637 113959 75273 38686 140608 63376 77232 972223 783737 188486 4426290 1815924 2610366 707367 698721 8646 SUPPLIES 12721379 12341608 379771 PROVISION FOR BAD DEBTS 5665085 5665085 QUALITY ASSESSMENT FEES 2394564 2394564 REPAIRS AND MAINTENANCE 1998230 1317770 680460 3232520 1147968 2084552 88141115 73325518 14815597 0 3175 3974 579394 4124085 9730577 8588533 2819224 2936528 450568 404007 74792224 36621499 22810828 38170725 3115369 3010533 1589791 268587 2434008 2272030 43532934 59779002 7992097 7835297 9080302 2268182 24964322 3025638 3757737 22366219 36557356 X 21166715 23221646 21166715 23221646 43532934 59779002 X 2332061 -277130 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9420 9420 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTION OF ANNUAL DUES TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND AGING SERVICES OF MICHIGAN THAT ARE USED TOWARD LOBBYING ACTIVITIES. 2819909 2819909 46280106 21095337 25184769 793301 228123 565178 23160078 15298039 7862039 1738830 1738830 38170725 ACCRUED POST-RETIREMENT BENEFIT COST 1238711 ACCRUED INSURANCE 400000 COST REPORT SETTLEMENT PAYABLE 389026 ACCRUED MALPRACTICE LIABILITY 1730000 3757737 90473176 88141115 2332061 -20375 -256755 -277130 2054931 85207782 -5611750 -5611750 90819532 -346356 -346356 90473176 83507089 977724 977724 82529365 5611750 5611750 88141115 PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS FROM JOINT VENTURES -610,993. TRANSFER OF NET ASSETS FROM RELATED HOSPITAL UPON DISSOLUTION 354,238. TOTAL TO SCHEDULE D, PART XI, LINE 8: -256,755. PART XII, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -5,665,085. EMPLOYED PHYSICIAN RENTAL INCOME 61,727. GRANT EXPENSES -8,392. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -16,735. RENTAL EXPENSES -208,128. LOSS ON EXTINGUISHMENT OF DEBT -121,493. PART XIII, LINE 2D - OTHER ADJUSTMENTS: NET UNREALIZED LOSSES ON INVESTMENTS 20,375. LOSS ON EXTINGUISHMENT OF DEBT 121,493. EQUITY LOSSES OF UNCONSOLIDATED INVESTEES 610,993. FUNDRAISING EXPENSES 16,735. RENTAL EXPENSES 208,128. PART XIII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 5,665,085. EMPLOYED PHYSICIAN RENTAL INCOME -61,727. GRANT EXPENSES 8,392. GOLF OUTING 37700 26976 10724 6011 7280 3444 NRS SCHOLARSHIP FUNDRAISER 1152 1152 38852 28128 10724 6011 7280 3444 16735 -6011 1 1 X 1 X 1 X 1 1 1 0 1 1 718506 156884 561622 0.00680 12873113 12036179 836934 0.01010 13591619 12193063 1398556 0.01690 160883 160883 0.00200 197700 197700 0.00240 6720061 4429019 2291042 0.02780 89355 89355 0.00110 7167999 4429019 2738980 0.03330 20759618 16622082 4137536 0.05020 10 158 13798 13798 0.00020 10 158 13798 13798 0.00020 0 5665085 2832543 23174704 18385026 4789678 X 1 1 1 1 CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL

500 OSBORN BOULEVARD SAULT STE MARIE MI 49783

X X X CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL 1 1 1 200.000000000000 1 250.000000000000 1 X X X X X 1 1 X 1 0 1 X 0 0 2 LONG TERM CARE

500 OSBORN BOULEVARD SAULT STE MARIE MI 49783

SKILLED NURSING FACILITY BEHAVIORAL HEALTH CENTER

500 OSBORN BOULEVARD SAULT STE MARIE MI 49783

INPATIENT PSYCHIATRIC FACILITY PART I, LINE 3C: THE HOSPITAL, THROUGH ITS PARTNERSHIP WITH COMMUNITY HEALTH ACCESS COALITION, UTILIZES 200% OF POVERTY GUIDELINES FOR INITIAL ACCESS AND APPLICATION FOR MEDICAID. FOR THOSE COMMUNITY MEMBERS THAT DO NOT QUALIFY, 250% OF POVERTY GUIDELINES ARE UTILIZED FOR ADDITIONAL DISCOUNTS OR FREE CARE ON REMAINING BALANCES AND NON-COVERED SERVICES. PART I, LINE 6A: N/A PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E) AND HEALTH PROFESSIONS EDUCATION (LINE 7F).A DIRECT COST AND STEP-DOWN APPROACH WAS USED TO COMPLETE THE SUBSIDIZED HEALTH SERVICES PROGRAMS (LINE 7G). PART I, LINE 7G: INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE: ORTHO SURGERY, GENERAL SURGERY, BLUE WATER PSYCH, OB PROFESSIONAL, AND OB PROGRAM. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $5,665,085. PART II: WAR MEMORIAL HOSPITAL IS ACTIVE IN BOTH THE PROMOTION OF HEALTHY LIFESTYLES FOR BOTH ITS EMPLOYEES AND COMMUNITY MEMBERS. WAR MEMORIAL HOSPITAL WILL TAKE A LEAD ROLE IN MANY OF THESE ENDEAVORS, BUT ALSO IS WILLING TO BE A SUPPORTIVE PARTNER AND TEAM MEMBER AS WELL. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. 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. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY, $2,832,543, IS EQUAL TO APPROXIMATELY 50 PERCENT OF BAD DEBT EXPENSE. PART III, LINE 8: THE MEDICARE SURPLUS(SHORTFALL) WAS CALCULATED BY UTILIZING COST ACCOUNTING WHEN APPROPRIATE AND AVAILABLE. IN SOME AREAS A COST TO CHARGE METHODOLOGY WAS REQUIRED. PART III, LINE 9B: WAR MEMORIAL HOSPITAL UTILIZES AN ON-LINE INSURANCE VERIFICATION PROCESS TO INITIATE THE EDUCATION AND ELIGIBILITY FROM THE ON-SET OF SERVICES. UPFRONT COLLECTIONS ARE AN ACTIVE PART OF THE PROCESS TO BOTH EDUCATE THE PATIENT AND TO REDUCE BACK-END COSTS OF COLLECTIONS. AT ANY TIME DURING THE PROCESS STAFF ARE TRAINED TO ADDRESS THE PERCEIVED FINANCIAL ASSISTANT NEEDS AND PROVIDE ACCESS TO THE IN-HOUSE PATIENT FINANCIAL COUNSELOR, COMMUNITY HEALTH ACCESS COALITION, OR THE DEPARTMENT OF HEALTH SERVICES REPRESENTATIVE. IN THE BILLING PROCESS, PATIENTS ARE STILL OFFERED ANY EDUCATION NECESSARY TO OBTAIN ASSISTANCE. ONCE SERVICES ARE RECEIVED AND THE PATIENT CHARGES HAVE ACCUMULATED PRIMARY SOURCES OF COVEAGE ARE BILLED. AFTER ALL EFFORTS OF COLLECTION FROM PRIMARY PAYOR (INSURANCE) THE PATIENT IS BALANCED BILL AND PROVIDED THE OPPORTUNITY FOR PAYMENT IN FULL OR OTHER PAYMENT OPTIONS. OTHER INFORMATION: AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE COSTS NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) ARE SUMMARIZED AS FOLLOWS:TOTAL COST: 11,213,297 TOTAL REIMBURSEMENT: 9,781,300 COST IN EXCESS OF REIMBURSEMENT: 1,431,997 PART VI, LINE 2: WAR MEMORIAL HOSPITAL WORKS IN CONJUNCTION WITH MANY OF THE HOSPITAL'S IN THE NORTHERN MICHIGAN AND THE UPPER PENINSULA. IN THESE EFFORTS "NEEDS" OF THE COMMUNITIES ARE ASSESSED THROUGH WORK WITH OTHER HOSPITAL'S, HEALTH RELATED ORGANIZATION'S, AND IN COMMUNITY FORUM'S. IN ADDITION, WAR MEMORIAL HOSPITAL HAS ENGAGED OUTSIDE ASSISTANCE IN THE PLANNING FOR "NEEDS" OF BOTH SERVICES AND PHYSICIANS TO BEST PLAN FOR CAPITAL AND RECRUITMENT APPROPRIATIONS. PART VI, LINE 3: WAR MEMORIAL HOSPITAL PRIDES ITSELF ON PROVIDING NEEDED CARE TO THE INDIGENT OF THE EASTERN UPPER PENINSULA IN A DIGNIFIED MANNER. THIS EDUCATION AND ASSISTANCE IS DONE THROUGH PARTNERSHIPS WITH OTHER "ACCESS" POINTS. SPECIFICALLY, WAR MEMORIAL HOSPITAL HAS PROVIDED RESOURCES TO THE CHAC (COMMUNITY HEALTH ACCESS COALTION) AND WAR MEMORIAL HOSPITAL HAS ENTERED INTO AN AGREEMENT WITH THE STATE OF MICHIGAN TO PROVIDE A DHS (DEPARTMENT OF HEALTH SERVICES) WORKER ON-SITE FOR READY ACCESS FOR OUR PATIENTS. THROUGH THE COLLABORATION OF THESE RELATIONSHIPS OUR PATIENTS ARE FIRST NOTIFIED AND REFERRED TO THE APPROPRIATE RESOURCE FROM THE ON-SET OF RECEIVING HEALTH CARE SERVICES. PART VI, LINE 4: WAR MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS THE EASTERN UPPER PENINSULA OF MICHIGAN. IN THIS AREA THERE ARE THREE COUNTIES WHICH CONSIST OF CHIPPEWA, MACKINAC, AND LUCE. WAR MEMORIAL HOSPITAL PRIDES ITSELF ON THE QUALITY OF SERVICES IT PROVIDES AS A RURAL SOLE COMMUNITY HOSPITAL. THE CLOSEST HOSPITAL IS 50 MILES AWAY AND IS A CRITICAL CARE HOSPITAL. THE CLOSEST TERTIARY FACILITY IS OVER AN HOUR AND A HALF AWAY. WAR MEMORIAL HOSPITAL STRIVES FOR PROVIDING SERVICES TO THE COMMUNITY FOR WHICH OTHERWISE THE COMMUNITY MEMBER WOULD MOST LIKELY HAVE TO TRAVEL TO A TERTIARY FACILITY. THROUGH ITS OWN EFFORTS AND JOINT VENTURES AREAS OF CARE SUCH AS OBSTETRICS AND DELIVERY, DIALYSIS, ONCOLOGY, CARDIOLOGY, PULMONOLOGY, INFECTIOUS DISEASE, AND I/P PSYCHIATRIC SERVICES WOULD NOT BE AVAILABLE. PART VI, LINE 5: WAR MEMORIAL HOSPITAL PROVIDES MANY POINTS OF ACCESS THAT ARE NOT PROFITABLE, BUT OTHERWISE WOULD REQUIRE OUR COMMUNITY MEMBERS TO TRAVEL GREAT DISTANCES. THE HOSPITAL MANAGEMENT AND STAFF PARTICIPATE ACTIVELY IN MANY HEALTH AND EDUCATIONAL ENDEAVORS. AN EXAMPLE IS PROVIDING CLINICAL STAFF TO THE LOCAL STATE UNIVERSITY TO ASSIST IN THE EDUCATION OF REGISTERED NURSES. OTHER EXAMPLES INCLUDE INFORMAL PARTNERSHIPS WITH TWO LOCALLY RECOGNIZED NATIVE AMERICAN TRIBES AND FULL SUPPORT OF COUNTY HEALTH INITIATIVES. PROGRAM EXAMPLES WOULD INCLUDE FLU-CLINIC, DIALYSIS, DIABETIC EDUCATION, COUNTY HEALTH DEPARTMENT COLON SCREENING, PHYSICALS FOR STUDENT ATHLETES, AND REGIONAL CHARITY CARE INITIATIVES. PART VI, LINE 6: NOT AFFILIATED. REPORTS FILED WITH STATES PART VI, LINE 7 MI X X X X 0 0 0 0 0 0 0 0 0 SUSAN TETZLAFF 137560 0 0 0 350 0 11896 0 19895 0 169701 0 0 0 DAVID JAHN 249999 0 0 0 118 0 32250 0 26114 0 308481 0 0 0 KEVIN KALCHIK 132105 0 0 0 110 0 11611 0 19896 0 163722 0 0 0 JAMES HAGLUND 161512 0 0 0 410 0 13076 0 7868 0 182866 0 0 0 WALEED DOGHMI 613903 0 0 0 10090 0 12250 0 19896 0 656139 0 0 0 RICHARD GANZHORN 727700 0 100000 0 0 0 12250 0 19896 0 859846 0 0 0 JAMIE ADAIR 461463 0 0 0 0 0 12250 0 19896 0 493609 0 0 0 JOHN GALEY 663307 0 0 0 340 0 12163 0 19896 0 695706 0 0 0 PAULA RECHNER 423449 0 26331 0 0 0 12250 0 19896 0 481926 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE DEPARTMENT WORKS WITH THE APPROPRIATE DEPARTMENTS TO PROVIDE RELEVANT INFORMATION TO THE PREPARER OF THE 990 (AN OUTSIDE FIRM SPECIALIZING IN TAX PREPARATION). REVIEW AND DISCUSSION OF ALL INFORMATION TAKES PLACE BETWEEN THE FINANCE DEPARTMENT AND THE CFO. THE FORM 990 IS THEN PROVIDED TO THE FULL BOARD, BEFORE FILING, WHERE THEY ARE GIVEN AN OPPORTUNITY TO ASK QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENT IS COMPLETED ANNUALLY FOR ALL BOARD MEMBERS AND SENIOR LEVEL ADMINISTRATION. ANY CONFLICTS WOULD BE REVIEWED AND KEPT UNDER CONSIDERATION ON AN ONGOING BASIS. BOARD MEMBERS AND ADMINISTRATION INFORM OR REMIND THE ATTENDEES IN THESE SITUATIONS AND ABSTAIN FROM BOTH DISCUSSION AND VOTE ON THE ITEM UNDER DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF BOTH MANAGEMENT AND PHYSICIANS IS REVIEWED UTILIZING THE MHA COMPENSATION SURVEY FOR MANAGEMENT AND MGMA DATA FOR PHYSICIANS. IT IS THE HOSPITAL'S DESIRE TO PAY A COMPETITIVE WAGE, BUT NOT PAY ABOVE THE 75TH PERCENTILE FOR MANAGEMENT. BASED ON THE MHA SURVEY THE CEO RECOMMENDS PROPOSED WAGE CHANGES AND HAS BOARD APPROVAL FOR SUCH CHANGES. THE CEO AND HUMAN RESOURCES DIRECTOR PROVIDES THE BOARD WITH CEO WAGE INFORMATION AND THE BOARD (CEO IS REQUESTED TO LEAVE THE MEETING AND IS NOT INVOLVED IN THE VOTE) APPROVES AND MAKES ANY CHANGES THAT ARE NECESSARY. FOR PHYSICIANS, THE CEO UTILIZES MGMA DATA AND BASED ON THE HOSPITAL'S COMMUNITY NEED ASSESSMENT MAKES A RECOMMENDATION TO THE BOARD SEEKING APPROVAL. THIS PROCESS WAS LAST UNDERTAKEN IN 2011. FORM 990, PART VI, SECTION C, LINE 19 THE 990 AND THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH A DISSEMINATION AGENT AND UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -20,375. LOSS FROM JOINT VENTURES -610,993. TRANSFER OF NET ASSETS FROM RELATED HOSPITAL UPON DISSOLUTION 354,238. TOTAL TO FORM 990, PART XI, LINE 5: -277,130. FORM 990, PART XII, LINE 2C: NO CHANGES FROM PRIOR YEAR.