2011-08-15T12:31:54-05:00 2010-09-30 Plante & Moran PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2009-10-01 381434090 INGHAM REGIONAL MEDICAL CENTER INGH 5179757555 401 W GREENLAWN AVE LANSING MI 48910 KEVIN LANCIOTTI 5179757555 2011-08-12 1 Susan Miencier 2695674500 2009 2016-02-24 21:20:13Z KEVIN LANCIOTTI 401 W GREENLAWN AVE LANSING MI 48910 326883930 0 X WWW.IRMC.ORG X 1942 MI INGHAM REGIONAL MEDICAL CENTER (IRMC) IS A COMMUNITY BASED, INTEGRATED HEALTHCARE DELIVERY SYSTEM AND MAJOR TEACHING HOSPITAL LOCATED IN LANSING, MICHIGAN. INGHAM IS COMPRISED OF TWO MEDICAL CENTERS AND VARIOUS AMBULATORY FACILITIES AND PROVIDES THE REGION WITH LEADING CARDIAC, ORTHOPEDIC, AND ONCOLOGY PROGRAMS. INGHAM PROVIDES CARE AND TREATMENT TO THE PEOPLE OF THE MID-MICHIGAN COMMUNITY SERVING INGHAM, EATON, AND CLINTON COUNTIES WITH A COMBINED POPULATION OF 450,000. INGHAM PROVIDED CARE TO OVER 17,129 INPATIENT ADMISSIONS, PERFORMED OVER 18,100 SURGICAL PROCEDURES AND PROVIDED MORE THAN 371,000 AMBULATORY VISITS TO THE COMMUNITY. 17 12 2509 769 961069 -121779 1132959 930822 322233235 315975928 5127921 3407717 4769883 6558787 333263998 326873254 366480 1759164 0 144663063 146808263 0 0 177464409 173586798 322493952 322154225 10770046 4719029 257629022 266236280 200549506 207943937 57079516 58292343 MCLAREN HEALTH CARE CORPORATION, ALONG WITH ITS SUBSIDIARIES, WILL BE MICHIGAN'S BEST VALUE IN HEALTHCARE AS DEFIEND BY QUALITY OUTCOMES AND COST. 0 0 269472113 1759164 315061299 INGHAM REGIONAL MEDICAL CENTER (IRMC) IS A COMMUNITY BASED, INTEGRATED HEALTHCARE DELIVERY SYSTEM AND MAJOR TEACHING HOSPITAL LOCATED IN LANSING, MICHIGAN. INGHAM IS COMPRISED OF TWO MEDICAL CENTERS AND VARIOUS AMBULATORY FACILITIES AND PROVIDES THE REGION WITH LEADING CARDIAC, ORTHOPEDIC, AND ONCOLOGY PROGRAMS. INGHAM PROVIDES CARE AND TREATMENT TO THE PEOPLE OF THE MID-MICHIGAN COMMUNITY SERVING INGHAM, EATON, AND CLINTON COUNTIES WITH A COMBINED POPULATION OF 450,000. INGHAM PROVIDED CARE TO OVER 17,129 INPATIENT ADMISSIONS, PERFORMED OVER 18,100 SURGICAL PROCEDURES AND PROVIDED MORE THAN 371,000 AMBULATORY VISITS TO THE COMMUNITY. 269472113 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 1 1 0 0 1 168 0 1 2509 1 1 1 0 0 0 0 0 0 0 0 17 12 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 MI X KEVIN LANCIOTTI 5179757555 401 W GREENLAWN AVE LANSING MI 48910 Robert Wright 40.00 X X 0 649761 74672 E James Barrett 1.50 X X 4600 0 0 David McSherry 1.50 X X 4200 0 0 Paula Cunningham 1.50 X 1800 0 0 Tico Duckett 1.50 X 2800 0 0 Ramiro Gonzalez 1.50 X 4300 0 0 Thomas Hoisington 1.50 X 2700 0 0 Theresa Hubbell 1.50 X 2500 0 0 Philip Incarnati 1.50 X 0 14617609 520640 Charles Steinberg 1.50 X 750 0 0 Everett Zack 1.50 X 3900 0 0 jeff williams 1.50 X 2000 0 0 RALPH SHAHEEN 1.50 X 0 0 0 THOMAS ARCHAMBEAU MD 1.50 X 0 0 0 MEHBOOB FATTEH MD 1.50 X 0 0 0 DENNIS LOUNEY 1.50 X 0 0 0 JAMES RICHARD 1.50 X 3100 0 0 PATRICIA LOWRIE 1.50 X X 2800 0 0 AMIT GHOSE MD 1.50 X 18000 0 0 KENNETH ELMASSIAN MD 1.50 X 18000 0 0 thomas petroff 40.00 X 283898 0 24839 carol jones 40.00 X 203591 0 25180 LAURIE BREWIS 40.00 X 141690 0 22024 PATRICK SALOW 40.00 X 142062 0 8176 KEVIN LANCIOTTI 40.00 X 0 0 0 RONALD COSSON 40.00 X 154746 0 13957 DR dIVYAKANT GANDHI 40.00 X 500011 0 27117 DR ALONSO COLLAR 40.00 X 580331 0 27117 DR ANDREW DUDA 40.00 X 550537 0 27094 GRACE GIBBS 40.00 X 481804 0 26708 SANDRA RUSSELL 40.00 X 488180 0 23451 Barbara Sawyer-Koch 1.50 X 600 0 0 Paula Reichle 40.00 X 142387 0 15381 Deborah Leblanc 40.00 X 78979 0 0 STEVEN HIGGENBOTHAM 40.00 X 91390 0 6039 ED MCREE 0.00 X 12357 0 0 3924013 15267370 842395 93 1 1 0 Provider Healthnet Services PO Box 671001 Dallas TX 752671001 Coding, Med Record, Transcription and ca 5441682 SPARROW HOSPITAL 1215 E MICHIGAN AVENUE LANSING MI 48912 PHYSICIAN ADMINISTRATION AND SUPPORT SER 1503688 Thoracic & Cardiovascular Institute 3500 S Cedar STE 116 Lansing MI 489104684 CLINICAL SERVICES AND TECHNICAL SUPPORT 1334781 MSU - COMBINED TOTAL MSU EAST LANSING MI 48823 MEDICAL EDUCATION RESIDENTS AND SUPPORT 1291595 MEDICAL STAFFING NETWORK 4125 OKEMOS ROAD 23 OKEMOS MI 48864 CRNA SERVICES 1237709 36 831620 99202 930822 Patient services 622110 314840639 314840639 LAB 621500 1135289 220660 914629 315975928 1461514 1461514 602950 602950 602950 602950 1942202 14677 10676 1942202 4001 1946203 1946203 OTHER OPERATING REV. 623000 3973028 6000 3967028 recovery of bad debt 900099 2438952 2438952 Non-operating rev. 900099 -456143 40440 -496583 5955837 326873254 315061299 961069 9920064 1759164 1759164 1367733 1367733 109856603 99554010 10302593 8045349 7208465 836884 19934097 17961206 1972891 7604481 6971517 632964 111777 111777 71043 71043 37613101 27853802 9759299 3236384 834990 2401394 1546091 1398964 147127 212410 137010 75400 227320 184970 42350 5994034 60428 5933606 13744875 13744875 1242422 11100 1231322 SUPPLIES 63629821 63489616 140205 BAD DEBTS 19991070 19991070 QAAP 11599529 11599529 EQUIPMENT RENTAL & MAIN 5585584 5527213 58371 UTILITIES 3762232 3386009 376223 5019105 1543050 3476055 322154225 269472113 52682112 0 35124890 34347826 43302383 27680285 514658 3241498 3360290 581062 547889 278421342 159037673 125426413 119383669 36507410 60502299 13445366 19899364 257629022 266236280 34552296 35043987 258876 192863 118601311 116237820 1373333 1728395 45763690 54740872 200549506 207943937 X 57079516 58292343 57079516 58292343 257629022 266236280 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 26434 26434 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: DUES PAID TO MHA, AHA, MICHIGAN CHAMBER OF COMMERCE, AND LANSING REGIONAL CHAMBER OF COMMERCE OF WHICH A PORTION IS DEEMED TO BE LOBBYING ACTIVITIES. 3491598 3491598 183948334 106864740 77083594 496681 288547 208134 89309591 51884386 37425205 1175138 1175138 119383669 GOODWILL/ORG COSTS 105608 BOND FINANCING 770450 OTHER ASSETS 870018 INVESTMENTS IN AFFILIATE 5595798 Other Deferred IT Equipment 4061326 DUE FROM AFFILIATES 791578 COST REPORT SETTLEMENTS 7117134 OTHER ACCOUNTS RECEIVABLE 587452 19899364 POST RETIREMENT BENEFITS 6545865 ACCRUED PENSION COST 42828406 MALPRACTICE RESERVE 3190270 OTHER LIABILITIES 870018 DUE TO AFFILIATES 1306313 54740872 326873254 322154225 4719029 4787279 -8293481 -3506202 1212827 Part XI, Line 8 - Other Adjustments: minimum pension liability adjustment: -6668849. LOSS ON INVESTMENT IN SUBSIDIARIES: -43335. transfer to affiliates - practice acquisitions: -958553. transfer to affiliates - premier dividend: -622744. 1 1 X 1 X 1 X 1 1 1 0 1 0 7577918 7577918 0.02510 19766781 16686037 3080744 0.01020 19668326 11397638 8270688 0.02740 47013025 28083675 18929350 0.06270 132416 132416 0.00040 9479123 6178191 3300932 0.01090 79238 40000 39238 0.00010 291315 291315 0.00100 9982092 6218191 3763901 0.01240 56995117 34301866 22693251 0.07510 45 3829 63783 63783 0.00020 45 3829 63783 63783 0.00020 0 6798534 633076 127775969 126076945 1699024 X 0 INGHAM REGIONAL MEDICAL CENTER

401 W GREENLAWN AVENUE LANSING MI 48910

X X X X INGHAM REGIONAL MEDICAL CENTER

2727 S PENNSYLVANIA AVENUE LANSING MI 48910

X X X X DEWITT WOMENS HEALTH CENTER

12805 ESCANABA DR STE 2 DEWITT MI 48820

PHYSICAN PRACTICE INGHAM CARDIAC & THORACIC SURGEONS

405 W GREENLAWN STE 305 LANSING MI 48910

PHYSICAN PRACTICE INGHAM REGIONAL MEDICAL CENTER

2316 S CEDAR ST LANSING MI 48910

PHYSICAN PRACTICE WOMENS HEALTH CENTER

6465 MILLENIUM DR STE 100 LANSING MI 48910

PHYSICAN PRACTICE SPORTS MEDICINE REHAB

3315 E MICHIGAN LANSING MI 48910

OUTPATIENT REHAB REBOUND REHAB

3394 E JOLLY ROAD STE B LANSING MI 48910

OUTPATIENT REHAB MERIDIAN WOMEN'S HEALTH

2104 JOLLY ROAD STE 220 OKEMOS MI 48864

PHYSICAN PRACTICE INGHAM RADIOLOGY CENTER

11653 HARTEL RD STES 101 208 209 GRAND LEDGE MI 48837

IMAGING CENTER INGHAM PAIN CLINIC

405 W GREENLAWN LANSING MI 48820

PHYSICAN PRACTICE CHARLOTTE WOMENS HEALTH

321 E HARRIS STREET CHARLOTTE MI 48813

PHYSICAN PRACTICE Part I, Line 3c: INCOME CRITERIA IS BASED UPON 200% OF THE FEDERAL POVERTY GUIDELINES PER THE FEDERAL REGISTER. COLLECTIONS MAY BE CONSIDERED IF THE PATIENT HAS SUFFICIENT LIQUID ASSETS. Part I, Line 6a: OUR PARENT, MCLAREN HEALTH CARE CORPORATION, PREPARES AN ANNUAL REPORT OF ITS MEMBER HOSPITALS. THIS ANNUAL REPORT IS AVAILABLE ON OUR WEBSITE. Part I, Line 7: COSTING METHODOLOGY - USED COST TO CHANGE RATIO PER OUR COST REPORTS. Part III, Line 4: 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 Corporation'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 from certain payors. WE USED OUR BAD DEBT EXPENSE PER OUR FINANCIAL STATEMENTS AND CONVERTED TO ESTIMATED COST USING OUR OVERALL COST TO CHANGE RATIO. lINE 3 WAS ESTIMATED BASED ON SAMPLES OF ACCOUNTS. Part III, Line 9b: AT THIS TIME WE DO NOT HAVE A FORMAL DEBT COLLECTION POLICY. CURRENTLY OUR PROCESS INCLUDES: SENDING OUR SELF AND PRIVATE PAY PATIENT ACTIVITY TO AN OUTSIDE VENDOR FOR FOLLOW-UP AND ASSISTANCE FOR THE PATIENT. SELF PAY PATIENTS REQUESTING FINANCIAL ASSISTANCE AT REGISTRATION ARE GIVEN A FINANCIAL ASSISTANCE APPLICATION WHICH IS THEN EVALUATED TO DETERMINE IF CHARITY CARE IS APPLICABLE. AN ATTEMPT IS ALSO MADE AT THAT TIME TO ASSIST PATIENTS WHO MEET MEDICAL ELIGIBILITY REQUIREMENTS. Part VI, Line 2: Primary and secondary market research is conducted by and through community-based health coalitions, academic institutions, third party data analytics organizations, health needs assessments and surveys, historic health services utilization patterns, demographic analysis and population-based health care services utilization forecasts. Part VI, Line 3: FINANCIAL ASSISTANCE INFORMATION AND APPLICATIONS ARE PROVIDED AT ALL INPATIENT AND OUTPATIENT REGISTRATION POINTS-OF-SERVICE. INFORMATION AND EDUCATION IS ALSO AVAILABLE THROUGH THE ORGANIZATIONS WEBSITE(S). ORGANIZATION AND ITS SUBSIDIARIES/AFFILIATES ALSO PROVIDE SPECIALLY-TRAINED COUNSELORS TO ASSIST PATIENTS AND REVIEW ELIGIBILITY FOR FEDERAL, STATE AND OTHER GOVERNMENT PROGRAMS, INCLUDING, BUT NOT LIMITED TO, MEDICAID, DISABILITY, SOCIAL SECURITY, AND ANY OTHER FORMS OF THIRD PARTY PAYMENT. Part VI, Line 4: The service area of Ingham Regional Medical Center is composed of 51 ZIP codes and is centered principally on the city of Lansing, MI in the county of Ingham. The primary service area, accounting for 92% of annual inpatient discharges, is composed of 27 ZIP codes and can be characterized as largely urban in nature. The secondary service area, accounting for 8% of annual inpatient discharges, is composed of 24 ZIP codes and can be characterized as a combination of urban and rural in nature. Primary Service Area Demographic DistributionsAge Distribution0 - 14 18.2%15 - 17 4.1%18 - 24 14.2%25 - 34 12.9%35 - 54 26.6%55 - 64 12.0%65+ 11.9%Education LevelLess than High School 2.6%Some High School 5.6%High School Degree 26.8%Some College/Assoc. Degree 34.2%Bachelors Degree or Greater 30.6%Household Income Distribution<$15K 12.4%$15 - 25K 11.0%$25 - 50K 27.9%$50 - 75K 20.7%$75 - 100K 12.7%Over $100K 15.3%Race/EthnicityWhite Non-Hispanic 81.2%Black Non-Hispanic 7.8%Hispanic 5.0%Asian & Pacific Is. Non-Hispanic 3.2%All Others 2.8% Part VI, Line 5: Community-building activities are designed and implemented based on community needs assessments and input from community-based organizations and other community stakeholders, including business vendors, religious organizations and political leaders. Each organization defines annual community-building and outreach activity plans. These plans are designed to address the specific health prevention, education, diagnosis, treatment and follow-up care requirements of unique disease, demographic and geographic communities identified by ongoing needs assessments described above. Part VI, Line 6: The parent organization and each of its subsidiary/affiliate members maintain a local community-based board with powers, responsibilities and accountabilities for the oversight of the operation of their respective organizations. Each subsidiary/affiliate organization maintains an open medical staff allowing any physician or other care provider with proper credentials to join the staff and provide approved care. The organization funds and maintains over 500 medical residency and fellowship programs to train future generations of physicians; organization funds, operates and maintains numerous health care education programs at the high school, community college, university and post-graduate levels of education. Organization provides sponsorship (financial and in-kind resources) support to community-level activities (health walks and races, fitness training, disease awareness events, cultural events and other health-related non-profit activities, events and organizations). Organization also directs, funds, supports and participates in fundraising activities that support health prevention/education, diagnosis and treatment provided by other non-profit community organizations. Part VI, Line 7: The role of the parent organization is to set the vision and strategic direction for the organization as a whole. This includes the development of the annual Strategic Plan which defines the strategic priorities for the organization and its members, the metrics to be measured for each strategic programs and the benchmark or target/goals for each metric. Strategic priorities directly address and measure (at a subsidiary level) clinical quality and clinical outcomes; patient, physician, employee and community satisfaction with the organization and its subsidiary/affiliate members; and development of new services to improve access to, quality of, and cost of health services.The role of the organizations subsidiaries/affiliates is the development and implementation of annual strategic and operational plans that support and advance the strategic plan of the parent organization. All local plans are developed and designed to reflect the unique population-based health care needs and requirements of the communities served by the subsidiary/affiliate organization.All local subsidiaries/affiliates have full authority and decision-making powers to define and execute the strategic and operational plans intended to improve the health and welfare of the communities they serve. MI 1 EAST LANSING ART FESTIVAL 410 ABBOTT BOARD EAST LANSING MI 48912 386004674 government 2500 N/a N/a Sponsorship Eaton Rapids Medical Center 1500 South Main St Eaton Rapids MI 48827 381559180 501(c)(3) 2900 n/a n/a General Support MICHIGAN STATE UNIVERSITY 1 Fee Hall East Lansing MI 48823 386005984 Government 208775 n/a n/a General Support AMERICAN CANCER SOCIETY 20450 CIVIC CENTER DR SOUTHFIELD MI 48076 131788491 501(c)(3) 10000 n/a n/a SPONSORSHIP GREATER LANSING FOOD BANK 5303 SOUTH CEDAR ST LANSING MI 48911 382424756 501(c)(3) 21500 n/a n/a GENERAL SUPPORT & SPONSORSHIP HIS HEALING HANDS URGENT CARE 2025 W HOLMES RD LANSING MI 48901 263067328 501(c)(3) 25000 n/a n/a GENERAL SUPPORT KELLEY-PERLES-SECCHIA (SPECIAL OLYMPICS OF MI) PO BOX 474 ALMA MI 48801 381964643 501(c)(3) 5000 n/a n/a SPONSORSHIP LANSING REGIONAL CHAMBER OF COMMERCE 500 E MICHIGAN AVE STE 200 LANSING MI 48912 380745180 government 5640 n/a n/a SPONSORSHIP MEMORIAL HEALTHCARE FOUNDATION 826 WEST KING ST OWOSSO MI 48867 383036586 501(c)(3) 5000 n/a n/a SPONSORSHIP TRI COUNTY OFFICE ON AGING 5303 SOUTH CEDAR ST LANSING MI 48911 382048955 115 5000 n/a n/a SPONSORSHIP MCLAREN MEDICAL MANAGEMENT INC 401 S BALLENGER HWY FLINT MI 48532 382988086 501(c)(3) 1467849 0 N/A N/A GENERAL SUPPORT 11 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: REQUESTS FOR FUNDS ARE REVIEWED BY THE SENIOR DIRECTOR OF FINANCE, CFO, AND CEO FOR CONSISTENCY WITH THE ORGANIZATION'S MISSION AND PURPOSE. FUNDS ARE DISTRIBUTED TO 501(C)(3) ORGANIZATIONS, TYPICALLY FOR GENERAL SUPPORT PURPOSES. 0 1 0 0 0 0 0 0 0 Robert Wright 0 524164 0 0 0 125597 0 59222 0 15450 0 724433 0 0 Philip Incarnati 0 1247074 0 1119378 0 12251157 0 507159 0 13481 0 15138249 0 2998959 thomas petroff 283898 0 0 0 0 0 9250 0 15589 0 308737 0 0 0 carol jones 196428 0 7163 0 0 0 10180 0 15000 0 228771 0 0 0 LAURIE BREWIS 141690 0 0 0 0 0 7085 0 14939 0 163714 0 0 0 PATRICK SALOW 142062 0 0 0 0 0 7103 0 1073 0 150238 0 0 0 RONALD COSSON 154746 0 0 0 0 0 7737 0 6220 0 168703 0 0 0 DR dIVYAKANT GANDHI 500011 0 0 0 0 0 11500 0 15617 0 527128 0 0 0 DR ALONSO COLLAR 425006 0 155325 0 0 0 11500 0 15617 0 607448 0 0 0 DR ANDREW DUDA 439426 0 111111 0 0 0 11500 0 15594 0 577631 0 0 0 GRACE GIBBS 298649 0 183155 0 0 0 11500 0 15208 0 508512 0 0 0 SANDRA RUSSELL 298268 0 189912 0 0 0 11500 0 11951 0 511631 0 0 0 Barbara Sawyer-Koch 0 0 0 0 600 0 0 0 0 0 600 0 0 0 Paula Reichle 121197 0 21190 0 0 0 6060 0 9321 0 157768 0 0 0 Deborah Leblanc 0 0 0 0 78979 0 0 0 0 0 78979 0 0 0 STEVEN HIGGENBOTHAM 89121 0 0 0 2269 0 4570 0 1469 0 97429 0 0 0 ED MCREE 0 0 0 0 12357 0 0 0 0 0 12357 0 0 0 Part I, Line 1a THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 1 BOXES HAVE BEEN CHECKED. THE CORPORATE CEO, SUBSIDIARY CEO'S AND CORPORATE VICE-PRESIDENTS IN SOME INSTANCES HAVE RECEIVED TAX INDEMNIFICATION FOR THE FOLLOWING BENEFITS: VEHICLE COSTS, GROUP TERM LIFE INSURANCE, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS, AND HEALTH CLUB OR SOCIAL DUES. THESE BENEFITS HAVE BEEN INCLUDED IN TAXABLE COMPENSATION. THE FOLLOWING INDIVIDUAL HAS RECEIVED THESE BENEFITS: ROBERT WRIGHT AND PHILIP INCARNATI. Part I, Line 4b: McLaren maintains two supplemental nonqualified retirement plans for a select group of management or highly compensated employees (the "SERPs"). The Old SERP was closed to new participants on October 1, 2006, and the New SERP became effective as of January 1, 2007. No employee may participate in both of the SERPs. The Old SERP is structured as a defined benefit plan that essentially replaces the benefits the participant is not permitted to receive under McLaren's qualified retirement plan due to IRS limitations applicable to qualified plans. The benefit under the Old SERP is payable in either the form of a single sum distribution or in monthly payments equal to the actuarial equivalent of the participant's accrued benefit. The benefit is paid at age 55, and if the participant remains employed, the benefit is paid upon termination of employment, reduced to take into account the benefit previously paid. The New SERP is structured as a defined contribution plan, and McLaren contributes 15 percent of each participant's compensation to the plan each year for allocation to the participant's account. Participants in the New SERP become vested in their accounts upon the earlier of five years of participation in the plan or attainment of age 60. Participants in the New SERP self-direct the investment of their accounts and have the actual investment return credited or debited to their accounts. The benefit under the New SERP is equal to the participant's account balance, and the benefit is paid in a single sum within 60 days of the participant' 0s termination date. Benefits under both SERPs are provided on a tax-neutral basis. Both SERPS are designed to comply with Internal Revenue Code sections 457(f) and 409A. The individuals listed in Part VII who participated in the Old SERP are: PHILIP INCARNATI AND ROBERT WRIGHT. There are no individuals listed in Part VII who participated in the New SERP. Part I, Line 6 MCLAREN HEALTH CARE CORPORATION (MHCC) HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION, SUBSIDIARY EXECUTIVES AND DIRECTORS, AND CORPORATE MANAGERS. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ORGANIZATION'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING TOP OFFICIALS AND THE BOARD OF DIRECTORS WITH A TOOL FOR (A) CLEARLY COMMUNICATING PERFORMANCE ON THE PART OF KEY LEADERS, (B) STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE ON THE PART OF KEY LEADERS WHICH WILL ULTIMATELY BENEFIT THE COMMUNITIES MHCC SERVES, AND (C) PROTECTING MHCC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH-TALENT LEADERS. Supplemental Information Part III SCH J, PART I, LINE 3: THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 3 BOXES HAVE BEEN CHECKED. THE RELATED ORGANIZATION USED THE FOLLOWING METHODOLOGIES TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. Capital Internal Medicine Associates Dr. Kowalczyk and Dr. Ghose, ownership of CIMA, loans are for recruitment X 165000 33333 0 0 1 33333 CAPITAL INTERNAL MEDICINE ASSOCIATES DR. AMIT GHOSE, DO, Current Chief of Staff AND PART OWNER OF CIMA 700153 Lease of Office space Med Directorships and other Healthcare services 0 CAPITAL AREA PATHOLOGISTS DR. JAMES RICHARD, Board Member AND PART OWNER OF CAPITAL AREA PATHOLOGISTS 1107775 Medical Director, Pathology and other Healthcare services 0 PHNS PHILIP INCARNATI, BOARD MEMBER OF PHNS 2332909 MHCC is the co-founder and has a minority interest in PHNS. As part of the agreement MHCC is entitled to appoint two directors to the PNHS board. MHCC appointed James Fitzgerald and Philip Incarnati to hold those positions. 0 CAPITAL AREA PATHOLOGISTS DR. MEHBOOB FATTEH, CURRENT CO-CHIEF OF STAFF AND PART OWNER OF CAP 1107775 Medical Director, Pathology and other Healthcare services 0 MEDICAL STAFFING NETWORK PHILIP INCARNATI, BOARD MEMBER OF MEDICAL STAFFING NETWORK 1237709 FEES PAID FOR TEMPORARY MEDICAL STAFFING 0 Form 990, Part VI, Section A, line 2 DR. KOWALCZYK AND DR. GHOSE HAVE A BUSINESS RELATIONSHIP. Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF THIS ORGANIZATION IS MCLAREN HEALTH CARE CORPORATION. Form 990, Part VI, Section A, line 7a THE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO ELECT OR APPOINT THE DIRECTORS OF THE CORPORATION. Form 990, Part VI, Section A, line 7b DECISIONS BY THE GOVERNING BODY ARE SUBJECT TO THE POWERS OF THE MEMBER. Form 990, Part VI, Section B, line 11 THE FORM 990 DATA IS PREPARED INTERNALLY AND SUBMITTED TO OUR AUDITING FIRM FOR RETURN PREPARATION. ONCE THE RETURNS HAVE BEEN COMPLETED, THE FORMS ARE REVIEWED BY THE CORPORATE DIRECTOR OF BUDGET, THE CORPORATE SENIOR VICE PRESIDENT AND CFO OF MCLAREN HEALTH CARE CORPORATION (MHCC). COPIES OF THE RETURNS ARE MADE AVAILABLE TO THE MHCC BOARD MEMBERS, WHO SERVE AS THE OVERALL GOVERNING BOARD. RETURNS ARE AVAILABLE FOR ALL CORPORATIONS OF WHICH MHCC IS THE SOLE MEMBER AS WELL AS OTHER RELATED ENTITIES OF THOSE CORPORATIONS FOR REVIEW RATHER THAN HAVING THE LOCAL BOARDS REVIEW THE RETURNS. THE BOARD OF MHCC IS THE ULTIMATE ACCOUNTABLE ORGANIZATION FOR THE SYSTEM; AS SUCH IT IS THE OVERALL GOVERNING BOARD OF OUR SYSTEM WHOSE RESPONSIBILITIES INCLUDES BUT ARE NOT LIMITED TO: APPROVING ALL SUBSIDIARY BOARD MEMBERS, FINANCIAL BUDGETS, AND ISSUANCE OF DEBT. Form 990, Part VI, Section B, line 12c THE CORPORATE COMPLIANCE DEPARTMENT, IN ACCORDANCE WITH THE MCLAREN HEALTH CARE (MHC) BOARD CONFLICT OF INTEREST POLICY, ANNUALLY DISTRIBUTES THE CONFLICT OF INTEREST DISCLOSURE SURVEY TO ALL MHC CORPORATE AND SUBSIDIARY ORGANIZATION BOARD MEMBERS, EXECUTIVES AND OTHER LEADERSHIP EMPLOYEES. THE CORPORATE COMPLIANCE DEPARTMENT THROUGH THE GOVERNANCE COMMITTEE, COMPILES AND ANALYZES SURVEY DATA BY ORGANIZATION, INVESTIGATES, AND REVIEWS POTENTIAL CONFLICTS WITH THE ORGANIZATION'S CEO AND BOARD CHAIR, AND WHEN NECESSARY, RECOMMENDS ACTIONS TO BE TAKEN TO RESOLVE IDENTIFIED CONFLICTS. A COMPLETE REPORT OF ALL CORPORATE AND SUBSIDIARY BOARD MEMBER AND EXECUTIVE DISCLOSURES, CONFLICTS IDENTIFIED AND ACTIONS TAKEN IS REVIEWED BY THE MHC GOVERNANCE COMMITTEE AND EACH SUBSIDIARY CEO AND BOARD CHAIR RECEIVES A REPORT SPECIFIC TO THEIR ORGANIZATION'S BOARD MEMBERS AND EXECUTIVES. CONFLICTS ARE DISCLOSED TO THE FULL BOARD AND BOARD COMMITTEES SO APPROPRIATE ACTIONS CAN BE TAKEN. ACTIONS MAY INCLUDE PROHIBITING A BOARD MEMBER FROM PARTICIPATING IN DELIBERATIONS INVOLVING TRANSACTIONS WITH A COMPANY WITH WHICH THEY CONDUCT FINANCIAL TRANSACTIONS; BOARD MEMBERS FAILING TO COMPLETE A DISCLOSURE SURVEY OR INTENTIONALLY FAILING TO REPORT A KNOWN CONFLICT OF INTEREST ARE ASKED TO RESIGN. Form 990, Part VI, Section B, line 15 THE COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF MCLAREN HEALTH CARE CORPORATION BASED UPON THE PERFORMANCE OF THE CEO. THE COMPENSATION OF THE CEO IS WITHIN THE SALARY RANGES DETERMINED BY THE COMPENSATION COMMITTEE OF MCLAREN HEALTH CARE CORPORATION. THE PROCESS OF THE COMPENSATION COMMITTEE IS AS FOLLOWS: THE COMPENSATION COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS TO REVIEW THE PERFORMANCE AND RECOMMEND THE TOTAL COMPENSATION PACKAGE OF THE MCLAREN HEALTHCARE CORPORATION'S CEO'S TO THE BOARD. FURTHER THE COMMITTEE ESTABLISHES THE SALARY RANGES AND PREREQUISITES OF THE CORPORATION'S OTHER MOST HIGHLY COMPENSATED OFFICERS (MHC VICE-PRESIDENTS AND MHC HOSPITAL/SUBSIDIARIES CEO'S) TO THE BOARD. THE MEMBERS OF THE COMMITTEE MUST MEET THE INDEPENDENCE REQUIREMENTS OF THE APPLICABLE PROVISIONS OF SECTION 4958 OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND FINAL TREASURY REGULATIONS SECTION 53.4956-6(C)(1)(III). THE COMMITTEE RETAINS THE SERVICES OF AN INDEPENDENT FIRM WITH SIGNIFICANT QUALIFICATIONS AND EXPERIENCE TO CONDUCT A REVIEW OF THE CORPORATION'S EXECUTIVE COMPENSATION PROGRAM. THE RETAINED FIRM UTILIZES APPROPRIATE COMPENSATION COMPARABILITY DATA. THE RETAINED FIRM CONDUCTS ANALYSIS OF THE COMPETITIVENESS OF THESE PROGRAMS AND EXPRESSES AN OPINION AS TO THE REASONABLENESS OF THESE COMPENSATION PROGRAMS. ALL DATA UTILIZED BY THE COMMITTEE, DELIBERATIONS OF THE COMMITTEE, AND FINAL COMPENSATION DECISIONS BY THE COMMITTEE ARE DOCUMENTED IN FORMAL REPORTS AND MINUTES. THE CORPORATE COMPENSATION COMMITTEE WORKS UNDER AND PERIODICALLY RENEWS THE MCLAREN HEALTH CARE CORPORATION COMPENSATION COMMITTEE CHARTER AND MCLAREN HEALTH CARE CORPORATION COMPENSATION PHILOSOPHY. FOR SUBSIDIARY VICE PRESIDENTS AND DIRECTORS, THE CORPORATE HUMAN RESOURCES COMMITTEE COORDINATES THE GATHERING OF MARKET INFORMATION FROM A NUMBER OF INDEPENDENT SOURCES. THIS DATA IS ANALYZED ALONG WITH EXPECTED BUDGETARY GUIDELINES. THE CORPORATE VICE PRESIDENT OF HUMAN RESOURCES DETERMINES THE AMOUNT, IF ANY, THAT PAY RANGES INCREASE. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS 2010. Form 990, Part VI, Section C, line 19 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: PHILIP INCARNATI AND ROBERT WRIGHT EACH WORKED AN AVERAGE OF AT LEAST 40 HOURS AND 0 HOURS PER WEEK AT MCLAREN HEALTH CARE CORPORATION, RESPECTIVELY. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BAY MEDICAL FOUNDATION 1900 COLUMBUS AVE BAY CITY MI 48708 382156534 FOUNDATION MI 501(c)(3) Line 11a, I BAY REGIONAL MEDICAL CENTER BAY REGIONAL MEDICAL CENTER 1900 COLUMBUS AVE BAY CITY MI 48708 381976271 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION BAY REGIONAL MEDICAL CENTER AUXILIARY 1908 COLUMBUS AVENUE BAY CITY MI 48708 386081235 SUPPORTING ORGANIZATION MI 501(c)(3) Line 11a, I BAY REGIONAL MEDICAL CENTER BAY SPECIAL CARE HOSPITAL 1900 COLUMBUS AVE BAY CITY MI 48708 383161753 HOSPITAL MI 501(c)(3) Line 3 BAY REGIONAL MEDICAL CENTER CENTRAL MICHIGAN COMMUNITY HOSPITAL 1221 SOUTH DRIVE MT PLEASANT MI 48858 381420304 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION CENTRAL MICHIGAN COMMUNITY HOSPITAL RADIATION ONCOLOGY 1000 HARRINGTON MT PLEASANT MI 48858 300312172 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION GREAT LAKES CANCER INSTITUTE 401 S BALLENGER HWY FLINT MI 48532 383584572 CANCER CARE CENTER MI 501(c)(3) Line 7 MCLAREN HEALTH CARE CORPORATION INGHAM REGIONAL HEALTHCARE FOUNDATION 401 S GREENLAWN AVE LANSING MI 48910 382463637 FOUNDATION MI 501(c)(3) Line 7 INGHAM REGIONAL MEDICAL CENTER LAPEER REGIONAL MEDICAL CENTER 1375 N MAIN ST LAPEER MI 48446 382689033 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION LAPEER REGIONAL MEDICAL CENTER FOUNDATION 1375 N MAIN ST LAPEER MI 48446 382689603 FOUNDATION MI 501(c)(3) Line 11a, I LAPEER REGIONAL MEDICAL CENTER MCLAREN HEALTH CARE CORPORATION 401 S BALLENGER HWY FLINT MI 48532 382397643 SUPPORTING ORG MI 501(c)(3) Line 11a, I N/A MCLAREN HEALTH PLAN G-3245 BEECHER ROAD FLINT MI 48532 383383640 HEALTH CARE SERVICES MI 501(c)(4) MCLAREN HEALTH CARE CORPORATION MCLAREN MEDICAL MANAGEMENT INC 401 S BALLENGER HWY FLINT MI 48532 382988086 MANAGEMENT COMPANY MI 501(c)(3) Line 11a, I MCLAREN HEALTH CARE CORPORATION MCLAREN REGIONAL MEDICAL CENTER 401 S BALLENGER HWY FLINT MI 48532 382383119 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION MOUNT CLEMENS REGIONAL HEALTHCARE FOUNDATION PO BOX 326 MOUNT CLEMENS MI 48046 382578873 FOUNDATION MI 501(c)(3) Line 9 MOUNT CLEMENS REGIONAL MEDICAL CENTER MOUNT CLEMENS REGIONAL MEDICAL CENTER 1000 HARRINGTON MOUNT CLEMENS MI 48043 381218516 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION POH REGIONAL MEDICAL CENTER 50 NORTH PERRY STREET PONTIAC MI 48342 381428164 HOSPITAL MI 501(c)(3) Line 3 MCLAREN HEALTH CARE CORPORATION POH RILEY FOUNDATION 50 NORTH PERRY STREET PONTIAC MI 48342 200442217 FOUNDATION MI 501(c)(3) Line 11c, III-FI POH REGIONAL MEDICAL CENTER VISITING NURSE SERVICE OF MICHIGAN 401 S BALLENGER HWY FLINT MI 48532 383491714 HEALTH CARE SERVICES MI 501(c)(3) Line 9 MCLAREN HEALTH CARE CORPORATION WOMENS HOSPITAL ASSOCIATION OF FLINT MICHIGAN 401 S BALLENGER HIGHWAY FLINT MI 48532 381358053 SUPPORTING ORGANIZATION MI 501(c)(3) Line 11a, I MCLAREN HEALTH CARE CORPORATION REGIONAL EMERGENCY MEDICAL SERVICE INC 25400 W 8 MILE ROAD SOUTHFIELD MI 48034 383255499 AMBULANCE SERVICE MI 501(c)(3) Line 9 MCLAREN MEDICAL MANAGEMENT INC NORTH OAKLAND NORTH MACOMB IMAGING INC 355 BARCLAY CIR STE A ROCHESTER HILLS MI 48307 382807040 MRI IMAGING MI 501(c)(3) Line 3 PRIMARY CARE 1900 COLUMBUS AVE BAY CITY MI 48708 202443604 HEALTH CARE SERVICES MI 501(c)(3) Line 9 BAY REGIONAL MEDICAL CENTER MCLAREN HEALTHCARE VILLAGE FOUNDATION 401 S BALLENGER HIGHWAY FLINT MI 48532 262693350 SUPPORTING ORGANIZATION MI 501(c)(3) Line 11a, I MCLAREN HEALTH CARE CORPORATION MCLAREN - NORTHERN EQUITIES CANCER CENTER PROJECT LLC 39000 COUNTRY CLUB DRIVE FARMINGTON HILLS MI 48331 263112935 RENTAL REAL ESTATE MI N/A JOINT VENTURE HOSPITAL LABORATORIES LLC 1633 FAIRLANE CIRCLE SUITE 300 ALLEN PARK MI 48101 383018129 LAB PROCEDURES MI N/A MOUNT CLEMENS REGIONAL HEALTH BUILDING HEALTH PARTNERS 1000 HARRINGTON ST MOUNT CLEMENS MI 48043 262524717 BUILDING MANAGEMENT MI N/A HEALTH ADVANTAGE INC G3245 BEECHER ROAD FLINT MI 48532 912141720 HEALTH CARE SERVICES MI N/A C CLARKSTON PROPERTY ASSOCIATES 50 NORTH PERRY STREET PONTIAC MI 48342 432006072 REAL ESTATE MI N/A C HOSPITAL HEALTH CARE INC 50 NORTH PERRY STREET PONTIAC MI 48342 382643070 HEALTH CARE MI N/A C PHYSICIAN ORGANIZED HEALTHCARE SYSTEM 50 NORTH PERRY STREET PONTIAC MI 48342 383136458 MANAGED CARE MI N/A C MCLAREN HEALTH PLAN INSURANCE COMPANY G-3245 BEECHER ROAD SUITE 200 FLINT MI 48532 271780283 INSURANCE MI N/A C 0 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 0 INGHAM REGIONAL HEALTH CARE FOUNDATION C 831620 INGHAM REGIONAL HEALTH CARE FOUNDATION N 215525 INGHAM REGIONAL HEALTH CARE FOUNDATION P 61523 MCLAREN HEALTH CARE CORPORATION L 19454140 MCLAREN HEALTH CARE CORPORATION L 274400 MCLAREN HEALTH PLAN K 10875584 MCLAREN MEDICAL MANAGEMENT INC B 1467849 MCLAREN MEDICAL MANAGEMENT INC Q 958552 LAPEER REGIONAL MEDICAL CENTER E 55346 MCLAREN HEALTH CARE CORPORATION O 23963440 VISITING NURSE SERVICES L 97516 VISITING NURSE SERVICES P 1240267 MCLAREN HEALTH CARE CORPORATION O 622744 MCLAREN MEDICAL MANAGEMENT INC K 6483467 MCLAREN MEDICAL MANAGEMENT INC I 65995 REMS L 227680