2011-05-04T12:59:35-05:00 2010-06-30 Plante & Moran PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2009-07-01 381369611 port huron hospital PORT 8109875000 1221 PINE GROVE AVENUE port huron MI 48060 john liston 8109875000 2011-04-25 1 Carol LaLonde CPA 2695674500 2009 2016-02-24 21:20:13Z THOMAS DEFAUW 1221 PINE GROVE AVENUE port huron MI 48060 173785358 0 X www.porthuronhospital.org X 1879 MI PROVISION OF ACUTE MEDICAL CARE. TO BE A LEADER IN HEALING, AND YOUR PARTNER IN HEALTH. 17 15 1642 278 2099382 -635645 11102 296889 161585142 170339895 -5049 1152025 2512639 1996549 164103834 173785358 0 0 75927080 77880661 0 0 82697545 84995297 158624625 162875958 5479209 10909400 130203552 147258456 95406795 111007610 34796757 36250846 PROVISION OF ACUTE MEDICAL CARE 0 0 122639065 168872719 FOR THE YEAR ENDED JUNE 30, 2010, PORT HURON HOSPITAL PROVIDED HEALTH CARE SERVICES TO THE POOR AND TO THE BROADER COMMUNITY FOR WHICH THE COST OF PROVIDING SUCH SERVICES EXCEEDED THE RELATED REVENUE. CHARITY CARE IN THE AMOUNT OF $5,208,594 WAS PROVIDED DURING THE YEAR. PORT HURON HOSPITAL PROVIDED $259,116,565 IN THIRD PARTY DISCOUNTS. IN TOTAL, THIS REPRESENTS 61% PERCENT OF THE GROSS PATIENT REVENUE FOR THIS YEAR.PORT HURON HOSPITAL ALSO PROVIDED THE COMMUNITY WITH OPPORTUNITIES TO PARTICIPATE IN NUMEROUS EDUCATIONAL, WELLNESS, SCREENING, AND SUPPORTIVE PROGRAMS AT EITHER NO COST OR AT A NOMINAL CHARGE. THE HOSPITAL PROVIDED A TOTAL OF 43 PROGRAMS TO APPROXIMATELY 56,304 PEOPLE OF THE COMMUNITY. 122639065 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 92 0 1 1642 1 1 1 0 0 0 0 0 0 0 0 17 15 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MI X john liston cfo 8109893737 1221 pine grove avenue port huron MI 48060 KAREN NIVER MD 3.00 X X 0 0 0 MONA ARMSTRONg 3.00 X X 0 0 0 JOHN OGDEN 3.00 X X 0 0 0 DAVID C WHIPPLE 3.00 X X 0 0 0 JOHN LISTON 40.00 X X X 227740 0 27916 MIKE TURNBULL 1.00 X 0 0 0 RONDA RYAN 1.00 X 0 0 0 BR REDDY MD 1.00 X 0 0 0 CLARE SCHEURER MD 1.00 X 0 0 0 TIM REGAN 1.00 X 0 0 0 FRANKLIN MORTIMER II 1.00 X 0 0 0 JOHN V BROOKS MD 1.00 X 0 0 0 GEOERGE STOMMEL 1.00 X 0 0 0 BASHAR SAMMAN MD 1.00 X 0 0 0 JAMES MARSH 1.00 X 0 0 0 KARL TOMION 1.00 X 0 0 0 BASSAM H NASR MD 1.00 X 0 0 0 PATRICK MORAN 3.00 X X 0 0 0 david thompson 3.00 X X 0 0 0 bashar nakhleh md 1.00 X 0 0 0 THOMAS D DEFAUW 40.00 X X 442365 0 52769 KATHLEEN METCALF 40.00 X 245481 0 0 DR MICHAEL TAWNEY 40.00 X X 275330 0 9862 DAVID MCEWEN 40.00 X 202749 0 16956 BRIAN BARKLEY 40.00 X 254729 0 0 TIMOTHY VANHOWE 40.00 X 243771 0 0 TROY REED 40.00 X 240999 0 0 THOMAS F BROZOVICH 40.00 X 238455 0 9862 Robert L Bauer 40.00 X 213270 0 9862 2584889 0 127227 43 0 1 0 MICHIGAN CO-TENANCY LABORATORY 300 WEST TEXTILE ROAD ANN ARBOR MI 48108 LAB TESTING 784940 american healthcare staffing association PO BOX 945 traverse city MI 49684 CONTRACTED LABOR 531795 scan medical services 1571 burnside road north branch MI 48461 CONTRACTED LABOR 472603 blue water pathology pc po box 77556 detroit MI 48277 lab services 330000 ALLIANCE-HNV PETCT SERVICES LLC PO BOX 402209 ATLANTA GA 30384 PET/CT SERVICES 246225 14 253404 43485 296889 PATIENT REVENUE 621500 167161026 167161026 LABORATORY 621500 1959400 492224 1467176 OPERATING REVENUE 621500 1219469 1219469 170339895 837002 837002 39023 39023 39023 39023 315023 315023 315023 315023 laundry 812300 799418 632206 167212 cafeteria 722210 787313 787313 MISCELLANEOUS 900099 370795 370795 1957526 173785358 168872719 2099382 2516368 1501168 1501168 60455877 53943819 6512058 4835292 4207618 627674 6449391 5615258 834133 4638933 4038956 599977 131181 131181 361445 361445 502893 502893 11833104 8442916 3390188 318276 2716 315560 895082 895082 5130311 52854 5077457 76809 2688 74121 101133 90772 10361 1340643 1340643 8838536 8838536 5087379 5087379 supply & minor equip 28813972 27948789 865183 Provision for Bad Debts 11109051 11109051 qaap tax 3490434 3490434 equip repair & maint 2400401 2336079 64322 utilities 1637584 1637584 2927063 2314883 612180 162875958 122639065 40236893 0 21464653 30697197 12821803 22947795 9120327 5691494 11769243 12550065 4048229 4367192 2824849 2718252 154336362 111505816 44389922 42830546 10520028 11819481 9968680 9698459 3275818 3937975 130203552 147258456 62085047 76067813 23545900 22685326 349985 204763 9425863 12049708 95406795 111007610 X 34796757 36250846 34796757 36250846 130203552 147258456 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1625341 1625341 83633227 62750161 20883066 658773 103810 554963 61425973 45035246 16390727 6993048 3616599 3376449 42830546 cash and marketable securities restricted for construction and debt service 4383524 F INVESTMENT IN OTHER ENTITIES 5314935 F 9698459 claim liability 10598000 accrued interest 351365 cost report settlement payable 1100343 12049708 173785358 162875958 10909400 -213162 -9242149 -9455311 1454089 Part XI, Line 8 - Other Adjustments: change in additional minimum pension liability: -9242149. 1 1 1 X 1 X 1 1 1 0 1 1 1 394 1733488 0 1733488 0.01060 3 2345 23307551 22917743 389808 0.00240 1 65 469686 57789 411897 0.00250 5 2804 25510725 22975532 2535193 0.01550 408 53500 663458 52023 611435 0.00380 1 181366 0 181366 0.00110 0 0 0 0 2 35952 0 35952 0.00020 411 53500 880776 52023 828753 0.00510 416 56304 26391501 23027555 3363946 0.02060 10 769 13180 7415 5765 0.00000 10 769 13180 7415 5765 1 3697237 1216006 54412483 54301547 110936 X 1 1 PORT HURON HOSPITAL

1221 PINE GROVE AVENUE PORT HURON MI 48060

X X X Part III, Line 4: THE COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO IN DETERMINING THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. Part III, Line 8: THE COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO IN DETERMINING THE MEDICARE ALLOWABLE COSTS OF CARE. Part III, Line 9b: IF A PATIENT PARTICIPATES IN THE CHARITY CARE PROCESS, THE ACCOUNT IS WRITTEN OFF THE CHARITY AS PER THE CHARITY CARE PROCESS. HOWEVER, IF THE PATIENT IS NON-PARTICIPATIVE IN THE CHARITY CARE PROCESS, THE NORMAL COLLECTION PROCESS WILL ENSUE. Part VI, Line 2: THE HOSPITAL ASSESSES HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY VARIOUS ONGOING AND AD HOC PROCESSES:-PARTICIPATION IN PERIODIC (ST. CLAIR) COUNTYWIDE NEEDS ASSESSMENT COORDINATED BY ST. CLAIR COUNTY HEALTH DEPARTMENT.-ANNUAL GAP ANALYSIS OF OUTMIGRATION FOR HEALTH CARE SERVICES THROUGH THE MICHIGAN INPATIENT DATA BASE.-PERIODIC CONSUMER PERCEPTION AND PREFERENCES SURVEYS CONDUCTED BY INDEPENDENT PROFESSIONAL SURVEY FIRMS, E.G. EPIC - MRA, LANSING, MI.-ANNUAL 10-STEP STRATEGIC PLANNING PROCESS INCLUDING STRATEGIC PLANNING EVENTS INVOLVING TRUSTEES, PHYSICIANS, AND MANAGEMENT TO REVIEW ENVIRONMENTAL ASSESSMENTS AND KEY STAKEHOLDER FEEDBACK TOWARD DEVELOPING HOSPITAL INITIATIVES FOR THE NEXT OPERATING CYCLE.-HOSPITAL-SPONSORED ADVISORY AND MEMBERSHIP GROUPS SUCH AS "55 PLUS" AND "WOMEN'S WELLNESS ADVISORY TEAM" WHICH PROVIDE INPUT AS TO HOSPITAL DIRECTION ON BETTER ADDRESSING COMMUNITY HEALTH NEEDS.-COMMITMENT TO ONGOING CONTINUOUS IMPROVEMENT. FOR 20 YEARS, THE HOSPITAL HAS BEEN COMMITTED TO THE PRINCIPLE OF CONTINUOUS IMPROVEMENT. APPLIED TO ONGOING MANAGEMENT PLANNING, NUMEROUS OPPORTUNITIES TO BETTER SERVE OUR COMMUNITIES HAVE BEEN IDENTIFIED AND PURSUED. SEVERAL OF THOSE PURSUITS CONTINUE TODAY AND ARE ENUMERATED ON THE IRS 990 SCHEDULE H WORKSHEET INCLUDED HERE: BREATHER'S CLUB, A SERVICE UNDER 55 PLUS MEETING THE DESPERATE NEEDS OF COPD SUFFERERS FOR SUPERVISED EXERCISE; THE LANG (HEALTH) LIBRARY INCORPORATED INTO THE HOSPITAL ENTRANCE ATRIUM PROVIDED SPECIAL HEALTH INFORMATION RESOURCES TO SCHOOLS, EDUCATORS, AND HEALTH CARE PROFESSIONALS; TODAY'S HEALTH WEEKLY HEALTH INFORMATION TELEVISION SHOW OVER THE LOCAL CABLE CHANNEL; AND HEALTH ACCESS, OUR HEALTH INFORMATION AND REFERRAL SERVICE OPERATING 80 HOURS PER WEEK, STAFFED BY RNS AND FIELDING 35,000 CALLS PER YEAR.-PARTICIPATION IN AD HOC COMMUNITY INITIATIVES FOR THE PURPOSE OF ADDRESSING SPECIFIC COMMUNITY HEALTH GAPS SUCH AS (1) RECENT UNITED WAY - ST. CLAIR COUNTY HEALTH DEPARTMENT INITIATIVE ON ESTABLISHING AN ADULT INDIGENT DENTAL CLINIC, AND (2) HELMET SAFETY INITIATIVE DEVELOPED THOUGH PHH FOUNDATION'S COMMUNITY BENEFIT COMMITTEE THAT INCLUDED SCHOOL DISTRICT AND POLICE REPRESENTATIVES. Part VI, Line 3: THE HOSPITAL HAS BROCHURES AVAILABLE FOR PATIENTS REGARDING THEIR OPTIONS. THE HOSPITAL ALSO COMMUNICATES THAT A PATIENT MAY CALL IF THEY NEED FINANCIAL ASSISTANCE VIA PHONE CALLS AND BILLING STATEMENTS. THE HOSPITAL HAS A REPRESENTATIVE THAT IS WILLING TO WORK WITH THE PATIENTS TO HELP THEM TRY TO GET INSURANCE OR OTHER FORMS OF ASSISTANCE. Part VI, Line 4: PORT HURON HOSPITAL AND ITS AFFILIATES SERVE A THREE-SIDED MARKET, LIMITED TO THE EAST BY LAKE HURON AND THE ONATRIO, CA BORDER. THAT MARKET IS DESCRIBED GENERALLY AS ST. CLAIR COUNTY, SANILAC COUNTY, PLUS LESSER PARTS OF FOUR CONTINUOUS COUNTIES: HURON, LAPEER, TUSCOLA, AND MACOMB. THIS AREA IS LARGELY RURAL WITH THE LARGEST CITY, PORT HURON, CLAIMING A POPULATION OF AROUND 36,000. SOME 25-30% OF WORKERS WHO RESIDE IN ST. CLAIR COUNTY COMMUTE OUT OF COUNTY TO JOBS. IN TOTAL, THE MARKET INCLUDES APPROXIMATELY 220,000 RESIDENTS, OF WHOM THREE QUARTERS RESIDE IN ST. CLAIR COUNTY.OUR MARKET FOLLOWS THE STATE AVERAGES DEMOGRAPHICALLY WITH SOME EXCEPTIONS: A LOWER PERCENTAGE OF AFRICAN-AMERICANS, A HIGHER PERCENTAGE OF NATIVE-AMERICANS, A LOWER AVERAGE HOUSEHOLD INCOME, A HIGHER PERCENTAGE OF OVER AGE 65 POPULATION. Part VI, Line 5: N/A MI X X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 JOHN LISTON 223823 0 0 0 3917 0 11085 0 16831 0 255656 0 0 0 THOMAS D DEFAUW 416446 0 0 0 25919 0 36295 0 16474 0 495134 0 0 0 KATHLEEN METCALF 245481 0 0 0 0 0 0 0 0 0 245481 0 0 0 DR MICHAEL TAWNEY 270765 0 0 0 4565 0 0 0 9862 0 285192 0 0 0 DAVID MCEWEN 200312 0 0 0 2437 0 0 0 16956 0 219705 0 0 0 BRIAN BARKLEY 254729 0 0 0 0 0 0 0 0 0 254729 0 0 0 TIMOTHY VANHOWE 243771 0 0 0 0 0 0 0 0 0 243771 0 0 0 TROY REED 240999 0 0 0 0 0 0 0 0 0 240999 0 0 0 THOMAS F BROZOVICH 238455 0 0 0 0 0 0 0 9862 0 248317 0 0 0 Robert L Bauer 213270 0 0 0 0 0 0 0 9862 0 223132 0 0 0 Part I, Line 1a HEALTH CLUB BENEFITS WERE PROVIDED TO THE CHIEF EXECUTIVE OFFICER. Part I, Line 4a THOMAS DEFAUW AND JOHN LISTON CONTRIBUTED $36,044 AND $11,085, RESPECTIVELY, TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HKZ8 2009-05-12 14645000 RENOVATIONS, EQUIPMENT, CURRENT REFUNDING 0 0 14645000 8060193 2091558 192540 4300709 2011 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 PHYSICIAN INVESTMENT GROUP BASSAM H. NASR, MD, BOARD MEMBER OF PHH AND PART OWNER 79426 RENTAL/LEASE SLEEP CENTER 0 Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF THIS COPRORATION IS BLUE WATER HEALTH SERVICES CORPORATION. Form 990, Part VI, Section A, line 7a THE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES. Form 990, Part VI, Section B, line 11 THE FORM 990 WAS PROVIDED TO THE BOARD FOR REVIEW. Form 990, Part VI, Section B, line 12c THE BOARD REVIEWS THE CONFLICT OF INTEREST POLICY ANNUALLY AND DISCLOSES ANY POTENTIAL CONFLICTS AT THAT TIME. Form 990, Part VI, Section B, line 15a THE EXECUTIVE COMPENSATION COMMITTEE IS A SUBCOMMITTEE OF THE BOARD OF DIRECTORS RESPONSIBLE FOR ANNUALLY EVALUATING THE PERFORMANCE AND COMPENSATION OF THE CHIEF EXECUTIVE OF THE CORPORATION. THEY ARE RESPONSIBLE FOR ENSURING PORT HURON HOSPITAL CAN ATTRACT, RETAIN AND MOTIVATE TALENTED EXECUTIVES WHO ARE ENTRUSTED TO ACHIEVE PERFORMANCE OBJECTIVES AND TO FULFILL THE HOSPITALS MISSION. THE COMMITTEE UTILIZES THE SERVICES OF AN INDEPENDENT CONSULTANT TO ANALYZE TOTAL REMUNERATION AND COMPARATIVE STUDIES TO ENSURE TOTAL COMPENSATION IS REASONABLE AND COMPETITIVE. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS FISCAL YEAR 2010. Form 990, Part VI, Section C, line 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. BLUE WATER HEALTH SERVICES CORPORATION 1221 PINE GROVE AVENUE PORT HURON MI 48060 382453295 MANAGEMENT CORP MI 501(c)(3) Line 9 N/A PORT HURON HOSPITAL FOUNDATION PO BOX 5011 PORT HURON MI 48061 382777750 SUPPORTING ORG MI 501(c)(3) Line 11a, I PORT HURON HOSPITAL MARWOOD MANOR NURSING HOME PO BOX 5011 PORT HURON MI 48061 382683251 NURSING HOME MI 501(c)(3) Line 9 BLUE WATER HEALTH SERVICES PARKVIEW PROPERTY MANAGEMENT CORP PO BOX 5011 PORT HURON MI 48061 382467310 MANAGEMENT CORP MI 501(c)(3) Line 11a, I PORT HURON HOSPITAL TRI-HOSPITAL MRI PO BOX 610988 PORT HURON MI 48061 382884297 HOSPITAL MI 501(c)(3) Line 3 PORT HURON HOSPITAL WILLOW ENTERPRISES PO BOX 5011 PORT HURON MI 48061 382491659 RENT/SALE OF MEDICAL EQUIPMENT MI PORT HURON HOSPITAL C 105297 3633220 1.00000 1 0 1 0 0 0 0 0 1 1 1 1 0 1 0 1 0 0 WILLOW ENTERPRISES N 1522456 PARKVIEW PROPERTY MANAGEMENT CORP J 731023 TRI-HOSPITAL MRI L 131751 PORT HURON HOSPITAL FOUNDATION C 298417 PORT HURON HOSPITAL FOUNDATION K 57769 PARKVIEW PROPERTY MANAGEMENT CORP K 223751 MARWOOD MANOR NURSING HOME N 49863 MARWOOD MANOR NURSING HOME K 326123 WILLOW ENTERPRISES A 36970 WILLOW ENTERPRISES K 2867056 WILLOW ENTERPRISES P 101405 TRI-HOSPITAL MRI I 160302 TRI-HOSPITAL MRI K 879158 tRI-HOSPITAL MRI P 176813