2011-05-16T10:07:36-05:00 2010-06-30 MAKELA TOUTANT HILL & NARDI PC 201 W BLUFF STREET MARQUETTE MI 49855 990 2009-07-01 381358036 MARQUETTE GENERAL HOSPITAL INC MARQ 9062253450 420 W MAGNETIC STREET MARQUETTE MI 49855 JERRY L WORDEN 9062253450 2011-05-12 1 9062283600 2009 2016-02-24 21:20:13Z JERRY L WORDEN 420 W MAGNETIC STREET MARQUETTE MI 49855 336037900 0 X WWW.MGH.ORG X 1897 MI TO BE A REGIONAL HEALTH RESOURCE, IMPROVING THE HEALTH OF THOSE WE SERVE. 12 8 2851 511 4432149 0 1605738 664278 317694912 323220852 -3288659 752096 11678 817 316023669 324638043 0 0 152059012 155517337 0 0 157053818 161525504 309112830 317042841 6910839 7595202 252619873 266525060 173258140 192888879 79361733 73636181 TO BE THE REGIONAL MEDICAL CENTER OF CHOICE BY PROVIDING EFFICIENTLY DELIVERED, HIGH QUALITY, COMPASSIONATE CARE. 0 0 217053761 235169490 HOSPITAL SERVICES ENCOMPASSING 10,898 INPATIENT ADMISSIONS; 55,797 INPATIENT DAYS AND 307,809 OUTPATIENT VISITS/REGISTRATIONS. 79812983 61277137 PHYSICIAN PRACTICES WITH 161,298 PATIENTS AND 324,747 VISITS. 4513570 5484419 HOME HEALTH SERVICES COVERS EIGHT COUNTIES AND SERVES 1900 PATIENTS WITH 36,955 HOME VISITS. 3124540 2951607 3124540 2951607 304504854 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 0 1 1 1 0 0 0 0 1 1 1 0 0 1 205 0 2851 1 1 1 0 0 0 0 0 0 0 0 12 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MI X JERRY L WORDEN 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 LOIS A MICHELIN 3.00 X X 0 0 0 MICHAEL L VONCK 2.00 X X 0 0 0 K MICHAEL SKYTTA 2.00 X 0 0 0 JOHN P BARTLETT MD 2.00 X 20004 0 0 LARRY S LEWIS MD 2.00 X 277673 0 10473 BRADLEY CORY 2.00 X 0 0 0 MARRYANNE SHANNON 2.00 X 0 0 0 GARY LAPLANT 2.00 X 0 0 0 JUDITH WATSON-OLSON 2.00 X 0 0 0 A GARY MULLER 50.00 X X 651605 0 71952 JERRY L WORDEN 50.00 X 348526 0 32335 DAVID S GRASER 50.00 X 282287 0 27937 THOMAS F NOREN MD 50.00 X 300276 0 20172 THOMAS A MOSER 50.00 X 275247 0 28992 FREDERICK P HOENKE MD 50.00 X 346303 0 32887 DENNIS D BOE 50.00 X 174673 0 20359 DAGMAR A RAICA 50.00 X 189419 0 16306 RICHARD ROVIN 50.00 X 672148 0 22442 CRAIG COCCIA 50.00 X 2011882 0 26442 PAUL LAHAYE 50.00 X 1154113 0 11642 ANDREW JAHODA 50.00 X 597566 0 14282 MICHAEL OUWENGA 50.00 X 580032 0 21442 MICHAEL J BECKSTROM 50.00 X 153200 0 20930 8034954 0 378593 164 1 1 0 REHAB CARE 7733 FORSYTH BLVD ST LOUIS MO 66105 THERAPY SERVICES 4689437 UPHEC 420 W MAGNETIC MARQUETTE MI 49855 EDUCATION MANAGEMENT 1453989 DMS IMAGING PO BOX 86 MINNEAPOLIS MN 55486 PET SCANNING 1223437 COMPHEALTH PO BOX 75397 DALLAS TX 75397 PHYSICIAN SERVICES 1032893 MAYO MEDICAL LABS PO BOX 9146 MINNEAPOLIS MN 55486 LAB SERVICES 996386 53 664278 664278 HEALTHCARE SERVICES 621500 319917849 315485700 4432149 BLOOD PRODUCTS 621990 1475276 1475276 EMPLOYEE & GUEST MEALS 722210 1184221 1184221 EMPLOYEE PHARMACY 446110 643506 643506 323220852 866731 866731 288516 288516 113455 112638 817 817 817 10868541 15527 11209121 78098 -340580 -62571 -403151 -403151 324638043 316960976 4432149 2580640 8324334 6063273 2261061 473997 387148 86849 115615425 112146962 3468463 5843074 5667782 175292 17210835 16694510 516325 8049672 7808182 241490 1249890 374967 874923 672401 336200 336201 122137 122137 56886 55179 1707 30775029 29851178 923851 858636 832877 25759 72768295 70585246 2183049 3214327 3117897 96430 6373992 6182772 191220 2031483 1970539 60944 710551 689234 21317 3647149 3537735 109414 11080861 10748435 332426 2014928 1954480 60448 UNCOMPENSATED CARE 10992918 10992918 QUALITY ASSURANCE ASSES 5460559 5296742 163817 MAINTENANCE CONTRACTS 3030864 2939938 90926 6464598 6270660 193938 317042841 304504854 12537987 0 28081601 36710985 45482008 49943474 307283 143572 8599310 8490577 2117770 2447369 310347616 209433811 105402559 100913805 38509588 39372126 15656432 19066010 8463322 9437142 252619873 266525060 36132581 44238277 68485508 63426933 5684615 4457289 62955436 80766380 173258140 192888879 X 77499381 70934334 1862352 2701847 79361733 73636181 252619873 266525060 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7570000 7570000 147919304 90318469 57600835 148527511 117027782 31499729 6330801 2087560 4243241 100913805 INVESTMENT IN UPHP 16519194 C INVESTMENT IN UPMC 2546816 C 19066010 PROFESSIONAL LIABILITY AND W/C RESERVES 4617120 ACCRUED EMPLOYEE COMP AND BENIFITS - LT 3696903 ACCRUED PENSION LIABILITY - LT 66915115 INTEREST RATE SWAP AGREEMENT 5537242 80766380 324638043 317042841 7595202 11264 -13332018 -13320754 -5725552 310939941 11264 -13709366 -13698102 324638043 0 324638043 317042841 0 317042841 0 317042841 Part XI, Line 8 - Other Adjustments: CONTRIBUTION RECEIVED - RESTRICTED PROPERTY: 769000. PENSION LIABILITY ADJUSTMENT: -14478366. INCREASE IN TEMPORARILY RESTRICTED NET ASSETS: 839495. LOSS ON DISCONTINUED OPERATION: -462147. Part XII, Line 2d - Other Adjustments: PENSION LIABILITY ADJUSTMENT: -14478366. CONTRIBUTION RECEIVED - RESTRICTED: 769000. 1 1 1 X 1 X 1 1 1 0 1 1 1019203 0 1019203 0.00330 39764695 26410695 13354000 0.04360 1357676 685138 672538 0.00220 42141574 27095833 15045741 0.04910 888788 160081 728707 0.00240 8513895 4504589 4009306 0.01310 27305621 21039556 6266065 0.02050 425301 46653 378648 0.00120 80764 80764 0.00030 37214369 25750879 11463490 0.03750 79355943 52846712 26509231 0.08660 191 191 0.00000 370 370 0.00000 65446 65446 0.00020 66007 66007 0.00020 1 4797518 1409873 73259382 57148007 16111375 X 1 0 UP IMAGING MANAGEMENT SERVICES LLC OUTPATIENT NON-INVASIVE DIAGNOSTIC CARDIOVASCULAR IMAGING SERVICES 0.60000 0.40000 MARQUETTE GENERAL HOSPITAL INC

420 W MAGNETIC ST MARQUETTE MI 49855

X X X X X OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

2500 7TH AVENUE SOUTH SUITE 100 ESCANABA MI 49829

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

2002 MINNEAPOLIS AVENUE GLADSTONE MI 49837

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

BURT TOWNSHIP HALL GRAND MARAIS MI 49839

OUTPATIENT CLINIC MARQUETTE SPECIALITY CLINIC

500 CAMPUS DRIVE HANCOCK MI 49930

OUTPATIENT CLINIC LAKEWOOD MEDICAL ASSOCIATES

5087 US 41 SOUTH MARQUETTE MI 49855

OUTPATIENT CLINIC NORTH COUNTRY MEDICAL SPECIALISTS

1711 S STEPHENSON SUITE 35 IRON MOUNTAIN MI 49801

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

1500 W ICE LAKE ROAD IRON RIVER MI 49935

OUTPATIENT CLINIC GRAND VIEW CLINIC

GOGEBIC RANGE N 10565 IRONWOOD MI 49938

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

800 E BOULEVARD KINGSFORD MI 49802

OUTPATIENT CLINIC MARQUETTE SPECIALITY CLINIC

205 OSCEOLA STREET LAURIUM MI 49913

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINICS

1414 W FAIR AVENUE MARQUETTE MI 49855

OUTPATIENT CLINIC NEGAUNEE MEDICAL ASSOCIATES

405 US 41 EAST NEGAUNEE MI 49866

OUTPATIENT CLINIC MARQUETTE MEDICAL CLINIC

COMMUNITY BUILDING TRENARY MI 49891

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. Part I, Line 7f: TOTAL EXPENSES WERE REDUCED BY $10,992,918 FOR BAD DEBT EXPENSE. 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.GROSS BAD DEBT EXPENSE WAS $10,992,918 WITH A COST OF $4,797,518. AN ATTORNEY REVIEWED THE ACCOUNTS TO DETERMINE 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. 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 5: 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. X X X X X X 0 1 0 0 0 0 0 0 0 LARRY S LEWIS MD 277673 0 0 0 0 0 0 0 10734 0 288407 0 0 0 A GARY MULLER 509668 0 121970 0 19967 0 59800 0 17389 0 728794 0 0 0 JERRY L WORDEN 280833 0 48258 0 19435 0 18883 0 16458 0 383867 0 0 0 DAVID S GRASER 239699 0 39602 0 2986 0 15785 0 16087 0 314159 0 0 0 THOMAS F NOREN MD 273322 0 24471 0 2483 0 8020 0 16395 0 324691 0 0 0 THOMAS A MOSER 199068 0 33636 0 42543 0 10000 0 22138 0 307385 0 0 0 FREDERICK P HOENKE MD 245338 0 100000 0 965 0 16588 0 19371 0 382262 0 0 0 DENNIS D BOE 149849 0 23182 0 1642 0 8367 0 15701 0 198741 0 0 0 DAGMAR A RAICA 163627 0 24727 0 1065 0 9073 0 9469 0 207961 0 0 0 RICHARD ROVIN 626574 0 45574 0 0 0 9800 0 15471 0 697419 0 0 0 CRAIG COCCIA 1963708 0 48174 0 0 0 9800 0 19471 0 2041153 0 0 0 PAUL LAHAYE 1130323 0 23790 0 0 0 0 0 14471 0 1168584 0 0 0 ANDREW JAHODA 558912 0 38654 0 0 0 9800 0 9333 0 616699 0 0 0 MICHAEL OUWENGA 541390 0 38642 0 0 0 9800 0 16493 0 606325 0 0 0 MICHAEL J BECKSTROM 153000 0 0 0 200 0 7338 0 15396 0 175934 0 0 0 Part I, Line 4a SUPPLEMENTAL RETIREMENT PAYMENTS MADE FOR THE FOLLOWING: A GARY MULLER 50,000 JERRY L WORDEN 14,000 DAVID S GRASER 11,500 THOMAS F NOREN 8,020 THOMAS A MOSER 10,000 MI STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HBA3 2005-05-04 29102140 FACILITY IMPROV & EQUIP 0 0 MI STATE HOSPITAL FINANCE AUTHORITY 382889417 59465HDX1 2006-08-23 37000000 FACILITY IMPROV & EQUIP 0 0 29483298 2222238 275951 26985109 2005 0 0 1 1 37067892 3700000 1480385 31887507 2006 0 0 1 1 1 0 0 0 1 0.00250 0.00250 1 0 0 0 0 1 0.00000 0.00000 1 0 0 0 1 SOCIETE GENERALE 28.000000000000 1 0 1 0 1 1 SEE SCHEDULE 0 1 SOCIETE GENERALE 15.700000000000 1 0 1 CRAIG COCCIA SIGNING BONUS X 240000 72000 0 1 1 PAUL LAHAYE SIGNING BONUS X 50000 2083 0 1 1 RICHARD ROVIN SIGNING BONUS X 227000 68100 0 1 1 ANDREW JAHODA SIGNING BONUS X 50000 1389 0 1 1 143572 CINDY MASSIE FAMILY MEMBER OF CURRENT BOARD CHAIRMAN, TIMOTHY J LARSON 49084 EMPLOYMENT 0 MICHAEL WORDEN FAMILY MEMBER OF CURRENT OFFICER, JERRY L WORDEN 149276 EMPLOYMENT 0 LIZABETH BOE FAMILY MEMBER OF KEY EMPLOYEE, DENNIS D BOE 46529 EMPLOYMENT 0 DRESSLER MECHANICAL INC OWNED BY CURRENT BOARD MEMBER, MICHAEL L VONCK 55409 MECHANICAL SERVICES 0 0 0 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. A COPY OF THE COMPLETED TAX RETURN IS PRESENTED TO THE BOARD OF DIRECTORS BEFORE FILING. Form 990, Part VI, Section B, line 12c EACH MEMBER OF THE BOARD OF TRUSTEES SIGNS A CONFLICT OF INTEREST STATEMENT ANNUALLY. COLLEAGUES ARE REMINDED AT THEIR ANNUAL EVALUATIONS TO ABIDE BY THE CODE OF CONDUCT. THEY ALSO COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT. 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 NO DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC. SCHEDULE K, PART II, LINE 5, COLUMN B, ISSUANCE COSTS: ISSUANCE COSTS: $484,965, CREDIT ENHANCEMENT FEE: $995,420 SCHEDULE K, PART IV, LINE 3B, COLUMN B, NAME OF HEDGE PROVIDER: DEUTSCH BANK (SWAP), JP MORGAN (RATE LOCK AGREEMENT TERMINATED ON 8/23/06 ISSUE DATE) SCHEDULE K, PART IV, LINE 3C, COLUMN B, TERM OF HEDGE: 15.8 YEARS (SWAP), 13.1 YEARS (RATE LOCK AGREEMET TERMINATED ON 8/23/06 ISSUE DATE) MATTSON MANAGEMENT GROUP LLC 420 W MAGNETIC ST MARQUETTE MI 49855 300136373 LANDHOLDING MI 0 127023 N/A RAMPART EMERGENCY MEDICAL SERVICES INC 828 SHERIDAN ROAD ESCANABA MI 49829 382413139 EMERGENCY MEDICAL SERVICES MI 501(C)(3) 9 N/A 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 UPPER PENINSULA HEALTH PLAN INC 228 W WASHINGTON ST MARQUETTE MI 49855 383379956 MEDICAID HMO MI 501(C)(4) N/A N/A UPPER PENINSULA MANAGED CARE LLC 228 W WASHINGTON ST MARQUETTE MI 49855 383323620 MANAGEMENT COMPANY OF UP HEALTH PLAN MI N/A RELATED 1384609 2103582 0 0 ICE LAKE MEDICAL ARTS BUILDING 420 W MAGNETIC ST MARQUETTE MI 49855 382206384 LEASING OF BUILDING SPACE MI N/A C 541 61866 0.66670 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 MARQUETTE GENERAL FOUNDATION C 532901 MARQUETTE GENERAL FOUNDATION K 551400 MARQUETTE GENERAL FOUNDATION M 148272 RAMPART EMERGENCY MEDICAL SERVICES INC P 578995 UPPER PENINSULA MANAGED CARE LLC R 3447275 UPPER PENINSULA HEALTH PLAN INC 0