2022-11-14T10:06:51-06:00 2021-12-31 990 2021-01-01 382027689 WA FOOTE MEMORIAL HOSPITAL WAFO 5172054800 205 N EAST AVENUE JACKSON MI 49201 JIM BONGIORNO CFO 5172054800 2022-11-14 JIM BONGIORNO 999009999 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z HENRY FORD HEALTH JACKSON HOSPITAL EMILY MOORHEAD 205 N EAST AVENUE JACKSON MI 49201 777611253 0 X WWW.HENRYFORD.COM/LOCATIONS/ALLEGIANCE-HEALTH X 1970 MI WE IMPROVE PEOPLE'S LIVES THROUGH EXCELLENCE IN THE SCIENCE AND ART OF HEALTH CARE AND HEALING. 16 9 4984 447 1610839 0 49961115 10271054 612801632 708536277 2574306 12380284 44246376 46423638 709583429 777611253 756371 916202 0 0 349305205 360098763 0 0 101104 337658845 387690971 687720421 748705936 21863008 28905317 830742312 867319103 423016758 390238278 407725554 477080825 X W.A. FOOTE MEMORIAL HOSPITAL DBA HENRY FORD HEALTH JACKSON HOSPITAL ("HFHJH") IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH") SERVING COMMUNITIES IN SOUTH CENTRAL MICHIGAN FOR MORE THAN 100 YEARS. AS AN INTEGRATED COMPONENT OF ONE OF THE NATION'S LEADING COMPREHENSIVE, INTEGRATED HEALTH SYSTEMS, W.A FOOTE MEMORIAL HOSPITAL DBA HENRY FORD HEALTH JACKSON HOSPITAL ("HFHJH") SHARES THE MISSION OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH") TO IMPROVE PEOPLE'S LIVES THROUGH EXCELLENCE IN THE SCIENCE AND ART OF HEALTH CARE AND HEALING. 0 0 683955858 916202 765337079 FOR MORE THAN 100 YEARS, HENRY FORD HEALTH JACKSON HOSPITAL HAS SERVED A NINE-COUNTY EXPANSE OF SOUTH-CENTRAL MICHIGAN WITH A COMMITMENT TO CHARITABLE GIVING, OUTREACH AND BUILDING STRONGER, HEALTHIER INDIVIDUALS AND FAMILIES. THE 365-BED ACUTE CARE HOSPITAL AND LEVEL II TRAUMA CENTER OFFERS A FULL RANGE OF CLINICAL SERVICES, INCLUDING GENERAL MEDICINE, SURGERY, BIRTHING CENTER AND 24-HOUR EMERGENCY CARE. HENRY FORD HEALTH JACKSON HOSPITAL ALSO PROVIDES PHYSICAL MEDICINE AND REHAB, CARDIAC, CANCER AND NEUROSURGICAL SERVICES. DURING 2021, HENRY FORD HEALTH JACKSON HOSPITAL HAD 16,149 DISCHARGES.THE CORONAVIRUS IMPACT AND RESPONSEADDRESSING THE IMPACT OF COVID 19 ON ITS COMMUNITY HAS BEEN A PRIORITY FOR THE SYSTEM, FROM THE ADMISSION OF ITS FIRST COVID 19 PATIENT IN EARLY 2020, THROUGHOUT 2021, WITH ONGOING IMPLICATIONS EXPECTED TO CONTINUE THROUGHOUT 2022. IN 2021 THE VOLUME OF COVID 19 ADMITTED PATIENTS INITIALLY SHOWED A STEADY DECREASE UNTIL A THIRD SURGE BEGAN IN MARCH AND CONTINUED THROUGH JUNE. IN THE SECOND HALF OF 2021, THE SYSTEM EXPERIENCED A STEADY INCREASE IN COVID 19 CASES ASSOCIATED WITH BOTH THE DELTA AND OMICRON VARIANTS.DRIVEN BY THE ECONOMIC IMPACT OF COVID 19, FRONT LINE CLINICAL AND SUPPORT STAFF LABOR SHORTAGES INCREASINGLY IMPACTED SYSTEM OPERATIONS IN 2021. THIS HAS REQUIRED RELIANCE UPON PREMIUM PAY PRACTICES AND USE OF HIGHER COST TEMPORARY AND CONTRACT LABOR TO MAINTAIN THESE ESSENTIAL WORKERS. LABOR DISRUPTIONS ARE EXPECTED TO PERSIST THROUGH THE DURATION OF THE PANDEMIC AND THROUGHOUT 2022.THE SYSTEM CONTINUES TO MONITOR PATIENT AND MEMBER UTILIZATION INFORMATION TO SUPPORT ESTIMATING THE IMPACT OF COVID 19 ON OPERATIONS AND FINANCIAL PERFORMANCE. WE BELIEVE THAT OUR CASH RESOURCES, BORROWING CAPACITY, AND CASH FLOWS GENERATED FROM OPERATIONS WILL CONTINUE TO BE SUFFICIENT TO WITHSTAND THE FINANCIAL IMPACT OF THE PANDEMIC, AND WILL ENABLE US TO CONTINUE TO SUPPORT OUR OPERATIONS, REGULATORY REQUIREMENTS, DEBT REPAYMENT OBLIGATIONS, AND CAPITAL EXPENDITURES FOR THE FORESEEABLE FUTURE. THE SYSTEM TOOK THE MARKET LEADING POSITION OF REQUIRING ALL TEAM MEMBERS AND MEDICAL STAFF, STUDENTS, VOLUNTEERS, AND CONTRACTORS TO BE FULLY VACCINATED BY SEPTEMBER 10, 2021. THE SYSTEM REPORTED THAT 99 PERCENT OF ITS WORKFORCE WERE COMPLIANT WITH ITS COVID 19 VACCINATION REQUIREMENT. THIS FIGURE MEANS TEAM MEMBERS WERE EITHER FULLY VACCINATED, ON THE WAY TO COMPLETING A TWO-DOSE REGIMEN, OR RECEIVED AN APPROVED MEDICAL OR RELIGIOUS EXEMPTION.THE SYSTEM BELIEVES THAT THE KNOWLEDGE GAINED REGARDING EFFECTIVE AND SAFE CLINICAL PRACTICES AND TREATMENT PROTOCOLS AND THE INCREASING LEVEL OF VACCINATION AND IMMUNITY AMONGST OUR TEAM MEMBERS AND THE COMMUNITY POSITIONED THE SYSTEM WELL TO PROTECT OUR STAFF AND PATIENTS FROM VIRUS TRANSMISSION AND TO MAINTAIN FULL SCOPE OPERATIONS.DURING 2021, THE SYSTEM SERVED AS THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ANCHOR NETWORK PARTNER FOR THE MONOCLONAL ANTIBODY (MAB) PROGRAM IN SOUTHEAST AND SOUTHCENTRAL MICHIGAN. UNDER THIS PARTNERSHIP, THE SYSTEM EXPANDED AVAILABILITY OF MAB BY OPENING AN INFUSION CENTER IN SOUTHWEST DETROIT AT COMMUNITY HEALTH AND SOCIAL SERVICES, A FEDERALLY QUALIFIED HEALTH CENTER WHOSE PHYSICIAN SERVICES ARE CONTRACTED THROUGH THE SYSTEM AND EXPANDING PROGRAMS AT THREE OF ITS HOSPITALS THAT CARE FOR PATIENTS IN UNDERSERVED COMMUNITIES.IN APRIL 2021, THE SYSTEM ESTABLISHED A SPECIALTY CLINIC TO TREAT COVID 19 AND OTHER PATIENTS WHO HAVE LINGERING COGNITIVE, EMOTIONAL, AND MENTAL HEALTH CONDITIONS AFTER BEING HOSPITALIZED IN THE INTENSIVE CARE UNIT. AS AN INCREASING NUMBER OF COVID 19 PATIENTS RECOVER AND ARE DISCHARGED FROM THE HOSPITAL, IT IS ANTICIPATED THAT MANY WILL NEED LONG TERM HELP GETTING BACK TO A NORMAL STATE OF PHYSICAL AND MENTAL WELL-BEING. THE POST ICU BRAIN HEALTH CLINIC OPENED RECENTLY AT THE NEUROPSYCHOLOGY CENTERS IN DETROIT AND WEST BLOOMFIELD. CLINIC STAFF CONDUCT EVALUATIONS, MAKE RECOMMENDATIONS FOR TREATMENT, AND PROVIDE RESOURCES FOCUSING ON PATIENTS AGED 55 AND OLDER WHO CONTINUE TO EXPERIENCE COGNITIVE, BEHAVIORAL, OR PSYCHIATRIC SYMPTOMS. IN ADDITION, SERVICES ARE OFFERED TO CAREGIVERS THAT PROVIDE NEW TOOLS AND STRATEGIES FOR CARING FOR AND SUPPORTING THEIR LOVED ONE,ALONG WITH HOME HEALTH VISITS TO ASSIST PATIENTS WITH USING TELEMEDICINE.WITH A SENSE OF HUMAN COMPASSION, WE GIVE, ORGANIZE, LEAD, PARTNER AND EMBRACE THE WIDE-RANGING COMMUNITY PROGRAMS AND SERVICES. IN GIVING BACK TO THE CULTURE AND PEOPLE THAT SURROUND US, WE GAIN FULFILLMENT IN KNOWING WE HAVE INVESTED IN THE HEALTH AND WELL-BEING OF THE COMMUNITY WHICH WE SERVE. ESTABLISHED IN 1918, OUR COMMITMENT TO THE COMMUNITY IS TO LEAD THEM TO BETTER HEALTH AND WELL-BEING AT EVERY STAGE OF LIFE. SERVING SOUTH CENTRAL MICHIGAN, HENRY FORD HEALTH JACKSON HOSPITAL IS THE LARGEST EMPLOYER IN JACKSON COUNTY. A GRADUATE MEDICAL EDUCATION PROGRAM OFFERS ROTATIONS TO RESIDENTS, INTERNS AND MEDICAL STUDENTS. A NATIONAL LEADER IN FORMING COMMUNITY PARTNERSHIPS, HENRY FORD HEALTH JACKSON HOSPITAL PROMOTES WELLNESS AND PREVENTION THROUGH OUR HEALTH IMPROVEMENT ORGANIZATION. HENRY FORD HEALTH JACKSON HOSPITAL PROVIDES OUTPATIENT SERVICES AT APPROXIMATELY 40 LOCATIONS THROUGHOUT SOUTH CENTRAL MICHIGAN. IN TOTAL THIS REPRESENTED 1,292,374 TOTAL OUTPATIENT FACILITY VISITS DURING 2021. HENRY FORD HEALTH JACKSON HOSPITAL OPERATES A 24 HOUR EMERGENCY DEPARTMENT. EMERGENCY SERVICES REPRESENTED 65,189 PATIENT VISITS DURING 2021. 683955858 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 362 0 1 4984 1 1 1 0 0 0 0 0 0 0 0 0 X 16 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JIM BONGIORNO 3138749506 ONE FORD PLACE DETROIT MI 48202 PAULA AUTRY TRUSTEE-PRESIDENT & CEO 58.00 7.00 X X 0 790772 126357 BRADLEY N CLARK TRUSTEE- SECRETARY/TREASUR THRU 7/2021 2.00 2.00 X X 0 0 0 MARTHA A FUERSTENAU TRUSTEE- CHAIR 2.00 2.00 X X 0 0 0 ROBERT G RINEY TRUSTEE 1.00 64.00 X 0 2175090 40731 ADNAN R MUNKARAH MD PHYSICIAN TRUSTEE 1.00 63.00 X 0 1423980 279396 MOHAN G KULKARNI MD PHYSICIAN TRUSTEE 60.00 1.00 X 0 1031486 39452 DAVID CRAFT TRUSTEE 1.00 2.00 X 0 0 0 KEVIN E OXLEY TRUSTEE 1.00 1.00 X 0 0 0 AARON S BOATIN TRUSTEE- VICE CHAIR 2.00 4.00 X X 0 0 0 MUMTAZ MEMON MD PHYSICIAN TRUSTEE 60.00 1.00 X 732725 0 33415 LAWRENCE NARKIEWICZMD PHYSICIAN TRUSTEE 60.00 1.00 X 570404 0 31730 CHRISSY SIDERS TRUSTEE 1.00 3.00 X 0 0 0 PHIL SPONSLER TRUSTEE THRU 7/2021 1.00 1.00 X 0 0 0 MARK S OLSON TRUSTEE 1.00 1.00 X 0 0 0 STEVEN D RICK TRUSTEE 1.00 1.00 X 0 0 0 MONICA MOSER TRUSTEE 1.00 1.00 X 0 0 0 SARIA RAMCHARAN DASS MD TRUSTEE 1.00 1.00 X 0 0 0 RAMI ABDEL RAHEEM ALZEBDEH MD TRUSTEE 1.00 1.00 X 0 0 0 EMILY MOORHEAD COO 59.00 6.00 X 392348 0 5805 KENNETH W EMPEY GENERAL COUNSEL 55.00 5.00 X 0 356931 23089 JIM BONGIORNO CENTRAL MARKET CFO, VP FIN 55.00 5.00 X 0 258642 42171 MARK A SMITH MD CMO/CEO HFAHMG 55.00 5.00 X 547840 0 38705 FRANK LAMARCA MD PHYSICIAN 60.00 0.00 X 2726979 0 33748 AZAM BASHEER MD PHYSICIAN 60.00 0.00 X 2419350 0 36191 AMRITRAJ G LOGANATHAN MD PHYSICIAN 60.00 0.00 X 1447707 0 32401 VISHAL GUPTA MD PHYSICIAN 60.00 0.00 X 1433941 0 22243 RYAN A BEEKMANMD PHYSICIAN 60.00 0.00 X 1239133 0 12185 SANDRA KILIAN MD FORMER PHYSICIAN TRUSTEE 60.00 0.00 X 88715 0 2321 MICHAEL GRISDELA FORMER INTERIM CENTRAL MAR 0.00 60.00 X 0 471789 35288 11599142 6508690 835228 444 1 1 0 INDEPENDENT HOSPITALIST PHYSICIANS PLLC PO BOX 100 ROYAL OAK MI 48068 HEALTHCARE SERVICES 16450301 PULMONARY CLINICS OF SOUTHERN MI PC 900 E MICHIGAN AVENUE STE 105 JACKSON MI 49201 HEALTHCARE SERVICES 5081061 CHRISTMAN COMPANY 208 N CAPITAL AVENUE LANSING MI 489331357 GENERAL CONTRACTOR 4288503 PROLINK HEALTHCARE LLC 4600 MONTGOMERY RD STE 300 CINCINNATI OH 45212 TEMP NURSING SERVICES 4115605 INDEPENDENT EMERGENCY PHYSICIANS PC 37000 GRAND RIVER AVE FARMINGTION HILLS MI 48335 HEALTHCARE SERVICES 2014713 69 8197644 2073410 10271054 PATIENT SERVICES 621990 708536277 707232310 1303967 708536277 4251375 4251375 392281 0 392281 392281 392281 8128909 0 8128909 8128909 8128909 CONTRACTED PHARMACY REVENUE 621110 39199634 39199634 JHN 621990 3399339 3399339 CAFETERIA 900099 1858293 1858293 1574091 1267219 306872 46031357 777611253 765337079 1610839 392281 852776 852776 63426 63426 4721059 3683398 952896 84765 91036 91036 297082527 270664145 26418382 1915095 1740962 173596 537 38144294 34675960 3457626 10708 18144752 16129454 2010204 5094 143549 9475 134074 57669345 55179676 2489669 1141841 194570 947271 9978471 6641650 3336821 1685977 1273698 412279 6194606 2976364 3218242 531874 404737 127137 600392 515503 84889 6850838 6850838 29978803 21960985 8017818 6770664 6770664 MEDICAL SUPPLIES 80767634 80767634 CORP OFFICE ALLOCATION 69181827 69181827 PHARMACEUTICAL SUPPLIES 57471827 57471827 BAD DEBT 16184318 16184318 42539005 29670935 12868070 748705936 683955858 64648974 101104 6169580 65536 186832779 99156365 261969 12941 82708371 103667392 13444962 14334525 4487986 3727024 378269768 148736048 245494839 229533720 264572594 379112325 5844155 6064455 20925077 31644820 830742312 867319103 174308262 154901488 152062049 142948275 96646447 92388515 423016758 390238278 X 404635709 473154911 3089845 3925914 407725554 477080825 830742312 867319103 X 28905317 28288623 12161331 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 41989 0 0 41989 0 PART II-B, LINE 1: HEALTH CARE IS A HIGHLY-REGULATED FIELD, REQUIRING FREQUENT AND HIGH-LEVEL COMMUNICATION WITH REGULATORS AND ELECTED OFFICIALS. A SMALL INVESTMENT IN LOBBYING ENABLES US TO REMAIN IN CONTACT WITH LEGISLATORS AND GOVERNMENT AGENCIES, MAXIMIZE THE RESOURCES WITH WHICH WE ARE ENTRUSTED AND ASSURE THAT WE PROVIDE THE BEST CARE TO OUR COMMUNITY. W.A. FOOTE MEMORIAL HOSPITAL DBA HENRY FORD HEALTH JACKSON HOSPITAL ENLISTS THE SERVICES OF SEVERAL LOBBYING CONSULTANTS, ATTORNEYS AND HEALTHCARE TRADE ASSOCIATIONS. 3089845 2032607 184527 1381066 3925913 2864539 1790548 125594 1690836 3089845 3183393 192950 2311804 2864539 2713012 2074346 -50758 1553207 3183393 2037753 1513373 93086 931200 2713012 0.24430 0.75570 0 0 9540626 9540626 182329628 48261566 134068062 210800 189993 20807 160933543 100284489 60649054 25255171 25255171 229533720 RETIREMENT PLAN LIABILITY 23911341 DEFERRED COMP 18851548 CORPORATE RESERVE 5869813 LIABILITY INSURANCE 23274001 WORKERS COMP LIABILITY 1074605 CURRENT OPERATING LEASE LIABILITY 2381134 LONG TERM OPERATING LEASE LIABILITY 11773007 OPERATING LEASE A/P PAYMENT -274387 SHORT-TERM BORROWINGS 5527453 92388515 X PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR VARIOUS CHARITABLE HOSPITAL PROGRAMS INCLUDING TREATMENT OF UNINSURED PATIENTS, COMMUNITY PREVENTATIVE HEALTH EDUCATION, PROGRAM DEVELOPMENT AND CAPITAL IMPROVEMENTS. PART X, LINE 2: THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2021 AND 2020. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 11104906 11104906 0.01520 223563269 167383234 56180035 0.07670 0.00000 234668175 167383234 67284941 0.09190 1205707 1205707 0.00160 19020969 8524172 10496797 0.01430 21041473 15954270 5087203 0.00690 0.00000 437619 437619 0.00060 41705768 24478442 17227326 0.02340 276373943 191861676 84512267 0.11530 14361 14361 0.00000 643843 643843 0.00090 658204 658204 0.00090 0 16202025 4050506 204977915 229062742 -24084827 X 1 1 1 FOOTE HEALTH CENTER ASSOCIATES ENTITY LEASES MEDICAL OFFICE SPACE. 0.86370 0.00000 0.13630 2 GRASS LAKE REAL ESTATE LLC TO BUILD AND MANAGE OUTPATIENT SURGICAL CENTER 0.46000 0.00000 0.46000 3 GRASS LAKE SURGERY CENTER LLC TO OPERATE OUTPATIENT SURGICAL CENTER 0.46000 0.00000 0.46000 1 1 HENRY FORD HEALTH JACKSON HOSPITAL 205 N EAST AVENUE JACKSON MI 49201 WWW.HENRYFORD.COM X X X X X HENRY FORD HEALTH JACKSON HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 0 1 X SEE LINE 10A BELOW X 1 19 1 SEE PART V, PAGE 8 0 1 X 250.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE X HTTPS://WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE X HTTPS://WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 HENRY FORD HEALTH JACKSON HOSPITAL PART V, SECTION B, LINE 5: OUR METHODOLOGY FOR DATA COLLECTION INVOLVED REACHING OUT TO COMMUNITY EXPERTS AND OTHER MEMBERS OF COMMUNITY AGENCIES IN JACKSON COUNTY USING A WEB-BASED 5-QUESTION SURVEY. THE SURVEY WAS DISTRIBUTED TO HEALTH LEADERS AND OTHER RESPECTED INDIVIDUALS WITHIN THE COMMUNITY REPRESENTING PUBLIC AGENCIES AND PROGRAMS FROM MAY THROUGH JULY OF 2019. INDIVIDUALS SURVEYED INCLUDED LEADERS FROM AGENCIES SUCH AS JACKSON COUNTY HEALTH DEPARTMENT, LIFE MISSIONS CENTER, CATHOLIC CHARITIES OF JACKSON, LENAWEE AND HILLSDALE COUNTIES, COMMUNITY ACTION AGENCY, UNITED WAY OF JACKSON COUNTY AND MANY OTHERS. PARTICIPANTS HAD A WIDE RANGE OF EXPERTISE. FROM THEIR SURVEY RESPONSES, WE GAINED INSIGHT INTO THE KINDS OF HEALTH ISSUES FACING OUR COMMUNITIES.OUR METHODOLOGY ALSO INCLUDED A WIDE VARIETY OF SECONDARY DATA SOURCES IN ADDITION TO RESULTS OBTAINED FROM BOTH SURVEY AND FOCUS GROUP PARTICIPANTS IN OAKLAND, MACOMB AND WAYNE COUNTIES. ADDITIONALLY, WE LOCATED STATE HEALTH NEEDS DATA FOR HF HEALTH USING THE MICHIGAN BEHAVIORAL RISK FACTOR SURVEY AND MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES PROFILES AMONG OTHER SOURCES. DATA FROM THESE SOURCES CAN BE FOUND IN THE APPENDIX. HENRY FORD HEALTH JACKSON HOSPITAL PART V, SECTION B, LINE 6A: HENRY FORD HEALTH HOSPITALHENRY FORD HEALTH KINGSWOOD HOSPITALHENRY FORD HEALTH MACOMB HOSPITALSHENRY FORD HEALTH WEST BLOOMFIELD HOSPITALHENRY FORD HEALTH WYANDOTTE HOSPITALHENRY FORD HEALTH COTTAGE HOSPITAL/MEDICAL CENTERHENRY FORD HEALTH ALLEGIANCE SPECIALTY HOSPITAL HENRY FORD HEALTH JACKSON HOSPITAL PART V, SECTION B, LINE 11: THE CHNA WAS CONDUCTED IN 2019 IN PARTNERSHIP WITH THE JACKSON COUNTY HEALTH DEPARTMENT AND THEIR COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN TEAMS. THE IMPLEMENTATION PLAN FOCUSES ON THE PROGRAMS IDENTIFIED WHICH WERE DEEMED TO BE THE AREAS OF MOST CRITICAL NEED, AND WITH THE GREATEST POTENTIAL FOR ACHIEVING A MEASURABLE IMPROVEMENT. SEVERAL SIGNIFICANT HEALTH NEEDS WITHIN THE SERVICE AREA OF HENRY FORD HEALTH JACKSON HOSPITAL WERE IDENTIFIED. HEALTH NEEDS WERE PRIORITIZED BASED ON SEVERAL CRITERIA INCLUDING THE IMPORTANCE GIVEN TO PARTICULAR HEALTH ISSUES BY SURVEY AND FOCUS GROUP PARTICIPANTS, STATISTICAL DATA FROM THE STATE OF MICHIGAN, AS WELL AS INPUT FROM HF HEALTH AND COMMUNITY LEADERS. HENRY FORD HEALTH JACKSON HOSPITAL'S RESOURCES AND OVERALL ALIGNMENT WITH THE HENRY FORD HEALTH, MISSION, VISION, GOALS AND STRATEGIC PRIORITIES WERE TAKEN INTO CONSIDERATION WHEN IDENTIFYING THE TOP THREE MOST SIGNIFICANT HEALTH ISSUES TO BE ADDRESSED: HEALTHY LIFESTYLES & DIABETES, SUBSTANCE ABUSE & MENTAL HEALTH AND INFANT MORTALITY. IN TERMS OF SIGNIFICANT HEALTH NEEDS THAT WILL NOT BE ADDRESSED, HENRY FORD HEALTH JACKSON HOSPITAL ACKNOWLEDGES THE WIDE RANGE OF HEALTH CONCERNS WHICH EMERGED FROM THE CHNA PROCESS, AND DETERMINED IT COULD MOST EFFECTIVELY ADDRESS THOSE HEALTH NEEDS THAT WERE DETERMINED TO BE MOST URGENT AND ESSENTIAL TO THE HEALTH OF THE COMMUNITY AS WELL AS WITHIN ITS ABILITY TO INFLUENCE. WHILE MOST OF THESE ADDITIONAL HEALTH ISSUES ARE CURRENTLY BEING ADDRESSED THROUGH SUPPORTIVE CLINICAL SERVICES, HFAH WILL NOT TAKE NEW OR SPECIFIC, ADDITIONAL ACTIONS RELATED TO THE FOLLOWING HEALTH NEEDS: KIDNEY DISEASE, FAMILY PLANNING, ASTHMA AND ALZHEIMER'S DISEASE. HENRY FORD HEALTH JACKSON HOSPITAL PART V, SECTION B, LINE 13B: HENRY FORD HEALTH JACKSON HOSPITAL ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNTED RATE THAT DOES NOT EXCEED 138% OF MEDICARE PAYMENT RATES. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES. HENRY FORD HEALTH JACKSON HOSPITAL PART V, SECTION B, LINE 15E: PART V, SECTION B, LINE 22A:HENRY FORD HEALTH JACKSON HOSPITAL ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNTED RATE THAT DOES NOT EXCEED 138% OF MEDICARE PAYMENT RATES. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES. PART V, LINE 10A HTTPS://WWW.HENRYFORD.COM/ABOUT/COMMUNITY-HEALTH/NEEDS-ASSESSMENT 50 1 - HFHJH HEMATOLOGYONCOLOGY 1100 E MICHIGAN AVE STE 307 JACKSON MI 49201 SPECIALTY PRACTICE AND INFUSION CENTER 2 - HFHJH ORTHOPEDIC & NEUROSCIENCE CNTR 1201 E MICHIGAN AVENUE JACKSON MI 49201 OUTPATIENT SPECIALTY, DIAGNOSTIC AND REHAB FACILITY 3 - HFHJH SURGERY CENTER 1125 E MICHIGAN AVENUE JACKSON MI 49201 OUTPATIENT SURGERY CENTER 4 - HFHJH DIGESTIVE HEALTH 205 S EAST AVE JACKSON MI 49201 OUTPATIENT SURGERY CENTER 5 - HFHJH RADIATION ONCOLOGY 1102 E MICHIGAN AVE JACKSON MI 49201 RADIATION THERAPY 6 - HFHJH HEALTH CARDIOLOGY 309 PAGE AVENUE JACKSON MI 49201 SPECIALTY PRACTICE AND DIAGNOSTIC TESTING CENTER 7 - HFHJH HEALTH CENTER - CASCADE RIDGE 3305/3333 SPRING ARBOR RD JACKSON MI 49203 FAMILY AND SPECIALTY PRACTICES, DIAGNOSTIC CENTER 8 - HFHJH VASCULAR LABORATORY 300 W WASHINGTON AVENUE STE 350 JACKSON MI 49201 VASCULAR TESTING 9 - HFHJH HEALTH CENTER - TOWNSEND 400 HINCKLEY BLVD JACKSON MI 49203 FAMILY MEDICINE AND DIAGNOSTIC CENTER 10 - HFHJH HEALTH CENTER - NORTH STREET 1401 W NORTH STREET JACKSON MI 49202 FAMILY MEDICINE AND DIAGNOSTIC CENTER 11 - HFHJH HEALTH CENTER - SPRINGPORT 2200 SPRINGPORT ROAD JACKSON MI 49202 OUTPATIENT SERVICES, DIAGNOSTIC CENTER, PHARMACY SVCS 12 - HFHJH GASTROENTEROLOGY 744 W MICHIGAN AVE STE 201 JACKSON MI 49201 SPECIALTY PRACTICE 13 - HFHJH HOME HEALTH CARE 100 E MICHIGAN AVE STE 400 JACKSON MI 49201 CLINICAL HOME CARE SERVICES 14 - HFHJH PHYSICAL REHAB-JACKSON 100 E MICHIGAN AVE STE 103 JACKSON MI 49201 PHYSICAL REHABILITATION 15 - HFHJH ADDICTION RECOVERY CENTER 2424 W WASHINGTON AVE JACKSON MI 49203 INPATIENT AND OUTPATIENT TREATMENT CENTER 16 - HFHJH UROLOGY - SPRING ARBOR ROAD 2800 SPRING ARBOR RD JACKSON MI 49201 SPECIALTY PRACTICE 17 - HFHJH UROLOGY - W MICHIGAN AVE 744 W MICHIGAN AVE STE 300 JACKSON MI 49201 SPECIALTY PRACTICE 18 - HFHJH ENTHEARING CENTER 1111 TENEYCK ST JACKSON MI 49201 SPECIALTY PRACTICE AND AUDIOLOGY SALES/SERVICE 19 - HFHJH OCCUPATIONAL HEALTH 100 E MICHIGAN AVE STE 101 JACKSON MI 49201 EMPLOYMENT SCREENING, WORK-RELATED INJURY TREATMENT 20 - HFHJH HOME MEDICAL EQUIP 700 E MICHIGAN AVE JACKSON MI 49201 SALE OF DURABLE MEDICAL EQUIPMENT 21 - HFHJH HEALTH CENTER - EAST MICHIGAN 3235 E MICHIGAN AVENUE JACKSON MI 49202 FAMILY MEDICINE AND BEHAVIORAL HEALTH SERVICES 22 - HFHJH NEUROPSYCHOLOGY 1400 E MICHIGAN AVE JACKSON MI 49202 SPECIALTY PRACTICE 23 - HFHJH PEDIATRICS 760 W FRANKLIN JACKSON MI 49203 PEDIATRIC MEDICINE 24 - HFHJH HEALTH CENTER - MASON 810 HOGSBACK RD MASON MI 48854 FAMILY AND SPECIALTY PRACTICE, DIAGNOSTICS, REHAB 25 - HFHJH HEALTH CENTER - LESLIE 130 N SHERMAN ST LESLIE MI 49251 FAMILY MEDICINE AND DIAGNOSTIC CENTER 26 - HFHJH VASCULAR HEALTH 300 W WASHINGTON AVENUE STE 300 JACKSON MI 49201 SPECIALTY PRACTICE 27 - HFHJH HEALTH CENTER - SPRING ARBOR 7845 SPRING ARBOR ROAD SPRING ARBOR MI 49283 FAMILY MEDICINE AND DIAGNOSTIC CENTER 28 - HFHJH GENERAL SURGERY 744 W MICHIGAN AVE STE 200 JACKSON MI 49201 SPECIALTY PRACTICE 29 - HFHJH GENERAL SURGERY 1100 E MICHIGAN AVE STE 300 JACKSON MI 49201 SPECIALTY PRACTICE 30 - HFHJH CARDIAC SURGERY 1100 E MICHIGAN AVE STE 201 JACKSON MI 49201 SPECIALTY PRACTICE 31 - HFHJH FAMILY MEDICINE AND DIAGNOSTIC CNTR 153 WAMPLERS LAKE RD BROOKLYN MI 49230 FAMILY MEDICINE AND DIAGNOSTIC CENTER 32 - HFHJH HEALTH CENTER - ALBION 27931 C DRIVE NORTH ALBION MI 49224 FAMILY AND SPECIALTY MEDICINE, DIAGNOSTIC CENTER 33 - HFHJH THORACIC SURGERY 1100 E MICHIGAN AVE STE 201 JACKSON MI 49201 SPECIALTY PRACTICE 34 - HFHJH FAMILY MEDICINE - SUMMIT WOODS 2585 SPRING ARBOR ROAD JACKSON MI 49203 FAMILY MEDICINE 35 - HFHJH FAMILY MEDICINE AND DIAGNOSTIC CNTR 12369 E MICHIGAN AVE GRASS LAKE MI 49240 FAMILY MEDICINE AND DIAGNOSTIC CENTER 36 - HFHJH HEALTH CENTER - MICHIGAN CENTER 4304 PAGE AVE MICHIGAN CENTER MI 49254 SPECIALTY PRACTICE, DIAGNOSTICS, REHAB 37 - HFHJH INTERNAL MEDICINE 100 E MICHIGAN AVE JACKSON MI 49201 OUTPATIENT SERVICES 38 - HFHJH DIAGNOSTIC CENTER 1100 E MICHIGAN AVE STE 104 JACKSON MI 49201 LAB AND IMAGING SERVICES 39 - HFHJH DIAGNOSTIC CENTER - NORTH JACKSON 505 N JACKSON ST STE 178 JACKSON MI 49201 LAB AND IMAGING SERVICES 40 - HFHJH OUTPATIENT PROCEDURE CENTER 1100 E MICHIGAN AVE STE 109 JACKSON MI 49201 OUTPATIENT SERVICES 41 - HFHJH CARDIAC REHAB 1100 E MICHIGAN AVE STE 100/102 JACKSON MI 49201 POST-SURGICAL REHABILITATION 42 - HFHJH BARIATRIC CENTER 744 W MICHIGAN AVE STE 101 JACKSON MI 49201 SPECIALTY PRACTICE 43 - HFHJH SENIOR HEALTH CENTER 100 E MICHIGAN AVE STE 102 JACKSON MI 49201 OUTPATIENT EVALUTION AND TESTING 44 - HFHJH PERSONAL CARE 100 E MICHIGAN AVE STE 400 JACKSON MI 49201 PRIVATE DUTY SERVICES 45 - HFHJH DIAGNOSTIC CENTER - GREENWOOD AVE 1310 GREENWOOD AVE JACKSON MI 49203 LABORATORY SERVICES 46 - HFHJH OUTPATIENT TRAUMA 1100 E MICHIGAN AVE STE 201 JACKSON MI 49201 SPECIALTY PRACTICE 47 - HFHJH PHYSICAL REHAB - HILLSDALE 61 W CARLTON HILLSDALE MI 49242 PHYSICAL REHABILITATION 48 - HFHJH HEALTH CENTER-CHELSEA 1145 S MAIN ST UNIT A CHELSEA MI 48119 LAB 49 - HFHJH HEALTH CENTER-COLDWATER 605 W CHICAGO STREET COLDWATER MI 49036 LAB 50 - HFHJH DIAGNOSTIC CENTER-HILLSDALE 3271 W CARLETON HILLSDALE MI 49242 LAB PART I, LINE 7G: SUBSIDIZED SERVICES CONSIST OF FACILITY COSTS OF WOMEN'S AND BEHAVIORAL HEALTH SERVICES. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $5,716,588 PART II, COMMUNITY BUILDING ACTIVITIES: HFHJH BELIEVES THAT THE STRENGTH AND VITALITY OF A COMMUNITY HAS A SIGNIFICANT IMPACT ON THE BEHAVIORS OF ITS RESIDENTS AND THAT THERE IS DIRECT CORRELATION BETWEEN THE VIABILITY OF A COMMUNITY AND THE ATTITUDE OF ITS RESIDENTS TOWARD HEALTHIER BEHAVIORS. THEREFORE, HFHJH INCLUDES IN ITS COMMITMENT TO COMMUNITY BENEFIT A FOCUS ON DIRECT INVOLVEMENT IN THE COMMUNITY TO BOTH IMPROVE THE ENVIRONMENT AND ENSURE THAT CRITICAL MESSAGES ON THE BENEFITS OF HEALTHIER BEHAVIORS ARE HEARD. HFHJH LEADERS COLLABORATE WITH COMMUNITY TASK FORCES AND COALITIONS IN ADDRESSING THE NEEDS OF OUR SERVICE AREA. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE IS STATED IN PATIENT GROSS CHARGES. PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION 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 ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. AT SUCH POINT IN TIME THAT A BILLED SERVICE IS BELIEVED TO BE UNCOLLECTIBLE, THE RELATED RECEIVABLE IS WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ESTIMATES OF RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS ARE ACCRUED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE RECEIVED.FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE ORGANIZATION OFFERS A DISCOUNT OFF STANDARD RATES FOR SERVICES PROVIDED THAT RESULT IN NET CHARGES THAT DO NOT EXCEED 138% OF MEDICARE RATES.FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. THE ORGANIZATION DETERMINES THE COSTS OF SUCH UNPAID SERVICES BY APPLYING A COST-TO-CHARGE RATIO TO THE BILLED CHARGES PART III, LINE 9B: SHOULD A PATIENT BE DEEMED ELIGIBLE FOR ASSISTANCE ANY COLLECTION EFFORTS ASSOCIATED WITH THE QUALIFYING SERVICE ARE SUSPENDED. IF THE PATIENT IS DETERMINED TO QUALIFY UNDER THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE POLICY PRIOR TO BILLING, NO BILL IS EVER GENERATED AND THEREFORE THE ELEMENTS OF THE COLLECTION POLICY ARE NEVER INVOKED. WHEN THE DETERMINATION IS NOT MADE PRIOR TO THE BILLING, THE ORGANIZATION'S COLLECTION POLICY WOULD APPLY. THIS POLICY READS IN PART:- "PATIENTS WILL BE EVALUATED FOR THE SYSTEM'S PATIENT FINANCIAL ASSISTANCE PROGRAM"- "UNINSURED PATIENTS WILL BE GIVEN A DISCOUNT"- "UNDERINSURED PATIENTS MAY QUALIFY FOR DISCOUNTED SERVICES BASED UPON THEIR AGGREGATE HOUSEHOLD INCOME" - "THE ORGANIZATION WILL REVIEW THE PATIENTS'S RECORD TO DETERMINE IF REASONABLE EFFORTS WERE UNDERTAKEN TO ENSURE THAT FINANCIAL ASSISTANCE WAS OFFERED AND/OR IF FINANCIAL ASSISTANCE IS REQUESTED"- "LEGAL ACTION...MAY BE TAKEN...WHEN THERE IS EVIDENCE THAT THE PATIENT OR RESPONSIBLE PARTY HAS INCOME AND/OR ASSETS TO MEET HIS OR HER OBLIGATION"- "THE ORGANIZATION WILL NOT FORCE THE SALE OF FORECLOSURE OF ANY PATIENT OR GUARANTOR'S PRIMARY RESIDENCE TO PAY AN OUTSTANDING MEDICAL BILL"- "THE ORGANIZATION WILL NOT...REQUIRE THE PATIENT OR RESPONSIBLE PARTY TO APPEAR IN COURT"- "THE ORGANIZATION WILL DIRECT THEIR COLLECTION AGENCIES TO FOLLOW THESE GUIDELINES" PART VI, LINE 2: HENRY FORD HEALTH (HF HEALTH) CONSIDERS THE ONGOING ASSESSMENT OF COMMUNITY HEALTH NEEDS AS AN ESSENTIAL FUNCTION. HENRY FORD HEALTH JACKSON HOSPITAL WAS ENCOMPASSED IN THE HF HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT. IT PROVIDES KEY INFORMATION REGARDING THE DEMOGRAPHICS AND MAJOR NEEDS OF THE COMMUNITIES SERVED, IT SUPPORTS THE PRIORITIZATION OF THE SERVICES MADE AVAILABLE, AND IT HELPS TARGET POPULATIONS WITH THE MOST VULNERABILITY TO HEALTH NEEDS SUCH AS THE POOR, UNINSURED, AS WELL AS VARIOUS OTHER POPULATIONS THAT MAY HAVE BEEN OVERLOOKED. THE COMMUNITY HEALTH NEEDS ASSESSMENT ALSO PROVIDES VALUABLE INFORMATION REGARDING OTHER ORGANIZATIONS SUPPORTING THE NEEDS WITHIN THE COMMUNITY SO PROGRAMS CAN BE COORDINATED AND LEVERAGED TO ENSURE THAT EVERY DOLLAR IS INVESTED WISELY.INTERNALLY THE COMMUNITY HEALTH ANCHOR COUNCIL ENTERPRISE (CHANCE) PROVIDES EXECUTIVE OVERSIGHT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR HENRY FORD HEALTH. THE CHNA WAS COMPLETED IN SEVERAL PHASES. THE FIRST PHASE INCLUDED DATA COLLECTION FROM A VARIETY OF PUBLIC AND PROPRIETARY SOURCES THAT PROVIDED INFORMATION AROUND POPULATION DEMOGRAPHICS, SOCIOECONOMIC DATA, HEALTH STATUS INDICATORS AS WELL AS SEVERAL OTHER DATA ELEMENTS. THE SECOND PHASE INVOLVED DEVELOPING AND DISTRIBUTING A KEY STAKEHOLDER SURVEY TO CAPTURE COMMUNITY ORGANIZATION AND COALITION INPUT AS TO MAJOR HEALTH NEEDS, THEY BELIEVE THAT SHOULD PRIORITIZED AND ADDRESSED IN THE FOUR-COUNTY AREA. THE THIRD PHASE INCORPORATED QUANTITATIVE AND QUALITATIVE DATA COLLECTED IN THE FIRST TWO PHASES AND BASED ON THIS INFORMATION IDENTIFIED PRIORITIES FOR HENRY FORD HEALTH TO ADDRESS WITHIN THE COMMUNITIES IT SERVES. THIS ASSESSMENT WAS PREPARED JOINTLY BY THE HF HEALTH BUSINESS INTEGRITY SERVICES AND CORPORATE STRATEGIC PLANNING DEPARTMENTS, ALONG WITH THE OFFICE OF COMMUNITY HEALTH, EQUITY AND WELLNESS. RESULTS ARE BEING USED AS A FOUNDATION FOR PLANNING, DEVELOPING, AND REFINING HF HEALTH'S FUTURE COMMUNITY SERVICES IN THE FOUR-COUNTY AREAS. RESULTS OF THIS ASSESSMENT HAVE BEEN REVIEWED WITH SEVERAL HENRY FORD HEALTH LEADERS, LEADING TO STRATEGIC AND IMPLEMENTATION PLAN MODIFICATIONS TO ALIGN STRATEGY WITH IDENTIFIED NEEDS. PART VI, LINE 3: HFHJH HAS VARIOUS APPROACHES TO TARGET AND INFORM RESIDENTS OF ITS COMMUNITIES ABOUT THE PROGRAMS AND SERVICES IT OFFERS. PROGRAMS WHERE WE PARTNER WITH ORGANIZATIONS WITH ESTABLISHED RELATIONSHIPS WITH THE INDIVIDUALS SUCH AS THROUGH COMMUNITY HEALTH CENTERS, THE PUBLIC SCHOOLS AND FAITH-BASED ORGANIZATIONS HAVE BEEN PARTICULARLY SUCCESSFUL. HFHJH FOLLOWS THE HFHS PATIENT FINANCIAL ASSISTANCE POLICY. HF HEALTH HAS A SINGULAR PATIENT FINANCIAL ASSISTANCE POLICY (PFAP). INDIVIDUALS WITHOUT ADEQUATE HEALTH INSURANCE COVERAGE MOST FREQUENTLY APPEAR IN OUR EMERGENCY ROOM FOR SERVICES, ALL PATIENTS ARE SEEN WITHOUT REGARD TO ABILITY TO PAY. INTAKE STAFF IS TRAINED HOW TO APPROACH AND ENGAGE AN INDIVIDUAL WHEN THERE IS AN APPARENT LACK OF ADEQUATE HEALTH COVERAGE. THIS INCLUDES INFORMING THEM OF THE PROGRAMS OFFERED BY HFHJH AS WELL AS OTHER COMMUNITY, LOCAL, STATE AND FEDERAL PROGRAMS OFFERING POTENTIAL SUPPORT. HFHJH HAS DEDICATED STAFF RESPONSIBLE TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR SUPPORTIVE PROGRAMS AND ASSIST THEM WITH THE ENROLLMENT PROCESS. THERE ARE MANY REASONS WHY A PATIENT IN NEED OF FINANCIAL ASSISTANCE WITH THEIR MEDICAL CARE MAY NOT HAVE BEEN IDENTIFIED AT THE TIME OF THE CARE DELIVERY. PATIENT FINANCIAL SERVICE AND COLLECTION STAFFS ARE TRAINED TO RECOGNIZE THESE INDIVIDUALS AND PROVIDE THEM WITH ADVICE REGARDING THE VARIOUS OPTIONS AVAILABLE TO SUPPORT THEIR CARE NEEDS. PART VI, LINE 4: THE FOUR-COUNTY AREA INCLUDES THE COUNTIES OF WAYNE, OAKLAND, MACOMB, AND JACKSON WHICH ARE LOCATED IN SOUTHEASTERN AND SOUTHCENTRAL MICHIGAN AND ACCOUNT FOR 41% OF THE MICHIGAN POPULATION. WAYNE, OAKLAND, AND MACOMB (IN THAT ORDER) ARE THE MOST POPULATED COUNTIES IN MICHIGAN. JACKSON COUNTY IS MUCH SMALLER. OF THE NEARLY 4 MILLION RESIDENTS, APPROXIMATELY 51% OF THE POPULATION IS FEMALE. WITH REGARD TO RACE/ETHNICITY, THE FOUR-COUNTY AREA IS 64% WHITE, COMPARED TO A NATIONAL AVERAGE OF 60%. OF NOTE, THE FOUR-COUNTY AREA IS 24% BLACK, WHICH IS TWICE THE NATIONAL PERCENTAGE OF 12%. CONVERSELY, THE HISPANIC POPULATION (5.0%) IS A LITTLE UNDER ONE THIRD THE NATIONAL PERCENTAGE OF 18%.THE NUMBER OF FOUR-COUNTY RESIDENTS IS EXPECTED TO REMAIN FLAT OVER THE NEXT SEVERAL YEARS. WHEN EXAMINING AGE DISTRIBUTION, THE FOUR-COUNTY AREA HAS A COMPARABLE POPULATION TO THAT OF THE COUNTRY WITH 17% OF THE POPULATION ABOVE THE AGE OF 65. OF PARTICULAR INTEREST TO HEALTHCARE PROVIDERS IS THE AGING POPULATION OF THE FOUR-COUNTY AREA WITH THE 65-YEARS-OLD AND ABOVE POPULATION EXPECTED TO RISE BY 15% FROM 2019 TO 2024.WITH REGARDS TO EDUCATION, THE FOUR-COUNTY AREA HAS APPROXIMATELY 11% OF RESIDENTS WHO HAVE SOME HIGH SCHOOL EDUCATION OR LESS COMPARED TO THE NATIONAL AVERAGE OF 13%. FURTHER, 29% OF RESIDENTS HAVE A BACHELOR'S DEGREE OR GREATER, WHICH IS COMPARABLE TO THE NATIONAL AVERAGE. THE FOUR-COUNTY AREA IS DIVERSE IN POPULATION, RACE/ETHNICITY, ECONOMIC GROWTH AND DEVELOPMENT. THE AUTOMOTIVE INDUSTRY REMAINS THE LARGEST EMPLOYER IN THE REGION, BUT THE HEALTH CARE SECTOR IS REPRESENTED AMONG THE TOP EMPLOYERS IN THE REGION AS WELL. THE AVERAGE MEDIAN HOUSEHOLD INCOME WITHIN THE FOUR-COUNTY AREA ($56,240) IS SLIGHTLY LESS THAN THE NATIONAL AVERAGE ($57,652). WITHIN THE FOUR-COUNTY AREA, THE MEDIAN HOUSEHOLD INCOME IN OAKLAND COUNTY ($73,369) IS SIGNIFICANTLY HIGHER THAN WAYNE COUNTY ($43,702), JACKSON COUNTY ($49,715) AND MACOMB COUNTY ($58,175). AT THE ZIP CODE LEVEL, AVERAGE HOUSEHOLD INCOMES VARY SIGNIFICANTLY.LOWER HOUSEHOLD INCOMES NEGATIVELY IMPACT PURCHASING POWER, HEALTH INSURANCE COVERAGE, AND COSTS OF BASIC NECESSITIES. AS A RESULT, THE FOUR-COUNTY AREA'S SAFETY NETS, INCLUDING HEALTHCARE SYSTEMS, ARE BEING STRETCHED TO THE LIMIT. MICHIGAN RANKS 33RD IN THE COUNTRY FOR CHILDREN UNDER 18 IN FAMILIES BELOW THE POVERTY LEVEL, AT 19.3%, A 3% IMPROVEMENT FROM 2016. UNEMPLOYMENT IN MICHIGAN HAS DROPPED TO 4.6% IN 2018, WHICH IS SIMILAR TO THE NATIONAL AVERAGE AND A DECLINE OF 0.8% SINCE 2016 IN MICHIGAN. CONVERSELY, WITHIN THE FOUR-COUNTY AREA THE UNEMPLOYMENT RATE MATCHES THE NATIONAL AVERAGE OF 4% AND RANGES FROM 3.2% IN OAKLAND COUNTY TO 5.0% IN WAYNE COUNTY.THERE ARE KEY DEMOGRAPHIC DIFFERENCES BETWEEN THE RESIDENTS OF EACH COUNTY WITHIN THE FOUR-COUNTY AREA. FOR EXAMPLE, AGE, SEX, EDUCATION, AND INCOME DISTRIBUTION DIFFER FROM COUNTY TO COUNTY. IN ORDER TO INCREASE THE UTILITY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, IT IS IMPORTANT TO ANALYZE THE PROFILE(S) OF EACH OF THESE COUNTIES AT A MORE DETAILED LEVEL, SUCH AS ZIP CODES, SO THAT CERTAIN DIFFERENCES WITHIN THE AREA BECOME EVIDENT.ONE COMMUNITY IN PARTICULAR NEED OF ATTENTION IS THE CITY OF DETROIT. WHEN EXAMINING THE CITY OF DETROIT THE AVERAGE HOUSEHOLD INCOME IS $40,314, WHICH IS SIGNIFICANTLY LESS THAN AVERAGE HOUSEHOLD INCOME OF THE OVERALL FOUR-COUNTY AREA ($68,064). REGARDING EDUCATION, 23% OF RESIDENTS HAVE LESS THAN A HIGH SCHOOL EDUCATION AND ONLY 14% HAVE A BACHELOR'S DEGREE OR HIGHER. IN TERMS OF RACE/ETHNICITY, APPROXIMATELY 91% OF DETROIT IS COMPOSED OF A MINORITY POPULATION VERSUS 37% FOR THE FOUR-COUNTY AREA AS A WHOLE. THE DETROIT UNEMPLOYMENT RATE IS 7.9% (NOVEMBER 2018), DOWN FROM 11.5% IN SEPTEMBER 2015.WHEN LOOKING OUTSIDE OF THE CITY OF DETROIT, VARIOUS OTHER ZIP CODES IN THE FOUR-COUNTY AREA INDICATE SECTIONS OF THE REGION THAT HAVE LOWER INCOMES, LESS EDUCATION, AND ARE MORE RACIALLY AND ETHNICALLY DIVERSE. THE AVERAGE HOUSEHOLD INCOME OF THESE ZIP CODES RANGES FROM $29,486-$54,251, LOWER THAN THE FOUR-COUNTY SERVICE AREA. OVERALL, 17% OF RESIDENTS IN THESE ZIP CODES HAVE LESS THAN A HIGH SCHOOL EDUCATION COMPARED TO 11% FOR THE FOUR-COUNTY AREA. THESE TWENTY ZIP CODES HAVE A SLIGHTLY DIFFERENT PERCENTAGE OF RACIAL/ETHNIC MINORITIES AS COMPARED TO THE REST OF THE FOUR-COUNTY AREA. AS A WHOLE THESE ZIP CODES ARE COMPOSED OF 40% MINORITIES COMPARED TO 36% FOR THE FOUR-COUNTY AREA.AS A RESULT, THE CITY OF DETROIT AND ABOVE TWENTY ZIP CODES ARE OF PARTICULAR INTEREST IN PLANNING COMMUNITY NEEDS INITIATIVES WITHIN THE FOUR-COUNTY AREA. PART VI, LINE 5: HENRY FORD HEALTH JACKSON HOSPITAL (HFHJH) IS PART OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH"), ONE OF THE NATION'S LARGEST INTEGRATED HEALTH DELIVERY SYSTEMS SERVING SOUTHEASTERN MICHIGAN. THIS TAX RETURN REFLECTS ACTIVITIES OF HFHJH, WHICH INCLUDES 365 INPATIENT BEDS WITH AN INTEGRATED MEDICAL STAFF SERVING MORE THAN 40 FACILITIES IN THE JACKSON COUNTY AREA OF MICHIGAN. HFHJH IS GOVERNED BY A DEDICATED VOLUNTEER COMMUNITY BOARD AND IT PROVIDES ITS COMMUNITIES WITH A FULL RANGE OF CLINICAL SERVICES INCLUDING GENERAL MEDICINE, SURGERY, PRIMARY CARE, OBSTETRICS, PEDIATRICS, CARDIAC CARE, CANCER CARE, ORTHOPEDICS, NEUROSURGERY, PHYSICAL AND REHABILITATION MEDICINE, AMBULATORY SURGERY, INPATIENT AND OUTPATIENT BEHAVIORAL SERVICES, AND 24-HOUR EMERGENCY CARE. PART VI, LINE 6: THE SYSTEM DEMONSTRATES ITS EXEMPT PURPOSE TO BENEFIT THE COMMUNITY BY OPERATING EMERGENCY ROOMS OPEN TO THE PUBLIC 24 HOURS A DAY, 7 DAYS A WEEK; PROVIDING FACILITIES FOR THE EDUCATION AND TRAINING OF HEALTH CARE PROFESSIONALS; AND MAINTAINING RESEARCH FACILITIES FOR THE STUDY OF NEW DRUGS AND MEDICAL DEVICES THAT OFFER THE PROMISE OF IMPROVING HEALTH CARE. THE SYSTEM ALSO PROVIDES COMMUNITY HEALTH SERVICES, SUCH AS COMMUNITY EDUCATION AND OUTREACH IN THE FORM OF FREE OR LOW-COST CLINICS; HEALTH EDUCATION TELEVISION PROGRAMMING; DONATIONS FOR THE COMMUNITY; MULTIPLE HEALTH PROMOTION AND WELLNESS PROGRAMS, SUCH AS HEALTH SCREENING; AND VARIOUS COMMUNITY PROJECTS AND SUPPORT GROUPS. 1 ARTS & CULTURAL ALLIANCE OF JACKSON COUNTY PO BOX 1463 JACKSON MI 49204 770612012 501(C)(3) 30000 0 N/A ORGANIZATIONAL SUPPORT JACKSON SYMPHONY ORCHESTRA 215 W MICHIGAN AVE JACKSON MI 49201 382146747 501(C)(3) 6480 0 N/A ORGANIZATIONAL SUPPORT ANCHOR INITIATIVE 141 S JACKSON ST JACKSON MI 49201 472475316 501(C)(3) 50000 0 N/A ORGANIZATIONAL SUPPORT ENTERPRISE GROUP 100 E MICHIGAN AVE 1100 JACKSON MI 49201 383326101 501(C)(6) 55000 0 N/A ORGANIZATIONAL SUPPORT JACKSON COMMUNITY FOUNDATION 100 S JACKSON ST SUITE 206B JACKSON MI 49201 386070739 501(C)(3) 10000 0 N/A ORGANIZATIONAL SUPPORT JACKSON SCHOOL OF THE ARTS 634 N MECHANIC JACKSON MI 49202 383581314 501(C)(3) 35000 0 N/A ORGANIZATIONAL SUPPORT AMERICAN HEART ASSOCIATION PO BOX 4002902 DES MOINES IA 50340 135613797 501(C)(3) 50000 0 N/A ORGANIZATIONAL SUPPORT GREATER JACKSON HABITAT FOR HUMANITY 251 W PROSPECT JACKSON MI 49203 383142455 501(C)(3) 50000 0 N/A ORGANIZATIONAL SUPPORT JACKSON YMCA INC 127 W WESLEY STREET JACKSON MI 49201 381381139 501(C)(3) 250000 0 N/A ORGANIZATIONAL SUPPORT CITY OF MASON 201 WEST AVE MASON MI 48854 115 GOVERMENT 25000 0 N/A ORGANIZATIONAL SUPPORT COMMUNITY ACTION AGENCY 1214 GREENWOOD AVENUE JACKSON MI 49203 381803599 501(C)(3) 55921 0 N/A ORGANIZATIONAL SUPPORT COMPASSIONATE MINISTRIES OF JACKSON COUNTY 3905 CLINTON ROAD JACKSON ROAD MI 49201 460811596 501(C)(3) 7500 0 N/A ORGANIZATIONAL SUPPORT GRASS LAKE COMMUNITY SCHOOLS 11500 WARRIOR TRL GRASS LAKE MI 49240 386001844 501(C)(3) 5200 0 N/A ORGANIZATIONAL SUPPORT JACKSON COMMUNITY COLLEGE FOUNDATION 3000 BLAKE ROAD JACKSON MI 49201 382468643 501(C)(3) 7500 0 N/A ORGANIZATIONAL SUPPORT JACKSON DISTRICT LIBRARY 244 W MICHIOGAN AVE JACKSON MI 49201 382184437 115 GOVERMENT 25000 0 N/A ORGANIZATIONAL SUPPORT JACKSON PRIDE CENTER 536 N JACKSON JACKSON MI 49201 824250359 501(C)(3) 27500 0 N/A ORGANIZATIONAL SUPPORT THE PURPLE ROSE THEATRE COMPANY 137 PARK STREET CHELSEA MI 48118 382946466 501(C)(3) 10000 0 N/A ORGANIZATIONAL SUPPORT SAVE OUR YOUTH HELP THEM PROSPER 110 LINCOLN CT JACKSON MI 49203 476554864 501(C)(3) 80000 0 N/A ORGANIZATIONAL SUPPORT JACKSON SYMPHONY GUILD PO BOX 602 JACKSON MI 49204 382380738 501(C)(3) 5200 0 N/A ORGANIZATIONAL SUPPORT 16 3 STAFF ASSISTANCE FUND FOR EMERGENCIES 67 53415 WE CARE PATIENT NEEDS FUND 11 1225 CANCER PATIENT IMMEDICATE NEEDS FUNDS 18 8786 PART I, LINE 2: AWARDS ARE GRANTED BASED ON AN APPLICATION AND REVIEW PROCESS.THE ORGANIZATION SENDS OUT AN AWARD LETTER TO ALL GRANTEE RECIPENTS. THE LETTER OUTLINES WHAT THE FUNDING MAY BE USED FOR AND REQUESTS A FINAL REPORT DETAILING THE YEAR'S ACTIVITIES. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 FRANK LAMARCA MD PHYSICIAN 1055454 0 1208754 0 462771 0 5075 0 28673 0 2760727 0 0 0 AZAM BASHEER MD PHYSICIAN 743817 0 1376119 0 299414 0 5075 0 31116 0 2455541 0 0 0 ROBERT G RINEY TRUSTEE 0 1226507 0 632294 0 316289 0 27649 0 13082 0 2215821 0 0 ADNAN R MUNKARAH MD PHYSICIAN TRUSTEE 0 919134 0 480444 0 24402 0 242905 0 36491 0 1703376 0 0 AMRITRAJ G LOGANATHAN MD PHYSICIAN 738370 0 432555 0 276782 0 4350 0 28051 0 1480108 0 0 0 VISHAL GUPTA MD PHYSICIAN 741100 0 596964 0 95877 0 5075 0 17168 0 1456184 0 0 0 RYAN A BEEKMANMD PHYSICIAN 554613 0 586264 0 98256 0 5075 0 7110 0 1251318 0 0 0 MOHAN G KULKARNI MD PHYSICIAN TRUSTEE 0 436609 0 388534 0 206343 0 6525 0 32927 0 1070938 0 0 PAULA AUTRY TRUSTEE-PRESIDENT & CEO 0 534102 0 232268 0 24402 0 99974 0 26383 0 917129 0 0 MUMTAZ MEMON MD PHYSICIAN TRUSTEE 473026 0 189873 0 69826 0 5075 0 28340 0 766140 0 0 0 LAWRENCE NARKIEWICZMD PHYSICIAN TRUSTEE 385466 0 24600 0 160338 0 5075 0 26655 0 602134 0 0 0 MARK A SMITH MD CMO/CEO HFAHMG 399087 0 123900 0 24853 0 5075 0 33630 0 586545 0 0 0 MICHAEL GRISDELA FORMER INTERIM CENTRAL MAR 0 341460 0 107160 0 23169 0 5075 0 30213 0 507077 0 0 EMILY MOORHEAD COO 278427 0 90272 0 23649 0 4350 0 1455 0 398153 0 0 0 KENNETH W EMPEY GENERAL COUNSEL 0 264311 0 73008 0 19612 0 7975 0 15114 0 380020 0 0 JIM BONGIORNO CENTRAL MARKET CFO, VP FIN 0 203633 0 53550 0 1459 0 16689 0 25482 0 300813 0 0 SANDRA KILIAN MD FORMER PHYSICIAN TRUSTEE 44902 0 43124 0 689 0 1557 0 764 0 91036 0 0 0 PART I, LINE 1A HENRY FORD HEALTH JACKSON HOSPITAL PROVIDES A COUNTRY CLUB MEMBERSHIP TO THREE EXECUTIVES. THE EXECUTIVES REIMBURSE THE HOSPITAL FOR ANY PERSONAL USE OF THE CLUB. THESE BENEFITS DID NOT RESULT IN TAXABLE COMPENSATION DURING FY 21. PART I, LINE 3 THE CHIEF EXECUTIVE OFFICER FOR HENRY FORD HEALTH JACKSON HOSPITAL IS AN EMPLOYEE OF HENRY FORD HEALTH (THE SOLE MEMBER OF HENRY FORD ALLEGIANCE HEALTH GROUP). HENRY FORD HEALTH ("HF HEALTH") HAS A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES CONSISTING OF ALL INDEPENDENT TRUSTEES. THE COMMITTEE MEETS THROUGHOUT THE YEAR AND IS CHARGED WITH THE APPROVAL OF THE ORGANIZATION'S OVERALL COMPENSATION AND BENEFIT PROGRAMS AS WELL AS THE SPECIFIC REVIEW AND APPROVAL OF THE COMPENSATION OF CERTAIN EMPLOYEES INCLUDING THE CHIEF EXECUTIVE OFFICER OF HENRY FORD HEALTH JACKSON HOSPITAL. THE COMMITTEE DIRECTLY ENGAGES AN INDEPENDENT COMPENSATION ADVISOR TO ASSIST WITH THIS PROCESS. THE PROCESS INCLUDES EVALUATION OF THE INDIVIDUAL'S PERFORMANCE, UTILIZATION OF COMPENSATION STUDIES OF SIMILARLY SITUATED POSITIONS AS WELL AS COMPARISONS TO COMPENSATION AS REPORTED BY OTHER HEALTH CARE ORGANIZATIONS. THE REASONABLENESS OF COMPENSATION IS EVALUATED BASED UPON THESE AND OTHER FACTORS. THE CEO IS ACCOUNTABLE FOR ENSURING THAT HENRY FORD HEALTH JACKSON HOSPITAL'S MISSION IS EFFICIENTLY CARRIED OUT WITH THE HIGHEST LEVELS OF QUALITY, SAFETY AND SERVICE, WHILE AT THE SAME TIME ENSURING THAT THE ORGANIZATION IS FINANCIALLY HEALTHY. EXECUTIVE COMPENSATION IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THIS COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT TO ENSURE THAT HENRY FORD HEALTH JACKSON HOSPITAL COMPENSATION PRACTICES ARE CONSISTENT WITH INDUSTRY STANDARDS AND THAT COMPENSATION LEVELS ARE FAIR COMPARED TO SIMILAR HEALTHCARE ORGANIZATIONS NATIONALLY. THE COMPENSATION CONSULTANT BENCHMARKS HENRY FORD HEALTH JACKSON HOSPITAL'S POSITIONS AGAINST DATA FROM MULTIPLE PUBLISHED SURVEYS OF HEALTH CARE EXECUTIVE COMPENSATION IN THE NATIONAL HEALTH CARE LABOR MARKET. BASED UPON THE CONSULTANTS RECOMMENDATIONS, THE EXECUTIVE COMPENSATION COMMITTEE MAKES A RECOMMENDATION TO THE BOARD OF TRUSTEES FOR APPROVAL OF THE EXECUTIVE COMPENSATION PROGRAM. ONLY INDEPENDENT TRUSTEES VOTE ON THIS RECOMMENDATION. PART I, LINE 4B 4B. CERTAIN MEMBERS OF THE ORGANIZATION'S SENIOR LEADERSHIP TEAM PARTICIPATE IN SUPPLEMENTAL RETIREMENT PROGRAMS THAT RESULT IN REPORTABLE TAXABLE INCOME AS THE BENEFITS ACCRUE, AND/OR AS PAID. IT IS AN ELEMENT OF SOME PLAN DESIGNS TO ABSORB THE ADVANCE TAX IMPACT OF THESE PLANS FOR THE PARTICIPANTS. IN SUCH CASES THE RELATED AMOUNTS ARE REPORTED AS TAXABLE INCOME TO THE INDIVIDUAL AND INCLUDED IN THE DETERMINATION OF REASONABLE COMPENSATION. THE FOLLOWING PROVIDES THE REQUIRED LISTING OF THE PARTICIPATING INDIVIDUALS: SEC 457(F) - SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) - HENRY FORD HEALTH SYSTEM PARTICIPANT ACCRUAL DISTRIBUTION NON-VESTED REPORTABLE W-2 ROBERT G. RINEY 289,266 - - 289,266 ADNAN R. MUNKARAH - - 216,706 - PAULA AUTRY - - 94,899 - SEC 457(B)-NON-QUALIFIED DEFERRED COMPENSATION RETIREMENT PLAN - HENRY FORD HEALTH SYSTEM EMPLOYEE EMPLOYER MEDICARE REPORTABLE 2021 CONTR. 2021 CONTR. TAX GROSS-UP W-2 AMOUNTS ROBERT G. RINEY 19,500 - - 19,500 ADNAN R. MUNKARAH 19,500 - - 19,500 VISHAL GUPTA, M.D. 3,400 16,100 387 19,887 PAULA AUTRY 19,500 - - 19,500 MICHAEL GRISDELA 17,148 2,352 57 19,557 KENNETH EMPEY 19,500 - 112 19,612 SEC 457(B)-NON-QUALIFIED DEFERRED COMPENSATION RETIREMENT PLAN - W.A. FOOTE MEMORIAL HOSPITAL EMPLOYEE EMPLOYER MEDICARE REPORTABLE 2021 CONTR. 2021 CONTR. TAX GROSS-UP W-2 AMOUNTS FRANK LAMARCA, M.D. - 19,500 469 19,969 AZAM BASHEER, M.D - 16,100 387 16,487 AMRITRAJ LOGANATHAN, M.D. - 13,800 332 14,132 MOHAN KULKARNI, M.D. 11,625 7,875 190 19,690 RYAN BEEKMAN, M.D. 9,700 9,800 236 19,736 MUMTAZ MEMON, M.D. 12,150 7,350 177 19,677 LAWRENCE NARKIEWICZ, M.D. 15,300 4,200 101 19,601 MARK SMITH, M.D. 19,500 - - 19,500 EMILY MOORHEAD 10,918 - - 10,918 PART I, LINE 7 COLUMN B(II) OF PART II, SCHEDULE J INCLUDES NON-FIXED PAYMENTS TO CERTAIN PHYSICIANS BASED ON THEIR PRODUCTIVITY AND OTHER PERFORMANCE METRICS. PULMONARY CLINICS SEE BELOW 5081061 SEE BELOW 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: PULMONARY CLINICS OF SOUTHERN MI P.C.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: OWNER/BOARD MEMBER(C) AMOUNT OF TRANSACTION $ 5,081,061(D) DESCRIPTION OF TRANSACTION: PROVIDED HEALTH CARE SERVICES(E) SHARING OF ORGANIZATION'S REVENUE? NO FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION IS ORGANIZED ON A MEMBERSHIP BASIS. THE SOLE CORPORATE MEMBER OF THE CORPORATION IS HENRY FORD ALLEGIANCE HEALTH GROUP (FORMERLY ALLEGIANCE HEALTH SERVICES). FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE ORGANIZATION MAY ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE CORPORATION'S TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE CORPORATE MEMBER OF THE CORPORATION IS HENRY FORD ALLEGIANCE HEALTH GROUP ("MEMBER"). THE MEMBER'S SOLE CORPORATE MEMBER IS HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH"). HF HEALTH SHALL HAVE THE SOLE AUTHORITY TO TAKE OR CAUSE TO BE TAKEN ANY OF THE FOLLOWING ACTIONS (THE "HF HEALTH'S RESERVED POWERS"). - APPOINT THE BOARD OF TRUSTEES, CHAIRPERSON, AND PRESIDENT OF THE CORPORATION AND THE OTHER SYSTEM ENTITIES - REMOVE THE BOARD OF TRUSTEES, CHAIRPERSON AND PRESIDENT OF THE CORPORATION AND THE OTHER SYSTEM ENTITIES - CHANGE THE CORPORATE MEMBER OF THE CORPORATION OR ANY SYSTEM ENTITY, PROVIDED SUCH ACTION SHALL HAVE BEEN APPROVED BY A VOTE OF THE MEMBER'S BOARD OF DIRECTORS; - AMEND THESE BYLAWS, THE CORPORATION'S ARTICLES OF INCORPORATION OR THE GOVERNING DOCUMENTS OF ANY SYSTEM ENTITY, PROVIDED (I) HF HEALTH FIRST CONSULTS WITH THE MEMBER'S BOARD OF DIRECTORS REGARDING THE PROPOSED AMENDMENT AND (II) THE AMENDMENT COMPLIES WITH ARTICLE XV OF THE BYLAWS REGARDING KEY SECTIONS; - APPROVE AN AGREEMENT OF (A) MERGER OR CONSOLIDATION OF THE CORPORATION OR ANY SYSTEM ENTITY, OR (B) SALE, LEASE, OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR ANY SYSTEM ENTITY, PROVIDED SUCH AGREEMENT SHALL HAVE BEEN APPROVED BY VOTE OF TWO-THIRDS OF THE MEMBER'S LOCAL DIRECTORS (AS DEFINED IN THE MEMBER'S BYLAWS) AND FURTHER PROVIDED THAT APPROVAL OF THE LOCAL DIRECTORS SHALL NOT BE REQUIRED WITH RESPECT TO (I) AN OVERALL AFFILIATION OR CHANGE IN OWNERSHIP OF HF HEALTH (INCLUDING THE SYSTEM) IF THE TERMS OF THAT TRANSACTION DO NOT VIOLATE THE KEY SECTIONS OR (II) A SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF HF HEALTH (INCLUDING THE ASSETS OF THE CORPORATION) TO A FOR-PROFIT ENTITY WHICH TRIGGERS APPLICATION OF THE TERMS OF SECTION 6.8(B) OF THE AFFILIATION AGREEMENT DATED MARCH 4, 2016 BETWEEN THE MEMBER (THEN KNOWN AS ALLEGIANCE HEALTH SERVICES) AND HF HEALTH, AS AMENDED FROM TIME TO TIME; - DISSOLVE THE CORPORATION OR ANY SYSTEM ENTITY OR REVOKE SUCH DISSOLUTION, PROVIDED SUCH ACTION SHALL HAVE BEEN APPROVED BY A VOTE OF THE MEMBER'S BOARD OF DIRECTORS; - RECEIVE FROM THE MEMBER STRATEGIC AND ANNUAL OPERATING PLANS AND ANNUAL OPERATING AND CAPITAL BUDGETS FOR THE SYSTEM ENTITIES, INCLUDING THE CORPORATION, THAT ARE DEVELOPED COLLABORATIVELY BY THE MEMBER'S AND HF HEALTH'S RESPECTIVE LEADERSHIP AND RECOMMENDED BY THE MEMBER'S BOARD OF DIRECTORS, AND ADOPT SUCH RECOMMENDED PLANS AND BUDGETS UNLESS AN UNUSUAL CIRCUMSTANCE ARISES IN WHICH HF HEALTH DETERMINES A CHANGE TO A PLAN OR BUDGET IS NECESSARY, AND APPROVE EXPENDITURES BY THE SYSTEM ENTITIES NOT INCLUDED IN SUCH BUDGETS OF AN ANNUAL AGGREGATE AMOUNT EXCEEDING $500,000. - CAUSE ANY SYSTEM ENTITY TO INCUR, ASSUME OR GUARANTY INDEBTEDNESS OR FULFILL OTHER OBLIGATIONS REQUIRED UNDER HF HEALTH DEBT AGREEMENTS, OR APPROVE INDEBTEDNESS OF THE SYSTEM ENTITIES IN AN ANNUAL AGGREGATE AMOUNT EXCEEDING $2,000,000 PROVIDED ALL INDEBTEDNESS SHALL COMPLY WITH HF HEALTH'S MASTER INDENTURE AND OTHER HF HEALTH CREDIT DOCUMENTS. - ENCUMBER THE ASSETS OF ANY SYSTEM ENTITY AS SECURITY FOR DEBTS OR OTHER LAWFUL ENGAGEMENTS SECURING INDEBTEDNESS, OR APPROVE ENCUMBRANCES SECURING INDEBTEDNESS OF THE SYSTEM ENTITIES IN AN ANNUAL AGGREGATE AMOUNT EXCEEDING $2,000,000 PROVIDED ALL ENCUMBRANCES SHALL COMPLY WITH HF HEALTH'S MASTER INDENTURE AND OTHER HF HEALTH CREDIT DOCUMENTS. - EXCHANGE, ABANDON OR DISPOSE OF FIXED ASSETS OF ANY SYSTEM ENTITY BY MEANS OF SALE, LEASE OR TRANSFER, AND APPROVE ALL SUCH ACTIONS PROPOSED BY THE SYSTEM ENTITIES WITH AN ANNUAL AGGREGATE VALUE IN EXCESS OF $2,000,000, PROVIDED SUCH ACTION SHALL HAVE BEEN APPROVED BY A VOTE OF THE MEMBER'S BOARD OF DIRECTORS. - AUTHORIZE THE FORMATION OR ACQUISITION OF NEW SUBSIDIARIES OF THE CORPORATION FOLLOWING CONSULTATION WITH THE MEMBER'S BOARD OF DIRECTORS. AS USED HEREIN, "INDEBTEDNESS" OF A PERSON SHALL MEAN: (A) OBLIGATIONS OF SUCH PERSON RELATING TO INDEBTEDNESS FOR BORROWED MONEY; (B) OBLIGATIONS OF SUCH PERSON EVIDENCED BY BONDS, NOTES, DEBENTURES OR SIMILAR INSTRUMENTS; AND (C) OBLIGATIONS IN THE NATURE OF GUARANTEES BY, OR JOINT AND SEVERAL LIABILITY OF, SUCH PERSON WITH RESPECT TO THE OBLIGATIONS OF ANY OTHER PERSON OF THE TYPE DESCRIBED IN CLAUSES (A) AND (B) ABOVE. RESPONSIBILITIES AND RESERVED POWERS OF THE MEMBER (HENRY FORD ALLEGIANCE HEALTH GROUP): IN ADDITION TO DOING ALL THINGS RESERVED TO THE MEMBER BY LAW AND WHICH ARE CONSISTENT WITH HF HEALTH'S RESERVED POWERS, THE MEMBER OF THE CORPORATION SHALL TAKE THE FOLLOWING ACTIONS WITH RESPECT TO THIS CORPORATION ("MEMBER'S RESERVED POWERS"): - ADOPT THE VISION, MISSION AND VALUES; AND - RATIFY OR REJECT OPERATING AND CAPITAL BUDGETS RECOMMENDED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH ("HF HEALTH") AND THE TAX DEPARTMENT OF HF HEALTH PREPARES THE ORGANIZATION'S FORM 990. AS PART OF THE PREPARATION AND REVIEW PROCESS PRIOR TO FILING THE RETURN, THE FOLLOWING REVIEW PROCESS IS CONDUCTED: - REVIEWED BY THE ORGANIZATION'S DIRECTOR AND VP OF FINANCE, CHIEF EXECUTIVE OFFICER, GENERAL COUNSEL, AND COMPLIANCE OFFICER. - REVIEW OF THE ENTIRE RETURN WITH THE HF HEALTH AND ORGANIZATION'S SENIOR VICE PRESIDENT FINANCIAL OPERATIONS AND CHIEF FINANCIAL OFFICER, - REVIEW OF ALL COMPENSATION MATTERS AND DISCLOSURES WITH THE COMPENSATION COMMITTEE OF THE HF HEALTH BOARD OF DIRECTORS - REVIEW OF THE RETURN WITH THE HF HEALTH CEO AND AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS - FINAL COPIES OF THE RETURN ARE DISTRIBUTED TO THE HOSPITAL'S BOARD OF TRUSTEES BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH (HF HEALTH) WHO OVERSEES THE CONFLICT OF INTEREST PROCESS WITH REGARD TO THE ORGANIZATION. HF HEALTH HAS A STANDING CONFLICT OF INTEREST COMMITTEE (THE COMMITTEE) THAT IS RESPONSIBLE FOR OVERSIGHT OF ALL CONFLICT OF INTEREST MATTERS. THE HF HEALTH CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS AND EMPLOYEES. ANNUALLY, DIRECTORS, EMPLOYEES OF A MANAGEMENT LEVEL, RESEARCHERS, AS WELL AS EMPLOYEES ASSOCIATED WITH PROCUREMENT, OR IN CERTAIN OTHER PREDEFINED ROLES MUST COMPLETE AN ANNUAL DISCLOSURE DESIGNED TO IDENTIFY ACTIVITIES AND RELATIONSHIPS THAT COULD POTENTIALLY GIVE RISE TO A CONFLICT OF INTEREST. IT IS THE RESPONSIBILITY OF THE COMMITTEE TO REVIEW THESE DISCLOSURES AND DETERMINE THE NEED FOR ANY ACTION TO MANAGE THE POTENTIAL CONFLICT. THE COMMITTEE ANNUALLY REPORTS THE RESULTS OF ITS ACTIVITIES TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE HF HEALTH BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH (HF HEALTH) WHO HAS RESPONSIBILITY TO OVERSEE THE COMPENSATION PRACTICES OF THE ORGANIZATION. HF HEALTH HAS A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS CONSISTING OF ALL EXTERNAL DIRECTORS. THEY MEET PERIODICALLY THROUGHOUT THE YEAR. THEY ARE CHARGED WITH APPROVAL OF THE ORGANIZATION'S OVERALL COMPENSATION AND BENEFIT PROGRAMS AS WELL AS THE SPECIFIC REVIEW AND APPROVAL OF THE COMPENSATION OF CERTAIN EMPLOYEES INCLUDING THE CHIEF EXECUTIVE OFFICER, ALL OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THEY DIRECTLY ENGAGE AN INDEPENDENT COMPENSATION ADVISOR TO ASSIST WITH THIS PROCESS. THE PROCESS INCLUDES EVALUATION OF THE INDIVIDUAL'S PERFORMANCE, UTILIZATION OF COMPENSATION STUDIES OF SIMILARLY SITUATED POSITIONS, AS WELL AS COMPARISONS TO COMPENSATION AS REPORTED BY OTHER HEALTH CARE ORGANIZATIONS. THE REASONABLENESS OF COMPENSATION IS EVALUATED BASED UPON THESE AND OTHER FACTORS. THE COMMITTEE ALSO REVIEWS THE COMPENSATION DISCLOSURES TO BE MADE ON FORM 990 IN ADVANCE OF FILING. FORM 990, PART VI, SECTION C, LINE 19 IT IS THE PRACTICE OF THE ORGANIZATION TO MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO ANY PARTY REQUESTING SUCH INFORMATION. AS A HOLDER OF TAX EXEMPT DEBT THE FINANCIAL STATEMENTS OF THE ORGANIZATION ARE MADE AVAILABLE TO A PUBLIC CLEARING HOUSE ON A QUARTERLY BASIS. PART IV, LINE 12 THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT OBTAINED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH. FORM 990, PART IV, LINE 24A, TAX-EXEMPT BOND ISSUE: THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM DBA HENRY FORD HEALTH. THE ALLOCATED TAX-EXEMPT BOND LIABILITY OF THE ORGANIZATION IS REPORTED UNDER THE FORM 990, SCHEDULE K OF ITS PARENT, HENRY FORD HEALTH. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT 12,161,331. FORM 990, PART XII, LINE 2C HENRY FORD HEALTH JACKSON HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF HENRY FORD HEALTH (THE SOLE MEMBER OF HENRY FORD ALLEGIANCE HEALTH GROUP). THE GOVERNING BODY OF HENRY FORD HEALTH HAS DELEGATED THE OVERSIGHT OF ITS FINANCIAL STATEMENTS, INCLUDING THE CHOICE OF INDEPENDENT AUDITORS, TO ITS AUDIT COMMITTEE. FORM 990, PART VII: AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: MANY EXECUTIVE EMPLOYEES OF HENRY FORD HEALTH AND AFFILIATES PROVIDE SERVICES TO MULTIPLE AFFILIATED ENTITIES. HENRY FORD HEALTH AND AFFILIATES USE ESTIMATES FOR REPORTING AVERAGE HOURS PER WEEK IN ALL SECTIONS OF FORM 990. GENERALLY 60 HOURS ARE REPORTED FOR THE HOURS ASSOCIATED FOR THE ORGANIZATION THAT THE INDIVIDUAL HAS PRINCIPAL RESPONSIBILITY FOR. HOURS ASSOCIATED WITH OTHER HOSPITALS OR AFFILIATES ARE REPORTED AT BETWEEN 1 TO 5 HOURS PER WEEK. FORM 990 DIVERSITY, EQUITY AND INCLUSION: HENRY FORD HEALTH IS COMMITTED TO ADDRESSING SYSTEMIC RACIAL, ECONOMIC, AND CLINICAL BARRIERS THAT INFLUENCE SOCIAL DETERMINANTS OF HEALTH, WORKFORCE CULTURE, AND COMMUNITY WEALTH BUILDING. IN SEPTEMBER 2021, HENRY FORD HEALTH'S FIVE-YEAR DIVERSITY, EQUITY, INCLUSION, AND SOCIAL JUSTICE PLAN WAS APPROVED BY THE HENRY FORD HEALTH BOARD OF DIRECTORS. WITH A MISSION OF "EQUITY FOR ALL," THE PLAN IS COMPRISED OF FOUR PILLARS WITH TARGETED STRATEGIC OUTCOMES AND SUPPORTING MACRO-TACTICS TO DRIVE MEASURABLE RESULTS WITHIN THE COMMUNITIES THAT HENRY FORD HEALTH SERVES. HENRY FORD HEALTH HAS ADOPTED A ZERO-TOLERANCE STANCE FOR UNJUST SOCIAL PRACTICES THAT THREATEN THE EQUITABLE TREATMENT OF ITS PATIENTS, MEMBERS, AND VISITORS. HENRY FORD HEALTH IS ACTIVELY ENGAGED IN SOCIAL JUSTICE ADVOCACY EFFORTS AT THE NATIONAL, STATE, AND LOCAL LEVEL. SELECT STRATEGIC OUTCOMES MAY INCLUDE VOTER ACCESS AND PARTICIPATION AT THE NATIONAL, STATE, AND LOCAL LEVELS; IMPLICIT BIAS TRAINING; BEHAVIORAL HEALTH SERVICES IN HENRY FORD HEALTH'S SCHOOL-BASED PROGRAMS; AND ADVOCACY FOR THE ADOPTION OF "BAN THE BOX" BY OTHER HEALTH CARE ORGANIZATIONS IN HENRY FORD HEALTH MARKET. HENRY FORD HEALTH STRIVES TO CREATE AN INTENTIONAL CULTURE OF BELONGING, GROWTH, EDUCATION, AND LEARNING AND IS RECOGNIZED FOR DIVERSE AND INCLUSIVE WORKFORCE PRACTICES AND A LEADERSHIP AND GOVERNANCE MODEL THAT REFLECTS THE DIVERSITY OF ITS MEMBERS, PATIENTS, AND EMPLOYEES. HENRY FORD HEALTH HAS ESTABLISHED GOALS FOCUSED ON MAINTAINING RETENTION RATES OF UNDER-REPRESENTED MINORITY TALENT ACROSS THE ORGANIZATION AND IN LEADERSHIP. HENRY FORD HEALTH SEEKS TO FOSTER AWARENESS THROUGH LEADERSHIP TRAINING SESSIONS THAT FOCUS ON INCLUSIVE CULTURE AND ELIMINATING UNCONSCIOUS BIAS. HENRY FORD HEALTH FOCUSES ON IDENTIFYING ROOT CAUSES OF HEALTH DISPARITIES AND ALIGNING SUPPORT FOR COMMUNITY RESOURCES TO ADDRESS THEM AND ADVOCATE FOR PROGRAMS THAT PROMOTE HEALTHY CHOICES. RECOGNIZING THE IMPACT OF DISCRIMINATION AND DISINVESTMENT ON COMMUNITY WEALTH BUILDING AND SUSTAINABILITY, THIS PILLAR ALSO ADVOCATES FOR RESOURCES THAT PROMOTE MOBILITY, ACCESS, OPPORTUNITY, AND HEALTH, WHILE LEVERAGING HENRY FORD HEALTH'S PURCHASING POWER TO GENERATE ECONOMIC OPPORTUNITIES FOR DIVERSE AND WOMEN-OWNED BUSINESSES. AS A PROVEN LEADER IN ELIMINATING HEALTHCARE DISPARITIES, HENRY FORD HEALTH PROVIDES PATIENTS WITH ACCESS TO TOOLS SUCH AS SCREENINGS AND RESOURCE MAPPING THAT ADDRESS SOCIAL NEEDS WHILE OVERCOMING SOCIOECONOMIC BARRIERS THAT CONTRIBUTE TO HEALTH DISPARITIES. HENRY FORD HEALTH DEVELOPS BEST PRACTICES IN RESEARCH AND EDUCATION THAT PROVIDES KNOWLEDGE AND INSIGHT ON HENRY FORD HEALTH ROOTS OF INEQUITIES AND CREATE OPPORTUNITIES FOR DIVERSE INNOVATION AND RESEARCH. FORM 990 SUSTAINABILITY: ENVIRONMENTAL FACTORS IMPACT COMMUNITY HEALTH AND HENRY FORD HEALTH RECOGNIZES THAT AS A COMMUNITY PARTNER WE CAN INFLUENCE MANY OF THESE FACTORS. OUR SUSTAINABILITY GOALS ARE INTENDED TO SIMULTANEOUSLY REDUCE GREENHOUSE GAS EMISSIONS, REDRESS ENVIRONMENTAL INJUSTICES, AND IMPROVE THE HEALTH OF THE PATIENTS, EMPLOYEES, AND COMMUNITIES WE SERVE. HENRY FORD HEALTH HAS ESTABLISHED THE FOLLOWING SUSTAINABILITY GOALS TO BE ACHIEVED BY 2030: REDUCE GREENHOUSE GAS EMISSIONS FROM OPERATIONS BY 50%, NET-ZERO BY 2040 ELIMINATE CHEMICALS OF CONCERN FROM PRIORITY PRODUCTS REDUCE WASTE SENT TO LANDFILL BY 50% 30% OF FOOD PURCHASED WILL MEET LOCAL OR SUSTAINABLE CRITERIA INCREASE ANNUAL INVESTMENT IN GREEN AND HEALTHY INFRASTRUCTURE FORM 5713 - INTERNATIONAL BOYCOTT ACTIVITY: A FORM 5713, INTERNATIONAL BOYCOTT REPORT, HAS BEEN FILED ON OUR BEHALF BY HENRY FORD HEALTH (SOLE MEMBER OF HENRY FORD ALLEGIANCE HEALTH GROUP). HENRY FORD HEALTH JACKSON HOSPITAL DID NOT ITSELF HAVE ANY ACTIVITIES ASSOCIATED WITH AN INTERNATIONAL BOYCOTT COUNTRY. PHYSICIANS CHOICE NETWORK LLC 205 N EAST AVENUE JACKSON MI 49201 PROVIDER NETWORK MI 0 0 HENRY FORD ALLEGIANCE HEALTH JACKSON HEALTH NETWORK L3C 205 N EAST AVENUE JACKSON MI 49201 453253643 CLINICALLY INTEGRATED NETWORK MI 3399339 4440046 HENRY FORD ALLEGIANCE HEALTH IT'S YOUR LIFE SERVICES LLC 205 N EAST AVENUE JACKSON MI 49201 PREVENTION AND COMMUNITY HEALTH MI 0 0 HENRY FORD ALLEGIANCE HEALTH HENRY FORD ALLEGIANCE HEALTH GROUP 205 N EAST AVENUE JACKSON MI 49201 382756428 EXEMPT ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD HEALTH SYSTEM 1 ALLEGIANCE HEALTH FOUNDATION 205 N EAST AVENUE JACKSON MI 49201 383607833 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD ALLEGIANCE HEALTH GROUP 1 HOSPICE OF JACKSON DBA ALLEGIANCE HOSPICE 205 N EAST AVENUE JACKSON MI 49201 382336367 HOSPICE CARE MI 501(C)(3) LINE 7 HEATHLINK 1 HEALTHLINK 205 N EAST AVENUE JACKSON MI 49201 382756425 HOME HEALTH CARE MI 501(C)(3) LINE 12A, I HENRY FORD ALLEGIANCE HEALTH GROUP 1 CARELINK OF JACKSON 110 NORTH ELM AVENUE JACKSON MI 49202 381218485 LONG TERM ACUTE CARE HOSPITAL MI 501(C)(3) LINE 3 HENRY FORD ALLEGIANCE HEALTH GROUP 1 HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT MI 48202 381357020 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 N/A 0 HENRY FORD WYANDOTTE HOSPITAL 2333 BIDDLE AVE WYANDOTTE MI 48192 382791823 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 HENRY FORD HEALTH SYSTEM 1 HENRY FORD HEALTH SYSTEM FOUNDATION ONE FORD PLACE DETROIT MI 48202 237383042 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I HENRY FORD HEALTH SYSTEM 1 HEALTH ALLIANCE PLAN 2850 W GRAND BLVD DETROIT MI 48202 382242827 HEALTH MAINTENANCE ORGANIZATION MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 HFII CORPORATION ONE FORD PLACE DETROIT MI 48202 900840304 SCIENTIFIC RESEARCH MI 501(C)(3) LINE 7 HENRY FORD HEALTH SYSTEM 1 HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES ONE FORD PLACE DETROIT MI 48202 464064067 ADVOCACY SERVICES FOR HF HEALTH AND AFFILIATES ME 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 HENRY FORD MACOMB HOSPITAL CORPORATION ONE FORD PLACE DETROIT MI 48202 382947657 HEALTHCARE SERVICE PROVIDER DE 501(C)(3) LINE 3 HENRY FORD HEALTH SYSTEM 1 THE CLARENCE S LIVINGOOD LECTURESHIP AND EDUCATION FUND 3031 WEST GRAND BOULEVARD NO 800 DETROIT MI 48202 382682321 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD HEALTH SYSTEM 1 HENRY FORD PHYSICIAN PARTNERS ONE FORD PLACE DETROIT MI 48202 871633901 PHYSICIAN SERVICES MI 501(C)(3) HENRY FORD HEALTH SYSTEM 1 FOOTE HEALTH CENTER ASSOCIATES 1100 E MICHIGAN AVENUE JACKSON MI 49201 383017711 LESSOR OF MEDICAL CONDOMINIUMS MI HENRY FORD ALLEGIANCE HEALTH RELATED 838170 917736 0 0 0.86370 NORTHWEST DETROIT DIALYSIS 30100 TELEGRAPH BINGHAM FARMS MI 48025 383232668 OPERATE DIALYSIS CLINIC MI HENRY FORD HEALTH SYSTEM RELATED 0 0 MACOMB REGIONAL DIALYSIS CENTERS 16151 NINETEEN MILE RD CLINTON TOWNSHIP MI 48038 260423581 OPERATE DIALYSIS CLINIC MI HENRY FORD HEALTH SYSTEM RELATED 0 0 HENRY FORD ALLEGIANCE PHARMACY 205 N EAST AVENUE JACKSON MI 49201 383370242 PHARMACY MI HENRY FORD ALLEGIANCE HEALTH GROUP C 1 SHA REALTY INC ONE FORD PLACE DETROIT MI 48202 381378121 REAL ESTATE HOLDING MI HENRY FORD HEALTH SYSTEM FOUNDATION C 1 FAIRLANE HEALTH SERVICES 30100 TELEGRAPH BINGHAM FARMS MI 48025 382565235 HEALTHCARE MANAGEMENT MI HENRY FORD HEALTH SYSTEM C 1 ALLIANCE HEALTH AND LIFE INSURNACE 2850 W GRAND BLVD DETROIT MI 48202 383291563 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HAP PREFERRED INC 2850 W GRAND BLVD DETROIT MI 48202 382513504 PROVIDER NETWORK LEASING MI HEALTH ALLIANCE PLAN C 1 ONIKA INSURANCE LTD FIRST CARRIBEAN HOUSE GRAND CAYMAN CJ CAPTIVE INSURANCE CJ HENRY FORD HEALTH SYSTEM C 1 HENRY FORD PHYSICIAN NETWORK ONE FORD PLACE DETROIT MI 48202 320306774 PHYSICIAN NETWORK MI HENRY FORD HEALTH SYSTEM C 1 ADMINSTRATION SYSTEMS RESEARCH CORPORATION 2850 W GRAND BLVD DETROIT MI 48202 382651185 THIRD PARTY INSURANCE ADMIN. MI HEALTH ALLIANCE PLAN C 1 HAP EMPOWERED HEALTH PLAN INC 2850 W GRAND BLVD DETROIT MI 48202 383123777 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HENRY FORD ELIJAH MCCOY CONDOMINIUM ASSOCIATION 1150 ELIJAH MCCOY DR DETROIT MI 48202 852144748 CONDOMINIUM ASSOCIATION MI HENRY FORD HEALTH SYSTEM C 1 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 1 0 1 ALLIANCE HEALTH AND LIFE INSURANCE CO M 3067255 COST HENRY FORD ALLEGIANCE PHARMACY Q 482091 COST JACKSON HEALTH NETWORK L3C Q 16840935 COST COMMUNITY HEALTH TECH NETWORK Q 1314295 COST ONIKA INSURANCE LTD P 2579011 COST ONIKA INSURANCE LTD Q 145667 COST FOOTE HEALTH CENTER ASSOCIATES M 68153 COST HEALTH ALLIANCE PLAN L 5990648 COST FOOTE HEALTH CENTER ASSOCIATES K 836727 COST HENRY FORD ALLEGIANCE HEALTH FOUNDATION S 166856 COST SCHEDULE R, PART V, LINE 1D & 1E: THE ORGANIZATION IS A MEMBER OF THE HENRY FORD HEALTH SYSTEM OBLIGATED GROUP. MEMBERS OF THE OBLIGATED GROUP ARE JOINTLY AND SEVERALLY LIABLE FOR OUTSTANDING OBLIGATIONS ISSUED UNDER THE 2016 AND 2019 HFHS BOND MASTER INDENTURES.