2021-08-11T10:17:51-05:00 2020-09-30 381357951 PLANTE & MORAN PLLC 3000 TOWN CENTER SUITE 100 SOUTHFIELD MI 48075 990 2019-10-01 383426063 CARO COMMUNITY HOSPITAL CARO 9896733141 401 N HOOPER STREET PO BOX 435 CARO MI 48723 DANIELLE JACKS-PORTER CFO 9896733141 2021-08-06 1 AMY CIMINELLO P00796388 2483522500 2021-08-06 2019 2022-09-23 18:48:47Z MCLAREN CARO REGION DANIELLE JACKS-PORTER 401 N HOOPER STREET PO BOX 435 CARO MI 48723 17130414 0 X WWW.MCLAREN.ORG/CARO-REGION/MCLAREN-CARO-REGION-H X 1999 MI CARO COMMUNITY HOSPITAL, A COMMUNITY-MINDED HEALTHCARE SYSTEM, IS DEDICATED TO PROVIDING COMPASSIONATE CARE AND SERVICES TO ENHANCE THE HEALTH OF ALL THE PATIENTS WE SERVE. 9 7 147 30 0 0 0 3512063 17206413 13535453 7011 14809 190916 68089 17404340 17130414 0 0 0 0 8509014 8137242 0 0 6928 7986068 8666400 16495082 16803642 909258 326772 9137345 13338857 4024767 7921418 5112578 5417439 CARO COMMUNITY HOSPITAL, A COMMUNITY-MINDED HEALTHCARE SYSTEM, IS DEDICATED TO PROVIDING COMPASSIONATE CARE AND SERVICES TO ENHANCE THE HEALTH OF ALL THE PATIENTS WE SERVE. 0 0 10573577 13571913 PROVISION OF NEEDED MEDICAL SERVICES TO THE COMMUNITY. 10573577 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 13 0 1 147 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 MI X X STEPHANIE REMLEY DIRECTOR OF FINAN 9896733141 401 N HOOPER STREET PO BOX 435 CARO MI 48723 CLARENCE SEVILLIAN TRUSTEE, BAY PRESIDENT/CEO 0.10 49.90 X 0 918356 32023 MICHAEL JOHNSTON PRESIDENT AND CEO 25.00 25.00 X X 0 287765 87244 MARC AUGSBURGER PRESIDENT AND CEO - PART YEAR 40.00 4.00 X X 0 266088 84937 STEPHANIE REMLEY DIRECTOR OF FINANCE 40.00 1.00 X 154211 0 0 TERESA MCDONALD NURSE PRACTITIONER 40.00 0.00 X 144810 0 0 LINDA LAFOREST NURSE PRACTITIONER 40.00 0.00 X 117800 0 0 GARY RAYMOND PHYSICAL THERAPIST 40.00 0.00 X 103104 0 0 DAN BRISTOL CHAIRMAN 0.10 0.00 X X 0 0 0 RAYMOND BATES VICE CHAIRMAN 0.10 0.00 X X 0 0 0 JOHN HUNTER SECRETARY 0.10 0.00 X X 0 0 0 ROBERT WOLAK TREASURER 0.10 0.00 X X 0 0 0 LISA COOK TRUSTEE 0.10 0.00 X 0 0 0 LAINEY RANSFORD TRUSTEE 0.10 0.00 X 0 0 0 BRANT WILSON TRUSTEE 0.10 0.00 X 0 0 0 519925 1472209 204204 4 0 1 0 AMERICAN PHYSICIAN PARTNERS 5121 MARYLAND WAY SUITE 300 BRENTWOOD TN 37027 ER PHYSICIANS 1141667 PSYCHIATRIC MEDICAL CARE LLC DBA SENIOR 4322 HARDING PIKE 417 NASHVILLE TN 37205 PSYCH SERVICES / STAFF 410969 AHSA PO BOX 670529 DALLAS TX 752670529 AGENCY NURSING 208773 ASA STAFFING 1000 W UNIVERSITY DRIVE SUITE 100 ROCHESTER MI 48307 CRNA 138910 4 36950 3475113 3512063 NET PATIENT SERVICE REVENUE 621400 13535453 13535453 13535453 14809 14809 36460 0 36460 36460 36460 CAFETERIA SALES 900099 15081 15081 GIFT SHOP REVENUE 900099 11809 11809 MISCELLANEOUS BILLING REVENUE 900099 4739 4739 31629 17130414 13571913 0 46438 X 106332 66342 39929 61 6460375 4030733 2425935 3707 149880 128091 21452 337 1039142 589060 447795 2287 381513 250913 130401 199 5818 5818 375 375 3953452 2601519 1351933 43911 43911 163893 78229 85327 337 687546 687546 61574 26160 35414 58023 14911 43112 40815 24497 16318 695543 417494 278049 140638 101736 38902 MEDICAL SUPPLIES 1360543 1121521 239022 BAD DEBT EXPENSE 558829 558829 STATE OF MICHIGAN QAAP 395129 395129 UTILITIES 213962 31360 182602 286349 136678 149671 16803642 10573577 6223137 6928 1423261 4298994 1982508 2644785 324139 305792 58126 91617 7348713 2010558 4671716 5338155 677595 659514 9137345 13338857 502819 748259 0 2514069 342353 301643 1085497 689516 2094098 3667931 4024767 7921418 X 4434983 5417439 677595 0 5112578 5417439 9137345 13338857 X 326772 -18081 -3830 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 375 375 0 PART II-B, LINE 1: A PORTION OF OUR DUES TO MICHIGAN HEALTH AND HOSPITAL ASSOCIATION SUPPORT LOBBYING ACTIVITIES. 150625 150625 3209700 472754 2736946 3988388 1537804 2450584 5338155 ACCRUED LIABILITIES 1206754 ESTIMATED THIRD-PARTY SETTLEMENTS 1781537 LIABILITY RESERVES 633215 OTHER LIABILITIES 46425 3667931 1 1 X 1 X 1 X 1 1 0 1 1 34162 34162 0.00210 3711054 3052797 658257 0.04050 3745216 3052797 692419 0.04260 3745216 3052797 692419 0.04260 290 47845 31701 16144 0.00100 290 47845 31701 16144 0.00100 558829 152729 4265388 4356447 -91059 X 1 1 1 1 CARO COMMUNITY HOSPITAL 401 N HOOPER ST PO BOX 43 CARO MI 48723 WWW.CCH-MI.ORG 1060000166 X X X X X CARO COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X HTTPS://TINYURL.COM/YAWXCYL4 X 1 18 1 HTTPS://TINYURL.COM/YAWXCYL4 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X HTTPS://TINYURL.COM/YYA9C5OC X HTTPS://TINYURL.COM/YYA9C5OC X HTTPS://TINYURL.COM/YYA9C5OC X X X X X X 1 X 0 X X X X 1 X 0 0 CARO COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: PARTICIPANTS INCLUDED CCH BOARD MEMBERS, CCH STAFF INCLUDING CLINICAL AND ADMINISTRATIVE PERSONS, THE OWNER OF A LOCAL FREE HEALTH CLINIC, TUSCOLA COUNTY HEALTH DEPT, MICHIGAN STATE UNIVERSITY EXTENSION, TUSCOLA INTERMEDIATE SCHOOL DISTRICT, GREAT START COLLABORATIVE, HOSPICE AND HOME HEALTH CARE EMPLOYEES, A LOCAL MEDICAL SUPPLY COMPANY, LOCAL MRI SERVICE, A LOCAL MINISTER, SENIOR CITIZENS, AND COMMUNITY MEMBERS.THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN CAN BE FOUND ON THE ORGANIZATION'S WEBSITE AT HTTPS://WWW.MCLAREN.ORG/MAIN/COMMUNITY-HEALTH-NEEDS-ASSESSMENT CARO COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE ORGANIZATION HAS PRIORITIZED THE SIGNIFICANT COMMUNITY HEALTH NEEDS AND IDENTIFIED THE FOLLOWING FOUR PRIORITIES TO FOCUS ITS EFFORTS ON:ACCESS TO CARESPECIALTY SERVICESHEALTH INSURANCE & HEALTHCARE COSTSRECRUITMENT & RETENTIONTHE ORGANIZATION HAS FOCUSED ITS EFFORTS ON THOSE NEEDS THAT IT CAN IMPACT THE MOST. THE HOSPITAL DID NOT ADDRESS ALL THE NEEDS IDENTIFIED DUE TO ALLOCATING SIGNIFICANT RESOURCES TO THE PRIORITY NEEDS IDENTIFIED. CARO COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: PRESUMPTIVE FINANCIAL ASSISTANCE MAY BE APPLIED BASED ON THIRD PARTY INFORMATION OR A PRIOR FINANCIAL ASSISTANCE DETERMINATION. DESIGNATED PERSONNEL WILL MAKE REASONABLE EFFORT TO NOTIFY THE INDIVIDUAL OF ASSISTANCE. PART I, LINE 3C: INCOME CRITERIA IS BASED UPON 200% OF THE FEDERAL POVERTY GUIDELINES PER THE FEDERAL REGISTER. COLLECTIONS MAY BE CONSIDERED IF THE PATIENT HAS SUFFICIENT LIQUID ASSETS. PART I, LINE 6A: OUR PARENT, MCLAREN HEALTH CARE CORPORATION, PREPARES AN ANNUAL REPORT OF ITS MEMBER HOSPITALS. THIS ANNUAL REPORT IS AVAILABLE ON OUR WEBSITE. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN LINES 7 (A)-(D) IS BASED ON THE COST-TO-CHARGE RATIOS. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24E - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $558,829 PART III, LINE 2: THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 3: THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO INDIVIDUALS THAT MAY QUALIFY FOR CHARITY CARE WAS CALCULATED BASED UPON THE AMOUNT OF SELF PAY EMERGENCY ROOM PATIENT CHARGES TIMES 33%, WHICH IS THE AMOUNT THAT PATIENTS WOULD QUALIFY FOR A DISCOUNT. THE BALANCE OF THE PATIENT ACCOUNTS WOULD THEN BE SUBJECTED TO CHARITY CARE GUIDELINES OF EARNINGS OF 200% OR LESS OF THE FEDERAL POVERTY GUIDELINES. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF THE CORPORATION'S FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO SELF-PAY PATIENTS. ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVANT PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CORPORATION RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 8: THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT. ALL OF THE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. PART III, LINE 9B: IF THE PATIENT IS NOT ABLE TO MAKE PAYMENT ARRANGEMENTS, THE STAFF WILL VERBALLY DETERMINE IF THE PATIENT IS POTENTIALLY ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL CHARITY CARE POLICY. PATIENTS WHO APPEAR TO MEET THE CARO COMMUNITY HOSPITAL CRITERIA ARE REFERRED TO THE SOCIAL WORKER FOR FURTHER REVIEW IN ACCORDANCE WITH THE HOSPITAL CHARITY CARE POLICY. PART VI, LINE 2: ORGANIZATION COMMUNICATED WITH STATE AND LOCAL AGENCIES TO DETERMINE THE HEALTHCARE NEEDS OF THE COMMUNITY. EXAMPLES OF SERVICES PROVIDED BASED ON COMMUNITY NEEDS ARE IMMUNIZATIONS, VACCINES, SPOTS PHYSICALS, SENIOR AND HEALTH FAIRS, FIRST AID BOOTH, AND DIABETIC CLASSES. CARO COMMUNITY HOSPITAL HAS CURRENTLY JOINED THE MICHIGAN RURAL HEALTH GROUP WHO WILL CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE HOSPITAL AS NEEDED. THE HEALTH NEEDS ASSESSMENT WAS DONE DURING FISCAL YEAR 2019 AND IS POSTED ON THE MCLAREN PUBLIC WEBSITE. IT HAS BEEN A BOARD AGENDA ITEM FROM 2014-2019. PART VI, LINE 3: EVERY UNINSURED PATIENT THAT IS AN INPATIENT, OUTPATIENT, SURGICAL, OBSERVATION, OR INCURS MORE THAN $5,000 IN MEDICAL EXPENSES, RECEIVES A CHARITY CARE PACKAGE. THE PACKAGE INCLUDES A CHARITY CARE AND MEDICAID APPLICATION AND A HUMAN SERVICES REFERRAL FORM. ALL OTHER NON-INSURED PATIENTS MAY REQUEST A CHARITY CARE APPLICATION AT ANY TIME. PART VI, LINE 4: ORGANIZATION IS LOCATED IN TUSCOLA COUNTY WHICH HAS A POPULATION OF APPROX. 56,500, CARO HAS A POPULATION OF APPROX 4,250. TUSCOLA COUNTY CONSISTS OF MOSTLY FARMLAND WITH VERY FEW MANUFACTURING FACILITIES. THE UNEMPLOYMENT RATE IN TUSCOLA COUNTY IS HIGH BECAUSE OF THE LOSS OF MANY SMALL AUTOMOTIVE RELATED JOBS AND IS AT OR ABOVE THE STATE OF MICHIGAN'S UNEMPLOYMENT RATE. PART VI, LINE 5: THE PARENT ORGANIZATION AND EACH OF ITS SUBSIDIARY/AFFILIATE MEMBERS MAINTAIN A LOCAL COMMUNITY-BASED BOARD WITH POWERS, RESPONSIBILITIES AND ACCOUNTABILITIES FOR THE OVERSIGHT OF THE OPERATION OF THEIR RESPECTIVE ORGANIZATIONS. EACH SUBSIDIARY/AFFILIATE ORGANIZATION MAINTAINS AN OPEN MEDICAL STAFF ALLOWING ANY PHYSICIAN OR OTHER CARE PROVIDER WITH PROPER CREDENTIALS TO JOIN THE STAFF AND PROVIDE APPROVED CARE. THE ORGANIZATION FUNDS AND MAINTAINS OVER 500 MEDICAL RESIDENCY AND FELLOWSHIP PROGRAMS TO TRAIN FUTURE GENERATIONS OF PHYSICIANS; ORGANIZATION FUNDS, OPERATES AND MAINTAINS NUMEROUS HEALTH CARE EDUCATION PROGRAMS AT THE HIGH SCHOOL, COMMUNITY COLLEGE, UNIVERSITY AND POST-GRADUATE LEVELS OF EDUCATION. ORGANIZATION PROVIDES SPONSORSHIP (FINANCIAL AND IN-KIND RESOURCES) SUPPORT TO COMMUNITY-LEVEL ACTIVITIES (HEALTH WALKS AND RACES, FITNESS TRAINING, DISEASE AWARENESS EVENTS, CULTURAL EVENTS AND OTHER HEALTH-RELATED NON-PROFIT ACTIVITIES, EVENTS AND ORGANIZATIONS). ORGANIZATION ALSO DIRECTS, FUNDS, SUPPORTS AND PARTICIPATES IN FUNDRAISING ACTIVITIES THAT SUPPORT HEALTH PREVENTION/EDUCATION, DIAGNOSIS AND TREATMENT PROVIDED BY OTHER NON-PROFIT COMMUNITY ORGANIZATIONS. PART VI, LINE 6: THE ROLE OF THE PARENT ORGANIZATION IS TO SET THE VISION AND STRATEGIC DIRECTION FOR THE ORGANIZATION AS A WHOLE. THIS INCLUDES THE DEVELOPMENT OF THE ANNUAL STRATEGIC PLAN WHICH DEFINES THE STRATEGIC PRIORITIES FOR THE ORGANIZATION AND ITS MEMBERS, THE METRICS TO BE MEASURED FOR EACH STRATEGIC PROGRAMS AND THE BENCHMARK OR TARGET/GOALS FOR EACH METRIC. STRATEGIC PRIORITIES DIRECTLY ADDRESS AND MEASURE (AT A SUBSIDIARY LEVEL) CLINICAL QUALITY AND CLINICAL OUTCOMES; PATIENT, PHYSICIAN, EMPLOYEE AND COMMUNITY SATISFACTION WITH THE ORGANIZATION AND ITS SUBSIDIARY/AFFILIATE MEMBERS; AND DEVELOPMENT OF NEW SERVICES TO IMPROVE ACCESS TO, QUALITY OF, AND COST OF HEALTH SERVICES.THE ROLE OF THE ORGANIZATION'S SUBSIDIARIES/AFFILIATES IS THE DEVELOPMENT AND IMPLEMENTATION OF ANNUAL STRATEGIC AND OPERATIONAL PLANS THAT SUPPORT AND ADVANCE THE STRATEGIC PLAN OF THE PARENT ORGANIZATION. ALL LOCAL PLANS ARE DEVELOPED AND DESIGNED TO REFLECT THE UNIQUE POPULATION-BASED HEALTH CARE NEEDS AND REQUIREMENTS OF THE COMMUNITIES SERVED BY THE SUBSIDIARY/AFFILIATE ORGANIZATION.ALL LOCAL SUBSIDIARIES/AFFILIATES HAVE FULL AUTHORITY AND DECISION-MAKING POWERS TO DEFINE AND EXECUTE THE STRATEGIC AND OPERATIONAL PLANS INTENDED TO IMPROVE THE HEALTH AND WELFARE OF THE COMMUNITIES THEY SERVE. PART VI, LINE 7, REPORTS FILED WITH STATES MI 0 1 0 0 0 0 0 0 0 CLARENCE SEVILLIAN TRUSTEE, BAY PRESIDENT/CEO 0 536485 0 143750 0 238121 0 14000 0 18023 0 950379 0 0 MICHAEL JOHNSTON PRESIDENT AND CEO 0 256919 0 0 0 30846 0 74270 0 12974 0 375009 0 0 MARC AUGSBURGER PRESIDENT AND CEO - PART YEAR 0 220504 0 0 0 45584 0 67987 0 16950 0 351025 0 0 STEPHANIE REMLEY DIRECTOR OF FINANCE 154211 0 0 0 0 0 0 0 0 0 154211 0 0 0 PART I, LINE 1A THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 1 BOXES HAVE BEEN CHECKED. THE CORPORATE CEO, SUBSIDIARY CEOS AND CORPORATE EXECUTIVE & SENIOR VICE-PRESIDENTS IN SOME INSTANCES HAVE RECEIVED TAX INDEMNIFICATION FOR THE FOLLOWING BENEFITS: VEHICLE COSTS, GROUP TERM LIFE INSURANCE, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS, AND HEALTH CLUB OR SOCIAL DUES. THESE BENEFITS HAVE BEEN INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 3 THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 3 BOXES HAVE BEEN CHECKED. THE RELATED ORGANIZATION USED THE FOLLOWING METHODOLOGIES TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B MCLAREN MAINTAINS TWO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES (THE "SERPS"). THE OLD SERP WAS CLOSED TO NEW PARTICIPANTS ON OCTOBER 1, 2006, AND THE NEW SERP BECAME EFFECTIVE AS OF JANUARY 1, 2007. NO EMPLOYEE MAY PARTICIPATE IN BOTH OF THE SERPS. THE OLD SERP IS STRUCTURED AS A DEFINED BENEFIT PLAN THAT ESSENTIALLY REPLACES THE BENEFITS THE PARTICIPANT IS NOT PERMITTED TO RECEIVE UNDER MCLAREN'S QUALIFIED RETIREMENT PLAN DUE TO IRS LIMITATIONS APPLICABLE TO QUALIFIED PLANS. THE BENEFIT UNDER THE OLD SERP IS PAYABLE IN EITHER THE FORM OF A LUMP SUM DISTRIBUTION OR IN MONTHLY PAYMENTS EQUAL TO THE ACTUARIAL EQUIVALENT OF THE PARTICIPANT'S ACCRUED BENEFIT. THE BENEFIT IS PAID AT AGE 55, AND IF THE PARTICIPANT REMAINS EMPLOYED, THE BENEFIT IS PAID UPON TERMINATION OF EMPLOYMENT, REDUCED TO TAKE INTO ACCOUNT THE BENEFIT PREVIOUSLY PAID. THE NEW SERP IS STRUCTURED AS A DEFINED CONTRIBUTION PLAN, AND MCLAREN CONTRIBUTES 15 PERCENT OF EACH PARTICIPANT'S COMPENSATION TO THE PLAN EACH YEAR FOR ALLOCATION TO THE PARTICIPANT'S ACCOUNT. PARTICIPANTS IN THE NEW SERP BECOME VESTED IN THEIR ACCOUNTS UPON THE EARLIER OF FIVE YEARS OF PARTICIPATION IN THE PLAN OR ATTAINMENT OF AGE 60. PARTICIPANTS IN THE NEW SERP SELF-DIRECT THE INVESTMENT OF THEIR ACCOUNTS AND HAVE THE ACTUAL INVESTMENT RETURN CREDITED OR DEBITED TO THEIR ACCOUNTS. THE BENEFIT UNDER THE NEW SERP IS EQUAL TO THE PARTICIPANT'S ACCOUNT BALANCE, AND THE BENEFIT IS PAID IN A SINGLE SUM WITHIN 60 DAYS OF THE PARTICIPANT'S TERMINATION DATE. BENEFITS UNDER BOTH SERPS ARE PROVIDED ON A TAX-NEUTRAL BASIS. BOTH SERPS ARE DESIGNED TO COMPLY WITH INTERNAL REVENUE CODE SECTIONS 457(F) AND 409A. PART I, LINE 7 MCLAREN HEALTH CARE (MHC) HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION, SUBSIDIARY EXECUTIVES AND DIRECTORS, MANAGERS AND SUPERVISORS. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ORGANIZATION'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING TOP OFFICIALS AND THE BOARD OF DIRECTORS WITH A TOOL FOR (A) CLEARLY COMMUNICATING PERFORMANCE ON THE PART OF KEY LEADERS, (B) STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE ON THE PART OF KEY LEADERS WHICH WILL ULTIMATELY BENEFIT THE COMMUNITIES MHC SERVES, AND (C) PROTECTING MHC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH-TALENT LEADERS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS MCLAREN HEALTH CARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO ELECT OR APPOINT THE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS BY THE GOVERNING BODY ARE SUBJECT TO THE POWERS OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 DATA IS PREPARED INTERNALLY AND SUBMITTED TO OUR AUDITING FIRM FOR RETURN PREPARATION. ONCE THE RETURNS HAVE BEEN COMPLETED, THE FORMS ARE REVIEWED BY ENTITY CFO AND THE FINANCE LEADERSHIP OF MCLAREN HEALTH CARE (MHC). COPIES OF DRAFT RETURNS ARE MADE AVAILABLE TO THE MHC BOARD MEMBERS, WHO SERVE AS THE OVERALL GOVERNING BOARD. RETURNS ARE AVAILABLE FOR ALL CORPORATIONS OF WHICH MHC IS THE SOLE MEMBER AS WELL AS OTHER RELATED ENTITIES OF THOSE CORPORATIONS FOR REVIEW RATHER THAN HAVING THE LOCAL BOARDS REVIEW THE RETURNS. THE BOARD OF MHC IS THE ULTIMATE ACCOUNTABLE ORGANIZATION FOR THE SYSTEM; AS SUCH IT IS THE OVERALL GOVERNING BOARD OF THE SYSTEM, WHOSE RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO: APPROVING ALL SUBSIDIARY BOARD MEMBERS, FINANCIAL BUDGETS, AND ISSUANCE OF DEBT. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE DEPARTMENT, IN ACCORDANCE WITH THE MCLAREN HEALTH CARE (MHC) BOARD CONFLICT OF INTEREST POLICY, ANNUALLY DISTRIBUTES THE CONFLICT OF INTEREST DISCLOSURE SURVEY TO ALL MHC CORPORATE AND SUBSIDIARY ORGANIZATION BOARD MEMBERS, EXECUTIVES AND OTHER LEADERSHIP EMPLOYEES. THE CORPORATE COMPLIANCE DEPARTMENT THROUGH THE GOVERNANCE COMMITTEE, COMPILES AND ANALYZES SURVEY DATA BY ORGANIZATION, INVESTIGATES AND REVIEWS POTENTIAL CONFLICTS WITH THE ORGANIZATION'S CEO AND BOARD CHAIR, AND WHEN NECESSARY, RECOMMENDS ACTIONS TO BE TAKEN TO RESOLVE IDENTIFIED CONFLICTS. A COMPLETE REPORT OF ALL CORPORATE AND SUBSIDIARY BOARD MEMBER AND EXECUTIVE DISCLOSURES, CONFLICTS IDENTIFIED AND ACTIONS TAKEN IS REVIEWED BY THE MHC GOVERNANCE COMMITTEE AND EACH SUBSIDIARY CEO AND BOARD CHAIR RECEIVES A REPORT SPECIFIC TO THEIR ORGANIZATION'S BOARD MEMBERS AND EXECUTIVES. CONFLICTS ARE DISCLOSED TO THE FULL BOARD AND BOARD COMMITTEES SO APPROPRIATE ACTIONS CAN BE TAKEN. ACTIONS MAY INCLUDE PROHIBITING A BOARD MEMBER FROM PARTICIPATING IN DELIBERATIONS INVOLVING TRANSACTIONS WITH A COMPANY WITH WHICH THEY CONDUCT FINANCIAL TRANSACTIONS; BOARD MEMBERS FAILING TO COMPLETE A DISCLOSURE SURVEY OR INTENTIONALLY FAILING TO REPORT A KNOWN CONFLICT OF INTEREST ARE RELIEVED OF THEIR SERVICE TO MHC. FORM 990, PART VI, SECTION B, LINE 15B THE COMPENSATION COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS TO REVIEW THE PERFORMANCE AND RECOMMEND THE TOTAL COMPENSATION PACKAGE OF THE MCLAREN HEALTHCARE CORPORATION'S CEO TO THE BOARD. FURTHER, THE COMMITTEE ESTABLISHES THE SALARY RANGES AND PREREQUISITES OF THE OTHER MOST HIGHLY COMPENSATED OFFICERS (MHC EXECUTIVE & SENIOR VICE-PRESIDENTS AND CEOS OF MHC SUBSIDIARY ORGANIZATIONS) TO THE BOARD. THE MEMBERS OF THE COMMITTEE MUST MEET THE INDEPENDENCE REQUIREMENTS OF THE APPLICABLE PROVISIONS OF SECTION 4958 OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND FINAL TREASURY REGULATIONS SECTION 53.4958-6(C)(1)(III). THE COMMITTEE RETAINS THE SERVICES ANNUALLY OF AN INDEPENDENT FIRM WITH SIGNIFICANT QUALIFICATIONS AND EXPERIENCE TO CONDUCT A REVIEW OF THE CORPORATION'S EXECUTIVE COMPENSATION PROGRAM. THE RETAINED FIRM UTILIZES APPROPRIATE COMPENSATION COMPARABILITY DATA. THE RETAINED FIRM CONDUCTS ANALYSIS OF THE COMPETITIVENESS OF THESE PROGRAMS AND EXPRESSES AN OPINION TO THE REASONABLENESS OF THESE COMPENSATION PROGRAMS. ALL DATA UTILIZED BY THE COMMITTEE, DELIBERATIONS OF THE COMMITTEE, AND FINAL COMPENSATION DECISIONS BY THE COMMITTEE ARE DOCUMENTED IN FORMAL REPORTS AND MINUTES. THE CORPORATE COMPENSATION COMMITTEE WORKS UNDER AND PERIODICALLY RENEWS THE MCLAREN HEALTH CARE CORPORATION COMPENSATION COMMITTEE CHARTER. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS FISCAL YEAR 2020. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE GENERAL PUBLIC. THEY ARE PROVIDED UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,089,768. MANAGEMENT AND GENERAL EXPENSES 1,351,933. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,441,701. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,507,921. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,507,921. CORPORATE ALLOCATION - PREMIER: PROGRAM SERVICE EXPENSES 3,830. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,830. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER -3,830. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MCLAREN BAY REGION FOUNDATION 1900 COLUMBUS AVE BAY CITY MI 48708 382156534 FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION 1 MCLAREN BAY REGION 1900 COLUMBUS AVE BAY CITY MI 48708 381976271 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 BAY REGIONAL MEDICAL CENTER AUXILIARY 1908 COLUMBUS AVENUE BAY CITY MI 48708 386081235 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I MCLAREN BAY REGION 1 MCLAREN BAY SPECIAL CARE 3250 E MIDLAND ROAD STE 1 BAY CITY MI 48706 383161753 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN BAY REGION 1 MCLAREN CENTRAL MICHIGAN 1221 SOUTH DRIVE MT PLEASANT MI 48858 381420304 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 CHARLEVOIX NURSING HOME CORPORATION DBA BOULDER PARK TERRACE 14676 WEST UPRIGHT CHARLEVOIX MI 49720 383038683 SKILLED NURSING FACILITY MI 501(C)(3) LINE 10 MCLAREN NORTHERN MICHIGAN 1 KARMANOS CANCER FOUNDATION 4100 JOHN R ST DETROIT MI 48201 383584572 CANCER CARE CENTER MI 501(C)(3) LINE 7 BARBARA ANN KARMANOS CANCER INSTITUTE 1 MCLAREN GREATER LANSING FOUNDATION 401 W GREENLAWN AVE LANSING MI 48910 382463637 FOUNDATION MI 501(C)(3) LINE 7 MCLAREN GREATER LANSING 1 MCLAREN GREATER LANSING 401 W GREENLAWN AVE LANSING MI 48910 381434090 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 BARBARA ANN KARMANOS CANCER HOSPITAL 4100 JOHN R ST DETROIT MI 48201 201649466 HOSPITAL MI 501(C)(3) LINE 3 BARBARA ANN KARMANOS CANCER INSTITUTE 1 BARBARA ANN KARMANOS CANCER INSTITUTE 4100 JOHN R ST DETROIT MI 48201 381613280 CANCER RESEARCH & CARE CENTER MI 501(C)(3) LINE 7 MCLAREN HEALTH CARE CORPORATION 1 MCLAREN LAPEER REGION 1375 N MAIN ST LAPEER MI 48446 382689033 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 MCLAREN LAPEER REGION FOUNDATION 1375 N MAIN ST LAPEER MI 48446 382689603 FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN LAPEER REGION 1 MARWOOD MANOR NURSING HOME PO BOX 5011 PORT HURON MI 48060 382683251 NURSING HOME MI 501(C)(3) LINE 10 PORT HURON HOSPITAL 1 MCLAREN HEALTH CARE CORPORATION ONE MCLAREN PARKWAY GRAND BLANC MI 48439 382397643 SUPPORTING ORG MI 501(C)(3) LINE 12A, I N/A 0 MCLAREN HEALTH CARE VILLAGE FOUNDATION 401 S BALLENGER HIGHWAY FLINT MI 48532 262693350 SUPPORTING ORG MI 501(C)(3) LINE 12A, I MCLAREN HEALTH CARE CORPORATION 1 MCLAREN HEALTH PLAN COMMUNITY G-3245 BEECHER ROAD FLINT MI 48532 272204037 INSURANCE MI 501(C)(4) MCLAREN HEALTH PLAN 1 MCLAREN HEALTH PLAN INC G-3245 BEECHER ROAD FLINT MI 48532 383252216 HEALTH CARE SERVICES MI 501(C)(4) MCLAREN INTEGRTAED HMO GROUP 1 MCLAREN HOSPICE AND HOME CARE FOUNDATION 1515 CAL DR DAVISON MI 48423 463643089 FOUNDATION MI 501(C)(3) LINE 12A, I MCLAREN HEALTH MANAGEMENT GROUP 1 MCLAREN MEDICAL GROUP 401 S BALLENGER HWY FLINT MI 48532 382988086 MANAGEMENT COMPANY MI 501(C)(3) LINE 12A, I MCLAREN HEALTH CARE CORPORATION 1 MCLAREN NORTHERN MICHIGAN 416 CONNABLE AVENUE PETOSKEY MI 49770 382146751 ACUTE CARE HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 MCLAREN NORTHERN MICHIGAN FOUNDATION 360 CONNABLE AVENUE PETOSKEY MI 49770 382445611 FOUNDATION MI 501(C)(3) LINE 7 MCLAREN NORTHERN MICHIGAN 1 MCLAREN PORT HURON 1221 PINE GROVE AVENUE PORT HURON MI 48060 381369611 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 MCLAREN FLINT 401 S BALLENGER HWY FLINT MI 48532 382383119 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 MICHIGAN CANCER SOCIETY 4100 JOHN R ST DETROIT MI 48201 382823451 CANCER RESEARCH MI 501(C)(3) LINE 7 BARBARA ANN KARMANOS CANCER INSTITUTE 1 MOUNT CLEMENS REGIONAL HEALTHCARE FOUNDATION PO BOX 326 MOUNT CLEMENS MI 48046 382578873 FOUNDATION MI 501(C)(3) LINE 10 MCLAREN MACOMB 1 MCLAREN MACOMB 1000 HARRINGTON MOUNT CLEMENS MI 48043 381218516 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 NORTH OAKLAND NORTH MACOMB IMAGING INC 50 NORTH PERRY STREET PONTIAC MI 48342 382807040 MRI IMAGING MI 501(C)(3) LINE 3 MCLAREN OAKLAND 1 NORTHERN MICHIGAN HEMATOLOGY AND ONCOLOGY 416 CONNABLE AVENUE PETOSKEY MI 49770 320020293 PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN 1 NORTHERN MICHIGAN MEDICAL MANAGEMENT 416 CONNABLE AVENUE PETOSKEY MI 49770 208458840 PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN 1 MCLAREN OAKLAND FOUNDATION 50 NORTH PERRY STREET PONTIAC MI 48342 200442217 FOUNDATION MI 501(C)(3) LINE 12C, III-FI MCLAREN OAKLAND 1 MCLAREN OAKLAND 50 NORTH PERRY STREET PONTIAC MI 48342 381428164 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 PORT HURON HOSPITAL FOUNDATION PO BOX 5011 PORT HURON MI 48060 382777750 FOUNDATION MI 501(C)(3) LINE 12A, I PORT HURON HOSPITAL 1 REGIONAL EMERGENCY MEDICAL SERVICE INC 25400 W 8 MILE ROAD SOUTHFIELD MI 48034 383255499 AMBULANCE SERVICE MI 501(C)(3) LINE 10 MCLAREN MEDICAL MANAGEMENT INC 1 THE CARDIAC INSTITUTE DBA MICHIGAN HEART & VASCULAR SPECIALISTS 416 CONNABLE AVENUE PETOSKEY MI 49770 262774689 PHYSICIAN PRACTICE MI 501(C)(3) LINE 3 MCLAREN NORTHERN MICHIGAN 1 MCLAREN HEALTH MANAGEMENT GROUP 1515 CAL DRIVE DAVISON MI 48423 383491714 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MCLAREN HEALTH CARE CORPORATION 1 VITALCARE INC 761 LAFAYETTE AVENUE CHEBOYGAN MI 49721 382527255 HOSPICE CARE/HOME HEALTH SERVICES MI 501(C)(3) LINE 10 MCLAREN NORTHERN MICHIGAN 1 MCLAREN FLINT FOUNDATION 401 S BALLENGER HIGHWAY FLINT MI 48532 381358053 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I MCLAREN FLINT 1 CARO COMMUNITY HOSPITAL ENDOWMENT FOUNDATION 410 N HOOPER ST CARO MI 48724 382422995 FOUNDATION MI 501(C)(3) LINE 12C, III-FI CARO COMMUNITY HOSPITAL 1 MDWISE INC 2955 N MERIDIAN STREET SUITE 201 INDIANAPOLIS IN 46208 351931354 HEALTH MAINTENANCE ORGANIZATION IN 501(C)(4) MCLAREN INTEGRTAED HMO GROUP 1 MDWISE MEDICAID NETWORK INC 2955 N MERIDIAN STREET SUITE 201 INDIANAPOLIS IN 46208 473192307 INSURANCE IN 501(C)(4) MCLAREN INTEGRTAED HMO GROUP 1 HURON MEMORIAL HOSPITAL 1100 S VAN DYKE ROAD BAD AXE MI 48413 381474929 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 HURON MEMORIAL FOUNDATION 1100 S VAN DYKE ROAD BAD AXE MI 48413 382717147 FOUNDATION MI 501(C)(3) LINE 7 HURON MEMORIAL HOSPITAL 1 MCLAREN INTEGRATED HMO GROUP G-3245 BEECHER ROAD FLINT MI 48532 824449304 HEALTH CARE SERVICES MI 501(C)(4) MCLAREN HEALTH CARE CORPORATION 1 LAKE ORION NURSING CENTER 50 NORTH PERRY STREET PONTIAC MI 48342 382895426 NURSING CENTER MI 501(C)(3) LINE 10 MCLAREN OAKLAND 1 MCLAREN - NORTHERN EQUITIES CANCER CENTER PROJECT LLC 39000 COUNTRY CLUB DRIVE FARMINGTON HILLS MI 48331 263112935 RENTAL REAL ESTATE MI N/A MOUNT CLEMENS REGIONAL HEALTH BUILDING HEALTH PARTNERS 1000 HARRINGTON ST MOUNT CLEMENS MI 48043 262524717 BUILDING MANAGEMENT MI N/A SOUTH VAN DYKE MEDICAL COMPLEX-A 125 N HANSELMAN ST BAD AXE MI 48413 383372174 VARIOUS HEALTHCARE ACTIVITIES MI N/A CLARKSTON PROPERTY ASSOCIATES 50 NORTH PERRY STREET PONTIAC MI 48342 432006072 REAL ESTATE MI N/A C 0 DELPHINUS INVESTMENT INC 4100 JOHN R ST DETROIT MI 48075 454758176 HOLD PASSIVE INVESTMENT MI N/A C 1 HEALTH ADVANTAGE INC G3245 BEECHER ROAD FLINT MI 48532 912141720 INSURANCE MI N/A C 1 MCLAREN INSURANCE COMPANY LTD 10 MAIN ST GRAND CAYMAN CJ INSURANCE CJ N/A C 1 MID-MICHIGAN PHYSICIANS PC 2510 KERRY STREET SUITE 200 LANSING MI 48912 383267121 PHYSICIAN PRACTICE MI N/A C 1 MCLAREN PHYSICIAN PARTNERS ONE MCLAREN PARKWAY GRAND BLANC MI 48439 383136458 MANAGED CARE MI N/A C 0 VITALCARE HOME MEDICAL EQUIPMENT INC 761 LAFAYETTE AVENUE CHEBOYGAN MI 49721 382662954 SALE AND RENTAL OF DURABLE MEDICAL EQUIPMENT MI N/A C 1 HURON CLINIC CONDOMINIUMS OWNERS 125 N HANSELMAN ST BAD AXE MI 48413 412144341 VARIOUS HEALTHCARE ACTIVITIES MI N/A C 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 HURON MEMORIAL HOSPITAL R 57166 CASH MCLAREN HEALTH PLAN S 256956 CASH MCLAREN HEALTH PLAN COMMUNITY S 156405 CASH HEALTH ADVANTAGE INC R 523135 CASH MCLAREN BAY REGION O 265294 COST OF COMPENSATION MCLAREN HEALTH MANAGEMENT GROUP P 249264 ALLOCATION OF ACTUAL COST