2020-11-05T06:55:15-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC 1111 MICHIGAN AVE STE 100 EAST LANSING MI 48823 990 2019-01-01 381358208 MEMORIAL HOSPITAL MEMO 9897235211 826 WEST KING STREET OWOSSO MI 48867 COLLEEN M KOPPENHAVER CFO 9897235211 2020-10-28 1 DAVID LOWENTHAL P00378651 5173326200 2020-10-28 73.161.36.242 2020-10-28 09:35:00 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 EBB51160BF2136090E0706D858221EDFD566B897 2019 2021-01-29 14:40:06Z MEMORIAL HEALTHCARE COLLEEN M KOPPENHAVER 826 WEST KING STREET OWOSSO MI 48867 274999569 0 X MEMORIALHEALTHCARE.ORG X 1919 MI TO PROVIDE HEALTHCARE SERVICES TO PATIENTS. 18 13 1339 154 194667 0 116063 200670 180051834 202883643 4723130 12509486 1988714 2195685 186879741 217789484 0 0 0 0 85080477 96625302 0 0 0 91540887 105401236 176621364 202026538 10258377 15762946 139002846 155656152 40101296 42200112 98901550 113456040 X TO PROMOTE HEALTH AND PROVIDE QUALITY COMPASSIONATE HEALTHCARE IN OUR REGION THROUGH A COMMITMENT TO SERVICE EXCELLENCE, TEAMWORK AND INNOVATION. 0 0 80960612 153100971 ANCILLARY SERVICES (REGISTRATIONS: 221,577, INPATIENT/OUTPATIENT SURGERIES: 3,385, EMERENCY DEPARTMENT VISITS: 25,022, PAIN MANAGEMENT VISITS: 7,847) 44064972 14528057 MMA SERVICES (PHYSICIAN CLINICS, MMA RVU'S: 291,347) 14011468 18228639 A MEDICAL AND SURGICAL HOSPITAL THAT PROVIDES INPATIENT AND OUTPATIENT PROGRAM SERVICES TO ALL PATIENTS. (INPATIENT DISCHARGES: 3,904, PATIENT DAYS: 27,078, BIRTHS: 429, INPATIENT SURGERIES: 754, EMERGENCY DEPARTMENT ADMITS: 3,774) 42334433 18230249 ALL OTHER PROGRAM SERVICES 42334433 18230249 181371485 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 201 0 1 1339 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X ROSE BROWN 9897294717 826 WEST KING STREET OWOSSO MI 48867 RANY ABURASHED PHYSICIAN 40.00 0.00 X 827932 0 27168 ASHRAF ELBANNA PHYSICIAN 40.00 0.00 X 834649 0 13720 BRIAN LONG PRESIDENT/CEO 58.00 2.00 X X 756241 0 22569 MICHAEL SCHMIDT DO CHIEF OF STAFF 40.00 0.00 X 690735 0 27400 TAREK PACHA PHYSICIAN 40.00 0.00 X 668508 0 25514 JOSEPH PALAZETI PHYSICIAN 40.00 0.00 X 626736 0 27399 LISA LEPAIN PHYSICIAN 40.00 0.00 X 616413 0 23528 JAMES NEMETH VP OF NURSING 40.00 0.00 X 397123 0 26809 JOSEPH BUSTAMANTE CHIEF MEDICAL OFFICER 40.00 0.00 X 382365 0 26765 COLLEEN KOPPENHAVER EXECUTIVE VP/CFO 40.00 0.00 X 345785 0 23450 MICHAEL KRAMER DO BOARD MEMBER 40.00 0.00 X 353600 0 13344 ANTHONY PATSY DO BOARD MEMBER 39.00 1.00 X 299064 0 25708 RONALD M BISHOP DO BOARD MEMBER 40.00 0.00 X 93360 0 4004 TONY YOUNG BOARD CHAIRMAN 2.00 0.00 X X 0 0 0 GREGORY BONTRAGER BOARD VICE CHAIRMAN 2.00 0.00 X X 0 0 0 WILFRED BILL FARRELL BOARD TREASURER 2.00 0.00 X X 0 0 0 BARBARA BAKEROMEROD BOARD MEMBER 2.00 0.00 X 0 0 0 THOMAS CAMPBELL BOARD MEMBER 2.00 0.00 X 0 0 0 JAMES CIVILLE BOARD MEMBER 2.00 1.00 X 0 0 0 DALE ESPICH BOARD MEMBER 2.00 0.00 X 0 0 0 SHANA ESPINOZA BOARD MEMBER 2.00 0.00 X 0 0 0 FRANK FEAR BOARD MEMBER 2.00 0.00 X 0 0 0 JOHN HAGEL BOARD MEMBER 2.00 0.00 X 0 0 0 JACKLYN HURD BOARD MEMBER 2.00 1.00 X 0 0 0 DONNA MCAVOY BOARD MEMBER 2.00 0.00 X 0 0 0 JERRY WALDEN SECRETARY 2.00 0.00 X 0 0 0 6892511 0 287378 127 0 1 0 INDIGO HOSPITAL MEDICINE 107 S CASS ST SUITE A TRAVERSE CITY MI 49684 CONTRACTED HOSPITALS 3251905 ALLIANCE - HNI LLC 7647 COLLECTION CENTER DRIVE CHICAGO IL 60693 RENTAL OF EQUIPMENT 1532841 ECS CENTRAL MICHIGAN 4100 EMBASSY DRIVE SUITE 400 GRAND RAPIDS MI 49546 CONTRACTED EMERGENCY ROOM PHYSICIANS 1285688 COMPHEALTH PO BOX 972651 DALLAS TX 75397 MEDICAL STAFFING 1135110 MCKEEN & ASSOCIATES PC 645 GRISWOLD ST SUITE 4200 DETROIT MI 48226 MEDICAL MALPRACTICE 950000 33 200670 200670 NET PATIENT SERVICE REVENUE 622110 193015606 193015606 340B REVENUE 622110 6392813 6392813 PHYSICIAN REVENUE 900099 3433782 3433782 BILLING SERVICES REVENUE 561000 41442 41442 202883643 1711 1711 1399293 153578 1245715 1245715 1245715 69433928 130354 57048974 7533 12384954 122821 12507775 12507775 CAFETERIA REVENUE 722513 796745 796745 LAB COURIER 621500 136838 136838 OUTSIDE MEALS 722513 16387 16387 949970 217789484 204087916 194667 13306231 4224978 4224978 70940756 65760458 5180298 1156314 1111085 45229 15011412 14641575 369837 5291842 5084853 206989 487966 487966 73730 73730 20224 20224 276907 276907 17393480 13587017 3806463 10145992 7339434 2806558 252386 203339 49047 540827 540827 8334828 7085155 1249673 891877 882195 9682 PHARMACEUTICAL EXPENSES 33109827 33109827 MEDICAL SUPPLIES 16541590 16239181 302409 PROVISION FOR BAD DEBTS 9380144 9380144 QAAP TAX EXPENSE 4145095 4145095 3806363 2261300 1545063 202026538 181371485 20655053 0 3479377 5012777 1227871 150184 16599134 25183011 3286941 2911210 1335494 1569296 156946320 91150872 56790919 65795448 38372166 18352937 15244770 33205424 2666174 3475865 139002846 155656152 19119436 22085989 17632150 15609578 2224189 3705928 1125521 798617 40101296 42200112 X 98901550 113456040 98901550 113456040 139002846 155656152 X 15762946 -1157751 -50705 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 20224 20224 0 PART II-B, LINE 1: MEMORIAL HEALTHCARE PAYS DUES TO MICHIGAN HEALTH AND HOSPITAL ASSOCIATION & MICHIGAN HEALTH COUNCIL. A PORTION OF THESE DUES GO TOWARDS LOBBYING. 4492321 36587 826200 12437 5342671 4653008 76952 -225393 12246 4492321 4231399 32323 550486 161200 4653008 4561819 108586 273144 712150 4231399 4549238 34657 -22076 4561819 0.56420 0.00000 0.43580 0 1 1 4523998 4523998 65233330 36625200 28608130 2564677 2599852 -35175 84149761 51527845 32621916 474554 397975 76579 65795448 WELLS FARGO MUTUAL FUNDS 33205424 F 33205424 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS PAYABLE 798617 798617 208159132 -1157751 2435188 1277437 206881695 10907789 10907789 217789484 193282843 2085261 2085261 191197582 10828956 10828956 202026538 PART V, LINE 4: THERE ARE VARIOUS PERMANENT AND BOARD DESIGNATED ENDOWMENT FUNDS. THE ONLY SPECIFICALLY IDENTIFIED USES OF THE VARIOUS FUNDS ARE AS FOLLOWS: NURSING SCHOLARSHIP AWARDS AND NURSING AND HEALTHCARE FOR THE ELDERLY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITY PER STATEMENTS NOT FORM 990 2,281,610. RENTAL EXPENSES 153,578. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL REVENUE RECORDED AS EXPENSE PER STATEMENTS 1,134,370. BAD DEBT EXPENSE 9,405,399. INVESTMENT FEES 276,907. EXPENSES RECORDED AS REVENUE PER STATEMENTS 91,113. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITY PER STATEMENTS NOT FORM 990 1,931,683. RENTAL EXPENSES 153,578. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 9,380,144. INVESTMENT FEES 276,907. RENTAL REVENUE RECORDED AS EXPENSE PER STATEMENTS 1,134,370. EXPENSES RECORDED AS REVENUE PER STATEMENTS 37,535. 1 1 X 1 X 1 X 1 1 1 0 1 1 1271136 1271136 0.00660 36351037 30482493 5868544 0.03050 37622173 30482493 7139680 0.03710 431154 431154 0.00220 1206786 1206786 0.00630 15124973 10055141 5069832 0.02630 530695 530695 0.00280 402558 402558 0.00210 17696166 10055141 7641025 0.03970 55318339 40537634 14780705 0.07680 24535 24535 0.00010 4522 4522 0.00000 284480 284480 0.00150 16010 16010 0.00010 329547 329547 0.00170 1 9380144 2814043 29003977 36419857 -7415880 X 1 1 1 1 MEMORIAL HEALTHCARE 826 WEST KING ST OWOSSO MI 48867 MEMORIALHEALTHCARE.ORG 1060000059 X X X LONG-TERM CARE HOSPITAL MEMORIAL HEALTHCARE 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X HTTPS://TINYURL.COM/YXEHQ8OW X HTTPS://TINYURL.COM/Y3L4CEMD X 1 17 1 HTTPS://TINYURL.COM/YXEHQ8OW 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X HTTPS://TINYURL.COM/Y64NPHXE X HTTPS://TINYURL.COM/Y64NPHXE X HTTPS://TINYURL.COM/Y64NPHXE X X X X X X X 1 X 0 X X X X X 1 X 0 0 MEMORIAL HEALTHCARE PART V, SECTION B, LINE 5: REFER TO THE COMMUNITY HEALTH NEEDS ASSESSMENT LOCATED AT THE FOLLOWING WEBSITE:HTTPS://WWW.MEMORIALHEALTHCARE.ORG/VISITORS/COMMUNITY-RESOURCESPARTICIPANTS IN THE CHNA:GREAT LAKES BAY HEALTHSAFECENTERSHIAWASSEE REGIONAL EDUCATION SERVICE DISTRICTSHIAWASSEE COUNTY HEALTH DEPARTMENTSHIAWASSEE HEALTH AND WELLNESSCATHOLIC CHARITIESMEMORIAL HEALTHCAREMEMORIAL HEALTHCARE FOUNDATIONMICHIGAN STATE UNIVERSITY EXTENSIONRESPITE VOLUNTEERS OF SHIAWASSEE COUNTYSHIAWASSEE GREAT START INITIATIVEGREATER LANSING FOOD BANKSHIAWASSEE HOPECOMMUNITY MEMBERSOWOSSO PUBLIC SCHOOLSSHIAWASSEE FAMILY YMCA - LIVE HEALTHYSHIAWASSEE HEALTH AND HUMAN SERVICES COUNCILSHIAWASSEE MINISTERIAL REPRESENTATIVESUNITED WAY OF GENESEE COUNTY (SHIAWASSEE)SHIAWASSEE COUNCIL ON AGINGHOMELESS ANGELSDISABILITY NETWORK CAPITAL AREABAKER PATHWAYSPARTICIPANTS IN THE IMPLEMENTATION PLANNING:BILL ARCHER, SHIAWASSEE COUNTY VASTEPHANIE ROWELL, MEMORIAL HEALTHCARE, TAYLOR LIFE CENTERDENNIS CHERNIN, SHIAWASSEE COUNTY HEALTH DEPARTMENT PENNY CORBIN, SHIAWASSEE COUNTY COMMUNITY MENTAL HEALTH AUTHORITY (SCCMHA) KRISTEN GILPIN, CATHOLIC CHARITIES NICOLE GREENWAY, SHIAWASSEE COUNTY HEALTH DEPARTMENT PHIL HATHAWAY, TOWN PLANS LLC, LIVE HEALTHY COALITIONCOURTNEY HERRICK, SHIAWASSEE EDUCATION SERVICE DISTRICT (SRESS)LARRY JOHNSON, SHIAWASSEE COUNTY HEALTH DEPARTMENTJEFF MCMANUS, RESPITE VOLUNTEERS OF SHIAWASSEE COUNTYMICHAEL DEWEY, SHIAWASSEE UNITED WAYMARLA PRICE, MEMORIAL HEALTHCARE DIETICIANCATHY SPRAGUE-EMANS, CATHOLIC CHARITIESTHOMAS TEAL, MD, MEMORIAL HEALTHCAREABBIE TIPTON. MEMORIAL HEALTHCAREJORRI TREMAIN, MEMORIAL HEALTHCAREMARLENE WEBSTER, SHIAWASSEE HOPESARA WRIGHT, GREAT LAKES BAY HEALTH CENTER SHIAWASSEE COUNTY MEMORIAL HEALTHCARE PART V, SECTION B, LINE 6B: MEMORIAL WAS THE LEAD ON THE CHNA BUT THERE WAS A SHIAWASSEE COMMUNITY HEALTH NEEDS TEAM THAT CONSISTED OF THE FOLLOWING ORGANIZATIONS:A. SHIAWASSEE UNITED WAYB. SHIAWASSEE REGIONAL EDUCATION SERVICEC. SHIAWASSEE COUNTY COMMUNITY MENTAL HEALTH AUTHORITYD. SHIAWASSEE COUNTY HEALTH DEPARTMENT MEMORIAL HEALTHCARE PART V, SECTION B, LINE 7D: A COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ON THE HOSPITAL'S WEBSITE LOCATED AT HTTPS://WWW.MEMORIALHEALTHCARE.ORG/WP-CONTENT/UPLOADS/2020/01/UPDATED-SHIAWASSEE-COUNTY-2019-CHA-1-21-20.PDFA COPY OF THE COMMUNIT HEALTH NEEDS ASSESSMENT IS ALSO AVAILABLE ON THE HOSPITAL COUNCIL OF NORTHWEST OHIO'S WEBSITE LOCATED AT HTTP://WWW.HCNO.ORG/COMMUNITY-SERVICES/COMMUNITY-HEALTH-ASSESSMENTS/ MEMORIAL HEALTHCARE PART V, SECTION B, LINE 11: DUE TO COVID-19, MEMORIAL HEALTHCARE WILL BEGIN WORKING ON ITS IMPLEMENTATION PLAN IN JULY OF 2020. HOWEVER ,THE PRIMARY NEEDS IDENTIFIED IN THE SURVEY WERE MENTAL HEALTH, OBESITY, AND SUBSTANCE ABUSE BASED ON THE RESPONSES. THESE DOMAINS WILL BE THE FOCUS OF MEMORIAL HEALTHCARE'S EFFORTS MOVING FORWARD AND WILL ENCOMPASS BOTH ADULTS AND CHILDREN. REFER TO THE MOST CURRENT IMPLEMENTATION PLAN LOCATED AT THE FOLLOWING WEBSITE: HTTPS://WWW.MEMORIALHEALTHCARE.ORG/VISITORS/COMMUNITY-RESOURCES MEMORIAL HEALTHCARE PART V, SECTION B, LINE 16J: THE FAP POLICY IS ALSO STATED ON ALL BILLING STATEMENTS SENT FROM THE HOSPITAL.PART V, SECTION B, LINE16I - THE HOSPITAL FACILITY HAS REVIEWED THE POPULATION OF ITS COMMUNITY AND CONCLUDED THAT ENGLISH IS THE ONLY PRIMARY LANGUAGE AS DEFINTED BY THE REGULATIONS OF MORE THAN 5% OR 1,000 PERSONS. THEREFORE, THE FAP, FAP APPLICATION FORM, OR PLAIN LANGUAGE SUMMARY HAVE NOT BEEN TRANSLATED INTO ANOTHER LANGUAGE. THE HOSPITAL FACILITY WILL CONTINUE TO MONITOR THIS GOING FORWARD AS NEW CENSUS DATA BECOMES AVAILABLE. MEMORIAL HEALTHCARE PART V, SECTION B, LINE 20E: SEND SELF-PAY ACCOUNTS TO ADVOMAS, A MEDICAL BILLING SERVICE, PRIOR TO SENDING TO CAREPAYMENT AND BEFORE SENDING TO BAD DEBT. 39 1 - MEMORIAL HEALTHCARE CANCER CENTER 721 N SHIAWASSEE OWOSSO MI 48867 CANCER CARE SERVICES/ONCOLOGY/ANTICOAG 2 - MEMORIAL HEALTHCARE OUT PT SERVICES 1975 W M21 STE 102 OWOSSO MI 48867 HOME HEALTH/HOSPICE 3 - MEMORIAL HEALTHCARE HEALTH PARK OFFICES 100 HEALTH PARK DRIVE OWOSSO MI 48867 MH LAB/MH RAD, MMA DR. VORENKAMP & OCC HEALTH 4 - MEMORIAL HEALTHCARE PAIN CLINIC 818 W KING ST STE 300 OWOSSO MI 48867 PAIN MANAGEMENT 5 - MEMORIAL HEALTHCARE'S OWOSSO WOODARD 317 S ELM ST STE 116 OWOSSO MI 48867 PHYSICAL THERAPY REHAB SERVICES/CARDIAC REHAB 6 - MID MICHIGAN ORTHOPEDICS 113 WILLIAMS STREET OWOSSO MI 48867 ORTHO SERVICES 7 - MEMORIAL HEALTHCARE OBGYN 1457 N M-52 STE 2 OWOSSO MI 48867 OBGYN 8 - MEMORIAL OVID-ELSIE OFFICES 9480 E M-21 OVID MI 48866 PRIMARY CARE 9 - MEMORIAL DURAND OFFICES 9099 E LANSING ROAD DURAND MI 48429 FAMILY MEDICINE 10 - MEMORIAL PERRY OFFICES 3337 W BRITTON ROAD PERRY MI 48872 FAMILY MEDICINE 11 - MEMORIAL PEDIATRIC CLINIC 802 W KING ST STE M OWOSSO MI 48867 PEDIATRICS 12 - INSTITUTE FOR NEUROSCIENCE & MULTIPLE SC 818 W KING STREET SUITE 101-103 OWOSSO MI 48867 NEUROLOGY 13 - MEMORIAL LAINGSBURG OFFICES 317 E GRAND RIVER LAINGSBURG MI 48848 FAMILY MEDICINE 14 - MEMORIAL SURGICAL ASSOCIATESWOUND CLINI 818 W KING ST STE 201 OWOSSO MI 48867 SURGERY/ WOUND CLINIC 15 - MEMORIAL CHESANING FAMILY PRACTICE 300 S CHAPMAN CHESANING MI 48616 FAMILY MEDICINE 16 - MEMORIAL PHYSICAL REHABILITATION CENTER 8906 E LANSING ROAD DURAND MI 48429 REHAB SERVICES 17 - MMA GASTRO OFFICES 721 N SHIAWASSEE STE 202 OWOSSO MI 48867 GASTROENTEROLOGY 18 - ARNOLD MEDICAL CLINIC 1975 W M-21 SUITE 204 OWOSSO MI 48867 FAMILY MEDICINE 19 - MEMORIAL OUTPATIENT SERVICES - CHESANING 305 S SAGINAW STREET CHESANING MI 48616 LAB, RAD, PT SERVICES 20 - MEMORIAL STATE ROAD OFFICES 239 N STATE ROAD OWOSSO MI 48867 MH LAB, MH RAD 21 - RED CEDAR ENT 818 W KING ST STE 301 OWOSSO MI 48867 ENT 22 - MEMORIAL NORTHSIDE FAMILY MEDICINE 802 W KING ST STE C OWOSSO MI 48867 FAMILY MEDICINE 23 - INTERNAL MEDICINE ASSOCIATES OF OWOSSO 100 HEALTH PARK DR STE 302 OWOSSO MI 48867 INTERNAL MEDICINE 24 - MEMORIAL HEALTHCARE UROLOGY 503 E MAIN ST OWOSSO MI 48867 UROLOGY 25 - PEDIATIC & ADOLESCENT SERVICES 802 W KING ST STE J OWOSSO MI 48867 PEDIATRICS 26 - MEMORIAL HEALTHCARE ORTHO & SPORTS MED 818 W KING ST LOWER LEVEL OWOSSO MI 48867 ORTHOPAEDICS 27 - MEMORIAL HEALTHCARE FAM MED & OCC MED 208 N SHIAWASSEE ST OWOSSO MI 48867 FAMILY PRACTICE & OCCUPATIONAL HEALTH 28 - MEMORIAL HEALTHCARE ENDOCRINOLOGY 802 W KING ST STE E OWOSSO MI 48867 ENDOCRINOLOGY 29 - MEMORIAL UROLOGY 818 W KING ST STE 202 OWOSSO MI 48867 UROLOGY 30 - MEMORIAL PHYSICAL REHAB - PERRY 3737 W LANSING ROAD PERRY MI 48872 REHAB SERVICES 31 - MEMORIAL HEALTHCARE HOSPITAL MEDICINE 826 W KING ST 3RD FLOOR OWOSSO MI 48867 HOSPITALISTS 32 - MEMORIAL HEALTHCARE PEDIATRIC GASTROENTE 1123 VILLA LINDE CT STE 38 FLINT MI 48532 PEDIATRICS 33 - MEMORIAL HEALTHCARE ALLERGY & IMMUNOLOGY 317 S ELM ST STE 205A OWOSSO MI 48867 ALLERGIST 34 - MEMORIAL HEALTHCARE INSTITUTE FOR NEUROS 4600 GARFIELD RD AUBURN MI 48611 NUERO 35 - MEMORIAL HEALTHCARE NUTRITION & DIABETES 317 S ELM ST STE 202 OWOSSO MI 48867 DIABETES 36 - MEMORIAL HEALTHCARE PALLIATIVE MEDICINE 1457 N M-52 STE 1 OWOSSO MI 48867 PALLATIVE CARE 37 - MEMORIAL HEALTHCARE INSTITUTE FOR NEUROS 1501 WATERFORD PARKWAY STE B ST JOHNS MI 48879 NUERO 38 - MEMORIAL HEALTHCARE PULMONOLOGY 826 W KING ST STE 200 OWOSSO MI 48867 PULMOMOLGIST 39 - MEMORIAL HEALTHCARE PHYSICAL MED & REHAB 1501 WATERFORD PARKWAY STE B ST JOHNS MI 48879 PHYSICAL MEDICINE & REHABILITATION PART I, LINE 7: THE COSTING METHODOLOGY USED FOR LINE 7A WAS THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 IN ADDITION TO DISCOUNTS AT COST PER THE HOSPITAL'S ACCOUNTING RECORDS. THE COSTING METHODOLOGY USED FOR LINES 7B - 7C WAS THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE COSTING METHODOLOGY USED FOR LINES 7E - 7I WERE ACTUAL COSTS PER THE HOSPITAL'S ACCOUNTING RECORDS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE EMERGENCY ROOM AND OR SERVICES. NO PHYSICIAN CLINICS ARE INCLUDED. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990 PART IX LINE 25 COLUMN A WAS SUBTRACTED FROM THE DENOMINATOR FOR PURPOSES OF CALCULATING THE PERCENT OF TOTAL EXPENSES. THE BAD DEBT EXPENSE EXCLUDED WAS $9,380,144. PART II, COMMUNITY BUILDING ACTIVITIES: MEMORIAL HEALTHCARE HAS A STRONG REPUTATION AS A COLLABORATOR AND SUPPORTER OF AGENCIES AND ORGANIZATIONS WORKING TO IMPROVE THE QUALITY OF LIFE IN OUR REGION. INCLUDED IN THESE EFFORTS IS A VIGOROUS SUPPORT BOTH FINANCIALLY AND IN-KIND OF THE ECONOMIC DEVELOPMENT EFFORTS IN OUR COUNTY. WE PLAY A LEADERSHIP ROLE IN THE HEALTH & HUMAN SERVICES COLLABORATIVE IN SHIAWASSEE COUNTY WHICH HAS MADE A DIFFERENCE IN IMPORTANT ISSUES TO OUR RESIDENTS SUCH AS: TRANSPORTATION, ACCESS TO HEALTH AND DENTAL CARE FOR THOSE ON MEDICAID OR UNINSURED, HOMELESSNESS PREVENTION, SUICIDE PREVENTION, ELDER CARE, ETC. 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: IT HAS BEEN ESTIMATED THAT APPROXIMATELY 30 PERCENT OF EXPENSES RELATING TO BAD DEBT ARE ATTRIBUTABLE TO PATIENTS THAT MAY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. THE ESTIMATE IS BASED ON THE HOSPITALS EXPERIENCE AND REVIEW OF CHARITY CARE APPLICATIONS. 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 OUR 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 MEMORIAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), MEMORIAL 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: MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. INPATIENT AND OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. COSTS ON STRESS, SUBACUTE AND LONG TERM CARE ARE ALSO INCLUDED. MEDICARE REVENUE AND COSTS RELATED TO THE SUBSIDIZED HEALTH SERVICES HAVE BEEN REMOVED IN ORDER TO AVOID DUPLICATION. ANY SHORTFALLS CALCULATED HERE ARE CONSIDERED TO BE A COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS RECEIVE A STATEMENT 14 DAYS AFTER THEIR INSURANCE PAYS OR 14 DAYS AFTER SERVICE FOR SELF PAY PATIENTS. PATIENT WILL RECEIVE A PAST DUE NOTICE (2ND STATEMENT) 30 DAYS AFTER FIRST STATEMENT IF NO PAYMENT MADE OR PAYMENT ARRANGEMENT SET UP. PATIENTS WILL THEN BE REFERRED TO OUR VENDOR CAREPAYMENT TO SET UP A 25 MONTH PAYMENT PLAN. IF THE PATIENT DEFAULTS (AFTER A MINIMUM OF 90 DAYS) ON THE PAYMENT PLAN THE ACCOUNT WILL BE RETURNED TO MEMORIAL AND THEN WILL BE SENT ONTO TO UNITED COLLECTION BUREAU FOR COLLECTION ACTIVITY. PATIENT WILL RECEIVE NOTICE OF ANY ECA'S 30 DAYS PRIOR TO BEING SENT TO COLLECTIONS. PART VI, LINE 2: WE ASSESS THE HEALTH NEEDS OF OUR RESIDENTS THROUGH COLLABORATIONS WITH THE COUNTY HEALTH DEPARTMENT, OUR 10 SCHOOL DISTRICTS, OUR COUNCIL OF HEALTH & HUMAN SERVICE AGENCIES AND THROUGH PHYSICIAN OBSERVATION AND REQUESTS. PART VI, LINE 3: WE COMMUNICATE THIS THROUGH SEVERAL METHODS INCLUDING: POSTING AT REGISTRATION POINTS, IN THE PATIENT HANDBOOK PROVIDED TO ALL INPATIENTS, IN A GUIDE TO THE BILLING PROCESS PAMPHLET HANDED OUT AT REGISTRATION POINTS, ON THE BACK OF OUR PATIENT STATEMENTS, VERBALLY THRU OUR FINANCIAL COUNSELING STAFF WHEN PATIENTS ARE IN-HOUSE AS WELL AS THROUGH PHONE CONVERSATIONS WITH PATIENTS CONCERNING THEIR BILLS. PART VI, LINE 4: MEMORIAL HEALTHCARE SERVES SHIAWASSEE COUNTY AND THE SURROUNDING REGION, APPROXIMATELY 105,000 PEOPLE. IT IS A RURAL COUNTY WITH A CENTRAL CITY OF OWOSSO (POPULATION 15,000). THE CENTER CORE OF THE COUNTY, OWOSSO, IS KNOWN AS A "MICROPOLITAN". THERE IS LITTLE RACIAL DIVERSITY, 94% OF THE RESIDENTS ARE WHITE, 4% ARE HISPANIC, 1% IS AFRICAN AMERICAN, AND 2% ARE OTHER/2 OR MORE RACES. THE DIVERSITY IS MORE APPARENT IN THE SOCIAL ECONOMIC DISPARITIES. IN JANUARY OF 2020, THE UNEMPLOYMENT RATE FOR SHIAWASSEE COUNTY WAS 4.40% WHICH WAS SLIGHTLY HIGHER THAN THE STATE AVERAGE OF 3.8%. IN MAY OF 2020, THE UNEMPLOYMENT RATE FOR SHIAWASSEE COUNTY WAS 29.2% WHICH WAS ALSO HIGHER THAN THE STATE AVERAGE OF 21.2%. 18.3% OF CHILDREN LIVE IN POVERTY. PART VI, LINE 5: MEMORIAL HEALTHCARE DEVELOPED A COLLABORATION WITH HEALTH DELIVERY, INC. OF SAGINAW TO SET UP A COMMUNITY HEALTH CENTER IN SHIAWASSEE COUNTY. THIS CENTER SERVES AS THE MEDICAL HOME FOR THOUSANDS WHO HAD NO ACCESS TO CARE. THROUGH A PARTNERSHIP WITH COMMUNITY MENTAL HEALTH, THIS CENTER ALSO NOW HAS A FULL TIME SOCIAL WORKER. CURRENTLY, WE ARE WORKING TO INCREASE ACCESS TO DENTAL HEALTH. WE ALSO RUN AN EFFECTIVE MEMORIAL FIT KIDS PROGRAM TEACHING 6 GRADERS HEALTH AND WELLNESS. PART VI, LINE 6: MEMORIAL HEALTHCARE FOUNDATION PROVIDES FUND DEVELOPMENT SERVICES TO ASSIST MEMORIAL HEALTHCARE. MEMORIAL HEALTHCARE OPERATES A SHORT-TERM, ACUTE-CARE FACILITY OFFERING INPATIENT AND OUTPATIENT HEALTHCARE, MENTAL HEALTH SERVICES, AND HOME CARE PRIMARILY TO CITIZENS OF SHIAWASSEE COUNTY, MICHIGAN. PART VI, LINE 7, REPORTS FILED WITH STATES MI X 1 1 X X 0 0 0 0 0 0 0 0 0 RANY ABURASHED PHYSICIAN 673501 0 154431 0 0 0 5600 0 21568 0 855100 0 0 0 ASHRAF ELBANNA PHYSICIAN 800010 0 34639 0 0 0 5600 0 8120 0 848369 0 0 0 BRIAN LONG PRESIDENT/CEO 630120 0 126121 0 0 0 5600 0 16969 0 778810 0 0 0 MICHAEL SCHMIDT DO CHIEF OF STAFF 620000 0 70735 0 0 0 5600 0 21800 0 718135 0 0 0 TAREK PACHA PHYSICIAN 617308 0 51200 0 0 0 4524 0 20990 0 694022 0 0 0 JOSEPH PALAZETI PHYSICIAN 620001 0 6735 0 0 0 5600 0 21799 0 654135 0 0 0 LISA LEPAIN PHYSICIAN 602002 0 14411 0 0 0 5600 0 17928 0 639941 0 0 0 JAMES NEMETH VP OF NURSING 345400 0 51723 0 0 0 5600 0 21209 0 423932 0 0 0 JOSEPH BUSTAMANTE CHIEF MEDICAL OFFICER 334395 0 47970 0 0 0 5600 0 21165 0 409130 0 0 0 COLLEEN KOPPENHAVER EXECUTIVE VP/CFO 291250 0 54535 0 0 0 5600 0 17850 0 369235 0 0 0 MICHAEL KRAMER DO BOARD MEMBER 230186 0 123414 0 0 0 5225 0 8119 0 366944 0 0 0 ANTHONY PATSY DO BOARD MEMBER 222691 0 76373 0 0 0 4743 0 20965 0 324772 0 0 0 PART I, LINE 1A PHYSICIANS LISTED IN FORM 990, PART VII (AS WELL AS ALL THE PHYSICIANS ON STAFF) ARE GENERALLY ALLOWED $4,000/YEAR PER THEIR CONTRACTS. USUALLY, THIS MONEY IS USED FOR BOOKS AND CONTINUING EDUCATION. THIS IS NOT REPORTED AS TAXABLE COMPENSATION TO THE PHYSICIANS. A MICHIGAN FINANCE AUTHORITY 381358208 2015-07-29 7055000 FUND $7 MILLION OF 2015 CAPITAL BUDGET 0 0 0 B MICHIGAN FINANCE AUTHORITY 381358208 59447PXT3 2013-08-06 19369159 PAY DOWN DEBT - $12 MILLION / FUND $8 MILLION OF 2013 CAPITAL BUDGET 0 0 0 A 2880792 7055000 64952 6990048 2015 1 0 0 1 B 7858344 19369159 70728 9991669 9306762 2014 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 1 0 B 0 0 0 0 0 0 0 1 0 A 1 B 1 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT. THE CEO, CFO, AND THE FINANCE DIRECTOR ALL REVIEWED THE 990. ADDITIONALLY, THE FINANCE COMMITTEE AND THE FULL BOARD REVIEWED THE 990 DURING THEIR OCTOBER MEETING. PRIOR TO FILING FORM 990, A COPY OF THE 990 WAS MADE AVAILABLE TO ALL OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS AND LEADERSHIP TEAM MEMBERS ARE COVERED BY THIS POLICY. EACH COVERED MEMBER IS REQUIRED TO COMPLETE A DISCLOSURE STATEMENT ANNUALLY. ANY POTENTIAL CONFLICT THAT ARISES DURING THE YEAR MUST BE DISCLOSED WITHIN 14 DAYS OF FIDUCIARY'S KNOWLEDGE THAT A CONFLICT MAY EXIST. THE BOARD CHAIR HAS ULTIMATE RESPONSIBILITY FOR ENFORCEMENT OF THE POLICY. IF A CONFLICT DOES EXIST, THE MEMBER WITH THE CONFLICT ABSTAINS FROM VOTING AND THE CONFLICT IS NOTED IN THE MINUTES OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT, OFFICERS AND KEY EMPLOYEES INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION UPON HIRING. THE FULL BOARD OF DIRECTORS REVIEWS THE CEO'S COMPENSATION ANNUALLY. A COMPENSATION COMMITTEE HAS BEEN FORMED AND ACTIVELY PARTICIPATES IN DECISIONS RELATED TO CEO AND EXECUTIVE PAY AND BENEFITS AS WELL AS PROVIDING INPUT AND OVERSIGHT FOR THE ORGANIZATIONS COMPENSATION PHILOSOPHY AND PROGRAM. CEO AND EXECUTIVE PAY IS REVIEWED AT LEAST ANNUALLY BY THIS COMMITTEE. THE MOST RECENT REVIEW OF CEO AND EXECUTIVE PAY WAS APRIL 2020. UPDATED SALARY RANGES ARE PROVIDED BY AN OUTSIDE COMPENSATION CONSULTING COMPANY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER TO/ FROM AFFILIATE -50,705. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND FOR SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MEMORIAL HEALTHCARE FOUNDATION 826 WEST KING STREET OWOSSO MI 48867 383036586 TO PROVIDE FUND DEVELOPMENT SERVICES TO ASSIST MEMORIAL HEALTHCARE. MI 501(C)(3) LINE 12A, I MEMORIAL HOSPITAL 1 MEMORIAL HEALTHCARE PAIN MANAGEMENT LLC 826 W KING STREET OWOSSO MI 48867 472218456 PROVIDE OUTPATIENT PAIN MANAGEMENT SERVICES MI MEMORIAL HOSPITAL RELATED 305190 572341 0 0 0.51000 MEMORIAL ASSISTED LIVING LLC 3520 DAVENPORT AVENUE SAGINAW MI 48602 464831571 PROVIDE ASSISTED LIVING AND MEMORY CARE SERVICES MI N/A MHC DEVELOPMENT CORPORATION 826 W KING STREET OWOSSO MI 48867 463742868 DEVELOPMENT OF ASSISTED LIVING PROPERTY MI MEMORIAL HOSPITAL C -2705 5012543 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 MEMORIAL HEALTHCARE FOUNDATION C 200670 ACTUAL CASH MEMORIAL HEALTHCARE FOUNDATION P 251899 ACTUAL CASH MEMORIAL HEALTHCARE PAIN MANAGEMENT S 108405 ACTUAL CASH