2015-11-11T15:33:46-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2014-01-01 382602147 CHIPPEWA CNTY WAR MEMORIAL HOSPITAL INC CHIP 9066354460 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 KEVIN KALCHIK CFO 9066354460 2015-11-06 1 MICHAEL A BAKER CPA P00053797 2319477800 2014 2016-02-25 16:41:14Z WAR MEMORIAL HOSPITAL DAVID JAHN CEO 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 96037937 0 X WWW.WARMEMORIALHOSPITAL.ORG X 1985 MI TO PROVIDE HEALTH CARE SERVICES AND ACCESS TO THE RESIDENTS OF SAULT STE. MARIE AND THE EASTERN UPPER PENINSULA. OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. 10 10 1026 335 0 0 171951 373707 94545838 93954531 287798 896767 664954 548461 95670541 95773466 0 0 0 0 50123624 51035235 0 0 0 44019002 41955711 94142626 92990946 1527915 2782520 69368473 69963819 46650859 45192929 22717614 24770890 X OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. 0 0 52948423 63604825 HOSPITAL INPATIENT AND OUTPATIENT SERVICES - WAR MEMORIAL HOSPITAL PROVIDED INPATIENT CARE TO 2,583 PATIENTS AND THERE WERE OVER 145,426 PATIENT REGISTRATIONS FOR THE HOSPITAL'S MULTIPLE OUTPATIENT SERVICE DEPARTMENTS (LAB, RADIOLOGY, CARDIOPULMONARY, REHABILITATION, NUCLEAR MEDICINE, SURGICAL SERVICES).OUR OBSTETRICS/NURSERY UNIT REPORTED 378 BIRTHS AND OUR SURGICAL SERVICES DEPARTMENT PROVIDED SURGICAL CARE FOR 5,716 PATIENTS.THE REHABILITATION DEPARTMENT CONTINUED ITS EXPANSION OF SERVICES IN CONTRACTING TO PROVIDE REHABILITATION SERVICES WITH MULTIPLE ORGANIZATIONS IN THE REGION; INCLUDING, BUT NOT LIMITED TO, AREA SCHOOLS, HOSPITALS, AND HOME HEALTH AGENCIES. NEARLY 354,469 REHABILITATION TREATMENTS WERE REPORTED IN THE DISCIPLINES OF PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY AND AUDIOLOGY SERVICES. 16297892 19578006 PROFESSIONAL SERVICES - THE HOSPITAL'S TWENTY FOUR HOUR EMERGENCY DEPARTMENT AND THE COMMUNITY CARE CLINIC (WALK-IN URGENT CARE CENTER) RECORDED 15,991 VISITS AND 11,521 VISITS RESPECTIVELY FOR A TOTAL CARE PROVIDED TO 27,512 PATIENTS. VISITS BY PHYSICIAN CLINIC:3,549 CEDARVILLE FAMILY PRACTICE 807 DETOUR CLINIC1,206 DRUMMOND ISLAND MEDICAL CENTER5,086 ADVANCED SURGICAL SERVICES2,732 NORTHERN SURGICAL ORTHOPEDICS1,935 SAULT PEDIATRICS3,364 SAULT WOMEN'S HEALTHCARE 681 SUPERIOR NEUROSCIENCES2,036 UP PAIN INSTITUTE1,783 UP UROLOGY1,738 DERMATOLOGY2,662 WMH COMMUNITY CARE KINROSS1,225 SLEEP CLINIC1,361 ONCOLOGY 719 NEPHROLOGY 952 INTERNAL MEDICINE 732 INFECTIOUS DISEASE 5009316 6017491 SKILLED NURSING - OUR 51 BED LONG TERM CARE UNIT (HOSPITAL-ATTACHED SKILLED NURSING HOME) HAD AN AVERAGE OCCUPANCY RATE OF 94 PERCENT DURING THE YEAR. 4028980 4839853 OTHER PROGRAM SERVICES - WHICH INCLUDES, BUT IS NOT LIMITED TO, INPATIENT PSYCH WITH 3,619 PATIENT DAYS. 4028980 4839853 78284611 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 136 0 1 1026 1 0 0 0 0 0 1 1 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN KALCHIK CFO 9066354456 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 FRANK SASSO CHAIR 1.50 0.00 X X 8685 0 0 JOHN JORGENSON SR SECRETARY 1.50 0.00 X X 7331 0 0 WW LAJOIE TREASURER 1.50 0.00 X X 7340 0 0 SCOTT SHACKLETON VICE CHAIR 1.50 0.00 X X 7335 0 0 TED POSTULA TRUSTEE 1.50 0.00 X 7556 0 0 GARY MCDOWELL TRUSTEE 1.50 0.00 X 7821 0 0 SHANE WOOLEVER TRUSTEE/PHYSICIAN 20.00 0.00 X 178511 0 0 MAXINE ANDERSON TRUSTEE 1.50 0.00 X 7376 0 0 HOLLY KIBBLE TRUSTEE 1.50 0.00 X 5666 0 0 KIM MCCULLOUGH TRUSTEE 20.00 0.00 X 96999 0 0 DAVID JAHN CEO 40.00 0.00 X 255684 0 38500 KEVIN KALCHIK CFO 40.00 0.00 X 154114 0 31904 MARLA BUNKER VP OF CLINICAL OPERATIONS 40.00 0.00 X 145258 0 31753 JAMES HAGLUND VICE PRESIDENT OF REHAB 40.00 0.00 X 185344 0 21477 RADWAN ALKIEK PHYSICIAN 40.00 0.00 X 445666 0 21961 RICHARD GANZHORN PHYSICIAN 40.00 0.00 X 920021 0 32389 JAMIE ADAIR PHYSICIAN 40.00 0.00 X 523176 0 32389 PAULA RECHNER PHYSICIAN 40.00 0.00 X 481943 0 32389 MOHAMMED HAIDER PHYSICIAN 40.00 0.00 X 454462 0 32389 3900288 0 275151 34 0 1 0 EASTERN UPPER PENINSULA PO BOX 2870 WHITEHOUSE OH 43571 E.R. PHYSICIAN COVERAGE 1487487 ABM HEALTHCARE SUPPORT SERVICES 22622 HARPER ST CLAIR SHORES MI 48080 CONTRACT SERVICES 436918 MEDICAN INFORMATION TECHNOLOGY INC PO BOX 7456 CHICAGO IL 60696 CONTRACT SERVICES 369107 CEDAR STRAIGHTS RADIOLOGY 2245 SOUTH CROOKED TREE LANE CEDARVILLE MI 49719 PROFESSIONAL FEES 351432 SAULT STE MARIE TRIBE OF INDIANS 523 ASHMUN STREET SAULT STE MARIE MI 49783 CONTRACT SERVICES 287299 26 2390 371317 373707 PATIENT SERVICE REVENUE 622110 92734791 92734791 EHR REVENUE 622110 870022 870022 OTHER RELATED REVENUE 622110 349718 349718 93954531 138295 138295 337771 252127 85644 85644 85644 758472 0 758472 758472 758472 27850 2390 12344 15506 15506 CAFETERIA REVENUE 722210 447311 447311 447311 95773466 94040175 0 1359584 948652 393380 555272 39336480 34690735 4645745 8181146 5522447 2658699 2568957 2227689 341268 173788 173788 171400 171400 8175610 6511458 1664152 142148 1743 140405 154860 66241 88619 319418 82431 236987 162592 101689 60903 144935 88716 56219 1707609 1464720 242889 4360297 3822849 537448 647020 644647 2373 SUPPLIES 15886361 15442415 443946 PROVISION FOR BAD DEBTS 2420760 2420760 QUALITY ASSESSMENT FEES 2351987 2351987 REPAIRS AND MAINTENANCE 2284571 1393040 891531 2852355 1057664 1794691 92990946 78284611 14706335 0 5781 5275 2889011 5291676 12069462 8665129 2240954 2205806 444108 580906 86399386 44327837 44162455 42071549 6161467 8736807 329868 256681 1065367 2149990 69368473 69963819 8448442 6882584 35404908 36168651 2797509 2141694 46650859 45192929 X 22717614 24770890 22717614 24770890 69368473 69963819 X 2782520 222811 -952055 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11235 11235 0 PART II-B, LINE 1: PORTION OF ANNUAL DUES TO THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARD LOBBYING ACTIVITIES. 2819909 2819909 57690074 25052377 32637697 757478 340610 416868 24714066 18934850 5779216 417859 417859 42071549 ACCRUED POST-RETIREMENT BENEFIT 930887 ACCRUED INSURANCE 428000 COST REPORT SETTLEMENT PAYABLE 297854 ACCRUED MALPRACTICE LIABILITY 484953 2141694 X 96257666 222811 -3082 219729 96037937 -264471 -264471 95773466 94204390 1216526 1216526 92987864 3082 3082 92990946 PART X, LINE 2: THE HOSPITAL IS A NONPROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PERSUANT TO SECTION 501(A) OF THE CODE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: GRANT EXPENSES -3,082. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -12,344. RENTAL EXPENSES -252,127. PART XII, LINE 2D - OTHER ADJUSTMENTS: EQUITY LOSSES OF UNCONSOLIDATED JOINT VENTURES 952,055. FUNDRAISING EXPENSES 12,344. RENTAL EXPENSES 252,127. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANT EXPENSES 3,082. GOLF OUTING 30000 2150 27850 989 4575 6780 NRS SCHOLARSHIP FUNDRAISER 240 240 30240 2390 27850 989 4575 6780 12344 15506 1 1 X 1 X 1 X 1 1 1 0 1 1 182336 0 182336 0.00200 13522296 15645973 -2123677 0.00000 13704632 15645973 -1941341 0.00200 2939 6096 223364 223364 0.00250 140 2249 361787 361787 0.00400 10351528 6449312 3902216 0.04310 41 3200 53335 53335 0.00060 3120 11545 10990014 6449312 4540702 0.05020 3120 11545 24694646 22095285 2599361 0.05220 0 2420760 1210380 17590798 16933082 657716 X 1 1 1 1 CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 WWW.WARMEMORIALHOSPITAL.ORG 1060000093 X X X CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 0 1 1 X HTTP://WWW.WARMEMORIALHOSPITAL.ORG/FILE-DOWNLOAD/7/FS71-1436891271-33408.PD X 1 13 1 HTTP://WWW.WARMEMORIALHOSPITAL.ORG/FILE-DOWNLOAD/7/FS07-1443731119-46619.PD 0 0 1 X 200.000000000000 250.000000000000 X X X X 1 1 X X X X 1 X X X X 1 0 X X X 1 X 0 0 CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: A COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ON THE HOSPITALS WEBSITE LOCATED AT HTTP://WWW.WARMEMORIALHOSPITAL.ORG/FILE-DOWNLOAD/7/FS71-1436891271-33408.PDF.CHIPPEWA WAR MEMORIAL HOSPITAL IN CONJUNCTION WITH CHIPPEWA COUNTY HEALTH DEPARTMENT AND MICHIGAN CENTER FOR RURAL HEALTH CONDUCTED A NEEDS ASSESSMENT. A COMPREHENSIVE NINE-PAGE SURVEY WAS DEVELOPED BY THE NATIONAL CENTER FOR RURAL HEALTH WORKS AND MODIFIED FOR THIS STUDY. A COMPANY NAMED ACCULEADS PROVIDED RANDOMIZED MAILING ADDRESSES FOR THE CITIES OF BARBEAU, BRIMLEY, DAFTER, DE TOUR VILLAGE, DRUMMOND ISLAND, ECKERMAN, FIBRE, GOETZVILLE, HULBERT, KINCHELOE, KINROSS, PARADISE, PICKFORD, RACO, RUDYARD, SAULT SAINTE MARIE, STALWART, STRONGS, AND TROUT LAKE. ALTOGETHER, 1,144 COMPLETED SURVEYS WERE RETURNED (57%). IN ADDITION, TWO COMMUNITY MEETINGS WERE FACILITATED BY ANGIE EMGE OF THE MICHIGAN CENTER FOR RURAL HEALTH AT THE LAKE SUPERIOR STATE UNIVERSITY CISLER CENTER IN SAULT STE. MARIE, MICHIGAN. PARTICIPANTS INCLUDED: COMMUNITY MEMBERS, NURSING SCHOOL STUDENTS FROM LAKE SUPERIOR STATE UNIVERSITY, INSTRUCTOR FROM LAKE SUPERIOR STATE UNIVERSITY, WAR MEMORIAL AUXILIARY MEMBERS, AND MEMBER FROM SAULT TRIBE OF CHIPPEWA INDIANS. CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: WHILE THE CHNA IDENTIFIED OTHER HEALTH NEEDS, THEY WERE SEEN TO BE BEYOND THE SCOPE OF OUR SERVICES OR WE COULD NOT MAKE A SIGNIFICANT IMPACT UPON THEM DUE TO LIMITED PERSONNEL AND/OR FINANCIAL RESOURCES.THE FULL COPY OF THE IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.WARMEMORIALHOSPITAL.ORG/FILE-DOWNLOAD/7/FS07-1443731119-46619.PDF. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.WARMEMORIALHOSPITAL.ORG/FILE-DOWNLOAD/65/FS16-1421965671-67484.P 2 LONG TERM CARE 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 SKILLED NURSING FACILITY BEHAVIORAL HEALTH CENTER 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 INPATIENT PSYCHIATRIC FACILITY PART I, LINE 3C: THE HOSPITAL, THROUGH ITS PARTNERSHIP WITH COMMUNITY HEALTH ACCESS COALITION, UTILIZES 200% OF POVERTY GUIDELINES FOR INITIAL ACCESS AND APPLICATION FOR MEDICAID. FOR THOSE COMMUNITY MEMBERS THAT DO NOT QUALIFY, 250% OF POVERTY GUIDELINES ARE UTILIZED FOR ADDITIONAL DISCOUNTS OR FREE CARE ON REMAINING BALANCES AND NON-COVERED SERVICES. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E) AND HEALTH PROFESSIONS EDUCATION (LINE 7F).A DIRECT COST AND STEP-DOWN APPROACH WAS USED TO COMPLETE THE SUBSIDIZED HEALTH SERVICES PROGRAMS (LINE 7G). PART I, LINE 7G: INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE: ORTHO SURGERY, GENERAL SURGERY, SURGICAL ASSISTANT, ER PROFESSIONAL, BEHAVIORAL HEALTH, OB PROFESSIONAL, AND OB PROGRAM. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $2,420,760. SCHEDULE H, PART I, LINE 7B: THE HOSPITAL PARTICIPATES IN THE MICHIGAN DISPROPORTIONATE SHARE PROGRAM (DSH) AS WELL AS THE MICHIGAN QUALITY ASSURANCE ASSESSMENT PROGRAMS (QAAP). THE DSH PROGRAM IS SET UP TO SUPPLEMENT FOR SHORTFALLS INCURRED DUE TO SERVING INDIGENT POPULATIONS IN THE COMMUNITY (SELF-PAY, MEDICAID, MEDICAID ADVANTAGE). THE QAAP PROGRAM IS SET UP TO SUPPLEMENT FOR SHORTFALLS INCURRED DUE TO SERVING MEDICAID PATIENTS. THE HOSPITAL PAID IN AMOUNTS TO FUND THE PROGRAM AND IN RETURN RECEIVED THEIR RESPECTIVE SHARE OF THE STATE DSH AND QAAP FUNDS. THE RESULT WAS A GAIN TO THE HOSPITAL, AS DETAILED BELOW: DSH PROGRAM QAAP PROGRAMREVENUE $1,714,164 $4,534,322EXPENSE $ 277,060 $2,074,927 ----------- -----------GAIN $1,437,104 $2,459,395IF THESE PROGRAMS DID NOT EXHIST, THE HOSPITAL WOULD HAVE REPORTED A SHORTFALL FROM PROVIDING SERVICES TO MEDICAID PATIENTS. PART II, COMMUNITY BUILDING ACTIVITIES: WAR MEMORIAL HOSPITAL IS ACTIVE IN BOTH THE PROMOTION OF HEALTHY LIFESTYLES FOR BOTH ITS EMPLOYEES AND COMMUNITY MEMBERS. WAR MEMORIAL HOSPITAL WILL TAKE A LEAD ROLE IN MANY OF THESE ENDEAVORS, BUT ALSO IS WILLING TO BE A SUPPORTIVE PARTNER AND TEAM MEMBER AS WELL. PART III, LINE 2: THE BAD DEBT EXPENSE ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY, $1,210,380, IS EQUAL TO APPROXIMATELY 50 PERCENT OF BAD DEBT EXPENSE. THIS IS DUE TO THE INABILITY TO OBTAIN FINANCIAL ASSISTANCE FORMS FROM UNWILLING PATIENTS. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL 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 HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). 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), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS 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. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.WAR MEMORIAL HOSPITAL PROVIDES CARE TO PATIENTS COVERED BY GOVERNMENTAL PROGRAMS AT REIMBURSEMENTS AT REIMBURSEMENT LESS THAN WHAT IS NEEDED IN ORDER TO PROVIDE STABILITY OF OPERATIONS. AS THE NUMBER OF UNINSURED OR UNDERINSURED CITIZENS CONTINUES TO INCREASE, THE HOSPITAL'S ABILITY TO COLLECT REIMBURSEMENTS FOR SERVICES PROVIDED CONTINUES TO BE A CHALLENGE. THEREFORE, HOSPITAL LEADERS HAVE SERVED IN LEADERSHIP CAPACITIES IN THE DEVELOPMENT OF A COMMUNITY HEALTH ACCESS COALITION WHICH HAS A MISSION TO PROVIDE ACCESS TO QUALITY HEALTH CARE FOR THE UNINSURED RESIDENTS OF CHIPPEWA, LUCE, AND MACKINAC COUNTIES BY COORDINATING SERVICES OF VARIOUS HEALTH CARE PROVIDERS TO OFFER AN AFFORDABLE, DIGNIFIED AND ENHANCED CONTINUUM OF CARE. THE HOSPITAL AS WELL AS LOCAL PHYSICIANS AGREE TO PROVIDE CARE THAT IS UNCOMPENSATED OR AT A REDUCED FEE. OVER THE PAST YEAR, THE HOSPITAL HAS EITHER BEEN ACTIVE OR SUPPORTED THE ACTIVITIES TO DEVELOP COMMUNITY AWARENESS FOR BOTH THE HEALTH EXCHANGES AND MEDICAID EXPANSION. PART III, LINE 8: THE MEDICARE SURPLUS(SHORTFALL) WAS CALCULATED BY UTILIZING COST ACCOUNTING WHEN APPROPRIATE AND AVAILABLE. IN SOME AREAS A COST TO CHARGE METHODOLOGY WAS REQUIRED. THE SURPLUS SHOULD BE CONSIDERED AND INCLUDED IN THE COMMUNITY BENEFIT AS THE REIMBURSEMENT DID NOT MEET THE "COST" OF THE EXPENSE BASED ON REASONABLE COSTING METHODOLOGIES. PART III, LINE 9B: WAR MEMORIAL HOSPITAL UTILIZES AN ON-LINE INSURANCE VERIFICATION PROCESS TO INITIATE THE EDUCATION AND ELIGIBILITY FROM THE ON-SET OF SERVICES. UPFRONT COLLECTIONS ARE AN ACTIVE PART OF THE PROCESS TO BOTH EDUCATE THE PATIENT AND TO REDUCE BACK-END COSTS OF COLLECTIONS. AT ANY TIME DURING THE PROCESS STAFF ARE TRAINED TO ADDRESS THE PERCEIVED FINANCIAL ASSISTANT NEEDS AND PROVIDE ACCESS TO THE IN-HOUSE PATIENT FINANCIAL COUNSELOR, COMMUNITY HEALTH ACCESS COALITION, OR THE DEPARTMENT OF HEALTH SERVICES REPRESENTATIVE. IN THE BILLING PROCESS, PATIENTS ARE STILL OFFERED ANY EDUCATION NECESSARY TO OBTAIN ASSISTANCE. ONCE SERVICES ARE RECEIVED AND THE PATIENT CHARGES HAVE ACCUMULATED PRIMARY SOURCES OF COVEAGE ARE BILLED. AFTER ALL EFFORTS OF COLLECTION FROM PRIMARY PAYOR (INSURANCE) THE PATIENT IS BALANCED BILL AND PROVIDED THE OPPORTUNITY FOR PAYMENT IN FULL OR OTHER PAYMENT OPTIONS. SCHEDULE H, PART III, LINES 5 AND 6: OTHER INFORMATION: AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE COSTS NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) ARE SUMMARIZED AS FOLLOWS:TOTAL COST: 8,587,710TOTAL REIMBURSEMENT 8,004,185COST IN EXCESS OF REIMBURSEMENT 583,526 PART VI, LINE 2: WAR MEMORIAL HOSPITAL WORKS IN CONJUNCTION WITH MANY OF THE HOSPITAL'S IN THE NORTHERN MICHIGAN AND THE UPPER PENINSULA. IN THESE EFFORTS "NEEDS" OF THE COMMUNITIES ARE ASSESSED THROUGH WORK WITH OTHER HOSPITAL'S, HEALTH RELATED ORGANIZATION'S, AND IN COMMUNITY FORUM'S. IN ADDITION, WAR MEMORIAL HOSPITAL HAS ENGAGED OUTSIDE ASSISTANCE IN THE PLANNING FOR "NEEDS" OF BOTH SERVICES AND PHYSICIANS TO BEST PLAN FOR CAPITAL AND RECRUITMENT APPROPRIATIONS. PART VI, LINE 3: WAR MEMORIAL HOSPITAL PRIDES ITSELF ON PROVIDING NEEDED CARE TO THE INDIGENT OF THE EASTERN UPPER PENINSULA IN A DIGNIFIED MANNER. THIS EDUCATION AND ASSISTANCE IS DONE THROUGH PARTNERSHIPS WITH OTHER "ACCESS" POINTS. SPECIFICALLY, WAR MEMORIAL HOSPITAL HAS PROVIDED RESOURCES TO THE CHAC (COMMUNITY HEALTH ACCESS COALTION) AND WAR MEMORIAL HOSPITAL HAS ENTERED INTO AN AGREEMENT WITH THE STATE OF MICHIGAN TO PROVIDE A DHS (DEPARTMENT OF HEALTH SERVICES) WORKER ON-SITE FOR READY ACCESS FOR OUR PATIENTS. THROUGH THE COLLABORATION OF THESE RELATIONSHIPS OUR PATIENTS ARE FIRST NOTIFIED AND REFERRED TO THE APPROPRIATE RESOURCE FROM THE ON-SET OF RECEIVING HEALTH CARE SERVICES. IN ADDITION, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS POSTED IN THE ADMISSIONS OFFICES AND IS PROVIDED IN WRITING TO PATIENTS UPON ADMISSION TO THE HOSPITAL. PART VI, LINE 4: WAR MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS THE EASTERN UPPER PENINSULA OF MICHIGAN. IN THIS AREA THERE ARE THREE COUNTIES WHICH CONSIST OF CHIPPEWA, MACKINAC, AND LUCE. WAR MEMORIAL HOSPITAL PRIDES ITSELF ON THE QUALITY OF SERVICES IT PROVIDES AS A RURAL SOLE COMMUNITY HOSPITAL. THE CLOSEST HOSPITAL IS 50 MILES AWAY AND IS A CRITICAL CARE HOSPITAL. THE CLOSEST TERTIARY FACILITY IS OVER AN HOUR AND A HALF AWAY. WAR MEMORIAL HOSPITAL STRIVES FOR PROVIDING SERVICES TO THE COMMUNITY FOR WHICH OTHERWISE THE COMMUNITY MEMBER WOULD MOST LIKELY HAVE TO TRAVEL TO A TERTIARY FACILITY. THROUGH ITS OWN EFFORTS AND JOINT VENTURES AREAS OF CARE SUCH AS OBSTETRICS AND DELIVERY, DIALYSIS, ONCOLOGY, CARDIOLOGY, PULMONOLOGY, INFECTIOUS DISEASE, AND I/P PSYCHIATRIC SERVICES WOULD NOT BE AVAILABLE.WAR MEMORIAL HOSPITAL IS ONE OF THE TOP THREE LARGEST EMPLOYERS IN OUR REGION. WE EMPLOY APPROXIMATELY 895 PEOPLE AND HAVE AN ANNUAL PAYROLL OF APPROXIMATELY $39.8 MILLION; PROVIDING A POSITIVE ECONOMIC IMPACT IN THE COMMUNITY. PART VI, LINE 5: WAR MEMORIAL HOSPITAL PROVIDES MANY POINTS OF ACCESS THAT ARE NOT PROFITABLE, BUT OTHERWISE WOULD REQUIRE OUR COMMUNITY MEMBERS TO TRAVEL GREAT DISTANCES. THE HOSPITAL MANAGEMENT AND STAFF PARTICIPATE ACTIVELY IN MANY HEALTH AND EDUCATIONAL ENDEAVORS. AN EXAMPLE IS PROVIDING CLINICAL STAFF TO THE LOCAL STATE UNIVERSITY TO ASSIST IN THE EDUCATION OF REGISTERED NURSES. OTHER EXAMPLES INCLUDE INFORMAL PARTNERSHIPS WITH TWO LOCALLY RECOGNIZED NATIVE AMERICAN TRIBES AND FULL SUPPORT OF COUNTY HEALTH INITIATIVES. PROGRAM EXAMPLES WOULD INCLUDE FLU-CLINIC, DIALYSIS, DIABETIC EDUCATION, COUNTY HEALTH DEPARTMENT COLON SCREENING, PHYSICALS FOR STUDENT ATHLETES, AND REGIONAL CHARITY CARE INITIATIVES.WAR MEMORIAL HOSPITAL CONTINUES TO PARTNER WITH TERTIARY FACILITIES TO PROVIDE CONSISTENT ACCESS TO PROVIDERS OF CARDIOLOGY. DUE TO THE HOSPITAL'S GEOGRAPHIC LOCATION AND COMMUNITY SIZE, THE HOSPITAL HAS CONTINUED TO INDEPENDENTLY RECRUIT OTHER SPECIALISTS TO ENSURE THAT COMMUNITY ACCESS TO SERVICES AND PROVIDERS IS ACCOMPLISHED THROUGH PROVIDER BASED CLINICS. THE HOSPITAL CONTINUES ITS EFFORTS IN PROVIDING PRIMARY CARE IN OUTREACH AREAS OF THE EASTERN UPPER PENINSULA. WITH THESE EFFORTS AND PARTNERSHIPS THE HOSPITAL HAS BEEN SUCCESSFUL IN MAINTAINING ALL OTHER SERVICES.WAR MEMORIAL HOSPITAL CONTINUED ITS LEADERSHIP AND INVOLVEMENT WITHIN THE COMMUNITY AND THE HEALTHCARE PROVIDER COMMUNITY BY PROVIDING EDUCATION AND TRAINING. EXAMPLES OF COMMUNITY EDUCATION AND/OR HEALTH SCREENINGS INCLUDED A SENIOR HEALTH FAIR, EARLY PRE-NATAL EDUCATION AND CHILDBIRTH CLASSES. THE HOSPITAL'S INVOLVEMENT IN HEALTHCARE PROVIDER EDUCATION AND TRAINING INCLUDED NURSE AIDE TRAINING PROGRAMS AND SERVING AS CLINICAL INTERNSHIP SITE FOR MANY COLLEGE AND UNIVERSITY TRAINING PROGRAMS FOR STUDENTS IN REGISTERED NURSING, PHARMACY, MEDICAL TECHNOLOGY, HEALTH INFORMATION MANAGEMENT, AND PHYSICIAN ASSISTANT PROGRAMS. THE HOSPITAL IS ALSO DESIGNATED AS A COMMUNITY TRAINING CENTER OFFERING TRAINING TO AREA PHYSICIANS AND STAFF ON PEDIATRIC ADVANCED LIFE SUPPORT, ADVANCED CARDIAC LIFE SUPPORT AND BASIC LIFE SUPPORT. THE HOSPITAL IS ALSO CERTIFIED TO PROVIDE CONTINUING MEDICAL EDUCATION TO AREA PHYSICIANS AND STAFF AND CONDUCTS MORE THAN 25 ON-SITE PROGRAMS PER YEAR. VIDEO CONFERENCING CAPABILITIES ALSO PROVIDE ACCESS TO COMMUNITY AND HEALTHCARE PROVIDER TRAINING THROUGHOUT THE YEAR.WAR MEMORIAL HOSPITAL EMPLOYEES HAVE EMPLOYMENT BENEFITS WHICH INCLUDE PAYMENT FOR EXPENSES FOR THE COMPLETION OF A BACHELOR OF SCIENCE IN NURSING FOR CURRENT REGISTERED NURSES. ADDITIONALLY, OTHER EMPLOYEES HAVE ANNUAL EDUCATION BENEFITS FOR CONTINUING OR ADVANCING THEIR EDUCATION IN A HEALTHCARE FIELD. THE HOSPITAL ALSO OFFERS AN EDUCATIONAL LOAN PROGRAM WITH A PERIOD OF NO-INTEREST LOANS WHILE ENROLLED IN AN EDUCATIONAL PROGRAM. FOR NEWLY HIRED EMPLOYEES IN JOB SHORTAGE CLASSIFICATIONS, EMPLOYEES CAN RECEIVE FUNDS FOR STUDENT LOAN REPAYMENT FOR A COMMITMENT TO SERVE WAR MEMORIAL HOSPITAL FOR A SPECIFIED NUMBER OF YEARS. PART VI, LINE 6: NOT AFFILIATED. PART VI, LINE 7, REPORTS FILED WITH STATES MI X X X X X 0 0 0 0 0 0 0 0 0 SHANE WOOLEVER TRUSTEE/PHYSICIAN 178511 0 0 0 0 0 0 0 0 0 178511 0 0 0 DAVID JAHN CEO 254934 0 0 0 750 0 23000 0 15500 0 294184 0 0 0 KEVIN KALCHIK CFO 146663 0 0 0 7451 0 12533 0 19371 0 186018 0 0 0 MARLA BUNKER VP OF CLINICAL OPERATIONS 139725 0 0 0 5533 0 12364 0 19389 0 177011 0 0 0 JAMES HAGLUND VICE PRESIDENT OF REHAB 184274 0 0 0 1070 0 14314 0 7163 0 206821 0 0 0 RADWAN ALKIEK PHYSICIAN 430666 0 15000 0 0 0 12266 0 9695 0 467627 0 0 0 RICHARD GANZHORN PHYSICIAN 719232 0 171197 0 29592 0 13000 0 19389 0 952410 0 0 0 JAMIE ADAIR PHYSICIAN 513777 0 0 0 9399 0 13000 0 19389 0 555565 0 0 0 PAULA RECHNER PHYSICIAN 441500 0 25000 0 15443 0 13000 0 19389 0 514332 0 0 0 MOHAMMED HAIDER PHYSICIAN 430414 0 24048 0 0 0 13000 0 19389 0 486851 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE DEPARTMENT WORKS WITH THE APPROPRIATE DEPARTMENTS TO PROVIDE RELEVANT INFORMATION TO THE PREPARER OF THE 990 (AN OUTSIDE FIRM SPECIALIZING IN TAX PREPARATION). REVIEW AND DISCUSSION OF ALL INFORMATION TAKES PLACE BETWEEN THE FINANCE DEPARTMENT AND THE CFO. THE FORM 990 IS THEN PROVIDED TO THE FULL BOARD, BEFORE FILING, WHERE THEY ARE GIVEN AN OPPORTUNITY TO ASK QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENT IS COMPLETED ANNUALLY FOR ALL BOARD MEMBERS AND SENIOR LEVEL ADMINISTRATION. ANY CONFLICTS WOULD BE REVIEWED AND KEPT UNDER CONSIDERATION ON AN ONGOING BASIS. BOARD MEMBERS AND ADMINISTRATION INFORM OR REMIND THE ATTENDEES IN THESE SITUATIONS AND ABSTAIN FROM BOTH DISCUSSION AND VOTE ON THE ITEM UNDER DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 MANAGEMENT: THE HOSPITAL IS COMMITTED TO COMPENSATING ALL EMPLOYEES AN EQUITABLE AND FAIR WAGE. THE HOSPITAL HAS CONSULTED AND CONTINUES TO WORK WITH AN INDEPENDENT SPECIALIST TO REVIEW ALL JOB DESCRIPTIONS TO ASSIST IN THE CLASSIFICATION OF WAGES BASED ON LOCAL, REGIONAL, AND NATIONAL STANDARDS. THE CLASSIFICATION AND COMPARISON OF LOCALITY IS BASED ON THE ABILITY TO RECRUIT AND TRAIN THE SPECIFIC JOB CLASSIFICATION. THIS SAME PROCESS IS FIRST UTILIZED FOR MANAGEMENT AND SENIOR LEADERS. IN ADDITION, SENIOR LEADERS ARE COMPARED TO THE MHA SURVEY THAT IS PUBLICIZED. ANY INCREASES IN SENIOR LEADERS IS PROPOSED BY THE PRESIDENT/CEO AND APPROVED BY THE BOARD OF TRUSTEES. THE CEO AND HUMAN RESOURCES DIRECTOR PROVIDES THE BOARD WITH CEO WAGE INFORMATION AND THE BOARD (CEO IS REQUESTED TO LEAVE THE MEETING AND IS NOT INVOLVED IN THE VOTE) APPROVES AND MAKES ANY CHANGES THAT ARE NECESSARY. THESE RECOMMENDATIONS ARE NOT ANNUAL AS THEY ARE ALSO BASED ON THE FINANCIAL PERFORMANCE OF THE HOSPITAL AND THE CONTRACTUAL ARRANGEMENT OF THE CEO. THESE RECOMMENDATIONS ARE FURTHER COMPARED TO "LIKE SIZE" HOSPITAL'S WITHIN THE MHA SURVEY. HUMAN RESOURCES MONITORS THIS PROCESS ANNUALLY AT VARIOUS LEVELS AND WAS LAST COMPLETED IN 2014. PHYSICIANS: AS A RURAL HOSPITAL AND DESIGNATED AS UNDERSERVED, WAR MEMORIAL HOSPITAL HAS BEEN FACED WITH THE NEED TO EMPLOY PHYSICIANS IN ORDER TO RECRUIT AND RETAIN PROVIDERS TO MEET THE NEEDS OF THE COMMUNITY. THE NEEDS OF OUR COMMUNITY ARE BASED ON INDEPENDENT EVALUATIONS AND COMMUNITY SURVEYS. BASED ON THESE NEEDS THE HOSPITAL UTILIZES MGMA DATA BASED ON SPECIALTY FOR ALL PROVIDERS IN THE UNITED STATES. THIS DATA PROVIDES INFORMATION SUCH AS RELATIVE VALUE UNITS, ENCOUNTER, AND COMPENSATION. THE INFORMATION IS CLASSIFIED BY THE 25TH, MEDIAN, 75TH, AND 90TH PERCENTILE AND IS USED TO DESIGNATE THE PHYSICIAN COMPENSATION AS THE HOSPITAL ESTABLISHES COMPENSATION DURING RECRUITMENT AND RETENTION EFFORTS. MEDIAN BASED COMPENSATION IS MOST TYPICAL FOR PHYSICIAN CONTRACTS WITH THE ABILITY FOR THE PROVIDER TO EARN ADDITIONAL COMPENSATION BASED ON THEIR ACTUAL WORKLOAD/ PRODUCTIVITY (RVU AND ENCOUNTER) WITH NO RELATIONSHIP TO REFERRALS TO THE HOSPITAL. IN RETENTION CONTRACTS THE BASE COMPENSATION IS SOMETIMES INCREASED BASED ON HISTORICAL WORKLOADS/ PRODUCTIVITY AND BASED ON THE MARKET COMPETITIVENESS FOR THE RESPECTIVE SPECIALTY. FORM 990, PART VI, SECTION C, LINE 19 THE 990 AND THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH A DISSEMINATION AGENT AND UPON REQUEST. FORM 990, PART XI, LINE 9: LOSS FROM JOINT VENTURES -952,055. FORM 990, PART XII, LINE 2C: NO CHANGES FROM PRIOR YEAR.