2015-11-13T14:00:30-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2014-01-01 381359247 CRITTENTON HOSPITAL MEDICAL CENTER CRIT 2486525000 1101 W UNIVERSITY DRIVE ROCHESTER MI 48307 TERRY HAMILTON INTERIM CEO 2486525000 2015-11-13 1 CAROL A LALONDE CPA P00181637 2483522500 2014 2016-03-07 17:11:31Z TERRY HAMILTON 1101 W UNIVERSITY DRIVE ROCHESTER MI 48307 331627623 0 X WWW.CRITTENTON.COM X 1900 MI CRITTENTON HOSPITAL MEDICAL CENTER IS DEDICATED TO ENHANCING THE HEALTH STATUS OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. 15 13 1731 375 3328561 -833603 141677 325202 219641639 223919269 12162018 4109875 2170026 2059011 234115360 230413357 70880 0 0 0 102401816 86817126 0 0 0 139628608 137646715 242101304 224463841 -7985944 5949516 389429741 380154978 215511510 214063057 173918231 166091921 X CRITTENTON HOSPITAL MEDICAL CENTER IS DEDICATED TO ENHANCING THE HEALTH STATUS OF THE INDIVIDUALS AND COMMUNITIES WE SERVE IN PARTNERSHIP WITH OUR PHYSICIANS, EMPLOYEES, AND COMMUNITY MEMBERS. 0 0 192887444 0 220594261 THE HOSPITAL WAS INVOLVED IN A LARGE NUMBER OF COMMUNITY CARE PROJECTS, EITHER AS A PARTICIPANT OR A SPONSORING ORGANIZATION. THESE INCLUDE, BUT ARE NOT LIMITED TO: HEALTHY PREGNANCY, WOMEN'S HEALTHY HEART, NUTRITION, WEIGHT LOSS, HEALTHY AGING, CHILD SAFETY, HEALTH RISK APPRAISALS, SMOKING CESSATION, MANAGING STRESS, CPR, SLEEP DISORDER AND MEN'S HEALTH CLASSES FOR THE COMMUNITY. IN ADDITION, FREE BLOOD PRESSURE SCREENINGS ARE MADE AVAILABLE TO THE COMMUNITY. A BEREAVEMENT PROGRAM IS OFFERED THROUGH THE OBSTETRICS DEPT FOR GRIEVING PARENTS OF INFANTS. ANNUALLY, VOLUNTEERS FROM THE HOSPITAL PARTICIPATE AT THE ROCHESTER ARTS AND APPLES FESTIVAL, COLLECT GIFTS FOR THE ROCHESTER NEIGHBORHOOD HOUSE, COLLECT FOOD FOR THE MICHIGAN HARVEST GATHERING AND PARTICIPATE IN THE NORTH OAKLAND AMERICAN HEART WALK, THE BROOKSIE WAY AND COATS FOR COLD. A GEROPSYCHIATRIC PROGRAM WAS STARTED TO ASSIST OLDER ADULTS WITH HEALTH CARE CHANGES AND THE HOSPITAL ALSO HAS WOUND CARE SERVICES, INCLUDING HYPERBARIC TREATMENTS. 192887444 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 271 0 1 1731 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 1 0 X KIM HAUSCHILD 2486525780 1101 W UNIVERSITY DRIVE ROCHESTER MI 48307 BEVERLY ALLEN TREASURER 1.00 0.00 X 0 0 0 LISA ASADOORIAN TRUSTEE 1.00 0.00 X 0 0 0 BRYAN BARNETT TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL BROWE TRUSTEE 1.00 0.00 X 0 0 0 JEFFREY DECLAIRE MD TRUSTEE 1.00 0.00 X 37143 0 0 PETER DESTEIGER TRUSTEE 1.00 0.00 X 0 0 0 ROBERT GO MD TRUSTEE 1.00 0.00 X 40724 0 0 KENNETH JOHNSON TRUSTEE 1.00 0.00 X 0 0 0 KATHRIN KUDNER TRUSTEE 1.00 0.00 X 0 0 0 ROBERT LENIHAN II CHAIRMAN 1.00 0.00 X 0 0 0 FREDERICK MAIBAUER MD TRUSTEE 1.00 0.00 X 0 0 0 F SCOTT MILLER TRUSTEE 1.00 0.00 X 0 0 0 RUSSELL SHELTON TRUSTEE 1.00 0.00 X 0 0 0 ROBERT SKANDALARIS TRUSTEE 1.00 0.00 X 0 0 0 BRAD UPTON TRUSTEE 1.00 0.00 X 0 0 0 ROY POWELL PRESIDENT & CHIEF EXECUTIVE OFFICER 40.00 0.00 X 469896 0 34663 FRANK SOTTILE MD FORMER CHIEF EXECUTIVE OFFICER 36.00 4.00 X 365011 0 0 KENNETH SANGER CHIEF NURSING OFFICER 40.00 0.00 X 132721 0 30506 AUDRIANNE MOCERI SECRETARY 40.00 0.00 X 69992 0 17758 PETER KORDA MD CHIEF OF STAFF 1.00 0.00 X 51680 0 0 MICHELLE HORNBERGER CHIEF STRATEGY OFFICER 30.00 10.00 X 169486 0 38445 DONNA KOPINSKI CHIEF FINANCIAL OFFICER 35.00 5.00 X 214278 0 40163 KEVIN FLOREK DO MED. DIRECTOR OCCUPATIONAL MEDICINE 40.00 0.00 X 264045 0 39263 SAMAR KAZZIHA MD EXECUTIVE MEDICAL DIRECTOR 40.00 0.00 X 384101 0 20945 DOUGLAS PUGMIRE DO MED. DIRECTOR ROBOTICS/GYN ONCOLOGY 40.00 0.00 X 313889 0 9667 AMARBIR S KHAIRA HOUSE PHYSICIAN 40.00 0.00 X 264232 0 0 ROBERT LACOSTE MD PHYSICIAN 40.00 0.00 X 254183 0 20945 LYNN ORFGEN FORMER CHIEF EXECUTIVE OFFICER 0.00 0.00 X 259669 0 0 3291050 0 252355 78 1 1 0 WAYNE STATE UNIVERSITY 1420 STEVENSON HIGHWAY TROY MI 48083 PROFESSIONAL SERVICES 8507162 UNASOURCE SURGERY CENTERLLC 4550 INVESTMENT DR STE 100 TROY MI 48098 SURGICAL SERVICES 6317148 CERNER HEALTHCARE SOLUTIONS 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 IT SERVICES 6003821 SODEXO INC AND AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 PROFESSIONAL SERVICES 5222445 CARETECH SOLUTIONS INC PO BOX 674271 DETROIT MI 48267 IT SERVICES 5064209 64 300604 24598 325202 NET PATIENT SERVICE REVENUE 621110 221864539 218721795 3142744 E.H.R INCENTIVE 900099 1118122 1118122 INVESTMENT IN JOINT VENTURES 900099 289216 106952 182264 AUC SCHOOL OF MEDICINE 611600 147500 147500 MEDICAL RECORDS 900099 116081 116081 383811 383811 223919269 2547424 2547424 99237631 3393042 98679337 2388885 558294 1004157 1562451 1562451 22989 28995 -6006 -6006 172045 117049 54996 54996 JVHL 621500 852610 852610 MRI AND LAND LEASE 532000 323235 323235 MEDICAL STAFF FUNCTIONS 900099 238643 238643 595533 3553 591980 2010021 230413357 220594261 3328561 6165333 X 3543405 3543405 69428283 67146039 2282244 1156905 1052552 104353 6753461 6162912 590549 5935072 5399729 535343 1188 1188 339546 2172 337374 281964 21899 260065 76123 76123 38424628 36471098 1953530 1482533 1265 1481268 2643379 2296351 347028 8118484 1595 8116889 5194142 2138221 3055921 56278 30469 25809 7254 3662 3592 5365082 5365082 14984350 9926768 5057582 325595 667 324928 MEDICAL SUPPLIES 38890562 38669541 221021 BAD DEBT EXPENSE 11079619 11079619 QAAP EXPENSE 4715011 4715011 MALPRACTICE 1893415 17163 1876252 3767562 2384441 1383121 224463841 192887444 31576397 0 12250 12814 29926431 21598459 24232038 27237915 3863059 3904647 3498974 4075262 379072714 206345986 179602892 172726728 89306084 93332899 43267 41224 9605551 9807256 49339195 47417774 389429741 380154978 33980588 22158333 156418380 153965478 510990 152861 24601552 37786385 215511510 214063057 X 173743773 166034360 174458 57561 173918231 166091921 389429741 380154978 X 5949516 4610265 104114 -18490205 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 141495 91800 2 62852 6230 164215 138145 182593 56 177223 2076 141495 827601 193472 7886 885577 5237 138145 843841 219377 12055 243647 4025 827601 964434 167277 17908 295562 10216 843841 1.00000 0 1 1 2565744 2565744 245015642 105122002 139893640 1732459 1071627 660832 124132941 97225263 26907678 5625928 2927094 2698834 172726728 ACCOUNTS RECEIVABLE AFFILIATES 17852827 MISCELLANEOUS ACCOUNTS RECEIVABLE 633434 ACCOUNTS RECEIVABLE POWERWORKS 1227 DEBT ISSUANCE COST 1871218 ACCOUNTS RECEIVABLE SAAC 3479276 DUE FROM THIRD PARTY 7925980 PHYSICIAN LOAN FOREGIVENESS 283912 PHYSICIAN LOANS 229708 LOAN RECEIVABLE DOCTORS HOSPITAL 1115023 CONTRUCTION FUND 2012A 4 FUNDS HELD BY TRUSTEE, LESS CURRENT 7100658 ACCOUNTS RECEIVABLE RHREH 408346 ACCOUNTS RECEIVABLE RREH 1787108 MALPRACTICE GROSS UP 4729053 47417774 SELF FUNDED MALPRACTICE INS CLAIMS LIABILITY 8138287 POST RETIREMENT HEALTH INS LIABILITY 413571 PENSION LIABILITY 29234527 37786385 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED FOR THE GIFT SHOP, THE AUXILLIARY AND THE HOSPITAL FOR GRANTS, SCHOLARSHIPS AND OTHER EXPENSES. PART X, LINE 2: CHMC, THE FOUNDATION, AND CCC ARE NONPROFIT, TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE, LOCAL, OR NON-U.S. INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. 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 MATERIAL UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. CENTRAL AMERICA/CARIBBEAN 0 0 PROGRAM SERVICES INSURANCE 667392 CENTRAL AMERICA/CARIBBEAN 0 0 INVESTMENT 163267 0 0 0 0 0 0 830659 0 830659 1 0 1 0 0 0 3 22989 22989 28995 22989 22989 28995 28995 -6006 1 1 X 1 X 1 X 1 1 0 1 1 459400 459400 0.00200 17673011 13776862 3896149 0.01740 101051 83509 17542 0.00010 18233462 13860371 4373091 0.01950 422537 422537 0.00190 11464567 4455131 7009436 0.03120 91000 91000 0.00040 520189 520189 0.00230 12498293 4455131 8043162 0.03580 30731755 18315502 12416253 0.05530 13 1046 3046 3046 0.00000 16 505 7530 7530 0.00000 35 1952 12356 12356 0.00010 12 222 1673 1673 0.00000 76 3725 24605 24605 0.00010 0 11079610 971266 62778609 65876725 -3098116 X 1 1 1 USC LLC SURGICAL CENTER 0.28640 0.71360 1 1 CRITTENTON HOSPITAL MEDICAL CENTER 1101 W UNIVERSITY ROCHESTER MI 48307 X X X X CRITTENTON HOSPITAL MEDICAL CENTER 1 0 0 1 X X X X X X X X 13 1 0 0 1 X WWW.CRITTENTON.COM X WWW.CRITTENTON.COM/PUBLIC/UPLOADS/2015/02/COMMUNITY-HEA X X 1 14 1 HTTP://WWW.CRITTENTON.COM/COMMUNITY-ASSESSMENT/ 0 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X X X X X 1 0 X X X X 1 X 0 0 CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 5: THE METHODOLOGY FOR SURVEY ASSESSMENT INVOLVED THE DISTRIBUTION OF THE SURVEY ELECTRONICALLY, ONLINE, AND ON PAPER DURING THE MONTHS OF SEPTEMBER THROUGH NOVEMBER 2012. THE SURVEY TOOL WAS DEVELOPED TO ASSESS THE NEEDS OF THE COMMUNITY, THE INDIVIDUAL NEEDS AND HEALTH STATUS OF THE RESPONDERS, AND TO ASSESS THE SERVICES THAT CHMC PROVIDES TO THE COMMUNITY. THE INTENTION OF THE SURVEY TOPIC SELECTION WAS TO ASSESS A GENERAL OVERVIEW OF THE COMMUNITY NEEDS. THE SURVEY TAKERS WERE GIVEN MULTIPLE CHOICE OPTIONS WITH IMPORTANT ISSUES IDENTIFIED BY: HIGH NEED/CONCERN, LOW NEED/CONCERN, NO NEED/CONCERN, AND DO NOT KNOW.COMMUNITY STAKEHOLDERS OF DIFFERENT AGES, SOCIOECONOMIC STATUS, OCCUPATION, AND CULTURAL BACKGROUNDS WERE INVITED TO PARTICIPATE. FEATURE ARTICLE AND INVITATION TO TAKE SURVEY IN OUR WELLSPRING PUBLICATION WAS DISTRIBUTED TO 15,000 HOUSEHOLDS IN OUR PRIMARY SERVICE AREA. EMAIL INVITATIONS WITH SURVEY WEBSITE LINK WERE SENT TO ALL OF OUR COMMUNITY MEMBERS IN OUR PRIMARY SERVICE AREAS:1.PUBLIC/PRIVATE SCHOOLS2.PUBLIC HEALTH3.BUSINESS LEADERS4.PHYSICIANS5.RELIGIOUS ORGANIZATIONS6.UNIVERSITIES/COLLEGES7.HIGH SCHOOL LEADERSHIP GROUPS8.SENIOR CENTERSHARD COPY INVITATIONS AND PAPER SURVEYS WERE DISTRIBUTED AT ALL COMMUNITY EVENTS WITH INSTRUCTIONS TO TAKE THE SURVEY ONLINE OR PAPER SURVEYS COMPLETED ON-SITE OR MAILED IN. THESE EVENTS INCLUDED:1.COMMUNITY HEALTH FAIRS AND EXPOS2.BREAST CANCER WALK3.PHYSICIAN LECTURES4.HEALTH SCREENINGS CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 7D: DISTRIBUTION OF ANNUAL COMMUNITY BENEFIT REPORT TO 15,000 HOUSEHOLDS, IN HOSPITAL AND AT COMMUNITY EVENTS CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 11: CHMC WILL NOT ADDRESS THE INCREASED AVAILABILITY OF CHILDCARE PRIORITY BECAUSE THERE ARE SUFFICIENT RESOURCES IN THE COMMUNITY. THERE ARE A VARIETY OF CHILDCARE OPTIONS FROM IN-HOME, LEARNING CENTERS, DAYCARE CENTERS, AND DROP-IN CARE. CHMC HAS A CHILDCARE FACILITY, CHILDREN'S CHOICE, AVAILABLE TO EMPLOYEES AND THE COMMUNITY. CHMC WILL NOT ADDRESS THE IMMUNIZATIONS FOR CHILDREN AND ADULTS PRIORITY BECAUSE THERE ARE SUFFICIENT RESOURCES IN THE COMMUNITY. CHMC OFFERS FRIENDS AND FAMILY FLU SHOT EVENT IN THE FALL, CHMC TRAVEL MEDICINE AND THE CRITTENTON WELLNESS CENTER AT OLDER PERSON COMMISSION (OPC) OFFERS IMMUNIZATIONS TO THE PUBLIC, THE PUBLIC HEALTH DEPARTMENT PROVIDES FREE IMMUNIZATIONS, AND LOCAL NON-PROFIT OFFERS FREE IMMUNIZATIONS FOR CHILDREN IN AUGUST AT AN ANNUAL HEALTH BAZAAR.CHMC WILL NOT ADDRESS THE LOW AWARENESS OF POTENTIAL HEALTH THREATS PRIORITY BECAUSE CHMC CURRENTLY HAS AND EMERGENCY MANAGEMENT COMMITTEE COMPRISED OF HOSPITAL TEAM MEMBERS, LOCAL AGENCIES AND BUSINESSES, AND COMMUNITY MEMBERS. INFORMATION IS POSTED ON THE WEBSITE AND ARTICLES ARE PUBLISHED IN WELLSPRING ON THIS ISSUE. CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 22D: THOSE PATIENTS THAT ARE ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ARE EITHER NOT CHARGED FOR THEIR SERVICES OR ARE CHARGED A 75% DISCOUNT RATE WHICH ON AVERAGE SHOULD NOT EXCEED THE GREATER OF OUR THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.CRITTENTON.COM/PATIENTS-VISITORS/BILLING-AND-INSURANCE/ CRITTENTON HOSPITAL MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.CRITTENTON.COM/PATIENTS-VISITORS/BILLING-AND-INSURANCE/ 3 USC LLC 4800 INVESTMENT DRIVE STE 370 TROY MI 48098 SURGICAL CENTER MICHIGAN RESONANCE IMAGING 355 BARCLAY CIRCLE STE A ROCHESTER MI 48307 IMAGING CENTER MICHIGAN MOBILE PET 15500 LUNDY PARKWAY DEARBORN MI 48126 IMAGING CENTER PART I, LINE 3C: CRITTENTON HOSPITAL MEDICAL CENTER USED THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILTY FOR PROVIDING BOTH 'FREE' CARE AND 'DISCOUNTED' CARE TO LOW INCOME INDIVIDUALS. THE FAMILY INCOME LIMIT USED IS 200% FOR 'FREE' CARE AND 250% FOR 'DISCOUNTED' CARE. PART I, LINE 7: THE COSTING METHOD USED FOR FINANCIAL ASSISTANCE AND MEANS TESTED GOVERNMENT PROGRAMS WAS A COST TO CHARGE RATIO FROM WORKSHEET 2 AND OTHER COMMUNITY BENEFITS WAS CALCULATED BASED UPON ACTUAL COST. PART I, LINE 7G: CRITTENTON HOSPITAL MEDICAL CENTER DOES NOT HAVE ANY SUBSIDIZED HEALTH SERVICES TO REPORT. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE OF $11,079,610 WAS REMOVED FROM THE DENOMINATOR FOR THE CALCULATION OF THE PERCENT OF TOTAL EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY HEALTH LEADERSHIP AND OTHER SENIOR LEADERS ACTIVELY PARTICIPATE ON A BROAD RANGE OF COMMUNITY COALITIONS SUCH AS THE OLDER PERSON'S COMMISSION, ROCHESTER COMMUNITY SCHOOLS, ROCHESTER/AUBURN HILLS COMMUNITY COALITION, OAKLAND COUNTY OBESITY COALITION, REGION 2 NORTH, OAKLAND COUNTY MEDICAL CONTROL AUTHORITY, MICHIGAN DEPT OF COMMUNITY HEALTH, CROSSROADS PREGNANCY CENTER AND OTHERS. THIS PROVIDES ONGOING KNOWLEDGE OF VARYING COMMUNITY NEEDS AND ADJUSTS AS ECONOMIC, ENVIRONMENTAL, AND HEALTHCARE CHANGES OCCUR IN CRITTENTON'S KEY COMMUNITIES. THE VARIOUS PROGRAMS THAT CHMC OFFERS TO THE COMMUNITY HELP TO ENHANCE THE HEALTH STATUS BY EDUCATION, EARLY DETECTION, SCREENING, AND ACCESSIBILITY TO RESOURCES. WE RECEIVE MULTIPLE STORIES EVERY YEAR STATING THAT IF THEY HAD NOT ATTENDED ONE OF OUR SCREENINGS, THEN THEY MAY NOT HAVE PURSUED FURTHER MEDICAL CARE OR TREATMENT. THE SCREENING OR EDUCATION IS WHAT INCREASED THEIR AWARENESS AND ENCOURAGED THEM TO SEEK CARE AND THAT SCREENING OR ACTIVITY IS WHAT HELPED TO ENHANCE THEIR HEALTH. PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THE REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. THE BAD DEBT AMOUNT REPORTED ON PART III LINE 2 IS CHMC'S PROVISION FOR BAD DEBT PER THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND PER FORM 990 PART IX. PART III, LINE 3: THE HOSPITAL FOLLOWS THE POLICY OF PROVIDING HEALTH SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CONSEQUENTLY, THE HOSPITAL PROVIDES HEALTH SERVICES FREE OF CHARGE OR AT AMOUNTS LESS THAN ITS FULL COSTS OF PROVIDING CARE TO CERTAIN CATEGORIES OF PATIENTS. THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS CALCULATED USING THE HISTORICAL PERCENTAGE BASED ON CHARITY CARE APPLICATIONS APPROVED. PART III, LINE 8: AS A NON-PROFIT HOSPITAL, CRITTENTON HOSPITAL MEDICAL CENTER IS REQUIRED TO PROVIDE MINIMAL LEVELS OF COMMUNITY BENEFIT IN EXCHANGE FOR OUR TAX EXEMPT STATUS. THESE COMMUNITY BENEFITS INCLUDE HEALTH EDUCATION OPPORTUNITIES, CHARITY AND BAD DEBT WRITEOFFS, AND OUR LOSSES ON MEDICARE. IN KEEPING WITH OUR MISSION TO PROMOTE HEALTH IN THE COMMUNITY, WE PROVIDE CARE TO MEDICARE BENEFICIARIES AT A LOSS, THUS HELPING TO RELIEVE THE GOVERNMENT BURDEN OF TREATING THESE PATIENTS WHO MAY OTHERWISE HAVE THEIR ACCESS TO CARE LIMITED. PART III, LINE 9B: IT IS THE POLICY OF CRITTENTON HOSPITAL MEDICAL CENTER TO REQUIRE PAYMENT IN FULL FOR ALL SERVICES RENDERED, WHICH ARE PATIENT PAY, UPON RECEIPT OF THEIR FIRST STATEMENT. THE PATIENT THEN HAS THIRTY DAYS TO REMIT PAYMENT IN FULL. THE BURDEN OF PROOF OF A PATIENT'S INABILITY TO PAY IN FULL IS THE RESPONSIBILITY OF THE PATIENT. IF THE PATIENT CAN PROVE AN INABILITY TO PAY THEIR DEBT IN FULL, PARTIAL PAYMENT ARRANGEMENTS CAN BE MADE. IT IS ALSO THE POLICY OF THE HOSPITAL TO PROVIDE THE PATIENT WITH INFORMATION REGARDING THE AVAILABILITY OF WHATEVER SOCIAL SERVICES MAY BE APPLICABLE FOR THE PATIENT. IN ADDITION, A CHARITY CARE APPLICATION MAY ALSO BE PROVIDED. PART VI, LINE 2: THE ALLOCATION OF CRITTENTON'S RESOURCES TO IMPROVE THE HEALTH STATUS AND QUALITY OF LIFE OF COMMUNITY RESIDENTS ARE BASED ON COMMUNITY NEEDS THAT ARE IDENTIFIED BOTH THROUGH THE STRATEGIC PLANNING PROCESS AND THROUGH A YEARLY COMPREHENSIVE REVIEW OF COUNTY, STATE AND FEDERAL HEALTHCARE DATA BY CRITTENTON'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT. COMMUNITY NEEDS INFORMATION IS GATHERED FROM BOTH THE CDC'S NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEMS AND THROUGH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH. FOR EXAMPLE, IN 2008 THE NEED FOR A SCHOOL NURSE PROGRAM WAS IDENTIFIED WITH THE ROCHESTER COMMUNITY SCHOOLS. CRITTENTON'S COMMUNITY HEALTH AND EDUCATION DEPARTMENT DEVELOPED AND IMPLEMENTED THE PROGRAM WHICH NOW SERVES 15,000 STUDENTS AND MANAGES APPROXIMATELY 450 MEDICAL MANAGEMENT PROGRAMS. PART VI, LINE 3: CRITTENTON HOSPITAL MEDICAL CENTER DOES A NUMBER OF THINGS IN ORDER TO EDUCATE AND/OR ASSIST A PATIENT IN RECEIVING OUTSIDE ASSISTANCE, INCLUDING THE FOLLOWING:1. SIGNAGE IS POSTED AT REGISTRATION POINTS AROUND THE HOSPITAL REGARDING ASSISTANCE AVAILABLE TO PAY FOR SERVICES AS WELL AS OUR UNCOMPENSATED SERVICES PROGRAM, HANDOUTS ARE GIVEN TO THE PATIENTS AND THE PROGRAM IS OUTLINED ON THE BACK OF EVERY STATEMENT THAT IS SENT TO THE PATIENT.2. FINANCIAL COUNSELORS ARE ON SITE THAT ARE CONTACTED EVERY TIME A PATIENT WITHOUT INSURANCE COMES INTO THE EMERGENCY ROOM OR IS ADMITTED TO THE HOSPITAL. IN THE PAST 12 MONTHS THE FINANCIAL COUNSELORS HAVE ASSISTED OVER 600 PATIENTS IN QUALIFYING FOR COUNTY, STATE, FEDERAL, OR HOSPITAL ASSISTANCE PROGRAMS.3. TAKE PART AND ASSIST PATIENTS IN QUALIFYING FOR THE COUNTY INDIGENT HOSPITATLIZATION PROGRAM WHICH IS RUN DIRECTLY THROUGH THE HOSPITAL AND PLACES VIRTUALLY NO BURDEN OF ANY TYPE ON THE PATIENT IN ORDER TO BE QUALIFIED.4. ALL MANAGERS THAT DEAL WITH THE PUBLIC ARE DIRECTLY INFORMED OF OUR UNCOMPENSATED SERVICE PROGRAMS AND VERBALLY ASSIST PATIENTS WITH SUGGESTIONS AS WELL AS OUR CASHIERS HAVING ACCESS TO THE SAME INFORMATION AND TRAINING.5. OFFER ASSISTANCE TO NEWBORN MOTHERS WITHOUT INSURANCE IN THE FORM OF ASSISTANCE IN APPLYING FOR MEDICAID AND PROVIDING MINIMAL PAYMENT OPTIONS. PART VI, LINE 4: CRITTENTON HOSPITAL MEDICAL CENTER IS A 290 BED ACUTE CARE HEALTH FACILITY SERVING COMMUNITIES IN OAKLAND, MACOMB AND LAPEER COUNTIES. THE ENTIRE SERVICE AREA ENCOMPASSES 35 ZIP CODES IN THREE REGIONS AND IS FURTHER SUBDIVIDED INTO THREE SECTORS: OUR CORE SECTOR WHICH ENCOMPASSES THE THREE ROCHESTER ZIP CODES, AND THE PRIMARY AND SECONDARY SECTORS. THE DEMOGRAPHIC SKEW FOR THE AREA IS SLIGHTLY OLDER THAN THE NORM WITH HIGHER HOUSEHOLD INCOMES. PART VI, LINE 5: CRITTENTON HOSPITAL MEDICAL CENTER DOES NOT WANT TO FORGET THE IMPORTANT ROLE THE COMMUNITY PLAYS IN ITS SUCCESS. THE HOSPITAL IS ESPECIALLY GRATEFUL THAT THEY ARE ABLE TO GIVE BACK TO THE COMMUNITY THROUGH ESSENTIAL HEALTHCARE SERVICES AND EDUCATION TO CATER TO THE UNMET NEEDS OF SO MANY IN ITS COMMUNITY. OFFERING ADVANCED CARE AND SERVICES IS ONE OF THE MANY WAYS CRITTENTON SERVES ITS COMMUNITY. CRITTENTON HAS PARTNERED WITH PREMIER ORGANIZATIONS TO FULFILL ITS MISSION OF ENHANCING THE HEALTH STATUS OF THE COMMUNITY, I.E. WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE AND OAKLAND UNIVERSITY SCHOOL OF NURSING ARE JUST A FEW. PART VI, LINE 6: CRITTENTON HOSPITAL MEDICAL CENTER IS DEDICATED TO PROVIDING CARE TO ALL RESIDENTS OF THE COMMUNITY, REGARDLESS OF THEIR FINANCIAL STATUS. THROUGH UNCOMPENSATED CARE, GOVERNMENT SPONSORED HEALTH CARE, COMMUNITY HEALTH SERVICES AND DONATIONS THE HOSPITAL IS ABLE TO REACH OUT TO THE COMMUNITY. THE FOUNDATION IS THE FUNDRAISING ARM OF THE ORGANIZATION. THEY HAVE HOSTED EVENTS SUCH AS THE GOLF, TENNIS AND FUN WALK BENEFIT AND THE GOURMET GALA BENEFIT WHICH HAS RAISED MONEY FOR A VARIETY OF ENHANCEMENTS TO THE HOSPITAL. THE CRITTENTON VOLUNTEER AUXILLARY IS AN INTEGRAL PART OF THE HOSPITAL'S SUCCESS. THE GROUP CONTRIBUTES A GREAT DEAL OF TIME AND SERVICE TO FURTHER THE GOAL OF PROVIDING CLINICAL EXCELLENCE IN A COMFORTABLE, WELCOMING ENVIRONMENT. SOME OF THE SERVICES THAT THEY PROVIDE INCLUDE CLERICAL ASSISTANCE, ESCORTING PATIENTS AROUND THE FACILITY, AND GREETING FAMILIES AND VISITORS. THE CRITTENTON WELLNESS CENTER AND THE OLDER PERSONS COMMISSION HAVE COMBINED HEALTH, WELLNESS, EDUCATION AND ACTIVITIES ALL WITH THE OLDER PERSON IN MIND. MEMBERSHIP IS FREE TO RESIDENTS OF ROCHESTER, ROCHESTER HILLS, AND OAKLAND TOWNSHIP WHO ARE OLDER THAN AGE FIFTY. PART VI, LINE 7, REPORTS FILED WITH STATES MI X X 1 0 0 0 0 0 0 0 0 ROY POWELL PRESIDENT & CHIEF EXECUTIVE OFFICER 469817 0 0 0 79 0 17500 0 17163 0 504559 0 0 0 FRANK SOTTILE MD FORMER CHIEF EXECUTIVE OFFICER 13842 0 0 0 351169 0 0 0 0 0 365011 0 0 0 KENNETH SANGER CHIEF NURSING OFFICER 132355 0 0 0 366 0 15200 0 15306 0 163227 0 0 0 MICHELLE HORNBERGER CHIEF STRATEGY OFFICER 169311 0 0 0 175 0 17500 0 20945 0 207931 0 0 0 DONNA KOPINSKI CHIEF FINANCIAL OFFICER 214228 0 0 0 50 0 23000 0 17163 0 254441 0 0 0 KEVIN FLOREK DO MED. DIRECTOR OCCUPATIONAL MEDICINE 263878 0 0 0 167 0 22100 0 17163 0 303308 0 0 0 SAMAR KAZZIHA MD EXECUTIVE MEDICAL DIRECTOR 382483 0 0 0 1618 0 0 0 20945 0 405046 0 0 0 DOUGLAS PUGMIRE DO MED. DIRECTOR ROBOTICS/GYN ONCOLOGY 313889 0 0 0 0 0 0 0 9667 0 323556 0 0 0 AMARBIR S KHAIRA HOUSE PHYSICIAN 264232 0 0 0 0 0 0 0 0 0 264232 0 0 0 ROBERT LACOSTE MD PHYSICIAN 253277 0 0 0 906 0 0 0 20945 0 275128 0 0 0 LYNN ORFGEN FORMER CHIEF EXECUTIVE OFFICER 0 0 0 0 259669 0 0 0 0 0 259669 0 0 0 PART I, LINE 4A LYNN ORFGEN RECEIVED A SEVERANCE PAYMENT OF $253,419 AND FRANK SOTTILE RECEIVED A SEVERANCE PAYMENT OF $351,118 IN 2014. THERE IS A SEVERANCE AGREEMENT SIGNED BY BOTH THE EMPLOYER AND EACH EMPLOYEE DETAILING THE TERMS. A MICHIGAN FINANCE AUTHORITY 382889417 59447PSU6 2012-11-14 113598798 COSTS OF TOWER PROJECT AND REFUND CERTAIN EXISTING INDEBTEDNESS OF CORP 0 0 0 B MICHIGAN FINANCE AUTHORITY 382889417 2012-12-01 45000000 COSTS OF TOWER PROJECT 0 0 0 A 113598912 7100622 92742139 1760849 11955302 2012 1 0 1 1 B 45000000 326050 44673950 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 1 0 0 0 0 0 0 B 0 1 0 0 1 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS GIVEN TO THE BOARD OF DIRECTORS VIA E-MAIL FOR REVIEW BEFORE FILING. AFTER THE REVIEW, THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL POLICY STATES THAT ALL EMPLOYEES HAVE A CONTINUOUS OBLIGATION TO DISCLOSE CONFLICTS OF INTEREST, AN ACTUAL IMPROPRIETY, AND/OR AN APPEARANCE OF IMPROPRIETY. EMPLOYEES AT THE MANAGER LEVEL AND ABOVE EACH SIGN A STATEMENT ON AN ANNUAL BASIS ACKNOWLEDGING THEIR UNDERSTANDING OF THE POLICY AND VERIFYING THEIR APPROPRIATE DISCLOSURE OF ANY CONFLICTS. ALL REPORTED CONFLICTS SHALL BE REVIEWED BY THE CEO IN CONJUCTION WITH THE COMPLIANCE OFFICER AND DEPARTMENT OF LEGAL AFFAIRS. IF IT IS DETERMINED THAT A CONFLICT EXISTS THE EMPLOYEEE SHALL DISCONTINUE ALL ACTIVITIES SURROUNDING THAT CONFLICT. THE EMPLOYEE MAY ALSO SEEK A WAIVER OF THE CONFLICT FROM THE CEO. CHMC ALSO HAS A QUESTIONNAIRE FOR INDIVIDUALS AND THEIR IMMEDIATE FAMILY MEMBERS, INCLUDING BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES REGARDING CONFICTS OF INTEREST AND THIS MUST BE SIGNED BY THE INDIVIDUALS. THE QUESTIONNAIRE INCLUDES THE FOLLOWING: 1. IDENTIFY YOUR SERVICE ON ANY BOARD OF DIRECTORS OR TRUSTEES OF ANY OF THE COMPANY'S WITH WHICH CHMC OR ANY OF ITS' AFFILIATES DOES BUSINESS. 2. IDENTIFY WHETHER YOU ARE ASSOCIATED DIRECTLY OR INDIRECTLY OR HOLD A POSITION OR FINANCIAL INTEREST IN ANY OUTSIDE ORGANIZATION OR CONCERN WITH WHICH CRITTENTON DOES BUSINESS. 3. IDENTIFY WHETHER YOU DIRECT, MANAGE,OR PROVIDE SERVICES OR CONSULTATION TO ANY OUTSIDE ORGANIZATION OR CONCERN THAT DOES BUSINESS WITH OR COMPETES WITH CRITTENTON. 4. IDENTIFY ANY ACTIVITIES IN WHICH YOU ARE ENGAGED THAT MIGHT BE REGARDED AS CONSTITUTING A POTENTIAL CONFLICT OF INTEREST WITH CRITTENTON. 5. DISCLOSE ANY DIRECT OR INDIRECT COMPENSATION THAT YOU RECEIVE, OR ANTICIPATE RECEIVING, FROM ANY PERSON, FIRM, CORPORATION, OR MARKET IN ANY WAY RELATED TO YOUR POSITION WITH CRITTENTON. IF AT ANY TIME THERE IS A MATTER UNDER CONSIDERATION WHICH MAY CREATE A DIRECT OR INDIRECT CONFLICT OF INTEREST, IT IS THE INDIVIDUAL'S OBLIGATION TO DISCLOSE THE FACTS SURROUNDING THE POSSIBLE CONFLICT TO THE CORPORATE COMPLIANCE OFFICER OR DEPARTMENT OF HUMAN RESOURCES AND THAT THE INDIVIDUAL AGREES TO PROMPTLY REPORT ANY NEW SITUATIONS THAT REQUIRE DISCLOSURE UNDER THIS QUESTIONNAIRE. THERE IS A SIGNED WRITTEN AGREEMENT/DOCUMENTATION FOR ANY BOARD MEMBER OR OFFICER IF A CONFLICT OF INTEREST ARISES. CURRENTLY THERE HAVE NOT BEEN ANY RESTRICTIONS PLACED ON ANY BOARD MEMBER OR OFFICER AS AN ISSUE HAS NOT ARISEN TO WARRANT THIS. FORM 990, PART VI, SECTION B, LINE 15A THE AUDIT COMMITTEE REVIEWS THE PERFORMANCE AGAINST THE GOALS SET FOR THE CEO. IN ADDITION THE AUDIT COMMITTEE PERFORMS A REVIEW OF THE TOTAL SALARY AGAINST MARKET STATISTICS. FROM THAT REVIEW, A RECOMMENDATION IS MADE TO THE EXECUTIVE COMMITTEE OF THE BOARD AND THE BOARD FOR APPROVAL. THE DETERMINATION AND DECISION ARE DOCUMENTED IN THE EXECUTIVE COMMITTEE OF THE BOARD MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST OF THE INDIVIDUAL. FORM 990, PART IX, LINE 11G CONTRACT SERVICES-PHYSICIANS, CLINICAL,CLERICAL: PROGRAM SERVICE EXPENSES 14,202,677. MANAGEMENT AND GENERAL EXPENSES 120,525. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,323,202. OP SURGICAL SERVICES: PROGRAM SERVICE EXPENSES 7,194,002. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,194,002. PURCHASED SERVICES-GENERAL: PROGRAM SERVICE EXPENSES 1,995,448. MANAGEMENT AND GENERAL EXPENSES 902,265. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,897,713. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 2,618,230. MANAGEMENT AND GENERAL EXPENSES 1,279. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,619,509. FOOD AND NUTRITION: PROGRAM SERVICE EXPENSES 2,374,541. MANAGEMENT AND GENERAL EXPENSES 43,206. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,417,747. BIO-MED: PROGRAM SERVICE EXPENSES 2,038,421. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,038,421. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,084,228. MANAGEMENT AND GENERAL EXPENSES 695,857. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,780,085. PURCHASED SERVICES-MEDICAL: PROGRAM SERVICE EXPENSES 1,760,662. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,760,662. LAUNDRY: PROGRAM SERVICE EXPENSES 1,345,538. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,345,538. REHAB SERVICES: PROGRAM SERVICE EXPENSES 738,519. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 738,519. PHARMACY: PROGRAM SERVICE EXPENSES 561,401. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 561,401. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 529,340. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 529,340. GROUNDS MAINTENANCE: PROGRAM SERVICE EXPENSES 28,091. MANAGEMENT AND GENERAL EXPENSES 190,398. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 218,489. FORM 990, PART XI, LINE 9: PENSION LIABILITY -18,311,200. ASSETS RELEASED FROM RESTRICTED -179,005. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT MAKE ANY SIGNIFICANT CHANGES IN THE PROCESS OF THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR. CRITTENTON HOSPITAL MEDICAL CENTER FOUNDATION 1101 W UNIVERSITY DR ROCHESTER MI 48307 382627336 SUPPORTING MI 501(C)(3) LINE 11A, I CRITTENTON HOSPITAL MEDICAL CENTER 1 CRITTENTON CANCER CENTER 1101 W UNIVERSITY DR ROCHESTER MI 48309 383239057 CANCER TREATMENT MI 501(C)(3) LINE 9 CRITTENTON HOSPITAL MEDICAL CENTER 1 CRITTENTON MEDICAL EQUIPMENT 161 S LIVERNOIS RD ROCHESTER HILLS MI 48307 383433794 MEDICAL EQUIPMENT SALES MI N/A HBC INFUSIONS 1101 W UNIVERSITY ROCHESTER MI 48307 753123093 INFUSION SERVICES MI N/A BALD MOUNTAIN SURGICAL CENTER 1375 S LAPEER RD STE 3109 LAKE ORION MI 48360 030444972 SURGICAL SERVICES MI N/A CRITTENTON DEVELOPMENT CORPORATION 2251 N SQUIRREL RD STE 310 AUBURN HILLS MI 48326 382594115 REAL ESTATE MI CRITTENTON HOSPITAL MEDICAL CENTER C 1.00000 0 CRITTENTON MEDICAL PHARMACY 1101 W UNIVERSITY ROCHESTER MI 48307 203773341 PHARMACY SALES MI CRITTENTON DEVELOPMENT CORPORATION C 0 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 CHMC FOUNDATION C 300604 ACTUAL CASH TRANSFERRED CHMC FOUNDATION L 77835 ACTUAL CASH TRANSFERRED CHMC FOUNDATION M 187322 ACTUAL CASH TRANSFERRED CRITTENTON CANCER CENTER J 153000 ACTUAL COST INCURRED CRITTENTON CANCER CENTER O 64965 ACTUAL COST INCURRED CHMC FOUNDATION O 132351 ACTUAL COST INCURRED CRITTENTON CANCER CENTER D 17617750 ACTUAL COST INCURRED