2014-03-28T15:06:35-05:00 2013-06-30 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2012-07-01 381984289 MERCY MEMORIAL HOSPITAL CORPORATION MERC 7342404520 718 N MACOMB STREET MONROE MI 48162 THOMAS W SCHILLING 7342404520 2014-03-24 1 BETSY ARETZ P00996282 2483522500 2012 2015-11-30 17:44:51Z THOMAS W SCHILLING 718 N MACOMB STREET MONROE MI 48162 217940526 0 X WWW.MERCYMEMORIAL.ORG X 1971 MI AS AN INDEPENDENT HEALTH CARE SYSTEM, WE PROVIDE HIGH QUALITY, COMPREHENSIVE SERVICES TO THE PEOPLE AND COMMUNITIES WE SERVE. 17 10 1907 759 5505758 -300001 1169957 1026597 171880471 163883977 3161149 5998902 -27991 -60873 176183586 170848603 41300 11376 0 0 86927030 88723092 0 0 216405 81826404 81427068 168794734 170161536 7388852 687067 205039704 193187007 113555727 90563680 91483977 102623327 X AS AN INDEPENDENT HEALTH CARE SYSTEM, WE PROVIDE HIGH QUALITY, COMPREHENSIVE SERVICES TO THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 142518709 6626 158366877 HOSPITAL BASED HEALTHCARE SERVICES -A MULTITUDE OF HEALTH CARE SERVICES WERE PROVIDED BY THE HOSPITAL TO THE PEOPLE OF MONROE COUNTY AND SURROUNDING AREAS. THESE PROGRAM SERVICES INCLUDED VARIOUS ASPECTS OF INPATIENT, OUTPATIENT, AND EMERGENCY CARE. THIS CARE WAS PROVIDED IN A MANNER THAT RESPECTED THE VALUE, PRIVACY, AND DIGNITY OF INDIVIDUAL PATIENTS AND THEIR FAMILIES. FURTHER, CONTINUOUS EFFORTS WERE MADE TO IDENTIFY AND IMPLEMENT NEW AND BETTER WAYS TO MEET THE PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL NEEDS OF PATIENTS. DURING THE YEAR THE HOSPITAL PROVIDED:[A] 38,861 DAYS OF ACUTE CARE FOR ADULT AND PEDIATRIC INPATIENTS,[B] 1,419 DAYS OF ACUTE CARE FOR NEWBORNS,[C] EMERGENCY CARE FOR 46,759 OUTPATIENTS, AND[D] 1,222,082 OUTPATIENT SERVICE REGISTRATIONS. 90847 3000 117298 HOSPITAL GUILD - 100 MEMBERS RENDERED SERVICES TO THE HOSPITAL AND ITS PATIENTS BY OPERATING A GIFT SHOP, KNITTING CAPS FOR NEWBORNS, MAKING CRADLE PICTURES AVAILABLE, ASSISTING IN THE INTERNAL TRANSPORTATION OF PATIENTS AND ASSISTING IN OTHER PATIENT RELATED ACTIVITIES THROUGHOUT THE HOSPITAL. THE GIFT SHOP AND CRADLE PICTURES ARE PRIMARILY FOR THE CONVENIENCE OF EMPLOYEES, PATIENTS AND VISITORS. THE GUILD ALSO OFFERS SOME NURSING SCHOLARSHIPS. 38114 1750 HOSPITAL MEDICAL STAFF - 341 MEMBERS [A] DIRECTED AND REVIEWED HOSPITAL BASED HEALTHCARE SERVICES AND [B] PARTICIPATED IN PERIODIC MEETINGS CONCERNING THE DELIVERY OF HEALTHCARE SERVICES, INCLUDING MEDICAL EDUCATION. 142647670 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 1 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 1 1 1 0 0 1 305 1 1 1907 1 1 1 1 CJ 0 0 0 1 1 0 0 0 0 X 17 10 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THOMAS W SCHILLING 7342404520 718 N MACOMB STREET MONROE MI 48162 BHURGRI MD AAMER 4.00 2.00 X 87870 9333 0 BRAUNLICH PAUL E 1.00 1.00 X 0 0 0 CALENDAR KAREN 1.00 1.00 X 0 0 0 CARTER KURT W 1.00 1.00 X 0 0 0 CHARBONEAU DO MICHAEL 40.00 1.00 X 586356 0 17172 COMPEAN MD JOSE R 1.00 1.00 X 31292 0 0 DARROW KURT L 1.00 1.00 X X 0 0 0 FRANZEN VICKI L 1.00 1.00 X X 0 0 0 KABIR MD ABDUL 1.30 1.00 X X 31049 0 0 KUBISKE DAVID 1.00 1.00 X 0 0 0 KULISH BARTON 1.00 1.00 X X 0 0 0 MCNAMEE MD KENNETH J 1.00 1.00 X 19508 0 0 PHILLIPS ANNETTE S 40.00 1.00 X X 444279 0 30327 ROBBINS BASIL D 1.00 1.00 X X 0 0 0 RYAN SISTER JANET 1.00 1.00 X X 0 0 0 SPENCER EDD DONALD A 1.00 1.00 X X 0 0 0 WALSH ARLENE R 1.00 1.00 X 0 0 0 WETZEL SUZANNE 1.00 1.00 X 0 0 0 WILBURN WALTER 1.00 1.00 X 0 0 0 ZWACK MATTHEW 1.00 1.00 X 0 0 0 SCHILLING THOMAS W 40.00 1.00 X 296196 0 30202 UBRANSKI PAM 40.00 0.00 X 209583 0 11141 PROCHNOW TODD 40.00 0.00 X 505712 0 29394 SOROSIAK MICHAEL J 40.00 0.00 X 224720 0 22051 OLENCHAK DANIEL 40.00 0.00 X 431284 0 28949 KIBBLE JOHN 40.00 0.00 X 214483 0 9755 SHERRARD MARK 40.00 0.00 X 269574 0 22058 3351906 9333 201049 62 0 1 0 ALLSCRIPTS 3 RAVINA DRIVE ATLANTA GA 30346 SOFTWARE SERVICES 2621015 GE HEALTHCARE 101 CARNEGIE CENTER PRINCETON NJ 08540 EQUIPMENT SERVICES 1462267 MICHIGAN CO-TENANCY LABS DEPT CH 14271 PALATINE IL 60055 LABORATORY SERVICES 1136074 MCKESSON INFORMATION SERVICES 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 SOFTWARE SERVICES 773002 AUCH GEORGE W CO 735 S PADDOCK PONTIAC MI 48341 CONSTRUCTION MGT. 700777 55 23450 109116 7476 886555 81981 1026597 HOSPITAL BASED HEALTHCARE SERVICE 621990 158260921 158260921 NON-PATIENT PHARMACY 446110 3801863 3801863 NON-PATIENT REF. LAB 621500 1325433 1325433 DME 446110 378462 378462 HOSPITAL GUILD 621990 117298 117298 163883977 1392588 1392588 1024211 1169168 -144957 -144957 -144957 50141853 19285 45554824 0 4587029 19285 4606314 4606314 157049 109116 180129 -23080 -23080 47716 46508 1208 1208 247250 141294 105956 105956 170848603 158484175 5505758 5832073 7576 7576 3800 3800 1784711 852239 932472 67915893 57578922 10230124 106847 616917 552993 62872 1052 13388358 11259484 2108225 20649 5017213 4210305 799203 7705 1256127 1256127 277933 277933 235610 235610 20560 20560 373824 373824 16404650 11952409 4444776 7465 269184 4691 262041 2452 1677778 954041 722602 1135 3938621 17287 3921334 3233325 2981963 251362 240098 239791 307 451974 170471 281503 2570545 2570545 10361126 9559629 800506 991 1063085 747005 316080 HOSPITAL SUPPLIES 25365393 25365393 PROVISION FOR BAD DEBTS 7930041 7930041 QUALITY ASSURANCE ASSES 4706409 4706409 DIETARY SUPPLIES 982676 982676 68109 68109 170161536 142647670 27297461 216405 118553 192721 16822030 9798063 35109790 22898993 28684 2598929 2588472 2071720 2297646 199227046 118600122 82266450 80626924 62924175 71881207 320601 428576 132458 2807456 2313263 205039704 193187007 63907268 42542630 43813402 42886500 5835057 5134550 113555727 90563680 X 88054229 99097292 3374057 3470122 55691 55913 91483977 102623327 205039704 193187007 X 687067 -310913 10763196 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 20560 20560 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION PAID DUES TO ORGANIZATIONS WHICH PERFORMED LOBBYING ACTIVITIES. 3429748 1122390 93639 1119743 3526034 3254087 1265452 96131 2500 1183422 3429748 3106926 1263779 87576 1204194 3254087 4973922 1132367 168896 3168259 3106926 5308021 1121436 -178473 3000 1274062 4973922 0.98000 0.02000 0 0 15360578 15360578 64104999 38810828 25294171 116617997 79789294 36828703 3143472 3143472 80626924 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TRUE ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR NURSING SCHOLARSHIPS. QUASI-ENDOWMENT FUNDS HAVE BEEN DESIGNATED FOR VARIOUS USES TO FURTHER THE HOSPITAL'S MISSION TO PROVIDE QUALITY, COMPREHENSIVE HEALTH CARE SERVICES. SOME OF THESE DESIGNATIONS INCLUDE HOSPICE, CHAPLAINCY, CANCER TREATMENT ASSISTANCE, CAPITAL IMPROVEMENTS, AND PHARMACY ASSISTANCE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2013, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICE PAYMENTS TO FOREIGN INSURANCE COMPANY THAT PROVIDES INSURANCE TO THE HOSPITAL 2812629 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 6372479 0 0 0 0 0 0 9185108 0 9185108 1 0 1 0 0 0 FANTASY OF TREES 2012 195565 53636 141929 100042 5355 23343 1223 13757 GOLF OUTING 2013 44645 30825 13820 4687 16625 858 2 25954 24654 1300 1682 53 3600 8905 266164 109115 157049 106411 5355 40021 4823 23520 180130 -23081 47716 4500 40740 1268 1 1.00000 47716 4500 40740 1268 46508 1208 MI 1 0 1 0 0.10000 0.90000 MOLLY MOORE 718 N MACOMB STREET MONROE MI 48162 0 MOLLY MOORE OVERSEES GAMING ACTIVITIES AND RECORDKEEPING X 0 1 1 X 1 X 0 1 1 1 0 1 1 3681203 3681203 0.02270 27671645 19753579 7918066 0.04880 31352848 19753579 11599269 0.07150 1049824 100759 949065 0.00590 845655 845655 0.00520 281127 3455 277672 0.00170 21151 21151 0.00010 2197757 104214 2093543 0.01290 33550605 19857793 13692812 0.08440 28142 28142 0.00020 1030 3792 3792 0.00000 200 200 0.00000 23999 23999 0.00010 1000 10647 10647 0.00010 108 23174 23174 0.00010 2138 89954 89954 0.00050 1 7930041 793004 40493203 51407716 -10914513 X 1 1 1 1 MERCY MEMORIAL HOSPITAL CORPORATION

718 N MACOMB STREET MONROE MI 48162

X X X MERCY MEMORIAL HOSPITAL CORPORATION 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X 0 0 1 1 200.000000000000 0 1 X X X X 1 1 X 1 0 X X X 1 X 0 0 35 MMH REHAB

700 STEWART ROAD MONROE MI 48162

REHAB SERVICES DIAGNOSTIC CENTER

901 N MACOMB STREET MONROE MI 48162

DIAGNOSTIC, CARDIOPULMONARY, LAB MERCY MEMORIAL HOSPICE

1070 N MONROE STREET MONROE MI 48162

HOSPICE SERVICES HOME CARE CONNECTION

1070 N MONROE STREET STE A MONROE MI 48162

HOME CARE SERVICES WESTSIDE MEDICAL

100 POWELL DUNDEE MI 48131

DIAGNOSTIC THERAPY, LAB PHLEBOTOMY-DELISLE CENTER

1056 N MONROE STREET MONROE MI 48162

OUTREACH LAB BEHAVIORAL HEALTH

700 STEWART RD MONROE MI 48162

BEHAVIORAL HEALTH MMH OUTPATIENT SURGERY CENTER

750 STEWART ROAD MONROE MI 48162

AMBULATORY SURGERY CENTER HOME RESPIRATORY DME

1070 N MONROE STREET STE C MONROE MI 48162

HOME RESPIRATORY DME PHLEBOTOMYXRAY-DRKABIR

219 W FRONT STREET MONROE MI 48162

OUTREACH LAB NEWPORT MEDICAL

7825 NORTH DIXIE NEWPORT MI 48166

PATIENT ACCOUNTING, LAB PHLEBOTOMY-DR STEWART

811 N MONROE STREET MONROE MI 48162

OUTREACH LAB DR MICHAEL CHARBONEAU

730 N MACOMB STREET MONROE MI 48162

DOCTOR OFFICE SLEEP LAB MACOMB

717 N MACOMB STREET MONROE MI 48162

SLEEP LAB SERVICES DR AHADI OFFICE COMPLEX

55 COLE ROAD MONROE MI 48162

OUTREACH LAB PHLEBOTMY-KARPENKO

323 STEWART ROAD MONROE MI 48162

OUTREACH LAB DR KURT ROECKER

14930 LAPLAISANCE ROAD SUITE 118 MONROE MI 48162

OUTREACH LAB DR TODD PROCHNOW

730 N MACOMB STREET SUITE 419 MONROE MI 48162

DOCTOR OFFICE PHLEBOTOMY-DR DONA

7505 GRAFTON ROAD SUITE 5 MONROE MI 48162

OUTREACH LAB PHLEBOTOMY-DR QURESHI

5290 W BROOKSHIRE ROAD MONROE MI 48161

OUTREACH LAB DR DANIEL OLENCHAK

730 N MACOMB STREET SUITE 419 MONROE MI 48162

DOCTOR OFFICE DR MARVIN CRAIG

4220 LUNA PIER ROAD LUNA PIER MI 48157

DOCTOR OFFICE DR BARNETT KANTZ

100 POWELL ROAD STE 2 DUNDEE MI 48131

DOCTOR OFFICE MMH POB

730 N MACOMB STREET MONROE MI 48162

OUTPATIENT CLINIC TEMPERANCE

1715 W DEAN ROAD TEMPERANCE MI 48182

SLEEP LAB, LAB SERVICES OUTPATIENT THERAPY

214 ELM STREET MONROE MI 48162

OCCUPATIONAL THERAPY SERVICES DR JAMES DOYLE

920 N MACOMB STREET MONROE MI 48162

DOCTOR OFFICE DR RAVI DAHR

721 N MACOMB STREET STE 6 MONROE MI 48162

DOCTOR OFFICE DR MICHELLE CHARTIER

7825 N DIXIE HWY NEWPORT MI 48166

DOCTOR OFFICE DR BETTY RUMSCHLAG

7470 SECOR ROAD LAMBERTVILLE MI 48144

DOCTOR OFFICE DR BETTY RUMSCHLAG

110 MAIN STREET DUNDEE MI 48131

DOCTOR OFFICE CANCER CONNECTION

800 STEWART ROAD MONROE MI 48162

CANCER SUPPORT DR KRISTA GUSTAD

730 N MACOMB STREET STE 329 MONROE MI 48162

DOCTOR OFFICE FAMILY MEDICAL RESIDENCY CENTER

650 STEWARD ROAD MONROE MI 48162

DOCTOR OFFICE MONROE CANCER CENTER

800 STEWART ROAD MONROE MI 48162

CANCER TREATMENT PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. ACTUAL COSTS FROM THE COST ACCOUNTING SYSTEM AND ACCOUNTING RECORDS ARE USED FOR LINES 7E THROUGH 7I. PART I, LINE 7G: N/A - THE HOSPITAL DID NOT LIST ANY SUBSIDIZED HEALTH SERVICES. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $7,930,041. PART II: PARTICIPATION IN TASK FORCES AND COMMITTEES ASSURES A MORE COORDINATED APPROACH TO SERVICES FOR AN AGING POPULATION. EMERGENCY PREPAREDNESS AND COORDINATION OF EFFORT AMONG AGENCIES PROVIDING HUMAN SERVICES. SPECIFIC AREAS OF IMPROVEMENT INCLUDE PRE-HOSPITAL AMBULANCE CARE, REFERRAL OF SENIORS TO SUPPORTIVE COMMUNITY SERVICES, SUICIDE PREVENTION, SUBSTANCE ABUSE, AND BREASTFEEDING FOR IMPROVED CHILD HEALTH. PART III, LINE 4: PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED UP ON MANAGEMENT'S ASSESSMENT OF THE HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTABLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. THE BAD DEBT AMOUNT REPORTED ON PART III LINE 2 IS BAD DEBT EXPENSE PER THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND PER FORM 990 PART IX. PART III, LINE 3: THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS ESTIMATED AT 10 PERCENT OF BAD DEBT EXPENSE. PART III, LINE 8: THE SHORTFALL 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. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 3: THE HOSPITAL CONSULTED WITH THE FOLLOWING INDIVIDUALS ON THE INDICATED AREAS: KIM COMERZAN, DIRECTOR MONROE COUNTY HEALTH DEPT AND DR. TATYANA IVANOVA, COMMUNITY HEALTH DIRECTOR MONROE COUNTY HEALTH DEPT., ON THE DEVELOPMENT OF COMMON CHNA SECONDARY DATA SET, CHN PRIORITIES, AND DESIGN OF FUTURE CHNA REPORTS. ED LARKINS, EXECUTIVE DIRECTOR FAMILY MEDICAL CENTER OF MICHIGAN FEDERALLY QUALIFIED CLINIC, AND DR. SUSAN HULSEMANN, DIRECTOR FAITHWORKS MEDICAL CLINIC FOR WORKING UNINSURED, ON THE NEEDS OF UNINSURED AND UNDERINSURED. ROB WHITNEY, COMMANDER MONROE COUNTY SALVATION ARMY, AND CONNIE CARROLL, EXECUTIVE DIRECTOR MONROE COUNTY UNITED WAY, ON NEEDS OF INDIGENT AND UNINSURED.ANDREA MULHEISEN, DIRECTOR NETWORK DEVELOPMENT AREA AGENCY ON AGING 1B, AND JEFF MCBEE, DIRECTOR MONROE COUNTY COMMISSION ON AGING, ON NEEDS OF ELDERLY. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 5C: THE CHNA CAN BE FOUND AT THE HOSPITAL'S WEBSITE: HTTP://WWW.MERCYMEMORIAL.ORG/RESOURCE.ASHX?SN=CHNA MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 7: THE IMPLEMENTATION PLAN INCLUDES ONLY CHNA IDENTIFIED NEEDS NOT CURRENTLY BEING ADDRESSED BY THE HOSPITAL. THE FOLLOWING NEEDS ARE, THEREFORE, NOT INCLUDED IN THE IMPLEMENTATION PLAN: SMOKING CESSATION- THE HOSPITAL CONTINUES TO IDENTIFY AND COUNSEL INPATIENTS WHO SMOKE, CONTINUES TO OFFER CESSATION CLASSES TO THE COMMUNITY, CONTINUES TO MAINTAIN A SMOKE FREE CAMPUS, AND CONTINUES TO HIRE ONLY NON-SMOKERS. MENTAL HEALTH SERVICES AND SUBSTANCE ABUSE- THE HOSPITAL CONTINUES TO OPERATE THE ONLY LICENSED INPATIENT PSYCHIATRIC UNIT IN MONROE COUNTY, CONTINUES TO PROVIDE OUTPATIENT PSYCHIATRY AND COUNSELING SERVICES, AND CONTINUES TO RECRUIT A CHILD/ADOLESCENT PSYCHIATRIST.PREVENTION OF INJURIES- THE HOSPITAL CONTINUES TO PROVIDE AMBULANCE AND EMT COVERAGE OF COMMUNITY EVENTS, CONTINUES TO ACTIVELY PARTICIPATE IN INFANT AND CHILD SAFETY PROGRAMS OFFERED BY OTHER COMMUNITY AGENCIES, AND CONTINUES TO OFFER FIRST AID CLASSES TO THE COMMUNITY. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 11: THE FINANCIAL ASSISTANCE POLICY IS FOR FREE CARE AND THE ONLY OTHER DISCOUNTED CARE AVAILABLE IS FOR ANY PATIENT PAYING WITHIN 30 DAYS RECEIVES A 20% DISCOUNT. MERCY MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 20D: FAP-ELIGIBLE INDIVIDUALS ARE NOT CHARGED AND DO NOT RECEIVE A BILL IF THEY QUALIFY UNDER THE HOSPITAL'S FAP. PART VI, LINE 2: SECONDARY COMMUNITY HEALTH DATA ARE CONSIDERED IN THE ANNUAL REVIEW AND ADJUSTMENT OF THE HOSPITAL'S 3-YEAR STRATEGIC PLAN; HOSPITAL LEADERS SERVE ON COMMUNITY BOARDS, COMMITTEES AND TASK FORCES WHERE NEEDS MAY BE IDENTIFIED; THE HOSPITAL AND MONROE COUNTY HEALTH DEPARTMENT ARE COLLABORATING ON DEVELOPING A PRIMARY DATA ACQUISITION PROCESS DESIGNED TO ENGAGE COMMUNITY PARTNER ORGANIZATIONS, OBTAIN BROADER INPUT FROM COMMUNITY MEMBERS ON HEALTH NEEDS AND PRIORITIES, AND PROVIDE THE FOUNDATION FOR THE NEXT CHNA. PART VI, LINE 3: WHEN IT IS DETERMINED THAT A PATIENT IS UNABLE TO PAY FOR SERVICES (EITHER BEFORE OR AFTER SERVICES ARE RENDERED) A FINANCIAL COUNSELOR WILL SPEAK TO THE PATIENT TO EXPLAIN FINANCIAL ASSISTANCE. THE FIRST OPTION OFFERED IS STATE MEDICAID. THE PATIENT IS ASSESSED FOR MEDICAID QUALIFICATION AND IF IT IS DETERMINED THE PATIENT DOES NOT QUALIFY, THEY ARE OFFERED CHARITY CARE ASSISTANCE. THE PATIENT IS GIVEN A CHARITY CARE APPLICATION AND REQUESTED TO COMPLETE AND RETURN TO THE FINANCIAL COUNSELOR WITH THE APPROPRIATE DOCUMENTATION. ONCE THE APPLICATION IS RETURNED TO THE FINANCIAL COUNSELOR, IT IS ASSEMBLED AND SENT TO THE PATIENT ACCOUNTING OFFICE FOR APPROVAL. DEPENDING ON THE AMOUNT, VARYING LEVELS OF APPROVAL ARE REQUIRED. PART VI, LINE 4: WITHIN THE 549.4 SQUARE MILES OF MONROE COUNTY A MIXED URBAN AND RURAL ENVIRONMENT IS SUPPORTED BY A DIVERSE ECONOMY. URBAN AND INDUSTRIAL DEVELOPMENTS PREDOMINATE ALONG LAKE ERIE, WHILE APPROXIMATELY 1,100 WORKING FARMS OCCUPY THE WESTERN TOWNSHIPS. FROM THE 2010 CENSUS THERE WERE 152,021 PEOPLE IN THE COUNTY IN 58,888 HOUSEHOLDS. THE RACIAL MAKEUP OF THE COUNTY WAS 94.4% WHITE, 2.1% BLACK OR AFRICAN AMERICAN,0.3% NATIVE AMERICAN, 0.6% ASIAN, 0.8% FROM OTHER RACES, AND 1.8% FROM TWO OR MORE RACES. 96.3% SPOKE ENGLISH AT HOME. ABOUT 12.1% OF THE POPULATION WAS BELOW THE FEDERAL POVERTY LEVEL, AND 15,339 INDIVIDUALS UNDER 65 YEARS WERE UNINSURED. 12.8% OF THE POPULATION WAS OVER 65 YEARS. IN 2012 DECEMBER UNEMPLOYMENT WAS 7.6%. PART VI, LINE 5: THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF; THE HOSPITAL'S BOARD OF TRUSTEES IS BROADLY REPRESENTATIVE OF THE COMMUNITY; HOSPITAL LEADERS SERVE ON COMMUNITY BOARDS, COMMITTEES AND TASKFORCES THAT ADDRESS HEALTH AND HUMAN SERVICES ISSUES. PART VI, LINE 6: N/A - NOT AFFILIATED. PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: THE HOSPITAL IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT IN MICHIGAN OR ANY OTHER STATE. 1 FAMILY MEDICAL CENTER 905 N MACOMB ST MONROE MI 48162 382308659 501(C)(3) 5826 RENT FOR FEDERALLY QUALIFIED CLINIC 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: NURSING SCHOLARSHIPS ARE AWARDED BASED ON AN APPLICATION PROCESS. THE FUNDS ARE DISBURSED DIRECTLY TO THE EDUCATIONAL INSTITUTION. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 CHARBONEAU DO MICHAEL 585231 0 225 0 900 0 179 0 16993 0 603528 0 0 0 PHILLIPS ANNETTE S 388637 0 50842 0 4800 0 13321 0 17006 0 474606 0 0 0 SCHILLING THOMAS W 263473 0 26723 0 6000 0 13207 0 16995 0 326398 0 0 0 UBRANSKI PAM 193750 0 15833 0 0 0 4170 0 6971 0 220724 0 0 0 PROCHNOW TODD 493086 0 225 0 12401 0 0 0 29394 0 535106 0 0 0 SOROSIAK MICHAEL J 224270 0 450 0 0 0 5065 0 16986 0 246771 0 0 0 OLENCHAK DANIEL 418260 0 225 0 12799 0 57 0 28892 0 460233 0 0 0 KIBBLE JOHN 194083 0 15600 0 4800 0 9697 0 58 0 224238 0 0 0 SHERRARD MARK 239934 0 24840 0 4800 0 5066 0 16992 0 291632 0 0 0 PART I, LINE 1A THE HOSPITAL MAINTAINS A MEMBERSHIP WITH A COMMUNITY GOLF / COUNTRY CLUB. THE MEMBERSHIP IS INTENDED FOR THE GENERAL USE OF THE HOSPITAL, AND IS MAINTAINED UNDER THE NAME OF THE CHIEF EXECUTIVE OFFICER (AS A REPRESENTATIVE MUST BE NAMED IN THIS INSTANCE). USE OF THE MEMBERSHIP IS MADE AVAILABLE FOR BUSINESS PURPOSES ONLY, AND PERSONAL USE IS PROHIBITED. FACILITIES AT THE COUNTRY CLUB ARE USED FOR HOSPITAL FUNCTIONS, BUSINESS MEETINGS, VOLUNTEER RECOGNITION, AND FUNDRAISING. THIS BENEFIT IS NOT TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B THE ORGANIZATION OFFERS SELECT MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES ANNUAL EMPLOYER-FUNDED CONTRIBUTIONS EQUAL TO A FIXED PERCENT OF BASE SALARY: 15% FOR CEO, 10% FOR SENIOR VICE PRESIDENTS AND 5% FOR VICE PRESIDENTS. BENEFITS ARE VESTED AFTER THREE YEARS OF SERVICE AND ARE PAID OUT IN A LUMP SUM BY MARCH 15 OF THE YEAR FOLLOWING THE YEAR IN WHICH THEY BECOME VESTED. THE FOLLOWING INDIVIDUALS REPORTED ON FORM 990, PART VII ARE PARTICIPANTS: ANNETTE PHILLIPS, THOMAS SCHILLING AND JOHN KIBBLE. A COUNTY OF MONROE HOSPITAL FINANCE AUTHORITY 386004873 610648AR8 2006-06-15 50405076 CONSTRUCTION PROJECT ADDING 58,995 SQ FT; RENOVATING 66,910 SQ FT 0 0 0 B COUNTY OF MONROE HOSPITAL FINANCE AUTHORITY 386004873 2012-03-30 3170830 CATH LAB RENOVATION AND EQUIPMENT 0 0 0 A 52639779 3812411 709013 36382719 2009 1 0 1 1 B 3170830 30000 3140830 2012 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 0 B 0 0 1 0 0 0 0 0 0 A 1 B 1 SCHEDULE K, PART I, BOND ISSUES: MONROE COMMUNITY HEALTH SERVICES IS A MEMBER OF THE MERCY MEMORIAL HOSPITAL CORPORATION OBLIGATED GROUP OF WHICH MONROE COMMUNITY HEALTH SERVICES HAS BEEN ALLOCATED FUNDS FROM THIS 2006 BOND ISSUANCE. SCHEDULE K, PART I, BOND ISSUES: A- THE BOND ISSUE PRICE WAS $50,405,076.58 WITH A REDEMPTION PRICE OF $49,550,000 AT MATURITY. PROCEEDS OF THE ISSUE WERE USED FOR BOND ISSUANCE COSTS, REQUIRED RESERVE FUND, REFUND PRIOR ISSUE BONDS AND INDEBTEDNESS (02/01/1994 BONDS) AND BUILDING EXPANSION AND EQUIPMENT. B - SIEMENS PUBLIC INC. PROGRAM REVENUE NOTE ISSUE PRICE WAS $3,170,830. PROCEEDS OF THE ISSUE WERE USED FOR NOTE ISSUANCE COSTS AND CATH LAB RENOVATION EQUIPMENT. COMPEAN MD JOSE R TRUSTEE PHYSICIAN RECRUITMENT X 156459 28684 0 0 1 28684 MARY CARTER FAMILY MEMBER OF BOARD MEMBER KURT CARTER. 28645 EMPLOYMENT 0 LARRY CSOKASY FAMILY MEMBER OF BOARD MEMBER KURT CARTER. 99783 EMPLOYMENT 0 MONROE HEALTH CENTER >35% OWNED BY BOARD MEMBER AAMER BHURGRI. 194231 LEASE OF PROPERTY 0 X 4 380 COMPARABLE SALES X 38590 COMPARABLE SALES X 1 300 COMPARABLE SALES X 9 1506 COMPARABLE SALES X 40 6850 COMPARABLE SALES X AUCTION ITEMS 104 34355 COMPARABLE SALES 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS DR. KENNETH MCNAMEE, DR. AAMER BHURGRI, DR. MICHAEL CHARBONEAU, AND DR. ABDUL KABIR HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS FOR THE FOLLOWING: TO STATE THAT 20% OF THE ELECTED BOARD MEMBERS MAY RESIDE OUTSIDE MONROE COUNTY; A MINIMUM OF TWO, QUALIFIED MEMBERS OF THE MEDICAL STAFF (INDEPENDENT OR EMPLOYED BY THE ORGANIZATION) WILL BE ON THE BOARD OF TRUSTEES; THE EXECUTIVE COMMITTEE MAY ACT AS THE NOMINATING COMMITTEE IF NO SEPARATE COMMITTEE IS CONSTITUTED; AND THE COMPENSATION COMMITTEE SHALL CONSIST OF AT LEAST THREE ELECTED TRUSTEES APPOINTED BY THE CHAIRPERSON OF THE BOARD AND A MAJORITY OF THE COMMITTEE IS TO BE INDEPENDENT. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 INPUT DATA IS REVIEWED AND ANALYZED BY THE CONTROLLER AND THEN SUBMITTED TO THE CERTIFIED PUBLIC ACCOUNTING FIRM FOR PREPARATION. THE COMPLETED FORM 990 IS THEN RETURNED TO THE CFO AND THE CEO FOR FINAL REVIEW AND APPROVAL BEFORE THE BOARD MEETING. BEFORE THE RETURN IS FILED, THE FORM 990 IS REVIEW BY THE BOARD. ALL MEMBERS RECEIVE A COPY OF THE FORM 990, EVEN THOSE THAT ARE UNABLE TO ATTEND THE SCHEDULED MEETING. THE REVIEW IS PERFORMED DURING ONE OF THE MONTHLY BOARD MEETINGS, WHERE EACH MEMBER HAS A CHANGE TO ASK QUESTIONS. THIS REVIEW IS DOCUMENTED VIA MINUTES TO THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS BOARD MEMBERS, OFFICERS AND EMPLOYEES OF THE HOSPITAL. ON AN ANNUAL BASIS, THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS DISTRIBUTED TO OFFICERS, EMPLOYEES, AND TRUSTEES OF MERCY MEMORIAL HOSPITAL CORPORATION. POTENTIAL CONFLICTS OF INTEREST ARE ANALYZED BY THE HOSPITAL'S LEGAL DEPARTMENT AND ARE GIVEN RANKINGS OF LOW, MODERATE, AND SEVERE RISK. THIS ANALYSIS IS GIVEN TO THE BOARD CHAIR AND THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. ANY MEMBER WITH AN IDENTIFIED CONFLICT OF INTEREST IS EXCUSED FROM THE MEETING DURING DISCUSSIONS PERTAINING TO THE ISSUE OF CONFLICT, AND THE MEMBER IS NOT PERMITTED TO VOTE ON ANY ISSUE OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES AND APPROVES ALL COMPENSATION FOR THOSE DESIGNATED IN SENIOR LEADERSHIP POSITIONS SUCH AS THE CHIEF EXECUTIVE OFFICER & PRESIDENT, THE CHIEF MEDICAL OFFICER & VICE PRESIDENT OF MEDICAL AFFAIRS, THE CHIEF FINANCIAL OFFICER & SENIOR VICE PRESIDENT OF FINANCE, THE CHIEF NURSING OFFICER & SENIOR VICE PRESIDENT OF CLINICAL OPERATIONS, AND OTHER VICE PRESIDENTS. THE INDEPENDENT BOARD COMMITTEE RETAINS AN OUTSIDE CONSULTANT TO ANALYZE AND ASSIST IN MAKING THESE DETERMINATIONS THROUGH A VARIETY OF MARKET SURVEYS/STUDIES. THIS PROCESS IS UNDERTAKEN ANNUALLY AND WAS LAST PERFORMED IN 2013. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT 10,741,282. INCOME FROM PROCEEDS OF BOND ISSUE NOT UNDER THE CONTROL OF THE HOSPITAL 21,914. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT OR SELECTION PROCESS FROM THE PRIOR YEAR. MONROE COMMUNITY HEALTH SERVICES 718 N MACOMB STREET MONROE MI 48164 382934134 SKILLED NURSING AND OUTPATIENT SURGERY MI 501(C)(3) LINE 9 MERCY MEMORIAL HOSPITAL CORPORATION 1 MONROE HEALTH VENTURES 718 N MACOMB STREET MONROE MI 48164 382704426 PHARMACY MI MERCY MEMORIAL HOSPITAL CORPORATION C 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 MONROE COMMUNITY HEALTH SERVICES L 261496 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES M 152284 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES P 130598 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES Q 1415661 ACTUAL ALLOCATED COST MONROE COMMUNITY HEALTH SERVICES S 473482 ACTUAL ALLOCATED COST