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WA FOOTE MEMORIAL HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
WA FOOTE MEMORIAL HOSPITAL (EIN 38-2027689)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-08
IRS object ID
201421289349301652
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-08T12:22:00-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN346565596EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Ernst & Young US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line141 South High StreetAddressLine1
CityColumbusCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN382027689EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WA Foote Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWAFONameControl
Phone5177884800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1205 N East AvenueAddressLine1
CityJacksonCity
StateMIState
ZIP Code49201ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGeorgia FojtasekName
TitlePresident & CEOTitle
Phone5177884800Phone
Date Signed2014-04-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDiane L BeanName
PTINP00104972PTIN
Phone6142245678Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Allegiance HealthBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonGeorgia FojtasekNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1205 N East AvenueAddressLine1
CityJacksonCity
StateMIState
ZIP Code49201ZIPCode
FieldValueIRS element (for citing)
Gross Receipts461998828GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.allegiancehealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1970YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionWe lead our community to better health and well-being at every stage of life.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees4074TotalNbrEmployees
Total Nbr Volunteers843TotalNbrVolunteers
Total Gross UBI4742289TotalGrossUBI
Net Unrelated Business Txbl Income-33106NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6245493ContributionsGrantsPriorYear
Contributions Grants Current Year3873688ContributionsGrantsCurrentYear
Program Service Revenue Prior Year399476676ProgramServiceRevenuePriorYear
Program Service Revenue CY404465728ProgramServiceRevenueCY
Investment Income Prior Year7629400InvestmentIncomePriorYear
Investment Income Current Year9911659InvestmentIncomeCurrentYear
Other Revenue Prior Year8143786OtherRevenuePriorYear
Other Revenue Current Year8953035OtherRevenueCurrentYear
Total Revenue Prior Year421495355TotalRevenuePriorYear
Total Revenue Current Year427204110TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year581000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY643000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year216798486SalariesEtcPriorYear
Salaries Etc Current Year230033028SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year199907478OtherExpensePriorYear
Other Expenses Current Year207310272OtherExpensesCurrentYear
Total Expenses Prior Year417286964TotalExpensesPriorYear
Total Expenses Current Year437986300TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4208391RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-10782190RevenuesLessExpensesCY
Total Assets BOY472377426TotalAssetsBOY
Total Assets EOY498210237TotalAssetsEOY
Total Liabilities BOY286171720TotalLiabilitiesBOY
Total Liabilities EOY292252910TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY186205706NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY205957327NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSee Schedule OOur MissionWe lead our community to better health and well-being at every stage of life.Our ValuesCompetence: expertise in carrying out responsibilities and inspiring others to have confidence in you.Integrity: behavior that is honest, fair, trustworthy and sincere, strength of character and respect for others.Teamwork: working together in an environment of mutual respect.Diversity: respect for individual beliefs, uniqueness, and differences.Quality: committment to excellence in care.Compassion: acknowledging the feelings of others with empathy, support, encouragement, and sensitivity. Listening and responding to individual needs in a patient and caring manner.Customer Service: taking pride in providing service beyond expectations.Healing Environment: providing an environment that promotes an atmosphere of trust, comfort, healing and security.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense355639154Expense
Grants643000Grants
Revenue410256681Revenue
DescriptionSee Schedule OThe Hospital devotes substantial efforts and resources to providing health services to people in its communities. The Hospital is engaged in the following activities to ensure that our mission is accomplished:Unreimbursed Services Provided to the Underserved:The Hospital provides a substantial portion of its services to the underserved (elderly and low income residents). During the fiscal year ended June 30, 2013, approximately 46% of the value of services rendered were to elderly patients under the Medicare program, and approximately 15% of the services were provided to patients who were deemed indigent under state, county, or Medicaid Center guidelines.In the spirit of our mission and values, the Hospital has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare services to all persons. During the fiscal year ended June 30, 2013, the Hospital provided charity care of $48.6 million and recorded a provision for bad debts of $42.7 million. Consistent with Schedule H reporting, charity care at cost for fiscal year 2013 was $14 million.Patient Services:The Hospital serves seven counties with a medical staff of more than 475 physicians. A complete listing of services is available at AllegianceHealth.org.The Hospital supports unprofitable/subsidized health services, including inpatient and outpatient behavioral health and substance abuse services, obstetrics, emergency and trauma services, general medicine, family/general practice, senior services, cardiac and pulmonary rehabilitation, palliative care, wound care, pain clinic and diabetes clinic.Community Benefit Activities:The Hospital is engaged in community programs and services that address identified community health needs regardless of source or availability of payment and provide measurable improvement in health access, health status, and the use of health care resources. These programs address one of the six criteria:Supports the Hospitals community-based missionTargets the problems of the poor or medically underservedImpacts the health status of the identified communityReduces community health costsIs accessible to the entire target community regardless of ability to payStimulates external community partnershipsThe Health Improvement Organization (HIO) was created by Allegiance Health in 2001 to promote a culture of continuous health improvement in our community and integrate wellness and prevention throughout our services. The Allegiance Department of Prevention and Community Health provides staff and infrastructure to facilitate the coordination of local health improvement activities. The HIO Coordinating Council (HIO CC) is a multi-disciplinary stakeholders group led by Allegiance Health with representation from local government, public health, health care, health and human service agencies, nonprofits, school districts, health plans, mental health, employers and the faith community. The HIO CC coordinates efforts across community leaders in health to create unprecedented alignment of goals and resources, as well as a strong community platform for advocacy. The work of the HIO CC has culminated in the completion of a Community Action Plan including goals, objectives and strategies to address physical activity, nutrition, tobacco use, and depression in Jackson County. The Plan is based on assessment and data-driven processes, as well as input from over 30 representatives from local health and human service agencies, and over 100 community stakeholders. The overarching tactics that the Community Action Plan relies upon include evidence-based activities to:Enhance media attention and public recognition of healthy lifestyle practices;Improve access to healthy foods and safe, attractive, affordable places for activity through supportive policies and physical environment changes;Provide social support and services that promote consistent screening, referral and supportive relationships for physical activity, nutrition, mental health and smoking behavior change.Health Improvement Organization: The HIO builds upon existing community strengths and infrastructure to support implementation of health initiatives that have been prioritized as part of a community wide plan with significant community engagement and an established infrastructure to support longevity. In addition to operational support for the HIO CC, the Allegiance Health Department of Prevention and Community Health provides subject matter expertise on wellness and prevention at the Board, Service Line and community level, and direct service delivery (including employer-based health management, tobacco treatment services, weight management, faith community nursing, etc.) to a broad base of community members to support the health improvement priorities identified by the HIO. The Department of Prevention and Community Health has an annual budget of around $1 million. Since 2001, the Hospital has committed over $21.4 million of funding to this program.Other Community Benefit Activities:Through Community Education and Outreach, the Hospital provided educational sessions and clinics that reached 108,751 individuals at a cost of $842,642 in fiscal year 2013. The sessions/clinics included education on asthma, AIDS/HIV, diabetes, family planning, fitness/exercise, overall health, cardiovascular health, nutrition and weight management, pulmonary, smoking cessation and womens health. These educational offerings were located at the Hospital, community fairs, parishes, schools, work sites and by phone. Free Medical Screenings for high blood pressure, diabetes, mental health/depression, vascular disease and womens health served 1,219 community members at a cost of $18,882 in fiscal year 2013.The Hospital funded a 24-hour nurse call center to provide health information to the community. The cost of the center in fiscal year 2013 was $388,790.Free and discounted prescription drug and medical supplies were provided to community members at a cost of $45,193 during fiscal year 2013. Through Meals on Wheels and other food donation programs, the Hospital served approximately 25,000 individuals at a cost of $42,978.Transportation Assistance, including wheelchair van, ambulance, transport to and from cancer centers and cab service served 6,947 community members in fiscal year 2013 at a cost of $174,072.Partnerships:The Hospital played a leadership role in the establishment of the Center for Family Health, a Federally Qualified Health Center, providing $600,000 in fiscal year 2013 support for the uninsured.The Hospital played a leadership role in the establishment of the Jackson County Health Plan, whose mission is to improve healthcare coverage in Jackson County for the underserved.The Hospital partnered with the medical staff and community to establish Project Access, a program which provides free physician and hospital care for 500 community members that do not qualify for federal or state financial assistance and are uninsured. The Hospital provides free care for medically necessary hospital based services. Hospital executive staff sit on a number of governance boards of non-profit organizations in our community, such as Center for Family Health, Ella Sharp Museum of Art and History, Jackson Community Foundation, Fitness Council of Jackson, Health Improvement Organization, Allegiance Hospice, Allegiance Health Foundation, CareLink, Healthlink, Jackson Community Ambulance, Huron Valley Ambulance, Jackson Community Medical Record, Michigan Health Information Network, United Way of Jackson, Jackson Health Network, and Junior Achievement of Michigan Edge.The Hospital is also represented on public and private organizations including The Enterprise Group of Jackson, Inc. (promotes economic development), Jackson Citizens for Economic Growth, and South Central Michigan Works. The Hospital donates office space to two area non-profit organizations. These organizations are the Enterprise Group of Jackson, Inc. and Birthline of Jackson.Description
Total Program Service Expense355639154TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office1ForeignOffice
Foreign Activities1ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096287NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees4074NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Jeanne WickensBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5177884800TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1205 N East AvenueAddressLine1
CityJacksonCity
StateMIState
ZIP Code49201ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (34 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Georgia Fojtasek
President & CEO55.005.00XX702224075587
Aaron Boatin
Trustee2.002.00X000
Neeta Delaney
Trustee2.001.00X000
Doug Finch
Trustee2.002.00X000
David Halsey
Trustee4.001.00X4125800
Steven Hogwood
Trustee2.001.00X000
Nitin Ambani
Chief of Staff thru 12/31/125.001.00X3720100
John Mogerman
Chief of Staff as of 01/01/135.001.00X357948045969
Steven Rick
Trustee2.001.00X000
Tim Levy
Vice Chairman3.001.00X000
John Nally
Secretary/Treasurer3.001.00XX000
Harish Rawal
Trustee thru 04/01/130.000.00X000
Larry Schultz
Chairman5.001.00X000
Lynn VanWagnen
Trustee thru 04/01/130.000.00X000
Allan Tompkins
Trustee3.001.00X974700
Michael Shore
Trustee3.001.00X000
Mohan Kulkarni
Trustee3.001.00X15645200
Karen Chaprnka
SVP & COO55.005.00X421296052700
Jeanne Wickens
SVP & CFO55.005.00X433569065139
Richard Warren
VP & CIO55.005.00X281524067769
Jacalyn Liebowitz
VP Patient Care55.005.00X290563046533
Kenneth Empey
General Counsel55.005.00X248309060381
Cheryl Lamborn
VP Human Resources55.005.00X243634033533
Anthony Gardner
VP Marketing55.001.00X173097031986
Beth Smith
VP Organizational Excellence55.001.00X158224033131
Gerald Grannan
VP Physician Integrationg & Planning55.001.00X181095028402
John Hyden
Chief Compliance Officer55.005.00X125882017629
Ray King
Chief Medical Officer55.005.00X360955056904
Ryan Beekman
Physician50.000.001322670051295X
Vishal Gupta
Physician50.000.00832452083098X
Tudor Tien
Physician50.000.00769645037906X
Brian Daly
Physician50.000.00718436051678X
Ivan Cubas
Physician50.000.00642543073080X
William Kiel
VP Development thru 04/10/120.000.00247239024226X
FieldValueIRS element (for citing)
Total Reportable Comp From Org8755963TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation936946TotalOtherCompensation
Number Individuals GT100 K207NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Mckesson Technologies Inc
PO Box 98347ChicagoIL60693Healthcare Consulting3578739
Independent Emergency Physicians
PO Box 100Royal OakMI48068Healthcare Services3555714
GE Healthcare Services
PO Box 96483ChicagoIL60693Healthcare Consulting2913195
Cogent Healthcare Management Inc
PO Box 645037CinncinnatiOH45264Hospitalists2800371
Pulmonary Clinics of southern MI
900 E Micigan AvenueJacksonIL49201Healthcare Services2707608
FieldValueIRS element (for citing)
Number Of Contractors GT100 K217NumberOfContractorsGT100K
Related Organizations368538RelatedOrganizations
Government Grants3505150GovernmentGrants
Total Contributions3873688TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Patient Services6219904039779814009139193064062
SubPart F Income524298281055281055
FHC, JCA, and JCMR621910206692206692
FieldValueIRS element (for citing)
Total Program Service Revenue404465728TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5440596TotalRevenueColumn
Exclusion$5,440,596ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column138404TotalRevenueColumn
Exclusion$138,404ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1013829Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real935453Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real78376Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column78376TotalRevenueColumn
Exclusion$78,376ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities38191144Securities
Other780Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities33753805Securities
Other105460Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4437339Securities
Other-104680Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4332659TotalRevenueColumn
Exclusion$4,332,659ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Services to Affiliates56100043289313433473895458
Cafeteria7222101703867$1,703,867
Vendor Rebates621990715272715272

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2126589TotalRevenueColumn
Related Or Exempt Function Income1624875RelatedOrExemptFunctionIncome
Unrelated Business Revenue501714UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue8874659TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column427204110TotalRevenueColumn
Related Or Exempt Function Income406894231RelatedOrExemptFunctionIncome
Unrelated Business Revenue4742289UnrelatedBusinessRevenue
Exclusion$11,693,902ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total643000Total
Program Services643000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4834416Total
Program Services491645ProgramServices
Management And General4342771ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total493170Total
Management And General493170ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total183268610Total
Program Services150967940ProgramServices
Management And General32300670ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total10457488Total
Program Services8399397ProgramServices
Management And General2058091ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total18047646Total
Program Services14495771ProgramServices
Management And General3551875ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total12931698Total
Program Services10386669ProgramServices
Management And General2545029ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total419000Total
Management And General419000ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1465911Total
Program Services1177412ProgramServices
Management And General288499ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total400136Total
Management And General400136ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total239057Total
Management And General239057ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total298750Total
Management And General298750ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total46366103Total
Program Services37241001ProgramServices
Management And General9125102ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1741904Total
Program Services1399088ProgramServices
Management And General342816ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total21668596Total
Program Services17404098ProgramServices
Management And General4264498ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total11372560Total
Program Services9134378ProgramServices
Management And General2238182ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total8539631Total
Program Services6858985ProgramServices
Management And General1680646ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total431763Total
Program Services346790ProgramServices
Management And General84973ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total431763Total
Program Services346790ProgramServices
Management And General84973ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total7503237Total
Program Services6026559ProgramServices
Management And General1476678ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total26363640Total
Program Services21175132ProgramServices
Management And General5188508ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1342834Total
Program Services1078557ProgramServices
Management And General264277ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies3339813533398135
Drugs3146266231462662
Swap Loss Transaction60387256038725
Food21918272191827

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total5634038Total
Program Services1013318ProgramServices
Management And General4620720ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total437986300Total
Program Services355639154ProgramServices
Management And General82347146ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY18448875BOY
EOY8560443EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3009859BOY
EOY1980897EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY59121532BOY
EOY50532032EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY4135BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY90000BOY
EOY115000EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2420563BOY
EOY2594211EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY6464600BOY
EOY6874186EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY7323770BOY
EOY9480192EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis337931169LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec182959803LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY155907043BOY
EOY154971366EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY211566539BOY
EOY249871604EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY8020510BOY
EOY13230306EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY472377426BOY
EOY498210237EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY44981101BOY
EOY53947584EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY169609993BOY
EOY169988808EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3367990BOY
EOY3367990EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY18000000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY68212636BOY
EOY46948528EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY286171720BOY
EOY292252910EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY186205706BOY
EOY205957327EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY186205706BOY
EOY205957327EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY472377426BOY
EOY498210237EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-10782190ReconcilationRevenueExpenses
Reconciliation Unrealized Invest10220992ReconciliationUnrealizedInvest
Reconcilation Other Changes20312819ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$286,916DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB286916TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationHealth care is a highly-regulated field, requiring frequent and high-level communication with regulators and elected officials. A small investment in lobbying enables us to remain in contact with legislators and government agencies, maximize the resources with which we are entrusted and assure that we provide the best care to our community. Allegiance enlists the services of several lobbying consultants, attorneys and healthcare trade associations. In addition, the hospital employs a corporate accounts specialist. The specialist spends a portion of his time contacting legislators, participating in grass roots advocacy, and other activities closely related to lobbying.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1250833BeginningOfYearBalance
Contributions671894Contributions
Grants Or Scholarships370538GrantsOrScholarships
End Of Year Balance1552189EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1124117BeginningOfYearBalance
Contributions2790346Contributions
Investment Earnings Or Losses5025InvestmentEarningsOrLosses
Grants Or Scholarships2015249GrantsOrScholarships
Other Expenditures653406OtherExpenditures
Administrative Expenses0AdministrativeExpenses
End Of Year Balance1250833EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance642729BeginningOfYearBalance
Contributions2045207Contributions
Investment Earnings Or Losses-5012InvestmentEarningsOrLosses
Grants Or Scholarships849502GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses709305AdministrativeExpenses
End Of Year Balance1124117EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance42176BeginningOfYearBalance
Contributions946077Contributions
Other Expenditures345524OtherExpenditures
End Of Year Balance642729EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis9630527OtherCostOrOtherBasis
Book Value9630527BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis182365338OtherCostOrOtherBasis
Depreciation89229289Depreciation
Book Value93136049BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis129313606OtherCostOrOtherBasis
Depreciation90801549Depreciation
Book Value38512057BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16621698OtherCostOrOtherBasis
Depreciation2928965Depreciation
Book Value13692733BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings154971366TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
Retirement Plan Liability$35,084,177
Note Payable$252,057
Physician Recruitment Loan$283,854
Tax Abatement Liability$231,630
Deferred Comp$2,660,775
Swap Market Value Adjustment$8,436,035
FieldValueIRS element (for citing)
Total Of Amounts46948528TotalOfAmounts

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDescription of Intended Use of Endowment Funds:Identifier
Return ReferencePart V, Line 4:ReturnReference
ExplanationThe organization's endowment funds are used for various charitable hospital programs including treatment of uninsured patients and community preventative health education.Explanation

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCayman IslandsRegion
Number Of Offices0NumberOfOffices
Number Of Employees1NumberOfEmployees
Type Of Activities ConductedProgram ServicesTypeOfActivitiesConducted
Specific Services ProvidedSelf & Malpractice InsuranceSpecificServicesProvided
Total Expenditures3435112TotalExpenditures
FieldValueIRS element (for citing)
Subtotal Number Of Offices0SubtotalNumberOfOffices
Subtotal Number Of Employees1SubtotalNumberOfEmployees
Cont Number Of Offices0ContNumberOfOffices
Cont Number Of Employees0ContNumberOfEmployees
Total Number Of Offices0TotalNumberOfOffices
Total Number Of Employees1TotalNumberOfEmployees
Subtotal Amount Spent3435112SubtotalAmountSpent
Cont Amount Spent0ContAmountSpent
Total Amount Spent3435112TotalAmountSpent
Transfer To Foreign Corp1TransferToForeignCorp
Interest In Foreign Trust0InterestInForeignTrust
Own Foreign Corp1OwnForeignCorp
Passive Foreign Invest Co0PassiveForeignInvestCo
Foreign Partnership0ForeignPartnership
Boycott Countries0BoycottCountries

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense14063924TotalCommunityBenefitExpense
Direct Offsetting Revenue26803DirectOffsettingRevenue
Net Community Benefit Expense14037121NetCommunityBenefitExpense
Percent Of Total Expense0.03200PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense62977078TotalCommunityBenefitExpense
Direct Offsetting Revenue51226140DirectOffsettingRevenue
Net Community Benefit Expense11750938NetCommunityBenefitExpense
Percent Of Total Expense0.02680PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense77041002TotalCommunityBenefitExpense
Direct Offsetting Revenue51252943DirectOffsettingRevenue
Net Community Benefit Expense25788059NetCommunityBenefitExpense
Percent Of Total Expense0.05880PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense913532TotalCommunityBenefitExpense
Net Community Benefit Expense913532NetCommunityBenefitExpense
Percent Of Total Expense0.00210PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1550172TotalCommunityBenefitExpense
Net Community Benefit Expense1550172NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2463704TotalCommunityBenefitExpense
Net Community Benefit Expense2463704NetCommunityBenefitExpense
Percent Of Total Expense0.00560PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense79504706TotalCommunityBenefitExpense
Direct Offsetting Revenue51252943DirectOffsettingRevenue
Net Community Benefit Expense28251763NetCommunityBenefitExpense
Percent Of Total Expense0.06440PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense31703TotalCommunityBuildingExpense
Net Community Building Expense31703NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense628505TotalCommunityBuildingExpense
Net Community Building Expense628505NetCommunityBuildingExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense660208TotalCommunityBuildingExpense
Net Community Building Expense660208NetCommunityBuildingExpense
Percent Of Total Expense0.00150PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$42,733,028BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare164820786AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare192889175CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-28068389MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 Foote Health Center Associates
Entity leases medical office space.0.544300.000000.45570
2 Jackson Community Medical Records
Entity provides electronic medical records to hospital & community doctors.0.510000.000000.49000
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1WA Foote Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1205 NEast AvenueAddressLine1
CityJacksonCity
StateMIState
ZIP Code49201ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.allegiancehealth.orgWebsiteAddress
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1WA Foote Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities1OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed1AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent350.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities38NumberOfOtherFacilities

Other Facilities OtherFacilities (38 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Allegiance Hematology Oncology
1100 E Michigan AvenueJacksonMI49201Cancer Treatment
Allegiance Vascular Health
300 W Washington AvenueJacksonMI49201Vascular Health
Allegiance Orthopedics
1201 E Michgan AvenueJacksonMI49201Orthopedics
Allegiance Gastroenterology
1100 E Michigan Avenue Ste 310JacksonMI49201Gastroenterology
Allegiance General Surgery
300 W Washington AvenueJacksonMI49201Surgery Center
Allegiance Hospitalist Service
205 N East AvenueJacksonMI49201Hospitalists Group
Allegiance Express Care
110 N ElmJacksonMI49202Emergency Care
Allegiance Family Medicine - Townsend
400 Hinckley BlvdJacksonMI49203Family Medicine
Allegiance Cardio Surgery
1125 E Michigan AvenueJacksonMI49201Surgery Center
Allegiance Family Medicine - Leslie
130 N ShermanLeslieMI49251Family Medicine
Allegiance Intensivist Services
205 N East AvenueJacksonMI49201Internal Medicine
Allegiance Behavioral Health
205 N East AvenueJacksonMI49201Behavioral Health
Allegiance Rheumatology
1201 E Michgan Avenue Ste 100JacksonMI49201Rheumatology
Allegiance Family Medicine - Summit Wood
2585 Spring Arbor RoadJacksonMI49203Family Medicine
Allegiance Family Medicine - Spring Arbo
7845 Spring Arbor RoadSpring ArborMI49283Family Medicine
Allegiance EKG
205 N East AvenueJacksonMI49201Pulmonary Medicine
Allegiance Family Medicine - Mason
810 Hogsback RoadMasonMI48854Family Medicine
Allegiance Hearing Center
1111 TeneyckJacksonMI49201Hearing Loss Treatment
Allegiance Family Medicine - Albion
27931 C Drive NorthAlbionMI49224Family Medicine
Express Care Kids
110 N ElmJacksonMI49202Emergency Care
Allegiance Neuropsychiatry
205 N East AvenueJacksonMI49201Neuropsychiatry
Allegiance Internal Medicine
900 E Michigan AvenueJacksonMI49201Internal Medicine
Allegiance Family Medicine - Brookyln
153 Wamplers Lake RoadBrooklynMI49230Family Medicine
Allegiance Family Medicine - Grass Lake
12369 E Michigan AvenueGrass LakeMI49240Family Medicine
Allegiance Family Medicine - Cascade Rid
3333 Spring Arbor Road Ste 100JacksonMI49203Family Medicine
Allegiance Family Medicine - MI CTR
4304 Page AvenueMichigan CenterMI49254Family Medicine
Allegiance Senior Health Center
205 N East AvenueJacksonMI49201Geriatric Services
Allegiance Palliative Care
205 N East AvenueJacksonMI49201Palliative Care
Allegiance Neurology
1201 E Michgan AvenueJacksonMI49201Neurology
Allegiance Diabetes Center
817 W High StreetJacksonMI49203Diabetes
Allegiance EEG
205 N East AvenueJacksonMI49201Brain Diagnostics
Allegiance Occupational Health Urgent Ca
One Jackson SquareJacksonMI49201Urgent Care
Allegiance Family Medicine - North Stree
1401 W North StreetJacksonMI49202Family Medicine
Allegiance Family Medicine - East Michig
3235 E Michigan AvenueJacksonMI49202Family Medicine
Allegiance Family Medicine - Onsted
8958 West M-50OnstedMI49265Family Medicine
Allegiance Family Medicine - Springport
2282 Springport Road Ste BJacksonMI49202Family Medicine
Michigan Heart
309 Page AvenueJacksonMI49201Cardiovascular Care
Allegiance Digestive Health
4400 Ann Arbor RoadJacksonMI49202Digestive Health

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanationIdentifierIdentifier
Part I, Line 6a: The Hospital prepares an annual community benefit report, which can be accessed at allegiancehealth.org/givingback.
Part I, Line 7: The Hospital used a cost-to-charge ratio to calculate the cost of charity care and Medicaid shortfall. Community Health Improvement Services and Cash and In-Kind Contributions are actual amounts.
Part I, L7 Col(f): Our total expense from Form 990, Part IX, line 25, column (A) was $437,986,300. This expense is used as the denominator for purposes of calculating Part I, Line 7, column(f). The denominator does not include bad debt expense. Bad debt expense is subtracted from net patient services revenue.
Part II: The Hospital is involved in numerous community building activities. We believe these activities, such as supporting affordable housing, working in partnership with the local community college to develop skilled nurses and supporting economic development programs directly improve the general health and wellness of the community. Also, staff at every level of the organization are encouraged to serve community groups that promote education, health and economic advocacy for the less fortunate.
Part III, Line 4: Accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its historical experience and identifies trends for each of its major payor sources to estimate the appropriate allowance for uncollectible accounts and the provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party health care coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and provision for bad debts. For receivables associated with self-pay accounts (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 and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts. The provision for bad debts has been reported as a deduction from net patient service revenue.The amount of bad debt reported in the fiscal year 2013 audited financial statements was $42,733,028.
Part III, Line 8: The organization believes the entire Medicare shortfall reported on Line 7 should be treated as Community Benefit. Allegiance Health is nationally recognized by Healthgrades as being in the top five percent nationally for clinical excellence and patient safety. Allegiance Health also benchmarks favorably on overall cost per case and is deemed to be an efficient provider. The organization is subsidizing a government program and sustaining significant losses in providing health care to Medicare receipients. By continuing to treat patients eligible for Medicare, hospitals alleviate the federal government's burden for directly providing medical services.
Part III, Line 9b: The Hospital does not collect from patients known to qualify for charity care or other financial assistance. Patients having difficulty paying their bills are directed to financial counselors. These counselors review the patients information in order to see if they qualify for assistance. In addition, bills sent to patients include a number to call for help in providing the required financial information to qualify for charity care.
Part V, Section B, Line 3: The Health Improvement Organization Coordinating Council, founded by Allegiance Health, is a collaborative of community stakeholders committed to improving the health status of the community through an integrated health improvement infrastructure that addresses Jacksons priority health issues. The HIO Coordinating Council serves as the stakeholder planning committee for Allegiances Board HIO Committee, Jackson Countys Healthy Community initiative, the United Way of Jackson Countys Community Solutions Team on Health, and the Health Strand of the Jackson 2020 initiative. The scope of our responsibility includes monitoring community level indicators, identifying specific health priorities and developing community action plans to address common goals.In this model, community stakeholders work with public health experts to develop and complete a community health assessment for Jackson County. This assessment provides a data collection mechanism that better aligns efforts among community partners and creates a more strategic framework for local health improvement activities.Contributing PartnersAARP of MichiganAllegiance HealthAstraZenecaAWARE, Inc.Community Action AgencyCareLinkCatholic Charities of JacksonCenter for Family HealthCommunity MembersFitness Council of JacksonGreat Lakes IndustryJackson Community CollegeJackson Community FoundationJackson County AdministrationJackson County Youth CenterJackson Health NetworkJackson County Health DepartmentJackson County Intermediate School DistrictLifeWaysMarriage MattersMeridian Health PlanMichigan Purchasers Health AlliancePartnership Park Downtown Neighborhood AssociationUnited Way of Jackson CountyYMCA of Jackson CountyYMCA Storer CampsW.A. Foote Memorial Hospital
Part V, Section B, Line 4: CareLink of Jackson, a Community Owned Specialty HospitalW.A. Foote Memorial Hospital
Part V, Section B, Line 14g: Financial assistance policy brochures are placed in the ER waiting room.W.A. Foote Memorial Hospital
Part VI, Line 2: Allegiance Health conducts a telephone survey every three years in order to gather information on the health status of Jackson County. Through a statistically valid survey, we collect responses from over 1,000 Jackson County residents age 18 and older to a 180 question survey about their health status, insurance coverage, personal health habits and health care experiences. The specific steps involve collecting and analyzing health information for our County (including subpopulations within our County); measuring our health status against other communities, the state and the nation; prioritizing health issues within the community; creating a system for sharing this data with community organizations and residents; initiating strategic planning to address these issues through collaborative activities; and monitoring impact of health initiatives on community health outcomes.
Part VI, Line 3: Uninsured inpatients and observation patients are referred to a financial counselor (contracted agent/partner) for assistance with Medicaid, SSI, and Allegiance Health program applications. Many outpatients needing or having received hospital services are also referred to the agent/partner for assistance. ER patients are provided with a packet of information at discharge from the department. This packet includes information about how assistance may be obtained through the local Medicaid office and about how to apply for our income structured payment plan and uncompensated care programs. When patients are billed for balances they owe, we solicit them to call the Business Office with any questions or for assistance. Additionally, a series of letters are sent to patients to apprise them of payment and assistance options. Allegiance has a printed brochure that is available through Registration that includes information regarding Medicaid application assistance and our internal programs. The Allegiance Health website includes a series of web pages related to transparency, quality, pricing, and our financial policies, procedures, and programs. Uninsured patients needing mental health services are screened for eligibility through our partnership with the Jackson Community Mental Health Agency, which funds care for indigent, dual diagnosis, and Medicaid patients. Patients seeking substance abuse care are linked with the Mid-South Substance Abuse Commission. Registration and Business Office team members receive direct training on our programs and scripting for ensuring information is provided to the patients and families with whom our staff interact. Education is provided to organizational leaders to ensure that team members outside of Finance are aware of our programs and where to direct patients and families who may need or who are seeking assistance.
Part VI, Line 4: Allegiance Health population is determined geographically by the boundaries of Jackson County. The hospital is a tax exempt Health System that serves the collective health needs of the more than 160,000 residents of Jackson County. The gender distribution of Jackson County residents is 49% female and 51% male. The age distribution of Jackson County is 26% of residents 19 years and under, 18% between 20 and 34 years, 29% between 35 and 54 years, 13% between 55 and 64 years, and 14% of residents are 65 years and older. Racial distribution of Jackson County residents according to the 2011 Census Data is 88.0% as white, 7.9% as African American, 0.7% as Asian, 0.4% as American Indian or Alaska Native, and 3.0% as some other race or two or more races. Of males aged 15 years and over, 33.0% have never married, 50.4% are married, 1.5% are separated, 2.9% are widowed, and 12.3% are divorced. Of females aged 15 and over, 25.0% have never married, 50.4% are married, 1.7% are separated, 9.8% are widowed, and 13.2% are divorced. According to the Bureau of Labor Statistics (2013), Jackson County also experiences a high unemployment rate of 8.8%. With 69,400 individuals in the civilian labor force, 6,100 residents are currently unemployed. Of those employed, major industries represented include educational services, health care, and social assistance (23.9%); manufacturing (18.7%); retail trade (12.1%); professional, scientific, management, administrative, and waste management services (7.7%); and arts, entertainment, recreation, accommodation, and food services (7.5%). Approximately 47% of Allegiance Hospital patients were covered by Medicare, while 15% were on Medicaid and 4% were uninsured. During the 2013 fiscal year, Allegiance Health had 9,399 Medicare discharges and 4,238 Medicaid discharges from inpatient services. Physician practice visits totaled 200,327 during FY 2013, with 126,337 primary care visits and 73,990 visits to specialists. Allegiance Health also provides financial and leadership support of primary care services for the underserved, regardless of their ability to pay, through the Center for Family Health (CFH), a federally qualified health center. In fiscal 2013, CFH saw 27,398 patients, which 54% were on Medicaid, 7% were on Medicare and 24% were uninsured.
Part VI, Line 5: Allegiance Health is honored to have received national recognition in recent years, including the American Hospital Associations 2010 Foster G. McGaw Prize for excellence in community service, which is presented to only one hospital in the United States each year. This award is the ultimate recognition of Allegiance Health's commitment to community health improvement and partnership.Allegiance Health is a community owned and locally governed integrated health system located in Jackson, Michigan. As the sole community provider in Jackson County, Allegiance offers a comprehensive range of inpatient and outpatient medical services. Originally founded in 1918 as a community hospital, Allegiance has grown in response to community demand and over the last decade has made substantial investments modernizing its more than 40 healthcare facilities, increasing staff, expanding and renovating its oncology centers, emergency department, and surgery facilities, and installing next generation electronic medical records system. Allegiance's modern facilities, state of the art technologies, and innovative new services ensure that area residents receive a full range of medical services close to home.Allegiance's commitment to building a patient centered, physician led community health system has resulted in numerous industry awards and national recognition. Recent awards include the Thomson Reuters 100 Top Hospitals (awarded in 1995,1996,2008,2010,2011), HealthGrades Distinguished Hospital Award for Clinical Excellence(awarded in 2008,2010,2011,2012,2013), HealthGrades Patient Safety Excellence Award (awarded in 2009,2010,2011,2012,2013), HealthGrades Top 100 Hospital Award for 2013, and the CareChex Top 100 Hospital Award for 2013.The Health Improvement Organization (HIO) was created by Allegiance Health in 2001 to promote a culture of continuous health improvement in our community and integrate wellness and prevention throughout our services. The Allegiance Department of Prevention and Community Health provides staff and infrastructure to facilitate the coordination of local health improvement activities. The HIO Coordinating Council (HIO CC) is a multi-disciplinary stakeholders group led by Allegiance Health with representation from local government, public health, health care, health and human service agencies and nonprofits, school districts, health plans, mental health, employers and the faith community. The HIO CC coordinates efforts across community leaders in health to create unprecedented alignment of goals and resources, as well as a strong community platform for advocacy. The work of the HIO CC has culminated in the completion of a Community Action Plan including Goals, Objectives and Strategies to address physical activity, nutrition, tobacco, and depression in Jackson County based on assessment and data-driven processes, as well as input from over 30 representatives from local health and human service agencies, and over 100 community stakeholders. The overarching tactics that the Community Action Plan relies upon include evidence-based activities to:Enhance media attention and public recognition of healthy lifestyle practicesImprove access to healthy foods and safe, attractive, affordable places for activity through supportive policies and physical environment changes Provide social support and services that promote consistent screening, referral and supportive relationships for physical activity, nutrition, mental health and smoking behavior changeSee Form 990, Schedule O, Program Service Accomplishments for more detail.
Part VI, Line 6: The Hospital's sole corporate member is Allegiance Health Services, a 501(c)(3) organization. Other affiliates include a Foundation, a Hospice, a Long Term Acute Care Hospital (LTACH), a Volunteer Organization and a Home Health Care company, all 501(c)(3) organizations. Additionally, the hospital recently formed a clinically integrated network.The Hospital, Hospice, LTACH and Home Health Care organization work together to provide necessary medical services to the Jackson Community. The Foundation and the Volunteer Organization work closely with the Parent and the Hospital in raising funds for projects and services that would benefit the overall well-being of the community. The most recent campaign is raising funds for a Graduate Medical Education program. Previous campaigns successfully raised funds to expand and improve our cancer care service line and provided free medical care to indigent patients. The clinically intergrated network works to improve patient clinical outcomes thru coordinated care and lowering overall health care costs. See Form 990, Schedule O, Program Service Accomplishments for more detail.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationPurpose Of GrantPurposeOfGrant
Center for Family Health
2298 Springport RoadJacksonMI49202383251354501(c)(3)6000000N/AThe Center for Family Health grant provides operational support for medically underserved populations.
Healthlink
205 N East AvenueJacksonMI49201382756425501(c)(3)300000N/AThe Helping Hands Home Care grant supports respite care for families without the financial means to pay for needed assistance.
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: The organization sends out an award letter to all grantee recipents. The letter outlines what the funding may be used for and requests a final report detailing the year's activities. Further funding is contingent upon satisfactory completion of this report.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (19 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Georgia Fojtasek
President & CEO6244640007776004784102774607778110234800
John Mogerman
Chief of Staff as of 01/01/13454480310902015980248630211060403917000
Mohan Kulkarni
Trustee156452000000000156452000
Karen Chaprnka
SVP & COO3537390006755704139401130604739960456300
Jeanne Wickens
SVP & CFO3755780005799104083102430804987080396200
Richard Warren
VP & CIO2318220004970204769102007803492930274150
Jacalyn Liebowitz
VP Patient Care2432910004727202141802511503370960284820
Kenneth Empey
General Counsel2277500002055903516102522003086900173550
Cheryl Lamborn
VP Human Resources171301000723330176370158960277167000
Anthony Gardner
VP Marketing1717770001320022398095880205083000
Beth Smith
VP Organizational Excellence1548420003382022191010940019135504410
Gerald Grannan
VP Physician Integrationg & Planning180216000879024991034110209497000
Ray King
Chief Medical Officer341064000198910336990232050417859000
Ryan Beekman
Physician67286091620303391810364480148470137396502840810
Vishal Gupta
Physician2807007760440283380619480211500915550000
Tudor Tien
Physician843804950390266168016680021226080755102357520
Brian Daly
Physician6936504285120220559031318020360077011401774940
Ivan Cubas
Physician400005999660385770518110212690715623000
William Kiel
VP Development thru 04/10/12519590001952800873901548702714650414380

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aGeorgia Fojtasek flew on a charter plane with a delegation of Michigan hospital delegates to a Regional Policy Board meeting. The hospital paid Georgia's proportionate charter flight cost. Allegiance Health provides a country club membership to three executives. The executives are Georgia Fojtasek, Ray King and Karen Chaprnka. Executives reimburse the hospital for any personal use of the club.
Part I, Line 3The CEO is accountable for ensuring that Allegiance Health's mission is efficiently carried out with the highest levels of quality, safety and service, while at the same time ensuring that the organization is financially healthy. Executive compensation is reviewed annually by the Executive Compensation Committee of the Board of Trustees. This committee works with an independent compensation consultant to ensure that Allegiance Health compensation practices are consistent with industry standards and that compensation levels are fair compared to similar healthcare organizations nationally. The compensation consultant benchmarks Allegiance positions against data from multiple published surveys of health care executive compensation in the national health care labor market. Based upon the consultants recommendations, the Executive Compensation Committee makes a recommendation to the Board of Trustees for approval of the executive compensation program. Only independent Trustees vote on this recommendation.
Part I, Lines 4a-bThe following former executives received severance payments in calendar year 2012. Cheryl Lamborn $53,681 William Kiel $143,706 Allegiance Health's officers and highest compensated employees participated in a non-qualified deferred compensation plan. The plan which began in 2005 partially vested for some executives in 2012. Payout of vested amounts resulted in an increase of salary for several executives. The calendar year 2012 contribution and payout amounts are as follows: 457(f) Contributions reported in Schedule J, Part II, column (C): Georgia Fojtasek $24,480, Karen Chaprnka $20,849, Jeanne Wickens $21,897, Ray King $19,644, Richard Warren $14,250, Jacalyn Liebowitz $7,363, Kenneth Empey $13,111, Anthony Gardner $9,669, Cheryl Lamborn $5,077, Gerald Grannan $9,120, Beth Smith $8,889, John Hyden $6,433, Ryan Beekman $34,560, Vishal Gupta $60,698, Tudor Tien $16,680, Brian Daly $29,491, Ivan Cubas $49,938 457(f) Payouts reported in Schedule J, Part II, column B(iii): Georgia Fojtasek $46,990, Karen Chaprnka $45,630, Jeanne Wickens $39,620, Richard Warren $27,415, Jacalyn Liebowitz $28,482, Kenneth Empey $17,355, William Kiel $41,438, Ryan Beekman $321,436, Tudor Tien $264,482, Brian Daly $183,899,
Part I, Line 7Column B(ii) of Part II, Schedule J includes non-fixed payments to certain physicians based on their productivity and other performance metrics.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
County of Jackson Hospital Finance Authority
A386004845467148EH12011-04-2165375000See Part VI - Supplemental Information000
County of Jackson Hospital Finance Authority
B386004845467148DC32010-11-02140238036See Part VI - Supplemental Information000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetiredAmount In Reserve FundAmountInReserveFundAmount UnspentAmountUnspent
A65375000540128184256481644720111011
B144677411840059495263136965114201010117241644748685591508416

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsEngage Bond Counsel ResearchEngageBondCounselResearchPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUseBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs
A0011110.000000.000000.00000001
B0011110.000000.000000.00000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsBusiness Name Line2NameOfHedgeProvider/BusinessNameLine2Term Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICWritten Proc To Monitor ReqsWrittenProcToMonitorReqs
Royal Bank of
A010011Canada25.0000000000000001
(no name)
B01000001

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A0
B0

Form990 Schedule K Part VI Form990ScheduleKPartVI (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part I, Line A, Column (f)Description of Bond PurposePrimarily to add marketability to underlying variable rates and refund Bonds. The Bonds refunded are as follows: $36,500,000 County of Jackson Hospital Finance Authority Variable Rate Hospital Revenue Refunding Bonds (Allegiance Health, Jackson, Michigan), Series 2011A were issued to refund the Series 2006A bonds. $28,875,000 County of Jackson Hospital Finance Authority Hospital Revenue Refunding Bonds (Allegiance Health, Jackson, Michigan), Series 2011B were issued to refund the Series 2006B bonds.
Part I, Line B, column (f)Description of Bond PurposePrimarily to obtain traditional fixed interest on bond debt at a time of low prevailing rates and to reissue and refund bonds. The bonds reissued and refunded are as follows: $29,925,000 County of Jackson Hospital Finance Authority Hospital Variable Rate Demand Revenue Refunding Bonds (W.A. Foote Memorial Hospital, Jackson, Michigan), Series 2006B-1, reissued for tax purposes on 11/02/2010 $8,940,000 County of Jackson Hospital Finance Authority Hospital Revenue Refunding Bonds (W.A. Foote Memorial Hospital, Jackson, Michigan) Series 2006B-2, reissued for tax purposes on 11/02/2010 $47,400,000 County of Jackson Hospital Finance Authority Hospital Revenue Refunding Bonds (W.A. Foote Memorial Hospital, Jackson, Michigan) Series 2006C, reissued for tax purposes on 11/02/2010 $51,655,000 County of Jackson Hospital Finance Authority Hospital Revenue Refunding Bonds (Allegiance Health, Jackson, Michigan), Series 2010A were issued to refund the Series 2007A and Series 1997A bonds.
Part II, Line 3, Column BThe difference of $4,439,375 between Part I, column (e) and Part II, Line 3 is due to net investment losses and investment income.
Part IV, Line 6No gross proceeds were invested beyond an available temporary period. The box is shown blank due to a software glitch that only allows the answer to be checked yes.
Part VProcedures to Undertake Corrective Action.The organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program. These written procedures were established in fiscal year 2014.

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonPatrick NallyNamePerson
Relationship With OrganizationSon of John Nally, Secretary/Treasurer of Allegiance HealthRelationshipWithOrganization
Purpose Of LoanEmployee Recruitment LoanPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$115,000OriginalPrincipalAmount
Balance Due115000BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due115000TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (8 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Amy Schultz
Daughter of Larry Schultz, Chairman of Allegiance Health184112Employee Wages0
Patrick Nally
Son of John Nally, Secretary/Treasurer of Allegiance Health10922Employee Wages0
Sona Ambani
Daughter of Nitin Ambani, Allegiance Health Chief of Staff/Director26406Employee Wages0
Jackson Physicians Alliance
JCMR Partnership1809462Reported amount is for payments by Jackson Community Medical Record (JCMR) to Allegiance Health for rent, leased employees, accounting services, information support and other miscellaneous services provided by the hospital. Lynn VanWagnen, Director of Allegiance Health, is an officer of Jackson Physicians Alliance (JPA). (JPA) holds a 49% ownership stake in JCMR. Allegiance Health holds a 51% JCMR ownership stake.0
VanWagnen Real Estate LLC
Leasing Services Provider11168Reported amount is for lease payments Allegiance Health makes to VanWagnen Real Estate LLC for medical diagnostic space. VanWagnen Real Estate LLC is owned by Trustee Lynn VanWagnen.0
Clark & King Investments LLC
Leasing Services Provider404323Reported amount is for lease payments made by Allegiance Health to Clark & King Investments LLC for a medical office building. Ray King an Allegiance Health officer is a partner in Clark & King Investments LLC.0
Jackson Physicians Alliance
JCMR Partnership1230252Reported amount is for payments by Allegiance Health to Jackson Community Medical Record(JCMR) to lease an electronic medical records license. Lynn VanWagnen, Director of Allegiance Health, is an officer of Jackson Physicians Alliance (JPA). (JPA) holds a 49% stake in JCMR. Allegiance Health holds a 51% ownership stake.0
Great Lakes Brain & Spine Institute
Medical Services Provider315432Reported amount is for services provided to Allegiance Health patients by Great Lakes Brain & Spine Institute. Harish Rawal an Allegiance Health Trustee is an owner of Great Lakes Brain & Spine Institute.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6The Corporation is organized on a membership basis. The sole corporate member of the Corporation is Allegiance Health Services.
Form 990, Part VI, Section A, line 7aThe sole Member of the organization may elect and remove, with or without cause, the Corporation's Trustees.
Form 990, Part VI, Section A, line 7bThe following powers are reserved for the sole corporate Member of the hospital. Approve any change in the Articles of Incorporation, purposes or philosophy of the Corporation; Approve changes in those provisions of the Corporation's Bylaws which affect the size, composition, and method of selection of the Board of Trustees, or which affect this Article; Approve plans of merger, consolidation or dissolution of the Corporation; Elect and remove, with or without cause, the Corporation's Trustees, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present; Approve guarantees by the Corporation of the debt of others in excess of maximum limits established by the Member, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present; Authorize the sale, lease, mortgage or other disposition of all or substantially all of the assets owned, held or leased by or to the Corporation, approve any decision by the Corporation which would have the net effect of diminution of governance control of the Member, and any decision by the Corporation which would have the net effect of diminution in the Corporations governance control over its own subsidiary; and Ratify or reject operating and capital budgets developed by the Board and any non-budgetary expenditures or creations of debt in excess of an amount designated by the Member from time to time, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present. Authorize the formation or acquisition of new subsidiaries of the Corporation or the sale or other disposition of existing subsidiaries.
Form 990, Part VI, Section B, line 11Form 990 is reviewed by the organization's Director and VP of Finance, Chief Executive Officer, Chief Financial Officer, General Counsel, Compliance Officer and its public accounting firm. Final copies of the return are distributed to the hospital's Board of Trustees before the return is e-filed.
Form 990, Part VI, Section B, line 12cThe Board Compliance Committee has ultimate responsibility over the enforcement of the Hospital's Conflict of Interest Policy. When a potential conflict of interest is identified, the Compliance Committee is responsible for review of the conflict of interest for compliance with the policy. Also, General Counsel routinely reviews upcoming Board and Committee meeting agendas to assess potential conflict situations. All employees are responsible to complete a conflict of interest statment. Trustees, directors, and key employees are required to fill out an annual conflict of interest questionnaire. Board Trustees identified as having a conflict of interest are permitted to discuss the potential transaction. They are not allowed to deliberate in the decision or vote on the matter.
Form 990, Part VI, Section B, line 15The organization performs an annual review and assessment of the compensation of the Chief Executive Officer and each of the executives listed in Part VII of the Form 990. This review includes an independent compensation committee and the engagement of an independent compensation consultant. This process is usually undertaken during the Fall. The Compensation Committee, an independent committee of the Board of Trustees, is responsible for the executive compensation program. This committee performs an annual review of the competitiveness, reasonablenes and effectiveness of all executive cash compensation and benefit programs. The committee also leads the Board in evaluating the performance of the Chief Executive Officer and recommends all aspects of the Chief Executive Officer's compensation. The committee reviews the Chief Executive Officer's recommendations regarding the compensation of all other members of executive leadership. The Compensation Committee engages an independent compensation consulting firm to conduct a comprehensive market analysis of total compensation for executive leadership. This firm uses data representing compensation levels and practices from national not-for-profit healthcare markets as Allegiance typically competes in the the national healthcare marketplace for executive talent. National data also provides more comparable information for size and operational characteristics so that comparisons are made to organizations with similiar scope and complexity.
Form 990, Part VI, Section C, line 19Forms 1023, 990 and 990-T are available upon request. Form 990 and the organization's conflict of interest policy are posted on the organization's website.
Form 990, Part VII, Section A, Line 1aAllegiance Health Trustees are not paid to serve on the Board. Compensation listed for Dr. David Halsey, Dr. Nitin Ambani, Dr. Allan Tompkins, Dr. Mohan Kulkarni, and Dr. John Mogerman in Part VII of the Form 990 is pay for on call medical service, medical director fees, employment compensation, and/or committee participation.
Form 990, Part IX, line 11gProfessional Other: Program service expenses 37,241,001. Management and general expenses 9,125,102. Fundraising expenses 0. Total expenses 46,366,103.Other Fees
Form 990, Part XI, line 9:Transfer to Parent -532,717. Change in Accounting for Pensions SFAS 158 9,662,793. Change in fair value of interest rate swap 11,182,743.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodePrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1EINEIN
Physicians Choice Network LLC
205 N East AvenueJacksonMI49201Provider NetworkMI78270WA Foote Memorial Hospital
Jackson Health Network L3C
205 N East AvenueJacksonMI49201Clinically Integrated NetworkMI-1248905538067WA Foote Memorial Hospital453253643

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Allegiance Health Services
205 N East AvenueJacksonMI49201382756428Exempt Health SystemMI501(c)(3)Line 11b, IIN/A0
Allegiance Health Foundation
205 N East AvenueJacksonMI49201383607833Supports Allegiance HealthMI501(c)(3)Line 11b, II1Allegiance Health Services
Hospice of Jackson dba Allegiance Hospice
205 N East AvenueJacksonMI49201382336367Hospice CareMI501(c)(3)Line 71Heathlink
The Hospice of Jackson Endowment Fund
One Jackson SquareJacksonMI49201383422146Raise Funds for Allegiance HospiceMI501(c)(3)Line 11c, III-FI1Allegiance Hospice
Healthlink
205 N East AvenueJacksonMI49201382756425Home Health CareMI501(c)(3)Line 11a, I1Allegiance Health Services
Michigan Imaging Services
205 N East AvenueJacksonMI49201382895225Medical ImagingMI501(c)(3)Line 11a, I1Allegiance Health Services
South Central Practice Association
205 N East AvenueJacksonMI49201383309805Idle OrganizationMI501(c)(3)Line 11a, I1Allegiance Health Services
Allegiance Health Volunteers
205 N East AvenueJacksonMI49201386082835Exempt AssociationMI501(c)(3)Line 11d, III-O1Allegiance Health Services
CareLink of Jackson
110 North Elm AvenueJacksonMI49202381218485Long Term Acute Care HospitalMI501(c)(3)Line 31Allegiance Health Services

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
Jackson Community Medical Records
205 N East AvenueJacksonMI49201371502443Electronic Medical RecordsMIWA Foote Memorial HospitalRelated-453011650036000.51000
Foote Health Center Associates
1100 E Michigan AvenueJacksonMI49201383017711Lessor of Medical CondominiumsMIWA Foote Memorial HospitalRelated1050481062004000.54430

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityPercentage OwnershipPercentageOwnershipControlled OrgControlledOrgLegal Domicile Foreign CountryLegalDomicileForeignCountryShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssets
Viking Health System Inc
205 N East AvenueJacksonMI49201382756161Idle Healthcare Administration CorporationMIWA Foote Memorial HospitalC1.000001
Cascades Insurance Company LTD
205 N East AvenueJacksonMI49201981132982Hospital Malpractice Insurance CaptiveWA Foote Memorial HospitalC1.000001CJ208379216647999
Cascades Professional Staffing Corporation
205 N East AvenueJacksonMI49201383370242Idle Staffing CorporationMIWA Foote Memorial HospitalC1.000001
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (20 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Foote Health Center Associates
D1735000FMV
Foote Health Center Associates
A102000FMV
Allegiance Health Services
R532717FMV
Hospice of Jackson dba Allegiance Hospice
J310536COST
Hospice of Jackson dba Allegiance Hospice
L880662COST
Hospice of Jackson dba Allegiance Hospice
O578716FMV
Cascades Insurance Company LTD
P3117476FMV
Cascades Insurance Company LTD
L2410315FMV
Jackson Community Medical Records
A8822FMV
Jackson Community Medical Records
A57558FMV
Jackson Community Medical Records
L1751904FMV
Jackson Community Medical Records
M1230252FMV
Jackson Community Medical Records
D2412889FMV
Allegiance Health Foundation
C368538FMV
Healthlink
K630216COST
Healthlink
D531000FMV
CareLink of Jackson
L4966035COST
CareLink of Jackson
M804727FMV
CareLink of Jackson
K143863COST
CareLink of Jackson
D328486FMV