2014-05-14T17:07:59-05:00 2013-06-30 ERNST & YOUNG US LLP 41 S HIGH ST 1100 HUNTINGTON CTR COLUMBUS OH 43215 990 2012-07-01 383369438 Covenant Medical Center Inc % MARK E GRONDA COVE 9895836006 1447 N Harrison Suite Saginaw MI 48602 MARK E GRONDA 2014-05-13 6142327414 2012 2015-11-30 17:44:51Z COVENANT HEALTHCARE SPENCER MAIDLOW 1447 N HARRISON SAGINAW MI 48602 513248493 false X www.covenanthealthcare.com X 1997 MI TO PROVIDE DIVERSE MEDICAL CARE TO MEET THE HEALTH CARE NEEDS OF THE 14 COUNTIES IN EAST CENTRAL MICHIGAN WE SERVE. 14 10 4715 385 153170 104762 5873350 2937916 490471893 483843245 9284228 18379563 7487821 7836405 513117292 512997129 0 0 0 0 269442456 266122545 0 0 0 218812864 215302133 488255320 481424678 24861972 31572451 529758145 555736306 327903598 292035317 201854547 263700989 X TO PROVIDE DIVERSE MEDICAL CARE TO MEET THE HEALTH CARE NEEDS OF THE 14 COUNTIES IN EAST CENTRAL MICHIGAN WE SERVE. false false 461981356 483843245 ONE OF THE LARGEST, MOST COMPREHENSIVE HEALTH CARE FACILITIES NORTH OF METRO DETROIT, COVENANT HEALTHCARE IS PREPARED TO RESPOND TO THE DIVERSE MEDICAL NEEDS OF OUR REGION. WE OFFER A BROAD SPECTRUM OF PROGRAMS AND SERVICES RANGING FROM OBSTETRICS, NEONATAL AND PEDIATRIC CARE, TO ACUTE CARE INCLUDING CARDIOLOGY, ONCOLOGY, SURGERY AND MANY OTHER SERVICES ON THE LEADING EDGE OF MEDICINE. ALL OF OUR PROGRAMS AND SERVICES EXEMPLIFY OUR COMMITMENT TO PROVIDING QUALITY, COMPASSIONATE CARE. AS A MEDICAL FACILITY WITH MORE THAN 600 BEDS AND A COMPLETE RANGE OF MEDICAL SERVICES, COVENANT HEALTHCARE STANDS READY TO MEET THE NEEDS OF THE 14 COUNTIES IN EAST CENTRAL MICHIGAN WE SERVE. WITH MORE THAN 20 INPATIENT AND OUTPATIENT FACILITIES, COVENANT HEALTHCARE OFFERS CONVENIENCE AND EASY ACCESS TO HIGH QUALITY CARE. THE MEDICAL CENTER PROVIDED THE FOLLOWING FOR THE FISCAL YEAR 2013: 6,966 WOMEN'S AND CHILDREN'S CASES, 8,132 CARDIOLOGY CASES, 3,879 GENERAL MEDICAL CASES, 2,599 ORTHOPEDIC CARE CASES, AND 2,511 PULMONARY CASES. 461981356 true true false true false false false false false false true true false false true false false true false false true false false false false false true true false false true true false false false false false false false false true false true false false false true true true true false false true 254 0 true 4715 true true true true CJ false false false false false false false false X 14 10 false false false false true true true true true false false true true true true true true true true true true X MARK E GRONDA 9895832769 1447 N HARRISON SAGINAW MI 48602 X JOHN SHELTON 4.0 0.0 X 1612 CULLI DAMUTH 4.0 0.0 X 1217 0 0 SPENCER MAIDLOW 50.0 8.0 X X 1973535 0 45833 Gene Pickelman 4.0 0.0 X LAWRENCE SIMS 4.0 0.0 X X GREGORY LUBBEN 4.0 0.0 X X 1612 MORRISON STEVENS SR 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1700686 X true true COV HLTH CRE PRTNRS HEALTH CARE 0.50000 0.50000 MACKINAW SURGERY SURGERY CENTER 0.49750 0.50250 COV HLCR MACKINAW FC RENTAL 0.82000 0.18000 COV POB LLC RENTAL 0.37500 0.50000 4 1 COVENANT MEDICAL CENTER INC (COOPER)

700 COOPER SAGINAW MI 48602

WWW.COVENANTHEALTHCARE.COM X X X X 2 COVENANT MEDICAL CENTER INC (HARRISON

1447 N HARRISON SAGINAW MI 48602

WWW.COVENANTHEALTHCARE.COM X X X X 3 COVENANT MEDICAL CENTER INC (REHAB)

515 N MICHIGAN AVE SAGINAW MI 48602

WWW.COVENANTHEALTHCARE.COM X X REHABILITATION UNIT 4 COVENANT MEDICAL CENTER INC (MICHIGAN

515 N MICHIGAN AVE SAGINAW MI 48602

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PM&R, OCC HEALTH, EMPLOYEE WELLNESS HOUGHTON CAMPUS

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LABORATORY DR CASTILLO

6614 DIXIE HWY BRIDEGEPORT TOWNSHIP MI 48722

PHYSICIAN OFFICE MED EXPRESS BAY CITYBAY PRIMARY CARE

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URGENT CARE/PHYSICIAN OFFICE MED EXPRESSBREAST IMAGING

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URGENT CARE COVENANT POB

800 COOPER AVE SAGINAW MI 48602

PHYSICIAN OFFICE COVENANT BREAST IMAGINGMED EXPRESSPRIM

600 N MAIN ST FRANKENMUTH MI 48734

URGENT CARE, IMAGING & PMR & /PHYSICIAN OFFICE DR EASTONLAB

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PHYSICIAN OFFICE/LAB VNA

500 S HAMILTON ST SAGINAW MI 48602

HOME CARE HEMLOCK FAMILY MEDICINEMED EXPRESS

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URGENT CARE/PHYSICIAN OFFICE VASSAR PRIMARY CARE

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PHYSICIAN OFFICE FREELAND PRIMARY CARE

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PHYSICIAN OFFICE/LAB SIBM

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PHYSICIAN OFFICE VNA CARTWRIGHT CENTER

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HOME HEALTH SAGINAW TWP FAMILY PRACTICE

3875 BAY RD SAGINAW MI 48602

PHYSICIAN OFFICE SILVERWOOD FAMILY MEDICINE

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PHYSICIAN OFFICE COVENANT PHYSIATRY

3350 SHATTUCK RD SAGINAW MI 48602

PHYSICIAN OFFICE MACKINAW CAMPUS

5400 MACKINAW RD SAGINAW MI 48602

HEALTHCARE OFFICE ECC

900 COOPER AVE SAGINAW MI 48602

ER-24 HRS DR JOHNSON

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PHYSICIAN OFFICE GRATIOT FAMILY PRACTICE

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PHYSICIAN OFFICE COVENANT OCC HEALTH

1549 WASHINGTON ST MIDLAND MI 48640

OCC HEALTH CENTER FOR THE HEART

4884 BERL DR SAGINAW MI 48604

PHYSICIAN OFFICE WEST BRANCH PRIMARY CARE

335 E HOUGHTON AVE WEST BRANCH MI 48661

PHYSICIAN OFFICE BIRCH RUN PRIMARY CARE

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PHYSICIAN OFFICE SAGINAW VALLEY PRIMARY CAREMED EXPRESS

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PHY OFFICE/PRIMARY CARE/ URGENT CARE DR DE BEAUBIEN

4701 TOWNE CENTRE RD SAGINAW MI 48604

PHYSICIAN OFFICE SEBEWAING PRIMARY CARE

616 UNIONVILLE RD SEBEWAING MI 48759

PHYSICIAN OFFICE SCHEDULE H, PART I, LINE 7 THE BEST AVAILABLE INFORMATION WAS USED TO CALCULATE THE COST IN LINE 7. COST IS BASED ON THE COST-TO-CHARGE RATIO. MEDICAID COST ON ROW (B.) CALCULATED USING RATIO OF COST TO CHARGE FROM WORKSHEET 3. SCHEDULE H, PART III, LINE 4 FOOTNOTE TO AUDITED FINANCIAL STATEMENTS OF DEBT DEBT EXPENSE THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE AND CURRENT MARKET CONDITIONS. THE RESULTS OF THESE REVIEWS ARE USED TO MAKE ANY MODIFICATIONS TO THE METHODOLOGY FOR ESTIMATING THE PROVISION FOR BAD DEBTS AND ESTABLISHING THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, COVENANT HEALTHCARE FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES. (FOOTNOTE 2, PAGE 10). SCHEDULE H, PART III, LINE 8 THE HOSPITAL REPORTED MEDICARE ALLOWABLE COST, AS REPORTED ON THE MEDICARE COST REPORT, ON WORKSHEET H, PART III, SECTION B, LINE 6. THE METHODOLOGY REMOVES NON-ALLOWABLE COST PER MEDICARE RULES AND OFFSETS OTHER OPERATING REVENUE AGAINST COST. PROFESSIONAL PART B COST IS ALSO REMOVED. THE COST OF SUPPORT DEPARTMENTS IS ALLOCATED TO REVENUE PRODUCING DEPARTMENTS USING THE STEP-DOWN METHODOLOGY. SCHEDULE H, PART III, LINE 9B APPLICATION OF COLLECTION PRACTICES TO THOSE QUALIFYING FOR FINANCIAL ASSISTANCE IT IS NOT OUR POLICY TO PURSUE COLLECTION AGAINST PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. IN CERTAIN CASES, IT MAY NOT BE EASILY DETERMINED WHETHER OR NOT A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE; HOWEVER, IF AFTER COLLECTION PRACTICES HAVE BEGUN IT LATER BECOMES KNOWN THAT A PATIENT QUALIFIES, THE COLLECTION EFFORTS CEASE. SCHEDULE H, PART V, LINE 3 INPUT FROM COMMUNITY REPRESENTATIVES THE CHNA DATA WAS GATHERED USING THE FOUR MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) ASSESSMENTS: COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM, COMMUNITY HEALTH STATUS, AND FORCES OF CHANGE. IN AN ATTEMPT TO ACQUIRE BROAD COMMUNITY INPUT REGARDING THE HEALTH CONCERNS OF SAGINAW COUNTY RESIDENTS, INFORMATION WAS GATHERED AT VARIOUS PUBLIC MEETINGS THROUGHOUT THE COUNTY AND FROM AREA AGENCIES USING SURVEYS CONDUCTED. SCHEDULE H, PART V, LINE 4 CHNA HOSPITAL FACILITIES THE HOSPITAL CONTRIBUTES AND PARTICIPATES IN THE SAGINAW COUNTY ROAD MAP TO HEALTH (CHNA) PARTICIPATING WITH SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH, ST MARY'S OF MICHIGAN, HEALTH DELIVERY, INC, SAGINAW INTERMEDIATE SCHOOL DISTRICT, SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY, AND ALIGNMENT SAGINAW. SCHEDULE H, PART V, LINE 20D THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS THE NET OF STANDARD CHARGES LESS APPLICABLE FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT COVENANT HEALTHCARE IS A STEERING COMMITTEE MEMBER IN THE SAGINAW COUNTY HEALTH IMPROVEMENT PLAN IN 2009 WHICH COVERS 2010 THROUGH 2015. THE STEERING COMMITTEE AGENCIES ARE SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH, COVENANT HEALTHCARE, ST MARY'S OF MICHIGAN, HEALTH DELIVERY INCORPORATED, SAGINAW INTERMEDIATE SCHOOL DISTRICT, SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY, AND ALIGNMENT SAGINAW. THE SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH, IN PARTNERSHIP WITH THE PREVENTION RESEARCH CENTER OF MICHIGAN, CREATED AND CONDUCTED AN ELECTRONIC SURVEY TO ASSESS THE COUNTY'S LOCAL PUBLIC HEALTH SYSTEM. THE SURVEY FOCUSED ON THE LOCAL PUBLIC HEALTH SYSTEM DEFINED AS ALL ENTITIES THAT CONTRIBUTE TO THE DELIVERY OF PUBLIC HEALTH SERVICES WITHIN A COMMUNITY. THIS SYSTEM INCLUDES ALL PUBLIC, PRIVATE, AND VOLUNTARY ENTITIES, AS WELL AS INDIVIDUALS AND INFORMAL ASSOCIATIONS. THE SURVEY USED THE TEN (10) ESSENTIAL PUBLIC HEALTH SERVICES, DEVELOPED BY CDC AND NACCHO, AS THE FUNDAMENTAL FRAMEWORK FOR ASSESSING THE LOCAL PUBLIC HEALTH SYSTEM. THE METHOD USED TO DEVELOP THE PLAN FOLLOWS THE NATIONAL MODEL KNOWN AS MAPP - MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS. THIS MODEL WAS DEVELOPED BY THE CENTER FOR DISEASE CONTROL (CDC) AND THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO). THE FOUR MAPP ASSESSMENTS INCLUDED COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM, COMMUNITY HEALTH ASSESSMENT, AND FORCES OF CHANGE. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE COVENANT HEALTHCARE COMMUNICATES OUR CHARITY CARE AND FINANCIAL ASSISTANCE POLICY VIA THE COVENANT WEBSITE, A LETTER TO THE GUARANTOR IF BENEFIT ELIGIBILITY IS NOT ESTABLISHED, OR IN PERSON IF GUARANTOR INDICATES FINANCIAL NEED. LITERATURE ON THIS POLICY IS ALSO AVAILABLE AT REGISTRATION AREAS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION COVENANT HEALTHCARE IS LOCATED IN SAGINAW COUNTY AND CLOSE TO 90% OF INPATIENT DISCHARGES ARE FROM PATIENTS WITHIN THE COUNTY. HOWEVER, COVENANT DOES REACH OUT INTO THE SURROUNDING COUNTIES AND HAS RELATIONSHIPS WITH SEVERAL CRITICAL ACCESS HOSPITALS IN THE REGION. COVENANT CONSIDERS SIX COUNTIES (SAGINAW, BAY, MIDLAND, TUSCOLA, HURON, AND SANILAC) AS IT'S PRIMARY MARKET. 14 COUNTIES IN THE REGION ARE CONSIDERED THE TOTAL SERVICE AREA. COVENANT HEALTHCARE IS LOCATED IN CBSA 40980 SAGINAW-SAGINAW TOWNSHIP NORTH WITHIN SAGINAW COUNTY, MICHIGAN. AS OF THE 2010 CENSUS, SAGINAW COUNTY'S POPULATION WAS 200,169. THERE WERE 80,430 HOUSEHOLDS OUT OF WHICH 32.70% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 50.20% WERE MARRIED COUPLES LIVING TOGETHER, 15.40% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 30.60% WERE NON-FAMILIES. IN THE COUNTY, THE POPULATION WAS SPREAD OUT WITH 26.60% UNDER THE AGE OF 18, 9.00% FROM 18 TO 24, 27.60% FROM 25 TO 44, 23.20% FROM 45 TO 64, AND 13.50% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 36 YEARS. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $38,637, AND THE MEDIAN INCOME FOR A FAMILY WAS $46,494. THE PER CAPITA INCOME FOR THE COUNTY WAS $19,438. ABOUT 11.00% OF FAMILIES AND 13.90% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 20.70% OF THOSE UNDER THE AGE 18 AND 9.50% OF THOSE AGE 65 OR OVER. THE JOBLESS RATE IN CALENDAR YEAR 2009 WAS 20.8% IN THE CITY OF SAGINAW, 12.5% IN SAGINAW COUNTY COMPARED TO 13.6% FOR THE STATE OF MICHIGAN AS A WHOLE. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH COVENANT HEALTHCARE IS ACTIVELY INVOLVED IN COMMUNITY BUILDING INITIATIVES. LEADERSHIP FROM THROUGHOUT THE ORGANIZATION HOLDS VOLUNTARY BOARD AND COMMITTEE POSITIONS IN COMMUNITY GROUPS AND ORGANIZATIONS FOCUSED ON IMPROVING THE QUALITY OF LIFE IN THE REGION, PARTICULARLY AROUND ISSUES OF COMMUNITY HEALTH. ADDITIONALLY, THE ORGANIZATION CONDUCTS COMMUNITY OUTREACH AND SCREENING ACTIVITIES IN THE VARIOUS COMMUNITIES IN OUR REGION TO IMPACT HEALTH IN SUCH WAYS AS TO EARLY DISEASE DETECTION TO TRAUMA PREVENTION. UNDER DIRECTION OF A VOLUNTEER COMMUNITY BOARD, COVENANT HEALTHCARE IS AN INTEGRAL PART OF THE COMMUNITIES IT SERVES. THE COVENANT VISION IS TO CONSISTENTLY DELIVER ON A PROMISE OF CARING AND A COMMITMENT TO SERVICE. GUIDED BY A SEPARATE VOLUNTEER BOARD, THE COVENANT HEALTHCARE FOUNDATION ASSISTS THE MEDICAL CENTER IN CARRYING OUT ITS SERVICE MISSION THROUGH THE ACQUISITION OF PHILANTHROPIC FUNDS TO SERVE AS A PRIME RESOURCE IN THE DELIVERY OF CARE TO THOSE COVENANT HEALTHCARE SERVICES. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM COVENANT MEDICAL CENTER IS A PART OF THE COVENANT HEALTH SYSTEM (DOING BUSINESS AS COVENANT HEALTHCARE). COVENANT HEALTHCARE IS A NON-PROFIT HEALTH SYSTEM THAT OFFERS A BROAD SPECTRUM OF PROGRAMS AND SERVICES RANGING FROM HIGH RISK OBSTETRICS, NEONATAL AND PEDIATRIC INTENSIVE CARE, TO ACUTE CARE INCLUDING A LEVEL II ADULT AND PEDIATRIC TRAUMA CENTER, CARDIOLOGY, ONCOLOGY, ORTHOPEDICS, ROBOTIC SURGERY AND MANY OTHER SERVICES ON THE LEADING EDGE OF MEDICINE. ALL PROGRAMS AND SERVICES EXEMPLIFY THE COVENANT COMMITMENT TO PROVIDING EXTRAORDINARY CARE FOR EVERY GENERATION. AS A MEDICAL FACILITY WITH 623 ACUTE CARE LICENSED BEDS, AND A COMPLETE RANGE OF MEDICAL SERVICES, COVENANT HEALTHCARE STANDS READY TO MEET THE HEALTH CARE NEEDS OF EAST CENTRAL MICHIGAN. WITH MORE THAN 20 INPATIENT AND OUTPATIENT FACILITIES AND A TRAUMA/EMERGENCY DEPARTMENT THAT PROVIDES 85,000 VISITS PER YEAR, COVENANT HEALTHCARE OFFERS CONVENIENCE AND EASY ACCESS TO HIGH QUALITY CARE THROUGHOUT THE REGION. SCHEDULE H, PART VI, LINE 7, STATE FILING STATE FILING OF COMMUNITY BENEFIT REPORT MICHIGAN X true true X X X false true false false false false false false false SPENCER MAIDLOW 738616 0 247112 0 987807 0 32821 0 13012 0 2019368 0 457091 0 MARK GRONDA 400952 0 127789 0 0 0 183526 0 13292 0 725559 0 0 0 EDWARD BRUFF 470546 0 147246 0 20530 0 299598 0 13292 0 951212 0 0 0 CAROL STOLL 245890 0 78540 0 5580 0 113671 0 6312 0 449993 0 0 0 DR JOHN KOSANOVICH 380650 0 124100 0 10705 0 259519 0 13251 0 788225 0 0 0 DANIEL GEORGE 243064 0 76316 0 208951 0 61024 0 0 0 589355 0 141432 0 TIM WENZEL 223939 0 67392 0 437517 0 162549 0 13292 0 904689 0 111004 0 DR Anthony DeBari 736187 0 97971 0 2322 0 0 0 0 0 836480 0 0 0 DR Umesh Badami 667381 0 142629 0 2322 0 0 0 0 0 812332 0 0 0 DR Scott Martin 538752 0 176880 0 540 0 0 0 0 0 716172 0 0 0 Stacy Goldsholl 387464 0 224400 0 0 0 0 0 13048 0 624912 0 0 0 Firas Alani 651633 0 54167 0 540 0 0 0 0 0 706340 0 0 0 Manoj Sharma 595161 0 101147 0 1242 0 0 0 0 0 697550 0 0 0 Supplemental Compensation Information SOCIAL CLUB AND HEALTH CLUB DUES SCHEDULE J, PART I, LINE 1A OFFICERS OF COVENANT MEDICAL CENTER GET HEALTH AND SOCIAL CLUB DUES PAID AND INCLUDED AS TAXABLE INCOME. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B THE ORGANIZATION MAINTAINS A NONQUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) FOR CERTAIN OF ITS EXECUTIVES. THE SERP HAS BEEN ESTABLISHED FOR THESE EXECUTIVES BY THE ORGANIZATION, FOLLOWING APPROPRIATE BOARD LEVEL REVIEW IN A MANNER INTENDED TO COMPLY WITH THE REBUTTABLE PRESUMPTION OF REASONABLENESS PROVISION UNDER IRC SECTION 4958. SPENCER MAIDLOW - $21,371 MARK GRONDA - $172,076 EDWARD BRUFF - $288,148 CAROL STOLL - $102,221 JOHN KOSANOVICH - $249,344 DANIEL GEORGE - $52,124 TIM WENZEL - $151,099 THE FOLLOWING SERP AMOUNTS ARE CURRENTLY TAXABLE TO THE INDIVIDUALS LISTED AND HAVE BEEN INCLUDED IN SCHEDULE J, PART II, COLUMN B(III): SPENCER MAIDLOW - $951,340 DANIEL GEORGE - $208,951 TIM WENZEL - $437,517 A CITY OF SAGINAW HOSP FIN AUTH 386004647 786744GX4 2004-04-07 39343085 RETIRE 8/15/1991 BONDS false false false B CITY OF SAGINAW HOSP FIN AUTH 386004647 786744HJ4 2010-10-28 76448883 RETIRE 7/7/99 AND 7/12/00 BONDS false false false A 0 0 39985810 3743952 640542 0 494736 0 0 0 35104849 0 2004 true false true true B 0 0 76458097 0 0 0 423626 0 0 0 76034471 0 2010 true false true true A 0 B 0 A true false false 0 true LEHMAN BROS SFI 32. true false true B false true false false 0 false 0 false true A true B true INVESTMENT AMOUNTS INCLUDED IN PROCEEDS 0 SCHEDULE K, PART II, LINE 3 COLUMN A BOND 2004G - $39,985,810 - INCLUDES SALE PROCEEDS OF $39,343,095 PLUS THE DEBT SERVICE RESERVE FUND EARNINGS OF $642,715. COLUMN B BOND 2010 H - $76,458,097 - INCLUDES SALE PROCEEDS OF $76,448,883 PLUS ESCROW ACCOUNT EARNINGS $9,214. DR JAMIE ROSS FAMILY OF BOARD MEMBER 323125 REPORTABLE COMPENSATION false DR T DAMUTH FAMILY OF BOARD MEMBER 110240 REPORTABLE COMPENSATION false MARY PICKELMAN FAMILY OF BOARD MEMBER 43618 REPORTABLE COMPENSATION false SCH L PART IV, COL C FEES FOR SERVICES FEES FOR ALL SERVICES ARE AT ARM'S LENGTH MARKET RATES AND ARE CONTRACTED IN ACCORDANCE WITH THE HOSPITAL'S CONFLICT OF INTEREST POLICY X EQUIP. (SUPPORTING ORG) 1 305135 FMV false false false DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS Form 990, Part VI, Line 6 COVENANT HEALTHCARE SYSTEM IS THE SOLE CORPORATE MEMBER OF COVENANT MEDICAL CENTER COVENANT. DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 7A THE CORPORATE MEMBER COVENANT HEALTHCARE SYSTEM MAY ELECT MEMBERS OF THE GOVERNING BODY. DESCRIPTION OF DECISIONS SUBJECT TO APPROVAL BY MEMBERS, STOCKHOLDERS OR OTHER PERSONS. FORM 990, PART VI, LINE 7B POWERS RESERVED BY THE SOLE MEMBER. THE FOLLOWING POWERS SHALL BE RESERVED FROM THE HOSPITAL, AND/OR SHALL REQUIRE THE AFFIRMATIVE ACTION OF THE SOLE MEMBER (ACTING THROUGH ITS BOARD OF DIRECTORS) IN ORDER TO BE EFFECTIVE: A. ALL MATTERS REQUIRING ACTION BY THE MEMBER OF A NONPROFIT CORPORATION UNDER THE LAWS OF THE STATE OF MICHIGAN; B. THE ELECTION OF THE BOARD OF DIRECTORS OF THE HOSPITAL; C. APPROVAL OF THE HOSPITAL BOARD'S SELECTION, OR VOTE TO TERMINATE THE PRESIDENT/CEO OF THE CORPORATION; D. APPROVAL OF THE INITIAL ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION; E. APPROVAL OF THE AMENDMENT OF THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS; F. APPROVAL OF THE STATEMENT OF MISSION, VISION, VALUES, ROLES AND GOALS OF THE HOSPITAL, TOGETHER WITH ANY AMENDMENTS THERETO; G. APPROVAL OF THE ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS AND FINANCIAL GUIDELINES OF THE HOSPITAL; H. APPROVAL OF UNBUDGETED CAPITAL EXPENDITURES BY THE HOSPITAL IN EXCESS OF AN ANNUAL AGGREGATE PERCENTAGE OF THE TOTAL CAPITAL EXPENDITURE BUDGET FOR THE HOSPITAL AS ESTABLISHED FROM TIME TO TIME BY RESOLUTION OF THE SOLE MEMBER; I. APPROVAL OF ALL SECURED BORROWINGS OF THE HOSPITAL, OTHER THAN BORROWINGS SECURED FROM THE SOLE MEMBER; J. APPROVAL OF ALL UNSECURED BORROWINGS OF THE HOSPITAL, OTHER THAN FROM THE SOLE MEMBER, IN AN AMOUNT IN EXCESS OF $750,000 OR IN EXCESS OF AN ANNUAL AGGREGATE PERCENTAGE OF THE TOTAL ASSETS OF THE HOSPITAL AS ESTABLISHED FROM TIME TO TIME BY RESOLUTION OF THE SOLE MEMBER; K. APPROVAL OF THE GUARANTEE BY THE HOSPITAL OF THE INDEBTEDNESS OF ANOTHER IN AN AMOUNT IN EXCESS OF A PERCENTAGE OF THE TOTAL ASSETS OF THE HOSPITAL AS ESTABLISHED FROM TIME TO TIME BY RESOLUTION OF THE SOLE MEMBER; L. APPROVAL OF THE SALE, ALIENATION, EXCHANGE, LEASE OR OTHER DISPOSITION OF ASSETS OF THE HOSPITAL IN AN UNBUDGETED AMOUNT IN EXCESS OF AN ANNUAL AGGREGATE PERCENTAGE OF THE TOTAL ASSETS OF THE HOSPITAL AS ESTABLISHED FROM TIME TO TIME BY RESOLUTION OF THE SOLE MEMBER; M. APPROVAL OF THE ESTABLISHMENT OF ANY SUBSIDIARIES OR AFFILIATES OF THE HOSPITAL; N. APPROVAL OF THE ADOPTION, REVOCATION OR ABANDONMENT OF ANY PLAN OF DISSOLUTION OF THE HOSPITAL, OR ANY SUBSIDIARY OR AFFILIATE OF THE HOSPITAL; O. APPROVAL OF THE ADOPTION, REVOCATION OR ABANDONMENT OF ANY PLAN OF MERGER, CONSOLIDATION, SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS AND/OR PROPERTY OF THE HOSPITAL OR ANY SUBSIDIARY OR AFFILIATE OF THE HOSPITAL, OR ANY OTHER PLAN OF MAJOR CORPORATE CHANGE ADOPTED BY THE HOSPITAL OR ANY SUBSIDIARY OR AFFILIATE OF THE HOSPITAL; AND P. APPROVAL OF THE SELECTION OF AUDITORS BY THE HOSPITAL. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B MANAGEMENT PRESENTS AND REVIEWS THE 990 WITH THE BOARD FOR ITS APPROVAL PRIOR TO FILING. THE BOARD IS PROVIDED FINAL COPIES FOR REVIEW VIA THE INTERNET, ONCE APPROVED BY THE BOARD, THE FINAL 990 IS ULTIMATELY FILED WITH THE IRS. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST DISCLOSURE STATEMENTS TO ITS OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES. EACH PERSON COVERED BY THE POLICY IS REQUIRED TO SUBMIT AND AFFIRM IN WRITING TO THE CHIEF EXECUTIVE OFFICER AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL INTERESTS, FAMILY AND BUSINESS RELATIONSHIPS, AND POTENTIAL CONFLICTS OF INTEREST AND PROVIDE UPDATES TO THIS AS NECESSARY. IN ADDITION, SUCH PERSONS HAVE AN OBLIGATION TO DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE BOARD AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS. POTENTIAL CONFLICTS THAT ARE IDENTIFIED ARE BROUGHT TO THE ATTENTION OF THE CHAIRMAN AND VICE CHAIRMAN OF THE BOARD. THE CHAIRMAN OF THE BOARD IS REQUIRED TO BE AWARE OF SUCH POTENTIAL CONFLICTS SO AS TO BE ABLE TO DETERMINE THE PROPER COURSE OF ACTION SHOULD A MATTER INVOLVING SUCH SITUATION ARISE THAT WOULD REQUIRE ACTION. AFTER DISCLOSURE OF A POTENTIAL CONFLICT TO THE BOARD OR COMMITTEE, SUCH PERSON IS EXCUSED AND ALL OTHER REMAINING BOARD OR COMMITTEE MEMBERS MAKE A DETERMINATION OF WHETHER A CONFLICT EXISTS. ANY PERSON WITH A POTENTIAL CONFLICT CAN MAKE A PRESENTATION TO THE BOARD OR COMMITTEE ON THE PROPOSED TRANSACTION, BUT MUST RECUSE HIMSELF FROM DELIBERATION AND VOTING ON THE PROPOSED TRANSACTION OR ARRANGEMENT. THE BOARD OR COMMITTEE SHALL EXPLORE WHETHER A MORE ADVANTAGEOUS TRANSACTION OR AGREEMENT WITH REASONABLE EFFORTS CAN BE ENTERED INTO WITH A PERSON OR ENTITY THAT DOES NOT HAVE A CONFLICT OF INTEREST. IF NO REASONABLE ALTERNATIVE EXISTS, THE BOARD OR COMMITTEE SHALL DECIDE WHETHER SUCH TRANSACTION IS IN THE BEST INTERESTS OF THE ORGANIZATION AND IS FAIR AND REASONABLE BEFORE MAKING ITS DECISION ON WHETHER OR NOT TO ENTER INTO THE TRANSACTION. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT AN OFFICER, DIRECTOR, KEY EMPLOYEE, OR TRUSTEE FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTERESTS, IT SHALL INFORM THE OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE OF THE BASIS FOR SUCH BELIEF AND AFFORD SAID PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. CORRECTIVE ACTION WILL BE TAKEN IF IT IS DETERMINED THAT A CONFLICT THAT WAS NOT DISCLOSED DOES EXIST. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINES 15A & 15B EXECUTIVE SALARY RANGES ARE ESTABLISHED THROUGH IN DEPTH EXTERNAL MARKET STUDIES AND APPROVED BY THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND APPROVES COMPENSATION CHANGES FOR VICE PRESIDENTS, AS RECOMMENDED BY THE CEO. THE COMPENSATION COMMITTEE RECOMMENDS ANNUALLY TO THE BOARD OF DIRECTORS A PERFORMANCE RATING AND COMPENSATION CHANGES FOR THE CEO. THE BOARD OF DIRECTORS ACTS ON ALL RECOMMENDATIONS FROM THE COMPENSATION COMMITTEE. THIS PROCESS IS CONDUCTED ANNUALLY. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS GEN PUBLIC FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. REPORTABLE COMPENSATION FROM THE ORGANIZATION FORM 990, PART VII, SECTION A, COLUMN (D) A 1099-MISC WAS ISSUED BY COVENANT MEDICAL CENTER TO THE FOLLOWING MEMBERS OF THE BOARD OF DIRECTORS: JOHN SHELTON, CULLI DAMUTH, GREGORY LUBBEN, TERRY NIEDERSTADT, MORTON WELDY, SUSAN STEMLER, JOHN JOHNSON, AND DAVID MEYER. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 9 CHANGE IN UNREALIZED APPRECIATION IN FV OF INVESTMENTS - $5,308,901 PENSION OBLIGATION ADJUSTMENT - $25,413,765 TRANSFER TO VISITING NURSE ASSOCIATION - ($448,675) TOTAL - $30,273,991 COVENANT MEDICAL OFFICE II LLC 1447 N HARRISON SAGINAW MI 48602 INACTIVE MI 0 0 NA COVENANT MACKINAW OFFICE LLC 1447 N HARRISON SAGINAW MI 48602 INACTIVE MI 0 0 NA J&F HOLDINGS 1447 N HARRISON SAGINAW MI 48602 382640101 INACTIVE MI 0 0 NA COVENANT HEALTHCARE FOUNDATION 1447 N HARRISON SAGINAW MI 48602 382572154 SUPPORT MI 501(c)(3) 11 TYPE III CHS true VISITING NURSE SPECIAL SERVICES 502 S HAMILTON SAGINAW MI 48602 382762248 NURSE VISITS MI 501(c)(3) 9 CHS true COVENANT HEALTHCARE SYSTEM 1447 N HARRISON SAGINAW MI 48602 383369443 HEALTHCARE MI 501(c)(3) 11 TYPE II NA false VISITING NURSE ASSOCIATION OF SAGINAW 500 S HAMILTON SAGINAW MI 48602 454929618 HOME CARE MI 501(C)(3) 3 CHS true COVENANT DEVELOPMENT CORPORATION 1447 N HARRISON SAGINAW MI 48602 382640101 HEALTH SERVICES MI CHS C Corp true COVENANT MEDICAL CTR OFFICE CONDO ASSOCI 1447 N HARRISON SAGINAW MI 48602 371477767 CONDOMINIUM MI NA C Corp 0 0 0.98740 true COVENANT HLTH MACKINAW FACTY CONDO ASSOC 1447 N HARRISON SAGINAW MI 48602 453327179 CONDOMINIUM MI NA C Corp 236275 336273 0.81480 true COVENANT SERVICES CORP 1447 N HARRISON SAGINAW MI 48602 HEALTHCARE MI CHS C Corp true false false true false false false false false false false false false false true false true true false COVENANT HEALTHCARE FOUNDATION C 305135 FMV COVENANT HEALTHCARE FOUNDATION O 460944 FMV COVENANT HEALTHCARE FOUNDATION Q 985935 FMV VISITING NURSE ASSOCIATION R 448675 FMV