2013-11-15T13:49:49-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2012-01-01 382602147 CHIPPEWA CNTY WAR MEMORIAL HOSPITAL INC CHIP 9066354460 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 KEVIN KALCHIK 9066354460 2013-11-13 1 P00053797 2319477800 2012 2016-03-07 17:11:31Z WAR MEMORIAL HOSPITAL DAVID JAHN CEO 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 96554180 0 X WWW.WARMEMORIALHOSPITAL.ORG X 1985 MI TO PROVIDE HEALTH CARE SERVICES AND ACCESS TO THE RESIDENTS OF SAULT STE. MARIE AND THE EASTERN UPPER PENINSULA. OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. 10 8 992 109 0 0 153499 106066 89034515 93297906 937587 242988 347575 619125 90473176 94266085 0 0 0 0 44910390 50523248 0 0 0 43230725 43918105 88141115 94441353 2332061 -175268 59779002 65405011 36557356 43284634 23221646 22120377 X OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. 0 0 40839577 0 61273600 HOSPITAL INPATIENT AND OUTPATIENT SERVICES - WAR MEMORIAL HOSPITAL PROVIDED INPATIENT CARE TO 2,999 PATIENTS AND THERE WERE OVER 150,835 PATIENT REGISTRATIONS FOR THE HOSPITALS MULTIPLE OUTPATIENT SERVICE DEPARTMENTS (LAB, RADIOLOGY, CARDIOPULMONARY, REHABILITATION).OUR OBSTETRICS/NURSERY UNIT REPORTED 331 BIRTHS AND OUR SURGICAL SERVICES DEPARTMENT PROVIDED SURGICAL CARE FOR 5536 PATIENTS.THE REHABILITATION DEPARTMENT CONTINUED IT EXPANSION OF SERVICES IN CONTRACTING TO PROVIDE REHABILITATION SERVICES WITH MULTIPLE ORGANIZATIONS IN THE REGION; INCLUDING, BUT NOT LIMITED TO, AREA SCHOOLS, HOSPITALS, AND HOME HEALTH AGENCIES. NEARLY 335,934 REHABILITATION TREATMENTS WERE REPORTED. 14708122 0 11432959 PROFESSIONAL SERVICES - THE HOSPITAL'S TWENTY FOUR HOUR EMERGENCY DEPARTMENT AND THE COMMUNITY CARE CLINIC (WALK-IN URGENT CARE CENTER) RECORDED 17,121 VISITS AND 12,050 VISITS RESPECTIVELY. VISITS BY PHYSICIAN CLINIC:4,115 CEDARVILLE FAMILY PRACTICE 691 DETOUR CLINIC1,087 DRUMMOND ISLAND MEDICAL CENTER4,359 ADVANCED SURGICAL SERVICES4,111 NORTHERN SURGICAL ORTHOPEDICS1,612 SAULT PEDIATRICS3,000 SAULT WOMEN'S HEALTHCARE1,418 SUPERIOR NEUROSCIENCES1,676 UP DIGESTIVE HEALTH1,309 UP PAIN INSTITUTE 535 UP UROLOGY2,176 VISITING SPECIALIST CLINIC 2922307 0 4664669 SKILLED NURSING - OUR 51 BED LONG TERM CARE UNIT (HOSPITAL-ATTACHED NURSING HOME) HAD AN AVERAGE OCCUPANCY RATE OF 93 PERCENT DURING THE YEAR. 16640865 0 16040093 OTHER PROGRAM SERVICES - WHICH INCLUDES* INPATIENT PSYCH - EXPENSES $2,806,095 - REVENUES $2,532,212 - WITH 3,514 PATIENT DAYS. 16640865 16040093 75110871 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 107 0 1 992 1 0 0 0 0 0 1 1 0 0 0 0 X 10 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X KEVIN KALCHIK CFO 9066354456 500 OSBORN BOULEVARD SAULT STE MARIE MI 49783 RONALD CALERY 1.50 X X 5730 0 0 SCOTT SHACKLETON 1.50 X 6030 0 0 JOHN JORGENSON SR 1.50 X 6030 0 0 WW LAJOIE 1.50 X X 5850 0 0 TED POSTULA 1.50 X 5760 0 0 GARY MCDOWELL 1.50 X 5805 0 0 FRANK SASSO 1.50 X X 6775 0 0 ELIZABETH DEMARAY 1.50 X X 5400 0 0 SHANE WOOLEVER 1.50 X 5715 0 0 TIMOTHY O'CONNOR 1.50 X 17475 0 0 SUSAN TETZLAFF 40.00 X 143423 0 32555 DAVID JAHN 40.00 X 262485 0 48546 KEVIN KALCHIK 40.00 X 146558 0 32405 MARLA BUNKER 40.00 X 119694 0 31164 JAMES HAGLUND 40.00 X 167984 0 22231 WALEED DOGHMI 40.00 X 821263 0 32902 RICHARD GANZHORN 40.00 X 831418 0 32902 JAMIE ADAIR 40.00 X 563353 0 22531 JOHN GALEY 40.00 X 689212 0 32902 ANN SILVERMAN 40.00 X 507501 0 31940 4323461 0 320078 33 0 1 0 EUPEP PO BOX 2870 WHITEHOUSE OH 43571 E.R. PHYSICIAN COVERAGE 1975173 WILLIAM GOOD MD 2625 KITCHEN ROAD CHEBOYGAN MI 49721 ANESTHESIOLOGIST 541078 JOHN D BOLDAN 500 OSBORN BLVD SAULT STE MARIE MI 49783 ANESTHESIOLOGIST 436763 HARLEY ELLIS DEVEREAUX 26913 NORTHWESTERN HWY SUITE 200 SOUTHFIELD MI 48033 CONTRACTOR 424022 HHA SERVICES INC 22622 HARPER ST CLAIR SHORES MI 48080 CONTRACT SERVICES 353957 26 3756 53640 48670 106066 PATIENT SERVICE REVENUE 622110 90984577 90984577 EHR REVENUE 622110 2042589 2042589 OTHER RELATED REVENUE 622110 270740 270740 93297906 255155 255155 345663 232248 113415 113415 113415 2030054 5468 2036753 -5468 -6699 -12167 -12167 46070 3756 13626 32444 32444 CAFETERIA REVENUE 722210 473266 473266 473266 94266085 93411321 0 748698 1077615 341073 736542 37572658 32767756 4804902 9423625 4725528 4698097 2449350 2117759 331591 347555 347555 89590 89590 8710137 7409302 1300835 154490 8453 146037 831709 616117 215592 142824 84845 57979 160021 57358 102663 1473974 1225511 248463 4499363 2036515 2462848 606489 163495 442994 SUPPLIES 13924727 13383971 540756 PROVISION FOR BAD DEBTS 5087651 5087651 QUALITY ASSESSMENT FEES 2539084 2539084 REPAIRS AND MAINTENANCE 2239113 1436230 802883 3111378 1110223 2001155 94441353 75110871 19330482 0 3974 5025 4124085 1927797 8588533 10737553 2936528 2797402 404007 488844 82434243 39231074 38170725 43203169 3010533 5284742 268587 366831 2272030 593648 59779002 65405011 7835297 7512123 24964322 31841704 3757737 3930807 36557356 43284634 X 23221646 22120377 23221646 22120377 59779002 65405011 X -175268 103994 -1029995 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11509 11509 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTION OF ANNUAL DUES TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND AGING SERVICES OF MICHIGAN THAT ARE USED TOWARD LOBBYING ACTIVITIES. 2819909 2819909 52758890 22403832 30355058 703372 275553 427819 23388073 16551689 6836384 2763999 2763999 43203169 ACCRUED POST-RETIREMENT BENEFIT 1208061 ACCRUED INSURANCE 403575 COST REPORT SETTLEMENT PAYABLE 1794171 ACCRUED MALPRACTICE LIABILITY 525000 3930807 X 94789018 103994 167597 271591 94517427 -251342 -251342 94266085 95890287 1281337 1281337 94608950 -167597 -167597 94441353 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: EMPLOYED PHYSICIAN RENTAL INCOME 172,007. GRANT EXPENSES -4,410. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -13,626. RENTAL EXPENSES -232,248. LOSS ON SECURITIES -5,468. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET UNREALIZED LOSSES ON INVESTMENTS 5,468. EQUITY LOSSES OF UNCONSOLIDATED INVESTEES 1,029,995. FUNDRAISING EXPENSES 13,626. RENTAL EXPENSES 232,248. PART XII, LINE 4B - OTHER ADJUSTMENTS: EMPLOYED PHYSICIAN RENTAL INCOME -172,007. GRANT EXPENSES 4,410. GOLF OUTING 48320 2250 46070 1450 4636 7540 NRS SCHOLARSHIP FUNDRAISER 1506 1506 49826 3756 46070 1450 4636 7540 13626 32444 1 1 X 1 X 1 X 1 1 1 0 1 1 888856 374639 514217 0.00580 13427154 12740321 686833 0.00770 14316010 13114960 1201050 0.01350 4696 10340 223253 223253 0.00250 70 3744 35700 35700 0.00040 8492579 6244928 2247651 0.02520 0 90 840 39510 39510 0.00040 4856 14924 8791042 6244928 2546114 0.02850 4856 14924 23107052 19359888 3747164 0.04200 1 500 500 0.00000 1 500 500 0 5087651 2543825 22809250 18682844 4126406 X 1 1 1 1 CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL

500 OSBORN BOULEVARD SAULT STE MARIE MI 49783

X X X CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL 1 1 1 200.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X 1 0 1 X 0 0 7 LONG TERM CARE

500 OSBORN BOULEVARD SAULT STE MARIE MI 49783

SKILLED NURSING FACILITY BEHAVIORAL HEALTH CENTER

500 OSBORN BOULEVARD SAULT STE MARIE MI 49783

INPATIENT PSYCHIATRIC FACILITY WAR MEMORIAL MUNSON HEALTH SERVICES

550 OSBORN BOULEVARD SAULT STE MARIE MI 49783

OUTPATIENT CARDIOLOGY JOINT VENTURE CHIPPEWA MEDICAL ASSOCIATES

510 ASHMUN STREET SAULT STE MARIE MI 49783

SPECIALTY CLINIC JOINT VENTURE WMH KINROSS COMMUNITY CLINIC

16523 S WATER TOWER DRIVE KINCHELOE MI 49788

OUTPATIENT CLINIC WMH CEDARVILLE CLINIC

391 HWY M-134 CEDARVILLE MI 49719

OUTPATIENT CLINIC WMH DRUMMOND ISLAND CLINIC

33896 S TOWNLINE ROAD DRUMMOND ISLAND MI 49726

OUTPATIENT CLINIC PART I, LINE 3C: THE HOSPITAL, THROUGH ITS PARTNERSHIP WITH COMMUNITY HEALTH ACCESS COALITION, UTILIZES 200% OF POVERTY GUIDELINES FOR INITIAL ACCESS AND APPLICATION FOR MEDICAID. FOR THOSE COMMUNITY MEMBERS THAT DO NOT QUALIFY, 250% OF POVERTY GUIDELINES ARE UTILIZED FOR ADDITIONAL DISCOUNTS OR FREE CARE ON REMAINING BALANCES AND NON-COVERED SERVICES. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E) AND HEALTH PROFESSIONS EDUCATION (LINE 7F).A DIRECT COST AND STEP-DOWN APPROACH WAS USED TO COMPLETE THE SUBSIDIZED HEALTH SERVICES PROGRAMS (LINE 7G). PART I, LINE 7G: INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE: ORTHO SURGERY, GENERAL SURGERY, BEHAVIORAL HEALTH, OB PROFESSIONAL, AND OB PROGRAM. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $5,087,651. PART II: WAR MEMORIAL HOSPITAL IS ACTIVE IN BOTH THE PROMOTION OF HEALTHY LIFESTYLES FOR BOTH ITS EMPLOYEES AND COMMUNITY MEMBERS. WAR MEMORIAL HOSPITAL WILL TAKE A LEAD ROLE IN MANY OF THESE ENDEAVORS, BUT ALSO IS WILLING TO BE A SUPPORTIVE PARTNER AND TEAM MEMBER AS WELL. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY, $2,543,826, IS EQUAL TO APPROXIMATELY 50 PERCENT OF BAD DEBT EXPENSE.WAR MEMORIAL HOSPITAL PROVIDES CARE TO PATIENTS COVERED BY GOVERNMENTAL PROGRAMS AT REIMBURSEMENTS AT LESS THAN WHAT IS NEEDED IN ORDER TO PROVIDE STABILITY OF OPERATIONS. THE UN-REIMBURSED VALUE OF PROVIDING CARE TO MEDICAID PATIENTS IS APPROXIMATELY $1,584,000. AS THE NUMBER OF UNINSURED OR UNDERINSURED CITIZENS CONTINUES TO INCREASE, THE HOSPITAL'S ABILITY TO COLLECT REIMBURSEMENTS FOR SERVICES PROVIDED CONTINUES TO BE A CHALLENGE. THEREFORE, HOSPITAL LEADERS HAVE SERVED IN LEADERSHIP CAPACITIES IN THE DEVELOPMENT OF A COMMUNITY HEALTH ACCESS COALITION WHICH HAS A MISSION TO PROVIDE ACCESS TO QUALITY HEALTH CARE FOR THE UNINSURED RESIDENTS OF CHIPPEWA, LUCE, AND MACKINAC COUNTIES BY COORDINATING SERVICES OF VARIOUS HEALTH CARE PROVIDERS TO OFFER AN AFFORDABLE, DIGNIFIED AND ENHANCED CONTINUUM OF CARE. THE HOSPITAL AS WELL AS LOCAL PHYSICIANS AGREE TO PROVIDE CARE THAT IS UNCOMPENSATED OR AT A REDUCED FEE.THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. PART III, LINE 8: THE MEDICARE SURPLUS(SHORTFALL) WAS CALCULATED BY UTILIZING COST ACCOUNTING WHEN APPROPRIATE AND AVAILABLE. IN SOME AREAS A COST TO CHARGE METHODOLOGY WAS REQUIRED. PART III, LINE 9B: WAR MEMORIAL HOSPITAL UTILIZES AN ON-LINE INSURANCE VERIFICATION PROCESS TO INITIATE THE EDUCATION AND ELIGIBILITY FROM THE ON-SET OF SERVICES. UPFRONT COLLECTIONS ARE AN ACTIVE PART OF THE PROCESS TO BOTH EDUCATE THE PATIENT AND TO REDUCE BACK-END COSTS OF COLLECTIONS. AT ANY TIME DURING THE PROCESS STAFF ARE TRAINED TO ADDRESS THE PERCEIVED FINANCIAL ASSISTANT NEEDS AND PROVIDE ACCESS TO THE IN-HOUSE PATIENT FINANCIAL COUNSELOR, COMMUNITY HEALTH ACCESS COALITION, OR THE DEPARTMENT OF HEALTH SERVICES REPRESENTATIVE. IN THE BILLING PROCESS, PATIENTS ARE STILL OFFERED ANY EDUCATION NECESSARY TO OBTAIN ASSISTANCE. ONCE SERVICES ARE RECEIVED AND THE PATIENT CHARGES HAVE ACCUMULATED PRIMARY SOURCES OF COVEAGE ARE BILLED. AFTER ALL EFFORTS OF COLLECTION FROM PRIMARY PAYOR (INSURANCE) THE PATIENT IS BALANCED BILL AND PROVIDED THE OPPORTUNITY FOR PAYMENT IN FULL OR OTHER PAYMENT OPTIONS. OTHER INFORMATION:AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE COSTS NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) ARE SUMMARIZED AS FOLLOWS:TOTAL COST: 15,964,156TOTAL REIMBURSEMENT 14,981,661COST IN EXCESS OF REIMBURSEMENT 982,495 PART VI, LINE 2: WAR MEMORIAL HOSPITAL WORKS IN CONJUNCTION WITH MANY OF THE HOSPITAL'S IN THE NORTHERN MICHIGAN AND THE UPPER PENINSULA. IN THESE EFFORTS "NEEDS" OF THE COMMUNITIES ARE ASSESSED THROUGH WORK WITH OTHER HOSPITAL'S, HEALTH RELATED ORGANIZATION'S, AND IN COMMUNITY FORUM'S. IN ADDITION, WAR MEMORIAL HOSPITAL HAS ENGAGED OUTSIDE ASSISTANCE IN THE PLANNING FOR "NEEDS" OF BOTH SERVICES AND PHYSICIANS TO BEST PLAN FOR CAPITAL AND RECRUITMENT APPROPRIATIONS. PART VI, LINE 3: WAR MEMORIAL HOSPITAL PRIDES ITSELF ON PROVIDING NEEDED CARE TO THE INDIGENT OF THE EASTERN UPPER PENINSULA IN A DIGNIFIED MANNER. THIS EDUCATION AND ASSISTANCE IS DONE THROUGH PARTNERSHIPS WITH OTHER "ACCESS" POINTS. SPECIFICALLY, WAR MEMORIAL HOSPITAL HAS PROVIDED RESOURCES TO THE CHAC (COMMUNITY HEALTH ACCESS COALTION) AND WAR MEMORIAL HOSPITAL HAS ENTERED INTO AN AGREEMENT WITH THE STATE OF MICHIGAN TO PROVIDE A DHS (DEPARTMENT OF HEALTH SERVICES) WORKER ON-SITE FOR READY ACCESS FOR OUR PATIENTS. THROUGH THE COLLABORATION OF THESE RELATIONSHIPS OUR PATIENTS ARE FIRST NOTIFIED AND REFERRED TO THE APPROPRIATE RESOURCE FROM THE ON-SET OF RECEIVING HEALTH CARE SERVICES. IN ADDITION, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS POSTED IN THE ADMISSIONS OFFICES AND IS PROVIDED IN WRITING TO PATIENTS UPON ADMISSION TO THE HOSPITAL. PART VI, LINE 4: WAR MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS THE EASTERN UPPER PENINSULA OF MICHIGAN. IN THIS AREA THERE ARE THREE COUNTIES WHICH CONSIST OF CHIPPEWA, MACKINAC, AND LUCE. WAR MEMORIAL HOSPITAL PRIDES ITSELF ON THE QUALITY OF SERVICES IT PROVIDES AS A RURAL SOLE COMMUNITY HOSPITAL. THE CLOSEST HOSPITAL IS 50 MILES AWAY AND IS A CRITICAL CARE HOSPITAL. THE CLOSEST TERTIARY FACILITY IS OVER AN HOUR AND A HALF AWAY. WAR MEMORIAL HOSPITAL STRIVES FOR PROVIDING SERVICES TO THE COMMUNITY FOR WHICH OTHERWISE THE COMMUNITY MEMBER WOULD MOST LIKELY HAVE TO TRAVEL TO A TERTIARY FACILITY. THROUGH ITS OWN EFFORTS AND JOINT VENTURES AREAS OF CARE SUCH AS OBSTETRICS AND DELIVERY, DIALYSIS, ONCOLOGY, CARDIOLOGY, PULMONOLOGY, INFECTIOUS DISEASE, AND I/P PSYCHIATRIC SERVICES WOULD NOT BE AVAILABLE.WAR MEMORIAL HOSPITAL IS ONE OF THE TOP TEN LARGEST EMPLOYERS IN OUR REGION. WE EMPLOY APPROXIMATELY 896 PEOPLE AND HAVE AN ANNUAL PAYROLL OF APPROXIMATELY $38.5 MILLION; PROVIDING A POSITIVE ECONOMIC IMPACT IN THE COMMUNITY. PART VI, LINE 5: WAR MEMORIAL HOSPITAL PROVIDES MANY POINTS OF ACCESS THAT ARE NOT PROFITABLE, BUT OTHERWISE WOULD REQUIRE OUR COMMUNITY MEMBERS TO TRAVEL GREAT DISTANCES. THE HOSPITAL MANAGEMENT AND STAFF PARTICIPATE ACTIVELY IN MANY HEALTH AND EDUCATIONAL ENDEAVORS. AN EXAMPLE IS PROVIDING CLINICAL STAFF TO THE LOCAL STATE UNIVERSITY TO ASSIST IN THE EDUCATION OF REGISTERED NURSES. OTHER EXAMPLES INCLUDE INFORMAL PARTNERSHIPS WITH TWO LOCALLY RECOGNIZED NATIVE AMERICAN TRIBES AND FULL SUPPORT OF COUNTY HEALTH INITIATIVES. PROGRAM EXAMPLES WOULD INCLUDE FLU-CLINIC, DIALYSIS, DIABETIC EDUCATION, COUNTY HEALTH DEPARTMENT COLON SCREENING, PHYSICALS FOR STUDENT ATHLETES, AND REGIONAL CHARITY CARE INITIATIVES.WAR MEMORIAL HOSPITAL CONTINUES TO PARTNER WITH TERTIARY FACILITIES TO PROVIDE CONSISTENT ACCESS TO PROVIDERS OF CARDIOLOGY, INTERNAL MEDICINE, ONCOLOGY, AND NEPHROLOGY. DUE TO THE HOSPITAL'S GEOGRAPHIC LOCATION AND COMMUNITY SIZE, THE HOSPITAL HAS CONTINUED TO INDEPENDENTLY RECRUIT OTHER SPECIALISTS TO ENSURE ACCESS TO PROVIDERS. THE HOSPITAL CONTINUES ITS EFFORTS IN PROVIDING PRIMARY CARE IN OUTREACH AREAS OF THE EASTERN UPPER PENINSULA. SIGNIFICANT PROVIDER ADDITIONS IN THE PAST COUPLE OF YEARS INCLUDE GASTROENTEROLOGY, NEUROLOGY, BARIATRIC, PAIN MANAGEMENT, ENT AND ENHANCING IT MEDICAL STAFF WITH ADDITIONAL PROVIDERS TO ENSURE ACCESS AND COVERAGE. WITH THESE EFFORTS AND PARTNERSHIPS THE HOSPITAL HAS BEEN SUCCESSFUL IN MAINTAINING ALL OTHER SERVICES.WAR MEMORIAL HOSPITAL CONTINUED ITS LEADERSHIP AND INVOLVEMENT IN COMMUNITY AND HEALTHCARE PROVIDER EDUCATION AND TRAINING. EXAMPLES OF COMMUNITY EDUCATION AND/OR HEALTH SCREENINGS INCLUDED A COMMUNITY BABY SHOWER, SENIOR HEALTH FAIR, EARLY PRE-NATAL EDUCATION AND CHILDBIRTH CLASSES. THE HOSPITAL'S INVOLVEMENT IN HEALTHCARE PROVIDER EDUCATION AND TRAINING INCLUDED NURSE AIDE TRAINING PROGRAMS AND SERVING AS CLINICAL INTERNSHIP SITE FOR MANY COLLEGE AND UNIVERSITY TRAINING PROGRAMS FOR STUDENTS IN REGISTERED NURSING, PHARMACY, MEDICAL TECHNOLOGY, HEALTH INFORMATION MANAGEMENT, AND PHYSICIAN ASSISTANT PROGRAMS. THE HOSPITAL IS ALSO DESIGNATED AS A COMMUNITY TRAINING CENTER OFFERING TRAINING TO AREA PHYSICIANS AND STAFF ON PEDIATRIC ADVANCED LIFE SUPPORT, ADVANCED CARDIAC LIFE SUPPORT AND BASIC LIFE SUPPORT. THE HOSPITAL IS ALSO CERTIFIED TO PROVIDE CONTINUING MEDICAL EDUCATION TO AREA PHYSICIANS AND STAFF AND CONDUCTS MORE THAN 25 ON-SITE PROGRAMS PER YEAR. VIDEO CONFERENCING CAPABILITIES ALSO PROVIDE ACCESS TO COMMUNITY AND HEALTHCARE PROVIDER TRAINING THROUGHOUT THE YEAR.WAR MEMORIAL HOSPITAL EMPLOYEES HAVE EMPLOYMENT BENEFITS WHICH INCLUDE PAYMENT FOR EXPENSES FOR THE COMPLETION OF A BACHELOR OF SCIENCE IN NURSING FOR CURRENT REGISTERED NURSES ON STAFF. ADDITIONALLY, OTHER EMPLOYEES HAVE ANNUAL EDUCATION BENEFITS FOR CONTINUING OR ADVANCING THEIR EDUCATION IN A HEALTHCARE FIELD. THE HOSPITAL ALSO OFFERS AN EDUCATIONAL LOAN PROGRAM WITH A PERIOD OF NO-INTEREST LOANS WHILE ENROLLED IN AN EDUCATIONAL PROGRAM. FOR NEWLY HIRED EMPLOYEES IN JOB SHORTAGE CLASSIFICATIONS, EMPLOYEES CAN RECEIVE FUNDS FOR STUDENT LOAN REPAYMENT FOR A COMMITMENT TO SERVE WAR MEMORIAL HOSPITAL FOR A SPECIFIED NUMBER OF YEARS. PART VI, LINE 6: NOT AFFILIATED. REPORTS FILED WITH STATES PART VI, LINE 7 MI X X X X X 0 0 0 0 0 0 0 0 0 SUSAN TETZLAFF 141003 0 2000 0 420 0 12153 0 20402 0 175978 0 0 0 DAVID JAHN 262325 0 0 0 160 0 22500 0 26046 0 311031 0 0 0 KEVIN KALCHIK 138008 0 2000 0 6550 0 12003 0 20402 0 178963 0 0 0 MARLA BUNKER 114782 0 2000 0 2912 0 10842 0 20322 0 150858 0 0 0 JAMES HAGLUND 167504 0 0 0 480 0 13378 0 8853 0 190215 0 0 0 WALEED DOGHMI 795144 0 0 0 26119 0 12500 0 20402 0 854165 0 0 0 RICHARD GANZHORN 723000 0 108418 0 0 0 12500 0 20402 0 864320 0 0 0 JAMIE ADAIR 502462 0 0 0 60891 0 2129 0 20402 0 585884 0 0 0 JOHN GALEY 672495 0 0 0 16717 0 12500 0 20402 0 722114 0 0 0 ANN SILVERMAN 500001 0 0 0 7500 0 11538 0 20402 0 539441 0 0 0 0 RIVERSIDE MEDICAL ASSOCIATES HOSPITAL OFFICER'S SPOUSE, TIM TETZLAFF, IS AN OWNER OF RIVERSIDE. 92000 ON-CALL COVERAGE PAYMENTS 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE DEPARTMENT WORKS WITH THE APPROPRIATE DEPARTMENTS TO PROVIDE RELEVANT INFORMATION TO THE PREPARER OF THE 990 (AN OUTSIDE FIRM SPECIALIZING IN TAX PREPARATION). REVIEW AND DISCUSSION OF ALL INFORMATION TAKES PLACE BETWEEN THE FINANCE DEPARTMENT AND THE CFO. THE FORM 990 IS THEN PROVIDED TO THE FULL BOARD, BEFORE FILING, WHERE THEY ARE GIVEN AN OPPORTUNITY TO ASK QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENT IS COMPLETED ANNUALLY FOR ALL BOARD MEMBERS AND SENIOR LEVEL ADMINISTRATION. ANY CONFLICTS WOULD BE REVIEWED AND KEPT UNDER CONSIDERATION ON AN ONGOING BASIS. BOARD MEMBERS AND ADMINISTRATION INFORM OR REMIND THE ATTENDEES IN THESE SITUATIONS AND ABSTAIN FROM BOTH DISCUSSION AND VOTE ON THE ITEM UNDER DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 MANAGEMENT: THE HOSPITAL IS COMMITTED TO COMPENSATING ALL EMPLOYEES AN EQUITABLE AND FAIR WAGE. THE HOSPITAL HAS CONSULTED AND CONTINUES TO WORK WITH AN INDEPENDENT SPECIALIST TO REVIEW ALL JOB DESCRIPTIONS TO ASSIST IN THE CLASSIFICATION OF WAGES BASED ON LOCAL, REGIONAL, AND NATIONAL STANDARDS. THE CLASSIFICATION AND COMPARISON OF LOCALITY IS BASED ON THE ABILITY TO RECRUIT AND TRAIN THE SPECIFIC JOB CLASSIFICATION. THIS SAME PROCESS IS FIRST UTILIZED FOR MANAGEMENT AND SENIOR LEADERS. IN ADDITION, SENIOR LEADERS ARE COMPARED TO THE MHA SURVEY THAT IS PUBLICIZED. ANY INCREASES IN SENIOR LEADERS IS PROPOSED BY THE PRESIDENT/CEO AND APPROVED BY THE BOARD OF TRUSTEES. THE CEO AND HUMAN RESOURCES DIRECTOR PROVIDES THE BOARD WITH CEO WAGE INFORMATION AND THE BOARD (CEO IS REQUESTED TO LEAVE THE MEETING AND IS NOT INVOLVED IN THE VOTE) APPROVES AND MAKES ANY CHANGES THAT ARE NECESSARY. THESE RECOMMENDATIONS ARE NOT ANNUAL AS THEY ARE ALSO BASED ON THE FINANCIAL PERFORMANCE OF THE HOSPITAL. THESE RECOMMENDATIONS ARE FURTHER COMPARED TO "LIKE SIZE" HOSPITAL'S WITHIN THE MHA SURVEY. THIS WAS LAST PERFORMED IN 2011. PHYSICIANS: AS A RURAL HOSPITAL DESIGNATED AS UNDERSERVED, WAR MEMORIAL HOSPITAL HAS BEEN FACED WITH THE NEED TO EMPLOY PHYSICIANS TO RECRUIT AND RETAIN PROVIDERS FOR THE SERVICES DEEMED NECESSARY FOR OUR COMMUNITY. THE NEEDS OF OUR COMMUNITY ARE BASED ON INDEPENDENT EVALUATIONS AND COMMUNITY SURVEYS. BASED ON THESE NEEDS THE HOSPITAL UTILIZES MGMA DATA BASED ON SPECIALTY FOR ALL PROVIDERS IN THE UNITED STATES. THIS DATA PROVIDES INFORMATION SUCH AS RELATIVE VALUE UNITS, ENCOUNTER, AND COMPENSATION. THE INFORMATION IS CLASSIFIED BY THE 25TH, MEDIAN, 75TH, AND 90TH PERCENTILE AND IS USED TO DESIGNATE THE PHYSICIAN COMPENSATION AS THE HOSPITAL ESTABLISHES COMPENSATION DURING RECRUITMENT AND RETENTION EFFORTS. MEDIAN BASED COMPENSATION IS MOST TYPICAL FOR PHYSICIAN CONTRACTS WITH THE ABILITY FOR THE PROVIDER TO EARN ADDITIONAL COMPENSATION BASED ON THEIR WORKLOAD (RVU AND ENCOUNTER) WITH NO RELATIONSHIP TO REFERRALS TO THE HOSPITAL. IN RETENTION CONTRACTS THE BASE COMPENSATION IS SOMETIMES INCREASED BASED ON HISTORICAL WORKLOADS AND THE NEEDS OF THE COMMUNITY. FORM 990, PART VI, SECTION C, LINE 19 THE 990 AND THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH A DISSEMINATION AGENT AND UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: LOSS FROM JOINT VENTURES -1,029,995. FORM 990, PART XII, LINE 2C: NO CHANGES FROM PRIOR YEAR.