2013-08-14T09:43:05-05:00 2012-09-30 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2011-10-01 381218516 MOUNT CLEMENS REGIONAL MEDICAL CENTER MOUN 5867414282 1000 HARRINGTON MOUNT CLEMENS MI 48043 DAMON SORENSEN 5867414282 2013-08-09 1 SUSAN R MIENCIER P00181637 2695674500 2011 2016-02-24 21:20:13Z MCLAREN MACOMB DAMON SORENSEN 1000 HARRINGTON MOUNT CLEMENS MI 48043 291871587 0 X WWW.MCRMC.ORG X 1946 MI PROVIDER OF HEALTH CARE SERVICES 15 13 2217 12 1178600 -355135 115003 615976 286807529 278743152 2214164 2702566 1985500 3667396 291122196 285729090 6034259 2963437 0 0 126504798 130251305 0 0 0 152493084 139108753 285032141 272323495 6090055 13405595 305085444 301880998 229235971 209470659 75849473 92410339 TO BE MICHIGAN'S BEST VALUE IN HEALTH CARE AS DEFINED BY QUALITY OUTCOMES AND COST. 0 0 210475908 2700876 279973362 MOUNT CLEMENS REGIONAL MEDICAL CENTER OBTAINED THE FOLLOWING FIGURES WITHIN FISCAL YEAR 2012: PATIENT DAYS 60,226. OUTPATIENT REGISTRATIONS 82,149. PHYSICIAN PRACTICE VISITS 26,980. EMERGENCY ROOM VISITS 64,464. LAB COURIER REGISTRATIONS 146,807. SURGICAL PROCEDURES 9,722. ANESTHESIA SERVICES 18,531 HOURS. 210475908 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 276 0 1 2217 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X DAMON SORENSEN 5864938090 1000 HARRINGTON MOUNT CLEMENS MI 48043 X ALBERT PRZYBYLSKI 1.00 X 0 0 0 BERNADETTE GENDERNALIK DO 1.00 X 42000 0 0 CAROLYN DORIAN 1.00 X X 0 0 0 CHRIS PEYERK 1.00 X 0 0 0 DEAN PETITPREN 1.00 X 0 0 0 HON GEORGE C STEEH 1.00 X 0 0 0 JAMES E JOHNSON DO 1.00 X 0 0 0 JAMES GEORGE 1.00 X X 0 8000 0 JOHN PAUL HUNT 1.00 X 0 0 0 MARK O'HALLA 40.00 X X 0 1154737 29030 MATTHEW MOROUN 1.00 X 0 0 0 MONROE ADAMS DO 1.00 X 0 0 0 PETER AJLUNI DO 1.00 X 0 0 0 PHILIP INCARNATI 1.00 X 0 5512732 837545 ROBERT CANNON 1.00 X 0 0 0 TED WAHBY 1.00 X X 0 0 0 THOMAS SCHWANITZ 1.00 X X 0 0 0 DAMON SORENSEN 40.00 X 89228 0 7133 DONNA KOPINSKI 40.00 X 121183 0 23016 LAURA GIBBARD 40.00 X 155916 0 28479 MICHAEL SMITH DO 40.00 X 272245 0 37225 SHARYL SMITH 40.00 X 140927 0 16357 SUSAN DURST 40.00 X 203175 0 36172 BRIAN D YOUNG 40.00 X 316667 0 21996 JEFFREY BALAZSY 40.00 X 825846 0 7971 MARK YUDELEV 40.00 X 272080 0 33719 PAUL PORTER 40.00 X 390124 0 14461 PRAVEEN DALMIA 40.00 X 308341 0 53197 3137732 6675469 1146301 90 0 1 0 SODEXO 4880 PAYSHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE 3290083 MORRISON MANAGEMENT SPECIALISTS INC 5801 PEACHTREE DUNWOODY RD ATLANTA GA 30342 CLEANING SERVICES 1939609 AMERICAN RED CROSS BLOOD SERVICES SOUTH PO BOX 73013 CHICAGO IL 60673 BLOOD SERVICES 1734535 PUBLICOM 333 ALBERT AVE STE 400 EAST LANSING MI 48823 ADVERTISING 1195148 HEMA TEC SERVICES INC 3120 MOMENTUM PLACE CHICAGO IL 60689 DIALYSIS 829986 27 615976 615976 PATIENT SERVICES 622110 277279963 277279963 LAB REVENUE 900099 1462212 244895 1217317 PHARMACY REVENUE 900099 977 977 278743152 2163049 2163049 2843085 1642701 1200384 1200384 -38717 1239101 4959481 79832 4386708 113088 572773 -33256 539517 539517 MISCELLANEOUS 900099 2378731 2378731 CAFETERIA REVENUE 722210 68796 68796 RESEARCH REVENUE 541700 19485 19485 2467012 285729090 279973362 1178600 3961152 2963437 2963437 1026719 1026719 105767767 76031500 29736267 2708139 1929278 778861 13754782 9847799 3906983 6993898 4982453 2011445 343352 5887 337465 68435 68435 11300 11300 38661293 24718364 13942929 1808804 1288592 520212 1394302 993301 401001 3328815 2371448 957367 191414 136363 55051 6512103 4639222 1872881 16245785 11573497 4672288 191195 136207 54988 MEDICAL SUPPLIES 42393175 42393175 BAD DEBTS 13133461 13122074 11387 QAAP 9584418 9584418 EQUIP REPAIR & MAINT 4956909 3531302 1425607 283992 227591 56401 272323495 210475908 61847587 0 11240529 6593698 40577966 16723851 4609175 4540243 1315337 1125537 385271627 269334003 116307116 115937624 100416693 127236568 23596119 23586373 815000 7022509 5322104 305085444 301880998 46563088 28558083 187586 249694 148028525 145686197 34456772 34976685 229235971 209470659 X 75567363 92118224 282110 292115 75849473 92410339 305085444 301880998 X 13405595 3155271 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11300 11300 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO MICHIGAN HEALTH AND HOSPITAL ASSOCIATION SUPPORT LOBBYING ACTIVITIES. 3489378 3489378 142573641 85383593 57190048 9485524 6026140 3459384 227947196 176856372 51090824 1775888 1067898 707990 115937624 INVESTMENTS IN AND ADVANCES TO AFFILIATES 23586373 F 23586373 PROFESSIONAL LIABILITY INSURANCE 6693350 WORKERS COMPENSATION INSURANCE 253341 MINIMUM PENSION LIABILITY 2072327 ACCRUED PENSION 22559919 COST REPORT SETTLEMENTS PAYABLE 2250869 CAPITAL LEASE OBLIGATION 1146879 34976685 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION AND SUBSTANTIALLY ALL OF ITS SUBSIDIARIES ARE NONPROFIT, TAX-EXEMPT ORGANIZATIONS; ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. SOME SUBSIDIARIES ARE FOR-PROFIT CORPORATIONS. INCOME TAX PROVISIONS ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE ACCOUNTING STANDARD THAT REFERS TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED ON THE CONSOLIDATED FINANCIAL STATEMENTS. COMPANIES MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE STANDARD ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. THE EVALUATED POTENTIAL EXPOSURE RELATED TO UNCERTAIN TAX POSITIONS WAS FOUND TO BE IMMATERIAL. THE CORPORATION IS SUBJECT TO EXAMINATION BY TAXING AUTHORITIES; HOWEVER, NO EXAMINATIONS ARE IN PROGRESS. MANAGEMENT BELIEVES THE CORPORATION IS NOT SUBJECT TO TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2009. SUBSEQUENT TO THE TAX YEAR ENDING 9/30/2012, THE ORGANIZATION HAS BEEN SELECTED FOR EXAMINATION. 1 1 X 1 X 1 X 1 1 0 1 0 6327449 6327449 0.02440 36899753 35542684 1357069 0.00520 42095 7766 34329 0.00010 43269297 35550450 7718847 0.02970 881395 881395 0.00340 13269011 5162334 8106677 0.03130 177122 177122 0.00070 209946 209946 0.00080 14537474 5162334 9375140 0.03620 57806771 40712784 17093987 0.06590 1 52 348 348 0.00000 26 1157 1159 1159 0.00000 27 1209 1507 1507 1 13133461 1313346 87716084 78614826 9101258 X 1 1 1 MT CLEMENS REGIONAL MEDICAL CENTER HEALTH PARTNERS LLC MEDICAL OFFICE BUILDING 0.66670 0.33330 1 1 MOUNT CLEMENS REGIONAL MEDICAL CENTER

1000 HARRINGTON MOUNT CLEMENS MI 48043

X X X X MT CLEMENS REGIONAL MEDICAL CENTER 1 1 1 200.000000000000 1 250.000000000000 1 X X X X X X X 1 1 X X X 1 0 1 X 0 0 PART I, LINE 3C: INCOME CRITERIA IS BASED UPON 200% OF THE FEDERAL POVERTY GUIDELINES PER THE FEDERAL REGISTER. COLLECTIONS MAY BE CONSIDERED IF THE PATIENT HAS SUFFICIENT LIQUID ASSETS. PART I, LINE 6A: OUR PARENT, MCLAREN HEALTH CARE CORPORATION, PREPARES AN ANNUAL REPORT OF ITS MEMBER HOSPITALS. THIS ANNUAL REPORT IS AVAILABLE ON OUR WEBSITE. PART I, LINE 7: COSTING METHODOLOGY - USED COST TO CHARGE RATIO FOR LINES 7A, B, AND C AND ACTUAL COST PER BOOKS FOR LINE 7F. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 13133461. PART II: COMMUNITY-BUILDING ACTIVITIES ARE DESIGNED AND IMPLEMENTED BASED ON COMMUNITY NEEDS ASSESSMENTS AND INPUT FROM COMMUNITY-BASED ORGANIZATIONS AND OTHER COMMUNITY STAKEHOLDERS, INCLUDING BUSINESS VENDORS, RELIGIOUS ORGANIZATIONS AND POLITICAL LEADERS. EACH ORGANIZATION DEFINES ANNUAL COMMUNITY-BUILDING AND OUTREACH ACTIVITY PLANS. THESE PLANS ARE DESIGNED TO ADDRESS THE SPECIFIC HEALTH PREVENTION, EDUCATION, DIAGNOSIS, TREATMENT AND FOLLOW-UP CARE REQUIREMENTS OF UNIQUE DISEASE, DEMOGRAPHIC AND GEOGRAPHIC COMMUNITIES IDENTIFIED BY ONGOING NEEDS ASSESSMENTS DESCRIBED ABOVE. PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. 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 FROM CERTAIN PAYORS. BAD DEBT EXPENSE REPORTED ON LINE 2 IS THE BAD DEBT EXPENSE AS REPORTED THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND ON FORM 990 PART IX. THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS 10 PERCENT OF TOTAL BAD DEBT EXPENSE. THIS ESTIMATE IS BASED ON SAMPLES OF ACCOUNTS. PART III, LINE 8: COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO AS REQUIRED FOR THE MEDICARE COST REPORT. PART III, LINE 9B: CURRENTLY OUR PROCESS INCLUDES SELF AND PRIVATE PAY PATIENT ACTIVITY IS SENT TO A VENDOR FOR ASSISTANCE. SELF PAY PATIENTS REQUESTING FINANCIAL ASSISTANCE AT REGISTRATION AND GIVEN A FINANCIAL ASSISTANCE APPLICATION WHICH IS EVALUATED TO DETERMINE IF CHARITY CARE IS APPLICABLE AND AN ATTEMPT IS ALSO MADE TO ASSIST PATIENTS FOR FINANCIAL ASSISTANCE POLICY ELIGIBILITY.THE HOSPITAL HAS A WRITTEN PATIENT COLLECTION POLICY THAT PROVIDES FOR A REVIEW OF THE PATIENT'S RECORDS BY THE HOSPITAL TO DETERMINE THAT REASONABLE EFFORTS WERE UNDERTAKEN TO ENSURE THAT FINANCIAL ASSISTANCE WAS OFFERED AND/OR FINANCIAL ASSISTANCE WAS REQUESTED. THE SPECIFIC ACTIONS TO BE TAKEN ARE OUTLINED IN THE POLICY. MT. CLEMENS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNTS THAT CAN BE CHARTED TO INDIVIDUALS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS 25% OF CHARGES BASED ON THE PATIENT'S INCOME AS COMPARED AGAINST THE FEDERAL POVERTY GUIDELINES. PART VI, LINE 2: PRIMARY AND SECONDARY MARKET RESEARCH IS CONDUCTED BY AND THROUGH COMMUNITY-BASED HEALTH COALITIONS, ACADEMIC INSTITUTIONS, THIRD PARTY DATA ANALYTICS ORGANIZATIONS, HEALTH NEEDS ASSESSMENTS AND SURVEYS, HISTORIC HEALTH SERVICES UTILIZATION PATTERNS, DEMOGRAPHIC ANALYSIS AND POPULATION-BASED HEALTH CARE SERVICES UTILIZATION FORECASTS. PART VI, LINE 3: AVAILABILITY OF FINANCIAL ASSISTANCE INFORMATION AND EDUCATION IS PROVIDED AT ALL INPATIENT AND OUTPATIENT REGISTRATION POINTS-OF-SERVICE. INFORMATION AND EDUCATION IS ALSO AVAILABLE THROUGH THE ORGANIZATIONS WEBSITE(S). FINANCIAL AND APPLICATION FORMS ARE AVAILABLE AT ALL INPATIENT AND OUTPATIENT POINTS-OF-SERVICE, INCLUDING PROVIDING ASSISTANCE IN COMPLETING THE APPLICATION. ORGANIZATION AND ITS SUBSIDIARIES/AFFILIATES ALSO PROVIDE SPECIALLY-TRAINED COUNSELORS TO ASSIST PATIENTS AND REVIEW ELIGIBILITY FOR FEDERAL, STATE AND OTHER GOVERNMENT PROGRAMS, INCLUDING, BUT NOT LIMITED TO, MEDICAID, DISABILITY, SOCIAL SECURITY, AND ANY OTHER FORMS OF THIRD PARTY PAYMENT. PART VI, LINE 4: THE SERVICE AREA OF MOUNT CLEMENS REGIONAL MEDICAL CENTER IS COMPOSED OF 29 ZIP CODES AND IS CENTERED PRINCIPALLY ON THE CITY OF MT. CLEMENS, MI IN THE COUNTY OF MACOMB. THE PRIMARY SERVICE AREA, ACCOUNTING FOR 83% OF ANNUAL INPATIENT DISCHARGES, IS COMPOSED OF 14 ZIP CODES AND CAN BE CHARACTERIZED AS LARGELY URBAN IN NATURE. THE SECONDARY SERVICE AREA, ACCOUNTING FOR 17% OF ANNUAL INPATIENT DISCHARGES, IS COMPOSED OF 15 ZIP CODES AND CAN BE CHARACTERIZED AS LARGELY URBAN IN NATURE. PRIMARY SERVICE AREA DEMOGRAPHIC DISTRIBUTIONSAGE DISTRIBUTION0 - 14 19.8%15 - 17 4.2%18 - 24 8.5%25 - 34 12.8%35 - 54 30.7%55 - 64 11.6%65+ 12.4%EDUCATION LEVELLESS THAN HIGH SCHOOL 3.2%SOME HIGH SCHOOL 8.3%HIGH SCHOOL DEGREE 32.7%SOME COLLEGE/ASSOC. DEGREE 36.4%BACHELORS DEGREE OR GREATER 19.4%HOUSEHOLD INCOME DISTRIBUTION<$15K 9.0%$15 25K 8.9%$25 50K 25.5%$50 75K 21.3%$75 100K 15.5%OVER $100K 19.8%RACE/ETHNICITYWHITE NON-HISPANIC 85.0%BLACK NON-HISPANIC 9.0%HISPANIC 2.3%ASIAN & PACIFIC IS. NON-HISPANIC 1.5%ALL OTHERS 2.2% PART VI, LINE 5: THE PARENT ORGANIZATION AND EACH OF ITS SUBSIDIARY/AFFILIATE MEMBERS MAINTAIN A LOCAL COMMUNITY-BASED BOARD WITH POWERS, RESPONSIBILITIES AND ACCOUNTABILITIES FOR THE OVERSIGHT OF THE OPERATION OF THEIR RESPECTIVE ORGANIZATIONS. EACH SUBSIDIARY/AFFILIATE ORGANIZATION MAINTAINS AN OPEN MEDICAL STAFF ALLOWING ANY PHYSICIAN OR OTHER CARE PROVIDER WITH PROPER CREDENTIALS TO JOIN THE STAFF AND PROVIDE APPROVED CARE. THE ORGANIZATION FUNDS AND MAINTAINS OVER 500 MEDICAL RESIDENCY AND FELLOWSHIP PROGRAMS TO TRAIN FUTURE GENERATIONS OF PHYSICIANS; ORGANIZATION FUNDS, OPERATES AND MAINTAINS NUMEROUS HEALTH CARE EDUCATION PROGRAMS AT THE HIGH SCHOOL, COMMUNITY COLLEGE, UNIVERSITY AND POST-GRADUATE LEVELS OF EDUCATION. ORGANIZATION PROVIDES SPONSORSHIP (FINANCIAL AND IN-KIND RESOURCES) SUPPORT TO COMMUNITY-LEVEL ACTIVITIES (HEALTH WALKS AND RACES, FITNESS TRAINING, DISEASE AWARENESS EVENTS, CULTURAL EVENTS AND OTHER HEALTH-RELATED NON-PROFIT ACTIVITIES, EVENTS AND ORGANIZATIONS). ORGANIZATION ALSO DIRECTS, FUNDS, SUPPORTS AND PARTICIPATES IN FUNDRAISING ACTIVITIES THAT SUPPORT HEALTH PREVENTION/EDUCATION, DIAGNOSIS AND TREATMENT PROVIDED BY OTHER NON-PROFIT COMMUNITY ORGANIZATIONS. PART VI, LINE 6: THE ROLE OF THE PARENT ORGANIZATION IS TO SET THE VISION AND STRATEGIC DIRECTION FOR THE ORGANIZATION AS A WHOLE. THIS INCLUDES THE DEVELOPMENT OF THE ANNUAL STRATEGIC PLAN WHICH DEFINES THE STRATEGIC PRIORITIES FOR THE ORGANIZATION AND ITS MEMBERS, THE METRICS TO BE MEASURED FOR EACH STRATEGIC PROGRAMS AND THE BENCHMARK OR TARGET/GOALS FOR EACH METRIC. STRATEGIC PRIORITIES DIRECTLY ADDRESS AND MEASURE (AT A SUBSIDIARY LEVEL) CLINICAL QUALITY AND CLINICAL OUTCOMES; PATIENT, PHYSICIAN, EMPLOYEE AND COMMUNITY SATISFACTION WITH THE ORGANIZATION AND ITS SUBSIDIARY/AFFILIATE MEMBERS; AND DEVELOPMENT OF NEW SERVICES TO IMPROVE ACCESS TO, QUALITY OF, AND COST OF HEALTH SERVICES.THE ROLE OF THE ORGANIZATIONS SUBSIDIARIES/AFFILIATES IS THE DEVELOPMENT AND IMPLEMENTATION OF ANNUAL STRATEGIC AND OPERATIONAL PLANS THAT SUPPORT AND ADVANCE THE STRATEGIC PLAN OF THE PARENT ORGANIZATION. ALL LOCAL PLANS ARE DEVELOPED AND DESIGNED TO REFLECT THE UNIQUE POPULATION-BASED HEALTH CARE NEEDS AND REQUIREMENTS OF THE COMMUNITIES SERVED BY THE SUBSIDIARY/AFFILIATE ORGANIZATION.ALL LOCAL SUBSIDIARIES/AFFILIATES HAVE FULL AUTHORITY AND DECISION-MAKING POWERS TO DEFINE AND EXECUTE THE STRATEGIC AND OPERATIONAL PLANS INTENDED TO IMPROVE THE HEALTH AND WELFARE OF THE COMMUNITIES THEY SERVE. REPORTS FILED WITH STATES PART VI, LINE 7 MI 1 MCLAREN MEDICAL MANAGEMENT INC 401 S BALLENGER HWY FLINT MI 48532 382988086 501(C)(3) 1929993 GENERAL SUPPORT MCLAREN HEALTH CARE CORPORATION 401 S BALLENGER HWY FLINT MI 48532 382397643 501(C)(3) 869255 PROGRAM SUPPORT 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CLIENT REVIEWS TAX-EXEMPT STATUS AND MONITORS OVERALL STANDING OF ORGANIZATION IN DETERMINING GRANTS. 0 1 0 0 0 0 0 0 0 MARK O'HALLA 0 514870 0 124850 0 515017 0 12250 0 16780 0 1183767 0 0 PHILIP INCARNATI 0 1366791 0 1303195 0 2842746 0 823518 0 14027 0 6350277 0 0 LAURA GIBBARD 136442 0 19474 0 0 0 15180 0 13299 0 184395 0 0 0 MICHAEL SMITH DO 247172 0 21390 0 3683 0 22000 0 15225 0 309470 0 0 0 SHARYL SMITH 128976 0 11550 0 401 0 0 0 16357 0 157284 0 0 0 SUSAN DURST 181749 0 16600 0 4826 0 22000 0 14172 0 239347 0 0 0 BRIAN D YOUNG 316667 0 0 0 0 0 0 0 21996 0 338663 0 0 0 JEFFREY BALAZSY 825846 0 0 0 0 0 0 0 7971 0 833817 0 0 0 MARK YUDELEV 272080 0 0 0 0 0 22000 0 11719 0 305799 0 0 0 PAUL PORTER 390124 0 0 0 0 0 0 0 14461 0 404585 0 0 0 PRAVEEN DALMIA 308341 0 0 0 0 0 38500 0 14697 0 361538 0 0 0 PART I, LINE 1A THE CORPORATE CEO, SUBSIDIARY CEO'S AND CORPORATE VICE-PRESIDENTS IN SOME INSTANCES HAVE RECEIVED TAX INDEMNIFICATION FOR THE FOLLOWING BENEFITS: VEHICLE COSTS, GROUP TERM LIFE INSURANCE, SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS, AND HEALTH CLUB OR SOCIAL DUES. THESE BENEFITS HAVE BEEN INCLUDED IN TAXABLE COMPENSATION. THE FOLLOWING INDIVIDUAL HAS RECEIVED THESE BENEFITS: MARK O'HALLA AND PHILIP INCARNATI. PART I, LINE 4B MCLAREN MAINTAINS TWO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES (THE "SERPS"). THE OLD SERP WAS CLOSED TO NEW PARTICIPANTS ON OCTOBER 1, 2006, AND THE NEW SERP BECAME EFFECTIVE AS OF JANUARY 1, 2007. NO EMPLOYEE MAY PARTICIPATE IN BOTH OF THE SERPS. THE OLD SERP IS STRUCTURED AS A DEFINED BENEFIT PLAN THAT ESSENTIALLY REPLACES THE BENEFITS THE PARTICIPANT IS NOT PERMITTED TO RECEIVE UNDER MCLAREN'S QUALIFIED RETIREMENT PLAN DUE TO IRS LIMITATIONS APPLICABLE TO QUALIFIED PLANS. THE BENEFIT UNDER THE OLD SERP IS PAYABLE IN EITHER THE FORM OF A LUMP SUM DISTRIBUTION OR IN MONTHLY PAYMENTS EQUAL TO THE ACTUARIAL EQUIVALENT OF THE PARTICIPANT'S ACCRUED BENEFIT. THE BENEFIT IS PAID AT AGE 55, AND IF THE PARTICIPANT REMAINS EMPLOYED, THE BENEFIT IS PAID UPON TERMINATION OF EMPLOYMENT, REDUCED TO TAKE INTO ACCOUNT THE BENEFIT PREVIOUSLY PAID. THE NEW SERP IS STRUCTURED AS A DEFINED CONTRIBUTION PLAN, AND MCLAREN CONTRIBUTES 15 PERCENT OF EACH PARTICIPANT'S COMPENSATION TO THE PLAN EACH YEAR FOR ALLOCATION TO THE PARTICIPANT'S ACCOUNT. PARTICIPANTS IN THE NEW SERP BECOME VESTED IN THEIR ACCOUNTS UPON THE EARLIER OF FIVE YEARS OF PARTICIPATION IN THE PLAN OR ATTAINMENT OF AGE 60. PARTICIPANTS IN THE NEW SERP SELF-DIRECT THE INVESTMENT OF THEIR ACCOUNTS AND HAVE THE ACTUAL INVESTMENT RETURN CREDITED OR DEBITED TO THEIR ACCOUNTS. THE BENEFIT UNDER THE NEW SERP IS EQUAL TO THE PARTICIPANT'S ACCOUNT BALANCE, AND THE BENEFIT IS PAID IN A SINGLE SUM WITHIN 60 DAYS OF THE PARTICIPANT'S TERMINATION DATE. BENEFITS UNDER BOTH SERPS ARE PROVIDED ON A TAX-NEUTRAL BASIS. BOTH SERPS ARE DESIGNED TO COMPLY WITH INTERNAL REVENUE CODE SECTIONS 457(F) AND 409A. THE INDIVIDUAL LISTED IN PART VII WHO PARTICIPATED IN THE OLD SERP IS PHILIP INCARNATI. THE INDIVIDUAL LISTED IN PART VII WHO PARTICIPATED IN THE NEW SERP IS MARK O'HALLA. PART I, LINE 6 MCLAREN HEALTH CARE CORPORATION (MHCC) HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION, SUBSIDIARY EXECUTIVES AND DIRECTORS, AND CORPORATE MANAGERS. THE PURPOSE OF THE PLAN IS TO ENHANCE THE ORGANIZATION'S ABILITY TO ACHIEVE ITS GOALS BY PROVIDING TOP OFFICIALS AND THE BOARD OF DIRECTORS WITH A TOOL FOR (A) CLEARLY COMMUNICATING PERFORMANCE ON THE PART OF KEY LEADERS, (B) STIMULATING AND REWARDING SUPERIOR LEVELS OF PERFORMANCE ON THE PART OF KEY LEADERS WHICH WILL ULTIMATELY BENEFIT THE COMMUNITIES MHCC SERVES, AND (C) PROTECTING MHCC'S ABILITY TO COMPETE WITH OTHER EMPLOYERS FOR HIGH-TALENT LEADERS. SUPPLEMENTAL INFORMATION PART III SCH J, PART I, LINE 3: THE CEO/EXECUTIVE DIRECTOR WAS COMPENSATED BY A RELATED ORGANIZATION, AND THEREFORE NONE OF THE LINE 3 BOXES HAVE BEEN CHECKED. THE RELATED ORGANIZATION USED THE FOLLOWING METHODOLOGIES TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ANTHELIO PHILIP INCARNATI, BOARD MEMBER AND SHAREHOLDER OF ANTHELIO 3728357 MHCC IS THE CO-FOUNDER AND HAS A MINORITY INTEREST IN ANTHELIO. AS PART OF THE AGREEMENT MHCC IS ENTITLED TO APPOINT TWO DIRECTORS TO THE ANTHELIO BOARD. MHCC APPOINTED JAMES FITZGERALD AND PHILIP INCARNATI TO HOLD THOSE POSITIONS. FEES PAID TO ANTHELIO FOR INFORMATION TECHNOLOGY SERVICES, MEDICAL RECORDS, TRANSCRIPTION, CODING, AND SYSTEM INSTALLATION. 0 0 FORM 990, PART VI, SECTION A, LINE 2 PHILIP INCARNATI AND MARK O'HALLA HAVE A BUSINESS RELATIONSHIP. ALBERT PRZYBYLSKI AND PETER AJLUNI HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS MCLAREN HEALTH CARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO ELECT OR APPOINT THE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS BY THE GOVERNING BODY ARE SUBJECT TO THE POWERS OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 DATA IS PREPARED INTERNALLY AND SUBMITTED TO OUR AUDITING FIRM FOR RETURN PREPARATION. ONCE THE RETURNS HAVE BEEN COMPLETED, THE FORMS ARE REVIEWED BY THE CORPORATE DIRECTOR OF BUDGET, THE CORPORATE SENIOR VICE PRESIDENT AND CFO OF MCLAREN HEALTH CARE CORPORATION (MHCC). COPIES OF THE RETURNS ARE MADE AVAILABLE TO THE MHCC BOARD MEMBERS, WHO SERVE AS THE OVERALL GOVERNING BOARD. RETURNS ARE AVAILABLE FOR ALL CORPORATIONS OF WHICH MHCC IS THE SOLE MEMBER AS WELL AS OTHER RELATED ENTITIES OF THOSE CORPORATIONS FOR REVIEW RATHER THAN HAVING THE LOCAL BOARDS REVIEW THE RETURNS. THE BOARD OF MHCC IS THE ULTIMATE ACCOUNTABLE ORGANIZATION FOR THE SYSTEM; AS SUCH IT IS THE OVERALL GOVERNING BOARD OF OUR SYSTEM WHOSE RESPONSIBILITIES INCLUDES BUT ARE NOT LIMITED TO: APPROVING ALL SUBSIDIARY BOARD MEMBERS, FINANCIAL BUDGETS, AND ISSUANCE OF DEBT. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE DEPARTMENT, IN ACCORDANCE WITH THE MCLAREN HEALTH CARE (MHC) BOARD CONFLICT OF INTEREST POLICY, ANNUALLY DISTRIBUTES THE CONFLICT OF INTEREST DISCLOSURE SURVEY TO ALL MHC CORPORATE AND SUBSIDIARY ORGANIZATION BOARD MEMBERS, EXECUTIVES AND OTHER LEADERSHIP EMPLOYEES. THE CORPORATE COMPLIANCE DEPARTMENT, THROUGH THE GOVERNANCE COMMITTEE, COMPILES AND ANALYZES SURVEY DATA BY ORGANIZATION, INVESTIGATES, AND REVIEWS POTENTIAL CONFLICTS WITH THE ORGANIZATION'S CEO AND BOARD CHAIR, AND WHEN NECESSARY, RECOMMENDS ACTIONS TO BE TAKEN TO RESOLVE IDENTIFIED CONFLICTS. A COMPLETE REPORT OF ALL CORPORATE AND SUBSIDIARY BOARD MEMBER AND EXECUTIVE DISCLOSURES, CONFLICTS IDENTIFIED AND ACTIONS TAKEN IS REVIEWED BY THE MHC GOVERNANCE COMMITTEE AND EACH SUBSIDIARY CEO AND BOARD CHAIR RECEIVES A REPORT SPECIFIC TO THEIR ORGANIZATION'S BOARD MEMBERS AND EXECUTIVES. CONFLICTS ARE DISCLOSED TO THE FULL BOARD AND BOARD COMMITTEES SO APPROPRIATE ACTIONS CAN BE TAKEN. ACTIONS MAY INCLUDE PROHIBITING A BOARD MEMBER FROM PARTICIPATING IN DELIBERATIONS INVOLVING TRANSACTIONS WITH A COMPANY WITH WHICH THEY CONDUCT FINANCIAL TRANSACTIONS; BOARD MEMBERS FAILING TO COMPLETE A DISCLOSURE SURVEY OR INTENTIONALLY FAILING TO REPORT A KNOWN CONFLICT OF INTEREST ARE ASKED TO RESIGN. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF MCLAREN HEALTH CARE CORPORATION BASED UPON THE PERFORMANCE OF THE CEO. THE COMPENSATION OF THE CEO IS WITHIN THE SALARY RANGES DETERMINED BY THE COMPENSATION COMMITTEE OF MCLAREN HEALTH CARE CORPORATION. THE PROCESS OF THE COMPENSATION COMMITTEE IS AS FOLLOWS: THE COMPENSATION COMMITTEE IS APPOINTED BY THE BOARD OF DIRECTORS TO REVIEW THE PERFORMANCE AND RECOMMEND THE TOTAL COMPENSATION PACKAGE OF MCLAREN HEALTH CARE CORPORATION'S CEO TO THE BOARD. FURTHER THE COMMITTEE ESTABLISHES THE SALARY RANGES AND PREREQUISITES OF THE CORPORATION'S OTHER MOST HIGHLY COMPENSATED OFFICERS (MHC VICE-PRESIDENTS AND MHC HOSPITAL/SUBSIDIARIES CEO'S) TO THE BOARD. THE MEMBERS OF THE COMMITTEE MUST MEET THE INDEPENDENCE REQUIREMENTS OF THE APPLICABLE PROVISIONS OF SECTION 4958 OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND FINAL TREASURY REGULATIONS SECTION 53.4956-6(C)(1)(III). THE COMMITTEE RETAINS THE SERVICES OF AN INDEPENDENT FIRM WITH SIGNIFICANT QUALIFICATIONS AND EXPERIENCE TO CONDUCT A REVIEW OF THE CORPORATION'S EXECUTIVE COMPENSATION PROGRAM. THE RETAINED FIRM UTILIZES APPROPRIATE COMPENSATION COMPARABILITY DATA. THE RETAINED FIRM CONDUCTS ANALYSIS OF THE COMPETITIVENESS OF THESE PROGRAMS AND EXPRESSES AN OPINION AS TO THE REASONABLENESS OF THESE COMPENSATION PROGRAMS. ALL DATA UTILIZED BY THE COMMITTEE, DELIBERATIONS OF THE COMMITTEE, AND FINAL COMPENSATION DECISIONS BY THE COMMITTEE ARE DOCUMENTED IN FORMAL REPORTS AND MINUTES. THE CORPORATE COMPENSATION COMMITTEE WORKS UNDER AND PERIODICALLY RENEWS THE MCLAREN HEALTH CARE CORPORATION COMPENSATION COMMITTEE CHARTER AND MCLAREN HEALTH CARE CORPORATION COMPENSATION PHILOSOPHY. FOR SUBSIDIARY VICE PRESIDENTS AND DIRECTORS, THE CORPORATE HUMAN RESOURCES COMMITTEE COORDINATES THE GATHERING OF MARKET INFORMATION FROM A NUMBER OF INDEPENDENT SOURCES. THIS DATA IS ANALYZED ALONG WITH EXPECTED BUDGETARY GUIDELINES. THE CORPORATE VICE PRESIDENT OF HUMAN RESOURCES DETERMINES THE AMOUNT, IF ANY, THAT PAY RANGES INCREASE. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS 2012. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A: THESE INDIVIDUALS DEVOTE THE FOLLOWING AVERAGE HOURS PER WEEK TO A RELATED ORGANIZATION: DAMON SORENSEN 0.5 HOUR DONNA KOPINSKI 0.5 HOUR JAMES GEORGE 1.0 HOUR MARK O'HALLA 1.3 HOURS PHILIP INCARNATI 51.3 HOURS TED WAHBY 0.5 HOUR CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 11,044,220. UNREALIZED GAIN ON INVESTMENT IN JOINT VENTURES 989,947. MINIMUM PENSION LIABILITY ADJUSTMENT -8,878,896. TOTAL TO FORM 990, PART XI, LINE 5: 3,155,271. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. BAY MEDICAL FOUNDATION 1900 COLUMBUS AVE BAY CITY MI 48708 382156534 FOUNDATION MI 501(C)(3) LINE 11A, I BAY REGIONAL MEDICAL CENTER 1 BAY REGIONAL MEDICAL CENTER 1900 COLUMBUS AVE BAY CITY MI 48708 381976271 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 BAY REGIONAL MEDICAL CENTER AUXILIARY 1908 COLUMBUS AVENUE BAY CITY MI 48708 386081235 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 11A, I BAY REGIONAL MEDICAL CENTER 1 BAY SPECIAL CARE HOSPITAL 1900 COLUMBUS AVE BAY CITY MI 48708 383161753 HOSPITAL MI 501(C)(3) LINE 3 BAY REGIONAL MEDICAL CENTER 1 CENTRAL MICHIGAN COMMUNITY HOSPITAL 1221 SOUTH DRIVE MT PLEASANT MI 48858 381420304 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 CENTRAL MICHIGAN COMMUNITY HOSPITAL RADIATION ONCOLOGY 1000 HARRINGTON MT PLEASANT MI 48858 300312172 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 CHARLEVOIX NURSING HOME CORPORATION DBA BOULDER PARK TERRACE 14676 WEST UPRIGHT CHARLEVOIX MI 49720 383038683 SKILLED 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HWY FLINT MI 48532 382397643 SUPPORTING ORG MI 501(C)(3) LINE 11A, I N/A 0 MCLAREN HEALTH CARE VILLAGE FOUNDATION 401 S BALLENGER HIGHWAY FLINT MI 48532 262693350 SUPPORTING ORG MI 501(C)(3) LINE 11A, I MCLAREN HEALTH CARE CORPORATION 1 MCLAREN HEALTH PLAN G-3245 BEECHER ROAD FLINT MI 48532 383383640 HEALTH CARE SERVICES MI 501(C)(4) MCLAREN HEALTH CARE CORPORATION 1 MCLAREN MEDICAL MANAGEMENT INC 401 S BALLENGER HWY FLINT MI 48532 382988086 MANAGEMENT COMPANY MI 501(C)(3) LINE 11A, I MCLAREN HEALTH CARE CORPORATION 1 MOUNT CLEMENS REGIONAL HEALTHCARE FOUNDATION PO BOX 326 MOUNT CLEMENS MI 48046 382578873 FOUNDATION MI 501(C)(3) LINE 9 MOUNT CLEMENS REGIONAL MEDICAL CENTER 1 MOUNT CLEMENS REGIONAL MEDICAL CENTER 1000 HARRINGTON MOUNT CLEMENS MI 48043 381218516 HOSPITAL MI 501(C)(3) LINE 3 MCLAREN HEALTH CARE CORPORATION 1 NORTH OAKLAND NORTH MACOMB IMAGING INC 355 BARCLAY CIR STE A ROCHESTER HILLS MI 48307 382807040 MRI IMAGING MI 501(C)(3) LINE 3 POH REGIONAL MEDICAL CENTER 1 NORTHERN 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