2012-05-15T09:14:01-05:00 2011-06-30 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2010-07-01 381671120 Standish Community Hospital STAN 9898464521 805 W Cedar Street Standish MI 48658 anthony J doud 9898464521 2012-05-15 1 Matthew Montogomery 5137847100 2010 2016-02-24 21:20:13Z St Mary's of MI Standish Hospital Sharon Leaman Case 805 W Cedar Street Standish MI 48658 24583983 0 0928 X N/A X 1960 MI Operation of a hospital, skilled nursing facility, emergency room and rural health clinic. 7 5 319 46 0 0 134023 90685 23486261 22560661 1210671 1638658 110831 182181 24941786 24472185 0 0 0 0 13239756 13375033 0 0 42531 9952926 9625079 23192682 23000112 1749104 1472073 26461487 28908250 7607437 7184300 18854050 21723950 X Operation of a non-profit hospital, skilled nursing facility, emergency room and rural health clinic to provide health care services to the sick and poor. 0 0 15982225 22560661 Standish Hospital is dedicated to spiritually centered, holistic care that sustains and improves the health of individuals and communities. It furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community. A substantial portion of its services are provided to the elderly and poor. During the fiscal year ending June 30, 2011, approximately 49.6% of the value of services rendered was to elderly patients under the Medicare program, and approximately 19% of the services were provided to patients who were deemed indigent under state, county, or Medical Center Guidelines. In the spirit of principles adopted by Ascension Health, St. Mary's of Michigan Standish Hospital has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2011, the estimated unreimbursed cost of services provided to the elderly, uninsured, and underinsured totaled $17,759,696. 15982225 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 21 2 1 319 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X Anthony J Doud 9898464521 805 W Cedar Street Standish MI 48658 X Curt Hillman 0.50 X X 0 0 0 Bill Borushko 0.50 X X 0 0 0 Keith Sivier 0.50 X X 0 0 0 Deb Morgan 0.50 X X 0 0 0 Tom Birkett 0.50 X 0 0 0 John Graham Sch O 0.50 X 0 608022 8297 Jaya Sankaran MD 0.50 X X 18000 0 0 Sharon Leaman-Case 45.00 X 0 167805 28235 Donna Washington 40.00 X 148002 0 1077 Marvin Keeling 40.00 X 108461 0 4750 Cesar Casten 40.00 X 186361 0 33131 Doraisamy Venkitapathy 84.00 X 471572 0 47108 Rasheed Siddiqui 84.00 X 554018 0 44956 1486414 775827 167554 7 0 1 0 Alliance HNI LLC 7647 Collections Drive Chicago IL 606930076 Mobile MRI Services 412650 Trimedx PO Box 636129 Cincinnati OH 45263 Equipment Maintenance 242748 Michigan Neurology Associates 1500 W Park Drive STE 390 Westborough MA 01581 Mobile MRI Services 215850 Community Hospital Services 1321 Cumberland Saginaw MI 48601 Laundry service 154508 Dr Brian McColgan 8340 E Orange Blossom Ln Scottsdale AZ 85250 ER Physician 144525 5 30827 19120 40738 90685 Patient Revenue 621990 22560661 22560661 22560661 1638658 1638658 67719 44481 23238 23238 23238 52846 30827 20210 32636 32636 61441 47107 14334 14334 Miscellaneous 621990 76908 76908 Cafeteria Revenue 722320 35065 35065 111973 24472185 22560661 0 1820839 195911 195911 10500882 7788108 2690508 22266 451885 335858 116027 1505745 1119363 386382 720610 513083 207527 5295 5295 56109 56109 551177 305596 245581 85759 2902 82857 48701 11251 37450 521250 319124 202126 47681 21217 26464 155532 115352 40180 890678 688784 201894 48118 28404 19714 Supplies 2283998 1937166 326567 20265 Purchased Services 2215673 183430 2032243 0 Repairs & Maintenance 1143515 1079802 63713 0 Bad Debt 1050452 1050452 0 0 Dues & Subscriptions 20472 8347 12125 0 500669 278075 222594 23000112 15982225 6975356 42531 1253020 1707131 458324 466565 3192846 2865111 6934 6934 247745 318401 110888 32712 16180566 11554149 4768435 4626417 16423295 18884979 26461487 28908250 3490045 3184548 4117392 3999752 7607437 7184300 X 18395726 21257385 458324 466565 18854050 21723950 26461487 28908250 X 1472073 1397827 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 500 500 5163018 3914387 1248631 4167624 1827302 2340322 5668140 4979478 688662 1181284 832982 348302 4626417 Health System Depository 18078333 Other Current Assets 801756 Patient Trusts-Checking 4890 18884979 Intercompany Debt to Ascension Health 3910319 IBNR Liability 89433 3999752 Living Legends Ball 31216 9125 22091 1000 16458 Dev Fund Auction 14544 1492 13052 350 2402 3 17703 17703 63463 10617 52846 1350 18860 20210 32636 Casino night fundraiser, includes card tables and roulette wheel 1 1 1 X 1 X 1 1 0 1 1 959458 959458 0.04170 382944 382944 0.01660 1342402 1342402 0.05830 93604 25045 68559 0.00300 93604 25045 68559 0.00300 1436006 25045 1410961 0.06130 0 1050452 7180901 7109803 71098 X 1 1 1 1 Standish Community Hospital

805 W Cedar Street Standish MI 48658

X X X Skilled Nursing Facility NA 1 Part I, Line 7: The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a costing accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied. Part I, Line 7g: The organization has not included costs attributable to a physician clinic as part of subsidized health services. Part I, L7 Col(f): The amount of bad debt expense reported on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentages in Part I, Line 7, column (f) is $1,050,452. Part II: St. Mary's of Michigan Standish Hospital provided the following community building activities in 2010: - Caring Bear Picnic: A health and safety day for children in the community that teaches proper hand washing, car seat safety, the importance of bicycle helmets, healthy nutrition, and the benefits of exercise.- Senior Olympics & Health Fair: An event focused on connecting Senior Citizens with health and wellness resources in the community.- Diabetes and Chronic Obstructive Pulmonary Disease (COPD) support group meetings were held on a bi-monthly basis, free of charge.- School education: St. Mary's of Michigan Standish Hospital nurses partner with the local school systems to provide education to both the teachers and students on flu prevention, proper nutrition and exercise. Part III, Line 4: The organization is a part of the St. Mary's Health consolidated audit. The provision for bad debts is based upon 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 allowance for uncollectible accounts based upon historical write off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, St. Mary's follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with St. Mary's policies. Part III, Line 9b: Patients are encouraged to participate in their own care by working with the financial counselor and applying for Medicaid or other public assistance programs to qualify for charity or financial assistance. Any patient that may be eligible for public assistance must make an application for such. A documented response from public assistance must be on file prior to final determination of charity care funds. Part VI, Line 2: St. Mary's of Michigan Standish Hospital (SMMSH) participates in Community Needs Assessments to gain information about the health care needs of the community. The Community Needs Assessments provides an assessment of Arenac County pertaining to demographics, health, safe and stable homes, and economic development. SMMSH uses this information to ensure that the organization is meeting the needs of the community. Part VI, Line 3: St. Mary's of Michigan Standish Hospital informs the community about their Charity Care Program, as well as other state or local government programs, through the following ways:- A Patient Financial Consultant is available Monday through Friday to discuss and assist with signup for state and local government programs, and/or the hospital's charity care program.- The Patient Financial Consultant or Case Manager meet with self-pay patients who have been admitted to the hospital to discuss financial assistance programs that are available.- Self-pay outpatients receive the hospital's financial assistance application, as well as other state and federal assistance program information (MI Child, Central Health Plan, Medicaid, and others as applicable), through the mail. Part VI, Line 4: St. Mary's of Michigan Standish Hospital is a critical access hospital which provides healthcare services to individuals in Arenac County and the surrounding communities (Pinconning, Rhodes, Bentley, Whittemore, Skidway, Alger). Arenac County is a rural community with a population of approximately 16,000. According to the U.S. Census Bureau, 18.2 percent of Arenac County residents were living under the poverty guidelines in 2008. Part VI, Line 7: St. Mary's of Michigan Standish Hospital is a member of Ascension Health. Ascension Health is a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 20 of the United States and the District of Columbia. Ascension Health is sponsored by the Northeast, Southeast, East Central, and West Central Provinces of the Daughters of Charity of St. Vincent de Paul, the Congregation of St. Joseph, and the Sisters of St. Joseph of Carondelet.Standish Community Hospital's sole corporate member is St. Mary's Health. Standish Community Hospital, located in Standish, Michigan, is a nonprofit critical care access hospital. Admitting physicians are primarily practitioners in the local area. St. Mary's is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of St. Mary's are related to providing healthcare services.Mission:Ascension Health directs its governance and management activities toward strong, vibrant, Catholic health ministries united in service and healing and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with Ascension Health's mission of service to those who are poor and vulnerable, each Health Ministry accepts patients regardless of their ability to pay. Ascension Health uses four categories to identify the resources utilized for the care of persons who are poor and community benefit programs:-Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured.-Unpaid cost of public programs represents the unpaid cost of services provided to persons covered by public programs for the poor.-Cost of other programs for the poor includes unreimbursed costs of programs intentionally designed to serve the poor and vulnerable of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.-Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the poor, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons who are poor and community benefit programs. The cost of providing care of persons who are poor and community benefit programs is estimated using internal cost data. Reports Filed With States Part VI, Line 7 MI 0 0 0 0 0 0 0 0 0 John Graham Sch O 0 389079 0 200002 0 18941 0 7350 0 947 0 616319 0 0 Sharon Leaman-Case 0 158142 0 0 0 9663 0 28235 0 0 0 196040 0 0 Cesar Casten 182803 0 0 0 3558 0 30318 0 2813 0 219492 0 0 0 Doraisamy Venkitapathy 469250 0 0 0 2322 0 40800 0 6308 0 518680 0 0 0 Rasheed Siddiqui 553208 0 0 0 810 0 29956 0 15000 0 598974 0 0 0 Supplemental Information Part III Part I, Line 3: St. Mary's of Michigan Medical Center, a related organization of Standish Community Hospital, uses the following to establish the compensation of the organization's CEO: -Independent Compensation Consultant -Written Employment Contract -Approval by the Board or Compensation Committe Form 990, Part VI Two Voting Members are not independent. John Graham receives compensationfrom St. Mary's , Dr. Jaya Sankarin receives 1099 to her company (Tawas Pathologists PC) for pathology work. Form 990, Part VI, Section A, line 6 Standish Community Hospital has a single corporate member, St. Mary's Health. Form 990, Part VI, Section A, line 7a Standish Community Hospital has a single corporate member, St. Mary's Health, who has the ability to elect members to the governing body of the Standish Community Hospital. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Standish Community Hospital financial information or corporation as a whole are subject to approval by its sole corporate member, St. Mary's Health. Form 990, Part VI, Section A, line 8b There are not any separate committees that have the authority to act on behalf of the governing body for Standish Community Hospital. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all committee members are provided the Form 990 and management team members are available to answer any committee member questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining the compensation of the organization's CEO, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Ascension Health board reviewed and approved the compensation. In the review of the compensation, the CEO was compared to other organizations in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. The individual was not present when his or her compensation was decided. The Executive Committee of the Board of Directors in conjunction with the Intermediate Sanctions Compliance Policy of the hospital is responsible for determining the compensation of other officers or key employees of the organization. The process includes a market analysis of comparable healthcare positions from other organizations of comparable size, complexity, and business activity. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request Explanation of the Compensation of John Graham: Form 990, Part VII: John Graham received payments from related organizations. The payments he received were for his role as the current CEO at St. Mary's of Michigan Medical Center, a related entity, and not for his role as a director of Standish Hospital. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 1,412,161. Adjustment to Auxiliary -14,334. Total to Form 990, Part XI, Line 5: 1,397,827. Community Benefit Report: Form 990, Part III, Line 4a: This report illustrates the significant degree to which St. Mary's of Michigan Standish Hospital contributes to the positive health status of the communities it serves. As a member of Ascension Health, the nation's largest Catholic healthcare system, St. Mary's of Michigan Standish Hospital continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of St. Mary's of Michigan Standish Hospital is to serve all persons with special attention to those who are poor and vulnerable. St. Mary's of Michigan Standish Hospital is dedicated to spiritually centered, holistic care that sustains and improves the health of individuals and communities. St. Mary's of Michigan Standish Hospital furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. St. Mary's of Michigan Standish Hospital has engaged in the following activities to ensure that our mission is accomplished: Unreimbursed Services Provided to the Elderly and the Poor St. Mary's of Michigan Standish Hospital provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2011 approximately 49.6% of the value of services rendered was to elderly patients under the Medicare program, and approximately 19% of the services were provided to patients who were deemed indigent under state, county, or Medical Center Guidelines. In the spirit of principles adopted by Ascension Health, St. Mary's of Michigan Standish Hospital has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2011, the estimated unreimbursed cost of services provided to the elderly, uninsured, and underinsured totaled $17,759,696. Patient Services St. Mary's of Michigan Standish Hospital provides the following in-patient and out-patient medical services to the community: - Ambulatory Care Services - Rural Health Clinic Office - Emergency Care Services - Visiting Physician Services - Cardiac Rehab Services - Rehabilitation Services - Operating Room Surgeries - Skilled Nursing Facility Some of the services listed above operate at a loss in order to ensure that all services are available to meet community health care needs. These include our Rural Health Clinic and Speech Therapy. During the fiscal year ending June 30, 2011, our hospital treated adults and children in the community for a total of 15,129 patient days of service. The medical center also provided services to 45,354 outpatients, including 78 outpatient surgery patients and 9,567 emergency visits. Community Outreach activities St. Mary's of Michigan Standish Hospital seeks to improve the physical, mental, social and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, St. Mary's of Michigan Standish Hospital has developed the following programs to help achieve its mission: - Diabetes Education - Chronic Obstructive Disease Education - Car Seat Safety Programs - Community Thanksgiving Dinner - MIChild and Healthy Kids Enrollment Summary St. Mary's of Michigan Standish Hospital furthers its charitable purposes by providing a broad array of services to meet the healthcare needs of patients and organizations in the community. We provide essential medical services to the community, train and recruit healthcare professionals to serve the needs of the broader community, provide appropriate charity services to those patients who are not able to pay for their own healthcare needs, provide services to other organizations that allow them to provide quality services to their patients or constituents, and present education information classes and activities to the community in order to improve its overall health status. Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 St Mary's Health 800 S Washington Saginaw MI 48601 383477071 Hospital Parent MI Section 501(c)(3) Schedule A, Line 11a St Mary's of Michigan Medical Center 0 St Mary's of Michigan Medical Center 800 S Washington Saginaw MI 48601 380997730 Hospital MI Section 501(c)(3) Schedule A, Line 3 Ascension Health 0 St Mary's Hospital Foundation 800 S Washington Saginaw MI 48601 382246366 Fundraising MI Section 501(c)(3) Schedule A, Line 11c St Mary's of Michigan Medical Center 1 Field Neurosciences Institute 800 S Washington Saginaw MI 48601 382790703 Medical Research Organization MI Section 501(c)(3) Schedule A, Line 9 St Mary's of Michigan Medical Center 1 Field Neurosciences Institute Foundation 800 S Washington Saginaw MI 48601 383638165 Fundraising MI Section 501(c)(3) Schedule A, Line 11c St Mary's of Michigan Medical Center 1 Towne Centre Surgery Center LLC 4599 Towne Centre Saginaw MI 48604 204943843 Outpatient services MI N/A St Mary's of Michigan Specialists 800 S Washington Saginaw MI 48601 Physician Practices MI N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 St Mary's of Michigan Medical Center O 1062106 Actual amount paid St Mary's of Michigan Medical Center N 228736 Actual amount paid Ascension Health O 1791822 Actual amount paid