2012-05-15T15:19:52-05:00 2011-09-30 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2010-10-01 381359266 MEMORIAL MEDICAL CENTER OF WEST MICHIGAN MEMO 2318432591 ONE ATKINSON DRIVE LUDINGTON MI 49431 KERRI L NELSON 2318432591 2012-05-08 1 2319477800 2010 2016-02-24 21:20:13Z MARK VIPPERMAN ONE ATKINSON DRIVE LUDINGTON MI 49431 57233978 0 X WWW.MMCWM.COM X 1906 MI TO ENHANCE LIFE THROUGH EXCEPTIONAL HEALTHCARE. 13 11 573 120 0 0 168260 238363 51151014 55345290 290538 395861 1429730 926373 53039542 56905887 20770 18950 0 0 27034680 27478191 0 0 207904 23133303 25805568 50188753 53302709 2850789 3603178 62545651 66646423 31103022 36234874 31442629 30411549 X TO ENHANCE LIFE THROUGH EXCEPTIONAL HEALTHCARE. 0 0 4420712 14440971 OPERATING ROOM (7,736 VISITS) - SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. 2654958 8010531 LAB (345,519 TESTS) - SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. 2893377 5208493 PHARMACY (587,574 UNITS) - SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. 33878869 18950 28471636 MEMORIAL MEDICAL CENTER (38-1359266) PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY.REALIZING THAT REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE ONGOING OPERATION AND STABILITY OF MEMORIAL MEDICAL, WE STILL RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER RECOGNIZE THAT OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY: A. FREE CARE AND/OR SUBSIDIZED CARE, B. CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT BELOW COST, C. HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S ABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.MEMORIAL MEDICAL CENTER SERVED 2,690 INPATIENTS WITH 11,674 DAYS OF CARE, AND PROVIDED OVER 95,000 OUTPATIENT SERVICES DURING FISCAL YEAR 2011.OUR HOSPITAL PROVIDES CARE TO PEOPLE COVERED BY GOVERNMENTAL PROGRAMS AT LESS THAN WHAT WE MUST GENERATE IN ORDER TO MAINTAIN STABILITY OF OPERATIONS. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS IS $91,405,740. IN ADDITION, FOR PATIENTS NOT COVERED BY A GOVERNMENTAL PROGRAM AND ALSO UNABLE TO PAY FOR SERVICES, WE RECOGNIZED $748,213 IN CHARITY CARE.OUR SCOPE OF COMMUNITY CARE WENT BEYOND THE AFOREMENTIONED RESPONSIBILITIES. IN ADDITION TO COMMUNITY BENEFIT EXPENDITURES, MANY REDUCED PRICE SERVICES AND FREE PROGRAMS ARE OFFERED THROUGHOUT THE YEAR, BASED UPON ACTIVITIES AND SERVICES WHICH MEMORIAL MEDICAL BELIEVES WILL SERVE COMMUNITY HEALTH NEEDS. THESE ARE DETAILED AS FOLLOWS: SCREENING PR0GRAMS:- MONTHLY BLOOD PRESSURE AND BLOOD SUGAR TESTING AT 3 COMMUNITY LOCATIONS- PARTICIPATION IN TISSUE/ORGAN DONATION PROGRAM IN CONJUNCTION WITH GIFT OF LIFE- WORKSITE WELLNESS SCREENING AT AREA MANUFACTURING ORGANIZATIONCOMMUNITY EDUCATION ONGOING PROGRAMS:- PRENATAL AND MATERNAL CLASSES- NUTRITION PROGRAMS, MONTHLY PROGRAMS TAUGHT BY REGISTERED DIETITIANS FOR VARIOUS ORGANIZATIONS IN LUDINGTON AND HART.- OUTPATIENT DIABETIC SELF MANAGEMENT PROGRAM- FAMILY FAIR (HEALTH FAIR) WITH AREA SCHOOLSCOMMUNITY EDUCATIONAL PROGRAMS ON VARIOUS DISEASES & HEALTH TOPICS:- DONE FOR VARIOUS SERVICE ORGANIZATIONS, SCHOOLS, COMMUNITY GROUPS TOPICS INCLUDE: STRESS MANAGEMENT, HEALTHY EATING, UNDERSTANDING CHOLESTEROL, DIABETES, EYE DISEASES, INFECTION CONTROL, BACK SAFETY.- ANNUAL HEALTH FAIR AT LONGFELLOW TOWERS, PROGRAMS DONE BY HOME CARE AND DIETITIANS.- TEDDY BEAR CLINICS FOR PRE-SCHOOL CLASSES- GRADE SCHOOL TOURS AND CAREER FOCUS DAY- HIGH SCHOOL HEALTH CLASS TOURS WITH WELLNESS FOCUSSUPPORT GROUPS & OTHER SPONSORSHIPS:- TYPE 1 DIABETES GROUP - TYPE 2 DIABETES GROUP CLINICAL EXPERIENCE FOR STUDENT PROGRAMS:- WEST SHORE COMMUNITY COLLEGE = LPN & RN PROGRAMS, PRE-PHYSICIAN THERAPY- WEST SHORE COMMUNITY COLLEGE/LIFE EMS = EMS PROGRAMS- MID MICHIGAN COLLEGE = RADIOLOGY TECHNICIAN STUDENTS- BAKER COLLEGE, MUSKEGON = SURGICAL SCRUB TECHNICIAN PROGRAM, MEDICAL RECORDS PROGRAM, EMS, PHLEBOTOMY PROGRAM, PHARMACY PROGRAM, STERILE PROCESSING PROGRAM, PHYSICAL AND OCCUPATIONAL THERAPY ASSISTANT- BAKER COLLEGE, CADILLAC = SURGICAL SCRUB TECHNICIAN PROGRAM, EKG/PULMONARY PROGRAMS, SOCIAL WORK, EMS- MUSKEGON COMMUNITY COLLEGE = PHLEBOTOMY PROGRAM, RESPIRATORY THERAPY- WESTERN UNIVERSITY OF HEALTH SCIENCE (CALIFORNIA) = NURSE PRACTITIONER- CENTRAL MICHIGAN UNIVERSITY = PHYSICAL THERAPY PROGRAM, FOOD SERVICES ADMINISTRATION, PHYSICIAN ASSISTANT PROGRAM- GRAND VALLEY STATE UNIVERSITY = PRE-PHYSICAL THERAPY/PHYSICAL THERAPY, OCCUPATIONAL THERAPY, LABORATORY TECHNICIAN, NURSING, SOCIAL WORK- LUDINGTON AND MASON COUNTY AREA SCHOOLS = CAREERS IN HEALTHCARE PROGRAM- ROSS MEDICAL STUDENT TRAINING PROGRAM = MEDICAL ASSISTANT PROGRAM- MASON-LAKE ISD = ALLIED HEALTH PROGRAMS- WESTERN MICHIGAN UNIVERSITY = PHYSICIAN ASSISTANT PROGRAM- WEST SHORE COMMUNITY COLLEGE = ACCOUNTING- MICHIGAN STATE UNIVERSITY = SOCIAL WORK, NURSE PRACTITIONER- FERRIS STATE UNIVERSITY = HEALTHCARE ADMINISTRATION, ALLIED HEALTH, MEDICAL TRANSCRIPTION, MEDICAL CODING, NURSING, NUCLEAR MEDICINE, ULTRASOUND, PHARMACY, PHLEBOTOMY, HEALTH INFORMATION- CHATHAM UNIVERSITY = PHYSICIANS ASSISTANT- DAVENPORT UNIVERSITY = ALLIED HEALTH/HEALTH INFORMATION MANAGEMENT- KETTERING COLLEGE = PHYSICIAN'S ASSISTANT- NUMEROUS JOB SHADOWING EXPERIENCES = FOR HIGH SCHOOL THROUGH COLLEGE LEVEL STUDENTS THROUGHOUT THE HOSPITAL- NORTHWESTERN MICHIGAN COLLEGE = ABNORMAL PSYCHOLOGY- WALDEN UNIVERSITY = MSNSPEAKERS BUREAU:- TOPICS AND SPEAKERS LISTING AVAILABLE UPON REQUEST- LECTURES FOR AREA AGENCIES DONE ON HEALTH RELATED SUBJECTS ON A REQUEST BASIS BY HOME CARE, EDUCATION, DIETITIAN, CARDIAC REHAB, MEDICAL/SURGICAL, AND E.R. STAFF. 33878869 18950 28471636 43847916 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 54 0 1 573 1 0 0 0 0 0 1 1 0 0 0 0 X 13 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 X KATIE STEWART DIRECTOR OF FISCAL SERVICES 2318453603 ONE ATKINSON DRIVE LUDINGTON MI 49431 JEANNE OAKES 2.00 X X 0 0 0 ALLEN DEERING 1.00 X X 0 0 0 CHARLES DILLON 0.50 X X 0 0 0 KENNETH ROCCO 0.50 X X 0 0 0 CONNIE KRUSNIAK 0.50 X 0 0 0 ANTHONY FABAZ DO 0.50 X 0 0 0 JDEAN GUSTAFSON 0.50 X 0 0 0 MARC LENZ 0.50 X 0 0 0 ANTHONY MONTON 0.50 X 0 0 0 ALLAN NELSON MD 0.50 X 5504 0 0 STANLEY SEUFERER DO 0.50 X 75250 0 0 MARGARET GUSTAFSON MD 0.50 X 0 0 0 JAMES SCATENA 0.50 X 0 0 0 MARK VIPPERMAN 40.00 X 337791 0 55432 BRUNO BETTIN 40.00 X 228614 0 37622 TIMOTHY HEINRICH 40.00 X 234216 0 62660 HELEN JOHNSON 40.00 X 156133 0 22786 JOHN P COONEY DO 40.00 X 162001 0 30524 MICHAEL GUNBERG 40.00 X 162016 0 29465 ROBERT JOHNSON 40.00 X 141272 0 40397 MARTI MILLER 40.00 X 131885 0 26682 DAVID ANDERSON 40.00 X 131018 0 26620 1765700 0 332188 17 0 1 0 QUEST DIAGNOSTICS 13138 COLLECTIONS CTR DRIVE LUDINGTON MI 49431 LAB SERVICES 684131 ANESTHESIOLOGY ASSOCIATES OF WEST MICHIG ONE ATKINSON DRIVE LUDINGTON MI 49431 ANESTHESIA SERVICES 506775 GEORGE KELEN MD 300 S RATH AVE LUDINGTON MI 49431 PHYSICIAN 272435 HOSPITAL SLEEP SERVICES 1375 DAGGET RD SAND LAKE MI 49343 SLEEP LAB 135100 TIMOTHY F MURPHY MD PC 913 E LUDINGTON AVE LUDINGTON MI 49431 PHYSICIAN 127844 7 178875 59488 238363 PROGRAM SERVICE REVENU 622110 55345290 55345290 55345290 402965 402965 218964 269156 -50192 -50192 -50192 2250 9354 -7104 -7104 -7104 22427 178875 49581 -27154 -27154 MISCELLANEOUS 900099 836533 836533 CAFETERIA SALES 722210 167186 167186 1003719 56905887 56131631 0 535893 18950 18950 1017934 80754 937180 19849600 17287278 2387481 174841 1895903 1506153 389750 3205248 2608616 596632 1509506 1199190 310316 43308 43308 57021 57021 4205816 3353134 843773 8909 479805 912 478893 521340 441574 79766 206864 149662 55964 1238 132601 90068 42533 2668249 2112366 555883 362014 362014 SUPPLIES 9249068 8217672 1026944 4452 PROVISION FOR BAD DEBTS 4523917 4523917 QUALITY ASSURANCE TAXES 1227253 1227253 DSH EXPENSES 973544 973544 UTILITIES 826364 11116 815248 328404 45757 264183 18464 53302709 43847916 9246889 207904 1155 1150 16100463 20283659 699157 603958 5989181 4876712 968826 1041317 746634 937617 53847913 32295166 21206022 21552747 8085579 7921644 8748634 9427619 62545651 66646423 4041161 4194535 4715309 6001683 2077920 2031888 20268632 24006768 31103022 36234874 X 31442629 30411549 31442629 30411549 62545651 66646423 X 3603178 -4634258 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 2934 2934 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PORTION OF ANNUAL DUES TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION THAT ARE USED TOWARD LOBBYING ACTIVITIES 3340111 3340111 18293608 9865300 8428308 1293613 737207 556406 30766283 21692659 9073624 154298 154298 21552747 PREPAID PENSION 9273035 COST REPORT SETTLEMENTS RECEIVABLE 154584 9427619 ACCRUED INSURANCE 758713 ACCRUED POST-RETIREMENT BENEFIT 21983452 COST REPORT SETTLEMENTS PAYABLE 1250002 PENDING REFUNDS 14601 24006768 56905887 53302709 3603178 -501023 -4133235 -4634258 -1031080 56723601 -501023 -501023 57224624 -318737 -318737 56905887 57754681 4451972 4451972 53302709 0 53302709 PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT -4,133,235. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES NETTED WITH REVENUE -49,581. RENTAL EXPENSES NETTED WITH REVENUE -269,156. PART XIII, LINE 2D - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT REPORTED ON SCHEDULE D, PART XI 4,133,235. SPECIAL EVENT EXPENSES NETTED WITH REVENUE 49,581. RENTAL EXPENSES NETTED WITH REVENUE 269,156. BENEFIT BALL 2011 141865 122435 19430 1725 43246 TEAM SPIRIT WEEK 2011 50541 50541 160 1785 1 8896 5899 2997 58 2607 201302 178875 22427 1943 47638 49581 -27154 1 1 X 1 X 1 X 1 1 1 0 1 1 1252013 1392206 -140193 0.00000 7287803 6009372 1278431 0.02620 8539816 7401578 1138238 0.02620 179020 0 179020 0.00370 3 4804913 4399685 405228 0.00830 33869 0 33869 0.00070 3 5017802 4399685 618117 0.01270 3 13557618 11801263 1756355 0.03890 290 290 0.00000 12084 12084 0.00020 385207 385207 0.00790 397581 397581 0.00810 1 1362324 169055 15930762 14917182 1013580 X 1 1 1 1 MEMORIAL MEDICAL CENTER OF WEST MICHIGAN

ONE ATKINSON DRIVE LUDINGTON MI 49431

X X X MEMORIAL MEDICAL CENTER OF WEST MICHIGAN 1 1 MEMORIAL FAMILY CARE CENTER

2481 N 72 AVE HART MI 49420

PHYSICIAN OFFICE PART I, LINE 6A: N/A PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED. PART I, LINE 7G: A PORTION OF THE REPORTED SUBSIDIZED HEALTH SERVICES INCLUDES EMPLOYED PHYSICIANS. 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 $4,523,917. PART II: MEMORIAL MEDICAL CENTER PARTICIPATES IN A MULTITUDE OF COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNNITY SUCH AS SEVERAL HEALTH FAIRS, BLOOD DRIVES, PRENATAL AND CHILDBIRTH EDUCATION, NUTRITION EDUCATION WITH LOCAL SCHOOLS AND SPORTS GROUPS, EDUCATIONAL PRESENTATIONS RELATED TO MEDICATIONS AND MEDICAL CONDITIONS, FURNISHES MEDICAL SUPPLIES FOR COMMUNITY CLINIC, STRONG PART IN DEVELOPMENT AND ADMINISTRATION OF HEALTHY COMMUNITIES COMMITTEE, AN INTERACTIVE HEALTH LIBRARY FOR PUBLIC EDUCATION, DISTRIBUTES COMMUNITY HEALTH NEWSLETTERS, PROVIDES DIABETES TESTING AND COMMUNITY EVENTS, AND ASSIST WITH MANY DIFFERENT SUPPORT GROUPS, ALONG WITH SUPPORT THE LOCAL WIN WITH WELLNESS INITIATIVE. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE: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 CENTER'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 BY CERTAIN PAYORS.BAD DEBT AT COST, $1,362,324, IS CALCULATED BASED ON A COST TO CHARGE RATIO.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $169,055. THIS AMOUNT IS COMPRISED OF TWO COMPONENTS,1. $25,021 OF PATIENTS THAT STARTED A FINANCIAL ASSISTANCE APPLICATION, THAT WOULD HAVE QUALIFIED, BUT DID NOT COMPLETE THE APPLICATION PROCESS, AND2. AN ESTIMATE, PROVIDED BY THE BUSINESS OFFICE DIRECTOR, OF APPROXIMATELY 10 PERCENT OF BAD DEBT EXPENSE AT COST PART III, LINE 8: THE HOSPITAL IS A LICENSED MEDICARE AND MEDICAID PROVIDER WITH APPROXIMATELY 67% OF ITS PATIENT BASE QUALIFYING FOR ONE OF THESE TWO PROGRAMS. AT PRESENT, THE AMOUNTS REPORTED FOR MEDICARE DO NOT SHOW A SHORTFALL. THE COST TO CHARGE RATIO METHOD IS USED. PART III, LINE 9B: ALL PATIENTS/GUARANTORS WITH A BALANCE FOR CARE PROVIDED ARE SENT A LETTER REGARDING THE BALANCE. A STATEMENT IS THEN SENT AFTER 30 DAYS. A SECOND STATEMENT IS SENT IF THERE IS A REMAINING BALANCE. IF NO PAYMENT IS RECEIVED AFTER THE THIRD NOTIFICATION THE ACCOUNT IS SENT TO PRE-COLLECTION STATUS. A FINAL LETTER IS SENT TO THE PATIENT/GUARANTOR IF NOTHING HAS BEEN RECEIVED. IF THERE IS NO RESPONSE THEN THE ACCOUNT IS SENT TO COLLECTIONS. IF A PAYMENT IS RECEIVED AT ANY TIME DURING THIS PROCESS THE PROCESS IS REPEATED UNTIL THE ACCOUNT IS PAID IN FULL OR IT IS SENT TO A COLLECTION AGENCY. PART VI, LINE 2: IN THE PAST THE MASON COUNTY HEALTH DEPARTMENT CONDUCTS A HEALTH NEEDS ASSESSMENT OF THE COMMUNITY. MEMORIAL MEDICAL CENTER THEN WORKS ALONG SIDE THE HEALTH DEPARTMENT TO ANALYZE THOSE NEEDS TO ENSURE THAT THOSE NEEDS ARE BEING MET.MEMORIAL MEDICAL CENTER IS CURRENTLY PERFORMING A NEEDS ASSESSMENT. PART VI, LINE 3: MEMORIAL MEDICAL CENTER PATIENTS HAVE A HOSPITAL FINANCIAL COUNSELOR THAT THEY MEET WITH. DURING THAT MEETING THE PATIENTS ARE INTERVIEWED TO ASSESS THEIR FINANCIAL ABILITY OR ASSISTANCE NEEDS. THEY ARE INFORMED AT THAT TIME IF THEY MAY BE POSSIBLE CANDIDATES FOR FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR THE HOPITAL'S CHARITY CARE PROGRAM. PART VI, LINE 4: MEMORIAL MEDICAL CENTER SERVES A RURAL COMMUNITY THAT IS LOCATED ON THE COAST OF LAKE MICHIGAN. BECAUSE THE LOCATION IS A SEASONAL TOURIST ATTRACTION THE POPULATION OF THE COMMUNITY SIGNIFICANTLY CHANGES WITH THE SEASONS. ALSO SEASONALLY DRIVEN, BECAUSE OF THE AGRICULTURAL EMPLOYMENT OPPORTUNITIES, IS A MIGRANT POPULATION. A LARGE PART OF THE HOSPITAL PATIENTS ARE COVERED BY EITHER MEDICARE OR MEDICAID. PART VI, LINE 6: NONE PART VI, LINE 7: N/A - NOT AFFILIATED. REPORTS FILED WITH STATES PART VI, LINE 7 MI 1 X PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: WHEN GRANTS ARE GIVEN TO PUBLIC CHARITIES, THE HOSPITAL REVIEWS EACH ORGANIZATION TO ENSURE THAT THEY ARE EXEMPT. X X 1 1 X X X X 0 0 0 0 0 0 0 0 0 MARK VIPPERMAN 337791 0 0 0 0 0 42859 0 12573 0 393223 0 0 0 BRUNO BETTIN 228614 0 0 0 0 0 25049 0 12573 0 266236 0 0 0 TIMOTHY HEINRICH 234216 0 0 0 0 0 48021 0 14639 0 296876 0 0 0 HELEN JOHNSON 156133 0 0 0 0 0 22786 0 0 0 178919 0 0 0 JOHN P COONEY DO 162001 0 0 0 0 0 18183 0 12341 0 192525 0 0 0 MICHAEL GUNBERG 162016 0 0 0 0 0 14826 0 14639 0 191481 0 0 0 ROBERT JOHNSON 141272 0 0 0 0 0 27824 0 12573 0 181669 0 0 0 MARTI MILLER 131885 0 0 0 0 0 12043 0 14639 0 158567 0 0 0 DAVID ANDERSON 131018 0 0 0 0 0 11981 0 14639 0 157638 0 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS: MARK VIPPERMAN, ALLOWED FOR IN HIS EMPLOYEMENT CONTRACT. TREATED AS TAXABLE COMPENSATION. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: MARK VIPPERMAN AND BOB JOHNSON, LINCOLN HILLS DUES. BOB JOHNSON, ROTARY CLUB DUES. MARK VIPPERMAN, TIM HEINRICH, HELEN JOHNSON, BOB JOHNSON, ECONOMIC CLUB OF WEST MICHIGAN DUES. SOCIAL CLUB DUES ARE NOT TREATED AS TAXABLE COMPENSATION. THE ONLY REASON THE STAFF MEMBERS OBTAIN A MEMBERSHIP TO THE LOCAL SOCIAL CLUBS, IS SO MEMORIAL MEDICAL CENTER CAN USE THE SOCIAL CLUB FACILITIES FOR HOSPITAL SPONSORED EVENTS SUCH AS THE BENEFIT HALL, EMPLOYEE SERVICE AWARDS DINNER, ETC. THE MEMBERSHIP WAS NOT UTILIZED FOR PERSONAL BENEFIT. MEMORIAL MEDICAL CENTER DOES NOT PAY FOR HEALTH CLUB DUES. MARK VIPPERMAN PARTICIPATES IN A 457B PLAN. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PLACED ON THE AGENDA FOR THE BOARD MEETING AND EACH BOARD MEMBER HAS A CHANCE TO REVIEW THE 990 AND THEN ASK QUESTIONS REGARDING DATA WITHIN THE FORM BEFORE IT IS FILED. EACH BOARD MEMBER IS PROVIDED WITH A COPY OF THE 990, EVEN THOSE WHO ARE UNABLE TO ATTEND THE SCHEDULED MEETING. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS THE OFFICERS AND TRUSTEES OF THE BOARD SIGN A DOCUMENT DISCLOSING THEIR CONFLICTS OF INTEREST. THE DOCUMENTS ARE REVIEWED ONCE A YEAR BY THE BOARD MEMBERS AND THEY WOULD DETERMINE WHETHER A CONFLICT EXISTS. ANY PERSON WHO IS DEEMED TO HAVE A CONFLICT OF INTEREST WOULD BE PROHIBITED FROM PARTICIPATING IN ANY DELIBERATION AND DECISIONS REGARDING THE RELATED TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15A ONCE A YEAR THE BOARD EXECUTIVE COMMITTEE REVIEWS THE CEO'S EMPLOYMENT AND PERFORMANCE AND RECOMMENDS TO THE FULL BOARD A CONTINUATION OF EMPLOYMENT AND ANY COMPENSATION INCREASES OR CHANGES. MEMORIAL MEDICAL CENTER'S HUMAN RESOURCES DIRECTOR COMPILES COMPARABILITY DATA FROM A NUMBER OF DIFFERENT COMPENSATION SURVEYS, THE BOARD COMPLETES AN EVALUATION FORM ON THE CEO'S PERFORMANCE, HUMAN RESOURCES COMPILES ALL OF THE DATA FROM THE SURVEYS AND PROVIDES THAT DATA - ALONG WITH THE COMPENSATION COMPARABILITY DATA TO THE BOARD. THIS WAS LAST PERFORMED IN DECEMBER 2010. THE REVIEW FOR THE CEO'S 10/01/10 - 9/30/11 PERFORMANCE AND THE REVIEW OF COMPENSATION COMPARABILITY DATA TO DETERMINE THE NEXT FISCAL YEARS OFFICER COMPENSATION WAS PERFORMED AT THE 12/6/2011 BOARD MEETING. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -501,023. PENSION LIABILITY ADJUSTMENT -4,133,235. TOTAL TO FORM 990, PART XI, LINE 5: -4,634,258. FORM 990, PART XII, LINE 2C: NO CHANGES FROM PRIOR YEAR FORM 990, PART X: FOR TAX RETURN PURPOSES, PREPAID PENSION HAS BEEN CLASSIFIED AS AN ASSET VERSUS NETTING AGAINST THE PENSION LIABILITY. DUE TO THIS, BALANCE SHEET ASSETS AND LIABILITIES ON THE 990 ARE HIGHER THAN THE AUDITED FINANCIAL STATEMENTS BY $9,273,035 AND $7,887,156 AS OF SEPTEMBER 30, 2011 AND 2010, RESPECTIVELY.