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MCLAREN PORT HURON: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MCLAREN PORT HURON (EIN 38-1369611)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-04-25
IRS object ID
201211169349300736
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-04-25T16:33:53-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1750 TRADE CENTRE WAY STE 300AddressLine1
CityPORTAGECity
StateMIState
ZIP Code49002ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN381369611EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PORT HURON HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPORTNameControl
Phone8109875000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11221 PINE GROVE AVENUEAddressLine1
CityPORT HURONCity
StateMIState
ZIP Code48060ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN LISTONName
TitleCFOTitle
Phone8109875000Phone
Date Signed2012-04-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCAROL LALONDE CPAName
Phone2695674500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTHOMAS DEFAUWNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11221 PINE GROVE AVENUEAddressLine1
CityPORT HURONCity
StateMIState
ZIP Code48060ZIPCode
FieldValueIRS element (for citing)
Gross Receipts194861027GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PORTHURONHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1879YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionPROVISION OF ACUTE MEDICAL CARE. TO BE A LEADER IN HEALING, AND YOUR PARTNER IN HEALTH.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees1696TotalNbrEmployees
Total Nbr Volunteers271TotalNbrVolunteers
Total Gross UBI2161010TotalGrossUBI
Net Unrelated Business Txbl Income-1400155NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year296889ContributionsGrantsPriorYear
Contributions Grants Current Year1203379ContributionsGrantsCurrentYear
Program Service Revenue Prior Year170339895ProgramServiceRevenuePriorYear
Program Service Revenue CY171454306ProgramServiceRevenueCY
Investment Income Prior Year1152025InvestmentIncomePriorYear
Investment Income Current Year1865147InvestmentIncomeCurrentYear
Other Revenue Prior Year1996549OtherRevenuePriorYear
Other Revenue Current Year1809677OtherRevenueCurrentYear
Total Revenue Prior Year173785358TotalRevenuePriorYear
Total Revenue Current Year176332509TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year77880661SalariesEtcPriorYear
Salaries Etc Current Year82444535SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year84995297OtherExpensePriorYear
Other Expenses Current Year86068615OtherExpensesCurrentYear
Total Expenses Prior Year162875958TotalExpensesPriorYear
Total Expenses Current Year168513150TotalExpensesCurrentYear
Revenues Less Expenses Prior Year10909400RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7819359RevenuesLessExpensesCY
Total Assets BOY147258456TotalAssetsBOY
Total Assets EOY152569124TotalAssetsEOY
Total Liabilities BOY111007610TotalLiabilitiesBOY
Total Liabilities EOY95385108TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY36250846NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY57184016NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPROVISION OF ACUTE MEDICAL CAREMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense131236496Expense
Revenue169944894Revenue
DescriptionFOR THE YEAR ENDED JUNE 30, 2011, PORT HURON HOSPITAL PROVIDED HEALTH CARE SERVICES TO THE POOR AND TO THE BROADER COMMUNITY FOR WHICH THE COST OF PROVIDING SUCH SERVICES EXCEEDED THE RELATED REVENUE. CHARITY CARE IN THE AMOUNT OF $2,942,233 WAS PROVIDED DURING THE YEAR. PORT HURON HOSPITAL PROVIDED $290,548,590 IN THIRD PARTY DISCOUNTS. IN TOTAL, THIS REPRESENTS 62.6% PERCENT OF THE GROSS PATIENT REVENUE FOR THIS YEAR.PORT HURON HOSPITAL ALSO PROVIDED THE COMMUNITY WITH OPPORTUNITIES TO PARTICIPATE IN NUMEROUS EDUCATIONAL, WELLNESS, SCREENING, AND SUPPORTIVE PROGRAMS AT EITHER NO COST OR AT A NOMINAL CHARGE. THE HOSPITAL PROVIDED A TOTAL OF 831 PROGRAMS TO APPROXIMATELY 47,732 PEOPLE OF THE COMMUNITY.Description
Total Program Service Expense131236496TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096125NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1696NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOHN LISTON CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8109893737TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11221 PINE GROVE AVENUEAddressLine1
CityPORT HURONCity
StateMIState
ZIP Code48060ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
KAREN NIVER MD
CHAIRMAN3.00XX000
MONA ARMSTRONG
VICE CHAIRMAN3.00XX000
JOHN OGDEN
SECRETARY3.00XX000
DAVID C WHIPPLE
TREASURER3.00XX000
JOHN LISTON
CFO40.00XX286879029112X
MIKE TURNBULL
TRUSTEE1.00X000
RONDA RYAN
TRUSTEE1.00X000
BR REDDY MD
TRUSTEE1.00X000
CLARE SCHEURER MD
TRUSTEE1.00X000
TIM REGAN
TRUSTEE1.00X000
FRANKLIN MORTIMER II
TRUSTEE1.00X000
JOHN V BROOKS MD
TRUSTEE1.00X000
GEORGE STOMMEL
TRUSTEE1.00X000
BASHAR SAMMAN MD
TRUSTEE - PART YEAR1.00X000
JAMES MARSH
TRUSTEE - PART YEAR1.00X000
KARL TOMION
TRUSTEE1.00X000
BASSAM H NASR MD
TRUSTEE1.00X000
SAMIR ALSAWAH MD
TRUSTEE1.00X000
DAVID A THOMPSON
TRUSTEE1.00X000
THOMAS D DEFAUW
PRESIDENT & CEO40.00X597028061934X
KATHLEEN METCALF
DIRECTOR PEROPERATIVE SERV40.002812240675X
DR MICHAEL TAWNEY
CHIEF MEDICAL OFFICER40.00344432047981XX
DAVID MCEWEN
VP OF OPERATIONS40.00248521047407X
MARYANN BARNES
VP OF NURSING - THRU 2/201140.0024266809999X
GARY LEROY
VP OF ADMINISTRATION & PLANNING40.00362940015771X
JENNIFER MONTGOMERY
VP OF NURSING - AS OF 2/201140.00000X
DORIS SEIDL
VP OF HUMAN RESOURCES - AS OF 1/201140.00000X
BRIAN BARKLEY
CRNA40.0024748400X
TIMOTHY VANHOWE
CRNA40.0025523300X
TROY REED
CRNA40.0022732300X
JOHN MITCHELL MD
PHYSICIAN40.0026914300X
THOMAS BROZOVICH MD
PHYSICIAN40.00223446011653X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3586321TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation224532TotalOtherCompensation
Number Individuals GT100 K59NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MICHIGAN CO-TENANCY LABORATORY
300 WEST TEXTILE ROADANN ARBORMI48108LAB TESTING752341
AMERICAN HEALTHCARE STAFFING ASSOCIATION
PO BOX 945TRAVERSE CITYMI49684CONTRACTED LABOR575038
SCAN MEDICAL SERVICES
PO BOX 96NORTH BRANCHMI48461CONTRACTED LABOR398377
BLUE WATER PATHOLOGY PC
PO BOX 77556DETROITMI48277LAB SERVICES327235
ALLIANCE-HNV PETCT SERVICES LLC
PO BOX 402209ATLANTAGA30384PET/CT SERVICES242400
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Related Organizations1203379RelatedOrganizations
Noncash Contributions2920NoncashContributions
Total Contributions1203379TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT REVENUE621500168397484168397484
LABORATORY62150019971284877161509412
OPERATING REVENUE62150010596941059694
FieldValueIRS element (for citing)
Total Program Service Revenue171454306TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1473181TotalRevenueColumn
Exclusion$1,473,181ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real39720Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real24418Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real15302Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column15302TotalRevenueColumn
Exclusion$15,302ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities18867885Securities
Other28181Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities18218659Securities
Other285441Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities649226Securities
Other-257260Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column391966TotalRevenueColumn
Exclusion$391,966ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
LAUNDRY812300816577651598$164,979
CAFETERIA722210816172$816,172
MISCELLANEOUS900099161626$161,626
FieldValueIRS element (for citing)
Total Other Revenue1794375TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column176332509TotalRevenueColumn
Related Or Exempt Function Income169944894RelatedOrExemptFunctionIncome
Unrelated Business Revenue2161010UnrelatedBusinessRevenue
Exclusion$3,023,226ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2748551Total
Management And General2748551ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total61799498Total
Program Services56887237ProgramServices
Management And General4912261ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6023184Total
Program Services5330518ProgramServices
Management And General692666ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7119520Total
Program Services6552049ProgramServices
Management And General567471ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4753782Total
Program Services4207097ProgramServices
Management And General546685ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total98359Total
Management And General98359ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total88438Total
Management And General88438ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total555366Total
Management And General555366ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total12923955Total
Program Services8714455ProgramServices
Management And General4209500ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total331714Total
Program Services4393ProgramServices
Management And General327321ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1003865Total
Program Services1003865ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5304030Total
Program Services53042ProgramServices
Management And General5250988ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total75633Total
Program Services3386ProgramServices
Management And General72247ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total143061Total
Program Services108923ProgramServices
Management And General34138ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1148420Total
Management And General1148420ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total8821216Total
Management And General8821216ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total935162Total
Management And General935162ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLY & MINOR EQUIP3089088530096216794669
PROVISION FOR BAD DEBTS1188647811886478
QAAP TAX40033674003367
EQUIP REPAIR & MAINT24423342276330166004
UTILITIES16370471637047

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3779285Total
Program Services2475460ProgramServices
Management And General1303825ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total168513150Total
Program Services131236496ProgramServices
Management And General37276654ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY30697197BOY
EOY24313909EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY22947795BOY
EOY26488103EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5691494BOY
EOY7968796EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY12550065BOY
EOY12369515EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4367192BOY
EOY4717804EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2718252BOY
EOY2806897EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis150095550LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec105108146LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY42830546BOY
EOY44987404EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY11819481BOY
EOY14665201EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY9698459BOY
EOY9715170EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3937975BOY
EOY4536325EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY147258456BOY
EOY152569124EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY76067813BOY
EOY61501420EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY22685326BOY
EOY20124635EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY204763BOY
EOY757267EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY12049708BOY
EOY13001786EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY111007610BOY
EOY95385108EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY36250846BOY
EOY57184016EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY36250846BOY
EOY57184016EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY147258456BOY
EOY152569124EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7819359ReconcilationRevenueExpenses
Reconcilation Other Changes13113811ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$16,274OtherActivitiesAmount
Total Lobbying Expenditures IIB16274TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationA PORTION OF DUES PAID TO MHA AND AHA ARE ALLOCATED TO LOBBYING EXPENSES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2132711OtherCostOrOtherBasis
Book Value2132711BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis76443089OtherCostOrOtherBasis
Depreciation57553556Depreciation
Book Value18889533BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis658773OtherCostOrOtherBasis
Depreciation288649Depreciation
Book Value370124BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis62255800OtherCostOrOtherBasis
Depreciation43221442Depreciation
Book Value19034358BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8605177OtherCostOrOtherBasis
Depreciation4044499Depreciation
Book Value4560678BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings44987404TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
CASH AND MARKETABLE SECURITIES RESTRICTED FOR CONSTRUCTION AND DEBT SERVICE4447483F
INVESTMENT IN OTHER ENTITIES5267687F
FieldValueIRS element (for citing)
Total Of Book Value Securities9715170TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
CLAIM LIABILITY$10,742,000
COST REPORT SETTLEMENT PAYABLE$2,259,786
FieldValueIRS element (for citing)
Total Of Amounts13001786TotalOfAmounts
Total Revenue176332509TotalRevenue
Total Expenses168513150TotalExpenses
Excess Or Deficit For Year7819359ExcessOrDeficitForYear
Net Unrealized GL On Investments4361675NetUnrealizedGLOnInvestments
Other$8,752,136OtherAmount
Total Adjustments13113811TotalAdjustments
Excess Or Deficit Per FS20933170ExcessOrDeficitPerFS

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPART XI, LINE 8 - OTHER ADJUSTMENTS:Identifier
ExplanationCHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY 8,752,136.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served443PersonsServed
Total Community Benefit Expense940844TotalCommunityBenefitExpense
Net Community Benefit Expense940844NetCommunityBenefitExpense
Percent Of Total Expense0.00600PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served2410PersonsServed
Total Community Benefit Expense25236304TotalCommunityBenefitExpense
Direct Offsetting Revenue24555900DirectOffsettingRevenue
Net Community Benefit Expense680404NetCommunityBenefitExpense
Percent Of Total Expense0.00430PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served9PersonsServed
Total Community Benefit Expense110118TotalCommunityBenefitExpense
Direct Offsetting Revenue8000DirectOffsettingRevenue
Net Community Benefit Expense102118NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Persons Served2862PersonsServed
Total Community Benefit Expense26287266TotalCommunityBenefitExpense
Direct Offsetting Revenue24563900DirectOffsettingRevenue
Net Community Benefit Expense1723366NetCommunityBenefitExpense
Percent Of Total Expense0.01100PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs791NumberOfActivitiesOrPrograms
Persons Served44905PersonsServed
Total Community Benefit Expense707343TotalCommunityBenefitExpense
Direct Offsetting Revenue52877DirectOffsettingRevenue
Net Community Benefit Expense654466NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense185985TotalCommunityBenefitExpense
Net Community Benefit Expense185985NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs37NumberOfActivitiesOrPrograms
Total Community Benefit Expense10778TotalCommunityBenefitExpense
Net Community Benefit Expense10778NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs829NumberOfActivitiesOrPrograms
Persons Served44905PersonsServed
Total Community Benefit Expense904106TotalCommunityBenefitExpense
Direct Offsetting Revenue52877DirectOffsettingRevenue
Net Community Benefit Expense851229NetCommunityBenefitExpense
Percent Of Total Expense0.00550PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs834NumberOfActivitiesOrPrograms
Persons Served47767PersonsServed
Total Community Benefit Expense27191372TotalCommunityBenefitExpense
Direct Offsetting Revenue24616777DirectOffsettingRevenue
Net Community Benefit Expense2574595NetCommunityBenefitExpense
Percent Of Total Expense0.01650PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served450PersonsServed
Total Community Building Expense207TotalCommunityBuildingExpense
Net Community Building Expense207NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served407PersonsServed
Total Community Building Expense725TotalCommunityBuildingExpense
Net Community Building Expense725NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served857PersonsServed
Total Community Building Expense932TotalCommunityBuildingExpense
Net Community Building Expense932NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,800,963BadDebtExpenseAmount
Amount Attributable To1059165AmountAttributableTo
Amount Reimbursed By Medicare60492878AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare61173708CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-680830MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1PORT HURON HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11221 PINE GROVE AVENUEAddressLine1
CityPORT HURONCity
StateMIState
ZIP Code48060ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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 $ 11886478.
PART II: N/A
PART III, LINE 4: THE COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO IN DETERMINING THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY.
PART III, LINE 8: THE COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO IN DETERMINING THE MEDICARE ALLOWABLE COSTS OF CARE.
PART III, LINE 9B: IF A PATIENT PARTICIPATES IN THE CHARITY CARE PROCESS, THE ACCOUNT IS WRITTEN OFF THE CHARITY AS PER THE CHARITY CARE PROCESS. HOWEVER, IF THE PATIENT IS NON-PARTICIPATIVE IN THE CHARITY CARE PROCESS, THE NORMAL COLLECTION PROCESS WILL ENSUE.
PART VI, LINE 2: THE HOSPITAL ASSESSES HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY VARIOUS ONGOING AND AD HOC PROCESSES:-PARTICIPATION IN PERIODIC (ST. CLAIR) COUNTYWIDE NEEDS ASSESSMENT COORDINATED BY ST. CLAIR COUNTY HEALTH DEPARTMENT.-ANNUAL GAP ANALYSIS OF OUTMIGRATION FOR HEALTH CARE SERVICES THROUGH THE MICHIGAN INPATIENT DATA BASE.-PERIODIC CONSUMER PERCEPTION AND PREFERENCES SURVEYS CONDUCTED BY INDEPENDENT PROFESSIONAL SURVEY FIRMS, E.G. EPIC - MRA, LANSING, MI.-ANNUAL 10-STEP STRATEGIC PLANNING PROCESS INCLUDING STRATEGIC PLANNING EVENTS INVOLVING TRUSTEES, PHYSICIANS, AND MANAGEMENT TO REVIEW ENVIRONMENTAL ASSESSMENTS AND KEY STAKEHOLDER FEEDBACK TOWARD DEVELOPING HOSPITAL INITIATIVES FOR THE NEXT OPERATING CYCLE.-HOSPITAL-SPONSORED ADVISORY AND MEMBERSHIP GROUPS SUCH AS "55 PLUS" AND "WOMEN'S WELLNESS ADVISORY TEAM" WHICH PROVIDE INPUT AS TO HOSPITAL DIRECTION ON BETTER ADDRESSING COMMUNITY HEALTH NEEDS.-COMMITMENT TO ONGOING CONTINUOUS IMPROVEMENT. FOR OVER 20 YEARS, THE HOSPITAL HAS BEEN COMMITTED TO THE PRINCIPLE OF CONTINUOUS IMPROVEMENT. APPLIED TO ONGOING MANAGEMENT PLANNING, NUMEROUS OPPORTUNITIES TO BETTER SERVE OUR COMMUNITIES HAVE BEEN IDENTIFIED AND PURSUED. SEVERAL OF THOSE PURSUITS CONTINUE TODAY AND ARE ENUMERATED ON THE IRS 990 SCHEDULE H WORKSHEET INCLUDED HERE: BREATHER'S CLUB, A SERVICE UNDER 55 PLUS MEETING THE DESPERATE NEEDS OF COPD SUFFERERS FOR SUPERVISED EXERCISE; THE LANG (HEALTH) LIBRARY INCORPORATED INTO THE HOSPITAL ENTRANCE ATRIUM PROVIDED SPECIAL HEALTH INFORMATION RESOURCES TO SCHOOLS, EDUCATORS, AND HEALTH CARE PROFESSIONALS; TODAY'S HEALTH WEEKLY HEALTH INFORMATION TELEVISION SHOW OVER THE LOCAL CABLE CHANNEL; AND HEALTH ACCESS, OUR HEALTH INFORMATION AND REFERRAL SERVICE OPERATING 80 HOURS PER WEEK, STAFFED BY RNS AND FIELDING 34,000 CALLS PER YEAR.-PARTICIPATION IN AD HOC COMMUNITY INITIATIVES FOR THE PURPOSE OF ADDRESSING SPECIFIC COMMUNITY HEALTH GAPS SUCH AS (1) RECENT UNITED WAY - ST. CLAIR COUNTY HEALTH DEPARTMENT INITIATIVE ON ESTABLISHING AN ADULT INDIGENT DENTAL CLINIC, AND (2) HELMET SAFETY INITIATIVE DEVELOPED THOUGH PHH FOUNDATION'S COMMUNITY BENEFIT COMMITTEE THAT INCLUDED SCHOOL DISTRICT AND POLICE REPRESENTATIVES.
PART VI, LINE 3: THE HOSPITAL HAS BROCHURES AVAILABLE FOR PATIENTS REGARDING THEIR OPTIONS. THE HOSPITAL ALSO COMMUNICATES THAT A PATIENT MAY CALL IF THEY NEED FINANCIAL ASSISTANCE VIA PHONE CALLS AND BILLING STATEMENTS. THE HOSPITAL HAS A REPRESENTATIVE THAT IS WILLING TO WORK WITH THE PATIENTS TO HELP THEM TRY TO GET INSURANCE OR OTHER FORMS OF ASSISTANCE.
PART VI, LINE 4: PORT HURON HOSPITAL AND ITS AFFILIATES SERVE A THREE-SIDED MARKET, LIMITED TO THE EAST BY LAKE HURON AND THE ONATRIO, CA BORDER. THAT MARKET IS DESCRIBED GENERALLY AS ST. CLAIR COUNTY, SANILAC COUNTY, PLUS LESSER PARTS OF FOUR CONTINUOUS COUNTIES: HURON, LAPEER, TUSCOLA, AND MACOMB. THIS AREA IS LARGELY RURAL WITH THE LARGEST CITY, PORT HURON, CLAIMING A POPULATION OF AROUND 36,000. SOME 25-30% OF WORKERS WHO RESIDE IN ST. CLAIR COUNTY COMMUTE OUT OF COUNTY TO JOBS. IN TOTAL, THE MARKET INCLUDES APPROXIMATELY 220,000 RESIDENTS, OF WHOM THREE QUARTERS RESIDE IN ST. CLAIR COUNTY.OUR MARKET FOLLOWS THE STATE AVERAGES DEMOGRAPHICALLY WITH SOME EXCEPTIONS: A LOWER PERCENTAGE OF AFRICAN-AMERICANS, A HIGHER PERCENTAGE OF NATIVE-AMERICANS, A LOWER AVERAGE HOUSEHOLD INCOME, A HIGHER PERCENTAGE OF OVER AGE 65 POPULATION.
PART VI, LINE 6: N/A
MIREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JOHN LISTON
237328044480050710113950177170315991000
THOMAS D DEFAUW
42516501216000502630420150199190658962000
KATHLEEN METCALF
256934024290000006750281899000
DR MICHAEL TAWNEY
286203050200080290203780276030392413000
DAVID MCEWEN
205549038040049320275450198620295928000
MARYANN BARNES
1981360380600647201705082940252667000
GARY LEROY
152450025000018549006500151210378711000
BRIAN BARKLEY
247484000000000247484000
TIMOTHY VANHOWE
255233000000000255233000
TROY REED
227323000000000227323000
JOHN MITCHELL MD
269143000000000269143000
THOMAS BROZOVICH MD
2234460000000116530235099000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1AHEALTH CLUB BENEFITS WERE PROVIDED TO THE CHIEF EXECUTIVE OFFICER AND TREATED AS TAXABLE COMPENSATION.
PART I, LINE 4BTHOMAS DEFAUW AND JOHN LISTON CONTRIBUTED $36,044 AND $11,085, RESPECTIVELY, TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN.
PART I, LINE 6PORT HURON HOSPITAL OFFERS AN ANNUAL INCENTIVE PROGRAM TO THE EXECUTIVE TEAM (PRESIDENT/CEO AND VICE-PRESIDENTS). THE EXECUTIVE COMPENSATION COMMITTEE OVERSEES THE ESTABLISHMENT, IMPLEMENTATION, AND APPROVAL OF THE INCENTIVE PROGRAMS. THE ANNUAL INCENTIVE PROGRAM PLAN CONTAINS 2 SETS OF MEASURES: CIRCUIT BREAKER AND ORGANIZATION INCENTIVE PROGRAM MEASURERS, STANDARDS, AND WEIGHTS. CIRCUIT BREAKER MEASURERS INCLUDE BOTH PATIENT SATISFACTION AND OERPATING INCOME PLUS A RESERVE FOR INCENTIVE COMPENSATION. THE SECOND SET OF MEASURES INCLUDES UP TO 5 MEASURES IMPORTANT TO THE ORGANIZATION. THE INCENTIVE PAYOUT IS CALCULATED AS A PERCENTAGE OF BASE SALARY, FROM A RANGE OF PERCENTAGES. THE PRESIDENT/CEO INCENTIVE RANGES FROM 18.5% TO 37% AND THE VICE PRESIDENTS RANGE FROM 12% TO 24%. FAILURE TO PREFORM AT BELOW THRESHOLD LEVELS FOR THE CIRCUIT BREAKER MEASURES RESULTS IN A CURTAILED OR ELIMINATED INCENTIVE PAYMENT.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
MICHIGAN STATE HOSPITAL FINANCE AUTHORITY
38288941759465HKZ82009-05-1214645000RENOVATIONS, EQUIPMENT, CURRENT REFUNDING000
MICHIGAN FINANCE AUTHORITY
80059618659447PDV02011-03-2423815000RENOVATIONS, EQUIPMENT, CURRENT REFUNDING000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapitalized InterestCapitalizedInterest
3743513146465821925405728635806019366521520121001
4526942381529719508439158712522332106560032013100150291

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
010000
000000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PHYSICIAN INVESTMENT GROUPBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipBASSAM H. NASR, MD, BOARD MEMBER OF PHH AND PART OWNERRelationship
Amount Of Transaction54000AmountOfTransaction
Description Of TransactionRENTAL/LEASE SLEEP CENTERDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THIS CORPORATION IS BLUE WATER HEALTH SERVICES CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WAS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING.
ALL TRUSTEES AND DIRECTORS ANNUALLY COMPLETE THE CONFLICT OF INTEREST POLICY. THE GOVERNANCE REVIEWS THE CONLFICT OF INTEREST POLICY ANNUALLY AND DISCLOSES ANY POTENTIAL CONFLICTS AT THAT TIME. ANY PERCEIVED OR POTENTIAL CONFLICTS ARE SHARED WITH THE BOARD CHAIR AND VICE-CHAIR FOR ANY DISCUSSION OR ACTION IF A CONFLICT SHOULD ARISE.FORM 990, PART VI, SECTION B, LINE 12C
THE EXECUTIVE COMPENSATION COMMITTEE IS A SUBCOMMITTEE OF THE BOARD OF DIRECTORS RESPONSIBLE FOR ANNUALLY EVALUATING THE PERFORMANCE AND COMPENSATION OF THE CHIEF EXECUTIVE OF THE CORPORATION. THEY ARE RESPONSIBLE FOR ENSURING PORT HURON HOSPITAL CAN ATTRACT, RETAIN AND MOTIVATE TALENTED EXECUTIVES WHO ARE ENTRUSTED TO ACHIEVE PERFORMANCE OBJECTIVES AND TO FULFILL THE HOSPITALS MISSION. THE COMMITTEE UTILIZES THE SERVICES OF AN INDEPENDENT CONSULTANT TO ANALYZE TOTAL REMUNERATION AND COMPARATIVE STUDIES TO ENSURE TOTAL COMPENSATION IS REASONABLE AND COMPETITIVE. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS FISCAL YEAR 2011.FORM 990, PART VI, SECTION B, LINE 15A
DOCUMENTS ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 4,361,675. CHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY 8,752,136. TOTAL TO FORM 990, PART XI, LINE 5: 13,113,811.FORM 990, PART XI, LINE 5:
THERE HAVE BEEN NO CHANGES FROM PRIOR YEAR.FORM 990, PART XII, LINE 2C:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
BLUE WATER HEALTH SERVICES CORPORATION
1221 PINE GROVE AVENUEPORT HURONMI48060382453295MANAGEMENT CORPMI501(C)(3)LINE 9N/A0
PORT HURON HOSPITAL FOUNDATION
PO BOX 5011PORT HURONMI48061382777750SUPPORTING ORGMI501(C)(3)LINE 11A, I1PORT HURON HOSPITAL
MARWOOD MANOR NURSING HOME
PO BOX 5011PORT HURONMI48061382683251NURSING HOMEMI501(C)(3)LINE 91BLUE WATER HEALTH SERVICES
PARKVIEW PROPERTY MANAGEMENT CORP
PO BOX 5011PORT HURONMI48061382467310MANAGEMENT CORPMI501(C)(3)LINE 11A, I1PORT HURON HOSPITAL

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1WILLOW ENTERPRISESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 5011AddressLine1
CityPORT HURONCity
StateMIState
ZIP Code48061ZIPCode
FieldValueIRS element (for citing)
EIN382491659EIN
Primary ActivityRENT/SALE OF MEDICAL EQUIPMENTPrimaryActivity
Legal Domicile StateMILegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PORT HURON HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income93148ShareOfTotalIncome
Share Of EOY Assets3342623ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (10 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
PARKVIEW PROPERTY MANAGEMENT CORP
J777055FMV
PORT HURON HOSPITAL FOUNDATION
C1203379CASH
PORT HURON HOSPITAL FOUNDATION
P133717ALLOCATION OF COST
PARKVIEW PROPERTY MANAGEMENT CORP
K219581ALLOCATION OF COST
MARWOOD MANOR NURSING HOME
N50734ALLOCATION OF COST
MARWOOD MANOR NURSING HOME
K352859ALLOCATION OF COST
WILLOW ENTERPRISES
K68924ALLOCATION OF COST
WILLOW ENTERPRISES
N2514782CONTRACT
WILLOW ENTERPRISES
J54956LEASE AGREEMENT
WILLOW ENTERPRISES
O1370716ACTUAL COST