Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
BOTSFORD GENERAL HOSPITAL
 
Doing Business As
BOTSFORD HOSPITAL
 
Number and street (or P.O. box if mail is not delivered to street address)
28050 GRAND RIVER AVENUE
 
Room/suite
City or town, state or country, and ZIP + 4
FARMINGTON HILLS, MI48336
D Employer identification number

38-1426919
E Telephone number

G Gross receipts $ 315,042,408
F Name and address of principal officer:
PAUL LACASSE
28050 GRAND RIVER AVENUE
FARMINGTON HILLS,MI48336
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
BOTSFORD.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1944
M State of legal domicile: MI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: COMMITMENT TO EXCELLENCE AND QUALITY IN THE DELIVERY OF PERSONAL AND COMPASSIONATE HEALTH CARE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 15
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 2,751
6 Total number of volunteers (estimate if necessary) .... 6 292
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 2,312,444
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -747,509
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,466,975 1,121,293
9 Program service revenue (Part VIII, line 2g) ......... 298,675,669 295,231,767
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,436,816 2,659,029
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 4,729,598 4,232,373
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 307,309,058 303,244,462
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 15,483,628 15,516,427
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 137,858,602 132,618,263
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet113,757    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 145,266,988 144,067,546
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 298,609,218 292,202,236
19 Revenue less expenses. Subtract line 18 from line 12...... 8,699,840 11,042,226
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 220,752,729 245,182,324
21 Total liabilities (Part X, line 26)............ 152,339,432 152,516,912
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 68,413,297 92,665,412
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: COMMITMENT TO EXCELLENCE AND QUALITY IN THE DELIVERY OF PERSONAL AND COMPASSIONATE HEALTH CARE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 203,604,515 including grants of $   ) (Revenue $ 270,274,937 )
PATIENT SERVICES: THE CORPORATION OPERATES A HOSPITAL FACILITY LICENSED FOR 330 BEDS, AND PROVIDES INPATIENT HOSPITAL SERVICES AS WELL AS A WIDE RANGE OF OUTPATIENT SERVICES. THE SERVICES ARE PROVIDED AT THE HOSPITAL FACILITY AND AT VARIOUS OFF-SITE FACILITIES WITHIN A SIX MILE RADIUS OF THE MAIN CAMPUS, SERVING THE NEEDS OF RESIDENTS OF SOUTHERN OAKLAND COUNTY AND NORTHERN WAYNE COUNTY. THE CORPORATION ALSO OPERATES A NETWORK OF PRIMARY CARE AND SPECIALTY PHYSICIAN PRACTICES, KNOWN AS THE BOTSFORD CLINIC SYSTEM, AT 24 OFFICE SITES. THERE WERE 16,894 ADMISSIONS TO THE HOSPITAL FOR A TOTAL OF 75,068 PATIENT DAYS. THERE WERE 58,852 EMERGENCY ROOM VISITS AND 9,377 SURGERIES. THERE WERE 2,884,617 LABORATORY PROCEDURES AND 151,795 OUTPATIENT THERAPY UNITS PROVIDED.
4b (Code:   ) (Expenses $ 26,067,215 including grants of $   ) (Revenue $   )
CHARITY CARE AND BAD DEBT: BOTSFORD HOSPITAL PROACTIVELY ADDRESSES ISSUES THAT AFFECT ACCESSIBILITY, FINANCING, AND DELIVERY OF HEALTH CARE TO ALL PEOPLE, PARTICULARLY THE UNINSURED, UNDERINSURED, AND THE UNDERSERVED. THE HOSPITAL PROVIDED APPROXIMATELY $26.1 MILLION IN UNCOMPENSATED CARE DURING THE FISCAL YEAR ENDING 12/31/10.
4c (Code:   ) (Expenses $ 16,056,572 including grants of $ 16,056,572 ) (Revenue $ 15,729,893 )
MEDICAL EDUCATION: OSTEOPATHIC MEDICAL EDUCATION AND CLINICAL TRAINING IS AN IMPORTANT COMPONENT OF THE MISSION OF THE CORPORATION. THE CORPORATION IS APPROVED FOR PRE-GRADUATE AND POST-GRADUATE PHYSICIAN TRAINING. THE AMERICAN OSTEOPATHIC ASSOCIATION APPROVES THE HOSPITAL FACILITY FOR TWENTY SPECIALTY AND SUB-SPECIALTY RESIDENCY PROGRAMS. CURRENTLY, THERE ARE 164 POST GRADUATE RESIDENTS. THE MAJOR EMPHASIS IN POST-DOCTORAL TRAINING IS IN THE PRIMARY CARE AREAS, WITH RESIDENCY PROGRAMS AND TEACHING CURRICULUMS ESTABLISHED IN FAMILY MEDICINE, INTERNAL MEDICINE, AND OBSTETRICS AND GYNECOLOGY. SPECIALTY TRAINING PROGRAMS ARE ALSO CONDUCTED.
(Code:   ) (Expenses $ 7,675,282 including grants of $ 508,217 ) (Revenue $ 7,301,753 )
BOTSFORD CONTINUING HEALTH CENTER AND BOTSFORD OUTPATIENT PHARMACY
4d Other program services. (Describe in Schedule O.)
(Expenses $ 7,675,282 including grants of $ 508,217 ) (Revenue $ 7,301,753 )
4e Total program service expensesMediumBullet$ 253,403,584
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
Yes
 
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
Yes
 
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
Yes
 
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
No
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
357
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
2,751
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
18
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
REGINA DOXTADER
28050 GRAND RIVER AVENUE
FARMINGTON HILLS,MI48336
(248) 471-8157
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JOHN ANHUT
DIRECTOR
 1.00 X           2,650 0 0
(2) STEVEN BARNABY
DIRECTOR
 1.00 X           8,000 900 0
(3) JEANNE CARLSON
DIRECTOR
 1.00 X           1,050 0 0
(4) GERSON COOPER
DIRECTOR
 1.00 X           3,900 5,300 0
(5) RAY DZENDZEL
DIRECTOR
 1.00 X           2,550 1,250 0
(6) WILLIAM HARTSOCK
DIRECTOR
 1.00 X           2,450 0 0
(7) RUDOLPH HOBBS
DIRECTOR
 1.00 X           1,000 0 0
(8) EDWARD HODGES
DIRECTOR
 1.00 X           2,650 0 0
(9) ED LONIEWSKI
DIRECTOR
 1.00 X           2,400 0 0
(10) HARRIS MAINSTER
DIRECTOR
 1.00 X           2,650 800 0
(11) KEN MASSEY
DIRECTOR
 1.00 X           2,750 0 0
(12) MAX MCKINNEY
DIRECTOR
 1.00 X           22,492 0 0
(13) DANIEL SCHIFFER
DIRECTOR
 1.00 X           2,950 850 0
(14) MARK SCHOSTAK
DIRECTOR
 1.00 X           800 0 0
(15) JACQUELINE SHADKO
DIRECTOR
 1.00 X           1,000 0 0
(16) DAVID SUSSER
DIRECTOR
 1.00 X           2,350 800 0
(17) JACK WAYNE
DIRECTOR
 1.00 X           1,950 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) PAUL LACASSE
C.E.O & PRESIDENT
 40.00 X   X       507,585 0 33,522
(19) DAVID MARCELLINO
EXECUTIVE V.P. & C.F.O.
 40.00     X       409,648 0 34,312
(20) LISA VANDECAVEYE
CORPORATE V.P. LEGAL AFFAI
 40.00     X       314,765 0 35,803
(21) MARGO GORCHOW
CORPORATE V.P. MARKETING
 40.00     X       224,753 0 20,973
(22) DAVID WALTERS
V.P. & C.M.O.
 40.00     X       343,626 0 36,520
(23) BARBARA PALMER
CORPORATE V.P. HUMAN RESOU
 40.00     X       247,241 0 20,509
(24) REGINA DOXTADER
CORPORATE V.P. & CONTROLLE
 40.00     X       207,735 0 31,568
(25) MARGARET HASLER
CORPORATE V.P. & CHIEF NUR
 40.00     X       241,827 0 20,560
(26) RONALD SZUMSKI
CLINIC SYSTEM EXECUTIVE
 40.00       X     225,605 0 36,613
(27) WILLIAM SCHEUBER
ADMINISTRATOR PROF.& SUPPO
 40.00       X     195,160 0 33,730
(28) ADAM COOPER
STAFF PHYSICIAN
 40.00         X   437,770 0 36,506
(29) ANDREW CYKIERT
STAFF PHYSICIAN
 40.00         X   479,152 0 36,498
(30) RICHARD HERMAN
STAFF PHYSICIAN
 40.00         X   441,170 0 37,360
(31) GILBERT HERMAN
STAFF PHYSICIAN
 40.00         X   292,133 0 35,743
(32) BEN ROSSI
STAFF PHYSICIAN
 40.00         X   443,691 0 32,487
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,075,453 9,900 482,704
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet113
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
ACS CONSULTANT COMPANY
PO BOX 201322
DALLAS,TX75320 		INFORMATION TECHNOLOGY SERVICES 9,193,497
SODEXHO INC
PO BOX 70060
CHICAGO,IL60673 		ENVIRONMENTAL & DIETARY SERVICES 9,186,403
FARMINGTON MRT INC
30000 NORTHWESTERN HWY
FARMINGTON HILLS,MI48334 		CANCER CENTER MGMNT & STAFFING 2,418,710
INTEGRATED MOBILE IMAGING
363 WBIG BEAVER RD
TROY,MI48084 		M.R.I. IMAGING SERVICES 1,563,643
MCKESSON INFORMATION SOLUTIONS
PO BOX 98347
CHICAGO,IL60693 		INFORMATION TECHNOLOGY SERVICES 1,513,446
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet62
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 132,693
d Related organizations...1d 800,190
e Government grants (contributions)1e 188,410
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$ 116,527
h Total. Add lines 1a-1f.......MediumBullet 1,121,293
Program Service Revenue Business Code
2a PATIENT SERVICES 621,990 272,587,381 270,274,937 2,312,444  
b MEDICAL EDUCATION 621,990 15,729,893 15,729,893    
c
d
e
f All other program service revenue . 6,914,493 6,914,493    
g Total. Add lines 2a–2f........MediumBullet 295,231,767
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 1,643,014     1,643,014
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 1,495,502  
b Less: rental expenses 1,669,759  
c Rental income or (loss) -174,257  
d Net rental income or (loss).......MediumBullet -174,257     -174,257
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 10,267,425 39,824
b Less: cost or other basis and sales expenses 9,291,234  
c Gain or (loss) 976,191 39,824
d Net gain or (loss)..........MediumBullet 1,016,015     1,016,015
8a Gross income from fundraising events (not including
$ 132,693
of contributions reported on line 1c). See Part IV, line 18 ...
a 23,830
b Less: direct expenses ...b 113,757
c Net income or (loss) from fundraising events..MediumBullet -89,927   -89,927
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 767,084
b Less: cost of goods sold ..b 723,196
c Net income or (loss) from sales of inventory..MediumBullet 43,888     43,888
Miscellaneous Revenue Business Code
11a EMPLOYEE SERVICES 900,099 1,607,084     1,607,084
b CAPTIVE PREMIUM REV 900,099 947,502     947,502
c MEDICAL STAFF EDUCATIO 611,710 460,828     460,828
d All other revenue .... 1,437,255 387,260   1,049,995
e Total. Add lines 11a–11d ......MediumBullet 4,452,669
12 Total revenue. See Instructions....MediumBullet 303,244,462 293,306,583 2,312,444 6,504,142
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 508,217 508,217
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 15,008,210 15,008,210
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 4,012,849 20,042 3,992,807  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 102,864,875 95,788,872 7,076,003  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 8,707,465 7,749,644 957,821  
9 Other employee benefits ....... 9,418,233 9,221,546 196,687  
10 Payroll taxes ........... 7,614,841 6,726,603 888,238  
11 Fees for services (non-employees):        
a Management ...... 544,385 500,000 44,385  
b Legal ......... 105,234   105,234  
c Accounting ........... 299,171   299,171  
d Lobbying ........... 30,759   30,759  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 30,672,706 29,074,573 1,598,133  
12 Advertising and promotion .... 2,130,861 22,939 2,107,922  
13 Office expenses ....... 6,642,373 4,653,396 1,875,220 113,757
14 Information technology ...... 9,357,795 234,952 9,122,843  
15 Royalties ..        
16 Occupancy ........... 6,732,582 6,011,184 721,398  
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 1,043,442 725,681 317,761  
20 Interest ........... 2,335,529 2,202,018 133,511  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 11,394,963 8,002,818 3,392,145  
23 Insurance .............. 3,470,928 427,750 3,043,178  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a MEDICAL SUPPLIES 37,224,489 36,873,826 350,663  
b UNCOMPENSATED CARE 26,067,215 26,067,215    
c EQUIPMENT RENTAL & MAIN 6,022,944 3,584,098 2,438,846  
d UBI TAX (FED & STATE) -7,830   -7,830  
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 292,202,236 253,403,584 38,684,895 113,757
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 34,116,096 2 22,019,302
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 23,150,253 4 22,341,427
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 4,782,935 8 4,878,762
9 Prepaid expenses and deferred charges ............ 3,577,139 9 3,900,619
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 231,930,311
b Less: accumulated depreciation. ..... 10b 139,288,307 87,438,067 10c 92,642,004
11 Investments—publicly traded securities .......... 26,027,967 11 53,040,270
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 112,561 13 155,877
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 41,547,711 15 46,204,063
16 Total assets. Add lines 1 through 15 (must equal line 34)... 220,752,729 16 245,182,324
Liabilities 17 Accounts payable and accrued expenses . 28,295,373 17 27,406,959
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 43,987,178 20 41,479,041
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 1,779,069 21 3,193,468
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 18,924,219 23 30,299,133
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 59,353,593 25 50,138,311
26 Total liabilities. Add lines 17 through 25..... 152,339,432 26 152,516,912
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 68,413,297 27 92,665,412
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 68,413,297 33 92,665,412
34 Total liabilities and net assets/fund balances ..... 220,752,729 34 245,182,324
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
303,244,462
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
292,202,236
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
11,042,226
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
68,413,297
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
13,209,889
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
92,665,412
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
BOTSFORD GENERAL HOSPITAL
  		Employer identification number

38-1426919
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
BOTSFORD GENERAL HOSPITAL
  		Employer identification number

38-1426919
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
BOTSFORD GENERAL HOSPITAL
  		Employer identification number

38-1426919
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
30,759
j
Total. lines 1c through 1i ...................................
30,759
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: DUES PAID TO MICHIGAN HOSPITAL ASSOCIATION IN THE AMOUNT OF $106,407. PER THE MICHIGAN HOSPITAL ASSOCIATION, 14.81% OF THEIR BUDGET SUPPORTS LOBBYING ACTIVITIES. TOTAL OF $15,759. DUES PAID TO STRATEGIC HEALTH CARE IN THE AMOUNT OF $15,000 TO INFLUENCE MEDICARE WAGE INDEX LEGISLATION.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   2,838,687 2,838,687
b Buildings ................   127,858,191 68,870,819 58,987,372
c Leasehold improvements ............   3,424,139 2,705,164 718,975
d Equipment ................   93,016,991 65,631,818 27,385,173
e Other .................   4,792,303 2,080,506 2,711,797
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 92,642,004
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) CONSTRUCTION IN PROGRESS 8,623,256
(2) DEBT SERVICE AND PROJECT FUND 5,116,093
(3) PROFESSIONAL LIABILITY FUND 14,522,290
(4) INVESTMENT AND RECEIVABLES FROM AFFILIATES 2,324,243
(5) FICA RECOVERY FUND 1,801,926
(6) 457 PLAN ASSETS 3,689,416
(7) OTHER RECEIVABLES 1,402,119
(8) AWUIL CAPTIVE PROF LIABILITY FUND 4,964,418
(9) MISCELLANEOUS 3,760,302
Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 46,204,063
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
ACCRUED PENSION COST 15,725,344
DUE TO AFFILIATES 285,997
PROFESSIONAL LIABILITY & OTHER CLAIMS 26,916,294
EST.THIRD- PARTY PAYOR SETTLEMENTS 7,210,676





Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 50,138,311
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
  PART IV, LINE 2B: THE ORGANIZATION REFLECTS AN AMOUNT AS BOTH AN ASSET AND LIABILITY RELATING TO RESIDENT FICA RECOVERY FUNDS.
    SCHEDULE D, PART X: UNSECURED PAYABLES TO RELATED ORGANIZATIONS - THE FOLLOWING REFLECTS BALANCES OWED TO RELATED ORGANIZATIONS AS OF DECEMBER 31, 2010: DUE TO COMMUNITY EMERGENCY MEDICAL SERVICES, INC. - $145,491 DUE TO PARASTAR - $10,631 DUE TO ZIEGER HEALTH CARE CORPORATION - $124,623 SCHEDULE D, PART X: OTHER AMOUNTS REFLECT LIABILITIES FOR DEFINED BENEFIT AND DEFINED CONTRIBUTION PLANS, PROFESSIONAL LIABILITY CLAIMS AND ESTIMATED THIRD PARTY SETTLEMENTS. SCHEDULE D, PART VIII INVESTMENTS- PROGRAM-RELATED. INVESTMENT IN BOTSFORD KIDNEY CENTER, INC. THIS IS AN EQUITY BASED INVESTMENT WHEREAS THE INVESTMENT IS ADJUSTED BASED ON THE PERFORMANCE OF THE JOINT VENTURE AND ANY DIVIDENDS RECEIVED. THIS JOINT VENTURE WAS SOLD TO AN UNRELATED PARTY IN 2009. FINAL DISTRIBUTION TO OCCUR IN 2011.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
CENTRAL AMERICAN AND CARRIBEAN 0 0 INVESTMENT    
CENTRAL AMERICAN AND CARRIBEAN 0 0 HEALTH CARE SERVICES   79,726
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....   0 79,726
b Total from continuation sheets to Part I ...   0 0
c Totals (add lines 3a and 3b)   0 79,726
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
  ANTIGUA, GUATEMALA 3,550     79,726 VOLUNTEER TIME AND MEDICAL SUPPLIES. FMV
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U.S.:   SCHEDULE F, PART I, LINE 2: LINE 1: THE ORGANIZATION DOES NOT MAKE GRANTS TO FOREIGN ORGANIZATIONS, GOVERNMENTS OR INDIVIDUALS. THE DIRECTOR OF MEDICAL ADMINISTRATION OVERSEES THE ARRANGEMENTS FOR VOLUNTEERS TO TRAVEL TO GUATEMALA.
EXPLANATION FOR ESTIMATED NUMBER OF RECIPIENTS:   SCHEDULE F, PART III, COL (C): IN MARCH OF 2010, A GROUP OF VOLUNTEER RESIDENTS AND INTERNS FROM BOTSFORD HOSPITAL, AN OSTEOPATHIC HOSPITAL IN FARMINGTON HILLS, MI, DONATED TIME AND EFFORT TO BRING MUCH NEEDED MEDICAL CARE TO THE PEOPLE OF ANTIGUA, GUATEMALA. DURING THIS MEDICAL MISSION, MEDICAL PERSONNEL TREATED NEWBORNS, THE ELDERLY, AND EVERYONE IN BETWEEN. MEDICAL PERSONNEL ADDRESSED THEIR HEALTH ISSUES RANGING FROM SIMPLE RASHES TO LIFE-THREATENING INFECTIONS. TO MOST OF THE POPULATION, OUR MEDICAL PERSONNEL WERE THE FIRST MEDICAL PROFESSIONALS THAT THEY ENCOUNTERED IN THEIR LIVES, BUT HOPEFULLY NOT THE LAST. THIS IS AN ANNUAL PROGRAM AND INCOME FROM SPECIAL FUNDRAISING EVENTS IS USED TO PAY FOR EXPENSES. ALL EXCESS FUNDRAISING INCOME FOR THIS PROGRAM FROM A PRIOR YEAR IS USED TO OFFSET EXPENSES FOR A FUTURE YEAR.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID:  
Software Version:  



SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

BOTSFORD MEDICAL STAFF GOLF OUTING
(event type) 		(b) Event #2

GUATEMALA MEDICAL MISSION
(event type) 		(c) Other Events

1
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 68,908 82,160 5,455 156,523
2 Less: Charitable
contributions . . . 		46,638 82,160 3,895 132,693
3 Gross income (line 1
minus line 2) . . . 		22,270   1,560 23,830
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . . 3,269     3,269
6 Rent/facility costs . . 28,427     28,427
7 Food and beverages . .        
8 Entertainment . . .        
9 Other direct expenses . 708 79,726 1,627 82,061
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 113,757
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -89,927
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
 
No
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
 
No
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
 
No
6b
If "Yes," does the organization make it available to the public? ..............
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    4,447,513   4,447,513 1.610 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    38,402,121 28,344,996 10,057,125 3.640 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    42,849,634 28,344,996 14,504,638 5.250 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    357,136 61,134 296,002 0.110 %
f Health professions education
(from Worksheet 5) .. 		    16,616,087 10,826,551 5,789,536 2.100 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    121,257   121,257 0.040 %
jTotal Other Benefits ...     17,094,480 10,887,685 6,206,795 2.250 %
kTotal. Add lines 7d and 7j. ..     59,944,114 39,232,681 20,711,433 7.500 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     1,939   1,939 0 %
3 Community support     24,107   24,107 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     3,001   3,001 0 %
7 Community health improvement advocacy     82,956   82,956 0.030 %
8 Workforce development     347   347 0 %
9 Other            
10 Total     112,350   112,350 0.040 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
7,115,181
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
 
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
120,180,887
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
107,406,821
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
12,774,066
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
11 BOTSFORD KIDNEY CENTER INC
  		KIDNEY DIALYSIS SERVICES TO THE ORGANIZATION'S COMMUNITY 20.000 %   72.500 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 BOTSFORD HOSPITAL
28050 GRAND RIVER
FARMINGTON HILLS,MI48336 		X X   X     X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NA
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8   No
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9   No
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11   No
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12   No
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13   No
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14   No
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16   No
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18   No
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?19
Name and address Type of Facility (Describe)
1 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
2 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
3 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
4 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
5 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
6 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
7 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
8 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
9 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
10 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
11 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
12 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
13 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
14 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
15 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
16 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
17 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
18 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
19 BOTSFORD PROFESSIONAL CENTER NORTH
28080 GRAND RIVER
FARMINGTON HILLS,MI48336 		GENERAL MEDICAL & SURGICAL
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 3C: BOTSFORD HOSPITAL USES AN ABILITY TO PAY (ATP) MODEL TO DETERMINE CHARITABLE CARE ASSISTANCE. VARIABLES USED IN THE ATP MODEL INCLUDE ZIP CODE, ESTIMATED HOUSEHOLD INCOME, ESTIMATED HOUSEHOLD SIZE, ESTIMATED MORTGAGE VALUE, ESTIMATED MORTGAGE BALANCE, ESTIMATED CREDIT LINES VALUE, ESTIMATED CREDIT BALANCES AND ESTIMATED MONTHLY OBLIGATIONS. THE ATP MODEL USES A POINT SCALE ON FIVE FACTORS, USING THE VARIABLES ABOVE, THAT ARE BOTH INCOME AND ASSET BASED TO CALCULATE AN OVERALL SCORE. THE OVERALL SCORE DETERMINES THE DISCOUNT TO BE APPLIED.
    PART II: BOTSFORD HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITIES IN WHICH IT SERVES IN A NUMBER OF DIFFERENT WAYS. THE CEO & PRESIDENT, CORPORATE VP OF MARKETING AND COMMUNITY HEALTH COORDINATOR LEAD MANY BOTSFORD EMPLOYEES IN THE PARTICIPATION AND INVOLVEMENT OF NUMEROUS COMMUNITY MEETINGS AND EVENTS. MEETINGS AND EVENTS THAT BOTSFORD STAFF HAVE ATTENDED INCLUDE: COMMISSION ON CHILDREN'S ISSUES, FARMINGTON PUBLIC SCHOOLS PARTNERSHIP, HEALTHY PARTNERS, HEALTHY COMMUNITY INITIATIVE, GREATER DETROIT AREA HEALTH COUNCIL, SAVE LIVES / SAVE DOLLARS, HEALTH CARE FORUMS AND CHAMBER OF COUNCIL MEETINGS OF FARMINGTON, FARMINGTON HILLS, REDFORD AND SOUTHFIELD.
    PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS DETERMINED BASED ON HISTORICAL LOSS RATE FACTORS AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF IN THE PERIOD THAT THEY ARE DEEMED UNCOLLECTIBLE.
    PART III, LINE 8: COSTING METHODOLOGY IS COST TO CHARGE RATIO.
    PART III, LINE 9B: THE GUARANTOR/PATIENT'S ACCOUNT WILL AUTOMATICALLY BE REVIEWED FOR CHARITABLE CARE ELIGIBILITY UNDER BOTSFORD'S FINANCIAL ASSISTANCE PROGRAM. THE PROGRAM IS ADMINISTERED THROUGH THE SYSTEM BUSINESS OFFICE AND AUTOMATICALLY REVIEWS EVERY SELF-PAY ACCOUNT BALANCE IN EXCESS OF AN ANNUALLY-PREDETERMINED "FAIR SHARE CONTRIBUTION" WHICH WILL REMAIN THE PATIENT'S RESPONSIBILITY. BOTSFORD'S PROGRAM ALSO ALLOWS FOR A CATASTROPHIC CAP, NOT TO EXCEED THAT OF $10,000 FOR ANY SELF-PAY PATIENT ACCOUNT BALANCE. THE PROGRAM IS AUTOMATIC, HAS EXTENSIVE USE OF CREDIT BUREAU REPORTING DATA, AND DOES NOT REQUIRE THE PATIENT TO SUPPLY ANY PERSONAL FINANCIAL INFORMATION.CHARITY CARE PROGRAM- THIS PROGRAM IS DESIGNED TO GIVE PRORATED DISCOUNTS TO QUALIFIED UNINSURED PATIENTS, BASED ON THEIR INCOME, ASSETS AND FINANCIAL NEEDS.- ALL SELF-PAY BALANCES WILL BE REVIEWED TO DETERMINE IF THE PATIENT MAY QUALIFY FOR REDUCTION OF THE BALANCE OWED, BASED ON OUR CHARITABLE PROGRAM GUIDELINES. - ALL PATIENTS WHO QUALIFY WILL BE RESPONSIBLE TO MAKE A FAIR CONTRIBUTION TOWARDS THEIR BALANCE, NOT TO EXCEED $10,000 FOR HOSPITAL ACCOUNTS THAT ARE FOUND TO BE ELIGIBLE UNDER THIS PROGRAM. TOTAL AMOUNT DUE IS BASED ON THE APPROVED CHARITY PERCENTAGE DETERMINATIONS.
    PART I, LINE 7, COLUMN (F):$16,040,633 OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE TOTAL EXPENSE FIGURE IN CALCULATING THE PERCENT OF COMMUNITY BENEFIT EXPENSE ON SCHEDULE H, PART I, LINE 7, COLUMN (F).
    PART VI, LINE 2: BOTSFORD HOSPITAL SEEKS TO IMPROVE THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH STATUS OF THE COMMUNITIES IT SERVES. THE HOSPITAL BELIEVES THAT WHEN PEOPLE HAVE ACCESS TO HEALTH CARE AND ARE EDUCATED REGARDING LIFESTYLE BEHAVIORS, THEY HAVE AN IMPROVED CHANCE OF LIVING A HEALTHY LIFE. TO THAT END, THE HOSPITAL DEVELOPS AND OFFERS A WIDE-RANGE OF HEALTH SERVICES, EDUCATION AND SCREENINGS. BOTSFORD HOSPITAL ENGAGES IN PARTNERSHIPS WITH GROUPS, SYSTEMS AND AGENCIES THROUGHOUT THE COMMUNITIES IT SERVES TO ASSESS ITS IMPACT ON ACHIEVING ITS GOALS. AMONG THE CONTRIBUTIONS THE HOSPITAL CONSIDERS WHEN ASSESSING ITS NON-PROFIT STATUS ARE THE DELIVERY OF FREE AND REDUCED PATIENT CARE, CARE OF THE ELDERLY AND INDIGENT, PATIENT EDUCATION AND HEALTH AWARENESS PROGRAMS FOR THE COMMUNITY, AND MEDICAL EDUCATION. ADDITIONALLY, THE HOSPITAL DELIVERS ALL OF THESE HEALTH CARE SERVICES TO PEOPLE IN THE COMMUNITY WITHOUT REGARD TO RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS OR ABILITY TO PAY.THE OPENING OF THE BOTSFORD CANCER CENTER IN 2009 IS A SPECIFIC EXAMPLE OF HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. IN 2005, A REVIEW OF BOTSFORD'S CANCER PATIENTS INDICATED A SIGNIFICANT NEED. THE ASSESSMENT IDENTIFIED THAT CANCER IS THE SECOND LEADING CAUSE OF DEATH IN BOTSFORD'S HOME COUNTIES, AND IS MOST PREVALENT IN PEOPLE OVER 55, WHICH IS SIGNIFICANT IN LIGHT OF THE AGING POPULATION. A REVIEW OF BOTSFORD'S PATIENT STATISTICS FOR 2003 AND 2004 SHOWED ALMOST 700 NEW CANCER CASES DIAGNOSED AT BOTSFORD ANNUALLY AND OVER 2,000 VISITS BY PATIENTS WITH PRIMARY OR SECONDARY CANCER DIAGNOSES. ADDITIONALLY, WAYNE AND OAKLAND COUNTIES REPORTED DEATHS DUE TO CANCER RELATED ILLNESSES OF 4,007 AND 2,062, RESPECTIVELY IN 2004. TO ADDRESS THE NEED TO CARE FOR THESE CANCER PATIENTS, BOTSFORD'S BOARD OF DIRECTORS DECIDED TO BUILD A CANCER CENTER. THE BOTSFORD CANCER CENTER WAS OPENED IN EARLY 2009.IN 2010 BOTSFORD RECEIVED TRAUMA CENTER VERIFICATION. BOTSFORD IS ONE OF ONLY EIGHT TRAUMA LEVEL II CENTERS IN MICHIGAN, ONE OF ONLY THREE TRAUMA CENTERS IN OAKLAND COUNTY AND THE ONLY ONE IN THE WESTERN PART OF OAKLAND COUNTY. BOTSFORD RECEIVED VERIFICATION AS A LEVEL II TRAUMA CENTER FROM THE AMERICAN COLLEGE OF SURGEONS (ACS) EFFECTIVE JANUARY 26, 2010. AS A LEVEL II TRAUMA CENTER, BOTSFORD IS EXPECTED TO PROVIDE INITIAL, DEFINITIVE TRAUMA CARE, REGARDLESS OF THE SEVERITY OF INJURY. THIS NEW CLINICAL DEPARTMENT PROVIDES THE HIGHEST LEVEL OF CARE FOR CRITICALLY INJURED PATIENTS IN BOTSFORD HOSPITALS SURROUNDING COMMUNITIES.
    PART VI, LINE 3: BOTSFORD HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS, WHO MAY BE BILLED FOR PATIENT CARE, ABOUT THEIR ELIGIBILITY FOR ASSISTANCE IN A NUMBER OF WAYS. A FEW OF THE COMMUNICATIONS INCLUDE A BROCHURE WITHIN THE PATIENT FOLDER WHICH IS GIVEN TO EVERY PATIENT ADMITTED TO THE HOSPITAL, A TOPIC IDENTIFIED IN THE FAQS WITHIN THE WWW. BOTSFORD.ORG WEBSITE RELATING TO ONLINE PAYMENTS AND BROCHURES MADE AVAILABLE AT ALL OF THE ORGANIZATION'S PATIENT SERVICE LOCATIONS INFORMING PATIENTS ON HOW TO OBTAIN INFORMATION ON ELIGIBILITY FOR ASSISTANCE.
    PART VI, LINE 4: BOTSFORD HOSPITAL IS LOCATED IN OAKLAND COUNTY AND SERVES COMMUNITIES IN BOTH OAKLAND AND WAYNE COUNTY. THE 2010 UNEMPLOYMENT RATE IN MICHIGAN OVERALL (ACCORDING TO THE MI DEPARTMENT OF ENERGY, LABOR AND ECONOMIC GROWTH) IS 12.5%, WHILE WAYNE COUNTY HAS AN UNEMPLOYMENT RATE OF 14.5% AND OAKLAND COUNTY HAS AN UNEMPLOYMENT RATE OF 12.1%.BOTSFORD HOSPITAL SERVES FOUR COMMUNITIES IN ITS PRIMARY SERVICE AREA; FARMINGTON/FARMINGTON HILLS, LIVONIA, REDFORD AND SOUTHFIELD. THE FARMINGTON/FARMINGTON HILLS AREA HAS A POPULATION OF 85,765 WITH A MEDIAN AGE OF 43.0 AND A MEDIAN HOUSE-HOLD INCOME OF $71,503. THE LIVONIA AREA HAS A POPULATION OF 87,330 WITH A MEDIAN AGE OF 44.8 AND A MEDIAN HOUSE-HOLD INCOME OF $68,376. THE REDFORD AREA HAS A POPULATION OF 139,071 WITH A MEDIAN AGE OF 36.7 AND A MEDIAN HOUSE-HOLD INCOME OF $43,769. THE SOUTHFIELD AREA HAS A POPULATION OF 109,048 WITH A MEDIAN AGE OF 41.2 AND A MEDIAN HOUSE-HOLD INCOME OF $52,912. BOTSFORD HOSPITAL HAS TWO SECONDARY SERVICE AREAS. COMMUNITIES IN OUR SOUTHEAST SECONDARY AREA INCLUDE AREAS OF DETROIT, WESTLAND, GARDEN CITY AND DEARBORN HEIGHTS. IN TOTAL, THE ZIP CODES WE SERVE HAVE A POPULATION OF 468,753 WITH A MEDIAN AGE OF 36.7 AND A MEDIAN HOUSE-HOLD INCOME OF $39,023. COMMUNITIES IN OUR NORTHWEST SECONDARY AREA INCLUDE AREAS OF WIXOM, WALLED LAKE, NOVI, WEST BLOOMFIELD, CANTON, PLYMOUTH, NORTHVILLE AND NEW HUDSON. IN TOTAL, THE ZIP CODES WE SERVE HAS A POPULATION OF 286,827 WITH A MEDIAN AGE OF 40.1 AND A MEDIAN HOUSE-HOLD INCOME OF $82,168.
    PART VI, LINE 6: BOTSFORD HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITIES IN WHICH IT SERVES THROUGH NUMEROUS OUTREACH ACTIVITIES. THESE ACTIVITIES INCLUDE: CHRONIC DISEASE MANAGEMENT AND EDUCATION THAT ADDRESSES DIABETES, CARDIAC HEALTH, HYPERTENSION, PULMONARY DISEASE AND OBESITY; COMPREHENSIVE LIFESTYLE BEHAVIOR EDUCATION AND INITIATIVES FOCUSED ON HEALTH RISK AND SUBSCRIBING TO THE HHS HEALTHY PEOPLE 2010 GOALS AND THE STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH GOALS. THIS EFFORT ALSO INCLUDES COMPREHENSIVE PARTNERSHIPS WITH LOCAL SCHOOL DISTRICTS ADDRESSING AT-RISK BEHAVIORS IN THE SCHOOL-AGE POPULATION.CONSUMER HEALTH RESOURCES SERVICES PROVIDED BY A MEDICAL LIBRARY AND WEBSITE, AND A QUARTERLY MAGAZINE, HEALTHSOURCE.HEALTH SCREENINGS IN MULTIPLE PUBLIC VENUES THAT INCLUDE TESTING FOR HYPERTENSION, CHOLESTEROL, FOOT DISORDERS, SKIN CANCER, BLOOD GLUCOSE, BONE DENSITY AND BODY FAT.MATERNAL-CHILD HEALTH EDUCATION THAT INCLUDES CHILDBIRTH, BABY CARE, BREAST-FEEDING, PARENTING, GRAND-PARENTING, AND BI-LINGUAL PROGRAMS FORM JAPANESE SPEAKING COMMUNITY MEMBERS.SENIOR RESOURCE PROGRAM THAT INCLUDES EDUCATION, REFERRAL AND SOCIAL ACTIVITIES.SUPPORT GROUP SYSTEM THAT INCLUDES ADDICTIONS, ALZHEIMER'S, CARDIOLOGY, CLOSED HEAD INJURY, STROKE SURVIVORS, GRIEF SUPPORT AND CARE GIVING.WEIGHT, NUTRITION AND FITNESS PROGRAMMING.BOTSFORD ALSO PARTICIPATES IN MANY CHARITABLE PROGRAMS IN THE COMMUNITIES IS SERVES THROUGH DIRECT FINANCIAL CONTRIBUTION, IN-KIND SUPPORT, AND TIME AND RESOURCES. THE HOSPITAL PROMOTES NUMEROUS FUNDRAISING EVENTS WITH BOTSFORD STAFF OR WITH FINANCIAL SUPPORT.
    PART VI, LINE 7: BOTSFORD HOSPITAL IS PART OF THE BOTSFORD HEALTH CARE (BHC) SYSTEM. THE MISSION OF BHC IS TO ADVANCE HEALTH IN THE COMMUNITIES IT SERVES. THE MISSION INCORPORATES CARING, COMMUNITY INVOLVEMENT, RESEARCH, EDUCATION AND LEADERSHIP. BHC'S VISION IS TO BE A STRONG INDEPENDENT SYSTEM OF HEALTH CARE, KNOWN FOR PROVIDING EXCELLENT CUSTOMER SERVICE, SUPERIOR VALUE, AND COMMUNITY SUPPORT THROUGH A NETWORK OF HEALTH AND HEALTH-RELATED SERVICES WHICH DEMONSTRATE A DEDICATION TO OUR PHILOSOPHY AND MISSION, A COMMITMENT TO COLLABORATION, AND RESPONSIBILITY TO FUTURE GENERATIONS.THE THREE MAIN ORGANIZATIONS OF BHC INCLUDE BOTSFORD HOSPITAL, BOTSFORD CONTINUING CARE CORPORATION AND COMMUNITY EMERGENCY MEDICAL SERVICES. EACH OF THESE ORGANIZATIONS IS BRIEFLY DESCRIBED BELOW:BOTSFORD HOSPITAL IS LICENSED FOR 330 BEDS, AND PROVIDES INPATIENT HOSPITAL SERVICES AS WELL AS A WIDE RANGE OF OUTPATIENT SERVICES. THE SERVICES ARE PROVIDED AT THE HOSPITAL FACILITY AND AT VARIOUS OFF-SITE FACILITIES WITHIN A SIX MILE RADIUS OF THE MAIN CAMPUS, SERVING THE NEEDS OF RESIDENTS OF SOUTHERN OAKLAND COUNTY AND NORTHERN WAYNE COUNTY. BOTSFORD HOSPITAL ALSO OPERATES A NETWORK OF PRIMARY CARE AND SPECIALTY PHYSICIAN PRACTICES, KNOWN AS THE BOTSFORD CLINIC SYSTEM, AT 24 OFFICE SITES. OSTEOPATHIC MEDICAL EDUCATION AND CLINICAL TRAINING IS AN IMPORTANT COMPONENT OF THE MISSION OF BOTSFORD HOSPITAL. BOTSFORD HOSPITAL IS APPROVED FOR PRE-GRADUATE AND POST-GRADUATE PHYSICIAN TRAINING. THE AMERICAN OSTEOPATHIC ASSOCIATION APPROVES THE HOSPITAL FACILITY FOR TWENTY SPECIALTY AND SUB-SPECIALTY RESIDENCY PROGRAMS.BOTSFORD CONTINUING CARE CORPORATION IS MADE UP OF THREE MAIN SERVICES. THE FIRST IS A SKILLED NURSING FACILITY WITH 179 BEDS LOCATED IN FARMINGTON HILLS, MICHIGAN. THE SECOND SERVICE IS AN ASSISTED LIVING FACILITY WITH 63 BEDS ALSO LOCATED IN FARMINGTON HILLS, MICHIGAN. IT IS A SAFE AND SUPPORTIVE ENVIRONMENT FOR OLDER ADULTS NEEDING SOME ASSISTANCE WITH THEIR DAILY ROUTINE. EACH RESIDENTS' CARE IS CUSTOMIZED TO HIS OR HER INDIVIDUAL NEEDS TO PROVIDE SUPPORT AND ASSISTANCE WHILE MAINTAINING AND PROVIDING INDEPENDENCE. THE THIRD SERVICE IS AN INDEPENDENT LIVING APARTMENT WITH 51 UNITS ALSO LOCATED IN FARMINGTON HILLS, MICHIGAN. EACH APARTMENT IS WHEELCHAIR ACCESSIBLE, HAS 24 HOUR SECURITY SERVICES, ILLUMINATED THERMOSTATS AND INCLUDES EMERGENCY CALL SERVICE.COMMUNITY EMERGENCY MEDICAL SERVICE (CEMS) PROVIDES AN ARRAY OF SERVICES FROM AMBULANCE SERVICE TO TRAINING AND EDUCATIONAL PROGRAMS FOR THE PUBLIC. CEMS PROVIDES MEDICAL DIRECTION AND TRANSPORTATION SUCH AS MOBILE INTENSIVE CARE UNITS, TRANSPORTING CRITICALLY ILL PATIENTS, NON-EMERGENCY VAN SERVICE, AND PROVIDING MEDICAL DIRECTION FOR 911 CALLERS. CEMS, THROUGH THE LIFE SUPPORT TRAINING INSTITUTE (LSTI), IS COMMITTED TO COMMUNITY INVOLVEMENT AND EDUCATION. LSTI PROVIDES TRAINING AND CERTIFICATION FOR PERSONS WHO WISH TO BECOME BASIC EMTS OR PARAMEDICS. THIS SERVICE IS PROVIDED TO MEMBERS OF THE GENERAL PUBLIC AND TO PERSONS WHO ARE EMPLOYED WITH A FIRE DEPARTMENT. LSTI IS ALSO AN AMERICAN HEART ASSOCIATION SITE THAT PROVIDES CPR TRAINING AND CERTIFICATION TO MEMBERS OF THE GENERAL PUBLIC.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number
38-1426919
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) FARMINGTON HILLS POLICE BENEVOLENT ASSOCIATION31655 WEST ELEVEN MILE
FARMINGTON HILLS,MI48336 		38-3245831 501(C)(3) 2,500       THE GRANT IS TO ASSIST THE FAMILIES OF FALLEN POLICE OFFICERS IN OUR COMMUNITY. BOTSFORD BELIEVES THAT WE SHOULD SUPPORT OUR LOCAL ORGANIZATIONS THAT NEED ASSISTANCE. THE ORGANIZATION RECEIVING THIS GRANT IS MONITORED THROUGH ACTIVE INVOLVEMENT OF BOTSFORD STAFF WITHIN THE FARMINGTON HILLS COMMUNITY.
(2) REDFORD CHILDREN'S ISSUES COMMISSION12121 HEMINGWAY
REDFORD,MI48239 		38-3169773 501(C)(3) 6,000       THE COMMISSION ON CHILDREN'S ISSUES HOSTS A VARIETY OF PROGRAMS AND SERVICES TO DETER JUVENILE DELINQUENCY WITHIN REDFORD TOWNSHIP. BOTSFORD BELIEVES THAT WE SHOULD SUPPORT OUR LOCAL ORGANIZATIONS THAT NEED ASSISTANCE. THE ORGANIZATION RECEIVING THIS GRANT IS MONITORED THROUGH ACTIVE INVOLVEMENT OF BOTSFORD STAFF WITHIN THE REDFORD COMMUNITY.
(3) ZIEGER HEALTH CARE CORPORATION28050 GRAND RIVER AVENUE
FARMINGTON HILLS,MI48336 		38-2500428 501(C)(3)   410,345 FMV PAYMENT OF EXPENSES THIS IS AN INTERNAL GRANT GIVEN TO A RELATED 501C(3) ORGANIZATION. TO HELP SUPPORT THE MISSION OF THE BOTSFORD FOUNDATION THROUGH CASH AND PAYMENT OF EXPENSES.
(4) ZIEGER HEALTH CARE CORPORATION28050 GRAND RIVER AVENUE
FARMINGTON HILLS,MI48336 		38-2500428 501(C)(3) 89,372   FMV   THIS IS AN INTERNAL GRANT GIVEN TO A RELATED 501C(3) ORGANIZATION TO HELP SUPPORT THE BOTSFORD FOUNDATION.
















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
3
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) RESIDENT STIPENDS 167 15,008,210      













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
OTHER INFORMATION: PART IV: SCHEDULE I, PART III: RESIDENT STIPENDS: OSTEOPATHIC MEDICAL EDUCATION AND CLINICAL TRAINING IS AN IMPORTANT COMPONENT OF THE MISSION OF THE CORPORATION. THE CORPORATION IS APPROVED FOR PRE-GRADUATE AND POST-GRADUATE PHYSICIAN TRAINING. THE AMERICAN OSTEOPATHIC ASSOCIATION APPROVES THE HOSPITAL FACILITY FOR TWENTY SPECIALTY AND SUB-SPECIALTY RESIDENCY PROGRAMS. CURRENTLY, THERE ARE 165 POST GRADUATE RESIDENTS. THE MAJOR EMPHASIS IN POST-DOCTORAL TRAINING IS IN THE PRIMARY CARE AREAS, WITH RESIDENCY PROGRAMS AND TEACHING CURRICULUMS ESTABLISHED IN FAMILY MEDICINE, INTERNAL MEDICINE, AND OBSTETRICS AND GYNECOLOGY. SPECIALTY TRAINING PROGRAMS ARE ALSO CONDUCTED.
Schedule I (Form 990) 2010


Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) PAUL LACASSE (i)
(ii)		 379,176
0 		85,200
0 		43,209
0 		14,699
0 		18,823
0 		541,107
0 		0
0
(2) DAVID MARCELLINO (i)
(ii)		 304,893
0 		61,390
0 		43,365
0 		14,700
0 		19,612
0 		443,960
0 		0
0
(3) LISA VANDECAVEYE (i)
(ii)		 229,898
0 		57,760
0 		27,107
0 		14,191
0 		21,612
0 		350,568
0 		0
0
(4) MARGO GORCHOW (i)
(ii)		 174,159
0 		31,758
0 		18,836
0 		11,741
0 		9,232
0 		245,726
0 		0
0
(5) DAVID WALTERS (i)
(ii)		 259,392
0 		56,424
0 		27,810
0 		14,700
0 		21,820
0 		380,146
0 		0
0
(6) BARBARA PALMER (i)
(ii)		 169,577
0 		37,254
0 		40,410
0 		12,391
0 		8,118
0 		267,750
0 		0
0
(7) REGINA DOXTADER (i)
(ii)		 145,717
0 		36,372
0 		25,646
0 		11,002
0 		20,566
0 		239,303
0 		0
0
(8) MARGARET HASLER (i)
(ii)		 189,886
0 		37,482
0 		14,459
0 		12,515
0 		8,045
0 		262,387
0 		0
0
(9) RONALD SZUMSKI (i)
(ii)		 178,203
0 		31,698
0 		15,704
0 		12,216
0 		24,397
0 		262,218
0 		0
0
(10) WILLIAM SCHEUBER (i)
(ii)		 159,142
0 		29,368
0 		6,650
0 		10,913
0 		22,817
0 		228,890
0 		0
0
(11) ADAM COOPER (i)
(ii)		 423,060
0 		0
0 		14,710
0 		14,700
0 		21,806
0 		474,276
0 		0
0
(12) ANDREW CYKIERT (i)
(ii)		 258,156
0 		203,572
0 		17,424
0 		14,700
0 		21,798
0 		515,650
0 		0
0
(13) RICHARD HERMAN (i)
(ii)		 426,236
0 		0
0 		14,934
0 		14,700
0 		22,660
0 		478,530
0 		0
0
(14) GILBERT HERMAN (i)
(ii)		 261,218
0 		0
0 		30,915
0 		14,700
0 		21,043
0 		327,876
0 		0
0
(15) BEN ROSSI (i)
(ii)		 233,136
0 		198,004
0 		12,551
0 		4,900
0 		27,587
0 		476,178
0 		0
0

Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A CLUB DUES PAID BY THE ORGANIZATION ON BEHALF OF THE CEO TO ENHANCE BUSINESS OPPORTUNITIES.
  PART I, LINE 7 NON-FIXED PAYMENTS ARE PAID ONLY UPON APPROVAL OF THE BOTSFORD HOSPITAL COMPENSATION COMMITTEE AND ARE BASED UPON ESTABLISHED METRICS.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number
38-1426919
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CITY OF FARMINGTON HILLS HOSPITAL FINANCE AUTHORITY
  		52-1719468 311166BJO 04-03-2008 11,835,179 CANCER CENTER CONSTRUCTION COSTS, EQUIPMENT & REFINANCE 1991 BOND   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 802,508      
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 11,901,948      
4 Gross proceeds in reserve funds . .        
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . .        
7 Issuance costs from proceeds . . . 236,704      
8 Credit enhancement from proceeds. 16,278      
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 11,407,495      
11 Other spent proceeds . . 241,472      
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2008
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? X              
15 Were the bonds issued as part of an advance refunding issue?   X            
16 Has the final allocation of proceeds been made? . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X            
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use? X              
b Are there any research agreements that may result in private business use of bond-financed property? . .   X            
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .   X            
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 %      
6 Total of lines 4 and 5 . . .. . . . . . 0 %      
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X            
2 Is the bond issue a variable rate issue? X              
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X            
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X            
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X            
6 Did the bond issue qualify for an exception to rebate? . . . X              
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SCHEDULE K SUPPLENTAL INFORMATION   THE BOND ISSUED 04/03/08 WAS ISSUED TO THE ZIEGER HEALTH CARE CORPORATION OBLIGATED GROUP IN THE AMOUNT OF $16,370,000. THE OBLIGATED GROUP CONSISTS OF ZIEGER HEALTH CARE CORPORATION, BOTSFORD GENERAL HOSPITAL, BOTSFORD CONTINUING CARE CORPORATION AND COMMUNITY EMERGENCY MEDICAL SERVICES. EACH ENTITY OF THE OBLIGATED GROUP WAS ALLOCATED A PORTION OF THIS DEBT AND THAT AMOUNT IS REFLECTED ON SCHEDULE K, PART 1 PART V- THE DIFFERENCE BETWEEN THE ISSUE PRICE (PART I, COLUMN (E)AND TOTAL PROCEEDS OF THE ISSUE (PART II, LINE 3) IS DUE TO INVESTMENT EARNINGS.
Schedule K (Form 990) 2010

Additional Data


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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) ADAM COOPER FAM MBR IS A BD MBR 488,986 COMP PAID   No
(2) CARDIOVASCULAR CLINICAL ASSOCIATES
  		BD MBR / >5% INTEREST IN VENDOR THAT PROVIDES SERVICES TO BH 340,384 VENDOR PROVIDES CARE TO BOTSFORD PATIENTS AS WELL AS INTERPRETING VARIOUS PROCEDURES SUCH AS ECHOCARDIOGRAMS, STRESS TESTS AND EKGS. THE VENDOR RECEIVES A MONTHLY PAYMENT FOR PERFORMING THESE SERVICES.   No
(3) MICHAEL SCHEUBER FATHER IS A KEY EMPLOYEE 12,000 SON RECEIVED COMPENSATION FROM BOTSFORD HOSPITAL FOR SERVICES AS A PROJECT INTERN IN THE CLINICAL PROCESS IMPROVEMENT DEPARTMENT.   No
(4) SURGERY SPECIALISTS
  		BD MBR / >5% INTEREST IN VENDOR THAT PROVIDES SERVICES TO BH 95,833 PROVIDES ONCALL SERVICES FOR THE TRAUMA CENTER   No
(5) ANNETTE LACASSE FAM MBR IS A BD MBR 15,495 PROVIDES PHYSICIAN SERVICES AS DERMATOLOGY PROGRAM DIRECTOR.   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
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SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( EQUIPMENT ) X 11 116,527 PURCHASE PRICE OF EQUIPMENT
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
Yes
 
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
THIRD PARTY USE: PART I, LINE 32B: BOTSFORD HOSPITAL USES ZIEGER HEALTH CARE CORPORATION TO SOLICIT, PROCESS AND SELL NON-CASH CONTRIBUTIONS. ADDITIONALLY, ZIEGER HEALTH CARE CORPORATION PURCHASES EQUIPMENT FOR THE BENEFIT OF BOTSFORD HOSPITAL.
Schedule M (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Identifier Return Reference Explanation
NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 2010 NEW SERVICES- TRAUMA CENTER. BOTSFORD IS ONE OF ONLY EIGHT TRAUMA LEVEL II CENTERS IN MICHIGAN, ONE OF ONLY THREE TRAUMA CENTERS IN OAKLAND COUNTY AND THE ONLY ONE IN THE WESTERN PART OF OAKLAND COUNTY. BOTSFORD RECEIVED VERIFICATION AS A LEVEL II TRAUMA CENTER FROM THE AMERICAN COLLEGE OF SURGEONS (ACS) EFFECTIVE JANUARY 26, 2010. AS A LEVEL II TRAUMA CENTER, BOTSFORD IS EXPECTED TO PROVIDE INITIAL, DEFINITIVE TRAUMA CARE, REGARDLESS OF THE SEVERITY OF INJURY. THIS NEW CLINICAL DEPARTMENT PROVIDES THE HIGHEST LEVEL OF CARE FOR CRITICALLY INJURED PATIENTS IN BOTSFORD HOSPITAL'S SURROUNDING COMMUNITIES. DAVINCI ROBOT. THIS ROBOTIC SURGERY PROGRAM BEGAN IN MARCH 2010. ROBOTIC SURGERY HAS BECOME THE STANDARD FOR SEVERAL TYPES OF SURGERY INCLUDING PROSTATE SURGERY. THIS ADVANCED TECHNOLOGY ROBOT IS CONTROLLED BY A TRAINED PHYSICIAN SEATED AT A CONSOLE IN THE OPERATING ROOM. THE ROBOT'S ARTICULATING ARMS ARE ABLE TO RESECT TISSUE IN CERTAIN TYPES OF CASES MUCH MORE EFFECTIVELY AND WITH BETTER, FASTER RECOVERY. TWO NEW AND VERY EXPERIENCED SURGEONS TRAINED IN ROBOTIC SURGERY HAVE JOINED BOTSFORD'S STAFF. 128-CT SLICE SCANNER. A NEW 128-SLICE CT SCANNER WAS INSTALLED IN APRIL 2010. THIS NEW CT SCANNER IS ONE OF THE FASTEST CT SCANNERS AVAILABLE ON THE MARKET AND WILL PRODUCE IMAGES WITH GREATER RESOLUTION AND LOWER RADIATION EXPOSURE. THIS ADVANCED TECHNOLOGY IS PARTICULARLY USEFUL FOR CARDIAC AND PERIPHERAL CT ANGIOGRAPHY. BALLOON SINUPLASTY IS AN ENDOSCOPIC, CATHETER-BASED SYSTEM FOR PATIENTS SUFFERING FROM SINUSITIS THAT USES A SMALL, FLEXIBLE BALLOON CATHETER TO ENLARGE SINUS PASSAGEWAYS. WHEN THE BALLOON IS INFLATED, IT RESTRUCTURES AND WIDENS THE WALLS OF THE SINUS PASSAGEWAY, WITH THE GOAL OF RESTORING NORMAL SINUS DRAINAGE WITHOUT DAMAGING THE SINUS LINING. PATIENTS DIAGNOSED WITH CHRONIC SINUSITIS BUT NOT RESPONDING WELL TO MEDICATIONS MAY BE CANDIDATES FOR SOME TYPE OF SINUS SURGERY, INCLUDING BALLOON. BRONCHIAL THERMOPLASTY. A NEW TREATMENT FOR SEVERE,PERSISTENT ASTHMA CALLED BRONCHIAL THERMOPLASTY. JUST RECENTLY APPROVED BY THE U.S.FOOD AND DRUG ADMINISTRATION, BRONCHIAL THERMOPLASTY IS AN OUTPATIENT PROCEDURE THAT INVOLVES TREATING THE LUNGS WITH THERMAL ENERGY TO REDUCE THE FREQUENCY OF ASTHMA ATTACKS.
FORM 990, PART VI, SECTION A, LINE 2   THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE BOARD MEMBERS OR SHARED OFFICERS ON TWO OR MORE ENTITIES WITHIN THE BOTSFORD HEALTH CARE SYSTEM. STEVEN BARNABY GERSON COOPER RAYMOND DZENDZEL HARRIS MAINSTER DAVID SUSSER PAUL LACASSE DAVID MARCELLINO LISA VANDECAVEYE REGINA DOXTADER MARGO GORCHOW IS IDENTIFIED AS A KEY EMPLOYEE ON BOTH ZIEGER HEALTH CARE CORPORATION AND BOTSFORD HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 2   FORM 990 PART VII COLUMN B/E HOURS WORKED FOR RELATED ORGANIZATIONS PAUL LACASSE, DAVID MARCELLINO, LISA VANDECAVEYE, REGINA DOXTADER, BARBARA PALMER, AND MARGO GORCHOW WORK ON AVERAGE 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS.
FORM 990, PART VI, SECTION A, LINE 6   ZIEGER HEALTH CARE CORPORATION IS THE SOLE CORPORATE MEMBER OF BOTSFORD HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A   AS THE SOLE CORPORATE MEMBER, ZIEGER HEALTH CARE CORPORATION APPROVED/ELECTS THE GOVERNING BODY OF BOTSFORD HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7B   AS THE SOLE CORPORATE MEMBER, ZIEGER HEALTH CARE CORPORATION HAS CERTAIN RESERVED POWERS OVER OPERATIONS AND CAPITAL OF BOTSFORD HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 11   THE FORM 990 AND ALL RELATED SCHEDULES WERE PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT AND REVIEWED BY AN OUTSIDE TAX FIRM. A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS. THE FORM 990 WAS PRESENTED BY THE CORPORATE VICE PRESIDENT AND CONTROLLER TO THE BOARD OF DIRECTORS IN OCTOBER, 2011. ALL QUESTIONS / COMMENTS WERE ADDRESSED.
  FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE OF THE CONFLICT OF INTEREST POLICY BY REVIEW OF THE POLICY ANNUALLY AT THE BOARD MEETING AND MANDATORY SUBMISSION OF CONFLICTS TO THE SECRETARY OF THE ORGANIZATION PER THE POLICY.
  FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION, BENEFITS AND RETIREMENT COMMITTEE (COMMITTEE) OF BOTSFORD HEALTH CARE WILL REVIEW AND MAKE RECOMMENDATIONS TO THE BOARD OF DIRECTORS WITH RESPECT TO ALL ASPECTS OF COMPENSATION AND OTHER BENEFITS, INCLUDING, WITHOUT LIMITATIONS, COMPENSATION OF THE CORPORATION'S DIRECTORS, OFFICERS, PHYSICIANS, EMPLOYEES AND CONTRACTORS. THE COMMITTEE RETAINS AN INDEPENDENT COMPENSATION CONSULTANT EACH YEAR TO ASSESS THE COMPETITIVENESS AND REASONABLENESS OF THE TOTAL COMPENSATION PROVIDED TO EXECUTIVES, DIRECTORS AND PHYSICIANS. THE COMPENSATION CONSULTANT ABSTRACTS BASE SALARY, TOTAL CASH COMPENSATION AND BENEFITS DATA FROM MAJOR SURVEYS FOR HEALTHCARE AND OTHER APPROPRIATE INDUSTRIES. THE FAIR MARKET REVIEW IS FOR COMPARABLE POSITIONS IN COMPARABLE ORGANIZATIONS BASED UPON SIZE, TOTAL REVENUES AND OTHER RELEVANT FACTORS. YEARLY, THE CONSULTANT WILL PRESENT A SUMMARY OF FINDINGS AND RECOMMENDATIONS INTENDED TO HELP THE COMMITTEE ESTABLISH THE "REBUTTABLE PRESUMPTION OF REASONABLENESS FOR EXECUTIVES, DIRECTORS AND PHYSICIANS." THE COMMITTEE WILL MAKE RECOMMENDATIONS TO THE VARIOUS BOARDS FOR APPROVAL. NO MEMBER OF THE COMMITTEE WILL EVALUATE ANY COMPENSATION ARRANGEMENT WITH RESPECT TO WHICH HE OR SHE HAS A CONFLICT OF INTEREST. YEARLY, THE COMMITTEE MEMBERS WILL SIGN A CONFLICT OF INTEREST POLICY. ALL COMMITTEE RECOMMENDATIONS AND ACTIONS ARE ADEQUATELY DOCUMENTED IN COMMITTEE MINUTES.
  FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS THAT ARE REQUIRED TO BE MADE AVAILABLE TO THE PUBLIC WILL BE MADE AVAILABLE UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,812,627. ADDITIONAL MINIMUM PENSION LIABILITY ADJUSTMENT 9,213,250. UNUSUAL AND INFREQUENT ITEMS(INTERN/RESIDENT FICA RECOVERY) 2,184,007. RECONCILIATION TO AUDIT REPORT 5. TOTAL TO FORM 990, PART XI, LINE 5: 13,209,889.
AUDIT COMMITTEE PROCESS FORM 990, PART XII, LINE 2C THE ORGANIZATION'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS THAT THE AUDIT COMMITTEE FOLLOWS FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BOTSFORD GENERAL HOSPITAL
 
Employer identification number

38-1426919
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) ZIEGER HEALTHCARE CORPORATION

28050 GRAND RIVER AVENUE

FARMINGTON HILLS,MI48336
38-2500428 		CENTRALIZED GOVERNANCE & MGMT MI 501 (C) (3) 9  
Yes
 
(2) BOTSFORD CONTINUING CARE CORPORATION

28050 GRAND RIVER AVENUE

FARMINGTON HILLS,MI48336
38-2549505 		LONG TERM NURSING CARE MI 501 (C) (3) 9 ZIEGER HEALTHCARE CORPORATION
 
Yes
 
(3) COMMUNITY EMERGENCY MEDICAL SERVICE INC

25400 W EIGHT MILE ROAD

SOUTHFIELD,MI48034
38-2410823 		AMBULANCE SERVICES MI 501 (C) (3) 9 ZIEGER HEALTHCARE CORPORATION
 
Yes
 
(4) CEMS OF OHIO

4581 POTH ROAD

COLUMBUS,OH43215
80-0249549 		AMBULANCE SERVICES OH 501 (C) (3) 9 COMMUNITY EMERGENCY MEDICAL SERVICES INC
 
Yes
 






For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) BOTSFORD COMMONS PROPERTY ASSOCIATION
21400 ARCHWOOD CIRCLE
FARMINGTON HILLS,MI48336
38-3203663 		PROPERTY MANAGEMENT MI BOTSFORD CONTINUING CARE CORPORATION
  		C      
(2) PARASTAR MEDICAL SERVICES
25250 W EIGHT MILE ROAD
SOUTHFIELD,MI48034
38-2755982 		MANAGEMENT & DISPATCH SERVICES MI COMMUNITY EMERGENCY MEDICAL SERVICES
  		C      
(3) BGH PHYSICIAN PORTFOLIO (CAPTIVE)
PO BOX 1109 68 WEST BAY ROAD
GEORGETOWN,GRAND CAYMANKY1-1102
CJ
38-1426919 		CAPTIVE INSURANCE (CELL) CJ BOTSFORD HOSPITAL
  		C   4,965,524 100.000 %








Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) BOTSFORD CONTINUING CARE CORPORATION

 N 460,779 COST
(2) BOTSFORD CONTINUING CARE CORPORATION

 P 3,464,950 COST
(3) COMMUNITY EMERGENCY MEDICAL SERVICES

 N 427,812 COST
(4) COMMUNITY EMERGENCY MEDICAL SERVICES

 P 1,543,738 COST
(5) PARASTAR

 N 773,007 COST
(6) PARASTAR

 P 272,360 COST
(7) COMMUNITY EMERGENCY MEDICAL SERVICES

 O 554,712 COST
(8) PARASTAR

 O 16,307 COST
(9) ZIEGER HEALTHCARE CORPORATION

 C 800,190 COST
(10) ZIEGER HEALTHCARE CORPORATION

 B 499,717 COST
(11) ZIEGER HEALTHCARE CORPORATION

 P 1,276,334 COST
(12) BOTSFORD CONTINUING CARE CORPORATION

 J 123,188 COST
(13) ZIEGER HEALTHCARE CORPORATION

 O 1,076,661 COST
(14) COMMUNITY EMERGENCY MEDICAL SERVICES

 L 98,129 COST
(15) COMMUNITY EMERGENCY MEDICAL SERVICES

 O 90,243 COST
(16) COMMUNITY EMERGENCY MEDICAL SERVICES

 L 382,842 COST
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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Software Version: