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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
3901 BEAUBIEN BLVD
 
Room/suite
City or town, state or country, and ZIP + 4
DETROIT, MI48201
D Employer identification number

38-1357994
E Telephone number

G Gross receipts $ 496,128,350
F Name and address of principal officer:
HERMAN B GRAY JR MD PRESIDENT
3901 BEAUBIEN BLVD
DETROIT,MI48201
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CHMKIDS.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: 1922
M State of legal domicile: MI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: CHILDREN'S HOSPITAL OF MICHIGAN WILL IMPROVE THE HEALTH AND WELL BEING OF ALL CHILDREN AND THEIR COMMUNITIES BY ADVANCING THE SCIENCE AND PRACTICE OF PEDIATRIC HEALTH CARE AND THROUGH ADVOCACY EFFORTS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 38
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 29
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 2,540
6 Total number of volunteers (estimate if necessary) .... 6 527
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 11,494,886 10,159,036
9 Program service revenue (Part VIII, line 2g) ......... 359,985,565 371,277,862
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 16,281,722 23,791,999
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 466,715 557,893
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 388,228,888 405,786,790
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...   0
14 Benefits paid to or for members (Part IX, column (A), line 4) ....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 164,727,369 164,951,721
16a Professional fundraising fees (Part IX, column (A), line 11e).... 42,050 31,960
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet3,208,102    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 203,358,761 197,597,915
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 368,128,180 362,581,596
19 Revenue less expenses. Subtract line 18 from line 12...... 20,100,708 43,205,194
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 707,139,888 230,520,710
21 Total liabilities (Part X, line 26)............ 85,732,896 49,707,310
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 621,406,992 180,813,400
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: CHILDREN'S HOSPITAL OF MICHIGAN WILL IMPROVE THE HEALTH AND WELL BEING OF ALL CHILDREN AND THEIR COMMUNITIES BY ADVANCING THE SCIENCE AND PRACTICE OF PEDIATRIC HEALTH CARE AND THROUGH ADVOCACY EFFORTS.
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 $ 63,583,708 including grants of $   ) (Revenue $ 64,561,964 )
PEDIATRICS - CHILDREN'S HOSPITAL OF MICHIGAN HAS BEEN DEDICATED TO PROVIDING THE HIGHEST QUALITY OF CARE TO CHILDREN AND ADOLESCENTS IN A CARING, EFFICIENT AND FAMILY-CENTERED ENVIRONMENT AND ENGAGES IN GROUNDBREAKING RESEARCH THAT HAS LONG SHAPED THE SCIENCE OF PEDIATRIC MEDICINE. IT IS RANKED AS ONE OF AMERICA'S BEST HOSPITALS FOR CHILDREN IN CANCER, CARDIOLOGY AND CARDIOVASCULAR SURGERY, GASTROENTEROLOGY, NEONATOLOGY, NEPHROLOGY, NEUROLOGY AND NEUROSURGERY, ORTHOPEDICS, PULMONARY AND UROLOGY BY U.S. NEWS & WORLD REPORT AND AMONG AMERICA'S BEST 25 CHILDREN'S HOSPITAL BY PARENT MAGAZINE. IT IS ALSO A NATIONALLY RECOGNIZED MAGNET HOSPITAL FOR NURSING EXCELLENCE, A TOP HOSPITAL FOR PATIENT SAFETY AND QUALITY PRACTICES BY THE LEAPFROG GROUP AND A TOP HOSPITAL IN PEDIATRICS BY HOUR DETROIT MAGAZINE. CHILDREN'S HOSPITAL OF MICHIGAN TREATED MORE THAN 90,000 CHILDREN IN ITS EMERGENCY DEPARTMENT IN 2010. WHILE MOST HOSPITALS HAVE EMERGENCY ROOMS THAT SEE BOTH ADULT AND CHILDREN, THE EMERGENCY DEPARTMENT AT CHILDREN'S HOSPITAL OF MICHIGAN IS COMPLETELY DEDICATED TO SERVING CHILDREN AND THEIR CHILDHOOD ILLNESSES AND INJURIES. CHILDREN'S HOSPITAL OF MICHIGAN'S EMERGENCY DEPARTMENT IS ONE OF A HANDFUL OF LEVEL ONE PEDIATRIC TRAUMA CENTERS IN THE UNITED STATES CERTIFIED BY THE AMERICAN COLLEGE OF SURGEONS. IN 2010, CHILDREN'S HOSPITAL OF MICHIGAN'S DEPARTMENT OF PEDIATRICS SAW 7,192 INPATIENT CASES RESULTING IN 34,030 DAYS OF PEDIATRIC INPATIENT MEDICAL CARE FOR CHILDREN THROUGHOUT OUR STATE. CHILDREN'S HOSPITAL HAS VIRTUALLY EVERY PEDIATRIC MEDICAL SUBSPECIALTY AND SERVICE DESIGNED TO MEET THE DIVERSE MEDICAL NEEDS OF CHILDREN OF ALL AGES. THESE YOUNG PATIENTS VISIT CHILDREN'S HOSPITAL FOR EVERYTHING FROM TREATMENT FOR AUTISM AND SEIZURES TO CARE FOR RARE CONGENITAL DISORDERS. PEDIATRIC SPECIALTIES AND SERVICES AVAILABLE AT CHILDREN'S HOSPITAL INCLUDE BUT ARE NOT LIMITED TO: PEDIATRIC MEDICINE, ADOLESCENT MEDICINE, ALLERGY, CRITICAL CARE, CARDIOLOGY, EMERGENCY CARE, ENDOCRINOLOGY, GASTROENTEROLOGY, INFECTIOUS DISEASE, NEONATOLOGY, NEPHROLOGY, NEUROLOGY, PHYSICAL MEDICINE AND REHABILITATION AND PULMONARY MEDICINE. MORE THAN 160 PEDIATRIC RESIDENTS, SPECIALISTS AND FELLOWS IN TRAINING AT CHILDREN'S HOSPITAL OF MICHIGAN AT ANY GIVEN TIME; GRADUATE MORE THAN 30 PEDIATRICIANS AND PEDIATRIC SPECIALISTS EACH YEAR, MAKING CHILDREN'S HOSPITAL THE LARGEST PEDIATRIC RESIDENCY PROGRAM IN MICHIGAN. THE FIRST IN THE STATE TO USE VEINVIEWER TECHNOLOGY TO HELP CLINICIANS FIND THE RIGHT VEIN, THE FIRST TIME. USING A COMBINATION OF NEAR-INFRARED LIGHT, THIS ADVANCED TECHNOLOGY PROJECTS IMAGES OF VEINS AND THEIR LOCATION TO THE SURFACE OF PATIENTS' SKIN, RESULTING IN FEWER POKES FOR KIDS. IDENTIFIED AN INFANT COOLING TECHNIQUE TO REDUCE THE INCIDENCE OF DISABILITY AND DEATH IN INFANTS WHO FAILED TO RECEIVE ENOUGH OXYGEN DURING BIRTH. IMPLANTED THE FIRST MECHANICAL HEART PUMP EVER RECEIVED BY A CHILD IN MICHIGAN. THE THORATEC LEFT VENTRICULAR ASSIST DEVICE SAVED A TWELVE-YEAR-OLD GIRL'S LIFE. HELPED DEVELOP THE GENESIS STENT, A LIFE-SAVING DEVICE THAT OPENS BLOOD VESSELS THAT GROW WITH THE CHILD, ELIMINATING THE NEED FOR OPEN-HEART SURGERY. HOME TO THE WORLD'S FIRST POSITRON EMISSION TOMOGRAPHY (PET) CENTER DEDICATED TO PEDIATRICS. USING PET SCANNING, NEUROLOGISTS AND NEUROSURGEONS CAN IDENTIFY AND REMOVE AREAS IN A CHILD'S BRAIN THAT CAUSE UNCONTROLLABLE SEIZURES, ALLOWING FOR NORMAL DEVELOPMENT. HOME TO THE PEDIATRIC PHARMACOLOGY RESEARCH UNIT (PPRU), ONE OF ONLY 13 SITES IN THE U.S. DEDICATED TO ENSURING DRUG SAFETY FOR CHILDREN. THE PPRU IS SUPPORTED BY THE PRESTIGIOUS NATIONAL INSTITUTE OF HEALTH. THE NATION'S FIRST CHILDREN'S HOSPITAL TO INTRODUCE A PEDIATRIC ORTHOSIS "SNUG-CP SUIT," DESIGNED FOR CHILDREN WITH CEREBRAL PALSY, WHICH PROVIDES SENSORY FEEDBACK THAT IMPROVES CONTROL AND REDUCES MUSCLE SPASTICITY. THE DESIGNATED SITE FOR THE NEWBORN SCREENING MANAGEMENT PROGRAM FOR THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, PROVIDING CARE FOR INDIVIDUALS WITH METABOLIC DISORDERS FROM BIRTH THROUGHOUT ADULTHOOD. HAS TWO STATE-OF-THE-ART CARDIAC CATHERIZATION LABS FEATURING THE LATEST EQUIPMENT FOR DIAGNOSTIC AND INTERVENTIONAL PROCEDURES. HOME TO MICHIGAN'S ONLY PEDIATRIC BURN CENTER. HOME TO MICHIGAN'S TOP PEDIATRIC IMAGING CENTER - OFFERING THE MOST ADVANCED PEDIATRIC IMAGING CAPABILITIES, INCLUDING A 3.0T SHORT BORE SCANNER, WHICH REDUCES THE INSTANCE OF SEDATION IN CHILDREN. OPERATES THE ONLY POISON CONTROL CENTER IN THE STATE OF MICHIGAN, FOCUSED ON POISON PREVENTION, EDUCATION, TRIAGE AND TREATMENT. THE POISON CONTROL CENTER ANSWERS MORE THAN 9,000 CALLS PER MONTH. THE RONALD MCDONALD HOUSE IS ON THE CAMPUS OF CHILDREN'S HOSPITAL OF MICHIGAN AND IS AVAILABLE TO FAMILIES OF SICK CHILDREN SO THAT THEY CAN SPEND THE NIGHT CLOSE TO THEIR CHILD.
4b (Code:   ) (Expenses $ 32,436,120 including grants of $   ) (Revenue $ 32,229,605 )
ONCOLOGY - THE DIVISION OF HEMATOLOGY/ONCOLOGY AT CHILDREN'S HOSPITAL OF MICHIGAN IS A NATIONAL AND INTERNATIONAL LEADER IN THE FIELD. IN 2010, PEDIATRIC HEMATOLOGY AND ONCOLOGY SPECIALISTS SAW 1,444 INPATIENT CASES, RESULTING IN 5,712 PATIENT DAYS IN THE HOSPITAL. THE OLDEST PEDIATRIC HEMATOLOGY/ONCOLOGY PROGRAM IN MICHIGAN, THE DIVISION COMBINES STATE-OF-THE-ART DIAGNOSIS AND TREATMENT OPTIONS WITH COMPASSIONATE CARE BY 13 BOARD-CERTIFIED PEDIATRIC SPECIALISTS AND MORE THAN 75 SUPPORT STAFF. DIVISION SPECIALISTS WORK CLOSELY WITH OTHER PEDIATRIC SUBSPECIALISTS TO PROVIDE THE HIGHEST LEVEL OF COORDINATED, MULTIDISCIPLINARY CARE. OVER THE YEARS, THE PROGRAM HAS MADE MAJOR CONTRIBUTIONS TO THE UNDERSTANDING AND TREATMENT OF PEDIATRIC BLOOD DISEASES AND CANCER. SERVICES PROVIDED IN THIS DIVISION ARE FOR CHILDREN SUFFERING FROM BLOOD AND CANCER RELATED DISEASES AND DISORDERS. AMONG THESE SERVICES ARE OUR SICKLE CELL CLINIC AND BONE MARROW TRANSPLANT PROGRAM AND DEDICATED UNIT. AS FACULTY MEMBERS AT WAYNE STATE UNIVERSITY, THE PHYSICIANS ARE INVOLVED IN EXTENSIVE CLINICAL, TRANSLATIONAL AND BENCH RESEARCH IN PEDIATRIC BLOOD DISEASES, COAGULATION AND BLEEDING DISORDERS AND CANCER/LEUKEMIA. MUCH OF THIS RESEARCH IS FUNDED BY THE NATIONAL INSTITUTES OF HEALTH, NATIONAL CANCER INSTITUTE AND OTHER AGENCIES, INCLUDING THE LEUKEMIA AND LYMPHOMA SOCIETY AND THE NATIONAL HEMOPHILIA FOUNDATION.
4c (Code:   ) (Expenses $ 26,868,829 including grants of $   ) (Revenue $ 31,333,420 )
SURGERY (GENERAL) - IN 2010, PEDIATRIC SURGICAL SPECIALISTS AT CHILDREN'S HOSPITAL OF MICHIGAN CONDUCTED 13,926 INPATIENT AND OUTPATIENT SURGICAL PROCEDURES OR OPERATIONS ON CHILDREN OF ALL AGES, RESULTING IN 2,809 INPATIENT CASES AND 14,506 DAYS OF HOSPITAL CARE. FROM APPENDECTOMIES TO HEART TRANSPLANTS, CHILDREN'S HOSPITAL OFFERS A WIDE RANGE OF PEDIATRIC SURGERY OPTIONS WITH A MULTIDISCIPLINARY TEAM OF SURGEONS AND OTHER HEALTH CARE PROVIDERS DELIVERING AN UNPARALLELLED LEVEL OF PEDIATRIC SURGICAL CARE. PEDIATRIC SURGERY SUBSPECIALISTS AT CHILDREN'S HOSPITAL INCLUDE THOSE IN THE FOLLOWING SPECIALTIES: ANESTHESIOLOGY, CARDIOVASCULAR SURGERY INCLUDING HEART TRANSPLANTS, CLEFT AND CRANIOFACIAL SURGERY, DENTAL AND ORAL SURGERY, EAR NOSE AND THROAT SURGERY, KIDNEY TRANSPLANTS, NEUROSURGERY INCLUDING BRAIN TUMOR REMOVAL, ORTHOPEDIC SURGERY, PEDIATRIC SURGERY INCLUDING BURN AND TRAUMA SURGERY, EYE SURGERY AND PLASTIC AND RECONSTRUCTIVE SURGERY AND UROLOGICAL SURGERY AMONG OTHER SERVICES. IF A CHILD REQUIRES SURGERY WHERE MULTIDISCIPLINARY CARE IS REQUIRED, CHILDREN'S PEDIATRIC SUBSPECIALTY SURGEONS WORK TOGETHER TO PROVIDE THE BEST CARE TO CHILDREN WITH COMPLEX INJURIES OR CONGENITAL ANOMOLIES. THE AVAILABILITY OF THESE MULTIDISCIPLINARY PEDIATRIC SURGICAL TEAMS IS ONE OF THE MANY ADVANTAGES OF TREATMENT AT THE CHILDREN'S HOSPITAL OF MICHIGAN.
(Code:   ) (Expenses $ 203,450,023 including grants of $   ) (Revenue $ 231,733,511 )
NEONATOLOGY - 1,458 TOTAL CASES; 6,133 INPATIENT DAYS; 1,044 OUTPATIENT REGISTRATIONS EMERGENCY MEDICINE - 59,836 TOTAL CASES; 2 INPATIENT DAYS; 59,834 OUTPATIENT REGISTRATIONS CRITICAL CARE/INTENSIVE CARE - 458 TOTAL CASES; 3,344 INPATIENT DAYS; 140 OUTPATIENT REGISTRATIONS NEUROSURGERY - 2,529 TOTAL CASES; 3,677 INPATIENT DAYS; 1,779 OUTPATIENT REGISTRATIONS
4d Other program services. (Describe in Schedule O.)
(Expenses $ 203,450,023 including grants of $   ) (Revenue $ 231,733,511 )
4e Total program service expensesMediumBullet$ 326,338,680
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 I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
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
 
No
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
 
No
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
Yes
 
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.........
14b
 
No
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..
15
 
No
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..
16
 
No
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 IClick to see attachment
17
Yes
 
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.......... Click to see attachment
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................... Click to see attachment
19
Yes
 
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. ..... Click to see attachment
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..
21
 
No
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.....
22
 
No
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................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
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
 
No
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
Yes
 
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
Yes
 
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
322
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
2,540
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
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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
38
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
29
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
Yes
 
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
Yes
 
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
 
No
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
JOSEPH T SCALLEN JR
3901 BEAUBIEN BLVD
DETROIT,MI48201
(313) 745-3280
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) HERMAN B GRAY JR MD
DMC SVP/PRES
 58.00 X   X       372,723 0 117,824
(2) ANGELILLI MARY LU MD
TRUSTEE
 1.00 X           0 0 0
(3) TONY ANTONE
TRUSTEE
 1.00 X           0 0 0
(4) ELAINE BAKER
TRUSTEE
 1.00 X           0 0 0
(5) JOHN D BAKER MD
CHAIRMAN
 3.00 X   X       0 0 0
(6) FRANK COUZENS JR
TRUSTEE
 1.00 X           0 0 0
(7) DOUGLAS M ETKIN
TRUSTEE
 1.00 X           0 0 0
(8) JOANNE B FAYCURRY
VICE CHAIR
 2.00 X   X       0 0 0
(9) CYNTHIA FORD
TRUSTEE
 1.00 X           0 0 0
(10) MATTHEW FRIEDMAN
TRUSTEE
 1.00 X           0 0 0
(11) MAXINE FRANKEL
TRUSTEE
 1.00 X           0 0 0
(12) ERICA WARD GERSON
TRUSTEE
 1.00 X           0 0 0
(13) JOHN GINOPOLIS
TRUSTEE
 1.00 X           0 0 0
(14) PATRICIA HEFTLER
TRUSTEE
 1.00 X           0 0 0
(15) REVEREND NICHOLAS HOOD III
TRUSTEE
 1.00 X           0 0 0
(16) JOSEPH G HORONZY
TRUSTEE
 1.00 X           0 0 0
(17) ARTHUR BUHL HUDSON
TRUSTEE
 1.00 X           0 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) GILBERT HUDSON
TRUSTEE
 1.00 X           0 0 0
(19) JANE IACOBELLI
TRUSTEE
 1.00 X           0 0 0
(20) ANNE-MARE ICE MD
TRUSTEE
 1.00 X           0 0 0
(21) JOSEPHINE KESSLER
TRUSTEE
 1.00 X           0 0 0
(22) NICK KHOURY
TREASURER
 2.00 X   X       0 0 0
(23) LINDA JACOB KOWALSKI
TRUSTEE
 1.00 X           0 0 0
(24) EDWARD C LEVY JR
TRUSTEE
 1.00 X           0 0 0
(25) CAROL MARANTETTE
TRUSTEE
 1.00 X           0 0 0
(26) FLORINE MARK
TRUSTEE
 1.00 X           0 0 0
(27) ALYSSA MARTINA
TRUSTEE
 1.00 X           0 0 0
(28) DAVID K PAGE
TRUSTEE
 1.00 X           0 0 0
(29) JESSICA S PELLEGRINO
TRUSTEE
 1.00 X           0 0 0
(30) GLORIA W ROBINSON
VICE CHAIR
 2.00 X   X       0 0 0
(31) BRUCE H ROSEN
TRUSTEE
 1.00 X           0 0 0
(32) DEREK SARAFA
TRUSTEE
 1.00 X           0 0 0
(33) ASHOK SARNAIK MD
TRUSTEE
 1.00 X           0 0 0
(34) AARON SHERBIN
TRUSTEE
 1.00 X           0 0 0
(35) THOMAS L SLOVIS MD
TRUSTEE
 1.00 X           0 0 0
(36) BONITA F STANTON MD
TRUSTEE
 1.00 X           0 0 0
(37) LYLE M WOLBERG
TRUSTEE
 1.00 X           0 0 0
(38) ALAN R WOODLIFF
VICE CHAIR
 2.00 X   X       0 0 0
(39) GEORGE W WRIGLEY
TRUSTEE
 1.00 X           0 0 0
(40) JOSEPH T SCALLEN JR
VP FINANCE C
 52.00     X       240,057 0 82,019
(41) LUANNE M EWALD
SECRETARY
 50.00     X       149,721 0 71,710
(42) RICHARD REYNOLDS MD
CHIEF OF PED
 71.00       X     820,565 0 31,428
(43) SHAWN LEVITT
VP/COO
 50.00       X     189,013 0 79,316
(44) RHONDA FOSTER
VP PAT CARE
 50.00       X     178,775 0 76,753
(45) HENRY WALTERS III
CF PED CARDI
 60.00         X   1,028,851 0 15,268
(46) WALID YASSIR
PHY PED SURG
 60.00         X   807,110 0 34,374
(47) RALPH DELIUS
AST CF PED S
 55.00         X   786,657 0 12,448
(48) ERIC JONES
PHYS PED SUR
 55.00         X   746,260 0 26,570
(49) YEGAPPAN LAKSHMANAN
CF PED UROLO
 60.00         X   613,743 0 33,726
(50) PATRICK R KELLY
FMR OFFICER
 50.00           X 197,814 0 26,529
(51) CHAD M GRANT
FMR OFFICER
 0.00           X 0 184,202 70,154
(52) JANICE COTTRELL
FR AS VP PAT
 50.00           X 146,795 0 45,056
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,278,084 184,202 723,175
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet77
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
Yes
 
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
WAYNE STATE UNIVERSITY
PO BOX 02788
DETROIT,MI48202 		PHYSICIAN SVS 22,110,133
MICHIGAN PEDIATRIC SURGERY ASSOC PC
PO BOX 36605
DETROIT,MI48236 		PHYSICIAN SVS 3,158,288
PEDIATRIC ANESTHESIA ASSOCIATES
PO BOX 67000 DRAWER 119901
DETROIT,MI48267 		PHYSICIAN SVS 2,443,087
UNIVERSITY PEDIATRICIANS
7112 GATEWAY PARK DRIVE
CLARKSTON,MI48346 		PHYSICIAN SVS 1,767,998
PEDIATRIC NEUROSURGERY GROUP PC
3901 BEAUBIEN BLVD
DETROIT,MI48201 		PHYSICIAN SVS 885,667
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet32
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a 220,348
b Membership dues....1b  
c Fundraising events....1c 13,053
d Related organizations...1d 597,399
e Government grants (contributions)1e 2,479,994
f All other contributions, gifts, grants, and
similar amounts not included above1f 		6,848,242
g Noncash contributions included in lines 1a-1f:$ 265,500
h Total. Add lines 1a-1f.......MediumBullet 10,159,036
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE   365,306,638 365,306,638    
b OUTPATIENT PHARMACY REVENUE   5,289,123 5,289,123    
c PET, KIDS HEAR AIDS, EEG, ETC   584,622 584,622    
d EDUCATION PROGRAM REVENUE   70,266 70,266    
e PROGRAM SERVICE RENTAL INC.   27,213 27,213    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 371,277,862
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 16,180,631     16,180,631
4 Income from investment of tax-exempt bond proceeds..MediumBullet 22     22
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 52,660  
b Less: rental expenses    
c Rental income or (loss) 52,660  
d Net rental income or (loss).......MediumBullet 52,660     52,660
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 97,926,074  
b Less: cost or other basis and sales expenses 90,314,728  
c Gain or (loss) 7,611,346  
d Net gain or (loss)..........MediumBullet 7,611,346     7,611,346
8a Gross income from fundraising events (not including
$ 13,053
of contributions reported on line 1c). See Part IV, line 18 ...
a 4,720
b Less: direct expenses ...b 5,040
c Net income or (loss) from fundraising events..MediumBullet -320   -320
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 47,642
b Less: direct expenses ...b 21,792
c Net income or (loss) from gaming activities...MediumBullet 25,850     25,850
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a PARKING REVENUE   442,853     442,853
b VENDING MACHINE COMMISSIONS   36,850     36,850
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 479,703
12 Total revenue. See Instructions....MediumBullet 405,786,790 371,277,862   24,349,892
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    
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
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 .... 2,131,180 1,536,003 516,567 78,610
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 131,816,703 130,239,634   1,577,069
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 5,764,190 5,711,062   53,128
9 Other employee benefits ....... 16,714,299 16,504,002   210,297
10 Payroll taxes ........... 8,525,349 8,412,241   113,108
11 Fees for services (non-employees):        
a Management ...... 1,034,676 1,034,676    
b Legal ......... 2,890 2,890    
c Accounting ........... 455 455    
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17.. 31,960 31,960
f Investment management fees ......        
g Other .......... 40,518,220 40,153,404 48,000 316,816
12 Advertising and promotion .... 2,407,093 2,176,250   230,843
13 Office expenses ....... 1,629,348 1,582,697   46,651
14 Information technology ...... 199,761 199,761    
15 Royalties ..        
16 Occupancy ........... 7,155,826 7,155,826    
17 Travel ............ 555,405 539,877   15,528
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 347,047 296,113   50,934
20 Interest ........... 2,710,662 2,710,662    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 13,549,815 13,549,815    
23 Insurance .............. 313,000 313,000    
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 SUPPLIES - MEDICAL 40,458,541 40,458,524   17
b DMC SUPPORT SERVICES 25,933,404   25,466,368 467,036
c DMC SUPPORT SVS - MIS 18,208,384 11,204,505 7,003,879  
d BAD DEBT EXPENSE 12,897,793 12,897,793    
e DMC SUPPORT SVS - LAB 9,013,916 9,013,916    
f All other expenses 20,661,679 20,645,574   16,105
25 Total functional expenses. Add lines 1 through 24f 362,581,596 326,338,680 33,034,814 3,208,102
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 .......... 32,455,112 1 11,594,419
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net ......... 2,732,047 3 1,457,893
4 Accounts receivable, net ......... 25,698,023 4 23,520,864
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 ............. 412,876,499 7  
8 Inventories for sale or use .............. 6,002,885 8 7,961,114
9 Prepaid expenses and deferred charges ............ 1,336,341 9 1,328,707
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 309,406,412
b Less: accumulated depreciation. ..... 10b 229,752,097 85,030,390 10c 79,654,315
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 141,008,591 15 105,003,398
16 Total assets. Add lines 1 through 15 (must equal line 34)... 707,139,888 16 230,520,710
Liabilities 17 Accounts payable and accrued expenses . 24,115,910 17 24,778,822
18 Grants payable ..........   18  
19 Deferred revenue .......... 13,528,134 19 14,964,029
20 Tax-exempt bond liabilities .......... 30,701,500 20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
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 .. 1,872,391 23 98,765
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 15,514,961 25 9,865,694
26 Total liabilities. Add lines 17 through 25..... 85,732,896 26 49,707,310
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 ..... 531,053,884 27 86,077,280
28 Temporarily restricted net assets ..... 42,563,345 28 46,891,148
29 Permanently restricted net assets ..... 47,789,763 29 47,844,972
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 ..... 621,406,992 33 180,813,400
34 Total liabilities and net assets/fund balances ..... 707,139,888 34 230,520,710
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
405,786,790
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
362,581,596
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
43,205,194
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
621,406,992
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-483,798,786
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
180,813,400
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
Yes
 
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
Yes
 
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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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
CHILDREN'S HOSPITAL OF MICHIGAN
  		Employer identification number

38-1357994
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
CHILDREN'S HOSPITAL OF MICHIGAN
  		Employer identification number

38-1357994
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
CHILDREN'S HOSPITAL OF MICHIGAN
  		Employer identification number

38-1357994
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 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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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 .... 68,156,940 56,521,334 84,514,698
b Contributions ........ 417,475 262,993 590,119
c Investment earnings or losses ... 8,846,343 13,016,148 -23,680,398
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		-14,704,747 -1,643,535 -4,903,085
f Administrative expenses ....      
g End of year balance ...... 62,716,011 68,156,940 56,521,334
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet73.000 %
c
Term endowment: SchDMd Bullet27.000 %
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)
Yes
 
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
No
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 .................   3,743,097 3,743,097
b Buildings ................   152,469,162 105,174,086 47,295,076
c Leasehold improvements ............   277,879 277,879  
d Equipment ................   149,478,645 123,932,304 25,546,341
e Other .................   3,437,629 367,828 3,069,801
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 79,654,315
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) PERM RESTRICTED ASSETS 47,684,168
(2) TEMP RESTRICTED ASSETS 46,362,306
(3) ESTIMATED 3RD PARTY SETTLEMENT 7,332,783
(4) OTHER RECEIVABLES 2,766,308
(5) OTHER ASSETS 342,040
(6) FUNDS FUNCTIONING AS ENDOWMENT 231,347
(7) INVESTMENT IN AHPF 132,760
(8) DUE FROM AFFILIATES 123,736
(9) INVESTMENT IN DMCIC 27,950
(10) FUNDS HELD - BOND AGREEMENT  
(11) DEFERRED DEBT ISSUANCE  
(12) FUNDED DEPRECIATION  
(13) OTHER BOARD DESIGNATED FUNDS  
Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 105,003,398
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
PROFESSIONAL LIABILITY 4,975,407
ESTIMATED SETTLEMENTS TO 3RD PARTIES 2,565,657
ADVANCES FROM 3RD PARTY PAYORS 1,832,029
DUE TO AFFILIATES 1,066,090
L/T LIABILITY PENSION -573,489




Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 9,865,694
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
SUPPLEMENTAL FINANCIAL INFORMATION SCHEDULE D, PAGE 4, PART XIV THE ENDOWMENTS SUPPORT PATIENTS' WELL-BEING BY PROVIDING OUTREACH SERVICES IN CHILD LIFE, TRAUMA-RELATED INJURIES AND PEDIATRIC PATIENT CARE EDUCATION. THEY SUPPORT RESEARCH IN OPHTHALMOLOGY, ONCOLOGY, HEMATOLOGY, COMMUNICATION DISORDERS, NEPHROLOGY, RHEUMATOLOGY, UROLOGY, ETC. THEY PROVIDE FOR EQUIPMENT PURCHASES AND COMMUNITY AND HOSPITAL EDUCATION FOR THE NURSES, PEDIATRICIANS AND OTHER HOSPITAL STAFF MEMBERS. ENDOWMENTS SUPPORT NINE CHAIRS AT WAYNE STATE UNIVERSITY IN SURGERY, UROLOGY, NEUROSCIENCE, OTORHINOLARYNGOLOGY, ONCOLOGY, HEMATOLOGY AND NEUROPSYCHIATRY. ENDOWMENTS SUPPORT THREE PROFESSORSHIPS AT WAYNE STATE UNIVERSITY IN URBAN HEALTH, PEDIATRIC NURSING AND PEDIATRIC NEUROSURGERY.
Schedule D (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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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
 
CONVIO
11501 DOMAIN DRIVE SUITE 200
 
AUSTIN, TX78758 		ONLINE PRG   No 50,597 31,960 18,637
Total .................right arrow 50,597 31,960 18,637
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.
MI, FL, NJ, NY
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

DON'T BE CRUEL
(event type) 		(b) Event #2

KIDNEYS FOR KID
(event type) 		(c) Other Events

  
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 10,950 6,823   17,773
2 Less: Charitable
contributions . . . 		6,880 6,173   13,053
3 Gross income (line 1
minus line 2) . . . 		4,070 650   4,720
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages . . 4,060 980   5,040
8 Entertainment . . .        
9 Other direct expenses .        
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 5,040
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -320
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 . . . .     47,642 47,642
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .     21,742 21,742
4 Rent/facility costs . . .        
5 Other direct expenses . .     50 50
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow 21,792
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow 25,850
9
Enter the state(s) in which the organization operates gaming activities: MI
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
100.000 %
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
JOSEPH T SCALLEN JR
Address right arrow
3901 BEAUBIEN BLVD
DETROIT,MI48201
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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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
Yes
 
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
Yes
 
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
Yes
 
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
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
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) .. 		    143,144   143,144 0.040 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    227,799,484 222,104,966 5,694,518 1.570 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     1,900,230 1,148,366 751,864 0.210 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		    229,842,858 223,253,332 6,589,526 1.820 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    790,033   790,033 0.220 %
f Health professions education
(from Worksheet 5) .. 		    17,403,475 18,134,982 -731,507  
g Subsidized health services
(from Worksheet 6) .. 		    5,822,312 4,673,407 1,148,905 0.320 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		           
jTotal Other Benefits ...     24,015,820 22,808,389 1,207,431 0.530 %
kTotal. Add lines 7d and 7j. ..     253,858,678 246,061,721 7,796,957 2.350 %
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            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
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
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
4,300,687
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
143,144
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
3,050,831
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
3,687,822
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-636,991
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 %
1
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?12
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 CHILDREN'S HOSPITAL OF MICHIGAN
3901 BEAUBIEN BLVD
DETROIT,MI48201 		X X X X   X X    
2 CHILDREN'S HOSPITAL OF MICHIGAN
STILSON SPECIALTY CTR CLINTON TWP
42700 GARFIELD ROAD
CLINTON TOWNSHIP,MI48038 		X                
3 WARREN REHABILITATION CENTER
28755 SCHOENHERR SUITE 100
WARREN,MI48088 		X                
4 NOVI REHABILITATION CENTER
42005 WEST TWELVE MILE ROAD
NOVI,MI48377 		X                
5 CHILDREN'S HOSPITAL OF MICHIGAN
SPECIALTY CENTER - NOVI
41935 W TWELVE MILE ROAD STE 100
NOVI,MI48377 		X                
6 WESTLAND REHABILITATION CENTER
36301 WARREN ROAD
WESTLAND,MI48185 		X                
7 CHILDREN'S HOSPITAL OF MICHIGAN
ALEX J ETKIN SPEC CTR-SOUTHFIELD
29120 FRANKLIN ROAD
SOUTHFIELD,MI48034 		X                
8 MADISON HEIGHTS REHABILITATION
CENTER
30671 STEPHENSON HIGHWAY
MADISON HEIGHTS,MI48071 		X                
9 CHILDREN'S HOSPITAL OF MICHIGAN
SPECIALTY CENTER - DEARBORN
25325 FORD ROAD
DEARBORN HEIGHTS,MI48128 		X                
10 CHILDREN'S HOSPITAL OF MICHIGAN
SPECIALTY CENTER - BIRMINGHAM
2059 E 14 MILE ROAD
BIRMINGHAM,MI48009 		X                
11 CHILDREN'S HOSPITAL OF MICHIGAN
SPECIALTY CENTER - CANTON
2050 HAGGERTY ROAD SUITE 200
CANTON,MI48187 		X                
12 CHILDREN'S HOSPITAL OF MICHIGAN
SPECIALTY CTR - WEST BLOOMFIELD
5635 W MAPLE ROAD
WEST BLOOMFIELD,MI48322 		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:CHILDREN'S HOSPITAL OF MICHIGAN
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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:CHILDREN'S HOSPITAL OF MICHIGAN
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:WARREN REHABILITATION CENTER
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:NOVI REHABILITATION CENTER
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:CHILDREN'S HOSPITAL OF MICHIGAN
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:WESTLAND REHABILITATION CENTER
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:CHILDREN'S HOSPITAL OF MICHIGAN
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:MADISON HEIGHTS REHABILITATION
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:CHILDREN'S HOSPITAL OF MICHIGAN
Line Number of Hospital Facility (from Schedule H, Part V, Section A):9

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:CHILDREN'S HOSPITAL OF MICHIGAN
Line Number of Hospital Facility (from Schedule H, Part V, Section A):10

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:CHILDREN'S HOSPITAL OF MICHIGAN
Line Number of Hospital Facility (from Schedule H, Part V, Section A):11

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
If “Yes,” explain in Part VI.
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:CHILDREN'S HOSPITAL OF MICHIGAN
Line Number of Hospital Facility (from Schedule H, Part V, Section A):12

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    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
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    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
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    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
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    
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    
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    
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    
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    
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?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
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
COSTING METHODOLOGY EXPLANATION PART I LINE 7 MEDICARE T18 RCC WITHOUT GME
COMMUNITY BUILDING ACTIVITIES PART II THE WAYNE EARLY ON INTERAGENCY COORDINATING COUNCIL ICC IS A GROUP OF WAYNE COUNTY PUBLIC AND PRIVATE ORGANIZATIONS THAT MEET FIVE TIMES PER YEAR TO PROVIDE GUIDANCE AND OVERSIGHT FOR THE EARLY ON PROGRAM EARLY ON IS A SYSTEM OF SERVICES FOR CHILDREN FROM BIRTH TO THREE YEARS OF AGE WITH SPECIAL NEEDS AND DEVELOPMENTAL DELAYS THE GREAT START COLLABORATIVEWAYNE IS A GROUP OF WAYNE COUNTY PUBLIC AND PRIVATE ORGANIZATIONS BUSINESSES AND LEGISLATORS THIS GROUP MEETS EACH QUARTER TO ENGAGE THE COMMUNITY TO ASSURE A COORDINATED SYSTEM OF SERVICES AND RESOURCES FOR ALL WAYNE COUNTY FAMILIES TO ASSIST THEM IN PROVIDING A GREAT START FOR THEIR CHILDREN FROM BIRTH TO FIVE YEARS OF AGE
BAD DEBT EXPENSE EXPLANATION PART III LINE 4 MEDICARE T18 RCC ST L24
COLLECTION PRACTICES EXPLANATION PART III LINE 9B FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE FOR FINANCIAL ASSISTANCE PATIENTS WHO QUALIFY FOR 100 CHARITY CARE BASED UPON DMC POLICY NO STATEMENTS OR COLLECTION ACTIVITY IS INITIATED OUTSTANDING ACCOUNT BALANCES ARE IMMEDIATELY ADJUSTED FROM ACCOUNTS RECEIVABLES PATIENTS WHO QUALIFY FOR A DISCOUNTED RATE BASED UPON DMC POLICY STATEMENTS ARE MAILED TO THE PATIENT AT REDUCED RATES EVERY ATTEMPT WILL BE MADE TO ESTABLISH A PAYMENT ARRANGEMENT COLLECTION ACTIVITY WILL BE INITIATED ONLY IF THE TERMS OF THE PAYMENT ARRANGEMENTS ARE BREECHED
NEEDS ASSESSMENT PART VI THE CHILDRENS HOSPITAL OF MICHIGAN WAS FIRST ESTABLISHED IN 1886 AS THE CHILDRENS FREE HOSPITAL ASSOCIATION AND BECAME THE CHILDRENS HOSPITAL OF MICHIGAN IN 1922 SINCE ITS VERY BEGINNING 125 YEARS AGO THE MISSION OF THE HOSPITAL HAS BEEN TO PROVIDE CARE TO ALL CHILDREN REGARDLESS OF THEIR ABILITY TO PAY FOR HEALTH CARE SERVICES THE MISSION TODAY REMAINS UNCHANGED AS OUR FOUNDER DR CHARLES DEVENDORF CONVEYED WE WILL TAKE THE MOST HOPELESS CASES THERE WILL BE NO DISTINCTION OF CREED OR RACE ALL THE CHILDREN WHO ARE SUFFERING FROM WANT OF CARE OR ILLNESS IN DETROIT WILL BE NURSED AND MADE WELL IF WE CAN DO IT HALF OF CHILDRENS INPATIENT ADMISSIONS ARE DERIVED FROM ITS PRIMARY MARKET REGION WHICH INCLUDES DETROIT AND PARTS OF WAYNE COUNTY ANOTHER 30 OF ITS MARKET SHARE COMES FROM OTHER COMMUNITIES WITHIN SOUTHEAST MICHIGAN WAYNE OAKLAND MACOMB AND OTHER COUNTIES AND THE REMAINING 20 OF ITS ADMISSIONS ARE FROM OTHER COMMUNITIES THROUGHOUT THE STATE OF MICHIGAN AND BEYOND CHILDRENS OFFERS MORE THAN 40 MEDICAL AND SURGICAL SPECIALTIES AND SERVICES AND TRAINS MORE PEDIATRIC SPECIALISTS THAN ANY OTHER HOSPITAL IN THE STATE IN 2011 THE TOTAL POPULATION IN THE TRICOUNTY AREA WAYNE OAKLAND AND MACOMB COUNTIES INCLUDING THE CITY OF DETROIT IS APPROXIMATELY 38 MILLION PEOPLE APPROXIMATELY 24 OF THE POPULATION IS COMPRISED OF CHILDREN UNDER THE AGE OF 18 TWENTY FIVE PERCENT 25 OF THE POPULATION IN WAYNE COUNTY IS UNDER THE AGE OF 18 MAKING IT THE COUNTY WITH THE GREATEST NUMBER OF CHILDREN IN THE TRICOUNTY AREA BASED UPON 2010 CENSUS DATA 83 OF THE CITY OF DETROITS POPULATION IS AFRICAN AMERICAN 11 IS WHITE AND 7 IS HISPANICLATINO IN COMPARISON 52 OF THE POPULATION IN WAYNE COUNTY IS WHITE 40 AFRICAN AMERICAN AND 8 REPRESENTS OTHER ETHNIC GROUPS IN MACOMB COUNTY 85 OF THE POPULATION IS WHITE 7 AFRICAN AMERICAN AND FEWER THAN 8 REPRESENTING OTHER RACESETHNICITIES SOURCE US CENSUS QUICK FACTS DATA 2010 WAYNE COUNTY RESIDENTS HAVE LOWER RATES OF HIGHSCHOOL COMPLETION WHEN COMPARED TO INDIVIDUALS IN NEIGHBORING COUNTIES AND THESE RATES ARE MUCH LOWER FOR THOSE LIVING IN THE CITY OF DETROIT RECENT REPORTS INDICATE THAT 6570 OF STUDENTS LIVING IN DETROIT WILL COMPLETE HIGH SCHOOL THE DETROIT LITERACY COALITION 2011 ESTIMATES THAT MORE THAN 47 OF METROPOLITAN DETROITERS ARE FUNCTIONALLY ILLITERATE DETROITERS ALSO FACE INCOME CHALLENGES WITH AN ESTIMATE OF MORE THAN 14 OF THE CITYS POPULATION LIVING BELOW THE POVERTY LINE IN 2010 OVER 21 OF WAYNE COUNTY RESIDENTS LIVE BELOW THE POVERTY LINE AS COMPARED TO FEWER THAN 9 OF RESIDENTS LIVING IN OAKLAND AND MACOMB COUNTIES CHILDRENS HOSPITAL SERVES A DIVERSE REGION WHERE THERE ARE GROSS DISPARITIES IN EDUCATION INCOME AND HEALTH OUTCOMES FOR CHILDREN LIVING IN THE CITY OF DETROIT OR WAYNE COUNTY ACCORDING TO THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH SOME OF THE MOST SIGNIFICANT HEALTH ISSUES AFFECTING CHILDREN IN DETROIT AND WAYNE COUNTY INCLUDE DEATHS FROM UNINTENTIONAL INJURIES THIS IS THE MOST FREQUENTLY REPORTED CAUSE OF DEATH FOR ALL CHILDREN UNDER THE AGE OF 20 REGARDLESS OF WHERE THEY RESIDE CHILDREN LIVING IN WAYNE COUNTY INCLUDING THE CITY OF DETROIT ARE 23 TIMES MORE LIKELY TO DIE BECAUSE OF AN UNINTENTIONAL INJURY THE SECOND MOST REPORTED CAUSE OF DEATH IS HEART DISEASE FOLLOWED BY CHRONIC RESPIRATORY DISEASES OTHER HEALTH ISSUES IMPACTING CHILDREN IN THE COMMUNITIES CHILDRENS SERVES INCLUDE CHILDHOOD ASTHMA LEAD POISONING CHILD MALTREATMENT SEXUALLY TRANSMITTED DISEASES CHILDHOOD NUTRITION OBESITY AND HUNGER MENTAL HEALTH ISSUES AND CHRONIC DISEASE THE HEALTH ISSUES AND CHALLENGES JUST REFERENCED HELP THE CHILDRENS HOSPITAL OF MICHIGAN PLAN AND DELIVER SERVICES PROGRAMS AND SUPPORT TO IMPROVE THE HEALTH AND WELL BEING OF CHILDREN THROUGHOUT THE COMMUNITY TO FULFILL ITS MISSION EACH YEAR IN ADDITION TO CARING FOR EVERY CHILD WHO ENTERS OUR DOORS FOR PEDIATRIC SPECIALTY CARE THE CHILDRENS HOSPITAL OF MICHIGAN SUPPORTS MANY COMMUNITY OUTREACH ACTIVITIES THAT IMPACT THE HEALTH AND WELL BEING OF CHILDREN CHILDRENS HAS DEDICATED STAFF THAT TREATS TEACHES AND INFORMS FAMILIES ABOUT HEALTH IMPROVEMENT AND PREVENTION ACTIVITIES THIS STAFF FOCUSES ON MANAGEMENT OF CHRONIC DISEASES FOR CHILDREN SUFFERING FROM EVERYTHING FROM SICKLE CELL DISEASE AND HEMOPHILIA TO HIVAIDS AND CANCER THROUGH SCHOOL AND FAITHBASED OUTREACH CHILDRENS INJURY PREVENTION TEAM EDUCATES AND INFORMS THE COMMUNITY ABOUT WAYS TO PREVENT UNINTENTIONAL INJURY CHILDRENS HOSPITALS POISON CONTROL CENTER PROVIDES FREE TELEPHONE SUPPORT AND TRIAGE TO THE ENTIRE STATE FIELDING MORE THAN 85000 CALLS ANNUALLY THIS SAME TEAM IS COMMITTED TO ATTENDING NUMEROUS HEALTH FAIRS EACH YEAR TO TEACH CHILDREN AND FAMILIES HOW TO BE SAFE FROM ACCIDENTAL POISONING IN 2010 CHILDRENS HOSPITAL SUPPORTED A HIGHLY SUCCESSFUL CEREAL DRIVE TO HELP GLEANERS COMMUNITY FOOD BANK FEED NEEDY CHILDREN LEAD BY OUR PROFESSIONAL NURSING PRACTICE COUNCIL THE HOSPITAL SECURED 337673 SERVINGS OF CEREAL FOR KIDS WHO MIGHT NOT GET AN ADEQUATE BREAKFAST DURING THE SUMMER MONTHS WHEN THEYRE NOT IN SCHOOL CHILDRENS HOSPITAL OF MICHIGANS PRESIDENT SERVED AS THE CHAIR OF THE ANNUAL METROPOLITAN DETROIT AMERICAN DIABETES WALK SECURING 320 WALKERS FROM THE HOSPITAL AND HEALTH SYSTEM AND RAISING 25118 FOR THIS IMPORTANT CAUSE AND ILLNESS THAT AFFECTS SO MANY CHILDREN AND THEIR FAMILIES OUR INJURY PREVENTION TEAMS WORK REACHES FAR AND WIDE THROUGHOUT THE COMMUNITIES WE SERVE THEY PROVIDED NEARLY 500 EDUCATIONAL PROGRAMS REACHING NEARLY 50000 PARENTS AND KIDS THROUGHOUT OUR REGION LAST YEAR ALONE TOPICS RANGED FROM BIKE HELMET GUN MOTOR VEHICLE AND BUS AND PET SAFETY TO GOOD TOUCHBAD TOUCH CHOKING PREVENTION HOME FIRE AND BURN SAFETY SAFE SLEEP FOR INFANTS AND CPRBASIC LIFE SUPPORT THE TEAM ALSO PARTICIPATED IN OVER 200 COMMUNITY EVENTS REACHING OVER 95000 CHILDREN AND ADULTS THESE EVENTS FOCUSED ON FITTING AND DISTRIBUTING FREE AND ATCOST BIKE HELMETS A SAFE HALLOWEEN EVENT CAR SEAT AND BOOSTER SEAT SAFETY CHECKS AND PROVIDING AND INSTALLING SMOKE ALARMS FOR FAMILIES THE CHILDRENS HOSPITAL OF MICHIGAN ALSO SERVES CHILDREN IN NEED THROUGH ITS HAMTRAMCK SCHOOLBASED HEALTH CENTER IN ADDITION TO PROVIDING IMMUNIZATIONS AND PHYSICALS THE SCHOOL BASED CLINIC PROVIDES A VARIETY OF HEALTH EDUCATION PROGRAMS TO AREA RESIDENTS AND FAMILIES ON TOPICS RANGING FROM TEEN HYGIENE BIKE SAFETY AND DENTAL HYGIENE AMONG OTHER HEALTH TOPICS TO ADDRESS THE SERIOUS ISSUES OF ILLITERACY HUNGER AND POVERTY CHILDRENS ASSESSES COMMUNITY NEED AND OFFERS FINANCIAL SUPPORT WITH PRESCRIPTION MEDICATIONS MEALS CLOTHING AND TRANSPORTATION EXPENSES EDUCATIONAL SUPPORT IS ALSO PROVIDED THROUGH CHILDRENS ONLINE KIDS HEALTH LIBRARY ON ITS WEBSITE WORKING WITH THE MICHIGAN HOSPITAL ASSOCIATION CHILDRENS HOSPITAL VOLUNTARILY REPORTS COMMUNITY BENEFIT PROGRAMS AND SERVICES IT DELIVERS TO HELP ACHIEVE ITS HEALTH CARE MISSION CHILDRENS COMMUNITY BENEFIT PROGRAMS AND SERVICES ADDRESS THE DYNAMIC HEALTH CARE NEEDS OF CHILDREN THROUGHOUT THE COMMUNITIES IT SERVES INCLUDING PARTICULARLY VULNERABLE CHILDREN IN UNDERSERVED COMMUNITIES IN DETROIT THE CHILDRENS HOSPITAL OF MICHIGAN SEES MORE CHILDREN THAN ANY OTHER HOSPITAL IN THE STATE WITH APPROXIMATELY 11500 INPATIENT ADMISSIONS 14000 SURGICAL PROCEDURES 89000 EMERGENCY VISITS AND 159000 TOTAL OUTPATIENT VISITS AT ITS MAIN FACILITY IN DETROIT AND AT ITS PEDIATRIC SPECIALTY CENTERS LOCATED THROUGHOUT SOUTHEAST MICHIGAN
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI OUR PATIENT ACCESS AND REVENUE CYCLE REPRESENTATIVES ARE WELL ABREAST OF STATE FEDERAL AND LOCAL GOVERNMENT PROGRAMS THAT PROVIDE HEALTHCARE COVERAGE ASSISTANCE TO PATIENTS THAT MEET CRITERIA IN LIGHT OF THIS THEY ARE WELL EQUIPPED TO EDUCATE PATIENTS ON ALL THEIR OPTIONS FOR ASSISTANCE THE PATIENT ACCESS AND REVENUE CYCLE REPRESENTATIVES COMPLETES ALL APPROPRIATE PAPERWORK FOR EACH PATIENT NEEDING GOVERNMENT ASSISTANCE WITH HEALTHCARE COVERAGE EDUCATING THE PATIENT EACH STEP ALONG THE WAY IN ADDITION THE REPRESENTATIVES ALSO EDUCATE AND PROVIDE APPROPRIATE DOCUMENTATION TO PATIENTS NEEDING CHARITY CARE FOR THOSE WHO DO NOT MEET CRITERIA FOR REIMBURSEMENT FROM GOVERNMENT PROGRAMS THE INTAKE STAFF ADVISES THE PATIENT OF PAYMENT OPTIONS AVAILABLE AT THE HOSPITAL
COMMUNITY INFORMATION PART VI SEE RESPONSE TO SCHEDULE H PART VI LINE 2 NEEDS ASSESSMENT
AFFILIATED HEALTH CARE INFORMATION PART VI CHILDRENS HOSPITAL OF MICHIGAN IS PART OF THE DETROIT MEDICAL CENTER AN ORGANIZATION WITH SEVEN AFFILIATE HOSPITALS DMC HARPER UNIVERSITY HOSPITAL HAS DISTINGUISHED ITSELF IN SURGICAL MEDICINE AND IS KNOWN FOR ITS CLINICAL EXPERTISE INNOVATIVE RESEARCH AND ADVANCED EDUCATION A SPECIALTY REFERRAL HOSPITAL HARPER HAS ESTABLISHED CENTERS OF EMPHASIS IN NEUROSCIENCES VASCULAR SERVICES MULTIDISCIPLINARY CARDIOVASCULAR SERVICES HYPERTENSION STROKE PREVENTION AND HEART FAILURE ADDITIONAL SPECIALTIES INCLUDE BARIATRIC GASTRIC BYPASS SURGERY CRITICAL CARE PULMONARY MEDICINE KIDNEY AND PANCREAS TRANSPLANTS THORACIC SURGERY AND MINIMALLY INVASIVE CARDIAC PROCEDURES HARPERS NEUROLOGY PROGRAM IS INTERNATIONALLY RECOGNIZED FOR NEW ADVANCES IN MULTIPLE SCLEROSIS NEUROMUSCULAR DISEASES EPILEPSY NEUROGENETIC DISORDERS NEUROBEHAVIORAL DISORDERS AND COGNITIVE DISORDERS AS THE HOSPITAL WITH THE FIRST MECHANICAL HEART BYPASS PUMP HARPER HAS RETAINED ITS LEADERSHIP POSITION IN STATEOFTHEART TECHNOLOGY TODAY HARPER HOUSES A 3T MRI MACHINE A 64SLICE CT SCANNER STATEOFTHEART ELECTROPHYSIOLOGY AND CARDIAC CATHETERIZATION LABS AND NUCLEAR CARDIAC IMAGING FACILITIES US NEWS WORLD REPORT NAMED HARPER UNIVERSITY HOSPITAL ONE OF 2009 AMERICAS BEST HOSPITALS FOR NEUROLOGYNEUROSURGERY AND HEARTHEART SURGERY AMONG THE TOP 50 DMC HUTZEL WOMENS HOSPITAL IS NATIONALLY RECOGNIZED FOR CUTTINGEDGE RESEARCH IN HIGHRISK OBSTETRICS INFERTILITY REPRODUCTIVE GENETICS NEONATOLOGY MATERNAL SPECIAL CARE MIDWIFERY GYNECOLOGY UROGYNECOLOGY MENOPAUSE PERMANENT BIRTH CONTROL AND ALTERNATIVES TO HYSTERECTOMY HUTZEL HAS BEEN RANKED AS THE NUMBER ONE HOSPITAL IN THE NATION IN RESEARCH AWARDS FOR ITS OBGYN PHYSICIANS WITH A RICH HISTORY OF OVER 137 YEARS AS MICHIGANS FIRST AND ONLY HOSPITAL FOR WOMEN THE PATIENTS ALSO BENEFIT FROM HUTZELS COMMITMENT TO RESEARCH AND EDUCATION HUTZEL WOMENS HOSPITAL IS HOME TO THE NATIONAL INSTITUTES OF HEALTH NIH PERINATOLOGY RESEARCH BRANCH PRB AND IS RECOGNIZED AS A LEADER IN WOMENS HEALTH BY PHYSICIANS AND RESEARCHERS ACROSS THE COUNTRY DMC CHILDRENS HOSPITAL OF MICHIGAN WITH MORE THAN 33 CLINICAL SPECIALTIES IS AN INTERNATIONAL LEADER IN PEDIATRIC AND ADOLESCENT MEDICINE SURGICAL SERVICES INCLUDE ANESTHESIOLOGY CARDIOVASCULAR SURGERY DEVELOPMENTAL DENTISTRY AND ORTHODONTICS NEUROSURGERY OPHTHALMOLOGY ORAL AND MAXILLOFACIAL ORTHOPAEDIC SURGERY OTOLARYNGOLOGY ENT PEDIATRIC SURGERY PLASTIC AND RECONSTRUCTIVE SURGERY SAME DAY SURGERY AND UROLOGY IMAGING TECHNOLOGY DESIGNED ESPECIALLY FOR CHILDREN PROVIDES ADVANCED DIAGNOSTIC SERVICES SUCH AS POSITRON EMISSION TOMOGRAPHY PET AND MRI CHILDRENS HOSPITAL IS SOUTHEAST MICHIGANS ONLY FREESTANDING PEDIATRIC LEVEL I TRAUMA CENTER EQUIPPED TO HANDLE THE MOST SEVERE INJURIES AND ILLNESSES EXPERTS IN PEDIATRIC CRITICAL CARE REHABILITATION NEONATAL AND PERINATAL MEDICINE PROVIDE CARE FOR THOUSANDS OF CHILDREN EVERY YEAR DMC DETROIT RECEIVING HOSPITAL MICHIGANS FIRST LEVEL I TRAUMA CENTER IS AN ADULT SPECIALTY HOSPITAL OFFERING EXPERTISE IN EMERGENCY MEDICINE COMPLEX TRAUMA CRITICAL CARE NEUROSCIENCE UROLOGY AND GERIATRICS AS THE REGIONS LEADER IN EMERGENCY MEDICINE RECEIVINGS EMERGENCY DEPARTMENT TREATS MORE THAN 88000 PATIENTS ANNUALLY AND NEARLY 60 OF MICHIGANS EMERGENCY PHYSICIANS ARE TRAINED AT RECEIVING DETROIT RECEIVING ALSO FEATURES THE STATES LARGEST BURN CENTER MICHIGANS FIRST HOSPITALBASED 247 HYPERBARIC OXYGEN THERAPY PROGRAM AND METRO DETROITS FIRST CERTIFIED PRIMARY STROKE CENTER DMC HURON VALLEY HOSPITAL INC IN OAKLAND COUNTY HAS EARNED RECOGNITION AS ONE OF THE AREAS AND THE NATIONS TOP HOSPITALS FOR PATIENT SATISFACTION THIS HOSPITAL FEATURES THE HARRIS BIRTHING CENTER WITH ALL PRIVATE BIRTHING SUITES A REGIONAL SPECIALTY CENTER THE CHARACH CANCER CENTER A PART OF THE BARBARA ANN KARMANOS CANCER CENTER THE KRIEGER CENTER FOR SENIOR ADULTS STATEOFTHEART SURGICAL SUITES CARDIAC SERVICES AND COMPREHENSIVE INPATIENT AND OUTPATIENT DIAGNOSTIC CARE DMC KRESGE EYE INSTITUTE IS CONSIDERED A LEADING CENTER FOR THE PRESERVATION OF SIGHT THE INSTITUTE OFFERS GENERAL VISION SERVICES FOR PATIENTS OF ALL AGES KNOWN INTERNATIONALLY FOR ITS CONTRIBUTIONS TO OPHTHALMOLOGY KRESGES CLINICAL SPECIALTIES INCLUDE GLAUCOMA CATARACT SURGERY CORNEA TRANSPLANTATION RETINAL VITREAL AND MACULAR DISEASES PLASTIC AND COSMETIC EYE SURGERY DIABETICRELATED EYE CONDITIONS NEURORELATED EYE DISORDERS AND OCULAR PROSTHETICS KRESGE EYE INSTITUTE HOUSES THE LIGON RESEARCH CENTER OF VISION WHERE PHYSICIANS ARE STUDYING ARTIFICIAL VISION KRESGE PHYSICIANS MAINTAIN A PROMINENT POSITION IN ALL AREAS OF VISION RESEARCH DMC REHABILITATION INSTITUTE INC IS ONE OF THE NATIONS LARGEST HOSPITALS SPECIALIZING IN REHABILITATION MEDICINE AND RESEARCH THE INSTITUTE IS HOME TO MANY INNOVATIVE PROGRAMS INCLUDING THE SOUTHEASTERN MICHIGAN TRAUMATIC BRAIN INJURY SYSTEM SEMTBIS AND THE CENTER FOR SPINAL CORD INJURY RECOVERY A WORLDCLASS FACILITY DESIGNED TO IMPLEMENT AND STUDY INNOVATIVE TREATMENTS IN SPINAL CORD INJURY RECOVERY WITH 30 OUTPATIENT SITES LOCATED THROUGHOUT SOUTHEAST MICHIGAN IT IS ALSO A CENTER OF CHOICE FOR PERSONS RECOVERING FROM SPORTS AND ORTHOPAEDIC INJURIES DMC SINAI HOSPITAL OF GREATER DETROIT IS DMCS LARGEST HOSPITAL AS A FULLSERVICE COMMUNITY HOSPITAL LOCATED IN NORTHWEST DETROIT SINAIGRACE OFFERS A COMPREHENSIVE HEART CENTER CANCER CARE GERONTOLOGY EMERGENCY MEDICINE OBSTETRICSGYNECOLOGY AND COSMETICPLASTIC SURGERY SINAIGRACES JOINT REPLACEMENT PROGRAM FEATURES A REVOLUTIONARY MINIMALLY INVASIVE KNEE REPLACEMENT SURGERY THAT ATTRACTS PEOPLE FROM ALL OVER THE COUNTRY SINAIGRACE ALSO OPERATES MORE THAN 25 OUTPATIENT CARE SITES AND AMBULATORY SURGERY CENTERS THROUGHOUT WAYNE AND OAKLAND COUNTIES RECOGNIZED NATIONALLY FOR QUALITY AND SAFETY SINAIGRACE IS ONE OF THE FEW HOSPITALS SELECTED TO PARTICIPATE IN TWO HEALTH CARE COLLABORATIVES FOCUSED ON DEVELOPING BEST PRACTICES FOR CARE AT THE BEDSIDE AND UPON DISCHARGE USNEWS WORLD REPORT NAMED SINAIGRACE HOSPITAL ONE OF 2009 AMERICAS BEST HOSPITALS FOR NEUROLOGY NEUROSURGERY AND GASTROINTESTINAL DISEASES AMONG THE TOP 50 DMC SURGERY HOSPITAL DMC SURGERY HOSPITAL IS DEDICATED TO THE SURGICAL NEEDS OF ADULTS AND CHILDREN AND MAINTAINS A COMMITMENT TO EXCELLENCE IN SERVICE FOR PATIENTS PHYSICIANS AND FAMILIES SURGERY FOR ADULTS COVERS THE FULL RANGE OF ORTHOPAEDIC SURGERIES NEUROSURGERY RELATIVE TO THE SPINE AND PODIATRIC SURGERY IN ASSOCIATION WITH CHILDRENS HOSPITAL OF MICHIGAN SURGERY FOR PEDIATRIC PATIENTS PRIMARILY PROVIDES SERVICES FOR ALL OUTPATIENT SURGICAL NEEDS THE MAJOR EMPHASIS OF THE FACILITY IS A COMMITMENT TO ORTHOPAEDIC SPORTS MEDICINE WHICH INCLUDES SERVICES FOR BOTH ADULTS AND ADOLESCENTS THE HOSPITAL ALSO OFFERS 24 HOUR EMERGENCY CARE AND PSYCHIATRIC INPATIENT SERVICES
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI MICHIGAN
ADDITIONAL INFORMATION PART VI SCHEDULE H PART I LINE 7B COLUMN D THE AMOUNTS REPORTED AS DIRECT OFFSETTING REVENUE INCLUDE AMOUNTS FOR 2009 RECEIVED IN 2010
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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
 
 
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
 
 
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
Yes
 
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) HERMAN B GRAY JR MD (i)
(ii)		 352,277
  		250
  		20,196
  		100,453
  		17,371
  		490,547
  		 
 
(2) JOSEPH T SCALLEN JR (i)
(ii)		 230,680
  		250
  		9,127
  		68,553
  		13,466
  		322,076
  		 
 
(3) LUANNE M EWALD (i)
(ii)		 140,836
  		250
  		8,635
  		45,230
  		26,480
  		221,431
  		 
 
(4) RICHARD REYNOLDS MD (i)
(ii)		 501,323
  		 
  		319,242
  		9,259
  		22,169
  		851,993
  		 
 
(5) SHAWN LEVITT (i)
(ii)		 187,953
  		250
  		810
  		56,271
  		23,045
  		268,329
  		 
 
(6) RHONDA FOSTER (i)
(ii)		 177,075
  		250
  		1,450
  		53,400
  		23,353
  		255,528
  		 
 
(7) HENRY WALTERS III (i)
(ii)		 1,027,471
  		 
  		1,380
  		9,187
  		6,081
  		1,044,119
  		 
 
(8) WALID YASSIR (i)
(ii)		 494,385
  		201,086
  		111,639
  		9,187
  		25,187
  		841,484
  		 
 
(9) RALPH DELIUS (i)
(ii)		 785,277
  		 
  		1,380
  		9,187
  		3,261
  		799,105
  		 
 
(10) ERIC JONES (i)
(ii)		 497,249
  		145,287
  		103,724
  		9,216
  		17,354
  		772,830
  		 
 
(11) YEGAPPAN LAKSHMANAN (i)
(ii)		 445,033
  		117,900
  		50,810
  		9,187
  		24,539
  		647,469
  		 
 
(12) PATRICK R KELLY (i)
(ii)		 196,657
  		250
  		907
  		7,124
  		19,405
  		224,343
  		 
 
(13) CHAD M GRANT (i)
(ii)		  
174,996 		 
250 		 
8,956 		 
52,513 		 
17,641 		 
254,356 		 
 
(14) JANICE COTTRELL (i)
(ii)		 141,525
  		250
  		5,020
  		42,228
  		2,828
  		191,851
  		 
 


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
COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 6A CHILDREN'S HOSPITAL OF MICHIGAN PARTICIPATES IN THE SHORT-TERM INCENTIVE PLAN (STIP) WHICH IS SPONSORED BY ITS PARENT ORGANIZATION, THE DETROIT MEDICAL CENTER. THE STIP PLAN PROVIDES ELIGIBLE EXECUTIVES OF THE DETROIT MEDICAL CENTER SYSTEM AN OPPORTUNITY TO EARN AN AWARD ANNUALLY BASED ON THE ACHIEVEMENT OF SPECIFIC HOSPITAL GOALS, INCLUDING INCOME FROM OPERATIONS AND OTHER METRICS SUCH AS LENGTH OF STAY AND QUALITY OF CARE. STIP AWARDS, WHICH ARE EARNED FOR PERFORMANCE DURING JANUARY 1 THROUGH DECEMBER 31, ARE IN ADDITION TO BASE SALARY. STIP AWARDS ARE CALCULATED AS A PERCENTAGE OF BASE SALARY. IN 2010, PARTICIPANTS RECEIVED UP TO 25% OF BASE SALARY, DEPENDING UPON THE HOSPITAL'S ACHIEVEMENTS. EXECUTIVE EMPLOYEES ELIGIBLE FOR THE STIP AWARD ARE THOSE HIRED PRIOR TO JULY 1 OF THE PLAN YEAR AND ARE IN ONE OF THE FOLLOWING CLASSIFICATIONS: PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE PRESIDENT, SENIOR VICE PRESIDENT, VICE PRESIDENT (INCLUDING ASSISTANT VICE PRESIDENT AND ASSOCIATE VICE PRESIDENT) AND CORPORATE VICE PRESIDENT. ANY EXPECTED PAYOUT WOULD OCCUR AFTER YEAR-END RESULTS HAVE BEEN CALCULATED AND AUDITED, TYPICALLY IN MARCH/APRIL FOLLOWING THE PLAN YEAR. STIP AWARDS FOR ALL SYSTEM-WIDE PARTICIPANTS FOR THE 2010 PLAN YEAR WERE ACCRUED AS OF 12/31/10 ON THE BOOKS OF THE PARENT ORGANIZATION, THE DETROIT MEDICAL CENTER, AND WERE PAID OUT IN MAY 2011. SEVEN OF THE INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A, WERE PARTICIPANTS FOR THE 2010 PLAN YEAR.
NON-FIXED PAYMENTS PROVIDED SCHEDULE J, PAGE 1, PART I, LINE 7 DURING 2010, A DISCRETIONARY BONUS OF 250.00 WAS PAID TO ALL FULL-TIME DMC SYSTEM-WIDE EMPLOYEES (125.00 TO PART-TIME EMPLOYEES). THE BONUS WAS PAID TO REWARD EMPLOYEES FOR GOOD 1ST QUARTER FINANCIAL RESULTS AND FOR MAKING CONCESSIONS EARLIER IN THE YEAR IN THE AREAS OF COMPENSATION AND BENEFITS. NINE OF THE INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A, RECEIVED THIS DISCRETIONARY BONUS.
OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III SCHEDULE J, PART II, COLUMN (B)(III), OTHER REPORTABLE COMPENSATION, AMOUNTS IN THIS COLUMN INCLUDE, BUT ARE NOT LIMITED TO, CASH AUTO AND CLUB ALLOWANCES, PHYSICIAN STIPENDS AND ON-CALL PAYMENTS AND TAXABLE EXPENSE REIMBURSEMENTS, OFFSET BY ANY PRE-TAX SECTION 125 DEDUCTIONS WHICH REDUCE THE AMOUNT OF COMPENSATION REPORTABLE IN FORM W-2, BOX 5.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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) SHIRLEY GRAY SEE PART V 111,075 EMPLOYMENT   No
(2) ETKIN EQUITY SEE PART V 250,000 FACILITY RENTAL   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
ADDITIONAL INFORMATION SCHEDULE L PART V SCHEDULE L PART IV BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS COLUMN A SHIRLEY GRAY COLUMN B FAMILY MEMBER OF HERMAN B GRAY TRUSTEE AND PRESIDENT COLUMN A ETKIN EQUITY COLUMN B MANAGING PARTNER OF ENTITY DOUGLAS ETKIN IS A TRUSTEE OF FILING ORGANIZATION
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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 .... X 4 7,455 VALUE BY DONOR
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications .. X 28,201 VALUE BY DONOR
5 Clothing and household
goods ....... 		X 43,744 VALUE BY DONOR
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 ... X 6 1,156 VALUE BY DONOR
20 Drugs and medical supplies . X 1 1,504 VALUE BY DONOR
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( TOYS/GAMES ) X 221 88,583 VALUE BY DONOR
26 Other Right pointing arrow large image ( SPEC EVT/RAFFLE ) X 94 21,742 VALUE BY DONOR
27 Other Right pointing arrow large image ( DVD/VIDEO GAMES ) X 115 18,598 VALUE BY DONOR
28 Other Right pointing arrow large image ( OTHER ) X 109 54,517 VALUE BY DONOR
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
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
 
No
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
SUPPLEMENTAL INFORMATION SCHEDULE M, PAGE 2, PART II PART I, COLUMN (B) NUMBER OF CONTRIBUTIONS THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RATHER THAN THE NUMBER OF ITEMS RECEIVED.
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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
Identifier Return Reference Explanation
FIRST ACHIEVEMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4A PEDIATRICS BY HOUR DETROIT MAGAZINE. CHILDREN'S HOSPITAL OF MICHIGAN TREATED MORE THAN 90,000 CHILDREN IN ITS EMERGENCY DEPARTMENT IN 2010. WHILE MOST HOSPITALS HAVE EMERGENCY ROOMS THAT SEE BOTH ADULT AND CHILDREN, THE EMERGENCY DEPARTMENT AT CHILDREN'S HOSPITAL OF MICHIGAN IS COMPLETELY DEDICATED TO SERVING CHILDREN AND THEIR CHILDHOOD ILLNESSES AND INJURIES. CHILDREN'S HOSPITAL OF MICHIGAN'S EMERGENCY DEPARTMENT IS ONE OF A HANDFUL OF LEVEL ONE PEDIATRIC TRAUMA CENTERS IN THE UNITED STATES CERTIFIED BY THE AMERICAN COLLEGE OF SURGEONS. IN 2010, CHILDREN'S HOSPITAL OF MICHIGAN'S DEPARTMENT OF PEDIATRICS SAW 7,192 INPATIENT CASES RESULTING IN 34,030 DAYS OF PEDIATRIC INPATIENT MEDICAL CARE FOR CHILDREN THROUGHOUT OUR STATE. CHILDREN'S HOSPITAL HAS VIRTUALLY EVERY PEDIATRIC MEDICAL SUBSPECIALTY AND SERVICE DESIGNED TO MEET THE DIVERSE MEDICAL NEEDS OF CHILDREN OF ALL AGES. THESE YOUNG PATIENTS VISIT CHILDREN'S HOSPITAL FOR EVERYTHING FROM TREATMENT FOR AUTISM AND SEIZURES TO CARE FOR RARE CONGENITAL DISORDERS. PEDIATRIC SPECIALTIES AND SERVICES AVAILABLE AT CHILDREN'S HOSPITAL INCLUDE BUT ARE NOT LIMITED TO: PEDIATRIC MEDICINE, ADOLESCENT MEDICINE, ALLERGY, CRITICAL CARE, CARDIOLOGY, EMERGENCY CARE, ENDOCRINOLOGY, GASTROENTEROLOGY, INFECTIOUS DISEASE, NEONATOLOGY, NEPHROLOGY, NEUROLOGY, PHYSICAL MEDICINE AND REHABILITATION AND PULMONARY MEDICINE. MORE THAN 160 PEDIATRIC RESIDENTS, SPECIALISTS AND FELLOWS IN TRAINING AT CHILDREN'S HOSPITAL OF MICHIGAN AT ANY GIVEN TIME; GRADUATE MORE THAN 30 PEDIATRICIANS AND PEDIATRIC SPECIALISTS EACH YEAR, MAKING CHILDREN'S HOSPITAL THE LARGEST PEDIATRIC RESIDENCY PROGRAM IN MICHIGAN. THE FIRST IN THE STATE TO USE VEINVIEWER TECHNOLOGY TO HELP CLINICIANS FIND THE RIGHT VEIN, THE FIRST TIME. USING A COMBINATION OF NEAR-INFRARED LIGHT, THIS ADVANCED TECHNOLOGY PROJECTS IMAGES OF VEINS AND THEIR LOCATION TO THE SURFACE OF PATIENTS' SKIN, RESULTING IN FEWER POKES FOR KIDS. IDENTIFIED AN INFANT COOLING TECHNIQUE TO REDUCE THE INCIDENCE OF DISABILITY AND DEATH IN INFANTS WHO FAILED TO RECEIVE ENOUGH OXYGEN DURING BIRTH. IMPLANTED THE FIRST MECHANICAL HEART PUMP EVER RECEIVED BY A CHILD IN MICHIGAN. THE THORATEC LEFT VENTRICULAR ASSIST DEVICE SAVED A TWELVE-YEAR-OLD GIRL'S LIFE. HELPED DEVELOP THE GENESIS STENT, A LIFE-SAVING DEVICE THAT OPENS BLOOD VESSELS THAT GROW WITH THE CHILD, ELIMINATING THE NEED FOR OPEN-HEART SURGERY. HOME TO THE WORLD'S FIRST POSITRON EMISSION TOMOGRAPHY (PET) CENTER DEDICATED TO PEDIATRICS. USING PET SCANNING, NEUROLOGISTS AND NEUROSURGEONS CAN IDENTIFY AND REMOVE AREAS IN A CHILD'S BRAIN THAT CAUSE UNCONTROLLABLE SEIZURES, ALLOWING FOR NORMAL DEVELOPMENT. HOME TO THE PEDIATRIC PHARMACOLOGY RESEARCH UNIT (PPRU), ONE OF ONLY 13 SITES IN THE U.S. DEDICATED TO ENSURING DRUG SAFETY FOR CHILDREN. THE PPRU IS SUPPORTED BY THE PRESTIGIOUS NATIONAL INSTITUTE OF HEALTH. THE NATION'S FIRST CHILDREN'S HOSPITAL TO INTRODUCE A PEDIATRIC ORTHOSIS "SNUG-CP SUIT," DESIGNED FOR CHILDREN WITH CEREBRAL PALSY, WHICH PROVIDES SENSORY FEEDBACK THAT IMPROVES CONTROL AND REDUCES MUSCLE SPASTICITY. THE DESIGNATED SITE FOR THE NEWBORN SCREENING MANAGEMENT PROGRAM FOR THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, PROVIDING CARE FOR INDIVIDUALS WITH METABOLIC DISORDERS FROM BIRTH THROUGHOUT ADULTHOOD. HAS TWO STATE-OF-THE-ART CARDIAC CATHERIZATION LABS FEATURING THE LATEST EQUIPMENT FOR DIAGNOSTIC AND INTERVENTIONAL PROCEDURES. HOME TO MICHIGAN'S ONLY PEDIATRIC BURN CENTER. HOME TO MICHIGAN'S TOP PEDIATRIC IMAGING CENTER - OFFERING THE MOST ADVANCED PEDIATRIC IMAGING CAPABILITIES, INCLUDING A 3.0T SHORT BORE SCANNER, WHICH REDUCES THE INSTANCE OF SEDATION IN CHILDREN. OPERATES THE ONLY POISON CONTROL CENTER IN THE STATE OF MICHIGAN, FOCUSED ON POISON PREVENTION, EDUCATION, TRIAGE AND TREATMENT. THE POISON CONTROL CENTER ANSWERS MORE THAN 9,000 CALLS PER MONTH. THE RONALD MCDONALD HOUSE IS ON THE CAMPUS OF CHILDREN'S HOSPITAL OF MICHIGAN AND IS AVAILABLE TO FAMILIES OF SICK CHILDREN SO THAT THEY CAN SPEND THE NIGHT CLOSE TO THEIR CHILD.
SECOND ACHIEVEMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4B LEVEL OF COORDINATED, MULTIDISCIPLINARY CARE. OVER THE YEARS, THE PROGRAM HAS MADE MAJOR CONTRIBUTIONS TO THE UNDERSTANDING AND TREATMENT OF PEDIATRIC BLOOD DISEASES AND CANCER. SERVICES PROVIDED IN THIS DIVISION ARE FOR CHILDREN SUFFERING FROM BLOOD AND CANCER RELATED DISEASES AND DISORDERS. AMONG THESE SERVICES ARE OUR SICKLE CELL CLINIC AND BONE MARROW TRANSPLANT PROGRAM AND DEDICATED UNIT. AS FACULTY MEMBERS AT WAYNE STATE UNIVERSITY, THE PHYSICIANS ARE INVOLVED IN EXTENSIVE CLINICAL, TRANSLATIONAL AND BENCH RESEARCH IN PEDIATRIC BLOOD DISEASES, COAGULATION AND BLEEDING DISORDERS AND CANCER/LEUKEMIA. MUCH OF THIS RESEARCH IS FUNDED BY THE NATIONAL INSTITUTES OF HEALTH, NATIONAL CANCER INSTITUTE AND OTHER AGENCIES, INCLUDING THE LEUKEMIA AND LYMPHOMA SOCIETY AND THE NATIONAL HEMOPHILIA FOUNDATION.
THIRD ACHIEVEMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4C FOLLOWING SPECIALTIES: ANESTHESIOLOGY, CARDIOVASCULAR SURGERY INCLUDING HEART TRANSPLANTS, CLEFT AND CRANIOFACIAL SURGERY, DENTAL AND ORAL SURGERY, EAR NOSE AND THROAT SURGERY, KIDNEY TRANSPLANTS, NEUROSURGERY INCLUDING BRAIN TUMOR REMOVAL, ORTHOPEDIC SURGERY, PEDIATRIC SURGERY INCLUDING BURN AND TRAUMA SURGERY, EYE SURGERY AND PLASTIC AND RECONSTRUCTIVE SURGERY AND UROLOGICAL SURGERY AMONG OTHER SERVICES. IF A CHILD REQUIRES SURGERY WHERE MULTIDISCIPLINARY CARE IS REQUIRED, CHILDREN'S PEDIATRIC SUBSPECIALTY SURGEONS WORK TOGETHER TO PROVIDE THE BEST CARE TO CHILDREN WITH COMPLEX INJURIES OR CONGENITAL ANOMOLIES. THE AVAILABILITY OF THESE MULTIDISCIPLINARY PEDIATRIC SURGICAL TEAMS IS ONE OF THE MANY ADVANTAGES OF TREATMENT AT THE CHILDREN'S HOSPITAL OF MICHIGAN.
ALL OTHER ACHIEVEMENTS DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4D NEONATOLOGY - 1,458 TOTAL CASES; 6,133 INPATIENT DAYS; 1,044 OUTPATIENT REGISTRATIONS EMERGENCY MEDICINE - 59,836 TOTAL CASES; 2 INPATIENT DAYS; 59,834 OUTPATIENT REGISTRATIONS CRITICAL CARE/INTENSIVE CARE - 458 TOTAL CASES; 3,344 INPATIENT DAYS; 140 OUTPATIENT REGISTRATIONS NEUROSURGERY - 2,529 TOTAL CASES; 3,677 INPATIENT DAYS; 1,779 OUTPATIENT REGISTRATIONS
ADDITIONAL INFORMATION FORM 990, PART V LINE 8 - SECTION 501(C)(3) AND OTHER SPONSORING ORGANIZATIONS MAINTAINING DONOR ADVISED FUNDS AND SECTION 509(A)(3) SUPPORTING ORGANIZATIONS: THE ORGANIZATION DOES NOT SPONSOR OR MAINTAIN DONOR ADVISED FUNDS.
RELATED PARTY INFORMATION AMONG OFFICERS FORM 990, PAGE 6, PART VI, LINE 2 FRANK COUZENS, JR. CAROL MARANTETTE TRUSTEE TRUSTEE FAMILY RELATIONSHIP TONY ANTONE DEREK SARAFA TRUSTEE TRUSTEE BUSINESS RELATIONSHIP FLORINE MARK DAVID PAGE TRUSTEE TRUSTEE BUSINESS RELATIONSHIP LYLE WOLBERG DAVID PAGE TRUSTEE TRUSTEE BUSINESS RELATIONSHIP LYLE WOLBERG AARON SHERBIN TRUSTEE TRUSTEE BUSINESS RELATIONSHIP LYLE WOLBERG MATTHEW FRIEDMAN TRUSTEE TRUSTEE BUSINESS RELATIONSHIP
CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 THE ORGANIZATION IS A MEMBERSHIP CORPORATION WHOSE SOLE MEMBER IS THE DETROIT MEDICAL CENTER.
ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE ORGANIZATION'S GOVERNING BODY APPOINTMENTS ARE SUBJECT TO APPROVAL BY ITS SOLE MEMBER.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B DECISIONS OF THE ORGANIZATION'S GOVERNING BODY ARE SUBJECT TO APPROVAL BY ITS SOLE MEMBER.
POLICIES AND PROCEDURES GOVERNING CHAPTERS FORM 990, PAGE 6, PART VI, LINE 10B THE ORGANIZATION'S POLICIES APPLY NOT ONLY TO ITS HEALTHCARE OPERATIONS LOCATED IN THE HOSPITAL FACILITIES BUT ALSO TO ITS HEALTHCARE OPERATIONS LOCATED IN OFFSITE FACILITIES WITHIN THE COMMUNITY SERVED BY THE ORGANIZATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE ORGANIZATION'S 2010 FORM 990 WAS REVIEWED WITH ITS THEN VP FINANCE/CFO AND A COMPLETE COPY PROVIDED TO EACH MEMBER OF ITS BOARD OF TRUSTEES (AT 12/31/10) PRIOR TO FILING WITH THE IRS.
ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C CHILDREN'S HOSPITAL OF MICHIGAN CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY DISTRIBUTING AN ANNUAL QUESTIONNAIRE TO TRUSTEES, OFFICERS AND KEY EMPLOYEES WHICH INCLUDES QUESTIONS RELATED TO EACH POLICY PROVISION. RESPONSES ARE THOROUGHLY REVIEWED AND ANY APPARENT CONFLICTS ARE INVESTIGATED AND APPROPRIATE ACTION IS TAKEN.
COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A CHILDREN'S HOSPITAL OF MICHIGAN USES THE FOLLOWING PROCESS FOR DETERMINING THE COMPENSATION OF ITS PRESIDENT (TOP MANAGEMENT OFFICIAL): 1. ANNUAL COMPARABILITY STUDIES ARE CONDUCTED BY INTERNAL STAFF IN THE HUMAN RESOURCES DEPARTMENT OF THE HOSPITAL'S PARENT COMPANY, THE DETROIT MEDICAL CENTER (DMC). THE COMPENSATION OF THE PRESIDENT IS COMPARED WITH SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THIS INFORMATION IS SUBMITTED TO THE PRESIDENT/CEO OF THE DMC FOR REVIEW AND APPROVAL. 2. USE OF AN INDEPENDENT COMPENSATION CONSULTANT TO CONDUCT A COMPARABILITY STUDY FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS (PERFORMED LATE 2009). 3. PERIODICALLY, THE COMPENSATION OF HOSPITAL PRESIDENTS IS TAKEN TO THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE DMC FOR REVIEW AND APPROVAL. THIS WAS LAST DONE IN FEBRUARY 2010. DECISIONS OF THE COMPENSATION COMMITTEE ARE RECORDED IN CONTEMPORANEOUS MINUTES.
COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF CHILDREN'S HOSPITAL OF MICHIGAN IS DETERMINED AS DESCRIBED IN LINE 15A, 1 ABOVE, WITH THE EXCEPTION OF PHYSICIANS. PROFESSIONAL SERVICE CONTRACTS FOR PHYSICIANS AT ALL DMC HOSPITALS ARE REVIEWED AND APPROVED BY A DMC PHYSICIAN CONTRACT COMMITTEE COMPRISED OF THE CHIEF OF BUSINESS OPERATIONS, THE CHIEF OPERATING OFFICER AND THE CHIEF MEDICAL OFFICER OF THE DMC. COMPENSATION IS DETERMINED USING THE SULLIVAN COTTER PHYSICIAN COMPENSATION AND PRODUCTIVITY SURVEY REPORT AND THE MGMA PHYSICIAN COMPENSATION AND PRODUCTION SURVEY REPORT, UPDATED ANNUALLY. INCENTIVE COMPENSATION IS BASED ON THE PERSONAL PRODUCTIVITY OF THE PHYSICIAN.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE FILING ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE STATE OF MICHIGAN WEBSITE HTTP://WWW.DLEG.STATE.MI.US/BCS_CORP/SR_CORP.ASP BY ENTERING THE ORGANIZATION NAME. THE BYLAWS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE INCLUDED IN THE ORGANIZATION'S FORM 990 AND AVAILABLE UPON REQUEST VIA THE IRS PUBLIC INSPECTION PROCESS. THE FILING ORGANIZATION PROVIDES MONTHLY INTERNAL UNAUDITED INCOME STATEMENTS AND STATISTICAL INFORMATION DIRECTLY TO CREDITORS INCLUDING RATING AGENCIES, BOND HOLDERS, BROKERS AND INVESTORS. IN ADDITION, THESE MONTHLY INTERNAL STATEMENTS AND INFORMATION ARE ALSO PROVIDED TO THE MICHIGAN STATE HOSPITAL FINANCE AUTHORITY (MSHFA) WHO WILL PROVIDE UPON REQUEST.
RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII SECTION A, 1A, (B): ESTIMATED HOURS WORKED AT RELATED ORGANIZATIONS NAME: HOURS: BAKER, JOHN D., MD 1.1 GRANT, CHAD 50.0 FORM 990, PART IV, LINE 32 - DID THE ORGANIZATION SELL, EXCHANGE, DISPOSE OF, OR TRANSFER MORE THAN 25% OF ITS NET ASSETS: CHILDREN'S HOSPITAL OF MICHIGAN (CHM) HAS RESPONDED "NO" TO THIS QUESTION BUT IS INCLUDING THIS FURTHER EXPLANATION WITH THE FORM 990 FILING. EFFECTIVE JANUARY 1, 2011, CHM COMPLETED A SALE OF SUBSTANTIALLY ALL OF ITS ASSETS TO A SUBSIDIARY OF VANGUARD HEALTH SYSTEMS, INC., A NASHVILLE, TENNESSEE BASED ENTITY (THE PURCHASER IS HEREIN REFERRED TO AS "VANGUARD"). VANGUARD IS A TAXABLE CORPORATION. VANGUARD ASSUMED SUBSTANTIALLY ALL OF CHM'S LIABILITIES IN THE TRANSACTION. THIS TRANSACTION WAS APPROVED BY THE MICHIGAN ATTORNEY GENERAL, AS REQUIRED BY STATE LAW. THE SALE TRANSACTION WAS COMPLETED ON DECEMBER 31, 2010, WITH AN EFFECTIVE DATE OF JANUARY 1, 2011. THE GROSS PROCEEDS PAID BY VANGUARD FOR ITS PURCHASE OF CHM'S ASSETS WERE PLACED INTO ESCROW ON DECEMBER 31, 2010. CHM HAD ACCESS TO THESE FUNDS ON JANUARY 1, 2011. CHM WILL REPORT ANY GAIN OR LOSS ON THE SALE OF THE ASSETS ON THE 2011 FORM 990 RETURN. CHM BELIEVES THIS TO BE THE PROPER REPORTING PERIOD FOR DISCLOSING SUCH GAIN OR LOSS, DUE TO THE EFFECTIVE DATE OF THE TRANSACTION BEING JANUARY 1, 2011. FURTHER, CHM DID NOT HAVE THE ABILITY TO ACCESS THE SALE PROCEEDS UNTIL THAT DATE. THIS REPORTING IS CONSISTENT WITH THE FINANCIAL ACCOUNTING TREATMENT AND DISCLOSURE OF THE TRANSACTION AS REFLECTED ON CHM'S 2010 AUDITED FINANCIAL STATEMENTS. IT IS NOTED THAT THE 2010 FORM 990 INSTRUCTIONS PROVIDE: "UNLESS INSTRUCTED OTHERWISE, THE ORGANIZATION SHOULD GENERALLY USE THE SAME ACCOUNTING METHOD ON THE RETURN (INCLUDING THE FORM 990 AND ALL SCHEDULES) TO REPORT REVENUE AND EXPENSES THAT IT REGULARLY USES TO KEEP ITS BOOKS AND RECORDS. TO BE ACCEPTABLE FOR FORM 990 REPORTING PURPOSES, HOWEVER, THE METHOD OF ACCOUNTING MUST CLEARLY REFLECT INCOME." THE INSTRUCTIONS FURTHER REFLECT THAT GENERALLY, ANY CHANGE IN METHOD OF ACCOUNTING MUST BE MADE THROUGH FILING OF FORM 3115 WITH THE INTERNAL REVENUE SERVICE. IF A CHANGE IN ACCOUNTING METHOD IS UNDERTAKEN, THE ORGANIZATION MUST REPORT ANY ADJUSTMENT REQUIRED BY SECTION 481(A) ON SCHEDULE D, PARTS XI, AND XIV. CHM IS FILING THE FORM 990 USING ACCOUNTING METHODS AND REPORTING OF FINANCIAL OPERATIONS ON A BASIS CONSISTENT WITH THE METHODS FOLLOWED FOR FINANCIAL STATEMENT REPORTING FOR 2010. THE FINANCIAL STATEMENTS DO NOT REFLECT THE SALE TRANSACTION AS A 2010 EVENT. CHM IS NOT CHANGING ITS ACCOUNTING METHOD FOR REPORTING OF THIS TRANSACTION AS IT BELIEVES THE FINANCIAL STATEMENT REPORTING CLEARLY REFLECTS INCOME.
OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 INCREASES: DMC CONSOLIDATED PENSION LIABILITY, WORKERS COMPENSATION, ETC. TRANSFERRED TO DMC PARENT 3,776,222 NET UNREALIZED APPRECIATION IN FMV OF INVESTMENT 2,464,797 NET UNREALIZED GAIN ON INVESTMENTS 650,898 NET UNREALIZED GAIN ON INVESTMENTS 1,213,854 DECREASES: OUTSTANDING BOND DEBT TRANSFERRED TO DMC PARENT TO BE PAID FROM DMC PARENT BOND ESCROW ACCOUNT (13,580,977) WRITE OFF INTERCOMPANY ACCOUNT BALANCES BETWEEN TAX EXEMPT 501(C)(3) MEMBERS OF DMC CONSOLIDATED CONTROL GROUP (477,468,110) ADJ. FOR SPECIAL PURPOSE FUNDS (855,470)
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
CHILDREN'S HOSPITAL OF MICHIGAN
 
Employer identification number

38-1357994
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







(1) CHILDREN'S AMBULATORY SERVICES LLC
3901 BEAUBIEN
DETROIT,MI48201
33-1149647 		BILLING MI     CHM
CHILDREN'S HOSPITAL OF MICHIGAN










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) CHILDREN'S HOSPITAL OF MICHIGAN AUX

3901 BEAUBIEN

DETROIT,MI48201
38-2119027 		AUXILIARY MI 501C3 11C MEMBERS
 
 
No
(2) DET MED CENTER COOPERATIVE SERVICES

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
23-7083832 		BILLING MI 501C3 3 DMC
 
Yes
 
(3) DETROIT MEDICAL CENTER GUILD

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
38-2480730 		AUXILIARY MI 501C3 11C MEMBERS
 
 
No
(4) DETROIT METRO CARE

3990 JOHN R

DETROIT,MI48201
56-2402607 		MCAID HMO MI 501C3 11C DMC
 
Yes
 
(5) DETROIT RECEIVING HOSPITAL & UHC

4201 ST ANTOINE BOULEVARD

DETROIT,MI48201
38-2320476 		HEALTHCARE MI 501C3 3 DMC
 
Yes
 
(6) DETROIT MEDICAL CENTER FOUNDATION

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
38-3021666 		HEALTHCARE MI 501C3 11A DMC
 
Yes
 
(7) DMC EDUCATION & RESEARCH

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
38-2562709 		HEALTHCARE MI 501C3 3 DMC
 
Yes
 
(8) DMC PRIMARY CARE SERVICES II

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
38-2578447 		HEALTHCARE MI 501C3 11A DMC
 
Yes
 
(9) HARPER-HUTZEL HOSPITAL

3990 JOHN R

DETROIT,MI48201
38-2391907 		HEALTHCARE MI 501C3 3 DMC
 
Yes
 
(10) HEALTHSOURCE

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
38-6095454 		MANAG CARE MI 501C3 11C DMC
 
Yes
 
(11) HURON VALLEY HOSPITAL INC

1 WILLIAM CARLS DRIVE

COMMERCE TOWNSHIP,MI48382
38-2155995 		HEALTHCARE MI 501C3 3 DMC
 
Yes
 
(12) REHABILITATION INSTITUTE INC

261 MACK BOULEVARD

DETROIT,MI48201
38-1417366 		HEALTHCARE MI 501C3 3 DMC
 
Yes
 
(13) RHHC INC

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
38-2086422 		HEALTHCARE MI 501C3 11C DMC
 
Yes
 
(14) SINAI HOSPITAL OF GREATER DETROIT

6071 WEST OUTER DRIVE

DETROIT,MI48235
38-1416522 		HEALTHCARE MI 501C3 3 DMC
 
Yes
 
(15) THE DETROIT MEDICAL CENTER

3663 WOODWARD AVENUE SUITE 200

DETROIT,MI48201
38-2571767 		SUPPORT SV MI 501C3 11A DIRECTORS
 
 
No
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
(1) ASC DEVELOPMENT LLC

7330 SHADELAND STATION SUITE 200
INDIANAPOLIS,IN46256
42-1690550 		SURGERY MI NA
N/A 		        No     No  
(2) DMC PARTNERSHIP IMAGING LLC

3990 JOHN R
DETROIT,MI48201
16-1750127 		HOLDING CO MI NA
N/A 		        No     No  
(3) NOVI REGIONAL IMAGING LLC

3901 BEAUBIEN SUITE 2B105
DETROIT,MI48201
45-0595233 		DIAGNOSTIC MI NA
N/A 		        No     No  
(4) MICHIGAN REGIONAL IMAGING LLC

3990 JOHN R
DETROIT,MI48201
56-2517225 		MRI SRVCS MI NA
N/A 		        No     No  
(5) ASC DEVELOPMENT LLC

7330 SHADELAND STATION SUITE 200
INDIANAPOLIS,IN46256
42-1690550 		SURGERY MI NA
N/A 		        No     No  
(6) DMC PARTNERSHIP IMAGING LLC

3990 JOHN R
DETROIT,MI48201
16-1750127 		HOLDING CO MI NA
N/A 		        No     No  
(7) NOVI REGIONAL IMAGING LLC

3901 BEAUBIEN SUITE 2B105
DETROIT,MI48201
45-0595233 		DIAGNOSTIC MI NA
N/A 		        No     No  
(8) MICHIGAN REGIONAL IMAGING LLC

3990 JOHN R
DETROIT,MI48201
56-2517225 		MRI SRVCS MI NA
N/A 		        No     No  
(9) ASC DEVELOPMENT LLC

7330 SHADELAND STATION SUITE 200
INDIANAPOLIS,IN46256
42-1690550 		SURGERY MI NA
N/A 		        No     No  
(10) DMC PARTNERSHIP IMAGING LLC

3990 JOHN R
DETROIT,MI48201
16-1750127 		HOLDING CO MI NA
N/A 		        No     No  
(11) NOVI REGIONAL IMAGING LLC

3901 BEAUBIEN SUITE 2B105
DETROIT,MI48201
45-0595233 		DIAGNOSTIC MI NA
N/A 		        No     No  
(12) MICHIGAN REGIONAL IMAGING LLC

3990 JOHN R
DETROIT,MI48201
56-2517225 		MRI SRVCS MI NA
N/A 		        No     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) CHILDREN'S CHOICE OF MICHIGAN
3990 JOHN R
DETROIT,MI48201
38-3318267 		MANAG CARE MI NA
  		C CORP      
(2) DMC HEALTH CARE CENTERS INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2648666 		MED SRVCS MI NA
  		C CORP      
(3) DMC INSURANCE CO LTD
C/O MARSH MGT SRVCS CYMN BOX 1051
GEORGETOWN,CAYMAN ISLANDS, BWI  
CJ
98-0198240 		CAPT INS   NA
  		C CORP      
(4) METRO TPA SERVICES INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
56-2402607 		TPA SVCS MI NA
  		C CORP      
(5) MULTI-CARE MEDICAL SERVICES & SUPPL
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2179342 		HEALTHCARE MI NA
  		C CORP      
(6) PHYX INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-3559445 		ADMIN SVCS MI NA
  		C CORP      
(7) RADIUS HEALTH CARE SYSTEMS INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2282743 		HEALTHCARE MI NA
  		C CORP      
(8) RADIUS REAL ESTATE INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2646917 		REAL EST MI NA
  		C CORP      
(9) THE MEDICAL PROVIDER ORGANIZATION
3990 JOHN R
DETROIT,MI48201
38-2833100 		ADMIN SVCS MI NA
  		C CORP      
(10) SE MICHIGAN PHYSICIANS' INSURANCE
3740 JOHN R FLOOR 2
DETROIT,MI48201
26-4383522 		CAPTV INS MI NA
  		C CORP      
(11) CHILDREN'S CHOICE OF MICHIGAN
3990 JOHN R
DETROIT,MI48201
38-3318267 		MANAG CARE MI NA
  		C CORP      
(12) DMC HEALTH CARE CENTERS INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2648666 		MED SRVCS MI NA
  		C CORP      
(13) DMC INSURANCE CO LTD
C/O MARSH MGT SRVCS CYMN BOX 1051
GEORGETOWN,CAYMAN ISLANDS, BWI  
CJ
98-0198240 		CAPT INS   NA
  		C CORP      
(14) METRO TPA SERVICES INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
56-2402607 		TPA SVCS MI NA
  		C CORP      
(15) MULTI-CARE MEDICAL SERVICES & SUPPL
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2179342 		HEALTHCARE MI NA
  		C CORP      
(16) PHYX INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-3559445 		ADMIN SVCS MI NA
  		C CORP      
(17) RADIUS HEALTH CARE SYSTEMS INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2282743 		HEALTHCARE MI NA
  		C CORP      
(18) RADIUS REAL ESTATE INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2646917 		REAL EST MI NA
  		C CORP      
(19) THE MEDICAL PROVIDER ORGANIZATION
3990 JOHN R
DETROIT,MI48201
38-2833100 		ADMIN SVCS MI NA
  		C CORP      
(20) SE MICHIGAN PHYSICIANS' INSURANCE
3740 JOHN R FLOOR 2
DETROIT,MI48201
26-4383522 		CAPTV INS MI NA
  		C CORP      
(21) CHILDREN'S CHOICE OF MICHIGAN
3990 JOHN R
DETROIT,MI48201
38-3318267 		MANAG CARE MI NA
  		C CORP      
(22) DMC HEALTH CARE CENTERS INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2648666 		MED SRVCS MI NA
  		C CORP      
(23) DMC INSURANCE CO LTD
C/O MARSH MGT SRVCS CYMN BOX 1051
GEORGETOWN,CAYMAN ISLANDS, BWI  
CJ
98-0198240 		CAPT INS   NA
  		C CORP      
(24) METRO TPA SERVICES INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
56-2402607 		TPA SVCS MI NA
  		C CORP      
(25) MULTI-CARE MEDICAL SERVICES & SUPPL
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2179342 		HEALTHCARE MI NA
  		C CORP      
(26) PHYX INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-3559445 		ADMIN SVCS MI NA
  		C CORP      
(27) RADIUS HEALTH CARE SYSTEMS INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2282743 		HEALTHCARE MI NA
  		C CORP      
(28) RADIUS REAL ESTATE INC
3663 WOODWARD AVENUE SUITE 200
DETROIT,MI48201
38-2646917 		REAL EST MI NA
  		C CORP      
(29) THE MEDICAL PROVIDER ORGANIZATION
3990 JOHN R
DETROIT,MI48201
38-2833100 		ADMIN SVCS MI NA
  		C CORP      
(30) SE MICHIGAN PHYSICIANS' INSURANCE
3740 JOHN R FLOOR 2
DETROIT,MI48201
26-4383522 		CAPTV INS MI NA
  		C CORP      
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
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
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
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
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
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
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) DETROIT MEDICAL CENTER

 A 547,000 CASH
(2) DETROIT MEDICAL CENTER

 L 50,785,000 CASH
(3) DETROIT RECEIVING HOSPITAL

 L 585,000 CASH
(4) HARPER-HUTZEL HOSPITAL

 L 1,672,000 CASH
(5) HARPER-HUTZEL HOSPITAL

 K 417,000 CASH
(6) MICHIGAN REGIONAL IMAGING

 L 203,000 CASH
(7) SINAI HOSPITAL OF GREATER DETROIT

 A 240,000 CASH
(8) REHABILITATION INSTITUTE INC

 L 183,000 CASH
(9) HARPER-HUTZEL HOSPITAL

 L 296,000 CASH
(10) DMC PRIMARY CARE SERVICES II

 L 120,000 CASH
(11) DETROIT MEDICAL CENTER

 A 547,000 CASH
(12) DETROIT MEDICAL CENTER

 L 50,785,000 CASH
(13) DETROIT RECEIVING HOSPITAL

 L 585,000 CASH
(14) HARPER-HUTZEL HOSPITAL

 L 1,672,000 CASH
(15) HARPER-HUTZEL HOSPITAL

 K 417,000 CASH
(16) MICHIGAN REGIONAL IMAGING

 L 203,000 CASH
(17) SINAI HOSPITAL OF GREATER DETROIT

 A 240,000 CASH
(18) REHABILITATION INSTITUTE INC

 L 183,000 CASH
(19) HARPER-HUTZEL HOSPITAL

 L 296,000 CASH
(20) DMC PRIMARY CARE SERVICES II

 L 120,000 CASH
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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