Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,969,646 | 1,416,506 | 1,508,762 | 1,072,964 | 725,475 | 6,693,353 |
| 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.. | 238,125 | 234,472 | 247,460 | 304,561 | 24,250 | 1,048,868 |
| 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. | 2,207,771 | 1,650,978 | 1,756,222 | 1,377,525 | 749,725 | 7,742,221 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 62,973 | 20,806 | 40,502 | 50,340 | 15,500 | 190,121 |
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 62,973 | 20,806 | 40,502 | 50,340 | 15,500 | 190,121 |
| 8 | Public support (Subtract line 7c from line 6.) | 7,552,100 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 2,207,771 | 1,650,978 | 1,756,222 | 1,377,525 | 749,725 | 7,742,221 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 95,114 | 99,344 | 121,700 | 135,374 | 102,512 | 554,044 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 95,114 | 99,344 | 121,700 | 135,374 | 102,512 | 554,044 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 2,302,885 | 1,750,322 | 1,877,922 | 1,512,899 | 852,237 | 8,296,265 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 3 | DURING 2014, ZIEGER HEALTH CARE CORPORATION CEASED CONDUCTING ITS PROGRAM SERVICE ACTIVITIES WITH RESPECT TO THE FUNDRAISING FOR AND MANAGEMENT OF THE BOTSFORD FOUNDATION. ON SEPTEMBER 1, 2014, ZIEGER HEALTH CARE CORPORATION, A 501(C)(3) ORGANIZATION WHICH IS NOT A PRIVATE FOUNDATION BECAUSE IT QUALIFIES AS A PUBLIC CHARITY UNDER 509(A)(2), CONTRIBUTED ITS ONGOING ACTIVITIES, INCLUDING THOSE RELATED TO THE BOTSFORD FOUNDATION, TO BOTSFORD GENERAL HOSPITAL, A RELATED 501(C)(3) ORGANIZATION. PRIOR TO, AND AT THE TIME OF THE TRANSFER, ZIEGER HEALTH CARE CORPORATION WAS THE SOLE MEMBER OF BOTSFORD GENERAL HOSPITAL. THE TRANSFER OF THE BOTSFORD FOUNDATION ACTIVITY WAS ACCOMPLISHED IN CONJUNCTION WITH THE BEAUMONT HEALTH AFFILIATION, WHICH IS DESCRIBED IN GREATER DETAIL IN THE SCHEDULE O RESPONSE FOR FORM 990, PART VI, SEC A, LINE 4. ZIEGER HEALTH CARE CORPORATION CONTINUES TO EXIST TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF BOTSFORD GENERAL HOSPITAL, AND TO SUPPORT AND CARRY OUT THE CHARITABLE AND EDUCATIONAL PURPOSES OF BOTSFORD GENERAL HOSPITAL. IN THIS ROLE, ZIEGER HEALTH CARE CORPORATION ALSO REMAINS IN PLACE TO MONITOR AND IF NECESSARY, SEEK SPECIFIC PERFORMANCE ON BEHALF OF BOTSFORD GENERAL HOSPITAL OF KEY PROVISIONS OF THE BEAUMONT HEALTH AFFILIATION AGREEMENT. |
| FORM 990, PART IV, LINE 24A | FOR PRIOR YEARS, ZIEGER HEALTH CARE CORPORATION ("ZIEGER") HAS REPORTED BOND LIABILITIES ON SCHEDULE K WITH RESPECT TO ITS SHARE OF DEBT OF THE ZIEGER HEALTH CARE CORPORATION OBLIGATED GROUP. DURING 2014, THE ACTIVITIES OF ZIEGER WERE MERGED INTO BOTSFORD GENERAL HOSPITAL (THOUGH ZIEGER CONTINUES TO EXIST AS A LEGAL ENTITY). ACCORDINGLY, BOTSFORD GENERAL HOSPITAL NOW REPORTS THE SHARES PREVIOUSLY REPORTED BY ZIEGER, AND ZIEGER IS NO LONGER REPORTING TAX-EXEMPT DEBT ON SCHEDULE K. |
| FORM 990, PART VI, SECTION A, LINE 2 | THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE BOARD MEMBERS OR SHARED OFFICERS OF A TAXABLE ENTITY WITHIN THE BEAUMONT HEALTH SYSTEM: GERSON COOPER PAUL LACASSE LISA VANDECAVEYE REGINA DOXTADER JOHN NEMES SANDFORD VIEDER |
| FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE SEPTEMBER 1, 2014, WILLIAM BEAUMONT HOSPITAL ("WBH"), OAKWOOD HEALTHCARE, INC. ("OAKWOOD"), AND ZIEGER HEALTH CARE CORPORATION, THE SOLE MEMBER OF BOTSFORD GENERAL HOSPITAL ("BOTSFORD"), CONSUMMATED THEIR AFFILIATION PURSUANT TO WHICH BEAUMONT HEALTH, A MICHIGAN NONPROFIT CORPORATION, WAS CREATED. AS PART OF THE AFFILIATION AGREEMENT, BEAUMONT HEALTH BECAME THE SOLE CORPORATE MEMBER OF WBH, OAKWOOD, AND BOTSFORD AND COMBINED THE OPERATIONS OF WBH, OAKWOOD, AND BOTSFORD, AND THEIR SUBSIDIARIES AND AFFILIATES, UNDER A NEW SYSTEM REFERRED TO AS BEAUMONT HEALTH. IN ADDITION, BOTSFORD GENERAL HOSPITAL BECAME THE SOLE MEMBER OF BOTSFORD CONTINUING CARE CORPORATION ("BCCC") AND COMMUNITY EMERGENCY MEDICAL SERVICE, INC. ("CEMS") PREVIOUSLY, ZIEGER HEALTH CARE CORPORATION WAS THE SOLE MEMBER OF BCCC AND CEMS. THE AMENDED ARTICLES AND BYLAWS OF ZEIGER HEALTH CARE CORPORATION PROVIDE THAT THE ENTITY CONTINUES TO EXIST TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF BOTSFORD GENERAL HOSPITAL, AND TO SUPPORT AND CARRY OUT THE CHARITABLE AND EDUCATIONAL PURPOSES OF BOTSFORD GENERAL HOSPITAL. IN THIS ROLE, ZIEGER HEALTH CARE CORPORATION ALSO REMAINS IN PLACE TO MONITOR AND IF NECESSARY, SEEK SPECIFIC PERFORMANCE ON BEHALF OF BOTSFORD GENERAL HOSPITAL OF KEY PROVISIONS OF THE BEAUMONT HEALTH AFFILIATION AGREEMENT. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 AND ALL RELATED SCHEDULES WERE PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT AND REVIEWED BY AN OUTSIDE TAX FIRM. A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE OF THE CONFLICT OF INTEREST POLICY BY A REVIEW OF THE POLICY ANNUALLY AT THE BOARD MEETING AND MANDATORY SUBMISSION OF CONFLICTS TO THE SECRETARY OF THE ORGANIZATION PER THE POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION, BENEFITS AND RETIREMENT COMMITTEE (COMMITTEE) OF BOTSFORD HEALTH CARE WILL REVIEW AND MAKE RECOMMENDATIONS TO THE BOARD OF DIRECTORS WITH RESPECT TO ALL ASPECTS OF COMPENSATION AND OTHER BENEFITS, INCLUDING, WITHOUT LIMITATIONS, COMPENSATION OF THE CORPORATION'S DIRECTORS, OFFICERS, PHYSICIANS, EMPLOYEES AND CONTRACTORS. THE COMMITTEE RETAINS AN INDEPENDENT COMPENSATION CONSULTANT EACH YEAR TO ASSESS THE COMPETITIVENESS AND REASONABLENESS OF THE TOTAL COMPENSATION PROVIDED TO EXECUTIVES, DIRECTORS AND PHYSICIANS. THE COMPENSATION CONSULTANT ABSTRACTS BASE SALARY, TOTAL CASH COMPENSATION AND BENEFITS DATA FROM MAJOR SURVEYS FOR HEALTHCARE AND OTHER APPROPRIATE INDUSTRIES. THE FAIR MARKET REVIEW IS FOR COMPARABLE POSITIONS IN COMPARABLE ORGANIZATIONS BASED UPON SIZE, TOTAL REVENUES AND OTHER RELEVANT FACTORS. YEARLY, THE CONSULTANT WILL PRESENT A SUMMARY OF FINDINGS AND RECOMMENDATIONS INTENDED TO HELP THE COMMITTEE ESTABLISH THE "REBUTTABLE PRESUMPTION OF REASONABLENESS FOR EXECUTIVES, DIRECTORS AND PHYSICIANS". THE COMMITTEE WILL MAKE RECOMMENDATIONS TO THE VARIOUS BOARDS FOR APPROVAL. NO MEMBER OF THE COMMITTEE WILL EVALUATE ANY COMPENSATION ARRANGEMENT WITH RESPECT TO WHICH HE OR SHE HAS A CONFLICT OF INTEREST. YEARLY, THE COMMITTEE MEMBERS WILL SIGN A CONFLICT OF INTEREST POLICY. ALL COMMITTEE RECOMMENDATIONS AND ACTIONS ARE ADEQUATELY DOCUMENTED IN COMMITTEE MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS THAT ARE REQUIRED TO BE MADE AVAILABLE TO THE PUBLIC WILL BE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 917,508. FUNDRAISING EXPENSES 28,470. TOTAL EXPENSES 945,978. SYSTEM SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 14,316. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,316. MISC EXP: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 79. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79. |
| FORM 990, PART XI, LINE 9: | CHANGE IN FUND BALANCES -50,345. NET ASSET TRANSFER TO BOTSFORD GENERAL HOSPITAL -5,865,146. |
| FORM 990, PART XII, LINE 2C | AUDIT COMMITTEE PROCESS THE ORGANIZATION'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THE PROCESS THAT THE AUDIT COMMITTEE FOLLOWS FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR HAS NOT CHANGED FORM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |