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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 40,000 | 40,000 | ||||
| 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...... | 17,684,947 | 23,770,815 | 23,271,776 | 26,006,190 | 28,672,103 | 119,405,831 |
| 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. | 17,684,947 | 23,770,815 | 23,271,776 | 26,046,190 | 28,672,103 | 119,445,831 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 119,445,831 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 17,684,947 | 23,770,815 | 23,271,776 | 26,046,190 | 28,672,103 | 119,445,831 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 251,734 | 530,386 | 424,455 | 533,758 | 1,145,288 | 2,885,621 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 251,734 | 530,386 | 424,455 | 533,758 | 1,145,288 | 2,885,621 |
| 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.).. | 17,936,681 | 24,301,201 | 23,696,231 | 26,579,948 | 29,817,391 | 122,331,452 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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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 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. GREG BEAUCHIMIN, GERSON COOPER, WILLIAM DWYER, PAUL LACASSE, ROBERT MASON, JOHN NEMES, CHRIS OSTER, THOMAS DEKAR, LISA VANDECAVEYE, SANFORD VIEDER, REGINA DOXTADER AND SHIRLEY POTTER |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERSHIP OF THE CORPORATION CONSISTS OF ONE CLASS AND THE SOLE MEMBER OF THE CORPORATION IS BOTSFORD GENERAL HOSPITAL, A TAX EXEMPT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | BEAUMONT HEALTH IS THE PARENT CORPORATION AND SOLE MEMBER OF BOTSFORD GENERAL HOSPITAL, WHICH IS THE SOLE MEMBER OF COMMUNITY EMERGENCY MEDICAL SERVICE, INC. BEAUMONT HEALTH HAS THE POWER TO ADD NEW OR ADDITIONAL MEMBERS PER ARTICLE III, SECTION 4.03 OF THE ARTICLES OF INCORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE GOVERNING BODY OF THIS ENTITY HAS FULL AUTHORITY TO GOVERN THE AFFAIRS OF THE ORGANIZATION, EXCEPT FOR POWERS WHICH ARE RESERVED TO BEAUMONT HEALTH OR BOTSFORD GENERAL HOSPITAL PER ARTICLE III, SECTION 3.03 AND 3.04 OF THE ARTICLES OF INCORPORATION. RESERVED POWERS INCLUDE AMENDING, MODIFYING OR REPEALING THE ARTICLES OF INCORPORATION OR BYLAWS; MERGER, CONSOLIDATION OR AFFILIATION OF THE CORPORATION WITH ANOTHER ENTITY; VOLUNTARY DISSOLUTION OF THE CORPORATION; NEW OR ADDITIONAL MEMBERS TO THE MEMBERSHIP OF THE CORPORATION; CHANGE IN THE VOTING POWERS OF THE MEMBERS; SALE, EXCHANGE, LEASE, TRANSFER OR MORTGAGE ANY REAL PROPERTY OF THE CORPORATION IN EXCESS OF $1 MILLION; DISCONTINUE OR MAKE MATERIAL MODIFICATION TO A MAJOR ACTIVITY, PROGRAM OR SERVICE OF THE CORPORATION; ADOPT A BUDGET WHICH WOULD RESULT IN A DEFICIT FROM OPERATIONS; STRATEGIC AND LONG RANGE PLANS, CREATE LONG TERM OBLIGATIONS OF THE CORPORATION WHERE THE PRINCIPAL EXCEEDS 25% OF THE VALUE OF THE NET ASSETS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 2015 FORM 990 WAS SUBJECTED TO A MULTI-STEP REVIEW PROCESS CULMINATING IN THE PROVISION OF SUCH FORM TO ALL VOTING MEMBERS OF THE COMMUNITY EMERGENCY MEDICAL SERVICE, INC. BOARD OF DIRECTORS PRIOR TO ITS FILING. THE FORM 990 IS PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT AND REVIEWED BY LEADERSHIP FOR COMPLETENESS AND CORRECTNESS. THE FORM 990 IS THEN REVIEWED BY THE CORPORATION'S OUTSIDE ACCOUNTING FIRM. AS THE FINAL STEP IN THE MULTI-LEVEL REVIEW PROCESS, A COPY OF THE FINAL VERSION OF THE FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF COMMUNITY EMERGENCY MEDICAL SERVICE, INC.'S GOVERNING BODY FOR THEIR REVIEW BEFORE IT WAS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REVIEW OF THE POLICY ANNUALLY AT THE BOARD MEETING AND MANDATORY SUBMISSION OF CONFLICTS TO THE SECRETARY OF THE ORGANIZATION PER THE POLICY. THE CONFLICT OF INTEREST POLICY COVERS ANY DIRECTOR, OFFICER, NON-DIRECTOR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWER OR OTHER PERSON IN A SIMILAR POSITION OF AUTHORITY OVER THE CORPORATION. THE CONFLICT OF INTEREST POLICY OUTLINES SPECIFIC RESTRICTIONS TO PROTECT THE INTERESTS OF THE CORPORATION WHEN A CONFLICT EXISTS. |
| 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 XI, LINE 9: | ADDITIONAL MINIMUM PENSION LIABILITY ADJUSTMENT 1,109,881. INVESTMENT ASSETS TRANSFERRED TO AFFILIATE WILLIAM BEAUMONT HOSPITAL -6,659,326. |
| FORM 990, PART XII, LINE 2C | IN 2015, BEAUMONT HEALTH, THE PARENT ORGANIZATION AND SOLE MEMBER OF BOTSFORD GENERAL HOSPITAL, OAKWOOD HEALTHCARE, INC. AND WILLIAM BEAUMONT HOSPITAL, RESOLVED TO SELECT ONE INDEPENDENT ACCOUNTING FIRM FOR THE SYSTEM, AND PUT THE WORK OUT TO BID WITH SEVERAL QUALIFIED FIRMS. AFTER REVIEW OF THE FIRMS' PROPOSALS AND CONSIDERATION OF THE QUALIFICATIONS OF EACH, THE FINAL DECISION WAS MADE BY THE GOVERNING BODY OF BEAUMONT HEALTH. |
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