TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Georgia R Fojtasek RN EdD...................................................................... Trustee-President & CEO	58.00 ................. 7.00	X	X	0	1,274,944	54,700
(2) Martha A Fuerstenau...................................................................... Trustee	1.00 ................. 1.00	X		0	0	0
(3) Robert G Riney...................................................................... Trustee	1.00 ................. 64.00	X		0	1,837,361	50,013
(4) Adnan R Munkarah MD...................................................................... Physician Trustee	1.00 ................. 63.00	X		0	923,523	55,624
(5) Sandra Kilian MD...................................................................... Trustee	60.00 ................. 1.00	X		179,151	0	26,458
(6) Kevin E Oxley...................................................................... Trustee-President & CEO	1.00 ................. 1.00	X		0	0	0
(7) Timothy K Levy...................................................................... Trustee- Chair	2.00 ................. 2.00	X	X	0	0	0
(8) Aaron S Boatin...................................................................... Trustee	1.00 ................. 3.00	X		0	0	0
(9) Neeta M Delaney...................................................................... Trustee- Vice Chair	2.00 ................. 2.00	X	X	0	0	0
(10) Bradley N Clark...................................................................... Trustee- Secretary/Treasurer	2.00 ................. 2.00	X	X	0	0	0
(11) David L Halsey MD...................................................................... Trustee	1.00 ................. 1.00	X		39,092	0	0
(12) Mark Olson...................................................................... Trustee	1.00 ................. 1.00	X		0	0	0
(13) Andrew F Caughey MD...................................................................... CMO/CEO HFAHMG	1.00 ................. 1.00	X		0	0	0
(14) Steven D Rick...................................................................... Trustee	1.00 ................. 1.00	X		0	0	0
(15) John C Nally...................................................................... Trustee	1.00 ................. 1.00	X		0	0	0
(16) Gregg A Patten MD...................................................................... Trustee	1.00 ................. 2.00	X		0	0	0
(17) Mohan G Kulkarni MD...................................................................... Physician Trustee	60.00 ................. 1.00	X		961,567	0	91,920

(A) Name and business address	(B) Description of services	(C) Compensation
CHRISTMAN COMPANY 208 N Capital Avenue Lansing,MI489331357	General Contractor	14,958,800
Independent Hospitalist Physicians PLLC PO BOX 100 Royal Oak,MI48068	Healthcare Services	10,001,757
ST JOSEPH MERCY HEALTH SYSTEM PO BOX 992 Ann Arbor,MI48106	Healthcare Services	9,822,125
Pulmonary Clinics Of Southern MI PC 900 E Michigan Avenue Ste 105 Jackson,MI49201	Healthcare Services	3,561,764
FOCUSONE SOLUTIONS LLC PO BOX 3037 OMAHA,NE681030037	Staffing Solutions	2,174,763
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 51

- TIN:

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization WA Foote Memorial Hospital

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization WA Foote Memorial Hospital		Employer identification number 38-2027689

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization WA Foote Memorial Hospital			Employer identification number 38-2027689
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

41,452

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

41,452

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	Health care is a highly-regulated field, requiring frequent and high-level communication with regulators and elected officials. A small investment in lobbying enables us to remain in contact with legislators and government agencies, maximize the resources with which we are entrusted and assure that we provide the best care to our community. W.A. Foote Memorial Hospital dba Henry Ford Allegiance Health enlists the services of several lobbying consultants, attorneys and healthcare trade associations. In addition, the Hospital employs a corporate accounts specialist. The specialist spends a portion of his time contacting legislators, participating in grass roots advocacy, and other activities closely related to lobbying.

Return Reference

Explanation

Part II-B, Line 1:

Health care is a highly-regulated field, requiring frequent and high-level communication with regulators and elected officials. A small investment in lobbying enables us to remain in contact with legislators and government agencies, maximize the resources with which we are entrusted and assure that we provide the best care to our community. W.A. Foote Memorial Hospital dba Henry Ford Allegiance Health enlists the services of several lobbying consultants, attorneys and healthcare trade associations. In addition, the Hospital employs a corporate accounts specialist. The specialist spends a portion of his time contacting legislators, participating in grass roots advocacy, and other activities closely related to lobbying.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can 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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax 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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), 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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII 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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds. Complete if the organization answered "Yes" on 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 ....	2,713,012	2,037,753	1,614,108	1,451,944	1,312,432
b	Contributions ...	2,074,346	1,513,373	471,995	463,114	558,781
c	Net investment earnings, gains, and losses	-50,758	93,086	19,074	12,856	-4,612
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	1,553,207	931,200	67,424	313,806	414,657
f	Administrative expenses ....
g	End of year balance ......	3,183,393	2,713,012	2,037,753	1,614,108	1,451,944

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

23.370 %

Temporarily restricted endowment SchDMd Bullet

76.630 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	4,034,484		4,034,484
b	Buildings ....	161,889,620	18,953,592	142,936,028
c	Leasehold improvements	210,800	90,866	119,934
d	Equipment ....	137,117,198	45,835,241	91,281,957
e	Other .....	3,503,562		3,503,562
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				241,875,965

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Retirement Plan Liability	36,955,071
Deferred Comp	6,315,850
Corporate Reserve	6,173,223
Liability Insurance	12,326,008
Workers Comp Liability	821,998
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	62,592,150
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	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 XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Part V, Line 4:	The Organization's endowment funds are used for various charitable hospital programs including treatment of uninsured patients, community preventative health education, program development and capital improvements.
Part X, Line 2:	The System does not have any material uncertain tax positions as of December 31, 2018 and 2017.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
WA Foote Memorial Hospital

Employer identification number

38-2027689

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	Central America and Carribean			Investments	29,337,965
















3a	Sub-total .....	0	0		29,337,965
b	Total from continuation sheets to Part I ...				0
c	Totals (add lines 3a and 3b)	0	0		29,337,965

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2018

Schedule F (Form 990) 2018

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2018

Schedule F (Form 990) 2018Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2018

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2018

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation

Schedule F (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 25000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	5,811,282		5,811,282	1.000 %
b	Medicaid (from Worksheet 3, column a) . . . . .	169,514,153	131,451,541	38,062,612	6.540 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	175,325,435	131,451,541	43,873,894	7.540 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	656,312	9,200	647,112	0.110 %
f	Health professions education (from Worksheet 5) . . .	16,118,833	6,527,528	9,591,305	1.650 %
g	Subsidized health services (from Worksheet 6) . . . .	18,647,245	16,836,981	1,810,264	0.310 %
h	Research (from Worksheet 7) .	333,006		333,006	0.060 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	687,892		687,892	0.120 %
j	Total. Other Benefits . .	36,443,288	23,373,709	13,069,579	2.250 %
k	Total. Add lines 7d and 7j .	211,768,723	154,825,250	56,943,473	9.790 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	200	8,197	8,197	0 %
4	Environmental improvements
5	Leadership development and training for community members		1,574	1,574	0 %
6	Coalition building	160,225	363,739	363,739	0.060 %
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	160,425	373,510	373,510	0.060 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

20,331,439

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

5,082,860

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

171,677,542

Enter Medicare allowable costs of care relating to payments on line 5.....

186,856,154

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-15,178,612

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 Foote Health Center Associates	Entity leases medical office space.	62.000 %	0 %	38.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	WA Foote Memorial Hospital 205 N East Avenue Jackson,MI49201 www.henryford.com	X	X	X	X	X

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	WA Foote Memorial Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V, Page 8

Other website (list url): www.myhio.org

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Part V, Page 8

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	WA Foote Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000% and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

https://www.henryford.com/visitors/billing/financial-assistance

The FAP application form was widely available on a website (list url):

https://www.henryford.com/visitors/billing/financial-assistance

A plain language summary of the FAP was widely available on a website (list url):
https://www.henryford.com/visitors/billing/financial-assistance

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	WA Foote Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	WA Foote Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
W.A. Foote Memorial Hospital	Part V, Section B, Line 2: Effective April 1, 2016, Henry Ford Health System became the sole member of Henry Ford Allegiance Health Group (formerly Allegiance Health Services). Henry Ford Allegiance Health Group is the sole member of W. A. Foote Memorial Hospital d/b/a Henry Ford Allegiance Health. Henry Ford Health System is a non-profit 501(c)(3) organization. This affiliation allows Henry Ford Allegiance Health Group to join forces with one of the largest healthcare providers in Michigan to continue to provide high-quality healthcare services to residents of the community it serves. It also ensures that Henry Ford Allegiance Health Group will have the commitment to capital to continue to pursue growth opportunities and to expand existing healthcare services, with the goal of providing the best care possible.
W.A. Foote Memorial Hospital	Part V, Section B, Line 5: The Health Improvement Organization Coordinating Council, founded by Henry Ford Allegiance Health (HFAH), is a collaborative of community stakeholders committed to improving the health status of the community through an integrated health improvement infrastructure that addresses Jackson's priority health issues. The HIO Coordinating Council serves as the health strand of the Jackson Collaborative Network which also includes the Cradle to Career Education network and the Financial Stability Network. The scope of the HIO Coordinating Council responsibility includes monitoring community level indicators, identifying specific health priorities and developing community action plans to address common goals.In this model, community stakeholders work with public health experts to develop and complete a community health assessment for Jackson County.This assessment provides a data collection mechanism that better aligns efforts among community partners and creates a more strategic framework for local health improvement activities.Individuals contributing input for HFAH's recent CHNA:Megan Albertson, HFAHKellie Baker, LifeWaysMarilyn Bell, Michigan Purchasers Health AllianceSara Benedetto, Center for Family Health Adam Brown, Jackson County AdministrationCindy Bruner, Meridian Health PlanShelly Bullinger, Jackson County Health DepartmentKathleen Clark, YMCA Storer CampsMark Fall, Henry Ford Allegiance CareLinkAndrew Farmer, AARP of MichiganKevin Ford, MSUTed Hilleary, Community MemberJennifer Johnson, Great Lakes IndustryDavid King, LifeWaysRay King, HFAHDavid Kirk, HFAHIrene LeCrone, United WayKatie Luke, Partnership Park Neighborhood Assoc.Katherine Martin, Community Action AgencyRebecca Mayer, AWAREPamela McCrum, Catholic Charities of Jackson Dani Meier, Jackson Public SchoolsMonica Moser, Jackson Community Foundation Wendy Murdock, United Way of Jackson CountyErin Norton, United WayAmy Pelletier, Marriage MattersRhonda Rudolph, Jackson County Health DepartmentScott Schmidt, United Way of Jackson County Amy Schultz, HFAHSteve Sukta, Intermediate School DistrictScott TenBrink, Fitness Council of Jackson Shaina Tinsey, HFAHJulie Weisbrod, Jackson County Health DepartmentTed Westmeier, Jackson County Health Department
W.A. Foote Memorial Hospital	Part V, Section B, Line 6a: Henry Ford Specialty Hospital, a Community-Owned Specialty Hospital. HFSH is a related non-profit corporation.
W.A. Foote Memorial Hospital	Part V, Section B, Line 6b: AARPBig Brothers/Big SistersCenter for Family HealthCommunity Action AgencyCradle to CareerFitness Council of JacksonGreat Lakes IndustryGreat StartJackson Community FoundationJackson County Health DepartmentJackson County Intermediate School DistrictJackson County Parks and RecreationJackson Health NetworkJackson YMCALifeWaysMarriage Matters JacksonMichigan State UniversityPartnership Park Downtown Neighborhood AssociationUnited Way of Jackson CountyUniversity of MichiganYMCA Storer Camps
W.A. Foote Memorial Hospital	Part V, Section B, Line 7d: The CHNA is posted on the hospital website at the address below. In addition, the CHNA is posted on other community organization websites, presented at public forums, and hard copies of the assessment are available upon request. www.henryford.com/about/community-health
W.A. Foote Memorial Hospital	Part V, Section B, Line 11: Henry Ford Allegiance Health and its community partners have a comprehensive implementation strategy to meet needs identified in the Community Health Needs Assessment (CHNA). The CHNA implementation strategy is rolled out in stages. Henry Ford Allegiance Health completed a Community Health Needs Assessment with partners across Jackson County. After surveying community stakeholders and analyzing local health data, the following indicates the priority areas of focus for HFAH.IDENTIFIED PRIORITIES / GOALSo Improve the knowledge, attitudes and behaviors of residents of Jackson Countyo Reduce the obesity rate amongst Jackson County residentso Reduce smoking rate and secondhand smoke exposure in Jackson Countyo Improve the behavioral health and emotional wellness of Jackson County residentso Enhance collaborative action planning, resource alignment, and linkages among clinical and social systems to achieve collective population health impactMultiple strategies were adopted to address each identified priority. HFAH serves as the "champions" for multiple strategies. While measuring improvement in health status for every priority can be challenging in the short term, updated data indicates local improvement in a number of areas including:o Proportion of Jackson County residents that received advice about their weight from a health care provider increased from 27% in 2010 CHNA to 39% in 2013 CHNA and 42% in 2016 CHNA.o Number of Jackson residents with low access to fresh food decreased from 19,000 to 12,000 from 2013 CHNA to 2016 CHNA.o Proportion of smokers who report receiving advice from their provider to quit increased from 61% to 68% from 2013 CHNA to 2016 CHNA.o Percent of adults who would 'definitely' seek professional help for a serious emotional problem increased from 54% to 63% from 2013 CHNA to 2016 CHNA.In terms of significant health needs that will not be addressed, Henry Ford Allegiance Health acknowledges the wide range of health concerns that emerged from the CHNA process, and determined it could most effectively focus on those health needs that were determined to be most urgent and essential to the health of the community as well as within its ability to influence. The implementation plan can be accessed on the hospital's website atwww.henryford.com/about/community-health
W.A. Foote Memorial Hospital	Part V, Section B, Line 15e: Invoice provides patient with a number to call if they believe they may qualify for financial assistance. Patients calling the number are guided through the financial assistance application process by hospital representatives.PART V, SECTION B, LINE 22A:Uninsured patients who do not otherwise qualify for insurance with household incomes at or below 250% of the Federal poverty level may qualify under the Patient Financial Assistance Policy (FAP) for medically necessary services to be provided at no cost.In addition, patients regardless of insurance status with annual medical liabilities to HFHS in excess of 30% of their household income may qualify for discounts on their personal obligations. Patient's personal responsibilities for medically necessary services not covered by insurance or FAP are generally based on the amount generally billed for the service, which approximates 115% of prevailing Medicare rates.

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?81
Name and address		Type of Facility (describe)
1	1 - Henry Ford Allegiance Occupational Hlth 100 E Michigan Ave Ste 101 Jackson,MI49201	Urgent care, employment screening
2	2 - Henry Ford Allegiance Physical Rehab-Jac 100 E Michigan Ave Ste 103 Jackson,MI49201	Rehab
3	3 - Henry Ford Allegiance Substance Abuse Se 2424 W Washington Ave Jackson,MI49201	Outpatient Treatment
4	4 - Henry Ford Allegiance Home Care 100 E Michigan Ave Ste 400 Jackson,MI49201	Visiting Nurses
5	5 - Henry Ford Allegiance Personal Care 100 E Michigan Ave Ste 400 Jackson,MI49201	Private duty nursing
6	6 - Henry Ford Allegiance Tobacco Treatment 100 E Michigan Ave Ste 900 Jackson,MI49201	Outpatient Treatment
7	7 - Gayle M Jacob Cancer Center 1100 E Michigan Ave Ste 307 Jackson,MI49201	Hematology Oncology practice and infusion center
8	8 - Allegiance Wellness Center 1100 E Michigan Ave Ste 100 Jackson,MI49201	Wellness Center
9	9 - Henry Ford Allegiance Cardiac Rehab 1100 E Michigan Ave Ste 102 Jackson,MI49201	Post-surgical Rehab facility
10	10 - Henry Ford Allegiance Pulmonary Rehab 1100 E Michigan Ave Ste 102 Jackson,MI49201	Post-surgical Rehab facility
11	11 - Henry Ford Allegiance Diagnostic Center- 1100 E Michigan Ave Ste 104 Jackson,MI49201	Lab and imaging services
12	12 - Henry Ford Allegiance Outpatient Trauma 1100 E Michigan Ave Ste 201 Jackson,MI49201	Physician specialty practice
13	13 - Henry Ford Allegiance Thoracic Surgery 1100 E Michigan Ave Ste 201 Jackson,MI49201	Physician specialty practice
14	14 - Henry Ford Allegiance Pediatric Cardiolo 1100 E Michigan Ave Ste 201 Jackson,MI49201	Physician specialty practice
15	15 - Henry Ford Allegiance Cardiac Surgery S 1100 E Michigan Ave Ste 201 Jackson,MI49201	Physician specialty practice
16	16 - Henry Ford Allegiance Radiation Oncology 1102 E Michigan Ave Jackson,MI49201	Radiation therapy
17	17 - Henry Ford Allegiance ENT 1111 Teneyck St Ste 100 Jackson,MI49201	Physician specialty practice
18	18 - Henry Ford Allegiance Hearing Center 1111 Teneyck St Ste 200 Jackson,MI49201	Hearing loss treatment; hearing aid sales/service
19	19 - Henry Ford Allegiance Surgery Center 1125 E Michigan Avenue Jackson,MI49201	Outpatient surgery center
20	20 - Henry Ford Allegiance Rheumatology 1201 E Michgan Avenue Ste 100 Jackson,MI49201	Physician specialty practice
21	21 - Henry Ford Allegiance Neurology 1201 E Michgan Avenue Ste 240 Jackson,MI49201	Physician practice
22	22 - Henry Ford Allegiance Orthopedics 1201 E Michgan Avenue Ste 300 Jackson,MI49201	Physician specialty practice
23	23 - Henry Ford Allegiance Senior Health Cntr 100 E Michigan Ave Ste 102 Jackson,MI49201	Retail sales of durable medical equipment
24	24 - Henry Ford Allegiance Osteoporosis Cntr 1201 E Michigan Ave Ste 120 Jackson,MI49201	Physician practice
25	25 - Allegiance Balance Center 1201 E Michigan Ave Ste 120 Jackson,MI49201	Rehabilitation services
26	26 - Henry Ford Allegiance Pain Management 1201 E Michigan Ave Ste 200 Jackson,MI49201	Physician practice
27	27 - Henry Ford Allegiance Neurosurgery 1201 E Michigan Ave Ste 240 Jackson,MI49201	Physician specialty practice
28	28 - Henry Ford Allegiance Physical Medicine 1201 E Michigan Ave Ste 300 Jackson,MI49201	Physician specialty practice
29	29 - Henry Ford Allegiance Physical Rehab 1201 E Michigan Ave Ste 300 Jackson,MI49201	Rehabilitation services
30	30 - Henry Ford Allegiance Diagnostic Center 1201 E Michigan Avenue Jackson,MI49201	Laboratory and imaging services
31	31 - Henry Ford Allegiance Diagnostic Center- 1310 Greenwood Ave Jackson,MI49203	Laboratory services
32	32 - Henry Ford Allegiance Neuropsychology 1400 E Michigan Ave Jackson,MI49202	Physician specialty practice
33	33 - Henry Ford Allegiance Diagnostic Center- 1401 W North Street Jackson,MI49202	Lab and imaging services
34	34 - Henry Ford Allegiance Family Medicine 1401 W North Street Jackson,MI49202	Family medicine and Extended Hours Clinic
35	35 - Henry Ford Allegiance CRNA 205 N East Ave Jackson,MI49201	Anesthesiology services
36	36 - Henry Ford Allegiance EEG 205 N East Ave Jackson,MI49201	Patient testing
37	37 - Henry Ford Allegiance EKG 205 N East Ave Jackson,MI49201	Patient testing
38	38 - Henry Ford Allegiance Emergency Care 205 N East Ave Jackson,MI49201	Emergency room and urgent care
39	39 - Henry Ford Allegiance Health Pharmacy 205 N East Ave Jackson,MI49201	Outpatient pharmacy
40	40 - Henry Ford Allegiance Sleep Health Cent 205 N East Ave Jackson,MI49201	Diagnostic and testing center
41	41 - Henry Ford Allegiance Behavioral Health 205 N East Ave Jackson,MI49201	Mental health outpatient services
42	42 - Henry Ford Allegiance Digestive Health 205 S East Ave Jackson,MI49201	Outpatient GI procedures
43	43 - Henry Ford Allegiance Behavioral Health 2200 Springport Road Ste 200 Jackson,MI49202	Mental health OP services
44	44 - Henry Ford Allegiance Infectious Disease 2200 Springport Road Ste 500 Jackson,MI49202	Geriatric services
45	45 - Henry Ford Allegiance Wound Care Center 2200 Springport Road Ste 500 Jackson,MI49202	Treatment and therapy
46	46 - Henry Ford Allegiance Diagnostic Center 2200 Springport Road Ste 800 Jackson,MI49202	Laboratory services
47	47 - Henry Ford Allegiance Medication Therapy 2200 Springport Road Ste 900 Jackson,MI49202	Pharmaceutical counseling services
48	48 - Henry Ford Allegiance Addiction Recovery 2424 W Washington Ave Jackson,MI49203	Outpatient treatment center
49	49 - Allegiance Family Medicine - Summit Wood 2585 Spring Arbor Road Jackson,MI49203	Family medicine
50	50 - Henry Ford Allegiance Vascular Health 300 W Washington Avenue Ste 300 Jackson,MI49201	Physician specialty practice
51	51 - Henry Ford Allegiance Vascular Laborator 300 W Washington Avenue Ste 350 Jackson,MI49201	Vascular system testing (ultrasound)
52	52 - Henry Ford Allegiance Health Cardiology 309 Page Avenue Jackson,MI49201	Cardiovascular care, diagnostic testing
53	53 - Henry Ford Allegiance Family Medicine 3235 E Michigan Avenue Ste 100 Jackson,MI49202	Family medicine
54	54 - Henry Ford Allegiance Internal Medicine 3235 E Michigan Avenue Ste 150 Jackson,MI49202	Internal medicine
55	55 - Henry Ford Allegiance Diagnostic Center 3305 Spring Arbor Rd Ste 100 Jackson,MI49203	Lab and imaging services
56	56 - Henry Ford Allegiance Women's Health Cnt 3305 Spring Arbor Rd Ste 500 Jackson,MI49203	Clinical exams, mammograms, spa services
57	57 - Henry Ford Allegiance Family Medicine 3333 Spring Arbor Rd Ste 100 Jackson,MI49203	Family medicine (pending, not currently open)
58	58 - Henry Ford Allegiance Family Medicine 400 Hinckley Blvd Ste 100 Jackson,MI49203	Family medicine
59	59 - Henry Ford Allegiance Diagnostic Center 400 Hinckley Blvd Ste 200 Jackson,MI49203	Lab and imaging services
60	60 - Henry Ford Allegiance Family Medicine 4304 Page Ave Michigan Center,MI49254	Family medicine (pending, not currently open)
61	61 - Henry Ford Allegiance Diagnostic Center 4304 Page Ave Michigan Center,MI49254	Lab and imaging services
62	62 - Henry Ford Allegiance Physical Rehabilit 4304 Page Ave Ste 100 Michigan Center,MI49254	Rehabilitation services
63	63 - Henry Ford Allegiance Diagnostic Center 505 N Jackson St Ste 178 Jackson,MI49201	Lab and imaging services
64	64 - Henry Ford Allegiance Home Medical Equip 700 E Michigan Ave Jackson,MI49201	Retail Sales of durable medical equipment
65	65 - Phlebotomy - Dr Lynd 724 W Franklin Jackson,MI49203	Phlebotomy office (independent physician practice)
66	66 - Henry Ford Allegiance General Surgery 744 W Michigan Ave Ste 200 Jackson,MI49201	Physician specialty practice
67	67 - Henry Ford Allegiance Gastroenterology 744 W Michigan Ave Ste 201 Jackson,MI49201	Physician specialty practice
68	68 - Henry Ford Allegiance Pediatrics 760 W Franklin Jackson,MI49203	Pediatric medicine
69	69 - Henry Ford Allegiance Diagnostic Center 12369 E Michigan Ave Grass Lake,MI49240	Lab and imaging services
70	70 - Henry Ford Allegiance Family Medicine 12369 E Michigan Ave Grass Lake,MI49240	Family medicine
71	71 - Henry Ford Allegiance Family Medicine 130 N Sherman St Leslie,MI49251	Family medicine
72	72 - Henry Ford Allegiance Family Medicine 810 Hogsback Rd Ste A Mason,MI48854	Family medicine
73	73 - Henry Ford Allegiance Health Diagnostic 810 Hogsback Rd Ste B Mason,MI48854	Lab and imaging services
74	74 - Henry Ford Allegiance Physical Rehab 810 Hogsback Rd Ste B Mason,MI48854	Rehabilitation services
75	75 - Henry Ford Allegiance Diagnostic Center 153 Wamplers Lake Rd Brooklyn,MI49230	Laboratory services (Jan 2016 adding imaging services)
76	76 - Henry Ford Allegiance Family Medicine 8958 M-50 Onsted,MI49265	Family medicine
77	77 - Henry Ford Allegiance Family Medicine 27931 C Drive North Albion,MI49224	Family medicine
78	78 - Henry Ford Allegiance Family Medicine 7845 Spring Arbor Road Spring Arbor,MI49283	Family medicine
79	79 - Henry Ford Allegiance Plastic Surgery 3305 Spring Arbor Rd Ste 200 Spring Arbor,MI49283	Plastic Surgery
80	80 - Henry Ford Allegiance Dermatology 3333 Spring Arbor Rd Ste 500 Spring Arbor,MI49283	Dermatology
81	81 - Henry Ford Allegiance Podiatry 3333 Spring Arbor Rd Ste 200 Spring Arbor,MI49283	Podiatry

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
Part I, Line 6a:	The Hospital prepares an annual community benefit report, which can be accessed at www.Henryford.com/locations/allegiance-health/about/giving-back/report-to-the-community
Part I, Line 7:	The Hospital used a cost-to-charge ratio to calculate the cost of charity care and Medicaid shortfall. Community Health Improvement Services, Health Professions Education, Research and Contributions are actual amounts.
Part I, Ln 7 Col(f):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $20,331,439
Part II, Community Building Activities:	The Hospital is involved in numerous community building activities. We believe these activities, such as supporting affordable housing, working in partnership with the local community college to develop skilled nurses and supporting economic development programs directly improve the general health and wellness of the community. Also, staff at every level of the organization are encouraged to serve community groups that promote education, health and economic advocacy for the less fortunate.
Part III, Line 2:	The organization's bad debt expense is stated in patient gross charges.
Part III, Line 4:	Accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its historical experience and identifies trends for each of its major payor sources to estimate the appropriate allowance for uncollectible accounts and the provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party health care coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and provision for bad debts. For receivables associated with self-pay accounts (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts. The amount of bad debt reported for the tweleve months ended Decemember 31,2018 financial statements was $20,331,439.
Part III, Line 8:	The Organization believes the entire Medicare shortfall reported on Line 7 should be treated as Community Benefit. Henry Ford Allegiance Health is nationally recognized by Healthgrades as being in the top five percent nationally for patient safety (seven years in a row). Henry Ford Allegiance Health also benchmarks favorably on overall cost per case and is deemed to be an efficient provider. The Organization is subsidizing a government program and sustaining significant losses in providing health care to Medicare receipients. By continuing to treat patients eligible for Medicare, hospitals alleviate the federal government's burden for directly providing medical services.
Part III, Line 9b:	The Hospital does not collect from patients known to qualify for charity care or other financial assistance. Patients having difficulty paying their bills are directed to financial counselors. These counselors review the patient's information in order to see if they qualify for assistance. In addition, bills sent to patients include a number to call for help in providing the required financial information to qualify for charity care.
Part VI, Line 2:	The Health Improvement Organization (HIO) was founded on the understanding that long-term health improvement requires that we extend beyond acute medical care to affect the social and environmental determinants of health. Since its creation in 2000, the HIO has evolved to become a national best practice model for organizing population health improvement efforts in a region. The Health Improvement Organization Coordinating Council (HIO CC) is the community stakeholder collaborative, led by Henry Ford Allegiance Health, responsible for completing shared needs assessments, identifying high priority health issues, developing and coordinating implementation of collaborative action plans and monitoring progress over time. In FY16, the HIO CC completed an updated Community Health Assessment report and 2016-2017 Community Action Plan. The Community Health Assessment was posted on the Henry Ford Allegiance Health and HIO websites and adopted by the Henry Ford Allegiance Board of Trustees and HIO Coordinating Council in June 2016. This plan reflects significant work of many dedicated organizations and individuals: Over 1200 Jackson County residents responded to our third Community Health Assessment phone survey or participated in focus group discussions to provide insight about local health status, attitudes, beliefs, behaviors and opportunities. More than 30 HIO Coordinating Council representatives from local government, public health, health care, school districts, mental health, employers and other human service sectors spent months reviewing local data, best practice research and community input to revise our Goals and Objectives for 2016-2017. Three existing community initiatives were voted into the Health Improvement Organization, resulting in seven Health Action Teams leading change around priority health issues.Over 20 organizations and individuals stepped up to lead Health Action Teams and champion specific strategies.Our Community Health Assessment gives Jackson a powerful tool to measure health indicators within geographic and demographic subpopulations and to track changes over time. Based on the most recent data, the HIO continues to prioritize obesity, smoking and behavioral health as targets for improvement. Action Teams organized around goals in each of these areas are pursuing evidence-based community strategies such as increasing access to healthy food, enhanced mental health screening, and anti-tobacco policies. In addition to topic-specific teams around improving nutrition, physical activity, smoke-free lifestyles, behavioral health, teen pregnancy prevention, maternal and child health, and substance abuse prevention, the HIO is active in two cross-network initiatives. The Collaborative Council is a stakeholder group comprised of individuals from health, education, and financial stability. The Collaborative Council exists to coordinate the work of all strands and agencies to maximize efficiency across the community. The Community Engagement Committee is a partnership of the HIO and Cradle to Career, Jackson's education network. Leaders from both initiatives recognized parallel goals to engage populations served and made the decision to combine efforts in order to maximize resources.The Community Action Plan (CAP) report approved by the Board of Trustees during FY 2016 clearly communicates Henry Ford Allegiance Health's role and responsibilities relative to implementation of action plans.
Part VI, Line 3:	Uninsured inpatients and observation patients are referred to a financial counselor (contracted agent/partner) for assistance with Medicaid, SSI, and Henry Ford Allegiance Health program applications. Many outpatients needing or having received hospital services are also referred to the agent/partner for assistance. ER patients are provided with a packet of information at discharge from the department. This packet includes information about how assistance may be obtained through the local Medicaid office and about how to apply for our income structured payment plan and uncompensated care programs. When patients are billed for balances they owe, we solicit them to call the Business Office with any questions or for assistance. Additionally, a series of letters are sent to patients to apprise them of payment and assistance options. Allegiance has a printed brochure that is available through Registration that includes information regarding Medicaid application assistance and our internal programs. The Henry Ford Allegiance Health website includes a series of web pages related to transparency, quality, pricing, and our financial policies, procedures, and programs. Uninsured patients needing mental health services are screened for eligibility through our partnership with the Jackson Community Mental Health Agency, which funds care for indigent, dual diagnosis, and Medicaid patients. Patients seeking substance abuse care are linked with the Mid-South Substance Abuse Commission. Registration and Business Office team members receive direct training on our programs and scripting for ensuring information is provided to the patients and families with whom our staff interact. Education is provided to organizational leaders to ensure that team members outside of Finance are aware of our programs and where to direct patients and families who may need or who are seeking assistance.
Part VI, Line 4:	Henry Ford Allegiance Health's market is determined geographically by the boundaries of Jackson County. The hospital is a tax exempt Health System that serves the collective health needs of the more than 160,000 residents of Jackson County. The gender distribution of Jackson County residents is 49% female and 51% male. The age distribution of Jackson County is 26% of residents 19 years and under, 18% between 20 and 34 years, 29% between 35 and 54 years, 13% between 55 and 64 years, and 14% of residents are 65 years and older. Racial distribution of Jackson County residents according to the 2011 Census Data is 88.0% as white, 7.9% as African American, 0.7% as Asian, 0.4% as American Indian or Alaska Native, and 3.0% as some other race or two or more races. Of males aged 15 years and over, 33.0% have never married, 50.4% are married, 1.5% are separated, 2.9% are widowed, and 12.3% are divorced. Of females aged 15 and over, 25.0% have never married, 50.4% are married, 1.7% are separated, 9.8% are widowed, and 13.2% are divorced. According to the Bureau of Labor Statistics (2013), Jackson County also experiences a high unemployment rate of 8.8%. With 69,400 individuals in the civilian labor force, 6,100 residents are currently unemployed. Of those employed, major industries represented include educational services, health care, and social assistance (23.9%); manufacturing (18.7%); retail trade (12.1%); professional, scientific, management, administrative, and waste management services (7.7%); and arts, entertainment, recreation, accommodation, and food services (7.5%). Approximately 51% of Allegiance Hospital patients were covered by Medicare, while 27% were on Medicaid and 1% were uninsured. During the 2018 fiscal year, Henry Ford Allegiance Health had 20,466 inpatient discharges, of which 9,939 Medicare discharges and 6,047 Medicaid discharges from inpatient services. Physician practice visits totaled 379,518 during FY 2018, with 178,377 primary care visits and 201,141 visits to specialists.
Part VI, Line 5:	The mission of Henry Ford Allegiance Health is to improve peoples's lives through excellence in the science and art of healthcare and healing.Recently celebrating a century of providing care to our community, Henry Ford Allegiance Health's success in creating an environment for safe, clinically sound, patient-centered care has earned many accolades from across the health care industry. While these awards recognize our commitment to providing exceptional patient care, they also challenge us toward continuous improvement across the continuum.CMS Four-Star Rating - Henry Ford Allegiance Health has received a four-star rating from the Centers for Medicare & Medicaid Services (CMS), largely reflecting our significant commitment to quality and safety.Fall 2019 "A" for Patient Safety from The Leapfrog Group - The Leapfrog Group, a national patient safety watchdog, once again awarded Henry Ford Allegiance Health with an "A," ranking it among the safest hospitals in the United States. We Honor Veterans - Henry Ford Allegiance Health is proud to have been designated a Level 3 Hospice Partner of the We Honor Veterans program, a collaboration with the National Hospice Palliative Care Organization and the Veterans Administration.Looking Toward our Community's Future: In September 2018, a new three-story, 59,000 square-feet patient tower opened on the hospital campus, creating a total of 66 private rooms. A two-story Center for Health Innovation & Education center-a regional training center for health care professionals that includes leading-edge technology, such as a simulation lab designed to look and feel like real inpatient and outpatient settings.Jackson Health Network is collaborating with Henry Ford Physician Network (comprised of more than 1,800 physicians throughout southeast Michigan) on ways to improve patient care system-wide.Clinicians and administrators are working to identify opportunities to bring new services to the Jackson area. Most recently, patients have been given access to new services related to oncology, rheumatology, urology, cardiovascular health and the neurosciences, including neurosurgery.Promoting Continuous Health Improvement in Our CommunityThe Health Improvement Organization (HIO) was created by our health system in 2000 to promote a culture of continuous health improvement in our community and integrate wellness and prevention throughout our services. The Henry Ford Allegiance Department of Prevention and Community Health provides staff and infrastructure to facilitate the coordination of local health improvement activities.
Part VI, Line 6:	The Hospital's sole corporate member is Henry Ford Allegiance Health Group, a 501(c)(3) organization. Other affiliates include: Henry Ford Allegiance Health Foundation; Henry Ford Allegiance Hospice; Henry Ford Allegiance Specialty Hospital, a Long Term Acute Care Hospital (LTACH); Volunteers of Henry Ford Allegiance Health. These are all 501(c)(3) non-profit organizations working together to improve healthcare in and around Jackson, MI. Additionally, the Hospital recently formed Jackson Health Network (JHN), a clinically integrated network. The Hospital is also affilated with Henry Ford Allegiance Pharmacy.The Foundation and the Volunteer organization work closely with Henry Ford Allegiance Health Group and the hospital to raise funds for projects and services that benefit the overall well-being of the community. Previous campaigns successfully raised funds to expand and improve our Graduate Medical Education program, cancer care service line and provided free medical care to indigent patients. Jackson Health Network works to improve patient clinical outcomes thru coordinated care and lowering overall health care costs.

Schedule H (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
WA Foote Memorial Hospital

Employer identification number
38-2027689

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)	(h) Purpose of grant or assistance
(1) Center for Family Health 505 N Jackson St Jackson,MI49201	38-3251354	501(c)(3)	100,000	N/A	The Center for Family Health grant provides operational support for medically underserved populations.
(2) Jackson Symphony Orchestra 215 W Michigan Ave Jackson,MI49201	38-2146747	501(c)(3)	5,000	N/A	Contribution to Endowment fund in support of Symphony Operations.
(3) Anchor Initiative 141 S Jackson St Jackson,MI49201	47-2475316	501(c)(3)	50,000	N/A	Annual Contribution to community growth org.
(4) Family Services and Childrens Aid 330 W Michigan Ave Jackson,MI49201	38-6088382	501(c)(3)	45,000	N/A	Support Of Jackson County guardianship program.
(5) Region II Area Agency on Aging 102 N Main St Brooklyn,MI49230	38-2056030	501(c)(3)	8,000	N/A	Support of educational programs
(6) Enterprise Group 100 E Michigan Ave 1100 Jackson,MI49201	38-3326101	501(c)(6)	25,000	N/A	Annual Contribution to community growth org.
(7) Jackson Community Foundation 100 S Jackson St Suite 206B Jackson,MI49201	38-6070739	501(c)(3)	5,000	N/A	Contribution to child advocacy fund honoring falle police officer

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) Staff Assistance Fund for Emergencies	125	102,658
(2) We Care Patient Needs Fund	50	3,053
(3) Womens Health Center Oncology Aesthetics	10	2,220
(4) Cancer Patient Immedicate Needs Funds	100	44,702
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
Part I, Line 2:	Awards are granted based on an application and review process.The Organization sends out an award letter to all grantee recipents. The letter outlines what the funding may be used for and requests a final report detailing the year's activities.

Schedule I (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2018

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Georgia R Fojtasek RN EdD Trustee-President & CEO	(i) (ii)	0 ------------- 644,465	0 ------------- 426,550	0 ------------- 203,929	0 ------------- 26,534	0 ------------- 28,166	0 ------------- 1,329,644	0 ------------- 0
2Robert G Riney Trustee	(i) (ii)	0 ------------- 990,589	0 ------------- 593,292	0 ------------- 253,480	0 ------------- 26,535	0 ------------- 23,478	0 ------------- 1,887,374	0 ------------- 0
3Adnan R Munkarah MD Physician Trustee	(i) (ii)	0 ------------- 734,522	0 ------------- 173,026	0 ------------- 15,975	0 ------------- 23,784	0 ------------- 31,840	0 ------------- 979,147	0 ------------- 0
4Sandra Kilian MD Trustee	(i) (ii)	136,053 ------------- 0	0 ------------- 0	43,098 ------------- 0	15,444 ------------- 0	11,014 ------------- 0	205,609 ------------- 0	34,514 ------------- 0
5Mohan G Kulkarni MD Physician Trustee	(i) (ii)	456,182 ------------- 0	336,034 ------------- 0	169,351 ------------- 0	63,066 ------------- 0	28,854 ------------- 0	1,053,487 ------------- 0	0 ------------- 0
6Kenneth W Empey General Counsel	(i) (ii)	241,414 ------------- 0	120,555 ------------- 0	122,673 ------------- 0	27,999 ------------- 0	21,178 ------------- 0	533,819 ------------- 0	90,008 ------------- 0
7Ondrea L Bates RN SVP Patient Care	(i) (ii)	277,696 ------------- 0	183,048 ------------- 0	36,664 ------------- 0	23,437 ------------- 0	33,887 ------------- 0	554,732 ------------- 0	0 ------------- 0
8Mark A Smith MD Chief Medical Officer	(i) (ii)	338,742 ------------- 0	36,634 ------------- 0	36,942 ------------- 0	19,690 ------------- 0	41,154 ------------- 0	473,162 ------------- 0	0 ------------- 0
9Kevin P Leonard VP Finance/ CFO	(i) (ii)	215,434 ------------- 0	122,362 ------------- 0	32,724 ------------- 0	19,201 ------------- 0	10,896 ------------- 0	400,617 ------------- 0	11,616 ------------- 0
10Azam Basheer MD Physician	(i) (ii)	745,205 ------------- 0	814,401 ------------- 0	326,729 ------------- 0	117,217 ------------- 0	24,838 ------------- 0	2,028,390 ------------- 0	0 ------------- 0
11Timothy Ephrian Ekpo DO Physician	(i) (ii)	692,279 ------------- 0	329,179 ------------- 0	373,795 ------------- 0	78,160 ------------- 0	24,507 ------------- 0	1,497,920 ------------- 0	292,598 ------------- 0
12Amritraj G Loganathan MD Physician	(i) (ii)	744,140 ------------- 0	547,189 ------------- 0	340,902 ------------- 0	94,394 ------------- 0	25,896 ------------- 0	1,752,521 ------------- 0	0 ------------- 0
13Frank LaMarca MD Physician	(i) (ii)	1,143,362 ------------- 0	600,324 ------------- 0	351,687 ------------- 0	122,814 ------------- 0	25,811 ------------- 0	2,243,998 ------------- 0	0 ------------- 0
14Stephen Lee Kirkner DO Physician	(i) (ii)	444,627 ------------- 0	366,591 ------------- 0	514,720 ------------- 0	64,821 ------------- 0	19,900 ------------- 0	1,410,659 ------------- 0	351,261 ------------- 0
15Karen Chaprnka Former SVP & COO	(i) (ii)	143,647 ------------- 0	0 ------------- 0	13,059 ------------- 0	0 ------------- 0	0 ------------- 0	156,706 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 1a	Henry Ford Allegiance Health provides a country club membership to three executives. The executives reimburse the hospital for any personal use of the club. These benefits did not result in taxable compensation during FY 18.
Part I, Line 3	The Chief Executive Officer for W.A. Foote Memorial Hospital is an employee of Henry Ford Health System (the sole member of Henry Ford Allegiance Health Group). Henry Ford Health System ("HFHS") has a Compensation Committee of the Board of Trustees consisting of all independent trustees. The committee meets throughout the year and is charged with the approval of the organization's overall compensation and benefit programs as well as the specific review and approval of the compensation of certain employees including the Chief Executive Officer of W.A. Foote Memorial Hospital. The committee directly engages an independent compensation advisor to assist with this process. The process includes evaluation of the individual's performance, utilization of compensation studies of similarly situated positions as well as comparisons to compensation as reported by other health care organizations. The reasonableness of compensation is evaluated based upon these and other factors. The CEO is accountable for ensuring that Allegiance Health's mission is efficiently carried out with the highest levels of quality, safety and service, while at the same time ensuring that the organization is financially healthy. Executive compensation is reviewed annually by the Executive Compensation Committee of the Board of Trustees. This committee works with an independent compensation consultant to ensure that Henry Ford Allegiance Health compensation practices are consistent with industry standards and that compensation levels are fair compared to similar healthcare organizations nationally. The compensation consultant benchmarks Henry Ford Allegiance Health's positions against data from multiple published surveys of health care executive compensation in the national health care labor market. Based upon the consultants recommendations, the Executive Compensation Committee makes a recommendation to the Board of Trustees for approval of the executive compensation program. Only independent Trustees vote on this recommendation.
Part I, Line 4b	4b. Certain members of the Organization's senior leadership team participate in supplemental retirement programs that result in reportable taxable income as the benefits accrue, and/or as paid. It is an element of some plan designs to absorb the advance tax impact of these plans for the participants. In such cases the related amounts are reported as taxable income to the individual and included in the determination of reasonable compensation. The following provides the required listing of the participating individuals: Sec 457(f)-Non-Qualified Deferred Compensation Retirement Plan - W.A. FOOTE MEMORIAL HOSPITAL Reportable Accrual Distribution Non-Vested W-2 Amounts Ray King 11,250 20,658 - 20,658 Mohan Kulkarni 63,066 - - - Ondrea Bates 15,875 - - - Mark Smith M.D. 15,565 - - - Ken Empey 13,626 90,008 - 90,008 Kevin Leonard 11,616 11,616 - 11,616 Amritra J Longanathan 94,394 - - - Frank LaMarca 122,814 - - - Stephen Kirkner 64,824 351,261 - 351,261 Azam Basheer 117,217 - - - Timothy E. Ekpo 78,160 292,598 - 292,598 Sandra Kilian 15,444 34,514 - 34,514 Sec 457(f) - Supplemental Executive Retirement Plan (SERP) - HENRY FORD HEALTH SYSTEM Participant Accrual Distribution Non-Vested Reportable W-2 Robert G. Riney 230,078 - - 230,078 Georgia Fojtasek 172,223 - - 172,223 Adnan R. Munkarah - - 154,094 - Sec 457(b)-Non-Qualified Deferred Compensation Retirement Plan - HENRY FORD HEALTH SYSTEM Employee Employer Medicare Reportable 2018 Contr. 20187 Contr. Tax gross-Up W-2 Amounts Robert G. Riney 18,500 - - 18,500 Adnan R. Munkarah 11,072 - - 11,072 Georgia Fojtasek 18,500 - - 18,500
Part I, Line 7	Column B(ii) of Part II, Schedule J includes non-fixed payments to certain physicians based on their productivity and other performance metrics.

Schedule J (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) Patrick Nally	Son of John Nally, Chairman of Allegiance Health	Employee Recruitment Loan		X	115,000	115,000		No	Yes		Yes





Total ............... $						115,000

Part III

Grants or Assistance Benefiting 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 assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Patrick Nally	Family Member/Officer	131,214	Employee Wages		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Return Reference	Explanation
Form 990, Part VI, Section A, line 6	The Corporation is organized on a membership basis. The sole corporate member of the Corporation is Henry Ford Allegiance Health Group (formerly Allegiance Health Services).
Form 990, Part VI, Section A, line 7a	The sole Member of the organization may elect and remove, with or without cause, the Corporation's Trustees.
Form 990, Part VI, Section A, line 7b	The following powers are reserved for the sole corporate Member of the hospital. Approve any change in the Articles of Incorporation, purposes or philosophy of the Corporation; Approve changes in those provisions of the Corporation's Bylaws which affect the size, composition, and method of selection of the Board of Trustees, or which affect this Article; Approve plans of merger, consolidation or dissolution of the Corporation; Elect and remove, with or without cause, the Corporation's Trustees, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present; Approve guarantees by the Corporation of the debt of others in excess of maximum limits established by the Member, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present; Authorize the sale, lease, mortgage or other disposition of all or substantially all of the assets owned, held or leased by or to the Corporation, approve any decision by the Corporation which would have the net effect of diminution of governance control of the Member, and any decision by the Corporation which would have the net effect of diminution in the Corporation's governance control over it's own subsidiary; Ratify or reject operating and capital budgets developed by the Board and any non-budgetary expenditures or creations of debt in excess of an amount designated by the Member from time to time, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present; and Authorize the formation or acquisition of new subsidiaries of the Corporation or the sale or other disposition of existing subsidiaries.
Form 990, Part VI, Section B, line 11b	The organization is an affiliate of Henry Ford Health System (HFHS) and the tax department of HFHS prepares the organization's Form 990. As part of the preparation and review process prior to filing the return, the following review process is conducted: - Reviewed by the Organization's Director and VP of Finance, Chief Executive Officer, General Counsel, and Compliance Officer. - Review of the entire return with the HFHS and organization's Senior Vice President Financial Operations and Chief Financial Officer, - Review of all compensation matters and disclosures with the Compensation Committee of the HFHS Board of directors - Review of the return with the HFHS Audit and Compliance Committee of the Board of director, including the CEO and COO - Final copies of the return are distributed to the Hospital's Board of Trustees before the return is filed.
Form 990, Part VI, Section B, line 12c	The organization is an affiliate of Henry Ford Health System (HFHS) who oversees the conflict of interest process with regard to the organization. HFHS has a standing Conflict of Interest Committee (the Committee) that is responsible for oversight of all conflict of interest matters. The HFHS Conflict of Interest Policy applies to all Directors and employees. Annually, Directors, employees of a management level, researchers, as well as employees associated with procurement, or in certain other predefined roles must complete an annual disclosure designed to identify activities and relationships that could potentially give rise to a conflict of interest. It is the responsibility of the Committee to review these disclosures and determine the need for any action to manage the potential conflict. The Committee annually reports the results of its activities to the Audit and Compliance Committee of the HFHS Board of Directors.
Form 990, Part VI, Section B, line 15	The organization is an affiliate of Henry Ford Health System (HFHS) who has responsibility to oversee the compensation practices of the organization. HFHS has a Compensation Committee of the Board of Directors consisting of all external directors. They meet periodically throughout the year. They are charged with approval of the organization's overall compensation and benefit programs as well as the specific review and approval of the compensation of certain employees including the Chief Executive Officer, all officers and key employees of the organization. They directly engage an independent compensation advisor to assist with this process. The process includes evaluation of the individual's performance, utilization of compensation studies of similarly situated positions, as well as comparisons to compensation as reported by other health care organizations. The reasonableness of compensation is evaluated based upon these and other factors. The Committee also reviews the compensation disclosures to be made on Form 990 in advance of filing.
Form 990, Part VI, Section C, line 19	Forms 1023, 990 and 990-T are available upon request. The conflict of interest policy is not available to the public. PART IV, LINE 12 The Organization is an element of the external audit report obtained for the consolidated operations of Henry Ford Health System. FORM 990, PART IV, LINE 24a, TAX-EXEMPT BOND ISSUE: THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM. THE ALLOCATED TAX-EXEMPT BOND LIABILITY OF THE ORGANIZATION IS REPORTED UNDER THE FORM 990, SCHEDULE K OF ITS PARENT, HENRY FORD HEALTH SYSTEM.
Form 990, Part IX, line 11g	Professional Other: Program service expenses 11,228,459. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,228,459. Physican Services: Program service expenses 17,746,119. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,746,119. Purchased Services Other: Program service expenses 23,812,301. Management and general expenses 7,564,265. Fundraising expenses 0. Total expenses 31,376,566.
Form 990, Part XI, line 9:	PENSION LIABILITY ADJUSTMENT 7,814,030. AFFILIATE EQUITY TRANSFERS 3,590,796.
Form 990, Part XII, Line 2C	Henry Ford Allegiance Health is included in the consolidated financial statements of Henry Ford Health System (the sole member of Henry Ford Allegiance Health Group). The governing body of Henry Ford Health System has delegated the oversight of its financial statements, including the choice of independent auditors, to its audit committee.
FORM 990, PART VII:	Average hours per week devoted to related organizations: Many executive employees of Henry Ford Health System and affiliates provide services to multiple affiliated entities. Henry Ford Health System and affiliates use estimates for reporting average hours per week in all sections of Form 990. Generally 60 hours are reported for the hours associated for the organization that the individual has principal responsibility for. Hours associated with other hospitals or affiliates are reported at between 1 to 5 hours per week.
Form 5713 - International Boycott Activity:	A Form 5713, International Boycott Report, has been filed on our behalf by Henry Ford Health System (sole member of Henry Ford Allegiance Health Group). Henry Ford Allegiance Health did not itself have any activities associated with an international boycott country.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

WA Foote Memorial Hospital

Employer identification number

38-2027689

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) 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) Physicians Choice Network LLC 205 N East Avenue Jackson,MI49201	Provider Network	MI	116,529	54,637	Henry Ford Allegiance Health
(2) Jackson Health Network L3C 205 N East Avenue Jackson,MI49201 45-3253643	Clinically Integrated Network	MI	3,150,850	4,453,366	Henry Ford Allegiance Health
(3) Jackson Community Medical Records LLC 205 N East Avenue Jackson,MI49201 37-1502443	Electronic Medical Records	MI	6,013,063	1,640,016	Henry Ford Allegiance Health
(4) It's Your Life Services LLC 205 N East Avenue Jackson,MI49201	Prevention and Community Health	MI	40,542	0	Henry Ford Allegiance Health
(5) Telehealth Michigan 205 N East Avenue Jackson,MI49201	Electronic Health Monitoring	MI	0	0	Henry Ford Allegiance Health

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 entity?
(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	Yes	No
(1)Henry Ford Allegiance Health Group 205 N East Avenue Jackson,MI49201 38-2756428	Exempt Health System	MI	501(c)(3)	Line 12b, II	Henry Ford Health System	Yes
(2)Allegiance Health Foundation 205 N East Avenue Jackson,MI49201 38-3607833	Supports Allegiance Health	MI	501(c)(3)	Line 12b, II	Henry Ford Allegiance Health Group	Yes
(3)Hospice of Jackson dba Allegiance Hospice 205 N East Avenue Jackson,MI49201 38-2336367	Hospice Care	MI	501(c)(3)	Line 7	Heathlink	Yes
(4)The Hospice of Jackson Endowment Fund One Jackson Square Jackson,MI49201 38-3422146	Raise Funds for Allegiance Hospice	MI	501(c)(3)	Line 12b, II	Allegiance Hospice	Yes
(5)Healthlink 205 N East Avenue Jackson,MI49201 38-2756425	Home Health Care	MI	501(c)(3)	Line 12a, I	Henry Ford Allegiance Health Group	Yes
(6)Henry Ford Allegiance Specialty Hospital 110 North Elm Avenue Jackson,MI49202 38-1218485	Long Term Acute Care Hospital	MI	501(c)(3)	Line 3	Henry Ford Allegiance Health Group	Yes
(7)Henry Ford Health System One Ford Place Detroit,MI48202 38-1357020	Healthcare Service Provider	MI	501(c)(3)	Line 3	N/A		No
(8)Henry Ford Wyandotte Hospital 2333 Biddle Ave Wyandotte,MI48192 38-2791823	Healthcare Service Provider	MI	501(c)(3)	Line 3	Henry Ford Health System	Yes
(9)Henry Ford Health System Foundation One Ford Place Detroit,MI48202 23-7383042	Supporting Organization	MI	501(c)(3)	Line 12a, I	Henry Ford Health System	Yes
(10)Health Alliance Plan 2850 W Grand Blvd Detroit,MI48202 38-2242827	Health Maintenance Organization	MI	501(c)(4)	N/A	Henry Ford Health System	Yes
(11)HFHS Self Funded Liability One Ford Place Detroit,MI48202 38-6553031	Malpractice Insurance	MI	501(c)(4)	N/A	Henry Ford Health System	Yes
(12)HFII Corporation One Ford Place Detroit,MI48202 90-0840304	Scientific Research	MI	501(c)(3)	Line 7	Henry Ford Health System	Yes
(13)Henry Ford Health System Government Affairs Services One Ford Place Detroit,MI48202 46-4064067	Advocacy Services for HFHS and affiliates	ME	501(c)(4)	N/A	Henry Ford Health System	Yes
(14)Henry Ford Macomb Hospital Corporation One Ford Place Detroit,MI48202 38-2947657	Healthcare Service Provider	DE	501(c)(3)	Line 3	Henry Ford Health System	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2018

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Foote Health Center Associates 1100 E Michigan Avenue Jackson,MI49201 38-3017711	Lessor of Medical Condominiums	MI	Henry Ford Allegiance Health	Related	107,489	1,107,666		No			No	62.000 %
(2) Northwest Detroit Dialysis 30100 Telegraph Bingham Farms,MI48025 38-3232668	Operate Dialysis Clinic	MI	Henry Ford Health System	Related				No			No
(3) Macomb Regional Dialysis Centers 16151 Nineteen Mile Rd Clinton Township,MI48038 26-0423581	Operate Dialysis Clinic	MI	Henry Ford Health System	related				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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) Henry Ford Allegiance Pharmacy 205 N East Avenue Jackson,MI49201 38-3370242	Pharmacy	MI	Henry Ford Allegiance Health Group	C			Yes
(2) Sha Realy Inc One Ford Place Detroit,MI48202 38-1378121	Real Estate Holding	MI	Henry Ford Health System	C			Yes
(3) Fairlane Health Services 30100 Telegraph Bingham Farms,MI48025 38-2565235	Healthcare Management	MI	Henry Ford Health System	C			Yes
(4) Alliance Health and Life Insurnace 2850 W Grand Blvd Detroit,MI48202 38-3291563	Health Insurance Provider	MI	Health Alliance Plan	C			Yes
(5) HAP Preferred Inc 2850 W Grand Blvd detroit,MI48202 38-2513504	Provider Network Leasing	MI	Health Alliance Plan	C			Yes
(6) Onika Insurance Ltd First Carribean House Grand Cayman CJ	Captive Insurance	CJ	Henry Ford Health System	C			Yes
(7) Henry Ford Physician Network One Ford Place Detroit,MI48202 32-0306774	Physician Network	MI	Henry Ford Health System	C			Yes
(8) Adminstration Systems Research Corporation 2850 W Grand Blvd detroit,MI48202 38-2651185	Third Party Insurance Admin.	MI	Health Alliance Plan	C			Yes
(9) HAP Midwest Health Plan Inc 2850 W Grand Blvd Detroit,MI48202 38-3123777	Health Insurance Provider	MI	Health Alliance Plan	C			Yes

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Hospice of Jackson dba Henry Ford Allegiance Hospice	J	126,060	Cost
(2) Hospice of Jackson dba Henry Ford Allegiance Hospice	L	619,129	Cost
(3) Alliance Health & Life Insurance Co	P	1,890,316	Cost
(4) Allegiance Health Foundation	S	2,756,386	Cost
(5) CareLink of Jackson	L	571,783	Cost
(6) Volunteers of Henry Ford Allegiance Health	R	171,312	FMV
(7) Health Alliance Plan	L	2,715,820	cost
(8) Jackson Community Ambulance	M	213,750	cost
(9) Health Alliance Plan	M	1,890,316	cost
(10) Onika Insurance Ltd	P	1,714,894	Cost
(11) Onika Insurance Ltd	Q	1,593,061	Cost

Schedule R (Form 990) 2018

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)	(e) Are all partners section 501(c)(3) organizations?		(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation
SCHEDULE R, PART V, LINE 1D & 1E:	The Organization is a member of the Henry Ford Health System Obligated Group. Members of the Obligated Group are jointly and severally liable for outstanding obligations issued under the 2016 HFHS Bond Master Indenture.

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: We lead our community to better health and well-being at every stage of life.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	4,870
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	2,461,737
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	889,761	2,556,493
9	Program service revenue (Part VIII, line 2g) .........	545,560,074	588,602,331
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	17,033,958	-8,028,399
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	15,363,778	33,287,400
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	578,847,571	616,417,825
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	323,378	390,633
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	295,554,499	302,378,836
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 169,589
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	292,082,959	299,275,503
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	587,960,836	602,044,972
19	Revenue less expenses. Subtract line 18 from line 12.......	-9,113,265	14,372,853
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	516,461,443	508,997,334
21	Total liabilities (Part X, line 26).............	305,080,415	271,838,627
22	Net assets or fund balances. Subtract line 21 from line 20.....	211,381,028	237,158,707

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 527,595,746 including grants of $ 390,633 ) (Revenue $ 641,981,359 )
	See Schedule OThe Hospital devotes substantial efforts and resources to providing health services to people in its communities. The Hospital is engaged in the following activities to ensure that our mission is accomplished:Unreimbursed Services Provided to the Underserved:The Hospital provides a substantial portion of its services to the underserved (elderly and low income residents). During 2018, approximately 51% of the value of services rendered were to elderly patients under the Medicare program, and approximately 18% of the services were provided to patients who were deemed indigent under state, county, or Medicaid Center guidelines.In the spirit of our mission and values, the Hospital has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare services to all persons. In 2018 the hospital recorded a provision for bad debts of $20.3 million. Consistent with Schedule H reporting, charity care at cost for 2018 was $5.8 million.Patient Services:The Hospital serves seven counties with a medical staff of more than 400 physicians. A complete listing of services is available at Henryford.com.The Hospital provides unprofitable health services on behalf of the community including inpatient and outpatient behavioral health and substance abuse services, obstetrics, emergency and trauma services, general medicine, family/general practice, senior services, cardiac and pulmonary rehabilitation, palliative care, wound care, pain clinic and diabetes clinic.Community Benefit Activities:The Hospital is engaged in community programs and services that address identified community health needs regardless of source or availability of payment and provide measurable improvement in health access, health status, and the use of health care resources. These programs address one of the six criteria:Supports the Hospital's community-based missionTargets the problems of the poor or medically underservedImpacts the health status of the identified communityReduces community health costsIs accessible to the entire target community regardless of ability to payStimulates external community partnershipsHealth Improvement Organization:The Health Improvement Organization (HIO) was created by Henry Ford Allegiance Health (HFAH) in 2001 to promote a culture of continuous health improvement in our community and integrate wellness and prevention throughout our services. The HFAH Department of Prevention and Community Health provides staff and infrastructure to facilitate the coordination of local health improvement activities. The HIO Coordinating Council (HIO CC) is a multi-disciplinary stakeholders group led by HFAH with representation from local government, public health, health care, health and human service agencies, nonprofits, school districts, health plans, mental health, employers and the faith community. The HIO CC coordinates efforts among community leaders in health to create unprecedented alignment of goals and resources, as well as a strong community platform for advocacy. The work of the HIO CC has culminated in the completion of a Community Action Plan including goals, objectives and strategies to address physical activity, nutrition, tobacco use, and depression in Jackson County. The Plan is based on assessment and data-driven processes, as well as input from over 30 representatives from local health and human service agencies, and over 100 community stakeholders. The overarching tactics that the Community Action Plan relies upon include evidence-based activities to:Enhance media attention and public recognition of healthy lifestyle practices;Improve access to healthy foods and safe, attractive, affordable places for activity through supportive policies and physical environment changes;Provide social support and services that promote consistent screening, referral and supportive relationships for physical activity, nutrition, mental health and smoking behavior change.The HIO builds upon existing community strengths and infrastructure to support implementation of health initiatives that have been prioritized as part of a community wide plan with significant community engagement and an established infrastructure to support longevity. In addition to operational support for the HIO CC, the HFAH Department of Prevention and Community Health provides subject matter expertise on wellness and prevention at the Board, Service Line and community level, and direct service delivery (including employer-based health management, tobacco treatment services, weight management, faith community nursing, etc.) to a broad base of community members to support the health improvement priorities identified by the HIO. The Department of Prevention and Community Health has an annual budget of around $1 million. Since 2001, the Hospital has committed over $24.4 million of funding to this program.Other Community Benefit Activities:Through Community Education and Outreach, the Hospital provided educational sessions and clinics that reached 33,520 individuals at a cost of $173,771 in 2018. The sessions/clinics included education on asthma, AIDS/HIV, diabetes, family planning, fitness/exercise, overall health, cardiovascular health, nutrition and weight management, pulmonary, smoking cessation and womens health. These educational offerings were located at the Hospital, community fairs, parishes, schools, work sites and by phone. Free Medical Screenings for high blood pressure, diabetes, mental health/depression, vascular disease and womens health served 2,965 community members at a cost of $30,709 in 2018.Free and discounted prescription drug and medical supplies were provided to community members at a cost of $4,164 during 2018. HFAH clinics provided reduced fee medical services at a cost of $1,104,264 in fiscal year 2018.Through Meals on Wheels and other food programs, the Hospital donated $11,728 in food.Patient transportation assistance was provided in 2018, including wheelchair van, ambulance, transport to and from cancer centers and cab service at a cost of $61,614.Partnerships:The Hospital played a leadership role in the establishment of the Center for Family Health, a Federally Qualified Health Center, providing $100,000 in fiscal year 2018 support for the uninsured.The Hospital donates office space to a area non-profit organization, the Enterprise Group of Jackson, Inc.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses527,595,746

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(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
(A) Name and Title
(18) Kenneth W Empey........................................................................ General Counsel	55.00 .......................5.00	X			484,642	0	49,177
(19) Ondrea L Bates RN........................................................................ SVP Patient Care	60.00 .......................5.00	X			497,408	0	57,324
(20) Mark A Smith MD........................................................................ Chief Medical Officer	55.00 .......................5.00	X			412,318	0	60,844
(21) Kevin P Leonard........................................................................ VP Finance/ CFO	55.00 .......................5.00	X			370,520	0	30,097
(22) Azam Basheer MD........................................................................ Physician	60.00 .......................0.00		X		1,886,335	0	142,055
(23) Timothy Ephrian Ekpo DO........................................................................ Physician	60.00 .......................0.00		X		1,395,253	0	102,667
(24) Amritraj G Loganathan MD........................................................................ Physician	60.00 .......................0.00		X		1,632,231	0	120,290
(25) Frank LaMarca MD........................................................................ Physician	60.00 .......................0.00		X		2,095,373	0	148,625
(26) Stephen Lee Kirkner DO........................................................................ Physician	60.00 .......................0.00		X		1,325,938	0	84,721
(27) Karen Chaprnka........................................................................ Former SVP & COO	55.00 .......................5.00			X	156,706	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	11,436,534	4,035,828	1,074,515

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	183,750
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	2,372,743

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		2,556,493

		Business Code
2a	Patient Services	621990	588,602,331	586,621,076	1,981,255
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		588,602,331

3 Investment income (including dividends, interest, and othersimilar amounts) ......			-30,648,908			-30,648,908
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		227,646
b	Less: rental expenses		0
c	Rental income or (loss)		227,646
d	Net rental income or (loss)......			227,646			227,646
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		172,047,384
b	Less: cost or other basis and sales expenses	160,502	149,266,373
c	Gain or (loss)	-160,502	22,781,011
d	Net gain or (loss).....			22,620,509	22,781,011		-160,502
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
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..
Business Code			Miscellaneous Revenue
11a	Contracted Pharmacy Revenue		621110	22,009,094	22,009,094
b	JHN		621990	3,150,850	3,150,850
c	Cafeteria		900099	2,067,920	2,067,920
d	All other revenue ....			5,831,890	5,351,408	480,482
e	Total. Add lines 11a–11d ......			33,059,754
12	Total revenue. See Instructions......			616,417,825	641,981,359	2,461,737	-30,581,764

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	238,000	238,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22	152,633	152,633
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	5,124,030	2,960,926	1,993,515	169,589
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	686,219	330,600	355,619
7	Other salaries and wages	251,882,765	209,234,039	42,648,726
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	8,402,104	6,910,361	1,491,743
9	Other employee benefits .......	19,319,429	15,889,381	3,430,048
10	Payroll taxes ...........	16,964,289	13,952,382	3,011,907
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	399,015	328,172	70,843
c	Accounting ...........	235,000		235,000
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	60,351,144	52,786,879	7,564,265
12	Advertising and promotion ....	1,640,736	1,349,433	291,303
13	Office expenses .......	13,697,876	11,265,901	2,431,975
14	Information technology ......	941,497	774,340	167,157
15	Royalties ..
16	Occupancy ...........	9,313,781	7,660,175	1,653,606
17	Travel ............	332,537	273,497	59,040
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	502,453	413,246	89,207
20	Interest ...........	4,620,388	3,800,066	820,322
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	29,058,016	23,898,941	5,159,075
23	Insurance ...	4,440,957	3,652,492	788,465
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	52,700,150	52,700,150
b	Pharmaceutical Supplies	48,118,075	48,118,075
c	Corp Office Allocation	24,427,299	24,427,299
d	Uncompensated Care	20,331,439	20,331,439
e	All other expenses	28,165,140	26,147,319	2,017,821
25	Total functional expenses. Add lines 1 through 24e	602,044,972	527,595,746	74,279,637	169,589
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,528,596	1	6,015,197
2	Savings and temporary cash investments .........			944,248	2	16,846,891
3	Pledges and grants receivable, net ......				3	911,234
4	Accounts receivable, net .............			68,768,324	4	78,705,782
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
				115,000	6	115,000
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			8,053,478	8	8,453,746
9	Prepaid expenses and deferred charges ......			5,291,637	9	4,035,255
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	306,755,664
b	Less: accumulated depreciation	10b	64,879,699	224,765,467	10c	241,875,965
11	Investments—publicly traded securities .			193,283,776	11	143,221,026
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13	4,684,605
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			12,710,917	15	4,132,633
16	Total assets. Add lines 1 through 15 (must equal line 34)...			516,461,443	16	508,997,334

17	Accounts payable and accrued expenses .....	100,503,140	17	53,597,922
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	156,439,744	20	155,513,098
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other 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 ..		23	135,457
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	48,137,531	25	62,592,150
26	Total liabilities. Add lines 17 through 25..	305,080,415	26	271,838,627

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	211,381,028	27	233,975,313
28	Temporarily restricted net assets ...........		28	2,439,366
29	Permanently restricted net assets		29	744,028
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	211,381,028	33	237,158,707
34	Total liabilities and net assets/fund balances ........	516,461,443	34	508,997,334

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No