TY 2017 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
Independent Hospitalist Physicians PLLC PO Box 110 Royal Oak,MI48068	Physician Services	1,136,131
Greentree Healthcare Partners LLC 110 Johnston Farm Lane Woodstock,GA30188	Management Services	636,199
Fresenius Management Services Inc 16343 Collections Center Drive Chicago,IL60693	Healthcare Services	157,219


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 3

- 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 instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CARELINK OF JACKSON
A COMMUNITY-OWNED SPECIALTY HOSPITAL

Employer identification number

38-1218485

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) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

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) 2019

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) 2019

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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, 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 2019. 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 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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

2019

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

CARELINK OF JACKSON
A COMMUNITY-OWNED SPECIALTY HOSPITAL

Employer identification number

38-1218485

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(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)? ........

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

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

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

Yes

1,984

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

1,984

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:	HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL PAYS MEMBERSHIP DUES TO SEVERAL NON-PROFIT ADVOCACY GROUPS INCLUDING THE AMERICAN HOSPITAL ASSOCIATION, MICHIGAN HOSPITAL ASSOCIATION, AND NATIONAL ASSOCIATION OF LONG-TERM ACUTE CARE HOSPITALS (NALTH). THESE ORGANIZATIONS USE A PORTION OF MEMBERSHIP DUES TO LOBBY FOR CAUSES RELATED TO THE EXEMPT MISSION OF HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL.

Schedule C (Form 990 or 990EZ) 2019

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 instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CARELINK OF JACKSON
A COMMUNITY-OWNED SPECIALTY HOSPITAL

Employer identification number

38-1218485

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 FASB 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 FASB 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 FASB 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) 2019

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Term endowment SchDMd Bullet

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)

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

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 .....	150,000		150,000
b	Buildings ....	3,920,076	391,346	3,528,730
c	Leasehold improvements
d	Equipment ....	1,296,144	359,948	936,196
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				4,614,926

Schedule D (Form 990) 2019

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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	3,811,353
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) 2019

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 X, Line 2:	THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2017 AND 2016.

Schedule D (Form 990) 2019

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

2019

Open to Public Inspection

Name of the organization

CARELINK OF JACKSON
A COMMUNITY-OWNED SPECIALTY HOSPITAL

Employer identification number

38-1218485

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? . . . . . .

Yes

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? . . . . . . . . .

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

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) . . .	102,504		102,504	0.660 %
b	Medicaid (from Worksheet 3, column a) . . . . .	1,522,190	670,107	852,083	5.460 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	1,624,694	670,107	954,587	6.120 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	2,534		2,534	0.020 %
j	Total. Other Benefits . .	2,534		2,534	0.020 %
k	Total. Add lines 7d and 7j .	1,627,228	670,107	957,121	6.140 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

63,348

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. ......

15,837

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).....

6,505,941

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

8,279,021

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

-1,773,080

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 %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

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)			Other (describe)
1	CARELINK OF JACKSON 110 NORTH ELM AVENUE JACKSON,MI49202 WWW.CARELINKOFJACKSON.ORG 380051	X	LONG-TERM ACUTE CARE HOSPITAL

Schedule H (Form 990) 2019

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)

	HENRY FORD ALLEGIANCE SPECIALTY 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, SECTION C FOR THE FULL WEBSITE

Other website (list url): HTTP://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, SECTION C FOR THE FULL WEBSITE

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HENRY FORD ALLEGIANCE SPECIALTY 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):

WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE

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

WWW.HENRYFORD.COM/VISITORS/BILLING/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
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) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	HENRY FORD ALLEGIANCE SPECIALTY 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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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

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) 2019

Page 7

Part VFacility Information (continued)

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

	HENRY FORD ALLEGIANCE SPECIALTY 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) 2019

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, 20a, 20b, 20c, 20d, 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
HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL	Part V, Section B, Line 5: THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL IS A COLLABORATION OF COMMUNITY STAKEHOLDERS COMMITTED TO IMPROVING THE HEALTH STATUS OF THE COMMUNITY THROUGH AN INTEGRATED HEALTH IMPROVEMENT INFRASTRUCTURE THAT ADDRESSES THE COMMUNITY'S PRIORITY HEALTH ISSUES. IN THIS MODEL, COMMUNITY STAKEHOLDERS WORK WITH PUBLIC HEALTH EXPERTS TO DEVELOP AND COMPILE A COMMUNITY HEALTH NEEDS ASSESSMENT FOR JACKSON COUNTY. MEMBERS OF THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL INCLUDED THE FOLLOWING INDIVIDUALS: AMY SCHULTZ - HENRY FORD ALLEGIANCE HEALTH; MEGAN IRENE ALBERTSON - HENRY FORD ALLEGIANCE HEALTH; BRITTANY EASTON - HENRY FORD ALLEGIANCE HEALTH; RICHARD THOUNE - HENRY FORD ALLEGIANCE HEALTH; SARAH ALLISON - HENRY FORD ALLEGIANCE HEALTH; SHAINA TINSEY - HENRY FORD ALLEGIANCE HEALTH; SHERI BUTTERS - HENRY FORD ALLEGIANCE HEALTH; TASHIA M. CARTER - HENRY FORD ALLEGIANCE HEALTH; JOSH WILLIAMS - HENRY FORD ALLEGIANCE HEALTH; KEVEN MOSLEY-KOEHLER - HENRY FORD ALLEGIANCE HEALTH; LAURIE GUSTAFSON - HENRY FORD ALLEGIANCE HEALTH; ROBERT ANDERSON - HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL; ANDREA PARSHALL - BIG BROTHERS BIG SISTERS OF JACKSON COUNTY; TONY HOLLOW - BIG BROTHERS BIG SISTERS OF JACKSON COUNTY; SARA BENEDETTO - CENTER FOR FAMILY HEALTH; MOLLY KASER - CENTER FOR FAMILY HEALTH; FREDDIE DANCY - CITY OF JACKSON; JENNIFER DARLING - COMMUNITY MEMBER; TED HILLEARY - COMMUNITY MEMBER; KATE MARTIN - COMMUNITY MEMBER; RHONDA RUDOLPH - COMMUNITY MEMBER; LAUREL MAULDIN - COMMUNITY MEMBER; TOBY BERRY - COMMUNITY ACTION AGENCY; ZOE LYONS - DHHS; KELLY SHEPARD - GREAT START COLLABORATIVE OF JACKSON COUNTY; CHRISSY BLACKWELL - GREAT START COLLABORATIVE OF JACKSON COUNTY; SHAY BRISTON - JACKSON COLLABORATIVE NETWORK; DONITA BENTLEY - JACKSON COLLABORATIVE NETWORK; MONICA MOSER - JACKSON COMMUNITY FOUNDATION; IRENE LECRONE - JACKSON COUNTY CRADLE TO CAREER EDUCATION NETWORK; KAITLYN STEIN - JACKSON COUNTY HEALTH DEPARTMENT; ANGELA ALDRICH - JACKSON COUNTY HEALTH DEPARTMENT; DON HAYDUK - JACKSON COUNTY HEALTH DEPARTMENT; AIMEE FORS - JACKSON COUNTY HEALTH DEPARTMENT; JULIE WEISBROD - JACKSON COUNTY HEALTH DEPARTMENT; MICHELLE WHITE - JACKSON COUNTY HEALTH DEPARTMENT; LIZ BREED - JACKSON DISTRICT LIBRARY; SARA TACKETT - JACKSON DISTRICT LIBRARY; WYNN HAZEN - JACKSON HEALTH NETWORK; RAY KING - JACKSON HEALTH NETWORK; COURTLAND KETEYIAN - JACKSON HEALTH NETWORK; JANELLE BUCHLER - JACKSON COUNTY ISD; LAURIE INGRAM - JACKSON HOUSING COMMISSION; SHAWNA TELLO - JACKSON YMCA; ELIZABETH KNOBLAUCH - LIFEWAYS; MARIBETH LEONARD - LIFEWAYS; TRACI FOWLER - LIFEWAYS; AMY PELLETIER - MARRIAGE MATTERS OF JACKSON; CATHY WEBB - MCLAREN HEALTH PLAN; KARA LORENZ - REGION 2 AREA AGENCY ON AGING; JULIE WETHERBY - REGION 2 AREA AGENCY ON AGING; ALLISON STONER - UNITED WAY OF JACKSON COUNTY; KEN TOLL - UNITED WAY OF JACKSON COUNTY; BETHANY STUTZMAN - UNITED WAY OF JACKSON COUNTY
HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL	Part V, Section B, Line 6a: W.A. FOOTE MEMORIAL HOSPITAL (DBA HENRY FORD ALLEGIANCE HEALTH)
HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL	Part V, Section B, Line 6b: BIG BROTHERS/BIG SISTERS OF JACKSON COUNTY; CENTER FOR FAMILY HEALTH; CITY OF JACKSON; COMMUNITY ACTION AGENCY; DHHS; GREAT START COLLABORATIVE OF JACKSON COUNTY; JACKSON COLLABORATIVE NETWORK; JACKSON COMMUNITY FOUNDATION; JACKSON COUNTY CRADLE TO CAREER EDUCATION NETWORK; JACKSON COUNTY HEALTH DEPARTMENT; JACKSON DISTRICT LIBRARY; JACKSON HEALTH NETWORK; JACKSON COUNTY ISD; JACKSON HOUSING COMMISSION; JACKSON YMCA; LIFEWAYS; MARRIAGE MATTERS OF JACKSON; MCLAREN HEALTH PLAN; REGION 2 AREA AGENCY ON AGING; UNITED WAY OF JACKSON COUNTYPART V, SECTION B, LINE 7A:A FULL COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND ON THE HOSPITALS WEBSITE AT:HTTPS://WWW.HENRYFORD.COM/LOCATIONS/ALLEGIANCE-SPECIALTY-HOSPITAL/COMMUNITY-HEALTH-ASSESSMENTPART V, SECTION B, LINE 10A:A FULL COPY OF THE IMPROVEMENT PLAN CAN BE FOUND ON THE FOLLOWING WEBSITE:HTTPS://WWW.HENRYFORD.COM/LOCATIONS/ALLEGIANCE-SPECIALTY-HOSPITAL/COMMUNITY-HEALTH-ASSESSMENT
HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL	Part V, Section B, Line 11: HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL COLLABORATED WITH THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL TO COMPILE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR JACKSON COUNTY. IN RESPONSE TO THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA, THE HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL BOARD OF TRUSTEE'S FORMALLY ADOPTED THE HENRY FORD SPECIALTY HOSPITAL COMMUNITY ACTION PLAN.THE ACTIONS AND STRATEGIES OUTLINED IN THE ACTION PLAN ARE SCHEDULED FOR EXECUTION BETWEEN 2017 AND 2020. SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA AND ADOPTED FOR THE PRIORITIZATION BY HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL INCLUDE:A) REDUCTION OF OBESITY RATES AMONGST JACKSON COUNTY RESIDENTS;B) REDUCTION OF TOBACCO AND SECOND-HAND SMOKE EXPOSURE AMONGST JACKSON COUNTY RESIDENTS; ANDC) REDUCTION OF SUBSTANCE ABUSE BEHAVIOR AMONGST JACKSON COUNTY RESIDENTS.IN REGARDS TO COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT SPECIFICALLY ADDRESSED WITHIN THE ORGANIZATION'S ACTION PLAN, HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL ACKNOWLEDGES THAT CERTAIN HEALTH NEEDS ARE MOST EFFECTIVELY AND EFFICIENTLY SERVED BY OTHER HEALTHCARE ORGANIZATIONS THAT POSSESS THE REQUISITE SPECIALIZATION CAPABILITIES AND RESOURCES. AS A RESULT, THE ORGANIZATIONS'S ACTION PLAN FOCUSES UPON THOSE COMMUNITY HEALTH NEEDS THAT FALL WITHIN THE SCOPE OF THE ORGANIZATION'S ABILITY TO INFLUENCE POSTIVE OUTCOMES.
HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL	Part V, Section B, Line 13b: PATIENTS DETERMINED TO BE INELIGIBLE FOR HEALTH INSURANCE COVERAGE AND WHOSE ANNUAL AGGREGATE HOUSEHOLD INCOME IS AT OR BELOW 250% OF THE FEDERAL POVERTY LEVEL, ARE ELIGIBLE FOR A 100% DISCOUNT ON ALL MEDICALLY NECESSARY SERVICES. PATIENTS WHO OVER A 12-MONTH PERIOD HAVE ACCUMULATED A LARGE MEDICAL DEBT AS A RESULT OF A CATASTROPHIC MEDICAL SITUATION WITH OUT-OF-POCKET EXPENSES THAT EXCEED 30% OF THEIR GROSS ANNUAL HOUSEHOLD INCOME WILL BE ELIGIBLE FOR EITHER A) 100% DISCOUNT IF THEIR HOUSEHOLD INCOME IS BELOW 250% OF THE FEDERAL POVERTY LEVEL; OR B) HAVING THEIR OUTSTANDING MEDICAL DEBT ADJUSTED TO 30% OF THEIR HOUSEHOLD INCOME IF THEIR ANNUAL HOUSEHOLD INCOME EXCEEDS 250% OF THE FEDERAL POVERTY LEVEL.

Schedule H (Form 990) 2019

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

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 3c:	PATIENTS (WHETHER INSURED OR NOT) HAVING HOUSEHOLD INCOMES AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINE LEVEL MAY QUALIFY UNDER THE PATIENT FINANCIAL ASSISTANCE POLICY (PFAP) FOR A 100% DISCOUNT ON ALL MEDICALLY NECESSARY SERVICES. IN ADDITION, PATIENTS (WHETHER INSURED OR NOT), HAVING ACCUMULATED OVER A 12-MONTH PERIOD OUTSTANDING MEDICAL LIABILITIES OWING TO HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL AN AMOUNT EXCEEDING 30% OF THEIR HOUSEHOLD INCOME MAY QUALIFY FOR DISCOUNTS ON THEIR PERSONAL OBLIGATION.
Part I, Line 7:	THE ORGANIZATION'S COST TO CHARGE RATIO IS USED TO CALCULATE COMMUNITY BENEFITS (INCLUDING CHARITY CARE AND MEDICAID SHORTFALL) AT COST. THIS RATIO IS DERIVED FROM WORKSHEET 2.
Part I, Ln 7 Col(f):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATION THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $63,348
PART III, LINE 2:	IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST HISTORY AND IDENTIFIES HISTORICAL TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES FOR PURPOSES OF ESTIMATING AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS.
PART III, LINE 3:	THE HOSPITAL DOES NOT COLLECT FROM PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. PATIENTS HAVING DIFFICULTY PAYING THE AMOUNTS FOR WHICH THEY ARE RESPONSIBLE ARE ENCOURAGED TO VISIT WITH FINANCIAL COUNSELORS. THE COUNSELORS ENCOURAGE PATIENTS TO SUBMIT PERSONAL FINANCIAL INFORMATION TO ASSESS THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, CERTAIN PATIENTS EITHER DO NOT QUALIFY FOR FINANCIAL ASSISTANCE OR ELECT NOT TO SUBMIT THE REQUISITE PERSONAL FINANCIAL INFORMATION NECESSSARY TO DETERMINE ELIGIBILITY. AS A RESULT, A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT ARE NOT GRANTED SUCH ASSISTANCE DUE TO FAILURE TO COMPLY WITH THE NECESSARY DATA REQUESTS.
Part III, Line 4:	THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT ISSUED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH SYSTEM.NET PATIENT SERVICE REVENUE, PATIENT CARE RECEIVABLES, AND ALLOWANCE FOR DOUBTFUL ACCOUNTS- NET PATIENTS SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS. NET PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS REPORTED ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. REIMBURSEMENT FROM MOST PAYORS FOR ACUTE INPATIENT AND OUTPATIENT SERVICES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. REIMBURSEMENTS FOR SERVICES TO CERTAIN PATIENTS INCLUDE PROSPECTIVELY DETERMINED PER DIEM RATES, FEE SCHEDULES, AND DISCOUNTS FROM ESTABLISHED CHARGES. MEDICARE, MEDICAID, AND BLUE CROSS HAVE COST-REIMBURSED ITEMS AND TENTATIVE RATES WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS AND A SUBSEQUENT AUDIT OR REVIEW PROCESS, AND REPRESENT THE MAJOR PAYORS INCLUDED IN PATIENT CARE RECEIVABLES AT DECEMBER 31, 2017 and 2016. REVENUES ASSOCIATED WITH HEALTH CARE SERVICES PROVIDED BY THE SYSTEM TO MEMBERS OF ITS HMO ARE INCLUDED IN HEALTH CARE PREMIUMS IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS.IN EVALUATIONG THE COLLECTABILTY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES IT'S HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTIONS OF THE BILL.), THE SYSTEM RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS EXPERIENCE. AT SUCH POINT IN TIME THAT A BILLED SERVICE IS BELIEVED TO BE UNCOLLECTIBLE, THE RELATED RECEIVABLE IS WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. ESTIMATES OF RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS ARE ACCRUED IN THE PERIOD THAT RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE RECEIVED.THE SYSTEM ADMINISTERS A PATIENT FINANCIAL ASSISTANCE POLICY DESIGNED TO PROVIDE FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS AS WELL AS FOR INSURED PATIENTS WITH LIMITED RESOURCES. FOR UNINSURED PATIENTS WHO MEET THE QUALIFICATIONS STIPULATED IN THE SYSTEM'S PATIENT FINANCIAL ASSISTANCE POLICY, EMERGENCY AND OTHER MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES ARE PROVIDED AT NO COST. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE SYSTEM OFFERS A DISCOUNT OFF STANDARD RATES FOR SERVICES PROVIDED THAT RESULT IN NET CHARGES THAT DO NOT EXCEED 115% OF MEDICARE PAYMENT RATES. THE ACCOUNTS RECEIVABLE FROM SELF-PAY PATIENTS REPRESENTED 12% OF TOTAL ACCOUNTS RECEIVABLE AT DECEMBER 31, 2017 AND 2016. INSURED PATIENTS WITH LIMITED FINANCIAL RESOURCES MAY QUALIFY FOR A DISCOUNT ON SELF-PAY BALANCES. THE SYSTEM'S ALLOWANCES, WHICH ARE PRIMARILY RELATED TO SELF-PAY PATIENTS, WERE $95,521,000 AND $124,399,000 AT DECEMBER 31, 2017 AND 2016, RESPECTIVELY. THESE ALLOWANCES INCLUDE ESTIMATES RELATED TO BOTH PRESUMPTIVE ELIGIBILTY FOR CHARITY OF $15,993,000 AND $32,294,000 AN BAD DEBTS OF $79,528,000 AND $92,105,000 AT DECEMBER 31, 2017 AND 2016, RESPECTIVELY. IN 2017, THE SYSTEM ENHANCED ITS COLLECTION POLICIES INCREASING COLLECTIONS ON PREVIOUSLY RESERVED ACCOUNTS, WHICH RESULTED IN A DECREASE IN THE ALLOWANCE IN THE CURRENT YEAR. THE DECEMBER 31, 2017 ALLOWANCE REFLECTS THIS IMPROVED COLLECTION EXPERIENCE COMBINED WITH FAVORABLE PAYER MIX IN YEAR-END PATIENT CARE RECEIVABLES.
Part III, Line 8:	ALLOWABLE MEDICARE COSTS REPORTED ON SCHEDULE H, PART III, LINE 6 ARE DETERMINED VIA UTALIZATIONS OF THE ORGANIZATION'S CURRENT COST-TO-CHARGE RATIO. MANAGEMENT BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL REPORTED ON LINE 7 SHOULD BE DEEMED A COMMUNITY BENEFIT. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS SUBSIDIZING A GOVERNMENT PROGRAM BY VIRTUE OF SUSTAINING MATERIAL FINANCIAL LOSSED IN THE PROVISION OF HEALTHCARE SERVICES TO MEDICARE BENEFICIARIES.
Part III, Line 9b:	HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL DOES NOT COLLECT FROM PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. PATIENTS HAVING DIFFICULTY PAYING THEIR PERSONAL RESPONSIBILITY ARE ENCOURAGED TO VISIT WITH FINANCIAL COUNSELORS. THE COUNSELORS REVIEW PATIENT'S PERSONAL FINANCIAL INFORMATION FOR PURPOSES OF DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. IN ADDITION, STATEMENTS SUBMITTED TO PATIENTS CONTAIN A TELEPHONE NUMBER FOR THEM TO CALL FOR POTENTIAL FINANCIAL ASSISTANCE.
PART VI, LINE 2:	A LOCAL HEALTH IMPROVEMENT ORGANIZATION (HIO) WAS INITIALLY ESTABLISHED BASED UPON THE PREMISE THAT LONG-TERM HEALTH IMPROVEMENT REQUIRES AN EXTENSION BEYOND ACUTE MEDICAL CARE IN ORDER TO AFFECT SOCIAL AND ENVIRONMENTAL DETERMINANTS OF HEALTH. SUBSEQUENT TO ITS FOUNDING IN 2000, THE HIO HAS EVOLVED TO BECOME A BEST PRACTICE MODEL FOR ORGANIZING POPULATION HEALTH IMPROVEMENT EFFORTS IN THE LOCAL REGION.THE HEALTH IMPROVEMENT ORGANIZATION COORDINATING COUNCIL IS A COLLABORATIVE OF COMMUNITY STAKEHOLDERS, OF WHICH HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS A MEMBER. THE HIO IS COMMITTED TO IMPROVING THE HEALTH STATUS OF THE LOCAL COMMUNITY THROUGH AN INTEGREATED HEALTH IMPROVEMENT INFRASTRUCTURE THAT ADDRESSES LOCAL PRIORITY HEALTH NEEDS. IT IS RESPONSIBLE FOR PERFORMING SHARED NEEDS ASSESSMENTS, IDENTIFYING HIGH PRIORITY HEALTH ISSUES, DEVELOPING AND COORDINATING THE IMPLEMENTATION OF COLLABORATIVE ACTION PLANS AND MONITORING PROGRESS OVER TIME.IN 2016, THE HIO COMPILED AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IS ACCESSIBLE VIA THE RESPECTIVE HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL AND HIO WEBSITES. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL HAS COLLABORATED WITH THE HIO TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT WAS CONDUCTED VIA A STATISTICALLY VALID TELEPHONE SURVEY OF OVER 1,200 JACKSON COUNTY RESIDENTS AND VARIOUS FOCUS DISCUSSION GROUPS FOR PURPOSE OF GAINING INSIGHT REGARDING LOCAL HEALTH STATUS, ATTITUDES, BELIEFS, BEHAVIORS AND OPPORTUNITIES.THE HIO COORDINATING COUNCIL INCLUDED REPRESENTATION FROM LOCAL GOVERMENT, PUBLIC HEALTH, HEALTHCARE ORGANIZATIONS, SCHOOL DISTRICTS, MENTAL HEALTH, LOCAL EMPLOYERS AND OTHER HUMAN SERVICE SECTORS. THE NEEDS ASSESSMENT PROVIDES A POWERFUL TOOL TO MEASURE HEALTH INDICATORS WITHIN GEOGRAPHIC AND DEMOGRAPHIC SUBPOPULATIONS; MEASURE HEALTH STATUS AGAINST OTHER COMMUNITIES, STATES AND THE NATION; PRIORITIZING HEALTH ISSUES WITHIN THE COMMUNITY; CREATING A SYSTEM FOR SHARING THIS DATA WITH COMMUNITY ORGANIZATIONS AND RESIDENTS; AND MONITORING CHANGES OVER TIME. BASED UPON RECENT DATA, THE HIO CONTINUES TO PRIORITIZE OBESITY, SMOKING AND SUBSTANCE ABUSE AS TARGETS FOR IMPROVMENT. ACTION TEAMS ORGANIZED AROUND GOALS IN EACH OF THESE AREAS PURSUE EVIDENCE-BASED COMMUNITY STRATEGIES SUCH AS ADDRESSING NUTRITION/WEIGHT ISSUES, ANTI-TOBACCO POLICIES, AND SCREENING, INTERVENTION AND TREATMENT REFERRAL TOOLS.THE HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL COMMUNITY ACTION PLAN WAS FORMALLY APPROVED BY THE BOARD OF TRUSTEES.
PART VI, LINE 3:	PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ARE NOTIFIED OF POTENTIAL ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER FEDERAL AND STATE PROGRAMS AS WELL AS UNDER THE COMPANY'S CHARITY CARE POLICY. PATIENTS ARE INFORMED VIA DIRECT COMMUNICATION FROM THE PATIENT ACCOUNT COORDINATOR, CASE MANAGERS, OR VARIOUS OTHER HOSPITAL PERSONNEL. WHEN BILLED FOR MEDICAL CARE, PATIENTS ARE ENCOURAGED TO CONTACT THE BUSINESS OFFICE FOR ASSISTANCE. ADDITIONALLY, A SERIES OF LETTERS ARE MAILED TO PATIENTS TO APPRISE THEM OF VARIOUS PAYMENT AND ASSISTANCE OPTIONS. WHEN APPROPRIATE, PATIENTS RECEIVE AN APPLICATION FOR CHARITY CARE THAT IS TO BE SUBMITTED FOR REVIEW AND ELIGIBILTY DETERMINATION BY THE FINANCE DEPARTMENT. FINALLY, THE HENRY FORD ALLEGIANCE SPECIALITY HOSPITAL WEBSITE CONTAINS ADDITIONAL INFORMATION PERTAINING TO FINANCIAL ASSISTANCE POLICIES AND APPLICABLE APPLICATION FORMS.
PART VI, LINE 4:	THE PRIMARY COMMUNITY SERVED BY HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS DETERMINED GEOGRAPHICALLY BY THE BOUNDARIES OF JACKSON COUNTY, MI. AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, THE HOSPITAL SERVES THE HEALTH NEEDS OF MORE THAN 160,000 RESIDENTS OF JACKSON COUNTY, MI. THE GENDER DISTRIBUTION OF JACKSON COUNTY RESIDENTS IS 51% MALE AND 49% FEMALE. THE AGE DISTRIBUTION OF JACKSON COUNTY RESIDENTS IS 26% AGE 19 YEARS OF AGE 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 AGE 65 AND OLDER. ACCORDING TO 2011 CENSUS DATA, THE RACIAL DISTRIBUTION OF JACKSON COUNTY RESIDENTS IS 88.0% AS CAUCASIAN, 7.9% AS AFRICAN AMERICAN, 0.7% AS ASIAN, 0.4% AS AMERICAN INDIAN OR ALASKA NATIVE, AND 3.0% AS ANOTHER RACE OR TWO OR MORE PLACES. OF MALES AGE 15 YEARS AND OLDER, 33.0% HAVE NEVER MARRIED, 50.3% ARE MARRIED, 1.5% ARE SEPARATED, 2.9% ARE WIDOWED, AND 12.3% ARE DIVORCED. OF FEMALES AGE 15 AND OVER, 25.0% HAVE NEVER MARRIED, 50.3% 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 EXPERIANCES 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, HEALTHCARE, AND SOCIAL ASSISTANCE (23.9%); MANUFACTURING (18.7%); RETAIL TRADE (12.1%); PROFESSIONAL, SCIENTIFIC, MANAGEMENT, ADMINSTRATIVE, AND WASTE MANAGEMENT SERVICES (7.7%); AND ARTS, ENTERTAINMENT, RECREATION, ACCOMMODATION AND FOOD SERVICES (7.5%). APPROXIMATELY 74.6% OF HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL PATIENTS WERE COVERED BY MEDICARE, WHILE 12.6% WERE INSURED BY MEDICAID.
PART VI, LINE 5:	HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING AND SAFEGUARDING THE HEALTH OF THE COMMUNITY IN WHICH IT IS LOCATED. A MAJORITY OF THE ORGANIZATION'S BOARD OF TRUSTEES (I.E. FOUR OF SEVEN VOTING MEMBERS) ARE APPOINTED FOR PURPOSES OF REPRESENTING THE HEALTHCARE NEEDS AND INTERESTS OF THE LOCAL COMMUNITY. NONE OF SAID COMMUNITY BOARD MEMBERS ARE: A) EMPLOYED BY THE ORGANIZATION OR ANY RELATED ENTITY; B) AN INDEPENDENT CONTRACTOR OF THE ORGANIZATION OR ANY RELATED ENTITY; OR C) A FAMILY MEMBER OF ANY ORGANIZATIONAL EMPLOYEE. ALL COMMUNITY BOARD MEMBERS ARE APPOINTED SOLELY FOR PURPOSES OF REPRESENTING THE HEALTHCARE NEEDS OF CITIZENS RESIDING WITHIN THE ORGANIZATION'S PRIMARY SERVICE AREA. FURTHER, THE ORGANIZATION MAINTAINS AN OPEN MEDICAL STAFF WHEREBY ALL LOCAL PHYSICIANS AND OTHER MEDICAL PROVIDERS ARE WELCOME TO APPLY FOR PRIVILEGES. FINALLY, THE ORGANIZATION'S FINANCIAL SURPLUS IS CONTINUALLY REINVESTED IN EQUIPMENT, STAFFING AND OTHER RESOURCES REQUIRED TO FURTHER THE HEALTH AND WELLBEING OF THE LOCAL COMMUNITY.
PART VI, LINE 6:	THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HENRY FORD ALLEGIANCE HEALTH GROUP, A 501(C)(3) ORGANIZATION. OTHER RELATED AFFILIATES INCLUDE A HOSPITAL WITH A 24-HOUR EMERGENCY ROOM, HOSPICE, HOME HEALTH CARE COMPANY, FOUNDATION AND A VOLUNTEER ORGANIZATION (ALL 501(C)(3) ORGANIZATIONS). IN ADDITION, THE AFFILIATED HOSPITAL MAINTAINS A CLINICALLY INTEGRATED NETWORK. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL AND THE AFFILIATED HOSPITAL, HOSPICE AND HOME HEALTH CARE ORGANIZATIONS COLLABORATE CLOSELY FOR PURPOSES OF PROVIDING MEDICALLY NECESSARY SERVICES TO THE JACKSON, MI COMMUNITY. THE AFFILIATED FOUNDATION AND VOLUNTEER ORGANIZATIONS WORK CLOSELY WITH HENRY FORD ALLEGIANCE HEALTH GROUP (PARENT ENTITY) AND THE AFFILIATED HOSPITAL TO RAISE FUNDS FOR THE PROJECTS AND SERVICES THAT BENEFIT THE OVERALL WELL-BEING OF THE COMMUNITY. PREVIOUSLY, CAMPAIGNS CONDUCTED BY THE AFFILIATED ENTITIES SUCCESSFULLY RAISED FUNDS TO EXPAND AND IMPROVE A GRADUATE MEDICAL EDUCATION PROGRAM, CANCER CARE SERVICE LINE AND TO PROVIDE FREE MEDICAL CARE TO THE INDIGENT PATIENTS. THE CLINICALLY INTEGRATED NETWORK SEEKS TO IMPROVE PATIENT CLINICAL OUTCOMES THROUGH ENCOURAGING COORDINATED CARE AND LOWERING OVERALL HEALTHCARE COSTS.
PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT:	MI

Schedule H (Form 990) 2019

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

2019

Open to Public Inspection

Name of the organization

CARELINK OF JACKSON
A COMMUNITY-OWNED SPECIALTY HOSPITAL

Employer identification number

38-1218485

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 on 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 .........

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 on Line 1a? ..

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 ............

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) 2019

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)
1Ondrea Bates President	(i) (ii)	0 ------------- 282,850	0 ------------- 90,000	0 ------------- 31,762	0 ------------- 34,742	0 ------------- 30,820	0 ------------- 470,174	0 ------------- 0
2Wendy Boersma Trustee	(i) (ii)	0 ------------- 180,090	0 ------------- 22,000	0 ------------- 17,035	0 ------------- 22,387	0 ------------- 3,799	0 ------------- 245,311	0 ------------- 0

Schedule J (Form 990) 2019

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 3

HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL DOES NOT PAY COMPENSATION TO ITS CEO. RATHER, THE ORGANIZATION CONTRACTS WITH GREENTREE HEALTHCARE PARTNERS, LLC, AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY, FOR THE SERVICES OF THE CEO. THE FORM 990 FOR HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS FOR THE TWELVE MONTHS ENDED FEBRUARY 28, 2018. HOWEVER, THE COMPENSATION REPORTED ON BOTH FORM 990. PART VII AND SCHEDULE J REFLECTS THE FULL YEAR 2017 W-2'S FOR EACH CURRENT AND FORMER OFFICER, TRUSTEE, KEY EMPLOYEE AND THE (5) HIGHEST COMPENSATED EMPLOYEES. ON THE STATEMENT OF FUNCTIONAL EXPENSE IN PART IX, THE COMPENSATION REPORTED ON LINES 5 AND 7 REPRESENTS THE COMPENSATION PAID TO THESE INDIVIDUALS FOR THE FISCAL YEAR ENDED FEBRUARY 28, 2018.

Part I, Line 4b

THE FOLLOWING HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL TRUSTEES PARTICIPATED IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN THROUGH THEIR EMPLOYMENT AS OFFICERS OF HENRY FORD ALLEGIANCE HEALTH,A RELATED TAX-EXEMPT ORGANIZATION. THE CALENDAR YEAR 2017 CONTRIBUTION AND DISTRIBUTION AMOUNTS ARE AS FOLLOWS: Sec 457(f)-Non-Qualified Deferred Compensation Retirement Plan - W.A. Foote Memorial Hospital Participant Accrual Distribution Non-Vested Reportable W-2 Ondrea Bates 15,625 - - - Wendy Boersma 9,833 - - - Sec 457(f) - Supplemental Executive Retirement Plan (SERP) - W.A. Foote Memorial Hospital Participant Accrual Distribution Non-Vested Reportable W-2 Ondrea Bates - 7,942 - 7,942

Schedule J (Form 990) 2019

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

2019

Open to Public
Inspection

Name of the organization

CARELINK OF JACKSON
A COMMUNITY-OWNED SPECIALTY HOSPITAL

Employer identification number

38-1218485

Return Reference	Explanation
Form 990, Part VI, Section A, line 3	OFFICERS OF THE ORGANIZATION ARE EMPLOYED BY AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY. SEE PART VII, SECTION B, INDEPENDENT CONTRACTORS. THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS OR KEY EMPLOYEES TO GREENTREE HEALTHCARE PARTNERS, LLC, AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY. GREENTREE HEALTHCARE PARTNERS, LLC ASSIGNED SPECIFIC EMPLOYEES TO SERVE IN THE CAPACITY OF CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND CHIEF OPERATING OFFICER OF THE ORGANIZATION. THE FOLLOWING OFFICERS, REPORTED ON FORM 990, PART VII, SECTION A, WERE EMPLOYED BY GREENTREE HEALTHCARE PARTNERS, LLC AND RECEIVED THE ACCOMPANYING COMPENSATION FROM THE MANAGEMENT COMPANY DURING THE CALENDAR YEAR ENDING WITHIN THE ORGANIZATION'S FISCAL YEAR. 1.) J. MARK FALL, CHIEF EXECUTIVE OFFICER: A. REGULAR COMPENSATION- $260,532 B. TRAVEL REIMBURSEMENT- $49,726 2.) DALE L. FRIESEN, CHIEF FINANCIAL OFFICER: A. REGULAR COMPENSATION- $133,000 B. TRAVEL REIMBURSEMENT- $16,943
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, A MICHIGAN NONPROFIT CORPORATION. THE MEMBER'S SOLE MEMBER IS HENRY FORD HEALTH SYSTEM.
Form 990, Part VI, Section A, line 7a	THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HENRY FORD ALLEGIANCE HEALTH GROUP (MEMBER). IN TURN, THE MEMBER'S SOLE CORPORATE MEMBER IS HENRY FORD HEALTH SYSTEM (HFHS). HFHS HAS THE POWER TO APPROVE CHANGES IN THOSE PROVISIONS OF THE CORPORATION'S BYLAWS WHICH AFFECT THE SIZE, COMPOSITION AND METHOD OF SELECTION OF THE BOARD OF DIRECTORS. THE SOLE MEMBER HAS THE POWER TO ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE CORPORATION'S DIRECTORS.
Form 990, Part VI, Section A, line 7b	THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HENRY FORD ALLEGIANCE HEALTH GROUP (MEMBER). IN TURN, THE MEMBER'S SOLE CORPORATE MEMBER IS HENRY FORD HEALTH SYSTEM (HFHS). THE RESERVED POWERS OF HENRY FORD HEALTH SYSTEM (HFHS) INCLUDE THE FOLLOWING: -APPOINT THE BOARD OF TRUSTEES, CHAIRPERSON, AND PRESIDENT OF THE CORPORATION AND ITS SUBSIDIARIES; -REMOVE THE BOARD OF TRUSTEES, CHAIRPERSON AND PRESIDENT OF THE CORPORATION AND IT'S SUBSIDIARIES; -CHANGE THE CORPORATE MEMBER OF THE CORPORATION OR ITS SUBSIDIARIES, PROVIDED SUCH ACTION SHALL HAVE BEEN APPROVED BY A VOTE OF THE MEMBER'S BOARD OF DIRECTORS; -AMEND THESE BYLAWS, THE CORPORATION'S SUBSIDIARIES, PROVIDED HFHS FIRST CONSULTS WITH THE MEMBER'S BOARD OF DIRECTORS REGARDING THE PROPOSED AMENDMENT; -APPROVE AN AGREEMENT OF (A) MERGER OR CONSOLIDATION OF THE CORPORATION OR ITS SUBSIDIARIES, OR (B) SALE, LEASE, OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR ITS SUBSIDIARIES, PROVIDED SUCH AGREEMENT SHALL HAVE BEEN APPROVED BY VOTE OF TWO-THIRDS OF THE MEMBER'S LOCAL DIRECTORS (AS DEFINED IN THE MEMBER'S BYLAWS) AND FURTHER PROVIDED THAT APPROVAL OF THE LOCAL DIRECTORS SHALL NOT BE REQUIRED WITH RESPECT TO CERTAIN TRANSACTIONS WITH RESPECT TO HFHS'S OVERALL HEALTH SYSTEM (INCLUDING THE SYSTEM) AS DESCRIBED IN SECTION 6.8 OF THE AFFILIATION AGREEMENT DATED MARCH 4, 2016 BETWEEN THE MEMBER (THEN KNOWN AS ALLEGIANCE HEALTH SERVICES) AND HFHS, AS AMENDED FROM TIME TO TIME; -DISSOLVE THE CORPORATION OR ITS SUBSIDIARIES OR REVOKE SUCH DISSOLUTION, PROVIDED SUCH ACTION SHALL HAVE BEEN APPROVED BY A VOTE OF THE MEMBER'S BOARD OF DIRECTORS; -CAUSE THE CORPORATION AND ITS SUBSIDIARIES TO INCUR, ASSUME OR GUARANTY INDEBTNESS OR FULFILL OTHER OBLIGATIONS REQUIRED UNDER HFHS DEBT AGREEMENTS; -ENCUMBER THE ASSETS OF THE CORPORATION AND ITS SUBSIDIARIES AS SECURITY FOR DEBTS OR OTHER LAWFUL ENGAGEMENTS SECURING INDEBTEDNESS; -AUTHORIZE THE FORMATION OR ACQUISTION OF NEW SUBSIDIARIES OF THE CORPORATION FOLLOWING CONSULTATION WITH THE MEMBER'S BOARD OF DIRECTORS. AS USED HEREIN, "INDEBTEDNESS" OF A PERSON SHALL MEAN: (A) OBLIGATIONS OF SUCH PERSON RELATING TO INDEBTEDNESS FOR BORROWED MONEY; (B) OBLIGATIONS OF SUCH PERSON EVIDENCED BY BONDS, NOTES, DEBENTURES OR SIMILAR INSTRUMENTS; AND (C) OBLIGATIONS IN THE NATURE OF GUARANTEES BY, OR JOINT AND SEVERAL LIABILITY OF, SUCH PERSON WITH RESPECT TO THE OBLIGATIONS OF ANY OTHER PERSON OF THE TYPE DESCRIBED IN CLAUSES (A) AND (B) ABOVE. THE CORPORATION SHALL CAUSE THE RESERVED POWERS LISTED TO BE INCLUDED IN THE ARTICLES OF INCORPORATION, BYLAWS, OR OTHER COMPARABLE GOVERNING DOCUMENTS, OF EACH SYSTEM ENTITY OF WHICH THE CORPORATION IS DIRECTLY OR INDIRECTLY THE SOLE OWNER OR MEMBER, PROVIDED HFHS'S AUTHORITY WITH RESPECT TO THE CORPORATION AND SAID SYSTEM ENTITIES SHALL BE DELEGATED AS DESCRIBED IN THE AUTHORITY MATRIX ATTACHED TO THESE BYLAWS AS EXHIBIT 1 AND HFHS SHALL CONSULT WITH THE BOARD OF THE MEMBER BEFORE MODIFYING THE AUTHORITY MATRIX.
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: - REVIEW OF THE ENTIRE RETURN WITH THE HFHS SENIOR VICE PRESIDENT OF FINANCIAL OPERATIONS AND THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. -REVIEW OF ALL COMPENSATION MATTERS AND DISCLOSURES WITH THE COMPENSATION COMMITTEE OF THE HFHS BOARD OF DIRECTORS. -PROVIDE A COPY OF THE RETURN TO THE ORGANIZATION'S BOARD OF DIRECTORS.
Form 990, Part VI, Section B, line 12c	THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT ISSUED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH SYSTEM. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL HAS ADOPTED THE CONFLICT OF INTEREST POLICY MAINTAINED BY ITS SOLE CORPORATE MEMBER. THE PARAGRAPH BELOW DETAILS HOW THE POLICY REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE MEMBER'S BOARD OF TRUSTEE'S COMPLIANCE COMMITTEE HAS ULTIMATE RESPONSIBILITY OVER THE ENFORCEMENT OF THE HOSPITAL'S CONFLICT OF INTEREST POLICY. WHEN A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THE COMPLIANCE COMMITTEE IS RESPONSIBLE FOR REVIEWING THE POTENTIAL CONFLICT TO ENSURE COMPLIANCE WITH THE POLICY. ALSO, GENERAL COUNSEL ROUTINELY REVIEWS UPCOMING BOARD AND COMMITTEE MEETING AGENDAS TO ASSESS POTENTIAL CONFLICT SITUATIONS. ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. TRUSTEES, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE AND SUBMIT AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. BOARD TRUSTEES IDENTIFIED AS HAVING A CONFLICT OF INTEREST ARE PERMITTED TO DISCUSS THE POTENTIAL TRANSACTION. THEY ARE NOT, HOWEVER, ALLOWED TO DELIBERATE IN ANY DECISIONS OR VOTES RELATIVE TO THE MATTER IN QUESTION.
Form 990, Part VI, Section B, line 15	HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS MANAGED BY AN UNRELATED THIRD-PARTY MANAGEMENT COMPANY. THE MANAGEMENT CONTRACT IS REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF TRUSTEES. EMPLOYEES OF THE OUTSIDE MANAGEMENT COMPANY DO NOT HAVE A VOTE IN APPROVING THE CONTRACT. THE FORM 990 FOR HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS FOR THE TWELVE MONTHS ENDED FEBRUARY 28, 2018. HOWEVER, THE COMPENSATION REPORTED ON BOTH FORM 990, PART VII AND SCHEDULE J REFLECTS THE FULL YEAR 2017 W-2'S FOR EACH CURRENT AND FORMER OFFICER, TRUSTEE, KEY EMPLOYEE AND THE (5) HIGHEST COMPENSATED EMPLOYEES. ON THE STATEMENT OF FUNCTIONAL EXPENSE IN PART IX, THE COMPENSATION REPORTED ON LINES 5 AND 7 REPRESENTS THE COMPENSATION PAID TO THESE INDIVIDUALS FOR THE FISCAL YEAR ENDED FEBRUARY 28, 2018.
Form 990, Part VI, Section C, line 19	THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND ALSO VIA THE STATE OF MICHIGAN WEBSITE. FORM 990 IS AVAILABLE UPON REQUEST. THE FORM 990 IS ALSO AVAILABLE ON THE FREE WEBSITE WWW.GUIDESTAR.ORG. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC.
Form 990, Part IX, line 11g	PURCHASED SERIVCES: Program service expenses 1,900,756. Management and general expenses 868,013. Fundraising expenses 0. Total expenses 2,768,769. PROVIDER SERVICES: Program service expenses 1,050,085. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,050,085. MEDICAL DIRECTOR FEES: Program service expenses 34,170. Management and general expenses 0. Fundraising expenses 0. Total expenses 34,170.
FORM 990, PART XII, LINE 2C	HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL 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 THE AUDIT COMMITTEE OF HENRY FORD HEALTH SYSTEM.
FORM 5713 - INTERNATIONAL BOYCOTT REPORT:	A FORM 5713, INTERNATIONAL BOYCOTT REPORT,HAS BEEN FILED ON OUR BEHALF BY HENRY FORD HEALTH SYSTEM (PARENT OF OUR CONTROLLED GROUP). THE ORGANIZATION 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) 2019

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

2019

Open to Public Inspection

Name of the organization

CARELINK OF JACKSON
A COMMUNITY-OWNED SPECIALTY HOSPITAL

Employer identification number

38-1218485

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

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)WA FOOTE MEMORIAL HOSPITAL DBA HENRY FORD ALLEGIANCE HEALTH 205 N EAST AVENUE JACKSON,MI49201 38-2027689	HEALTHCARE SERVICE PROVIDER	MI	501(c)(3)	Line 3	HENRY FORD ALLEGIANCE HEALTH GROUP	Yes
(2)HENRY FORD ALLEGIANCE HEALTH GROUP 205 N EAST AVENUE JACKSON,MI49201 38-2756428	HEALTHCARE SERVICE PROVIDER	MI	501(c)(3)	Line 12b, II	HENRY FORD HEALTH SYSTEM	Yes
(3)ALLEGIANCE HEALTH FOUNDATION 205 N EAST AVENUE JACKSON,MI49201 38-3607833	SUPPORTING ORGANIZATION	MI	501(c)(3)	Line 12b, II	HENRY FORD ALLEGIANCE HEALTH GROUP	Yes
(4)HOSPICE OF JACKSON DBA ALLEGIANCE HOSPICE 205 N EAST AVENUE JACKSON,MI49201 38-2336367	HOSPICE CARE	MI	501(c)(3)	Line 7	HEALTHLINK	Yes
(5)THE HOSPICE OF JACKSON ENDOWMENT FUND ONE JACKSON SQUARE JACKSON,MI49201 38-3422146	SUPPORTING ORGANIZATION	MI	501(c)(3)	Line 12b, II	ALLEGIANCE HOSPICE	Yes
(6)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
(7)VOLUNTEERS OF HENRY FORD ALLEGIANCE HEALTH 205 N EAST AVENUE JACKSON,MI49201 38-6082835	SUPPORTING ORGANIZATION	MI	501(c)(3)	Line 7	HENRY FORD ALLEGIANCE HEALTH GROUP	Yes
(8)HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT,MI48202 38-1357020	HEALTHCARE SERVICE PROVIDER	MI	501(c)(3)	Line 3			No
(9)HENRY FORD MACOMB HOSPITAL ONE FORD PLACE DETROIT,MI48202 38-2947657	HEALTHCARE SERVICE PROVIDER	MI	501(c)(3)	Line 3	HENRY FORD HEALTH SYSTEM	Yes
(10)HENRY FORD WYANDOTTE ONE FORD PLACE DETROIT,MI48202 38-2791823	HEALTHCARE SERVICE PROVIDER	MI	501(c)(3)	Line 3	HENRY FORD HEALTH SYSTEM	Yes
(11)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
(12)HEALTH ALLIANCE PLAN 2850 W GRAND BLVD DETROIT,MI48202 38-2242827	HEALTH MAINTENANCE ORGANIZATION	MI	501(c)(4)		HENRY FORD HEALTH SYSTEM	Yes
(13)HFHS SELF FUNDED LIABILITY ONE FORD PLACE DETROIT,MI48202 38-6553031	MALPRACTICE INSURANCE	MI	501(c)(4)		HENRY FORD HEALTH SYSTEM	Yes
(14)HENRY FORD CONTINUING CARE ONE FORD PLACE DETROIT,MI48202 38-2433285	NURSING HOME	MI	501(c)(3)	Line 10	HENRY FORD HEALTH SYSTEM	Yes
(15)HFII CORPORATION ONE FORD PLACE DETROIT,MI48202 90-0840304	SCIENTIFIC RESEARCH	MI	501(c)(3)	Line 7	HENRY FORD HEALTH SYSTEM	Yes
(16)HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES ONE FORD PLACE DETROIT,MI48202 46-4064067	ADVOCACY SERVICES FOR THE HFHS AND AFFILIATES	MI	501(c)(4)			Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(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 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					No			No
(2) NORTHWEST DETROIT DIALYSIS 30100 TELEGRAPH BINGHAM FARMS,MI48025 38-3232668	OPERATES DIALYSIS CLINIC	MI					No			No
(3) MACOMB REGIONAL DIALYSIS 16151 NINETEEN MILE CLINTON TOWNSHIP,MI48038 26-0423581	OPERATES DIALYSIS CLINIC	MI					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) VIKING HEALTH SYSTEM 205 N EAST AVENUE JACKSON,MI49201 38-2756161	IDLE HEALTHCARE ADMINISTRATION CORPORATION	MI		C				No
(2) CASCADES INSURANCE COMPANY LTD 205 N EAST AVENUE JACKSON,MI49201 98-1132982	HOSPITAL MALPRACTICE INSURANCE CAPTIVE	CJ		C				No
(3) SHA REALTYINC ONE FORD PLACE DETROIT,MI48202 38-1378121	REAL ESTATE HOLDING	MI		C				No
(4) FAIRLANE HEALTH SERVICES 30100 TELEGRAPH BINGHAM FARMS,MI48025 38-2565235	HEALTHCARE MANAGEMENT	MI		C				No
(5) ALLIANCE HEALTH AND LIFE INSURANCE 2850 W GRAND BLVD DETROIT,MI48202 38-3291563	HEALTH INSURANCE PROVIDER	MI		C				No
(6) HAP PREFERREDINC 2850 W GRAND BLVD DETROIT,MI48202 38-2513504	PROVIDER NTEWORK LEASING	MI		C				No
(7) HAP MIDWEST HEALTH PLANINC 2850 W GRAND BLVD DETROIT,MI48202 38-3123777	HEALTH INSURANCE PROVIDER	MI		C				No
(8) HAP COMMUNITY ALLIANCE 2850 W GRAND BLVD DETROIT,MI48202 32-0306774	MANAGEMENT COMPANY	MI		C				No
(9) ADMINISTRATION SYSTEMS RESEARCH CORPORATION 2850 W GRAND BLVD DETROIT,MI48202 38-2651185	THIRD-PARTY INSURANCE ADMINISTRATION	MI		C				No
(10) ONIKA INSURANCE LTD FIRST CARRIBEAN HOUSE GRAND CAYMAN CJ	CAPTIVE INSURANCE	CJ		C				No
(11) HENRY FORD PHYSICIAN NETWORK ONE FORD PLACE DETROIT,MI48202 38-0306774	PHYSICIAN NETWORK	MI		C				No

Schedule R (Form 990) 2019

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 .....................

Yes

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) .......................

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) ............................

Yes

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

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

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

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

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) HENRY FORD ALLEGIANCE HEALTH	L	37,736	COST
(2) HENRY FORD ALLEGIANCE HEALTH	M	825,611	AGREEMENT

Schedule R (Form 990) 2019

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) 2019

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE LONG-TERM ACUTE HEALTHCARE TO THE RESIDENTS OF JACKSON, MI AND SURROUNDING AREAS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	6
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	144
6	Total number of volunteers (estimate if necessary) .............	6	1
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,004	2,088
9	Program service revenue (Part VIII, line 2g) .........	14,222,577	13,280,401
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,554	2,411
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	101,589	38,916
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	14,332,724	13,323,816
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	7,012,326	6,685,210
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	8,802,276	8,179,324
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	15,814,602	14,864,534
19	Revenue less expenses. Subtract line 18 from line 12.......	-1,481,878	-1,540,718
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	8,474,568	7,899,704
21	Total liabilities (Part X, line 26).............	3,410,260	4,376,114
22	Net assets or fund balances. Subtract line 21 from line 20.....	5,064,308	3,523,590

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 12,514,624 including grants of $ ) (Revenue $ 13,317,645 )
	HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS A LONG-TERM ACUTE CARE HOSPITAL FULLY ACCREDITED BY THE JOINT COMMISSION.THE FACILITY IS DESIGNED AND MANAGED TO PROVIDE CARE FOR MEDICALLY COMPLEX PATIENTS REQUIRING AN AVERAGE HOSPITAL STAY IN EXCESS OF 25 DAYS. ANY PATIENT HAVING AN ACUTE CHRONIC CONDITION, COMPLICATION FROM A SURGICAL PROCEDURE OR EXPECTED TO REQUIRE A LONGER ACUTE HOSPITAL STAY MAY BE CONSIDERED FOR ADMISSION. HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL IS A FREE-STANDING HOSPITAL WHEREBY PATIENTS ARE ACCEPTED FROM MULTIPLE SOURCES.PATIENTS ARE FREQUENTLY REFERRED TO THE FACILITY FROM OTHER ACUTE CARE HOSPITALS, SKILLED NURSING FACILITIES, PHYSICIAN OFFICES,WOUND CLINICS, DIALYSIS CENTERS AND OTHER SOURCES.DURING THE FISCAL YEAR ENDED 02/28/2018, HENRY FORD ALLEGIANCE SPECIALTY HOSPITAL MAINTAINED AN AVERAGE DAILY CENSUS OF 22.6 PATIENTS AND PROVIDED 8,245 DAYS OF PATIENT CARE. DUE TO THE COMPLEX MEDICAL NEEDS OF PATIENTS SERVED BY THE HOSPITAL, THE AVERAGE PATIENT RESIDED AT THE FACILITY FOR 25.2 DAYS. PATIENTS WHO SATISFIED MINIMUM MEDICARE ADMISSION CRITERIA MAINTAINED AN AVERAGE LENGTH OF STAY OF 28.6 DAYS. APPROXIMATELY 74.6% OF ALL DISCHARGED PATIENTS WERE MEDICARE ELIGIBLE.

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 expenses12,514,624

(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)		(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
(1) Ondrea Bates...................................................................... President	2.00 ................. 63.00	X	X	0	404,612	65,562
(2) Brent Ellis...................................................................... Chairperson	2.00 ................. 0.00	X	X	0	0	0
(3) Maryanne Fuchs...................................................................... Vice Chairperson (Thru Feb 6 2018)	2.00 ................. 0.00	X	X	0	0	0
(4) David K Schmidt...................................................................... Trustee	1.00 ................. 0.00	X		0	0	0
(5) Bruce A Insencio Jr...................................................................... Trustee	1.00 ................. 0.00	X		0	0	0
(6) Vlad Motoc MD...................................................................... Trustee	1.00 ................. 0.00	X		0	0	0
(7) Gregg Patten MD...................................................................... Trustee	1.00 ................. 0.00	X		0	0	0
(8) Wendy Boersma...................................................................... Trustee	1.00 ................. 59.00	X		0	219,125	26,186
(9) J Mark Fall...................................................................... Chief Executive Officer	40.00 ................. 0.00		X	0	0	0
(10) Dale L Friesen...................................................................... Chief Financial Officer	50.00 ................. 0.00		X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	623,737	91,748

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

f	All other contributions, gifts, grants, and similar amounts not included above		1f	2,088

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,088

		Business Code
2a	PATIENT SERVICES	621990	13,280,401	13,280,401
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		13,280,401

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,411			2,411
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	DIETARY CAFETERIA		722210	35,842	35,842
b	MEDICAL RECORDS FEES		900099	1,402	1,402
c
d	All other revenue ....			1,672			1,672
e	Total. Add lines 11a–11d ......			38,916
12	Total revenue. See instructions.....			13,323,816	13,317,645	0	4,083

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	5,491,640	5,006,474	485,166
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	107,822	98,296	9,526
9	Other employee benefits .......	682,636	584,656	97,980
10	Payroll taxes ...........	403,112	367,499	35,613
11	Fees for services (non-employees):
a	Management ......	781,747		781,747
b	Legal .........	5,118		5,118
c	Accounting ...........	22,400		22,400
d	Lobbying ...........	1,984		1,984
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)	3,853,024	2,985,011	868,013
12	Advertising and promotion ....	744		744
13	Office expenses .......	1,055,717	1,055,717
14	Information technology ......	24,959	24,959
15	Royalties ..
16	Occupancy ...........	248,933	248,933
17	Travel ............	37,942		37,942
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	398,572	398,572
23	Insurance ...	36,770	33,093	3,677
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	PHARMACEUTICALS	1,076,375	1,076,375
b	MEDICAL SUPPLIES	444,100	444,100
c	FOOD	127,591	127,591
d	BAD DEBTS	63,348	63,348
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	14,864,534	12,514,624	2,349,910	0
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 ........			299,890	1	502,555
2	Savings and temporary cash investments .........			1,140,428	2	451,530
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			2,176,441	4	2,295,523
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			82,732	9	35,170
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	5,366,220
b	Less: accumulated depreciation	10b	751,294	4,775,077	10c	4,614,926
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 33)...			8,474,568	16	7,899,704

17	Accounts payable and accrued expenses .....	419,798	17	564,761
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
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	2,990,462	25	3,811,353
26	Total liabilities. Add lines 17 through 25..	3,410,260	26	4,376,114

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	5,064,308	32	3,523,590
33	Total liabilities and net assets/fund balances ........	8,474,568	33	7,899,704