Henry Ford Health Providence Hospital

“The process for determining compensation of the organization's ceo, executive director, or top management official, as well as that of any other officers or senior executives (if any), is directed by a related organization. The related organization's board committee responsible for compensation oversees the process, utilizing independent delegees within the organization as appropriate, depending on the role. In some cases, the process may utilize comparability data and analysis from a national third-party compensation firm; or, if more appropriate for the role, it may instead utilize other applicable sources of market comparability data as needed to verify reasonableness. The process also includes contemporaneous substantiation of the analysis and decision regarding the compensation arrangement. Compensation is reviewed at least annually and the process is administered to assure independence, avoid conflicts of interest, ensure reasonableness and market comparability of total compensation, and to otherwise abide by pertinent laws and regulations.”

“Ascension Providence Hospital has a single corporate member, Ascension Michigan.”

“Ascension Providence Hospital has a single corporate member, Ascension Michigan, who has the ability to elect members to the governing body of ASCENSION PROVIDENCE HOSPITAL.”

“All decisions that have a material impact to Ascension Providence Hospital financial information or corporation as a whole are subject to approval by its sole corporate member, Ascension Michigan.”

“During the return preparation process, the tax department works with other functional areas which may include, as needed, finance, accounting, treasury, legal, human resources, and corporate compliance for advice, information and assistance in order to prepare a complete and accurate return. A complete final copy of the return is provided to designated management team members with experience in tax in lieu of the full board.”

“The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.”

“The organization will provide any documents open to public inspection upon request.”

“The organization utilizes an affiliate as the common pay agent. Employees reported in part vii may have duties that impact multiple related entities. Total average hours worked and compensation and benefits paid are reported. In doing so, if available, a common law employer analysis is used to determine whether the hours and compensation/benefits are reportable as attributable directly to the filing organization or another entity; otherwise, the best available information has been used as the basis for allocations utilized in the reporting.”

“Interest Income from Patient Accounts - Total Revenue: 90328, Related or Exempt Function Revenue: 90328, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Management Fees - Total Revenue: 275616, Related or Exempt Function Revenue: 275616, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Rental Income from Affiliates - Total Revenue: 501844, Related or Exempt Function Revenue: 501844, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Services to Affiliates - Total Revenue: 5050, Related or Exempt Function Revenue: 5050, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Contracted Services Revenue - Total Revenue: 168324, Related or Exempt Function Revenue: 168324, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Other Program Revenue - Total Revenue: 4005589, Related or Exempt Function Revenue: 4005589, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“Escheatment Revenue - Total Revenue: 419558, Related or Exempt Function Revenue: 419558, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Medical Records Fees - Total Revenue: 64118, Related or Exempt Function Revenue: 64118, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Late Penalty Fees - Total Revenue: 1897, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1897; Sponsored Project Revenue - Total Revenue: 1000, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1000; Miscellaneous Revenue - Total Revenue: 740547, Related or Exempt Function Revenue: 653176, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 87371; MEI Income - Total Revenue: 146088, Related or Exempt Function Revenue: , Unrelated Business Revenue: 143966, Revenue Excluded from Tax Under Sections 512, 513, or 514: 2122; Leased Employees - Total Revenue: 389550, Related or Exempt Function Revenue: , Unrelated Business Revenue: 389550, Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“The activity of THE FILING ORGANIZATION is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of THE FILING ORGANIZATION completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of THE FILING ORGANIZATION.”

“The organization is part of ascension health system. Ascension health alliance, d/b/a ascension, is a missouri nonprofit corporation. Ascension is the sole corporate member and parent organization of ascension health. Ascension health alliance is either the borrower for, or secures, tax exempt hospital revenue bonds. The organization may hold an intercompany note payable with ascension health alliance, and this information is reported on the balance sheet.”

“Transfers with Affiliates - 44680165; FAS 158 Pension Adjustment - 7041; Unconsolidated ASC JV Adjustment - 353011;”

“The filing organization is included in the consolidated financial statements of ascension health alliance. The finance and audit committee of ascension health alliance's board assumes responsibility for the consolidated organization as a whole.”

“https://www.henryford.com/locations/providence-novi-hospital https://www.henryford.com/locations/providence-southfield-hospital”

“THE PHYSICAL ADDRESS FOR THIS ENTITY IS 16001 WEST NINE MILE ROAD, SOUTHFIELD, Michigan 48075. THE ADDRESS ON PAGE 1 IS FOR MAILING PURPOSES ONLY”

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