OMB No 1545-0047

Form 990 Return of Organization Exempt From Income Tax tinder section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung

benefit trust or private foundation) 2002

state Y " me organization may have to use a copy of this return to satisfy reporting requirements im iai 1 m fis~enue Swrxa

A For the 2002 calendar year, or tax milling June 30 20 03 D Employer Identification number

38 1956056 R E Telephone number

~989453-7301 x102 F Actanhg meCq? O Cash [N Accrual

0 Other (soecH)

170 N CASEVILLE RD PIGEON MI 467658781 P39 P57

M and I a2 not applicable to section 527 o r2a,n¢ahons His) IS this a group return for affiliates? LJ Yes ERNo

H(b) If "Yes,' enter number of affiliates ~ . . .. . . . . . .

H(e) Are all affiliates included? El Yn 0 No (Ii "NO," attach a list See instructions

H(d) Is this a separate return filed by an organization covered by a group ailing? 0 Yea E3 No

I Enter 4-digit GEN ~

e Section 507(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts moat attach a completed Schedule A (Form 990 or 990-EZ)

G Web site

K Check here W 1-1 d the organization s gross recepis ere nortnaly not more than $25 000 me organization need net file e return with the IRS but d the organization reserved a Form 990 Package in the mail it should file a return without fnanc.al data Some states require a complete return

72,708

69,345

10c

13 Program services (tram line 44, column (B)) n 14 Management and general (from line 44, column (Q) c

g 15 Fundraising (from line 44, column (D)) u~ 16 Payments to affiliates (attach schedule)

17 Total expenses (add lines 16 and 44, column (A))

18 Excess or (defeat) for the year (subtract line 17 from line 12) 19 Net assets or fund balances at beginning of year (from line 73, column (A))

m 20 Other changes in net assets or fund balances (attach explanation) :, tatelnEnt: 1 z 21 Net assets of fund balances at end of veer (combine lines 18 . 19, and 20)

7

Form 990 (2002)

~' L7

!,

B Check 0 applicable

Address change 0 Name Change

0 Instal return

Final return Amended return

o Application pending

" ". . " . . . " . . . "'21-DIG IT 487 29 IB LK 38-1466066 200306 SCHEURER HOSPITAL

3 i .

M Check L Gross receipts Add lines 6b, Bb, 9b, and tOb to line 12 " to attach

Revenue Ex enses, and Changes in Net Assets or Fund Balances See a

1 Contributions, gifts, grants, and similar amounts received a Direct public support 1a 150

7 b Indirect public support it

933 c Government contributions (grants) d Total (add lines 1a through t c) (cash $ noncash $

2 Program service revenue including government fees and contracts (from Part VII, line 93) 3 Membership dues and assessments 4 Interest on savings and temporary cash investments 5 Dividends and interest from securities 6a Gross rents 6a69 345

b Less rental expenses 6b

c Net rental income r (los line 6a) m 7 Other investment c ai6A'Ittp )

m 8a Gross amount fro `~ ales of assets other 0 ) secunnes (e) omen

than inventory ~ NOV Z 4 2003 b Less cost or other s and sales expenses ' 8b c Gain or (loss) (att ch s p~ d Net gain or poss) ,~oqluYr~ (A) d (B)) 9 Special events and activities (attach sc a Gross revenue (not including $ of

contributions reported on line 1a) 9a b Less direct expenses other than fundraising expenses 9 c Net income or (loss) from special events (subtract line 9b from line 9a)

10a Gross sales of inventory, less returns and allowances 10a

c.~ b Less cost of goods sold 10b Z5 c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line tOb from line 10x)

11 Other revenue (from Part VII, line 103) 12 Total revenue (add lines 1d, 2, 3, 4, 5, 6c, 7, Bd, 9c, 10c, and 11)

{ it the organization is not required B (Form 990, 990-EZ, or 990-PFD 17 of the instructions )

For Paperwork Reduction Act Notice, see we separate instructions Cat No 112B2V

Statement of Program Service Accomplishments See page 24 of the instructions What is the organization's primary exempt purposes "- . See statement // 3 Program Service

Expenses All organizations must describe their exempt purpose achievements in a clear and concise manner State the number (peQuffea ion soyq(3) and of clients served, publications issued, etc Discuss achievements that are not measurable (Section 501(c)(3) and (4) la) orps and 4947(a)(1) organizations and 4947(a)(1) nonexempt chantable trusts must also enter the amount of grants and allocations to others ) "gyp oiners~

°al for

a Hospital services were provided to 666 patients who were admitted to Acute Care for a total of 2,141 clays and 43-,510 patients received out patient services .

(Grants and allocations $ ) 22, 343, 821 bNursing Home-The hospital operates an attached basic Long Term Care facility which provided 6,843_days_ of care .

(Grants and allocations $ ) 1 799 , 195 c

(Grants and allocations $ )

(Grants and allocations $ ) e Other program services (attach schedule) (Grants and allocations $ ) f Total of Program Service Expenses (should equal line 44, column (B), Program services) " 24,14 3,016

Forth 990 (2002)

Fornn 990 (2002) SCHEURER HOSPITAL 38-1456056 Page 2

StetBRICfIt of All organizations must complete column (A) Columns (B), (C) and (D) are required for section 501(c)(3) and (4) organizations Functional Expenses and season 4947(a)(1) nonexempt charitable trusts but optional for others (See page 21 of the instructions)

Do not include amounts reported on line (B) Program ~c) Management 1 66, 8b, 9b, lob, or 16 0l Part I ~a T°~°~ services and general ID) Fundraising

22 Grants and allocations (attach schedule) (cash $ noncash $ ) 22

23 Specific assistance to individuals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 25 Compensation of officers, directors, etc 25 272 , 423 272 .423 26 Other salaries and wages 26 9 , 364 . 879 6 .400 .674 2 .964 .. 27 Pension plan contributions 27 734 , 289 487 , 683 4 28 Other employee benefits 28 1 , 893 , 948 1 , 257 , 877 36, 071 29 Payroll taxes 29 685 , 969 455 591 230 ,3 7 8 30 Professional fundraising tees 30 31 Accounting fees 31 32 Legal fees 32 33 Supplies 33 2 664 012 2 , 34 5 799 1 34 Telephone 34 87 , 803 20 , 125 67 , 678 35 Postage and shipping 35 34, 510 7,420 27 , 090 36 Occupancy 36 298,107 298 , 107 0 37 Equipment rental and maintenance - 37 367,07-1 - 193 , 907 - 17-3- 1 1 64 - - -38 Punting and publications 38 78,621 40,034 38 587 39 Travel 39 40 Conferences, conventions, and meetings 40 47 , 632 28 , 848 18 , 7 8 4 41 Interest 41 617 , 165 617 , 165 0 42 Depreciation, depletion, etc (attach schedule) 42 1 043 , 797 892 , 738 1 51 059 43 Other expenses not covered above (itemize) a . . . .

_ 43b 43c

-- - -- 43d e See statement #2 43e11 531 85 11 097 09 434 , 805

44 Total functional expenses (add lines 22 through 43) Organ vahons completing columns /B)-(D/, carry these totals

to Imes 19-15 qq 2 9 , 738 , 22~24 , 143 , 01 6 5, 595 , 20~

Joint Costs Check " 0 it you are following SOP 98-2 Are any point costs from a combined educational campaign and fundraising solicitation reported in (B) Program services " El Yes [M No If "Yes," enter p) the aggregate amount of these point costs $-, (u) the amount allocated to Program services $ , (w) the amount allocated to Management and general $ , and (iv) the amount allocated to Fundraising $

Faim 990 (2002) SCHEURER HOSPITAL 38-1456056 page 3

FURM Bulance'Sheets (See page 24 of the instructions)

Note Whet required, attached schedules and amounts within the description (A) (B) column should be /or end-of-year amounts only Beginning of year End of year

45 Cash--non-interest-bearing 0 45 0 46 Savings and temporary cash investments 3 , 729 , 380 46 3 , 874 , 306

47a Accounts receivable 47a 3, 216, 189

b Less allowance for doubtful accounts 47b ~ 1,9111936 q7c 2,642,079

48a Pledges receivable b Less allowance for doubtful accounts 48b 48c

49 Grants receivable 49

50 Recervables from officers, directors, trustees, and key employees (attach schedule)

51a Other notes and loans receivable (attach schedule)sQe statement #4 51a 1 Q80 663

b Less allowance fordoubHulaccounts accounts 51b 1 270 000 325,748 51c 610 , 663 52 Inventories for sale or use 484 , 370 52 531 000 53 Prepaid expenses and deferred charges 432, 173 53 456 013

54 Investments-secunties (attach schedule) " 0 Cost El FMV 54

55a Investments-land, buildings, and equipment basis 155a I

b Less accumulated depreciation (attach hiii schedule) ~b SSc

7,226,451 56 Investments--other (attachschedule~ee statement //5 95 57a Land, buildings, and equipment basis 57a

b Less accumulated depreciation (attach schedule see statement ~/6 57b ~ 7 255 094 7 , 446 , 977 57c 8 . 087 . 674

58 Other assets (describe " Bond issue costs ) 103 ,214

59 Total assets (add lines 45 through 58 must equal line 74) 20 , 428 , 867 59 23 , 55 9,58 1 60 Accounts payable and accrued expenses 1,886,222 60 9 , 3 6 9 , 9 2 7 61 Grants payable 61 -62 Deferred revenue 62

m 63 Loans from officers, directors, trustees, and key employees (attach = schedule) m

63 64 C) 0 64a Tax-exempt bond liabilities (attach schedule) see Statement

b Mortgages and other notes payable (attach schedule) 65 Other liabilities (describe " LeaGes pavahl P ) 31 C; F 884 65

6,478,558 8,979,428 86 Total liabilities (add lines 60 through 65 66

Organizations that follow SFAS 117, check here " 0 and complete lines q 67 through 69 and lines 73 and 74 ///// v 67 Unrestricted

13,893,265 - 14,994,589 67 c 57 , 044 68 85 , 564 !~ 68 Temporarily restricted ago 69 Permanently restricted c

69

Organizations that do not follow SFAS 177, check here " El and ii complete lines 70 through 74 0 70 Capital stock, trust principal, or current funds 70

71 Paid-in or capital surplus, or land, building, and equipment fund '~

71 72 Retained earnings, endowment, accumulated income, or other funds

a

_ 72

73 Total net assets or fund balances (add lines 67 through 69 or lines 7othrough 72, 13,950,309 15,080,153 column (A) must equal line 19, column (B) must equal line 21) 73

74 Total liabilities and net assets / fund balances add lines 66 and 73 20, 428, 867 74 23 , 559 , 581 Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a

particular organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments

Fo"sso(zaoz) SCHEURER HOSPITAL 38-19 Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See page 26 of the instructions )

a Total revenue, gains, and other support a 230239 per audited financial statements Bo.

b Amounts included on line a but not on line 12, Form 990

(1) Net unrealized gains on investments $

(2) Donated services and use of facilities $

(3) Recoveries of pnor year grants

(4) Other (specify) Rounding . 0

S

4

a Total expenses and losses per audited financial statements

b Amounts included on line a but not on line 17, Form 990

(1) Donated services and use of facilities $

(2) Prior year adjustments reported on line 20, Form 990

(3) Losses reported on line 20, Forth 990 $

(4) Rouri~in~~~ ( 4 ) Add amounts on lines (1) through (4) " b 9 y y . . . . . .

Add amounts on lines (1) through (4)" b ~ 4 ~

c Line a minus line b t c _c one a minus line b _ _ " c 20971 433 .

d Amounts included on line 12, d Amounts included on line 17, Form 990 but not on line a: Form 990 but not on line a

(1) Investment expenses (1) Investment expenses not included on line not included on line 6b, Forth 990 $ 6b, Form 990

(2) Other (specify) (2) pther (s ecifv) see statement / Contractual

-- -- -- - #8 $8795312 ~ Adjustments $8766792

Add amounts on lines (7) and (2) " d Add amounts on lines (1) and (2) " d 8766792

e Total revenue per line 12, Form 990 e Total expenses per line 17, Form 990 line c plus line d 111~ e 308188 1 1 line c plus line d t e 29738225

`/ List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated, see page 26 of the instructions )

Contributions to I (E) Expense ;ee Wait pWS d account and other (B) Title and average hours per

week devoted to position (F,) Name and address

_See-statement #9 . .

Form 990 (2002)

Reconciliation of Expenses per ~4udited Financial Statements with Expenses per Return

75 Did any officer, director, trustee or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations " [N Yes [--] No If "Yes," attach schedule-see page 26 of the instructions

SCIILURER HOSPITAL 38-1456056 Form 990 (2002) FTrnM Other Infqrmation (See page 27 of the instructions )

r 76 Did the organization engage in any activity not previously reported to the IRS If "Yes," attach a detailed descnption of each activity 77 Were any changes made in the organizing or governing documents but not reported to the IRS

Ii "Yes," attach a conformed copy of the changes 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? b If "Yes," has it filed a tax return on Form 990-T for this year

79 Was there a liquidation, dissolution, termination, or substantial contraction dunng the yea( If "Yes," attach a statement 80a Is the organization related (other than by association with a statewide or nationwide organization) through common

membership, governing bodies, trustees, officers, etc , to any other exempt or nonexempt organization? b I( "Yes," enter the name of the organization " SEE STATEMENT /t 1 0 . . . . . . . . .

and check whether it is 0 exempt or 1:1 nonexempt 87a Enter direct or indirect political expenditures See line 81 instructions b Did the organization file Form 1120-POL for this year?

82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value

b It "Yes," you may indicate the value of these items here Do not include this amount as revenue in Part I or as an expense in Part II (See instructions in Part III )

83a Did the organization comply with the public inspection requirements for returns and exemption applications b Did the organization comply with the disclosure requirements relating to quid pro quo contributions

84a Did the organization solicit any contributions or gigs that were not tax deductible b If "Yes," did the organization include with every solicitation an express statement that such contributions

or gifts were not tax deductible 85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members b Did the organization make only in-house lobbying expenditures of $2,000 or less

If "Yes" was answered to either BSa or 85b, do not complete BSc through 85h below unless the organization received a waiver for proxy tax owed for the prior year

c Dues, assessments, and similar amounts from members 185C 1 d Section 162(e) lobbying and political expenditures e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices f Taxable amount of lobbying and political expenditures (line 85d less 85e) g Does the organization elect to pay the section 6033(e) tax on the amount on line BSi9 h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line BSf to its

reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year

86 507(c)(7) orgs Enter a Initiation fees and capital contributions included on line 12 B6a b Gross receipts, included on line 12, for public use of club facilities 86b

87 507(c)(12) orgs Enter a Gross income from members or shareholders b Gross income from other sources (Do not net amounts due or paid to other

sources against amounts due or received horn them ) 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or

partnership, or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701-37 If "Yes," complete Part IX

89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 " , section 4912 " , section 4955

X

85b

b 507(c)(3) and 507(c)(4) orgs Did the organization engage in any section 4958 excess benefit transaction X dunnq the year or did it become aware of an excess benefit transaction from a prior years If "Yes," attach a statement explaining each transaction 89b

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under p sections 4912, 4955, and 4958

d Enter Amount of tax on line 89c, above, reimbursed by the organization 90a list the states with which a copy of this return is filed " None requl red _ _ b Number of employees employed in the pay period that includes March 12, 2002 (See instructions) I90b 1 268

91 The books are in care of " Terry _J . Lutz Telephone no " (989 )453-73011x`102 Located at t 170 N . Caseville Rd . Pigeon MI ZIP +a " _48755 . .

92 Section 4947(x)(1) nonexempt charitable trusts filing Form 990 in Oeu o/ Form 1041-Check here 1 0 and enter the amount of tax-exempt interest received or accrued during the tax year " I 92 I

Form 990 (2002)

78a

83aIX

No

SCHEURER HOSPITAL 38-1456056 Page 6 Form 990 (2002) jjMjWAt Analysis of Income-Producing Activities See a e 31 of the instructions

Note : Enter gross amounts unless otherwise Unrelated business income Excluded by section 512, 513, or 514 indicated (A) (B) (p) (p) Related or indicated exempt function 93 Business code Amount Exclusion code Amount Program service revenue income a Patient service revenue 29,276,39

b c d e f Medicare/Medicaid payments g Fees and contracts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments 1 98 Dividends and interest from securities 97 Net rental income or (loss) from real estate a debt-financed property b not debt-financed property 3 1 69,345

98 Net rental income or (loss) from personal property 99_ Other investment income 100 Gain or (loss) from sales of assets other than inventory 101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of inventory 103 Other revenue a Purchase discounts 23 . 324

y Cafeteria 8 Meals on Wheels 3 60 , 853 Finance Charges in c;nn Contracted services 3 841 , 553 Other operating revenue 5-7 1 8-6-1

104 Subtotal (add columns (8), (D), and (E)) 3 7 A . 0 2 629 , 3 6 R , n 7 105 Total (add line 104, columns (B), (D), and (E)) " 30,746,103 Note' Line 105 plus line id, Part l, should equal the amount on line 12, Part I

Relationship of Activities to the Accomplishment of Exem pt Purposes See page 32 of the instructions Line No Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment

of the organization's exempt purposes (other than by providing funds for such purposes) I See statemen t #11

FURW Information Regarding Taxable Subsidiaries and Disregarded Entities See page 32 of the instructions (al IBI f~l lDl E~ Name, address, and EIN of corporation, Percentage of Nature of activities Total income End-of-year

artnershi , or disr arded entity ownershi p interest assets

04

(a) Did the organization, during the year, receive any lands, directly or endue (b) Did the organization, during the year, pay premiums, dvei Note, I/ "Yes" to (b), file Form 8870 and Form 4720 (see ins

Under penalties of penury 1 declare that I hay a examined this return, and belief it is yye, cortect, and compbjyDeclarabon of preparer

Please Sign ignatura of officer Here Dwight Gascho, P

' Type or print name and title

Paid

$

Prepareia rsignature

'

Finn's name (or ywrs 1 X52 011E d sell-empbyed)

SCHEDULE A Organization Exempt Under Section 501(c)(3) (FORM 990 Or 990-EZ) . (Except Private Foundation) and Section 501(e), 5070, 501(k),

501(n), or Section 4947(a)(1) Nonexempt Charitable Trust

" Supplementary Informatiori--(See separate instructions .) Department of the Treawry Internal ae+enw s«V,ca " MUST be completed by the above organizations and attached to then Form 990 or 990-EZ

OMB No 1 545-0047

20 02 Name of tie organization Employer Identification number

SCHEURER HOSPITAL 38 1456056

NONE

Total number of others receiving over $50,000 for professional services

For Paperwork Reduction Act NoLCe, See the Instructions for Form 990 and Forth 99QEZ Cat No 112B5F Schedule A (Form 990 or 990-EZ) 2002

j Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions List each one If there are none, enter "None ")

(a) Name end address of each employee pad more (b) Title and average hours (d) Contributions to (e) Expense than 550,000 per week devoted to position (c) Compensation mDloyee benefit plans d account and other

deferred compensation allowances

Scott Reiter DO Physician 299--3ecoTrd-St---- ---- -- --- - 40 hrs/week 177,687 25,179 0 Bay Port MI 48720

Cynthia S . Herrin CRNA 7052 Scheurer--St . --- 40 hrs ./week 165,272 24,355 0 Pigeon MI 48755

Blair K . Hough MD Physician 6858 Stephens ~ ----- Caseville MI 48725 40 hrs ./week 160,000 23,751 0

Paul Schneider MD Physician 7095 Park St . ---- -- 40 hrs ./week 160,000 23751 0 Caseville MI 48725

Antonio Uvas MD Physician 3935--N-. '8lkton Rd . Elkton MI 98731 40 hrs ./week 145,655 21,967 0 Total number of other employees paid over $50.000 111~ 1 28

/I Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions List each one (whether individuals or firms) If there are none, enter "None ")

(s) Name end address of each independent contractor paid more than $50,000 (b) Type of semca (c) Compensation

-- -- -- --- - --

Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions )

The organization is not a private foundation because it is (Please check only ONE applicable box ) 5 0 A church, convention of churches, or association of churches Section 170(b)(1)(A)(i) 6 0 A school Section 170(b)(1)(A)(i) (Also complete Part V ) 7 99 A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(1u) 8 El A Federal, state, or focal government or governmental unit Section 170(b)(1)(A)(v) 9 0 A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(u) Enter the hospital's name, city,

and state " . . . . . . . . . . . . . . . . 10 El M organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)Crv)

(Also complete the Support Schedule in Part IV-A ) 11a El An organization that normally receives a substantial part of its support from a governmental unit or from the general public

Section 170(b)(1)(A)(w) (Also complete the Support Schedule in Part IV-A ) 11b 0 A community mist Section 170(b)(7)(A)(v) (Also complete the Support Schedule in Part IV-A) 12 E3 An organization that normally receives (7) more than 33'/a% of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc , functions-subject to certain exceptions, and (2) no more than 33%a% 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) (Also complete the Support Schedule in Part IV-A )

13 El M organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in (1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), d they meet the test of section 509(a)(2) (See section 509(a)(3) )

Provide the following information about (b) Line number

horn above (a) Name(s) of supported organization(s)

14 [_1 M organization organized and operated to test for public safety Section 509(a)(4) (See page 5 of the instructions ) Schedule A (Form 990 or 990-EZ) 2002

Schedule A(Fortn990or990-EZ) 20o2 SCHEURER HOSPITAL 38-1456056 Page

Statements About Activities (See page 2 of the instructions ) Yes No

1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If "Yes," enter the total expenses paid or incurred in connection with the lobbying activities 11- $ (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B ) Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other organizations checking "Yes," must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities

2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? of the answer to any question is "Yes," attach a detailed statement explaining the transactions)

a Sale, exchange, or leasing of property? 2a X

X b Lending of money or other extension of credit

X

c Furnishing of goods, services, or facilities

d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)9- - - - - 2d -

e Transfer of any part of its income or assets? 2e X

X

3 Does the organization make grants for scholarships, fellowships, student loans, etc 7 (See Note below ) 4 Do you have a section 403(b) annuity plan for your employees? 4

Note: Attach a statement to explain how the organization determines that individuals or organizations receiving grants or loans from it in furtherance of it charitable programs "qualify" to receive payments

26 Organizations described on lines 10 or 11 a Enter 2% of amount in column (e), line 24

b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts for 1998 through 2001 exceeded the amount shown in line 26a Do not file this list with your retain Enter the total of all these excess amounts

c Total support for section 509(a)(1) test Enter line 24, column (e) d Add Amounts from column (e) for lines 18 19

22 26b t e Public support (line 26c minus line 26d total) 1 f Public suoooR oercentaae (line 26e Inumerator) divided by line 26c (denommatorl)

G�edu,va ;-,- e;0 _.9M =~0~2 SCNErJREF HOSPITAL 3°-'.45G056 Page 3

SUppolt Schedule (Complete only if you checked a box on line 10, 11, or 12 ) Use cash method o1 accounting Note. You may ese the worksheet m the instructions for converting from the accrual to the cash method o/ accounting N / A Calendar year (or fiscal year beginning m) " (a) 2001 (b) 2000 (c) 1999 (d) 1998 (e) Total 15 Gifts, grants, and contributions received (Do

not include unusual grants See line 28) 16 Membership fees received 17 Gross receipts from admissions, merchandise

sold or services performed, or furnishing of facilities in any activit y that is related to the organization's charitable, etc , purpose

18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and I unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975

19 Net income from unrelated business activities not included m line 18

20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf

21 The value of services or facilities furnished to the organization by a governmental unit without charge Do not include the value of services or facilities generally famished to the public without charge

22 Other income Attach a schedule Do not include gain or (loss) Tram sale of capital assets

23 Total of lines 15 through 22 24 Line 23 minus line 17 25 Enter 1 % of line 23

27 Organizations described on line 12 : a For amounts included in lines 15, 16, and 17 that were received from a "disqualified person," prepare a list for your records to show the name of, and total amounts received in each year from, each "disqualified person " Do not file this list with your retain Enter the sum of such amounts for each year

(2001) (2000) . . . (1999) . . . . . . (1998) b For any amount included in line 17 that was received from each person (other than "disqualified persons"), prepare a list for your records to

show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations described in lines 5 through 11, as well as individuals) Do not file this list tenth your retain After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year (2001) (2000) (1999) . . (1998) . . . .

c Add Amounts from column (e) for lines 15 16 17 20 21 1

d Add Line 27a total and line 27b total t e Public support (line 27c total minus line 27d total) t 1 Total support for section 509(a)(2) test Enter amount from line 23, column (e) g Public support percentage (line 27e (numerator) divided by dine 271 (denominator)) t h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator)

28 Unusual Grants For an organization described in line 10, ti, or 12 that received any unusual grants during 1998 through 2001, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant Do not file this list with your retain Do not include these grants in line 15

Schedule A (Form 990 or 99o-EZ) 2002

Schedule A(FOrmeeooreso-EZ) 2002 SCHEURER HOSPITAL 38-1456056 4

Private School Questionnaire (See page 7 of the instructions) (To be completed ONLY by schools that checked the box online 8 in Part IV) N/A

Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution o1 its governing body? Does the organization include a statement of its racially nondiscnminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships?

Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves If "Yes," please describe, d "No," please explain (If you need more space, attach a separate statement )

No

31

If you answered "No" to any of the above, please explain (If you need more space, attach a separate statement )

r;]

30

32 Does the organization maintain the following a Records indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory

basis? 32b

c Copies of all catalogues; brochures, announcements, and other written communications to-the public dealing with student admissions, programs, and scholarships? 32c

d Copies of all material used by the organization or on its behalf to solicit contributions? 32d

33 Does the organization discriminate by race in any way with respect to

a Students' rights or privileges?

b Admissions policies

c Employment of faculty or administrative staff?

d Scholarships or other financial assistance

e Educational policies?

If Use of facilities?

g Athletic programs

h Other extracurricular activities?

If you answered "Yes" to any of the above, please explain (If you need more space, attach a separate statement )

34a Does the organization receive any financial aid or assistance from a governmental agency

b Has the organization's right to such aid ever been revoked or suspended It you answered "Yes" to either 34a or b, please explain using an attached statement

35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 05 of Rev Proc 75-50,_1975-2 C B 587, covering racial nondiscrimination? It "No," attach an explanation

Schedule A (Form B80 or 990-EZ) 2002

Schedule n(FO,rri ssoorsso-EZ zoaz SCHEURER HOSPITAL 38-1456056

Lobbing Expenditures by Electing Public Charities (See page £ . (TO b completed ONLY by an eligible organization that filed Form

Check " a 0 if the organization belongs to an affiliated group Check " b ~ if you check

Limits on Lobbying Expenditures

(The term "expenditures" means amounts paid or incurred )

38 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 38 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add fines 38 and 39) 41 Lobbying nontaxable amount Enter the amount from the following table -

if the amount on line 40 is- The lobbying nontaxable amount is- Not over $500,000 20% of the amount on line 40 Over E500,000 but not over $1,000,000 $700,000 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 $7,000,000 Over $7,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000 $1,000,000

42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36 44 Subtract line 41 from line 38 Enter -D- if line 41 is more than line 38

Caution I! there is an amount on ether line 43 or line 44, you must file Form 4720

N/A "limited control"

(a) Affiliated group

totals

(b) To he cwnplaled for ALL electing

42

Lobbying Expenditures During 4-Year Averaging Period

(a) I Ib1 I ICI I (dl I (e) 2002 2001 2000 7999 Total

50 Grassroots ruouc cnannes N/ A that did not complete Part 71 of the instructions

41

4-Year Averaging Penod Under Section 507(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below

See the instructions for fines 45 through 50 on page 11 of the instructions I

Calendar year (or fiscal year beginning in)

45 Lobbying nontaxable amount

48 Lobbying ceiling amount (150% of line

47 Total lobbying expenditures

48 Grassroots nontaxable amount

49 Grassroots ceiling amount (150% of line 48(e))

During the year, did the organization attempt to influence national, state or local legislation, including any Yes No Amount attempt to influence public opinion on a legislative matter or referendum, through the use of

a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h ) e Media advertisements d Mailings to members, legislators, of the public e Publications, or published or broadcast statements f Grants to other organizations for lobbying purposes g Direct contact with legislators, then staffs, government officials . or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means I Total lobbying expenditures (Add lines c through h .)

If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities Schedule A (Form 990 or 89D-EZ) 2002

Schedule n(FOnmssoors9o-EZ) 2002 SCHEURER HOSPITAL 38-1456056 Page 6 V Information Regarding Transfers To and Transactions and Relationships With Nonchantable

Exempt Organizations (See page 12 of the instructions 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations a Transfers from the reporting organization to a noncharitable exempt organization of

(i) Cash (u) Other assets

b Other transactions (i) Sales or exchanges of assets with a noncharitable exempt organization (u) Purchases of assets from a noncharitable exempt organization (m) Rental of facilities, equipment, or other assets (iv) Reimbursement arrangements (v) Loans or loan guarantees

(vi) Performance of services or membership or fundraising solicitations Sharing of facilities, equipment, mailing lists, other assets, or paid employees If the answer to any of the above is "Yes," complete the following schedule Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting organization If the organization received less than fair market value in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received

(a) (b1 Ic) Idl Line n-1 Amount involved - I - Name of nonchanlaDle exempt organization - I--Description of transfers Iransacvons-and shanng arrangements

No

lal Ibl Icl Name of organization Type o! organization Description of relationship

cnnrea on iarycisdpaper Schedule A (Form 990 or 990-EZ)

52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 " El Yes

b If "Yes," complete the following schedule

38-1456056 SGT iEuRER HOSPITAL

OTHER CHANGES IN NET ASSETS OR FUND BALANCES

49.255 $49.255

Transfer from Scheurer Foundation TOTAL OTHER CHANGES

FORM 990, PART IV, LINE 51a STATEMENT 4 OTHER NOTES & LOANS RECEIVABLE

DOUBTFUL ACCT BALANCE ALLOWANCE DUE

$690,000 $4,832 RELATIONSHIP TO BORROWER AFFILIATE

BORROWER'S NAME TERM OF REPAYMENT SCHEURER COMMUNITY SERVICES - CG UPON DEMAND

INTEREST FMV OF RATE CONSIDERATION 500% 0

DOUBTFUL ACCT ALLOWANCE

$0

BALANCE DUE $137,370

RELATIONSHIP TO BORROWER AFFILIATE

FORM 990, PART I, LINE 20 STATEMENT 1

FORM 990, PART II, LINE 43e STATEMENT 2 OTHER EXPENSES

DESCRIPTION ~ TOTAL ~ SERVICES ~ GENERAL INSURANCE $209,821 $199,874 $9,947 PROPERTY TAXES & OTHER 11,609 11,609 PROF FEES & SERVICES 1,754,895 1,330,037 424,858 PHYSICIAN FEES 420,428 420,428 CONTRACTUAL ADJUSTMENTS 8,766,792 8,766,792 BAD DEBTS 165,481 165,481 FOOD 202.827 202.827

$11.531 .853 $11 .097.048 $434.805

FORM 990, PART III STATEMENT 3 STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS

PRIMARY EXEMPT PURPOSE TO PROVIDE MEDICAL AND SURGICAL HELP FOR THE COMMUNITIES OF PIGEON AND SURROUNDING AREAS TO PROVIDE NURSING SERVICES TO THE AGED AND PROMOTE GENERAL HEALTH

BORROWER'S NAME SCHEURER COMMUNITY SERVICES - CBV

DATE OF ORIGINAL LOAN INTEREST NOTE AMOUNT RATE

VARIOUS $694,832 500%

TERM OF REPAYMENT UPON DEMAND

FMV OF

DATE OF ORIGINAL LOAN NOTE AMOUNT

VARIOUS $137,370

BORROWER'S NAME SCHEURER FAMILY PHARMACY-SEB

TERM OF REPAYMENT MONTHLY

FMV OF CONSIDERATION

0 DOUBTFUL ACCT ALLOWANCE

$0

BALANCE DUE $308,297

RELATIONSHIP TO BORROWER AFFILIATE

BORROWER'S NAME SCHEURER FAMILY PHARMACY-PIGEON

TERM OF REPAYMENT MONTHLY

FMV OF CONSIDERATION

0 DOUBTFUL ACCT BALANCE ALLOWANCE DUE

$0 $160,004 RELATIONSHIP TO BORROWER AFFILIATE

TOTAL LINE 56 $7.226.451

SCHcURER HvSPiTAL

BORROWER'S' NAME SCHEURER FAMILY VISION CENTER

DATE OF ORIGINAL LOAN INTEREST NOTE AMOUNT RATE

VARIOUS $580,160 500%

RELATIONSHIP TO BORROWER AFFILIATE

TERM OF REPAYMENT UPON DEMAND

FMV OF

DOUBTFUL ACCT ALLOWANCE

$580,000

DATE OF MATURITY ORIGINAL LOAN INTEREST NOTE DATE AMOUNT RATE

08/06/02 10/31/12 $389,380 500%

38-1456056

BALANCE DUE

$160

DATE OF MATURITY ORIGINAL LOAN INTEREST NOTE DATE AMOUNT RATE 11/15/01 11/15/07 $176,000 500%

TOTAL INCLUDED ON PART IV, LINE 51 (a) (b) (c) $1,880 .663 $1 .270.000 $610,663

FORM 990, PART IV, LINE 56 OTHER INVESTMENTS

VALUATION DESCRIPTION METHOD AMBULANCE EQUIP FUND COST $85,564

DEPRECIATION RESERVE FUND COST 1,680,253

BOND FUNDS COST 5,385,634

THUMB DIALYSIS CENTER COST 75.000

38-1456056 SCHEURER HOSPITAL

DEPRECIATION OF ASSETS NOT HELD FOR

STATEMENT 7

OF HURON ADJUSTABLE RATE DEMAND LIMITED OBLIGATION REVENUE BONDS SERIES 2001 (SCHEURER HOSPITAL PROJECT) DUE IN ANNUAL INSTALLMENTS THROUGH AUGUST, 2021 5.650.000

TOTAL LINE 64b $5.650.000

TOTAL LINE 64b $8.795.312

FORM 990, PART IV, LINE 57 STATEMENT 6

COST OR ACCUM DESCRIPTION OTHER BASIS DEPREC LAND $648,279 LAND IMPROVEMENTS 380,447 BUILDINGS & FIXTURES 8,453,894 MEDICAL 8 OTHER EQUIPMENT 5.860.148

TOTAL TO PART IV, LINE 57 $15,342,768 $7 .255 .094

NOTE DEPRECIATION IS COMPUTED ON A STRAIGHT LINE BASIS

FORM 990, PART IV, LIN TAX-EXEMPT BOND LIABILITIES

THE ECONOMIC DEVELOPMENT CORPORATION OF THE COUNTY

BOOK VALUE

$8 ,087,674

FORM 990, p 4/PART IV-A, LINE d(2) STATEMENT 8 AMOUNTS INCLUDED ON LINE 12, FORM 990 BUT NOT ON LINE a

CONTRACTUAL ADJUSTMENTS $8,766,792 DONATIONS 28,083 INTEREST ON RESTRICTED FUND 437

Scheurer Hospital 38-1456056

Form 990 (2002) STATEMENT 9

Part V - List of Officers, Directors, Trustees, and Key Employees (B) Title and average (C) Compensation (D) Contributions to (E) Expense

(A) Name and address hours per week If not paid, enter emp ben plans account and devoted to position -0-) 8 def comp other allow

scoff Meyersieck Chairman -0- -0- -0- 7434 Paul St , Pigeon, MI 48755 2 hours per week Dwight Gascho President $272,423 $66,507 -0- 9325 Pointe Charity Dr , Pigeon, MI 48755 40 hours per week Peggy McCormick 1 st Vice Chairman -0- -0- -0- 515 Camelot Lane, Pigeon, MI 48755 1 hour per week Mike Otto 2nd Vice Chairman -0- -0- -0- 317 Brown Rd , Bay Port, MI 48720 1 hour per week Jay Dube Secretary -0- -0- -0- 7061 Charles St , Pigeon, MI 48755 1 hour per week Joe Maust, Jr Treasurer -0- -0- -0- 3130 N Caseville Rd , Pigeon, MI 48755 1 hour per week Ali Khan, M D Board Member -0- -0- -0- 9000 Crescent Beach Rd , Pigeon, MI 48755 1 hour per week John Schaefer Board Member -0- -0- -0- 7086 Charles St , Pigeon, MI 48755 1 hour per week Barbara Quinn Board Member -0- -0- -0- 6883 Stephens Dr , Caseville, MI 48725 1 hour per week Paul Clabuesch Board Member -0- -0- -0- 6446 Caseville Rd , Caseville, MI 48725 1 hour per week Denson Smith Board Member -0- -0- -0- 6279 Limerick Rd , Caseville, MI 48725 1 hour per week Janet Rink Board Member -0- -0- -0- 623 E Hickory, Sebewaing, MI 48759 1 hour per week Mike Power Board Member -0- -0- -0- 7050 Ponderosa, Caseville, MI 48725 1 hour per week Dennis Ropp Board Member -0- -0- -0- 5175 Hoffman St , Elkton, MI 48731 1 hour per week Chuck Squires Board Member -0- -0- -0- 55 Auch St, Sebewaing, MI 48759 1 hour per week

l

Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations I I Yes JXJ No

SCHEURER HOSPITAL 38-1456056

SCHEURER HEALTHCARE NETWORK X SCHEURER HOSPITAL X SCHEURER HOSPITAL FOUNDATION X MEDICAL ENTERPRISES X

11

103e MISC RECEIPTS INCIDENTAL TO THE OPERATION OF A HOSPITAL INCLUDING SCRAP SALES, CONSUMER PRODUCT SAFETY COMMISSION, MEDICAL RECORD FEES, GRANTS, LAB DRAW FEES, HEALTH EDUCATION, ETC

FORM 990, PART VI, LINE 80b STATEMENT 10 IDENTIFICATION OF RELATED ORGANIZATIONS

NAME OF ORGANIZATION EXEMPT NONEXEMPT

FORM 990, PART VII, LINE 93 - 103 STA' RELATIONSHIP OF ACTIVITIES TO EXEMPT PURPOSE

93a FEES FROM FURNISHING MEDICAL AND SURGICAL CARE TO SICK, DISEASED, AND INJURED PEOPLE, ALSO, FROM FURNISHING BASIC NURSING SERVICES TO THE AGED

103a TIME OF PAYMENT DISCOUNTS RECEIVED ON SUPPLY AND FOOD PURCHASES WHICH ARE INCIDENTAL TO THE OPERATION OF THE BUSINESS

103c FEES APPLIED ON A PERCENTAGE BASIS TO PATIENT PAY ACCOUNTS RECEIVABLE AT OR OVER 60 DAYS OLD