NORTHERN HEALTH PLAN: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN HEALTH PLAN (EIN 20-1477015)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-13
- IRS object ID
- 202142259349300504
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-13T06:53:23-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382157642 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MANER COSTERISAN PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2425 E GRAND RIVER SUITE 1 | AddressLine1Txt |
| City | LANSING | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 489123291 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201477015 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN HEALTH PLAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 2315477627 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 W GARFIELD | AddressLine1Txt |
| City | CHARLEVOIX | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49720 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID BELLAMY | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 2315477627 | PhoneNum |
| Signature | 2021-03-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES A MC NEELEY CPA | PreparerPersonNm |
| PTIN | P00364811 | PTIN |
| Phone | 5173237500 | PhoneNum |
| Preparation | 2021-03-26 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | DAVID BELLAMY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 W GARFIELD | AddressLine1Txt |
| City | CHARLEVOIX | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49720 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $676,827 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.COMMUNITYHEALTHPLANS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROMOTE, ORGANIZE, MANAGE AND ADMINISTER PROJECTS TO ASSURE COST-EFFECTIVE CARE FOR LOW INCOME PERSONS. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 3 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $490 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,323,660 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $658,213 | CYProgramServiceRevenueAmt |
| PY Investment Income | $44,718 | PYInvestmentIncomeAmt |
| CY Investment Income | -$31,655 | CYInvestmentIncomeAmt |
| PY Other Revenue | $60,500 | PYOtherRevenueAmt |
| CY Other Revenue | $148 | CYOtherRevenueAmt |
| PY Total Revenue | $1,428,878 | PYTotalRevenueAmt |
| CY Total Revenue | $627,196 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,886,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $31,940 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $35,316 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,554,672 | PYOtherExpensesAmt |
| CY Other Expenses | $717,002 | CYOtherExpensesAmt |
| PY Total Expenses | $1,586,612 | PYTotalExpensesAmt |
| CY Total Expenses | $2,638,318 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$157,734 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,011,122 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,248,282 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $237,160 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,011,122 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO FURNISH ORGANIZATIONAL AND OPERATION MANAGEMENT AND PROGRAM DIRECTION FOR PROJECTS DESIGNED TO ALLEVIATE THE COST OF UNCOMPENSATED HEALTH CARE BY HOSPITALS AND OTHER HEALTH PROVIDERS IN THE NORTHERN LOWER PENINSULA OF MICHIGAN. TO DEVELOP AND OPERATE, WITH THE SUPPORT AND COOPERATION OF PRIVATE SECTOR RESOURCES, PUBLIC AND PRIVATE SERVICES AGENCIES AND GOVERNMENTAL BODIES, PROGRAMS TO ENHANCE THE ECONOMIC AND SOCIAL WELL BEING AND TO IMPROVE THE LEVEL OF HEALTH OF THE SERVICE AREA, AND TO INCREASE ACCESS TO HEALTH CARE SERVICES FOR RESIDENTS OF THE SERVICE AREA WHO ARE UNABLE TO PAY FOR HEALTH CARE. TO PROVIDE ADVICE ON METHODS AND PROGRAMS DESIGNED TO DECREASE COSTS ASSOCIATED WITH UNCOMPENSATED HEALTH CARE IN SERVICE AREA, AND TO ACT AS A CLEARINGHOUSE FOR INFORMATION INVOLVED IN PROVIDING HEALTH CARE SERVICES TO PERSONS UNABLE TO PAY FOR SUCH HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,963,709 | ExpenseAmt |
| Grant | $1,886,000 | GrantAmt |
| Revenue | $6,148 | RevenueAmt |
| Desc | TO PROVIDE SUPPORT FOR PROJECTS INTENDED TO REDUCE THE COST OF UNCOMPENSATED CARE IN THE REGION. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $652,213 | ExpenseAmt |
| Revenue | $652,213 | RevenueAmt |
| Desc | THE COMMUNITY HEALTH INNOVATION REGION PROJECT IS AN EFFORT TO HELP THE STATE AND FEDERAL GOVERNMENT IMPLEMENT INNOVATIONS INTENDED TO ADDRESS THE TRIPLE AIM OF BETTER HEALTH, BETTER CARE AND LOWER COST. IT DOES THIS THROUGH PROJECTS INTENDED TO HELP VULNERABLE PEOPLE GET THE RIGHT CARE AT THE RIGHT PLACE AT THE RIGHT TIME AND THROUGH PROJECTS INTENDED TO ADDRESS SOCIAL DETERMINATES OF HEALTH. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $2,615,922 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | Yes (1) | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 3 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY DECKER | PersonNm |
| Phone | 2315477627 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 W GARFIELD | AddressLine1Txt |
| City | CHARLEVOIX | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49720 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| CHRISTINE BAUMGARDNER | ||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MYRNA HOLLAND | ||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |
| ROBERT COURTOIS | ||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CAROL SHAFTO | ||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| LISA PEACOCK | ||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JOHN BRUNING | ||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DAVID BELLAMY | ||||||
| EXECUTIVE DIRECTOR | 8.00 | $2,080 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,080 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HEALTH DEPARTMENT OF NORTHWEST MICHIGAN | |||||
| 220 W GARFIELD | CHARLEVOIX | MI | 49720 | CONTRACTED SERVICES | $281,377 |
| DISTRICT HEALTH DEPT #10 | |||||
| 1049 NEWELL ST PO BOX 850 | WHITE CLOUD | MI | 49349 | CONTRACTED SERVICES | $176,040 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $490 | AllOtherContributionsAmt |
| Total Contributions | $490 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| COMMUNITY HEALTH INNOV | 621300 | $652,213 | $652,213 |
| BREAST HEALTH ASSISTAN | 621300 | $6,000 | $6,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $658,213 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,976 | TotalRevenueColumnAmt |
| Exclusion | $17,976 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $49,631 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$49,631 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$49,631 | TotalRevenueColumnAmt |
| Exclusion | -$49,631 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $148 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $148 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $148 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $627,196 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $658,361 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$31,655 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,886,000 | TotalAmt |
| Program Services | $1,886,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,080 | TotalAmt |
| Program Services | $2,080 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,343 | TotalAmt |
| Program Services | $30,343 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,893 | TotalAmt |
| Program Services | $2,893 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,750 | TotalAmt |
| Management And General | $20,750 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,134 | TotalAmt |
| Program Services | $1,134 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,646 | TotalAmt |
| Management And General | $1,646 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| CONTRACT SERVICES | $676,834 | $676,834 |
| ADMIN. SERVICES/SUPPORT | $8,000 | $8,000 |
| MISCELLANEOUS EXPENSES | $6,159 | $6,159 |
| OTHER SERVICES | $2,479 | $2,479 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,638,318 | TotalAmt |
| Program Services | $2,615,922 | ProgramServicesAmt |
| Management And General | $22,396 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,039,003 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $208,135 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,144 | BOYAmt |
| EOY | $0 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,248,282 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,160 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,160 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,011,122 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,011,122 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,248,282 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,011,122 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,595 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $740,765 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,201,935 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,323,660 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $658,703 | CurrentTaxYearAmt |
| Total | $3,949,658 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $31,560 | CurrentTaxYearMinus4YearsAmt |
| Total | $31,560 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $56,155 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $740,765 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,201,935 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,323,660 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $658,703 | CurrentTaxYearAmt |
| Total | $3,981,218 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $3,981,218 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,016 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $29,353 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $31,265 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $44,718 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $17,976 | CurrentTaxYearAmt |
| Total | $135,328 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,016 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $29,353 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $31,265 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $44,718 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $17,976 | CurrentTaxYearAmt |
| Total | $135,328 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $38,854 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $60,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $148 | CurrentTaxYearAmt |
| Total | $99,502 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $68,171 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $770,118 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,272,054 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,428,878 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $676,827 | CurrentTaxYearAmt |
| Total | $4,216,048 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.94430 | PublicSupportCY509Pct |
| Public Support PY509 | 0.94690 | PublicSupportPY509Pct |
| Investment Income CY | 0.03210 | InvestmentIncomeCYPct |
| Investment Income PY | 0.02880 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| ALCONA CITIZENS FOR HEALTH INC | |||||||
| 1035 W WASHINGTON AVE PO BOX 655 | ALPENA | MI | 49707 | 382170985 | 501(C)(3) | $330,050 | GENERAL SUPPORT |
| DISTRICT HEALTH DEPARTMENT NO 4 | |||||||
| 100 WOODS CIRCLE SUITE 200 | ALPENA | MI | 49721 | 383145897 | PUBLIC HEALTH DEPT. | $10,000 | GENERAL SUPPORT |
| MCLAREN NORTHERN MICHIGAN FOUNDATION | |||||||
| 360 CONNABLE AVENUE | PETOSKEY | MI | 49770 | 382445611 | 501(C)(3) | $330,050 | GENERAL SUPPORT |
| MUNSON HEALTHCARE FOUNDATIONS | |||||||
| 1150 MEDICAL CAMPUS DR | TRAVERSE CITY | MI | 49684 | 382642724 | 501(C)(3) | $330,050 | GENERAL SUPPORT: OTSEGO COUNTY |
| MUNSON HEALTHCARE FOUNDATIONS | |||||||
| 1150 MEDICAL CAMPUS DR | TRAVERSE CITY | MI | 49684 | 382642724 | 501(C)(3) | $330,050 | GENERAL SUPPORT: CHARLEVOIX COUNTY |
| NORTHERN MICHIGAN HEALTH CONSORTIUM | |||||||
| 220 GARLFIELD AVE | CHARLEVOIX | MI | 49720 | 824279556 | 501(C)(3) | $272,900 | GENERAL SUPPORT: FIDUCIARY ON BEHALF OF DISTRICT HEALTH DEPARTMENT NO. 4 |
| NORTHERN MICHIGAN HEALTH CONSORTIUM | |||||||
| 220 GARLFIELD AVE | CHARLEVOIX | MI | 49720 | 824279556 | 501(C)(3) | $282,900 | GENERAL SUPPORT: FIDUCIARY ON BEHALF OF HEALTH DEPARTMENT OF NORTHWEST MICHIGAN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail (5 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| ALCONA CITIZENS FOR HEALTH INC | |||||||||
| CASH | 2020-09-30 | $330,050 | ACTUAL VALUE | 382170985 | 1035 W WASHINGTON AVE PO BOX 655 | ALPENA | MI | 49707 | 501(C)(3) |
| DISTRICT HEALTH DEPT NO 4 | |||||||||
| CASH | 2020-09-30 | $10,000 | ACTUAL VALUE | 383145897 | 100 WOODS CIRCLE SUITE 200 | ALPENA | MI | 49721 | PUBLIC HEALTH DEPT. |
| MCLAREN NORTHERN MICHIGAN FOUNDATION | |||||||||
| CASH | 2020-09-30 | $330,050 | ACTUAL VALUE | 382445611 | 360 CONNABLE AVENUE | PETOSKEY | MI | 49770 | 501(C)(3) |
| MUNSON HEALTHCARE FOUNDATIONS | |||||||||
| CASH | 2020-09-30 | $660,100 | ACTUAL VALUE | 382642724 | 1150 MEDICAL CAMPUS DR | TRAVERSE CITY | MI | 49684 | 501(C)(3) |
| NORTHERN MICHIGAN HEALTH CONSORTIUM | |||||||||
| CASH | 2020-09-30 | $555,800 | ACTUAL VALUE | 824279556 | 220 GARLFIELD AVE | CHARLEVOIX | MI | 49720 | 501(C)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 0 | DirectorOfSuccessorInd |
| Employee Of Successor | 0 | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR, BOARD PRESIDENT, CHIEF FINANCIAL OFFICER, AND ACCOUNTANT FOR ACCURACY. UPON COMPLETION, A REVIEW OF THE 990 IS SCHEDULED FOR THE BOARD OF DIRECTORS. THE PRESENTATION IS CARRIED OUT BY A REPRESENTATIVE FROM THE MANER COSTERISAN CPA FIRM, WHICH PRODUCES THE 990. AFTER QUESTIONS ARE ANSWERED, THE BOARD ACCEPTS THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST STATEMENT IS GIVEN ANNUALLY TO BOARD MEMBERS WHO SIGN A WRITTEN STATEMENT ACKNOWLEDGING THAT THEY HAVE RECEIVED, UNDERSTAND AND AGREE TO ADHERE TO THE POLICY. THERE IS ALSO AN ETHICS COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS. BOARD MEMBERS AND CONTRACTED EMPLOYEES RECEIVE INFORMATION ON HOW TO REPORT POTENTIAL VIOLATIONS OF ETHICAL BEHAVIOR TO THIS COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL INFORMATION IS AVAILABLE UPON REQUEST. FORM 990 IS ALSO POSTED ANNUALLY ON GUIDESTAR'S WEBSITE. THE 990 IS PUBLIC INFORMATION THROUGH THE MICHIGAN ATTORNEY GENERAL'S OFFICE. |