MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (EIN 38-1303843)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-13
- IRS object ID
- 201733179349300728
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-13T07:53:29-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 E Front St Ste 300 | AddressLine1Txt |
| City | Traverse City | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49686 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381303843 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OTSE | BusinessNameControlTxt |
| Phone | 9897312100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER | AddressLine1Txt |
| City | GAYLORD | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49735 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THOMAS LEMON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9897312100 | PhoneNum |
| Signature | 2017-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CAROL LALONDE CPA | PreparerPersonNm |
| PTIN | P00181637 | PTIN |
| Phone | 2319477800 | PhoneNum |
| Preparation | 2017-11-07 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.59.56.32 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-07 | IPDt |
| IP Tm | 12:56:55 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | EBB51160BF2136090E0706D858221EDFD566B897 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | THOMAS LEMON CEO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER | AddressLine1Txt |
| City | GAYLORD | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49735 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $105,302,277 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MYOMH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS AND THE COMMUNITIES WE SERVE BY: WORKING IN PARTNERSHIP WITH AREA PHYSICIANS TO PROVIDE PATIENT-FOCUSED CARE WITH QUALITY AND SERVICE SECOND TO NONE; DELIVERING A FULL CONTINUUM OF ACCESSIBLE CARE THAT ADDRESSES THE COMMUNITIES NEEDS; WORKING TO INCREASE THE PUBLIC'S AWARENESS OF THE BREADTH AND DEPTH OF OTSEGO MEMORIAL HOSPITAL'S SERVICES; MEETING THE PROFESSIONAL NEEDS OF OUR DEDICATED STAFF BY PROVIDING THEM WITH OPPORTUNITIES FOR PROFESSIONAL GROWTH AND EDUCATIONAL DEVELOPMENT; AND REMAINING FISCALLY SOUND. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 857 | TotalEmployeeCnt |
| Total Volunteers | 120 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $160,212 | PYContributionsGrantsAmt |
| CY Contributions Grants | $571,473 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $90,870,515 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $97,810,021 | CYProgramServiceRevenueAmt |
| PY Investment Income | $129,774 | PYInvestmentIncomeAmt |
| CY Investment Income | $478,049 | CYInvestmentIncomeAmt |
| PY Other Revenue | $362,712 | PYOtherRevenueAmt |
| CY Other Revenue | $419,976 | CYOtherRevenueAmt |
| PY Total Revenue | $91,523,213 | PYTotalRevenueAmt |
| CY Total Revenue | $99,279,519 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $54,520,053 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $58,317,495 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $954,353 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $33,061,704 | PYOtherExpensesAmt |
| CY Other Expenses | $34,931,049 | CYOtherExpensesAmt |
| PY Total Expenses | $87,581,757 | PYTotalExpensesAmt |
| CY Total Expenses | $93,248,544 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,941,456 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,030,975 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $65,008,048 | TotalAssetsBOYAmt |
| Total Assets EOY | $70,739,661 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $30,293,266 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $29,382,126 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $34,714,782 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $41,357,535 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS, AND THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $46,097,458 | ExpenseAmt |
| Revenue | $67,888,609 | RevenueAmt |
| Desc | ACUTE INPATIENT AND OUTPATIENT CARE FOR DIAGNOSTIC AND MEDICAL CARE: THERE WERE 83,614 ADMISSIONS FOR MEDICAL SURGICAL (1,371), ICU (327), BIRTHING CENTER (398), AND OUTPATIENT REGISTRATIONS (81,518). | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $25,321,847 | ExpenseAmt |
| Revenue | $26,292,162 | RevenueAmt |
| Desc | PHYSICIAN DIAGNOSTIC OFFICES AND URGENT CARE CLINIC: THERE WERE 167,784 PATIENTS FOR MEDICAL GROUP (84,210), LEWISTON/MONTMORENCY (13,288), URGENT CARE (18,523), INDIAN RIVER (25,604), ORTHOPEDICS (16,396) AND BOYNE VALLEY (7,763). | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,057,421 | ExpenseAmt |
| Revenue | $3,458,345 | RevenueAmt |
| Desc | LONG TERM CARE FOR THE ELDERLY: THIS PAST YEAR THERE WERE 118 ADMISSIONS WITH 11,025 MCREYNOLDS HALL PATIENT DAYS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,868,915 | ExpenseAmt |
| Revenue | $170,905 | RevenueAmt |
| Desc | ALL OTHER PROGRAM SERVICES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,868,915 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $170,905 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $77,345,641 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 857 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMY BILYEA CONTROLLER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9897312100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER AVE | AddressLine1Txt |
| City | GAYLORD | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49735 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DR BECKY ASHLEY | |||||||||
| DIRECTOR | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID BRINEY | |||||||||
| DIRECTOR | 0.20 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| CHRISTOPHER COLLINS | |||||||||
| DIRECTOR-VICE PRESIDENT | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| KEVIN REYNOLDS | |||||||||
| DIRECTOR | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY SANDERS | |||||||||
| DIRECTORS-PRESIDENT | 0.20 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DR STEVEN SELLA | |||||||||
| DIRECTOR | 0.20 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| DONALD SKLARCZYK | |||||||||
| DIRECTOR-SECRETARY | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DANIEL SMITH | |||||||||
| DIRECTOR-TREASURER | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DR KEVIN SMITH | |||||||||
| DIRECTOR-CHIEF OF STAFF | 40.00 | 0.00 | Yes (X) | $342,015 | $0 | $5,300 | |||
| MARCUS WEGMEYER | |||||||||
| DIRECTOR-TREASURER | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| CAROLYN STUDY | |||||||||
| DIRECTOR-SECRETARY PARTIAL YEAR | 0.20 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| THOMAS LEMON | |||||||||
| PRESIDENT & CEO | 39.50 | 0.50 | $392,750 | $0 | $23,300 | Yes (X) | |||
| ROBERT COURTOIS | |||||||||
| VP OF FINANCE / CFO | 39.50 | 0.50 | $230,650 | $0 | $23,300 | Yes (X) | |||
| DIANE FISHER | |||||||||
| VP OF PATIENT CARE SERVICES | 40.00 | 0.00 | $189,987 | $0 | $3,204 | Yes (X) | |||
| BARBARA MILLER | |||||||||
| VP OF PHYSICIAN SERVICES | 40.00 | 0.00 | $192,674 | $0 | $5,300 | Yes (X) | |||
| CHRISTOPHER SQUIRE | |||||||||
| VP OF PROFESSIONAL & ANCILLARY SERVI | 40.00 | 0.00 | $164,187 | $0 | $3,317 | Yes (X) | |||
| JAMES FLICKEMAA | |||||||||
| VP OF MARKET DEVELOPMENT | 40.00 | 0.00 | $160,903 | $0 | $5,300 | Yes (X) | |||
| DR JOHN MOFFATT | |||||||||
| GENERAL SURGEON | 40.00 | 0.00 | $932,121 | $0 | $5,300 | Yes (X) | |||
| DR CHANGXIN LI | |||||||||
| INTERNAL MEDICINE PHYSICIAN | 40.00 | 0.00 | $903,250 | $0 | $5,300 | Yes (X) | |||
| DR MATTHEW MAZUR | |||||||||
| INTERNAL MEDICINE PHYSICIAN | 40.00 | 0.00 | $619,331 | $0 | $22,809 | Yes (X) | |||
| DR LOUIS HABRYL | |||||||||
| ORTHOPEDIC SURGEON | 40.00 | 0.00 | $558,272 | $0 | $5,300 | Yes (X) | |||
| DR JAMES SHURLOW | |||||||||
| GENERAL SURGEON | 40.00 | 0.00 | $528,876 | $0 | $23,300 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,215,016 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $131,030 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 70 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BURDCO | |||||
| 1222 VETERANS | TRAVERSE CITY | MI | 49684 | CONSTRUCTION | $1,305,988 |
| GE MEDICAL SYSTEMS INFO TECH | |||||
| 5517 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | MED EQUIP SERVICES | $698,228 |
| MUNSON MEDICAL | |||||
| PO BOX 1188 | TRAVERSE CITY | MI | 49684 | SERVICES | $572,884 |
| MAYO COLLABORATIVE SERVICES | |||||
| PO BOX 9146 | MINNEAPOLIS | MN | 55480 | DIAGNOSTIC SERVICE | $476,569 |
| GREENWAY HEALTH | |||||
| PO BOX 203658 | DALLAS | TX | 75320 | SOFTWARE SERVICES | $472,287 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 24 | CntrctRcvdGreaterThan100KCnt |
| Membership Dues | $3,517 | MembershipDuesAmt |
| Related Organizations | $448,771 | RelatedOrganizationsAmt |
| Government Grants | $9,377 | GovernmentGrantsAmt |
| All Other Contributions | $109,808 | AllOtherContributionsAmt |
| Total Contributions | $571,473 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 622110 | $96,055,066 | $96,055,066 |
| OTHER RELATED REVENUE | 622110 | $1,214,699 | $1,214,699 |
| EHR REVENUE | 622110 | $540,256 | $540,256 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $97,810,021 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $500,796 | TotalRevenueColumnAmt |
| Exclusion | $500,796 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $191,054 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $38,970 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $152,084 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $152,084 | TotalRevenueColumnAmt |
| Exclusion | $152,084 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,455,706 | SecuritiesAmt |
| Other | $1,505,335 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,266,017 | SecuritiesAmt |
| Other | $1,717,771 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $189,689 | SecuritiesAmt |
| Other | -$212,436 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$22,747 | TotalRevenueColumnAmt |
| Exclusion | -$22,747 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA REVENUE | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $267,892 | TotalRevenueColumnAmt |
| Exclusion | $267,892 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $267,892 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $99,279,519 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $97,810,021 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $898,025 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,361,342 | TotalAmt |
| Program Services | $738,480 | ProgramServicesAmt |
| Management And General | $622,862 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,604,750 | TotalAmt |
| Program Services | $38,404,323 | ProgramServicesAmt |
| Management And General | $5,941,213 | ManagementAndGeneralAmt |
| Fundraising | $259,214 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,377,248 | TotalAmt |
| Program Services | $1,173,936 | ProgramServicesAmt |
| Management And General | $195,535 | ManagementAndGeneralAmt |
| Fundraising | $7,777 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,122,971 | TotalAmt |
| Program Services | $6,959,874 | ProgramServicesAmt |
| Management And General | $1,116,934 | ManagementAndGeneralAmt |
| Fundraising | $46,163 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,851,184 | TotalAmt |
| Program Services | $2,430,286 | ProgramServicesAmt |
| Management And General | $404,798 | ManagementAndGeneralAmt |
| Fundraising | $16,100 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $259,154 | TotalAmt |
| Management And General | $259,154 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,501 | TotalAmt |
| Management And General | $174,501 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,751 | TotalAmt |
| Management And General | $4,751 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,002 | TotalAmt |
| Management And General | $107,002 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,293,158 | TotalAmt |
| Program Services | $3,227,932 | ProgramServicesAmt |
| Management And General | $1,712,045 | ManagementAndGeneralAmt |
| Fundraising | $353,181 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,903 | TotalAmt |
| Management And General | $13,232 | ManagementAndGeneralAmt |
| Fundraising | $64,671 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $718,606 | TotalAmt |
| Program Services | $355,883 | ProgramServicesAmt |
| Management And General | $311,488 | ManagementAndGeneralAmt |
| Fundraising | $51,235 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $275,077 | TotalAmt |
| Program Services | $136,166 | ProgramServicesAmt |
| Management And General | $135,725 | ManagementAndGeneralAmt |
| Fundraising | $3,186 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,799,789 | TotalAmt |
| Program Services | $582,990 | ProgramServicesAmt |
| Management And General | $1,216,799 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,408 | TotalAmt |
| Program Services | $97,204 | ProgramServicesAmt |
| Management And General | $56,070 | ManagementAndGeneralAmt |
| Fundraising | $5,134 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,444 | TotalAmt |
| Program Services | $73,374 | ProgramServicesAmt |
| Management And General | $52,392 | ManagementAndGeneralAmt |
| Fundraising | $5,678 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $526,362 | TotalAmt |
| Program Services | $393,525 | ProgramServicesAmt |
| Management And General | $131,385 | ManagementAndGeneralAmt |
| Fundraising | $1,452 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,903,799 | TotalAmt |
| Program Services | $2,170,970 | ProgramServicesAmt |
| Management And General | $724,817 | ManagementAndGeneralAmt |
| Fundraising | $8,012 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $873,572 | TotalAmt |
| Program Services | $139,368 | ProgramServicesAmt |
| Management And General | $734,204 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $14,310,576 | $14,103,940 | $204,488 | $2,148 |
| PROVISION FOR BAD DEBT | $2,771,295 | $2,771,295 | ||
| REPAIRS AND MAINTENANCE | $2,004,977 | $1,398,155 | $593,406 | $13,416 |
| QUALITY ASSESSMENT FEES | $1,631,848 | $1,631,848 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $908,827 | TotalAmt |
| Program Services | $556,092 | ProgramServicesAmt |
| Management And General | $235,749 | ManagementAndGeneralAmt |
| Fundraising | $116,986 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,248,544 | TotalAmt |
| Program Services | $77,345,641 | ProgramServicesAmt |
| Management And General | $14,948,550 | ManagementAndGeneralAmt |
| Fundraising | $954,353 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,633,310 | BOYAmt |
| EOY | $2,390,635 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,935 | BOYAmt |
| EOY | $1,281,424 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,231,822 | BOYAmt |
| EOY | $6,929,334 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,339,443 | BOYAmt |
| EOY | $1,376,738 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,836,927 | BOYAmt |
| EOY | $3,295,815 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $65,123,216 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,408,140 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,165,863 | BOYAmt |
| EOY | $33,715,076 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,584,507 | BOYAmt |
| EOY | $16,756,845 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,803,241 | BOYAmt |
| EOY | $1,931,661 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,375,000 | BOYAmt |
| EOY | $3,062,133 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,008,048 | BOYAmt |
| EOY | $70,739,661 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,857,772 | BOYAmt |
| EOY | $10,566,456 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $185,506 | BOYAmt |
| EOY | $185,508 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,192,875 | BOYAmt |
| EOY | $16,686,413 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,057,113 | BOYAmt |
| EOY | $1,943,749 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,293,266 | BOYAmt |
| EOY | $29,382,126 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,685,605 | BOYAmt |
| EOY | $41,052,403 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,177 | BOYAmt |
| EOY | $305,132 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,714,782 | BOYAmt |
| EOY | $41,357,535 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,008,048 | BOYAmt |
| EOY | $70,739,661 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $6,030,975 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $611,778 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,751 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,751 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | SUPPORTED LOBBYING ACTIVITIES THROUGH ANNUAL DUES PAID TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,455,291 | OtherCostOrOtherBasisAmt |
| Book Value | $1,455,291 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,880,985 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,567,411 | DepreciationAmt |
| Book Value | $22,313,574 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,015,366 | OtherCostOrOtherBasisAmt |
| Depreciation | $311,728 | DepreciationAmt |
| Book Value | $703,638 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,328,707 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,529,001 | DepreciationAmt |
| Book Value | $8,799,706 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $442,867 | OtherCostOrOtherBasisAmt |
| Book Value | $442,867 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $33,715,076 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | COST REPORT SETTLEMENT PAYABLE | Desc |
| Amt | $1,943,749 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,943,749 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 1286 | PersonsServedCnt |
| Total Community Benefit Expns | $262,182 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $262,182 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 34091 | PersonsServedCnt |
| Total Community Benefit Expns | $16,058,812 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,129,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,928,907 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04340 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 35377 | PersonsServedCnt |
| Total Community Benefit Expns | $16,320,994 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,129,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,191,089 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04630 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1105 | ActivitiesOrProgramsCnt |
| Persons Served | 55453 | PersonsServedCnt |
| Total Community Benefit Expns | $392,894 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,248 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $385,646 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 165784 | PersonsServedCnt |
| Total Community Benefit Expns | $19,503,161 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,939,136 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $564,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00620 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 18 | ActivitiesOrProgramsCnt |
| Persons Served | 105 | PersonsServedCnt |
| Total Community Benefit Expns | $25,687 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,687 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1129 | ActivitiesOrProgramsCnt |
| Persons Served | 221342 | PersonsServedCnt |
| Total Community Benefit Expns | $19,921,742 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,946,384 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $975,358 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1131 | ActivitiesOrProgramsCnt |
| Persons Served | 256719 | PersonsServedCnt |
| Total Community Benefit Expns | $36,242,736 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $31,076,289 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,166,447 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05710 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $5,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $484 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $484 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 119 | ActivitiesOrProgramsCnt |
| Persons Served | 100 | PersonsServedCnt |
| Total Community Benefit Expns | $45,401 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,401 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $51 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $51 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 10 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $395,889 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $395,889 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 135 | ActivitiesOrProgramsCnt |
| Persons Served | 100 | PersonsServedCnt |
| Total Community Benefit Expns | $446,825 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $446,825 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,771,296 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $914,528 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $22,083,632 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $20,582,120 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,501,512 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER AVE | AddressLine1Txt |
| City | GAYLORD | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49735 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MYOMH.ORG | WebsiteAddressTxt |
| State License | 1060000063 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | long-term care FACILITY AND PHYSICIAN CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PAGE 8, PART V | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.myomh.org/community-needs-assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.myomh.org/patient-visitor-guide/payment-financing/financial-ass | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.myomh.org/patient-visitor-guide/payment-financing/financial-ass | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.myomh.org/patient-visitor-guide/payment-financing/financial-ass | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OTSEGO MEMORIAL HOSPITAL ASSOCIATION | Part V, Section B, Line 5: IN CONDUCTING THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, OTSEGO MEMORIAL HOSPITAL, IN CONJUNCTION WITH ITS PARTNERING HOSPITALS, CONDUCTED A DAYLONG SESSION WITH HEALTH PROFESSIONALS AND SECTOR REPRESENTATIVES IN LATE DECEMBER 2015. ADDITIONALLY, MORE THAN 1,200 INDIVIDUALS PARTICPATED IN SURVEYS AND/OR FOCUS GROUPS THROUGHOUT NORTHERN MICHIGAN IN 2015 FOR THE REGIONAL COMMUNITY HEALTH ASSESSMENT. ABOUT 1,100 RESIDENTS COMPLETED A "WHAT MATTERS TO YOU" SURVEY, INCLUDING 445 RESIDENTS FROM ANTRIM, CHEOYGAN, OTSEGO AND MONTMORENCY COUNTIES. MORE THAN 122 PHYSCIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS COMPLETED A "HEALTH CARE PROVIDER" SURVEY. ADDITIONALLY, EXTRA EFFORT WAS MADE TO REACH LOW-INCOME RESIDENTS, MINORITIES, AND THE UNINSURED. THE COMMUNITY MEETINGS WERE HELD MOSTLY AT HEALTH DEPARTMENT OFFICES AND MARKETED THROUGH EXISTING SOCIAL SERVICE ORGANIZATIONS WORKING WITH THOSE POPULATIONS. A COMBINED TOTAL OF 74 PARTICIPANTS TOOK PART IN THE FOUR COMMUNITY CONVERSATIONS HELD IN CHEBOYGAN, MONTMORENCY, ANTRIM, AND OTSEGO COUNTIES. IN ADDITION TO THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, CHARLEVOIX AREA HOSPITAL, AND MCLAREN NORTHERN MICHIGAN HOSPITAL, ALL PARTNERED WITH OTSEGO MEMORIAL HOSPITAL IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT COMMITTEE INCLUDED REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: OTSEGO COUNTY MSU EXTENSION, ALCONA HEALTH CENTER, HEALTH DEPT OF NW MICHIGAN, OTSEGO MEMORIAL HOSPITAL, COP EDUCATION SERVICE DISTRICT, CHARLEVOIX AREA HOSPITAL, NORTH COUNTY CMH SERVICES, MCLAREN NORTHERN MICHIGAN, THUNDER BAY COMMUNITY HEALTH SERVICE, WOMEN'S RESOURCE CENTER, HARBOR HALL, NE MICHIGAN CMH AUTHORITY, CHAR-EM UNITED WAY, EAST JORDAN FAMILY HEALTH CENTER, DISTRICT HEALTH DEPT #4, NORTHERN HEALTH PLAN, MUNSON MEDICAL CENTER, NORTHERN MICHIGAN REGIONAL ENTITY, ALPENA REGIONAL MEDICAL CENTER, MSU COLLEGE OF HUMAN MEDICINE, AND NORTHERN MICHIGAN SUBSTANCE ABUSE SERVICES.ADDITIONAL INFORMATION CAN BE FOUND IN THE COMMUNITY HEALTH NEEDS ASSESSMENT LOCATED AT THE FOLLOWING WEBSITE: HTTP://WWW.MYOMH.ORG/COMMUNITY-NEEDS-ASSESSMENT. |
| OTSEGO MEMORIAL HOSPITAL ASSOCIATION | Part V, Section B, Line 6a: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING OTHER HOSPITAL FACILITIES - CHARLEVOIX AREA HOSPITAL AND MCLAREN NORTHERN MICHIGAN. |
| OTSEGO MEMORIAL HOSPITAL ASSOCIATION | Part V, Section B, Line 6b: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING OTHER NON-HOSPITAL ORGANIZATIONS - HEALTH DEPARTMENT OF NORTH WEST MICHIGAN, AND DISTRICT HEALTH DEPARTMENT #4. |
| OTSEGO MEMORIAL HOSPITAL ASSOCIATION | Part V, Section B, Line 11: FROM THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, THE TOP THREE AREAS OF HEALTH CONCERN IDENTIFIED ARE: EXPANDING ACCESS TO CARE, CHRONIC DISEASE EDUCATION AND MANAGEMENT, AND MATERNAL AND CHILD HEALTH AND WELLNESS ACTIVITIES. FOR ALL THREE AREAS OTSEGO MEMORIAL HOSPITAL BELIEVES THEY COULD DIRECT RESOURCES TO HELP ADDRESS THE GROWING HEALTH CONCERN. REGARDING ACCESS TO CARE, OTSEGO MEMORIAL HOSPITAL IS WORKING TO EXPAND SERVICES IN RURAL COMMUNITIES, OFFER ONSITE SCREENINGS AND EXPANDING OFFERINGS FOR SERVICES AT LOCAL HEALTH FAIRS, AND SIGNING INDIVIDUALS UP FOR INSURANCE BY EMPLOYING A CERTIFIED APPLICATION COUNSELOR. FOR CHRONIC DISEASE, OTSEGO MEMORIAL HOSPITAL IS COMMITTED TO OFFERING AND EXPANDING A CDC DIABETES PREVENTION PROGRAM, DOUBLING THE NUMBER OF CLASSES OFFERED. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO EDUCATE THE COMMUNITY ON IMPORTANT CHRONIC DISEASE TOPICS SUCH AS CANCER, HEART HEALTH, AND DIABETES THROUGH PRINT AND SPEAKING EVENTS. FOR MATERNAL AND CHILD HEALTH, OTSEGO MEMORIAL HOSPITAL IS EXPANDING OFFERINGS IN THE LOCAL SCHOOLS, INCLUDING A 6 WEEK HEALTH PROGRAM FOR ELEMENTARY STUDENTS. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO OFFER CLASSES TO NEW PARENTS, WILL EXPLORE OFFERING A HEALTH LIFESTYLES CLASS FOR FAMILIES--WORKING TO REDUCE OBESITY AND INCREASE HEALTH EATING AND ACTIVITY LEVELS FOR YOUTH IN THE COUNTIES SERVED BY OTSEGO MEMORIAL HOSPITAL. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO OFFER OB/GYN SERVICES IN INDIAN RIVER, AND WILL WORK TO EDUCATE COMMUNITY MEMBERS ON SERVICES OFFERED FOR MOTHER AND CHILD IN THIS VERY RURAL SETTING. OTHER NEEDS IDENTIFIED IN THE MOST RECENT CHNA INCLUDE: SUBSTANCE USE, MENTAL HEALTH AND HEALTH DISPARITIES. THESE ISSUES RANKED 4-6 IN THE CHNA. OTSEGO MEMORIAL HOSPITAL FEELS THAT BASED ON AVAILBLE RESOURCES AND EXPERTISE OF STAFF, THE TOP THREE ISSUES CAN BE BEST ADDRESSED BY THE HOSPITAL. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - OMH MEDICAL GROUP GAYLORD | ||||
| 829 N CENTER AVENUE | GAYLORD | MI | 49735 | OUTPATIENT CLINIC |
| 2 - MEDCARE CLINIC | ||||
| 1996 WALDEN DRIVE | GAYLORD | MI | 49735 | WALK-IN AND OUTPATIENT CLINIC |
| 3 - NORTHOPEDICS CLINIC | ||||
| 2147 PROFESSIONAL DRIVE | GAYLORD | MI | 49735 | OUTPATIENT CLINIC |
| 4 - MCREYNOLDS HALL | ||||
| 825 N CENTER AVENUE | GAYLORD | MI | 49735 | LONG-TERM CARE |
| 5 - LEWISTON CLINIC | ||||
| 3040 BOURN STREET | LEWISTON | MI | 49756 | WALK-IN AND OUTPATIENT CLINIC |
| 6 - INDIAN RIVER CLINIC | ||||
| 3696 SOUTH STRAITS HWY | INDIAN RIVER | MI | 49749 | WALK-IN AND OUTPATIENT CLINIC |
| 7 - BOYNE VALLEY CLINIC | ||||
| 2572 NORTH US-131 | ELMIRA | MI | 49730 | WALK-IN AND OUTPATIENT CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | UNDER ITS ASSISTANCE PROGRAM, OTSEGO MEMORIAL HOSPITAL WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED OR REDUCED PRICE SERVICES TO PERSONS ELIGIBLE UNDER APPLICABLE GUIDELINES. OTSEGO MEMORIAL HOSPITAL'S ASSISTANCE PROGRAM SERVICES ARE NOT LIMITED TO ANY SPECIFIC HOSPITAL SERVICE. INDIVIDUAL ELIGIBILITY FOR ASSISTANCE IS DETERMINED BY MEASURING FAMILY INCOME IN RELATION TO FAMILY SIZE AGAINST THE INCOME POVERTY GUIDELINE ESTABLISHED BY THE COMMUNITY SERVICE ADMINISTRATION. IF THE HOSPITAL DETERMINES THAT SERVICES ARE NOT MEDICALLY NECESSARY, ELECTIVE OR OTHERWISE, THE HOSPITAL CAN DENY SERVICES UNDER THE FINANCIAL ASSISTANCE PROGRAM. ASSETS INCLUDING THE PATIENT'S PLACE OF RESIDENCE ARE ALSO CONSIDERED AS PART OF THE EVALUATION. |
| Part I, Line 7: | A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E), HEALTH PROFESSIONS EDUCATION (LINE 7F), SUBSIDIZED HEALTH SERVICES (LINE 7G) AND CASH AND IN-KIND CONTRIBUTIONS (LINE 7I). |
| Part I, Line 7g: | ALL PHYSICIAN CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES. THE COST REPORTED ON PAGE 1, LINE 7G OF $19,503,161 IS FOR THESE PHYSICIAN CLINICS. |
| Part I, Ln 7 Col(f): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $2,771,296. |
| Part II, Community Building Activities: | OTSEGO MEMORIAL HOSPITAL IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. OTSEGO MEMORIAL HOSPITAL STAFF REPRESENT OTSEGO MEMORIAL HOSPITAL ON A VARIETY OF COMMITTEES AND COMMUNITY BOARDS IN WHICH OTSEGO MEMORIAL HOSPITAL OFFERS ASSISTANCE THROUGH STAFF, FACILITIES, AND RESOURCES WITH THE END GOAL OF WORKING TO ADDRESS COMMUNITY ISSUES RELATED TO HEALTH IMPROVEMENT, EDUCATION, POVERTY, WORKFORCE DEVELOPMENT AND ACCESS TO CARE. WE ALSO ENCOURAGE OUR EMPLOYEES TO SERVE IN THE COMMUNITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. AND, WE WORK WITH NEIGHBORHOOD PROGRAMS, INCLUDING PUBLIC AND PRIVATE LOCAL SCHOOLS, OTSEGO COUNTY COMMISSION ON AGING, WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. |
| Part III, Line 4: | ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST 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 ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. |
| Part III, Line 8: | THE FOLLOWING COSTING METHOD OF COST TO CHARGE RATE IS USED; MEDICARE COSTS DIVIDED BY MEDICARE CHARGES. ANY SHORTFALLS CALCULATED ARE CONSIDERED TO BE COMMUNITY BENEFIT. |
| Part III, Line 9b: | ALL PATIENTS RECEIVING TREATMENT AT OTSEGO MEMORIAL HOSPITAL (INCLUDING CHARITY CARE PATIENTS) ARE RESPONSIBLE FOR PAYING IN FULL ALL CHARGES FOR SUCH TREATMENT, LESS ANY AMOUNTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, DISCOUNT CONSIDERATIONS OR INSURANCE COVERAGE, PER POINT OF SERVICE COLLECTION POLICY. |
| Part VI, Line 2: | OTSEGO MEMORIAL HOSPITAL CONDUCTED AN EXTENSIVE AND COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSEMENT THROUGHOUT 2015 AND COMPLETED A COMMUNITY HEALTH IMPROVEMENT ACTION PLAN WHICH WAS ADOPTED BY THE HOSPITAL BOARD OF DIRECTORS IN APRIL 2016. THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED MULTIPLE COMMUNITY FOCUS GROUPS, ONLINE SURVEYS, AND A PRIORITIZATION MEETING AIMED TO IDENTIFY THE TOP HEALTH CONCERNS FOR THE COMMUNITIES BEING SERVED BY OTSEGO MEMORIAL HOPSITAL. IN ADDITION, OTSEGO MEMORIAL HOSPITAL USES INPUT FROM PHYSICIANS, MEDICAL PROVIDERS, AND COMMUNITY MEMBERS TO ASSIST IN ITS ASSESSMENT AND PRIORITIZATION OF THE COMMUNITIES' HEALTHCARE NEEDS. OTSEGO MEMORIAL HOSPITAL WORKS IN COLLABORATION WITH VARIOUS COMMUNITY GROUPS INCLUDING BUT NOT LIMITED TO: THE HEALTH DEPARTMENT, NORTHERN HEALTH PLAN, UNITED WAY, OTSEGO COUNTY COMMISSION ON AGING, OTSEGO AREA CHAMBER OF COMMERCE, AND OTHER LOCAL ASSOCIATIONS IN ORDER TO CONTINUE TO UNDERSTAND THE LOCAL HEALTHCARE NEEDS OF OUR SERVICE AREA. |
| Part VI, Line 3: | THE OTSEGO MEMORIAL HOSPITAL REGISTRATION MANAGER OR THE CERTIFIED APPLICATION COUNSELOR (CAC) ATTEMPTS TO SEE THE PATIENTS IN EMERGENCY ROOM OR AT REGISTRATION. REGISTRATION STAFF HAVE ALSO BEEN TRAINED TO HAND OUT ASSISTANCE PACKAGES AND TO DIRECT PATIENTS TO SEE THE CERTIFIED APPLICATION COUNSELOR (CAC) OR FINANCIAL ADVISOR. WHEN THE PATIENT COMES IN ON THE WORK LIST THEY ARE ALSO INFORMED OF THE ASSISTANCE PACKAGE AND/OR APPLICATION. THE FORM IS ALSO ON THE OTSEGO MEMORIAL HOSPITAL WEBSITE. THERE ARE ALSO WRITTEN NOTICES AT THE BOTTOM OF THE PATIENT STATEMENTS. WHEN THERE IS A SCHEDULED PROCEDURE AND THE PATIENT DOES NOT HAVE INSURANCE, A CALL IS MADE FOR PAYMENT, CAC APPOINTMENT, OR CHARITY CARE ARRANGEMENTS. PATIENTS IDENTIFIED WITHOUT INSURANCE OR NEEDING FINANCIAL EDUCATION, ARE SCHEDULED FOR AN APPOINTMENT WITH THE CERTIFIED APPLICATION COUNSELOR (CAC). THE CAC HELPS PATIENTS TO APPLY FOR MEDICAID, INSURANCE EXCHANGE PLANS, OTHER PROGRAMS OR FINANCIAL ASSISTANCE. |
| Part VI, Line 4: | Otsego Memorial Hospital is located in Gaylord, MI and serves the counties of Cheboygan, Otsego, and Montmorency. All three counties served by OMH are extremely rural. In Otsego, Cheboygan, Montmorency, and Antrim Counties, 95% of residents are non-Hispanic white. Hispanics represent the second largest minority group in Otsego (1.5%) and Montmorency (1.2%) Counties while Native Americans represent the second largest minority group in Cheboygan County with 3.1%. The Hispanic population represents the third largest minority group of all three counties with 1.5% in Otsego and 1.2% in Cheboygan and Montmorency Counties respectively. At 18.9%, older adults represent a larger proportion of the population in Otsego county than they do statewide (15%), 23.9% percent of Cheboygan County's population is age 65 and older followed closely by Antrim County with 24.7% and in Montmorency County, seniors represent an even larger share at 29.2%. (Source: countyhealthrankings.org). OMH serves a very rural aging population. |
| Part VI, Line 5: | Otsego Memorial Hospital (OMH) offers a variety of programs and services with the end goal of promoting the greater health of the community. OMH provided discounted sports physicals to area student athletes, donating one hundred percent of the proceeds back to the local school athletic departments. The hospital participates in a variety of local health events, including offering free health screenings to participants; screenings included blood pressure, pulmonary, BMI, height and weight. Additionally, the hospital offered discounted full lipid profile screenings to more than 500 participants at a Senior Expo. OMH hosts monthly Wellness Wednesdays, offering cholesterol, blood pressure, BMI, height, weight at a discounted rate to community members and free to anyone who is unable to pay the nominal rate. The hospital offers a mammography assistance program, to ensure that women who do not qualify for a free mammogram through the local health department, yet have no means to pay for it privately, are covered and receive a screening and if necessary diagnostic mammogram and other services at no charge. Additionally, the hospital offers a Diabetes Assistance Program and an Oncology Assistance Program designed to help those diagnosed with those diseases and struggling financially to received the assistance they need to attend treatments and test regularly for diabetes. In 2014 OMH began offering the CDC's year long Diabetes Prevention Program, working with individuals who have been diagnosed as pre diabetic to reduce calorie intake, increase exercise, and understand portion control among others. This program has seen a high success rate of completion and BMI reduction. Currently the program is working toward being the only recognized program in northern Michigan. OMH also works closely with the local schools to assist the high school level Medical Occupational Program in job shadowing and education program for students throughout the facility and school year. New parents are invited to participate in childbirth education classes offered by OMH staff for a nominal fee or free to those unable to pay. On a quarterly basis the hospital produces and distributes to more than 44,000 households throughout the service area literature on various healthcare issues and topics, including information on local free health events. OMH has numerous medical practices that are federally qualified rural healthcare clinics, as well as OMH is located within a health professional shortage area. Both of these qualifications demonstrate OMH's isolated service area which has resulted in challenging physician recruitment and retention. OMH's commitment to providing the highest level of care starts with physician and other providers. Extensive recruitment activities must take place in order to provide care to these health professional shortage areas. Additionally, OMH is working diligently to bring services into the rural setting. This includes opening the newly built OMH Medical Group-Indian River, which not only expanded testing services, but brought full time OB/GYN and Pediatric services to that rural area (note: this clinic is a federally qualified rural health center) (1). A majority of the hospital's board of trustees is made up of community representatives residing within the hospital's service area. (2). The organization extends medical staff privileges to all qualified physicians as approved by our hospital board of directors. Due to the size and rural nature of the hospital service area, not all healthcare specialties are offered through the hospital. (3). The hospital applies surplus funds, including donations from the foundation, to assist in purchasing equipment for patient use and funding many of the community health education programs listed above. Additionally, the hospital works to use any surplus funds to continue to advance the mission of the organization through growth and development opportunities. |
| Part VI, Line 6: | Otsego Memorial Hospital has an affiliation agreement with Munson Medical Center where they cooperate in providing health care services to the community. Included in the affiliation agreement are various purchased services such as: information technology, laundry, physician recruitment assistance, reimbursement support, management development, mobile imaging, etc. Also included in the affiliation agreement are collaboration on various initiatives, such as: ICD-10 implementation, HIPAA Compliance, Reimbursement modeling strategic planning, CEO and other forums, education, consulting, etc. OMH works with Munson Medical Center to offer cardiology and sleep lab services in Otsego County. |
| Part VI, Line 7, Reports Filed With States | MI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR KEVIN SMITH | ||||||||||||||
| DIRECTOR-CHIEF OF STAFF | $335,637 | $0 | $0 | $0 | $6,378 | $0 | $0 | $0 | $5,300 | $0 | $347,315 | $0 | $0 | $0 |
| THOMAS LEMON | ||||||||||||||
| PRESIDENT & CEO | $368,681 | $0 | $0 | $0 | $24,069 | $0 | $18,000 | $0 | $5,300 | $0 | $416,050 | $0 | $0 | $0 |
| ROBERT COURTOIS | ||||||||||||||
| VP OF FINANCE / CFO | $206,581 | $0 | $0 | $0 | $24,069 | $0 | $18,000 | $0 | $5,300 | $0 | $253,950 | $0 | $0 | $0 |
| DIANE FISHER | ||||||||||||||
| VP OF PATIENT CARE SERVICES | $165,918 | $0 | $0 | $0 | $24,069 | $0 | $0 | $0 | $3,204 | $0 | $193,191 | $0 | $0 | $0 |
| BARBARA MILLER | ||||||||||||||
| VP OF PHYSICIAN SERVICES | $176,837 | $0 | $0 | $0 | $15,837 | $0 | $0 | $0 | $5,300 | $0 | $197,974 | $0 | $0 | $0 |
| CHRISTOPHER SQUIRE | ||||||||||||||
| VP OF PROFESSIONAL & ANCILLARY SERVI | $154,317 | $0 | $0 | $0 | $9,870 | $0 | $0 | $0 | $3,317 | $0 | $167,504 | $0 | $0 | $0 |
| JAMES FLICKEMAA | ||||||||||||||
| VP OF MARKET DEVELOPMENT | $152,796 | $0 | $0 | $0 | $8,107 | $0 | $0 | $0 | $5,300 | $0 | $166,203 | $0 | $0 | $0 |
| DR JOHN MOFFATT | ||||||||||||||
| GENERAL SURGEON | $908,052 | $0 | $0 | $0 | $24,069 | $0 | $0 | $0 | $5,300 | $0 | $937,421 | $0 | $0 | $0 |
| DR CHANGXIN LI | ||||||||||||||
| INTERNAL MEDICINE PHYSICIAN | $879,250 | $0 | $0 | $0 | $24,000 | $0 | $0 | $0 | $5,300 | $0 | $908,550 | $0 | $0 | $0 |
| DR MATTHEW MAZUR | ||||||||||||||
| INTERNAL MEDICINE PHYSICIAN | $601,262 | $0 | $0 | $0 | $18,069 | $0 | $17,509 | $0 | $5,300 | $0 | $642,140 | $0 | $0 | $0 |
| DR LOUIS HABRYL | ||||||||||||||
| ORTHOPEDIC SURGEON | $536,310 | $0 | $0 | $0 | $21,962 | $0 | $0 | $0 | $5,300 | $0 | $563,572 | $0 | $0 | $0 |
| DR JAMES SHURLOW | ||||||||||||||
| GENERAL SURGEON | $510,807 | $0 | $0 | $0 | $18,069 | $0 | $18,000 | $0 | $5,300 | $0 | $552,176 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| COUNTY OF OTSEGO HOSPITAL FINANCE | ||||||||
| A | 386004882 | 689065AA8 | 2013-10-31 | $10,000,000 | REFINANCE | 0 | 0 | 0 |
| CITY OF GAYLORD HOSPITAL | ||||||||
| B | 383635769 | 368175AA8 | 2013-10-31 | $6,095,324 | REFINANCE | 0 | 0 | 0 |
| CITY OF GAYLORD HOSPITAL | ||||||||
| C | 383635769 | 368175AB1 | 2013-10-31 | $1,885,925 | REFINANCE | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Other Spent ProceedsOtherSpentProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $10,000,000 | $10,000,000 | $9,795,755 | $200,000 | $4,245 | 2013 | 0 | Yes (1) | Yes (1) | Yes (1) | |
| B | $6,095,324 | $6,095,324 | $6,095,324 | 2013 | 0 | Yes (1) | Yes (1) | Yes (1) | |||
| C | $1,764,677 | $1,885,925 | $1,721,661 | 2013 | 0 | Yes (1) | Yes (1) | Yes (1) | $164,264 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | Yes (1) | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | Yes (1) | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | Yes (1) | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| C | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | THE ORGANIZATION HAS APPROXIMATELY 151 GENERAL MEMBERS. ANNUAL DUES ARE $5 PER INDIVIDUAL OR $8 PER FAMILY. REQUIREMENTS TO BE A MEMBER ARE A MINIMUM OF EIGHTEEN YEARS OF AGE AND HAS A RESIDENCE IN THE AREA THAT THE HOSPITAL SERVES. EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. |
| Form 990, Part VI, Section A, line 7a | EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. |
| Form 990, Part VI, Section A, line 7b | EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. |
| Form 990, Part VI, Section B, line 11b | THE 990 IS REVIEWED BEFORE FILING BY THE FOLLOWING INDIVIDUALS: 1. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER, THOMAS LEMON; 2. THE HOSPITAL'S VP OF FINANCE, ROBERT COURTOIS; AND 3. THE HOSPITAL'S CONTROLLER, AMY BILYEA. THE 990 IS ALSO PRESENTED TO THE ENTIRE HOSPITAL BOARD BEFORE FILING. DURING THIS MEETING MEMBERS HAVE A CHANCE TO ASK QUESTIONS REGARDING THE FORM 990. |
| Form 990, Part VI, Section B, line 12c | THE HOSPITAL'S POLICY REGARDING "CONFLICT OF INTEREST" REQUIRES EACH BOARD MEMBER AND OFFICER TO COMPLETE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES TO DEMONSTRATE CORPORATE COMPLIANCE. THESE FORMS ARE REVIEWED AND ANY CONFLICTS ARE INVESTIGATED BY MANAGEMENT. POTENTIAL CONFLICTS AND RESTRICTIONS ARE DETERMINED AND THEN VOTED UPON, PER POLICY GUIDELINES. IN THE EVENT THAT AN OFFICER OR BOARD MEMBER HAS A CONFLICT OF INTEREST, THAT BOARD MEMBER MUST GIVE WRITTEN NOTICE OF SUCH AN INTEREST OR RELATIONSHIP TO THE BOARD OF DIRECTORS, AND SHALL THEREAFTER REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE DECISION. |
| Form 990, Part VI, Section B, line 15a | THE BOARD'S PERSONNEL SUB-COMMITTEE, WHICH CONSISTS OF FOUR MEMBERS, ANNUALLY REVIEWS THE COMPENSATION OF THE CEO ONLY. THEY UTILIZE MHA SALARY SURVEY DATA, AS WELL AS A MARKET ANALYSIS PERFORMED BY BOTH HOSPITAL'S HUMAN RESOURCES DEPARTMENT AND MUNSON'S HR DEPARTMENT. THE HUMAN RESOURCES MARKET ANALYSIS INCLUDES THREE SOURCES FOR DATA: INTEGRATED HEALTHCARE STRATEGIES, MERCER AND SULLIVAN COTTER, WITH REGRESSION POINT USING $70M IN NET REVENUES AND AN AVERAGE BASED ON HOSPITALS WITHIN A SIMILAR RANGE OF NET REVENUES. EACH OF THE THREE SOURCES USE NATIONAL DATA AND ARE BASED ON A FREE-STANDING HOSPITAL CEO POSITION. THE CEO DETERMINES THE STARTING COMPENSATION FOR THE VICE PRESIDENTS BASED ON MARKET DATA AND ANNUAL INCREASES OCCUR BASED ON PAY-FOR-PERFORMANCE SYSTEMS. THESE PROCESSES WERE LAST UNDERTAKEN IN 2016. |
| Form 990, Part VI, Section C, line 19 | THE OTSEGO MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY , AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY CONTACTING THE HOSPITAL AT 825 N. CENTER GAYLORD MI 49735 OR BY PHONE 989-731-2100. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER STREET | AddressLine1Txt |
| City | GAYLORD | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49735 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382135473 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| OTSEGO MEMORIAL HOSPITAL FOUNDATION | ||
| C | $448,771 | CASH |
| OTSEGO MEMORIAL HOSPITAL FOUNDATION | ||
| L | $276,898 | ACTUAL COST ALLOCATION |