2017-02-14T07:36:54-06:00 2016-03-31 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2015-04-01 208756459 Mackinac Straits Health System Inc MACK 9066438585 1140 N State Street St Ignace MI 49781 JASON ANDERSON CFO 9066438585 2017-02-13 1 Terri Rexrode CPA MST P00096513 9206620016 2017-02-09 2015 2021-01-29 14:40:06Z JASON ANDERSON 1140 N State Street St Ignace MI 49781 41167143 0 X mackinacstraitshealth.org X 2008 MI WE WILL BE THE HOSPITAL OF CHOICE AND RECOGNIZED FOR OUR EXEMPLARY PATIENT CARE, PEOPLE AND PERFORMANCE. WE HAVE A PASSION FOR EXCELLENCE AND STRIVE TO SET AND DELIVER THE HIGHEST STANDARDS OF SERVICE, INTEGRITY AND MOST OF ALL QUALITY. WE VALUE THE DIVERSITY AND CULTURES IN OUR COMMUNITY. 11 8 190 20 0 0 84624 683656 33552611 39145773 15595 3394 1310964 1286225 34963794 41119048 0 0 0 0 17507033 19310776 0 0 0 24920073 22539250 42427106 41850026 -7463312 -730978 50127033 45940916 69856953 68349944 -19729920 -22409028 PROVIDING LOCAL ACCESS AND QUALITY HEALTHCARE TO THE FAMILIES AND COMMUNITIES WE SERVE. 0 0 39349509 40329238 MACKINAC STRAITS HEALTH SYSTEM, INC. OPERATES A 15-BED ACUTE CARE FACILITY, A 48-BED LONG-TERM CARE UNIT, AND SEVERAL PHYSICIAN CLINICS IN MACKINAC COUNTY, MICHIGAN. THE Health System PROVIDEs COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, AND PHYSICIAN SERVICES TO THE RESIDENTS OF MACKINAC COUNTY AND THE SURROUNDING AREAS. 39349509 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 37 0 190 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JASON ANDERSON 9066438585 1140 N State Street ST IGNACE MI 49781 JAMES NORTH TREASURER 1.00 3.70 X X 0 0 0 PRENTISS BROWN BOARD MEMBER 1.00 3.70 X 0 0 0 CHRISTINE MCPHERSON BOARD MEMBER 1.00 3.00 X 0 0 0 Dr CARL HAWKINS Board Member/Post-Chief of Staff 40.00 3.00 X 146383 0 14898 PATRICK SHANNON CHAIRMAN 1.00 3.00 X X 0 0 0 STEVE AUTORE Vice Chair 1.00 3.70 X X 0 0 0 MARGARET DOUD Secretary 1.00 3.70 X X 0 0 0 DR EDWARD SMITH Board Member/Chief of Staff-Elect 40.00 3.00 X 400256 0 19624 DR MATTHEW BOWES Board Member/Chief of Staff 40.00 3.00 X 431864 0 17547 Mary Maurer Board Member 1.00 3.00 X 0 0 0 Richard Smith Board Member 1.00 3.00 X 0 0 0 RODNEY NELSON CEO 40.00 2.00 X 150038 0 17547 JASON ANDERSON CFO 40.00 2.00 X 107271 0 17547 Dr SUSAN HEPKER Physician 40.00 X 420419 0 17547 Roderick Baltzer Physician 40.00 X 278297 0 5849 Amy Bolmer Physician 40.00 X 248441 0 6482 Lisa Van Hevel Physician 40.00 X 206736 0 5849 Loretta Leja Physician 40.00 X 204451 0 15076 2594156 0 137966 19 0 1 0 Tom Teittjen 859 Surry Road Petoskey MI 49770 PHYSICIAN SERVICES 198041 RALPH OLECHOWSKI PO Box 833 Sault Ste Marie MI 49783 PHYSICIAN SERVICES 193135 Norman Schultz PO Box 1906 Mackinac Island MI 49757 pHYSICIAN SERVICES 107790 3 673779 9877 683656 Patient Revenue 900099 37747933 37747933 QAAP REVENUE 900099 1376825 1376825 Affiliate rental revenue 900099 21015 21015 39145773 51489 48095 3394 3394 3394 Tax Levy 900099 1183465 1183465 Physician Incentives 900099 102760 102760 1286225 41119048 40329238 0 106154 X 1322973 1030571 292402 12476344 11664365 811979 1261482 1163175 98307 3313655 3083724 229931 936322 863355 72967 184116 183993 123 224879 224879 4514853 4242362 272491 74369 74369 7792109 7748265 43844 1647761 1635370 12391 123073 103193 19880 75570 62948 12622 2236706 2236706 2632296 2632296 195921 195921 Bad Debt Expense 1789039 1789039 QAAP Taxes Paid 618907 618907 Minor equipment 173865 173865 Dues & subscriptions 126983 126052 931 128803 115061 13742 41850026 39349509 2500517 0 1997116 628356 78903 47664 4898078 3615432 22297 500000 515000 933098 1043501 57483 89840 52976527 13404577 41263601 39571950 376457 429173 50127033 45940916 4690114 3279315 2209406 1727354 54838489 54754922 8118944 8588353 69856953 68349944 X -19758675 -22437783 28755 28755 -19729920 -22409028 50127033 45940916 X -730978 -1948130 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2839 2839 0 Part II-B, Line 1: The organization belongs to the AHA and MHA and pays dues. A portion of the dues are spent on lobbying activities. 1200000 1200000 37770740 8922512 28848228 3193628 839378 2354250 10777493 3642687 7134806 34666 34666 39571950 Amounts Payable to Third Parties 817246 Pension Liability 7457820 Patient Trust Savings 18909 Line of Credit 294378 8588353 38999022 -1446247 -1446247 40445269 673779 673779 41119048 39748723 306643 306643 39442080 2407946 2407946 41850026 Part XI, Line 2d - Other Adjustments: QAAP Payments -618,907. Bad debt expense -1,789,039. FDN Revenue 961,699. Part XI, Line 4b - Other Adjustments: Grant from Foundation 673,779. Part XII, Line 2d - Other Adjustments: Foundation expenses 306,643. Part XII, Line 4b - Other Adjustments: Provision for bad debt 1,789,039. QAAP Payments 618,907. 1 1 1 X 1 X 1 0 0 206648 206648 0.00520 3059282 1648657 1410625 0.03520 3265930 1648657 1617273 0.04040 1812 1812 0.00000 81792 81792 0.00200 540195 294648 245547 0.00610 12118 12118 0.00030 635917 294648 341269 0.00840 3901847 1943305 1958542 0.04880 0 1370221 11737551 11928549 -190998 X 1 0 1 1 MACKINAC STRAITS HEALTH SYSTEM INC 1140 N State Street ST IGNACE MI 49781 www.mackinacstraitshealth.org MW0043832 X X X RHC MACKINAC STRAITS HEALTH SYSTEM INC 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://mackinacstraitshealth.org/about-us/community-needs-assessment.html X 1 15 1 http://mackinacstraitshealth.org/about-us/community-needs-assessment.html 1 0 1 X 100.000000000000 300.000000000000 X X X X 1 1 X X X 1 X http://mackinacstraitshealth.org/patient-resources.html X http://mackinacstraitshealth.org/patient-resources.html X X X X 1 X 0 X X X 1 X 0 0 MACKINAC STRAITS HEALTH SYSTEM, INC. Part V, Section B, Line 5: KEY INFORMATIONAL INTERVIEWS WERE CONDUCTED WITH MEMBERS OF THE COMMUNITY SERVED BY MACKINAC STRAITS HEALTH SYSTEM. THESE INDIVIDUALS WERE IDENTIFIED BY THE COMMITTEE BASED ON THEIR QUALIFICATIONS TO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED. GENERALLY, THE INTERVIEWEES INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH AND PERSONS WHO REPRESENT THE MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS. MACKINAC STRAITS HEALTH SYSTEM, INC. Part V, Section B, Line 11: See CHNA Appendix 5 MACKINAC STRAITS HEALTH SYSTEM, INC. Part V, Section B, Line 22d: We use the look-back method on actual paid claims from Medicare fee-for service and private health insurers. 3 3 - MACKINAW CITY MEDICAL CLINIC 580 SOUTH NICOLET ST MACKINAW CITY MI 49701 physician Office 4 - Mackinac Island Medical Clinic 7474 Market Street Mackinac island MI 49757 emergency room & Physician Office 5 - Rivertown Medical Center 920 South Huron Street Cheboygan MI 49721 physician Office Part I, Line 7: THE ORGANIZATION UTILIZES A COST TO CHARGE RATIO WHEN CALCULATING THE PERCENTAGE OF CHARITY CARE AND COMMUNITY BENEFIT PERCENTAGES. Part I, Line 7g: The entire amount of subsidized health services is from physician clinics. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,789,039. Part II, Community Building Activities: Provided 24 hour emergency and essential health care services to rural community. Part III, Line 2: The bad debt expense at cost is calculated using the cost to charge ratio. Part III, Line 3: The bad debt expense is calculated utilizing actual write-offs and the amounts that have been determined likely to be written off given past experience of the collection possibilities. Although there are some amounts of charity care included in this amount, there is not a current method to easily obtain the amount that should have been charity care. Part III, Line 4: In evaluating the collectability of patient accounts receivable, the Organization analyzes past results and identifies trends for each major payor source of revenue for the purpose of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source is regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established based on historical write-off percentages; for receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Part III, Line 8: Medicare allowable costs are from the Medicare cost report Part VI, Line 2: Feedback from community members via survey and presentations at local organizations Part VI, Line 3: Pamplets and other literature and signage Part VI, Line 4: Mackinac County - a rural county in Michigan's Upper Penninsula. Seasonal economy with higher than average unemployment. Aging population with large number of Native Americans. Part VI, Line 5: A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND ALSO PROVIDES COURTESY PRIVILIGES TO AMNY VISITING SPECIALISTS WHO ARE ALSO PROVIDED SPACE IN OUR BUILDINGS IN ORDER TO SEE THEIR PATIENTS. X X X X 0 0 0 0 0 0 0 0 0 Dr CARL HAWKINS Board Member/Post-Chief of Staff 145798 0 0 0 585 0 0 0 14898 0 161281 0 0 0 DR EDWARD SMITH Board Member/Chief of Staff-Elect 399341 0 0 0 915 0 0 0 19624 0 419880 0 0 0 DR MATTHEW BOWES Board Member/Chief of Staff 431864 0 0 0 0 0 0 0 17547 0 449411 0 0 0 RODNEY NELSON CEO 144779 0 0 0 5259 0 0 0 17547 0 167585 0 0 0 Dr SUSAN HEPKER Physician 396329 0 0 0 24090 0 0 0 17547 0 437966 0 0 0 Roderick Baltzer Physician 248419 0 0 0 29878 0 0 0 5849 0 284146 0 0 0 Amy Bolmer Physician 238189 0 0 0 10252 0 0 0 6482 0 254923 0 0 0 Lisa Van Hevel Physician 199176 0 0 0 7560 0 0 0 5849 0 212585 0 0 0 Loretta Leja Physician 193491 0 0 0 10960 0 0 0 15076 0 219527 0 0 0 Form 990, Part VI, Section B, line 11 THE BOARD OF DIRECTORS HAS DELEGATED TO REVIEW AND APPROVAL OF THE FORM 990 TO THE CFO. The 990 return is e-mailed to the board members prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Board of Directors monitors the conflict of interest policy. New conflicts of interest are reviewed by the Board in accordance with the policy and documented. Form 990, Part VI, Section B, line 15 THE PROCESS FOR DETERMINING ALL COMPENSATION IS BASED ON THE MHA ANNUAL SURVEY. THE COMPENSATION IS THEN REVIEWED BY THE BOARD FOR THE CEO AND IS REVIEWED BY THE CEO FOR OTHER OFFICERS AND KEY EMPLOYEES. Form 990, Part VI, Section C, line 19 The organization makes their documentation available to the public by request only. The audited financial statements are attached to the Form 990 making them available for public inspection. Form 990, Part IX, line 11g physician services: Program service expenses 1,871,810. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,871,810. Therapy services: Program service expenses 332,223. Management and general expenses 0. Fundraising expenses 0. Total expenses 332,223. Nursing services: Program service expenses 119,405. Management and general expenses 0. Fundraising expenses 0. Total expenses 119,405. Surgery Services: Program service expenses 44,982. Management and general expenses 0. Fundraising expenses 0. Total expenses 44,982. Laboratory services: Program service expenses 250,676. Management and general expenses 0. Fundraising expenses 0. Total expenses 250,676. Radiology Services: Program service expenses 99,098. Management and general expenses 0. Fundraising expenses 0. Total expenses 99,098. Pharmacy Services: Program service expenses 112,111. Management and general expenses 0. Fundraising expenses 0. Total expenses 112,111. Clinic Services: Program service expenses 91,654. Management and general expenses 0. Fundraising expenses 0. Total expenses 91,654. Maintenance Services: Program service expenses 155,662. Management and general expenses 0. Fundraising expenses 0. Total expenses 155,662. laundry services: Program service expenses 119,194. Management and general expenses 0. Fundraising expenses 0. Total expenses 119,194. information technology services: Program service expenses 708,790. Management and general expenses 0. Fundraising expenses 0. Total expenses 708,790. risk management services: Program service expenses 39,495. Management and general expenses 0. Fundraising expenses 0. Total expenses 39,495. materials management services: Program service expenses 21,996. Management and general expenses 162,764. Fundraising expenses 0. Total expenses 184,760. miscellaneous services: Program service expenses 33,893. Management and general expenses 34,090. Fundraising expenses 0. Total expenses 67,983. Oncology Services: Program service expenses 55,083. Management and general expenses 0. Fundraising expenses 0. Total expenses 55,083. Fiscal & Administration services: Program service expenses 7,005. Management and general expenses 4,144. Fundraising expenses 0. Total expenses 11,149. human resources services: Program service expenses 0. Management and general expenses 61,124. Fundraising expenses 0. Total expenses 61,124. edcuation services: Program service expenses 0. Management and general expenses 10,369. Fundraising expenses 0. Total expenses 10,369. medical records services: Program service expenses 179,285. Management and general expenses 0. Fundraising expenses 0. Total expenses 179,285. Form 990, Part XI, line 9: Change in Pension Obligation other than Pension Expense -1,997,217. Change in interest in Foundation 49,087. FORM 990, PART XI, LINE 2C The audited financial statements are presented to the Mackinac Straits Health System finance committee and recommendations are taken to the Mackinac Straits Health System Board of Directors. The process has not changed from the prior year. MACKINAC STRAITS AREA HEALTH 1140 North State Street ST Ignace MI 49781 472021925 SUPPORT MACKINAC STRAITS HEALTH SYSTEM MI 501(c)(3) Line 11b, II N/A 0 MACKINAC STRAITS HEALTH FOUNDATION 1140 North State Street ST Ignace MI 49781 465296565 FOUNDATION MI 501(c)(3) Line 11b, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0