MUNSON HEALTHCARE CHARLEVOIX HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (EIN 38-1459366)
- Tax period
- 2013-04-01 to 2014-03-31
- Filed
- 2015-02-13
- IRS object ID
- 201510449349300126
- Schema version
- 2013v4.0
- 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 | 2015-02-13T12:08:58-06:00 | ReturnTs |
| Tax Period End | 2014-03-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381459366 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHAR | BusinessNameControlTxt |
| Phone | 2315474024 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GLADYLYN JENKS | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 2315474024 | PhoneNum |
| Signature | 2015-02-12 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LYN JENKS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $41,260,714 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CAH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1919 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EXCELLENT HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 398 | TotalEmployeeCnt |
| Total Volunteers | 57 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $195,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $203,436 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $39,232,741 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,898,646 | CYProgramServiceRevenueAmt |
| PY Investment Income | $31,128 | PYInvestmentIncomeAmt |
| CY Investment Income | -$44,023 | CYInvestmentIncomeAmt |
| PY Other Revenue | $103,419 | PYOtherRevenueAmt |
| CY Other Revenue | $109,748 | CYOtherRevenueAmt |
| PY Total Revenue | $39,562,288 | PYTotalRevenueAmt |
| CY Total Revenue | $41,167,807 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $21,344,081 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,233,036 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,993,561 | PYOtherExpensesAmt |
| CY Other Expenses | $19,466,903 | CYOtherExpensesAmt |
| PY Total Expenses | $39,337,642 | PYTotalExpensesAmt |
| CY Total Expenses | $41,699,939 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $224,646 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$532,132 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,923,065 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,509,568 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,575,829 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,482,098 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,347,236 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,027,470 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE EXCELLENT HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $10,407,864 | ExpenseAmt |
| Revenue | $20,528,522 | RevenueAmt |
| Desc | OPERATING ROOM SERVICES - SURGERIES: 2,962 | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,269,033 | ExpenseAmt |
| Revenue | $6,578,422 | RevenueAmt |
| Desc | PRIMARY CARE SERVICES: 30,390 | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,417,243 | ExpenseAmt |
| Revenue | $4,525,986 | RevenueAmt |
| Desc | EMERGENCY ROOM SERVICES - PATIENTS SEEN IN THE ER: 11,046 | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $13,567,940 | ExpenseAmt |
| Revenue | $9,304,951 | RevenueAmt |
| Desc | INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $13,567,940 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $9,304,951 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $34,662,080 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 398 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | Yes (true) | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TABITHA RUDOLPH | PersonNm |
| Phone | 2315478508 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| MARC LAME MD | |||||||||
| VICE CHAIR | 40.00 | Yes (X) | Yes (X) | $333,424 | $0 | $19,931 | |||
| MICHAEL HARMELING MD | |||||||||
| DIR/CHIEF OF | 40.00 | Yes (X) | Yes (X) | $187,437 | $0 | $9,155 | |||
| GLADYLYN JENKS | |||||||||
| CEO | 40.00 | Yes (X) | Yes (X) | $142,832 | $0 | $622 | 1.00 | ||
| STEVE HUFFORD OD | |||||||||
| DIRECTOR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| SCOTT BEATTY | |||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 1.00 | ||
| MARY JASON | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| RICHARD FISH DDS | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| STEVE WEBER | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| RUTH B HOPPE MD | |||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 1.00 | ||
| MICHAEL ORTWINE | |||||||||
| SECRETARY/TR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MARY FACULAK | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | 2.00 | |||
| NANCY SHERMAN | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARK ECKHARDT | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| DENISE HOLMES | |||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| ROBERT ZIMMERMAN | |||||||||
| CHIEF FINANC | 8.00 | Yes (X) | $0 | $0 | $0 | ||||
| JAMES JEAKLE MD | |||||||||
| OBSTETRICIAN | 40.00 | $376,389 | $0 | $21,970 | 1.00 | Yes (X) | |||
| CRAIG WENDT MD | |||||||||
| PHYSICIAN | 40.00 | $362,185 | $0 | $18,780 | Yes (X) | ||||
| MARY IVEY MD | |||||||||
| OBSTETRICIAN | 40.00 | $355,504 | $0 | $20,077 | Yes (X) | ||||
| CATHERINE WONSKI MD | |||||||||
| PHYSICIAN | 40.00 | $301,741 | $0 | $26,129 | Yes (X) | ||||
| NATHAN BOSS MD | |||||||||
| PHYSICIAN | 40.00 | $242,347 | $0 | $19,457 | Yes (X) | ||||
| WILLIAM JACKSON | |||||||||
| PAST PRESIDE | 0.00 | $112,472 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,414,331 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $136,121 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PINE RIVER MEDICAL ASSOCIATES | |||||
| 14734 PARK AVENUE | CHARLEVOIX | MI | 49720 | ER PHYSICIAN | $1,544,087 |
| ALLIANCE-HNI LLC | |||||
| 525 S GOULD | OWOSSO | MI | 48867 | MOBILE MRI SERV | $426,234 |
| MUNSON HEALTHCARE | |||||
| 1105 SIXTH ST | TRAVERSE CITY | MI | 49684 | CFO/REIMB. SVCS | $171,609 |
| QUEST DIAGNOSTICS | |||||
| 4444 GIDDINGS ROAD | AUGURN HILLS | MI | 48326 | LABORATORY SERV | $145,688 |
| SMITHGROUP JJR | |||||
| 500 GRISWOLD SUITE 1700 | DETROIT | MI | 48226 | ARCHITECT | $136,283 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $193,947 | RelatedOrganizationsAmt |
| Government Grants | $9,489 | GovernmentGrantsAmt |
| Noncash Contributions | $14,394 | NoncashContributionsAmt |
| Total Contributions | $203,436 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HEALTH SERVICES | 621110 | $20,191,156 | $20,191,156 |
| MEDICARE/MEDICAID PAYMENTS | 621110 | $17,199,209 | $17,199,209 |
| OTHER RELATED REVENUE | 621110 | $3,508,281 | $3,508,281 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,898,646 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$107,871 | TotalRevenueColumnAmt |
| Exclusion | -$107,871 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $63,911 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $92,907 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$28,996 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$28,996 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$28,996 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $63,848 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $63,848 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,848 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $63,848 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | BusinessBusinessCd | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA SALES | $134,361 | $134,361 | ||
| MISCELLANEOUS INCOME | $4,383 | 621110 | $4,383 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $138,744 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,167,807 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,937,881 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $26,490 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $740,124 | TotalAmt |
| Program Services | $596,125 | ProgramServicesAmt |
| Management And General | $143,999 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,267,556 | TotalAmt |
| Program Services | $14,972,063 | ProgramServicesAmt |
| Management And General | $2,295,493 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,371 | TotalAmt |
| Program Services | $216,966 | ProgramServicesAmt |
| Management And General | $39,405 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,734,731 | TotalAmt |
| Program Services | $2,251,900 | ProgramServicesAmt |
| Management And General | $482,831 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,234,254 | TotalAmt |
| Program Services | $1,055,474 | ProgramServicesAmt |
| Management And General | $178,780 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,489 | TotalAmt |
| Management And General | $175,489 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,861 | TotalAmt |
| Management And General | $35,861 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,675 | TotalAmt |
| Management And General | $76,675 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,679,599 | TotalAmt |
| Program Services | $3,041,350 | ProgramServicesAmt |
| Management And General | $638,249 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,244 | TotalAmt |
| Management And General | $181,244 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,353 | TotalAmt |
| Program Services | $30,755 | ProgramServicesAmt |
| Management And General | $11,598 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $184,938 | TotalAmt |
| Management And General | $184,938 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $802,398 | TotalAmt |
| Program Services | $655,158 | ProgramServicesAmt |
| Management And General | $147,240 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,539 | TotalAmt |
| Program Services | $41,549 | ProgramServicesAmt |
| Management And General | $10,990 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,375 | TotalAmt |
| Program Services | $40,160 | ProgramServicesAmt |
| Management And General | $35,215 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,145 | TotalAmt |
| Program Services | $134,841 | ProgramServicesAmt |
| Management And General | $30,304 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,881,259 | TotalAmt |
| Program Services | $1,536,048 | ProgramServicesAmt |
| Management And General | $345,211 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $287,052 | TotalAmt |
| Program Services | $89,761 | ProgramServicesAmt |
| Management And General | $197,291 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $8,213,468 | $7,844,766 | $368,702 |
| PROVISION FOR BAD DEBTS | $1,452,391 | $1,452,391 | |
| QAAP TAX | $821,463 | $821,463 | |
| EQUIPMENT SERVICE & RENTA | $581,627 | $480,532 | $101,095 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $758,027 | TotalAmt |
| Program Services | $222,241 | ProgramServicesAmt |
| Management And General | $535,786 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,699,939 | TotalAmt |
| Program Services | $34,662,080 | ProgramServicesAmt |
| Management And General | $7,037,859 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $226,280 | BOYAmt |
| EOY | $205,429 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,794,055 | BOYAmt |
| EOY | $1,305,482 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,421 | BOYAmt |
| EOY | $19,421 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,828,835 | BOYAmt |
| EOY | $4,777,381 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $141,375 | BOYAmt |
| EOY | $78,802 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $814,582 | BOYAmt |
| EOY | $863,947 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $401,978 | BOYAmt |
| EOY | $260,492 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $46,878,619 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $33,303,933 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,707,730 | BOYAmt |
| EOY | $13,574,686 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,134 | BOYAmt |
| EOY | $1,036,812 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,693,952 | BOYAmt |
| EOY | $1,569,865 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,213,723 | BOYAmt |
| EOY | $1,817,251 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,923,065 | BOYAmt |
| EOY | $25,509,568 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,624,769 | BOYAmt |
| EOY | $4,674,377 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,371,715 | BOYAmt |
| EOY | $2,371,715 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,579,345 | BOYAmt |
| EOY | $1,436,006 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,575,829 | BOYAmt |
| EOY | $8,482,098 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,591,741 | BOYAmt |
| EOY | $16,511,862 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $755,495 | BOYAmt |
| EOY | $515,608 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,347,236 | BOYAmt |
| EOY | $17,027,470 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,923,065 | BOYAmt |
| EOY | $25,509,568 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$532,132 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $212,366 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $5,508 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,508 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | PORTION OF ANNUAL DUES PAID TO THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARDS LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $503,375 | OtherCostOrOtherBasisAmt |
| Book Value | $503,375 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,368,525 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,091,188 | DepreciationAmt |
| Book Value | $9,277,337 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,538,221 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,212,745 | DepreciationAmt |
| Book Value | $3,325,476 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $468,498 | OtherCostOrOtherBasisAmt |
| Book Value | $468,498 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,574,686 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENT IN CHARLEVOIX NURSING HOM | $1,073,678 | F |
| INVESTMENT IN CHARLEVOIX FOUNDATION | $496,187 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,569,865 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| COST REPORT SETTLEMENT RECEIVABLE | $1,598,946 |
| BOND ISSUE COSTS | $103,307 |
| AFFILIATE RECEIVABLE | $79,148 |
| ACCRUED MEANINGFUL USE FUNDING RECEI | $35,850 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,817,251 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $39,808,323 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,452,391 | OtherRevenueAmt |
| Revenue Not Reported | -$1,452,391 | RevenueNotReportedAmt |
| Revenue Subtotal | $41,260,714 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$92,907 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$92,907 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $41,167,807 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $40,340,455 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$1,452,391 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$1,452,391 | ExpensesNotReportedAmt |
| Expenses Subtotal | $41,792,846 | ExpensesSubtotalAmt |
| Other Expenses Not Included | -$92,907 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | -$92,907 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $41,699,939 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | PROVISION FOR BAD DEBT -1,452,391 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | RENTAL EXPENSES -92,907 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | PROVISION FOR BAD DEBT -1,452,391 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | RENTAL EXPENSES -92,907 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 2.600000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $182,368 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $174,805 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,563 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,286,348 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,188,201 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,098,147 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02630 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,468,716 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,363,006 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,105,710 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02650 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $387,932 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,283 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $380,649 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00910 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $387,932 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,283 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $380,649 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00910 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,856,648 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,370,289 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,486,359 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03560 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,452,391 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $101,123 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,479,640 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,391,219 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $88,421 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CAH.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 260.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 3 | MAJOR PARTNERS IN THE EXECUTION OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT WERE THE NORTHWEST MICHIGAN COMMUNITY HEALTH DEPARTMENT AND HEALTH DEPARTMENT DISTRICT 4, ALONG WITH HOSPITAL PARTNERS AS DESCRIBED IN V.4 AND THE NORTHERN HEALTH PLAN. THESE PARTNERS FORMED THE STEERING COMMITTEE THAT DEVELOPED THE PLAN FOR THE ASSESSMENT; THEN FOLLOWED IT THROUGH TO FULL EXECUTION. IN ADDITION, MORE THAN 1,200 INDIVIDUALS PARTICIPATED IN SURVEYS AND/OR FOCUS GROUPS THROUGHOUT NORTHERN MICHIGAN IN 2012. ABOUT 900 RESIDENTS COMPLETED THE "HEALTHY COMMUNITY" SURVEY, INCLUDING 226 FROM ANTRIM AND CHARLEVOIX COUNTIES. APPROXIMATELY 100 PHYSICIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS COMPLETED A "HEALTH CARE PROVIDER" SURVEY. MORE THAN 200 PEOPLE FROM ACROSS THE NORTHERNMOST PART OF THE LOWER PENINSULA OF MICHIGAN, INCLUDING EMMET, CHARLEVOIX, OTSEGO, CHEBOYGAN, CHARLEVOIX, AND ANTRIM COUNTIES PARTICIPATED IN 22 FOCUS GROUPS, COMMUNITY DIALOGUES, AND KEY INFORMANT INTERVIEWS; THESE INCLUDED COMMUNITY HEALTH NEEDS ASSESSMENT ACTIVITIES LED BY MUNSON MEDICAL CENTER, WHICH COVERED ANTRIM COUNTY. |
| FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 4 | MCLAREN NORTHERN MICHIGAN, PETOSKEY MI OTSEGO MEMORIAL HOSPITAL, GAYLORD MI |
| FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 7 | ABUSE AND NEGLECT: WE HAVE NO CURRENT PLANS TO ADDRESS THIS ISSUE AS THERE ARE OTHER AGENCIES AND ORGANIZATIONS WITHIN OUR REGION THAT ROUTINELY PROVIDE PREVENTIVE AND OTHER SERVICES FOR THIS POPULATION, INCLUDING THE WOMEN'S RESOURCE CENTER, NORTHERN MICHIGAN COMMUNITY MENTAL HEALTH, THE CHILD ABUSE PREVENTION COUNCIL AND THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN. MATERNAL SMOKING: WE HAVE NO CURRENT PROGRAMS SPECIFICALLY TARGETING SMOKING MOTHERS BUT WE WILL WORK WITH AREA PHYSICIANS TO REFER THEM TO AVAILABLE SMOKING CESSATION PROGRAMS PROVIDED AS NOTED ELSEWHERE IN THE PLAN. IN ADDITION, A CAH RESPIRATORY THERAPIST IS CONSULTED TO INSTRUCT IN THE DANGER OF SECOND-HAND SMOKE WITH EACH NEWBORN MOTHER WITH A SMOKING HABIT. A SMOKING CESSATION PACKET IS PROVIDED WITH QUITTING TECHNIQUES AND STATE AND LOCAL RESOURCE INFORMATION. THE LOCAL PUBLIC HEALTH DEPARTMENT PROVIDES SIGNIFICANT SUPPORT TO EXPECTANT MOTHERS IN THIS AREA, ALONG WITH ADDITIONAL COUNSELING ON OTHER FORMS OF ADDICTION. |
| FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 20D | A PERCENTAGE DISCOUNT RANGING FROM 50% TO 100% IS APPLIED TO GROSS CHARGES FOR INDIVIDUALS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THE DISCOUNT IS DETERMINED ON A SLIDING SCALE USING THE FEDERAL POVERTY GUIDELINES GRID FOR INCOMES UP TO 260% OF THE FEDERAL POVERTY LEVEL AND TAKING INTO ACCOUNT THE NUMBER OF MEMBERS IN THE FAMILY. THE DISCOUNT EXCEEDS THE DISCOUNT NEGOTIATED WITH CHARLEVOIX AREA HOSPITAL'S TWO LARGEST PRIVATE INSURERS, WHICH REPRESENT 30% OF OUR PAYER MIX. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| BOYNE AREA MEDICAL CENTER | ||||
| 223 N PARK | BOYNE CITY | MI | 49712 | OUTPATIENT PHYSICIAN OFFICE |
| CHARLEVOIX WOMEN'S HEALTH CARE | ||||
| 14651 W UPRIGHT STREET | CHARLEVOIX | MI | 49720 | OUTPATIENT PHYSICIAN OFFICE |
| CHARLEVOIX SURGEONS | ||||
| 14695 PARK AVENUE | CHARLEVOIX | MI | 49720 | PHYSICIAN OFFICE |
| PHYSICIAN CLINIC OF CHARLEVOIX | ||||
| 14705 W UPRIGHT STREET | CHARLEVOIX | MI | 49720 | PHYSICIAN OFFICE |
| PINE RIVER CLINIC | ||||
| 14374 PARK AVE | CHARLEVOIX | MI | 49720 | FAMILY PRACTICE OFFICE |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION | THE HOSPITAL DID NOT REPORT SUBSIDIZED HEALTH SERVICES. |
| PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H, PART I, COLUMN F PERCENTAGE, EQUALS 1,452,391. |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. ACTUAL COSTS ARE REPORTED ON LINE 7E. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | THE HOSPITAL PROVIDES CARE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. WHILE THE HOSPITAL MAKES EVERY EFFORT TO IDENTIFY ALL CANDIDATES WHO WOULD QUALIFY UNDER ITS FINANCIAL ASSISTANCE POLICY, THERE ARE CIRCUMSTANCES UNDER WHICH THAT DETERMINATION CANNOT BE MADE. AS SUCH, IT IS OUR BELIEF THAT 101,123 OF BAD DEBT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY AND SHOULD BE INCLUDED AS COMMUNITY BENEFIT. BASED ON AN ANALYSIS OF SELF PAY ENCOUNTERS WHOSE GROSS CHARGES EXCEEDED 1,000 AND THEREFORE WERE AUTOMATICALLY SENT A FINANCIAL ASSISTANCE APPLICATION, IT WAS DETERMINED THAT APPROXIMATELY 30% QUALIFIED FOR FINANCIAL ASSISTANCE. THIS PERCENTAGE WAS THEN APPLIED TO SELF PAY BAD DEBT AND THEN CONVERTED TO COST THROUGH APPLICATION OF THE RATIO OF PATIENT CARE COST TO CHARGES. |
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | ACCOUNTS RECEIVABLE - 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 HOSPITAL 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 HOSPITAL 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, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). 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 HOSPITAL 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 - MEDICARE EXPLANATION | THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DOES NOT SHOW A SHORTFALL. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | CHARLEVOIX AREA HOSPITAL HAS PARTICIPATED IN NEEDS ASSESSMENT SURVEYS CONSISTENTLY DURING THE PAST 10 YEARS, TYPICALLY IN COOPERATION WITH OTHER ORGANIZATIONS BUT AT TIMES SPECIFICALLY DRIVEN BY OUR HOSPITAL. IN ADDITION TO DATA PROCURED THROUGH THESE SURVEYS, OUR HOSPITAL HAS ALSO USED MICHIGAN DEPARTMENT OF COMMUNITY HEALTH DATA, AND DATA FROM THE ECONOMIC DEVELOPMENT COUNCIL TO ASSESS THE ONGOING HEALTHCARE NEEDS OF OUR COMMUNITY. THE SURVEYS HAVE RESULTED IN MANY JOINT EFFORTS TO ADDRESS OUR COMMUNITY'S HEALTH CARE NEEDS (FLU CLINICS IN COOPERATION WITH LOCAL MDCH, GRANT PROCUREMENT FOR PACS AND DIGITAL MAMMOGRAPHY, AND FITKIDS.) ADDITIONALLY, THE HOSPITAL HAS SOLELY SPONSORED WELLNESS WEDNESDAY'S, FREE MAMMOGRAPHY, AND SPORTS PHYSICALS FOR STUDENT ATHLETES. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE HOSPITAL'S ADMISSIONS AREAS. IF, DURING THE REGISTRATION PROCESS, IT BECOMES APPARENT THAT A PATIENT HAS NEED FOR POSSIBLE FINANCIAL OR DISCOUNTED ASSISTANCE, A REFERRAL IS MADE TO THE HOSPITAL'S FINANCIAL COUNSELOR OR SOCIAL WORKER. DURING THIS ASSESSMENT, ELIGIBILITY FOR ASSISTANCE UNDER EXISTING FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS FIRST EXPLORED. SHOULD THE PATIENT FAIL TO QUALIFY FOR EXISTING PROGRAMS, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION IS MADE AVAILABLE. IN THE EVENT THE PATIENT'S NEED IS NOT IDENTIFIED DURING REGISTRATION, ADDITIONAL OPPORTUNITIES TO INQUIRE ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE. FOR EXAMPLE, THE PHONE NUMBER FOR INQUIRIES INTO FINANCIAL ASSISTANCE ARE PRINTED ON ANY STATEMENTS SENT TO THE PATIENT. FURTHERMORE, PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE AND HAVE AN ENCOUNTER BALANCE THAT EXCEEDS 1,000 ARE AUTOMATICALLY SENT AN APPLICATION. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | CHARLEVOIX AREA HOSPITAL SERVES THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES, AS WELL AS THE SEASONAL RESIDENTS THAT FLOOD THE AREA DURING THE SUMMER MONTHS. THIS SMALL, RURAL COMMUNITY IS HOME TO APPROXIMATELY 27,000 RESIDENTS, WITH A PER CAPITA INCOME OF 47,177. BASED ON 2013 ESTIMATES, 12.4% OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL. SIMILARLY, MEDICAID RECIPIENTS ACCOUNTED FOR APPROXIMATELY 8% OF THE HOSPITAL'S GROSS PATIENT CHARGES. IN ADDITION, PATIENTS REFERRED FROM NEIGHBORING EAST JORDAN FAMILY HEALTH CENTER, A FEDERALLY QUALIFIED RURAL HEALTH CLINIC, WERE AMONG THOSE SERVED BY THE HOSPITAL. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | THE BOARD OF DIRECTORS IS COMPRISED OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THIS VOLUNTARY BOARD PROVIDES COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS. CHARLEVOIX AREA HOSPITAL UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA. EXAMPLES OF HOW CAH PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PROGRAMS INCLUDE: AMERICAN RED CROSS BLOOD DRIVES AREA BUSINESS HEALTH SCREENINGS FREEDOM FROM SMOKING CLINIC FIT-4-LIFE FOR ADULTS WEIGHT WATCHERS AT WORK CIRCLE OF STRENGTH CANCER SUPPORT GROUP CIRCLE OF STRENGTH MAMMOGRAM VOUCHERS PINK RIBBON RIDE FIT-4-LIFE FOR KIDS HOSPITAL AND CAREER EXPLORATION TOURS READ TO ME PROGRAM SCHOOL NURSE PROGRAM |
| PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM | THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT | MICHIGAN |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|
| MARC LAME MD | ||||||
| VICE CHAIR | $300,542 | $32,882 | $5,805 | $14,126 | $353,355 | |
| MICHAEL HARMELING MD | ||||||
| DIR/CHIEF OF STAFF | $153,009 | $34,109 | $3,076 | $6,079 | $196,592 | $319 |
| JAMES JEAKLE MD | ||||||
| OBSTETRICIAN | $231,912 | $142,417 | $4,728 | $17,242 | $398,359 | $2,060 |
| CRAIG WENDT MD | ||||||
| PHYSICIAN | $300,452 | $59,330 | $3,596 | $15,184 | $380,965 | $2,403 |
| MARY IVEY MD | ||||||
| OBSTETRICIAN | $235,045 | $103,286 | $4,893 | $15,184 | $375,581 | $17,173 |
| CATHERINE WONSKI MD | ||||||
| PHYSICIAN | $229,881 | $64,533 | $5,913 | $20,216 | $327,870 | $7,327 |
| NATHAN BOSS MD | ||||||
| PHYSICIAN | $239,137 | $2,050 | $4,805 | $14,652 | $261,804 | $1,160 |
| WILLIAM JACKSON | ||||||
| PAST PRESIDENT | $112,472 | $112,472 | ||||
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX TWP HOSP FIN AUTH 2001 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 383203086 | BondIssuerEIN |
| Bond Issued | 2013-03-28 | BondIssuedDt |
| Issue Price | $3,230,010 | IssuePriceAmt |
| Purpose | REFUND/REISSUE 2001 SERIES CHARLEVOIX TOWNSHIP HOSPITAL FINANCE AUTHORITY | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $3,230,010 | TotalProceedsAmt |
| Other Spent Proceeds | $3,230,010 | OtherSpentProceedsAmt |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | false | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | Yes (true) | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqsInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION | CHARLEVOIX TWP HOSP FIN AUTH 2001 LIMITED OBLIGATION HOSPITAL REVENUE AND REFUNDING BONDS; ISSUE DATE 11/13/2001 |
| SCHEDULE K - ADDITIONAL INFORMATION | CHARLEVOIX TWP HOSP FIN AUTH 2001 CHARLEVOIX AREA HOSPITAL IS IN THE PROCESS OF ADOPTING WRITTEN PROCEDURES FOR POST-ISSUANCE COMPLIANCE WHICH WILL INCLUDE PROVISIONS TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH A VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 3 | CHARLEVOIX AREA HOSPITAL CONTRACTED THE CHIEF FINANCIAL OFFICER RESPONSIBILITIES TO MUNSON HEALTHCARE, AN AFFILIATE HEALTHCARE SYSTEM IN ITS SERVICE AREA. MUNSON HEALTHCARE ASSIGNED ROBERT ZIMMERMAN TO FULFILL THAT ROLE. NONE OF CHARLEVOIX AREA HOSPITAL'S CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY MUNSON HEALTHCARE DURING THE CALENDAR YEAR ENDED IN CHARLEVOIX'S TAX YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 9 | WILLIAM JACKSON 00270 TURKEY RUN CHARLEVOIX, MI 49720 |
| FORM 990, PAGE 6, PART VI, LINE 11B | CAH CONTRACTS FOR CERTAIN ACCOUNTING SERVICES FROM MUNSON HEALTHCARE WHICH INCLUDE ASSISTANCE WITH THE FORM 990 PREPARATION AND REVIEW. A REVIEW OF THE 990 IS PERFORMED BY THE ADMINISTRATIVE TEAM AS WELL AS THE MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ALL INDIVIDUALS SERVING ON THE BOARD ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND ARE PERIODICALLY REMINDED OF THEIR OBLIGATION TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT MAY ARISE AS PART OF INTERRELATIONSHIPS RESULTING FROM THEIR PROFESSIONAL CAREERS, THEIR FAMILIES, THEIR PERSONAL ACQUAINTANCES WITH KEY EMPLOYEES OF THE HOSPITAL, AND THEIR DUTIES AS A BOARD MEMBER. MONITORING IS CONDUCTED ON AN ONGOING BASIS, WITH THE EXPECTATION THAT BOARD MEMBERS WILL MEET THEIR AFFIRMATIVE OBLIGATION TO REPORT CONFLICTS OF INTEREST PRIOR TO THE EXECUTION OF BOARD TRANSACTIONS INVOLVING SUCH CONFLICTS. CHARLEVOIX AREA HOSPITAL CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY DISTRIBUTING AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE TO BOARD MEMBERS, EMPLOYED PHYSICIANS, AND KEY EMPLOYEES, WHICH INCLUDES QUESTIONS RELATED TO EACH POLICY PROVISION. RESPONSES ARE THOROUGHLY REVIEWED AND ANY APPARENT CONFLICTS ARE THOROUGHLY INVESTIGATED. IN THE EVENT THAT A POTENTIAL CONFLICT IS IDENTIFIED PRIOR TO ACTION ON A CONTRACT OR TRANSACTION, THE CONFLICTED PERSON IS NOT ALLOWED TO PARTICIPATE INDISCUSSIONS ON THE MATTER, NOT ALLOWED TO VOTE ON THE MATTER, AND NOT ALLOWED TO BE PRESENT DURING VOTING ON THE MATTER. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE PROCESS FOR DETERMINING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER (CEO)WAS WORKED THROUGH THE BOARD EXECUTIVE COMMITTEE, WHICH INCLUDED THREE INDIVIDUALS, ALL OF WHOM WERE/ARE INDEPENDENT (IE, UNDER NO COMPENSATION AGREEMENT, NOR UNDER CONTROL OF ANYONE BEING COMPENSATED). THE PROCESS INCLUDED A DATA COLLECTION PHASE WHICH REVIEWED ARTICLES DEALING WITH CONTEMPORARY PHILOSOPHY OF CEO COMPENSATION, AND ALSO INCLUDED A REVIEW OF THE VARIOUS QUARTILES OF CEO COMPENSATION FOR CRITICAL ACCESS HOSPITALS COMPILED IN 2012 BY YAFFE AND CO., INC. FOLLOWING THIS PHASE OF DATA COLLECTION, THE EXECUTIVE COMMITTEE CAREFULLY DELIBERATED IN SETTING THE COMPENSATION LEVEL FOR FY 2013/14 BASED ON DATA FROM SIMILARLY FINANCIALLY-SIZED CRITICAL ACCESS HOSPITALS IN THE MIDWEST. IT ADDITION, AN OUTLINE FOR A COMPENSATION STRUCTURE FOR THE NEXT FIVE YEARS WAS DEVELOPED, WHICH ALSO INCLUDES AN INCENTIVE COMPONENT. THE FULL BOARD REVIEWED AND APPROVED THE PROCESS, BUT DID NOT PARTICIPATE IN THE DELIBERATION ABOUT COMPENSATION, NOR IN THE FINAL DECISION. |
| FORM 990, PAGE 6, PART VI, LINE 15B | CHARLEVOIX AREA HOSPITAL CONTRACTS WITH MUNSON HEALTHCARE TO PROVIDE MANAGEMENT SERVICES FOR ITS CHIEF FINANCIAL OFFICER, FINANCE DIRECTOR AND REIMBURSEMENT RESPONSIBILITIES. THIS CONTRACT DICTATES FIXED MONTHLY PAYMENTS TO MUNSON HEALTHCARE. THE PAYMENTS WERE DERIVED FROM THE COST-BASED HOURLY RATE SET BY MUNSON FOR ITS PERSONNEL. THE CHARLEVOIX AREA HOSPITAL BOARD OF DIRECTORS REVIEWED THE CONTRACT FOR REASONABLENESS AND APPROVED THE CONTRACT. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | PROVISION FOR BAD DEBT -1,452,391 RENTAL EXPENSES 92,907 PROVISION FOR BAD DEBT 1,452,391 RENTAL EXPENSES -92,907 |
| FORM 990, PART XI, LINE 9 | AFFILIATE TRANSFER 212,366 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL FOUNDATION | BusinessNameLine1 |
| Business Name Line2 | CHARLEVOIX AREA HOSPITAL FOUNDATION | BusinessNameLine2 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 753078034 | EIN |
| Primary Activities | FUNDRAISIN | PrimaryActivitiesTxt |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 11A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX | BusinessNameLine1 |
| Business Name Line2 | AREA HOSPITAL | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| C | $406,314 | CASH |
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| O | $77,010 | FMV - ACTUAL AMOUNTS PAID |