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MERCY-MEMORIAL HOSPITAL CORPORATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MERCY-MEMORIAL HOSPITAL CORPORATION (EIN 38-1984289)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-03-28
IRS object ID
201420879349300822
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-03-28T15:06:35-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 307AddressLine1
CitySOUTHFIELDCity
StateMIState
ZIP Code480370307ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN381984289EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MERCY MEMORIAL HOSPITAL CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMERCNameControl
Phone7342404520Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1718 N MACOMB STREETAddressLine1
CityMONROECity
StateMIState
ZIP Code48162ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTHOMAS W SCHILLINGName
TitleCFO & SR VP OF FINANCETitle
Phone7342404520Phone
Date Signed2014-03-24DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBETSY ARETZName
PTINP00996282PTIN
Phone2483522500Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTHOMAS W SCHILLINGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1718 N MACOMB STREETAddressLine1
CityMONROECity
StateMIState
ZIP Code48162ZIPCode
FieldValueIRS element (for citing)
Gross Receipts217940526GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MERCYMEMORIAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionAS AN INDEPENDENT HEALTH CARE SYSTEM, WE PROVIDE HIGH QUALITY, COMPREHENSIVE SERVICES TO THE PEOPLE AND COMMUNITIES WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees1907TotalNbrEmployees
Total Nbr Volunteers759TotalNbrVolunteers
Total Gross UBI5505758TotalGrossUBI
Net Unrelated Business Txbl Income-300001NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1169957ContributionsGrantsPriorYear
Contributions Grants Current Year1026597ContributionsGrantsCurrentYear
Program Service Revenue Prior Year171880471ProgramServiceRevenuePriorYear
Program Service Revenue CY163883977ProgramServiceRevenueCY
Investment Income Prior Year3161149InvestmentIncomePriorYear
Investment Income Current Year5998902InvestmentIncomeCurrentYear
Other Revenue Prior Year-27991OtherRevenuePriorYear
Other Revenue Current Year-60873OtherRevenueCurrentYear
Total Revenue Prior Year176183586TotalRevenuePriorYear
Total Revenue Current Year170848603TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year41300GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY11376GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year86927030SalariesEtcPriorYear
Salaries Etc Current Year88723092SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year216405TotalFundrsngExpCurrentYear
Other Expense Prior Year81826404OtherExpensePriorYear
Other Expenses Current Year81427068OtherExpensesCurrentYear
Total Expenses Prior Year168794734TotalExpensesPriorYear
Total Expenses Current Year170161536TotalExpensesCurrentYear
Revenues Less Expenses Prior Year7388852RevenuesLessExpensesPriorYear
Revenues Less Expenses CY687067RevenuesLessExpensesCY
Total Assets BOY205039704TotalAssetsBOY
Total Assets EOY193187007TotalAssetsEOY
Total Liabilities BOY113555727TotalLiabilitiesBOY
Total Liabilities EOY90563680TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY91483977NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY102623327NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionAS AN INDEPENDENT HEALTH CARE SYSTEM, WE PROVIDE HIGH QUALITY, COMPREHENSIVE SERVICES TO THE PEOPLE AND COMMUNITIES WE SERVE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense142518709Expense
Grants6626Grants
Revenue158366877Revenue
DescriptionHOSPITAL BASED HEALTHCARE SERVICES -A MULTITUDE OF HEALTH CARE SERVICES WERE PROVIDED BY THE HOSPITAL TO THE PEOPLE OF MONROE COUNTY AND SURROUNDING AREAS. THESE PROGRAM SERVICES INCLUDED VARIOUS ASPECTS OF INPATIENT, OUTPATIENT, AND EMERGENCY CARE. THIS CARE WAS PROVIDED IN A MANNER THAT RESPECTED THE VALUE, PRIVACY, AND DIGNITY OF INDIVIDUAL PATIENTS AND THEIR FAMILIES. FURTHER, CONTINUOUS EFFORTS WERE MADE TO IDENTIFY AND IMPLEMENT NEW AND BETTER WAYS TO MEET THE PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL NEEDS OF PATIENTS. DURING THE YEAR THE HOSPITAL PROVIDED:[A] 38,861 DAYS OF ACUTE CARE FOR ADULT AND PEDIATRIC INPATIENTS,[B] 1,419 DAYS OF ACUTE CARE FOR NEWBORNS,[C] EMERGENCY CARE FOR 46,759 OUTPATIENTS, AND[D] 1,222,082 OUTPATIENT SERVICE REGISTRATIONS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense90847Expense
Grants3000Grants
Revenue117298Revenue
DescriptionHOSPITAL GUILD - 100 MEMBERS RENDERED SERVICES TO THE HOSPITAL AND ITS PATIENTS BY OPERATING A GIFT SHOP, KNITTING CAPS FOR NEWBORNS, MAKING CRADLE PICTURES AVAILABLE, ASSISTING IN THE INTERNAL TRANSPORTATION OF PATIENTS AND ASSISTING IN OTHER PATIENT RELATED ACTIVITIES THROUGHOUT THE HOSPITAL. THE GIFT SHOP AND CRADLE PICTURES ARE PRIMARILY FOR THE CONVENIENCE OF EMPLOYEES, PATIENTS AND VISITORS. THE GUILD ALSO OFFERS SOME NURSING SCHOLARSHIPS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense38114Expense
Grants1750Grants
DescriptionHOSPITAL MEDICAL STAFF - 341 MEMBERS [A] DIRECTED AND REVIEWED HOSPITAL BASED HEALTHCARE SERVICES AND [B] PARTICIPATED IN PERIODIC MEETINGS CONCERNING THE DELIVERY OF HEALTHCARE SERVICES, INCLUDING MEDICAL EDUCATION.Description
FieldValueIRS element (for citing)
Total Program Service Expense142647670TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities1ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming1Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art1DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096305NumberFormsTransmittedWith1096
Number W2 G Included1NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1907NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTHOMAS W SCHILLINGNamePerson
Telephone Number7342404520TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1718 N MACOMB STREETAddressLine1
CityMONROECity
StateMIState
ZIP Code48162ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
BHURGRI MD AAMER
CHIEF OF STAFF - EX OFFICIO4.002.00X8787093330
BRAUNLICH PAUL E
TRUSTEE (PARTIAL YEAR)1.001.00X000
CALENDAR KAREN
TRUSTEE1.001.00X000
CARTER KURT W
TRUSTEE1.001.00X000
CHARBONEAU DO MICHAEL
TRUSTEE, SURGEON40.001.00X586356017172
COMPEAN MD JOSE R
TRUSTEE1.001.00X3129200
DARROW KURT L
VICE CHAIR1.001.00X000X
FRANZEN VICKI L
SECRETARY1.001.00X000X
KABIR MD ABDUL
TRUSTEE1.301.00X3104900X
KUBISKE DAVID
TRUSTEE1.001.00X000
KULISH BARTON
TREASURER1.001.00X000X
MCNAMEE MD KENNETH J
TRUSTEE1.001.00X1950800
PHILLIPS ANNETTE S
PRESIDENT & CEO - EX OFFICIO40.001.00X444279030327X
ROBBINS BASIL D
TREASURER (PARTIAL YEAR)1.001.00X000X
RYAN SISTER JANET
TRUSTEE (CHAIR PERSON -PARTIAL YEAR)1.001.00X000X
SPENCER EDD DONALD A
CHAIR PERSON (VICE CHAIR-PARTIAL YR)1.001.00X000X
WALSH ARLENE R
TRUSTEE1.001.00X000
WETZEL SUZANNE
TRUSTEE1.001.00X000
WILBURN WALTER
TRUSTEE1.001.00X000
ZWACK MATTHEW
TRUSTEE (PARTIAL YEAR)1.001.00X000
SCHILLING THOMAS W
CFO SENIOR VP FINANCE40.001.00296196030202X
UBRANSKI PAM
CNO40.000.00209583011141X
PROCHNOW TODD
PHYSICIAN40.000.00505712029394X
SOROSIAK MICHAEL J
CRNA40.000.00224720022051X
OLENCHAK DANIEL
PHYSICIAN40.000.00431284028949X
KIBBLE JOHN
VP BUSINESS DEVELOPMENT40.000.0021448309755X
SHERRARD MARK
CMO40.000.00269574022058X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3351906TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs9333TotalReportableCompFrmRltdOrgs
Total Other Compensation201049TotalOtherCompensation
Number Individuals GT100 K62NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALLSCRIPTS
3 RAVINA DRIVEATLANTAGA30346SOFTWARE SERVICES2621015
GE HEALTHCARE
101 CARNEGIE CENTERPRINCETONNJ08540EQUIPMENT SERVICES1462267
MICHIGAN CO-TENANCY LABS
DEPT CH 14271PALATINEIL60055LABORATORY SERVICES1136074
MCKESSON INFORMATION SERVICES
5995 WINDWARD PARKWAYALPHARETTAGA30005SOFTWARE SERVICES773002
AUCH GEORGE W CO
735 S PADDOCKPONTIACMI48341CONSTRUCTION MGT.700777
FieldValueIRS element (for citing)
Number Of Contractors GT100 K55NumberOfContractorsGT100K
Membership Dues23450MembershipDues
Fundraising Events109116FundraisingEvents
Government Grants7476GovernmentGrants
All Other Contributions886555AllOtherContributions
Noncash Contributions81981NoncashContributions
Total Contributions1026597TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
HOSPITAL BASED HEALTHCARE SERVICE621990158260921158260921
NON-PATIENT PHARMACY44611038018633801863
NON-PATIENT REF. LAB62150013254331325433
DME446110378462378462
HOSPITAL GUILD621990117298117298
FieldValueIRS element (for citing)
Total Program Service Revenue163883977TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1392588TotalRevenueColumn
Exclusion$1,392,588ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1024211Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1169168Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-144957Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-144957TotalRevenueColumn
Exclusion-$144,957ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities50141853Securities
Other19285Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities45554824Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4587029Securities
Other19285Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4606314TotalRevenueColumn
Exclusion$4,606,314ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events157049GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events109116CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses180129FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-23080TotalRevenueColumn
Exclusion-$23,080ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming47716GrossIncomeGaming
Gaming Direct Expenses46508GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column1208TotalRevenueColumn
Exclusion$1,208ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory247250GrossSalesOfInventory
Cost Of Goods Sold141294CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column105956TotalRevenueColumn
Related Or Exempt Function Income105956RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column170848603TotalRevenueColumn
Related Or Exempt Function Income158484175RelatedOrExemptFunctionIncome
Unrelated Business Revenue5505758UnrelatedBusinessRevenue
Exclusion$5,832,073ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total7576Total
Program Services7576ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total3800Total
Program Services3800ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1784711Total
Program Services852239ProgramServices
Management And General932472ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total67915893Total
Program Services57578922ProgramServices
Management And General10230124ManagementAndGeneral
Fundraising106847Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total616917Total
Program Services552993ProgramServices
Management And General62872ManagementAndGeneral
Fundraising1052Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total13388358Total
Program Services11259484ProgramServices
Management And General2108225ManagementAndGeneral
Fundraising20649Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5017213Total
Program Services4210305ProgramServices
Management And General799203ManagementAndGeneral
Fundraising7705Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1256127Total
Management And General1256127ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total277933Total
Management And General277933ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total235610Total
Management And General235610ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total20560Total
Management And General20560ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total373824Total
Management And General373824ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total16404650Total
Program Services11952409ProgramServices
Management And General4444776ManagementAndGeneral
Fundraising7465Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total269184Total
Program Services4691ProgramServices
Management And General262041ManagementAndGeneral
Fundraising2452Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1677778Total
Program Services954041ProgramServices
Management And General722602ManagementAndGeneral
Fundraising1135Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total3938621Total
Program Services17287ProgramServices
Management And General3921334ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3233325Total
Program Services2981963ProgramServices
Management And General251362ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total240098Total
Program Services239791ProgramServices
Management And General307ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total451974Total
Program Services170471ProgramServices
Management And General281503ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2570545Total
Program Services2570545ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total10361126Total
Program Services9559629ProgramServices
Management And General800506ManagementAndGeneral
Fundraising991Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total1063085Total
Program Services747005ProgramServices
Management And General316080ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
HOSPITAL SUPPLIES2536539325365393
PROVISION FOR BAD DEBTS79300417930041
QUALITY ASSURANCE ASSES47064094706409
DIETARY SUPPLIES982676982676

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total68109Total
Fundraising68109Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total170161536Total
Program Services142647670ProgramServices
Management And General27297461ManagementAndGeneral
Fundraising216405Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY118553BOY
EOY192721EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY16822030BOY
EOY9798063EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY35109790BOY
EOY22898993EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY28684EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2598929BOY
EOY2588472EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2071720BOY
EOY2297646EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis199227046LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec118600122LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY82266450BOY
EOY80626924EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY62924175BOY
EOY71881207EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY320601BOY
EOY428576EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY132458EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2807456BOY
EOY2313263EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY205039704BOY
EOY193187007EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY63907268BOY
EOY42542630EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY43813402BOY
EOY42886500EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY5835057BOY
EOY5134550EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY113555727BOY
EOY90563680EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY88054229BOY
EOY99097292EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3374057BOY
EOY3470122EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY55691BOY
EOY55913EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY91483977BOY
EOY102623327EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY205039704BOY
EOY193187007EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses687067ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-310913ReconciliationUnrealizedInvest
Reconcilation Other Changes10763196ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$20,560OtherActivitiesAmount
Total Lobbying Expenditures IIB20560TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE ORGANIZATION PAID DUES TO ORGANIZATIONS WHICH PERFORMED LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3429748BeginningOfYearBalance
Contributions1122390Contributions
Investment Earnings Or Losses93639InvestmentEarningsOrLosses
Other Expenditures1119743OtherExpenditures
End Of Year Balance3526034EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3254087BeginningOfYearBalance
Contributions1265452Contributions
Investment Earnings Or Losses96131InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
Other Expenditures1183422OtherExpenditures
End Of Year Balance3429748EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3106926BeginningOfYearBalance
Contributions1263779Contributions
Investment Earnings Or Losses87576InvestmentEarningsOrLosses
Other Expenditures1204194OtherExpenditures
End Of Year Balance3254087EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4973922BeginningOfYearBalance
Contributions1132367Contributions
Investment Earnings Or Losses168896InvestmentEarningsOrLosses
Other Expenditures3168259OtherExpenditures
End Of Year Balance3106926EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5308021BeginningOfYearBalance
Contributions1121436Contributions
Investment Earnings Or Losses-178473InvestmentEarningsOrLosses
Grants Or Scholarships3000GrantsOrScholarships
Other Expenditures1274062OtherExpenditures
End Of Year Balance4973922EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.98000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.02000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis15360578OtherCostOrOtherBasis
Book Value15360578BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis64104999OtherCostOrOtherBasis
Depreciation38810828Depreciation
Book Value25294171BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis116617997OtherCostOrOtherBasis
Depreciation79789294Depreciation
Book Value36828703BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3143472OtherCostOrOtherBasis
Book Value3143472BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings80626924TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:TRUE ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR NURSING SCHOLARSHIPS. QUASI-ENDOWMENT FUNDS HAVE BEEN DESIGNATED FOR VARIOUS USES TO FURTHER THE HOSPITAL'S MISSION TO PROVIDE QUALITY, COMPREHENSIVE HEALTH CARE SERVICES. SOME OF THESE DESIGNATIONS INCLUDE HOSPICE, CHAPLAINCY, CANCER TREATMENT ASSISTANCE, CAPITAL IMPROVEMENTS, AND PHARMACY ASSISTANCE.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2013, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS.

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable (2 entries)

RegionRegionNumber Of OfficesNumberOfOfficesNumber Of EmployeesNumberOfEmployeesType Of Activities ConductedTypeOfActivitiesConductedSpecific Services ProvidedSpecificServicesProvidedTotal ExpendituresTotalExpenditures
CENTRAL AMERICA AND THE CARIBBEAN00PROGRAM SERVICEPAYMENTS TO FOREIGN INSURANCE COMPANY THAT PROVIDES INSURANCE TO THE HOSPITAL2812629
CENTRAL AMERICA AND THE CARIBBEAN00INVESTMENT6372479
FieldValueIRS element (for citing)
Subtotal Number Of Offices0SubtotalNumberOfOffices
Subtotal Number Of Employees0SubtotalNumberOfEmployees
Cont Number Of Offices0ContNumberOfOffices
Cont Number Of Employees0ContNumberOfEmployees
Total Number Of Offices0TotalNumberOfOffices
Total Number Of Employees0TotalNumberOfEmployees
Subtotal Amount Spent9185108SubtotalAmountSpent
Cont Amount Spent0ContAmountSpent
Total Amount Spent9185108TotalAmountSpent
Transfer To Foreign Corp1TransferToForeignCorp
Interest In Foreign Trust0InterestInForeignTrust
Own Foreign Corp1OwnForeignCorp
Passive Foreign Invest Co0PassiveForeignInvestCo
Foreign Partnership0ForeignPartnership
Boycott Countries0BoycottCountries

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1FANTASY OF TREES 2012NameOfEvent1
Gross Receipts Event1195565GrossReceiptsEvent1
Charitable Contributions Event153636CharitableContributionsEvent1
Gross Revenue Event1141929GrossRevenueEvent1
Non Cash Prizes Event1100042NonCashPrizesEvent1
Rent Facility Costs Event15355RentFacilityCostsEvent1
Food And Beverage Event123343FoodAndBeverageEvent1
Entertainment Event11223EntertainmentEvent1
Other Direct Expenses Event113757OtherDirectExpensesEvent1
Name Of Event2GOLF OUTING 2013NameOfEvent2
Gross Receipts Event244645GrossReceiptsEvent2
Charitable Contributions Event230825CharitableContributionsEvent2
Gross Revenue Event213820GrossRevenueEvent2
Non Cash Prizes Event24687NonCashPrizesEvent2
Food And Beverage Event216625FoodAndBeverageEvent2
Other Direct Expenses Event2858OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events25954GrossReceiptsOtherEvents
Charitable Contrib Other Events24654CharitableContribOtherEvents
Gross Revenue Other Events1300GrossRevenueOtherEvents
Non Cash Prizes Other Events1682NonCashPrizesOtherEvents
Food And Beverage Other Events53FoodAndBeverageOtherEvents
Entertainment Other Events3600EntertainmentOtherEvents
Other Direct Expenses Other Events8905OtherDirectExpensesOtherEvents
Gross Receipts Total266164GrossReceiptsTotal
Charitable Contributions Total109115CharitableContributionsTotal
Gross Revenue Total Events157049GrossRevenueTotalEvents
Non Cash Prizes Total Events106411NonCashPrizesTotalEvents
Rent Facility Costs Total Events5355RentFacilityCostsTotalEvents
Food And Beverage Total Events40021FoodAndBeverageTotalEvents
Entertainment Total Events4823EntertainmentTotalEvents
Other Direct Expenses Total Events23520OtherDirectExpensesTotalEvents
Direct Expense Summary Events180130DirectExpenseSummaryEvents
Net Income Summary-23081NetIncomeSummary

Gaming Information GamingInformation

FieldValueIRS element (for citing)
Gross Revenue Other Gaming47716GrossRevenueOtherGaming
Cash Prizes Other Gaming4500CashPrizesOtherGaming
Non Cash Prizes Other Gaming40740NonCashPrizesOtherGaming
Other Direct Expenses Other Gaming1268OtherDirectExpensesOtherGaming
Volunteer Labor Other Gaming1VolunteerLaborOtherGaming
Volunteer Labor Prcnt Other Gaming1.00000VolunteerLaborPrcntOtherGaming
Gross Revenue Total Gaming47716GrossRevenueTotalGaming
Cash Prizes Total Gaming4500CashPrizesTotalGaming
Non Cash Prizes Total Gaming40740NonCashPrizesTotalGaming
Other Direct Expenses Total Gaming1268OtherDirectExpensesTotalGaming
Direct Expense Summary Gaming46508DirectExpenseSummaryGaming
Net Gaming Income Summary1208NetGamingIncomeSummary
FieldValueIRS element (for citing)
States Where Gaming ConductedMIStatesWhereGamingConducted
Licensed1Licensed
License Suspended Etc0LicenseSuspendedEtc
Gaming With Nonmembers1GamingWithNonmembers
Member Of Other Entity0MemberOfOtherEntity
Percentage Of Gaming Own Facility0.10000PercentageOfGamingOwnFacility
Percentage Of Gaming Othr Facility0.90000PercentageOfGamingOthrFacility
Name Of Gaming Rec Keeper PersonMOLLY MOORENameOfGamingRecKeeperPerson

Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS

FieldValueIRS element (for citing)
Address Line1718 N MACOMB STREETAddressLine1
CityMONROECity
StateMIState
ZIP Code48162ZIPCode
FieldValueIRS element (for citing)
Contract With3rd Party For Gam Rev0ContractWith3rdPartyForGamRev
Gaming Manager Name PersonMOLLY MOOREGamingManagerNamePerson
Gaming Manager Services ProvidedOVERSEES GAMING ACTIVITIES AND RECORDKEEPINGGamingManagerServicesProvided
Gaming Manager Is EmployeeXGamingManagerIsEmployee
Charitable Distrib Required0CharitableDistribRequired

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3681203TotalCommunityBenefitExpense
Net Community Benefit Expense3681203NetCommunityBenefitExpense
Percent Of Total Expense0.02270PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense27671645TotalCommunityBenefitExpense
Direct Offsetting Revenue19753579DirectOffsettingRevenue
Net Community Benefit Expense7918066NetCommunityBenefitExpense
Percent Of Total Expense0.04880PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense31352848TotalCommunityBenefitExpense
Direct Offsetting Revenue19753579DirectOffsettingRevenue
Net Community Benefit Expense11599269NetCommunityBenefitExpense
Percent Of Total Expense0.07150PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1049824TotalCommunityBenefitExpense
Direct Offsetting Revenue100759DirectOffsettingRevenue
Net Community Benefit Expense949065NetCommunityBenefitExpense
Percent Of Total Expense0.00590PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense845655TotalCommunityBenefitExpense
Net Community Benefit Expense845655NetCommunityBenefitExpense
Percent Of Total Expense0.00520PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense281127TotalCommunityBenefitExpense
Direct Offsetting Revenue3455DirectOffsettingRevenue
Net Community Benefit Expense277672NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense21151TotalCommunityBenefitExpense
Net Community Benefit Expense21151NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2197757TotalCommunityBenefitExpense
Direct Offsetting Revenue104214DirectOffsettingRevenue
Net Community Benefit Expense2093543NetCommunityBenefitExpense
Percent Of Total Expense0.01290PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense33550605TotalCommunityBenefitExpense
Direct Offsetting Revenue19857793DirectOffsettingRevenue
Net Community Benefit Expense13692812NetCommunityBenefitExpense
Percent Of Total Expense0.08440PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense28142TotalCommunityBuildingExpense
Net Community Building Expense28142NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Persons Served1030PersonsServed
Total Community Building Expense3792TotalCommunityBuildingExpense
Net Community Building Expense3792NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense200TotalCommunityBuildingExpense
Net Community Building Expense200NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense23999TotalCommunityBuildingExpense
Net Community Building Expense23999NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Persons Served1000PersonsServed
Total Community Building Expense10647TotalCommunityBuildingExpense
Net Community Building Expense10647NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Persons Served108PersonsServed
Total Community Building Expense23174TotalCommunityBuildingExpense
Net Community Building Expense23174NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Persons Served2138PersonsServed
Total Community Building Expense89954TotalCommunityBuildingExpense
Net Community Building Expense89954NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$7,930,041BadDebtExpenseAmount
Amount Attributable To793004AmountAttributableTo
Amount Reimbursed By Medicare40493203AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare51407716CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-10914513MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MERCY MEMORIAL HOSPITAL CORPORATIONBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1718 N MACOMB STREETAddressLine1
CityMONROECity
StateMIState
ZIP Code48162ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MERCY MEMORIAL HOSPITAL CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed0AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities35NumberOfOtherFacilities

Other Facilities OtherFacilities (35 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
MMH REHAB
700 STEWART ROADMONROEMI48162REHAB SERVICES
DIAGNOSTIC CENTER
901 N MACOMB STREETMONROEMI48162DIAGNOSTIC, CARDIOPULMONARY, LAB
MERCY MEMORIAL HOSPICE
1070 N MONROE STREETMONROEMI48162HOSPICE SERVICES
HOME CARE CONNECTION
1070 N MONROE STREET STE AMONROEMI48162HOME CARE SERVICES
WESTSIDE MEDICAL
100 POWELLDUNDEEMI48131DIAGNOSTIC THERAPY, LAB
PHLEBOTOMY-DELISLE CENTER
1056 N MONROE STREETMONROEMI48162OUTREACH LAB
BEHAVIORAL HEALTH
700 STEWART RDMONROEMI48162BEHAVIORAL HEALTH
MMH OUTPATIENT SURGERY CENTER
750 STEWART ROADMONROEMI48162AMBULATORY SURGERY CENTER
HOME RESPIRATORY DME
1070 N MONROE STREET STE CMONROEMI48162HOME RESPIRATORY DME
PHLEBOTOMYXRAY-DRKABIR
219 W FRONT STREETMONROEMI48162OUTREACH LAB
NEWPORT MEDICAL
7825 NORTH DIXIENEWPORTMI48166PATIENT ACCOUNTING, LAB
PHLEBOTOMY-DR STEWART
811 N MONROE STREETMONROEMI48162OUTREACH LAB
DR MICHAEL CHARBONEAU
730 N MACOMB STREETMONROEMI48162DOCTOR OFFICE
SLEEP LAB MACOMB
717 N MACOMB STREETMONROEMI48162SLEEP LAB SERVICES
DR AHADI OFFICE COMPLEX
55 COLE ROADMONROEMI48162OUTREACH LAB
PHLEBOTMY-KARPENKO
323 STEWART ROADMONROEMI48162OUTREACH LAB
DR KURT ROECKER
14930 LAPLAISANCE ROAD SUITE 118MONROEMI48162OUTREACH LAB
DR TODD PROCHNOW
730 N MACOMB STREET SUITE 419MONROEMI48162DOCTOR OFFICE
PHLEBOTOMY-DR DONA
7505 GRAFTON ROAD SUITE 5MONROEMI48162OUTREACH LAB
PHLEBOTOMY-DR QURESHI
5290 W BROOKSHIRE ROADMONROEMI48161OUTREACH LAB
DR DANIEL OLENCHAK
730 N MACOMB STREET SUITE 419MONROEMI48162DOCTOR OFFICE
DR MARVIN CRAIG
4220 LUNA PIER ROADLUNA PIERMI48157DOCTOR OFFICE
DR BARNETT KANTZ
100 POWELL ROAD STE 2DUNDEEMI48131DOCTOR OFFICE
MMH POB
730 N MACOMB STREETMONROEMI48162OUTPATIENT CLINIC
TEMPERANCE
1715 W DEAN ROADTEMPERANCEMI48182SLEEP LAB, LAB SERVICES
OUTPATIENT THERAPY
214 ELM STREETMONROEMI48162OCCUPATIONAL THERAPY SERVICES
DR JAMES DOYLE
920 N MACOMB STREETMONROEMI48162DOCTOR OFFICE
DR RAVI DAHR
721 N MACOMB STREET STE 6MONROEMI48162DOCTOR OFFICE
DR MICHELLE CHARTIER
7825 N DIXIE HWYNEWPORTMI48166DOCTOR OFFICE
DR BETTY RUMSCHLAG
7470 SECOR ROADLAMBERTVILLEMI48144DOCTOR OFFICE
DR BETTY RUMSCHLAG
110 MAIN STREETDUNDEEMI48131DOCTOR OFFICE
CANCER CONNECTION
800 STEWART ROADMONROEMI48162CANCER SUPPORT
DR KRISTA GUSTAD
730 N MACOMB STREET STE 329MONROEMI48162DOCTOR OFFICE
FAMILY MEDICAL RESIDENCY CENTER
650 STEWARD ROADMONROEMI48162DOCTOR OFFICE
MONROE CANCER CENTER
800 STEWART ROADMONROEMI48162CANCER TREATMENT

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. ACTUAL COSTS FROM THE COST ACCOUNTING SYSTEM AND ACCOUNTING RECORDS ARE USED FOR LINES 7E THROUGH 7I.
PART I, LINE 7G: N/A - THE HOSPITAL DID NOT LIST ANY SUBSIDIZED HEALTH SERVICES.
PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $7,930,041.
PART II: PARTICIPATION IN TASK FORCES AND COMMITTEES ASSURES A MORE COORDINATED APPROACH TO SERVICES FOR AN AGING POPULATION. EMERGENCY PREPAREDNESS AND COORDINATION OF EFFORT AMONG AGENCIES PROVIDING HUMAN SERVICES. SPECIFIC AREAS OF IMPROVEMENT INCLUDE PRE-HOSPITAL AMBULANCE CARE, REFERRAL OF SENIORS TO SUPPORTIVE COMMUNITY SERVICES, SUICIDE PREVENTION, SUBSTANCE ABUSE, AND BREASTFEEDING FOR IMPROVED CHILD HEALTH.
PART III, LINE 4: PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED UP ON MANAGEMENT'S ASSESSMENT OF THE HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTABLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. THE BAD DEBT AMOUNT REPORTED ON PART III LINE 2 IS BAD DEBT EXPENSE PER THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND PER FORM 990 PART IX. PART III, LINE 3: THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS ESTIMATED AT 10 PERCENT OF BAD DEBT EXPENSE.
PART III, LINE 8: THE SHORTFALL SHOULD BE CONSIDERED AND INCLUDED IN THE COMMUNITY BENEFIT AS THE REIMBURSEMENT DID NOT MEET THE "COST" OF THE EXPENSE BASED ON REASONABLE COSTING METHODOLOGIES. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT.
PART V, SECTION B, LINE 3: THE HOSPITAL CONSULTED WITH THE FOLLOWING INDIVIDUALS ON THE INDICATED AREAS: KIM COMERZAN, DIRECTOR MONROE COUNTY HEALTH DEPT AND DR. TATYANA IVANOVA, COMMUNITY HEALTH DIRECTOR MONROE COUNTY HEALTH DEPT., ON THE DEVELOPMENT OF COMMON CHNA SECONDARY DATA SET, CHN PRIORITIES, AND DESIGN OF FUTURE CHNA REPORTS. ED LARKINS, EXECUTIVE DIRECTOR FAMILY MEDICAL CENTER OF MICHIGAN FEDERALLY QUALIFIED CLINIC, AND DR. SUSAN HULSEMANN, DIRECTOR FAITHWORKS MEDICAL CLINIC FOR WORKING UNINSURED, ON THE NEEDS OF UNINSURED AND UNDERINSURED. ROB WHITNEY, COMMANDER MONROE COUNTY SALVATION ARMY, AND CONNIE CARROLL, EXECUTIVE DIRECTOR MONROE COUNTY UNITED WAY, ON NEEDS OF INDIGENT AND UNINSURED.ANDREA MULHEISEN, DIRECTOR NETWORK DEVELOPMENT AREA AGENCY ON AGING 1B, AND JEFF MCBEE, DIRECTOR MONROE COUNTY COMMISSION ON AGING, ON NEEDS OF ELDERLY.MERCY MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 5C: THE CHNA CAN BE FOUND AT THE HOSPITAL'S WEBSITE: HTTP://WWW.MERCYMEMORIAL.ORG/RESOURCE.ASHX?SN=CHNAMERCY MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 7: THE IMPLEMENTATION PLAN INCLUDES ONLY CHNA IDENTIFIED NEEDS NOT CURRENTLY BEING ADDRESSED BY THE HOSPITAL. THE FOLLOWING NEEDS ARE, THEREFORE, NOT INCLUDED IN THE IMPLEMENTATION PLAN: SMOKING CESSATION- THE HOSPITAL CONTINUES TO IDENTIFY AND COUNSEL INPATIENTS WHO SMOKE, CONTINUES TO OFFER CESSATION CLASSES TO THE COMMUNITY, CONTINUES TO MAINTAIN A SMOKE FREE CAMPUS, AND CONTINUES TO HIRE ONLY NON-SMOKERS. MENTAL HEALTH SERVICES AND SUBSTANCE ABUSE- THE HOSPITAL CONTINUES TO OPERATE THE ONLY LICENSED INPATIENT PSYCHIATRIC UNIT IN MONROE COUNTY, CONTINUES TO PROVIDE OUTPATIENT PSYCHIATRY AND COUNSELING SERVICES, AND CONTINUES TO RECRUIT A CHILD/ADOLESCENT PSYCHIATRIST.PREVENTION OF INJURIES- THE HOSPITAL CONTINUES TO PROVIDE AMBULANCE AND EMT COVERAGE OF COMMUNITY EVENTS, CONTINUES TO ACTIVELY PARTICIPATE IN INFANT AND CHILD SAFETY PROGRAMS OFFERED BY OTHER COMMUNITY AGENCIES, AND CONTINUES TO OFFER FIRST AID CLASSES TO THE COMMUNITY.MERCY MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 11: THE FINANCIAL ASSISTANCE POLICY IS FOR FREE CARE AND THE ONLY OTHER DISCOUNTED CARE AVAILABLE IS FOR ANY PATIENT PAYING WITHIN 30 DAYS RECEIVES A 20% DISCOUNT.MERCY MEMORIAL HOSPITAL CORPORATION
PART V, SECTION B, LINE 20D: FAP-ELIGIBLE INDIVIDUALS ARE NOT CHARGED AND DO NOT RECEIVE A BILL IF THEY QUALIFY UNDER THE HOSPITAL'S FAP.MERCY MEMORIAL HOSPITAL CORPORATION
PART VI, LINE 2: SECONDARY COMMUNITY HEALTH DATA ARE CONSIDERED IN THE ANNUAL REVIEW AND ADJUSTMENT OF THE HOSPITAL'S 3-YEAR STRATEGIC PLAN; HOSPITAL LEADERS SERVE ON COMMUNITY BOARDS, COMMITTEES AND TASK FORCES WHERE NEEDS MAY BE IDENTIFIED; THE HOSPITAL AND MONROE COUNTY HEALTH DEPARTMENT ARE COLLABORATING ON DEVELOPING A PRIMARY DATA ACQUISITION PROCESS DESIGNED TO ENGAGE COMMUNITY PARTNER ORGANIZATIONS, OBTAIN BROADER INPUT FROM COMMUNITY MEMBERS ON HEALTH NEEDS AND PRIORITIES, AND PROVIDE THE FOUNDATION FOR THE NEXT CHNA.
PART VI, LINE 3: WHEN IT IS DETERMINED THAT A PATIENT IS UNABLE TO PAY FOR SERVICES (EITHER BEFORE OR AFTER SERVICES ARE RENDERED) A FINANCIAL COUNSELOR WILL SPEAK TO THE PATIENT TO EXPLAIN FINANCIAL ASSISTANCE. THE FIRST OPTION OFFERED IS STATE MEDICAID. THE PATIENT IS ASSESSED FOR MEDICAID QUALIFICATION AND IF IT IS DETERMINED THE PATIENT DOES NOT QUALIFY, THEY ARE OFFERED CHARITY CARE ASSISTANCE. THE PATIENT IS GIVEN A CHARITY CARE APPLICATION AND REQUESTED TO COMPLETE AND RETURN TO THE FINANCIAL COUNSELOR WITH THE APPROPRIATE DOCUMENTATION. ONCE THE APPLICATION IS RETURNED TO THE FINANCIAL COUNSELOR, IT IS ASSEMBLED AND SENT TO THE PATIENT ACCOUNTING OFFICE FOR APPROVAL. DEPENDING ON THE AMOUNT, VARYING LEVELS OF APPROVAL ARE REQUIRED.
PART VI, LINE 4: WITHIN THE 549.4 SQUARE MILES OF MONROE COUNTY A MIXED URBAN AND RURAL ENVIRONMENT IS SUPPORTED BY A DIVERSE ECONOMY. URBAN AND INDUSTRIAL DEVELOPMENTS PREDOMINATE ALONG LAKE ERIE, WHILE APPROXIMATELY 1,100 WORKING FARMS OCCUPY THE WESTERN TOWNSHIPS. FROM THE 2010 CENSUS THERE WERE 152,021 PEOPLE IN THE COUNTY IN 58,888 HOUSEHOLDS. THE RACIAL MAKEUP OF THE COUNTY WAS 94.4% WHITE, 2.1% BLACK OR AFRICAN AMERICAN,0.3% NATIVE AMERICAN, 0.6% ASIAN, 0.8% FROM OTHER RACES, AND 1.8% FROM TWO OR MORE RACES. 96.3% SPOKE ENGLISH AT HOME. ABOUT 12.1% OF THE POPULATION WAS BELOW THE FEDERAL POVERTY LEVEL, AND 15,339 INDIVIDUALS UNDER 65 YEARS WERE UNINSURED. 12.8% OF THE POPULATION WAS OVER 65 YEARS. IN 2012 DECEMBER UNEMPLOYMENT WAS 7.6%.
PART VI, LINE 5: THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF; THE HOSPITAL'S BOARD OF TRUSTEES IS BROADLY REPRESENTATIVE OF THE COMMUNITY; HOSPITAL LEADERS SERVE ON COMMUNITY BOARDS, COMMITTEES AND TASKFORCES THAT ADDRESS HEALTH AND HUMAN SERVICES ISSUES.
PART VI, LINE 6: N/A - NOT AFFILIATED.
THE HOSPITAL IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT IN MICHIGAN OR ANY OTHER STATE.PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1FAMILY MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1905 N MACOMB STAddressLine1
CityMONROECity
StateMIState
ZIP Code48162ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient382308659EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Non Cash Assistance5826AmountOfNonCashAssistance
Purpose Of GrantRENT FOR FEDERALLY QUALIFIED CLINICPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: NURSING SCHOLARSHIPS ARE AWARDED BASED ON AN APPLICATION PROCESS. THE FUNDS ARE DISBURSED DIRECTLY TO THE EDUCATIONAL INSTITUTION.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CHARBONEAU DO MICHAEL
TRUSTEE, SURGEON5852310225090001790169930603528000
PHILLIPS ANNETTE S
PRESIDENT & CEO - EX OFFICIO388637050842048000133210170060474606000
SCHILLING THOMAS W
CFO SENIOR VP FINANCE263473026723060000132070169950326398000
UBRANSKI PAM
CNO1937500158330004170069710220724000
PROCHNOW TODD
PHYSICIAN4930860225012401000293940535106000
SOROSIAK MICHAEL J
CRNA224270045000050650169860246771000
OLENCHAK DANIEL
PHYSICIAN41826002250127990570288920460233000
KIBBLE JOHN
VP BUSINESS DEVELOPMENT19408301560004800096970580224238000
SHERRARD MARK
CMO23993402484004800050660169920291632000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE HOSPITAL MAINTAINS A MEMBERSHIP WITH A COMMUNITY GOLF / COUNTRY CLUB. THE MEMBERSHIP IS INTENDED FOR THE GENERAL USE OF THE HOSPITAL, AND IS MAINTAINED UNDER THE NAME OF THE CHIEF EXECUTIVE OFFICER (AS A REPRESENTATIVE MUST BE NAMED IN THIS INSTANCE). USE OF THE MEMBERSHIP IS MADE AVAILABLE FOR BUSINESS PURPOSES ONLY, AND PERSONAL USE IS PROHIBITED. FACILITIES AT THE COUNTRY CLUB ARE USED FOR HOSPITAL FUNCTIONS, BUSINESS MEETINGS, VOLUNTEER RECOGNITION, AND FUNDRAISING. THIS BENEFIT IS NOT TREATED AS TAXABLE COMPENSATION.
PART I, LINE 4BTHE ORGANIZATION OFFERS SELECT MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES ANNUAL EMPLOYER-FUNDED CONTRIBUTIONS EQUAL TO A FIXED PERCENT OF BASE SALARY: 15% FOR CEO, 10% FOR SENIOR VICE PRESIDENTS AND 5% FOR VICE PRESIDENTS. BENEFITS ARE VESTED AFTER THREE YEARS OF SERVICE AND ARE PAID OUT IN A LUMP SUM BY MARCH 15 OF THE YEAR FOLLOWING THE YEAR IN WHICH THEY BECOME VESTED. THE FOLLOWING INDIVIDUALS REPORTED ON FORM 990, PART VII ARE PARTICIPANTS: ANNETTE PHILLIPS, THOMAS SCHILLING AND JOHN KIBBLE.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
COUNTY OF MONROE HOSPITAL FINANCE AUTHORITY
A386004873610648AR82006-06-1550405076CONSTRUCTION PROJECT ADDING 58,995 SQ FT; RENOVATING 66,910 SQ FT000
COUNTY OF MONROE HOSPITAL FINANCE AUTHORITY
B3860048732012-03-303170830CATH LAB RENOVATION AND EQUIPMENT000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A5263977938124117090133638271920091011
B317083030000314083020120011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUseBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs
A001100.000000.000000.00000000
B001100.000000.000000.00000000

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqsRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDue
A100000
B000000010

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A1
B1

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierExplanationExplanation
SCHEDULE K, PART I, BOND ISSUES:MONROE COMMUNITY HEALTH SERVICES IS A MEMBER OF THE MERCY MEMORIAL HOSPITAL CORPORATION OBLIGATED GROUP OF WHICH MONROE COMMUNITY HEALTH SERVICES HAS BEEN ALLOCATED FUNDS FROM THIS 2006 BOND ISSUANCE.
SCHEDULE K, PART I, BOND ISSUES:A- THE BOND ISSUE PRICE WAS $50,405,076.58 WITH A REDEMPTION PRICE OF $49,550,000 AT MATURITY. PROCEEDS OF THE ISSUE WERE USED FOR BOND ISSUANCE COSTS, REQUIRED RESERVE FUND, REFUND PRIOR ISSUE BONDS AND INDEBTEDNESS (02/01/1994 BONDS) AND BUILDING EXPANSION AND EQUIPMENT. B - SIEMENS PUBLIC INC. PROGRAM REVENUE NOTE ISSUE PRICE WAS $3,170,830. PROCEEDS OF THE ISSUE WERE USED FOR NOTE ISSUANCE COSTS AND CATH LAB RENOVATION EQUIPMENT.

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonCOMPEAN MD JOSE RNamePerson
Relationship With OrganizationTRUSTEERelationshipWithOrganization
Purpose Of LoanPHYSICIAN RECRUITMENTPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$156,459OriginalPrincipalAmount
Balance Due28684BalanceDue
Default0Default
Approved By Board0ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due28684TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
MARY CARTER
FAMILY MEMBER OF BOARD MEMBER KURT CARTER.28645EMPLOYMENT0
LARRY CSOKASY
FAMILY MEMBER OF BOARD MEMBER KURT CARTER.99783EMPLOYMENT0
MONROE HEALTH CENTER
>35% OWNED BY BOARD MEMBER AAMER BHURGRI.194231LEASE OF PROPERTY0

Schedule M IRS990ScheduleM

Works Of Art WorksOfArt

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions4NumberOfContributions
Noncash Contribs Rptd F990380NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALESMethodOfDeterminingRevenues

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F99038590NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALESMethodOfDeterminingRevenues

Collectibles Collectibles

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990300NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALESMethodOfDeterminingRevenues

Food Inventory FoodInventory

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions9NumberOfContributions
Noncash Contribs Rptd F9901506NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALESMethodOfDeterminingRevenues

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions40NumberOfContributions
Noncash Contribs Rptd F9906850NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALESMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionAUCTION ITEMSDescription
Number Of Contributions104NumberOfContributions
Noncash Contribs Rptd F99034355NoncashContribsRptdF990
Method Of Determining RevenuesCOMPARABLE SALESMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierMETHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS:Identifier
Return ReferencePART I, COLUMN (B):ReturnReference
ExplanationNUMBER OF CONTRIBUTIONSExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2BOARD MEMBERS DR. KENNETH MCNAMEE, DR. AAMER BHURGRI, DR. MICHAEL CHARBONEAU, AND DR. ABDUL KABIR HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 4THE ORGANIZATION AMENDED ITS BYLAWS FOR THE FOLLOWING: TO STATE THAT 20% OF THE ELECTED BOARD MEMBERS MAY RESIDE OUTSIDE MONROE COUNTY; A MINIMUM OF TWO, QUALIFIED MEMBERS OF THE MEDICAL STAFF (INDEPENDENT OR EMPLOYED BY THE ORGANIZATION) WILL BE ON THE BOARD OF TRUSTEES; THE EXECUTIVE COMMITTEE MAY ACT AS THE NOMINATING COMMITTEE IF NO SEPARATE COMMITTEE IS CONSTITUTED; AND THE COMPENSATION COMMITTEE SHALL CONSIST OF AT LEAST THREE ELECTED TRUSTEES APPOINTED BY THE CHAIRPERSON OF THE BOARD AND A MAJORITY OF THE COMMITTEE IS TO BE INDEPENDENT.
FORM 990, PART VI, SECTION B, LINE 11FORM 990 INPUT DATA IS REVIEWED AND ANALYZED BY THE CONTROLLER AND THEN SUBMITTED TO THE CERTIFIED PUBLIC ACCOUNTING FIRM FOR PREPARATION. THE COMPLETED FORM 990 IS THEN RETURNED TO THE CFO AND THE CEO FOR FINAL REVIEW AND APPROVAL BEFORE THE BOARD MEETING. BEFORE THE RETURN IS FILED, THE FORM 990 IS REVIEW BY THE BOARD. ALL MEMBERS RECEIVE A COPY OF THE FORM 990, EVEN THOSE THAT ARE UNABLE TO ATTEND THE SCHEDULED MEETING. THE REVIEW IS PERFORMED DURING ONE OF THE MONTHLY BOARD MEETINGS, WHERE EACH MEMBER HAS A CHANGE TO ASK QUESTIONS. THIS REVIEW IS DOCUMENTED VIA MINUTES TO THE MEETING.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY COVERS BOARD MEMBERS, OFFICERS AND EMPLOYEES OF THE HOSPITAL. ON AN ANNUAL BASIS, THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS DISTRIBUTED TO OFFICERS, EMPLOYEES, AND TRUSTEES OF MERCY MEMORIAL HOSPITAL CORPORATION. POTENTIAL CONFLICTS OF INTEREST ARE ANALYZED BY THE HOSPITAL'S LEGAL DEPARTMENT AND ARE GIVEN RANKINGS OF LOW, MODERATE, AND SEVERE RISK. THIS ANALYSIS IS GIVEN TO THE BOARD CHAIR AND THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. ANY MEMBER WITH AN IDENTIFIED CONFLICT OF INTEREST IS EXCUSED FROM THE MEETING DURING DISCUSSIONS PERTAINING TO THE ISSUE OF CONFLICT, AND THE MEMBER IS NOT PERMITTED TO VOTE ON ANY ISSUE OF CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES AND APPROVES ALL COMPENSATION FOR THOSE DESIGNATED IN SENIOR LEADERSHIP POSITIONS SUCH AS THE CHIEF EXECUTIVE OFFICER & PRESIDENT, THE CHIEF MEDICAL OFFICER & VICE PRESIDENT OF MEDICAL AFFAIRS, THE CHIEF FINANCIAL OFFICER & SENIOR VICE PRESIDENT OF FINANCE, THE CHIEF NURSING OFFICER & SENIOR VICE PRESIDENT OF CLINICAL OPERATIONS, AND OTHER VICE PRESIDENTS. THE INDEPENDENT BOARD COMMITTEE RETAINS AN OUTSIDE CONSULTANT TO ANALYZE AND ASSIST IN MAKING THESE DETERMINATIONS THROUGH A VARIETY OF MARKET SURVEYS/STUDIES. THIS PROCESS IS UNDERTAKEN ANNUALLY AND WAS LAST PERFORMED IN 2013.
FORM 990, PART VI, SECTION C, LINE 19DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:PENSION LIABILITY ADJUSTMENT 10,741,282. INCOME FROM PROCEEDS OF BOND ISSUE NOT UNDER THE CONTROL OF THE HOSPITAL 21,914.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C:THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT OR SELECTION PROCESS FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MONROE COMMUNITY HEALTH SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1718 N MACOMB STREETAddressLine1
CityMONROECity
StateMIState
ZIP Code48164ZIPCode
FieldValueIRS element (for citing)
EIN382934134EIN
Primary ActivitiesSKILLED NURSING AND OUTPATIENT SURGERYPrimaryActivities
Legal Domicile StateMILegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MERCY MEMORIAL HOSPITAL CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org1ControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1MONROE HEALTH VENTURESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1718 N MACOMB STREETAddressLine1
CityMONROECity
StateMIState
ZIP Code48164ZIPCode
FieldValueIRS element (for citing)
EIN382704426EIN
Primary ActivityPHARMACYPrimaryActivity
Legal Domicile StateMILegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MERCY MEMORIAL HOSPITAL CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Percentage Ownership1.00000PercentageOwnership
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
MONROE COMMUNITY HEALTH SERVICES
L261496ACTUAL ALLOCATED COST
MONROE COMMUNITY HEALTH SERVICES
M152284ACTUAL ALLOCATED COST
MONROE COMMUNITY HEALTH SERVICES
P130598ACTUAL ALLOCATED COST
MONROE COMMUNITY HEALTH SERVICES
Q1415661ACTUAL ALLOCATED COST
MONROE COMMUNITY HEALTH SERVICES
S473482ACTUAL ALLOCATED COST