MUNSON HEALTHCARE CHARLEVOIX HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (EIN 38-1459366)
- Tax period
- 2012-04-01 to 2013-03-31
- Filed
- 2014-02-13
- IRS object ID
- 201430449349301038
- Schema version
- 2012v2.3
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-02-13T13:58:10-06:00 | Timestamp |
| Tax Period End Date | 2013-03-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381459366 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHAR | NameControl |
| Phone | 2315474024 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LYN JENKS | Name |
| Title | PRESIDENT | Title |
| Phone | 2315474024 | Phone |
| Date Signed | 2014-02-13 | DateSigned |
| Authorize Third Party | false | AuthorizeThirdParty |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LYN JENKS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 39684244 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CAH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1919 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE EXCELLENT HEALTHCARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 379 | TotalNbrEmployees |
| Total Nbr Volunteers | 57 | TotalNbrVolunteers |
| Total Gross UBI | 200864 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 67768 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 274383 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 195000 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 33233011 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 39232741 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 179243 | InvestmentIncomePriorYear |
| Investment Income Current Year | 31128 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 109631 | OtherRevenuePriorYear |
| Other Revenue Current Year | 103419 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 33796268 | TotalRevenuePriorYear |
| Total Revenue Current Year | 39562288 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21188447 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21344081 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14052496 | OtherExpensePriorYear |
| Other Expenses Current Year | 17993561 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 35240943 | TotalExpensesPriorYear |
| Total Expenses Current Year | 39337642 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1444675 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 224646 | RevenuesLessExpensesCY |
| Total Assets BOY | 26227208 | TotalAssetsBOY |
| Total Assets EOY | 26923065 | TotalAssetsEOY |
| Total Liabilities BOY | 9184499 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9575829 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17042709 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 17347236 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE EXCELLENT HEALTHCARE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 8922220 | Expense |
| Revenue | 17167405 | Revenue |
| Description | OPERATING ROOM SERVICES - SURGERIES: 2,779 | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6828808 | Expense |
| Revenue | 6438212 | Revenue |
| Description | PRIMARY CARE SERVICES: 23,051 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3381578 | Expense |
| Revenue | 4445739 | Revenue |
| Description | EMERGENCY ROOM SERVICES - PATIENTS SEEN IN THE ER: 11,772 | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 13599771 | Expense |
| Revenue | 11510932 | Revenue |
| Description | OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, EMERGENCY ROOM SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. PATIENTS SEEN IN THE EMERGENCY ROOM TOTAL 11,772 | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 13599771 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 11510932 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 32732377 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 50 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 379 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | TABITHA RUDOLPH | NamePerson |
| Telephone Number | 2315478508 | TelephoneNumber |
Address US AddressUS
| 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) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (27 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| MARC LAME MD | ||||||||
| DIRECTOR | 40.00 | X | 288899 | 0 | 10050 | |||
| WILLIAM JACKSON | ||||||||
| PAST PRESIDE | 40.00 | X | 186771 | 0 | 19011 | X | ||
| MICHAEL HARMELING MD | ||||||||
| DIR/CHIEF OF | 40.00 | X | 162929 | 0 | 20035 | X | ||
| STEVE HUFFORD OD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | X | ||
| SCOTT BEATTY | ||||||||
| CHAIR | 1.00 | X | 0 | 0 | 0 | X | ||
| MARY JASON | ||||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | X | ||
| RICHARD FISH DDS | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| REBECCA HANEY | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| HAROLD PERKINS | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| STEVE WEBER | ||||||||
| SECRETARY/TR | 1.00 | X | 0 | 0 | 0 | X | ||
| RUTH B HOPPE MD | ||||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | X | ||
| JOHN KURTZ | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MICHAEL ORTWINE | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MARILYN DUMBAULD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| KATHY WEBER | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MELODIE BROWN MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MARY FACULAK | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| NANCY SHERMAN | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MARK ECKHARDT | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JOSEPH SCHODDE | ||||||||
| VP OF FINANC | 40.00 | 140160 | 0 | 18309 | X | |||
| GLADYLYN JENKS | ||||||||
| CEO | 40.00 | 65167 | 50000 | 0 | X | 1.00 | ||
| ROBERT ZIMMERMAN | ||||||||
| CHIEF FINANC | 8.00 | 0 | 0 | 0 | X | |||
| MARY IVEY MD | ||||||||
| OBSTETRICIAN | 40.00 | 367279 | 0 | 18301 | X | |||
| JAMES JEAKLE MD | ||||||||
| OBSTETRICIAN | 40.00 | 322028 | 0 | 20660 | X | |||
| CRAIG WENDT MD | ||||||||
| PHYSICIAN | 40.00 | 290776 | 0 | 12852 | X | |||
| CATHERINE WONSKI MD | ||||||||
| PHYSICIAN | 40.00 | 216792 | 0 | 21386 | X | |||
| BRIAN DISHINGER MD | ||||||||
| PHYSICIAN | 40.00 | 202092 | 0 | 10935 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2242893 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 50000 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 151539 | TotalOtherCompensation |
| Number Individuals GT100 K | 24 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PINE RIVER MEDICAL ASSOCIATES | |||||
| 14734 PARK AVENUE | CHARLEVOIX | MI | 49720 | ER PHYSICIAN | 1442825 |
| ALLIANCE-HNI LLC | |||||
| 525 S GOULD | OWOSSO | MI | 48867 | MOBILE MRI SERV | 372794 |
| QUEST DIAGNOSTICS | |||||
| 4444 GIDDINGS ROAD | AUGURN HILLS | MI | 48326 | LABORATORY SERV | 201633 |
| PLANTE & MORAN PLLC | |||||
| 600 EAST FRONT ST | TRAVERSE CITY | MI | 49686 | AUDIT & ACCOUNT | 157935 |
| MUNSON SUPPORT SERVICES | |||||
| 1105 SIXTH STREET | TRAVERSE CITY | MI | 49685 | LAUNDRY SERVICE | 125309 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 187734 | RelatedOrganizations |
| Government Grants | 7266 | GovernmentGrants |
| Noncash Contributions | 7913 | NoncashContributions |
| Total Contributions | 195000 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| HEALTH SERVICES | 621110 | 32705388 | 32705388 | |
| OTHER RELATED REVENUE | 621110 | 6326489 | 6326489 | |
| OTHER HEALTH SERVICES | 621110 | 200864 | 200864 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 39232741 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29628 | TotalRevenueColumn |
| Exclusion | $29,628 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 97181 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 121956 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -24775 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -24775 | TotalRevenueColumn |
| Related Or Exempt Function Income | -24775 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1500 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1500 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1500 | TotalRevenueColumn |
| Exclusion | $1,500 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA SALES | Description |
| Total Revenue Column | 128194 | TotalRevenueColumn |
| Exclusion | $128,194 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 128194 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 39562288 | TotalRevenueColumn |
| Related Or Exempt Function Income | 39007102 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 200864 | UnrelatedBusinessRevenue |
| Exclusion | $159,322 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 960738 | Total |
| Program Services | 518557 | ProgramServices |
| Management And General | 442181 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16405830 | Total |
| Program Services | 14345058 | ProgramServices |
| Management And General | 2060772 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 261918 | Total |
| Program Services | 218464 | ProgramServices |
| Management And General | 43454 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2551755 | Total |
| Program Services | 2184749 | ProgramServices |
| Management And General | 367006 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1163840 | Total |
| Program Services | 981019 | ProgramServices |
| Management And General | 182821 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56250 | Total |
| Management And General | 56250 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74420 | Total |
| Management And General | 74420 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 176935 | Total |
| Management And General | 176935 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3546310 | Total |
| Program Services | 3019309 | ProgramServices |
| Management And General | 527001 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 126024 | Total |
| Management And General | 126024 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47020 | Total |
| Program Services | 34450 | ProgramServices |
| Management And General | 12570 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 179131 | Total |
| Management And General | 179131 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 757585 | Total |
| Program Services | 618568 | ProgramServices |
| Management And General | 139017 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69887 | Total |
| Program Services | 60892 | ProgramServices |
| Management And General | 8995 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67753 | Total |
| Program Services | 41089 | ProgramServices |
| Management And General | 26664 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104836 | Total |
| Program Services | 85598 | ProgramServices |
| Management And General | 19238 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2044532 | Total |
| Program Services | 1669360 | ProgramServices |
| Management And General | 375172 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222463 | Total |
| Program Services | 66452 | ProgramServices |
| Management And General | 156011 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 7129904 | 6773612 | 356292 |
| PROVISION FOR BAD DEBTS | 1411205 | 1411205 | |
| QAAP TAX | 697796 | 697796 | |
| EQUIPMENT SERVICE & RENTA | 590457 | 493960 | 96497 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 691053 | Total |
| Program Services | 210035 | ProgramServices |
| Management And General | 481018 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39337642 | Total |
| Program Services | 32732377 | ProgramServices |
| Management And General | 6605265 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 186619 | BOY |
| EOY | 226280 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37404 | BOY |
| EOY | 1794055 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25347 | BOY |
| EOY | 21421 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4958932 | BOY |
| EOY | 4828835 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 137968 | BOY |
| EOY | 141375 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 372078 | BOY |
| EOY | 814582 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 892940 | BOY |
| EOY | 401978 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 46057591 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 31349861 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16284119 | BOY |
| EOY | 14707730 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72632 | BOY |
| EOY | 79134 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1668278 | BOY |
| EOY | 1693952 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1590891 | BOY |
| EOY | 2213723 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26227208 | BOY |
| EOY | 26923065 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3203562 | BOY |
| EOY | 4624769 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4092706 | BOY |
| EOY | 2371715 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1888231 | BOY |
| EOY | 2579345 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9184499 | BOY |
| EOY | 9575829 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16187042 | BOY |
| EOY | 16591741 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 855667 | BOY |
| EOY | 755495 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17042709 | BOY |
| EOY | 17347236 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26227208 | BOY |
| EOY | 26923065 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 224646 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 79881 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $4,824 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4824 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | SCHEDULE C, PART II-B, LINE 1 | ReturnReference |
| Explanation | PORTION OF ANNUAL DUES PAID TO THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARDS LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 502714 | OtherCostOrOtherBasis |
| Book Value | 502714 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29306268 | OtherCostOrOtherBasis |
| Depreciation | 19071620 | Depreciation |
| Book Value | 10234648 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16090887 | OtherCostOrOtherBasis |
| Depreciation | 12278241 | Depreciation |
| Book Value | 3812646 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 157722 | OtherCostOrOtherBasis |
| Book Value | 157722 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14707730 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN CHARLEVOIX NURSING HOM | 959878 | F |
| INVESTMENT IN CHARLEVOIX FOUNDATION | 734074 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1693952 | TotalOfBookValueSecurities |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| COST REPORT SETTLEMENT RECEIVABLE | 1775475 |
| AFFILIATE RECEIVABLE | 189326 |
| BOND ISSUE COSTS | 142047 |
| ACCRUED MEANINGFUL USE FUNDING RECEI | 106875 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2213723 | TotalBookValueOtherAssets |
| Tot Revenue Etc Audited Fincl Stmt | 38273039 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1411205 | OtherRevenues |
| Revenue Not Rptd F990 | -1411205 | RevenueNotRptdF990 |
| Revenue Subtotal | 39684244 | RevenueSubtotal |
| Other Revenues Not Included | -121956 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -121956 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 39562288 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 38048393 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | -1411205 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | -1411205 | ExpensesNotRptdF990 |
| Expenses Subtotal | 39459598 | ExpensesSubtotal |
| Other Expenses Not Included | -121956 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | -121956 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 39337642 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 2D | PROVISION FOR BAD DEBT -1,411,205 |
| REVENUE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 4B | RENTAL EXPENSES -121,956 |
| EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 2D | PROVISION FOR BAD DEBT -1,411,205 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 4B | RENTAL EXPENSES -121,956 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 238845 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 99754 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 139091 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00360 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3713718 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2361301 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1352417 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03470 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3952563 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2461055 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1491508 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03830 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 384460 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5521 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 378939 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00970 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 384460 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5521 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 378939 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00970 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4337023 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2466576 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1870447 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04800 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,411,205 | BadDebtExpenseAmount |
| Amount Attributable To | 189840 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9816468 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9729213 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 87255 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
Address Address
| 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 | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Other | X | Other |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | false | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE | PART I LINE 3C | IN ADDITION TO USE OF THE FEDERAL POVERTY GUIDELINES PATIENTS MUST ALSO SATISFY AN ASSET TEST LIMIT OF 62000 FURTHERMORE TOTAL MEDICAL DEBT WILL BE CONSIDERED ON A CASE BY CASE BASIS AS AN ADDITIONAL ELEMENT IN DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE |
| SUBSIDIZED HEALTH SERVICES EXPLANATION | PART I LINE 7G | THE HOSPITAL DID NOT REPORT SUBSIDIZED HEALTH SERVICES |
| EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | PART I LINE 7 COLUMN F | 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 1411205 |
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IS USED FOR LINES 7A AND 7B ACTUAL COSTS ARE REPORTED ON LINE 7E |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | 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 THIRDPARTY 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 THIRDPARTY 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 SELFPAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY 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 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 189840 OF BAD DEBT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITALS CHARITY CARE POLICY AND SHOULD BE INCLUDED AS COMMUNITY BENEFIT BASED ON AN ANALYSIS OF SELF PAY ENCOUNTERS WHOSE GROSS CHARGES EXCEEDED 1000 AND THEREFORE WERE AUTOMATICALLY SENT A FINANCIAL ASSISTANCE APPLICATION IT WAS DETERMINED THAT APPROXIMATELY 45 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 |
| MEDICARE EXPLANATION | PART III LINE 8 | 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 |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE |
| NEEDS ASSESSMENT | PART VI | 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 COMMUNITYS 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 WEDNESDAYS FREE MAMMOGRAPHY AND SPORTS PHYSICALS FOR STUDENT ATHLETES |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE HOSPITALS 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 HOSPITALS 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 HOSPITALS FINANCIAL ASSISTANCE APPLICATION IS MADE AVAILABLE IN THE EVENT THE PATIENTS 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 1000 ARE AUTOMATICALLY SENT AN APPLICATION |
| COMMUNITY INFORMATION | PART VI | 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 26000 RESIDENTS WITH A PER CAPITA INCOME OF APPROXIMATELY 40000 BASED ON 2008 ESTIMATES 112 OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL SIMILARLY MEDICAID RECIPIENTS ACCOUNTED FOR APPROXIMATELY 12 OF THE HOSPITALS 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 |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | THE BOARD OF DIRECTORS IS COMPRISED OF MEDICAL AND BUSINESS PROFESSIONALS ALMOST ALL OF WHOM RESIDE IN THE HOSPITALS 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 FIT4LIFE FOR ADULTS WEIGHT WATCHERS AT WORK CIRCLE OF STRENGTH CANCER SUPPORT GROUP CIRCLE OF STRENGTH MAMMOGRAM VOUCHERS PINK RIBBON RIDE FIT4LIFE FOR KIDS HOSPITAL AND CAREER EXPLORATION TOURS READ TO ME PROGRAM SCHOOL NURSE PROGRAM |
| AFFILIATED HEALTH CARE INFORMATION | PART VI | THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM |
| LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED | PART VI | MICHIGAN |
| CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 3 | 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 V4 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 1200 INDIVIDUALS PARTICIPATED IN SURVEYS ANDOR 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 |
| CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 4 | PART V LINE 4 | MCLAREN NORTHERN MICHIGAN PETOSKEY MI OTSEGO MEMORIAL HOSPITAL GAYLORD MI |
| CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 7 | 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 WOMENS 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 SECONDHAND 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 |
| CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 20D | PART V LINE 20D | A PERCENTAGE DISCOUNT RANGING FROM 20 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 300 OF THE FEDERAL POVERTY LEVEL AND TAKING INTO ACCOUNT THE NUMBER OF MEMBERS IN THE FAMILY THE 20 DISCOUNT EXCEEDS THE DISCOUNT NEGOTIATED WITH CHARLEVOIX AREA HOSPITALS TWO LARGEST PRIVATE INSURERS WHICH REPRESENT 30 OF OUR PAYER MIX |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg |
|---|---|---|---|---|---|---|
| MARC LAME MD | ||||||
| DIRECTOR | 288284 | 615 | 10050 | 298949 | ||
| WILLIAM JACKSON | ||||||
| PAST PRESIDENT | 141552 | 15618 | 205782 | 45219 | 3393 | |
| MICHAEL HARMELING MD | ||||||
| DIRCHIEF OF STAFF | 139237 | 23383 | 17158 | 182964 | 309 | 2877 |
| JOSEPH SCHODDE | ||||||
| VP OF FINANCIAL SERV | 58110 | 15766 | 158469 | 82050 | 2543 | |
| MARY IVEY MD | ||||||
| OBSTETRICIAN | 209450 | 143148 | 13948 | 385580 | 14681 | 4353 |
| JAMES JEAKLE MD | ||||||
| OBSTETRICIAN | 206209 | 113830 | 16447 | 342688 | 1989 | 4213 |
| CRAIG WENDT MD | ||||||
| PHYSICIAN | 287924 | 615 | 12852 | 303628 | 2237 | |
| CATHERINE WONSKI MD | ||||||
| PHYSICIAN | 183163 | 27697 | 17623 | 238178 | 5932 | 3763 |
| BRIAN DISHINGER MD | ||||||
| PHYSICIAN | 161238 | 27000 | 7562 | 213027 | 13854 | 3373 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS | SCHEDULE J, PAGE 1, PART I, LINE 4 | JOSEPH SCHODDE 52,560 0 0 |
| OTHER ADDITIONAL INFORMATION | SCHEDULE J, PART III | SEVERANCE COMPENSAION: SUBJECT TO REVIEW AND APPROVAL BY THE BOARD, IN ORDER TO RECRUIT AND MAINTAIN QUALIFIED EXECUTIVES, A COMPETITIVE BENEFIT PACKAGE WAS OFFERED TO THE CHIEF FINANCIAL OFFICER WHICH INCLUDED A SEVERANCE PROVISON IN THEIR EMPLOYMENT CONTRACT. THERE IS NO FORMAL SEVERANCE PLAN AT CHARLEVOIX AREA HOSPITAL. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| 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) |
|---|---|---|
| Issuer EIN | 383203086 | IssuerEIN |
| Date Issued | 2013-03-28 | DateIssued |
| Issue Price | 3230010 | IssuePrice |
| Description Of Purpose | REFUND/REISSUE 2001 SERIES CHARLEVOIX TOWNSHIP HOSPITAL FINANCE AUTHORITY | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 3230010 | TotalProceeds |
| Other Spent Proceeds | 3230010 | OtherSpentProceeds |
| Current Refunding | true | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | false | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedProp |
| Remedial Action Taken | false | RemedialActionTaken |
| Non Qualified Bond Remed Procdrs | false | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiled |
| Rebate Not Due Yet | false | RebateNotDueYet |
| Exception To Rebate | true | ExceptionToRebate |
| No Rebate Due | false | NoRebateDue |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | false | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PURPOSE OF ISSUE DESCRIPTION | SCHEDULE K | CHARLEVOIX TWP HOSP FIN AUTH 2001 LIMITED OBLIGATION HOSPITAL REVENUE AND REFUNDING BONDS ISSUE DATE 11132001 |
| ADDITIONAL INFORMATION | SCHEDULE K | CHARLEVOIX TWP HOSP FIN AUTH 2001 CHARLEVOIX AREA HOSPITAL IS IN THE PROCESS OF ADOPTING WRITTEN PROCEDURES FOR POSTISSUANCE COMPLIANCE WHICH WILL INCLUDE PROVISIONS TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH A VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELFREMEDIATION IS NOT AVAILABLE |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| KAYE BEATTY | |||
| WIFE OF BOARD M | 35892 | COMPENSATION | false |
| PINE RIVER MEDICAL ASSOCIATES | |||
| BOARD MEMBER | 1474678 | INDEPENDENT | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | A NAME OF PERSON KAYE BEATTY B RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION WIFE OF BOARD MEMBER SCOTT BEATTY D DESCRIPTION OF TRANSACTION COMPENSATED AS AN EMPLOYEE OF THE HOSPITAL A NAME OF PERSON PINE RIVER MEDICAL ASSOCIATES B RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION BOARD MEMBER MELODIE BROWN IS AN OWNER OF PINE RIVER MEDICAL ASSOCIATES D DESCRIPTION OF TRANSACTION INDEPENDENT CONTRACTOR ARRANGEMENT FOR ER AND HOSPITALIST PHYSICIAN SERVIES 1104617 PROFESSIONAL SERVICES AGREEMENT 47333 TRANSCRIPTION SERVICES PROVIDED BY THE HOSPITAL TO PINE RIVER 25200 RENTAL OF SPACE AND OFFICE STAFF FOR HOSPITALEMPLOYED PEDIATRICIAN HOUSED AT PINE RIVER 207000 RENTAL OF PHYSICIAN OFFICE BUILDING TO PINE RIVER BY THE HOSPITAL 30834 DURING 2013 CHARLEVOIX AREA HOSPITAL PURCHASED THE ASSETS OF PINE RIVER MEDICAL ASSOCIATES FOR 48180 AND EXECUTED A THREE YEAR NONCOMPETE AGREEMENT FOR 10000 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ALL OTHER ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, EMERGENCY ROOM SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. PATIENTS SEEN IN THE EMERGENCY ROOM TOTAL 11,772 |
| MANAGEMENT DELEGATED | 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. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | 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. |
| ENFORCEMENT OF CONFLICTS POLICY | 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. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | 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. |
| COMPENSATION PROCESS FOR OFFICERS | 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. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLIT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPSON REQUEST. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | LYN JENKS, PRESIDENT OF CHARLEVOIX AREA HOSPITAL, SPENDS APPROXIMATELY 1 HOUR A WEEK FOR THE CHARLEVOIX AREA HOSPITAL FOUNDATION. |
| RECONCILIATION OF CHANGES - OTHER | FORM 990, PART XI, LINE 9 | PROVISION FOR BAD DEBT -1,411,205 RENTAL EXPENSES 121,956 PROVISION FOR BAD DEBT 1,411,205 RENTAL EXPENSES -121,956 |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 9 | AFFILIATE TRANSFER 79,881 TRANSFER FROM FOUNDATION AFFILIATE 79,881 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL FOUNDATION | BusinessNameLine1 |
| Business Name Line2 | CHARLEVOIX AREA HOSPITAL FOUNDATION | BusinessNameLine2 |
Address US AddressUS
| 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 | PrimaryActivities |
| Legal Domicile State | MI | LegalDomicileState |
| Exempt Code Section | 501C3 | ExemptCodeSection |
| Public Charity Status | 11A | PublicCharityStatus |
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 Org | true | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| C | 267617 | CASH |
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| N | 45908 | FMV ACTUAL AMOUNTS PAID |
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| P | 102231 | FMV ACTUAL AMOUNTS PAID |