DECKERVILLE COMMUNITY HOSPITAL INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: DECKERVILLE COMMUNITY HOSPITAL INC (EIN 38-1415390)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2014-03-11
IRS object ID: 201440709349300769
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 D
Schedule H
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-03-11T13:40:46-05:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MYLER & SZCZYPKA PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 435	AddressLine1
City	ANN ARBOR	City
State	MI	State
ZIP Code	481060435	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	381415390	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	DECKERVILLE COMMUNITY HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	DECK	NameControl
Phone	8103762835	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3559 PINE STREET	AddressLine1
City	DECKERVILLE	City
State	MI	State
ZIP Code	484270126	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	VALERIE BRYANT	Name
Title	CFO	Title
Phone	8103762835	Phone
Date Signed	2014-02-13	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	K G SZCZYPKA	Name
Phone	7349305500	Phone
Date Prepared	2014-03-06	DatePrepared

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	VALERIE BRYANT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	3559 PINE STREET	AddressLine1
City	DECKERVILLE	City
State	MI	State
ZIP Code	484270126	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	7073480	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.DECKERVILLEHOSP.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1968	YearFormation
State Legal Domicile	MI	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES CLOSE TO HOME IN A PATIENT-CENTERED ENVIRONMENT, PROVIDE COORDINATION OF SPECIALTY AND TERTIARY CARE, AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO PROVIDE HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY IN MEETING THE NEEDS OF THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND ECONOMICALLY DISADVANTAGED IN ITS SERVICE AREA.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	3	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	3	NbrIndependentVotingMembers
Total Nbr Employees	105	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	18333	ContributionsGrantsPriorYear
Contributions Grants Current Year	21839	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	7553546	ProgramServiceRevenuePriorYear
Program Service Revenue CY	6496425	ProgramServiceRevenueCY
Investment Income Prior Year	2593	InvestmentIncomePriorYear
Investment Income Current Year	4875	InvestmentIncomeCurrentYear
Other Revenue Prior Year	384082	OtherRevenuePriorYear
Other Revenue Current Year	550341	OtherRevenueCurrentYear
Total Revenue Prior Year	7958554	TotalRevenuePriorYear
Total Revenue Current Year	7073480	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	3583122	SalariesEtcPriorYear
Salaries Etc Current Year	3733085	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2784872	OtherExpensePriorYear
Other Expenses Current Year	2920221	OtherExpensesCurrentYear
Total Expenses Prior Year	6367994	TotalExpensesPriorYear
Total Expenses Current Year	6653306	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	1590560	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	420174	RevenuesLessExpensesCY
Total Assets BOY	3299609	TotalAssetsBOY
Total Assets EOY	3771339	TotalAssetsEOY
Total Liabilities BOY	2091663	TotalLiabilitiesBOY
Total Liabilities EOY	2143219	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1207946	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1628120	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES CLOSE TO HOME IN A PATIENT-CENTERED ENVIRONMENT, PROVIDE COORDINATION OF SPECIALTY AND TERTIARY CARE, AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO PROVIDE HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY IN MEETING THE NEEDS OF THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND ECONOMICALLY DISADVANTAGED IN ITS SERVICE AREA.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	5493328	Expense
Description	TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES CLOSE TO HOME IN A PATIENT-CENTERED ENVIRONMENT, PROVIDE COORDINATION OF SPECIALTY AND TERTIARY CARE, AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO PROVIDE HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY IN MEETING THE NEEDS OF THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND ECONOMICALLY DISADVANTAGED IN ITS SERVICE AREA. DURING THE FISCAL YEAR ENDED JUNE 30, 2013, THE HOSPITAL SERVICED 88 INPATIENTS, 1,590 EMERGENCY ROOM PATIENTS, AND OVER 10,698 OUTPATIENTS THROUGH ITS CLINICS, OFFICE PRACTICES, AND ANCILLARY DEPARTMENTS.	Description
Total Program Service Expense	5493328	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	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	true	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	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	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	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	false	TaxExemptBonds
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	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	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	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	27	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	105	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	3	NbrVotingGoverningBodyMembers
Number Independent Voting Members	3	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	false	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	false	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	VALERIE BRYANT	NamePerson
Telephone Number	8103767018	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	3559 PINE STREET	AddressLine1
City	DECKERVILLE	City
State	MI	State
ZIP Code	48427	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
ANGELA MCCONNACHIE
DIRECTOR OF	40.00	X	51979	0	0
BRAD KREINER
DIRECTOR	1.00	X	0	0	0
DAVID L WEST
DIRECTOR/COO	40.00		86189	0	0	X
VALERIE BRYANT
CFO	40.00		74938	0	0	X
GERALD SCHELL
DIRECTOR	1.00		0	0	0	X
MATT CAMPBELL
DIRECTOR	1.00		0	0	0	X
DR BASSAM AFANEH
PHYSICAN	40.00		400115	0	3873		X
DR PANNY DECOSSARD
PHYSICAN	40.00		139216	0	435		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	752437	TotalReportableCompFromOrg
Total Other Compensation	4308	TotalOtherCompensation
Number Individuals GT100 K	2	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
CARDINAL HEALTH
44425 PHOENIX DR	STERLING HEIGHTS	MI	48314	SUPPLIES	270728
AMENDIA INC
1755 WEST OAK PARKWAY	MARIETTA	GA	30062	SUPPLIES	173331
EMERGENCY MEDICAL
3559 PINE STREET	DECKERVILLE	MI	48427	SUPPLIES	124020

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	3	NumberOfContractorsGT100K
All Other Contributions	21839	AllOtherContributions
Total Contributions	21839	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	NET PATIENT REVENUE	Description
Total Revenue Column	6496425	TotalRevenueColumn
Related Or Exempt Function Income	6496425	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	6496425	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	4875	TotalRevenueColumn
Exclusion	$4,875	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
OTHER REVENUE	519461	$519,461
CLINIC REVENUE	30880	$30,880

Field	Value	IRS element (for citing)
Total Other Revenue	550341	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	7073480	TotalRevenueColumn
Related Or Exempt Function Income	6496425	RelatedOrExemptFunctionIncome
Exclusion	$555,216	ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	3003705	Total
Program Services	2402964	ProgramServices
Management And General	600741	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	729380	Total
Program Services	605385	ProgramServices
Management And General	123995	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	16322	Total
Management And General	16322	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	19500	Total
Management And General	19500	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	469397	Total
Program Services	295719	ProgramServices
Management And General	173678	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	663949	Total
Program Services	497962	ProgramServices
Management And General	165987	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	62188	Total
Program Services	43532	ProgramServices
Management And General	18656	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	233794	Total
Program Services	198725	ProgramServices
Management And General	35069	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	17636	Total
Program Services	16578	ProgramServices
Management And General	1058	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	20686	Total
Program Services	20686	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	230056	Total
Program Services	227640	ProgramServices
Management And General	2416	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	51119	Total
Program Services	48563	ProgramServices
Management And General	2556	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
MEDICAL SUPPLIES	1000858	1000858
MAINTENANCE & REPAIRS	129800	129800
DUES & SUBSCRIPTIONS	4916	4916

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	6653306	Total
Program Services	5493328	ProgramServices
Management And General	1159978	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	150	BOY
EOY	150	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	845527	BOY
EOY	1049781	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	1053392	BOY
EOY	1496160	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	11433	BOY
EOY	14046	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	159910	BOY
EOY	159674	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	75705	BOY
EOY	81738	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	4527152	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	4043849	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	585066	BOY
EOY	483303	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	568426	BOY
EOY	486487	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	3299609	BOY
EOY	3771339	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1611459	BOY
EOY	1893219	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	46000	BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	250000	BOY
EOY	250000	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	184204	BOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	2091663	BOY
EOY	2143219	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1164900	BOY
EOY	1586523	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	194	BOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	42852	BOY
EOY	41597	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1207946	BOY
EOY	1628120	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3299609	BOY
EOY	3771339	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	420174	ReconcilationRevenueExpenses
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 Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	43046	BeginningOfYearBalance
Investment Earnings Or Losses	2128	InvestmentEarningsOrLosses
Other Expenditures	3194	OtherExpenditures
Administrative Expenses	383	AdministrativeExpenses
End Of Year Balance	41597	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	55889	BeginningOfYearBalance
Investment Earnings Or Losses	-310	InvestmentEarningsOrLosses
Other Expenditures	12000	OtherExpenditures
Administrative Expenses	533	AdministrativeExpenses
End Of Year Balance	43046	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	46756	BeginningOfYearBalance
Investment Earnings Or Losses	9133	InvestmentEarningsOrLosses
End Of Year Balance	55889	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	41199	BeginningOfYearBalance
Investment Earnings Or Losses	5557	InvestmentEarningsOrLosses
End Of Year Balance	46756	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.00010	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.99990	PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs	true	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	58998	OtherCostOrOtherBasis
Book Value	58998	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1383171	OtherCostOrOtherBasis
Depreciation	1319271	Depreciation
Book Value	63900	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	34874	OtherCostOrOtherBasis
Depreciation	34874	Depreciation

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3050109	OtherCostOrOtherBasis
Depreciation	2689704	Depreciation
Book Value	360405	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	483303	TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescription	Book ValueBookValue
ADVANCE PAYMENTS	444890
ENDOWMENT FUND	41597

Field	Value	IRS element (for citing)
Total Book Value Other Assets	486487	TotalBookValueOtherAssets
Tot Revenue Etc Audited Fincl Stmt	7073480	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	7073480	RevenueSubtotal
Total Revenue Per Form990	7073480	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	6653306	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	6653306	ExpensesSubtotal
Total Expenses Per Form990	6653306	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Field	Value	IRS element (for citing)
Identifier	INTENDED USES FOR ENDOWMENT FUNDS	Identifier
Return Reference	SCHEDULE D, PAGE 2, PART V, LINE 4	ReturnReference
Explanation	TO BE USED TO PROVIDE SUPPORT TO DECKERVILLE COMMUNITY HOSPITAL TO CARRY OUT ITS ROLE AND MISSION AS DESIRED BY ITS GOVERNING DOCUMENTS.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
FPG Reference Free Care	false	FPGReferenceFreeCare
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent250	X	Pcent250
Free Disc Care Medically Indigent	false	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	false	AmountsBudgetedForCharityCare
Annual Community Benefit Report	false	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	18762	TotalCommunityBenefitExpense
Net Community Benefit Expense	18762	NetCommunityBenefitExpense
Percent Of Total Expense	0.00280	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1073616	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1210127	DirectOffsettingRevenue
Net Community Benefit Expense	-136511	NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3460786	TotalCommunityBenefitExpense
Direct Offsetting Revenue	9820701	DirectOffsettingRevenue
Net Community Benefit Expense	-6359915	NetCommunityBenefitExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4553164	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11030828	DirectOffsettingRevenue
Net Community Benefit Expense	-6477664	NetCommunityBenefitExpense
Percent Of Total Expense	0.00280	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4553164	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11030828	DirectOffsettingRevenue
Net Community Benefit Expense	-6477664	NetCommunityBenefitExpense
Percent Of Total Expense	0.00280	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$442,288	BadDebtExpenseAmount
Amount Reimbursed By Medicare	5717223	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	1872891	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	3844332	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	DECKERVILLE COMMUNITY HOSPITAL INC	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	3559 PINE STREET	AddressLine1
City	DECKERVILLE	City
State	MI	State
ZIP Code	48427	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
Critical Access Hospital	X	CriticalAccessHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	DECKERVILLE COMMUNITY HOSPITAL INC	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	13	NeedsAssessmentConducted
Take Into Account	true	TakeIntoAccount
Other Facilities	false	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	false	UsesFPGFree
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	250.0	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Insurance Status	X	InsuranceStatus
Medicaid Medicare	X	MedicaidMedicare
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	false	ActionsOnNonpayment
Permit Report To Credit Agency	X	PermitReportToCreditAgency
Permit Lawsuit	X	PermitLawsuit
Collection Activities	true	CollectionActivities
Report To Credit Agency	X	ReportToCreditAgency
Lawsuit	X	Lawsuit
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DECKERVILLE COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 3	PART V LINE 3	THE HOSPITAL ADMINISTRATION HAS COORDINATED THE DEVELOPMENT OF A COMMUNITY ADVISORY BOARD COMPRISED OF AREA BUSINESS LEADERS AND COMMUNITY MEMBERS TO BRING COMMUNITY INPUT TO HOSPITAL PROGRAMS AND EVENTS ADMINISTRATION IS ALSO WORKING TO IDENTIFY BUILD AND STRENGTHEN STRONGER COMMUNITY AND TERTIARY PARTNERSHIPS TO MAXIMIZE THE SERVICE POTENTIAL OF A VARIETY OF HEALTH AND HUMAN SERVICES TO DEMONSTRATE OUR CONNECTION WITH AND COMMITMENT TO THE COMMUNITY A COVER LETTER AND SURVEY WERE SENT TO 1000 RANDOM COMMUNITY MEMBERS IN THE DECKERVILLE SERVICE AREAS 207 OF THE SURVEYS WERE COMPLETED AND RETURNED THE DATA WAS ENTERED INTO A SURVEY MONKEY DATABASE AND INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT ATTACHED
DECKERVILLE COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 7	PART V LINE 7	DECKERVILLE COMMUNITY HOSPITAL BOARD HAS IDENTIFIED PRIORITY AREAS OF FOCUS AND ACTION PLANS FROM THE INFORMTION PUT FORTH IN THE SURVEY OBJECTIVES AND STRATEGIES IDENTIFIED ARE MADE WITH REGARDS TO THE ECONOMICAL AND SOCIO FACTORS AS WELL AS FINANCIAL RESTRAINTS ON A SMALL NONPROFIT HOSPITAL SERVING RURAL MICHIGAN OVER THE COURSE OF THE NEXT THREE YEARS DECKERVILLE WILL FOCUS ATTENTION ON THE PRIORITY AREAS IDENTIFIED AS WELL AS INITIATIVES AND PROGRAMS CURRENTLY IN PROGRESS TO PREVENT ILLNESS AND KEEP AREA FAMILIES HEALTHY AND PRODUCTIVE SEE THE CHNA FOR LIST OF ENTIRE LIST OF COMMUNITY NEEDS WHILE DECKERVILLE COMMUNITY HOSPITAL HAS AND WILL CONTINUE TO DELIVER DYNAMIC SERVICES AND LEADERSHIP FOR COMMUNITY FAMILIES MANY HELATH AND HELATH RELATED CONDITIONS ARE DIRECTLY RELATED TO BEHAVIORAL CHOICES IT WILL REQUIRE THE ENTIRE COMMUNITY INCLUDING THEHOSPITAL AND ITS COMMUNITY PARTNERSHIPS TO ADDRESS AND EFFECT CHANGE
DECKERVILLE COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 20D	PART V LINE 20D	DECKERVILLE IS A CRITICAL ACCESS HOSPITAL AND IS REQUIRED TO BILL ALL PATIENTS THE SAME REGARLESS OF WHETHER OR NOT THE ARE INSURED

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	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

Field	Value	IRS element (for citing)
Name Person	DR BASSAM AFANEH	NamePerson
Title	PHYSICAN	Title
Base Compensation Filing Org	400115	BaseCompensationFilingOrg
Nontaxable Benefits Filing Org	3873	NontaxableBenefitsFilingOrg
Total Compensation Filing Org	403988	TotalCompensationFilingOrg

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ORGANIZATION'S MISSION	FORM 990 - ORGANIZATION'S MISSION	TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES CLOSE TO HOME IN A PATIENT-CENTERED ENVIRONMENT, PROVIDE COORDINATION OF SPECIALTY AND TERTIARY CARE, AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO PROVIDE HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY IN MEETING THE NEEDS OF THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND ECONOMICALLY DISADVANTAGED IN ITS SERVICE AREA.
MANAGEMENT DELEGATED	FORM 990, PAGE 6, PART VI, LINE 3	THE ENTITY CONTRACTED IN DECEMBER 2010 WITH MICHIGAN RURAL HEALTHCARE PRESERVATION, INC. TO OVERSEE AND ASSIST IN THE DAILY MANAGEMENT DUTIES OF THE HOSPITAL.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE RETURN IS PREPARED BY OUTSIDE PROFESSIONALS AND REVIEWED BY HOSPITAL PERSONNEL RESPONSIBLE FOR THE INFORMATION THAT IS RELEVANT TO ITS PREPARATION.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT'S SALARIES ARE REVIEWED BY THE BOARD OF DIRECTORS, THESE ARE COMPARED TO THE SALARIES OF SOMEONE IN A SIMILAR POSITION, AND DOCUMENTED IN THE MINUTES OF THE BOARD MEETING.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	THE OFFICERS OR KEY EMPLOYEE'S SALARIES ARE REVIEWED BY THE BOARD OF DIRECTORS, THESE ARE COMPARED TO THE SALARIES OF SOMEONE IN A SIMILAR POSITION, AND DOCUMENTED IN THE MINUTES OF THE BOARD MEETING.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE ENTITY MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.