MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (EIN 38-1303843)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-11
- IRS object ID
- 201313169349301571
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-11T08:06:47-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 E FRONT ST SUITE 300 | AddressLine1 |
| City | TRAVERSE CITY | City |
| State | MI | State |
| ZIP Code | 49686 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381303843 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | OTSE | NameControl |
| Phone | 9897312100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER | AddressLine1 |
| City | GAYLORD | City |
| State | MI | State |
| ZIP Code | 49735 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | THOMAS LEMON | Name |
| Title | CEO | Title |
| Phone | 9897312100 | Phone |
| Date Signed | 2013-11-04 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| PTIN | P00053797 | PTIN |
| Phone | 2319477800 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO COUNTY MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | THOMAS LEMON CEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER | AddressLine1 |
| City | GAYLORD | City |
| State | MI | State |
| ZIP Code | 49735 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 84320184 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MYOMH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE QUALITY HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS AND THE COMMUNITIES WE SERVE BY: WORKING IN PARTNERSHIP WITH AREA PHYSICIANS TO PROVIDE PATIENT-FOCUSED CARE WITH QUALITY AND SERVICE SECOND TO NONE; DELIVERING A FULL CONTINUUM OF ACCESSIBLE CARE THAT ADDRESSES THE COMMUNITIES NEEDS; WORKING TO INCREASE THE PUBLIC'S AWARENESS OF THE BREADTH AND DEPTH OF OTSEGO MEMORIAL HOSPITAL'S SERVICES; MEETING THE PROFESSIONAL NEEDS OF OUR DEDICATED STAFF BY PROVIDING THEM WITH OPPORTUNITIES FOR PROFESSIONAL GROWTH AND EDUCATIONAL DEVELOPMENT; AND REMAINING FISCALLY SOUND. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 725 | TotalNbrEmployees |
| Total Nbr Volunteers | 145 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 329925 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 469328 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 73460197 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 81251509 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 122202 | InvestmentIncomePriorYear |
| Investment Income Current Year | 795398 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 357588 | OtherRevenuePriorYear |
| Other Revenue Current Year | 405796 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 74269912 | TotalRevenuePriorYear |
| Total Revenue Current Year | 82922031 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 38832855 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 42170956 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 642355 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 31320215 | OtherExpensePriorYear |
| Other Expenses Current Year | 34137839 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 70153070 | TotalExpensesPriorYear |
| Total Expenses Current Year | 76308795 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4116842 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 6613236 | RevenuesLessExpensesCY |
| Total Assets BOY | 48015526 | TotalAssetsBOY |
| Total Assets EOY | 52622542 | TotalAssetsEOY |
| Total Liabilities BOY | 31089878 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 29807579 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 16925648 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 22814963 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS, AND THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 40941002 | Expense |
| Grants | 0 | Grants |
| Revenue | 62218606 | Revenue |
| Description | ACUTE INPATIENT AND OUTPATIENT CARE FOR DIAGNOSTIC AND MEDICAL CARE: THERE WERE 70,967 ADMISSIONS FOR MEDICAL SURGICAL (1,085), ICU (321), BIRTHING CENTER (256), AND OUTPATIENT REGISTRATIONS (69,305) THIS PAST YEAR. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 14349383 | Expense |
| Grants | 0 | Grants |
| Revenue | 15294764 | Revenue |
| Description | PHYSICIAN DIAGNOSTIC OFFICES AND URGENT CARE CLINIC: THERE WERE 106,749 PATIENTS FOR MED GROUP (66,805), LEWISTON/MONTMORENCY (9,346), URGENT CARE (16,416), INDIAN RIVER (653), AND ORTHOPEDICS (13,529). | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2891395 | Expense |
| Grants | 0 | Grants |
| Revenue | 3395280 | Revenue |
| Description | LONG TERM CARE FOR THE ELDERLY: THIS PAST YEAR THERE WERE 103 ADMISSIONS WITH 10,816 MCREYNOLDS HALL PATIENT DAYS USED. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3582091 | Expense |
| Grants | 0 | Grants |
| Revenue | 411238 | Revenue |
| Description | ALL OTHER PROGRAM SERVICES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 3582091 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 411238 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 61763871 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 25 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 725 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMY BILYEA CONTROLLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9897312100 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER AVE | AddressLine1 |
| City | GAYLORD | City |
| State | MI | State |
| ZIP Code | 49735 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| CHRISTOPHER COLLINS | |||||||||
| DIRECTOR-VICE PRESIDENT | 0.20 | 0.00 | X | X | 0 | 0 | 0 | ||
| THOMAS TOMASKI | |||||||||
| DIRECTOR-TREASURER | 0.20 | 0.00 | X | X | 0 | 0 | 0 | ||
| MARY SANDERS | |||||||||
| DIRECTOR-PRESIDENT | 0.20 | 0.50 | X | X | 0 | 0 | 0 | ||
| CAROLYN STUDY | |||||||||
| DIRECTOR-SECRETARY | 0.20 | 0.50 | X | X | 0 | 0 | 0 | ||
| DAVID BRINEY | |||||||||
| DIRECTOR | 0.20 | 0.50 | X | 0 | 0 | 0 | |||
| SCOTT CHESLEY | |||||||||
| DIRECTOR | 0.20 | 0.00 | X | 0 | 0 | 0 | |||
| DR PETER HANDLEY | |||||||||
| DIRECTOR | 39.50 | 0.50 | X | 250454 | 0 | 33990 | |||
| DONALD SKLARCZYK | |||||||||
| DIRECTOR | 0.20 | 0.00 | X | 0 | 0 | 0 | |||
| DR BECKY ASHLEY | |||||||||
| DIRECTOR | 0.20 | 0.00 | X | 0 | 0 | 0 | |||
| MARCUS WEGMEYER | |||||||||
| DIRECTOR | 0.20 | 0.00 | X | 0 | 0 | 0 | |||
| THOMAS LEMON | |||||||||
| PRESIDENT AND CEO | 39.50 | 0.50 | X | 233711 | 0 | 26136 | |||
| ROBERT COURTOIS | |||||||||
| VP OF FINANCE & CFO | 39.50 | 0.50 | X | 146378 | 0 | 39500 | |||
| BARBARA MILLER | |||||||||
| VP OF PHYSICIAN SERVICES | 40.00 | 0.00 | 157396 | 0 | 0 | X | |||
| DR CHANGXIN LI | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 608684 | 0 | 23191 | X | |||
| DR JOHN MOFFAT | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 935025 | 0 | 22500 | X | |||
| DR LOUIS HABRYL | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 603034 | 0 | 22500 | X | |||
| DR ARMIN AALAMI HARANDI | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 442978 | 0 | 34000 | X | |||
| DR MEDINA SHALTRY | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 397652 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3775312 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 201817 | TotalOtherCompensation |
| Number Individuals GT100 K | 45 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MAYO COLLABORATIVE SERVICES | |||||
| PO BOX 9146 | MINNEAPOLIS | MN | 55480 | DIAGNOSTIC SERVICES | 497619 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | INFORMATION TECHNOLOGY | 397520 |
| SIEMENS MEDICAL SOLUTIONS | |||||
| DEPT CH 14195 | PALATINE | IL | 60055 | MEDICAL EQUIPMENT SERVICE | 393482 |
| NORTHERN MICHIGAN HEMATOLOGY | |||||
| 416 CONNABLE | PETOSKEY | MI | 49770 | PHYSICIAN ONCOLOGY SERVICES | 342833 |
| AHSA LLC | |||||
| PO BOX 945 | TRAVERSE CITY | MI | 49685 | TEMPORARY LOCUM SERVICES | 274419 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Membership Dues | 6562 | MembershipDues |
| Related Organizations | 422911 | RelatedOrganizations |
| Government Grants | 24032 | GovernmentGrants |
| All Other Contributions | 15823 | AllOtherContributions |
| Total Contributions | 469328 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 622110 | 78926987 | 78926987 |
| OTHER RELATED REVENUE | 622110 | 2324522 | 2324522 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 81251509 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 223582 | TotalRevenueColumn |
| Exclusion | $223,582 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 181559 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 72106 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 109453 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 109453 | TotalRevenueColumn |
| Exclusion | $109,453 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 796774 | Securities |
| Other | 1101089 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 795585 | Securities |
| Other | 530462 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1189 | Securities |
| Other | 570627 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 571816 | TotalRevenueColumn |
| Exclusion | $571,816 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA REVENUE | 722210 | 227964 | $227,964 | |
| REVENUE FROM JOINT VENTURE | 523000 | 68379 | 68379 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 296343 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82922031 | TotalRevenueColumn |
| Related Or Exempt Function Income | 81319888 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,132,815 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1015255 | Total |
| Program Services | 333228 | ProgramServices |
| Management And General | 682027 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32461299 | Total |
| Program Services | 28281274 | ProgramServices |
| Management And General | 4020973 | ManagementAndGeneral |
| Fundraising | 159052 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 934672 | Total |
| Program Services | 800616 | ProgramServices |
| Management And General | 129599 | ManagementAndGeneral |
| Fundraising | 4457 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5722667 | Total |
| Program Services | 2994126 | ProgramServices |
| Management And General | 2728426 | ManagementAndGeneral |
| Fundraising | 115 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2037063 | Total |
| Program Services | 1744895 | ProgramServices |
| Management And General | 282453 | ManagementAndGeneral |
| Fundraising | 9715 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 163475 | Total |
| Management And General | 163475 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209861 | Total |
| Management And General | 209861 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39611 | Total |
| Management And General | 39611 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3543312 | Total |
| Program Services | 2199397 | ProgramServices |
| Management And General | 1099308 | ManagementAndGeneral |
| Fundraising | 244607 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65932 | Total |
| Management And General | 10719 | ManagementAndGeneral |
| Fundraising | 55213 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 800124 | Total |
| Program Services | 249205 | ProgramServices |
| Management And General | 490596 | ManagementAndGeneral |
| Fundraising | 60323 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1294511 | Total |
| Program Services | 476487 | ProgramServices |
| Management And General | 817519 | ManagementAndGeneral |
| Fundraising | 505 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89885 | Total |
| Program Services | 42679 | ProgramServices |
| Management And General | 39637 | ManagementAndGeneral |
| Fundraising | 7569 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200977 | Total |
| Program Services | 138868 | ProgramServices |
| Management And General | 56283 | ManagementAndGeneral |
| Fundraising | 5826 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1390946 | Total |
| Program Services | 1025065 | ProgramServices |
| Management And General | 363064 | ManagementAndGeneral |
| Fundraising | 2817 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2816968 | Total |
| Program Services | 2075979 | ProgramServices |
| Management And General | 735283 | ManagementAndGeneral |
| Fundraising | 5706 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 885386 | Total |
| Program Services | 193464 | ProgramServices |
| Management And General | 691922 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL & OTHER SUPPLIE | 13787957 | 13378836 | 408224 | 897 |
| PROVISION FOR BAD DEBT | 3778631 | 3778631 | ||
| QUALITY ASSESSMENT FEES | 2016717 | 2016717 | ||
| REPAIRS AND MAINTENANCE | 1845392 | 1093243 | 730574 | 21575 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1208154 | Total |
| Program Services | 941161 | ProgramServices |
| Management And General | 203015 | ManagementAndGeneral |
| Fundraising | 63978 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76308795 | Total |
| Program Services | 61763871 | ProgramServices |
| Management And General | 13902569 | ManagementAndGeneral |
| Fundraising | 642355 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1577324 | BOY |
| EOY | 2174381 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 976379 | BOY |
| EOY | 1712855 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5358931 | BOY |
| EOY | 4952226 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8000 | BOY |
| EOY | 4000 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1192161 | BOY |
| EOY | 1363756 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2016581 | BOY |
| EOY | 2073296 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 54543707 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 26363676 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27518637 | BOY |
| EOY | 28180031 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5447514 | BOY |
| EOY | 9613898 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 428411 | BOY |
| EOY | 1165198 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3491588 | BOY |
| EOY | 1382901 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48015526 | BOY |
| EOY | 52622542 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7402106 | BOY |
| EOY | 7269458 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15417 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20736517 | BOY |
| EOY | 19748695 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 570885 | BOY |
| EOY | 435339 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2364953 | BOY |
| EOY | 2354087 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31089878 | BOY |
| EOY | 29807579 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15826331 | BOY |
| EOY | 22807763 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1099317 | BOY |
| EOY | 7200 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16925648 | BOY |
| EOY | 22814963 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48015526 | BOY |
| EOY | 52622542 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 6613236 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 432316 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -1156237 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | 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 | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $5,567 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5567 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | SUPPORTED LOBBYING ACTIVITIES THROUGH ANNUAL DUES PAID TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 869562 | OtherCostOrOtherBasis |
| Book Value | 869562 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 35999485 | OtherCostOrOtherBasis |
| Depreciation | 14306997 | Depreciation |
| Book Value | 21692488 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 373203 | OtherCostOrOtherBasis |
| Depreciation | 281131 | Depreciation |
| Book Value | 92072 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17242201 | OtherCostOrOtherBasis |
| Depreciation | 11775548 | Depreciation |
| Book Value | 5466653 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 59256 | OtherCostOrOtherBasis |
| Book Value | 59256 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 28180031 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | COST REPORT SETTLEMENT PAYABLE | Description |
| Amount | $2,354,087 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2354087 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2008. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 903 | PersonsServed |
| Total Community Benefit Expense | 637403 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 477268 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 160135 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 21476 | PersonsServed |
| Total Community Benefit Expense | 13271143 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12302714 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 968429 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01340 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 22379 | PersonsServed |
| Total Community Benefit Expense | 13908546 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12779982 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1128564 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01560 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 261 | NumberOfActivitiesOrPrograms |
| Persons Served | 2621 | PersonsServed |
| Total Community Benefit Expense | 116913 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6530 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 110383 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 63 | NumberOfActivitiesOrPrograms |
| Persons Served | 67 | PersonsServed |
| Total Community Benefit Expense | 63623 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 63623 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 12942111 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11474213 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1467898 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 254 | PersonsServed |
| Total Community Benefit Expense | 19398 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 19398 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 330 | NumberOfActivitiesOrPrograms |
| Persons Served | 2942 | PersonsServed |
| Total Community Benefit Expense | 13142045 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11480743 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1661302 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02290 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 332 | NumberOfActivitiesOrPrograms |
| Persons Served | 25321 | PersonsServed |
| Total Community Benefit Expense | 27050591 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 24260725 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2789866 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03850 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 2000 | PersonsServed |
| Total Community Building Expense | 812 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 812 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 106 | NumberOfActivitiesOrPrograms |
| Persons Served | 120 | PersonsServed |
| Total Community Building Expense | 22612 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 22612 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 110 | NumberOfActivitiesOrPrograms |
| Persons Served | 2120 | PersonsServed |
| Total Community Building Expense | 23424 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 23424 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,778,631 | BadDebtExpenseAmount |
| Amount Attributable To | 594326 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 17063951 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16139329 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 924622 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | 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 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER AVE | AddressLine1 |
| City | GAYLORD | City |
| State | MI | State |
| ZIP Code | 49735 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | LONG-TERM CARE FACILITY AND PHYSICIAN CLINICS | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 6 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| N'ORTHOPEDICS CLINIC | ||||
| 2147 PROFESSIONAL DRIVE | GAYLORD | MI | 49735 | OUTPATIENT CLINIC |
| MCREYNOLDS HALL | ||||
| 825 N CENTER AVENUE | GAYLORD | MI | 49735 | LONG-TERM CARE |
| LEWISTON CLINIC | ||||
| 3040 BOURN STREET | LEWISTON | MI | 49756 | OUTPATIENT CLINIC |
| MEDCARE CLINIC | ||||
| 1996 WALDEN DRIVE | GAYLORD | MI | 49735 | OUTPATIENT CLINIC |
| DIALYSIS SERVICES OF GAYLORD | ||||
| 1989 WALDEN DRIVE | GAYLORD | MI | 49735 | KIDNEY DIALYSIS |
| INDIAN RIVER CLINIC | ||||
| 3696 SOUTH STRAITS HWY | INDIAN RIVER | MI | 49749 | OUTPATIENT CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: UNDER ITS ASSISTANCE PROGRAM OTSEGO MEMORIAL HOSPITAL WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED OR REDUCED PRICE SERVICES TO PERSONS ELIGIBLE UNDER APPLICABLE GUIDELINES. OTSEGO MEMORIAL HOSPITAL'S ASSISTANCE PROGRAM SERVICES ARE NOT LIMITED TO ANY SPECIFIC HOSPITAL SERVICE. INDIVIDUAL ELIGIBILITY FOR ASSISTANCE IS DETERMINED BY MEASURING FAMILY INCOME IN RELATION TO FAMILY SIZE AGAINST THE INCOME POVERTY GUIDELINE ESTABLISHED BY THE COMMUNITY SERVICE ADMINISTRATION. IF THE HOSPITAL DETERMINES THAT SERVICES ARE NOT MEDICALLY NECESSARY, THE HOSPITAL CAN DENY SERVICES UNDER THE FINANCIAL ASSISTANCE PROGRAM. | ||
| PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E), HEALTH PROFESSIONS EDUCATION (LINE 7F), SUBSIDIZED HEALTH SERVICES (LINE 7G) AND CASH AND IN-KIND CONTRIBUTIONS (LINE 7I). | ||
| PART I, LINE 7G: ALL PHYSICIAN CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES. | ||
| PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $3,778,631. | ||
| PART II: OTSEGO MEMORIAL HOSPITAL IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. OTSEGO MEMORIAL HOSPITAL STAFF REPRESENT OTSEGO MEMORIAL HOSPITAL ON A VARIETY OF COMMITTEES AND COMMUNITY BOARDS IN WHICH OTSEGO MEMORIAL HOSPITAL OFFERS ASSISTANCE THROUGH STAFF, FACILITIES, AND RESOURCES WITH THE END GOAL OF WORKING TO ADDRESS COMMUNITY ISSUES RELATED TO HEALTH IMPROVEMENT, EDUCATION, POVERTY, WORKFORCE DEVELOPMENT AND ACCESS TO CARE. WE ALSO ENCOURAGE OUR EMPLOYEES TO SERVE IN THE COMMUNITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. AND, WE WORK WITH NEIGHBORHOOD PROGRAMS, INCLUDING PUBLIC AND PRIVATE LOCAL SCHOOLS, OTSEGO COUNTY COMMISSION ON AGING, WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. ADDITIONALLY, OTSEGO MEMORIAL HOSPITAL STAFF SIT ON THE MOBILIZING THROUGH ACTION FOR PLANNING AND PARTNERSHIPS (A THOROUGH AND NATIONALLY RECOGNIZED PROGRAM FOR CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT). AS WELL, OTSEGO MEMORIAL HOSPITAL STAFF MEMBERS WERE ACTIVELY INVOLVED IN A BLUE CROSS BLUE SHIELD GRANT RECEIVED BY THE GAYLORD COMMUNITY SCHOOLS TO ENHANCE PHYSICAL ACTIVITY AND PROMOTE HEALTHY EATING IN THE SCHOOLS FOR SCHOOL YEAR 2011-2012. THIS COMMITTEE WAS COMPRISED OF COMMUNITY OFFICIALS, PARENTS, TEACHERS, HOSPITAL STAFF AND PHYSICIANS. | ||
| PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE: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 EVALULATING THE COLLECTIBILITY OF ACCOUNT RECEIVABLE, THE ORGANIZATION 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 EVALULATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNT AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION 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 CALCULATION FOR ESTIMATED AMOUNT OF THE ORGANIZATIONS BAD DEBT EXPENSE ATTIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY, $594,326, IS BASED ON OTSEGO MEMORIAL HOSPITAL'S ACTUAL FINANCIAL ASSISTANCE WRITE-OFFS AS A PERCENTAGE OF ACTUAL UNCOMPENSATED CARE (FINANCIAL ASSISTANCE PLUS BAD DEBT). AN ADDED ASSUMPTION IS USED BASED ON THE IDEA THAT BAD DEBT WOULD LIKELY INCREASE BY A PARTICULAR PERCENTAGE DUE TO THE ECONOMIC CLIMATE IN THE DEMOGRAPHIC AREA.THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. | ||
| PART III, LINE 8: OTSEGO MEMORIAL HOSPITAL PROVIDES HEALTHCARE TO NINE COMMUNITIES IN OTSEGO AND MONTMORENCY COUNTIES, AND IS THE ONLY HEALTHCARE SYSTEM IN THE AREA AND INCLUDES SEVERAL SMALL TOWNS. THE POPULATION INCLUDES A SIGNIFICANT NUMBER OF RETIREES. SERVICES ARE NOT LIMITED TO RESIDENTS OF THESE COMMUNITIES AS THE AREA HAS A HIGH VOLUME OF TRANSIENTS THAT COME FOR THE NUMEROUS RECREATIONAL ACTIVITIES. THE OUTLYING AREAS ARE PREDOMINANTLY IN A RURAL, AGRICULTURAL BASED SETTING. THE FOLLOWING COSTING METHOD OF COST TO CHARGE RATE IS USED; MEDICARE COSTS DIVIDED BY MEDICARE CHARGES. | ||
| PART III, LINE 9B: ALL PATIENTS RECEIVING TREATMENT AT OTSEGO MEMORIAL HOSPITAL (INCLUDING CHARITY CARE PATIENTS) ARE RESPONSIBLE FOR PAYING IN FULL ALL CHARGES FOR SUCH TREATMENT, LESS ANY AMOUNTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, DISCOUNT CONSIDERATIONS OR INSURANCE COVERAGE, PER POINT OF SERVICE COLLECTION POLICY. | ||
| PART VI, LINE 2: OTSEGO MEMORIAL HOSPITAL CONDUCTED AN EXTENSIVE AND COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSEMENT THROUGHOUT 2012. IN ADDITION, OTSEGO MEMORIAL HOSPITAL USES INPUT FROM PHYSICIANS, MEDICAL PROVIDERS, AND COMMUNITY MEMBERS TO ASSIST IN ITS ASSESSMENT OF THE COMMUNITIES' HEALTHCARE NEEDS. OMH WORKS IN COLLABORATION WITH VARIOUS COMMUNITY GROUPS INCLUDING BUT NOT LIMITED TO: UNITED WAY, OTSEGO COUNTY COMMISSION ON AGING, OTSEGO AREA CHAMBER OF COMMERCE, AND OTHER LOCAL ASSOCIATIONS IN ORDER TO CONTINUE TO UNDERSTAND THE LOCAL HEALTHCARE NEEDS OF OUR SERVICE AREA. | ||
| PART VI, LINE 3: THE OTSEGO MEMORIAL HOSPITAL REGISTRATION MANAGER TRIES TO SEE THE PATIENTS IN ER OR IP. REGISTRATION STAFF HAVE ALSO BEEN TRAINED TO HAND OUT ASSISTANCE PACKAGES. WHEN THE PATIENT COMES IN ON THE WORK LIST THEY ARE ALSO INFORMED OF THE ASSISTANCE PACKAGE AND/OR APPLICATION. THE FORM IS ALSO ON THE OTSEGO MEMORIAL HOSPITAL WEBSITE AND THE ADMISSIONS OFFICE. THERE ARE ALSO WRITTEN NOTICES AT THE BOTTOM OF THE PATIENT STATEMENTS. WHEN THERE IS A SCHEDULED PROCEDURE AND THE PATIENT DOES NOT HAVE INSURANCE, A CALL IS MADE FOR PAYMENT AND/OR CHARITY CARE ARRANGEMENTS. | ||
| PART VI, LINE 4: OTSEGO MEMORIAL HOSPITAL PROVIDES HEALTHCARE TO TEN COMMUNITIES LOCATED WITHIN CHEBOYGAN, OTSEGO AND MONTMORENCY COUNTIES (THE COMMUNITIES ARE: ATLANTA, ELMIRA, FREDERIC, GAYLORD, INDIAN RIVER, JOHANNESBURG, LEWISTON, WATER, WOLVERINE, AND VANDERBILT). THE POPULATION INCLUDES A SIGNIFICANT NUMBER OF RETIREES. SERVICES ARE NOT LIMITED TO RESIDENTS OF THESE COMMUNITIES AS THE AREA HAS A HIGH VOLUME OF TRANSIENTS THAT COME FOR NUMEROUS RECREATIONAL AND SEASONAL ACTIVITIES. THE OUTLYING AREAS ARE PREDOMINANTLY IN A RURAL, AGRICULTURAL BASED SETTING. | ||
| PART VI, LINE 5: OTSEGO MEMORIAL HOSPITAL (OMH) OFFERS A VARIETY OF PROGRAMS AND SERVICES WITH THE END GOAL OF PROMOTING THE GREATER HEALTH OF THE COMMUNITY. OMH PROVIDED DISCOUNTED SPORTS PHYSICALS TO MORE THAN 250 AREA STUDENT ATHLETES, DONATING ONE HUNDRED PERCENT OF THE PROCEEDS BACK TO THE LOCAL SCHOOL ATHLETIC DEPARTMENTS. THE HOSPITAL PARTICIPATES IN A VARIETY OF LOCAL HEALTH EVENTS, INCLUDING OFFERING FREE HEALTH SCREENINGS TO PARTICIPANTS; SCREENINGS INCLUDED BLOOD PRESSURE, PULMONARY, BMI, HEIGHT AND WEIGHT. ADDITIONALLY, THE HOSPITAL OFFERED DISCOUNTED FULL LIPID PROFILE SCREENINGS TO MORE THAN 500 PARTICIPANTS AT A SENIOR EXPO. THE HOSPITAL OFFERS FREE ON SITE HEALTH FAIRS FOR LOCAL BUSINESSES AS REQUESTED. THE HOSPITAL OFFERS A MAMMOGRAPHY ASSISTANCE PROGRAM, TO ENSURE THAT WOMEN WHO DO NOT QUALIFY FOR A FREE MAMMOGRAM THROUGH THE LOCAL HEALTH DEPARTMENT, YET HAVE NO MEANS TO PAY FOR IT PRIVATELY, ARE COVERED AND RECEIVE A SCREENING AND IF NECESSARY DIAGNOSTIC MAMMOGRAM AT NO CHARGE. OMH ALSO WORKS CLOSELY WITH THE LOCAL SCHOOLS TO ASSIST THE HIGH SCHOOL LEVEL MEDICAL OCCUPATIONAL PROGRAM IN JOB SHADOWING AND EDUCATION PROGRAM FOR STUDENTS THROUGHOUT THE FACILITY AND SCHOOL YEAR. NEW PARENTS ARE INVITED TO PARTICIPATE IN CHILDBIRTH EDUCATION CLASSES OFFERED BY OMH STAFF FOR A NOMINAL FEE. ON A QUARTERLY BASIS THE HOSPITAL PRODUCES AND DISTRIBUTES TO MORE THAN 19,000 HOUSEHOLDS THROUGHOUT THE SERVICE AREA LITERATURE ON VARIOUS HEALTHCARE ISSUES AND TOPICS, INCLUDING INFORMATION ON LOCAL HEALTH EVENTS. OMH HAS NUMEROUS MEDICAL PRACTICES THAT ARE FEDERALLY QUALIFIED RURAL HEALTHCARE CLINICS, AS WELL AS OMH IS LOCATED WITHIN A HEALTH PROFESSIONAL SHORTAGE AREA. BOTH OF THESE QUALIFICATIONS DEMONSTRATE OMH'S ISOLATED SERVICE AREA WHICH HAS RESULTED IN CHALLENGING PHYSICIAN RECRUITMENT AND RETENTION. OMH'S COMMITMENT TO PROVIDING THE HIGHEST LEVEL OF CARE STARTS WITH PHYSICIAN AND OTHER PROVIDERS. EXTENSIVE RECRUITMENT ACTIVITIES MUST TAKE PLACE IN ORDER TO PROVIDE CARE TO THESE HEALTH PROFESSIONAL SHORTAGE AREAS. (1). A MAJORITY OF THE HOSPITALS BOARD OF TRUSTEES IS MADE UP OF COMMUNITY REPRESENTATIVES RESIDING WITHIN THE HOSPITALS SERVICE AREA. (2). THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS AS APPROVED BY OUR HOSPITAL BOARD OF DIRECTORS. DUE TO THE SIZE AND RURAL NATURE OF THE HOSPITAL SERVICE AREA, NOT ALL HEALTHCARE SPECIALTIES ARE OFFERED THROUGH THE HOSPITAL. (3). THE HOSPITAL APPLIES SURPLUS FUNDS, INCLUDING DONATIONS FROM THE FOUNDATION, TO ASSIST IN PURCHASING EQUIPMENT FOR PATIENT USE AND FUNDING MANY OF THE COMMUNITY HEALTH EDUCATION PROGRAMS LISTED ABOVE. ADDITIONALLY, THE HOSPITAL WORKS TO USE ANY SURPLUS FUNDS TO CONTINUE TO ADVANCE THE MISSION OF THE ORGANIZATION THROUGH GROWTH AND DEVELOPMENT OPPORTUNITIES. | ||
| PART VI, LINE 6: OTSEGO MEMORIAL HOSPITAL HAS AN AFFILIATION AGREEMENT WITH MUNSON MEDICAL CENTER WHERE THEY COOPERATE IN PROVIDING HEALTH CARE SERVICES TO THE COMMUNITY. INCLUDED IN THE AFFILIATION AGREEMENT ARE VARIOUS PURCHASED SERVICES, SUCH AS: INFORMATION TECHNOLOGY, LAUNDRY, PHYSICIAN RECRUITMENT ASSISTANCE, REIMBURSEMENT SUPPORT, MANAGEMENT DEVELOPMENT, MOBILE IMAGING, ETC. ALSO INCLUDED IN THE AFFILIATION AGREEMENT ARE COLLABORATION ON VARIOUS INITIATIVES, SUCH AS: ICD-10 IMPLEMENTATION, STRATEGIC PLANNING, CEO AND OTHER FORUMS, EDUCATION, CONSULTING, ETC. OMH WORKS WITH MUNSON MEDICAL CENTER TO OFFER CARDIOLOGY AND SLEEP LAB SERVICES IN OTSEGO COUNTY. | ||
| MI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR PETER HANDLEY | ||||||||||||||
| DIRECTOR | 250094 | 0 | 0 | 0 | 360 | 0 | 33990 | 0 | 0 | 0 | 284444 | 0 | 0 | 0 |
| THOMAS LEMON | ||||||||||||||
| PRESIDENT AND CEO | 233159 | 0 | 0 | 0 | 552 | 0 | 24881 | 0 | 1255 | 0 | 259847 | 0 | 0 | 0 |
| ROBERT COURTOIS | ||||||||||||||
| VP OF FINANCE & CFO | 145346 | 0 | 0 | 0 | 1032 | 0 | 39500 | 0 | 0 | 0 | 185878 | 0 | 0 | 0 |
| BARBARA MILLER | ||||||||||||||
| VP OF PHYSICIAN SERVICES | 155891 | 0 | 0 | 0 | 1505 | 0 | 0 | 0 | 0 | 0 | 157396 | 0 | 0 | 0 |
| DR CHANGXIN LI | ||||||||||||||
| PHYSICIAN | 608132 | 0 | 0 | 0 | 552 | 0 | 23191 | 0 | 0 | 0 | 631875 | 0 | 0 | 0 |
| DR JOHN MOFFAT | ||||||||||||||
| PHYSICIAN | 933993 | 0 | 0 | 0 | 1032 | 0 | 22500 | 0 | 0 | 0 | 957525 | 0 | 0 | 0 |
| DR LOUIS HABRYL | ||||||||||||||
| PHYSICIAN | 601450 | 0 | 1584 | 0 | 0 | 0 | 22500 | 0 | 0 | 0 | 625534 | 0 | 0 | 0 |
| DR ARMIN AALAMI HARANDI | ||||||||||||||
| PHYSICIAN | 442762 | 0 | 216 | 0 | 0 | 0 | 34000 | 0 | 0 | 0 | 476978 | 0 | 0 | 0 |
| DR MEDINA SHALTRY | ||||||||||||||
| PHYSICIAN | 397292 | 0 | 360 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 397652 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| GAYLORD HOSPITAL FINANCE AUTHORITY | ||||||||
| A | 383635769 | 368177AB7 | 2004-11-23 | 5285000 | REFINANCE & CONSTRUCTION | 0 | 0 | 0 |
| GAYLORD HOSPITAL FINANCE AUTHORITY | ||||||||
| B | 383635769 | 368177AC5 | 2004-11-23 | 5110000 | REFINANCE & CONSTRUCTION | 0 | 0 | 0 |
| GAYLORD HOSPITAL FINANCE AUTHORITY | ||||||||
| C | 383635769 | 368177AD3 | 2004-11-23 | 7465000 | REFINANCE & CONSTRUCTION | 0 | 0 | 0 |
| GAYLORD HOSPITAL FINANCE AUTHORITY | ||||||||
| D | 383635769 | 2005-02-14 | 9000000 | CONSTRUCTION | 0 | 0 | 0 | |
Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Amount Bond DefeasedAmountBondDefeased | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 2942021 | 2942021 | 5285000 | 457147 | 256111 | 102861 | 1419302 | 2005 | 0 | 1 | 1 | 1 |
| B | 2844583 | 2844583 | 5110000 | 442009 | 247629 | 99454 | 1372295 | 2005 | 0 | 1 | 1 | 1 |
| C | 4156014 | 4156014 | 7465000 | 645714 | 361793 | 145305 | 2004961 | 2005 | 0 | 1 | 1 | 1 |
| D | 9000000 | 9000000 | 2005 | 0 | 1 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part V Form990ScheduleKPartV (4 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
| D | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | OTSEGO MEMORIAL HOSPITAL OPENED A NEW CLINIC IN THE 4TH QUARTER OF 2012 IN INDIAN RIVER, MICHIGAN TO BETTER SERVE THE SURROUNDING COMMUNITIES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS APPROXIMATELY 200 GENERAL MEMBERS. ANNUAL DUES ARE $5 PER INDIVIDUAL OR $8 PER FAMILY. REQUIREMENTS TO BE A MEMBER ARE A MINIMUM OF EIGHTEEN YEARS OF AGE AND HAS A RESIDENCE IN THE AREA THAT THE HOSPITAL SERVES. EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS REVIEWED BEFORE FILING BY THE FOLLOWING INDIVIDUALS: 1. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER, THOMAS LEMON; 2. THE HOSPITAL'S VP OF FINANCE, ROBERT COURTOIS; AND 3. THE HOSPITAL'S CONTROLLER, AMY BILYEA. THE 990 IS ALSO PRESENTED TO THE ENTIRE HOSPITAL BOARD BEFORE FILING. DURING THIS MEETING MEMBERS HAVE A CHANCE TO ASK QUESTIONS REGARDING THE FORM 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE HOSPITAL'S POLICY REGARDING "CONFLICT OF INTEREST" REQUIRES EACH BOARD MEMBER AND OFFICER TO COMPLETE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES TO DEMONSTRATE CORPORATE COMPLIANCE. THESE FORMS ARE REVIEWED AND ANY CONFLICTS ARE INVESTIGATED BY MANAGEMENT. POTENTIAL CONFLICTS AND RESTRICTIONS ARE DETERMINED AND THEN VOTED UPON, PER POLICY GUIDELINES. IN THE EVENT THAT AN OFFICER OR BOARD MEMBER HAS A CONFLICT OF INTEREST, THAT BOARD MEMBER MUST GIVE WRITTEN NOTICE OF SUCH AN INTEREST OR RELATIONSHIP TO THE BOARD OF DIRECTORS, AND SHALL THEREAFTER REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE DECISION. | |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD'S PERSONNEL SUB-COMMITTEE, WHICH CONSISTS OF FOUR MEMBERS, ANNUALLY REVIEWS THE COMPENSATION OF THE CEO ONLY. THEY UTILIZE MHA SALARY SURVEY DATA, AS WELL AS A MARKET ANALYSIS PERFORMED BY THE HOSPITAL'S HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES MARKET ANALYSIS INCLUDES THREE SOURCES FOR DATA: INTEGRATED HEALTHCARE STRATEGIES, MERCER AND SULLIVAN COTTER, WITH REGRESSION POINT USING $70M IN NET REVENUES AND AN AVERAGE BASED ON HOSPITALS WITHIN A SIMILAR RANGE OF NET REVENUES. EACH OF THE THREE SOURCES USE NATIONAL DATA AND ARE BASED ON A FREE-STANDING HOSPITAL CEO POSITION. THE CEO DETERMINES THE STARTING COMPENSATION FOR THE VICE PRESIDENTS BASED ON MARKET DATA AND ANNUAL INCREASES OCCUR BASED ON PAY-FOR-PERFORMANCE SYSTEMS. THESE PROCESSES WERE LAST UNDERTAKEN IN 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE OTSEGO MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY , AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY CONTACTING THE HOSPITAL AT 825 N. CENTER GAYLORD MI 49735 OR BY PHONE 989-731-2100. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST OF NET ASSETS OF CHARITABLE FOUNDATION -733,322. NET ASSETS RELEASED FROM RESTRICTION -422,911. ROUNDING -4. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 N CENTER STREET | AddressLine1 |
| City | GAYLORD | City |
| State | MI | State |
| ZIP Code | 49735 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382135473 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | MI | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OTSEGO MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| OTSEGO MEMORIAL HOSPITAL FOUNDATION | ||
| C | 422911 | CASH |
| OTSEGO MEMORIAL HOSPITAL FOUNDATION | ||
| L | 159775 | ACTUAL COST ALLOCATION |