2013-02-15T15:49:42-06:00 2012-03-31 381357951 PLANTE & MORAN PLLC 600 E FRONT STREET SUITE 300 TRAVERSE CITY MI 49686 990 2011-04-01 381459366 CHARLEVOIX AREA HOSPITAL CHAR 2315474024 14700 LAKESHORE DRIVE CHARLEVOIX MI 49720 LYN JENKS 2315474024 2013-02-15 1 P00053797 2319477800 2011 2016-03-07 17:11:31Z LYN JENKS 14700 LAKESHORE DRIVE CHARLEVOIX MI 49720 36809782 0 X WWW.CAH.ORG X 1919 MI PROVIDE HEALTHCARE TO THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES. 15 15 364 57 185756 30258 391054 274383 34048433 33233011 143210 179243 68546 109631 34651243 33796268 0 0 0 0 19028228 21188447 0 0 75271 15058132 14052496 34086360 35240943 564883 -1444675 27826701 26227208 9218503 9184499 18608198 17042709 X DEPEND ON US FOR EXCELLENT HEALTH CARE 0 0 6337631 4961832 PHYSICIAN OFFICES: 15,146 5253570 10712021 OPERATING ROOM SERVICES - SURGERIES: 2,608 3289707 2207472 ROUTINE INPATIENT - DAYS OF CARE: 2, 547 14162017 15133730 OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, EMERGENCY ROOM SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. PATIENTS SEEN IN THE EMERGENCY ROOM TOTAL 10,877. 14162017 15133730 29042925 1 1 0 1 0 0 0 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 46 0 1 364 1 1 1 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X TABITHA RUDOLPH 2315478508 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 X STEVE HUFFORD OD 1.00 X X 0 0 0 SCOTT BEATTY 1.00 X X 0 0 0 MARY JASON 1.00 X X 0 0 0 RICHARD FISH DDS 1.00 X 0 0 0 MARC LAME MD 1.00 X 0 0 0 REBECCA HANEY 1.00 X 0 0 0 HAROLD NORM PERKINS 1.00 X 0 0 0 STEVE WEBER 1.00 X X 0 0 0 RUTH B HOPPE MD 1.00 X X 0 0 0 WILLIAM JACKSON 40.00 X X 155162 0 19646 JOHN KURTZ 1.00 X 0 0 0 MICHAEL ORTWINE 1.00 X 0 0 0 MARILYN DUMBAULD 1.00 X 0 0 0 KATHY WEBER 1.00 X 0 0 0 MELODIE BROWN MD 1.00 X 0 0 0 MICHEAL HARMELING MD 1.00 X 175472 0 24001 JOSEPH SCHODDE 40.00 X 115611 0 22185 JAMES JEAKLE MD 40.00 X 332917 0 24998 RODERIC TINNEY MD 40.00 X 224638 0 18262 MARY IVEY MD 40.00 X 393533 0 21615 WILLIAM MOSHER III MD 40.00 X 214585 0 9644 BRIAN DISHINGER MD 40.00 X 366586 0 22751 1978504 0 163102 20 0 1 0 PINE RIVER MEDICAL ASSOCIATES 14734 PARK AVENUE CHARLEVOIX MI 49720 ER PHYSICIAN COVERAGE 1286335 ALLIANCE-HNI LLC 525 S GOULD OWOSSO MI 48867 MOBILE MRI SERVICES 221751 QUEST DIAGNOSTICS 4444 GIDDINGS ROAD AUBURN HILLS MI 48326 LABORATORY SERVICES 215554 PLANTE & MORAN PLLC 600 EAST FRONT ST TRAVERSE CITY MI 49686 AUDIT & ACCOUNTING 115500 MUNSON SUPPORT SERVICES 1105 SIXTH STREET TRAVERSE CITY MI 49685 LAUNDRY SERVICES 114468 5 257661 16722 2530 274383 HEALTH SERVICES 622110 27288084 27288084 OTHER RELATED REVENUE 622110 5944927 5759171 185756 33233011 32984 32984 141121 173321 -32200 -32200 -32200 2973264 13188 2840193 0 133071 13188 146259 146259 CAFETERIA SALES 722210 141831 141831 141831 33796268 33015055 185756 321074 329451 329451 16879850 14824224 2020160 35466 119117 102449 16503 165 2765956 2378617 369293 18046 1094073 924940 166630 2503 16939 16939 111465 111465 3020061 2555090 463957 1014 146894 146894 67574 48083 19491 150402 150402 734478 734478 89323 77773 11550 224371 183200 39473 1698 1961500 1571292 374123 16085 265626 338 265288 SUPPLIES 3998056 3642572 355194 290 PROVISION FOR BAD DEBTS 984053 984053 QAAP TAX 563097 563097 DUES AND SUBSCRIPTIONS 511696 108562 403134 1206961 907254 299703 4 35240943 29042925 6122747 75271 114692 186619 1497058 37404 33597 25347 3149189 4958932 482447 297902 642669 372078 567894 892940 45647458 29363339 16741843 16284119 2430012 72632 1672938 1668278 494362 1430957 27826701 26227208 2620093 3203562 4890396 4092706 1357011 1888231 351003 0 9218503 9184499 X 17350568 16187042 1257630 855667 18608198 17042709 27826701 26227208 X -1444675 -120814 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4188 4188 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTION OF ANNUAL DUES PAID TO THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARD LOBBYING ACTIVITIES. 898861 898861 30654858 18707838 11947020 14074058 10655501 3418557 19681 19681 16284119 INVESTMENT IN CHARLEVOIX NURSING HOME 837958 F INVESTMENT IN CHARLEVOIX FOUNDATION 830320 F 1668278 COST REPORT SETTLEMENT RECEIVABLE 228578 BOND ISSUE COSTS 21379 ACCRUED MEANINGFUL USE FUNDING RECEIVABLE 1181000 1430957 33796268 35240943 -1444675 -120814 -120814 -1565489 1 1 X 1 X 1 X 1 1 0 1 1 506067 157781 348286 0.01020 4228319 2036849 2191470 0.06400 4734386 2194630 2539756 0.07420 316008 316008 0.00920 316008 316008 0.00920 5050394 2194630 2855764 0.08340 0 984053 177129 7965969 7887098 78871 X 1 1 1 1 CHARLEVOIX AREA HOSPITAL

14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720

X X X CHARLEVOIX AREA HOSPITAL 1 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X 1 0 1 X 0 0 4 BOYNE AREA MEDICAL CENTER

223 N PARK BOYNE CITY MI 49712

OUTPATIENT PHYSICIAN OFFICE CHARLEVOIX WOMEN'S HEALTH CARE

14651 W UPRIGHT STREET CHARLEVOIX MI 49720

OUTPATIENT PHYSICIAN OFFICE CHARLEVOIX SURGEONS

14695 PARK AVENUE CHARLEVOIX MI 49720

PHYSICIAN OFFICE PHYSICIAN CLINIC OF CHARLEVOIX

14705 W UPRIGHT STREET CHARLEVOIX MI 49720

PHYSICIAN OFFICE PART I, LINE 3C: IN ADDITION TO USE OF THE FEDERAL POVERTY GUIDELINES, PATIENTS MUST ALSO SATISFY AN ASSET TEST LIMIT OF $62,000. FURTHERMORE, TOTAL MEDICAL DEBT WILL BE CONSIDERED ON A CASE BY CASE BASIS AS AN ADDITIONAL ELEMENT IN DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE. PART I, LINE 6A: N/A PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. ACTUAL COSTS ARE REPORTED ON LINE 7E. PART I, LINE 7G: THE HOSPITAL DID NOT REPORT SUBSIDIZED HEALTH SERVICES. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $985,053. PART II: N/A - THE HOSPITAL DID NOT LIST ANY COMMUNITY BUILDING ACTIVITIES ON SCHEDULE H. PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. 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.THE BAD DEBT EXPENSE IS THE BAD DEBT EXPENSE REPORTED IN FORM 990 PART IX AND IN THE AUDITED FINANCIAL STATEMENTS.THE HOSPITAL PROVIDES CARE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. WHILE THE HOSPITAL MAKES EVERY EFFORT TO IDENTIFY ALL CANDIDATES WHO WOULD QUALIFY UNDER ITS FINANCIAL ASSISTANCE POLICY, THERE ARE CIRCUMSTANCES UNDER WHICH THAT DETERMINATION CANNOT BE MADE. AS SUCH, IT IS OUR BELIEF THAT $177,129 OF BAD DEBT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY AND SHOULD BE INCLUDED AS COMMUNITY BENEFIT. BASED ON AN ANALYSIS OF SELF PAY ENCOUNTERS WHOSE GROSS CHARGES EXCEEDED $1,000 AND THEREFORE WERE AUTOMATICALLY SENT A FINANCIAL ASSISTANCE APPLICATION, IT WAS DETERMINED THAT APPROXIMATELY 45% QUALIFIED FOR FINANCIAL ASSISTANCE. THIS PERCENTAGE WAS THEN APPLIED TO TOTAL SELF PAY BAD DEBT AND THEN CONVERTED TO COST THROUGH APPLICATION OF THE RATIO OF PATIENT CARE COST TO CHARGES. PART III, LINE 8: THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DO NOT SHOW A SHORTFALL. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. PART III, LINE 9B: THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARLEVOIX AREA HOSPITAL PART V, SECTION B, LINE 13G: SUMMARY INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE HOSPITAL'S ADMISSIONS AREAS. CHARLEVOIX AREA HOSPITAL PART V, SECTION B, LINE 19D: A PERCENTAGE DISCOUNT RANGING FROM 20% TO 100% IS APPLIED TO GROSS CHARGES FOR INDIVIDUALS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THE DISCOUNT IS DETERMINED ON A SLIDING SCALE USING THE FEDERAL POVERTY GUIDELINES GRID FOR INCOMES UP TO 300% OF THE FEDERAL POVERTY LEVEL AND TAKING INTO ACCOUNT THE NUMBER OF MEMBERS IN THE FAMILY. PART VI, LINE 2: CHARLEVOIX AREA HOSPITAL HAS PARTICIPATED IN NEEDS ASSESSMENT SURVEYS CONSISTENTLY DURING THE PAST 10 YEARS, TYPICALLY IN COOPERATION WITH OTHER ORGANIZATIONS BUT AT TIMES SPECIFICALLY DRIVEN BY OUR HOSPITAL. IN ADDITION TO DATA PROCURED THROUGH THESE SURVEYS, OUR HOSPITAL HAS ALSO USED MICHIGAN DEPARTMENT OF COMMUNITY HEALTH HEALTH DATA, STATE OF MICHIGAN CENSUS DATA, AND DATA FROM THE ECONOMIC DEVELOPMENT COUNCIL TO ASSESS THE ONGOING HEALTHCARE NEEDS OF OUR COMMUNITY. THE SURVEYS HAVE RESULTED IN MANY JOINT EFFORTS TO ADDRESS OUR COMMUNITY'S HEALTH CARE NEEDS (FLU CLINICS IN COOPERATION WITH LOCAL MDCH, GRANT PROCUREMENT FOR PACS AND DIGITAL MAMMOGRAPHY, AND FITKIDS). ADDITIONALLY, THE HOSPITAL HAS SOLELY SPONSORED WELLNESS WEDNESDAY'S, FREE MAMMOGRAPHY, AND SPORTS PHYSICALS FOR STUDENT ATHLETES. PART VI, LINE 3: INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE HOSPITAL'S ADMISSIONS AREAS. IF, DURING THE REGISTRATION PROCESS, IT BECOMES APPARENT THAT A PATIENT HAS NEED FOR POSSIBLE FINANCIAL OR DISCOUNTED ASSISTANCE, A REFERRAL IS MADE TO THE HOSPITAL'S FINANCIAL COUNSELOR OR SOCIAL WORKER. DURING THIS ASSESSMENT, ELIGIBILITY FOR ASSISTANCE UNDER EXISTING FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS FIRST EXPLORED. SHOULD THE PATIENT FAIL TO QUALIFY FOR EXISTING PROGRAMS, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION IS MADE AVAILABLE. IN THE EVENT THE PATIENT'S NEED IS NOT IDENTIFIED DURING REGISTRATION, ADDITIONAL OPPORTUNITIES TO INQUIRE ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE. FOR EXAMPLE, THE PHONE NUMBER FOR INQUIRIES INTO FINANCIAL ASSISTANCE ARE PRINTED ON ANY STATEMENTS SENT TO THE PATIENT. FURTHERMORE, PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE AND HAVE AN ENCOUNTER BALANCE THAT EXCEEDS $1,000 ARE AUTOMATICALLY SENT AN APPLICATION. PART VI, LINE 4: CHARLEVOIX AREA HOSPITAL SERVES THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES, AS WELL AS THE SEASONAL RESIDENTS THAT FLOOD THE AREA DURING THE SUMMER MONTHS. THIS SMALL, RURAL COMMUNITY IS HOME TO APPROXIMATELY 26,000 RESIDENTS, WITH A PER CAPITA INCOME OF APPROXIMATELY $40,000. BASED ON 2008 ESTIMATES, 11.2% OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL. SIMILARLY, MEDICAID RECIPIENTS ACCOUNTED FOR APPROXIMATELY 12% OF THE HOSPITAL'S GROSS PATIENT CHARGES. IN ADDITION, PATIENTS REFERRED FROM NEIGHBORING EAST JORDAN FAMILY HEALTH CENTER, A FEDERALLY QUALIFIED RURAL HEALTH CLINIC, WERE AMONG THOSE SERVED BY THE HOSPITAL. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPRISED OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THIS VOLUNTARY BOARD PROVIDES COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. PART VI, LINE 6: N/A - THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 MI X X 0 0 0 1 0 0 0 0 0 WILLIAM JACKSON 148537 0 0 0 6625 0 3093 0 16553 0 174808 0 0 0 MICHEAL HARMELING MD 138719 0 36542 0 211 0 2877 0 21124 0 199473 0 0 0 JAMES JEAKLE MD 223631 0 108799 0 487 0 4390 0 20608 0 357915 0 0 0 RODERIC TINNEY MD 147201 0 76604 0 833 0 2961 0 15301 0 242900 0 0 0 MARY IVEY MD 255978 0 137217 0 338 0 5109 0 16506 0 415148 0 0 0 WILLIAM MOSHER III MD 210308 0 0 0 4277 0 4212 0 5432 0 224229 0 0 0 BRIAN DISHINGER MD 322731 0 43500 0 355 0 6245 0 16506 0 389337 0 0 0 PART I, LINE 5 EMPLOYED PHYSICIANS ARE PAID AN INCENTIVE BONUS BASED ON THE GROSS VALUE OF PROFESSIONAL SERVICE CHARGES RENDERED TO ANY AND ALL PATIENTS, REGARDLESS OF THE PATIENTS' ABILITY TO PAY. NET REVENUE COLLECTED ON THE PRO CHARGES IS NOT CONSIDERED WHEN CALCULATING THE INCENTIVE BONUS. ALL INCENTIVE BONUS AGREEMENTS HAVE OVERALL CAPS ON TOTAL COMPENSATION FOR WHICH THE PHYSICIAN IS ELIGIBLE IN A TWELVE MONTH TIME PERIOD. MARC E LAME MD BOARD MEMBER MARC LAME IS OWNER OF PHYSICIAN PRACTICE MARC E. LAME MD. 102523 RENTAL OF SPACE AND OFFICE STAFF FOR HOSPITAL EMPLOYED SURGEON HOUSED AT THE PRIVATE PHYSICIAN PRACTICE OF MARC LAME, MD ($75,523). RENTAL OF PHYSICIAN OFFICE BUILDING TO MARC E. LAME, MD BY THE HOSPITAL ($27,000). 0 KAYE BEATTY WIFE OF BOARD MEMBER SCOTT BEATTY. 36498 COMPENSATED AS AN EMPLOYEE OF THE HOSPITAL 0 PINE RIVER MEDICAL ASSOCIATES BOARD MEMBER MELODIE BROWN IS AN OWNER OF PINE RIVER MEDICAL ASSOCIATES 1354418 INDEPENDENT CONTRACTOR ARRANGEMENT FOR ER AND HOSPITALIST PHYSICIAN SERVICES ($1,058,906); TRANSCRIPTION SERVICES PROVIDED BY THE HOSPITAL TO PINE RIVER ($14,400); RENTAL OF SPACE AND OFFICE STAFF FOR HOSPITAL-EMPLOYED PEDIATRICIAN HOUSED AT PINE RIVER ($240,000); AND RENTAL OF PHYSICIAN OFFICE BUILDING TO PINE RIVER BY THE HOSPITAL ($41,112). 0 FORM 990, PART VI, SECTION B, LINE 11 AN INFORMAL REVIEW OF THE 990 IS PERFORMED BY THE ADMINISTRATIVE TEAM AND BY MEMBERS OF THE EXECUTIVE COMMITTEE OF THE BOARD BEFORE THE RETURN IS FILED. THIS REVIEW IS NOT DOCUMENTED. FORM 990, PART VI, SECTION B, LINE 12C ALL INDIVIDUALS SERVING ON THE BOARD ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND ARE PERIODICALLY REMINDED OF THEIR OBLIGATION TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT MAY ARISE AS PART OF INTERRELATIONSHIPS RESULTING FROM THEIR PROFESSIONAL CAREERS, THEIR FAMILIES, THEIR PERSONAL ACQUAINTANCES WITH KEY EMPLOYEES OF THE HOSPITAL, AND THEIR DUTIES AS A BOARD MEMBER. MONITORING IS CONDUCTED ON AN ONGOING BASIS, WITH THE EXPECTATION THAT BOARD MEMBERS WILL MEET THEIR AFFIRMATIVE OBLIGATION TO REPORT CONFLICTS OF INTEREST PRIOR TO THE EXECUTION OF BOARD TRANSACTIONS INVOLVING SUCH CONFLICTS. CHARLEVOIX AREA HOSPITAL CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY DISTRIBUTING AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE TO BOARD MEMBERS, EMPLOYED PHYSICIANS, AND KEY EMPLOYEES, WHICH INCLUDES QUESTIONS RELATED TO EACH POLICY PROVISION. RESPONSES ARE THOROUGHLY REVIEWED AND ANY APPARENT CONFLICTS ARE THOROUGHLY INVESTIGATED. IN THE EVENT THAT A POTENTIAL CONFLICT IS IDENTIFIED PRIOR TO ACTION ON A CONTRACT OR TRANSACTION, THE CONFLICTED PERSON IS NOT ALLOWED TO PARTICIPATE IN DISCUSSIONS ON THE MATTER, NOT ALLOWED TO VOTE ON THE MATTER, AND NOT ALLOWED TO BE PRESENT DURING VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15A THE HIGHEST PAID EMPLOYEES ARE OUR PHYSICIANS, AND THE MGMA ANNUAL PHYSICIAN COMPENSATION SURVEY IS USED TO DETERMINE THAT SALARIES PAID TO OUR EMPLOYED PHYSICIANS ARE APPROPRIATE. EXECUTIVE COMPENSATION FOR THE CEO IS CHECKED AGAINST REGIONAL COMPENSATION THROUGH THE USE OF A WELL RESPECTED EMPLOYMENT AND RECRUITING FIRM IN MICHIGAN. IT IS ALSO COMPARED TO COMPENSATION DATA PROVIDED BY OUR STATE HOSPITAL ASSOCIATION. THEIR REVIEW IS PERFORMED ANNUALLY BY THE COMPENSATION COMMITTEE OF THE BOARD. THIS REVIEW WAS LAST PERFORMED IN FISCAL YEAR 2009. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: THESE INDIVIDUALS DEVOTE THE FOLLOWING HOURS PER WEEK TO, RELATED ORGANIZATION, CHARLEVOIX AREA HOSPITAL FOUNDATION: WILLIAM JACKSON 2 HOURS REBECCA HANEY 2 HOURS JAMES JEAKLE, MD 2 HOURS SCOTT BEATTY 2 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -120,814. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CHARLEVOIX AREA HOSPITAL FOUNDATION 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 753078034 FUNDRAISING MI 501(C)(3) LINE 11A, I CHARLEVOIX AREA HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 CHARLEVOIX AREA HOSPITAL FOUNDATION C 370539 CASH CHARLEVOIX AREA HOSPITAL FOUNDATION P 68865 FMV - ACTUAL AMOUNTS PAID