2013-04-24T14:41:59-05:00 2012-06-30 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2011-07-01 382934134 MONROE COMMUNITY HEALTH SERVICES MONR 7342404520 718 N MACOMB STREET MONROE MI 48162 THOMAS W SCHILLING 7342404520 2013-04-05 1 SUSAN MIENCIER P00842339 2483522500 2011 2016-03-07 17:11:31Z THOMAS W SCHILLING 718 N MACOMB STREET MONROE MI 48162 7538030 0 X WWW.MERCYMEMORIAL.ORG X 1989 MI PROMOTE THE GENERAL HEALTH OF THE PUBLIC IN MONROE COUNTY, MICHIGAN AND SURROUNDING AREAS. 16 12 172 24 0 0 189 44 9296773 7513194 32718 24792 -22063 0 9307617 7538030 0 0 0 0 4443800 3724246 0 0 0 4270334 3102401 8714134 6826647 593483 711383 5731986 6930200 2898991 3385822 2832995 3544378 PROMOTE THE GENERAL HEALTH OF THE PUBLIC IN MONROE COUNTY, MICHIGAN AND SURROUNDING AREAS. 0 0 6298757 7513194 OPERATED A 70-BED SKILLED NURSING FACILITY, DBA MERCY MEMORIAL NURSING CENTER. THIS FACILITY PROVIDED 23,264 RESIDENT DAYS OF CARE IN 2012 AS FOLLOWS:- MEDICAID 10,848- PRIVATE PAY 4,408- MEDICARE 8,008THIS REPRESENTS AN AVERAGE CENSUS OF 63.6 RESIDENT UNITS PER DAY. 6298757 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 9 0 1 172 1 0 0 0 0 0 0 0 0 0 0 X 16 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X THOMAS W SCHILLING 7342404520 718 N MACOMB STREET MONROE MI 48162 BELLINO KAREN M VUICH 1.00 X 0 0 0 BHURGRI MD AAMER 4.00 X 0 49278 45929 BRAUNLICH PAUL E 1.00 X 0 0 0 CALENDAR KAREN 1.00 X 0 0 0 CALENDAR KENYON S 1.00 X 0 0 0 CARTER KURT W 1.00 X 0 0 0 CHARBONEAU DO MICHAEL 1.00 X 0 363926 12543 DARROW KURT L 1.00 X 0 0 0 FRANZEN VICKI L 1.00 X X 0 0 0 KABIR MD ABDUL 1.00 X 0 35394 531 MCNAMEE MD KENNETH J 1.00 X 0 0 0 PETERS RUTH ANN 1.00 X 0 0 0 PHILLIPS ANNETTE S 4.00 X X 0 434409 29668 ROBBINS BASIL D 1.00 X X 0 0 0 RYAN SISTER JANET 1.00 X X 0 0 0 SABO CPA DEBORAH A 1.00 X X 0 0 0 SPENCER EDD DONALD A 1.00 X X 0 0 0 WALSH ARLENE R 1.00 X 0 0 0 WILBURN WALTER 1.00 X 0 0 0 WORRELL MARK 1.00 X 0 0 0 KUBISKE DAVID 1.00 X 0 0 0 KULISH BARTON 1.00 X 0 0 0 AMIN JATIN 1.00 X 0 0 0 JAVAID MUHAMMAD 1.00 X 0 0 0 SCHILLING THOMAS W 4.00 X 0 311655 30325 JAN MARTIN 40.00 X 118869 0 30624 118869 1194662 149620 1 0 1 0 CONCEPT REHAB INC 7150 GRANITE CIRCLE SUITE 200 TOLEDO OH 43617 PATIENT THERAPY 905762 1 44 44 SKILLED NURSING - MMNC 623000 7513194 7513194 7513194 8892 8892 15900 0 15900 15900 15900 7538030 7513194 0 24792 2797896 2549026 248870 12846 11703 1143 701830 639403 62427 211674 192846 18828 44916 44916 18008 18008 137 137 1138567 1088479 50088 9734 9734 53587 22650 30937 263920 246636 17284 11090 7324 3766 1489 75 1414 90690 90690 253333 236743 16590 45997 42249 3748 MEDICAL SUPPLIES 472417 472417 QUALITY ASSURANCE ASSES 304349 304349 BAD DEBT EXPENSE 229021 229021 DIETARY 165146 165146 6826647 6298757 527890 0 2996612 7790 3292340 1054182 1814462 19803 8561 9511084 7711752 1652104 1799332 9285 7715 5731986 6930200 1123252 1755134 1775739 1630688 2898991 3385822 X 2832207 3543546 788 832 2832995 3544378 5731986 6930200 711383 0 X X 0 1 1 X 0 X 1812 2001 1664 189 44 5710 10629556 9875332 10714465 9296773 7513194 48029320 10631368 9877333 10716129 9296962 7513238 48035030 0 26311 45342 15346 202777 289776 26311 45342 15346 202777 289776 47745254 403763 355462 198647 59779 8892 1026543 403763 355462 198647 59779 8892 1026543 11035131 10232795 10914776 9356741 7522130 49061573 0.97320 0.97180 0.02090 0.02590 X 0 0 0 0 0 0 0 0 1 137 137 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PERCENTAGE OF DUES PAID TO VARIOUS ORGANIZATIONS IS ALLOCATED BY THOSE ORGANIZATIONS AS LOBBYING COSTS. 788 44 832 636 152 788 542 94 636 464 78 542 1.00000 0.00000 0.00000 0 1 1 375115 375115 6017214 5231892 785322 29780 28925 855 2696652 2450935 245717 392323 392323 1799332 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS FOR RESIDENT ACTIVITIES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. 0 1 0 0 0 0 0 0 0 CHARBONEAU DO MICHAEL 0 276533 0 75 0 87318 0 4000 0 8543 0 376469 0 0 PHILLIPS ANNETTE S 0 340138 0 89471 0 4800 0 10378 0 19290 0 464077 0 0 SCHILLING THOMAS W 0 254155 0 51500 0 6000 0 10559 0 19766 0 341980 0 0 PART I, LINE 3 THE CHIEF EXECUTIVE OFFICERS COMPENSATION WAS ESTABLISHED BY A RELATED ORGANIZATION USING THE FOLLOWING RESOURCES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B A RELATED ORGANIZATION OFFERS SELECT MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES ANNUAL EMPLOYER-FUNDED CONTRIBUTIONS EQUAL TO A FIXED PERCENT OF BASE SALARY: 15% FOR CEO, 10% FOR SENIOR VICE PRESIDENTS AND 5% FOR VICE PRESIDENTS. BENEFITS ARE VESTED AFTER THREE YEARS OF SERVICE AND ARE PAID OUT IN A LUMP SUM BY MARCH 15 OF THE YEAR FOLLOWING THE YEAR IN WHICH THEY BECOME VESTED. THE FOLLOWING INDIVIDUALS REPORTED ON FORM 990, PART VII ARE PARTICIPANTS: ANNETTE PHILLIPS AND THOMAS SCHILLING. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS DR. KENNETH MCNAMEE, DR. AAMER BHURGRI, DR. MICHAEL CHARBONEAU, JATIN AMIN AND DR. ABDUL KABIR HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS KAREN CALENDAR AND KENYON CALENDAR HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MONROE COMMUNITY HEALTH SERVICES HAS MEMBERS. MERCY MEMORIAL HOSPITAL CORPORATION IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER HAS THE POWERS AND VOTING RIGHTS TO: [A] APPOINT, ELECT, AND REMOVE TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE POWERS AND VOTING RIGHTS TO: [B] APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION; [C] ADOPT, AMEND, OR REPEAL THE BYLAWS; [D] APPROVE EACH BUDGET AND LONG-RANGE PLAN; [E] APPROVE CONTRACT OR LOAN OBLIGATING THE CORPORATION TO EXPEND/REPAY AN AMOUNT IN EXCESS OF $50,000 WHICH WAS NOT INCLUDED IN PREVIOUSLY APPROVED BUDGETS; [F] APPROVE CONTRACTS OUTSIDE THE ORDINARY COURSE OF THE BUSINESS OF THE CORPORATION; [G] APPROVE ALL PLANS OF MERGER OR CONSOLIDATION; [H] APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE PROPERTY AND ASSETS OF THE CORPORATION; AND [I] APPROVE A VOLUNTARY DISSOLUTION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 INPUT DATA IS REVIEWED AND ANALYZED BY THE CONTROLLER AND THEN SUBMITTED TO THE CERTIFIED PUBLIC ACCOUNTING FIRM FOR PREPARATION. THE COMPLETED FORM 990 IS THEN RETURNED TO THE CFO AND THE CEO FOR FINAL REVIEW AND APPROVAL BEFORE THE BOARD MEETING. BEFORE THE RETURN IS FILED, THE FORM 990 IS REVIEW BY THE BOARD. ALL MEMBERS RECEIVE A COPY OF THE FORM 990, EVEN THOSE THAT ARE UNABLE TO ATTEND THE SCHEDULED MEETING. THE REVIEW IS PERFORMED DURING ONE OF THE MONTHLY BOARD MEETINGS, WHERE EACH MEMBER HAS A CHANGE TO ASK QUESTIONS. THIS REVIEW IS DOCUMENTED VIA MINUTES TO THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS BOARD MEMBERS, OFFICERS AND EMPLOYEES OF THE ORGANIZATION. ON AN ANNUAL BASIS, THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS DISTRIBUTED TO OFFICERS, EMPLOYEES, AND TRUSTEES OF MONROE COMMUNITY HEALTH SERVICES. POTENTIAL CONFLICTS OF INTEREST ARE ANALYZED BY THE HOSPITAL'S LEGAL DEPARTMENT AND ARE GIVEN RANKINGS OF LOW, MODERATE, AND SEVERE RISK. THIS ANALYSIS IS GIVEN TO THE BOARD CHAIR AND THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. ANY MEMBER WITH AN IDENTIFIED CONFLICT OF INTEREST IS EXCUSED FROM THE MEETING DURING DISCUSSIONS PERTAINING TO THE ISSUE OF CONFLICT, AND THE MEMBER IS NOT PERMITTED TO VOTE ON ANY ISSUE OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 OFFICERS ARE COMPENSATED BY MERCY MEMORIAL HOSPITAL CORPORATION, A RELATED ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE OF THE HOSPITAL'S BOARD OF TRUSTEES DETERMINES AND APPROVES ALL COMPENSATION FOR THOSE DESIGNATED IN SENIOR LEADERSHIP POSITIONS, SUCH AS THE CHIEF EXECUTIVE OFFICER & PRESIDENT AND THE CHIEF FINANCIAL OFFICER & SENIOR VICE PRESIDENT OF FINANCE. THE INDEPENDENT BOARD COMMITTEE RETAINS AN OUTSIDE CONSULTANT TO ANALYZE AND ASSIST IN MAKING THESE DETERMINATIONS THROUGH A VARIETY OF MARKET SURVEYS/STUDIES. THIS PROCESS IS UNDERTAKEN ANNUALLY AND WAS LAST PERFORMED IN 2012. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT OR SELECTION PROCESS FROM THE PRIOR YEAR. FORM 990, PART IV, LINE 24 & SCHEDULE K: TAX EXEMPT BONDS: MONROE COMMUNITY HEALTH SERVICES IS A MEMBER OF THE MERCY MEMORIAL HOSPITAL CORPORATION OBLIGATED GROUP OF WHICH MONROE COMMUNITY HEALTH SERVICES HAS BEEN ALLOCATED FUNDS FROM A 2006 BOND ISSUANCE. DUE TO THIS, ALL INFORMATION RELATING TO THE 2006 BOND ISSUANCE HAS BEEN REPORTED ON THE MERCY MEMORIAL HOSPITAL CORPORATION 2010 FORM 990 AND IS NOT INCLUDED ON THIS RETURN. FORM 990, PART VII, SECTION A: THESE INDIVIDUALS DEVOTE THE FOLLOWING HOURS PER WEEK TO, RELATED ORGANIZATION, MERCY MEMORIAL HOSPITAL CORPORATION: JATIN AMIN 1 HOUR KAREN M. VUICH BELLINO 1 HOUR AAMER BHURGRI, M.D. 4 HOURS PAUL E. BRAUNLICH 1 HOUR KAREN CALENDAR 1 HOUR KENYON S. CALENDAR 1 HOUR KURT W. CARTER 1 HOUR MICHAEL CHARBONEAU, D.O. 40 HOURS KURT L. DARROW 1 HOUR VICKI L. FRANZEN 1 HOUR MUHAMMAD JAVAID 1 HOUR ABDUL KABIR, M.D. 4 HOURS DAVID KUBISKE 1 HOUR BARTON KULISH 1 HOUR KENNETH J. MCNAMEE, M.D. 1 HOUR RUTH ANN PETERS 1 HOUR ANNETTE S. PHILLIPS 40 HOURS BASIL D. ROBBINS 1 HOUR SISTER JANET RYAN 1 HOUR DEBORAH A. SABO, C.P.A. 1 HOUR DONALD A. SPENCER, ED.D. 1 HOUR ARLENE R. WALSH 1 HOUR WALTER WILBURN 1 HOUR MARK WORRELL 1 HOUR THOMAS W. SCHILLING 40 HOURS MERCY MEMORIAL HOSPITAL CORPORATION 718 N MACOMB STREET MONROE MI 48162 381984289 HOSPITAL MI 501(C)(3) LINE 3 N/A 0 MONROE HEALTH VENTURES 718 N MACOMB STREET MONROE MI 48164 382704426 PHARMACY MI N/A C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 MERCY MEMORIAL HOSPITAL CORPORATION L 133397 ACTUAL ALLOCATED COST MERCY MEMORIAL HOSPITAL CORPORATION K 134415 ACTUAL ALLOCATED COST MERCY MEMORIAL HOSPITAL CORPORATION O 1263606 ACTUAL ALLOCATED COST MERCY MEMORIAL HOSPITAL CORPORATION P 81828 ACTUAL ALLOCATED COST MERCY MEMORIAL HOSPITAL CORPORATION Q 1028460 ACTUAL ALLOCATED COST