DECKERVILLE COMMUNITY HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: DECKERVILLE COMMUNITY HOSPITAL INC (EIN 38-1415390)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-03-21
IRS object ID: 201330809349300218
Schema version: 2011v1.5
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule D
Schedule H
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-03-21T11:52:28-05:00	Timestamp
Tax Period End Date	2012-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

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

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	381415390	EIN

Name Name

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

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

US Address USAddress

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

Officer Officer

Field	Value	IRS element (for citing)
Name	VALERIE BRYANT	Name
Title	CFO	Title
Phone	8103762835	Phone
Date Signed	2013-02-20	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	K G SZCZYPKA	Name
Phone	7349305500	Phone
Date Prepared	2013-03-07	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	VALERIE BRYANT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

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

Field	Value	IRS element (for citing)
Gross Receipts	7958554	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.DECKERVILLEHOSP.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1968	YearFormation
State Legal Domicile	MI	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES CLOSE TO HOME IN A PATIENT-CENTERED ENVIRONMENT, PROVIDE COORDINATION OF SPECIALTY AND TERTIARY CARE, AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO PROVIDE HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY IN MEETING THE NEEDS OF THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND ECONOMICALLY DISADVANTAGED IN ITS SERVICE AREA.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	3	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	3	NbrIndependentVotingMembers
Total Nbr Employees	107	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	8911	ContributionsGrantsPriorYear
Contributions Grants Current Year	18333	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	6074099	ProgramServiceRevenuePriorYear
Program Service Revenue CY	7553546	ProgramServiceRevenueCY
Investment Income Prior Year	1713	InvestmentIncomePriorYear
Investment Income Current Year	2593	InvestmentIncomeCurrentYear
Other Revenue Prior Year	665178	OtherRevenuePriorYear
Other Revenue Current Year	384082	OtherRevenueCurrentYear
Total Revenue Prior Year	6749901	TotalRevenuePriorYear
Total Revenue Current Year	7958554	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	3224468	SalariesEtcPriorYear
Salaries Etc Current Year	3583122	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2649059	OtherExpensePriorYear
Other Expenses Current Year	2784872	OtherExpensesCurrentYear
Total Expenses Prior Year	5873527	TotalExpensesPriorYear
Total Expenses Current Year	6367994	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	876374	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1590560	RevenuesLessExpensesCY
Total Assets BOY	2194151	TotalAssetsBOY
Total Assets EOY	3299609	TotalAssetsEOY
Total Liabilities BOY	2592756	TotalLiabilitiesBOY
Total Liabilities EOY	2091663	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	-398605	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1207946	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES CLOSE TO HOME IN A PATIENT-CENTERED ENVIRONMENT, PROVIDE COORDINATION OF SPECIALTY AND TERTIARY CARE, AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO PROVIDE HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY IN MEETING THE NEEDS OF THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND ECONOMICALLY DISADVANTAGED IN ITS SERVICE AREA.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	5424595	Expense
Description	TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES CLOSE TO HOME IN A PATIENT-CENTERED ENVIRONMENT, PROVIDE COORDINATION OF SPECIALTY AND TERTIARY CARE, AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO PROVIDE HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY IN MEETING THE NEEDS OF THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND ECONOMICALLY DISADVANTAGED IN ITS SERVICE AREA. DURING THE FISCAL YEAR ENDED JUNE 30, 2012, THE HOSPITAL SERVICED 121 INPATIENTS, 1,664 EMERGENCY ROOM PATIENTS, AND OVER 14,295 OUTPATIENTS THROUGH ITS CLINICS, OFFICE PRACTICES, AND ANCILLARY DEPARTMENTS.	Description
Total Program Service Expense	5424595	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	true	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	true	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	true	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	25	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	107	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	3	NbrVotingGoverningBodyMembers
Number Independent Voting Members	3	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	true	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	false	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	false	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	VALERIE BRYANT	NamePerson
Telephone Number	8103767018	TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee
DAVID L WEST
DIRECTOR/COO	40.00	X	X	91472	0	0
ANGELA MCCONNACHIE
DIRECTOR OF	40.00	X		45813	0	0
BRAD KREINER
DIRECTOR	1.00	X		0	0	0
VALERIE BRYANT
CFO	40.00		X	12500	0	0
GERALD SCHELL
DIRECTOR	1.00		X	0	0	0
MATT CAMPBELL
DIRECTOR	1.00		X	0	0	0
DR BASSAM AFANEH
PHYSICAN	40.00			407568	0	1393	X
DR PANNY DECOSSARD
PHYSICAN	40.00			337429	0	1393	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	894782	TotalReportableCompFromOrg
Total Other Compensation	2786	TotalOtherCompensation
Number Individuals GT100 K	2	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
CARDINAL HEALTH
44425 PHOENIX DR	STERLING HEIGHTS	MI	48314	SUPPLIES	260686
AMENDIA INC
1755 WEST OAK PARKWAY	MARIETTA	GA	30062	SUPPLIES	212519
SIEMENS CORP
300 NEW JERSEY AVE STE 1000	WASHINGTON	DC	20001	SUPPLIES	121245

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	3	NumberOfContractorsGT100K
All Other Contributions	18333	AllOtherContributions
Total Contributions	18333	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	NET PATIENT REVENUE	Description
Total Revenue Column	7553546	TotalRevenueColumn
Related Or Exempt Function Income	7553546	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	7553546	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	2593	TotalRevenueColumn
Exclusion	$2,593	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
OTHER REVENUE	333109	$333,109
CLINIC REVENUE	30625	$30,625
CONSULTING REVENUE	20348	$20,348

Field	Value	IRS element (for citing)
Total Other Revenue	384082	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	7958554	TotalRevenueColumn
Related Or Exempt Function Income	7553546	RelatedOrExemptFunctionIncome
Exclusion	$386,675	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	149785	Total
Program Services	45813	ProgramServices
Management And General	103972	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2813203	Total
Program Services	2399562	ProgramServices
Management And General	413641	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	620134	Total
Program Services	514711	ProgramServices
Management And General	105423	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	12042	Total
Management And General	12042	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	15500	Total
Management And General	15500	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	190827	Total
Program Services	120221	ProgramServices
Management And General	70606	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	667149	Total
Program Services	500362	ProgramServices
Management And General	166787	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	57278	Total
Program Services	40095	ProgramServices
Management And General	17183	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	203189	Total
Program Services	172711	ProgramServices
Management And General	30478	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	21326	Total
Program Services	20046	ProgramServices
Management And General	1280	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	50709	Total
Program Services	50709	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	238714	Total
Program Services	236208	ProgramServices
Management And General	2506	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	79629	Total
Program Services	75648	ProgramServices
Management And General	3981	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
MEDICAL SUPPLIES	1151010	1151010
MAINTENANCE & REPAIRS	94406	94406
DUES & SUBSCRIPTIONS	3093	3093

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	6367994	Total
Program Services	5424595	ProgramServices
Management And General	943399	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
EOY	150	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	367889	BOY
EOY	845527	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	757196	BOY
EOY	1053392	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	6263	BOY
EOY	11433	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	141303	BOY
EOY	159910	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	52832	BOY
EOY	75705	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	4398860	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	3813794	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	808404	BOY
EOY	585066	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	60264	BOY
EOY	568426	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	2194151	BOY
EOY	3299609	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2108552	BOY
EOY	1611459	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	50000	BOY
EOY	46000	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

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

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	184204	BOY
EOY	184204	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	2592756	BOY
EOY	2091663	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	-454494	BOY
EOY	1164900	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	12194	BOY
EOY	194	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	43695	BOY
EOY	42852	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	-398605	BOY
EOY	1207946	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2194151	BOY
EOY	3299609	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	1590560	ReconcilationRevenueExpenses
Reconcilation Other Changes	15991	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited

Schedule A IRS990ScheduleA

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

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Disclosed Orgs Legal Control	false	DisclosedOrgsLegalControl
Disclosed For Charitable Purposes	false	DisclosedForCharitablePurposes
Written Policy Monitoring	false	WrittenPolicyMonitoring
Sect170h Requirements Satisfied	false	Sect170hRequirementsSatisfied
Solicited Assets For Sale	false	SolicitedAssetsForSale
Agent Trustee Etc	false	AgentTrusteeEtc
Included On FS	false	IncludedOnFS

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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

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

Land Land

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

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1383171	OtherCostOrOtherBasis
Depreciation	1311199	Depreciation
Book Value	71972	BookValue

Leasehold Improvements LeaseholdImprovements

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

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2921817	OtherCostOrOtherBasis
Depreciation	2467721	Depreciation
Book Value	454096	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	585066	TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescription	Book ValueBookValue
ADVANCE PAYMENTS	525380
ENDOWMENT FUND	43046

Field	Value	IRS element (for citing)
Total Book Value Other Assets	568426	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	DEBIT IN DISPUTE	Description
Amount	$184,204	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	184204	TotalOfAmounts
Total Revenue	7958554	TotalRevenue
Total Expenses	6367994	TotalExpenses
Excess Or Deficit For Year	1590560	ExcessOrDeficitForYear
Excess Or Deficit Per FS	1590560	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	7958554	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	7958554	RevenueSubtotal
Total Revenue Per Form990	7958554	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	6367994	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	6367994	ExpensesSubtotal
Total Expenses Per Form990	6367994	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

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

Schedule H IRS990ScheduleH

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

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	29570	TotalCommunityBenefitExpense
Net Community Benefit Expense	29570	NetCommunityBenefitExpense
Percent Of Total Expense	0.00460	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	369578	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1420351	DirectOffsettingRevenue
Net Community Benefit Expense	-1050773	NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3947904	TotalCommunityBenefitExpense
Direct Offsetting Revenue	10450677	DirectOffsettingRevenue
Net Community Benefit Expense	-6502773	NetCommunityBenefitExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4347052	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11871028	DirectOffsettingRevenue
Net Community Benefit Expense	-7523976	NetCommunityBenefitExpense
Percent Of Total Expense	0.00460	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4347052	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11871028	DirectOffsettingRevenue
Net Community Benefit Expense	-7523976	NetCommunityBenefitExpense
Percent Of Total Expense	0.00460	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$149,366	BadDebtExpenseAmount
Amount Reimbursed By Medicare	6030246	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	2758060	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	3272186	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

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

Address Address

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

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

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	false	EligibilityCriteriaExplained
Uses FPG Free	false	UsesFPGFree
Uses FPG Discounted	false	UsesFPGDiscounted
Explains Basis	false	ExplainsBasis
Explains Application Method	false	ExplainsApplicationMethod
Includes Publicity Measures	false	IncludesPublicityMeasures
Actions On Nonpayment	false	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
DR BASSAM AFANEH
407568	1393	408961
DR PANNY DECOSSARD
337429	1393	338822

Schedule L IRS990ScheduleL

Loan Table LoanTable

Field	Value	IRS element (for citing)
Name Person	KATHERINE GOHEEN	NamePerson
Loan To Organization	X	LoanToOrganization
Original Principal	$130,000	OriginalPrincipalAmount
Balance Due	46000	BalanceDue
Default	true	Default
Approved By Board	true	ApprovedByBoard
Written Agreement	true	WrittenAgreement

Field	Value	IRS element (for citing)
Total Balance Due	46000	TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

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