NORTHERN HEALTH PLAN: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN HEALTH PLAN (EIN 20-1477015)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-07
- IRS object ID
- 201332199349300113
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-07T09:44:35-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382157642 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MANER COSTERISAN PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2425 E GRAND RIVER SUITE 1 | AddressLine1 |
| City | LANSING | City |
| State | MI | State |
| ZIP Code | 489123291 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201477015 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN HEALTH PLAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 2315477627 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 W GARFIELD | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRUCE MILLER | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 2315477627 | Phone |
| Date Signed | 2013-07-29 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES A MC NEELEY CPA | Name |
| PTIN | P00364811 | PTIN |
| Phone | 5173237500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | BRUCE MILLER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 W GARFIELD | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3998538 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.COMMUNITYHEALTHPLANS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2001 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE MEDICAL SERVICES TO INDIGENT RESIDENTS OF NORTHERN MICHIGAN. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 14 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 14370 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 4377682 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3996752 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 514 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1786 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 4392566 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3998538 | 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 | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4202460 | OtherExpensePriorYear |
| Other Expenses Current Year | 3793409 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 4202460 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3793409 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 190106 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 205129 | RevenuesLessExpensesCY |
| Total Assets BOY | 2864185 | TotalAssetsBOY |
| Total Assets EOY | 2999713 | TotalAssetsEOY |
| Total Liabilities BOY | 710344 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 640743 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2153841 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2358970 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE PLAN PROVIDES MEDICAL SERVICES TO INDIGENT RESIDENTS OF THE NORTHERN PORTION ON MICHIGAN'S LOWER PENINSULA WHO ARE NOT COVERED BY A GOVERNMENTAL HEALTH PROGRAM OR HEALTH INSURANCE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 3648333 | Expense |
| Revenue | 3996752 | Revenue |
| Description | TO PROVIDE DIRECT MEDICAL SERVICES FOR LOW-INCOME, UNINSURED PEOPLE WITHOUT ACCESS TO OTHER GOVERNMENT HEALTH CARE PROGRAMS. AS OF SEPTEMBER 30, 2012, A TOTAL OF 4,531 PEOPLE ARE RECEIVING MEDICAL SERVICES UNDER THE PLAN. | Description |
| Total Program Service Expense | 3648333 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MI | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | BRUCE MILLER | NamePerson |
| Telephone Number | 2315477627 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 W GARFIELD | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| CHRISTINE BAUMGARDNER | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| JOHN MCVEETY | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| CAROL SHAFTO | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| MARTA OLSON | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| MYRNA HOLLAND | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| LARRY LOSINSKI | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| LYN JENKS | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| FRED HARRIS | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| DAVID BELLAMY | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| ROBERT COURTOIS | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| JIM BEACH | ||||||
| BOARD MEMBER | 0.50 | X | 0 | 0 | 0 | |
| JOHN BRUNING | ||||||
| PRESIDENT | 2.00 | X | 0 | 0 | 0 | X |
| RICHARD WAKULAT | ||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | X |
| LINDA YAROCH | ||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X |
| BRUCE MILLER | ||||||
| EXECUTIVE DIRECTOR | 20.00 | 0 | 0 | 0 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| NORTHWEST MICHIGAN COMMUNITY | |||||
| 220 W GARFIELD | CHARLEVOIX | MI | 49726 | MEDICAL SERVICES | 1068720 |
| 4D PHARMACY MANAGEMENT SYSTEMS INC | |||||
| 2520 INDUSTRIAL ROW DRIVE | TROY | MI | 48084 | PHARMACY SERVICES | 396153 |
| DISTRICT HEALTH DEPARTMENT #4 | |||||
| 825 S HURON ST | CHEBOYGAN | MI | 49721 | MEDICAL SERVICES | 302364 |
| HEALTH ADVANTAGE | |||||
| G-3245 BEECHER ROAD SUITE 200 | FLINT | MI | 48532 | PLAN ADMINISTRATION AND CLAIMS PROCESSIN | 279090 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICAL PROGRAMS | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 3996752 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3996752 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3996752 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1786 | TotalRevenueColumn |
| Exclusion | $1,786 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3998538 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3996752 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,786 | ExclusionAmount |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23540 | Total |
| Management And General | 23540 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1435631 | Total |
| Program Services | 1432159 | ProgramServices |
| Management And General | 3472 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7875 | Total |
| Management And General | 7875 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SERVICES | 1614886 | 1614886 | |
| ADMIN. SERVICES/SUPPORT | 355893 | 249207 | 106686 |
| PHARMACY CLAIMS | 321625 | 321625 | |
| ENROLLMENT AND OUTREACH | 17248 | 17248 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16711 | Total |
| Program Services | 13208 | ProgramServices |
| Management And General | 3503 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3793409 | Total |
| Program Services | 3648333 | ProgramServices |
| Management And General | 145076 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2859592 | BOY |
| EOY | 1032628 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4593 | BOY |
| EOY | 4593 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1962492 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2864185 | BOY |
| EOY | 2999713 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85081 | BOY |
| EOY | 177044 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 625263 | BOY |
| EOY | 463699 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 710344 | BOY |
| EOY | 640743 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2153841 | BOY |
| EOY | 2358970 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2153841 | BOY |
| EOY | 2358970 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2864185 | BOY |
| EOY | 2999713 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 205129 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 14370 | CurrentTaxYearMinus1Year |
| Total | 14370 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4162571 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4134015 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3839040 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4377682 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3996752 | CurrentTaxYear |
| Total | 20510060 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4162571 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4134015 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3839040 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4392052 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3996752 | CurrentTaxYear |
| Total | 20524430 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 20524430 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 52555 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5298 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3339 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 514 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1786 | CurrentTaxYear |
| Total | 63492 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 52555 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5298 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3339 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 514 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1786 | CurrentTaxYear |
| Total | 63492 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4215126 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4139313 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3842379 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4392566 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3998538 | CurrentTaxYear |
| Total | 20587922 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99690 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99310 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00310 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00690 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | HOSPITAL PAYMENTS RECEIVABLE | Description |
| Book Value | 1962492 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1962492 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CLAIMS INCURRED BUT NOT REPORTED | $195,000 |
| RISK SHARE PAYABLE | $268,699 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 463699 | TotalOfAmounts |
| Total Revenue | 3998538 | TotalRevenue |
| Total Expenses | 3793409 | TotalExpenses |
| Excess Or Deficit For Year | 205129 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 205129 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 3998538 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 3998538 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 3998538 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3793409 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 3793409 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 3793409 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE PLAN IS A NONPROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE FINANCIAL STATEMENTS REFLECT NO PROVISION OR LIABILITY FOR FEDERAL INCOME TAXES. IN ADDITION, THE PLAN HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A "PRIVATE FOUNDATION" WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEAR ENDED SEPTEMBER 30, 2012. THE PLAN'S FEDERAL TAX RETURNS FOR THE YEARS 2008, 2009 AND 2010 ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THE RETURNS WERE FILED. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND THE BOARD PRESIDENT FOR ACCURACY. UPON APPROVAL, THE 990 IS ALSO MADE AVAILABLE TO THE BOARD OF DIRECTORS IN ELECTRONIC FORMAT. AFTER ANY CONCERNS PRESENTED BY THE BOARD ARE ADDRESSED, THE EXECUTIVE DIRECTOR SIGNS AND FILES THE RETURN. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST STATEMENT IS GIVEN ANNUALLY TO BOARD MEMBERS WHO SIGN A WRITTEN STATEMENT ACKNOWLEDGING THAT THEY HAVE RECEIVED, UNDERSTAND AND AGREE TO ADHERE TO THE POLICY. THERE IS ALSO AN ETHICS COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS. BOARD MEMBERS AND CONTRACTED EMPLOYEES RECEIVE INFORMATION ON HOW TO REPORT POTENTIAL VIOLATIONS OF ETHICAL BEHAVIOR TO THIS COMMITTEE. | |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL INFORMATION IS AVAILABLE UPON REQUEST. FORM 990 IS ALSO POSTED ANNUALLY ON GUIDESTAR'S WEBSITE. THE 990 IS PUBLIC INFORMATION THROUGH THE MICHIGAN ATTORNEY GENERAL'S OFFICE. | |
| FORM 990, PART XI, LINE 2C | NORTHERN HEALTH PLAN HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | OVERSIGHT OF AUDIT |