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ASPIRUS IRON RIVER HOSPITAL & CLINICS INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ASPIRUS IRON RIVER HOSPITAL & CLINICS INC (EIN 38-3236977)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201343189349301249
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-14T09:07:18-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390758449EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 12237AddressLine1
CityGREEN BAYCity
StateWIState
ZIP Code543072237ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN383236977EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTHSTAR HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone9062656121Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11400 W ICE LAKE RDAddressLine1
CityIRON RIVERCity
StateMIState
ZIP Code49935ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGLENN DOBSONName
TitleCFOTitle
Phone9062656121Phone
Date Signed2013-11-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTERRI REXRODE CPA MSTName
PTINP00096513PTIN
Phone9206620016Phone
Date Prepared2013-11-11DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGLENN DOBSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11400 W ICE LAKE RDAddressLine1
CityIRON RIVERCity
StateMIState
ZIP Code49935ZIPCode
FieldValueIRS element (for citing)
Gross Receipts43311616GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.NORTHSTARHS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionOUR ORGANIZATION CONTINUES TO STRIVE TO MEET THE EVOLVING NEEDS OF OUR SERVICE AREA WITH THE CONTINUATION AND EXPANSION OF SERVICES TO A LARGER DEMOGRAPHIC AREA. WE PROVIDE AMBULANCE SERVICE ALONG WITH CONTINUING TO BRING IN ADDITIONAL PHYSICIANS AND SERVICES INCLUDING EXPANSION OF ORTHOPAEDICS IN 2010. OUR FOCUS IN 2011 HAS BEEN TO IDENTIFY THE NEEDS OF THE AREA AND INCREASE MARKET SHARE BY OFFERING THE SERVICES IDENTIFIED THROUGH SURVEYS TO BE NEEDED AND IN DEMAND BY THE POPULATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees340TotalNbrEmployees
Total Nbr Volunteers35TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year101218ContributionsGrantsPriorYear
Contributions Grants Current Year75546ContributionsGrantsCurrentYear
Program Service Revenue Prior Year36919006ProgramServiceRevenuePriorYear
Program Service Revenue CY39701678ProgramServiceRevenueCY
Investment Income Prior Year117172InvestmentIncomePriorYear
Investment Income Current Year277383InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year37137396TotalRevenuePriorYear
Total Revenue Current Year40054607TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1925GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY8968GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year18927138SalariesEtcPriorYear
Salaries Etc Current Year20588991SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year18981270OtherExpensePriorYear
Other Expenses Current Year20196698OtherExpensesCurrentYear
Total Expenses Prior Year37910333TotalExpensesPriorYear
Total Expenses Current Year40794657TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-772937RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-740050RevenuesLessExpensesCY
Total Assets BOY34633921TotalAssetsBOY
Total Assets EOY35383689TotalAssetsEOY
Total Liabilities BOY26540480TotalLiabilitiesBOY
Total Liabilities EOY27831836TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8093441NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7551853NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionNORTHSTAR HEALTH SYSTEM IS A COMMUNITY-OWNED, NOT-FOR-PROFIT ORGANIZATION RESPONSBILE FOR THE PHYSICAL AND EMOTIONAL HEALTH OF PEOPLE LIVING IN SOUTH CENTRAL UPPER PENINSULA OF MICHIGAN AND NORTHERN WISCONSIN. DIRECTLY, AND IN GENERAL PARTNERSHIP WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, AS WELL AS SELECT PARTNERSHIPS WITH OTHER HEALTH CARE PROVIDERS, WE GUIDE INDIVIDUALS AND FAMILIES IN THEIR LIFELONG JOURNEY TOWARDS OPTIMAL HEALTH. WE ARE COMMITTED TO PROVIDING HIGH QUALITY, RELIABLE, COST-EFFECTIVE, TOTAL HEALTH SOLUTIONS WITH RESPECT AND COMPASSION. OUR INNOVATIVE EFFORTS WILL POSITIVELY IMPACT HEALTH CARE DELIVERY IN OUR SERVICE AREA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense35718880Expense
Grants8968Grants
Revenue39605537Revenue
DescriptionNORTHSTAR HEALTH SYSTEM PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL, AND PHYSICIAN CLINIC SERVICES TO THE RESIDENTS OF IRON COUNTY, MICHIGAN AND SURROUNDING AREAS. THE ORGANIZATION IS DESIGNATED BY MEDICARE AS A CRITICAL ACCESS HOSPITAL. IT OPERATES SEVERAL CLINICS ALONG WITH THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES ON A NON-PROFIT BASIS TO THE GENERAL PUBLIC. THE ORGANIZATION RECORDED APPROXIMATELY 3,258 INPATIENT DAYS; 61,486 OUTPATIENT VISITS; 569 SWING BED DAYS; AND 6,024 HOME HEALTH VISITS IN 2012. THE ORGANIZATION ALSO PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THIS POLICY FOR 2012 WAS APPROXIMATELY $343,000.Description
Total Program Service Expense35718880TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account1EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109684NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees340NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1GLENN DOBSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9062656121TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11400 W ICE LAKE ROADAddressLine1
CityIRON RIVERCity
StateMIState
ZIP Code499359594ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
MARK TOUSIGNANT
CHAIRMAN1.000.50XX360000
JIM GIBULA
VICE CHAIR/TREASURER1.000.50XX360000
SANDRA BATTYE
SECRETARY1.000.50XX360000
DIANE ROSTAGNO
BOARD MEMBER1.000.50X000
RANDY JACOBS
BOARD MEMBER1.000.50X165000
BRUCE RAMPAGE
BOARD MEMBER/CHIEF EXECUTIVE OFFICER40.000.80XX255644023960
RICK KENT
BOARD MEMBER1.000.80X150000
WILLIAM MAYER
BOARD MEMBER1.000.50X165000
KIM MAHLER MD
EX-OFFICIO MEMBER40.000.50X297065026140
GLENN E DOBSON
CHIEF FINANCIAL OFFICER40.000.50X139712022621
CONNIE KUOTOUZOS
CHIEF OPERATING OFFICER40.000.50X161678010061
MARTIES ANSAY MD
PHYSICIAN40.00222134013521X
HAROLD CLINE MD
PHYSICIAN40.00602995025590X
NASSEEM RIZKALLA MD
PHYSICIAN40.00406837025404X
DANNY YARGER MD
PHYSICIAN40.00183993017077X
GREGORY PEYER MD
PHYSICIAN40.00545482022800X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2831140TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation187174TotalOtherCompensation
Number Individuals GT100 K11NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MARQUETTE GENERAL HEALTH SYSTEMS
580 W COLLEGE AVEMARQUETTEMI49855EMERGENCY ROOM DOCTORS1434460
CUBE IMAGING PLC - DR CUBE
PO BOX 335IRON RIVERMI49935RADIOLOGIST573661
ARAMARK UNIFORM COMPANY
5330 INDUSTRIAL BLVD SUITE 616FRIDLEYMN55412LAUNDRY SERVICES443072
ANESTHESIA ASSOCIATES
788 PENTOGA TRAILCRYSTAL FALLSMI49920ANESTHESIA288631
UP HEALTH CARE NETWORK
228 W WASHINGTON AVEMARQUETTEMI49855MRI MOBILE264945
FieldValueIRS element (for citing)
Number Of Contractors GT100 K84NumberOfContractorsGT100K
All Other Contributions75546AllOtherContributions
Total Contributions75546TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
NET PATIENT SERVICE REVENUE9000993960553739605537
CAFETERIA MEALS90009996141$96,141
FieldValueIRS element (for citing)
Total Program Service Revenue39701678TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column136628TotalRevenueColumn
Exclusion$136,628ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3376450Securities
Other21314Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3257009Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities119441Securities
Other21314Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column140755TotalRevenueColumn
Exclusion$140,755ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column40054607TotalRevenueColumn
Related Or Exempt Function Income39605537RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$373,524ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total8968Total
Program Services8968ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2836015Total
Program Services2378478ProgramServices
Management And General457537ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12574006Total
Program Services11178033ProgramServices
Management And General1395973ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total455356Total
Program Services407706ProgramServices
Management And General47650ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3741543Total
Program Services3318539ProgramServices
Management And General423004ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total982071Total
Program Services863517ProgramServices
Management And General118554ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total15421Total
Management And General15421ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total104799Total
Management And General104799ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total132195Total
Management And General132195ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4511498Total
Program Services3677464ProgramServices
Management And General834034ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total151606Total
Management And General151606ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1262591Total
Program Services1059268ProgramServices
Management And General203323ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total42500Total
Management And General42500ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total631766Total
Program Services470242ProgramServices
Management And General161524ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total214894Total
Program Services179227ProgramServices
Management And General35667ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1400029Total
Program Services1042067ProgramServices
Management And General357962ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1642746Total
Program Services1642746ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total208231Total
Program Services33712ProgramServices
Management And General174519ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES50218555021855
REPAIRS AND MAINTENANCE23203232165425154898
PROVISION FOR BAD DEBTS21933312193331
DUES & SUBSCRIPTION18063478302102332

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total162279Total
Management And General162279ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total40794657Total
Program Services35718880ProgramServices
Management And General5075777ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY902388BOY
EOY1568917EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY692222BOY
EOY1939140EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5402962BOY
EOY4521232EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY39188BOY
EOY17529EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY424616BOY
EOY509334EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY210853BOY
EOY242874EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis40454986LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec20154565LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY21381260BOY
EOY20300421EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY5166776BOY
EOY5229491EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY413656BOY
EOY1054751EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY34633921BOY
EOY35383689EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4413068BOY
EOY5898060EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY21992486BOY
EOY21719322EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY134926BOY
EOY178923EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY35531EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY26540480BOY
EOY27831836EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8078441BOY
EOY7536853EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY15000BOY
EOY15000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8093441BOY
EOY7551853EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY34633921BOY
EOY35383689EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-740050ReconcilationRevenueExpenses
Reconciliation Unrealized Invest281429ReconciliationUnrealizedInvest
Reconcilation Other Changes-82967ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance15000BeginningOfYearBalance
End Of Year Balance15000EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance15000BeginningOfYearBalance
End Of Year Balance15000EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Contributions15000Contributions
End Of Year Balance15000EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis235876OtherCostOrOtherBasis
Book Value235876BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis26317045OtherCostOrOtherBasis
Depreciation8111050Depreciation
Book Value18205995BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis799958OtherCostOrOtherBasis
Depreciation618626Depreciation
Book Value181332BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis13102107OtherCostOrOtherBasis
Depreciation11424889Depreciation
Book Value1677218BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20300421TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionPENSION LIABILITYDescription
Amount$35,531Amount
FieldValueIRS element (for citing)
Total Of Amounts35531TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt37852308TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal37852308RevenueSubtotal
Other Revenues Not Included2202299OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt2202299RevenueNotRptdOnFinStmt
Total Revenue Per Form99040054607TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt38592358TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal38592358ExpensesSubtotal
Other Expenses Not Included2202299OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt2202299ExpensesNotRptdOnFinStmt
Total Expenses Per Form99040794657TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:WOMEN'S HEALTH INITIATIVES
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE CORPORATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 OR 2011. FEDERAL INCOME TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2009, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITIES.
PART XI, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR BAD DEBTS 2,193,331. SCHOOL GRANT EXPENSES 8,968.
PART XII, LINE 4B - OTHER ADJUSTMENTS:PROVISION FOR BAD DEBTS 2,193,331. SCHOOL GRANT EXPENSES 8,968.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage100.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense195239TotalCommunityBenefitExpense
Net Community Benefit Expense195239NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3005439TotalCommunityBenefitExpense
Direct Offsetting Revenue1055000DirectOffsettingRevenue
Net Community Benefit Expense1950439NetCommunityBenefitExpense
Percent Of Total Expense0.05050PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3200678TotalCommunityBenefitExpense
Direct Offsetting Revenue1055000DirectOffsettingRevenue
Net Community Benefit Expense2145678NetCommunityBenefitExpense
Percent Of Total Expense0.05560PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense39500TotalCommunityBenefitExpense
Direct Offsetting Revenue320DirectOffsettingRevenue
Net Community Benefit Expense39180NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense12000TotalCommunityBenefitExpense
Net Community Benefit Expense12000NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense2923814TotalCommunityBenefitExpense
Direct Offsetting Revenue2674700DirectOffsettingRevenue
Net Community Benefit Expense249114NetCommunityBenefitExpense
Percent Of Total Expense0.00650PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense9200TotalCommunityBenefitExpense
Net Community Benefit Expense9200NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2984514TotalCommunityBenefitExpense
Direct Offsetting Revenue2675020DirectOffsettingRevenue
Net Community Benefit Expense309494NetCommunityBenefitExpense
Percent Of Total Expense0.00800PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense6185192TotalCommunityBenefitExpense
Direct Offsetting Revenue3730020DirectOffsettingRevenue
Net Community Benefit Expense2455172NetCommunityBenefitExpense
Percent Of Total Expense0.06360PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,248,470BadDebtExpenseAmount
Amount Reimbursed By Medicare16412839AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16450632CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-37793MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTHSTAR HEALTH SYSTEMBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11400 W ICE LAKE ROADAddressLine1
CityIRON RIVERCity
StateMIState
ZIP Code49935ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NORTHSTAR HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted0CHNAConducted
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent100.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Other ActionsXPermitOtherActions
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
Notify Upon AdmissionXNotifyUponAdmission
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities7NumberOfOtherFacilities

Other Facilities OtherFacilities (7 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
NORTHSTAR HOME CARE AND HOSPICE
927 RIVERSIDE AVENUEIRON RIVERMI49935HOME HEALTH AGENCY
NORTHSTAR HEALTH SYSTEM - ERSD
1328 US HWY 2CRYSTAL FALLSMI49920DIALYSIS/FAMILY PRACTICE
GENESEE CLINIC
229 W GENESEE STIRON RIVERMI49935ORTHOPEDICS/REHAB
NORTHSTAR ICE LAKE
1300 WEST ICE LAKEIRON RIVERMI49935FAMILY PRACTICE
NORTHSTAR RIVERSIDE PLAZA
927 RIVERSIDE AVENUEIRON RIVERMI49935FAMILY PRACTICE
MARENISCO CLINIC
236 MAIN STREETMARENISCOMI49947FAMILY PRACTICE
NORTHSTAR SURGERY
1500 WEST ICE LAKE RDIRON RIVERMI49935SURGERY

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 7: THE COSTING METHODOLOGY USED WAS A COST-TO-CHARGE RATIO.
PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY PHYSICIAN CLINICS IN CALCULATING SUBSIDIZED HEALTH SERVICE COSTS.
PART I, L7 COL(F): IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $2,193,331 WAS EXCLUDED FROM THE DENOMINATOR.
PART II: COMMUNITY BUILDING ACTIVITIES CONSISTED OF MISCELLANEOUS COMMUNITY SUPPORT.
PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING AMOUNTS REPORTED ABOVE IS THE COST TO CHARGE RATIO.
PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE ALLOWABLE COSTS REPORTED ABOVE IS THE COST TO CHARGE RATIO.
PART III, LINE 9B: IF THE PATIENT QUALIFIES FOR CHARITY CARE AND A 100% WRITE-OFF IS NOT QUALIFIED FOR, THE PATIENT MUST MAKE MONTHLY PAYMENT ACCORDING TO FACILITY PAYMENT POLICY. IF PATIENT DOES NOT MAKE MONTHLY PAYMENTS AND CANNOT BE REACHED BY TELEPHONE, THE FORMAL COLLECTION PROCESS WOULD BEGIN.
PART V, SECTION B, LINE 16E: SYSTEM GENERATED LETTERS REMINDING THE PATIENT OF HIS/HER RESPONSIBILITIES IN MAKING PAYMENT ARRANGEMENTS.NORTHSTAR HEALTH SYSTEM
PART V, SECTION B, LINE 20D: PER OUR POLICY ON HOW CHARGES ARE CALCULATED. APPLICATION FOR CHARITY CARE IS REQUIRED. IF INDIGENT - NO BALANCE IS DUE FROM THE PATIENT. OTHERWISE A SLIDING FEE SCALE IS USED AS DETERMINED UPON 100% OF THE CURRENT POVERTY LEVEL.NORTHSTAR HEALTH SYSTEM
PART VI, LINE 2: THE ORGANIZATION ASSESSES THE NEEDS OF THE COMMUNITY THROUGH A NEEDS ASSESSMENT SURVEY, THROUGH DOCUMENTATION OF REQUESTS FROM OUTLYING AGENCIES OR COMMUNITY GROUPS, AND FROM EVALUATION OF THE REPEAT DIAGNOSIS OF PATIENTS SERVED WITHIN THE SERVICE AREA.
PART VI, LINE 3: THE ORGANIZATION HAS A DEPARTMENT DEVOTED TO SELF PAY ACCOUNTS RECEIVABLE WITH THEIR MAIN FOCUS ON MAKING PATIENT CONTACT WITH THOSE PATIENTS THAT EITHER HAVE NO INSURANCE OR ARE UNDER INSURED BASED UPON INFORMATION COLLECTED AT THE TIME OF SERVICE. THIS STAFF IS EDUCATED ON WHAT PROGRAMS ARE AVAILABLE WITHIN THE COMMUNITY AND CAN ASSIST THE PATIENT IN MAKING CONTACT WITH THESE AGENCIES AND CAN ASSIST IN APPLICATION COMPLETION FOR OUTSIDE PROGRAMS. THE CHARITY CARE PROGRAM IS ALSO COMMUNICATED THE SAME WAY.
PART VI, LINE 4: THE COMMUNITY SERVED IS RELATIVELY OLDER IN AGE WITH A HIGH UTILIZATION OF MEDICARE. THERE IS LITTLE INDUSTRY, NO AIRPORT, AND THE NEAREST TRAUMA CENTER IS 90 MILES AWAY. THE NEXT CLOSEST HOSPITALS ARE 45 TO 55 MILES AWAY. THE GEOGRAPHIC AREA, BY COUNTY, IS VERY LARGE BUT VERY LITTLE POPULATED. THE AREA SUPPORTS SEVERAL RURAL HEALTH CLINICS AND THIS FACILITY SURVIVES BECAUSE OF THE CRITICAL ACCESS HOSPITAL DESIGNATION ONLY.
PART VI, LINE 5: OUR BOARD IS MADE UP OF VOLUNTEER INDIVIDUALS FROM WITHIN THE DIRECT COMMUNITY. MEDICAL STAFF PRIVILEGES TO ALL PROVIDERS WITHIN THE COMMUNITY AND SURROUDING AREA/COUNTIES AS THE TRAVEL TIME TO OTHER HOSPITALS IS OVER 1 HR TO THE NEAREST. SURPLUS FUNDS HAVE BEEN PUT INTO AN $18 MILLION EXPANSION COMPLETED IN 2009 INCLUDING THE EXPANSION OF ED SERVICES AND IP ROOMS/ETC.
MIREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE ORGANIZATION PROVIDED GRANTS TO 2 SCHOOLS IN THE LOCAL AREA AND MONITORED THE FUNDS TO ENSURE THEY WERE USED FOR THEIR SPECIFIED PURPOSE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BRUCE RAMPAGE
BOARD MEMBER/CHIEF EXECUTIVE OFFICER2556440000075000164600279604000
KIM MAHLER MD
EX-OFFICIO MEMBER2970650000075000186400323205000
GLENN E DOBSON
CHIEF FINANCIAL OFFICER1397120000043410182800162333000
CONNIE KUOTOUZOS
CHIEF OPERATING OFFICER161678000004741053200171739000
MARTIES ANSAY MD
PHYSICIAN222134000006717068040235655000
HAROLD CLINE MD
PHYSICIAN6029950000073500182400628585000
NASSEEM RIZKALLA MD
PHYSICIAN4068370000075000179040432241000
DANNY YARGER MD
PHYSICIAN1839930000056050114720201070000
GREGORY PEYER MD
PHYSICIAN5454820000000228000568282000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF IRON RIVER HOSPITAL FINANCE AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN383527449IssuerEIN
CUSIP Number463003AA1CUSIPNumber
Date Issued2008-05-15DateIssued
Issue Price22721540IssuePrice
Description Of PurposeHOSPITAL FACILITY IMPROVEMENTSDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired1030000AmountRetired
Total Proceeds22721540TotalProceeds
Amount In Reserve Fund1713975AmountInReserveFund
Refunding Escrow5667697RefundingEscrow
Issuance Costs From Proceeds422278IssuanceCostsFromProceeds
Capital Expenditures14917591CapitalExpenditures
Other Spent Proceeds15339968OtherSpentProceeds
Year Of Subst Completion2010YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty1MngmentCntrctBondFinancdPrprty
Engage Bond Counsel Contracts1EngageBondCounselContracts
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs1NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action0ProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierSCHEDULE K SUPPLENTAL INFORMATIONIdentifier
ExplanationTHIS BOND ISSUE WAS COMPRISED OF THREE BONDS THAT WERE ALL ISSED ON 5/15/2008. THE CUSIP NUMBERS INCLUDED IN THIS ONE ISSUANCE WERE ARE FOLLOWS: 463003AA1 463003AL7 463003AT0Explanation

Schedule L IRS990ScheduleL

Loan Table LoanTable (3 entries)

Relationship With OrganizationRelationshipWithOrganizationPurpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
KIM MAHLER DO
BOARD MEMBERSIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACTX$20,0001696011
HAROLD CLINE MD
HIGHLY COMPENSATED EMPLOYEESIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACTX$24,2388333011
GREGORY PEYER MD
HIGHLY COMPENSATED EMPLOYEESIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACTX$15,0007500011
FieldValueIRS element (for citing)
Total Balance Due17529TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11A COPY OF THE FORM 990 IS E-MAILED TO ALL BOARD MEMBERS PRIOR TO MAILING/SUBMITTING THE FORM. MEMBERS OF THE BOARD ARE ALLOWED TO SUBMIT FEEDBACK AND APPROPRIATE REQUESTED CHANGES ARE INCORPORATED, IF WARRANTED, INTO THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12CTHE WRITTEN CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. THIS REQUIREMENT IS STATED IN THE ORGANIZATION'S BYLAWS.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION'S KEY EMPLOYEES AND HIGHEST PAID EMPLOYEES HAVE EMPLOYMENT CONTRACTS THAT GOVERN THEIR COMPENSATION. COMPENSATION LEVELS ARE REVIEWED BY THE APPLICABLE LEVEL OF MANAGEMENT AND/OR THE BOARD OF DIRECTORS. FOR GUIDANCE RELATED TO COMPENSATION LEVELS, MANAGEMENT GATHERS MARKET DATA AND COMPENSATION STUDIES TO ARRIVE AT AMOUNTS THAT ARE COMPETITIVE WITHIN THEIR MARKET AREA. THE COMPENSATION IS APPROVED BY INDIVIDUALS WITHOUT A CONFLICT OF INTEREST AND THEN DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19A COPY OF THE FILED FORM 990 IS AVAILABLE TO THE PUBLIC THROUGH A REQUEST FROM ANY MEMBER OF THE PUBLIC.
FORM 990, PART IX, LINE 11GPURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,677,464. MANAGEMENT AND GENERAL EXPENSES 834,034. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,511,498.OTHER FEES
FORM 990, PART XI, LINE 9:CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE -56,612. NET ASSET TRANSFER TO FOUNDATION -26,355.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CAUDIT FIRM IS APPROVED BY THE FINANCE COMMITTEE. THE AUDIT FIRM PRESENTS THE AUDIT RESULTS TO THE FINANCE COMMITTEE.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
GREATER IRON COUNTY EMS INC
1400 WEST ICE LAKE ROADIRON RIVERMI49935383491283EMERGENCY MEDICAL SERVICESMI501(C)3LINE 11A, INORTHSTAR HEALTH SYSTEM1
NORTHSTAR HEALTH SYSTEM FOUNDATION
1400 WEST ICE LAKE ROADIRON RIVERMI49935383762132RAISE FUNDS FOR NORTHSTAR HEALTH SYSTEMMI501(C)3LINE 11A, INORTHSTAR HEALTH SYSTEM1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
GREATER IRON COUNTY EMS INC
S895000BANK TRANSFERS
GREATER IRON COUNTY EMS INC
O344673PAYROLL REPORTS
GREATER IRON COUNTY EMS INC
Q103285DIRECT INVOICES/REPORTS