MUNSON HEALTHCARE CHARLEVOIX HOSPITAL: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (EIN 38-1459366)
- Tax period
- 2010-04-01 to 2011-03-31
- Filed
- 2012-03-30
- IRS object ID
- 201210909349300806
- Schema version
- 2010v3.4
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-30T08:09:42-05:00 | Timestamp |
| Tax Period End Date | 2011-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 E FRONT STREET SUITE 300 | AddressLine1 |
| City | TRAVERSE CITY | City |
| State | MI | State |
| ZIP Code | 49686 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381459366 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHAR | NameControl |
| Phone | 2315474024 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKESHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WILLIAM JACKSON | Name |
| Title | PRESIDENT | Title |
| Phone | 2315474024 | Phone |
| Date Signed | 2012-03-29 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2319477800 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WILLIAM JACKSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKESHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 35768104 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CAH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1919 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE HEALTHCARE TO THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 350 | TotalNbrEmployees |
| Total Nbr Volunteers | 72 | TotalNbrVolunteers |
| Total Gross UBI | 202107 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 36772 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 231547 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 391054 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 31448335 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 34048433 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2191088 | InvestmentIncomePriorYear |
| Investment Income Current Year | 143210 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 116985 | OtherRevenuePriorYear |
| Other Revenue Current Year | 68546 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 33987955 | TotalRevenuePriorYear |
| Total Revenue Current Year | 34651243 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 14129 | 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 | 19208506 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 19028228 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 47429 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13562763 | OtherExpensePriorYear |
| Other Expenses Current Year | 15058132 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 32785398 | TotalExpensesPriorYear |
| Total Expenses Current Year | 34086360 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1202557 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 564883 | RevenuesLessExpensesCY |
| Total Assets BOY | 27657672 | TotalAssetsBOY |
| Total Assets EOY | 27826701 | TotalAssetsEOY |
| Total Liabilities BOY | 9659203 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9218503 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17998469 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 18608198 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | DEPEND ON US FOR EXCELLENT HEALTH CARE | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 6409226 | Expense |
| Revenue | 4730310 | Revenue |
| Description | PHYSICIAN OFFICES | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5030183 | Expense |
| Revenue | 11121156 | Revenue |
| Description | OPERATING ROOM SERVICES - SURGERIES: 2,424 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3690543 | Expense |
| Revenue | 2450043 | Revenue |
| Description | ROUTINE INPATIENT - DAYS OF CARE: 3,157 | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 13896317 | Expense |
| Revenue | 15480680 | Revenue |
| Description | OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, EMERGENCY ROOM SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. PATIENTS SEEN IN THE EMERGENCY ROOM TOTAL 11,600. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 13896317 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 15480680 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 29026269 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | 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 | 1 | 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 | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 43 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 350 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 12 | 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 | 0 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TABITHA RUDOLPH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2315478508 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 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 | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| STEVE HUFFORD OD | ||||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| SCOTT BEATTY | ||||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| MARY JASON | ||||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| RICHARD FISH DDS | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MARC LAME MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| REBECCA HANEY | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| HAROLD NORM PERKINS | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| STEVE WEBER | ||||||||
| SECRETARY/TREASURER | 1.00 | X | X | 0 | 0 | 0 | ||
| MARK GROENINK | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| WILLIAM JACKSON | ||||||||
| PRESIDENT | 40.00 | X | X | 154139 | 0 | 20956 | ||
| MELODIE BROWN MD | ||||||||
| CHIEF OF STAFF | 1.00 | X | 0 | 0 | 0 | |||
| RICHARD KRUEGER | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JOHN KURTZ | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| CHRIS UNBEHAUN | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MICHAEL ORTWINE | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MARILYN DUMBAULD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| KATHY WEBER | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JOSEPH SCHODDE | ||||||||
| VP OF FINANCIAL SERVICES | 40.00 | X | 109071 | 0 | 19362 | |||
| JAMES JEAKLE MD | ||||||||
| OBSTETRICIAN | 40.00 | 303245 | 0 | 22040 | X | |||
| RODERIC TINNEY MD | ||||||||
| PEDIATRICIAN | 40.00 | 230525 | 0 | 19040 | X | |||
| MARY IVEY MD | ||||||||
| OBSTETRICIAN | 40.00 | 343425 | 0 | 18621 | X | |||
| WILLIAM MOSHER III MD | ||||||||
| OBSTETRICIAN | 40.00 | 218198 | 0 | 9519 | X | |||
| BRIAN DISHINGER MD | ||||||||
| GENERAL SURGEON | 40.00 | 336220 | 0 | 17185 | X | |||
| GERALYN DOSKOCH MD | ||||||||
| FORMER VOTING DIRECTOR (PHYSICIAN) | 40.00 | 121340 | 0 | 16222 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1816163 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 142945 | TotalOtherCompensation |
| Number Individuals GT100 K | 21 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PINE RIVER MEDICAL ASSOCIATES | |||||
| 14734 PARK AVENUE | CHARLEVOIX | MI | 49720 | ER PHYSICIAN COVERAGE | 1300687 |
| FLOYD & TODD WRIGHT BUILDERS INC | |||||
| 216 RAY STREET | BOYNE CITY | MI | 49712 | CONSTRUCTION SERVICES | 184374 |
| QUEST DIAGNOSTICS | |||||
| 4444 GIDDINGS ROAD | AUBURN HILLS | MI | 48326 | LABORATORY SERVICES | 171616 |
| MICHIGAN NEUROLOGY ASSOCIATES | |||||
| 1500 WEST PARK DRIVE SUITE 390 | WESTBOROUGH | MA | 01581 | MOBILE MRI SERVICES | 141300 |
| MUNSON SUPPORT SERVICES | |||||
| 1105 SIXTH STREET | TRAVERSE CITY | MI | 49685 | LAUNDRY SERVICES | 108007 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 344985 | RelatedOrganizations |
| Government Grants | 45069 | GovernmentGrants |
| All Other Contributions | 1000 | AllOtherContributions |
| Noncash Contributions | 11398 | NoncashContributions |
| Total Contributions | 391054 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| HEALTH SERVICES | 622110 | 27020725 | 26818618 | 202107 |
| OTHER RELATED REVENUE | 622110 | 7027708 | 7027708 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 34048433 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 103259 | TotalRevenueColumn |
| Exclusion | $103,259 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 151667 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 215804 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -64137 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -64137 | TotalRevenueColumn |
| Related Or Exempt Function Income | -64137 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 937708 | Securities |
| Other | 3300 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 901057 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 36651 | Securities |
| Other | 3300 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 39951 | TotalRevenueColumn |
| Exclusion | $39,951 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA SALES | Description |
| Business Code | 722210 | BusinessCode |
| Total Revenue Column | 132683 | TotalRevenueColumn |
| Exclusion | $132,683 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 132683 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34651243 | TotalRevenueColumn |
| Related Or Exempt Function Income | 33782189 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 202107 | UnrelatedBusinessRevenue |
| Exclusion | $275,893 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 315006 | Total |
| Management And General | 315006 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15035766 | Total |
| Program Services | 13045272 | ProgramServices |
| Management And General | 1953047 | ManagementAndGeneral |
| Fundraising | 37447 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259219 | Total |
| Program Services | 215287 | ProgramServices |
| Management And General | 43595 | ManagementAndGeneral |
| Fundraising | 337 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2400352 | Total |
| Program Services | 2061457 | ProgramServices |
| Management And General | 335425 | ManagementAndGeneral |
| Fundraising | 3470 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1017885 | Total |
| Program Services | 859779 | ProgramServices |
| Management And General | 155294 | ManagementAndGeneral |
| Fundraising | 2812 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17559 | Total |
| Management And General | 17559 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78810 | Total |
| Management And General | 78810 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2542103 | Total |
| Program Services | 2223632 | ProgramServices |
| Management And General | 318309 | ManagementAndGeneral |
| Fundraising | 162 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147023 | Total |
| Management And General | 147023 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80172 | Total |
| Program Services | 52983 | ProgramServices |
| Management And General | 27189 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122644 | Total |
| Management And General | 122644 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81882 | Total |
| Program Services | 65523 | ProgramServices |
| Management And General | 16359 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 317065 | Total |
| Program Services | 258019 | ProgramServices |
| Management And General | 58642 | ManagementAndGeneral |
| Fundraising | 404 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2004033 | Total |
| Program Services | 1601527 | ProgramServices |
| Management And General | 399755 | ManagementAndGeneral |
| Fundraising | 2751 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 277123 | Total |
| Management And General | 277123 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES | 4409768 | 4069054 | 340669 | 45 |
| NORTHERN HEALTH PLAN | 1282260 | 1282260 | ||
| PROVISION FOR BAD DEBTS | 821461 | 821461 | ||
| UTILITIES | 707463 | 707463 | ||
| QAAP TAX | 591388 | 591388 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1577378 | Total |
| Program Services | 1171164 | ProgramServices |
| Management And General | 406213 | ManagementAndGeneral |
| Fundraising | 1 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34086360 | Total |
| Program Services | 29026269 | ProgramServices |
| Management And General | 5012662 | ManagementAndGeneral |
| Fundraising | 47429 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38222 | BOY |
| EOY | 114692 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2700727 | BOY |
| EOY | 1497058 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45429 | BOY |
| EOY | 33597 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2455563 | BOY |
| EOY | 3149189 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7000 | BOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 396747 | BOY |
| EOY | 482447 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 640179 | BOY |
| EOY | 642669 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 498002 | BOY |
| EOY | 567894 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 44869270 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 28127427 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16422382 | BOY |
| EOY | 16741843 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2612066 | BOY |
| EOY | 2430012 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1337969 | BOY |
| EOY | 1672938 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 503386 | BOY |
| EOY | 494362 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27657672 | BOY |
| EOY | 27826701 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2472189 | BOY |
| EOY | 2620093 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5631016 | BOY |
| EOY | 4890396 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1172998 | BOY |
| EOY | 1357011 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 383000 | BOY |
| EOY | 351003 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9659203 | BOY |
| EOY | 9218503 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16970320 | BOY |
| EOY | 17350568 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1028149 | BOY |
| EOY | 1257630 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17998469 | BOY |
| EOY | 18608198 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27657672 | BOY |
| EOY | 27826701 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 564883 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 44846 | 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 Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,116 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4116 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | PORTION OF ANNUAL DUES TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARD LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 898861 | OtherCostOrOtherBasis |
| Book Value | 898861 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 28901182 | OtherCostOrOtherBasis |
| Depreciation | 16678444 | Depreciation |
| Book Value | 12222738 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13914542 | OtherCostOrOtherBasis |
| Depreciation | 11448983 | Depreciation |
| Book Value | 2465559 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1154685 | OtherCostOrOtherBasis |
| Book Value | 1154685 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 16741843 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN CHARLEVOIX NURSING HOME | 729740 | F |
| INVESTMENT IN CHARLEVOIX FOUNDATION | 943198 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1672938 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | COST REPORT SETTLEMENT PAYABLE | Description |
| Amount | $351,003 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 351003 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 513563 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 419725 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 93838 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00280 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4128162 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2278166 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1849996 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05560 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4641725 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2697891 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1943834 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05840 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 100435 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3873 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 96562 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 100435 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3873 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 96562 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4742160 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2701764 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2040396 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06130 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $588,280 | BadDebtExpenseAmount |
| Amount Attributable To | 146316 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9448181 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9362388 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 85793 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | 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 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 6 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| BOYNE AREA MEDICAL CENTER | ||||
| 223 N PARK | BOYNE CITY | MI | 49712 | OUTPATIENT PHYSICIAN OFFICE |
| CHARLEVOIX WOMEN'S HEALTH CARE | ||||
| 14651 W UPRIGHT STREET | CHARLEVOIX | MI | 49720 | OUTPATIENT PHYSICIAN OFFICE |
| BOYNE REHABILITATION CENTER | ||||
| 197 STATE STREET | BOYNE CITY | MI | 49712 | REHABILITATION CLINIC |
| JORDAN VALLEY REHABILITATION CENTER | ||||
| 100 MAIN STREET | EAST JORDAN | MI | 49727 | REHABILITATION CLINIC |
| CHARLEVOIX SURGEONS | ||||
| 14695 PARK AVENUE | CHARLEVOIX | MI | 49720 | OUTPATIENT PHYSICIAN OFFICE |
| PHYSICIAN CLINIC OF CHARLEVOIX | ||||
| 14705 W UPRIGHT STREET | CHARLEVOIX | MI | 49720 | OUTPATIENT PHYSICIAN OFFICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: IN ADDITION TO USE OF THE FEDERAL POVERTY GUIDELINES, PATIENTS MUST ALSO SATISFY AN ASSET TEST LIMIT OF $62,000. FURTHERMORE, TOTAL MEDICAL DEBT WILL BE CONSIDERED ON A CASE BY CASE BASIS AS AN ADDITIONAL ELEMENT IN DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE. | ||
| PART I, LINE 6A: N/A | ||
| PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED. | ||
| PART I, LINE 7G: THE HOSPITAL DID NOT REPORT SUBSIDIZED HEALTH SERVICES. | ||
| PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $821,461. | ||
| PART II: N/A - THE HOSPITAL DID NOT LIST ANY COMMUNITY BUILDING ACTIVITIES ON SCHEDULE H. | ||
| PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO BAD DEBT EXPENSE, NET OF RECOVERIES, TO ARRIVE AT THE ESTIMATED COST OF BAD DEBT $588,280.THE HOSPITAL PROVIDES CARE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. WHILE THE HOSPITAL MAKES EVERY EFFORT TO IDENTIFY ALL CANDIDATES WHO WOULD QUALIFY UNDER ITS FINANCIAL ASSISTANCE POLICY, THERE ARE CIRCUMSTANCES UNDER WHICH THAT DETERMINATION CANNOT BE MADE. AS SUCH, IT IS OUR BELIEF THAT $146,316 OF BAD DEBT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY AND SHOULD BE INCLUDED AS COMMUNITY BENEFIT. BASED ON AN ANALYSIS OF SELF PAY ENCOUNTERS WHOSE GROSS CHARGES EXCEEDED $1,000 AND THEREFORE WERE AUTOMATICALLY SENT A FINANCIAL ASSISTANCE APPLICATION, IT WAS DETERMINED THAT APPROXIMATELY 46% QUALIFIED FOR FINANCIAL ASSISTANCE. THIS PERCENTAGE WAS THEN APPLIED TO TOTAL SELF PAY BAD DEBT AND THEN CONVERTED TO COST THROUGH APPLICATION OF THE RATIO OF PATIENT CARE COST TO CHARGES. | ||
| PART III, LINE 8: THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DO NOT SHOW A SHORTFALL. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. | ||
| PART III, LINE 9B: THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE. | ||
| PART VI, LINE 2: CHARLEVOIX AREA HOSPITAL HAS PARTICIPATED IN NEEDS ASSESSMENT SURVEYS CONSISTENTLY DURING THE PAST 10 YEARS, TYPICALLY IN COOPERATION WITH OTHER ORGANIZATIONS BUT AT TIMES SPECIFICALLY DRIVEN BY OUR HOSPITAL. IN ADDITION TO DATA PROCURED THROUGH THESE SURVEYS, OUR HOSPITAL HAS ALSO USED MICHIGAN DEPARTMENT OF COMMUNITY HEALTH HEALTH DATA, STATE OF MICHIGAN CENSUS DATA, AND DATA FROM THE ECONOMIC DEVELOPMENT COUNCIL TO ASSESS THE ONGOING HEALTHCARE NEEDS OF OUR COMMUNITY. THE SURVEYS HAVE RESULTED IN MANY JOINT EFFORTS TO ADDRESS OUR COMMUNITY'S HEALTH CARE NEEDS (FLU CLINICS IN COOPERATION WITH LOCAL MDCH, GRANT PROCUREMENT FOR PACS AND DIGITAL MAMMOGRAPHY, AND FITKIDS). ADDITIONALLY, THE HOSPITAL HAS SOLELY SPONSORED WELLNESS WEDNESDAY'S, FREE MAMMOGRAPHY, AND SPORTS PHYSICALS FOR STUDENT ATHLETES. | ||
| PART VI, LINE 3: INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE HOSPITAL'S ADMISSIONS AREAS. IF, DURING THE REGISTRATION PROCESS, IT BECOMES APPARENT THAT A PATIENT HAS NEED FOR POSSIBLE FINANCIAL OR DISCOUNTED ASSISTANCE, A REFERRAL IS MADE TO THE HOSPITAL'S FINANCIAL COUNSELOR OR SOCIAL WORKER. DURING THIS ASSESSMENT, ELIGIBILITY FOR ASSISTANCE UNDER EXISTING FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS FIRST EXPLORED. SHOULD THE PATIENT FAIL TO QUALIFY FOR EXISTING PROGRAMS, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION IS MADE AVAILABLE. IN THE EVENT THE PATIENT'S NEED IS NOT IDENTIFIED DURING REGISTRATION, ADDITIONAL OPPORTUNITIES TO INQUIRE ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE. FOR EXAMPLE, THE PHONE NUMBER FOR INQUIRIES INTO FINANCIAL ASSISTANCE ARE PRINTED ON ANY STATEMENTS SENT TO THE PATIENT. FURTHERMORE, PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE AND HAVE AN ENCOUNTER BALANCE THAT EXCEEDS $1,000 ARE AUTOMATICALLY SENT AN APPLICATION. | ||
| PART VI, LINE 4: CHARLEVOIX AREA HOSPITAL SERVES THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES, AS WELL AS THE SEASONAL RESIDENTS THAT FLOOD THE AREA DURING THE SUMMER MONTHS. THIS SMALL, RURAL COMMUNITY IS HOME TO APPROXIMATELY 26,000 RESIDENTS, WITH A PER CAPITA INCOME OF APPROXIMATELY $40,000. BASED ON 2008 ESTIMATES, 11.2% OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL. SIMILARLY, MEDICAID RECIPIENTS ACCOUNTED FOR APPROXIMATELY 12% OF THE HOSPITAL'S GROSS PATIENT CHARGES. IN ADDITION, PATIENTS REFERRED FROM NEIGHBORING EAST JORDAN FAMILY HEALTH CENTER, A FEDERALLY QUALIFIED RURAL HEALTH CLINIC, WERE AMONG THOSE SERVED BY THE HOSPITAL. | ||
| PART VI, LINE 6: THE BOARD OF DIRECTORS IS COMPRISED OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THIS VOLUNTARY BOARD PROVIDES COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. | ||
| PART VI, LINE 7: N/A - THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| MI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WILLIAM JACKSON | |||||||||||||
| 147965 | 0 | 0 | 0 | 6174 | 0 | 3092 | 0 | 17864 | 0 | 175095 | 0 | 0 | 0 |
| JAMES JEAKLE MD | |||||||||||||
| 206174 | 0 | 96680 | 0 | 391 | 0 | 4212 | 0 | 17828 | 0 | 325285 | 0 | 0 | 0 |
| RODERIC TINNEY MD | |||||||||||||
| 145302 | 0 | 84848 | 0 | 375 | 0 | 2960 | 0 | 16080 | 0 | 249565 | 0 | 0 | 0 |
| MARY IVEY MD | |||||||||||||
| 209772 | 0 | 133352 | 0 | 301 | 0 | 4212 | 0 | 14409 | 0 | 362046 | 0 | 0 | 0 |
| WILLIAM MOSHER III MD | |||||||||||||
| 210392 | 0 | 5244 | 0 | 2562 | 0 | 4212 | 0 | 5307 | 0 | 227717 | 0 | 0 | 0 |
| BRIAN DISHINGER MD | |||||||||||||
| 299979 | 0 | 36000 | 0 | 241 | 0 | 3008 | 0 | 14177 | 0 | 353405 | 0 | 0 | 0 |
| GERALYN DOSKOCH MD | |||||||||||||
| 118889 | 0 | 0 | 0 | 2451 | 0 | 2403 | 0 | 13819 | 0 | 137562 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 5 | ReturnReference |
| Explanation | EMPLOYED PHYSICIANS ARE PAID AN INCENTIVE BONUS BASED ON THE GROSS VALUE OF PROFESSIONAL SERVICE CHARGES RENDERED TO ANY AND ALL PATIENTS, REGARDLESS OF THE PATIENTS' ABILITY TO PAY. NET REVENUE COLLECTED ON THE PRO CHARGES IS NOT CONSIDERED WHEN CALCULATING THE INCENTIVE BONUS. ALL INCENTIVE BONUS AGREEMENTS HAVE OVERALL CAPS ON TOTAL COMPENSATION FOR WHICH THE PHYSICIAN IS ELIGIBLE IN A TWELVE MONTH TIME PERIOD. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARC LAME MD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | CURRENT VOTING BOARD MEMBER OF THE HOSPITAL | Relationship |
| Amount Of Transaction | 129720 | AmountOfTransaction |
| Description Of Transaction | RENTAL OF SPACE AND OFFICE STAFF FOR HOSPITAL EMPLOYED SURGEON HOUSED AT THE PRIVATE PHYSICIAN PRACTICE OF MARC LAME, MD ($93,720). RENTAL OF PHYSICIAN OFFICE BUILDING TO MARC LAME BY THE HOSPITAL ($36,000). | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | AN INFORMAL REVIEW OF THE 990 IS PERFORMED BY THE ADMINISTRATIVE TEAM AND BY MEMBERS OF THE EXECUTIVE COMMITTEE OF THE BOARD BEFORE THE RETURN IS FILED. THIS REVIEW IS NOT DOCUMENTED. | |
| ALL INDIVIDUALS SERVING ON THE BOARD ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND ARE PERIODICALLY REMINDED OF THEIR OBLIGATION TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT MAY ARISE AS PART OF INTERRELATIONSHIPS RESULTING FROM THEIR PROFESSIONAL CAREERS, THEIR FAMILIES, THEIR PERSONAL ACQUAINTANCES WITH KEY EMPLOYEES OF THE HOSPITAL, AND THEIR DUTIES AS A BOARD MEMBER. MONITORING IS CONDUCTED ON AN ONGOING BASIS, WITH THE EXPECTATION THAT BOARD MEMBERS WILL MEET THEIR AFFIRMATIVE OBLIGATION TO REPORT CONFLICTS OF INTEREST PRIOR TO THE EXECUTION OF BOARD TRANSACTIONS INVOLVING SUCH CONFLICTS. CHARLEVOIX AREA HOSPITAL CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY DISTRIBUTING AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE TO BOARD MEMBERS, EMPLOYED PHYSICIANS, AND KEY EMPLOYEES, WHICH INCLUDES QUESTIONS RELATED TO EACH POLICY PROVISION. RESPONSES ARE THOROUGHLY REVIEWED AND ANY APPARENT CONFLICTS ARE THOROUGHLY INVESTIGATED. IN THE EVENT THAT A POTENTIAL CONFLICT IS IDENTIFIED PRIOR TO ACTION ON A CONTRACT OR TRANSACTION, THE CONFLICTED PERSON IS NOT ALLOWED TO PARTICIPATE IN DISCUSSIONS ON THE MATTER, NOT ALLOWED TO VOTE ON THE MATTER, AND NOT ALLOWED TO BE PRESENT DURING VOTING ON THE MATTER. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE HIGHEST PAID EMPLOYEES ARE OUR PHYSICIANS, AND THE MGMA ANNUAL PHYSICIAN COMPENSATION SURVEY IS USED TO DETERMINE THAT SALARIES PAID TO OUR EMPLOYED PHYSICIANS ARE APPROPRIATE. EXECUTIVE COMPENSATION FOR THE CEO IS CHECKED AGAINST REGIONAL COMPENSATION THROUGH THE USE OF A WELL RESPECTED EMPLOYMENT AND RECRUITING FIRM IN MICHIGAN. IT IS ALSO COMPARED TO COMPENSATION DATA PROVIDED BY OUR STATE HOSPITAL ASSOCIATION. THEIR REVIEW IS PERFORMED ANNUALLY BY THE COMPENSATION COMMITTEE OF THE BOARD. THIS REVIEW WAS LAST PERFORMED IN FISCAL YEAR 2009. | FORM 990, PART VI, SECTION B, LINE 15A | |
| THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 44,846. | FORM 990, PART XI, LINE 5: |
| THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | FORM 990, PART XII, LINE 2C: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14700 LAKE SHORE DRIVE | AddressLine1 |
| City | CHARLEVOIX | City |
| State | MI | State |
| ZIP Code | 49720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 753078034 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | MI | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLEVOIX AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| C | 103672 | CASH |
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| N | 41965 | FMV - ACTUAL AMOUNTS PAID |
| CHARLEVOIX AREA HOSPITAL FOUNDATION | ||
| P | 60487 | FMV - ACTUAL AMOUNTS PAID |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | THIS RETURN IS BEING FILED BETWEEN MARCH 1, 2012 AND MARCH 30, 2012, AS DIRECTED BY THE IRS NOTICE 2012-4, BECAUSE ELECTRONIC FILING WAS NOT AVAILABLE JANUARY 1, 2012 THROUGH FEBRUARY 29, 2012. WE REQUEST THAT PENALTIES BE WAIVED BECAUSE IT WOULD BE INEQUITABLE TO IMPOSE A PENALTY ON US DUE TO THE UNUSUAL CIRCUMSTANCES REQUIRING US TO DELAY THE FILING OF THIS RETURN. | Explanation |