2012-09-11T16:11:36-05:00 2011-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2011-01-01 383236977 NORTHSTAR HEALTH SYSTEM NORT 9062656121 1400 W ICE LAKE RD IRON RIVER MI 49935 GLENN DOBSON 9062656121 2012-08-24 1 TERRI REXRODE CPA MST P00096513 9206620016 2012-08-24 2011 2016-02-24 21:20:13Z GLENN DOBSON 1400 W ICE LAKE RD IRON RIVER MI 49935 37812000 0 X WWW.NORTHSTARHS.ORG X 1995 MI OUR 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. 9 7 332 25 0 0 85125 101218 33543939 36919006 190800 117172 0 0 33819864 37137396 0 1925 0 0 18363547 18927138 0 0 0 17864069 18981270 36227616 37910333 -2407752 -772937 35976625 34633921 26981293 26540480 8995332 8093441 X NORTHSTAR HEALTH SYSTEM IS A COMMUNITY-OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR THE PHYSICAL AND EMOTIONAL HEALTH OF PEOPLE LIVING IN SOUTH CENTRAL UPPER PENINSULA OF MICHIGAN AND NORTHERN WISCONSIN. DIRECTION, 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 TOWARD 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. NORTHSTAR HEALTH SYSTEM'S VISIONS IS THAT THE PEOPLE WE SERVE WILL BE AMONG THE HEALTHIEST IN THE NATION. 0 0 33097368 36824555 NORTHSTAR 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 3,360 INPATIENT DAYS; 63,500 OUTPATIENT VISITS; 400 SWING BED DAYS; AND 7,000 HOME HEALTH VISITS IN 2011. 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 2011 WAS APPROXIMATELY $172,000. 33097368 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 80 0 1 332 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X GLENN DOBSON 9062656121 1400 W ICE LAKE ROAD IRON RIVER MI 499359594 MARK TOUSIGNANT 1.00 X X 4798 0 0 RICK KENT 1.00 X 2838 0 0 DIANNE ROSTAGNO 1.00 X 0 0 0 RANDY JACOBS 1.00 X 1200 0 0 SANDRA BATTYE 1.00 X X 3600 0 0 JIM GIBULA 1.00 X X 3623 0 0 MARGARET SMITH 1.00 X 600 0 0 BRUCE RAMPAGE 40.00 X X 263636 0 26472 DANNY YARGER MD 40.00 X 273373 0 27419 WILLIAM MAYER 1.00 X 600 0 0 GLENN DOBSON 40.00 X 124971 0 25148 CONNIE KOUTOUZOS 40.00 X 130237 0 2606 MARITES ANSAY MD 40.00 X 185354 0 14591 KIM MAHLER MD 40.00 X 274480 0 28006 HAROLD CLINE MD 40.00 X 604453 0 31534 NASEEM RIZKALLA MD 40.00 X 307656 0 31331 ALAN CAUDILL MD 40.00 X 289266 0 24918 2470685 0 212025 14 0 1 0 MARQUETTE GENERAL HEALTH SYSTEMS 580 W COLLEGE AVE MARQUETTE MI 49855 EMERGENCY ROOM DOCTORS 1801775 DR CUBE PO BOX 335 IRON RIVER MI 49935 RADIOLOGIST 585250 ARAMARK UNIFORM COMPANY 5330 INDUSTRIAL BLVD SUITE 616 FRIDLEY MN 55412 LAUNDRY SERVICES 443314 ANESTHESIA ASSOCIATES 788 PENTOGA TRAIL CRYSTAL FALLS MI 49920 ANESTHESIA 273550 UP HEALTH CARE NETWORK 228 W WASHINGTON AVE MARQUETTE MI 49855 COMPUTER SERVICES 239994 6 101218 101218 NET PATIENT SERVICE RE 900099 36824555 36824555 CAFETERIA MEALS 900099 94451 94451 36919006 134678 134678 635998 21100 636963 37641 -965 -16541 -17506 -17506 37137396 36824555 0 211623 1925 1925 2665451 2092381 573070 12006463 10733996 1272467 544252 483964 60288 2766652 2444741 321911 944320 831366 112954 17838 17838 199686 199686 117099 117099 3952546 3217184 735362 114652 114652 1050046 859816 190230 46800 46800 632286 462968 169318 188772 164964 23808 1480860 1084306 396554 1760819 1760819 186619 44242 142377 MEDICAL SUPPLIES 4793388 4793388 REPAIRS AND MAINTENANCE 2256562 2087091 169471 PROVISION FOR BAD DEBTS 1947886 1947886 DUES & SUBSCRIPTION 150006 86331 63675 85405 85405 37910333 33097368 4812965 0 0 902388 122292 692222 5768804 5402962 39180 39188 457968 424616 228209 210853 39936293 18555033 22782984 21381260 5321478 5166776 0 1255710 413656 35976625 34633921 3982685 4413068 22551080 21992486 161697 134926 285831 0 26981293 26540480 X 8995332 8093441 8995332 8093441 35976625 34633921 X -772937 -128954 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 235876 235876 26131135 7054108 19077027 222569 212426 10143 12769324 10933452 1835872 577389 355047 222342 21381260 37137396 37910333 -772937 -324302 195348 -128954 -901891 35187585 0 35187585 1949811 1949811 37137396 35960522 0 35960522 1949811 1949811 37910333 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2011 OR 2010. FEDERAL INCOME TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2008, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE 256,912. NET ASSET TRANSFER TO FOUNDATION -61,564. TOTAL TO SCHEDULE D, PART XI, LINE 8: 195,348. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,947,886. SCHOOL GRANT EXPENSES 1,925. PART XIII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,947,886. SCHOOL GRANT EXPENSES 1,925. 1 1 1 X 1 X 100.000000000000 1 1 0 1 0 97719 97719 0.00270 2556596 900000 1656596 0.04610 2654315 900000 1754315 0.04880 37200 200 37000 0.00100 15000 15000 0.00040 1424919 1351800 73119 0.00200 10100 10100 0.00030 1487219 1352000 135219 0.00370 4141534 2252000 1889534 0.05250 1 1106657 0 13959926 15315869 -1355943 X 1 1 1 1 NORTHSTAR HEALTH SYSTEM

1400 W ICE LAKE ROAD IRON RIVER MI 49935

X NORTHSTAR HEALTH SYSTEM 1 0 1 1 100.000000000000 1 100.000000000000 1 X X X X X 1 1 X X X X 1 X 1 X X X 1 X 0 0 7 NORTHSTAR HOME CARE AND HOSPICE

927 RIVERSIDE AVENUE IRON RIVER MI 49935

HOME HEALTH AGENCY NORTHSTAR HEALTH SYSTEM - ERSD

1328 US HWY 2 CRYSTAL FALLS MI 49920

DIALYSIS/FAMILY PRACTICE GENESEE CLINIC

229 W GENESEE ST IRON RIVER MI 49935

ORTHOPEDICS/REHAB NORTHSTAR ICE LAKE

1300 WEST ICE LAKE IRON RIVER MI 49935

FAMILY PRACTICE NORTHSTAR RIVERSIDE PLAZA

927 RIVERSIDE AVENUE IRON RIVER MI 49935

FAMILY PRACTICE MARENISCO CLINIC

236 MAIN STREET MARENISCO MI 49947

FAMILY PRACTICE NORTHSTAR SURGERY

1500 WEST ICE LAKE RD IRON RIVER MI 49935

SURGERY 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 $1,947,886 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. NORTHSTAR HEALTH SYSTEM PART V, SECTION B, LINE 15E: SYSTEM GENERATED LETTERS REMINDING THE PATIENT OF HIS/HER RESPONSIBILITIES IN MAKING PAYMENT ARRANGEMENTS. NORTHSTAR HEALTH SYSTEM PART V, SECTION B, LINE 19D: 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. 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. REPORTS FILED WITH STATES PART VI, LINE 7 MI X X X X 0 0 0 0 0 0 0 0 0 BRUCE RAMPAGE 249978 0 0 0 13658 0 8273 0 18199 0 290108 0 0 0 DANNY YARGER MD 238478 0 0 0 34895 0 8939 0 18480 0 300792 0 0 0 GLENN DOBSON 112098 0 0 0 12873 0 4208 0 20940 0 150119 0 0 0 MARITES ANSAY MD 173997 0 0 0 11357 0 6087 0 8504 0 199945 0 0 0 KIM MAHLER MD 241730 0 0 0 32750 0 7906 0 20100 0 302486 0 0 0 HAROLD CLINE MD 584722 0 0 0 19731 0 8734 0 22800 0 635987 0 0 0 NASEEM RIZKALLA MD 280626 0 0 0 27030 0 9341 0 21990 0 338987 0 0 0 ALAN CAUDILL MD 235516 0 0 0 53750 0 8100 0 16818 0 314184 0 0 0 CITY OF IRON RIVER HOSPITAL FINANCE AUTHORITY 383527449 463003AA1 2008-05-15 22721540 HOSPITAL FACILITY IMPROVEMENTS 0 0 0 265000 22721540 1713975 5667697 422278 14917591 15339869 2010 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 1 SCHEDULE K SUPPLENTAL INFORMATION THIS 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 463003AT0 DANNY YARGER MD SIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACT X 12500 6667 0 1 1 KIM MAHLER DO SIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACT X 20000 6688 0 1 1 HAROLD CLINE MD SIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACT X 24238 13333 0 1 1 GREGORY PEYER MD SIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACT X 15000 12500 0 1 1 39188 FORM 990, PART VI, SECTION B, LINE 11 A 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 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. THIS REQUIREMENT IS STATED IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 15 THE 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 19 A COPY OF THE FILED FORM 990 IS AVAILABLE TO THE PUBLIC THROUGH A REQUEST FROM ANY MEMBER OF THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -324,302. CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE 256,912. NET ASSET TRANSFER TO FOUNDATION -61,564. TOTAL TO FORM 990, PART XI, LINE 5: -128,954. FORM 990, PART XII, LINE 2C AUDIT FIRM IS APPROVED BY THE FINANCE COMMITTEE. THE AUDIT FIRM PRESENTS THE AUDIT RESULTS TO THE FINANCE COMMITTEE. GREATER IRON COUNTY EMS INC 1400 WEST ICE LAKE ROAD IRON RIVER MI 49935 383491283 EMERGENCY MEDICAL SERVICES MI 501(C)3 11 NORTHSTAR HEALTH SYSTEM 1 NORTHSTAR HEALTH SYSTEM FOUNDATION 1400 WEST ICE LAKE ROAD IRON RIVER MI 49935 383762132 RAISE FUNDS FOR NORTHSTAR HEALTH SYSTEM MI 501(C)3 11 I NORTHSTAR HEALTH SYSTEM 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1 GREATER IRON COUNTY EMS INC R 585000 GREATER IRON COUNTY EMS INC N 350000 GREATER IRON COUNTY EMS INC P 82000