MYMICHIGAN MEDICAL CENTER SAULT: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MYMICHIGAN MEDICAL CENTER SAULT (EIN 38-2602147)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-01
- IRS object ID
- 201223069349301567
- Schema version
- 2011v1.2
- 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 G
- Schedule H
- Schedule J
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-01T13:56:54-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
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 ST 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 | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382602147 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHIPPEWA CNTY WAR MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHIP | NameControl |
| Phone | 9066354460 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 OSBORN BOULEVARD | AddressLine1 |
| City | SAULT STE MARIE | City |
| State | MI | State |
| ZIP Code | 49783 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KEVIN KALCHIK | Name |
| Title | CFO | Title |
| Phone | 9066354460 | Phone |
| Date Signed | 2012-10-29 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| PTIN | P00053797 | PTIN |
| Phone | 2319477800 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAR MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID JAHN CEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 OSBORN BOULEVARD | AddressLine1 |
| City | SAULT STE MARIE | City |
| State | MI | State |
| ZIP Code | 49783 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 95843902 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.WARMEMORIALHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTH CARE SERVICES AND ACCESS TO THE RESIDENTS OF SAULT STE. MARIE AND THE EASTERN UPPER PENINSULA. OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 953 | TotalNbrEmployees |
| Total Nbr Volunteers | 90 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 101848 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 153499 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 83026437 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 89034515 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 102786 | InvestmentIncomePriorYear |
| Investment Income Current Year | 937587 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 511463 | OtherRevenuePriorYear |
| Other Revenue Current Year | 347575 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 83742534 | TotalRevenuePriorYear |
| Total Revenue Current Year | 90473176 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 42687012 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 44910390 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 41242688 | OtherExpensePriorYear |
| Other Expenses Current Year | 43230725 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 83929700 | TotalExpensesPriorYear |
| Total Expenses Current Year | 88141115 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -187166 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2332061 | RevenuesLessExpensesCY |
| Total Assets BOY | 43532934 | TotalAssetsBOY |
| Total Assets EOY | 59779002 | TotalAssetsEOY |
| Total Liabilities BOY | 22366219 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 36557356 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 21166715 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 23221646 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | OUR COMMITMENT IS TO IMPROVE THE QUALITY OF LIFE AND HEALTH THROUGH PARTNERSHIPS WITH THOSE WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 53770839 | Expense |
| Grants | 0 | Grants |
| Revenue | 72233941 | Revenue |
| Description | OUTPATIENT ANCILLARY AND PROFESSIONAL SERVICES - THE PROGRAM HAD 149,006 OUTPATIENT VISITS IN 2011. SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 13319458 | Expense |
| Grants | 0 | Grants |
| Revenue | 12424779 | Revenue |
| Description | INPATIENT ACUTE SERVICES - THE PROGRAM HAD 2,827 ADMISSIONS WITH A TOTAL OF 11,546 PATIENT DAYS IN 2011. SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2778396 | Expense |
| Grants | 0 | Grants |
| Revenue | 2104965 | Revenue |
| Description | BEHAVIORAL HEALTH CLINIC - THE PROGRAM HAD 387 ADMISSIONS WITH A TOTAL OF 3,921 PATIENT DAYS IN 2011. SEE LINE 4D "OTHER PROGRAM SERVICES" FOR ADDITIONAL DESCRIPTION. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3456825 | Expense |
| Grants | 0 | Grants |
| Revenue | 2301407 | Revenue |
| Description | 1. WAR MEMORIAL HOSPITAL PROVIDED INPATIENT CARE TO 2,827 PATIENTS IN FISCAL YEAR 2011. OUR 51 BED LONG TERM CARE UNIT (HOSPITAL-ATTACHED NURSING HOME) HAD AN AVERAGE OCCUPANCY RATE OF 95% DURING THE YEAR. OUR OBSTETRICS/NURSERY UNIT REPORTED 339 BIRTHS AND OUR SURGICAL SERVICES DEPARTMENT PROVIDED SURGICAL CARE FOR 5,175 PATIENTS. THE HOSPITAL'S TWENTY FOUR HOUR EMERGENCY DEPARTMENT AND THE COMMUNITY CARE CLINIC (WALK-IN URGENT CARE CENTER) RECORDED 18,248 VISITS AND 11,688 VISITS RESPECTIVELY. IN FISCAL YEAR 2011, THERE WERE OVER 148,999 PATIENT REGISTRATIONS FOR THE HOSPITAL'S MULTIPLE OUTPATIENT SERVICE DEPARTMENTS (LAB, RADIOLOGY, CARDIOPULMONARY, REHABILITATION). THE REHABILITATION DEPARTMENT CONTINUED IT EXPANSION OF SERVICES IN CONTRACTING TO PROVIDE REHABILITATION SERVICES WITH MULTIPLE ORGANIZATIONS IN THE REGION; INCLUDING, BUT NOT LIMITED TO, AREA SCHOOLS, HOSPITALS, AND HOME HEALTH AGENCIES. NEARLY 357,633 REHABILITATION TREATMENTS WERE REPORTED.2. WAR MEMORIAL HOSPITAL CONTINUES TO PARTNER WITH TERTIARY FACILITIES TO PROVIDE CONSISTENT ACCESS TO PROVIDERS OF CARDIOLOGY, INTERNAL MEDICINE, ONCOLOGY, AND NEPHROLOGY. DUE TO THE HOSPITAL'S GEOGRAPHIC LOCATION AND COMMUNITY SIZE, THE HOSPITAL HAS CONTINUED TO INDEPENDENTLY RECRUIT OTHER SPECIALISTS TO ENSURE ACCESS TO PROVIDERS. THE HOSPITAL CONTINUES ITS EFFORTS IN PROVIDING PRIMARY CARE IN OUTREACH AREAS OF THE EASTERN UPPER PENINSULA. SIGNIFICANT PROVIDER ADDITIONS IN THE PAST COUPLE OF YEARS INCLUDE GASTROENTEROLOGY, NEUROLOGY, BARIATRIC, PAIN MANAGEMENT, AND ENHANCING IT MEDICAL STAFF WITH ADDITIONAL PROVIDERS TO ENSURE ACCESS AND COVERAGE. WITH THESE EFFORTS AND PARTNERSHIPS THE HOSPITAL HAS BEEN SUCCESSFUL IN MAINTAINING ALL OTHER SERVICES.3. WAR MEMORIAL HOSPITAL CONTINUED ITS LEADERSHIP AND INVOLVEMENT IN COMMUNITY AND HEALTHCARE PROVIDER EDUCATION AND TRAINING. EXAMPLES OF COMMUNITY EDUCATION AND/OR HEALTH SCREENINGS INCLUDED A COMMUNITY BABY SHOWER, SENIOR HEALTH FAIR, EARLY PRE-NATAL EDUCATION AND CHILDBIRTH CLASSES. THE HOSPITAL'S INVOLVEMENT IN HEALTHCARE PROVIDER EDUCATION AND TRAINING INCLUDED NURSE AIDE TRAINING PROGRAMS AND SERVING AS CLINICAL INTERNSHIP SITE FOR MANY COLLEGE AND UNIVERSITY TRAINING PROGRAMS FOR STUDENTS IN REGISTERED NURSING, PHARMACY, MEDICAL TECHNOLOGY, HEALTH INFORMATION MANAGEMENT, AND PHYSICIAN ASSISTANT PROGRAMS. THE HOSPITAL IS ALSO DESIGNATED AS A COMMUNITY TRAINING CENTER OFFERING TRAINING TO AREA PHYSICIANS AND STAFF ON PEDIATRIC ADVANCED LIFE SUPPORT, ADVANCED CARDIAC LIFE SUPPORT AND BASIC LIFE SUPPORT. THE HOSPITAL IS ALSO CERTIFIED TO PROVIDE CONTINUING MEDICAL EDUCATION TO AREA PHYSICIANS AND STAFF AND CONDUCTS MORE THAN 25 ON-SITE PROGRAMS PER YEAR. VIDEO CONFERENCING CAPABILITIES ALSO PROVIDE ACCESS TO COMMUNITY AND HEALTHCARE PROVIDER TRAINING THROUGHOUT THE YEAR.4. WAR MEMORIAL HOSPITAL EMPLOYEES HAVE EMPLOYMENT BENEFITS WHICH INCLUDE PAYMENT FOR EXPENSES FOR THE COMPLETION OF A BACHELOR OF SCIENCE IN NURSING FOR CURRENT REGISTERED NURSES ON STAFF. ADDITIONALLY, OTHER EMPLOYEES HAVE ANNUAL EDUCATION BENEFITS FOR CONTINUING/ADVANCING THEIR EDUCATION IN A HEALTHCARE FIELD. THE HOSPITAL ALSO OFFERS AN EDUCATIONAL LOAN PROGRAM WITH A PERIOD OF NO-INTEREST LOANS WHILE ENROLLED IN AN EDUCATIONAL PROGRAM. FOR NEWLY HIRED EMPLOYEES IN JOB SHORTAGE CLASSIFICATIONS, EMPLOYEES CAN RECEIVE FUNDS FOR STUDENT LOAN REPAYMENT FOR A COMMITMENT TO SERVE WAR MEMORIAL HOSPITAL FOR A SPECIFIED NUMBER OF YEARS.5. WAR MEMORIAL HOSPITAL IS ONE OF THE TOP TEN LARGEST EMPLOYERS IN OUR REGION. WE EMPLOY APPROXIMATELY 854 PEOPLE AND HAVE AN ANNUAL PAYROLL OF APPROXIMATELY $35.7 MILLION; PROVIDING A POSITIVE ECONOMIC IMPACT IN THE COMMUNITY. 6. WAR MEMORIAL HOSPITAL PROVIDES CARE TO PATIENTS COVERED BY GOVERNMENTAL PROGRAMS AT REIMBURSEMENTS AT LESS THAN WHAT IS NEEDED IN ORDER TO PROVIDE STABILITY OF OPERATIONS. THE UN-REIMBURSED VALUE OF PROVIDING CARE TO MEDICAID PATIENTS IS APPROXIMATELY $2,665,997. AS THE NUMBER OF UNINSURED OR UNDERINSURED CITIZENS CONTINUES TO INCREASE, THE HOSPITAL'S ABILITY TO COLLECT REIMBURSEMENTS FOR SERVICES PROVIDED CONTINUES TO BE A CHALLENGE. THEREFORE, HOSPITAL LEADERS HAVE SERVED IN LEADERSHIP CAPACITIES IN THE DEVELOPMENT OF A COMMUNITY HEALTH ACCESS COALITION WHICH HAS A MISSION TO PROVIDE ACCESS TO QUALITY HEALTH CARE FOR THE UNINSURED RESIDENTS OF CHIPPEWA, LUCE, AND MACKINAC COUNTIES BY COORDINATING SERVICES OF VARIOUS HEALTH CARE PROVIDERS TO OFFER AN AFFORDABLE, DIGNIFIED AND ENHANCED CONTINUUM OF CARE. THE HOSPITAL AS WELL AS LOCAL PHYSICIANS AGREE TO PROVIDE CARE THAT IS UNCOMPENSATED OR AT A REDUCED FEE. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 3456825 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 2301407 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 73325518 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | 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 | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | 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 | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 108 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 953 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | 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 | KEVIN KALCHIK CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9066354456 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 OSBORN BOULEVARD | AddressLine1 |
| City | SAULT STE MARIE | City |
| State | MI | State |
| ZIP Code | 49783 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 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 |
|---|---|---|---|---|---|---|---|
| RONALD CALERY | |||||||
| VICE CHAIR | 1.50 | X | X | 6435 | 0 | 0 | |
| SCOTT SHACKLETON | |||||||
| TRUSTEE | 1.50 | X | 6885 | 0 | 0 | ||
| JOHN JORGENSON SR | |||||||
| TRUSTEE | 1.50 | X | 6570 | 0 | 0 | ||
| WW LAJOIE | |||||||
| TREASURER | 1.50 | X | X | 5400 | 0 | 0 | |
| TED POSTULA | |||||||
| TRUSTEE | 1.50 | X | 5940 | 0 | 0 | ||
| GARY MCDOWELL | |||||||
| TRUSTEE | 1.50 | X | 5985 | 0 | 0 | ||
| FRANK SASSO | |||||||
| CHAIR | 1.50 | X | X | 7530 | 0 | 0 | |
| FREDERICK LUDWIG | |||||||
| PAST CHIEF OF STAFF | 40.00 | X | 103293 | 0 | 8955 | ||
| ELIZABETH DEMARAY | |||||||
| SECRETARY | 1.50 | X | X | 6390 | 0 | 0 | |
| TIMOTHY O'CONNOR | |||||||
| CHIEF OF STAFF | 1.50 | X | 25350 | 0 | 0 | ||
| SUSAN TETZLAFF | |||||||
| VP OF NURSING | 40.00 | X | 137910 | 0 | 31791 | ||
| DAVID JAHN | |||||||
| CEO | 40.00 | X | 250117 | 0 | 58364 | ||
| KEVIN KALCHIK | |||||||
| CFO | 40.00 | X | 132215 | 0 | 31507 | ||
| MARLA BUNKER | |||||||
| VP OF CLINICAL OPERATIONS | 40.00 | X | 110318 | 0 | 30411 | ||
| JAMES HAGLUND | |||||||
| VP OF REHAB | 40.00 | X | 161922 | 0 | 20944 | ||
| WALEED DOGHMI | |||||||
| PHYSICIAN | 40.00 | 623993 | 0 | 32146 | X | ||
| RICHARD GANZHORN | |||||||
| PHYSICIAN | 40.00 | 827700 | 0 | 32146 | X | ||
| JAMIE ADAIR | |||||||
| PHYSICIAN | 40.00 | 461463 | 0 | 32146 | X | ||
| JOHN GALEY | |||||||
| PHYSICIAN | 40.00 | 663647 | 0 | 32059 | X | ||
| PAULA RECHNER | |||||||
| PHYSICIAN | 40.00 | 449780 | 0 | 32146 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3998843 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 342615 | TotalOtherCompensation |
| Number Individuals GT100 K | 28 | NumberIndividualsGT100K |
| Formers Listed | 0 | 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 |
|---|---|---|---|---|---|
| EUPEP | |||||
| PO BOX 2870 | WHITEHOUSE | OH | 43571 | E.R. PHYSICIAN COVERAGE | 1875324 |
| DEVERE CONSTRUCTION COMPANY | |||||
| 1030 DEVERE DRIVE | ALPENA | MI | 49707 | CONTRACTOR | 1005243 |
| MAXIT HEALTHCARE LLC | |||||
| PO BOX 2589 | FORT WAYNE | IN | 46801 | INFORMATION SYSTEMS | 575176 |
| WILLIAM GOOD MD | |||||
| 2625 KITCHEN ROAD | CHEBOYGAN | MI | 49721 | ANESTHESIOLOGIST | 536719 |
| HORIZON HEALTH | |||||
| PO BOX 840839 | DALLAS | TX | 75284 | MANAGEMENT FEE | 478112 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 24 | NumberOfContractorsGT100K |
| Fundraising Events | 28128 | FundraisingEvents |
| Government Grants | 69454 | GovernmentGrants |
| All Other Contributions | 55917 | AllOtherContributions |
| Total Contributions | 153499 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 622110 | 88774969 | 88774969 |
| OTHER RELATED REVENUE | 622110 | 259546 | 259546 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 89034515 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 878272 | TotalRevenueColumn |
| Exclusion | $878,272 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 238705 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 208128 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 30577 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30577 | TotalRevenueColumn |
| Related Or Exempt Function Income | 30577 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5193986 | Securities |
| Other | 11192 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 5145863 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 48123 | Securities |
| Other | 11192 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 59315 | TotalRevenueColumn |
| Exclusion | $59,315 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 10724 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 28128 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 16735 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -6011 | TotalRevenueColumn |
| Exclusion | -$6,011 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA REVENUE | 722210 | 444502 | $444,502 |
| EXTINGUISHMENT OF DEBT | 900099 | -121493 | -$121,493 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 323009 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 90473176 | TotalRevenueColumn |
| Related Or Exempt Function Income | 89065092 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,254,585 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1154232 | Total |
| Program Services | 323595 | ProgramServices |
| Management And General | 830637 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34761527 | Total |
| Program Services | 30462854 | ProgramServices |
| Management And General | 4298673 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6696444 | Total |
| Program Services | 5950331 | ProgramServices |
| Management And General | 746113 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2298187 | Total |
| Program Services | 1986392 | ProgramServices |
| Management And General | 311795 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 607545 | Total |
| Management And General | 607545 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156985 | Total |
| Management And General | 156985 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8496928 | Total |
| Program Services | 7305849 | ProgramServices |
| Management And General | 1191079 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 163136 | Total |
| Program Services | 7202 | ProgramServices |
| Management And General | 155934 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1433906 | Total |
| Program Services | 985269 | ProgramServices |
| Management And General | 448637 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113959 | Total |
| Program Services | 75273 | ProgramServices |
| Management And General | 38686 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 140608 | Total |
| Program Services | 63376 | ProgramServices |
| Management And General | 77232 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 972223 | Total |
| Program Services | 783737 | ProgramServices |
| Management And General | 188486 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4426290 | Total |
| Program Services | 1815924 | ProgramServices |
| Management And General | 2610366 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 707367 | Total |
| Program Services | 698721 | ProgramServices |
| Management And General | 8646 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 12721379 | 12341608 | 379771 |
| PROVISION FOR BAD DEBTS | 5665085 | 5665085 | |
| QUALITY ASSESSMENT FEES | 2394564 | 2394564 | |
| REPAIRS AND MAINTENANCE | 1998230 | 1317770 | 680460 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3232520 | Total |
| Program Services | 1147968 | ProgramServices |
| Management And General | 2084552 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88141115 | Total |
| Program Services | 73325518 | ProgramServices |
| Management And General | 14815597 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3175 | BOY |
| EOY | 3974 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 579394 | BOY |
| EOY | 4124085 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9730577 | BOY |
| EOY | 8588533 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2819224 | BOY |
| EOY | 2936528 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 450568 | BOY |
| EOY | 404007 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 74792224 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 36621499 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22810828 | BOY |
| EOY | 38170725 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3115369 | BOY |
| EOY | 3010533 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1589791 | BOY |
| EOY | 268587 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2434008 | BOY |
| EOY | 2272030 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43532934 | BOY |
| EOY | 59779002 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7992097 | BOY |
| EOY | 7835297 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9080302 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2268182 | BOY |
| EOY | 24964322 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3025638 | BOY |
| EOY | 3757737 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22366219 | BOY |
| EOY | 36557356 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21166715 | BOY |
| EOY | 23221646 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21166715 | BOY |
| EOY | 23221646 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43532934 | BOY |
| EOY | 59779002 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2332061 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -277130 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
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 | $9,420 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 9420 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | PORTION OF ANNUAL DUES TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND AGING SERVICES OF MICHIGAN THAT ARE USED TOWARD LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2819909 | OtherCostOrOtherBasis |
| Book Value | 2819909 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 46280106 | OtherCostOrOtherBasis |
| Depreciation | 21095337 | Depreciation |
| Book Value | 25184769 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 793301 | OtherCostOrOtherBasis |
| Depreciation | 228123 | Depreciation |
| Book Value | 565178 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23160078 | OtherCostOrOtherBasis |
| Depreciation | 15298039 | Depreciation |
| Book Value | 7862039 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1738830 | OtherCostOrOtherBasis |
| Book Value | 1738830 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38170725 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED POST-RETIREMENT BENEFIT COST | $1,238,711 |
| ACCRUED INSURANCE | $400,000 |
| COST REPORT SETTLEMENT PAYABLE | $389,026 |
| ACCRUED MALPRACTICE LIABILITY | $1,730,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3757737 | TotalOfAmounts |
| Total Revenue | 90473176 | TotalRevenue |
| Total Expenses | 88141115 | TotalExpenses |
| Excess Or Deficit For Year | 2332061 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -20375 | NetUnrealizedGLOnInvestments |
| Other | -$256,755 | OtherAmount |
| Total Adjustments | -277130 | TotalAdjustments |
| Excess Or Deficit Per FS | 2054931 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 85207782 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -5611750 | OtherRevenues |
| Revenue Not Rptd F990 | -5611750 | RevenueNotRptdF990 |
| Revenue Subtotal | 90819532 | RevenueSubtotal |
| Other Revenues Not Included | -346356 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -346356 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 90473176 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 83507089 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 977724 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 977724 | ExpensesNotRptdF990 |
| Expenses Subtotal | 82529365 | ExpensesSubtotal |
| Other Expenses Not Included | 5611750 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 5611750 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 88141115 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | LOSS FROM JOINT VENTURES -610,993. TRANSFER OF NET ASSETS FROM RELATED HOSPITAL UPON DISSOLUTION 354,238. TOTAL TO SCHEDULE D, PART XI, LINE 8: -256,755. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS -5,665,085. EMPLOYED PHYSICIAN RENTAL INCOME 61,727. GRANT EXPENSES -8,392. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES -16,735. RENTAL EXPENSES -208,128. LOSS ON EXTINGUISHMENT OF DEBT -121,493. |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | NET UNREALIZED LOSSES ON INVESTMENTS 20,375. LOSS ON EXTINGUISHMENT OF DEBT 121,493. EQUITY LOSSES OF UNCONSOLIDATED INVESTEES 610,993. FUNDRAISING EXPENSES 16,735. RENTAL EXPENSES 208,128. |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 5,665,085. EMPLOYED PHYSICIAN RENTAL INCOME -61,727. GRANT EXPENSES 8,392. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 37700 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 26976 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 10724 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 6011 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 7280 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 3444 | FoodAndBeverageEvent1 |
| Name Of Event2 | NRS SCHOLARSHIP FUNDRAISER | NameOfEvent2 |
| Gross Receipts Event2 | 1152 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 1152 | CharitableContributionsEvent2 |
| Gross Receipts Total | 38852 | GrossReceiptsTotal |
| Charitable Contributions Total | 28128 | CharitableContributionsTotal |
| Gross Revenue Total Events | 10724 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 6011 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 7280 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 3444 | FoodAndBeverageTotalEvents |
| Direct Expense Summary Events | 16735 | DirectExpenseSummaryEvents |
| Net Income Summary | -6011 | NetIncomeSummary |
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 |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| 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 | 718506 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 156884 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 561622 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00680 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12873113 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12036179 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 836934 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01010 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13591619 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12193063 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1398556 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01690 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 160883 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 160883 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 197700 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 197700 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6720061 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4429019 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2291042 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02780 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 89355 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 89355 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7167999 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4429019 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2738980 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03330 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20759618 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 16622082 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4137536 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05020 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 158 | PersonsServed |
| Total Community Building Expense | 13798 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 13798 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 158 | PersonsServed |
| Total Community Building Expense | 13798 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 13798 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $5,665,085 | BadDebtExpenseAmount |
| Amount Attributable To | 2832543 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 23174704 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 18385026 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 4789678 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| 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 | CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 OSBORN BOULEVARD | AddressLine1 |
| City | SAULT STE MARIE | City |
| State | MI | State |
| ZIP Code | 49783 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| 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 | CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| LONG TERM CARE | ||||
| 500 OSBORN BOULEVARD | SAULT STE MARIE | MI | 49783 | SKILLED NURSING FACILITY |
| BEHAVIORAL HEALTH CENTER | ||||
| 500 OSBORN BOULEVARD | SAULT STE MARIE | MI | 49783 | INPATIENT PSYCHIATRIC FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: THE HOSPITAL, THROUGH ITS PARTNERSHIP WITH COMMUNITY HEALTH ACCESS COALITION, UTILIZES 200% OF POVERTY GUIDELINES FOR INITIAL ACCESS AND APPLICATION FOR MEDICAID. FOR THOSE COMMUNITY MEMBERS THAT DO NOT QUALIFY, 250% OF POVERTY GUIDELINES ARE UTILIZED FOR ADDITIONAL DISCOUNTS OR FREE CARE ON REMAINING BALANCES AND NON-COVERED SERVICES. | ||
| PART I, LINE 6A: N/A | ||
| PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E) AND HEALTH PROFESSIONS EDUCATION (LINE 7F).A DIRECT COST AND STEP-DOWN APPROACH WAS USED TO COMPLETE THE SUBSIDIZED HEALTH SERVICES PROGRAMS (LINE 7G). | ||
| PART I, LINE 7G: INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE: ORTHO SURGERY, GENERAL SURGERY, BLUE WATER PSYCH, OB PROFESSIONAL, AND OB PROGRAM. | ||
| PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $5,665,085. | ||
| PART II: WAR MEMORIAL HOSPITAL IS ACTIVE IN BOTH THE PROMOTION OF HEALTHY LIFESTYLES FOR BOTH ITS EMPLOYEES AND COMMUNITY MEMBERS. WAR MEMORIAL HOSPITAL WILL TAKE A LEAD ROLE IN MANY OF THESE ENDEAVORS, BUT ALSO IS WILLING TO BE A SUPPORTIVE PARTNER AND TEAM MEMBER AS WELL. | ||
| PART III, LINE 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. 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. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL ASSISTANCE POLICY, $2,832,543, IS EQUAL TO APPROXIMATELY 50 PERCENT OF BAD DEBT EXPENSE. | ||
| PART III, LINE 8: THE MEDICARE SURPLUS(SHORTFALL) WAS CALCULATED BY UTILIZING COST ACCOUNTING WHEN APPROPRIATE AND AVAILABLE. IN SOME AREAS A COST TO CHARGE METHODOLOGY WAS REQUIRED. | ||
| PART III, LINE 9B: WAR MEMORIAL HOSPITAL UTILIZES AN ON-LINE INSURANCE VERIFICATION PROCESS TO INITIATE THE EDUCATION AND ELIGIBILITY FROM THE ON-SET OF SERVICES. UPFRONT COLLECTIONS ARE AN ACTIVE PART OF THE PROCESS TO BOTH EDUCATE THE PATIENT AND TO REDUCE BACK-END COSTS OF COLLECTIONS. AT ANY TIME DURING THE PROCESS STAFF ARE TRAINED TO ADDRESS THE PERCEIVED FINANCIAL ASSISTANT NEEDS AND PROVIDE ACCESS TO THE IN-HOUSE PATIENT FINANCIAL COUNSELOR, COMMUNITY HEALTH ACCESS COALITION, OR THE DEPARTMENT OF HEALTH SERVICES REPRESENTATIVE. IN THE BILLING PROCESS, PATIENTS ARE STILL OFFERED ANY EDUCATION NECESSARY TO OBTAIN ASSISTANCE. ONCE SERVICES ARE RECEIVED AND THE PATIENT CHARGES HAVE ACCUMULATED PRIMARY SOURCES OF COVEAGE ARE BILLED. AFTER ALL EFFORTS OF COLLECTION FROM PRIMARY PAYOR (INSURANCE) THE PATIENT IS BALANCED BILL AND PROVIDED THE OPPORTUNITY FOR PAYMENT IN FULL OR OTHER PAYMENT OPTIONS. | ||
| OTHER INFORMATION: AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE COSTS NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) ARE SUMMARIZED AS FOLLOWS:TOTAL COST: 11,213,297 TOTAL REIMBURSEMENT: 9,781,300 COST IN EXCESS OF REIMBURSEMENT: 1,431,997 | ||
| PART VI, LINE 2: WAR MEMORIAL HOSPITAL WORKS IN CONJUNCTION WITH MANY OF THE HOSPITAL'S IN THE NORTHERN MICHIGAN AND THE UPPER PENINSULA. IN THESE EFFORTS "NEEDS" OF THE COMMUNITIES ARE ASSESSED THROUGH WORK WITH OTHER HOSPITAL'S, HEALTH RELATED ORGANIZATION'S, AND IN COMMUNITY FORUM'S. IN ADDITION, WAR MEMORIAL HOSPITAL HAS ENGAGED OUTSIDE ASSISTANCE IN THE PLANNING FOR "NEEDS" OF BOTH SERVICES AND PHYSICIANS TO BEST PLAN FOR CAPITAL AND RECRUITMENT APPROPRIATIONS. | ||
| PART VI, LINE 3: WAR MEMORIAL HOSPITAL PRIDES ITSELF ON PROVIDING NEEDED CARE TO THE INDIGENT OF THE EASTERN UPPER PENINSULA IN A DIGNIFIED MANNER. THIS EDUCATION AND ASSISTANCE IS DONE THROUGH PARTNERSHIPS WITH OTHER "ACCESS" POINTS. SPECIFICALLY, WAR MEMORIAL HOSPITAL HAS PROVIDED RESOURCES TO THE CHAC (COMMUNITY HEALTH ACCESS COALTION) AND WAR MEMORIAL HOSPITAL HAS ENTERED INTO AN AGREEMENT WITH THE STATE OF MICHIGAN TO PROVIDE A DHS (DEPARTMENT OF HEALTH SERVICES) WORKER ON-SITE FOR READY ACCESS FOR OUR PATIENTS. THROUGH THE COLLABORATION OF THESE RELATIONSHIPS OUR PATIENTS ARE FIRST NOTIFIED AND REFERRED TO THE APPROPRIATE RESOURCE FROM THE ON-SET OF RECEIVING HEALTH CARE SERVICES. | ||
| PART VI, LINE 4: WAR MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS THE EASTERN UPPER PENINSULA OF MICHIGAN. IN THIS AREA THERE ARE THREE COUNTIES WHICH CONSIST OF CHIPPEWA, MACKINAC, AND LUCE. WAR MEMORIAL HOSPITAL PRIDES ITSELF ON THE QUALITY OF SERVICES IT PROVIDES AS A RURAL SOLE COMMUNITY HOSPITAL. THE CLOSEST HOSPITAL IS 50 MILES AWAY AND IS A CRITICAL CARE HOSPITAL. THE CLOSEST TERTIARY FACILITY IS OVER AN HOUR AND A HALF AWAY. WAR MEMORIAL HOSPITAL STRIVES FOR PROVIDING SERVICES TO THE COMMUNITY FOR WHICH OTHERWISE THE COMMUNITY MEMBER WOULD MOST LIKELY HAVE TO TRAVEL TO A TERTIARY FACILITY. THROUGH ITS OWN EFFORTS AND JOINT VENTURES AREAS OF CARE SUCH AS OBSTETRICS AND DELIVERY, DIALYSIS, ONCOLOGY, CARDIOLOGY, PULMONOLOGY, INFECTIOUS DISEASE, AND I/P PSYCHIATRIC SERVICES WOULD NOT BE AVAILABLE. | ||
| PART VI, LINE 5: WAR MEMORIAL HOSPITAL PROVIDES MANY POINTS OF ACCESS THAT ARE NOT PROFITABLE, BUT OTHERWISE WOULD REQUIRE OUR COMMUNITY MEMBERS TO TRAVEL GREAT DISTANCES. THE HOSPITAL MANAGEMENT AND STAFF PARTICIPATE ACTIVELY IN MANY HEALTH AND EDUCATIONAL ENDEAVORS. AN EXAMPLE IS PROVIDING CLINICAL STAFF TO THE LOCAL STATE UNIVERSITY TO ASSIST IN THE EDUCATION OF REGISTERED NURSES. OTHER EXAMPLES INCLUDE INFORMAL PARTNERSHIPS WITH TWO LOCALLY RECOGNIZED NATIVE AMERICAN TRIBES AND FULL SUPPORT OF COUNTY HEALTH INITIATIVES. PROGRAM EXAMPLES WOULD INCLUDE FLU-CLINIC, DIALYSIS, DIABETIC EDUCATION, COUNTY HEALTH DEPARTMENT COLON SCREENING, PHYSICALS FOR STUDENT ATHLETES, AND REGIONAL CHARITY CARE INITIATIVES. | ||
| PART VI, LINE 6: NOT AFFILIATED. | ||
| MI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN TETZLAFF | |||||||||||||
| 137560 | 0 | 0 | 0 | 350 | 0 | 11896 | 0 | 19895 | 0 | 169701 | 0 | 0 | 0 |
| DAVID JAHN | |||||||||||||
| 249999 | 0 | 0 | 0 | 118 | 0 | 32250 | 0 | 26114 | 0 | 308481 | 0 | 0 | 0 |
| KEVIN KALCHIK | |||||||||||||
| 132105 | 0 | 0 | 0 | 110 | 0 | 11611 | 0 | 19896 | 0 | 163722 | 0 | 0 | 0 |
| JAMES HAGLUND | |||||||||||||
| 161512 | 0 | 0 | 0 | 410 | 0 | 13076 | 0 | 7868 | 0 | 182866 | 0 | 0 | 0 |
| WALEED DOGHMI | |||||||||||||
| 613903 | 0 | 0 | 0 | 10090 | 0 | 12250 | 0 | 19896 | 0 | 656139 | 0 | 0 | 0 |
| RICHARD GANZHORN | |||||||||||||
| 727700 | 0 | 100000 | 0 | 0 | 0 | 12250 | 0 | 19896 | 0 | 859846 | 0 | 0 | 0 |
| JAMIE ADAIR | |||||||||||||
| 461463 | 0 | 0 | 0 | 0 | 0 | 12250 | 0 | 19896 | 0 | 493609 | 0 | 0 | 0 |
| JOHN GALEY | |||||||||||||
| 663307 | 0 | 0 | 0 | 340 | 0 | 12163 | 0 | 19896 | 0 | 695706 | 0 | 0 | 0 |
| PAULA RECHNER | |||||||||||||
| 423449 | 0 | 26331 | 0 | 0 | 0 | 12250 | 0 | 19896 | 0 | 481926 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE FINANCE DEPARTMENT WORKS WITH THE APPROPRIATE DEPARTMENTS TO PROVIDE RELEVANT INFORMATION TO THE PREPARER OF THE 990 (AN OUTSIDE FIRM SPECIALIZING IN TAX PREPARATION). REVIEW AND DISCUSSION OF ALL INFORMATION TAKES PLACE BETWEEN THE FINANCE DEPARTMENT AND THE CFO. THE FORM 990 IS THEN PROVIDED TO THE FULL BOARD, BEFORE FILING, WHERE THEY ARE GIVEN AN OPPORTUNITY TO ASK QUESTIONS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST STATEMENT IS COMPLETED ANNUALLY FOR ALL BOARD MEMBERS AND SENIOR LEVEL ADMINISTRATION. ANY CONFLICTS WOULD BE REVIEWED AND KEPT UNDER CONSIDERATION ON AN ONGOING BASIS. BOARD MEMBERS AND ADMINISTRATION INFORM OR REMIND THE ATTENDEES IN THESE SITUATIONS AND ABSTAIN FROM BOTH DISCUSSION AND VOTE ON THE ITEM UNDER DISCUSSION. | |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF BOTH MANAGEMENT AND PHYSICIANS IS REVIEWED UTILIZING THE MHA COMPENSATION SURVEY FOR MANAGEMENT AND MGMA DATA FOR PHYSICIANS. IT IS THE HOSPITAL'S DESIRE TO PAY A COMPETITIVE WAGE, BUT NOT PAY ABOVE THE 75TH PERCENTILE FOR MANAGEMENT. BASED ON THE MHA SURVEY THE CEO RECOMMENDS PROPOSED WAGE CHANGES AND HAS BOARD APPROVAL FOR SUCH CHANGES. THE CEO AND HUMAN RESOURCES DIRECTOR PROVIDES THE BOARD WITH CEO WAGE INFORMATION AND THE BOARD (CEO IS REQUESTED TO LEAVE THE MEETING AND IS NOT INVOLVED IN THE VOTE) APPROVES AND MAKES ANY CHANGES THAT ARE NECESSARY. FOR PHYSICIANS, THE CEO UTILIZES MGMA DATA AND BASED ON THE HOSPITAL'S COMMUNITY NEED ASSESSMENT MAKES A RECOMMENDATION TO THE BOARD SEEKING APPROVAL. THIS PROCESS WAS LAST UNDERTAKEN IN 2011. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE 990 AND THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH A DISSEMINATION AGENT AND UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -20,375. LOSS FROM JOINT VENTURES -610,993. TRANSFER OF NET ASSETS FROM RELATED HOSPITAL UPON DISSOLUTION 354,238. TOTAL TO FORM 990, PART XI, LINE 5: -277,130. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | NO CHANGES FROM PRIOR YEAR. |