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MCLAREN NORTHERN MICHIGAN: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MCLAREN NORTHERN MICHIGAN (EIN 38-2146751)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201103199349305265
Schema version
2010v3.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-15T12:11:14-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN382146751EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Northern Michigan HospitalsBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone2314874094Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1416 Connable AvenueAddressLine1
CityPetoskeyCity
StateMIState
ZIP Code49770ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameStephen J ScannellName
TitleVP of Finance & CFOTitle
Phone2314874094Phone
Date Signed2011-11-15DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Northern Michigan Regional HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonStephen J ScannellNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1416 Connable AvenueAddressLine1
CityPetoskeyCity
StateMIState
ZIP Code49770ZIPCode
FieldValueIRS element (for citing)
Gross Receipts191279453GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.northernhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1977YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionTo provide healthcare as we expect for our own family.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees1508TotalNbrEmployees
Total Nbr Volunteers281TotalNbrVolunteers
Total Gross UBI399769TotalGrossUBI
Net Unrelated Business Txbl Income24615NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1177098ContributionsGrantsPriorYear
Contributions Grants Current Year4058815ContributionsGrantsCurrentYear
Program Service Revenue Prior Year184828665ProgramServiceRevenuePriorYear
Program Service Revenue CY179137908ProgramServiceRevenueCY
Investment Income Prior Year567108InvestmentIncomePriorYear
Investment Income Current Year759413InvestmentIncomeCurrentYear
Other Revenue Prior Year2048205OtherRevenuePriorYear
Other Revenue Current Year2383786OtherRevenueCurrentYear
Total Revenue Prior Year188621076TotalRevenuePriorYear
Total Revenue Current Year186339922TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year597563GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY692174GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year85130467SalariesEtcPriorYear
Salaries Etc Current Year81376953SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year90636192OtherExpensePriorYear
Other Expenses Current Year97284195OtherExpensesCurrentYear
Total Expenses Prior Year176364222TotalExpensesPriorYear
Total Expenses Current Year179353322TotalExpensesCurrentYear
Revenues Less Expenses Prior Year12256854RevenuesLessExpensesPriorYear
Revenues Less Expenses CY6986600RevenuesLessExpensesCY
Total Assets BOY126226022TotalAssetsBOY
Total Assets EOY110661858TotalAssetsEOY
Total Liabilities BOY50720436TotalLiabilitiesBOY
Total Liabilities EOY49605850TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY75505586NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY61056008NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionEstablish, maintain and operate hospital to care for the sick, injured and disabled. Prevention of illness, injury and disability and maintenance of health. More specifically, Northern Michigan Regional Hospital and its 1,508 employees are dedicated to providing quality healthcare services to the people of northern Michigan.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense21562800Expense
Revenue37627866Revenue
DescriptionThe treatment and diagnosis of cardiac disease. Discharges 1,862Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense9426351Expense
Revenue16542976Revenue
DescriptionThe treatment and diagnosis of orthopaedic care. Discharges 932Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense6253061Expense
Revenue12854756Revenue
DescriptionThe treatment and diagnosis of oncology care. Discharges 541Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense99641450Expense
Grants692174Grants
Revenue112112310Revenue
FieldValueIRS element (for citing)
Total Of Other Program Service Exp99641450TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt692174TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev112112310TotalOfOtherProgramServiceRev
Total Program Service Expense136883662TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org1TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096216NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1508NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Stephen J ScannellBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2314874094TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1416 Connable AvenueAddressLine1
CityPetoskeyCity
StateMIState
ZIP Code49770ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Catherine DeVet
Trustee & President/CEO22.00XX431554054591
David Buzzelli
Chairperson2.50X000
Thomas Irwin
Vice Chairperson2.50X000
Robert Foster
Treasurer2.00X000
Thomas Moran
Secretary2.00X000
Ann Stallkamp
Trustee2.00X000
Joseph Hance MD
Trustee1.30X000
Elise Hayes
Trustee1.30X000
John Kohler
Trustee2.00X000
Stephen Eibling
Trustee2.00X000
David Rynbrandt MD
Trustee1.30X000
Irene Kazmers MD Chief of Staff
Trustee1.30X000
Stephen Scannell
VP of Finance/CFO22.00X44335027953
Eugene Kaminski
VP of Human Resources22.00X213264034721
Robert Dean Jr
VP Chief Medical Officer22.00X147135027291
Mary-Anne Ponti
COO22.00X251161029375
Caroline Seagren
Chief Dev Off/Exec Dir Fou22.00X1445754819233917
Timothy Jodway
VP of Finance/CFO22.00X204424012402
Andrew Smith
VP Chief Medical Officer22.00X10188203428
Mark Gray
Chief Info Officer40.00188192018652X
Guy Golembiewski
Physician40.0020622609052X
Daniel Dryden
Medical Physicist40.00146884025489X
Kevin Pendleton
Director of Pharmacy40.00156146012029X
Barbara Berry
Sr Director Planning & Mar40.0015382707129X
Linda Schofield
Research Coordinator40.00138658010764X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2528263TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs48192TotalReportableCompFrmRltdOrgs
Total Other Compensation306793TotalOtherCompensation
Number Individuals GT100 K39NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Northern Anesthesia Providers
602 JacksonPetoskeyMI49770Physician Services1457582
Mayo Collaborative Services
PO Box 9146MinnepolisMN554809146Laboratory Services782205
Nuyen Tomtishen and Aoun PC
2001 Commonwealth Blvd Suite 300Ann ArborMI48105Legal Services567661
Caretech Solutions Inc
PO Box 674271DetroitMI482674271Information Technology Services384524
Northern Pathology Associates
416 Connable AvenuePetoskeyMI49770Physician Services340160
FieldValueIRS element (for citing)
Number Of Contractors GT100 K18NumberOfContractorsGT100K
Related Organizations4058815RelatedOrganizations
Total Contributions4058815TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net IP, OP and Prof Sv622110176998605176998605
Revenue From Affil62211013670121367012
Other Ancillary Svcs622110520951520951
Miscellaneous622110130295130295
Other Community Svc622110121045121045
FieldValueIRS element (for citing)
Total Program Service Revenue179137908TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column819728TotalRevenueColumn
Exclusion$819,728ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real401888Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real401888Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column401888TotalRevenueColumn
Exclusion$401,888ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4879216Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4904184Securities
Other35347Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-24968Securities
Other-35347Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-60315TotalRevenueColumn
Exclusion-$60,315ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
Cafeteria Sales900099873002$873,002
Pharm Research900099541538$541,538
Gift Shop453220269633269633

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column297725TotalRevenueColumn
Unrelated Business Revenue130136UnrelatedBusinessRevenue
Exclusion$167,589ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1981898TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column186339922TotalRevenueColumn
Related Or Exempt Function Income179137908RelatedOrExemptFunctionIncome
Unrelated Business Revenue399769UnrelatedBusinessRevenue
Exclusion$2,743,430ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total692174Total
Program Services692174ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1962284Total
Management And General1962284ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total64244460Total
Program Services50990871ProgramServices
Management And General13253589ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total10755227Total
Program Services8283422ProgramServices
Management And General2471805ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4414982Total
Program Services3400315ProgramServices
Management And General1014667ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total681178Total
Management And General681178ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total102473Total
Management And General102473ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total11880342Total
Program Services5743094ProgramServices
Management And General6137248ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total722868Total
Program Services41811ProgramServices
Management And General681057ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total46841433Total
Program Services42179150ProgramServices
Management And General4662283ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5327253Total
Program Services2938982ProgramServices
Management And General2388271ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4222599Total
Program Services1918652ProgramServices
Management And General2303947ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total250815Total
Program Services111901ProgramServices
Management And General138914ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total495287Total
Program Services348152ProgramServices
Management And General147135ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1519782Total
Program Services838446ProgramServices
Management And General681336ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7291717Total
Program Services3154414ProgramServices
Management And General4137303ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2297363Total
Program Services2219891ProgramServices
Management And General77472ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
Income Tax99019901
Bad Debt Expense1118742378224410405179
Medicaid QAAP Tax35236663523666
Dues52981149612833683
Miscellaneous27631725200724310

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total123967Total
Program Services35549ProgramServices
Management And General88418ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total179353322Total
Program Services136883662ProgramServices
Management And General42469660ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1640BOY
EOY1923EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY39465191BOY
EOY26163975EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY14401437BOY
EOY9218394EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY7017232BOY
EOY7464818EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2816704BOY
EOY2829776EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis167479235LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec115468842LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY47593499BOY
EOY52010393EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY661428BOY
EOY665343EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY14159579BOY
EOY12197924EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY109312BOY
EOY109312EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY126226022BOY
EOY110661858EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY14792257BOY
EOY15792301EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY48000BOY
EOY27204EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY35799660BOY
EOY33786345EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY80519BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY50720436BOY
EOY49605850EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY75505586BOY
EOY61056008EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY75505586BOY
EOY61056008EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY126226022BOY
EOY110661858EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses6986600ReconcilationRevenueExpenses
Reconcilation Other Changes-21436178ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis496200OtherCostOrOtherBasis
Book Value496200BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis91386752OtherCostOrOtherBasis
Depreciation58053047Depreciation
Book Value33333705BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis75596283OtherCostOrOtherBasis
Depreciation57415795Depreciation
Book Value18180488BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings52010393TotalOfBookValueLandBuildings

Other Securities OtherSecurities (4 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Osborn Property32319C
Investment - Caymich Insurance Co., Ltd.7260C
Investment - Petoskey Assurance Ltd.120000C
Investment - Board Designated Funds12038345C
FieldValueIRS element (for citing)
Total Of Book Value Securities12197924TotalOfBookValueSecurities

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCentral America and the CaribbeanRegion
Type Of Activities ConductedProgram ServicesTypeOfActivitiesConducted
Specific Services ProvidedTransfer funds to wholly owned subsidiary for insurance servicesSpecificServicesProvided
Total Expenditures1226131TotalExpenditures
FieldValueIRS element (for citing)
Subtotal Number Of Employees0SubtotalNumberOfEmployees
Cont Number Of Employees0ContNumberOfEmployees
Total Number Of Employees0TotalNumberOfEmployees
Subtotal Amount Spent1226131SubtotalAmountSpent
Cont Amount Spent0ContAmountSpent
Total Amount Spent1226131TotalAmountSpent
Transfer To Foreign Corp1TransferToForeignCorp
Interest In Foreign Trust0InterestInForeignTrust
Own Foreign Corp1OwnForeignCorp
Passive Foreign Invest Co0PassiveForeignInvestCo
Foreign Partnership0ForeignPartnership
Boycott Countries0BoycottCountries

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2862322TotalCommunityBenefitExpense
Net Community Benefit Expense2862322NetCommunityBenefitExpense
Percent Of Total Expense0.01600PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense12550522TotalCommunityBenefitExpense
Direct Offsetting Revenue10611444DirectOffsettingRevenue
Net Community Benefit Expense1939078NetCommunityBenefitExpense
Percent Of Total Expense0.01080PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense1343875TotalCommunityBenefitExpense
Net Community Benefit Expense1343875NetCommunityBenefitExpense
Percent Of Total Expense0.00750PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense16756719TotalCommunityBenefitExpense
Direct Offsetting Revenue10611444DirectOffsettingRevenue
Net Community Benefit Expense6145275NetCommunityBenefitExpense
Percent Of Total Expense0.03430PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs367NumberOfActivitiesOrPrograms
Persons Served20117PersonsServed
Total Community Benefit Expense880235TotalCommunityBenefitExpense
Net Community Benefit Expense880235NetCommunityBenefitExpense
Percent Of Total Expense0.00490PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served4PersonsServed
Total Community Benefit Expense400654TotalCommunityBenefitExpense
Net Community Benefit Expense400654NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense20813960TotalCommunityBenefitExpense
Direct Offsetting Revenue16645677DirectOffsettingRevenue
Net Community Benefit Expense4168283NetCommunityBenefitExpense
Percent Of Total Expense0.02320PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense318001TotalCommunityBenefitExpense
Net Community Benefit Expense318001NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs304NumberOfActivitiesOrPrograms
Persons Served1743PersonsServed
Total Community Benefit Expense76884TotalCommunityBenefitExpense
Net Community Benefit Expense76884NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs674NumberOfActivitiesOrPrograms
Persons Served21864PersonsServed
Total Community Benefit Expense22489734TotalCommunityBenefitExpense
Direct Offsetting Revenue16645677DirectOffsettingRevenue
Net Community Benefit Expense5844057NetCommunityBenefitExpense
Percent Of Total Expense0.03250PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs674NumberOfActivitiesOrPrograms
Persons Served21864PersonsServed
Total Community Benefit Expense39246453TotalCommunityBenefitExpense
Direct Offsetting Revenue27257121DirectOffsettingRevenue
Net Community Benefit Expense11989332NetCommunityBenefitExpense
Percent Of Total Expense0.06680PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served1355PersonsServed
Total Community Building Expense17797TotalCommunityBuildingExpense
Net Community Building Expense17797NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served154PersonsServed
Total Community Building Expense373TotalCommunityBuildingExpense
Net Community Building Expense373NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense946TotalCommunityBuildingExpense
Net Community Building Expense946NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served696PersonsServed
Total Community Building Expense13916TotalCommunityBuildingExpense
Net Community Building Expense13916NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served58PersonsServed
Total Community Building Expense5841TotalCommunityBuildingExpense
Net Community Building Expense5841NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs12NumberOfActivitiesOrPrograms
Persons Served100PersonsServed
Total Community Building Expense3432TotalCommunityBuildingExpense
Net Community Building Expense3432NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs30NumberOfActivitiesOrPrograms
Persons Served2363PersonsServed
Total Community Building Expense42305TotalCommunityBuildingExpense
Net Community Building Expense42305NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$7,991,225BadDebtExpenseAmount
Amount Reimbursed By Medicare36613629AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare44335989CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-7722360MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Northern Michigan HospitalsBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1416 Connable AvenueAddressLine1
CityPetoskeyCity
StateMIState
ZIP Code49770ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Research FacilityXResearchFacility
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Northern Michigan HospitalsBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent200.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Used Other MethodXUsedOtherMethod
Amounts Generally Billed1AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationReturn ReferenceReturnReference
Part I, Line 7: We utilize a step down costing methodology. First direct expenses are reduced by any non patient revenues received. Then indirect departments (those without patient charges) are allocated to direct departments using department specific statistics. The step down process includes nine iterations. When the costing process is complete, costs are assigned to each unique patient. This allows us to determine the actual cost of providing services to each unique patient.
Part II: Community building activities support identified community needs and community collaboratives such as poverty reduction, transportation, workforce development and community health, by providing in-kind services, financial resources and staff expertise from the hospital.
Part III, Line 4: 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. To determine the cost of bad debt, we isolated all patient accounts written off during the reporting year. We then offset the cost of providing those services by any payment received for those services, thus reporting the true net cost to the system. The same methodology was used for determining the cost of charity care.
Part III, Line 8: To determine the cost of Medicare shortfalls, we isolated all patient accounts where Medicare was the primary payers, and offset the cost of services provided by any payment received, from either the patient, primary, secondary or tertiary payors. We then rolled those accounts up by sub service line for both in- and out-patient accounts, and reported the net shortfall of services provided at a loss. One hundred percent of that shortfall should be treated as community benefit.
Part III, Line 9b: The organization's written debt collection policy does not contain provisions on the collection practices to be followed for patients who are known to qualify for charity care because if possible we try to identify and determine eligibility for charity care before services are provided. Also, it is stated in our Charity Care policy that once eligible, no collection agencies or other collection processes will be followed unless the patient's financial circumstances materially change.
C. The hospital facility uses the Medicare rates for services when requested by the patient.D. The hospital facility uses 20% on uninsured claims for 2010.Part V, Section B, Question 19
If the patient did not respond to charity care applications or to statements received they did not know of discounts and would have been charged more than the amounts generally billed to individuals who had insurance. The hospital facility has now implemented that discounts for self pay be printed on statements and are implementing presumptive charity care.Part V, Section B, Question 20
Yes, for patients that did not respond to charity care applications or statements received.Part V, Section B, Question 21
Part VI, Line 2: Northern Michigan Regional Hospital assesses the needs and assets of the community by collaborating with community and strategic partners, reviewing demographics, health indicators, morbidity and mortality data, analyzing cost drivers, and conducting focus groups, surveys, and community forums.
Part VI, Line 3: As patients are registered either in person or over the phone they are given contact information for Patient Financial Services representatives if they have no insurance, are under insured or have high co-pay's. There are Patient Financial Services brochures displayed at all registration areas that describe the various financial assistance programs available. Through our Care Coordination program all patients with no insurance are seen to assist with financial assistance programs.
Part VI, Line 4: Northern Michigan Regional Hospital is a 214-bed regional referral center serving a 22-county region spanning northern Michigan and the eastern part of the Upper Peninsula. With a total market population of over 440,000, US Census Bureau data (2006) estimates that nearly 30% are age 45-64, and nearly 20% are over age 65. According to the Michigan Department of Community Health, top adult health concerns include: overweight and obese, high cholesterol, high blood pressure, smoking, diabetes and uninsured. Predicated on a vision to provide patient-centered care, extensive efforts in targeting regional health concerns has led to collaborative programs and services in primary care, heart, cancer and diagnostics. This approach to high quality, cost effective healthcare delivery in this rural and remote area has been strengthened by a long standing practice of specialty physicians hosting on-site clinic visits to outlying communities. Northern Michigan Regional Hospital is working to infuence behavior through education, prevention through screening,and provide accessible treatment through physician clinics and health centers throughout the region.
Part VI, Line 6: The hospital has an established regional Community Advisory Board which meets to actively address healthcare issues in the region. The hospital provides community benefit activities including community health improvement and health education programs and services to improve access to healthcare, promote health and wellness, and manage chronic disease.
Part VI, Line 7: Affiliates of the Northern Michigan Regional Health System include the following organizations, each of which contribute to health promotion in the manner indicated:Northern Michigan Regional Health System Foundation - raises, manages, and dispenses funds to support the mission of Northern Michigan Regional Health System and provide programs that enhance the well-being of the community.Community Free Clinic - provides medical treatment to the area's uninsured.Boulder Park Terrace - provides skilled nursing and sub-acute rehabilitation services.VitalCare - provides home health services, home medical equipment and supplies, hospice services, private duty services, and adult day services.Physician Practices - offer the opportunity for seamless patient care within the region through a system of wholly-owned specialty medicine practices: Michigan Heart & Vascular Specialists, Northern Michigan Infectious Diseases, Northern Michigan Hematology/Oncology, Rogers City Medical Group (primary care), and Northern Michigan Regional Hospital Neurosurgery Services.Prescriptions Services Pharmacy - offers retail pharmacy services.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Petoskey Regional Chamber of Commerce
401 East MitchellPetoskeyMI49770380924480501 (c) 68001Various Sponsorships
Northern Michigan Regional Hospital Foundation
360 Connable AvenuePetoskeyMI49770382445611501 (c) 3152166Home Office Expense/Rent
Petoskey Community Free Clinic
416 Connable AvenuepetoskeyMI49770203675817501 (c) 3408364Home Office Expense/General Operations
ALcona Health Center
PO Box 655AlpenaMI49707382170985501 (c) 3112944General Operations Health Clinic
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations1TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Grants made to related organizations are monitored through the monthly accounting processes. Grants made to the Regional Chamber of Commerce are event specific sponsorships. Grants made to Alcona Health Center, a FQHC, are based on a percent of their operating losses as presented on their financial statements.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Catherine DeVet
327587043669060298048976056150486145000
Eugene Kaminski
1622740316520193380228860118350247985000
Robert Dean Jr
12361402000003521098000174910174426000
Mary-Anne Ponti
200558033272017331022898064770280536000
Caroline Seagren
98620481922945501650001383301351865661719265475800
Timothy Jodway
111845040042052537038910851102168260165000
Mark Gray
16490202045202838068170118350206844000
Guy Golembiewski
204456000177007841012110215278000
Daniel Dryden
14654101610182060280194610172373000
Kevin Pendleton
138705016803063805601064280168175000
Barbara Berry
1347410165010258505500016290160956000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 4bReturnReference
ExplanationAll officers listed participated in a supplemental qualified 457(b) and a nonqualified 457(f) retirement plan. Catherine DeVet received a payment of $42,372 from the nonqualified 457(f) retirement plan in 2010.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Petoskey Hospital Finance AuthorityBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN382834360IssuerEIN
Date Issued2003-10-15DateIssued
Issue Price10000000IssuePrice
Description Of PurposeER/Heart Ctr addtnDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds10000000TotalProceeds
Issuance Costs From Proceeds110249IssuanceCostsFromProceeds
Capital Expenditures9889751CapitalExpenditures
Year Of Subst Completion2004YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section B, line 11Once the Form 990 has been prepared, it is reviewed by the Finance Manager, the CFO, and the CEO. The completed Form 990 is then provided to the Board of Directors before it is filed.
The Board of Trustees review and sign a conflict of interest statement annually. If any conflicts of interest arise during a board meeting, the trustee will leave the room or refrain from voting. Colleagues are reminded at their annual evaluation to abide by the Code of Conduct, which includes a statement on Conflict of Interest. All researchers sign a Conflict of Interest Statement prior to any research being initiated. These statements are reviewed by the Medical Research Committee and the Internal Review Board.Form 990, Part VI, Section B, line 12c
To determine executive compensation for the CEO, Vice Presidents, and Officers of the corporation, NMRHS uses an independent consultant to conduct salary surveys of the health care market. Recommendations are reviewed at the Board level and approved before implementation. This was last reviewed January-April of 2010.Form 990, Part VI, Section B, line 15
No documents are made available to the public.Form 990, Part VI, Section C, line 19
Reportable compensation from related organizations:Reportable compensation in Column E is from a related organization to which an average of 40 hours or more per week was devoted.Form 990, Part VII
Changes in Net Assets or Fund Balances:Net unrealized gains on investments: 1,581,355. Rounding -1. Equity Transfer-Northern Michigan Regional Health System -23,173,397. Equity Transfer-Northern Michigan Auxiliary 155,865. Total to Form 990, Part XI, Line 5: -21,436,178.Form 990, Part XI, line 5:
Review of financial statements and oversight of audit:The Finance Committee of the health system assumes responsibility for review of financial statements and oversight of the consolidated audit.Form 990, Part XII, line 2c.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
Living Room Adult Day Services
416 Connable AvenuePetoskeyMI49770204047415Adult Day CareMI501(c)39N/A0
Northern Michigan Medical Management
416 Connable AvenuePetoskeyMI49770208458840Physician PracticeMI501(c)33N/A0
Northern Michigan Hematology and Oncology
416 Connable AvenuePetoskeyMI49770320020293Physician PracticeMI501(c)33N/A0
The Cardiac Institute DBA Michigan Heart & Vascular Specialists
416 Connable AvenuePetoskeyMI49770262774689Physician PracticeMI501(c)33N/A0
Hospice of Little Traverse Bay
1 Hiland DrivePetoskeyMI49770382425019Hospice CareMI501(c)37N/A0
Petoskey Community Free Clinic
416 Connable AvenuePetoskeyMI49770203675817Health ServicesMI501(c)33N/A0
Northern Michigan Regional Hospital Auxiliary
416 Connable AvenuePetoskeyMI49770382835548FundraisingMI501(c)311N/A0
Northern Michigan Regional Health System
416 Connable AvenuePetoskeyMI49770382445613Health ServicesMI501(c)311N/A0
Charlevoix Nursing Home Corporation DBA Boulder Park Terrace
14676 West UprightCharlevoixMI49720383038683Skilled Nursing FacilityMI501(c)39N/A0
Healthshare Real Estate
416 Connable AvenuePetoskeyMI49770382492223Real Estate HoldingsMI501(c)2N/A0
Northern Michigan Regional Health System Foundation
360 Connable AvenuePetoskeyMI49770382445611FundraisingMI501(c)311N/A0
VitalCare Inc
761 Lafayette AvenueCheboyganMI49721382527255Hospice Care/Home Health ServicesMI501(c)39N/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountryPercentage OwnershipPercentageOwnership
VitalCare Home Medical Equipment Inc
761 Lafayette AvenueCheboyganMI49721382662954Retail for Home Medical EquipmentMIN/AC
Petoskey Assurance LTD
980628316Professional and General Liability CoverageN/AC68 West Bay Road PO Box 1109Grand CaymanCayman IslandsCJKY1-1102CJ1.00000
Rapin & Rapin Inc DBA Prescription Services Pharmacy
416 Connable AvenuePetoskeyMI49770383465261Retail PharmacyMIN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (16 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Northern Michigan Regional Health System Foundation
B152166Cost
Petoskey Community Free Clinic
B408364Cost
Northern Michigan Regional Health System Foundation
C4058815Cost
Northern Michigan Regional Health System
O82717209Cost
Northern Michigan Hematology and Oncology
O350004Cost
Northern Michigan Medical Management
O2531206Cost
Northern Michigan Hematology and Oncology
P1496109Cost
Northern Michigan Medical Management
P425774Cost
The Cardiac Institute
P794671Cost
Hospice of Little Traverse Bay
P245561Cost
Charlevoix Nursing Home Corporation
P168518Cost
Rapin & Rapin Inc
P79308Cost
Petoskey Community Free Clinic
P57868Cost
Northern Michigan Regional Health System
Q23173397Cost
Northern Michigan Regional Health System Foundation
P152166Cost
Northern Michigan Hospital Auxiliary
R155865Cost