COMMUNITY MEMORIAL HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEMORIAL HOSPITAL (EIN 38-1398825)
- Tax period
- 2009-04-01 to 2010-03-31
- Filed
- 2011-02-15
- IRS object ID
- 201110469349301501
- Schema version
- 2009v1.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule N
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-02-15T10:44:49-06:00 | Timestamp |
| Tax Period End Date | 2010-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 E FRONT 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 | 2009-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381398825 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 2316275601 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 748 SOUTH MAIN STREET | AddressLine1 |
| City | CHEBOYGAN | City |
| State | MI | State |
| ZIP Code | 49721 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY CAMPA | Name |
| Title | Vice President of Finance | Title |
| Phone | 2316275601 | Phone |
| Date Signed | 2011-02-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2319477800 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | 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 | Cheboygan Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Holly Campa | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 748 SOUTH MAIN STREET | AddressLine1 |
| City | CHEBOYGAN | City |
| State | MI | State |
| ZIP Code | 49721 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 53922160 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.CHEBOYGANHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1929 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | CHEBOYGAN MEMORIAL HOSPITAL IS A NON-PROFIT, COMMUNITY HEALTH CENTER PROVIDER DEDICATED TO PROVIDING PERSONALIZED, QUALITY HEALTHCARE SERVICES AND EDUCATION IN RESPONSE TO COMMUNITY NEED. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 509 | TotalNbrEmployees |
| Total Nbr Volunteers | 270 | TotalNbrVolunteers |
| Total Gross UBI | 133485 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 41377 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 218118 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 205156 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 51251714 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 50581379 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 26000 | InvestmentIncomePriorYear |
| Investment Income Current Year | 554431 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1442 | OtherRevenuePriorYear |
| Other Revenue Current Year | 71123 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 51497274 | TotalRevenuePriorYear |
| Total Revenue Current Year | 51412089 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 5000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 27853079 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 28347371 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 26127145 | OtherExpensePriorYear |
| Other Expenses Current Year | 26269940 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 53985224 | TotalExpensesPriorYear |
| Total Expenses Current Year | 54617311 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2487950 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3205222 | RevenuesLessExpensesCY |
| Total Assets BOY | 29856233 | TotalAssetsBOY |
| Total Assets EOY | 28115719 | TotalAssetsEOY |
| Total Liabilities BOY | 21699196 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22793064 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8157037 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5322655 | NetAssetsOrFundBalancesEOY |
| Mission Description | CHEBOYGAN MEMORIAL HOSPITAL IS A NON-PROFIT, COMMUNITY HEALTH CARE PROVIDER DEDICATED TO PROVIDING PERSONALIZED, QUALITY HEALTHCARE SERVICES AND EDUCATION IN RESPONSE TO COMMUNITY NEED. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Expense | 9288566 | Expense |
| Revenue | 9092502 | Revenue |
| Description | CLINICS (72,163 PROCEDURES) | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2539159 | Expense |
| Revenue | 5356892 | Revenue |
| Description | LABORATORY (476,404 PROCEDURES) | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3141504 | Expense |
| Revenue | 11257791 | Revenue |
| Description | DIAGNOSTIC IMAGING (38,332 PROCEDURES) | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 28273212 | Expense |
| Revenue | 24740709 | Revenue |
| Description | OTHER PROGRAM SERVICES:Cheboygan Memorial Hospital (38-1398825) is dedicated to providing quality medical healthcare services to our service area regardless of a patient's race, creed, sex, national origin, handicap, age, or ability to pay.Reimbursement for services rendered is crucial to the successful operation and financial well being of Cheboygan Memorial Hospital. We also recognize the fact that not all individuals possess the ability to purchase essential medical services. Our mission is to provide personalized, quality healthcare services and education in response to community need. Therefore, in keeping with our commitment to serve all members of the community, Cheboygan Memorial Hospital offers: charity care and/or subsidized care; care provided to persons covered by government programs at below cost; and health care activities and programs to support the community and encourage healthy lifestyle choices.These programs and services will be considered where the need and/or an individual's ability to pay co-exist. These activities include wellness programs, community education programs, and special programs for the elderly, and a variety of broad community support activities. Cheboygan Memorial Hospital provides services as an inpatient, out patient, clinical patient and extended care unit. We provided 1,984 inpatients with 5,923 days of care, and had 81,794 out patient visits along with 79,447 clinical encounters. Our extended care provided 17,570 days of care in fiscal year 2010.Our hospital provides care to people covered by governmental programs at less than what we must generate in order to maintain stability of operations. The reimbursement value of providing care to these patients is $60,709,848. In addition, for patients not covered by a governmental program and also unable to pay for services, we recognized $617,279. in charity care.According to our vision statement, Cheboygan Memorial Hospital strives to be the "indispensable provider of care for the whole person". Based on this vision and community needs and trends, CMH provides numerous free and low cost programs throughout the year. These programs and services are listed below. Classes Offered:*Diabetes Classes - Free group classes. Series of four, two-hour classes held every other month.*Cardiac Rehab Classes - Held every day*Better Breather Class and support group - Free group class held four times a month*Smoking Cessation Class - Free one-on-one counseling sessions by appointment*Breast Feeding Support Group - Provide space for free support group*Childbirth Education Classes - Low cost, series of classes, Held monthly*Community CPR/First Aid classes - Low cost, held several times a yearSchool and Community Programs:*Let's Get Moving Northern Michigan - Free motivational exercise program, walk 100 miles in 100 days. *Sport's Physicals - Yearly free sports physicals for middle school and high school student athletes*Health Talks upon request from schoolsClinical Experiences for student programs:*North Central Michigan College - RN program*Lake Superior State University - RN and LPN program*Ferris State University - Radiography program*Jackson Community College - Radiography program*Delta Community College - Ultrasound program*Concordia University - Physical Therapy program*Allied Health Program - High School Students health careers class Seminars:*Five Wishes - Free program to explain end of life wishes, Held several times throughout year*Heart to Heart talk - Free program held yearly, Focus on heart disease for women.*Men's Hunter Safety - Low cost program to provide information on emergencies and safe hunting*Becoming A Woman - Free program focusing on pre-teen to teen years for girls, held yearly*"Heart Disease Awareness" luncheon and Fashion Show, minimal costExpos/Health Fairs:*Diabetes Expo - Free, held yearly, diabetes health fair*Diabetes/Cholesterol Screening - Laboratory testing supplies at minimal cost*Women's Health Expo - Free, held yearly, health and beauty features*Senior Expo - Free, held yearly in collaboration with Catholic Human Services, Free flu shots to seniors, and health information*Rogers City Health Fair - Free, every other year, participator and provide resources and screenings*Kid's Quest - Go to elementary schools and provide stations dealing with hand hygiene, nutrition, exercise, exposure to health careers*Cheboygan County Fair - Ladies Day, yearly. Provide free bone density and blood sugar, blood pressure screenings*Free cervical cancer screenings - provide resources for free/low cost cervical cancer screenings, yearly in partnership and at the District Health Dept.*Spring Resource Fair - In collaboration with numerous agencies, provides numerous resource information available in county, held once a year, Free admissionResources:*Provide free use of computers and internet access for patients to look up health information in the Health Center *Free pamphlets and literature provided in patient education area of lobby *Articles in local newspaper - weekly articles written by hospital employees dealing with health issues*Log Mark Book Store - help host programs dealing with health and wellness issues*Cheboygan Arts Council - host annual student art show, FreeSpeakers:*Lectures and Health Talks for area agencies and groups done upon request utilizing Pharmacist, Nurses, Diabetic Educators, Respiratory Therapist, Dietitians and Cardiac Rehab specialist. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 28273212 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 24740709 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 43242441 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 1 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 64 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 509 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | 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 | 1 | 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 | DONNA WOIDERSKI | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2316271285 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 748 S MAIN STREET | AddressLine1 |
| City | CHEBOYGAN | City |
| State | MI | State |
| ZIP Code | 49721 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 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 |
|---|---|---|---|---|---|---|---|
| BARBARA CLIFF | |||||||
| PRESIDENT/CEO | 40.00 | X | X | 85787 | 0 | 4092 | |
| donald Watson | |||||||
| TRUSTEE | 40.00 | X | 274704 | 0 | 10112 | ||
| SUSAN ENO | |||||||
| CHAIRMAN | 5.00 | X | X | 0 | 0 | 0 | |
| JAMES MCCLURG | |||||||
| VICE CHAIR | 5.00 | X | X | 0 | 0 | 0 | |
| NANCY DEXTROM | |||||||
| SECRETARY | 5.00 | X | X | 0 | 0 | 0 | |
| WILLIAM BORGERDING DO | |||||||
| TRUSTEE | 5.00 | X | 121656 | 0 | 21475 | ||
| EUGENE COOLEY | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| CARL FRANZON | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| KATHLEEN LIEDER | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| KEN PLETCHER | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| JOHN WARD | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| BRIAN DIETZ | |||||||
| INTERIM CEO | 40.00 | X | 210000 | 0 | 0 | ||
| MIKE WEEKS | |||||||
| INTERIM CFO | 40.00 | X | 89000 | 0 | 0 | ||
| PAUL COURTNEY | |||||||
| INTERIM CFO | 40.00 | X | 43500 | 0 | 0 | ||
| FRED VITELLO | |||||||
| INTERIM CFO | 40.00 | X | 0 | 0 | 0 | ||
| HOLLY CAMPA | |||||||
| VP OF FINANCE | 40.00 | X | 110977 | 0 | 19598 | ||
| timothy Burandt | |||||||
| PHYSICIAN | 40.00 | 372397 | 0 | 25504 | X | ||
| craig duncan | |||||||
| phySICIAN | 40.00 | 370251 | 0 | 25333 | X | ||
| kenneTH PARADA | |||||||
| phySICIAN | 40.00 | 245868 | 0 | 24157 | X | ||
| lawrence sherman | |||||||
| PHYSICIAN | 40.00 | 245809 | 0 | 15439 | X | ||
| THOMAS FASBENDER | |||||||
| PHYSICIAN | 40.00 | 266918 | 0 | 25018 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2436867 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 170728 | TotalOtherCompensation |
| Number Individuals GT100 K | 31 | 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 |
|---|---|---|---|---|---|
| AGILITY HEALTH Professionals | |||||
| 560 Fifth Street NW Ste 404 | DETROIT | MI | 48279 | PHYSICAL THERAPY, Speech therapy, & occu | 983151 |
| ANESTHESIA STAFFING | |||||
| 30200 TELEGRAPH RD STE 220 | Bingham Farms | MI | 48025 | ANESTHESIA STAFFING, BILLING AND OVERSIG | 893002 |
| BE SMITH | |||||
| 9777 RIDGE DRIVE SUITE 300 | LENEXA | KS | 66219 | INTERIM STAFFING POSITIONS | 586578 |
| HOSPITALIST OF NORTHWEST MICHIGAN | |||||
| PO BOX 107 | TRAVERSE CITY | MI | 49685 | HOSPITALIST STAFFING | 566539 |
| STAFF CARE INC | |||||
| PO BOX 281923 | ATLANTA | GA | 30384 | VARIOUS PHYSICIANS LOCUM STAFFING | 445697 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Fundraising Events | 6549 | FundraisingEvents |
| Related Organizations | 15375 | RelatedOrganizations |
| Government Grants | 49089 | GovernmentGrants |
| All Other Contributions | 134143 | AllOtherContributions |
| Total Contributions | 205156 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PROGRAM SERVICES | 900099 | 50279819 | 50146334 | 133485 |
| OTHER RELATED REVENUE | 900099 | 301560 | 301560 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 50581379 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14304 | TotalRevenueColumn |
| Exclusion | $14,304 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 153251 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 80640 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 72611 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 72611 | TotalRevenueColumn |
| Exclusion | $72,611 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2960370 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2420243 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 540127 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 540127 | TotalRevenueColumn |
| Exclusion | $540,127 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 7700 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 6549 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 9188 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1488 | TotalRevenueColumn |
| Exclusion | -$1,488 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51412089 | TotalRevenueColumn |
| Related Or Exempt Function Income | 50447894 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 133485 | UnrelatedBusinessRevenue |
| Exclusion | $625,554 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1048342 | Total |
| Program Services | 492877 | ProgramServices |
| Management And General | 555465 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21292036 | Total |
| Program Services | 18512610 | ProgramServices |
| Management And General | 2779426 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6006993 | Total |
| Program Services | 4777286 | ProgramServices |
| Management And General | 1229707 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1213096 | Total |
| Program Services | 419947 | ProgramServices |
| Management And General | 793149 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 254897 | Total |
| Management And General | 254897 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109800 | Total |
| Management And General | 109800 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2399609 | Total |
| Program Services | 2398154 | ProgramServices |
| Management And General | 1455 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103378 | Total |
| Management And General | 103378 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79386 | Total |
| Program Services | 3929 | ProgramServices |
| Management And General | 75457 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83185 | Total |
| Program Services | 52810 | ProgramServices |
| Management And General | 30375 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 605859 | Total |
| Program Services | 480667 | ProgramServices |
| Management And General | 125192 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1777867 | Total |
| Program Services | 1396809 | ProgramServices |
| Management And General | 381058 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 642467 | Total |
| Program Services | 163663 | ProgramServices |
| Management And General | 478804 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 7057576 | 6775095 | 282481 |
| Contracted Labor | 3937150 | 3020982 | 916168 |
| Provision for Bad Debts | 3003497 | 3003497 | |
| RENTAL EXPENSES | 1518963 | 882426 | 636537 |
| QUALITY ASSURANCE TAXES | 1471849 | 225034 | 1246815 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2011361 | Total |
| Program Services | 636655 | ProgramServices |
| Management And General | 1374706 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54617311 | Total |
| Program Services | 43242441 | ProgramServices |
| Management And General | 11374870 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124683 | BOY |
| EOY | -61675 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1644105 | BOY |
| EOY | 707683 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98021 | BOY |
| EOY | 66463 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5994657 | BOY |
| EOY | 9763256 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 609614 | BOY |
| EOY | 565049 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 443819 | BOY |
| EOY | 329142 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 35295595 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 19602397 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16977152 | BOY |
| EOY | 15693198 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 278093 | BOY |
| EOY | 25275 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2667942 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1018147 | BOY |
| EOY | 1027328 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29856233 | BOY |
| EOY | 28115719 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6253720 | BOY |
| EOY | 7622926 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35675 | BOY |
| EOY | 15675 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4190645 | BOY |
| EOY | 4064893 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9614689 | BOY |
| EOY | 9350004 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1604467 | BOY |
| EOY | 1739566 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21699196 | BOY |
| EOY | 22793064 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7999772 | BOY |
| EOY | 5214197 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 157265 | BOY |
| EOY | 108458 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8157037 | BOY |
| EOY | 5322655 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29856233 | BOY |
| EOY | 28115719 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $3,198 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3198 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | Supported lobbying activities through annual dues paid to Michigan Health & Hospital Association. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1107212 | OtherCostOrOtherBasis |
| Book Value | 1107212 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22114264 | OtherCostOrOtherBasis |
| Depreciation | 10787279 | Depreciation |
| Book Value | 11326985 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 171793 | OtherCostOrOtherBasis |
| Depreciation | 123859 | Depreciation |
| Book Value | 47934 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11841483 | OtherCostOrOtherBasis |
| Depreciation | 8691259 | Depreciation |
| Book Value | 3150224 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 60843 | OtherCostOrOtherBasis |
| Book Value | 60843 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 15693198 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| COST REPORT SETTLEMENTS PAYABLE | $206,000 |
| ACCOUNTS RECEIVABLE OVERPAYMENTS | $504,326 |
| ACCRUED PENSION LIABILITY | $1,029,240 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1739566 | TotalOfAmounts |
| Total Revenue | 51412089 | TotalRevenue |
| Total Expenses | 54617311 | TotalExpenses |
| Excess Or Deficit For Year | -3205222 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -2247 | NetUnrealizedGLOnInvestments |
| Other | $373,087 | OtherAmount |
| Total Adjustments | 370840 | TotalAdjustments |
| Excess Or Deficit Per FS | -2834382 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 51865816 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 453727 | OtherRevenues |
| Revenue Not Rptd F990 | 453727 | RevenueNotRptdF990 |
| Revenue Subtotal | 51412089 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 51412089 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 54700198 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 82887 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 82887 | ExpensesNotRptdF990 |
| Expenses Subtotal | 54617311 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 54617311 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | Pension adjustment: 250786. INCOME FROM NONPROFIT EQUITY INVESTMENT: 122301. |
| Part XII, Line 2d - Other Adjustments: | INCOME FROM NONPROFIT EQUITY INVESTMENT INCLUDED IN SCHEDULE D, PART XI: 122301. pension adjustment INCLUDED IN SCHEDULE D, PART XI: 250786. RENTAL EXPENSES INCLUDED IN PART VIII: 80640. |
| Part XIII, Line 2d - Other Adjustments: | NET UNREALIZED GAINS AND LOSSES INCLUDED IN SCHEDULE D, PART XI: 2247. RENTAL EXPENSES INCLUDED IN PART VIII: 80640. |
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 |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 530278 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 530278 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01030 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10914234 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9410380 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1503854 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02910 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11444512 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9410380 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2034132 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03940 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 88823 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 88823 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7350 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7350 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 13500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 109673 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 109673 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11554185 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9410380 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2143805 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04150 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 70 | PersonsServed |
| Total Community Building Expense | 600 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 600 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 25 | PersonsServed |
| Total Community Building Expense | 1000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 20 | PersonsServed |
| Total Community Building Expense | 1000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 115 | PersonsServed |
| Total Community Building Expense | 4600 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4600 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,388,517 | BadDebtExpenseAmount |
| Amount Attributable To | 164250 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12285454 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11746962 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 538492 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|
| COMMUNITY MEMORIAL HOSPITAL | |||||||
| 748 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | X | X | X | |
| CHEBOYGAN MEMORIAL HEALTH CENTER | |||||||
| 740 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | FAMILY & INTERNAL MEDICINE PRACTICES | |||
| CHEBOYGAN SURGICAL ASSOCIATES | |||||||
| 810 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | SURGICAL PRACTICE | |||
| INDIAN RIVER MEDICAL CENTER | |||||||
| 6135 CRESSY STREET | INDIAN RIVER | MI | 49749 | FAMILY PRACTICE | |||
| WOMEN'S & CHILDREN'S CLINIC | |||||||
| 722 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | OB-GYN & PEDIATRIC PRACTICE | |||
| ONCOLOGY CLINIC | |||||||
| 740 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | ONCOLOGY CLINIC | |||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C IS NOT INCLUDED IN THE CALCULATION ON SCHEDULE H, PART I, LINE 7, COLUMN F. TOTAL BAD DEBT EXPENSE EXCLUDED FROM THIS CALCULATION EQUALS $3,003,497. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.BAD DEBT AT COST, $1,388,517, IS CALCULATED BASED ON A COST TO CHARGE RATIO.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, $164,250, IS EQUAL TO 1/4 OF BAD DEBT EXPENSE AT COST MULTIPLIED BY THE COST TO CHARGE RATIO FROM WORKSHEET 2. THIS IS AN ESTIMATE BASED ON ADMINISTRATIONS KNOWLEDGE OF THE CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DO NOT SHOW A SHORTFALL. THIS IS DUE TO THE INCREASED REIMBURSEMENT FROM THE RURAL HEALTH CLINICS. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: CHEBOYGAN MEMORIAL HOSPITAL WILL PROVIDE SERVICE(S) FREE OF CHARGE TO ANY PATIENT WHO HAS FAMILY INCOME ON THE DATE-OF-SERVICE WHICH IS AT OR BELOW THE FEDERAL POVERTY INCOME GUIDELINES. IF THE PATIENT'S GUARANTOR IS UNABLE TO MAKE FULL PAYMENT, ASSISTANCE MAY BE PROVIDED UNDER CHEBOYGAN MEMORIAL HOSPITAL'S CHARITY CARE PROGRAM.IF A PATIENT PRESENTS WITH NO INSURANCE COVERAGE OR REQUESTS TO APPLY FOR CHARITY CARE THEY WILL BE GIVEN A CHARITY CARE APPLICATION. THE APPLICATION IS REVIEWED BY A FINANCIAL COUNSELOR WHO DETERMINES IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE. THE APPLICATION IS APPROVED BY THE APPROPRIATE HOSPITAL PERSONNEL, AND THE PATIENT ACCOUNT IS ADJUSTED ACCORDINGLY. FREE CARE - OUR CHARITY PROGRAM INCORPORATES MICHIGAN'S FREE CARE REQUIREMENTS. HOSPITAL SERVICES FOR MEDICALLY NECESSARY SERVICES ARE AVAILABLE AT NO CHARGE TO THOSE FAMILIES WHOSE INCOME IS AT OR BELOW THE FEDERAL INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY AND PUBLISHED EACH SPRING IN THE FEDERAL REGISTER. THESE GUIDELINES ESTABLISH A THRESHOLD OF INCOME WHICH GROWS AS THE FAMILY SIZE OF THE APPLICANT DOES. APPLYING FOR ASSISTANCE - A RELATIVELY SIMPLE APPLICATION HAS BEEN DESIGNED TO HELP DETERMINE ELIGIBILITY FOR BASIC PROGRAMS. A PATIENT ACCOUNT REPRESENTATIVE SHALL ASSIST EACH APPLICANT WITH NECESSARY PAPERWORK. A DECISION REGARDING ELIGIBILITY WILL NORMALLY BE MADE WITHIN FIVE BUSINESS DAYS OF THE APPLICATION.IF A PATIENT WHO QUALIFIES FOR FINANCIAL ASSISTANCE DOES NOT PAY THE PATIENT PORTION OF A CHARGE, THE HOSPITAL WILL ATTEMPT TO COLLECT. THESE PATIENTS ARE TREATED THE SAME AS ALL OTHER PATIENTS, AND ARE SENT TO COLLECTIONS IF NO PAYMENT IS RECEIVED. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: CHEBOYGAN MEMORIAL HOSPITAL CONDUCTS PERIODIC PATIENT SURVEYS AND COMMUNITY NEED ASSESSMENTS. OUR COMMUNITY OUTREACH DEPARTMENT WORKS WITH SEVERAL LOCAL AND STATE AGENCIES TO ADDRESS THE HEALTH ISSUES OF THE REGION. WE INVITE PEOPLE TO SEND COMMENTS AND CONCERNS REGARDING OUR SERVICES THROUGH MESSAGES ON OUR WEBSITE AND BROCHURES. ALSO, OUR BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS WHICH HELPS INFLUENCE DECISIONS REGARDING THE MISSION OF THE ORGANIZATION. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: DURING REGISTRATION, AN INFORMATIONAL PAMPHLET IS PROVIDED TO PATIENTS WHO DO NOT HAVE INSURANCE OR COMMUNICATE THEIR INABILITY TO PAY FOR THE SERVICES TO BE PROVIDED. THE PAMPHLET OUTLINES A VARIETY OF SOURCES OF ASSISTANCE, INCLUDING THE HOSPITAL'S CHARITY CARE POLICY. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: POPULATION OVERVIEW:THE PRIMARY SERVICE AREA FOR CHEBOYGAN MEMORIAL HOSPITAL (CMH) IS CHEBOYGAN COUNTY, WHICH HAS A PERMANENT POPULATION OF CLOSE TO 29,000. CMH ALSO SERVES MOST OF PRESQUE ISLE COUNTY, THE NORTHERN HALF OF EMMET COUNTY AND THE STRAITS AREA WHICH WOULD INCLUDE AN ADDITIONAL POPULATION OF APPROXIMATELY 22,000. THE POPULATION OF CHEBOYGAN COUNTY HAS INCREASED SLIGHTLY OVER THE LAST DECADE. IN SPITE OF THE LOSS OF MANY MANUFACTURING JOBS, THIS AREA HAS BECOME A POPULAR RELOCATION DESTINATION FOR RETIREES. THIS TREND HAS LED TO AN AGING OF THE POPULATION. DEMOGRAPHICS:IN 2005, 18.5% OF THE POPULATION OF CHEBOYGAN COUNTY WAS OVER 65 YEARS OLD, COMPARED TO 12.5% STATEWIDE AND 12.4% NATIONALLY. THIS SEGMENT OF THE POPULATION IS EXPECTED TO GROW AS LONG-TIME RESIDENTS AGE AND MORE RETIREES MOVE INTO THE AREA. SEASONAL POPULATION:CHEBOYGAN COUNTY IS KNOWN AS A PRIME DESTINATION FOR OUTDOOR RECREATIONAL ACTIVITIES SUCH AS BOATING, FISHING, SNOWMOBILING AND HUNTING. TOURISM HAS A BIG IMPACT ON THE AREA'S INFRASTRUCTURE AND SERVICES - FROM MORE SEASONAL TRAFFIC ON THE ROADS TO THE INCREASED NEED FOR HEALTH CARE SERVICES. MORE THAN A MILLION TOURISTS PASS THROUGH THE AREA EACH SUMMER TO VISIT HISTORIC MACKINAC ISLAND. THE AREA ALSO SWELLS FROM SEASONAL RESIDENTS WHO SPEND TIME AT THEIR WATERFRONT COTTAGES OR SECOND HOMES. THE POPULATION OF MANY AREA COMMUNITIES MORE THAN DOUBLES IN THE SUMMER MONTHS. INCOME AND EMPLOYMENT OVERVIEW:FOR SEVERAL DECADES, NORTHEAST MICHIGAN HAS BEEN BELEAGUERED WITH LOW-PAYING, SEASONAL JOBS - MANY OF WHICH OFFER NO HEALTH BENEFITS. THE UNEMPLOYMENT FOR THIS AREA HAS ALWAYS BEEN WELL ABOVE THE STATE AND NATIONAL AVERAGES, ESPECIALLY DURING THIS TIME OF RECESSION. CHEBOYGAN COUNTY'S CURRENT UNEMPLOYMENT RATE FOR 2009 HAS HOVERED NEAR 20%. DURING THE WINTER MONTHS IT IS EXPECTED TO RISE TO ABOUT 30%. THE SERVICE SECTOR PROVIDES THE LARGEST AMOUNT OF EMPLOYMENT WITH 28.3%, THANKS MAINLY TO THE TOURISM INDUSTRY. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: CHEBOYGAN MEMORIAL HOSPITAL IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES. OUR CONTRIBUTIONS IN THIS CATEGORY INCLUDE OUR PARTICIPATION IN LOCAL CHAMBERS OF COMMERCE (CHEBOYGAN, INDIAN RIVER, MACKINAW CITY AND ONAWAY), HABITAT FOR HUMANITY, CHEBOYGAN COUNTY RECYCLING EFFORTS, COOPERATION WITH THE ALLIED HEALTH PROGRAM AT CHEBOYGAN HIGH SCHOOL, INVOLVEMENT WITH THE AMERICAN RED CROSS AND SUPPORT OF THE CHEBOYGAN SALVATION ARMY. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: COMMUNITY HEALTH STATUS:RECENT INFORMATION FROM 2007, ACCORDING TO THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, SHOWS THAT CHEBOYGAN COUNTY HAS A HIGHER RATE THAN THE STATE AVERAGE OF THE FOLLOWING:DIABETES, OVARIAN CANCER, LUNG CANCER, AND HEART DISEASE. DEATHS DUE TO ALZHEIMER'S, LOWER RESPIRATORY, DIABETES, PNEUMONIA/INFLUENZA ARE SLIGHTLY HIGHER THAN STATE AND NATIONAL BENCHMARKS. MUCH OF THIS CAN BE ATTRIBUTED TO A SEDENTARY LIFESTYLE AMONG MANY YEAR-ROUND RESIDENTS, AS WELL AS THE AGING OF THE POPULATION.PREVENTATIVE HEALTH AND BEHAVIOR RISK FACTORS THAT HAVE BEEN IDENTIFIED INCLUDE:* AN INCREASING AMOUNT OF YOUNG SMOKERS.* THOSE WHO HAVE NO LEISURE-TIME PHYSICAL ACTIVITY WITH MANY MORE RESIDENTS BEING CLASSIFIED AS OBESE AT ALL AGE LEVELS.* THE AMOUNT OF PEOPLE THAT HAVE BEEN LABELED BINGE-DRINKERS, ESPECIALLY TEENAGERS.* LOW-BIRTH WEIGHT BABIES AND PRE-TERM BIRTHS ARE CLOSE TO THE STATE PERCENTAGES. UNMARRIED AND THOSE MOTHERS UNDER 20 YEARS OLD ARE SLIGHTLY HIGHER THAN STATE NORMS. CMH'S RESPONSE TO COMMUNITY HEALTH STATUS:CHEBOYGAN MEMORIAL HOSPITAL IS DEDICATED TO PROVIDING PERSONALIZED, QUALITY HEALTHCARE SERVICES AND EDUCATION IN RESPONSE TO COMMUNITY NEED. CMH HAS A VISION OF BEING THE INDISPENSABLE PROVIDER OF CARE FOR THE WHOLE PERSON WITH VALUES BASED ON CARING, COMPETENCE, INTEGRITY AND RESPECT.ONE OF THE CHIEF GOALS OF THE STRATEGIC PLAN AT CMH IS TO SHIFT THE HOSPITAL FROM A TRADITIONAL SICKNESS MODEL TO A WELLNESS MODEL. THROUGH INTERNAL AND EXTERNAL EFFORTS, CMH HAS IMPLEMENTED A PROCESS AND FORMED PARTNERSHIPS TO MAKE THAT VISION A REALITY. IN 2008, CMH OPENED A CARDIAC WELLNESS CENTER THAT INCLUDES STATE-OF-THE ART EXERCISE EQUIPMENT, PRIVATE AREAS FOR COUNSELING AND A FULLY-EQUIPPED TEACHING KITCHEN TO HELP PROMOTE HEALTHY COOKING. THIS NEW ADDITION ADDRESSES A COUPLE OF THE MAJOR HEALTH RISK FACTORS IN OUR REGION, HEART DISEASE AND DIABETES.OUR COMMUNITY OUTREACH DEPARTMENT PROVIDES SEVERAL ON-GOING EDUCATIONAL OPPORTUNITIES FOR THOSE RESIDENTS IDENTIFIED WITH CHRONIC AILMENTS. FOR EXAMPLE, CMH PROVIDES A BETTER BREATHERS CLASS. THIS PULMONARY REHABILITATION SUPPORT GROUP MEETS EVERY WEEK. IT'S FREE OF CHARGE AND IS DESIGNED FOR ANYONE SUFFERING FROM BREATHING PROBLEMS. FOR DIABETES EDUCATION, CMH OFFERS A SERIES OF CLASSES EVERY OTHER MONTH. THEY ARE FREE OF CHARGE AND ARE OPEN TO ANYONE INTERESTED IN LEARNING MORE ABOUT DIABETES. A SIX-WEEK CHILDBIRTH EDUCATION CLASS IS ALSO OFFERED FOR EXPECTANT PARENTS THROUGH THE OBSTETRICS DEPARTMENT. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: N/A | AffiliatedHealthCareSystem |
| Reports Filed With States | MI | ReportsFiledWithStates |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| donald Watson | |||||||||||||
| 274704 | 0 | 0 | 0 | 0 | 0 | 8582 | 0 | 1530 | 0 | 284816 | 0 | 0 | 0 |
| BRIAN DIETZ | |||||||||||||
| 210000 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 210000 | 0 | 0 | 0 |
| timothy Burandt | |||||||||||||
| 354397 | 0 | 18000 | 0 | 0 | 0 | 9053 | 0 | 16451 | 0 | 397901 | 0 | 0 | 0 |
| craig duncan | |||||||||||||
| 352251 | 0 | 18000 | 0 | 0 | 0 | 8882 | 0 | 16451 | 0 | 395584 | 0 | 0 | 0 |
| kenneTH PARADA | |||||||||||||
| 245868 | 0 | 0 | 0 | 0 | 0 | 8606 | 0 | 15551 | 0 | 270025 | 0 | 0 | 0 |
| lawrence sherman | |||||||||||||
| 232809 | 0 | 13000 | 0 | 0 | 0 | 8580 | 0 | 6859 | 0 | 261248 | 0 | 0 | 0 |
| THOMAS FASBENDER | |||||||||||||
| 220050 | 0 | 46868 | 0 | 0 | 0 | 8567 | 0 | 16451 | 0 | 291936 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 4a | |
| Part I, Line 5 | DONALD WATSON AND WILLIAM BORGERDING: PHYSICIAN PRODUCTIVITY BONUSES ARE PAID OUT BASED ON NUMBER OF RVU'S (RELATIVE VALUE UNIT) THEY PRODUCE. THERE IS A MINIMUM THRESHOLD AND A 9-STEP SCALE. EACH LEVEL ON THE SCALE PAYS A HIGHER PERCENTAGE BONUS. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Economic Development Corporation of the County of Cheboygan | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 382495755 | IssuerEIN |
| Date Issued | 2008-04-29 | DateIssued |
| Issue Price | 4300000 | IssuePrice |
| Description Of Purpose | Refinancing & Equipment Purchase | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 4300000 | TotalProceeds |
| Amount Defeased | 3364998 | AmountDefeased |
| Issuance Costs From Proceeds | 57610 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 157100 | WorkingCapitalExpenditures |
| Capital Expenditures | 720292 | CapitalExpenditures |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 1 | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| CITIZENS NATIONAL BANK | |||
| SUSAN ENO-Chairperson of our Board & President of Citizens National Bank | 534845 | INTERST PAID TO BANK ON DEBT BALANCE | 0 |
| CITIZENS NATIONAL BANK | |||
| KATHY LIEDER-TRUSTEE OF OUR BOARD & BOARD MEMBER OF CITIZENS NATIONAL BANK | 534845 | INTERST PAID TO BANK ON DEBT BALANCE | 0 |
| WENDY PLETCHER | |||
| SPOUSE OF KEN PLETCHER, TRUSTEE OF OUR BOARD | 24430 | WAGES EARNED BY HOSPITAL EMPLOYEE | 0 |
| NANCY BARR | |||
| SISTER-IN-LAW OF SUSAN ENO, CHAIRPERSON OF OUR BOARD | 86520 | WAGES EARNED BY HOSPITAL EMPLOYEE | 0 |
Schedule N IRS990ScheduleN
Disposition Table DispositionTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Asset | SOLD THEIR 50% INTEREST IN VITALCARE, INC. TO NORTHERN MICHIGAN REGIONAL HOSPITAL. | DescriptionOfAsset |
| Date Of Distribution | 2009-06-30 | DateOfDistribution |
| FMV Of Asset | 2960370 | FMVOfAsset |
| Method Of FMV Determination | AN INDEPENDENT APPRAISAL WAS PERFORMED TO DETERMINE THE FMV AND SALES PRICE OF VITALCARE. | MethodOfFMVDetermination |
| EIN | 382146751 | EIN |
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MICHIGAN REGIONAL HOSPITAL | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 416 CONNABLE AVENUE | AddressLine1 |
| City | PETOSKEY | City |
| State | MI | State |
| ZIP Code | 49770 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSection |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2 |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2 |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2 |
| Receive Compensation2 | 0 | ReceiveCompensation2 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part III, line 3 | Changes in Program Services | THE URGENT CARE CLINIC WAS CLOSED ON 2/7/2010. THE OB UNIT WAS CLOSED ON 3/27/2010. |
| Form 990, Part VI, Section A, line 2 | COMMUNITY MEMORIAL HOSPITAL BOARD MEMBERS KATHLEEN LIEDER AND SUSAN ENO HAVE A BUSINESS RELATIONSHIP, AS DESCRIBED IN SCHEDULE L. | |
| Form 990, Part VI, Section B, line 11 | A COPY OF THE 990 IS MADE AVAILABLE FOR THE BOARD OF TRUSTEES TO REVIEW THROUGH A SECURE WEB-BASED PORTAL PRIOR TO SUBMISSION. BOARD MEMBERS HAVE THE OPPORTUNITY TO DISCUSS THE RETURN WITH A MEMBER OF THE HOSPITAL'S FINANCE DEPARTMENT. IN ADDITION, THE CHAIRMAN OF THE HOSPITAL'S AUDIT COMMITTEE WILL PERFORM A DETAILED REVIEW OF THE TAX RETURN PRIOR TO SUBMISSION. THIS REVIEW IS DOCUMENTED THROUGH THE WEB-BASED PORTAL AND THROUGH E-MAILS. | |
| Form 990, Part VI, Section B, line 12c | CHEBOYGAN MEMORIAL HOSPITAL'S CONFLICT OF INTEREST POLICY IS APPLICABLE TO ALL BOARD MEMBERS AND KEY MANAGEMENT OFFICERS. BOARD MEMBERS AND OFFICERS COMPLETE AN ANNUAL STATEMENT OF RELATED INTERESTS, WHICH IS REVIEWED BY THE CHAIRPERSON OF THE BOARD AND THE CHIEF EXECUTIVE OFFICER. THE BOARD MEMBER OR OFFICER IS REQUIRED TO WITHDRAW FROM ANY BOARD MATTERS THAT GIVE RISE TO A CONFLICT OF INTEREST. | |
| Form 990, Part VI, Section B, line 15 | THE EXECUTIVE COMMITTEE OF THE BOARD EVALUATES COMPARABILITY DATA TO DETERMINE SALARY. SALARIES FOR THE CEO AND OTHER TOP MANAGEMENT OFFICIALS ARE COMPARED TO INDUSTRY STANDARDS FOR LIKE SIZE AND TYPE OF FACILITY. THIS PROCESS WAS LAST UNDERTAKEN DURING FISCAL YEAR 2010. | |
| Form 990, Part VI, Section C, line 19 | THE HOSPITALS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON PUBLIC REQUEST -- PENDING APPROVAL OF ADMINISTRATION. | |
| Form 990, Part VII | Contact Addresses for Officers, Directors, Etc | BARBARA CLIFF - 473 OLD FARM LANE, JOHNSTOWN, PA 15904. timothy Burandt - 3638 WATERWAY CT., GRASS LAKE, MI 49240. BRIAN DIETZ - 16280 12B ROAD, PLYMOUTH, IN 46563. MIKE WEEKS - 110 LIBERTY LANE, BATESVILLE, AR 72501. PAUL COURTNEY - 10105 CARIBOU TRAIL, DALLAS, TX 75238. FRED VITELLO - PO BOX 217, BRIGANTINE, NJ 08203. |
| FORM 990, PART VII, SECTION A: | THE HOSPITAL PAID A STAFFING COMPANY (BE SMITH) AND IN TURN, THE STAFFING COMPANY PAID THE WAGES OF THE INTERIM CEO AND CFO'S: BRIAN DIETZ, MIKE WEEKS, PAUL COURTNEY, AND FRED VITELLO. THE HOSPITAL WAS UNABLE TO OBTAIN W-2/1099 WAGE INFORMATION FROM BE SMITH FOR THESE INDIVIDUALS, SO IN TURN, THEY HAVE INSTEAD REPORTED THE AMOUNTS PAID TO BE SMITH TO CONTRACT EACH INDIVIDUAL. THESE AMOUNTS WILL BE HIGHER THAN THEIR W-2/1099 WAGES, BUT IT IS THE ONLY RELEVANT DATA AVAILABLE FOR THE HOSPITAL TO REPORT HERE. THE HOSPITAL DOES NOT PROVIDE BENEFITS TO THESE INDIVIDUALS. | |
| FORM 990, PART XI, LINE 2C: | NO CHANGES FROM PRIOR YEAR. | |
| Schedule K Supplental Information | THE BONDS THAT WERE REFINANCED WERE 1998 BONDS, AND AS SUCH, SCHEDULE K, PART III IS NOT COMPLETED FOR THE 1998 ASSETS. |