2011-02-15T10:44:49-06:00 2010-03-31 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2009-04-01 381398825 COMMUNITY MEMORIAL HOSPITAL COMM 2316275601 748 SOUTH MAIN STREET CHEBOYGAN MI 49721 HOLLY CAMPA 2316275601 2011-02-14 1 2319477800 2009 2016-02-24 21:20:13Z Cheboygan Memorial Hospital Holly Campa 748 SOUTH MAIN STREET CHEBOYGAN MI 49721 53922160 0 X WWW.CHEBOYGANHOSPITAL.ORG X 1929 MI 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. 10 5 509 270 133485 41377 218118 205156 51251714 50581379 26000 554431 1442 71123 51497274 51412089 5000 0 0 27853079 28347371 0 0 26127145 26269940 53985224 54617311 -2487950 -3205222 29856233 28115719 21699196 22793064 8157037 5322655 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. 0 1 9288566 9092502 CLINICS (72,163 PROCEDURES) 2539159 5356892 LABORATORY (476,404 PROCEDURES) 3141504 11257791 DIAGNOSTIC IMAGING (38,332 PROCEDURES) 28273212 24740709 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. 28273212 24740709 43242441 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 64 0 1 509 1 1 1 0 0 0 0 1 1 0 0 0 10 5 1 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 1 1 1 0 X DONNA WOIDERSKI 2316271285 748 S MAIN STREET CHEBOYGAN MI 49721 BARBARA CLIFF 40.00 X X 85787 0 4092 donald Watson 40.00 X 274704 0 10112 SUSAN ENO 5.00 X X 0 0 0 JAMES MCCLURG 5.00 X X 0 0 0 NANCY DEXTROM 5.00 X X 0 0 0 WILLIAM BORGERDING DO 5.00 X 121656 0 21475 EUGENE COOLEY 5.00 X 0 0 0 CARL FRANZON 5.00 X 0 0 0 KATHLEEN LIEDER 5.00 X 0 0 0 KEN PLETCHER 5.00 X 0 0 0 JOHN WARD 5.00 X 0 0 0 BRIAN DIETZ 40.00 X 210000 0 0 MIKE WEEKS 40.00 X 89000 0 0 PAUL COURTNEY 40.00 X 43500 0 0 FRED VITELLO 40.00 X 0 0 0 HOLLY CAMPA 40.00 X 110977 0 19598 timothy Burandt 40.00 X 372397 0 25504 craig duncan 40.00 X 370251 0 25333 kenneTH PARADA 40.00 X 245868 0 24157 lawrence sherman 40.00 X 245809 0 15439 THOMAS FASBENDER 40.00 X 266918 0 25018 2436867 0 170728 31 0 1 0 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 7 6549 15375 49089 134143 205156 PROGRAM SERVICES 900099 50279819 50146334 133485 OTHER RELATED REVENUE 900099 301560 301560 50581379 14304 14304 153251 80640 72611 72611 72611 2960370 2420243 540127 540127 540127 7700 6549 9188 -1488 -1488 51412089 50447894 133485 625554 1048342 492877 555465 21292036 18512610 2779426 6006993 4777286 1229707 1213096 419947 793149 254897 254897 109800 109800 2399609 2398154 1455 103378 103378 79386 3929 75457 83185 52810 30375 605859 480667 125192 1777867 1396809 381058 642467 163663 478804 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 2011361 636655 1374706 54617311 43242441 11374870 0 124683 -61675 1644105 707683 98021 66463 5994657 9763256 609614 565049 443819 329142 35295595 19602397 16977152 15693198 278093 25275 2667942 1018147 1027328 29856233 28115719 6253720 7622926 35675 15675 4190645 4064893 9614689 9350004 1604467 1739566 21699196 22793064 X 7999772 5214197 157265 108458 8157037 5322655 29856233 28115719 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3198 3198 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Supported lobbying activities through annual dues paid to Michigan Health & Hospital Association. 1107212 1107212 22114264 10787279 11326985 171793 123859 47934 11841483 8691259 3150224 60843 60843 15693198 COST REPORT SETTLEMENTS PAYABLE 206000 ACCOUNTS RECEIVABLE OVERPAYMENTS 504326 ACCRUED PENSION LIABILITY 1029240 1739566 51412089 54617311 -3205222 -2247 373087 370840 -2834382 51865816 453727 453727 51412089 0 51412089 54700198 82887 82887 54617311 0 54617311 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. 1 1 X 1 X 1 X 0 1 0 1 1 530278 530278 0.01030 10914234 9410380 1503854 0.02910 11444512 9410380 2034132 0.03940 88823 88823 0.00170 7350 7350 0.00010 13500 13500 0.00030 109673 109673 0.00210 11554185 9410380 2143805 0.04150 2 70 600 600 0.00000 1 25 1000 1000 0.00000 2000 2000 0.00000 1 20 1000 1000 0.00000 4 115 4600 4600 0 1388517 164250 12285454 11746962 538492 X 1 1 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 Part I, Line 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED. 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. 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. 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. 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. 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. 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. 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. 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. 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. Part VI, Line 7: N/A MI X X X 0 0 0 1 0 0 0 0 0 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 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. Economic Development Corporation of the County of Cheboygan 382495755 2008-04-29 4300000 Refinancing & Equipment Purchase 0 0 4300000 3364998 57610 157100 720292 2009 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 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 SOLD THEIR 50% INTEREST IN VITALCARE, INC. TO NORTHERN MICHIGAN REGIONAL HOSPITAL. 2009-06-30 2960370 AN INDEPENDENT APPRAISAL WAS PERFORMED TO DETERMINE THE FMV AND SALES PRICE OF VITALCARE. 382146751 NORTHERN MICHIGAN REGIONAL HOSPITAL 416 CONNABLE AVENUE PETOSKEY MI 49770 501(C)(3) 0 0 0 0 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.