2011-11-09T10:59:31-06:00 2010-12-31 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2010-01-01 383236977 NORTHSTAR HEALTH SYSTEM NORT 9062656121 1400 W ICE LAKE RD IRON RIVER MI 49935 GLENN DOBSON 9062656121 2011-10-25 1 TERRI REXRODE CPA MST 9206620016 2011-10-25 2010 2016-02-24 21:20:13Z GLENN DOBSON 1400 W ICE LAKE RD IRON RIVER MI 49935 35043897 0 X WWW.NORTHSTARHS.ORG X 1995 MI OUR ORGANIZATION CONTINUES TO STRIVE TO MEET THE EVOLVING NEEDS OF OUR SERVICE AREA WITH THE CONTINUATION AND EXPANSION OF SERVICES TO A LARGER DEMOGRAPHIC AREA. WE PROVIDE AMBULANCE SERVICE ALONG WITH CONTINUING TO BRING IN ADDITIONAL PHYSICIANS AND SERVICES INCLUDING EXPANSION OF ORTHOPAEDICS IN 2010. OUR FOCUS IN 2010 HAS BEEN TO IDENTIFY THE NEEDS OF THE AREA AND INCREASE MARKET SHARE BY OFFERING THE SERVICES IDENTIFIED THROUGH SURVEYS TO BE NEEDED AND IN DEMAND BY THE POPULATION. 9 7 336 30 0 0 76902 85125 31676810 33543939 250577 190800 0 0 32004289 33819864 0 0 0 0 17178550 18363547 0 0 0 15600247 17864069 32778797 36227616 -774508 -2407752 39024167 35976625 28124112 26981293 10900055 8995332 X THE MISSION OF NORTHSTAR HEALTH SYSTEM IS TO PROVIDE QUALITY HEALTH CARE SERVICES WITHIN THE SCOPE OF ITS SKILLS AND TECHNOLOGIES IN A SAFE, PROGRESSIVE, COST EFFECTIVE, AND NON-DISCRIMINATORY MANNER. 0 0 31551346 33458888 NORTHSTAR HEALTH SYSTEM PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL, AND PHYSICIAN CLINIC SERVICES TO THE RESIDENTS OF IRON COUNTY, MICHIGAN AND SURROUNDING AREAS. THE ORGANIZATION IS DESIGNATED BY MEDICARE AS A CRITICAL ACCESS HOSPITAL. IT OPERATES SEVERAL CLINICS ALONG WITH THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES ON A NON-PROFIT BASIS TO THE GENERAL PUBLIC. THE ORGANIZATION RECORDED APPROXIMATELY 3,300 INPATIENT DAYS; 64,000 OUTPATIENT VISITS; 466 SWING BED DAYS; AND 5,800 HOME HEALTH VISITS IN 2010. THE ORGANIZATION ALSO PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THIS POLICY FOR 2010 WAS APPROXIMATELY $258,000. 31551346 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 408 0 1 336 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X GLENN DOBSON 9062656121 1400 W ICE LAKE ROAD IRON RIVER MI 499359594 MARK TOUSIGNANT 1.00 X 0 0 0 RICK KENT 1.00 X 0 0 0 DIANNE ROSTAGNO 1.00 X 0 0 0 RANDY JACOBS 1.00 X 0 0 0 SANDRA BATTYE 1.00 X 0 0 0 JAMES GIBULA 1.00 X 0 0 0 MARGARET NOREUS SMITH 1.00 X 0 0 0 BRUCE RAMPAGE 40.00 X X 234239 0 26957 DANNY YARGER MD 40.00 X X 225907 0 26424 GLENN DOBSON 40.00 X 119920 0 23924 MARITES ANSAY MD 40.00 X 166289 0 15225 KIM MAHLER MD 40.00 X 206420 0 21572 HAROLD CLINE 40.00 X 620877 0 27313 NASEEM RIZKALLA MD 40.00 X 295878 0 27314 ALAN CAUDILL MD 40.00 X 321600 0 25800 MATHEW WELCH 40.00 X 134448 0 23673 PHILIP WOJDULA 40.00 X 112610 0 24460 RONALD DALTON MD 40.00 X 225521 0 22578 2663709 0 265240 11 1 1 0 MARQUETTE GENERAL HEALTH SYSTEMS 580 W COLLEGE AVE MARQUETTE MI 49855 EMERGENCY ROOM DOCTORS 1473996 DR CUBE PO BOX 335 IRON RIVER MI 49935 RADIOLOGIST 546250 ARAMARK UNIFORM COMPANY PO BOX 1114 APPLETON WI 54912 LAUNDRY SERVICES 448124 UP HEALTH CARE NETWORK 228 W WASHINGTON AVE MARQUETTE MI 49855 MRI SERVICES 319230 ANESTHESIA ASSOCIATES 788 PENTOGA TRAIL CRYSTAL FALLS MI 49920 ANESTHESIA 249514 8 85125 85125 NET PATIENT SERVICE RE 900099 33458888 33458888 CAFETERIA MEALS 900099 85051 85051 33543939 142561 142561 1272272 1224033 48239 48239 48239 33819864 33458888 0 275851 2680236 2275196 405040 11599512 10247026 1352486 443520 388278 55242 2727638 2415538 312100 912641 802317 110324 23040 23040 175687 175687 104666 104666 3445177 2883062 562115 163794 163794 943555 763615 179940 44400 44400 604890 442909 161981 174839 157312 17527 1468594 1075325 393269 1850064 1850064 340800 79462 261338 MEDICAL SUPPLIES 4464849 4464849 REPAIRS AND MAINTENANCE 2146137 2012501 133636 PROVISION FOR BAD DEBTS 1635525 1635525 RECRUITMENT EXPENSE 158696 158696 DUES & SUBSCRIPTION 119356 58367 60989 36227616 31551346 4676270 0 196519 445175 122292 3986446 5768804 51671 39180 479626 457968 77158 228209 39756613 16973629 23367617 22782984 7615371 5321478 2804584 1255710 39024167 35976625 4729604 3982685 22795077 22551080 137632 161697 461799 285831 28124112 26981293 X 10900055 8995332 10900055 8995332 39024167 35976625 X -2407752 503029 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 235876 235876 25979995 5987376 19992619 222569 206179 16390 12740784 10474079 2266705 577389 305995 271394 22782984 INVESTMENTS-SECURITIES 5321478 F 5321478 PENSION LIABILITY 235831 LIABILITY INSURANCE RESERVE 50000 285831 33819864 36227616 -2407752 316633 186396 503029 -1904723 33819864 0 33819864 0 33819864 36227616 0 36227616 0 36227616 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, ASC TOPIC 740, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE COMBINED FINACIAL STATEMENTS. THE HOSPITAL RECORDED NO TAX ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2010 OR 2009. FEDERAL INCOME TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2007, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE 225,968. NET ASSET TRANFER TO FOUNDATION -39,572. 1 1 1 X 1 X 100.000000000000 1 1 0 1 0 171938 171938 0.00500 3195042 956600 2238442 0.06470 3366980 956600 2410380 0.06970 36800 75 36725 0.00110 15000 15000 0.00040 5900 5900 0.00020 57700 75 57625 0.00170 3424680 956675 2468005 0.07140 1 1090461 0 15201614 16018299 -816685 X 1 1 3 1 NORTHSTAR HEALTH SYSTEM

1400 W ICE LAKE ROAD IRON RIVER MI 49935

X 2 NORTHSTAR HOME CARE AND HOSPICE

RIVERSIDE PLAZA IRON RIVER MI 49935

HOME HEALTH AGENCY 3 NORTHSTAR HEALTH SYSTEM - ERSD

1328 US HWY 2 CRYSTAL FALLS MI 49920

DIALYSIS NA 1 PART I, LINE 7: THE COSTING METHODOLOGY USED WAS A COST-TO-CHARGE RATIO. PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY PHYSICIAN CLINICS IN CALCULATING SUBSIDIZED HEALTH SERVICE COSTS. PART I, L7 COL(F): IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $1,635,525 WAS EXCLUDED FROM THE DENOMINATOR. PART II: COMMUNITY BUILDING ACTIVITIES CONSISTED OF MISCELLANEOUS COMMUNITY SUPPORT. PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING AMOUNTS REPORTED ABOVE IS THE COST TO CHARGE RATIO. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE ALLOWABLE COSTS REPORTED ABOVE IS THE COST TO CHARGE RATIO. PART III, LINE 9B: IF THE PATIENT QUALIFIES FOR CHARITY CARE AND A 100% WRITE-OFF IS NOT QUALIFIED FOR, THE PATIENT MUST MAKE MONTHLY PAYMENT ACCORDING TO FACILITY PAYMENT POLICY. IF PATIENT DOES NOT MAKE MONTHLY PAYMENTS AND CANNOT BE REACHED BY TELEPHONE, THE FORMAL COLLECTION PROCESS WOULD BEGIN. PART VI, LINE 2: THE ORGANIZATION ASSESSES THE NEEDS OF THE COMMUNITY THROUGH A NEEDS ASSESSMENT SURVEY, THROUGH DOCUMENTATION OF REQUESTS FROM OUTLYING AGENCIES OR COMMUNITY GROUPS, AND FROM EVALUATION OF THE REPEAT DIAGNOSIS OF PATIENTS SERVED WITHIN THE SERVICE AREA. PART VI, LINE 3: THE ORGANIZATION HAS A DEPARTMENT DEVOTED TO SELF PAY ACCOUNTS RECEIVABLE WITH THEIR MAIN FOCUS ON MAKING PATIENT CONTACT WITH THOSE PATIENTS THAT EITHER HAVE NO INSURANCE OR ARE UNDER INSURED BASED UPON INFORMATION COLLECTED AT THE TIME OF SERVICE. THIS STAFF IS EDUCATED ON WHAT PROGRAMS ARE AVAILABLE WITHIN THE COMMUNITY AND CAN ASSIST THE PATIENT IN MAKING CONTACT WITH THESE AGENCIES AND CAN ASSIST IN APPLICATION COMPLETION FOR OUTSIDE PROGRAMS. THE CHARITY CARE PROGRAM IS ALSO COMMUNICATED THE SAME WAY. PART VI, LINE 4: THE COMMUNITY SERVED IS RELATIVELY OLDER IN AGE WITH A HIGH UTILIZATION OF MEDICARE. THERE IS LITTLE INDUSTRY, NO AIRPORT, AND THE NEAREST TRAUMA CENTER IS 90 MILES AWAY. THE NEXT CLOSEST HOSPITALS ARE 45 TO 55 MILES AWAY. THE GEOGRAPHIC AREA, BY COUNTY, IS VERY LARGE BUT VERY LITTLE POPULATED. THE AREA SUPPORTS SEVERAL RURAL HEALTH CLINICS AND THIS FACILITY SURVIVES BECAUSE OF THE CRITICAL ACCESS HOSPITAL DESIGNATION ONLY. PART VI, LINE 6: OUR BOARD IS MADE UP OF VOLUNTEER INDIVIDUALS FROM WITHIN THE DIRECT COMMUNITY. MEDICAL STAFF PRIVILEGES TO ALL PROVIDERS WITHIN THE COMMUNITY AND SURROUDING AREA/COUNTIES AS THE TRAVEL TIME TO OTHER HOPSITALS IS OVER 1 HR TO THE NEAREST. SURPLUS FUNDS HAVE BEEN PUT INTO A $18 MILLION EXPANSION COMPLETED IN 2009 INCLUDING THE EXPANSION OF ED SERVICES AND IP ROOMS/ETC. REPORTS FILED WITH STATES PART VI, LINE 7 MI X X X X 0 0 0 0 0 0 0 0 0 BRUCE RAMPAGE 214844 0 0 0 19395 0 9557 0 17400 0 261196 0 0 0 DANNY YARGER MD 198697 0 0 0 27210 0 9174 0 17250 0 252331 0 0 0 MARITES ANSAY MD 144900 0 0 0 21389 0 6721 0 8504 0 181514 0 0 0 KIM MAHLER MD 177120 0 0 0 29300 0 3422 0 18150 0 227992 0 0 0 HAROLD CLINE 581646 0 0 0 39231 0 6463 0 20850 0 648190 0 0 0 NASEEM RIZKALLA MD 283186 0 0 0 12692 0 6464 0 20850 0 323192 0 0 0 ALAN CAUDILL MD 288225 0 0 0 33375 0 9877 0 15923 0 347400 0 0 0 MATHEW WELCH 124538 0 0 0 9910 0 5523 0 18150 0 158121 0 0 0 RONALD DALTON MD 192267 0 0 0 33254 0 9128 0 13450 0 248099 0 0 0 CITY OF IRON RIVER HOSPITAL FINANCE AUTHORITY 383527449 463003AA1 2008-05-15 23150000 HOSPITAL FACILITY IMPROVEMENTS 0 0 0 22721540 1713975 5667697 15339869 422278 14917591 2010 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 SCHEDULE K SUPPLENTAL INFORMATION THIS BOND ISSUE WAS COMPRISED OF THREE BONDS THAT WERE ALL ISSED ON 5/15/2008. THE CUSIP NUMBERS INCLUDED IN THIS ONE ISSUANCE WERE ARE FOLLOWS: 463003AA1 463003AL7 463003AT0 DANNY YARGER MD SIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACT X 12500 9167 0 1 1 KIM MAHLER DO SIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACT X 20000 11680 0 1 1 HAROLD CLINE MD SIGN ON BONUS FORGIVEN OVER LIFE OF CONTRACT X 24238 18333 0 1 1 39180 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS E-MAILED TO ALL BOARD MEMBERS PRIOR TO MAILING/SUBMITTING THE FORM. MEMBERS OF THE BOARD ARE ALLOWED TO SUBMIT FEEDBACK AND APPROPRIATE REQUESTED CHANGES ARE INCORPORATED, IF WARRANTED, INTO THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. THIS REQUIREMENT IS STATED IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S KEY EMPLOYEES AND HIGHEST PAID EMPLOYEES HAVE EMPLOYMENT CONTRACTS THAT GOVERN THEIR COMPENSATION. COMPENSATION LEVELS ARE REVIEWED BY THE APPLICABLE LEVEL OF MANAGEMENT AND/OR THE BOARD OF DIRECTORS. FOR GUIDANCE RELATED TO COMPENSATION LEVELS, MANAGEMENT GATHERS MARKET DATA AND COMPENSATION STUDIES TO ARRIVE AT AMOUNTS THAT ARE COMPETITIVE WITHIN THEIR MARKET AREA. THE COMPENSATION IS APPROVED BY INDIVIDUALS WITHOUT A CONFLICT OF INTEREST AND THEN DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 A COPY OF THE FILED FORM 990 IS AVAILABLE TO THE PUBLIC THROUGH A REQUEST FROM ANY MEMBER OF THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 316,633. CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE 225,968. NET ASSET TRANFER TO FOUNDATION -39,572. TOTAL TO FORM 990, PART XI, LINE 5: 503,029. FORM 990, PART XXI, LINE 2C AUDIT FIRM IS APPROVED BY THE FINANCE COMMITTEE. THE AUDIT FIRM PRESENTS THE AUDIT RESULTS TO THE FINANCE COMMITTEE. GREATER IRON COUNTY EMS INC 1400 WEST ICE LAKE ROAD IRON RIVER MI 49935 383491283 EMERGENCY MEDICAL SERVICES MI 501(C)3 11 N/A 0 IRON COUNTY COMMUNITY HEALTH FOUNDATION 1400 WEST ICE LAKE ROAD IRON RIVER MI 49935 383762132 RAISE FUNDS FOR NORTHSTAR HEALTH SYSTEM MI 501(C)3 11 I N/A 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1 0 1 GREATER IRON COUNTY EMS INC O 45645 GREATER IRON COUNTY EMS INC O 740000 GREATER IRON COUNTY EMS INC N 496812 GREATER IRON COUNTY EMS INC N 91388 GREATER IRON COUNTY EMS INC P 87347 NORTHSTAR HEALTH SYSTEM FOUNDATION N 49982 NORTHSTAR HEALTH SYSTEM FOUNDATION N 10000 NORTHSTAR HEALTH SYSTEM FOUNDATION P 7800 NORTHSTAR HEALTH SYSTEM FOUNDATION H 3503