2023-02-16T00:00:57-07:00 2022-03-31 990 2021-04-01 381369796 SHERIDAN COMMUNITY HOSPITAL SHER 9892916235 301 N Main Sheridan MI 48884 Newton Mulama Controller 9892916235 2023-02-01 1 11 0 AAL2 X 2021 2023-03-07 01:45:13Z X Lilijana Petricevic 301 N Main Street Sheridan MI 48884 16264593 0 X sheridanhospital.com X 1950 MI Dedicated to provide individual -based professional healthcare for the families in our rural community 5 0 261 9 0 0 5176233 3158171 9678899 13099813 0 0 103475 6609 14958607 16264593 0 0 0 0 6529263 8397273 0 0 0 5696328 6746280 12225591 15143553 2733016 1121040 5237839 8579215 4792619 7012955 445220 1566260 Dedicated to provide individual-based professional healthcare for the families in our rural community 0 0 15143553 3158171 13106422 Sheridan Community Hospital provided care to 103 inpatients and 92 swing bed patients with 2035 days of care. SCH also provided care to 19502 outpatients. 0 0 0 15143553 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 261 1 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X Sheridan Community Hospital 9892913261 301 N Main Sheridan MI 48884 Doctor Eva Bartlett Chief Medical Officer 40 X X X X 310370 0 18430 Doctor Stephen Frey Emergency Room Physician 40 X 255317 0 12008 Doctor Michael Cearlock Emergency Room Physician 40 X 169691 0 6379 Lilijana Petricevic Chief Executive Officer 40 X X X X 144260 0 24976 Jenny Kipp DNP Hospitalist 40 X X 118795 0 18430 Doctor Bhavesh Amin Emergency Room Physician 40 X 131999 0 0 Doctor Bader Elder Emergency Room Physician 40 X 125544 0 0 Jalil Rizqallah Chief Operating Officer / Chairman Of The Board 40 X X X 85715 0 0 Kim Christensen Risk Manager 40 X X X 74996 0 5552 Bobbi McColley Chief Compliance Officer 40 0 X X X 69383 0 2712 Mary Soper Practice Manager 40 X X X 52836 0 5614 Newton Mulama Controller 40 0 X X X 54388 0 2939 David Bussler Director of IT and Infrustructure 40 X X X 50077 0 4918 Julie Calderone Director of Clinical operations 40 X X X 37890 0 3978 Sarah Fryover Director of Human Resources 40 X X X 37890 0 3978 Thomas Lyon Safety and Emergency Preparedness Director 40 X X X 26017 0 5274 Doctor Mark Clark Board Member/Anesthesiology Manager 8 X X 12000 0 0 1757168 0 115188 11 0 1 0 CPSI Evident 100 main st mobile AL 36609 Computer software 151339 Anesthesia Today Staffing 802 GREENWICH GRAND LEDGE MI 48884 NURSE ANESTHESTIST 167490 MIVRX LLC 49 E Isabella Midland MI 48640 Pharmacist staffing and Supply 303535 Medical Solutions Post office Box 850737 Meniappolis MN 55485 Nurse Staffing 144622 BellMedex Post Office Box 88942 Seattle WA 98138 Billing Company 128154 5 0 0 4816 0 3153135 220 0 3158171 Patient Services 622110 12001969 12001969 0 0 QAAP Payments 900099 597921 597921 0 0 340B Pharmacy Program Royalties 621399 97928 97928 0 0 Capitation Revenue 900099 81534 81534 0 0 320461 320461 0 0 13099813 6609 0 0 0 6609 0 6609 6609 0 0 0 0 4816 0 16264593 13106422 0 0 X 0 0 0 0 0 0 0 0 1756947 1756947 0 0 0 0 0 0 4518861 4518861 0 0 82873 82873 0 0 499149 499149 0 0 1539443 1539443 0 0 0 0 0 0 51193 51193 0 0 19600 19600 0 0 3307 3307 0 0 0 0 0 0 0 0 0 0 0 0 6029 6029 0 0 82567 82567 0 0 360739 360739 0 0 0 0 0 0 79454 79454 0 0 826 826 0 0 0 0 0 0 6482 6482 0 0 18764 18764 0 0 0 0 0 0 314573 314573 0 0 124810 124810 0 0 Medical Supplies 426003 426003 0 0 Medicaid Provider Tax 309117 309117 0 0 Provision For Bad Debt 1701674 1701674 0 0 3241142 3241142 0 0 15143553 15143553 0 0 1007656 1910659 2500 2500 1276376 2854850 470900 123352 203876 427447 8409157 5148750 3260407 0 0 0 0 2276531 5237839 8579215 2217570 5296325 2575049 1716630 4792619 7012955 X 445220 1566260 0 0 445220 1566260 5237839 8579215 1121040 0 0 0 0 0 X 0 0 0 X 427916 0 427916 3042967 0 2201144 841823 0 0 0 0 4387155 0 2947606 1439549 551119 0 0 551119 3260407 894756 Leases 143871 Accrued PTO 574616 Health Benefits and 401K 103387 1716630 X X X X 0 0 0 0 0 0 0 0 0 Doctor Eva Bartlett Chief Medical Officer 310370 0 0 0 0 0 0 0 18430 0 328800 0 Doctor Stephen Frey Emergency Room Physician 255317 0 0 0 0 0 0 0 12008 0 267325 0 Lilijana Petricevic Chief Executive Officer 144260 0 0 0 0 0 0 0 24976 0 169236 0 Doctor Michael Cearlock Emergency Room Physician 169690 0 0 0 0 0 0 0 6379 0 176069 0 Doctor Bhavesh Amin Emergency Room Physician 131999 0 0 0 0 0 0 0 0 0 131999 0 Doctor Bader Elder Emergency Room Physician 125544 0 0 0 0 0 0 0 0 0 125544 0 Jenny Kipp DNP Hospitalist 118795 0 0 0 0 0 0 0 18430 0 137225 0 Jalil Rizqallah Chief Operating Officer 192000 Operating Capital for Payroll 0 Form 990, Part VI, Section A, Line 6 The chief operating officer was also the Board chairman and had the power to appoint new board members for a vote both in the preservation board and operational board Form 990, Part VI, Section A, Line 7a The chief operating officer who was also Chairman/President of the board had powers to appoint new members to the preservation board and Operational board for a vote Form 990, Part VI, Section B, Line 11b It is presented to the board members at the preservation board meeting for review Form 990, Part VI, Section B, Line 12c Conflict of interest questionnaire is presented to the board annually for completion and reviewed by Chief Compliance Officer. If a conflict exits, the board is informed and steps are taken to correct it and if need be penalty or remedial action is enforced. Form 990, Part VI, Section B, Line 15 Human Resources Director provides compensation data provided by MHA in the form of executive compensation survey. This information is then presented to the board for a vote of approval and documented in the board minutes before its implemented Form 990, Part VI, Section C, Line 19 ALL governing Documents, conflict of interest policy, financial statements that are open to public for inspection are available upon request. Form 990, Part IX, Line 24e These Expenses Cover Collection Services House keeping Lab Professional services ER professional services Other Purchased professional services such as Preventative Maintenance per HFAP requirement OR professional services Administration professional fees We requested for An extension due to an internal Financial software overhaul and the extension was granted October 24th 2022