MCKENIZE MEMORIAL HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- MCKENIZE MEMORIAL HOSPITAL (EIN 38-1738615)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-05-21
- IRS object ID
- 202041429349300504
- Schema version
- 2018v3.1
- 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 D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-05-21T08:37:00-06:00 | ReturnTs |
| Tax Period End | 2019-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381738615 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | MCKENZIE HEALTH SYSTEM | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % AMY RUEDISUELI | InCareOfNm |
| Business Name Control | MCKE | BusinessNameControlTxt |
| Phone | 8106483770 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 DELAWARE STREET | AddressLine1Txt |
| City | SANDUSKY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48471 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY RUEDISUELI | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8106486162 | PhoneNum |
| Signature | 2020-05-21 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 208.99.236.18 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 21010520201420619319 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2020-05-21 | FederalOriginalSubmissionIdDt |
| Filing License Type | O | FilingLicenseTypeCd |
| At Submission Creation Device Id | CD4DB2C882C2D55109A1CD9D9D6F8E20F69FA1D3 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2E51A4E308B92B7848342C1302627A70825CA69B | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVE BARNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 DELWARE STREET | AddressLine1Txt |
| City | SANDUSKY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48471 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,068,294 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCKENZIEHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1961 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | FOUNDED AS A COMMUNITY HOSPITAL MCKENZIE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT COMPASSIONATE AND ESSENTIAL HEALTHCARE | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 316 | TotalEmployeeCnt |
| Total Volunteers | 65 | TotalVolunteersCnt |
| Total Gross UBI | $41,754 | TotalGrossUBIAmt |
| PY Contributions Grants | $106,661 | PYContributionsGrantsAmt |
| CY Contributions Grants | $182,515 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,021,651 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,692,699 | CYProgramServiceRevenueAmt |
| PY Investment Income | $27,590 | PYInvestmentIncomeAmt |
| CY Investment Income | $67,207 | CYInvestmentIncomeAmt |
| PY Other Revenue | $59,698 | PYOtherRevenueAmt |
| CY Other Revenue | $73,653 | CYOtherRevenueAmt |
| PY Total Revenue | $22,215,600 | PYTotalRevenueAmt |
| CY Total Revenue | $24,016,074 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,398,952 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,359,367 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $27,644 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,443,988 | PYOtherExpensesAmt |
| CY Other Expenses | $8,906,198 | CYOtherExpensesAmt |
| PY Total Expenses | $21,842,940 | PYTotalExpensesAmt |
| CY Total Expenses | $23,265,565 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $372,660 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $750,509 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,088,606 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,457,405 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,338,113 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,956,405 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,750,493 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,501,000 | NetAssetsOrFundBalancesEOYAmt |
| Mission | FOUNDED AS A COMMUNITY HOSPITAL, MCKENZIE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $23,265,565 | ExpenseAmt |
| Revenue | $24,016,073 | RevenueAmt |
| Desc | PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES INPATIENT REGISTRATION = 172 OUTPATIENT REGISTRATION = 23,780 EMERGENCY ROOM = 5681 AMBULANCE RUNS = 2,251 | Desc |
| Total Program Service Expenses | $23,265,565 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 316 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY RUEDISUELI | PersonNm |
| Phone | 8106486162 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 DELAWARE STREET | AddressLine1Txt |
| City | SANDUSKY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48471 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|---|
| MICHAEL DREYER | ||||||||
| Chairperson | 1.000 | Yes (X) | $0 | $0 | $0 | |||
| LARRY MICHELL | ||||||||
| Director | 1.000 | Yes (X) | $0 | $0 | $0 | |||
| JOAN NAGELKIRK | ||||||||
| ViceChairperson | 1.000 | Yes (X) | $0 | $0 | $0 | |||
| ORIN CAMPBELL | ||||||||
| Director | 1.000 | Yes (X) | $0 | $0 | $0 | |||
| STEVE BARNETT | ||||||||
| CEOPresident | 40.00 | Yes (X) | $217,149 | $0 | $26,445 | Yes (X) | ||
| AMY RUEDISUELI | ||||||||
| CFO | 40.00 | $149,419 | $0 | $7,887 | Yes (X) | |||
| MICHAEL MERKLER | ||||||||
| Physician | 40.00 | $267,379 | $0 | $9,358 | Yes (X) | |||
| JAMES SAMS | ||||||||
| Director | 40.00 | Yes (X) | $203,686 | $0 | $11,770 | |||
| MATTHEW GORMLEY | ||||||||
| Chief of Staff | 40.00 | Yes (X) | $194,579 | $0 | $28,065 | |||
| MARK ENGLISH | ||||||||
| Physician | 40.00 | $171,393 | $0 | $28,109 | Yes (X) | |||
| GINA PATTERSON | ||||||||
| Director of Pharmacy | 32.00 | $134,789 | $16,389 | $26,493 | Yes (X) | 8.000 | ||
| BILLI JO HENNIKA | ||||||||
| COO | 40.00 | $144,196 | $0 | $24,841 | Yes (X) | |||
| JAMES KOSIUR | ||||||||
| Physician | 40.00 | $352,037 | $0 | $20,325 | Yes (X) | |||
| JAY SMITH | ||||||||
| Director of Radiology | 40.00 | $137,349 | $0 | $13,136 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,971,976 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $16,389 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $196,429 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Michigan Emergency PHYS L | |||||
| PO Box 674579 | Detroit | MI | 482674579 | ER Doctors | $1,447,344 |
| EVIDENT | |||||
| PO Box 850309 | Mobile | AL | 366850309 | IT and Data Services | $301,518 |
| MCKESSON | |||||
| 38220 Plymouth Road | Livonia | MI | 48150 | Drugs | $297,916 |
| OWENS & MINOR | |||||
| 12199 Collections Center Drive | Chicago | IL | 60693 | Medical Supplies | $243,074 |
| Integrated Systems Consult | |||||
| 3333 Cass Road Ste Suite A | Traverse City | MI | 49684 | IT services | $223,372 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $182,515 | AllOtherContributionsAmt |
| Total Contributions | $182,515 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Other Income | 900099 | $1,860,759 | $1,860,759 |
| Inpatient Outpatient | 621400 | $34,247,394 | $34,247,394 |
| Provider Offices | 621110 | $4,354,303 | $4,354,303 |
| RHC Revenue | 621110 | $1,230,507 | $1,230,507 |
| Contractual Adjust | 621400 | -$16,891,676 | -$16,891,676 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,108,588 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$1,108,588 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,692,699 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,207 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,207 | RelatedOrExemptFuncIncomeAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $41,754 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $41,754 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,754 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $41,754 | UnrelatedBusinessRevenueAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $45,000 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $45,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,000 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $84,119 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $31,899 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $52,220 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,899 | TotalRevenueColumnAmt |
| Exclusion | $31,899 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,016,074 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,759,906 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $41,754 | UnrelatedBusinessRevenueAmt |
| Exclusion | $31,899 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $626,749 | TotalAmt |
| Management And General | $626,749 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,336,485 | TotalAmt |
| Program Services | $8,909,321 | ProgramServicesAmt |
| Management And General | $2,408,623 | ManagementAndGeneralAmt |
| Fundraising | $18,541 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $320,805 | TotalAmt |
| Program Services | $100,404 | ProgramServicesAmt |
| Management And General | $220,401 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,282,827 | TotalAmt |
| Program Services | $258,328 | ProgramServicesAmt |
| Management And General | $1,024,499 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $792,501 | TotalAmt |
| Program Services | $608,395 | ProgramServicesAmt |
| Management And General | $182,786 | ManagementAndGeneralAmt |
| Fundraising | $1,320 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,974,458 | TotalAmt |
| Program Services | $2,546,416 | ProgramServicesAmt |
| Management And General | $428,042 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,274 | TotalAmt |
| Management And General | $84,274 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,980 | TotalAmt |
| Management And General | $54,980 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,744 | TotalAmt |
| Management And General | $96,744 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,101 | TotalAmt |
| Program Services | $28,275 | ProgramServicesAmt |
| Management And General | $79,211 | ManagementAndGeneralAmt |
| Fundraising | $2,615 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $369,218 | TotalAmt |
| Program Services | $163,853 | ProgramServicesAmt |
| Management And General | $203,597 | ManagementAndGeneralAmt |
| Fundraising | $1,768 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,587 | TotalAmt |
| Program Services | $47,954 | ProgramServicesAmt |
| Management And General | $294,633 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,785 | TotalAmt |
| Program Services | $239,238 | ProgramServicesAmt |
| Management And General | $7,547 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,495 | TotalAmt |
| Program Services | $21,399 | ProgramServicesAmt |
| Management And General | $27,966 | ManagementAndGeneralAmt |
| Fundraising | $3,130 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,817 | TotalAmt |
| Program Services | $47,441 | ProgramServicesAmt |
| Management And General | $26,376 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,171 | TotalAmt |
| Program Services | $44,178 | ProgramServicesAmt |
| Management And General | $2,993 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $808,066 | TotalAmt |
| Program Services | $662,053 | ProgramServicesAmt |
| Management And General | $146,013 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243,378 | TotalAmt |
| Program Services | $174,595 | ProgramServicesAmt |
| Management And General | $68,783 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $1,228,117 | $1,228,117 | |
| Drugs | $766,071 | $766,071 | |
| Repairs & Maintenance | $676,197 | $596,214 | $79,983 |
| Taxes & Licenses | $488,813 | $48,280 | $440,533 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,926 | TotalAmt |
| Program Services | $132,768 | ProgramServicesAmt |
| Management And General | $109,888 | ManagementAndGeneralAmt |
| Fundraising | $270 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,265,565 | TotalAmt |
| Program Services | $16,623,300 | ProgramServicesAmt |
| Management And General | $6,614,621 | ManagementAndGeneralAmt |
| Fundraising | $27,644 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,481 | BOYAmt |
| EOY | $179,513 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,993,389 | BOYAmt |
| EOY | $2,391,989 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,162,991 | BOYAmt |
| EOY | $3,558,877 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $463,727 | BOYAmt |
| EOY | $428,108 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $298,643 | BOYAmt |
| EOY | $354,332 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,762,512 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,217,926 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,969,375 | BOYAmt |
| EOY | $4,544,586 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,088,606 | BOYAmt |
| EOY | $11,457,405 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,943,286 | BOYAmt |
| EOY | $2,423,405 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,023,859 | BOYAmt |
| EOY | $815,617 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,968 | BOYAmt |
| EOY | $717,383 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,338,113 | BOYAmt |
| EOY | $3,956,405 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,700,016 | BOYAmt |
| EOY | $7,450,322 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,477 | BOYAmt |
| EOY | $50,678 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,750,493 | BOYAmt |
| EOY | $7,501,000 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,088,606 | BOYAmt |
| EOY | $11,457,405 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $750,509 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
| Public Support Total170 | $0 | PublicSupportTotal170Amt |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Org Leg Ctrl | false | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | false | DisclosedForCharitablePrpsInd |
| Written Policy Monitoring | false | WrittenPolicyMonitoringInd |
| Section170h Rqr Stsfd | false | Section170hRqrStsfdInd |
| Solicited Assets Sale | false | SolicitedAssetsSaleInd |
| Agent Trustee Etc | false | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | false | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $133,080 | OtherCostOrOtherBasisAmt |
| Book Value | $133,080 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,972,532 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,822,694 | DepreciationAmt |
| Book Value | $2,149,838 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $148,698 | OtherCostOrOtherBasisAmt |
| Depreciation | $131,317 | DepreciationAmt |
| Book Value | $17,381 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,508,202 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,263,915 | DepreciationAmt |
| Book Value | $2,244,287 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,544,586 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $23,734,455 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $23,734,455 | RevenueSubtotalAmt |
| Other Revenues Not Included | $281,619 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $281,619 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $24,016,074 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $23,265,565 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $23,265,565 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $23,265,565 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| P11, Ln 4b | INTEREST INCOME; $21,808, GAIN ON SALE OF ASSETS; $45,000 |
| P11, Ln 4b | CONTRIB NET OF FUNDRAISING; $175,077, CONTRIB OF PP&E; $39,337 |
| P11, Ln 4b | INTEREST; $399, MISC ADJUSTMENT; ($2). |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | HOSP AUXILI | Event1Nm |
| Gross Receipts Event1 | $44,352 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $44,352 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $40,833 | OtherDirectExpensesEvent1Amt |
| Event2 | BNFT DINNER | Event2Nm |
| Gross Receipts Event2 | $37,417 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $37,417 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $7,682 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $81,769 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $81,769 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $48,515 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $48,515 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $33,254 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 26 | PersonsServedCnt |
| Total Community Benefit Expns | $13,517 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,517 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0006 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 4768 | PersonsServedCnt |
| Total Community Benefit Expns | $4,398,496 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,245,880 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,152,616 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0925 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $63,058 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $60,443 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,615 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 4794 | PersonsServedCnt |
| Total Community Benefit Expns | $4,475,071 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,306,323 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,168,748 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0932 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 106 | ActivitiesOrProgramsCnt |
| Persons Served | 4487 | PersonsServedCnt |
| Total Community Benefit Expns | $65,252 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $36,088 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $29,164 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0013 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 103 | PersonsServedCnt |
| Total Community Benefit Expns | $32,313 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $32,313 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0014 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 108 | PersonsServedCnt |
| Total Community Benefit Expns | $12,585 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,002 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,583 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0004 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 112 | ActivitiesOrProgramsCnt |
| Persons Served | 4698 | PersonsServedCnt |
| Total Community Benefit Expns | $110,150 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,090 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $71,060 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0031 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 115 | ActivitiesOrProgramsCnt |
| Persons Served | 9492 | PersonsServedCnt |
| Total Community Benefit Expns | $4,585,221 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,345,413 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,239,808 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0963 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,069,824 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,984,339 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,082,446 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$98,107 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE HEALTH SYSTEM | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 DELAWARE STREET | AddressLine1Txt |
| City | Sandusky | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48471 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.mckenziehealth.org | WebsiteAddressTxt |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | Yes (true) | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.mckenziehealth.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.mckenziehealth.org/wp-content/uploads/2016/12/2 | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.mckenziehealth.org/patien | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.mckenziehealth.o | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.mckenzieh | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (23 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 3J | None |
| 5 | Stakeholders were defined as agency and community leaders that have a wide |
| 5 | knowledge base of the region and including human service |
| 5 | agencies, behavioral health agencies, Great Start |
| 5 | Collaboratives, education, government, law enforcement and MSU |
| 5 | Extension. 484 survey participants from four counties. |
| 6a | None |
| 6b | Michigan Thumb Public Alliance |
| 7d | CHNA was distributed to Lions Club, MHS BOD, Sanilac County Mental Health, |
| 7d | Sanilac County Transportation, Sanilac County Dept of Health & Human Serv. |
| 7d | Great Start Collaborative, Blue water Center for Rural Living, Sanilac Lit. |
| 7d | Sanilac probation & Sanilac County Sherif's Dept. |
| 11 | Committies address significant needs identified by the CHNA, including; |
| 11 | Access to Care, Behavioral Health & Chronic Disease. |
| 11 | Continue community presentations & use a variety of methods to reach |
| 11 | audiences of all ages. Continue to grow Chronic Care Management. |
| 11 | Explore community paramedicine and continue to |
| 11 | promote annual wellness visits. Explore behavioral health |
| 11 | integration with primary care clinics. |
| 11 | Open Medication Assisted Treatment in primary care clinics. |
| 11 | Emergency Department tele-psychiatry and social work consults. |
| Part V Section B Line 6b | Michigan Thumb Alliance |
| 38-1738615 | 3J |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| MCKENZIE HEALTH & WELLNESS | ||||
| 170 W ARGYLE STREET | Sandusky | MI | 48471 | PROVIDER OFFICE |
| MCKENZIE RURAL HEALTH CLIN | ||||
| 75 DAWSON STREET | Sandusky | MI | 48471 | PROVIDER OFFICE |
| MCKENZIE FAMILY HEALTHCARE | ||||
| 109 N DELAWARE STREET | Sandusky | MI | 48471 | PROVIDER OFFICE |
| LAKESHORE INTERNAL MEDICIN | ||||
| 7307 CHERRY STREET | Port Sanilac | MI | 48469 | PROVIDER OFFICE |
| CROSWELL CLINIC | ||||
| N HOWARD STREET | Croswell | MI | 48422 | PROVIDER OFFICE |
| PECK MEDICAL CLINIC | ||||
| 251 E PECK ROAD | Peck | MI | 48466 | PROVIDER OFFICE |
| MCKENZIE AFTER-HOURS CLINI | ||||
| 115 DELAWARE STREET | Sandusky | MI | 48471 | PROVIDER OFFICE |
| MCKENZIE ORTHOPEDICS | ||||
| 100 W ARGYLE STREET | Sandusky | MI | 48471 | PROVIDER OFFICE/RENTAL |
Supplemental Information Detail SupplementalInformationDetail (26 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I Line 6a | A community benefit report was prepared during the 2018 tax year. |
| Part I Line 7 | Schedule H worksheets were used to prepare the cost to charge ratio. |
| Part II | McKenzie promoted Community health through various activities, such as; |
| Part II | Senior fair, school tours, County 4-H Fair, & various showcases. |
| Part III Line 2 | Bad debts are est. by the allowance method & indp. audited annually; listed |
| Part III Line 2 | net of discounts and payments rec'd on account post bad debt determination. |
| Part III Line 4 | See attached audited Financial Statements, page 10, Note 1. |
| Part III Line 8 | Mckenzie is a critical access Hospital under medicare reg., reimbursed |
| Part III Line 8 | based on cost. |
| Part III Line 8 | The shortfall of $98,107 consists of 2% sequestration. |
| Part III Line 8 | medicare cost report data was used to calculate these figures. |
| Part III Line 9b | Collection policy references the FAP for those patients that are eligable |
| Part III Line 9b | for assistance as a method of payment. |
| Part VI-2 | In addition to items in SCH H part V sec B, CNHA describes how identified |
| Part VI-2 | needs were prioritized & strategy was implemented. MHS also continuously |
| Part VI-2 | monitors quality scores and patient satisfaction surveys. MHS leadership |
| Part VI-2 | is in constant contact with other healthcare agencies in the community and |
| Part VI-2 | accesses any findings identified through collaboration. |
| Part VI-3 | Uninsured patients receive a Financial policy brochure from staff. Dir. of |
| Part VI-3 | Human Services then follows up with the patient to help apply for medicare/ |
| Part VI-3 | Medicaid and apply for FAP program; this info is also available in brochure |
| Part VI-3 | website, patient statement, hospital lobby, ER & patient fin. services. |
| Part VI-4 | MHS is a CAH located in Sanilac County; population 41,587, 1,600sq miles. |
| Part VI-4 | and 90% rural. 52% of population is uninsured. Unemployment rate is 6.6% |
| Part VI-4 | and 23% of children live in poverty. |
| Part VI-5 | Gov. by board of directors, Serv.; Geriatrics, immunization, Physicals, etc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|
| MICHAEL DREYER | ||||||
| Chairperson | ||||||
| LARRY MICHELL | ||||||
| Director | ||||||
| JOAN NAGELKIRK | ||||||
| ViceChairperson | ||||||
| ORIN CAMPBELL | ||||||
| Director | ||||||
| STEVE BARNETT | ||||||
| CEOPresident | $217,149 | $7,966 | $18,479 | $243,594 | ||
| AMY RUEDISUELI | ||||||
| CFO | $149,419 | $5,625 | $2,262 | $157,306 | ||
| MICHAEL MERKLER | ||||||
| Physician | $267,379 | $9,358 | $276,737 | |||
| JAMES SAMS | ||||||
| Director | $203,686 | $7,247 | $4,523 | $215,456 | ||
| MATTHEW GORMLEY | ||||||
| Chief of Staff | $194,579 | $7,300 | $20,765 | $222,644 | ||
| MARK ENGLISH | ||||||
| Physician | $171,393 | $6,590 | $21,519 | $199,502 | ||
| GINA PATTERSON | ||||||
| Director of Pharmacy | $134,789 | $6,445 | $20,048 | $161,282 | $16,389 | $16,389 |
| BILLI JO HENNIKA | ||||||
| COO | $144,196 | $5,479 | $19,362 | $169,037 | ||
| JAMES KOSIUR | ||||||
| Physician | $352,037 | $9,625 | $10,700 | $372,362 | ||
| JAY SMITH | ||||||
| Director of Radiology | $137,349 | $4,897 | $3,789 | $146,035 | ||
Schedule L IRS990ScheduleL
Disqualified Person Ex Bnft Tr DisqualifiedPersonExBnftTrGrp (6 entries)
| Transaction CorrectedTransactionCorrectedInd |
|---|
| false |
| false |
| false |
| false |
| false |
| false |
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (10 entries)
| DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|
| false | false | false |
| false | false | false |
| false | false | false |
| false | false | false |
| false | false | false |
| false | false | false |
| false | false | false |
| false | false | false |
| false | false | false |
| false | false | false |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (10 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| BARNETT ANESTHESIA | |||
| CEO'S SPOUSE | $106,738 | CRNA SERVICES | false |
| JOAN NAGELKIRK | |||
| DIRECTOR | $96,401 | MARKETING SERV & SUPPLIES | false |
| (no name) | |||
| false | |||
| (no name) | |||
| false | |||
| (no name) | |||
| false | |||
| (no name) | |||
| false | |||
| (no name) | |||
| false | |||
| (no name) | |||
| false | |||
| (no name) | |||
| false | |||
| (no name) | |||
| false | |||
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part VI Line 11b | . |
| Part VI Line 19 | . |
| Part XI Line 9 | Rounding ($2) |
| Part VI Line 6 | Classes of Members make up the Board of Directors. |
| Part VI Line 7a | Board members must be approved by the Board of McKenzie Healthcare Corp. |
| Part VI Line 7a | to become Board Members. |
| Part VI Line 7b | McKenzie Healthcare Corp. must approve any financial transaction above |
| Part VI Line 7b | $1 million dollars prior to being taken to MHS Board of Directors. |
| Part VI Line 11b | MHS Board of Directors are provide a full copy of the 990 & 990T. |
| Part VI Line 11b | MHS CFO reviews and provides a reconciliation of 990 to audited FS. |
| Part VI Line 12c | Board and Committee Members are required to annually fill out a conflict of |
| Part VI Line 12c | interest policy and abstain from any conflicting vote. |
| Part VI Line 15a or b | Compensation is approved by the full MHS Board, based on recommendations |
| Part VI Line 15a or b | and recent compensation surveys. |
| Part VI Line 19 | All documents are available for review by request at the CEO's office. |
| Part VII | Compensation is provided for the 2018 tax (calendar) year. |
| Part IX Line 24e | Food, Laundry, & Misc. Total exp. $242,926 |
| Part IX Line 24e | Program service; $132,768, Mgmt & General; $109,888, Fundraising; $270. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MARLETTE REGIONAL HOSPITAL | ||||||||||
| 2770 MAIN ST PO BOX 307 | Marlette | MI | 48453 | 381507302 | HEALTHCARE | MI | 501 C | 3 | UNITED HEALTHCARE PARTNER | false |
| UNITED HEALTHCARE PARTNERS | ||||||||||
| 120 DELAWARE ST | Sandusky | MI | 48471 | 465444203 | HEALTHCARE | MI | 501 C | 3 | ITSELF | false |
| MCKENZIE HEALTHCARE CORPORATION | ||||||||||
| 120 DELAWARE STREET | Sandusky | MI | 48471 | 382702946 | HEALTHCARE | MI | 501 C | 3 | ITSELF | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SANILAC SERVICES INC | |||||||||||||
| 78 ELK ST | Sandusky | MI | 48471 | 382774983 | RETAIL PHARMACY | MI | MCKENZIE MEMORIAL HOSPITA | C CORP | -$103,523 | $854,802 | 1.00000 | Yes (true) | |
| (no name) | |||||||||||||
| false | N/A | ||||||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (8 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MARLETTE REGIONAL HOSPITAL | ||
| O | $105,407 | COST BASIS |
| (no name) | ||
| P | $26,297 | COST BASIS |
| Marlette | ||
| Q | $14,295 | COST BASIS |
| SANILAC SERVICES INC | ||
| L | $36,050 | COST BASIS |
| (no name) | ||
| Q | $31,438 | COST BASIS |
| Sandusky | ||
| S | $254,446 | COST BASIS |
| (no name) | ||
| A | $625 | COST BASIS |
| (no name) | ||
| R | $10,654 | COST BASIS |
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