2018-02-09T11:22:10-06:00 2017-03-31 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2016-04-01 208756459 Mackinac Straits Health System Inc MACK 9066438585 1140 N State Street St Ignace MI 49781 JASON ANDERSON CFO 9066438585 2018-02-08 1 Terri Rexrode CPA MST P00096513 9206620016 2018-01-29 74.87.127.142 2018-02-08 07:34:11 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2016 2021-01-29 14:40:06Z JASON ANDERSON 1140 N State Street St Ignace MI 49781 42130542 0 X mackinacstraitshealth.org X 2008 MI WE WILL BE THE HOSPITAL OF CHOICE AND RECOGNIZED FOR OUR EXEMPLARY PATIENT CARE, PEOPLE AND PERFORMANCE. WE HAVE A PASSION FOR EXCELLENCE AND STRIVE TO SET AND DELIVER THE HIGHEST STANDARDS OF SERVICE, INTEGRITY AND MOST OF ALL QUALITY. WE VALUE THE DIVERSITY AND CULTURES IN OUR COMMUNITY. 11 8 358 20 0 0 683656 598179 39145773 39403985 3394 29500 1286225 2098878 41119048 42130542 0 0 0 0 19310776 19422645 0 0 0 22539250 22430921 41850026 41853566 -730978 276976 45940916 42819542 68349944 65555007 -22409028 -22735465 PROVIDING LOCAL ACCESS AND QUALITY HEALTHCARE TO THE FAMILIES AND COMMUNITIES WE SERVE. 0 0 39214768 41290320 MACKINAC STRAITS HEALTH SYSTEM, INC. OPERATES A 15-BED ACUTE CARE FACILITY, A 48-BED LONG-TERM CARE UNIT, AND SEVERAL PHYSICIAN CLINICS IN MACKINAC COUNTY, MICHIGAN. THE Health System PROVIDEs COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, AND PHYSICIAN SERVICES TO THE RESIDENTS OF MACKINAC COUNTY AND THE SURROUNDING AREAS. 39214768 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 42 0 358 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JASON ANDERSON 9066438585 1140 N State Street ST IGNACE MI 49781 CHRISTINE MCPHERSON BOARD MEMBER 1.00 3.00 X 0 0 0 Dr CARL HAWKINS Board Member/Post-Chief of 40.00 3.00 X 113221 0 17150 DR EDWARD SMITH Board Member/Chief of Staff - elect 40.00 3.00 X 386950 0 23126 DR MATTHEW BOWES Board Member/Chief of Staff 40.00 3.00 X 292699 0 21307 JAMES NORTH TREASURER 1.00 3.70 X X 0 0 0 MARGARET DOUD Secretary 1.00 3.70 X X 0 0 0 Mary Maurer Board Member 1.00 3.00 X 0 0 0 PATRICK SHANNON CHAIRMAN 1.00 3.00 X X 0 0 0 PRENTISS BROWN BOARD MEMBER 1.00 3.70 X 0 0 0 Richard Smith Board Member 1.00 3.00 X 0 0 0 STEVE AUTORE Vice Chair 1.00 3.70 X X 0 0 0 JASON ANDERSON CFO 40.00 3.00 X 105663 0 20588 RODNEY NELSON CEO 40.00 3.70 X 166063 0 20588 Amy Bolmer Physician 40.00 X 231120 0 7287 Charlene Sweeney physician 40.00 X 206270 0 28088 Roderick Baltzer Physician 40.00 X 276814 0 8738 Susan Strich Physician 40.00 X 421293 0 20588 Todd Harburn Physician 40.00 X 211998 0 17670 2412091 0 185130 19 0 1 0 Tom Tietjen 859 Surry Road Petoskey MI 49770 PHYSICIAN SERVICES 261747 Wipfli LLP PO Box 3160 Milwaukee WI 53201 Accounting Services 153364 Venable LLP PO Box 62727 Baltimore MD 21264 Legal services 119356 3 428675 169504 598179 Patient Revenue 900099 37999676 37890208 109468 QAAP REVENUE 900099 1394109 1394109 Affiliate rental revenue 900099 10200 10200 39403985 29500 0 29500 29500 29500 Tax Levy 900099 1210983 1210983 Meaningful Use Incentive 900099 784820 784820 Physician Incentives 900099 103075 103075 2098878 42130542 41290320 0 242043 X 1167715 854813 312902 12680974 11785602 895372 1284357 1175306 109051 3346450 3094734 251716 943149 863069 80080 157505 156855 650 233537 233537 4942891 4678413 264478 57725 57725 7500079 7461943 38136 1827076 1826701 375 94279 69765 24514 51785 34726 17059 2194232 2194232 2846045 2846045 201349 201349 Bad Debt Expense 1330901 1330901 QAAP Taxes Paid 630120 630120 Minor equipment 136883 136883 Dues & subscriptions 94397 93312 1085 132117 118857 13260 41853566 39214768 2638798 0 628356 681823 47664 58552 3615432 3021805 515000 441000 1043501 1032540 89840 214420 53377286 16021545 39571950 37355741 429173 13661 45940916 42819542 3279315 3457567 1727354 1245302 54754922 53576882 8588353 7275256 68349944 65555007 X -22437783 -22764665 28755 29200 -22409028 -22735465 45940916 42819542 X 276976 -603413 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2278 2278 0 Part II-B, Line 1: The organization belongs to the AHA and MHA and pays dues. A portion of the dues are spent on lobbying activities. 1200000 1200000 37770740 10280821 27489919 3193628 981245 2212383 10862223 4759479 6102744 350695 350695 37355741 Amounts Payable to Third Parties 15020 Pension Liability 7234792 Patient Trust Savings 25444 7275256 39958691 -1743176 -1743176 41701867 428675 428675 42130542 39955075 108066 108066 39847009 2006557 2006557 41853566 Part XI, Line 2d - Other Adjustments: QAAP Payments -630,120. Bad debt expense -1,330,901. Foundation Revenue 263,381. 340b expense -45,536. Part XI, Line 4b - Other Adjustments: Grant from Foundation 428,675. Part XII, Line 2d - Other Adjustments: Foundation expenses 108,066. Part XII, Line 4b - Other Adjustments: Provision for bad debt 1,330,901. QAAP Payments 630,120. 340b expense 45,536. 1 1 X 1 X 1 X 1 0 0 254570 254570 0.00630 3537018 3160872 376146 0.00930 3791588 3160872 630716 0.01560 3740 3740 0.00010 85965 85965 0.00210 582233 268377 313856 0.00770 3861 3861 0.00010 675799 268377 407422 0.01000 4467387 3429249 1038138 0.02560 0 975034 11555643 11771283 -215640 X 1 0 1 1 MACKINAC STRAITS HEALTH SYSTEM INC 1140 N State Street ST IGNACE MI 49781 www.mackinacstraitshealth.org MW0043832 X X X RHC MACKINAC STRAITS HEALTH SYSTEM INC 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://mackinacstraitshealth.org/about-us/community-needs-assessment.html X 1 15 1 http://mackinacstraitshealth.org/about-us/community-needs-assessment.html 0 1 X 100.000000000000 300.000000000000 X X X X 1 1 X X X 1 X http://mackinacstraitshealth.org/patient-resources.html X http://mackinacstraitshealth.org/patient-resources.html X http://mackinacstraitshealth.org/patient-resources.html X X X X X 1 X 0 X X 1 X 0 0 MACKINAC STRAITS HEALTH SYSTEM, INC. Part V, Section B, Line 5: KEY INFORMATIONAL INTERVIEWS WERE CONDUCTED WITH MEMBERS OF THE COMMUNITY SERVED BY MACKINAC STRAITS HEALTH SYSTEM. THESE INDIVIDUALS WERE IDENTIFIED BY THE COMMITTEE BASED ON THEIR QUALIFICATIONS TO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED. GENERALLY, THE INTERVIEWEES INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH AND PERSONS WHO REPRESENT THE MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS. MACKINAC STRAITS HEALTH SYSTEM, INC. Part V, Section B, Line 11: The following needs were identified during the CHNA conducted in 2016: Mental health and substance abuse, access to pharmacy, cost of care, obesity/diabetes, and transportation. Mental health and substance abuse: A large amount of resources of the community task force are being directed towards mental health and substance abuse issues in addition to working towards increased accessability to enhanced mental health and treatment services within the community. Access to Pharmacy: Continued development of the 340b program along with enhanced pharmacy services via new retail pharmacy. Cost of Care: Improve communication of services such as charity care and similar programs through outreach initiatives. Obesity/diabetes: Continued development of diabetes education program and promotion of physical activity and healthy eating habits. Transportation: System Resources are limited as to the impact that can be made in this area of concern. 3 1 - MACKINAW CITY MEDICAL CLINIC 580 SOUTH NICOLET ST MACKINAW CITY MI 49701 physician Office 2 - Mackinac Island Medical Clinic 7474 Market Street Mackinac island MI 49757 emergency room & Physician Office 3 - Rivertown Medical Center 920 South Huron Street Cheboygan MI 49721 physician Office Part I, Line 7: THE ORGANIZATION UTILIZES A COST TO CHARGE RATIO WHEN CALCULATING THE PERCENTAGE OF CHARITY CARE AND COMMUNITY BENEFIT PERCENTAGES. Part I, Line 7g: The entire amount of subsidized health services is from physician clinics. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,330,901. Part II, Community Building Activities: Provided 24 hour emergency and essential health care services to rural community. Part III, Line 2: The bad debt expense at cost is calculated using the cost to charge ratio. Part III, Line 3: The bad debt expense is calculated utilizing actual write-offs and the amounts that have been determined likely to be written off given past experience of the collection possibilities. Although there are some amounts of charity care included in this amount, there is not a current method to easily obtain the amount that should have been charity care. Part III, Line 4: In evaluating the collectability of patient accounts receivable, the Organization analyzes past results and identifies trends for each major payor source of revenue for the purpose of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source is regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established based on historical write-off percentages; for receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Part III, Line 8: It is considered community benefit as the Hospital is reimbursed on Medicare allowable costs. Medicare allowable costs are defined by Medicare. They do not necessarily capture all costs of the hospital providing services to the community. Consequently, there are costs not reimbursed by either patient or the program. Medicare allowable costs are from the Medicare cost report. Part VI, Line 2: Feedback from community members via survey and presentations at local organizations Part VI, Line 3: Pamplets and other literature and signage Part VI, Line 4: Mackinac County - a rural county in Michigan's Upper Penninsula. Seasonal economy with higher than average unemployment. Aging population with large number of Native Americans. Part VI, Line 5: A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND ALSO PROVIDES COURTESY PRIVILIGES TO ANY VISITING SPECIALISTS WHO ARE ALSO PROVIDED SPACE IN OUR BUILDINGS IN ORDER TO SEE THEIR PATIENTS. X X X X 0 0 0 0 0 0 0 0 0 DR EDWARD SMITH Board Member/Chief of Staff - elect 326583 0 60367 0 0 0 738 0 22388 0 410076 0 0 0 DR MATTHEW BOWES Board Member/Chief of Staff 292699 0 0 0 0 0 719 0 20588 0 314006 0 0 0 RODNEY NELSON CEO 156659 0 0 0 9404 0 0 0 20588 0 186651 0 0 0 Amy Bolmer Physician 219936 0 0 0 11184 0 0 0 7287 0 238407 0 0 0 Charlene Sweeney physician 206270 0 0 0 0 0 0 0 28088 0 234358 0 0 0 Roderick Baltzer Physician 247250 0 0 0 29564 0 677 0 8061 0 285552 0 0 0 Susan Strich Physician 400820 0 0 0 20473 0 0 0 20588 0 441881 0 0 0 Todd Harburn Physician 204589 0 0 0 7409 0 0 0 17670 0 229668 0 0 0 Form 990, Part VI, Section B, line 11b THE BOARD OF DIRECTORS HAS DELEGATED TO REVIEW AND APPROVAL OF THE FORM 990 TO THE CFO. The 990 return is e-mailed to the board members prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Board of Directors monitors the conflict of interest policy. New conflicts of interest are reviewed by the Board in accordance with the policy and documented. Form 990, Part VI, Section B, line 15 THE PROCESS FOR DETERMINING ALL COMPENSATION IS BASED ON THE MHA ANNUAL SURVEY. All changes to officer compensation are reviewed and approved independently by the board of directors and documented in the board of director minutes. Form 990, Part VI, Section C, line 19 The organization makes their documentation available to the public by request only. The audited financial statements are attached to the Form 990 making them available for public inspection. Form 990, Part IX, line 11g physician services: Program service expenses 2,564,097. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,564,097. Therapy services: Program service expenses 336,202. Management and general expenses 0. Fundraising expenses 0. Total expenses 336,202. Nursing services: Program service expenses 57,075. Management and general expenses 0. Fundraising expenses 0. Total expenses 57,075. Surgery Services: Program service expenses 60,373. Management and general expenses 0. Fundraising expenses 0. Total expenses 60,373. Laboratory services: Program service expenses 292,417. Management and general expenses 0. Fundraising expenses 0. Total expenses 292,417. Radiology Services: Program service expenses 110,970. Management and general expenses 0. Fundraising expenses 0. Total expenses 110,970. Pharmacy Services: Program service expenses 68,310. Management and general expenses 0. Fundraising expenses 0. Total expenses 68,310. Clinic Services: Program service expenses 53,561. Management and general expenses 0. Fundraising expenses 0. Total expenses 53,561. Maintenance Services: Program service expenses 118,646. Management and general expenses 0. Fundraising expenses 0. Total expenses 118,646. laundry services: Program service expenses 151,957. Management and general expenses 0. Fundraising expenses 0. Total expenses 151,957. information technology services: Program service expenses 567,592. Management and general expenses 0. Fundraising expenses 0. Total expenses 567,592. risk management services: Program service expenses 12,904. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,904. materials management services: Program service expenses 22,446. Management and general expenses 0. Fundraising expenses 0. Total expenses 22,446. miscellaneous services: Program service expenses 34,046. Management and general expenses 2,518. Fundraising expenses 0. Total expenses 36,564. Oncology Services: Program service expenses 54,536. Management and general expenses 0. Fundraising expenses 0. Total expenses 54,536. Fiscal & Administration services: Program service expenses 7,005. Management and general expenses 156,885. Fundraising expenses 0. Total expenses 163,890. human resources services: Program service expenses 0. Management and general expenses 81,312. Fundraising expenses 0. Total expenses 81,312. edcuation services: Program service expenses 0. Management and general expenses 23,763. Fundraising expenses 0. Total expenses 23,763. medical records services: Program service expenses 166,276. Management and general expenses 0. Fundraising expenses 0. Total expenses 166,276. Form 990, Part XI, line 9: Change in Pension Obligation other than Pension Expense -584,975. Change in interest in Foundation -18,438. FORM 990, PART XI, LINE 2C The audited financial statements are presented to the Mackinac Straits Health System finance committee and recommendations are taken to the Mackinac Straits Health System Board of Directors. The process has not changed from the prior year. MACKINAC STRAITS AREA HEALTH 1140 North State Street ST Ignace MI 49781 472021925 SUPPORT MACKINAC STRAITS HEALTH SYSTEM MI 501(c)(3) Line 12b, II N/A 0 MACKINAC STRAITS HEALTH FOUNDATION 1140 North State Street ST Ignace MI 49781 465296565 FOUNDATION MI 501(c)(3) Line 12b, II Mackinac Straits Health System 0 Straits Area Pharmacy Inc 1140 N State Street St Ignace MI 49781 813168928 Retail Pharmacy MI N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 Mackinac straits health foundation C 428675 FMV