MCKENIZE MEMORIAL HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MCKENIZE MEMORIAL HOSPITAL (EIN 38-1738615)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-05-12
- IRS object ID
- 201741359349301334
- Schema version
- 2015v3.0
- 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 | 2017-05-12T14:40:00-06:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | 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 | % STEVE BARNETT | InCareOfNm |
| Business Name Control | MCKE | BusinessNameControlTxt |
| Phone | 8106483770 | PhoneNum |
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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVE BARNETT | PersonNm |
| Person Title | PRESIDENTCEO | PersonTitleTxt |
| Phone | 8106486171 | PhoneNum |
| Signature | 2017-04-21 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | 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 | $20,983,705 | 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 | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 279 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | $39,713 | TotalGrossUBIAmt |
| PY Contributions Grants | $44,215 | PYContributionsGrantsAmt |
| CY Contributions Grants | $35,373 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $20,316,098 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,076,383 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,111 | PYInvestmentIncomeAmt |
| CY Investment Income | -$132,080 | CYInvestmentIncomeAmt |
| PY Other Revenue | $85,063 | PYOtherRevenueAmt |
| CY Other Revenue | -$37,386 | CYOtherRevenueAmt |
| PY Total Revenue | $20,449,487 | PYTotalRevenueAmt |
| CY Total Revenue | $20,942,290 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,195,653 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,085,316 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $22,020 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,425,864 | PYOtherExpensesAmt |
| CY Other Expenses | $8,360,447 | CYOtherExpensesAmt |
| PY Total Expenses | $19,621,517 | PYTotalExpensesAmt |
| CY Total Expenses | $20,445,763 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $827,970 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $496,527 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,660,200 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,254,065 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,366,227 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,463,565 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,293,973 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,790,500 | 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 | $20,445,763 | ExpenseAmt |
| Revenue | $20,942,290 | RevenueAmt |
| Desc | PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES INPATIENT REGISTRATION = 194 OUTPATIENT REGISTRATION = 21,318 EMERGENCY ROOM = 6,082 AMBULANCE RUNS = 21,318 | Desc |
| Total Program Service Expenses | $20,445,763 | 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 | false | 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 | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 39 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 279 | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | false | 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 |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|---|
| STEVE BARNETT | ||||||||
| CEOPRESIDENT | 40.00 | Yes (X) | Yes (X) | $216,390 | $0 | $0 | ||
| AMY RUEDISUELI | ||||||||
| VP OF FINANCE | 40.00 | Yes (X) | $117,361 | $0 | $0 | |||
| MICHAEL MERKLER | ||||||||
| CHIEF OF STAFF | 40.00 | Yes (X) | $262,728 | $0 | $0 | |||
| JAMES SAMS | ||||||||
| PHYSICIAN | 40.00 | $235,369 | $0 | $0 | Yes (X) | |||
| MATTHEW GORMLEY | ||||||||
| PHYSICIAN | 40.00 | $224,627 | $0 | $0 | Yes (X) | |||
| MARK ENGLISH | ||||||||
| PHYSICIAN | 40.00 | $205,024 | $0 | $0 | Yes (X) | |||
| ALFREDO DOMINGO | ||||||||
| PHYSICIAN | 40.00 | $368,690 | $0 | $0 | Yes (X) | |||
| GINA PATTERSON | ||||||||
| DIRECTOR OF PHARMACY | 32.00 | $142,352 | $27,198 | $0 | Yes (X) | 8.000 | ||
| ROGER LODING | ||||||||
| CHAIRPERSON | Yes (X) | $0 | $0 | $0 | ||||
| CHRIS CLARK | ||||||||
| VICE CHAIRPERSON | Yes (X) | $0 | $0 | $0 | ||||
| SUE COOK | ||||||||
| SECRETARY | Yes (X) | $0 | $0 | $0 | ||||
| GAIL DENTON | ||||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | ||||
| JUDITH FERGUSON | ||||||||
| BOARDMEMBER | Yes (X) | $0 | $0 | $0 | ||||
| MICHAEL DREYER | ||||||||
| TREASURER | Yes (X) | $0 | $0 | $0 | ||||
| GLEN KAMPMAN | ||||||||
| BOARDMEMBER | Yes (X) | $0 | $0 | $0 | ||||
| DANIEL BABCOCK | ||||||||
| MARLETTE CEO | Yes (X) | $0 | $0 | $0 | ||||
| LARRY MITCHELL | ||||||||
| BOARDMEMBER | Yes (X) | $0 | $0 | $0 | ||||
| SCOTT ORR | ||||||||
| BOARDMEMBER | Yes (X) | $0 | $0 | $0 | ||||
| LORAINE REISH | ||||||||
| BOARDMEMBER | Yes (X) | $0 | $0 | $0 | ||||
| AL STOUTENBURG | ||||||||
| BOARDMEMBER | Yes (X) | $0 | $0 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,772,541 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $27,198 | TotReportableCompRltdOrgAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MICHGIAN EMERGENCY PHYSICI | |||||
| PRO BOX 674579 | DETROIT | MI | 48267 | ER COVERAGE | $1,481,358 |
| JOHNSON & JOHNSON HEALTHCA | |||||
| 5972 COLLECTIONS CENTER LOCK BOX 12 | CHICAGO | IL | 60693 | $217,364 | |
| CPSI | |||||
| 36695 WALL STREET | MOBILE | AL | 36695 | COMPUTER TECH | $186,196 |
| FISCHER HEALTHCARE | |||||
| 13551 COLLECTION CTR DR | CHICAGO | IL | 60693 | SERVICE EQUIPMENT | $145,387 |
| BIOMET | |||||
| 75 REMITTANCE DRIVE SUITE 3283 | CHICAGO | IL | 606753283 | SERVICE EQUIPMENT | $119,325 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $35,373 | AllOtherContributionsAmt |
| Total Contributions | $35,373 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| INPATIENT OUTPATIENT | $31,536,096 | $31,536,096 |
| PROVIDER OFFICE REVENU | $3,753,242 | $3,753,242 |
| RHC REVENUE | $606,567 | $606,567 |
| CONTRACTUAL ADJUST | -$15,628,446 | -$15,628,446 |
| BAD DEBT CHARITY CAR | -$433,191 | -$433,191 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,242,115 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,242,115 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,076,383 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$132,080 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$132,080 | RelatedOrExemptFuncIncomeAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,713 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,713 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,713 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $39,713 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $40,568 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $41,415 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$847 | TotalRevenueColumnAmt |
| Exclusion | -$847 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| LOSS-DISPOSE OF ASSETS | -$76,252 | -$76,252 |
| LOSS-DISPOSE OF ASSETS | -$76,252 | -$76,252 |
| LOSS-DISPOSE OF ASSETS | -$76,252 | -$76,252 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$76,252 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,942,290 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,868,051 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $39,713 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$847 | 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 | $379,573 | TotalAmt |
| Program Services | $379,573 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,504,963 | TotalAmt |
| Program Services | $7,269,677 | ProgramServicesAmt |
| Management And General | $2,223,217 | ManagementAndGeneralAmt |
| Fundraising | $12,069 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $291,905 | TotalAmt |
| Program Services | $216,843 | ProgramServicesAmt |
| Management And General | $75,062 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,167,187 | TotalAmt |
| Program Services | $806,042 | ProgramServicesAmt |
| Management And General | $361,145 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $741,688 | TotalAmt |
| Program Services | $561,668 | ProgramServicesAmt |
| Management And General | $179,184 | ManagementAndGeneralAmt |
| Fundraising | $836 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,032 | TotalAmt |
| Management And General | $80,032 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,366 | TotalAmt |
| Management And General | $38,366 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,364,246 | TotalAmt |
| Program Services | $2,844,976 | ProgramServicesAmt |
| Management And General | $519,270 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,014 | TotalAmt |
| Program Services | $20,280 | ProgramServicesAmt |
| Management And General | $37,836 | ManagementAndGeneralAmt |
| Fundraising | $7,898 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,003,020 | TotalAmt |
| Program Services | $795,493 | ProgramServicesAmt |
| Management And General | $206,883 | ManagementAndGeneralAmt |
| Fundraising | $644 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,828 | TotalAmt |
| Program Services | $31,364 | ProgramServicesAmt |
| Management And General | $259,292 | ManagementAndGeneralAmt |
| Fundraising | $172 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,587 | TotalAmt |
| Program Services | $331,419 | ProgramServicesAmt |
| Management And General | $7,168 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,770 | TotalAmt |
| Program Services | $94,591 | ProgramServicesAmt |
| Management And General | $22,877 | ManagementAndGeneralAmt |
| Fundraising | $302 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,488 | TotalAmt |
| Program Services | $18,266 | ProgramServicesAmt |
| Management And General | $31,222 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,766 | TotalAmt |
| Program Services | $11,923 | ProgramServicesAmt |
| Management And General | $3,843 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $785,044 | TotalAmt |
| Program Services | $637,681 | ProgramServicesAmt |
| Management And General | $147,363 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,440 | TotalAmt |
| Program Services | $118,927 | ProgramServicesAmt |
| Management And General | $13,513 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| RX | $705,549 | $705,549 | ||
| IMPLANT/BLOOD | $220,771 | $211,648 | $9,123 | |
| TAX/LICENSES | $531,792 | $531,792 | ||
| FOOD/LAUNDRY/MISC | $620,734 | $143,542 | $477,093 | $99 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,445,763 | TotalAmt |
| Program Services | $15,731,254 | ProgramServicesAmt |
| Management And General | $4,692,489 | ManagementAndGeneralAmt |
| Fundraising | $22,020 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $403,224 | BOYAmt |
| EOY | $102,046 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,139,326 | BOYAmt |
| EOY | $2,193,100 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,721,648 | BOYAmt |
| EOY | $3,131,057 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,099 | BOYAmt |
| EOY | $464,564 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,586 | BOYAmt |
| EOY | $239,478 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,648,757 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,524,937 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,542,453 | BOYAmt |
| EOY | $4,123,820 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,864 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,660,200 | BOYAmt |
| EOY | $10,254,065 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,130,814 | BOYAmt |
| EOY | $2,588,244 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,688,200 | BOYAmt |
| EOY | $1,459,538 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $547,213 | BOYAmt |
| EOY | $415,783 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,366,227 | BOYAmt |
| EOY | $4,463,565 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,220,399 | BOYAmt |
| EOY | $5,716,567 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,574 | BOYAmt |
| EOY | $73,933 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,293,973 | BOYAmt |
| EOY | $5,790,500 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,660,200 | BOYAmt |
| EOY | $10,254,065 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $496,527 | ReconcilationRevenueExpnssAmt |
| 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 | $7,674,204 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,131,793 | DepreciationAmt |
| Book Value | $2,542,411 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $138,279 | OtherCostOrOtherBasisAmt |
| Depreciation | $125,586 | DepreciationAmt |
| Book Value | $12,693 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,699,494 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,267,558 | DepreciationAmt |
| Book Value | $1,431,936 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,700 | OtherCostOrOtherBasisAmt |
| Book Value | $3,700 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,123,820 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $21,116,096 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $173,806 | OtherRevenueAmt |
| Revenue Not Reported | $173,806 | RevenueNotReportedAmt |
| Revenue Subtotal | $20,942,290 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $20,942,290 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,522,011 | TotExpnsEtcAuditedFinclStmtAmt |
| Losses Reported | $76,252 | LossesReportedAmt |
| Other Expenses Included | -$4 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $76,248 | ExpensesNotReportedAmt |
| Expenses Subtotal | $20,445,763 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $20,445,763 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| P11, Ln 4b | 17,764 Interest; (149,864) Consolidated Affiliate; 34,189 Contribution |
| P11, Ln 4b | 336 RESTRICTED CONTRIBUTION; 21 RESTRICTED INTEREST |
| P12, Ln 2d | 4 ROUNDING |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Hosp Auxil | Event1Nm |
| Gross Receipts Event1 | $38,268 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $38,268 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $40,235 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $38,268 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $38,268 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $40,235 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $40,235 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$1,967 | 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 | 8 | PersonsServedCnt |
| Total Community Benefit Expns | $69,487 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $69,487 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 4215 | PersonsServedCnt |
| Total Community Benefit Expns | $3,782,228 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,587,742 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,194,485 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05840 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 4223 | PersonsServedCnt |
| Total Community Benefit Expns | $3,851,715 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,587,742 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,263,972 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06180 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 73 | ActivitiesOrProgramsCnt |
| Persons Served | 3824 | PersonsServedCnt |
| Total Community Benefit Expns | $90,853 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $47,209 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $43,644 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,166 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00074 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $4,966 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,966 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 200 | PersonsServedCnt |
| Total Community Benefit Expns | $200 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $200 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 76 | ActivitiesOrProgramsCnt |
| Persons Served | 4024 | PersonsServedCnt |
| Total Community Benefit Expns | $111,185 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $47,209 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $63,976 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00304 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 78 | ActivitiesOrProgramsCnt |
| Persons Served | 8247 | PersonsServedCnt |
| Total Community Benefit Expns | $3,962,900 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,634,951 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,327,948 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06484 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $439 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $439 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00002 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 16 | ActivitiesOrProgramsCnt |
| Persons Served | 1210 | PersonsServedCnt |
| Total Community Benefit Expns | $2,265 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,265 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00011 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 60 | PersonsServedCnt |
| Total Community Benefit Expns | $185 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00001 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 18 | ActivitiesOrProgramsCnt |
| Persons Served | 1270 | PersonsServedCnt |
| Total Community Benefit Expns | $2,889 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,889 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00014 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $391,774 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $7,181 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,687,311 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,796,463 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$109,152 | 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 | WWWMCKENZIEHEALTHORG | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48466 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 760030 | StateLicenseNum |
| 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 MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | 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/wp-content/uploa | 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 | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.mckenziehealth.org/wp-content/uploads/ | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Form4720 Filed | false | Form4720FiledInd |
| 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 | http://www.mckenziehealth.org | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.mckenzieh | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.mc | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (29 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 3j | DESCRIBES HOW ID NEEDS WERE PRIORITIZED. CHNA CONTAINS IMPLENT PLAN & STRAT |
| 5 | HOSPITAL HELD A FOCUS GROUP WHICH INCLUDED REPS FROM SANDUSKY CITY COUNCIL, |
| 5 | THUMB ELITE ATHLETICS, SANDUSKY ARTS COUNCIL, SANDUSKY POLICE DEPARTMENT, |
| 5 | LOCAL PARENTS, EDUCATION PROFESSIONALS, CHURCHES. THE HOSPITAL HELD KEY |
| 5 | STAKEHOLDER INTERVIEWS WITH A REP FROM THE MICHIGAN DEPARTMENT OF HEALTH & |
| 5 | HUMAN SERVICES, SANILAC COUNTY MENTAL HEALTH & THE SANILAC INTERMEDIATE SCH |
| 6a | MARLETTE REGIONAL HOSPITAL, SCHEURER HOSPITAL, DECKERVILLE HOSPITAL, CARO |
| 6a | COMMUNITY HOSPITAL, HURON MEDICAL CENTER & HILLS AND DALES HOSPITAL. |
| 6b | SANILAC COUNTY HEALTH DEPT, TUSCOLA HEALTH DEPT & HURON COUNTY HEALTH DEPT. |
| 7d | THE CHNA REPORT IS BEING DISTRIBUTED TO COMMUNITY MEMBERS, INCLUDING THE |
| 7d | LIONS CLUB, COMMUNITY COLLABORATIVE COMMITTEE & MCKENZIE'S BOARD OF DIRECT |
| 7d | COMMUNITY COLLABORATIVE CONSISTS OF SANILAC COUNTY COMMUNITY MENTAL HEALTH, |
| 7d | SANILAC TRANSPORTATION, SANILAC COUNTY DEPT OF HEALTH & HUMAN SERVICES, |
| 7d | GREAT START COLLABORATIVE, BLUE WATER CENTER FOR RURAL LIVING, SANILAC |
| 7d | LITERACY, SANILAC PROBATION & SANILAC COUNTY SHERIFFS DEPT |
| 11 | COMMITTES WERE FORMED TO ADDRESS SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA. |
| 11 | THE FOLLOWING NEEDS WERE IDENTIFIED FROM THE CHNA: NOT ENOUGH PROVIDER |
| 11 | EVENING & WEEKEND HOURS, NOT ENOUGH SPECIALIST, LACK OF HEALTH INSURANCE, |
| 11 | LACK OF AWARENESS OF LOCAL HEALTH RESOURCES & SERVICES, LACK OF JOBS WITH |
| 11 | LIVEABLE WAGE, AVAILABILITY OF MENTAL HEALTH SERVICES, CONCERNS ABOUT CRIME |
| 11 | & SAFETY, COST OF INSURANCE, YOUTH OBESITY, YOUTH DRUG ABUSE, LACK OF |
| 11 | RESOURCES FOR FRIENDS & FAMILY CARING FOR ELDERY & THE ABILITY TO KEEP |
| 11 | ELDERLY IN THEIR HOME, NOT ENOUGH PUBLIC TRANSPORTATION & ADULT OBESITY. |
| 11 | COMMITTES WILL WORK WITH LOCAL ORGANIZATIONS TO ADDRESS NEEDS OUTLINED BY |
| 11 | THE CHNA, INCLUDING, LAW ENFORCEMENT, MENTAL HEALTH, SCHOOLS, SANILAC |
| 11 | TRANSPORTATION, SPECIALTY PRACTICES IN THE SURRONDING AREAS, TELEHEALTH |
| 11 | OPTIONS, NURSE HOTLINES & LOCAL MEDIA FOR INCREASED ADV OF SERIVCES & PROGR |
| 22d | MEDICARE & CONTRACTED COMMERICAL CARRIER RATES WERE USED |
| 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 AND WELLNE | ||||
| 170 W ARGYLE STREET | SANDUSKY | MI | 48471 | PROVIDER OFFICE |
| MCKENZIE RURAL HEALTH CLIN | ||||
| 75 DAWSON STREET | SANDUSKY | MI | 48471 | PROVIDER OFFICE |
| MAIN STREET HEALTH CENTER | ||||
| 74 SOUTH ELK STREET | SANDUSKY | MI | 48471 | ORTHOPEDIC OFFICES |
| 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 | ||||
| 8 N HOWARD STREET | CROSWELL | MI | 48422 | PROVIDER OFFICE |
| PECK MEDICAL CENTER | ||||
| 251 E PECK ROAD | PECK | MI | 48466 | PROVIDER OFFICE |
| SANILAC MEDICAL PLAZA | ||||
| 100 W ARGYLE STREET | SANDUSKY | MI | 48471 | PROVIDER OFFICE/RENTAL |
Supplemental Information Detail SupplementalInformationDetail (32 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I LINE 6A | A COMMUNITY BENEFIT REPORT WAS PREPARED DURING THE 2015 TAX YEAR. |
| PART I LINE 7 | MCKENZIE USES SCHEDULE H WORKSHEETS TO PREPARE THE COST TO CHARGE RATIO |
| PART II | MCKENZIE COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITY |
| PART II | BY SUPPORTING THE LOCAL COMMUNITY THROUGH VARIOUS ACTIVITES. EXAMPLES: |
| PART II | COMMUNITY SENIOR FAIR, SCHOOL TOURS, SANILAC 4-H FAIR & VARIOUS SHOWCASES |
| PART III LINE 2 | BAD DEBTS ARE ESTIMATED USING THE ALLOWANCE METHOD. THE BAD DEBT EXPENSE |
| PART III LINE 2 | COST DETRIMINED BASED UPON THE COST TO CHARGE RATIO PER SCH H WORKSHEET |
| PART III LINE 3 | COST OF BAD DEBT EXPENSES ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE |
| PART III LINE 3 | ANALYZED FAP APPLICATIONS THAT WERE DENIED DUE INCOMPLETE DOCUMENTATION |
| PART III LINE 3 | APPLIED COST TO CHARGE RATIO DEVELOPED IN SCHEDULE H. THIS EXPENSE IS |
| PART III LINE 3 | INCLUDED AS IT IS OUR COMMUNITY THAT CAN NOT AFFORD TO PAY THEIR BILL |
| PART III LINE 4 | FOOTNOTE INCLUDED IN ATTACHED AUDITED FINANCIAL STATEMENTS, PG 11&14, NOTE1 |
| PART III LINE 8 | THE HOSPITAL IS DESIGNATED A CRITICAL ACCESS HOSPITAL UNDER MEDICARE REGS. |
| PART III LINE 8 | MOST SERVICES OF CAH'S ARE COST REIMBURSED;THERE ARE CERTAIN NECESSARY SERV |
| PART III LINE 8 | THAT ARE NOT. THE SHORTFALL OF $109,152 IS DERIVED FROM THOSE TYPES OF SERV |
| PART III LINE 8 | THE MEDICARE COST REPORT DATA WAS USED TO CALCULATE THESE FIGURES. |
| PART III LINE 9b | COLLECTION POLICY REFERENCES THE FAP FOR THOSE PATIENTS THAT ARE ELIGIBLE |
| PART III LINE 9b | FOR ASSISTANCE AS A METHOD OF PAYMENT/COLLECTIONS FOR HOSPITAL ACCOUNTS. |
| PART VI 2 | REPORT DESCRIBES HOW IDENTIFIED NEEDS WERE PRIORITIZED & IMPLEMENATION |
| PART VI 2 | STRATEGY. LEADERSHIP CONTINUES TO WORK WITH HEALTHCARE ORG THROUGH COMM. |
| PART VI 3 | ALL PATIENTS WHO ARE UNINSURED ARE GIVEN A FINANCIAL POLICY BROCHURE, THE |
| PART VI 3 | DIRECTOR OF HUMAN RESOURCES IS THEN NOTIFIED FOR FOLLOW UP WITH PATIENT |
| PART VI 3 | THE FAP IS LOCATED ON PATIENT STATEMENTS, MHS'S WEBSITE & HOSPITAL LOBBIES |
| PART VI 4 | MHS IS A CAH IN RURAL SANILAC COUNTY, POPULATION=41,587.UNISUREDPOPULATION |
| PART VI 4 | =15% UNEMPLOYMENT=8.4%. CHILDREN LIVE IN POVERTY=23%. MEDIAN INCOME=42,100. |
| PART VI 5 | GOVERNED BY COMMUNITY BOARD OF DIRECTORS. SERVICE PROVIDED BASED UPON COMM |
| PART VI 5 | NEEDS= GERATRICS PROGRAM, SENIOR FAIR, SPORTS PHYSICALS &IMMUNIZATIONS |
| PART VI 6 & 7 | NOT APPLICABLE |
| Part III Line 2 | ESTIMATED USING THE ALLOW ANCE METHOD & COST TO CHG |
| Part III Line 3 | ANALYZED FAP LOG FOR DENIALS, COST TO CHARGE |
| Part III Line 4 | SEE ATTACHED AUDITIED FS PG 11 & 14 NOTE 1 |
| Part III Line 9b | THE COLLECTION POLICY REFERENCES THE FAP |
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 (20 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|
| STEVE BARNETT | |||||
| CEOPRESIDENT | $189,960 | $26,430 | $216,390 | ||
| AMY RUEDISUELI | |||||
| VP OF FINANCE | $110,379 | $6,982 | $117,361 | ||
| MICHAEL MERKLER | |||||
| CHIEF OF STAFF | $253,453 | $9,275 | $262,728 | ||
| JAMES SAMS | |||||
| PHYSICIAN | $223,555 | $11,814 | $235,369 | ||
| MATTHEW GORMLEY | |||||
| PHYSICIAN | $196,506 | $28,121 | $224,627 | ||
| MARK ENGLISH | |||||
| PHYSICIAN | $176,627 | $28,397 | $205,024 | ||
| ALFREDO DOMINGO | |||||
| PHYSICIAN | $368,690 | $368,690 | |||
| GINA PATTERSON | |||||
| DIRECTOR OF PHARMACY | $117,913 | $24,439 | $142,352 | $27,198 | $27,198 |
| ROGER LODING | |||||
| CHAIRPERSON | |||||
| CHRIS CLARK | |||||
| VICE CHAIRPERSON | |||||
| SUE COOK | |||||
| SECRETARY | |||||
| GAIL DENTON | |||||
| BOARD MEMBER | |||||
| JUDITH FERGUSON | |||||
| BOARDMEMBER | |||||
| MICHAEL DREYER | |||||
| TREASURER | |||||
| GLEN KAMPMAN | |||||
| BOARDMEMBER | |||||
| DANIEL BABCOCK | |||||
| MARLETTE CEO | |||||
| LARRY MITCHELL | |||||
| BOARDMEMBER | |||||
| SCOTT ORR | |||||
| BOARDMEMBER | |||||
| LORAINE REISH | |||||
| BOARDMEMBER | |||||
| AL STOUTENBURG | |||||
| BOARDMEMBER | |||||
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 | $1,011 | CRNA SERVICES | 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 | |||
| (no name) | |||
| false | |||
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 BLUE WAATER HEALTHCARE |
| Part VI Line 7a | NETWORK TO BECOME BOARD MEMBERS. |
| Part VI Line 7b | BLUE WATER HEALTHCARE NETWORK MUST APPROVE ANY FINANCIAL TRANSACTIONS ABOVE |
| Part VI Line 7b | ONE MILLION DOLLARS BEFORE ANY ACTION CAN BE TAKE BY THE BOD AT MCKENZIE. |
| Part VI Line 11b | FINANCE COMMITTEE FIRST REVIEWS THE 990 WITH ALL SCHEDULES AND THE 990-T |
| Part VI Line 11b | REPORT IS THEN REVIEWED BY FULL BOARD. |
| Part VI Line 12c | BOARD AND COMMITTEE MEMBERS ARE REQUIRED TO ANNUALLY FILL OUT THE ANNUAL |
| Part VI Line 12c | CONFLICT OF INTEREST POLICY AND ABSTAIN FROM ANY CONFLICTING VOTE. |
| Part VI Line 15a or b | COMPENSATION IS APPROVED BY THE FULL BOARD, BASED UPON RECOMMENDATIONS |
| Part VI Line 15a or b | FROM COMPENSATION SURVEYS. |
| Part VI Line 19 | ALL DOCUMENTS ARE AVAILABLE FOR INSPECTION AT REQUEST AT THE CEO/PRESIDENTS |
| Part VI Line 19 | OFFICE. |
| Part IX Line 11g | MISC Total expenses - $3364246.00 Program service expenses - $2844976.00 Mgmt and general expenses - $519270.00 Fundraising expenses - $0.00 |
| PART X LINE 11 | PUBLICLY TRADED SECRUTIES, THIS AMOUNT WAS PREVIOUSLY LISTED UNDER LINE 15. |
| PART X LINE 11 | THIS SECRUITY HAS BEEN DEEMED WORTHLESS DURING TAX YEAR 2015. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 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 STREET PO BOX 307 | MARLETTE | MI | 48453 | 381507302 | HEALTHCARE | MI | 501 C | 3 | UNITED HEALTHCARE PARTNER | false |
| UNITED HEALTHCARE PARTNERS | ||||||||||
| 120 DELAWARE STREET | SANDUSKY | MI | 48471 | 465444203 | HEALTCHARE | MI | 501 C | 3 | ITSELF | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANILAC SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 78 S ELK ST | AddressLine1Txt |
| City | SANDUSKY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48471 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382774983 | EIN |
| Primary Activities | PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | MI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | 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 | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | 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 | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MARLETTE REGIONAL HOSPITAL | ||
| O | $76,997 | COST BASIS |
| MARLETTE REGIONAL HOSPITAL | ||
| P | $38,541 | COST BASIS |
| MARLETTE REGIONAL HOSPITAL | ||
| Q | $39,215 | COST BASIS |
| UNITED HEALTHCARE PARTNERS | ||
| UNITED HEALTHCARE PARTNERS | ||
| UNITED HEALTHCARE PARTNERS | ||
| SANILAC SERVICES | ||
| K | $15,000 | FMV |
| SANILAC SERVICES | ||
| P | $12,944 | COST BASIS |
| SANILAC SERVICES | ||
| Q | $90,000 | COST BASIS |