2016-02-12T10:17:59-06:00 2015-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2014-04-01 320031170 MOSES DIALYSIS UNIT MOSE 9066438585 1140 NORTH STATE STREET ST IGNACE MI 49781 JASON ANDERSON CFO 9066438585 2016-02-08 1 TERRI REXRODE CPA MST P00096513 9206620016 2016-02-08 2014 2016-08-17 19:52:53Z X JASON ANDERSON 1140 NORTH STATE STREET ST IGNACE MI 49781 102712 0 X WWW.MACKINACSTRAITSHEALTH.ORG X 2002 MI TO PROVIDE EFFICIENT DELIVERY OF QUALITY DIALYSIS HEALTH CARE, ACHEIVE SUPERIOR PATIENT OUTCOMES AND IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITY WE SERVE. X 9 7 0 9 0 0 0 0 322253 102712 0 0 0 0 322253 102712 0 0 0 0 267627 160517 0 0 0 127972 55979 395599 216496 -73346 -113784 274340 0 0 0 274340 0 NONE 0 0 216496 102712 MOSES DIALYSIS UNIT PROVIDES CARE AND TREATMENT TO INDIVIDUALS IN NEED OF RENAL DIALYSIS SERVICES IN THE GREATER ST. IGNACE, MI AREA. 216496 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 1 0 0 0 1 1 1 1 1 0 0 1 0 0 0 1 0 0 X JASON ANDERSON 9066438585 1140 NORTH STATE STREET ST IGNACE MI 49781 STEVE LUTZ BOARD MEMBER 1.00 X 0 0 0 BONNIE CULFA BOARD MEMBER 1.00 X 0 0 0 REV WAYNE FOOTE BOARD MEMBER 1.00 X 0 0 0 RICHARD SMITH BOARD MEMBER 1.00 X 0 0 0 BILL CONNOLLY BOARD CHAIRPERSON 1.00 X X 0 0 0 ILENE MOSES BOARD VICE CHAIRPERSON 1.00 X X 0 0 0 RODNEY NELSON BOARD SECRETARY/TREASURER 1.00 40.00 X X 0 143433 18296 GARY SHAW MD BOARD MEMBER/CEO 1.00 4.00 X X 0 9000 0 JASON ANDERSON BOARD MEMBER/CFO 2.00 40.00 X X 0 104771 18296 NANCY NELSON MANAGER 40.00 X 0 59217 945 0 316421 37537 0 0 1 0 MACKINAC STRAITS HEALTH SYSTEM INC 1140 NORTH STATE STREET ST IGNACE MI 49781 NURSING SERVICES 174605 1 NET DIALYSIS REVENUE 621400 102712 102712 102712 102712 102712 0 0 65647 65647 50218 50218 9615 9615 26080 26080 8957 8957 20704 20704 7077 7077 680 680 MEDICAL SUPPLIES 26299 26299 OUTSIDE TRAINING AND MI 1219 1219 216496 216496 0 0 0 0 0 139183 0 0 0 0 0 0 0 0 0 0 0 135157 0 274340 0 0 0 X 274340 0 0 0 0 0 274340 0 274340 0 X -113784 -160556 X X 0 1 X 1 0 X X 0 0 0 0 0 0 0 0 0 RODNEY NELSON BOARD SECRETARY/TREASURER 0 142980 0 0 0 453 0 0 0 18296 0 161729 0 0 PART I, LINE 3 THE PROCESS FOR DETERMINING ALL COMPENSATION IS BASED ON THE MHA ANNUAL SURVEY. COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS REVIEWED BY THE CEO OF MACKINAC STRAITS HEALTH SYSTEM, INC., WHICH CONTRACTS ALL EMPLOYEES OF MOSES DIALYSIS UNIT. NET ASSETS 2014-10-30 160556 BOOK VALUE AT OCTOBER 30, 2014 208756459 MACKINAC STRAITS AREA HEALTH SYSTEM INC 1140 NORTH STATE STREET IGNACE MI 49781 501(C)(3) 1 1 0 0 0 0 0 0 0 PART I, LINE 2E: PERSON(S) INVOLVED: JASON ANDERSON, RODNEY NELSON, NANCY NELSON, AND GARY SHAW HAVE HISTORICAL WORKED FOR MACKINAC STRAITS AREA HEALTH SYSTEM. JASON ANDERSON AND RODNEY NELSON ARE BOTH OFFICERS AND DIRECTORS AT MACKINAC STRAITS AREA HEALTH SYSTEM. PART I, LINE 2E THE AFFILIATES OF THE SYSTEM ARE MOSES DIALYSIS UNIT ("MOSES DIALYSIS") AND MACKINAC STRAITS HEALTH FOUNDATION (THE "FOUNDATION"). MOSES DIALYSIS IS A SEPARATE NOT-FOR-PROFIT CORPORATION THAT WAS INCORPORATED FOR THE PURPOSE OF PROVIDING DIALYSIS SERVICES. THE SYSTEM WAS THE SOLE CORPORATE MEMBER OF MOSES DIALYSIS. MOSES DIALYSIS WAS DISSOLVED ON OCTOBER 30, 2014 AND NET ASSETS TRANSFERRED INTO THE SYSTEM ON MARCH 31, 2015. FORM 990, PART VI, SECTION A, LINE 2 RODNEY NELSON AND NANCY NELSON HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MACKINAC STRAITS HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF MOSES DIALYSIS UNIT. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER IS MACKINAC STRAITS HEALTH SYSTEMS, INC. FORM 990, PART VI, SECTION A, LINE 7B MOSES BOARD SUBJECT TO APPROVAL OF HOSPITAL BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS HAS DELEGATED THE REVIEW AND APPROVAL OF THE FORM 990 TO THE CFO. A COPY OF THE FORM 990 WILL BE PROVIDED TO BOARD MEMBERS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12 MOSES DIALYSIS UNIT DOES NOT HAVE ITS OWN CONFLICT OF INTEREST OR DOCUMENT RETENTION POLICIES. ALL PROFESSIONALS OF MOSES ARE CONTRACTED FROM MACKINAC STRAITS HEALTH SYSTEM, INC., THE COMPANY'S SOLE CORPORATE OWNER. CONTRACTED PROFESSIONALS ARE REQUIRED TO FOLLOW THE CONFLICT OF INTEREST AND DOCUMENT RETENTION POLICIES ENFORCED BY MACKINAC STRAITS HEALTH SYSTEMS, INC. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS FOR DETERMINING ALL COMPENSATION IS BASED ON THE MHA ANNUAL SURVEY. COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS REVIEWED BY THE CEO OF MACKINAC STRAITS HEALTH SYSTEM, INC., WHICH CONTRACTS ALL EMPLOYEES OF MOSES DIALYSIS UNIT. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST ONLY. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS -160,556. FORM 990, PART XI, LINE 2C MOSES DIALYSIS UNIT IS INCLUDED IN THE CONSOLIDATED AUDIT OF MACKINAC STRAITS HEALTH SYSTEM, INC. AND AFFILIATE. 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 HEALTH SYSTEM INC 1140 NORTH STATE STREET ST IGNACE MI 49781 208756459 HOSPITAL MI 501(C)(3) LINE 3 MACKINAC STRAITS AREA HEALTH 0 MACKINAC STRAITS AREA HEALTH 1140 NORTH STATE STREET ST IGNACE MI 49781 472021925 HOSPITAL MI 501(C)(3) LINE 3 N/A 0 MACKINAC STRAITS HEALTH FOUNDATION 1140 NORTH STATE STREET ST IGNACE MI 49781 465296565 FOUNDATION MI 501(C)(3) LINE 3 MACKINAC STRAITS HEALTH SYSTEM INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0