2016-02-16T09:06:52-06:00 2015-03-31 990 2014-04-01 381459366 CHARLEVOIX AREA HOSPITAL CHAR 2315474024 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 GLADYLYN JENKS PRESIDENT 2315474024 2016-02-12 2014 2016-08-17 19:52:53Z LYN JENKS 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 46678359 false X WWW.CAH.ORG X 1919 MI TO PROVIDE ACCESSIBLE, HIGH QUALITY, COMPASSIONATE HEALTHCARE SERVICES TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 13 9 419 65 0 203436 449414 40898646 44791814 -44023 1210443 109748 110413 41167807 46562084 0 0 22233036 23923025 0 0 19466903 19640728 41699939 43563753 -532132 2998331 25509568 28052355 8482098 8026554 17027470 20025801 X TO PROVIDE ACCESSIBLE, HIGH QUALITY, COMPASSIONATE HEALTHCARE SERVICES TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 9548295 19332938 OPERATING ROOM SERVICES - SURGERIES: 2,951 5901908 5320849 PRIMARY CARE SERVICES: 24,573 3488283 5179934 EMERGENCY ROOM SERVICES - PATIENTS SEEN IN THE ER: 12,477 18003683 15605060 INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. 18003683 15605060 36942169 true true false true false false false false false false true true false false false false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 51 0 true 419 true false false false false false false false false false false X 13 9 false true false false false false false true true false false true true true true true true true true false X TABITHA RUDOLPH 2315478508 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 MARC LAME MD PAST CHAIR 40.00 X 370660 0 20491 MICHAEL HARMELING MD DIR/CHIEF OF 40.00 X 244265 0 20410 ANNA YOUNG MD DIRECTOR/PHY 40.00 X 188628 0 16017 GLADYLYN JENKS CEO 40.00 1.00 X X 163474 0 1819 STEVE HUFFORD OD DIRECTOR 1.00 X 0 0 0 SCOTT BEATTY VICE CHAIR 2.00 X X 0 0 0 MARY JASON DIRECTOR 1.00 X 0 0 0 RICHARD FISH DDS DIRECTOR 1.00 X 0 0 0 RUTH B HOPPE MD CHAIR 2.00 X X 0 0 0 MICHAEL ORTWINE SECRETARY/TR 2.00 X X 0 0 0 MARY FACULAK DIRECTOR 1.00 X 0 0 0 NANCY SHERMAN DIRECTOR 1.00 X 0 0 0 DENISE HOLMES DIRECTOR 1.00 X 0 0 0 MICHAEL HINKLE DIRECTOR 1.00 X 0 0 0 ROBERT ZIMMERMAN CHIEF FINANC 8.00 X 0 0 0 CRAIG WENDT MD PHYSICIAN 40.00 X 429376 0 25412 CARL HARLAN PHYSICIAN 40.00 X 389035 0 15809 NATHAN BOSS MD PHYSICIAN 40.00 X 379359 0 24087 JAMES JEAKLE MD OBSTETRICIAN 40.00 X 341324 0 24614 CATHERINE WONSKI MD PHYSICIAN X 324882 0 23764 2831003 172423 22 false true false PINE RIVER MEDICAL ASSOCIATES 14734 PARK AVENUE CHARLEVOIX MI 49720 ER/PC PHYSICIAN 1437404 THE CHRISTMAN COMPANY 208 N CAPITOL AVENUE LANSING MI 48933 CONSTURCTION 462432 ALLIANCE-HNI LLC 525 S GOULD OWOSSO MI 48867 MOBILE MRI SERV 433291 SMITHGROUP JJR 500 GRISWOLD SUITE 1700 DETROIT MI 48226 ARCHITECT 329437 MUNSON HEALTHCARE 1105 SIXTH ST TRAVERSE CITY MI 49684 CFO/REIMB. SVCS 216204 10 434448 14966 78 449414 HEALTH SERVICES 621110 25488498 25488498 MEDICARE/MEDICAID PAYMENTS 621110 18490188 18490188 OTHER RELATED REVENUE 621110 813128 813128 44791814 525724 525724 58471 96223 -37752 -37752 -37752 704771 20052 684719 684719 684719 CAFETERIA SALES 145303 145303 DISCOUNTS TAKEN 621110 2862 2862 148165 46562084 45438781 673889 999219 832547 166672 18339116 16106582 2232534 253494 217097 36397 3074631 2626394 448237 1256565 1092767 163798 172378 172378 45380 45380 130200 130200 4141990 3435336 706654 156874 156874 34613 26021 8592 174547 174547 803704 701632 102072 70192 62032 8160 84381 77736 6645 134082 113970 20112 1626626 1382632 243994 368823 81344 287479 SUPPLIES 8156791 8039664 117127 PROVISION FOR BAD DEBTS 1377410 1377410 EQUIPMENT SERVICE & RENTA 839804 493472 346332 QAAP TAX 805015 805015 517918 275533 242385 43563753 36942169 6621584 0 205429 136671 1305482 4555945 19421 1281 4777381 4420048 78802 93023 863947 1053286 260492 264194 48618178 34939408 13574686 13678770 1036812 1706042 1569865 2067868 1817251 75227 25509568 28052355 4674377 5287574 81755 2371715 1497773 1436006 1159452 8482098 8026554 X 16511862 19181882 515608 843919 17027470 20025801 25509568 28052355 2998331 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5022 5022 false SCHEDULE C, PART II-B, LINE 1 PORTION OF ANNUAL DUES PAID TO THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARDS LOBBYING ACTIVITIES. 503376 503376 29446677 20975419 8471258 17053904 13963989 3089915 1614221 1614221 13678770 INVESTMENT IN CHARLEVOIX NURSING HOM 1225231 F INVESTMENT IN CHARLEVOIX FOUNDATION 842637 F 2067868 45280899 -1377410 -1377410 46658309 -96225 -96225 46562084 42282568 -1377410 -1377410 43659978 -96225 -96225 43563753 SCHEDULE D, PAGE 4, PART XI, LINE 2D PROVISION FOR BAD DEBT -1,377,410 SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -96,225 SCHEDULE D, PAGE 4, PART XII, LINE 2D PROVISION FOR BAD DEBT -1,377,410 SCHEDULE D, PAGE 4, PART XII, LINE 4B RENTAL EXPENSES -96,225 true true X true X true X 2.600000000000 true true false true true 153818 104633 49185 0.00120 4724845 2491625 2233220 0.05290 4878663 2596258 2282405 0.05410 386459 9836 376623 0.00890 386459 9836 376623 0.00890 5265122 2606094 2659028 0.06300 true 835770 48293 10621291 10663168 -41877 X true true 1 1 CHARLEVOIX AREA HOSPITAL 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 X X X CHARLEVOIX AREA HOSPITAL 1 false false true X X X X X X X X X X 12 true true true true X WWW.CAH.ORG X true 12 true WWW.MUNSONHEALTHCARE.ORG/?ID=48 false false true X 200.000000000000 260.000000000000 false true X X X true X HTTPWWWMUNSONHEALTHCAREORGID47 X X X true X true X X true X false false FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 5 MAJOR PARTNERS IN THE EXECUTION OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT WERE THE NORTHWEST MICHIGAN COMMUNITY HEALTH DEPARTMENT AND HEALTH DEPARTMENT DISTRICT 4, ALONG WITH HOSPITAL PARTNERS AS DESCRIBED IN V.4 AND THE NORTHERN HEALTH PLAN. THESE PARTNERS FORMED THE STEERING COMMITTEE THAT DEVELOPED THE PLAN FOR THE ASSESSMENT; THEN FOLLOWED IT THROUGH TO FULL EXECUTION. IN ADDITION, MORE THAN 1,200 INDIVIDUALS PARTICIPATED IN SURVEYS AND/OR FOCUS GROUPS THROUGHOUT NORTHERN MICHIGAN IN 2012. ABOUT 900 RESIDENTS COMPLETED THE "HEALTHY COMMUNITY" SURVEY, INCLUDING 226 FROM ANTRIM AND CHARLEVOIX COUNTIES. APPROXIMATELY 100 PHYSICIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS COMPLETED A "HEALTH CARE PROVIDER" SURVEY. MORE THAN 200 PEOPLE FROM ACROSS THE NORTHERNMOST PART OF THE LOWER PENINSULA OF MICHIGAN, INCLUDING EMMET, CHARLEVOIX, OTSEGO, CHEBOYGAN, CHARLEVOIX, AND ANTRIM COUNTIES PARTICIPATED IN 22 FOCUS GROUPS, COMMUNITY DIALOGUES, AND KEY INFORMANT INTERVIEWS; THESE INCLUDED COMMUNITY HEALTH NEEDS ASSESSMENT ACTIVITIES LED BY MUNSON MEDICAL CENTER, WHICH COVERED ANTRIM COUNTY. FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 6A MCLAREN NORTHERN MICHIGAN, PETOSKEY MI OTSEGO MEMORIAL HOSPITAL, GAYLORD MI FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 6B NORTHWEST MICHIGAN COMMUNITY HEALTH DEPARTMENT HEALTH DEPARTMENT DISTRICT 4 NORTHERN HEALTH PLAN FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 11 ABUSE AND NEGLECT: WE HAVE NO CURRENT PLANS TO ADDRESS THIS ISSUE AS THERE ARE OTHER AGENCIES AND ORGANIZATIONS WITHIN OUR REGION THAT ROUTINELY PROVIDE PREVENTIVE AND OTHER SERVICES FOR THIS POPULATION, INCLUDING THE WOMEN'S RESOURCE CENTER, NORTHERN MICHIGAN COMMUNITY MENTAL HEALTH, THE CHILD ABUSE PREVENTION COUNCIL AND THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN. MATERNAL SMOKING: WE HAVE NO CURRENT PROGRAMS SPECIFICALLY TARGETING SMOKING MOTHERS BUT WE WILL WORK WITH AREA PHYSICIANS TO REFER THEM TO AVAILABLE SMOKING CESSATION PROGRAMS PROVIDED AS NOTED ELSEWHERE IN THE PLAN. IN ADDITION, A CAH RESPIRATORY THERAPIST IS CONSULTED TO INSTRUCT IN THE DANGER OF SECOND-HAND SMOKE WITH EACH NEWBORN MOTHER WITH A SMOKING HABIT. A SMOKING CESSATION PACKET IS PROVIDED WITH QUITTING TECHNIQUES AND STATE AND LOCAL RESOURCE INFORMATION. THE LOCAL PUBLIC HEALTH DEPARTMENT PROVIDES SIGNIFICANT SUPPORT TO EXPECTANT MOTHERS IN THIS AREA, ALONG WITH ADDITIONAL COUNSELING ON OTHER FORMS OF ADDICTION. FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 22D A PERCENTAGE DISCOUNT RANGING FROM 50% TO 100% IS APPLIED TO GROSS CHARGES FOR INDIVIDUALS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THE DISCOUNT IS DETERMINED ON A SLIDING SCALE USING THE FEDERAL POVERTY GUIDELINES GRID FOR INCOMES UP TO 260% OF THE FEDERAL POVERTY LEVEL AND TAKING INTO ACCOUNT THE NUMBER OF MEMBERS IN THE FAMILY. THE DISCOUNT EXCEEDS THE DISCOUNT NEGOTIATED WITH CHARLEVOIX AREA HOSPITAL'S TWO LARGEST PRIVATE INSURERS, WHICH REPRESENT 30% OF OUR PAYER MIX. 5 BOYNE AREA MEDICAL CENTER 223 N PARK BOYNE CITY MI 49712 OUTPATIENT PHYSICIAN OFFICE CHARLEVOIX WOMEN'S HEALTH CARE 14651 W UPRIGHT STREET CHARLEVOIX MI 49720 OUTPATIENT PHYSICIAN OFFICE CHARLEVOIX SURGEONS 14695 PARK AVENUE CHARLEVOIX MI 49720 PHYSICIAN OFFICE PHYSICIAN CLINIC OF CHARLEVOIX 14705 W UPRIGHT STREET CHARLEVOIX MI 49720 PHYSICIAN OFFICE PINE RIVER CLINIC 14374 PARK AVE CHARLEVOIX MI 49720 FAMILY PRACTICE OFFICE PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION THE HOSPITAL DID NOT REPORT SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H, PART I, COLUMN F PERCENTAGE, EQUALS 1,377,410. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED FOR LINES 7A AND 7B. ACTUAL COSTS ARE REPORTED ON LINE 7E. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY TO ESTIMATE THE ALLOWANCE FOR DOUBTFUL ACCOUNTS, THEREBY DETERMINING THE PROVISION FOR BAD DEBT, CAH ANALYZES ITS PAST HISTORY OF PAYMENT TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE ALLOWANCE AND PROVISION. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE THE HOSPITAL PROVIDES CARE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. WHILE THE HOSPITAL MAKES EVERY EFFORT TO IDENTIFY ALL CANDIDATES WHO WOULD QUALIFY UNDER ITS FINANCIAL ASSISTANCE POLICY, THERE ARE CIRCUMSTANCES UNDER WHICH THAT DETERMINATION CANNOT BE MADE. AS SUCH, IT IS OUR BELIEF THAT 79,590 OF BAD DEBT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY AND SHOULD BE INCLUDED AS COMMUNITY BENEFIT. BASED ON AN ANALYSIS OF SELF PAY ENCOUNTERS WHOSE GROSS CHARGES EXCEEDED 1,000 AND THEREFORE WERE AUTOMATICALLY SENT A FINANCIAL ASSISTANCE APPLICATION, IT WAS DETERMINED THAT APPROXIMATELY 30% QUALIFIED FOR FINANCIAL ASSISTANCE. THIS PERCENTAGE WAS THEN APPLIED TO SELF PAY BAD DEBT. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS ACCOUNTS RECEIVABLE - ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8 - MEDICARE EXPLANATION CHARLEVOIX AREA HOSPITAL CONSIDERS THE ENTIRE MEDICARE SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. THAT AMOUNT IS 41,877. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE. PART VI, LINE 2 - NEEDS ASSESSMENT CHARLEVOIX AREA HOSPITAL HAS PARTICIPATED IN NEEDS ASSESSMENT SURVEYS CONSISTENTLY DURING THE PAST 10 YEARS, TYPICALLY IN COOPERATION WITH OTHER ORGANIZATIONS BUT AT TIMES SPECIFICALLY DRIVEN BY OUR HOSPITAL. IN ADDITION TO DATA PROCURED THROUGH THESE SURVEYS, OUR HOSPITAL HAS ALSO USED MICHIGAN DEPARTMENT OF COMMUNITY HEALTH DATA, AND DATA FROM THE ECONOMIC DEVELOPMENT COUNCIL TO ASSESS THE ONGOING HEALTHCARE NEEDS OF OUR COMMUNITY. THE SURVEYS HAVE RESULTED IN MANY JOINT EFFORTS TO ADDRESS OUR COMMUNITY'S HEALTH CARE NEEDS. MOST RECENTLY THAT FOCUS HAS BEEN ON THE SCHOOL NURSE PROGRAM. ADDITIONALLY, THE HOSPITAL HAS SOLELY SPONSORED WELLNESS WEDNESDAY'S, FREE MAMMOGRAPHY, AND SPORTS PHYSICALS FOR STUDENT ATHLETES. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE HOSPITAL'S ADMISSIONS AREAS. IF, DURING THE REGISTRATION PROCESS, IT BECOMES APPARENT THAT A PATIENT HAS NEED FOR POSSIBLE FINANCIAL OR DISCOUNTED ASSISTANCE, A REFERRAL IS MADE TO THE HOSPITAL'S FINANCIAL COUNSELOR OR SOCIAL WORKER. DURING THIS ASSESSMENT, ELIGIBILITY FOR ASSISTANCE UNDER EXISTING FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS FIRST EXPLORED. SHOULD THE PATIENT FAIL TO QUALIFY FOR EXISTING PROGRAMS, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION IS MADE AVAILABLE. IN THE EVENT THE PATIENT'S NEED IS NOT IDENTIFIED DURING REGISTRATION, ADDITIONAL OPPORTUNITIES TO INQUIRE ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE. FOR EXAMPLE, THE PHONE NUMBER FOR INQUIRIES INTO FINANCIAL ASSISTANCE ARE PRINTED ON ANY STATEMENTS SENT TO THE PATIENT. FURTHERMORE, PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE AND HAVE AN ENCOUNTER BALANCE THAT EXCEEDS 1,000 ARE AUTOMATICALLY SENT AN APPLICATION. PART VI, LINE 4 - COMMUNITY INFORMATION CHARLEVOIX AREA HOSPITAL SERVES THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES, AS WELL AS THE SEASONAL RESIDENTS THAT FLOOD THE AREA DURING THE SUMMER MONTHS. THIS SMALL, RURAL COMMUNITY IS HOME TO APPROXIMATELY 26,000 RESIDENTS, WITH A MEDIAN HOUSEHOLD INCOME OF 45,949. BASED ON 2014 ESTIMATES, 13.3% OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL. SIMILARLY, MEDICAID RECIPIENTS ACCOUNTED FOR APPROXIMATELY 12.5% OF THE HOSPITAL'S GROSS PATIENT CHARGES. IN ADDITION, PATIENTS REFERRED FROM NEIGHBORING EAST JORDAN FAMILY HEALTH CENTER, A FEDERALLY QUALIFIED RURAL HEALTH CLINIC, WERE AMONG THOSE SERVED BY THE HOSPITAL. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE BOARD OF DIRECTORS IS COMPRISED OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THIS VOLUNTARY BOARD PROVIDES COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS. CHARLEVOIX AREA HOSPITAL UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA. EXAMPLES OF HOW CAH PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PROGRAMS INCLUDE: AMERICAN RED CROSS BLOOD DRIVES AREA BUSINESS HEALTH SCREENINGS FREEDOM FROM SMOKING CLINIC FIT-4-LIFE FOR ADULTS CIRCLE OF STRENGTH CANCER SUPPORT GROUP CIRCLE OF STRENGTH MAMMOGRAM VOUCHERS PINK RIBBON RIDE FIT-4-LIFE FOR KIDS HOSPITAL AND CAREER EXPLORATION TOURS READ TO ME PROGRAM SCHOOL NURSE PROGRAM PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM SUBSEQUENT TO THE FISCAL YEAR COVERED BY THIS RETURN, CHARLEVOIX AREA HOSPITAL (CAH) JOINED THE MUNSON HEALTHCARE SYSTEM DECEMBER 1, 2015. CAH WORKS IN COOPERATION WITH OTHER ENTITIES IN THE MUNSON HEALTHCARE SYSTEM TO PROVIDE A FULL RANGE OF HEALTH SERVICES TO THE COMMUNITIES IN ITS SERVICE AREA. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT MICHIGAN X X X false false false false false false false false false MARC LAME MD PAST CHAIR 344613 10998 15049 7054 13437 391151 MICHAEL HARMELING MD DIR/CHIEF OF STAFF 222006 13896 8363 4445 15965 264675 ANNA YOUNG MD DIRECTOR/PHYSICIAN 186865 1763 16017 204645 GLADYLYN JENKS CEO 149017 7160 7297 1503 316 165293 CRAIG WENDT MD PHYSICIAN 384074 33143 12159 7538 17874 454788 CARL HARLAN PHYSICIAN 385348 3687 15809 404844 NATHAN BOSS MD PHYSICIAN 312732 2604 64023 6651 17436 403446 JAMES JEAKLE MD OBSTETRICIAN 306069 35255 5635 18979 365938 CATHERINE WONSKI MD PHYSICIAN 310375 5593 8914 5765 17999 348646 A CHARLEVOIX TWP HOSP FIN AUTH 2001 383203086 2013-03-28 3230010 REFUND/REISSUE 2001 SERIES CHARLEVOIX TOWNSHIP HOSPITAL FINANCE AUTHORITY false false false A 3230010 3230010 true false true true A false false false false false false false A false false true false false false false false false A false SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION CHARLEVOIX TWP HOSP FIN AUTH 2001 LIMITED OBLIGATION HOSPITAL REVENUE AND REFUNDING BONDS; ISSUE DATE 11/13/2001 SCHEDULE K - ADDITIONAL INFORMATION CHARLEVOIX TWP HOSP FIN AUTH 2001 CHARLEVOIX AREA HOSPITAL IS IN THE PROCESS OF ADOPTING WRITTEN PROCEDURES FOR POST-ISSUANCE COMPLIANCE WHICH WILL INCLUDE PROVISIONS TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH A VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE. FORM 990, PAGE 2, PART III, LINE 4D INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. FORM 990, PAGE 6, PART VI, LINE 3 CHARLEVOIX AREA HOSPITAL CONTRACTED THE CHIEF FINANCIAL OFFICER RESPONSIBILITIES TO MUNSON HEALTHCARE, AN AFFILIATE HEALTHCARE SYSTEM IN ITS SERVICE AREA. MUNSON HEALTHCARE ASSIGNED ROBERT ZIMMERMAN TO FULFILL THAT ROLE. NONE OF CHARLEVOIX AREA HOSPITAL'S CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY MUNSON HEALTHCARE DURING THE CALENDAR YEAR ENDED IN CHARLEVOIX'S TAX YEAR. FORM 990, PAGE 6, PART VI, LINE 11B CHARLEVOIX AREA HOSPITAL CONTRACTS FOR CERTAIN ACCOUNTING SERVICES FROM MUNSON HEALTHCARE WHICH INCLUDE ASSISTANCE WITH THE FORM 990 PREPARATION AND REVIEW. A REVIEW OF THE 990 IS PERFORMED BY THE ADMINISTRATIVE TEAM AS WELL AS THE MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. FORM 990, PAGE 6, PART VI, LINE 12C ALL INDIVIDUALS SERVING ON THE BOARD ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND ARE PERIODICALLY REMINDED OF THEIR OBLIGATION TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT MAY ARISE AS PART OF INTERRELATIONSHIPS RESULTING FROM THEIR PROFESSIONAL CAREERS, THEIR FAMILIES, THEIR PERSONAL ACQUAINTANCES WITH KEY EMPLOYEES OF THE HOSPITAL, AND THEIR DUTIES AS A BOARD MEMBER. MONITORING IS CONDUCTED ON AN ONGOING BASIS, WITH THE EXPECTATION THAT BOARD MEMBERS WILL MEET THEIR AFFIRMATIVE OBLIGATION TO REPORT CONFLICTS OF INTEREST PRIOR TO THE EXECUTION OF BOARD TRANSACTIONS INVOLVING SUCH CONFLICTS. CHARLEVOIX AREA HOSPITAL CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY DISTRIBUTING AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE TO BOARD MEMBERS, EMPLOYED PHYSICIANS, AND KEY EMPLOYEES, WHICH INCLUDES QUESTIONS RELATED TO EACH POLICY PROVISION. RESPONSES ARE THOROUGHLY REVIEWED AND ANY APPARENT CONFLICTS ARE THOROUGHLY INVESTIGATED. IN THE EVENT THAT A POTENTIAL CONFLICT IS IDENTIFIED PRIOR TO ACTION ON A CONTRACT OR TRANSACTION, THE CONFLICTED PERSON IS NOT ALLOWED TO PARTICIPATE IN DISCUSSIONS ON THE MATTER, NOT ALLOWED TO VOTE ON THE MATTER, AND NOT ALLOWED TO BE PRESENT DURING VOTING ON THE MATTER. FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS FOR DETERMINING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER (CEO) WAS WORKED THROUGH THE BOARD EXECUTIVE COMMITTEE, WHICH INCLUDED THREE INDIVIDUALS, ALL OF WHOM WERE/ARE INDEPENDENT (I.E. UNDER NO COMPENSATION AGREEMENT, NOR UNDER CONTROL OF ANYONE BEING COMPENSATED). THE PROCESS INCLUDED A DATA COLLECTION PHASE WHICH REVIEWED ARTICLES DEALING WITH CONTEMPORARY PHILOSOPHY OF CEO COMPENSATION, AND ALSO INCLUDED A REVIEW OF THE VARIOUS QUARTILES OF CEO COMPENSATION FOR CRITICAL ACCESS HOSPITALS COMPILED IN 2014 BY YAFFE AND CO., INC. FOLLOWING THIS PHASE OF DATA COLLECTION, THE EXECUTIVE COMMITTEE CAREFULLY DELIBERATED IN SETTING THE COMPENSATION LEVEL FOR FY 2014/15 BASED ON DATA FROM SIMILARLY FINANCIALLY-SIZED CRITICAL ACCESS HOSPITALS IN THE MIDWEST. IT ADDITION, AN OUTLINE FOR A COMPENSATION STRUCTURE FOR THE NEXT FIVE YEARS WAS DEVELOPED, WHICH ALSO INCLUDES AN INCENTIVE COMPONENT. THE FULL BOARD REVIEWED AND APPROVED THE PROCESS, BUT DID NOT PARTICIPATE IN THE DELIBERATION ABOUT COMPENSATION, NOR IN THE FINAL DECISION. FORM 990, PAGE 6, PART VI, LINE 15B CHARLEVOIX AREA HOSPITAL CONTRACTS WITH MUNSON HEALTHCARE TO PROVIDE MANAGEMENT SERVICES FOR ITS CHIEF FINANCIAL OFFICER, FINANCE DIRECTOR AND REIMBURSEMENT RESPONSIBILITIES. THIS CONTRACT DICTATES FIXED MONTHLY PAYMENTS TO MUNSON HEALTHCARE. THE PAYMENTS WERE DERIVED FROM THE COST-BASED HOURLY RATE SET BY MUNSON FOR ITS PERSONNEL. THE CHARLEVOIX AREA HOSPITAL BOARD OF DIRECTORS REVIEWED THE CONTRACT FOR REASONABLENESS AND APPROVED THE CONTRACT. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 PROVISION FOR BAD DEBT -1,377,410 RENTAL EXPENSES 96,225 PROVISION FOR BAD DEBT 1,377,410 RENTAL EXPENSES -96,225 CHARLEVOIX AREA HOSPITAL FOUNDATION CHARLEVOIX AREA HOSPITAL FOUNDATION 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 753078034 FUNDRAISIN MI 501C3 11A CHARLEVOIX AREA HOSPITAL true false false true false false false false false false false false false false false true false false false false CHARLEVOIX AREA HOSPITAL FOUNDATION C 434448 CASH CHARLEVOIX AREA HOSPITAL FOUNDATION O 113920 FMV - ACTUAL AMOUNTS PAID