2016-05-13T08:03:27-05:00 2015-09-30 382477354 BRINING & NARTKER PC 47 AUSTIN STREET PO BOX 348 SANDUSKY MI 484710348 990 2014-10-01 381738615 MCKENZIE MEMORIAL HOSPITAL MCKE 8106486162 120 DELAWARE STREET SANDUSKY MI 48471 AMY RUEDISUELI VP OF FINANCE 8106486162 2016-05-02 true JOSEPH NARTKER P00297844 8106484931 2016-05-13 2014 2016-08-17 19:52:53Z MCKENZIE HEALTH SYSTEM STEVE BARNETT 120 DELEWARE STREET SANDUSKY MI 48471 20500084 false X WWW.MCKENZIEHEALTH.ORG X 1961 MI FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. 14 11 249 35 48304 -58361 50352 44215 18843161 20316098 24930 4111 86741 85063 19005184 20449487 0 0 10631086 11195653 0 23785 8355257 8425864 18986343 19621517 18841 827970 9361826 9660200 4895823 4366227 4466003 5293973 FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. false false 19621517 20449487 PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SANILAC COUNTY. FISCAL YEAR REGISTRATIONS ARE: INPATIENT = 210 OUTPATIENT = 21,284 EMERGENCY ROOM = 6,020 AMBULANCE = 2,019 19621517 true true false false false false false false false false true false false false true false true false false false false false false false true false true true false false true false false false false false false true false false false false false false true false false false true 44 0 true 249 true true true false false false false false false false false false false false X 14 11 false false false false true true false true true false false true true true true true true true true true true X X AMY RUEDISUELI 8106486162 394 LORAINE STREET SANDUSKY MI 48471 STEVE BARNETT MCKENZIE CEO 40.00 X X 194207 0 24632 ROGER LODING CHAIR PERSON X 0 0 0 CHRIS CLARK VICE CHAIR P X 0 0 0 AL STOUTENBURG TRUSTEE X 0 0 0 DAN BABCOCK MARLETTE CEO X 0 0 0 JUDITH FERGUSON TRUSTEE X 0 0 0 LARRY MITCHELL TRUSTEE X 0 0 0 MICHAEL DREYER TREASURER X 0 0 0 GLEN KAMPMAN TRUSTEE X 0 0 0 SCOTT ORR TRUSTEE X 0 0 0 SUE COOK TRUSTEE X 0 0 0 MEREDITH LYONS TRUSTEE X 0 0 0 JOAN NAGELKIRK SECRETARY X 0 0 0 DR ALFREDO DOMINGO PHYSICIAN 40.00 X 371810 0 0 DR MICHAEL MERKLER CHIEF OF STA 40.00 X 224375 0 8282 DR JAMES SAMS PHYSICIAN 40.00 X 208663 0 13076 DR MATTHEW GORMLEY PHYSICIAN 40.00 X 192180 0 27051 GINA PATTERSON PHARMACY DIR 32.00 8.00 X 127000 21973 23208 MARK ENGLISH CHIEF OF ST 40.00 X 166283 0 28032 1484518 21973 124281 7 true true false MICHIGAN EMERGENCY PHYSICIANS LLP PO BOX 674579 DETROIT MI 48267 ER COVERAGE 1506462 CPSI 6600 WALL STREET MOBILE AL 36695 COMPUTER TECH 186196 TOSHIBA AMERICAN MEDICAL PO BOX 91605 TUSTIN CA 92780 CT MAINT 110917 BARNETT ANESTHESIA 830 HEMINGWAY LAKE ORION MI 48362 ANES COVERAGE 107413 MICHAEL MACMILLAN 1707 LAKE LANSING RD LANSING MI 489123742 ANES COVERAGE 100925 5 44215 44215 INPATIENT & OUTPATIENT REVENU 31148083 31148083 PHYSICIAN REVENUE 3611153 3611153 RURAL HEALTH REVENUE 759573 759573 BAD DEBT & CHARITY CARE -462385 -462385 CONTRACTUAL ADJUSTMENTS -16173005 -16173005 1432679 1432679 20316098 4111 4111 48304 48304 48304 48304 71156 50597 20559 20559 SALE OF ASSETS 16200 16200 16200 20449487 20336409 48304 20559 X 352541 352541 8846917 6774189 2061414 11314 262214 201917 60297 1050556 749241 301315 683425 515241 167348 836 57324 57324 36230 36230 3384595 2794311 590284 64600 10270 44590 9740 1104974 904281 199089 1604 300566 38601 261965 370065 362861 7204 124239 95855 28133 251 42451 17342 25109 18895 17774 1121 799066 649476 149590 148703 135338 13365 DRUGS 612232 612232 IMPLANTABLES & BLOOD 517955 517955 TAXES & LICENSES 385800 41377 344423 FOOD, LAUNDRY, DUES 264199 104363 159796 40 193970 184191 9779 19621517 14726815 4870917 23785 267705 403224 1720836 2139326 1763585 1721648 462932 474099 142224 229586 16481403 11938950 4854680 4542453 149864 149864 9361826 9660200 2429030 2130814 1918189 1688200 548604 547213 4895823 4366227 X 4392009 5220399 73994 73574 4466003 5293973 9361826 9660200 827970 X true true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 160652 160652 7638501 4929749 2708752 264108 222222 41886 8381791 6786979 1594812 36351 36351 4542453 EVERBANK - DIG MAM 96264 EASTERN, INSIGHT & NORTHSTAR 85222 FIRST AMERICAN - ROOF 83726 ZOLL - DEFIBS 70224 ESB - 2 AMBULANCES & TRUCK 60487 KINGSBRIDGE - TELEMETRY 58155 ALCON - PHACEO 51495 DE-LAGE LANDEN - CHEM ANALYZER 41640 GE FINANCIAL TRI-COUNTY BANK 547213 20380603 20380603 68884 68884 20449487 19621517 19621517 19621517 SCHEDULE D, PAGE 4, PART XI, LINE 4B INTEREST INCOME 4,110 CONTRIBUTIONS 64,449 CONTRIBUTIONS RELEASED FROM TEMP RESTRICTED NET ASSETS 325 MI HOSP AUXILARY 45262 45262 43329 BENEFIT RAFFLE 25894 25894 1500 4113 500 1155 71156 71156 1500 4113 500 44484 50597 20559 true true true X true X true true false false 1 13 46312 46312 0.00240 1 3816215 2553394 1262821 0.06440 2 13 3862527 2553394 1309133 0.06670 940 4842 54026 37463 16563 0.00080 1 11925 11925 0.00060 1 4452 4452 0.00020 3 315 603 603 945 5157 71006 37463 33543 0.00170 947 5170 3933533 2590857 1342676 0.06840 2 246 529 529 1 160 1056 1056 0.00010 3 406 1585 1585 0.00010 true 451872 5564 6345444 6447868 -102424 X true true 1 1 MCKENZIE MEMORIAL HOSPITAL DBA MCKENZIE HEALTH SYSTEM 120 DELAWARE STREET SANDUSKY MI 48471 WWW.MCKENZIEHEALTH.ORG L414719 X MCKENZIE MEMORIAL HOSPITAL 1 false false true X X X X X X X 12 true false false true X WWW.MCKENZIEHEALTH.ORG X false false true X 100.000000000000 250.000000000000 X X X true true X X X X true X HTTPWWWMCKENZIEHEALTHORG X HTTPWWWMCKENZIEHEALTHORGSITE X HTTPMCKENZIEHEALTHORG X X X X X true X true X X X X true X false false FACILITY 1, MCKENZIE MEMORIAL HOSPITAL - PART V, LINE 5 PART V, NO 5 - THE PURPOSE OF THE 2013 MCKENZIE MEMORIAL HOSPITAL COMMUNITY NEEDS ASSESSMENT WAS TO COLLECT DATA ON SPECIFIC INFORMATION REGARDING COMMUNITY PERCEPTION OF THE USE OF HEALTHCARE SERVICES, COMMUNITY HEALTH AND HEALTH INSURANCE. A COMPREHENSIVE NINE PAGE SURVEY WAS DEVELOPED. A COVER LETTER AND SURVEY WERE SENT TO 1,000 RANDOM COMMUNITY MEMBERS IN THE MCKENZIE SERVICE AREA. IN ADDITION, MCKENZIE MEMORIAL HOSPITAL PARTICIPATES IN A COMMUNITY MANAGERS COMMITTEE WHICH CONSISTS OF MEMBERS FROM THE FOLLOWING ORGANIZATIONS: SANILAC COUNTY, SANILAC COUNTY MEDICAL CARE FACILITY, SANILAC COUNTY INTERMEDIATE SCHOOL DISTRICT, SANDUSKY COMMUNITY SCHOOLS, SANILAC COUNTY COMMUNITY MENTAL HEALTH, CITY OF SANDUSKY, SANILAC COUNTY HEALTH DEPARTMENT AND SANILAC COUNTY ROAD COMMISSION. INPUT FROM THESE ORGANIZATIONS WERE CONSIDERED. FACILITY 1, MCKENZIE MEMORIAL HOSPITAL - PART V, LINE 11 ACCESS TO SPECIALISTS AND LONGER PHYSICIAN OFFICE HOURS WERE IDENTIFIED AS SIGNIFICANT COMMUNITY NEEDS. MCKENZIE HAS IMPROVED ITS ACCESS TO SPECIALISTS THROUGH TELEMEDICINE, HOWEVER, IT IS DIFFICULT TO RECRUIT SOME SPECIALISTS TO OUR SMALL, RURAL TOWN BECAUSE OF THE LACK OF VOLUME TO SUSTAIN A SPECIFIC SPECIALIST. WE HAVE EXTENDED PHYSICIAN OFFICE HOURS IN SOME CLINICS TO 7AM TO 7PM AND ADDED A SATURDAY CLINIC. THE PRIMARY HURDLE TO EXTENDING HOURS FURTHER OR OPENING AN URGENT CARE CLINIC IS THE AVAILABILITY OF HEALTH CARE PROVIDERS TO STAFF THE CLINIC. 8 MCKENZIE HEALTH AND WELLNESS 170 W ARGYLE STREET SANDUSKY MI 48471 PHYSICIAN OFFICE/PT OFFICE AUSTIN STREET RURAL HEALTH CLINIC 51 AUSTIN STREET SANDUSKY MI 48471 RURAL HEALTH CLINIC MAIN STREET HEALTH CENTER 74 S ELK ST SANDUSKY MI 48471 PHYSICIAN ORTHOPEDIC OFFICE MCKENZIE FAMILY HEALTHCARE 109 N DELAWARE STREET SANDUSKY MI 48471 PHYSICIAN OFFICE LAKESHORE INTERNAL MEDICINE 7307 CHERRY STREET PORT SANILAC MI 48469 PHYSICIAN OFFICE CROSWEL CLINIC 8 N HOWARD STREET CROSWELL MI 48422 PHSICIAN OFFICE PECK MEDICAL CENTER 251 E PECK RD PECK MI 48466 PHYSICIAN OFFICE SANILAC MEDICAL PLAZA 100 W ARGYLE STREET SANDUSKY MI 48471 PHYSICIAN OFFICE RENTAL PART I, LINE 6A - RELATED ORGANIZATION INFORMATION A COMMUNITY BENEFIT REPORT WAS PREPARED DURING A PREVIOUS TAX YEAR; IN JUNE 2013. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION MCKENZIE USES SCHEDULE H WORKSHEETS TO PREPARE THE INFORMATION IN BOX 7, USING OUR COST TO CHARGE RATIO. PART II - COMMUNITY BUILDING ACTIVITIES MCKENZIE'S COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITY BY SUPPORTING THE LOCAL COMMUNITY THROUGH VARIOUS ACTIVITIES. EXAMPLES OF THESE ACTIVITIES ARE THE COMMUNITY SENIOR FAIR, SCHOOL TOURS, SANILAC 4-H FAIR AND OTHER VARIOUS SHOWCASES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY BAD DEBTS ARE ESTIMATED USING THE ALLOWANCE METHOD. THE BAD DEBT EXPENSE LISTED ON LINE 2 IS DETERMINED USING COST BASED UPON THE COST TO CHARGE RATIO THAT IS DEVELOPED IN SCHEDULE H. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE COST OF BAD DEBT EXPENSES ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. ANALYZED FINANCIAL ASSISTANCE/CHARITY CARE APPLICATIONS THAT WERE DENIED DUE TO INCOMPLETE DOCUMENTATION AND FAILURE TO PROVIDE REQUESTED INFORMATION AND APPLIED COST TO CHARGE RATIO AS DETERMINED IN SCHEDULE H. THIS EXPENSE IS INCLUDED AS IT IS OUR COMMUNITY THAT CANNOT AFFORD TO PAY THEIR HEALTHCARE EXPENSES. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS BAD DEBT FOOTNOTE IS INCLUDED IN THE ATTACHED AUDITED FINANCIAL STATEMENTS ON PAGE 10 AND 11, NOTE 1. PART III, LINE 8 - MEDICARE EXPLANATION THE HOSPITAL IS DESIGNATED A CRITICAL ACCESS HOSPITAL UNDER MEDICARE REGULATIONS. ALTHOUGH MOST SERVICES OF CRITICAL ACCESS HOSITALS ARE COST REIMBURSED, THERE ARE CERTIAN SERVICES THAT ARE PROVIDED THAT DO NOT FALL UNDER THE REIMBURSEMENT METHODOLOGY. THE SHORTFALL OF 102,424 DERIVES FORM THOSE NECESSARY SERVICES THAT ARE PROVIDED THAT ARE NOT COST BASED REIMBURSED. COST REPORT DATA OR THE APPLICABLE COST TO CHARGE RATIO WAS USED TO COMPUTE THESE FIGURES. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION MCKENZIE'S COLLECTION POLICY REFERENCES THE CHARITY CARE/FINANCIAL ASSISTANCE POLICY FOR THOSE PATIENTS THAT ARE ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE AS A METHOD OF PAYMENT/COLLECTIONS. PART VI, LINE 2 - NEEDS ASSESSMENT THE PURPOSE OF THE 2013 MCKENZIE MEMORIAL HOSPITAL COMMUNITY NEEDS ASSESSMENT WAS TO COLLECT DATA ON SPECIFIC INFORMATION REGARDING COMMUNITY PERCEPTION OF THE USE OF HEALTHCARE SERVICES, COMMUNITY HEALTH AND HEALTH INSURANCE. A COMPREHENSIVE NINE PAGE SURVEY WAS DEVELOPED. A COVER LETTER AND SURVEY WERE SENT TO 1,000 RANDOM COMMUNITY MEMBERS IN THE MCKENZIE SERVICE AREAS. THE COMPANY ACCULEADS, PROVIDED RANDOMIZED MAILING ADDRESSES FOR THE CITIES OF APPLEGATE, CARSONVILLE, DECKERVILLE, LEXINGTON, MARLETTE, PECK, PORT SANILAC, SANDUSKY AND SNOVER. IN ADDITION, MCKENZIE MEMORIAL HOSPITAL PARTICIPATES IN A COMMUNITY MANAGERS COMMITTEE WHICH CONSISTS OF MEMBERS FROM THE FOLLOWING ORGANIZATIONS: SANILAC COUNTY, SANILAC COUNTY MEDICAL CARE FACILITY, SANILAC COUNTY INTERMEDIATE SCHOOL DISTRICT, SANDUSKY COMMUNITY SCHOOLS, SANILAC COUNTY COMMUNITY MENTAL HEALTH, CITY OF SANDUSKY, SANILAC COUNTY HEALTH DEPARTMENT AND SANILAC COUNTY ROAD COMMISSION. INPUT FROM THESE ORGANIZATIONS WERE CONSIDERED. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE EVERY UNINSURED PATIENT, THAT INCURS MORE THAN 1,000 IN MEDICAL EXPENSES, RECEIVES A CHARITY CARE/FINANCIAL ASSISTANCE APPLICATION, A MEDICAID APPLICATION, AND A HUMAN SERVICES REFERRAL. ALL OTHER UNINSURED OR UNDER INSURED PATIENTS MAY REQUEST A CHARITY CARE/FINANCIAL ASSISTANCE APPLICATION AT ANY TIME. INSURANCE AND SELF PAY BROCHURES ARE AVAILABLE THROUGHOUT THE HOSPITAL. IN ADDITION, THE SOCIAL WORKER WILL ASSIST PATIENTS WHO NEED HELP IN APPLYING FOR GOVERNMENT ASSISTANCE PROGRAMS. PART VI, LINE 4 - COMMUNITY INFORMATION MCKENZIE MEMORIAL HOSPITAL IS LOCATED IN SANILAC COUNTY WHICH HAS A POPULATION OF APPROXIMATELY 41,475. SANILAC COUNTY CONSISTS OF MOSTLY FARMLAND WITH VERY FEW MANUFACTURING FACILITIES. THE UNEMPLOYMENT RATE IN SANILAC COUNTY IS AROUND 6.9%. X X X false false false false false false false false false STEVE BARNETT MCKENZIE CEO/PRES 194207 7188 17444 218839 DR ALFREDO DOMINGO PHYSICIAN 371810 371810 DR MICHAEL MERKLER CHIEF OF STAFF 224375 8282 232657 DR JAMES SAMS PHYSICIAN 208663 7827 5249 221739 DR MATTHEW GORMLEY PHYSICIAN 192180 7363 19688 219231 GINA PATTERSON PHARMACY DIRECTOR 127000 21973 5416 17792 150208 21973 MARK ENGLISH CHIEF OF STAFF 166283 6477 21555 194315 BARNETT ANESTESIA INC CEO'S SPOUSE 101725 CRNA SERVICES false FORM 990, PAGE 6, PART VI, LINE 6 CLASSES OF MEMBERS THAT MAKE UP THE BOARD OF DIRECTORS FORM 990, PAGE 6, PART VI, LINE 7A BOARD MEMBERS MUST BE APPROVED BY THE BOARD OF BLUE WATER HEALTHCARE NETWORK TO BECOME BOARD MEMBERS. FORM 990, PAGE 6, PART VI, LINE 11B THE 990 IS REVIEWED BY THE FINANCE COMMITTEE FOR APPROVAL AND IS THEN SUBMITTED TO THE FULL BOARD FOR APPROVAL PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS AND ALL COMMITTEES MEMBERS ARE REQUIRED TO FILL OUT AND SIGN THE ANNUAL CONFLICT OF INTEREST POLICY FORM. IN THE EVENT OF A CONFLICT APPLICABLE BOARD MEMBERS MUST ABSTAIN FROM THE VOTE. FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION OF THE CEO/PRESIDENT IS APPROVED BY THE FULL BOARD BASED ON THE RECOMMENDATION OF THE EXECUTIVE COMMITTEE THROUGH EXECUTIVE SURVEY INFORMATION. ANY EXECUTIVE BONUSES ARE APPROVED BY THE BOARD AT THE END OF A FISCAL YEAR BASED ON GOALS AND SUCCESS OF THE ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE FULL BOARD THROUGH RECOMMENDATIONS BASED ON COMPENSATION SURVEYS AND APPROVAL OF THE HOSPITAL'S ANNUAL BUDGET. BONUS AMOUNTS ARE IN THE CONTRACTS APPROVED BY THE FULL BOARD. FORM 990, PAGE 6, PART VI, LINE 19 THE HOSPITALS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION AT THE PRESIDENT/CEO'S OFFICE FORM 990, PART IX, LINE 11G PROFESSIONAL MEDICAL SERVICES 1,752,996 0 0 MEDICAL SERVICE CONTRACTS 48,008 0 0 COLLECTION SERVICES 93,418 0 0 ADMINISTRATIVE PROFESSIONAL 592,282 590,284 0 REFERENCE LAB SERVICES 72,815 0 0 ADMINISTRATIVE SERVICE CONT. 234,792 0 0 FORM 990, PART XI, LINE 9 INTEREST INCOME -4,110 CONTRIBUTIONS -64,449 CONTRIBUTIONS RELEASED FROM TEMP RESTRICTED NET ASSETS -325 FORM 990, PART XI, LINE 9 REVENUE REPORTED ON LINE 1 68,884 MARLETTE REGIONAL HOSPITAL 2770 MAIN STREET PO BOX 307 MARLETTE MI 48453 381507302 HEALTHCARE MI 501C3 3 UHP false UNITED HEALTHCARE PARTNERS 120 DELAWARE STREET SANDUSKY MI 48471 465444203 HEALTHCARE MI 501C3 3 ITSELF false SANILAC SERVICES INC 78 SOUTH ELK SANDUSKY MI 48471 382774983 PHARMACY MI MCKENIZE HEALTHCARE CORPORATION C CORP false false false false false false false false false false false true false false false true true true false false SANILAC SERVICES INC SANILAC PHARMACY K 15000 FMV SANILAC SERVICES INC SANILAC PHARMACY P 6155 COST BASIS SANILAC SERVICES INC SANILAC PHARMACY Q 90000 COST BASIS MARLETTE REGIONAL HOSPITAL O 59525 COST BASIS MARLETTE REGIONAL HOSPITAL Q 14213 COST BASIS MARLETTE REGIONAL HOSPITAL P 53446 COST BASIS