2015-02-13T12:08:58-06:00 2014-03-31 990 2013-04-01 381459366 CHARLEVOIX AREA HOSPITAL CHAR 2315474024 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 GLADYLYN JENKS PRESIDENT 2315474024 2015-02-12 2013 2016-02-25 16:41:14Z LYN JENKS 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 41260714 false X WWW.CAH.ORG X 1919 MI TO PROVIDE EXCELLENT HEALTHCARE. 13 10 398 57 0 195000 203436 39232741 40898646 31128 -44023 103419 109748 39562288 41167807 0 0 21344081 22233036 0 0 17993561 19466903 39337642 41699939 224646 -532132 26923065 25509568 9575829 8482098 17347236 17027470 X TO PROVIDE EXCELLENT HEALTHCARE. false false 10407864 20528522 OPERATING ROOM SERVICES - SURGERIES: 2,962 7269033 6578422 PRIMARY CARE SERVICES: 30,390 3417243 4525986 EMERGENCY ROOM SERVICES - PATIENTS SEEN IN THE ER: 11,046 13567940 9304951 INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. 13567940 9304951 34662080 true true false true false false false false false false true true false true 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 47 0 true 398 true false false false false false false false false false false X 13 10 false true false false false false false true true true false true true true true true true true true false X TABITHA RUDOLPH 2315478508 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 MARC LAME MD VICE CHAIR 40.00 X X 333424 0 19931 MICHAEL HARMELING MD DIR/CHIEF OF 40.00 X X 187437 0 9155 GLADYLYN JENKS CEO 40.00 1.00 X X 142832 0 622 STEVE HUFFORD OD DIRECTOR 1.00 X X 0 0 0 SCOTT BEATTY CHAIR 1.00 1.00 X X 0 0 0 MARY JASON DIRECTOR 1.00 X 0 0 0 RICHARD FISH DDS DIRECTOR 1.00 X 0 0 0 STEVE WEBER DIRECTOR 1.00 X 0 0 0 RUTH B HOPPE MD CHAIR 1.00 1.00 X X 0 0 0 MICHAEL ORTWINE SECRETARY/TR 1.00 X X 0 0 0 MARY FACULAK DIRECTOR 1.00 2.00 X 0 0 0 NANCY SHERMAN DIRECTOR 1.00 X 0 0 0 MARK ECKHARDT DIRECTOR 1.00 X 0 0 0 DENISE HOLMES DIRECTOR 1.00 X 0 0 0 ROBERT ZIMMERMAN CHIEF FINANC 8.00 X 0 0 0 JAMES JEAKLE MD OBSTETRICIAN 40.00 1.00 X 376389 0 21970 CRAIG WENDT MD PHYSICIAN 40.00 X 362185 0 18780 MARY IVEY MD OBSTETRICIAN 40.00 X 355504 0 20077 CATHERINE WONSKI MD PHYSICIAN 40.00 X 301741 0 26129 NATHAN BOSS MD PHYSICIAN 40.00 X 242347 0 19457 WILLIAM JACKSON PAST PRESIDE 0.00 X 112472 0 0 2414331 136121 22 true true false PINE RIVER MEDICAL ASSOCIATES 14734 PARK AVENUE CHARLEVOIX MI 49720 ER PHYSICIAN 1544087 ALLIANCE-HNI LLC 525 S GOULD OWOSSO MI 48867 MOBILE MRI SERV 426234 MUNSON HEALTHCARE 1105 SIXTH ST TRAVERSE CITY MI 49684 CFO/REIMB. SVCS 171609 QUEST DIAGNOSTICS 4444 GIDDINGS ROAD AUGURN HILLS MI 48326 LABORATORY SERV 145688 SMITHGROUP JJR 500 GRISWOLD SUITE 1700 DETROIT MI 48226 ARCHITECT 136283 8 193947 9489 14394 203436 HEALTH SERVICES 621110 20191156 20191156 MEDICARE/MEDICAID PAYMENTS 621110 17199209 17199209 OTHER RELATED REVENUE 621110 3508281 3508281 40898646 -107871 -107871 63911 92907 -28996 -28996 -28996 63848 63848 63848 63848 CAFETERIA SALES 134361 134361 MISCELLANEOUS INCOME 621110 4383 4383 138744 41167807 40937881 26490 740124 596125 143999 17267556 14972063 2295493 256371 216966 39405 2734731 2251900 482831 1234254 1055474 178780 175489 175489 35861 35861 76675 76675 3679599 3041350 638249 181244 181244 42353 30755 11598 184938 184938 802398 655158 147240 52539 41549 10990 75375 40160 35215 165145 134841 30304 1881259 1536048 345211 287052 89761 197291 SUPPLIES 8213468 7844766 368702 PROVISION FOR BAD DEBTS 1452391 1452391 QAAP TAX 821463 821463 EQUIPMENT SERVICE & RENTA 581627 480532 101095 758027 222241 535786 41699939 34662080 7037859 0 226280 205429 1794055 1305482 21421 19421 4828835 4777381 141375 78802 814582 863947 401978 260492 46878619 33303933 14707730 13574686 79134 1036812 1693952 1569865 2213723 1817251 26923065 25509568 4624769 4674377 2371715 2371715 2579345 1436006 9575829 8482098 X 16591741 16511862 755495 515608 17347236 17027470 26923065 25509568 -532132 212366 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5508 5508 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. 503375 503375 29368525 20091188 9277337 16538221 13212745 3325476 468498 468498 13574686 INVESTMENT IN CHARLEVOIX NURSING HOM 1073678 F INVESTMENT IN CHARLEVOIX FOUNDATION 496187 F 1569865 COST REPORT SETTLEMENT RECEIVABLE 1598946 BOND ISSUE COSTS 103307 AFFILIATE RECEIVABLE 79148 ACCRUED MEANINGFUL USE FUNDING RECEI 35850 1817251 39808323 -1452391 -1452391 41260714 -92907 -92907 41167807 40340455 -1452391 -1452391 41792846 -92907 -92907 41699939 SCHEDULE D, PAGE 4, PART XI, LINE 2D PROVISION FOR BAD DEBT -1,452,391 SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -92,907 SCHEDULE D, PAGE 4, PART XII, LINE 2D PROVISION FOR BAD DEBT -1,452,391 SCHEDULE D, PAGE 4, PART XII, LINE 4B RENTAL EXPENSES -92,907 true true X true X true X 2.600000000000 true true true false true true 182368 174805 7563 0.00020 3286348 2188201 1098147 0.02630 3468716 2363006 1105710 0.02650 387932 7283 380649 0.00910 387932 7283 380649 0.00910 3856648 2370289 1486359 0.03560 true 1452391 101123 11479640 11391219 88421 X true true 1 1 CHARLEVOIX AREA HOSPITAL 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 X X X CHARLEVOIX AREA HOSPITAL 1 true X X X X X X X X X X 12 true true true X WWW.CAH.ORG X X X X X X X X X false false true true 200.000000000000 true 260.000000000000 true X X X X true true X X true false true X false false FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 3 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 4 MCLAREN NORTHERN MICHIGAN, PETOSKEY MI OTSEGO MEMORIAL HOSPITAL, GAYLORD MI FACILITY 1, CHARLEVOIX AREA HOSPITAL - PART V, LINE 7 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 20D 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 1,452,391. 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 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 101,123 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 AND THEN CONVERTED TO COST THROUGH APPLICATION OF THE RATIO OF PATIENT CARE COST TO CHARGES. 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 THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DOES NOT SHOW A SHORTFALL. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. 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 (FLU CLINICS IN COOPERATION WITH LOCAL MDCH, GRANT PROCUREMENT FOR PACS AND DIGITAL MAMMOGRAPHY, AND FITKIDS.) 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 27,000 RESIDENTS, WITH A PER CAPITA INCOME OF 47,177. BASED ON 2013 ESTIMATES, 12.4% OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL. SIMILARLY, MEDICAID RECIPIENTS ACCOUNTED FOR APPROXIMATELY 8% 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 WEIGHT WATCHERS AT WORK 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 THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 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 VICE CHAIR 300542 32882 5805 14126 353355 MICHAEL HARMELING MD DIR/CHIEF OF STAFF 153009 34109 319 3076 6079 196592 JAMES JEAKLE MD OBSTETRICIAN 231912 142417 2060 4728 17242 398359 CRAIG WENDT MD PHYSICIAN 300452 59330 2403 3596 15184 380965 MARY IVEY MD OBSTETRICIAN 235045 103286 17173 4893 15184 375581 CATHERINE WONSKI MD PHYSICIAN 229881 64533 7327 5913 20216 327870 NATHAN BOSS MD PHYSICIAN 239137 2050 1160 4805 14652 261804 WILLIAM JACKSON PAST PRESIDENT 112472 112472 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 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 9 WILLIAM JACKSON 00270 TURKEY RUN CHARLEVOIX, MI 49720 FORM 990, PAGE 6, PART VI, LINE 11B CAH 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 INDISCUSSIONS 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 (IE, 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 2012 BY YAFFE AND CO., INC. FOLLOWING THIS PHASE OF DATA COLLECTION, THE EXECUTIVE COMMITTEE CAREFULLY DELIBERATED IN SETTING THE COMPENSATION LEVEL FOR FY 2013/14 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 -1,452,391 RENTAL EXPENSES 92,907 PROVISION FOR BAD DEBT 1,452,391 RENTAL EXPENSES -92,907 FORM 990, PART XI, LINE 9 AFFILIATE TRANSFER 212,366 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 406314 CASH CHARLEVOIX AREA HOSPITAL FOUNDATION O 77010 FMV - ACTUAL AMOUNTS PAID