2015-02-13T15:41:39-06:00 2014-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-04-01 320031170 MOSES DIALYSIS UNIT MOSE 9066438585 1140 NORTH STATE STREET ST IGNACE MI 49781 JASON ANDERSON CFO 9066438585 2015-02-13 1 TERRI REXRODE CPA MST P00096513 9206620016 2015-02-13 2013 2016-02-25 16:41:14Z JASON ANDERSON 1140 NORTH STATE STREET ST IGNACE MI 49781 322253 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. 9 6 0 5 0 0 0 0 717385 322253 0 0 0 0 717385 322253 0 0 0 0 320627 267627 0 0 0 168383 127972 489010 395599 228375 -73346 347686 274340 0 0 347686 274340 NONE 0 0 395599 322253 6MOSES DIALYSIS UNIT PROVIDES CARE AND TREATMENT TO INDIVIDUALS IN NEED OF RENAL DIALYSIS SERVICES IN THE GREATER ST. IGNACE, MI AREA. 395599 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 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 158194 22171 GARY SHAW MD BOARD MEMBER/CEO 1.00 4.00 X X 0 17200 0 JASON ANDERSON BOARD MEMBER/CFO 2.00 40.00 X X 0 130175 20355 NANCY NELSON MANAGER 40.00 X 59466 0 804 59466 305569 43330 0 0 1 0 MACKINAC STRAITS HEALTH SYSTEM INC 1140 NORTH STATE STREET ST IGNACE MI 49781 NURSING SERVICES 267627 1 NET DIALYSIS REVENUE 621400 322253 322253 322253 322253 322253 0 0 X 60270 60270 135280 135280 18977 18977 39170 39170 13930 13930 51736 51736 97 97 4875 4875 MEDICAL SUPPLIES 70296 70296 OUTSIDE TRAINING 672 672 DUES & SUBSCRIPTIONS 110 110 186 186 395599 395599 0 0 213923 139183 133763 135157 347686 274340 0 0 X 347686 274340 0 0 0 0 347686 274340 347686 274340 -73346 0 X X 0 1 X 1 0 X PART I, LINE 3 ALTHOUGH MOSES DIALYSIS UNIT IS CLASSIFIED AS A HOSPITAL FOR SCHEDULE A PURPOSES, WE ARE NOT A LICENSED HOSPITAL AND, THEREFORE SCHEDULE H IS NOT REQUIRED. 0 DUE FROM RELATED PARTY 135157 135157 X PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHINCAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF MARCH 31, 2014 OR 2013. THE ORGANIZATION'S TAX RETURNS FOR TAX YEARS 2011 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. X 0 0 0 0 0 0 0 0 0 RODNEY NELSON BOARD SECRETARY/TREASURER 0 150000 0 0 0 8194 0 0 0 22171 0 180365 0 0 JASON ANDERSON BOARD MEMBER/CFO 0 130175 0 0 0 0 0 0 0 20355 0 150530 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. 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 IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 51,736. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,736. 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 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0