MCKENIZE MEMORIAL HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MCKENIZE MEMORIAL HOSPITAL (EIN 38-1738615)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-05-14
- IRS object ID
- 201531349349302193
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-14T09:27:15-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382477354 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRINING & NARTKER PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 47 AUSTIN STREET PO BOX 348 | AddressLine1 |
| City | SANDUSKY | City |
| State | MI | State |
| ZIP Code | 484710348 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381738615 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MCKE | BusinessNameControlTxt |
| Phone | 8106486162 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 DELAWARE STREET | AddressLine1 |
| City | SANDUSKY | City |
| State | MI | State |
| ZIP Code | 48471 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY RUEDISUELI | PersonNm |
| Person Title | VP OF FINANCE | PersonTitleTxt |
| Phone | 8106486162 | PhoneNum |
| Signature | 2015-04-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOSEPH NARTKER | PreparerPersonNm |
| PTIN | P00297844 | PTIN |
| Phone | 8106484931 | PhoneNum |
| Preparation | 2015-05-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVE BARNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 DELEWARE STREET | AddressLine1 |
| City | SANDUSKY | City |
| State | MI | State |
| ZIP Code | 48471 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,045,776 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCKENZIEHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1961 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 254 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $61,761 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$12,076 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $54,535 | PYContributionsGrantsAmt |
| CY Contributions Grants | $50,352 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,312,035 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,843,161 | CYProgramServiceRevenueAmt |
| PY Investment Income | $84,310 | PYInvestmentIncomeAmt |
| CY Investment Income | $24,930 | CYInvestmentIncomeAmt |
| PY Other Revenue | $99,270 | PYOtherRevenueAmt |
| CY Other Revenue | $86,741 | CYOtherRevenueAmt |
| PY Total Revenue | $19,550,150 | PYTotalRevenueAmt |
| CY Total Revenue | $19,005,184 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,594,857 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,631,086 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $23,447 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,441,308 | PYOtherExpensesAmt |
| CY Other Expenses | $8,355,257 | CYOtherExpensesAmt |
| PY Total Expenses | $19,036,165 | PYTotalExpensesAmt |
| CY Total Expenses | $18,986,343 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $513,985 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $18,841 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,808,280 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,361,826 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,361,118 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,895,823 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,447,162 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,466,003 | NetAssetsOrFundBalancesEOYAmt |
| Mission | FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $18,986,343 | ExpenseAmt |
| Revenue | $19,005,184 | RevenueAmt |
| Desc | PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SANILAC COUNTY. FISCAL YEAR REGISTRATIONS ARE: INPATIENT = 273 OUTPATIENT = 24,799 EMERGENCY ROOM = 5,630 AMBULANCE = 1,905 | Desc |
| Total Program Service Expenses | $18,986,343 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 46 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 254 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AMY RUEDISUELI | PersonNm |
| Phone | 8106486162 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 394 LORAINE STREET | AddressLine1 |
| City | SANDUSKY | City |
| State | MI | State |
| ZIP Code | 48471 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| DR WILLIAM STARBIRD | |||||||||
| MARLETTE PHY | 40.00 | Yes (X) | $0 | $241,925 | $32,190 | ||||
| DAN BABCOCK | |||||||||
| MARLETTE CEO | 40.00 | Yes (X) | $0 | $184,422 | $17,500 | ||||
| STEVE BARNETT | |||||||||
| MCKENZIE CEO | Yes (X) | $177,640 | $0 | $21,889 | 40.00 | Yes (X) | |||
| MARK ENGLISH | |||||||||
| CHIEF OF STA | Yes (X) | $168,599 | $0 | $25,528 | 40.00 | ||||
| ROGER LODING | |||||||||
| CHAIR PERSON | Yes (X) | $0 | $0 | $0 | |||||
| CHRIS CLARK | |||||||||
| VICE CHAIR P | Yes (X) | $0 | $0 | $0 | |||||
| AL STOUTENBURG | |||||||||
| SECRETARY | Yes (X) | $0 | $0 | $0 | |||||
| JUDITH FERGUSON | |||||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |||||
| LARRY MITCHELL | |||||||||
| TRUSTEE | Yes (X) | $0 | $0 | $0 | |||||
| RALPH DESHETSKY | |||||||||
| TRUSTEE | Yes (X) | $0 | $0 | $0 | |||||
| MICHAEL DREYER | |||||||||
| TREASURY | Yes (X) | $0 | $0 | $0 | |||||
| GLEN KAMPMAN | |||||||||
| TRUSTEE | Yes (X) | $0 | $0 | $0 | |||||
| SCOTT ORR | |||||||||
| Yes (X) | $0 | $0 | $0 | ||||||
| SUE COOK | |||||||||
| TRUSTEE | Yes (X) | $0 | $0 | $0 | |||||
| MEREDITH LYONS | |||||||||
| TRUSTEE | Yes (X) | $0 | $0 | $0 | |||||
| JOAN NAGELKIRK | |||||||||
| TRUSTEE | Yes (X) | $0 | $0 | $0 | |||||
| AMY RUEDISUELI | |||||||||
| VP OF FINANC | $107,406 | $0 | $7,758 | 40.00 | Yes (X) | ||||
| DR ALFREDO DOMINGO | |||||||||
| PHYSICIAN | $282,888 | $0 | $0 | 40.00 | Yes (X) | ||||
| DR JAMES SAMS | |||||||||
| PHYSICIAN | $213,688 | $0 | $13,569 | 40.00 | Yes (X) | ||||
| DR MICHAEL MERKLER | |||||||||
| PHYSICIAN | $207,067 | $0 | $17,002 | 40.00 | Yes (X) | ||||
| DR MATTHEW GORMLEY | |||||||||
| PHYSICIAN | $195,399 | $0 | $25,129 | 40.00 | Yes (X) | ||||
| GINA PATTERSON | |||||||||
| PHARMACY DIR | 8.00 | $126,905 | $27,276 | $20,968 | 32.00 | Yes (X) | |||
| DR MELANIE KRAMER | |||||||||
| PHYSICIAN | $123,751 | $0 | $8,835 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,603,343 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $453,623 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $190,368 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MICHIGAN EMERGENCY PHYSICIANS LLP | |||||
| PO BOX 674579 | DETROIT | MI | 48267 | ER COVERAGE | $1,512,751 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | COMPUTER TECH | $228,776 |
| HALL RENDER AND KILLIAN | |||||
| 39778 TREASURY CENTER | CHICAGO | IL | 60694 | LEGAL SERVICE | $158,702 |
| TOSHIBA AMERICAN MEDICAL | |||||
| PO BOX 91605 | TUSTIN | CA | 92780 | CT MAINT | $124,583 |
| COVENANT HEALTHCARE | |||||
| 1447 NORTH HARRISON | SAGINAW | MI | 48602 | REFERENCE LAB | $115,666 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $50,352 | AllOtherContributionsAmt |
| Total Contributions | $50,352 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| INPATIENT & OUTPATIENT REVENU | $29,965,337 | $29,965,337 |
| PHYSICIAN REVENUE | $2,760,874 | $2,760,874 |
| ALL OTHER PROGRAM SERVICE REV | $952,390 | $952,390 |
| RURAL HEALTH REVENUE | $661,719 | $661,719 |
| BAD DEBT & CHARITY CARE | -$856,603 | -$856,603 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$14,640,556 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$14,640,556 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,843,161 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,930 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,930 | RelatedOrExemptFuncIncomeAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $61,761 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $61,761 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,761 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $61,761 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $61,637 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $40,592 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,045 | TotalRevenueColumnAmt |
| Exclusion | $21,045 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SALE OF ASSET | Desc |
| Total Revenue Column | $3,935 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,935 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,935 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,005,184 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,872,026 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $61,761 | UnrelatedBusinessRevenueAmt |
| Exclusion | $21,045 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,102 | TotalAmt |
| Management And General | $234,102 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,413,638 | TotalAmt |
| Program Services | $6,299,901 | ProgramServicesAmt |
| Management And General | $2,102,507 | ManagementAndGeneralAmt |
| Fundraising | $11,230 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,881 | TotalAmt |
| Program Services | $188,280 | ProgramServicesAmt |
| Management And General | $62,601 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,066,582 | TotalAmt |
| Program Services | $757,050 | ProgramServicesAmt |
| Management And General | $309,532 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $665,883 | TotalAmt |
| Program Services | $500,695 | ProgramServicesAmt |
| Management And General | $164,422 | ManagementAndGeneralAmt |
| Fundraising | $766 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,530 | TotalAmt |
| Management And General | $80,530 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,871 | TotalAmt |
| Management And General | $32,871 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,198,241 | TotalAmt |
| Program Services | $2,774,201 | ProgramServicesAmt |
| Management And General | $424,040 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,172 | TotalAmt |
| Program Services | $13,107 | ProgramServicesAmt |
| Management And General | $44,796 | ManagementAndGeneralAmt |
| Fundraising | $10,269 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,142,084 | TotalAmt |
| Program Services | $938,678 | ProgramServicesAmt |
| Management And General | $202,524 | ManagementAndGeneralAmt |
| Fundraising | $882 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,661 | TotalAmt |
| Program Services | $31,141 | ProgramServicesAmt |
| Management And General | $219,520 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $396,986 | TotalAmt |
| Program Services | $389,258 | ProgramServicesAmt |
| Management And General | $7,728 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,165 | TotalAmt |
| Program Services | $106,355 | ProgramServicesAmt |
| Management And General | $28,573 | ManagementAndGeneralAmt |
| Fundraising | $237 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,840 | TotalAmt |
| Program Services | $15,598 | ProgramServicesAmt |
| Management And General | $15,242 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,999 | TotalAmt |
| Program Services | $24,292 | ProgramServicesAmt |
| Management And General | $2,707 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $767,783 | TotalAmt |
| Program Services | $593,339 | ProgramServicesAmt |
| Management And General | $174,444 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,652 | TotalAmt |
| Program Services | $153,363 | ProgramServicesAmt |
| Management And General | $13,289 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| IMPLANTABLES & BLOOD | $597,331 | $597,331 | ||
| DRUGS | $556,347 | $556,347 | ||
| TAXES & LICENSES | $415,671 | $48,358 | $367,313 | |
| FOOD, LAUNDRY, DUES | $286,092 | $94,414 | $191,615 | $63 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,832 | TotalAmt |
| Program Services | $193,762 | ProgramServicesAmt |
| Management And General | $9,070 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,986,343 | TotalAmt |
| Program Services | $14,275,470 | ProgramServicesAmt |
| Management And General | $4,687,426 | ManagementAndGeneralAmt |
| Fundraising | $23,447 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,607 | BOYAmt |
| EOY | $267,705 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,857,145 | BOYAmt |
| EOY | $1,720,836 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,246,210 | BOYAmt |
| EOY | $1,763,585 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $462,844 | BOYAmt |
| EOY | $462,932 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $224,235 | BOYAmt |
| EOY | $142,224 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,026,084 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,171,404 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,764,375 | BOYAmt |
| EOY | $4,854,680 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,864 | BOYAmt |
| EOY | $149,864 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,808,280 | BOYAmt |
| EOY | $9,361,826 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,561,324 | BOYAmt |
| EOY | $2,429,030 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,332 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,028,420 | BOYAmt |
| EOY | $1,918,189 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $634,042 | BOYAmt |
| EOY | $548,604 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,361,118 | BOYAmt |
| EOY | $4,895,823 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,382,077 | BOYAmt |
| EOY | $4,392,009 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,085 | BOYAmt |
| EOY | $73,994 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,447,162 | BOYAmt |
| EOY | $4,466,003 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,808,280 | BOYAmt |
| EOY | $9,361,826 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $18,841 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $160,652 | OtherCostOrOtherBasisAmt |
| Book Value | $160,652 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,502,133 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,755,923 | DepreciationAmt |
| Book Value | $2,746,210 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $264,108 | OtherCostOrOtherBasisAmt |
| Depreciation | $206,392 | DepreciationAmt |
| Book Value | $57,716 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,080,805 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,209,089 | DepreciationAmt |
| Book Value | $1,871,716 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,386 | OtherCostOrOtherBasisAmt |
| Book Value | $18,386 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,854,680 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (13 entries)
| DescDesc | AmtAmt |
|---|---|
| EVERBANK - DIG MAM | $132,159 |
| ESB - 2 AMBULANCES & TRUCK | $103,167 |
| KINGSBRIDGE - TELEMETRY | $100,470 |
| INSIGHT - ULTRASOUND | $61,231 |
| EMB - ULTRASOUND | $48,629 |
| TRI COUNTY - AUTOCLAVE & COMPUTERS | $45,517 |
| NORTHSTAR - AMBULANCE | $33,085 |
| GE - C - ARM & BONE DENSITY | $24,346 |
| KINGSBRIDGE - DIGITIZER & CR | |
| TRI - COUNTY - AUTOCLAVE | |
| ESB - AMBULANCE | |
| KINGSBRIDE - STERILIZER | |
| ESB - 2013 FORD |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $548,604 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $18,908,859 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $18,908,859 | RevenueSubtotalAmt |
| Other Revenues Not Included | $96,325 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $96,325 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $19,005,184 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,986,334 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $18,986,334 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $9 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $9 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,986,343 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | INTEREST INCOME 24,883 CONTRIBUTIONS 62,439 CONTRIBUTIONS RELEASED FROM TEMP. RESTRICTED NET ASSETS 8,958 INTEREST FROM TEMPORARY RESTRICITIONS 48 ROUNDING -3 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | ROUNDING 9 |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed States | MI | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | BENEFIT RAFFLE | NameOfEvent1Amt |
| Gross Receipts Event1 | $33,867 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $33,867 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $4,500 | CashPrizesEvent1Amt |
| Food And Beverage Event1 | $4,599 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $450 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $1,364 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | HOSP AUXILARY | NameOfEvent2Amt |
| Gross Receipts Event2 | $27,770 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $27,770 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $29,679 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $61,637 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $61,637 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $4,500 | CashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $4,599 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $450 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $31,043 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $40,592 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $21,045 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | false | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 33 | PersonsServedCnt |
| Total Community Benefit Expns | $64,130 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $64,130 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $3,436,788 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,317,096 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,119,692 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05900 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 33 | PersonsServedCnt |
| Total Community Benefit Expns | $3,500,918 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,317,096 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,183,822 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06240 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 366 | ActivitiesOrProgramsCnt |
| Persons Served | 3592 | PersonsServedCnt |
| Total Community Benefit Expns | $72,209 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $42,491 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $29,718 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $11,473 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,473 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $6,587 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,587 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 152 | PersonsServedCnt |
| Total Community Benefit Expns | $1,664 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,134 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 371 | ActivitiesOrProgramsCnt |
| Persons Served | 3744 | PersonsServedCnt |
| Total Community Benefit Expns | $91,933 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $43,021 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $48,912 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00260 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 373 | ActivitiesOrProgramsCnt |
| Persons Served | 3777 | PersonsServedCnt |
| Total Community Benefit Expns | $3,592,851 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,360,117 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,232,734 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 10 | ActivitiesOrProgramsCnt |
| Persons Served | 794 | PersonsServedCnt |
| Total Community Benefit Expns | $3,728 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $150 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,578 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 9 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $228 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $228 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Persons Served | 794 | PersonsServedCnt |
| Total Community Benefit Expns | $3,956 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $150 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $475,884 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $45,564 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,158,569 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,257,349 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$98,780 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Business Name Line2 | DBA MCKENZIE HEALTH SYSTEM | BusinessNameLine2 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 DELAWARE STREET | AddressLine1 |
| City | SANDUSKY | City |
| State | MI | State |
| ZIP Code | 48471 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MCKENZIEHEALTH.ORG | WebsiteAddressTxt |
| State License | L414719 | StateLicenseNum |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, MCKENZIE MEMORIAL HOSPITAL - PART V, LINE 3 | MCKENZIE MEMORIAL HOSPITAL PARTICIPATED IN A COMMUNITY MANAGERS COMMITTEE WHICH CONSISTS OF MEMBERS FROM THE FOLLOWING ORGANIZATIONS: SANILAC COUNTY, SANILAC COUNTY MEDICAL FACILITY, SANILAC COUNTY INTERMEDIATE SCHOOL DISTRICT, SANDUSKY COMMUNITY SCHOOLS, SANILAC COUNTY COMMUNITY MENTAL HEALTH, CITY OF SANDUSKY, SANILAC COUNTY HEALTH DEPARTMENT AND THE SANILAC ROAD COMMISSION. INPUT FROM THESE ORGANIZATIONS REGARDING THE HEALTH OF OUR COMMUNITY AND ITS NEEDS IS CONSIDERED. IN ADDITION, MCKENZIE HELD TWO PUBLIC MEETINGS IN APRIL 2013 WHERE WE INVITED OVER 1000 PARTICIPANTS TO COME AND SHARE THEIR CONCERNS ABOUT THE HEALTH OF THE COMMUNITY. PARTICIPATING COMMUNITY EMPLOYERS INCLUDED THE SANILAC COUNTY COURT HOUSE, SANDUSKY SCHOOLS, TELLEBORG, INC., JENSEN BRIDGE, INC. AND THE SANILAC MEDICAL CARE FACILTY. |
| FACILITY 1, MCKENZIE MEMORIAL HOSPITAL - PART V, LINE 7 | MCKENZIE MEMORIAL HOSPITAL WAS NOT ABLE TO ADDRESS ALL THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA. IT WAS IDENTIFIED THAT AN EAR, NOSE, AND THROAT (ENT) SPECIALIST IS NEEDED IN SANDUSKY. IT IS VERY DIFFICULT TO RECRUIT SPECIALISTS TO OUR SMALL RURAL TOWN BECAUSE OF THE LACK OF VOLUME TO SUSTAIN THIS TYPE OF SPECIALIST. HOWEVER, WE ARE WORKING TO BRING SPECIALIST TO OUR HOSPITAL VIA TELEMEDICINE. THE SECOND ITEM THAT WE WERE UNABLE TO SOLVE IS LONGER PHYSICIAN OFFICE HOURS AND WEEKEND HOURS. WE ARE CURRENTLY EVALUATING THE FINANCIAL VIABILITY OF AN URGENT CARE CLINIC. THE PRIMARY HURDLE IN OPERATING A LOCAL URGENT CARE CLINIC IS THE AVAILABILITY OF HEALTH CARE PROVIDERS TO STAFF THE CLINIC. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 ACTIVITES 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, NOTE 1, PARAGRAPH 3. |
| 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 98,780 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 ASSESMENT 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, SEE ANSWER TO PART V, LINE 3 ABOVE. EXAMPLES OF SERVICE PROVIDED BASED ON COMMUNITY NEED ARE GERIATRICS PROGRAM, IMMUNIZATIONS, SPORTS PHYSICALS, SENIOR FAIR, HEALTH FAIRS, FIRST AID BOOTH AND DIABETIC CLASSES. |
| 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 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 THROUTHOUT THE HOSIPTAL. 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 41,587. SANILAC COUNTY CONSISTS OF MOSTLY FARMLAND WITH VERY FEW MANUFACTURING FACILITIES. THE UNEMPLOYMENT RATE IN SANILAC COUNTY IS BETWEEN 6.01-6.9%. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|
| DR WILLIAM STARBIRD | |||||||
| MARLETTE PHYSICIAN | $241,925 | $32,190 | $274,115 | ||||
| DAN BABCOCK | |||||||
| MARLETTE CEO | $184,422 | $17,500 | $201,922 | ||||
| STEVE BARNETT | |||||||
| MCKENZIE CEO/PRES | $177,640 | $6,945 | $14,944 | $199,529 | |||
| MARK ENGLISH | |||||||
| CHIEF OF STAFF | $168,599 | $6,349 | $19,179 | $194,127 | |||
| DR ALFREDO DOMINGO | |||||||
| PHYSICIAN | $282,888 | $282,888 | |||||
| DR JAMES SAMS | |||||||
| PHYSICIAN | $213,688 | $7,756 | $5,813 | $227,257 | |||
| DR MICHAEL MERKLER | |||||||
| PHYSICIAN | $207,067 | $7,834 | $9,168 | $224,069 | |||
| DR MATTHEW GORMLEY | |||||||
| PHYSICIAN | $195,399 | $7,144 | $17,985 | $220,528 | |||
| GINA PATTERSON | |||||||
| PHARMACY DIRECTOR | $27,276 | $27,276 | $126,905 | $5,476 | $15,492 | $147,873 | |
| DR MELANIE KRAMER | |||||||
| PHYSICIAN | $123,751 | $8,835 | $132,586 | ||||
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BARNETT ANESTESIA INC | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | CEO'S SPOUSE | RelationshipDescriptionTxt |
| Transaction | $101,575 | TransactionAmt |
| Transaction | CRNA SERVICES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 7B | BLUE WATER HEALTHCARE NETWORK MUST APPROVE ANY FINANCIAL TRANSACTIONS ABOVE ONE MILLION DOLLARS BEFORE ANY ACTION CAN BE TAKEN BY THE BOARD OF DIRECTORS OF MCKENZIE MEMORIAL HOSPITAL. |
| 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 2,532,626 0 0 MEDICAL SERVICE CONTRACTS 241,575 0 0 ADMINISTRATIVE PROFESSIONAL 0 372,353 0 ADMINISTRATIVE SERVICE CONT. 0 31,695 0 AQUA AEROBIC INSTRUCTIONS 0 19,992 0 |
| FORM 990, PART XI, LINE 9 | INTEREST INCOME -24,883 CONTRIBUTIONS -62,439 CONTRIBUTIONS RELEASED FROM TEMP. RESTRICTED NET ASSETS -8,958 INTEREST FROM TEMPORARY RESTRICITIONS -48 ROUNDING 3 ROUNDING 9 |
| FORM 990, PART XI, LINE 9 | 96,316 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Business Name Line2DirectControllingEntityName/BusinessNameLine2 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MCKENIZE HEALTHCARE CORPORATION | |||||||||||
| 120 DELAWARE STREET | SANDUSKY | MI | 48471 | 382702946 | HEALTHCARE | MI | 501C3 | 3 | ITSELF | false | |
| SANILAC HEALTHCARE CORP | |||||||||||
| 120 DELAWARE STEET | SANDUSKY | MI | 48471 | 382702948 | PHARMACY | MI | 501C3 | 3 | MCKENIZE | false | HEALTHCARE CORPORATION |
| 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 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANILAC SERVICES INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 78 SOUTH ELK | AddressLine1 |
| City | SANDUSKY | City |
| State | MI | State |
| ZIP Code | 48471 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382774983 | EIN |
| Primary Activities | PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | MI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENIZE | BusinessNameLine1 |
| Business Name Line2 | HEALTHCARE CORPORATION | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Business Name Line2OtherOrganizationName/BusinessNameLine2 | Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|---|
| SANILAC SERVICES INC | |||
| SANILAC PHARMACY | K | $15,000 | FMV |
| SANILAC SERVICES INC | |||
| SANILAC PHARMACY | P | $9,811 | COST BASIS |
| SANILAC SERVICES INC | |||
| SANILAC PHARMACY | Q | $90,000 | COST BASIS |
| MARLETE REGIONAL HOSPITAL | |||
| O | $160,895 | COST BASIS | |
| MARLETTE REGIONAL HOSPITAL | |||
| O | $34,393 | COST BASIS | |