SPARROW CARSON HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- SPARROW CARSON HOSPITAL (EIN 38-1490180)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-12
- IRS object ID
- 201533169349304798
- Schema version
- 2014v5.0
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-12T15:04:32-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 383133790 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDREWS HOOPER PAVLIK PLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4295 OKEMOS RD STE 200 | AddressLine1Txt |
| City | OKEMOS | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 488646201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381490180 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARSON CITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARS | BusinessNameControlTxt |
| Phone | 9895843971 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 E ELM STREET PO BOX 879 | AddressLine1Txt |
| City | CARSON CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48811 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD REID | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 9895843971 | PhoneNum |
| Signature | 2015-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARK E HOOPER | PreparerPersonNm |
| PTIN | P00039887 | PTIN |
| Phone | 5177060800 | PhoneNum |
| Preparation | 2015-11-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MATTHEW THOMPSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 E ELM STREET PO BOX 879 | AddressLine1Txt |
| City | CARSON CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48811 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $58,584,356 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CARSONHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1938 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY & ACCESSIBLE HEALTH CARE SERVICES TO COMMUNITIES WE SERVE IN CONJUNCTION, CCH PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 630 | TotalEmployeeCnt |
| Total Volunteers | 98 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $61,573,854 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $55,370,899 | CYProgramServiceRevenueAmt |
| PY Investment Income | $495,155 | PYInvestmentIncomeAmt |
| CY Investment Income | $672,143 | CYInvestmentIncomeAmt |
| PY Other Revenue | $988,025 | PYOtherRevenueAmt |
| CY Other Revenue | $2,461,472 | CYOtherRevenueAmt |
| PY Total Revenue | $63,057,034 | PYTotalRevenueAmt |
| CY Total Revenue | $58,504,514 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $35,381,239 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $39,365,045 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $33,118,415 | PYOtherExpensesAmt |
| CY Other Expenses | $18,084,101 | CYOtherExpensesAmt |
| PY Total Expenses | $68,499,654 | PYTotalExpensesAmt |
| CY Total Expenses | $57,449,146 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,442,620 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,055,368 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $43,059,007 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,334,883 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,110,571 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,057,136 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,948,436 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,277,747 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY & ACCESSIBLE HEALTH CARE SERVICES TO COMMUNITIES WE SERVE IN CONJUNCTION, CCH PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $30,484,735 | ExpenseAmt |
| Revenue | $40,793,665 | RevenueAmt |
| Desc | CARSON CITY HOSPITAL (CCH) IS A 61-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, DO. SINCE THIS TIME, CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS IN A FOUR-COUNTY AREA. CCH CURRENTLY OPERATES A SHORT-TERM, ACUTE-CARE FACILITY AND SEVERAL SATELLITE CLINICS OFFERING INPATIENT AND OUTPATIENT HEALTHCARE SERVICES, PSYCHIATRIC SERVICES, PHYSICIAN SERVICES, AND HOME HEALTH CARE, PRIMARILY TO PATIENTS IN THE CARSON CITY, MICHIGAN AREA, INCLUDING GRATIOT, MONTCALM, CLINTON, AND IONIA COUNTIES. CCH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE CCH DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE UNDER ARRANGEMENTS WITH VARIOUS GOVERNMENTAL INSURANCE PROGRAMS. CCH PROVIDES SIGNIFICANT CARE TO THE LOCAL INDIGENT POPULATION FOR WHICH REIMBURSEMENT FOR SERVICES RENDERED IS GENERALLY LESS THAN THE COST OF PROVIDING SUCH SERVICES AS PART OF ITS OBLIGATION TO THE LOCAL COMMUNITY. CCH ALSO PROVIDES SERVICES TO INDIGENT PATIENTS UNDER THE MEDICAID PROGRAM AT PAYMENT AMOUNTS LESS THAN THE COST OF THE SERVICES PROVIDED. FOR THE YEAR ENDED DECEMBER 31, 2014, CCH PROVIDED OVER 2 MILLION IN UNCOMPENSATED CARE. THE ESTIMATED ANNUAL TOTAL LOCAL ECONOMIC IMPACT IS 30,000,000. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,730,722 | ExpenseAmt |
| Revenue | $1,787,847 | RevenueAmt |
| Desc | ITHACA FAMILY CARE CENTER (IFCC) IS AN OFFICE WITH 2 PHYSICIANS, 1 NURSE PRACTITIONER, AND 1 PHYSICIAN ASSISTANT THAT FOCUSES ON FAMILY PRACTICE FOR GRATIOT COUNTY. IFCC PROVIDES OUTPATIENT SERVICES SUCH AS AUDIOMETRY, BLOOD PRESSURE CHECK, EAR EXAMINATION, EKG, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATIONS, HEALTH EDUCATION, HEMOCCULT, IMMUNIZATION, LACERATION, OFFICE VISITS, OSTEOPATHIC MANIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS AND PREMARITAL COUNSELING. THEY ALSO PROVIDE LABORATORY SERVICES SUCH AS BLOOD SUGAR, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $925,005 | ExpenseAmt |
| Revenue | $1,139,261 | RevenueAmt |
| Desc | CARSON FAMILY CARE CENTER (CFCC) IS AN OFFICE WITH 2 PHYSICIANS, 1 NURSE PRACTITIONER, AND 1 PHYSICIAN ASSISTANT THAT FOCUSES ON FAMILY PRACTICE FOR MONTCALM COUNTY. CFCC PROVIDES OUTPATIENT SERVICES SUCH AS ASTHMA SERVICES, AUDIOMETRY, BLOOD PRESSURE CHECKS, DISABILITY/IMPAIRMENT EVALUATIONS, DRUG AND ALCOHOL SCREENING, EAR EXAMINATION, EKG, EMPLOYEE SCREENING, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATION, HEALTH EDUCATION, IMMUNIZATION, IMMUNOTHERAPY, INJURY MANAGEMENT WORK RELATED INJURIES, LACERATION, LASER COSMETICS, OFFICE VISITS, OSTEOPATHIC MANIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS, PRE-EMPLOYMENT PHYSICALS, PREMARITAL COUNSELING, SAFETY PROGRAMS AND WORK SITE VISITS. THEY ALSO PROVIDE LABORATORY SERVICES SUCH AS BLOOD SUGAR, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $11,082,500 | ExpenseAmt |
| Revenue | $11,650,126 | RevenueAmt |
| Desc | OTHER PROGRAM SERVICES INCLUDE THE OPERATION OF THE FOLLOWING FACILITIES: ASHLEY FAMILY CARE CENTER, CARSON CITY HOSPITAL, ORTHOPEDICS AND GENERAL SURGERY, PHYSICAL REHABILITATION CENTER, FOWLER FAMILY CARE CENTER, GREENVILLE FAMILY CARE CENTER, HOSPITALISTS, LYONS FAMILY CARE CENTER, PEDIATRIC AND ADOLESCENT SPECIALISTS, STANTON FAMILY CARE CENTER, CARSON HOME CARE, CARSON PAIN MANAGEMENT. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $11,082,500 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $11,650,126 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $44,222,962 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | 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 | Yes (true) | 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 | false | 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 | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| 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 | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | 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 | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 54 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 630 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD REID | PersonNm |
| Phone | 9895843971 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 E ELM STREET | AddressLine1Txt |
| City | CARSON CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48811 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| ROBERT SEALS | |||||||||
| SEC/TREAS/ME | 40.00 | Yes (X) | Yes (X) | $302,042 | $0 | $14,180 | |||
| DAVID J FREESTONE MD | |||||||||
| BOARD MBR/PH | 40.00 | Yes (X) | $283,323 | $0 | $14,180 | ||||
| MATTHEW J THOMPSON | |||||||||
| PRESIDENT/CE | 40.00 | Yes (X) | Yes (X) | $215,727 | $0 | $14,180 | 0.20 | ||
| DOUGLAS POFF DO | |||||||||
| BOARD MBR/PH | 40.00 | Yes (X) | $207,302 | $0 | $11,409 | ||||
| HAROLD HOUSE | |||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| BRENT WILSON | |||||||||
| CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| GARY REETZ | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARK BRETT | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| TOM MACDONALD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| TOM OSTRANDER | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| RICHARD SCHROEDER | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| RODERICK COY | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CINDA KOSLOSKI | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| RICHARD REID | |||||||||
| CFO | 40.00 | Yes (X) | $165,527 | $0 | $12,980 | 1.00 | |||
| NANCY WEAVER | |||||||||
| VP NURSING/C | 40.00 | Yes (X) | $155,549 | $0 | $534 | ||||
| GEORGETTE RUSSELL | |||||||||
| VP/TALENT & | 40.00 | Yes (X) | $143,009 | $0 | $1,692 | ||||
| RICHARD D TERRY | |||||||||
| VP/CIO | 40.00 | Yes (X) | $123,082 | $0 | $4,928 | ||||
| CHRISTOPHER E HERALD MD | |||||||||
| ER DIRECTOR | 40.00 | $323,215 | $0 | $14,230 | Yes (X) | ||||
| ADAM Z COTE | |||||||||
| PHYSICIAN | 40.00 | $728,690 | $0 | $14,180 | Yes (X) | ||||
| JOSEPH B WHITE | |||||||||
| PHYSICIAN | 40.00 | $615,140 | $0 | $12,980 | Yes (X) | ||||
| PARUTAPPA BHIMALLI | |||||||||
| PHYSICIAN | 40.00 | $522,345 | $0 | $2,086 | Yes (X) | ||||
| RAYMOND P ALLARD | |||||||||
| PHYSICIAN | 40.00 | $520,704 | $0 | $12,980 | Yes (X) | ||||
| VINCENT DUBE | |||||||||
| PHYSICIAN | 40.00 | $415,343 | $0 | $10,209 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,720,998 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $140,748 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 42 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PRISM HEALTHCARE PARTNERS LTD | |||||
| 190 S LA SALLE ST SUITE 2900 | CHICAGO | IL | 60603 | CONSULTING | $616,202 |
| PHARMACY SYSTEMS | |||||
| PO BOX 71-0716 | COLUMBUS | OH | 43271 | CONSULTING | $251,680 |
| QUEUE ADVERTISING | |||||
| 410 S CEDAR | LANSING | MI | 48912 | ADVERSITING | $181,224 |
| LIFE CARE SLEEP DIAGNOSTICS LLC | |||||
| 7200 W SAGINAW HWY SUITE 1 | LANSING | MI | 48917 | SLEEP STUDY CON | $168,000 |
| PSI SUPPLY CHAIN SOLUTIONS LLC | |||||
| 5050 BRADENTON AVE | DUBLIN | OH | 43017 | SUPPLY CHAIN MG | $163,141 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $55,081,902 | $55,081,902 |
| MEDICARE/MEDICAID "HITECH" | 900099 | $288,997 | $288,997 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $55,370,899 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $640,207 | TotalRevenueColumnAmt |
| Exclusion | $640,207 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $90,310 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $79,842 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,468 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,468 | TotalRevenueColumnAmt |
| Exclusion | $10,468 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $31,936 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $31,936 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,936 | TotalRevenueColumnAmt |
| Exclusion | $31,936 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| COFFEE SHOP/CAFETERIA/OTHER | 722210 | $2,086,964 | $2,086,964 |
| CONTRACTED PHARMACY 340B REV | 900099 | $364,040 | $364,040 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,451,004 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,504,514 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $55,370,899 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $3,133,615 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,853,593 | TotalAmt |
| Program Services | $3,899,721 | ProgramServicesAmt |
| Management And General | $953,872 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,557,747 | TotalAmt |
| Program Services | $23,724,594 | ProgramServicesAmt |
| Management And General | $3,833,153 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,467,845 | TotalAmt |
| Program Services | $907,843 | ProgramServicesAmt |
| Management And General | $1,560,002 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,649,826 | TotalAmt |
| Program Services | $370,165 | ProgramServicesAmt |
| Management And General | $3,279,661 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $836,034 | TotalAmt |
| Program Services | $765,473 | ProgramServicesAmt |
| Management And General | $70,561 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,066 | TotalAmt |
| Program Services | $13,462 | ProgramServicesAmt |
| Management And General | $180,604 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,864 | TotalAmt |
| Program Services | $11,505 | ProgramServicesAmt |
| Management And General | $26,359 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,032 | TotalAmt |
| Management And General | $45,032 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $417,581 | TotalAmt |
| Program Services | $104,424 | ProgramServicesAmt |
| Management And General | $313,157 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,955,140 | TotalAmt |
| Program Services | $3,001,315 | ProgramServicesAmt |
| Management And General | $953,825 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,163,701 | TotalAmt |
| Program Services | $317,301 | ProgramServicesAmt |
| Management And General | $846,400 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,170,502 | TotalAmt |
| Program Services | $4,183,176 | ProgramServicesAmt |
| Management And General | $987,326 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $307,300 | TotalAmt |
| Program Services | $237,266 | ProgramServicesAmt |
| Management And General | $70,034 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $318,356 | TotalAmt |
| Program Services | $318,356 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,539,106 | TotalAmt |
| Program Services | $1,528,119 | ProgramServicesAmt |
| Management And General | $10,987 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $766,249 | TotalAmt |
| Program Services | $671,038 | ProgramServicesAmt |
| Management And General | $95,211 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PROVISION FOR BAD DEBTS | $2,500,000 | $2,500,000 |
| IMPLANTS | $684,160 | $684,160 |
| ORTHO JOINT REPLACEMENT | $666,478 | $666,478 |
| OTHER EXPENSES | $318,566 | $318,566 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,449,146 | TotalAmt |
| Program Services | $44,222,962 | ProgramServicesAmt |
| Management And General | $13,226,184 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,704 | BOYAmt |
| EOY | $4,304 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,513,798 | BOYAmt |
| EOY | $2,347,333 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,658,136 | BOYAmt |
| EOY | $6,221,175 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,882 | BOYAmt |
| EOY | $108,783 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,577,849 | BOYAmt |
| EOY | $1,704,292 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,500,123 | BOYAmt |
| EOY | $985,576 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $48,110,012 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $27,571,512 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,238,586 | BOYAmt |
| EOY | $20,538,500 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,843,661 | BOYAmt |
| EOY | $6,113,800 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $239,804 | BOYAmt |
| EOY | $239,804 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,367,464 | BOYAmt |
| EOY | $1,071,316 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,059,007 | BOYAmt |
| EOY | $39,334,883 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,627,418 | BOYAmt |
| EOY | $7,009,217 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,632,780 | BOYAmt |
| EOY | $12,949,986 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,966,218 | BOYAmt |
| EOY | $1,964,917 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,510 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,866,645 | BOYAmt |
| EOY | $2,133,016 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,110,571 | BOYAmt |
| EOY | $24,057,136 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,767,354 | BOYAmt |
| EOY | $15,170,944 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,082 | BOYAmt |
| EOY | $106,803 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,948,436 | BOYAmt |
| EOY | $15,277,747 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,059,007 | BOYAmt |
| EOY | $39,334,883 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,055,368 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$185,296 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$1,540,761 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $4,560 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,560 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION INDIRECTLY INFLUENCED LEGISLATION THROUGH ITS ANNUAL DUES PAID TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION. 17.25% OF DUES PAID WERE USED FOR SPECIFIC LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $751,643 | OtherCostOrOtherBasisAmt |
| Book Value | $751,643 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,843,974 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,421,553 | DepreciationAmt |
| Book Value | $16,422,421 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,688,493 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,754,750 | DepreciationAmt |
| Book Value | $1,933,743 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,825,902 | OtherCostOrOtherBasisAmt |
| Depreciation | $395,209 | DepreciationAmt |
| Book Value | $1,430,693 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,538,500 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| EST THIRD-PARTY PAYOR SETTLEMENTS | $1,299,755 |
| CURRENT PORTION ON LT DEBT | $833,261 |
| OTHER LONG TERM LIABILITIES |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,133,016 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $55,899,060 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$185,296 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $79,842 | OtherRevenueAmt |
| Revenue Not Reported | -$105,454 | RevenueNotReportedAmt |
| Revenue Subtotal | $56,004,514 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,500,000 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,500,000 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $58,504,514 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $56,495,470 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1,546,324 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,546,324 | ExpensesNotReportedAmt |
| Expenses Subtotal | $54,949,146 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,500,000 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,500,000 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $57,449,146 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRED RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDIT BY TAXING JURISDICTIONS, HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2011. |
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | RENT EXPENSES INCLUDED IN REVENUE 79,842 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | PROVISION FOR BAD DEBTS 2,500,000 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | RENT EXPENSES INCLUDED IN REVENUE 79,842 CHANGE IN PENSION LIABILITY 1,466,482 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | PROVISION FOR BAD DEBTS 2,500,000 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 2.500000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $717,972 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $717,972 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01250 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,925,320 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,640,062 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,285,258 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07460 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,643,292 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,640,062 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,003,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08710 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,300 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $198,211 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,790 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $195,421 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $690,307 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $690,307 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01200 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $897,818 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,790 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $895,028 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01560 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,541,110 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,642,852 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,898,258 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10270 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,500,000 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $68,690 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,814,284 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,847,443 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,033,159 | 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 | CARSON CITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 E ELM STREET | AddressLine1Txt |
| City | CARSON CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48811 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARSON CITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| 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 | 11 | CHNAConductedYr |
| Take Into Account Others Input | false | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CARSONHEALTH.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 11 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, CARSON CITY HOSPITAL - PART V, LINE 6A | SPECTRUM HEALTH KELSEY HOSPITAL, SHERIDAN COMMUNITY HOSPITAL, AND CHERRY STREET - MONTCALM AREA HEALTH CENTER |
| FACILITY 1, CARSON CITY HOSPITAL - PART V, LINE 11 | CARSON CITY HOSPITAL WILL NOT BE SPECIFICALLY ADDRESSING EACH AND EVERY HEALTH NEED LISTED IN THE CHNA DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO ITS TWO PRIORITY HEALTH NEEDS IDENTIFIED IMPROVED ACCESS TO HEALTH CARE AND INCREASED AWARENESS OF EXISTING COMMUNITY RESOURCES. SOME OF THESE HEALTH NEEDS WILL BE INDIRECTLY IMPACTED BY FOCUSING ON THE TWO PRIORITY HEALTH NEEDS IDENTIFIED ABOVE. |
| FACILITY 1, CARSON CITY HOSPITAL - PART V, LINE 22D | DURING 2011, THE HOSPITAL FACILITY USED THE HIGHEST COMMERCIAL RATE WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. DURING 2012, THE HOSPITAL FACILITY HAS CHANGED ITS PRACTICE AND USES THE AVERAGE OF THE THREE HIGHEST COMMERCIAL RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AND THIS IS CONSISTENT WITH THE YEAR 2014. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 14 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| ITHACA FAMILY CARE CENTER | ||||
| 114 N MAIN ST | ITHACA | MI | 48847 | GENERAL MEDICAL OUTPATIENT CLINIC |
| CARSON FAMILY CARE CENTER | ||||
| 102 S THIRD ST SUITE 100 BOX 277 | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| PHYSICAL REHABILITATION CARE CENTER | ||||
| 602 E ELM STREET | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| CARSON HOME CARE | ||||
| 406 E ELM STREET | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| GREENVILLE FAMILY CARE CENTER | ||||
| 1014 E WASHINGTON | GREENVILLE | MI | 48838 | GENERAL MEDICAL OUTPATIENT CLINIC |
| PEDIATRIC & ADOLESCENT SPECIALISTS | ||||
| 245 S SECOND ST BOX 847 | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| STANTON FAMILY CARE CENTER | ||||
| 545 N STATE ST BOX 638 | STANTON | MI | 48888 | GENERAL MEDICAL OUTPATIENT CLINIC |
| ASHLEY FAMILY CARE CENTER | ||||
| 320 S STERLING ST BOX 96 | ASHLEY | MI | 48806 | GENERAL MEDICAL OUTPATIENT CLINIC |
| CARSON PAIN MANAGEMENT | ||||
| 102 S THIRD ST SUITE 300 | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| CARSON CITY HOSPITAL ORTHOPEDICS AN | ||||
| 102 S THIRD ST SUITE 400 BOX 326 | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| HOSPITALISTS | ||||
| 406 E ELM STREET | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| CARSON BEHAVIORAL HEALTH CENTER | ||||
| 102 S THIRD ST SUITE 500 BOX 417 | CARSON CITY | MI | 48811 | GENERAL MEDICAL OUTPATIENT CLINIC |
| FOWLER FAMILY CARE CENTER | ||||
| 11017 W THIRD ST BOX 19 | FOWLER | MI | 48835 | GENERAL MEDICAL OUTPATIENT CLINIC |
| LYONS FAMILY CARE CENTER | ||||
| 505 E BRIDGE ST BOX 186 | LYONS | MI | 48851 | GENERAL MEDICAL OUTPATIENT CLINIC |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION | THE COMMUNITY BENEFIT REPORT TAKES THE WHOLE HOSPITAL, WHICH ALSO TAKES THE MEDICAL SERVICES GROUP PHYSICIAN CLINICS INTO CONSIDERATION. SOME ITEMS CAN ONLY BE DONE IN THE HOSPITAL WHILE MANY OTHERS CAN BE DONE IN A PHYSICIAN CLINIC SETTING. THE REVENUE THAT IS BROUGHT IN FROM THE PHYSICIAN CLINIC SETTING INCLUDES BLOOD PRESSURE CHECKS, CHILD IMMUNIZATIONS, AND CHOLESTEROL TESTING, AS WELL AS MANY OTHER PREVENTATIVE SERVICES IN LOW POPULATION, RURAL COMMUNITIES. |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | THE DEFINITION OF A COMMUNITY BENEFIT IS A SERVICE OR PROGRAM THAT THE HOSPITAL PROVIDES TO PROMOTE HEALTH AND HEALING AS A RESPONSE TO COMMUNITY NEEDS. COMMUNITY BENEFITS USUALLY GENERATE A LOW OR NEGATIVE FINANCIAL RETURN, RESPOND TO PUBLIC HEALTH NEEDS, INVOLVE EDUCATION OR RESEARCH THAT IMPROVES THE OVERALL COMMUNITY HEALTH, AND RESPOND TO THE NEEDS OF SPECIAL POPULATIONS SUCH AS PERSONS LIVING IN POVERTY AND OTHER DISENFRANCHISED PERSONS. THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. |
| PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE | THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY REPORTED IN PART III, LINE 3 IS DETERMINED BY USING A PERCENTAGE (2.75%) OF THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE AT COST. THIS PERCENTAGE IS DETERMINED BY ANALYZING THE HOSPITAL'S WRITE-OFFS COMPARED TO ITS TOTAL GROSS REVENUE. |
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | 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 PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER 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 CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD- PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT 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 COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. ANY SHORTFALLS THAT RESULT FROM MEDICARE ALLOWABLE COSTS EXCEEDING MEDICARE REVENUE CAN BE CONSIDERED A COMMUNITY BENEFIT IF THE ACTIVITY IS SOMETHING THAT CARSON CITY HOSPITAL IS DOING TO CREATE THE AWARENESS AND WELL-BEING OF THE HOSPITAL COMMUNITY. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | CARSON CITY HOSPITAL INITIATES COLLECTION AT THE POINT OF SERVICE THROUGH THE PATIENT ACCESS DEPARTMENT. PATIENTS ARE ADVISED OF THEIR CO-PAY AND DEDUCTIBLE AND ASKED FOR A DEPOSIT ON THESE SELF-PAY CONTRIBUTIONS. PATIENTS WHO DO NOT HAVE INSURANCE ARE ADVISED OF ESTIMATED COST AND ASSISTANCE PROGRAMS ARE OFFERED ALONG WITH CONTACT INFORMATION TO OBTAIN FURTHER INFORMATION. THE PATIENT'S BILL IS CHARGED, CODED, AND PROCESSED WITH THE APPROPRIATE PAYERS, IF APPLICABLE, AND AT THE POINT ALL THIRD PAYERS HAVE MADE PAYMENT, THE REMAINING BALANCE IS BILLED ON A STATEMENT TO THE PATIENT. AT THE POINT THAT THE PATIENT RECEIVES THE STATEMENT, THEY MAY CHOOSE TO MAKE PAYMENT ARRANGEMENTS THROUGH A PAYMENT PLAN, OR MAY CHOOSE TO APPLY FOR ASSISTANCE. THE PATIENT WHO DOES NOT MAKE PAYMENT ARRANGEMENTS OR DOES NOT APPLY FOR ASSISTANCE, WILL RECEIVE THREE STATEMENTS OVER A 90-DAY PERIOD. IF NO RESOLUTION IS ACHIEVED THE ACCOUNT WILL BE REFERRED TO AN OUTSIDE AGENCY FOR COLLECTION. THE PATIENT HAS 60 DAYS AT THE AGENCY BEFORE THEIR ACCOUNT IS RECORDED AS BAD DEBT. THE PATIENT STILL HAS THE OPTION OF APPLYING FOR ASSISTANCE OR MAKING PAYMENT ARRANGEMENTS WITH THE AGENCY. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | CARSON CITY HOSPITAL RESPONDS TO THE HEALTHCARE NEEDS OF ITS ENTIRE SERVICE AREA. ITS DOORS ARE OPEN TO ALL THOSE WHO NEED HEALTHCARE SERVICES. INFORMATION ABOUT HEALTHCARE NEEDS IS RECEIVED THROUGH PARTNERSHIPS WITH LOCAL NON-PROFITS, GOVERNMENT AGENCIES AND OTHER HEALTHCARE ORGANIZATIONS, SUCH AS THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT AND THE IONIA COUNTY HEALTH DEPARTMENT - WHICH, TOGETHER, MONITOR THE MORTALITY RATES AND CAUSES IN CLINTON, GRATIOT, IONIA AND MONTCALM COUNTIES. HOSPITAL SERVICE RECORDS AND PATIENT SATISFACTION SURVEYS - MANAGED BY PRESS GANEY - ALSO PROVIDE FEEDBACK TO HOSPITAL STAFF ABOUT THE NEEDS OF THE COMMUNITY. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | ALTHOUGH NOT SPECIFICALLY OUTLINED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL USES THE FOLLOWING METHODS TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY: WITHIN THE COMMUNITY SERVED THE POLICY WAS POSTED ON THE HOSPITAL FACILITY'S WEBSITE; THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS OR WAITING ROOMS; THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICE; THE POLICY WAS AVAILABLE UPON REQUEST. PATIENTS WERE MADE AWARE OF THE POLICY UPON ADMISSION, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS CURRENTLY UNDER REVIEW AND THE HOSPITAL IS CONSIDERING ADDING SPECIFIC INFORMATION RELATED TO THE METHODS USED TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | CARSON CITY HOSPITAL (CCH) IS A 61-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, DO. SINCE THIS TIME CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS OF COMMUNITIES IN A FOUR-COUNTY AREA. THE HOSPITALS GOVERNING BODY CONSISTS PRIMARILY OF VOLUNTEER MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN THE FALL OF 1996, CARSON BECAME A PART OF CARSON HEALTH NETWORK (CHN). CHN WAS INTRODUCED TO WORK AS AN UMBRELLA UNDER WHICH ALL THE INDIVIDUAL HEALTHCARE ENTITIES ARE CONTAINED. CHN INCLUDES CARSON CITY HOSPITAL, FAMILY MEDICINE PRACTICES AND SEVERAL SPECIALTY CLINICS OFFERING A WIDE VARIETY OF SERVICES. THE FAMILY MEDICINE PROFESSIONAL, MEDICAL STAFF, IN COOPERATION WITH HOSPITAL BASED SPECIALISTS, SERVES PATIENTS IN ASHLEY, CARSON CITY, FOWLER, GREENVILLE, ITHACA, LYONS, MAPLE RAPIDS AND STANTON. THESE OFFICES FALL INTO 4 COUNTIES WHICH INCLUDE MONTCALM, IONIA, CLINTON AND GRATIOT COUNTIES. ALL AREAS ARE DESIGNATED AS RURAL BASED WITH AN AVERAGE OF 20,210 HOUSEHOLDS WITH AN AVERAGE HOUSEHOLD SIZE OF 2-7 PEOPLE. THE AVERAGE INCOME PER HOUSEHOLD IS 42,590 WHILE 6.20% OF ALL FAMILIES ARE BELOW THE POVERTY LEVEL. ALSO INCLUDED IN THIS GEOGRAPHIC AREA ARE 5 OTHER HOSPITALS: SPARROW CLINTON HOSPITAL, SPARROW IONIA HOSPITAL, SPECTRUM HEALTH UNITED CAMPUS, SHERIDAN COMMUNITY HOSPITAL, AND MID-MICHIGAN MEDICAL CENTER GRATIOT. IN ADDITION TO ACUTE HOSPITAL CARE, CCH PROVIDES A VARIETY OF ADVANCED SERVICES, RANGING FROM AN INTENSIVE/CORONARY CARE UNIT TO A BEHAVIORAL HEALTH UNIT AND MULTIPLE OUTPATIENT SERVICES. CCH ALSO PROVIDES 24 - HOUR EMERGENCY ROOM CARE. PHYSICIANS ARE AVAILABLE TO YOU ANY TIME AT THE HOSPITAL, DAY OR NIGHT FOR EMERGENCY OR NON-EMERGENCY MEDICAL ASSISTANCE. ANY SURPLUS FUNDS AVAILABLE TO THE HOSPITAL ARE USED FOR FACILITY AND EQUIPMENT IMPROVEMENTS IN ORDER TO PROVIDE BETTER PATIENT CARE. THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 INCLUDED PROVISIONS FOR IMPLEMENTING HEALTH INFORMATION TECHNOLOGY UNDER THE HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT ("HITECH"). THESE PROVISIONS WERE DESIGNED TO INCREASE THE USE OF ELECTRONIC HEALTH RECORDS("EHR") TECHNOLOGY AND ESTABLISH REQUIREMENTS FOR A MEDICARE AND MEDICAID INCENTIVE PAYMENTS PROGRAM BEGINNING IN 2011 FOR ELIGIBLE HOSPITALS AND PROVIDERS THAT ADOPT AND MEANINGFULLY USE CERTIFIED EHR TECHNOLOGY. ELIGIBILITY FOR ANNUAL MEDICARE INCENTIVE PAYMENTS IS DEPENDENT ON PROVIDERS DEMONSTRATING MEANINGFUL USE OF EHR TECHNOLOGY IN EACH PERIOD OVER A FOUR YEAR PERIOD. INITIAL MEDICAID INCENTIVE PAYMENTS ARE AVAILABLE TO PROVIDERS THAT ADOPT, IMPLEMENT, OR UPGRADE CERTIFIED EHR TECHNOLOGY, BUT PROVIDERS MUST DEMONSTRATE MEANINGFUL USE OF SUCH TECHNOLOGY IN SUBSEQUENT YEARS TO QUALIFY FOR ADDITIONAL INCENTIVE PAYMENTS. DURING 2012, CARSON CITY HOSPITAL DEMONSTRATED THE MEANINGFUL USE OF ITS CERTIFIED EHR TECHNOLOGY AND WAS ABLE TO RECOGNIZE APPROXIMATELY 1.3 MILLION IN REVENUE FOR HITECH INCENTIVES FROM MEDICARE AND MEDICAID. THESE INCENTIVE PAYMENTS ALLOW THE HOSPITAL TO PROVIDE ADDITIONAL QUALITY SERVICES TO THOSE IN THE COMMUNITY. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | CARSON CITY HOSPITAL PROVIDES A SPEAKERS BUREAU LIST OF PHYSICIANS AND STAFF MEMBERS WHO ARE WILLING TO GO OUT INTO THE COMMUNITY AND SPEAK ON A VARIETY OF HEALTHCARE, QUALITY-OF-LIFE, AND GENERAL-INTEREST TOPICS TO SCHOOL CHILDREN, BUSINESS CLUBS, AND OTHER NON-PROFIT ORGANIZATIONS. THE HOSPITAL ALSO MAINTAINS A MONTHLY BROWN BAG LUNCH SERIES FEATURING SIMILAR TOPICS, WHICH IS HELD INSIDE THE HOSPITAL AND OPEN TO THE COMMUNITY. CARSON CITY HOSPITAL'S ACTIVITIES PROMOTE THE HEALTHCARE OF THE COMMUNITY BY EDUCATING AND PROVIDING EASY ACCESSIBLE HEALTHCARE WITH A 24-HOUR EMERGENCY DEPARTMENT. OUTSIDE PHYSICIANS CAN APPLY FOR PRIVILEGES AT CARSON CITY HOSPITAL THROUGH A PROCESS TO TREAT AND PROVIDE MEDICAL CARE AT THE HOSPITAL. IN ADDITION, CARSON CITY HOSPITAL IS COMPRISED OF SEVEN HOSPITAL-OWNED PHYSICIAN CLINICS IN A RURAL SETTING, FREE AND REDUCED RATE SPORTS PHYSICALS ARE PROVIDED AT SELECTED CLINICS. |
| PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM | IN JANUARY 1997, CCH BECAME AFFILIATED WITH THE SPARROW HEALTH SYSTEM OF LANSING, MICHIGAN. THIS AFFILIATION HAS MANY BENEFITS INCLUDING HOLDING DOWN HEALTH CARE COSTS, IMPROVED ACCESS TO SPECIALIZED SERVICES, ACCESS TO INFORMATION SYSTEMS, MANAGED CARE CONTRACTS AND NEW PHYSICIAN RECRUITMENT. CCH IS A MEMBER OF THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND THE MICHIGAN OSTEOPATHIC ASSOCIATION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| ROBERT SEALS | |||||
| SEC/TREAS/MED DIR | $293,694 | $8,348 | $14,180 | $316,222 | |
| DAVID J FREESTONE MD | |||||
| BOARD MBR/PHYSICIAN | $236,829 | $46,494 | $14,180 | $297,503 | |
| MATTHEW J THOMPSON | |||||
| PRESIDENT/CEO | $215,712 | $15 | $14,180 | $229,907 | |
| DOUGLAS POFF DO | |||||
| BOARD MBR/PHYSICIAN | $175,046 | $32,256 | $11,409 | $218,711 | |
| RICHARD REID | |||||
| CFO | $165,512 | $15 | $12,980 | $178,507 | |
| NANCY WEAVER | |||||
| VP NURSING/CNO | $155,534 | $15 | $534 | $156,083 | |
| CHRISTOPHER E HERALD MD | |||||
| ER DIRECTOR | $323,200 | $15 | $14,230 | $337,445 | |
| ADAM Z COTE | |||||
| PHYSICIAN | $575,530 | $135,660 | $14,180 | $742,870 | $17,500 |
| JOSEPH B WHITE | |||||
| PHYSICIAN | $597,625 | $15 | $12,980 | $628,120 | $17,500 |
| PARUTAPPA BHIMALLI | |||||
| PHYSICIAN | $522,330 | $15 | $2,086 | $524,431 | |
| RAYMOND P ALLARD | |||||
| PHYSICIAN | $520,689 | $15 | $12,980 | $533,684 | |
| VINCENT DUBE | |||||
| PHYSICIAN | $415,328 | $15 | $10,209 | $425,552 | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | PHYSICIANS RECEIVED ANNUAL PRODUCTION INCENTIVE COMPENSATION, WHICH IS CALCULATED BASED ON EQUALING OR EXCEEDING CERTAIN NET PATIENT REVENUE TARGETS. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| MICHIGAN STATE HOSPITAL FIN AUTH | ||||||||
| A | 382889417 | 54965HKS4 | 2006-02-01 | $18,000,000 | HOSP EQUIP LOAN PRGM | false | false | Yes (true) |
| MICHIGAN STATE HOSPITAL FIN AUTH | ||||||||
| B | 382889417 | 594654HG5 | 2007-12-18 | $455,937 | HOSP EQUIP LOAN PRGM | false | false | Yes (true) |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|
| A | $4,005,915 | $18,000,000 | $133,000 | $14,012,600 | $3,854,400 | false | false | Yes (true) | Yes (true) |
| B | $210,838 | $455,937 | $455,937 | false | false | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false | Yes (true) |
| B | false | false | false | false | false | false | Yes (true) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | Yes (true) | Yes (true) | false | false | false | Yes (true) |
| B | false | false | false | Yes (true) | Yes (true) | false | false | false | Yes (true) |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K - DATE REBATE COMPUTATION PERFORMED | MICHIGAN STATE HOSPITAL FIN. AUTH. 02/01/11 MICHIGAN STATE HOSPITAL FIN. AUTH. 12/18/12 |
| SCHEDULE K - ADDITIONAL INFORMATION | MICHIGAN STATE HOSPITAL FIN. AUTH. SCHEDULE K, PART II, LINE 3 THE ORGANIZATION SPENT ITS OWN OPERATING FUNDS AND IN TURN WAS REIMBURSED WITH THE BOND PROCEEDS, THEREFORE THERE ARE NO INTEREST EARNINGS ON THE PROCEEDS. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SPARROW HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BUSINESS | RelationshipDescriptionTxt |
| Transaction | $449,354 | TransactionAmt |
| Transaction | SEE SUPPLEMENTAL SEC | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | MARK BRETT, TOM OSTRANDER, AND CINDA KOSLOSKI, SPARROW CARSON HOSPITAL BOARD MEMBERS, SERVE AS THE SENIOR VICE PRESIDENT - AFFILIATE OPERATIONS, VICE PRESIDENT - PROFESSIONAL SERVICES, AND DIRECTOR OF DECISION SUPPORT, RESPECTIVELY, FOR SPARROW HEALTH SYSTEM, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2014, SPARROW CARSON HOSPITAL MADE PAYMENTS TO SPARROW HEALTH SYSTEM IN THE AMOUNT OF 449,354 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICALS, LABORATORY AND OTHER PATIENT CARE SERVICES, SOFTWARE SUPPORT, EQUIPMENT RENTAL, AND PHYSICIAN RECRUITING. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 | ALL LINES LEFT BLANK ARE NOT APPLICABLE TO THE ORGANIZATION. |
| FORM 990, PAGE 2, PART III, LINE 4A | DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE UNDER ARRANGEMENTS WITH VARIOUS GOVERNMENTAL INSURANCE PROGRAMS. CCH PROVIDES SIGNIFICANT CARE TO THE LOCAL INDIGENT POPULATION FOR WHICH REIMBURSEMENT FOR SERVICES RENDERED IS GENERALLY LESS THAN THE COST OF PROVIDING SUCH SERVICES AS PART OF ITS OBLIGATION TO THE LOCAL COMMUNITY. CCH ALSO PROVIDES SERVICES TO INDIGENT PATIENTS UNDER THE MEDICAID PROGRAM AT PAYMENT AMOUNTS LESS THAN THE COST OF THE SERVICES PROVIDED. FOR THE YEAR ENDED DECEMBER 31, 2014, CCH PROVIDED OVER 2 MILLION IN UNCOMPENSATED CARE. THE ESTIMATED ANNUAL TOTAL LOCAL ECONOMIC IMPACT IS 30,000,000. |
| FORM 990, PAGE 2, PART III, LINE 4C | PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. |
| FORM 990, PAGE 2, PART III, LINE 4D | OTHER PROGRAM SERVICES INCLUDE THE OPERATION OF THE FOLLOWING FACILITIES: ASHLEY FAMILY CARE CENTER, CARSON CITY HOSPITAL, ORTHOPEDICS AND GENERAL SURGERY, PHYSICAL REHABILITATION CENTER, FOWLER FAMILY CARE CENTER, GREENVILLE FAMILY CARE CENTER, HOSPITALISTS, LYONS FAMILY CARE CENTER, PEDIATRIC AND ADOLESCENT SPECIALISTS, STANTON FAMILY CARE CENTER, CARSON HOME CARE, CARSON PAIN MANAGEMENT. |
| FORM 990, PAGE 6, PART VI | THE EXECUTIVE COMMITTEE OF THE BOARD SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, THE PRESIDENT, THE VICE-CHAIRPERSON, THE SECRETARY/TREASURER AND THE MEDICAL DIRECTOR. A SIXTH MEMBER SHALL BE APPOINTED BY THE CHAIRPERSON AND CHOSEN FROM ONE OF THE CLASS B MEMBERS OF THE BOARD. THE CHAIRPERSON SHALL APPOINT REPLACEMENTS WHEN NECESSARY. A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM. IT SHALL HAVE THE AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. THE COMMITTEE SHALL MAKE A FULL REPORT OF ITS ACTIONS, IF ANY, AT THE NEXT REGULAR MEETING OF THE BOARD. MEETINGS OF THE COMMITTEE MAY BE HELD AT ANY TIME ON CALL BY THE CHAIRPERSON OF THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 6 | CARSON CITY HOSPITAL (CCH) IS ORGANIZED ON A MEMBERSHIP BASIS. THERE ARE TWO CLASSES OF MEMBERS: CLASS A MEMBERSHIP CONSISTS OF THE ORIGINAL DIRECTORS OF CCH, EXCLUDING THOSE DIRECTORS WHO ARE ELECTED OR APPOINTED BY THE CLASS B MEMBER; THE CLASS B MEMBER IS SPARROW HEALTH SYSTEM (SPARROW), AN UNRELATED MICHIGAN NONPROFIT CORPORATION. OTHER THAN SPARROW, THERE SHALL BE NO ADDITIONAL CLASS B MEMBERSHIP INTERESTS WITHOUT THE CONSENT OF SPARROW. |
| FORM 990, PAGE 6, PART VI, LINE 7A | CLASS A MEMBERS EACH HAVE ONE VOTE FOR PURPOSES OF VOTING BY MEMBERS. THE NUMBER OF VOTES HELD BY THE CLASS B MEMBER (SPARROW) IS PROPORTIONATE TO THE SPARROW PERCENTAGE INTEREST MULTIPLIED BY THE VOTES HELD IN THE AGGREGATE BY BOTH CLASS A AND CLASS B MEMBERS. AT THE ANNUAL MEETING OF THE MEMBERS, THE CLASS A MEMBERS ELECT 9 DIRECTORS OF THE BOARD BY MAJORITY VOTE OF THE CLASS A MEMBERS, AND THE CLASS B MEMBER (SPARROW) ELECTS A NUMBER OF DIRECTORS OF THE BOARD THAT IS CONSISTENT WITH THE CURRENT SPARROW PERCENTAGE INTEREST. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE FOLLOWING ACTIVITIES REQUIRE THE AFFIRMATIVE VOTE OF THE CLASS B MEMBER (SPARROW): 1) AMENDMENTS TO THE ARTICLES OF INCORPORATION AND THE BYLAWS 2) THE DISSOLUTION, SALE, MERGER, SALE OF SUBSTANTIALLY ALL OF THE ASSETS, LEASE, OR TRANSFER OF CONTROL 3) THE SALE OF A MAJORITY OWNERSHIP INTEREST IN CCH 4) THE PUBLICLY RECOGNIZED "AFFILIATION" WITH ANY ORGANIZATION OTHER THAN THE CLASS B MEMBER (SPARROW) 5) APPROVAL OF CCH'S ANNUAL OPERATING BUDGET, WHEN SUCH BUDGET REFLECTS A TOTAL MARGIN OF LESS THAN 2% OF NET REVENUE 6) APPROVAL OF CCH'S ANNUAL CAPITAL BUDGET, WHEN SUCH BUDGET ANTICIPATES AN ADDITIONAL CAPITAL CONTRIBUTION FROM THE CLASS B MEMBER (SPARROW) BEYOND ITS ORIGINAL CAPITAL CONTRIBUTION 7) THE INCURRENCE OF ANY DEBT OBLIGATION IN THE AGGREGATE GREATER THAN 500,000 8) THE APPROVAL OF CAPITAL EXPENDITURES IN EXCESS OF 500,000 (EXCEPT AS TO REPLACE EQUIPMENT) 9) ANY ACTION THAT ALLOWS OR FACILITATES THE CREATION OF A NEW CLASS OF MEMBERS OR CREATION OF A MEMBERSHIP INTEREST IN CCH. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S MANAGEMENT. A BOARD MEETING IS HELD WITH OUR TAX ADVISORS WHERE A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY FOR REVIEW BEFORE THE RETURN IS FILED WITH THE IRS. THE BOARD IS GIVEN A SUMMARY OF KEY POINTS REGARDING THE FORM 990, AND IS ALLOWED TO ASK ANY QUESTIONS THEY MAY HAVE. ONCE ALL BOARD MEMBERS HAVE REVIEWED THE RETURN, IT IS THEN SUBMITTED TO THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED TO ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO DETERMINE WHETHER ANY POTENTIAL CONFLICTS OF INTEREST EXIST. ON AN ANNUAL BASIS THE HOSPITAL EXECUTIVE COMMITTEE, WHICH INCLUDES THE PRESIDENT OF THE BOARD OF DIRECTORS, DISCUSSES THE CONFLICT OF INTEREST QUESTIONNAIRES TO DETERMINE WHETHER AN ACTUAL CONFLICT EXISTS. IF A CONFLICT IS DETERMINED TO EXIST, THE PERSON WITH THE CONFLICT IS RECUSED FROM TAKING PART IN ANY DECISIONS CONCERNING THE CONFLICTING ISSUE. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/CEO. THE BOARD PRESIDENT/CEO IS REMOVED FROM THE BOARD DISCUSSIONS TO PREVENT HIM FROM DISCUSSING AND DETERMINING HIS OWN COMPENSATION. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR THE CEO, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. COMPENSATION FOR THE CURRENT YEAR IS DISCUSSED AND APPROVED IN THE PREVIOUS YEAR DURING THE BUDGET APPROVAL PROCESS. THE 2014 COMPENSATION WAS REVIEWED AND APPROVED AT THE END OF 2013 DURING THE ANNUAL BUDGETING PROCESS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR ALL POSITIONS, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR ALL POSITIONS, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. THE 2014 COMPENSATION WAS REVIEWED AND APPROVED AT THE END OF 2013 DURING THE ANNUAL BUDGETING PROCESS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. AS A HOSPITAL, THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS AN ATTACHMENT TO ITS FORM 990, WHICH IS A REQUIRED DISCLOSURE PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. |
| FORM 990, PART XI, LINE 9 | RENT EXPENSES INCLUDED IN REVENUE 79,842 PROVISION FOR BAD DEBTS -2,500,000 RENT EXPENSES INCLUDED IN REVENUE -79,842 CHANGE IN PENSION LIABILITY -1,466,482 PROVISION FOR BAD DEBTS 2,500,000 |
| FORM 990, PART XI, LINE 9 | RELEASE FROM RESTRICTIONS 74,279 CHANGE IN PENSION LIABILITY -1,466,482 TOTAL OTHER CHANGES IN NET ASSETS -1,540,761 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARSON FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 E ELM STREET | AddressLine1Txt |
| City | CARSON CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48811 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460877509 | EIN |
| Primary Activities | FUNDRAISE | PrimaryActivitiesTxt |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 11A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CCH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | 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 | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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