2014-02-15T16:21:02-06:00 2013-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2012-04-01 320031170 MOSES DIALYSIS UNIT MOSE 9066438585 1140 NORTH STATE STREET ST IGNACE MI 49781 JASON ANDERSON 9066438585 2014-02-14 1 TERRI REXRODE CPA MST P00096513 9206620016 2014-02-14 2012 2015-11-30 17:44:51Z JASON ANDERSON 1140 NORTH STATE STREET ST IGNACE MI 49781 717385 0 X WWW.MACKINACSTRAITSHEALTH.ORG X 2002 MI TO PROVIDE EFFICIENT DELIVERY OF QUALITY DIALYSIS HEALTH CARE, ACHEIVE SUPERIOR PATIENT OUTCOMES AND IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITY WE SERVE. 9 5 0 9 0 0 50000 0 567363 717385 0 0 0 0 617363 717385 0 0 0 0 60928 320627 0 0 0 448859 168383 509787 489010 107576 228375 189513 347686 70202 0 119311 347686 NONE 0 0 467280 717385 6MOSES DIALYSIS UNIT PROVIDES CARE AND TREATMENT TO INDIVIDUALS IN NEED OF RENAL DIALYSIS SERVICES IN THE GREATER ST. IGNACE, MI AREA. 467280 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 1 1 1 0 0 1 0 0 0 1 0 0 X JASON ANDERSON 9066438585 1140 NORTH STATE STREET ST IGNACE MI 49781 STEVE LUTZ 1.00 X 0 0 0 BONNIE CULFA 1.00 X 0 0 0 REV WAYNE FOOTE 1.00 X 0 0 0 RICHARD SMITH 1.00 X 0 0 0 BILL CONNOLLY 1.00 X X 0 0 0 ILENE MOSES 1.00 X X 0 0 0 RODNEY NELSON 1.00 40.00 X X 0 150278 20899 GARY SHAW MD 1.00 X X 0 11300 0 JASON ANDERSON 2.00 40.00 X X 0 81814 20803 NANCY NELSON 40.00 X 61980 0 0 61980 243392 41702 0 0 1 0 MACKINAC STRAITS HEALTH SYSTEM INC 1140 NORTH STATE STREET ST IGNACE MI 49781 NURSING SERVICES 320627 1 NET DIALYSIS REVENUE 621400 717385 717385 717385 717385 717385 0 0 X 61980 61980 177442 177442 29547 29547 32822 32822 18836 18836 56802 35072 21730 367 367 1606 1606 MEDICAL SUPPLIES 106945 106945 2663 2663 489010 467280 21730 0 189513 213923 0 133763 189513 347686 70202 70202 0 X 119311 347686 0 0 0 0 119311 347686 189513 347686 228375 0 X X 0 1 X 1 0 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: ALTHOUGH MOSES DIALYSIS UNIT IS CLASSIFIED AS A HOSPITAL FOR SCHEDULE A PURPOSES, WE ARE NOT A LICENSED HOSPITAL AND, THEREFORE, SCHEDULE H IS NOT REQUIRED. 0 DUE FROM RELATED PARTY 133763 133763 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. FEDERAL INCOME TAX RETURNS FOR TAX YEARS 2010 AND BEYOND THAT REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. FEDERAL INCOME TAX RETURNS FOR THE YEAR ENDED MARCH 31, 2013, ARE NOT YET DUE AND HAVE NOT BEEN FILED AS OF THE REPORT DATE. 0 0 0 0 0 0 0 0 0 RODNEY NELSON 0 150000 0 0 0 278 0 0 0 20899 0 171177 0 0 FORM 990, PART VI, SECTION A, LINE 6 MACKINAC STRAITS HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF MOSES DIALYSIS UNIT. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER IS MACKINAC STRAITS HEALTH SYSTEMS, INC. FORM 990, PART VI, SECTION A, LINE 7B MOSES BOARD SUBJECT TO APPROVAL OF HOSPITAL BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS HAS DELEGATED THE REVIEW AND APPROVAL OF THE FORM 990 TO THE CFO. A COPY OF THE FORM 990 WILL BE PROVIDED TO BOARD MEMBERS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12 MOSES DIALYSIS UNIT DOES NOT HAVE ITS OWN CONFLICT OF INTEREST OR DOCUMENT RETENTION POLICIES. ALL PROFESSIONALS OF MOSES ARE CONTRACTED FROM MACKINAC STRAITS HEALTH SYSTEM, INC., THE COMPANY'S SOLE CORPORATE OWNER. CONTRACTED PROFESSIONALS ARE REQUIRED TO FOLLOW THE CONFLICT OF INTEREST AND DOCUMENT RETENTION POLICIES ENFORCED BY MACKINAC STRAITS HEALTH SYSTEMS, INC. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS FOR DETERMINING ALL COMPENSATION IS BASED ON THE MHA ANNUAL SURVEY. COMPENSATION FOR OFFICERS AND KEY EMPLOYEES IS REVIEWED BY THE CEO OF MACKINAC STRAITS HEALTH SYSTEM, INC., WHICH CONTRACTS ALL EMPLOYEES OF MOSES DIALYSIS UNIT. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST ONLY. OTHER FEES FORM 990, PART IX, LINE 11G BILLING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,730. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,730. MAINTENANCE: PROGRAM SERVICE EXPENSES 23,772. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,772. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 11,300. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,300. OVERSIGHT OF AUDIT FORM 990, PART XI, LINE 2C MOSES DIALYSIS UNIT IS INCLUDED IN THE CONSOLIDATED AUDIT OF MACKINAC STRAITS HEALTH SYSTEM, INC. AND AFFILIATE. THE AUDITED FINANCIAL STATEMENTS ARE PRESENTED TO THE MACKINAC STRAITS HEALTH SYSTEM FINANCE COMMITTEE AND RECOMMENDATIONS ARE TAKEN TO THE MACKINAC STRAITS HEALTH SYSTEM BOARD OF DIRECTORS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MACKINAC STRAITS HEALTH SYSTEM INC 1140 NORTH STATE STREET ST IGNACE MI 49781 208756459 HOSPITAL MI 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0