MCKENIZE MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MCKENIZE MEMORIAL HOSPITAL (EIN 38-1738615)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-05-15
- IRS object ID
- 201301359349302135
- Schema version
- 2011v1.5
- 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 M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-15T09:44:13-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRINING & NARTKER PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381738615 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MCKE | NameControl |
| Phone | 8106486162 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY RUEDISUELI | Name |
| Title | VP OF FINANCE | Title |
| Phone | 8106486162 | Phone |
| Date Signed | 2013-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOSEPH NARTKER | Name |
| Phone | 8106484931 | Phone |
| Date Prepared | 2013-05-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STEVE BARNETT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 20986637 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MCKENZIEHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 234 | TotalNbrEmployees |
| Total Nbr Volunteers | 40 | TotalNbrVolunteers |
| Total Gross UBI | 56901 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -40192 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 34257 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 225878 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 31633047 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 20613821 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 8856 | InvestmentIncomePriorYear |
| Investment Income Current Year | 28514 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 70852 | OtherRevenuePriorYear |
| Other Revenue Current Year | 77700 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 31747012 | TotalRevenuePriorYear |
| Total Revenue Current Year | 20945913 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10123289 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10155361 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 21838940 | OtherExpensePriorYear |
| Other Expenses Current Year | 9906892 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 31962229 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20062253 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -215217 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 883660 | RevenuesLessExpensesCY |
| Total Assets BOY | 9455041 | TotalAssetsBOY |
| Total Assets EOY | 10469675 | TotalAssetsEOY |
| Total Liabilities BOY | 6405524 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6536498 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3049517 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3933177 | NetAssetsOrFundBalancesEOY |
| Mission Description | FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 20062253 | Expense |
| Revenue | 20945913 | Revenue |
| Description | PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SANILAC COUNTY. FISCAL YEAR REGISTRATIONS ARE: INPATIENT = 462; OUTPATIENT = 27,040 EMERGENCY ROOM = 5,874; AND AMBULANCE = 1,780. | Description |
| Total Program Service Expense | 20062253 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | true | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 52 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 234 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MCKENIZE MEMORIAL HOSPITAL | NamePerson |
| Telephone Number | 8106486162 | TelephoneNumber |
Address US AddressUS
| 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) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| STEVE BARNETT | ||||||||
| CEO | 40.00 | X | X | 197127 | 0 | 24391 | ||
| MARK ENGLISH | ||||||||
| CHIEF OF STA | 40.00 | X | 160537 | 0 | 21594 | X | ||
| MARCUS FREE | ||||||||
| CHEIF OF STA | 40.00 | X | 155796 | 0 | 10189 | |||
| AL STOUTENBURG | ||||||||
| CHAIRMAN | X | X | 0 | 0 | 0 | |||
| JOAN NAGELKIRK | ||||||||
| TREASURER | X | X | 0 | 0 | 0 | |||
| DAVID TUBBS | ||||||||
| BOARD MEMBER | X | 0 | 0 | 0 | ||||
| DR ROBERT HASSLER | ||||||||
| BOARD MEMBER | X | 0 | 0 | 0 | ||||
| ROGER LODING | ||||||||
| SECRETARY | X | X | 0 | 0 | 0 | |||
| JUDITH FERGUSON | ||||||||
| VICE CHAIR | X | X | 0 | 0 | 0 | |||
| LARRY MITCHELL | ||||||||
| BOARD MEMBER | X | 0 | 0 | 0 | ||||
| MICHAEL DREYER | ||||||||
| BOARD MEMBER | X | 0 | 0 | 0 | ||||
| ALFREDO DOMINGO | ||||||||
| DOCTOR | 40.00 | 331250 | 0 | 0 | X | |||
| MICHAEL MERKLER | ||||||||
| PHYSICIAN | 40.00 | 200036 | 0 | 22003 | X | |||
| JAMES SAMS | ||||||||
| PHYSICIAN | 40.00 | 193377 | 0 | 9107 | X | |||
| GINA PATTERSON | ||||||||
| DIRECTOR OF | 32.00 | 108756 | 23303 | 19628 | X | |||
| MELANIE KRAMER | ||||||||
| DOCTOR | 40.00 | 193289 | 0 | 25830 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1540168 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 23303 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 132742 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MICHIGAN EMERGENCY PHYSICIANS LLP | |||||
| PO BOX 793 | TRAVERSE CITY | MI | 49685 | ER COVERAGE | 1324168 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | COMPUTER TECH | 262828 |
| COVENANT HEALTHCARE | |||||
| 800 COOPER AVE | SAGINAW | MI | 48602 | REFERENCE LAB | 181064 |
| BARNETT ANESTHESIA | |||||
| 830 HEMINGWAY | LAKE ORION | MI | 48362 | ANESTHESIA SERV | 137413 |
| TOSHIBA AMERICAN MEDICAL | |||||
| 2441 MICHELLE DRIVE | TUSTIN | CA | 92780 | CT SERVICES AGR | 115000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| All Other Contributions | 225878 | AllOtherContributions |
| Noncash Contributions | 110000 | NoncashContributions |
| Total Contributions | 225878 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| PROGRAM REVENUE | 33982086 | 33982086 |
| OTHER INCOME | 831180 | 831180 |
| CONTRACTUAL | -14199445 | -14199445 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 20613821 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28514 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28514 | RelatedOrExemptFunctionIncome |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 56901 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 56901 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56901 | TotalRevenueColumn |
| Unrelated Business Revenue | 56901 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 61523 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 40724 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20799 | TotalRevenueColumn |
| Exclusion | $20,799 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20945913 | TotalRevenueColumn |
| Related Or Exempt Function Income | 20642335 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 56901 | UnrelatedBusinessRevenue |
| Exclusion | $20,799 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 234316 | Total |
| Program Services | 234316 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8083708 | Total |
| Program Services | 8083708 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 218198 | Total |
| Program Services | 218198 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1047583 | Total |
| Program Services | 1047583 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 571556 | Total |
| Program Services | 571556 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61964 | Total |
| Program Services | 61964 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32100 | Total |
| Program Services | 32100 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2539388 | Total |
| Program Services | 2539388 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79555 | Total |
| Program Services | 79555 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1595500 | Total |
| Program Services | 1595500 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 218858 | Total |
| Program Services | 218858 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 467599 | Total |
| Program Services | 467599 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108777 | Total |
| Program Services | 108777 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35815 | Total |
| Program Services | 35815 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21501 | Total |
| Program Services | 21501 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 791552 | Total |
| Program Services | 791552 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 253615 | Total |
| Program Services | 253615 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| BAD DEBTS | 1351087 | 1351087 |
| LEASE, RENT & MISC | 1277562 | 1277562 |
| DRUGS | 569680 | 569680 |
| REPAIRS & MAINTENANCE | 502339 | 502339 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20062253 | Total |
| Program Services | 20062253 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82136 | BOY |
| EOY | 45884 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1111813 | BOY |
| EOY | 1973814 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2500743 | BOY |
| EOY | 2814277 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 486725 | BOY |
| EOY | 463141 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 132482 | BOY |
| EOY | 200094 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 15190256 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10367655 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4991278 | BOY |
| EOY | 4822601 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 149864 | BOY |
| EOY | 149864 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9455041 | BOY |
| EOY | 10469675 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2822642 | BOY |
| EOY | 2598992 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 258639 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2856331 | BOY |
| EOY | 2434891 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 619355 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 726551 | BOY |
| EOY | 624621 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6405524 | BOY |
| EOY | 6536498 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3002108 | BOY |
| EOY | 3829263 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47409 | BOY |
| EOY | 103914 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3049517 | BOY |
| EOY | 3933177 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9455041 | BOY |
| EOY | 10469675 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 883660 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 160652 | OtherCostOrOtherBasis |
| Book Value | 160652 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7309928 | OtherCostOrOtherBasis |
| Depreciation | 4313169 | Depreciation |
| Book Value | 2996759 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 165941 | OtherCostOrOtherBasis |
| Depreciation | 149376 | Depreciation |
| Book Value | 16565 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7444219 | OtherCostOrOtherBasis |
| Depreciation | 5819925 | Depreciation |
| Book Value | 1624294 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 109516 | OtherCostOrOtherBasis |
| Depreciation | 85185 | Depreciation |
| Book Value | 24331 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4822601 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (10 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| KINGSBRIDGE - TELEMETRY | $89,329 |
| KINGSBRIDGE - DIGITIZER & CR | $87,443 |
| GE - C - ARM & BONE DENSITY | $87,284 |
| TRI COUNTY - COMPUTER SERVERS | $86,812 |
| CAHSE - LINE OF CREDIT | $79,705 |
| NORTHSTAR - AMBULANCE | $70,475 |
| TRI - COUNTY - AUTOCLAVE | $47,782 |
| ESB - AMBULANCE | $33,549 |
| KINGSBRIDE - STERILIZER | $29,234 |
| ESB - X-RAY | $13,008 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 624621 | TotalOfAmounts |
| Total Revenue | 20945913 | TotalRevenue |
| Total Expenses | 20062253 | TotalExpenses |
| Excess Or Deficit For Year | 883660 | ExcessOrDeficitForYear |
| Other | -$191,423 | OtherAmount |
| Total Adjustments | -191423 | TotalAdjustments |
| Excess Or Deficit Per FS | 692237 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 20523901 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 20523901 | RevenueSubtotal |
| Other Revenues Not Included | 422012 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 422012 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 20945913 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 19831664 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 19831664 | ExpensesSubtotal |
| Other Expenses Not Included | 230589 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 230589 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20062253 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RECONCILIATION OF CHANGES - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 8 | CONTRIBUTION FOR PP&E -171,183 TEMPORARILY RESTRICTED NET ASSETS -20,186 TEMPORARILY RESTRICTED NET ASSETS INTEREST INCOME -54 CHARITY CARE -230,589 CHARITY CARE 230,589 |
| REVENUE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 4B | CONTRIBUTION FOR PP&E 171,183 TEMPORARILY RESTRICTED NET ASSETS 20,186 TEMPORARILY RESTRICTED NET ASSETS INTEREST INCOME 54 CHARITY CARE 230,589 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 4B | CHARITY CARE 230,589 |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed States | MI | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | BENEFIT RAFFLE | NameOfEvent1 |
| Gross Receipts Event1 | 35474 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 35474 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 4500 | CashPrizesEvent1 |
| Rent Facility Costs Event1 | 550 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 4815 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 400 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 2478 | OtherDirectExpensesEvent1 |
| Name Of Event2 | HOSP AUXILARY | NameOfEvent2 |
| Gross Receipts Event2 | 26049 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 26049 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 27981 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 61523 | GrossReceiptsTotal |
| Gross Revenue Total Events | 61523 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 4500 | CashPrizesTotalEvents |
| Rent Facility Costs Total Events | 550 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 4815 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 400 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 30459 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 40724 | DirectExpenseSummaryEvents |
| Net Income Summary | 20799 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | false | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | false | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 151294 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 151294 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00750 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3412605 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2402689 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1009916 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3563899 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2402689 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1161210 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05790 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 243843 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 227178 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16665 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19122 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 19122 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8651 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8633 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 271616 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 227196 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 44420 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3835515 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2629885 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1205630 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $689,054 | BadDebtExpenseAmount |
| Amount Attributable To | 8861 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5150688 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5147565 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 3123 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 8 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (8 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| MCKENZIE HEALTH AND WELLNESS | ||||
| 170 W ARGYLE STREET | SANDUSKY | MI | 48471 | PHYSICIAN OFFICE |
| AUSTIN STREET RURAL HEALTH CLINIC | ||||
| 51 AUSTIN STREET | SANDUSKY | MI | 48471 | RURAL HEALTH CLINIC |
| MAIN STREET HELATH 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 |
| FAMILY PLANNING & GERIATRIC | ||||
| 171 N DAWSON STREET | SANDUSKY | MI | 48471 | FAMILY PLANNING & GERIATRIC SERVICES |
| SANILAC MEDICAL PLAZA | ||||
| 100 W ARGYLE STREET | SANDUSKY | MI | 48471 | PHYSICIAN OFFICE RENTAL |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | MCKENIZE USES SCHEDULE H WORKSHEETS TO PREPARE INFORMATION IN BOX 7 COST TO CHARGE RATIO |
| COMMUNITY BUILDING ACTIVITIES | PART II | MCKENIZE DID NOT CONDUCT ANY COMMUNITY BUILDING ACTIVITIES DURING THE FISCAL YEAR 2012 |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | PART III LINE 3 COST OF BAD DEBT EXPENSES ATTRIBUTIABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS CHARITY CARE POLICY ANALYZED 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 WORKSHEET 2 PATIENTS RECEIVE THREE MONTHLY STATEMENTS IF NO PAYMENTS WERE MADE DURING THAT TIME PERIOD THEY RECEIVE A LETTER STATING THAT THEY WILL BE SENT TO COLLECTIONS IN THE 4TH MONTH IF NO ACTION IS TAKEN BY THE PATIENT THE ACCOUNT IS SENT TO COLLECTIONS AND RECORDED AS A BAD DEBT THE ORGANIZATION DOES NOT INCLUDE A FOOTNOTE IN THE FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE THE FINANCIAL STATEMENTS LIST BAD DEBT AS A SEPARATE LINE ITEM IN THE EXPENSE SECTION BAD DEBT EXPENSE IS INCLUDED IN THE COMMUNITY BENEFIT EXPENSE AS IT IS OUR COMMUNITY THAT CANNOT AFFORD TO PAY THEIR HEALTHCARE EXPENSE |
| MEDICARE EXPLANATION | PART III LINE 8 | NO SHORTFALL REPORTED PART III LINE 6 WAS DETERMINED USING ALLOWABLE COSTS AS REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | COLLECTION POLICY REFERENCES THE CHARITY CARE POLICY FOR THOSE POSSIBLY ELIGIBLE FOR CHARITY CARE AS A METHOD OF PAYMENTCOLLECTIONS |
| NEEDS ASSESSMENT | PART VI | PART VI LINE 2 ORGANIZATION COMMUNICATED WITH STATE AND LOCAL AGENCIES TO DETERMINE HEALTHCARE NEEDS OF THE COMMUNITY EXAMPLES OF SERVICES PROVIDED BASED ON COMMUNITY NEED ARE FAMILY PLANNING GERIATRICS PROGRAM IMMUNIZATIONS SPORTS PHYSICALS SENIOR FAIR HEALTH FAIRS FIRST AID BOOTH AND DIABETIC CLASSES |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | PART VI LINE 3 EVERY UNISURED PATIENT OUTPATIENT SURGICAL OBSERVATION THAT INCURS MORE THAN 1000 IN MEDICAL EXPENSES RECEIVES A CHARITY CARE APPLICATION A MEDICAID APPLICATION AND A HUMAN SERVICES REFERRAL FORM ALL OTHER UNINSURED OR UNDER ISSURED PATIENTS MAY REQUEST A CHARITY CARE APPLICATION AT ANY TIME NO INSURANCE AND SELF PAY BROCHURES ARE ALSO AVAILABLE THROUGHOUT THE HOSPITAL |
| COMMUNITY INFORMATION | PART VI | PART VI LINE 4 ORGANIZATION IS LOCATED IN SANILAC COUNTY WHICH HAS A POPULATION OF APPROX 43000 SANDUSKY HAS A POPULATION OF APPROX 2500 SANILAC COUNTY CONSISTS OF MOSTLY FARMLAND WITH VERY FEW MANUFACTURING FACILITIES THE UNEMPLOYMENT RATE IN SANILAC COUNTY IS 1160 |
| ADDITIONAL INFORMATION | PART VI | PART VI LINES 56 7 NO OTHER INFORMATION TO REPORT PART I LINE 6A MCKENZIE PREPARED A COMMUNITY BENEFITS FOR THE FISCAL YEAR 2012 BUT DID NOT PUBLISH IT |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs |
|---|---|---|---|---|---|---|
| STEVE BARNETT | ||||||
| 197127 | 6834 | 17557 | 221518 | |||
| MARK ENGLISH | ||||||
| 160537 | 5886 | 15708 | 182131 | |||
| MARCUS FREE | ||||||
| 155796 | 10189 | 165985 | ||||
| ALFREDO DOMINGO | ||||||
| 331250 | 331250 | |||||
| MICHAEL MERKLER | ||||||
| 200036 | 7267 | 14736 | 222039 | |||
| JAMES SAMS | ||||||
| 193377 | 3369 | 5738 | 202484 | |||
| GINA PATTERSON | ||||||
| 108756 | 4109 | 14217 | 127082 | 23303 | 1302 | 24605 |
| MELANIE KRAMER | ||||||
| 193289 | 7490 | 18340 | 219119 | |||
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | BARNETT ANESTESIA INC | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | CEO'S SPOUSE | Relationship |
| Amount Of Transaction | 137413 | AmountOfTransaction |
| Description Of Transaction | CRNA SERVICES | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercial
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 110000 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGifts |
| Third Parties Used | false | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | CLASSES OF MEMBERS OR STOCKHOLDERS |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | THE BOARD MEMBERS MUST BE APPROVED FIRST BY THE BOARD OF MCKENIZE HEALTHCARE CORPORATION TO BECOME BOARD MEMBERS. |
| DECISIONS SUBJECT TO APPROVAL OF MEMBERS | FORM 990, PAGE 6, PART VI, LINE 7B | MCKENIZE HEALTHCARE CORPORATION MUST APPROVE ANY FINANCIAL TRANSACTIONS ABOVE ONE MILLION DOLLARS BEFORE ANY ACTION CAN BE TAKEN BY THE BOARD OF DIRECTORS OF MCKENZIE MEMORIAL HOSPITAL. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | 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. |
| ENFORCEMENT OF CONFLICTS POLICY | 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 MEMBER MUST ABSTAIN FROM THE VOTE. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | 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. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE FULL BOARD THROUGH THE RECOMMENDATION BASED ON COMPENSATION SURVEYS AND APPROVAL OF THE HOSPITAL ANNUAL BUDGET. BONUS AMOUNTS ARE IN THE CONTRACTS APPROVED BY THE FULL BOARD. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITIED FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION AT THE ORGANIZATION'S CEO/PRESIDENT'S OFFICE. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | GINA PATTERSON WORKS AN AVERAGE OF 8 HOURS PER WEEK AT SANILAC SERVICES INC., ONE OF OUR RELATED ORGAINIZATIONS. |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | OTHER CHANGES IN NET ASSETS CONSIST OF CONTRIBUTIONS USED FOR PROPERTY, PLANT, EQUIPMENT AND CONTRIBUTIONS FOR TEMPORARILY RESTRICTED NET ASSETS. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | 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 | HOMECARE | MI | 501C3 | 3 | MCKENIZE | false | HEALTHCARE CORPORATION |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Business Name Line2DirectControllingEntityName/BusinessNameLine2 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|---|
| SANILAC SERVICES INC | |||||||||
| 48 SOUTH ELK | SANDUSKY | MI | 48471 | 382774983 | PHARMACY | MI | MCKENIZE | HEALTHCARE CORPORATION | C CORP |
| SANILAC CATALOG INC | |||||||||
| 48 SOUTH ELK | SANDUSKY | MI | 48471 | 383254153 | CATALOG | MI | SANILAC | SERVICES INC | C CORP |
| SANILAC EQUIPMENT & SUPPLY CO | |||||||||
| 120 DELAWARE STREET | SANDUSKY | MI | 48471 | 382662256 | SUPPLIES | MI | MCKENIZE | HEALTHCARE CORPORATION | C CORP |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Business Name Line2NameOfOtherOrganization/BusinessNameLine2 | Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|---|
| SANILAC SERVICES INC | ||
| SANILAC PHARMACY | O | 10339 |
| SANILAC SERVICES INC | ||
| SANILAC PHARMACY | P | 90000 |