2013-05-15T09:44:13-05:00 2012-09-30 BRINING & NARTKER PC 47 AUSTIN STREET PO BOX 348 SANDUSKY MI 484710348 990 2011-10-01 381738615 MCKENZIE MEMORIAL HOSPITAL MCKE 8106486162 120 DELAWARE STREET SANDUSKY MI 48471 AMY RUEDISUELI 8106486162 2013-05-15 true JOSEPH NARTKER 8106484931 2013-05-15 2011 2016-02-25 16:41:14Z MCKENZIE HEALTH SYSTEM STEVE BARNETT 120 DELEWARE STREET SANDUSKY MI 48471 20986637 false X WWW.MCKENZIEHEALTH.ORG X MI FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. 10 8 234 40 56901 -40192 34257 225878 31633047 20613821 8856 28514 70852 77700 31747012 20945913 0 0 10123289 10155361 0 0 21838940 9906892 31962229 20062253 -215217 883660 9455041 10469675 6405524 6536498 3049517 3933177 FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. false false 20062253 20945913 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. 20062253 true true false false false false false false false false true false false false true false true false false false false false false false true false true true false false true false false false false false false true false true false false false false true true true false false true 52 0 true 234 true true true false false false false false false false false false false false X 10 8 false false false false true true true true true false false true true true true true true true true true true X X MCKENIZE MEMORIAL HOSPITAL 8106486162 120 DELAWARE STREET SANDUSKY MI 48471 X STEVE BARNETT 40.00 X X 197127 0 24391 MARK ENGLISH 40.00 X X 160537 0 21594 MARCUS FREE 40.00 X 155796 0 10189 AL STOUTENBURG X X 0 0 0 JOAN NAGELKIRK X X 0 0 0 DAVID TUBBS X 0 0 0 DR ROBERT HASSLER X 0 0 0 ROGER LODING X X 0 0 0 JUDITH FERGUSON X X 0 0 0 LARRY MITCHELL X 0 0 0 MICHAEL DREYER X 0 0 0 ALFREDO DOMINGO 40.00 X 331250 0 0 MICHAEL MERKLER 40.00 X 200036 0 22003 JAMES SAMS 40.00 X 193377 0 9107 GINA PATTERSON 32.00 X 108756 23303 19628 MELANIE KRAMER 40.00 X 193289 0 25830 1540168 23303 132742 8 true true false 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 8 225878 110000 225878 PROGRAM REVENUE 33982086 33982086 OTHER INCOME 831180 831180 CONTRACTUAL -14199445 -14199445 20613821 28514 28514 56901 56901 56901 56901 61523 40724 20799 20799 20945913 20642335 56901 20799 234316 234316 8083708 8083708 218198 218198 1047583 1047583 571556 571556 61964 61964 32100 32100 2539388 2539388 79555 79555 1595500 1595500 218858 218858 467599 467599 108777 108777 35815 35815 21501 21501 791552 791552 253615 253615 BAD DEBTS 1351087 1351087 LEASE, RENT & MISC 1277562 1277562 DRUGS 569680 569680 REPAIRS & MAINTENANCE 502339 502339 20062253 20062253 0 0 82136 45884 1111813 1973814 2500743 2814277 486725 463141 132482 200094 15190256 10367655 4991278 4822601 149864 149864 9455041 10469675 2822642 2598992 258639 2856331 2434891 619355 726551 624621 6405524 6536498 X 3002108 3829263 47409 103914 3049517 3933177 9455041 10469675 X 883660 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 160652 160652 7309928 4313169 2996759 165941 149376 16565 7444219 5819925 1624294 109516 85185 24331 4822601 KINGSBRIDGE - TELEMETRY 89329 KINGSBRIDGE - DIGITIZER & CR 87443 GE - C - ARM & BONE DENSITY 87284 TRI COUNTY - COMPUTER SERVERS 86812 CAHSE - LINE OF CREDIT 79705 NORTHSTAR - AMBULANCE 70475 TRI - COUNTY - AUTOCLAVE 47782 ESB - AMBULANCE 33549 KINGSBRIDE - STERILIZER 29234 ESB - X-RAY 13008 624621 20945913 20062253 883660 -191423 -191423 692237 20523901 20523901 422012 422012 20945913 19831664 19831664 230589 230589 20062253 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 MI BENEFIT RAFFLE 35474 35474 4500 550 4815 400 2478 HOSP AUXILARY 26049 26049 27981 61523 61523 4500 550 4815 400 30459 40724 20799 true true true X true X false true true false true false 151294 151294 0.00750 3412605 2402689 1009916 0.05030 3563899 2402689 1161210 0.05790 243843 227178 16665 0.00080 19122 19122 0.00100 8651 18 8633 0.00040 271616 227196 44420 0.00220 3835515 2629885 1205630 0.06010 true 689054 8861 5150688 5147565 3123 X true true 1 1 MCKENZIE MEMORIAL HOSPITAL

120 DELAWARE STREET SANDUSKY MI 48471

X X X X MCKENZIE MEMORIAL HOSPITAL 1 true true 100.0 true 200.0 true X X X X true true X X X X true false X X X X true X false false 8 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 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 X X X false false false false false false false false false 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 23303 4109 14217 1302 127082 24605 MELANIE KRAMER 193289 7490 18340 219119 BARNETT ANESTESIA INC CEO'S SPOUSE 137413 CRNA SERVICES false X 1 110000 FAIR MARKET VALUE false false false 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. 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 HEALTHCARE CORPORATION false 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 false false false false false false false false false false false false false false true true false false SANILAC SERVICES INC SANILAC PHARMACY O 10339 SANILAC SERVICES INC SANILAC PHARMACY P 90000