STURGIS HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
STURGIS HOSPITAL INC (EIN 35-2362438)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-13
IRS object ID
201322259349302317
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-13T13:37:39-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 E Main St Suite 700AddressLine1
CityFort WayneCity
StateINState
ZIP Code46802ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN352362438EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1STURGIS HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% ROBERT J LABARGEInCareOfName
Name ControlSTURNameControl
Phone2696594400Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1916 MYRTLE AVENUEAddressLine1
CitySTURGISCity
StateMIState
ZIP Code49091ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROBERT J LABARGEName
TitleCEOTitle
Date Signed2013-08-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJoyce A DulworthName
Phone2604604000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonROBERT J LABARGENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1916 MYRTLE AVENUEAddressLine1
CitySTURGISCity
StateMIState
ZIP Code49091ZIPCode
FieldValueIRS element (for citing)
Gross Receipts43983141GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.STURGISHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2009YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionSTURGIS HOSPITAL IS AN 84-BED LICENSED, ACUTE CARE FACILITY SERVING A POPULATION OF APPROXIMATELY 50,000 PEOPLE. STURGIS HOSPITAL, INC EXISTS TO ENSURE THAT THE COMMUNITY HAS ADEQUATE ACCESS TO HEALTHCARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees418TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year466484ContributionsGrantsPriorYear
Contributions Grants Current Year86876ContributionsGrantsCurrentYear
Program Service Revenue Prior Year42576586ProgramServiceRevenuePriorYear
Program Service Revenue CY43418062ProgramServiceRevenueCY
Investment Income Prior Year13825InvestmentIncomePriorYear
Investment Income Current Year17323InvestmentIncomeCurrentYear
Other Revenue Prior Year346678OtherRevenuePriorYear
Other Revenue Current Year172991OtherRevenueCurrentYear
Total Revenue Prior Year43403573TotalRevenuePriorYear
Total Revenue Current Year43695252TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year22235964SalariesEtcPriorYear
Salaries Etc Current Year22516038SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year21449641OtherExpensePriorYear
Other Expenses Current Year23036688OtherExpensesCurrentYear
Total Expenses Prior Year43685605TotalExpensesPriorYear
Total Expenses Current Year45552726TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-282032RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1857474RevenuesLessExpensesCY
Total Assets BOY35489638TotalAssetsBOY
Total Assets EOY34602810TotalAssetsEOY
Total Liabilities BOY17560469TotalLiabilitiesBOY
Total Liabilities EOY18062773TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY17929169NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY16540037NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSTURGIS HOSPITAL INC. IS COMMITTED TO THE PROVISION OF THE HIGHEST QUALITY PRIMARY AND SECONDARY HEALTHCARE TO THE COMMUNITY WE SERVE. STURGIS HOSPITAL INC. STRIVES, IN ALL CIRCUMSTANCES TO PROVIDE ACUTE AND PREVENTATIVE CARE THAT IS CONSISTENT WITH THE VALUES AND NEEDS OF THE UNIQUE SEGMENTS OF OUR POPULATION. BY EXCERCISING RESPONSIBLE STEWARDSHIP OF OUR RESOURCES, STURGIS HOSPITAL INC. WILL ALSO ENDEAVOR TO MAXIMIZE THE BREADTH AND DEPTH OF CARE PROVIDED TO OUR COMMUNITY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense38124663Expense
Revenue43593261Revenue
DescriptionSTURGIS HOSPITAL IS A 84-BED LICENSED, ACUTE CARE FACILITY. NEARLY 40 ACTIVE MEDICAL STAFF MEMBERS, AVAILABLE WITHIN THE STURGIS AND SURROUNDING COMMUNITIES, REPRESENT A WIDE VARIETY OF SPECIALTIES INCLUDING ANESTHESIOLOGY, FAMILY PRACTICE, GENERAL SURGERY, GYNECOLOGY, INTERNAL MEDICINE, OBSTETRICS, OPHTHALMOLOGY, ORTHOPAEDICS, PATHOLOGY, PEDIATRICS, PODIATRY, RADIOLOGY, UROLOGY AND VASCULAR SURGERY. ADDITIONAL SPECIALTIES ARE OFFERED THROUGH THE HOSPITAL'S COURTESY, CONSULTING AND AFFILIATE MEDICAL STAFFMEMBERS. THESE SERVICES INCLUDE CARDIOLOGY, NEUROLOGY, NEUROSURGERY, ONCOLOGY, AND PULMONARY MEDICINE. MEDICAL/SURGICAL CARE IS OFFERED ON AN INPATIENT AND OUTPATIENT LEVEL. BOTH LASER AND LAPAROSCOPIC PROCEDURES ARE PERFORMED IN THE HOSPITAL'S THREE ROOM SURGICAL SUITE. A FOUR-BED CORONARY/INTENSIVE CARE UNIT IS ALSO AVAILABLE FOR CRITICAL PATIENTS. THE 12-BED OBSTETRICAL DEPARTMENT OFFERS LABOR/DELIVERY/RECOVERY/POSTPARTUM ROOMS FOR THE EXPECTANT MOM AND HER FAMILY. EMERGENCY SERVICES ARE AVAILABLE 24 HOURS A DAY, 365 DAYS A YEAR, WITH FULL-TIME MEDICAL STAFF COVERAGE. CARDIAC REHABILITATION AND PHYSICAL THERAPY PROGRAMS AS WELL AS COMMUNITY EDUCATION PROGRAMS DESIGNED TO HELP OUR COMMUNITY LEAD A HEALTHIER LIFESTYLE, ARE ALSO AVAILABLE. STURGIS HOSPITAL HAS A COMMITMENT TO MAINTAIN STATE-OF-THE-ART DIAGNOSTIC TECHNOLOGY, WHICH INCLUDES ANGIOGRAPHY, 64-SLICE CT SCANNING, MAMMOGRAPHY, MOBILE MRI, A SLEEP DISORDER LABORATORY AND SPECT IMAGING AND ULTRASOUND. STURGIS HOME HEALTH CARE--A TOP 500 AGENCY IN THE NATION--IS A DIVISION OF STURGIS HOSPITAL. IT WORKS CLOSELY WITH PHYSICIANS TO PROVIDE QUALITY HOME HEALTH CARE SERVICES FOLLOWING DISCHARGE FROM A HOSPITAL OR FOR THOSE WITH SPECIAL MEDICAL NEEDS THAT DO NOT REQUIRE HOSPITALIZATION. THESE SERVICES INCLUDE NURSING ASSISTANCE, AIDS, COMPANIONS, PHYSICAL, OCCUPATIONAL, SPEECH AND LANGUAGE THERAPIES, AS WELL AS A MEDICAL SOCIAL WORKER. HOSPICE OF STURGIS PROVIDES SUPPORT AND CARE FOR PERSONS IN THE LAST PHASES OF AN INCURABLE DISEASE. THESE SERVICES CAN BE PROVIDED IN A PATIENT'S HOME, NURSING HOME OR ADULT FOSTER CARE SETTING. THE HOSPICE TEAM INCLUDES PHYSICIANS, NURSES, THERAPISTS,AIDES, SOCIAL WORKERS, NUTRITIONISTS, VOLUNTEERS AND CLERGY, AS WELL AS BEREAVEMENT AND SUPPORT GROUPS.Description
Total Program Service Expense38124663TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvesttrueReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096100NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees418NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonROBERT J LABARGENamePerson
Telephone Number2696594400TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1916 MYRTLE AVENUEAddressLine1
CitySTURGISCity
StateMIState
ZIP Code49091ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
KEYER PATEL
MEDICAL STAFF PRESIDENT40.0XX525591034103
JOSE ALBARRAN
BOARD DIRECTOR1.0X000
JEANNIE GERCHOW
BOARD DIRECTOR1.0X000
P JOSEPH HAAS JR
BOARD DIRECTOR1.0X000
MEREDITH HUNT
BOARD DIRECTOR1.0X000
FLOYD KUNCE
BOARD VICE PRESIDENT1.0XX000
DAVID LOCEY
BOARD DIRECTOR1.0X000
JOHN MAYER
BOARD PRESIDENT1.0XX000
ERIC WYNES
BOARD DIRECTOR1.0X000
THOMAS ROCK
BOARD DIRECTOR1.0X000
BHARAT VAKHARIA MD
BOARD DIRECTOR1.0X000
PHILIP WARD
BOARD SECRETARY/TREASURER1.0XX000
SHARI RANSBERGER
DIRECTOR OF QUALITY MANAGEMENT40.0X94845019602
JOSEPHINE IDEN - HIRED 092011
DIRECTOR OF PHYSICIAN SERVICES40.0X2035302102
CHARLOTTE PAVILANIS
DIRECTOR OF PATIENT SERVICES40.0X602680606
MARY KAY SCHULTZ
DIRECTOR OF HUMAN RESOURCES40.0X97789016533
ASHISH VERMA
PHYSICIAN40.0445626037232X
WILSON SAWA
PHYSICIAN40.0287335037232X
JAMES GRANNELL
PHYSICIAN40.0444632039603X
ELIEZER MELENDEZ
PHYSICIAN40.0438851042732X
DAVID SARACENO
CRNA40.0221537014238X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2636827TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation243983TotalOtherCompensation
Number Individuals GT100 K12NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
QUORUM HEALTH RESOURCES
PO BOX 305172NASHVILLETN37230MANAGEMENT795205
PT SERVICES REHABILITATION
PO BOX 833TIFFINOH44883REHAB SERVICES528605
SOUTH BEND MEDICAL FOUNDATION
PO BOX 2030MISHAWAKAIN46546LAB SERVICES450514
ALLIANCE-HNI LLC
7647 COLLECTION CENTER DRIVECHICAGOIL60693MRI SERVICES450275
SODEXO OPERATIONS LLC
4880 PAYSPHERE CIRCLECHICAGOIL60674DIETARY MAINT, MGMT409794
FieldValueIRS element (for citing)
Number Of Contractors GT100 K13NumberOfContractorsGT100K
Fundraising Events14670FundraisingEvents
All Other Contributions72206AllOtherContributions
Total Contributions86876TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
INPATIENT REVENUE9000991794553017945530
OUTPATIENT REVENUE9000991439457514394575
PHYSICIAN OFFICE REVENUE9000991077261510772615
CAFETERIA REVENUE9000998925589255
OTHER REVENUE900099216087216087
FieldValueIRS element (for citing)
Total Program Service Revenue43418062TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column17323TotalRevenueColumn
Exclusion$17,323ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real455678Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real280479Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real175199Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column175199TotalRevenueColumn
Related Or Exempt Function Income175199RelatedOrExemptFunctionIncome

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events5202GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events14670CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses7410FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-2208TotalRevenueColumn
Exclusion-$2,208ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column43695252TotalRevenueColumn
Related Or Exempt Function Income43593261RelatedOrExemptFunctionIncome
Exclusion$15,115ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2880809Total
Program Services2304647ProgramServices
Management And General576162ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15201457Total
Program Services12161166ProgramServices
Management And General3040291ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total127580Total
Program Services102064ProgramServices
Management And General25516ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2989797Total
Program Services2391838ProgramServices
Management And General597959ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1316395Total
Program Services1053116ProgramServices
Management And General263279ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total267469Total
Program Services213975ProgramServices
Management And General53494ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total134916Total
Program Services107933ProgramServices
Management And General26983ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total74085Total
Program Services59268ProgramServices
Management And General14817ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5473828Total
Program Services4379062ProgramServices
Management And General1094766ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total203016Total
Program Services162413ProgramServices
Management And General40603ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5692806Total
Program Services4554245ProgramServices
Management And General1138561ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total255160Total
Program Services204128ProgramServices
Management And General51032ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1657377Total
Program Services1491639ProgramServices
Management And General165738ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total49804Total
Program Services39843ProgramServices
Management And General9961ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total95657Total
Program Services76526ProgramServices
Management And General19131ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total616350Total
Program Services554715ProgramServices
Management And General61635ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1879353Total
Program Services1691418ProgramServices
Management And General187935ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total75904Total
Program Services68314ProgramServices
Management And General7590ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraisingManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES13449591344959
BAD DEBT495295649529560
MISCELLANEOUS EXPENSE26304821043852610

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total45552726Total
Program Services38124663ProgramServices
Management And General7428063ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY650BOY
EOY650EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2122270BOY
EOY1719010EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5972542BOY
EOY5814639EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY825063BOY
EOY824204EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY747426BOY
EOY390280EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis47803854LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec29266454LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY19550611BOY
EOY18537400EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY1773908BOY
EOY1848088EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4497168BOY
EOY5468539EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY35489638BOY
EOY34602810EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4062326BOY
EOY4993823EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY11956055BOY
EOY11655656EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1542088BOY
EOY1413294EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY17560469BOY
EOY18062773EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY17902398BOY
EOY16497485EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY26771BOY
EOY42552EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17929169BOY
EOY16540037EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY35489638BOY
EOY34602810EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1857474ReconcilationRevenueExpenses
Reconcilation Other Changes468342ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis109943OtherCostOrOtherBasis
Book Value109943BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis28366153OtherCostOrOtherBasis
Depreciation12003890Depreciation
Book Value16362263BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis18819708OtherCostOrOtherBasis
Depreciation16981368Depreciation
Book Value1838340BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis508050OtherCostOrOtherBasis
Depreciation281196Depreciation
Book Value226854BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings18537400TotalOfBookValueLandBuildings
Total Of Book Value Program Related0TotalOfBookValueProgramRelated

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
PENSION ASSET2796299
DEFERRED FINANCING COSTS276078
DUE FROM THIRD PARTY PAYERS2396162
FieldValueIRS element (for citing)
Total Book Value Other Assets5468539TotalBookValueOtherAssets
Total Revenue43695252TotalRevenue
Total Expenses45552726TotalExpenses
Excess Or Deficit For Year-1857474ExcessOrDeficitForYear
Net Unrealized GL On Investments82000NetUnrealizedGLOnInvestments
Other$386,342OtherAmount
Total Adjustments468342TotalAdjustments
Excess Or Deficit Per FS-1389132ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt39112185TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments82000NetUnrealizedGainsInvestments
Other Revenues287889OtherRevenues
Revenue Not Rptd F990369889RevenueNotRptdF990
Revenue Subtotal38742296RevenueSubtotal
Other Revenues Not Included4952956OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt4952956RevenueNotRptdOnFinStmt
Total Revenue Per Form99043695252TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt40887659TotExpensesEtcAuditedFinclStmt
Other Expenses Included287889OtherExpensesIncluded
Expenses Not Rptd F990287889ExpensesNotRptdF990
Expenses Subtotal40599770ExpensesSubtotal
Other Expenses Not Included4952956OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt4952956ExpensesNotRptdOnFinStmt
Total Expenses Per Form99045552726TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
ASC 740MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
RECONCILIATIONPART XI, LINE 8 CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS $386,342 PART XII, LINE 2D RENTAL EXPENSE $280,479 SPECIAL EVENTS EXPENSE 7,410 TOTAL: $287,889 PART XII, LINE 4B BAD DEBT EXPENSE $4,952,956 PART XIII, LINE 2D RENTAL EXPENSE $280,479 SPECIAL EVENTS EXPENSE 7,410 TOTAL: $287,889 PART XIII, LINE 4B BAD DEBT EXPENSE $4,952,956

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CHEF COOK-OFFNameOfEvent1
Gross Receipts Event119872GrossReceiptsEvent1
Charitable Contributions Event114670CharitableContributionsEvent1
Gross Revenue Event15202GrossRevenueEvent1
Other Direct Expenses Event17410OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total19872GrossReceiptsTotal
Charitable Contributions Total14670CharitableContributionsTotal
Gross Revenue Total Events5202GrossRevenueTotalEvents
Other Direct Expenses Total Events7410OtherDirectExpensesTotalEvents
Direct Expense Summary Events7410DirectExpenseSummaryEvents
Net Income Summary-2208NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense1564080TotalCommunityBenefitExpense
Net Community Benefit Expense1563716NetCommunityBenefitExpense
Percent Of Total Expense0.03850PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense7866606TotalCommunityBenefitExpense
Direct Offsetting Revenue6678301DirectOffsettingRevenue
Net Community Benefit Expense1188305NetCommunityBenefitExpense
Percent Of Total Expense0.02930PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense9430686TotalCommunityBenefitExpense
Direct Offsetting Revenue6678301DirectOffsettingRevenue
Net Community Benefit Expense2752021NetCommunityBenefitExpense
Percent Of Total Expense0.06780PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense23693TotalCommunityBenefitExpense
Direct Offsetting Revenue820DirectOffsettingRevenue
Net Community Benefit Expense22873NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense23693TotalCommunityBenefitExpense
Direct Offsetting Revenue820DirectOffsettingRevenue
Net Community Benefit Expense22873NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense9454379TotalCommunityBenefitExpense
Direct Offsetting Revenue6679121DirectOffsettingRevenue
Net Community Benefit Expense2774894NetCommunityBenefitExpense
Percent Of Total Expense0.06840PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$4,952,956BadDebtExpenseAmount
Amount Attributable To2287374AmountAttributableTo
Amount Reimbursed By Medicare11077647AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare10973436CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall104211MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1STURGIS HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1916 MYRTLE AVENUEAddressLine1
CitySTURGISCity
StateMIState
ZIP Code49091ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1STURGIS HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent200.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (4 entries)

IdentifierIdentifierExplanationExplanation
PART ISTURGIS HOSPITAL ACKNOWLEDGES THAT ALL INDIVIDUALS ARE NOT EQUALLY CAPABLE OF WITHSTANDING THE BURDEN OF PAYMENT FOR HEALTHCARE SERVICES.THE HOSPITAL PROVIDES AND PROMOTES ACCESS TO EMERGENCY AND MEDICALLY NECESSARY SERVICES WITHOUT REGARD TO ABILITY TO PAY. LINE 3C ACCORDING TO THE HOSPITAL'S EXISTING PUBLIC POLICY, ALL PATIENTS RECEIVING MEDICALLY NECESSARY SERVICES ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. ELIGIBILITY CRITERIA IS BASED ON THE NEED OF THE PATIENTS, LACK OF EXISTING INSURANCE, AND OTHER RESOURCES REQUIRED FOR PAYMENT. ELIGIBILITY CRITERIA IS FURTHER BASED ON THE FEDERAL POVERTY GUIDELINES AT A LEVEL OF 200% OF THAT GUIDELINE. LINE 6A STURGIS HOSPITAL PUBLISHES ITS ANNUAL REPORT WHICH INCLUDES ALL RELATED ORGANIZATIONS' PROGRAMS AND SERVICES DESIGNED TO LEAD THE COMMUNITY TO IMPROVED HEALTH AND PROMOTE HEALTHY LIFESTYLES. THE REPORT IS AVAILABLE ON STURGIS'S WEBSITE. LINE 7 COLUMN F BAD DEBT EXPENSE IN THE AMOUNT OF $4,952,956 IS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) ("TOTAL FUNCTIONAL EXPENSES"), BUT IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN. THE ORGANIZATION USES A COMBINATION OF THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF SCHEDULE H AND DIRECT COSTING METHOD OF CERTAIN PROGRAMS
PART IIILINE 4 THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENTS LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. CHARGES ARE REPORTED AT 100%, AND THE AMOUNT WRITTEN OFF TO BAD DEBT IS REDUCED TO COST BY APPLYING THE COST TO CHARGE RATIO. LINE 8 COSTING METHODOLOGY TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MCR IS A STATISTICAL STEP DOWN ALLOCATION METHOD. ANY SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE THE HOSPITAL PROVIDES THESE SERVICES AS A COMMUNITY BENEFIT DESPITE THE FACT THAT THEY ARE PROVIDED AT A FINANCIAL LOSS. LINE 9B ONCE A THE EVALUATION IS COMPLETED AND A DETERMINATION HAS BEEN MADE THAT PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE, NO COLLECTION EFFORTS ARE MADE. CONSIDERATION FOR ASSISTANCE IS ALSO GIVEN TO OTHER TYPES OF PATIENTS IF THE NEED FOR ASSISTANCE IS REQUIRED. PART V LINE 19D: FLAT DISCOUNT OF 100% IS PROVIDED FOR ELIGIBLE PATIENTS UNDER THE FEDERAL POVERTY GUIDELINES
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY AND AVAILABILITY OF FINANCIAL ASSISTANCE BY: POSTING THE ORGANIZATIONS CHARITY CARE POLICY IN ACCESS AND REGISTRATION AREAS WITHIN THE HOSPITAL INDIVIDUAL INTERVIEW OF PATIENTS BY FINANCIAL COUNSELORS AND PREADMISSION STAFF WITH DISCUSSIONS CONCERNING FINANCIAL ASSISTANCE, AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS AND ASSISTANCE WITH THE APPLICATION FOR ASSISTANCE. THE HOSPITAL HAS ENTERED A MEMORANDUM OF UNDERSTANDING WITH THE COUNTY WHEREAS THE HOSPITAL MAKES A COMMITMENT TO PROVIDE HEALTH CARE SERVICES TO LOW INCOME RESIDENTS OF THE COUNTY (PUBLIC RECORD) THE HOSPITAL DOES NOT INCLUDE A COPY OF THE POLICY AS PART OF THE INTAKE OR DISCHARGE PROCESS, NOR IS IT INCLUDED IN THE PATIENT BILL
COMMUNITY BENEFIT REPORTTHE HOSPITAL DEMONSTRATES ITS DESIRE TO FURTHER ITS EXEMPT PURPOSE AND MISSION BY: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED BY PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA, WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY (OPEN MEDICAL STAFF). ALL SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION TO PROMOTE SERVICE ENHANCEMENT TO ITS COMMUNITY AS WELL AS CAPITAL REPLACEMENT AND SERVICE DEVELOPMENT. THE ORGANIZATION FURTHER PROMOTES ITS MISSION BY PARTICIPATION IN HEALTH CARE SCREENING, HEALTH CARE EDUCATION AND CERTAIN SERVICES MADE TO THE COMMUNITY AT NO COST TO THE COMMUNITY. ORGANIZATION HAS ENTERED INTO MEMORANDUM OF UNDERSTANDING WITH ST.JOSEPH COUNTY COMMITTING TO PROVIDE SERVICES TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY FOR THOSE SERVICES. COMMUNITY BENEFIT REPORT WOULD BE FILED ONLY IN THE STATE OF MICHIGAN.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KEYER PATEL
5254290001620165000176030559694000
ASHISH VERMA
4454460001800165000207320482858000
WILSON SAWA
2871550001800165000207320324567000
JAMES GRANNELL
4438580007740220000176030484235000
ELIEZER MELENDEZ
4384370004140220000207320481583000
DAVID SARACENO
221267000270000142380235775000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPART I LINE 3Identifier
ExplanationTHE ORGANIZATION'S TOP MANAGEMENT OFFICIALS ARE LEASED FROM A MANAGEMENT COMPANY. THEREFORE, THEIR COMPENSATION IS DETERMINED AND PAID BY THIS MANAGEMENT COMPANY.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
CITY OF STURGIS BUILDING AUTHORITY
386004653864108BE42004-12-2910000000HOSPITAL EXPANSION PROJECTfalsefalsefalse
CITY OF STURGIS BUILDING AUTHORITY
386004653864108CK92005-08-11995000HOSPITAL EXPANSION PROJECTfalsefalsefalse
CITY OF STURGIS FACILITIES & HOSPITAL AUTHORITY
3860046532010-04-282334795HOSPITAL EXPANSION PROJECTfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Amount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
170000010044029000279030096461990002006falsefalsetruetrue
20000010011840004258409586000002007falsefalsetruetrue
833900233479500043541022912540002012falsefalsefalsetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalse0.000000.000000.00000true
falsefalsefalsefalse0.000000.000000.00000true
falsefalsefalsefalse0.000000.000000.00000true

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line1NameOfGICProvider/BusinessNameLine1Gross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
0
falsefalsefalsefalse0falsefalse
0
falsefalsefalsefalse0falsefalse
0
falsetruefalsefalse0falsefalse
FieldValueIRS element (for citing)
Fed Tax Requirements ComplianceXFedTaxRequirementsCompliance

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
GOVERNING BODY & MANAGEMENTPART VI, SECTION AQUESTION 1B: KAYUR PATEL, M.D. IS A PAID EMPLOYEE OF THE HOSPITAL AND IS THEREFORE CONSIDERED NON-INDEPENDENT. QUESTION 3: BOARD OF TRUSTEES HAS ENGAGED QUORUM HEALTH RESOURCES TO PROVIDE MANAGEMENT SERVICES UNDER THE STRICT POLICIES AND BY-LAWS ADOPTED BY THE BOARD OF TRUSTEES.
POLICIESPART VI, SECTION BQUESTION 11: THE FORM 990 IS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM AND FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO THE FULL BOARD PRIOR TO FILING WITH THE IRS. QUESTION 12: BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY DISCLOSE POTENTIAL CONFLICTS OF INTEREST. DISCLOSURES ARE REVIEWED TO DETERMINE WHETHER A CONFLICT EXISTS. IF A CONFLICT EXISTS, BOARD MEMBERS ARE ASKED TO RECUSE THEMSELVES FROM DISCUSSIONS RELATING TO THE CONFLICT. QUESTION 15: COMPENSATION LEVELS ARE DETERMINED AT THE BOARD LEVEL UTILIZING VARIOUS SALARY SURVEYS FROM STATE HOSPITAL ASSOCIATION AS WELL AS THE MANAGEMENT COMPANY'S DATA BASE OF SALARY SCALES AND PROFESSIONAL RECRUITMENT FIRMS. QUESTION 19: STURGIS HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.
PART XILINE 5CHANGE IN DEFINED BENEFIT PENSION PLAN GAINS $386,342 UNREALIZED GAIN ON INVESTMENTS 82,000 TOTAL: $468,342

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