GREAT LAKES MOBILE PET: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: GREAT LAKES MOBILE PET (EIN 36-4508671)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-08-15
IRS object ID: 201332279349302258
Schema version: 2012v2.1
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 D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-08-15T11:07:09-05:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	364508671	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	GREAT LAKES MOBILE PET	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	GREA	NameControl
Phone	2319355000	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 1188	AddressLine1
City	TRAVERSE CITY	City
State	MI	State
ZIP Code	496851188	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	LINDA WARD	Name
Title	TREASURER	Title
Phone	2319355000	Phone
Date Signed	2013-08-13	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	DERK PRONGER	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1105 SIXTH ST	AddressLine1
City	TRAVERSE CITY	City
State	MI	State
ZIP Code	49684	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	1314800	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2002	YearFormation
State Legal Domicile	MI	StateLegalDomicile
Activity Or Mission Description	TO ESTABLISH, ACQUIRE AND MAINTAIN A MOBILE POSITRON EMISSION TOMOGRAPHY NETWORK TO IMPROVE AND PROMOTE THE HEALTH OF THE CITIZENS OF NORTHERN MICHIGAN.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	8	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	8	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	1129900	ProgramServiceRevenuePriorYear
Program Service Revenue CY	1314800	ProgramServiceRevenueCY
Investment Income Current Year	0	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	1129900	TotalRevenuePriorYear
Total Revenue Current Year	1314800	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1088393	OtherExpensePriorYear
Other Expenses Current Year	1089666	OtherExpensesCurrentYear
Total Expenses Prior Year	1088393	TotalExpensesPriorYear
Total Expenses Current Year	1089666	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	41507	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	225134	RevenuesLessExpensesCY
Total Assets BOY	1247002	TotalAssetsBOY
Total Assets EOY	940506	TotalAssetsEOY
Total Liabilities BOY	917512	TotalLiabilitiesBOY
Total Liabilities EOY	385882	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	329490	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	554624	NetAssetsOrFundBalancesEOY
Mission Description	TO ESTABLISH, ACQUIRE AND MAINTAIN A MOBILE POSITRON EMISSION TOMOGRAPHY NETWORK TO IMPROVE AND PROMOTE THE HEALTH OF THE CITIZENS OF NORTHERN MICHIGAN.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	1045592	Expense
Revenue	1314800	Revenue
Description	PROVISION OF POSITRON EMISSION TOMOGRAPHY TO PATIENTS OF THREE MEMBER HOSPITALS: MUNSON MEDICAL CENTER, ALPENA GENERAL HOSPITAL AND NORTHERN MICHIGAN HOSPITAL. IN 2012, GREAT LAKES MOBILE PET PERFORMED 1,991 SCANS IN NORTHERN MICHIGAN.	Description
Total Program Service Expense	1045592	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	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	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	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	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	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	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	1	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	0	NumberOfEmployees
Unrelated Business Income	false	UnrelatedBusinessIncome
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
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	8	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	false	RegularMonitoringEnforcement
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	MUNSON HEALTHCARE CORPORATE ACCOUNT	NamePerson
Telephone Number	2319357777	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	3668 N US 31 S	AddressLine1
City	TRAVERSE CITY	City
State	MI	State
ZIP Code	49684	ZIPCode

Field	Value	IRS element (for citing)
No Listed Persons Compensated	X	NoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
DERK PRONGER
PRESIDENT	1.00	X	X	0	0	0
CHUCK SHERWIN
SECRETARY	1.00	X	X	0	0	0
LINDA WARD
TREASURER	1.00	X	X	0	0	0
KATHLEEN A MCMANUS
DIRECTOR	1.00	X		0	0	0
DOUG KREIS
DIRECTOR	1.00	X		0	0	0
STEVE CROSS
DIRECTOR	1.00	X		0	0	0
KRISTY SMOLINSKI
DIRECTOR	1.00	X		0	0	0
CHRIS PODGES
PAST PRESIDE	1.00	X	X	0	0	0

Field	Value	IRS element (for citing)
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	MUNSON MEDICAL CENTER	BusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1105 SIXTH ST	AddressLine1
City	TRAVERSE CITY	City
State	MI	State
ZIP Code	49684	ZIPCode

Field	Value	IRS element (for citing)
Description Of Services	MEDICAL & TECH	DescriptionOfServices
Compensation	242377	Compensation

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	1	NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	MEDICAL SERVICES FEES	Description
Business Code	621990	BusinessCode
Total Revenue Column	1314800	TotalRevenueColumn
Related Or Exempt Function Income	1314800	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	1314800	TotalProgramServiceRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	1314800	TotalRevenueColumn
Related Or Exempt Function Income	1314800	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	X	InfoInScheduleOPartIX

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	2916	Total
Management And General	2916	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	254278	Total
Program Services	247742	ProgramServices
Management And General	6536	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	14636	Total
Program Services	13781	ProgramServices
Management And General	855	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	510	Total
Program Services	510	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	6617	Total
Program Services	6617	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	11425	Total
Program Services	11425	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	490568	Total
Program Services	484683	ProgramServices
Management And General	5885	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	24912	Total
Management And General	24912	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
VEHICLE REPAIR AND FUEL	266066	266066
ELECTRICITY FOR PET MACHI	13489	13489
LICENSE FEES	2420		2420
TELEPHONE	1279	1279

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	550	Total
Management And General	550	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	1089666	Total
Program Services	1045592	ProgramServices
Management And General	44074	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	129237	BOY
EOY	287544	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	140620	BOY
EOY	141300	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	35910	BOY
EOY	57133	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	2424123	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	1979830	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	928975	BOY
EOY	444293	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	12260	BOY
EOY	6375	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
EOY	3861	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	1247002	BOY
EOY	940506	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	30927	BOY
EOY	31248	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	886585	BOY
EOY	354634	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	917512	BOY
EOY	385882	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	329490	BOY
EOY	554624	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	329490	BOY
EOY	554624	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1247002	BOY
EOY	940506	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	225134	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule D IRS990ScheduleD

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2424123	OtherCostOrOtherBasis
Depreciation	1979830	Depreciation
Book Value	444293	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	444293	TotalOfBookValueLandBuildings

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
CLASSES OF MEMBERS OR STOCKHOLDERS	FORM 990, PAGE 6, PART VI, LINE 6	GREAT LAKES MOBILE PET IS ORGANIZED AS A NON-STOCK MEMBERSHIP CORPORATION.
ELECTION OF MEMBERS AND THEIR RIGHTS	FORM 990, PAGE 6, PART VI, LINE 7A	EACH MEMBER OF THE CORPORATION SHALL APPOINT TWO TRUSTEES TO THE BOARD OF TRUSTEES.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS	FORM 990, PAGE 6, PART VI, LINE 7B	MEMBER ORGANIZATIONS APPROVE THE DECISIONS OF THE BOARD OF TRUSTEES.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	ONE MEMBER ORGANIZATION PREPARES THE FORM 990 AT THE CORPORATE OFFICE. MANAGEMENT AT THE ORGANIZATION, KNOWLEDGEABLE ABOUT THE REQUIREMENTS FOR FORM 990, REVIEWS THE RETURN FOR ACCURACY. THE VICE PRESIDENT OF GENERAL COUNSEL FOR THAT MEMBER ORGANIZATION REVIEWS THE GOVERNANCE PORTION OF THE RETURN. A COPY OF THE RETURN IS PROVIDED TO THE MEMBERS OF THE BOARD PRIOR TO ITS FILING WITH THE IRS. ANY QUESTIONS ARE CLARIFIED PRIOR TO FILING.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE ORGANIZATION DOES NOT MAKE ITS BYLAWS, CONFLICT OF INTEREST POLICY OR FINANCIALS STATEMENTS AVAILABLE TO THE PUBLIC.
OTHER FEES FOR SERVICES	FORM 990, PART IX, LINE 11G	CONTRACT LABOR 247,742 6,536 0