2013-11-15T09:36:10-06:00 2012-12-31 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2012-01-01 381490180 CARSON CITY HOSPITAL CARS 9895843971 406 E Elm Street PO Box 879 Carson City MI 48811 DUANE C MILLER 2013-04-11 true Geralyn Hurd P00933422 3128997000 2012 2016-02-25 16:41:14Z MATTHEW THOMPSON 406 E Elm Street Carson City MI 48811 60626534 false X WWW.CARSONHEALTH.ORG X 1938 MI THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY & ACCESSIBLE HEALTH CARE SERVICES TO COMMUNITIES WE SERVE. IN CONJUNCTION, CCH PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. 13 6 729 130 0 0 179222 101927 59862979 58936320 164770 416201 602659 712517 60809630 60166965 19979 0 0 0 32574506 35461383 0 0 14370 27476512 25339837 60070997 60801220 738633 -634255 46428348 45594758 23228049 25177381 23200299 20417377 THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY AND ACCESSIBLE HEALTH CARE SERVICES TO THE COMMUNITIES WE SERVE AND TO PROVIDE CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. false false 36526667 50203892 CCH IS A 77-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, D.O. SINCE THIS TIME, CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS IN A FOUR-COUNTY AREA. CCH CURRENTLY OPERATES A SHORT-TERM, ACUTE-CARE FACILITY AND SEVERAL SATELLITE CLINICS OFFERING INPATIENT AND OUTPATIENT HEALTHCARE SERVICES, PSYCHIATRIC SERVICES, PHYSICIAN SERVICES, AND HOME HEALTH CARE, PRIMARILY TO PATIENTS IN THE CARSON CITY, MICHIGAN AREA, INCLUDING GRATIOT, MONTCALM, CLINTON, AND IONIA COUNTIES. CCH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE CCH DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. UNDER ARRANGEMENTS WITH VARIOUS GOVERNMENTAL INSURANCE PROGRAMS, CCH PROVIDES SIGNIFICANT CARE TO THE LOCAL INDIGENT POPULATION FOR WHICH REIMBURSEMENT FOR SERVICES RENDERED IS GENERALLY LESS THAN THE COST OF PROVIDING SUCH SERVICES. AS PART OF ITS OBLIGATION TO THE LOCAL COMMUNITY, CCH ALSO PROVIDES NUMEROUS OTHER SERVICES, WHICH BENEFIT THE COMMUNITY AND ARE GENERALLY PERFORMED AT NO CHARGE AND PROVIDES SERVICES TO INDIGENT PATIENTS UNDER THE MEDICAID PROGRAM AT PAYMENT AMOUNTS LESS THAN THE COST OF THE SERVICES PROVIDED. FOR THE YEAR ENDED DECEMBER 31, 2012, CCH PROVIDED OVER $2 MILLION IN UNCOMPENSATED CARE. THE ESTIMATED ANNUAL TOTAL LOCAL ECONOMIC IMPACT IS $30,000,000. 1670043 1637982 ITHACA FAMILY CARE CENTER (IFCC) IS AN OFFICE WITH 2 PHYSICIANS, 1 NURSE PRACTITIONER, AND 1 PHYSICIAN ASSISTANT THAT FOCUSES ON FAMILY PRACTICE FOR GRATIOT COUNTY. IFCC PROVIDES OUTPATIENT SERVICES SUCH AS AUDIOMETRY, BLOOD PRESSURE CHECK, EAR EXAMINATION, EKG, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATIONS, HEALTH EDUCATION, HEMOCCULT, IMMUNIZATION, LACERATION, OFFICE VISITS, OSTEOPATHIC MANIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS AND PREMARITAL COUNSELING. THEY ALSO PROVIDE LABORATORY SERVICES SUCH AS BLOOD SUGAR, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. 1471162 1325873 CARSON FAMILY CARE CENTER (CFCC) IS AN OFFICE WITH 2 PHYSICIANS AND 1 NURSE PRACTITIONER THAT FOCUSES ON FAMILY PRACTICE FOR MONTCALM COUNTY. CFCC PROVIDES OUTPATIENT SERVICES SUCH AS ASTHMA SERVICES, AUDIOMETRY, BLOOD PRESSURE CHECKS, DISABILITY/IMPAIRMENT EVALUATIONS, DRUG AND ALCOHOL SCREENING, EAR EXAMINATION, EKG, EMPLOYEE SCREENING, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATION, HEALTH EDUCATION, IMMUNIZATION, IMMUNOTHERAPY, INJURY MANAGEMENT WORK RELATED INJURIES, LACERATION, LASER COSMETICS, OFFICE VISITS, OSTEPATHIC MANIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS, PRE-EMPLOYMENT PHYSICALS, PREMARITAL COUNSELING, SAFETY PROGRAMS AND WORK SITE VISITS. THEY ALSO PROVIDE LABORATORY SERVICES SUCH AS BLOOD SUGAR, HEMOCCULT, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. 6076484 5768573 OTHER PROGRAM SERVICES INCLUDE THE OPERATION OF THE FOLLOWING FACILITIES: ASHLEY FAMILY CARE CENTER CARSON BEHAVIORAL CARE CENTER CARSON CITY HOSPITAL ORTHOPEDICS AND GENERAL SURGERY PHYSICAL REHABILITATION CENTER FOWLER FAMILY CARE CENTER GREENVILLE FAMILY CARE CENTER HOSPITALISTS LYONS FAMILY CARE CENTER PEDIATRIC AND ADOLESCENT SPECIALISTS STANTON FAMILY CARE CENTER CARSON HOME CARE CARSON PAIN MANAGEMENT 6076484 5768573 45744356 true true false true false false false false false true false false false true true true false false false false false false false false false true true false false true true false false false false false false false false false true false false false false false true true false false false true 170 0 true 729 true false false false false false true true false false false false X 13 6 false false false false true true true true true false true true true true true true true true true true false X Duane Miller 9895843971 406 E Elm Street Carson City MI 48811 BRENT WILSON 2.00 X X 0 0 0 HAROLD HOUSE 2.00 X X 0 0 0 MATTHEW J THOMPSON 40.00 X X 232493 0 14421 ROBERT SEALS DO 40.00 X X 316669 0 13142 CINDA KOSLOSKI 2.00 X 0 0 0 DEBBY CASSADY 2.00 X 0 0 0 DOUGLAS POFF DO 40.00 X 192626 0 14202 GARY REETZ 2.00 X 0 0 0 JARED MERCHANT 2.00 X 0 0 0 MARK BRETT 2.00 X 0 0 0 REX A RIMMEL DO 2.00 X 0 0 0 RODERICK COY 2.00 X 0 0 0 TOM MACDONALD 2.00 X 0 0 0 TOM OSTRANDER 2.00 X 0 0 0 DUANE C MILLER 40.00 X 150658 0 11670 NANCY A WEAVER 40.00 X 150939 0 10006 NATALIE W BUSLEPP 40.00 X 151895 0 11007 RICHARD D TERRY 40.00 X 101806 0 6404 CHRISTOPHER E HERALD MD 40.00 X 311931 0 15069 DAVID J FREESTONE MD 40.00 X 302556 0 14400 ADAM Z COTE 40.00 X 566664 0 16197 JOSEPH B WHITE 40.00 X 604033 0 7204 MICHAEL H MULLINS 40.00 X 359727 0 7773 PARUTAPPA R BHIMALLI 40.00 X 490994 0 16725 RAYMOND P ALLARD 40.00 X 499314 0 8786 4432305 0 167006 43 false true false PHARMACY SYSTEMS INC PO BOX 71-0716 COLUMBUS OH 43271 PHARMACY CONSULTING SERVICES 223700 ROBERT HALF INTERNATIONAL 12400 COLLECTIONS CENTER DR CHICAGO IL 60693 ACCOUNTING SERVICES/CONSULTING 183773 QUEUE ADVERTISING 410 S CEDAR STE F LANSING MI 48912 ADVERTISING SERVICES 170032 LIFE CARE SLEEP AND HEALTH CENTER LLC 7200 W SAGINAW HWY SUITE 1 LANSING MI 48917 SLEEP STUDY CONSULTING 154950 INNOVATIVE PRACTICE CONCEPTS LLC 2350 OAK INDUSTRIAL DR NE STE A GRAND RAPIDS MI 49505 MEDICAL PRACTICE CONSULTING 125707 7 35550 66377 101927 NET PATIENT SERVICE REVENUE 621300 60483245 60483245 MEDICARE/MEDICAID "HITECH" REVENUE 900099 1348670 1348670 BAD DEBT EXPENSE -2895595 -2895595 0 0 0 0 0 0 58936320 408646 408646 0 0 507597 458224 49373 0 49373 49373 8900 1345 0 7555 7555 7555 0 0 0 CAFETERIA/COFFEE SHOP/VENDING 722219 308449 308449 MISCELLANEOUS 900099 354695 354695 0 0 0 0 0 663144 60166965 58936320 0 1128718 0 0 0 0 2160630 1066894 1093736 0 27205076 23505530 3699546 1444077 481906 962171 2713924 523007 2190917 1937676 1453547 484129 277846 277846 131294 127726 3568 309882 309882 0 0 39981 39981 0 0 0 0 1158631 5718 1145617 7296 3799064 2701528 1094054 3482 1379759 250466 1129293 0 3511189 2950844 560345 174011 97802 76185 24 0 0 354650 354650 0 1829065 1829065 823743 823743 DIRECT PATIENT CARE SUPPLIES & EXPENSES 9081688 9081688 RECRUITING 347895 347895 PROVIDER/OTHER TAXES 2121139 1441711 679428 0 0 0 0 60801220 45744356 15042494 14370 0 4633 4654 3996424 3657966 28207 0 10007350 8979500 0 0 43588 65356 987209 1357876 2136643 2295049 46576330 24339968 23307798 22236362 5065752 5511066 0 0 0 0 239804 239805 610940 1247124 46428348 45594758 6029100 7468462 15147534 14390157 0 1318003 2140214 22510 20010 710902 1158538 23228049 25177381 X 22936749 20180658 263550 236719 23200299 20417377 46428348 45594758 X -634255 156525 -1788410 -516782 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3830 3830 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 THE ORGANIZATION INDIRECTLY INFLUENCED LEGISLATION THOUGH ITS ANNUAL DUES PAID TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION; 16.32% OF DUES PAID WERE USED FOR SPECIFIC LOBBYING PURPOSES. 731643 731643 31425804 14141512 17284292 1512074 594823 917251 12725441 9603633 3121808 181368 181368 22236362 0 DEFINED BENEFIT PENSION LIABILITY 1158538 1158538 X FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. ACCOUNTING PRINCIPALS GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2009. true true X true X true X true true false true true 2267877 0 2267877 0.03730 10916508 8905959 2010549 0.03310 2327642 613133 1714509 0.02820 0 0 15512027 9519092 5992935 0.09860 3214512 0 3214512 0.05290 108179 22011 86168 0.00140 5893518 2786519 3106999 0.05110 0 0 0 0.00000 17721 0 17721 0.00030 0 0 9233930 2808530 6425400 0.10570 0 0 24745957 12327622 12418335 0.20430 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 true 2895595 75285 10927919 12309911 -1381992 X true true 1 1 CARSON CITY HOSPITAL

406 E ELM STREET CARSON CITY MI 48811

X X X X CARSON CITY HOSPITAL 1 true true 200 true false true false true X X false X X true X false false 14 ITHACA FAMILY CARE CENTER

114 N MAIN ST ITHACA MI 48847

GENERAL MEDICAL OUTPATIENT CLINIC CARSON FAMILY CARE CENTER

102 S THIRD ST STE 100 BOX 277 CARSON CITY MI 48811

GENERAL MEDICAL OUTPATIENT CLINIC PHYSICAL REHABILITATION CARE CENTER

602 E ELM STREET CARSON CITY MI 48811

OUTPATIENT REHABILITATION CLINIC CARSON HOME CARE

406 E ELM ST CARSON CITY MI 48811

HOME HEALTH CARE GREENVILLE FAMILY CARE CENTER

1014 E WASHINGTON GREENVILLE MI 48838

GENERAL MEDICAL OUTPATIENT CLINIC PEDIATRIC & ADOLESCENT SPECIALISTS

245 S SECOND ST BOX 847 CARSON CITY MI 48811

GENERAL MEDICAL OUTPATIENT CLINIC STANTON FAMILY CARE CENTER

545 N STATE ST BOX 638 STANTON MI 48888

GENERAL MEDICAL OUTPATIENT CLINIC ASHLEY FAMILY CARE CENTER

320 S STERLING ST BOX 96 ASHLEY MI 48806

GENERAL MEDICAL OUTPATIENT CLINIC CARSON PAIN MANAGEMENT

102 S THIRD STREET SUITE 300 CARSON CITY MI 48811

OUTPATIENT PAIN MANAGEMENT OFFICE CARSON CITY HOSPITAL ORTHOPEDICS AND GENERAL SURGERY

102 S THIRD ST STE 400 BOX 326 CARSON CITY MI 48811

GENERAL MEDICAL/SURGICAL OUTPATIENT CLINIC HOSPITALISTS

406 E ELM ST CARSON CITY MI 48811

GENERAL MEDICAL INPATIENT CLINIC CARSON BEHAVIORAL HEALTH CENTER

102 S THIRD ST STE 500 BOX 417 CARSON CITY MI 48811

BEHAVIORAL HEALTH CLINIC FOWLER FAMILY CARE CENTER

11017 W THIRD ST BOX 19 FOWLER MI 48835

GENERAL MEDICAL OUTPATIENT CLINIC LYONS FAMILY CARE CENTER

505 E BRIDGE ST BOX 186 LYONS MI 48851

GENERAL MEDICAL OUTPATIENT CLINIC Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 THE DEFINITION OF A COMMUNITY BENEFIT IS A SERVICE OR PROGRAM THAT THE HOSPITAL PROVIDES TO PROMOTE HEALTH AND HEALING AS A RESPONSE TO COMMUNITY NEEDS. COMMUNITY BENEFITS USUALLY GENERATE A LOW OR NEGATIVE FINANCIAL RETURN, RESPOND TO PUBLIC HEALTH NEEDS, INVOLVE EDUATION OR RESEARCH THAT IMPROVES THE OVERALL COMMUNITY HEALTH, AND RESPOND TO THE NEEDS OF SPECIAL POPULATIONS SUCH AS PERSONS LIVING IN POVERTY AND OTHER DISENFRANCHISED PERSONS. THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 0 Subsidized Health Services Schedule H, Part I, Line 7g THE COMMUNITY BENEFITS REPORT TAKES THE WHOLE HOSPITAL, WHICH ALSO TAKES THE MEDICAL SERVICES GROUP PHYSICIAN CLINICS INTO CONSIDERATION. SOME ITEMS CAN ONLY BE DONE IN THE HOSPITAL WHILE MANY OTHERS CAN BE DONE IN A PHYSICIAN CLINIC SETTING. THE $8.7 MILLION IN REVENUE THAT IS BROUGHT IN FROM THE PHYSICIAN CLINIC SETTING INCLUDES BLOOD PRESSURE CHECKS, CHILD IMMUNIZATIONS, AND CHOLESTEROL TESTING, AS WELL AS MANY OTHER PREVENTATIVE SERVICES IN LOW POPULATION, RURAL COMMUNITIES. Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. Bad debt expense - methodology used to estimate amount as community benefit Schedule H, Part III, Line 3 THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY REPORTED IN PART III, LINE 3 IS DETERMINED BY USING A PERCENTAGE (2.6%) OF THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE AT COST. THIS PERCENTAGE IS DETERMINED BY ANALYZING THE HOSPITAL'S WRITE-OFFS COMPARED TO ITS TOTAL GROSS REVENUE. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 SEE NOTE 1, PAGE 8 IN THE ATTACHED FINANCIAL STATEMENTS. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. ANY SHORTFALLS THAT RESULT FROM MEDICARE ALLOWABLE COSTS EXCEEDING MEDICARE REVENUE CAN BE CONSIDERED A COMMUNITY BENEFIT IF THE ACTIVITY IS SOMETHING THAT CARSON CITY HOSPITAL IS DOING TO CREATE THE AWARENESS AND WELL-BEING OF THE HOSPITAL COMMUNITY. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b CARSON CITY HOSPITAL INITIATES COLLECTION AT THE POINT OF SERVICE THROUGH THE PATIENT ACCESS DEPARTMENT. PATIENTS ARE ADVISED OF THEIR CO-PAY AND DEDUCTIBLE AND ASKED FOR A DEPOSIT ON THESE SELF-PAY CONTRIBUTIONS. PATIENTS WHO DO NOT HAVE INSURANCE ARE ADVISED OF ESTIMATED COST, AND ASSISTANCE PROGRAMS ARE OFFERED ALONG WITH CONTACT INFORMATION TO OBTAIN FURTHER INFORMATION. THE PATIENT'S BILL IS CHARGED, CODED, AND PROCESSED WITH THE APPROPRIATE PAYORS, IF APPLICABLE, AND AT THE POINT ALL THIRD PARTY PAYORS HAVE MADE PAYMENT, THE REMAINING BALANCE IS BILLED ON A STATEMENT TO THE PATIENT. AT THE POINT THAT THE PATIENT RECEIVES THE STATEMENT, THEY MAY CHOOSE TO MAKE PAYMENT ARRANGEMENTS THROUGH A PAYMENT PLAN, OR MAY CHOOSE TO APPLY FOR ASSISTANCE. THE PATIENT WHO DOES NOT MAKE PAYMENT ARRANGEMENTS OR DOES NOT APPLY FOR ASSISTANCE, WILL RECEIVE THREE STATEMENTS OVER A 90-DAY PERIOD. IF NO RESOLUTION IS ACHIEVED THE ACCOUNT WILL BE REFERRED TO AN OUTSIDE AGENCY FOR COLLECTION. THE PATIENT HAS 60 DAYS AT THE AGENCY BEFORE THEIR ACCOUNT IS RECORDED AS BAD DEBT. THE PATIENT STILL HAS THE OPTION OF APPLYING FOR ASSISTANCE OR MAKING PAYMENT ARRANGEMENTS WITH THE AGENCY. FINANCIAL ASSISTANCE POLICY: BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS SCHEDULE H, PART V, SECTION B, LINE 11 AS SPECIFICALLY OUTLINED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL USES THE FOLLOWING FACTORS IN DETERMINING THE AMOUNTS CHARGED TO PATIENTS: - INCOME LEVEL - ASSET LEVEL - EXEMPT HOUSEHOLD ASSETS USING FEDERAL POVERTY INCOME GUIDELINES - FAMILY ASSETS - FAMILY EXPENSES AND OBLIGATIONS - MEDICAL INDIGENCY - INSURANCE STATUS - UNINSURED DISCOUNT - MEDICAID/MEDICARE FINANCIAL ASSISTANCE POLICY: MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED SCHEDULE H, PART V, SECTION B, LINE 13 ALTHOUGH NOT SPECIFICALLY OUTLINED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL USES THE FOLLOWING METHODS TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED: - THE POLICY WAS POSTED ON THE HOSPITAL FACILITY'S WEBSITE. - THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS OR WAITING ROOMS. - THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICE. - THE POLICY WAS AVAILABLE UPON REQUEST. - PATIENTS WERE MADE AWARE OF THE POLICY UPON ADMISSION. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS CURRENTLY UNDER REVIEW, AND THE HOSPITAL IS CONSIDERING ADDING SPECIFIC INFORMATION RELATED THE METHODS USED TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED. Other collection actions permitted Schedule H, Part V Section B, Line 16e (1) CARSON CITY HOSPITAL - IF AN ACCOUNT IS DELINQUENT BY 120 DAYS, AND THERE HAS BEEN NO PLAN FOR PAYMENT MADE OR FOLLOWED, THE ACCOUNT WILL BE CONSIDERED FOR FURTHER ACTION WHICH MAY INCLUDE: AN OUTSIDE COLLECTION AGENCY, SMALL CLAIMS COURT, OR OTHER ACTION. ALL REASONABLE EFFORTS MUST BE MADE BEFORE SENDING AN ACCOUNT TO A COLLECTION AGENCY, AND NO ACCOUNT SHALL BE SENT TO AN OUTSIDE COLLECTION AGENCY WITHOUT APPROVAL FROM AN AUTHORIZED ASSOCIATE OR OTHER APPROVED INDIVIDUAL. IF AN ACCOUNT PLACED IN A COLLECTION AGENCY HAS BEEN DETERMINED TO NEED LEGAL ACTION TO COLLECT THE BALANCE, THE ACCOUNT MUST BE REVIEWED BY AN ADMINISTRATOR BEFORE SUIT CAN BE FILED.; Means used to determine amounts billed Schedule H, Part V Section B, Line 20d (1) CARSON CITY HOSPITAL - DURING 2011, THE HOSPITAL FACILITY USED THE HIGHEST COMMERCIAL RATE WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. DURING 2012, THE HOSPITAL FACILITY HAS CHANGED ITS PRACTICE AND USES THE AVERAGE OF THE THREE HIGHEST COMMERCIAL RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.; Needs assessment. Schedule H, Part VI, Line 2 CARSON CITY HOSPITAL RESPONDS TO THE HEALTHCARE NEEDS OF ITS ENTIRE SERVICE AREA. ITS DOORS ARE OPEN TO ALL THOSE WHO NEED HEALTHCARE SERVICES. INFORMATION ABOUT HEALTHCARE NEEDS IS RECEIVED THROUGH PARTNERSHIPS WITH LOCAL NON-PROFITS, GOVERNMENT AGENCIES AND OTHER HEALTHCARE ORGANIZATIONS, SUCH AS THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT AND THE IONIA COUNTY HEALTH DEPARTMENT - WHICH, TOGETHER, MONITOR THE MORTALITY RATES AND CAUSES IN CLINTON, GRATIOT, IONIA AND MONTCALM COUNTIES. HOSPITAL SERVICE RECORDS AND PATIENT SATISFACTION SURVEYS - MANAGED BY PRESS GANEY - ALSO PROVIDE FEEDBACK TO HOSPITAL STAFF ABOUT THE NEEDS OF THE COMMUNITY. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 CARSON CITY HOSPITAL OFFERS SEVERAL OPTIONS FOR ASSISTING PATIENTS WITH THEIR BILLS; THIS ASSISTANCE INFORMATION IS OFFERED AT THE TIME OF REGISTRATION, THROUGH PHONE CONTACT, AND IS ADVISED ON THE PATIENTS STATEMENTS. A TOLL FREE NUMBER IS PROVIDED FOR PATIENTS TO CALL AND INQUIRE ABOUT ASSISTANCE IF PERSONAL CONTACT WAS NOT AVAILABLE AT THE TIME THE PATIENT RECEIVED SERVICES. CARSON CITY HOSPITAL, THROUGH A PARTNERSHIP WITH MONTCALM COUNTY DEPARTMENT OF HUMAN SERVICES, PROVIDES DIRECT ON-SITE ACCESS TO A MARA (MEDICAID ASSISTANCE REVIEW AGREEMENT) WORKER (DHS TRAINED STAFF MEMBER) WHO ASSISTS THE PATIENT WITH THE APPLICATION PROCESS FOR STATE OR COUNTY PROGRAMS, AND IF THE PATIENT DOES NOT MEET THE REQUIREMENTS FOR THESE TYPES OF ASSISTANCE, PROVIDES THE PATIENT WITH THE CHARITY CARE APPLICATION. THIS APPLICATION IS PROCESSED BY THE HOSPITAL BILLING DEPARTMENT AND IF APPROVED FOR ASSISTANCE PROVIDES CHARITY CARE AT 200% OF THE FEDERAL POVERTY GUIDELINES. THE ASSISTANCE PROGRAM INFORMATION FOR PATIENTS IS HANDED OUT AT THEIR TIME OF SERVICE BY THE RESPECTED DEPARTMENTS (RADIOLOGY, LABORATORY, PRE-ADMISSION TESTING, ETC). A MARA (MEDICAID ASSISTANCE REVIEW AGREEMENT) WORKER IS ON-SITE FOR INDIVIDUALS THAT DO SEEK ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY IS ALSO POSTED ON THE HOSPITAL'S WEBSITE, IS AVAILABLE TO ANYONE UPON REQUEST, AND IS POSTED IN THE EMERGENCY/WAITING ROOMS AND ADMISSIONS OFFICE. Community information. Schedule H, Part VI, Line 4 CARSON CITY HOSPITAL (CCH) IS A 77-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, DO. SINCE THIS TIME CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS OF COMMUNITIES IN A FOUR-COUNTY AREA. THE HOSPITALS GOVERNING BODY CONSISTS PRIMARILY OF VOLUNTEER MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN THE FALL OF 1996, CARSON BECAME A PART OF CARSON HEALTH NETWORK (CHN). CHN WAS INTRODUCED TO WORK AS AN UMBRELLA UNDER WHICH ALL THE INDIVIDUAL HEALTHCARE ENTITIES ARE CONTAINED. CHN INCLUDES CARSON CITY HOSPITAL, FAMILY MEDICINE PRACTICES AND SEVERAL SPECIALTY CLINICS OFFERING A WIDE VARIETY OF SERVICES. THE FAMILY MEDICINE PROFESSIONAL MEDICAL STAFF, IN COOPERATION WITH HOSPITAL BASED SPECIALISTS, SERVES PATIENTS IN ASHLEY, CARSON CITY, FOWLER, GREENVILLE, ITHACA, LYONS, MAPLE RAPIDS AND STANTON. THESE OFFICES FALL INTO 4 COUNTIES WHICH INCLUDE MONTCALM, IONIA, CLINTON AND GRATIOT COUNTIES. ALL AREAS ARE DESIGNATED AS RURAL BASED WITH AN AVERAGE OF 21,750 HOUSEHOLDS WITH AN AVERAGE HOUSEHOLD SIZE OF 2.7 PEOPLE. THE AVERAGE INCOME PER HOUSEHOLD IS $47,355 WHILE 13.75% OF ALL FAMILIES ARE BELOW THE POVERTY LEVEL. ALSO INCLUDED IN THIS GEOGRAPHIC AREA ARE 5 OTHER HOSPITALS: SPARROW CLINTON HOSPITAL, SPARROW IONIA HOSPITAL, SPECTRUM HEALTH UNITED CAMPUS, SHERIDAN COMMUNITY HOSPITAL, AND GRATIOT MEDICAL CENTER. IN ADDITION TO ACUTE HOSPITAL CARE, CCH PROVIDES A VARIETY OF ADVANCED SERVICES, RANGING FROM AN INTENSIVE/CORONARY CARE UNIT TO A BEHAVIORAL HEALTH UNIT AND MULTIPLE OUTPATIENT SERVICES. CCH ALSO PROVIDES 24-HOUR EMERGENCY ROOM CARE. PHYSICIANS ARE AVAILABLE TO YOU ANY TIME AT THE HOSPITAL, DAY OR NIGHT FOR EMERGENCY OR NON-EMERGENCY MEDICAL ASSISTANCE. ANY SURPLUS FUNDS AVAILABLE TO THE HOSPITAL ARE USED FOR FACILITY AND EQUIPMENT IMPROVEMENTS IN ORDER TO PROVIDE BETTER PATIENT CARE. THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 INCLUDED PROVISIONS FOR IMPLEMENTING HEALTH INFORMATION TECHNOLOGY UNDER THE HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT ("HITECH"). THESE PROVISIONS WERE DESIGNED TO INCREASE THE USE OF ELECTRONIC HEALTH RECORDS ("EHR") TECHNOLOGY AND ESTABLISH REQUIREMENTS FOR A MEDICARE AND MEDICAID INCENTIVE PAYMENTS PROGRAM BEGINNING IN 2011 FOR ELIGIBLE HOSPITALS AND PROVIDERS THAT ADOPT AND MEANINGFULLY USE CERTIFIED EHR TECHNOLOGY. ELIGIBILITY FOR ANNUAL MEDICARE INCENTIVE PAYMENTS IS DEPENDENT ON PROVIDERS DEMONSTRATING MEANINGFUL USE OF EHR TECHNOLOGY IN EACH PERIOD OVER A FOUR-YEAR PERIOD. INITIAL MEDICAID INCENTIVE PAYMENTS ARE AVAILABLE TO PROVIDERS THAT ADOPT, IMPLEMENT, OR UPGRADE CERTIFIED EHR TECHNOLOGY, BUT PROVIDERS MUST DEMONSTRATE MEANINGFUL USE OF SUCH TECHNOLOGY IN SUBSEQUENT YEARS TO QUALIFY FOR ADDITIONAL INCENTIVE PAYMENTS. DURING 2012, CARSON CITY HOSPITAL DEMONSTRATED THE MEANINGFUL USE OF ITS CERTIFIED EHR TECHNOLOGY AND WAS ABLE TO RECOGNIZE APPROXIMATELY $1.3 MILLION IN REVENUE FOR HITECH INCENTIVES FROM MEDICARE AND MEDICAID. THESE INCENTIVE PAYMENTS ALLOW THE HOSPITAL TO PROVIDE ADDITIONAL QUALITY SERVICES TO THOSE IN THE COMMUNITY. Promotion of community health Schedule H, Part VI, Line 5 CARSON CITY HOSPITAL PROVIDES A SPEAKERS BUREAU LIST OF PHYSICIANS AND STAFF MEMBERS WHO ARE WILLING TO GO OUT INTO THE COMMUNITY AND SPEAK ON A VARIETY OF HEALTHCARE, QUALITY-OF-LIFE, AND GENERAL-INTEREST TOPICS TO SCHOOLCHILDREN, BUSINESS CLUBS, AND OTHER NON-PROFIT ORGANIZATIONS. THE HOSPITAL ALSO MAINTAINS A MONTHLY BROWN BAG LUNCH SERIES FEATURING SIMILAR TOPICS, WHICH IS HELD INSIDE THE HOSPITAL AND OPEN TO THE COMMUNITY. CARSON CITY HOSPITAL'S ACTIVITIES PROMOTE THE HEALTHCARE OF THE COMMUNITY BY EDUCATING AND PROVIDING EASY ACCESSIBLE HEALTHCARE WITH A 24-HOUR EMERGENCY DEPARTMENT. OUTSIDE PHYSICIANS CAN APPLY FOR PRIVILEGES AT CARSON CITY HOSPITAL THROUGH A PROCESS TO TREAT AND PROVIDE MEDICAL CARE AT THE HOSPITAL. IN ADDITION, CARSON CITY HOSPITAL IS COMPRISED OF SEVEN HOSPITAL-OWNED PHYSICIAN CLINICS IN A RURAL SETTING. FREE AND REDUCED RATE SPORTS PHYSICALS ARE PROVIDED AT SELECTED CLINICS. Affiliated health care system Schedule H, Part VI, Line 6 IN JANUARY 1997, CHN BECAME AFFILIATED WITH THE SPARROW HEALTH SYSTEM OF LANSING, MICHIGAN. THIS AFFILIATION HAS MANY BENEFITS INCLUDING HOLDING DOWN HEALTH CARE COSTS, IMPROVED ACCESS TO SPECIALIZED SERVICES, ACCESS TO INFORMATION SYSTEMS, MANAGED CARE CONTRACTS AND NEW PHYSICIAN RECRUITMENT. CCH IS A MEMBER OF THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND THE MICHIGAN OSTEOPATHIC ASSOCIATION. X X false false false false false false false true false ROBERT SEALS DO 282820 0 33849 0 0 0 7500 0 5642 0 329811 0 0 0 MICHAEL H MULLINS 359727 0 0 0 0 0 7500 0 273 0 367500 0 0 0 ADAM Z COTE 543789 0 8141 0 14734 0 7500 0 8697 0 582861 0 0 0 CHRISTOPHER E HERALD MD 311331 0 600 0 0 0 7500 0 7569 0 327000 0 0 0 MATTHEW J THOMPSON 209423 0 600 0 22470 0 7207 0 7214 0 246914 0 0 0 DOUGLAS POFF DO 171855 0 20771 0 0 0 5873 0 8329 0 206828 0 0 0 DUANE C MILLER 150058 0 600 0 0 0 4728 0 6942 0 162328 0 0 0 PARUTAPPA R BHIMALLI 490994 0 0 0 0 0 7500 0 9225 0 507719 0 0 0 NANCY A WEAVER 150339 0 600 0 0 0 4719 0 5287 0 160945 0 0 0 NATALIE W BUSLEPP 112875 0 0 0 39020 0 4104 0 6903 0 162902 0 0 0 JOSEPH B WHITE 586433 0 600 0 17000 0 0 0 7204 0 611237 0 0 0 RAYMOND P ALLARD 498714 0 600 0 0 0 7500 0 1286 0 508100 0 0 0 DAVID J FREESTONE MD 230568 0 71988 0 0 0 7500 0 6900 0 316956 0 0 0 Non-fixed payments Schedule J, Part I, Line 7 PHYSICIANS RECEIVED ANNUAL PRODUCTION INCENTIVE COMPENSATION, WHICH IS CALCULATED BASED ON EQUALLING OR EXCEEDING CERTAIN NET PATIENT REVENUE TARGETS. A MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 54965HKS4 2006-02-01 18000000 HOSPITAL EQUIPMENT LOAN PROGRAM (HELP) false false true B MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 594654HG5 2007-12-18 455937 HOSPITAL EQUIPMENT LOAN PROGRAM (HELP) false false true A 3970793 0 18000000 0 0 0 133000 0 0 14012600 3854400 0 2009 false false true true B 94987 0 455937 0 0 0 0 0 0 0 455937 0 2007 false false true true A false false false false false false 0.0000 0.0000 0.0000 false false 0.000000 false true B false false false false false false 0.0000 0.0000 0.0000 false false 0.000000 false true A false false false true true false 0 false false false 0 false false true B false false false true true false 0.0 false false false 0.0 false false true A true B true TOTAL PROCEEDS OF ISSUE SCHEDULE K, PART II, LINE 3 THE ORGANIZATION SPENT ITS OWN OPERATING FUNDS AND IN TURN WAS REIMBURSED WITH THE BOND PROCEEDS; THEREFORE THERE ARE NO INTEREST EARNINGS ON THE PROCEEDS. ISSUER NAME: Michigan State Hospital Finance Authority: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 2/1/2011. ISSUER NAME: Michigan State Hospital Finance Authority: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 12/18/2012. SPARROW HEALTH SYSTEM M. BRETT, T. OSTRANDER, G. REETZ, AND C. KOSLOSKI ARE CCH BOARD MEMBERS AND SPARROW OFFICERS 357385 MARK BRETT, TOM OSTRANDER, GARY REETZ AND CINDA KOSLOSKI, CARSON CITY HOSPITAL BOARD MEMBERS, SERVE AS THE SENIOR VICE PRESIDENT, AFFILIATE OPERATIONS; VICE PRESIDENT, PROFESSIONAL SERVICES; CONTROLLER; AND DIRECTOR OF DECISION SUPPORT, RESPECTIVELY, FOR SPARROW HEALTH SYSTEM, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2012, CARSON CITY HOSPITAL MADE PAYMENTS TO SPARROW HEALTH SYSTEM IN THE AMOUNT OF $357,385 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICALS, LABORATORY AND OTHER PATIENT CARE SERVICES, SOFTWARE SUPPORT, EQUIPMENT RENTAL, AND PHYSICIAN RECRUITING. false SPARROW HEALTH SYSTEM M. BRETT, T. OSTRANDER, G. REETZ, AND C. KOSLOSKI ARE CCH BOARD MEMBERS AND SPARROW OFFICERS 197500 MARK BRETT, TOM OSTRANDER, GARY REETZ AND CINDA KOSLOSKI, CARSON CITY HOSPITAL BOARD MEMBERS, SERVE AS THE SENIOR VICE PRESIDENT, AFFILIATE OPERATIONS; VICE PRESIDENT, PROFESSIONAL SERVICES; CONTROLLER; AND DIRECTOR OF DECISION SUPPORT, RESPECTIVELY, FOR SPARROW HEALTH SYSTEM, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2012, CARSON CITY HOSPITAL RECEIVED PAYMENTS FROM SPARROW HEALTH SYSTEM IN THE AMOUNT OF $197,500 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICALS, OFFICE RENT, AND SUPPORT FOR PSYCHIATRIC MEDICAL EDUCATION. false Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a THE EXECUTIVE COMMITTEE OF THE BOARD SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, THE PRESIDENT, THE VICE-CHAIRPERSON, THE SECRETARY/TREASURER AND THE MEDICAL DIRECTOR. A SIXTH MEMBER SHALL BE APPOINTED BY THE CHAIRPERSON AND CHOSEN FROM ONE OF THE CLASS B MEMBERS OF THE BOARD. THE CHAIRPERSON SHALL APPOINT REPLACEMENTS WHEN NECESSARY. A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM. IT SHALL HAVE THE AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. THE COMMITTEE SHALL MAKE A FULL REPORT OF ITS ACTIONS, IF ANY, AT THE NEXT REGULAR MEETING OF THE BOARD. MEETINGS OF THE COMMITTEE MAY BE HELD AT ANY TIME ON CALL BY THE CHAIRPERSON OF THE BOARD. DIRECTOR INDEPENDENCE FORM 990, PART VI, LINE 1B BOARD OF DIRECTORS MEMBER GARY REETZ RESIGNED HIS POSITION AS A CLASS B (NON-INDEPENDENT SPARROW HEALTH SYSTEMS) BOARD MEMBER IN AUGUST OF 2012 DUE TO HIS RETIREMENT FROM SHS. HE WAS THEN ELECTED TO FILL A CLASS A (INDEPENDENT) VACANCY EFFECTIVE IN SEPTEMBER OF 2012. MR. REETZ'S CLASS B POSITION WAS THEN FILLED BY CINDA KOSLOSKI IN DECEMBER. ALTHOUGH MR. REETZ DID NOT QUALIFY TO BE COUNTED AS INDEPENDENT DUE TO HIS COMPENSATION PRIOR TO HIS RETIREMENT WHICH HE RECEIVED DURING 2012, IN REALITY THERE WAS NEVER A TIME DURING 2012 WHEN NON-INDEPENDENT BOARD MEMBERS MADE UP A MAJORITY OF THE BOARD COMPOSITION. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 CARSON CITY HOSPITAL (CCH) IS ORGANIZED ON A MEMBERSHIP BASIS. THERE ARE TWO CLASSES OF MEMBERS: CLASS A MEMBERSHIP CONSISTS OF THE ORIGINAL DIRECTORS OF CCH, EXCLUDING THOSE DIRECTORS WHO ARE ELECTED OR APPOINTED BY THE CLASS B MEMBER; THE CLASS B MEMBER IS SPARROW HEALTH SYSTEM (SPARROW), AN UNRELATED MICHIGAN NONPROFIT CORPORATION. OTHER THAN SPARROW, THERE SHALL BE NO ADDITIONAL CLASS B MEMBERSHIP INTERESTS WITHOUT THE CONSENT OF SPARROW. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a CLASS A MEMBERS EACH HAVE ONE VOTE FOR PURPOSES OF VOTING BY MEMBERS; THE NUMBER OF VOTES HELD BY THE CLASS B MEMBER (SPARROW) IS PROPORTIONATE TO THE SPARROW PERCENTAGE INTEREST MULTIPLIED BY THE VOTES HELD IN THE AGGREGATE BY BOTH CLASS A AND CLASS B MEMBERS. AT THE ANNUAL MEETING OF THE MEMBERS, THE CLASS A MEMBERS ELECT 9 DIRECTORS OF THE BOARD OF DIRECTORS BY MAJORITY VOTE OF THE CLASS A MEMBERS, AND THE CLASS B MEMBER (SPARROW) ELECTS A NUMBER OF DIRECTORS OF THE BOARD OF DIRECTORS THAT IS CONSISTENT WITH THE CURRENT SPARROW PERCENTAGE INTEREST. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b THE FOLLOWING ACTIVITIES REQUIRE THE AFFIRMATIVE VOTE OF THE CLASS B MEMBER (SPARROW): 1. AMENDMENTS TO THE ARTICLES OF INCORPORATION AND THE BYLAWS; 2. THE DISSOLUTION, MERGER, SALE, SALE OF SUBSTANTIALLY ALL OF THE ASSETS, LEASE, OR TRANSFER OF CONTROL; 3. THE SALE OF A MAJORITY OWNERSHIP INTEREST IN CCH; 4. THE PUBLICLY RECOGNIZED "AFFILIATION" WITH ANY ORGANIZATION OTHER THAN THE CLASS B MEMBER (SPARROW); 5. APPROVAL OF CCH'S ANNUAL OPERATING BUDGET, WHEN SUCH BUDGET REFLECTS A TOTAL MARGIN OF LESS THAN 2% OF NET REVENUE; 6. APPROVAL OF CCH'S ANNUAL CAPITAL BUDGET, WHEN SUCH BUDGET ANTICIPATES AN ADDITIONAL CAPITAL CONTRIBUTION FROM THE CLASS B MEMBER (SPARROW) BEYOND ITS ORIGINAL CAPITAL CONTRIBUTION; 7. THE INCURRENCE OF ANY DEBT OBLIGATION IN THE AGGREGATE GREATER THAN $500,000; 8. THE APPROVAL OF CAPITAL EXPENDITURES IN EXCESS OF $500,000 (EXCEPT AS TO REPLACE EQUIPMENT); AND 9. ANY ACTION THAT ALLOWS OR FACILITATES THE CREATION OF A NEW CLASS OF MEMBERS OR CREATION OF A MEMBERSHIP INTEREST IN CCH. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE FORM 990 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S MANAGEMENT. A BOARD MEETING IS HELD WITH OUR TAX ADVISORS WHERE A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY FOR REVIEW BEFORE THE RETURN IS FILED WITH THE IRS. THE BOARD IS GIVEN A SUMMARY OF KEY POINTS REGARDING THE FORM 990, AND IS ALLOWED TO ASK ANY QUESTIONS THEY MAY HAVE. ONCE ALL BOARD MEMBERS HAVE REVIEWED THE RETURN, IT IS THEN SUBMITTED TO THE IRS. Conflict of interest policy Form 990, Part VI, Section B, Line 12c CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED TO ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO DETERMINE WHETHER ANY POTENTIAL CONFLICTS OF INTEREST EXIST ON AN ANNUAL BASIS. THE HOSPITAL EXECUTIVE COMMITTEE, WHICH INCLUDES THE PRESIDENT OF THE BOARD OF DIRECTORS, DISCUSSES THE CONFLICT OF INTEREST QUESTIONNAIRES TO DETERMINE WHETHER AN ACTUAL CONFLICT EXISTS. IF A CONFLICT IS DETERMINED TO EXIST, THE PERSON WITH THE CONFLICT IS RECUSED FROM TAKING PART IN ANY DECISIONS CONCERNING THE CONFLICTING ISSUE. Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/CEO. THE BOARD PRESIDENT/CEO IS REMOVED FROM THE BOARD DISCUSSIONS TO PREVENT HIM FROM DISCUSSING AND DETERMINING HIS OWN COMPENSATION. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR THE CEO, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. COMPENSATION FOR THE CURRENT YEAR IS DISCUSSED AND APPROVED IN THE PREVIOUS YEAR DURING THE BUDGET APPROVAL PROCESS. THE 2012 COMPENSATION WAS REVIEWED AND APPROVED DURING NOVEMBER/DECEMBER 2011 DURING THE ANNUAL BUDGETING PROCESS; THE 2013 COMPENSATION WAS REVIEWED AND APPROVED DURING NOVEMBER/DECEMBER 2012 DURING THE ANNUAL BUDGETING PROCESS. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR ALL POSITIONS, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR ALL POSITIONS, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. THE 2012 COMPENSATION WAS REVIEWED AND APPROVED AT THE END OF 2011 DURING THE ANNUAL BUDGETING PROCESS. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 AN ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. AS A HOSPITAL, THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS AN ATTACHMENT TO ITS FORM 990, WHICH IS A REQUIRED DISCLOSURE PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. Other changes in net assets or fund balances Form 990 , Part XI, Line 9 CHANGE IN PENSION LIABILITY - -511792; CHANGE IN CARSON FOUNDATION NET ASSETS INCLUDED IN AUDITED FINANCIAL STATEMENTS - -4990; CARSON FOUNDATION INC 406 E ELM ST CARSON CITY MI 488119693 ENHANCE RESOURCES FOR HIGH QUALITY AND ACCESSIBLE HEALTH CARE MI 501(C)(3) 11 - Type I CARSON CITY HOSPITAL true false true false false false false false false false false false false true true true false false false false