CARELINK OF JACKSON: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CARELINK OF JACKSON (EIN 38-1218485)
- Tax period
- 2011-03-01 to 2012-02-29
- Filed
- 2013-01-08
- IRS object ID
- 201340089349300604
- Schema version
- 2011v1.2
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-01-08T08:44:17-06:00 | Timestamp |
| Tax Period End Date | 2012-02-29 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-03-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381218485 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CareLink of Jackson | BusinessNameLine1 |
| Business Name Line2 | a Community-Owned Speciality Hospital | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CARE | NameControl |
| Phone | 5177871440 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 North Elm Avenue | AddressLine1 |
| City | Jackson | City |
| State | MI | State |
| ZIP Code | 49202 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Dale Friesen | Name |
| Title | Chief Financial Officer | Title |
| Phone | 5177871440 | Phone |
| Date Signed | 2013-01-08 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | J Mark Fall | NameOfPrincipalOfficerPerson |
| Gross Receipts | 15117775 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.carelinkofjackson.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2003 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | To provide long-term acute healthcare to the residents of Jackson, MI and surrounding areas. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 163 | TotalNbrEmployees |
| Total Nbr Volunteers | 2 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 16148886 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14865922 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1319 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2515 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 328125 | OtherRevenuePriorYear |
| Other Revenue Current Year | 198526 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 16478330 | TotalRevenuePriorYear |
| Total Revenue Current Year | 15066963 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6188656 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6688354 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8821071 | OtherExpensePriorYear |
| Other Expenses Current Year | 9374822 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15009727 | TotalExpensesPriorYear |
| Total Expenses Current Year | 16063176 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1468603 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -996213 | RevenuesLessExpensesCY |
| Total Assets BOY | 6928605 | TotalAssetsBOY |
| Total Assets EOY | 6473108 | TotalAssetsEOY |
| Total Liabilities BOY | 2655839 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3196555 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4272766 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3276553 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CareLink of Jackson is committed to holistic care of individuals with complex medical needs. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 13856898 | Expense |
| Revenue | 14871465 | Revenue |
| Description | CareLink of Jackson is a long-term acute care hospital fully accredited by The Joint Commission. The facility is designed to provide care for medically complex patients requiring an average hospital stay in excess of 25 days. Any patient having an acute chronic condition, complication from a surgical procedure or may be expected to require a longer acute hospital stay may be considered for admission.CareLink of Jackson is a free-standing hospital whereby patients are accepted from multiple sources. Patients are frequently referred to CareLink of Jackson from other acute care hospitals, skilled nursing facilities, physician offices, wound clinics, dialysis centers and others. During the fiscal year ended 02/29/12, CareLink of Jackson maintained an average daily census of 34.2 patients and provided 12,511 days of patient care. Due to the complex medical needs served by the hospital, the average patient resided at the facility for 26.93 days. Approximately 86% of all patients are Medicare-eligible. | Description |
| Total Program Service Expense | 13856898 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 14 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 163 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dale Friesen | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5177964475 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 North Elm Avenue | AddressLine1 |
| City | Jackson | City |
| State | MI | State |
| ZIP Code | 49202 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Jacalyn Liebowitz | |||||||
| Chairperson | 1.00 | X | 0 | 329583 | 64646 | ||
| Karen Chaprnka | |||||||
| Trustee | 1.00 | X | 0 | 491711 | 71571 | ||
| Robert Albertson MD | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Brent Ellis | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Maryanne Fuchs | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| David Schmidt | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| J Mark Fall | |||||||
| CEO | 50.00 | 0 | 0 | 0 | X | ||
| Dale Friesen | |||||||
| CFO | 50.00 | 0 | 0 | 0 | X | ||
| Jeremy Curtis | |||||||
| Director Clinical Services | 50.00 | 126442 | 0 | 16114 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 126442 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 821294 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 152331 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Greentree Healthcare Partners LLC | |||||
| 3296 Hutton Walk | Marietta | GA | 30066 | Management Services | 705479 |
| Pulmonary Clinics of Southern MI | |||||
| 900 East Michigan Avenue | Jackson | MI | 49201 | Healthcare Services | 261399 |
| Fresenius Management Services | |||||
| 16343 Collections Center Drive | Chicago | IL | 60693 | Healthcare Services | 145831 |
| Jackson Community Ambulance | |||||
| PO Box 673985 | Detroit | MI | 48267 | Healthcare Services | 127676 |
| Optimal Staffing Solutions INC | |||||
| 15945 Wood Road | Lansing | MI | 48906 | Staffing Services | 120989 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Revenue | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 14865922 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14865922 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14865922 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2515 | TotalRevenueColumn |
| Exclusion | $2,515 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 243795 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 50812 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 192983 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 192983 | TotalRevenueColumn |
| Exclusion | $192,983 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Miscellaneous Income | 900099 | 4739 | 4739 |
| Medical Record Release | 621990 | 804 | 804 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 5543 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15066963 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14871465 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $195,498 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5456567 | Total |
| Program Services | 4836422 | ProgramServices |
| Management And General | 620145 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80436 | Total |
| Program Services | 71588 | ProgramServices |
| Management And General | 8848 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 736592 | Total |
| Program Services | 655567 | ProgramServices |
| Management And General | 81025 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 414759 | Total |
| Program Services | 369136 | ProgramServices |
| Management And General | 45623 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 752731 | Total |
| Management And General | 752731 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21262 | Total |
| Management And General | 21262 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30800 | Total |
| Management And General | 30800 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5260 | Total |
| Management And General | 5260 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3757058 | Total |
| Program Services | 3397438 | ProgramServices |
| Management And General | 359620 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20241 | Total |
| Management And General | 20241 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 582723 | Total |
| Program Services | 434371 | ProgramServices |
| Management And General | 148352 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21290 | Total |
| Management And General | 21290 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 300611 | Total |
| Program Services | 300611 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89716 | Total |
| Program Services | 7672 | ProgramServices |
| Management And General | 82044 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 703 | Total |
| Management And General | 703 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 403621 | Total |
| Program Services | 403621 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75768 | Total |
| Program Services | 67434 | ProgramServices |
| Management And General | 8334 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Pharmaceuticals | 1913023 | 1913023 |
| Medical Supplies | 659401 | 659401 |
| Bad Debt | 580823 | 580823 |
| Food | 130906 | 130906 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28885 | Total |
| Program Services | 28885 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16063176 | Total |
| Program Services | 13856898 | ProgramServices |
| Management And General | 2206278 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200124 | BOY |
| EOY | 200538 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1429143 | BOY |
| EOY | 808812 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2562834 | BOY |
| EOY | 2737524 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22159 | BOY |
| EOY | 23221 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74975 | BOY |
| EOY | 93823 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 6059012 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3530197 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2559156 | BOY |
| EOY | 2528815 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80214 | BOY |
| EOY | 80375 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6928605 | BOY |
| EOY | 6473108 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 603980 | BOY |
| EOY | 464101 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2051859 | BOY |
| EOY | 2732454 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2655839 | BOY |
| EOY | 3196555 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4272766 | BOY |
| EOY | 3276553 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4272766 | BOY |
| EOY | 3276553 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6928605 | BOY |
| EOY | 6473108 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -996213 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $5,260 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5260 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| Explanation | CareLink of Jackson pays membership dues to several non-profit advocacy groups including Michigan Hospital Association, American Hospital Association and Acute-Care Long-Term Hospital Association. These organizations use a portion of membership dues to lobby for causes related to CareLink of Jackson's exempt mission. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 198058 | OtherCostOrOtherBasis |
| Book Value | 198058 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4411126 | OtherCostOrOtherBasis |
| Depreciation | 2574592 | Depreciation |
| Book Value | 1836534 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1435663 | OtherCostOrOtherBasis |
| Depreciation | 955605 | Depreciation |
| Book Value | 480058 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14165 | OtherCostOrOtherBasis |
| Book Value | 14165 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2528815 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Compensation Amounts Withheld | $368,275 |
| Payable to Affiliate | $1,779,418 |
| Cost Report Settlement Payable | $584,761 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2732454 | TotalOfAmounts |
| Total Revenue | 15066963 | TotalRevenue |
| Total Expenses | 16063176 | TotalExpenses |
| Excess Or Deficit For Year | -996213 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -996213 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 15100397 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 15100397 | RevenueSubtotal |
| Other Revenues Not Included | -33434 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -33434 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 15066963 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 16096610 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 33434 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 33434 | ExpensesNotRptdF990 |
| Expenses Subtotal | 16063176 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 16063176 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XII, Line 4b - Other Adjustments: | Revenue counted as expense in audited financial statements -33,434. |
| Part XIII, Line 2d - Other Adjustments: | Revenue counted as expense in audited financial statements 33,434. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 152669 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 152669 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00990 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 152669 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 152669 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00990 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9027 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 9027 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22858 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 22858 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 31885 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 31885 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 184554 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 184554 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01200 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $221,104 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9957485 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10585672 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -628187 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CareLink of Jackson | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 North Elm Avenue | AddressLine1 |
| City | Jackson | City |
| State | MI | State |
| ZIP Code | 49202 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Other | Long-Term Acute Care Hospital | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CareLink of Jackson | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 350.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| No Emergency Care | X | NoEmergencyCare |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 7: The Hospital used a cost-to-charge ratio to calculate charity care at cost. | |
| Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 580823. | |
| Part II: N/A | |
| Part III, Line 4: There is not a bad debt expense footnote in the organization's audited financial statements. The company's bad debt expense at cost is determined by multiplying total bad debt expense by the overall cost-to-charge ratio. | |
| Part III, Line 8: The organization believes the entire shortfall reported on Line 7 should be treated as Community Benefit. CareLink of Jackson is subsidizing a government program and sustaining material losses in providing health care to Medicare recipients. The organization's cost-to charge ratio method was used in calculating Medicare allowable costs. | |
| Part III, Line 9b: The collection practices employed by CareLink of Jackson include telephone contact with Third-Party payors, a series of letters and telephone contacts with individual patients, and, if necessary, submission of the claim to a third-party collection agency. | |
| Part V, Section B, Line 19d: The hospital facility determined the maximum amounts that can be charged to FAP-eligible individuals as the commercial insurance rate of its largest contract provider. | CareLink of Jackson |
| Part VI, Line 2: CareLink of Jackson will be joining the next community needs assessment conducted by Allegiance Health and the Jackson County Health Department. The survey conducted with input from community partners gathers information on the health status of Jackson County. | |
| Part VI, Line 3: Patients are notified of potential eligibility for financial assistance under federal and state programs as well as the company's charity care policy. Patients are informed via direct communication with the patient account coordinator, the case manager, or various other hospital personnel. Where appropriate, patients receive an application for charity care that is to be submitted for review by the finance department. | |
| Part VI, Line 4: Jackson County has a population of approximately 33,300 residents. The median resident age is 31.3 years. The estimated median household income in 2008 was $33,994 and the estimated per capita income was $16,595. The estimated median house or condo value in 2008 was $90,280. The demographic constituents of Jackson County are comprised of approximately 72.7% White/Caucasian, 19.9% African American, 3.9% Hispanic, 0.2% Asian, and 3.3% Other. The nearest city with a population of 50,000+ residents is 33.6 miles away and the nearest city with a population of $200,000+ residents is 58.6 miles away. Jackson County has one general acute care hospital located in the city of Jackson, MI. | |
| Part VI, Line 5: Representatives of the local community comprise a voting majority of the Board of Trustees. The purpose of community representation on the Board of Trustees is to facilitate organizational sensitivity and awareness to the health needs of the local community. | |
| Part VI, Line 6: Both the organization and its affiliated healthcare entities exist for the purpose of addressing the healthcare needs of the local community. The governing bodies of the affiliated entities maintain significant representation from the local community to ensure overall community awareness, sensitivity and response. As a long-term acute care hospital, CareLink of Jackson serves as a unique discharge destination for medically complex patients upon discharge from the affiliated short-term acute care hospital (i.e. brother/sister entity). Patients admitted to CareLink of Jackson are typically not appropriate admission candidates to either skilled nursing facilities or their personal residence. Accordingly, CareLink of Jackson provides an intermediate source of specialized medical care not typically available in other communities. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jacalyn Liebowitz | |||||||||||||
| 0 | 203222 | 0 | 52218 | 0 | 74143 | 0 | 45328 | 0 | 19318 | 0 | 394229 | 0 | 34609 |
| Karen Chaprnka | |||||||||||||
| 0 | 314333 | 0 | 78229 | 0 | 99149 | 0 | 60103 | 0 | 11468 | 0 | 563282 | 0 | 53228 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 4b | Certain CareLink of Jackson directors participated in a non-qualified deferred compensation plan through their employment as officers of Allegiance Health a related tax-exempt organization. The plan which began in 2005 partially vested in 2010. Payout of vested amounts resulted in an increase of salary for these directors. The calendar year 2011 contribution and payout amounts are as follows: 457(f) Contributions Karen Chaprnka $39,278, Jacalyn Liebowitz $26,953 457(f) Payouts Karen Chaprnka $53,228, Jacalyn Liebowitz $34,609 | |
| Part I, Line 6 | Greentree Healthcare Partners provides management consulting services to CareLink, including the services of the CEO, CFO and Chief Operating Officer, per the terms of a three-year management agreement. The agreement calls for a fixed monthly fee, plus the opportunity for Greentree to earn additional compensation that is based, in part, on the profitability of the organization. In addition to the financial measure, the additional compensation is also based on measures of quality, growth and management of the organization | |
| Part III | Part I, Line 3: CareLink of Jackson does not pay compensation to its CEO. CareLink contracts with Greentree Healthcare Partners for the services of the CEO. | Supplemental Information |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Greentree Healthcare Partners LLC | |||
| Contractor | 752731 | Reported amount is for payments made by CareLink of Jackson to Greentree Healthcare Partners for outsourced management services. J. Mark Fall a CareLink of Jackson Officer is a partner in Greentree Healthcare Partners. | 0 |
| Pulmonary Clinic of SO MI | |||
| Contractor | 260334 | Reported amount is for payments CareLink of Jackson made to Pulmonary Clinic of SO MI for healthcare services. Pulmonary Clinic of SO MI is part-owned by CareLink Trustee Dr. Robert Albertson. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 3 | Officers of the organization are employed by a management company. See Part VII, Section B, Independent Contractors. |
| Form 990, Part VI, Section A, line 6 | The corporation is organized on a membership basis. The sole member of the Corporation is Allegiance Health Services. |
| Form 990, Part VI, Section A, line 7a | The member has the power to elect and remove, with or without cause, the Corporation's Trustees, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present. |
| Form 990, Part VI, Section A, line 7b | Powers reserved to the Member: In addition to doing all things required or allowed by law, the Member of the Corporation shall take the following actions, by a two-thirds majority vote of the directors then serving on the Board of the Member, unless a different majority voting requirement is otherwise specified in this Article. Approve any change in these Articles of Incorporation, purposes or philosophy of the Corporation; Approve changes in those provisions of the Corporation's Bylaws which affect the size, composition, and method of selection of the Board of Trustees, or which affect this Article; Approve plans of merger, consolidation or dissolution of the Corporation; Authorize the sale, lease, mortgage or other disposition of all or substantially all of the assets owned, held or leased by or to the Corporation, or approve any decision by the Corporation which would have the net effect of diminution of governance control of the Member, and any decision by the Corporation which would have the net effect of diminution in the Corporation's governance control over its own subsidiary. Authorize the formation or acquisition of new subsidiaries of the Corporation or the sale or other disposition of existing subsidiaries. Approve guarantees by the Corporation of the debt of others in excess of maximum limits established by the Member, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting which a quorum is present; and Ratify or reject operating and capital budgets developed by the Board and any non-budgetary expenditures or creations of debt in excess of an amount designated by the Member from time to time, upon a simple majority vote of the Directors then serving on the Board of the Member present at a meeting at which a quorum is present. |
| Form 990, Part VI, Section B, line 11 | Form 990 is reviewed by CareLink's CFO and Allegiance Health's Director of Finance. Allegiance Health is a related organization. Final copies of the return are distributed to CareLink's CEO and Board of Trustees for review before the return is filed. |
| Form 990, Part VI, Section B, line 12c | The Board Finance Committee has ultimate responsibility over the enforcement of the Hospital's Conflict of Interest Policy. When a potential conflict of interest is identified, the Finance Committee is responsible for review of the conflict of interest for complaince with the policy. Also, General Counsel routinely reviews upcoming Board and Committee meeting agendas to assess potential conflict situations. All employees and Trustees of the organization are required to fill out an annual conflict of interest questionnaire. Board Trustees identified as having a conflict of interest are permitted to discuss the potential transaction. They are not allowed to deliberate in the decision or vote on the matter. |
| Form 990, Part VI, Section B, line 15 | CareLink of Jackson is managed by a third party consulting group. This contract is reviewed and approved annually by the board of Trustees. Employees of the outside consulting group do not have a vote in approving the contract. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents are available to the public upon request and also on the State of Michigan website. Form 990 is available upon request. The Form 990 is also available on the free website www.guidestar.org. The organization's conflict of interest policy is not available to the public. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | EINEIN |
|---|---|---|---|---|---|---|---|---|---|
| PCN LLC | |||||||||
| 205 N East Avenue | Jackson | MI | 49201 | Physician Rental Network | MI | 0 | 0 | WA Foote Memorial Hospital | |
| Jackson Health Network L3C | |||||||||
| 205 N East Avenue | Jackson | MI | 49201 | Clinically Integrated Network | MI | 0 | 0 | WA Foote Memorial Hospital | 453253643 |
Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WA Foote Memorial Hospital | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382027689 | Exempt Hospital | MI | 501(c)(3) | Line 3 | Allegiance Health Services | 1 | |
| Allegiance Health Services | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382756428 | Exempt Health System | MI | 501(c)(3) | Line 11b, II | 0 | N/A | |
| Allegiance Health Foundation | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 383607833 | Exempt Foundation | MI | 501(c)(3) | Line 11a, I | Allegiance Health Services | 1 | |
| Hospice of Jackson dba Allegiance Hospice | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382336367 | Hospice Care | MI | 501(c)(3) | Line 7 | Heathlink | 1 | |
| The Hospice of Jackson Endowment Fund | |||||||||||
| One Jackson Square | Jackson | MI | 49201 | 383422146 | Raise Funds for Allegiance Hospice | MI | 501(c)(3) | Line 11c, III-FI | Allegiance Hospice | 1 | |
| Healthlink | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382756425 | Home Health Care | MI | 501(c)(3) | Line 11a, I | Allegiance Health Services | 1 | |
| Physicians Health Plan of South Michigan | |||||||||||
| One Jackson Square | Jackson | MI | 49201 | 383311905 | Exempt HMO | MI | 501(c)(4) | Allegiance Health Services | 1 | ||
| Michigan Imaging Services | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382895225 | Medical Imaging | MI | 501(c)(3) | Line 11a, I | Allegiance Health Services | 1 | |
| South Central Practice Association | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 383309805 | Idle Organization | MI | 501(c)(3) | Line 11a, I | Allegiance Health Services | 1 | |
| Allegiance Health Volunteers | |||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 386082835 | Exempt Association | MI | 501(c)(3) | Line 11d, III-O | Allegiance Health Services | 1 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|
| Jackson Community Medical Records | ||||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 371502443 | Electronic Medical Records | MI | WA Foote Memorial Hospital | Unrelated | 0 | 0 |
| Foote Health Center Associates | ||||||||||
| 1100 E Michigan Avenue | Jackson | MI | 49201 | 383017711 | Lessor of Medical Condominiums | MI | WA Foote Memorial Hospital | Related | 0 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|
| Physicians Choice Network Inc | |||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382594857 | Physician Rental Network | MI | N/A | C | |
| Viking Health System Inc | |||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382756161 | Idle Healthcare Administration Corporation | MI | N/A | C | |
| Cascades Insurance Company LTD | |||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 382027689 | Hospital Malpractice Insurance Captive | N/A | C | CJ | |
| Cascades Professional Staffing Corporation | |||||||||
| 205 N East Avenue | Jackson | MI | 49201 | 383370242 | Idle Staffing Corporation | MI | N/A | C | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| WA Foote Memorial Hospital | ||
| I | 243795 | FMV |
| WA Foote Memorial Hospital | ||
| K | 518635 | FMV |
| WA Foote Memorial Hospital | ||
| L | 6570000 | FMV |
| WA Foote Memorial Hospital | ||
| E | 600000 | FMV |
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