2013-02-14T15:03:52-06:00 2012-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2011-04-01 208756459 MACKINAC STRAITS HEALTH SYSTEM INC MACK 9066438585 1140 N STATE STREET ST IGNACE MI 49781 JASON ANDERSON 9066438585 2013-02-12 1 TERRI REXRODE CPA MST P00096513 9206620016 2013-02-12 2011 2016-03-07 17:11:31Z JASON ANDERSON 1140 N STATE STREET ST IGNACE MI 49781 29445123 0 X MACKINACSTRAITSHEALTH.ORG X 2008 MI WE WILL BE THE HOSPITAL OF CHOICE AND RECOGNIZED FOR OUR EXEMPLARY PATIENT CARE, PEOPLE AND PERFORMANCE. WE HAVE A PASSION FOR EXCELLENCE AND STRIVE TO SET AND DELIVER THE HIGHEST STANDARDS OF SERVICE, INTEGRITY AND MOST OF ALL QUALITY. WE VALUE THE DIVERSITY AND CULTURES IN OUR COMMUNITY. 7 6 280 7 0 0 368890 650867 25230129 28369336 100113 45944 361459 371110 26060591 29437257 0 4000 0 0 14961097 14582996 0 29740 29740 15720367 16364646 30681464 30981382 -4620873 -1544125 44680382 48421691 49621847 54875938 -4941465 -6454247 PROVIDING LOCAL ACCESS AND QUALITY HEALTHCARE TO THE FAMILIES AND COMMUNITIES WE SERVE. 0 0 28196415 4000 27274174 MACKINAC STRAITS HEALTH SYSTEM, INC. OPERATES A 15-BED ACUTE CARE FACILITY, A 48-BED LONG-TERM CARE UNIT, AND SEVERAL PHYSICIAN CLINICS IN MACKINAC COUNTY, MICHIGAN. THE PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, AND PHYSICIAN SERVICES TO THE RESIDENTS OF MACKINAC COUNTY AND THE SURROUNDING AREAS. 28196415 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 25 0 1 280 1 0 0 0 0 0 1 1 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JASON ANDERSON 9066438585 1140 N STATE STREET ST IGNACE MI 49781 X RONALD MITCHELL 1.00 X X 0 0 0 PATRICK SHANNON 1.00 X X 0 0 0 MARGARET DOUD 1.00 X X 0 0 0 RICHARD SMITH 1.00 X 0 0 0 WALTER NORTH 1.00 X 0 0 0 STEVE AUTORE 1.00 X 0 0 0 DR SUSAN HEPKER 40.00 X 418213 0 20521 RODNEY NELSON 40.00 X 154159 0 23551 JASON ANDERSON 40.00 X 68218 0 19749 DR EDWARD SMITH 40.00 X 389587 0 9459 DR ALICE LINDSEY 40.00 X 141000 0 6710 DR JENNIFER SHOCKLEY 40.00 X 187500 0 0 DR CARL HAWKINS 40.00 X 146788 0 22650 DR MATHEW BOWES 40.00 X 338085 0 20789 1843550 0 123429 9 0 1 0 RALPH OLECHOWSKI 1140 N STATE ST ST IGNACE MI 49781 PHYSICIAN SERVICES 180487 RICHARD HODGEMAN 1140 N STATE ST ST IGNACE MI 49781 PHYSICIAN SERVICES 147687 DONZA WORDEN 1140 N STATE ST ST IGNACE MI 49781 PHYSICIAN SERVICES 132000 RUTH HOLTHUIS 1140 N STATE ST ST IGNACE MI 49781 PHYSICIAN SERVICES 106318 4 71212 579655 650867 PATIENT REVENUE 900099 26195525 26195525 OTHER REVENUE 900099 1095162 1095162 TAX LEVY REVENUE 900099 1078649 1078649 28369336 45944 45944 356977 0 356977 356977 356977 21999 7866 14133 14133 29437257 27274174 0 1512216 4000 4000 641362 418985 222377 9575782 9032320 543462 1042697 334262 708435 2560237 2368331 191906 762918 705733 57185 48552 48552 178236 178236 29740 29740 2791690 2534492 257198 58736 58736 3827842 3814173 13669 2644304 2635022 9282 93169 82739 10430 21872 16133 5739 2217292 2217292 2355868 2355868 139002 139002 BAD DEBT EXPENSE 1083202 1083202 QAAP TAXES PAID 722429 722429 MINOR EQUIPMENT 57601 57601 DUES AND SUBSCRIPTIONS 54357 53822 535 70494 57914 12580 30981382 28196415 2755227 29740 68465 316060 15924 256884 330631 359913 3999887 4660190 59892 242325 160329 306879 316727 106073 162999 46163521 8247942 35295058 37915579 4315140 4213118 44680382 48421691 4137350 5704697 760000 520000 38025000 41947307 6699497 6703934 49621847 54875938 X -4968505 -6481662 27040 27415 -4941465 -6454247 44680382 48421691 X -1544125 31343 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 2421 0 1 735 3156 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION BELONGS TO THE AHA AND PAYS DUES. THE ORGANIZATION PAYS A TOTAL OF $8,842 IN DUES TO THE AHA. OF THAT AMOUNT, $735 OF THE DUES IS SPENT ON LOBBYING ACTIVITIES. THE ORGANIZATION SPENT $2,421 IN EXPENSES AT THE GREATER DETROIT CHAMBER MEETING THAT WAS HELD ON MACKINAC ISLAND. 1213406 1213406 38828870 6957075 31871795 2562161 301770 2260391 3501618 989097 2512521 57466 57466 37915579 UNAMORTIZED DEBT ISSUE COSTS 2135398 OTHER ASSETS 178777 DEBT SERVICE RESERVE 1572979 CAPITALIZED INTEREST 325964 4213118 AMOUNTS PAYABLE TO THIRD PARTIES 1066992 PENSION LIABILITY 4695600 PATIENT TRUST SAVINGS 13340 LINE OF CREDIT 495000 CAPITAL LEASE OBLIGATION 433002 6703934 29437257 30981382 -1544125 31343 31343 -1512782 28754037 31343 -722429 -691086 29445123 -7866 -7866 29437257 30266819 7866 7866 30258953 722429 722429 30981382 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. FEDERAL INCOME TAX RETURNS FOR TAX YEARS 2008 AND BEYOND THAT REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. FEDERAL INCOME TAX RETURNS FOR THE YEAR ENDED MARCH 31, 2012, ARE NOT YET DUE AND HAVE NOT BEEN FILED AS OF THE REPORT DATE. PART XII, LINE 2D - OTHER ADJUSTMENTS: QAAP PAYMENTS -722,429. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -7,866. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 7,866. PART XIII, LINE 4B - OTHER ADJUSTMENTS: QAAP PAYMENTS 722,429. X X X X X 1 PARISH CONSULTING 4290 CASCADE RD SE GRAND RAPIDS MI 49546 GENERAL CONSULTING ON ALL FUNDRAISING ACTIVITIES 0 0 29740 0 29740 MI HOOPING FOR A CURE 21999 21999 7866 21999 21999 7866 7866 14133 EXPLANATION OF FUNDRAISING PAYMENTS SCHEDULE G, PART I, LINE 2B, COLUMN (V) GENERAL CONSULTING WITH PARISH CONSULTING ON ALL FUNDRAISING ACTIVITIES. 1 1 1 X 1 X 150.000000000000 1 0 1 1 948201 729651 218550 0.00730 5650373 3488809 2161564 0.07230 6598574 4218460 2380114 0.07960 6970 6970 0.00020 94584 94584 0.00320 101554 101554 0.00340 6700128 4218460 2481668 0.08300 0 947895 90790 8338065 8327176 10889 X 1 0 1 1 MACKINAC STRAITS HEALTH SYSTEM INC

1140 N STATE STREET ST IGNACE MI 49781

X X RHC MACKINAC STRAITS HEALTH SYSTEM INC 1 1 1 100.000000000000 1 150.000000000000 1 X X X 1 1 X X 1 1 X X X 1 X 0 0 4 PICKFORD MEDICAL CENTER

7742 N M-129 PICKFORD MI 49774

PHYSICIAN OFFICE NAUBINWAY FAMILY HEALTH CLINIC

11650 W HWY US-2 NAUBINWAY MI 49762

PHYSICIAN OFFICE MACKINAW CITY MEDICAL CLINIC

580 SOUTH NICOLET ST MACKINAW CITY MI 49701

PHYSICIAN OFFICE MACKINAW ISLAND MEDICAL CLINIC

7474 MARKET STREET MACKINAC ISLAND MI 49757

CLINIC AND 24 HOUR ER PART I, LINE 7: THE ORGANIZATION UTILIZES A COST TO CHARGE RATIO WHEN CALCULATING THE PERCENTAGE OF CHARITY CARE AND COMMUNITY BENEFIT PERCENTAGES. PART I, L7 COL(F): THE BAD DEBT EXPENSE IS CALCULATED UTILIZING ACTUAL WRITE-OFFS AND THE AMOUNTS THAT HAVE BEEN DETERMINED LIKELY TO BE WRITTEN OFF GIVEN PAST EXPERIENCE OF THE COLLECTION POSSIBILITIES. ALTHOUGH THERE ARE SOME AMOUNTS OF CHARITY CARE INCLUDED IN THIS AMOUNT, THERE IS NOT A CURRENT METHOD TO EASILY OBTAIN THE AMOUNT THAT SHOULD HAVE BEEN CHARITY CARE. SCHEDULE H, PART I, LINE 7, COLUMN (F) THE DENOMINATOR WAS REDUCED BY THE BAD DEBT EXPENSE OF $1,083,202. PART II: PROVIDED 24 HOUR EMERGENCY AND ESSENTIAL HEALTH CARE SERVICES TO RURAL COMMUNITY. PART III, LINE 4: THERE IS NOT ANY FINANCIAL STATEMENT FOOTNOTE ON BAD DEBT EXPENSE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE FROM THE MEDICARE COST REPORT MACKINAC STRAITS HEALTH SYSTEM, INC. PART V, SECTION B, LINE 19D: FAP ELIGIBLE PATIENTS RECEIVE A DISCOUNT WHICH IS A SLIDING FEE BASED ON POVERTY LEVEL. PART VI, LINE 2: FEEDBACK FROM COMMUNITY MEMBERS VIA SURVEY AND PRESENTATIONS AT LOCAL ORGANIZATIONS PART VI, LINE 3: PAMPLETS AND OTHER LITERATURE AND SIGNAGE PART VI, LINE 4: MACKINAC COUNTY - A RURAL COUNTY IN MICHIGAN'S UPPER PENNINSULA. SEASONAL ECONOMY WITH HIGHER THAN AVERAGE UNEMPLOYMENT. AGING POPULATION WITH LARGE NUMBER OF NATIVE AMERICANS. PART VI, LINE 5: A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND ALSO PROVIDES COURTESY PRIVILIGES TO AMNY VISITING SPECIALISTS WHO ARE ALSO PROVIDED SPACE IN OUR BUILDINGS IN ORDER TO SEE THEIR PATIENTS. X X X X 0 0 0 0 0 0 0 0 0 DR SUSAN HEPKER 397028 0 0 0 21185 0 0 0 20521 0 438734 0 0 0 RODNEY NELSON 153895 0 0 0 264 0 0 0 23551 0 177710 0 0 0 DR EDWARD SMITH 330762 0 58470 0 355 0 0 0 9459 0 399046 0 0 0 DR JENNIFER SHOCKLEY 187500 0 0 0 0 0 0 0 0 0 187500 0 0 0 DR CARL HAWKINS 146500 0 0 0 288 0 0 0 22650 0 169438 0 0 0 DR MATHEW BOWES 338085 0 0 0 0 0 0 0 20789 0 358874 0 0 0 DR SUSAN HEPKER RELOCATION/HOUSING X 90000 59892 0 1 1 59892 FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS HAS DELEGATED TO REVIEW AND APPROVAL OF THE FORM 990 TO THE CFO. THE 990 RETURN IS E-MAILED TO THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS MONITORS THE CONFLICT OF INTEREST POLICY. NEW CONFLICTS OF INTEREST ARE REVIEWED BY THE BOARD IN ACCORDANCE WITH THE POLICY AND DOCUMENTED. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING ALL COMPENSATION IS BASED ON THE MHA ANNUAL SURVEY. THE COMPENSATION IS THEN REVIEWED BY THE BOARD FOR THE CEO AND IS REVIEWED BY THE CEO FOR OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THEIR DOCUMENTATION AVAILABLE TO THE PUBLIC BY REQUEST ONLY. THE AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FORM 990 MAKING THEM AVAILABLE FOR PUBLIC INSPECTION. AVERAGE HOURS WORKED AT RELATED ORGANIZATIONS FORM 990, PART VII RONALD MITCHELL WORKED, AS AN UNCOMPENSATED BOARD MEMBER, AN AVERAGE OF 1.0 HOUR PER WEEK AT A RELATED ORGANIZATION. RODNEY NELSON WORKED, AS AN UNCOMPENSATED BOARD MEMBER, AN AVERAGE OF 1.0 HOUR PER WEEK AT A RELATED ORGANIZATION. JASON ANDERSON WORKED, AS AN UNCOMPENSATED BOARD MEMBER/CFO, AN AVERAGE OF 2.0 HOURS PER WEEK AT A RELATED ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 31,343. OVERSIGHT OF AUDIT FORM 990, PART XI, LINE 2C THE AUDITED FINANCIAL STATEMENTS ARE PRESENTED TO THE MACKINAC STRAITS HEALTH SYSTEM FINANCE COMMITTEE AND RECOMMENDATIONS ARE TAKEN TO THE MACKINAC STRAITS HEALTH SYSTEM BOARD OF DIRECTORS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MOSES DIALYSIS UNIT 1140 NORTH STATE STREET ST IGNACE MI 49781 320031170 RENAL DIALYSIS SERVICES MI 501(C)(3) LINE 3 MACKINAC STRAITS HEALTH SYSTEM INC 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 MOSES DIALYSIS UNIT N 315227 MOSES DIALYSIS UNIT P 194560