2012-05-14T15:08:20-05:00 2011-09-30 BRINING & NARTKER PC 47 AUSTIN STREET PO BOX 348 SANDUSKY MI 484710348 990 2010-10-01 381738615 MCKENZIE MEMORIAL HOSPITAL MCKE 8106486162 120 DELAWARE STREET SANDUSKY MI 48471 AMY RUEDISUELI 8106486162 2012-05-10 true JOSEPH H NARTKER 8106484931 2012-05-14 2010 2016-02-24 21:20:13Z MCKENZIE HEALTH SYSTEM STEVE BARNETT 120 DELEWARE STREET SANDUSKY MI 48471 31777325 false X WWW.MCKENZIEHEALTH.ORG X MI FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. 10 8 234 40 52399 -50801 167438 34257 30502345 31633047 19046 8856 81493 70852 30770322 31747012 0 0 10300492 10123289 0 0 21328624 21838940 31629116 31962229 -858794 -215217 9669040 9455041 6426003 6405524 3243037 3049517 FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. false false 31962229 31747012 PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SANILAC COUNTY. FISCAL YEAR REGISTRATIONS ARE: INPATIENT = 386; OUTPATIENT = 19,224 EMERGENCY ROOM = 5,771; AND AMBULANCE RUNS = 1,686. 31962229 true true false false false false false false false false true false false false true false true false false false false false false false true false true true false false true false false false false false false true false false false false false false true true true false false true 52 0 true 234 true true true false false false false false false false false false false false X 10 8 false false false false true true true true true false false true true true true true true true true true true X X MCKENIZE MEMORIAL HOSPITAL 8106486162 120 DELAWARE STREET SANDUSKY MI 48471 MARCUS FREE 40.00 X 234977 0 13212 STEVE BARNETT 40.00 X X 174853 0 15323 AL STOUTENBURG X X 0 0 0 JOAN NAGELKIRK X X 0 0 0 DAVID TUBBS X 0 0 0 DR ROBERT HASSLER X 0 0 0 ROGER LODING X X 0 0 0 JUDITH FERGUSON X X 0 0 0 LARRY MITCHELL 0.00 X 0 0 0 MICHAEL DREYER 0.00 X 0 0 0 ALFREDO DOMINGO 40.00 X 343991 0 0 MELANIE KRAMER 40.00 X 260474 0 17051 THOMAS BILKO 40.00 X 259908 0 13172 MARK ENGLISH 40.00 X 164163 0 21139 JAY SMITH 40.00 X 113442 0 9645 1551808 89542 8 false true false NES PO BOX 277001 ATLANTA GA 30384 ER COVERAGE 572410 MICHIGAN EMERGENCY PHYSICIANS LLP PO BOX 793 TRAVERSE CITY MI 49685 ER COVERAGE 564970 MIDWEST MEDICAL STAFFING INC 4805 CHEVINGTON RD DECKERVILLE MI 48427 OR COVERAGE 200000 CPSI 6600 WALL STREET MOBILE AL 36695 COMPUTER TECH 142147 4 34257 34257 OUTPATIENT 23347360 23347360 INPATIENT 3591443 3591443 PHYSICIANS REVENUE 3337983 3337983 OTHER INCOME 698704 698704 RURAL HEALTHCARE 657557 657557 31633047 8856 8856 52399 52399 52399 52399 46466 30313 16153 16153 OTHER INCOME 2300 2300 2300 31747012 31644203 52399 16153 212732 212732 7920529 7920529 221145 221145 1195577 1195577 573306 573306 60895 60895 27200 27200 2507717 2507717 91327 91327 1539460 1539460 221950 221950 514715 514715 100176 100176 24124 24124 20760 20760 857872 857872 243087 243087 CONTRACTUAL ADJUSTMENTS 12295852 12295852 BAD DEBTS 1216190 1216190 DRUGS 545943 545943 REPAIRS & MAINTENANCE 394141 394141 TAXES & LICENSES 385349 385349 792182 792182 31962229 31962229 0 0 25858 82136 1066994 1111813 2358322 2500743 498410 486725 123520 132482 14671772 9680494 5446072 4991278 149864 149864 9669040 9455041 2351402 2822642 3250301 2856331 824300 726551 6426003 6405524 X 3198618 3002108 44419 47409 3243037 3049517 9669040 9455041 X -215217 21697 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 160652 160652 7144728 4090728 3054000 165941 149376 16565 7107413 5357354 1750059 93038 83036 10002 4991278 CHASE - LINE OF CREDIT 129705 TRI COUNTY - COMPUTER SERVERS 112542 KINGSBRIDGE - TELEMETRY LEASE 108135 NORTHSTAR - AMBULANCE 87554 GE FINANCIAL - C ARM 81466 TRI COUNTY - AUTOCLAVE 62850 JPM - OR SCOPE LOAN 55634 BONE DENSITY GE LEASE 46703 ESB - X-RAY EQUIPMENT 31572 ESB - 2009 FORD PICKIP LOAN 10390 TRI COUNTY BANK - FURNITURE ESB - AMBULANCE NUCL MEDICINE SIEMENS LEASE 726551 31747012 31962229 -215217 -215217 19308150 19308150 12438862 12438862 31747012 19523367 19523367 12438862 12438862 31962229 RECONCILIATION OF CHANGES - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 8 CONTRACTUAL ADJUSTMENTS -12,295,852 CHARITY CARE -143,010 CONTRACTUAL ADJUSTMENTS 12,295,852 CHARITY CARE 143,010 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B CONTRACTUAL ADJUSTMENTS 12,295,852 CHARITY CARE 143,010 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XIII, LINE 4B CONTRACTUAL ADJUSTMENTS 12,295,852 CHARITY CARE 143,010 MI BENEFIT RAFFLE 26264 26264 4500 750 968 6050 HOSP AUXILARY 20202 20202 18045 46466 46466 4500 750 968 24095 30313 16153 true true true X true X false true false false 78791 78791 0.00250 3801062 2150176 1650886 0.05170 3879853 2150176 1729677 0.05410 242701 237908 4793 0.00010 13453 13453 0.00040 5939 2740 3199 0.00010 262093 240648 21445 0.00070 4141946 2390824 1751122 0.05480 true 685688 10983 5286702 5274369 12333 X true true 1 1 MCKENZIE MEMORIAL HOSPITAL

120 DELAWARE STREET SANDUSKY MI 48471

X X X X MCKENZIE MEMORIAL HOSPITAL 1 BAD DEBT EXPENSE EXPLANATION PART III LINE 4 PART I LINE 7 COSTING METHODOLOGY COSTTOCHARGE RATIO WAS USED TO DETERMINE FIGURES REPORTED IN LINE 7 THE COSTTOCHARGE RATIO WAS DERIVED FROM WORKSHEET 2 RATIO OF PATIENT CARE COSTTOCHARGES PART III LINE 4 COST OF BAD DEBT EXPENSE FOR PART III LINE 2 WAS CALCULATED USING WORKSHEET A CONTAINED IN THE INSTRUCTIONS FOR SCHEDULE H RATIO OF PATIENT CARE COST TO CHARGES PERCENTAGE WAS USED FROM WORKSHEET 2 PART III LINE 3 BAD DEBT EXPENSE ATTRIBUTIABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS CHARITY CARE POLICY ANALYZED CHARITY CARE APPLICATIONS THAT WERE DENIED DUE TO INCOMPLETE DOCUMENTATION AND FAILURE TO PROVIDE REQUESTED INFORMATION AND APPLIED COST TO CHARGE RATIO AS DETERMINED IN WORKSHEET 2 PATIENTS RECEIVE THREE MONTHLY STATEMENTS IF NO PAYMENTS WERE MADE DURING THAT TIME PERIOD THE FOURTH MONTH THEY WILL GET A LETTER STATING THAT THEY WILL BE TURNED OVER TO A COLLECTION AGENCY IF NO ACTION IS TAKEN BY THE PATIENT THE ACCOUNT IS SENT TO BAD DEBT AND TURNED OVER TO A COLLECTION AGENCY THE ORGANIZATION DOES NOT INCLUDE A FOOTNOTE IN THE FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE THE FINANCIAL STATEMENTS LIST BAD DEBT AS A SEPARATE LINE ITEM IN THE EXPENSE SECTION BAD DEBT EXPENSE IS INCLUDED AS A COMMUNITY BENEFIT AS IT BENEFITS OUR COMMUNITY THAT CANNOT AFFORD TO PAY THEIR HEALTHCARE EXPENSES MEDICARE EXPLANATION PART III LINE 8 NO SHORTFALL REPORTED PART III LINE 6 WAS DETERMINED USING ALLOWABLE COSTS AS REPORTED IN THE ORGANIZATIONSS MEDICARE COST REPORT NO COSTS WERE REPORTED IN PART 1 LINE 7G OR COSTS ASSOCIATED WITH DIRECT GME REPORTED IN PART I LINE 7F COLLECTION PRACTICES EXPLANATION PART III LINE 9B COLLECTION POLICY REFERENCES THE CHARITY CARE POLICY FOR THOSE POSSIBLY ELIGIBLE FOR CHARITY CARE AS A METHOD OF PAYMENTCOLLECTIONS NEEDS ASSESSMENT PART VI PART VI LINE 2 ORGANIZATION COMMUNICATED WITH STATE AND LOCAL AGENCIES TO DETERMINE HEALTHCARE NEEDS OF THE COMMUNITY EXAMPLES OF SERVICES PROVIDED BASED ON COMMUNITY NEED ARE FAMILY PLANNING GERIATRICS PROGRAM IMMUNIZATIONS VACCINES SPORTS PHYSICALS SENIOR FAIR HEALTH FAIRS FIRST AID BOOTH AND DIABETIC CLASSES PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI PART VI LINE 3 EVERY UNISURED PATIENT THAT IS AN INPATIENT OUTPATIENT SURGICAL OBSERVATION OR INCURS MORE THAN 2000 IN MEDICAL EXPENSES RECEIVES A CHARITY CARE PACKAGE WHICH INCLUDES A CHARITY CARE APPLICATION A MEDICAID APPLICATION AND A HUMAN SERVICES REFERRAL FORM ALL OTHER NON INSURED PAIENTS MAY REQUEST A CHARITY CARE APPLICATION AT ANY TIME COMMUNITY INFORMATION PART VI PART VI LINE 4 ORGANIZATION IS LOCATED IN SANILAC COUNTY WHICH HAS A POPULATION OF APPROX 43000 SANDUSKY HAS A POPULATION OF APPROX 2500 SANILAC COUNTY CONSISTS OF MOSTLY FARMLAND WITH VERY FEW MANUFACTURING FACILITIES THE UNEMPLOYMENT RATE IN SANILAC COUNTY IS 1190 ADDITIONAL INFORMATION PART VI PART VI LINES 56 7 NO OTHER INFORMATION TO REPORT false false false false false false false false false MARCUS FREE 234977 5458 7754 248189 STEVE BARNETT 174853 6958 8365 190176 ALFREDO DOMINGO 343991 343991 MELANIE KRAMER 260474 7560 9491 277525 THOMAS BILKO 259908 13172 273080 MARK ENGLISH 164163 5869 15270 185302 BARNETT ANESTESIA INC CEO'S SPOUSE 69150 CRNA SERVICES false CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 MCKENZIE MEMORIAL HOSPITAL HAS MEMBERS WHO MAKE UP THE BOARD OF DIRECTORS. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD MEMBERS MUST BE APPROVED FIRST BY THE BOARD OF MCKENIZE HEALTHCARE CORPORATION TO BECOME BOARD MEMBERS. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B MCKENIZE HEALTHCARE CORPORATION MUST APPROVE ANY FINANCIAL TRANSACTIONS ABOVE ONE MILLION DOLLARS BEFORE ANY ACTION CAN BE TAKEN BY THE BOARD OF DIRECTORS OF MCKENZIE MEMORIAL HOSPITAL. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE 990 IS REVIEWED BY THE FINANCE COMMITTEE FOR APPROVAL AND IS THEN SUBMITTED TO THE FULL BOARD FOR APPROVAL PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS AND ALL COMMITTEES ARE REQUIRED TO FILL OUT AND SIGN THE ANNUAL CONFLICT OF POLICIES. IN THE EVENT OF A CONFLICT A BOARD MEMBER ABSTAINS FROM THE VOTE AND IS ABSENT FROM THE DISCUSSION. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION OF THE CEO/PRESIDENT IS APPROVED BY THE FULL BOARD BASED ON THE RECOMMENDATION OF THE EXECUTIVE COMMITTEE THROUGH EXECUTIVE SURVEY INFORMATION. ANY EXECUTIVE BONUSES ARE APPROVED BY THE BOARD AT THE END OF A FISCAL YEAR BASED ON GOALS AND SUCCESS OF THE ORGANIZATION. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE FULL BOARD THROUGH THE RECOMMENDATION OF THE FINANCE COMMITTEE OF EMPLOYMENT CONTRACTS AND PAYROLL RATE INCREASES. RECOMMENDATIONS ARE BASED ON COMPENSATION SURVEYS AND APPROVAL OF THE HOSPITAL ANNUAL BUDGET. BONUS AMOUNTS ARE IN THE CONTRACTS APPROVED BY THE FULL BOARD. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITIED FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION AT THE ORGANIZATION'S CEO/PRESIDENT'S OFFICE. OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 OTHER CHANGES IN NET ASSETS CONSIST OF UNRESTRICTED CONTRIBUTIONS USED FOR PROPERTY, PLANT AND EQUIPMENT AND CONTRIBUTIONS USED FOR TEMPORARILY RESTRICTED NET ASSETS. MCKENIZE HEALTHCARE CORPORATION 120 DELAWARE STREET SANDUSKY MI 48471 382702946 HEALTHCARE MI 501C3 3 ITSELF false SANILAC HEALTHCARE CORP 120 DELAWARE STEET SANDUSKY MI 48471 382702948 HOMECARE MI 501C3 3 MCKENIZE HEALTHCARE CORPORATION false SANILAC SERVICES INC 48 SOUTH ELK SANDUSKY MI 48471 382774983 PHARMACY MI MCKENIZE HEALTHCARE CORPORATION C CORP SANILAC CATALOG INC 48 SOUTH ELK SANDUSKY MI 48471 383254153 CATALOG MI SANILAC SERVICES INC C CORP SANILAC EQUIPMENT & SUPPLY CO 120 DELAWARE STREET SANDUSKY MI 48471 382662256 SUPPLIES MI MCKENIZE HEALTHCARE CORPORATION C CORP false false false false false false false false false false false false false false true true false false SANILAC SERVICES INC SANILAC PHARMACY O 116697 FAIR MARKET VALUE SANILAC SERVICES INC SANILAC PHARMACY P 90000 FAIR MARKET VALUE