MACKINAC ISLAND MEDICAL CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MACKINAC ISLAND MEDICAL CENTER INC (EIN 38-2218858)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201203209349307665
Schema version
2011v1.2
Note
A later return for the same period supersedes this one.
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T15:26:35-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN383635706EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1REHMANN ROBSONBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1902 S HURON PO BOX 250AddressLine1
CityCHEBOYGANCity
StateMIState
ZIP Code49721ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN382218858EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MACKINAC ISLAND MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMACKNameControl
Phone9068473715Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 536AddressLine1
CityMACKINAC ISLANDCity
StateMIState
ZIP Code49757ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARGARET M DOUDName
TitlePRESIDENTTitle
Phone9068473715Phone
Date Signed2012-11-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL J KONICKI CPAName
PTINP00086743PTIN
Phone2316273143Phone
Date Prepared2012-11-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARGARET M DOUDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 536AddressLine1
CityMACKINAC ISLANDCity
StateMIState
ZIP Code49757ZIPCode
FieldValueIRS element (for citing)
Gross Receipts310061GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MSHOSP.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1977YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionTO SUPPORT FUNDING OF HEALTH CARE SERVICES FOR RESIDENTS OF MACKINAC ISLAND.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers5TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year237379ContributionsGrantsPriorYear
Contributions Grants Current Year118110ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year2309InvestmentIncomePriorYear
Investment Income Current Year939InvestmentIncomeCurrentYear
Other Revenue Prior Year94830OtherRevenuePriorYear
Other Revenue Current Year168000OtherRevenueCurrentYear
Total Revenue Prior Year334518TotalRevenuePriorYear
Total Revenue Current Year287049TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year404368OtherExpensePriorYear
Other Expenses Current Year298490OtherExpensesCurrentYear
Total Expenses Prior Year404368TotalExpensesPriorYear
Total Expenses Current Year298490TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-69850RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-11441RevenuesLessExpensesCY
Total Assets BOY853597TotalAssetsBOY
Total Assets EOY825743TotalAssetsEOY
Total Liabilities BOY500064TotalLiabilitiesBOY
Total Liabilities EOY483651TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY353533NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY342092NetAssetsOrFundBalancesEOY
Mission DescriptionTO SUPPORT FUNDING OF HEALTHCARE SERVICES FOR RESIDENTS OF MACKINAC ISLAND.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense296178Expense
Revenue287049Revenue
DescriptionTO OPERATE AND MAINTAIN A GENERAL HEALTHCARE FACILITY THAT IS WITHIN THE CITY OF MACKINAC ISLAND.Description
Total Program Service Expense296178TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JASON ANDERSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9066438585TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1MACKINAC STRAITS HOSPITAL AUTHORITYAddressLine1
CityST IGNACECity
StateMIState
ZIP Code49781ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
BEVERLY BENJAMIN
DIRECTOR1.00X000
ARMAND HORN
DIRECTOR1.00X000
FRANCIS STRAUS MD
DIRECTOR1.00X000
ANNA M TIMMONS
DIRECTOR1.00X000
WALTER NORTH
DIRECTOR1.00X000
JAMES HAVEMAN
DIRECTOR1.00X000
MARGARET M DOUD
PRESIDENT1.00000X
RD MUSSER III
VICE PRESIDENT1.00000X
BRADLEY CHAMBERS
TREASURER1.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions118110AllOtherContributions
Total Contributions118110TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column939TotalRevenueColumn
Exclusion$939ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events81957GrossIncomeFundraisingEvents
Fundraising Direct Expenses527FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column81430TotalRevenueColumn
Exclusion$81,430ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming109055GrossIncomeGaming
Gaming Direct Expenses22485GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column86570TotalRevenueColumn
Exclusion$86,570ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column287049TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$168,939ExclusionAmount

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total1050Total
Management And General1050ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total26Total
Management And General26ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total220Total
Management And General220ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total31441Total
Program Services31441ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total29557Total
Program Services29557ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7057Total
Program Services7057ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES FOR RE225000225000
SUPPLIES25882588
CREDIT CARD FEES859859
LICENSES535535

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total157Total
Management And General157ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total298490Total
Program Services296178ProgramServices
Management And General2312ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY189430BOY
EOY168151EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis690789LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec33197LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY664167BOY
EOY657592EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY853597BOY
EOY825743EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY500064BOY
EOY483651EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY500064BOY
EOY483651EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY353533BOY
EOY342092EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY353533BOY
EOY342092EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY853597BOY
EOY825743EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-11441ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis427720OtherCostOrOtherBasis
Book Value427720BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis252280OtherCostOrOtherBasis
Depreciation28302Depreciation
Book Value223978BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10789OtherCostOrOtherBasis
Depreciation4895Depreciation
Book Value5894BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings657592TotalOfBookValueLandBuildings

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1AUGUST MEDICAL CENTER BENEFITNameOfEvent1
Gross Receipts Event159778GrossReceiptsEvent1
Gross Revenue Event159778GrossRevenueEvent1
Name Of Event2CHRISTMAS BAZAARNameOfEvent2
Gross Receipts Event27500GrossReceiptsEvent2
Gross Revenue Event27500GrossRevenueEvent2
Gross Receipts Other Events14679GrossReceiptsOtherEvents
Gross Revenue Other Events14679GrossRevenueOtherEvents
Other Direct Expenses Other Events527OtherDirectExpensesOtherEvents
Gross Receipts Total81957GrossReceiptsTotal
Gross Revenue Total Events81957GrossRevenueTotalEvents
Other Direct Expenses Total Events527OtherDirectExpensesTotalEvents
Direct Expense Summary Events527DirectExpenseSummaryEvents
Net Income Summary81430NetIncomeSummary

Gaming Information GamingInformation

FieldValueIRS element (for citing)
Gross Revenue Other Gaming109056GrossRevenueOtherGaming
Cash Prizes Other Gaming22485CashPrizesOtherGaming
Volunteer Labor Other Gaming1VolunteerLaborOtherGaming
Volunteer Labor Prcnt Other Gaming1.00000VolunteerLaborPrcntOtherGaming
Gross Revenue Total Gaming109056GrossRevenueTotalGaming
Cash Prizes Total Gaming22485CashPrizesTotalGaming
Direct Expense Summary Gaming22485DirectExpenseSummaryGaming
Net Gaming Income Summary86571NetGamingIncomeSummary
FieldValueIRS element (for citing)
States Where Gaming ConductedMIStatesWhereGamingConducted
Licensed1Licensed
License Suspended Etc0LicenseSuspendedEtc
Gaming With Nonmembers1GamingWithNonmembers
Member Of Other Entity0MemberOfOtherEntity
Percentage Of Gaming Othr Facility1.00000PercentageOfGamingOthrFacility
Name Of Gaming Rec Keeper PersonJASON ANDERSONNameOfGamingRecKeeperPerson

Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS

FieldValueIRS element (for citing)
Address Line1P O BOX 536AddressLine1
CityMACKINAC ISLANDCity
StateMIState
ZIP Code49757ZIPCode
FieldValueIRS element (for citing)
Contract With3rd Party For Gam Rev0ContractWith3rdPartyForGamRev
Charitable Distrib Required0CharitableDistribRequired

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11IT IS THE POLICY OF MACKINAC ISLAND MEDICAL CENTER TO REVIEW THE COMPLETED FORM 990 WITH THE BOARD OF DIRECTORS. EVERY EFFORT WILL BE MADE TO HAVE THE FORM 990 REVIEWED PRIOR TO THE FILING DEADLINE. IF THIS IS NOT POSSIBLE THEN THE 990 WILL BE REVIEWED AT THE NEXT SCHEDULED BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12BOARD MEMBERS COMPLETE AN ANNUAL QUESTIONNAIRE TO DETERMINE IF A CONFLICT EXISTS.
FORM 990, PART VI, SECTION C, LINE 19UPON REQUEST

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