COMMUNITY MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEMORIAL HOSPITAL (EIN 38-1398825)
- Tax period
- 2011-04-01 to 2012-03-31
- Filed
- 2012-11-14
- IRS object ID
- 201213199349301841
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-14T10:33:46-06:00 | Timestamp |
| Tax Period End Date | 2012-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381398825 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 2316275601 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 748 SOUTH MAIN STREET | AddressLine1 |
| City | CHEBOYGAN | City |
| State | MI | State |
| ZIP Code | 49721 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES MCCLURG | Name |
| Title | CHAIRMAN OF BOARD OF DIRECTORS | Title |
| Phone | 2316275601 | Phone |
| Date Signed | 2012-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | Phone |
| Date Prepared | 2012-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEBOYGAN MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES MCCLURG | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 748 SOUTH MAIN STREET | AddressLine1 |
| City | CHEBOYGAN | City |
| State | MI | State |
| ZIP Code | 49721 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 41819509 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHEBOYGANHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1929 | YearFormation |
| State Legal Domicile | MI | StateLegalDomicile |
| Activity Or Mission Description | CHEBOYGAN MEMORIAL HOSPITAL IS A NON-PROFIT, COMMUNITY HEALTH CENTER PROVIDER DEDICATED TO PROVIDING PERSONALIZED, QUALITY HEALTHCARE SERVICES AND EDUCATION IN RESPONSE TO COMMUNITY NEED. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 512 | TotalNbrEmployees |
| Total Nbr Volunteers | 97 | TotalNbrVolunteers |
| Total Gross UBI | 89731 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 10376 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 174964 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 208610 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 44438616 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 41435270 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 12533 | InvestmentIncomePriorYear |
| Investment Income Current Year | -61957 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 64984 | OtherRevenuePriorYear |
| Other Revenue Current Year | 88218 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 44691097 | TotalRevenuePriorYear |
| Total Revenue Current Year | 41670141 | 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 | 23894168 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 22077075 | 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 | 27625776 | OtherExpensePriorYear |
| Other Expenses Current Year | 25099828 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 51519944 | TotalExpensesPriorYear |
| Total Expenses Current Year | 47176903 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -6828847 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -5506762 | RevenuesLessExpensesCY |
| Total Assets BOY | 25254772 | TotalAssetsBOY |
| Total Assets EOY | 22653323 | TotalAssetsEOY |
| Total Liabilities BOY | 26702494 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 29588799 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -1447722 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -6935476 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CHEBOYGAN MEMORIAL HOSPITAL IS A NON-PROFIT, COMMUNITY HEALTH CARE SERVICE PROVIDER DEDICATED TO PROVIDING PERSONALIZED, QUALITY HEALTHCARE SERVICES AND EDUCATION IN RESPONSE TO COMMUNITY NEED. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 36230915 | Expense |
| Revenue | 41047556 | Revenue |
| Description | CHEBOYGAN MEMORIAL HOSPITAL (38-1398825) IS DEDICATED TO PROVIDING QUALITY MEDICAL HEALTHCARE SERVICES TO OUR SERVICE AREA REGARDLESS OF A PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY.REIMBURSEMENT FOR SERVICES RENDERED IS CRUCIAL TO THE SUCCESSFUL OPERATION AND FINANCIAL WELL BEING OF CHEBOYGAN MEMORIAL HOSPITAL. WE ALSO RECOGNIZE THE FACT THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION IS TO PROVIDE PERSONALIZED, QUALITY HEALTHCARE SERVICES AND EDUCATION IN RESPONSE TO COMMUNITY NEED. THEREFORE, IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, CHEBOYGAN MEMORIAL HOSPITAL OFFERS: CHARITY CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT/BELOW COST AND HEALTH CARE ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY AND ENCOURAGE HEALTHY LIFESTYLE CHOICES.THESE PROGRAMS AND SERVICES WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S ABILITY TO PAY CO-EXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.CLASSES OFFERED:*DIABETES CLASSES - FREE GROUP CLASSES. SERIES OF FOUR, TWO-HOUR CLASSES HELD EVERY OTHER MONTH.*CARDIAC REHAB CLASSES - HELD MONDAY THROUGH FRIDAY*BETTER BREATHER CLASS AND SUPPORT GROUP - FREE CLASS HELD FOUR TIMES A MONTH.*SMOKING CESSATION CLASS - FREE ONE-ON-ONE COUNSELING SESSIONS BY APPOINTMENT.*COMMUNITY CPR/FIRST AID CLASSES - LOW COST, HELD SEVERAL TIMES A YEARSCHOOL AND COMMUNITY PROGRAMS:*SPORTS PHYSICALS - YEARLY FREE SPORTS PHYSICALS FOR MIDDLE SCHOOL AND HIGH SCHOOL STUDENT ATHLETES THROUGHOUT THE COUNTY.*HEALTH TALKS UPON REQUEST FROM SCHOOLS CLINICAL EXPERIENCES FOR STUDENT PROGRAMS: *NORTH CENTRAL MICHIGAN COLLEGE - RN PROGRAM*LAKE SUPERIOR STATE UNIVERSITY - RN AND LPN PROGRAM*FERRIS STATE UNIVERSITY - RADIOGRAPHY PROGRAM*JACKSON COMMUNITY COLLEGE - RADIOGRAPHY PROGRAM*DELTA COMMUNITY COLLEGE - ULTRASOUND PROGRAM*CONCORDIA UNIVERSITY - PHYSICAL THERAPY PROGRAM*ALLIED HEALTH PROGRAM - HIGH SCHOOL STUDENTS HEALTH CAREERS CLASS. *CHEBOYGAN ARTS COUNCIL - DISPLAY STUDENT ARTWORK IN HOSPITAL, FREESPEAKERS:*LECTURES AND HEALTH TALKS FOR AREA AGENCIES AND GROUPS DONE UPONREQUEST UTILIZING PHARMACIST, NURSES, DIABETIC EDUCATORS, RESPIRATORYTHERAPIST, DIETITIANS AND CARDIAC REHAB SPECIALIST. | Description |
| Total Program Service Expense | 36230915 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 71 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 512 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONNA WOIDERSKI | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2316271200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 748 S MAIN STREET | AddressLine1 |
| City | CHEBOYGAN | City |
| State | MI | State |
| ZIP Code | 49721 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| SHARI SCHULT | |||||||
| CEO | 40.00 | X | X | 136489 | 0 | 2882 | |
| JAMES MCCLURG | |||||||
| BOARD OF TRUSTEES - CHAIR | 5.00 | X | X | 0 | 0 | 0 | |
| NANCY DEXTROM | |||||||
| BOARD OF TRUSTEES - VICE C | 5.00 | X | X | 0 | 0 | 0 | |
| MARVIN COY | |||||||
| PHYSICIAN AND TRUSTEE | 40.00 | X | 259394 | 0 | 20112 | ||
| GENE COOLEY | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| CARL FRANZON | |||||||
| BOARD OF TRUSTEES - SECRET | 5.00 | X | X | 0 | 0 | 0 | |
| BRIAN BURNS | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| JEFFERY CHAULK | |||||||
| PHYSICIAN AND TRUSTEE | 40.00 | X | 0 | 0 | 0 | ||
| DANIEL NIELAND | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| CAROLYN RILEY | |||||||
| CEO | 40.00 | X | 254007 | 0 | 2257 | ||
| JOHN PARIGI II | |||||||
| INTERIM CFO | 40.00 | X | 150407 | 0 | 2295 | ||
| GARY LEWINS | |||||||
| INTERIM CFO | 40.00 | X | 178949 | 0 | 0 | ||
| CRAIG DUNCAN | |||||||
| SURGEON | 40.00 | 440091 | 0 | 24038 | X | ||
| DONALD WATSON | |||||||
| PHYSICIAN | 40.00 | 296108 | 0 | 152891 | X | ||
| DONALD RAMSAY | |||||||
| PHYSICIAN | 40.00 | 230795 | 0 | 156343 | X | ||
| AUDREY CARTWRIGHT | |||||||
| PHYSICIAN | 40.00 | 243566 | 0 | 81863 | X | ||
| MANUEL DURON | |||||||
| PHYSICIAN | 40.00 | 273821 | 0 | 17132 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2463627 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 459813 | TotalOtherCompensation |
| Number Individuals GT100 K | 26 | 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 |
|---|---|---|---|---|---|
| AGILITY HEALTH INC | |||||
| 607 DEWEY AVE NW STE 300 | GRAND RAPIDS | MI | 49504 | REHAB SERVICES | 1060072 |
| CONWAY MACKENZIE INC | |||||
| 401 SOUTH OLD WOODWARD AVE SUITE 3 | BIRMINGHAM | MI | 48009 | FINANCIAL ADVISORS | 691636 |
| ANESTHESIA STAFFING CONSULTANTS | |||||
| 30200 TELEGRAPH RD STE 220 | BINGHAM FARMS | MI | 48025 | ANESTHIA SERVICES | 688255 |
| HEALTHCARE CLAIMS SOLUTIONS INC | |||||
| 3460 S DIXIE HWY | MORAIN | OH | 45439 | BILLING SERVICES | 575585 |
| DELL PEROT SYSTEMS | |||||
| LOCKBOX 12020 7489 COLLECTIONS CENT | CHICAGO | IL | 60693 | BILLING SERVICES | 575000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 14 | NumberOfContractorsGT100K |
| Government Grants | 15488 | GovernmentGrants |
| All Other Contributions | 193122 | AllOtherContributions |
| Total Contributions | 208610 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| PROGRAM SERVICES | 900099 | 41137287 | 41047556 | 89731 | |
| OTHER RELATED REVENUE | 900099 | 297983 | $297,983 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 41435270 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7205 | TotalRevenueColumn |
| Exclusion | $7,205 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 168424 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 80206 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 88218 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 88218 | TotalRevenueColumn |
| Exclusion | $88,218 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 69162 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -69162 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -69162 | TotalRevenueColumn |
| Exclusion | -$69,162 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 41670141 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41047556 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 89731 | UnrelatedBusinessRevenue |
| Exclusion | $324,244 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 798427 | Total |
| Program Services | 258704 | ProgramServices |
| Management And General | 539723 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17459653 | Total |
| Program Services | 15308692 | ProgramServices |
| Management And General | 2150961 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 154258 | Total |
| Program Services | 131525 | ProgramServices |
| Management And General | 22733 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2468759 | Total |
| Program Services | 2104939 | ProgramServices |
| Management And General | 363820 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1195978 | Total |
| Program Services | 1019727 | ProgramServices |
| Management And General | 176251 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 590958 | Total |
| Program Services | 106919 | ProgramServices |
| Management And General | 484039 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 490438 | Total |
| Management And General | 490438 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81750 | Total |
| Management And General | 81750 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1425897 | Total |
| Management And General | 1425897 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53378 | Total |
| Management And General | 53378 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4994900 | Total |
| Program Services | 4871462 | ProgramServices |
| Management And General | 123438 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 809782 | Total |
| Program Services | 35532 | ProgramServices |
| Management And General | 774250 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37977 | Total |
| Program Services | 18217 | ProgramServices |
| Management And General | 19760 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 779936 | Total |
| Program Services | 768472 | ProgramServices |
| Management And General | 11464 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1758880 | Total |
| Program Services | 1733026 | ProgramServices |
| Management And General | 25854 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 511160 | Total |
| Program Services | 120066 | ProgramServices |
| Management And General | 391094 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| CONTRACT LABOR | 5185583 | 3448339 | 1737244 |
| PROVISION FOR BAD DEBTS | 4297712 | 4297712 | |
| OTHER EXPENSES | 1719807 | 1024967 | 694840 |
| EQUIPMENT RENTAL | 1261016 | 642194 | 618822 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1100654 | Total |
| Program Services | 340422 | ProgramServices |
| Management And General | 760232 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47176903 | Total |
| Program Services | 36230915 | ProgramServices |
| Management And General | 10945988 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 133768 | BOY |
| EOY | 571547 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 976853 | BOY |
| EOY | 371271 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43095 | BOY |
| EOY | 39334 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8565757 | BOY |
| EOY | 6762139 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 489239 | BOY |
| EOY | 454887 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 310485 | BOY |
| EOY | 587612 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 36897477 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 23103354 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14661245 | BOY |
| EOY | 13794123 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22321 | BOY |
| EOY | 22321 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52009 | BOY |
| EOY | 50089 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25254772 | BOY |
| EOY | 22653323 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7969405 | BOY |
| EOY | 8465194 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3912293 | BOY |
| EOY | 3775959 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9932049 | BOY |
| EOY | 9114236 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1530994 | BOY |
| EOY | 4582892 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3357753 | BOY |
| EOY | 3650518 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26702494 | BOY |
| EOY | 29588799 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1502676 | BOY |
| EOY | -7009438 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54954 | BOY |
| EOY | 73962 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1447722 | BOY |
| EOY | -6935476 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25254772 | BOY |
| EOY | 22653323 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -5506762 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 19008 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
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 | $3,016 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3016 | 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 | A PERCENTAGE OF DUES PAID TO MHA | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1107212 | OtherCostOrOtherBasis |
| Book Value | 1107212 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22147104 | OtherCostOrOtherBasis |
| Depreciation | 12725207 | Depreciation |
| Book Value | 9421897 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 177428 | OtherCostOrOtherBasis |
| Depreciation | 140249 | Depreciation |
| Book Value | 37179 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13313952 | OtherCostOrOtherBasis |
| Depreciation | 10237898 | Depreciation |
| Book Value | 3076054 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 151781 | OtherCostOrOtherBasis |
| Book Value | 151781 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13794123 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| COST REPORT SETTLEMENTS PAYABLE | $2,592,541 |
| ACCRUED PENSION LIABILITY | $1,057,977 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3650518 | TotalOfAmounts |
| Total Revenue | 41670141 | TotalRevenue |
| Total Expenses | 47176903 | TotalExpenses |
| Excess Or Deficit For Year | -5506762 | ExcessOrDeficitForYear |
| Other | $19,008 | OtherAmount |
| Total Adjustments | 19008 | TotalAdjustments |
| Excess Or Deficit Per FS | -5487754 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | FORM 990, PART XII, LINE 2B FOOTNOTE FROM FINANCIAL STATEMENTS - INCOME TAXES: THERE WAS NO AUDIT PERFORMED IN THE CURRENT YEAR. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | MISCELLANEOUS ADJUSTMENT 19,008. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 546833 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 546833 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01280 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4629953 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2586264 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2043689 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04770 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5176786 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2586264 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2590522 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5176786 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2586264 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2590522 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06050 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $2,251,460 | BadDebtExpenseAmount |
| Amount Attributable To | 207999 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 13664956 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 13761767 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -96811 | 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 | COMMUNITY MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 748 SOUTH MAIN STREET | AddressLine1 |
| City | CHEBOYGAN | City |
| State | MI | State |
| ZIP Code | 49721 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| Other Reason | X | OtherReason |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| WOMEN'S & CHILDREN'S CLINIC | ||||
| 722 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | GYN & PEDIATRIC PRACTICE |
| INDIAN RIVER MEDICAL CENTER | ||||
| 6135 CRESSY STREET | INDIAN RIVER | MI | 49749 | FAMILY PRACTICE |
| CHEBOYGAN MEMORIAL HEALTH CENTER | ||||
| 740 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | FAMILY & INTERNAL MEDICINE PRACTICES |
| CHEBOYGAN SURGICAL ASSOCIATES | ||||
| 810 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | SURGICAL PRACTICE |
| ONCOLOGY CLINIC | ||||
| 740 SOUTH MAIN STREET | CHEBOYGAN | MI | 49721 | ONCOLOGY CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED. | ||
| PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B IS NOT INCLUDED IN THE CALCULATION ON SCHEDULE H, PART I, LINE 7, COLUMN F. TOTAL BAD DEBT EXPENSE EXCLUDED FROM THIS CALCULATION EQUALS $4,297,712. | ||
| PART II: CHEBOYGAN MEMORIAL HOSPITAL IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES. OUR CONTRIBUTIONS IN THIS CATEGORY INCLUDE OUR PARTICIPATION IN LOCAL CHAMBERS OF COMMERCE (CHEBOYGAN, INDIAN RIVER, MACKINAW CITY), HABITAT FOR HUMANITY, CHEBOYGAN COUNTY RECYCLING EFFORTS, COOPERATION WITH THE ALLIED HEALTH PROGRAM AT CHEBOYGAN HIGH SCHOOL, INVOLVEMENT WITH THE AMERICAN RED CROSS AND SUPPORT OF THE CHEBOYGAN SALVATION ARMY. | ||
| PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS. AGING LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS. BASED ON CURRENT REIMBURSEMENT METHODOLOGIES THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. BAD DEBT AT COST, $2,129,352, IS CALCULATED BASED ON A COST TO CHARGE RATIO. THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, $259,726, IS EQUAL TO 1/4 OF BAD DEBT EXPENSE AT COST MULTIPLIED BY THE COST TO CHARGE RATIO FROM WORKSHEET 2. THIS IS AN ESTIMATE BASED ON ADMINISTRATION'S KNOWLEDGE OF THE CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES. THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DO NOT SHOW A SHORTFALL. THIS IS DUE TO THE INCREASED REIMBURSEMENT FROM THE RURAL HEALTH CLINICS AND OUR CRITICAL ACCESS STATUS. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. | ||
| PART III, LINE 8: THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DO NOT SHOW A SHORTFALL. THIS IS DUE TO THE INCREASED REIMBURSEMENT FROM THE RURAL HEALTH CLINICS AND OUR CRITICAL ACCESS STATUS. THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. | ||
| PART III, LINE 9B: CHEBOYGAN MEMORIAL HOSPITAL WILL PROVIDE SERVICE(S) FREE OF CHARGE TO ANY PATIENT WHO HAS FAMILY INCOME ON THE DATE-OF-SERVICE WHICH IS AT OR BELOW THE FEDERAL POVERTY INCOME GUIDELINES. IF THE PATIENT'S GUARANTOR IS UNABLE TO MAKE FULL PAYMENT, ASSISTANCE MAY BE PROVIDED UNDER CHEBOYGAN MEMORIAL HOSPITAL'S CHARITY CARE PROGRAM. IF A PATIENT PRESENTS WITH NO INSURANCE COVERAGE OR REQUESTS TO APPLY FOR CHARITY CARE THEY WILL BE GIVEN A CHARITY CARE APPLICATION. THE APPLICATION IS REVIEWED BY A FINANCIAL COUNSELOR WHO DETERMINES IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE. THE APPLICATION IS APPROVED BY THE APPROPRIATE HOSPITAL PERSONNEL, AND THE PATIENT ACCOUNT IS ADJUSTED ACCORDINGLY. FREE CARE- OUR CHARITY PROGRAM INCORPORATES MICHIGAN'S FREE CARE REQUIREMENTS. HOSPITAL SERVICES FOR MEDICALLY NECESSARY SERVICES ARE AVAILABLE AT NO CHARGE TO THOSE FAMILIES WHOSE INCOME IS AT OR BELOW THE FEDERAL INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY AND PUBLISHED EACH SPRING IN THE FEDERAL REGISTER. THESE GUIDELINES ESTABLISH A THRESHOLD OF INCOME WHICH GROWS AS THE FAMILY SIZE OF THE APPLICANT DOES. APPLYING FOR ASSISTANCE- A RELATIVELY SIMPLE APPLICATION HAS BEEN DESIGNED TO HELP DETERMINE ELIGIBILITY FOR BASIC PROGRAMS, A PATIENT ACCOUNT REPRESENTATIVE SHALL ASSIST EACH APPLICANT WITH NECESSARY PAPERWORK. A DECISION REGARDING ELIGIBILITY WILL NORMALLY BE MADE WITHIN FIVE BUSINESS DAYS OF THE APPLICATION. IF A PATIENT WHO QUALIFIES FOR FINANCIAL ASSISTANCE DOES NOT PAY THE PATIENT PORTION OF A CHARGE, THE HOSPITAL WILL ATTEMPT TO COLLECT. THESE PATIENTS ARE TREATED THE SAME AS ALL OTHER PATIENTS, AND ARE SENT TO COLLECTIONS IF NO PAYMENT IS RECEIVED. | ||
| PART V, SECTION B, LINE 18D: THE HOSPITAL CLOSED ITS DOORS APRIL 4, 2012 AND HAS FILED FOR BANKRUPTCY. | COMMUNITY MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 19D: THE HOSPITAL CLOSED ITS DOORS APRIL 4, 2012 AND HAS FILED FOR BANKRUPTCY. | COMMUNITY MEMORIAL HOSPITAL | |
| PART VI, LINE 2: CHEBOYGAN MEMORIAL HOSPITAL CONDUCTS PERIODIC PATIENT SURVEYS AND COMMUNITY NEED ASSESSMENTS. OUR COMMUNITY OUTREACH DEPARTMENT WORKS WITH SEVERAL LOCAL AND STATE AGENCIES TO ADDRESS THE HEALTH ISSUES OF THE REGION. WE INVITE PEOPLE TO SEND COMMENTS AND CONCERNS REGARDING OUR SERVICES THROUGH MESSAGES ON OUR WEBSITE AND BROCHURES. ALSO, OUR BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS WHICH HELPS INFLUENCE DECISIONS REGARDING THE MISSION OF THE ORGANIZATION. | ||
| PART VI, LINE 3: DURING REGISTRATION, AN INFORMATIONAL PAMPHLET IS PROVIDED TO PATIENTS WHO DO NOT HAVE INSURANCE OR COMMUNICATE THEIR INABILITY TO PAY FOR THE SERVICES TO BE PROVIDED. THE PAMPHLET OUTLINES A VARIETY OF SOURCES OF ASSISTANCE, INCLUDING THE HOSPITAL'S CHARITY CARE POLICY. | ||
| PART VI, LINE 4: POPULATION OVERVIEW: THE PRIMARY SERVICE AREA FOR CHEBOYGAN MEMORIAL HOSPITAL (CMH) IS CHEBOYGAN COUNTY, WHICH HAS A PERMANENT POPULATION OF CLOSE TO 29,000. CMH ALSO SERVES MOST OF PRESQUE ISLE COUNTY, THE NORTHERN HALF OF EMMET COUNTY AND THE STRAITS AREA WHICH WOULD INCLUDE AN ADDITIONAL POPULATION OF APPROXIMATELY 22,000. THE POPULATION OF CHEBOYGAN COUNTY HAS INCREASED SLIGHTLY OVER THE LAST DECADE. IN SPITE OF THE LOSS OF MANY MANUFACTURING JOBS, THIS AREA HAS BECOME A POPULAR RELOCATION DESTINATION FOR RETIREES. THIS TREND HAS LED TO AN AGING OF THE POPULATION DEMOGRAPHICS. IN 2005, 18.5% OF THE POPULATION OF CHEBOYGAN COUNTY WAS OVER 65 YEARS OLD, COMPARED TO 12.5% STATEWIDE AND 12.4% NATIONALLY. THIS SEGMENT OF THE POPULATION IS EXPECTED TO GROW AS LONG-TIME RESIDENTS AGE AND MORE RETIREES MOVE INTO THE AREA. SEASONAL POPULATION -- CHEBOYGAN COUNTY IS KNOWN AS A PRIME DESTINATION FOR OUTDOOR RECREATIONAL ACTIVITIES SUCH AS BOATING, FISHING, SNOWMOBILING AND HUNTING. TOURISM HAS A BIG IMPACT ON THE AREA'S INFRASTRUCTURE AND SERVICES - FROM MORE SEASONAL TRAFFIC ON THE ROADS TO THE INCREASED NEED FOR HEALTH CARE SERVICES. MORE THAN A MILLION TOURISTS PASS THROUGH THE AREA EACH SUMMER TO VISIT HISTORIC MACKINAC ISLAND. THE AREA ALSO SWELLS FROM SEASONAL RESIDENTS WHO SPEND TIME AT THEIR WATERFRONT COTTAGES OR SECOND HOMES. THE POPULATION OF MANY AREA COMMUNITIES MORE THAN DOUBLES IN THE SUMMER MONTHS. INCOME AND EMPLOYMENT OVERVIEW: FOR SEVERAL DECADES, NORTHEAST MICHIGAN HAS BEEN BELEAGUERED WITH LOW-PAYING, SEASONAL JOBS- MANY OF WHICH OFFER NO HEALTH BENEFITS. THE UNEMPLOYMENT FOR THIS AREA HAS ALWAYS BEEN WELL ABOVE THE STATE AND NATIONAL AVERAGES, ESPECIALLY DURING THIS TIME OF RECESSION. CHEBOYGAN COUNTY'S CURRENT UNEMPLOYMENT RATE FOR 2009 HAS HOVERED NEAR 20%. DURING THE WINTER MONTHS IT IS EXPECTED TO RISE TO ABOUT 30%. THE SERVICE SECTOR PROVIDES THE LARGEST AMOUNT OF EMPLOYMENT WITH 28.3%, THANKS MAINLY TO THE TOURISM INDUSTRY. | ||
| PART VI, LINE 5: COMMUNITY HEALTH STATUS RECENT INFORMATION FROM 2007. ACCORDING TO THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, IT SHOWS THAT CHEBOYGAN COUNTY HAS A HIGHER RATE THAN THE STATE AVERAGE OF THE FOLLOWING: DIABETES, OVARIAN CANCER, LUNG CANCER, AND HEART DISEASE DEATHS DUE TO ALZHEIMER'S, LOWER RESPIRATORY, DIABETES, PNEUMONIA/INFLUENZA ARE SLIGHTLY HIGHER THAN STATE AND NATIONAL BENCHMARKS. MUCH OF THIS CAN BE ATTRIBUTED TO A SEDENTARY LIFESTYLE AMONG MANY YEAR-ROUND RESIDENTS, AS WELL AS THE AGING OF THE POPULATION. PREVENTATIVE HEALTH AND BEHAVIOR RISK FACTORS THAT HAVE BEEN IDENTIFIED INCLUDE* AN INCREASING AMOUNT OF YOUNG SMOKERS* THOSE WHO HAVE NO LEISURE-TIME PHYSICAL ACTIVITY WITH MANY MORE RESIDENTS BEING CLASSIFIED AS OBESE AT ALL AGE LEVELS* THE AMOUNT OF PEOPLE THAT HAVE BEEN LABELED BINGE DRINKERS, ESPECIALLY TEENAGERS* LOW-BIRTH WEIGHT BABIES AND PRE-TERM BIRTHS ARE CLOSE TO THE STATE PERCENTAGES, UNMARRIED AND THOSE MOTHERS UNDER 20 YEARS OLD ARE SLIGHTLY HIGHER THAN STATE NORMS. CMH'S RESPONSE TO COMMUNITY HEALTH STATUS: CHEBOYGAN MEMORIAL HOSPITAL IS DEDICATED TO PROVIDING PERSONALIZED, QUALITY HEALTHCARE SERVICES AND EDUCATION IN RESPONSE TO COMMUNITY NEED. CMH HAS A VISION OF BEING THE INDISPENSABLE PROVIDER OF CARE FOR THE WHOLE PERSON WITH VALUES BASED ON CARING, COMPETENCE, INTEGRITY AND RESPECT. ONE OF THE CHIEF GOALS OF THE STRATEGIC PLAN AT CMH IS TO SHIFT THE HOSPITAL FROM A TRADITIONAL SICKNESS MODEL TO A WELLNESS MODEL. THROUGH INTERNAL AND EXTERNAL EFFORTS, CMH HAS IMPLEMENTED A PROCESS AND FORMED PARTNERSHIPS TO MAKE THAT VISION A REALITY. IN 2008, CMH OPENED A CARDIAC WELLNESS CENTER THAT INCLUDES STATE-OF-THE ART EXERCISE EQUIPMENT, PRIVATE AREAS FOR COUNSELING AND A FULLY-EQUIPPED TEACHING KITCHEN TO HELP PROMOTE HEALTHY COOKING. THIS NEW ADDITION ADDRESSES A COUPLE OF THE MAJOR HEALTH RISK FACTORS IN OUR REGION, HEART DISEASE AND DIABETES. OUR COMMUNITY OUTREACH DEPARTMENT PROVIDES SEVERAL ONGOING EDUCATIONAL OPPORTUNITIES FOR THOSE RESIDENTS IDENTIFIED WITH CHRONIC AILMENTS. FOR EXAMPLE, CMH PROVIDES A BETTER BREATHERS CLASS. THIS PULMONARY REHABILITATION SUPPORT GROUP MEETS EVERY WEEK. IT'S FREE OF CHARGE AND IS DESIGNED FOR ANYONE SUFFERING FROM BREATHING PROBLEMS. FOR DIABETES EDUCATION, CMH OFFERS A SERIES OF CLASSES EVERY OTHER MONTH. THEY ARE FREE OF CHARGE AND ARE OPEN TO ANYONE INTERESTED IN LEARNING MORE ABOUT DIABETES. | ||
| PART VI, LINE 6: N/A | ||
| MI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 | 0 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARVIN COY | |||||||||||||
| 258704 | 0 | 0 | 0 | 690 | 0 | 1225 | 0 | 18887 | 0 | 279506 | 0 | 0 | 0 |
| CAROLYN RILEY | |||||||||||||
| 253362 | 0 | 0 | 0 | 645 | 0 | 0 | 0 | 2257 | 0 | 256264 | 0 | 0 | 0 |
| JOHN PARIGI II | |||||||||||||
| 150274 | 0 | 0 | 0 | 133 | 0 | 0 | 0 | 2295 | 0 | 152702 | 0 | 0 | 0 |
| GARY LEWINS | |||||||||||||
| 178949 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 178949 | 0 | 0 | 0 |
| CRAIG DUNCAN | |||||||||||||
| 439641 | 0 | 0 | 0 | 450 | 0 | 1225 | 0 | 22813 | 0 | 464129 | 0 | 0 | 0 |
| DONALD WATSON | |||||||||||||
| 295808 | 0 | 0 | 0 | 300 | 0 | 1225 | 0 | 151666 | 0 | 448999 | 0 | 0 | 0 |
| DONALD RAMSAY | |||||||||||||
| 228815 | 0 | 0 | 0 | 1980 | 0 | 1164 | 0 | 155179 | 0 | 387138 | 0 | 0 | 0 |
| AUDREY CARTWRIGHT | |||||||||||||
| 242276 | 0 | 0 | 0 | 1290 | 0 | 1217 | 0 | 80646 | 0 | 325429 | 0 | 0 | 0 |
| MANUEL DURON | |||||||||||||
| 273631 | 0 | 0 | 0 | 190 | 0 | 0 | 0 | 17132 | 0 | 290953 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | DONALD WATSON $134,079 DONALD RAMSAY $137,592 AUDREY CARTWRIGHT $65,847 CRAIG DUNCAN $5,226 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ECONOMIC DEVELOPMENT CORPORATION OF THE COUNTY OF CHEBOYGAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 392495755 | IssuerEIN |
| Date Issued | 2008-04-29 | DateIssued |
| Issue Price | 4300000 | IssuePrice |
| Description Of Purpose | REFINANCING AND EQUIPMENT PURCHASE | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 524041 | AmountRetired |
| Total Proceeds | 4300000 | TotalProceeds |
| Refunding Escrow | 3364998 | RefundingEscrow |
| Issuance Costs From Proceeds | 57610 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 157100 | WorkingCapitalExpenditures |
| Capital Expenditures | 720292 | CapitalExpenditures |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| CITIZENS NATIONAL BANK | |||
| SUSAN ENO- FORMER TRUSTEE | 533425 | LOAN PAYMENTS | 0 |
| CITIZENS NATIONAL BANK | |||
| KATHY LIEDER- FORMER TRUSTEE | 533452 | LOAN PAYMENTS | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHAIRS OF THE FINANCE AND AUDIT COMMITTEES HAVE BEEN GIVEN THE AUTHORITY TO REVIEW THE FORM 990 ON BEHALF OF THE BOARD OF DIRECTORS. OTHER BOARD MEMBERS HAVE THE ABILITY TO SEE THE RETURN. | |
| FORM 990, PART VI, SECTION B, LINE 12C | CHEBOYGAN MEMORIAL HOSPITAL'S CONFLICT OF INTEREST POLICY IS APPLICABLE TO ALL BOARD MEMBERS AND KEY MANAGEMENT OFFICERS. BOARD MEMBERS AND OFFICERS COMPLETE AN ANNUAL STATEMENT OF RELATED INTERESTS, WHICH IS REVIEWED BY THE CHAIRPERSON OF THE BOARD AND THE CHIEF EXECUTIVE OFFICER. THE BOARD MEMBER OR OFFICER IS REQUIRED TO WITHDRAW FROM ANY BOARD MATTERS THAT GIVE RISE TO A CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE COMMITTEE OF THE BOARD EVALUATES COMPARABILITY DATA TO DETERMINE SALARY. SALARIES FOR THE CEO AND OTHER TOP MANAGEMENT OFFICIALS ARE COMPARED TO INDUSTRY STANDARDS FOR LIKE SIZE AND TYPE OF FACILITY. THIS PROCESS WAS LAST UNDERTAKEN DURING FISCAL YEAR 2011. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON PUBLIC REQUEST -- PENDING APPROVAL OF ADMINISTRATION. | |
| FORM 990, PART XI, LINE 5: | MISCELLANEOUS ADJUSTMENT 19,008. TOTAL TO FORM 990, PART XI, LINE 5: 19,008. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | HOSPITAL DECLARED BANKRUPTCY DURING FISCAL YEAR 2012, THEREFORE NO AUDIT WAS PERFORMED. |
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