2012-11-14T10:33:46-06:00 2012-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2011-04-01 381398825 COMMUNITY MEMORIAL HOSPITAL COMM 2316275601 748 SOUTH MAIN STREET CHEBOYGAN MI 49721 JAMES MCCLURG 2316275601 2012-11-14 1 TERRI REXRODE CPA MST P00096513 9206620016 2012-11-14 2011 2016-02-24 21:20:13Z CHEBOYGAN MEMORIAL HOSPITAL JAMES MCCLURG 748 SOUTH MAIN STREET CHEBOYGAN MI 49721 41819509 0 X WWW.CHEBOYGANHOSPITAL.ORG X 1929 MI 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. 9 7 512 97 89731 10376 174964 208610 44438616 41435270 12533 -61957 64984 88218 44691097 41670141 0 0 0 0 23894168 22077075 0 0 0 27625776 25099828 51519944 47176903 -6828847 -5506762 25254772 22653323 26702494 29588799 -1447722 -6935476 X 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. 0 0 36230915 41047556 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. 36230915 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 71 0 1 512 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 1 0 X DONNA WOIDERSKI 2316271200 748 S MAIN STREET CHEBOYGAN MI 49721 SHARI SCHULT 40.00 X X 136489 0 2882 JAMES MCCLURG 5.00 X X 0 0 0 NANCY DEXTROM 5.00 X X 0 0 0 MARVIN COY 40.00 X 259394 0 20112 GENE COOLEY 5.00 X 0 0 0 CARL FRANZON 5.00 X X 0 0 0 BRIAN BURNS 5.00 X 0 0 0 JEFFERY CHAULK 40.00 X 0 0 0 DANIEL NIELAND 5.00 X 0 0 0 CAROLYN RILEY 40.00 X 254007 0 2257 JOHN PARIGI II 40.00 X 150407 0 2295 GARY LEWINS 40.00 X 178949 0 0 CRAIG DUNCAN 40.00 X 440091 0 24038 DONALD WATSON 40.00 X 296108 0 152891 DONALD RAMSAY 40.00 X 230795 0 156343 AUDREY CARTWRIGHT 40.00 X 243566 0 81863 MANUEL DURON 40.00 X 273821 0 17132 2463627 0 459813 26 0 1 0 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 14 15488 193122 208610 PROGRAM SERVICES 900099 41137287 41047556 89731 OTHER RELATED REVENUE 900099 297983 297983 41435270 7205 7205 168424 80206 88218 88218 88218 69162 -69162 -69162 -69162 41670141 41047556 89731 324244 798427 258704 539723 17459653 15308692 2150961 154258 131525 22733 2468759 2104939 363820 1195978 1019727 176251 590958 106919 484039 490438 490438 81750 81750 1425897 1425897 53378 53378 4994900 4871462 123438 809782 35532 774250 37977 18217 19760 779936 768472 11464 1758880 1733026 25854 511160 120066 391094 CONTRACT LABOR 5185583 3448339 1737244 PROVISION FOR BAD DEBTS 4297712 4297712 OTHER EXPENSES 1719807 1024967 694840 EQUIPMENT RENTAL 1261016 642194 618822 1100654 340422 760232 47176903 36230915 10945988 0 133768 571547 976853 371271 43095 39334 8565757 6762139 489239 454887 310485 587612 36897477 23103354 14661245 13794123 22321 22321 52009 50089 25254772 22653323 7969405 8465194 3912293 3775959 9932049 9114236 1530994 4582892 3357753 3650518 26702494 29588799 X -1502676 -7009438 54954 73962 -1447722 -6935476 25254772 22653323 X -5506762 19008 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3016 3016 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PERCENTAGE OF DUES PAID TO MHA 1107212 1107212 22147104 12725207 9421897 177428 140249 37179 13313952 10237898 3076054 151781 151781 13794123 COST REPORT SETTLEMENTS PAYABLE 2592541 ACCRUED PENSION LIABILITY 1057977 3650518 41670141 47176903 -5506762 19008 19008 -5487754 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. 1 1 1 X 1 X 0 1 0 1 1 546833 546833 0.01280 4629953 2586264 2043689 0.04770 5176786 2586264 2590522 0.06050 5176786 2586264 2590522 0.06050 0 2251460 207999 13664956 13761767 -96811 X 1 1 1 1 COMMUNITY MEMORIAL HOSPITAL

748 SOUTH MAIN STREET CHEBOYGAN MI 49721

X X X X COMMUNITY MEMORIAL HOSPITAL 1 0 1 1 100.000000000000 1 200.000000000000 0 0 0 0 0 0 X X 0 0 5 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 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. COMMUNITY MEMORIAL HOSPITAL 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. 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 REPORTS FILED WITH STATES PART VI, LINE 7 MI X 1 1 X X X 0 1 0 0 0 0 0 0 0 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 PART I, LINE 4B DONALD WATSON $134,079 DONALD RAMSAY $137,592 AUDREY CARTWRIGHT $65,847 CRAIG DUNCAN $5,226 ECONOMIC DEVELOPMENT CORPORATION OF THE COUNTY OF CHEBOYGAN 392495755 2008-04-29 4300000 REFINANCING AND EQUIPMENT PURCHASE 0 0 0 524041 4300000 3364998 57610 157100 720292 2009 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 CITIZENS NATIONAL BANK SUSAN ENO- FORMER TRUSTEE 533425 LOAN PAYMENTS 0 CITIZENS NATIONAL BANK KATHY LIEDER- FORMER TRUSTEE 533452 LOAN PAYMENTS 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: MISCELLANEOUS ADJUSTMENT 19,008. TOTAL TO FORM 990, PART XI, LINE 5: 19,008. FORM 990, PART XII, LINE 2C HOSPITAL DECLARED BANKRUPTCY DURING FISCAL YEAR 2012, THEREFORE NO AUDIT WAS PERFORMED.