2012-11-14T08:00:25-06:00 2011-12-31 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2011-01-01 381490180 CARSON CITY HOSPITAL CARS 9895843971 406 E Elm Street PO Box 879 Carson City MI 48811 DUANE C MILLER 2012-11-05 true Geralyn Hurd P00933422 3128997000 2011 2016-02-24 21:20:13Z MATTHEW THOMPSON 406 E Elm Street Carson City MI 48811 61352450 false X WWW.CARSONHEALTH.ORG X 1938 MI THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY & ACCESSIBLE HEALTH CARE SERVICES TO COMMUNITIES WE SERVE. IN CONJUNCTION, CCH PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. 13 7 718 145 0 0 173923 179222 56098857 59862979 268368 164770 544801 602659 57085949 60809630 0 19979 0 0 29805940 32574506 0 0 1052 25973959 27476512 55779899 60070997 1306050 738633 46633993 46428348 23285826 23228049 23348167 23200299 X THE MISSION OF CARSON CITY HOSPITAL (CCH) IS TO PROVIDE HIGH QUALITY AND ACCESSIBLE HEALTH CARE SERVICES TO THE COMMUNITIES WE SERVE AND TO PROVIDE CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. false false 45201899 19979 52532051 CCH IS A 77-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, DO. SINCE THIS TIME, CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS IN A FOUR-COUNTY AREA. CCH CURRENTLY OPERATES A SHORT-TERM, ACUTE-CARE FACILITY AND SEVERAL SATELLITE CLINICS OFFERING INPATIENT AND OUTPATIENT HEALTHCARE SERVICES, PSYCHIATRIC SERVICES, PHYSICIAN SERVICES, AND HOME HEALTH CARE, PRIMARILY TO PATIENTS IN THE CARSON CITY, MICHIGAN AREA, INCLUDING GRATIOT, MONTCALM, CLINTON, AND IONIA COUNTIES. CCH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE CCH DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. UNDER ARRANGEMENTS WITH VARIOUS GOVERNMENTAL INSURANCE PROGRAMS, CCH PROVIDES SIGNIFICANT CARE TO THE LOCAL INDIGENT POPULATION FOR WHICH REIMBURSEMENT FOR SERVICES RENDERED IS GENERALLY LESS THAN THE COST OF PROVIDING SUCH SERVICES. AS PART OF ITS OBLIGATION TO THE LOCAL COMMUNITY, CCH ALSO PROVIDES NUMEROUS OTHER SERVICES, WHICH BENEFIT THE COMMUNITY AND ARE GENERALLY PERFORMED AT NO CHARGE AND PROVIDES SERVICES TO INDIGENT PATIENTS UNDER THE MEDICAID PROGRAM AT PAYMENT AMOUNTS LESS THAN THE COST OF THE SERVICES PROVIDED. FOR THE YEAR ENDED DECEMBER 31, 2011, CCH PROVIDED OVER $2 MILLION IN UNCOMPENSATED CARE. DURING THE YEAR ENDED DECEMBER 31, 2011, CCH PROVIDED 6,564 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 3.02 DAYS. THERE WERE ALSO 12,497 EMERGENCY ROOM VISITS, 67,245 OUTPATIENT HOSPITAL VISITS, 1,874 HOSPITAL ADMISSIONS, AND 319 BIRTHS DURING THE YEAR. CCH PERFORMED 5,940 SURGERIES, 193,874 LAB TESTS, 13,323 DIAGNOSTIC IMAGING EXAMS, 4,102 CT SCANS, AND 2,947 M.R.I. SCANS. THE ESTIMATED TOTAL LOCAL ECONOMIC IMPACT FOR THE YEAR WAS $30,139,891. 1504356 0 1729023 ITHACA FAMILY CARE CENTER (IFCC) IS AN OFFICE WITH 3 PHYSICIANS AND 1 PHYSICIAN ASSISTANT THAT FOCUSES ON FAMILY PRACTICE FOR GRATIOT COUNTY. IFCC PROVIDES OUTPATIENT SERVICES SUCH AS AUDIOMETRY, BLOOD PRESSURE CHECK, EAR EXAMINATION, EKG, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATIONS, HEALTH EDUCATION, HEMOCCULT, IMMUNIZATION, LACERATION, OFFICE VISITS, OSTEOPATHIC MANIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS AND PREMARITAL COUNSELING. THEY ALSO PROVIDE LABORATORY SERVICES SUCH AS BLOOD SUGAR, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. 1192853 0 1400611 CARSON FAMILY CARE CENTER (CFCC) IS AN OFFICE WITH 2 PHYSICIANS AND 1 NURSE PRACTITIONER THAT FOCUSES ON FAMILY PRACTICE FOR MONTCALM COUNTY. CFCC PROVIDES OUTPATIENT SERVICES SUCH AS ASTHMA SERVICES, AUDIOMETRY, BLOOD PRESSURE CHECKS, DISABILITY/IMPAIRMENT EVALUATIONS, DRUG AND ALCOHOL SCREENING, EAR EXAMINATION, EKG, EMPLOYEE SCREENING, EXCISION, FOREIGN BODY REMOVAL, GYNECOLOGICAL EXAMINATION, HEALTH EDUCATION, IMMUNIZATION, IMMUNOTHERAPY, INJURY MANAGEMENT WORK RELATED INJURIES, LACERATION, LASER COSMETICS, OFFICE VISITS, OSTEPATHIC MANIPULATIVE THERAPY, PATIENT COUNSELING, PHYSICAL EXAMINATIONS, PRE-EMPLOYMENT PHYSICALS, PREMARITAL COUNSELING, SAFETY PROGRAMS AND WORK SITE VISITS. THEY ALSO PROVIDE LABORATORY SERVICES SUCH AS BLOOD SUGAR, HEMOCCULT, HEMOGLOBIN, PREGNANCY TESTING, UA (DIPSTICK) AND WET PREP. 1132381 0 4201294 OTHER PROGRAM SERVICES INCLUDE THE OPERATION OF THE FOLLOWING FACILITIES: ASHLEY FAMILY CARE CENTER CARSON BEHAVIORAL CARE CENTER CARSON CITY HOSPITAL ORTHOPEDICS AND GENERAL SURGERY PHYSICAL REHABILITATION CENTER FOWLER FAMILY CARE CENTER GREENVILLE FAMILY CARE CENTER HOSPITALISTS LYONS FAMILY CARE CENTER PEDIATRIC AND ADOLESCENT SPECIALISTS STANTON FAMILY CARE CENTER CARSON HOME CARE CARSON PAIN MANAGEMENT 1132381 0 4201294 49031489 true true false true false false false false false true false false false true true true false false false false false false false true false true true true false true true false false false false false false false false false true false false false false false false false false false false true 179 0 true 718 true false false false false false true true false false false false X 13 7 false false false false true true true true true false false true true true true true true true true false X Duane Miller 9895843971 406 E Elm Street Carson City MI 48811 BRENT WILSON 2.00 X X 0 0 0 HAROLD HOUSE 2.00 X X 0 0 0 PATRICK E BURNS 2.00 X X 0 0 0 DAVID FREESTONE MD 40.00 X 240625 0 13640 DEBBY CASSADY 2.00 X 0 0 0 DOUGLAS POFF DO 40.00 X 200582 0 14572 GARY REETZ 2.00 X 0 0 0 MARK BRETT 2.00 X 0 0 0 REX A RIMMEL DO 2.00 X 0 0 0 ROBERT SEALS DO 40.00 X 270372 0 12602 RODERICK COY 2.00 X 0 0 0 TOM MACDONALD 2.00 X 0 0 0 TOM OSTRANDER 2.00 X 0 0 0 BRUCE L TRAVERSE 40.00 X 239392 0 7734 DUANE C MILLER 40.00 X 150658 0 11262 MATTHEW J THOMPSON 40.00 X 161307 0 7438 NANCY A WEAVER 40.00 X 143944 0 9374 NATALIE W BUSLEPP 40.00 X 110535 0 10503 RICHARD D TERRY 40.00 X 103289 0 6340 CHRISTOPHER E HERALD 40.00 X 301475 0 14503 ADAM Z COTE 40.00 X 346684 0 4811 BRUCE MURRAY 40.00 X 318431 0 14161 JANMEET SAHOTA 40.00 X 447609 0 14716 MICHAEL H MULLINS 40.00 X 346171 0 7623 PARUTAPPA R BHIMALLI 40.00 X 489493 0 18075 3870567 0 167354 46 false true false PHARMACY SYSTEMS INC PO BOX 71-0716 COLUMBUS OH 43271 PHARMACY CONSULTING SERVICES 239539 GARY RALPH 400 WILDWOOD DR EAST LANSING MI 48823 PHYSICIAN CONSULTING SERVICES 163350 PROMED 17197 LAUREL PARK N STE 521 LIVONIA MI 48152 HOME HEALTH CARE BILLING CONSULTING 149584 LIFE CARE SLEEP AND HEALTH CENTER LLC 7200 W SAGINAW HWY SUITE 2 LANSING MI 48917 SLEEP STUDY CONSULTING 145825 4 51800 6720 120702 179222 NET PATIENT SERVICE REVENUE 621300 57765950 57765950 MEDICARE/MEDICAID "HITECH" REVENUE 900099 2097029 2097029 0 0 0 0 59862979 263679 263679 0 0 591282 441006 150276 0 150276 150276 0 98909 0 -98909 -98909 -98909 16484 51800 2905 13579 13579 1582 1582 1582 0 CAFETERIA/COFFEE SHOP/VENDING 722219 323974 323974 MISCELLANEOUS 900099 113248 113248 0 0 0 0 437222 60809630 59862979 0 767429 19979 19979 0 0 0 2030147 1342727 687420 0 26402918 23491354 2911564 789777 589803 199974 1498094 1107947 390147 1853570 1620200 233370 0 118520 118520 70374 70374 0 0 40382 40382 4083309 1575732 2507577 533783 8051 525732 2838495 2347267 491228 745207 211171 534036 0 2923965 1544985 1378980 117110 114838 2272 0 0 419059 419059 0 1859186 1859186 833937 81714 752223 DIRECT PATIENT CARE SUPPLIES & EXPENSES 8309383 8309383 BAD DEBT EXPENSE 2333022 2333022 PROVIDER/OTHER TAXES 1725486 1689854 35632 RECRUITING 238633 218072 20561 286661 147145 138464 1052 60070997 49031489 11038456 1052 0 4202 4633 6202651 3996424 50900 28207 8138330 10007350 59492 43588 1065956 987209 1230733 2136643 45885042 22577244 23913240 23307798 5100698 5065752 0 0 0 0 239804 239804 627987 610940 46633993 46428348 4213919 6029100 0 15904911 15147534 1492963 1318003 25010 22510 1649023 710902 23285826 23228049 X 23141058 22936749 207109 263550 23348167 23200299 46633993 46428348 X 738633 -886501 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3234 3234 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 THE ORGANIZATION INDIRECTLY INFLUENCED LEGISLATION THOUGH ITS ANNUAL DUES PAID TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION; 13.92% OF DUES PAID WERE USED FOR SPECIFIC LOBBYING PURPOSES. 731643 731643 31154525 13250793 17903732 1471761 532525 939236 12287183 8793926 3493257 239930 239930 23307798 0 DEFINED BENEFIT PENSION LIABILITY 710902 710902 60809630 60070997 738633 -200065 -686436 -886501 -147868 59885652 -200065 2905 -197160 60082812 40382 686436 726818 60809630 60033520 2905 2905 60030615 40382 0 40382 60070997 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 CARSON CITY HOSPITAL IS A NONPROFIT, TAX-EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES ON RELATED INCOMES PURSUANT TO SECTION 501(A). ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE FINANCIAL STATEMENTS. HOWEVER, INCOME NOT DIRECTLY RELATED TO THE HOSPITAL'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE MORE LIKELY THAN NOT TEST, NO TAX BENEFIT IS RECORDED. THE HOSPITAL RECOGNIZES INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES AND INCLUDES THESE IN INTEREST AND INCOME TAX EXPENSE. THE HOSPITAL HAS NO AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AS OF DECEMBER 31, 2011 OR 2010. THE HOSPITAL DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX LIABILITIES TO SIGNIFICANTLY CHANGE OVER THE NEXT TWELVE MONTHS. THE HOSPITAL IS NO LONGER SUBJECT TO EXAMINATION BY TAXING AUTHORITIES FOR YEARS BEFORE 2008. SUMMER DANCE 68284 51800 16484 2905 0 0 68284 51800 16484 0 0 0 2905 0 0 2905 13579 true true X true X true X true true true false true true 0 0 2162964 0 2162964 0.03750 22 30157 11714532 7895636 3818896 0.06610 0 0 0 0 0 0.00000 22 30157 13877496 7895636 5981860 0.10360 84 3275 2281433 0 2281433 0.03950 4 19 218126 16262 201864 0.00350 13 88440 11488220 9616313 1871907 0.03240 0 0 0 0 0 0.00000 97 150 19979 0 19979 0.00030 198 91884 14007758 9632575 4375183 0.07570 220 122041 27885254 17528211 10357043 0.17930 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 true 2333022 45599 10152773 12475165 -2322392 X true true 1 1 CARSON CITY HOSPITAL

406 E ELM STREET CARSON CITY MI 48811

X X X X 14 CARSON PAIN MANAGEMENT

102 S THIRD STREET SUITE 300 CARSON CITY MI 48811

OUTPATIENT PAIN MANAGEMENT OFFICE CARSON CITY HOSPITAL ORTHOPEDICS AND GENERAL SURGERY

102 S THIRD ST STE 400 BOX 326 CARSON CITY MI 48811

GENERAL MEDICAL/SURGICAL OUTPATIENT CLINIC PHYSICAL REHABILITATION CARE CENTER

602 E ELM STREET CARSON CITY MI 48811

OUTPATIENT REHABILITATION CLINIC ITHACA FAMILY CARE CENTER

114 N MAIN ST ITHACA MI 48847

GENERAL MEDICAL OUTPATIENT CLINIC CARSON FAMILY CARE CENTER

102 S THIRD ST STE 100 BOX 277 CARSON CITY MI 48811

GENERAL MEDICAL OUTPATIENT CLINIC CARSON HOME CARE

406 E ELM ST CARSON CITY MI 48811

HOME HEALTH CARE GREENVILLE FAMILY CARE CENTER

1014 E WASHINGTON GREENVILLE MI 48838

GENERAL MEDICAL OUTPATIENT CLINIC PEDIATRIC & ADOLESCENT SPECIALISTS

245 S SECOND ST BOX 847 CARSON CITY MI 48811

GENERAL MEDICAL OUTPATIENT CLINIC STANTON FAMILY CARE CENTER

545 N STATE ST BOX 638 STANTON MI 48888

GENERAL MEDICAL OUTPATIENT CLINIC ASHLEY FAMILY CARE CENTER

320 S STERLING ST BOX 96 ASHLEY MI 48806

GENERAL MEDICAL OUTPATIENT CLINIC HOSPITALISTS

406 E ELM ST CARSON CITY MI 48811

GENERAL MEDICAL INPATIENT CLINIC CARSON BEHAVIORAL HEALTH CENTER

102 S THIRD ST STE 500 BOX 417 CARSON CITY MI 48811

BEHAVIORAL HEALTH CLINIC FOWLER FAMILY CARE CENTER

11017 W THIRD ST BOX 19 FOWLER MI 48835

GENERAL MEDICAL OUTPATIENT CLINIC LYONS FAMILY CARE CENTER

505 E BRIDGE ST BOX 186 LYONS MI 48851

GENERAL MEDICAL OUTPATIENT CLINIC Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 THE DEFINITION OF A COMMUNITY BENEFIT IS A SERVICE OR PROGRAM THAT THE HOSPITAL PROVIDES TO PROMOTE HEALTH AND HEALING AS A RESPONSE TO COMMUNITY NEEDS. COMMUNITY BENEFITS USUALLY GENERATE A LOW OR NEGATIVE FINANCIAL RETURN, RESPOND TO PUBLIC HEALTH NEEDS, INVOLVE EDUATION OR RESEARCH THAT IMPROVES THE OVERALL COMMUNITY HEALTH, AND RESPOND TO THE NEEDS OF SPECIAL POPULATIONS SUCH AS PERSONS LIVING IN POVERTY AND OTHER DISENFRANCHISED PERSONS. THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 2,333,022 Subsidized Health Services Schedule H, Part I, Line 7g THE COMMUNITY BENEFITS REPORT TAKES THE WHOLE HOSPITAL, WHICH ALSO TAKES THE MEDICAL SERVICES GROUP PHYSICIAN CLINICS INTO CONSIDERATION. SOME ITEMS CAN ONLY BE DONE IN THE HOSPITAL WHILE MANY OTHERS CAN BE DONE IN A PHYSICIAN CLINIC SETTING. OF THE $9.6 MILLION IN REVENUE THAT IS BROUGHT IN FROM THE PHYSICIAN CLINIC SETTING, $100 FROM BLOOD PRESSURE CHECKS, $5,300 FROM CHILD IMMUNIZATIONS, AND $230 FROM CHOLESTEROL TESTING. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON 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 UNCOLLECTIBLE 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. THE HOSPITAL DOES NOT ACCRUE INTEREST ON ANY OF ITS ACCOUNTS RECEIVABLE. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVELY CALCULATED ADJUSTMENTS ARISING UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED. BAD DEBT REPORTED IN PART III, LINE 2 IS REPORTED AT THE ESTIMATED NET REALIZABLE VALUE, THE SAME METHODOLOGY USED TO REPORT BAD DEBT IN THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS. THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY REPORTED IN PART III, LINE 3 IS DETERMINED BY USING A PERCENTAGE (2.6%) OF THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE AT COST. THIS PERCENTAGE IS DETERMINED BY ANALYZING THE HOSPITAL'S WRITE-OFFS COMPARED TO ITS TOTAL GROSS REVENUE. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE COST TO CHARGE RATIO IS FIGURED BY TAKING THE TOTAL EXPENSES EXCLUSIVE OF BAD DEBT AND DIVIDING THAT BY GROSS PATIENT REVENUE AND OTHER OPERATING REVENUE. ANY SHORTFALLS THAT RESULT FROM MEDICARE ALLOWABLE COSTS EXCEEDING MEDICARE REVENUE CAN BE CONSIDERED A COMMUNITY BENEFIT IF THE ACTIVITY IS SOMETHING THAT CARSON CITY HOSPITAL IS DOING TO CREATE THE AWARENESS AND WELL-BEING OF THE HOSPITAL COMMUNITY. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b CARSON CITY HOSPITAL INITIATES COLLECTION AT THE POINT OF SERVICE THROUGH THE PATIENT ACCESS DEPARTMENT. PATIENTS ARE ADVISED OF THEIR CO-PAY AND DEDUCTIBLE AND ASKED FOR A DEPOSIT ON THESE SELF-PAY CONTRIBUTIONS. PATIENTS WHO DO NOT HAVE INSURANCE ARE ADVISED OF ESTIMATED COST, AND ASSISTANCE PROGRAMS ARE OFFERED ALONG WITH CONTACT INFORMATION TO OBTAIN FURTHER INFORMATION. THE PATIENT'S BILL IS CHARGED, CODED, AND PROCESSED WITH THE APPROPRIATE PAYORS, IF APPLICABLE, AND AT THE POINT ALL THIRD PARTY PAYORS HAVE MADE PAYMENT, THE REMAINING BALANCE IS BILLED ON A STATEMENT TO THE PATIENT. AT THE POINT THAT THE PATIENT RECEIVES THE STATEMENT, THEY MAY CHOOSE TO MAKE PAYMENT ARRANGEMENTS THROUGH A PAYMENT PLAN, OR MAY CHOOSE TO APPLY FOR ASSISTANCE. THE PATIENT WHO DOES NOT MAKE PAYMENT ARRANGEMENTS OR DOES NOT APPLY FOR ASSISTANCE, WILL RECEIVE THREE STATEMENTS OVER A 90-DAY PERIOD. IF NO RESOLUTION IS ACHIEVED THE ACCOUNT WILL BE REFERRED TO AN OUTSIDE AGENCY FOR COLLECTION. THE PATIENT HAS 60 DAYS AT THE AGENCY BEFORE THEIR ACCOUNT IS RECORDED AS BAD DEBT. THE PATIENT STILL HAS THE OPTION OF APPLYING FOR ASSISTANCE OR MAKING PAYMENT ARRANGEMENTS WITH THE AGENCY. FINANCIAL ASSISTANCE POLICY: BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS SCHEDULE H, PART V, SECTION B, LINE 11 ALTHOUGH NOT SPECIFICALLY OUTLINED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL USES THE FOLLOWING FACTORS IN DETERMINING THE AMOUNTS CHARGED TO PATIENTS: - INCOME LEVEL - ASSET LEVEL - MEDICAL INDIGENCY - INSURANCE STATUS - UNINSURED DISCOUNT - MEDICAID/MEDICARE THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS CURRENTLY UNDER REVIEW, AND THE HOSPITAL IS CONSIDERING ADDING SPECIFIC INFORMATION RELATED THE FACTORS USED IN DETERMINING THE BASIS FOR AMOUNTS CHARGED TO PATIENTS. FINANCIAL ASSISTANCE POLICY: MEASURES TO PUBLICIZE THE POLICY WITHIN THE COMMUNITY SERVED SCHEDULE H, PART V, SECTION B, LINE 13 ALTHOUGH NOT SPECIFICALLY OUTLINED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL USES THE FOLLOWING METHODS TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED: - THE POLICY WAS POSTED ON THE HOSPITAL FACILITY'S WEBSITE. - THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS OR WAITING ROOMS. - THE POLICY WAS POSTED IN THE HOSPITAL FACILITY'S ADMISSIONS OFFICE. - THE POLICY WAS AVAILABLE UPON REQUEST. - PATIENTS WERE MADE AWARE OF THE POLICY UPON ADMISSION. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS CURRENTLY UNDER REVIEW, AND THE HOSPITAL IS CONSIDERING ADDING SPECIFIC INFORMATION RELATED THE METHODS USED TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED. Other collection actions permitted Schedule H, Part V Section B, Line 15e (1) CARSON CITY HOSPITAL - IF AN ACCOUNT IS DELINQUENT BY 90 DAYS, AND THERE HAS BEEN NO PLAN FOR PAYMENT MADE OR FOLLOWED, THE ACCOUNT WILL BE CONSIDERED FOR FURTHER ACTION WHICH MAY INCLUDE: AN OUTSIDE COLLECTION AGENCY, SMALL CLAIMS COURT, OR OTHER ACTION. ALL REASONABLE EFFORTS MUST BE MADE BEFORE SENDING AN ACCOUNT TO A COLLECTION AGENCY, AND NO ACCOUNT SHALL BE SENT TO AN OUTSIDE COLLECTION AGENCY WITHOUT APPROVAL FROM AN AUTHORIZED ASSOCIATE OR OTHER APPROVED INDIVIDUAL. IF AN ACCOUNT PLACED IN A COLLECTION AGENCY HAS BEEN DETERMINED TO NEED LEGAL ACTION TO COLLECT THE BALANCE, THE ACCOUNT MUST BE REVIEWED BY AN ADMINISTRATOR BEFORE SUIT CAN BE FILED.; Means used to determine amounts billed Schedule H, Part V Section B, Line 19d (1) CARSON CITY HOSPITAL - DURING 2011, THE HOSPITAL FACILITY USED THE HIGHEST COMMERCIAL RATE WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. DURING 2012, THE HOSPITAL FACILITY HAS CHANGED ITS PRACTICE AND USES THE AVERAGE OF THE THREE HIGHEST COMMERCIAL RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.; Needs assessment. Schedule H, Part VI, Line 2 CARSON CITY HOSPITAL RESPONDS TO THE HEALTHCARE NEEDS OF ITS ENTIRE SERVICE AREA. ITS DOORS ARE OPEN TO ALL THOSE WHO NEED HEALTHCARE SERVICES. INFORMATION ABOUT HEALTHCARE NEEDS IS RECEIVED THROUGH PARTNERSHIPS WITH LOCAL NON-PROFITS, GOVERNMENT AGENCIES AND OTHER HEALTHCARE ORGANIZATIONS, SUCH AS THE MID-MICHIGAN DISTRICT HEALTH DEPARTMENT AND THE IONIA COUNTY HEALTH DEPARTMENT - WHICH, TOGETHER, MONITOR THE MORTALITY RATES AND CAUSES IN CLINTON, GRATIOT, IONIA AND MONTCALM COUNTIES. HOSPITAL SERVICE RECORDS AND PATIENT SATISFACTION SURVEYS - MANAGED BY PRESS GANEY - ALSO PROVIDE FEEDBACK TO HOSPITAL STAFF ABOUT THE NEEDS OF THE COMMUNITY. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 CARSON CITY HOSPITAL OFFERS SEVERAL OPTIONS FOR ASSISTING PATIENTS WITH THEIR BILLS; THIS ASSISTANCE INFORMATION IS OFFERED AT THE TIME OF REGISTRATION, THROUGH PHONE CONTACT, AND IS ADVISED ON THE PATIENTS STATEMENTS. A TOLL FREE NUMBER IS PROVIDED FOR PATIENTS TO CALL AND INQUIRE ABOUT ASSISTANCE IF PERSONAL CONTACT WAS NOT AVAILABLE AT THE TIME THE PATIENT RECEIVED SERVICES. CARSON CITY HOSPITAL, THROUGH A PARTNERSHIP WITH MONTCALM COUNTY DEPARTMENT OF HUMAN SERVICES, PROVIDES DIRECT ON-SITE ACCESS TO A MARA (MEDICAID ASSISTANCE REVIEW AGREEMENT) WORKER (DHS TRAINED STAFF MEMBER) WHO ASSISTS THE PATIENT WITH THE APPLICATION PROCESS FOR STATE OR COUNTY PROGRAMS, AND IF THE PATIENT DOES NOT MEET THE REQUIREMENTS FOR THESE TYPES OF ASSISTANCE, PROVIDES THE PATIENT WITH THE CHARITY CARE APPLICATION. THIS APPLICATION IS PROCESSED BY THE HOSPITAL BILLING DEPARTMENT AND IF APPROVED FOR ASSISTANCE PROVIDES CHARITY CARE AT 200% OF THE FEDERAL POVERTY GUIDELINES. THE ASSISTANCE PROGRAM INFORMATION FOR PATIENTS IS HANDED OUT AT THEIR TIME OF SERVICE BY THE RESPECTED DEPARTMENTS (RADIOLOGY, LABORATORY, PRE-ADMISSION TESTING, ETC). AN ON-SITE MARA (MEDICAID ASSISTANCE REVIEW AGREEMENT) WORKER IS ON-SITE FOR INDIVIDUALS THAT DO SEEK ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY IS ALSO POSTED ON THE HOSPITAL'S WEBSITE, IS AVAILABLE TO ANYONE UPON REQUEST, AND IS POSTED IN THE EMERGENCY/WAITING ROOMS AND ADMISSIONS OFFICE. Community information. Schedule H, Part VI, Line 4 CARSON CITY HOSPITAL (CCH) IS A 77-BED, ACUTE CARE HOSPITAL LOCATED IN CENTRAL MICHIGAN. IT IS THE OLDEST OSTEOPATHIC HOSPITAL IN MICHIGAN, FOUNDED IN 1936 BY EMMETT BINKERT, DO. SINCE THIS TIME CCH HAS BEEN COMMITTED TO SERVING THE RESIDENTS OF COMMUNITIES IN A FOUR-COUNTY AREA. THE HOSPITALS GOVERNING BODY CONSISTS PRIMARILY OF VOLUNTEER MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. IN THE FALL OF 1996, CARSON BECAME A PART OF CARSON HEALTH NETWORK (CHN). CHN WAS INTRODUCED TO WORK AS AN UMBRELLA UNDER WHICH ALL THE INDIVIDUAL HEALTHCARE ENTITIES ARE CONTAINED. CHN INCLUDES CARSON CITY HOSPITAL, FAMILY MEDICINE PRACTICES AND SEVERAL SPECIALTY CLINICS OFFERING A WIDE VARIETY OF SERVICES. THE FAMILY MEDICINE PROFESSIONAL MEDICAL STAFF, IN COOPERATION WITH HOSPITAL BASED SPECIALISTS, SERVES PATIENTS IN ASHLEY, CARSON CITY, FOWLER, GREENVILLE, ITHACA, LYONS, MAPLE RAPIDS AND STANTON. THESE OFFICES FALL INTO 4 COUNTIES WHICH INCLUDE MONTCALM, IONIA, CLINTON AND GRATIOT COUNTIES. ALL AREAS ARE DESIGNATED AS RURAL BASED WITH AN AVERAGE OF 21,750 HOUSEHOLDS WITH AN AVERAGE HOUSEHOLD SIZE OF 2.7 PEOPLE. THE AVERAGE INCOME PER HOUSEHOLD IS $47,355 WHILE 13.75% OF ALL FAMILIES ARE BELOW THE POVERTY LEVEL. ALSO INCLUDED IN THIS GEOGRAPHIC AREA ARE 5 OTHER HOSPITALS, SPARROW CLINTON HOSPITAL, SPARROW IONIA HOSPITAL, SPECTRUM HEALTH UNITED CAMPUS, SHERIDAN COMMUNITY HOSPITAL, AND GRATIOT MEDICAL CENTER. IN ADDITION TO ACUTE HOSPITAL CARE, CCH PROVIDES A VARIETY OF ADVANCED SERVICES, RANGING FROM AN INTENSIVE/CORONARY CARE UNIT TO A BEHAVIORAL HEALTH UNIT AND MULTIPLE OUTPATIENT SERVICES. CCH ALSO PROVIDES 24-HOUR EMERGENCY ROOM CARE. PHYSICIANS ARE AVAILABLE TO YOU ANY TIME AT THE HOSPITAL, DAY OR NIGHT FOR EMERGENCY OR NON-EMERGENCY MEDICAL ASSISTANCE. ANY SURPLUS FUNDS AVAILABLE TO THE HOSPITAL ARE USED FOR FACILITY AND EQUIPMENT IMPROVEMENTS IN ORDER TO PROVIDE BETTER PATIENT CARE. THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 INCLUDED PROVISIONS FOR IMPLEMENTING HEALTH INFORMATION TECHNOLOGY UNDER THE HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT ("HITECH"). THESE PROVISIONS WERE DESIGNED TO INCREASE THE USE OF ELECTRONIC HEALTH RECORDS ("EHR") TECHNOLOGY AND ESTABLISH REQUIREMENTS FOR A MEDICARE AND MEDICAID INCENTIVE PAYMENTS PROGRAM BEGINNING IN 2011 FOR ELIGIBLE HOSPITALS AND PROVIDERS THAT ADOPT AND MEANINGFULLY USE CERTIFIED EHR TECHNOLOGY. ELIGIBILITY FOR ANNUAL MEDICARE INCENTIVE PAYMENTS IS DEPENDENT ON PROVIDERS DEMONSTRATING MEANINGFUL USE OF EHR TECHNOLOGY IN EACH PERIOD OVER A FOUR-YEAR PERIOD. INITIAL MEDICAID INCENTIVE PAYMENTS ARE AVAILABLE TO PROVIDERS THAT ADOPT, IMPLEMENT, OR UPGRADE CERTIFIED EHR TECHNOLOGY, BUT PROVIDERS MUST DEMONSTRATE MEANINGFUL USE OF SUCH TECHNOLOGY IN SUBSEQUENT YEARS TO QUALIFY FOR ADDITIONAL INCENTIVE PAYMENTS. DURING 2011, CARSON CITY HOSPITAL DEMONSTRATED THE MEANINGFUL USE OF ITS CERTIFIED EHR TECHNOLOGY AND WAS ABLE TO RECOGNIZE APPROXIMATELY $2.1 MILLION IN REVENUE FOR HITECH INCENTIVES FROM MEDICARE AND MEDICAID. THESE INCENTIVE PAYMENTS ALLOW THE HOSPITAL TO PROVIDE ADDITIONAL QUALITY SERVICES TO THOSE IN THE COMMUNITY. Promotion of community health Schedule H, Part VI, Line 5 CARSON CITY HOSPITAL PROVIDES A SPEAKERS BUREAU LIST OF PHYSICIANS AND STAFF MEMBERS WHO ARE WILLING TO GO OUT INTO THE COMMUNITY AND SPEAK ON A VARIETY OF HEALTHCARE, QUALITY-OF-LIFE, AND GENERAL-INTEREST TOPICS TO SCHOOLCHILDREN, BUSINESS CLUBS, AND OTHER NON-PROFIT ORGANIZATIONS. THE HOSPITAL ALSO MAINTAINS A MONTHLY BROWN BAG LUNCH SERIES FEATURING SIMILAR TOPICS, WHICH IS HELD INSIDE THE HOSPITAL AND OPEN TO THE COMMUNITY. CARSON CITY HOSPITAL'S ACTIVITIES PROMOTE THE HEALTHCARE OF THE COMMUNITY BY EDUCATING AND PROVIDING EASY ACCESSIBLE HEALTHCARE WITH A 24-HOUR EMERGENCY DEPARTMENT. OUTSIDE PHYSICIANS CAN APPLY FOR PRIVILEGES AT CARSON CITY HOSPITAL THROUGH A PROCESS TO TREAT AND PROVIDE MEDICAL CARE AT THE HOSPITAL. IN ADDITION, CARSON CITY HOSPITAL IS COMPRISED OF SEVEN HOSPITAL-OWNED PHYSICIAN CLINICS IN A RURAL SETTING. FREE AND REDUCED RATE SPORTS PHYSICALS ARE PROVIDED AT SELECTED CLINICS. Affiliated health care system Schedule H, Part VI, Line 6 IN JANUARY 1997, CHN BECAME AFFILIATED WITH THE SPARROW HEALTH SYSTEM OF LANSING, MICHIGAN. THIS AFFILIATION HAS MANY BENEFITS INCLUDING HOLDING DOWN HEALTH CARE COSTS, IMPROVED ACCESS TO SPECIALIZED SERVICES, ACCESS TO INFORMATION SYSTEMS, MANAGED CARE CONTRACTS AND NEW PHYSICIAN RECRUITMENT. CCH IS A MEMBER OF THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND THE MICHIGAN OSTEOPATHIC ASSOCIATION. State filing of community benefit report Schedule H, Part VI, Line 7 MI true CARSON CITY FRONTIER DAYS INC 123 MAIN STREET PO BOX 340 CARSON CITY MI 48811 386111280 501(C)(4) 7519 0 N/A N/A N/A 0 1 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE HOSPITAL MAKES GRANTS TO VARIOUS COMMUNITY ORGANIZATIONS. GRANTS MADE ARE UNRESTRICTED AND CAN BE USED IN ANY WAY THE DONEE ORGANIZATION SEES FIT TO FURTHER ITS MISSION. X true true X X X false false false false false false false true false ROBERT SEALS DO 215738 0 49871 0 4763 0 7350 0 5252 0 282974 0 0 0 JANMEET SAHOTA 447464 0 0 0 145 0 7350 0 7366 0 462325 0 0 0 MICHAEL H MULLINS 345835 0 0 0 336 0 7350 0 273 0 353794 0 0 0 ADAM Z COTE 346684 0 0 0 0 0 0 0 4811 0 351495 0 0 0 CHRISTOPHER E HERALD 300200 0 600 0 675 0 7350 0 7153 0 315978 0 0 0 MATTHEW J THOMPSON 158962 0 0 0 2345 0 4860 0 2578 0 168745 0 0 0 BRUCE L TRAVERSE 187471 0 10100 0 41821 0 7209 0 525 0 247126 0 0 0 DOUGLAS POFF DO 172401 0 28181 0 0 0 6116 0 8456 0 215154 0 0 0 DAVID FREESTONE MD 189510 0 50485 0 630 0 7350 0 6290 0 254265 0 0 0 DUANE C MILLER 147584 0 600 0 2474 0 4710 0 6552 0 161920 0 0 0 BRUCE MURRAY 317524 0 600 0 307 0 7350 0 6811 0 332592 0 0 0 PARUTAPPA R BHIMALLI 474774 0 0 0 14719 0 7350 0 10725 0 507568 0 0 0 NANCY A WEAVER 138808 0 2670 0 2466 0 4477 0 4897 0 153318 0 0 0 Housing allowance or residence for personal use Schedule J, Part I, Line 1a MATTHEW J. THOMSON (COO) RECEIVED A HOUSING ALLOWANCE IN THE AMOUNT OF $300 DURING 2011. THE AMOUNT WAS INCLUDED IN HIS 2011 FORM W-2 AS TAXABLE COMPENSATION. Non-fixed payments Schedule J, Part I, Line 7 BRUCE L. TRAVERSE (PRESIDENT/CEO) RECEIVED A DISCRETIONARY QUARTERLY STIPEND IN THE AMOUNT OF $9,500 DURING 2011. THE AMOUNT WAS INCLUDED IN HIS 2011 FORM W-2 AS TAXABLE COMPENSATION. MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 54965HKS4 2006-02-01 18000000 HOSPITAL EQUIPMENT LOAN PROGRAM (HELP) false false true MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 594654HG5 2007-12-18 455937 HOSPITAL EQUIPMENT LOAN PROGRAM (HELP) false false true 3601603 0 18000000 0 0 0 133000 0 0 14012600 3854400 0 2009 false false true true 85488 0 455937 0 0 0 0 0 0 0 455937 0 2007 false false true true false false false false 0.0000 0.0000 0.0000 true false false false false 0.0000 0.0000 0.0000 true false true false false false true false true false false false true X TOTAL PROCEEDS OF ISSUE PART II, LINE 3 THE ORGANIZATION SPENT ITS OWN OPERATING FUNDS AND IN TURN WAS REIMBURSED WITH THE BOND PROCEEDS; THEREFORE THERE ARE NO INTEREST EARNINGS ON THE PROCEEDS. Procedures to take corrective action Schedule K, Part V THE ORGANIZATION WORKS DIRECTLY WITH THE MICHIGAN HOSPITAL ASSOCIATION (MHA) TO ENSURE COMPLIANCE, AS THE BONDS ARE PART OF A POOLED FINANCING AND ARE ISSUED TO MHA. SPARROW HEALTH SYSTEM M. BRETT, T. OSTRANDER AND G. REETZ ARE CCH BOARD MEMBERS AND SPARROW OFFICERS 466097 MARK BRETT, TOM OSTRANDER AND GARY REETZ, CARSON CITY HOSPITAL BOARD MEMBERS, SERVE AS THE SENIOR VICE PRESIDENT, AFFILIATE OPERATIONS; VICE PRESIDENT, PROFESSIONAL SERVICES; AND CONTROLLER, RESPECTIVELY, FOR SPARROW HEALTH SYSTEM, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2011, CARSON CITY HOSPITAL MADE PAYMENTS TO SPARROW HEALTH SYSTEM IN THE AMOUNT OF $406,135 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICALS, LABORATORY AND OTHER PATIENT CARE SERVICES, SOFTWARE SUPPORT, EQUIPMENT RENTAL, AND PHYSICIAN RECRUITING. false SPARROW HEALTH SYSTEM M. BRETT, T. OSTRANDER AND G. REETZ ARE CCH BOARD MEMBERS AND SPARROW OFFICERS 204784 MARK BRETT, TOM OSTRANDER AND GARY REETZ, CARSON CITY HOSPITAL BOARD MEMBERS, SERVE AS THE SENIOR VICE PRESIDENT, AFFILIATE OPERATIONS; VICE PRESIDENT, PROFESSIONAL SERVICES; AND CONTROLLER, RESPECTIVELY, FOR SPARROW HEALTH SYSTEM, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2011, CARSON CITY HOSPITAL RECEIVED PAYMENTS FROM SPARROW HEALTH SYSTEM IN THE AMOUNT OF $204,784 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICALS, OFFICE RENT, AND SUPPORT FOR PSYCHIATRIC MEDICAL EDUCATION. false Description of other program services Form 990, Part III, Line 4d OTHER PROGRAM SERVICES INCLUDE THE OPERATION OF THE FOLLOWING FACILITIES: ASHLEY FAMILY CARE CENTER CARSON BEHAVIORAL CARE CENTER CARSON CITY HOSPITAL ORTHOPEDICS AND GENERAL SURGERY PHYSICAL REHABILITATION CENTER FOWLER FAMILY CARE CENTER GREENVILLE FAMILY CARE CENTER HOSPITALISTS LYONS FAMILY CARE CENTER PEDIATRIC AND ADOLESCENT SPECIALISTS STANTON FAMILY CARE CENTER CARSON HOME CARE CARSON PAIN MANAGEMENT Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a THE EXECUTIVE COMMITTEE OF THE BOARD SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, THE PRESIDENT, THE VICE-CHAIRPERSON, THE SECRETARY/TREASURER AND THE MEDICAL DIRECTOR. A SIXTH MEMBER SHALL BE APPOINTED BY THE CHAIRPERSON AND CHOSEN FROM ONE OF THE CLASS B MEMBERS OF THE BOARD. THE CHAIRPERSON SHALL APPOINT REPLACEMENTS WHEN NECESSARY. A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM. IT SHALL HAVE THE AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. THE COMMITTEE SHALL MAKE A FULL REPORT OF ITS ACTIONS, IF ANY, AT THE NEXT REGULAR MEETING OF THE BOARD. MEETINGS OF THE COMMITTEE MAY BE HELD AT ANY TIME ON CALL BY THE CHAIRPERSON OF THE BOARD. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 CARSON CITY HOSPITAL (CCH) IS ORGANIZED ON A MEMBERSHIP BASIS. THERE ARE TWO CLASSES OF MEMBERS: CLASS A MEMBERSHIP CONSISTS OF THE ORIGINAL DIRECTORS OF CCH, EXCLUDING THOSE DIRECTORS WHO ARE ELECTED OR APPOINTED BY THE CLASS B MEMBER; THE CLASS B MEMBER IS SPARROW HEALTH SYSTEM (SPARROW), AN UNRELATED MICHIGAN NONPROFIT CORPORATION. OTHER THAN SPARROW, THERE SHALL BE NO ADDITIONAL CLASS B MEMBERSHIP INTERESTS WITHOUT THE CONSENT OF SPARROW. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a CLASS A MEMBERS EACH HAVE ONE VOTE FOR PURPOSES OF VOTING BY MEMBERS; THE NUMBER OF VOTES HELD BY THE CLASS B MEMBER (SPARROW) IS PROPORTIONATE TO THE SPARROW PERCENTAGE INTEREST MULTIPLIED BY THE VOTES HELD IN THE AGGREGATE BY BOTH CLASS A AND CLASS B MEMBERS. AT THE ANNUAL MEETING OF THE MEMBERS, THE CLASS A MEMBERS ELECT 9 DIRECTORS OF THE BOARD OF DIRECTORS BY MAJORITY VOTE OF THE CLASS A MEMBERS, AND THE CLASS B MEMBER (SPARROW) ELECTS A NUMBER OF DIRECTORS OF THE BOARD OF DIRECTORS THAT IS CONSISTENT WITH THE CURRENT SPARROW PERCENTAGE INTEREST. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b THE FOLLOWING ACTIVITIES REQUIRE THE AFFIRMATIVE VOTE OF THE CLASS B MEMBER (SPARROW): 1. AMENDMENTS TO THE ARTICLES OF INCORPORATION AND THE BYLAWS; 2. THE DISSOLUTION, MERGER, SALE, SALE OF SUBSTANTIALLY ALL OF THE ASSETS, LEASE, OR TRANSFER OF CONTROL; 3. THE SALE OF A MAJORITY OWNERSHIP INTEREST IN CCH; 4. THE PUBLICLY RECOGNIZED "AFFILIATION" WITH ANY ORGANIZATION OTHER THAN THE CLASS B MEMBER (SPARROW); 5. APPROVAL OF CCH'S ANNUAL OPERATING BUDGET, WHEN SUCH BUDGET REFLECTS A TOTAL MARGIN OF LESS THAN 2% OF NET REVENUE; 6. APPROVAL OF CCH'S ANNUAL CAPITAL BUDGET, WHEN SUCH BUDGET ANTICIPATES AN ADDITIONAL CAPITAL CONTRIBUTION FROM THE CLASS B MEMBER (SPARROW) BEYOND ITS ORIGINAL CAPITAL CONTRIBUTION; 7. THE INCURRENCE OF ANY DEBT OBLIGATION IN THE AGGREGATE GREATER THAN $500,000; 8. THE APPROVAL OF CAPITAL EXPENDITURES IN EXCESS OF $500,000 (EXCEPT AS TO REPLACE EQUIPMENT); AND 9. ANY ACTION THAT ALLOWS OR FACILITATES THE CREATION OF A NEW CLASS OF MEMBERS OR CREATION OF A MEMBERSHIP INTEREST IN CCH. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE FORM 990 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S MANAGEMENT. A BOARD MEETING IS HELD WITH OUR TAX ADVISORS WHERE A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY FOR REVIEW BEFORE THE RETURN IS FILED WITH THE IRS. THE BOARD IS GIVEN A SUMMARY OF KEY POINTS REGARDING THE FORM 990, AND IS ALLOWED TO ASK ANY QUESTIONS THEY MAY HAVE. ONCE ALL BOARD MEMBERS HAVE REVIEWED THE RETURN, IT IS THEN SUBMITTED TO THE IRS. Conflict of interest policy Form 990, Part VI, Section B, Line 12c CONFLICT OF INTEREST QUESTIONNAIRES ARE DISTRIBUTED TO ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO DETERMINE WHETHER ANY POTENTIAL CONFLICTS OF INTEREST EXIST. THE HOSPITAL EXECUTIVE COMMITTEE, WHICH INCLUDES THE PRESIDENT OF THE BOARD OF DIRECTORS, DISCUSSES THE CONFLICT OF INTEREST QUESTIONNAIRES TO DETERMINE WHETHER AN ACTUAL CONFLICT EXISTS. IF A CONFLICT IS DETERMINED TO EXIST, THE PERSON WITH THE CONFLICT IS RECUSED FROM TAKING PART IN ANY DECISIONS CONCERNING THE CONFLICTING ISSUE. Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/CEO. THE BOARD PRESIDENT/CEO IS REMOVED FROM THE BOARD DISCUSSIONS TO PREVENT HIM FROM DISCUSSING AND DETERMINING HIS OWN COMPENSATION. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR THE CEO, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. COMPENSATION FOR THE CURRENT YEAR IS DISCUSSED AND APPROVED IN THE PREVIOUS YEAR DURING THE BUDGET APPROVAL PROCESS. THE 2011 COMPENSATION WAS REVIEWED AND APPROVED DURING NOVEMBER/DECEMBER 2010 DURING THE ANNUAL BUDGETING PROCESS; THE 2012 COMPENSATION WAS REVIEWED AND APPROVED DURING NOVEMBER/DECEMBER 2011 DURING THE ANNUAL BUDGETING PROCESS. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b THE ORGANIZATION'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION FOR ALL POSITIONS, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES. THE BOARD OF DIRECTORS USES COMPENSATION STUDIES AND WAGE SURVEYS IN DETERMINING THE AMOUNT OF COMPENSATION FOR ALL POSITIONS, AND THEIR DISCUSSIONS ARE DOCUMENTED IN THE BOARD MEETING MINUTES. THE 2011 COMPENSATION WAS REVIEWED AND APPROVED AT THE END OF 2010 DURING THE ANNUAL BUDGETING PROCESS. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 AN ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. AS A HOSPITAL, THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS AN ATTACHMENT TO ITS FORM 990, WHICH IS A REQUIRED DISCLOSURE PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -200065; CHANGE IN PENSION LIABILITY - -686436;