2011-05-16T07:13:04-05:00 2010-09-30 BRINING & NARTKER PC 47 AUSTIN STREET PO BOX 348 SANDUSKY MI 484710348 990 2009-10-01 381738615 MCKENZIE MEMORIAL HOSPITAL MCKE 8106486162 120 DELAWARE STREET SANDUSKY MI 48471 AMY RUEDISUELI 8106486162 2011-05-11 true JOSEPH H NARTKER 8106484931 2011-05-16 2009 2016-02-24 21:20:13Z MCKENZIE HEALTH SYSTEM 30801520 false X WWW.MCKENZIEHEALTH.ORG X MI FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. 11 9 246 40 54641 -57549 220811 167438 29697175 30502345 16001 19046 86739 81493 30020726 30770322 0 0 10591721 10300492 0 0 19649555 21328624 30241276 31629116 -220550 -858794 10120515 9669040 6217131 6426003 3903384 3243037 FOUNDED AS A COMMUNITY HOSPITAL, MCKENIZE MEMORIAL HOSPITAL EXISTS TO PROVIDE EXCELLENT, COMPASSIONATE AND ESSENTIAL HEALTHCARE. false false 31629116 30770322 PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SANILAC COUNTY. FISCAL YEAR REGISTRATIONS ARE: INPATIENT = 406; OUTPATIENT = 18,785 EMERGENCY ROOM = 5,972; AND AMBULANCE RUNS = 1,814 31629116 true true false false false false false false false true true false false false false false false false true false true false false true false false false false false false true false false false false false false true true false false true 49 0 true 246 true true true false false false false false false false false false false 11 9 false false false false true true true true true false false true true true true true true true true true true X X MCKENIZE MEMORIAL HOSPITAL 8106486162 120 DELAWARE STREET SANDUSKY MI 48471 MELANIE KRAMER 40.00 X 230895 0 27182 STEVE BARNETT 40.00 X X 181317 0 18335 AL STOUTENBURG X X 0 0 0 JOAN NAGELKIRK X X 0 0 0 DAVID TUBBS X 0 0 0 DR ROBERT HASSLER X 0 0 0 ROGER LODING X X 0 0 0 JUDITH FERGUSON X X 0 0 0 LARRY MITCHELL X 0 0 0 LINDA KELKE 40.00 X 0 0 0 MICHAEL DRYER 40.00 X 0 0 0 MARCUS FREE 40.00 X 396533 0 17645 ALFRED DOMINGO 40.00 X 343991 0 0 WILLIAM WEINER 40.00 X 231116 0 12417 MOHAMED ELRAHMAN 40.00 X 210111 0 24518 MARK ENGLISH 40.00 X 164105 0 29764 1758068 129861 17 false true false NES PO BOX 277001 ATLANTA GA 30384 ER COVERAGE 1100893 CPSI 6600 WALL STREET MOBILE AL 36695 COMPUTER TECH 235619 2 167438 167438 OUTPATIENT 23123435 23123435 INPATIENT 3368926 3368926 PHYSICIANS REVENUE 3210725 3210725 RURAL HEALTHCARE 402616 402616 OTHER INCOME 396643 396643 30502345 19046 19046 54641 54641 54641 54641 55018 31198 23820 23820 OTHER INCOME 3032 3032 3032 30770322 30548243 54641 192863 192863 8090116 8090116 245466 245466 1199527 1199527 572520 572520 67799 67799 21400 21400 2191963 2191963 142781 142781 1624332 1624332 222180 222180 547789 547789 95092 95092 27249 27249 28873 28873 254559 254559 CONTRACTUAL ADJUSTMENTS 11804167 11804167 BAD DEBTS 1240147 1240147 DEPRECIATION 882113 882113 DRUGS 531716 531716 REPAIRS & MAINTENANCE 471741 471741 1174723 1174723 31629116 31629116 0 0 117252 25858 1784302 1066994 2323545 2358322 478667 498410 82834 123520 14349345 8903273 5333915 5446072 149864 10120515 9669040 1942158 2351402 3634184 3250301 640789 824300 6217131 6426003 X 3856220 3198618 47164 44419 3903384 3243037 10120515 9669040 X false true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 160652 160652 7025318 3871304 3154014 165360 149254 16106 6904977 4800799 2104178 93038 81916 11122 5446072 CHASE - LINE OF CREDIT 179705 TRI COUNTY - COMPUTER SERVERS 136818 JPM - OR SCOPE LOAN 135886 GE FINANCIAL - C ARM 101172 TRI COUNTY - AUTOCLAVE 77066 BONE DENSITY GE LEASE 65913 NUCL MEDICINE SIEMENS LEASE 50792 ESB - X-RAY EQUIPMENT 49057 ESB - 2009 FORD PICKIP LOAN 18723 ESB - AMBULANCE 5290 TRI COUNTY BANK - FURNITURE 3878 TRI COUNTY BANK - AMBULANCE TRI COUNTY BANK - PHONE SYSTEM CITIZENS BANK - CT RENOVATIONS RADIOMETER LEASE 824300 30770322 31629116 -858794 -858794 18809613 18809613 11960709 11960709 30770322 19668407 19668407 11960709 11960709 31629116 RECONCILIATION OF CHANGES - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 8 CONTRACTUAL ADJUSTMENTS -11,804,167 CHARITY CARE -156,542 CONTRACTUAL ADJUSTMENTS 11,804,167 CHARITY CARE 156,542 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B CONTRACTUAL ADJUSTMENTS 11,804,167 CHARITY CARE 156,542 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XIII, LINE 4B CONTRACTUAL ADJUSTMENTS 11,804,167 CHARITY CARE 156,542 MI HOSP AUXILARY 29592 29592 28157 BENEFIT RAFFLE 25426 25426 750 375 1916 55018 55018 750 375 30073 31198 23820 true true true X true X false true false false 87864 87864 0.00280 3645712 2172756 1472956 0.04660 3733576 2172756 1560820 0.04930 289496 232003 57493 0.00180 8550 8550 0.00030 2675 2675 0.00010 300721 232003 68718 0.00220 4034297 2404759 1629538 0.05150 true 720525 36676 5591445 5536521 54924 X true true MCKENIZE MEMORIAL HOSPITAL

120 DELAWARE STREET SANDUSKY MI 48471

X X AUSTIN STREET RURAL HEALTH CLINIC

51 AUSTIN STREET SANDUSKY MI 48471

SANILAC AMBULANCE SERVICES

120 DELAWARE STREET SANDUSKY MI 48471

MCKENIZIE HEALTH AND WELLNESS

170 ARGYLE STREET SANDUSKY MI 48471

MCKENIZE FAMILY HEALTHCARE

109 DELAWARE STREET SANDUSKY MI 48471

MAIN STREET HEALTH CLINIC

74 S ELK STREET SANDUSKY MI 48471

LAKESHORE INTERNAL MEDICINE

76307 CHERRY STREET PORT SANILAC MI 48469

SANILAC MEDICAL PLAZA

100 ARGYLE STREET SUITE 4 SANDUSKY MI 48471

PART I, LINE 7, COLUMN (F) - BAD DEBT EXPENSE OF 1,240,147 INCLUDED ON FORM 990, PART 1X, LINE 25, COLUMN A, BUT SUBSTRACTED FOR PURPOSES OF CALCULATING PERCENTAGE IN COLUMN (F). PART I, LINE 7- COSTING METHODOLOGY. COST-TO-CHARGE RATIO WAS USED TO DETERMINE FIGURES REPORTED IN LINE 7. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART III, LINE 4- COST OF BAD DEBT EXPENSE FOR PART III LINE 2 WAS CALCULATED USING WORKSHEET "A" CONTAINED IN THE INSTRUCTIONS FOR SCHEDULE H. RATIO OF PATIENT CARE COST TO CHARGES PERCENTAGE WAS USED FROM WORKSHEET 2 PART III LINE 3. BAD DEBT EXPENSE ATTRIBUTIABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. ANALYZED CHARITY CARE APPLICATIONS THAT WERE DENIED DUE TO INCOMPLETE DOCUMENTATION AND FAILURE TO PROVIDE REQUESTED INFORMATION AND APPLIED COST TO CHARGE RATIO AS DETERMINED IN WORKSHEET 2. PATIENTS RECEIVE THREE MONTHLY STATEMENTS, IF NO PAYMENTS WERE MADE DURING THAT TIME PERIOD THE FOURTH MONTH THEY WILL GET A LETTER STATING THAT THEY WILL BE TURNED OVER TO A COLLECTION AGENCY. IF NO ACTION IS TAKEN BY THE PATIENT THE ACCOUNT IS SENT TO BAD DEBT AND TURNED OVER TO A COLLECTION AGENCY. THE ORGANIZATION DOES NOT INCLUDE A FOOTNOTE IN THE FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE. THE FINANCIAL STATEMENTS LIST BAD DEBT AS A SEPARATE LINE ITEM IN THE EXPENSE SECTION. BAD DEBT EXPENSE IS INCLUDED AS A COMMUNITY BENEFIT AS IT BENEFITS OUR COMMUNITY THAT CANNOT AFFORD TO PAY THEIR HEALTHCARE EXPENSES. NO SHORTFALL REPORTED. PART III LINE 6 WAS DETERMINED USING ALLOWABLE COSTS AS REPORTED IN THE ORGANIZATIONS'S MEDICARE COST REPORT. NO COSTS WERE REPORTED IN PART 1, LINE 7G OR COSTS ASSOCIATED WITH DIRECT GME REPORTED IN PART I LINE 7F. COLLECTION POLICY REFERENCES THE CHARITY CARE POLICY FOR THOSE POSSIBLY ELIGIBLE FOR CHARITY CARE AS A METHOD OF PAYMENT/COLLECTIONS. PART VI LINES 6,7, & 8 - NO OTHER INFORMATION TO REPORT. PART VI LINE 2 ORGANIZATION COMMUNICATED WITH STATE AND LOCAL AGENCIES TO DETERMINE HEALTHCARE NEEDS OF THE COMMUNITY. EXAMPLES OF SERVICES PROVIDED BASED ON COMMUNITY NEED ARE FAMILY PLANNING, GERIATRICS PROGRAM, IMMUNIZATIONS, VACCINES, SPORTS PHYSICALS, SENIOR FAIR, HEALTH FAIRS, FIRST AID BOOTH AND DIABETIC CLASSES. PART VI LINE 3 EVERY UNISURED PATIENT THAT IS AN INPATIENT, OUTPATIENT, SURGICAL, OBSERVATION OR INCURS MORE THAN 3,000 IN MEDICAL EXPENSES, RECEIVES A CHARITY CARE PACKAGE WHICH INCLUDES A CHARITY CARE APPLICAIONT, A MEDICAID APPLICAITON AND A HUMAN SERVICES REFERRAL FORM. ALL OTHER NON INSURED PAIENTS MAY REQUEST A CHARITY CARE APPLICATION AT ANY TIME. PART VI LINE 4 ORGANIZATION IS LOCATED IN SANILAC COUNTY WHICH HAS A POPULATION OF APPROX 43,000. SANDUSKY HAS A POPULATION OF APPROX 2,500. SANILAC COUNTY CONSISTS OF MOSTLY FARMLAND WITH VERY FEW MANUFACTURING FACILITIES. THE UNEMPLOYMENT RATE IN SANILAC COUNTY IS 13.70% PART VI LINE 4 NO COMMUNITY BUILDING ACTIVIES THAT ARE NOT ALREADY REPORTED IN PART 1. X X X false false false false false false false false false MELANIE KRAMER 216378 14517 8575 18607 258077 STEVE BARNETT 181317 6168 12167 199652 MARCUS FREE 386533 10000 8575 9070 414178 ALFRED DOMINGO 343991 343991 WILLIAM WEINER 199616 31500 12417 243533 MOHAMED ELRAHMAN 207179 2932 24518 234629 MARK ENGLISH 159883 4222 6010 23754 193869 BARNETT ANESTESIA CEO'S SPOUSE 93950 CRNA SERVICES false CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 MCKENIZIE MEMORIAL HOSPITAL HAS MEMBERS WHO MAKE UP THE BOARD OF DIRECTORS. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD MEMBERS MUST BE APPROVED FIRST BY THE BOARD OF MCKENIZE HEALTHCARE CORPORATION TO BECOME BOARD MEMBERS. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B MCKENIZE HEALTHCARE CORPORATION MUST APPROVE ANY FINANCIAL TRANSACTIONS ABOVE ONE MILLION DOLLARS BEFORE ANY ACTION CAN BE TAKEN BY THE BOARD OF DIRECTORS OF MCKENZIE MEMORIAL HOSPITAL. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11 THE 990 IS REVIEWED BY THE FINANCE COMMITTEE FOR APPROVAL AND IS THEN SUBMITTED TO THE FULL BOARD FOR APPROVAL PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS AND ALL COMMITTEES ARE REQUIRED TO FILL OUT AND SIGN THE ANNUAL CONFLICT OF POLICIES. IN THE EVENT OF A CONFLICT A BOARD MEMBER ABSTAINS FROM THE VOTE AND IS ABSENT FROM THE DISCUSSION. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION OF THE CEO/PRESIDENT IS APPROVED BY THE FULL BOARD BASED ON THE RECOMMENDATION OF THE EXECUTIVE COMMITTEE THROUGH EXECUTIVE SURVEY INFORMATION. ANY EXECUTIVE BONUSES ARE APPROVED BY THE BOARD AT THE END OF A FISCAL YEAR BASED ON GOALS AND SUCCESS OF THE ORGANIZATION. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE FULL BOARD THROUGH THE RECOMMENDATION OF THE FINANCE COMMITTEE OF EMPLOYMENT CONTRACTS AND PAYROLL RATE INCREASES. RECOMMENDATIONS ARE BASED ON COMPENSATION SURVEYS AND APPROVAL OF THE HOSPITAL ANNUAL BUDGET. BONUS AMOUNTS ARE IN THE CONTRACTS APPROVED BY THE FULL BOARD. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITIED FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION AT THE ORGANIZATION'S CEO/PRESIDENT'S OFFICE. ADDITIONAL INFORMATION SCHEDULE O 990 PART VI, LINE 18 - 990 PUBLIC DISCLOSURE. THE 990 FORM IS AVAILABLE ON THE WEB AT THE GUIDESTAR.ORG WEBSITE. IT IS ALSO AVAILABLE UPON REQUEST AT THE HOSPITAL. MCKENIZE HEALTHCARRE CORPORATION 120 DELAWARE STREET SANDUSKY MI 48471 382702946 HEALTHCARE MI 501 3 ITSELF SANILAC HEALTHCARE CORP 120 DELAWARE STEET SANDUSKY MI 48471 382702948 HOMECARE MI 501 3 MCKENIZE HEALTHCARE CORPORATION SANILAC SERVICES INC 48 SOUTH ELK SANDUSKY MI 48471 382774983 PHARMACY MI MCKENIZE HEALTHCARE CORPORATION C CORP SANILAC CATALOG INC 48 SOUTH ELK SANDUSKY MI 48471 383254153 CATALOG MI SANILAC SERVICES INC C CORP SANILAC EQUIPMENT & SUPPLY CO 120 DELAWARE STREET SANDUSKY MI 48471 382662256 SUPPLIES MI MCKENIZE HEALTHCARE CORPORATION C CORP false false false false false false false false false false false false false false true true false false SANILAC SERVICES INC SANILAC PHARMACY O 136664 SANILAC SERVICES INC SANILAC PHARMACY P 90000