2011-11-15T09:00:25-06:00 2010-12-31 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2010-01-01 381490180 CARSON CITY HOSPITAL CARS 9895843971 406 E Elm Street PO Box 879 Carson City MI 48811 DUANE C MILLER 2011-11-14 true 3128997000 2010 2016-03-07 17:11:31Z BRUCE L TRAVERSE 406 E Elm Street Carson City MI 48811 59424550 false X WWW.CARSONCITYHOSPITAL.COM 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 7 705 207 0 0 208713 173923 56127926 56098857 -161522 268368 614451 544801 56789568 57085949 0 0 0 0 29461637 29805940 0 0 0 25979611 25973959 55441248 55779899 1348320 1306050 46397599 46633993 25401539 23285826 20996060 23348167 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 39152348 49025245 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, 2010, CCH PROVIDED OVER $3 MILLION IN UNCOMPENSATED CARE. DURING THE YEAR ENDED DECEMBER 31, 2010, CCH PROVIDED 7,010 PATIENT DAYS, WITH AN AVERAGE LENGTH OF STAY OF 3.17 DAYS. THERE WERE ALSO 12,739 EMERGENCY ROOM VISITS, 70,293 OUTPATIENT HOSPITAL VISITS, 1,978 HOSPITAL ADMISSIONS, AND 351 BIRTHS DURING THE YEAR. CCH PERFORMED 5,537 SURGERIES, 236,286 LAB TESTS, 15,845 DIAGNOSTIC IMAGING EXAMS, 5,260 CT SCANS, AND 2,918 M.R.I. SCANS. THE ESTIMATED TOTAL LOCAL ECONOMIC IMPACT FOR THE YEAR WAS $22,611,875. 1746145 1731715 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. 1418652 1377774 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. 2798181 4684123 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 INTERNAL MEDICINE SPECIALISTS (CLOSED EFFECTIVE 5/10/2010) 2798181 4684123 45115326 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 false false false true true false false false false false false false false false true false false false false false false false false false false true 168 0 true 705 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 ROBERT SEALS DO 40 X 229683 0 10846 JANMEET SAHOTA 40 X 499504 0 18525 MICHAEL H MULLINS 40 X 299767 0 7919 EVAN C YOUNG 40 X 350002 0 8904 CHRISTOPHER E HERALD 40 X 270320 0 16470 MATTHEW J THOMPSON 40 X 132529 0 6034 RICHARD D TERRY 40 X 93576 0 6049 GARY REETZ 2 X 0 0 0 MARK BRETT 2 X 0 0 0 DEBBY CASSADY 2 X 0 0 0 TOM MACDONALD 2 X 0 0 0 TOM OSTRANDER 2 X 0 0 0 REX A RIMMEL DO 2 X 0 0 0 JAE EVANS 2 X X 0 0 0 BRENT WILSON 2 X X 0 0 0 PATRICK E BURNS 2 X X 0 0 0 BRUCE L TRAVERSE 40 X 175790 0 16783 JAMES D BANNER DO 40 X 227060 0 14578 DAVID FREESTONE MD 40 X 246715 0 14641 RODERICK COY 2 X 0 0 0 DUANE C MILLER 40 X 137859 0 13375 BRUCE MURRAY 40 X 275266 0 7276 RISHI MAHABIR 40 X 232957 0 15443 NANCY A WEAVER 40 X 133858 0 11952 NATALIE W BUSLEPP 40 X 108107 0 11854 3412993 0 180649 37 false true false US PAIN MANAGEMENT PC 430 S FIRST STREET CARSON CITY MI 48811 PAIN MANAGEMENT CONSULTING FEES 285536 PHARMACY SYSTEMS INC PO BOX 71-0716 COLUMBUS OH 43271 PHARMACY CONSULTING SERVICES 239170 GARY RALPH 400 WILDWOOD DR EAST LANSING MI 48823 CONTRACT PSYCHIATRY PHYSICIAN 178200 JUDY FOLEY PO BOX 4463 EAST LANSING MI 48826 PATIENT REGISTRATIONS CONSULTING SERVICES 168980 GOLDFISH LOCUM TENENS 5741 LEGACY DRIVE SUITE 200 PLANO TX 75024 PHYSICIAN CONTRACTING SERVICES 150270 7 38700 35608 99615 3167 173923 NET PATIENT SERVICE REVENUE 56098857 56098857 0 0 0 0 56098857 158636 158636 0 0 586569 510360 76209 0 76209 76209 1925923 1816191 109732 0 109732 109732 14704 38700 12050 2654 2654 501 501 501 0 CAFETERIA/COFFEE SHOP/VENDING 333856 333856 MISCELLANEOUS 131581 131581 0 0 0 0 465437 57085949 56098857 0 813169 0 0 0 0 1878079 743523 1134556 0 23581701 21390124 2191577 792614 512945 279669 1789056 1156058 632998 1764490 1539281 225209 0 87588 87588 89478 89478 0 0 41438 41438 4842832 2490344 2352488 416134 37385 378749 8871065 8320782 550283 543199 154843 388356 0 2931064 1508124 1422940 92385 90238 2147 0 0 431780 431780 0 1769032 1769032 616583 100367 516216 BAD DEBT EXPENSE 3583931 3583931 PROVIDER/OTHER TAXES 1121572 1045902 75670 RECRUITING 193046 193046 EDUCATION & DEVELOPMENT 109726 65711 44015 DUES, LICENSES, & SUBSCRIPTIONS 108371 51276 57095 124735 123680 1055 0 55779899 45115326 10664573 0 0 3762 4202 6121583 6202651 163641 50900 7715928 8138330 105190 59492 821011 1065956 1629302 1230733 48200093 24286853 24432889 23913240 4593063 5100698 0 0 239804 239804 571426 627987 46397599 46633993 3651702 4213919 79025 0 16599173 15904911 2041344 1492963 27510 25010 3002785 1649023 25401539 23285826 X 20454234 23141058 541826 207109 20996060 23348167 46397599 46633993 X 1306050 1046057 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 false false false false false false false false true 3456 3456 false 0 Description of other lobbying activities Schedule C, Part II-B, Line 1i THE ORGANIZATION INDIRECTLY INFLUENCED LEGISLATION THOUGH ITS ANNUAL DUES PAID TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION; 14.81% OF DUES PAID WERE USED FOR SPECIFIC LOBBYING PURPOSES. 731643 731643 32003885 13364357 18639528 1471761 471928 999833 13896283 10450568 3445715 96521 96521 23913240 0 DEFINED BENEFIT PENSION LIABILITY 735773 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 913250 1649023 57085949 55779899 1306050 243269 329075 572344 1878394 58407653 243269 1123040 1366309 57041344 41438 3167 44605 57085949 56529259 790798 790798 55738461 41438 0 41438 55779899 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. EFFECTIVE JANUARY 1, 2009, THE HOSPITAL ADOPTED THE PROVISIONS OF FASB ASC 740, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. IN ACCORDANCE WITH FASB ASC 740, 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 ADOPTION HAD NO EFFECT ON THE FINANCIAL STATEMENTS. 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, 2010 OR 2009. 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 2007. Other changes in net assets Schedule D, Part XI, Line 8 PENSION ADJUSTMENT - 124741; CARSON APOTHECARY SHOPPE NET INCOME (JANUARY 1 - NOVEMBER 30) - 207501; AUXILIARY CONTRIBUTIONS - -3167; Other revenues in audited financial statements not in form 990 Schedule D, Part XII, Line 2d PENSION ADJUSTMENT - 124741; FUNDRAISING EXPENSES - 12050; CARSON APOTHECARY SHOPPE REVENUE (JANUARY 1 - NOVEMBER 30) - 986249; Other revenues in form 990 not in audited financial statements Schedule D, Part XII, Line 4b AUXILIARY CONTRIBUTIONS - 3167; Other expenses in audited financial statements not in form 990 Schedule D, Part XIII, Line 2d FUNDRAISING EXPENSES - 12050; CARSON APOTHECARY SHOPPE EXPENSES (JANUARY 1 - NOVEMBER 30) - 778748; SUMMER DANCE PARTY 53404 38700 14704 1086 10964 0 0 53404 38700 14704 0 0 0 1086 0 10964 12050 2654 true true X true X true X true true true false true true 0 0 1651993 1511176 140817 0.00270 2 0 10653569 7819800 2833769 0.05350 0 0 0 0 0 0.00000 2 0 12305562 9330976 2974586 0.05620 62 5015 53127 0 53127 0.00100 24 259 6500 23844 -17344 0 15 85520 11220085 10268952 951133 0.01800 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 101 90794 11279712 10292796 986916 0.01870 103 90794 23585274 19623772 3961502 0.07490 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 true 1589731 53886 8323927 9521419 X true true 1 1 CARSON CITY HOSPITAL

406 E ELM STREET CARSON CITY MI 48811

X X X X X CARSON CITY HOSPITAL 1 14 PHYSICAL REHABILITATION 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 CITY HOSPITAL ORTHOPEDICS AND GENERAL SURGERY

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

GENERAL MEDICAL/SURGICAL OUTPATIENT CLINIC CARSON FAMILY CARE CENTER

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

GENERAL MEDICAL OUTPATIENT CLINIC 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 CARSON HOME CARE

406 E ELM ST CARSON CITY MI 48811

HOME HEALTH CARE 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 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 CARSON BEHAVIORAL HEALTH CENTER

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

BEHAVIORAL HEALTH CLINIC HOSPITALISTS

406 E ELM ST CARSON CITY MI 48811

GENERAL MEDICAL OUTPATIENT CLINIC INTERNAL MEDICINE SPECIALISTS

245 S 2ND ST STE 100 CARSON CITY MI 48811

GENERAL MEDICAL OUTPATIENT CLINIC 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 $9,173,050 REVENUE THAT IS BROUGHT IN FROM THE PHYSICIAN CLINIC SETTING, $4,500 IS FROM SPORTS PHYSICALS, $100 FROM BLOOD PRESSURE CHECKS, $2,000 FROM CANCER/PROSTRATE SCREENINGS, AND $500 FROM CHOLESTEROL TESTING. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 3,583,931 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 - financial statement footnote Schedule H, Part III, Line 4 THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE AND RECORDED AS A COMMUNITY BENEFIT. UNDER ARRANGEMENTS WITH VARIOUS GOVERNMENTAL INSURANCE PROGRAMS, THE HOSPITAL 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, THE HOSPITAL 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. 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 EDUCATION 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. 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. 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 PATIENTS 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 90 DAYS. 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. 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. 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. 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. 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 X true true X X X false false false false false false false true false ROBERT SEALS DO 229083 0 0 0 600 0 7060 0 3786 0 240529 0 0 0 JANMEET SAHOTA 499504 0 0 0 0 0 7350 0 11175 0 518029 0 0 0 MICHAEL H MULLINS 299767 0 0 0 0 0 7350 0 569 0 307686 0 0 0 EVAN C YOUNG 350002 0 0 0 0 0 7350 0 1554 0 358906 0 0 0 CHRISTOPHER E HERALD 270320 0 0 0 0 0 7350 0 9120 0 286790 0 0 0 BRUCE L TRAVERSE 162494 0 11783 0 1513 0 5499 0 11284 0 192573 0 0 0 JAMES D BANNER DO 226460 0 0 0 600 0 7038 0 7540 0 241638 0 0 0 DAVID FREESTONE MD 190290 0 55825 0 600 0 7350 0 7291 0 261356 0 0 0 DUANE C MILLER 136103 0 1756 0 0 0 4343 0 9032 0 151234 0 0 0 BRUCE MURRAY 275266 0 0 0 0 0 0 0 7276 0 282542 0 0 0 RISHI MAHABIR 232957 0 0 0 0 0 7084 0 8359 0 248400 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 $3,750 DURING 2010. THE AMOUNT WAS INCLUDED IN HIS 2010 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 2010. THE AMOUNT WAS INCLUDED IN HIS 2010 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 594654GG5 2007-12-18 455937 HOSPITAL EQUIPMENT LOAN PROGRAM (HELP) false false true 1818769 0 18000000 0 0 0 133000 0 0 14012600 0 0 2009 false false true true 37995 0 455937 0 0 0 0 0 0 0 0 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 NA 0.0 false NA 0.0 false true false true false NA 0.0 false NA 0.0 false true TOTAL PROCEEDS OF ISSUE SCHEDULE K, 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. SPARROW HEALTH SYSTEM M. BRETT, T. OSTRANDER AND G. REETZ ARE CCH BOARD MEMBERS AND SPARROW OFFICERS 444519 MARK BRETT, TOM OSTRANDER AND GARY REETZ, CARSON CITY HOSPITAL BOARD MEMBERS, SERVE AS THE VICE PRESIDENT AND INTERIM CHIEF OPERATING OFFICER, VICE PRESIDENT OF HUMAN RESOURCES AND CONTROLLER, RESPECTIVELY, FOR SPARROW HEALTH SYSTEM, AN UNRELATED ORGANIZATION. FOR THE YEAR ENDED DECEMBER 31, 2010, CARSON CITY HOSPITAL MADE PAYMENTS TO SPARROW HEALTH SYSTEM IN THE AMOUNT OF $444,519 FOR REIMBURSEMENT OF SUPPLIES AND PHARMACEUTICAL, LABORATORY, AND HEMATOLOGY ONCOLOGY SERVICE. false New program services Form 990, Part III, Line 2 PRIOR TO DECEMBER 1, 2010, CARSON CITY HOSPITAL (CCH) OWNED 100% OF THE CARSON APOTHECARY SHOPPE, INC. (CAS) AND CCH AND CAS OPERATED UNDER THEIR OWN EMPLOYER IDENTIFICATION NUMBERS. EFFECTIVE DECEMBER 1, 2010, CAS WAS REORGANIZED UNDER COMMON OWNERSHIP AND BECAME A DEPARTMENT OF CCH OPERATING UNDER CCH'S EMPLOYER IDENTIFICATION NUMBER. CAS IS LOCATED INSIDE CARSON CITY HOSPITAL AND OFFERS A FULL LINE OF PRESCRIPTION DRUGS AND OTHER HEALTH CARE ITEMS. 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 INTERNAL MEDICINE SPECIALISTS (CLOSED EFFECTIVE 5/10/2010) 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. THE 2010 COMPENSATION WAS REVIEWED AND APPROVED AT THE END OF 2009 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 2010 COMPENSATION WAS REVIEWED AND APPROVED AT THE END OF 2009 DURING THE ANNUAL BUDGETING PROCESS. Public Disclosure Form 990, Part VI, Section C, Line 19 AN ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 243269; PENSION ADJUSTMENT - 124741; CARSON APOTHECARY SHOPPE NET INCOME (JANUARY 1 - NOVEMBER 30) - 207501; AUXILIARY CONTRIBUTIONS - -3167; CARSON APOTHECARY SHOPPE NET ASSETS (PRIOR TO REORGANIZATION) - 473713;