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MUNSON HEALTHCARE CHARLEVOIX HOSPITAL: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (EIN 38-1459366)
Tax period
2021-07-01 to 2022-06-30
Filed
2023-05-15
IRS object ID
202331359349301248
Schema version
2021v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-05-15T09:52:45-04:00ReturnTs
Tax Period End2022-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2021-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN381459366EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MUNSON HEALTHCARE CHARLEVOIXBusinessNameLine1Txt
Business Name Line2HOSPITALBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlMUNSBusinessNameControlTxt
Phone2315474024PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line114700 LAKE SHORE DRIVEAddressLine1Txt
CityCHARLEVOIXCityNm
State AbbreviationMIStateAbbreviationCd
ZIP49720ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPAUL KONOPACKIPersonNm
Person TitleCFOPersonTitleTxt
Phone2315474024PhoneNum
Signature2023-05-15SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstPAULPersonFirstNm
Person LastKONOPACKIPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOANNE SCHROEDERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line114700 LAKE SHORE DRIVEAddressLine1Txt
CityCHARLEVOIXCityNm
State AbbreviationMIStateAbbreviationCd
ZIP49720ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$80,174,109GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MUNSONHEALTHCARE.ORG/CHARLEVOIXWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1919FormationYr
Legal Domicile StateMILegalDomicileStateCd
Activity Or MissionMUNSON HEALTHCARE CHARLEVOIX HOSPITAL AND ITS PARTNERS WORK TOGETHER TO PROVIDE SUPERIOR QUALITY CARE AND PROMOTE COMMUNITY HEALTH.ActivityOrMissionDesc
Voting Members Governing Body24VotingMembersGoverningBodyCnt
Voting Members Independent22VotingMembersIndependentCnt
Total Employee473TotalEmployeeCnt
Total Volunteers26TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$876,588PYContributionsGrantsAmt
CY Contributions Grants$3,135,287CYContributionsGrantsAmt
PY Program Service Revenue$66,280,640PYProgramServiceRevenueAmt
CY Program Service Revenue$72,397,491CYProgramServiceRevenueAmt
PY Investment Income$857,707PYInvestmentIncomeAmt
CY Investment Income$311,866CYInvestmentIncomeAmt
PY Other Revenue$152,691PYOtherRevenueAmt
CY Other Revenue$162,476CYOtherRevenueAmt
PY Total Revenue$68,167,626PYTotalRevenueAmt
CY Total Revenue$76,007,120CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$28,400,302PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$30,304,254CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$79,309CYTotalFundraisingExpenseAmt
PY Other Expenses$30,557,328PYOtherExpensesAmt
CY Other Expenses$38,774,392CYOtherExpensesAmt
PY Total Expenses$58,957,630PYTotalExpensesAmt
CY Total Expenses$69,078,646CYTotalExpensesAmt
PY Revenues Less Expenses$9,209,996PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$6,928,474CYRevenuesLessExpensesAmt
Total Assets BOY$70,162,827TotalAssetsBOYAmt
Total Assets EOY$54,369,111TotalAssetsEOYAmt
Total Liabilities BOY$16,243,685TotalLiabilitiesBOYAmt
Total Liabilities EOY$17,214,079TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$53,919,142NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$37,155,032NetAssetsOrFundBalancesEOYAmt
MissionAS A VITAL PART OF MUNSON HEALTHCARE, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL EXISTS TO DELIVER COMPREHENSIVE QUALITY CARE TO PATIENTS IN PARTNERSHIP WITH PHYSICIANS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$61,683,190ExpenseAmt
Revenue$72,304,450RevenueAmt
DescEXPENSES INCURRED WHILE PROVIDING HOSPITAL SERVICES TO THE RESIDENTS OF CHARLEVOIX, MICHIGAN AND THE SURROUNDING AREA WHILE FULFILLING THE HOSPITAL'S MISSION TO PROVIDE HEALTHCARE IN THE COMMUNITY. MUNSON HEALTHCARE CHARLEVOIX HOSPITAL HAD 779 INPATIENT ADMISSIONS IN FISCAL YEAR 2022 AND OVER 64,000 OUTPATIENT VISITS. THE HOSPITAL SERVED MORE THAN 2,700 SURGICAL CASES, 184 OBSTETRICAL BIRTHS, AND OVER 9,700 EMERGENCY ROOM VISITS. MUNSON HEALTHCARE CHARLEVOIX HOSPITAL ACCEPTS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. THE HOSPITAL HAS APPROXIMATELY 43 ACTIVE MEDICAL STAFF AND 26 VOLUNTEERS. INCLUDED IN PROGRAM SERVICE EXPENSES ARE 171,000 OF COVID-19 EXPENSES FOR PATIENT CARE AND OTHER RELATED EXPENSES.Desc
Total Program Service Expenses$61,683,190TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document31IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee473EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members24GoverningBodyVotingMembersCnt
Independent Voting Member22IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsYes (true)ChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonNICOLE SULAK MUNSON HEALTHCAREPersonNm
Phone2319357777PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14230 COPPER RIDGE DRAddressLine1Txt
CityTRAVERSE CITYCityNm
State AbbreviationMIStateAbbreviationCd
ZIP49684ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (45 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndOfficerOfficerInd
EDWIN NESS
DIRECTOR1.0040.00Yes (X)$0$1,193,233$223,158
LAURA GLENN
PRESIDENT AM2.0040.00$0$607,688$85,269Yes (X)
TONYA SMITH
DIRECTOR1.0040.00Yes (X)$0$529,801$82,494
JAMES JEAKLE MD
PHYSICIAN40.00$568,861$0$41,007Yes (X)
BARRETT KIELHORN DO
PHYSICIAN40.00$566,115$0$40,605Yes (X)
MARK HEPLER
FORMER CFO$0$528,784$18,309Yes (X)
HOWARD TOPLEY MD
PHYSICIAN20.0020.00$236,652$234,465$10,144Yes (X)
ALICIA MAITLAND
CFO2.0040.00$0$368,822$67,951Yes (X)
CASEY KANDOW
VP ANCILLARY2.0040.00$0$356,026$55,923Yes (X)
JOANNE SCHROEDER
PRESIDENT40.00Yes (X)$0$337,274$63,544Yes (X)
ELLEN SMITH
COO PHYSICIA2.0040.00$0$329,713$31,694Yes (X)
NATHAN BOSS MD
PHYSICIAN40.00$319,348$0$36,085Yes (X)
MARK LAME MD
SURGEON40.00$318,989$0$26,013Yes (X)
CHRISTOPHER SQUIRE
VP ANCILLARY2.0040.00$0$273,298$53,734Yes (X)
ANNA YOUNG MD
DIRECTOR40.00Yes (X)$253,071$0$20,761
CATHERINE WONSKI MD
DIRECTOR40.00Yes (X)$255,246$0$16,854
BERNADETTE GREEN COLE RN
CHIEF NURSIN40.00$178,290$0$41,212Yes (X)
THEODORE BATZER
DIRECTOR1.00Yes (X)$0$0$0
SCOTT BEATTY
DIRECTOR1.00Yes (X)$0$0$0
KENNETH BLOEM
VICE CHAIR P2.00Yes (X)$0$0$0
NICK CEGLAREK
DIRECTOR1.00Yes (X)$0$0$0
ALAN CONRAD
DIRECTOR1.00Yes (X)$0$0$0
CASEY COWELL
DIRECTOR1.00Yes (X)$0$0$0
KATHY DIXON
DIRECTOR1.00Yes (X)$0$0$0
MICHAEL HINKLE
CHAIR PT-YR2.00Yes (X)$0$0$0Yes (X)
MARLENE HULTEEN
DIRECTOR1.00Yes (X)$0$0$0
KATHLEEN LAUWERS
DIRECTOR1.00Yes (X)$0$0$0
DOUG LUCIANI
DIRECTOR1.00Yes (X)$0$0$0
DAVID MCCURDY
DIRECTOR3.00Yes (X)$0$0$0
RUTH B HOPPE MD
SECRETARY PT3.00Yes (X)$0$0$0
KIM MORLEY
DIRECTOR1.00Yes (X)$0$0$0
BENJAMEN MULADORE
DIRECTOR1.00Yes (X)$0$0$0
TIM NELSON
TREASURER PT3.00Yes (X)$0$0$0Yes (X)
MICHAEL ORTWINE
DIRECTOR1.00Yes (X)$0$0$0
CLIFF PORTER
DIRECTOR1.00Yes (X)$0$0$0
BRIAN POSTMA
DIRECTOR2.00Yes (X)$0$0$0
OWEN ROBERTS
DIRECTOR2.00Yes (X)$0$0$0
MICHELLE RUSSELL
DIRECTOR1.00Yes (X)$0$0$0
MARY SANDERS
DIRECTOR2.00Yes (X)$0$0$0
NANCY SHERMAN
SEC/TREAS PT2.00Yes (X)$0$0$0Yes (X)
SAKURA TAKANO
DIRECTOR1.00Yes (X)$0$0$0
KRISTINE THOMAS
DIRECTOR2.00Yes (X)$0$0$0
THOMAS VERYSER
VICE CHAIR P1.00Yes (X)$0$0$0Yes (X)
ELAINE WOOD
CHAIR PT-YR2.00Yes (X)$0$0$0Yes (X)
BRUCE ZENNER
DIRECTOR1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,696,572TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$4,759,104TotReportableCompRltdOrgAmt
Total Other Compensation$914,757TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K43IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
HALLMARK HEALTHCARE SOLUTIONS
PO BOX 22937NEW YORKNY100872938STAFFING$1,135,626
NORTHWESTERN MICHIGAN EMERGENCY PHY
4624 N SPIDER LAKE ROADTRAVERSE CITYMI49696MEDICAL$924,777
CERNER CORP
PO BOX 959156ST LOUISMO631959156SUPPORT SERV$887,213
SOUND PHYSICIANS
PO BOX 742936LOS ANGELESCA900742936MEDICAL$689,456
ALLIANCE HNI LLC
PO BOX 772550DETROITMI482772550MOBILE MRI SERV$406,672
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K11CntrctRcvdGreaterThan100KCnt
Related Organizations$98,254RelatedOrganizationsAmt
Government Grants$3,037,033GovernmentGrantsAmt
Total Contributions$3,135,287TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621990$41,173,759$41,173,759
MEDICARE/MEDICAID PAYMENTS621990$29,090,291$29,090,291
340B PRESCRIPTION REVENUE621990$1,617,208$1,617,208
MISC HEALTHCARE REVENUE531120$324,933$324,933
QUALITY INCENTIVE PAYMENTS621990$181,688$181,688

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,612TotalRevenueColumnAmt
Related Or Exempt Func Income$9,612RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$72,397,491TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$161,453TotalRevenueColumnAmt
Exclusion$161,453ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$41,062RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$41,062RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,062TotalRevenueColumnAmt
Exclusion$41,062ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$4,300,425SecuritiesAmt
Other$16,977OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$4,084,154SecuritiesAmt
Other$82,835OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$216,271SecuritiesAmt
Other-$65,858OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$150,413TotalRevenueColumnAmt
Related Or Exempt Func Income-$93,041RelatedOrExemptFuncIncomeAmt
Exclusion$243,454ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
CAFETERIA SALES722210$109,356$109,356
MISCELLANEOUS621110$12,058$12,058
FieldValueIRS element (for citing)
Other Revenue Total$121,414OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$76,007,120TotalRevenueColumnAmt
Related Or Exempt Func Income$72,304,450RelatedOrExemptFuncIncomeAmt
Exclusion$567,383ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$607,807TotalAmt
Program Services$607,807ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$23,976,536TotalAmt
Program Services$22,531,073ProgramServicesAmt
Management And General$1,445,463ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,141,338TotalAmt
Program Services$1,073,016ProgramServicesAmt
Management And General$68,322ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,979,172TotalAmt
Program Services$2,801,900ProgramServicesAmt
Management And General$177,272ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,599,401TotalAmt
Program Services$1,505,207ProgramServicesAmt
Management And General$94,194ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$2,550TotalAmt
Management And General$2,550ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$22,370TotalAmt
Management And General$22,370ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$3,614TotalAmt
Management And General$3,614ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$29,610TotalAmt
Management And General$29,610ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$14,132,910TotalAmt
Program Services$9,853,856ProgramServicesAmt
Management And General$4,199,745ManagementAndGeneralAmt
Fundraising$79,309FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,237TotalAmt
Program Services$1,237ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$561,554TotalAmt
Program Services$399,887ProgramServicesAmt
Management And General$161,667ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,514,016TotalAmt
Program Services$806,568ProgramServicesAmt
Management And General$707,448ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$907,561TotalAmt
Program Services$907,561ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$31,079TotalAmt
Program Services$30,722ProgramServicesAmt
Management And General$357ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$59,808TotalAmt
Program Services$55,043ProgramServicesAmt
Management And General$4,765ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$111,071TotalAmt
Program Services$99,180ProgramServicesAmt
Management And General$11,891ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,597,777TotalAmt
Program Services$2,319,663ProgramServicesAmt
Management And General$278,114ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$292,432TotalAmt
Program Services$209,700ProgramServicesAmt
Management And General$82,732ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$14,447,418$14,447,418
PROVISION FOR BAD DEBTS$2,325,710$2,325,710
QAAP TAXES$1,278,217$1,278,217
REPAIRS AND MAINTENANCE$321,790$321,710$80

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$133,668TotalAmt
Program Services$107,715ProgramServicesAmt
Management And General$25,953ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$69,078,646TotalAmt
Program Services$61,683,190ProgramServicesAmt
Management And General$7,316,147ManagementAndGeneralAmt
Fundraising$79,309FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$14,106,719BOYAmt
EOY$7,250,396EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$16,962,949BOYAmt
EOY$5,293,616EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$6,984,933BOYAmt
EOY$12,075,098EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$768,118BOYAmt
EOY$1,532,822EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$336,214BOYAmt
EOY$259,830EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$29,634,669LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,391,335LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$18,033,355BOYAmt
EOY$17,243,334EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$7,433,038BOYAmt
EOY$6,405,996EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$3,320,722BOYAmt
EOY$4,020,572EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$2,216,779BOYAmt
EOY$287,447EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$70,162,827BOYAmt
EOY$54,369,111EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,194,127BOYAmt
EOY$5,800,879EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$100,000BOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,133,333BOYAmt
EOY$4,666,667EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,816,225BOYAmt
EOY$6,746,533EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,243,685BOYAmt
EOY$17,214,079EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$52,474,319BOYAmt
EOY$35,104,388EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,444,823BOYAmt
EOY$2,050,644EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$53,919,142BOYAmt
EOY$37,155,032EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$70,162,827BOYAmt
EOY$54,369,111EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$6,928,474ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,379,708NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$22,312,876OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$3,614OtherActivitiesAmt
Total Lobbying Expenditures$3,614TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1FormAndLineReferenceDesc
ExplanationOTHER ACTIVITIES INDICATE THE PORTION OF DUES ALLOCATED TO LOBBYING EXPENSES PAID TO THE AMERICAN HOSPITAL ASSOCIATION.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,490,000OtherCostOrOtherBasisAmt
Book Value$2,490,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,916,823OtherCostOrOtherBasisAmt
Depreciation$6,439,127DepreciationAmt
Book Value$9,477,696BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,150OtherCostOrOtherBasisAmt
Depreciation$2,464DepreciationAmt
Book Value$2,686BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,574,654OtherCostOrOtherBasisAmt
Depreciation$5,568,540DepreciationAmt
Book Value$4,006,114BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,648,042OtherCostOrOtherBasisAmt
Depreciation$381,204DepreciationAmt
Book Value$1,266,838BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$17,243,334TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
INVESTMENT IN MUNSON HEALTHCARE FOUN$2,050,645F
INVESTMENT IN CHARLEVOIX NURSING HOM$1,969,927F
FieldValueIRS element (for citing)
Total Book Value Securities$4,020,572TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
THIRD PARTY SETTLEMENTS AND RESERVES$6,623,149
LONG TERM OPERATING LEASE LIABILITY$59,961
SHORT TERM OPERATING LEASE LIABILITY$44,130
CAPITAL LEASE$19,293
FieldValueIRS element (for citing)
Total Liability$6,746,533TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$107,006TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$107,006NetCommunityBenefitExpnsAmt
Total Expense0.00160TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,792,288TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,908,463DirectOffsettingRevenueAmt
Net Community Benefit Expns$883,825NetCommunityBenefitExpnsAmt
Total Expense0.01320TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,899,294TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,908,463DirectOffsettingRevenueAmt
Net Community Benefit Expns$990,831NetCommunityBenefitExpnsAmt
Total Expense0.01480TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$93,081TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$93,081NetCommunityBenefitExpnsAmt
Total Expense0.00140TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$23,273TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$23,273NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,779,272TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,612,386DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,166,886NetCommunityBenefitExpnsAmt
Total Expense0.03250TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$221TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$221NetCommunityBenefitExpnsAmt

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,895,847TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,612,386DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,283,461NetCommunityBenefitExpnsAmt
Total Expense0.03420TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,795,141TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$9,520,849DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,274,292NetCommunityBenefitExpnsAmt
Total Expense0.04900TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$21,800TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$21,800NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$21,800TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$21,800NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$2,325,710BadDebtExpenseAmt
Bad Debt Expense Attributable$349,344BadDebtExpenseAttributableAmt
Reimbursed By Medicare$12,971,052ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$12,439,826CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$531,226MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MUNSON HEALTHCARE CHARLEVOIX HOSPITBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line114700 LAKE SHORE DRIVEAddressLine1Txt
CityCHARLEVOIXCityNm
State AbbreviationMIStateAbbreviationCd
ZIP49720ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.MUNSONHEALTHCARE.ORG/CHARLEVOIXWebsiteAddressTxt
State License1060000154StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MUNSON HEALTHCARE CHARLEVOIX HOSPITBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
OtherYes (X)OtherInd
CHNA Conducted21CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTPS://TINYURL.COM/YSZBXMYSOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt22ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLHTTPS://TINYURL.COM/YSZBXMYSStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTPS://TINYURL.COM/2TNSZ8PSFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTPS://TINYURL.COM/2TNSZ8PSFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTPS://TINYURL.COM/2TNSZ8PSFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 3EYES, THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND WERE IDENTIFIED THROUGH THE CHNA.
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 5WE ARE FOLLOWING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP FRAMEWORK TO GUIDE OUR PROCESS WHICH INCLUDES FOUR ASSESSMENTS TO GATHER INPUT. 1.COMMUNITY THEMES AND STRENGTHS ASSESSMENT: THIS ASSESSMENT PROVIDES A DEEP UNDERSTANDING OF THE ISSUES THAT RESIDENTS FEEL ARE SIGNIFICANT BY ANSWERING THE FOLLOWING QUESTIONS: WHAT IS IMPORTANT TO OUR COMMUNITY?; HOW IS QUALITY PERCEIVED IN OUR COMMUNITY?; WHAT ASSETS DO WE HAVE THAT CAN BE USED TO IMPROVE WELLBEING? IT CONSISTED OF THREE SURVEYS: COMMUNITY SURVEY, HEALTHCARE PROVIDER SURVEY, AND PULSE SURVEY. RESULTS FROM EACH WERE ANALYZED BY COUNTY, HOSPITAL SERVICE AREA, AND THE THREE MITHRIVE REGIONS. 2.COMMUNITY HEALTH STATUS ASSESSMENT: THE COMMUNITY HEALTH STATUS ASSESSMENT IDENTIFIES PRIORITY COMMUNITY HEALTH AND QUALITY OF LIFE ISSUES. IT ANSWERS THE QUESTIONS, HOW HEALTHY ARE OUR RESIDENTS? AND WHAT DOES THE HEALTH STATUS OF OUR COMMUNITY LOOK LIKE? ITS PURPOSE IS TO COLLECT QUANTITATIVE SECONDARY DATA ABOUT THE HEALTH AND WELL-BEING OF RESIDENTS AND COMMUNITIES. WE COLLECTED APPROXIMATELY 100 STATISTICS, BY COUNTY, FOR THE 31-COUNTY REGION FROM RELIABLE SOURCES SUCH AS THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND THE US CENSUS BUREAU. 3.COMMUNITY SYSTEM ASSESSMENT: THE COMMUNITY SYSTEM ASSESSMENT FOCUSES ON ORGANIZATIONS THAT CONTRIBUTE TO WELL-BEING. IT ANSWERS THE QUESTIONS, WHAT ARE THE COMPONENTS, ACTIVITIES, COMPETENCIES, AND CAPACITIES IN THE REGIONAL SYSTEM? AND HOW ARE SERVICES BEING PROVIDED TO OUR RESIDENTS? FIRST, COMMUNITY-WIDE VIRTUAL MEETINGS WERE CONVENED IN THE NORTHWEST, NORTHEAST, AND NORTH CENTRAL MITHRIVE REGIONS WHERE PARTICIPANTS DISCUSSED VARIOUS ATTRIBUTES OF THE COMMUNITY SYSTEM. THESE WERE FOLLOWED BY RELATED DISCUSSIONS AT LOCAL COMMUNITY COLLABORATIVE MEETINGS. 4.FORCES OF CHANGE ASSESSMENT: THE FORCES OF CHANGE ASSESSMENT IDENTIFIES FORCES SUCH AS LEGISLATION, TECHNOLOGY, AND OTHER FACTORS THAT AFFECT THE COMMUNITY CONTEXT. IT ANSWERS THE QUESTIONS, WHAT IS OCCURRING OR MIGHT OCCUR THAT AFFECTS THE HEALTH OF OUR COMMUNITY OR THE LOCAL SYSTEM? AND WHAT SPECIFIC THREATS OR OPPORTUNITIES ARE GENERATED BY THESE OCCURRENCES? LIKE THE COMMUNITY SYSTEM ASSESSMENT, THE FORCES OF CHANGE ASSESSMENT WAS COMPOSED OF COMMUNITY MEETINGS CONVENED VIRTUALLY IN THE NORTHWEST, NORTHEAST, AND NORTH CENTRAL REGIONS. AS ONE OF THE FIRST STEPS OF ACHIEVING HEALTH EQUITY IS TO UNDERSTAND CURRENT HEALTH DISPARITIES, WE INVITED DIVERSE COMMUNITY PARTNERS TO JOIN THE MITHRIVE STEERING COMMITTEE, DESIGN TEAM, AND WORKGROUPS, AND WE GATHERED PRIMARY AND SECONDARY DATA FROM MEDICALLY UNDERSERVED, MINORITY, AND LOW-INCOME POPULATIONS IN EACH OF THE FOUR MITHRIVE ASSESSMENTS, BY THE FOLLOWING METHODS: CROSS-TABULATING DEMOGRAPHIC INDICATORS SUCH AS AGE, RACE, AND SEX FOR THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT ENGAGING RESIDENTS EXPERIENCING BARRIERS TO SOCIAL DETERMINANTS OF HEALTH AND ORGANIZATIONS THAT SERVE THEM IN THE COMMUNITY SYSTEM ASSESSMENT, COMMUNITY THEMES AND STRENGTHS ASSESSMENT, AND FORCES OF CHANGE ASSESSMENT REACHING OUT TO MEDICALLY UNDERSERVED AND LOW-INCOME POPULATIONS THROUGH PULSE SURVEYS ADMINISTERED BY ORGANIZATIONS THAT SERVE THEM INCREASING INCLUSION OF PEOPLE WITH DISABILITIES IN THE COMMUNITY HEALTH NEEDS ASSESSMENT THROUGH PARTNERSHIP WITH THE DISABILITY NETWORK OF NORTHERN MICHIGAN SURVEYING PROVIDERS WHO CARE FOR PATIENTS/CLIENTS ENROLLED IN MEDICAID HEALTH PLANS RECRUITING 1) RESIDENTS EXPERIENCING BARRIERS TO SAFE, AFFORDABLE, AND ACCESSIBLE HOUSING; HEALTHY FOOD; TRANSPORTATION OPTIONS; AND OTHER SOCIAL DETERMINANTS OF HEALTH AND 2) REPRESENTATIVES FROM THE DIVERSE ORGANIZATIONS THAT SERVE THEM TO MITHRIVE DATA WALKS AND PRIORITY-SETTING EVENTS
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 6AMITHRIVE WAS IMPLEMENTED ACROSS A 31-COUNTY REGION THROUGH A PARTNERSHIP OF HOSPITAL SYSTEMS, LOCAL HEALTH DEPARTMENTS, AND OTHER COMMUNITY PARTNERS. OUR AIM IS TO LEVERAGE RESOURCES AND REDUCE DUPLICATION WHILE STILL ADDRESSING UNIQUE LOCAL NEEDS FOR HIGH QUALITY, COMPARABLE, COUNTY-LEVEL DATA. THE 2021 MITHRIVE COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZED THREE REGIONS: NORTHWEST, NORTHEAST, AND NORTH CENTRAL. ALL OF THE MUNSON HEALTHCARE HOSPITALS WORKED TOGETHER ON REGIONAL CHNA EFFORTS AS PART OF THE MITHRIVE REGIONAL CHNA INITIATIVE. THESE INCLUDE: MUNSON MEDICAL CENTER, MUNSON HEALTHCARE CADILLAC, MUNSON HEALTHCARE GRAYLING, PAUL OLIVER MEMORIAL HOSPITAL, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL, MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL, MUNSON HEALTHCARE MANISTEE HOSPITAL, AND KALKASKA MEMORIAL HEALTH CENTER. IN ADDITION, HOSPITALS FORM THE MCLAREN AND SPECTRUM HEALTH SYSTEMS COLLABORATED ON THIS EFFORT.
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 6BIN ADDITION TO DOZENS OF LOCAL AND REGIONAL ORGANIZATIONS, ALL HEALTH DEPARTMENTS IN THE REGION SERVED PARTICIPATED, INCLUDING: GRAND TRAVERSE HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT 10, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, BENZIE LEELANAU DISTRICT HEALTH DEPARTMENT, CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT 2, DISTRICT HEALTH DEPARTMENT 4. FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 7A HTTPS://WWW.MUNSONHEALTHCARE.ORG/SERVICES/COMMUNITY-HEALTH/COMMUNITY- HEALTH-NEEDS-ASSESSMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 10A HTTPS://WWW.MUNSONHEALTHCARE.ORG/SERVICES/COMMUNITY-HEALTH/COMMUNITY- HEALTH-NEEDS-ASSESSMENT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 11WE IDENTIFIED STRATEGIC ISSUES AS PART OF THE MITHRIVE COLLABORATIVE. STRATEGIC ISSUES ARE BROADER THAN INDIVIDUAL HEALTH CONDITIONS, AND REPRESENT UNDERLYING CHALLENGES THAT NEED TO BE ADDRESSED, WHICH WOULD LEAD TO IMPROVEMENT IN HEALTH CONDITIONS. EACH STRATEGIC ISSUE SHOULD IMPACT MORE THAN ONE HEALTH CONDITION. THE TOP PRIORITY ISSUES TO BE ADDRESSED: MENTAL HEALTH AND SUBSTANCE USE DISORDERS SAFE, AFFORDABLE AND ACCESSIBLE HOUSING ACCESS TO HEALTHCARE CHRONIC DISEASE A COMPLETE LIST OF STRATEGIES PLANNED TO ADDRESS THE PRIORITIZED NEEDS MAY BE VIEWED WITHIN THE CHNA IMPLEMENTATION PLAN. GENERALLY, THE HOSPITAL SYSTEM IS COMMITTED TO PROVIDING RESOURCES TO SUPPORT PROGRAMMING, PARTICIPATION IN COLLABORATIVE PROJECTS, BOARDS, AND SUPPORT FOR OTHER COMMUNITY IMPROVEMENT PROJECTS RELATED TO OUR PRIORITY STRATEGIC ISSUES. IN ADDITION TO THE STRATEGIC ISSUES LISTED ABOVE, THE FOLLOWING CHALLENGES WERE ALSO UNCOVERED IN THE DATA: BROADBAND ACCESS COVID-19 ECONOMIC SECURITY EQUITY HEALTHY FOOD HEALTHY WEIGHT INFRASTRUCTURE FOR HEALTHY LIVES SAFETY AND WELL-BEING TRANSPORTATION MUNSON HEALTHCARE ACKNOWLEDGES THE WIDE RANGE OF ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT WITH THE BROAD NATURE OF THE STRATEGIC ISSUES WE COULD EFFECTIVELY FOCUS ON ONLY THOSE ISSUES THAT WERE PRIORITIZED THE HIGHEST BY OUR COMMUNITY. HOWEVER, SOME OF THESE ISSUES INCLUDING EQUITYARE FOUNDATIONAL COMPONENTS OF ALL THE WORK OF THE ORGANIZATION AND WILL BE INDIRECTLY TARGETED THROUGH MANY OF THE STRATEGIES LISTED IN THIS PLAN.
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 13HPATIENTS WHOSE FAMILY INCOME EXCEEDS 400% OF THE FPG MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, AT THE SOLE DISCRETION OF MUNSON HEALTHCARE. FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 16A HTTPS://WWW.MUNSONHEALTHCARE.ORG/PATIENTS-VISITORS/BILL-PAY/ FINANCIAL-ASSISTANCE FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 16B HTTPS://WWW.MUNSONHEALTHCARE.ORG/PATIENTS-VISITORS/BILL-PAY/ FINANCIAL-ASSISTANCE FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 16C HTTPS://WWW.MUNSONHEALTHCARE.ORG/PATIENTS-VISITORS/BILL-PAY/ FINANCIAL-ASSISTANCE
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 16JIT IS THE GOAL OF MUNSON HEALTHCARE TO COMMUNICATE TO THE PATIENTS AND TO THE PUBLIC THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY. THIS WILL BE ACHIEVED THROUGH ONE OR MORE OF THE FOLLOWING METHODS: INFORMATION BROCHURES AVAILABLE AT THE REGISTRATION DESKS; BROCHURES DISTRIBUTED TO ALL SELF-PAY PATIENTS; INFORMATION POSTED ON THE WEBSITE; STATEMENT ON BILLS; SIGNS IN THE REGISTRATION AREAS; AND CALLS MADE TO ALL SELF-PAY PATIENTS AFTER SERVICE.
FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 20EMUNSON HEALTHCARE CHARLEVOIX HOSPITAL (CHARLEVOIX) REVIEWS LARGE DOLLAR ACCOUNTS TO ENSURE ASSISTANCE HAS BEEN OFFERED TO PATIENTS BEFORE THE ACCOUNTS ARE TRANSFERRED TO A CREDIT AGENCY. ONCE AN ACCOUNT HAS BEEN TRANSFERRED TO A CREDIT AGENCY, THE AGENCY REVIEWS THE ACCOUNT TO SEE IF THE PATIENT WOULD BE A POSSIBLE CANDIDATE FOR FINANCIAL ASSISTANCE BEFORE FILING ANY LAWSUITS OR LIENS. CHARLEVOIX WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS WAGE GARNISHMENTS, LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE: 1.VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; 2.DOCUMENTING THAT CHARLEVOIX HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITAL'S APPLICATION REQUIREMENTS; 3.DOCUMENTING THAT THE PATIENT HAS BEEN OFFERED THE OPPORTUNITY TO ENTER INTO A PAYMENT PLAN BUT HAS NOT DONE SO, OR HAS ENTERED INTO A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. THE METHOD IN WHICH CHARLEVOIX DOES THIS IS AS FOLLOWS: ALL STATEMENTS INCLUDE A STATEMENT REGARDING THE AVAILABILITY OF PAYMENT PLANS, FINANCIAL ASSISTANCE AND CHARITY CARE. CHARLEVOIX WORKS WITH THE COLLECTION AGENCIES TO IDENTIFY INDIVIDUALS THAT MAY QUALIFY FOR CHARITY. IF THEY FIND AN INDIVIDUAL, THEY MAY REFER THE PATIENT TO PATIENT ACCOUNTS FOR EVALUATION. ALL ACCOUNTS THAT ARE PATIENT-PAY RECEIVE A PHONE CALL TO MAKE THE PATIENT AWARE OF OUR FINANCIAL ASSISTANCE POLICY PRIOR TO THEM GOING TO COLLECTIONS.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxtAddress Line2USAddress/AddressLine2Txt
MHC BOYNE AREA HEALTH CENTER
223 N PARKBOYNE CITYMI49712RURAL HEALTH CLINIC
MHC CHARLEVOIX SURGEONS
14695 PARK AVENUECHARLEVOIXMI49720SURGICAL SERVICESSUITE A
MHC BOYNE REHAB CENTER
197 STATE STREETBOYNE CITYMI49712REHABILITATION SERVICES
MHC JORDAN VALLEY REHAB CENTER
100 MAIN STREET 9EAST JORDANMI49727REHABILITATION SERVICES

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3CINCOME UP TO 200% OF THE FPG = 100% DISCOUNT ON CHARGES INCOME BETWEEN 201% AND 300% FPG = 75% DISCOUNT ON CHARGES INCOME BETWEEN 301% AND 400% FPG = 65% DISCOUNT ON CHARGES FAMILY INCOME MAY INCLUDE ALL INCOME ATTRIBUTABLE TO ALL MEMBERS OF THE FAMILY IN THE RESIDENCE, OTHER THAN MINIMAL AMOUNTS EARNED BY MINORS. FAMILY INCOME INCLUDES THE FOLLOWING WHEN COMPUTING FPG: EARNINGS, UNEMPLOYMENT COMPENSATION, WORKER'S COMPENSATION, SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, PUBLIC ASSISTANCE, VETERANS' PAYMENTS, SURVIVOR BENEFITS, PENSION OR RETIREMENT INCOME, INTEREST, DIVIDENDS, RENTS, ROYALTIES, INCOME FROM ESTATES, EDUCATIONAL ASSISTANCE, ALIMONY, CHILD SUPPORT, ASSISTANCE FROM OUTSIDE THE HOUSEHOLD, AND OTHER MISCELLANEOUS SOURCES; CASH, CHECKING AND SAVINGS BALANCES, MONEY MARKET ACCOUNTS, CERTIFICATES OF DEPOSIT, IRAS TRUSTS, INHERITANCES, ANNUITIES, SAVINGS BONDS, STOCKS, MUTUAL FUNDS, AND/OR CASH VALUE OF LIFE INSURANCE.
SCHEDULE H, PART I, LINE 7GTHE COSTS RELATED TO PHYSICIAN CLINICS IN SUBSIDIZED HEALTH SERVICES TOTAL 4,585,211. THESE COSTS ARE OFFSET BY RELATED REVENUES IN COMPUTING THE NET COMMUNITY BENEFIT.
SCHEDULE H, PART I, LINE 7, COLUMN (F)TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, ARE 69,078,646. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS 2,325,710. THE NET EXPENSE OF 66,752,936 WAS USED FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F).
SCHEDULE H, PART I, LINE 7COST VALUES FOR LINE 7 ARE BASED ON THE COST TO CHARGE RATIO.
SCHEDULE H, PART IIMUNSON HEALTHCARE CHARLEVOIX HOSPITAL (CHARLEVOIX) BELIEVES COMMUNITY BUILDING ACTIVITIES PROMOTE HEALTH BY SUPPORTING THE UNDERLYING STRUCTURE OF COMMUNITY HEALTH. CHARLEVOIX PROVIDED 21,800 OF COMMUNITY BUILDING FUNDING IN FISCAL YEAR 2022 TO SUPPORT WORKFORCE DEVELOPMENT THROUGH PHYSICIAN RECRUITMENT.
SCHEDULE H, PART III, LINE 2DIRECT WRITE-OFF FROM UNPAID ACCOUNTS WHICH ARE DEEMED NO LONGER COLLECTIBLE ARE RECORDED AGAINST THE ALLOWANCE FOR BAD DEBT. AN ESTIMATE OF BAD DEBT EXPENSE IS RECORDED BASED ON 1) AN ANALYSIS OF THE DIRECT WRITE- OFFS AND 2) AN ESTIMATE OF THE AMOUNT OF BAD DEBT, NET OF DISCOUNTS, IN THE ACCOUNTS RECEIVABLE BALANCE, CONSIDERING THE PAST EXPERIENCE AND CURRENT TRENDS OF PAYMENTS ON PATIENT ACCOUNTS FOR EACH OF THE MAJOR PAYOR SOURCES OF REVENUE.
SCHEDULE H, PART III, LINE 3THE METHODOLOGY USED TO DETERMINE THE ESTIMATED AMOUNT OF CHARITY IN BAD DEBT IS AS FOLLOWS. WE DETERMINED THE APPROVAL RATE OF FINANCIAL COUNSELING BY TAKING THE VALUE OF THE ACCOUNTS THAT SUCCESSFULLY QUALIFIED FOR CHARITY (INCLUDING PRESUMPTIVE APPROVALS) AND DIVIDING THAT NUMBER BY THE ACCOUNTS THAT WERE APPROVED FOR CHARITY PLUS THE ACCOUNTS THAT WERE DENIED. THEN WE APPLIED THAT PERCENTAGE TO THE VALUE OF ACCOUNTS THAT DID NOT COMPLETE FINANCIAL COUNSELING AND WERE ASSIGNED TO BAD DEBT, MULTIPLIED BY THE APPROVAL RATE FOR FINANCIAL COUNSELING.
SCHEDULE H, PART III, LINE 4SEE NOTE 2 ON PAGE 10 OF ATTACHED AUDITED FINANCIAL STATEMENTS UNDER ACCOUNTS RECEIVABLE.
SCHEDULE H, PART III, LINE 9BMUNSON HEALTHCARES INTERNAL AND EXTERNAL COLLECTION PRACTICES REFERENCED IN THE CREDIT AND COLLECTION POLICY (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, INCLUDING COLLECTION ACTIONS AND REPORTING TO COLLECTION AGENCIES) SHALL TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENTS GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM MUNSON HEALTHCARE (MHC), AND A PATIENTS GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS WITH MHC. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, MHC MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS ON ANY UNPAID BALANCES ON ACCOUNTS THAT WERE OPENED WITHIN ONE YEAR OF THE DATE THAT THE PATIENT QUALIFIED FOR CHARITY UNDER THIS POLICY. MHC WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS WAGE GARNISHMENTS, LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE: 1) VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; 2) DOCUMENTING THAT MHC HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITALS APPLICATION REQUIREMENTS; 3) DOCUMENTING THAT THE PATIENT HAS BEEN OFFERED THE OPPORTUNITY TO ENTER INTO A PAYMENT PLAN BUT HAS NOT DONE SO, OR HAS ENTERED INTO A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. PATIENTS WILL BE NOTIFIED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR A PERIOD OF AT LEAST 120 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. PATIENT BALANCES WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE CONSIDERATION FOR AT LEAST 240 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. MEMBERS OF THE PUBLIC MAY OBTAIN THE CURRENT CREDIT AND COLLECTION POLICY FOR ANY MUNSON HEALTHCARE HOSPITAL ON THE WEBSITE, IN WRITING, AND FREE OF CHARGE BY CONTACTING MUNSON HEALTHCARE PATIENT FINANCIAL SERVICES DEPARTMENT AT 4230 COPPER RIDGE DR., TRAVERSE CITY, MI 49684
SCHEDULE H, PART VI, LINE 2MUNSON HEALTHCARE SYSTEM ASSESS THE HEALTH STATUS OF THE TOTAL POPULATION WITHIN MUNSON HEALTHCARE'S EXTENSIVE GEOGRAPHICAL AREA. COMMUNITY HEALTH ASSESSMENT IS AN IMPORTANT COMPONENT OF A COMMUNITY HEALTH IMPROVEMENT STRATEGY AS IT PROVIDES GUIDANCE AS TO WHERE EFFORTS SHOULD BE CONCENTRATED, AS WELL AS WHERE PROGRESS HAS BEEN MADE. THE DATA DOCUMENTED THROUGH AN ASSESSMENT SERVES AS A USEFUL REFERENCE FOR PROGRAM AND RESOURCE DEVELOPMENT EFFORTS COMMUNITY-WIDE. THE HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM PARTICIPATE IN A COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY TO MEET THE REQUIREMENTS OF IRC SEC 501(R) IN ACCORDANCE WITH THE PLANS OF THE COMMUNITY HEALTH COMMITTEE OF THE BOARD. THE ASSESSMENT IS ACCOMPLISHED THROUGH COLLABORATION WITH MANY OF THE HUMAN SERVICE ORGANIZATIONS IN THE LOCAL COMMUNITIES.
SCHEDULE H, PART VI, LINE 3IT IS THE GOAL OF MUNSON HEALTHCARE TO COMMUNICATE AND EDUCATE PATIENTS AND THE PUBLIC REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. THIS IS ACHIEVED THROUGH ONE OR MORE OF THE FOLLOWING METHODS: INFORMATION BROCHURES AVAILABLE AT THE REGISTRATION DESKS: BROCHURES THAT DESCRIBE MUNSON HEALTHCARE'S FINANCIAL ASSISTANCE PROGRAM ARE AVAILABLE AT ALL REGISTRATION SITES. THE BROCHURE HAS CLEAR INFORMATION ON HOW TO CONTACT A FINANCIAL COUNSELOR. STATEMENT ON BILLS: STATEMENTS INCLUDE VERBIAGE THAT INSTRUCTS THE PATIENT TO CALL PATIENT FINANCIAL ASSISTANCE IF THEY NEED HELP WITH THEIR BILL. SIGNS IN THE ER REGISTRATION AREA: ADVISES THE PATIENTS THAT THEIR CARE IS NOT WITHHELD IF THEY HAVE NO INSURANCE OR MEANS TO PAY. THE MUNSON HEALTHCARE INTERNET HAS THE FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION, THE PLAIN LANGUAGE SUMMARY AND THE BILLING AND COLLECTIONS POLICY AVAILABLE TO REVIEW AND PRINT. REFERRAL BY REGISTRATION STAFF: AT THE TIME OF REGISTRATION, SELF-PAY PATIENTS OR ANY PATIENT THAT MAY HAVE CONCERNS REGARDING THEIR UPCOMING ADMISSION IS REFERRED TO THE FINANCIAL COUNSELING STAFF. MUNSON HEALTHCARE FINANCIAL COUNSELORS ARE AVAILABLE TO TALK WITH PATIENTS ABOUT THEIR FINANCIAL CONCERNS. THE COUNSELOR VISIT ALL INPATIENTS THAT ARE DEEMED SELF-PAY, TO SEE IF THEY HAVE CONCERNS AND TO DETERMINE IF THEY WOULD LIKE HELP. IF THE PATIENT WOULD LIKE HELP, THE COUNSELORS GATHER INCOME INFORMATION AND SCREEN THE PATIENT FOR MEDICAID. GENERALLY, THESE TWO ACTIONS WILL DETERMINE WHAT PROGRAM THE PATIENT MIGHT QUALIFY FOR. ONCE THE COUNSELOR DETERMINES WHAT THE PATIENT MAY QUALIFY FOR, THE COUNSELOR EDUCATES THE PATIENT ON THE AVAILABLE PROGRAMS AND ASSISTS THEM WITH COMPLETING THE APPROPRIATE APPLICATIONS. THE COUNSELORS ALSO IDENTIFY ALL SELF-PAY OUTPATIENTS AND GO THROUGH THE SAME PROCESS, ONLY BY PHONE. THE GOAL IS TO TALK WITH PATIENTS PRIOR TO ADMISSION, BUT WHEN THAT IS NOT POSSIBLE, THE CALL IS MADE SOON AFTER DISCHARGE. AVAILABLE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO: MEDICAID (AND ALL OF ITS SUBSETS), SOCIAL SECURITY DISABILITY, TRAVERSE HEALTH CLINIC, MUNSON HEALTHCARE FINANCIAL ASSISTANCE, AND MUNSON MEDICAL CENTER MEDS PROGRAM. MUNSON HEALTHCARE MAKES A PHONE CALL TO ALL PRIVATE-PAY PATIENTS PRIOR TO TRANSFERRING THEIR ACCOUNT TO A COLLECTION AGENCY TO INFORM THEM OF OUR FINANCIAL ASSISTANCE POLICY.
SCHEDULE H, PART VI, LINE 4DESCRIPTION LOCATED IN CHARLEVOIX, MICHIGAN, ABOUT 50 MILES NORTH OF TRAVERSE CITY, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (CHARLEVOIX HOSPITAL) IS ONE OF EIGHT HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM. THE 25-BED CRITICAL ACCESS HOSPITAL, AS DEFINED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, HAS AN ACTIVE MEDICAL STAFF (PRIMARY FACILITY) OF 43 AND IS ONE OF THE LARGEST EMPLOYERS IN THE REGION. HOSPITAL SERVICES NOT UNLIKE MANY RURAL COMMUNITY HOSPITALS, CHARLEVOIX HOSPITAL OFFERS A FULL SPECTRUM OF HEALTHCARE SERVICES, INCLUDING EMERGENCY, OBSTETRIC, UROLOGY, AND INPATIENT CARE. IT OFFERS A WIDE ARRAY OF SURGICAL SERVICES, INCLUDING ORTHOPEDIC, NEUROSURGICAL SPINE, EYE, AND GENERAL SURGERY PROCEDURES. IN ADDITION TO TRADITIONAL DIAGNOSTIC AND SCREENING XRAYS, MAMMOGRAMS, AND CT, CHARLEVOIX HOSPITAL MAKES AVAILABLE THROUGH MOBILE PROVIDERS, BOTH PET AND MRI SERVICES. THE INFUSION SUITE, OVERLOOKING BEAUTIFUL LAKE MICHIGAN, OFFERS A SERENE AND TRANQUIL ENVIRONMENT FOR THOSE FACING THE CHALLENGES OF A CANCER DIAGNOSIS. CHARLEVOIX HOSPITAL OWNS SEVERAL SATELLITE FACILITIES, INCLUDING A RURAL HEALTH CLINIC IN BOYNE CITY AND PHYSICAL THERAPY LOCATIONS IN BOYNE CITY AND EAST JORDAN. THE HOSPITAL SERVED OVER 2,700 SURGICAL CASES, OVER 64,000 OUTPATIENT VISITS, OVER 9,700 EMERGENCY ROOM VISITS, 779 INPATIENT ADMISSIONS AND 184 BIRTHS IN FISCAL YEAR 2022. POPULATION SERVED CHARLEVOIX HOSPITAL SERVES THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES, AS WELL AS THE SEASONAL RESIDENTS THAT FLOOD THE AREA DURING THE SUMMER MONTHS. THE SMALL, RURAL COMMUNITY IS HOME TO APPROXIMATELY 26,086 RESIDENTS IN CHARLEVOIX COUNTY, WITH A MEDIAN HOUSEHOLD INCOME OF 60,433. BASED ON ESTIMATES, 8.7% OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL. IN ADDITION, PATIENTS REFERRED FROM NEIGHBORING EAST JORDAN FAMILY HEALTH CENTER, A FEDERALLY QUALIFIED RURAL HEALTH CLINIC, WERE AMONG THOSE SERVED BY THE HOSPITAL. . QUALITY TOP 100 CRITICAL ACCESS HOSPITAL - CHARLEVOIX HOSPITAL WAS NAMED ONE OF IVANTAGE HEALTH ANALYTICS' TOP 100 CRITICAL ACCESS HOSPITALS (CAHS) IN THE UNITED STATES IN 2016. TOP 100 CRITICAL ACCESS HOSPITALS ARE CHARACTERIZED BY EXCELLENCE IN MANAGING RISK, ACHIEVING HIGHER QUALITY, SECURING BETTER OUTCOMES, INCREASING PATIENT SATISFACTION, AND OPERATING AT A LOWER COST THAN THEIR PEERS. CHARLEVOIX HOSPITAL HAS RECEIVED A 5-STAR CMS RATING FOR OVERALL HOSPITAL QUALITY FULLY ACCREDITED - MUNSON HEALTHCARE CHARLEVOIX HOSPITAL IS ACCREDITED BY THE JOINT COMMISSION IN THE CRITICAL ACCESS HOSPITAL AND LABORATORY ACCREDITATION PROGRAM CATEGORIES.
SCHEDULE H, PART VI, LINE 5MUNSON HEALTHCARE CHARLEVOIX HOSPITAL'S BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS, THE MAJORITY OF WHOM RESIDE IN THE MUNSON HEALTHCARE PRIMARY SERVICE AREA. THESE VOLUNTEERS GIVE NUMEROUS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS. THE HOSPITAL UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT THE SERVICE AREA. THESE FUNDS ARE REINVESTED INTO OUR HOSPITALS IN THE FORM OF EMPLOYEE WAGE ADJUSTMENTS AND TECHNOLOGY NEEDED TO ENSURE THE HIGHEST QUALITY CARE IS AVAILABLE IN NORTHERN MICHIGAN. THE HOSPITAL ALSO HAS AN OPEN MEDICAL STAFF WHERE PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF. IN ADDITION, THE HOSPITAL CONTINUES TO INVEST IN PUBLIC HEALTH PROGRAMING AND INITIATIVES PRIORITIZED AND DEVELOPED IN PRIOR CHNA CYCLES. FOR EXAMPLE, THE MUNSON HEALTHCARE SYSTEM SUPPORTS: HEALTHY FUTURES: FOR OVER 20 YEARS, HEALTHY FUTURES A PARTNERSHIP OF MUNSON HEALTHCARE AND LOCAL HEALTH DEPARTMENTS HAS HELPED PARENTS AND BABIES HAVE A HEALTHY START. THIS INCLUDES A POSTPARTUM HOME VISITING PROGRAM, 1:1 BREASTFEEDING ASSISTANCE, INFANT SLEEP AND IMMUNIZATION EDUCATION AND AGE APPROPRIATE NEWSLETTERS. HEALTHY FUTURES ENROLLS OVER 1,300 FAMILIES ANNUALLY. NORTHERN MICHIGAN DIABETES INITIATIVE (NMDI)- AN INITIATIVE COMMITTED TO PROVIDING LOCAL, REGIONAL, AND NATIONAL RESOURCES FOR THE PREVENTION AND MANAGEMENT OF DIABETES. WHILE MOST DIABETES COLLABORATIVES FOCUS ON PROVIDING OPTIMAL EVIDENCE-BASED CARE MANAGEMENT TO THE PERSON ALREADY DIAGNOSED WITH DIABETES, NMDI FOCUSES ON CONCURRENT UPSTREAM TARGETED EDUCATION OF THREE SPECIFIC POPULATIONS: THE GENERAL COMMUNITY; THE SOCIOECONOMICALLY CHALLENGED HIGH RISK POPULATION; AND RURAL PRIMARY CARE PROVIDERS (PCP) CARING FOR DIABETIC PATIENTS. NORTHERN MICHIGAN VACCINE PREVENTABLE DISEASE TASK FORCE: A GROUP COORDINATED AND LED BY MUNSON HEALTHCARE, IS WORKING TO INFORM, EDUCATE, AND SUPPORT POLICY CHANGE THAT REVERSES THE REGIONS ONGOING TREND OF VERY LOW VACCINATION RATES AND SUPPORTS HEALTHY COMMUNITIES. ALTHOUGH, THE NORTHERN MICHIGAN VACCINE PREVENTABLE DISEASE TASK FORCE NO LONGER MEETS IN PERSON THE COLLABORATIVE BODY REMAINS INTACT TO ENGAGE IN LEGISLATIVE ACTIVITIES AND SHARE APPROPRIATE INFORMATION AS NEEDED. FRUIT AND VEGETABLE PROGRAM: MUNSON SUPPORTS AREA PROGRAMS TO BUILD SYSTEMATIC SUPPORT FOR HEALTHY BEHAVIOR CHANGES IN PATIENTS WITH CHRONIC DISEASE. THE PROGRAM ALSO CREATES STRONGER PARTNERSHIPS BETWEEN HEALTH CARE PROVIDERS, PATIENTS AND THEIR LOCAL FOOD SECTOR. THE PROGRAM OFFERS NUTRITIONAL EDUCATION AND FOOD TASTING THROUGH OUR PARTNERS AT MICHIGAN STATE UNIVERSITY EXTENSION AND FARMERS MARKET TOKENS TO PURCHASE FRESH FRUITS AND VEGETABLES CREATING HEALTHY HABITS FOR LONG TERM HEALTH. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS. MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (MHCH) UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA. EXAMPLES OF HOW MHCH PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PROGRAMS INCLUDE: AMERICAN RED CROSS BLOOD DRIVES AREA BUSINESS HEALTH SCREENINGS FREEDOM FROM SMOKING CLINIC SUPPORT GROUPS DIABETES MANAGEMENT EDUCATION PINK RIBBON RIDE HOSPITAL AND CAREER EXPLORATION TOURS SCHOOL NURSE PROGRAM THANKSGIVING TURKEY TROT 5K RUN/WALK YOGA CLASSES HEALTHY COOKING CLASSES LOW COST HEALTH SCREENINGS
SCHEDULE H, PART VI, LINE 6MUNSON HEALTHCARE CHARLEVOIX HOSPITAL'S SOLE CORPORATE MEMBER IS MUNSON HEALTHCARE, A 501(C)(3) CORPORATION. THE MUNSON HEALTHCARE SYSTEM CONSISTS OF A MAJOR TERTIARY REFERRAL HOSPITAL, SEVERAL RURAL-BASED MEDICAL CENTERS, EXTENSIVE OUTPATIENT TREATMENT AND REHABILITATION FACILITIES, AND ANCILLARY EMERGENCY, TRANSPORTATION AND HOME-BASED MEDICAL SERVICES THAT COVER 24 COUNTIES IN MICHIGANS NORTHERN LOWER PENINSULA AND THE EASTERN PORTION OF THE UPPER PENINSULA. THE MOST SIGNIFICANT OF THE MUNSON HEALTHCARE SUBSIDIARIES IS MUNSON MEDICAL CENTER (MMC). MMC IS ONE OF NINE NOT-FOR-PROFIT HOSPITALS WHICH ARE AFFILIATED WITH EACH OTHER AND SERVE AS THE ONLY HOSPITALS IN THEIR COMMUNITIES. EACH OF THE AFFILIATED HOSPITALS HAS INDIVIDUAL COMMUNITY HEALTH INITIATIVES AND/OR PROMOTION ACTIVITIES, AS WELL AS SHARED INITIATIVES. THE OWNED HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM WHICH INCLUDE MUNSON MEDICAL CENTER, PAUL OLIVER MEMORIAL HOSPITAL, MUNSON HEALTHCARE CADILLAC, MUNSON HEALTHCARE GRAYLING, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL, MUNSON HEALTHCARE MANISTEE HOSPITAL AND MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL PROVIDED 141.2 MILLION OF COMMUNITY BENEFIT IN THE 2021 TAX YEAR. ADDITIONALLY, MMC WORKS IN COOPERATION WITH OTHER ENTITIES IN THE MUNSON HEALTHCARE SYSTEM TO PROVIDE A FULL RANGE OF HEALTH SERVICES TO THE COMMUNITIES IN ITS SERVICE AREA. THE HOME HEALTH DIVISION OF MUNSON HEALTHCARE PROVIDES HOME NURSE AND AIDE SERVICES IN ADDITION TO DURABLE MEDICAL EQUIPMENT AND A PALLIATIVE CARE AND HOSPICE PROGRAM ON THE MUNSON CAMPUS. COMMUNITY BENEFIT, IN THE FORM OF CHARITY CARE AND UNREIMBURSED MEDICAID ARE PROVIDED THROUGH THIS DIVISION EACH YEAR. MUNSON MEDICAL GROUP, THE EMPLOYED PHYSICIAN ORGANIZATION IN THE SYSTEM, PROVIDED 1.7 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN TAX YEAR 2021. MMC PERFORMS THE NEEDS ASSESSMENTS FOR MUNSON HEALTHCARE. UTILIZING THIS NEEDS ASSESSMENT, MUNSON HEALTHCARE COORDINATES COMMUNITY BENEFIT PROGRAMS THROUGH PLANNING, DEVELOPING, IMPLEMENTING, EVALUATING AND FUNDING PROGRAMS THAT ADDRESS COMMUNITY NEEDS. IN TOTAL, THE MUNSON HEALTHCARE SYSTEM PROVIDED 153.3 MILLION IN CHARITY CARE AND COMMUNITY BENEFITS, INCLUDING NUMEROUS UNCOMPENSATED COMMUNITY HEALTH IMPROVEMENT SERVICES AND PROGRAMS, OUTREACH PROGRAMS, BAD DEBT, AND UNREIMBURSED MEDICARE AND MEDICAID SERVICES TO NORTHERN MICHIGAN.
SCHEDULE H, PART VI, LINE 7MICHIGAN

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (17 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
EDWIN NESS
DIRECTOR$883,584$280,959$28,690$190,789$32,369$1,416,391
LAURA GLENN
PRESIDENT AMB SERVIC$462,670$124,952$20,066$63,530$21,739$692,957
TONYA SMITH
DIRECTOR$409,775$118,506$1,520$56,121$26,373$612,295
JAMES JEAKLE MD
PHYSICIAN$564,917$3,944$14,529$26,478$609,868
BARRETT KIELHORN DO
PHYSICIAN$485,733$20,382$14,529$26,076$606,720$60,000
MARK HEPLER
FORMER CFO$227,786$109,926$191,072$11,390$6,919$547,093$85,313
HOWARD TOPLEY MD
PHYSICIAN$231,993$2,472$513$234,978$231,993$4,659$8,700$931$246,283
ALICIA MAITLAND
CFO$311,916$46,733$10,173$46,343$21,608$436,773
CASEY KANDOW
VP ANCILLARY SERVICE$309,195$46,512$319$33,286$22,637$411,949
JOANNE SCHROEDER
PRESIDENT$247,743$67,524$22,007$41,402$22,142$400,818
ELLEN SMITH
COO PHYSICIAN NETWOR$274,087$54,320$1,306$29,033$2,661$361,407
NATHAN BOSS MD
PHYSICIAN$270,207$1,529$14,529$21,556$355,433$47,612
MARK LAME MD
SURGEON$271,064$22,489$13,559$12,454$345,002$25,436
CHRISTOPHER SQUIRE
VP ANCILLARY SER EAS$243,934$29,104$260$30,989$22,745$327,032
ANNA YOUNG MD
DIRECTOR$218,499$2,478$12,812$7,949$273,832$32,094
CATHERINE WONSKI MD
DIRECTOR$236,301$18,945$5,122$11,732$272,100
BERNADETTE GREEN COLE RN
CHIEF NURSING OFFICE$149,438$1,788$17,291$23,921$219,502$27,064

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 1AMUNSON HEALTHCARE MAINTAINS A SOCIAL MEMBERSHIP AT THE TRAVERSE CITY COUNTRY CLUB. A REQUIREMENT OF THE COUNTRY CLUB IS THAT A MEMBERSHIP BE IN AN INDIVIDUAL NAME AND NOT A CORPORATE NAME, SO EDWIN NESS IS LISTED AS THE INDIVIDUAL FOR THE MEMBERSHIP. MUNSON HEALTHCARE USES THE SOCIAL MEMBERSHIP TO CONDUCT OFF-SITE MEETINGS AND RETREATS.
SCHEDULE J, PAGE 1, PART I, LINE 3THE PROCESS FOR DETERMINING APPROPRIATE LEVELS OF PAY FOR EXECUTIVE POSITIONS WITHIN MUNSON HEALTHCARE SYSTEM IS CAREFULLY AND THOUGHTFULLY DIRECTED BY THE MUNSON HEALTHCARE BOARD OF DIRECTORS, THROUGH THE COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE. THE COMMITTEE UTILIZES "BEST PRACTICES" METHODS OF DETERMINING COMPENSATION AND, AS SUCH, IS COMPOSED OF SEVEN MEMBERS WHOSE VOTING MEMBERS ARE INDEPENDENT. THE COMMITTEE IS CHARGED WITH ENSURING THAT EXECUTIVE COMPENSATION IS DESIGNED TO ATTRACT AND RETAIN HIGH QUALITY, PROFESSIONAL LEADERSHIP WHILE MAINTAINING STRONG STEWARDSHIP FOR THE ORGANIZATION. COMPENSATION LEVELS REFLECT THE SCOPE OF EACH EXECUTIVE'S RESPONSIBILITIES, EDUCATIONAL BACKGROUND, EXPERIENCE, AND INDUSTRY STANDING AS WELL AS INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. ANNUALLY, THE COMMITTEE RETAINS A NATIONAL INDEPENDENT CONSULTANT TO ENSURE MUNSON HEALTHCARE'S COMPENSATION PRACTICES AND LEVELS ARE INDEPENDENTLY REVIEWED WHILE BEING COMPETITIVE AND REASONABLE. THE MUNSON HEALTHCARE CONFLICT, VALUATION AND COMPLIANCE ("CVC") COMMITTEE ALSO REVIEWS THE SURVEY INFORMATION TO EVALUATE THE REASONABLENESS OF EXECUTIVE COMPENSATION. THAT ANALYSIS OCCURS EACH NOVEMBER. THE COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
SCHEDULE J, PAGE 1, PART I, LINE 4EDWIN NESS 0 176,260 0 LAURA GLENN 0 49,001 0 TONYA SMITH 0 41,999 0 ALICIA MAITLAND 0 32,080 0 CASEY KANDOW 0 18,912 0 JOANNE SCHROEDER 0 27,589 0 ELLEN SMITH 0 16,524 0 CHRISTOPHER SQUIRE 0 24,310 0 BERNADETTE GREEN COLE, RN 0 9,426 0
SCHEDULE J, PAGE 1, PART I, LINE 7MUNSON HEALTHCARE EXECUTIVES ARE ELIGIBLE FOR AN ANNUAL BONUS BASED ON MEETING ORGANIZATIONAL GOALS, WHICH ARE SET IN ADVANCE AND APPROVED BY THE COMPENSATION COMMITTEE OF THE MUNSON HEALTHCARE BOARD. THE GOALS INCLUDE A COMBINATION OF FINANCIAL TARGETS, STRATEGIC TARGETS AND OPERATIONAL TARGETS INCLUDING QUALITY HEALTHCARE DELIVERY, DISEASE MANAGEMENT, PATIENT SATISFACTION, EMPLOYEE SAFETY, AND EMPLOYEE ENGAGEMENT. AT THE END OF EACH FISCAL YEAR, THE COMPENSATION COMMITTEE OF THE MUNSON HEALTHCARE BOARD IS CHARGED WITH REVIEWING AND APPROVING EXECUTIVE BONUSES BASED ON PROGRESS TOWARD MEETING ORGANIZATIONAL GOALS.
SCHEDULE J, PART IIISUPPLEMENTAL EXECUTIVE RETIREMENT PLANS: SUBJECT TO REVIEW AND APPROVAL BY THE BOARD COMPENSATION AND EXECUTIVE LEADERSHIP COMMITTEE, IN ORDER TO RECRUIT AND MAINTAIN QUALIFIED EXECUTIVES, INCLUDING THE PRESIDENT AND VICE-PRESIDENTS, A COMPETITIVE BENEFIT PACKAGE IS OFFERED WHICH INCLUDES PARTICIPATION IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. ANNUAL CONTRIBUTIONS, AT MUNSON HEALTHCARE'S DISCRETION, ARE MADE TO THE PLAN IN ORDER TO ACHIEVE THE TARGETED RETIREMENT BENEFIT LEVEL. THESE FUNDS ARE AVAILABLE TO VESTED PARTICIPANTS UPON SEPARATION OF EMPLOYMENT FROM MUNSON HEALTHCARE.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CHARLEVOIX TWP HOSP FIN AUTH 2016BusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN383203086BondIssuerEIN
Bond Issued2016-06-23BondIssuedDt
Issue Price$7,000,000IssuePriceAmt
PurposeRENOVATION & EQUIPMENT THE 2016 BONDS WERE ISSUED TO FUND THE PROJECT COSTS WHICH INCLUDE RENOVATIONPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds$7,006,486TotalProceedsAmt
Issuance Costs From Proceeds$64,904IssuanceCostsFromProceedsAmt
Capital Expenditures$6,941,582CapitalExpendituresAmt
Substantial Completion2019SubstantialCompletionYr
Refunding Tax Exempt BondsfalseRefundingTaxExemptBondsInd
Refunding Taxable BondsfalseRefundingTaxableBondsInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (true)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsfalseEngageBondCounselContractsInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DueYes (true)NoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
DIFFERENCES IN ISSUE PRICE EXPLANATIONCHARLEVOIX TWP HOSP FIN AUTH 2016 INVESTMENT EARNINGS
PURPOSE OF ISSUE DESCRIPTIONCHARLEVOIX TWP HOSP FIN AUTH 2016 RENOVATION & EQUIPMENT THE 2016 BONDS WERE ISSUED TO FUND THE PROJECT COSTS WHICH INCLUDE RENOVATION OF THE EMERGENCY ROOM, AN OPERATING ROOM, LAB AND INFUSION AS WELL AS THE PURCHASE OF IMAGING EQUIPMENT AND OTHER CAPITAL EQUIPMENT.
DATE REBATE COMPUTATION PERFORMEDCHARLEVOIX TWP HOSP FIN AUTH 2016 08/16/21
ADDITIONAL INFORMATIONCHARLEVOIX TWP HOSP FIN AUTH 2016 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL MAINTAINS POLICIES AND PROCEDURES TO REVIEW AND MONITOR ALL CONTRACTS, INCLUDING LEASES, MANAGEMENT, SERVICE AND RESEARCH CONTRACTS. THE MONITORING PROCESS INCLUDES A REVIEW BY THE CORPORATE INTERNAL LEGAL DEPARTMENT. OUTSIDE COUNSEL MAY BE CONSULTED, AS NECESSARY. OUTSIDE COUNSEL IS RETAINED FOR ALL NEW EXEMPT BOND OFFERINGS, DURING WHICH A THOROUGH DUE DILIGENCE PROCESS REVIEWS APPLICABLE CONTACTS. SINCE NEW BONDS WERE ISSUED IN THE MUNSON HEALTHCARE SYSTEM IN 2021, OUTSIDE COUNSEL WAS ENGAGED DURING THAT TAX YEAR.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
TRACEY SHERMAN
SEE PART V$23,276COMPENSATION PAIDfalse
CAITLYN MONKS
SEE PART V$352,078COMPENSATION PAIDfalse

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART VFormAndLineReferenceDesc
ExplanationPART IV, LINE 1 TRACEY SHERMAN IS A FAMILY MEMBER OF BOARD MEMBER MICHAEL ORTWINE AND BOARD MEMBER NANCY SHERMAN. PART IV, LINE 2 CAITLYN MONKS IS A FAMILY MEMBER OF BOARD MEMBER CATHERINE WONKSI.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 4EFFECTIVE 1/1/2022, THE MUNSON HEALTHCARE CHARLEVOIX HOSPITAL BYLAWS WERE AMENDED TO CHANGE THE SIZE OF THE BOARD. WITH THE BYLAWS CHANGE, THE BOARD WILL BE 10-20 ELECTED DIRECTORS PLUS UP TO 10 APPOINTED EX OFFICIO DIRECTORS, FOR A TOTAL OF 20-30 DIRECTORS.
FORM 990, PAGE 6, PART VI, LINE 6MUNSON HEALTHCARE CHARLEVOIX HOSPITAL IS ORGANIZED ON A NONSTOCK MEMBERSHIP BASIS. THE SOLE MEMBER IS MUNSON HEALTHCARE, AN IRS SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 7AMUNSON HEALTHCARE, AS THE SOLE MEMBER, ELECTS THE TRUSTEES FOR ALL SUBSIDIARY ENTITIES, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL. EFFECTIVE 1/1/2022, THE BOARD OF TRUSTEES OF MUNSON HEALTHCARE CHARLEVOIX HOSPITAL CONSISTS OF THOSE INDIVIDUALS THAT ARE ELECTED OR APPOINTED TO SERVE AS THE DIRECTORS OF MUNSON HEALTHCARE. NOMINATIONS TO MUNSON HEALTHCARE ARE CONSIDERED AND RECOMMENDED BY THE MUNSON HEALTHCARE GOVERNANCE COMMITTEE.
FORM 990, PAGE 6, PART VI, LINE 7BCERTAIN DECISIONS OF THE MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (CHARLEVOIX HOSPITAL) TRUSTEES ARE SUBJECT TO APPROVAL BY THE MUNSON HEALTHCARE BOARD OF TRUSTEES INCLUDING THE ADOPTION, AMENDMENT, RESTATEMENT OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS OF CHARLEVOIX HOSPITAL; THE ADOPTION, EXECUTION, REVOCATION OR ABANDONMENT OF A PLAN OF DISSOLUTION, MERGER, CONSOLIDATION, OR REORGANIZATION; THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF CHARLEVOIX HOSPITAL; THE ACQUISITION OF OR THE ESTABLISHMENT OF ANY SUBSIDIARY OR AFFILIATE OF CHARLEVOIX HOSPITAL; THE ADOPTION OF ALL OPERATING BUDGETS AND CAPITAL EXPENDITURE BUDGETS FOR CHARLEVOIX HOSPITAL INCURRENCE OF OPERATING OR CAPITAL EXPENDITURES BY CADILLAC FOUNDATION WHICH CAUSE THE AGGREGATE OPERATING OR CAPITAL EXPENDITURES TO EXCEED BUDGETED AGGREGATES BY MORE THAN FIVE PERCENT (5%) IN ANY FISCAL YEAR; INCURRENCE OF SECURED BORROWINGS OF CHARLEVOIX HOSPITAL WITH THE EXCEPTION OF EQUIPMENT LEASES AND PURCHASE MONEY SECURITY INTERESTS APPROVED AS PART OF THE BUDGET; THE ADOPTION OR AMENDMENT OF THE MISSION STATEMENT, PURPOSES OR THE STRATEGIC GOALS OF CHARLEVOIX HOSPITAL; CHANGE IN SCOPE OF CLINICAL SERVICES OR PROGRAMS PROVIDED BY CHARLEVOIX HOSPITAL; AND APPOINTMENT OR REMOVAL OF THE PRESIDENT.
FORM 990, PAGE 6, PART VI, LINE 11BTHE MUNSON HEALTHCARE CHARLEVOIX HOSPITAL BOARD IS COMMITTED TO THE ACCURACY AND THOROUGHNESS OF THE FORM 990 REPORTING. MUNSON HEALTHCARE CHARLEVOIX HOSPITAL BELONGS TO THE MUNSON HEALTHCARE SYSTEM. MUNSON HEALTHCARE IS THE PARENT COMPANY IN THE MUNSON HEALTHCARE SYSTEM, WHICH UNDERGOES AN AUDIT BY AN EXTERNAL AUDIT FIRM. AT THE CORPORATE LEVEL, THE RESPONSIBLE INDIVIDUALS FROM THE FINANCE, ADMINISTRATION, PATIENT FINANCIAL SERVICES, LEGAL, HUMAN RESOURCES, PUBLIC RELATIONS, AND FUND DEVELOPMENT DEPARTMENTS PREPARE AND REVIEW PORTIONS OF THE FORM 990. THE COMPENSATION AND LEADERSHIP DEVELOPMENT COMMITTEE REVIEWS THE COMPENSATION INFORMATION CONTAINED IN THE CORE FORM AS WELL AS THE SCHEDULE J INFORMATION. THE CONFLICT, VALUATION AND COMPLIANCE COMMITTEE OVERSEES THE CONFLICT OF INTEREST DISCLOSURE PROCESS FOR BOARD MEMBERS AND KEY EMPLOYEES TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE FINANCE AND AUDIT COMMITTEE OVERSEES THE FORM 990 PREPARATION PROCESS BY ENSURING PROPER CONTROLS, POLICIES, PEOPLE AND RESOURCES ARE IN PLACE TO PRODUCE AN ACCURATE RETURN.
FORM 990, PAGE 6, PART VI, LINE 12CTHE MUNSON HEALTHCARE BOARD OF DIRECTORS (THE SYSTEM PARENT ORGANIZATION) HAS A STANDING CONFLICT, VALUATION AND COMPLIANCE ("CVC") COMMITTEE. THE CVC COMMITTEE IS COMPOSED OF INDEPENDENT BOARD AND COMMUNITY MEMBERS. THE CVC COMMITTEE IS DELEGATED AUTHORITY BY THE BOARD TO REVIEW AND APPROVE THE REASONABLENESS/FAIR MARKET VALUE OF FINANCIAL TRANSACTIONS/ARRANGEMENTS WITH DISQUALIFIED PERSONS. ANNUALLY, EACH BOARD MEMBER OF MUNSON HEALTHCARE AND ALL OF ITS SUBSIDIARY/CONTROLLED ENTITIES AND ALL MUNSON EXECUTIVES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE/QUESTIONNAIRE. THE RESPONSES TO THE DISCLOSURE/QUESTIONNAIRE ARE REVIEWED BY THE MUNSON LEGAL DEPARTMENT. ANY FINANCIAL ARRANGEMENTS/POTENTIAL CONFLICTS IDENTIFIED THROUGH THE DISCLOSURE/QUESTIONNAIRES ARE PRESENTED TO THE CVC COMMITTEE FOR ITS REVIEW AND DETERMINATION AS TO THE REASONABLENESS/FAIR MARKET VALUE. WHEN AN ACTION ITEM IS CONSIDERED BY A BOARD WHICH INVOLVES A POTENTIAL CONFLICT BY A BOARD MEMBER, THE CONFLICT IS DISCLOSED AND A BOARD MEMBER WILL ABSTAIN FROM A VOTE ON THE ACTION ITEM, AND, IN ADDITION, THE BOARD CHAIR HAS THE DISCRETION/AUTHORITY TO REQUEST THAT THE CONFLICTED BOARD MEMBER BE EXCUSED FROM THE MEETING FOR AN OPPORTUNITY FOR THE BOARD TO DISCUSS THE MATTER WITHOUT THE PRESENCE OF THE CONFLICTED BOARD MEMBER.
FORM 990, PAGE 6, PART VI, LINE 15ACOMPENSATION FOR THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION IS DETERMINED THROUGH THE FOLLOWING PROCESS: FIRST, AN INDEPENDENT FIRM IS ENGAGED TO PROVIDE COMPARABILITY DATA. THEN, THAT DATA IS REVIEWED BY TWO MUNSON HEALTHCARE COMMITTEES, EACH OF WHICH ARE COMPRISED OF INDIVIDUALS WHO ARE NOT EMPLOYEES OR OTHERWISE INSIDERS (DEFINED AS BOARD MEMBERS, PHYSICIANS & EXECUTIVES) OF THE ORGANIZATION. FIRST, THE BOARD COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE EVALUATES THE DATA AND DETERMINES A RECOMMENDED COMPENSATION MODEL BASED ON THE COMPARABILITY DATA. NEXT, THE BOARD CONFLICT, VALUATION AND COMPLIANCE COMMITTEE REVIEWS THE RECOMMENDATIONS AS COMPARED TO THE COMPARABILITY DATA. THIS COMMITTEE'S ROLE IS TO DETERMINE WHETHER THE PROPOSED COMPENSATION IS CONSISTENT WITH FAIR MARKET VALUE. IF PHYSICIANS ARE INCLUDED IN THE DEFINITION OF KEY EMPLOYEE, THE BOARD CONFLICT, VALUATION, AND COMPLIANCE COMMITTEE REVIEWS ALL FINANCIAL RELATIONSHIPS WITH PHYSICIANS AND COMPARES THE PROPOSED FINANCIAL ARRANGEMENT WITH COMPARABILITY DATA PRODUCED BY AN OUTSIDE, INDEPENDENT FIRM. PHYSICIAN COMPENSATION DOES NOT GO TO THE COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE. THE COMPARABILITY DATA AS WELL AS THE MINUTES OF EACH OF THESE COMMITTEE MEETINGS ARE MAINTAINED FOR FUTURE REFERENCE. THE MHC BOARD APPROVES THE MHC CEO'S COMPENSATION. THE MHC BOARD HAS DELEGATED TO THE CVC COMMITTEE THE AUTHORITY TO REVIEW AND APPROVE COMPENSATION ARRANGEMENTS WITH INSIDERS.
FORM 990, PAGE 6, PART VI, LINE 15BCOMPENSATION OF OTHER OFFICERS IS CONSISTENT WITH THAT OF THE TOP EXECUTIVES OF MUNSON HEALTHCARE CHARLEVOIX HOSPITAL AND MUNSON HEALTHCARE.
FORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GPURCHASED SERVICES 7,488,796 4,199,745 79,309 PROFESSIONAL FEES 2,365,060 0 0 TOTAL 9,853,856 4,199,745 79,309
FORM 990, PART XI, LINE 9CHANGE IN INVESTMENT IN MUNSON HEALTHCARE FOUNDATI 605,821 DEPRECIATION INHERENT CONTRIBUTION 81,303 EQUITY TSF TO PARENT -23,000,000 TOTAL -22,312,876

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtBusiness Name Line2DirectControllingEntityName/BusinessNameLine2TxtControlled OrganizationControlledOrganizationInd
MUNSON DIALYSIS CENTER
1105 SIXTH STTRAVERSE CITYMI49684383097861DIALYSISMIC33MUNSON HCMUNSON HEALTHCAREYes (true)
MUNSON HEALTHCARE
1105 SIXTH STTRAVERSE CITYMI49684382640544PARENTMIC312BNAfalse
MUNSON HEALTHCARE CADILLAC
1105 SIXTH STTRAVERSE CITYMI49684471156297HOSPITALMIC33MUNSON HCMUNSON HEALTHCAREYes (true)
MUNSON HEALTHCARE GRAYLING
1105 SIXTH STTRAVERSE CITYMI49684471161992HOSPITALMIC33MUNSON HCMUNSON HEALTHCAREYes (true)
MUNSON HEALTHCARE FOUNDATIONS
1105 SIXTH STTRAVERSE CITYMI49684382642724RAISE FUNDMIC37MUNSON HCMUNSON HEALTHCAREYes (true)
MUNSON HOME CARE
1105 SIXTH STTRAVERSE CITYMI49684382191390HOME HEALTMIC310MUN HOME HMUNSON HOME HEALTHYes (true)
MUNSON HOME SERVICES
1105 SIXTH STTRAVERSE CITYMI49684382543463HOME HEALTMIC310MUN HOME HMUNSON HOME HEALTHYes (true)
MUNSON MEDICAL CENTER
1105 SIXTH STTRAVERSE CITYMI49684381362830HOSPITALMIC33MUNSON HCMUNSON HEALTHCAREYes (true)
MUNSON MEDICAL GROUP
1105 SIXTH STTRAVERSE CITYMI49684273600575HEALTHCAREMIC310MUNSON MEDMUNSON MEDICAL CENTERYes (true)
NORTH FLIGHT INC
1105 SIXTH STTRAVERSE CITYMI49684382657917MED TRANSPMIC312BMUNSON HCMUNSON HEALTHCAREYes (true)
PAUL OLIVER MEMORIAL HOSPITAL
1105 SIXTH STTRAVERSE CITYMI49684381415623HEALTHCAREMIC33MUNSON HCMUNSON HEALTHCAREYes (true)
MUNSON HEALTHCARE MANISTEE HOSPITAL
1465 E PARKDALE AVEMANISTEEMI496609709380350304HOSPITALMIC33MUNSON HCYes (true)
MUNSON HEALTHCARE OTSEGO MEMORIAL H
825 N CENTER AVEGAYLORDMI497351592381303843HOSPITALMIC33MUNSON HCMUNSON HEALTHCAREYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1NORTHERN MICHIGAN SUPPLY ALLIANCEBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12651 AERO PARK DRAddressLine1Txt
CityTRAVERSE CITYCityNm
State AbbreviationMIStateAbbreviationCd
ZIP49686ZIPCd
FieldValueIRS element (for citing)
EIN383453378EIN
Primary ActivitiesPURCHASINGPrimaryActivitiesTxt
Legal Domicile StateMILegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerfalseGeneralOrManagingPartnerInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Business Name Line2RelatedOrganizationName/BusinessNameLine2TxtAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
MEDICAL OFFICE CONDOMINIUM
ASSOCIATIONPO BOX 1188TRAVERSE CITYMI496851188201902620REAL ESTATMIN/AYes (true)
SIXTH STREET DRUGS
PO BOX 1188TRAVERSE CITYMI496851188382298290PHARMACYMIN/AYes (true)
MUNSON SUPPORT SERVICES
PO BOX 1188TRAVERSE CITYMI496851188382872821LAUNDRYMIN/AYes (true)
MUNSON SERVICES INC
PO BOX 1188TRAVERSE CITYMI496851188383144382PHARMACYMIN/AYes (true)
MEDICAL OFFICE BUILDING CONDOMINIUM
ASSOCIATIONPO BOX 1188TRAVERSE CITYMI496851188383567278REAL ESTATMIN/AYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (17 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
MUNSON HEALTHCARE
B$23,000,000ACTUAL AMOUNTS PAID
MUNSON HEALTHCARE
M$3,627,348ACTUAL AMOUNTS PAID
MUNSON HEALTHCARE
O$1,516,664ACTUAL AMOUNTS PAID
MUNSON HEALTHCARE
P$5,404,757ACTUAL AMOUNTS PAID
MUNSON HEALTHCARE
Q$333,331ACTUAL AMOUNTS PAID
MUNSON HEALTHCARE FOUNDATIONS
C$98,254ACTUAL AMOUNTS PAID
MUNSON HEALTHCARE FOUNDATIONS
M$79,309ACTUAL AMOUNTS PAID
MUNSON HEALTHCARE OTSEGO MEMORIAL
M$51,906ACTUAL AMOUNT PAID
MUNSON HEALTHCARE OTSEGO MEMORIAL
P$69,415ACTUAL AMOUNT PAID
MUNSON MEDICAL CENTER
M$131,374ACTUAL AMOUNTS PAID
MUNSON MEDICAL CENTER
O$18,821,292ACTUAL AMOUNTS PAID
MUNSON MEDICAL CENTER
P$8,693,131ACTUAL AMOUNTS PAID
MUNSON MEDICAL CENTER
Q$6,787,083ACTUAL AMOUNTS PAID
MUNSON MEDICAL GROUP
M$86,369ACTUAL AMOUNTS PAID
NORTHERN MICHIGAN SUPPLY ALLIANCE
M$374,255ACTUAL AMOUNTS PAID
NORTHERN MICHIGAN SUPPLY ALLIANCE
P$1,160,421ACTUAL AMOUNTS PAID
NORTHERN MICHIGAN SUPPLY ALLIANCE
S$238,142ACTUAL AMOUNTS PAID

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE RFormAndLineReferenceDesc
ExplanationMUNSON HEALTHCARE CHARLEVOIX HOSPITAL USED THE ACCRUAL METHOD OF ACCOUNTING TO VALUE THE TRANSACTIONS WITH RELATED ENTITIES. ALL INTERCOMPANY TRANSACTIONS WITH RELATED ENTITIES WERE REVIEWED, SUMMARIZED, AND RECONCILED TO DETERMINE THE DISCLOSURE AMOUNTS.ExplanationTxt