2022-05-16T11:03:04-05:00 2021-06-30 990 2020-07-01 381459366 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL MUNS 2315474024 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 ALICIA M MAITLAND CFO 2315474024 2022-05-13 ALICIA M MAITLAND 999009999 2020 2022-09-23 18:48:47Z JOANNE SCHROEDER 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 71895648 false X WWW.MUNSONHEALTHCARE.ORG/CHARLEVOIX X 1919 MI MUNSON HEALTHCARE CHARLEVOIX HOSPITAL AND ITS PARTNERS WORK TOGETHER TO PROVIDE SUPERIOR QUALITY CARE AND PROMOTE COMMUNITY HEALTH. 13 7 449 7 0 6563265 876588 58858771 66280640 486976 857707 163436 152691 66072448 68167626 0 0 29062286 28400302 0 211441 31128070 30557328 60190356 58957630 5882092 9209996 59920165 70162827 16238442 16243685 43681723 53919142 AS A VITAL PART OF MUNSON HEALTHCARE, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL EXISTS TO DELIVER COMPREHENSIVE QUALITY CARE TO PATIENTS IN PARTNERSHIP WITH PHYSICIANS. false false 51904554 66281367 EXPENSES 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 918 INPATIENT ADMISSIONS IN FISCAL YEAR 2021 AND OVER 84,600 OUTPATIENT VISITS. THE HOSPITAL SERVED MORE THAN 2,500 SURGICAL CASES, 185 OBSTETRICAL BIRTHS, AND OVER 7,600 EMERGENCY ROOM VISITS. MUNSON HEALTHCARE CHARLEVOIX HOSPITAL ACCEPTS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. THE HOSPITAL HAS APPROXIMATELY 40 ACTIVE MEDICAL STAFF. INCLUDED IN PROGRAM SERVICE EXPENSES ARE 308,000 OF EXPENSES RELATED TO THE COMPREHENSIVE CARE OF COVID-19 PATIENTS. 51904554 true true false true false false false false false false true false false false true false false true false false false false false false false false true true false false true true false false false false false false false false true false false false false false false true false false false true 34 0 true 449 true false false false false false false false false 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 NICOLE SULAK MUNSON HEALTHCARE 2319357777 4230 COPPER RIDGE DR TRAVERSE CITY MI 49684 EDWIN NESS DIRECTOR 1.00 40.00 X 0 915969 209738 JAMES JEAKLE MD PHYSICIAN 40.00 X 578840 0 40241 MARK HEPLER CFO 2.00 40.00 X 0 522987 84099 LAURA GLENN PRESIDENT AM 2.00 40.00 X 0 439683 79501 GREGORY MCBRIDE DO PHYSICIAN 40.00 X 440623 0 37165 TONYA SMITH DIRECTOR 1.00 40.00 X 0 377457 80762 BARRETT KIELHORN DO PHYSICIAN 40.00 X 393073 0 40702 MARK LAME MD SURGEON 40.00 X 380172 0 34519 CATHERINE WONSKI MD DIRECTOR 40.00 X 366808 0 28947 RACHEL MASON MD PHYSICIAN 40.00 X 335628 0 22089 RODERICK TINNEY MD DIRECTOR 40.00 X 305394 0 31503 JOANNE SCHROEDER PRESIDENT 40.00 X X 0 267669 63201 ANNA YOUNG MD DIRECTOR 40.00 X 219312 0 29476 CHRISTOPHER SQUIRE VP ANCILLARY 2.00 40.00 X 0 198669 44946 BERNADETTE COLE RN CHIEF NURSIN 40.00 X 147587 0 41130 SCOTT BEATTY DIRECTOR 1.00 X 0 0 0 MARK GREYERBIEHL DIRECTOR 1.00 X 0 0 0 MICHAEL HINKLE CHAIR 2.00 X X 0 0 0 KATHLEEN LAUWERS DIRECTOR 1.00 X 0 0 0 ALAN MCBRIDE DIRECTOR 1.00 X 0 0 0 RUTH B HOPPE MD DIRECTOR 1.00 X 0 0 0 BENJAMEN MULADORE DIRECTOR 1.00 X 0 0 0 MICHAEL ORTWINE DIRECTOR 1.00 X 0 0 0 CLIFF PORTER DIRECTOR 1.00 X 0 0 0 NANCY SHERMAN SECRETARY/TR 2.00 X X 0 0 0 THOMAS VERYSER VICE CHAIR 2.00 X X 0 0 0 3167437 2722434 868019 46 true true false NORTHWESTERN MICHIGAN EMERGENCY PHY 4624 N SPIDER LAKE ROAD TRAVERSE CITY MI 49696 ER PHYSICIAN 937795 CERNER CORP PO BOX 959156 ST LOUIS MO 631959156 SUPPORT SERV 934556 GRAND TRAVERSE RADIOLOGISTS PC 10850 E TRAVERSE HWY SUITE 60 TRAVERSE CITY MI 49684 MEDICAL 605931 ALLIANCE-HNI LLC PO BOX 772550 DETROIT MI 482772550 MOBILE MRI SERV 380929 STT SECURITY SERVICES 1600 N MISSION STREET MOUNT PLEASANT MI 48858 SECURITY 229235 8 193522 683066 876588 PATIENT SERVICE REVENUE 621990 34279323 34279323 MEDICARE/MEDICAID PAYMENTS 621990 28781766 28781766 340B PRESCRIPTION REVENUE 621990 2574250 2574250 MISC HEALTHCARE REVENUE 531120 407557 407557 QUALITY INCENTIVE PAYMENTS 621990 228128 228128 9616 9616 66280640 348251 348251 38256 38256 38256 38256 4226262 11216 3719744 8278 506518 2938 509456 727 508729 CAFETERIA SALES 722210 91525 91525 MISCELLANEOUS 621110 22910 22910 114435 68167626 66281367 1009671 X 861342 861342 22863770 20942198 1921572 844775 773050 71725 2751875 2524196 227679 1078540 990866 87674 3490 3490 12677 12677 3454 3454 28258 28258 8550530 5234048 3105041 211441 238 238 569408 402003 167405 1499750 795829 703921 835923 835923 20007 19374 633 36951 32640 4311 121042 106562 14480 2805402 2469793 335609 313885 269459 44426 MEDICAL SUPPLIES 12588988 12588988 QAAP TAXES 1544685 1544685 PROVISION FOR BAD DEBTS 1225644 1225644 REPAIRS AND MAINTENANCE 195830 183121 12709 201166 104595 96571 58957630 51904554 6841635 211441 18537721 14106719 4122700 16962949 6415383 6984933 1114399 768118 126313 336214 28084545 10051190 20125557 18033355 6036426 7433038 2952252 3320722 489414 2216779 59920165 70162827 4889381 5194127 49461 100000 5600000 5133333 5699600 5816225 16238442 16243685 X 42422540 52474319 1259183 1444823 43681723 53919142 59920165 70162827 X 9209996 760480 266943 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3454 3454 false SCHEDULE C, PART II-B, LINE 1 PORTION OF ANNUAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARDS LOBBYING ACTIVITIES. DIRECT PAYMENTS WERE MADE TO HEALTH ASSOCIATIONS FOR SPECIFIC ISSUES. 2490000 2490000 15764604 5443732 10320872 5150 2080 3070 9132037 4299484 4832553 692754 305894 386860 18033355 THIRD PARTY SETTLEMENTS AND RESERVES 5263706 LONG TERM DEFERRED PAYROLL TAX LIABI 372095 LONG TERM OPERATING LEASE LIABILITY 104091 SHORT TERM OPERATING LEASE LIABILITY 43421 CAPITAL LEASE 32912 5816225 true true X true X true X true true false false 152034 152034 0.00260 7469139 5899934 1569205 0.02720 7621173 5899934 1721239 0.02980 4101 600 3501 0.00010 292 292 4393 600 3793 0.00010 7625566 5900534 1725032 0.02990 true 1225644 430675 13192117 12880283 311834 X true true 1 1 MUNSON HEALTHCARE CHARLEVOIX HOSPIT 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 WWW.MUNSONHEALTHCARE.ORG/CHARLEVOIX 1060000154 X X X MUNSON HEALTHCARE CHARLEVOIX HOSPIT 1 false false true X X X X X X X X X X 18 true true true true X HTTPS://TINYURL.COM/YAUD54T5 X true 19 true HTTPS://TINYURL.COM/YABQ4ZFC false true X 200.000000000000 400.000000000000 X X X true true X X X true X HTTPS://TINYURL.COM/4HVNZX67 X HTTPS://TINYURL.COM/Y9REDD4G X HTTPS://TINYURL.COM/49JBJKMU X X X X X X X true X false X X X X X true X false false FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 3E STRATEGIC ISSUES AND HOW PRIORITIES WERE ESTABLISHED 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. WE NEEDED TO PRIORITIZE THESE ISSUES TO DECIDE WHICH STRATEGIC ISSUES WE WERE GOING TO FOCUS ON FOR OUR COLLABORATIVE COMMUNITY HEALTH IMPROVEMENT STRATEGY. FIRST, WE HELD A MEETING TO LOOK AT NEEDS AND CONDITIONS ACROSS THE ENTIRE 31-COUNTY NORTHERN MICHIGAN REGION, AND THROUGH A FACILITATED PROCESS, IDENTIFIED A TOP ISSUE TO APPROACH COLLECTIVELY ON A LARGE REGIONAL SCALE. NEXT, WE HELD MEETINGS AROUND NORTHERN MICHIGAN TO IDENTIFY ADDITIONAL PRIORITIES FOR SMALLER GROUPS OF COUNTIES, BASED ON LOCAL DATA, CONDITIONS, AND EXPERIENCE. A STANDARDIZED PROCESS WAS USED AT EACH MEETING. EACH STRATEGIC ISSUE WAS PRIORITIZED USING THE FOLLOWING CRITERIA: 1. MAGNITUDE: HOW MANY PEOPLE ARE IMPACTED BY THIS ISSUE? 2. SEVERITY: HOW URGENT IS THIS ISSUE AND WHAT ARE THE CONSEQUENCES OF NOT ADDRESSING IT NOW? 3. VALUES: DOES THE COMMUNITY CARE ABOUT THIS ISSUE? WHICH ISSUE IS MOST IMPORTANT TO THE COMMUNITY? 4. IMPACT: HOW MUCH IMPACT WOULD IMPROVING OR FOCUSING ON THIS ISSUE HAVE ON HEALTH, HEALTH EQUITY, AND QUALITY OF LIFE? 5. SUSTAINABILITY AND ACHIEVABILITY: IS THE ISSUE WITHIN OUR SPHERE OF CONTROL? WILL WE HAVE THE EXPERTISE NECESSARY TO ADDRESS IT? ORGANIZATIONS INVITED TO PARTICIPATE IN EACH MEETING INCLUDED THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH. FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 5 THROUGH A FACILITATED PROCESS SUPPORTED BY THE MICHIGAN PUBLIC HEALTH INSTITUTE, MITHRIVE PARTNERS REVIEWED ALL THE KEY FINDINGS FROM THE FOUR ASSESSMENTS, WHICH INCLUDED COMPILING EXISTING STATISTICS, HEARING FROM RESIDENTS, LEARNING FROM GROUPS OF COMMUNITY ORGANIZATIONS, AND SURVEYING HEALTH CARE PROVIDERS AND COMMUNITY MEMBERS, AND LOOKED FOR THE UNDERLYING CHALLENGES THAT ARE PREVENTING US FROM ACHIEVING OUR SHARED VISION. REGULAR ATTENDEES OF MITHRIVE STEERING COMMITTEE MEETINGS ATTENDED, AS WELL AS ADDITIONAL INTERESTED MITHRIVE PARTNERS. THROUGH COMBINING THE DATA FROM THE FOUR ASSESSMENTS AND LOOKING AT THE COMMUNITY FROM A HOLISTIC PERSPECTIVE, WE IDENTIFIED THE SEVEN STRATEGIC ISSUES, TWO OF WHICH WERE CATEGORIZED TO BE USED IN OUR IMPLEMENTATION STRATEGY ACTION PLANNING, LEAVING FIVE UNCATEGORIZED STRATEGIC ISSUES. FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 6A 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 ALL WORKED TOGETHER ON REGIONAL CHNA EFFORTS AS PART OF THE MITHRIVE REGIONAL CHNA INITIATIVE. FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 6B OUR CONTINUED COMMITMENT TO OUR MISSION OF WORKING TOGETHER WITH OUR PARTNERS TO PROVIDE SUPERIOR QUALITY CARE AND PROMOTE COMMUNITY HEALTH IS REFLECTED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AS WELL AS IN THE WORK WE DO EACH DAY TO BETTER UNDERSTAND AND ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY. FOR THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THIS COMMITMENT IS EVIDENT IN OUR PARTICIPATION IN MITHRIVE, A REGIONAL, COLLABORATIVE PROJECT DESIGNED TO BRING TOGETHER DOZENS OF ORGANIZATIONS ACROSS 31 COUNTIES OF NORTHERN MICHIGAN TO IDENTIFY LOCAL NEEDS AND WORK TOGETHER TO IMPROVE OUR COMMUNITIES. WHERE WE LIVE, LEARN, WORK, AND PLAY POWERFULLY INFLUENCES OUR HEALTH. IMPROVING COMMUNITY HEALTH REQUIRES A BROAD FOCUS AND COORDINATION AMONG DIVERSE AGENCIES AND STAKEHOLDERS. THE GOAL IS TO CONTINUE TO BUILD NEW PARTNERSHIPS AND GATHER INPUT FROM MORE ORGANIZATIONS AND RESIDENTS. OUR CHNA REPRESENTS A COLLABORATIVE, COMMUNITY-BASED APPROACH TO IDENTIFY, ASSESS, AND PRIORITIZE THE MOST IMPORTANT HEALTH ISSUES AFFECTING OUR COMMUNITY, GIVING SPECIAL ATTENTION TO THE POOR AND UNDERSERVED IN OUR SERVICE AREA. THE PROCESS IS ALSO THE FOUNDATION THAT WE WILL USE TO COLLABORATIVELY PLAN, DEVELOP, AND FOSTER PROGRAMS TO EFFECTIVELY ADDRESS THOSE NEEDS IN OUR COMMUNITY. FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 7A HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/4988%20CHARLEVOIX%20CHNA %20REPORT%202019.PDF FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 10A HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/4988%20CHARLEVOIX%20CHNA %20IMPLEMENTATION%20STRATEGY%202019.PDF FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 11 THROUGH A FACILITATED PROCESS SUPPORTED BY THE MICHIGAN PUBLIC HEALTH INSTITUTE, MITHRIVE PARTNERS REVIEWED ALL THE KEY FINDINGS FROM THE FOUR ASSESSMENTS, WHICH INCLUDED COMPILING EXISTING STATISTICS, HEARING FROM RESIDENTS, LEARNING FROM GROUPS OF COMMUNITY ORGANIZATIONS, AND SURVEYING HEALTHCARE PROVIDERS AND COMMUNITY MEMBERS AND LOOKED FOR THE UNDERLYING CHALLENGES THAT ARE PREVENTING US FROM ACHIEVING OUR SHARED VISION. REGULAR ATTENDEES OF MITHRIVE STEERING COMMITTEE MEETINGS ATTENDED, AS WELL AS ADDITIONAL INTERESTED MITHRIVE PARTNERS. THROUGH COMBINING THE DATA FROM THE FOUR ASSESSMENTS AND LOOKING AT THE COMMUNITY FROM A HOLISTIC PERSPECTIVE, WE IDENTIFIED THE SEVEN STRATEGIC ISSUES, TWO OF WHICH WERE CATEGORIZED TO BE USED IN OUR IMPLEMENTATION STRATEGY ACTION PLANNING, LEAVING FIVE STRATEGIC ISSUES. NEXT, WE NEEDED TO PRIORITIZE THESE ISSUES TO DECIDE WHICH STRATEGIC ISSUES WE WERE GOING TO FOCUS ON FOR OUR COLLABORATIVE COMMUNITY HEALTH IMPROVEMENT STRATEGY. FIRST, WE HELD A MEETING TO LOOK AT NEEDS AND CONDITIONS ACROSS THE ENTIRE 31-COUNTY NORTHERN MICHIGAN REGION, AND THROUGH A FACILITATED PROCESS, IDENTIFIED A TOP ISSUE TO APPROACH COLLECTIVELY ON A LARGE REGIONAL SCALE. NEXT, WE HELD MEETINGS AROUND NORTHERN MICHIGAN TO IDENTIFY ADDITIONAL PRIORITIES FOR SMALLER GROUPS OF COUNTIES, BASED ON LOCAL DATA, CONDITIONS, AND EXPERIENCE. A STANDARDIZED PROCESS WAS USED AT EACH MEETING. EACH STRATEGIC ISSUE WAS PRIORITIZED USING THE FOLLOWING CRITERIA: 1. MAGNITUDE: HOW MANY PEOPLE ARE IMPACTED BY THIS ISSUE? 2. SEVERITY: HOW URGENT IS THIS ISSUE AND WHAT ARE THE CONSEQUENCES OF NOT ADDRESSING IT NOW? 3. VALUES: DOES THE COMMUNITY CARE ABOUT THIS ISSUE? WHICH ISSUE IS MOST IMPORTANT TO THE COMMUNITY? 4. IMPACT: HOW MUCH IMPACT WOULD IMPROVING OR FOCUSING ON THIS ISSUE HAVE ON HEALTH, HEALTH EQUITY, AND QUALITY OF LIFE? 5. SUSTAINABILITY AND ACHIEVABILITY: IS THE ISSUE WITHIN OUR SPHERE OF CONTROL? WILL WE HAVE EXPERTISE NECESSARY TO ADDRESS IT? ORGANIZATIONS INVITED TO PARTICIPATE IN EACH MEETING INCLUDED THOSE WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH, LOCAL PUBLIC HEALTH DEPARTMENTS, AND ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY GROUPS. THROUGH THIS PROCESS THESE PRIORITY ISSUES WERE IDENTIFIED: THE TWO TOP PRIORITY ISSUES TO BE ADDRESSED: HOW DO WE ENSURE A COMMUNITY THAT PROVIDES PREVENTIVE & ACCESSIBLE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES? - ACTION PLAN ON PAGE HOW DO WE ADDRESS BASIC NEEDS OF LIVING TO CREATE RESILIENCY AND PROMOTE EQUITY? - ACTION PLAN ON PAGE ADDITIONAL STRATEGIC ISSUES IDENTIFIED: HOW DO WE IMPROVE ACCESS TO COMPREHENSIVE HEALTH CARE FOR ALL? HOW DO WE FOSTER A SENSE OF COMMUNITY THAT PROMOTES TRUST, SOCIAL SUPPORT, AND INCLUSIVENESS? HOW DO WE IMPROVE PREVENTION AND REDUCE HEALTH RISKS FOR LEADING CAUSES OF DEATH? IMPROVING THE PLANNING PROCESS IN ADDITION TO THE STRATEGIC ISSUES, WE IDENTIFIED TWO MAJOR AREAS FOR IMPROVEMENT IN HOW WE GO ABOUT ADDRESSING THESE ISSUES AND PLANNING INTERVENTIONS: 1) IMPROVE CROSS-SECTOR COLLABORATION AND THE COMMUNITY HEALTH IMPROVEMENT PLANNING PROCESS. 2) IMPROVE COMMUNITY VOICE AND PARTICIPATION IN PLANNING. STRATEGIC ISSUES THAT WILL NOT BE TARGETED AND THE REASON MUNSON HEALTHCARE CHARLEVOIX HOSPITAL 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. DUE TO THE LOWER PRIORITIZATION, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL WILL NOT TARGET THE FOLLOWING IDENTIFIED STRATEGIC ISSUES: HOW DO WE IMPROVE ACCESS TO COMPREHENSIVE HEALTH CARE FOR ALL? HOW DO WE FOSTER A SENSE OF COMMUNITY THAT PROMOTES TRUST, SOCIAL SUPPORT, AND INCLUSIVENESS? HOW DO WE IMPROVE PREVENTION AND REDUCE HEALTH RISKS FOR LEADING CAUSES OF DEATH? WHILE WE ARE NOT TARGETING THESE STRATEGIC ISSUES IN THIS IMPLEMENTATION STRATEGIC WE STILL COMMIT TO CONTINUE TO WORK ON EFFORTS TO ACTIVELY WORK TO IMPROVE THESE ISSUES AS WELL. FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 13H PATIENTS 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/MEDIA/FILE/FINANCIAL_ASSISTANCE_POLICY.PDF FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 16B HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/CHARLEVOIX%20HOSPITAL%20- %20FINANCIAL%20ASSISTANCE.PDF FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL - PART V, LINE 16C HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/PLAIN%20LANGUAGE%20SUMMARY.PDF FACILITY 1, MUNSON HEALTHCARE CHARLEVOIX HOSPIT - PART V, LINE 16J IT 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 20E MUNSON 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. 4 MHC BOYNE AREA HEALTH CENTER 223 N PARK BOYNE CITY MI 49712 RURAL HEALTH CLINIC MHC CHARLEVOIX SURGEONS 14695 PARK AVENUE SUITE A CHARLEVOIX MI 49720 SURGICAL SERVICES MHC BOYNE REHAB CENTER 197 STATE STREET BOYNE CITY MI 49712 REHABILITATION SERVICES MHC JORDAN VALLEY REHAB CENTER 100 MAIN STREET 9 EAST JORDAN MI 49727 REHABILITATION SERVICES SCHEDULE H, PART I, LINE 3C INCOME 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 7, COLUMN (F) TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, ARE 58,957,630. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS 1,225,644. THE NET EXPENSE OF 57,731,986 WAS USED FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). SCHEDULE H, PART I, LINE 7 COST VALUES FOR LINE 7 ARE BASED ON THE COST TO CHARGE RATIO. SCHEDULE H, PART III, LINE 2 DIRECT 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 3 THE 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 4 SEE NOTE 2 ON PAGE 8 OF ATTACHED AUDITED FINANCIAL STATEMENTS UNDER ACCOUNTS RECEIVABLE. SCHEDULE H, PART III, LINE 9B MUNSON 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 2 THE MUNSON HEALTHCARE BOARD OF DIRECTORS MAINTAINS A STANDING COMMUNITY HEALTH COMMITTEE (CHC) TO SERVE THE MUNSON HEALTHCARE SYSTEM. THE CHC CONSISTS OF MUNSON HEALTHCARE BOARD MEMBERS FROM MUNSON HEALTHCARE HOSPITALS AND OTHER INTERESTED AREA PHYSICIANS AND COMMUNITY MEMBERS APPOINTED BY THE MUNSON HEALTHCARE BOARD CHAIRPERSON. THE CHC MEETS AT LEAST QUARTERLY TO REVIEW EXISTING PROGRAMS AND SERVICES RELATED TO CURRENT COMMUNITY HEALTH NEEDS, CONSIDER THE MHC RESPONSE TO ANY EMERGING HEALTH TRENDS AS IDENTIFIED BY COMMUNITY HEALTH NEEDS ASSESSMENT, AND REVIEW ANY NEW COMMUNITY HEALTH BASED COLLABORATION OR PROGRAM. THE CHC IS RESPONSIBLE FOR COMMUNICATING INTERNALLY AND EXTERNALLY THE SIGNIFICANCE OF MHC COMMUNITY BENEFIT PROGRAMS AND SERVICES. THIS COMMITTEE IS SUPPORTED BY A COMMUNITY HEALTH DEPARTMENT EMPLOYEES OF THE HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM. MUNSON 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 3 IT 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 4 DESCRIPTION LOCATED IN CHARLEVOIX, MICHIGAN, ABOUT 50 MILES NORTH OF TRAVERSE CITY, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (CHARLEVOIX HOSPITAL) IS ONE OF NINE HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM. THE 25-BED CRITICAL ACCESS HOSPITAL, AS DEFINED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, EMPLOYS IN EXCESS OF 400 INDIVIDUALS, AND IS ONE OF THE LARGEST EMPLOYERS IN THE AREA. HOSPITAL SERVICES NOT UNLIKE MANY RURAL COMMUNITY HOSPITALS, CHARLEVOIX HOSPITAL OFFERS A FULL SPECTRUM OF HEALTHCARE SERVICES, INCLUDING EMERGENCY, OBSTETRIC, AND INPATIENT CARE. IN 2016, IT ADDED A THIRD OPERATING ROOM, ALLOWING FOR 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. ROUGHLY 40 PHYSICIANS COMPRISE THE ACTIVE MEDICAL STAFF, PROVIDING PRIMARY AND SPECIALTY CARE PHYSICIAN SERVICES TO THE SURROUNDING COMMUNITIES. 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 2020 LUDWIG COMMUNITY BENEFIT AWARD FOR COMMUNITY OUTREACH AND WELLNESS INITIATIVE AT THE MUNSON CHARLEVOIX WELLNESS WORKSHOP 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. NATIONAL HOSPITAL CHARITABLE SERVICES AWARD - CHARLEVOIX HOSPITAL SCHOOL NURSES PROGRAM WAS AMONG ONLY 10 PROGRAMS IN THE NATION NAMED A PROGRAM OF EXCELLENCE BY THE HOSPITAL CHARITABLE SERVICES AWARDS, A NATIONAL PROGRAM SPONSORED BY JACKSON HEALTHCARE. THIS MULTIFACETED SCHOOL NURSES PROGRAM WAS CREATED AND FULLY FUNDED BY CHARLEVOIX HOSPITAL AND SERVES COMMUNITY RESIDENTS WHO EXPERIENCE THE GREATEST DISPARITIES IN HEALTH STATUS AND ACCESS BY PROVIDING REGISTERED NURSES IN LOCAL AREA SCHOOL SYSTEMS - WHERE PREVIOUSLY THERE WERE NONE- AT NO COST TO THE SCHOOLS. 2015 LUDWIG COMMUNITY BENEFIT AWARD - THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION NAMED CHARLEVOIX HOSPITAL AS ONE OF FOUR WINNERS OF ITS 2015 LUDWIG COMMUNITY BENEFIT AWARD. THE AWARD IS PRESENTED TO MEMBER ORGANIZATIONS INTEGRALLY INVOLVED IN COLLABORATIVE PROGRAMS TO IMPROVE THE HEALTH AND WELL-BEING OF AREA RESIDENTS. THE HOSPITAL WAS HONORED FOR IMPLEMENTING A SCHOOL NURSES PROGRAM WHICH, AMONG OTHER BENEFITS, REDUCED CHRONIC SCHOOL ABSENTEEISM BY 6 PERCENT IN THE FIRST THREE YEARS. 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 5 THE BOARD OF DIRECTORS IS COMPRISED OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THIS VOLUNTARY BOARD PROVIDES COUNTLESS 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. 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 6 MUNSON 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 72.7 MILLION OF COMMUNITY BENEFIT IN THE 2020 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. NORTH FLIGHT, INC. IS THE CHARITABLE TRANSPORTATION ENTITY IN THE SYSTEM. WITH ITS GROUND MEDICAL TRANSPORTATION SERVICES, PATIENTS IN THE SYSTEM ARE ABLE TO ACCESS APPROPRIATE CARE. NORTH FLIGHT, INC. PROVIDED 208,000 IN CHARITY CARE AND UNREIMBURSED MEDICAID IN THE PAST FISCAL YEAR. MUNSON MEDICAL GROUP, THE EMPLOYED PHYSICIAN ORGANIZATION IN THE SYSTEM, PROVIDED 1.4 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN TAX YEAR 2020. 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 80.9 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 7 MICHIGAN X true true false true false false false false false false false EDWIN NESS DIRECTOR 877571 700 37698 177479 32259 1125707 JAMES JEAKLE MD PHYSICIAN 574037 700 4103 14279 25962 619081 MARK HEPLER CFO 451179 700 71108 69989 14110 607086 14141 LAURA GLENN PRESIDENT AMB SERVIC 423775 700 15208 56998 22503 519184 GREGORY MCBRIDE DO PHYSICIAN 392031 48247 345 14279 22886 477788 TONYA SMITH DIRECTOR 352563 23393 1501 54279 26483 458219 BARRETT KIELHORN DO PHYSICIAN 363774 24034 5265 14279 26423 433775 MARK LAME MD SURGEON 354987 700 24485 14279 20240 414691 CATHERINE WONSKI MD DIRECTOR 319979 2792 44037 14279 14668 395755 RACHEL MASON MD PHYSICIAN 314714 20700 214 12624 9465 357717 RODERICK TINNEY MD DIRECTOR 262976 2752 39666 13951 17552 336897 JOANNE SCHROEDER PRESIDENT 244890 700 22079 40730 22471 330870 ANNA YOUNG MD DIRECTOR 210314 1483 7515 10822 18654 248788 CHRISTOPHER SQUIRE VP ANCILLARY SERVICE 191084 2292 5293 3617 41329 243615 BERNADETTE COLE RN CHIEF NURSING OFFICE 142934 756 3897 16781 24349 188717 SCHEDULE J, PAGE 1, PART I, LINE 1A MUNSON 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 3 THE 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 4 EDWIN NESS 0 163,201 0 MARK HEPLER 0 47,430 0 LAURA GLENN 0 42,800 0 TONYA SMITH 0 40,000 0 JOANNE SCHROEDER 0 27,050 0 BERNADETTE COLE, RN 0 9,240 0 SCHEDULE J, PART III SUPPLEMENTAL 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. A CHARLEVOIX TWP HOSP FIN AUTH 2016 383203086 2016-06-23 7000000 RENOVATION & EQUIPMENT THE 2016 BONDS WERE ISSUED TO FUND THE PROJECT COSTS WHICH INCLUDE RENOVATION false false false A 7006486 64904 6941582 2019 false false false true A false false true false false false false true A false false false true false false false false true A true DIFFERENCES IN ISSUE PRICE EXPLANATION CHARLEVOIX TWP HOSP FIN AUTH 2016 INVESTMENT EARNINGS PURPOSE OF ISSUE DESCRIPTION CHARLEVOIX 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 PERFORMED CHARLEVOIX TWP HOSP FIN AUTH 2016 08/16/21 ADDITIONAL INFORMATION CHARLEVOIX 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 2019, OUTSIDE COUNSEL WAS ENGAGED DURING THAT TAX YEAR. TRACEY SHERMAN SEE PART V 21723 COMPENSATION PAID false CAITLYN MONKS SEE PART V 152787 COMPENSATION PAID false SCHEDULE L, PART V PART 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. FORM 990, PAGE 6, PART VI, LINE 6 MUNSON 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 7A MUNSON HEALTHCARE, AS THE SOLE MEMBER, ELECTS THE TRUSTEES FOR SUBSIDIARY ENTITIES. NOMINATIONS TO MUNSON HEALTHCARE FOR SUBSIDIARY DIRECTORS ARE CONSIDERED AND RECOMMENDED BY THE MUNSON HEALTHCARE GOVERNANCE COMMITTEE. FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN 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 11B THE 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 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 12C THE 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 15A THE PROCESS FOR DETERMINING APPROPRIATE LEVELS OF PAY FOR EXECUTIVE POSITIONS WITHIN MUNSON HEALTHCARE IS CAREFULLY AND THOUGHTFULLY DIRECTED BY THE 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. MINUTES ARE PREPARED FOR MEETINGS OF THE COMMITTEE. 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. ANNUALLY, THE COMMITTEE RETAINS A NATIONAL INDEPENDENT CONSULTANT TO ENSURE THAT 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. COMPENSATION LEVELS REFLECT THE SCOPE OF EACH EXECUTIVE'S RESPONSIBILITIES, EDUCATIONAL BACKGROUND, EXPERIENCE, AND INDUSTRY STANDING AS WELL AS INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. ANNUAL COMPENSATION FOR MUNSON EXECUTIVES IS DETERMINED IN PART BY MEASURABLE PROGRESS TOWARD THE ORGANIZATION'S GOALS INCLUDING CONTINUED IMPROVEMENT IN CLINICAL QUALITY, COMMUNITY HEALTH, AND OPERATIONAL EFFICIENCIES. MUNSON HEALTHCARE'S INTENT FOR EXECUTIVE BASE COMPENSATION IS TO BE AT THE MEDIAN WHEN COMPARED TO LIKE-SIZE NON-PROFIT HOSPITALS AND HEALTHCARE SYSTEMS. FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES 3,721,014 3,105,041 211,441 PROFESSIONAL FEES 1,513,034 0 0 TOTAL 5,234,048 3,105,041 211,441 FORM 990, PART XI, LINE 9 CHANGE IN INVESTMENT IN MUNSON HEALTHCARE FOUNDATI 185,640 DEPRECIATION INHERENT CONTRIBUTION 81,303 TOTAL 266,943 MUNSON DIALYSIS CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 383097861 DIALYSIS MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE 1105 SIXTH ST TRAVERSE CITY MI 49684 382640544 PARENT MI C3 12B NA false MUNSON HEALTHCARE CADILLAC 1105 SIXTH ST TRAVERSE CITY MI 49684 471156297 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE GRAYLING 1105 SIXTH ST TRAVERSE CITY MI 49684 471161992 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE FOUNDATIONS 1105 SIXTH ST TRAVERSE CITY MI 49684 382642724 RAISE FUND MI C3 7 MUNSON HC MUNSON HEALTHCARE true MUNSON HOME CARE 1105 SIXTH ST TRAVERSE CITY MI 49684 382191390 HOME HEALT MI C3 10 MUN HOME H MUNSON HOME HEALTH true MUNSON HOME HEALTH 1105 SIXTH ST TRAVERSE CITY MI 49684 383335362 HOME HEALT MI C3 12B MUNSON HC HEALTHCARE true MUNSON HOME SERVICES 1105 SIXTH ST TRAVERSE CITY MI 49684 382543463 HOME HEALT MI C3 10 MUN HOME H MUNSON HOME HEALTH true MUNSON MEDICAL CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 381362830 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON MEDICAL GROUP 1105 SIXTH ST TRAVERSE CITY MI 49684 273600575 HEALTHCARE MI C3 10 MUNSON MED MUNSON MEDICAL CENTER true NORTH FLIGHT INC 1105 SIXTH ST TRAVERSE CITY MI 49684 382657917 MED TRANSP MI C3 12B MUNSON HC MUNSON HEALTHCARE true PAUL OLIVER MEMORIAL HOSPITAL 1105 SIXTH ST TRAVERSE CITY MI 49684 381415623 HEALTHCARE MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE MANISTEE HOSPITAL 1465 E PARKDALE AVE MANISTEE MI 496609709 380350304 HOSPITAL MI C3 3 MUNSON HC true MUNSON HEALTHCARE OTSEGO MEMORIAL H 825 N CENTER AVE GAYLORD MI 497351592 381303843 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true NORTHERN MICHIGAN SUPPLY ALLIANCE 2651 AERO PARK DR TRAVERSE CITY MI 49686 383453378 PURCHASING MI N/A false false MEDICAL OFFICE CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 201902620 REAL ESTAT MI N/A true SIXTH STREET DRUGS PO BOX 1188 TRAVERSE CITY MI 496851188 382298290 PHARMACY MI N/A true MUNSON SUPPORT SERVICES PO BOX 1188 TRAVERSE CITY MI 496851188 382872821 LAUNDRY MI N/A true MUNSON SERVICES INC PO BOX 1188 TRAVERSE CITY MI 496851188 383144382 PHARMACY MI N/A true MEDICAL OFFICE BUILDING CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 383567278 REAL ESTAT MI N/A true true false true false false false false false false false false true true false true true true true true MUNSON HEALTHCARE Q 2624120 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE M 2313333 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE P 6269066 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE O 1699619 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER M 436906 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER P 3743728 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER O 18291189 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER R 68344 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER S 74273 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER Q 1091707 ACTUAL AMOUNTS PAID MUNSON SUPPORT SERVICES M 94563 ACTUAL AMOUNTS PAID NORTHERN MICHIGAN SUPPLY ALLIANCE M 83116 ACTUAL AMOUNTS PAID NORTHERN MICHIGAN SUPPLY ALLIANCE P 947359 ACTUAL AMOUNTS PAID NORTHERN MICHIGAN SUPPLY ALLIANCE S 163367 ACTUAL AMOUNTS PAID NORTHERN MICHIGAN SUPPLY ALLIANCE R 101752 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE FOUNDATIONS C 193522 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE FOUNDATIONS M 211441 ACTUAL AMOUNTS PAID MUNSON MEDICAL GROUP M 81293 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE OTSEGO MEEMORIAL O 103340 ACTUAL AMOUNT PAID MUNSON HEALTHCARE MANISTEE HOSPITAL Q 1245795 ACTUAL AMOUNT PAID MUNSON HEALTHCARE MANISTEE HOSPITAL P 427178 ACTUAL AMOUNT PAID SCHEDULE R MUNSON 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.