2021-05-17T09:41:22-05:00 2020-06-30 990 2019-07-01 381303843 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL MUNS 9877312100 825 N CENTER AVE GAYLORD MI 49735 MARK A HEPLER CFO 9877312100 2021-05-13 2019 2022-09-23 18:48:47Z CHRISTOPHER SQUIRE 825 N CENTER GAYLORD MI 49735 129810162 false X WWW.MUNSONHEALTHCARE.ORG X 1946 MI TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS AND THE COMMUNITIES WE SERVE. 11 8 904 77 0 1023280 9490286 113564808 105313459 1048353 1387692 464483 453446 116100924 116644883 0 0 66348607 60950803 0 133366 42229086 45035508 108577693 105986311 7523231 10658572 97969489 117875247 46250501 52453708 51718988 65421539 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL AND ITS PARTNERS WORK TOGETHER TO PROVIDE SUPERIOR QUALITY CARE AND PROMOTE COMMUNITY HEALTH. false false 94545404 105559199 EXPENSES INCURRED WHILE PROVIDING HOSPITAL SERVICES TO THE RESIDENTS OF GAYLORD, MICHIGAN AND THE SURROUNDING AREA WHILE FULFILLING THE HOSPITAL'S MISSION TO PROVIDE HEALTHCARE IN THE COMMUNITY. MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL HAD 1,711 INPATIENT ADMISSIONS IN FISCAL YEAR 2020 AND OVER 94,000 OUTPATIENT VISITS. THE HOSPITAL SERVED MORE THAN 4,000 SURGICAL CASES, 421 OBSTETRICAL BIRTHS, AND OVER 14,500 EMERGENCY ROOM VISITS. MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL ACCEPTS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. 94545404 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 false false false false false false false true true true false false true 59 0 true 904 true false false false false false false false false false false false false X 11 8 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 2319357792 4230 COPPER RIDGE DR TRAVERSE CITY MI 49684 EDWIN A NESS DIRECTOR 1.00 40.00 X 0 1005520 194310 CHANGXIN LI MD PHYSICIAN 40.00 X 807022 0 24799 JAMES SHURLOW DO SURGEON 40.00 X 775582 0 22769 MATTHEW MAZUR DO SURGEON 40.00 X 765673 0 29524 JOHN MOFFAT MD SURGEON 40.00 X 753885 0 27494 JANELLE HENDRIAN DO ANESTHESIOLO 40.00 X 640639 0 31333 MARK A HEPLER CFO 2.00 40.00 X 0 556013 79684 THOMAS LEMON PRESIDENT 40.00 2.00 X X 0 470967 78449 LAURA GLENN PRESIDENT AM 2.00 40.00 X 0 395850 75368 PETER HANDLEY MD DIRECTOR 40.00 1.00 X 437920 0 31332 ROBERT COURTOIS VP FINANCE 40.00 1.00 X 275297 0 24248 CHRISTOPHER SQUIRE VP ANCILLARY 40.00 X 215645 0 25431 JAMES FLICKEMA VP PATIENT C 40.00 X 199893 0 25891 DAWN HALLECK VP PATIENT C 40.00 X 180567 0 24979 DAVID BRINEY DIRECTOR 1.00 1.00 X 5000 0 0 CHRISTOPHER COLLINS VICE CHAIR 2.00 X X 5000 0 0 JIM HILGENDORF DIRECTOR 1.00 X 5000 0 0 BECKY ASHLEY MD DIRECTOR 1.00 X 5000 0 0 STEVEN SELLA MD DIRECTOR 1.00 X 5000 0 0 KEVIN REYNOLDS DIRECTOR 1.00 X 5000 0 0 MARY SANDERS CHAIR 2.00 1.00 X X 0 5000 0 DONALD SKLARCZYK SECRETARY 2.00 X X 5000 0 0 DANIEL SMITH TREASURER 2.00 X X 5000 0 0 5092123 2433350 695611 81 true true false NORTHWESTERN MI EMERGENCY PHYS 4624 N SPIDER LAKE ROAD TRAVERSE CITY MI 49696 MEDICAL 1376970 BURDCO 1222 VETERANS DRIVE STE A TRAVERSE CITY MI 49684 CONSTRUCTION 1199447 AMERICAN HEALTHCARE SERVICES PO BOX 1928 EDMOND OK 73083 MEDICAL 750816 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 DIAGNOSTIC 520342 GREENWAY HEALTH 4301 WEST BOY SCOUT BLVD STE 800 TAMPA FL 33607 MEDICAL BILLING 487153 24 873261 8617025 9490286 PATIENT SERVICE REVENUE 621990 64684867 64684867 MEDICARE/MEDICAID PAYMENTS 621990 34180779 34180779 HEALTH SERVICES REVENUE 621990 5067846 5067846 INCENTIVE PAYMENT 621990 1357489 1357489 RENT FROM RELATED ORGS 531120 22478 22478 105313459 730412 730412 73982 64205 9777 9777 9777 13710975 47379 13093089 7985 617886 39394 657280 39394 617886 CAFETERIA REVENUE 722210 237323 237323 MISCELLANEOUS 621990 206346 206346 443669 116644883 105559199 1595398 X 1153027 572157 580870 46773224 42562682 4210542 1194160 1083672 110488 8800242 7965121 835121 3030150 2730015 300135 31416 31416 42612 42612 4010 4010 118939 118939 11740841 8443147 3164328 133366 35730 35730 1176748 787509 389239 2600037 1569886 1030151 1022177 1020927 1250 125706 103446 22260 96841 72448 24393 977703 872163 105540 3564052 3179323 384729 470650 373140 97510 MEDICAL SUPPLIES 16545744 16545744 BAD DEBT 4125304 4125304 QAAP TAXES 1596472 1596472 REPAIRS AND MAINTENANCE 519288 518817 471 241238 423431 -182193 105986311 94545404 11307541 133366 8747 9615 13616706 28164026 11983747 11932680 53523 1471843 1466249 682705 829134 48612316 5860125 42012407 42752191 25461602 26837540 2677559 5444028 650 439784 97969489 117875247 12244151 14394565 65564 30701805 30077182 3304545 7916397 46250501 52453708 X 51718988 64488342 933197 51718988 65421539 97969489 117875247 X 10658572 443024 2600955 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4010 4010 false SCHEDULE C, PART II-B, LINE 1 OTHER GRASSROOTS LOBBYING INCLUDES THE PORTION OF DUES ALLOCATED TO LOBBYING. 1935760 1935760 27583262 1799012 25784250 1223341 231763 991578 14278985 3711745 10567240 3590968 117605 3473363 42752191 THIRD PARTY SETTLEMENTS AND RESERVES 7339610 LONG TERM DEFERRED PAYROLL TAX LIAB 369801 CAPITAL LEASE 170566 LONG TERM OPERATING LEASE LIAB 19349 SHORT TERM OPERATING LEASE LIAB 17071 7916397 true true X true X true X true true true false false 502650 502650 0.00490 18408118 13653264 4754854 0.04670 18910768 13653264 5257504 0.05160 98124 2715 95409 0.00090 49794 49794 0.00050 147918 2715 145203 0.00140 19058686 13655979 5402707 0.05300 7820 7820 0.00010 7820 7820 0.00010 true 4125304 1865071 15996255 14957522 1038733 X true true 1 1 MUNSON HEALTHCARE OTSEGO MEMORIAL H 825 N CENTER AVE GAYLORD MI 49735 WWW.MYOMH.ORG 1060000063 X X X LONG TERM CARE FACILITY MUNSON HEALTHCARE OTSEGO MEMORIAL H 1 false false true X X X X X X X X X X 18 true true true true X HTTPS://TINYURL.COM/YBF2T46T X true 19 true HTTPS://TINYURL.COM/YCJDWU2K 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/3CECA9ZB X HTTPS://TINYURL.COM/5MBBBV5X X X X X X X X true X false X X X X X true X false false FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL H - PART V, LINE 3E YES, SIGNIFICANT HEALTH NEEDS ARE PRIORTIZED AND IDENTIFIED THROUGH CHNA. FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL H - PART V, LINE 5 IN CONDUCTING THE MOST RECENT CHNA OMH IN CONJUNCTION WITH ITS PARTNERING HOSPITALS CONDUCTED A DAYLONG SESSION WITH HEALTH PROFESSIONALS AND SECTOR REPRESENTATIVES IN LATE 2019. ADDITIONALLY, MORE THAN 1,200 INDIVIDUALS PARTICIPATED IN SURVEYS AND/OR FOCUS GROUPS THROUGHOUT NORTHERN MICHIGAN IN 2019 FOR THE REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT. ABOUT 1,100 RESIDENTS COMPLETED A "WHAT MATTER'S TO YOU' SURVEY, INCLUDING 445 RESIDENTS FROM ANTRIM, CHEBOYGAN, OTSEGO AND MONTMORENCY COUNTIES. MORE 122 PHYSICIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS COMPLETED A "HEALTH CARE PROVIDER" SURVEY. ADDITIONALLY, EXTRA EFFORT WAS MADE TO REACH LOW-INCOME RESIDENTS, MINORITIES, AND THE UNINSURED. THE COMMUNITY MEETINGS WERE HELD MOSTLY AT HEALTH DEPARTMENT OFFICES AND MARKETED THROUGH EXISTING SOCIAL SERVICE ORGANIZATIONS WORKING WITH THOSE POPULATIONS. A COMBINED TOTAL OF 74 PARTICIPANTS TOOK PART IN THE FOUR COMMUNITY CONVERSATIONS HELD IN CHEBOYGAN, MONTMORENCY, ANTRIM AND OTSEGO COUNTIES. IN ADDITION TO THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, CHARLEVOIX AREA HOSPITAL, AND MCLAREN NORTHERN MICHIGAN HOSPITAL, ALL PARTNERED WITH OTSEGO MEMORIAL HOSPITAL IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT COMMITTEE INCLUDED REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: OTSEGO COUNTY MSU EXTENSION, ALCONA HEALTH CENTER, HEALTH DEPT OF NW MICHIGAN, OTSEGO MEMORIAL HOSPITAL, COP EDUCATION SERVICE DISTRICT, CHARLEVOIX AREA HOSPITAL, NORTH COUNTY CMH SERVICES, MCLAREN NORTHERN MICHIGAN, THUNDER BAY COMMUNITY HEALTH SERVICE, WOMEN'S RESOURCE CENTER, HARBOR HALL, NE MICHIGAN CMH AUTHORITY, CHAR-EM UNITED WAY, EAST JORDAN FAMILY HEALTH CENTER, DISTRICT HEALTH DEPT 4, NORTHERN HEALTH PLAN, MUNSON MEDICAL CENTER, NORTHERN MICHIGAN REGIONAL ENTITY, ALPENA REGIONAL MEDICAL CENTER, MSU COLLEGE OF HUNMAN MEDICINE, AND NORTHERN MICHIGAN SUBSTANCE ABUSE SERVICES. FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL H - 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 OTSEGO MEMORIAL H - PART V, LINE 6B HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, HEALTH DEPARTMENT DISTRICT 4 FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL - PART V, LINE 7A HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/4992%20OMH%20CHNA%20REPORT %202019.PDF FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL - PART V, LINE 10A HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/4992%20OMH%20CHNA %20IMPLEMENTATION%20STRATEGY%202019.PDF FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL H - PART V, LINE 11 FROM THE MOST RECENT CHNA, THE TOP THREE AREAS OF HEALTH CONCERN IDENTIFIED ARE: EXPANDING ACCESS TO CARE, CHRONIC DISEASE EDUCATION AND MANAGEMENT, AND MATERNAL AND CHILD HEALTH AND WELLNESS ACTIVITIES. FOR ALL THREE AREAS OMH BELIEVES THEY COULD DIRECT RESOURCES TO HELP ADDRESS THE GROWING HEALTH CONCERN. REGARDING ACCESS TO CARE, OMH IS WORKING TO EXPAND SERVICES IN RURAL COMMUNITIES, OFFER ONSITE SCREENINGS AND EXPANDING OFFERINGS FOR SERVICES AT LOCAL HEALTH FAIRS, AND SIGNING INDIVIDUALS UP FOR INSURANCE THROUGH A CERTIFIED APPLICATION COUNSELOR. FOR CHRONIC DISEASE, OMH IS COMMITTED TO OFFERING AND EXPANDING A CDC DIABETES PREVENTION PROGRAM, DOUBLING THE NUMBER OF CLASSES OFFERED. OMH WILL CONTINUE TO EDUCATE THE COMMUNITY ON IMPORTANT CHRONIC DISEASE TOPICS SUCH AS CANCER, HEART HEALTH, COPD, DEPRESSION & ANXIETY, AND DIABETES THROUGH PRINT AND SPEAKING EVENTS. FOR MATERNAL AND CHILD HEALTH, OMH WILL CONTINUE TO OFFER CLASSES TO NEW PARENTS IN ORDER TO BETTER PREPARE GROWING FAMILIES FOR THEIR TRANSITION AHEAD. OMH WILL CONTINUE TO OFFER OB/GYN SERVICES IN INDIAN RIVER, AND WILL WORK TO EDUCATE COMMUNITY MEMBERS ON SERVICES OFFERED FOR MOTHER AND CHILD IN THIS VERY RURAL SETTING. OTHER NEEDS IDENTIFIED IN THE MOST RECENT CHNA INCLUDE: SUBSTANCE USE, MENTAL HEALTH AND HEALTH DISPARITIES. THESE ISSUES RANKED 4-6 IN THE CHNA. OMH FEELS THAT BASED ON AVAILABLE RESOURCES AND EXPERTISE OF STAFF, THE TOP THREE ISSUES CAN BE BEST ADDRESSED BY THE HOSPITAL. FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL H - PART V, LINE 13H PRIOR TO SEEKING FINANCIAL ASSISTANCE, THE PATIENT AND MHC WILL PURSUE ALL POSSIBLE FORMS OF THIRD PARTY PAYMENT. MHC RESERVES THE RIGHT TO INVESTIGATE, VERIFY, AND REQUEST ASSIGNMENT OF: ALL BENEFITS FROM ANY THIRD PARTY INSURANCE SOURCE ALL BENEFITS FROM STATE AND FEDERAL ASSISTANCE PROGRAMS FOR WHICH THE INDIVIDUAL MAY BE ELIGIBLE (E.G. MEDICAID) ALL BENEFITS FROM ANY OUTSIDE FINANCIAL ASSISTANCE PROGRAM PENDING LITIGATION SERVICES ELIGIBLE UNDER THIS POLICY WILL BE MADE AVAILABLE TO THE PATIENT ON A SLIDING FEE SCALE, IN ACCORDANCE WITH NEED. UNINSURED/UNDERINSURED PATIENTS WHOSE FAMILY INCOME MEETS THE FOLLOWING CRITERIA WILL BE ELIGIBLE FOR A DISCOUNT ON GROSS CHARGES AS FOLLOWS: UP TO 200% OF THE FPL: 100% DISCOUNT ON GROSS CHARGES BETWEEN 201% AND 300% OF THE FPL: 75% DISCOUNT ON GROSS CHARGES BETWEEN 301% AND 400% OF THE FPL: 65% DISCOUNT ON GROSS CHARGES PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY: THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL ASSISTANCE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE APPLICATION ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER SOURCES, WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH FINANCIAL ASSISTANCE. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, MHC, IN ITS SOLE DISCRETION, MAY USE INFORMATION PROVIDED BY OUTSIDE AGENCIES IN DETERMINING ESTIMATE INCOME AMOUNTS FOR THE BASIS OF DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY FOR POTENTIAL DISCOUNT AMOUNTS. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES. SEE ADDENDUM B AT THE END OF THIS POLICY, (PRESUMPTIVE ELIGIBILITY DETERMINATION). COBRA PAYMENTS: WHEN A PATIENT HAS SERVICES AT MHC AND IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR COBRA AND CANNOT PURCHASE COBRA THEMSELVES, MHC, IN ITS SOLE DISCRETION, MAY ELECT TO PURCHASE THE COBRA COVERAGE FOR THEM. COBRA WILL BE PURCHASED FOR PATIENTS WHOSE FAMILY INCOME IS UP TO 250% FPL AND THE BENEFIT OUTWEIGHS THE COSTS OF THE ASSISTANCE. NEED FOR CONTINUATION OF COBRA COVERAGE WILL BE EVALUATED MONTHLY. THE APPLICANT WILL BE EXPECTED TO COOPERATE AND ASSIST WITH ALL APPLICATIONS FOR BENEFITS FROM FEDERAL, STATE OR OTHER CHARITABLE SOURCES. BASED ON EXTENUATING CIRCUMSTANCES, THE NEED FOR ALL OF THE SUPPORTING DOCUMENTATION MAY BE WAIVED AT THE DISCRETION OF AN MHC FINANCIAL DIRECTOR. IT IS EXPECTED THAT A PATIENT WHO MAY BE MEDICAID ELIGIBLE APPLY FOR MEDICAID (SEE ADDENDUM C FOR EXCEPTIONS). IN ORDER TO RECEIVE FINANCIAL ASSISTANCE, THE PATIENT MUST APPLY FOR MEDICAID AND BE DENIED FOR ANY REASON OTHER THAN THE FOLLOWING: DID NOT APPLY; DID NOT FOLLOW THROUGH WITH THE APPLICATION PROCESS; DID NOT PROVIDE REQUESTED VERIFICATIONS. FAILURE BY THE PATIENT OR GUARANTOR TO FULFILL ALL RESPONSIBILITIES UNDER ANY OF THE ABOVE PROGRAMS, OR WHO DO NOT PROVIDE THE REQUESTED INFORMATION NECESSARY TO COMPLETELY AND ACCURATELY ASSESS THEIR FINANCIAL SITUATION IN A TIMELY MANNER, MAY RESULT IN DENIAL OF THE APPLICATION FOR FINANCIAL ASSISTANCE. IF AT A LATER DATE IT IS DISCOVERED THAT THE APPLICATION WAS FALSIFIED, MHC RESERVES THE RIGHT TO CANCEL ANY FINANCIAL ASSISTANCE CARE AWARDED AND BILL THE PATIENT THE ACCOUNT BALANCE. FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL - PART V, LINE 16A HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/FINANCIAL_ASSISTANCE_POLICY.PDF FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL - PART V, LINE 16B HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/FA%20APP %202021_OTSEGOMEMORIALHOSPITAL.PDF FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL - PART V, LINE 16C HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/SYSTEM%20PLS.PDF FACILITY 1, MUNSON HEALTHCARE OTSEGO MEMORIAL H - 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 OTSEGO MEMORIAL H - PART V, LINE 20E MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL 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. MUNSON 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 MUNSON 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 MUNSON DOES THIS IS AS FOLLOWS: ALL STATEMENTS INCLUDE A STATEMENT REGARDING THE AVAILABILITY OF PAYMENT PLANS, FINANCIAL ASSISTANCE AND CHARITY CARE. MUNSON 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. 3 MEDCARE CLINIC 1996 WALDEN DRIVE GAYLORD MI 49735 URGENT CARE ORTHOPEDICS CLINIC 2147 PROFESSIONAL DRIVE GAYLORD MI 49735 ORTHOPEDICS AND REHABILITATION MCREYNOLDS HALL 825 N CENTER AVENUE GAYLORD MI 49735 LONG-TERM CARE SCHEDULE H, PART I, LINE 3C UNDER IT'S ASSISTANCE PROGRAM MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (OTSEGO) WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED OR REDUCED PRICE SERVICES TO PERSONS ELIGIBLE UNDER APPLICABLE GUIDELINES. OTSEGO ASSISTANCE PROGRAM SERVICES ARE NOT LIMITED TO ANY SPECIFIC HOSPITAL SERVICE. INDIVIDUAL ELIGIBILITY FOR ASSISTANCE IS DETERMINED BY MEASURING FAMILY INCOME IN RELATION TO FAMILY SIZE AGAINST THE INCOME POVERTY GUIDELINE ESTABLISHED BY THE COMMUNITY SERVICE ADMINISTRATION. IF THE HOSPITAL DETERMINES THAT SERVICES ARE ELECTIVE OR OTHERWISE NOT MEDICALLY NECESSARY, THE HOSPITAL CAN DENY SERVICES UNDER THE FINANCIAL ASSISTANCE PROGRAM. ASSETS ARE NOT CONSIDERED AS PART OF EVALUATION FOR ASSISTANCE AS REQUIRED UNDER THE NATIONAL HEALTH SERVICE CORP. AGREEMENT FOR WHICH OTSEGO PARTICIPATES. SCHEDULE H, PART I, LINE 7, COLUMN (F) TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, ARE 105,986,311. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS 4,125,304. THE NET EXPENSE OF 101,861,007 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 COMPUTATION OR ACTUAL CASH PAID. SCHEDULE H, PART II MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (OTSEGO HOSPITAL) PROVIDED 7,820 OF COMMUNITY BUILDING ACTIVITIES DURING THE 2020 FISCAL YEAR. OTSEGO HOSPITAL SERVES AS A COLLABORATIVE PARTNER WITH LOCAL COMMUNITY GROUPS THAT PROMOTE HEALTH AND WELLNESS AS WELL AS ACCESS TO CARE WITHIN THE COMMUNITY IT SERVES. SCHEDULE H, PART III, LINE 2 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (OTSEGO) REPORTS ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. OTSEGO PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS AND TRENDS. THE COSTING METHOD USED IS THE COST TO CHARGE RATE. SCHEDULE H, PART III, LINE 3 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL ESTIMATES THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBILE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY USING THE METHOD IDENITIFED BY HFMA. THE FORMULA BEING USED IS THE TOTAL SELF-PAY IN BAD DEBT (AT COST) X THE FINANCIAL ASSISTANCE APPROVAL RATE. DURING FY 2020 806 HOSPITAL PATIENTS APPLIED FOR FINANCIAL ASSISTANCE. 42 OF THOSE APPLICATIONS WERE DENIED. 764/806 WERE APPROVED FOR AN APPROVAL PERCENTAGE OF 94.8%. THE BAD DEBT WAS FIRST ADJUSTED FOR COST BASED ON THE MUNSON HEALTHCARE OMH METHODOLOGY OF ITS COST/CHARGE RATIO FOR THE FY. THE COST PER CHARGE RATIO FOR 2020 FY OF .476904 X 4,125,304 = 1,967,373.98 (BAD DEBT AT COST). BAD DEBT (AT COST) 1,967,373.98 X FINANCIAL ASSISTANCE APPROVAL RATE OF .948 = 1,865,070.53 FOR PART III SEC A LINE 3. 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 ALL PATIENTS RECEIVING TREATMENT AT MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL ARE RESPONSIBLE FOR PAYING IN FULL ALL CHARGES FOR SUCH TREATMENT, LESS ANY AMOUNTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, DISCOUNT CONSIDERATIONS OR INSURANCE COVERAGE, PER POINT OF SERVICE COLLECTION POLICY. 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 FROM THE MOST RECENT CHNA, THE TOP THREE AREAS OF HEALTH CONCERN IDENTIFIED ARE: EXPANDING ACCESS TO CARE, CHRONIC DISEASE EDUCATION AND MANAGEMENT, AND MATERNAL AND CHILD HEALTH AND WELLNESS ACTIVITIES. FOR ALL THREE AREAS OMH BELIEVES THEY COULD DIRECT RESOURCES TO HELP ADDRESS THE GROWING HEALTH CONCERN. REGARDING ACCESS TO CARE, OMH IS WORKING TO EXPAND SERVICES IN RURAL COMMUNITIES, OFFER ONSITE SCREENINGS AND EXPANDING OFFERINGS FOR SERVICES AT LOCAL HEALTH FAIRS, AND SIGNING INDIVIDUALS UP FOR INSURANCE THROUGH A CERTIFIED APPLICATION COUNSELOR. FOR CHRONIC DISEASE, OMH IS COMMITTED TO OFFERING AND EXPANDING A CDC DIABETES PREVENTION PROGRAM, DOUBLING THE NUMBER OF CLASSES OFFERED. OMH WILL CONTINUE TO EDUCATE THE COMMUNITY ON IMPORTANT CHRONIC DISEASE TOPICS SUCH AS CANCER, HEART HEALTH, COPD, DEPRESSION & ANXIETY, AND DIABETES THROUGH PRINT AND SPEAKING EVENTS. FOR MATERNAL AND CHILD HEALTH, OMH WILL CONTINUE TO OFFER CLASSES TO NEW PARENTS IN ORDER TO BETTER PREPARE GROWING FAMILIES FOR THEIR TRANSITION AHEAD. OMH WILL CONTINUE TO OFFER OB/GYN SERVICES IN INDIAN RIVER, AND WILL WORK TO EDUCATE COMMUNITY MEMBERS ON SERVICES OFFERED FOR MOTHER AND CHILD IN THIS VERY RURAL SETTING. OTHER NEEDS IDENTIFIED IN THE MOST RECENT CHNA INCLUDE: SUBSTANCE USE, MENTAL HEALTH AND HEALTH DISPARITIES. THESE ISSUES RANKED 4-6 IN THE CHNA. OMH FEELS THAT BASED ON AVAILABLE RESOURCES AND EXPERTISE OF STAFF, THE TOP THREE ISSUES CAN BE BEST ADDRESSED BY THE HOSPITAL. 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.OMH PATIENT ACCESS SERVICES (PAS) EDUCATOR/COORDINATOR OR THE FINANCIAL ASSISTANCE SPECIALIST ATTEMPTS TO SEE THE PATIENTS IN ER OR IP. PAS STAFF HAS ALSO BEEN TRAINED TO HAND OUT ASSISTANCE PACKAGES AND TO DIRECT PATIENTS TO SEE THE FINANCIAL ASSISTANCE SPECIALIST/FINANCIAL ADVISOR. WHEN THE PATIENT COMES IN ON THE WORK LIST THEY ARE ALSO INFORMED OF ASSISTANCE PACKAGE AND/OR APPLICATION. THE FORM IS ON THE OMH WEBSITE. WHEN THERE IS A SCHEDULED PROCEDURE AND THE PATIENT DOES NOT HAVE INSURANCE, A CALL IS MADE FOR PAYMENT, FINANCIAL ASSISTANCE APPOINTMENT AND/OR CHARITY ARRANGEMENTS. PATIENTS IDENTIFIED WITHOUT INSURANCE OR NEEDING FINANCIAL EDUCATION, ARE SCHEDULED FOR AN APPOINTMENT WITH THE FINANCIAL ASSISTANCE SPECIALIST. THE FINANCIAL ASSISTANCE SPECIALIST HELPS PATIENTS TO APPLY FOR MEDICAID, INSURANCE EXCHANGE PLANS, OTHER PROGRAMS OR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE SPECIALIST HELPS PATIENTS APPLY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 4 DESCRIPTION MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (OTSEGO HOSPITAL) IS LOCATED IN GAYLORD, MI AND SERVES THE COUNTIES OF CHEBOYGAN, OTSEGO, MONTMORENCY AND ANTRIM. ALL FOUR COUNTIES SERVED BY OTSEGO HOSPITAL ARE EXTREMELY RURAL. HOSPITAL SERVICES OTSEGO HOSPITAL PROVIDES IT'S RESIDENCE WITH ACUTE INPATIENT STAYS (INCLUDING MEDICAL, INTENSIVE CARE AND OBSTETRICS), 4 SURGICAL SUITES THAT PERFORM BOTH IN AND OUT-PATIENT SERVICES (GENERAL, ORTHOPEDIC AND GASTROINTESTINAL), LABORATORY, DIAGNOSTIC RADIOLOGY SERVICES (GENERAL, ULTRASOUND, NUCLEAR MEDICINE, MAMMOGRAPHY, PET, CT AND MRI), RESPIRATORY THERAPY, THERAPIES, INCLUDING PHYSICAL, OCCUPATIONAL, SPEECH AND WOUND CARE. EMERGENCY ROOM SERVICES OPEN 24 HOURS A DAY 365 DAYS A YEAR. OTSEGO HOSPITAL ALSO PROVIDES A LONG-TERM CARE STAY FACILITY (INCLUDING SKILLED AND NON-SKILLED CARE). CARDIAC REHAB AND PREVENTION SERVICES ARE ALSO OFFERED AT OTSEGO HOSPITAL. IN ADDITION, OTSEGO HOSPITAL OFFERS MANY OUTPATIENT SERVICES CLINICS INCLUDING URGENT CARE, GYNECOLOGIC AND OBSTETRICS, INTERNAL MEDICINE, UROLOGY, ORTHOPEDICS, SURGICAL CARE, ONCOLOGY, PEDIATRICS AND FAMILY PRACTICES. POPULATION SERVED IN OTSEGO AND ANTRIM COUNTIES, 94% OF RESIDENTS ARE NON-HISPANIC WHITE, 92% IN CHEBOYGAN COUNTY AND 95% IN MONTMORENCY COUNTY. HISPANICS REPRESENT THE LARGEST MINORITY GROUP IN OTSEGO (1.9%), MONTMORENCY (1.4%), AND ANTRIM (2.5%) COUNTIES WHILE NATIVE AMERICANS REPRESENT THE LARGEST MINORITY GROUP IN CHEBOYGAN COUNTY WITH 3%. AT 21.7%, OLDER ADULTS REPRESENT A LARGER PROPORTION OF THE POPULATION IN OTSEGO COUNTY THAN THEY DO STATEWIDE (17.7%), 28% PERCENT OF CHEBOYGAN COUNTY AND ANTRIM COUNTY'S POPULATION IS AGE 65 AND OLDER AND IN MONTMORENCY COUNTY, SENIORS REPRESENT AN EVEN LARGER SHARE AT 32.8%. (SOURCE: COUNTYHEALTHRANKINGS.ORG). OTSEGO HOSPITAL SERVES A VERY RURAL AGING POPULATION. QUALITY OTSEGO HOSPITAL STAYS AT THE FOREFRONT OF MEDICAL TECHNIQUES, TREATMENTS, AND TECHNOLOGY TO ENSURE A HIGH QUALITY EXPERIENCE FOR ITS PATIENTS INCLUDING ADVANCED BREAST CANCER SCREENINGS WITH 3-D TOMOGRAPHY. SCHEDULE H, PART VI, LINE 5 THE MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (OTSEGO HOSPITAL) BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS THAT RESIDE IN THE HOSPITALS PRIMARY SERVICE AREA. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. ADDITIONALLY, 100% OF OTSEGO HOSPITAL TRUSTEES SUPPORT OTSEGO HOSPITAL FINANCIALLY. OTSEGO HOSPITAL OFFERS A VARIETY OF PROGRAMS AND SERVICES WITH THE END GOAL OF PROMOTING THE GREATER HEALTH OF THE COMMUNITY. OTSEGO HOSPITAL PROVIDED DISCOUNTED SPORTS PHYSICALS TO AREA STUDENT ATHLETES, DONATING ONE HUNDRED PERCENT OF THE PROCEEDS BACK TO THE LOCAL SCHOOL ATHLETIC DEPARTMENTS. THE HOSPITAL OFFERED FREE PROFILE SCREENINGS FOR MORE THAN 65 PARTICIPANTS AT A MENS HEALTH FAIR PRIOR TO HUNTING SEASON; SCREENINGS INCLUDED BLOOD PRESSURE, PULMONARY, BMI, HEIGHT AND WEIGHT. OTSEGO HOSPITAL HOSTS MONTHLY WELLNESS WEDNESDAYS, OFFERING CHOLESTEROL, BLOOD PRESSURE, BMI, HEIGHT, WEIGHT AT A DISCOUNTED RATE TO COMMUNITY MEMBERS AND FREE TO ANYONE WHO IS UNABLE TO PAY THE NOMINAL RATE. WELLNESS WEDNESDAYS HAVE ALSO EXPANDED TO OPERATE AS A SAFE NEEDLE DROP OFF FOR AREA RESIDENTS. A NEW MEDSAFE DISPOSAL CONTAINER IS BEING INSTALLED ON THE HOSPITAL CAMPUS TO OFFER AREA RESIDENTS A SAFE AND EASY METHOD TO DISPOSE OF UNUSED OR EXPIRED MEDICATIONS. THE HOSPITAL OFFERS A MAMMOGRAPHY ASSISTANCE PROGRAM, TO ENSURE THAT WOMEN WHO DO NOT QUALIFY FOR A FREE MAMMOGRAM THROUGH THE LOCAL HEALTH DEPARTMENT, YET HAVE NO MEANS TO PAY FOR IT PRIVATELY, ARE COVERED AND RECEIVE A SCREENING AND IF NECESSARY DIAGNOSTIC MAMMOGRAM AND OTHER SERVICES AT NO CHARGE. ADDITIONALLY, THE HOSPITAL OFFERS A DIABETES ASSISTANCE PROGRAM AND AN ONCOLOGY ASSISTANCE PROGRAM DESIGNED TO HELP THOSE DIAGNOSED WITH THOSE DISEASES AND STRUGGLING FINANCIALLY TO RECEIVE THE ASSISTANCE THEY NEED TO ATTEND TREATMENTS AND TEST REGULARLY FOR DIABETES. OTSEGO HOSPITAL CONTINUES TO OFFER THE CDC'S YEAR-LONG DIABETES PREVENTION PROGRAM, WORKING WITH INDIVIDUALS WHO HAVE BEEN DIAGNOSED AS PRE DIABETIC TO REDUCE CALORIE INTAKE, INCREASE EXERCISE, AND UNDERSTAND PORTION CONTROL AMONG OTHERS. THIS PROGRAM HAS SEEN A HIGH SUCCESS RATE OF COMPLETION AND BMI REDUCTION. THE PROGRAM AT OTSEGO HOSPITAL IS ONE OF THE ONLY RECOGNIZED PROGRAMS IN NORTHERN MICHIGAN. OTSEGO HOSPITAL ALSO WORKS CLOSELY WITH THE LOCAL SCHOOLS TO ASSIST THE HIGH SCHOOL LEVEL MEDICAL OCCUPATIONAL PROGRAM IN JOB SHADOWING AND EDUCATION PROGRAM FOR STUDENTS THROUGHOUT THE FACILITY AND SCHOOL YEAR. NEW PARENTS ARE INVITED TO PARTICIPATE IN CHILDBIRTH EDUCATION CLASSES OFFERED BY OTSEGO HOSPITAL STAFF FOR A NOMINAL FEE OR FREE TO THOSE UNABLE TO PAY. ON A BIMONTHLY BASIS, THE HOSPITAL PRODUCES AND DISTRIBUTES TO MORE THAN 47,000 HOUSEHOLDS THROUGHOUT THE SERVICE AREA LITERATURE ON VARIOUS HEALTHCARE ISSUES AND TOPICS, INCLUDING INFORMATION ON LOCAL FREE HEALTH EVENTS. IN THE OFF MONTHS, AN EMAIL NEWSLETTER IS DEPLOYED TO MORE THAN 17,000 RECIPIENTS WITH SIMILAR CONTENT. OTSEGO HOSPITAL HAS NUMEROUS MEDICAL PRACTICES THAT ARE FEDERALLY QUALIFIED RURAL HEALTHCARE CLINICS. ADDITIONALLY, OTSEGO HOSPITAL IS LOCATED WITHIN A HEALTH PROFESSIONAL SHORTAGE AREA. BOTH OF THESE QUALIFICATIONS DEMONSTRATE OTSEGO HOSPITAL'S ISOLATED SERVICE AREA WHICH HAS RESULTED IN CHALLENGING PHYSICIAN RECRUITMENT AND RETENTION. OTSEGO HOSPITAL'S COMMITMENT TO PROVIDING THE HIGHEST LEVEL OF CARE STARTS WITH PHYSICIAN AND OTHER PROVIDERS. EXTENSIVE RECRUITMENT ACTIVITIES MUST TAKE PLACE IN ORDER TO PROVIDE CARE TO THESE HEALTH PROFESSIONAL SHORTAGE AREAS. ADDITIONALLY, OTSEGO HOSPITAL IS WORKING DILIGENTLY TO BRING SERVICES INTO THE RURAL SETTING. THIS INCLUDES THE COMPLETION OF THE NEWLY RENOVATED OTSEGO HOSPITAL MEDICAL GROUP-LEWISTON, WHICH NOT ONLY EXPANDED REHABILITATIVE SERVICES, BUT BROUGHT ULTRASOUND SERVICES TO THAT RURAL AREA (NOTE: THIS CLINIC IS A FEDERALLY QUALIFIED RURAL HEALTH CENTER) (1). A MAJORITY OF THE HOSPITALS BOARD OF TRUSTEES IS MADE UP OF COMMUNITY REPRESENTATIVES RESIDING WITHIN THE HOSPITALS SERVICE AREA. (2). THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS AS APPROVED BY OUR HOSPITAL BOARD OF DIRECTORS. DUE TO THE SIZE AND RURAL NATURE OF THE HOSPITAL SERVICE AREA, NOT ALL HEALTHCARE SPECIALTIES ARE OFFERED THROUGH THE HOSPITAL. (3). THE HOSPITAL APPLIES SURPLUS FUNDS, INCLUDING DONATIONS FROM THE FOUNDATION, TO ASSIST IN PURCHASING EQUIPMENT FOR PATIENT USE AND FUNDING MANY OF THE COMMUNITY HEALTH EDUCATION PROGRAMS LISTED ABOVE. ADDITIONALLY, THE HOSPITAL WORKS TO USE ANY SURPLUS FUNDS TO CONTINUE TO ADVANCE THE MISSION OF THE ORGANIZATION THROUGH GROWTH AND DEVELOPMENT OPPORTUNITIES. SCHEDULE H, PART VI, LINE 6 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITALS 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 96.4 MILLION OF COMMUNITY BENEFIT IN THE 2019 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 1 MILLION IN CHARITY CARE AND UNREIMBURSED MEDICAID IN THE PAST FISCAL YEAR. MUNSON MEDICAL GROUP, THE EMPLOYED PHYSICIAN ORGANIZATION IN THE SYSTEM, PROVIDED APPROXIMATELY 942,000 IN CHARITY CARE AND COMMUNITY BENEFIT IN TAX YEAR 2019. 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 107.8 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 false true false false false false false false false EDWIN A NESS DIRECTOR 798100 198983 8437 164228 30082 1199830 CHANGXIN LI MD PHYSICIAN 708406 85466 13150 4639 20160 831821 JAMES SHURLOW DO SURGEON 737595 37987 5600 17169 798351 MATTHEW MAZUR DO SURGEON 729044 36629 5600 23924 795197 JOHN MOFFAT MD SURGEON 728765 25120 5600 21894 781379 JANELLE HENDRIAN DO ANESTHESIOLOGIST 602540 38099 5600 25733 671972 MARK A HEPLER CFO 418294 71314 66405 65664 14020 635697 12893 THOMAS LEMON PRESIDENT 401109 66109 3749 56144 22305 549416 LAURA GLENN PRESIDENT AMB SERVIC 343499 52033 318 53857 21511 471218 PETER HANDLEY MD DIRECTOR 397393 40527 5600 25732 469252 ROBERT COURTOIS VP FINANCE 197562 33082 44653 5395 18853 299545 CHRISTOPHER SQUIRE VP ANCILLARY SERVICE 162602 32385 20658 3786 21645 241076 JAMES FLICKEMA VP PATIENT CARE SERV 152825 30209 16859 4084 21807 225784 DAWN HALLECK VP PATIENT CARE SERV 140003 30804 9760 3688 21291 205546 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 A. NESS 0 150,200 0 MARK A HEPLER 0 44,749 0 THOMAS LEMON 0 42,116 0 LAURA GLENN 0 40,000 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 OF MUNSON HEALTHCARE, A COMPETITIVE BENEFIT PACKAGE IS OFFERED WHICH INCLUDES PARTICIPATION IN A SUPPLEMENTAL RETIREMENT PLAN. ANNUAL CONTRIBUTIONS, AT MUNSON'S DISCRETION, ARE MADE TO THE PLAN IN ORDER TO ACHIEVE THE TARGETED RETIREMENT BENEFIT LEVEL. THESE RETIREMENT FUNDS ARE AVAILABLE TO THE PARTICIPANTS UPON THEIR RETIREMENT FROM MUNSON. A CNTY OF OTSEGO HOSPITAL FIN 2013A 386004832 689065AA8 2013-10-31 10000000 REFINANCE false false false B GAYLORD HOSPITAL FIN AUTH 2014B 383635769 368175AA8 2013-10-31 6095324 REFINANCE false false false C GAYLORD HOSPITAL FIN AUTH 2015C 383635769 368175AB1 2013-10-31 1885925 REFINANCE false false false D CNTY GRD TRAVSE HOSP FIN AUTH 2019B CONSTRUCT RENOVATE PURCHASE BLDG 386004852 386523HQ0 2019-01-16 15191945 CONSTRUCT, RENOVATE, PURCHASE BLDG THE SERIES 2019B BONDS WERE ISSUED TO (1) REFINANCE A TAXABLE LIN false false false A 10022999 200000 9822999 2013 false true true true B 6103380 6103380 2014 true false true true C 1885925 1885925 2015 true false true true D 15275282 175340 10795906 3900000 404036 false true false true A false true true false false false false true B false true true false false false false true C false true true false false false false true D false true true false false 0.01000 0.01000 false false true A false false false true false false false false true B false false false true false false false false true C false false true false false false false false true D false true false false false false false false true A true B true C true D true DIFFERENCES IN ISSUE PRICE EXPLANATION CNTY OF OTSEGO HOSPITAL FIN 2013A INVESTMENT INCOME EARNED DIFFERENCES IN ISSUE PRICE EXPLANATION GAYLORD HOSPITAL FIN AUTH 2014B INVESTMENT INCOME EARNED DIFFERENCES IN ISSUE PRICE EXPLANATION CNTY GRD TRAVSE HOSP FIN AUTH 2019B INVESTMENT INCOME EARNED PURPOSE OF ISSUE DESCRIPTION CNTY OF OTSEGO HOSPITAL FIN 2013A REFINANCE PURPOSE OF ISSUE DESCRIPTION GAYLORD HOSPITAL FIN AUTH 2014B REFINANCE PURPOSE OF ISSUE DESCRIPTION GAYLORD HOSPITAL FIN AUTH 2015C REFINANCE PURPOSE OF ISSUE DESCRIPTION CNTY GRD TRAVSE HOSP FIN AUTH 2019B CONSTRUCT, RENOVATE, PURCHASE BLDG THE SERIES 2019B BONDS WERE ISSUED TO (1) REFINANCE A TAXABLE LINE OF CREDIT WHICH FINANCED THE ACQUISITION OF A FACILITY USED FOR PHYSICAL AND OCCUPATIONAL THERAPY, AND (2) FINANCE THE CONSTRUCTION, RENOVATION, EXPANSION AND EQUIPPING OF THE HOSPITAL FACILITIES. DATE REBATE COMPUTATION PERFORMED CNTY OF OTSEGO HOSPITAL FIN 2013A 03/30/15 DATE REBATE COMPUTATION PERFORMED GAYLORD HOSPITAL FIN AUTH 2014B 02/23/15 ADDITIONAL INFORMATION CNTY OF OTSEGO HOSPITAL FIN 2013A THE COUNTY OF OTSEGO HOSPITAL FINANCE AUTHORITY SERIES 2013A BONDS WERE ISSUED TO REFINANCE THE GAYLORD HOSPITAL FINANCE AUTHORITY HOSPITAL REVENUE AND REFUNDING BONDS (OTSEGO MEMORIAL HOSPITAL OBLIGATED GROUP) SERIES 2004 ISSUED 11/23/04. ADDITIONAL INFORMATION CNTY GRD TRAVSE HOSP FIN AUTH 2019B OBLIGATED GROUP ISSUE RECORDED ON RELATED ORGANIZATIONS ON JANUARY 16, 2019, THE MUNSON HEALTHCARE OBLIGATED GROUP ISSUED COUNTY OF GRAND TRAVERSE HOSPITAL FINANCE AUTHORITY REVENUE BONDS (MUNSON HEALTHCARE OBLIGATED GROUP) SERIES 2019A, 2019B AND 2019C. THE 2019 SERIES A BONDS WERE RECORDED ON MUNSON HEALTHCARE MANISTEE HOSPITAL'S BOOKS AND RECORDS AT A PAR VALUE OF 18,360,000. THE 2019 SERIES B BONDS WERE RECORDED ON MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL'S BOOKS AND RECORDS AT A PAR VALUE OF 14,520,000. THE RELATED BOND PREMIUM WAS RECORDED ON THE RESPECTIVE ENTITIES' BOOKS AND RECORDS. THE 2019C BONDS WERE RECORDED ON MUNSON MEDICAL CENTER'S BOOKS AND RECORDS AT A PAR VALUE OF 22,300,000. PART III, QUESTION 3B AND D MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPTIAL 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 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 CONTRACTS. SINCE NEW BONDS WERE ISSUED IN 2019, OUTSIDE COUNSEL WAS ENGAGED DURING THAT TAX YEAR. FORM 990, PAGE 6, PART VI, LINE 6 MUNSON HEALTHCARE OTSEGO MEMORIAL 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 DIRECTORS 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 OTSEGO MEMORIAL HOSPITAL (OMH) 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 OMH; 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 OMH; THE ACQUISITION OF OR THE ESTABLISHMENT OF ANY SUBSIDIARY OR AFFILIATE OF OMH; THE ADOPTION OF ALL OPERATING BUDGETS AND CAPITAL EXPENDITURE BUDGETS FOR OMH; INCURRENCE OF OPERATING OR CAPITAL EXPENDITURES BY MAN 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 OMH 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 OMH; CHANGE IN SCOPE OF CLINICAL SERVICES OR PROGRAMS PROVIDED BY OMH; AND APPOINTMENT OR REMOVAL OF THE PRESIDENT. FORM 990, PAGE 6, PART VI, LINE 11B THE MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL BOARD IS COMMITTED TO THE ACCURACY AND THOROUGHNESS OF THE FORM 990 REPORTING. MUNSON HEALTHCARE OTSEGO MEMORIAL 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 EXECUTIVE COMPENSATION AND 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 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. 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 HEALTHCARE SYSTEM 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 AND KEY EMPLOYEES IS CONSISTENT WITH THAT OF THE TOP EXECUTIVES OF MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL AND MUNSON HEALTHCARE. FORM 990, PAGE 6, PART VI, LINE 19 THE MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON THE MICHIGAN DEPARTMENT OF TREASURY WEBSITE. MUNSON HEALTHCARE MANISTEE HOSPITAL DOES NOT MAKE THE BYLAWS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. ANNUALLY, MUNSON HEALTHCARE, PARENT CORPORATION, SUBMITS ITS ANNUAL CONSOLIDATED FINANCIAL STATEMENTS TO THE MSRB IN COMPLIANCE WITH BOND DISCLOSURE REQUIREMENTS. FORM 990, PART IX, LINE 11G PURCHASED SERVICES 5,082,245 2,848,895 133,366 PROFESSIONAL FEES 3,360,902 315,433 0 TOTAL 8,443,147 3,164,328 133,366 FORM 990, PART XI, LINE 9 CHANGE IN INVESTMENT IN MUNSON HEALTHCARE FOUND 2,839,165 INHERENT CONTRIBUTION DEPRECIATION -238,210 TOTAL 2,600,955 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 DIALYSIS CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 383097861 DIALYSIS 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 MUNSON HEALTHCARE CHARLEVOIX HOSPIT 1105 SIXTH ST TRAVERSE CITY MI 49684 381459366 HOSPITAL MI C3 3 MUNSON HC true MUNSON HEALTHCARE MANISTEE HOSPITAL 1465 E PARKDALE AVE MANISTEE MI 496609709 380350304 HOSPITAL MI C3 3 MUNSON HC true PAUL OLIVER MEMORIAL HOSPITAL 1105 SIXTH ST TRAVERSE CITY MI 49684 381415623 HEALTHCARE MI C3 3 MUNSON HC HEALTHCARE true MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL FOUNDATION 825 N CENTER AVE GAYLORD MI 497351592 382135473 RAISE FUND MI C3 12A MHC OTSEGO HOSPITAL true NORTHERN MICHIGAN SUPPLY ALLIANCE 2651 AERO PARK DR TRAVERSE CITY MI 49686 383453378 PURCHASING MI N/A false false MEDICAL OFFICE BUILDING CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 383567278 REAL ESTAT MI N/A true MEDICAL OFFICE CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 201902620 REAL ESTAT MI N/A true MUNSON SERVICES INC PO BOX 1188 TRAVERSE CITY MI 496851188 383144382 PHARMACY MI N/A true MUNSON SUPPORT SERVICES PO BOX 1188 TRAVERSE CITY MI 496851188 382872821 LAUNDRY MI N/A true SIXTH STREET DRUGS INC PO BOX 1188 TRAVERSE CITY MI 496851188 382298290 PHARMACY MI N/A true false false true false false false false false false true false true true false true true true true true MHC OTSEGO MEMORIAL FOUNDATION M 133366 ACTUAL AMOUNT PAID MHC OTSEGO MEMORIAL FOUNDATION C 873261 ACTUAL AMOUNT PAID MUNSON HEALTHCARE P 2860247 ACTUAL AMOUNT PAID MUNSON HEALTHCARE Q 444319 ACTUAL AMOUNT PAID MUNSON HEALTHCARE M 2109086 ACTUAL AMOUNT PAID MUNSON HEALTHCARE O 91750 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE P 603095 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE Q 190741 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE R 73779 ACTUAL AMOUNT PAID MUNSON MEDICAL CENTER M 355076 ACTUAL AMOUNT PAID MUNSON MEDICAL CENTER Q 544499 ACTUAL AMOUNT PAID MUNSON MEDICAL CENTER P 740789 ACTUAL AMOUNT PAID MUNSON MEDICAL CENTER O 129232 ACTUAL AMOUNT PAID MUNSON SUPPORT SERVICES M 171808 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING L 315561 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING O 72268 ACTUAL AMOUNT PAID SCHEDULE R MUNSON HEALTHCARE OTSEGO MEMORIAL 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.