2021-01-29T14:41:26-06:00 2020-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2019-04-01 381507046 MUNISING MEMORIAL HOSPITAL ASSOCIATION MUNI 9063874110 1500 SAND POINT ROAD MUNISING MI 49862 KEVIN CARLSON CFO 9063874110 2021-01-20 1 TERRI REXRODE CPA MST P00096513 9206620016 2021-01-15 2019 2022-09-23 18:48:47Z KEVIN CARLSON 1500 SAND POINT ROAD MUNISING MI 49862 11233805 0 X WWW.MUNISINGMEMORIAL.ORG X 1961 MI THE MISSION OF MUNISING MEMORIAL HOSPITAL IS TO BE THE PROVIDER OF CHOICE FOR PRIMARY MEDICAL AND HOSPITAL CARE FOR THE RESIDENTS OF ALGER COUNTY. WITH UNSURPASSED PERSONAL AND PROFESSIONAL INTEGRITY, OUR EMPLOYEES AND PRACTITIONERS WILL PROVIDE THE HIGHEST LEVEL OF QUALITY CARE WITHIN OUR RESOURCES. 7 6 97 7 0 0 109567 268016 10698307 10883773 224651 37473 4800 0 11037325 11189262 0 0 0 0 5863776 6187769 0 0 0 4844677 5352258 10708453 11540027 328872 -350765 10891561 9996823 9692644 9315876 1198917 680947 X THE MISSION OF MUNISING MEMORIAL HOSPITAL IS TO BE THE PROVIDER OF CHOICE FOR PRIMARY MEDICAL AND HOSPITAL CARE FOR THE RESIDENTS OF ALGER COUNTY. WITH UNSURPASSED PERSONAL AND PROFESSIONAL INTEGRITY, OUR EMPLOYEES AND PRACTITIONERS WILL PROVIDE THE HIGHEST LEVEL OF QUALITY CARE WITHIN OUR RESOURCES. 1 0 7958596 8697594 TO PROVIDE INPATIENT AND OUTPATIENT CARE TO THE COMMUNITY AND SURROUNDING AREA. DURING 2019, THERE WERE 97 ADMISSIONS, 788 PATIENT DAYS AND 13,873 OUTPATIENT VISITS. 1897943 2158789 BAYCARE PHYSICIAN OFFICE PROVIDING REGULAR OFFICE AND WALK-IN CARE TO OUR PATIENTS. BAYCARE HAD 11985 VISITS DURING THE 2019 YEAR. GRAND MARAIS PHYSICIAN CLINIC PROVIDING REGULAR OFFICE AND WALK IN CARE TO OUR PATIENTS. GRAND MARAIS HAD 167 VISITS DURING 2019 YEAR. 9856539 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 17 0 97 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN CARLSON 9063874110 1500 SAND POINT ROAD MUNISING MI 49862 CHELSEA RAY PHYSICIAN 40.00 X 314357 0 16066 COLIN IRISH PHYSICIAN 40.00 X 231498 0 9477 PAUL HADUCK PHYSICIAN 40.00 X 203904 0 16759 DAVID GAST PHYSICIAN 40.00 X 203512 0 10453 BONNIE KILPELA PHYSICIAN 40.00 X 144026 0 1121 CHRISTI SALO CNO 40.00 X 90998 0 4193 FLOYD BOUNDS INTERIM CEO 40.00 X 72000 0 0 WENDY RAUTIO CFO 40.00 X 65238 0 0 MELISSA HALL CEO 40.00 X 55216 0 0 KEVIN CARLSON CFO 40.00 X 9286 0 0 R JOHN REYNOLDS INTERIM CEO 40.00 X 2025 0 0 MARILYN BEVERLY PRESIDENT 0.30 X X 0 0 0 ALLISON BOWERMAN-JOHNSON VICE PRESIDENT 0.30 X X 0 0 0 DEBORAH NEDEAU SECRETARY 0.30 X X 0 0 0 THOMAS LUCKEY III TREASURER 0.30 X X 0 0 0 JOHN BARNHART - TERMED FORMER PRESIDENT 0.30 X X 0 0 0 RUTHANN POKELA TRUSTEE 0.30 X 0 0 0 KATHY REYNOLDS TRUSTEE 0.30 X 0 0 0 JOHN MADIGAN TRUSTEE 0.30 X 0 0 0 1392060 0 58069 7 0 1 0 CERNER 2800 ROCKCREEK PKWY KANSAS CITY MO 84117 EHR CONTRACTED SERVICES 495676 UP REHAB 841 W WASHINGTON ST MARQUETTE MI 49855 OUTPATIENT THERAPY CONTRACTED SERVICES 474159 JACOB MACKENZIE 5548 HIGH RIDGE DR YPSILANTI MI 48197 ER CONTRACTED PROVIDER 161684 GE HEALTHCARE 15724 COLLECTIONS CENTER DR CHICAGO IL 60693 RADIOLOGY CONTRACTED SERVICES 106192 4 268016 268016 NET PATIENT SERVICE REVENUE 621610 9493951 9493951 340B PROGRAM REVENUE 621610 1102535 1102535 OTHER RELATED REVENUE 621610 250252 250252 CAFETERIA SALES 722210 27390 27390 CLINIC RENTAL INCOME 900099 9645 9645 10883773 82016 82016 44543 -44543 -44543 -44543 11189262 10856383 0 64863 X 294764 90998 203766 4874413 4571195 303218 105043 103177 1866 574009 149728 424281 339540 307271 32269 19457 19457 128854 128854 1609334 1552023 57311 17426 17426 1166786 1117774 49012 9072 9072 253673 190362 63311 58861 55212 3649 14954 4044 10910 307453 230719 76734 757615 568531 189084 89435 74341 15094 BAD DEBT EXPENSE 167973 167973 DUES & SUBSCRIPTIONS 67657 27119 40538 REPAIRS & MAINTENANCE 67528 67528 EQUIPMENT RENTALS & LEA 49895 40251 9644 566285 529221 37064 11540027 9856539 1683488 0 8196 42127 1094662 896037 1447951 1438037 89197 140037 87201 49094 17660864 12274752 5970245 5386112 2194109 2045379 10891561 9996823 627203 595700 226 8294676 8159510 770539 560666 9692644 9315876 X 1198917 680947 1198917 680947 10891561 9996823 -350765 -167205 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1008 1008 0 PART II-B, LINE 1: MEMBERSHIP DUES RENEWAL PACKAGE TO MHA 20275 20275 11442222 7738081 3704141 36724 20491 16233 6161643 4516180 1645463 5386112 COST REPORT SETTLEMENT 24314 CERNER CAPITAL LEASE 94294 OTHER LIABILITIES -880 LONG TERM LEASE 442938 560666 1 1 X 1 X 1 X 1 1 0 0 158003 155228 2775 0.00020 1823905 660146 1163759 0.10230 1981908 815374 1166534 0.10250 1981908 815374 1166534 0.10250 1 167973 3408869 3491498 -82629 X 1 1 1 1 MUNISING MEMORIAL HOSPITAL ASSOCIATION 1500 SAND POINT ROAD MUNISING MI 49862 WWW.MUNISINGMEMORIAL.ORG 5301002603 X X X X MUNISING MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X WWW.MUNISINGMEMORIAL.ORG X 1 19 1 HTTPS://MUNISINGMEMORIAL.ORG/COMMUNITY-HEALTH/ 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X 1 X HTTPS://MUNISINGMEMORIAL.ORG X HTTPS://MUNISINGMEMORIAL.ORG/WP-C X HTTPS://MUNISINGMEMORIAL.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 MUNISING MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: SURVEY ON OUT WEBSITE MUNISING MEMORIAL HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6B: GREATER MUNISING BAY PARTNERSHIP FOR COMMERCE DEVELOPMENT 1 1 - BAY CARE MEDICAL CENTER 1514 SAND POINT ROAD MUNISING MI 49862 GENERAL PRACTIONERS PART I, LINE 7: A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IS USED. EXCEPT FOR PART 1 LINE 7G, WHERE A COST TO CHARGE RATIO BASED ON DIRECT COST AND STEPDOWN WAS MORE APPROPRIATE. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGES EQUALS $167,973. PART III, LINE 2: PERCENTAGE OF ACCOUNTS RECEIVABLES PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICES ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 8: THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT. THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. PART III, LINE 9B: THE ACCOUNT IS CREDITED THE AMOUNT DETERMINED BY THE PERCENTAGE PATIENTS QUALIFY FOR, IF THERE IS A SELF PAY BALANCE THE PATIENT HAS UP TO 10 MONTHS TO PAY THE BALANCE IF OVER $1000.00 OR IF UNDER THEY HAVE UP TO 4 MONTHS BEFORE THE ACCOUNT IS TRANSFERRED TO BAD DEBT. PART VI, LINE 3: WHEN A PATIENT ARRIVES WITHOUT HEALTHCARE COVERAGE THEY ARE INFORMED OF OUR FINANCIAL ASSISTANCE POLICY AND GIVEN AN APPLICATION. THE APPLICATION ALSO STATES THAT THERE IS A POSSIBILITY THEY COULD BE ELIGIBLE FOR THE STATE MEDICAID PLANS. PART VI, LINE 4: IT IS SMALL RURAL COMMUNITY WITH THE NEAREST REGIONAL HOSPITAL 45 MILES AWAY. WE HAVE SEVERE WINTERS THAT AFFECT TRAVEL OUT OF THE COMMUNITY PERIODICALLY. WE SERVE A MIX OF ELDERLY, LOW INCOME AND WORKING CLASS PATIENTS. PART VI, LINE 5: WE HAVE STARTED A SCHOOL BASED CLINIC WHERE OUR PROVIDERS TRAVEL TO THE SCHOOLS IN ALGER COUNTY TO SERVE THE STUDENTS. THESE SERVICES ARE BILLED THROUGH OUR CLINIC. PART VI, LINE 7 NONE. X X X 0 0 0 0 0 0 0 0 0 CHELSEA RAY PHYSICIAN 252605 0 61649 0 103 0 11223 0 4843 0 330423 0 0 0 COLIN IRISH PHYSICIAN 231395 0 0 0 103 0 9477 0 0 0 240975 0 0 0 PAUL HADUCK PHYSICIAN 203416 0 70 0 418 0 7696 0 9063 0 220663 0 0 0 DAVID GAST PHYSICIAN 202926 0 70 0 516 0 1346 0 9107 0 213965 0 0 0 DEBORAH NEDEAU SECRETARY OF THE BOARD OF DIRECTORS 978099 PAYMENTS FOR DRUGS PURCHASED FOR PUTVNS DRUG 340B PROGRAM 0 FORM 990, PART III, LINE 2 WE RESTARTED HAVING COLONOSCOPIES PERFORMED AT OUR FACILITY, WE ALSO STARTED A SCHOOL BASE CLINIC THAT SEEN IT'S FIRST PATIENT IN DECEMBER 2018. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS. THE MEMBERSHIP OF THE ASSOCIATION SHALL CONSIST OF THE FOLLOWING CLASSES; CHARTER MEMBERS AND ASSOCIATION MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A ASSOCIATION MEMBERS IF THEY HAVE PAID THEIR DUES, MAY PARTICIPATE IN THE VOTE TO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS EMAILED TO EACH BOARD MEMBER AND GIVEN A DEADLINE TO WHICH THEY NEED TO RESPOND. THEY EACH HAVE A CHANCE TO REVIEW THE 990 AND ASK QUESTIONS REGARDING THE DATA WITHIN THE FORM BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C INDIVIDUALS REQUIRED TO COMPLY WITH THE CONFLICT OF INTEREST POLICY INCLUDE THE CHIEF EXECUTIVE OFFICER, THE CHIEF FINANCIAL OFFICER, AND ALL OF THE MEMBERS OF THE BOARD. ON AN ANNUAL BASIS, DOCUMENTS ARE DISTRIBUTED AND SIGNED BY EACH INDIVIDUAL DISCLOSING ALL CONFLICTS. IF THERE IS A CONFLICT IDENTIFIED, THAT INDIVIDUAL CANNOT VOTE ON THE MATTER AND IT MUST BE INDICATED IN THE MEETING MINUTES THAT A DISCLOSURE WAS MADE AND THE BOARD MEMBER ABSTAINED FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 MICHIGAN HOSPITAL ASSOCIATION'S WAGE SURVEY IS CONSULTED. THE BOARD OF DIRECTORS APPROVE THE COMPENSATION OF THE CEO'S EMPLOYMENT CONTRACT DURING MEETINGS. UPON RECOMMENDATION FROM THE CEO, THE BOARD ALSO APPROVES THE COMPENSATION FOR THE CFO, WHICH IS INCLUDED IN THE APPROVAL OF THE ANNUAL BUDGET. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 3,788. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,788. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 66,011. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,011. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,482,224. MANAGEMENT AND GENERAL EXPENSES 33,744. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,515,968. ADMIN & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 23,567. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,567. PART XII, LINE 2C THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THE BOARD OF DIRECTORS RECEIVES A REPORT FROM THE INDEPENDENT AUDITORS UPON THE COMPLETION OF THE AUDIT. THE PROCESS HAS NOT CHANGED FROM LAST YEAR. MUNISING BAY HEALTHCARE 1500 SAND POINT RD MUNISING MI 49862 474314554 PROVIDE THE OWNERSHIP, FINANCING, CONSTRUCTION, ETC OF A HOSPITAL BUILDING MI 501(C)(3) LINE 9 MUNISING MEMORIAL HOSPITAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0