2018-05-15T08:57:31-04:00 2017-06-30 990 2016-07-01 471161992 MUNSON HEALTHCARE GRAYLING MUNS 2319355000 1105 SIXTH STREET TRAVERSE CITY MI 49684 MARK A HEPLER CFO 2319355000 2018-05-14 2016 2022-09-23 18:48:47Z STEPHANIE RIEMER 1100 E MICHIGAN AVENUE GRAYLING MI 49738 89266162 false X WWW.MUNSONHEALTHCARE.ORG X 2014 MI COMMUNITY HOSPITAL AND HEALTH-RELATED SERVICES 14 10 794 63 0 764860 697157 79144685 87271212 1912 15707 1108327 1282086 81019784 89266162 12895 10157 0 40792301 42113946 0 60000 40211840 42457526 81017036 84581629 2748 4684533 35906799 37502370 22331391 21742429 13575408 15759941 NONE. false false 73166722 10157 87283712 PROVIDING HOSPITAL SERVICES TO THE RESIDENTS OF THE CRAWFORD COUNTY REGION. 73166722 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 true true true false false false false false false false false true false false false false false false true false false false true 62 0 true 794 true false false false false false false false false false false X 14 10 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 A NESS DIRECTOR 1.00 40.00 X 0 940867 171580 STEPHANIE RIEMER PRESIDENT 2.00 X X 0 292792 55058 THAD JACKSON DIRECTOR 1.00 X 142572 0 22933 PAUL B LERG DIRECTOR 1.00 X 0 12500 0 DANIEL T WOLF DIRECTOR 1.00 X 0 3125 0 PAUL MESACK DVM SECRETARY/TR 2.00 X X 0 0 0 JANET BERSTED DIRECTOR 1.00 X 0 0 0 PAUL COMPO DIRECTOR 1.00 X 0 0 0 GARY D GANDOLFI DIRECTOR 1.00 X 0 0 0 DANIEL MCGREGOR DC PART-YEAR VI 2.00 X X 0 0 0 ANITA MERCHANT DIRECTOR 1.00 X 0 0 0 KIM MORLEY DIRECTOR 1.00 X 0 0 0 RALPH OPPERMANN DDS PART-YEAR VI 2.00 X X 0 0 0 THOMAS QUINN EDD DIRECTOR 1.00 X 0 0 0 ALICE SNYDER CHAIR 2.00 X X 0 0 0 SONJA HANDRICH DIRECTOR 1.00 X 0 0 0 MARK A HEPLER CFO 1.00 40.00 X 0 492007 81915 KIRSTEN KORTH-WHITE CHIEF OPERAT 40.00 X 198665 0 39100 CYNTHIA K RUBERT PHYSICIAN 40.00 X 542016 0 38115 BRIAN N STIRLING PHYSICIAN 40.00 X 509446 0 51983 JASON D BENNETT PHYSICIAN 40.00 X 486117 0 31534 GARRICK CVITKOVICH PHYSICIAN 40.00 X 447222 0 32929 CARL F SCHUBERT PHYSICIAN 40.00 X 427029 0 28440 2753067 1741291 553587 38 false true false AGILITY HEALTH-GRAND RAPIDS PO BOX 5509 CAROL STREAM IL 601975509 MEDICAL SERVICE 2308644 SOUND PHYS DBA SOUND INPATIENT PHYS 1498 PACIFIC AVENUE STE 400 TACOMA WA 984024208 MEDICAL SERVICE 1861501 GRAYLING ANESTHESIA ASSOCIATES PC 10 COMMERCE DRIVE NEW ROCHELE NY 10801 MEDICAL SERVICE 1466531 EPMG OF MICH PC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 MEDICAL SERVICE 702269 SODEXO INC AND AFFILIATES 10 EARHART DRIVE WILLIAMSVILLE NY 14221 FOOD SERVICE 672054 12 546869 149288 1000 697157 PATIENT SERVICE REVENUE 621990 43331391 43331391 MEDICARE/MEDICAID PAYMENTS 621990 42695065 42695065 HEALTH SERVICE REVENUE 621990 1242034 1242034 SERVICES TO OTHER ORGS 2722 2722 87271212 3207 3207 10924 10924 10924 10924 12500 12500 12500 12500 INCENTIVE PAYMENT 722210 750355 750355 CAFETERIA SALES 621990 349362 349362 MISCELLANEOUS INCOME 446199 102961 102961 68484 68484 1271162 89266162 87283712 1285293 X 10157 10157 385333 157759 227574 34242834 31295316 2947518 873366 801136 72230 4367941 3988233 379708 2244472 2040225 204247 16693 16693 5682 5682 19088049 12393404 6634645 60000 69406 3728 65678 652419 478750 173669 171487 133259 38228 1437617 1437617 143810 113993 29817 114869 90724 24145 524046 453300 70746 1922957 1663358 259599 432905 337666 95239 MEDICAL SUPPLIES 14141713 14141713 BAD DEBT EXPENSE 2273995 2273995 REPAIRS AND MAINTENANCE 1143425 1133751 9674 HOSPITAL SUPPORT 124948 108918 16030 193505 109720 83785 84581629 73166722 11354907 60000 4102 4229 85708 2685847 15151325 13600230 1499606 1693104 190331 174928 24430491 5888686 17407312 18541805 165534 165534 1402881 636693 35906799 37502370 5557402 6881175 13925561 13654323 2848428 1206931 22331391 21742429 X 13575408 15759941 13575408 15759941 35906799 37502370 4684533 -2500000 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5682 5682 false SCHEDULE C, PART II-B, LINE 1 OTHER ACTIVITIES INDICATE THE PORTION OF DUES ALLOCATED TO LOBBYING EXPENSES PAID TO REGIONAL OR NATIONAL ORGANIZATIONS. 1535000 1535000 13683873 1969931 11713942 8774804 3874546 4900258 436814 44209 392605 18541805 ESTIMATE FOR THIRD PARTY SETTLEMENTS 876360 RESERVE FOR THIRD PARTY SETTLEMENTS 330571 1206931 true true X true X true X true true false false 215094 215094 0.00260 12366869 10361931 2004938 0.02440 12581963 10361931 2220032 0.02700 384108 384108 0.00470 414157 414157 0.00500 12515226 9374852 3140374 0.03820 225170 225170 0.00270 13538661 9374852 4163809 0.05060 26120624 19736783 6383841 0.07760 9430 9430 0.00010 16696 16696 0.00020 67 67 26193 26193 0.00030 true 2273995 378627 19793120 18932939 860181 X true true 1 1 MUNSON HEALTHCARE GRAYLING 1100 E MICHIGAN AVE GRAYLING MI 49738 HTTP://WWW.MUNSONHEALTHCARE.ORG 1060000029 X X X MUNSON HEALTHCARE GRAYLING 1 false false true X X X X X X X X 15 true false true true X HTTP://WWW.MUNSONHEALTHCARE.ORG/UPLOAD X true 15 true HTTPS://WWW.MUNSONHEALTHCARE.ORG/UPLOA false true X 200.000000000000 400.000000000000 X X X true true X X X true X HTTP://WWW.MUNSONHEALTHCARE.ORG/UPLOAD X HTTP://WWW.MUNSONHEALTHCARE.ORG/UPLOAD X HTTP://WWW.MUNSONHEALTHCARE.ORG/FINANC X X X X X X X true X false X X X X X true X false false FACILITY 1, MUNSON HEALTHCARE GRAYLING - PART V, LINE 5 FROM OCTOBER 2015 THROUGH MARCH 2016, A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY MUNSON HEALTHCARE GRAYLING HOSPITAL IN COLLABORATION WITH DISTRICT HEALTH DEPARTMENT 10, THE AUSABLE FREE CLINIC, THE ROSCOMMON COUNTY HUMAN SERVICES COLLABORATIVE BODY, OSCODA COUNTY HUMAN SERVICES COORDINATING COUNCIL, THE CRAWFORD COUNTY COLLABORATIVE, AND OTHER COMMUNITY AGENCIES TO IDENTIFY SIGNIFICANT HEALTH ISSUES IN CRAWFORD, ROSCOMMON, AND OSCODA COUNTIES. SPECIAL ATTENTION WAS GIVEN TO THE POOR AND UNDERSERVED IN OUR SERVICE AREA, IN KEEPING WITH THE HERITAGE OF THE GRAYLING HOSPITAL AND MISSION OF MUNSON HEALTHCARE. MUNSON HEALTHCARE GRAYLING HOSPITAL PARTNERED WITH DISTRICT HEALTH DEPARTMENT 10 TO CONDUCT COMMUNITY CONVERSATIONS IN CRAWFORD AND ROSCOMMON COUNTIES AND WITH THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN TO CONDUCT A COMMUNITY CONVERSATION IN OSCODA COUNTY. THESE CONVERSATIONS WERE BASED ON THE QUESTION: "WHAT CAN WE DO IN OUR COUNTY TO MOVE CLOSER TO OUR VISION OF A HEALTHY COMMUNITY?" AMONG THE THREE COMMUNITY CONVERSATIONS THAT WERE OPEN TO THE PUBLIC AND ADVERTISED IN THE THREE COUNTIES, 58 COMMUNITY MEMBERS, AND REPRESENTATIVES FROM LOCAL HEALTH DEPARTMENTS, SOCIAL SERVICE AGENCIES, SCHOOLS, BUSINESS, AND GOVERNMENT PARTICIPATED. IN COLLABORATION WITH DISTRICT HEALTH DEPARTMENT 10 AND THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, TWO SURVEYS WERE DEVELOPED TO GAIN PUBLIC INPUT INTO THE COMMUNITY HEALTH NEEDS ASSESSMENT, A SURVEY OF COMMUNITY MEMBERS WITH EMPHASIS ON THE AT-RISK AND UNDERSERVED, AND A HEALTH PROVIDER SURVEY, INCLUDING BOTH PHYSICIANS AND MID-LEVEL PROVIDERS. SEVEN HUNDRED AND NINETY SIX RESIDENTS COMPLETED THE "WHAT MATTERS TO YOU" SURVEY, AND A TOTAL OF 23 PHYSICIANS AND MID-LEVEL PROVIDERS PARTICIPATED IN THE HEALTH CARE PROVIDER SURVEY. FACILITY 1, MUNSON HEALTHCARE GRAYLING - PART V, LINE 6B FACILITY 1, MUNSON HEALTHCARE GRAYLING - PART V, SECTION B, LINE 7: 7A. FULL URL TO THE CHNA: HTTP://WWW.MUNSONHEALTHCARE.ORG/UPLOAD/DOCS/CHNA/2016%20MMC%20CHNA.PDF FACILITY 1, MUNSON HEALTHCARE GRAYLING - PART V, SECTION B, LINE 10: 10A. FULL URL TO THE IMPLEMENTATION STRATEGY HTTPS://WWW.MUNSONHEALTHCARE.ORG/UPLOAD/DOCS/CHNA/2016%20MMC%20CHNA %20IMPLEMENTATION%20STRATEGY%20-%20MMC%20(11.03.16).PDF FACILITY 1, MUNSON HEALTHCARE GRAYLING - PART V, LINE 11 MUNSON HEALTHCARE GRAYLING HOSPITAL USES THE COMMUNITY HEALTH NEEDS ASSESSMENT AS A VALUABLE TOOL FOR PLANNING, AND WAS USED TO IDENTIFY AND PRIORITIZE HEALTH ISSUES, AND DEVELOP AN IMPLEMENTATION PLAN. WITH LIMITED RESOURCES AND SIGNIFICANT COMMUNITY NEEDS, WE ARE CHALLENGED TO STEWARD OUR RESOURCES AS WE WORK TOGETHER WITH COMMUNITY PARTNERS TO IMPROVE THE HEALTH OF OUR COMMUNITIES, IMPROVE ACCESS TO CARE AND REDUCE HEALTH DISPARITIES, AND PROVIDE THE GREATEST BENEFIT TO ALL RESIDENTS IN THE MOST COST EFFECTIVE MANNER POSSIBLE. AS OUTLINED IN THE FISCAL 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGY, HEALTHY LIFESTYLES, CHRONIC DISEASE, ACCESS TO HEALTHCARE AND MATERNAL, INFANT AND CHILD HEALTH WERE PRIORITIZED AS THE TOP FOUR HEALTH ISSUES BY A KEY GROUP OF STAKEHOLDERS INCLUDING HOSPITAL BOARD MEMBERS, MEDICAL STAFF, AUSABLE FREE CLINIC LEADERSHIP, DISTRICT HEALTH DEPARTMENT REPRESENTATIVES, AND REPRESENTATIVES FROM THE HEALTH SYSTEM. MUNSON HEALTHCARE GRAYLING HOSPITAL WILL ADDRESS THESE NEEDS THROUGH ITS EXISTING PROGRAMS AND PARTNERSHIPS, AS WELL AS THE IMPLEMENTATION OF NEW STRATEGIES. OTHER SIGNIFICANT NEEDS THAT HAVE BEEN IDENTIFIED IN THE NEEDS ASSESSMENT INCLUDE: SUBSTANCE ABUSE, TOBACCO USE, DENTAL HEALTH, AND MENTAL HEALTH. GRAYLING HOSPITAL WILL CONTINUE TO WORK WITH DISTRICT HEALTH DEPARTMENTS 2 AND 10, THE CENTRAL MICHIGAN HEALTH DEPARTMENT, AND OTHER COMMUNITY PARTNERS TOWARD ADDRESSING UNMET NEEDS. GRAYLING HOSPITAL CANNOT ADDRESS ALL OF THE IDENTIFIED NEEDS, BUT WILL SUPPORT OTHER COMMUNITY ORGANIZATIONS AS THEY USE THEIR EXPERTISE TO DO SO. FACILITY 1, MUNSON HEALTHCARE GRAYLING - 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 GRAYLING - QUESTION V, SECTION B, LINE 16: 16A. FULL URL TO FINANCIAL ASSISTANCE POLICY: HTTP://WWW.MUNSONHEALTHCARE.ORG/UPLOAD/DOCS/PATIENTS%20AND %20VISITORS/FINANCIAL%20ASSISTANCE/FINANCIAL-ASSISTANCE-POLICY-10.16-17.PDF 16B. FULL URL TO FINANCIAL ASSISTANCE POLICY APPLICATION: HTTP://WWW.MUNSONHEALTHCARE.ORG/UPLOAD/DOCS/MUNSON%20HEALTHCARE/FINANCIAL %20ASSISTANCE/MUNSON%20MEDICAL%202.18.PDF 16C. FULL URL TO PLAIN LANGUAGE SUMMARY: HTTP://WWW.MUNSONHEALTHCARE.ORG/FINANCIALHELP FACILITY 1, MUNSON HEALTHCARE GRAYLING - 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 GRAYLING - PART V, LINE 20E MUNSON HEALTHCARE GRAYLING 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 MHC 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. 5 CRAWFORD CONTINUING CARE CENTER 1100 EAST MICHIGAN AVE GRAYLING MI 49738 EXTENDED CARE FACILITY GRAYLING COMMUNITY HEALTH CENTER 1250 EAST MICHIGAN AVE GRAYLING MI 49738 PHYSICIAN CLINIC PRUDENVILLE COMMUNITY HEALTH CENTER 2585 WEST HOUGHTON LAKE DR PRUDENVILLE MI 48651 PHYSICIAN CLINIC AUSABLE UROLOGY 809 MICHIGAN AVE GRAYLING MI 49738 PHYSICIAN CLINIC GRAYLING SURGICAL SERVICES 1010 W NORTH DOWN RIVER RD GRAYLING MI 49738 PHYSICIAN CLINIC PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE 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. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION THE COSTS RELATED TO PHYSICIAN CLINICS IN SUBSIDIZED HEALTH SERVICES TOTAL 12,515,226. THESE COSTS ARE OFFSET BY RELATED REVENUES IN COMPUTING THE NET COMMUNITY BENEFIT. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, ARE 84,581,629. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS 2,273,995. THE NET EXPENSE OF 82,307,634 WAS USED FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION COST VALUES FOR LINE 7 ARE BASED ON THE COST TO CHARGE RATIO. PART II - COMMUNITY BUILDING ACTIVITIES MUNSON HEALTHCARE GRAYLING PROVIDED 26,193 OF COMMUNITY-BUILDING ACTIVITIES DURING THE 2017 FISCAL YEAR. GRAYLING HOSPITAL BELIEVES THESE ACTIVITIES PROMOTE HEALTH BY SUPPORTING THE UNDERLYING STRUCTURE OF COMMUNITY HEALTH. THE MAJORITY OF COMMUNITY BUILDING FUNDS WERE DESIGNATED FOR WORKFORCE DEVELOPMENT. DESPITE LARGE FINANCIAL LOSSES IN PHYSICIAN PRACTICES, GRAYLING HOSPITAL ACTIVELY WORKS TO SECURE NEEDED PHYSICIAN SPECIALTIES FOR THE SERVICE AREA INCLUDING PRIMARY CARE, OBSTETRICS, PEDIATRICS AND SURGERY. THE ADDITION OF THESE PROVIDERS HELPS TO EXPAND SERVICES TO THE COMMUNITY IN AREAS OF GREATEST NEED AND TO PROMOTE PATIENT ACCESS TO CARE. GRAYLING HOSPITAL ALSO OFFERS OPPORTUNITIES FOR LOCAL STUDENTS TO JOB SHADOW AND PROVIDES INFORMATION ON HEALTH CAREERS AT LOCAL JOB AND CAREER FAIRS HELD IN THE COMMUNITY AND AT LOCAL SCHOOLS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY 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. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE 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 SUCCESFULLY QUALIFIED FOR CHARITY (INCLUDING PRESUMPTIVE APPROVALS) AND DIVIDING THAT NUMBER BY THE ACCOUNTS THAT WERE APPROVED FOR CHARITY PLUS THE ACCOUNTS THAT DID NOT COMPLETE FINANCIAL COUNSELING AND WERE ASSIGNED TO BAD DEBT, MULTIPLIED BY THE APPROVAL RATE FOR FINANCIAL COUNSELING. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE ACCOUNTS RECEIVABLE FOOTNOTE TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF MUNSON HEALTHCARE AND SUBSIDIARIES OF THE ATTACHED STATEMENTS STATES: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ACCOUNTS RECEIVABLE PAYOR COMPOSITION AND AGING AND HISTORICAL WRITE- OFF EXPERIENCE BY PAYOR CATEGORY AND OTHER FACTORS. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. AFTER AMOUNTS DUE FROM THIRD-PARTY PAYORS ARE SATISFIED AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES. PART III, LINE 8 - MEDICARE EXPLANATION MUNSON HEALTHCARE GRAYLING CONSIDERS THE ENTIRE MEDICARE SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION MUNSON HEALTHCARE'S 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 PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM MUNSON HEALTHCARE (MHC), AND A PATIENT'S 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 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. 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. PART VI, LINE 2 - NEEDS ASSESSMENT 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. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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. PART VI, LINE 4 - COMMUNITY INFORMATION GRAYLING HOSPITAL DESCRIPTION MUNSON HEALTHCARE GRAYLING HOSPITAL SERVES A SPARSELY POPULATED, RURAL REGION IN CENTRAL NORTHERN MICHIGAN COMPRISED OF ALL OF CRAWFORD COUNTY (WHERE THE HOSPITAL IS LOCATED) AND MOST OF ROSCOMMON COUNTY, AS WELL AS MUCH OF OSCODA COUNTY AND SMALL PORTIONS OF MONTMORENCY AND OTSEGO COUNTIES. MUNSON HEALTHCARE GRAYLING HOSPITAL IS THE ONLY INPATIENT AND EMERGENCY SERVICE PROVIDER FOR THIS REGION, AND ONE OF ONLY NINE BIRTHING HOSPITALS IN THE NORTHERN 21 COUNTIES OF THE LOWER PENINSULA. GRAYLING OFFERS QUALITY, PERSONALIZED CARE FOR PRIMARY AND URGENT MEDICAL NEEDS. THE ORGANIZATION HAS 81 LICENSED INPATIENT BEDS, A 39-BED SKILLED NURSING/ LONG-TERM CARE UNIT, AN ACTIVE EMERGENCY DEPARTMENT, AND FIVE PHYSICIAN OFFICES LOCATED IN GRAYLING, PRUDENVILLE AND ROSCOMMON. THERE ARE NEARLY 50,000 PEOPLE LIVING IN GRAYLING HOSPITAL'S THREE COUNTY SERVICE AREAS. FROM 2010-2014, THE POPULATION IN CRAWFORD, OSCODA AND ROSCOMMON COUNTIES HAS DECREASED, WITH THE LARGEST DECREASE OCCURRING IN OSCODA COUNTY. THE PERCENTAGE OF PERSONS BELOW POVERTY CONTINUES TO BE HIGHER IN ALL THREE COUNTIES THAN IN ALL OF MICHIGAN WITH ROSCOMMON HAVING THE HIGHEST RATE AT 20.7% COMPARED TO MICHIGAN'S RATE OF 16.2%. THE PERCENTAGE OF PERSONS 65 AND OLDER ALSO IS HIGHER IN ALL THREE COUNTIES THAN IN ALL OF MICHIGAN (15.4%), WITH ROSCOMMON AT 30%, OSCODA AT 26%, AND CRAWFORD AT 24%. THE POPULATION WITH ANY DISABILITY IS ALSO HIGHER IN ALL THREE COUNTIES THAN IN ALL OF MICHIGAN (13.9%), WITH ROSCOMMON AT 25.2%, OSCODA AT 21.9%, AND CRAWFORD AT 21.1%. CRAWFORD, OSCODA AND ROSCOMMON COUNTIES ARE ALL DESIGNATED AS MEDICALLY UNDERSERVED AREAS. THE CONCERN FOR SINGLE PARENT STATUS SURFACES AS AN ONGOING ISSUE FOR OUR COMMUNITY FAMILIES TODAY. THE PERCENTAGE OF CHILDREN THAT ARE LIVING IN SINGLE PARENT HOUSEHOLDS IS HIGHER THAN MICHIGAN IN ROSCOMMON (45%), WITH OSCODA (29%) AND CRAWFORD (33%) BEING SLIGHTLY LOWER MICHIGAN'S RATE OF 34%. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE MUNSON HEALTHCARE GRAYLING HOSPITAL BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS, THE MAJORITY OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THESE VOLUNTEERS GIVE NUMEROUS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS. GRAYLING HOSPITAL UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA. EXAMPLES OF HOW GRAYLING HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PROGRAM SUPPORT INCLUDES: "THE GRAYLING HOSPITAL RESOURCE CORDINATION TEAM" IS SUPPORTED BY COMMUNITY BENEFIT FUNDING.THE RESOURCE COORDINATION TEAM CONTINUES TO ASSIST UNINSURED AND UNDERINSURED PATIENTS, AS WELL AS PATIENTS WITH LIMITED FINANCIAL RESOURCES BY CONNECTING THEM WITH RESOURCES TO ADDRESS BARRIERS SUCH AS TRANSPORTATION, INABILITY TO PAY UTILITY BILLS, ACCESS TO PRIMARY CARE AND WALK-IN CARE, THE HIGH COST OF MEDICATIONS, AND REFERRALS TO OTHER COMMUNITY BASED RESOURCES. THE RESOURCE COORDINATION TEAM HAS BEEN ACTIVE IN CONNECTING PATIENTS WITH THE HOSPITAL'S PATIENT FINANCIAL ASSISTANCE COORDINATOR AND MEDICAID COORDINATOR FOR FREE HEALTH INSURANCE ENROLLMENT ASSISTANCE. MUNSON HEALTHCARE GRAYLING PHYSICIAN NETWORK CHRONIC DISEASE CARE COORDINATORS COLLABORATE WITH THE RESOURCE COORDINATION TEAM TO GET THEIR PATIENTS ASSISTANCE IN MEETING UNMET SOCIAL NEEDS. THE MEDICATION ACCESS PROGRAM OFFERED BY THE RESOURCE COORDINATION TEAM HELPS MANY PATIENTS WITH MORE AFFORDABLE OPTIONS TO OBTAIN MEDICATIONS. "PRENATAL EDUCATION AND CARE COORDINATION - MUNSON HEALTHCARE GRAYLING HOSPITAL OFFERS CHILDBIRTH AND BREASTFEEDING EDUCATION. OB CARE COORDINATORS ASSIST HIGH RISK PATIENTS TO IMPROVE PREGNANCY OUTCOMES. MUNSON HEALTHCARE ALSO HELPS FUND THE HEALTHY FUTURES PROGRAM SO THAT EVERY MOTHER-TO-BE THAT HAS A CHILD BORN AT MUNSON HEALTHCARE GRAYLING HOSPITAL AND CHILDREN UP TO AGE TWO, CAN HAVE ACCESS, REGARDLESS OF HEALTH INSURANCE COVERAGE, TO EVERYTHING NEEDED FOR A HEALTHY BEGINNING. "TRANSPORTATION - AS PART OF MUNSON HEALTHCARE, GRAYLING HOSPITAL SUBSIDIZES FUNDING FOR TRANSPORTATION WHICH PROVIDES ACCESS TO HEALTHCARE SERVICES FOR DISADVANTAGED PERSONS SUCH AS THE ELDERLY, PERSONS WITH DISABILITIES, AND PERSONS OF LOW INCOME WHO HAVE DIFFICULTY PROVIDING THEIR OWN TRANSPORTATION. "GRAYLING HOSPITAL HOLDS NATIONAL DIABETES PREVENTION PROGRAM CLASSES FOR COMMUNITY MEMBERS AT THE HOSPITAL. "SUPPORT GROUPS AND ASSISTANT ACTIVITIES FOR CHRONIC DISEASES SUCH AS: DIABETES, COPD, BARIATRIC PATIENTS, AND ALCOHOL RECOVERY. "NORTHERN MICHIGAN DIABETES INITIATIVE (NMDI)- A GROUP OF STAKEHOLDERS AND STEERING COMMITTEE MEMBERS THAT REPRESENT THE 11 COUNTY SERVICE AREA, WITH A VISION TO IMPROVE THE CHRONIC CARE MANAGEMENT OF DIABETES. NMDI IS COMMITTED TO PROVIDING LOCAL, REGIONAL, AND NATIONAL RESOURCES FOR THE PREVENTION AND MANAGEMENT OF DIABETES. WHILE MOST DIABETES COLLABORATIVES FOCUS ON PROVIDING OPTIMAL EVIDENCE BASED CARE MANAGEMENT TO THE PERSON ALREADY DIAGNOSED WITH DIABETES, NMDI FOCUSES ON CONCURRENT UPSTREAM TARGETED EDUCATION OF THREE SPECIFIC POPULATIONS: THE GENERAL COMMUNITY; THE SOCIOECONOMICALLY CHALLENGED HIGH RISK POPULATION; AND RURAL PRIMARY CARE PROVIDERS (PCP) CARING FOR DIABETIC PATIENTS. "SENIOR EXERCISE CLASSES LED BY MUNSON HEALTHCARE GRAYLING HOSPITAL'S REHAB STAFF ARE HELD ON THURSDAYS AND FRIDAYS AT THE CRAWFORD COUNTY COMMISSION ON AGING AND SENIOR CENTER. "MEDICATION ASSISTANCE PROGRAM - PROVIDES ESSENTIAL PRESCRIPTIONS TO PATIENTS WHO HAVE LIMITED RESOURCES "CLINICAL TRAINING SITE FOR MEDICAL STUDENTS, NURSE PRACTITIONER STUDENTS, PHYSICIAN ASSISTANT STUDENTS, NURSING STUDENTS, SURGICAL TECH STUDENTS, PHLEBOTOMY STUDENTS, AND OTHER ALLIED HEALTH STUDENTS. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM MUNSON HEALTHCARE GRAYLING'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 AND MUNSON HEALTHCARE MANISTEE HOSPITAL PROVIDED 53.6 MILLION OF COMMUNITY BENEFIT IN THE 2016 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 FIXED WING AND HELICOPTER AIR SERVICES, IN COMBINATION WITH GROUND TRANSPORT, PATIENTS IN THE SYSTEM ARE ABLE TO ACCESS APPROPRIATE CARE. NORTH FLIGHT, INC. PROVIDED APPROXIMATELY 631,000 IN CHARITY CARE AND UNREIMBURSED MEDICAID IN THE PAST FISCAL YEAR. MUNSON MEDICAL GROUP, THE EMPLOYED PHYSICIAN ORGANIZATION IN THE SYSTEM, PROVIDED APPROXIMATELY 910,000 IN CHARITY CARE AND COMMUNITY BENEFIT IN TAX YEAR 2016. 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 64.8 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. true PATIENT MEDICATION ASSIST 41 5157 N. MI DIABETES INITIATIVE 72 5000 SCHEDULE I, PAGE 1, PART I, LINE 2 AWARDS GIVEN TO ASSIST INDVIDUALS ARE BASED ON AN EVALUATION OF THEIR ELIGIBILITY. SINCE THESE ARE SINGLE EVENTS FOR SPECIFIC NEEDS, THERE IS NO REASON TO MONITOR THE FURTHER USE OF FUNDS. false true false false false false false false false EDWIN A NESS DIRECTOR 675627 261450 3790 146937 24643 1112447 STEPHANIE RIEMER PRESIDENT 242996 26078 23718 28938 26120 347850 THAD JACKSON DIRECTOR 122452 6875 13245 6372 16561 165505 MARK A HEPLER CFO 336845 96246 58916 56740 25175 573922 10889 KIRSTEN KORTH-WHITE CHIEF OPERATING OFFI 176584 21296 785 19598 19502 237765 CYNTHIA K RUBERT PHYSICIAN 537145 2500 2371 12677 25438 580131 BRIAN N STIRLING PHYSICIAN 489931 15000 4515 25342 26641 561429 JASON D BENNETT PHYSICIAN 478822 6250 1045 11177 20357 517651 GARRICK CVITKOVICH PHYSICIAN 444131 2500 591 9473 23456 480151 CARL F SCHUBERT PHYSICIAN 400209 7500 19320 12677 15763 455469 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 0 134,260 0 STEPHANIE RIEMER 0 16,321 0 MARK A. HEPLER 0 36,529 0 KIRSTEN KORTH-WHITE 0 10,925 0 SCHEDULE J, PART III EXECUTIVE 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 CNTY GRD TRAV HOSP FIN AUTH 2014B 386004832 386523EH3 2014-12-17 14185862 PURCHASE HOSPITAL ASSETS false false false A 14185862 173507 14012413 2015 false false false true A false true false false false false true A false false true false false false false false true A true SCHEDULE K - DIFFERENCES IN ISSUE PRICE EXPLANATION CNTY GRD TRAV HOSP FIN AUTH 2014B INVESTMENT INCOME EARNED SCHEDULE K - ADDITIONAL INFORMATION CNTY GRD TRAV HOSP FIN AUTH 2014B MUNSON HEALTHCARE GRAYLING 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 2014, OUTSIDE COUNSEL WAS ENGAGED DURING THAT TAX YEAR. OBLIGATED GROUP ISSUE RECORDED ON RELATED ORGANIZATIONS ON DECEMBER 17, 2014, THE MUNSON HEALTHCARE OBLIGATED GROUP ISSUED COUNTY OF GRAND TRAVERSE HOSPITAL FINANCE AUTHORITY REVENUE BONDS (MUNSON HEALTHCARE OBLIGATED GROUP) SERIES 2014A, 2014B AND 2014C, AT A PREMIUM. THE 2014 SERIES A BONDS ARE RECORDED ON MUNSON MEDICAL CENTER'S BOOKS AND RECORDS AT A PAR VALUE OF 27,620,000. THE 2014 SERIES B BONDS ARE RECORDED ON MUNSON HEALTHCARE GRAYLING'S BOOKS AND RECORDS AT A PAR VALUE OF 13,805,000. THE 2014 SERIES C BONDS ARE RECORDED ON MUNSON HEALTHCARE CADILLAC'S BOOKS AND RECORDS AT A PAR VALUE OF 15,870,000. THE RELATED BOND PREMIUM WAS RECORDED ON THE RESPECTIVE ENTITIES' BOOKS AND RECORDS LISA HARRINGTON FAMILY OF TRUST 186079 RELATED FAMILY COMP false AMBER GOODRICH FAMILY OF TRUST 73892 RELATED FAMILY COMP false FORM 990, PAGE 6, PART VI, LINE 6 MUNSON HEALTHCARE GRAYLING 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 GRAYLING (GRY) 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 GRY; 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 GRY; THE ACQUISITION OF OR THE ESTABLISHMENT OF ANY SUBSIDIARY OR AFFILIATE OF GRY; THE ADOPTION OF ALL OPERATING BUDGETS AND CAPITAL EXPENDITURE BUDGETS FOR GRY; INCURRENCE OF OPERATING OR CAPITAL EXPENDITURES BY GRY 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 GRY 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 GRY; CHANGE IN SCOPE OF CLINICAL SERVICES OR PROGRAMS PROVIDED BY GRY; AND APPOINTMENT OR REMOVAL OF THE PRESIDENT. FORM 990, PAGE 6, PART VI, LINE 11B THE MUNSON HEALTHCARE GRAYLING BOARD IS COMMITTED TO THE ACCURACY AND THOROUGHNESS OF THE FORM 990 REPORTING. MUNSON HEALTHCARE GRAYLING 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 EXECUTIVE COMPENSATION INFORMATION CONTAINED IN THE CORE FORM AS WELL AS THE SCHEDULE J INFORMATION. THE CONFLICT, VALUATION AND COMPLIANCE COMMITTEE OVERSEES THE EXECUTIVE COMPENSATION PROCESS AND 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 GRAYLING AND MUNSON HEALTHCARE. FORM 990, PAGE 6, PART VI, LINE 19 THE MUNSON HEALTHCARE GRAYLING ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON THE MICHIGAN DEPARTMENT OF TREASURY WEBSITE. MUNSON HEALTHCARE GRAYLING 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 7,593,500 6,570,939 60,000 PROFESSIONAL FEES 4,799,904 63,706 0 TOTAL 12,393,404 6,634,645 60,000 FORM 990, PART XI, LINE 9 EQUITY TRANSFER TO MUNSON HEALTHCARE, PARENT -2,500,000 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 HEALTHCARE MI C3 12B N/A false 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 MUNSON 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 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 MEDICAL GROUP 1105 SIXTH ST TRAVERSE CITY MI 49684 273600575 PHYSICIAN MI C3 10 MUNSON MED MUNSON MEDICAL CENTER true MUNSON MEDICAL CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 381362830 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE CADILLAC 1105 SIXTH ST TRAVERSE CITY MI 49684 471156297 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE CADILLAC FOUNDATI 1105 SIXTH ST TRAVERSE CITY MI 49684 472857600 RAISE FUND MI C3 7 MUN HC CAD MUNSON HEALTHCARE CADILLAC true MUNSON HEALTHCARE CHARLEVOIX HOSPIT 1105 SIXTH ST TRAVERSE CITY MI 49684 381459366 HOSPITAL MI C3 3 MUNSON HC true MUNSON HEALTHCARE CHARLEVOIX HOSPITAL FOUNDATION 1105 SIXTH ST TRAVERSE CITY MI 49684 753078034 RAISE FUND MI C3 12A MHC CHARLE HOSPITAL true MUNSON HEALTHCARE MANISTEE HOSPITAL 1465 E PARKDALE AVE MANISTEE MI 496609709 380350304 HOSPITAL MI C3 3 MUNSON HC true MUNSON HEALTHCARE MANISTEE HOSPITAL FOUNDATION 1465 E PARKDALE AVE MANISTEE MI 496609709 383565083 RAISE FUND MI C3 12A MHC MANIST HOSPITAL true MUNSON MEDICAL BUILDING PARTNERS PO BOX 1188 TRAVERSE CITY MI 496851188 382830005 REAL ESTAT MI N/A false false NORTHERN MICHIGAN SUPPLY ALLIANCE 2651 AERO PARK DR TRAVERSE CITY MI 49686 383453378 PURCHASING MI N/A false false MEDICAL OFFICE BUILDING CONDOMINIUM PO BOX 1188 TRAVERSE CITY MI 496851188 383567278 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 MEDICAL OFFICE CONDOMINIUM ASSOCIAT PO BOX 1188 TRAVERSE CITY MI 496851188 201902620 REAL ESTAT MI N/A true MUNSON MOBILE IMAGING PO BOX 1188 TRAVERSE CITY MI 496851188 382704069 IMAGING MI N/A true false true true false false false false false false true false true true false true true true true true MUNSON HEALTHCARE B 2500000 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE L 105606 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE M 6838313 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE O 76426 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE P 8206474 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE Q 5382475 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE CADILLAC O 380020 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE CADILLAC M 52178 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE CADILLAC P 484893 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE CADILLAC Q 262166 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE FOUNDATIONS M 60000 ACTUAL AMOUNTS PAID MUNSON HEALTHCARE FOUNDATIONS C 546869 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER L 83704 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER M 821349 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER O 77901 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER P 27363020 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER Q 417128 ACTUAL AMOUNTS PAID MUNSON MEDICAL CENTER S 136000 ACTUAL AMOUNTS PAID MUNSON SUPPORT SERVICES M 285598 ACTUAL AMOUNTS PAID NORTHERN MI SUPPLY ALIANCE M 860357 ACTUAL AMOUNTS PAID NORTHERN MI SUPPLY ALIANCE O 246450 ACTUAL AMOUNTS PAID NORTHERN MI SUPPLY ALIANCE Q 58252 ACTUAL AMOUNTS PAID NORTHERN MI SUPPLY ALIANCE P 3408901 ACTUAL AMOUNTS PAID MUNSON MEDICAL GROUP M 925042 ACTUAL AMOUNTS PAID SCHEDULE R MUNSON HEALTHCARE GRAYLING 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.