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MUNSON MEDICAL CENTER SERVES AS A RURAL REFERRAL CENTER FOR THE SURROUNDING 24-COUNTY AREA, WITH 22,056 INPATIENT ADMISSIONS IN FISCAL YEAR 2017 AND OVER 490,000 OUTPATIENT VISITS. THE HOSPITAL SERVED MORE THAN 16,000 SURGICAL CASES, 1,825 OBSTETRICAL BIRTHS, AND OVER 54,000 EMERGENCY ROOM VISITS. MUNSON MEDICAL CENTER ACCEPTS ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. THE HOSPITAL HAS 494 ACTIVE MEDICAL STAFF AND 352 VOLUNTEERS. 488005607 true true false true false false false false false true true false false false true false false true false false false false false false false false true true true true true true false false false false false false false false true true false false false false false true true true false false true 416 0 true 4667 true true true false false false false false false false false false X 18 11 false false false false true true true true true false false true true true true true true true true true true 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 ALFRED PILONG CEO & PRESID 40.00 1.00 X X 638022 0 106859 WALTER NOBLE MD DIRECTOR 40.00 X 234909 0 15099 JILL E VOLLBRECHT MD DIRECTOR 40.00 X 230916 0 43890 BRIAN KIESSLING DIRECTOR 1.00 1.00 X 25000 0 0 GEORGE BEARUP PART-YEAR CH 2.00 1.00 X X 24500 0 0 DAVID FRIAR MD DIRECTOR 1.00 X 12500 0 0 SUSAN J UNGER DIRECTOR 1.00 X 12500 0 0 JOHN ERB DIRECTOR 1.00 X 12500 0 0 PATRICK E HEINTZ PART-YEAR CH 2.00 1.00 X X 12500 0 0 JAMES W HOOK PART-YEAR VI 2.00 0.00 X X 12500 0 0 DANIEL NAVIN MD SECRETARY 2.00 X X 12500 0 0 ROBERT P SCHAFER TREASURER 2.00 X X 12500 0 0 DOUGLAS LUCIANI DIRECTOR 1.00 X 12500 0 0 CHARLES HAVILL DIRECTOR 1.00 X 12500 0 0 CATHERINE COLLINS DIRECTOR 1.00 X 9375 0 0 DANIEL C EDSON DIRECTOR 1.00 0.00 X 0 0 0 TIMOTHY NELSON DIRECTOR 1.00 X 0 0 0 JOHN PELIZZARI DIRECTOR 1.00 2.00 X 0 0 0 BARBARA MATTHEWS DIRECTOR 1.00 X 0 0 0 DAVID WRIGHT DIRECTOR 1.00 X 0 0 0 MARK A HEPLER CFO 2.00 40.00 X 0 492007 81915 DAVID MCGREAHAM MD VP MEDICAL 40.00 X 389131 0 55929 DERK PRONGER CHIEF OPERAT 40.00 X 337590 0 59870 JAMES FISCHER VP PATIENT C 40.00 X 283672 0 19046 THOMAS SCHERMERHORN MD NEUROSURGEON 40.00 X 955712 0 36022 ANDREW LUEA PHYSICIAN 40.00 X 425832 0 30574 AHMET SEVIMLI MD NEPHROLOGIST 40.00 X 405609 0 47241 JAMSHID AMANZADEH PHYSICIAN 40.00 X 373625 0 21298 YELENA KIER PHYSICIAN 40.00 X 357954 0 33003 4804347 1432874 722326 160 false true false INDIGO HOSPITAL MEDICINE TRAVERSE C 10850 E TRAVERSE HWY TRAVERSE CITY MI 496841320 MEDICAL SERVICE 9378477 AHSA LLC PO BOX 945 TRAVERSE CITY MI 49685 TEMPORARY STAFF 6761187 CARDIOTHORACIC SURGEONS GT PC 107 S CASS ST TRAVERSE CITY MI 49684 MEDICAL SERVICE 3835428 SURGEONS NORTH PLLC 1221 SIXTH ST SUITE 308 TRAVERSE CITY MI 49684 MEDICAL SERVICE 3041427 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SRV 2702556 93 3404481 3000553 332463 6737497 MEDICARE AND MEDICAID PMTS 621990 303785489 303785489 PATIENT SERVICE REVENUE 621990 283999210 283999210 HEALTH SERVICE REVENUE 621990 4626511 4626511 SERVICES TO OTHER ORGANIZATIO 621990 1410543 1410543 RENT FROM RELATED ORGS 531120 475452 475452 45504 45504 594342709 8832912 2998272 5834640 174114 174114 174114 174114 249508761 64013 245443909 34468 4064852 29545 4094397 29545 4064852 34495 32801 1694 1694 CAFETERIA SALES 722210 4348208 4348208 MISCELLANEOUS 621990 829528 829528 AUXILIARY GIFT SHOP 446199 431414 431414 5609150 619792473 597325022 47198 15682756 X 75068 75068 479554 479554 2633330 590395 2042935 180076139 167412268 12663871 18255381 16956383 1298998 27648327 25508456 2139871 12831110 11812668 1018442 177303 177303 19556 19556 114669817 69164132 44141095 1364590 143242 143242 4357382 3476930 880452 2491597 2129186 362411 8128537 7789333 339204 474790 383214 91576 737102 632840 104262 6680351 5837705 842646 22630308 19778572 2851736 3356237 2599099 757138 MEDICAL SUPPLIES 139961981 139961981 BAD DEBT 11314594 11314594 REPAIRS AND MAINTENANCE 6435605 6249951 185654 DIETARY 731560 531334 200226 -5865140 -4821298 -1043842 558443731 488005607 69073534 1364590 26812 89215 189838925 197811581 927154 1686819 74662538 85015891 670728 1200368 15711452 17636807 7680766 4962476 498109695 244853722 268841459 253255973 227518969 262212955 19784072 24510737 280000 280000 359395 1241910 806302270 849904732 46465706 48914380 818388 743554 150916387 148503047 170862505 125369547 369062986 323530528 X 421489016 506048345 15750268 20325859 437239284 526374204 806302270 849904732 61348742 10699995 17086183 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false false false true 6500 false false true 13056 19556 false SCHEDULE C, PART II-B, LINE 1 GRASSROOTS LOBBYING EXPENSES GRANTED TO ORGANIZATIONS. OTHER ACTIVITIES INDICATE THE PORTION OF DUES ALLOCATED TO LOBBYING EXPENSES PAID TO REGIONAL OR NATIONAL ORGANIZATIONS. 243272793 22196661 20969306 406382 2213218 1277310 282541850 244152852 6254359 4518422 548791 10014072 1089977 243272793 233458837 5839692 10191121 277824 3960064 1098910 244152852 209694426 4386641 28104434 662105 6934457 1130102 233458837 180234157 12760078 18163160 589921 80507 792541 209694426 0.92800 0.07200 false true true 14842977 14842977 321868560 152842466 169026094 1791373 768787 1022586 133839366 89664230 44175136 25767419 1578239 24189180 253255973 MINIMUM PENSION LIABILITY 102108088 ESTIMATED THIRD PARTY SETTLEMENTS 10368952 RESERVE FOR THIRD PARTY SETTLEMENTS 9187606 SWAP MARKET VALUE BASIS 3701787 OTHER 3114 125369547 SCHEDULE D, PAGE 2, PART V, LINE 4 THE BOARD OF TRUSTEES DESIGNATES SUBSTANTIAL INVESTMENTS FOR THE REPLACEMENT, IMPROVEMENT, AND THE EXPANSION OF TANGIBLE FACILITIES OWNED BY MUNSON MEDICAL CENTER TO ENSURE FUNDS ARE AVAILABLE TO MAINTAIN THE HOSPITAL ASSETS TO CARRY OUT ITS MISSION. A PORTION OF THE TERM ENDOWMENT ASSETS ARE THOSE HELD FOR SPECIFIC MEDICAL PURPOSES, AS DEFINED BY DONORS. THOSE ASSETS ARE BEING HELD FOR A VARIETY OF DONOR INTERESTS INCLUDING ADAPTIVE SPORTS, PEDIATRIC THERAPY, OTHER PEDIATRIC MEDICAL NEEDS, RESEARCH, AND PATIENT ASSISTANCE. true true X true X true X true true false false 687017 687017 0.00120 43911036 36032471 7878565 0.01420 44598053 36032471 8565582 0.01540 2306808 421833 1884975 0.00340 2142813 664108 1478705 0.00270 311084637 298178235 12906402 0.02320 940651 404055 536596 0.00100 123503 123503 0.00020 316598412 299668231 16930181 0.03050 361196465 335700702 25495763 0.04590 1500 1500 10040 10040 28803 28803 5119 5119 30549 30549 0.00010 76011 76011 0.00010 true 11563928 1879689 197871020 188789395 9081625 X true true NW MI SURGERY CENTER AMBULATORY SURGERY CENTER 0.49000 0.51000 1 1 MUNSON MEDICAL CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 HTTP://WWW.MUNSONHEALTHCARE.ORG 1060000048 X X X X X MUNSON MEDICAL CENTER 1 false false true X X X X X X X X 15 true true 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 MEDICAL CENTER - PART V, LINE 5 A COLLABORATIVE 21-MEMBER STEERING COMMITTEE GUIDED THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS. THIS STEERING COMMITTEE WAS COMPRISED OF HOSPITAL LEADERS AND PUBLIC HEALTH OFFICIALS. AS THE CHNA PROCESS PROGRESSED, 5 COMMUNITY CONVERSATIONS WERE HELD WITH REPRESENTATION RANGING FROM 12 TO 30 AREA GROUPS AND ORGANIZATIONS AT EACH, TO ENSURE INPUT FROM THOSE WHO HAVE A BROAD KNOWLEDGE OF THE COMMUNITY. THESE COMMUNITY CONVERSATION SESSIONS WERE CONDUCTED AT THE FIVE AREA COUNTY COLLABORATIVES, WITH ORGANIZATIONS REPRESENTING, OR MEMBERS OF, MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY GROUPS. INDIVIDUALS POSSESSING BROAD KNOWLEDGE OF ALL SEGMENTS OF THE FIVE-COUNTY AREA PARTICIPATED AS TO HELP ASSESS HEALTH CARE NEEDS. THESE GROUPS INCLUDED INDIVIDUALS WITH KNOWLEDGE OF PEOPLE AND AREAS MOST IMPACTED BY HEALTH DISPARITIES. FURTHER, A "WHAT MATTERS TO YOU?" SURVEY WAS DISTRIBUTED TO THE MUNSON MEDICAL CENTER (MMC) MAIN SERVICE AREA TO GATHER INPUT FROM THE BROAD COMMUNITY. A HEALTH CARE PROVIDER SURVEY ALSO WAS DISTRIBUTED TO GAIN TARGETED PHYSICIAN INPUT AS WELL. IN ADDITION TO SECONDARY DATA FROM OUR COMMUNITY DASHBOARD, THE PRIMARY DATA DISCUSSED ABOVE WAS USED TO COMPILE A COMPREHENSIVE LIST OF HEALTH NEEDS; THEN PRIORITIZED ITS TOP SEVEN HEALTH NEEDS. FACILITY 1, MUNSON MEDICAL CENTER - PART V, LINE 6A PAUL OLIVER MEMORIAL HOSPITAL (POMH) AND KALKASKA MEMORIAL HEALTH CENTER (KMHC) ALSO PARTICIPATED; HOWEVER KMHC IS NOT REQUIRED TO REPORT ON 501(R) COMPLIANCE DUE TO THEIR EXEMPTION AS A GOVERNMENTAL ENTITY. FACILITY 1, MUNSON MEDICAL CENTER - PART V, LINE 6B A COLLABORATIVE 21-MEMBER STEERING COMMITTEE GUIDED THE CHNA PROCESS. THIS STEERING COMMITTEE WAS COMPRISED OF HOSPITAL LEADERS AND PUBLIC HEALTH OFFICIALS, AS LISTED IN APPENDIX A OF THE CHNA. AS THE CHNA PROCESS PROGRESSED, 5 COMMUNITY CONVERSATIONS WERE HELD WITH REPRESENTATION RANGING FROM 12 TO 30 AREA GROUPS AND ORGANIZATIONS AT EACH, TO ENSURE INPUT FROM THOSE WHO HAVE A BROAD KNOWLEDGE OF THE COMMUNITY. SEE APPENDIX B OF THE CHNA FOR A LIST OF GROUPS AND AGENCIES THAT PARTICIPATED IN COMMUNITY CONVERSATIONS. FACILITY 1, MUNSON MEDICAL CENTER - 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 MEDICAL CENTER - 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 MEDICAL CENTER - PART V, LINE 11 WITH THE SUPPORT OF THE MUNSON MEDICAL CENTER BOARD'S COMMUNITY HEALTH COMMITTEE, MUNSON MEDICAL CENTER THOUGHTFULLY PARTICIPATES IN THE CONTINUAL EVALUATION OF THE HEALTH PROGRAMS DESIGNED TO MEET THE NEEDS OF THE COMMUNITIES IN MUNSON'S SERVICE AREA. AS OUTLINED IN THE COMMUNITY HEALTH IMPLEMENTATION STRATEGY, THE CONTINUATION OF SUCCESSFUL PROGRAMS, COMBINED WITH OPPORTUNITIES TO INITIATE NEW PROGRAMS AT THE HOSPITAL OR AS A PARTNER IN MORE BROAD-BASED EFFORTS, FORM THE STRATEGIC BASIS TO IMPROVE ISSUES SURROUNDING HEALTH AND HEALTHCARE DELIVERY. SEVEN TOP SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED. DUE TO THE CLEAR INTERCONNECTIVITY AMONG THE ISSUES, ALL WERE CONSIDERED IN THE BUILDING THE IMPLEMENTATION STRATEGY. TECHNIQUES THAT CROSS OVER BETWEEN HEALTH ISSUES WERE USED AS TO ENHANCE COLLECTIVE IMPACT ON IMPROVING COMMUNITY HEALTH. MMC'S ROLE IN ADDRESSING EACH VARIES AS FOR SOME MMC IS THE CONVENER WHILE FOR OTHER STRATEGIES OUR ROLE IS BEST SUITED TO BE A PARTICIPANT IN ACTIVELY ADDRESSING THE NEED. FACILITY 1, MUNSON MEDICAL CENTER - 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 MEDICAL CENTER - 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 MEDICAL CENTER - 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 MEDICAL CENTER - PART V, LINE 20E MUNSON MEDICAL CENTER (MUNSON) 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. 9 MUNSON COMMUNITY HEALTH CENTER 550 MUNSON AVENUE TRAVERSE CITY MI 49686 OUTPATIENT COWELL FAMILY CANCER CENTER 217 S MADISON ST TRAVERSE CITY MI 49684 RADIATION THERAPY AND MRI SMITH FAMILY BREAST HEALTH CENTER 4100 PARK FOREST DR TRAVERSE CITY MI 49684 MAMMOGRAPHY AND WOMEN'S HEALTH INFUSION CLINIC 217 S MADISON ST TRAVERSE CITY MI 49684 IV THERAPY CHEMICAL DEPENDENCY CENTER 420 BROOK ST TRAVERSE CITY MI 49684 REHABILITATION MUNSON MANOR 1220 MEDICAL CAMPUS DR TRAVERSE CITY MI 49684 HOSPITALITY HOUSE ADVANCED WOUND CENTER 5085 ANNA DR TRAVERSE CITY MI 49684 PATIENT WOUND CARE MUNSON HOSPICE HOUSE 450 BROOK ST TRAVERSE CITY MI 49684 HOSPICE CARE HOUSE MUNSON RENAL DIALYSIS 4062 WEST ROYAL DRIVE TRAVERSE CITY MI 49684 RENAL DIALYSIS UNIT 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 15,958,042. 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 558,443,731 AND THE PROPORTIONATE SHARE OF TOTAL EXPENSES OF THE AMBULATORY SURGERY CENTER IS 9,384,444. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS 11,563,928. THE NET EXPENSE OF 547,129,137 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 COMPUTATION OR ACTUAL CASH PAID. PART II - COMMUNITY BUILDING ACTIVITIES MUNSON MEDICAL CENTER (MMC) PROVIDED 76,011 IN COMMUNITY-BUILDING ACTIVITIES DURING THE 2016 TAX YEAR. THE MOST SIGNIFICANT PORTION OF THIS INVESTMENT WAS IN ENVIRONMENTAL IMPROVEMENTS RELATING TO THE RECYCLING OF ELECTRONIC EQUIPMENT. ANOTHER SIGNIFICANT PORTION WAS DEDICATED TO RECRUITMENT OF PHYSICIANS IN NEEDED SPECIALTIES FOR UNDERSERVED AREAS. ADDITIONAL ACTIVITIES INCLUDED ADMINISTRATIVE SUPPORT BOARDS, WORKFORCE DEVELOPMENT, ADVISORY COMMITTEES, AND COLLABORATIVE EFFORTS. 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 DET IS AS FOLLOWS.WE DETERMINED THE APPROVAL RATE OF FINANCIAL COUNSELING BY TAKNG THE VALUE OF THE ACCOUNTS THAT SUCCESSFULLY QUALIFIED FOR CHARITY (INCLUDING PRESUMPTIVE APPROVALS) AND DIVIDING THAT NUMBER BY THE ACCOUNTS THAT WERE APPORVED FOR CHARITY PLUS THE ACCOUNTS THAT WERE DENIED. THEN WE APPLIED THAT PERCENTAGE TO THE VALUE OF ACCOUNTS THAT DID NOT COMPLETE FINANCIAL COUNSELING AND WERE ASSIGNED TO BAD DEBT, MULTIPLIED BY THE APPROVAL RATE FOR FINANCIAL COUNSELING. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE ACCOUNTS RECEIVABLE FOOTNOTE TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF MUNSON HEALTHCARE AND SUBSIDIARIES 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 9B - COLLECTION PRACTICES EXPLANATION MUNSON HEALTHCARE'S (MHC) 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 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)DOCUMENTATING 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 MEDICAL CENTER BOARD OF DIRECTORS MAINTAINS A STANDING COMMUNITY HEALTH COMMITTEE (CHC) TO SERVE MUNSON MEDICAL CENTER. THE CHC CONSISTS OF MUNSON MEDICAL CENTER BOARD MEMBERS AND OTHER INTERESTED AREA PHYSICIANS AND COMMUNITY MEMBERS APPOINTED BY THE MUNSON MEDICAL CENTER BOARD CHAIRPERSON. THE CHC MEETS AT LEAST QUARTERLY TO REVIEW EXISTING PROGRAMS AND SERVICES RELATED TO CURRENT COMMUNITY HEALTH NEEDS, CONSIDER THE MMC 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 MMC COMMUNITY BENEFIT PROGRAMS AND SERVICES. THIS COMMITTEE IS SUPPORTED BY A COMMUNITY HEALTH DEPARTMENT OF MUNSON MEDICAL CENTER. MUNSON MEDICAL CENTER (MMC) IS A SIGNIFICANT CONTRIBUTOR TO REGIONAL EFFORTS THAT ASSESS THE HEALTH STATUS OF THE TOTAL POPULATION WITHIN OUR 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. MUNSON PREPARED A COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY TO MEET THE REQUIREMENTS OF IRC SEC 501(R) DURING FISCAL 2016 IN ACCORDANCE WITH THE PLANS OF THE COMMUNITY HEALTH COMMITTEE OF THE BOARD. ADDITIONALLY, MUNSON WORKS IN CONJUNCTION WITH COMMUNITY COLLABORATIVES IN FIVE COUNTIES ANTRIM, BENZIE, GRAND TRAVERSE, LEELANAU, AND KALKASKA; AREA HEALTH DEPARTMENTS, AND OTHER REGIONAL ASSOCIATIONS TO MAINTAIN CURRENT UNDERSTANDING OF COMMUNITY NEED. 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 MUNSON MEDICAL CENTER DESCRIPTION MUNSON MEDICAL CENTER (MMC) IS THE LARGEST HOSPITAL IN NORTHERN LOWER PENINSULA OF MICHIGAN, WITH 439 LICENSED ACUTE CARE BEDS AND FACILITIES ON TWO MAJOR CAMPUSES. ONE OF NINE HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM, MMC SERVES AS A RURAL REFERRAL CENTER FOR THE SURROUNDING 24-COUNTY AREA, WITH 22,056 INPATIENT ADMISSIONS IN FISCAL YEAR 2017 AND AN ADDITIONAL 501,300 OUTPATIENT VISITS. THE HOSPITAL SERVED MORE THAN 16,141 SURGICAL CASES,1,825 OBSTETRICAL BIRTHS, AND OVER 54,923 EMERGENCY ROOM VISITS IN FISCAL YEAR 2017. THE HOSPITAL HAS AN ACTIVE MEDICAL STAFF OF 494 PROVIDERS AND 352 VOLUNTEERS. WITH APPROXIMATELY 3,880 EMPLOYEES, MMC IS THE LARGEST EMPLOYER IN NORTHERN MICHIGAN. DUE TO ITS GEOGRAPHIC LOCATION AND COMPREHENSIVE ARRAY OF SERVICES OFFERED, MMC IS DESIGNATED A RURAL REFERRAL CENTER BY THE CENTERS FOR MEDICARE AND MEDICAID. MMC IS ALSO RECOGNIZED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) AS A SOLE COMMUNITY HOSPITAL. BECAUSE OF THIS STATUS, IT IS EQUIPPED TO PROVIDE CRITICAL CARE FOR PATIENTS ACROSS THE 24-COUNTY REGION. MMC PROVIDES SERVICES IN MORE THAN 76 DIFFERENT MEDICAL SPECIALTIES AND OFFERS A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICE. MMC HAS AN AWARD- WINNING OPEN-HEART SURGERY AND INTERVENTIONAL CARDIOLOGY PROGRAM, PLUS THE ONLY LEVEL II TRAUMA CENTER IN MICHIGAN'S REGION 7, WHICH COVERS 17 COUNTIES, AND THE ONLY NEONATAL INTENSIVE CARE UNIT IN NORTHERN LOWER MICHIGAN. MMC IS ALSO DESIGNATED AS A PRIMARY STROKE CENTER BY THE JOINT COMMISSION AND ACCREDITED AS A COMPREHENSIVE COMMUNITY CANCER CENTER BY THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS. SPECIALIZED INPATIENT UNITS AVAILABLE AT MMC INCLUDE MEDICAL/SURGICAL INTENSIVE CARE, CARDIAC INTENSIVE CARE, NEONATAL INTENSIVE CARE, ONCOLOGY, ORTHOPEDICS, INPATIENT MENTAL HEALTH, AND PHYSICAL MEDICINE AND REHABILITATION. COMPLEX SURGERIES INCLUDING CARDIOTHORACIC, HAND, NEURO, AND VASCULAR SURGERIES ARE AVAILABLE, AS WELL AS LESS COMPLEX SAME-DAY SURGERY. A BROAD SPECTRUM OF DIAGNOSTIC AND THERAPEUTIC SERVICES SUPPORT MMC'S PROGRAMS, INCLUDING: COMPREHENSIVE RADIOLOGY SERVICES WITH CT, MRI (TRADITIONAL, OPEN BORE, AND BREAST), PET/CT, ULTRASOUND, NUCLEAR MEDICINE, DIGITAL MAMMOGRAPHY, AND X-RAY COMPREHENSIVE CANCER TREATMENT INCLUDING RADIATION ONCOLOGY DELIVERED VIA BRACHYTHERAPY, IGRT AND IMRT RADIATION THERAPY, AND THE LATEST IN STEREOTACTIC RADIOSURGERY COMPUTERIZED INPATIENT AND OUTPATIENT LABORATORY SERVICES INCLUDING THE REGIONS ONLY MALDI-TOF SYSTEM FOR RAPID IDENTIFICATION OF MICROORGANISMS COMPREHENSIVE REHABILITATION SERVICES, INCLUDING PHYSICAL, OCCUPATIONAL, SPEECH AND HEARING, AND WOUND THERAPY PROGRAMS A DEDICATED CARDIAC DIAGNOSTIC SUITE USING THE LATEST IN ECHOCARDIOGRAPHY, AN ADJACENT LAB FOR DIAGNOSTIC CATHETERIZATION AND ELECTROPHYSIOLOGY STUDIES, AND A DEDICATED CARDIAC REHABILITATION AND PREVENTION PROGRAM OBSTETRIC CLINIC FOR INDIGENT PATIENTS MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES; HOME HEALTH, DME AND DIALYSIS SERVICES POPULATION SERVED BY MUNSON MEDICAL CENTER MMC SERVES PATIENTS FROM 24 COUNTIES IN NORTHERN LOWER MICHIGAN AND THE EASTERN PORTION OF THE UPPER PENINSULA - A POPULATION BASE OF APPROXIMATELY 540,000. IN THE 12-COUNTY REGION IMMEDIATELY SURROUNDING MMC: 23% OF THE POPULATION ARE 65 YEARS OR OLDER UNEMPLOYMENT RATE (AS OF DECEMBER 2017) IS ABOVE THE MICHIGAN RATE OF 4.4% IN 10 OF THE 12 COUNTIES SERVED, AVERAGING 6.8% WITH RATES RANGING FROM 4.3% TO 9.9% (SOURCE: MICHIGAN BUREAU OF LABOR MARKET INFORMATION AND STRATEGIC INITIATIVES) ABOUT 68% OF MMC INPATIENT DISCHARGES ORIGINATE FROM THE FIVE COUNTIES IN CLOSEST PROXIMITY TO MMC - ANTRIM, BENZIE, GRAND TRAVERSE, LEELANAU AND KALKASKA. 44% OF BIRTHS ARE COVERED BY MEDICAID IN THE SIX COUNTIES IMMEDIATELY SURROUNDING MMC: 14.1 PERCENT OF ADULTS 18-64 YEARS OF AGE LACK HEALTH INSURANCE, COMPARED TO A STATE AVERAGE OF 12.4 PERCENT. (SOURCE: US CENSUS BUREAU, SMALL AREA HEALTH INSURANCE ESTIMATES (SAHIE), 2014) QUALITY MMC'S REPUTATION FOR THE HIGHEST QUALITY CARE IS REPRESENTED BY REPEATED NATIONAL RECOGNITION RECEIVED. MMCS REPUTATION FOR THE HIGHEST QUALITY CARE IS REPRESENTED BY REPEATED NATIONAL RECOGNITION RECEIVED. THE AMERICAN NURSES CREDENTIALING CENTER HAS RE-DESIGNATED MMC AS A MAGNET HOSPITAL FOR THE THIRD CONSECUTIVE TIME. MMC WAS FIRST DESIGNATED IN 2006. MMC IS ONE OF JUST TWO PERCENT OF HOSPITALS IN THE WORLD AND ONE OF TWO HOSPITALS IN MICHIGAN THAT HAS BEEN RE-DESIGNATED FOR A THIRD TIME. MAGNET DESIGNATION RECOGNIZES EXCELLENCE IN PATIENT CARE STANDARDS, RESPECT OF CULTURAL AND ETHNIC DIVERSITY, AND LEADERSHIP OF THE NURSE ADMINISTRATOR IN SUPPORTING PROFESSIONAL NURSING PRACTICE, AND THE MANAGEMENT AND PHILOSOPHY OF NURSING SERVICES. MAGNET HOSPITALS ARE KNOWN TO HAVE THE HIGHEST QUALITY OF PATIENT CARE, HIGH LEVELS OF PATIENT SATISFACTION, LOWER VACANCY AND TURNOVER RATES FOR REGISTERED NURSE POSITIONS, AND HIGHER RATES OF JOB SATISFACTION. MMC IS FULLY ACCREDITED BY THE JOINT COMMISSION AND HAS EARNED THE GOLD SEAL OF APPROVAL, AN INTERNATIONALLY-RECOGNIZED SYMBOL OF HEALTH CARE QUALITY. THE ACCREDITATION PROCESS DRIVES QUALITY CARE AND PATIENT SAFETY IMPROVEMENTS THROUGH NATIONALLY RECOGNIZED EVIDENCE-BASED STANDARDS WHICH ADDRESS CRITICAL PATIENT SAFETY AND QUALITY ISSUES, NATIONAL PATIENT SAFETY GOALS, AND PERFORMANCE MEASURES WHICH PROVIDE A FOUNDATION FOR QUALITY. THE JOINT COMMISSION, ALONG WITH THE AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION HAS ALSO CERTIFIED MMC AS A PRIMARY STROKE CENTER SINCE 2012 FOR MEETING ALL CRITICAL ELEMENTS OF PERFORMANCE TO ACHIEVE LONG-TERM SUCCESS IN IMPROVING OUTCOMES FOR STROKE PATIENTS. CERTIFICATION RECOGNIZES HOSPITALS THAT HAVE A DEDICATED STROKE-FOCUSED PROGRAM, ARE STAFFED BY QUALIFIED MEDICAL PROFESSIONALS TRAINED IN STROKE CARE, INVOLVE THE PATIENT IN THEIR HOSPITAL CARE, AND WHO USE DATA TO ASSESS AND CONTINUALLY IMPROVE QUALITY OF CARE FOR STROKE PATIENTS. MMC IS RATED FOUR STARS BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. THE RATING SUMMARIZES UP TO 64 QUALITY MEASURES ON THE HOSPITAL COMPARE WEB SITE REFLECTING COMMON CONDITIONS THAT HOSPITALS TREAT, SUCH AS HEART ATTACKS OR PNEUMONIA. HOSPITALS MAY PERFORM MORE COMPLEX SERVICES OR PROCEDURES NOT REFLECTED IN THE MEASURES ON HOSPITAL COMPARE. THE OVERALL RATING SHOWS HOW WELL EACH HOSPITAL PERFORMED, ON AVERAGE, COMPARED TO OTHER HOSPITALS IN THE U.S. MMC IS RECOGNIZED AS A BLUE DISTINCTION CENTER+ IN THREE AREAS - CARDIAC CARE, MATERNITY CARE AND KNEE AND HIP REPLACEMENT - BY BLUE CROSS BLUE SHIELD OF MICHIGAN FOR DEMONSTRATING ITS EXPERTISE IN DELIVERING SAFE AND EFFECTIVE CARE, MEETING OUTLINED QUALITY MEASURES AND DEMONSTRATING EXPERTISE IN THESE AREAS. MMC'S STROKE PROGRAM IS REPEATEDLY RECOGNIZED BY THE AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION FOR HIGH QUALITY CARE. IN 2016, THE HOSPITAL WAS ONE OF FOUR IN MICHIGAN TO RECEIVE BOTH GOLD PLUS ACHIEVEMENT AND ELITE HONOR ROLL RECOGNITION IN THE NATIONAL ASSOCIATIONS GET WITH THE GUIDELINES QUALITY IMPROVEMENT PROGRAM. IN 2016, THE AMERICAN ASSOCIATION OF CRITICAL-CARE NURSES CONFERRED A SILVER-LEVEL BEACON AWARD FOR EXCELLENCE ON MMCS A2 CARDIOTHORACIC NURSING UNIT IN THE WEBBER HEART CENTER. THE NURSING STAFF OF A4 WEBBER HEART CENTER WON THE SAME AWARD IN 2014. THE BEACON AWARD FOR EXCELLENCE RECOGNIZES UNIT CAREGIVERS WHO SUCCESSFULLY IMPROVE PATIENT OUTCOMES AND ALIGN PRACTICES WITH AACNS SIX STANDARDS FOR A HEALTHY WORK ENVIRONMENT. UNITS THAT ACHIEVE THIS THREE-YEAR, THREE-LEVEL AWARD WITH GOLD, SILVER, AND BRONZE DESIGNATIONS MEET NATIONAL CRITERIA CONSISTENT WITH MAGNET RECOGNITION, THE MALCOLM BALDRIDGE NATIONAL QUALITY AWARD, AND THE NATIONAL QUALITY HEALTHCARE AWARD. SEVEN MUNSON HEALTHCARE SYSTEM HOSPITALS WERE NAMED MOST WIRED FOR 2016 BY THE AMERICAN HOSPITAL ASSOCIATIONS JOURNAL HOSPITALS AND HEALTH NETWORKS. MMC HAS BEEN NAMED A MOST WIRED HOSPITAL IN SIX OUT OF THE SEVEN YEARS THE LIST HAS BEEN PUBLISHED, INCLUDING, 2011 (SMALL & RURAL), 2012 (MOST IMPROVED) AND 2013 2016. THE AMERICAN COLLEGE OF SURGEONS REVERIFIED MUNSON MEDICAL CENTER AS A LEVEL II TRAUMA CENTER IN 2015. IT IS THE ONLY LEVEL II FACILITY IN MICHIGAN'S NORTHERN LOWER PENINSULA AND WAS FIRST VERIFIED IN 2006. MMCS SMITH FAMILY BREAST HEALTH CENTER IS ACCREDITED BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC). THE THREE-YEAR RECOGNITION IS A PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS. THE NAPBC IS A CONSORTIUM OF PROFESSIONAL ORGANIZATIONS DEDICATED TO THE IMPROVEMENT OF THE QUALITY OF CARE AND MONITORING OF OUTCOMES OF PATIENTS WITH DISEASE OF THE BREAST. ACCREDITATION BY THE NAPBC IS ONLY GIVEN TO THOSE CENTERS THAT HAVE VOLUNTARILY COMMITTED TO PROVIDE THE HIGHEST QUALITY BREAST CARE AND THAT UNDERGO A RIGOROUS EVALUATION AND REVIEW OF THEIR PERFORMANCE. THE CENTER HAS BEEN DESIGNATED AS A BREAST IMAGING CENTER OF EXCELLENCE BY THE AMERICAN COLLEGE OF RADIOLOGY SINCE 2010. MMCS CARDI PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE MUNSON MEDICAL CENTER BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE. ADDITIONALLY, 100% OF MUNSON MEDICAL CENTER TRUSTEES SUPPORT MUNSON FINANCIALLY. 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 TRUSTEES. MUNSON MEDICAL CENTER UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA. EXAMPLES OF HOW MUNSON MEDICAL CENTER PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PROGRAMS INCLUDE: HEALTHY FUTURES- A PARTNERSHIP OF AREA HEALTH CARE PROVIDERS, HEALTH DEPARTMENTS AND MUNSON HEALTHCARE, CREATED TO IMPROVE THE HEALTH OF PREGNANT WOMEN AND CHILDREN UP TO AGE FIVE. THE PROGRAM INCLUDES CENTRAL ACCESS/DATA MANAGEMENT, REGISTERED NURSE (RN) CARE COORDINATION, EDUCATIONAL MAILINGS, AND HEALTH CARE-RELATED FINANCIAL ASSISTANCE. THE HEALTHY FUTURES MODEL OF RN CARE COORDINATION CONSISTS OF AN OUTCOMES-BASED APPROACH TO INTERVENTION IN THE AREAS OF BREASTFEEDING LONGEVITY, ACCESS TO HEALTH CARE AND IMMUNIZATIONS. MEDS PROGRAM- A PROGRAM THAT PROVIDES TO PATIENTS WITHOUT RESOURCES BEING DISCHARGED FROM THE HOSPITAL NEEDED MEDICATIONS, AS WELL AS ENROLLING THOSE PATIENTS INTO PHARMACEUTICAL COMPANY SPONSORED ASSISTANCE PROGRAMS SO THEY MAY CONTINUE TO GET THE NEEDED PHARMACEUTICALS. NORTHERN MICHIGAN DIABETES INITIATIVE (NMDI)- A GROUP OF STAKEHOLDERS AND STEERING COMMITTEE MEMBERS THAT REPRESENT THE 14 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. NORTHERN MICHIGAN VACCINE PREVENTABLE DISEASE TASK FORCE - A GROUP COORDINATED AND LED BY MUNSON HEALTHCARE, IS WORKING TO INFORM, EDUCATE, AND SUPPORT POLICY CHANGE THAT REVERSES THE REGION'S ONGOING TREND OF VERY LOW VACCINATION RATES AND SUPPORTS HEALTHY COMMUNITIES. MEDICAL EDUCATION-THE MUNSON FAMILY PRACTICE RESIDENCY PROGRAM INTEGRATES OSTEOPATHIC AND ALLOPATHIC MEDICINE TOGETHER, WITH THE RESOURCES OF MUNSON MEDICAL CENTER. THIS DUALLY ACCREDITED 5/5/5 PROGRAM ACCEPTS BOTH DO AND MD TRAINEES. THE PROGRAM IS AFFILIATED WITH MICHIGAN STATE UNIVERSITY. MMC ALSO PARTNERS WITH SEVERAL COLLEGES AND SCHOOLS OF NURSING TO PROVIDE INTERNSHIPS AND CLINICAL EXPERIENCES FOR REGISTERED NURSES, RESPIRATORY THERAPISTS, PHARMACISTS, AND OTHER HEALTH PROFESSIONALS. SHAPE UP NORTH- A COLLABORATIVE EFFORT LED BY MUNSON MEDICAL CENTER WITH OVER TWENTY COMMITTED COMMUNITY PARTNERS. FOUR FOCUS AREA STRATEGIES WERE SELECTED FOR GREATEST COMMUNITY IMPACT: PROVIDERS, SCHOOLS, BUSINESSES AND COMMUNITY AWARENESS. THIS COLLABORATION ALLOWS PARTNERS TO WORK TOGETHER TO ADOPT CONSISTENT, CLEAR, AND UNIFIED MESSAGES AND DEVELOP COMMON INTERVENTION STRATEGIES IN AN EFFORT TO CREATE COLLECTIVE IMPACT. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM MUNSON MEDICAL CENTER'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 TRAVERSE HEALTH CLINIC & COALITION 1719 S GARFIELD AVENUE TRAVERSE CITY MI 49686 300224028 501C3 55068 FMV MEDICATION MEDICALLY UNDERSERVE UNITED WAY OF NORTHWEST MICHIGAN 521 SOUTH UNION STREET TRAVERSE CITY MI 49684 381679060 501C3 20000 COMMUNITY SUPPORT 2 MEDICAL INSURANCE PAYMENT 45 23507 TRANSPORT, HOUSING, WIGS 754 185625 TRANSPORT, HOUSING, FOOD 2305 134506 MAMMOGRAPHY ASSISTANCE 439 56534 MEALS FOR PATIENT FAMILY 1291 27320 FMV MEALS MEDICAL, TRANSPORT & DRUG 129 52062 SCHEDULE I, PAGE 1, PART I, LINE 2 MUNSON MEDICAL CENTER AWARDS MOST GRANTS BASED ON AN APPLICATION PROCESS FOR PRE-APPROVED SERVICES AND PURCHASES IN ACCORDANCE WITH PROTOCOLS ESTABLISHED WITH CASE MANAGERS WORKING FOR THE DEPARTMENTS WHICH APPLY FOR ASSISTANCE. THE ASSISTANCE CAN EITHER BE REQUESTED FOR THE DEPARTMENT OR ON BEHALF OF PATIENTS WHO INDICATE AN UNMET NEED THAT POSES A BARRIER TO THE RECEIPT OF HEALTH CARE SERVICES. CASE MANAGERS MONITOR THE USE OF THE FUNDS IN LINE WITH THE PROTOCOLS. MUNSON MEDICAL CENTER MAINTAINS RECORDS OF SUPPORT FOR EXPENSES USED FOR FUNDED REQUESTS. MUNSON MEDICAL CENTER MAY AWARD A GRANT OR CONTRIBUTION TO ANOTHER TAX- EXEMPT ORGANIZATION BASED ON A REQUEST FOR REIMBURSEMENT FOR PRE-APPROVED SERVICES OR PURCHASES. THE AWARD IS BASED ON AN EVALUATION OF THE USE OF THE FUNDS FOR THE PROMOTION OF HEALTH IN THE COMMUNITY. THE ONGOING RELATIONSHIP OF MUNSON MEDICAL CENTER WITH ITS PARTNERS IN THE COMMUNITY FOR THE PROMOTION OF HEALTH ALLOWS FOR THE MONITORING OF THE GRANT AWARD. X X X X true true false false false false false false false EDWIN A NESS DIRECTOR 675627 261450 3790 146937 24643 1112447 ALFRED PILONG CEO & PRESIDENT 467145 151661 19216 86215 20644 744881 WALTER NOBLE MD DIRECTOR 217189 16697 1023 5968 9131 250008 JILL E VOLLBRECHT MD DIRECTOR 214186 16730 19807 24083 274806 MARK A HEPLER CFO 336845 96246 58916 56740 25175 573922 10889 DAVID MCGREAHAM MD VP MEDICAL AFFAIRS 299888 66474 22769 37448 18481 445060 DERK PRONGER CHIEF OPERATING OFFI 243762 74532 19296 39648 20222 397460 JAMES FISCHER VP PATIENT CARE 105920 38624 139128 6355 12691 302718 THOMAS SCHERMERHORN MD NEUROSURGEON 937157 18555 12677 23345 991734 ANDREW LUEA PHYSICIAN 352757 54829 18246 12677 17897 456406 AHMET SEVIMLI MD NEPHROLOGIST 385907 19702 23154 24087 452850 JAMSHID AMANZADEH PHYSICIAN 347463 25000 1162 12182 9116 394923 YELENA KIER PHYSICIAN 357387 567 12677 20326 390957 SCHEDULE J, PAGE 1, PART I, LINE 4 EDWIN A. NESS 0 134,260 0 ALFRED PILONG 0 73,538 0 MARK A. HEPLER 0 36,529 0 DAVID MCGREAHAM, MD 0 19,455 0 DERK PRONGER 0 27,009 0 JAMES FISCHER 96,044 0 0 SCHEDULE J, PART III PART I, LINE 4A EXECUTIVE SEVERANCE PLAN: SUBJECT TO REVIEW AND APPROVAL BY THE BOARD COMPENSATION AND EXECUTIVE LEADERSHIP COMMITTEE, IN ORDER TO RECRUIT AND MAINTAIN QUALIFIED EXECUTIVES, A COMPETITIVE BENEFIT PACKAGE IS OFFERED TO THE PRESIDENT AND VICE-PRESIDENTS, WHICH INCLUDES A SEVERANCE PLAN. MUNSON HAS A SEVERANCE PLAN FOR THE PRESIDENT AND VICE-PRESIDENT/EXECUTIVE LEVEL POSITIONS, WHICH PROVIDES FOR THE PRESIDENT UP TO TWO YEARS OF PAY IN THE EVENT EMPLOYMENT ENDS UNDER CERTAIN CONDITIONS AND FOR VICE-PRESIDENTS, UP TO ONE-YEAR OF PAY IN THE EVENT EMPLOYMENT ENDS UNDER CERTAIN CONDITIONS. THE PLAN PROVIDES FOR A 50% OFFSET FOR SUBSEQUENT EMPLOYMENT DURING THE SEVERANCE PERIOD. MEDICAL BENEFITS ARE PROVIDED DURING THE SEVERANCE PERIOD. PART I, LINE 4B 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. FOR THE PRESIDENT, THE PLAN PROVIDES A TARGETED BENEFIT AT AGE 62. ANNUAL CONTRIBUTIONS, AT MUNSON'S DISCRETION, ARE MADE TO THE PLAN IN ORDER TO ACHIEVE THE TARGETED RETIREMENT BENEFIT LEVEL. VICE-PRESIDENTS ARE ELIGIBLE TO PARTICIPATE IN AN AMOUNT NOT TO EXCEED 6% OF BASE COMPENSATION, FUNDED ANNUALLY, AT THE SOLE DISCRETION OF MUNSON. THESE FUNDS ARE AVAILABLE TO VESTED PARTICIPANTS UPON SEPARATION OF EMPLOYMENT FROM MUNSON. A CNTY GRD TRAVSE HOSP FIN AUTH 2011 386004832 386523EE0 2011-08-10 128728067 REFUND PRIOR BONDS false false false B CNTY GRAD TRAV HOSP FIN AUTH 2014 A 386004832 386523EH3 2014-12-17 30370807 CANCER CENTER CONSTUCTION false false false A 128728067 1756787 126971281 true false true true B 30374573 370807 30003766 2016 false false false true A false true true false true false 0.00090 0.00090 false false true B false false false false false false true A false false false true true false false false true B false false true false false false false false true A true B true SCHEDULE K - DIFFERENCES IN ISSUE PRICE EXPLANATION CNTY GRAD TRAV HOSP FIN AUTH 2014 A INVESTMENT INCOME EARNED SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION CNTY GRD TRAVSE HOSP FIN AUTH 2011 THE SERIES 2011A, 2011B AND 2011C BONDS WERE ISSUED TO PURCHASE AND CANCEL TENDERED BONDS, TENDERED DURING A TENDER PROGRAM INITIATED BY MUNSON HEALTHCARE. THE TENDERED BONDS INCLUDED COUNTY OF GRAND TRAVERSE HOSPITAL AUTHORITY (MUNSON HEALTHCARE OBLIGATED GROUP) HOSPITAL REVENUE AND REFUNDING BONDS SERIES 1998A, ISSUED 9/1/98; REVENUE BONDS SERIES 2001A, ISSUED 1/9/01; REVENUE REFUNDING BONDS SERIES 2002A, ISSUED 9/17/02; REVENUE REFUNDING BONDS SERIES 2005A, ISSUED 11/3/05 AND REVENUE BONDS SERIES 2005B, ISSUED 11/3/05. SCHEDULE K - DATE REBATE COMPUTATION PERFORMED CNTY GRD TRAVSE HOSP FIN AUTH 2011 02/05/14 SCHEDULE K - ADDITIONAL INFORMATION CNTY GRAD TRAV HOSP FIN AUTH 2014 A 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. PART III, QUESTION 3B AND D MUNSON MEDICAL CENTER 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 2014, OUTSIDE COUNSEL WAS ENGAGED DURING THAT TAX YEAR. JEFF BERRY FAMILY OF TRUST 125767 RELATED FAMILY COMP false KRISTINE NAVIN FAMILY OF TRUST 16791 RELATED FAMILY COMP false FORM 990, PAGE 6, PART VI, LINE 6 MUNSON MEDICAL CENTER IS ORGANIZED ON A NONSTOCK MEMBERSHIP BASIS. THE SOLE MEMBER IS MUNSON HEALTHCARE, AN IRS SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. IN THE EVENT OF DISSOLUTION, MUNSON MEDICAL CENTER'S NET ASSETS WOULD BE DISTRIBUTED TO MUNSON HEALTHCARE. FORM 990, PAGE 6, PART VI, LINE 7A MUNSON HEALTHCARE, AS THE SOLE MEMBER, ELECTS THE TRUSTEES FOR ALL SUBSIDIARY ENTITIES, INCLUDING MUNSON MEDICAL CENTER. NOMINATIONS TO MUNSON HEALTHCARE FOR SUBSIDIARY TRUSTEES ARE CONSIDERED AND RECOMMENDED BY THE MUNSON HEALTHCARE GOVERNANCE COMMITTEE. FOUR TRUSTEES OF MUNSON MEDICAL CENTER ALSO ARE DIRECTORS OF MUNSON HEALTHCARE. FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN DECISIONS OF THE MUNSON MEDICAL CENTER (MMC) TRUSTEES ARE APPROVED BY THE MUNSON HEALTHCARE BOARD OF DIRECTORS INCLUDING: ADOPTION, AMENDMENT, RESTATEMENT OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS OF MMC; ADOPTION, EXECUTION, REVOCATION OR ABANDONMENT OF A PLAN OF DISSOLUTION, MERGER, CONSOLIDATION, OR REORGANIZATION INVOLVING MMC; SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF MMC; ACQUISITION OF OR THE ESTABLISHMENT OF ANY SUBSIDIARY OR AFFILIATE OF MMC; ADOPTION OF ALL OPERATING BUDGETS AND CAPITAL EXPENDITURE BUDGETS FOR MMC; INCURRENCE OF OPERATING OR CAPITAL EXPENDITURES BY MMC 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 MMC, WITH THE EXCEPTION OF EQUIPMENT LEASES AND PURCHASE MONEY SECURITY INTERESTS APPROVED AS PART OF MMC'S BUDGET; ADOPTION OR CHANGE IN THE MISSION STATEMENT, PURPOSES OR THE STRATEGIC GOALS OF MMC; CHANGING SUBSTANTIALLY THE SCOPE OF MMC'S CLINICAL SERVICES AND PROGRAMS OFFERED BY MMC; AND APPOINTMENT OR REMOVAL THE PRESIDENT OF MMC. FORM 990, PAGE 6, PART VI, LINE 11B THE MUNSON MEDICAL CENTER BOARD IS COMMITTED TO THE ACCURACY AND THOROUGHNESS OF THE FORM 990 REPORTING. MUNSON MEDICAL CENTER BELONGS TO THE MUNSON HEALTHCARE SYSTEM. MUNSON HEALTHCARE IS THE PARENT COMPANY IN THE MUNSON HEALTHCARE SYSTEM, WHICH UNDERGOES AN AUDIT BY AN EXTERNAL AUDIT FIRM. AT THE CORPORATE LEVEL, THE RESPONSIBLE INDIVIDUALS FROM THE FINANCE, ADMINISTRATION, PATIENT FINANCIAL SERVICES, LEGAL, HUMAN RESOURCES, PUBLIC RELATIONS, AND FUND DEVELOPMENT DEPARTMENTS PREPARE AND REVIEW PORTIONS OF THE FORM 990. THE COMPENSATION AND LEADERSHIP DEVELOPMENT COMMITTEE REVIEWS THE COMPENSATION INFORMATION CONTAINED IN THE CORE FORM AS WELL AS THE SCHEDULE J INFORMATION. THE CONFLICT, VALUATION AND COMPLIANCE COMMITTEE OVERSEES THE CONFLICT OF INTEREST DISCLOSURE PROCESS FOR BOARD MEMBERS AND KEY EMPLOYEES TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE AUDIT COMMITTEE OVERSEES THE FORM 990 PREPARATION PROCESS BY ENSURING PROPER CONTROLS, POLICIES, PEOPLE AND RESOURCES ARE IN PLACE TO PRODUCE AN ACCURATE RETURN. FORM 990, PAGE 6, PART VI, LINE 12C THE MUNSON HEALTHCARE BOARD OF DIRECTORS (THE SYSTEM PARENT ORGANIZATION) HAS A STANDING CONFLICT, VALUATION AND COMPLIANCE ("CVC") COMMITTEE. THE CVC COMMITTEE IS COMPOSED OF INDEPENDENT BOARD AND COMMUNITY MEMBERS. THE CVC COMMITTEE IS DELEGATED AUTHORITY BY THE BOARD TO REVIEW AND APPROVE THE REASONABLENESS/FAIR MARKET VALUE OF FINANCIAL TRANSACTIONS/ARRANGEMENTS WITH DISQUALIFIED PERSONS. ANNUALLY, EACH BOARD MEMBER OF MUNSON HEALTHCARE AND ALL OF ITS SUBSIDIARY/CONTROLLED ENTITIES AND ALL MUNSON EXECUTIVES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE/QUESTIONNAIRE. THE RESPONSES TO THE DISCLOSURE/QUESTIONNAIRE ARE REVIEWED BY THE MUNSON LEGAL DEPARTMENT. ANY FINANCIAL ARRANGEMENTS/POTENTIAL CONFLICTS IDENTIFIED THROUGH THE DISCLOSURE/QUESTIONNAIRES ARE PRESENTED TO THE CVC COMMITTEE FOR ITS REVIEW AND DETERMINATION AS TO THE REASONABLENESS/FAIR MARKET VALUE. WHEN AN ACTION ITEM IS CONSIDERED BY A BOARD WHICH INVOLVES A POTENTIAL CONFLICT BY A BOARD MEMBER, THE CONFLICT IS DISCLOSED AND A BOARD MEMBER WILL ABSTAIN FROM A VOTE ON THE ACTION ITEM, AND, IN ADDITION, THE BOARD CHAIR HAS THE DISCRETION/AUTHORITY TO REQUEST THAT THE CONFLICTED BOARD MEMBER BE EXCUSED FROM THE MEETING FOR AN OPPORTUNITY FOR THE BOARD TO DISCUSS THE MATTER WITHOUT THE PRESENCE OF THE CONFLICTED BOARD MEMBER. FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS FOR DETERMINING APPROPRIATE LEVELS OF PAY FOR EXECUTIVE POSITIONS WITHIN MUNSON HEALTHCARE IS CAREFULLY AND THOUGHTFULLY DIRECTED BY THE BOARD OF DIRECTORS, THROUGH THE COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE. THE COMMITTEE UTILIZES "BEST PRACTICES" METHODS OF DETERMINING COMPENSATION AND, AS SUCH, IS COMPOSED OF SEVEN MEMBERS WHOSE VOTING MEMBERS ARE INDEPENDENT. THE COMMITTEE IS CHARGED WITH ENSURING THAT EXECUTIVE COMPENSATION IS DESIGNED TO ATTRACT AND RETAIN HIGH QUALITY, PROFESSIONAL LEADERSHIP WHILE MAINTAINING STRONG STEWARDSHIP FOR THE ORGANIZATION. ANNUALLY, THE COMMITTEE RETAINS A NATIONAL INDEPENDENT CONSULTANT TO ENSURE THAT MUNSON HEALTHCARE'S COMPENSATION PRACTICES AND LEVELS ARE INDEPENDENTLY REVIEWED WHILE BEING COMPETITIVE AND REASONABLE. THE MUNSON HEALTHCARE CONFLICT, VALUATION AND COMPLIANCE ("CVC") COMMITTEE ALSO REVIEWS THE SURVEY INFORMATION TO EVALUATE THE REASONABLENESS OF EXECUTIVE COMPENSATION. THAT ANALYSIS OCCURS EACH NOVEMBER. COMPENSATION LEVELS REFLECT THE SCOPE OF EACH EXECUTIVE'S RESPONSIBILITIES, EDUCATIONAL BACKGROUND, EXPERIENCE, AND INDUSTRY STANDING AS WELL AS INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. ANNUAL COMPENSATION FOR MUNSON EXECUTIVES IS DETERMINED IN PART BY MEASURABLE PROGRESS TOWARD THE ORGANIZATION'S GOALS INCLUDING CONTINUED IMPROVEMENT IN CLINICAL QUALITY, COMMUNITY HEALTH, AND OPERATIONAL EFFICIENCIES. MUNSON HEALTHCARE'S INTENT FOR EXECUTIVE BASE COMPENSATION IS TO BE AT THE MEDIAN WHEN COMPARED TO LIKE-SIZE NON-PROFIT HOSPITALS AND HEALTHCARE SYSTEMS. FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION OF OTHER KEY EMPLOYEES IS CONSISTENT WITH THAT OF THE TOP EXECUTIVES FOR MUNSON MEDICAL CENTER. FORM 990, PAGE 6, PART VI, LINE 19 THE MUNSON MEDICAL CENTER ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON THE MICHIGAN DEPARTMENT OF TREASURY WEBSITE. MUNSON MEDICAL CENTER 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. ADDITIONALLY, MUNSON MEDICAL CENTER PREPARES AND DISTRIBUTES AN ANNUAL REPORT TO THE COMMUNITY, WHICH CONTAINS FINANCIAL AS WELL AS PROGRAM DATA. FORM 990, PART IX, LINE 11G PURCHASED SERVICES 35,249,035 43,943,179 1,364,590 PROFESSIONAL FEES 33,915,097 197,916 0 TOTAL 69,164,132 44,141,095 1,364,590 FORM 990, PART XI, LINE 9 INVEST IN MUNSON HEALTHCARE FOUNDATION CONTRIBUTIO 7,193,442 PENSION AND POST RETIREMENT CHANGES 45,678,257 SWAP MARKET VALUE CHANGE 1,723,339 TEMPORARILY RESTRICTED ACTIVITY -2,617,851 TRANSFERS TO AFFILIATES -34,891,004 TOTAL 17,086,183 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 HEALTHCARE CADILLAC 1105 SIXTH ST TRAVERSE CITY MI 49684 471156297 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE GRAYLING 1105 SIXTH ST TRAVERSE CITY MI 49684 471161992 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE CADILLAC FOUNDATI FOUNDATION 1105 SIXTH ST TRAVERSE CITY MI 49684 472857600 RAISE FUND MI C3 7 MHC CADILL MUNSON HEALTHCARE CADILLAC true MUNSON HEALTHCARE CHARLEVOIX HOSPIT 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 381459366 HOSPITAL MI C3 3 MUNSON HC true MUNSON HEALTHCARE CHARLEVOIX HOSPITAL FOUNDATION 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 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 MUNSON MED MUNSON MEDICAL CENTER RELATED 484345 3983664 false true 0.84000 NORTHERN MICHIGAN SUPPLY ALLIANCE 2651 AERO PARK DR TRAVERSE CITY MI 49686 383453378 PURCHASING MI N/A false false MEDICAL OFFICE CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 201902620 REAL ESTAT MI N/A true SIXTH STREET DRUGS PO BOX 1188 TRAVERSE CITY MI 496851188 382298290 PHARMACY MI N/A true MUNSON SUPPORT SERVICES PO BOX 1188 TRAVERSE CITY MI 496851188 382872821 LAUNDRY MI N/A true MUNSON SERVICES INC PO BOX 1188 TRAVERSE CITY MI 496851188 383144382 PHARMACY MI N/A true MEDICAL OFFICE BUILDING CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 383567278 REAL ESTAT MI N/A true 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 true true true false true true true true true MUNSON DIALYSIS CENTER O 87327 ACTUAL AMOUNT PAID MUNSON DIALYSIS CENTER Q 3722853 ACTUAL AMOUNT PAID MUNSON HEALTHCARE B 34881820 ACTUAL AMOUNT PAID MUNSON HEALTHCARE L 596255 ACTUAL AMOUNT PAID MUNSON HEALTHCARE M 44588146 ACTUAL AMOUNT PAID MUNSON HEALTHCARE O 354458 ACTUAL AMOUNT PAID MUNSON HEALTHCARE P 151865562 ACTUAL AMOUNT PAID MUNSON HEALTHCARE Q 153591729 ACTUAL AMOUNT PAID MUNSON DIALYSIS CENTER P 1374120 ACTUAL AMOUNT PAID MUNSON HEALTHCARE S 272653 ACTUAL AMOUNT PAID MUNSON HEALTHCARE R 425821 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CADILLAC M 123150 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CADILLAC O 110739 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CADILLAC P 941922 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CADILLAC L 900225 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CADILLAC Q 27940060 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CADILLAC R 182693 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING M 83704 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING P 417128 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING L 821349 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING O 77901 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING Q 27363020 ACTUAL AMOUNT PAID MUNSON HEALTHCARE GRAYLING R 136000 ACTUAL AMOUNT PAID MUNSON HEALTHCARE FOUNDATIONS Q 669321 ACTUAL AMOUNT PAID MUNSON HEALTHCARE FOUNDATIONS C 3404481 ACTUAL AMOUNT PAID MUNSON HEALTHCARE FOUNDATIONS P 169663 ACTUAL AMOUNT PAID MUNSON HOME CARE J 169320 LEASE CONTRACT AMOUNT MUNSON HOME CARE Q 13581741 ACTUAL AMOUNT PAID MUNSON HOME CARE P 57839 ACTUAL AMOUNT PAID MUNSON HOME SERVICES Q 3040360 ACTUAL AMOUNT PAID MUNSON MEDICAL BUILDING PARTNERS Q 92325 ACTUAL AMOUNT PAID MUNSON MEDICAL GROUP M 1913309 ACTUAL AMOUNT PAID MUNSON MEDICAL GROUP O 5674197 ACTUAL AMOUNT PAID MUNSON MEDICAL GROUP Q 17062112 ACTUAL AMOUNT PAID MUNSON MEDICAL GROUP P 169313 ACTUAL AMOUNT PAID MUNSON SERVICES INC J 72048 LEASE CONTRACT AMOUNT MUNSON SERVICES INC Q 10728122 ACTUAL AMOUNT PAID MUNSON SERVICES INC P 1198203 ACTUAL AMOUNT PAID MUNSON SERVICES INC L 105652 ACTUAL AMOUNT PAID MUNSON SUPPORT SERVICES Q 1565002 ACTUAL AMOUNT PAID MUNSON SUPPORT SERVICES M 1809937 ACTUAL AMOUNT PAID MUNSON SUPPORT SERVICES R 178379 ACTUAL AMOUNT PAID NORTH FLIGHT INC P 107943 ACTUAL AMOUNT PAID NORTH FLIGHT INC Q 5176900 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE J 227400 LEASE CONTRACT AMOUNT NORTHERN MICHIGAN SUPPLY ALLIANCE L 496719 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE O 479544 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE M 7750676 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE Q 5733273 ACTUAL AMOUNT PAID NORTHERN MICHIGAN SUPPLY ALLIANCE S 30936861 ACTUAL AMOUNT PAID PAUL OLIVER MEMORIAL HOSPITAL P 421178 ACTUAL AMOUNT PAID PAUL OLIVER MEMORIAL HOSPITAL L 164379 ACTUAL AMOUNT PAID PAUL OLIVER MEMORIAL HOSPITAL O 73693 ACTUAL AMOUNT PAID PAUL OLIVER MEMORIAL HOSPITAL Q 6888669 ACTUAL AMOUNT PAID SIXTH STREET DRUGS Q 606392 ACTUAL AMOUNT PAID SIXTH STREET DRUGS P 242189 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CHARLEVOIX HOSPIT L 167484 ACTUAL AMOUNT PAID MUNSON HEALTHCARE CHARLEVOIX HOSPIT Q 237776 ACTUAL AMOUNT PAID MUNSON HEALTHCARE MANISTEE HOSPITAL P 67415 ACTUAL AMOUNT PAID SCHEDULE R MUNSON MEDICAL CENTER 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.