2017-11-13T07:53:29-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 600 E Front St Ste 300 Traverse City MI 49686 990 2016-01-01 381303843 OTSEGO MEMORIAL HOSPITAL ASSOCIATION OTSE 9897312100 825 N CENTER GAYLORD MI 49735 THOMAS LEMON CEO 9897312100 2017-11-07 1 CAROL LALONDE CPA P00181637 2319477800 2017-11-07 67.59.56.32 2017-11-07 12:56:55 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 EBB51160BF2136090E0706D858221EDFD566B897 2016 2017-02-10 21:41:12Z OTSEGO MEMORIAL HOSPITAL THOMAS LEMON CEO 825 N CENTER GAYLORD MI 49735 105302277 0 X WWW.MYOMH.ORG X 1946 MI TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS AND THE COMMUNITIES WE SERVE BY: WORKING IN PARTNERSHIP WITH AREA PHYSICIANS TO PROVIDE PATIENT-FOCUSED CARE WITH QUALITY AND SERVICE SECOND TO NONE; DELIVERING A FULL CONTINUUM OF ACCESSIBLE CARE THAT ADDRESSES THE COMMUNITIES NEEDS; WORKING TO INCREASE THE PUBLIC'S AWARENESS OF THE BREADTH AND DEPTH OF OTSEGO MEMORIAL HOSPITAL'S SERVICES; MEETING THE PROFESSIONAL NEEDS OF OUR DEDICATED STAFF BY PROVIDING THEM WITH OPPORTUNITIES FOR PROFESSIONAL GROWTH AND EDUCATIONAL DEVELOPMENT; AND REMAINING FISCALLY SOUND. 10 9 857 120 0 0 160212 571473 90870515 97810021 129774 478049 362712 419976 91523213 99279519 0 0 0 0 54520053 58317495 0 0 954353 33061704 34931049 87581757 93248544 3941456 6030975 65008048 70739661 30293266 29382126 34714782 41357535 X TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS, AND THE COMMUNITIES WE SERVE. 0 0 46097458 67888609 ACUTE INPATIENT AND OUTPATIENT CARE FOR DIAGNOSTIC AND MEDICAL CARE: THERE WERE 83,614 ADMISSIONS FOR MEDICAL SURGICAL (1,371), ICU (327), BIRTHING CENTER (398), AND OUTPATIENT REGISTRATIONS (81,518). 25321847 26292162 PHYSICIAN DIAGNOSTIC OFFICES AND URGENT CARE CLINIC: THERE WERE 167,784 PATIENTS FOR MEDICAL GROUP (84,210), LEWISTON/MONTMORENCY (13,288), URGENT CARE (18,523), INDIAN RIVER (25,604), ORTHOPEDICS (16,396) AND BOYNE VALLEY (7,763). 3057421 3458345 LONG TERM CARE FOR THE ELDERLY: THIS PAST YEAR THERE WERE 118 ADMISSIONS WITH 11,025 MCREYNOLDS HALL PATIENT DAYS. 2868915 170905 ALL OTHER PROGRAM SERVICES. 2868915 170905 77345641 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 29 0 1 857 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X AMY BILYEA CONTROLLER 9897312100 825 N CENTER AVE GAYLORD MI 49735 DR BECKY ASHLEY DIRECTOR 0.20 0.00 X 0 0 0 DAVID BRINEY DIRECTOR 0.20 0.50 X 0 0 0 CHRISTOPHER COLLINS DIRECTOR-VICE PRESIDENT 0.20 0.00 X X 0 0 0 KEVIN REYNOLDS DIRECTOR 0.20 0.00 X 0 0 0 MARY SANDERS DIRECTORS-PRESIDENT 0.20 0.50 X X 0 0 0 DR STEVEN SELLA DIRECTOR 0.20 0.50 X 0 0 0 DONALD SKLARCZYK DIRECTOR-SECRETARY 0.20 0.00 X X 0 0 0 DANIEL SMITH DIRECTOR-TREASURER 0.20 0.00 X X 0 0 0 DR KEVIN SMITH DIRECTOR-CHIEF OF STAFF 40.00 0.00 X 342015 0 5300 MARCUS WEGMEYER DIRECTOR-TREASURER 0.20 0.00 X X 0 0 0 CAROLYN STUDY DIRECTOR-SECRETARY PARTIAL YEAR 0.20 0.50 X X 0 0 0 THOMAS LEMON PRESIDENT & CEO 39.50 0.50 X 392750 0 23300 ROBERT COURTOIS VP OF FINANCE / CFO 39.50 0.50 X 230650 0 23300 DIANE FISHER VP OF PATIENT CARE SERVICES 40.00 0.00 X 189987 0 3204 BARBARA MILLER VP OF PHYSICIAN SERVICES 40.00 0.00 X 192674 0 5300 CHRISTOPHER SQUIRE VP OF PROFESSIONAL & ANCILLARY SERVI 40.00 0.00 X 164187 0 3317 JAMES FLICKEMAA VP OF MARKET DEVELOPMENT 40.00 0.00 X 160903 0 5300 DR JOHN MOFFATT GENERAL SURGEON 40.00 0.00 X 932121 0 5300 DR CHANGXIN LI INTERNAL MEDICINE PHYSICIAN 40.00 0.00 X 903250 0 5300 DR MATTHEW MAZUR INTERNAL MEDICINE PHYSICIAN 40.00 0.00 X 619331 0 22809 DR LOUIS HABRYL ORTHOPEDIC SURGEON 40.00 0.00 X 558272 0 5300 DR JAMES SHURLOW GENERAL SURGEON 40.00 0.00 X 528876 0 23300 5215016 0 131030 70 0 1 0 BURDCO 1222 VETERANS TRAVERSE CITY MI 49684 CONSTRUCTION 1305988 GE MEDICAL SYSTEMS INFO TECH 5517 COLLECTIONS CENTER DR CHICAGO IL 60693 MED EQUIP SERVICES 698228 MUNSON MEDICAL PO BOX 1188 TRAVERSE CITY MI 49684 SERVICES 572884 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 DIAGNOSTIC SERVICE 476569 GREENWAY HEALTH PO BOX 203658 DALLAS TX 75320 SOFTWARE SERVICES 472287 24 3517 448771 9377 109808 571473 PATIENT SERVICE REVENUE 622110 96055066 96055066 OTHER RELATED REVENUE 622110 1214699 1214699 EHR REVENUE 622110 540256 540256 97810021 500796 500796 191054 38970 152084 152084 152084 4455706 1505335 4266017 1717771 189689 -212436 -22747 -22747 CAFETERIA REVENUE 722210 267892 267892 267892 99279519 97810021 0 898025 1361342 738480 622862 44604750 38404323 5941213 259214 1377248 1173936 195535 7777 8122971 6959874 1116934 46163 2851184 2430286 404798 16100 259154 259154 174501 174501 4751 4751 107002 107002 5293158 3227932 1712045 353181 77903 13232 64671 718606 355883 311488 51235 275077 136166 135725 3186 1799789 582990 1216799 158408 97204 56070 5134 131444 73374 52392 5678 526362 393525 131385 1452 2903799 2170970 724817 8012 873572 139368 734204 SUPPLIES 14310576 14103940 204488 2148 PROVISION FOR BAD DEBT 2771295 2771295 REPAIRS AND MAINTENANCE 2004977 1398155 593406 13416 QUALITY ASSESSMENT FEES 1631848 1631848 908827 556092 235749 116986 93248544 77345641 14948550 954353 1633310 2390635 37935 1281424 6231822 6929334 1339443 1376738 2836927 3295815 65123216 31408140 32165863 33715076 15584507 16756845 2803241 1931661 2375000 3062133 65008048 70739661 9857772 10566456 185506 185508 17192875 16686413 3057113 1943749 30293266 29382126 X 34685605 41052403 29177 305132 34714782 41357535 65008048 70739661 6030975 611778 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4751 4751 0 Part II-B, Line 1: SUPPORTED LOBBYING ACTIVITIES THROUGH ANNUAL DUES PAID TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION. 0 1455291 1455291 39880985 17567411 22313574 1015366 311728 703638 22328707 13529001 8799706 442867 442867 33715076 COST REPORT SETTLEMENT PAYABLE 1943749 1943749 1 1 X 1 X 1 X 1 1 0 1 1 1 1286 262182 262182 0.00290 1 34091 16058812 12129905 3928907 0.04340 2 35377 16320994 12129905 4191089 0.04630 1105 55453 392894 7248 385646 0.00430 6 165784 19503161 18939136 564025 0.00620 18 105 25687 25687 0.00030 1129 221342 19921742 18946384 975358 0.01080 1131 256719 36242736 31076289 5166447 0.05710 1 5000 5000 0.00010 4 484 484 0.00000 119 100 45401 45401 0.00050 1 51 51 0.00000 10 395889 395889 0.00440 135 100 446825 446825 0.00500 1 2771296 914528 22083632 20582120 1501512 X 1 1 1 1 OTSEGO MEMORIAL HOSPITAL ASSOCIATION 825 N CENTER AVE GAYLORD MI 49735 WWW.MYOMH.ORG 1060000063 X X X long-term care FACILITY AND PHYSICIAN CLINICS OTSEGO MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE PAGE 8, PART V X 1 16 1 http://www.myomh.org/community-needs-assessment 0 1 X 100.000000000000 350.000000000000 X X X X X 1 1 X X X 1 X https://www.myomh.org/patient-visitor-guide/payment-financing/financial-ass X https://www.myomh.org/patient-visitor-guide/payment-financing/financial-ass X https://www.myomh.org/patient-visitor-guide/payment-financing/financial-ass X X X X X 1 X 0 X X X 1 X 0 0 OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 5: IN CONDUCTING THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, OTSEGO MEMORIAL HOSPITAL, IN CONJUNCTION WITH ITS PARTNERING HOSPITALS, CONDUCTED A DAYLONG SESSION WITH HEALTH PROFESSIONALS AND SECTOR REPRESENTATIVES IN LATE DECEMBER 2015. ADDITIONALLY, MORE THAN 1,200 INDIVIDUALS PARTICPATED IN SURVEYS AND/OR FOCUS GROUPS THROUGHOUT NORTHERN MICHIGAN IN 2015 FOR THE REGIONAL COMMUNITY HEALTH ASSESSMENT. ABOUT 1,100 RESIDENTS COMPLETED A "WHAT MATTERS TO YOU" SURVEY, INCLUDING 445 RESIDENTS FROM ANTRIM, CHEOYGAN, OTSEGO AND MONTMORENCY COUNTIES. MORE THAN 122 PHYSCIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS COMPLETED A "HEALTH CARE PROVIDER" SURVEY. ADDITIONALLY, EXTRA EFFORT WAS MADE TO REACH LOW-INCOME RESIDENTS, MINORITIES, AND THE UNINSURED. THE COMMUNITY MEETINGS WERE HELD MOSTLY AT HEALTH DEPARTMENT OFFICES AND MARKETED THROUGH EXISTING SOCIAL SERVICE ORGANIZATIONS WORKING WITH THOSE POPULATIONS. A COMBINED TOTAL OF 74 PARTICIPANTS TOOK PART IN THE FOUR COMMUNITY CONVERSATIONS HELD IN CHEBOYGAN, MONTMORENCY, ANTRIM, AND OTSEGO COUNTIES. IN ADDITION TO THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, CHARLEVOIX AREA HOSPITAL, AND MCLAREN NORTHERN MICHIGAN HOSPITAL, ALL PARTNERED WITH OTSEGO MEMORIAL HOSPITAL IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT COMMITTEE INCLUDED REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: OTSEGO COUNTY MSU EXTENSION, ALCONA HEALTH CENTER, HEALTH DEPT OF NW MICHIGAN, OTSEGO MEMORIAL HOSPITAL, COP EDUCATION SERVICE DISTRICT, CHARLEVOIX AREA HOSPITAL, NORTH COUNTY CMH SERVICES, MCLAREN NORTHERN MICHIGAN, THUNDER BAY COMMUNITY HEALTH SERVICE, WOMEN'S RESOURCE CENTER, HARBOR HALL, NE MICHIGAN CMH AUTHORITY, CHAR-EM UNITED WAY, EAST JORDAN FAMILY HEALTH CENTER, DISTRICT HEALTH DEPT #4, NORTHERN HEALTH PLAN, MUNSON MEDICAL CENTER, NORTHERN MICHIGAN REGIONAL ENTITY, ALPENA REGIONAL MEDICAL CENTER, MSU COLLEGE OF HUMAN MEDICINE, AND NORTHERN MICHIGAN SUBSTANCE ABUSE SERVICES.ADDITIONAL INFORMATION CAN BE FOUND IN THE COMMUNITY HEALTH NEEDS ASSESSMENT LOCATED AT THE FOLLOWING WEBSITE: HTTP://WWW.MYOMH.ORG/COMMUNITY-NEEDS-ASSESSMENT. OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 6a: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING OTHER HOSPITAL FACILITIES - CHARLEVOIX AREA HOSPITAL AND MCLAREN NORTHERN MICHIGAN. OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 6b: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING OTHER NON-HOSPITAL ORGANIZATIONS - HEALTH DEPARTMENT OF NORTH WEST MICHIGAN, AND DISTRICT HEALTH DEPARTMENT #4. OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 11: FROM THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, THE TOP THREE AREAS OF HEALTH CONCERN IDENTIFIED ARE: EXPANDING ACCESS TO CARE, CHRONIC DISEASE EDUCATION AND MANAGEMENT, AND MATERNAL AND CHILD HEALTH AND WELLNESS ACTIVITIES. FOR ALL THREE AREAS OTSEGO MEMORIAL HOSPITAL BELIEVES THEY COULD DIRECT RESOURCES TO HELP ADDRESS THE GROWING HEALTH CONCERN. REGARDING ACCESS TO CARE, OTSEGO MEMORIAL HOSPITAL IS WORKING TO EXPAND SERVICES IN RURAL COMMUNITIES, OFFER ONSITE SCREENINGS AND EXPANDING OFFERINGS FOR SERVICES AT LOCAL HEALTH FAIRS, AND SIGNING INDIVIDUALS UP FOR INSURANCE BY EMPLOYING A CERTIFIED APPLICATION COUNSELOR. FOR CHRONIC DISEASE, OTSEGO MEMORIAL HOSPITAL IS COMMITTED TO OFFERING AND EXPANDING A CDC DIABETES PREVENTION PROGRAM, DOUBLING THE NUMBER OF CLASSES OFFERED. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO EDUCATE THE COMMUNITY ON IMPORTANT CHRONIC DISEASE TOPICS SUCH AS CANCER, HEART HEALTH, AND DIABETES THROUGH PRINT AND SPEAKING EVENTS. FOR MATERNAL AND CHILD HEALTH, OTSEGO MEMORIAL HOSPITAL IS EXPANDING OFFERINGS IN THE LOCAL SCHOOLS, INCLUDING A 6 WEEK HEALTH PROGRAM FOR ELEMENTARY STUDENTS. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO OFFER CLASSES TO NEW PARENTS, WILL EXPLORE OFFERING A HEALTH LIFESTYLES CLASS FOR FAMILIES--WORKING TO REDUCE OBESITY AND INCREASE HEALTH EATING AND ACTIVITY LEVELS FOR YOUTH IN THE COUNTIES SERVED BY OTSEGO MEMORIAL HOSPITAL. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO OFFER OB/GYN SERVICES IN INDIAN RIVER, AND WILL WORK TO EDUCATE COMMUNITY MEMBERS ON SERVICES OFFERED FOR MOTHER AND CHILD IN THIS VERY RURAL SETTING. OTHER NEEDS IDENTIFIED IN THE MOST RECENT CHNA INCLUDE: SUBSTANCE USE, MENTAL HEALTH AND HEALTH DISPARITIES. THESE ISSUES RANKED 4-6 IN THE CHNA. OTSEGO MEMORIAL HOSPITAL FEELS THAT BASED ON AVAILBLE RESOURCES AND EXPERTISE OF STAFF, THE TOP THREE ISSUES CAN BE BEST ADDRESSED BY THE HOSPITAL. 7 1 - OMH MEDICAL GROUP GAYLORD 829 N CENTER AVENUE GAYLORD MI 49735 OUTPATIENT CLINIC 2 - MEDCARE CLINIC 1996 WALDEN DRIVE GAYLORD MI 49735 WALK-IN AND OUTPATIENT CLINIC 3 - NORTHOPEDICS CLINIC 2147 PROFESSIONAL DRIVE GAYLORD MI 49735 OUTPATIENT CLINIC 4 - MCREYNOLDS HALL 825 N CENTER AVENUE GAYLORD MI 49735 LONG-TERM CARE 5 - LEWISTON CLINIC 3040 BOURN STREET LEWISTON MI 49756 WALK-IN AND OUTPATIENT CLINIC 6 - INDIAN RIVER CLINIC 3696 SOUTH STRAITS HWY INDIAN RIVER MI 49749 WALK-IN AND OUTPATIENT CLINIC 7 - BOYNE VALLEY CLINIC 2572 NORTH US-131 ELMIRA MI 49730 WALK-IN AND OUTPATIENT CLINIC Part I, Line 3c: UNDER ITS ASSISTANCE PROGRAM, OTSEGO MEMORIAL HOSPITAL WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED OR REDUCED PRICE SERVICES TO PERSONS ELIGIBLE UNDER APPLICABLE GUIDELINES. OTSEGO MEMORIAL HOSPITAL'S ASSISTANCE PROGRAM SERVICES ARE NOT LIMITED TO ANY SPECIFIC HOSPITAL SERVICE. INDIVIDUAL ELIGIBILITY FOR ASSISTANCE IS DETERMINED BY MEASURING FAMILY INCOME IN RELATION TO FAMILY SIZE AGAINST THE INCOME POVERTY GUIDELINE ESTABLISHED BY THE COMMUNITY SERVICE ADMINISTRATION. IF THE HOSPITAL DETERMINES THAT SERVICES ARE NOT MEDICALLY NECESSARY, ELECTIVE OR OTHERWISE, THE HOSPITAL CAN DENY SERVICES UNDER THE FINANCIAL ASSISTANCE PROGRAM. ASSETS INCLUDING THE PATIENT'S PLACE OF RESIDENCE ARE ALSO CONSIDERED AS PART OF THE EVALUATION. Part I, Line 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E), HEALTH PROFESSIONS EDUCATION (LINE 7F), SUBSIDIZED HEALTH SERVICES (LINE 7G) AND CASH AND IN-KIND CONTRIBUTIONS (LINE 7I). Part I, Line 7g: ALL PHYSICIAN CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES. THE COST REPORTED ON PAGE 1, LINE 7G OF $19,503,161 IS FOR THESE PHYSICIAN CLINICS. Part I, Ln 7 Col(f): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $2,771,296. Part II, Community Building Activities: OTSEGO MEMORIAL HOSPITAL IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. OTSEGO MEMORIAL HOSPITAL STAFF REPRESENT OTSEGO MEMORIAL HOSPITAL ON A VARIETY OF COMMITTEES AND COMMUNITY BOARDS IN WHICH OTSEGO MEMORIAL HOSPITAL OFFERS ASSISTANCE THROUGH STAFF, FACILITIES, AND RESOURCES WITH THE END GOAL OF WORKING TO ADDRESS COMMUNITY ISSUES RELATED TO HEALTH IMPROVEMENT, EDUCATION, POVERTY, WORKFORCE DEVELOPMENT AND ACCESS TO CARE. WE ALSO ENCOURAGE OUR EMPLOYEES TO SERVE IN THE COMMUNITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. AND, WE WORK WITH NEIGHBORHOOD PROGRAMS, INCLUDING PUBLIC AND PRIVATE LOCAL SCHOOLS, OTSEGO COUNTY COMMISSION ON AGING, WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. Part III, Line 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. Part III, Line 8: THE FOLLOWING COSTING METHOD OF COST TO CHARGE RATE IS USED; MEDICARE COSTS DIVIDED BY MEDICARE CHARGES. ANY SHORTFALLS CALCULATED ARE CONSIDERED TO BE COMMUNITY BENEFIT. Part III, Line 9b: ALL PATIENTS RECEIVING TREATMENT AT OTSEGO MEMORIAL HOSPITAL (INCLUDING CHARITY CARE PATIENTS) ARE RESPONSIBLE FOR PAYING IN FULL ALL CHARGES FOR SUCH TREATMENT, LESS ANY AMOUNTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, DISCOUNT CONSIDERATIONS OR INSURANCE COVERAGE, PER POINT OF SERVICE COLLECTION POLICY. Part VI, Line 2: OTSEGO MEMORIAL HOSPITAL CONDUCTED AN EXTENSIVE AND COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSEMENT THROUGHOUT 2015 AND COMPLETED A COMMUNITY HEALTH IMPROVEMENT ACTION PLAN WHICH WAS ADOPTED BY THE HOSPITAL BOARD OF DIRECTORS IN APRIL 2016. THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED MULTIPLE COMMUNITY FOCUS GROUPS, ONLINE SURVEYS, AND A PRIORITIZATION MEETING AIMED TO IDENTIFY THE TOP HEALTH CONCERNS FOR THE COMMUNITIES BEING SERVED BY OTSEGO MEMORIAL HOPSITAL. IN ADDITION, OTSEGO MEMORIAL HOSPITAL USES INPUT FROM PHYSICIANS, MEDICAL PROVIDERS, AND COMMUNITY MEMBERS TO ASSIST IN ITS ASSESSMENT AND PRIORITIZATION OF THE COMMUNITIES' HEALTHCARE NEEDS. OTSEGO MEMORIAL HOSPITAL WORKS IN COLLABORATION WITH VARIOUS COMMUNITY GROUPS INCLUDING BUT NOT LIMITED TO: THE HEALTH DEPARTMENT, NORTHERN HEALTH PLAN, UNITED WAY, OTSEGO COUNTY COMMISSION ON AGING, OTSEGO AREA CHAMBER OF COMMERCE, AND OTHER LOCAL ASSOCIATIONS IN ORDER TO CONTINUE TO UNDERSTAND THE LOCAL HEALTHCARE NEEDS OF OUR SERVICE AREA. Part VI, Line 3: THE OTSEGO MEMORIAL HOSPITAL REGISTRATION MANAGER OR THE CERTIFIED APPLICATION COUNSELOR (CAC) ATTEMPTS TO SEE THE PATIENTS IN EMERGENCY ROOM OR AT REGISTRATION. REGISTRATION STAFF HAVE ALSO BEEN TRAINED TO HAND OUT ASSISTANCE PACKAGES AND TO DIRECT PATIENTS TO SEE THE CERTIFIED APPLICATION COUNSELOR (CAC) OR FINANCIAL ADVISOR. WHEN THE PATIENT COMES IN ON THE WORK LIST THEY ARE ALSO INFORMED OF THE ASSISTANCE PACKAGE AND/OR APPLICATION. THE FORM IS ALSO ON THE OTSEGO MEMORIAL HOSPITAL WEBSITE. THERE ARE ALSO WRITTEN NOTICES AT THE BOTTOM OF THE PATIENT STATEMENTS. WHEN THERE IS A SCHEDULED PROCEDURE AND THE PATIENT DOES NOT HAVE INSURANCE, A CALL IS MADE FOR PAYMENT, CAC APPOINTMENT, OR CHARITY CARE ARRANGEMENTS. PATIENTS IDENTIFIED WITHOUT INSURANCE OR NEEDING FINANCIAL EDUCATION, ARE SCHEDULED FOR AN APPOINTMENT WITH THE CERTIFIED APPLICATION COUNSELOR (CAC). THE CAC HELPS PATIENTS TO APPLY FOR MEDICAID, INSURANCE EXCHANGE PLANS, OTHER PROGRAMS OR FINANCIAL ASSISTANCE. Part VI, Line 4: Otsego Memorial Hospital is located in Gaylord, MI and serves the counties of Cheboygan, Otsego, and Montmorency. All three counties served by OMH are extremely rural. In Otsego, Cheboygan, Montmorency, and Antrim Counties, 95% of residents are non-Hispanic white. Hispanics represent the second largest minority group in Otsego (1.5%) and Montmorency (1.2%) Counties while Native Americans represent the second largest minority group in Cheboygan County with 3.1%. The Hispanic population represents the third largest minority group of all three counties with 1.5% in Otsego and 1.2% in Cheboygan and Montmorency Counties respectively. At 18.9%, older adults represent a larger proportion of the population in Otsego county than they do statewide (15%), 23.9% percent of Cheboygan County's population is age 65 and older followed closely by Antrim County with 24.7% and in Montmorency County, seniors represent an even larger share at 29.2%. (Source: countyhealthrankings.org). OMH serves a very rural aging population. Part VI, Line 5: Otsego Memorial Hospital (OMH) offers a variety of programs and services with the end goal of promoting the greater health of the community. OMH provided discounted sports physicals to area student athletes, donating one hundred percent of the proceeds back to the local school athletic departments. The hospital participates in a variety of local health events, including offering free health screenings to participants; screenings included blood pressure, pulmonary, BMI, height and weight. Additionally, the hospital offered discounted full lipid profile screenings to more than 500 participants at a Senior Expo. OMH hosts monthly Wellness Wednesdays, offering cholesterol, blood pressure, BMI, height, weight at a discounted rate to community members and free to anyone who is unable to pay the nominal rate. The hospital offers a mammography assistance program, to ensure that women who do not qualify for a free mammogram through the local health department, yet have no means to pay for it privately, are covered and receive a screening and if necessary diagnostic mammogram and other services at no charge. Additionally, the hospital offers a Diabetes Assistance Program and an Oncology Assistance Program designed to help those diagnosed with those diseases and struggling financially to received the assistance they need to attend treatments and test regularly for diabetes. In 2014 OMH began offering the CDC's year long Diabetes Prevention Program, working with individuals who have been diagnosed as pre diabetic to reduce calorie intake, increase exercise, and understand portion control among others. This program has seen a high success rate of completion and BMI reduction. Currently the program is working toward being the only recognized program in northern Michigan. OMH also works closely with the local schools to assist the high school level Medical Occupational Program in job shadowing and education program for students throughout the facility and school year. New parents are invited to participate in childbirth education classes offered by OMH staff for a nominal fee or free to those unable to pay. On a quarterly basis the hospital produces and distributes to more than 44,000 households throughout the service area literature on various healthcare issues and topics, including information on local free health events. OMH has numerous medical practices that are federally qualified rural healthcare clinics, as well as OMH is located within a health professional shortage area. Both of these qualifications demonstrate OMH's isolated service area which has resulted in challenging physician recruitment and retention. OMH's commitment to providing the highest level of care starts with physician and other providers. Extensive recruitment activities must take place in order to provide care to these health professional shortage areas. Additionally, OMH is working diligently to bring services into the rural setting. This includes opening the newly built OMH Medical Group-Indian River, which not only expanded testing services, but brought full time OB/GYN and Pediatric services to that rural area (note: this clinic is a federally qualified rural health center) (1). A majority of the hospital's board of trustees is made up of community representatives residing within the hospital's service area. (2). The organization extends medical staff privileges to all qualified physicians as approved by our hospital board of directors. Due to the size and rural nature of the hospital service area, not all healthcare specialties are offered through the hospital. (3). The hospital applies surplus funds, including donations from the foundation, to assist in purchasing equipment for patient use and funding many of the community health education programs listed above. Additionally, the hospital works to use any surplus funds to continue to advance the mission of the organization through growth and development opportunities. Part VI, Line 6: Otsego Memorial Hospital has an affiliation agreement with Munson Medical Center where they cooperate in providing health care services to the community. Included in the affiliation agreement are various purchased services such as: information technology, laundry, physician recruitment assistance, reimbursement support, management development, mobile imaging, etc. Also included in the affiliation agreement are collaboration on various initiatives, such as: ICD-10 implementation, HIPAA Compliance, Reimbursement modeling strategic planning, CEO and other forums, education, consulting, etc. OMH works with Munson Medical Center to offer cardiology and sleep lab services in Otsego County. Part VI, Line 7, Reports Filed With States MI X X X 0 0 0 0 0 0 0 0 0 DR KEVIN SMITH DIRECTOR-CHIEF OF STAFF 335637 0 0 0 6378 0 0 0 5300 0 347315 0 0 0 THOMAS LEMON PRESIDENT & CEO 368681 0 0 0 24069 0 18000 0 5300 0 416050 0 0 0 ROBERT COURTOIS VP OF FINANCE / CFO 206581 0 0 0 24069 0 18000 0 5300 0 253950 0 0 0 DIANE FISHER VP OF PATIENT CARE SERVICES 165918 0 0 0 24069 0 0 0 3204 0 193191 0 0 0 BARBARA MILLER VP OF PHYSICIAN SERVICES 176837 0 0 0 15837 0 0 0 5300 0 197974 0 0 0 CHRISTOPHER SQUIRE VP OF PROFESSIONAL & ANCILLARY SERVI 154317 0 0 0 9870 0 0 0 3317 0 167504 0 0 0 JAMES FLICKEMAA VP OF MARKET DEVELOPMENT 152796 0 0 0 8107 0 0 0 5300 0 166203 0 0 0 DR JOHN MOFFATT GENERAL SURGEON 908052 0 0 0 24069 0 0 0 5300 0 937421 0 0 0 DR CHANGXIN LI INTERNAL MEDICINE PHYSICIAN 879250 0 0 0 24000 0 0 0 5300 0 908550 0 0 0 DR MATTHEW MAZUR INTERNAL MEDICINE PHYSICIAN 601262 0 0 0 18069 0 17509 0 5300 0 642140 0 0 0 DR LOUIS HABRYL ORTHOPEDIC SURGEON 536310 0 0 0 21962 0 0 0 5300 0 563572 0 0 0 DR JAMES SHURLOW GENERAL SURGEON 510807 0 0 0 18069 0 18000 0 5300 0 552176 0 0 0 A COUNTY OF OTSEGO HOSPITAL FINANCE 386004882 689065AA8 2013-10-31 10000000 REFINANCE 0 0 0 B CITY OF GAYLORD HOSPITAL 383635769 368175AA8 2013-10-31 6095324 REFINANCE 0 0 0 C CITY OF GAYLORD HOSPITAL 383635769 368175AB1 2013-10-31 1885925 REFINANCE 0 0 0 A 10000000 10000000 9795755 200000 4245 2013 0 1 1 1 B 6095324 6095324 6095324 2013 0 1 1 1 C 1764677 1885925 1721661 164264 2013 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Form 990, Part VI, Section A, line 6 THE ORGANIZATION HAS APPROXIMATELY 151 GENERAL MEMBERS. ANNUAL DUES ARE $5 PER INDIVIDUAL OR $8 PER FAMILY. REQUIREMENTS TO BE A MEMBER ARE A MINIMUM OF EIGHTEEN YEARS OF AGE AND HAS A RESIDENCE IN THE AREA THAT THE HOSPITAL SERVES. EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. Form 990, Part VI, Section A, line 7a EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. Form 990, Part VI, Section A, line 7b EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. Form 990, Part VI, Section B, line 11b THE 990 IS REVIEWED BEFORE FILING BY THE FOLLOWING INDIVIDUALS: 1. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER, THOMAS LEMON; 2. THE HOSPITAL'S VP OF FINANCE, ROBERT COURTOIS; AND 3. THE HOSPITAL'S CONTROLLER, AMY BILYEA. THE 990 IS ALSO PRESENTED TO THE ENTIRE HOSPITAL BOARD BEFORE FILING. DURING THIS MEETING MEMBERS HAVE A CHANCE TO ASK QUESTIONS REGARDING THE FORM 990. Form 990, Part VI, Section B, line 12c THE HOSPITAL'S POLICY REGARDING "CONFLICT OF INTEREST" REQUIRES EACH BOARD MEMBER AND OFFICER TO COMPLETE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES TO DEMONSTRATE CORPORATE COMPLIANCE. THESE FORMS ARE REVIEWED AND ANY CONFLICTS ARE INVESTIGATED BY MANAGEMENT. POTENTIAL CONFLICTS AND RESTRICTIONS ARE DETERMINED AND THEN VOTED UPON, PER POLICY GUIDELINES. IN THE EVENT THAT AN OFFICER OR BOARD MEMBER HAS A CONFLICT OF INTEREST, THAT BOARD MEMBER MUST GIVE WRITTEN NOTICE OF SUCH AN INTEREST OR RELATIONSHIP TO THE BOARD OF DIRECTORS, AND SHALL THEREAFTER REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE DECISION. Form 990, Part VI, Section B, line 15a THE BOARD'S PERSONNEL SUB-COMMITTEE, WHICH CONSISTS OF FOUR MEMBERS, ANNUALLY REVIEWS THE COMPENSATION OF THE CEO ONLY. THEY UTILIZE MHA SALARY SURVEY DATA, AS WELL AS A MARKET ANALYSIS PERFORMED BY BOTH HOSPITAL'S HUMAN RESOURCES DEPARTMENT AND MUNSON'S HR DEPARTMENT. THE HUMAN RESOURCES MARKET ANALYSIS INCLUDES THREE SOURCES FOR DATA: INTEGRATED HEALTHCARE STRATEGIES, MERCER AND SULLIVAN COTTER, WITH REGRESSION POINT USING $70M IN NET REVENUES AND AN AVERAGE BASED ON HOSPITALS WITHIN A SIMILAR RANGE OF NET REVENUES. EACH OF THE THREE SOURCES USE NATIONAL DATA AND ARE BASED ON A FREE-STANDING HOSPITAL CEO POSITION. THE CEO DETERMINES THE STARTING COMPENSATION FOR THE VICE PRESIDENTS BASED ON MARKET DATA AND ANNUAL INCREASES OCCUR BASED ON PAY-FOR-PERFORMANCE SYSTEMS. THESE PROCESSES WERE LAST UNDERTAKEN IN 2016. Form 990, Part VI, Section C, line 19 THE OTSEGO MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY , AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY CONTACTING THE HOSPITAL AT 825 N. CENTER GAYLORD MI 49735 OR BY PHONE 989-731-2100. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OTSEGO MEMORIAL HOSPITAL FOUNDATION 825 N CENTER STREET GAYLORD MI 49735 382135473 FUNDRAISING MI 501(c)(3) Line 12a, I OTSEGO MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 OTSEGO MEMORIAL HOSPITAL FOUNDATION C 448771 CASH OTSEGO MEMORIAL HOSPITAL FOUNDATION L 276898 ACTUAL COST ALLOCATION