2013-05-14T09:27:23-05:00 2012-06-30 990 2011-07-01 381415623 PAUL OLIVER MEMORIAL HOSPITAL PAUL 2313529621 224 PARK AVE FRANKFORT MI 496359658 MARK A HEPLER 2313529621 2013-05-13 2011 2016-02-24 21:20:13Z JAMES D AUSTIN 224 PARK AVE FRANKFORT MI 49635 17804173 false X WWW.MUNSONHEALTHCARE.ORG X 1944 MI PAUL OLIVER MEMORIAL HOSPITAL DELIVERS QUALITY HEALTHCARE FOR THE PEOPLE OF THE BENZIE REGION TO IMPROVE THE HEALTH OF THE COMMUNITY IN PARTNERSHIP WITH MUNSON HEALTHCARE. PAUL OLIVER MEMORIAL HOSPITAL'S EXEMPT PURPOSE IS TO OPERATE A HOSPITAL, LONG-TERM CARE FACILITY AND OTHER ANCILLARY FACILITIES TO PROMOTE AND IMPROVE THE HEALTH OF THE RESIDENTS OF THE BENZIE, MICHIGAN AREA. PAUL OLIVER MEMORIAL HOSPITAL IS PART OF THE MUNSON HEALTHCARE SYSTEM. THROUGH ITS HOSPITALS AND OTHER AFFILIATES, THE SYSTEM DELIVERS A BROAD ARRAY OF HEALTH CARE SERVICES TO 24 COUNTIES IN MICHIGAN'S NORTHERN LOWER PENINSULA AND THE EASTERN PORTION OF THE UPPER PENINSULA. CONSISTENT WITH ITS MISSION, THE MUNSON HEALTHCARE SYSTEM PROVIDED 39.9 MILLION IN CHARITY CARE AND OTHER COMMUNITY BENEFITS, INCLUDING BAD DEBT AND THE SYSTEM MEDICARE FUNDS SHORTFALL FOR RESIDENTS OF NORTHERN MICHIGAN IN THE 2011 TAX YEAR. 12 8 195 58 0 27515 64605 15775190 17486866 169951 137683 78952 76678 16051608 17765832 0 0 6538166 6561317 0 55189 8274372 9439776 14812538 16001093 1239070 1764739 15742268 21165084 1800732 3279288 13941536 17885796 X PAUL OLIVER MEMORIAL HOSPITAL DELIVERS QUALITY HEALTHCARE FOR THE PEOPLE OF THE BENZIE REGION TO IMPROVE THE HEALTH OF THE COMMUNITY IN PARTNERSHIP WITH MUNSON HEALTHCARE. PAUL OLIVER MEMORIAL HOSPITAL'S EXEMPT PURPOSE IS TO OPERATE A HOSPITAL, LONG-TERM CARE FACILITY AND OTHER ANCILLARY FACILITIES TO PROMOTE AND IMPROVE THE HEALTH OF THE RESIDENTS OF THE BENZIE, MICHIGAN AREA. PAUL OLIVER MEMORIAL HOSPITAL IS PART OF THE MUNSON HEALTHCARE SYSTEM. THROUGH ITS HOSPITALS AND OTHER AFFILIATES, THE SYSTEM DELIVERS A BROAD ARRAY OF HEALTH CARE SERVICES TO 24 COUNTIES IN MICHIGAN'S NORTHERN LOWER PENINSULA AND THE EASTERN PORTION OF THE UPPER PENINSULA. CONSISTENT WITH ITS MISSION, THE MUNSON HEALTHCARE SYSTEM PROVIDED 39.9 MILLION IN CHARITY CARE AND OTHER COMMUNITY BENEFITS, INCLUDING BAD DEBT AND THE SYSTEM MEDICARE FUNDS SHORTFALL FOR RESIDENTS OF NORTHERN MICHIGAN IN THE 2011 TAX YEAR. false false 14423546 17344856 PROVIDING HOSPITAL AND LONG-TERM CARE SERVICES TO THE RESIDENTS OF THE BENZIE, MICHIGAN REGION. 14423546 true false false true false false false false false true true true false false true false false true false false false false false false true false true true false false true false false false false false false false true false false false false false true true true true false true 39 0 195 true false false false false false true false false false false false X 12 8 false false false false true true true true true false false true true true true true true true true false X MUNSON HEALTHCARE 2319357777 4230 COPPER RIDGE DR TRAVERSE CITY MI 49684 X PAUL M SHIRILLA 2.00 X 0 293209 47142 JAMES D AUSTIN 16.00 X X 0 256356 40601 GERARD MAHONEY DO 2.00 X 8200 0 0 GEORGE RYCKMAN DO 2.00 X 2650 0 0 BRENDA SUE WEBBER 2.00 X 0 0 0 CHARLES TULL 2.00 X 0 0 0 DAVID MICINSKI 2.00 X 0 0 0 HON PAUL J CLULO 2.00 X X 0 0 0 IRENE A NUGENT 2.00 X X 0 0 0 JOETTA RILEY PARRIS 2.00 X X 0 0 0 PAUL PATTERSON 2.00 X 0 0 0 BETSY EVANS 2.00 X 0 0 0 MARK A HEPLER 1.00 X 0 322835 48469 10850 872400 136212 false true false SPENCE BROTHERS 417 MCCORSKRY ST SAGINAW MI 48605 CONSTRUCTION 1311164 CRYSTAL LAKE EMERGE 6227 FRANKFORT HWY BENZONIA MI 496169654 EMERGENCY SERVI 810891 SODEXO INC AND AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 FOOD SERVICE 140682 MICHIGAN NEUROLOGY ASSOCIATES 1500 WEST PARK DR STE 390 WESTBOROUGH MA 01581 MRI SERVICES 131975 40530 22075 2000 64605 MEDICARE AND MEDICAID PMTS 621990 9192677 9192677 PATIENT SERVICE REVENUE 621990 7946337 7946337 COMMUNITY FITNESS CENTER 713940 187540 187540 IN HOUSE CHILD CARE 624410 160312 160312 17486866 70324 70324 4058 4058 4058 4058 76644 9285 76644 -9285 67359 67359 55900 40530 29056 26844 CAFETERIA SALES 722210 22723 22723 MISCELLANEOUS 621990 18302 18302 AUXILIARY GIFT SHOP 446199 4751 4751 45776 17765832 17344856 329527 4889193 4628320 260873 451836 427708 24128 863767 817642 46125 356521 337483 19038 30000 30000 4255441 3654102 547784 53555 38291 16502 21649 140 505031 443426 60602 1003 158363 146862 11501 621897 621897 100504 65118 35220 166 985 985 978279 881821 96458 93964 69260 24704 MEDICAL SUPPLIES 1350880 1350880 BAD DEBT 876617 876617 LICENSES AND TAXES 315498 14712 300786 MISCELLANEOUS 61156 36330 24501 325 52870 33881 18989 16001093 14423546 1522358 55189 1050 1050 2436679 4711939 2169618 2643673 146603 117397 19799618 13577861 5529354 6221757 3211077 3285702 2042406 3862347 205481 321219 15742268 21165084 1262817 1011201 537915 2268087 1800732 3279288 X 11899130 14023449 2042406 3862347 13941536 17885796 15742268 21165084 X 1764739 2179521 X false true true X false X false false false false false false false false false false false false true 1537 1537 false false false false false SCHEDULE C, PART II-B, LINE 1 OTHER GRASSROOTS LOBBYING INCLUDES THE PORTION OF DUES ALLOCATED TO LOBBYING. false false false false false false false 5253482 1819941 91515 16889 7148049 4052095 757959 458819 15390 5253483 3736794 260254 288192 224769 8376 4052095 4099630 332714 -535126 149924 10500 3736794 0.45970 0.54030 false true true 193750 193750 12520672 8502950 4017722 120618 22616 98002 6851877 4952599 1899278 112701 99696 13005 6221757 INVEST IN PAUL OLIVER MEM FOUNDATION 3862347 F 3862347 ESTIMATED THIRD PARTY PAYMENTS 1998509 CAREPAYMENT LIABILITY 269578 2268087 INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 THE FUNDS ARE INTENDED FOR THE OPERATIONS AND CAPITAL NEEDS OF THE PAUL OLIVER MEMORIAL HOSPITAL. A SIGNIFICANT PORTION OF THE TEMPORARILY RESTRICTED FUNDS ARE FOR THE CAPITAL NEEDS OF THE HOSPITAL. MI GOLF BENEFIT 23363 9175 14188 7347 APPRECIATION DA 20495 7743 12752 2482 4 50772 23612 27160 17237 94630 40530 54100 27066 27066 27034 true true true X true X true true false true true 170241 170241 0.01130 4136895 3252968 883927 0.05840 71196 21569 49627 0.00330 4378332 3274537 1103795 0.07300 117693 403 117290 0.00780 7084 7084 0.00050 32140 32140 0.00210 156917 403 156514 0.01040 4535249 3274940 1260309 0.08340 286 286 3349 3349 0.00020 35143 35143 0.00220 250 250 1877 1877 0.00010 1415 1415 0.00010 42320 42320 0.00260 true 439053 66034 4920253 4920253 X true true 1 1 PAUL OLIVER MEMORIAL HOSPITAL

224 PARK AVE FRANKFORT MI 49635

X X X X PAUL OLIVER MEMORIAL HOSPITAL 1 true true 200.0 true 400.0 true X X X X true true X X true false true X false false 5 PAUL OLIVER MEMORIAL HOSPITAL SNF

224 PARK AVE FRANKFORT MI 49635

LONG TERM CARE PHYSICAL THERAPY

9975 W OTTAWA AVE EMPIRE MI 49630

PHYSICAL THERAPY FITNESS CENTER

102 AIRPORT RD FRANKFORT MI 49635

PHYSICAL THERAPY, CARDIAC REHAB AND EDU PHYSICAL THERAPY

6227 FRANKFORT HIGHWAY BENZONIA MI 49616

PHYSICAL THERAPY PHYSICAL THERAPY

1975 STIRLING DR INTERLOCHEN MI 49643

PHYSICAL THERAPY OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE PART I LINE 3C 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 50 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 INCLUDES EARNINGS UNEMPLOYMENT COMPENSATION WORKERS 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 ANDOR CASH VALUE OF LIFE INSURANCE RELATED ORGANIZATION INFORMATION PART I LINE 6A MUNSON MEDICAL CENTER BROTHER CORPORATION SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G THERE ARE NO PHYSICIAN CLINICS IN SUBSIDIZED HEALTH SERVICES EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F TOTAL EXPENSES FROM FORM 990 PART IX LINE 25 ARE 16001093 THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS 876617 THE NET EXPENSE OF 15124476 WAS USED FOR PURPOSES OF CALCULATING LINE 7 COLUMN F COSTING METHODOLOGY EXPLANATION PART I LINE 7 COST VALUES FOR LINE 7 ARE BASED ON THE COST TO CHARGE RATIO COMPUTATION COMMUNITY BUILDING ACTIVITIES PART II POMH PROVIDED 42320 TO COMMUNITYBUILDING ACTIVITIES DURING THE 2012 FISCAL YEAR WHILE WE BELIEVE THESE ACTIVITIES PROMOTE COMMUNITY HEALTH BY SUPPORTING THE UNDERLYING CAUSES OF COMMUNITY HEALTH THESE ACTIVITIES ARE NOT INCLUDED ELSEWHERE ON THE SCHEDULE H THESE ACTIVITIES INCLUDE ADMINISTRATIVE AND CASH SUPPORT FOR COALITION BUILDING ACTIVITIES IN BENZIE COUNTY MEETING THE BASIC NEEDS OF PEOPLE IN POVERTY ON A LOCAL LEVEL BY MULTIPLE COLLABORATIVE ACTIVITIES PARTICIPATION IN THE BENZIE COUNTY CHAMBER OF COMMERCE TO PROMOTE WORKFORCE DEVELOPMENT AND SEVERAL ENVIRONMENTAL IMPROVEMENTS RELATED TO COMMUNITY GARDENING AND HEALTHY SCHOOL LUNCHES ALSO BECAUSE BENZIE COUNTY IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA POMH INVESTS DOLLARS INTO THE RECRUITMENT OF CRITICALLY NEEDED PHYSICIANS TO THE AREA TO PROMOTE PATIENT ACCESS TO CARE BAD DEBT EXPENSE EXPLANATION PART III LINE 4 TO DETERMINE THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS WHO WOULD PROBABLY QUALIFY UNDER MUNSON MEDICAL CENTERS CHARITY CARE POLICY MUNSON DIRECTED AN INTERNAL STUDY FROM A 3MONTH SAMPLE OF CURRENT BAD DEBT ACCOUNTS FIRST THE STUDY IDENTIFIED THE SELFPAY PORTION OF THE BAD DEBT EXPENSE THEN THE SELFPAY ACCOUNTS WERE ANALYZED USING REVENUE CYCLE ANALYTIC SOFTWARE TO IDENTIFY POTENTIAL CHARITY CARE CANDIDATES USING THE SOFTWARE ESTIMATIONS A PORTION OF THE SELFPAY ACCOUNTS WERE DEEMED CHARITY CARE ELIGIBLE THAT ESTIMATED PORTION WAS APPLIED TO THE SELFPAY BAD DEBT DOLLAR AMOUNT TO DETERMINE THE AMOUNT OF BAD DEBT THAT WOULD BE CONSIDERED CHARITY IF THE PROPER APPLICATIONS AND DOCUMENTATION WERE AVAILABLE FROM THE PATIENTS THE ACCOUNTS RECEIVABLE FOOTNOTE TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF MUNSON HEALTHCARE AND SUBSIDIARIES STATES THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENTS ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITION IN ITS SERVICE AREA TRENDS IN HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS THROUGHOUT THE YEAR MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITEOFF 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 THE ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PASTDUE PATIENT BALANCES WITH COLLECTION AGENCIES COLLECTION PRACTICES EXPLANATION PART III LINE 9B MUNSON HEALTHCARES INTERNAL AND EXTERNAL COLLECTION PRACTICES INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NONPAYMENT INCLUDING COLLECTIONS ACTIONS AND REPORTING TO COLLECTION AGENCIES SHALL TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY A PATIENTS GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM MUNSON HEALTHCARE AND A PATIENTS GOOD FAITH EFFORT TO COMPLY WITH HISHER PAYMENT AGREEMENTS WITH MUNSON HEALTHCARE FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS MUNSON HEALTHCARE 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 NEEDS ASSESSMENT PART VI THE MUNSON HEALTHCARE BOARD OF DIRECTORS MAINTAINS A STANDING COMMUNITY HEALTH COMMITTEE TO SERVE THE MUNSON SYSTEM BY REVIEWING INFORMATION ON COMMUNITY HEALTH NEEDS PRIORITIZING PROGRAMS AND SERVICES TO BE FUNDED REVIEWING PERFORMANCE INFORMATION REGARDING THE IMPACT AND COST EFFECTIVENESS OF PROGRAMS TARGETED TO IMPROVE THE HEALTH OF THE COMMUNITY IN GENERAL OR A TARGETED POPULATION INCLUDING THE UNDERSERVED AND UNDERINSURED AND TAKING RESPONSIBILITY FOR COMMUNICATING INTERNALLY AND EXTERNALLY THE SIGNIFICANCE OF MUNSON HEALTHCARES COMMUNITY BENEFIT PROGRAMS AND EXPENDITURES THIS COMMITTEE IS SUPPORTED BY A COMMUNITY HEALTH DEPARTMENT OF MUNSON MEDICAL CENTER BROTHER CORPORATION PAUL OLIVER MEMORIAL HOSPITAL POMH A MEMBER OF THE MUNSON HEALTHCARE SYSTEM IS A CONTRIBUTOR TO REGIONAL EFFORTS THAT ASSESS THE HEALTH STATUS OF THE TOTAL POPULATION WITHIN MUNSON HEALTHCARES 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 COMMUNITYWIDE PAUL OLIVER MEMORIAL HOSPITAL POMH IN CONJUNCTION WITH MUNSON HEALTHCARE PARENT AND SOLE MEMBER IS PREPARING A COMMUNITY NEEDS ASSESSMENT TO MEET THE REQUIREMENTS OF IRC SEC 501R WHICH WILL BE CONDUCTED IN FISCAL 2013 IN ACCORDANCE WITH THE PLANS OF THE COMMUNITY HEALTH COMMITTEE OF THE BOARD POMH ALSO WILL COMPLETE AN IMPLEMENTATION PLAN IN FISCAL 2013 POMH REGULARLY SEEKS INFORMATION FROM AND PARTICIPATES IN THE BENZIE COUNTY COLLABORATIVE THE LOCAL UNITED WAY AND OTHER REGIONAL ASSOCIATIONS TO MAINTAIN CURRENT UNDERSTANDING OF COMMUNITY HEALTH NEEDS POMH IN CONJUNCTION WITH MUNSON HEALTHCARE SEEKS TO COLLABORATE WITH REGIONAL PARTNERS ASSESSING FOR EXISTING PROGRAMS AND STRATEGIES THAT ARE ALREADY WORKING WELL AND THEN PARTNERING NOT REINVENTING IF A NEW PROGRAMMING NEED IS IDENTIFIED POMH SEEKS TO POOL ASSETS WITH THE MULTICOUNTY HEALTH DEPARTMENTS OTHER NONPROFITS AND LOCAL GOVERNMENTAL SERVICES FOR THE MOST EFFECTIVE USAGE OF RESOURCES ADDITIONALLY MUNSON HEALTHCARE WORKS IN CONJUNCTION WITH EFFORTS BY THE FIVECOUNTY COLLABORATIVES OF ANTRIM BENZIE GRAND TRAVERSE LEELANAU AND KALKASKA COUNTIES THE TRAVERSE CITY CHAMBER OF COMMERCE THE LOCAL UNITED WAY AND OTHER REGIONAL ASSOCIATIONS TO MAINTAIN CURRENT UNDERSTANDING OF COMMUNITY NEED PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI 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 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 REFERRAL BY REGISTRATION STAFF AT THE TIME OF REGISTRATION SELFPAY PATIENTS OR ANY PATIENT THAT MAY HAVE CONCERNS REGARDING THEIR UPCOMING ADMISSION IS REFERRED TO THE FINANCIAL COUNSELING STAFF PAUL OLIVER MEMORIAL HOSPITAL FINANCIAL COUNSELORS ARE AVAILABLE TO TALK WITH PATIENTS ABOUT THEIR FINANCIAL CONCERNS IF THE PATIENT WOULD LIKE HELP THE COUNSELORS GATHER INCOME INFORMATION AND SCREEN THE PATIENT FOR MEDICAID 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 AVAILABLE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO MEDICAID AND ALL OF ITS SUBSETS SOCIAL SECURITY DISABILITY TRAVERSE HEALTH CLINIC CHARITY CARE CATASTROPHIC CARE COVERAGE AND CAREPAYMENT COMMUNITY INFORMATION PART VI PAUL OLIVER MEMORIAL HOSPITAL POMH IS LOCATED IN FRANKFORT MICHIGAN ONE OF SEVEN HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM POMH OFFERS QUALITY PERSONALIZED CARE FOR PRIMARY AND URGENT MEDICAL NEEDS DUE TO ITS RURAL GEOGRAPHIC LOCATION POMH IS DESIGNATED AS A MICHIGAN CRITICAL ACCESS HOSPITAL LABORATORY RADIOLOGY AND REHABILITATION SERVICES AT POMH ARE NETWORKED WITH MUNSON MEDICAL CENTER MMC BROTHER ORGANIZATION ENSURING PROMPT AND CONVENIENT DIAGNOSIS AND TREATMENT POMH HAS 8 ACUTE CARE BEDS AS WELL AS A 39BED EXTENDED CARE UNIT WHERE RESIDENTS ENJOY A SAFE WARM AND COMFORTABLE HOMELIKE SETTING FOUNDED ON PRINCIPLES OF QUALITY AND PERSONAL CARE BECAUSE THE CARE CENTER IS HOSPITALBASED PHYSICIANS AND EMERGENCY MEDICAL CARE ARE AVAILABLE 24 HOURS A DAY HOSPITAL SERVICES POMH PROVIDES 24HOUR EMERGENCY CARE ACUTE CARE LONGTERM CARE OUTPATIENT SURGICAL SERVICES AND RESPITE CARE MMC SPECIALISTS REGULARLY HOLD CLINICS AT POMH MAKING IT EASY TO RECEIVE SPECIALIZED CARE POPULATION SERVED BY PAUL OLIVER MEMORIAL HOSPITAL IN THE POMH MAIN SERVICE AREA OF BENZIE COUNTY 195 OF THE POPULATION IS 65 YEARS OR OLDER THE CENSUS BUREAU CURRENT POPULATION ESTIMATES 2009 UNEMPLOYMENT IS 11 OR HIGHER 23 OF ADULTS AGED 1864 YEARS OF AGE LACK HEALTH INSURANCE PREVALENCE ESTIMATES FOR BENZIE COUNTY 20062010 MICHIGAN BRFS 103 LIVE BELOW THE FEDERAL POVERTY LEVEL THE CENSUS BUREAU SMALL AREA INCOME POVERTY ESTIMATES 2009 QUALITY PAUL OLIVER MEMORIAL HOSPITAL HAS RECEIVED THE FOLLOWING AWARDS 2009 2010 AND 2011 SUMMIT AWARD FOR EMERGENCY CARE FROM PRESS GANEY ASSOCIATES INC POMH ALSO WON A SUMMIT AWARD IN 2011 FOR ITS OUTPATIENT CARE THE SUMMIT AWARD WAS PRESENTED FOR RANKING IN THE TOP 5 PERCENT IN THE NATION FOR PATIENT SATISFACTION FOR 12 CONSECUTIVE QUARTERS IN 2011 PAUL OLIVER MEMORIAL HOSPITAL WAS THE ONLY HOSPITAL IN MICHIGAN TO RECEIVE TWO SUMMIT AWARDS FROM PRESS GANEY THE 2009 2010 AND 2011 MICHIGAN RURAL HEALTH QUALITY IMPROVEMENT AWARD OF EXCELLENCE FOR ITS COMMITMENT TO QUALITY CARE AND EVIDENCEBASED MEDICINE IN THE AREA OF EMERGENCY ROOM TRANSFERS 2010 AND 2011 MICHIGAN RURAL HEALTH QUALITY IMPROVEMENT EXCELLENCE FOR ITS COMMITMENT TO OUTPATIENT CARE THE GOVERNORS AWARD OF EXCELLENCE FOR IMPROVING PATIENT SAFETY AND QUALITY OF CARE IN THE CRITICAL ACCESS SETTING THE AWARD HONORS MICHIGAN HOSPITALS THAT PERFORM QUALITY INITIATIVES AIMED AT IMPROVING PATIENT CARE THE HOSPITAL HAS REPEATEDLY RECEIVED THIS AWARD HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI THE POMH BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS THE MAJORITY OF WHOM RESIDE IN THE HOSPITALS 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 POMH UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA A DESCRIPTION OF SEVERAL SIGNIFICANT PROGRAMS INITIATED BY THE HOSPITAL FOLLOWS HEALTHY FUTURES A PARTNERSHIP OF AREA HEALTH CARE PROVIDERS HEALTH DEPARTMENTS AND MUNSON HEALTHCARE MUNSON HEALTHCARE SYSTEM PARENT AND SOLE MEMBER CREATED TO IMPROVE THE HEALTH OF PREGNANT WOMEN AND CHILDREN UNDER AGE TWO THE HEALTHY FUTURES MODEL OF RN CARE COORDINATION CONSISTS OF AN OUTCOMESBASED APPROACH TO INTERVENTION IN THE AREAS OF BREASTFEEDING LONGEVITY ACCESS TO HEALTH CARE AND IMMUNIZATIONS BECAUSE OF THE RURAL NATURE OF THE COMMUNITY TRAVEL TIME TO THE NEAREST MATERNAL CHILD HEALTHCARE SPECIALIST MAY BE GREATER THAN 30 MINUTES COST AND AVAILABILITY OF TRANSPORTATION CAN BE A DIFFICULT BARRIER TO ACCESS HEALTHCARE FOR YOUNG FAMILIES POMH PARTNERS WITH MUNSON MEDICAL CENTER TO BRING MATERNAL CHILD HEALTHCARE SPECIALISTS TO PAUL OLIVER MAKING IT EASY AND CONVINENT TO RECEIVE THE SPECIALIZED CARE NEEDED TRANSPORTATION AS PART OF MUNSON HEALTHCARE POMH SUBSIDIZES FUNDING FOR COUNTY TRANSPORTATION AUTHORITIES 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 BETSIE HOSICK HEALTH AND FITNESS CENTER THE BETSIE HOSICK HEALTH AND FITNESS CENTER IS OPEN TO PEOPLE OF ALL AGES ABILITIES AND FITNESS LEVELS TO ACHIEVE BETTER HEALTH THE FITNESS CENTER OFFERS A FULL RANGE OF FITNESS EQUIPMENT AND CLASSES MEDICALLY CREDENTIALED FITNESS PROFESSIONALS ARE ON STAFF TO ASSIST MEMBERS THROUGH THE BETSIE HOSICK HEALTH AND FITNESS CENTER SENIOR MOVEMENT AND BALANCE CLASSES ARE HELD AT SENIOR SITES AROUND THE COUNTY FREE OF CHARGE TO PROMOTE WELLNESS PAUL OLIVER HOLDS NUTRITIONAL EDUCATION CLASSES FOR COMMUNITY MEMBERS AT THE HOSPITAL CAREGIVER LIBRARY A LIBRARY INCLUDING COMPUTERS TO ASSIST THE PUBLIC TO OBTAIN HEALTHCARE INFORMATION SUPPORT GROUPS AND ASSISTANT ACTIVITIES FOR CHRONIC DISEASES SUCH AS ALZHEIMERS DISEASE PARKINSONS AND CANCER SCREENING SERVICES SUCH AS BLOOD PRESSURE CHECKS MAMMOGRAMS AND LABORATORY TESTS TO THOSE IN NEED NORTHERN MICHIGAN DIABETES INITIATIVE NMDI 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 COLLABORATION WITH THE TRAVERSE HEALTH CLINIC THE TRAVERSE HEALTH CLINIC THC PROVIDES ACCESS TO AFFORDABLE HEALTH SERVICES THROUGH COMMUNITY COLLABORATION TO PEOPLE IN NEED IN BENZIE LEELANAU AND GRAND TRAVERSE COUNTIES THC SERVES AS A PRIMARY CARE PROVIDER FOR THOSE ADULTS WITH MEDICAID AND RUNS THE COALITION HEALTH ACCESS PROGRAM CHAP FOR THOSE ADULTS WITH NO INSURANCE WHO QUALIFY INCOME 200 OF FPG POMH DONATES LABS XRAYS AND OTHER SERVICES TO THC PATIENTS LIVING IN THEIR RURAL SERVICE AREA AFFILIATED HEALTH CARE INFORMATION PART VI PAUL OLIVER MEMORIAL HOSPITAL IS A MEMBER OF THE MUNSON HEALTHCARE SYSTEM A COMMUNITYOWNED HEALTH SYSTEM THAT INCLUDES SEVEN ACUTE CARE HOSPITALS AS WELL AS NUMEROUS OUTPATIENT SERVICES AND CLINICS ALL THE HOSPITALS IN THE SYSTEM ARE AFFILIATED WITH EACH OTHER AND SERVE AS THE ONLY HOSPITALS IN THEIR RESPECTIVE COMMUNITIES EACH OF THE AFFILIATED HOSPITALS HAS INDIVIDUAL INITIATIVES ANDOR PROMOTION ACTIVITIES AS WELL AS SHARED INITIATIVES PAUL OLIVERS SOLE CORPORATE MEMBER IS MUNSON HEALTHCARE A 501C3 CORPORATION AFFILIATES OTHER THAN THE HOSPITALS INCLUDE TWO FOUNDATIONS HOME HEALTH ORGANIZATIONS MOBILE IMAGING COMPANIES AND AN EMERGENCY TRANSPORTATION ORGANIZATION ALL 501C ENTITIES IN ADDITION TO DIRECTING COMMUNITY BENEFIT ACTIVITIES OF THE SYSTEM MUNSON HEALTHCARE COORDINATES COMMUNITY BENEFITS PROGRAMS FOR THE SYSTEM THROUGH PLANNING DEVELOPING IMPLEMENTING AND FUNDING PROGRAMS THAT ADDRESS COMMUNITY NEEDS POMH 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 A PALLIATIVE CARE PROGRAM AND A HOSPICE PROGRAM ON THE MUNSON MEDICAL CENTER CAMPUS CLOSE TO 300000 DOLLARS IN 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 12 MILLION IN CHARITY CARE AND UNREIMBURSED MEDICAID IN THE PAST FISCAL YEAR MUNSON MEDICAL GROUP THE EMPLOYED PHYSICIAN ORGANIZATION IN THE SYSTEM PROVIDED OVER A HALF MILLION DOLLARS IN CHARITY CARE AND COMMUNITY BENEFIT IN TAX YEAR 2011 PAUL OLIVER MEMORIAL HOSPITAL PARTICIPATES IN MUNSON HEALTHCARE SYSTEM NEEDS ASSESSMENT PROCESS 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 399 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 PAUL OLIVER MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 11H PART V LINE 11H PATIENTS WHOSE FAMILY INCOME EXCEEDS 400 OF THE FPG MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASEBYCASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES IE HIGH DEBTTOINCOME RATIO AT THE SOLE DISCRETION OF MUNSON HEALTHCARE PAUL OLIVER MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 13G PART V LINE 13G 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 INFORMATION POSTED ON THE WEBSITE STATEMENT ON BILLS ANDOR SIGNS IN THE REGISTRATION AREAS PAUL OLIVER MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 19D PART V LINE 19D SELFPAYNO INSURANCE PATIENTS ARE GIVEN A DISCOUNT EQUAL TO 15 OFF THEIR TOTAL BILL FOR ALL MEDICALLY NECESSARY AND EMERGENCY SERVICES THIS RATE WAS DETERMINED BY TAKING THE AVERAGE OF COMMERCIAL RATES NOT INCLUDING BLUE CROSS false true false false false false false false false PAUL M SHIRILLA 259620 29778 3811 31773 15369 340351 JAMES D AUSTIN 176495 45865 33996 22596 18005 296957 3698 MARK A HEPLER 228393 25779 68663 27822 20647 371304 20253 RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION 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. 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. 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. SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 PAUL M. SHIRILLA 0 16,196 0 JAMES D. AUSTIN 0 12,006 0 MARK A. HEPLER 0 14,118 0 OTHER ADDITIONAL INFORMATION 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 OF MUNSON HEALTHCARE, A COMPETITIVE BENEFIT PACKAGE IS OFFERED WHICH INCLUDES PARTICIPATION IN A SUPPLEMENTAL RETIREMENT PLAN. ANNUAL CONTRIBUTIONS, AT MUNSON'S DISCRETION, ARE MADE TO THE PLAN IN ORDER TO ACHIEVE THE TARGETED RETIREMENT BENEFIT LEVEL. THESE RETIREMENT FUNDS ARE AVAILABLE TO THE PARTICIPANTS UPON THEIR RETIREMENT FROM MUNSON. CRYSTAL LAKE CLINIC OWNER DIRECTOR 50108 MEDICAL SERVICES false CRYSTAL LAKE EMERGENCY SERVICES PC OWNER DIRECTOR 910408 GROUP PHYSICIAN PRAC false NRTW LLC OWNER DIRECTOR 63068 LEASE false INTERLOCHEN MEDICAL PROPERTIES LLC OWNER DIRECTOR 80040 LEASE false ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION PAUL OLIVER MEMORIAL HOSPITAL DELIVERS QUALITY HEALTHCARE FOR THE PEOPLE OF THE BENZIE REGION TO IMPROVE THE HEALTH OF THE COMMUNITY IN PARTNERSHIP WITH MUNSON HEALTHCARE. PAUL OLIVER MEMORIAL HOSPITAL'S EXEMPT PURPOSE IS TO OPERATE A HOSPITAL, LONG-TERM CARE FACILITY AND OTHER ANCILLARY FACILITIES TO PROMOTE AND IMPROVE THE HEALTH OF THE RESIDENTS OF THE BENZIE, MICHIGAN AREA. PAUL OLIVER MEMORIAL HOSPITAL IS PART OF THE MUNSON HEALTHCARE SYSTEM. THROUGH ITS HOSPITALS AND OTHER AFFILIATES, THE SYSTEM DELIVERS A BROAD ARRAY OF HEALTH CARE SERVICES TO 24 COUNTIES IN MICHIGAN'S NORTHERN LOWER PENINSULA AND THE EASTERN PORTION OF THE UPPER PENINSULA. CONSISTENT WITH ITS MISSION, THE MUNSON HEALTHCARE SYSTEM PROVIDED 39.9 MILLION IN CHARITY CARE AND OTHER COMMUNITY BENEFITS, INCLUDING BAD DEBT AND THE SYSTEM MEDICARE FUNDS SHORTFALL FOR RESIDENTS OF NORTHERN MICHIGAN IN THE 2011 TAX YEAR. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 PAUL OLIVER MEMORIAL HOSPITAL IS ORGANIZED ON A NONSTOCK MEMBERSHIP BASIS. THE SOLE MEMBER IS MUNSON HEALTHCARE, AN IRS SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A DIRECTORS ARE ELECTED FROM AMONG THOSE PERSONS RECOMMENDED BY THE MUNSON HEALTHCARE GOVERNANCE COMMITTEE AT THE MUNSON HEALTHCARE ANNUAL MEETING. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN DECISIONS OF THE PAUL OLIVER MEMORIAL HOSPITAL DIRECTORS ARE SUBJECT TO APPROVAL BY THE MUNSON HEALTHCARE BOARD OF DIRECTORS INCLUDING THE AMENDMENT OF THE ARTICLES OF INCORPORATION; AMENDMENT OF THE MISSION STATEMENT; ADOPTION OF A PLAN OF DISSOLUTION, MERGER, CONSOLIDATION OR REORGANIZATION; SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL TO THE PROPERTY AND ASSETS; ACQUISITION OF OR THE ESTABLISHMENT OF ANY SUBSIDIARY OR AFFILIATE OF PAUL OLIVER MEMORIAL HOSPITAL; ACCEPTANCE OF THE ANNUAL BUDGET AND ANNUAL FINANCIAL STATEMENTS; INCURRENCE OF EXPENDITURES EXCEEDING BUDGETED AGGREGATES BY MORE THAN FIVE PERCENT; INCURRENCE OF CERTAIN DEBT; CHANGE IN SCOPE OF SERVICES OR PROGRAMS PROVIDED BY PAUL OLIVER MEMORIAL HOSPITAL; AND APPOINTMENT OF THE PRESIDENT. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE PAUL OLIVER MEMORIAL HOSPITAL BOARD IS COMMITTED TO THE ACCURACY AND THOROUGHNESS OF THE FORM 990 REPORTING. PAUL OLIVER MEMORIAL HOSPITAL BELONGS TO THE MUNSON HEALTHCARE SYSTEM. MUNSON HEALTHCARE IS THE PARENT COMPANY IN THE MUNSON HEALTHCARE SYSTEM, WHICH UNDERGOES AN AUDIT BY AN EXTERNAL AUDIT FIRM. AT THE CORPORATE LEVEL, THE RESPONSIBLE INDIVIDUALS FROM THE FINANCE, ADMINISTRATION, PATIENT FINANCIAL SERVICES, LEGAL, HUMAN RESOURCES, PUBLIC RELATIONS, AND FUND DEVELOPMENT DEPARTMENTS PREPARE AND REVIEW PORTIONS OF THE FORM 990. THE COMPENSATION AND LEADERSHIP DEVELOPMENT COMMITTEE REVIEWS THE COMPENSATION INFORMATION CONTAINED IN THE CORE FORM AS WELL AS THE SCHEDULE J INFORMATION. THE CONFLICT, VALUATION AND COMPLIANCE COMMITTEE OVERSEES THE CONFLICT OF INTEREST DISCLOSURE PROCESS FOR BOARD MEMBERS AND KEY EMPLOYEES TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE AUDIT COMMITTEE OVERSEES THE FORM 990 PREPARATION PROCESS BY ENSURING PROPER CONTROLS, POLICIES, PEOPLE AND RESOURCES ARE IN PLACE TO PRODUCE AN ACCURATE RETURN. ENFORCEMENT OF CONFLICTS POLICY 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. COMPENSATION PROCESS FOR TOP OFFICIAL 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. 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. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION OF OTHER OFFICERS IS CONSISTENT WITH THAT OF THE TOP EXECUTIVES PAUL OLIVER MEMORIAL HOSPITAL AND MUNSON HEALTHCARE. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE PAUL OLIVER MEMORIAL HOSPITAL ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON THE MICHIGAN DEPARTMENT OF TREASURY WEBSITE. PAUL OLIVER MEMORIAL HOSPITAL DOES NOT MAKE THE BYLAWS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. GROUP RETURN METHOD FORM 990, PAGE 7, PART VII PARENT ORGANIZATION HAS FILED A SEPARATE RETURN RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII JAMES D. AUSTIN ALLOCATES 16 HOURS TO PAUL OLIVER MEMORIAL HOSPITAL AND THE REMAINDER OF HIS TIME TO OTHER MUNSON HEALTHCARE SYSTEM RESPONSIBILITIES. MARK HEPLER, CFO, ALLOCATES 40% OF HIS TIME TO MUNSON HEALTHCARE, SYSTEM PARENT ORGANIZATION; 60% TO MUNSON MEDICAL CENTER; AND LESS THAN AN HOUR A WEEK TO THE REMAINING ORGANIZATIONS IN THE MUNSON HEALTHCARE SYSTEM IN HIS CAPACITY AS CFO FOR ALL MUNSON SYSTEM ORGANIZATIONS. PAUL M. SHIRILLA, VICE PRESIDENT OF GENERAL COUNSEL FOR THE MUNSON HEALTHCARE SYSTEM, ALLOCATES 85% OF HIS TIME TO SYSTEM MATTERS AND 15% TO MUNSON MEDICAL CENTER. OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 INVESTMENT IN SUB - PAUL OLIVER HOSPITAL FND 2,963,458 TRANSFER TO AFFILIATE -641,311 UNREALIZED INVESTMENT LOSS -68,885 PRIOR PERIOD ADJUSTMENT -73,740 MUNSON DIALYSIS CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 383097861 DIALYSIS MI (C)(3) 3 MUNSON HC MUNSON HEALTHCARE false MUNSON HEALTHCARE 1105 SIXTH ST TRAVERSE CITY MI 49684 382640544 PARENT MI (C)(3) 11B NA false MUNSON HEALTHCARE REGIONAL FOUNDATI 1105 SIXTH ST TRAVERSE CITY MI 49684 382642724 RAISE FUND MI (C)(3) 7 MUNSON HC MUNSON HEALTHCARE false MUNSON HOME CARE 1105 SIXTH ST TRAVERSE CITY MI 49684 382191390 HOME HEALT MI (C)(3) 9 MUN HOME H MUNSON HOME HEALTH false MUNSON HOME HEALTH 1105 SIXTH ST TRAVERSE CITY MI 49684 383335362 HOME HEALT MI (C)(3) 11B MUNSON HC HEALTHCARE false MUNSON HOME SERVICES 1105 SIXTH ST TRAVERSE CITY MI 49684 382543463 HOME HEALT MI (C)(3) 9 MUN HOME H MUNSON HOME HEALTH false MUNSON MEDICAL CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 381362830 HOSPITAL MI (C)(3) 3 MUNSON HC MUNSON HEALTHCARE false NORTH FLIGHT INC 1105 SIXTH ST TRAVERSE CITY MI 49684 382657917 MED TRANSP MI (C)(3) 11B MUNSON HC MUNSON HEALTHCARE false PAUL OLIVER MEMORIAL HOSPITAL FOUND 1105 SIXTH ST TRAVERSE CITY MI 49684 237201619 RAISE FUND MI (C)(3) 3 PAUL OLIVE PAUL OLIVER MEMORIAL HOSPITAL true MUNSON MEDICAL GROUP 1105 SIXTH ST TRAVERSE CITY MI 49684 273600575 HEALTHCARE MI (C)(3) 9 MUNSON MED MUNSON MEDICAL CENTER false 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 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 MEDICAL OFFICE BUILDING CONDOMINIUM PO BOX 1188 TRAVERSE CITY MI 496851188 383567278 REAL ESTAT MI N/A MUNSON SERVICES INC PO BOX 1188 TRAVERSE CITY MI 496851188 383144382 PHARMACY MI N/A MUNSON SUPPORT SERVICES PO BOX 1188 TRAVERSE CITY MI 496851188 382872821 LAUNDRY MI N/A SIXTH STREET DRUGS INC PO BOX 1188 TRAVERSE CITY MI 496851188 382298290 PHARMACY MI N/A MEDICAL OFFICE CONDOMINIUM MEDICAL OFFICE CONDOMINIUM PO BOX 1188 TRAVERSE CITY MI 496851188 201902620 REAL ESTAT MI N/A MUNSON MOBILE IMAGING PO BOX 1188 TRAVERSE CITY MI 496851188 382704069 IMAGING MI N/A MEDICAL OFFICE BUILDING CONDOMINIUM MEDICAL OFFICE BUILDING CONDOMINIUM PO BOX 1188 TRAVERSE CITY MI 496851188 383567278 REAL ESTAT MI N/A MUNSON SERVICES INC PO BOX 1188 TRAVERSE CITY MI 496851188 383144382 PHARMACY MI N/A MUNSON SUPPORT SERVICES PO BOX 1188 TRAVERSE CITY MI 496851188 382872821 LAUNDRY MI N/A SIXTH STREET DRUGS INC PO BOX 1188 TRAVERSE CITY MI 496851188 382298290 PHARMACY MI N/A MEDICAL OFFICE CONDOMINIUM MEDICAL OFFICE CONDOMINIUM PO BOX 1188 TRAVERSE CITY MI 496851188 201902620 REAL ESTAT MI N/A MUNSON MOBILE IMAGING PO BOX 1188 TRAVERSE CITY MI 496851188 382704069 IMAGING MI N/A false true false false false false false false false false false true false true true true true false MUNSON MEDICAL CENTER O 6375983 FMV MUNSON MEDICAL CENTER N 1024071 FMV MUNSON HEALTHCARE B 1000000 FMV MUNSON MEDICAL CENTER L 920273 FMV NORTHERN MICHIGAN SUPPLY ALLIANCE O 183922 FMV MUNSON HEALTHCARE L 135948 FMV MUNSON DIALYSIS CENTER P 125000 FMV MUNSON HEALTHCARE N 124936 FMV MUNSON HEALTHCARE O 120366 FMV MUNSON SUPPORT SERVICES L 86090 FMV PAUL OLIVER MEM HOS FOUNDATION Q 68000 FMV MUNSON SERVICES INC L 59018 FMV PAUL OLIVER MEM HOS FOUNDATION L 53088 FMV MUNSON MEDICAL CENTER O 6375983 FMV MUNSON MEDICAL CENTER N 1024071 FMV MUNSON HEALTHCARE B 1000000 FMV MUNSON MEDICAL CENTER L 920273 FMV NORTHERN MICHIGAN SUPPLY ALLIANCE O 183922 FMV MUNSON HEALTHCARE L 135948 FMV MUNSON DIALYSIS CENTER P 125000 FMV MUNSON HEALTHCARE N 124936 FMV MUNSON HEALTHCARE O 120366 FMV MUNSON SUPPORT SERVICES L 86090 FMV PAUL OLIVER MEM HOS FOUNDATION Q 68000 FMV MUNSON SERVICES INC L 59018 FMV PAUL OLIVER MEM HOS FOUNDATION L 53088 FMV MUNSON MEDICAL CENTER O 6375983 FMV MUNSON MEDICAL CENTER N 1024071 FMV MUNSON HEALTHCARE B 1000000 FMV MUNSON MEDICAL CENTER L 920273 FMV NORTHERN MICHIGAN SUPPLY ALLIANCE O 183922 FMV MUNSON HEALTHCARE L 135948 FMV MUNSON DIALYSIS CENTER P 125000 FMV MUNSON HEALTHCARE N 124936 FMV MUNSON HEALTHCARE O 120366 FMV MUNSON SUPPORT SERVICES L 86090 FMV PAUL OLIVER MEM HOS FOUNDATION Q 68000 FMV MUNSON SERVICES INC L 59018 FMV PAUL OLIVER MEM HOS FOUNDATION L 53088 FMV ADDITIONAL INFORMATION SCHEDULE R PAUL OLIVER MEMORIAL HOSPITAL USED THE ACCRUAL METHOD OF ACCOUNTING TO VALUE THE TRANSACTIONS WITH RELATED ENTITIES ALL INTERCOMPANY TRANSACTIONS WITH RELATED ENTITIES WERE REVIEWED SUMMARIZED AND RECONCILED TO DETERMINE THE DISCLOSURE AMOUNTS