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      <Form990PartVIISectionAGrp>
        <PersonNm>Lynne Giles</PersonNm>
        <TitleTxt>Trustee (as of June)</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Kevin Knaffla</PersonNm>
        <TitleTxt>Trustee (as of Aug.)</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Richard Hueter</PersonNm>
        <TitleTxt>Trustee (until May)</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2964395</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>283197</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>33</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>BerryDunn</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>100 Middle St</AddressLine1Txt>
            <CityNm>Portland</CityNm>
            <StateAbbreviationCd>ME</StateAbbreviationCd>
            <ZIPCd>04104</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>EMR Implementation Support</ServicesDesc>
        <CompensationAmt>534548</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>UP Health Care Solutions</BusinessNameLine1Txt>
          </BusinessName>
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        <ContractorAddress>
          <USAddress>
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            <CityNm>Marquette</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
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          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MRI Services</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Green Bay Oncology Ltd</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1726 Shawano Ave</AddressLine1Txt>
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            <StateAbbreviationCd>WI</StateAbbreviationCd>
            <ZIPCd>54303</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Oncology Services</ServicesDesc>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Marquette General Hospital</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
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            <StateAbbreviationCd>IL</StateAbbreviationCd>
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          </USAddress>
        </ContractorAddress>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Joseph Hance MD PLLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <ZIPCd>49770</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Orthopedics</ServicesDesc>
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      <CntrctRcvdGreaterThan100KCnt>9</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>4671487</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>493413</AllOtherContributionsAmt>
      <NoncashContributionsAmt>52774</NoncashContributionsAmt>
      <TotalContributionsAmt>5164900</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
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        <BusinessCd>621990</BusinessCd>
        <TotalRevenueColumnAmt>35850624</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>35850624</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>Pharmacy Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1619080</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1619080</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
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        <RelatedOrExemptFuncIncomeAmt>744064</RelatedOrExemptFuncIncomeAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>38213768</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>509941</TotalRevenueColumnAmt>
        <ExclusionAmt>509941</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>21886</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>3747</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>18139</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>18139</TotalRevenueColumnAmt>
        <ExclusionAmt>18139</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>43906748</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>38213768</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>528080</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>27908</TotalAmt>
        <ProgramServicesAmt>27908</ProgramServicesAmt>
      </GrantsToDomesticIndividualsGrp>
      <CompCurrentOfcrDirectorsGrp>
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        <ManagementAndGeneralAmt>468322</ManagementAndGeneralAmt>
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      <CompDisqualPersonsGrp>
        <TotalAmt>69052</TotalAmt>
        <ProgramServicesAmt>69052</ProgramServicesAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
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        <ProgramServicesAmt>16104795</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2279423</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>1835531</TotalAmt>
        <ProgramServicesAmt>1835531</ProgramServicesAmt>
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      <OtherEmployeeBenefitsGrp>
        <TotalAmt>3017512</TotalAmt>
        <ProgramServicesAmt>2445996</ProgramServicesAmt>
        <ManagementAndGeneralAmt>571516</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
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        <ProgramServicesAmt>1078510</ProgramServicesAmt>
        <ManagementAndGeneralAmt>179293</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
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        <ProgramServicesAmt>226</ProgramServicesAmt>
        <ManagementAndGeneralAmt>75106</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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        <ProgramServicesAmt>104189</ProgramServicesAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>3488</TotalAmt>
        <ManagementAndGeneralAmt>3488</ManagementAndGeneralAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>5584183</TotalAmt>
        <ProgramServicesAmt>2816098</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2768085</ManagementAndGeneralAmt>
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      <AdvertisingGrp>
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        <ProgramServicesAmt>822</ProgramServicesAmt>
        <ManagementAndGeneralAmt>64199</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
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        <ProgramServicesAmt>1081265</ProgramServicesAmt>
        <ManagementAndGeneralAmt>249636</ManagementAndGeneralAmt>
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      <OccupancyGrp>
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        <ProgramServicesAmt>572221</ProgramServicesAmt>
        <ManagementAndGeneralAmt>65495</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
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        <ProgramServicesAmt>46535</ProgramServicesAmt>
        <ManagementAndGeneralAmt>183559</ManagementAndGeneralAmt>
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      <ConferencesMeetingsGrp>
        <TotalAmt>53744</TotalAmt>
        <ProgramServicesAmt>41558</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12186</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>1010316</TotalAmt>
        <ProgramServicesAmt>1010316</ProgramServicesAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>2356432</TotalAmt>
        <ProgramServicesAmt>2356432</ProgramServicesAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>409960</TotalAmt>
        <ManagementAndGeneralAmt>409960</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>4689747</TotalAmt>
        <ProgramServicesAmt>4689747</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Bad Debt Expense</Desc>
        <TotalAmt>821668</TotalAmt>
        <ProgramServicesAmt>821668</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Dues and Licenses</Desc>
        <TotalAmt>130801</TotalAmt>
        <ProgramServicesAmt>64592</ProgramServicesAmt>
        <ManagementAndGeneralAmt>66209</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Food</Desc>
        <TotalAmt>122099</TotalAmt>
        <ProgramServicesAmt>122099</ProgramServicesAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>279974</TotalAmt>
        <ProgramServicesAmt>4555</ProgramServicesAmt>
        <ManagementAndGeneralAmt>275419</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>42966011</TotalAmt>
        <ProgramServicesAmt>35294115</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7671896</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2925429</BOYAmt>
        <EOYAmt>9879138</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>5712829</BOYAmt>
        <EOYAmt>6373170</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>10000</BOYAmt>
        <EOYAmt>10000</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>60074</BOYAmt>
        <EOYAmt>133448</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>607023</BOYAmt>
        <EOYAmt>641200</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>154495</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>41584315</LandBldgEquipCostOrOtherBssAmt>
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      <LandBldgEquipBasisNetGrp>
        <BOYAmt>18494136</BOYAmt>
        <EOYAmt>18329168</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>3239426</EOYAmt>
      </InvestmentsPubTradedSecGrp>
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        <BOYAmt>2503520</BOYAmt>
        <EOYAmt>1888945</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>40648990</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>2432816</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>23489760</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
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      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
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        <EOYAmt>8735592</EOYAmt>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>38210268</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrgDoesNotFollowFASB117Ind>X</OrgDoesNotFollowFASB117Ind>
      <CapStkTrPrinCurrentFundsGrp>
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        <EOYAmt>0</EOYAmt>
      </CapStkTrPrinCurrentFundsGrp>
      <PdInCapSrplsLandBldgEqpFundGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PdInCapSrplsLandBldgEqpFundGrp>
      <RtnEarnEndowmentIncmOthFndsGrp>
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        <EOYAmt>2438722</EOYAmt>
      </RtnEarnEndowmentIncmOthFndsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>1174371</BOYAmt>
        <EOYAmt>2438722</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>34456660</BOYAmt>
        <EOYAmt>40648990</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>940737</ReconcilationRevenueExpnssAmt>
      <PriorPeriodAdjustmentsAmt>323614</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
      </ContributorInformationGrp>
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    <IRS990ScheduleC documentId="RetDoc1039700001">
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      <PaidStaffOrManagementInd>0</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>0</MediaAdvertisementsInd>
      <MailingsMembersInd>0</MailingsMembersInd>
      <PublicationsOrBroadcastInd>0</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>0</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>0</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>0</RalliesDemonstrationsInd>
      <OtherActivitiesInd>1</OtherActivitiesInd>
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      <TotalLobbyingExpendituresAmt>3488</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>0</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part II-B, Line 1:</FormAndLineReferenceDesc>
        <ExplanationTxt>SMH is a member of the American Hospital Association (AHA) and Michigan Health and Hospital Association (MHA). A portion of the membership dues for these organizations is used for lobbying - $1588 MHA and $1900 AHA.</ExplanationTxt>
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        <BookValueAmt>668758</BookValueAmt>
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      <BuildingsGrp>
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        <DepreciationAmt>12569372</DepreciationAmt>
        <BookValueAmt>10750601</BookValueAmt>
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      <EquipmentGrp>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Pension Liability</Desc>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Pension Inflows Liability</Desc>
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      <OtherLiabilitiesOrgGrp>
        <Desc>CMS Advance Payment</Desc>
        <Amt>3494640</Amt>
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      <TotalRevEtcAuditedFinclStmtAmt>42078511</TotalRevEtcAuditedFinclStmtAmt>
      <OtherRevenueAmt>-1831984</OtherRevenueAmt>
      <RevenueNotReportedAmt>-1831984</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>43910495</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-3747</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-3747</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>43906748</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>41137774</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>3747</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>3747</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>41134027</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>1831984</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>1831984</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>42966011</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Interest Expenses reported in Revenue on Financial Statements -1,010,316. Bad Debt Expenses reported in Revenue on Financial Statements -821,668.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Rental Expenses Reported in Expenses on Financial Statements -3,747.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Rental Expenses Reported in Expenses on Financial Statements 3,747.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Interest Expenses reported in Revenue on Financial Statements 1,010,316. Bad Debt Expenses reported in Revenue on Financial Statements 821,668.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
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      <FinancialAssistancePolicyInd>1</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>1</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>1</FPGReferenceFreeCareInd>
      <Percent200Ind>X</Percent200Ind>
      <FPGReferenceDiscountedCareInd>0</FPGReferenceDiscountedCareInd>
      <FreeCareMedicallyIndigentInd>1</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>1</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>0</ExpensesExceedBudgetInd>
      <AnnualCommunityBnftReportInd>0</AnnualCommunityBnftReportInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>159000</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>159000</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00380</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>6935278</TotalCommunityBenefitExpnsAmt>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schoolcraft Memorial Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 5: The Community Health Needs Assessment contains findings from the regional community health needs assessment conducted in 2017-2018 by Western U.P. Health Department, in collaboration with 31 community partners. The assessment covers the 15 counties of Michigan's Upper Peninsula, the rural, rugged and remote home to more than 300,000 residents.Data for the community health needs assessment were gathered from a wide array of published sources, from a survey of 4,820 residents of the 15 counties, and from health care providers. External, or secondary, data sources include the U.S. Census Bureau and its American Community Survey, as well as statistics compiled by the Michigan Department of Health and Human Services, the federal Centers for Disease Control and Prevention, and other government and private agencies.The regional adult health survey was the most ambitious and unique element of this project. A shortcoming of national and state health surveys is that the samples are designed to represent the national or state population as a whole. This means that in small population cohorts, like Upper Peninsula counties, not enough residents are included in the sample to make reasonable annual estimates at the county level. The addition of local survey data to this report helps us understand the health needs of our residents more thoroughly and measure changes over time.The survey was patterned after the Behavioral Risk Factor Surveillance System survey conducted by the CDC and state health departments. In consultation with our partners, additional topics were included in the local survey, including questions on mental health, substance abuse, access to care, dementia and elder care, and a section for ranking the perceived importance of 16 broad community health issues.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schoolcraft Memorial Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6a: Aspirus Iron River Hospital Munising Memorial HospitalAspirus Ironwood Hospital Northcare NetworkAspirus Keweenaw Hospital Northpointe Behavioral Health SystemsAspirus Ontonagon Hospital OSF St. Francis HospitalDickinson County Healthcare System Upper Great Lakes Family Health CenterHelen Newberry Joy Hospital Upper Peninsula Health PlanMichigan Health Endowment Fund War Memorial Hospital</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schoolcraft Memorial Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 6b: Central U.P. Planning &amp; Development Pathways Community Mental HealthRegional Commission Public Health of Delta &amp; Menominee CountiesCopper Country Community Mental Health Superior Health FoundationrDickinson-Iron District Health Department Upper Peninsula Health Care SolutionsGogebic County Community Mental Health Upper Peninsula Health GroupLuce-Mackinac-Alger-Schoolcraft District U.P. Health System-BellHealth Department U.P. Health System-MarquetteMarquette County Health Department U.P. Health System-PortageMichigan Technological University Western U.P. Health Department</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schoolcraft Memorial Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 7d: As a part of the implementation strategy, there will be hard copy binders containing the report that will be distributed to various communities within Manistique, such as the public library, etc. There have been several newsletter articles in hospital-based publications, some of which are distributed in the community, keeping the community apprised about progress on the CHNA and availability of the report &amp; implementation strategy.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schoolcraft Memorial Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 11: Schoolcraft Memorial Hospital partnered withother UP Hospitals and organizations to conduct a Community Health NeedsAssessment in 2018. and the following reflects the implementationstrategies and results.The assessment will be used for implementation goals for years 2019 through 2021.In April 2019, the LMAS District Health Department lead focus groups whichled to 3 Priorities for our service area:1. Youth Mentoring and BusinessObjective: Recruit adult volunteers to serve as mentors for teens incommunity leadership (at least 1 year commitment) or as mentors in "spingroups" (shorter commitment and multiple topics) through partnership withMSU-Extension in Schoolcraft County.2020 Due to COVID-19 restrictions, work in this area was not completed. 2. Substance Use and Attitudes about Drugs, Alcohol, Tobacco, VapingObjective: Investigate creation of a FAN (Families Against Narcotics)group in Schoolcraft County. The Patient Navigator at Schoolcraft Memorial Hospital researched information about creating a FAN chapter in conjunction with drug court in Schoolcraft County. There was shared interest but a lot of resources and collaboration needed to take place. Unfortunately with the pandemic, this effort was put on hold. We did find out that there are a number of programs that we could utilize in the future as they relate to this goal: Hope Not Handcuffs: Hope not handcuffs is an initiative started by families against narcotics (FAN), aimed at bringing law enforcement and community organizations together in an effort to find appropriate treatment options for individuals seeking help to reduce dependency with heroin, prescription drugs and alcohol. It is a solution. School Presentations: Each year, FAN speaks to thousands of students throughout the state. Our school presentations can be tailored to large groups or individual classes. We have presentations for students involved in athletics and separate discussions for parents. Speakers include parents affected by addiction and 2-3 young people in recovery. Naloxone Training: Families Against Narcotics offers free Naloxone training sessions for community members interested in learning how to properly administer the medication. Family Coaching: Families often need help while struggling with a loved one who suffers from Substance Use Disorder. Sometimes things that we do naturally for a loved one, can be the very thing that hinders recovery. It's just as important for the family to heal as it is for the one struggling. FAN offers Family Coaching Services free of charge, designed to help you and your family heal and recover regardless of where your loved one is in their recovery. Peer Recovery Coach: FAN offers everyone that comes through the Hope Not Handcuffs program a Peer Recovery Coach. FAN will also CCAR train free of charge Peer Recovery Coaches meeting the criteria and willing to work for FAN on a contractual basis.3. Behavioral Health, Mental Health, Peer SupportInvestigate evidence-based critical response training programs and submitfor consideration Continued work to expand awareness of the Community Connect Program. The website has been added and can be used but a formal launch will take place in 2021. Through the pandemic, the behavioral health team made a shift with most of their appointments occurring online. Many patients preferred this method of therapy and continue to utilize telemedicine for both therapy and psychiatric evaluations/treatment. Dr. Sloane is a childhood trauma specialist and was hired through a grant. He offered free consultations with children and families through our grant period. He collaborated with family practice providers, offering recommendations for medication, ongoing support and follow up visits. Schoolcraft Memorial Hospital's Patient Navigator secured a grant through Meijer to provide essential materials for a Play Therapy Room. The hospital added a second Therapist who quickly filled her practice offering therapy sessions across the lifespan. The team uses evidence-based therapies and assessments for traumatic experiences with every patient. The Behavioral Health Team moved to the Downtown Clinic at 101 Walnut Street offering a private and comfortable setting which has resulted in increased patient satisfaction. The team successfully implemented a treatment program in the local jail offering Vivitrol Medication Assisted Treatment, group counseling and follow up counseling once inmates are released. They are dedicated to patients' mental and emotional health and offer services to individuals across the lifespan. The Patient Navigator assists patients to ensure they have access to care and connects them to vital community resources.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schoolcraft Memorial Hospital</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 13h: Schoolcraft Memorial Hospital offers a self-pay discount of 41% of gross charges for uninsured patients regardless of income.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 7a:</FormAndLineReferenceDesc>
        <ExplanationTxt>http://www.scmh.org/community/community-health-needs-assessment/</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 10a:</FormAndLineReferenceDesc>
        <ExplanationTxt>https://www.wupdhd.org/community-health-needs-assessment/</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 7b:</FormAndLineReferenceDesc>
        <ExplanationTxt>https://www.wupdhd.org/wp-content/uploads/2019/03/Upper-Peninsula-Community-Health-Needs-Assessment-2018-Second-Edition.pdf</ExplanationTxt>
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            <BusinessNameLine1Txt>1 - SMH Homecare &amp; Hospice Agency</BusinessNameLine1Txt>
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            <AddressLine1Txt>115 N Lake St</AddressLine1Txt>
            <CityNm>Manistique</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
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          <FacilityTxt>Homecare and Hospice</FacilityTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3c:</FormAndLineReferenceDesc>
        <ExplanationTxt>Schoolcraft Memorial Hospital offers a self-pay discount of 41% of gross charges for uninsured patients regardless of income.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 6a:</FormAndLineReferenceDesc>
        <ExplanationTxt>The community benefit report was made available to the public on the Hospital's website at www.SCMH.org/community/community-benefits/.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>Financial assistance was calculated using the cost-to-charge ratio. Unreimbursed Medicaid and subsidized health services were calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Ln 7 Col(f):</FormAndLineReferenceDesc>
        <ExplanationTxt>The amount of bad debt expense backed out of total expenses to determine the percentage was $821,668.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization determines its bad debt expense based on actual charges. Self-pay discounts are applied to patient accounts before balances are deemed to be bad debt.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>The amount listed on line 3 is an estimate of community care applications not returned. Approximately 60% of applications were not returned that may have qualified for community care.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The footnote to the organization's financial statements addressing implicit price concessions may be found on page 17 of the attached audited financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>The shortfall should be considered as community benefit as this amount is not included in bad debt and no effort is made to collect this shortfall. In addition, providing services to the Medicare population is a community benefit as the elderly are a charitable class and providing them with healthcare helps the community.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Schoolcraft Memorial Hospital works with patients to help them qualify for financial assistance. If a patient does not complete the financial assistance application or provide the required documentation, SCMH follows the same collection efforts as it does with other delinquent accounts. SCMH will attempt to work with the patient to set up a payment plan or make payment on the amount. If the patient does not respond the SCMH efforts, the account is referred to an external collection agency.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The CHNA is the only formal assessment of broad scope that the hospital has utilized in recent years to assess the health care needs of the community. The CHNA was completed in 2018 and is posted to the website www.SCMH.org. The needs identified in the CHNA include steps to: research, plan and develop a provider network to improve access to care for behavioral health; work with community partners to improve access to food assistance for elderly and low income residents of Schoolcraft County.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>Schoolcraft Memorial Hospital posts a summary of its charity care policy, and financial assistance contact information in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a summary of the policy, and financial assistance contact information to patients as part of the intake process; (3) includes a statement regarding the policy, along with financial assistance contact information, on patient bills; and assists the patient with qualification for charity care where applicable.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>Schoolcraft Memorial Hospital primarily provides services to the residents of Schoolcraft County. The county is 1,884 square miles of which 1,178 is land, and 706 is water. As of July 1, 2016 the population is estimated to be 8,001. Approximately 28.7% is estimated to be 62 years and older. As of 2015 the median household income in the county was $34,118. The unemployment rate was at 7.4%. The percentage of individuals whose income was below the poverty level was 21.4% as of July, 2015.Schoolcraft Memorial Hospital is the only hospital in the county. The nearest hospital is approximately 50 miles from Schoolcraft Memorial Hospital. Schoolcraft County is not designated as a Medically Underserved Area. It has been designated as a low-income health care professional shortage area.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>SMH donates staff (board members) and health care services in the amount of $70,000/year to the low-income uninsured clients of the Medical Care Access Coalition, Schoolcraft County Office. The hospital has one staff person on the executive board of the Eastern Upper Peninsula Crisis Response team, and several additional staff who provide critical incident response interventions to first responders, schools, hospital staff, businesses, etc., throughout the region following an emotionally traumatic critical/crisis incident. The hospital has taken a leading role with the Sault Tribe Strategic Alliance for Health in planning and developing a farmers' market (the first in Manistique), as well as assisting in the planning for several miles of new sidewalk and safer intersections for the benefit of local schoolchildren and to encourage increased physical activity among all residents to fight the obesity epidemic. The hospital has a staff person who participates as a part of a local suicide &amp; bullying prevention coalition and gives time to local awareness activities such as the annual suicide memorial vigil. The hospital has several staff who actively participate as a part of the local substance abuse prevention task force. The hospital wellness committee plans and implements activities in the schools to encourage nutritious eating habits and increase physical activity. The hospital donates staff time to the Great Start Collaborative and other early childhood programs toward the development of annual strategic plans, fundraising efforts, etc. One of the hospital's social workers is a trained Medicare/Medicaid assistance program counselor who sees about 200 people per year during the "open window" for Medicare Part D enrollment, and assists others throughout the year upon request. A hospital social worker is a certified child passenger safety seat technician and assists low income families that are unable to afford safety seats by providing a new seat and instructing in their safe installment. The hospital has the majority of the vendor booths and low cost or free screenings and services provided at the annual community health fair. The social workers educate and assist community members in completing advance directives. A social worker actively participates in the planning and on the day of the Walk to End Alzheimer's Diesease as well as sitting on the regional board of the Alzheimer's Association.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 7, Reports Filed With States</FormAndLineReferenceDesc>
        <ExplanationTxt>MI</ExplanationTxt>
      </SupplementalInformationDetail>
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        <GrantTypeTxt>Educational Assistance Program</GrantTypeTxt>
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        <FormAndLineReferenceDesc>Part I, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>Schoolcraft Memorial Hospital's Educational Assistance Program encourages and supports employees who enroll in a college or university to obtain a certificate or degree. Full-time and part-time employees who work an average of 20 hours per week per year are eligibile to apply for educational assistance on or after the first anniversary of their employment date. To be eligible the following criteria must be met: - Coursework must be offered by an accredited college or university. - Courses must earn degree credits towards a certificate, associate's, bachelor's, or master's degree. - Coursework must be related to the business of SMH. The education must qualify the employee for a position within the hospital. - Employee must earn a grade of "C or better. If the course is on a "pass/fail" grading system, the associate must earn a "pass" grade. If the program requires higher than a "C" to stay in the program, the employee must meet the grade required by the program. - The Educational Assistance Expense Reimbursement Form must be received by the employee's supervisor no later than 75 days after the completion of the course. - The employee's employment status must be "active" on the date the educational assistance reimbursement is paid.</ExplanationTxt>
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        <ExplanationTxt>Board members may elect new board members as vacancies occur. Appointments to the Board must be ratified by the county commissioners.</ExplanationTxt>
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        <ExplanationTxt>The Articles of Incorporation may be amended by resolution approved by affirmative vote of the majority of the members serving on the Schoolcraft County Board of Commissioners. The Corporation, if it has completed the purposes for which it was organized, shall be dissolved by the adoption of a resolution by the affirmative vote of two-thirds of the members serving on the Board of Trustees, and approved by a majority of the members serving on the Schoolcraft County Board of Commissioners.</ExplanationTxt>
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        <ExplanationTxt>SMH sends Form 990 and all accompanying schedules to the full board for review and ratification. The CEO/CFO will present the 990 to the full board. The full board has opportunity to ask questions prior to ratification of the 990.</ExplanationTxt>
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        <ExplanationTxt>All board members and officers are required to complete the conflict of interest statement annually. This is reviewed by the board annually to identify any potential issues. Any board member or officer having a conflict of interest or possible conflict of interest should not vote or use their personal influence on the matter and they should not be counted as a part of the quorum for the meeting.</ExplanationTxt>
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