2019-05-15T12:26:11-05:00 2018-06-30 990 2017-07-01 380350304 MUNSON HEALTHCARE MANISTEE HOSPITAL MUNS 2313981000 1465 EAST PARKDALE AVENUE MANISTEE MI 496609709 MARK A HEPLER CFO 2313981000 2019-05-14 204.63.207.116 2019-05-15 12:26:11 CD P 3AD8FE5AAD7F1E7C8842AE1699DABE20D9503696 3AD8FE5AAD7F1E7C8842AE1699DABE20D9503696 2017 2019-02-21 02:37:17Z JAMES BARKER 1465 EAST PARKDALE AVENUE MANISTEE MI 496609709 85542572 false X WWW.MUNSONHEALTHCARE.ORG/MANISTEE X 1988 MI MUNSON HEALTHCARE MANISTEE HOSPITAL AND ITS PARTNERS WILL WORK TOGETHER TO PROVIDE SUPERIOR QUALITY CARE AND PROMOTE COMMUNITY HEALTH. 13 10 469 78 0 35263 144746 352349 19644146 76295122 158029 904691 115566 805542 20062487 78357704 0 0 8819912 35300112 0 66127 9277844 39889057 18097756 75189169 1964731 3168535 55183998 62648504 19128472 23292814 36055526 39355690 AS A VITAL PART OF MUNSON HEALTHCARE, MUNSON HEALTHCARE MANISTEE HOSPITAL EXISTS TO DELIVER COMPREHENSIVE QUALITY CARE TO PATIENTS IN PARTNERSHIP WITH PHYSICIANS. false false 65323210 76291614 EXPENSES INCURRED WHILE PROVIDING HOSPITAL SERVICES TO THE RESIDENTS OF MANISTEE, MICHIGAN AND THE SURROUNDING AREA WHILE FULFILLING THE HOSPITAL'S MISSION TO PROVIDE HEALTHCARE IN THE COMMUNITY. MUNSON HEALTHCARE MANISTEE HOSPITAL HAD 1,500 INPATIENT ADMISSIONS AND OVER 95,000 OUTPATIENT VISITS DURING THE TAX YEAR. 65323210 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 54 0 true 469 true true true false false false false false false false false false X 13 10 false false false false true true true true true false false true true true true true true true true false X AMY LYMAN 2313981363 1465 EAST PARKDALE AVENUE MANISTEE MI 496609709 EDWIN NESS DIRECTOR 1.00 40.00 X 0 883822 176242 JULIE FITZGERALD MD DIRECTOR 40.00 X 463344 0 36630 JAMES BARKER PRESIDENT 2.00 40.00 X X 0 299967 49399 KELLIE PARKES CHAIR 2.00 1.00 X X 3180 0 0 GLENN ZARING DIRECTOR 1.00 X 3180 0 0 BEN HENGY DO DIRECTOR 1.00 X 3020 0 0 BRIAN POSTMA VICE CHAIR 2.00 X X 2940 0 0 JOEL MEISTER TREASURER 2.00 X X 2810 0 0 JOEL ANHALT DO DIRECTOR 1.00 0.00 X 2780 0 0 BRYAN DUNLOP MD DIRECTOR 1.00 0.00 X 2500 0 0 BETH MCCARTHY SECRETARY 2.00 1.00 X X 2500 0 0 AMY WOJCIECHOWSKI PHD DIRECTOR 1.00 X 2500 0 0 THOMAS ST DENNIS DIRECTOR 1.00 X 0 0 0 MARK A HEPLER CFO 2.00 40.00 X 0 470545 84671 DON LEMMER HOSPITAL CFO 40.00 X 276271 0 21224 TINA MILLER CNO 40.00 X 151138 0 29821 DOUGLAS RICHLEY DO DERMATOLOGIS 40.00 X 680447 0 32411 MARK D'ANGELO DO SURGEON 40.00 X 663071 0 25876 ROBERT BARRY MD SURGEON 40.00 X 505139 0 32198 NEIL DIGIOVANNI MD ANESTHESIOLO 40.00 X 457040 0 15629 AARON BENNETT DO SURGEON 40.00 X 433465 0 32050 3655325 1654334 536151 46 false true false ELZINGA VOLKERS INC 86 EAST SIXTH STREET HOLLAND MI 49423 BUILDING CONTRA 5451747 INDIGO SERVICES PLC 10850 E TRAVERSE HWY STE 4400 TRAVERSE CITY MI 49684 MEDICAL 2299188 MORRISON MANAGEMENT SPECIALISTS 400 NORTHRIDGE RD STE 600 SANDY SPRINGS GA 30350 NUTRITIONAL/ENV 1975126 EMERGENCY CARE SPECIALISTS 4100 EMBASSY DR SE STE 400 KENTWOOD MI 49546 MEDICAL 1385862 AMERICAN HEALTHCARE STAFFING 400 W FRONT STREET TRAVERSE CITY MI 49684 CONTRACT LABOR 759764 19 56488 295861 352349 PATIENT SERVICE REVENUE 621990 44546837 44546837 MEDICARE/MEDICAID PAYMENTS 621990 28735586 28735586 HEALTH SERVICE REVENUE 621990 2782344 2782344 INCENTIVE PAYMENTS 621990 230355 230355 76295122 377744 377744 142875 142875 142875 142875 7711815 7181360 3508 530455 -3508 526947 -3508 530455 MISCELLANEOUS 621990 626742 626742 GIFT SHOP 446199 35925 35925 662667 78357704 76291614 1713741 X 1004856 704705 300151 27658474 24855659 2802815 3595859 3206522 389337 1270311 1143418 126893 1770612 1579491 191121 293850 293850 4850 4850 69792 69792 17145919 13277555 3802237 66127 30915 255 30660 1557132 1068840 488292 1215338 946245 269093 1155024 1153324 1700 63382 63382 214580 145453 69127 155417 135024 20393 3472738 3017062 455676 437699 437699 MEDICAL SUPPLIES 10435768 10435768 BAD DEBT EXPENSE 3076657 3076657 EQUIPMENT RENTAL 231245 231245 DUES AND SUBSCRIPTIONS 198252 152151 46101 130499 130454 45 75189169 65323210 9799832 66127 3758 3111 5364677 3782146 11053530 11915127 281505 220893 974284 836017 583355 745261 86104679 56096812 22742932 30007867 14179957 15138082 55183998 62648504 9428377 9285713 348223 348223 526202 266287 8825670 13392591 19128472 23292814 X 36055526 39355690 36055526 39355690 55183998 62648504 3168535 131629 X false true X true false X false false false false false false false false true 4850 4850 false SCHEDULE C, PART II-B, LINE 1 OTHER GRASSROOTS LOBBYING INCLUDES THE PORTION OF DUES ALLOCATED TO LOBBYING. 14179958 1027916 69792 15138082 14001696 239097 114835 14179958 1.00000 false true true 1849703 1849703 36704495 26500704 10203791 241010 241010 37342446 28432315 8910131 9967025 1163793 8803232 30007867 RELATED PARTY ACCOUNTS PAYABLE 11500265 THIRD PARTY RESERVES 1892326 13392591 SCHEDULE D, PAGE 2, PART V, LINE 4 THE FUNDS ARE INTENDED FOR THE OPERATIONS AND CAPITAL NEEDS OF MUNSON HEALTHCARE MANISTEE HOSPITAL. true true X true X true X true true false true true 48015 48015 0.00070 12676789 8235583 4441206 0.06160 12724804 8235583 4489221 0.06230 111811 111811 0.00160 100180 100180 0.00140 211991 211991 0.00300 12936795 8235583 4701212 0.06530 true 3076657 1384496 16694180 15981522 712658 X true true 1 1 MUNSON HEALTHCARE MANISTEE HOSPITAL 1465 EAST PARKDALE AVENUE MANISTEE MI 496609709 WWW.MUNSONHEALTHCARE.ORG/MANISTEE 1060000184 X X X MUNSON HEALTHCARE MANISTEE HOSPITAL 1 false true false false true X 200.000000000000 400.000000000000 X X X X X X true true X X X X true X HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA X HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA X HTTPS://WWW.MUNSONHEALTHCARE.ORG/PATIE X X X X X X X true X false X X X X true X false false FACILITY 1, MUNSON HEALTHCARE MANISTEE HOSPITAL - PART V, LINE 2 ON APRIL 1, 2017, MUNSON HEALTHCARE MANISTEE HOSPITAL INTEGRATED INTO THE MUNSON HEALTHCARE SYSTEM AS A SUBSIDIARY OF MUNSON HEALTHCARE, A SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. MUNSON HEALTHCARE MANISTEE HOSPITAL APPLIED FOR AND WAS GRANTED TAX-EXEMPT STATUS AS A IRC SECTION 501(C)(3) ORGANIZATION EFFECTIVE FOR THE DATE OF THE INTEGRATION. PRIOR TO THE INTEGRATION, MUNSON HEALTHCARE MANISTEE HOSPITAL WAS NAMED WEST SHORE MEDICAL CENTER AND WAS AN INDEPENDENT GOVERNMENTAL HOSPITAL. FACILITY 1, MUNSON HEALTHCARE MANISTEE HOSPITAL - PART V, LINE 13B PATIENTS WHOSE FAMILY INCOME EXCEEDS 400% OF THE FPG MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, AT THE SOLE DISCRETION OF MUNSON HEALTHCARE. FACILITY 1, MUNSON HEALTHCARE MANISTEE HOSPITAL - PART V, LINE 16A HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/FINANCIAL_ASSISTANCE_%20POLICY %20(10_16_17)8_24_18.PDF FACILITY 1, MUNSON HEALTHCARE MANISTEE HOSPITAL - PART V, LINE 16B HTTPS://WWW.MUNSONHEALTHCARE.ORG/MEDIA/FILE/MANISTEE%20HOSPITAL%20- %20FINANCIAL%20ASSISTANCE.PDF FACILITY 1, MUNSON HEALTHCARE MANISTEE HOSPITAL - PART V, LINE 16C HTTPS://WWW.MUNSONHEALTHCARE.ORG/PATIENTS-VISITORS/BILL-PAY/ FINANCIAL-ASSISTANCE FACILITY 1, MUNSON HEALTHCARE MANISTEE HOSPITAL - PART V, LINE 16J IT IS THE GOAL OF MUNSON HEALTHCARE TO COMMUNICATE TO THE PATIENTS AND TO THE PUBLIC THE AVAILABILITY OF FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY. THIS WILL BE ACHIEVED THROUGH ONE OR MORE OF THE FOLLOWING METHODS: INFORMATION BROCHURES AVAILABLE AT THE REGISTRATION DESKS; BROCHURES DISTRIBUTED TO ALL SELF-PAY PATIENTS; INFORMATION POSTED ON THE WEBSITE; STATEMENT ON BILLS; SIGNS IN THE REGISTRATION AREAS; AND CALLS MADE TO ALL SELF-PAY PATIENTS AFTER SERVICE. FACILITY 1, MUNSON HEALTHCARE MANISTEE HOSPITAL - PART V, LINE 20E MUNSON HEALTHCARE MANISTEE HOSPITAL (MANISTEE) REVIEWS LARGE DOLLAR ACCOUNTS TO ENSURE ASSISTANCE HAS BEEN OFFERED TO PATIENTS BEFORE THE ACCOUNTS ARE TRANSFERRED TO A CREDIT AGENCY. ONCE AN ACCOUNT HAS BEEN TRANSFERRED TO A CREDIT AGENCY, THE AGENCY REVIEWS THE ACCOUNT TO SEE IF THE PATIENT WOULD BE A POSSIBLE CANDIDATE FOR FINANCIAL ASSISTANCE BEFORE FILING ANY LAWSUITS OR LIENS. MANISTEE WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS WAGE GARNISHMENTS, LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE: 1.VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY MANISTEE; 2.DOCUMENTING THAT MANISTEE HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH MANISTEE'S APPLICATION REQUIREMENTS; 3.DOCUMENTING THAT THE PATIENT HAS BEEN OFFERED THE OPPORTUNITY TO ENTER INTO A PAYMENT PLAN BUT HAS NOT DONE SO, OR HAS ENTERED INTO A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. THE METHOD IN WHICH MANISTEE DOES THIS IS AS FOLLOWS: ALL STATEMENTS INCLUDE A STATEMENT REGARDING THE AVAILABILITY OF PAYMENT PLANS, FINANCIAL ASSISTANCE AND CHARITY CARE. MANISTEE WORKS WITH THE COLLECTION AGENCIES TO IDENTIFY INDIVIDUALS THAT MAY QUALIFY FOR CHARITY. IF THEY FIND AN INDIVIDUAL, THEY MAY REFER THE PATIENT TO PATIENT ACCOUNTS FOR EVALUATION. ALL ACCOUNTS THAT ARE PATIENT-PAY RECEIVE A PHONE CALL TO MAKE THE PATIENT AWARE OF OUR FINANCIAL ASSISTANCE POLICY PRIOR TO THEM GOING TO COLLECTIONS. 4 MHC MANISTEE DERMATOLOGY 315 OAK GROVE ST MANISTEE MI 49660 DERMATOLOGY MHC WELLSTON OUTPAITIENT SERVICES 14477 CABERFAE HWY WELLSTON MI 49689 LAB AND RADIOLOGY MHC BEAR LAKE OUTPATIENT SERVICES 8225 LAKE ST BEAR LAKE MI 49614 LAB, RADIOLOGY AND REHABILITATION MHC MANISTEE WELLNESS CENTER 2198 US-31 S MANISTEE MI 49660 LAB, RADIOLOGY AND REHABILITATION PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE INCOME UP TO 200% OF THE FPG = 100% DISCOUNT ON CHARGES INCOME BETWEEN 201% AND 300% FPG = 75% DISCOUNT ON CHARGES INCOME BETWEEN 301% AND 400% FPG = 65% DISCOUNT ON CHARGES FAMILY INCOME MAY INCLUDE ALL INCOME ATTRIBUTABLE TO ALL MEMBERS OF THE FAMILY IN THE RESIDENCE, OTHER THAN MINIMAL AMOUNTS EARNED BY MINORS. FAMILY INCOME INCLUDES THE FOLLOWING WHEN COMPUTING FPG: EARNINGS, UNEMPLOYMENT COMPENSATION, WORKER'S COMPENSATION, SOCIAL SECURITY, SUPPLEMENTAL SECURITY INCOME, PUBLIC ASSISTANCE, VETERANS' PAYMENTS, SURVIVOR BENEFITS, PENSION OR RETIREMENT INCOME, INTEREST, DIVIDENDS, RENTS, ROYALTIES, INCOME FROM ESTATES, EDUCATIONAL ASSISTANCE, ALIMONY, CHILD SUPPORT, ASSISTANCE FROM OUTSIDE THE HOUSEHOLD, AND OTHER MISCELLANEOUS SOURCES; CASH, CHECKING AND SAVINGS BALANCES, MONEY MARKET ACCOUNTS, CERTIFICATES OF DEPOSIT, IRAS TRUSTS, INHERITANCES, ANNUITIES, SAVINGS BONDS, STOCKS, MUTUAL FUNDS, AND/OR CASH VALUE OF LIFE INSURANCE. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, ARE 75,189,169. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS 3,076,657. THE NET EXPENSE OF 72,112,512 WAS USED FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION COST VALUES FOR LINE 7 ARE BASED ON THE COST TO CHARGE RATIO COMPUTATION OR ACTUAL CASH PAID. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY DIRECT WRITE-OFF FROM UNPAID ACCOUNTS WHICH ARE DEEMED NO LONGER COLLECTIBLE ARE RECORDED AGAINST THE ALLOWANCE FOR BAD DEBT. AN ESTIMATE OF BAD DEBT EXPENSE IS RECORDED BASED ON 1) AN ANALYSIS OF THE DIRECT WRITE- OFFS AND 2) AN ESTIMATE OF THE AMOUNT OF BAD DEBT, NET OF DISCOUNTS, IN THE ACCOUNTS RECEIVABLE BALANCE, CONSIDERING THE PAST EXPERIENCE AND CURRENT TRENDS OF PAYMENTS ON PATIENT ACCOUNTS FOR EACH OF THE MAJOR PAYOR SOURCES OF REVENUE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE THE HOSPITAL PROVIDES CARE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. WHILE THE HOSPITAL MAKES EVERY EFFORT TO IDENTIFY ALL CANDIDATES WHO WOULD QUALIFY UNDER ITS FINANCIAL ASSISTANCE POLICY, THERE ARE CIRCUMSTANCES UNDER WHICH THAT DETERMINATION CANNOT BE MADE. AS SUCH, IT IS OUR BELIEF THAT 1,384,496 OF BAD DEBT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY AND SHOULD BE INCLUDED AS COMMUNITY BENEFIT. BASED ON AN ANALYSIS OF SELF PAY ENCOUNTERS WHOSE GROSS CHARGES EXCEEDED 1,000 AND THEREFORE WERE AUTOMATICALLY SENT A FINANCIAL ASSISTANCE APPLICATION, IT WAS DETERMINED THAT APPROXIMATELY 45% QUALIFIED FOR FINANCIAL ASSISTANCE. THIS PERCENTAGE WAS THEN APPLIED TO SELF PAY DEBT. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE ACCOUNTS RECEIVABLE FOOTNOTE TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF MUNSON HEALTHCARE AND SUBSIDIARIES OF THE ATTACHED STATEMENTS STATES: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENTS ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ACCOUNTS RECEIVABLE PAYOR COMPOSITION AND AGING AND HISTORICAL WRITE- OFF EXPERIENCE BY PAYOR CATEGORY AND OTHER FACTORS. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. AFTER AMOUNTS DUE FROM THIRD-PARTY PAYORS ARE SATISFIED AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION MUNSON HEALTHCARES INTERNAL AND EXTERNAL COLLECTION PRACTICES REFERENCED IN THE CREDIT AND COLLECTION POLICY (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, INCLUDING COLLECTION ACTIONS AND REPORTING TO COLLECTION AGENCIES) SHALL TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENTS GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM MUNSON HEALTHCARE (MHC), AND A PATIENTS GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS WITH MHC. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, MHC MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS ON ANY UNPAID BALANCES ON ACCOUNTS THAT WERE OPENED WITHIN ONE YEAR OF THE DATE THAT THE PATIENT QUALIFIED FOR CHARITY UNDER THIS POLICY. MHC WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS WAGE GARNISHMENTS, LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE: 1) VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL; 2) DOCUMENTING THAT MHC HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITALS APPLICATION REQUIREMENTS; 3) DOCUMENTING THAT THE PATIENT HAS BEEN OFFERED THE OPPORTUNITY TO ENTER INTO A PAYMENT PLAN BUT HAS NOT DONE SO, OR HAS ENTERED INTO A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. PATIENTS WILL BE NOTIFIED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR A PERIOD OF AT LEAST 120 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. PATIENT BALANCES WILL BE ELIGIBLE FOR FINANCIAL ASSISTANCE CONSIDERATION FOR AT LEAST 240 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT. MEMBERS OF THE PUBLIC MAY OBTAIN THE CURRENT CREDIT AND COLLECTION POLICY FOR ANY MUNSON HEALTHCARE HOSPITAL ON THE WEBSITE, IN WRITING, AND FREE OF CHARGE BY CONTACTING MUNSON HEALTHCARE PATIENT FINANCIAL SERVICES DEPARTMENT AT 4230 COPPER RIDGE DR., TRAVERSE CITY, MI 49684. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE IT IS THE GOAL OF MUNSON HEALTHCARE TO COMMUNICATE AND EDUCATE PATIENTS AND THE PUBLIC REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. THIS IS ACHIEVED THROUGH ONE OR MORE OF THE FOLLOWING METHODS: INFORMATION BROCHURES AVAILABLE AT THE REGISTRATION DESKS: BROCHURES THAT DESCRIBE MUNSON HEALTHCARE'S FINANCIAL ASSISTANCE PROGRAM ARE AVAILABLE AT ALL REGISTRATION SITES. THE BROCHURE HAS CLEAR INFORMATION ON HOW TO CONTACT A FINANCIAL COUNSELOR. STATEMENT ON BILLS: STATEMENTS INCLUDE VERBIAGE THAT INSTRUCTS THE PATIENT TO CALL PATIENT FINANCIAL ASSISTANCE IF THEY NEED HELP WITH THEIR BILL. SIGNS IN THE ER REGISTRATION AREA: ADVISES THE PATIENTS THAT THEIR CARE IS NOT WITHHELD IF THEY HAVE NO INSURANCE OR MEANS TO PAY. THE MUNSON HEALTHCARE INTERNET HAS THE FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION, THE PLAIN LANGUAGE SUMMARY AND THE BILLING AND COLLECTIONS POLICY AVAILABLE TO REVIEW AND PRINT. REFERRAL BY REGISTRATION STAFF: AT THE TIME OF REGISTRATION, SELF-PAY PATIENTS OR ANY PATIENT THAT MAY HAVE CONCERNS REGARDING THEIR UPCOMING ADMISSION IS REFERRED TO THE FINANCIAL COUNSELING STAFF. MUNSON HEALTHCARE FINANCIAL COUNSELORS ARE AVAILABLE TO TALK WITH PATIENTS ABOUT THEIR FINANCIAL CONCERNS. THE COUNSELOR VISIT ALL INPATIENTS THAT ARE DEEMED SELF-PAY, TO SEE IF THEY HAVE CONCERNS AND TO DETERMINE IF THEY WOULD LIKE HELP. IF THE PATIENT WOULD LIKE HELP, THE COUNSELORS GATHER INCOME INFORMATION AND SCREEN THE PATIENT FOR MEDICAID. GENERALLY, THESE TWO ACTIONS WILL DETERMINE WHAT PROGRAM THE PATIENT MIGHT QUALIFY FOR. ONCE THE COUNSELOR DETERMINES WHAT THE PATIENT MAY QUALIFY FOR, THE COUNSELOR EDUCATES THE PATIENT ON THE AVAILABLE PROGRAMS AND ASSISTS THEM WITH COMPLETING THE APPROPRIATE APPLICATIONS. THE COUNSELORS ALSO IDENTIFY ALL SELF-PAY OUTPATIENTS AND GO THROUGH THE SAME PROCESS, ONLY BY PHONE. THE GOAL IS TO TALK WITH PATIENTS PRIOR TO ADMISSION, BUT WHEN THAT IS NOT POSSIBLE, THE CALL IS MADE SOON AFTER DISCHARGE. AVAILABLE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO: MEDICAID (AND ALL OF ITS SUBSETS), SOCIAL SECURITY DISABILITY, TRAVERSE HEALTH CLINIC, MUNSON HEALTHCARE FINANCIAL ASSISTANCE, AND MUNSON MEDICAL CENTER MEDS PROGRAM. MUNSON HEALTHCARE MAKES A PHONE CALL TO ALL PRIVATE-PAY PATIENTS PRIOR TO TRANSFERRING THEIR ACCOUNT TO A COLLECTION AGENCY TO INFORM THEM OF OUR FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4 - COMMUNITY INFORMATION DESCRIPTION MANISTEE HOSPITALS PRIMARY SERVICE AREA IS MANISTEE COUNTY AND PORTION OF CERTAIN NEIGHBORING COUNTIES. THE AREA IS LARGELY RURAL, WITH A FEW SMALL CITIES AND QUAINT TOWNS. HOSPITAL SERVICES MUNSON HEALTHCARE MANISTEE HOSPITAL PROVIDES A FULL RANGE OF EMERGENCY, DIAGNOSTIC, TREATMENT, AND REHABILITATION SERVICES. MANISTEE HOSPITAL HAS MORE THAN 50 SPECIALISTS IN THE MANISTEE AREA TO PROVIDE A WIDE RANGE OF CARE TO THE COMMUNITY. WHEN A HIGHER LEVEL OF TREATMENT IS NEEDED, MANISTEE HOSPITAL PHYSICIANS WORK COLLABORATIVELY WITH SPECIALISTS AT MUNSON MEDICAL CENTER AND OTHER HEALTH CARE FACILITIES. POPULATION SERVED MANISTEE COUNTY HAS A POPULATION OF ABOUT 26,000 INDIVIDUALS. THE CITY OF MANISTEE, WITH A POPULATION OF ABOUT 6,200, IS THE LARGEST COMMUNITY IN THE COUNTY. THE CITIZENS OF THE COUNTY ARE PRIMARILY CAUCASIAN (91%), AND 14% LIVE BELOW THE POVERTY LEVEL. A QUARTER OF THE POPULATION IS OVER AGE 65. THIRTEEN PERCENT OF THOSE UNDER AGE 65 HAVE A DISABILITY. EIGHT PERCENT OF THE COUNTY IS UNINSURED. (DATA FROM US CENSUS BUREAU) QUALITY MANISTEE HOSPITAL SCORES WELL ON CLINICAL QUALITY MEASURES. OUR PERFORMANCE IMPROVEMENT TEAM CONTINUOUSLY TRACKS DATA RELATED TO QUALITY MEASURES, INCLUDING PATIENT EXPERIENCE, HOSPITAL ACQUIRED INFECTIONS, AND SAFETY EVENTS. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE MUNSON HEALTHCARE MANISTEE HOSPITAL BOARD OF TRUSTEES IS MADE UP OF COMMUNITY MEMBERS, A MAJORITY OF WHOM RESIDE IN THE HOSPITALS PRIMARY SERVICE AREA. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE, DEDICATED TO ENSURING QUALITY HEALTH CARE. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF AND THE BOARD OF TRUSTEES. MUNSON HEALTHCARE MANISTEE HOSPITAL UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA. MANISTEE HOSPITAL IS ACTIVE IN COMMUNITY HEALTH EFFORTS. MANISTEE HOSPITAL HAS PARTNERED WITH OTHER AREA HEALTH AND HUMAN SERVICE AGENCIES IN ADDRESSING HEALTH ISSUES SUCH AS OBESITY, DIABETES, AND THE OPIOID EPIDEMIC. MEMBERS OF OUR STAFF ARE ACTIVE IN GROUPS THAT STRIVE TO BETTER THE COMMUNITY. WE PROVIDE EDUCATIONAL AND HEALTH PROMOTION ACTIVITIES TO THE COMMUNITY AND SUPPORT THE EFFORTS OF OTHER GROUPS THROUGH SPONSORSHIPS, MEMBERSHIPS, AND USE OF HOSPITAL MEETING SPACE. MEMBERS OF THE MEDICAL STAFF ARE RECRUITED AS NEEDED TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM MUNSON HEALTHCARE MANISTEE HOSPITAL'S SOLE CORPORATE MEMBER IS MUNSON HEALTHCARE, A 501(C)(3) CORPORATION. THE MUNSON HEALTHCARE SYSTEM CONSISTS OF A MAJOR TERTIARY REFERRAL HOSPITAL, SEVERAL RURAL-BASED MEDICAL CENTERS, EXTENSIVE OUTPATIENT TREATMENT AND REHABILITATION FACILITIES, AND ANCILLARY EMERGENCY, TRANSPORTATION AND HOME-BASED MEDICAL SERVICES THAT COVER 24 COUNTIES IN MICHIGANS NORTHERN LOWER PENINSULA AND THE EASTERN PORTION OF THE UPPER PENINSULA. THE MOST SIGNIFICANT OF THE MUNSON HEALTHCARE SUBSIDIARIES IS MUNSON MEDICAL CENTER (MMC). MMC IS ONE OF NINE NOT-FOR-PROFIT HOSPITALS WHICH ARE AFFILIATED WITH EACH OTHER AND SERVE AS THE ONLY HOSPITALS IN THEIR COMMUNITIES. EACH OF THE AFFILIATED HOSPITALS HAS INDIVIDUAL COMMUNITY HEALTH INITIATIVES AND/OR PROMOTION ACTIVITIES, AS WELL AS SHARED INITIATIVES. THE OWNED HOSPITALS IN THE MUNSON HEALTHCARE SYSTEM WHICH INCLUDE MUNSON MEDICAL CENTER, PAUL OLIVER MEMORIAL HOSPITAL, MUNSON HEALTHCARE CADILLAC, MUNSON HEALTHCARE GRAYLING, MUNSON HEALTHCARE CHARLEVOIX HOSPITAL, MUNSON HEALTHCARE MANISTEE HOSPITAL AND MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL PROVIDED 55.5 MILLION OF COMMUNITY BENEFIT IN THE 2017 TAX YEAR. ADDITIONALLY, MMC WORKS IN COOPERATION WITH OTHER ENTITIES IN THE MUNSON HEALTHCARE SYSTEM TO PROVIDE A FULL RANGE OF HEALTH SERVICES TO THE COMMUNITIES IN ITS SERVICE AREA. THE HOME HEALTH DIVISION OF MUNSON HEALTHCARE PROVIDES HOME NURSE AND AIDE SERVICES IN ADDITION TO DURABLE MEDICAL EQUIPMENT AND A PALLIATIVE CARE AND HOSPICE PROGRAM ON THE MUNSON CAMPUS. COMMUNITY BENEFIT, IN THE FORM OF CHARITY CARE AND UNREIMBURSED MEDICAID ARE PROVIDED THROUGH THIS DIVISION EACH YEAR. NORTH FLIGHT, INC. IS THE CHARITABLE TRANSPORTATION ENTITY IN THE SYSTEM. THE GROUND AMBULANCE PROGRAM SERVICES THE MUNSON HEALTHCARE PRIMARY SERVICE AREA. THE AIR AMBULANCE PROGRAM IS CONDUCTED THROUGH A JOINT VENTURE VIA BOTH FIXED WING AND ROTOR WING SERVICES. COMBINED, BOTH PROGRAMS ENSURE SYSTEM PATIENTS ARE ABLE TO ACCESS APPROPRIATE CARE. NORTH FLIGHT, INC. PROVIDED 590,000 IN CHARITY CARE AND UNREIMBURSED MEDICAID IN THE PAST FISCAL YEAR. MUNSON MEDICAL GROUP, THE EMPLOYED PHYSICIAN ORGANIZATION IN THE SYSTEM, PROVIDED APPROXIMATELY 858,000 IN CHARITY CARE AND COMMUNITY BENEFIT IN TAX YEAR 2017. MMC PERFORMS THE NEEDS ASSESSMENTS FOR MUNSON HEALTHCARE. UTILIZING THIS NEEDS ASSESSMENT, MUNSON HEALTHCARE COORDINATES COMMUNITY BENEFIT PROGRAMS THROUGH PLANNING, DEVELOPING, IMPLEMENTING, EVALUATING AND FUNDING PROGRAMS THAT ADDRESS COMMUNITY NEEDS. IN TOTAL, THE MUNSON HEALTHCARE SYSTEM PROVIDED 65.6 MILLION IN CHARITY CARE AND COMMUNITY BENEFITS, INCLUDING NUMEROUS UNCOMPENSATED COMMUNITY HEALTH IMPROVEMENT SERVICES AND PROGRAMS, OUTREACH PROGRAMS, BAD DEBT, AND UNREIMBURSED MEDICARE AND MEDICAID SERVICES TO NORTHERN MICHIGAN. true true false false false false false false false EDWIN NESS DIRECTOR 682931 196867 4024 149728 26514 1060064 JULIE FITZGERALD MD DIRECTOR 418909 9712 34723 7350 29280 499974 JAMES BARKER PRESIDENT 227701 62021 10245 26368 23031 349366 MARK A HEPLER CFO 340821 68700 61024 57891 26780 555216 11542 DON LEMMER HOSPITAL CFO 105784 27853 142634 3174 18050 297495 TINA MILLER CNO 136257 11948 2933 4088 25733 180959 DOUGLAS RICHLEY DO DERMATOLOGIST 670160 8187 2100 7350 25061 712858 MARK D'ANGELO DO SURGEON 620153 6918 36000 7350 18526 688947 ROBERT BARRY MD SURGEON 469709 4830 30600 7350 24848 537337 NEIL DIGIOVANNI MD ANESTHESIOLOGIST 447495 9545 7350 8279 472669 AARON BENNETT DO SURGEON 428950 4515 7350 24700 465515 SCHEDULE J, PAGE 1, PART I, LINE 3 THE PROCESS FOR DETERMINING APPROPRIATE LEVELS OF PAY FOR EXECUTIVE POSITIONS WITHIN MUNSON HEALTHCARE SYSTEM IS CAREFULLY AND THOUGHTFULLY DIRECTED BY THE MUNSON HEALTHCARE BOARD OF DIRECTORS, THROUGH THE COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE. THE COMMITTEE UTILIZES "BEST PRACTICES" METHODS OF DETERMINING COMPENSATION AND, AS SUCH, IS COMPOSED OF SEVEN MEMBERS WHOSE VOTING MEMBERS ARE INDEPENDENT. THE COMMITTEE IS CHARGED WITH ENSURING THAT EXECUTIVE COMPENSATION IS DESIGNED TO ATTRACT AND RETAIN HIGH QUALITY, PROFESSIONAL LEADERSHIP WHILE MAINTAINING STRONG STEWARDSHIP FOR THE ORGANIZATION. COMPENSATION LEVELS REFLECT THE SCOPE OF EACH EXECUTIVE'S RESPONSIBILITIES, EDUCATIONAL BACKGROUND, EXPERIENCE, AND INDUSTRY STANDING AS WELL AS INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. ANNUALLY, THE COMMITTEE RETAINS A NATIONAL INDEPENDENT CONSULTANT TO ENSURE MUNSON HEALTHCARE'S COMPENSATION PRACTICES AND LEVELS ARE INDEPENDENTLY REVIEWED WHILE BEING COMPETITIVE AND REASONABLE. THE MUNSON HEALTHCARE CONFLICT, VALUATION AND COMPLIANCE ("CVC") COMMITTEE ALSO REVIEWS THE SURVEY INFORMATION TO EVALUATE THE REASONABLENESS OF EXECUTIVE COMPENSATION. THAT ANALYSIS OCCURS EACH NOVEMBER. THE COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PAGE 1, PART I, LINE 4 EDWIN NESS 0 136,951 0 JAMES BARKER 0 14,683 0 MARK A. HEPLER 0 37,442 0 DON LEMMER 110,432 0 0 SCHEDULE J, PART III PART I, LINE 4A EXECUTIVE SEVERANCE PLAN: SUBJECT TO REVIEW AND APPROVAL BY THE BOARD COMPENSATION AND EXECUTIVE LEADERSHIP COMMITTEE, IN ORDER TO RECRUIT AND MAINTAIN QUALIFIED EXECUTIVES, A COMPETITIVE BENEFIT PACKAGE IS OFFERED TO THE PRESIDENT AND VICE-PRESIDENTS, WHICH INCLUDES A SEVERANCE PLAN. MUNSON HAS A SEVERANCE PLAN FOR THE PRESIDENT AND VICE-PRESIDENT/EXECUTIVE LEVEL POSITIONS, WHICH PROVIDES FOR THE PRESIDENT UP TO TWO YEARS OF PAY IN THE EVENT EMPLOYMENT ENDS UNDER CERTAIN CONDITIONS AND FOR VICE-PRESIDENTS, UP TO ONE-YEAR OF PAY IN THE EVENT EMPLOYMENT ENDS UNDER CERTAIN CONDITIONS. THE PLAN PROVIDES FOR A 50% OFFSET FOR SUBSEQUENT EMPLOYMENT DURING THE SEVERANCE PERIOD. MEDICAL BENEFITS ARE PROVIDED DURING THE SEVERANCE PERIOD. PART I, LINE 4B EXECUTIVE SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS: SUBJECT TO REVIEW AND APPROVAL BY THE BOARD COMPENSATION AND EXECUTIVE LEADERSHIP COMMITTEE, IN ORDER TO RECRUIT AND MAINTAIN QUALIFIED EXECUTIVES, INCLUDING THE PRESIDENT AND VICE-PRESIDENTS, A COMPETITIVE BENEFIT PACKAGE IS OFFERED WHICH INCLUDES PARTICIPATION IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. FOR THE PRESIDENT, THE PLAN PROVIDES A TARGETED BENEFIT AT AGE 62. ANNUAL CONTRIBUTIONS, AT MUNSON'S DISCRETION, ARE MADE TO THE PLAN IN ORDER TO ACHIEVE THE TARGETED RETIREMENT BENEFIT LEVEL. VICE-PRESIDENTS ARE ELIGIBLE TO PARTICIPATE IN AN AMOUNT NOT TO EXCEED 6% OF BASE COMPENSATION, FUNDED ANNUALLY, AT THE SOLE DISCRETION OF MUNSON. THESE FUNDS ARE AVAILABLE TO VESTED PARTICIPANTS UPON SEPARATION OF EMPLOYMENT FROM MUNSON. FORM 990, PAGE 6, PART VI, LINE 6 MUNSON HEALTHCARE MANISTEE HOSPITAL IS ORGANIZED ON A NONSTOCK MEMBERSHIP BASIS. THE SOLE MEMBER IS MUNSON HEALTHCARE, AN IRS SECTION 501(C)(3) TAX- EXEMPT ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7A MUNSON HEALTHCARE, AS THE SOLE MEMBER, ELECTS THE DIRECTORS FOR SUBSIDIARY ENTITIES. NOMINATIONS TO MUNSON HEALTHCARE FOR SUBSIDIARY DIRECTORS ARE CONSIDERED AND RECOMMENDED BY THE MUNSON HEALTHCARE GOVERNANCE COMMITTEE. FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN DECISIONS OF THE MUNSON HEALTHCARE MANISTEE HOSPITAL (MAN) TRUSTEES ARE SUBJECT TO APPROVAL BY THE MUNSON HEALTHCARE BOARD OF TRUSTEES INCLUDING THE ADOPTION, AMENDMENT, RESTATEMENT OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS OF MAN; THE ADOPTION, EXECUTION, REVOCATION OR ABANDONMENT OF A PLAN OF DISSOLUTION, MERGER, CONSOLIDATION, OR REORGANIZATION; THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF MAN; THE ACQUISITION OF OR THE ESTABLISHMENT OF ANY SUBSIDIARY OR AFFILIATE OF MAN; THE ADOPTION OF ALL OPERATING BUDGETS AND CAPITAL EXPENDITURE BUDGETS FOR MAN; INCURRENCE OF OPERATING OR CAPITAL EXPENDITURES BY MAN WHICH CAUSE THE AGGREGATE OPERATING OR CAPITAL EXPENDITURES TO EXCEED BUDGETED AGGREGATES BY MORE THAN FIVE PERCENT (5%) IN ANY FISCAL YEAR; INCURRENCE OF SECURED BORROWINGS OF MAN WITH THE EXCEPTION OF EQUIPMENT LEASES AND PURCHASE MONEY SECURITY INTERESTS APPROVED AS PART OF THE BUDGET; THE ADOPTION OR AMENDMENT OF THE MISSION STATEMENT, PURPOSES OR THE STRATEGIC GOALS OF MAN; CHANGE IN SCOPE OF CLINICAL SERVICES OR PROGRAMS PROVIDED BY MAN; AND APPOINTMENT OR REMOVAL OF THE PRESIDENT. FORM 990, PAGE 6, PART VI, LINE 11B THE MUNSON HEALTHCARE MANISTEE HOSPITAL BOARD IS COMMITTED TO THE ACCURACY AND THOROUGHNESS OF THE FORM 990 REPORTING. MUNSON HEALTHCARE MANISTEE 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. FORM 990, PAGE 6, PART VI, LINE 12C THE MUNSON HEALTHCARE BOARD OF DIRECTORS (THE SYSTEM PARENT ORGANIZATION) HAS A STANDING CONFLICT, VALUATION AND COMPLIANCE ("CVC") COMMITTEE. THE CVC COMMITTEE IS COMPOSED OF INDEPENDENT BOARD AND COMMUNITY MEMBERS. THE CVC COMMITTEE IS DELEGATED AUTHORITY BY THE BOARD TO REVIEW AND APPROVE THE REASONABLENESS/FAIR MARKET VALUE OF EXECUTIVE COMPENSATION AND FINANCIAL TRANSACTIONS/ARRANGEMENTS WITH DISQUALIFIED PERSONS. ANNUALLY, EACH BOARD MEMBER OF MUNSON HEALTHCARE AND ALL OF ITS SUBSIDIARY/CONTROLLED ENTITIES AND ALL MUNSON EXECUTIVES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE/QUESTIONNAIRE. THE RESPONSES TO THE DISCLOSURE/QUESTIONNAIRE ARE REVIEWED BY THE MUNSON LEGAL DEPARTMENT. ANY FINANCIAL ARRANGEMENTS/POTENTIAL CONFLICTS IDENTIFIED THROUGH THE DISCLOSURE/QUESTIONNAIRES ARE PRESENTED TO THE CVC COMMITTEE FOR ITS REVIEW AND DETERMINATION AS TO THE REASONABLENESS/FAIR MARKET VALUE. WHEN AN ACTION ITEM IS CONSIDERED BY A BOARD WHICH INVOLVES A POTENTIAL CONFLICT BY A BOARD MEMBER, THE CONFLICT IS DISCLOSED AND A BOARD MEMBER WILL ABSTAIN FROM A VOTE ON THE ACTION ITEM, AND, IN ADDITION, THE BOARD CHAIR HAS THE DISCRETION/AUTHORITY TO REQUEST THAT THE CONFLICTED BOARD MEMBER BE EXCUSED FROM THE MEETING FOR AN OPPORTUNITY FOR THE BOARD TO DISCUSS THE MATTER WITHOUT THE PRESENCE OF THE CONFLICTED BOARD MEMBER. FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS FOR DETERMINING APPROPRIATE LEVELS OF PAY FOR EXECUTIVE POSITIONS WITHIN MUNSON HEALTHCARE SYSTEM IS CAREFULLY AND THOUGHTFULLY DIRECTED BY THE MUNSON HEALTHCARE BOARD OF DIRECTORS, THROUGH THE COMPENSATION AND EXECUTIVE LEADERSHIP DEVELOPMENT COMMITTEE. THE COMMITTEE UTILIZES "BEST PRACTICES" METHODS OF DETERMINING COMPENSATION AND, AS SUCH, IS COMPOSED OF SEVEN MEMBERS WHOSE VOTING MEMBERS ARE INDEPENDENT. THE COMMITTEE IS CHARGED WITH ENSURING THAT EXECUTIVE COMPENSATION IS DESIGNED TO ATTRACT AND RETAIN HIGH QUALITY, PROFESSIONAL LEADERSHIP WHILE MAINTAINING STRONG STEWARDSHIP FOR THE ORGANIZATION. ANNUALLY, THE COMMITTEE RETAINS A NATIONAL INDEPENDENT CONSULTANT TO ENSURE THAT MUNSON HEALTHCARE'S COMPENSATION PRACTICES AND LEVELS ARE INDEPENDENTLY REVIEWED WHILE BEING COMPETITIVE AND REASONABLE. THE MUNSON HEALTHCARE CONFLICT, VALUATION AND COMPLIANCE ("CVC") COMMITTEE ALSO REVIEWS THE SURVEY INFORMATION TO EVALUATE THE REASONABLENESS OF EXECUTIVE COMPENSATION. THAT ANALYSIS OCCURS EACH NOVEMBER. COMPENSATION LEVELS REFLECT THE SCOPE OF EACH EXECUTIVE'S RESPONSIBILITIES, EDUCATIONAL BACKGROUND, EXPERIENCE, AND INDUSTRY STANDING AS WELL AS INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. ANNUAL COMPENSATION FOR MUNSON HEALTHCARE SYSTEM EXECUTIVES IS DETERMINED, IN PART, BY MEASURABLE PROGRESS TOWARD THE ORGANIZATION'S GOALS INCLUDING CONTINUED IMPROVEMENT IN CLINICAL QUALITY, COMMUNITY HEALTH, AND OPERATIONAL EFFICIENCIES. MUNSON HEALTHCARE'S INTENT FOR EXECUTIVE BASE COMPENSATION IS TO BE AT THE MEDIAN WHEN COMPARED TO LIKE-SIZE NON-PROFIT HOSPITALS AND HEALTHCARE SYSTEMS. FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS CONSISTENT WITH THAT OF THE TOP EXECUTIVES OF MUNSON HEALTHCARE MANISTEE HOSPITAL AND MUNSON HEALTHCARE. FORM 990, PAGE 6, PART VI, LINE 19 THE MUNSON HEALTHCARE MANISTEE HOSPITAL ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON THE MICHIGAN DEPARTMENT OF TREASURY WEBSITE. MUNSON HEALTHCARE MANISTEE HOSPITAL DOES NOT MAKE THE BYLAWS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. ANNUALLY, MUNSON HEALTHCARE, PARENT CORPORATION, SUBMITS ITS ANNUAL CONSOLIDATED FINANCIAL STATEMENTS TO THE MSRB IN COMPLIANCE WITH BOND DISCLOSURE REQUIREMENTS. FORM 990, PART IX, LINE 11G PURCHASED SERVICES 9,974,196 3,802,237 66,127 PROFESSIONAL FEES 3,303,359 0 0 TOTAL 13,277,555 3,802,237 66,127 MUNSON DIALYSIS CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 383097861 DIALYSIS MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE 1105 SIXTH ST TRAVERSE CITY MI 49684 382640544 PARENT MI C3 12B N/A false MUNSON HOME CARE 1105 SIXTH ST TRAVERSE CITY MI 49684 382191390 HOME HEALT MI C3 10 MUN HOME H MUNSON HOME HEALTH true MUNSON HOME HEALTH 1105 SIXTH ST TRAVERSE CITY MI 49684 383335362 HOME HEALT MI C3 12B MUNSON HC MUNSON HEALTHCARE true MUNSON HOME SERVICES 1105 SIXTH ST TRAVERSE CITY MI 49684 382543463 HOME HEALT MI C3 10 MUN HOME H MUNSON HOME HEALTH true MUNSON MEDICAL CENTER 1105 SIXTH ST TRAVERSE CITY MI 49684 381362830 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true NORTH FLIGHT INC 1105 SIXTH ST TRAVERSE CITY MI 49684 382657917 MED TRANSP MI C3 12B MUNSON HC MUNSON HEALTHCARE true PAUL OLIVER MEMORIAL HOSPITAL 1105 SIXTH ST TRAVERSE CITY MI 49684 381415623 HEALTHCARE MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON MEDICAL GROUP 1105 SIXTH ST TRAVERSE CITY MI 49684 273600575 PHYSICIAN MI C3 10 MUNSON MED MUNSON MEDICAL CENTER true MUNSON HEALTHCARE CADILLAC 1105 SIXTH ST TRAVERSE CITY MI 49684 471156297 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE GRAYLING 1105 SIXTH ST TRAVERSE CITY MI 49684 471161992 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE CADILLAC FOUNDATI 1105 SIXTH ST TRAVERSE CITY MI 49684 472857600 RAISE FUND MI C3 7 MHC CADILL MUNSON HEALTHCARE CADILLAC true MUNSON HEALTHCARE CHARLEVOIX HOSPIT 1105 SIXTH ST TRAVERSE CITY MI 49684 381459366 HOSPITAL MI C3 3 MUNSON HC true MUNSON HEALTHCARE CHARLEVOIX HOSPITAL FOUNDATION 1105 SIXTH ST TRAVERSE CITY MI 49684 753078034 RAISE FUND MI C3 12A MHC CHARLE HOSPITAL true MUNSON HEALTHCARE MANISTEE HOSPITAL FOUNDATION 1465 E PARKDALE AVE MANISTEE MI 496609709 383565083 RAISE FUND MI C3 12A MHC MANIST HOSPITAL true MUNSON HEALTHCARE FOUNDATIONS 1105 SIXTH ST TRAVERSE CITY MI 49684 382642724 RAISE FUND MI C3 7 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE OTSEGO MEMORIAL H 825 N CENTER AVE GAYLORD MI 497351592 381303843 HOSPITAL MI C3 3 MUNSON HC MUNSON HEALTHCARE true MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL FOUNDATION 825 N CENTER AVE GAYLORD MI 497351592 382135473 RAISE FUND MI C3 12A MHC OTSEGO HOSPITAL true MUNSON MEDICAL BUILDING PARTNERS PO BOX 1188 TRAVERSE CITY MI 496851188 382830005 REAL ESTAT MI N/A false false NORTHERN MICHIGAN SUPPLY ALLIANCE 2651 AERO PARK DR TRAVERSE CITY MI 49686 383453378 PURCHASING MI N/A false false MUNSON SUPPORT SERVICES PO BOX 1188 TRAVERSE CITY MI 496851188 382872821 LAUNDRY MI N/A true MUNSON SERVICES INC PO BOX 1188 TRAVERSE CITY MI 496851188 383144382 PHARMACY MI N/A true MEDICAL OFFICE BUILDING CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 383567278 REAL ESTAT MI N/A true SIXTH STREET DRUGS INC PO BOX 1188 TRAVERSE CITY MI 496851188 382298290 PHARMACY MI N/A true MEDICAL OFFICE CONDOMINIUM ASSOCIATION PO BOX 1188 TRAVERSE CITY MI 496851188 201902620 REAL ESTAT MI N/A true MUNSON MOBILE IMAGING PO BOX 1188 TRAVERSE CITY MI 496851188 382704069 IMAGING MI N/A true false false true false false false false false false false false false true false false true true false false MUNSON HEALTHCARE M 2564851 ACTUAL AMOUNT PAID MUNSON HEALTHCARE Q 192492 ACTUAL AMOUNT PAID MUNSON HEALTHCARE P 228313 ACTUAL AMOUNT PAID MUNSON HEALTHCARE MANISTEE FOUNDATI C 56488 ACTUAL AMOUNT PAID MUNSON SERIVCES INC Q 393561 ACTUAL AMOUNT PAID SCHEDULE R MUNSON HEALTHCARE MANISTEE 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.