2016-11-14T14:50:08-06:00 2015-12-31 381357951 PLANTE & MORAN PLLC 600 E Front St Ste 300 Traverse City MI 49686 990 2015-01-01 381303843 OTSEGO MEMORIAL HOSPITAL ASSOCIATION OTSE 9897312100 825 N CENTER GAYLORD MI 49735 THOMAS LEMON CEO 9897312100 2016-11-14 1 CAROL LALONDE CPA P00181637 2319477800 2015 2017-02-10 21:41:12Z OTSEGO COUNTY MEMORIAL HOSPITAL THOMAS LEMON CEO 825 N CENTER GAYLORD MI 49735 93469592 0 X WWW.MYOMH.ORG X 1946 MI TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS AND THE COMMUNITIES WE SERVE BY: WORKING IN PARTNERSHIP WITH AREA PHYSICIANS TO PROVIDE PATIENT-FOCUSED CARE WITH QUALITY AND SERVICE SECOND TO NONE; DELIVERING A FULL CONTINUUM OF ACCESSIBLE CARE THAT ADDRESSES THE COMMUNITIES NEEDS; WORKING TO INCREASE THE PUBLIC'S AWARENESS OF THE BREADTH AND DEPTH OF OTSEGO MEMORIAL HOSPITAL'S SERVICES; MEETING THE PROFESSIONAL NEEDS OF OUR DEDICATED STAFF BY PROVIDING THEM WITH OPPORTUNITIES FOR PROFESSIONAL GROWTH AND EDUCATIONAL DEVELOPMENT; AND REMAINING FISCALLY SOUND. 10 9 846 120 0 0 672032 160212 85859000 90870515 978417 129774 336309 362712 87845758 91523213 0 0 0 0 49650857 54520053 0 0 837551 32289796 33061704 81940653 87581757 5905105 3941456 59493151 65314526 28177385 30599744 31315766 34714782 X TO PROVIDE EXCEPTIONAL HEALTHCARE THAT MEETS THE NEEDS OF OUR PATIENTS, AND THE COMMUNITIES WE SERVE. 1 0 44911336 63364251 ACUTE INPATIENT AND OUTPATIENT CARE FOR DIAGNOSTIC AND MEDICAL CARE: THERE WERE 82,054 ADMISSIONS FOR MEDICAL SURGICAL (1,316), ICU (318), BIRTHING CENTER (412), AND OUTPATIENT REGISTRATIONS (80,008). 23299220 23790966 PHYSICIAN DIAGNOSTIC OFFICES AND URGENT CARE CLINIC: THERE WERE 151,592 PATIENTS FOR MEDICAL GROUP (82,652), LEWISTON/MONTMORENCY (12,955), URGENT CARE (18,114), INDIAN RIVER (14,364), ORTHOPEDICS (17,276) AND BOYNE VALLEY (6,231). 2887523 3342967 LONG TERM CARE FOR THE ELDERLY: THIS PAST YEAR THERE WERE 144 ADMISSIONS WITH 10,563 MCREYNOLDS HALL PATIENT DAYS. 2831262 372331 ALL OTHER PROGRAM SERVICES. 2831262 372331 73929341 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 14 0 1 846 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X AMY BILYEA CONTROLLER 9897312100 825 N CENTER AVE GAYLORD MI 49735 CAROLYN STUDY DIRECTOR-SECRETARY 0.20 0.50 X X 0 0 0 CHRISTOPHER COLLINS DIRECTOR-VICE PRESIDENT 0.20 0.50 X X 0 0 0 DANIEL SMITH DIRECTOR 0.20 0.50 X 0 0 0 DAVID BRINEY DIRECTOR 0.20 0.50 X 0 0 0 DONALD SKLARCZYK DIRECTOR 0.20 0.00 X 0 0 0 DR STEVEN SELLA DIRECTOR 0.20 0.50 X 0 0 0 DR BECKY ASHLEY DIRECTOR 0.20 0.00 X 0 0 0 DR KEVIN SMITH DIRECTOR 40.00 0.00 X 342029 0 0 MARCUS WEGMEYER DIRECTOR-TREASURER 0.20 0.00 X X 0 0 0 MARY SANDERS DIRECTOR-PRESIDENT 0.20 0.50 X X 0 0 0 DR JOHN FOLTZ DIRECTOR - 1ST PART YEAR 40.00 0.00 X 324631 0 17500 SCOTT CHESLEY DIRECTOR - 1ST PART YEAR 0.20 0.00 X 0 0 0 ROBERT COURTOIS VP OF FINANCE & CFO 39.50 0.50 X 201829 0 18000 THOMAS LEMON PRESIDENT AND CEO 39.50 0.50 X 334998 0 18000 BARBARA MILLER VP OF PHYSICIAN SERVICES 40.00 0.00 X 186768 0 0 CHRISTOPHER SQUIRE VP OF PROFESSIONAL & ANCILLARY SERVICES 40.00 0.00 X 158081 0 0 DIANE FISHER VP OF PATIENT CARE SERVICE 40.00 0.00 X 184536 0 0 DR JAMES SHURLOW PHYSICIAN 40.00 0.00 X 452043 0 0 DR STEVEN WISNIEWSKI PHYSICIAN 40.00 0.00 X 460878 0 17498 DR CHANGXIN LI PHYSICIAN 40.00 0.00 X 833842 0 0 DR JOHN MOFFAT PHYSICIAN 40.00 0.00 X 994741 0 0 DR LOUIS HABRYL PHYSICIAN 40.00 0.00 X 647202 0 0 5121578 0 70998 54 0 1 0 BURDCO 1222 VETERNS TRAVERSE CITY MI 49684 CONSTRUCTION 2392338 REMER PLUMBING & HEATING PO BOX 1569 SAGINAW MI 48605 PLUMBING/HEATING 718981 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 DIAGNOSTIC SERVICES 494484 STRYKER SALES PO 70119 CHICAGO IL 60673 MEDICAL EQUIPMENT 433855 SIEMENS MEDICAL SOLUTIONS USA DEPT CH 14195 PALATINE IL 60055 MEDICAL EQUIPMENT SERVICES 427533 23 6843 120951 8996 23422 160212 PATIENT SERVICE REVENUE 622110 89973816 89973816 OTHER RELATED REVENUE 622110 803338 803338 EHR REVENUE 622110 93361 93361 90870515 442871 442871 143022 46475 96547 96547 96547 1574107 12700 1537804 362100 36303 -349400 -313097 -313097 CAFETERIA REVENUE 722210 266165 266165 266165 91523213 90870515 0 492486 1498671 804483 694188 41709200 36256550 5235919 216731 1194318 1026865 161434 6019 7528719 7171498 340178 17043 2589145 2226126 349970 13049 196397 196397 314072 314072 5803 5803 96510 96510 4125524 2779901 1018226 327397 109484 26184 83300 676894 318528 323645 34721 329176 159943 167127 2106 1785422 690546 1094876 164034 110206 47886 5942 142684 97027 44857 800 543370 405710 136335 1325 2794515 2087749 699965 6801 964514 235020 729494 SUPPLIES 13660875 13484575 174987 1313 PROVISION FOR BAD DEBT 2493059 2493059 REPAIRS AND MAINTENANCE 1934867 1246036 671096 17735 QUALITY ASSESSMENT FEES 1735313 1735313 989191 600206 285716 103269 87581757 73929341 12814865 837551 2844933 1633310 1736051 37935 5983568 6231822 1358751 1339443 2667844 2836927 62292336 30126473 28263532 32165863 12710080 15584507 1517015 2803241 2411377 2681478 59493151 65314526 8325395 9857772 186001 185506 17981249 17499353 136849 0 1547891 3057113 28177385 30599744 X 31294076 34685605 21690 29177 31315766 34714782 59493151 65314526 3941456 -542440 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5803 5803 0 Part II-B, Line 1: SUPPORTED LOBBYING ACTIVITIES THROUGH ANNUAL DUES PAID TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION. 0 1455291 1455291 39766542 16990499 22776043 911194 348384 562810 19848151 12787590 7060561 311158 311158 32165863 COST REPORT SETTLEMENT PAYABLE 3057113 3057113 X Part X, Line 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE ORGANIZATION AND ITS SUBSIDIARY ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2012. 1 1 X 1 X 1 X 1 1 0 1 1 1 767 285597 485274 -199677 0.00000 1 32412 15200051 14754695 445356 0.00520 2 33179 15485648 15239969 245679 0.00520 1956 4546 366130 5528 360602 0.00420 1 15 7880 0 7880 0.00010 5 22790 18108066 16728134 1379932 0.01620 8 0 38284 0 38284 0.00040 1970 27351 18520360 16733662 1786698 0.02090 1972 60530 34006008 31973631 2032377 0.02610 1 0 10000 10000 0.00010 4 0 193 193 0.00000 1 10 329 329 0.00000 114 220 42071 42071 0.00050 10 0 1023 1023 0.00000 11 0 358233 358233 0.00420 141 230 411849 411849 0.00480 1 2493058 371552 22197091 21192143 1004948 X 1 1 1 1 OTSEGO MEMORIAL HOSPITAL ASSOCIATION 825 N CENTER AVE GAYLORD MI 49735 WWW.MYOMH.ORG 1060000063 X X X long-term care FACILITY AND PHYSICIAN CLINICS OTSEGO MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X 15 1 1 1 1 X http://www.myomh.org/community-needs-assessment X 1 13 1 http://www.myomh.org/community-needs-assessment 0 0 1 X 100.000000000000 350.000000000000 X X X X X 1 1 X X X 1 X http://www.myomh.org/patient-assistance-program X http://www.myomh.org/patient-assistance-program X http://www.myomh.org/patient-assistance-program X X X X X 1 X 0 X X 1 X 0 0 OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 5: IN CONDUCTING THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, OTSEGO MEMORIAL HOSPITAL, IN CONJUNCTION WITH ITS PARTNERING HOSPITALS, CONDUCTED A DAYLONG SESSION WITH HEALTH PROFESSIONALS AND SECTOR REPRESENTATIVES IN LATE DECEMBER 2015. ADDITIONALLY, MORE THAN 1,200 INDIVIDUALS PARTICPATED IN SURVEYS AND/OR FOCUS GROUPS THROUGHOUT NORTHERN MICHIGAN IN 2015 FOR THE REGIONAL COMMUNITY HEALTH ASSESSMENT. ABOUT 1,100 RESIDENTS COMPLETED A "WHAT MATTERS TO YOU" SURVEY, INCLUDING 445 RESIDENTS FROM ANTRIM, CHEOYGAN, OTSEGO AND MONTMORENCY COUNTIES. MORE THAN 122 PHYSCIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS COMPLETED A "HEALTH CARE PROVIDER" SURVEY. ADDITIONALLY, EXTRA EFFORT WAS MADE TO REACH LOW-INCOME RESIDENTS, MINORITIES, AND THE UNINSURED. THE COMMUNITY MEETINGS WERE HELD MOSTLY AT HEALTH DEPARTMENT OFFICES AND MARKETED THROUGH EXISTING SOCIAL SERVICE ORGANIZATIONS WORKING WITH THOSE POPULATIONS. A COMBINED TOTAL OF 74 PARTICIPANTS TOOK PART IN THE FOUR COMMUNITY CONVERSATIONS HELD IN CHEBOYGAN, MONTMORENCY, ANTRIM, AND OTSEGO COUNTIES. IN ADDITION TO THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, CHARLEVOIX AREA HOSPITAL, AND MCLAREN NORTHERN MICHIGAN HOSPITAL, ALL PARTNERED WITH OTSEGO MEMORIAL HOSPITAL IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT COMMITTEE INCLUDED REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: OTSEGO COUNTY MSU EXTENSION, ALCONA HEALTH CENTER, HEALTH DEPT OF NW MICHIGAN, OTSEGO MEMORIAL HOSPITAL, COP EDUCATION SERVICE DISTRICT, CHARLEVOIX AREA HOSPITAL, NORTH COUNTY CMH SERVICES, MCLAREN NORTHERN MICHIGAN, THUNDER BAY COMMUNITY HEALTH SERVICE, WOMEN'S RESOURCE CENTER, HARBOR HALL, NE MICHIGAN CMH AUTHORITY, CHAR-EM UNITED WAY, EAST JORDAN FAMILY HEALTH CENTER, DISTRICT HEALTH DEPT #4, NORTHERN HEALTH PLAN, MUNSON MEDICAL CENTER, NORTHERN MICHIGAN REGIONAL ENTITY, ALPENA REGIONAL MEDICAL CENTER, MSU COLLEGE OF HUMAN MEDICINE, AND NORTHERN MICHIGAN SUBSTANCE ABUSE SERVICES.ADDITIONAL INFORMATION CAN BE FOUND IN THE COMMUNITY HEALTH NEEDS ASSESSMENT LOCATED AT THE FOLLOWING WEBSITE: HTTP://WWW.MYOMH.ORG/COMMUNITY-NEEDS-ASSESSMENT. OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 6a: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING OTHER HOSPITAL FACILITIES - CHARLEVOIX AREA HOSPITAL AND MCLAREN NORTHERN MICHIGAN. OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 6b: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING OTHER NON-HOSPITAL ORGANIZATIONS - HEALTH DEPARTMENT OF NORTH WEST MICHIGAN, AND DISTRICT HEALTH DEPARTMENT #4. OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 11: FROM THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, THE TOP THREE AREAS OF HEALTH CONCERN IDENTIFIED ARE: EXPANDING ACCESS TO CARE, CHRONIC DISEASE EDUCATION AND MANAGEMENT, AND MATERNAL AND CHILD HEALTH AND WELLNESS ACTIVITIES. FOR ALL THREE AREAS OTSEGO MEMORIAL HOSPITAL BELIEVES THEY COULD DIRECT RESOURCES TO HELP ADDRESS THE GROWING HEALTH CONCERN. REGARDING ACCESS TO CARE, OTSEGO MEMORIAL HOSPITAL IS WORKING TO EXPAND SERVICES IN RURAL COMMUNITIES, OFFER ONSITE SCREENINGS AND EXPANDING OFFERINGS FOR SERVICES AT LOCAL HEALTH FAIRS, AND SIGNING INDIVIDUALS UP FOR INSURANCE BY EMPLOYING A CERTIFIED APPLICATION COUNSELOR. FOR CHRONIC DISEASE, OTSEGO MEMORIAL HOSPITAL IS COMMITTED TO OFFERING AND EXPANDING A CDC DIABETES PREVENTION PROGRAM, DOUBLING THE NUMBER OF CLASSES OFFERED. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO EDUCATE THE COMMUNITY ON IMPORTANT CHRONIC DISEASE TOPICS SUCH AS CANCER, HEART HEALTH, AND DIABETES THROUGH PRINT AND SPEAKING EVENTS. FOR MATERNAL AND CHILD HEALTH, OTSEGO MEMORIAL HOSPITAL IS EXPANDING OFFERINGS IN THE LOCAL SCHOOLS, INCLUDING A 6 WEEK HEALTH PROGRAM FOR ELEMENTARY STUDENTS. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO OFFER CLASSES TO NEW PARENTS, WILL EXPLORE OFFERING A HEALTH LIFESTYLES CLASS FOR FAMILIES--WORKING TO REDUCE OBESITY AND INCREASE HEALTH EATING AND ACTIVITY LEVELS FOR YOUTH IN THE COUNTIES SERVED BY OTSEGO MEMORIAL HOSPITAL. OTSEGO MEMORIAL HOSPITAL WILL CONTINUE TO OFFER OB/GYN SERVICES IN INDIAN RIVER, AND WILL WORK TO EDUCATE COMMUNITY MEMBERS ON SERVICES OFFERED FOR MOTHER AND CHILD IN THIS VERY RURAL SETTING. OTHER NEEDS IDENTIFIED IN THE MOST RECENT CHNA INCLUDE: SUBSTANCE USE, MENTAL HEALTH AND HEALTH DISPARITIES. THESE ISSUES RANKED 4-6 IN THE CHNA. OTSEGO MEMORIAL HOSPITAL FEELS THAT BASED ON AVAILBLE RESOURCES AND EXPERTISE OF STAFF, THE TOP THREE ISSUES CAN BE BEST ADDRESSED BY THE HOSPITAL. OTSEGO MEMORIAL HOSPITAL ASSOCIATION Part V, Section B, Line 22d: FAP ELIGIBLE PATIENTS ARE NOT CHARGED MORE THAN THE AMOUNT GENERALLY BILLED (AGB) TO PATIENTS WITH INSURANCE. WE DETERMINE THE AGB BY: AS A NUMERATOR, THE AVERAGE AMOUNT ALLOWED BY INSURANCE FOR PATIENTS COVERED UNDER MEDICAID, MEDICARE OR COMMERCIAL INSURANCE (LOOKING BACK ONE YEAR) DIVIDED BY THE GROSS CHARGES FOR ALL THE SAME SERVICES AS THE DENOMINATOR. THE 501R RULE REQUIRES PATIENTS WHO "MAY BE ELIGIBLE FOR THE FAP WILL NOT BE CHARGED MORE THAN THIS AMOUNT". THIS PERCENTAGE WILL BE MULTIPLED BY THE CHARGES AMOUNT IN OUR SYSTEM TO DERIVE THE MAXIMUM BILLED AMOUNT. THE CALCULATION OF THE AGB WILL BE UPDATED ANNUALLY WITHIN THE 120-DAY PERIOD FOLLOWING THE ANNIVERSARY DATE OF THE INITIAL AGB CALCULATION. 7 1 - OMH MEDICAL GROUP GAYLORD 829 N CENTER AVENUE GAYLORD MI 49735 OUTPATIENT CLINIC 2 - MEDCARE CLINIC 1996 WALDEN DRIVE GAYLORD MI 49735 WALK-IN AND OUTPATIENT CLINIC 3 - NORTHOPEDICS CLINIC 2147 PROFESSIONAL DRIVE GAYLORD MI 49735 OUTPATIENT CLINIC 4 - MCREYNOLDS HALL 825 N CENTER AVENUE GAYLORD MI 49735 LONG-TERM CARE 5 - LEWISTON CLINIC 3040 BOURN STREET LEWISTON MI 49756 WALK-IN AND OUTPATIENT CLINIC 6 - INDIAN RIVER CLINIC 3696 SOUTH STRAITS HWY INDIAN RIVER MI 49749 WALK-IN AND OUTPATIENT CLINIC 7 - BOYNE VALLEY CLINIC 2572 NORTH US-131 ELMIRA MI 49730 WALK-IN AND OUTPATIENT CLINIC Part I, Line 3c: UNDER ITS ASSISTANCE PROGRAM, OTSEGO MEMORIAL HOSPITAL WILL MAKE AVAILABLE A REASONABLE AMOUNT OF UNCOMPENSATED OR REDUCED PRICE SERVICES TO PERSONS ELIGIBLE UNDER APPLICABLE GUIDELINES. OTSEGO MEMORIAL HOSPITAL'S ASSISTANCE PROGRAM SERVICES ARE NOT LIMITED TO ANY SPECIFIC HOSPITAL SERVICE. INDIVIDUAL ELIGIBILITY FOR ASSISTANCE IS DETERMINED BY MEASURING FAMILY INCOME IN RELATION TO FAMILY SIZE AGAINST THE INCOME POVERTY GUIDELINE ESTABLISHED BY THE COMMUNITY SERVICE ADMINISTRATION. IF THE HOSPITAL DETERMINES THAT SERVICES ARE NOT MEDICALLY NECESSARY, ELECTIVE OR OTHERWISE, THE HOSPITAL CAN DENY SERVICES UNDER THE FINANCIAL ASSISTANCE PROGRAM. ASSETS INCLUDING THE PATIENT'S PLACE OF RESIDENCE ARE ALSO CONSIDERED AS PART OF THE EVALUATION. Part I, Line 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E), HEALTH PROFESSIONS EDUCATION (LINE 7F), SUBSIDIZED HEALTH SERVICES (LINE 7G) AND CASH AND IN-KIND CONTRIBUTIONS (LINE 7I). Part I, Line 7g: ALL PHYSICIAN CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES. THE COST REPORTED ON PAGE 1, LINE 7G OF $18,108,066 IS FOR THESE PHYSICIAN CLINICS. Part I, Ln 7 Col(f): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $2,493,058. Part II, Community Building Activities: OTSEGO MEMORIAL HOSPITAL IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. OTSEGO MEMORIAL HOSPITAL STAFF REPRESENT OTSEGO MEMORIAL HOSPITAL ON A VARIETY OF COMMITTEES AND COMMUNITY BOARDS IN WHICH OTSEGO MEMORIAL HOSPITAL OFFERS ASSISTANCE THROUGH STAFF, FACILITIES, AND RESOURCES WITH THE END GOAL OF WORKING TO ADDRESS COMMUNITY ISSUES RELATED TO HEALTH IMPROVEMENT, EDUCATION, POVERTY, WORKFORCE DEVELOPMENT AND ACCESS TO CARE. WE ALSO ENCOURAGE OUR EMPLOYEES TO SERVE IN THE COMMUNITY TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE. AND, WE WORK WITH NEIGHBORHOOD PROGRAMS, INCLUDING PUBLIC AND PRIVATE LOCAL SCHOOLS, OTSEGO COUNTY COMMISSION ON AGING, WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. Part III, Line 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.EFFECTIVE APRIL 1, 2014, THE STATE OF MICHIGAN EXTENDED MEDICAID TO MORE LOW-INCOME PATIENTS, WHICH RESULTED IN PATIENTS PREVIOUSLY CLASSIFIED AS SELF-PAY TO BE ELIGIBLE FOR MEDICAID. THE ALLOWANCES FOR BAD DEBT, PROVISION FOR MEDICAID RECEIVABLE, AND AMOUNT REPORTED AS CHARITY CARE AS OF DECEMBER 31, 2015 AND 2014 HAVE BEEN SIGNIFICANTLY IMPACTED BY THIS PROGRAM. Part III, Line 8: THE FOLLOWING COSTING METHOD OF COST TO CHARGE RATE IS USED; MEDICARE COSTS DIVIDED BY MEDICARE CHARGES. ANY SHORTFALLS CALCULATED ARE CONSIDERED TO BE COMMUNITY BENEFIT. Part III, Line 9b: ALL PATIENTS RECEIVING TREATMENT AT OTSEGO MEMORIAL HOSPITAL (INCLUDING CHARITY CARE PATIENTS) ARE RESPONSIBLE FOR PAYING IN FULL ALL CHARGES FOR SUCH TREATMENT, LESS ANY AMOUNTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, DISCOUNT CONSIDERATIONS OR INSURANCE COVERAGE, PER POINT OF SERVICE COLLECTION POLICY. Part VI, Line 2: OTSEGO MEMORIAL HOSPITAL CONDUCTED AN EXTENSIVE AND COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSEMENT THROUGHOUT 2015 AND COMPLETED A COMMUNITY HEALTH IMPROVEMENT ACTION PLAN WHICH WAS ADOPTED BY THE HOSPITAL BOARD OF DIRECTORS IN APRIL 2016. THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED MULTIPLE COMMUNITY FOCUS GROUPS, ONLINE SURVEYS, AND A PRIORITIZATION MEETING AIMED TO IDENTIFY THE TOP HEALTH CONCERNS FOR THE COMMUNITIES BEING SERVED BY OTSEGO MEMORIAL HOPSITAL. IN ADDITION, OTSEGO MEMORIAL HOSPITAL USES INPUT FROM PHYSICIANS, MEDICAL PROVIDERS, AND COMMUNITY MEMBERS TO ASSIST IN ITS ASSESSMENT AND PRIORITIZATION OF THE COMMUNITIES' HEALTHCARE NEEDS. OTSEGO MEMORIAL HOSPITAL WORKS IN COLLABORATION WITH VARIOUS COMMUNITY GROUPS INCLUDING BUT NOT LIMITED TO: THE HEALTH DEPARTMENT, NORTHERN HEALTH PLAN, UNITED WAY, OTSEGO COUNTY COMMISSION ON AGING, OTSEGO AREA CHAMBER OF COMMERCE, AND OTHER LOCAL ASSOCIATIONS IN ORDER TO CONTINUE TO UNDERSTAND THE LOCAL HEALTHCARE NEEDS OF OUR SERVICE AREA. Part VI, Line 3: THE OTSEGO MEMORIAL HOSPITAL REGISTRATION MANAGER OR THE CERTIFIED APPLICATION COUNSELOR (CAC) ATTEMPTS TO SEE THE PATIENTS IN EMERGENCY ROOM OR AT REGISTRATION. REGISTRATION STAFF HAVE ALSO BEEN TRAINED TO HAND OUT ASSISTANCE PACKAGES AND TO DIRECT PATIENTS TO SEE THE CERTIFIED APPLICATION COUNSELOR (CAC) OR FINANCIAL ADVISOR. WHEN THE PATIENT COMES IN ON THE WORK LIST THEY ARE ALSO INFORMED OF THE ASSISTANCE PACKAGE AND/OR APPLICATION. THE FORM IS ALSO ON THE OTSEGO MEMORIAL HOSPITAL WEBSITE. THERE ARE ALSO WRITTEN NOTICES AT THE BOTTOM OF THE PATIENT STATEMENTS. WHEN THERE IS A SCHEDULED PROCEDURE AND THE PATIENT DOES NOT HAVE INSURANCE, A CALL IS MADE FOR PAYMENT, CAC APPOINTMENT, OR CHARITY CARE ARRANGEMENTS. PATIENTS IDENTIFIED WITHOUT INSURANCE OR NEEDING FINANCIAL EDUCATION, ARE SCHEDULED FOR AN APPOINTMENT WITH THE CERTIFIED APPLICATION COUNSELOR (CAC). THE CAC HELPS PATIENTS TO APPLY FOR MEDICAID, INSURANCE EXCHANGE PLANS, OTHER PROGRAMS OR FINANCIAL ASSISTANCE. Part VI, Line 4: OTSEGO MEMORIAL HOSPITAL PROVIDES HEALTHCARE TO TWELVE COMMUNITIES LOCATED WITHIN ANTRIM, CHEBOYGAN, OTSEGO AND MONTMORENCY COUNTIES (THE COMMUNITIES ARE: BOYNE FALLS, ATLANTA, ELMIRA, FREDERIC, GAYLORD, INDIAN RIVER, JOHANNESBURG, LEWISTON, MANCELONA, WATERS, WOLVERINE, AND VANDERBILT). THE POPULATION INCLUDES A SIGNIFICANT NUMBER OF RETIREES. SERVICES ARE NOT LIMITED TO RESIDENTS OF THESE COMMUNITIES AS THE AREA HAS A HIGH VOLUME OF TRANSIENTS THAT COME FOR NUMEROUS RECREATIONAL AND SEASONAL ACTIVITIES. THE OUTLYING AREAS ARE PREDOMINANTLY IN A RURAL, AGRICULTURAL BASED SETTING. Part VI, Line 5: OTSEGO MEMORIAL HOSPITAL (OMH) OFFERS A VARIETY OF PROGRAMS AND SERVICES WITH THE END GOAL OF PROMOTING THE GREATER HEALTH OF THE COMMUNITY. OMH PROVIDED DISCOUNTED SPORTS PHYSICALS TO MORE THAN 330 AREA STUDENT ATHLETES, DONATING ONE HUNDRED PERCENT OF THE PROCEEDS BACK TO THE LOCAL SCHOOL ATHLETIC DEPARTMENTS. THE HOSPITAL PARTICIPATES IN A VARIETY OF LOCAL FREE HEALTH EVENTS, INCLUDING OFFERING FREE HEALTH SCREENINGS TO PARTICIPANTS; SCREENINGS INCLUDED BLOOD PRESSURE, PULMONARY, BMI, HEIGHT AND WEIGHT. ADDITIONALLY, THE HOSPITAL OFFERED DISCOUNTED FULL LIPID PROFILE SCREENINGS TO MORE THAN 500 PARTICIPANTS AT A SENIOR EXPO. OMH HOSTS MONTHLY WELLNESS WEDNESDAYS, OFFERING CHOLESTEROL, BLOOD PRESSURE, BMI, HEIGHT, WEIGHT AT A DISCOUNTED RATE TO COMMUNITY MEMBERS. THE HOSPITAL OFFERS A MAMMOGRAPHY ASSISTANCE PROGRAM, TO ENSURE THAT WOMEN WHO DO NOT QUALIFY FOR A FREE MAMMOGRAM THROUGH THE LOCAL HEALTH DEPARTMENT, YET HAVE NO MEANS TO PAY FOR IT PRIVATELY, ARE COVERED AND RECEIVE A SCREENING AND IF NECESSARY DIAGNOSTIC MAMMOGRAM AND OTHER SERVICES AT NO CHARGE. ADDITIONALLY, THE HOSPITAL OFFERS A DIABETES ASSISTANCE PROGRAM AND AN ONCOOGY ASSISTANCE PROGRAM DESIGNED TO HELP THOSE DIAGNOSED WITH THOSE DISEASES AND STRUGGLING FINANCIALLY TO RECEIVE THE ASSISTANCE THEY NEED TO ATTEND TREATMENTS AND TEST REGULARLY FOR DIABETES. IN 2014, OMH BEGAN OFFERING THE CDC'S YEAR LONG DIABETES PREVENTION PROGRAM, WORKING WITH INDIVIDUALS WHO HAVE BEEN DIAGNOSED AS PRE-DIABETIC TO REDUCE CALORIE INTAKE, INCREASE EXERCISE, AND UNDERSTAND PORTION CONTROL. THIS PROGRAM HAS SEEN A HIGH SUCCESS RATE OF COMPLETEION AND BMI REDUCTION. OMH ALSO WORKS CLOSELY WITH THE LOCAL SCHOOLS TO ASSIST THE HIGH SCHOOL LEVEL MEDICAL OCCUPATIONAL PROGRAM IN JOB SHADOWING AND EDUCATION PROGRAM FOR STUDENTS THROUGHOUT THE FACILITY AND SCHOOL YEAR. NEW PARENTS ARE INVITED TO PARTICIPATE IN CHILDBIRTH EDUCATION CLASSES OFFERED BY OMH STAFF FOR A NOMINAL FEE. ON A QUARTERLY BASIS THE HOSPITAL PRODUCES AND DISTRIBUTES LITERATURE TO MORE THAN 38,000 HOUSEHOLDS THROUGHOUT THE SERVICE AREA ON VARIOUS HEALTHCARE ISSUES AND TOPICS, INCLUDING INFORMATION ON LOCAL FREE HEALTH EVENTS. OMH HAS NUMEROUS MEDICAL PRACTICES THAT ARE FEDERALLY QUALIFIED RURAL HEALTHCARE CLINICS, AS WELL AS OMH IS LOCATED WITHIN A HEALTH PROFESSIONAL SHORTAGE AREA. BOTH OF THESE QUALIFICATIONS DEMONSTRATE OMH'S ISOLATED SERVICE AREA WHICH HAS RESULTED IN CHALLENGING PHYSICIAN RECRUITMENT AND RETENTION. OMH'S COMMITMENT TO PROVIDING THE HIGHEST LEVEL OF CARE STARTS WITH PHYSICIAN AND OTHER PROVIDERS. EXTENSIVE RECRUITMENT ACTIVITIES MUST TAKE PLACE IN ORDER TO PROVIDE CARE TO THESE HEALTH PROFESSIONAL SHORTAGE AREAS. ADDITIONALLY, OMH IS WORKING DILIGENTLY TO BRING SERVICES INTO THE RURAL SETTING. THIS INCLUDES OPENING THE NEWLY BUILDT OMH MEDICAL GROUP-INDIAN RIVER, WHICH NOT ONLY EXPANDED TESTING SERVICES, BUT ALSO BROUGHT FULL TIME OB/GYN AND PEDIATRIC SERVICES TO THAT RURAL AREA (NOTE: THIS CLINIC IS A FEDERALLY QUALIFIED RURAL HEALTH CENTER).(1). A MAJORITY OF THE HOSPITAL'S BOARD OF TRUSTEES IS MADE UP OF COMMUNITY REPRESENTATIVES RESIDING WITHIN THE HOSPITAL'S SERVICE AREA. (2). THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS AS APPROVED BY OUR HOSPITAL BOARD OF DIRECTORS. DUE TO THE SIZE AND RURAL NATURE OF THE HOSPITAL SERVICE AREA, NOT ALL HEALTHCARE SPECIALTIES ARE OFFERED THROUGH THE HOSPITAL. (3). THE HOSPITAL APPLIES SURPLUS FUNDS, INCLUDING DONATIONS FROM THE FOUNDATION, TO ASSIST IN PURCHASING EQUIPMENT FOR PATIENT USE AND FUNDING MANY OF THE COMMUNITY HEALTH EDUCATION PROGRAMS LISTED ABOVE. ADDITIONALLY, THE HOSPITAL WORKS TO USE ANY SURPLUS FUNDS TO CONTINUE TO ADVANCE THE MISSION OF THE ORGANIZATION THROUGH GROWTH AND DEVELOPMENT OPPORTUNITIES. Part VI, Line 6: OTSEGO MEMORIAL HOSPITAL (OMH) HAS HAD AN AFFILIATION AGREEEMENT WITH MUNSON MEDICAL CENTER (MUNSON) SINCE 2006. UNDER THE AGREEMENT, OMH HAS EFFECTIVELY EXPANDED SERVICES AVAILABLE TO THE PATIENTS IN ITS PRIMARY AND SECONDARY SERVICE AREAS AND CAN ENSURE PATIENTS WILL HAVE A SMOOTH TRANSITION WHEN THEY REQUIRE THE SERVCIES OF A LARGER MEDICAL CENTER. UNDER THE AFFILATION, THE ESSENTIAL GOALS ARE TO ENHANCE THE QUALITY OF CLINICAL SERVICES; AND MAINTAIN AND IMPROVE CLINICAL AND ADMINISTRATIVEEFFICIENCY, EFFECTIVENESS AND FINANCIAL PERFORMANCE.UNDER THE AFFILIATION AGREEMENT OMH IS ABLE TO TAKE ADVANTAGE OF A VARIETY OF PURCHASED SERVICES, SUCH AS: INFORMATION TECHNOLOGY HOSTING, TELECOMMUNICATIONS TECHNICAL ASSISTANCE, IT BUSINESS CONTINUITY PLANNING & SECURITY AUDITING; LAUNDRY SERVICES; PHYSICIAN NEEDS ASSESSMENTS AND RECURUITMENT; REIMBURSEMENT MODELING AND COST REPORT PREPARATION; FINANCIAL PLANNING FOR DEBT OFFERINGS; EDUCATION AND TRAINING FOR EMPLOYEES, MANAGEMENT, AND BOARD MEMBERS; GROUP PURCHASING ACCESS; PRODUCT VALUE ANALYSIS; MARKETING; AND BRANDING.ALSO FACILITATED THROUGH THE AFFILITAION ARE COLLABORATIVE EFFORTS FOR VARIOUS INITIATIVES, SUCH AS ICD-10 DOCUMENTATION AND CODING; HIPAA COMPLIANCE; REIMBURSEMENT MODELING, STATEGIC PLANNING; REGIONAL ANALYSIS OF SERVICES NEEDS AND OPPORTUNITIES; ACCESS TO MEDICAL TECHNOLOGIES; FORUMS FOR MANAGERS, EXECUTIVES AND BOARD MEMBERS AND THE ABILITY OF MANAGERS TO BENCHMARK WITH THEIR COUNTERPARTS AMONG ALL THE MEMBERS OF THE AFFILIATION.OMH AND MUNSON ALSO COLLABORATE TO OFFER SERVICES CLOSE TO HOME THAT MIGHT NOT OTHERWISE BE AVAILABLE TO THE GAYLORD COMMMUNITY. THESE SERVICE LINES INCLUDE: CARDIOLOGY, ONCOLOGY, MOBILE IMAGING AND INFECTIOUS DISEASES. Part VI, Line 7, Reports Filed With States MI X X X 0 0 0 0 0 0 0 0 0 DR KEVIN SMITH DIRECTOR 341813 0 0 0 216 0 0 0 0 0 342029 0 0 0 DR JOHN FOLTZ DIRECTOR - 1ST PART YEAR 306771 0 0 0 17860 0 17500 0 0 0 342131 0 0 0 ROBERT COURTOIS VP OF FINANCE & CFO 176245 0 0 0 25584 0 18000 0 0 0 219829 0 0 0 THOMAS LEMON PRESIDENT AND CEO 309966 0 0 0 25032 0 18000 0 0 0 352998 0 0 0 BARBARA MILLER VP OF PHYSICIAN SERVICES 171350 0 0 0 15418 0 0 0 0 0 186768 0 0 0 CHRISTOPHER SQUIRE VP OF PROFESSIONAL & ANCILLARY SERVI 151871 0 0 0 6210 0 0 0 0 0 158081 0 0 0 DIANE FISHER VP OF PATIENT CARE SERVICE 158952 0 0 0 25584 0 0 0 0 0 184536 0 0 0 DR JAMES SHURLOW PHYSICIAN 433851 0 0 0 18192 0 0 0 0 0 452043 0 0 0 DR STEVEN WISNIEWSKI PHYSICIAN 435846 0 0 0 25032 0 17498 0 0 0 478376 0 0 0 DR CHANGXIN LI PHYSICIAN 808810 0 0 0 25032 0 0 0 0 0 833842 0 0 0 DR JOHN MOFFAT PHYSICIAN 969157 0 0 0 25584 0 0 0 0 0 994741 0 0 0 DR LOUIS HABRYL PHYSICIAN 620552 0 0 0 26650 0 0 0 0 0 647202 0 0 0 A COUNTY OF OTSEGO HOSPITAL FINANCE 386004882 689065AA8 2013-10-31 10000000 REFINANCE 0 0 0 B CITY OF GAYLORD HOSPITAL 383635769 368175AA8 2013-10-31 6095324 REFINANCE 0 0 0 C CITY OF GAYLORD HOSPITAL 383635769 368175AB1 2013-10-31 1885925 REFINANCE 0 0 0 A 10000000 10000000 9795755 200000 4245 2013 0 1 1 1 B 6095324 6095324 6095324 2013 0 1 1 1 C 1764677 1885925 1721661 164264 2013 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Form 990, Part I, Item C DBA: OTSEGO COUNTY MEMORIAL HOSPITAL DBA: OTSEGO MEMORIAL HOSPITAL Form 990, Part III, line 2 EXPANSION OF THE INDIAN RIVER CLINIC FROM A 4,200 SQUARE FOOT LEASED FACILITY TO A 12,400 OWNED FACILITY WHICH INCLUDES AN EXPANSION OF FAMLY PRACTICE AND WALK-IN. ADDITIONALLY, OB/GYN AND PEDIATRICS ARE NEW SERVICES ADDED WITH THE EXPANSION. Form 990, Part VI, Section A, line 6 THE ORGANIZATION HAS APPROXIMATELY 151 GENERAL MEMBERS. ANNUAL DUES ARE $5 PER INDIVIDUAL OR $8 PER FAMILY. REQUIREMENTS TO BE A MEMBER ARE A MINIMUM OF EIGHTEEN YEARS OF AGE AND HAS A RESIDENCE IN THE AREA THAT THE HOSPITAL SERVES. EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. Form 990, Part VI, Section A, line 7a EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. Form 990, Part VI, Section A, line 7b EACH MEMBER HAS TWO RIGHTS: ELECTION OF THE BOARD OR OF THE CANDIDATES PROPOSED AND TO VOTE APPROVAL FOR REVISIONS TO CORPORATE BYLAWS. Form 990, Part VI, Section B, line 11 THE 990 IS REVIEWED BEFORE FILING BY THE FOLLOWING INDIVIDUALS: 1. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER, THOMAS LEMON; 2. THE HOSPITAL'S VP OF FINANCE, ROBERT COURTOIS; AND 3. THE HOSPITAL'S CONTROLLER, AMY BILYEA. THE 990 IS ALSO PRESENTED TO THE ENTIRE HOSPITAL BOARD BEFORE FILING. DURING THIS MEETING MEMBERS HAVE A CHANCE TO ASK QUESTIONS REGARDING THE FORM 990. Form 990, Part VI, Section B, line 12c THE HOSPITAL'S POLICY REGARDING "CONFLICT OF INTEREST" REQUIRES EACH BOARD MEMBER AND OFFICER TO COMPLETE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES TO DEMONSTRATE CORPORATE COMPLIANCE. THESE FORMS ARE REVIEWED AND ANY CONFLICTS ARE INVESTIGATED BY MANAGEMENT. POTENTIAL CONFLICTS AND RESTRICTIONS ARE DETERMINED AND THEN VOTED UPON, PER POLICY GUIDELINES. IN THE EVENT THAT AN OFFICER OR BOARD MEMBER HAS A CONFLICT OF INTEREST, THAT BOARD MEMBER MUST GIVE WRITTEN NOTICE OF SUCH AN INTEREST OR RELATIONSHIP TO THE BOARD OF DIRECTORS, AND SHALL THEREAFTER REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE DECISION. Form 990, Part VI, Section B, line 15a THE BOARD'S PERSONNEL SUB-COMMITTEE, WHICH CONSISTS OF FOUR MEMBERS, ANNUALLY REVIEWS THE COMPENSATION OF THE CEO ONLY. THEY UTILIZE MHA SALARY SURVEY DATA, AS WELL AS A MARKET ANALYSIS PERFORMED BY BOTH HOSPITAL'S HUMAN RESOURCES DEPARTMENT AND MUNSON'S HR DEPARTMENT. THE HUMAN RESOURCES MARKET ANALYSIS INCLUDES THREE SOURCES FOR DATA: INTEGRATED HEALTHCARE STRATEGIES, MERCER AND SULLIVAN COTTER, WITH REGRESSION POINT USING $70M IN NET REVENUES AND AN AVERAGE BASED ON HOSPITALS WITHIN A SIMILAR RANGE OF NET REVENUES. EACH OF THE THREE SOURCES USE NATIONAL DATA AND ARE BASED ON A FREE-STANDING HOSPITAL CEO POSITION. THE CEO DETERMINES THE STARTING COMPENSATION FOR THE VICE PRESIDENTS BASED ON MARKET DATA AND ANNUAL INCREASES OCCUR BASED ON PAY-FOR-PERFORMANCE SYSTEMS. THESE PROCESSES WERE LAST UNDERTAKEN IN 2015. Form 990, Part VI, Section C, line 19 THE OTSEGO MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY , AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY CONTACTING THE HOSPITAL AT 825 N. CENTER GAYLORD MI 49735 OR BY PHONE 989-731-2100. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OTSEGO MEMORIAL HOSPITAL FOUNDATION 825 N CENTER STREET GAYLORD MI 49735 382135473 FUNDRAISING MI 501(c)(3) Line 11a, I OTSEGO MEMORIAL HOSPITAL ASSOCIATION 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 OTSEGO MEMORIAL HOSPITAL FOUNDATION C 120951 CASH OTSEGO MEMORIAL HOSPITAL FOUNDATION L 229032 ACTUAL COST ALLOCATION