2011-02-15T14:54:00-06:00 2010-03-31 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2009-04-01 381507046 MUNISING MEMORIAL HOSPITAL ASSOCIATION MUNI 9063874110 1500 SAND POINT ROAD MUNISING MI 49862 Kevin Calhoun 9063874110 2011-02-15 1 2319477800 2009 2016-02-24 21:20:13Z kevin calhoun 1500 SAND POINT ROAD MUNISING MI 49862 9602410 0 X www.munisingmemorial.org X 1961 MI TO PROVIDE MEDICAL SERVICES TO THE COMMUNITY. 9 9 130 20 418410 -24100 60212 2947 8434971 9006941 -325250 502186 47728 34065 8217661 9546139 500 500 0 4736800 4685351 0 0 4656617 5139598 9393917 9825449 -1176256 -279310 17955550 17764327 16593357 16327294 1362193 1437033 TO PROVIDE HEALTH CARE SERVICES TO ALL RESIDENTS OF THE GREATER MUNISING AREA, TO PROVIDE A LINK TO WELLNESS AND HEALTHCARE, AND TO SERVE AS AN INTEGRAL PART OF THE QUALITY OF LIFE IN THE ENTIRE REGION. 0 0 5981769 500 7417686 PROVIDE INPATIENT AND OUTPATIENT CARE TO THE COMMUNITY AND SURROUNDING AREA. 911479 752435 BAY CARE PHYSICIAN OFFICE PROVIDING REGULAR OFFICE AND WALK-IN VISITS TO OUR PATIENTS. 442510 418410 HARBOUR VIEW ASSISTED LIVING FACILITY PROVIDING LIVING ACCOMMODATIONS, MEALS, AND ASSISTANCE TO THE ELDERLY - SEE 990-T FOR ADDITIONAL DETAIL. 7335758 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 21 0 1 130 1 1 1 0 0 0 0 0 0 0 0 9 9 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 0 0 0 X Lorraine Hawley 9063874110 1500 Sand Point Rd MUNISING MI 49862 PETE KELTO 0.30 X X 0 0 0 JOHN BARNHART 0.30 X 0 0 0 KIRT HARMON 0.30 X X 0 0 0 JAMES BROGAN 0.30 X X 0 0 0 TARI JOHNSON 0.30 X 0 0 0 HELEN PETERS 0.30 X X 2090 0 0 DEBORAH NEDEAU 0.30 X 0 0 0 Allison Bowerman-Johnson 0.30 X 0 0 0 MARK ARRIERI 0.30 X 0 0 0 Kevin Calhoun 40.00 X 141240 0 12104 LORRAINE HAWLEY 40.00 X 86681 0 9360 Mark Gerold 40.00 X 159815 0 21991 Christine Krueger 40.00 X 163744 0 22170 Michael Johnson 40.00 X 127265 0 17788 CARL VELTE X 58337 0 0 739172 0 83413 4 0 1 0 ELSI BACCARI MD 4621 S NICOLET ROAD SAULT STE MARIE MI 49783 ER PHYS. COVERAGE 231746 LARRY F CARLYON MD 7 CHILMAN LANE ISHPEMING MI 49849 ER PHYS. COVERAGE 143581 PLANTE & MORAN PLLC 16060 COLLECTION CENTER DRIVE CHICAGO IL 60693 CONSULTING 103933 3 2947 2947 HEALTH SERVICES 900099 8350300 8350300 ASSISTED LIVING 623990 418410 418410 OTHER RELATED REVENUE 900099 238231 238231 9006941 49362 49362 29755 30209 -454 -454 -454 475736 3150 26062 449674 3150 452824 452824 CAFETERIA SALES 722210 34519 34519 34519 9546139 8588531 418410 536251 500 500 252579 252579 3588037 3036672 551365 167230 132125 35105 418558 345662 72896 258947 206554 52393 3358 3358 81600 81600 1026711 913961 112750 40055 40055 883771 656734 227037 1175653 873633 302020 151324 151324 Supplies 737179 646688 90491 Provision for Bad Debts 342700 342700 Utilities 341914 341914 Other Expenses 227288 180529 46759 QUALITY ASSURANCE TAXES 128045 128045 9825449 7335758 2489691 0 365417 300317 354577 353449 1047559 1656889 53149 40353 68600 62500 109854 96851 17427832 4380884 14038785 13046948 1263757 1497236 653852 709784 17955550 17764327 1092842 1323879 38242 30597 14010000 13760000 1452273 1212818 16593357 16327294 X 1362193 1437033 1362193 1437033 17955550 17764327 X 0 1 1 X 0 X 0 0 0 0 0 0 0 0 1 967 967 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: PORTION OF ANNUAL DUES TO MICHIGAN HEALTH & HOSPITAL ASSOCIATION THAT ARE USED TOWARD LOBBYING ACTIVITIES. 20275 20275 13246361 2023500 11222861 4159696 2357384 1802312 1500 1500 13046948 FAIR VALUE OF INTEREST RATE SWAP 1145818 OTHER ACCRUED LIABILITIES 67000 1212818 9546139 9825449 -279310 236786 117364 354150 74840 9930498 236786 147573 384359 9546139 0 9546139 9855658 30209 30209 9825449 0 9825449 Part XI, Line 8 - Other Adjustments: Change in value of Interest Rate Swap: 117364. Part XII, Line 2d - Other Adjustments: Change in fair value of interest rate swap agreements: 117364. RENTAL EXPENSES INCLUDED ON FORM 990, PART VIII: 30209. Part XIII, Line 2d - Other Adjustments: RENTAL EXPENSES INCLUDED ON FORM 990, PART VIII: 30209. 1 1 X 1 X 1 X 0 1 1 0 0 1 42 43785 0 43785 0.00460 1114999 363967 751032 0.07920 1 42 1158784 363967 794817 0.08380 1 42 1158784 363967 794817 0.08380 2 602 90841 47543 43298 0.00460 2 602 90841 47543 43298 0.00460 1 260607 7673 2815570 2788412 27158 X 1 1 Munising Memorial Hospital Association

1500 Sand Point Rd Munising MI 49862

X X X X Part I, Line 3c: Part I, Line 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2, IS USED. Part I, Line 7f: 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 $342,700. Part III, Line 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. 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.BAD DEBT AT COST, $260,607, IS CALCULATED BASED ON A COST TO CHARGE RATIO.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $7,673. THE HOSPITAL'S BEST ESTIMATE WAS BASED ON SELF-PAY REVENUE AS A PERCENTAGE OF TOTAL REVENUE (2.86%) MULTIPLIED BY BAD DEBT EXPENSE AT COST x THE COST TO CHARGE RATIO FROM WORKSHEET 2. Part III, Line 8: THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT, WHICH DO NOT SHOW A SHORTFALL. THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE COST REPORT. Part III, Line 9b: ALL PATIENTS OR THEIR INSURANCE COMPANIES ARE BILLED FOR SERVICES. STATEMENTS ARE SENT MONTHLY TO ALL PATIENTS WITH THE EXCEPTION OF THE MEDICAID PATIENTS.THOSE THAT ARE QUALIFIED FOR FINANCIAL ASSISTANCE ARE NOT BILLED OR RECEIVE STATEMENTS. IF WE ARE WAITING FOR PENDING INFORMATION FROM THE RESPONSIBLE PARTY SUCH AS DETERMINATION ON APPLICATION OF DHS, THEN STATMENTS ARE SENT BUT FURTHER COLLECTION WILL NOT BE INITIATED. Part VI, Line 2: THE HOSPITAL PROVIDES OFFICE SPACE WITHIN THE HOSPITAL FOR (AMAC) ALGER MEDICAL ACCESS COALITION. THEY SCREEN PATIENTS WHO NEED ACCESS TO MEDICAL CARE BUT DO NOT HAVE THE MEANS TO PAY. THEY PROVIDE ASSISTANCE TO THE RESIDENTS OF THE COMMUNITY TO OBTAIN DRUGS THAT ARE NEEDED, BUT THEY ARE UNABLE TO PAY FOR THEM. Part VI, Line 3: PAMPHLETS AND FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE IN ADMISSION, WHICH DESCRIBE THE HOSPITALS COLLECTION POLICY AND FINANCIAL ASSISTANCE PROGRAM. THE PAMPHLET EXPLAINS WHAT RESOURCES MUST BE EXHAUSTED AND WHAT QUALIFIES. IF A PATIENT APPLIES FOR FINANCIAL ASSISTANCE, THEIR APPLICATION IS REVIEWED AND THEY ARE NOTIFIED IF THEY QUALIFY AND FOR HOW MUCH. THE ADMISSION PERSON ONLY GIVES THEM THE PAMPHLETS AND TELLS THEM IT IS AVAILABLE. THE POLICY IS ALSO ON THE HOSPITAL WEB SITE. Part VI, Line 4: MUNISING MEMORIAL HOSPITAL SERVES THE RESIDENTS OF ALGER COUNTY MICHIGAN IN THE CENTRAL UPPER PENINSULA. ALGER COUNTY IS A RURAL AND RELATIVELY ISOLATED GEOGRAPHY WITH A POPULATION OF 9,862. THE RURAL NATURE OF THE COUNTY IS DEMONSTRATED BY THE POPULATION'S DENSITY OF 11 PEOPLE PER SQUARE MILE. THE ALGER COUNTY ECONOMY IS PRIMARILY DEPENDENT UPON TOURISM, LUMBER HARVESTING, MANUFACTURING AND A LARGE STATE PRISON.THE NEAREST FULL SERVICE ACUTE CARE HOSPITAL IS 45 MILES FROM THE ALGER COUNTY POPULATION, ACCESSIBLE ONLY BY TWO LANE HIGHWAY THAT IS FREQUENTLY CLOSED IN THE WINTER DUE TO WEATHER.THE POPULATION OF ALGER COUNTY IS TYPICAL OF RURAL COMMUNITIES WITH LARGER THAN NORMAL PERCENTAGE OF OLDER THAN 65 POPULATION AND SIGNIFICANTLY LOWER THAN NORMAL PERCENTAGE OF POPULATION BETWEEN THE AGES OF 20-40. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY 70% OF THE NATIONAL AND STATE MEDIAN HOUSEHOLD INCOME.MUNISING MEMORIAL HOSPITAL PROVIDES ESSENTIAL PRIMARY CARE MEDICAL SERVICES, AMBULATORY CARE, DIAGNOSTIC AND THERAPY SERVICES, AND LOCAL HOSPITALIZATION, PRIMARILY FOR THE ELDERLY.MUNISING MEMORIAL HOSPITAL SERVICES ARE NOT ONLY ESSENTIAL TO THE HEALTH AND WELLBEING OF THE COMMUNITY, BUT AS TYPICAL IN RURAL COMMUNITIES; MUNISING MEMORIAL IS ONE OF THE LARGEST EMPLOYERS IN ALGER COUNTY. IN ADDITION TO BELOW NATIONAL AND STATE MEDIAN INCOMES, ALGER COUNTY UNEMPLOYMENT TYPICALLY RUNS BETWEEN 50 - 100% HIGHER THAN THE NATIONAL AND STATE UNEMPLOYMENT PERCENTAGE. CONSEQUENTLY, MUNISING MEMORIAL EMPLOYMENT PROVIDES ECONOMIC STABILITY TO THE COMMUNITY. Part VI, Line 5: BY PROVIDING SPACE FOR AMAC THIS GIVES THE UNINSURED AND UNDERINSURED ASSISTANCE IN PREPARING FINANCIAL ASSISTANCE APPLICATIONS AND A MEANS OF OBTAINING DRUGS THROUGH THE PHARMACY COMPANIES THAT WOULD NOT BE AVAILABLE TO THEM. THE UNISURED ARE NOTIFIED OF THE VARIOUS OPPORTUNITES THAT ARE AVAILABLE TO THEM TO SEEK MEDICAL CARE. Part VI, Line 6: MUNISING MEMORIAL HOSPITAL'S DIETICIAN HAS PARTICIPATED IN A COMMUNITY ADVISORY BOARD FOR THE PAST SEVERAL YEARS WITH MEMBERS OF THE COMMUNITY. THE ADVISORY BOARD SENT OUT SURVEYS OF APPROXIMATELY 150 QUESTIONS RELATING TO GENERAL HEALTH, ACCESS TO HEALTHCARE, NUTRITION, PHYSICAL & MENTAL HEALTH, LIFESTYLE, EXERCISE, ETC. THE DIETICIAN USED THIS DATA TO IMPROVE DIABETES EDUCATION PROGRAMS AND TO HELP BRING THE ALGER COUNTY MEDICAL ACCESS PROGRAM (ACMA) TO ALGER COUNTY. IN JUNE OF 2009 ACMA OPENED THEIR DOORS IN OFFICE SPACE WITHIN THE HOSPITAL -- THAT IS PROVIDED TO THEM BY THE HOSPTIAL. THROUGH THIS PROGRAM THE HOSPITAL PROVIDES MEDICAL VISITS TO PATIENTS FREE OF CHARGE. ACMA ALSO OFFERS A PRESCRIPTION ASSISTANCE PROGRAM TO THEIR CLIENTS. THIS BOARD MET THROUGH 2009; THEY DISBANDED AFTER THE ACMA OFFICE WAS UP AND RUNNING. X X 0 0 0 0 0 0 0 0 0 Kevin Calhoun 141240 0 0 0 0 0 7150 0 4954 0 153344 0 0 0 Mark Gerold 159815 0 0 0 0 0 8310 0 13681 0 181806 0 0 0 Christine Krueger 163744 0 0 0 0 0 8490 0 13680 0 185914 0 0 0 Michigan State Hospital Finance Authority 382889417 59465HDW3 2006-09-27 14200000 Construction 0 0 14200000 867442 12834918 2008 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 1 SOVERIGN BANK 16.000000000000 0 0 1 Form 990, Part VI, Section B, line 11 THE 990 IS E-MAILED TO EACH BOARD MEMBER AND GIVEN A DEADLINE TO WHICH THEY NEED TO RESPOND. THEY EACH HAVE A CHANCE TO REVIEW THE 990 AND ASK QUESTIONS REGARDING DATA WITHIN THE FORM BEFORE IT IS FILED. THIS REVIEW IS DOCUMENTED VIA E-MAIL RECORDS. Form 990, Part VI, Section B, line 12c INDIVIDUALS REQUIRED TO COMPLY WITH THE CONFLICT OF INTEREST POLICY INCLUDE THE CHIEF EXECUTIVE OFFICER, THE CHIEF FINANICAL OFFICER, AND ALL OF THE MEMBERS OF THE BOARD. ON AN ANNUAL BASIS, DOCUMENTS ARE DISTRIBUTED AND SIGNED BY EACH INDIVIDUAL DISCLOSING ALL CONFLICTS. IF THERE IS A CONFLICT INDENTIFIED, THAT INDIVIDIUAL CANNOT VOTE ON THE MATTER AND IT MUST BE INDICATED IN THE MEETING MINUTES THAT A DISCLOSURE WAS MADE AND THE BOARD MEMBER ABSTAINED FROM VOTING. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part VII Contact Addresses for Officers, Directors, Etc CARL VELTE - 870 Clearview Drive, Port Charlotte, FL 33953. FORM 990, PART XI, LINE 2C: NO CHANGES FROM PRIOR YEAR