SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Hospice of Michigan Inc
 
Employer identification number

38-2255529
Return Reference Explanation
Form 990, Part VI, Line 1a Delegate broad authority to a committee The Executive Committee shall consist of the Chairperson of the Board, the Vice Chairperson, the Secretary-Treasurer, the Immediate Past Chairperson of the Board, and the Chairperson of the Board Development and Evaluation and Nominating Committee. The Executive Committee shall possess and exercise the authority and powers of the Board of Trustees in the management and direction of the Corporation in the interim periods between meetings of the Board and shall discharge the duties of said Board during such interim periods, except that the Executive Committee shall not have power or authority to: (a) amend the Articles of Incorporation; (b) dissolve the Corporation or revoke a dissolution; (c) amend the Bylaws of the Corporation; or (d) fill vacancies in the Board.
Form 990, Part VI, Line 11b Review of form 990 by governing body A final draft of the full Form 990 is reviewed with our tax advisors and approved by an Executive Committee of the board. Then a copy of the full Form 990 draft is sent out to each voting member of the governing body. These reviews take place prior to filing the Form 990 with the IRS.
Form 990, Part VI, Line 12c Conflict of interest policy Procedure: Employees, both paid and unpaid( from here forward referred to as "employee"), and Board members, have a fundamental obligation to act in the best interest of patient care and Hospice of Michigan (HOM). Every Board member and employee is responsible for acting consistent with this obligation when engaging in activities, and should not let other personal and financial interests interfere with this obligation. General Practice Guidelines: (1) HOM requires that all members of its Boards of Trustees and employees disclose interests that could result in a conflict. Annually, all board members sign off on a Conflict of Interest policy and disclose any situation which may represent a conflict. The Corporate Compliance Officer (CCO) also has access to the Board at least annually. The organization also utilizes C-TRAC (Crowe Tax Risk Assessment and Control), a tool provided by our tax advisors, to send conflict of interest surveys to all voting board members, executives, and the highest paid staff. (2) All Board members and employees are required to submit a disclosure statement, if there is a conflict of interest that meets the stated definition, at the beginning of employment or term. (3) If a matter arises in which a member of the Board or employee has a conflict of interest, the individual shall promptly disclose it to the CEO, or in the case of the CEO, the Board Chairperson. (4) An individual with a potential conflict of interest shall not proceed to make any decision or take any action on behalf of the organization with the approval of the Board of Trustees. (5) HOM employees are precluded from engaging in activities with any "Vendor or Supplier Business" (as that term is defined in the policy) that does or seeks business with HOM which may result in a personal benefit to the employee at the expense of HOM or may influence the employee's decisions on matters involving HOM and a Vendor or Supplier Business.
Form 990, Part VI, Line 15a Process to establish compensation of top management official THE PRESIDENT/CEO AND OTHER OFFICERS ARE COMPENSATED BY HOSPICE OF MICHIGAN. THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES MEETS ANNUALLY IN APRIL SUBSEQUENT TO THE ACCEPTANCE OF THE AUDITED FINANCIAL STATEMENTS TO REVIEW AND APPROVE AS APPROPRIATE, FUNDS TO BE ALLOCATED FOR TOTAL COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/CEO, INCLUDING BASE SALARY, BONUS, CAR ALLOWANCE, AND OTHER BENEFITS. THE EXECUTIVE COMMITTEE ALSO DETERMINES IF THE PRESIDENT/CEO'S CONTRACT NEEDS TO BE UPDATED OR RENEWED AT THIS TIME. MINUTES ARE TAKEN UP UNTIL THE POINT WHERE DISCUSSION OF COMPENSATION TAKES PLACE AND A VOTE/DECISION IS MADE IN REGARDS TO COMPENSATION. IN ADDITION, IN 2021 THE ANNUAL EXTERNAL COMPENSATION STUDY WAS PERFORMED TO ASSESS EXECUTIVE COMPENSATION. THE COMPENSATION STUDY AIMS TO PRICE POSITIONS AT MARKET BY USING LOCAL, NATIONAL, AND INDUSTRY SPECIFIC SURVEY DATA. AN OUTSIDE CONSULTANT IS ENGAGED THROUGH AMERICAN SOCIETY OF EMPLOYERS (ASE). MARKET DATA WAS GATHERED THROUGH AT LEAST THREE EXTERNAL SURVEYS AND NATIONALLY COMPARED 990'S OF THE LARGEST HOSPICES NATIONALLY AS WELL AS THE TOP MICHIGAN HOSPITALS WITH REVENUES OF $150 MILLION OR LESS.
Form 990, Part VI, Line 15b Process to establish compensation of other employees The Executive Committee of the Board of Trustees meets annually in April subsequent to the acceptance of the audited financial statements to review and approve as appropriate, funds to be allocated for total compensation for the organization's Chief Financial Officer, Chief Operating Officer, Chief Medical Officer, and Chief Fundraising Officer, including base salary, bonus, car allowance, and other benefits. Minutes are taken up until the point where discussion of compensation takes place and a vote/decision is made in regards to compensation. In addition, in 2021 the annual external compensation study was performed to assess executive compensation. The compensation study aims to price positions at market by using local, national, and industry specific survey data. An outside consultant is engaged through American Society of Employers (ASE). Market data was gathered through at least three external surveys and nationally compared 990's of the largest hospices nationally as well as the top Michigan hospitals with revenues of $150 million or less.
Form 990, Part VI, Line 19 Required documents available to the public The organization's governing documents, conflict of interest policy, and audited financial statements can be available upon request.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances Beneficial interest in net assets of Arbor Hospice - 3324005; Beneficial interest in net assets of NorthStar Palliative Care - -404166;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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