THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. PUBLIC DISCLOSURE POLICY

POLICY

Hospice of Michigan (HOM) is a 501(c)(3) not-for-profit corporation. As such, HOM’s programs are community-based, and HOM has a responsibility to be open to the public about the organization’s licensure, activities, goals, procedures and philosophy. However, HOM reserves the right to retain as private and not subject to public inspections certain information relating to internal operations, strategic planning, trade secrets and patents, styles of work, patients, protected health information (PHI) and personnel administration.

PROCEDURE
1. Hospice of Michigan (HOM) will make the following documents available to the public:

a. IRS determination letter as an exempt organization, including Form 1023 (original application with IRS for determination)

b. Incorporation papers, Articles of Incorporations

c. Bylaws are available but must be requested in writing

d. IRS Form 990 are available but must be requested in writing

e. Audited financial statements are available but must be requested in writing.

f. Mission and Vision Statements

g. Research partnerships

h. Conflict of Interest Policy

i. Corporate Compliance Plan

2. All documents listed above can be found on HOM’s corporate website, with the exception of Bylaws, IRS form 990 and audited financial statements, which must be requested in writing.

3. Any person seeking hard copies of any of the public documents listed above shall ask in writing, or in person at any of the locations listed below and with due specificity of what is being sought. Copies will be sent within 14 business days after HOM receives copying fees and postage costs.

a. Corporate Offices, 400 Mack Avenue, Detroit, Michigan, 48201

b. Central Hub, 3995 Fashion Square Blvd., Saginaw, MI. 486033

c. Northeast Hub, 112 Chisholm, Alpena, MI. 49707

d. Northwest Hub, 400 Perry, Big Rapids, MI. 49307

e. Southeast Hub, 26957 Northwestern Hwy., Southfield, MI. 48033

f. Southwest Hub, 1260 Ekhart, NE., Grand Rapids, MI. 49503

4. Pursuant to IRS Publication 557, copying fees are $1.00 for the first pages and $0.15 for each additional page.

CONTACT PERSON

Hospice of Michigan's contact person for all patient privacy issues and your rights under the federal privacy standards is:

This Notice is effective July 10, 2008.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE CORPORATE DIRECTOR OF ORGANIZATIONAL INTEGRITY AT THE ABOVE ADDRESS OR PHONE NUMBER.