2024-11-12T10:37:07-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 260624696 MANOR CARE OF TACOMA WA ASSOCIATION MANO 4192525772 PO BOX 10086 ATTN TAX-5 TOLEDO OH 436990086 TERRENCE METZGER CFO 4192525772 2024-11-07 1 1 AMY CIMINELLO P00796388 3122071040 2024-11-07 2023 2024-10-15 13:58:12Z TERRENCE METZGER 100 MADISON AVE TOLEDO OH 43604 3658919 0 X WWW.PROMEDICASENIORCARE.ORG X 2007 DE MANORCARE PROVIDES INDIVIDUALIZED POST-HOSPITAL SKILLED NURSING CARE IN A COMFORTABLE ENVIRONMENT. CLINICAL AND THERAPY TEAMS ARE EXPERIENCED IN PROVIDING SPECIALIZED CARE FOCUSED ON PATIENTS' NEEDS, INTERESTS, AND ABILITY. THIS COMMITMENT RESULTS IN A SMOOTHER AND SAFER TRANSITION THROUGHOUT RECUPERATION. X 5 0 130 1 0 0 316607 0 12503285 3645499 21908 -19098 6873 13140 12848673 3639541 0 0 0 0 7746805 2384561 0 0 0 7463597 1337063 15210402 3721624 -2361729 -82083 1637053 109405 7745832 6300267 -6108779 -6190862 X OUR MISSION IS TO IMPROVE YOUR HEALTH AND WELL-BEING. 0 0 3588267 3645499 HCR MANORCARE'S SKILLED NURSING FACILITIES (SNF), PRIMARILY OPERATING UNDER THE BRAND NAME MANORCARE IN THE STATE OF WASHINGTON, PROVIDE SKILLED NURSING AND REHABILITATION SERVICES DURING RECOVERY AFTER A HOSPITALIZATION STAY. HCR MANORCARE IS THE POST-ACUTE DIVISION OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION FOCUSED ON THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. HEADQUARTERED IN TOLEDO, OHIO, WE ARE AMONG THE REGION'S LARGEST EMPLOYERS. THE COMPANY'S STEWARDSHIP OF RESOURCES HAS ENABLED WISE INVESTMENT IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING. HCR MANORCARE OPERATES SKILLED NURSING FACILITIES, WHERE NURSES AND PHYSICIANS WORK COLLABORATIVELY TO MANAGE COMPLEX MEDICAL CONDITIONS PROVIDING CARDIOLOGY, NEUROLOGY, ONCOLOGY, PULMONARY, ORTHOPEDIC AND WOUND CARE SERVICES. REHABILITATION SERVICES PROVIDE PATIENTS WITH THE TOOLS THEY NEED TO FUNCTION AT THEIR HIGHEST POTENTIAL. THESE SERVICES INCLUDE PHYSICAL AND OCCUPATIONAL THERAPIES, AS WELL AS SPEECH AND LANGUAGE PATHOLOGY. HCR MANORCARE FACILITIES PROVIDE LONG-TERM CARE ASSISTANCE 24 HOURS A DAY TO THOSE WHO MEET THE SKILLED NURSING REQUIREMENTS AND CANNOT LIVE INDEPENDENTLY. ADDITIONAL SERVICES SUCH AS PALLIATIVE AND HOSPICE CARE CAN ALSO BE PROVIDED IN THE SKILLED NURSING SETTING. PROMEDICA SENIOR CARE'S SKILLED NURSING AND REHABILITATION CENTERS, PRIMARILY OPERATING UNDER THE BRAND NAMES PROMEDICA, HEARTLAND AND MANORCARE, DEMONSTRATE PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL ELIGIBLE PATIENTS REGARDLESS OF THEIR RACE, CREED, NATIONAL ORIGIN, DISABILITY OR AGE. THE CENTERS PROVIDE PATIENTS WITH HOME ASSESSMENTS AND COMMUNITY RESOURCES FOR A SAFE AND HEALTHY TRANSITION HOME. AS WE NAVIGATE THROUGH COVID AND ADDRESS WORKFORCE CHALLENGES, THE FACILITIES ARE WORKING WITH OUR SOCIAL DETERMINANTS OF HEALTH TEAM TO HELP ASSESS EMPLOYEES' NEEDS SUCH AS TRANSPORTATION, ACCESS TO NUTRITIOUS FOOD AND CHILD CARE. THE CENTERS GRANT PATIENTS AND RESIDENTS THEIR WISHES THROUGH THE ORGANIZATION'S HEARTS' DESIRE PROGRAM. THE FACILITIES CONTINUE TO FACILITATE LONG DISTANCE VISITS THROUGH THE HUNDREDS OF IPADS THAT WERE ACQUIRED TO KEEP RESIDENTS AND PATIENTS ENGAGED WITH THE OUTSIDE COMMUNITY DURING COVID. IN 2021, THE ORGANIZATION CONTINUED TO OFFER COMMUNITY HEALTH RELATED EDUCATIONAL EVENTS SUCH AS REDUCING STRESS AND HEALTH AND WELLNESS THROUGH VIRTUAL AND ONLINE EDUCATION. ALSO, IN 2021, THE ORGANIZATION LAUNCHED A CUSTOM APP, PURPOSEFUL AND RESOURCEFUL WELL-BEING RESOURCES, TO EMPLOYEES. IN 2021, THE ORGANIZATION LAUNCHED DEI INITIATIVES ACROSS THE SYSTEM BY SPONSORING INCLUSION INNOVATION COMMUNITIES FOR EMPLOYEES AND HOSTING VIRTUAL AND IN-PERSON MEETINGS TO SHARE THE ORGANIZATION'S STRATEGIC DEI COMMITMENT TO INCREASE DIVERSITY, EQUITY AND INCLUSION FOR OUR EMPLOYEES, PATIENTS, RESIDENTS, VENDORS, AND THE COMMUNITIES WE SERVE. AS PART OF THEIR REBRANDING ANNOUNCEMENTS, FACILITIES HOSTED DRIVES TO COLLECT DONATIONS SUCH AS FOOD FOR NON-PROFIT ORGANIZATIONS. THROUGHOUT THE YEAR, THE SKILLED NURSING FACILITIES WERE PROACTIVE IN PROTECTING AND ENGAGING PATIENTS WITH ACTIVITIES SUCH AS EVENTS WITH FAMILY, COMMUNITY ENTERTAINMENT AND PET THERAPY. THE SKILLED NURSING CENTERS PROVIDED NEARLY 50 COMMUNITY-BASED HEALTH CARE PROFESSIONALS WITH CONTINUING EDUCATION CREDITS THROUGH THE OFFERING OF 5 COURSES.IN SUMMARY, THESE INITIATIVES NOT ONLY INDICATE HCR MANORCARE'S COMMITMENT TO THE COMMUNITY, BUT ALSO FULFILL OUR NOT-FOR-PROFIT STATUS BY PROVIDING ACCESS TO A VARIETY OF POST-HOSPITAL CARE SERVICES IN THE COMMUNITIES WE SERVE.IN APRIL 2023, MANORCARE OF TACOMA WA, ASSOCIATION WAS SOLD TO A NEW OWNER. 3588267 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 130 1 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TERRENCE METZGER 4192525772 100 MADISON AVE TOLEDO OH 43604 X ANGELA BRANDT TRUSTEE-PART YEAR 1.00 44.00 X 0 1233231 2999 JAMES F WHITE JR TRUSTEE 1.00 7.00 X 0 0 0 JUSTIN SKIVER TRUSTEE/PRESIDENT 1.00 44.00 X 0 914603 7106 MARY JANE WURTH TRUSTEE - PART YEAR 1.00 7.00 X 0 30000 0 RAVI NARRA TRUSTEE/PHYSICIAN 1.00 44.00 X 0 550819 5857 ROBERT LACLAIR TRUSTEE 1.00 23.00 X 0 30000 0 STEPHEN STAELIN TRUSTEE 1.00 7.00 X 0 0 0 ARTURO POLIZZI PRESIDENT AND CEO 1.00 54.00 X 0 2121593 5857 LOUIS ROBICHAUX TREASURER-PART YEAR 1.00 54.00 X 0 0 0 STEVE SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 1.00 54.00 X 0 1407180 6028 TERRENCE METZGER CHIEF FINANCIAL OFFICER 1.00 54.00 X 0 1055090 4079 GARY AKENBERGER CHIEF EXECUTIVE OFFICER-FORMER 0.00 0.00 X 0 548330 3400 JEFFREY C KUHN CHIEF LEGAL OFFICER - FORMER 0.00 0.00 X 0 721900 30922 STEVEN M CAVANAUGH TREASURER, CFO - FORMER 0.00 0.00 X 0 1335180 995 0 9947926 67243 0 1 1 0 0 NET PATIENT REVENUE 623000 3645499 3645499 3645499 280 280 19378 -19378 -19378 -19378 DIETARY CAFETERIA SALE 900099 9747 9747 BEAUTY AND BARBER 812900 2447 2447 AUXILIARY DEPARTMENTAL 900099 588 588 358 358 13140 3639541 3645499 0 -5958 2186771 2186771 18183 18183 116641 116641 62966 62966 127654 127654 3950 3950 1753 1753 310503 310503 396 396 71128 71128 89670 89670 9254 9254 58879 58879 PROVIDER TAXES 166221 166221 BAD DEBT EXPENSE 126400 126400 INTERCOMPANY ALLOCATED 85598 85598 FOOD 82870 82870 202787 202787 3721624 3588267 133357 0 700 699 1619181 88615 17172 0 20091 1637053 109405 1112368 19328 6633464 6280939 7745832 6300267 X -6108779 -6190862 -6108779 -6190862 1637053 109405 -82083 0 X X 0 1 X 1 1 1 X 933602 258195 316607 1508404 3624875 12011830 11959642 12503285 3645499 43745131 3624875 12945432 12217837 12819892 3645499 45253535 0 0 0 45253535 73 86 114 280 553 73 86 114 280 553 1704 3009 6873 13140 24726 3624875 12947209 12220932 12826879 3658919 45278814 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: VENDING MACHINE INCOME - 2020 AMOUNT: $ 1,556. 2021 AMOUNT: $ 706. 2022 AMOUNT: $ 1,040. 2023 AMOUNT: $ 358. MISC INCOME - 2020 AMOUNT: $ 100. 2022 AMOUNT: $ 3,109. 2023 AMOUNT: $ 588. MEAL INCOME - 2020 AMOUNT: $ 48. 2022 AMOUNT: $ 6. 2023 AMOUNT: $ 9,747. BEAUTY AND BARBER - 2021 AMOUNT: $ 1,097. 2022 AMOUNT: $ 2,718. 2023 AMOUNT: $ 2,447. PERSONAL PURCHASES - 2021 AMOUNT: $ 1,206. PART III, SHORT YEAR EXPLANATION MANOR CARE OF TACOMA WA ASSOCIATION WAS RECOGNIZED AS A 501(C)(3) TAX-EXEMPT ORGANIZATION AS OF SEPTEMBER 1, 2019. AS A RESULT, TAX YEAR 2019 WAS A SHORT YEAR COVERING THE PERIOD FROM SEPTEMBER 1, 2019 THROUGH DECEMBER 31, 2019. 0 0 0 0 0 0 0 0 1 264 264 0 PART II-B, LINE 1: MANOR CARE OF TACOMA WA, ASSOCIATION PAYS DUES TO THE WASHINGTON HEALTH CARE ASSOCIATION. A PORTION OF THESE DUES ARE USED BY THAT ORGANIZATION FOR LOBBYING ACTIVITIES. 0 MEDICARE SETTLEMENT ACCOUNT 20091 20091 DUE FROM AFFILIATE 6280939 6280939 1 1 0 0 0 0 0 0 0 ARTURO POLIZZI PRESIDENT AND CEO 0 1315647 0 789979 0 15967 0 0 0 5857 0 2127450 0 2127450 STEVE SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 0 625095 0 774925 0 7160 0 0 0 6028 0 1413208 0 1413208 STEVEN M CAVANAUGH TREASURER, CFO - FORMER 0 0 0 0 0 1335180 0 0 0 995 0 1336175 0 1336175 ANGELA BRANDT TRUSTEE-PART YEAR 0 630060 0 597921 0 5250 0 0 0 2999 0 1236230 0 1236230 TERRENCE METZGER CHIEF FINANCIAL OFFICER 0 480090 0 575000 0 0 0 0 0 4079 0 1059169 0 1059169 JUSTIN SKIVER TRUSTEE/PRESIDENT 0 509605 0 404998 0 0 0 0 0 7106 0 921709 0 921709 JEFFREY C KUHN CHIEF LEGAL OFFICER - FORMER 0 0 0 0 0 721900 0 26526 0 4396 0 752822 0 752822 RAVI NARRA TRUSTEE/PHYSICIAN 0 319380 0 229897 0 1542 0 0 0 5857 0 556676 0 556676 GARY AKENBERGER CHIEF EXECUTIVE OFFICER-FORMER 0 243969 0 300000 0 4361 0 0 0 3400 0 551730 0 551730 PART I, LINE 3 A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, INC., USES AN INDEPENDENT CONSULTANT, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVES. PART I, LINES 4A-B UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM PROMEDICA. STEVEN CAVANAUGH RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $1,335,180 DURING 2023. JEFFERY KUHN RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $721,900 DURING 2023. MATTHEW KANG RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $583,664 DURING 2023. MARTIN ALLEN RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $216,683 DURING 2023. DELAINE RICE-WHITE RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $164,769 DURING 2023. GARY AKENBERGER RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, THE TOLEDO HOSPITAL, IN THE AMOUNT OF $195,150 DURING 2023. ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. SKILLED NURSING FACILITIES 2023-04-01 1527648 ACTUAL COST INTEGRA WIP TENANT LLC 351 SPOOK ROCK RD SUFFERN NY 10901 LIMITED LIABILITY COMPANY 0 0 0 0 SCHEDULE N, PART II THE SCHEDULE N IS FILED TO SHOW THE CONTINUATION OF THE DISBURSEMENT OF ASSETS RELATED TO THE 2022 SALE OF THE SKILLED NURSING SERVICES. FORM 990, PART VI, SECTION A, LINE 6 AS A DELAWARE NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE ULTIMATE MEMBER/PARENT CORPORATION OF MANOR CARE OF TACOMA WA, ASSOCIATION. AS THE ULTIMATE MEMBER/PARENT CORPORATION, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF MANOR CARE OF TACOMA WA, ASSOCIATION, AND (B) FILL ANY VACANCY. FORM 990, PART VI, SECTION A, LINE 7B WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION, OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE, OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, AND (VI) ANY MERGER, CONSOLIDATIONS, REORGANIZATION, DISSOLUTION, OR LIQUIDATION. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED BY MANAGEMENT BEFORE BEING PROVIDED TO THE BOARD OF TRUSTEES PRIOR TO FILING. ANY COMMENTS OR QUESTIONS FROM THE BOARD ARE REVIEWED AND INCORPORATED INTO THE RETURN IF APPROPRIATE. FINAL RETURNS ARE PROVIDED TO A PRINCIPAL OFFICER FOR SIGNATURE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER SOC SURVEY WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER SOC SURVEYS ARE REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER SOC SURVEYS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED, AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO COMPLETE THE SURVEY OR THE SUBMISSION OF A FALSE OR INCOMPLETE SURVEY, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S SURVEY RESULTS OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PROVIDERS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL BONUS-ELIGIBLE SENIOR LEADERSHIP AND SPECIFICALLY IDENTIFIED ADDITIONAL EMPLOYEES, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PROVIDERS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, THE CHIEF HUMAN RESOURCE OFFICER, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. ADDITIONALLY, AS PART OF THE ANNUAL MANDATORY COMPLIANCE TRAINING ASSIGNED TO ALL PROMEDICA EMPLOYEES, EACH EMPLOYEE IS REQUIRED TO ELECTRONICALLY ACKNOWLEDGE THAT THEY HAVE RECEIVED A COPY OF THE PROMEDICA STANDARDS OF CONDUCT, THAT THEY UNDERSTAND HOW THE STANDARDS APPLY TO THEM, ACKNOWLEDGE THEIR OBLIGATION TO FOLLOW THEM, THEIR OBLIGATION TO REPORT VIOLATIONS OF THE STANDARDS OR REQUESTS THAT WOULD RESULT IN VIOLATIONS OF THE STANDARDS TO APPROPRIATE COMPANY OFFICERS AND THAT THEY HAVE REPORTED ALL VIOLATIONS KNOWN TO THEM AS REQUIRED BY THE STANDARDS. IN ADDITION THE ATTESTATION STATES ANY CONFLICTS OF INTEREST OR OTHER MATTERS FOR WHICH THE STANDARDS REQUIRE WRITTEN DISCLOSURE TO THE COMPANY HAVE BEEN SO DISCLOSED BY THE EMPLOYEE AND THEY UNDERSTAND AND ACKNOWLEDGE THAT TO THE EXTENT THEY ARE AN AT-WILL EMPLOYEE, THE STANDARDS DO NOT AFFECT THE AT-WILL NATURE OF MY EMPLOYMENT RELATIONSHIP WITH THE COMPANY. EMPLOYED PROVIDERS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PROVIDERS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PROVIDER CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER FOR PROMEDICA PHYSICIAN GROUP, INC. (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE OFFICE OF THE PROMEDICA HEALTH SYSTEM, INC. ("PHS") V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PROVIDER CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE PHS AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PROVIDERS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PROVIDER STANDARD OF CONDUCT AND THE PROVIDER CERTIFICATION STATEMENT WHICH THE NEW PROVIDER IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, OR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE PHS V.P., AUDIT & COMPLIANCE. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL BY THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER. RESULTS OF THE EMPLOYED PROVIDER AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. ANY ITEMS THAT MEET CRITERIA FOR PUBLIC DISCLOSURE WILL BE COMMUNICATED TO THE IDENTIFIED PROVIDER BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, OR DESIGNEE, IN ADVANCE OF THE POSTING. THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, OR DESIGNEE, WILL PROVIDE THE PROVIDER-INDUSTRY RELATIONSHIP DISCLOSURES TO THE APPLICABLE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. THE PUBLIC DISCLOSURE WILL BE POSTED ON THE PHS WEBSITE (HTTPS://WWW.PROMEDICA.ORG/PAGES/ABOUT-US/INDUSTRY-RELATIONSHIPS.ASPX) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEWS ARE COMPLETED BY PROMEDICA HEALTH SYSTEM, INC. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VII, LINE 1A THE PROMEDICA HEALTH SYSTEM PROCESSES ALL ACCOUNTS PAYABLE THROUGH ONE PAY COMPANY. ALL 1099 FORMS FOR PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES ARE FILED UNDER PROMEDICA HEALTH SYSTEM, INC. FEIN 34-1517671. PART VII, SECTION B PROMEDICA HEALTH SYSTEM PROCESSES ALL ACCOUNTS PAYABLE THROUGH ONE PAY COMPANY, PROMEDICA HEALTH SYSTEM, INC. THE INDEPENDENT CONTRACTORS OVER $100,000 WILL BE LISTED ON THE 990 FILED FOR PROMEDICA HEALTH SYSTEM, INC. FEIN 34-1517671. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BAY PARK COMMUNITY HOSPITAL 100 MADISON AVE TOLEDO OH 43604 341883132 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 COMMUNITY HEALTH CENTER OF BRANCH COUNTY 100 MADISON AVE TOLEDO OH 43604 386108110 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 DEFIANCE HOSPITAL AUXILIARY 1200 RALSTON DEFIANCE OH 43512 510173779 HOSPITAL / FOUNDATION SUPPORT OH 501(C)(3) 10 DEFIANCE HOSPITAL INC 1 DEFIANCE HOSPITAL INC 100 MADISON AVE TOLEDO OH 43604 344446484 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 EMMA L BIXBY MEDICAL CENTER 100 MADISON AVE TOLEDO OH 43604 382796005 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 EMMA L BIXBY MEDICAL CENTER AUXILIARY 818 RIVERSIDE AVE ADRIAN MI 43604 382149602 HOSPITAL / FOUNDATION SUPPORT MI 501(C)(3) 12B, II EMMA L BIXBY MEDICAL CENTER 1 FOSTORIA HOSPITAL ASSOCIATION 100 MADISON AVE TOLEDO OH 43604 340898745 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 FOSTORIA HOSPITAL AUXILIARY PO BOX 907 FOSTORIA OH 44830 346517634 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