2024-11-12T09:52:25-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 454781053 KAITLYN'S COTTAGE INC KAIT 4192525772 100 MADISON AVE ATTN TAX DEPARTM TOLEDO OH 43604 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 ATTN TAX DEPARTMENT TOLEDO OH 43604 529968 0 X WWW.PROMEDICA.ORG X 2012 OH LOCATED ON THE CAMPUS OF DEFIANCE HOSPITAL, INC., KAITLYN'S COTTAGE, INC. OFFERS RESPITE CARE TO INDIVIDUALS WITH DISABILITIES, AS WELL AS ASSISTANCE TO FAMILY MEMBERS AND OTHER CAREGIVERS OF YOUNG ADULTS WITH SPECIAL NEEDS. 27 19 21 19 0 0 292494 437895 67631 82622 0 0 3989 9451 364114 529968 0 0 0 0 283723 303057 0 0 0 201280 218915 485003 521972 -120889 7996 1846862 1830559 221466 197167 1625396 1633392 X KAITLYN'S COTTAGE, INC. IS A SAFE AND NURTURING COUNTRY COTTAGE GETAWAY WHERE PROFESSIONAL STAFF PROVIDE COMPASSIONATE CARE FOR PERSONS WITH COGNITIVE OR PHYSICAL DISABILITIES. 0 0 521972 0 92073 KAITLYN'S COTTAGE, INC. IS A FACILITY WHICH PROVIDES SHORT-TERM RESPITE CARE SERVICES TO INDIVIDUALS WITH INTELLECTUAL AND PHYSICAL DISABILITIES.KAITLYN'S COTTAGE, INC. (KAITLYN'S) IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 28 STATES ACROSS THE COUNTRY AND IS ONE OF THE NATION'S LEADING HEALTH SYSTEMS. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST 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, REGARDLESS OF A PATIENT'S ABILITY TO PAY. WITH STRONG PHILANTHROPIC SUPPORT, KAITLYN'S OPENED ON THE CAMPUS OF DEFIANCE HOSPITAL, INC. IN 2012 FOR DAYTIME AND OVERNIGHT RESPITE CARE FOR INDIVIDUALS WITH INTELLECTUAL AND PHYSICAL DISABILITIES. AT THE TIME, IT WAS THOUGHT TO BE THE FIRST OF ITS KIND IN THE UNITED STATES. THE 5,000-SQUARE-FOOT FACILITY HAS FOUR PRIVATE BEDROOMS FOR OVERNIGHT GUESTS, A LIBRARY, AND ACTIVITY AND DINING AREAS. GUESTS ARE OFFERED ACTIVITIES SUCH AS ARTS AND CRAFTS, COOKING, GARDENING, PLAYING MUSIC, PLAYING GAMES, OR MANY OTHER ACTIVITIES OF THEIR CHOOSING. FIVE, THREE-DAY SUMMER CAMPS ALSO ARE AVAILABLE, WITH SCHEDULING BASED UPON EACH CAMPERS' NEEDS FOR FULL OR PARTIAL DAYS. SPECIAL EVENTS SUCH AS DANCES, KARAOKE NIGHTS, HOLIDAY PARTIES, AND MONTHLY SOCIAL EVENTS ARE DESIGNED TO PROVIDE ADDITIONAL SOCIAL INTERACTION FOR GUESTS THROUGHOUT THE YEAR. IN 2023, KAITLYN'S COTTAGE ALSO HOSTED NIGHT TO SHINE. SPONSORED BY THE TIM TEBOW FOUNDATION FOR PEOPLE WITH SPECIAL NEEDS AGES 14 AND OLDER, THE EVENT INCLUDED A RED CARPET, A CATERED DINNER, DANCING, SINGING, LIMO RIDES, AND MASSAGES. THIS ALL CUMULATED INTO CROWNING ALL HONORED GUESTS PROM KING AND QUEEN. STAFF PROVIDE FAMILY AND CAREGIVER SUPPORT GROUPS, EDUCATION SESSIONS ON A VARIETY OF CAREGIVER TOPICS, AND OTHER TYPES OF SUPPORT. FURTHER, THERE IS A SLIDING-SCALE FEE (STARTING AT A NOMINAL AMOUNT) FOR PAYMENTS, AND AN ENDOWMENT HAS BEEN ESTABLISHED TO HELP ASSIST THOSE WHO CANNOT AFFORD SERVICES.AT KAITLYN'S, ALL STAFF MEMBERS ARE TRAINED IN MEDICATION ADMINISTRATION, CPR/FIRST AID CERTIFIED, AND CPI (NON-VIOLENT CRISIS INTERVENTION) TRAINED. TO HELP ENSURE THAT CARE AND SERVICES ARE PROVIDED APPROPRIATELY, KAITLYN'S HAS A PROFESSIONAL ADVISORY COUNCIL THAT CAN BE CONSULTED; MEMBERS INCLUDE A PHYSICIAN, CLERGY MEMBER, AN ATTORNEY, AND PATIENT FAMILY MEMBERS.IN SUMMARY, KAITLYN'S DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING FAMILY EDUCATION, FOSTERING CONTINUED EXCELLENCE IN PROGRAMS AND SERVICES, AND OFFERING HIGH-QUALITY RESPITE CARE FOR THE BENEFIT OF ALL ITS GUESTS AND FAMILY CAREGIVERS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. PROMEDICA RECOGNIZES THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL OFFERINGS AND OTHER OUTREACH ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. 521972 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 0 0 1 0 0 0 1 X 0 0 21 1 0 0 0 0 0 0 0 0 0 0 0 0 X 27 19 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 ARTURO POLIZZI TRUSTEE/CEO 1.00 54.00 X X 0 2121593 5857 LOUIS ROBICHAUX TREASURER - PART YEAR 1.00 54.00 X X 0 0 0 TERRENCE METZGER TRUSTEE/TREASURER 1.00 54.00 X X 0 1055090 4079 STEVE SADOWSKI TRUSTEE/SECRETARY 1.00 54.00 X X 0 1407180 6028 LISA HAWKER TRUSTEE 1.00 14.00 X 0 40000 0 BILL MCDONNELL TRUSTEE 1.00 15.00 X 0 0 0 NANCY KABAT TRUSTEE 1.00 15.00 X 0 0 0 MARCY BROWN TRUSTEE 1.00 14.00 X 0 0 0 LISA MILLER TRUSTEE/DIRECTOR 1.00 14.00 X 0 90513 4657 KATHLEEN MERRILL TRUSTEE 1.00 14.00 X 0 0 0 LAURA KLINE TRUSTEE 1.00 14.00 X 0 0 0 AMANDA KISSNER TRUSTEE 1.00 14.00 X 0 0 0 LINDA THIEL TRUSTEE 1.00 14.00 X 0 0 0 BARRY LUSE TRUSTEE 1.00 14.00 X 0 0 0 SUE VANISACKER TRUSTEE 1.00 14.00 X 0 0 0 KRISTINE BRENNER TRUSTEE 1.00 14.00 X 0 0 0 JIM BRENNAN TRUSTEE 1.00 15.00 X 0 0 0 VICTOR CHERFAN TRUSTEE/PHYSICIAN 1.00 44.00 X 0 659149 0 DONALD CRESCENZO TRUSTEE/PHYSICIAN 1.00 44.00 X 0 918456 0 TIM BUBLICK TRUSTEE 1.00 13.00 X 0 0 0 EVON EBEID TRUSTEE 1.00 13.00 X 0 0 0 ALEX GERKEN TRUSTEE 1.00 13.00 X 0 0 0 KEVIN PIROZEK TRUSTEE 1.00 13.00 X 0 0 0 DAVE SNAVELY TRUSTEE 1.00 13.00 X 0 0 0 DAWN BUSKEY TRUSTEE/PRESIDENT 1.00 54.00 X 0 1412400 5337 KENT BISHOP TRUSTEE/PRESIDENT 1.00 54.00 X 0 1437763 4120 ROBERT LACLAIR TRUSTEE 1.00 23.00 X 0 30000 0 STEVEN M CAVANAUGH TREASURER, CFO - FORMER 0.00 0.00 X 0 1335180 5657 JEFFREY C KUHN SECRETARY, CHIEF LEGAL OFFICER - FORMER 0.00 0.00 X 0 748426 30922 GARY AKENBERGER SR VP FINANCE - FORMER 0.00 0.00 X 0 528647 43532 0 11784397 110189 0 1 1 0 0 437193 702 437895 RESPITE CARE SERVICES 623000 82622 82622 82622 CAMPS/REC ACTIVITIES 900099 9451 9451 9451 529968 92073 0 0 281523 281523 1107 1107 20427 20427 11983 11983 4493 4493 2716 2716 236 236 26927 26927 4105 4105 123443 123443 FOOD 17660 17660 SUPPLIES 8563 8563 ALLOCATED EXPENSE 8390 8390 MINOR EQUIPMENT 5351 5351 5048 5048 521972 521972 0 0 200 200 0 4572 2903488 1160592 1846662 1742896 0 82891 1846862 1830559 86735 197167 134731 0 221466 197167 X 1625396 1503392 130000 1625396 1633392 1846862 1830559 7996 0 X X 0 1 X 1 1 1 X X 1 DEFIANCE HOSPITAL INC 344446484 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2516626 922442 1594184 351541 222505 129036 35321 15645 19676 1742896 1 1 0 0 0 0 0 0 0 ARTURO POLIZZI TRUSTEE/CEO 0 1315647 0 789979 0 15967 0 0 0 5857 0 2127450 0 0 KENT BISHOP TRUSTEE/PRESIDENT 0 679900 0 752663 0 5200 0 0 0 4120 0 1441883 0 0 DAWN BUSKEY TRUSTEE/PRESIDENT 0 658750 0 751150 0 2500 0 0 0 5337 0 1417737 0 0 STEVE SADOWSKI TRUSTEE/SECRETARY 0 625095 0 774925 0 7160 0 0 0 6028 0 1413208 0 0 STEVEN M CAVANAUGH TREASURER, CFO - FORMER 0 0 0 0 0 1335180 0 0 0 5657 0 1340837 0 0 TERRENCE METZGER TRUSTEE/TREASURER 0 480090 0 575000 0 0 0 0 0 4079 0 1059169 0 0 DONALD CRESCENZO TRUSTEE/PHYSICIAN 0 887550 0 25800 0 5106 0 9766 0 0 0 928222 0 0 JEFFREY C KUHN SECRETARY, CHIEF LEGAL OFFICER - FOR 0 26526 0 0 0 721900 0 26526 0 4396 0 779348 0 0 VICTOR CHERFAN TRUSTEE/PHYSICIAN 0 383348 0 274961 0 840 0 5857 0 3307 0 668313 0 0 GARY AKENBERGER SR VP FINANCE - FORMER 0 246095 0 83570 0 198982 0 36639 0 6893 0 572179 0 0 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 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. 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. GARY AKENBERGER RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, THE TOLEDO HOSPITAL, IN THE AMOUNT OF $195,150 DURING 2023. PART V, 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. FORM 990, PART VI, SECTION A, LINE 6 AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE SOLE MEMBER OF DEFIANCE HOSPITAL, INC., WHICH IS THE SOLE MEMBER OF KAITLYN'S COTTAGE. PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF KAITLYN'S COTTAGE, AND (B) APPROVE THE NOMINEES TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES, A MAJORITY OF WHOM ARE NOMINATED BY DEFIANCE HOSPITAL, INC. 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, CONSOLIDATION, 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 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. FORM 990, PART VI, SECTION B, LINE 15 KAITLYN'S COTTAGE, INC.'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF PROMEDICA FOUNDATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. 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. 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 VII, SECTION A LOUIS ROBICHAUX IS EMPLOYED BY A MANAGEMENT AGENCY THAT IS UNDER A CONTRACT TO PROVIDE MANAGEMENT SERVICES TO PROMEDICA HEALTH SERVICES. FORM 990, PART XII, LINE 2C: THE 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 HOSPITAL / FOUNDATION SUPPORT OH 501(C)(3) 10 FOSTORIA HOSPITAL ASSOCIATION 1 HCR MANORCARE FOUNDATION INC 444 N SUMMIT ST TOLEDO OH 43604 522031975 FOUNDATION OH 501(C)(3) 12B, II PROMEDICA FOUNDATION 1 HCR MANORCARE INC PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 825373223 SKILLED NURSING FACILITIES OH 501(C)(3) 10 PROMEDICA HEALTH SYSTEM INC 1 HEARTLAND HOSPICE MEMORIAL FUND INC 444 N SUMMIT ST TOLEDO OH 43604 270497199 FOUNDATION OH 501(C)(3) 12B, II PROMEDICA FOUNDATION 1 HERRICK MEDICAL CENTER AUXILIARY 500 E POTTAWATAMIE ST TECUMSEH MI 49286 383076105 HOSPITAL / FOUNDATION SUPPORT MI 501(C)(3) 12B, II HERRICK MEMORIAL HOSPITAL INC 1 HERRICK MEMORIAL HOSPITAL INC 100 MADISON AVE TOLEDO OH 43604 383049015 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 LENAWEE LONG TERM CARE PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 382879330 LONG TERM CARE MI 501(C)(3) 10 HCR MANORCARE INC 1 MANOR CARE OF GIG HARBOR WA ASSOCIATION PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 260624719 SKILLED NURSING 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