2023-11-14T10:52:04-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2022-01-01 341623770 JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL JOIN 4193943387 200 ST CLAIR STREET ST MARYS OH 45885 TRICIA A POHL CFO 4193943387 2023-11-10 1 TRICIA POHL 999009999 0 AMY CIMINELLO P00796388 6148493000 2023-11-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GRAND LAKE HEALTH SYSTEM CYNTHIA BERNING 200 ST CLAIR STREET ST MARYS OH 45885 100878263 0 X WWW.GRANDLAKEHEALTH.ORG X 1989 OH THE MISSION OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG. 9 8 787 50 -886 8376 357017 751504 99420541 98185957 988164 391544 941075 949625 101706797 100278630 79350 95450 0 0 34650505 33243264 0 0 142122 57006556 57419123 91736411 90757837 9970386 9520793 92663170 86269366 33047816 28893218 59615354 57376148 X THE MISSION OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG.VISION: TO BE: THE REGION'S LEADER AND PREFERRED CHOICE FOR HEALTHCARE; THE MOST DESIRED PLACE FOR EMPLOYMENT; THE RECOGNIZED SOURCE FOR HEALTH AND WELLNESS; AND THE COORDINATOR OF PATIENT SERVICES THAT EXCEED THE SCOPE OF OUR HEALTH SYSTEM.VALUES:- COMPASSION: TO SERVE WITH DIGNITY, CONCERN, TRUST AND KINDNESS- RESPECT: FOR OUR PATIENTS, FAMILIES, COMMUNITIES AND EACH OTHER- STEWARDSHIP: MAKING THE BEST USE OF OUR HUMAN AND ECONOMIC RESOURCES- SERVICE EXCELLENCE: ANTICIPATING CUSTOMER NEEDS, CONTINUOUSLY IMPROVING AND CONSISTENTLY EXCEEDING EXPECTATIONS- COLLABORATION: TO WORK IN PARTNERSHIP, INTERNALLY AND EXTERNALLY, TO BETTER SERVE OUR COMMUNITIES- WORKFORCE: TO VALUE AND RESPECT THE TALENTED, COMMITTED AND DIVERSE PEOPLE WHO MAKE UP OUR HEALTH SYSTEM 0 0 74972954 95450 98310721 GRAND LAKE HEALTH SYSTEM AND AFFILIATED HEALTH CENTERS ARE ORGANIZED AS A CHARITABLE, NON-PROFIT COMMUNITY HOSPITAL OFFERING A WIDE RANGE OF PRIMARY, ACUTE AND REHABILITATIVE SERVICES TO THE RESIDENTS OF THE GRAND LAKE REGION.THE ANCHOR OF GRAND LAKE HEALTH SYSTEM IS JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL (JTDMH) IN ST. MARYS OHIO. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL OPENED ITS DOORS ON MAY 5, 1953 AND TODAY AS THE GRAND LAKE HEALTH SYSTEM, HAS GROWN TO A STATE-OF-THE-ART COMMUNITY HOSPITAL INCLUDING OVER 800 MEDICAL PROFESSIONALS, 200 + PHYSICIANS AND OVER 20 AFFILIATES.JTDMH IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL-TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND MANUFACTURING. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDES A POPULATION OF 24,483 WITH THE ADJACENT COMMUNITIES OF CELINA (ZIP CODE POPULATION OF 20,375) AND WAPAKONETA (POPULATION 18,399) ALSO BEING SERVED BY THE HOSPITAL. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTDMH'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 63,257 WITH 17% IN THE MEDICARE AGE GROUP (65+).JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A FULL RANGE OF ACUTE AND OUTPATIENT SERVICES INCLUDING A 24-HOUR EMERGENCY ROOM AND OBSTETRICAL SERVICE. MAJOR SERVICES INCLUDE SURGICAL; MEDICAL; SKILLED NURSING UNIT; INPATIENT REHABILITATION UNIT; INPATIENT PSYCHIATRIC UNIT; ICU/CCU; DIAGNOSTIC RADIOLOGY INCLUDING CT, MRI AND 3D MAMMOGRAPHY; PHYSICAL THERAPY; OCCUPATIONAL MEDICINE; CARDIAC SERVICES; URGENT CARE; HOME HEALTH SERVICES; HOSPICE; WOUND CARE; HEARTBURN CENTER AND VEIN CLINIC SERVICES.THE GRAND LAKE SYSTEM COMMUNITY OUTREACH DEPARTMENT OFFERS A VARIETY OF OUTREACH PROGRAMS THAT PROMOTE GOOD HEALTH AMONG ALL AREA CITIZENS NOT JUST PATIENTS. THE GOAL IS TO EDUCATE PEOPLE SO THEY GAIN THE SKILLS AND KNOWLEDGE TO KEEP THEMSELVES AND THOSE AROUND THEM HEALTHY. MANY OF THE CLASSES, SERVICES, AND PROGRAMS HAVE EVOLVED FROM A SUGGESTION BY A HEALTHCARE PROVIDER OR LOCAL RESIDENT. THE OUTREACH DEPARTMENT OFFERS HUNDREDS OF PROGRAMS A YEAR RANGING FROM BLOOD PRESSURE SCREENINGS, SUPPORT GROUPS, SCHOOL PROGRAMS, AND COMMUNITY HEALTH FAIRS TO NAME A FEW. DURING 2022, JTDMH PROVIDED SERVICES TO THE FOLLOWING BY CATEGORY:ACUTE PATIENTS ADMITTED: 1,627SNF PATIENTS ADMITTED: 113INPATIENT PSYCH PATIENTS ADMITTED: 186BIRTHS: 313OUTPATIENT VISITS: 79,761 E.R. VISITS: 12,288HOME HEALTH VISITS: 5,357OCCUPATIONAL HEALTH VISITS: 11,265URGENT CARE VISITS: 6,074JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL AND GRAND LAKE HEALTH SYSTEM IS THE HUB OF THE LOCAL HEALTH CARE DELIVERY SYSTEM IN ST. MARYS AND SURROUNDING COMMUNITIES. THE NON-PROFIT COMMUNITY HOSPITAL ALSO HAS A MAJOR ECONOMIC IMPACT ON THE LOCAL COMMUNITY BY PROVIDING EMPLOYMENT TO APPROXIMATELY 700 INDIVIDUALS. THE GRAND LAKE HEALTH SYSTEM INCLUDES PHYSICIAN PRACTICES AND FACILITIES IN CELINA, ST. MARYS, WAPAKONETA, AND MINSTER. IN 2022, THESE PRACTICES HAD 90,347 PATIENT VISITS.GRAND LAKE AFFILIATES INCLUDE: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL GRAND LAKE FAMILY PRACTICE & PEDIATRICS AT THE CELINA MEDICAL CENTER WAPAKONETA PRIMARY CARE AT THE WAPAKONETA MEDICAL CENTER GRAND LAKE FOOT & ANKLE CENTER GRAND LAKE HOME HEALTH GRAND LAKE HOSPICE GRAND LAKE PRIMARY CARE AT ST. MARYS GRAND LAKE OB/GYN GRAND LAKE OCCUPATIONAL MEDICINE GRAND LAKE REHAB & WELLNESS CENTER GRAND LAKE HEARTBURN CENTER MIAMI & ERIE FAMILY PRACTICE & PEDIATRICS GRAND LAKE SLEEP CENTER NEW DAY PAIN MANAGEMENT CENTER GRAND LAKE NEUROLOGICAL CENTER VANAN ENT & SINUS CENTER JTDMH TRANSITIONAL CARE UNIT JTDMH INPATIENT REHAB UNIT AUGLAIZE + MERCER GENERAL & BARIATRIC SURGERY URGENT CARE AT JTDMH INPATIENT PSYCHIATRIC CENTER CANCER CENTER OF NORTHWEST OHIO GRAND LAKE PEDIATRICS KEMMLER ORTHOPAEDIC MOR REHAB CIAO MED SPAWE HAVE INVESTED SIGNIFICANTLY IN THE BUILDING DURING THE PAST TEN YEARS INCLUDING COMPLETING A NEW WOMEN'S CENTER, LABORATORY, WOUND CARE CENTER WITH TWO HYPERBARIC CHAMBERS, A NEUROLOGY CENTER, SLEEP CENTER AND THE MIAMI & ERIE MEDICAL CENTER IN MINSTER. IN EARLY 2021, GRAND LAKE HEALTH SYSTEM COMPLETED A NEW STATE OF THE ART 31,286 SQ. FT. MEDICAL OFFICE BUILDING THAT PROVIDES SPACE FOR PRIMARY CARE, OB/GYN, LAB, ADMINISTRATIVE PHYSICIANS' OFFICES, AMONG OTHER SERVICES. IN CONJUNCTION WITH PREMIER HEALTH, GRAND LAKE HEALTH SYSTEM ENTERED INTO A TEN YEAR NAMING RIGHTS PARTNERSHIP WITH THE AUGLAIZE MERCER FAMILY YMCA LOCATED IN MINSTER & CELINA. THIS PARTNERSHIP FOCUSES ON MEETING THE NEEDS OF THOSE SERVED BY EXTENDING THE MUTUAL MISSION TO BUILD HEALTHY COMMUNITIES.JTDMH RECEIVED THE FOLLOWING CERTIFICATIONS AND WAS THE RECIPIENT OF THE FOLLOWING AWARDS IN THE PAST THREE YEARS. BIRTHING CENTER 2020 ANTHEM BLUE DISTINCTION 2021 ANTHEM BLUE DISTINCTION 2021 OHIO FIRST STEPS FOR HEALTHY BABIES, THREE STAR AWARD 2022 OHIO FIRST STEPS FOR HEALTHY BABIES, FOUR STAR AWARD 2022 RECERTIFIED AS GOLD SAFE SLEEP CHAMPION 2022 ANTHEM BLUE DISTINCTION CARDIAC REHAB 2020 AACVPR CARDIAC REHAB REACCREDITATION 2021 INTENSIVE CARDIAC REHAB NEW SERVICECOMMUNITY OUTREACH AWARDS 2020 HEALTHY WORKSITE GOLD AWARD LEVEL 2021 HEALTHY WORKSITE GOLD AWARD LEVEL 2022 HEALTHY WORKSITE PLATINUM AWARD LEVELDIABETIC EDUCATION & CLINICAL NUTRITIONOUTPATIENT DIABETES SELF-MANAGEMENT EDUCATION CERTIFICATE OF RECOGNITION FOR MEETING NATIONAL STANDARDS, FROM AMERICAN DIABETES ASSOCIATION 2023-2027CDC FULL RECOGNITION FOR DIABETES PREVENTION PROGRAM 2019-2021CDC FULL RECOGNITION FOR DIABETES PREVENTION PROGRAM 2022-2024EMERGENCY DEPARTMENT 2020 ACUTE STROKE READY CERTIFICATION: DEFICIENCY FREE SURVEY 2021 ACUTE STROKE READY CERTIFICATION: DEFICIENCY FREE SURVEY 2022 ACUTE STROKE READY CERTIFICATION: DEFICIENCY FREE SURVEYINPATIENT PSYCHIATRIC CENTER 2020 CNV SURVEY: NO CITATIONSMEDICAL IMAGING 2021 ACR REACCREDITATION IN 3D MAMMOGRAPHY 2021 ACR REACCREDITATION IN MAMMOGRAPHY 2022-2025 ACR REACCREDITATION IN MRI 2022-2026 ACR REACCREDITATION IN CT NEW VISION MEDICAL LABORATORY 2023-2025 RECERTIFICATION OF HFAPPHARMACY 2020 COMPREHENSIVE PHARMACY SERVICES TOP 10% 2020 COMPREHENSIVE PHARMACY BEST PRACTICE SITE AWARD 2020 COMPREHENSIVE PHARMACY SERVICE GLENN ETOW PRESIDENT AWARD QUALITY 2020 ANNUAL ACCREDITATION: 0 DEFICIENCIES 2020 ISO SURVEY: 5/5 SCORE 2021 5-STAR RATING MEDICARE COMPARE 2022 5-STAR RATING MEDICARE COMPARESLEEP 2021 AASM SLEEP CENTER REACCREDITATION TRANSITIONAL CARE UNIT 2020 5-STAR MEDICARE COMPARE FACILITY 2021 5-STAR MEDICARE COMPARE FACILITY 2022 5-STAR MEDICARE COMPARE FACILITYVOLUNTEERS 2020 CERTIFIED DIRECTOR OF VOLUNTEER SERVICES (CDVS)WOUND CARE CENTER 2020 HEALOGICS CENTER OF DISTINCTION AWARD 2020 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARD 2021 ROBERT A WARRINER III, CLINICAL EXCELLENCE AWARD 2021 CENTER OF DISTINCTION AWARD 2021 PRESIDENTS CIRCLE AWARD 2022 CENTER OF DISTINCTION 2022 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARDWELCOMED THE FOLLOWING PROVIDERS IN 2022:PADMAJA CHALASANI, MD 74972954 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 152 0 1 787 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X TRICIA A POHL 4193943387 200 ST CLAIR ST ST MARYS OH 45885 RAJENDRA KAKARLA MD DIRECTOR 1.00 0.00 X 404553 0 0 KEN FOX DIRECTOR 1.00 0.00 X 4200 0 0 CHRIS SCHROER CHAIR 2.00 0.00 X X 0 0 0 JEFFREY SQUIRE VICE CHAIR 1.50 0.00 X X 0 0 0 ANITA GREEN CHAIR - PART YEAR 2.00 0.00 X X 0 0 0 CLAUDIA COE DIRECTOR 1.00 0.00 X 0 0 0 ISAAC HOYING DIRECTOR 1.00 0.00 X 0 0 0 RANDALL NIEKAMP DIRECTOR 1.00 0.00 X 0 0 0 WALLY WAGNER DIRECTOR 1.00 0.00 X 0 0 0 BRIAN SCHLOSSER DIRECTOR 1.00 0.00 X 0 0 0 CYNTHIA BERNING PRESIDENT 24.00 21.00 X 333700 150208 30998 TRICIA POHL TREASURER 38.00 7.00 X 217895 0 46830 LESLIE WOBLER SECRETARY 30.00 10.00 X 64891 0 23152 LANA HINDERS CHIEF CLINICAL OFFICER 44.00 1.00 X 200082 0 44921 TYLER KROEGER VP OF OPERATIONS 45.00 0.00 X 156389 0 26735 HOLLY JACOMET VP OF QUALITY AND PHYSICIAN PRACTICES 45.00 0.00 X 154045 0 5433 SHELLY RUPPERT EXECUTIVE DIRECTOR OF HR 40.00 0.00 X 157362 0 40633 AMY DIRKSEN ED OF SPECIALTY CARE SERVICES 40.00 0.00 X 143065 0 38604 JILL ENGEL DIRECTOR OF INPATIENT SERVICES 40.00 0.00 X 138861 0 38158 LORI MILLER CHIEF OF INFORMATION SERVICES 40.00 0.00 X 133349 0 35628 LESIA ARNETT EXEC DIRECTOR DEVELOPMENT, MARKETING 40.00 0.00 X 139005 0 27680 KEVIN HARLAN FORMER PRESIDENT 0.00 0.00 X 242771 0 0 JEFF VOSSLER FORMER CFO 0.00 0.00 X 107823 0 11935 2597991 150208 370707 17 1 1 0 EMERGENCY PHYSICIANS OF NW OHIO PO BOX 351357 TOLEDO OH 43635 MEDICAL SERVICES 3923400 JTDM FAMILY PRACTICE 200 ST CLAIR ST ST MARYS OH 45885 MEDICAL SERVICES 3023404 THERAPY SOLUTIONS 120 W MAIN ST VAN WERT OH 45891 MEDICAL SERVICES 2239541 NEW VISION MEDICAL LABORATORIES INC 680 S FOURTH STREET LOUISVILLE KY 63150 MEDICAL SERVICES 2012166 QUALIVIS LLC PO BOX 123847 DALLAS TX 75312 MEDICAL SERVICES 1470461 31 306991 444513 751504 NET PATIENT REVENUE 621400 98191372 98191372 PASSTHROUGH INCOME 621400 -5415 -5415 98185957 434289 434289 905675 542424 363251 363251 -16289 379540 14464 57209 -42745 -42745 -42745 CAFETERIA AND VENDING SALES 722514 441436 441436 HPSA INCENTIVES 621400 62903 62903 OUTREACH 621400 37203 37203 44832 24658 15403 4771 586374 100278630 98310721 -886 1217291 X 95450 95450 1751971 1751971 20983807 18837619 2060385 85803 1144154 1006153 133503 4498 7440085 6324296 1087516 28273 1923247 1610122 305927 7198 164184 164184 151957 151957 61682 61682 25097433 22859249 2234956 3228 245886 13912 231974 3589192 2719446 857150 12596 7516317 3936943 3579374 173185 161926 10733 526 442139 357953 84186 415431 415431 4462567 3391551 1071016 1312300 1312300 MEDICAL SUPPLIES 9043566 9043566 BAD DEBT EXPENSE 4591347 4591347 PHYSICIAN RECRUITMENT 36446 36446 AWARDS AND RECOGNITION 16502 16502 98989 23421 75568 90757837 74972954 15642761 142122 218737 155614 18072505 15115291 19295359 16459827 1215450 1558078 1883686 1648414 101987899 71270041 32927121 30717858 16233799 13519708 2409830 2363562 406683 4731014 92663170 86269366 7160183 7472597 2564103 2307693 8530411 6985039 14793119 12127889 33047816 28893218 X 59615354 57376148 59615354 57376148 92663170 86269366 X 9520793 -3000286 -8759713 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 1793 1793 0 PART II-B, LINE 1: LINE 1(G): EXECUTIVE OFFICERS OF JTD MEMORIAL HOSPITAL PLACED CALLS WITH THEIR LEGISLATORS TO HELP EDUCATE THE LEGISLATORS ON VARIOUS HEALTH CARE RELATED ISSUES. LINE 1(I): THE HOSPITAL PAID DUES TO OHA, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 166975 41309 -18361 5292 184631 62756 100100 4119 166975 63135 100 5916 6395 62756 54607 8528 63135 57509 -2902 54607 0.00000 1.00000 0.00000 0 1 1 1840845 1840845 63588730 44317503 19271227 36484471 26952538 9531933 73853 73853 30717858 MISCELLANEOUS ACCOUNTS RECEIVABLE 368141 COST REPORT SETTLEMENT RECEIVABLE 1641485 RIGHT OF USE ASSET 2721388 4731014 PROFESSIONAL LIABILITY 6865085 COST REPORT SETTLEMENT PAYABLE 1396210 OTHER LONG TERM LIABILITIES 1057935 LEASE LIABILITY 2808659 12127889 PART V, LINE 4: JTD HOSPITAL FOUNDATION, A RELATED ORGANIZATION, HOLDS THE NED & FERN JOHNS INPATIENT PSYCHIATRIC ENDOWMENT FUND AND THE HEINRICH FAMILY ENDOWMENT FUND. THE NED & FERN JOHNS INPATIENT PSYCHIATRIC ENDOWMENT FUND THE INTENTION OF THIS FUND IS TO SUPPORT SPECIALIZED SERVICES TO THE INPATIENT PSYCHIATRIC CENTER. THIS ENDOWMENT FUND MAY UTILIZED TO SUPPORT SPECIALIZED SERVICES INCLUDING BUT NOT LIMITED TO MUSIC THERAPY, ART THERAPY, EDUCATION FOR PATIENTS, FAMILIES, AND THE COMMUNITY, ONGOING EDUCATIONAL NEEDS OF THE INPATIENT PSYCHIATRIC STAFF RELATED TO THE TYPE OF CARE, PROVIDED ON THIS UNIT, AND SUPPLIES SPECIFIC FOR INPATIENT PSYCH PATIENTS SUCH AS WEIGHTED BLANKETS, SENSORY BOXES, FIDGET BOARDS, OR OTHER ACTIVITIES THAT PROVIDE A SAFE SUPPORTIVE ENVIRONMENT AIMED AT HELPING PATIENTS ACHIEVE THEIR OPTIMAL LEVEL OF FUNCTIONING. THE HEINRICH FAMILY ENDOWMENT FUND THE HEINRICH FAMILY ENDOWMENT FUND HAS BEEN ESTABLISHED TO PROVIDE FUTURE INCOME TO SUPPORT JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S EFFORTS TO MEET THE HEALTH CARE NEEDS OF OUR SURROUNDING COMMUNITIES. THE REQUEST FOR A GRANT MUST BE FOR AN ITEM OR SERVICE THAT WILL BENEFIT THE SAFETY, CARE, AND/OR COMFORT OF PATIENTS BEING CARED FOR BY JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. REQUESTS FOR FUNDS MAY ALSO BE REQUESTED TO SUPPORT A COMMUNITY PARTNERSHIP INITIATIVE THAT RELATES TO A NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. 1 1 X 1 X 120.000000000000 1 X 1 1 0 1 1 134 112875 112875 0.00130 11363 13660550 6016555 7643995 0.08870 11497 13773425 6016555 7756870 0.09000 63 14495 718165 3938 714227 0.00830 3 45 60088 60088 0.00070 1 686 61822 61822 0.00070 1 0 62 62 0.00000 3 706 101860 74 101786 0.00120 71 15932 941997 4012 937985 0.01090 71 27429 14715422 6020567 8694855 0.10090 1 0 999 999 0.00000 7 1162 37025 5565 31460 0.00040 2 251 1091 1091 0.00000 0 0 0 0 5 1 11977 11977 0.00010 3 163 9172 9172 0.00010 0 0 18 1577 60264 5565 54699 0.00060 0 4591347 50046 12736491 19232469 -6495978 X 1 1 1 1 JTD MEMORIAL HOSPITAL 200 SAINT CLAIR STREET ST MARYS OH 45885 WWW.GRANDLAKEHEALTH.ORG STATE REG. NO. 1111 X X X INPATIENT REHAB UNIT, TRANSITIONAL CARE UNIT, GERIATRIC PSYCH UNIT JTD MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V, PAGE 8 X 1 22 0 1 0 1 X 120.000000000000 200.000000000000 X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 1 X 0 X X X 1 X 0 0 JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: JTD MEMORIAL HOSPITAL CREATED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT MET ON JUNE 17, 2019. PARTICIPANTS INCLUDED THE AUGLAIZE COUNTY HEALTH DEPARTMENT, THE MERCER COUNTY HEALTH DEPARTMENT, THE AUGLAIZE COUNTY COUNCIL ON AGING, ST. MARY'S CITY SCHOOLS, UNITED WAY, AND THE FOLLOWING GROUPS FROM JTD MEMORIAL HOSPITAL:- PATIENT CARE SERVICES- HOSPITAL FOUNDATION AND GRAND LAKE HOME HEALTH/HOSPICE- EMPLOYED PHYSICIAN PRACTICES- COMMUNITY OUTREACH- ADMINISTRATIONPARTICIPANTS WERE PROVIDED A REPORT COMPILED BY AN INDEPENDENT CONSULTANT, WHICH DREW DATA FROM VARIOUS WEB SOURCES WITH BOTH AUGLAIZE AND MERCER COUNTY HEALTH INDICATORS AND HEALTH STATUS PROFILES FROM 2019. THERE WERE FIVE MAIN SOURCES FOR THIS DATA OHIO DEPARTMENT OF DEVELOPMENT COUNTY PROFILES, OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE, COUNTY HEALTH RANKINGS AND ROADMAPS 2019, AUGLAIZE COUNTY COMMUNITY HEALTH ASSESSMENT 2017, AND GRAND LAKE HEALTH SYSTEM/JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL COMMUNITY HEALTH ASSESSMENT 2016. PARTICIPANTS REVIEWED ALL DATA AND INFORMATION IDENTIFIED IN THE CHNA IN ORDER TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. PARTICIPANTS IDENTIFIED THE HEALTH NEEDS OF THE COMMUNITY BY CONSIDERING THOSE REQUISITES FOR THE IMPROVEMENT OR MAINTENANCE OF HEALTH STATUS IN THE COMMUNITY USING ALL FACTS AND CIRCUMSTANCES PRESENTED. PARTICIPANTS CONSIDERED THE SEVERITY OF EACH NEED, EFFECTIVENESS OF INTERVENTION, HEALTH DISPARITIES ASSOCIATED WITH THE NEED, AND IMPORTANCE THE COMMUNITY PLACES ON ADDRESSING THE NEED. JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: AUGLAIZE COUNTY HEALTH DEPARTMENT, MERCER COUNTY HEALTH DEPARTMENT, AUGLAIZE COUNTY COUNCIL ON AGING, ST. MARY'S CITY SCHOOLS, UNITED WAY JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL, CONDUCTED AND ADOPTED ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2022 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - SOCIAL DETERMINANTS OF HEALTH- ACCESS TO CARE- HEALTH BEHAVIORS TO ADDRESS OBESITY, HEART DISEASE, AND STROKE- MENTAL HEALTH AND ADDICTIONTHE CHNA DISCUSSED IN THE BELOW DISCLOSURES WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2019, AND THESE NEEDS HAVE BEEN ADDRESSED THROUGH 2022. THE LATEST CHNA WAS ADOPTED AT THE END OF 2022, AND WILL BE ADDRESSED IN 2023-2025.THE 2019 CHNA WAS APPROVED BY THE BOARD ON OCTOBER 23, 2019 WITH THE CORRESPONDING IMPLEMENTATION STRATEGY APPROVED BY THE BOARD JANUARY 22, 2020 AND EFFECTIVE 2020 - 2022. THEREFORE, THE FOLLOWING ACTIONS TAKEN DURING THE 2022 TAXABLE YEAR WERE ASSOCIATED WITH THE 2019 CHNA:SIGNIFICANT HEALTH NEED 1: MENTAL HEALTH-COLEMAN BEHAVIORAL HEALTH PARTNERSHIP: ONGOING INTEGRATION OF COLEMAN STAFF INTO THE GRAND LAKE PHYSICIAN PRACTICES THAT BEGAN IN 2014 CONTINUED THROUGH 2022. THE PEER COUNSELOR REFERRALS FOR OPIOID OVERDOSES WAS IMPLEMENTED IN 2018, AS WELL AS PRE-SCREENS FOR CRISIS INTERVENTIONS CONTINUED THROUGH 2022. BEGINNING IN JUNE 2019, COLEMAN EXPANDED TO BOTH CELINA AND MINSTER LOCATION OFFERINGS TO INCREASE ACCESS AND HAS CONTINUED THROUGH 2022.-HORIZON HEALTH PARTNERSHIP: JTDMH'S INPATIENT GERO-PSYCH UNIT IN COLLABORATION WITH HORIZON HEALTH, CONTINUED TO SEE STEADILY INCREASING AVERAGE DAILY CENSUS THROUGHOUT THE YEAR. IN 2022, THE UNIT HAD 186 ADMISSIONS WITH AN ADC OF 6.2.-TELE MENTAL HEALTH PILOT: IN EXPLORATION OF TELEMEDICINE OFFERINGS FOR JTDMH'S POPULATION, THE TELEMEDICINE PROCESS FOR ADDICTION SERVICES VIA BRIGHT HEART HEALTH ESTABLISHED IN AUGUST 2018 IN THE EMERGENCY DEPARTMENT CONTINUED THROUGH 2022. SIGNIFICANT HEALTH NEED 2: OBESITY-HEALTH SMART: CONTINUED TO SPONSOR HEALTH SMART PROGRAM IN CONJUNCTION WITH THE EMPLOYER-SPONSORED HEALTH PLAN WITH IMPROVED BIOMETRICS NOTED DURING 2022 IN MULTIPLE CATEGORIES FOR THOSE JTDMH EMPLOYEES AND THEIR SPOUSES AND DEPENDENTS WHO PARTICIPATE.-GRAND HEALTH CHALLENGE: 16TH ANNUAL GRAND HEALTH CHALLENGE WAS HELD JANUARY THRU MAY 2022 IN WHICH 243 PARTICIPANTS LOST 1,690.7 POUNDS. THE 1ST PLACE FINISHER OF THE 'MASTER MAINTAINER' PROGRAM, LOST 36.68% OF THEIR BODYWEIGHT.SIGNIFICANT HEALTH NEED 3: RISKY BEHAVIORS-SMOKING CESSATION PROGRAM: SMOKING CESSATION PROGRAM FOR JTDMH/GLHS EMPLOYEES, SPOUSES AND DEPENDENTS CONSISTING OF 8-12 ONE-ON-ONE SESSIONS WITH THE EMPLOYER OUTREACH COORDINATOR BEGAN IN EARLY 2019. SIGNIFICANT HEALTH NEED 4: ACCESS TO CARE- JTDMH/GLHS PRIMARY CARE SERVICES EDUCATION: CONTINUE TO COLLABORATE WITH AUGLAIZE COUNTY HEALTH DEPARTMENT IN DISTRIBUTION OF COMPREHENSIVE AUGLAIZE COUNTY PRIMARY CARE PROVIDER LISTINGS, WITH LOCATION, CONTACT INFO, OFFICE HOURS, AND MEDICAID ACCEPTANCE TO PARENTS OF YOUNG CHILDREN AT IMMUNIZATION APPOINTMENTS.-PROMOTION OF JTDMH/GLHS SERVICES VIA WEBSITE AND SOCIAL MEDIA OUTLETS: TRACKING OF PAGE VIEWS AND SOCIAL MEDIA SESSIONS CONTINUED IN COLLABORATION WITH JTDMH'S MARKETING FIRM TO ASSIST IN ASSESSING COMMUNITY REACH OF SERVICES PROMOTION. THE 'URGENT CARE', 'FIND A PHYSICIAN AND 'PEDIATRICS' PAGES REPRESENTED THE LARGEST YEAR-OVER-YEAR INCREASE IN PAGE VIEWS.SIGNIFICANT HEALTH NEED 5: EDUCATION/PREVENTION/HEALTH PROMOTION-HEALTH SCREENINGS AT COMMUNITY FUNCTIONS: COMMUNITY OUTREACH EFFORTS TO INCREASE BLOOD PRESSURE SCREENINGS WITHIN THE COMMUNITY CONTINUED IN 2022.-COLORECTAL SCREENINGS: COMMUNITY OUTREACH CONTINUED EFFORTS IN 2022 TO INCREASE COLORECTAL SCREENING KIT DISTRIBUTION. PART V, LINE 7A HTTPS://WWW.GRANDLAKEHEALTH.ORG/NEWS-AND-EVENTS/COMMUNITY-HEALTH-ASSESSMENT.HTML PARY V, LINE 16A, FAP HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE.HTML PART V, LINE 16B, FAP APPLICATION HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE.HTML PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE.HTML PART V, SECTION B, LINE 20D JTDMH DOES NOT HAVE PRESUMPTIVE ELIGIBILITY DETERMINATIONS, AT THIS POINT IN TIME. AN INDIVIDUAL'S ELIGIBILITY IS ONLY DETERMINED AFTER AN APPLICATION HAS BEEN COMPLETED AND SUBMITTED. FINANCIAL ASSISTANCE COUNSELORS ARE TRAINED TO PROVIDE CANDIDATES IN HOW TO COMPLETE THE APPLICATION, AND WORK WITH CANDIDATES THROUGHOUT THE APPROVAL PROCESS. EVERY EFFORT IS MADE TO IDENTIFY POTENTIAL CANDIDATES AND ASSIST POTENTIAL CANDIDATES IN COMPLETING THE APPLICATION. 5 1 - URGENT CARE AT JTDMH 200 ST CLAIR STREET ST MARYS OH 45885 URGENT CARE 2 - GRAND LAKE HOME HEALTH 1122 EAST SPRING STREET ST MARYS OH 45885 HOME HEALTH 3 - GRAND LAKE HOSPICE 1122 EAST SPRING STREET ST MARYS OH 45885 HOSPICE 4 - GRAND LAKE OCCUPATIONAL MEDICINE 200 ST CLAIR STREET ST MARYS OH 45885 OCCUPATIONAL MEDICINE 5 - CELINA PRO HEALTH DIAGNOSTIC CENTER 801 PRO DRIVE CELINA OH 45822 DIAGNOSTIC CENTER PART I, LINE 7: THE HOSPITAL USED THE MEDICARE COST REPORT AS THEIR BASIS FOR CALCULATING THE AMOUNTS REPORTED IN LINE 7A & 7B. ON THE COST REPORT, IT FIRST ALLOCATES OVERHEAD DEPARTMENTS VIA A COST STEP DOWN METHODOLOGY AND THEN CALCULATES A COST TO CHARGE RATIO. FOR LINES 7E, 7F,7G & 7I ACTUAL COSTS WERE USED. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $4,591,347 PART II, COMMUNITY BUILDING ACTIVITIES: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY BUILDING ACTIVITIES IN 2022 RANGING FROM PARTICIPATION IN COMMUNITY BOARDS, COMMITTEES AND CLUBS THAT WERE ENGAGED IN IMPROVING THE OVERALL COMMUNITY INCLUDING THE COMMUNITY'S HEALTH/MEDICAL NEEDS TO OFFERING BABYSITTING TRAINING CLASSES TO ASSURE THE CHILDREN OF THE COMMUNITY ARE WELL CARED FOR IN THEIR PARENT'S ABSENCE. OTHER EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO PARTICIPATING IN WORKFORCE DEVELOPMENT OF HEALTH CARE CAREERS THROUGH JOB SHADOWING AND SEMINARS AND ACTIVE PARTICIPATION IN THE COMMITTEE THAT IS WORKING TO RESTORE CLEAN AND HEALTHY WATER TO THE COMMUNITIES LARGEST RECREATION RESOURCE, GRAND LAKE ST. MARYS. PART III, LINE 2: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL RECORDS GROSS BAD DEBT EXPENSE WHEN AN ACCOUNT IS DEEMED UNCOLLECTIBLE AT THE VALUE OF CHARGES. IF IT BECOMES NECESSARY TO ESTIMATE BAD DEBT EXPENSE, ESTIMATES ARE DONE BASED UPON HISTORIC RELATIONSHIPS BETWEEN CHARGES AND BAD DEBT. PART III, LINE 3: THE HOSPITAL ESTIMATES THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY BASED UPON A HISTORIC REVIEW OF THE APPLICABLE BAD DEBT ACCOUNTS. EVERY EFFORT IS MADE TO IDENTIFY THESE ACCOUNTS PRIOR TO BEING WRITTEN OFF AS UNCOLLECTIBLE, INCLUDING MULTIPLE EFFORTS TO CONTACT THE PATIENT. AS SOON AS THESE ACCOUNTS ARE DEEMED UNCOLLECTIBLE, ALL COLLECTION WORK AND ACTIVITY IS IMMEDIATELY CEASED. THESE ACCOUNTS ARE THEN TREATED THE SAME AS ANY OTHER ACCOUNT QUALIFYING FOR FINANCIAL ASSISTANCE. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. 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. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES REMAINING AFTER THIRD-PARTY COVERAGE FOR A PORTION OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: THE HOSPITAL USED A COST STEP DOWN METHODOLOGY FROM THE MEDICARE COST REPORT TO CALCULATE THE AMOUNTS REPORTED IN LINE 6. THE COST OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2022 WAS $19,232,469 THE PAYMENTS RELATED TO THESE SERVICES WERE $12,736,491. LEAVING A MEDICARE SHORTFALL OF $6,495,978 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH JTD MEMORIAL HOSPITAL'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. PART III, LINE 9B: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL FOLLOWS THE SAME COLLECTION PRACTICES NO MATTER THE TYPE OF PATIENT. ALL PATIENTS ARE TREATED EQUALLY. COLLECTION PRACTICES ARE NOT PURSUED FOR PATIENTS THAT THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE/CHARITY CARE. PART VI, LINE 2: N/A - ALL NEEDS WERE ASSESSED WHILE CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: PATIENTS ARE INFORMED ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH SIGNS POSTED AT REGISTRATION, IN ER/WAITING ROOMS, ON THE WEBSITE, THROUGH INFORMATION INCLUDED IN THE PATIENT HANDBOOK, THROUGH INFORMATION PRINTED ON THE REVERSE SIDE OF THE STATEMENTS THEY RECEIVE FOR SERVICES, AND IS AVAILABLE UPON REQUEST. PART VI, LINE 4: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND SMALL MANUFACTURING JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDES A POPULATION OF 24,483. THE ADJACENT COMMUNITY OF CELINA (ZIP CODE POPULATION OF 20,375) IS ALSO SERVED BY THE HOSPITAL. THE HOSPITAL ALSO PROVIDES SERVICES TO THE WAPAKONETA COMMUNITY (POPULATION 18,399) ALTHOUGH THE TRADITIONAL SERVICE PATTERNS SEND THAT COMMUNITY'S PATIENTS TO LIMA. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTDMH'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 63,257 WITH 17% IN THE MEDICARE AGE GROUP (65+). PART VI, LINE 5: JTD MEMORIAL HOSPITAL/GRAND LAKE HEALTH COMMUNITY OUTREACHPART OF THE HOSPITAL'S PHILOSOPHY HAS BEEN TO PROMOTE THE HEALTH AND WELLNESS OF COMMUNITY MEMBERS. THE HOSPITAL HAS A HISTORY OF REACHING OUT TO THE COMMUNITY TO PROMOTE WELLNESS AND PREVENTIVE MEDICINE AND HAS AN OFFICE THAT IS DEDICATED TO COORDINATING HEALTHCARE, OUTREACH, AND EDUCATION.FOLLOWING IS A LISTING OF THE WIDE VARIETY OF OUTREACH PROGRAMS THAT ARE SPONSORED BY GRAND LAKE HEALTH SYSTEM.- MONTHLY BLOOD PRESSURE CHECKS - BREASTFEEDING CLASSES- CHILDBIRTH CLASSES - CALL A NURSE- CPR CLASSES - DIABETIC SUPPORT GROUP- HEALING MEMORIES SUPPORT GROUP- STROKE SUPPORT GROUP- PARKINSON'S SUPPORT GROUP- COMMUNITY HEALTH FAIRS/ROTARY BLOOD TEST CLINICS- SCHOOL HEALTH FAIRS- MAKE BELIEVE HOSPITAL (KINDERGARTEN PROGRAM TO ALLEVIATE FEARS OF HOSPITAL)- NEW BREMEN SENIOR CITIZEN PROGRAM- FREE PROSTATE SCREENING- SENIOR SUPPER HOUR- SENIORCISE- AMERICAN SIGN LANGUAGE CLASSES (I & II)- SPEAKERS BUREAU- SUPERSITTERS CLASSES- FREE MONTHLY WELLNESS EDUCATION & SCREENING (WRIGHT STATE, AGAPE, WAGNERS IGA)- WOMEN'S WALK FOR WELLNESS- COORDINATION OF THE UNITED WAY CAMPAIGN FOR THE HOSPITAL- ROAD TO FITNESS PROGRAM (12 MONTHS)- MAN TO MAN PROSTATE SUPPORT GROUP- DRUG TAKEBACK PROGRAM- PRE-DIABETES CLASSES (ADVANCED LIFE BALANCED CLASS)IN ADDITION, WE SUPPORT THE WELLNESS OF THE COMMUNITY BY PARTICIPATING IN EVENTS HOSTED AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. FOLLOWING IS A LIST OF TOPICS THAT ARE COVERED:- NUTRITION- HEART EDUCATION- SKIN CANCER- OSTEOPOROSIS SCREEN- BREAST CANCER AWARENESS- CHOLESTEROL AWARENESS- ASSESSMENT OF DIABETES- ALCOHOL EDUCATION- COLORECTAL CANCER EDUCATION- ASTHMA EDUCATION- PERIPHERAL SCREENING- SLEEP APNEA INFORMATION- STROKE EDUCATIONWE ALSO PARTNER WITH ONE LOCAL RADIO STATION PROVIDING MONTHLY INTERVIEWS ON A WIDE VARIETY OF HEALTHCARE TOPICS.SINCE 2007, WE HAVE SPONSORED A WEIGHT LOSS/WELLNESS PROGRAM, ENTITLED, "THE GRAND HEALTH CHALLENGE." IN THE PAST 16 YEARS, THIS PROGRAM HAS SERVED 6,344 RESIDENTS OF BOTH MERCER AND AUGLAIZE COUNTIES, LOSING MORE THAN 50,000 LBS. 1 AUGLAIZE-MERCER COUNTY YMCA 7590 STATE ROUTE 703 CELINA OH 45822 341371829 501(C)(3) 25000 0 YMCA ANNUAL FUND DRIVE DONATION ST MARYS COMMUNITY FOUNDATION 146 E SPRING ST ST MARYS OH 45885 237372270 501(C)(3) 35000 0 ST MARYS ATHLETIC COMPLEX JTD FOUNDATION 200 ST CLAIR STREET ST MARYS OH 45885 341623769 501(C)(3) 20000 0 GLHS VOLUNTEERS DONATION TO SUPPORT THE FOUNDATION AUGLAIZE COUNTY FAIR BOARD PO BOX 431 WAPAKONETA OH 45895 344427752 501(C)(3) 7500 0 GIFT OF LIGHTS SPONSORSHIP 4 0 PART I, LINE 2: THE HOSPITAL MAKES GRANTS TO COMMUNITY ORGANIZATIONS. GRANTS ARE MONITORED THROUGH DIRECT INVOLVEMENT AND CONTACT WITH THE ORGANIZATION OR EVENT IN WHICH THE GRANT WAS GIVEN. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 CYNTHIA BERNING PRESIDENT 304560 130208 29140 20000 0 0 6000 0 23915 1083 363615 151291 0 0 RAJENDRA KAKARLA MD DIRECTOR 404553 0 0 0 0 0 0 0 0 0 404553 0 0 0 TRICIA POHL TREASURER 217895 0 0 0 0 0 23053 0 23777 0 264725 0 0 0 LANA HINDERS CHIEF CLINICAL OFFICER 193082 0 7000 0 0 0 21193 0 23728 0 245003 0 0 0 KEVIN HARLAN FORMER PRESIDENT 0 0 0 0 242771 0 0 0 0 0 242771 0 242771 0 SHELLY RUPPERT EXECUTIVE DIRECTOR OF HR 154362 0 3000 0 0 0 16976 0 23657 0 197995 0 0 0 TYLER KROEGER VP OF OPERATIONS 153389 0 3000 0 0 0 3046 0 23689 0 183124 0 0 0 AMY DIRKSEN ED OF SPECIALTY CARE SERVICES 143065 0 0 0 0 0 14966 0 23638 0 181669 0 0 0 JILL ENGEL DIRECTOR OF INPATIENT SERVICES 138861 0 0 0 0 0 14536 0 23622 0 177019 0 0 0 LORI MILLER CHIEF OF INFORMATION SERVICES 133349 0 0 0 0 0 12008 0 23620 0 168977 0 0 0 LESIA ARNETT EXEC DIRECTOR DEVELOPMENT, MARKETING 136005 0 3000 0 0 0 4046 0 23634 0 166685 0 0 0 HOLLY JACOMET VP OF QUALITY AND PHYSICIAN PRACTICE 151045 0 3000 0 0 0 4376 0 1057 0 159478 0 0 0 JEFF VOSSLER FORMER CFO 100823 0 7000 0 0 0 10825 0 1110 0 119758 0 0 0 PART I, LINE 1A JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A PORTION OF YMCA DUES TO THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES; HOWEVER, THIS IS AN EMPLOYEE BENEFIT AVAILABLE TO ALL ELIGIBLE EMPLOYEES OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL TO PROMOTE COMMUNITY WELLNESS (ONE OF THE PEOPLE LISTED IN PART VII, SECTION A, LINE 1A RECEIVED THIS BENEFIT). THE YMCA DUES WERE NOT INCLUDED IN THE RECIPIENT'S COMPENSATION. PART I, LINE 4B KEVIN HARLAN, THE FORMER PRESIDENT, HAS RECEIVED A PAYOUT FROM THE NON QUALIFIED RETIREMENT PLAN OF 242,771 IN THE CURRENT YEAR DUE TO HIS DEPARTURE FROM JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. THE PLAN IS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN MAINTAINED BY A RELATED ORGANIZATION FOR KEY EMPLOYEES OF THE RELATED ORGANIZATION. THERE IS AN INCENTIVE BONUS PLAN AND A PRODUCTION COMPENSATION PLAN. VESTING HAPPENS OVER A 3 OR A 5 YEAR TIME FRAME DEPENDING IF THE CONTRIBUTION WAS MADE TO THE INCENTIVE BONUS PLAN OR THE PRODUCTION COMPENSATION PLAN. THERE ARE CERTAIN CIRCUMSTANCES WHERE A PARTICIPANT WILL FORFEIT ANY AND ALL OF THE COMPANY CONTRIBUTIONS MADE INTO THE PLAN INCLUDING ENGAGING IN ACTIVITIES WHICH ARE DEEMED TO BE SIGNIFICANTLY COMPETITIVE WITH THE COMPANY WITHIN A 50 MILE RADIUS OF ANY EXISTING OFFICE, IF IT IS DEEMED THE PARTICIPANT ACTED IN A DISHONEST WAY, BREACHES HIS OR HER FIDUCIARY OBLIGATIONS, CONVICTED OF A FELONY INVOLVING SIGNIFICANT MORAL TURPITUDE, OR OTHER ACTS WHICH WOULD CAUSE THE COMPANY SUBSTANTIAL HARM. PART I, LINE 7 EMPLOYEE'S BONUSES ARE DETERMINED AT THE DISCRETION OF THE PRESIDENT. A HOSPITAL FACILITIES REVENUE IMPROVEMENT BONDS SERIES 2012 341623770 2012-12-14 8500000 ASU BUILDING PROJECT AND CAPITAL EQUIPMENT 0 0 0 A 8500000 8500000 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE BOARD-DESIGNATED COMMITTEE FOR THEIR REVIEW PRIOR TO FILING. THE BOARD-DESIGNATED COMMITTEE WILL REPORT THEIR REVIEW AND APPROVAL OF FORM 990 TO THE FULL BOARD OF DIRECTORS. A PAPER COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL BOARD MEMBERS FOR THEIR INDEPENDENT REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS, OFFICERS, AND MANAGERS OF GRAND LAKE HEALTH SYSTEM. ANNUALLY, THESE INDIVIDUALS, AS WELL AS, NEW BOARD MEMBERS WHEN THEY FIRST JOIN, PROVIDE THE PRESIDENT OF THE CORPORATION AN UPDATED LISTING OF ALL BUSINESSES OR OTHER ORGANIZATIONS OF WHICH HE OR SHE IS A TRUSTEE, OFFICER, DIRECTOR, MEMBER, PARTNER, OWNER, GENERAL MANAGER, SUBSTANTIAL SHAREHOLDER, EMPLOYEE OR FOR WHICH HE OR SHE ACTS AS AN AGENT. WHEN A CONFLICT OF INTEREST IS IDENTIFIED THE DETERMINATION IS MADE AND DISCUSSED OPENLY AT THE BOARD LEVEL. THE INDIVIDUAL IS THEN PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS. FORM 990, PART VI, SECTION B, LINE 15 THE SALARY AMOUNT FOR THE PRESIDENT IS REVIEWED AND APPROVED BY JTDMH'S BOARD EXECUTIVE COMMITTEE. THE EXEC COMMITTEE USES THE OHIO HOSPITAL ASSOCIATION'S ANNUAL CHIEF EXECUTIVE OFFICER COMPENSATION SURVEY, INTEGRATED HEALTHCARE STRATEGIES (AN INDEPENDENT COMPENSATION CONSULTANT), ANNUAL NATIONAL HEALTHCARE LEADERSHIP COMPENSATION SURVEY, AND INPUT FROM THE BOARD OF TRUSTEES AND BOARD EXEC COMMITTEE TO DETERMINE THE PRESIDENT'S SALARY. THE BOARD CHAIR SIGNS THE CHANGE OF PAY FORM AS WELL AS WRITES A MEMO TO THE DIRECTOR OF FINANCIAL SERVICES. DOCUMENTATION REGARDING THE PRESIDENT'S SALARY AND RECORD KEEPING REGARDING DELIBERATIONS IS KEPT BY THE BOARD EXEC COMMITTEE. SALARY AMOUNTS FOR OFFICERS AND OTHER KEY EMPLOYEES ARE REVIEWED AND APPROVED BY THE PRESIDENT. THE PRESIDENT REFERENCES THE OHA COMPENSATION SALARY SURVEY. THE PRESIDENT IS APPROVED BY THE BOARD OF DIRECTORS TO PERFORM THIS PROCESS. FURTHERMORE, THE PRESIDENT IS COMPLETELY INDEPENDENT FROM ALL OFFICERS AND KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN DECEMBER 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G HOSPITAL CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 12,460,766. MANAGEMENT AND GENERAL EXPENSES 1,979,108. FUNDRAISING EXPENSES 3,228. TOTAL EXPENSES 14,443,102. OTHER CONTRACTED PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 7,404,479. MANAGEMENT AND GENERAL EXPENSES 226,448. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,630,927. FAMILY PRACTICE PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,994,004. MANAGEMENT AND GENERAL EXPENSES 29,400. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,023,404. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTION IN JTD FAMILY PRACTICE, INC. -8,430,312. DIFFERENCE BETWEEN BOOK AND TAX PASS THROUGH INCOME -329,401. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. JTD HOSPITAL FOUNDATION 200 ST CLAIR STREET ST MARYS OH 45885 341623769 TO RAISE FUNDS FOR JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. OH 501(C)(3) LINE 7 JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL 1 JTDMH PAIN MANAGEMENT LLC 200 ST CLAIR ST ST MARYS OH 45885 465353958 PAIN MANAGEMENT SERVICES OH JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL RELATED 41923 178731 0 1 0.51000 JTDM FAMILY PRACTICE LLC 200 ST CLAIR STREET ST MARYS OH 45885 341689161 PHYSICIANS PROVIDING MEDICAL SERVICES OH JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL C -8719668 7621699 1.00000 1 1 1 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 JTD HOSPITAL FOUNDATION C 306991 CASH TRANSACTION JTD HOSPITAL FOUNDATION R 55367 CASH TRANSACTION JTDM FAMILY PRACTICE LLC A 773025 CASH TRANSACTION JTDM FAMILY PRACTICE LLC B 5885000 CASH TRANSACTION JTDM FAMILY PRACTICE LLC O 3005124 CASH TRANSACTION JTDM FAMILY PRACTICE LLC P 921447 CASH TRANSACTION JTDM FAMILY PRACTICE LLC Q 6375755 CASH TRANSACTION JTDMH PAIN MANAGEMENT LLC J 92300 AMOUNT INVOICED JTDMH PAIN MANAGEMENT LLC F 90122 CASH TRANSACTION