2023-11-14T16:12:38-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2022-01-01 341517672 PROMEDICA FOUNDATION PROM 5675853618 100 MADISON AVE ATTN TAX DEPARTM TOLEDO OH 43604 TERRENCE METZGER CFO 5675853618 2023-11-10 1 TERRENCE METZGER 999009999 1 AMY CIMINELLO P00796388 3122071040 2023-11-06 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z TERRENCE METZGER 100 MADISON AVE ATTN TAX DEPARTMENT TOLEDO OH 43604 71769433 0 X WWW.PROMEDICA.ORG X 1986 OH THE PROMEDICA FOUNDATION'S MISSION IS TO GENERATE AND DIRECT THE UTILIZATION OF RESOURCES TO ENRICH EXISTING PROGRAMS AND FUND NEW SERVICES, INSPIRING EXCELLENT IN THE PROVISION OF HEALTH CARE AND ENHANCING QUALITY OF LIFE FOR THE PEOPLE OF OUR COMMUNITY. 7 2 0 100 0 0 14467690 13037948 0 0 19549963 9062063 -71522 -609496 33946131 21490515 13182080 14309297 0 0 3502662 3877723 0 491218 4848861 4115217 3184135 20799959 21862373 13146172 -371858 412976640 332575061 6470806 1984612 406505834 330590449 THE PROMEDICA FOUNDATION'S MISSION IS TO GENERATE AND DIRECT THE UTILIZATION OF RESOURCES TO ENRICH EXISTING PROGRAMS AND FUND NEW SERVICES, INSPIRING EXCELLENCE IN THE PROVISION OF HEALTH CARE AND ENHANCING QUALITY OF LIFE FOR THE PEOPLE OF OUR COMMUNITY. 0 0 14309297 14309297 0 PROMOTE HEALTH AND WELL-BEING WITH SUPPORT FOR MEDICAL CARE, MEDICAL EDUCATION, MEDICAL RESEARCH, AND SOCIAL DETERMINANTS OF HEALTH, AND BY SOLICITING CONTRIBUTIONS, PROVIDING GRANTS, AND INVESTING FUNDS TO GENERATE INCOME TO SUPPORT PROMEDICA HEALTH SYSTEM, INC. ENTITIES. 14309297 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 1 X 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 X 7 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X TERRENCE METZGER 4192525772 100 MADISON AVE TOLEDO OH 43604 X ANGELA BRANDT TRUSTEE 1.00 15.00 X 0 858024 10246 ARTURO POLIZZI EX-OFFICIO/PRESIDENT AND CEO 1.00 54.00 X X 0 1605830 12750 GARY M CATES TRUSTEE 1.00 2.00 X 0 565615 4880 JAMES HOFFMAN CHAIRMAN 1.00 13.00 X X 0 0 0 LESLIE A CHAPMAN CHAIRMAN 1.00 13.00 X X 0 0 0 LOUIS ROBICHAUX TRUSTEE/TREASURER 1.00 54.00 X X 0 0 0 RANDALL OOSTRA EX-OFFICIO/PHS PRES. & CEO - PART YEAR 1.00 54.00 X X 0 5476040 3579 ROBERT W LACLAIR EX-OFFICIO 1.00 16.00 X 0 50000 0 STEVEN M CAVANAUGH TRUSTEE/TREASURER, CFO - PART YEAR 1.00 54.00 X X 0 2435815 41525 JEFFREY C KUHN SEC./CHIEF LEGAL OFF - PART YEAR 1.00 54.00 X 0 927467 44223 STEPHEN M SADOWSKI CHIEF LEGAL OFFICER 1.00 54.00 X 0 683615 6102 ELIZABETH SAVAGE AVP DEVELOPMENT 40.00 0.00 X 0 150787 2994 CHRISTI ANSBERG VP PHILANTHROPY 40.00 0.00 X 0 300364 6313 DASA DZIERWA ASSOCIATE VP 40.00 0.00 X 0 173446 0 0 13227003 132612 0 0 1 0 0 21171 909850 100600 12006327 10476 13037948 7404520 7404520 50990804 4300 49337561 0 1653243 4300 1657543 1657543 331861 909850 941357 -609496 -609496 21490515 0 0 8452567 14036059 14036059 273238 273238 3170033 280691 2889342 41690 4462 37228 471133 50418 420715 194867 20854 174013 58551 58551 491218 491218 770888 770888 327688 327688 45582 45582 276760 276760 232 232 95352 95352 446376 446376 225895 225895 546746 546746 INTERCOMPANY SERVICES 285250 285250 SUPPLIES 27014 27014 EQUIPMENT 15224 15224 FOOD EXPENSE 233 233 62344 63 62281 21862373 14309297 2704215 4848861 1184917 2524387 16838991 13620792 30205 12380 2473771 1977652 1871250 1871250 1871250 348922838 277640915 3018339 2142076 38636329 32785609 412976640 332575061 142371 83537 6328435 1901075 6470806 1984612 X 249380839 194138971 157124995 136451478 406505834 330590449 412976640 332575061 X -371858 -74380573 113000 -1275954 X X 0 1 X 1 1 1 X X 35 BAY PARK COMMUNITY HOSPITAL 341883132 3 1 148647 0 COMMUNITY HEALTH CENTER OF BRANCH COUNTY 386108110 3 1 157534 0 DEFIANCE HOSPITAL INC 344446484 3 1 105631 0 EMMA L BIXBY MEDICAL CENTER 382796005 3 1 1465399 0 FOSTORIA HOSPITAL ASSOCIATION 340898745 3 1 119533 0 HERRICK MEMORIAL HOSPITAL INC 383049015 3 1 0 0 MEMORIAL HOSPITAL 344430849 3 1 250041 0 MERCY MEMORIAL HOSPITAL CORPORATION 381984289 3 1 139331 0 THE TOLEDO HOSPITAL 344428256 3 1 4314793 0 HCR MANORCARE INC 825373223 10 0 90000 0 KAITLYN'S COTTAGE INC 454781053 10 0 289368 0 LENAWEE LONG TERM CARE 382879330 10 0 0 0 MONROE COMMUNITY HEALTH SERVICES 382934134 10 0 0 0 PROMEDICA CONTINUING CARE SERVICES CORPORATION 344492440 10 0 0 0 PROMEDICA PHYSICIAN GROUP 341899439 10 1 0 0 TOLEDO DISTRICT NURSE ASSOCIATION 344427949 10 0 0 0 VISITING NURSE HOSPICE AND HEALTH CARE 341831624 10 0 0 0 PROMEDICA CONTINUUM SERVICES 341880767 10 0 0 0 MANOR CARE OF GIG HARBOR WA ASSOCIATION 260624719 10 0 0 0 MANOR CARE OF LACEY WA ASSOCIATION 260624391 10 0 0 0 MANOR CARE OF LYNNWOOD WA ASSOCIATION 260624675 10 0 0 0 MANOR CARE OF SALMON CREEK WA ASSOCIATION 260624375 10 0 0 0 MANOR CARE OF SPOKANE WA ASSOCIATION 260624687 10 0 0 0 MANOR CARE OF TACOMA WA ASSOCIATION 260624696 10 0 0 0 PROMEDICA CENTRAL PHYSICIANS 341881137 10 0 0 0 PROMEDICA CHILDRENS SPECIALISTS 208734161 10 0 0 0 PROMEDICA GENITO-URINARY SURGEONS 461120436 10 0 0 0 PROMEDICA MONROE CARDIOLOGY 272920342 10 0 0 0 PROMEDICA MONROE PHYSICIANS 461111822 10 0 0 0 PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS 263888045 10 0 0 0 PROMEDICA PHYSICIANS AT HOME INC 852181349 10 0 0 0 PROMEDICA PRIMARY CARE PROVIDERS 831731861 10 0 0 0 MEMORIAL PROFESSIONAL SERVICES 273763993 10 0 0 0 PROMEDICA MULTI SPECIALTY PHYSICIANS 454976786 10 0 0 0 PROMEDICA HEALTH SYSTEM 341517671 10 1 4076508 0 35 11156785 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION A, LINE 1: PROMEDICA HEALTH SYSTEM, INC. (34-1517671) & AFFILIATES ARE DESIGNATED BY THE CLASS AND PURPOSE LISTED ON SCHEDULE R, PART II. THE SUPPORTED ORGANIZATIONS ARE ALL DESIGNATED AS EITHER 509(A)(1) OR SECTION 509(A)(2) ORGANIZATIONS. PART IV, SECTION A, LINE 2 PROMEDICA FOUNDATION PROVIDES SUPPORT FOR THE FOLLOWING ENTITIES THAT CURRENTLY HAVE NOT RECEIVED AN IRS DETERMINATION OF STATUS. THE 1023 APPLICATION FORMS FOR THESE ENTITIES ARE EITHER IN THE FINAL STEP OF REVIEW PRIOR TO BEING ELECTRONICALLY FILED OR HAVE NOT YET RECEIVED A DETERMINATION LETTER: - PROMEDICA MULTI SPECIALTY PHYSCIANS FEIN 45-4976786 PART IV, SECTION C, LINE 1: PROMEDICA FOUNDATION IS AN OHIO NOT-FOR-PROFIT CORPORATION THAT OPERATES TO SUPPORT, BENEFIT, AND, THROUGH ITS ACTIVITIES, CARRY OUT AND FURTHER THE PURPOSE OF PROMEDICA HEALTH SYSTEM, INC. (PHS) AFFILIATES. PROMEDICA FOUNDATION QUALIFIES AS A TYPE II SUPPORTING ORGANIZATION BECAUSE IT IS SUPERVISED AND CONTROLLED IN CONNECTION WITH ALL ORGANIZATIONS THAT ARE EXEMPT AFFILIATED MEMBERS OF PHS. COMMON SUPERVISION AND CONTROL ARE SHARED THROUGH THE STRUCTURAL RELATIONSHIP OF PHS. THERE HAS BEEN A HISTORIC AND CONTINUING RELATIONSHIP BETWEEN PROMEDICA FOUNDATION AND ITS SUPPORTED ORGANIZATIONS, WHICH HAS CREATED A SUBSTANTIAL IDENTITY OF INTERESTS BETWEEN THE ORGANIZATIONS. PROMEDICA FOUNDATION HAS MAINTAINED, AND WILL CONTINUE TO MAINTAIN, A SIGNIFICIANT INVOLVEMENT IN EACH SUPPORTED ORGANIZATIONS' OPERATIONS. PHS IS THE MEMBER OF PROMEDICA FOUNDATION AND THE PARENT OF AN INTEGRATED HEALTH CARE DELIVERY NETWORK MADE UP OF AN AFFILIATED GROUP OF EXEMPT ORGANIZATIONS WHICH INCLUDES HOSPITALS, HEALTH CARE PROVIDERS, CONTINUING CARE SERVICES, SPECIALIZED HEALTH SERVICES, ENTITIES PROVIDING SUPPORT SERVICES, AND FOUNDATIONS. PHS PROVIDES OVERALL DIRECTION, MANAGEMENT, AND CONTROL TO ITS FIRST TIER SUBSIDIARIES, INCLUDING PROMEDICA FOUNDATION, AND INDIRECTLY THROUGH ITS FIRST TIER SUBSIDIARIES, TO ALL AFFILIATED SECOND TIER SUBSIDIARIES OF EACH FIRST TIER SUBSIDIARY. THE ACTIVITIES OF PHS SUPPORT THE EXEMPT PURPOSES OF THE AFFILIATED ORGANIZATIONS IN THE PHS NETWORK AND ENHANCE AND IMPROVE THE DELIVERY OF EFFECTIVE HEALTH CARE SERVICES TO THE COMMUNITIES SERVED BY THE PHS NETWORK. CONTROL AND MANAGEMENT EFFECTIVELY IS VESTED IN THE SAME PERSONS THAT CONTROL AND MANAGE ALL SUBSIDIARY ORGANIZATIONS THROUGH RESERVED POWERS. PHS HAS RESERVED POWERS IN EACH SUBSIDIARY'S CODE OF REGULATIONS OR BYLAWS ALONG WITH THE RIGHT TO APPROVE CERTAIN ACTIONS OF EACH SUBSIDIARY'S BOARD OF TRUSTEES. THE FIRST TIER SUBSIDIARIES HAVE IN TURN RESERVED SIMILAR POWERS OVER THE SECOND TIER SUBSIDIARIES TO INTEGRATE OVERALL DIRECTION, MANAGEMENT, AND CONTROL. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 66141078 -10551236 87191 55502651 60983875 2000 5185950 30747 66141078 57669824 2000 3812051 500000 60983875 50971352 10450 6688022 57669824 56244034 8450 -4741132 540000 50971352 0.34520 0.65480 0.00000 1 0 1871250 1871250 1871250 CASH VALUE OF LIFE INSURANCE 2369828 FUNDED PERPETUITIES 30415781 32785609 DUE TO AFFILIATES 1669757 ACCRUED WAGES 231318 1901075 PART V, LINE 4: THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT PROMEDICA HEALTH SYSTEM, INC. ENTITIES CONSISTENT WITH DONOR INTENT. X X X X X X 1 ALY STERLING PHILANTHROPY PO BOX 140668 TOLEDO OH 43614 CAMPAIGN CONSULTING 0 13150948 415923 12735025 13150948 415923 12735025 FL MI OH AK CA CO IL KS KY MA MD ME MN MS NC ND NH NJ NM NV NY OK OR PA SC TN UT VA WA WI WV AL AR CT LA MO RI TX CHILDREN'S HOSPITAL EVENT 204901 155726 49175 9503 66877 14380 28581 DEFIANCE GOLF EVENT 144175 127515 16660 1125 19267 9755 8 892635 626609 266026 21706 41960 212244 415910 100049 1241711 909850 331861 21706 52588 298388 430290 138385 941357 -609496 PART I, LINE 2B, COLUMN (V): AMOUNTS PAID FOR THE REIMBURSEMENT OF EXPENSES TO PROFESSIONAL FUNDRAISING COMPANIES IS $5,923. PAYMENT FOR PROFESSIONAL FUNDRAISING SERVICES IS DISTINGUISHED FROM EXPENSE PAYMENTS ON THE DETAIL OF THE INVOICES. 1 ALLIANCE FOR A HEALTHIER GENERATION 1028 SE WATER AVENUE NO 215 PORTLAND OR 97214 272028308 501(C)(3) 10000 0 OPERATING GRANT BAY PARK COMMUNITY HOSPITAL 2801 BAY PARK DR ORGEON OH 43616 341883132 501(C)(3) 148647 0 OPERATING GRANT BOYS & GIRLS CLUB OF SANDHILLS PO BOX 1761 SOUTHERN PINES NC 28388 911877405 501(C)(3) 87500 0 OPERATING GRANT COMMUNITY HEALTH CENTER OF BRANCH COUNTY 274 E CHICAGO ST COLDWATER MI 49036 386108110 501(C)(3) 157534 0 OPERATING GRANT TOLEDO CLASSIC INC 3400 EXECUTIVE PARKWAY SUITE 1A TOLEDO OH 43606 341499072 501(C)(3) 10000 0 OPERATING GRANT DEFIANCE HOSPITAL INC 1200 RALSTON AVE DEFIANCE OH 43512 344446484 501(C)(3) 105631 0 OPERATING GRANT EMMA L BIXBY MEDICAL CENTER 818 RIVERSIDE AVENUE ADRIAN MI 49221 382796005 501(C)(3) 1465399 0 OPERATING GRANT FIRST TEE OF LAKE ERIE PO BOX 351142 TOLEDO OH 43635 465657531 501(C)(3) 379588 0 OPERATING GRANT FOLDS OF HONOR 5971 N PATRIOT DRIVE OWASSO OK 74055 753240683 501(C)(3) 25000 0 OPERATING GRANT FOSTORIA HOSPITAL ASSOCIATION PO BOX 907 FOSTORIA OH 44830 340898745 501(C)(3) 119533 0 OPERATING GRANT FOUNDATION OF FIRST HEALTH 150 APPLECROSS ROAD PINEHURST NC 28374 510191937 501(C)(3) 87500 0 OPERATING GRANT HCR MANORCARE INC 333 N SUMMIT ST TOLEDO OH 43604 825373223 501(C)(3) 90000 0 OPERATING GRANT HOPE TOLEDO 300 MADISON AVE STE 1400A TOLEDO OH 43604 852018307 501(C)(3) 825000 0 OPERATING GRANT KAITLYN'S COTTAGE 1260 RALSTON AVE DEFIANCE OH 43512 454781053 501(C)(3) 289368 0 OPERATING GRANT MEMORIAL HOSPITAL 715 S TAFT AVE FREMONT OH 43420 344430849 501(C)(3) 250041 0 OPERATING GRANT MERCY MEMORIAL HOSPITAL CORPORATION 718 N MACOMB MONROE MI 48162 381984539 501(C)(3) 139331 0 OPERATING GRANT NAMI 4301 WILSON BLVD SUITE 300 ARLINGTON VA 22203 431201653 501(C)(3) 31503 0 OPERATING GRANT OWENS CORNING 1 OWENS CORNING PKWY TOLEDO OH 43659 341270856 501(C)(3) 25000 0 OPERATING GRANT PROMEDICA HEALTH SYSTEM INC 100 MADISON AVE TOLEDO OH 43604 341517671 501(C)(3) 4076508 0 OPERATING GRANT RALLY CAP SPORTS PO BOX 81 SEA GIRT NJ 08750 223681722 501(C)(3) 10000 0 OPERATING GRANT THE ROOT CAUSE COALITION 975 F ST NW STE 400A WASHINGTON DC 20004 475126498 501(C)(3) 30000 0 OPERATING GRANT THE TOLEDO HOSPITAL 2142 NORTH COVE BLVD TOLEDO OH 43606 344453256 501(C)(3) 4314793 0 OPERATING GRANT TIGER WOODS FOUNDATION 1 TIGER WOODS WAY ANAHEIM CA 92801 200677815 501(C)(3) 140000 0 OPERATING GRANT UNIVERSITY OF TOLEDO FOUNDATION 4510 DORR ST MS 820 TOLEDO OH 43615 346555110 501(C)(3) 86000 0 OPERATING GRANT YWCA OF NORTHWEST OHIO 1018 JEFFERSON AVENUE TOLEDO OH 43604 344428265 501(C)(3) 1122182 0 OPERATING GRANT 27 0 SCHOLARSHIPS 68 273238 PART I, LINE 2: AS AN AFFILIATE OF PROMEDICA HEALTH SYSTEM, INC. (PHS) CORPORATE POLICIES EXIST TO ENSURE THAT THE APPROVAL AND DISTRIBUTION OF FOUNDATION FUNDS ARE CONSISTENT WITH THE APPROVED CORPORATE MISSION, SUPPORTED BUSINESS UNIT STRATEGIC PLAN AND DOCUMENTED DONOR INTENT. ALL REQUESTS FOR FUNDS MUST BE SUBMITTED ON THE "FUND UTILIZATION REQUEST" FORM AND INCLUDE WRITTEN SUPPORTING DOCUMENTATION AND APPROPRIATE APPROVALS, INCLUDING BOARD APPROVALS, DEPENDING ON THE DOLLAR AMOUNT OF THE REQUEST. ON A REGULAR BASIS A REPORT LISTING ALL FUND DISTRIBUTIONS IS DISTRIBUTED TO THE CHIEF PHILANTHROPY OFFICER, CHIEF FINANCIAL OFFICER AND RESPECTIVE FOUNDATION BOARDS. 1 1 0 0 0 0 0 0 0 RANDALL OOSTRA EX-OFFICIO/PHS PRES. & CEO - PART YE 0 1664907 0 2628840 0 1182293 0 0 0 3579 0 5479619 0 0 STEVEN M CAVANAUGH TRUSTEE/TREASURER, CFO - PART YEAR 0 604206 0 1107251 0 724358 0 28986 0 12539 0 2477340 0 0 ARTURO POLIZZI EX-OFFICIO/PRESIDENT AND CEO 0 1003178 0 597348 0 5304 0 0 0 12750 0 1618580 0 0 JEFFREY C KUHN SEC./CHIEF LEGAL OFF - PART YEAR 0 390988 0 196494 0 339985 0 23904 0 20319 0 971690 0 0 ANGELA BRANDT TRUSTEE 0 634364 0 220060 0 3600 0 0 0 10246 0 868270 0 0 STEPHEN M SADOWSKI CHIEF LEGAL OFFICER 0 596289 0 86275 0 1051 0 0 0 6102 0 689717 0 0 GARY M CATES TRUSTEE 0 478526 0 83613 0 3476 0 0 0 4880 0 570495 0 0 CHRISTI ANSBERG VP PHILANTHROPY 0 241767 0 55646 0 2951 0 0 0 6313 0 306677 0 0 DASA DZIERWA ASSOCIATE VP 0 153212 0 19934 0 300 0 0 0 0 0 173446 0 0 ELIZABETH SAVAGE AVP DEVELOPMENT 0 140307 0 10480 0 0 0 0 0 2994 0 153781 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 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. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: STEVEN CAVANAUGH RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $688,132 DURING 2022. JEFFERY KUHN RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $333,184 DURING 2022. 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 LIMTATION 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. SCHEDULE J, SUPPLEMENTAL INFORMATION: IN ADDITION, HCR MANORCARE, INC. A RELATED ORGANIZATION PROVIDES A SPLIT-DOLLAR LIFE INSURANCE PLAN TO ITS CHIEF EXECUTIVE OFFICER FROM WHICH NO CASH PAYMENTS WERE MADE DURING THE YEAR. X 1 10476 COST OR SELLING PRICE 0 0 1 0 SCHEDULE M, PART I LINE 9 THE AMOUNT IN COLUMN B REFERS TO THE NUMBER OF DONORS THAT CONTRIBUTED STOCK. 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 PARENT CORPORATION AND SOLE MEMBER OF PROMEDICA FOUNDATION. AS THE MEMBER, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF PROMEDICA FOUUNDATION, AND (B) FILL ANY VACANCY ON THE BOARD OF TRUSTEES. 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, 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 PROMEDICA FOUNDATION'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 XI, LINE 9: UNCOLLECTIBLE PLEDGES -1,275,954. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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