2023-11-14T15:07:04-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2022-01-01 382796005 EMMA L BIXBY MEDICAL CENTER EMMA 4192525772 100 MADISON AVE ATTN TAX DEPARTM TOLEDO OH 43604 TERRENCE METZGER CFO 4192525772 2023-11-10 1 TERRENCE METZGER 999009999 1 AMY CIMINELLO P00796388 3122071040 2023-11-10 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL TERRENCE METZGER 100 MADISON AVE ATTN TAX DEPARTMENT TOLEDO OH 43604 134953302 0 X WWW.PROMEDICA.ORG X 1989 MI PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL IS AN ACUTE CARE HOSPITAL THAT PROVIDES HEALTHCARE SERVICES PRIMARILY TO INDIVIDUALS OF LENAWEE COUNTY. 20 15 677 15 0 0 4855455 1477078 132177597 131691698 26427 135856 2143373 1648670 139202852 134953302 10000 1072641 0 0 45598185 38331295 0 0 0 64711302 86287808 110319487 125691744 28883365 9261558 214732301 223622255 141064883 152517755 73667418 71104500 X EMMA L. BIXBY MEDICAL CENTER IS DEDICATED TO IMPROVING HUMAN LIFE AND DEVOTED TO THE PATIENTS AND FAMILIES WE SERVE THROUGH INNOVATIVE CARE, SUPERIOR QUALITY, AND PREMIER CUSTOMER SERVICE. 0 0 108393904 1072641 131691698 EMMA L. BIXBY MEDICAL CENTER IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. FOUNDED IN 1911, EMMA L. BIXBY MEDICAL CENTER (D/B/A PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL CONTINUES TO MEET THE HEALTHCARE NEEDS OF ADRIAN, MICHIGAN AND SURROUNDING SOUTHEAST MICHIGAN COMMUNITIES AS THE LARGEST ACUTE CARE FACILITY IN LENAWEE COUNTY. IT 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 HEALTH CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL (CVHH) IS A 50-BED, FULL-SERVICE, ACUTE CARE HOSPITAL STAFFED BY MORE THAN 120 ACTIVE PROVIDERS WORKING TO MEET IDENTIFIED NEEDS OF THE COMMUNITY. THE FACILITY IS MORE THAN 200,000 SQUARE FEET, CONSISTING OF 40 MEDICAL-SURGICAL BEDS, 10 CRITICAL CARE BED, FOUR OPERATING ROOMS WITH THREE MINOR PROCEDURE ROOMS, 27 EMERGENCY ROOMS AND EIGHT LABOR AND DELIVERY ROOMS AS WELL AS A FULL ARRAY OF DIAGNOSTIC SERVICES. THE HOSPITAL ALSO PROVIDES NUMEROUS INPATIENT AND OUTPATIENT SERVICES, WITH ITS STAFF OF PROFESSIONALS OFFERING CARE IN GENERAL SURGERY, HEART AND VASCULAR CARE, WOMEN'S HEALTH, ORTHOPAEDICS, PEDIATRICS, FAMILY MEDICINE, CRITICAL CARE, AND CANCER TREATMENT SERVICES. IN 2022, CVHH SERVED 2,943 INPATIENTS; 89,207 OUTPATIENTS; AND 28,926 EMERGENCY CENTER PATIENTS. THE HICKMAN CANCER CENTER, ON THE HICKMAN HOSPITAL CAMPUS, IS ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS. AS PART OF THE PROMEDICA CANCER INSTITUTE, HICKMAN CANCER CENTER OFFERS DIAGNOSTIC SERVICES, AS WELL AS RADIATION AND MEDICAL ONCOLOGY TREATMENT FOR HUNDREDS OF NEW PATIENTS ANNUALLY. AS A MEMBER OF THE TOLEDO COMMUNITY HOSPITAL ONCOLOGY PROGRAM, HICKMAN CANCER CENTER OFFERS PATIENTS THE OPPORTUNITY TO PARTICIPATE IN NATIONAL CANCER TRIALS. FURTHER, CVHH'S CARDIAC AND PULMONARY REHABILITATION PROGRAM IS CERTIFIED BY THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION. ADDITIONALLY, CVHH OFFERS TELEMEDICINE SERVICE TO ITS INPATIENT CARE UNITS TO HELP PROVIDE REAL-TIME PATIENT DIAGNOSIS AND TREATMENT FROM A PHYSICIAN. THE SERVICE ALLOWS A DOCTOR'S VISIT TO BE CONDUCTED WITH A SPECIAL COMPUTER AND INTERNET CONNECTION AND HELPS THE HOSPITAL PROVIDE SAFE, QUALITY CARE WHEN IT'S NEEDED DURING NIGHT SHIFTS WHEN FEWER PHYSICIANS MAY BE AVAILABLE. CVHH HAS ALSO RECEIVED THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES GOLD PLUS ACHIEVEMENT FOR ITS COMMITMENT TO ENSURING STROKE PATIENTS RECEIVE THE MOST APPROPRIATE TREATMENT ACCORDING TO NATIONALLY RECOGNIZED STANDARDS OF CARE.THE HOSPITAL CONTRIBUTED $22,594,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE IN 2022.THROUGH COMMUNITY HEALTH SERVICES, HEALTH PROFESSIONAL EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH ACTIVITIES, CASH AND IN-KIND CONTRIBUTIONS, AND COMMUNITY BENEFIT OPERATIONS, CVHH CONTRIBUTED $633,000 TO THE COMMUNITY DURING 2022. THE FOLLOWING ARE EXAMPLES OF SUCH CONTRIBUTIONS: - SUPPORT OF PROMEDICA FARMS AND SOUTH MICHIGAN FOOD BANK TO PROVIDE FRESH PRODUCE TO THE LENAWEE COUNTY COMMUNITY, INCLUDING CVHH PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY. - SUPPORT GROUPS FOR INDIVIDUALS WITH CHRONIC DISEASES, FOCUSED ON PATIENTS' EMOTIONAL, PHYSIOLOGICAL AND PSYCHOLOGICAL NEEDS; - CHILDHOOD AND ADULT IMMUNIZATIONS AND ASTHMA CARE - COMMUNITY HEALTH AND WELLNESS SERVICES, WHICH INCLUDED TOBACCO CESSATION PROGRAMS, NUTRITION AND HEALTHY LIFESTYLES CLASSES, PRENATAL CLASSES, AND CPR TRAINING; AND - COLLECTION AND RESPONSIBLE DISPOSAL OF UNUSED MEDICATIONS THROUGH TWO COMMUNITY TAKE BACK EVENTS AND MEDSAFE COLLECTION BINS WITH THE EMERGENCY DEPARTMENT.CVHH PROVIDED A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO THE COMMUNITY DURING 2022, OF WHICH $3,752,000 REPRESENTED UNCOMPENSATED AMOUNTS FOR TREATMENT TO THOSE PATIENTS WHO DID NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR HOSPITAL SERVICES. FINANCIAL ASSISTANCE REPRESENTS THE COST TO PROVIDE SERVICE AND DOES NOT INCLUDE THE COSTS FOR ACCOUNTS WRITTEN OFF TO BAD DEBT FOR PATIENTS WHO DO NOT PAY THEIR BILLS. CVHH'S COST OF BAD DEBT FOR 2022 WAS $6,020,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $22,594,000 NOTED ABOVE.FURTHER, CVHH PROVIDED $4,324,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. ALSO, IN 2022, THE TOTAL COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS WAS $448,000 AND IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $22,594,000 NOTED ABOVE.CVHH PROVIDED 677 JOBS THROUGH DIRECT EMPLOYMENT IN 2022, EXPENDING $28,486,000 IN NET PAYROLL. A TOTAL OF $1,822,000 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES. IN SUMMARY, CVHH DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. AND, WE RECOGNIZE 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 CLASSES, HEALTH FAIRS AND OTHER OUTREACH ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. 108393904 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 X 0 0 677 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 0 X TERRENCE METZGER 4192525772 100 MADISON AVE TOLEDO OH 43604 X DAWN M BUSKEY TRUSTEE 1.00 54.00 X 0 750062 11796 MARCY L BROWN CHAIRMAN 1.00 14.00 X X 0 0 0 DE'ANGELO BOONE VICE CHAIR 1.00 0.00 X X 0 0 0 PAULA K HOLTZ VICE CHAIR 1.00 1.00 X X 0 0 0 LOUIS ROBICHAUX TREASURER 1.00 54.00 X X 0 0 0 AARON SWIGGUM TRUSTEE 1.00 0.00 X 0 0 0 BRANDON FARVER TRUSTEE 1.00 0.00 X 0 0 0 CHRISTI L ANSBERG TRUSTEE 1.00 40.00 X 0 300364 6313 DARRIN ARQUETTE TRUSTEE 1.00 40.00 X 0 387645 35300 DENNIS M SMOKE TRUSTEE 1.00 1.00 X 0 0 0 ELIZABETH A KENNEDY TRUSTEE 1.00 1.00 X 0 0 0 FRANK DICK TRUSTEE 1.00 1.00 X 0 0 0 GARY E MCDOWELL TRUSTEE 1.00 1.00 X 0 0 0 GRACE M GARNO TRUSTEE 1.00 1.00 X 0 0 0 JOHN C AKENS TRUSTEE 1.00 1.00 X 0 0 0 JULIE K YAROCH DO TRUSTEE 1.00 40.00 X 392736 0 19095 MARCIA J BOYNTON JD TRUSTEE 1.00 1.00 X 0 0 0 MARK HAAG TRUSTEE 1.00 0.00 X 0 0 0 MARSHA L DAVIS TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL B ADAMS TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL J UCKELE TRUSTEE 1.00 1.00 X 0 0 0 PAUL E GIETZEN MD TRUSTEE 1.00 40.00 X 0 369146 26180 RICK K KNIERIM TRUSTEE 1.00 1.00 X 0 0 0 RUDY FLORES TRUSTEE 1.00 0.00 X 0 0 0 RUSSELL L DEMPSEY TRUSTEE 1.00 1.00 X 0 0 0 RANDALL OOSTRA PHS PRES. & CEO-PART YEAR 1.00 54.00 X 0 5476040 3579 STEVEN M CAVANAUGH TREASURER, CFO-PART YEAR 1.00 54.00 X 0 2435815 41525 ARTURO POLIZZI PRESIDENT AND CEO 1.00 54.00 X 0 1605830 12750 JEFFREY C KUHN SECRETARY, CHIEF LEGAL OFFICER-PART YEAR 1.00 54.00 X 0 927467 44223 STEPHEN M SADOWSKI CHIEF LEGAL OFFICER 1.00 54.00 X 0 683615 6102 CHRISTINA BELL DIRECTOR OF PHARMACY 40.00 0.00 X 144143 0 30573 ALEXA SIMKOW DIR-SURGICAL SVCS. 40.00 0.00 X 137819 0 23665 VERONICA HARTZELL RN, HOSPITAL 40.00 0.00 X 131358 0 29611 MELISSA THOMPSON CLINICAL PHARMACIST 40.00 0.00 X 144438 0 9543 LISA BACHMAYER THERAPIST-PHYSICAL 40.00 0.00 X 145689 0 1980 1096183 12935984 302235 41 0 1 0 0 1465399 11679 1477078 NET PATIENT SERVICES 621110 130758073 130758073 AFFILIATED ORG RENT 531120 933625 933625 131691698 135856 135856 53088 0 53088 53088 53088 AUXILARY INCOME 900099 1595582 1595582 1595582 134953302 131691698 0 1784526 X 1072641 1072641 31349065 24787763 6561302 194182 153540 40642 4483047 3544753 938294 2305001 1822569 482432 164044 164044 2831 2831 18025615 11881914 6143701 10249 982 9267 1438048 137849 1300199 4070 2503 1567 3280683 3182263 98420 164507 15769 148738 3193028 3193028 7748237 6899156 849081 INTERCOMPANY SERVICES 22601167 22601167 DRUGS 10626990 10626990 MEDICAL SUPPLIES 8688124 8688124 PROVISION FOR BAD DEBT 6020260 6020260 4319955 3762633 557322 125691744 108393904 17297840 0 7075986 26220159 16548901 18155916 2557469 2695744 189074 225851 164111468 23818086 146867662 140293382 886381 0 1047603 1736886 39559225 34294317 214732301 223622255 14172579 6494807 49361865 49389706 77530439 96633242 141064883 152517755 X 34593529 70181253 39073889 923247 73667418 71104500 214732301 223622255 X 9261558 -11824476 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2831 2831 0 PART II-B, LINE 1: EMMA L. BIXBY MEDICAL CENTER PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, A PORTION OF WHICH IS ALLOCABLE TO LOBBYING BY THE ORGANIZATION. 24519146 -4022944 87011 20409191 22620000 1929793 30647 24519146 771892 19420909 2927199 500000 22620000 689791 82101 771892 1270935 -81144 500000 689791 0.93890 0.06110 0 1 1 1244583 1244583 129497551 11006853 118490698 23748 14668 9080 27906485 12221737 15684748 5439101 574828 4864273 140293382 BENEFICIAL INTEREST IN FOUNDATION 34016079 ESTIMATED THIRD PARTY PAYOR RECEIVABLE 278238 34294317 ESTIMATED THIRD PARTY PAYOR RECEIVABLE 4348954 INTERCOMPANY DEBT TO THE TOLEDO HOSPITAL 84598118 OPERATING LEASE LIABILITY 2000395 ACCRUED SALARIES & BENEFITS 2774508 REMEDIATION 2694811 ACCRUED PENSION COST 216456 96633242 PART V, LINE 4: THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT EMMA L. BIXBY MEDICAL CENTER CONSISTENT WITH DONOR INTENT. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 733156 733156 0.00610 21227625 16902738 4324887 0.03610 21960781 16902738 5058043 0.04220 135647 135647 0.00110 358682 358682 0.00300 139157 139157 0.00120 633486 633486 0.00530 22594267 16902738 5691529 0.04750 3 15 154 110 44 0.00000 1 200 273 195 78 0.00000 4 92 3922 2798 1124 0.00000 8 307 4349 3103 1246 0.00000 1 6020260 299025 26115769 26604047 -488278 X 1 1 1 HERRICK MEMORIAL OFFICE PLAZA CONDO ASSOCIATION FACILITY SUPPORT 0.71800 0.28200 2 LENAWEE CLINICAL PARTNERS PHYSICIAN MGMT SERVICES 0.50000 0.38460 1 1 PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL 5640 N ADRIAN HWY ADRIAN MI 49221 WWW.PROMEDICA.ORG 1060000004 X X X PROMEDICA CHARLES AND VIRGINIA HICKMAN H 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 600.000000000000 X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. FOLLOWING THE FORMAL COUNTY ASSESSMENT SURVEY PROCESS PROMEDICA CHARLES & VIRGINIA HICKMAN HOSPITAL WITH THE LENAWEE HEALTH NETWORK, COMPRISED OF MULTIPLE COMMUNITY ORGANIZATIONS, COLLABORATED TO DEVELOP A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR LENAWEE COUNTY. A RESOURCE ASSESSMENT AND GAP ANALYSIS WERE COMPILED AS PART OF THIS PROCESS.IN 2022, PROMEDICA CHARLES & VIRGINIA HICKMAN HOSPITAL CONVENED A CHNA COMMITTEE TO REVIEW THE MOST RECENT LENAWEE COUNTY CHA AND CHIP, TAKING INTO ACCOUNT THE GAP AND RESOURCE ASSESSMENTS. THE COMMITTEE THEN SELECTED AND PRIORITIZED KEY HEALTH INDICATORS FOR THEIR DEFINED COMMUNITY, IDENTIFIED RESOURCES AND GAPS IN THESE AREAS, AND DEVELOPED IMPLEMENTATION PLANS TO ADDRESS THESE PRIORITY HEALTH NEEDS IN THE COMMUNITY OVER THE NEXT THREE YEARS. THE HOSPITAL RECEIVED FEEDBACK ON THE CHNA PLAN FROM THE LENAWEE COUNTY HEALTH DEPARTMENT, TO CONFIRM THESE NEEDS FROM A COMMUNITY HEALTH EXPERT PERSPECTIVE.THE LENAWEE HEALTH NETWORK STRATEGIC PLANNING PROCESS INCLUDED INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY. COLLABORATING ORGANIZATIONS INCLUDED:CATHOLIC CHARITIES OF JACKSON, HILLSDALE, & LENAWEE COUNTIES, COMMUNITY ACTION AGENCY OF JACKSON, LENAWEE & HILLSDALE COUNTIES, CRADLE TO CAREER, FAMILY MEDICAL CENTER OF MICHIGAN, GOODWILL INDUSTRIES OF SE MICHIGAN, HEAD START, ADRIAN PUBLIC SCHOOLS, HOSPICE OF LENAWEE, INTERCONNECTIONS DROP-IN CENTER, LENAWEE COMMUNITY FOUNDATION, LENAWEE COUNTY DEPARTMENT OF VETERANS AFFAIRS, LENAWEE COUNTY HEALTH DEPARTMENT, LENAWEE COMMUNITY MENTAL HEALTH AUTHORITY, LENAWEE DEPARTMENT ON AGING, LENAWEE DEPARTMENT OF HEALTH AND HUMAN SERVICES, LENAWEE INTERMEDIATE SCHOOL DISTRICT, LENAWEE SUBSTANCE ABUSE PREVENTION COALITION, MSU-EXTENSION, ONE LENAWEE, PROMEDICA CHARLES & HICKMAN HOSPITAL, REGION 2 AREA AGENCY ON AGING, THE CARE PREGNANCY CENTER OF LENAWEE, UNITED WAY OF MONROE/LENAWEE COUNTIES, THOME PACE, YMCA OF LENAWEE COUNTY PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY CONDUCTED ITS 2022 CHNA WITH THE FOLLOWING HOSPITAL FACILITY: HERRICK MEMORIAL HOSPITAL, INC. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY CONDUCTED ITS 2022 CHNA WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 11: EMMA L. BIXBY MEDICAL CENTER (DBA PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL) CONDUCTED AND ADOPTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2022 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - OPIOIDS AND SUBSTANCE ABUSE - CHRONIC DISEASE PREVENTION - MENTAL HEALTH- CANCER THE 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.EMMA L. BIXBY MEDICAL CENTER DOES NOT INTEND TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT GIVEN THAT SOME OF THE IDENTIFIED HEALTH NEEDS ARE EITHER BEING ADDRESSED DURING PHYSICIAN VISITS, GO BEYOND THE SCOPE OF THE HOSPITAL, OR ARE BEING ADDRESSED BY, OR WITH, OTHER ORGANIZATIONS IN THE COMMUNITY. TO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOST IMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OF RESOURCES, MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITY ORGANIZATIONS AND COALITIONS. THE 2019 SIGNIFICANT HEALTH NEEDS IDENTIFIED, BUT SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS 2019 IMPLEMENTATION PLAN INCLUDE: ADULT - HEALTHCARE COVERAGE, UTILIZATION, PREVENTIVE MEDICINE, WOMEN'S HEALTH, MEN'S HEALTH, ORAL HEALTH, HEALTH STATUS PERCEPTIONS, ADULT WEIGHT STATUS, ADULT TOBACCO USE, ADULT ALCOHOL USE, ADULT SEXUAL BEHAVIOR, ADULT MENTAL HEALTH, CANCER, QUALITY OF LIFE, SOCIAL DETERMINANTS OF HEALTH, ENVIRONMENTAL HEALTH, PARENTING; CHILD HEALTH, HEALTH AND FUNCTIONAL STATUS. HEALTH CARE ACCESS, EARLY CHILDHOOD, MIDDLE CHILDHOOD, FAMILY AND COMMUNITY CHARACTERISTICS, AND PARENT HEALTH.DUE TO RESTRICTIONS AND REGULATIONS PUT IN PLACE DUE TO THE COVID-19 PANDEMIC, MANY OF THE STRATEGIES MEANT TO BE IMPLEMENTED HAD TO BE DELAYED. EMMA L. BIXBY MEDICAL CENTER DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2022 WITH RESPECT TO THE CHNA CONDUCTED IN 2019. THE LATEST CHNA WAS ADOPTED IN DECEMBER OF 2022.HEALTH NEED IDENTIFIED: OPIOIDS AND SUBSTANCE ABUSESTRATEGY #1 - PARTICIPATE IN COMMUNITY DRUG TAKE BACK DAYS ANNUALLY AND MED SAFE COLLECTION AND DISPOSAL.ACTIONS TAKEN: - 857 POUNDS OF DRUGS WERE COLLECTED FROM MEDSAFE BOXES AND DRUG TAKE BACK DAY EVENTS AND DISPOSED OF APPROPRIATELY. STRATEGY #2 - OFFER PEER RECOVERY COACHES FOR THOSE PATIENTS SEEKING HELP WITH SUBSTANCE ABUSE.ACTIONS TAKEN: - FIFTEEN (15) PATIENTS WERE CONNECTED TO PEER RECOVERY COACHES WITH COMMUNITY MENTAL HEALTH & PATHWAYS FOR POST DISCHARGE TREATMENT IN 2022. STRATEGY #3 - CONTINUE THE ALTO (ALTERNATIVES TO OPIOIDS) PROJECT TO REDUCE THE AMOUNT OF OPIOIDS PRESCRIBED AT DISCHARGE FOR PATIENT PAIN MANAGEMENT. ACTIONS TAKEN:- USING ALTO PROGRAM, IN 2020, THE AVERAGE NUMBER OF DAYS OPIOIDS WERE PRESCRIBED AT DISCHARGE WAS DECREASED TO 3.06 DAYS BY DECEMBER 2020, DECREASED FURTHER TO 2.836 IN 2021, AND SLIGNTLY INCREASED TO 2.89 IN 2022. THIS IS A 5.5% REDUCTION SINCE THE PROGRAM STARTED. HEALTH NEED IDENTIFIED: CHRONIC DISEASE PREVENTION STRATEGY #1 - PROVIDE ANNUAL BLOOD PRESSURE SCREENINGS AT KEY COMMUNITY LOCATIONS. ACTIONS TAKEN: - PROVIDED 195 COMMUNITY PARTICIPANTS WITH BLOOD PRESSURE SCREENINGS AND EDUCATION IN 2022. STRATEGY #2 - PROVIDE ANNUAL BLOOD SUGAR SCREENINGS AT KEY COMMUNITY LOCATIONS.ACTIONS TAKEN: - HOSPITAL PROVIDED 102 NO COST BLOOD SUGAR SCREENINGS AND EDUCATION AT KEY COMMUNITY LOCATIONS IN 2022.STRATEGY #3 - PROVIDE EDUCATION TO THE COMMUNITY ABOUT BLOOD PRESSURE AND BLOOD SUGAR SELF-MONITORING VIA VIRTUAL SUPPORT GROUP MEETINGS.ACTIONS TAKEN: - 124 COMMUNITY MEMBERS RECEIVED SELF-MONITORING EDUCATION RELATED EDUCATION AT BLOOD PRESSURE SUPPORT GROUPS AND DIABETES SUPPORT GROUPSSTRATEGY #4 PROVIDE EDUCATION MATERIALS RELATED TO RESPIRATORY DISEASE (COPD) PREVENTION AND SELF-MANAGEMENT TO PATIENTS AT DISCHARGE AND AT KEY COMMUNITY LOCATIONS.ACTIONS TAKEN: - DISTRIBUTED SMOKING CESSATION AND COPD EDUCATION TO EIGHT (8) COMMUNITY MEMBERS AT TWO (2) EVENTS IN 2022.STRATEGY #5 CONTINUE TO FUND PROMEDICA FARMS AND VEGGIE MOBILE PROGRAM TO EXPAND THE OUTREACH OF FRESH PRODUCE ACCESS THROUGH COLLABORATIONS WITH LOCAL PRODUCERS AND COMMUNITY AGENCIES.ACTIONS TAKEN: - TOTAL FRESH PRODUCE DONATED TO THE COMMUNITY WAS 7,142 POUNDS IN 2022.STRATEGY #6 SCREEN INPATIENTS FOR FOOD INSECURITY, AND PROVIDE COMMUNITY RESOURCE LISTING, IMMEDIATE FOOD SOURCE, AND VEGGIE MOBILE VOUCHER. ACTIONS TAKEN: - FOUR (4) FOOD AT DISCHARGE BOXES WERE PROVIDED TO INPATIENTS WHO SCREENED POSITIVE FOR FOOD INSECURITY IN 2022.HEALTH NEED IDENTIFIED: MENTAL HEALTHSTRATEGY #1 - DEVELOP AND DISTRIBUTE A MENTAL HEALTH RESOURCE GUIDE TO PATIENTS AND THE COMMUNITY.ACTIONS TAKEN: - 317 MENTAL HEALTH RESOURCE GUIDES WERE DISTRIBUTED TO PATIENTS AND THE COMMUNITY IN 2022, TO IMPROVE AWARENES OF LOCAL RESOURCES.STRATEGY #2 - PROVIDE COMMUNITY MEMBERS AND PATIENTS WITH MENTAL HEALTH SELF-MANAGEMENT AND PREVENTION EDUCATION MATERIALS.ACTIONS TAKEN:- PROVIDED 378 PACKETS OF MENTAL HEALTH SELF-MANAGEMENT AND PREVENTION EDUCATION MATERIALS TO COMMUNITY MEMBERS AND PATIENTS IN 2022.HEALTH NEED IDENTIFIED: CANCERSTRATEGY #1 - PROVIDE HEALTH EDUCATION RELATED TO SCREENING AND PREVENTION OF CANCER IN LENAWEE COUNTY BY TRAINING HAIR STYLISTS, FOOD PANTRIES, AND KEY COMMUNITY ORGANIZATIONS TO BE CANCER HEALTH ADVOCATES THROUGH THE DELIVERY OF MESSAGES AND EDUCATION TO THE COMMUNITY. ACTIONS TAKEN:- EIGHT (8) EDUCATIONAL PACKETS ABOUT COLORECTAL CANCER SCREENING GUIDELINES WERE DISTRIBUTED TO COMMUNITY MEMBERS AT ALL ABOUT ADRIAN RESIDENT EVENTS IN 2022.STRATEGY #2 - CONTINUE PARTICIPATION IN BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCP) FOR FREE WOMEN'S HEALTH SCREENINGS.ACTIONS TAKEN:- 48 COMMUNITY MEMBERS WERE PROVIDED WITH NO COST WOMEN'S HEALTH SCREENINGS IN 2022 THROUGH THE BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCP). PART V, SECTION B, LINE 7A THE 2022 CHNA CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ABOUT-PROMEDICA/COMMUNITY PART V, SECTION B, LINE 10A THE 2023-2025 CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ABOUT-PROMEDICA/COMMUNITY PART V, SECTION B, LINE 16A: THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C: A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE 9 1 - HICKMAN CANCER CTR 777 KIMOLE LANE STE 130 ADRIAN MI 492211400 CANCER CARE 2 - CTR TOTAL REHAB 5660 ADRIAN HWY ADRIAN MI 492218318 PHYSICAL THERAPY 3 - WOLF CREEK 901 KIMOLE LN ADRIAN MI 492211491 LAB 4 - PROMEDICA LABORATORIES- ADRIAN 3245 N ADRIAN HWY STE E ADRIAN MI 492211139 LAB 5 - BIXBY-ONSTED HEALTH CENTER 400 N MAIN ST ONSTED MI 492659202 PHYSICAL THERAPY/LAB 6 - BIXBY-TECUMSEH HEALTH CENTER 501 E CUMMINS STREET UNIT A TECUMSEH MI 492862070 LAB 7 - TOTAL REHAB AT DUNDEE 119 WATERSTRADT-COMMERCE DR UNIT 5 DUNDEE MI 481319696 PHYSICAL THERAPY 8 - PROMEDICA HUDSON HEALTH CTR 331 W MAIN ST HUDSON MI 492471051 LAB 9 - BLISSFIELD HEALTH CTR 157 W BROOKE LN BLISSFIELD MI 492288601 LAB PART I, LINE 3C: IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY USES INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY STATUS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 6A: PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE PROMEDICA HEALTH SYSTEM, INC. ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. OTHER BENEFITS AMOUNTS REPORTED ON LINE 7 WERE CALCULATED USING COSTS CHARGED DIRECTLY TO THE INDIVIDUAL PROGRAMS VIA THE FINANCIAL ACCOUNTING SYSTEM. AN INDIRECT COST ALLOCATION FACTOR FOR SHARED SERVICES IS ALSO CALCULATED AND INCLUDED IN APPLICABLE PROGRAMS LISTED IN OTHER BENEFITS. PART I, LINE 7, COLUMN (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 $ 6,020,260. PART III, LINE 2: PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL'S ANALYSIS AND ASSESSMENT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED BAD DEBT EXPENSE USES A RECEIPTS "LOOK-BACK" METHOD UTILIZING HISTORICAL PAYMENT DATA ON ACCOUNTS, INCLUDING CONTRACTUAL ADJUSTMENTS FOR PAYER DISCOUNTS, AS WELL AS PATIENT PAYMENTS, SUCH AS CO-PAYS AND DEDUCTIBLES, TO ESTABLISH ANTICIPATEDCOLLECTABILITY RATES FOR ACCOUNTS RECEIVABLE WITHIN EACH PAYER CATEGORY. PART III, LINE 3: PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL ESTIMATED THE POSSIBLE AMOUNT OF FINANCIAL ASSISTANCE WITHIN BAD DEBT EXPENSE BY REVIEWING ACCOUNTS THAT WERE INTERNALLY CODED AS HAVING BEEN PROVIDED A FINANCIAL ASSISTANCE APPLICATION, BUT THAT WAS NOT ADEQUATELY COMPLETED BY THE PATIENT OR GUARANTOR, IN WHICH THE ACCOUNT WAS SUBSEQUENTLY WRITTEN OFF TO BAD DEBT. PART III, LINE 4: PROVISION FOR BAD DEBTS AND ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ARE DISCUSSED ON PAGE 19 AND 20 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL REPORT WITH SUPPLEMENTAL INFORMATION. PART III, LINE 9B: FINANCIAL ASSISTANCE DISCOUNTS ARE GRANTED FOR MEDICALLY NECESSARY SERVICES WHEN IT IS DETERMINED THAT THE PATIENT AND FAMILY INCOME MEETS THE CRITERIA ESTABLISHED. PATIENTS WHO HAVE INSURANCE COVERAGE OR WHO ARE ENTITLED TO GOVERNMENTAL ASSISTANCE ARE IDENTIFIED IN ORDER FOR REIMBURSEMENT TO BE OBTAINED. ALL PATIENTS WITH SELF-PAY BALANCES AFTER INSURANCE MAY OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS IF THEY PROVIDE APPROPRIATE DOCUMENTATION THAT THEY SATISFY THE INCOME GUIDELINES. VERIFICATION OF FINANCIAL ASSISTANCE IS PURSUED THROUGHOUT THE INTERNAL COLLECTION PROCESS UNTIL ALL OPTIONS HAVE BEEN EXHAUSTED. ALL PATIENTS THAT HAVE A SELF-PAY BALANCE, INCLUDING PATIENTS THAT MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, RECEIVE BILLING STATEMENTS AND PAYMENT REMINDERS. THESE STATEMENTS INFORM ALL PATIENTS OF THE OPPORTUNITY TO SEEK A FINANCIAL ASSISTANCE ADJUSTMENT FOR MEDICALLY NECESSARY SERVICES, THE ELIGIBILITY CRITERIA, AND THE METHOD TO APPLY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN COMPLETED AND/OR REQUESTED INCOME VERIFICATION HAS NOT BEEN RECEIVED FROM A PATIENT WHO COULD POTENTIALLY QUALIFY, THE PATIENT WILL CONTINUE TO RECEIVE BILLING STATEMENTS THROUGH THE NORMAL COLLECTION PROCESS. IF A PATIENT DOES NOT HAVE INSURANCE, A PRESUMPTIVE CHARITY DETERMINATION (WHICH USES PUBLICLY AVAILABLE DATA SUCH AS DEMOGRAPHIC INFORMATION, CREDIT HISTORY, ETC.) MAY BE MADE TO ASSIST WITH QUALIFYING FOR FINANCIAL ASSISTANCE. ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, AN ADJUSTMENT IS PROCESSED. THE PATIENT ACCOUNT ANALYST WILL DETERMINE PATIENT ELIGIBILITY AND CALCULATE THE ADJUSTMENT BASED ON POLICY GUIDELINES. AN ADJUSTMENT FORM IS PREPARED AND APPROVED PER POLICY. UNINSURED PATIENTS MAY BE REQUIRED TO COMPLETE AN APPLICATION AND PROVIDE REQUIRED DOCUMENTATION, INCLUDING ANY DOCUMENTATION REQUIRED TO DETERMINE ELIGIBILITY. UNINSURED PATIENTS ARE NOTIFIED IN WRITING WHETHER OR NOT THEY QUALIFY FOR ANY FINANCIAL ASSISTANCE ADJUSTMENT FOR WHICH THEY HAVE SUBMITTED AN APPLICATION, AND OF ANY REMAINING BALANCE OWED. THE ADJUSTMENT IS THEN APPLIED TO THE PATIENT'S ACCOUNT.PATIENTS MAY BE OFFERED PAYMENT PLANS WHEN APPROPRIATE BASED ON DOCUMENTED FINANCIAL NEED AND CIRCUMSTANCES. LONGER PAYMENT PLANS MAY BE OFFERED ON AN EXCEPTION BASIS FOR CASES WITH UNUSUALLY HIGH BALANCES OR SPECIAL CIRCUMSTANCES DEMONSTRATING AN INABILITY TO PAY. ONCE THE INTERNAL COLLECTION PROCESS HAS BEEN COMPLETED, PATIENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY IF THE PATIENT HAS NOT CONTACTED US REGARDING THEIR DESIRE TO APPLY FOR FINANCIAL ASSISTANCE, SENT IN A FINANCIAL ASSISTANCE APPLICATION, RESPONDED TO REQUESTS FOR ADDITIONAL INFORMATION, OR WE ARE UNABLE TO MAKE A PRESUMPTIVE CHARITY DETERMINATION. IT IS THE EXPECTATION OF THE EXTERNAL COLLECTION AGENCY AS THEY WORK ACCOUNTS TO OFFER FINANCIAL ASSISTANCE WHEN APPLICABLE. THROUGHOUT THE COLLECTION PROCESS, THE COLLECTION AGENCY WILL INFORM UNINSURED PATIENTS OF THE CRITERIA TO OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS BASED ON FAMILY INCOME AND FAMILY SIZE, AND WILL FORWARD APPLICATIONS FOR PATIENTS WHO SUBMIT THE REQUIRED DOCUMENTATION TO THE CENTRAL BUSINESS OFFICE FOR PROCESSING. PART VI, LINE 2: PROMEDICA HEALTH SYSTEM AND HOSPITALS DEMONSTRATE A COMMITMENT TO THE COMMUNITIES IT SERVES AND THEREFORE, BELIEVES IT IS CRITICAL TO UNDERSTAND THE HEALTH CARE NEEDS OF ITS PRIMARY SERVICE AREA. TO THAT END, PROMEDICA HOSPITALS CONDUCT NEEDS ASSESSMENTS IN ITS PRIMARY SERVICE AREAS USING A VARIETY OF METHODOLOGIES TO ASSESS EACH COUNTY'S HEALTH CARE DATA, IDENTIFY GAPS IN HEALTH CARE INITIATIVES, AND MAKE RECOMMENDATIONS FOR THE BETTERMENT OF THE GENERAL COMMUNITY HEALTH. ANALYSIS OF PUBLISHED COUNTY HEALTH DATA, INTERVIEWS WITH KEY STAKEHOLDERS, AND REVIEW OF HISTORICAL AND EXISTING PROMEDICA COMMUNITY ASSESSMENTS ARE ALL MEANS BY WHICH RECOMMENDATIONS FOR THE PROMEDICA COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLANS ARE DEVELOPED. INFORMATION IS REVIEWED AND APPROVED BY HOSPITAL GOVERNANCE LEADERSHIP TO ASSURE THAT PLANS ARE DEVELOPED TO MEET THE NEEDS OF THE COMMUNITY. PUBLISHED COUNTY HEALTH DATACOUNTY HEALTH DATA WERE OBTAINED FROM SEVERAL SOURCES, INCLUDING THE OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE, THE MICHIGAN DEPARTMENT OF HEALTH, AND FORMAL COUNTY ASSESSMENTS CONDUCTED WITHIN THE INDIVIDUAL COUNTIES. ALTHOUGH MOST COUNTIES CONDUCTING A FORMAL ASSESSMENT UTILIZE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) QUESTIONNAIRE DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AS THE BASIS OF THE COUNTY QUESTIONNAIRE, COUNTY COMMITTEES TYPICALLY ADD AND/OR CHANGE QUESTIONS TO MEET THE COUNTY'S PERCEIVED NEEDS. PROMEDICA'S COMMUNITY GOALS ARE SET BASED ON THIS DATA.PROMEDICA COMMUNITY HEALTH PLANOVERALL, EMPHASIS IS PLACED ON CLINICAL PROGRAMS FOCUSED ON LEADING CAUSES OF DEATH: CHRONIC DISEASES, MENTAL HEALTH, AND HUNGER/OBESITY DUE TO THE LARGE NUMBERS OF INDIVIDUALS AFFECTED BY THESE DISEASES. THE PRIMARY FOCUS FOR COMMUNITY HEALTH ACTIVITIES ARE RELATED TO EDUCATION, SCREENING, AND PREVENTION OF CHRONIC DISEASES, MENTAL HEALTH ISSUES, AND HUNGER/OBESITY; AND IMPROVING RELATED CONDITIONS THAT RESULT IN HIGH MORBIDITY AND MORTALITY IN OUR COMMUNITIES, WITH SPECIAL EMPHASIS PLACED ON SERVING UNDERSERVED POPULATIONS. AS A SYSTEM, WE ARE ALSO COMMITTED TO WORKING BEYOND OUR FOUR WALLS, ON THE SOCIAL AND ECONOMIC ISSUES THAT IMPACT HEALTH. IN ADDITION, PROMEDICA STRATEGIC PLANNING CONTINUES TO DEVELOP PATIENT-CENTERED, INTEGRATED CLINICAL SERVICE LINES INCLUDING CANCER, CARDIOVASCULAR, BEHAVIORAL HEALTH, SOCIAL DETERMINANTS OF HEALTH, AND MATERNAL FETAL MEDICINE. PART VI, LINE 3: THE OPPORTUNITY FOR FINANCIAL ASSISTANCE ADJUSTMENTS IS COMMUNICATED TO PATIENTS AT PROMEDICA HEALTH SYSTEM HOSPITALS THROUGH THE FOLLOWING METHODS:A. DURING THE PRE-REGISTRATION PROCESS FOR SCHEDULED INPATIENTS AND HIGH-DOLLAR OUTPATIENT CASES, THE CENTRALIZED PRE-REGISTRATION STAFF WILL NOTIFY A PATIENT FINANCIAL ADVOCATE TO CONTACT THE PATIENT PRIOR TO SERVICE TO DISCUSS POTENTIAL ELIGIBILITY FOR GOVERNMENT PROGRAMS AND FINANCIAL ASSISTANCE. THE PRE-SERVICE FUNCTION INCLUDES ACCOUNT REGISTRATION, INSURANCE VERIFICATION, PRE-CERTIFICATION AND FINANCIAL COUNSELING.B. ADMITTING LOCATIONS WILL HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE WHEN REGISTERED AS UNINSURED. AT ADMITTING, UNINSURED PATIENTS ARE INFORMED OF THE OPPORTUNITY TO SEEK FINANCIAL ASSISTANCE. C. PATIENT FINANCIAL ADVOCATES ARE AVAILABLE AT THE HOSPITALS TO ASSIST UNINSURED PATIENTS IN COMPLETING THE FORMS. PATIENT FINANCIAL ADVOCATES ATTEMPT TO MEET WITH IN-HOUSE PATIENTS TO ASSESS ELIGIBILITY AND TO ASSIST WITH APPLICATION FOR GOVERNMENT ASSISTANCE PROGRAMS, TO EXPLAIN PATIENT LIABILITY FOR CHARGES, TO PROVIDE AN ESTIMATE OF CHARGES WHEN FEASIBLE, TO EXPLAIN THE OPPORTUNITY FOR FINANCIAL ASSISTANCE, INCLUDING THE CRITERIA AND THE METHOD FOR APPLYING, AND TO EXPLAIN PAYMENT OPTIONS.D. A MESSAGE IS PRINTED ON THE PATIENT BILLING STATEMENTS TO NOTIFY THE UNINSURED PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE, TO EXPLAIN THE ELIGIBILITY CRITERIA, AND TO DESCRIBE THE METHOD TO APPLY.E. A SUMMARY OF THE POLICY FOR UNINSURED PATIENTS IS INCLUDED IN THE STATEMENTS OF UNINSURED PATIENT, AVAILABLE VIA THE PROMEDICA WEB SITE, AVAILABLE AT HOSPITAL REGISTRATION LOCATIONS, OR BY CALLING THE PROMEDICA CUSTOMER SERVICE DEPARTMENT. BUSINESS OFFICE PERSONNEL ALSO NOTIFY UNINSURED PATIENTS OF THE FINANCIAL ADJUSTMENT POLICY THROUGH THE CUSTOMER SERVICE AND COLLECTION DEPARTMENTS. PART VI, LINE 4: EMMA L. BIXBY MEDICAL CENTER, DOING BUSINESS AS PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL, LOCATED IN ADRIAN, MI, SERVES AN AREA PRIMARILY AROUND LENAWEE COUNTY AND HAS A SERVICE AREA POPULATION OF APPROXIMATELY 80,000. APPROXIMATELY, 19% OF THE SERVICE AREA IS AGE 65 OR OVER; 60% IS BETWEEN AGE 18 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $55,000; 91% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER; 45% OF HOUSEHOLDS HAVE AN INCOME OF $50,000 OR LESS. LENAWEE COUNTY HAS A POPULATION OF APPROXIMATELY 99,000 WITH APPROXIMATELY 10% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 21% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 7% OF LENAWEE COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE AT THE END OF 2022 FOR LENAWEE COUNTY WAS 4.1%. THE LEADING CAUSES OF DEATH IN LENAWEE COUNTY, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, CANCER, COVID, UNINTENTIONAL INJURIES/ACCIDENTS, STROKE, LUNG DISEASE, ALZHEIMER'S, AND DIABETES. ACCORDING TO THE 2022 COUNTY HEALTH RANKINGS, LENAWEE COUNTY RANKED 24 OF 83 COUNTIES FOR HEALTH OUTCOMES AND 29 OF 83 FOR HEALTH FACTORS. THERE ARE NINE HOSPITALS WITHIN A 30-MILE RADIUS OF CHARLES AND VIRGINIA HICKMAN HOSPITAL: HERRICK MEMORIAL HOSPITAL, INC., ST. JOSEPH MERCY SALINE HOSPITAL, FLOWER HOSPITAL, FULTON COUNTY HEALTH CENTER, ST. ANNE MERCY HOSPITAL, CHELSEA COMMUNITY HOSPITAL, THE TOLEDO HOSPITAL, HENRY FORD ALLEGIANCE HEALTH, AND UNIVERSITY OF TOLEDO MEDICAL CENTER. PART VI, LINE 5: EMMA L. BIXBY MEDICAL CENTER IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC., WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. IN 2022:- THERE WERE APPROXIMATELY 300 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), SERVING ON MORE THAN 25 DIFFERENT BOARDS, COMMITTEES, COUNCILS AND FOUNDATIONS. OF THOSE BOARD MEMBERS, MOST LIVE WITHIN PROMEDICA'S OHIO AND MICHIGAN ACUTE CARE SERVICE AREA, WITH THE MAJORITY RESIDING WITHIN THE GREATER TOLEDO AREA WHERE PROMEDICA'S ADULT AND PEDIATRIC TERTIARY HOSPITALS (THE TOLEDO HOSPITAL AND TOLEDO CHILDREN'S HOSPITAL) ARE LOCATED. - PROMEDICA NON-PARENT BOARD MEMBERS' DONATION OF TIME AND EXPERTISE, INCLUDING ATTENDING BOARD MEETINGS, RETREATS AND OTHER ACTIVITIES, WERE PERFORMED ON A VOLUNTEER BASIS. - PROMEDICA'S MEDICAL STAFF PRIVILEGES WERE EXTENDED TO ALL QUALIFIED PHYSICIANS AT OUR METRO TOLEDO AND REGIONAL HOSPITALS. QUALIFICATION MAY VARY BY HOSPITAL, BUT ANY PHYSICIAN WHO MET THOSE QUALIFICATIONS WAS GRANTED PRIVILEGES, UPON THEIR REQUEST.- AS PART OF PROMEDICA'S ELECTRONIC HEALTH RECORD (EHR) JOURNEY, THE INFORMATION TECHNOLOGY SERVICES TEAM COMPLETED TWO SYSTEM-WIDE UPGRADES TO THE EPIC PLATFORM. THE UPGRADES ALLOW PROMEDICA TO TAKE ADVANTAGE OF SOME OF THE MANY ENHANCEMENTS THAT EPIC HAS MADE TO ITS SOFTWARE BASED ON USER INPUT.- PROMEDICA PRIMARY CARE PROVIDERS CONTINUED SCREENING PATIENTS FOR RISK FACTORS OF SOCIAL DETERMINANTS OF HEALTH BY ASKING QUESTIONS RELATED TO EDUCATION, EMPLOYMENT, FOOD SECURITY, HOUSING, TRANSPORTATION, AND VIOLENCE. PATIENTS WHO SCREENED POSITIVE FOR ANY OF THE FACTORS WERE CONNECTED TO COMMUNITY PROGRAMS AND RESOURCES FOR ASSISTANCE.- PROMEDICA CANCER INSTITUTE (PCI) COMPLETED LUNG CANCER SCREENINGS, SCREENING MAMMOGRAMS AND SCREENING COLONOSCOPIES. ADDITIONALLY, PCI CONTINUES TO BE INSTRUMENTAL IN HELPING PROMEDICA IMPLEMENT MONOCLONAL ANTIBODY TREATMENT AT ITS INFUSION CENTERS FOR COVID-19 PATIENTS TO IMPROVE SYMPTOM MANAGEMENT. - PROMEDICA SENIOR CARE SKILLED NURSING FACILITIES AND HOME HEALTH AND HOSPICE AGENCIES PROVIDE UNIQUE SERVICES TO VETERANS, HOLIDAY SUPPORT, SUPPORT GROUPS, AND WORKSHOPS TO ANYONE IN THE COMMUNITY WHO NEEDS ADDITIONAL HELP TO GET THROUGH THE LOSS OF A LOVED ONE. PATIENTS AND RESIDENTS' WISHES ARE GRANTED THROUGH THE ORGANIZATION'S HEART'S DESIRE PROGRAM. THROUGH GRANTS FROM THE HOSPICE MEMORIAL FUND, GRIEF CAMPS FOR CHILDREN AND ADULTS ARE OFFERED AS WELL AS EDUCATIONAL SESSIONS AND LIFE CELEBRATION EVENTS. THE FUND ALSO PROVIDES STABILIZING RESOURCES FOR HOSPICE PATIENTS AND FAMILIES IN FINANCIAL DISTRESS DUE TO THE LACK OF OR REDUCTION IN INCOME FROM TERMINAL ILLNESS OR DISEASE.- PROMEDICA CONTINUES TO EXPAND ITS OPTIONS FOR HOSPITAL-LEVEL CARE IN THE COMFORT OF A PATIENT'S HOME. PROMEDICA ACUTE CARE AT HOME COMBINES PROMEDICA'S EXTENSIVE NETWORK OF IN-HOME CARE PROVIDERS WITH A SOPHISTICATED TECHNOLOGY PLATFORM TO DELIVER SEAMLESS AND EFFECTIVE CARE AT HOME FOR PATIENTS WITH SELECT CHRONIC CONDITIONS OR DIAGNOSES SUCH AS HEART FAILURE, PNEUMONIA OR COPD. RECENTLY, PROMEDICA ACUTE CARE AT HOME EXPANDED ITS SERVICES TO INCLUDE CARE FOR SELECT ONCOLOGY PATIENTS BY COLLABORATING THE PROMEDICA CANCER CENTER. THE CARE TEAM CONSISTS OF PHYSICIANS, NURSE PRACTITIONERS, REGISTERED NURSES, AND MAY INCLUDE OTHER HEALTHCARE PROFESSIONALS, SUCH AS PHYSICAL OR OCCUPATIONAL THERAPISTS, AS NEEDED. PART VI, LINE 6: PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A NATIONWIDE, MISSION-BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT WAS FORMED IN TOLEDO, OHIO IN 1986. IN 2022 PROMEDICA WAS COMPRISED OF MORE THAN 45,000 EMPLOYEES, NEARLY 850 VOLUNTEERS AND MORE THAN 2,100 PHYSICIANS AND ADVANCED PRACTICE PROVIDERSINCLUDING APPROXIMATELY 1,200 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS EMPLOYED BY PROMEDICA PHYSICIAN GROUP (PPG) WHO FORM A PROVIDER NETWORK ACROSS 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN. AS AN INTEGRATED DELIVERY SYSTEM, PROMEDICA PROVIDERS SHARE RESOURCES SUCH AS ADVANCED TECHNOLOGY, QUALITY STANDARDS, SAFETY PRACTICES, MEDICAL EXPERTISE, AND SPECIALTY SERVICES TO ENSURE COMMUNITY MEMBERS HAVE READY ACCESS TO HIGH-QUALITY CARE IN THE MOST APPROPRIATE SETTING IN ORDER TO PROVIDE COST-EFFICIENT SERVICES. IN 2022:- PROMEDICA MEMBERS AND AFFILIATE HOSPITALS INCLUDED: THE TOLEDO HOSPITAL D/B/A PROMEDICA TOLEDO HOSPITAL; PROMEDICA TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF PROMEDICA TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL; FLOWER HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL D/B/A PROMEDICA FLOWER HOSPITAL; BAY PARK COMMUNITY HOSPITAL (D/B/A PROMEDICA BAY PARK HOSPITAL); EMMA L. BIXBY MEDICAL CENTER (D/B/A PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL); FOSTORIA HOSPITAL ASSOCIATION (D/B/A PROMEDICA FOSTORIA COMMUNITY HOSPITAL); DEFIANCE HOSPITAL, INC. (D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL); MERCY MEMORIAL HOSPITAL CORPORATION (D/B/A PROMEDICA MONROE REGIONAL HOSPITAL); MEMORIAL HOSPITAL (D/B/A PROMEDICA MEMORIAL HOSPITAL); AND COMMUNITY HEALTH CENTER OF BRANCH COUNTY (D/B/A PROMEDICA COLDWATER REGIONAL HOSPITAL). PROMEDICA ALSO INCLUDES PROMEDICA INSURANCE CORPORATION; PROMEDICA PHYSICIAN GROUP; AND PROMEDICA CONTINUING CARE SERVICES CORPORATION AS WELL AS HUNDREDS OF SKILLED NURSING AND REHABILITATION CENTERS, ASSISTED LIVING FACILITIES AND MEMORY CARE COMMUNITIES, ALL UNDER THE PROMEDICA SENIOR CARE/HCR MANORCARE UMBRELLA.- PROMEDICA CONTINUED TO OPERATE THREE COMMUNITY FOOD CLINICS, LOCATED AT PROMEDICA BAY PARK HOSPITAL, THE PROMEDICA HEALTH AND WELLNESS CENTER AND PROMEDICA'S CENTER FOR HEALTH SERVICES, TO SERVE PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND HAVE A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. PATIENTS ARE ABLE TO RECEIVE FOOD FOR THEMSELVES AND THEIR FAMILY FROM ONE OF THESE FOOD CLINICS. AS PART OF THE PROGRAM, PATIENTS CAN RECEIVE TWO TO THREE DAYS OF SUPPLEMENTAL FOOD. - FOR ITS MICHIGAN PATIENTS, PROMEDICA PARTNERED WITH THE SOUTH MICHIGAN FOOD BANK TO DISTRIBUTE FOOD RESOURCES TO PROMEDICA PHYSICIANS GROUP OFFICES FOR PATIENTS SCREENING POSITIVE FOR FOOD INSECURITY. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PROVIDE THE $5 VOUCHERS AT DISCHARGE SO PATIENTS CAN REDEEM FRESH PRODUCE FROM THE VEGGIE MOBILE THAT IS SOURCED FROM PROMEDICA FARMS, LOCAL GROWERS, AND A WHOLESALER. - PROMEDICA EBEID INSTITUTE'S MARKET ON THE GREEN PROVIDED BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES AND A FINANCIAL OPPORTUNITY CENTER TO PROVIDE FINANCIAL COUNSELING FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. ADDITIONALLY, TWO NEW FINANCIAL OPPORTUNITY CENTERS (FOC) WERE OPENED IN FREMONT AND DEFIANCE, OHIO. MUCH LIKE THE FOC LOCATED IN UPTOWN TOLEDO, THE NEW LOCATIONS OFFER SERVICES AND ASSIST LOW TO MODERATE-INCOME FAMILIES WITH SECURING LIVING WAGE JOBS, BUILDING CREDIT, REDUCING DEBT, AND GAINING WEALTH. THE FOC ALSO HELPS INDIVIDUALS NEEDING INCOME SUPPORT (PUBLIC BENEFITS) AND EMPLOYMENT COACHING AND COUNSELING AS WELL AS FREE TAX PREPARATION. 1 PROMEDICA FOUNDATION 444 N SUMMIT STREET TOLEDO OH 43604 341517672 501(C)(3) 584000 0 N/A N/A OPERATING GRANT HEALTH RESOURCES AND SERVICES ADMINISTRATION 5600 FISHERS LANE ROCKVILLE MD 20857 GOVT 230788 0 N/A N/A RURAL HEALTH, CARE SERVICES, OUTREACH, RURAL HEALTH NETWORK DEVELOPMENT AND SMALL HEALTH CARE MICHIGAN CENTER FOR RURAL HEALTH B-218 WEST FREE HALL EAST LANSING MI 48824 GOVT 257853 0 N/A N/A RURAL HEALTH RESEARCH CENTERS 3 0 PART I, LINE 2: AS AN AFFILIATE OF PROMEDICA HEALTH SYSTEM, INC. (PHS), CORPORATE TREASURY, WITH THE APPROVAL AND OVERSIGHT OF THE FINANCE COMMITTEE, ENSURES THAT FUNDS ARE DISTRIBUTED APPROPRIATELY ACCORDING TO PHS'S STRATEGIC BUSINESS PLAN AND CONSISTENT WITH CORPORATE TREASURY POLICIES AND PROCEDURES. 1 1 0 0 0 0 0 0 0 RANDALL OOSTRA PHS PRES. & CEO-PART YEAR 0 1664907 0 2628840 0 1182293 0 0 0 3579 0 5479619 0 0 STEVEN M CAVANAUGH TREASURER, CFO-PART YEAR 0 604206 0 1107251 0 724358 0 28986 0 12539 0 2477340 0 0 ARTURO POLIZZI PRESIDENT AND CEO 0 1003178 0 597348 0 5304 0 0 0 12750 0 1618580 0 0 JEFFREY C KUHN SECRETARY, CHIEF LEGAL OFFICER-PART 0 390988 0 196494 0 339985 0 23904 0 20319 0 971690 0 0 DAWN M BUSKEY TRUSTEE 0 650606 0 96246 0 3210 0 0 0 11796 0 761858 0 0 STEPHEN M SADOWSKI CHIEF LEGAL OFFICER 0 596289 0 86275 0 1051 0 0 0 6102 0 689717 0 0 DARRIN ARQUETTE TRUSTEE 0 327854 0 57069 0 2722 0 5846 0 29454 0 422945 0 0 JULIE K YAROCH DO TRUSTEE 314974 0 75729 0 2033 0 1300 0 17795 0 411831 0 0 0 PAUL E GIETZEN MD TRUSTEE 0 275908 0 90149 0 3089 0 0 0 26180 0 395326 0 0 CHRISTI L ANSBERG TRUSTEE 0 241767 0 55646 0 2951 0 0 0 6313 0 306677 0 0 CHRISTINA BELL DIRECTOR OF PHARMACY 139500 0 4568 0 75 0 762 0 29811 0 174716 0 0 0 ALEXA SIMKOW DIR-SURGICAL SVCS. 120045 0 9299 0 8475 0 1084 0 22581 0 161484 0 0 0 VERONICA HARTZELL RN, HOSPITAL 106597 0 24761 0 0 0 0 0 29611 0 160969 0 0 0 MELISSA THOMPSON CLINICAL PHARMACIST 144138 0 0 0 300 0 0 0 9543 0 153981 0 0 0 PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF EMMA L. BIXBY MEDICAL CENTER, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE 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. IN ADDITION, THE ORGANIZATION PROVIDES A SPLIT-DOLLAR LIFE INSURANCE PLAN TO ITS CHIEF EXECUTIVE OFFICER FROM WHICH NO CASH PAYMENTS WERE MADE DURING THE YEAR. 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. 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. 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 A MICHIGAN 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 EMMA L. BIXBY MEDICAL CENTER. AS THE MEMBER, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF EMMA L. BIXBY MEDICAL CENTER, 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, 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 STATEMENT OF CONFLICT (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. FORM 990, PART VI, SECTION B, LINE 15 EMMA L. BIXBY MEDICAL CENTER'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. FORM 990, PART VI, SECTION B, LINE 16B: JOINT VENTURE OPERATING AGREEMENTS INVOLVING PROMEDICA HEALTH SYSTEM, INC. OR ITS SUBSIDIARIES (COLLECTIVELY, PHS) INCLUDE PROVISIONS TO PROTECT PHS'S TAX-EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. PHS CONTINUALLY ENSURES THAT ITS TAX-EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL PHS JOINT VENTURES. 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 IX, LINE 11G PHYSICIAN AND MEDICAL STAFFING FEES: PROGRAM SERVICE EXPENSES 4,562,322. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,562,322. SERVICE CONTRACT FEES: PROGRAM SERVICE EXPENSES 1,490,567. MANAGEMENT AND GENERAL EXPENSES 1,676,578. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,167,145. TEMPORARY AGENCY FEES: PROGRAM SERVICE EXPENSES 4,191,290. MANAGEMENT AND GENERAL EXPENSES 2,625,230. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,816,520. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,637,735. MANAGEMENT AND GENERAL EXPENSES 1,841,893. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,479,628. FORM 990, PART XI, LINE 9: PENSION/POST-RETIREMENT EXPENSE ADJUSTMENT -40,635. REVERSE OF BOOK ENTRY FOR AUXILIARY ACTIVITY -11,210,041. TRANSFERS BETWEEN RELATED ENTITIES -573,800. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR WOLF CREEK ASSOCIATES LLC 901 KIMOLE LN ADRIAN MI 49221 383164818 FACILITY LEASE MI 119918 1992168 EMMA L BIXBY MEDICAL CENTER 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 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 KAITLYN'S COTTAGE INC 100 MADISON AVE TOLEDO OH 43604 454781053 RESPITE CARE OH 501(C)(3) 10 DEFIANCE HOSPITAL 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 FACILITY DE 501(C)(3) 10 HCR MANORCARE INC 1 MANOR CARE OF LACEY WA ASSOCIATION PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 260624391 SKILLED NURSING FACILITY DE 501(C)(3) 10 HCR MANORCARE INC 1 MANOR CARE OF LYNNWOOD WA ASSOCIATION PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 260624675 SKILLED NURSING FACILITY DE 501(C)(3) 10 HCR MANORCARE INC 1 MANOR CARE OF SALMON CREEK WA ASSOCIATION PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 260624375 SKILLED NURSING FACILITY DE 501(C)(3) 10 HCR MANORCARE INC 1 MANOR CARE OF SPOKANE WA ASSOCIATION PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 260624687 SKILLED NURSING FACILITY DE 501(C)(3) 10 HCR MANORCARE INC 1 MANOR CARE OF TACOMA WA ASSOCIATION PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 260624696 SKILLED NURSING FACILITY DE 501(C)(3) 10 HCR MANORCARE INC 1 MEMORIAL HOSPITAL 100 MADISON AVE TOLEDO OH 43604 344430849 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 MEMORIAL PROFESSIONAL SERVICES 100 MADISON AVE TOLEDO OH 43604 273763993 PHYSICIAN HEALTH CARE SERVICES MI 501(C)(3) 10 PROMEDICA PHYSICIAN GROUP INC 1 MERCY MEMORIAL HOSPITAL CORPORATION 100 MADISON AVE TOLEDO OH 43604 381984289 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 MONROE COMMUNITY HEALTH SERVICES PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 382934134 LONG TERM CARE MI 501(C)(3) 10 HCR MANORCARE INC 1 PARAMOUNT ADVANTAGE 1901 INDIAN WOOD CIR MAUMEE OH 43537 203376102 HEALTH INSURANCE OH 501(C)(3) 10 PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES 1 PROMEDICA CENTRAL PHYSICIANS 100 MADISON AVE TOLEDO OH 43604 341881137 PHYSICIAN HEALTH CARE SERVICES MI 501(C)(3) 10 PROMEDICA PHYSICIAN GROUP INC 1 PROMEDICA CHILDRENS SPECIALISTS 100 MADISON AVE TOLEDO OH 43604 208734161 PHYSICIAN HEALTH CARE SERVICES MI 501(C)(3) 10 PROMEDICA PHYSICIAN GROUP INC 1 PROMEDICA CONTINUING CARE 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