2022-05-13T11:10:13-05:00 2021-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2020-07-01 311156690 HOLZER HEALTH SYSTEM HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 MICHAEL HAYNES CFO 7404465060 2022-05-10 1 MICHAEL HAYNES 999009999 AMY CIMINELLO P00796388 6148493000 2022-05-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MICHAEL CANADY 100 JACKSON PIKE GALLIPOLIS OH 45631 110340875 0 X WWW.HOLZER.ORG X 1985 OH THE PRIMARY EXEMPT PURPOSE OF HOLZER HEALTH SYSTEM IS TO ACT AS THE MANAGING PARENT, SOLE VOTING MEMBER OF THE FOLLOWING 501(C)(3) ENTITIES, WHOSE PRIMARY PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES: HOLZER HOSPITAL FOUNDATION, HOLZER MEDICAL CENTER-JACKSON, HOLZER SENIOR CARE CENTER, HOLZER ASSISTED LIVING-GALLIPOLIS, HOLZER ASSISTED LIVING-JACKSON, HOLZER FOUNDATION AND HOLZER VANGUARD, A FOR-PROFIT SUBSIDIARY (COLLECTIVELY REFERRED TO AS CONSOLIDATED). 22 0 837 39 0 0 25 5058527 120029090 125579594 190141 58498 26167 -20584353 120245423 110112266 0 0 0 0 89059468 94000219 0 0 13644 70606405 65638150 159665873 159638369 -39420450 -49526103 165436816 126656683 158053155 145929181 7383661 -19272498 FRIENDLY VISITS, EXCELLENT CARE; EVERY PATIENT, EVERY TIME. 0 0 3657707 0 6997622 HOLZER HEALTH SYSTEM PROVIDED MANAGEMENT SERVICES/REAL ESTATE TO ITS SUBSIDIARIES WHOSE EXEMPT PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. 1097818 0 1057931 HOLZER DENTAL CLINIC-JACKSON STRIVES TO IMPROVE THE DENTAL HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. 90473807 0 117524041 HOLZER CLINIC, LLC IS A MULTIPLE DISCIPLINE HEALTH CARE SYSTEM OF OVER 160 PROVIDERS PROVIDING CARE IN MORE THAN THIRTY-FOUR AREAS OF EXPERTISE. 95229332 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 87 0 1 837 1 0 0 0 0 0 0 0 0 0 0 0 0 X 22 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL HAYNES CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 DR STEVEN CONLEY PHYSICIAN 50.00 0.00 X 1658937 0 0 DEAN SICILIANO PHYSICIAN 50.00 0.00 X 1329176 0 0 MATTHEW COSENZA PHYSICIAN 50.00 0.00 X 1160177 0 0 SANTPAL MAVI PHYSICIAN 50.00 0.00 X 1032694 0 0 DR ROBERT BRADLEY PHYSICIAN 50.00 0.00 X 885480 0 0 DR MICHAEL CANADY CEO 46.00 4.00 X X 617183 0 0 DR PHIL LONG TRUSTEE 49.00 1.00 X 505779 0 0 DR LOUIS WICKAS TRUSTEE 50.00 0.00 X 431858 0 0 DR RODNEY STOUT TRUSTEE - CMO 49.00 1.00 X 418431 0 0 BRENT SAUNDERS CHAIRMAN 46.00 4.00 X X 405662 0 1719 DR LANCE BROY TRUSTEE 49.00 1.00 X 393164 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 49.00 1.00 X 354794 0 0 LISA HACKWORTH TRUSTEE - CAO 50.00 0.00 X 340001 0 1518 MICHAEL HAYNES CFO 46.00 4.00 X 340001 0 0 TODD FOWLER TRUSTEE - EVP AMBULARTORY 50.00 0.00 X 340001 0 0 ELLEN GARLING TRUSTEE - CLO 50.00 0.00 X 340001 0 0 TROY MILLER TRUSTEE - CSO 50.00 0.00 X 340001 0 0 DR SCOTT DAVIS TRUSTEE 50.00 0.00 X 323576 0 0 DR RENUKA KANDULA TRUSTEE 49.00 1.00 X 311707 0 0 DR JARED SHEETS TRUSTEE 49.00 1.00 X 302942 0 0 LISA DETTY TRUSTEE - CNO 50.00 0.00 X 300019 0 0 LARRY KIDD TREASURER 1.00 3.00 X X 24000 0 0 STEVE CHAPMAN TRUSTEE 1.00 3.00 X X 24000 0 0 BOB GRILLO TRUSTEE 1.00 3.00 X 24000 0 0 TOM WISEMAN TRUSTEE 1.00 3.00 X 24000 0 0 DANNY HOLSCHUH TRUSTEE 1.00 3.00 X 24000 0 0 GARY ROACH TRUSTEE 1.00 3.00 X 24000 0 0 PAUL REED TRUSTEE 1.00 3.00 X 24000 0 0 BRAD MUNN TRUSTEE 1.00 3.00 X 24000 0 0 ROBBIE PUGH TRUSTEE 1.00 3.00 X 24000 0 0 12347584 0 3237 175 0 1 0 OHIO VALLEY PHYSICIANS INC PO BOX 390 HUNTINGTON WV 25708 EMERGENCY DEPT. STAFFING 17441592 SAVISTA LLC PO BOX 676188 DALLAS TX 752676188 MEDICAL CODING & MANAGEMENT SERVICES 1508092 JACKSON & COKER LOCUMTENENS LLC PO BOX 277638 ATLANTA GA 303847638 PHYSICIAN STAFFING 756215 MARSHALL HEALTH PO BOX 1896 HUNTINGTON WV 257191896 ORTHOPEDICS CONSULTING 240000 SYED NAJEED 7316 WETHERINGTON DR WEST CHESTER OH 45069 LOCUM PHYSICIAN 223010 12 5058527 5058527 NET PATIENT SERVICE REVENUE 621110 116355185 116355185 INVESTMENTS IN JVS 523930 3450729 3450729 MANAGEMENT FEES 561000 3431749 3431749 RENTAL TO AFFILIATES 531120 2341931 2341931 125579594 33896 33896 21528 4315 17213 17213 17213 245847 3049 224294 0 21553 3049 24602 24602 VENDOR REBATE 900099 11387 11387 LOSS ON BOND 900099 -20612953 -20612953 -20601566 110112266 125579594 0 -20525855 X 6607656 6607656 71322826 52648204 18674622 916800 52095 864705 11224808 2779702 8445106 3928129 1444648 2483481 5822503 1872991 3949512 153639 290 153349 232043 232043 31155103 18710695 12444408 13644 13644 6163922 3791701 2372221 1182678 1182678 824350 410644 413706 543503 222092 321411 4763578 3824237 939341 4368670 101829 4266841 1235267 1066044 169223 BAD DEBT EXPENSE 7020221 7020221 MEDICAL SUPPLIES 1125074 1103079 21995 LICENSURE FEES 403217 90923 312294 DUES AND MEMBERSHIPS 300195 59632 240563 330543 30305 300238 159638369 95229332 64395393 13644 13533137 18042755 18325066 18236029 1634422 3919609 100965272 30752773 72682049 70212499 4636219 4906882 513570 464365 3904000 3904000 18812055 0 31396298 6970544 165436816 126656683 28965174 19713131 1263631 0 112839470 -3976763 4709287 122341147 10275593 7851666 158053155 145929181 X 7383661 -19272498 7383661 -19272498 165436816 126656683 X -49526103 218776 22651168 X X 0 1 X 1 0 X X 4 HOLZER HOSPITAL FOUNDATION 314379491 3 1 0 32342390 HOLZER MEDICAL CENTER-JACKSON 311724085 3 1 0 13228406 HOLZER SENIOR CARE CENTER 311534051 10 1 0 0 HOLZER HERITAGE FOUNDATION 310927482 7 1 0 0 4 0 45570796 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART IV, SECTION D, LINE 3: HOLZER HEALTH SYSTEMS' BOARD OVERLAPS WITH THE BOARD OF THE SUPPORTING ORGANIZATIONS. THIS OVERLAP CAUSES THE SUPPORTED ORGANIZATIONS TO HAVE A SIGNIFICANT VOICE OVER THE HOLZER HEALTH SYSTEM. SCHEDULE A, PART IV, SECTION E, LINE 3A: HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS. SCHEDULE A, PART IV, SECTION E, LINE 3B: DECISIONS MADE BY THE BOARD OF DIRECTORS OF EACH SUPPORTED ORGANIZATION CAN BE OVERRULED BY THE BOARD OF DIRECTORS OF HOLZER HEALTH SYSTEM. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8869 8869 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ARE CONSIDERED LOBBYING ACTIVITIES. IN TOTAL $40,576 WERE PAID TO OHA OF WHICH $2,516 ARE CONSIDERED LOBBYING ACTIVITIES. A PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION ARE CONSIDERED LOBBYING ACTIVITIES. IN TOTAL $24,854 WERE PAID TO AHA OF WHICH $6,353 ARE CONSIDERED LOBBYING ACTIVITIES. 6672087 6672087 85245029 27908012 57337017 8568772 2829371 5739401 479384 15390 463994 70212499 RELATED PARTY RECEIVABLES 6970544 6970544 RELATED PARTY PAYABLES 7851666 7851666 X X X X 0 0 0 0 0 0 0 0 0 DR STEVEN CONLEY PHYSICIAN 1658937 0 0 0 0 0 0 0 0 0 1658937 0 0 0 DEAN SICILIANO PHYSICIAN 1329176 0 0 0 0 0 0 0 0 0 1329176 0 0 0 MATTHEW COSENZA PHYSICIAN 1160177 0 0 0 0 0 0 0 0 0 1160177 0 0 0 SANTPAL MAVI PHYSICIAN 1032694 0 0 0 0 0 0 0 0 0 1032694 0 0 0 DR ROBERT BRADLEY PHYSICIAN 885480 0 0 0 0 0 0 0 0 0 885480 0 0 0 DR MICHAEL CANADY CEO 617183 0 0 0 0 0 0 0 0 0 617183 0 0 0 DR PHIL LONG TRUSTEE 505779 0 0 0 0 0 0 0 0 0 505779 0 0 0 DR LOUIS WICKAS TRUSTEE 431858 0 0 0 0 0 0 0 0 0 431858 0 0 0 DR RODNEY STOUT TRUSTEE - CMO 418431 0 0 0 0 0 0 0 0 0 418431 0 0 0 BRENT SAUNDERS CHAIRMAN 405662 0 0 0 0 0 0 0 1719 0 407381 0 0 0 DR LANCE BROY TRUSTEE 393164 0 0 0 0 0 0 0 0 0 393164 0 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 354794 0 0 0 0 0 0 0 0 0 354794 0 0 0 LISA HACKWORTH TRUSTEE - CAO 340001 0 0 0 0 0 0 0 1518 0 341519 0 0 0 MICHAEL HAYNES CFO 340001 0 0 0 0 0 0 0 0 0 340001 0 0 0 TODD FOWLER TRUSTEE - EVP AMBULARTORY 340001 0 0 0 0 0 0 0 0 0 340001 0 0 0 ELLEN GARLING TRUSTEE - CLO 340001 0 0 0 0 0 0 0 0 0 340001 0 0 0 TROY MILLER TRUSTEE - CSO 340001 0 0 0 0 0 0 0 0 0 340001 0 0 0 DR SCOTT DAVIS TRUSTEE 323576 0 0 0 0 0 0 0 0 0 323576 0 0 0 DR RENUKA KANDULA TRUSTEE 311707 0 0 0 0 0 0 0 0 0 311707 0 0 0 DR JARED SHEETS TRUSTEE 302942 0 0 0 0 0 0 0 0 0 302942 0 0 0 LISA DETTY TRUSTEE - CNO 300019 0 0 0 0 0 0 0 0 0 300019 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER AND THE CFO REVIEW FORM 990 AND A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION FOLLOWS THE ADOPTED POLICIES OF HOLZER MEDICAL CENTER- JACKSON AND HOLZER HOSPITAL FOUNDATION, RELATED TAX-EXEMPT ORGANIZATIONS. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND OFFICERS, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING 2019. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 18,582,705. MANAGEMENT AND GENERAL EXPENSES 10,593,115. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,175,820. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 127,990. MANAGEMENT AND GENERAL EXPENSES 1,851,293. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,979,283. FORM 990, PART XI, LINE 9: TRANSFERS TO/FROM AFFILIATES 41,463,223. IMPAIRMENT LOSS -18,812,055. FORM 990, PART XI, LINE 2C THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, LINE 16 THE ORGANIZATION DOES NOT HAVE IN PLACE A WRITTEN POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURES, HOWEVER IT MAKES SURE TO TAKE THE NECESSARY PRECAUTIONS TO SAFEGUARD ITS TAX-EXEMPT STATUS. IN ADDITION, LEGAL COUNSEL IS CONSULTED BEFORE CONSIDERING A NEW JOINT VENTURE. HOLZER DENTAL CLINIC JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 275346256 HEALTHCARE OH 1057931 1791608 HOLZER HEALTH SYSTEM HOLZER CLINIC LLC 90 JACKSON PIKE GALLIPOLIS OH 45631 310917085 PHYSICIAN PRACTICES OH 122582851 32687666 HOLZER HEALTH SYSTEM HOLZER HERITAGE FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH HOLZER HEALTH SYSTEM C 471581 5190335 1.00000 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 HOLZER HOSPITAL FOUNDATION L 32234214 ACCRUAL TRANSACTION HOLZER MEDICAL CENTER- JACKSON L 13228406 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION J 557629 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION K 108176 ACCRUAL TRANSACTION HOLZER HERITAGE FOUNDATION M 3549944 ACCRUAL TRANSACTION