2022-11-15T09:23:21-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2021-03-24 852985806 ADENA FAYETTE MEDICAL CENTER ADEN 7403351210 272 HOSPITAL ROAD CHILLICOTHE OH 45601 JAMES P MCMANUS CFO 7403351210 2022-11-11 1 JAMES MCMANUS 999009999 AMY CIMINELLO P00796388 6148493000 2022-11-11 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z X X 272 HOSPITAL ROAD CHILLICOTHE OH 45601 48739632 0 X HTTPS://WWW.ADENA.ORG X 2021 OH ADENA FAYETTE MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL THAT HAS SERVES THE HEALTH NEEDS OF FAYETTE COUNTY. 5 5 342 22 0 0 4259829 43875316 22121 565552 48722818 0 0 16547929 0 0 23637290 40185219 8537599 42268764 10264051 32004713 X CALLED TO SERVE OUR COMMUNITIES 0 0 33298503 43875316 ADENA FAYETTE MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL THAT HAS SERVED THE HEALTH NEEDS OF FAYETTE COUNTY FOR 70 YEARS.SINCE 1950, ADENA FAYETTE MEDICAL CENTER, FORMERLY KNOWN AS FAYETTE COUNTY MEMORIAL HOSPITAL, HAS SERVED THE HEALTHCARE NEEDS OF OUR COMMUNITY. OUR TRADITION OF PROVIDING COMPASSIONATE CARE CONTINUES TO HELP THOUSANDS OF PEOPLE EACH YEAR. WHILE AFMC HAS GROWN IN SIZE AND SERVICES, WE HAVE RETAINED THE PERSONAL TOUCH THAT IS OUR TRADEMARK. OUR TEAM CONSISTS OF MORE THAN 300 HIGHLY SKILLED, COMPASSIONATE HEALTHCARE PROFESSIONALS DEDICATED TO DELIVERING PERSONAL CARE.PHYSICIANS AFFILIATED WITH OUR HOSPITAL ARE TRAINED IN A NUMBER OF SPECIALTIES, AND THEY, ALONG WITH OUR NURSE PRACTITIONERS, LOOK FORWARD TO ESTABLISHING LONG-TERM RELATIONSHIPS WITH OUR PATIENTS AND THEIR FAMILIES.COMPREHENSIVE CARE AND SERVICESPATIENTS AND VISITORS TO ADENA FAYETTE MEDICAL CENTER CAN EXPECT A FULL RANGE OF MEDICAL SERVICES AS WELL AS PERSONAL CARE FROM OUR DEDICATED PROVIDERS AND CAREGIVERS.SERVICES AT ADENA FAYETTE MEDICAL CENTERCANCERCARDIOPULMONARYDIAGNOSTIC TESTINGEMERGENCY SERVICESFOOD SERVICESGASTROENTEROLOGYLAB SERVICESNEPHROLOGYOCCUPATIONAL HEALTHOPHTHALMOLOGYORTHOPEDICSOUTPATIENT SERVICESPRIMARY CAREPULMONOLOGYREHABILITATION SERVICESSENIOR LIFE SOLUTIONSSLEEPSTROKESURGICAL SERVICESURGENT CARE AND WALK-IN CLINICWOMEN'S HEALTH 33298503 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 342 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X JEFF CRAFT VP SYSTEM FINANCE 7407794481 272 HOSPITAL ROAD CHILLICOTHE OH 456019031 JENNY BREEDLOVE SECRETARY/TREASURER 2.00 0.00 X X 0 0 0 MYRON PRIEST TRUSTEE 2.00 0.00 X 0 0 0 BRIAN REAM CHAIR 2.00 0.00 X X 0 0 0 MARK RICHARDS VICE CHAIR 2.00 0.00 X X 0 0 0 RALPH STEGBAUER TRUSTEE 2.00 0.00 X 0 0 0 JEFF GRAHAM AHS CEO 1.00 54.00 X 0 1123172 333237 LISA CARLSON AHS CFO 1.00 54.00 X 0 751765 253223 KATHERINE EDRINGTON AHS COO 1.00 54.00 X 0 650248 167390 DONALD DIENER ADMINISTRATOR 50.00 0.00 X 171201 0 64469 CAROLYN WALLIN SYSTEMS DIRECTOR 50.00 0.00 X 172493 0 47120 TAMMY WILSON DIRECTOR QUALITY IMPROVEMENT 50.00 0.00 X 123855 0 20471 JEANETTE MORGAN PHYSICIAN 50.00 0.00 X 160953 0 18679 BRANDY JORDAN PHYSICIAN 50.00 0.00 X 135319 0 39905 763821 2525185 944494 6 0 1 0 RURAL PHYSICIANS GROUP 5575 DTC PKWY 225 GREENWOOD VILLAGE CO 80111 PHYSICIAN SERVICES 693333 COMMUNITY EMERGENCY MEDICINE PARTNERS L 1430 COLUMBUS AVE WASHINGTON COURT HOUSE OH 43160 PHYSICIAN SERVICES 686000 UNIVERSITY REFERENCE LABS 680 ACKERMAN RD COLUMBUS OH 43202 LAB SERVICES 549861 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET SUIITE 300 OMAHA NE 68114 NURSING SERVICES 397175 CAPTIVE RADIOLOGY LLC 6273 FRANK AVE NW NORTH CANTON OH 44720 MRI SERVICES 362000 14 4259829 4259829 NET PATIENT SVC REV 622110 43875316 43875316 43875316 22121 22121 46645 16814 29831 29831 29831 PHARMACY 446110 398702 398702 CAFETERIA 722514 102507 102507 INCENTIVE PAYMENTS 621400 34512 34512 535721 48722818 43875316 0 587673 X 754331 615364 138967 12331999 10038247 2293752 341772 280937 60835 2399272 1972202 427070 720555 592296 128259 117107 117107 5373670 3539652 1834018 11250 4759 6491 431149 401831 29318 570092 531326 38766 1457287 437186 1020101 12722 6450 6272 53635 27193 26442 35970 29747 6223 1683456 1230606 452850 120448 90697 29751 MEDICAL EQUIPMENT & SUP 8615033 8615033 PROVISION FOR BAD DEBTS 3290060 3290060 TAXES 1217335 990911 226424 CAFETERIA/CATERING 153940 143472 10468 494136 460534 33602 40185219 33298503 6886716 0 15526598 14041651 1565343 24677 11476639 1683456 0 9793183 0 1317312 0 42268764 6194852 966634 0 3102565 0 10264051 X 31568264 436449 0 32004713 0 42268764 X 8537599 23467114 X X 0 1 X 1 1 0 X 860000 860000 7672785 523218 7149567 2659480 1097044 1562436 284374 63194 221180 9793183 RIGHT OF USE LIABILITY 1317312 COST REPORT SETTLEMENT PAYABLE 1785253 3102565 1 1 X 1 X 1 X 1 1 1 0 0 174101 174101 0.00470 8340173 4902017 3438156 0.09320 8514274 4902017 3612257 0.09790 8514274 4902017 3612257 0.09790 0 3290060 0 14875279 17818767 -2943488 X 1 1 1 1 ADENA FAYETTE MEDICAL CENTER 272 HOSPITAL ROAD CHILLICOTHE OH 45601 HTTPS://WWW.ADENA.ORG 1168 X X X X ADENA FAYETTE MEDICAL CENTER 1 0 1 0 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTPS://TINYURL.COM/UJBAHXW4 X HTTPS://TINYURL.COM/UJBAHXW4 X HTTPS://TINYURL.COM/UJBAHXW4 X X X X X X 1 X 0 X X X X X 1 X 0 0 ADENA FAYETTE MEDICAL CENTER PART V, SECTION B, LINE 2: FAYETTE MEDICAL GROUP WAS A GOVERNMENTAL HOSPITAL PRIOR TO 2021 AND BECAME A PART OF THE ADENA HEALTH SYSTEM DURING THE TAX YEAR. ADENA HEALTH SYSTEM COMPLETES A CHNA EVERY THREE YEARS. FAYETTE MEDICAL CENTER WILL BE INCLUDED IN THE 2022 CHNA. ADENA FAYETTE MEDICAL CENTER PART V, SECTION B, LINE 20E: PATIENTS HAVE 120 DAYS FROM THE TIME THEIR ACCOUNT GOES TO "SELF-PAY" TO PAY IN FULL OR MAKE PAYMENT ARRANGEMENTS. ON THE 121ST DAY, THEY ARE SENT TO A COLLECTION AGENCY. COLLECTION AGENCIES REQUIRE ADENA MANAGEMENT APPROVAL TO PURSUE LEGAL ACTION. IF AVAILABLE, SELFPAY PATIENTS ARE SCREENED FOR GOVERNMENT ASSISTANCE PROGRAMS AND FINANCIAL ASSISTANCE DURING THE INPATIENT STAY. FAP APPLICATIONS ARE PROVIDED TO THE PATIENT AS PART OF THE SCREENING. FINANCIAL ASSISTANCE APPLICATIONS ARE ALSO AVAILABLE ONLINE AND THROUGHOUT THE HOSPITAL. PART I, LINE 6A: ADENA HEALTH SYSTEM EIN: 31-4379443 PART I, LINE 7: THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $3,290,060 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. PART III, LINE 2: THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS WITH THE COST TO CHARGE RATIO AGREED. PART III, LINE 4: WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA FAYETTE MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF THE SYSTEM'S FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO SELF-PAY PATIENTS. ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVANT PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE, ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE." PART III, LINE 8: THE ADENA HEALTH SYSTEM SERVICE AREA IS A RURAL 13 COUNTY AREA IN SOUTHERN OHIO. THE POPULATION IS AN AGING POPULATION WHICH RESULTS IN MEDICARE AS OUR LARGEST PAYOR GROUP. THE MEDICARE TWO PERCENT SEQUESTRATION IS ALSO A COMPONENT OF THE SHORTFALL CALCULATION. EFFECTIVE MAY 1, 2020 THE TWO PERCENT SEQUESTRATION WAS REMOVED, A CHANGE BROUGHT BY THE CARES ACT. BASED ON THESE ISSUES, WE BELIEVE SERVICING OUR MEDICARE POPULATION, THAT RESULTED IN A MEDICARE SHORTFALL OF $2,943,488 IS A COMMUNITY BENEFIT. ALSO, THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6. PART III, LINE 9B: IF THE RESPONSIBLE INDIVIDUAL HAS NOT SUBMITTED A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE OR HAS NOT PAID-IN-FULL, FOUR SEPARATE STATEMENTS ARE SENT OUT FOR THE COLLECTION OF SELF-PAY ACCOUNTS. THE FINAL STATEMENT SENT WILL INFORM THE INDIVIDUAL OF POSSIBLE EXTRAORDINARY COLLECTION ACTIONS (ECA) TO BE TAKEN IF FINANCIAL ASSISTANCE IS NOT APPLIED FOR OR THE ACCOUNT IS NOT PAID IN FULL. AFTER THE FINAL STATEMENT AND BEFORE ECAS ARE TAKEN, REASONABLE EFFORTS ARE MADE TO ORALLY CONTACT THE INDIVIDUAL AS A FINAL NOTICE. PATIENTS WHO CANNOT PAY CHARGES IN FULL MAY ALSO BE OFFERED A PAYMENT PLAN THAT IS CONSISTENT WITH ADENA FAYETTE MEDICAL CENTER'S CUSTOMER SERVICE PROCEDURES. PART VI, LINE 3: THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. A CONTRACTED VENDOR SUPPLIES STAFF AT THE CASHIER AREA TO EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE. 7. LASTLY, WE UTILIZE A "HINDSIGHT" VENDOR THAT SCREENS ALL BAD DEBT ACCOUNTS, AFTER THE YEAR-END, AGAINST THE STATE MEDICAID ELIGIBILITY AND FEDERAL POVERTY GUIDELINES TO ATTEMPT ONE LAST EFFORT TO OBTAIN FINANCIAL ASSISTANCE FOR INDIVIDUALS. PART VI, LINE 5: ADENA FAYETTE MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A VARIETY OF MEANS, INCLUDING BOARD MEMBERS, ADMINISTRATIONS, EMPLOYEES AND VOLUNTEERS. THE 2021 BOARD OF TRUSTEES OF ADENA FAYETTE MEDICAL CENTER WAS COMPRISED OF 5 MEMBERS WHO ALL RESIDE IN THE HOSPITAL'S SERVICE AREA. PART VI, LINE 6: FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES FOUR HOSPITALS AND EIGHT REGIONAL CLINICS, WITH A TOTAL OF 311 REGISTERED BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. FAYETTE MEDICAL GROUP, NOW KNOWN AS ADENA FAYETTE MEDICAL CENTER, WAS A GOVERNMENTAL HOSPITAL PRIOR TO 2021 AND BECAME A PART OF THE ADENA HEALTH SYSTEM DURING THE TAX YEAR. ADENA FAYETTE MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL IN CHILLICOTHE, OH, BENEFITTING THE FAYETTE COUNTY. ADENA GREENFIELD MEDICAL CENTER AND ADENA PIKE MEDICAL CENTER: BOTH ARE CRITICAL ACCESS HOSPITALS EACH, WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (ADENA GREENFIELD MEDICAL CENTER) AND PIKE COUNTY (ADENA PIKE MEDICAL CENTER) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WELLSTON, HILLSBORO, WASHINGTON COURT HOUSE AND WAVERLY, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE AND WAVERLY. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN). THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. X X X X 0 1 0 0 0 0 0 1 0 JEFF GRAHAM AHS CEO 0 845204 0 241003 0 36965 0 276203 0 57034 0 1456409 0 262215 LISA CARLSON AHS CFO 0 538525 0 131057 0 82183 0 226846 0 26377 0 1004988 0 196098 KATHERINE EDRINGTON AHS COO 0 515416 0 117865 0 16967 0 146797 0 20593 0 817638 0 129609 DONALD DIENER ADMINISTRATOR 168478 0 1100 0 1623 0 41688 0 22781 0 235670 0 0 0 CAROLYN WALLIN SYSTEMS DIRECTOR 145237 0 22806 0 4450 0 25985 0 21135 0 219613 0 21806 0 JEANETTE MORGAN PHYSICIAN 153168 0 7646 0 139 0 17000 0 1679 0 179632 0 0 0 BRANDY JORDAN PHYSICIAN 125033 0 2096 0 8190 0 3929 0 35976 0 175224 0 0 0 PART I, LINE 3 STARTING IN 2021, EXECUTIVE LEADERSHIP AT ADENA FAYETTE MEDICAL CENTER WILL HAVE THEIR COMPENSATION REVIEWED EVERY YEAR BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. OTHER ADENA FAYETTE MEDICAL CENTER MANAGEMENT WAGES ARE REVIEWED INTERNALLY USING MARKET DATA. THIS PROCESS WAS LAST UNDERTAKEN IN 2021. PART I, LINE 4B ADENA HEALTH SYSTEM HAS A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENT FROM THE SERP IN 2021: LISA CARLSON $66,739 SERP ACCRUAL THE SERP ACCRUALS, INCLUDED IN PART II, COLUMN (C), ARE AMOUNTS CREDITED TO THE EXECUTIVE UNDER THE SECTION 457(F) DEFERRED COMPENSATION PLAN. PART I, LINE 7 MANAGEMENT OF ADENA HEALTH SYSTEM HAVE A PORTION OF THEIR ANNUAL SALARY AT RISK UNDER A VARIABLE COMPENSATION PLAN. IF THE OPERATING RESULTS OF AHS MEET A MARGIN TARGET IN ANY FISCAL YEAR, ADDITIONAL COMPENSATION IS PAID THAT IS CALCULATED USING THE OPERATING MARGIN ALONG WITH RESULTS IN EMPLOYEE ENGAGEMENT, PATIENT QUALITY, AND SATISFACTION USING A BALANCED SCORECARD FORMULA. FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE MAY 2, 2021, ADENA HEALTH SYSTEM ENTERED INTO AN ASSET ACQUISITION AGREEMENT WITH FAYETTE COUNTY MEMORIAL HOSPITAL AND BECAME THE SOLE CORPORATE MEMBER OF FAYETTE, WHICH IS NOW DOING BUSINESS AS ADENA FAYETTE MEDICAL CENTER (ADENA FAYETTE). THE PRIMARY REASON FOR THE TRANSACTION WAS TO INCREASE EFFICIENCY AND EFFECTIVENESS OF HOSPITAL OPERATIONS AND TO IMPROVE THE ONGOING DELIVERY OF HEALTH CARE SERVICES TO THE CITIZENS OF FAYETTE COUNTY AND SURROUNDING AREAS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ADENA FAYETTE MEDICAL CENTER IS ADENA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF THE ORGANIZATION NOMINATES TRUSTEES, AND ADENA HEALTH SYSTEM, AS THE SOLE MEMBER OF THE ORGANIZATION, ELECTS THE TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNANCE DECISIONS ARE RESERVED FOR ADENA HEALTH SYSTEM AS THE SOLE MEMBER OF THE ORGANIZATION, SUCH AS THE ELECTION OF MEMBERS OF THE BOARD OF TRUSTEES OF THE ORGANIZATION, APPROVAL OF STRATEGIC PLANS OF THE ORGANIZATION, AND APPROVAL OF AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND CODE OF REGULATIONS. ADENA HEALTH SYSTEM CAN ACT ON THESE RIGHTS BY A VOTE AT ANY MEETING, AN ACTION WITHOUT A MEETING, OR THROUGH OTHER AUTHORIZED MEANS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS REVIEWED PRIOR TO FILING, AND COPIES OF THE FORM 990 WERE PROVIDED ONLY TO THE ADENA HEALTH SYSTEM BOD MEMBERS VIA THE BOARD PORTAL. ADDITIONALLY, ONE COPY OF THE 990 WAS MADE AVAILABLE UNTIL THE NOVEMBER 15 FILING DATE. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. ALL CONFLICTS ARE REVIEWED, AND THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. FRONT LINE SUPERVISORS UP THROUGH THE CEO AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A STARTING IN 2021, EXECUTIVE LEADERSHIP WILL HAVE COMPENSATION REVIEWED EVERY YEAR BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. OTHER MANAGEMENT WAGES ARE REVIEWED INTERNALLY USING MARKET DATA. THIS PROCESS WAS LAST UNDERTAKEN IN 2021. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED STAFF: PROGRAM SERVICE EXPENSES 2,147,704. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,147,704. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,343,577. MANAGEMENT AND GENERAL EXPENSES 1,832,727. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,176,304. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 48,371. MANAGEMENT AND GENERAL EXPENSES 1,291. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,662. FORM 990, PART XI, LINE 9: TRANSFER (TO) FROM RELATED ORGANIZATION 12,878,415. INHERENT CONTRIBUTION FROM ACQUISITION 10,588,699. FORM 990, PART XII, LINE 2C: THE ADENA HEALTH SYSTEM'S AUDIT COMMITTEE ENGAGES THE INDEPENDENT AUDIT FIRM FOR THE AUDIT, REVIEWS RESULTS, AND REPORTS TO THE BOARD. ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. FAYETTE MEDICAL CENTER IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. FORM 990: PART XII, LINE 3B THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT BEEN COMPLETED YET FOR THE CALENDAR YEAR-END 12/31/21 IS IN PROCESS AND WILL BE COMPLETED AS SOON AS POSSIBLE. FORM 990, PART V, LINE 1 A RELATED ORGANIZATION, ADENA HEALTH SYSTEM, ISSUES THE 1099S. ADENA HEALTH FOUNDATION 272 HOSPITAL ROAD CHILLICOTHE OH 45601 753008742 FUNDRAISNG OH 501(C)(3) 12A ADENA HEALTH SYSTEM 1 ADENA HEALTH SYSTEM 272 HOSPITAL ROAD CHILLICOTHE OH 45601 314379443 HOSPITAL OH 501(C)(3) 3 N/A 0 GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD OH 45123 310993422 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 PIKE HEALTH SERVICES 100 DAWN LANE WAVERLY OH 45690 311072406 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 SOUTHERN OHIO HEALTHCARE NETWORK 272 HOSPITAL ROAD CHILLICOTHE OH 45601 261566590 FIBEROPTIC NETWORK GRANTS OH 501(C)(3) 12A ADENA HEALTH SYSTEM 1 ADENA CARE 272 HOSPITAL ROAD CHILLICOTHE OH 45601 453980850 SEE SCHEDULE R, PART VII OH N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 SCHEDULE R, PART IV, COLUMN (B) THE PRIMARY ACTIVITY OF ADENA CARE IS TO DEVELOP STRATEGIC RELATIONSHIPS TO THE SERVICE AREAS MAJOR EMPLOYERS THROUGH HEALTH MANAGEMENT AND WELLNESS SERVICES.