2021-09-16T11:00:33-05:00 2020-12-31 350921680 CROWE LLP 155 West Nationwide Blvd Suite 500 Columbus OH 432152570 990 2020-01-01 344428598 Wayne Hospital Company WAYN 9375481141 835 Sweitzer Street Greenville OH 45331 Jennifer Williams CFO 2021-09-16 true Jennifer Williams 999009999 RACHEL SPURLOCK P00520729 6144690001 2020 2022-09-23 18:48:47Z Wayne HealthCare Wayne Deschambeau President & CEO 835 Sweitzer Street Greenville OH 45331 77033745 false X www.waynehealthcare.org X 1922 OH The mission of Wayne Hospital Company is providing quality care and promoting wellness close to home. 16 15 616 68 172741 95638 28201 10867308 66115391 59657912 6495267 3722687 492178 561205 73131037 74809112 142855 122465 0 34262895 33040283 0 0 32795059 34441008 67200809 67603756 5930228 7205356 186619457 202344337 65835889 71438131 120783568 130906206 The mission of Wayne Hospital Corporation is to provide outpatient and inpatient services at a level to rank prominently on a regional and national basis for quality of care, patient satisfaction and spirituality support. The hospital collaborates with other health care providers to develop new and/or improved services for residents of Darke County, Ohio. false false 53664536 122465 60037986 AS A FULL-SERVICE PRIMARY CARE FACILITY, WAYNE HOSPITAL OFFERS PHYSICIANS AND THEIR PATIENTS ACCESS TO A VARIETY OF INPATIENT AND OUTPATIENT SERVICES INCLUDING: EMERGENCY, RADIOLOGY, MATERNITY/SPECIAL BEGINNINGS, SURGERY, SENIOR BEHAVIORAL HEALTH, HEART HEALTH, CANCER CARE, REHABILITATION SERVICES, LABORATORY, CHRONIC DIALYSIS CENTER, AMBULATORY CARE, OUTPATIENT REHABILITATION, DIABETES EDUCATION PROGRAM, SLEEP CARE SERVICES, AND ENTEROSTOMAL THERAPY. THE HOSPITAL HAD APPROXIMATELY 1,623 ADMISSIONS AND 69,452 OUTPATIENT VISITS IN 2020. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. IN ADDITION TO THE FINANCIAL ASSISTANCE PROVIDED, WAYNE HOSPITAL ALSO IS PROACTIVE IN SUPPORTING COMMUNITY WELLNESS THROUGH HEALTH SCREENINGS, EDUCATION, AND HEALTH MANAGEMENT. 262783 350 WAYNE HOSPITAL HAS MANY ADDITIONAL PROGRAMS. ADDITIONAL PROGRAMS INCLUDE THE COUNTY AND CORPORATE HEALTH FAIRS IN WHICH EMPLOYEES FROM THE HOSPITAL PROVIDED 182 HOURS OF TIME TO HELP WITH HEALTH SCREENINGS AND PROVIDE EDUCATIONAL INFORMATION TO THE COMMUNITY. IN ADDITION TO THE COUNTY AND CORPORATE HEALTH FAIRS, WAYNE HOSPITAL TYPICALLY CONTRIBUTES HOURS TO THE YOUTH HEALTH FAIR, WHICH IS A HEALTH FAIR GEARED TO ALL THE FIFTH GRADERS IN DARKE COUNTY. 0 STUDENTS WERE IN ATTENDANCE FOR 2020, AS IT WAS NOT ABLE TO BE HELD DUE TO COVID. (CONTINUED ON SCHEDULE O) 53927319 true true false true false false false false true true false false true true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 62 0 true 616 true true true false false false false false false false false false false false X 16 15 false false false false true true true true true false false false true true true true true true false true true X JENNIFER WILLIAMS 9375696758 VP of Finance / CFO Greenville OH 45331 DAN WATREN BOARD MEMBER(PART YEAR)/SEC/TREASURER(PART YEAR) 1.0 X X 0 0 0 ERIC EVERMAN VICE CHAIR (PART YEAR)/CHAIR (PART YEAR) 1.0 X X 0 0 0 JOHN DUTRO MD CHAIR (PART YEAR)/PAST CHAIR (PART YEAR)/SURGEON 39.0 1.0 X X 178134 0 13018 TODD DURHAM SEC/TREASURER (PART YEAR)/VICE CHAIR (PART YEAR) 1.0 X X 0 0 0 TRAVIS FLIEHMAN PAST CHAIR (PART YEAR)/BOARD MEMBER (PART YEAR) 1.0 1.0 X X 0 0 0 ANNA HATIC DO BOARD MEMBER 1.0 X 0 0 0 CAROLINE SCHMIDT BOARD MEMBER 1.0 X 0 0 0 DON MILLER BOARD MEMBER 1.0 X 0 0 0 GEOFF WALKER BOARD MEMBER 1.0 X 0 0 0 JANELLE BRINKSNEADER BOARD MEMBER (PART YEAR) 1.0 X 0 0 0 JOHN WARNER BOARD MEMBER 1.0 X 0 0 0 M LYNNE HAWLEY MD BOARD MEMBER 1.0 X 0 0 0 MARY GARMAN BOARD MEMBER 1.0 X 0 0 0 MIKE GRAY BOARD MEMBER (PART YEAR) 1.0 X 0 0 0 SCOTT SHELTON BOARD MEMBER (PART YEAR) 1.0 X 0 0 0 SUSAN SHIELDS BOARD MEMBER 1.0 X 0 0 0 TIM SNIDER BOARD MEMBER 1.0 X 0 0 0 JENNIFER WILLIAMS CFO 39.0 1.0 X 199959 0 27558 WAYNE DESCHAMBEAU CEO 39.0 1.0 X 390135 0 30546 JEFFREY SUBLER VP OF SUPPORT SERVICES 40.0 X 158280 0 26876 KIMBERLEE FREEMAN VP OF PATIENT CARE/CNO 40.0 X 197157 0 28051 PEGGY SCHULTZ VP HUMAN RESOURCES 40.0 X 169496 0 15146 SHELTON MONGER CIO 40.0 X 177174 0 6419 ALISHA REISS SURGEON 40.0 X 424285 0 30577 KARA SCHULTZ SURGEON 40.0 X 358394 0 8832 PATRICK KARR OB/GYN 40.0 X 449406 0 30595 PETER LACHIEWICZ OB/GYN 40.0 X 448312 0 20658 STEPHANIE BUCHANAN SURGEON 40.0 X 404650 0 20641 3555382 0 258917 23 false true false HORIZON HEALTH PO BOX 840839 DALLAS TX 752840839 SENIOR BEHAVIORAL HEALTH SERVICES 2031723 HOSPITAL CARE GROUP PC 6435 W JEFFERSON BLVD PMB 109 FORT WAYNE IN 46804 HOSPITALISTS 1613482 KETTERING ANESTHESIA ASSOC 3500 PENTAGON BLVD SUITE 200 BEAVERCREEK OH 45431 ANESTHESIA SERVICES 1585550 LABORATORY CORP OF AMERICA 11751 INTERCHANGE DR LOUISVILLE KY 40229 LAB MANAGEMENT 735114 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 152516170 DIETARY MANAGEMENT 627736 26 14039 10841269 12000 10867308 NET PATIENT SERVICE REVENUE 621110 59657912 59657912 0 0 0 0 59657912 2265416 0 172741 2092675 347982 389546 -41564 0 -41564 -41564 3291958 400 1831298 3789 1460660 -3389 1457271 1457271 FOOD SALES 722210 222345 222345 HOUSEKEEPING 812900 10346 10346 REBATE REVENUE 900099 253939 253939 116139 116139 0 0 602769 74809112 60038336 172741 3730727 X 122465 122465 1617949 191152 1426797 21882393 19707188 2175205 671350 604615 66735 7117778 6410240 707538 1750813 1482458 268355 187475 187475 52000 52000 291942 291942 13936999 11684066 2252933 0 374195 322736 51459 75363 51213 24150 494245 170935 323310 1244731 1030485 214246 26957 16889 10068 131809 123665 8144 1187054 462951 724103 5038967 1783794 3255173 488243 283071 205172 MEDICAL SUPPLIES 7786415 7778503 7912 MAINTENANCE AGREEMENTS 1636634 968316 668318 DIETARY 348520 316652 31868 1139459 415925 723534 0 67603756 53927319 13676437 0 6127013 5859702 20331981 23362539 6992162 7530834 0 0 0 0 205064 80804 1478448 1735390 925418 975544 156273584 80008262 48270240 76265322 57455045 63257025 7953613 9234338 0 0 36880473 14042839 186619457 202344337 10191011 8802023 51672646 59007296 0 0 289885 221695 3682347 3407117 65835889 71438131 X 120707286 130786562 76282 119644 120783568 130906206 186619457 202344337 X 7205356 4306450 -1389168 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6275 6275 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY WAYNE HOSPITAL COMPANY PAYS DUES TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THESE DUES, $6,275 WAS SPENT ON LOBBYING. 12921 12921 0 202019 4114 29113 164099 12921 202019 202019 202019 0 0 0 0 0 202019 202019 0 0 0 0 0 202019 0.0 0.0 0.0 false false 2127405 2127405 72382583 49616555 22766028 2952581 2281140 671441 37030625 28110567 8920058 41780390 41780390 76265322 INSURANCE RECOVERY RECEIVABLE 303287 ACCOUNTS RECEIVABLE- OTHER 19211 ACCRUED INTEREST RECEIVABLE 65403 HOSPITALIST INCOME GUARANTEE - CURRENT PORTION TRUSTEE HELD ASSETS 13654938 14042839 INTEREST RATE SWAP LIABILITY 3027117 ESTIMATED THIRD PARTY SETTLEMENTS 380000 HOSPITALIST INCOME GUARANTEE - CURRENT PORTION DUE TO/FROM CARE ASSURANCE 3407117 X 78546569 4306450 -640558 3665892 74880677 291942 -363507 -71565 74809112 68423931 1112117 1112117 67311814 291942 0 291942 67603756 Schedule D, Part V, Line 4 Intended uses of endowment funds ENDOWMENT FUNDS ARE SPECIFICALLY SET ASIDE FOR CLINICALLY RELATED SCHOLARSHIPS GRANTED TO STUDENTS GOING INTO A HEALTH RELATED FIELD OF STUDY AND FOR INDIGENT CARE. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The Internal Revenue Service has ruled the Hospital and Foundation are tax-exempt organizations as defined under Section 501(c)(3) of the Internal Revenue Code and are exempt from income taxes on related income pursuant to Section 501(a). WHC Professional Services, LLC. is a limited liability corporation and as such passes income to the members. Accordingly, no provision for income taxes has been made for this entity in the consolidated financial statements. The Hospital, Foundation, and WHC Professional Services, LLC. have filed their applicable federal and state income tax returns for periods through December 31, 2019. These income tax returns are generally open to examination by the relevant taxing authorities for a period of three years from the later of the dates the return was filed or its due date (including approved extensions). Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken and recognize a tax liability if an uncertain position has been taken that more likely than not would not be sustained upon examination by various federal and state taxing authorities. Management has analyzed the tax positions taken by these entities, and has concluded that as of December 31, 2020 and 2019, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the accompanying consolidated financial statements. The entities are subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 CHANGE IN INTEREST OF RELATED PARTIES - 10789 TRANSFER TO AFFILIATE - -651347 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements RENTAL EXPENSES INCLUDED IN REVENUE - -389546 CONTRIBUTIONS NETTED WITH EXPENSES - 26039 Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990 RENTAL EXPENSES INCLUDED IN REVENUE - 389546 CHANGE IN VALUE OF INTEREST RATE SWAP - 748610 CONTRIBUTIONS NETTED WITH EXPENSES - -26039 true true X true X true X true true false true true 613850 0 613850 0.0091 13146322 5540984 7605338 0.1125 794452 0 794452 0.0118 0 0 14554624 5540984 9013640 0.1333 51562 350 51212 0.0008 0 0.0 0 0.0 0 0.0 100770 100770 0.0015 0 0 152332 350 151982 0.0022 0 0 14706956 5541334 9165622 0.1356 0 0.0 1 5000 5000 0.0001 10 100450 100450 0.0015 0 0.0 0 0.0 1 5000 5000 0.0001 0 0.0 0 0.0 0 0.0 12 0 110450 0 110450 0.0016 true 0 0 20130135 14855974 5274161 X true true 1 1 Wayne Hospital Company 835 Sweitzer Street Greenville OH 45331 WWW.WAYNEHEALTHCARE.ORG Ohio Department of Health 1159AHR X X X Wayne Hospital Company 1 false false true X X X X X X X X X 18 true true true true X https://www.waynehealthcare.org X true 18 true https://www.waynehealthcare.org/our-community/community-health-needs-assessment-chna-/ false true X 100.0 200.0 X X X true true X X X true X https://www.waynehealthcare.org/visitors-and-patients/financial-assistance/ X https://www.waynehealthcare.org/visitors-and-patients/financial-assistance/ X https://www.waynehealthcare.org/visitors-and-patients/financial-assistance/ X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E The significant health needs of the community are identified and prioritized through the CHNA. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - WAYNE HOSPITAL COMPANY. The following organizations and other groups consulted with Wayne HealthCare while conducting its most recent CHNA: - Greater Dayton Area Hospital Association - The Southwest District of the Association of Ohio Health Commissioners - Ohio Department of Health - Center for Disease Control and Prevention - Ohio Department of Job and Family Services This effort included: 42 community meetings that attracted 440 (unduplicated) participants; 715 Individual Consumer Surveys (includes 223 Mobile Surveys); 96 Agency Surveys; 74 Latino Consumer Surveys; 39 Surveys from refugees from Rwanda; 29 Health Department Surveys; as well as analysis of secondary data from the local and state level. The study addresses secondary data for maternal and infant health, clinical and preventive services, hospital data, and leading causes of death. Secondary data sources included: - AIDSvu - https://aidsvu.org/ - American Community Survey (5-year estimate 2012-2016) - Business Analyst, Delorme map data, ESRI, U.S. Census provided by RWJF 2018 County Health Rankings - Cancer Incidence: Ohio Department of Health, Ohio Cancer Incidence Surveillance System, 2014- 2015 - Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System - Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. 500 Cities Project Data 2016 - Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER Online Database, Underlying Causes of Death and Multiple Causes of Death - Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention - Centers for Disease Control and Prevention's national HIV surveillance program - Comprehensive Housing Affordability Strategy (CHAS) data - County Health Rankings 2018 - American Community Survey, 5-year estimates - County Health Rankings 2018 - Area Health Resource File/American Medical Association - County Health Rankings 2018 - Area Health Resource File/National Provider Identification File - County Health Rankings 2018 - Behavioral Risk Factor Surveillance System - County Health Rankings 2018 - Bureau of Labor Statistics - County Health Rankings 2018 - Centers for Disease Control and Prevention Diabetes Interactive Atlas - County Health Rankings 2018 - National Highway Traffic Safety Administration, Fatality Analysis Reporting System - County Health Rankings 2018 - National Center for Education Statistics - County Health Rankings 2018 - National Center for Health Statistics - County Health Rankings 2018 - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB prevention - County Health Rankings 2018 - Small Area Income and Poverty Estimates - County Health Rankings 2018 - U.S. Census Bureau's Small Area Health Insurance - Dartmouth Atlas of Healthcare. Accessed on 2/6/18 at www.countyhealthrankings.org/explore-health-rankings/rankings-data-documentation - Data USA (Cincinnati) - Access to Care - ED Facts provided by RWJF 2018 County Health Rankings - Environmental Protection Agency. Air Quality System Monitoring Data. State Air Monitoring Data. Annual PM 2.5 Level (Monitor only). Accessed from Environmental Public Health Tracking Network: https://ephtracking.cdc.gov/ accessed on 03/01/2018 - Environmental Public Health Tracking Network - Federal Bureau of Investigation (FBI), Uniform Crime Reporting (UCR), Crime in the United States. Available at: https://crime-data-explorer.fr.cloud.gov/ - Feeding America, Map the Meal Gap, Accessed March 9, 2018 - Greater Cincinnati Community Health Status Survey - www.governing.com/gov-data/health/county-suicide-death-rates-map.html - Indiana State Health Department - Kentucky Cancer Registry - Kentucky State Health Department - http://kentuckyhealthfacts.org/ - Measure of America - National Center for Health Statistics - https://data.cdc.gov/ - National Center for Health Statistics - Mortality Files - National Center for Health Statistics - Natality files - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention - Northern Kentucky Health District - Ohio Department of Health, Death Certificates - Ohio Department of Health, HIV/AIDS Surveillance Program. Data reported through 6/30/17 - Ohio Department of Health, STD Surveillance Program. Data reported through 5/7/2017 - Ohio Department of Health: Center for Public Health Statistics and Informantics. Ohio Public Health Information Warehouse - Ohio Emergency Medical Services; Naloxone Administration by Ohio EMS Providers, accessed at https://www.ems.ohio.gov/index.aspx#gsc.tab=0 - Population: Bridged-Race County Population data from National Center for Health Statistics (NCHS), Ohio Department of Health, 2014-2015 - PreventionFIRST! Student Drug Use Survey, through 2017 - Safe Drinking Water Information System - U.S. Census Bureau, 2012-2016 American Community Survey 5-Year Estimates - U.S. Census Bureau, County Business Patterns - U.S. Census Population Estimates - Uniform Crime Reporting - FBI - USDA Food Environment Atlas To ensure broad representation but also inclusion of vulnerable populations, the CHNA Team and its partners did the following: - Marketing the community meetings through hospitals, health departments, and community-based nonprofit organizations with follow-up email and phone calls to nonprofit agencies that had not been engaged in past CHNA meetings. - Addressed two meetings of grantees for Interact for Health's Thriving Community initiative to publicize the meetings and share the link to the online survey. - Solicited input in smaller focus group settings for people who were African-American; Latino; elderly; identifying as belonging within the LBGTQ+ community; or members of Cincinnati's Creating Healthy Communities initiative - and asked them to share the survey link with friends, family, and colleagues. - Engaged native speakers who were health and outreach workers to conduct one-on-one surveys with Latinos and refugees from the conflict in Rwanda. - Sent college student interns to community events and festivals, which attracted the general public as well as those which targeted specific populations, such as Cincy Cinco, Asian Food Fest, and Juneteenth (among others) - they conducted the surveys on mobile tablets with drop-down menus. - People Working Cooperatively also administered mobile surveys in low-income homes, for elderly and disabled residents, where their nonprofit was making repairs and/or accessibility modifications. - Medical offices shared surveys with patients who were minorities or receiving substance abuse treatment. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - LIST OF ALL HOSPITAL FACILITIES WITH WHICH WE COLLABORATED:. The Christ Hospital Health Network Cincinnati Children's Hospital Medical Center Clinton Memorial Hospital Highpoint Health Kettering Health Network Fort Hamilton Hospital Grandview Medical Center Greene Memorial Hospital Kettering Behavioral Medicine Center Kettering Medical Center Soin Medical Center Southview Medical Center Sycamore Medical Center Lindner Center of HOPE McCullough Hyde Memorial Hospital Mercy Health | Cincinnati Region Mercy Health - Anderson Hospital Mercy Health - Clermont Hospital Mercy Health - Fairfield Hospital Mercy Health - West Hospital The Jewish Hospital - Mercy Health Mercy Health | Springfield Region Mercy Health - Urbana Hospital Springfield Regional Medical Center Premier Health Atrium Medical Center Miami Valley Hospital Miami Valley Hospital North Miami Valley Hospital South Upper Valley Medical Center TriHealth Bethesda Butler Hospital Bethesda North Hospital Good Samaritan Hospital TriHealth Evendale Hospital UC Health Daniel Drake Center for Post-Acute Care University of Cincinnati Medical Center West Chester Hospital Wayne HealthCare Wilson Health Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - WAYNE HOSPITAL COMPANY. - BRETHERN RETIREMENT COMMUNTY - COUNCIL ON RURAL SERVICES - DARKE COUNTY - DARKE COUNTY CHAMBER OF COMMERCE - DARKE COUNTY COMMISSONER'S OFFICE - DARKE COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES - DARKE COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES - DARKE COUNTY HEALTH DEPARTMENT - DARKE COUNTY HEALTH DEPARTMENT - DARKE COUNTY HEALTH DEPARTMENT - DARKE COUNTY PARK DISTRICT - DARKE COUNTY SCHOOLS - DARKE COUNTY UNITED WAY - FAMILY HEALTH - GRACE RESURRECTION COMMUNITY CENTER - GREATER DAYTON AREA HOSPITAL ASSOCIATION - THE HEALTH COLLABORATIVE - THE SOUTHWEST DISTRICT OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS - TRI-COUNTY BOARD OF RECOVERY AND MENTAL SERVICES - TRI-COUNTY BOARD OF RECOVERY AND MENTAL SERVICES Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - WAYNE HOSPITAL COMPANY. Wayne HealthCare partnered with the Greater Dayton Area Hospital Association, the Southwest District of the Association of Ohio Health Commissioners, Ohio Department of Health, Darke County Health Department, Tri-county Board of Mental Health, Job & Family Services, the Darke County Chamber of Commerce, and Family Health to prepare the 2019-2021 Community Health Needs Assessment (CHNA) with Gwen Finegan serving as the lead consultant. Her role involved responsibility for the following activities: Day-to-day management of operations; Identifying and vetting data resources; Liaison with THC and GDAHA; Regular reporting to THC; Liaison with community organizations; Liaison with Southwest Association of Ohio Health Commissioners; Process design and implementation (including but not limited to timeline creation; creation of materials; creation of survey questions; meeting design; and overall approach and methodology); Quality control and oversight; Supervision of subcontractors; Support for hospital and public health representatives (including presentation at meetings, webinar training, communication by phone and email, facilitation of specific requests, and sharing best practice resources); Selection of data and creation of tables for mapping; Creation of regional data tables; Research for causes of death; Designing and formatting final report; Writing final report A community health needs assessment engages community members and partners to collect and analyze health-related data from many sources. The 2019-21 Wayne Healthcare Implementation Strategy focuses on the health priorities discovered during the assessment process that were identified as the most serious threats to the health of the Darke County community. Using the data gathered during the CHNA, three health priorities were identified for the service area: chronic disease prevention & health education/promotion; access to care; and mental health. In support of the 2019-21 Community Health Needs Assessment and ongoing community benefit initiatives, Wayne HealthCare will implement the following strategies to impact and measure community health improvement. Chronic Disease Prevention & Health Education/Promotion Implementation Strategies Goal: Improve opportunities for chronic disease prevention by supporting education and programming that focuses on risk factor management. Objective 1: By December 2021, increase opportunities for health education/promotion and prevention programs outside of the traditional healthcare setting. Activity 1: Inventory existing partnerships with organizations that do not directly provide healthcare services. Activity 2: Partner with local businesses, human service organizations, libraries, and other entities that may not traditionally offer health education and prevention programs to meet people where they are by going to them with prevention-focused programming and educational opportunities. Activity 3: Increase marketing of behavior change and risk factor management programs and availability of health education activities, such as the Healthy Living Series, Cardiopulmonary rehabilitation, and clinical exercise program, to organizations in the community. Objective 2: By December 2021, increase participation in primary and secondary prevention programs and activities. Activity 1: Increase participation in the Healthy Living Series Program (Prevent T2), which meets the guidelines for the National Diabetes Prevention Program and is approved by the Centers for Medicare and Medicaid Services. Strategy 1: Provide enrollment and retention support for the National Diabetes Prevention Program through a grant from the Ohio Department of Health (ODH). The grant will cover the cost to participate in the program for those who meet grant requirements. Strategy 2: Increase awareness of the program by using the new wellness digital platform to educate individuals in the community the lifestyle skills the program teaches. Strategy 3: Partner with providers and community organizations to inform individuals in the community that Medicare will cover the cost of the program when they meet requirements to participate. Strategy 4: Expand grant eligibility standards to reach more low-income participants. Activity 2: Increase participation in primary and secondary prevention programs in the Lifestyle Enhancement Center. Strategy 1: Expand opportunities for community to participate in clinical exercise program, with a renewed focus on weight management. Strategy 2: Improve marketing aimed at the general community and providers regarding opportunities for cardiopulmonary rehabilitation. Strategy 3: Increase retention rate of patients transitioning to maintenance phase of cardiopulmonary rehabilitation. Activity 3: Expand availability of cancer-focused primary and secondary prevention programs. Strategy 1: Initiate Survivor's Strength clinical exercise secondary prevention program. Strategy 2: Expand marketing of tobacco cessation programs currently available to the public in the Lifestyle Enhancement Center. Activity 4: Implement wellness portal to increase access to information on age-appropriate preventive screening, health education materials, and promote opportunities for engagement in primary and secondary prevention. Priority: Mental Health Goal: Improve opportunities for geriatric behavioral health management and support through patient screening and community education opportunities. Objective 1: By December 2021, implement geriatric depression and geriatric anxiety screenings on all patients to the inpatient Senior Behavioral Health unit. Activity 1: Implement Geriatric Depression Scale screening on all patients admitted to the Senior Behavioral Health unit completed at the time of admission and the time of discharge. Activity 2: Implement Geriatric Anxiety Scale screening on all patients admitted to the Senior Behavioral Health unit completed at the time of admission and the time of discharge. Objective 2: By December 2021, increase community education programming based on the data gathered through the geriatric screening tools. Activity 1: Analyze data geriatric anxiety and depression screening results on patients admitted to the Senior Behavioral Health unit. Activity 2: Increase the number of community partners, skilled facilities, and other geriatric health and wellness providers reached through outreach meetings, community activities, and other networking events, to promote and share the findings of the data collected. Activity 3: Actively promote the online mental health screening tool provided by the Tri-County Board of Recovery and Mental Health Services during community outreach events. Activity 4: Partner with more organization to provide information on geriatric mental health and wellness at community events and health fairs. Objective 3: By December 2021, expand education opportunities among staff and volunteers for identifying mental health issues. Activity 1: Expand opportunities for education on suicidal risk assessments and risk for self-harm assessment for all hospital personnel. Activity 2: Improve competencies for nursing personnel regarding assessment of the psychiatric mental health patient. Priority: Access to Care Goal: Improve access to clinical care in Darke County. Objective 1: By December 2021, leverage Wayne HealthCare Professional Services LLC to increase primary care access in Darke County. Activity 1: Continually assess needs and meet identified needs with appropriate service lines and personnel. Activity 2: Increase primary care opportunities within Wayne HealthCare Professional Services LLC. Activity 3: Increase marketing of current primary care providers and Walk-in Care. Objective 2: By December 2021, streamline processes to increase reach of OB/GYN services, with a focus on engagement in prenatal care. Activity 1: Market availability of OB/GYN services. Activity 2: Increase health education regarding prenatal care, targeting vulnerable populations For more information on how Wayne HealthCare is addressing health priorities in our community, visit https://www.waynehealthcare.org/documents/content/Implementation_Strategy-2019_2021_Final.pdf 1 WAYNE HOSPITAL COMPANY PROFESSIONAL SERVICES LLC 835 SWEITZER STREET GREENVILLE OH 45331 PHYSICIAN PROFESSIONAL SERVICES ORGANIZATION Schedule H, Part V, Section B, Line 3 Line 3i Supplemental Information THE HOSPITAL PARTICIPATED IN THE PREPARATION OF A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT THAT COVERED 35 HOSPITALS AND 28 LOCAL HEALTH DEPARTMENTS. IN ADDITION TO THE COLLABORATIVE CHNA REPORT, ON SEPTEMBER 16, 2020, THE BOARD OF THE HOSPITAL ADOPTED AN ADDENDUM TO THE REPORT THAT ADDRESSES (1) THE PRIORITIZATION PROCESS AND ITS RESULTS TO IDENTIFY SIGNIFICANT HEALTH NEEDS SPECIFIC TO THE HOSPITAL; (2) THE IMPACT OF THE ACTIONS THAT WERE TAKEN, SINCE THE HOSPITAL FINISHED CONDUCTING ITS IMMEDIATELY PRECEDING CHNA, TO ADDRESS THE SIGNIFICANT HEALTH NEEDS THAT WERE IDENTIFIED IN THAT CHNA; AND (3) WRITTEN COMMENTS RECEIVED ON THE HOSPITAL'S MOST RECENTLY CONDUCTED CHNA. GOING FORWARD, THE HOSPITAL INTENDS TO ESTABLISH PRACTICES AND PROCEDURES TO ADD ANY ADDITIONAL INFORMATION TO A COLLABORATIVE CHNA REPORT THAT IS REQUIRED BY SECTION 501(R)(3), AND THAT IS NOT ADDRESSED IN THE REPORT, ON A TIMELY BASIS. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance IN ORDER TO CALCUATE THE AMOUNTS REPORTED IN THE TABLE FOR LINE 7, A COST-TO-CHARGE RATIO WAS USED. THIS COST-TO-CHARGE RATIO WAS DERVIED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES AS PROVIDED WITHIN THE IRS INSTRUCTIONS FOR COMPLETION OF SCHEDULE H. Schedule H, Part II Community Building Activities WAYNE HEALTHCARE CONTRIBUTED TO THE FOLLOWING ORGANIZATIONS: $5,000 TO PARTNERING FOR PROGRESS WHICH IS A COLLABORATIVE ECONOMIC DEVELOPMENT EFFORT PROVIDING COMPREHENSIVE SUPPORT TO THE DARKE COUNTY BUSINESS COMMUNITY $2,500 TO EDISON COMMUNITY STATE COLLEGE FOUNDATION TO SUPPORT THE NURSING STUDENTS IN THE PROGRAM TO EARN AN RN DEGREE $3,500 TO DARKE COUNTY WELLNESS CHALLENGE TO PROMOTE COMMUNITY HEALTH THROUGHTOUT A MULTITUDE OF RUNNING/WALKING EVENTS IN DARKE COUNTY $2,500 TO THE YMCA OF DARKE COUNTY FOR THEIR ANNUAL CAMPAIGN THAT ASSISTS FAMILIES TO SUBSIDIZE THEIR MEMBERSHIP FEES, ENABLING THEM TO RECEIVE DISCOUNTED CHILDCARE, TAKE SWIM LESSONS, PARTICIPATE IN GROUP EXERCISE CLASSES AND USE THE YMCA FAMILY ACTIVITIES $4,500 TO YOLO OF DARKE COUNTY, INC. TO SUPPORT BRINGING TOGETHER HIGH ENERGY INDIVIDUALS WITH A GOAL OF LIVING LIFE TO THE FULLEST AND GIVING BACK TO THE COMMUNITY $1,100 TO BIG BROTHERS BIG SISTERS OF SHELBY AND DARKE COUNTY TO HELP SPONSOR FAMILY ACTIVITIES $3,150 TO DARKE COUNTY UNITED WAY TO HELP ASSESS AND ADDRESS HEALTH AND HUMAN SERVICES NEEDS IN OUR COMMUNITY $5,000 TO COALITION FOR HEALTHY DARKE COUNTY TO HELP SUPPORT THE CREATION OF A HEALTHY, VIBRANT, SAFE AND SECURE COMMUNITY $75,000 TO THE CITY OF GREENVILLE SOUTH PARK PROJECT TO HELP SUPPORT FAMILY ACTIVITIES $1,200 TO DARKE COUNTY CENTER FOR THE ARTS TO PROVIDE A POSITIVE IMPACT ON THE QUALITY OF LIFE IN OUR COMMUNITY $2,000 TO THE DARKE COUNTY AGRICULTURAL SOCIETY FOR THE JUNIOR FAIR RENOVATION CAMPAIGN $5,000 TO BRETHREN RETIREMENT COMMUNITY FOR THEIR ANNUAL CAPITAL CAMPAIGN Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount For financial statement purposes, Wayne Hospital Company has adopted accounting standards update No. 2014-09 (Topic 606). Implicit price concessions includes Bad Debts. Therefore, Bad debts are included in Net Patient Revenue in accordance with Healthcare Financial Management Association Statement No. 15 and bad debt expense is not separately reported as an expense on IRS Form 990, Part IX. The amount reported on Part III, Line 3 is the estimated cost of Bad Debt attributable to patients eligible under the Hospital's financial assistance policy on a gross basis. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Please refer to page 16 of the attached financial statements on the determination of bad debt expense. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The Medicare allowable costs are determined using the internal cost accounting system, which incorporates the cost to charge ratio. Wayne HealthCare has a large percentage of Medicare patients in the community it serves and shortfalls may arise when payments received are less than the cost to provide the care or services. As provided in IRS Revenue Ruling 69-545, the community benefit standard for nonprofit hospitals states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Patients known to qualify for charity care or financial assistance are not sent to a collection agency. The organization repeatedly offers patients access to financial help during their hospital stays and after, as well as with each billing notice. Bills are sent to a collection agency as a last resort and only: when patients have the ability to pay some portion of their healthcare expenses but refuse to do so; when patients refuse to work with the organization to determine if they qualify for free or discounted care via federal, state, local or hospital assistance programs; when the organization is unable to locate the patient or person responsible for the bill. Schedule H, Part V, Section B, Line 16a FAP website - Wayne Hospital Company: Line 16a URL: https://www.waynehealthcare.org/visitors-and-patients/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - Wayne Hospital Company: Line 16b URL: https://www.waynehealthcare.org/visitors-and-patients/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Wayne Hospital Company: Line 16c URL: https://www.waynehealthcare.org/visitors-and-patients/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment THE ORGANIZATION ASSESES THE NEEDS OF THE COMMUNITY BY REACHING OUT TO LOCAL ORGANIZATIONS TO SURVEY THE HEALTH NEEDS OF THEIR EMPLOYEES. ADDITIONALLY THE HOSPITAL ASSESSES THE TRENDS OF INPATIENT ADMISSIONS TO DETERMINE WHAT THE CURRENT NEEDS ARE AND WHAT ADDITIONAL PROGRAMMING MAY BENEFIT THE NEEDS OF THE COMMUNITY. WAYNE HOSPITAL COMPANY WORKED IN CONJUNCTION WITH THE GREATER DAYTON AREA HOSPITAL ASSOCIATION, WITH GWEN FINEGAN SERVING AS THE LEAD CONSULTANT, AND THE DARKE COUNTY HEALTH DEPARTMENT TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance WAYNE HOSPITAL PROVIDES PAMPHLETS TO PATIENTS THAT DESCRIBE THE FINANCIAL ASSISTANCE POLICIES. THERE IS SIGNAGE UP THROUGHOUT THE KEY PATIENT AREAS IN THE HOSPITAL ALONG WITH FINANCIAL ASSISTANCE APPLICATIONS. THE HOSPITAL'S WEBSITE HAS THE FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO THE PATIENTS. WAYNE HOSPITAL SENDS A FINANCIAL COUNSELOR TO SPEAK WITH OUR INPATIENTS AS WELL AS EMERGENCY DEPARTMENT PATIENTS THAT MAY BE ELIGIBLE FOR ASSISTANCE. FINALLY, WAYNE HOSPITAL PUTS THE FINANCIAL ASSISTANCE APPLICATION DIRECTLY ON THE BACK OF ALL PATIENT STATEMENTS SO THAT THE PATIENT HAS IMMEDIATE ACCESS TO THE APPLICATION. Schedule H, Part VI, Line 4 Community information WAYNE HOSPITAL SERVES THE DARKE COUNTY COMMUNITY. DARKE COUNTY IS MAINLY A RURAL FARMING COMMUNITY WITH A POPULATION OF 51,100. APPROXIMATELY 12.1% OF THE COUNTY INCOME LEVEL IS UNDER THE FEDERAL POVERTY GUIDELINES AND 27.34% OF THE REVENUES FOR THE HOSPITAL WERE MEDICAID PATIENTS IN 2020. THE COUNTY UNEMPLOYMENT RATE IN 2020 WAS 4.2%. WAYNE HOSPITAL IS THE ONLY HOSPITAL WITHIN THE COUNTY AND THERE IS A FEDERALLY QUALIFIED HEALTH CENTER THAT SERVES THE COUNTY AND THEREFORE PROVIDES A SIGNIFICANT AMOUNT OF REFERRALS TO THE FACILITY. Schedule H, Part VI, Line 5 Promotion of community health WAYNE HOSPITAL'S GOVERNING BODY IS COMPRISED OF LOCAL COMMUNITY AND COUNTY RESIDENTS WHO HAVE A VESTED INTEREST IN THE VIABILITY OF THE FACILITY. THE MEMBERS ARE ATTORNEYS, BANK EXECUTIVES, SCHOOL OFFICIALS, RETIRED BUSINESS OWNERS, AND OTHER LOCAL MEDICAL PROFESSIONALS. A MAJORITY OF THESE INDIVIDUALS ARE NEITHER EMPLOYEE'S OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. WAYNE HOSPITAL EXTENDS STAFF PRIVILEGES NOT ONLY TO OUR EMPLOYED PHYSICIANS, BUT TO THE COMMUNITY'S MEDICAL PROFESSIONALS AS WELL IN ORDER TO KEEP AS MUCH OF OUR PATIENT POTENTIAL AT THE FACILITY AS POSSIBLE. THE LIFESTYLE ENHANCEMENT CENTER EXPANDED CHRONIC DISEASE MANAGEMENT PROGRAMS TO INCLUDE CARDIAC REHABILITATION AND CONGESTIVE HEART FAILURE CLINIC. CURRENT EXISTING PROGRAMS INCLUDE DIABETES EDUCATION PROGRAMS, SMOKING CESSATION AND PULMONARY REHABILITATION. THE GROUP LIFESTYLE BALANCE PROGRAM EXPANDED FROM WAYNE HEALTHCARE EMPLOYEES TO INVITING THE PUBLIC TO PARTICIPATE. 65 PEOPLE PARTICIPATED IN THE PROGRAMS FOR TOBACCO CESSATION, CARDIAC DISEASE, HEART FAILURE, CARDIAC & PULMONARY REHAB . THE HEALTHY MOMENTS PROGRAM IS AVAILABLE TO THE EMPLOYEES AND THE PUBLIC IS INVITED. IN 2020, 23 PARTICIPANTS ATTENDED THE HEALTHY MOMENTS SESSIONS. ATTENDANCE WAS LOW DUE TO COVID. Schedule H, Part VI, Line 7 State filing of community benefit report OH true CITY OF GREENVILLE 100 PUBLIC SQUARE GREENVILLE OH 45331 346400593 CITY OF GREENVILLE 75000 PROGRAM SUPPORT BRETHREN RETIREMENT COMMUNITY 750 CHESTNUT STREET GREENVILLE OH 45331 344431168 501(C)3 6500 GENERAL SUPPORT 2 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Wayne HealthCare provides grant support to perpetuate and advance the highest quality of health care services at Wayne HealthCare and the surrounding communities along with providing funds to other organizations that will improve the health of the community. Wayne HealthCare's Senior Leadership team reviews and approves all grants and other assistance provided to organizations and individuals to ensure that grants are used for proper purposes and are not otherwise diverted from the intended use. If the Hospital receives a large request mid year that has not been budgeted the request is taken to the Board for review and approval. X X X false false false true false false false false false JOHN DUTRO MD CHAIR (PART YEAR)/PAST CHAIR (PART YEAR)/SURGEON 168134 0 10000 0 0 0 5502 0 7516 0 191152 0 0 0 JENNIFER WILLIAMS CFO 176284 0 23675 0 0 0 6233 0 21325 0 227517 0 0 0 WAYNE DESCHAMBEAU CEO 325061 0 61074 0 4000 0 8630 0 21916 0 420681 0 0 0 SHELTON MONGER CIO 156322 0 20852 0 0 0 5413 0 1006 0 183593 0 0 0 PEGGY SCHULTZ VP HUMAN RESOURCES 148698 0 20798 0 0 0 5360 0 9786 0 184642 0 0 0 KIMBERLEE FREEMAN VP OF PATIENT CARE/CNO 173968 0 23189 0 0 0 6152 0 21899 0 225208 0 0 0 JEFFREY SUBLER VP OF SUPPORT SERVICES 139689 0 18591 0 0 0 5021 0 21855 0 185156 0 0 0 PETER LACHIEWICZ OB/GYN 433229 0 15083 0 0 0 8630 0 12028 0 468970 0 0 0 PATRICK KARR OB/GYN 416118 0 33288 0 0 0 8630 0 21965 0 480001 0 0 0 STEPHANIE BUCHANAN SURGEON 394650 0 10000 0 0 0 8630 0 12011 0 425291 0 0 0 KARA SCHULTZ SURGEON 350394 0 8000 0 0 0 8630 0 202 0 367226 0 0 0 ALISHA REISS SURGEON 421488 0 2797 0 0 0 8630 0 21947 0 454862 0 0 0 Schedule J, Part I, Line 5a Compensation contingent on revenues of the organization THE ORGANIZATION PAYS PHYSICIAN INCENTIVE PAYMENTS TO PETER LACHIEWICH, PATRICK KARR, AND ALISHA REISS BASED ON THE REVENUE AND QUALITATIVE PERFORMANCE OF THEIR PRACTICES, WHICH IN PART MAKE UP THE REVENUES OF THE ORGANIZATION. THE INCENTIVE PAYMENTS ARE CONTINGENT ON THE PHYSICIAN'S GENERATED CHARGES. A COUNTY OF DARKE OHIO 346400361 237242AS1 2019-09-12 27449851 SEE PART VI false false false B COUNTY OF DARKE OHIO 346400361 000000000 2019-09-12 39414756 SEE PART VI false false false A 0 0 27722962 1106272 1060645 0 225000 0 0 16259377 0 9071668 false false false true B 1040000 0 39414756 0 0 0 565661 0 0 9034494 24102135 5712467 true false false true A false false true true false 0.0 0.0 0.0 false false true B false false true true false 0.0 0.0 0.0 false false true A false true false false false false false false true B false true false false true false false false true A true B true Schedule K, Part I, Column (f) BOND ISSUES LINE A THE SERIES 2019A BONDS WERE ISSUED TO PROVIDE THE FUNDS WHICH WILL BE USED TO (I) PROVIDE A PORTION OF THE MONIES NECESSARY TO FINANCE CERTAIN CAPITAL IMPROVEMENT PROJECTS CONSISTING OF THE ACQUISITION, CONSTRUCTION, FURNISHING AND EQUIPPING OF ADDITIONS AND IMPROVEMENTS TO "HOSPITAL FACILITIES" AS THE TERM IS DEFINED IN SECTION 140.01 OF THE OHIO REVISED CODE; (II) FUND A DEBT SERVICE RESERVE FUND FOR THE SERIES 2019A BONDS, (III) PAY INTEREST ON A PORTION OF THE SERIES 2019A BONDS; AND (IV) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2019A BONDS. Schedule K, Part I, Column (f) BOND ISSUES LINE B THE SERIES 2019BC BONDS WERE ISSUED TO (I) FINANCE THE COSTS OF ACQUIRING, CONSTRUCTING, EQUIPPING, INSTALLING AND IMPROVING "HOSPITAL FACILITIES" AS THE TERM IS DEFINED IN SECTION 140.01 OF THE OHIO REVISED CODE; (II) CURRENTLY REFUND THE OUTSTANDING PRINCIPAL AMOUNT OF THE COUNTY'S ADJUSTABLE RATE DEMAND HOSPITAL FACILITIES REFUNDING REVENUE BONDS, SERIES 2010 (WAYNE HOSPITAL) DATED NOVEMBER 1, 2010 ISSUED IN THE ORIGINAL PRINCIPAL AMOUNT OF $30,000,000, WHICH FINANCED AND REFINANCED THE COSTS OF EQUIPPING, INSTALLING AND IMPROVING HOSPITAL FACILITIES; AND (III) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2019BC BONDS. Schedule K, Part II, Line 3 BOND ISSUES COLUMN A TOTAL PROCEEDS OF THE ISSUE 27,722,962, WHICH ARE TOTAL PROCEEDS OF 27,449,851 PLUS INTEREST EARNINGS OF 273,111. Schedule K, Part II, Line 11 BOND ISSUES COLUMN B Related to the current refunding of the Series 2010 Bonds described above. Schedule K, Part II, Line 12 BOND ISSUES COLUMNS A AND B Relates to the remaining amount of undrawn bond proceeds. Form 990, Part I, Line 1 COVID-19 IMPACT ON WAYNE HOSPITAL COMPANY AND ITS OPERATIONS On March 11, 2020, the World Health Organization declared COVID-19 a pandemic. Because Wayne HealthCare ("WHC") continued to stay a clean hospital, COVID-19 patients were transferred to Premier Health ("PH") through mid-November 2020. At this time, PH reached maximum capacity and was only taking transfers for our critical patients. At that time, WHC had not reached maximum capacity and our six bed ICU Unit continued to be the hospitals primary Covid-19 Unit. The hospital continued to monitor patients, staff and positive Covid-19 cases daily to make necessary adjustments. The hospital continues to care for Covid-19 patients, with an average of two patients per day. The hospital supply chain continues to secure the PPE needs for our staff, providers, visitors, and patients. Most of our items are still on allocation with our distributor, but our allocated amounts have increased over the past few months. Although the supplies are not back to pre-Covid-19 allotments, the hospital is beginning to see the flow of supplies slowly increase. To adjust for loss of revenue, staffing changes continued in the third and fourth quarter of 2020. The hospital did experience a shortage in clinical staff. Due to high demand of clinical staff, the hospital had to contract with travel nurses at a higher rate, and into the first quarter of 2021 to cover patient care. At the end of December 2020, WHC received relief funding in the amount of $10,882,725 and Wayne Hospital Company Professional Services LLC ("LLC"), a disregarded entity of WHC for U.S. tax purposes, received relief funding of $23,437. The calculated lost revenues were determined by CY 2020 net revenue less CY 2020 budget net revenue. WHC had lost revenues of $7.3 million and the LLC had lost revenues of $637,000. The operations expense to "prevent, prepare for and treat COVID-19 patients" for WHC was $2.3 million, and the LLC was $18,300. The hospital also had capital cost totaling $1.7 million, and workforce-related expenses totaled $280,000. At the end of April 2021, the operations expense for Covid-19 related matters added an additional $1 million to the overall total expenses. The decision to become a clean Covid-19 hospital did impact our patient days in 2020. At the end of December, inpatient days were down 22% and our Emergency Room visits had a decline of 19.8%. The LLC did provide tele primary care visits and continues to offer these services for family practice needs. Surgeries did ramp back up and ended the year with 2,145 procedures. As of April 30, 2021, inpatient days were down 8.9% compared to the same data for 2019, but the Emergency Room visits continue to see a decline of 23.7% visits compared to 2019. Surgery continues to grow but is under by 12.9% compared to 2019. Form 990, Part III, Line 1 ORGANIZATION'S MISSION (CONTINUED FROM PART III) THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SCHEDULE H PROVIDES INFORMATION ABOUT WAYNE HOSPITAL CORPORATION PROVIDING CARE REGARDLESS OF PATIENT'S ABILITY TO PAY. Form 990, Part III, Line 4b PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED FROM PART III, LINE 4B) ANOTHER PROGRAM INVOLVES CONDUCTING VARIOUS DIABETES SEMINARS AND CLASSES HELD AT WAYNE HOSPITAL WHICH PROVIDE INFORMATION TO THE PUBLIC ON DIABETES AWARENESS, OFFER THE COMMUNITY HEALTH SCREENINGS FOR DIABETES, AND EDUCATE THOSE WITH DIABETES ABOUT MANAGING THE DISEASE. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT OVER 45 HOURS OF TIME ON THE DIABETES SEMINARS AND CLASSES AND THE HOSPITAL HAS CONTRIBUTED MATERIALS AND SUPPLIES TO THE PROGRAM. AN ADDITIONAL PROGRAM OF WAYNE HOSPITAL IS THE CANCER AWARENESS, PREVENTION, SCREENING AND TREATMENT PROGRAM IN WHICH THE HOSPITAL OFFERS DIAGNOSTIC AND THERAPEUTIC SERVICES IN ADDITION TO SEMINARS AND CLASSES TO THE COMMUNITY IN ORDER TO PROMOTE AWARENESS, TEACH WAYS OF PREVENTION, AND OFFER HEALTH SCREENINGS TO THE COMMUNITY. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT OVER 101 HOURS OF TIME ON THE CANCER AWARENESS SEMINARS. WAYNE HOSPITAL ALSO PROVIDED AWARENESS, PREVENTION, SCREENING OF BLOOD PRESSURE CLINIC. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT 12 HOURS OF TIME ON THE CLINIC. CHILD BIRTHING CLASSES, BREASTFEEDING CLASSES AND CHILD SIBLING CLASSES WERE OFFERED TO THE COMMUNITY. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT 45 HOURS OF TIME ON THE CHILD BIRTHING CLASSES. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED BY THE CEO USING MARKET STUDIES PROVIDED BY HUMAN RESOURCES, EVALUATION, AND PERFORMANCE. THE CEO DETERMINES THE APPROPRIATE COMPENSATION. THIS PROCESS WAS COMPLETED FOR THE CFO AND KEY EMPLOYEES AND WAS LAST UNDERTAKEN IN 2020. Form 990, Part VI, Line 1a Delegate broad authority to a committee Section 2. Executive Committee. The Executive Committee shall consist of the Chairman, Vice Chairman, Secretary/Treasurer and two additional members of the Board of Trustees. The Corporate Member shall have the right to appoint up to two (2) representatives from the Directors appointed by it (or their designees) to be member(s) of the Executive Committee; provided that any such Director (or their designee) is either a senior Premier Health Partners clinical or management employee. To the extent a Director's designee is appointed by the Corporate Member to serve on the Executive Committee, such designee shall be considered an ex-officio Director, with vote, for the purposes of his/her service on the Executive Committee only. Duties. The Executive Committee shall have power to transact all regular business of the Hospital during the period between the meetings of the board of Trustees, subject to any prior limitation imposed by the Board of Trustees and with the understanding that all matters of major importance shall be referred to the Board of Trustees. Minutes of the executive committee meetings shall be submitted to the Board and its actions shall be subject to approval or disapproval at the next regular Board meeting. Form 990, Part VI, Line 6 Classes of members or stockholders The Corporation shall have two (2) Members as follows: (1) those persons, corporations, associations or other entities who shall have been members as set forth in the register of membership book of the Corporation as of April 1, 2017 (the "Individual Members") and those additional Individual Members admitted as Members to the Corporation in accordance with Section 1.2 hereof shall collectively hold a 66.7% (two-thirds) percentage interest in the Corporation; and (3) Premier Health Partners (the "Corporate Member") shall hold a 33.3% (one-third) percentage interest in the Corporation. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD SHALL CONSIST OF EIGHTEEN (18) DIRECTORS ELECTED BY THE MEMBERS AS FOLLOWS: (1) TWELVE (12) DIRECTORS SHALL BE ELECTED BY THE INDIVIDUAL MEMBERS AND SIX (6) DIRECTORS SHALL BE APPOINTED BY THE CORPORATE MEMBER. EXCEPT AS OTHERWISE PROVIDED IN THIS CODE OF REGULATIONS OR BY THE ARTICLES OF INCORPORATION, THE ACT OF THE MAJORITY OF THE DIRECTORS, EXCLUDING NONVOTING, EX OFFICIO DIRECTORS PRESENT AT ANY MEETING OF THE BOARD AT WHICH A QUORUM IS PRESENT SHALL BE THE ACT OF THE BOARD. DIRECTORS MAY NOT VOTE BY PROXY. FOR THE PURPOSES OF VOTING ON ANY MATTER BEFORE THE BOARD, EACH DIRECTOR ELECTED BY THE INDIVIDUAL MEMBERS SHALL HAVE ONE (1) VOTE AND THE DIRECTORS APPOINTED BY THE CORPORATE MEMBER SHALL COLLECTIVELY HAVE THE RIGHT TO EXERCISE A TOTAL OF SIX (6) VOTES ON ANY MATTER BEFORE THE BOARD, SUCH THAT THE DIRECTORS ELECTED BY THE INDIVIDUAL MEMBERS SHALL HAVE THE AUTHORITY TO EXERCISE TWO-THIRDS OF THE VOTING POWER OF THE BOARD AND THE CORPORATE MEMBER'S APPOINTED DIRECTORS SHALL HAVE THE AUTHORITY TO COLLECTIVELY EXERCISE ONE-THIRD OF THE VOTING POWER OF THE BOARD. THE VOTING RIGHTS OF THE CORPORATE MEMBER'S APPOINTED DIRECTORS AT ANY BOARD MEETING SHALL BE DETERMINED BY DIVING SIX (6) BY THE NUMBER OF CORPORATE MEMBER'S DIRECTORS IN ATTENDANCE AT SUCH MEETING. THE CORPORATE MEMBER SHALL UNDERTAKE GOOD FAITH EFFORTS TO ENSURE THAT THREE (3) OF ITS SIX (6) APPOINTED DIRECTORS ATTEND BOARD MEETINGS, IN WHICH EVENT, EACH SUCH DIRECTOR SHALL HAVE THE RIGHT TO EXERCISE TWO (2) VOTES. DUE TO UNFORESEEN OR UNEXPECTED CIRCUMSTANCES, THERE MAY BE OCCASIONS WHERE LESS THAN THREE (3) OF THE CORPORATE MEMBER'S APPOINTED DIRECTORS WILL BE ABLE TO ATTEND A BOARD MEETING, IN WHICH CASE, THE CORPORATE MEMBER'S APPOINTED DIRECTOR(S) IN ATTENDANCE SHALL HAVE THE VOTING RIGHTS AS DETERMINED PURSUANT TO THE FORMULA SET FORTH ABOVE. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE CORPORATE MEMBER SHALL HAVE RESERVED POWERS OVER SIGNIFICANT GOVERNANCE TRANSACTIONS, SUCH AS THE FOLLOWING: MATERIAL CHANGES TO THE CORPORATION'S ARTICLES OF INCORPORATION AND/OR CODE OF REGULATIONS; DISTRIBUTION OR TRANSFER OF ASSETS; MATERIAL CHANGES IN THE OPERATIONS, PURPOSE OR STATUS OF THE HOSPITAL, OR AS AN ORGANIZATION EXEMPT FROM TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE; MERGER, CONSOLIDATION, SALE, DISSOLUTION OR ANY OTHER COMBINATION; AND SIGNIFICANT BORROWING AND CAPITAL EXPENDITURES (AS MORE FULLY DESCRIBED IN SECTION 1.14 OF THE CODE OF REGULATIONS.) Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 is reviewed and approved by the CFO. Due to the timing of the organizations governing body meeting schedule the Finance Committee then reviews the Form 990 in detail and approves. The Finance Committee then reports to the full governing body at a board meeting. During the board meeting any questions or discussions related to the Form 990 are addressed. Form 990, Part VI, Line 12c Conflict of interest policy The conflict of interest policy is signed annually by all management, senior management, officers, directors, and key employees. After the signed conflict of interest statements are submitted, they are reviewed by the CFO. Any conflicts of interest that are disclosed and discussed with the board chair, which ensures that the interested person abstains from voting on matters related to the conflict of interest. Form 990, Part VI, Line 15a Process to establish compensation of top management official The executive board reviews and determines the compensation for the CEO. They use compensation surveys conducted by independent consulting companies in their decision making process. The VP of Human Resources compiles the survey information and provides to the Chairman of the Board independently of the CEO's influence. This process is completed for Wayne Deschambeau, CEO and was last undertaken in 2020. Form 990, Part VI, Line 19 Required documents available to the public The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: 116139, Related or Exempt Function Revenue: 116139, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 5 JOHN DUTRO, SEC/TREAS/SURGEON JOHN DUTRO IS AN OFFICER OF THE BOARD IN HIS CAPACITY AS THE SECRETARY AND TREASURER. HE IS NOT COMPENSATED FOR HIS SERVICES RENDERED TO THE BOARD AS AN OFFICER. IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS, PART IX, LINE 5 REPORTS DR. DUTRO'S COMPENSATION FOR SERVICES RENDERED AS A SURGEON OF THE ORGANIZATION. Form 990, Part IX, Line 11g Other Fees Agency Employees - Total Expense: 8751653, Program Service Expense: 8286759, Management and General Expenses: 464894, Fundraising Expenses: ; Data Processing - Total Expense: 247313, Program Service Expense: 174096, Management and General Expenses: 73217, Fundraising Expenses: ; Consulting - Total Expense: 3283552, Program Service Expense: 3223211, Management and General Expenses: 60341, Fundraising Expenses: ; Collection Fees - Total Expense: 814239, Program Service Expense: 0, Management and General Expenses: 814239, Fundraising Expenses: ; Purchased Services - Total Expense: 840242, Program Service Expense: 0, Management and General Expenses: 840242, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN VALUE OF INTEREST RATE SWAP - -748610; CHANGE IN VALUE IN RELATED ENTITIES - 10789; TRANSFER TO AFFILIATE - -651347; WAYNE HOSPITAL COMPANY PROFESSIONAL SERVICES LLC 835 SWEITZER STREET GREENVILLE OH 45331 270581440 PROFESSIONAL MEDICAL SERVICES OH -2421867 587034 WAYNE HEALTHCARE THE WAYNE HOSPITAL FOUNDATION INC 835 SWEITZER STREET GREENVILLE OH 45331 260380696 FUNDRAISING OH 501(c)(3) Type I WAYNE HEALTHCARE true false true true false false false false false false false false true true true true false true false false