2021-11-12T15:07:41-06:00 2020-12-31 990 2020-01-01 383049015 HERRICK MEMORIAL HOSPITAL INC HERR 4192525772 100 MADISON AVE ATTN TAX DEPARTM TOLEDO OH 43604 STEVEN M CAVANAUGH TREASURER 4192525772 2021-11-11 0 STEVEN CAVANAUGH 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z PROMEDICA HERRICK HOSPITAL STEVEN M CAVANAUGH 100 MADISON AVE TOLEDO OH 43604 20520076 0 X WWW.PROMEDICA.ORG X 1989 MI HERRICK MEMORIAL HOSPITAL, INC. IS AN ACUTE CARE CRITICAL ACCESS HOSPITAL THAT PROVIDES HEALTHCARE SERVICES TO ALL INDIVDUALS IN LENAWEE COUNTY. X 22 16 89 45 0 0 27055 4261759 24416302 16056414 1993177 -1184154 190218 92280 26626752 19226299 217833 44032 0 0 10776875 6715127 0 0 0 17765542 14435565 28760250 21194724 -2133498 -1968425 79610197 5946601 20334173 17080707 59276024 -11134106 X HERRICK MEMORIAL HOSPITAL, INC. IS AN ACUTE CARE CRITICAL ACCESS HOSPITAL THAT PROVIDES HEALTH CARE DEDICATED TO IMPROVING HUMAN LIFE, AND IS DEVOTED TO THE PATIENTS AND FAMILIES WE SERVE THROUGH INNOVATIVE CARE, SUPERIOR QUALITY, AND PREMIER CUSTOMER SERVICE. 0 1 17112968 44032 14833414 HERRICK MEMORIAL HOSPITAL, INC. IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. - SEE SCHEDULE O. 17112968 1 1 0 0 0 0 0 0 0 1 0 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 1 0 1 1 0 0 0 1 0 0 1 89 1 0 0 0 0 0 0 0 0 0 0 0 0 X 22 16 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 X ROBERT SHARON 5675855652 100 MADISON AVE TOLEDO OH 43604 RANDALL OOSTRA PHS PRES. & CEO 1.00 55.00 X 0 3971638 136986 STEVEN M CAVANAUGH TREASURER 1.00 55.00 X 0 2048174 105065 JEFFREY C KUHN SECRETARY 1.00 55.00 X 0 1123411 62157 KEVIN C WEBB PHD EX OFFICIO 1.00 42.00 X 0 1049317 51281 GARY W AKENBERGER COO, ACUTE CARE & SVP, DIAG 0.00 40.00 X 0 483424 41276 VICTOR J CHERFAN DO TRUSTEE 1.00 41.00 X 0 453907 26830 DEANA SIEVERT SR VP, PAT CARE/CNO, SYSTEM 0.00 40.00 X 0 402381 35116 DARRIN ARQUETTE TRUSTEE 1.00 42.00 X 0 391028 40287 JULIE K YAROCH DO PRES., EX OFFICIO 1.00 40.00 X X 0 358522 26934 PAUL E GIETZEN MD TRUSTEE 1.00 40.00 X 0 311426 26216 ALAN M SATTLER FORMER OFFICER 0.00 40.00 X 0 249480 36266 CHRISTI L ANSBERG TRUSTEE 1.00 41.00 X 0 183370 26205 MARCY L BROWN CHAIRMAN 1.00 1.00 X X 0 0 0 PAULA K HOLTZ VICE CHAIRMAN 1.00 0.00 X 0 0 0 AARON D SWIGGUM TRUSTEE 1.00 0.00 X 0 0 0 BRENDA G BAKER TRUSTEE (PARTIAL YEAR) 1.00 0.00 X 0 0 0 DENNIS M SMOKE TRUSTEE 1.00 0.00 X 0 0 0 EDWARD J ENGLE TRUSTEE 1.00 0.00 X 0 0 0 ELIZABETH A KENNEDY TRUSTEE 1.00 0.00 X 0 0 0 FRANK DICK TRUSTEE 1.00 0.00 X 0 0 0 GARY E MCDOWELL TRUSTEE 1.00 0.00 X 0 0 0 GRACE M GARNO TRUSTEE 1.00 0.00 X 0 0 0 JOHN C AKENS TRUSTEE 1.00 0.00 X 0 0 0 L CHARLES FORCE TRUSTEE (PARTIAL YEAR) 1.00 0.00 X 0 0 0 MARCIA J BOYNTON JD TRUSTEE 1.00 0.00 X 0 0 0 MARSHA L DAVIS TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL B ADAMS TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL J UCKELE TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL R OLSAVER TRUSTEE (PARTIAL YEAR) 1.00 0.00 X 0 0 0 MICHAEL R HERR DVM TRUSTEE (PARTIAL YEAR) 1.00 0.00 X 0 0 0 RICK K KNIERIM TRUSTEE 1.00 0.00 X 0 0 0 RUSSELL L DEMPSEY TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM B NOE TRUSTEE (PARTIAL YEAR) 1.00 0.00 X 0 0 0 0 11026078 614619 4 1 1 0 0 43811 4217948 4261759 NET PATIENT SERVICES 621110 15998987 15998987 AFFILIATED ORG RENT 531120 57427 57427 16056414 59717 59717 2834 0 2834 2834 2834 39106 10800 38644 1255133 462 -1244333 -1243871 -1244333 462 ER MEDICAL PROF. SVC 900099 30309 30309 WELLNESS FEES 900099 22966 22966 CAFETERIA & VENDING 722514 10686 10686 25485 25485 89446 19226299 14833414 0 131126 X 44032 44032 5336374 4055644 1280730 252106 163869 88237 736924 560062 176862 389723 296189 93534 63756 63756 19865 19865 3862371 3592005 270366 98205 98205 180511 144409 36102 14871 14871 727404 705582 21822 16449 5922 10527 445542 445542 1568690 1254952 313738 227970 225690 2280 RESTRUCTURING EXPENSE 3601899 2701424 900475 INTERCOMPANY SERVICES 1816347 1671039 145308 PROVIDER TAXES 829120 829120 MEDICAL SUPPLIES 564415 564415 398150 298614 99536 21194724 17112968 4081756 0 X 5061407 4209155 3384045 1395485 435726 41187 0 6595175 38553737 339063 25199857 341961 79610197 5946601 1483234 36301 18850939 17044406 20334173 17080707 X 35031492 -11144506 24244532 10400 59276024 -11134106 79610197 5946601 X -1968425 89016 -68530721 X X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19420909 -19420909 16775870 2645039 19420909 17581920 -806050 16775870 15606550 1975370 17581920 14946310 660240 15606550 0 1 1 0 DUES FROM AFFILIATE 341961 341961 DUE TO AFFILIATES 14995020 ESTIMATED THIRD PARTY SETTLEMENTS PAYABLE 2049386 17044406 PART V, LINE 4: THE ENDOWMENT FUNDS WERE TRANSFERRED TO EMMA L. BIXBY MEDICAL CENTER, A RELATED NON-PROFIT ORGANIZATION. THESE FUNDS WILL CONTINUE TO BE USED WITH THE ORIGINAL DONOR INTENT. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 160405 160405 0.00760 3602052 2048459 1553593 0.07330 6774 2772 4002 0.00020 3769231 2051231 1718000 0.08110 3769231 2051231 1718000 0.08110 1 1275692 64469 4225423 4207517 17906 X 1 1 1 1 HERRICK MEMORIAL HOSPITAL INC 500 E POTTAWATAMIE ST TECUMSEH MI 49286 WWW.PROMEDICA.ORG 1060000169 X X X X HERRICK MEMORIAL HOSPITAL INC 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE PART V, SECTION C X 1 19 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 HERRICK MEMORIAL HOSPITAL, INC. 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, THE LENAWEE HEALTH NETWORK, COMPRISED OF MULTIPLE COMMUNITY ORGANIZATIONS, COLLABORATED TO DEVELOP A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR LENAWEE COUNTY, WITH PROMEDICA BIXBY AND HERRICK HOSPITALS REPRESENTED ON THIS CHIP COMMITTEE. A GAP ANALYSIS AND RESOURCE ASSESSMENT WAS CONDUCTED AS PART OF THIS PROCESS.IN 2019, PROMEDICA BIXBY AND HERRICK HOSPITALS 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 CHNA AND STRATEGIC IMPLEMENTATION PLAN WAS DEVELOPED WITH FEEDBACK 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:ADRIAN FARMER'S MARKET, CARE PREGNANCY CENTER OF LENAWEE, CATHOLIC CHARITIES OF LENAWEE AND JACKSON, COMMUNITY ACTION AGENCY, FAMILY MEDICAL CENTER, GOODWILL INDUSTRIES, INTERCONNECTIONS DROP IN CENTER, LENAWEE COMMUNITY FOUNDATION, LENAWEE COMMUNITY MENTAL HEALTH AUTHORITY, LENAWEE COUNTY HEALTH DEPARTMENT, LENAWEE DEPARTMENT ON AGING, LENAWEE DEPARTMENT OF HUMAN SERVICES, LENAWEE DEPARTMENT OF VETERANS AFFAIRS, LENAWEE INTERMEDIATE SCHOOL DISTRICT, LENAWEE SUBSTANCE ABUSE PREVENTION COALITION, MCCULLOUGH, VARGAS & ASSOCIATES, MHP SALUD, MICHIGAN OPIOID COLLABORATIVE, MSU EXTENSION, ONE LENAWEE, PROMEDICA BIXBY HOSPITAL, PROMEDICA HERRICK HOSPITAL, REGION 2 AREA AGENCY ON AGING, SIENA HEIGHTS, THE UNITED WAY OF MONROE AND LENAWEE COUNTIES, YMCA OF LENAWEE HERRICK MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY CONDUCTED ITS 2019 CHNA WITH THE FOLLOWING HOSPITAL FACILITY: EMMA L. BIXBY MEDICAL CENTER. HERRICK MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY CONDUCTED ITS 2019 CHNA WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO HERRICK MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: HERRICK MEMORIAL HOSPITAL, INC. CONDUCTED AND ADOPTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2019 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - MENTAL HEALTH- CANCER THIS CHNA WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2019; THEREFORE, THESE HEALTH NEEDS WILL BE ADDRESSED OVER THE THREE TAX YEARS, 2020-2022. HERRICK MEMORIAL HOSPITAL, INC. 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 2020-2022 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 DRUG USE, ADULT SEXUAL BEHAVIOR, QUALITY OF LIFE, SOCIAL DETERMINANTS OF HEALTH, ENVIRONMENTAL HEALTH, PARENTING. CHILD HEALTH HEALTH AND FUNCTIONAL STATUS, HEALTH CARE ACCESS, EARLY CHILDHOOD, MIDDLE CHILDHOOD AND 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. LISTED HERE ARE THE STRATEGIES THAT WERE ABLE TO BE MAINTAINED WHILE FOLLOWING PROPER PUBLIC HEALTH GUIDELINES IN PLACE AT THE TIME. ITEMS UNABLE TO BE ADDRESSED IN 2020 WILL BE ADDRESSED IN THE SUBSEQUENT YEAR. HERRICK MEMORIAL HOSPITAL, INC. DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2020 WITH RESPECT TO ITS MOST RECENT CHNA, CONDUCTED IN 2019:HEALTH NEED IDENTIFIED: MENTAL HEALTHSTRATEGY #1 - DEVELOP AND DISTRIBUTE A MENTAL HEALTH RESOURCE GUIDE TO PATIENTS AND THE COMMUNITY.ACTIONS TAKEN: - 616 MENTAL HEALTH RESOURCE GUIDES WERE DISTRIBUTED TO PATIENTS AND THE COMMUNITY IN 2020, TO IMPROVE ACCESS TO THESE RESOURCESSTRATEGY #2 - PROVIDE COMMUNITY MEMBERS AND PATIENTS WITH MENTAL HEALTH SELF-MANAGEMENT AND PREVENTION EDUCATION MATERIALS.ACTIONS TAKEN:- PROVIDED 385 PACKETS OF MENTAL HEALTH SELF-MANAGEMENT AND PREVENTION EDUCATION MATERIALS TO COMMUNITY MEMBERS AND PATIENTS IN 2020.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:- 200 SCREENING AND PREVENTION OF CANCER EDUCATIONAL PACKETS WERE DISTRIBUTED TO COMMUNITY MEMBERS BY FIVE (5) SALONS IN 2020.STRATEGY #2 - CONTINUE PARTICIPATION IN BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCP) FOR FREE WOMEN'S HEALTH SCREENINGS.ACTIONS TAKEN:- 44 WOMEN WERE PROVIDED WITH NO COST WOMEN'S HEALTH SCREENINGS IN 2020 THROUGH THE BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCP). PART V, SECTION B, LINE 7A THE 2019 CHNA CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/CHNA/PROMEDICA-BIXBY-AND-HERRICK-HOSPITALS-2019-JOINT-CHNA.PDF PART V, SECTION B, LINE 10A THE 2020-2020 CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/CHNA/PROMEDICA-BIXBY-AND-HERRICK-HOSPITAL-2019-JOINT-CHNA-IMPLEMENTATION-PLAN-2020-2022-.PDF PART V, SECTION B, LINE 16A: THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/PATIENT-RESOURCES/UNINSURED_DISCOUNT_POLICY.PDF PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/PATIENT-RESOURCES/FINANCIAL_ASSISTANCE_APPLICATION.PDF PART V, SECTION B, LINE 16C: A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/PATIENT-RESOURCES/PLAIN_LANGUAGE_FINANCIAL_ASSISTANCE.PDF 1 1 - TOTAL REHAB AT DUNDEE 119 WATERSTRADT-COMMERCE DR UNIT 5 DUNDEE MI 481319696 PHYSICAL THERAPY 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: HERRICK MEMORIAL HOSPITAL, INC. REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE PROMEDICA HEALTH SYSTEM, INC. ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: HERRICK MEMORIAL HOSPITAL, INC. 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 III, LINE 2: HERRICK MEMORIAL HOSPITAL, INC.'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 ANTICIPATED COLLECTABILITY RATES FOR ACCOUNTS RECEIVABLE WITHIN EACH PAYER CATEGORY. PART III, LINE 3: HERRICK MEMORIAL HOSPITAL, INC. 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 18 AND 19 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL REPORT WITH SUPPLEMENTAL INFORMATION. PART III, LINE 8: HERRICK MEMORIAL HOSPITAL, INC. USED THE MEDICARE ALLOWABLE COSTS PER ITS 2020 AS-FILED MEDICARE COST REPORTS, LESS ANY ADJUSTMENTS FOR SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION, IF APPLICABLE. ALLOWABLE COSTS ARE CALCULATED BY ALLOCATING TOTAL FACILITY COSTS TO REVENUE GENERATING UNITS WITHIN THE HOSPITAL. THE MEDICARE COST REPORT DOES NOT REFLECT ALL OF THE COSTS ASSOCIATED WITH MEDICARE PROGRAMS. 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 THESE 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: HERRICK MEMORIAL HOSPITAL, INC., LOCATED IN TECUMSEH, MI, SERVES AN AREA PRIMARILY AROUND LENAWEE COUNTY AND HAS A SERVICE AREA POPULATION OF APPROXIMATELY 80,000. APPROXIMATELY, 18% OF THE SERVICE AREA IS AGE 65 OR OVER; 38% IS BETWEEN AGE 35 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $61,000; 79% 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 98,000 WITH APPROXIMATELY 12% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 16% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 7% OF LENAWEE COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE AT THE END OF 2020 FOR LENAWEE COUNTY WAS 6.3%. THE LEADING CAUSES OF DEATH IN LENAWEE COUNTY, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, CANCER, LUNG DISEASE, STROKE, ALZHEIMER'S, DIABETES, AND UNINTENTIONAL INJURIES/ACCIDENTS. ACCORDING TO THE 2020 COUNTY HEALTH RANKINGS, LENAWEE COUNTY RANKED 22 OF 83 COUNTIES FOR HEALTH OUTCOMES, 30 OF 83 FOR LENGTH OF LIFE, AND 24 OF 83 FOR QUALITY OF LIFE. THERE ARE ELEVEN HOSPITALS WITHIN A 30-MILE RADIUS OF HERRICK MEMORIAL HOSPITAL, INC.: EMMA L. BIXBY MEDICAL CENTER, ST. JOSEPH MERCY SALINE HOSPITAL, CHELSEA COMMUNITY HOSPITAL, UNIVERSITY OF MICHIGAN HOSPITALS, VA ANN ARBOR HEALTHCARE SYSTEM, ST. JOSEPH MERCY ANN ARBOR HOSPITAL, FLOWER HOSPITAL, ST. ANNE MERCY HOSPITAL, MERCY MEMORIAL HOSPITAL CORPORATION, THE TOLEDO HOSPITAL, AND HENRY FORD ALLEGIANCE HEALTH. PART VI, LINE 5: HERRICK MEMORIAL HOSPITAL, INC. IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC., WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. IN 2020: THERE WERE APPROXIMATELY 313 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. BOARD MEMBERS INCLUDED 63 PHYSICIANS WITH A BALANCE OF 190 MEN AND 140 WOMEN. 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 MORE THAN 2,300 LUNG CANCER SCREENINGS AT ITS LUNG CLINICS, EXPANDED ITS GENETICS COUNSELING PROGRAM TO INCLUDE VIRTUAL OPTIONS DURING THE PANDEMIC, AND ESTABLISHED A NEW SEXUAL HEALTH PROGRAM FOR CANCER PATIENTS BY HOSTING TWO WEBINARS. ADDITIONALLY, PCI WAS INSTRUMENTAL IN HELPING PROMEDICA IMPLEMENT MONOCLONAL ANTIBODY TREATMENT AT ITS INFUSION CENTERS FOR COVID-19 PATIENTS TO IMPROVE SYMPTOM MANAGEMENT. APPROXIMATELY 700 ATTENDEES PARTICIPATED IN THE ANNUAL PROMEDICA BARBERSHOP INITIATIVE, ART OF THE CUT, WHICH CELEBRATED THE ROLE OF LOCAL BARBERS AS ARTISTS, MEN'S HEALTH ADVOCATES, AND COMMUNITY LEADERS WHILE EXAMINING THE INTERSECTION OF ART AND WELLNESS. AS PART OF THE BARBERSHOP INITIATIVE, MORE THAN 30 METRO TOLEDO BARBERS RECEIVED TRAINING IN THE USE OF AUTOMATED EXTERNAL DEFIBRILLATORS (AED) AND UNITS WERE INSTALLED IN SIX BLACK-OWNED BARBERSHOPS. ADDITIONALLY, MORE THAN 1,200 HEALTH AND WELLNESS BAGS AND MORE THAN 2,000 CANCER SCREENING EDUCATIONAL MATERIALS WERE PROVIDED TO BARBERSHOPS AND SALONS IN LUCAS AND LENAWEE COUNTIES TO SHARE IMPORTANT HEALTH AND SCREENING INFORMATION WITH TRADITIONALLY UNDERSERVED COMMUNITIES. PROMEDICA'S FOUNDATIONS RAISED FUNDS FOR PHILANTHROPY IN SUPPORT OF PROMEDICA'S MISSION TO IMPROVE HEALTH AND WELL-BEING. THIS INCLUDED A COVID-19 EMERGENCY EMPLOYEE COMPASSION FUND, WHICH PROVIDED $250 EMERGENCY GRANTS TO EMPLOYEES ACROSS THE COUNTRY WHO FOUND THEMSELVES IN IMMEDIATE FINANCIAL STRAIN DUE TO THE PANDEMIC. NEARLY 10,000 GRANTS WERE GIVEN TO HELP WITH FOOD, HOUSING, CHILDCARE, AND OTHER EXPENSES. THE PROMEDICA FOUNDATION ALSO ESTABLISHED THE PROMEDICA IMPACT FUND TO RAISE $1 BILLION IN THE NEXT EIGHT YEARS TO ACCELERATE NATIONWIDE EFFORTS AROUND THE SOCIAL DETERMINANTS OF HEALTH (SDOH). THESE EFFORTS INCLUDE ADDRESSING HUNGER, AFFORDABLE HOUSING, WORKFORCE DEVELOPMENT, AND EDUCATION. 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 2020 PROMEDICA WAS COMPRISED OF MORE THAN 45,000 EMPLOYEES, APPROXIMATELY 1,200 VOLUNTEERS AND MORE THAN 2,100 PHYSICIANS AND ADVANCED PRACTICE PROVIDERSINCLUDING APPROXIMATELY 1,100 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 2020:- 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 MANAGED APPROXIMATELY 1.85 MILLION PPG EMPLOYED PROVIDER ENCOUNTERS, 50,400 SURGERIES, 6,700 BIRTHS, AND MORE THAN 226,500 EMERGENCY ROOM VISITS AND CONTRIBUTED A TOTAL COMMUNITY BENEFIT OF OVER $319,240,000 MILLION.- 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. THROUGH DECEMBER 2020, MORE THAN 8,357 VISITS TO THE FOOD CLINIC, IMPACTING MORE THAN 2,860 UNIQUE HOUSEHOLDS, FURTHERED PROMEDICA'S EFFORTS TO REDUCE FOOD INSECURITY. THIS TRANSLATES TO ABOUT 67,535 DAYS' WORTH OF FOOD PROVIDED TO PATIENTS AND FAMILIES, THE EQUIVALENT OF 202,605 MEALS.- FOR ITS MICHIGAN PATIENTS, PROMEDICA OFFERED VEGGIE MOBILE VOUCHERS TO PATIENTS WHO SCREENED POSITIVE FOR FOOD INSECURITY. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PROVIDE THE $5 VOUCHERS SO PATIENTS CAN REDEEM FRESH PRODUCE FROM THE VEGGIE MOBILE THAT IS SOURCED FROM PROMEDICA FARMS, LOCAL GROWERS, AND A WHOLESALER. IN 2020, NEARLY 1,848 POUNDS OF PRODUCE WAS GROWN AT PROMEDICA FARMS, 44 PATIENTS IDENTIFIED AS FOOD INSECURE REDEEMED A VOUCHER ISSUED BY A PHYSICIAN OR DISCHARGE PLANNING, AND AN ADDITIONAL 18 PATIENTS WERE PROVIDED A FOOD BOX AND VEGGIE VOUCHER UPON DISCHARGE. - 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) 34032 OPERATING GRANT LENAWEE COMMUNITY FOUNDATION 1440 W MAUMEE ST ADRIAN MI 49221 386095474 501(C)(3) 10000 DONATION 2 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. X 0 0 0 1 0 0 0 0 0 0 0 RANDALL OOSTRA PHS PRES. & CEO 0 1973076 0 1805059 0 193503 0 117599 0 19387 0 4108624 0 0 STEVEN M CAVANAUGH TREASURER 0 1330912 0 710821 0 6441 0 82144 0 22921 0 2153239 0 0 JEFFREY C KUHN SECRETARY 0 716660 0 391346 0 15405 0 44915 0 17242 0 1185568 0 0 KEVIN C WEBB PHD EX OFFICIO 0 663831 0 370658 0 14828 0 31704 0 19577 0 1100598 0 0 GARY W AKENBERGER COO, ACUTE CARE & SVP, DIAG 0 390451 0 88180 0 4793 0 19393 0 21883 0 524700 0 0 VICTOR J CHERFAN DO TRUSTEE 0 396106 0 56936 0 865 0 0 0 26830 0 480737 0 0 DEANA SIEVERT SR VP, PAT CARE/CNO, SYSTEM 0 327015 0 72423 0 2943 0 8160 0 26956 0 437497 0 0 DARRIN ARQUETTE TRUSTEE 0 324493 0 63579 0 2956 0 11877 0 28410 0 431315 0 0 JULIE K YAROCH DO PRES., EX OFFICIO 0 292648 0 64622 0 1252 0 10818 0 16116 0 385456 0 0 PAUL E GIETZEN MD TRUSTEE 0 249981 0 58119 0 3326 0 0 0 26216 0 337642 0 0 ALAN M SATTLER FORMER OFFICER 0 210691 0 35926 0 2863 0 10110 0 26156 0 285746 0 0 CHRISTI L ANSBERG TRUSTEE 0 156738 0 23748 0 2884 0 3721 0 22484 0 209575 0 0 PART I, LINE 1A CHARTER TRAVEL: 2 OFFICERS- NOT INCLUDED IN TAXABLE COMPENSATION PART I, LINE 1B DUE TO EXTENUATING CIRCUMSTANCES RELATED TO THE COVID-19 PANDEMIC THAT LIMITED FLIGHT SCHEDULES AND ABILITY TO TRAVEL, CHARTERED FLIGHT SERVICES WERE UTILIZED WHEN NECESSARY AS THE ONLY FEASIBLE TRAVEL SOLUTION DURING TAX YEAR 2020. THIS WAS NECESSARY IN ORDER TO ENABLE EXECUTIVES TO BE ABLE TO CONTINUE TO CONDUCT BUSINESS WHEN COMMERCIAL FLIGHTS WERE NOT AVAILABLE TO MEET SCHEDULED MEETINGS AND DUE TO SCHEDULE CONSTRAINTS. DURING 2020 THERE WAS NOT A POLICY GOVERNING THIS TYPE OF TRAVEL IN PLACE AS IT WAS NOT FORESEEN IT WOULD BE NECESSARY. CURRENTLY A POLICY IS BEING DRAFTED TO ENSURE PROPER COMPLIANCE AND GOVERNANCE OF THESE EXPENDITURES IN THE FUTURE. PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF HERRICK MEMORIAL HOSPITAL, INC., 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, LINE 4B 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. SCHEDULE J, SUPPLEMENTAL INFORMATION: 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. ENDOWMENT FUND 2020-12-31 25022603 ACTUAL VALUE 382796005 EMMA L BIXBY MEDICAL CENTER 100 MADISON AVE TOLEDO OH 43604 501(C)(3) PUBLICLY TRADED SECURITIES 2020-02-22 38683938 ACTUAL VALUE 344428256 THE TOLEDO HOSPITAL 100 MADISON AVE TOLEDO OH 43604 501(C)(3) 0 0 0 0 FORM 990, PART III, LINE 3 THE HERRICK MEMORIAL HOSPITAL CEASED OPERATION DURING 2020 DUE TO THE OPENING OF A NEW HOSPITAL LOCATION WITHIN THE PROMEDICA SYSTEM. PROGRAMS SERVICES HAVE CEASED AT THE HERRICK MEMORIAL HOSPITAL, BUT PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL WILL CONTINUE TO SERVE THE COMMUNITY AS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. FORM 990, PART III, LINE 4: HERRICK MEMORIAL HOSPITAL, INC. - PROGRAM SERVICE ACCOMPLISHMENTS HERRICK MEMORIAL HOSPITAL, INC. (D/B/A PROMEDICA HERRICK HOSPITAL) 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 CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. PROMEDICA HERRICK HOSPITAL (HH) IS A 25-BED, GENERAL ACUTE CARE AND CRITICAL ACCESS HOSPITAL, PROVIDING HEALTHCARE SERVICES TO RESIDENTS IN TECUMSEH, MICHIGAN. HH IS ACCREDITED BY HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES AT HH INCLUDE GENERAL SURGERY, CARDIOLOGY, GYNECOLOGY, ORTHOPAEDICS, RESPIRATORY CARE, FAMILY MEDICINE, INTERNAL MEDICINE, AND VASCULAR CARE AS WELL AS A SLEEP DISORDERS CENTER WHICH IS ACCREDITED BY THE AMERICAN ACADEMY OF SLEEP MEDICINE (AASM) FOR MEETING SPECIFIC AASM STANDARDS AND GUIDELINES IN THE DIAGNOSIS AND TREATMENT OF SLEEP DISORDERS. IN ADDITION, HH OFFERS EMERGENCY MEDICINE SERVICES FEATURING 10 PRIVATE PATIENT ROOMS WITH 24-HOUR COMPREHENSIVE CARE AND SUPPORT. ADDITIONALLY, HH PLAYS A KEY ROLE PROMOTING THE HEALTH AND WELL-BEING OF COMMUNITY MEMBERS THROUGH VARIOUS WELLNESS CLINICS AND OUTREACH SERVICES. FOR EXAMPLE, HH PROVIDES A COMPREHENSIVE WOMEN'S HEALTH CENTER THAT OFFERS SPECIALIZED SERVICES FOR WOMEN, INCLUDING DIGITAL MAMMOGRAPHY, STEREOTACTIC BREAST BIOPSY AND BREAST CANCER SURGERY, BONE DENSITY SCANS, HEART AND VASCULAR HEALTH SERVICES. EDUCATION RELATED TO HEART HEALTH AND STROKE PREVENTION ARE PROVIDED TO THE COMMUNITY AS WELL. IN SEPTEMBER 2020, THE NEW STATE-OF-THE-ART PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL (CVHH) OPENED ITS DOORS. THE NEW HOSPITAL ALLOWED FOR THE CONSOLIDATION OF HH AND PROMEDICA BIXBY HOSPITAL TO PROVIDE A SINGLE POINT OF CARE TO THE LENAWEE COUNTY COMMUNITY. CVHH 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. HH HAS SERVED THE COMMUNITY FOR NEARLY 70 YEARS, WORKING TO MEET THE COMMUNITY'S HEALTHCARE NEEDS. IN 2020, HH SERVED 19 INPATIENTS; 17,392 OUTPATIENTS; AND 5,117 EMERGENCY CENTER PATIENTS. HH CONTRIBUTED $1,718,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE. HH PROVIDED FINANCIAL ASSISTANCE TO THE COMMUNITY DURING 2020, OF WHICH $160,000 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. HH COST OF BAD DEBT FOR 2020 WAS $431,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $1,718,000 NOTED ABOVE. FURTHER, HH PROVIDED $1,558,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. ALSO, IN 2020, THE TOTAL COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS WAS $798,000 AND IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $1,718,000 NOTED ABOVE. DURING 2020, HH PROVIDED 89 JOBS AND EXPENDED $2,371,000 IN NET PAYROLL. A TOTAL OF $109,500 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES. IN SUMMARY, HH 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. FORM 990, PART IV, LINE 24A: HERRICK MEMORIAL HOSPITAL, INC. IS A HEALTH FACILITY THAT IS A SUBSIDIARY OF PROMEDICA HEALTH SYSTEM, INC. (PHS). HERRICK MEMORIAL HOSPITAL, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE TO THE TOLEDO HOSPITAL, WHICH IS ALSO A SUBSIDIARY OF PHS. THE NOTE PAYABLE REPRESENTS HERRICK MEMORIAL HOSPITAL, INC.'S PORTION OF TAXABLE AND TAX-EXEMPT BONDS ISSUED BY PROMEDICA HEALTHCARE OBLIGATED GROUP. 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 HERRICK MEMORIAL HOSPITAL, INC. AS THE MEMBER, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF HERRICK MEMORIAL HOSPITAL, INC. AND (B) FILL ANY VACANCY ON THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 RETURNS OF PROMEDICA HEALTH SYSTEM, INC. (PHS) AND ITS SUBSIDIARIES ARE PREPARED BY THE PHS TAX DEPARTMENT WITH THE ASSISTANCE OF FINANCE. THE RETURNS ARE REVIEWED BY THE AVP OF TAX BEFORE BEING PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES PRIOR TO FILING. ANY COMMENTS OR QUESTIONS FROM THE BOARD ARE REVIEWED AND INCORPORATED INTO THE RETURN IF APPROPRIATE. FINAL RETURNS ARE PROVIDED TO A PRINCIPAL OFFICER FOR SIGNATURE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER SOC SURVEY WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER SOC SURVEYS ARE REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER SOC SURVEYS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED, AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO COMPLETE THE SURVEY OR THE SUBMISSION OF A FALSE OR INCOMPLETE SURVEY, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S SURVEY RESULTS OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS 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 PHYSICIANS, 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 PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PHYSICIANS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PHYSICIAN CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER FOR PROMEDICA PHYSICIAN GROUP (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PHYSICIAN CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PHYSICIANS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PHYSICIAN STANDARD OF CONDUCT AND THE PHYSICIAN CERTIFICATION STATEMENT WHICH THE NEW PHYSICIAN IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, CHIEF OPERATING OFFICER OR THEIR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE 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 PHYSICIAN AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. ANY ITEMS THAT MEET CRITERIA FOR PUBLIC DISCLOSURE WILL BE COMMUNICATED TO THE APPROPRIATE PHYSICIAN BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE IN ADVANCE OF THE POSTING. THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE WILL PROVIDE THE PHYSICIAN-INDUSTRY RELATIONSHIP DISCLOSURES TO THE APPLICABLE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. THE PUBLIC DISCLOSURE WILL BE POSTED ON THE PROMEDICA HEALTH SYSTEM, INC. WEBSITE (HTTPS://WWW.PROMEDICA.ORG/PAGES/ABOUT-US/INDUSTRY-RELATIONSHIPS.ASPX) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. FORM 990, PART VI, SECTION B, LINE 15 HERRICK MEMORIAL HOSPITAL, INC.'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 IX, LINE 11G OTHER CONTRACT FEES: PROGRAM SERVICE EXPENSES 1,686,145. MANAGEMENT AND GENERAL EXPENSES 126,914. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,813,059. CONTRACTED PHYSICIANS: PROGRAM SERVICE EXPENSES 1,307,195. MANAGEMENT AND GENERAL EXPENSES 98,391. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,405,586. TEMP AGENCY FEES: PROGRAM SERVICE EXPENSES 219,776. MANAGEMENT AND GENERAL EXPENSES 16,542. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 236,318. LAB HOSPITAL FEES: PROGRAM SERVICE EXPENSES 378,889. MANAGEMENT AND GENERAL EXPENSES 28,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 407,408. FORM 990, PART X, LINE 16 DUE TO THE CLOSURE OF HERRICK MEMORIAL HOSPITAL, ASSETS WERE TRANSFERRED TO NON-PROFIT AFFILIATES. THE MAJORITY OF THESE WENT EMMA L. BIXBY MEDICAL CENTER, INCLUDING THE ENDOWMENT FUND. THE BUILDING HAS BEEN IMPAIRED ON GENERAL LEDGER. FORM 990, PART XI, LINE 9: BENEFICIAL INTEREST IN FOUNDATION -24,244,532. TRANSFERS BETWEEN RELATED ENTITIES -2,013,539. TRANSFER EQUIPMENT TO RELATED ENTITIES -1,087,263. TRANSFER OF SECURITIES TO TOLEDO HOSPITAL -38,683,938. TRANSFER ASSETS TO EMMA L BIXBY HOSPITAL -2,501,449. 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