2021-11-12T15:07:41-06:00 2020-12-31 990 2020-01-01 454781053 KAITLYN'S COTTAGE INC KAIT 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 STEVEN M CAVANAUGH 100 MADISON AVE TOLEDO OH 43604 312834 0 X WWW.PROMEDICA.ORG X 2012 OH LOCATED ON THE CAMPUS OF DEFIANCE HOSPITAL, INC., KAITLYN'S COTTAGE, INC. OFFERS RESPITE CARE TO INDIVIDUALS WITH DISABILTIES, AS WELL AS ASSISTANCE TO FAMILY MEMBERS AND OTHER CAREGIVERS OF YOUNG ADULTS WITH SPECIAL NEEDS. 17 10 22 300 0 0 6205 266747 47911 43006 0 0 8485 3081 62601 312834 0 0 0 0 214928 235724 0 0 0 196503 198138 411431 433862 -348830 -121028 2075601 2106103 21644 137848 2053957 1968255 X KAITLYN'S COTTAGE, INC. IS A SAFE AND NURTURING COUNTRY COTTAGE GETAWAY WHERE PROFESSIONAL STAFF PROVIDE COMPASSIONATE CARE FOR PERSONS WITH COGNITIVE OR PHYSICAL DISABILITIES. 0 0 383374 46087 KAITLYN'S COTTAGE, INC. IS A FACILITY WHICH PROVIDES SHORT-TERM RESPITE CARE SERVICES TO INDIVIDUALS WITH INTELLECTUAL AND PHYSICAL DISABILITIES. - SEE SCHEDULE O. 383374 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 22 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 10 0 0 0 0 1 1 1 1 1 0 0 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 AMER ARSHAD MD TRUSTEE 1.00 40.00 X 0 701628 28709 JORDAN W STUCKEY MD TRUSTEE 1.00 40.00 X 0 566389 29509 HOLLY L BRISTOLL TRUSTEE 1.00 40.00 X 0 523344 46484 GARY W AKENBERGER FORMER OFFICER 0.00 40.00 X 0 483424 41276 GARY M CATES TRUSTEE 1.00 41.00 X 0 485715 32373 JOSHUA M LUCAS MD TRUSTEE 1.00 40.00 X 0 472177 28641 DARRIN ARQUETTE FORMER OFFICER 0.00 43.00 X 0 391028 40287 PAMELA M JENSEN EX OFFICIO 1.00 42.00 X 0 391013 32951 JULIE K YAROCH DO FORMER OFFICER 0.00 41.00 X 0 358522 26934 NEERAJ K KANWAL MD FORMER OFFICER 0.00 40.00 X 0 263236 74245 ALAN M SATTLER FORMER OFFICER 0.00 40.00 X 0 249480 36266 DOUGLAS J BUSH PRES., TRUSTEE 1.00 40.00 X X 0 231482 33838 LAURA W KLINE CHAIRMAN 1.00 1.00 X X 0 0 0 AMANDA K KISSNER VICE CHAIRMAN 1.00 0.00 X 0 0 0 ANDREW D SHINDLER TRUSTEE 1.00 0.00 X 0 0 0 BRANDON M MCCANN TRUSTEE (PARTIAL YEAR) 1.00 0.00 X 0 0 0 CRYSTAL HORNISH TRUSTEE 1.00 0.00 X 0 0 0 JENNIFER A BOYD TRUSTEE 1.00 0.00 X 0 0 0 KATHRYN E GROFF TRUSTEE 1.00 0.00 X 0 0 0 KENNETH EDWIN BOROFF TRUSTEE 1.00 0.00 X 0 0 0 MICHELLE E STAHL CPA TRUSTEE 1.00 0.00 X 0 0 0 RICHANNE C MANKEY EDD MSED BA TRUSTEE 1.00 0.00 X 0 0 0 SUE A STRAUSBAUGH TRUSTEE 1.00 0.00 X 0 0 0 0 12260661 755721 0 1 1 0 0 266747 266747 RESPITE CARE SERVICES 623000 43006 43006 43006 CAMPS/REC ACTIVITIES 721210 2178 2178 TRANSPORTATION 480000 270 270 633 633 3081 312834 46087 0 0 220381 173179 47202 15343 12057 3286 3118 3118 772 772 8761 8761 35786 35786 1264 1264 118404 118404 SPECIAL EVENTS 15985 15985 FOOD 8065 8065 MINOR EQUIPMENT 1448 1448 VEHICLE EXPENSE 1445 1445 3090 3090 433862 383374 50488 0 200 199 2750610 797464 2071551 1953146 3850 152758 2075601 2106103 6243 7437 15401 130411 21644 137848 X 2053957 1968255 2053957 1968255 2075601 2106103 X -121028 35326 X X 0 1 X 1 1 0 X 259162 12658 26284 6205 266747 571056 44031 57988 62755 47911 43006 255691 303193 70646 89039 54116 309753 826747 225248 12165 25654 6205 266747 536019 1329 1329 225248 13494 25654 6205 266747 537348 289399 801 926 941 8485 3081 14234 303994 71572 89980 62601 312834 840981 0.34410 0.59910 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: RESIDENT CRAFT SALE - 2016 AMOUNT: $ 201. TRANSPORTATION - 2016 AMOUNT: $ 600. 2017 AMOUNT: $ 926. 2018 AMOUNT: $ 745. 2019 AMOUNT: $ 850. 2020 AMOUNT: $ 270. MISCELLANEOUS REVENUE - 2018 AMOUNT: $ 196. 2019 AMOUNT: $ 826. 2020 AMOUNT: $ 633. CAMPS/RECREATIONAL ACTIVITIES - 2019 AMOUNT: $ 6,809. 2020 AMOUNT: $ 2,178. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2516626 615213 1901413 218339 168953 49386 15645 13298 2347 1953146 DUE FROM AFFILIATES 150100 OTHER RECEIVABLES 2658 152758 DUE TO AFFILIATES 130411 130411 X 0 0 1 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 AMER ARSHAD MD TRUSTEE 0 521290 0 178562 0 1776 0 0 0 28709 0 730337 0 0 JORDAN W STUCKEY MD TRUSTEE 0 565175 0 0 0 1214 0 0 0 29509 0 595898 0 0 HOLLY L BRISTOLL TRUSTEE 0 331217 0 183179 0 8948 0 21127 0 25357 0 569828 0 0 GARY W AKENBERGER FORMER OFFICER 0 390451 0 88180 0 4793 0 19393 0 21883 0 524700 0 0 GARY M CATES TRUSTEE 0 376904 0 98080 0 10731 0 14575 0 17798 0 518088 0 0 JOSHUA M LUCAS MD TRUSTEE 0 283563 0 188182 0 432 0 0 0 28641 0 500818 0 0 DARRIN ARQUETTE FORMER OFFICER 0 324493 0 63579 0 2956 0 11877 0 28410 0 431315 0 0 PAMELA M JENSEN EX OFFICIO 0 314905 0 72966 0 3142 0 11862 0 21089 0 423964 0 0 JULIE K YAROCH DO FORMER OFFICER 0 292648 0 64622 0 1252 0 10818 0 16116 0 385456 0 0 NEERAJ K KANWAL MD FORMER OFFICER 0 17612 0 79954 0 165670 0 0 0 74245 0 337481 0 0 ALAN M SATTLER FORMER OFFICER 0 210691 0 35926 0 2863 0 10110 0 26156 0 285746 0 0 DOUGLAS J BUSH PRES., TRUSTEE 0 186190 0 44404 0 888 0 5965 0 27873 0 265320 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 KAITLYN'S COTTAGE, 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, LINES 4A-B UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM PROMEDICA. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: NEERAJ K. KANWAL, M.D. $ 165,297.60 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. FORM 990, PART III, LINE 4: KAITLYN'S COTTAGE, INC. - PROGRAM SERVICE ACCOMPLISHMENTS KAITLYN'S COTTAGE, INC. (KAITLYN'S) 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 A PATIENT'S ABILITY TO PAY. WITH STRONG PHILANTHROPIC SUPPORT, KAITLYN'S OPENED ON THE CAMPUS OF DEFIANCE HOSPITAL, INC. IN 2012 FOR DAYTIME AND OVERNIGHT RESPITE CARE FOR INDIVIDUALS WITH INTELLECTUAL AND PHYSICAL DISABILITIES. AT THE TIME, IT WAS THOUGHT TO BE THE FIRST OF ITS KIND IN THE UNITED STATES. THE 5,000-SQUARE-FOOT FACILITY HAS FOUR PRIVATE BEDROOMS FOR OVERNIGHT GUESTS, A LIBRARY, AND ACTIVITY AND DINING AREAS. GUESTS ARE OFFERED ACTIVITIES SUCH AS ARTS AND CRAFTS, COOKING, GARDENING, PLAYING MUSIC, PLAYING GAMES, OR MANY OTHER ACTIVITIES OF THEIR CHOOSING. FOUR, THREE-DAY SUMMER CAMPS ALSO ARE AVAILABLE, WITH SCHEDULING BASED UPON EACH CAMPERS' NEEDS FOR FULL OR PARTIAL DAYS. SPECIAL EVENTS SUCH AS A SPRING DANCE, HOLIDAY COOKOUTS, A FALL FESTIVAL, AND A NEW YEAR'S EVE PARTY ARE DESIGNED TO PROVIDE ADDITIONAL SOCIAL INTERACTION FOR GUESTS THROUGHOUT THE YEAR. IN 2020, KAITLYN'S RECEIVED A GENEROUS DONATION FROM THE SLEEPSAFE BED COMPANY TO HELP ACCOMMODATE A PATIENT WHO NEEDED A SPECIAL BED WITH ADDITIONAL SAFETY MEASURES IN PLACE. THE ADDITION GIVES THE FACILITY THREE SEPARATE OPTIONS FOR GUESTS REQUIRING UNIQUE SLEEP ACCOMMODATIONS. ADDITIONALLY, STAFF PROVIDES FAMILY AND CAREGIVER SUPPORT GROUPS, EDUCATION SESSIONS ON A VARIETY OF CAREGIVER TOPICS, AND OTHER TYPES OF SUPPORT. FURTHER, THERE IS A SLIDING-SCALE FEE (STARTING AT A NOMINAL AMOUNT) FOR PAYMENTS, AND AN ENDOWMENT HAS BEEN ESTABLISHED TO HELP ASSIST THOSE WHO CANNOT AFFORD SERVICES. AT KAITLYN'S, ALL STAFF MEMBERS ARE TRAINED IN MEDICATION ADMINISTRATION, CPR/FIRST AID CERTIFIED, AND CPI (NON-VIOLENT CRISIS INTERVENTION) TRAINED. TO HELP ENSURE THAT CARE AND SERVICES ARE PROVIDED APPROPRIATELY, KAITLYN'S HAS A PROFESSIONAL ADVISORY COUNCIL THAT CAN BE CONSULTED; MEMBERS INCLUDE A PHYSICIAN, CLERGY MEMBER, AN ATTORNEY, AND PATIENT FAMILY MEMBERS. IN SUMMARY, KAITLYN'S DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING FAMILY EDUCATION, FOSTERING CONTINUED EXCELLENCE IN PROGRAMS AND SERVICES, AND OFFERING HIGH-QUALITY RESPITE CARE FOR THE BENEFIT OF ALL ITS GUESTS AND FAMILY CAREGIVERS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. PROMEDICA RECOGNIZES 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 OFFERINGS AND OTHER OUTREACH ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. FORM 990, PART VI, SECTION A, LINE 6 AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE SOLE MEMBER OF DEFIANCE HOSPITAL, INC., WHICH IS THE SOLE MEMBER OF KAITLYN'S COTTAGE. PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF KAITLYN'S COTTAGE, AND (B) APPROVE THE NOMINEES TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES, A MAJORITY OF WHOM ARE NOMINATED BY DEFIANCE HOSPITAL, INC. 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 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. FORM 990, PART VI, SECTION B, LINE 15 KAITLYN'S COTTAGE, 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 XI, LINE 9: TRANSFERS BETWEEN RELATED ENTITIES 35,326. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 3B THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT YET BEEN COMPLETED. PLANS HAVE BEEN MADE TO HAVE THE REQUIRED SINGLE AUDIT COMPLETED BY THE EXTENDED DUE DATE AS ESTABLISHED IN OMB M-20-26. BAY PARK COMMUNITY HOSPITAL 100 MADISON AVE TOLEDO OH 43604 341883132 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 COMMUNITY HEALTH CENTER OF BRANCH COUNTY 100 MADISON AVE TOLEDO OH 43604 386108110 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 DEFIANCE HOSPITAL AUXILIARY 1200 RALSTON DEFIANCE OH 43512 510173779 HOSPITAL / FOUNDATION SUPPORT OH 501(C)(3) 10 DEFIANCE HOSPITAL INC 1 DEFIANCE HOSPITAL INC 100 MADISON AVE TOLEDO OH 43604 344446484 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 EMMA L BIXBY MEDICAL CENTER 100 MADISON AVE TOLEDO OH 43604 382796005 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 EMMA L BIXBY MEDICAL CENTER AUXILIARY 818 RIVERSIDE AVE ADRIAN MI 43604 382149602 HOSPITAL / FOUNDATION SUPPORT MI 501(C)(3) 12B, II EMMA L BIXBY MEDICAL CENTER 1 FOSTORIA HOSPITAL ASSOCIATION 100 MADISON AVE TOLEDO OH 43604 340898745 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 FOSTORIA HOSPITAL AUXILIARY PO BOX 907 FOSTORIA OH 44830 346517634 HOSPITAL / FOUNDATION SUPPORT OH 501(C)(3) 10 FOSTORIA HOSPITAL ASSOCIATION 1 HCR MANORCARE FOUNDATION INC 444 N SUMMIT ST TOLEDO OH 43604 522031975 FOUNDATION OH 501(C)(3) 12B, II PROMEDICA FOUNDATION 1 HCR MANORCARE INC PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 825373223 SKILLED NURSING FACILITIES OH 501(C)(3) 10 PROMEDICA HEALTH SYSTEM INC 1 HEARTLAND HOSPICE MEMORIAL FUND INC 444 N SUMMIT ST TOLEDO OH 43604 270497199 FOUNDATION OH 501(C)(3) 12B, II PROMEDICA FOUNDATION 1 HERRICK MEDICAL CENTER AUXILIARY 500 E POTTAWATAMIE ST TECUMSEH MI 49286 383076105 HOSPITAL / FOUNDATION SUPPORT MI 501(C)(3) 12B, II HERRICK MEMORIAL HOSPITAL INC 1 HERRICK MEMORIAL HOSPITAL INC 100 MADISON AVE TOLEDO OH 43604 383049015 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 LENAWEE LONG TERM CARE PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 382879330 LONG TERM CARE MI 501(C)(3) 10 HCR MANORCARE INC 1 MANOR CARE OF GIG HARBOR WA ASSOCIATION PO BOX 10086 ATTN TAX-5 TOLEDO OH 43699 260624719 SKILLED NURSING 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