2021-05-17T09:57:36-05:00 2020-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2019-07-01 311724085 HOLZER MEDICAL CENTER - JACKSON HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 MICHAEL HAYNES CFO 7404465060 2021-05-12 1 AMY CIMINELLO P00796388 6148493000 2021-05-07 2019 2022-09-23 18:48:47Z MICHAEL CANADY 100 JACKSON PIKE GALLIPOLIS OH 45631 29323693 0 X WWW.HOLZER.ORG X 2000 OH TO ENHANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE. 10 0 286 1 0 0 0 60 29225685 26586330 11800 8181 143061 2690839 29380546 29285410 0 0 0 0 9612951 10142181 0 0 0 12758399 13287113 22371350 23429294 7009196 5856116 30022249 30536154 49256409 47644903 -19234160 -17108749 X FRIENDLY VISITS, EXCELLENT CARE; EVERY PATIENT, EVERY TIME. 0 0 22057106 0 29178682 THE HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO CERTAIN ESTABLISHED POLICIES OF THE HOSPITAL. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL COMPARES INCURRED CHARGES WITH GENERALLY RECOGNIZED POVERTY INCOME LEVELS AND THE PATIENT'S FINANCIAL RESOURCES. BECAUSE THE HOSPITAL DOES NOT EXPECT TO RECEIVE PAYMENT FOR AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUES.CONSISTENT WITH ITS MISSION, THE HOSPITAL PROVIDES COMMUNITY SERVICES INTENDED TO BENEFIT THE UNDERSERVED AND ENHANCE THE HEALTH STATUS OF THE COMMUNITY. THE HOSPITAL OPERATES A 24 HOUR PER DAY, 7 DAY PER WEEK EMERGENCY ROOM PROVIDING CARE TO ALL PATIENTS. CONTINUING EDUCATION, CERTIFICATION PROGRAMS AND INFORMATIONAL SEMINARS ARE CONDUCTED FOR BOTH HOSPITAL AND MEDICAL STAFF. HEALTH FAIRS FOR THE COMMUNITY ARE CONDUCTED AT NO CHARGE. HOSPITAL STAFF ALSO RESPONDS TO REQUESTS FROM EMPLOYERS AND COMMUNITY GROUPS, ALONG WITH SENIOR CITIZENS CENTERS, FOR SCREENINGS AND INFORMATIONAL PROGRAMS.THE HOSPITAL'S MEETING ROOMS ARE MADE AVAILABLE TO ORGANIZATIONS AT NO CHARGE FOR HEALTH-RELATED PROGRAMMING AND MEETINGS. ADDITIONALLY, CIVIC AND PROFESSIONAL ORGANIZATIONS ARE INVITED TO THE HOSPITAL REGULARLY FOR PROGRAMS THAT ARE EDUCATIONAL AND INFORMATIONAL ON HEALTH CARE SERVICES AS DEVELOPED.SPEAKERS FROM THE HOSPITAL STAFF ARE AVAILABLE AND RESPOND TO SPEAKING INVITATIONS FOR GROUPS AND ORGANIZATIONS IN THE HOSPITAL'S SERVICE AREA. THE HOSPITAL OFFERS MANY SERVICES TO THE COMMUNITY AT NOMINAL OR NO CHARGE, INCLUDING BLOOD PRESSURE AND BLOOD SUGAR SCREENINGS, CHOLESTEROL CHECKS, PULSE OXIMETRY, PROSTRATE CHECKS AND BONE DENSITY. ASSISTANCE IS ALSO PROVIDED TO SENIOR CITIZENS AND OTHER PATIENTS AND THEIR FAMILIES WITH THE SUBMISSIONS OF FORMS FOR INSURANCE, FINANCIAL COUNSELING, AND APPLICATION TO THE MEDICARE AND MEDICAID PROGRAMS FOR HEALTH SERVICE COVERAGE. COSTS ASSOCIATED WITH THESE PROGRAMS ARE INCLUDED IN THE HOSPITAL'S EXPENSES. 22057106 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 1 286 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 0 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X MICHAEL HAYNES CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 MICHAEL CANADY MD CEO - HHS 1.00 49.00 X 0 648610 0 BRENT SAUNDERS CHAIRMAN HHS 1.00 49.00 X 0 446228 1719 MICHAEL HAYNES CFO - HHS 1.00 49.00 X 0 374000 0 JENNIFER M CALAFATO PHYSICIAN 50.00 0.00 X 302503 0 0 ZACHARY BOSLEY PHYSICIAN 50.00 0.00 X 257500 0 0 AASIA BUTT PHYSICIAN 50.00 0.00 X 241499 0 0 AMANDA L FORCHE DENTIST 50.00 0.00 X 193697 0 0 HERMAN D CRABTREE JR PHARMACY DIRECTOR 50.00 0.00 X 153622 0 1481 STEVE CHAPMAN CHAIRMAN 1.00 3.00 X X 0 24000 0 TOM WISEMAN VICE CHAIR 1.00 3.00 X X 0 24000 0 DANNY HOLSCHUH TRUSTEE 1.00 3.00 X 0 24000 0 GARY ROACH SECRETARY 1.00 3.00 X X 0 24000 0 LARRY KIDD TREASURER 1.00 3.00 X X 0 24000 0 BOB GRILLO TRUSTEE 1.00 3.00 X 0 24000 0 BRAD MUNN TRUSTEE 1.00 3.00 X 0 24000 0 PAUL REED TRUSTEE 1.00 3.00 X 0 24000 0 ROBBIE PUGH TRUSTEE 1.00 3.00 X 0 24000 0 1148821 1684838 3200 7 0 1 0 HEALOGICS WOUND CARE & HYPERBARIC SERVIC 28525 NETWORK PLACE CHICAGO IL 606731285 WOUND CARE & HBOT SERVICES 421666 SHIFTWISE INC 200 SW MARKET ST SUITE 700 PORTLAND OR 97201 MEDICAL STAFFING 173422 QUALIVIS DEPT 3847 PO BOX 123847 DALLAS TX 753123847 STAFFING SERVICES 106701 3 60 60 NET PATIENT SERVICES 622110 25196830 25196830 HCAP 622110 1389500 1389500 26586330 7100 7100 109511 38283 71228 71228 71228 1081 0 1081 1081 1081 COVID RELIEF FUNDS 900099 2521118 2521118 CAFETERIA SALES 900099 98487 98487 MEDICAL RECORD FEES 900099 6 6 2619611 29285410 29178682 0 106668 7445352 6813056 632296 2099062 1920799 178263 597767 547002 50765 7017 3000 4017 71260 71260 1050272 1025913 24359 451138 399373 51765 570144 570809 -665 684317 607657 76660 95150 68241 26909 1767789 1617660 150129 1353527 1238579 114948 139029 133806 5223 BAD DEBT EXPENSE 4910095 4910095 MEDICAL SUPPLIES 1755814 1746037 9777 FRANCHISE FEE 498318 498318 VEHICLE EXPENSES 18340 1280 17060 -85097 -115779 30682 23429294 22057106 1372188 0 1151 1151 12361784 12895319 2625111 1765415 356472 1494057 233383 308421 101332 139496 52525828 41876356 11606707 10649472 350384 355116 2385925 2927707 30022249 30536154 5149409 3704558 0 1519281 28604127 28604127 1434233 1306271 14068640 12510666 49256409 47644903 X -19239932 -17113606 5772 4857 -19234160 -17108749 30022249 30536154 X 5856116 -3730705 X X 0 1 X 1 0 X 1633793 1633793 18868322 12851937 6016385 29108752 26533600 2575152 2914961 2490819 424142 10649472 OTHER ASSETS -18107 RELATED PARTY RECEIVABLE 2945814 2927707 RELATED PARTY PAYABLE 12510666 12510666 1 1 X 1 X 1 X 1 1 1 0 0 161312 275635 0 0.00000 6125062 4951256 1173806 0.05280 6286374 5226891 1173806 0.05280 45665 45665 0.00210 24258 24258 0.00110 69923 69923 0.00320 6356297 5226891 1243729 0.05600 0 4910095 245505 9236794 9785113 -548319 X 1 1 1 1 HOLZER MEDICAL CENTER - JACKSON 500 BURLINGTON ROAD JACKSON OH 45640 X X X X X HOLZER MEDICAL CENTER- JACKSON 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.HOLZER.ORG/APP/FILES/PUBLIC/1024/2019-CHNA-ASSESSMENT.PDF X 1 18 1 HTTPS://WWW.HOLZER.ORG/APP/FILES/PUBLIC/1120/IMPLEMENTATION-19.PDF 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X WWW.HOLZER.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/HOLZER-FINANCIAL X WWW.HOLZER.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/HOLZER-FINANCIAL X WWW.HOLZER.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/HOLZER-FINANCIAL X X X X X 1 X 0 X X X 1 X 0 0 HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 5: THE COMMUNITY NEEDS ASSESSMENT TEAM SURVEYED KEY COMMUNITY PARTNERS, INCLUDING REPRESENTATIVES OF THE LOCAL CITY/COUNTY HEALTH DEPARTMENT, COMMUNITY OUTREACH GROUPS, AND OTHER FOCUS GROUPS TO SUPPLEMENT THE FINDINGS OF THE ASSESSMENT. HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 6A: HOLZER HOSPITAL FOUNDATION (HOLZER MEDICAL CENTER) HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 6B: GALLIA COUNTY HEALTH DEPARTMENTJACKSON COUNTY HEALTH DEPARTMENTMEIGS COUNTY HEALTH DEPARTMENTVINTON COUNTY HEALTH DEPARTMENT HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 11: HOLZER MEDICAL CENTER JACKSON DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA BECAUSE OF LIMITED FINANCIAL RESOURCES. AN IMPLEMENTATION PLAN WILL BE ROLLED OUT OVER THE NEXT THREE YEARS. THE IMPLEMENTATION PLAN WAS ADOPTED IN OCTOBER 2019. PART V, SECTION B, LINE 20C HOLZER PROCESSES ALL COMPLETE FAP APPLICATIONS BUT DOES NOT PROCESS INCOMPLETE APPLICATIONS. THEY REACH OUT TO INDIVIDUALS WHO DO NOT COMPLETE THE FAP APPLICATION WITH ADDITIONAL INFORMATION LETTERS ON HOW TO COMPLETE AND GIVE THEM 30 DAYS TO COMPLETE THE APPLICATION BEFORE SENDING A FAILURE TO PROVIDE ADDITIONAL INFORMATION LETTER. PART I, LINE 7: EXPENSES WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4,910,095. PART III, LINE 4: BAD DEBT WAS RECORDED AT GROSS CHARGES ONCE AN ACCOUNT HAD BEEN THROUGH MULTIPLE ATTEMPTS FOR PAYMENT. IT WAS THEN SUBMITTED FOR COLLECTIONS, LESS ANY AMOUNTS THAT MAY HAVE BEEN PAID THROUGH INSURANCE OR PRIVATE PAYMENTS. BAD DEBT WAS CALCULATED ON AUDITED FINANCIAL STATEMENT BALANCES. NONE OF THE BAD DEBT IS TREATED AS COMMUNITY BENEFIT. 5% OF THE BAD DEBT IS ESTIMATED AS LIKELY ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE. IF IT IS UNCLEAR WHETHER AN ACCOUNT MAY QUALIFY AS CHARITY, IT IS FIRST ASSUMED TO BE CHARITY, NOT BAD DEBT, UNTIL ADDITIONAL INFORMATION SHOWS OTHERWISE. PART III, LINE 8: MEDICARE COSTS AS REPORTED IN THE MEDICARE COST REPORT WERE CALCULATED USING A COST-TO-CHARGE RATIO METHODOLOGY AS REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. PART III, LINE 9B: FOUR PATIENT STATEMENTS ARE SENT TO NON-MEDICARE ACCOUNTS AND FIVE STATEMENTS ARE SENT TO MEDICARE ACCOUNTS, EACH TOTALING 120 DAYS. IF NO PATIENT PAYMENT RESPONSE, ACCOUNTS ARE SELECTED AND PROCESSED TO BAD DEBT. PART VI, LINE 2: NEEDS ARE ASSESSED THROUGH COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: NOTICES ARE POSTED THAT SPECIFY THE RIGHTS OF THESE INDIVIDUALS TO RECEIVE WITHOUT CHARGE BASIC, MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES. THE POSTINGS ARE PRINTED IN ENGLISH AND SPANISH AND ARE LOCATED IN ADMISSIONS AREAS, THE BUSINESS OFFICE, AND THE EMERGENCY DEPARTMENT. PATIENT STATEMENTS CONTAIN FEDERAL POVERTY GUIDELINES, AN EXPLANATION OF WHAT SERVICES MAY QUALIFY FOR FREE CARE, AND INFORMATION ON HOW TO APPLY. THE ORGANIZATION ALSO EMPLOYS FINANCIAL ADVOCATES AND BENEFIT ELIGIBILITY COORDINATORS TO ASSIST IN THE INFORMATION/EDUCATION PROCESS. PART VI, LINE 4: HOLZER MEDICAL CENTER - JACKSON IS LOCATED ON APPROXIMATELY 11 ACRES OF A 77-ACRE TRACT OF LAND FACING US 32 APPROXIMATELY ONE MILE SOUTH OF THE INTERSECTION OF US 32 AND US 35 NEAR THE CITY OF JACKSON, OHIO. THE INTERSECTION OF THESE TWO US HIGHWAYS IS A CENTRAL HUB OF THE HIGHWAY SYSTEM IN SOUTHEASTERN OHIO. THE PRIMARY SERVICE AREA FOR HOLZER MEDICAL CENTER - JACKSON IS JACKSON COUNTY, OHIO. THE SECONDARY SERVICE AREA INCLUDES PORTIONS OF PIKE, GALLIA, VINTON, SCIOTO, LAWRENCE, ROSS AND ATHENS COUNTIES IN OHIO. PART VI, LINE 5: HOLZER MEDICAL CENTER-JACKSON BELIEVES THAT EDUCATIONAL AND PREVENTATIVE SERVICES ARE IMPERITIVE TO IMPROVING THE HEALTH OF OUR COMMUNITY. AS SUCH, THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT AT HOLZER MEDICAL CENTER-JACKSON ORGANIZES AND PROVIDES HEALTH SCREENING THROUGHOUT THE YEAR AT OUR CAMPUS, AT VARIOUS FAIRS AND FESTIVALS IN THE COMMUNITY, AT OUR LOCAL SCHOOLS AND ALSO AT AREA BUSINESSES. NO-COST HEALTH SCREENINGS INCLUDE: BLOOD PRESSURE, GLUCOSE, CHOLESTEROL, HEMOGLOBIN, BONE DENSITY AND BODY COMPOSITION SCREENING AND PULMONARY FUNCTION TESTING. SOME OF OUR LARGER COMMUNITY EVENTS INCLUDE: THE JACKSON COUNTY APPLE FESTIVAL, JACKSON COUNTY FAIR, GENERAL MILLS EMPLOYEE HEALTH FAIR, ANNUAL BREAST CANCER AWARENESS HEALTH FAIR AND THE ANNUAL COMMUNITY HEART HEALTH FAIR. HOLZER MEDICAL CENTER-JACKSON ALSO HOSTS MONTHLY DIABETES EDUCATION MEETINGS AND FREE HEART SAVER CPR CLASSES ARE OFFERED TO VARIOUS GROUPS AND COMMUNITY MEMBERS. DURING TAX YEAR 2019, HOLZER MEDICAL CENTER JACKSON PROVIDED MEDICAL EQUIPMENT TO SUPPORT HOSPITALS IN THE AREA WITH CRITICAL NEED DUE TO COVID 19. IN ADDITION, HOLZER MEDICAL CENTER JACKSON PROVIDED THE GENERAL PUBLIC EDUCATION AND PREVENTION STRATEGIES TO HELP DECREASE THE SPREAD OF COVID 19. PART VI, LINE 6: HOLZER MEDICAL CENTER AND HOLZER MEDICAL CENTER-JACKSON COMPRISE THE TWO HOSPITALS IN THE SYSTEM, WITH HOLZER MEDICAL CENTER-JACKSON ACCOUNTING FOR 18% OF HOSPITAL ADMISSIONS. HOLZER MEDICAL CENTER IS LOCATED IN GALLIA COUNTY AND HOLZER MEDICAL CENTER-JACKSON IS LOCATED IN JACKSON COUNTY. ALL HEALTH SCREENING AND PATIENT EDUCATION IS PROVIDED BY STAFF IN AREAS WITHIN OUR PRIMARY SERVICE AREA WHICH INCLUDES GALLIA, JACKSON AND MEIGS COUNTIES IN OHIO AND MASON COUNTY, WEST VIRGINIA AS WELL AS SOME SERVICES PROVIDED IN OUR SECONDARY SERVICE AREA. 0 0 0 0 0 0 0 0 0 MICHAEL CANADY MD CEO - HHS 0 590145 0 58465 0 0 0 0 0 0 0 648610 0 0 BRENT SAUNDERS CHAIRMAN HHS 0 405662 0 40566 0 0 0 0 0 1719 0 447947 0 0 MICHAEL HAYNES CFO - HHS 0 340000 0 34000 0 0 0 0 0 0 0 374000 0 0 JENNIFER M CALAFATO PHYSICIAN 302503 0 0 0 0 0 0 0 0 0 302503 0 0 0 ZACHARY BOSLEY PHYSICIAN 257500 0 0 0 0 0 0 0 0 0 257500 0 0 0 AASIA BUTT PHYSICIAN 241499 0 0 0 0 0 0 0 0 0 241499 0 0 0 AMANDA L FORCHE DENTIST 193697 0 0 0 0 0 0 0 0 0 193697 0 0 0 HERMAN D CRABTREE JR PHARMACY DIRECTOR 153622 0 0 0 0 0 0 0 1481 0 155103 0 0 0 PART I, LINE 3 COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION, HOLZER HEALTH SYSTEM, AND INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B HOLZER MEDICAL CENTER - JACKSON'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY HOLZER HEALTH SYSTEM'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER AND THE CFO OF HOLZER HEALTH SYSTEM REVIEW FORM 990. A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING 2019 AS THERE WERE NO EXECUTIVE COMPENSATION CHANGES NECESSARY IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATE -3,729,790. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -915. FORM 990, PART XII, LINE 2C: THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. HOLZER HEALTH SYSTEM 100 JACKSON PIKE GALLIPOLIS OH 45631 311156690 MANAGEMENT SERVICES OH 501(C)(3) LINE 12A, I N/A 0 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER HERITAGE FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC AND AFFILIATES 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH N/A C 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0