2021-11-12T15:07:41-06:00 2020-12-31 990 2020-01-01 260624719 MANOR CARE OF GIG HARBOR WA ASSOCIATION MANO 4192525772 PO BOX 10086 ATTN TAX-5 TOLEDO OH 436990086 STEVEN M CAVANAUGH TREASURER 4192525772 2021-11-11 STEVEN CAVANAUGH 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEVEN M CAVANAUGH 100 MADISON AVE TOLEDO OH 43604 7449518 0 X WWW.PROMEDICASENIORCARE.ORG X 2007 DE MANORCARE PROVIDES INDIVIDUALIZED POST-HOSPITAL SKILLED NURSING CARE IN A COMFORTABLE ENVIRONMENT. CLINICAL AND THERAPY TEAMS ARE EXPERIENCED IN PROVIDING SPECIALIZED CARE FOCUSED ON PATIENTS' NEEDS, INTERESTS, AND ABILITY. THIS COMMITMENT RESULTS IN A SMOOTHER AND SAFER TRANSITION THROUGHOUT RECUPERATION. 9 0 0 9 0 0 0 849653 2532943 6599092 0 2 0 771 2532943 7449518 0 0 0 0 1541783 4043224 0 0 0 2033339 5955154 3575122 9998378 -1042179 -2548860 1250296 508081 4696853 6503498 -3446557 -5995417 X OUR MISSION IS TO IMPROVE YOUR HEALTH AND WELL-BEING. 0 0 9415551 0 6599092 SKILLED NURSING AND REHABILITATION SERVICES:MANOR CARE OF LACEY WA, ASSOCIATION PROVIDES SHORT-TERM REHABILITATION AND SKILLED NURSING SERVICES FOR THOSE PATIENTS TRANSITIONING BETWEEN HOSPITAL AND HOME. AN INTERDISCIPLINARY TEAM APPROACH HELPS ENSURE THE PATIENT AND THEIR FAMILY ARE READY FOR A SAFE AND HEALTHY RETURN HOME. THE CENTER ALSO PROVIDES LONG-TERM RESIDENTIAL CARE DESIGNED TO PROVIDE ASSISTANCE TO THOSE WHO ARE NO LONGER ABLE TO CARE FOR THEMSELVES DUE TO PHYSICAL LIMITATIONS, CHRONIC CONDITIONS OR CHANGES IN MENTAL CAPACITY. - SEE SCHEDULE O. 9415551 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 0 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, EX OFFICIO 1.00 55.00 X 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 DAVID PARKER PRESIDENT 1.00 44.00 X 0 859031 64425 SUSAN MOREY SVP OPERATIONS (SKILLED NURSING AND REHABILITATION 0.00 40.00 X 0 552636 37106 RAMI UBAYDI TRUSTEE 1.00 40.00 X 0 472133 46090 MARTIN ALLEN TRUSTEE 1.00 42.00 X 0 324000 43472 DELAINE RICE-WHITE TRUSTEE 1.00 40.00 X 0 291179 37809 JOHN HUBER TRUSTEE 1.00 40.00 X 0 296088 28560 ROBERT SHARON TRUSTEE 1.00 42.00 X 0 272854 26512 PATRICIA A MCCORMICK TRUSTEE (PARTIAL YEAR) 1.00 40.00 X 0 268422 21300 ELIZABETH MARY KACZOR TRUSTEE (PARTIAL YEAR) 1.00 40.00 X 0 180176 17037 THOMAS R KILE TRUSTEE 1.00 45.00 X 0 132226 2215 LYNNE DAVIS TRUSTEE (PARTIAL YEAR) 1.00 10.00 X 0 127978 1307 ANDREA SYPE TRUSTEE 1.00 45.00 X 0 112058 0 KATHRYN SUE HOOPS TRUSTEE 1.00 10.00 X 0 35029 0 0 11067033 630041 0 0 1 0 ADVANCE BUSINESS CAPITAL LLC PO BOX 610028 DALLAS TX 75261 INVOICE FACTORING 635756 PRIME TIME HEALTHCARE LLC 14811 SHEPHARD ST OMAHA NE 68138 MEDICAL STAFFING 308405 INTEGRATED MEDICAL SYSTEMS LLC 4380 SW MACADAM AVE SUITE 530 PORTLAND OR 97239 MEDICAL EQUIPMENT REPAIR 279657 ONESTAFF MEDICAL PO BOX 3544 OMAHA NE 68103 MEDICAL STAFFING 270419 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 MEDICAL STAFFING 261042 10 849653 849653 NET PATIENT REVENUE 623000 6599092 6599092 6599092 2 2 VENDING MACHINE 900099 612 612 MICELLANEOUS REVENUE 900099 159 159 771 7449518 6599092 0 773 X 3357730 3357730 14959 14959 412127 412127 258408 258408 526817 526817 5711 5711 21002 21002 2186 2186 2837724 2837724 11557 11557 2627 2627 898 898 940221 940221 11432 11432 109164 109164 84270 84270 PROVIDER TAXES 483115 483115 MEDICAL SUPPLIES 304787 304787 FOOD 197386 197386 RECRUITMENT 95837 95837 320420 293309 27111 9998378 9415551 582827 0 5343 528 824179 129179 37763 553525 212914 345228 340611 75546 0 1250296 508081 838223 611501 3858630 5891997 4696853 6503498 X -3446557 -5995417 -3446557 -5995417 1250296 508081 -2548860 0 X X 0 1 X 1 1 0 X 849653 849653 2532943 6599092 9132035 2532943 7448745 9981688 0 0 0 9981688 2 2 2 2 771 771 2532943 7449518 9982461 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: VENDING MACHINE INCOME - 2020 AMOUNT: $ 612. MISC REVENUE - 2020 AMOUNT: $ 159. PART III, SHORT YEAR EXPLANATION MANOR CARE OF GIG HARBOR WA ASSOCIATION WAS RECOGNIZED AS A 501(C)(3) TAX-EXEMPT ORGANIZATION AS OF SEPTEMBER 1, 2019. AS A RESULT, TAX YEAR 2019 WAS A SHORT YEAR COVERING THE PERIOD FROM SEPTEMBER 1, 2019 THROUGH DECEMBER 31, 2019. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2186 2186 0 PART II-B, LINE 1: MANOR CARE OF GIG HARBOR WA, ASSOCIATION PAYS DUES TO THE WASHINGTON HEALTH CARE ASSOCIATION. A PORTION OF THESE DUES ARE USED BY THAT ORGANIZATION FOR LOBBYING ACTIVITIES. 137044 25101 111943 416481 187813 228668 340611 DUE TO AFFILIATES 5739784 MEDICARE SETTLEMENT 152213 5891997 X 0 0 0 1 0 0 0 0 0 0 0 RANDALL OOSTRA PHS PRES. & CEO, EX OFFICIO 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 DAVID PARKER PRESIDENT 0 682589 0 175361 0 1081 0 33745 0 30680 0 923456 0 0 SUSAN MOREY SVP OPERATIONS (SKILLED NURSING AND 0 435120 0 114763 0 2753 0 22231 0 14875 0 589742 0 0 RAMI UBAYDI TRUSTEE 0 368420 0 102448 0 1265 0 17958 0 28132 0 518223 0 0 MARTIN ALLEN TRUSTEE 0 251085 0 70989 0 1926 0 13546 0 29926 0 367472 0 0 DELAINE RICE-WHITE TRUSTEE 0 222811 0 67067 0 1301 0 12133 0 25676 0 328988 0 0 JOHN HUBER TRUSTEE 0 228670 0 63191 0 4227 0 12041 0 16519 0 324648 0 0 ROBERT SHARON TRUSTEE 0 217820 0 54534 0 500 0 4284 0 22228 0 299366 0 0 PATRICIA A MCCORMICK TRUSTEE (PARTIAL YEAR) 0 207989 0 59907 0 526 0 0 0 21300 0 289722 0 0 ELIZABETH MARY KACZOR TRUSTEE (PARTIAL YEAR) 0 133619 0 45564 0 993 0 7115 0 9922 0 197213 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 MANOR CARE OF GIG HARBOR WA, ASSOCIATION, 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. FORM 990, PART III, LINE 4 MANOR CARE OF GIG HARBOR WA, ASSOCIATION PROGRAM SERVICE ACCOMPLISHMENTS HCR MANORCARE'S SKILLED NURSING FACILITIES (SNF), PRIMARILY OPERATING UNDER THE BRAND NAME MANORCARE IN THE STATE OF WASHINGTON, PROVIDE SKILLED NURSING AND REHABILITATION SERVICES DURING RECOVERY AFTER A HOSPITALIZATION STAY. HCR MANORCARE IS THE POST-ACUTE DIVISION OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION FOCUSED ON THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA IS THE COUNTRY'S 15TH LARGEST HEALTHCARE PROVIDER. THE COMPANY'S STEWARDSHIP OF RESOURCES HAS ENABLED WISE INVESTMENT 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. HCR MANORCARE OPERATES 172 SKILLED NURSING FACILITIES, WHERE NURSES AND PHYSICIANS WORK COLLABORATIVELY TO MANAGE COMPLEX MEDICAL CONDITIONS PROVIDING CARDIOLOGY, NEUROLOGY, ONCOLOGY, PULMONARY, ORTHOPAEDIC AND WOUND CARE SERVICES. REHABILITATION SERVICES PROVIDE PATIENTS WITH THE TOOLS THEY NEED TO FUNCTION AT THEIR HIGHEST POTENTIAL. THESE SERVICES INCLUDE PHYSICAL AND OCCUPATIONAL THERAPIES, AS WELL AS SPEECH AND LANGUAGE PATHOLOGY. HCR MANORCARE FACILITIES PROVIDE LONG-TERM CARE ASSISTANCE 24 HOURS A DAY TO THOSE WHO MEET THE SKILLED NURSING REQUIREMENTS AND CANNOT LIVE INDEPENDENTLY. ADDITIONAL SERVICES SUCH AS PALLIATIVE AND HOSPICE CARE CAN ALSO BE PROVIDED IN THE SKILLED NURSING SETTING. IN 2020, MANOR CARE OF GIG HARBOR WA, ASSOCIATION PROVIDED OVER 23,500 CARE DAYS TO ITS RESIDENTS. IN 2020, UNDER A CO-EMPLOYMENT ARRANGEMENT, MANOR CARE OF GIG HARBOR WA, ASSOCIATION EXPENDED $2,551,000 IN NET PAYROLL, PROVIDING 132 JOBS IN WASHINGTON. PROMEDICA SENIOR CARE'S, FORMERLY HCR MANORCARE, SKILLED NURSING AND REHABILITATION CENTERS, PRIMARILY OPERATING UNDER THE BRAND NAMES HEARTLAND, MANORCARE AND PROMEDICA, DEMONSTRATE PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL ELIGIBLE PATIENTS REGARDLESS OF THEIR RACE, CREED, NATIONAL ORIGIN, DISABILITY OR AGE. THROUGHOUT THE PANDEMIC, THE FACILITY WAS PROACTIVE IN PROTECTING AND ENGAGING PATIENTS WITH THE CREATION OF AN AIRBORNE ISOLATION UNIT WITHIN THE CENTER, AND PROVIDING SOCIALLY DISTANCED ACTIVITIES AND VIRTUAL VISITS WITH FAMILY, COMMUNITY ENTERTAINMENT AND PET THERAPY. IN 2019, THE ORGANIZATION BEGAN SENDING PATIENTS HOME WITH TWO NUTRITIOUS MEALS. THIS PROGRAM WAS ROLLED OUT IN MICHIGAN, CALIFORNIA AND WASHINGTON, BUT WAS PUT ON HOLD DURING THE COVID-19 PANDEMIC AS MEALS WERE RE-DIRECTED TO EMPLOYEES. IN 2020, THE ORGANIZATION CONTINUED TO OFFER COMMUNITY HEALTH RELATED EDUCATIONAL EVENTS SUCH AS REDUCING STRESS AND HEALTH AND WELLNESS THROUGH VIRTUAL AND ONLINE EDUCATION. IN SUMMARY, MANOR CARE OF GIG HARBOR WA, ASSOCIATION CONTRIBUTED $2,337,000 IN COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE. IN ADDITION, MANOR CARE OF GIG HARBOR'S COST OF BAD DEBT FOR 2020 WAS $174,000, THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $2,337,000. THESE NUMBERS NOT ONLY INDICATE HCR MANORCARE'S COMMITMENT TO THE COMMUNITY, BUT ALSO FULFILL OUR NOT-FOR-PROFIT STATUS BY PROVIDING ACCESS TO A VARIETY OF POST-HOSPITAL CARE SERVICES IN THE COMMUNITIES WE SERVE. FORM 990, PART VI, SECTION A, LINE 6 AS A DELAWARE NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE ULTIMATE MEMBER/PARENT CORPORATION OF MANOR CARE OF GIG HARBOR WA, ASSOCIATION. AS THE ULTIMATE MEMBER/PARENT CORPORATION, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF MANOR CARE OF GIG HARBOR WA, ASSOCIATION, AND (B) FILL ANY VACANCY. 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 COMPENSATION OF HCR MANORCARE, INC. AND SUBSIDIARIE'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS WAS DETERMINED BY A COMPENSATION COMMITTEE OF PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. 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 PURCHASED SERVICE- MEDICAL STAFF: PROGRAM SERVICE EXPENSES 2,404,041. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,404,041. REPAIRS AND MAINTENACE : PROGRAM SERVICE EXPENSES 76,243. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,243. MEDICAL TRANSPORT: PROGRAM SERVICE EXPENSES 16,705. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,705. CONSULTING FEES: PROGRAM SERVICE EXPENSES 475. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 475. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 340,260. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 340,260. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR 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 KAITLYN'S COTTAGE INC 100 MADISON AVE TOLEDO OH 43604 454781053 RESPITE CARE OH 501(C)(3) 10 DEFIANCE HOSPITAL 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 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