COMMUNITY HOSPITALS AND WELLNESS CENTERS: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY HOSPITALS AND WELLNESS CENTERS (EIN 34-1048666)
Tax period: 2018-10-01 to 2019-09-30
Filed: 2020-08-07
IRS object ID: 202002209349300130
Schema version: 2018v3.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2020-08-07T13:58:50-05:00	ReturnTs
Tax Period End	2019-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	381357951	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	PLANTE & MORAN PLLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	250 S HIGH ST SUITE 100	AddressLine1Txt
City	COLUMBUS	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	43215	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2018-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	341048666	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITALS & WELLNESS CENTERS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	COMM	BusinessNameControlTxt
Phone	4196361131	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	433 W HIGH STREET	AddressLine1Txt
City	BRYAN	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	43506	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ROBERT L GOSHIA	PersonNm
Person Title	VP/CFO	PersonTitleTxt
Phone	4196361131	PhoneNum
Signature	2020-07-20	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	AMY CIMINELLO	PreparerPersonNm
PTIN	P00796388	PTIN
Phone	6148493000	PhoneNum
Preparation	2020-07-15	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	65.60.155.87	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2020-07-20	IPDt
IP Tm	14:31:43	IPTm
IP Timezone	ED	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	DA39A3EE5E6B4B0D3255BFEF95601890AFD80709	AtSubmissionCreationDeviceId
At Submission Filing Device Id	F23B626FF7BA699FD824818B7D825A8FA45A01E7	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2018	TaxYr
Build TS	2020-09-23 17:36:50Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	CHAD D TINKEL	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	433 W HIGH STREET	AddressLine1Txt
City	BRYAN	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	43506	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$91,048,785	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.CHWCHOSPITALS.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1969	FormationYr
Legal Domicile State	OH	LegalDomicileStateCd
Activity Or Mission	TO PROVIDE QUALITY PATIENT CARE AT EVERY POINT OF SERVICE; TO RESPECT THE DIGNITY AND UNIQUENESS OF ALL PATIENTS; TO PROMOTE SAFE MEDICAL PRACTICES; TO ENCOURAGE MEDICAL RESEARCH; TO PERMIT ACCESS TO ALL SEEKING HEALTHCARE; AND TO MAINTAIN FISCAL SOUNDNESS.	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	844	TotalEmployeeCnt
Total Volunteers	62	TotalVolunteersCnt
Total Gross UBI	-$26,438	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$26,438	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$69,386	PYContributionsGrantsAmt
CY Contributions Grants	$37,725	CYContributionsGrantsAmt
PY Program Service Revenue	$79,537,116	PYProgramServiceRevenueAmt
CY Program Service Revenue	$88,490,404	CYProgramServiceRevenueAmt
PY Investment Income	$1,497,415	PYInvestmentIncomeAmt
CY Investment Income	$1,527,372	CYInvestmentIncomeAmt
PY Other Revenue	$897,549	PYOtherRevenueAmt
CY Other Revenue	$787,206	CYOtherRevenueAmt
PY Total Revenue	$82,001,466	PYTotalRevenueAmt
CY Total Revenue	$90,842,707	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$45,868,815	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$47,220,611	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$37,024,957	PYOtherExpensesAmt
CY Other Expenses	$39,332,173	CYOtherExpensesAmt
PY Total Expenses	$82,893,772	PYTotalExpensesAmt
CY Total Expenses	$86,552,784	CYTotalExpensesAmt
PY Revenues Less Expenses	-$892,306	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$4,289,923	CYRevenuesLessExpensesAmt
Total Assets BOY	$154,833,054	TotalAssetsBOYAmt
Total Assets EOY	$158,158,601	TotalAssetsEOYAmt
Total Liabilities BOY	$68,832,650	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$65,927,504	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$86,000,404	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$92,231,097	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	TO PROVIDE QUALITY PATIENT CARE AT EVERY POINT OF SERVICE; TO RESPECT THE DIGNITY AND UNIQUENESS OF ALL PATIENTS; TO PROMOTE SAFE MEDICAL PRACTICES; TO ENCOURAGE MEDICAL RESEARCH; TO PERMIT ACCESS TO ALL SEEKING HEALTHCARE; AND TO MAINTAIN FISCAL SOUNDNESS.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$9,034,992	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$8,390,936	RevenueAmt
Desc	INPATIENT CARE: BRYAN HOSPITAL MEDICAL & SURGICAL UNIT HAS 54 BEDS AND PROVIDE CARE FOR 736 PATIENTS AND 247 OBSERVATION PATIENTS; BRYAN HOSPITAL INTENSIVE CARE UNIT AND TELEMETRY UNIT HAS 16 BEDS AND PROVIDE CARE FOR 925 INPATIENTS AND 351 OBSERVATION PATIENTS; BRYAN HOSPITAL OBSTETRICS HAS 9 BEDS AND PROVIDED CARE FOR 376 INPATIENTS. MONTPELIER HOSPITAL HAS 25 BEDS AND PROVIDED CARE TO 281 INPATIENTS.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$10,808,102	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$18,546,760	RevenueAmt
Desc	SURGERY CARE: BRYAN SURGERY HAS 6 OPERATING ROOMS THAT DID 1,877 GENERAL SURGERY CASES, 2,152 PAIN MANAGEMENT CASES, 684 ORTHOPEDIC CASES, 785 OPHTHALMOLOGY CASES, 368 GYNECOLOGY CASES, 230 ENT CASES, AND 456 UROLOGY CASES. ARCHBOLD SURGERY HAS 4 OPERATING ROOMS THAT DID 8 ORTHOPEDIC CASES, 463 GENERAL SURGERY CASES, AND 55 UROLOGY CASES.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$4,652,937	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$8,728,870	RevenueAmt
Desc	EMERGENCY ROOM CARE: BRYAN ED CARED FOR 13,719 PATIENTS WITH 1,127 BEING ADMITTED; MONTPELIER ED CARED FOR 3,630 PATIENTS WITH 1 BEING ADMITTED.	Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

Field	Value	IRS element (for citing)
Expense	$44,168,048	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$52,823,838	RevenueAmt
Desc	COMMUNITY HOSPITALS AND WELLNESS CENTERS PROVIDED SERVICES TO APPROXIMATELY 2,691 INPATIENTS, APPROXIMATELY 1,041 OBSERVATION PATIENTS, AND APPROXIMATELY 15,714 EMERGENCY DEPARTMENT PATIENTS DURING THIS FISCAL YEAR. THE HOSPITAL UTILIZES A BOARD APPROVED CHARITABLE CARE PROGRAM THAT MEASURES INDIVIDUAL AND FAMILY NEEDS BASED ON FEDERAL POVERTY GUIDELINES. THE PROGRAM IS APPLIED UNIFORMLY ACROSS ALL LEVELS OF HOSPITAL SERVICES. THE PROGRAM EXTENDS BEYOND THE FEDERAL POVERTY DEFINITIONS TO ALLOW THE HOSPITAL TO PROVIDE FREE AND/OR SUBSIDIZED CARE FOR PERSONS FALLING WITHIN AND BEYOND THE FEDERAL GUIDELINES. THIS PROGRAM PROVIDED ASSISTANCE TO APPROXIMATELY 4,218 ACCOUNTS DURING THIS FISCAL YEAR.	Desc

Field	Value	IRS element (for citing)
Total Other Prog Srvc Expense	$44,168,048	TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant	$0	TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue	$52,823,838	TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses	$68,664,079	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	0	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	Yes (1)	InvestTaxExemptBondsInd
Escrow Account	Yes (1)	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (1)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	44	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	844	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	11	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	Yes (1)	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ROBERT L GOSHIA	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	4196333594	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	433 W HIGH STREET	AddressLine1Txt
City	BRYAN	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	43506	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
CHAD D TINKEL
PRESIDENT/SECRETARY, CEO (PART YEAR)	50.00	0.50	Yes (X)	Yes (X)	$264,769	$0	$26,720
KATRINA P HESTER
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
CHRISTOPHER CULLIS
CHAIRMAN	0.10	0.10	Yes (X)	Yes (X)	$0	$0	$0
BRUCE SPANGLER
VICE CHAIR	0.10	0.10	Yes (X)	Yes (X)	$0	$0	$0
JIM WYSE
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
JAMES RUPP
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
STEVE BUMB MD
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
PEGGY WATSON MD
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
CHRISTOPHER KANNEL
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
DAVID SWANSON
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
NIKI MOSIER
DIRECTOR	0.10	0.10	Yes (X)		$0	$0	$0
PHILIP L ENNEN
PRESIDENT/SECRETARY, CEO (PART YEAR)	50.00	0.50	Yes (X)	Yes (X)	$376,572	$0	$3,600
MICHAEL CULLER
VP/COO (PART YEAR)	50.00	0.00	Yes (X)	Yes (X)	$204,006	$0	$26,100
ANGELIA FOSTER
VP/CHRO	50.00	0.00		Yes (X)	$180,487	$0	$21,720
WADE PATRICK
VP/CIO	50.00	0.00		Yes (X)	$204,125	$0	$9,960
ROBET L GOSHIA
VP/CFO	50.00	0.50		Yes (X)	$0	$0	$0
JANICE DAVID
VP PATIENT CARE	50.00	0.00			$193,173	$0	$14,960	Yes (X)
JODI TINKEL MD
PHYSICIAN	50.00	0.00			$620,623	$0	$0		Yes (X)
MICHAEL NOSANOV
PHYSICIAN	50.00	0.00			$555,629	$0	$9,960		Yes (X)
DAVID COOLEY MD
PHYSICIAN	50.00	0.00			$186,570	$0	$0		Yes (X)
SHANNN KEIL MD
PATHOLOGY PHYSICIAN	50.00	0.00			$304,718	$0	$21,265		Yes (X)
HANAN BAZZI MD
PHYSICIAN	50.00	0.00			$430,636	$0	$21,720		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,521,308	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$156,005	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	28	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
WILLIAMS EMERGENCY GROUP LLP
PO BOX 677979	DALLAS	TX	60693	PHYSICIAN SERVICES	$2,238,495
PARVIEW HEALTH
BOX 5600	FT WAYNE	IN	46895	PHYSICIAN SERVICES	$1,401,676
TOLEDO RADIATION ONCOLOGY
3000 RECENCY COURT	TOLEDO	OH	43623	PHYSICIAN SERVICES	$821,645
ALLSCRIPTS HEALTHCARE LLC
24630 NETWORK PLACE	CHICAGO	IL	60673	COMPUTER	$578,683
ASSOCIATED ANESTHESIOLOGIST
10315 DAWSON CREEK	FT WAYNE	IN	46825	ANESTHESIOLOGY SERVICES	$565,371

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	14	CntrctRcvdGreaterThan100KCnt
All Other Contributions	$37,725	AllOtherContributionsAmt
Total Contributions	$37,725	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	PATIENT REVENUE	Desc
Business	621400	BusinessCd
Total Revenue Column	$88,490,404	TotalRevenueColumnAmt
Related Or Exempt Func Income	$88,490,404	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$88,490,404	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,513,122	TotalRevenueColumnAmt
Exclusion	$1,513,122	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$427,547	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$204,428	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$223,119	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$223,119	TotalRevenueColumnAmt
Exclusion	$223,119	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$15,900	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$1,650	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$14,250	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$14,250	TotalRevenueColumnAmt
Exclusion	$14,250	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
CAFETERIA/VENDING	621400	$539,399	$539,399
CASH SURRENDER VALUE INCREASE	900099	$51,126	$51,126
LOSS FROM VANTAGE HEALTHCARE	621400	-$26,438		-$26,438

Field	Value	IRS element (for citing)
Other Revenue Total	$564,087	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$90,842,707	TotalRevenueColumnAmt
Related Or Exempt Func Income	$88,490,404	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	-$26,438	UnrelatedBusinessRevenueAmt
Exclusion	$2,341,016	ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$36,067,127	TotalAmt
Program Services	$28,973,689	ProgramServicesAmt
Management And General	$7,093,438	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,147,939	TotalAmt
Program Services	$822,445	ProgramServicesAmt
Management And General	$325,494	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$7,514,560	TotalAmt
Program Services	$6,126,271	ProgramServicesAmt
Management And General	$1,388,289	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,490,985	TotalAmt
Program Services	$1,987,599	ProgramServicesAmt
Management And General	$503,386	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$7,385,194	TotalAmt
Program Services	$5,873,023	ProgramServicesAmt
Management And General	$1,512,171	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$155,703	TotalAmt
Program Services	$14,908	ProgramServicesAmt
Management And General	$140,795	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$178,256	TotalAmt
Management And General	$178,256	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$325,091	TotalAmt
Program Services	$159,057	ProgramServicesAmt
Management And General	$166,034	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$253,186	TotalAmt
Program Services	$179,864	ProgramServicesAmt
Management And General	$73,322	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,845,672	TotalAmt
Program Services	$165,156	ProgramServicesAmt
Management And General	$1,680,516	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$115,347	TotalAmt
Program Services	$71,790	ProgramServicesAmt
Management And General	$43,557	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$188,704	TotalAmt
Program Services	$59,864	ProgramServicesAmt
Management And General	$128,840	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,917,731	TotalAmt
Program Services	$1,687,603	ProgramServicesAmt
Management And General	$230,128	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$5,109,074	TotalAmt
Program Services	$4,501,493	ProgramServicesAmt
Management And General	$607,581	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$430,383	TotalAmt
Program Services	$42,745	ProgramServicesAmt
Management And General	$387,638	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
BILLABLE/NONBILLABLE SU	$11,594,548	$11,023,073	$571,475
BAD DEBT EXPENSE	$4,377,869	$4,377,869
REPAIRS & MAINTENANCE	$3,741,703	$2,208,994	$1,532,709
TAXES	$1,310,321	$89,056	$1,221,265

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$403,391	TotalAmt
Program Services	$299,580	ProgramServicesAmt
Management And General	$103,811	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$86,552,784	TotalAmt
Program Services	$68,664,079	ProgramServicesAmt
Management And General	$17,888,705	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$20,121,857	BOYAmt
EOY	$20,583,811	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$29,697,512	BOYAmt
EOY	$17,217,291	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$8,856,078	BOYAmt
EOY	$8,428,280	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,405,663	BOYAmt
EOY	$1,497,870	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$2,764,799	BOYAmt
EOY	$3,162,567	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$171,600,823	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$96,671,061	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$75,770,102	BOYAmt
EOY	$74,929,762	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$13,953,924	BOYAmt
EOY	$32,188,326	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$370,102	BOYAmt
EOY	$97,656	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,893,017	BOYAmt
EOY	$53,038	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$154,833,054	BOYAmt
EOY	$158,158,601	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$7,735,099	BOYAmt
EOY	$10,107,395	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$38,479,999	BOYAmt
EOY	$37,490,001	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$16,341,502	BOYAmt
EOY	$15,025,707	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$6,276,050	BOYAmt
EOY	$3,304,401	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$68,832,650	BOYAmt
EOY	$65,927,504	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$86,000,404	BOYAmt
EOY	$92,231,097	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$86,000,404	BOYAmt
EOY	$92,231,097	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$154,833,054	BOYAmt
EOY	$158,158,601	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$4,289,923	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$1,940,770	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$2,315	OtherActivitiesAmt
Total Lobbying Expenditures	$2,315	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	PART OF OHA DUES ARE ATTRIBUTED TO LOBBYING, TOTAL DUES WERE $39,233 OF WHICH 5.9% WERE CONTRIBUTED TO LOBBYING.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$830,800	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$2,124,658	OtherCostOrOtherBasisAmt
Book Value	$2,955,458	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$96,155,145	OtherCostOrOtherBasisAmt
Depreciation	$35,119,918	DepreciationAmt
Book Value	$61,035,227	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$8,914,990	InvestmentCostOrOtherBasisAmt
Depreciation	$5,653,137	DepreciationAmt
Book Value	$3,261,853	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$61,612,214	OtherCostOrOtherBasisAmt
Depreciation	$55,678,354	DepreciationAmt
Book Value	$5,933,860	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,963,016	OtherCostOrOtherBasisAmt
Depreciation	$219,652	DepreciationAmt
Book Value	$1,743,364	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$74,929,762	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
DEFERRED COMPENSATION	$511,481
SETTLEMENTS PAYABLE UNDER THIRD PARTY REIMBURSEMENT CONTRACTS	$2,792,920

Field	Value	IRS element (for citing)
Total Liability	$3,304,401	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART X, LINE 2:	FormAndLineReferenceDesc
Explanation	ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND TO RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT, AS OF SEPTEMBER 30, 2019 AND 2018, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS.	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,197,388	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,914,789	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,282,599	NetCommunityBenefitExpnsAmt
Total Expense	0.02780	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,573,671	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,757,112	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,816,559	NetCommunityBenefitExpnsAmt
Total Expense	0.07080	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,771,059	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,671,901	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,099,158	NetCommunityBenefitExpnsAmt
Total Expense	0.09860	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$141,599	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$141,599	NetCommunityBenefitExpnsAmt
Total Expense	0.00170	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$141,599	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$141,599	NetCommunityBenefitExpnsAmt
Total Expense	0.00170	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,912,658	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,671,901	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,240,757	NetCommunityBenefitExpnsAmt
Total Expense	0.10030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$4,377,869	BadDebtExpenseAmt
Bad Debt Expense Attributable	$437,787	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$16,791,990	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$20,704,186	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$3,912,196	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	2	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (2 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Emergency Room24 HrsEmergencyRoom24HrsInd	Critical Access HospitalCriticalAccessHospitalInd	OtherOtherDesc
BRYAN HOSPITAL
1	433 WEST HIGH STREET	BRYAN	OH	43506	Yes (X)	Yes (X)	Yes (X)
MONTPELIER HOSPITAL
2	909 EAST SNYDER AVENUE	MONTPELIER	OH	43543	Yes (X)		Yes (X)	Yes (X)	SWING BEDS

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp (2 entries)

FacilityFacilityNum	First Licensed CY Or PYFirstLicensedCYOrPYInd	Tax Exempt Hospital CY Or PYTaxExemptHospitalCYOrPYInd	CHNA ConductedCHNAConductedInd	Community DefinitionCommunityDefinitionInd	Community DemographicsCommunityDemographicsInd	Existing ResourcesExistingResourcesInd	How Data ObtainedHowDataObtainedInd	Community Health NeedsCommunityHealthNeedsInd	Other Health IssuesOtherHealthIssuesInd	Community Hlth Needs Id ProcessCommunityHlthNeedsIdProcessInd	Consulting ProcessConsultingProcessInd	Prior CHNA ImpactPriorCHNAImpactInd	OtherOtherInd	CHNA ConductedCHNAConductedYr	Take Into Account Others InputTakeIntoAccountOthersInputInd	CHNA Conducted With Other FcltsCHNAConductedWithOtherFcltsInd	CHNA Conducted With Non FcltsCHNAConductedWithNonFcltsInd	CHNA Report Widely AvailableCHNAReportWidelyAvailableInd	Rpt Available On Own WebsiteRptAvailableOnOwnWebsiteInd	Own Website URLOwnWebsiteURLTxt	Other WebsiteOtherWebsiteInd	Other Website URLOtherWebsiteURLTxt	Paper Copy Public InspectionPaperCopyPublicInspectionInd	Rpt Available Thru Other MethodRptAvailableThruOtherMethodInd	Implementation Strategy AdoptImplementationStrategyAdoptInd	Implementation Strategy AdptImplementationStrategyAdptYr	Strategy Posted WebsiteStrategyPostedWebsiteInd	Strategy Website URLStrategyWebsiteURLTxt	Organization Incur Excise TaxOrganizationIncurExciseTaxInd	Elig Criteria ExplainedEligCriteriaExplainedInd	FPG Family Incm Lmt Free DscntFPGFamilyIncmLmtFreeDscntInd	FPG Family Incm Lmt Free CareFPGFamilyIncmLmtFreeCarePct	FPG Family Incm Lmt Dscnt CareFPGFamilyIncmLmtDscntCarePct	Income Level CriteriaIncomeLevelCriteriaInd	Asset Level CriteriaAssetLevelCriteriaInd	Medical Indigency CriteriaMedicalIndigencyCriteriaInd	Explained BasisExplainedBasisInd	App Financial Asst ExplnAppFinancialAsstExplnInd	Described InfoDescribedInfoInd	Described Suprt DocDescribedSuprtDocInd	Provided Hospital ContactProvidedHospitalContactInd	Includes Publicity MeasuresIncludesPublicityMeasuresInd	FAP Available On WebsiteFAPAvailableOnWebsiteInd	FAP Available On Website URLFAPAvailableOnWebsiteURLTxt	FAP App Available On WebsiteFAPAppAvailableOnWebsiteInd	FAP App Available On Website URLFAPAppAvailableOnWebsiteURLTxt	FAP Summary On WebsiteFAPSummaryOnWebsiteInd	FAP Summary On Website URLFAPSummaryOnWebsiteURLTxt	FAP Avlbl On Request No ChargeFAPAvlblOnRequestNoChargeInd	FAP App Avlbl On Request No ChrgFAPAppAvlblOnRequestNoChrgInd	FAP Sum Avlbl On Request No ChrgFAPSumAvlblOnRequestNoChrgInd	Notified FAP Copy Bill DisplayNotifiedFAPCopyBillDisplayInd	Communtity Notified FAPCommuntityNotifiedFAPInd	FAP TranslatedFAPTranslatedInd	FAP Actions On NonpaymentFAPActionsOnNonpaymentInd	Permit No ActionsPermitNoActionsInd	Collection ActivitiesCollectionActivitiesInd	Provided Written NoticeProvidedWrittenNoticeInd	Made Effort Orally NotifyMadeEffortOrallyNotifyInd	Processed FAP ApplicationProcessedFAPApplicationInd	Made Presumptive Elig DetermMadePresumptiveEligDetermInd	Other Actions TakenOtherActionsTakenInd	Nondis Emergency Care PolicyNondisEmergencyCarePolicyInd	Look Back Medicare PrivateLookBackMedicarePrivateInd	Amounts Generally BilledAmountsGenerallyBilledInd	Gross ChargesGrossChargesInd	Insurance Status CriteriaInsuranceStatusCriteriaInd	Underinsurance Stat CriteriaUnderinsuranceStatCriteriaInd	Residency CriteriaResidencyCriteriaInd	Other CriteriaOtherCriteriaInd
BRYAN HOSPITAL
1	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	Yes (1)	Yes (1)	Yes (1)	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/	Yes (X)	HTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2014/08/2019-WILLIAM	Yes (X)	Yes (X)	Yes (1)	18	Yes (1)	HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/	0	Yes (1)	Yes (X)	200.000000000000	300.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0
MONTPELIER HOSPITAL
2	0	0	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	18	Yes (1)	Yes (1)	Yes (1)	Yes (1)	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/	Yes (X)	HTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2014/08/2019-WILLIAM	Yes (X)	Yes (X)	Yes (1)	18	Yes (1)	HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/	0	Yes (1)	Yes (X)	200.000000000000	300.000000000000	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (1)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/	Yes (X)	HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (X)	Yes (1)	Yes (X)	0	0	Yes (X)	Yes (X)	Yes (X)	Yes (X)

Supplemental Information SupplementalInformationGrp (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
BRYAN HOSPITAL	PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH.
BRYAN HOSPITAL	PART V, SECTION B, LINE 5: WILLIAMS COUNTY PARTNERS FOR HEALTH (WCPH) BEGAN CONDUCTING COMMUNITY HEALTH ASSESSMENTS (CHA) FOR THE PURPOSE OF MEASURING AND ADDRESSING HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND THE YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THE DATA COLLECTED IN THEIR CHA TO NATIONAL, STATE AND LOCAL HEALTH TRENDS. WILLIAMS COUNTY CHA ALSO FULFILLS NATIONAL MANDATED REQUIREMENTS FOR THE HOSPITALS IN OUR COUNTY. H.R. 3590 PATIENT PROTECTION AND AFFORDABLE CARE ACT STATES THAT IN ORDER TO MAINTAIN TAX-EXEMPT STATUS, NOT-FOR-PROFIT HOSPITALS ARE REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS, AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE NEEDS IDENTIFIED THROUGH THE ASSESSMENT. FROM THE BEGINNING PHASES OF THE CHA, COMMUNITY LEADERS WERE ACTIVELY ENGAGED IN THE PLANNING PROCESS AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. ACTIVE ENGAGEMENT OF COMMUNITY MEMBERS THROUGHOUT THE PLANNING PROCESS IS REGARDED AS AN IMPORTANT STEP IN COMPLETING A VALID NEEDS ASSESSMENT. THE WILLIAMS COUNTY CHA HAS BEEN UTILIZED AS A VITAL TOOL FOR CREATING THE WILLIAMS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE PUBLIC HEALTH ACCREDITATION BOARD (PHAB) DEFINES A CHIP AS A LONG-TERM, SYSTEMATIC EFFORT TO ADDRESS HEALTH PROBLEMS ON THE BASIS OF THE RESULTS OF ASSESSMENT ACTIVITIES AND THE COMMUNITY HEALTH IMPROVEMENT PROCESS. THIS PLAN IS USED BY HEALTH AND OTHER GOVERNMENTAL EDUCATION AND HUMAN SERVICE AGENCIES, IN COLLABORATION WITH COMMUNITY PARTNERS, TO SET PRIORITIES AND COORDINATE AND TARGET RESOURCES. A CHIP IS CRITICAL FOR DEVELOPING POLICIES AND DEFINING ACTIONS TO TARGET EFFORTS THAT PROMOTE HEALTH. IT SHOULD DEFINE THE VISION FOR THE HEALTH OF THE COMMUNITY INCLUSIVELY AND SHOULD BE DONE IN A TIMELY WAY. TO FACILITATE THE COMMUNITY HEALTH IMPROVEMENT PROCESS, THE WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD) AND COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC) INVITED KEY COMMUNITY LEADERS TO PARTICIPATE IN AN ORGANIZED PROCESS OF STRATEGIC PLANNING TO IMPROVE THE HEALTH OF RESIDENTS OF THE COUNTY. THE NATIONAL ASSOCIATION OF CITY COUNTY HEALTH OFFICER'S (NACCHO) STRATEGIC PLANNING TOOL, MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP), WAS USED THROUGHOUT THIS PROCESS.THE 2017-2019 COMMUNITY HEALTH IMPROVEMENT PLAN WAS DRAFTED BY AGENCIES AND SERVICE PROVIDERS WITHIN WILLIAMS COUNTY. DURING JUNE-JULY, 2016, THE COMMITTEE REVIEWED MANY SOURCES OF INFORMATION CONCERNING THE HEALTH AND SOCIAL CHALLENGES WILLIAMS COUNTY ADULTS AND YOUTH MAY BE FACING. THEY DETERMINED PRIORITY ISSUES WHICH IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES, DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES AND EXAMINED BEST PRACTICES AND SOLUTIONS. THE COMMITTEE HAS RECOMMENDED SPECIFIC ACTIONS STEPS THEY HOPE MANY AGENCIES AND ORGANIZATIONS WILL EMBRACE TO ADDRESS THE PRIORITY ISSUES IN THE COMING MONTHS AND YEARS. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEVOTION TO THIS PROCESS AND THIS BODY OF WORK: WILLIAMS COUNTY PARTNERS FOR HEALTH ABBY CALVIN, COMMUNITY HOSPITALS AND WELLNESS CENTERS AMY BOEHM, AMERICAN CANCER SOCIETY ANNA MEYERS, JOB & FAMILY SERVICES BILL PEPPLE, UNITED WAY OF WILLIAMS COUNTY DAVID TILLY, MONTPELIER MINISTERIAL ASSOCIATION DIANA SAVAGE, BRYAN CITY SCHOOLS DOTTIE VOLLMAR, BUCKEYE COMMUNITY HOPE FOUNDATION JAMIE MARSHALL, PARKVIEW PHYSICIANS GROUP JAN DAVID, COMMUNITY HOSPITALS AND WELLNESS CENTERS JEANETTE ROBERTS, COMMUNITY HOSPITALS AND WELLNESS CENTERS JERRY STOLLINGS, JUVENILE COURT ADMINISTRATION JESSICA REITZEL, COMMUNITY HOSPITALS AND WELLNESS CENTERS JILL OSTREM, PARKVIEW PHYSICIANS GROUP JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT KIM OWEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS KIRSTEN FRISSORA, WILLIAMS COUNTY HEALTH DEPARTMENT LARRY LONG, MILLCREEK-WEST UNITY SCHOOLS LES MCCASLIN, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD LINDA TRAUSCH, COMMUNITY HOSPITALS AND WELLNESS CENTERS LORI PHILLIPS, PARKVIEW PHYSICIANS GROUP MAGGIE FISHER, WILLIAMS COUNTY DEPARTMENT OF AGING MEGAN RILEY, WILLIAMS COUNTY HEALTH DEPARTMENT MICHELLE PRICE, STEP TOWARD HEALTH NATE JOHNSON, STRYKER LOCAL SCHOOLS PAM PFLUM, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD PHIL ENNEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS RACHEL AESCHLIMAN, WILLIAMS COUNTY HEALTH DEPARTMENT ROB IMBER, YMCA RON RITTICHIER, SAFE SCHOOLS/HEALTHY STUDENTS RONDA MUEHLFELD, BRYAN COMMUNITY HEALTH CENTER SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP STEVE TOWNS, WILLIAMS COUNTY SHERIFF.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 5: WILLIAMS COUNTY PARTNERS FOR HEALTH (WCPH) BEGAN CONDUCTING COMMUNITY HEALTH ASSESSMENTS (CHA) FOR THE PURPOSE OF MEASURING AND ADDRESSING HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND THE YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THE DATA COLLECTED IN THEIR CHA TO NATIONAL, STATE AND LOCAL HEALTH TRENDS. WILLIAMS COUNTY CHA ALSO FULFILLS NATIONAL MANDATED REQUIREMENTS FOR THE HOSPITALS IN OUR COUNTY. H.R. 3590 PATIENT PROTECTION AND AFFORDABLE CARE ACT STATES THAT IN ORDER TO MAINTAIN TAX-EXEMPT STATUS, NOT-FOR-PROFIT HOSPITALS ARE REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST ONCE EVERY THREE YEARS, AND ADOPT AN IMPLEMENTATION STRATEGY TO MEET THE NEEDS IDENTIFIED THROUGH THE ASSESSMENT. FROM THE BEGINNING PHASES OF THE CHA, COMMUNITY LEADERS WERE ACTIVELY ENGAGED IN THE PLANNING PROCESS AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. ACTIVE ENGAGEMENT OF COMMUNITY MEMBERS THROUGHOUT THE PLANNING PROCESS IS REGARDED AS AN IMPORTANT STEP IN COMPLETING A VALID NEEDS ASSESSMENT. THE WILLIAMS COUNTY CHA HAS BEEN UTILIZED AS A VITAL TOOL FOR CREATING THE WILLIAMS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE PUBLIC HEALTH ACCREDITATION BOARD (PHAB) DEFINES A CHIP AS A LONG-TERM, SYSTEMATIC EFFORT TO ADDRESS HEALTH PROBLEMS ON THE BASIS OF THE RESULTS OF ASSESSMENT ACTIVITIES AND THE COMMUNITY HEALTH IMPROVEMENT PROCESS. THIS PLAN IS USED BY HEALTH AND OTHER GOVERNMENTAL EDUCATION AND HUMAN SERVICE AGENCIES, IN COLLABORATION WITH COMMUNITY PARTNERS, TO SET PRIORITIES AND COORDINATE AND TARGET RESOURCES. A CHIP IS CRITICAL FOR DEVELOPING POLICIES AND DEFINING ACTIONS TO TARGET EFFORTS THAT PROMOTE HEALTH. IT SHOULD DEFINE THE VISION FOR THE HEALTH OF THE COMMUNITY INCLUSIVELY AND SHOULD BE DONE IN A TIMELY WAY. TO FACILITATE THE COMMUNITY HEALTH IMPROVEMENT PROCESS, THE WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD) AND COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC) INVITED KEY COMMUNITY LEADERS TO PARTICIPATE IN AN ORGANIZED PROCESS OF STRATEGIC PLANNING TO IMPROVE THE HEALTH OF RESIDENTS OF THE COUNTY. THE NATIONAL ASSOCIATION OF CITY COUNTY HEALTH OFFICER'S (NACCHO) STRATEGIC PLANNING TOOL, MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP), WAS USED THROUGHOUT THIS PROCESS.THE 2017-2019 COMMUNITY HEALTH IMPROVEMENT PLAN WAS DRAFTED BY AGENCIES AND SERVICE PROVIDERS WITHIN WILLIAMS COUNTY. DURING JUNE-JULY, 2016, THE COMMITTEE REVIEWED MANY SOURCES OF INFORMATION CONCERNING THE HEALTH AND SOCIAL CHALLENGES WILLIAMS COUNTY ADULTS AND YOUTH MAY BE FACING. THEY DETERMINED PRIORITY ISSUES WHICH IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES, DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES AND EXAMINED BEST PRACTICES AND SOLUTIONS. THE COMMITTEE HAS RECOMMENDED SPECIFIC ACTIONS STEPS THEY HOPE MANY AGENCIES AND ORGANIZATIONS WILL EMBRACE TO ADDRESS THE PRIORITY ISSUES IN THE COMING MONTHS AND YEARS. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEVOTION TO THIS PROCESS AND THIS BODY OF WORK: WILLIAMS COUNTY PARTNERS FOR HEALTH ABBY CALVIN, COMMUNITY HOSPITALS AND WELLNESS CENTERS AMY BOEHM, AMERICAN CANCER SOCIETY ANNA MEYERS, JOB & FAMILY SERVICES BILL PEPPLE, UNITED WAY OF WILLIAMS COUNTY DAVID TILLY, MONTPELIER MINISTERIAL ASSOCIATION DIANA SAVAGE, BRYAN CITY SCHOOLS DOTTIE VOLLMAR, BUCKEYE COMMUNITY HOPE FOUNDATION JAMIE MARSHALL, PARKVIEW PHYSICIANS GROUP JAN DAVID, COMMUNITY HOSPITALS AND WELLNESS CENTERS JEANETTE ROBERTS, COMMUNITY HOSPITALS AND WELLNESS CENTERS JERRY STOLLINGS, JUVENILE COURT ADMINISTRATION JESSICA REITZEL, COMMUNITY HOSPITALS AND WELLNESS CENTERS JILL OSTREM, PARKVIEW PHYSICIANS GROUP JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT KIM OWEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS KIRSTEN FRISSORA, WILLIAMS COUNTY HEALTH DEPARTMENT LARRY LONG, MILLCREEK-WEST UNITY SCHOOLS LES MCCASLIN, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD LINDA TRAUSCH, COMMUNITY HOSPITALS AND WELLNESS CENTERS LORI PHILLIPS, PARKVIEW PHYSICIANS GROUP MAGGIE FISHER, WILLIAMS COUNTY DEPARTMENT OF AGING MEGAN RILEY, WILLIAMS COUNTY HEALTH DEPARTMENT MICHELLE PRICE, STEP TOWARD HEALTH NATE JOHNSON, STRYKER LOCAL SCHOOLS PAM PFLUM, FOUR COUNTY ALCOHOL, DRUG AND MENTAL HEALTH BOARD PHIL ENNEN, COMMUNITY HOSPITALS AND WELLNESS CENTERS RACHEL AESCHLIMAN, WILLIAMS COUNTY HEALTH DEPARTMENT ROB IMBER, YMCA RON RITTICHIER, SAFE SCHOOLS/HEALTHY STUDENTS RONDA MUEHLFELD, BRYAN COMMUNITY HEALTH CENTER SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP STEVE TOWNS, WILLIAMS COUNTY SHERIFF.
BRYAN HOSPITAL	PART V, SECTION B, LINE 6A: MONTPELIER HOSPITAL
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 6A: BRYAN HOSPITAL
BRYAN HOSPITAL	PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT
BRYAN HOSPITAL	PART V, SECTION B, LINE 7D: THE 2019 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE ON THE FOLLOWING WEBSITES:COMMUNITY HOSPITALS AND WELLNESS CENTERSHTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESMENT/WILLIAMS COUNTY COMBINED HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/HOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 7D: THE 2019 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE ON THE FOLLOWING WEBSITES:COMMUNITY HOSPITALS AND WELLNESS CENTERSHTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESMENT/WILLIAMS COUNTY COMBINED HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/HOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML
BRYAN HOSPITAL	PART V, SECTION B, LINE 11: TO WORK TOWARD DECREASING ADULT AND YOUTH OBESITY, THE FOLLOWING ACTION STEPS ARE RECOMMENDED: 1. INCREASE EDUCATION OF HEALTHY EATING FOR ADULTS 2. IMPLEMENT FOOD PHARMACY PROGRAM 3. INCREASE EDUCATION OF HEALTHY EATING FOR YOUTH 4. IMPLEMENT COMPLETE STREETS POLICIES 5. IMPLEMENT OHA HEALTHY HOSPITALS INITIATIVETO WORK TOWARD IMPROVING ADULT CARDIOVASCULAR HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. IMPLEMENT GO RED FOR WOMEN INITIATIVE 2. INCREASE NUTRITION/PHYSICAL EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICESTO WORK TOWARD IMPROVING YOUTH MENTAL HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. INCREASE AWARENESS OF TRAUMA INFORMED CARE 2. INCREASE THE NUMBER PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS 3. EXPAND EVIDENCE-BASED PROGRAMS TARGETING YOUTH 4. PROVIDE MENTAL HEALTH FIRST AID TRAINING 5. IMPLEMENT EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH 6. INCREASE EVIDENCE-BASED SERVICES THROUGH PROVIDERSTO WORK TOWARD DECREASING YOUTH SUBSTANCE ABUSE, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. EXPAND EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH AND FAMILIES 2. INCREASE THE NUMBER OF SCHOOLS SCREENING FOR ALCOHOL 3. IMPLEMENT A COMMUNITY BASED COMPREHENSIVE PROGRAM TO REDUCE ALCOHOL ABUSE 4. INCREASE COMMUNITY AWARENESS & EDUCATION OF SUBSTANCE ABUSE ISSUES AND TRENDS 5. IMPLEMENT PARENT PROJECTTO WORK TOWARD INCREASING WOMEN'S HEALTH SCREENINGS, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. CREATE CONSISTENT WOMEN'S HEALTH SCREENING RECOMMENDATIONS 2. INCREASE EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICES 3. DECREASE BARRIERS TO TREATMENT
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 11: TO WORK TOWARD DECREASING ADULT AND YOUTH OBESITY, THE FOLLOWING ACTION STEPS ARE RECOMMENDED: 1. INCREASE EDUCATION OF HEALTHY EATING FOR ADULTS 2. IMPLEMENT FOOD PHARMACY PROGRAM 3. INCREASE EDUCATION OF HEALTHY EATING FOR YOUTH 4. IMPLEMENT COMPLETE STREETS POLICIES 5. IMPLEMENT OHA HEALTHY HOSPITALS INITIATIVETO WORK TOWARD IMPROVING ADULT CARDIOVASCULAR HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. IMPLEMENT GO RED FOR WOMEN INITIATIVE 2. INCREASE NUTRITION/PHYSICAL EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICESTO WORK TOWARD IMPROVING YOUTH MENTAL HEALTH, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. INCREASE AWARENESS OF TRAUMA INFORMED CARE 2. INCREASE THE NUMBER PRIMARY CARE PHYSICIANS SCREENING FOR DEPRESSION DURING OFFICE VISITS 3. EXPAND EVIDENCE-BASED PROGRAMS TARGETING YOUTH 4. PROVIDE MENTAL HEALTH FIRST AID TRAINING 5. IMPLEMENT EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH 6. INCREASE EVIDENCE-BASED SERVICES THROUGH PROVIDERSTO WORK TOWARD DECREASING YOUTH SUBSTANCE ABUSE, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. EXPAND EVIDENCE-BASED PROGRAMS AND COUNSELING SERVICES TARGETING YOUTH AND FAMILIES 2. INCREASE THE NUMBER OF SCHOOLS SCREENING FOR ALCOHOL 3. IMPLEMENT A COMMUNITY BASED COMPREHENSIVE PROGRAM TO REDUCE ALCOHOL ABUSE 4. INCREASE COMMUNITY AWARENESS & EDUCATION OF SUBSTANCE ABUSE ISSUES AND TRENDS 5. IMPLEMENT PARENT PROJECTTO WORK TOWARD INCREASING WOMEN'S HEALTH SCREENINGS, THE FOLLOWING ACTIONS STEPS ARE RECOMMENDED: 1. CREATE CONSISTENT WOMEN'S HEALTH SCREENING RECOMMENDATIONS 2. INCREASE EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICES 3. DECREASE BARRIERS TO TREATMENT
BRYAN HOSPITAL	PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY.

Field	Value	IRS element (for citing)
Facility	2	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - ARCHBOLD MEDICAL CENTER
121 WESTFIELD DR	ARCHBOLD	OH	43502	OP SURGERY CENTER, OP RADIOLOGY, OP LAB, OP THERAPIES, AND MOB
2 - RADIATION ONCOLOGY CENTER
524 WEST HIGH ST	BRYAN	OH	43506	RADIATION ONCOLOGY

Supplemental Information Detail SupplementalInformationDetail (17 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C:	NOT APPLICABLE
PART I, LINE 6A:	NOT APPLICABLE
PART I, LINE 7:	CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO (54%) WHICH WAS DERIVED FROM WORKSHEET 2.
PART I, LINE 7G:	NOT APPLICABLE
PART I, LN 7 COL(F):	THE PERCENTAGE CALCULATED ON LINE 7F IS BASED ON TOTAL EXPENSES FROM FORM 990, PART IX, LESS BAD DEBTS IN THE AMOUNT OF $4,377,869.
PART I, LINE 7E:	CHWC OFFERS ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS) COURSES FOR PHYSICIANS, COUNTY EMS PROVIDERS, AND OTHER AREA HOSPITAL EMPLOYEES AT NO CHARGE.THE ORGANIZATION CONDUCTED FREE CPR CLASSES TO AREA LIFEGUARDS AND COACHES. IT ALSO PROVIDED CPR EQUIPMENT TO AREA SCHOOLS FOR STUDENT TRAINING AT NO CHARGE.CHWC OFFERS CHILDBIRTH EDUCATION CLASSES (INCLUDING PREPARED CHILDBIRTH, BABY CARE, SIBLING READINESS, AND BREASTFEEDING) AT NO CHARGE. LACTATION CONSULTING IS ALSO PROVIDED WITH FOLLOW UP HOME VISITS WHEN NECESSARY. REPRESENTATIVES OF CHWC GAVE COMMUNITY PRESENTATIONS ON A VARIETY OF HEALTHCARE- RELATED TOPICS.SMOKING CESSATION PROGRAMS AND SPEAKERS WERE ALSO OFFERED TO COMMUNITY AT NO COST.CHWC HAS HOSTED CAREER DAY FOR LOCAL SCHOOLS, WITH A FOCUS ON OPPORTUNITIES IN HEALTH CARE PROFESSIONS.MONTHLY DIABETIC SUPPORT GROUPS ARE AVAILABLE BY LICENSED DIETITIANS THAT PROVIDE RESOURCES TO APPROXIMATELY 11 COMMUNITY MEMBERS. THESE MEMBERS OF OUR STAFF ALSO PRESENT TO LOCAL BUSINESSES, SCHOOLS, AND CIVIC GROUPS.MINDFULNESS- BASED STRESS REDUCTION CLASSES WERE GIVEN AWAY TO 33 COMMUNITY PARTICIPANTS.THE ORGANIZATION PAID $100,214 FOR TWO SCHOOL- BASED MENTAL HEALTH COUNSELORS WERE PROVIDED TO SCHOOLS WITHIN THE COUNTY AT NO COST.
PART II, COMMUNITY BUILDING ACTIVITIES:	NOT APPLICABLE
PART III, LINE 2:	BAD DEBT WAS CALCULATED USING AUDITED FINANCIAL, IT IS NOT AN ESTIMATED AMOUNT.
PART III, LINE 3:	ESTIMATE OF 10% OF TOTAL BAD DEBT EXPENSE IN ORDER TO CALCULATE THE AMOUNT RECORDED AS BAD DEBT THAT WOULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. NONE OF THE BAD DEBT EXPENSE IS TREATED AS A COMMUNITY BENEFIT.
PART III, LINE 4:	ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	MEDICARE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO BASED ON METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. THE SHORTFALL IS CONSIDERED COMMUNITY BENEFIT DUE TO THE ELDERLY POPULATION IN THE HOSPITAL'S SERVICE AREA.
PART III, LINE 9B:	THE FOLLOWING COLLECTION PRACTICES ARE CONSISTENT WITH ALL PATIENTS:STATEMENT CYCLE:THE FIRST STATEMENT MAILED TO THE PATIENT/GUARANTOR IS A STATEMENT SUMMARIZING THE CHARGES AND INSURANCE PAYMENTS, IF APPLICABLE. THIS STATEMENT IS MAILED TO THE GUARANTOR THE DAY AFTER THE ACCOUNT IS FINAL BILLED IN THE HOSPITAL SYSTEM, OR THE DAY FOLLOWING RECEIPT AND SETTLEMENT OF INSURANCE PAYMENT, IF APPLICABLE. IF INSURANCE HAS PENDED PROCESSING OF A CLAIM, HOLDING FOR REQUESTED INFORMATION FROM THE POLICY HOLDER, A LETTER IS SENT TO THE PATIENT/GUARANTOR ASKING THEM TO PROVIDE THE INSURANCE WITH THE REQUESTED INFORMATION AND NOTIFY THE PATIENT ACCOUNTS OFFICE WHEN IT IS COMPLETED. IF THE PATIENT DOES NOT RESPOND TO THE LETTER BY THE DUE DATE, THE ACCOUNT WILL BE CHANGED TO SELF PAY PRIOR TO INSURANCE PAYMENT, AND THE PATIENT WILL BEGIN RECEIVING STATEMENTS. FOLLOWING THE INITIAL SUMMARY STATEMENT, A GUARANTOR STATEMENT IS MAILED TO THE GUARANTOR THE FIRST WEEK OF EACH MONTH, UNTIL THE ACCOUNT IS SETTLED IN FULL, OR REFERRED TO AN OUTSIDE AGENCY FOR COLLECTIONS. THE GUARANTOR STATEMENT LISTS ALL ACCOUNTS WITH AN OUTSTANDING PATIENT BALANCE, EXCLUDING BAD DEBT ACCOUNTS THAT ARE PROCESSING WITH A COLLECTION AGENCY. ACCOUNTS PROCESSING WITH INSURANCE WILL NOT BE INCLUDED ON PATIENT/GUARANTOR STATEMENTS, UNTIL THERE IS A PATIENT BALANCE DUE ON THE ACCOUNT. PHONE CALLS:CHWC WILL ATTEMPT TO MAKE A PHONE CALL TO ALL PATIENTS WITH NO INSURANCE APPROXIMATELY 2 WEEKS AFTER THE DATE OF SERVICE, TO DISCUSS POTENTIAL ENROLLMENT IN AN INSURANCE PLAN THROUGH THE HEALTH INSURANCE MARKETPLACE, OFFER ASSISTANCE WITH MEDICAID ENROLLMENT, FINANCIAL ASSISTANCE OR SETTING UP PAYMENT ARRANGEMENTS. THIS PHONE CALL WILL BE DOCUMENTED ON THE ACCOUNT NOTES. PAYMENT ARRANGEMENT GUIDELINES:THE PATIENT STATEMENT INCLUDES CONTACT INFORMATION FOR THE PATIENT ACCOUNTS BILLING OFFICE. PATIENT REPRESENTATIVES ARE AVAILABLE TO SET UP PAYMENT ARRANGEMENTS WITH THE GUARANTOR. WHEN A GUARANTOR CALLS TO SET UP PAYMENT ARRANGEMENTS, THE GUARANTOR IS ASKED TO PAY IN FULL, AND OFFERED THE OPTION OF A 15% PROMPT PAY DISCOUNT IF PAID IN FULL WITHIN 30 DAYS OF THE FIRST STATEMENT DATE. REQUESTS FOR DISCOUNTS EXCEEDING 15% ARE TO BE APPROVED BY THE PRESIDENT/CEO OR EVP OF FINANCE. IF PAYMENT IN FULL IS NOT POSSIBLE, THE GUARANTOR IS ASKED TO MAKE MONTHLY PAYMENTS TO PAY THE ACCOUNT IN FULL WITHIN 18 MONTHS, AND WITH A MINIMUM PAYMENT OF $50.00 PER MONTH. EXCEPTIONS CAN BE MADE TO THESE PAYMENT GUIDELINES TO ALLOW A SMALLER PAYMENT OR EXTENDED TIME TO PAY OFF THE BILL, IF DETERMINATION IS MADE THAT THE GUARANTOR IS MAKING EVERY EFFORT TO PAY AND AGREES TO INCREASE PAYMENTS IN THE FUTURE, IF THE FINANCIAL CIRCUMSTANCES CHANGE. THE GUARANTOR MAY BE ASKED TO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, IF HE/SHE IS NOT ABLE TO MAKE ACCEPTABLE PAYMENT ARRANGEMENTS. (SEE FINANCIAL ASSISTANCE POLICY). FINAL NOTICE:IF NO PAYMENT IS RECEIVED OR PAYMENT ARRANGEMENT ESTABLISHED BY DAY 63 FROM THE INITIAL STATEMENT DATE, A "PAST DUE LETTER" IS SENT TO THE GUARANTOR WITH A REQUEST TO PAY IN FULL OR CONTACT PATIENT ACCOUNTS WITHIN 30 DAYS. THE PAST DUE LETTER WILL INCLUDE THE 'PLAIN LANGUAGE SUMMARY". THE PAST DUE LETTER WILL INFORM THE PATIENT THAT THE ACCOUNT WILL BE CONSIDERED FOR COLLECTIONS IF THERE IS NO RESPONSE WITHIN 30 DAYS, AND WILL ALSO LIST THE ECA'S (SEE ECA BELOW) THAT MAY BE INITIATED IF THE GUARANTOR DOES NOT RESPOND. IF THERE IS NO RESPONSE BY THE 38TH DAY FOLLOWING THE DATE OF THE 'PAST DUE LETTER OR ACCEPTABLE PAYMENTS HAVE NOT BEEN ESTABLISHED, THE ACCOUNT IS REVIEWED BY THE PATIENT REPRESENTATIVE TO DETERMINE ELIGIBILITY FOR BAD DEBT AND COLLECTION AGENCY PROCESSING. IF THE PATIENT HAD PREVIOUSLY ESTABLISHED A PAYMENT ARRANGEMENT BUT DID NOT FOLLOW THROUGH WITH TIMELY PAYMENTS, A PHONE CALL TO THE PATIENT WILL BE MADE IN AN ATTEMPT TO RE-ESTABLISH THE PAYMENT ARRANGEMENT. IF THE PATIENT IS NOT ABLE TO BE REACHED AFTER A MINIMUM OF 2 ATTEMPTS, OR IS NOT COOPERATIVE, THE ACCOUNT WILL BE CONSIDERED FOR BAD DEBT/COLLECTIONS DURING THE NEXT TRANSFER OF ACCOUNTS. INVALID ADDRESS OR CONTACT INFORMATION:IF A PATIENT STATEMENT IS RETURNED FOR AN INVALID ADDRESS, THE PATIENT WILL BE CONTACTED BY PHONE TO OBTAIN CORRECT BILLING INFORMATION. IF THERE IS NO VALID PHONE CONTACT, OR THE PATIENT DOESN'T RESPOND TO A PHONE CALL, THE ACCOUNT MAY BE SENT TO THE COLLECTION AGENCY PRIOR TO SENDING A FINAL "PAST DUE LETTER". THE AGENCY WILL ATTEMPT TO LOCATE A VALID ADDRESS FOR THE GUARANTOR. THE AGENCY WILL NOTIFY THE HOSPITAL IF A VALID ADDRESS IS OBTAINED. IF THE PATIENT DOES NOT COOPERATE WITH THE COLLECTION AGENCY REGARDING PAYMENT OR COMPLETION OF A FINANCIAL APPLICATION, THE AGENCY WILL CONTACT THE HOSPITAL SO THAT A FINAL 'PAST DUE LETTER' CAN BE SENT. IF THERE IS NO RESPONSE TO THE PAST DUE LETTER, THE COLLECTION AGENCY MAY CONTINUE WITH APPROPRIATE ECA'S 240 DAYS FROM THE ORIGINAL STATEMENT DATE. THE HOSPITAL AND AGENCY WILL WORK TOGETHER TO ASSURE THE AGENCY HAS THE APPROPRIATE 1ST STATEMENT DATE SINCE THE ACCOUNTS MAY BE INITIALLY SENT TO THE AGENCY PRIOR TO THE NORMAL MINIMUM OF DAY 100. PRESUMPTIVE ELIGIBILITY:PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS, THE ACCOUNT IS SENT TO "I-SOLUTIONS" TO REVIEW AND DETERMINE CHARITY ELIGIBILITY AND PROPENSITY TO PAY. ANY ACCOUNTS THAT LIST ON THE I-SOLUTIONS REPORT AS "YES" UNDER THE CHARITY COLUMN WILL RECEIVE A CHARITY DISCOUNT EQUAL TO 75% OF THE "W/O AMOUNT" LISTED ON THE REPORT. ANY ACCOUNT THAT LISTS A POSITIVE "W/O AMOUNT AND FALLS IN THE "BD OR "LOW" PROPENSITY TO PAY CATEGORY WILL RECEIVE A CHARITY DISCOUNT EQUAL TO 75% OF THE "W/O AMOUNT" LISTED ON THE REPORT. ACCOUNTS WITH NO LISTED PROPENSITY TO PAY AND A POSITIVE "W/O AMOUNT" WILL ALSO RECEIVE A CHARITY DISCOUNT EQUAL TO 75% OF THE "W/O AMOUNT" LISTED ON THE REPORT. THE MINIMUM DISCOUNT APPLIED TO ANY CHARITY ELIGIBLE ACCOUNT THROUGH I-SOLUTIONS WILL BE NO LESS THAN THE MINIMUM CHARITY LEVEL APPLIED FROM A FINANCIAL APPLICATION, WHICH IS BASED ON THE AGB FOR THE APPLICABLE FISCAL YEAR. VISITS WITH A PROPENSITY TO PAY "NMD" (NEED MORE DATA) DO NOT RECEIVE A CHARITY DISCOUNT. THE BALANCE AFTER ALL CHARITY DISCOUNTS ARE APPLIED, IS MOVED TO BAD DEBT IN THE HOSPITAL SYSTEM AND SENT TO THE APPROPRIATE COLLECTION AGENCY.THE ADMISSION AUTHORIZATION FORM INCLUDES A STATEMENT AUTHORIZING THE HOSPITAL TO REVIEW THE GUARANTOR'S CREDIT INFORMATION. IF THIS IS NOT SIGNED BY THE PATIENT OR HIS/HER REPRESENTATIVE, THE VISIT WILL NOT BE SENT TO I-SOLUTIONS FOR REVIEW. IT WILL BE FORWARDED DIRECTLY TO THE COLLECTION AGENCY. THE ADMISSIONS OFFICE WILL SEND A TICKLER NOTE TO PATIENT ACCOUNTS STATING THAT THE PATIENT REFUSED TO SIGN THE AUTHORIZATION. ACCOUNTS RECEIVING A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY ARE ELIGIBLE TO APPLY FOR AN ADDITIONAL DISCOUNT, IF A FINANCIAL APPLICATION IS COMPLETED WITHIN 240 DAYS FROM THE 1ST STATEMENT DATE.
PART VI, LINE 2:	THE WILLIAMS COUNTY PARTNERS FOR HEALTH COMMITTEE PRESENTS THE 2019 WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT. THE DATA CONTAINED IN THIS REPORT IS A SCIENTIFICALLY VALID SAMPLING CONDUCTED EVERY THREE YEARS IN THE COMMUNITY TO BETTER IDENTIFY AND UNDERSTAND HEALTH ISSUES FACING WILLIAMS COUNTY RESIDENTS. THROUGH A COMBINED EFFORT BY THE WILLIAMS COUNTY HEALTH DEPARTMENT, COMMUNITY HOSPITALS AND WELLNESS CENTERS BRYAN AND MONTPELIER, AND THE MANY ORGANIZATIONS LISTED IN THIS PUBLICATION, WE ARE ABLE TO PROVIDE VALUABLE INFORMATION BOTH TO INDIVIDUAL RESIDENTS AND ORGANIZATIONS IN THE COMMUNITY. IN THE PAST, THIS INFORMATION HAS HELPED TO EDUCATE CITIZENS ABOUT THEIR COMMUNITY AND WE HOPE YOU FIND THE NEW REPORT HELPFUL IN THAT REGARD. IN THE 2019 REPORT YOU WILL FIND THAT IN MANY WAYS THE HEALTH OF OUR COMMUNITY IS VERY GOOD AND RANKS HIGHER THAN BOTH THE NATION AND STATE AVERAGES. IN OTHER AREAS, YOU WILL FIND WE STILL HAVE CHALLENGES THAT NEED TO BE ADDRESSED FOR THE BETTERMENT OF OUR COMMUNITY. WHETHER YOU USE THIS INFORMATION TO APPLY FOR GRANTS OR JUST BECOME MORE INFORMED WE HOPE THAT YOU FIND THIS REPORT USEFUL FOR YOUR PURPOSES.
PART VI, LINE 3:	ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS.PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT. THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THIS FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE. IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE. SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT. THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCIAL PROGRAM AND THE APPLICATION PROCESS.COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY ARE DISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREE CLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. CHWC WILL PERIODICALLY INCLUDE INFORMATION ON THE HOSPITAL FINANCIAL ASSISTANCE POLICIES, IN THE QUARTERLY NEWSLETTER THAT IS MAILED TO RESIDENTS IN THE 4 COUNTY AREA.
PART VI, LINE 4:	HOSPITALS ARE LOCATED IN BRYAN AND MONTPELIER, OHIO. IN ADDITION TO A MEDICAL CENTER LOCATED IN ARCHBOLD. CHWC SERVICES THE FOLLOWING THREE COUNTIES: WILLIAMS, DEFIANCE AND FULTON. APPROXIMATELY 16.0% OF THE POPULATION IS 65 YEARS OR OLDER, 13.5% IS BELOW POVERTY LEVEL, AND 7.0% OF ADULTS ARE WITHOUT HEALTH INSURANCE.
PART VI, LINE 5:	TEN OUT OF 11 OF THE ORGANIZATION'S BOARD RESIDES IN THE ORGANIZATION'S PRIMARY SERVICE AREA, WITH NONE BEING EMPLOYEES BESIDES THE PRESIDENT, INDEPENDENT CONTRACTORS OR RELATED TO THE MANAGEMENT TEAM AND ONLY TWO BEING ON THE MEDICAL STAFF. TEN OF THE ELEVEN BOARD MEMBERS ARE VOLUNTEER POSITIONS WITH NO PAY.THE HOSPITAL PROVIDES THE HIGHEST QUALITY OF CARE IN THE MOST EFFICIENT MANNER POSSIBLE. CHWC TYPICALLY RUNS AROUND A 1% OPERATING MARGIN. WE TAKE INTO CONSIDERATION THE COMMUNITIES FEEDBACK ON SERVICES THEY WOULD LIKE PROVIDED LOCALLY AND ASSESS IF WE CAN PROVIDE THEM WITH THE UPMOST QUALITY AND EFFICIENCY.
PART VI, LINE 6:	NOT APPLICABLE

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Form990 Of Other Organizations	Yes (X)	Form990OfOtherOrganizationsInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CHAD D TINKEL
PRESIDENT/SECRETARY, CEO (PART YEAR)	$264,769	$0	$0	$0	$0	$0	$5,000	$0	$21,720	$0	$291,489	$0	$0	$0
PHILIP L ENNEN
PRESIDENT/SECRETARY, CEO (PART YEAR)	$352,996	$0	$10,000	$0	$13,576	$0	$0	$0	$3,600	$0	$380,172	$0	$0	$0
MICHAEL CULLER
VP/COO (PART YEAR)	$204,006	$0	$0	$0	$0	$0	$22,500	$0	$3,600	$0	$230,106	$0	$0	$0
ANGELIA FOSTER
VP/CHRO	$180,487	$0	$0	$0	$0	$0	$0	$0	$21,720	$0	$202,207	$0	$0	$0
WADE PATRICK
VP/CIO	$204,125	$0	$0	$0	$0	$0	$0	$0	$9,960	$0	$214,085	$0	$0	$0
JANICE DAVID
VP PATIENT CARE	$193,173	$0	$0	$0	$0	$0	$5,000	$0	$9,960	$0	$208,133	$0	$0	$0
JODI TINKEL MD
PHYSICIAN	$620,623	$0	$0	$0	$0	$0	$0	$0	$0	$0	$620,623	$0	$0	$0
MICHAEL NOSANOV
PHYSICIAN	$555,629	$0	$0	$0	$0	$0	$0	$0	$9,960	$0	$565,589	$0	$0	$0
DAVID COOLEY MD
PHYSICIAN	$186,570	$0	$0	$0	$0	$0	$0	$0	$0	$0	$186,570	$0	$0	$0
SHANNN KEIL MD
PATHOLOGY PHYSICIAN	$304,718	$0	$0	$0	$0	$0	$0	$0	$21,265	$0	$325,983	$0	$0	$0
HANAN BAZZI MD
PHYSICIAN	$430,636	$0	$0	$0	$0	$0	$0	$0	$21,720	$0	$452,356	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 3	FormAndLineReferenceDesc
Explanation	THE FOLLOWING INDVIDUALS PARTICIPATED IN A 457(B) RETIREMENT PLAN: JANICE DAVID AND CHAD D. TINKEL. A $5,000 CONTRIBUTION WAS MADE FOR EACH OF THESE INDIVIDUALS TO THE 457(B) PLAN. THESE AMOUNTS HAVE BEEN PROPERLY INCLUDED IN OFFICERS' COMPENSATION ON SCHEDULE J, PART II, COLUMN B(III). THE HOSPITAL HAS A SUPPLEMENTAL EXECUTIVE RETENTION PLAN FOR THESE EXECUTIVES UNDER IRC SECTION 457(B). THE AMOUNTS DEFERRED UNDER THIS PLAN WILL BE TAXABLE TO THE EXECUTIVE WHEN VESTED AND THERE IS NO LONGER A SUBSTANTIAL RISK OF FORFEITURE. IN ORDER TO HAVE THE RIGHT TO FUTURE PAYMENT OF ANY EMPLOYER DEFERRAL, THE EXECUTIVE WILL HAVE TO REMAIN IN SERVICE UNTIL THE ACCOUNT BECOMES VESTED AS PROVIDED IN THE PLAN DOCUMENT.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
CITY OF BRYAN OH
A	346400228	2008-07-01	$10,000,000	SEE PART VI	0	0	0
VILLAGE OF ARCHBOLD OH
B	346400063	2008-08-20	$10,000,000	SEE PART VI	0	0	0
COUNTY OF WILLIAMS OH
C	346401595	2012-09-26	$2,905,428	SEE PART VI	0	0	0
CITY OF BRYAN OH
D	346400228	2016-06-15	$10,000,000	SEE PART VI	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Refunding Tax Exempt BondsRefundingTaxExemptBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd
A	$2,675,666	$10,208,153	$10,208,153	2011	0	Yes (1)	Yes (1)
B	$2,695,646	$10,208,153	$10,208,153	2011	0	Yes (1)	Yes (1)
C	$2,905,428	$2,905,428	$2,905,428	2005	Yes (1)	Yes (1)	Yes (1)
D	$704,190	$10,000,000	$10,000,000		Yes (1)	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Any Lease ArrangementsAnyLeaseArrangementsInd	Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd	Engage Bond Counsel ContractsEngageBondCounselContractsInd	Private Bus Use By OthersPrivateBusUseByOthersPct	Total Private Business UseTotalPrivateBusinessUsePct	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	0	Yes (1)	Yes (1)	0.01240	0.01240	Yes (1)
B	0	Yes (1)	Yes (1)			Yes (1)
C	0	Yes (1)	Yes (1)			Yes (1)
D	Yes (1)	Yes (1)	Yes (1)	0.31000	0.31000	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd
(no name)
A	0	0	Yes (1)	Yes (1)	Yes (1)	0	0	0	Yes (1)
(no name)
B	0	0	Yes (1)	Yes (1)	Yes (1)	0	0	0	Yes (1)
(no name)
C	0	0	Yes (1)	0	0	0	0	0	Yes (1)
FIFTH THIRD BANK
D	0	Yes (1)	Yes (1)	0	Yes (1)	Yes (1)	0	0	Yes (1)	1.400000000000	0	0

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

SCHEDULE K SUPPLENTAL INFORMATION

PART 1: ONE ADDITIONAL SCHEDULE K IS INCLUDED TO DESCRIBE AN ADDITIONAL ISSUE OF TAX-EXEMPT OBLIGATIONS. PART I, LINE C, COLUMN (F): CURRENLTY REFUND A PORTION OF THE MASTER LEASE-PURCHASE AND SUBLEASE-PURCHASE AGREEMENT, DATED AS OF SEPTEMBER 1, 2005, BY AND AMOUNG FIFTH THIRD BANK, THE COUNTY OF WILLIAMS, OHIO AND COMMUNITY HOSPITAL AND WELLNESS CENTERS, ORGINALLY IN THE AMOUNT OF $9,447,848, AS A RESULT OF A DEEMED REISSUANCE OF $2,905,428.02 OF SUCH OBLIGATIONS ON SEPTEMBER 26, 2012. PART 1, LINE D, COLUMN (F): CURRENTLY REFUNED A PORTION OF THE $45,000,000 COUNTY OF WILLIAMS, OHIO ADJUSTABLE RATE DEMAND HOSPITAL FACILITIES REVENUE BONDS, SERIES 2008 (COMMUNITY HOSPITALS AND WELLNESS CENTER PROJECT).

FORM 990, SCHEDULE K, PART II

PART II, LINE 3, COLUMN A: TOTAL PROCEEDS OF ISSUE ARE $10,208,153, WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART II, LINE 3, COLUMN B: TOTAL PROCEEDS OF ISSUE ARE $10,208,153 WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART III, LINE 4, COLUMN D: PRIVATE BUSINESS USE OF 1.24% IS A RESULT OF A DISCRETE PAIN MANAGEMENT AREA WITHIN THE BOND-FINANCED PROJECT. PART IV, LINE 2C, COLUMN A: REBATE COMPUTATION WAS PERFORMED ON 02/04/2013. PART IV, LINE 2C, COLUMN B: REBATE COMPUTATION WAS PERFORMED ON 02/04/2013.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	COUNTY OF WILLIAMS OH	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	346401595	BondIssuerEIN
Bond Issued	2016-06-30	BondIssuedDt
Issue Price	$10,000,000	IssuePriceAmt
Purpose	SEE PART VI	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$704,190	RetiredAmt
Total Proceeds	$10,000,000	TotalProceedsAmt
Capital Expenditures	$10,000,000	CapitalExpendituresAmt
Substantial Completion	2011	SubstantialCompletionYr
Refunding Tax Exempt Bonds	Yes (1)	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	0	RefundingTaxableBondsInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	Yes (1)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	Yes (1)	MgmtContractBondFincdPropInd
Engage Bond Counsel Contracts	Yes (1)	EngageBondCounselContractsInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.01240	PrivateBusUseByOthersPct
Total Private Business Use	0.01240	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	Yes (1)	RebateNotDueYetInd
Exception To Rebate	Yes (1)	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	Yes (1)	VariableRateIssueInd
Hedge Identified In Bks And Rec	Yes (1)	HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

Field	Value	IRS element (for citing)
Business Name Line1	FIFTH THIRD BANK	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Term Of Hedge	1.400000000000	TermOfHedgePct
Superintegrated Hedge	0	SuperintegratedHedgeInd
Hedge Terminated	0	HedgeTerminatedInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
PPG OHIOMIDWEST COMMUNITY HEALTH ASSOCIATES
SEE SCH L, PART V	$1,336,094	PPG OHIO/MCHA PROVIDES MEDICAL SERVICES TO CHWC.	0
JODI TINKEL
SEE SCH L, PART V	$616,489	JODI TINKEL RECEIVES COMPENSATION IN HER CAPACITY AS A PHYSICIAN FROM CHWC.	0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	FORM 990, SCHEDULE L, PART IV, COLUMN B:	FormAndLineReferenceDesc
Explanation	DR. WATSON AND DR. BUMB ARE BOTH VOTING MEMBERS OF CHWC AND VOTING MEMBERS OF PPG OHIO/MCHA.JODI TINKEL IS THE SPOUSE OF CHAD TINKEL, PRESIDENT/CEO.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2	DRS. WATSON AND BUMB HAVE A BUSINESS RELATIONSHIP WITH THE PHYSICIAN GROUP MCHA/PPG-OH. CHRISTOPHER CULLIS IS THE OWNER/EDITOR OF THE LOCAL NEWSPAPER AND THUS HAS BUSINESS RELATIONSHIPS WITH THE ORGANIZATION AND OTHER TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 3	DRS. BUMB AND WATSON PROVIDE SERVICES AS CHIEF AND VICE-CHIEF OVER THE MEDICAL STAFF, THROUGH THEIR OUTSIDE EMPLOYER. THE AMOUNTS ARE $4,500 AND $9,000 RESPECTIVELY.
FORM 990, PART VI, SECTION B, LINE 11B	PRIOR TO FILING, FORM 990 IS PROVIDED TO THE BOARD, AND A SUMMARY OF THE DISCLOSURES AND CHANGES TO THE FORM IS PRESENTED BY THE PREPARERS OF THE TAX RETURN (PLANTE & MORAN) AT A MONTHLY BOARD MEETING. IF A BOARD MEMBER IS NOT IN ATTENDANCE FOR THIS PRESENTATION, THAT INDIVIDUAL WILL RECEIVE A COPY OF FORM 990 AT A LATER DATE, PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	OFFICERS AND VOTING MEMBERS OF THE BOARD ARE COVERED BY THE CONFLICT OF INTEREST POLICY, WHICH THEY SIGN ON AN ANNUAL BASIS. CONFLICTS OF INTEREST ARE REVIEWED ON A CASE BY CASE BASIS. IF A TRANSACTION ARISES THAT WOULD RESULT IN A CONFLICT, THE INTERESTED INDIVIDUAL SIGNS A CONFLICT OF INTEREST STATEMENT NOTING THAT THEY ARE NOT INDEPENDENT WITH RESPECT TO THE TRANSACTION, AND THEY ABSTAIN FROM VOTING ON THAT MATTER. THE POLICY IS MONITORED BY ALL BOARD MEMBERS AND OFFICERS. THE POLICY IS REVIEWED WITH ANY NEW BOARD MEMBERS OR OFFICERS.
FORM 990, PART VI, SECTION B, LINE 15	THE CEO'S COMPENSATION IS REVIEWED ANNUALLY AND APPROVED BY THE COMPENSATION COMMITTEE. THE VICE PRESIDENTS' COMPENSATIONS ARE REVIEWED BIENNEAL AND APPROVED BY THE COMPENSATION COMMITTEE. THE DECISIONS REGARDING COMPENSATION ARE DOCUMENTED IN THE MINUTES FROM THE COMPENSATION COMMITTEE MEETINGS. OHA SURVEY DATA IS USED FOR COMPARABILITY PURPOSES. SIMILAR HOSPITALS' 990'S ARE REVIEWED FOR COMPARABILITY PURPOSES. THE PROCESS WAS LAST UNDERTAKEN APRIL 2019 FOR THE VICE PRESIDENTS AND DECEMBER 2019 FOR THE PRESIDENT.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, LINE 16:	CHWC DID NOT ENTER INTO ANY NEW JOINT VENTURES DURING THE YEAR. WHEN THE PAIN MANAGEMENT JOINT VENTURE WAS ESTABLISHED CHWC HAD OUTSIDE LEGAL COUNCIL REVIEW AND APPROVE THE DOCUMENTS.
FORM 990, PART XII, LINE 2C:	THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

Field	Value	IRS element (for citing)
Business Name Line1	SHARE FOUNDATION	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	433 WEST HIGH STREET	AddressLine1Txt
City	BRYAN	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	43506	ZIPCd

Field	Value	IRS element (for citing)
EIN	341596175	EIN
Primary Activities	ASSIST COMMUNITY HOSPITALS AND WELLNESS CENTERS WITH FUNDRAISING	PrimaryActivitiesTxt
Legal Domicile State	OH	LegalDomicileStateCd
Exempt Code Section	501(C)(3)	ExemptCodeSectionTxt
Public Charity Status	11A	PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITALS AND WELLNESS CENTERS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Controlled Organization	Yes (1)	ControlledOrganizationInd

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITALS & WELLNESS CENTERS PAIN MANAGEMENT LLC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	433 WEST HIGH STREET	AddressLine1Txt
City	BRYAN	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	43506	ZIPCd

Field	Value	IRS element (for citing)
EIN	461084537	EIN
Primary Activities	MEDICAL SERVICES	PrimaryActivitiesTxt
Legal Domicile State	OH	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITALS & WELLNESS CENTERS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Predominant Income Type	RELATED	PredominantIncomeTypeTxt
Share Of Total Income	$1,049,641	ShareOfTotalIncomeAmt
Share Of EOY Assets	$609,119	ShareOfEOYAssetsAmt
Disproportionate Allocations	0	DisproportionateAllocationsInd
General Or Managing Partner	Yes (1)	GeneralOrManagingPartnerInd
Ownership	0.51000	OwnershipPct

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
CHWC PAIN MANAGEMENT LLC
Q	$1,258,746	ACTUAL EXPENSES
CHWC PAIN MANAGEMENT LLC
O	$503,431	ACTUAL EXPENSES