2020-08-07T13:58:50-05:00 2019-09-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2018-10-01 341048666 COMMUNITY HOSPITALS & WELLNESS CENTERS COMM 4196361131 433 W HIGH STREET BRYAN OH 43506 ROBERT L GOSHIA VP/CFO 4196361131 2020-07-20 1 AMY CIMINELLO P00796388 6148493000 2020-07-15 65.60.155.87 2020-07-20 14:31:43 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F23B626FF7BA699FD824818B7D825A8FA45A01E7 2018 2020-09-23 17:36:50Z CHAD D TINKEL 433 W HIGH STREET BRYAN OH 43506 91048785 0 X WWW.CHWCHOSPITALS.ORG X 1969 OH 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. 11 8 844 62 -26438 -26438 69386 37725 79537116 88490404 1497415 1527372 897549 787206 82001466 90842707 0 0 0 0 45868815 47220611 0 0 0 37024957 39332173 82893772 86552784 -892306 4289923 154833054 158158601 68832650 65927504 86000404 92231097 X 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. 0 0 9034992 0 8390936 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. 10808102 0 18546760 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. 4652937 0 8728870 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. 44168048 0 52823838 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. 44168048 0 52823838 68664079 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 44 0 1 844 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 8 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROBERT L GOSHIA 4196333594 433 W HIGH STREET BRYAN OH 43506 CHAD D TINKEL PRESIDENT/SECRETARY, CEO (PART YEAR) 50.00 0.50 X X 264769 0 26720 KATRINA P HESTER DIRECTOR 0.10 0.10 X 0 0 0 CHRISTOPHER CULLIS CHAIRMAN 0.10 0.10 X X 0 0 0 BRUCE SPANGLER VICE CHAIR 0.10 0.10 X X 0 0 0 JIM WYSE DIRECTOR 0.10 0.10 X 0 0 0 JAMES RUPP DIRECTOR 0.10 0.10 X 0 0 0 STEVE BUMB MD DIRECTOR 0.10 0.10 X 0 0 0 PEGGY WATSON MD DIRECTOR 0.10 0.10 X 0 0 0 CHRISTOPHER KANNEL DIRECTOR 0.10 0.10 X 0 0 0 DAVID SWANSON DIRECTOR 0.10 0.10 X 0 0 0 NIKI MOSIER DIRECTOR 0.10 0.10 X 0 0 0 PHILIP L ENNEN PRESIDENT/SECRETARY, CEO (PART YEAR) 50.00 0.50 X X 376572 0 3600 MICHAEL CULLER VP/COO (PART YEAR) 50.00 0.00 X X 204006 0 26100 ANGELIA FOSTER VP/CHRO 50.00 0.00 X 180487 0 21720 WADE PATRICK VP/CIO 50.00 0.00 X 204125 0 9960 ROBET L GOSHIA VP/CFO 50.00 0.50 X 0 0 0 JANICE DAVID VP PATIENT CARE 50.00 0.00 X 193173 0 14960 JODI TINKEL MD PHYSICIAN 50.00 0.00 X 620623 0 0 MICHAEL NOSANOV PHYSICIAN 50.00 0.00 X 555629 0 9960 DAVID COOLEY MD PHYSICIAN 50.00 0.00 X 186570 0 0 SHANNN KEIL MD PATHOLOGY PHYSICIAN 50.00 0.00 X 304718 0 21265 HANAN BAZZI MD PHYSICIAN 50.00 0.00 X 430636 0 21720 3521308 0 156005 28 0 1 0 WILLIAMS EMERGENCY GROUP LLP PO BOX 677979 DALLAS TX 60693 PHYSICIAN SERVICES 2238495 PARVIEW HEALTH BOX 5600 FT WAYNE IN 46895 PHYSICIAN SERVICES 1401676 TOLEDO RADIATION ONCOLOGY 3000 RECENCY COURT TOLEDO OH 43623 PHYSICIAN SERVICES 821645 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 60673 COMPUTER 578683 ASSOCIATED ANESTHESIOLOGIST 10315 DAWSON CREEK FT WAYNE IN 46825 ANESTHESIOLOGY SERVICES 565371 14 37725 37725 PATIENT REVENUE 621400 88490404 88490404 88490404 1513122 1513122 427547 204428 223119 223119 223119 15900 1650 14250 14250 14250 CAFETERIA/VENDING 621400 539399 539399 CASH SURRENDER VALUE INCREASE 900099 51126 51126 LOSS FROM VANTAGE HEALTHCARE 621400 -26438 -26438 564087 90842707 88490404 -26438 2341016 36067127 28973689 7093438 1147939 822445 325494 7514560 6126271 1388289 2490985 1987599 503386 7385194 5873023 1512171 155703 14908 140795 178256 178256 325091 159057 166034 253186 179864 73322 1845672 165156 1680516 115347 71790 43557 188704 59864 128840 1917731 1687603 230128 5109074 4501493 607581 430383 42745 387638 BILLABLE/NONBILLABLE SU 11594548 11023073 571475 BAD DEBT EXPENSE 4377869 4377869 REPAIRS & MAINTENANCE 3741703 2208994 1532709 TAXES 1310321 89056 1221265 403391 299580 103811 86552784 68664079 17888705 0 20121857 20583811 29697512 17217291 8856078 8428280 1405663 1497870 2764799 3162567 171600823 96671061 75770102 74929762 13953924 32188326 370102 97656 1893017 53038 154833054 158158601 7735099 10107395 38479999 37490001 16341502 15025707 6276050 3304401 68832650 65927504 X 86000404 92231097 86000404 92231097 154833054 158158601 4289923 1940770 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2315 2315 0 PART II-B, LINE 1: PART OF OHA DUES ARE ATTRIBUTED TO LOBBYING, TOTAL DUES WERE $39,233 OF WHICH 5.9% WERE CONTRIBUTED TO LOBBYING. 830800 2124658 2955458 96155145 35119918 61035227 8914990 5653137 3261853 61612214 55678354 5933860 1963016 219652 1743364 74929762 DEFERRED COMPENSATION 511481 SETTLEMENTS PAYABLE UNDER THIRD PARTY REIMBURSEMENT CONTRACTS 2792920 3304401 X PART X, LINE 2: 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. 1 1 X 1 X 1 X 1 1 0 1 1 4197388 1914789 2282599 0.02780 10573671 4757112 5816559 0.07080 14771059 6671901 8099158 0.09860 141599 141599 0.00170 141599 141599 0.00170 14912658 6671901 8240757 0.10030 1 4377869 437787 16791990 20704186 -3912196 X 1 1 2 1 BRYAN HOSPITAL 433 WEST HIGH STREET BRYAN OH 43506 X X X 2 MONTPELIER HOSPITAL 909 EAST SNYDER AVENUE MONTPELIER OH 43543 X X X SWING BEDS BRYAN HOSPITAL 1 0 0 1 X X X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ X HTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2014/08/2019-WILLIAM X X 1 18 1 HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ X HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ X HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X X 1 X 0 0 MONTPELIER HOSPITAL 2 0 0 1 X X X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ X HTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2014/08/2019-WILLIAM X X 1 18 1 HTTPS://WWW.CHWCHOSPITAL.ORG/COMMUNITY-HEALTH-ASSESSMENT/ 0 1 X 200.000000000000 300.000000000000 X X X X X X X 1 1 X X X 1 X HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ X HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ X HTTPS://WWW.CHWCHOSPITAL.ORG/CHWC-FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X X 1 X 0 0 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. 2 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 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 X X X X 0 1 0 0 0 0 0 0 0 CHAD D TINKEL PRESIDENT/SECRETARY, CEO (PART YEAR) 264769 0 0 0 0 0 5000 0 21720 0 291489 0 0 0 PHILIP L ENNEN PRESIDENT/SECRETARY, CEO (PART YEAR) 352996 0 10000 0 13576 0 0 0 3600 0 380172 0 0 0 MICHAEL CULLER VP/COO (PART YEAR) 204006 0 0 0 0 0 22500 0 3600 0 230106 0 0 0 ANGELIA FOSTER VP/CHRO 180487 0 0 0 0 0 0 0 21720 0 202207 0 0 0 WADE PATRICK VP/CIO 204125 0 0 0 0 0 0 0 9960 0 214085 0 0 0 JANICE DAVID VP PATIENT CARE 193173 0 0 0 0 0 5000 0 9960 0 208133 0 0 0 JODI TINKEL MD PHYSICIAN 620623 0 0 0 0 0 0 0 0 0 620623 0 0 0 MICHAEL NOSANOV PHYSICIAN 555629 0 0 0 0 0 0 0 9960 0 565589 0 0 0 DAVID COOLEY MD PHYSICIAN 186570 0 0 0 0 0 0 0 0 0 186570 0 0 0 SHANNN KEIL MD PATHOLOGY PHYSICIAN 304718 0 0 0 0 0 0 0 21265 0 325983 0 0 0 HANAN BAZZI MD PHYSICIAN 430636 0 0 0 0 0 0 0 21720 0 452356 0 0 0 PART I, LINE 3 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. A CITY OF BRYAN OH 346400228 2008-07-01 10000000 SEE PART VI 0 0 0 B VILLAGE OF ARCHBOLD OH 346400063 2008-08-20 10000000 SEE PART VI 0 0 0 C COUNTY OF WILLIAMS OH 346401595 2012-09-26 2905428 SEE PART VI 0 0 0 D CITY OF BRYAN OH 346400228 2016-06-15 10000000 SEE PART VI 0 0 0 A 2675666 10208153 10208153 2011 0 0 1 1 B 2695646 10208153 10208153 2011 0 0 1 1 C 2905428 2905428 2905428 2005 1 0 1 1 D 704190 10000000 10000000 1 0 1 1 A 0 0 1 1 0 0.01240 0.01240 0 0 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 0 0 0 1 D 0 1 1 1 0 0.31000 0.31000 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 0 1 1 1 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 1 1 0 1 1 FIFTH THIRD BANK 1.400000000000 0 0 0 0 1 A 1 B 1 C 1 D 1 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. A COUNTY OF WILLIAMS OH 346401595 2016-06-30 10000000 SEE PART VI 0 0 0 A 704190 10000000 10000000 2011 1 0 1 1 A 0 1 1 1 0 0.01240 0.01240 0 0 1 A 0 1 1 0 1 1 FIFTH THIRD BANK 1.400000000000 0 0 0 0 1 A 1 PPG OHIOMIDWEST COMMUNITY HEALTH ASSOCIATES SEE SCH L, PART V 1336094 PPG OHIO/MCHA PROVIDES MEDICAL SERVICES TO CHWC. 0 JODI TINKEL SEE SCH L, PART V 616489 JODI TINKEL RECEIVES COMPENSATION IN HER CAPACITY AS A PHYSICIAN FROM CHWC. 0 FORM 990, SCHEDULE L, PART IV, COLUMN B: 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. 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. SHARE FOUNDATION 433 WEST HIGH STREET BRYAN OH 43506 341596175 ASSIST COMMUNITY HOSPITALS AND WELLNESS CENTERS WITH FUNDRAISING OH 501(C)(3) 11A COMMUNITY HOSPITALS AND WELLNESS CENTERS 1 COMMUNITY HOSPITALS & WELLNESS CENTERS PAIN MANAGEMENT LLC 433 WEST HIGH STREET BRYAN OH 43506 461084537 MEDICAL SERVICES OH COMMUNITY HOSPITALS & WELLNESS CENTERS RELATED 1049641 609119 0 1 0.51000 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 CHWC PAIN MANAGEMENT LLC Q 1258746 ACTUAL EXPENSES CHWC PAIN MANAGEMENT LLC O 503431 ACTUAL EXPENSES