2020-11-12T14:49:00-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2019-01-01 311072406 PIKE HEALTH SERVICES INC PIKE 7409472186 100 DAWN LANE WAVERLY OH 45690 LISA CARLSON CFO 7409472186 2020-11-11 1 AMY CIMINELLO P00796388 6148493000 2020-11-11 65.24.98.214 2020-11-11 08:18:59 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 0E91126D0FB3B5231D35CFCADBE487908A76FDB7 2019 2021-01-29 14:40:06Z ADENA PIKE MEDICAL CENTER DAVE ZANNI 100 DAWN LANE WAVERLY OH 45690 21053650 0 X WWW.ADENA.ORG X 1983 OH PIKE HEALTH SERVICES, INC. IS HIGH QUALITY, COMPASSIONATE HEALTHCARE ORGANIZATION. PIKE HEALTH SERVICES IS ACCESSIBLE TO THE COMMUNITY, COMMITTED TO EXCELLENCE, RESPECTFUL OF EACH INDIVIDUAL, AND FOUNDED ON SERVICE TO OTHERS. 9 8 162 24 0 0 17357 43203 17723468 20676215 2708 4175 202496 330057 17946029 21053650 0 0 0 0 8996333 9580873 0 0 0 9915821 11939754 18912154 21520627 -966125 -466977 15792103 15049767 3181004 3062291 12611099 11987476 X TO CARE, TO HEAL, TO EDUCATE. 0 0 15652165 0 20932813 PIKE HEALTH SERVICES, INC. IS A 25- BED CRITICAL ACCESS HOSPITAL LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. IN 2019, PIKE HEALTH SERVICES, INC. HAD 545 INPATIENT DISCHARGES AND 10,774 EMERGENCY ROOM PATIENTS. DURING THE YEAR, PIKE HEALTH SERVICES, INC PARTICIPATED IN HEALTH FAIRS OFFERING SCREENING AND EDUCATION FOR DIABETES, CHOLESTEROL AND ARTHRITIS FOR BOTH ADULTS AND CHILDREN.PIKE HEALTH SERVICES MAINTAINS CLINIC OFFICE SPACE FOR VISITING PHYSICIAN SPECIALISTS FROM ADENA HEALTH SYSTEM TO SEE PATIENTS AT A DESTINATION CLOSER TO THEIR HOMES. THESE INCLUDE GENERAL SURGEONS, ONCOLOGISTS, UROLOGISTS, AND GYNECOLOGISTS. 15652165 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 162 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X SHARON WISECUP VP SYSTEM FINANCE 7407794478 272 HOSPITAL ROAD CHILLICOTHE OH 456019031 JEFF GRAHAM AHS CEO 1.00 50.00 X 0 1145693 461792 LISA CARLSON AHS CFO 1.00 50.00 X 0 735044 261617 KATHI EDRINGTON AHS COO 1.00 50.00 X 0 660899 247871 JOHN FORTNEY FORMER AHS CEO 0.00 50.00 X 0 703192 4181 DAVID KESSLER CHIEF OF MEDICAL STAFF 0.00 50.00 X 0 321009 3757 DAVE ZANNI CEO 50.00 0.00 X 239025 0 79916 ANDREW BAUER ASST ADMINISTRATOR 45.00 0.00 X 108078 0 55397 PAUL MONTAVON PHARMACIST 45.00 0.00 X 0 136257 21239 ELEANOR BOLNER DEPT MGR 45.00 0.00 X 0 110857 34157 KELLEY MURPHY DEPT MGR 45.00 0.00 X 0 119659 24288 CONNIE SHELLEY TRUSTEE 2.00 0.00 X 0 0 0 JOSH REMY TRUSTEE 2.00 0.00 X 0 0 0 JUDY SCHMITT TRUSTEE 2.00 0.00 X 0 0 0 PAUL ADKINS TRUSTEE 2.00 0.00 X 0 0 0 RENEA GREGORY TRUSTEE 2.00 0.00 X 0 0 0 TONY DIXON TRUSTEE 2.00 0.00 X 0 0 0 ANTHONY FISH TRUSTEE/CHAIR 2.00 0.00 X X 0 0 0 VAL FRANCIS TRUSTEE/VICE CHAIR 2.00 0.00 X X 0 0 0 347103 3932610 1194215 6 1 1 0 PREMIER PHYSICIAN SERVICES 332 CONGRESS PARK DRIVE DAYTON OH 45459 ER COVERAGE 1423750 CAPTIVE RADIOLOGY 6273 FRANK AVENUE NW NORTH CANTON OH 44720 MRI SERVICES 645355 NTHRIVE INC 200 NORTH POINT CENTER E ALPHARETTA GA 30022 REVENUE CYCLE MANAGEMENT 196584 MEDCARE AMBULANCE 3699 PARAGON DRIVE COLUMBUS OH 43228 TRANSPORT SERVICES 116341 4 16239 10170 16794 43203 NET PATIENT SVC REV 622110 20676215 20676215 20676215 4175 4175 13598 0 13598 13598 13598 EHR IMPLEMENTATION 622110 243000 243000 CAFETERIA REVENUE 722514 73459 73459 316459 21053650 20932813 0 77634 X 318942 318942 7026859 5818956 1207903 1715199 1362978 352221 519873 412062 107811 2352912 2028686 324226 1158328 709036 449292 397098 16182 380916 50099 30082 20017 4070 4148 -78 1316893 1124211 192682 63493 37784 25709 CORPORATE OVERHEAD ALLO 2991265 568685 2422580 BAD DEBT EXPENSE 1806433 1806433 MEDICAL SUPPLIES 1370434 1315845 54589 FRANCHISE FEES 428729 417077 11652 21520627 15652165 5868462 0 2058012 1911489 2030030 2433606 650963 165891 291768 389477 15978161 7599857 8948330 8378304 1813000 1771000 15792103 15049767 1184598 1113860 1996406 1948431 3181004 3062291 X 12611099 11984709 0 2767 12611099 11987476 15792103 15049767 X -466977 -156646 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 834 834 0 PART II-B, LINE 1: THE OHIO HOSPITAL ASSOCIATION DOES LOBBYING ON BEHALF OF HOSPITAL RELATED CAUSES. THIS ACTIVITY IS PAID FOR THROUGH DUES PAID TO THE OHIO HOSPITAL ASSOCIATION. 350000 350000 7305067 2241607 5063460 7998225 5147775 2850450 324869 210475 114394 8378304 GROUND LEASE 1771000 1771000 COST REPORT SETTLEMENTS PAYABLE 1836671 CAPITAL LEASE OBLIGATION 111760 1948431 1 1 X 1 X 1 X 1 1 1 0 1 1 613191 1208824 0 0.00000 5466760 2843951 2622809 0.13300 6079951 4052775 2622809 0.13300 9980 9980 0.00050 1173369 1173369 0.05950 1183349 1183349 0.06000 7263300 4052775 3806158 0.19300 0 1806433 10494622 10857603 -362981 X 1 1 1 1 PIKE HEALTH SERVICES INC 100 DAWN LANE WAVERLY OH 45690 WWW.ADENA.ORG ST. REG. NUM. 1299 X X X X PIKE HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X HTTPS://TINYURL.COM/YXWFCDQ6 X X 1 19 1 HTTPS://TINYURL.COM/YXWFCDQ6 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTPS://TINYURL.COM/Y5BP84C7 X HTTPS://TINYURL.COM/Y5BP84C7 X HTTPS://TINYURL.COM/Y5BP84C7 X X X X X X 1 X 0 X X X X 1 X 0 0 PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 5: THE ADENA PIKE MEDICAL CENTER CAPTURED THE BROAD INTERESTS OF THE COMMUNITY FOR THE CHNA THROUGH THREE PRIMARY METHODS: PUBLIC SURVEYS, FOCUS GROUPS AND KEY STAKEHOLDER INTERVIEWS. A HEALTH NEEDS SURVEY WAS WIDELY DISTRIBUTED IN BOTH ELECTRONIC AND PAPER FORM ACROSS THE ROSS COUNTY COMMUNITY AND RECEIVED MORE THAN 600 RESPONSES. IN ADDITION TO THE SURVEYS, INTERVIEWS WITH LOCAL COMMUNITY LEADERS, INCLUDING CIVIC, PUBLIC HEALTH AND EMERGENCY RESPONSE WERE REQUESTED AND/OR CONDUCTED TO GAIN FURTHER KNOWLEDGE OF SURVEY TOPICS. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 6A: THE CHNA FOR ADENA PIKE MEDICAL CENTER WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING HOSPITALS: ADENA HEALTH SYSTEM AND SOUTHERN OHIO MEDICAL CENTER PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 6B: THE CHNA FOR ADENA PIKE MEDICAL CENTER WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING ORGANIZATIONS: PIKE COUNTY GENERAL HEALTH DISTRICT, VALLEY VIEW HEALTH CENTER, COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, OSU EXTENSION-PIKE COUNTY, PIKE HEALTHY LIFESTYLE INITIATIVE (PHLI), PIKE COUNTY JOB AND FAMILY SERVICES, PIKE COUNTY SENIOR CENTER, PIKE COUNTY CHILDREN'S SERVICES, THE RECOVERY COUNCIL, PAINT VALLEY ADAMH, PIKE COUNTY YMCA, PIKE COUNTY SHERIFF'S DEPARTMENT, PIKE COUNTY PARTNERSHIP AGAINST DOMESTIC VIOLENCE, ROSS-PIKE EDUCATIONAL SERVICES DISTRICT. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 7D: THE CHNA WAS MADE AVAILABLE IN ELECTRONIC FORM THROUGH SOCIAL MEDIA, NEWSPAPER AND RADIO WEBSITES. PRESENTATIONS OF ITS CONTENT WERE MADE TO GOVERNMENT, COMMUNITY AND CIVIC ORGANIZATIONS. HARD COPIES OF THE CHNA REPORT WERE ALSO PRINTED AND SENT TO COMMUNITY LEADERS AND AGENCIES. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 11: THE FOLLOWING DETAILS THE SPECIFIC IMPLEMENTATION STRATEGIES USED FOR HEALTH PRIORITIES IDENTIFIED FOR THE ADENA PIKE MEDICAL CENTER DURING 2019.SUBSTANCE USE DISORDER COMMUNITY DEVELOPMENTNO COLLABORATIVE AGREEMENT WITH AN IN-PATIENT DETOX FACILITY WAS ACCOMPLISHED IN 2019 IN PIKE COUNTY. HOWEVER A FORMAL AGREEMENT WITH BRIGHTVIEW TREATMENT CENTERS WAS EXECUTED PROVIDING PRIORITY APPOINTMENTS TO ADENA PATIENTS IDENTIFIED WITH SUBSTANCE USE DISORDER. A GRANT FROM OHIO MENTAL HEALTH AND ADDICTION SERVICES WAS ALSO OBTAINED WHICH INSTALLED AN EMERGENCY ROOM SUD NAVIGATOR IN 2019, WHICH WILL INCLUDED SERVICES TO APMC EMERGENCY ROOM PATIENTS. ADVOCACYADENA HEALTH SYSTEM HAS ONE EMPLOYEE WHO DEDICATED A MINIMUM TOTAL OF TWO HOURS A MONTH TO PARTICIPATING IN PIKE COUNTY HEALTH DRUG COALITION MEETINGS AND COORDINATING PROJECTS FOR THE GROUP IN 2019. PROGRAMMING & INITIATIVESTHE BABY CENTERED RECOVERY PROGRAM PROVIDED A TOTAL OF 33 WOMEN (FROM MULTIPLE COUNTIES INCLUDING ROSS) WITH PREGNANCY EDUCATION AND ADDICTION COUNSELING, AS WELL AS FOOD AND BABY SUPPLIES AT NO CHARGE TO PARTICIPANTS. A TOTAL OF 23 COMPLETED THE PROGRAM. THE PROGRAM WAS RECOGNIZED AS THE 2018 PROMISING PRACTICES PROGRAM BY THE CENTERS FOR MEDICAID AND MEDICARE.THE EMERGENCY DEPARTMENT WAS ALSO AWARDED A GRANT BY THE OHIO MENTAL HEALTH AND ADDICTION SERVICES FOR THE EDINS PROJECT (EMERGENCY DEPARTMENT INTERCEPT AND NAVIGATION TO SUPPORT) AGENCY IN 2018 TO PROVIDE A SOCIAL WORKER/SUBSTANCE USE DISORDER NAVIGATOR TO ENGAGE PATIENTS IDENTIFIED AS NEEDING SERVICES IN RESOURCES FOR RECOVERY. THESE SERVICES CONTINUED IN 2019.OBESITY AND DIABETESADVOCACYAPMC DEPLOYED REGIONAL PUBLIC SERVICE ANNOUNCEMENTS, INCLUDING PIKE COUNTY, VIA LOCAL RADIO AND SOCIAL MEDIA FOCUSED ON NUTRITION AND FITNESS EDUCATION AND AWARENESS.PROGRAMMING & INITIATIVESAPMC PARTNERED WITH THE PIKE COUNTY OHIO STATE UNIVERSITY EXTENSION OFFICE TO DELIVER COOKING CLASSES TO ADENA PATIENTS WITH OBESITY AND DIABETES. A TOTAL OF 13 FAMILIES WERE SERVED IN ROSS COUNTY WITH NUTRITION EDUCATION, FOOD PREPARATION AND EDUCATION ON SHOPPING HEALTHY ON A BUDGET AND LABEL READING. A TOTAL OF $1,489 WAS EXPENDED PROVIDING PATIENTS WITH THE SIX-WEEK LONG EDUCATION SERIES. ADENA HEALTH SYSTEM COORDINATED A HEALTHY KIDS EVENT AT THE PIKE COUNTY FAIR WHERE A TOTAL OF 135 CHILDREN WERE PROVIDED 45 MINUTES OF HEALTHY COOKING INSTRUCTION FOLLOWED BY THIRTY MINUTES OF NUTRITION, FITNESS AND WELLBEING EDUCATION.ADENA HEALTH SYSTEM PARTNERED WITH THE PIKE COUNTY LIBRARIES TO COORDINATE THE HEALTHY KIDS SUMMER FUN CHALLENGE, COORDINATED WITH THE BOOKWORM SUMMER READING PROGRAM. A TOTAL OF 276 CHILDREN WERE ENGAGED IN THE PROGRAM WITH 74% PERSISTING THROUGHOUT THE SUMMER WITH THE PROGRAM AND 18% COMPLETING ALL OF THEIR HEALTHY CHALLENGES. PARTICIPANTS ARE OFFERED THE OPPORTUNITY TO EARN PRIZES AS THEY COMPLETE CHALLENGES AND THOSE WHO COMPLETE ALL CHALLENGES ARE ENTERED INTO A DRAWING FOR A NEW BICYCLE. FINANCIAL SUPPORT & CLINICAL ALIGNMENTADENA HEALTH SYSTEM WORKS TO ALIGN ITS SERVICE LINES AND CLINICS WITH COMMUNITY RESOURCES THAT WILL ADDRESS THE SOCIAL FACTORS AND BARRIERS FACED BY MANY OF ITS RURAL PATIENTS. THIS OFTEN INVOLVES COMMUNITY PARTNERING AND MONETARY SUPPORT FROM ADENA COMMUNITY HEALTH AND DEVELOPMENT. THESE TWO STRATEGIES ARE CONNECTED AND REPORTED TOGETHER. ADENA HEALTH SYSTEM PARTNERED WITH THE WAY FARMS AND THE PIKE COUNTY OSU EXTENSION TO FUND THE FOOD RX AND FRUIT & VEGGIE PERKS PROGRAM WHICH PROVIDED 25 INDIVIDUAL ADENA PATIENTS AND COMMUNITY SNAP BENEFICIARIES A TOTAL OF $1,020 OF FRESH FRUITS AND VEGETABLES.RESPIRATORY ISSUESPROGRAMMING & INITIATIVESADENA HEALTH SYSTEM COORDINATED THE ADENA QUIT CLINIC WHICH PROVIDED A TOTAL OF 26 PATIENTS FROM PIKE, ROSS AND HIGHLAND COUNTIES, TOBACCO CESSATION COUNSELING, SUPPORT AND NICOTINE REPLACEMENT EDUCATION BY ADENA PHARMACISTS IN 2019.THE ADENA CANCER CENTER PROVIDED A TOTAL OF 1,184 PATIENTS FROM THE REGION INCLUDING PIKE, HIGHLAND AND ROSS COUNTIES WITH FREE LUNG CANCER SCREENINGS IN 2019 WHICH RESULTED IN 33 POSITIVE CANCER FINDINGS.FINANCIAL SUPPORT & CLINICAL ALIGNMENTADENA HEALTH SYSTEM WORKS TO ALIGN ITS SERVICE LINES AND CLINICS WITH COMMUNITY RESOURCES THAT WILL ADDRESS THE SOCIAL FACTORS AND BARRIERS FACED BY MANY OF ITS RURAL PATIENTS. THIS OFTEN INVOLVES COMMUNITY PARTNERING AND MONETARY SUPPORT FROM ADENA COMMUNITY HEALTH AND DEVELOPMENT. THESE TWO STRATEGIES ARE CONNECTED AND REPORTED TOGETHER. ADENA HEALTH SYSTEM PROVIDED $15,000 IN SUPPORT FOR RELAY FOR LIFE WHICH ENGAGED THE ROSS, PIKE AND HIGHLAND COMMUNITIES IN CANCER AWARENESS (INCLUDING LUNG CANCER) AND FUNDRAISING FOR RESEARCH.MENTAL HEALTHADVOCACYARMC DEPLOYED REGIONAL PUBLIC SERVICE ANNOUNCEMENTS, INCLUDING PIKE COUNTY, VIA LOCAL RADIO AND SOCIAL MEDIA FOCUSED ON MENTAL HEALTH AWARENESS.PROGRAMMINGTHE ADENA HEALTH SYSTEM HOUSES A VICTIM'S ADVOCATE TEAM IN THE ARMC EMERGENCY DEPARTMENT WHICH PROVIDED A TOTAL OF 432 VICTIMS OF SEXUAL ASSAULT (ADULT AND PEDIATRIC), DOMESTIC VIOLENCE, CHILD ABUSE, ELDER ABUSE, HUMAN TRAFFICKING AND HATE CRIMES WITH MENTAL HEALTH REFERRAL, SAFETY NET AND SUPPORT SERVICES FREE OF CHARGE, VALUED AT $225,000 IN 2019.FINANCIAL SUPPORTADENA PARTNERED WITH THE PIKE COUNTY SUICIDE PREVENTION COALITION AND THE PAINT VALLEY ADAMH BOARD TO COORDINATE THE COMMUNITY'S FIRST SUICIDE PREVENTION WALK AND MEMORIAL IN AUGUST OF 2019. A TOTAL OF $1,000 IN SUPPORT WAS PROVIDED FOR THE EVENT.CHILD SAFETY & WELLNESSADVOCACYARMC DEPLOYED REGIONAL PUBLIC SERVICE ANNOUNCEMENTS ACROSS THE HEALTH SYSTEM AND CLINICS FOCUSED ON SAFE SLEEP AWARENESS IN ALL OF ITS COMMUNITIES, INCLUDING PIKE.PROGRAMMING & INITIATIVESTHE ADENA HEALTH SYSTEM PROVIDED MORE THAN $449,509 IN ATHLETIC INJURY PREVENTION, DIAGNOSIS, AND EVALUATION SERVICES TO 12 LOCAL PUBLIC HIGH SCHOOLS WITHIN THE SERVICE REGION IN 2019. A TOTAL OF 12 ATHLETIC TRAINERS WORK WITHIN THE SCHOOL'S ATHLETIC DEPARTMENTS AND FOCUS ON EDUCATING STUDENTS, PARENTS AND COACHES ON SPORTS MEDICINE TOPICS, INCLUDING CONCUSSION IDENTIFICATION AND TREATMENT. THE STAFF IS ALSO READILY AVAILABLE AT ATHLETIC EVENTS AND PROVIDES YEARLY SPORTS PHYSICALS TO MORE THAN 1,200 STUDENTS IN HIGHLAND, JACKSON, PICKAWAY, PIKE, AND ROSS COUNTIES. FINANCIAL SUPPORTADENA HEALTH SYSTEM PROVIDED A TOTAL OF 4 CRIBS AND 1,280 SLEEP SACKS FOR THE 1,280 BABIES BORN AT THE ADENA WOMEN'S AND CHILDREN'S CENTER IN 2019. PATIENTS COME FROM A NUMBER OF COUNTIES INCLUDING ROSS, PIKE AND HIGHLAND.COMMUNITY HEALTH OUTCOMES AND HEALTH FACTORS SUMMARY-PIKE COUNTY HEALTH OUTCOMES MOVED FROM 87 TO 87 IN 2019 (COUNTY HEALTH RANKINGS).-PIKE COUNTY HEALTH FACTORS MOVED FROM 86 TO 83 IN 2019 (COUNTY HEALTH RANKINGS). PART V, SECTION B, LINE 11 CONTINUED ADDITIONAL INITIATIVES AND RESOURCESTHE ADENA FAMILY MEDICINE - RESIDENCY CLINIC AND THE ADENA RESIDENCY CLINIC INTERNAL MEDICINE CONTINUED OPERATIONS OF ITS CLINIC IN 2019 PROVIDING AFFORDABLE, QUALITY HEALTH CARE. THE CLINICS PAIRED ACCESSIBLE PRIMARY CARE MEDICAL SERVICES PROVIDED BY PHYSICIAN INTERNS AND RESIDENTS OF ADENA'S GRADUATE MEDICAL EDUCATION PROGRAM, FAMILY AND INTERNAL MEDICINE PRECEPTORS PROVIDING SERVICES TO PATIENTS IN THE CLINIC. A TOTAL OF 3,908 UNIQUE PATIENTS, MOSTLY FROM SEVEN COUNTIES (ROSS, FAYETTE, VINTON, PICKAWAY, PIKE, HIGHLAND AND JACKSON) MADE A TOTAL OF 11,807 VISITS TO THE TWO CLINICS IN 2019.ADENA ALSO PROVIDES SUPPORT TO THE PIKE COUNTY COMMUNITY THROUGH A VARIETY OF ENGAGEMENT ACTIVITIES, INCLUDING FINANCIAL SUPPORT AND PARTICIPATION IN LOCAL COMMUNITY EVENTS AND INITIATIVES. IN 2019, MORE THAN 200 ARMC CAREGIVERS PROVIDED A TOTAL OF 3,200 HOURS OF COMMUNITY SERVICE AND VOLUNTEER TIME ENGAGING COMMUNITY AT LOCAL FAIRS AND FESTIVALS, PACKING WEEKEND FOOD BAGS FOR FOOD INSECURE CHILDREN, NON-PROFIT BOARD PARTICIPATION AND LEADERSHIP, AS WELL AS A VARIETY OF ROSS, PIKE AND HIGHLAND COMMUNITY IMPROVEMENT EFFORTS. THESE INCLUDED:-$865 TO SUPPORT AN ORAL HEALTHCARE INITIATIVE (DENTAL HYGIENE KITS) FOR STUDENTS ALL FOUR PIKE COUNTY SCHOOL DISTRICTS. -$700 IN SUPPORT OF VERIFICATION OF THE DATA PORTION OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS PROVIDED IN PARTNERSHIP WITH THE HIGHLAND COUNTY HEALTH DISTRICT. APPROXIMATELY 10% OF THE ADENA COMMUNITY HEALTH AND DEVELOPMENT DIRECTOR'S TIME WAS ALSO SUPPLIED TO COMPLETE THE WRITING AND PRODUCTION OF THE ASSESSMENT. -$10,000 IN SUPPORT OF THE ECONOMIC DEVELOPMENT ALLIANCE OF SOUTHERN OHIO, WHICH PROVIDES BUSINESS AND ECONOMIC DEVELOPMENT SERVICES TO THE REGION. -OVER $12,918 IN COORDINATED TRANSPORTATION SERVICES TO PATIENTS WITHOUT TRANSPORT TO MEDICAL APPOINTS AND NO INSURANCE COVERAGE INCLUDING PATIENTS IN ROSS, PIKE AND HIGHLAND COUNTIES.-$5,000 IN SUPPORT TO THE RONALD MCDONALD HOUSE IN COLUMBUS, OHIO TO SUPPORT NIGHTS OF STAY FOR ROSS COUNTY, HIGHLAND COUNTY AND PIKE COUNTY PARENTS WITH CHILDREN COMPLETING AN IN-PATIENT STAY AT NATIONWIDE CHILDREN'S HOSPITAL. -OVER $1,300 TO PIKE COUNTY FARM BUREAU TO SUPPORT PIKE COUNTY 4H AND FARM EDUCATION PROGRAMS. ADDITIONAL COMMUNITY COLLABORATIONSROSS COUNTY CHILD PROTECTION CENTER: ADENA HEALTH SYSTEM CONTINUED IT'S MORE THAN 20 YEAR RELATIONSHIP WITH AND SUPPORT OF THE ROSS COUNTY CHILD PROTECTION CENTER IN 2019 WHICH PROVIDES RESOURCES AND COUNSELING TO YOUNG VICTIMS OF INTERPERSONAL VIOLENCE AND SEXUAL ASSAULT IN A NINE COUNTY SERVICE REGION THAT INCLUDES ROSS, PIKE AND HIGHLAND COUNTIES. ADENA PROVIDED A TOTAL OF $63,374 IN FINANCIAL SUPPORT FOR THE CPC'S FACILITY COSTS AND INFORMATION TECHNOLOGY NEEDS. MEDICAL AND NURSING STAFF ALSO PROVIDE SUPPORT TO THE CENTER. HOPE CLINIC: ADENA PROVIDER, JAMI EASTERDAY, CNP, CONTINUED VOLUNTEER EFFORTS AS THE DIRECTOR OF THE HOPE CLINIC OF ROSS COUNTY IN 2019. A TOTAL OF 11 PROVIDERS (9 FROM ADENA HEALTH SYSTEM) VOLUNTEERED MORE THAN 280 HOURS OF CARE AT HOPE CLINIC IN 2019. A TOTAL OF 635 PATIENTS WERE SERVED WITH DENTAL AND MEDICAL CARE, WORTH $349, 603. THIS CLINIC PROVIDES FREE MEDICAL CARE TO THOSE WITHOUT HEALTH INSURANCE COVERAGE, INCLUDING MEDICAL, DENTAL AND VISION CARE. THE CLINIC IS LOCATED IN CHILLICOTHE, OH BUT SERVES PATIENTS FROM AROUND THE REGION INCLUDING ROSS, PIKE AND HIGHLAND COUNTIES. IT IS OPEN ONE DAY PER WEEK. AHS PROVIDES AN ADDITIONAL $4,000 IN MONETARY SUPPORT FROM ITS COMMUNITY HEALTH BUDGET TO THE HOPE CLINIC FOR CLINICAL RESOURCES. FOR MORE INFORMATION, GO TO HTTP://WWW.HOPECLINICFREE.ORG/ 1 1 - ADENA FAMILY MEDICINE - PIKETON 100 INDIAN RIDGE DRIVE PIKETON OH 45661 PHYSICIAN OFFICES PART I, LINE 6A: ADENA HEALTH SYSTEM EIN: 31-4379443 PART I, LINE 7: THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $1,806,433 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. PART III, LINE 2: THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS WITH THE COST TO CHARGE RATIO AGREED. PART III, LINE 4: WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA PIKE MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF THE SYSTEM'S FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO SELF-PAY PATIENTS. ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVANT PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE, ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS 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." PART III, LINE 8: THE ADENA HEALTH SYSTEM SERVICE AREA IS A RURAL 13 COUNTY AREA IN SOUTHERN OHIO. ADENA HEALTH SYSTEM HAS EVALUATED THE COMMUNITY HEALTH NEEDS AND HAS IMPORTANT PROGRAMS AND SERVICES THAT ARE DESIGNED TO MEET THE NEEDS OF ADENA'S BROAD SERVICE AREA. HOWEVER, ONE OF THE MOST SIGNIFICANT HEALTH NEEDS MET BY ADENA IS THE IDENTIFICATION OF PHYSICIAN AND ADVANCED PRACTICE PROVIDERS FOR EACH SPECIALTY OF CARE. ADENA RECRUITS, SUPPORTS, AND PROVIDES THE INFRASTRUCTURE FOR PROVIDERS IN SPECIALTIES RANGING FROM PRIMARY CARE TO INTERVENTIONAL CARDIOLOGY. IN ADENA'S RURAL, APPALACHIAN SERVICE AREA, PHYSICIAN AND OTHER KEY CLINICAL AND SUPPORT STAFF ARE DIFFICULT TO RECRUIT AND RETAIN WHICH ELEVATES THE MARKET SALARY FOR SPECIALIZED STAFF. THE MEDICARE TWO PERCENT SEQUESTRATION IS ALSO A COMPONENT OF THE SHORTFALL CALCULATION. BASED ON THESE ISSUES, WE BELIEVE SERVICE TO OUR MEDICARE POPULATION, THAT RESULTED IN A MEDICARE SHORTFALL OF $362,981 IS A COMMUNITY BENEFIT. ALSO, THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6.PRIOR YEAR SETTLEMENTS FOR MEDICARE-RELATED SERVICES THAT WERE BOOKED IN THE CURRENT TAX YEAR ARE ALSO INCLUDED IN THE CURRENT TAX YEAR CALCULATION. PART III, LINE 9B: IF THE RESPONSIBLE INDIVIDUAL HAS NOT SUBMITTED A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE OR HAS NOT PAID-IN-FULL, FOUR SEPARATE STATEMENTS ARE SENT OUT FOR THE COLLECTION OF SELF-PAY ACCOUNTS. THE FINAL STATEMENT SENT WILL INFORM THE INDIVIDUAL OF POSSIBLE EXTRAORDINARY COLLECTION ACTIONS (ECA) TO BE TAKEN IF FINANCIAL ASSISTANCE IS NOT APPLIED FOR OR THE ACCOUNT IS NOT PAID IN FULL. AFTER THE FINAL STATEMENT AND BEFORE ECAS ARE TAKEN, REASONABLE EFFORTS ARE MADE TO ORALLY CONTACT THE INDIVIDUAL AS A FINAL NOTICE. PATIENTS WHO CANNOT PAY CHARGES IN FULL MAY ALSO BE OFFERED A PAYMENT PLAN THAT IS CONSISTENT WITH PIKE HEALTH SERVICES INC.'S CUSTOMER SERVICE PROCEDURES. PART VI, LINE 3: THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. A CONTRACTED VENDOR SUPPLIES STAFF AT THE CASHIER AREA TO EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE. 7. LASTLY, WE UTILIZE A "HINDSIGHT" VENDOR THAT SCREENS ALL BAD DEBT ACCOUNTS, AFTER THE YEAR-END, AGAINST THE STATE MEDICAID ELIGIBILITY AND FEDERAL POVERTY GUIDELINES TO ATTEMPT ONE LAST EFFORT TO OBTAIN FINANCIAL ASSISTANCE FOR INDIVIDUALS. PART VI, LINE 4: PIKE COUNTY, HOME OF THE ADENA PIKE MEDICAL CENTER (APMC), IS LOCATED IN SOUTH CENTRAL OHIO. IT IS PART OF THE 2ND CONGRESSIONAL DISTRICT AND IS ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT CONTAINS THE POPULATION PATTERNS AND DISTINCT ECONOMIC CONDITIONS INHERENT OF THIS REGION OF THE U.S AND FACES SIMILAR CHALLENGES IN DIVERSIFYING ITS ECONOMY TO IMPROVE THE LIVES OF ITS 28,160 RESIDENTS.THERE ARE 10,816 HOUSEHOLDS IN PIKE COUNTY. THE AVERAGE HOUSEHOLD SIZE IS 2.61 PEOPLE, COMPARABLE WITH THE REST OF THE 12 COUNTY SERVICE REGION AND OHIO. THE AVERAGE FAMILY SIZE IS AS WELL WITH 3.11 PEOPLE.MORE THAN 22% OF THE ADULTS IN PIKE COUNTY HAVE NOT GRADUATED FROM HIGH SCHOOL. THIS PERCENTAGE IS HIGHER THAN THE AVERAGES FOR THE REGION (18.9%), OHIO (12.2%) AND THE NATION (14.6%). LESS THAN 12% HAVE A COLLEGE DEGREE. MORE THAN 12% OF THE POPULATION OF PIKE COUNTY IS ESTIMATED TO BE FUNCTIONALLY ILLITERATE, OR LACKING THE READING AND WRITING SKILLS SUFFICIENT FOR ORDINARY PRACTICAL NEEDS. THE UNEMPLOYMENT RATE IN PIKE COUNTY (10.7%) IS CONSIDERABLY HIGHER THAN THE REGIONAL (6.8%), STATE (6%) AND U.S. (7.7%) AVERAGES. IN ADDITION, MORE THAN 44.5% OF THE POPULATION IS NOT IN THE WORKFORCE. THIS IS HIGHER THAN THE STATE (35.4%) AND NATIONAL AVERAGES (35.2%). THE TOP FIVE EMPLOYMENT INDUSTRIES IN PIKE COUNTY ARE MANAGEMENT/BUSINESS/SCIENCE (28.9%), SERVICE (21.5%) SALES (23%), PRODUCTION/TRANSPORTATION SERVICES (19.2%), SALES (18.2%), AND NATURAL RESOURCES/CONSTRUCTION/MAINTENANCE. PIKE COUNTY HAS A GREATER PERCENTAGE OF PEOPLE EMPLOYED IN PRODUCTION, TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS (19.2%) THAN THE REGIONAL, STATE AND NATIONAL AVERAGES. THE PER CAPITA MEDIAN AND MEAN HOUSEHOLD INCOMES IN PIKE COUNTY OHIO ARE MUCH LOWER THAN THE STATE AND U.S. AVERAGES. POVERTY RATES ARE ALSO HIGHER THAN REGIONAL, STATE AND NATIONAL AVERAGES. ACCESS TO EMPLOYMENT IN PIKE COUNTY IS ALSO LOWER THAN OTHER COUNTIES IN THE REGION.PIKE COUNTY AND ITS ENTIRE SURROUNDING SERVICE REGION HAVE A HIGHER PREVALENCE OF DISABILITY THAN THE REST OF OHIO. SEVEN OF THE 12 COUNTIES IN THE SERVICE REGION, INCLUDING PIKE COUNTY, HAVE DISABILITY PREVALENCE RATES OF 16.7% - 22%. PART VI, LINE 5: ADENA PIKE MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A LOCAL BOARD. THE 2019 BOARD OF TRUSTEES OF ADENA PIKE MEDICAL CENTER WAS COMPRISED OF NINE MEMBERS. ONE OF THE BOARD MEMBERS IS AN EMPLOYEE OF ADENA HEALTH SYSTEM. ALL BOARD MEMBERS RESIDE IN THE HOSPITAL'S SERVICE AREA. PART VI, LINE 6: FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WELLSTON, HILLSBORO, WASHINGTON COURT HOUSE AND WAVERLY, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE, HILLSBORO, AND WAVERLY. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN). THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. X 1 1 X X X X 1 1 0 0 0 0 0 1 0 JEFF GRAHAM AHS CEO 0 766803 0 295478 0 83412 0 432671 0 29121 0 1607485 0 369586 LISA CARLSON AHS CFO 0 454336 0 217922 0 62786 0 243085 0 18532 0 996661 0 207902 KATHI EDRINGTON AHS COO 0 459195 0 154512 0 47192 0 233532 0 14339 0 908770 0 198707 JOHN FORTNEY FORMER AHS CEO 0 81026 0 131440 0 490726 0 1418 0 2763 0 707373 0 188152 DAVID KESSLER CHIEF OF MEDICAL STAFF 0 319391 0 0 0 1618 0 0 0 3757 0 324766 0 0 DAVE ZANNI CEO 182112 0 50725 0 6188 0 64343 0 15573 0 318941 0 50725 0 ANDREW BAUER ASST ADMINISTRATOR 88708 0 19301 0 69 0 21895 0 33502 0 163475 0 19301 0 PAUL MONTAVON PHARMACIST 0 136090 0 0 0 167 0 8436 0 12803 0 157496 0 0 PART I, LINE 1A DAVE ZANNI HAS MEMBERSHIP IN ROTARY. PURPOSE IS TO ENHANCE PIKE'S ENGAGEMENT IN THE ACTIVITES OF WAVERLY AND SURROUNDING COMMUNITIES. DAVE ZANNI IS REIMBURSED FOR HIS ROTARY CLUB DUES. THIS IS NOT TREATED AS TAXABLE COMPENSATION. PART I, LINE 3 THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED EVERY OTHER YEAR BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2019. PART I, LINES 4A-B JOHN FORTNEY RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $422,814. THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENT FROM THE SERP IN 2019: JEFF GRAHAM $107,467 SERP ACCRUAL KATHI EDRINGTON $61,748 SERP ACCRUAL LISA CARLSON $61,522 SERP ACCRUAL INCLUDED IN PART II, COLUMN (C) ARE AMOUNTS CREDITED TO THE EXECUTIVE UNDER THE SECTION 457(F) DEFERRED COMPENSATION PLAN. THESE AMOUNTS WERE CREDITED TO AN ACCOUNT FOR THE EXECUTIVE IN PRIOR YEARS. PLEASE NOTE THAT IN PRIOR PERIOD(S) AMOUNTS CREDITED TO THE EXECUTIVE'S ACCOUNT HAVE NOT BEEN DISCLOSED IN PART II, COLUMN (C). PART I, LINE 7 MANAGEMENT OF ADENA HEALTH SYSTEM HAVE A PORTION OF THEIR ANNUAL SALARY AT RISK UNDER A VARIABLE COMPENSATION PLAN. IF THE OPERATING RESULTS OF AHS MEET A MARGIN TARGET IN ANY FISCAL YEAR, ADDITIONAL COMPENSATION IS PAID THAT IS CALCULATED USING THE OPERATING MARGIN ALONG WITH RESULTS IN EMPLOYEE ENGAGEMENT, PATIENT QUALITY, AND SATISFACTION USING A BALANCED SCORECARD FORMULA. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PIKE HEALTH SERVICES IS ADENA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF THE ORGANIZATION NOMINATES TRUSTEES, AND ADENA HEALTH SYSTEM, AS THE SOLE MEMBER OF THE ORGANIZATION, ELECTS THE TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNANCE DECISIONS ARE RESERVED FOR ADENA HEALTH SYSTEM AS THE SOLE MEMBER OF THE ORGANIZATION, SUCH AS THE ELECTION OF MEMBERS OF THE BOARD OF TRUSTEES OF THE ORGANIZATION, APPROVAL OF STRATEGIC PLANS OF THE ORGANIZATION, AND APPROVAL OF AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND CODE OF REGULATIONS. ADENA HEALTH SYSTEM CAN ACT ON THESE RIGHTS BY A VOTE AT ANY MEETING, AN ACTION WITHOUT A MEETING, OR THROUGH OTHER AUTHORIZED MEANS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS REVIEWED AT A BOARD MEETING, AND COPIES OF THE FORM 990 WERE PROVIDED TO THE BOD MEMBERS. ADDITIONALLY, COPIES OF THE 990 WERE MADE AVAILABLE IN THE ADMINISTRATION OFFICE UNTIL THE NOVEMBER 15 FILING DATE. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. ALL CONFLICTS ARE REVIEWED, AND THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. FRONT LINE SUPERVISORS UP THROUGH THE CEO AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED EVERY OTHER YEAR BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2019. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 20,004. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,004. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 790,599. MANAGEMENT AND GENERAL EXPENSES 118,559. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 909,158. EMERGENCY DEPARTMENT SERVICES: PROGRAM SERVICE EXPENSES 1,238,087. MANAGEMENT AND GENERAL EXPENSES 185,663. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,423,750. FORM 990, PART XI, LINE 9: TRANSFER (TO) FROM RELATED ORGANIZATION -153,142. NET ASSETS RELEASED FROM RESTRICTION -3,504. FORM 990, PART XII, LINE 2C: THE ADENA HEALTH SYSTEM'S AUDIT COMMITTEE ENGAGES THE INDEPENDENT AUDIT FIRM FOR THE AUDIT, REVIEWS RESULTS, AND REPORTS TO THE BOARD. ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. PIKE HEALTH SERVICES IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. FORM 990, PART V, LINE 1 A RELATED ORGANIZATION, ADENA HEALTH SYSTEM, ISSUES THE 1099S AND W-2S. GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD OH 45123 310993422 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 ADENA HEALTH FOUNDATION 272 HOSPITAL ROAD CHILLICOTHE OH 45601 753008742 FUNDRAISING OH 501(C)(3) 12A ADENA HEALTH SYSTEM 1 SOUTHERN OHIO HEALTHCARE NETWORK 272 HOSPITAL ROAD CHILLICOTHE OH 45601 261566590 FIBEROPTIC NETWORK GRANTS OH 501(C)(3) 12A ADENA HEALTH SYSTEM 1 ADENA HEALTH SYSTEM 272 HOSPITAL ROAD CHILLICOTHE OH 45601 314379443 HOSPITAL OH 501(C)(3) 3 N/A 0 ADENA CARE 272 HOSPITAL ROAD CHILLICOTHE OH 45601 453980850 SEE SCHEDULE R, PART VII OH N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 ADENA HEALTH SYSTEM R 153142 BOOK VALUE SCHEDULE R, PART IV, COLUMN (B) THE PRIMARY ACTIVITY OF ADENA CARE IS TO DEVELOP STRATEGIC RELATIONSHIPS TO THE SERVICE AREAS MAJOR EMPLOYERS THROUGH HEALTH MANAGEMENT AND WELLNESS SERVICES.