2020-11-16T09:03:52-06:00 2019-12-31 351178661 BLUE & CO LLC 9200 WORTHINGTON RD STE 200 WESTERVILLE OH 43082 990 2019-01-01 311518658 POMERENE HOSPITAL FKA JOEL POMERENE FOUNDATION POME 3306741015 981 WOOSTER RD MILLERSBURG OH 446541094 TIA CERNAVA CHIEF FINANCIAL OFFICER 3306741015 2020-11-15 1 NATHAN A RODGERS CPA P01568275 6148852583 2020-11-13 76.245.71.191 2020-11-15 13:15:05 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 50BA67CF2BE9AFE4130FCD26086E06618A5B98E5 2019 2021-01-29 14:40:06Z TIA CERNAVA 981 WOOSTER RD MILLERSBURG OH 446541094 36354677 0 X WWW.POMERENEHOSPITAL.ORG X 1937 OH WE WILL BE A LEADER AND PARTNER IN PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE FOR ALL RESIDENTS OF GREATER HOLMES COUNTY. 11 10 416 60 0 0 0 9658 36491451 35878951 73433 76832 377055 389236 36941939 36354677 38482 26856 0 0 18478840 19489955 0 0 0 18356231 17903425 36873553 37420236 68386 -1065559 28715628 28007755 3495578 3840832 25220050 24166923 HOLMES COUNTY'S COMMUNITY HOSPITAL. WE PROVIDE HIGH-QUALITY, COST EFFECTIVE HEALTHCARE SERVICES TO OUR COMMUNITY. 0 0 25239403 26856 35896892 NOT-FOR-PROFIT HOSPITAL THAT PROVIDES ACUTE CARE INPATIENT AND OUTPATIENT SERVICES TO THE HOLMES COUNTY AREA. WE PROVIDED THIS THROUGH MEDICAL, SURGICAL, MATERNAL, AND NURSERY INPATIENT SERVICES. OUTPATIENT SERVICES INCLUDE LABORATORY, RADIOLOGY, REHABILITATION, AND RESPIRATORY SERVICES. POMERENE HOSPITAL PROVIDED 11,146 ED VISITS, 2,035 DISCHARGES, AND 40,423 OUTPATIENT REGISTRATIONS IN 2019. 25239403 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 75 0 1 416 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X JASON JUSTUS 3306741015 981 WOOSTER RD MILLERSBURG OH 44654 DAN MATHIE CHAIRMAN 1.00 1.00 X X 0 0 0 ERNEST HERSHBERGER VICE CHAIRMAN 1.00 1.00 X X 0 0 0 ELLIE RAMSEYER TREASURER 1.00 1.00 X X 0 0 0 JANE GRAVEN SECRETARY 1.00 1.00 X X 0 0 0 DAVE FINLEY TRUSTEE 1.00 1.00 X 0 0 0 SHEILA KNAPP TRUSTEE 1.00 1.00 X 0 0 0 CRAIG MULLET TRUSTEE 1.00 1.00 X 0 0 0 JOHN HENRY TROYER TRUSTEE 1.00 1.00 X 0 0 0 LEROY YODER TRUSTEE 1.00 1.00 X 0 0 0 MELVIN YODER TRUSTEE 1.00 1.00 X 0 0 0 TONY SNYDER CEO-TERM ENDED 08/'19 40.00 2.00 X X 254460 0 0 JASON JUSTUS CFO TO CEO 09/'19 40.00 2.00 X 258293 0 0 TIA CERNAVA CFO-TERM BEGAN 09/'19 40.00 2.00 X 43367 0 0 EUGENE KOSER ANESTHESIOLOGIST 40.00 0.00 X 354670 0 0 DR MICHAEL T SCHELL PHYSICIAN 40.00 0.00 X 381165 0 0 DR LEON MILLER PHYSICIAN 40.00 0.00 X 345096 0 0 DR ROHINI KALISETTI PHYSICIAN 40.00 0.00 X 230719 0 0 DR YASSER OMRAN HEAD OF MEDICAL STAFF 40.00 0.00 X 266324 0 0 2134094 0 0 17 0 1 0 POMERENE EMERGENCY PHYSICIANS 2625 MACNAUGHTEN RD NORTH CANTON OH 44720 ED PHYSICIANS 2020808 201 MEDICINE 2600 SIXTH ST SW ROOM 412-672 CANTON OH 44706 HOSPITALIST PHYSICIAN COVERAGE 365932 ALLIANCE HEALTHCARE SERVICES 18201 VON KARMAN AVE IRVINE CA 92612 MRI MOBILE SERVICES 244996 OHIO PHYSICIANS PROFESSIONAL CORP 2600 SIXTH ST SW CANTON OH 44710 CARDIOLOGY PHYSICIAN COVERAGE 240845 PROFESSIONAL MEDICAL RECORDS PO BOX 67 CLINTON OH 44216 TRANSCRIPTION SERVICES 132168 10 9658 9658 PATIENT SERVICE REVENUE 900099 35878951 35878951 35878951 76832 76832 252213 0 252213 252213 252213 MEALS REVENUE 900099 105655 105655 31368 17941 13427 137023 36354677 35896892 0 448127 X 26856 26856 16005712 11871400 4134312 415969 338793 77176 2208519 1798765 409754 859755 699631 160124 45212 45212 80732 40500 40232 90141 45221 44920 7833968 4455452 3378516 138832 69647 69185 321670 161370 160300 376196 188724 187472 1524677 764876 759801 283229 142086 141143 12234 6137 6097 5466 2742 2724 1314138 599781 714357 300927 150964 149963 MEDICAL AND OTHER SUPPL 4565385 3369467 1195918 FRANCHISE FEE 507563 254626 252937 DIETARY 152036 76271 75765 DUES, PUBS, AND SUBSCRI 147589 74040 73549 203430 102054 101376 37420236 25239403 12180833 0 1358 1608 3352203 3163214 5007161 4298377 347655 470581 517506 470620 38921927 29829661 9803294 9092266 9686451 10511089 28715628 28007755 2324911 2277681 66917 63480 1103750 1103750 0 395921 3495578 3840832 X 25220050 24166923 25220050 24166923 28715628 28007755 -1065559 12432 0 X X 0 1 X 1 0 X 631987 631987 17537449 11697321 5840128 101852 66350 35502 20562717 18065990 2496727 87922 87922 9092266 OTHER RECEIVABLES 182869 INVESTMENT IN JOINT VENTURES 5144 ASSETS WHOSE USE IS LIMITED 10323076 10511089 ESTIMATED THIRD PARTY SETTLEMENT 395921 395921 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 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 ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 175.000000000000 1 1 1 0 1 1 308142 88872 219270 0.00590 4188182 2332623 1855559 0.04960 4496324 2421495 2074829 0.05550 130026 130026 0.00350 26856 26856 0.00070 156882 156882 0.00420 4653206 2421495 2231711 0.05970 1 2137538 4819301 4743008 76293 X 1 1 1 1 POMERENE HOSPITAL 981 WOOSTER MILLERSBURG OH 44654 WWW.POMERENE.ORG 1202 X X X POMERENE HOSPITAL 1 1 1 X X X X X X X X X 17 1 0 1 1 X SEE PART V, PAGE 8 X HTTPS://HOLMESHEALTH.ORG/ X 1 17 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 175.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.POMERENEHOSPITAL.ORG/FINANCIAL-ASSISTANCE-PROGRAMS X HTTPS://WWW.POMERENEHOSPITAL.ORG/FINANCIAL-ASSISTANCE-PROGRAMS X X X X X 1 X 0 X X X X 1 X 0 0 POMERENE HOSPITAL PART V, SECTION B, LINE 5: THE 2017 HOLMES COUNTY COMMUNITY HEALTH ASSESSMENT PRESENTS THE RESULTS FROM THE HEALTH ASSESSMENT SURVEY GIVEN TO A RANDOM SAMPLE OF HOLMES COUNTY ADULTS AND YOUTH. THE SURVEY CONSISTED OF ADULTS AGES 19 AND OVER (27,147) AND YOUTH AGES 12-18 (GRADES 6-12) IN HOLMES COUNTY PUBLIC SCHOOL DISTRICTS (5,415). A SAMPLE SIZE OF 379 ADULTS ALONG WITH A SAMPLE SIZE OF 358 ADOLESCENTS WERE DEEMED APPROPRIATE FOR A 95% CONFIDENCE INTERVAL. THE INFORMATION PRESENTED CONSISTS OF DATA COLLECTED FROM THE SURVEYS AS WELL AS HEALTH INFORMATION FROM THE OHIO DEPARTMENT OF HEALTH AND RELEVANT NATIONAL, STATE AND LOCAL DATA SOURCES. THE REPORT WAS REVIEWED AND ANALYZED BY THE PARTNERS FOR A HEALTHIER HOLMES COUNTY COMMITTEE (THE "PARTNERS"), WHICH WAS COMPRISED OF HOLMES COUNTY COMMUNITY PARTNERS AND AGENCIES: HOLMES COUNTY GENERAL HEALTH DISTRICT, POMERENE HOSPITAL, WAYNE-HOLMES MENTAL HEALTH AND RECOVERY BOARD, HOLMES COUNTY BOARD OF DEVELOPMENTAL DISABILITIES, THE HOLMES COUNTY EMERGENCY MANAGEMENT AGENCY, AND THE EAST HOLMES AND WEST HOLMES SCHOOL DISTRICTS. THE PARTNERS COMMITTEE WERE ORGANIZED AND GOVERNED BY THE EXECUTIVE COMMITTEE CONSISTING TO THE HOLMES COUNTY GENERAL HEALTH DISTRICT ("HEALTH DEPARTMENT") AND POMERENE HOSPITAL. IN ADDITION, THE PARTNERS INCLUDED OTHER LOCAL AND EXTERNAL COMMUNITY RESOURCES SUCH AS THE VIOLA STARTZMAN CLINIC, CENTER FOR APPALACHIA RESEARCH IN CANCER CARE AND THE HOLMES COUNTY COMMISSIONERS. THE PARTNERS SOLICITED INPUT AND RESPONSES FROM MEMBERS OF THE COMMUNITY BY CONDUCTING FOCUS GROUPS AND MEETINGS TO DISCUSS THE SURVEY DATA RESULTS IN ORDER TO DEVELOP STRATEGIES TO ADDRESS THE HEALTH AND WELLNESS ISSUES FACING THE HOLMES COUNTY COMMUNITY. COLLECTIVELY, THE PARTNERS CONDUCTED ONGOING AND FREQUENT MEETINGS TO ANALYZE, DISCUSS AND DEVELOP EACH UNDERLYING COMMUNITY HEALTH ASSESSMENT INITIATIVE. AS EACH COMMUNITY INITIATIVE WAS ENACTED FOLLOW UP MEETINGS BY THE PARTNERS WERE CONDUCTED TO RECORD AND TRACK RESULTS AND PROGRESS ON EACH PROJECT. POMERENE HOSPITAL PART V, SECTION B, LINE 6B: HOLMES COUNTY HEALTH DISTRICT POMERENE HOSPITAL PART V, SECTION B, LINE 11: THE 2017 HOLMES COUNTY HEALTH ASSESSMENT IDENTIFIED FIVE PRIMARY NEEDS: HEALTHCARE ACCESS, HEALTH BEHAVIORS, CHRONIC DISEASE, SOCIAL CONDITIONS AND YOUTH HEALTH. POMERENE HOSPITAL IS ADDRESSING FOUR OUT OF FIVE OF THE HEALTHCARE ASSESSMENT PRIMARY NEED CATEGORIES BY UNDERTAKING A LEAD ROLE ON SEVERAL PROJECT/INITIATIVES WITHIN EACH CATEGORY. POMERENE HOSPITAL DECIDED NOT TO PURSUE THE PRIMARY NEED OF SOCIAL CONDITIONS. THE SOCIAL CONDITIONS NEED (I.E. SOCIAL DETERMINANTS OF HEALTH) INCLUDES ECONOMIC STABILITY, EDUCATION, SOCIAL AND COMMUNITY CONTEXT, HEALTH AND HEALTH CARE, AND NEIGHBORHOOD AND BUILD ENVIRONMENT. POMERENE DID NOT DEVELOP AN INITIATIVE WITHIN THE SOCIAL DETERMINANTS OF HEALTH CATEGORIES BECAUSE:- ECONOMIC STABILITY - MEDIAN HOUSEHOLD INCOME IN HOLMES COUNTY ($58,728) IS HIGHER THAN THE STATE AND FEDERAL MEDIAN HOUSEHOLD INCOME LEVELS IN ADDITION, THE HOLMES COUNTY UNEMPLOYMENT RATE WAS 3.9% WHICH IS LOWER THAN THE STATE AND FEDERAL UNEMPLOYMENT RATES. - EDUCATION - 58% OF HOLMES COUNTY ADULTS 25 YEARS AND OLDER HAVE AT LEAST A HIGH SCHOOL DIPLOMA AND CULTURALLY, FIFTY PERCENT (50%) OF THE ENTIRE HOLMES COUNTY POPULATION (ANABAPTIST/AMISH) ONLY ATTEND SCHOOL UNTIL THE COMPLETION OF 8TH GRADE.- SOCIAL AND COMMUNITY CONTEXT POMERENE DOES NOT MAINTAIN PROFESSIONAL STAFF SUCH AS LAW ENFORCEMENT AND LEGAL EXPERTISE TO ADDRESS VARIOUS FORMS OF INDIVIDUAL/FAMILY ABUSE; POMERENE ALREADY PROVIDES TRANSPORTATION FOR PATIENTS WHO RECEIVE HEALTHCARE SERVICES AT ONE OF OUR FACILITIES. - HEALTH AND HEALTH CARE 24% OF HOLMES COUNTY RESIDENTS WERE CLASSIFIED AS UNINSURED, BUT FIFTY PERCENT (50%) OF THE TOTAL POPULATION PARTICIPATE IN COMMUNITY-BASED FINANCIAL SUPPORT PROGRAMS UNDERTAKEN BY THE ANABAPTIST/AMISH COMMUNITY. THE AMISH COMMUNITY COLLECTIVELY CONTRIBUTES TOWARDS THE COST OF HEALTHCARE SERVICES UTILIZED BY ITS COMMUNITY MEMBERS.- NEIGHBORHOOD AND BUILD ENVIRONMENT POMERENE DOES NOT MAINTAIN PROFESSIONAL STAFF SUCH AS LAW ENFORCEMENT NECESSARY TO ADDRESS FIREARMS; THE ANABAPTIST COMMUNITY (50% OF THE TOTAL POPULATION) DOES NOT USE ELECTRONIC DEVICES SUCH AS CELL PHONES, NOR DO THEY DRIVE MOTORIZED VEHICLES.POMERENE HOSPITAL DID UNDERTAKE THE FOLLOWING INITIATIVES AIMED TOWARDS IMPROVING THE OVERALL HEALTH OF THE RESIDENTS OF HOLMES COUNTY:- HEALTHCARE ACCESS RECRUIT AND EMPLOY PROVIDERS TO ADDRESS KEY HEALTH CONDITIONS OR PROVISION OF CARE "GAPS" IDENTIFIED WITHIN ADULT MEDICINE, WOMEN'S HEALTH, FAMILY MEDICINE, CARDIOLOGY AND OCCUPATIONAL MEDICINE.- EXPAND SERVICES CHRONIC CARE MANAGEMENT, OUTPATIENT UTILIZATION AND CASE MANAGEMENT, EXTENDED CARE SERVICES, DIABETIC EDUCATION, CORPORATE WELLNESS/PREVENTION, OUTPATIENT PRIMARY CARE PROVIDER OFFICES AND INPATIENT HOSPITAL-BASED CARDIOLOGY SERVICES. - COMMUNITY BASED SUPPORT FOR PHYSICAL ACTIVITY DEVELOPED A COMMUNITY WALKING PROGRAM; DEVELOPED A YOUTH SUMMER ACTIVITY PROGRAM ("CAMP") INCORPORATING PLAY, PHYSICAL EXERCISE AND NUTRITION EDUCATION; BEGIN OFFERING AN ADULT MOVEMENT AND TAI CHI CLASS WITHIN POMERENE'S KINETICS FITNESS FACILITY; - NUTRITION EDUCATION AND HEALTHY CHOICE PROGRAM INTRODUCED A "HEALTHY" FOOD CHOICE OPTION WITHIN A LOCAL SCHOOL CONCESSION STAND OFFERINGS.- ORGANIZED AND CONDUCTED TRAINING AND EDUCATION FOR ER AND PRIMARY CARE PROVIDERS AND STAFF ON MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES AND AVAILABLE RESOURCES.- CONDUCTED RESEARCH AND EVALUATION OF POTENTIAL TELEMEDICINE PROVIDERS FOR POMERENE HOSPITAL OUTBUILDINGS AND SERVICES IN ORDER TO IMPROVE ACCESS AND CONTINUITY OF CARE.- PARTICIPATED IN MULTIPLE COMMUNITY-BASED EVENTS ("FAIRS") FOCUSING UPON HEALTH CONDITIONS WITHIN HOLMES COUNTY, AVAILABLE RESOURCES AND PROVIDERS AS WELL AS PROVIDING EDUCATION MATERIALS. POMERENE HOSPITAL: SCHEDULE H, PART V, LINE 7A:HTTPS://WWW.POMERENEHOSPITAL.ORG/ABOUT-US/COMMUNITY-CARE POMERENE HOSPITAL: SCHEDULE H, PART V, LINE 10:HTTPS://WWW.POMERENEHOSPITAL.ORG/ABOUT-US/COMMUNITY-CARE PART I, LINE 3C: IN ADDITION TO FPG, POMERENE HOSPITAL USES THE FOLLOWING METHODS TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY. PART I, LINE 7: POMERENE HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2 AND A COST ACCOUNTING SYSTEM (MEDLINK). THE ORGANIZATION'S SYSTEM CALCULATES COST BASED ON PATIENT TYPE AND FINANCIAL CLASS. PART II, COMMUNITY BUILDING ACTIVITIES: THESE ACTIVITIES PROVIDE FREE TRANSPORTATION TO THE HOSPITAL FOR HEALTH SERVICES. THESE ACTIVITIES ALSO PROVIDE EDUCATION TO IMPROVE OUR COMMUNITY'S HEALTH DECISIONS. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE ORGANIZATION'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THE 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 ORGANIZATION 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 THIRDPARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTY THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, 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 ORGANIZATION 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.THE DECEMBER 31, 2019 AND 2018 ALLOWANCE FOR DOUBTFUL ACCOUNTS OF APPROXIMATELY $1,217,000 AND $1,197,000, RESPECTIVELY, RELATES TO RESERVES FOR SELF-PAY BALANCES. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON A PERCENTAGE OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2019 AND 2018. THE ORGANIZATION'S SELF-PAY WRITE-OFFS INCREASED $17,436 FROM $2,120,102 FOR 2018 TO $2,137,538 FOR 2019. THE ORGANIZATION HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2019 OR 2018. THE ORGANIZATION DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS. PART III, LINE 3: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND UNDER THE HEADING 'PATIENT CARE SERVICE REVENUE' STARTING ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 12/31/19 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. THE ORGANIZATION DOES NOT CONSIDER MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. PART III, LINE 9B: WHEN A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FAP BASED UPON A PRIOR FAP ELIGIBILITY DETERMINATION OR DUE TO INFORMATION ACQUIRED FROM A THIRD-PARTY (I.E. SOMEONE OTHER THAN THE PATIENT OR HIS/HER REPRESENTATIVE) AND THE ELIGIBILITY DETERMINATION IS FOR LESS THAN THE MOST GENEROUS ASSISTANCE AVAILABLE UNDER THE FAP, POMERENE WILL DO THE FOLLOWING BEFORE INSTITUTING ANY ECA:- NOTIFY THE PATIENT (VIA A BILLING STATEMENT) OF THE BASIS FOR THE PRESUMPTIVE ELIGIBILITY DETERMINATION AND HOW TO APPLY FOR MORE GENEROUS ASSISTANCE;- PROVIDE THE PATIENT A REASONABLE PERIOD OF TIME (NOT LESS THAN 90 DAYS FROM THE FIRST BILLING STATEMENT) TO APPLY FOR MORE GENEROUS ASSISTANCE BEFORE INSTITUTING AN ECA TO OBTAIN PAYMENT OF THE DISCOUNTED AMOUNT OWED; AND- IF THE PATIENT SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE, MEET THE REQUIREMENTS FOR NOTICE OF ELIGIBILITY DETERMINATIONS OF COMPLETE APPLICATIONS SET FORTH BELOW. PART VI, LINE 2: POMERENE HOSPITAL CONDUCTS ONGOING, INTERMITTENT AND ANNUAL RESEARCH, DATA GATHERING, ANALYZING OF LARGE QUANTITIES OF DATA AND METRICS REGARDING LOCAL HOLMES COUNTY AND SURROUNDING COMMUNITIES AS WELL AS EXTERNAL COMPARISON DATA FROM STATE, REGION AND FEDERAL SOURCES. POMERENE ATTEMPTS TO BUILD A COMPREHENSIVE PERSPECTIVE AND VIEW TOWARDS LOCAL, STATE AND NATIONAL ECONOMIC, SOCIAL, ENVIRONMENTAL, HEALTHCARE AND FINANCIAL CONDITIONS AND TRENDS IN ORDER TO POSITIVELY IMPROVE DECISION MAKING AND STRATEGIC PLANNING. EXAMPLES OF INTERNAL AND EXTERNAL DATA SOURCES POMERENE MAY USE ARE: CENTERS FOR MEDICARE AND MEDICAID (CMS), OHIO HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, TRUVEN, MOODY'S AND STANDARD AND POOR'S, HOLMES COUNTY HEALTH DISTRICT, OHIO DEPARTMENT OF HEALTH AS WELL AS HEALTHCARE INDUSTRY RESEARCH. AS MEMBERS OF AN ACO AND OTHER COLLECTIVE HEALTHCARE ORGANIZATIONS, POMERENE ALSO RECEIVES POPULATION-BASED DATA AND ACTIVITY. LAST, POMERENE COLLECTS INTERNAL COMMUNITY AND PATIENT DATA FROM SERVICES PROVIDED TO THE COMMUNITY, CONDUCTING COMMUNITY HEALTH TALKS AND EDUCATION, CONDUCTING COMMUNITY-BASED FOCUS GROUPS, REFERRAL-BASED DATA, COLLABORATING WITH LOCAL INDEPENDENT PROVIDERS AND COMMUNITY AGENCIES AS WELL AS THE POMERENE CARE TEAM WHICH IS A MULTI-DISCIPLINE TEAM OF HEALTHCARE PROVIDERS, STAFF AND ORGANIZATION LEADERS WHO ANALYZE DATA TO HELP IMPROVE THE QUALITY, SAFETY AND EFFICIENCY OF PATIENT CARE WITHIN POMERENE. PART VI, LINE 3: OUR ORGANIZATION VISITS PATIENTS WHO ARE IN THE ED, UNDER OBSERVATION, OR INPATIENT TO DISTRIBUTE PACKETS CONTAINING FINANCIAL ASSISTANCE ELIGIBILITY INFORMATION. ADMISSIONS IS TRAINED TO HAND OUT THESE PACKETS. THE FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE ON THE ORGANIZATION'S WEBSITE FOR EASY ACCESS. ADDITIONALLY, SIGNS ARE POSTED IN ALL PATIENT AREAS AND BUSINESS OFFICES THAT DETAIL WHO TO CONTACT FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: HOLMES COUNTY IS ONE OF 88 COUNTIES LOCATED WITHIN THE STATE OF OHIO. THE GEOGRAPHIC FOOTPRINT CONSISTS OF 423 SQ MILES OF RURAL LAND WHICH PRIMARILY SUPPORTS AGRICULTURE, MANUFACTURING, TRADE AND PUBLIC ADMINISTRATION INDUSTRIES. ACCORDING TO THE U.S. CENSUS BUREAU (2018) THE POPULATION OF HOLMES COUNTY IS APPROXIMATELY 43,892. POPULATION AND DEMOGRAPHIC CHARACTERISTICS OF HOLMES COUNTY ARE: FEMALE (49%)/MALE (51%); MEDIAN AGE OF 30.8 (UNDER 18 (33%), 18-64 (55%) AND 65+ (13%)) WHICH IS LESS THAN THE OHIO AVERAGE OF 39.3; CULTURAL DIVERSITY NEARLY 50/50 BETWEEN ENGLISH AND ANABAPTIST/AMISH; RACE AND ETHNICITY PRIMARILY WHITE (98.6%) FOLLOWED BY BLACK/AFRICAN AMERICAN (0.4%), AMERICAN INDIAN (0.1%), ASIAN (0.2%), HISPANIC (1.0%) AND TWO OR MORE RACES (0.6%); EDUCATION DISTRIBUTION OF NO DEGREE (42%), HIGH SCHOOL (35%), SOME COLLEGE (15%), BACHELORS (6%), POST GRADUATE (2%) UP TO MIDDLE SCHOOL LEVEL (53%); MEDIAN HOUSEHOLD INCOME OF $58,728 (PER CAPITA INCOME $21,143) WITH 12-13% OF THE POPULATION LIVING IN POVERTY; PERSONS WITHOUT HEALTH INSURANCE 24% AND PERSONS WITH MEDICAID 14%; AND, MORE THAN 52% OF HOUSEHOLDS ARE WITHOUT A BROADBAND INTERNET SUBSCRIPTION.HOLMES COUNTY, OHIO CONTAINS ONE HOSPITAL, POMERENE HOSPITAL, THAT IS LOCATED IN THE TOWN OF MILLERSBURG AND SERVES THE ENTIRE COUNTY INCLUDING SURROUNDING CONTIGUOUS COMMUNITIES. HOLMES COUNTY IS DESIGNATED BY CMS AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AS WELL AS A MEDICARE LOW VOLUME COMMUNITY. POMERENE IS CURRENTLY WORKING TO OBTAIN A RURAL HEALTHCARE CLINIC (RHC) FOR ITS POMERENE FAMILY CARE OFFICE LOCATED IN MILLERSBURG, OHIO. PART VI, LINE 5: POMERENE HOSPITAL'S MISSION IS "CARING FOR OUR COMMUNITIES HEALTH." THE POMERENE BOARD UNDERTAKES AN ACTIVE ROLE IN ITS RESPONSIBILITY TO PROVIDE OVERSIGHT AND APPROVAL OF THE ORGANIZATIONS MISSION AND ITS STRATEGIC DIRECTION AND PLAN. POMERENE ADHERES TO MAINTAINING SEVENTY-FIVE PERCENT (75%) OF ITS GOVERNING BOARD OF DIRECTORS SHOULD RESIDE WITHIN THE BORDERS OF HOLMES COUNTY, OHIO. DURING 2019 ALL 11 MEMBERS OF THE BOARD CONSISTED OF INDIVIDUALS WHO RESIDED WITHIN HOLMES COUNTY. MEMBERSHIP OF THE POMERENE BOARD INCLUDES REPRESENTATION FROM BOTH PRIMARY CULTURAL DEMOGRAPHIC SEGMENTS OF HOLMES COUNTY, ANABAPTIST/AMISH (25%) AND NON-ANABAPTIST/ENGLISH (75%). BOARD MEMBERSHIP CONSISTED OF A DIVERSE LIST OF PERSONAL AND PROFESSIONAL BACKGROUNDS SUCH AS AN ATTORNEY, FORMER EDUCATOR, DIRECTOR OF A POST-ACUTE HEALTHCARE FACILITY, LOCAL BUSINESS OWNERS, NON-PROFIT DIRECTOR, PREVIOUS NURSE, LOCAL COMMUNITY TOURISM DIRECTOR, HUMAN RESOURCES, CORPORATE AND EMPLOYEE SAFETY MANAGER, ETC.ONE OF POMERENE'S SIX STRATEGIC INITIATIVES WAS "DEVELOP POPULATION HEALTH MODEL FOR POMERENE HOSPITAL AND HOLMES COUNTY." KEY OBJECTIVES WERE TO DEFINE AN INTERNAL/EXTERNAL HEALTH RISK PROFILE FOR EMPLOYEES AND DISTINCT POPULATION OF HOLMES COUNTY; DELIVER POPULATION HEALTH CARE MANAGEMENT TO POMERENE EMPLOYEES; EXPAND POPULATION HEALTH INITIATIVES TO COMMUNITY POPULATIONS. INDIVIDUAL PROJECTS CONSISTED OF DEVELOPING AN ANNUAL PLAN FOR EMPLOYEE WELLNESS ACTIVITIES AND SERVICES (SUCH AS DIABETIC EDUCATION) BASED UPON THE EMPLOYEE RISK PROFILE, BIOMETRIC RESULTS AND HEALTH PLAN CLAIM ACTIVITY. PROVIDE CORPORATE WELLNESS/PREVENTION SERVICES TO LOCAL HOLMES COUNTY EMPLOYERS. INTEGRATE AND OPERATE CARDIAC REHABILITATION AND PHYSICAL THERAPY SERVICES WITHIN KINETICS, WHICH IS POMERENE'S MEDICAL FITNESS FACILITY. DEVELOP AND OPERATE OCCUPATIONAL MEDICINE SERVICES TO MEET THE NEEDS OF HOLMES COUNTY EMPLOYERS. PARTICIPATE IN ACO-LIKE ORGANIZATIONS TO COORDINATE PRIMARY AND POST-ACUTE PATIENT CARE DELIVERY. CONDUCT UTILIZATION REVIEW AND CASE MANAGEMENT WITHIN POMERENE FAMILY CARE OFFICE SETTING.THE PROVISION OF PATIENT CARE ASSOCIATED WITH POMERENE HOSPITAL WAS DELIVERED BY MORE THAN NINETY-SIX (96) PROVIDERS CONSISTING OF HOSPITAL AND NON-HOSPITAL-BASED, EMPLOYED AND INDEPENDENT, PHYSICIANS AND ADVANCED PRACTICE PROVIDERS, AS WELL AS PRIMARY CARE AND SPECIALISTS. THE HOSPITAL REINVESTED NEARLY 25% OF ITS ANNUAL EBITDA OF $4.2 MILLION ($900,000) IN CAPITAL IMPROVEMENTS SUCH AS PATIENT CARE (53%), INFORMATION TECHNOLOGY (27%), FACILITY (6%), POPULATION HEALTH/MEDICAL GROUP (5%) AND ADMINISTRATIVE (9%). POMERENE PROVIDED APPROXIMATELY $2.4 MILLION IN UNCOMPENSATED CARE FOR HOLMES COUNTY AND THE SURROUNDING COMMUNITIES IT SERVES. POMERENE DONATED IN EXCESS OF $34,000 TO LOCAL COMMUNITY AGENCIES AND CHARITABLE ORGANIZATIONS. AS WELL AS INTRODUCED NEW SERVICE PROGRAMS AIMED AT COMMUNITY HEALTH NEEDS SUCH AS CHRONIC CARE MANAGEMENT, DIABETIC EDUCATION, EXTENDED CARE SERVICES AND NUTRITIONAL COUNSELING. 0 HOLMES COUNTY ECONOMIC DEVELOPMENT 2 COURT STREET SUITE 16 MILLERSBURG OH 44654 352257820 GOV'T ENTITY 5000 CONTRIBUTION FOR ECONOMIC DEVELOPMENT IN HOLMES COUNTY 1 X X X X X 0 0 0 0 0 0 0 0 0 TONY SNYDER CEO-TERM ENDED 08/'19 254460 0 0 0 0 0 0 0 0 0 254460 0 0 0 JASON JUSTUS CFO TO CEO 09/'19 258293 0 0 0 0 0 0 0 0 0 258293 0 0 0 EUGENE KOSER ANESTHESIOLOGIST 354670 0 0 0 0 0 0 0 0 0 354670 0 0 0 DR MICHAEL T SCHELL PHYSICIAN 381165 0 0 0 0 0 0 0 0 0 381165 0 0 0 DR LEON MILLER PHYSICIAN 345096 0 0 0 0 0 0 0 0 0 345096 0 0 0 DR ROHINI KALISETTI PHYSICIAN 230719 0 0 0 0 0 0 0 0 0 230719 0 0 0 DR YASSER OMRAN HEAD OF MEDICAL STAFF 266324 0 0 0 0 0 0 0 0 0 266324 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. THE GOVERNING BODY RECEIVES AN ELECTRONIC COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C UPON APPOINTMENT, AND THEREAFTER ANNUALLY, THROUGH SIGNED ACKNOWLEDGEMENT OF THE CONFLICT OF INTEREST AGREEMENT, OR AT THE TIME WHEN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MAY ARISE, THE COVERED PERSON MUST IDENTIFY AND DISCLOSE AT ANY MEETING ALL MATERIAL FACTS AND DETAILS RELATING TO THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST SO THAT THE DISINTERESTED POMERENE DECISION MAKERS ARE ABLE TO MAKE AN OBJECTIVE BUSINESS DETERMINATION CONSISTENT WITH POMERENE'S MISSION AND PURPOSE. ANY COVERED PERSON WITH AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MUST NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE WITH RESPECT TO ANY VOTE OR ACTION TAKEN BY POMERENE DECISION MAKERS VOTING ON THE PROPOSED MATTER, CONTRACT, TRANSACTION OR BUSINESS ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES CONDUCTS A PERIODIC REVIEW OF THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE AND COMPENSATION DURING AN EXECUTIVE SESSION OF THE BOARD. THE CEO CONDUCTS AN ANNUAL REVIEW OF THE PERFORMANCE AND COMPENSATION FOR EACH OTHER KEY EMPLOYEE (CFO, CNO, OTHER KEY LEADERSHIP PERSONNEL). THE CEO'S SALARY RECOMMENDATIONS ARE PRESENTED INFORMATIONALLY TO THE EXECUTIVE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,384,658. MANAGEMENT AND GENERAL EXPENSES 1,227,222. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,611,880. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 70,794. MANAGEMENT AND GENERAL EXPENSES 2,151,294. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,222,088. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. POMERENE HEALTH FOUNDATION 981 WOOSTER RD MILLERSBURG OH 44654 475317369 FUNDRAISING FOR HOSPITAL OH 501(C)(3) LINE 12B, II POMERENE HOSPITAL 1 HEALTH PROFESSIONALS OF HOLMES COUNTY 981 WOOSTER RD MILLERSBURG OH 44654 300329769 LEASING OF PROFESSIONAL SERVICES OH 501(C)(3) LINE 10 POMERENE HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0