2025-10-14T16:05:28-05:00 2024-12-31 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2024-01-01 382796005 EMMA L BIXBY MEDICAL CENTER EMMA 4192525772 100 MADISON AVE ATTN TAX DEPARTM TOLEDO OH 43604 TERRENCE METZGER CFO 4192525772 2025-10-09 1 1 AMY CIMINELLO P00796388 6148493000 2025-10-09 2024 2025-03-06 01:10:19Z PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL TERRENCE METZGER 100 MADISON AVE ATTN TAX DEPARTMENT TOLEDO OH 43604 156099363 0 X WWW.PROMEDICA.ORG X 1989 MI PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL IS AN ACUTE CARE HOSPITAL THAT PROVIDES HEALTHCARE SERVICES PRIMARILY TO INDIVIDUALS OF LENAWEE COUNTY. 18 12 670 70 0 0 972844 1326738 132915911 154139706 72831 -215687 1645707 587943 135607293 155838700 0 0 0 0 38765650 39525272 0 0 0 91537385 88636542 130303035 128161814 5304258 27676886 202967096 189644112 169385389 65492272 33581707 124151840 X EMMA L. BIXBY MEDICAL CENTER IS DEDICATED TO IMPROVING HUMAN LIFE AND DEVOTED TO THE PATIENTS AND FAMILIES WE SERVE THROUGH INNOVATIVE CARE, SUPERIOR QUALITY, AND PREMIER CUSTOMER SERVICE. 0 0 111946849 0 154139706 EMMA L. BIXBY MEDICAL CENTER IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. FOUNDED IN 1911, EMMA L. BIXBY MEDICAL CENTER (D/B/A PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL CONTINUES TO MEET THE HEALTHCARE NEEDS OF ADRIAN, MICHIGAN AND SURROUNDING SOUTHEAST MICHIGAN COMMUNITIES AS THE LARGEST ACUTE CARE FACILITY IN LENAWEE COUNTY. IT IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 28 COUNTIES ACROSS NORTHWEST OHIO AND SOUTHEAST MICHIGAN. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS, AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE HEALTH CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL (CVHH) IS A 50-BED, FULL-SERVICE, ACUTE CARE HOSPITAL STAFFED BY MORE THAN 120 ACTIVE PROVIDERS WORKING TO MEET IDENTIFIED NEEDS OF THE COMMUNITY. THE FACILITY IS MORE THAN 200,000 SQUARE FEET, CONSISTING OF 40 MEDICAL-SURGICAL BEDS, 10 CRITICAL CARE BED, FOUR OPERATING ROOMS WITH THREE MINOR PROCEDURE ROOMS, 27 EMERGENCY ROOMS AND EIGHT LABOR AND DELIVERY ROOMS AS WELL AS A FULL ARRAY OF DIAGNOSTIC SERVICES. THE HOSPITAL ALSO PROVIDES NUMEROUS INPATIENT AND OUTPATIENT SERVICES, WITH ITS STAFF OF PROFESSIONALS OFFERING CARE IN GENERAL SURGERY, HEART AND VASCULAR CARE, WOMEN'S HEALTH, ORTHOPAEDICS, PEDIATRICS, FAMILY MEDICINE, CRITICAL CARE, AND CANCER TREATMENT SERVICES. IN 2024, CVHH SERVED 10,313 INPATIENTS; 80,126 OUTPATIENTS; AND 28,983 EMERGENCY CENTER PATIENTS. THE HICKMAN CANCER CENTER IS ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS. AS PART OF THE PROMEDICA CANCER INSTITUTE, HICKMAN CANCER CENTER OFFERS DIAGNOSTIC SERVICES, AS WELL AS RADIATION AND MEDICAL ONCOLOGY TREATMENT FOR HUNDREDS OF NEW PATIENTS ANNUALLY. AS A MEMBER OF THE TOLEDO COMMUNITY HOSPITAL ONCOLOGY PROGRAM, HICKMAN CANCER CENTER OFFERS PATIENTS THE OPPORTUNITY TO PARTICIPATE IN NATIONAL CANCER TRIALS. FURTHER, THE HOSPITAL IS RECOGNIZED BY THE CHARTIS TOP QUARTILE PERFORMERS AS A PERFORMANCE LEADERSHIP AWARDEE. CVHH OFFERS TELEMEDICINE SERVICE TO ITS INPATIENT CARE UNITS TO HELP PROVIDE REAL-TIME PATIENT DIAGNOSIS AND TREATMENT FROM A PHYSICIAN. THE SERVICE ALLOWS A DOCTOR'S VISIT TO BE CONDUCTED WITH A SPECIAL COMPUTER AND INTERNET CONNECTION AND HELPS THE HOSPITAL PROVIDE SAFE, QUALITY CARE WHEN IT'S NEEDED DURING NIGHT SHIFTS WHEN FEWER PHYSICIANS MAY BE AVAILABLE. CVHH HAS ALSO RECEIVED THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES GOLD PLUS ACHIEVEMENT FOR ITS COMMITMENT TO ENSURING STROKE PATIENTS RECEIVE THE MOST APPROPRIATE TREATMENT ACCORDING TO NATIONALLY RECOGNIZED STANDARDS OF CARE.THE HOSPITAL CONTRIBUTED $25,034,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE IN 2024. THROUGH COMMUNITY HEALTH SERVICES, HEALTH PROFESSIONAL EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH ACTIVITIES, CASH AND IN-KIND CONTRIBUTIONS, AND COMMUNITY BENEFIT OPERATIONS, CVHH CONTRIBUTED $596,000 TO THE COMMUNITY DURING 2024. EXAMPLES OF PROGRAMS SERVING COMMUNITY INCLUDE FOOD SECURITY PROGRAMS PROVIDING FOOD AT DISCHARGE AND OUT IN THE COMMUNITY THROUGH PROMEDICA, FARMS, VEGGIE MOBILE AND PARTNERSHIP WITH THE SOUTH MICHIGAN FOOD BANK; COMPLEMENTARY TRANSPORTATION AT DISCHARGE FOR PATIENTS WITH TRANSPORTATION AND FINANCIAL BARRIERS; SUPPORT GROUPS FOR INDIVIDUALS WITH CHRONIC DISEASES, FOCUSED ON PATIENTS' EMOTIONAL, PHYSIOLOGICAL AND PSYCHOLOGICAL NEEDS; CHILDHOOD AND ADULT IMMUNIZATIONS AND ASTHMA CARE; COMMUNITY HEALTH AND WELLNESS SERVICES, WHICH INCLUDED TOBACCO CESSATION PROGRAMS, NUTRITION AND HEALTHY LIFESTYLES CLASSES, PRENATAL CLASSES; COLLABORATION WITH THE UNITED WAY OF MONROE AND LENAWEE COUNTIES HEALTH CHECK EVENTS AND COLLECTION AND RESPONSIBLE DISPOSAL OF UNUSED MEDICATIONS THROUGH TWO COMMUNITY TAKE BACK EVENTS AND MEDSAFE COLLECTION BINS WITH THE EMERGENCY DEPARTMENT.CVHH PROVIDED A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO THE COMMUNITY DURING 2024, OF WHICH $7,703,000 REPRESENTED UNCOMPENSATED AMOUNTS FOR TREATMENT TO THOSE PATIENTS WHO DID NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR HOSPITAL SERVICES. FINANCIAL ASSISTANCE REPRESENTS THE COST TO PROVIDE SERVICE AND DOES NOT INCLUDE THE COSTS FOR ACCOUNTS WRITTEN OFF TO BAD DEBT FOR PATIENTS WHO DO NOT PAY THEIR BILLS. CVHH'S COST OF BAD DEBT FOR 2024 WAS $6,214,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $523,000 NOTED ABOVE.FURTHER, CVHH PROVIDED $1,369,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. CVHH PROVIDED 476 JOBS THROUGH DIRECT EMPLOYMENT IN 2024, EXPENDING $37,133,000 IN NET PAYROLL. A TOTAL OF $2,392,000 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES. IN SUMMARY, CVHH DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. AND WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL CLASSES, HEALTH FAIRS AND OTHER OUTREACH ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. 111946849 1 1 0 1 0 0 0 0 0 1 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 1 0 0 0 0 0 1 1 1 0 0 0 1 X 0 0 670 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X TERRENCE METZGER 4192525772 100 MADISON AVE TOLEDO OH 43604 X MIKE ADAMS CHAIRPERSON 1.00 16.00 X X 0 0 0 CHRISTI ANSBERG TRUSTEE/CHIEF PHILATHROPY OFFICER 1.00 44.00 X 0 246354 4057 DARRIN ARQUETTE TRUSTEE/PRESIDENT - MONROE 1.00 44.00 X 0 640902 10194 MELISSA BAER TRUSTEE/PHYSICIAN 1.00 44.00 X 0 434958 14405 MARCY BROWN TRUSTEE 1.00 16.00 X 0 0 0 DAWN BUSKEY TRUSTEE/CHIEF ACUTE CARE OFFICER 1.00 44.00 X 0 1340164 14772 MARSHA DAVIS TRUSTEE 1.00 0.00 X 0 0 0 DAVID DIEP TRUSTEE/PHYSICIAN- PART YEAR 1.00 44.00 X 0 570299 1371 KATIE E MATTISON TRUSTEE 1.00 0.00 X 0 0 0 BRANDON FARVER TRUSTEE 1.00 0.00 X 0 0 0 RUDY FLORES TRUSTEE 1.00 0.00 X 0 0 0 PAUL GIETZEN TRUSTEE/PHYSICIAN 1.00 44.00 X 0 343143 13612 MARK HAAG TRUSTEE 1.00 0.00 X 0 0 0 JENNIFER HUNTER TRUSTEE 1.00 0.00 X 0 0 0 BRONNA KAHLE TRUSTEE 1.00 0.00 X 0 0 0 THOMAS KEITH TRUSTEE 1.00 0.00 X 0 0 0 GARY MCDOWELL TRUSTEE 1.00 0.00 X 0 0 0 DENNIS SMOKE TRUSTEE 1.00 0.00 X 0 0 0 JULIE YAROCH PRESIDENT 1.00 44.00 X X 0 432377 7144 TERRENCE METZGER TREASURER/CFO 1.00 54.00 X 0 1209318 6610 STEPHEN SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 1.00 54.00 X 0 1180376 6038 ARTURO POLIZZI CEO 1.00 54.00 X 0 3119320 14012 CHRISTINA BELL DIRECTOR OF PHARMACY SERVICES 45.00 0.00 X 170780 0 12134 CINNAMON BERNARDO DIRECTOR OF CLINICAL SERVICES 45.00 0.00 X 150303 0 3566 MELISSA THOMPSON STAFF PHARMACIST 45.00 0.00 X 148034 0 4678 LISA BACHMAYER PHYSICAL THERAPIST 45.00 0.00 X 139542 0 2305 SANDRA KENDZIORA RN CVH MNA 45.00 0.00 X 134941 0 2362 743600 9517211 117260 48 0 1 0 0 681868 644870 1326738 NET PATIENT SERVICES 621110 153180034 153180034 AFFILIATED ORG RENT 531120 959672 959672 154139706 44976 44976 134716 0 134716 134716 134716 260663 -260663 -260663 -260663 AUXILARY INCOME 900099 453227 453227 453227 155838700 154139706 0 372256 33146294 26208836 6937458 3986638 3152242 834396 2392340 1891628 500712 80000 80000 3654 3654 12735163 7807303 4927860 613 59 554 2170559 208067 1962492 14225 8747 5478 3685821 3575247 110574 30682 2941 27741 2893523 2893523 7519776 6695730 824046 INTERCOMPANY SERVICES 17469326 17469326 DRUGS 17072254 17072254 MEDICAL SUPPLIES 10800445 10800445 BAD DEBT EXPENSE 6214437 6214437 7946064 7946064 128161814 111946849 16214965 0 8996491 3582461 17823720 15118222 2661854 2522108 264891 273677 165233087 38676874 133289030 126556213 1531709 0 38399401 41591431 202967096 189644112 6930694 9537913 49417548 49445387 113037147 6508972 169385389 65492272 X 32798286 122732494 783421 1419346 33581707 124151840 202967096 189644112 X 27676886 62893247 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3654 3654 0 PART II-B, LINE 1: EMMA L. BIXBY MEDICAL CENTER PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, A PORTION OF WHICH IS ALLOCABLE TO LOBBYING BY THE ORGANIZATION. 22300636 2206439 -26830 24533905 20409191 1891445 22300636 24519146 -4022944 87011 20409191 22620000 1929793 30647 24519146 771892 19420909 2927199 500000 22620000 0.94215 0.05785 0.00000 0 1 1 1244583 1244583 129872319 18007711 111864608 23748 17169 6579 28839074 19731101 9107973 5253363 920893 4332470 126556213 BENEFICIAL INTEREST IN FOUNDATION 39307928 DUE FROM RELATED PARTY 1182312 RIGHT OF USE ASSET LEASE 1101191 41591431 ESTIMATED THIRD PARTY PAYOR RECEIVABLE 3792063 OPERATING LEASE LIABILITY 1068796 REMEDIATION 1648113 6508972 PART V, LINE 4: THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT EMMA L. BIXBY MEDICAL CENTER CONSISTENT WITH DONOR INTENT. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 1296470 1296470 0.01060 23142286 24511443 0 0.00000 24438756 24511443 1296470 0.01060 72 1883 62353 62353 0.00050 528727 528727 0.00430 4500 4500 0.00000 72 1883 595580 595580 0.00480 72 1883 25034336 24511443 1892050 0.01540 1 50 300 300 0.00000 5 712 1 15 180 180 0.00000 7 777 480 480 0.00000 1 6214437 138706 24751786 24247545 504241 X 1 1 1 HERRICK MEMORIAL OFFICE PLAZA CONDO ASSOCIATION FACILITY SUPPORT 0.71800 0.28200 2 LENAWEE CLINICAL PARTNERS PHYSICIAN MGMT SERVICES 0.50000 0.38460 1 1 PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL 5640 N ADRIAN HWY ADRIAN MI 49221 WWW.PROMEDICA.ORG 1060000004 X X X PROMEDICA CHARLES AND VIRGINIA HICKMAN H 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 600.000000000000 X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. FOLLOWING THE FORMAL COUNTY ASSESSMENT SURVEY PROCESS PROMEDICA CHARLES & VIRGINIA HICKMAN HOSPITAL WITH THE LENAWEE HEALTH NETWORK, COMPRISED OF MULTIPLE COMMUNITY ORGANIZATIONS, COLLABORATED TO DEVELOP A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR LENAWEE COUNTY. A RESOURCE ASSESSMENT AND GAP ANALYSIS WERE COMPILED AS PART OF THIS PROCESS.IN 2022, PROMEDICA CHARLES & VIRGINIA HICKMAN HOSPITAL CONVENED A CHNA COMMITTEE TO REVIEW THE MOST RECENT LENAWEE COUNTY CHA AND CHIP, TAKING INTO ACCOUNT THE GAP AND RESOURCE ASSESSMENTS. THE COMMITTEE THEN SELECTED AND PRIORITIZED KEY HEALTH INDICATORS FOR THEIR DEFINED COMMUNITY, IDENTIFIED RESOURCES AND GAPS IN THESE AREAS, AND DEVELOPED IMPLEMENTATION PLANS TO ADDRESS THESE PRIORITY HEALTH NEEDS IN THE COMMUNITY OVER THE NEXT THREE YEARS. THE HOSPITAL RECEIVED FEEDBACK ON THE CHNA PLAN FROM THE LENAWEE COUNTY HEALTH DEPARTMENT, TO CONFIRM THESE NEEDS FROM A COMMUNITY HEALTH EXPERT PERSPECTIVE.THE LENAWEE HEALTH NETWORK STRATEGIC PLANNING PROCESS INCLUDED INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY. COLLABORATING ORGANIZATIONS INCLUDED:CATHOLIC CHARITIES OF JACKSON, HILLSDALE, & LENAWEE COUNTIES, COMMUNITY ACTION AGENCY OF JACKSON, LENAWEE & HILLSDALE COUNTIES, CRADLE TO CAREER, FAMILY MEDICAL CENTER OF MICHIGAN, GOODWILL INDUSTRIES OF SE MICHIGAN, HEAD START, ADRIAN PUBLIC SCHOOLS, HOSPICE OF LENAWEE, INTERCONNECTIONS DROP-IN CENTER, LENAWEE COMMUNITY FOUNDATION, LENAWEE COUNTY DEPARTMENT OF VETERANS AFFAIRS, LENAWEE COUNTY HEALTH DEPARTMENT, LENAWEE COMMUNITY MENTAL HEALTH AUTHORITY, LENAWEE DEPARTMENT ON AGING, LENAWEE DEPARTMENT OF HEALTH AND HUMAN SERVICES, LENAWEE INTERMEDIATE SCHOOL DISTRICT, LENAWEE SUBSTANCE ABUSE PREVENTION COALITION, MSU-EXTENSION, ONE LENAWEE, PROMEDICA CHARLES & HICKMAN HOSPITAL, REGION 2 AREA AGENCY ON AGING, THE CARE PREGNANCY CENTER OF LENAWEE, UNITED WAY OF MONROE/LENAWEE COUNTIES, THOME PACE, YMCA OF LENAWEE COUNTY PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY CONDUCTED ITS 2022 CHNA WITH THE FOLLOWING HOSPITAL FACILITY: HERRICK MEMORIAL HOSPITAL, INC. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY CONDUCTED ITS 2022 CHNA WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PART V, SECTION B, LINE 11: EMMA L. BIXBY MEDICAL CENTER CONDUCTED AND ADOPTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2022 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - BEHAVIORAL & MENTAL HEALTH - SOCIAL DETERMINANTS OF HEALTH- CHRONIC CONDITIONS- HEALTH EQUITY THIS CHNA WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2022, THEREFORE, THESE HEALTH NEEDS WILL BE ADDRESSED OVER THE THREE TAX YEARS, 2023-2025. EMMA L. BIXBY MEDICAL CENTER DOES NOT INTEND TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT GIVEN THAT SOME OF THE IDENTIFIED HEALTH NEEDS ARE EITHER BEING ADDRESSED DURING PHYSICIAN VISITS, GO BEYOND THE SCOPE OF THE HOSPITAL, OR ARE BEING ADDRESSED BY, OR WITH, OTHER ORGANIZATIONS IN THE COMMUNITY. TO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOST IMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OF RESOURCES, MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITY ORGANIZATIONS AND COALITIONS. THE SIGNIFICANT HEALTH NEEDS IDENTIFIED, BUT SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS 2022 IMPLEMENTATION PLAN INCLUDE: OLDER ADULT SOCIAL ISOLATION, EXPANDED SERVICES FOR OLDER ADULTS, ACCESS TO HEALTHY NUTRITION, YOUTH MENTORING BY ADULTS, ACCESS TO PHYSICAL ACTIVITY IN THE COMMUNITY, SUBSTANCE ABUSE PREVENTION, TREATMENT AND RECOVERY SERVICES, TRAUMA SERVICES, AFTER SCHOOL PROGRAMS AND ACTIVITIES FOR YOUTH AND TEENS, LOW COST AND CONFIDENTIAL FAMILY PLANNING AND STD SERVICES, CASE MANAGEMENT FOR CHILDREN WITH ELEVATED LEAD LEVELS, FUNDING/SERVICES FOR HOMELESS STUDENTS, MENTORING SYSTEM FOR YOUTH, DENTAL SERVICES, AND EXPANSION OF PRIMARY CARE, DENTAL, MENTAL HEALTH, AND PREVENTATIVE HEALTH SERVICES FOR UNINSURED/UNDERINSURED PATIENTS. EMMA L. BIXBY MEDICAL CENTER DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2024 WITH RESPECT TO ITS MOST RECENT CHNA, CONDUCTED IN 2022:HEALTH NEED IDENTIFIED: BEHAVIORAL & MENTAL HEALTH STRATEGY #1 CONTINUE THE ALTERNATIVES TO OPIOIDS (ALTO) TO DECREASE THE VOLUME OF OPIOID PRESCRIPTIONS AT DISCHARGEACTIONS TAKEN: - IN 2024, THE DAYS OPIOIDS PRESCRIBED AT DISCHARGE STARTED AT 2.91 BUT ENDED THE YEAR WITH AN AVERAGE OF 2.83 DAYS. STRATEGY #2 CONVENE BIANNUAL MEETINGS WITH LEGAL REPRESENTATION, COMMUNITY MENTAL HEALTH, AND FIRST RESPONDERS TO ASSESS THE COMMUNITY NEEDS AND LINKAGES TO RESOURCES. ACTIONS TAKEN: - SIX (6) MEETINGS WERE HELD WITH COMMUNITY MENTAL HEALTH, LAW ENFORCEMENT, FIRST RESPONDERS AND THE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT OPIOID ACTION PLANNING SUPPORTING COMMUNITY NEEDS AND COLLABORATIONS FOR LINKAGES TO LOCAL RESOURCES.- THREE (3) SECTORS ATTENDED THESE MEETINGS, WHICH INCLUDE HEALTHCARE, LAW ENFORCEMENT, MENTAL HEALTH, GOVERNMENT, AND COMMUNITY MEMBERS.STRATEGY #3 UPDATE LENAWEE MENTAL HEALTH RESOURCE GUIDE ANNUALLY & DISTRIBUTE TO COMMUNITY. ACTIONS TAKEN:- THE LENAWEE MENTAL HEALTH RESOURCE GUIDE WAS UPDATED IN JUNE 2024. - 38 PAPER COPIES OF THE MENTAL HEALTH RESOURCE GUIDE WERE DISTRIBUTED. A POSTCARD WITH A QR CODE IS DISTRIBUTED SO THAT PEOPLE CAN ACCESS THE DIGITAL FILE THAT PROCESSES REAL-TIME UPDATES TO INFORMAITON WITHIN THE DOCUMENT. STRATEGY #4 LAUNCH AND CONTINUE NALOXONE DISTRIBUTION PROGRAM IN THE EMERGENCY DEPARTMENT & EDUCATION WITH LOCAL LAW ENFORCEMENT. ACTIONS TAKEN:- ELEVEN (11) PATIENTS RECEIVED NALOXONE IN THE EMERGENCY DEPARTMENT. STRATEGY #5 CONTINUE HOSTING DRUG TAKE BACK DAY EVENTS AND THE MEDSAFE DISPOSAL SITE IN THE EMERGENCY DEPARTMENT FOR MEDICATION DISPOSAL ACTIONS TAKEN:- 468.5 POUNDS OF UNUSED MEDICATIONS WERE COLLECTED AND DISPOSED OF RESPONSIBLY THROUGH THE HOSPITAL'S MEDSAFE COLLECTION SITE. - 1410 POUNDS OF UNUSED MEDICATIONS, SHARPS, INHALERS, AND LIQUIDS WERE COLLECTED AND DISPOSED OF RESPONSIBLY THROUGH DEA APPROVED DRUG TAKE BACK DAY EVENTS AT THE HOSPITAL IN APRIL AND OCTOBER. - 468 COMMUNITY MEMBERS PARTICIPATED IN DISPOSING OF THEIR MEDICATIONS IN DRUG TAKE BACK DAY EVENTS IN 2024. HEALTH NEED IDENTIFIED: SOCIAL DETERMINANTS OF HEALTH STRATEGY #1 CONTINUE PARTNERSHIP WITH MICHIGAN TRANSPORTATION CONNECTION TO PROVIDE COMPLEMENTARY TRANSPORT TO PATIENTS AT DISCHARGE, WITH INSECURITY. ACTIONS TAKEN: - 214 PATIENTS WERE PROVIDED WITH TRANSPORTATION AT DISCHARGE THROUGH PARTNERSHIP WITH MICHIGAN TRANSPORTATION CONNECTION IN 2024. STRATEGY #2 REFER PATIENTS TO RESOURCES ADDRESSING SOCIAL DETERMINANTS OF HEALTH (FINANCIAL STRAIN, FOOD INSECURITY). ACTIONS TAKEN: - 21 PATIENTS SCREENING POSITIVE FOR FOOD INSECURITY RECEIVED FOOD AT DISCHARGE. - SEVEN (7) EMPLOYEES EXPERIENCING GFOOD INSECURITY RECEVIED FOOD IN 2024. - 317 PATIENTS WERE REFERRED TO THE FINANCIAL OPPORTUNITY CENTER TO WORK DIRECTLY WITH A FINANCIAL COACH. - THROUGH CONTINUED COLLABORATION WITH COMMUNITY ACTION AGENCY, 29 NO-COST AND EVIDENCE-BASED FINANCIAL LITERACY WORKSHOPS WERE OFFERED TO THE COMMUNITY IN 2024. INFORMAITON ABOUT WORKSHOPS IS SHARED WITH PATIENTS THROUGH CARE NAVIGATION AND THE ADRIAN EBEID NEIGHBORHOOD PROMISE. STRATEGY #3 REFER PATIENTS TO REGION 2 AAA EVIDENCE-BASED PROGRAMS PROMOTING HEALTHY AGING (FRIENDLY REASSURANCE, AND PERSONAL ACTIONS TOWARD HEALTH).ACTIONS TAKEN:- THROUGH COLLABORATION WITH WELLWISE SERVICES AREA AGENCY ON AGING, 14 NO-COST AND EVIDENCE-BASED WORKSHOPS WERE OFFERED TO THE COMMUNITY, WHICH INCLUDED PERSONAL ACTION TOWARD HEALTH, MATTER OF BALANCE, SUPPORT GROUPS, AND CONVERSATION CAF'S. INFORMATION ABOUT WORKSHOPS IS SHARED WITH PATIENTS THROUGH CARE NAVIGATION, THE ADRIAN EBEID NEIGHBORHOOD PROMISE, AND THE LENAWEE HEALTH NETWORK.STRATEGY #4 CONTINUE FARM AND VEGGIE MOBILE PROGRAM TO PROVIDE ACCESS TO FRESH PRODUCE AND GARDENING EDUCATION. ACTIONS TAKEN: - 2567 COMMUNITY MEMBERS WERE SERVED WITH FRESH PRODUCE THROUGH THE VEGGIE MOBILE IN 2024. - 11 VOUCHERS FOR FRESH PRODUCE WERE REDEEMED BY PATIENTS SCREENING POSITIVE FOR FOOD INSECURITY AT HOSPITAL DISCHARGE AND REFERRING PHYSICIAN OFFICES.- 36 GARDENING WORKSHOPS SERVED 158 COMMUNITY MEMBERS IN 2024.HEALTH NEED IDENTIFIED: CHRONIC CONDITIONS STRATEGY #1 PROVIDE THE COMMUNITY WITH EDUCAITON PERTAINING TO RESPIRATORY HEALTH (SMOKING/VAPING, COPD, GREAT AMERICAN SMOKE OUT)ACTIONS TAKEN: - IN 2024, THE HOSPITAL RESPIRATORY DEPARTMENT PROVIDED 5 SESSIONS TO STUDENTS AT LOCAL SCHOOLS ABOUT THE HARSM OF VAPING PRODUCTS, NICOTINE, AND REASONS TO NOT USE THE PRODUCTS. BECAUSE OF THE SUPPORT OF SCHOOL TEACHERS AND ADMINISTRATION, 742 STUDENTS PARTICIPATED IN EDUCATION SESSIONS. STRATEGY #2 COLLABORATE WITH SENIOR CENTERS AND COMMUNITY LOCATIONS TO PROVIDE HEALTH RELATED EDUCATION, SCREENINGS, SELF-MONITORING RESOURCES (STROKE, BLOOD PRESSURE, CHF, DIABETES)ACTIONS TAKEN:- 80 COMMUNITY MEMBERS RECEIVED BLOOD PRESSURE, BLOOD SUGAR, OR NO-COST CANCER SCREENINGS IN 2024. - TWO (2) HEALTH EDUCAITON WORKSHOPS WERE HELD IN 2024 TO INCREASE KNOWLEDGE OF SELF-MONITORING OF CHRONIC CONDITIONS AND AWARENESS OF LOCAL RESOURCES. STRATEGY #3 COLLABORATE WITH COMMUNITY PARTNERS TO HOST EVIDENCE-INFORMED WORKSHOPS AT PROMEDICA FARMS FOR PATIENTS AND COMMUNITY MEMBERS. ACTIONS TAKEN:- THROUGH COLLABORATION WITH MICHIGAN STATE UNIVERSITY EXTENSION, 13 NO-COST AND EVIDENCE-BASED COOKING MATTERS CLASSES WERE OFFERED TO PROVIDE THE COMMUNITY WITH NUTRITION EDUCATION AND COOKING DEMONSTRATIONS AT THE FARM. FRESH PRODUCE FROM THE CAMPUS IS INCORPORATED INTO THE CIRRICULUM. - 512 COMMUNITY MEMBERS PARTICIPATED IN GARDENING WORKSHOPS AND EVIDENCE-BASED WORKSHOPS WITH MSU-E IN 2024. HEALTH NEED IDENTIFIED: HEALTH EQUITYSTRATEGY #1 CONTINUE PARTNERSHIP WITH ALL ABOUT ADRIAN RESIDENT COALITION TO MOBILIZE SCREENING AND HEALTH EDUCATION TO SECOND FRIDAY'S AND OTHER COMMUNITY EVENTS IN UNDERSERVED CENSUS TRACTS. ACTIONS TAKEN:- IN 2024, FOUR (4) HEALTH WORKSHOPS WERE HELD AT ADRIAN EBEID NEIGHBORHOOD PROMISE IN COLLBAORATION WITH THE M-SOCIETY, PROMEDICA STROKE EDUCATION, AND LENAWEE COUNTY STI CLINIC THAT SERVED 26 COMMUNITY MEMBERS. STRATEGY #2 CONTINUE PARTNERSHIP WITH THE UNITED WAY HEALTH CHECK EVENT TO PROVIDE HEALTH SCREENINGS AND BLOOD PANEL TESTING. ACTIONS TAKEN:- THROUGH COLLABORATION WITH THE UNITED WAY OF LENAWEE COUNTY, THE HOSPITAL LAB DEPARTMENT PROVIDED IN-KIND SUPPORT TOWARD PROVIDING 22-PANEL BLOOD TESTING AT 2 HEALTH CHECK EVENTS. - 200 PARTICIPANTS RECEIVED BLOOD PANEL TESTING AT THE HEALTH CHECK EVENT- 221 PARTICIPANTS ATTENDED THE UNITED WAY HEALTH CHECK EVENTS AND RECEVIED A CONTINUUM OF RESOURCES AND WRAP AROUND SUPPORTS FROM AGENCIES AND PROMEDICA DEPARTMENTS DISTRIBUTING EDUCATION AND HEALTH RELATED RESOURCES. PART V, SECTION B, LINE 7A THE 2022 CHNA CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ABOUT-PROMEDICA/COMMUNITY PART V, SECTION B, LINE 10A THE 2023-2025 CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ABOUT-PROMEDICA/COMMUNITY PART V, SECTION B, LINE 16A: THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C: A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE 15 1 - PROMEDICA DUNDEE - TOTAL REHAB 100 POWELL DR STE 3 DUNDEE MI 48131 TOTAL REHAB 2 - PROMEDICA BLISSFIELD - LAB 157 WEST BROOKE LANE BLISSFIELD MI 49228 LAB 3 - LENAWEE MEDICAL CARE FACILITY 200 SAND CREEK HWY ADRIAN MI 49221 LAB LENAWEE MEDICAL 4 - PROMEDICA CVHH N ADRIAN HWY - LAB 3245 N ADRIAN HWY ADRIAN MI 49221 LAB 5 - PROMEDICA HUDSON - LAB 331 W MAIN ST HUDSON MI 49247 LAB 6 - CAMBRIAN ASSISTED LIVING AND MEMORY CARE 333 N OCCIDENTAL HWY TECUMSEH MI 49286 LAB CAMBRIAN 7 - PROMEDICA ONSTED - LAB 400 N MAIN ST ONSTED MI 49265 LAB 8 - PROMEDICA ONSTED -TOTAL REHAB 400 N MAIN ST STE B ONSTED MI 49265 TOTAL REHAB 9 - PROMEDICA CVHH TECUMSEH FAMILY PRACTICE 501 E CUMMINS ST TECUMSEH MI 49286 LAB 10 - YMCA ON PROMEDICA CVHH CAMPUS TOTAL REHA 5660 ADRIAN HWY ADRIAN MI 49221 TOTAL REHAB 11 - ADRIAN URGENT CARE 715 N MAIN ST ADRIAN MI 49221 LAB ADRIAN URGENT CARE 12 - LYNWOOD MANOR 730 KIMOLE LN ADRIAN MI 49221 LAB LYNWOOD MANOR 13 - PROMEDICA BIXBY GRACE CHRISTMAN - DIABET 777 KIMOLE LANE STE 110 ADRIAN MI 49221 DIABETES CENTER 14 - PROMEDICA CVHH GRACE CHRISTMAN - RADIATI 777 KIMOLE LANE STE 130 ADRIAN MI 49221 RADIATION ONCOLOGY 15 - PROMEDICA CVHH WOLF CREEK- LAB 901 KIMOLE LN ADRIAN MI 49221 LAB PART I, LINE 3C: IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY USES INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY STATUS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. OTHER BENEFITS AMOUNTS REPORTED ON LINE 7 WERE CALCULATED USING COSTS CHARGED DIRECTLY TO THE INDIVIDUAL PROGRAMS VIA THE FINANCIAL ACCOUNTING SYSTEM. AN INDIRECT COST ALLOCATION FACTOR FOR SHARED SERVICES IS ALSO CALCULATED AND INCLUDED IN APPLICABLE PROGRAMS LISTED IN OTHER BENEFITS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,214,437. PART III, LINE 2: PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL'S ANALYSIS AND ASSESSMENT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED BAD DEBT EXPENSE USES A RECEIPTS "LOOK-BACK" METHOD UTILIZING HISTORICAL PAYMENT DATA ON ACCOUNTS, INCLUDING CONTRACTUAL ADJUSTMENTS FOR PAYER DISCOUNTS, AS WELL AS PATIENT PAYMENTS, SUCH AS CO-PAYS AND DEDUCTIBLES, TO ESTABLISH ANTICIPATEDCOLLECTABILITY RATES FOR ACCOUNTS RECEIVABLE WITHIN EACH PAYER CATEGORY. PART III, LINE 3: PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL ESTIMATED THE POSSIBLE AMOUNT OF FINANCIAL ASSISTANCE WITHIN BAD DEBT EXPENSE BY REVIEWING ACCOUNTS THAT WERE INTERNALLY CODED AS HAVING BEEN PROVIDED A FINANCIAL ASSISTANCE APPLICATION, BUT THAT WAS NOT ADEQUATELY COMPLETED BY THE PATIENT OR GUARANTOR, IN WHICH THE ACCOUNT WAS SUBSEQUENTLY WRITTEN OFF TO BAD DEBT. PART III, LINE 4: PROVISION FOR BAD DEBTS AND ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ARE DISCUSSED ON PAGE 15 AND 16 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL REPORT WITH SUPPLEMENTAL INFORMATION. PART III, LINE 9B: FINANCIAL ASSISTANCE DISCOUNTS ARE GRANTED FOR MEDICALLY NECESSARY SERVICES WHEN IT IS DETERMINED THAT THE PATIENT AND FAMILY INCOME MEETS THE CRITERIA ESTABLISHED. PATIENTS WHO HAVE INSURANCE COVERAGE OR WHO ARE ENTITLED TO GOVERNMENTAL ASSISTANCE ARE IDENTIFIED IN ORDER FOR REIMBURSEMENT TO BE OBTAINED. ALL PATIENTS WITH SELF-PAY BALANCES AFTER INSURANCE MAY OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS IF THEY PROVIDE APPROPRIATE DOCUMENTATION THAT THEY SATISFY THE INCOME GUIDELINES. VERIFICATION OF FINANCIAL ASSISTANCE IS PURSUED THROUGHOUT THE INTERNAL COLLECTION PROCESS UNTIL ALL OPTIONS HAVE BEEN EXHAUSTED. ALL PATIENTS THAT HAVE A SELF-PAY BALANCE, INCLUDING PATIENTS THAT MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, RECEIVE BILLING STATEMENTS AND PAYMENT REMINDERS. THESE STATEMENTS INFORM ALL PATIENTS OF THE OPPORTUNITY TO SEEK A FINANCIAL ASSISTANCE ADJUSTMENT FOR MEDICALLY NECESSARY SERVICES, THE ELIGIBILITY CRITERIA, AND THE METHOD TO APPLY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN COMPLETED AND/OR REQUESTED INCOME VERIFICATION HAS NOT BEEN RECEIVED FROM A PATIENT WHO COULD POTENTIALLY QUALIFY, THE PATIENT WILL CONTINUE TO RECEIVE BILLING STATEMENTS THROUGH THE NORMAL COLLECTION PROCESS. IF A PATIENT DOES NOT HAVE INSURANCE, A PRESUMPTIVE CHARITY DETERMINATION (WHICH USES PUBLICLY AVAILABLE DATA SUCH AS DEMOGRAPHIC INFORMATION, CREDIT HISTORY, ETC.) MAY BE MADE TO ASSIST WITH QUALIFYING FOR FINANCIAL ASSISTANCE. ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, AN ADJUSTMENT IS PROCESSED. THE PATIENT ACCOUNT ANALYST WILL DETERMINE PATIENT ELIGIBILITY AND CALCULATE THE ADJUSTMENT BASED ON POLICY GUIDELINES. AN ADJUSTMENT FORM IS PREPARED AND APPROVED PER POLICY. UNINSURED PATIENTS MAY BE REQUIRED TO COMPLETE AN APPLICATION AND PROVIDE REQUIRED DOCUMENTATION, INCLUDING ANY DOCUMENTATION REQUIRED TO DETERMINE ELIGIBILITY. UNINSURED PATIENTS ARE NOTIFIED IN WRITING WHETHER OR NOT THEY QUALIFY FOR ANY FINANCIAL ASSISTANCE ADJUSTMENT FOR WHICH THEY HAVE SUBMITTED AN APPLICATION, AND OF ANY REMAINING BALANCE OWED. THE ADJUSTMENT IS THEN APPLIED TO THE PATIENT'S ACCOUNT.PATIENTS MAY BE OFFERED PAYMENT PLANS WHEN APPROPRIATE BASED ON DOCUMENTED FINANCIAL NEED AND CIRCUMSTANCES. LONGER PAYMENT PLANS MAY BE OFFERED ON AN EXCEPTION BASIS FOR CASES WITH UNUSUALLY HIGH BALANCES OR SPECIAL CIRCUMSTANCES DEMONSTRATING AN INABILITY TO PAY. ONCE THE INTERNAL COLLECTION PROCESS HAS BEEN COMPLETED, PATIENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY IF THE PATIENT HAS NOT CONTACTED US REGARDING THEIR DESIRE TO APPLY FOR FINANCIAL ASSISTANCE, SENT IN A FINANCIAL ASSISTANCE APPLICATION, RESPONDED TO REQUESTS FOR ADDITIONAL INFORMATION, OR WE ARE UNABLE TO MAKE A PRESUMPTIVE CHARITY DETERMINATION. IT IS THE EXPECTATION OF THE EXTERNAL COLLECTION AGENCY AS THEY WORK ACCOUNTS TO OFFER FINANCIAL ASSISTANCE WHEN APPLICABLE. THROUGHOUT THE COLLECTION PROCESS, THE COLLECTION AGENCY WILL INFORM UNINSURED PATIENTS OF THE CRITERIA TO OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS BASED ON FAMILY INCOME AND FAMILY SIZE, AND WILL FORWARD APPLICATIONS FOR PATIENTS WHO SUBMIT THE REQUIRED DOCUMENTATION TO THE CENTRAL BUSINESS OFFICE FOR PROCESSING. PART VI, LINE 2: PROMEDICA HEALTH SYSTEM AND HOSPITALS DEMONSTRATE A COMMITMENT TO THE COMMUNITIES IT SERVES AND THEREFORE, BELIEVES IT IS CRITICAL TO UNDERSTAND THE HEALTH CARE NEEDS OF ITS PRIMARY SERVICE AREA. TO THAT END, PROMEDICA HOSPITALS CONDUCT NEEDS ASSESSMENTS IN ITS PRIMARY SERVICE AREAS USING A VARIETY OF METHODOLOGIES TO ASSESS EACH COUNTY'S HEALTH CARE DATA, IDENTIFY GAPS IN HEALTH CARE INITIATIVES, AND MAKE RECOMMENDATIONS FOR THE BETTERMENT OF THE GENERAL COMMUNITY HEALTH. ANALYSIS OF PUBLISHED COUNTY HEALTH DATA, INTERVIEWS WITH KEY STAKEHOLDERS, AND REVIEW OF HISTORICAL AND EXISTING PROMEDICA COMMUNITY ASSESSMENTS ARE ALL MEANS BY WHICH RECOMMENDATIONS FOR THE PROMEDICA COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLANS ARE DEVELOPED. INFORMATION IS REVIEWED AND APPROVED BY HOSPITAL GOVERNANCE LEADERSHIP TO ASSURE THAT PLANS ARE DEVELOPED TO MEET THE NEEDS OF THE COMMUNITY. PUBLISHED COUNTY HEALTH DATACOUNTY HEALTH DATA WERE OBTAINED FROM SEVERAL SOURCES, INCLUDING THE OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE, THE MICHIGAN DEPARTMENT OF HEALTH, AND FORMAL COUNTY ASSESSMENTS CONDUCTED WITHIN THE INDIVIDUAL COUNTIES. ALTHOUGH MOST COUNTIES CONDUCTING A FORMAL ASSESSMENT UTILIZE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) QUESTIONNAIRE DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AS THE BASIS OF THE COUNTY QUESTIONNAIRE, COUNTY COMMITTEES TYPICALLY ADD AND/OR CHANGE QUESTIONS TO MEET THE COUNTY'S PERCEIVED NEEDS. PROMEDICA'S COMMUNITY GOALS ARE SET BASED ON THIS DATA.PROMEDICA COMMUNITY HEALTH PLANOVERALL, EMPHASIS IS PLACED ON CLINICAL PROGRAMS FOCUSED ON LEADING CAUSES OF DEATH: CHRONIC DISEASES, MENTAL HEALTH, AND HUNGER/OBESITY DUE TO THE LARGE NUMBERS OF INDIVIDUALS AFFECTED BY THESE DISEASES. THE PRIMARY FOCUS FOR COMMUNITY HEALTH ACTIVITIES ARE RELATED TO EDUCATION, SCREENING, AND PREVENTION OF CHRONIC DISEASES, MENTAL HEALTH ISSUES, AND HUNGER/OBESITY; AND IMPROVING RELATED CONDITIONS THAT RESULT IN HIGH MORBIDITY AND MORTALITY IN OUR COMMUNITIES, WITH SPECIAL EMPHASIS PLACED ON SERVING UNDERSERVED POPULATIONS. AS A SYSTEM, WE ARE ALSO COMMITTED TO WORKING BEYOND OUR FOUR WALLS, ON THE SOCIAL AND ECONOMIC ISSUES THAT IMPACT HEALTH. IN ADDITION, PROMEDICA STRATEGIC PLANNING CONTINUES TO DEVELOP PATIENT-CENTERED, INTEGRATED CLINICAL SERVICE LINES INCLUDING CANCER, CARDIOVASCULAR, BEHAVIORAL HEALTH, SOCIAL DETERMINANTS OF HEALTH, AND MATERNAL FETAL MEDICINE. PART VI, LINE 3: THE OPPORTUNITY FOR FINANCIAL ASSISTANCE ADJUSTMENTS IS COMMUNICATED TO PATIENTS AT PROMEDICA HEALTH SYSTEM HOSPITALS THROUGH THE FOLLOWING METHODS:A. DURING THE PRE-REGISTRATION PROCESS FOR SCHEDULED INPATIENTS AND HIGH-DOLLAR OUTPATIENT CASES, THE CENTRALIZED PRE-REGISTRATION STAFF WILL NOTIFY A PATIENT FINANCIAL ADVOCATE TO CONTACT THE PATIENT PRIOR TO SERVICE TO DISCUSS POTENTIAL ELIGIBILITY FOR GOVERNMENT PROGRAMS AND FINANCIAL ASSISTANCE. THE PRE-SERVICE FUNCTION INCLUDES ACCOUNT REGISTRATION, INSURANCE VERIFICATION, PRE-CERTIFICATION AND FINANCIAL COUNSELING.B. ADMITTING LOCATIONS WILL HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE WHEN REGISTERED AS UNINSURED. AT ADMITTING, UNINSURED PATIENTS ARE INFORMED OF THE OPPORTUNITY TO SEEK FINANCIAL ASSISTANCE. C. PATIENT FINANCIAL ADVOCATES ARE AVAILABLE AT THE HOSPITALS TO ASSIST UNINSURED PATIENTS IN COMPLETING THE FORMS. PATIENT FINANCIAL ADVOCATES ATTEMPT TO MEET WITH IN-HOUSE PATIENTS TO ASSESS ELIGIBILITY AND TO ASSIST WITH APPLICATION FOR GOVERNMENT ASSISTANCE PROGRAMS, TO EXPLAIN PATIENT LIABILITY FOR CHARGES, TO PROVIDE AN ESTIMATE OF CHARGES WHEN FEASIBLE, TO EXPLAIN THE OPPORTUNITY FOR FINANCIAL ASSISTANCE, INCLUDING THE CRITERIA AND THE METHOD FOR APPLYING, AND TO EXPLAIN PAYMENT OPTIONS.D. A MESSAGE IS PRINTED ON THE PATIENT BILLING STATEMENTS TO NOTIFY THE UNINSURED PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE, TO EXPLAIN THE ELIGIBILITY CRITERIA, AND TO DESCRIBE THE METHOD TO APPLY.E. A SUMMARY OF THE POLICY FOR UNINSURED PATIENTS IS INCLUDED IN THE STATEMENTS OF UNINSURED PATIENT, AVAILABLE VIA THE PROMEDICA WEB SITE, AVAILABLE AT HOSPITAL REGISTRATION LOCATIONS, OR BY CALLING THE PROMEDICA CUSTOMER SERVICE DEPARTMENT. BUSINESS OFFICE PERSONNEL ALSO NOTIFY UNINSURED PATIENTS OF THE FINANCIAL ADJUSTMENT POLICY THROUGH THE CUSTOMER SERVICE AND COLLECTION DEPARTMENTS. PART VI, LINE 4: EMMA L. BIXBY MEDICAL CENTER, DOING BUSINESS AS PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL, LOCATED IN ADRIAN, MI, SERVES AN AREA PRIMARILY AROUND LENAWEE COUNTY. THERE IS A COUNTY POPULATION OF APPROXIMATELY 99,000. APPROXIMATELY, 20% OF THE SERVICE AREA IS AGE 65 OR OVER; 60% IS BETWEEN AGE 18 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $62,000; 91% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER; APPROXIMATELY 15% OF FAMILIES ARE BELOW THE POVERTY LEVEL. APPROXIMATELY, 7% OF LENAWEE COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE AT THE END OF 2024 FOR LENAWEE COUNTY WAS 4.7%. THE LEADING CAUSES OF DEATH IN LENAWEE COUNTY, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, CANCER, COVID, UNINTENTIONAL INJURIES/ACCIDENTS, STROKE, LUNG DISEASE, ALZHEIMER'S, AND DIABETES. THERE ARE NINE HOSPITALS WITHIN A 30-MILE RADIUS OF CHARLES AND VIRGINIA HICKMAN HOSPITAL: HERRICK MEMORIAL HOSPITAL, INC., ST. JOSEPH MERCY SALINE HOSPITAL, FLOWER HOSPITAL, FULTON COUNTY HEALTH CENTER, ST. ANNE MERCY HOSPITAL, CHELSEA COMMUNITY HOSPITAL, THE TOLEDO HOSPITAL, HENRY FORD ALLEGIANCE HEALTH, AND UNIVERSITY OF TOLEDO MEDICAL CENTER. PART VI, LINE 5: EMMA L. BIXBY MEDICAL CENTER IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC., WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. IN 2024:- THERE WERE APPROXIMATELY 300 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), SERVING ON MORE THAN 25 DIFFERENT BOARDS, COMMITTEES, COUNCILS AND FOUNDATIONS. OF THOSE BOARD MEMBERS, MOST LIVE WITHIN PROMEDICA'S OHIO AND MICHIGAN ACUTE CARE SERVICE AREA, WITH THE MAJORITY RESIDING WITHIN THE GREATER TOLEDO AREA WHERE PROMEDICA'S ADULT AND PEDIATRIC TERTIARY HOSPITALS (THE TOLEDO HOSPITAL AND TOLEDO CHILDREN'S HOSPITAL) ARE LOCATED. - PROMEDICA NON-PARENT BOARD MEMBERS' DONATION OF TIME AND EXPERTISE, INCLUDING ATTENDING BOARD MEETINGS, RETREATS AND OTHER ACTIVITIES, WERE PERFORMED ON A VOLUNTEER BASIS. - PROMEDICA'S MEDICAL STAFF PRIVILEGES WERE EXTENDED TO ALL QUALIFIED PHYSICIANS AT OUR METRO TOLEDO AND REGIONAL HOSPITALS. QUALIFICATION MAY VARY BY HOSPITAL, BUT ANY PHYSICIAN WHO MET THOSE QUALIFICATIONS WAS GRANTED PRIVILEGES, UPON THEIR REQUEST.- AS PART OF PROMEDICA'S ELECTRONIC HEALTH RECORD (EHR) JOURNEY, THE INFORMATION TECHNOLOGY SERVICES TEAM COMPLETED TWO SYSTEM-WIDE UPGRADES TO THE EPIC PLATFORM. THE UPGRADES ALLOW PROMEDICA TO TAKE ADVANTAGE OF SOME OF THE MANY ENHANCEMENTS THAT EPIC HAS MADE TO ITS SOFTWARE BASED ON USER INPUT.- PROMEDICA PRIMARY CARE PROVIDERS CONTINUED SCREENING PATIENTS FOR RISK FACTORS OF SOCIAL DETERMINANTS OF HEALTH BY ASKING QUESTIONS RELATED TO EDUCATION, EMPLOYMENT, FOOD SECURITY, HOUSING, TRANSPORTATION, AND VIOLENCE. PATIENTS WHO SCREENED POSITIVE FOR ANY OF THE FACTORS WERE CONNECTED TO COMMUNITY PROGRAMS AND RESOURCES FOR ASSISTANCE.- PROMEDICA CANCER INSTITUTE (PCI) COMPLETED LUNG CANCER SCREENINGS, SCREENING MAMMOGRAMS AND SCREENING COLONOSCOPIES. ADDITIONALLY, PCI CONTINUES TO BE INSTRUMENTAL IN HELPING PROMEDICA IMPLEMENT MONOCLONAL ANTIBODY TREATMENT AT ITS INFUSION CENTERS FOR COVID-19 PATIENTS TO IMPROVE SYMPTOM MANAGEMENT. - PROMEDICA SENIOR CARE SKILLED NURSING FACILITIES AND HOME HEALTH AND HOSPICE AGENCIES PROVIDE UNIQUE SERVICES TO VETERANS, HOLIDAY SUPPORT, SUPPORT GROUPS, AND WORKSHOPS TO ANYONE IN THE COMMUNITY WHO NEEDS ADDITIONAL HELP TO GET THROUGH THE LOSS OF A LOVED ONE. PATIENTS AND RESIDENTS' WISHES ARE GRANTED THROUGH THE ORGANIZATION'S HEART'S DESIRE PROGRAM. THROUGH GRANTS FROM THE HOSPICE MEMORIAL FUND, GRIEF CAMPS FOR CHILDREN AND ADULTS ARE OFFERED AS WELL AS EDUCATIONAL SESSIONS AND LIFE CELEBRATION EVENTS. THE FUND ALSO PROVIDES STABILIZING RESOURCES FOR HOSPICE PATIENTS AND FAMILIES IN FINANCIAL DISTRESS DUE TO THE LACK OF OR REDUCTION IN INCOME FROM TERMINAL ILLNESS OR DISEASE.- PROMEDICA CONTINUES TO EXPAND ITS OPTIONS FOR HOSPITAL-LEVEL CARE IN THE COMFORT OF A PATIENT'S HOME. PROMEDICA ACUTE CARE AT HOME COMBINES PROMEDICA'S EXTENSIVE NETWORK OF IN-HOME CARE PROVIDERS WITH A SOPHISTICATED TECHNOLOGY PLATFORM TO DELIVER SEAMLESS AND EFFECTIVE CARE AT HOME FOR PATIENTS WITH SELECT CHRONIC CONDITIONS OR DIAGNOSES SUCH AS HEART FAILURE, PNEUMONIA OR COPD. RECENTLY, PROMEDICA ACUTE CARE AT HOME EXPANDED ITS SERVICES TO INCLUDE CARE FOR SELECT ONCOLOGY PATIENTS BY COLLABORATING THE PROMEDICA CANCER CENTER. THE CARE TEAM CONSISTS OF PHYSICIANS, NURSE PRACTITIONERS, REGISTERED NURSES, AND MAY INCLUDE OTHER HEALTHCARE PROFESSIONALS, SUCH AS PHYSICAL OR OCCUPATIONAL THERAPISTS, AS NEEDED. PART VI, LINE 6: PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A NATIONWIDE, MISSION-BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT WAS FORMED IN TOLEDO, OHIO IN 1986. IN 2024 PROMEDICA WAS COMPRISED OF MORE THAN 45,000 EMPLOYEES, NEARLY 850 VOLUNTEERS AND MORE THAN 2,100 PHYSICIANS AND ADVANCED PRACTICE PROVIDERSINCLUDING APPROXIMATELY 1,200 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS EMPLOYED BY PROMEDICA PHYSICIAN GROUP (PPG) WHO FORM A PROVIDER NETWORK ACROSS 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN. AS AN INTEGRATED DELIVERY SYSTEM, PROMEDICA PROVIDERS SHARE RESOURCES SUCH AS ADVANCED TECHNOLOGY, QUALITY STANDARDS, SAFETY PRACTICES, MEDICAL EXPERTISE, AND SPECIALTY SERVICES TO ENSURE COMMUNITY MEMBERS HAVE READY ACCESS TO HIGH-QUALITY CARE IN THE MOST APPROPRIATE SETTING IN ORDER TO PROVIDE COST-EFFICIENT SERVICES. IN 2024:- PROMEDICA MEMBERS AND AFFILIATE HOSPITALS INCLUDED: THE TOLEDO HOSPITAL D/B/A PROMEDICA TOLEDO HOSPITAL; PROMEDICA TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF PROMEDICA TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL; FLOWER HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL D/B/A PROMEDICA FLOWER HOSPITAL; BAY PARK COMMUNITY HOSPITAL (D/B/A PROMEDICA BAY PARK HOSPITAL); EMMA L. BIXBY MEDICAL CENTER (D/B/A PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL); FOSTORIA HOSPITAL ASSOCIATION (D/B/A PROMEDICA FOSTORIA COMMUNITY HOSPITAL); DEFIANCE HOSPITAL, INC. (D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL); MERCY MEMORIAL HOSPITAL CORPORATION (D/B/A PROMEDICA MONROE REGIONAL HOSPITAL); MEMORIAL HOSPITAL (D/B/A PROMEDICA MEMORIAL HOSPITAL); AND COMMUNITY HEALTH CENTER OF BRANCH COUNTY (D/B/A PROMEDICA COLDWATER REGIONAL HOSPITAL). PROMEDICA ALSO INCLUDES PROMEDICA INSURANCE CORPORATION; PROMEDICA PHYSICIAN GROUP; AND PROMEDICA CONTINUING CARE SERVICES CORPORATION AS WELL AS HUNDREDS OF SKILLED NURSING AND REHABILITATION CENTERS, ASSISTED LIVING FACILITIES AND MEMORY CARE COMMUNITIES, ALL UNDER THE PROMEDICA SENIOR CARE/HCR MANORCARE UMBRELLA.- PROMEDICA CONTINUED TO OPERATE THREE COMMUNITY FOOD CLINICS, LOCATED AT PROMEDICA BAY PARK HOSPITAL, THE PROMEDICA HEALTH AND WELLNESS CENTER AND PROMEDICA'S CENTER FOR HEALTH SERVICES, TO SERVE PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND HAVE A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. PATIENTS ARE ABLE TO RECEIVE FOOD FOR THEMSELVES AND THEIR FAMILY FROM ONE OF THESE FOOD CLINICS. AS PART OF THE PROGRAM, PATIENTS CAN RECEIVE TWO TO THREE DAYS OF SUPPLEMENTAL FOOD. - FOR ITS MICHIGAN PATIENTS, PROMEDICA PARTNERED WITH THE SOUTH MICHIGAN FOOD BANK TO DISTRIBUTE FOOD RESOURCES TO PROMEDICA PHYSICIANS GROUP OFFICES FOR PATIENTS SCREENING POSITIVE FOR FOOD INSECURITY. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PROVIDE THE $5 VOUCHERS AT DISCHARGE SO PATIENTS CAN REDEEM FRESH PRODUCE FROM THE VEGGIE MOBILE THAT IS SOURCED FROM PROMEDICA FARMS, LOCAL GROWERS, AND A WHOLESALER. - PROMEDICA EBEID INSTITUTE'S MARKET ON THE GREEN PROVIDED BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES AND A FINANCIAL OPPORTUNITY CENTER TO PROVIDE FINANCIAL COUNSELING FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. ADDITIONALLY, TWO NEW FINANCIAL OPPORTUNITY CENTERS (FOC) WERE OPENED IN FREMONT AND DEFIANCE, OHIO. MUCH LIKE THE FOC LOCATED IN UPTOWN TOLEDO, THE NEW LOCATIONS OFFER SERVICES AND ASSIST LOW TO MODERATE-INCOME FAMILIES WITH SECURING LIVING WAGE JOBS, BUILDING CREDIT, REDUCING DEBT, AND GAINING WEALTH. THE FOC ALSO HELPS INDIVIDUALS NEEDING INCOME SUPPORT (PUBLIC BENEFITS) AND EMPLOYMENT COACHING AND COUNSELING AS WELL AS FREE TAX PREPARATION. 0 1 0 0 0 0 0 0 0 ARTURO POLIZZI CEO 0 1585940 0 1530880 0 2500 0 0 0 14012 0 3133332 0 0 DAWN BUSKEY TRUSTEE/CHIEF ACUTE CARE OFFICER 0 645947 0 692842 0 1375 0 0 0 14772 0 1354936 0 0 TERRENCE METZGER TREASURER/CFO 0 771258 0 438060 0 0 0 0 0 6610 0 1215928 0 0 STEPHEN SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 0 618697 0 561679 0 0 0 0 0 6038 0 1186414 0 0 DARRIN ARQUETTE TRUSTEE/PRESIDENT - MONROE 0 329393 0 308712 0 2797 0 0 0 10194 0 651096 0 0 DAVID DIEP TRUSTEE/PHYSICIAN- PART YEAR 0 451329 0 117991 0 979 0 0 0 1371 0 571670 0 0 MELISSA BAER TRUSTEE/PHYSICIAN 0 250996 0 183144 0 818 0 0 0 14405 0 449363 0 0 JULIE YAROCH PRESIDENT 0 315156 0 114899 0 2322 0 0 0 7144 0 439521 0 0 PAUL GIETZEN TRUSTEE/PHYSICIAN 0 301294 0 37145 0 4704 0 0 0 13612 0 356755 0 0 CHRISTI ANSBERG TRUSTEE/CHIEF PHILATHROPY OFFICER 0 191623 0 54686 0 45 0 0 0 4057 0 250411 0 0 CHRISTINA BELL DIRECTOR OF PHARMACY SERVICES 142496 0 28218 0 66 0 0 0 12134 0 182914 0 0 0 CINNAMON BERNARDO DIRECTOR OF CLINICAL SERVICES 123746 0 26139 0 418 0 0 0 3566 0 153869 0 0 0 MELISSA THOMPSON STAFF PHARMACIST 147734 0 0 0 300 0 0 0 4678 0 152712 0 0 0 PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF EMMA L. BIXBY MEDICAL CENTER, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. ELIZABETH HALFMANN FAMILY MEMBER OF G. MCDOWELL (BOARD MEMBER) 21594 EMPLOYED BY EMMA L. BIXBY MEDICAL CENTER 0 JESSICA CERVANTES FAMILY MEMBER OF M. BAER (BOARD MEMBER) 39457 EMPLOYED BY EMMA L. BIXBY MEDICAL CENTER 0 PART V, LINE 1A: THE PROMEDICA HEALTH SYSTEM PROCESSES ALL ACCOUNTS PAYABLE THROUGH ONE PAY COMPANY. ALL 1099 FORMS FOR PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES ARE FILED UNDER PROMEDICA HEALTH SYSTEM, INC. FEIN 34-1517671 FORM 990, PART VI, SECTION A, LINE 6 AS A MICHIGAN NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF EMMA L. BIXBY MEDICAL CENTER. AS THE MEMBER, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF EMMA L. BIXBY MEDICAL CENTER, AND (B) FILL ANY VACANCY ON THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION, OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE, OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, AND (VI) ANY MERGER, CONSOLIDATIONS, REORGANIZATION, DISSOLUTION, OR LIQUIDATION. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED BY MANAGEMENT BEFORE BEING PROVIDED TO THE BOARD OF TRUSTEES PRIOR TO FILING. ANY COMMENTS OR QUESTIONS FROM THE BOARD ARE REVIEWED AND INCORPORATED INTO THE RETURN IF APPROPRIATE. FINAL RETURNS ARE PROVIDED TO A PRINCIPAL OFFICER FOR SIGNATURE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER STATEMENT OF CONFLICT (SOC) SURVEY WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER SOC SURVEYS ARE REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER SOC SURVEYS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED, AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO COMPLETE THE SURVEY OR THE SUBMISSION OF A FALSE OR INCOMPLETE SURVEY, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S SURVEY RESULTS OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PROVIDERS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL BONUS-ELIGIBLE SENIOR LEADERSHIP AND SPECIFICALLY IDENTIFIED ADDITIONAL EMPLOYEES, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PROVIDERS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, THE CHIEF HUMAN RESOURCE OFFICER, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. ADDITIONALLY, AS PART OF THE ANNUAL MANDATORY COMPLIANCE TRAINING ASSIGNED TO ALL PROMEDICA EMPLOYEES, EACH EMPLOYEE IS REQUIRED TO ELECTRONICALLY ACKNOWLEDGE THAT THEY HAVE RECEIVED A COPY OF THE PROMEDICA STANDARDS OF CONDUCT, THAT THEY UNDERSTAND HOW THE STANDARDS APPLY TO THEM, ACKNOWLEDGE THEIR OBLIGATION TO FOLLOW THEM, THEIR OBLIGATION TO REPORT VIOLATIONS OF THE STANDARDS OR REQUESTS THAT WOULD RESULT IN VIOLATIONS OF THE STANDARDS TO APPROPRIATE COMPANY OFFICERS AND THAT THEY HAVE REPORTED ALL VIOLATIONS KNOWN TO THEM AS REQUIRED BY THE STANDARDS. IN ADDITION THE ATTESTATION STATES ANY CONFLICTS OF INTEREST OR OTHER MATTERS FOR WHICH THE STANDARDS REQUIRE WRITTEN DISCLOSURE TO THE COMPANY HAVE BEEN SO DISCLOSED BY THE EMPLOYEE AND THEY UNDERSTAND AND ACKNOWLEDGE THAT TO THE EXTENT THEY ARE AN AT-WILL EMPLOYEE, THE STANDARDS DO NOT AFFECT THE AT-WILL NATURE OF MY EMPLOYMENT RELATIONSHIP WITH THE COMPANY. EMPLOYED PROVIDERS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PROVIDERS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PROVIDER CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER FOR PROMEDICA PHYSICIAN GROUP, INC. (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE OFFICE OF THE PROMEDICA HEALTH SYSTEM, INC. ("PHS") V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PROVIDER CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE PHS AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PROVIDERS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PROVIDER STANDARD OF CONDUCT AND THE PROVIDER CERTIFICATION STATEMENT WHICH THE NEW PROVIDER IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, OR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE PHS V.P., AUDIT & COMPLIANCE. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL BY THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER. RESULTS OF THE EMPLOYED PROVIDER AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 EMMA L. BIXBY MEDICAL CENTER'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF PROMEDICA FOUNDATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 16B: JOINT VENTURE OPERATING AGREEMENTS INVOLVING PROMEDICA HEALTH SYSTEM, INC. OR ITS SUBSIDIARIES (COLLECTIVELY, PHS) INCLUDE PROVISIONS TO PROTECT PHS'S TAX-EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. PHS CONTINUALLY ENSURES THAT ITS TAX-EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL PHS JOINT VENTURES. PART VII, SECTION B PROMEDICA HEALTH SYSTEM PROCESSES ALL ACCOUNTS PAYABLE THROUGH ONE PAY COMPANY, PROMEDICA HEALTH SYSTEM, INC. THE INDEPENDENT CONTRACTORS OVER $100,000 WILL BE LISTED ON THE 990 FILED FOR PROMEDICA HEALTH SYSTEM, INC. FEIN 34-1517671. FORM 990, PART XI, LINE 9: TRANSFERS BETWEEN RELATED ENTITIES 62,893,247. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR WOLF CREEK ASSOCIATES LLC 901 KIMOLE LN ADRIAN MI 49221 383164818 FACILITY LEASE MI 122534 2116022 EMMA L BIXBY MEDICAL CENTER BAY PARK COMMUNITY HOSPITAL 100 MADISON AVE TOLEDO OH 43604 341883132 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 COMMUNITY HEALTH CENTER OF BRANCH COUNTY 100 MADISON AVE TOLEDO OH 43604 386108110 HOSPITAL MI 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 DEFIANCE HOSPITAL AUXILIARY 1200 RALSTON DEFIANCE OH 43512 510173779 HOSPITAL / FOUNDATION SUPPORT OH 501(C)(3) 10 DEFIANCE HOSPITAL INC 1 DEFIANCE HOSPITAL INC 100 MADISON AVE TOLEDO OH 43604 344446484 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH SYSTEM INC 1 EMMA L BIXBY MEDICAL CENTER AUXILIARY 818 RIVERSIDE AVE ADRIAN MI 43604 382149602 HOSPITAL / FOUNDATION SUPPORT MI 501(C)(3) 12B, II EMMA L BIXBY MEDICAL CENTER 1 FOSTORIA HOSPITAL ASSOCIATION 100 MADISON AVE TOLEDO OH 43604 340898745 HOSPITAL OH 501(C)(3) 3 PROMEDICA HEALTH 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