2025-10-21T10:28:04-05:00 2024-12-31 351178661 BLUE & CO LLC 9200 WORTHINGTON RD STE 200 WESTERVILLE OH 43082 990 2024-01-01 311518658 POMERENE HOSPITAL FKA JOEL POMERENE FOUNDATION POME 3306741015 981 WOOSTER RD MILLERSBURG OH 446541094 TIA CERNAVA CHIEF FINANCIAL OFFICER 3306741015 2025-10-21 1 1 EMILIE M KNIERIEM CPA P01330194 6148852583 2025-10-21 2024 2025-03-06 01:10:19Z TIA CERNAVA 981 WOOSTER RD MILLERSBURG OH 446541094 43423887 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. 12 11 561 56 0 0 1526526 45010 40473441 42599867 528145 580302 191375 198708 42719487 43423887 70762 59547 0 0 18145435 20640916 0 0 0 20062500 21104839 38278697 41805302 4440790 1618585 40653925 33820684 4904964 4425879 35748961 29394805 WE WILL BE A LEADER AND PARTNER IN PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE FOR ALL RESIDENTS OF GREATER HOLMES COUNTY. 0 0 29119495 59547 42603496 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 10,030 ED VISITS, 2,093 DISCHARGES, AND 46,172 OUTPATIENT REGISTRATIONS IN 2024. 29119495 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 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 1 0 0 1 53 0 1 561 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X TIA CERNAVA 3306741015 981 WOOSTER RD MILLERSBURG OH 44654 MELVIN YODER CHAIRMAN 1.00 0.00 X X 0 0 0 SHEILA KNAPP VICE CHAIRMAN 1.00 0.00 X X 0 0 0 JOHN HENRY TROYER TREASURER 1.00 0.00 X X 0 0 0 JANE GRAVEN SECRETARY 1.00 0.00 X X 0 0 0 DAVE FINDLEY DIRECTOR 1.00 0.00 X 0 0 0 ERNEST HERSHBERGER TRUSTEE 1.00 0.00 X 0 0 0 CRAIG MULLET TRUSTEE 1.00 0.00 X 0 0 0 DANIEL MATHIE TRUSTEE 1.00 0.00 X 0 0 0 TODD SOMMER TRUSTEE 1.00 0.00 X 0 0 0 JAMIE TIPPETT TRUSTEE 1.00 0.00 X 0 0 0 LEROY J YODER TRUSTEE 1.00 0.00 X 0 0 0 JASON JUSTUS CEO 40.00 2.00 X X 358984 0 44450 TIA CERNAVA CFO 40.00 2.00 X 220887 0 28216 DR MICHAEL T SCHELL GENERAL SURGEON 40.00 0.00 X 484735 0 13800 LEON MILLER GENERAL SURGEON 40.00 0.00 X 398214 0 13566 EUGENE R KOSER ANESTHESIOLOGIST 40.00 0.00 X 450515 0 13800 DURRELL R BEACHY CRNA 40.00 0.00 X 322580 0 12325 BRITTON HOSTETLER CRNA 40.00 0.00 X 302565 0 11683 2538480 0 137840 33 0 1 0 AULTMAN DEUBLE HEART & VASCULAR HOSPITAL PO BOX 80690 CANTON OH 44708 CARDIOVASCULAR CONSULTING 205850 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 LOCUM TENENS STAFFING 173208 CASSEL BEAR LTD 4884 DRESSLER RD NW CANTON OH 44718 MARKETING CONSULTING 158965 ROZUK RADIOLOGY INC PKGS PO BOX 392 MILLERSBURG OH 44654 RADIOLOGY SERVICES 145350 SLEEPWORKS LLC 536 OLD HOWELL RD GREENVILLE SC 29615 SLEEP LAB SERVICES 123300 7 45010 45010 NET PATIENT REVENUE 621110 42599867 42599867 42599867 576702 576702 4800 0 4800 4800 4800 3600 0 3600 3600 3600 CAFETERIA INCOME 624200 178915 178915 14993 3629 11364 193908 43423887 42603496 0 775381 X 59547 59547 652536 430606 221930 14374233 9485490 4888743 601813 525469 76344 4139575 3614440 525135 872759 762043 110716 86293 57254 29039 247310 164085 83225 8518716 5523228 2995488 297437 197344 100093 2375496 1867792 507704 496740 329577 167163 452496 300222 152274 307349 203920 103429 25573 16967 8606 204858 135919 68939 1428078 506064 922014 256488 170175 86313 MEDICAL SUPPLIES&EQUIP 4856713 3719553 1137160 FRANCHISE FEE 1042197 691477 350720 DIETARY 200710 153715 46995 DUES, PUBS, & SUBS 135821 90115 45706 172564 114493 58071 41805302 29119495 12685807 0 1908 2208 9976648 3653015 6640892 6798950 833857 680706 941798 1025822 40276070 30628037 8463941 9648033 13794881 12011950 40653925 33820684 2454488 2715858 55916 49628 2019822 1660393 374738 0 4904964 4425879 X 35748961 29394805 35748961 29394805 40653925 33820684 X 1618585 -84560 -7888181 X X 0 1 X 1 0 X 631987 631987 18230912 14288906 3942006 345007 187911 157096 19999751 16151220 3848531 1068413 1068413 9648033 OTHER RECEIVABLES 622449 INVESTMENT IN JOINT VENTURES 5144 ASSETS WHOSE USE IS LIMITED 10358860 RIGHT OF USE ASSETS 983169 OTHER ASSETS 42328 12011950 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, 2024 AND 2023, 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. THE ORGANIZATION IS REQUIRED TO FILE FEDERAL FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, WHICH IS AN INFORMATION RETURN ONLY. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. HOWEVER, AS OF THE DATE THE CONSOLIDATED FINANCIAL STATEMENTS WERE AVAILABLE TO BE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). THE ORGANIZATION HAS FILED ITS APPLICABLE FEDERAL INCOME TAX RETURNS FOR PERIODS THROUGH DECEMBER 31, 2023. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). 1 1 X 1 X 1 X 1 1 1 0 1 1 320208 320208 0.00770 5021182 3085218 1935964 0.04630 5341390 3085218 2256172 0.05400 226758 226758 0.00540 226758 226758 0.00540 5568148 3085218 2482930 0.05940 1 2641884 3946458 4914955 -968497 X 1 1 1 1 POMERENE HOSPITAL 981 WOOSTER MILLERSBURG OH 44654 WWW.POMERENE.ORG 1202 X X X POMERENE HOSPITAL 0 0 1 X X X X X X X X X 23 1 0 1 1 X SEE PART V, PAGE 8 X HTTPS://HOLMESHEALTH.ORG/ X 1 23 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.POMERENEHOSPITAL.ORG/FINANCIAL-SERVICES X HTTPS://WWW.POMERENEHOSPITAL.ORG/FINANCIAL-ASSISTANCE-APPLICATION X HTTPS://WWW.POMERENEHOSPITAL.ORG/FINANCIAL-SERVICES 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 2023 HOLMES COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WAS COORDINATED, REVIEWED, AND ANALYZED BY VVV CONSULTANTS LLC ON BEHALF OF POMERENE HOSPITAL IN COLLABORATION WITH THE HOLMES COUNTY GENERAL HEALTH DISTRICT. THE CHNA CONSISTED OF AN ONLINE SURVEY TO STAKEHOLDERS, AND A TOWN HALL TO DISCUSS HEALTH DATA, SURVEY FEEDBACK, AND RANK UNMET HEALTH NEEDS. THE ONLINE SURVEY WAS EMAILED TO RESIDENTS, COMMUNITY LEADERS, AND PROVIDERS RESULTING IN 216 SURVEYS BEING COMPLETED. HEALTH INFORMATION DATA WAS ALSO COLLECTED FROM THE OHIO DEPARTMENT OF HEALTH AND RELEVANT NATIONAL, STATE, AND LOCAL DATA SOURCES THAT IS PUBLICLY AVAILABLE. THE PARTNERS SOLICITED INPUT AND RESPONSES FROM MEMBERS OF THE COMMUNITY BY CONDUCTING FOCUS GROUPS AND MEETINGS TO DISCUSS THE SURVEY 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 2023 HOLMES COUNTY HEALTH ASSESSMENT IDENTIFIED SIX PRIORITY UNMET NEEDS: LACK OF PROVIDERS, MENTAL HEALTH, CHRONIC DISEASE MANAGEMENT & PREVENTION, DELIVERY OF INTEGRATED TRADITIONAL & ALTERNATIVE MEDICINE, WELLNESS EDUCATION, MOBILE HEALTH/TELEHEALTH. POMERENE HOSPITAL IS ADDRESSING ALL SIX OF THE HEALTHCARE ASSESSMENT'S PRIMARY NEED CATEGORIES IN THE 2024-2027 COMMUNITY HEALTH IMPROVEMENT PLAN. THE COLLABORATORS OF THE IMPROVEMENT PLAN ARE POMERENE MEDICAL GROUP, ANAZO, MENTAL HEALTH AND RECOVERY BOARD, HOLMES FAMILY MEDICINE, ONE-EIGHTY, VIOLA STARTZMAN CLINIC, OHIO'S HOSPICE (LIFECARE). THE LACK OF PROVIDERS IS ADDRESSED THROUGH RECRUITING, EXPLORING SHARED WORKPLACE, WORKFORCE, AND EQUIPMENT OPPORTUNITIES, AND USING PROVIDER MANPOWER ANALYSIS. POMERENE HOSPITAL IS IMPROVING ITS PROVIDER RECRUITMENT EFFORTS BY EXPLORING COLLECTIVE RECRUITMENT WITH LOCAL PARTNERS, DISCUSSING FOREIGN CANDIDATES/OPPORTUNITIES, UTILIZING REGIONAL RECRUITERS, AND ENCOURAGING THE DEVELOPMENT OF NEW PROVIDERS WITHIN HOLMES COUNTY. MENTAL HEALTH IS BEING ADDRESSED BY CONTINUING TO DEVELOP REFERRAL RELATIONSHIPS WITH KEY COMMUNITY PARTNERS; EXPLORING POTENTIAL TELEHEALTH OR SATELLITE OFFICE SITES FOR ADDITIONAL MENTAL HEALTH; CONTINUING TO SUPPORT/PROMOTE 24-HOUR CRISIS HOTLINES; PROVIDING EDUCATION REGARDING MENTAL HEALTH DELIVERY ISSUES; WORKING TO CREATE CENTRALIZED FILE TO UPDATE COMMUNITY INVENTORY RESOURCE SOURCES, IMPROVING COMMUNITY AWARENESS AND PROGRAMMING; INVESTIGATING/SEEKING GRANT OPPORTUNITIES. CHRONIC DISEASE PREVENTION AND MANAGEMENT IMPROVEMENT INITIATIVES ARE EXPLORING GRANT OPPORTUNITIES; COMMUNITY EDUCATION, PREVENTATIVE AND REMINDER PROGRAMS; ENCOURAGE USE OF LOCAL RESOURCES (DIABETIC EDUCATION AND DIETETIC SERVICES, CHRONIC CARE MANAGEMENT, REMOTE MONITORING); EDUCATE THE COMMUNITY ON HOW TO MAINTAIN HEALTH (HEALTH TALKS, SOCIAL MEDIA, PARTNERSHIPS FOR EDUCATIONAL SERVICES). DELIVERY OF INTEGRATED TRADITIONAL & ALTERNATIVE MEDICINE IS BEING ADDRESSED WITH TRIAL ALTERNATIVE MEDICINE THERAPEUTIC OFFERINGS, STARTING WITH ESSENTIAL OILS; ACUPUNCTURE SERVICES AT POMERENE PAIN MANAGEMENT (POSSIBLE EXPANSION); CONTINUE AMISH OUTREACH ACTIVITIES TO EDUCATE REGARDING SERVICE OFFERINGS; PROVIDER EDUCATION; ENCOURAGE THE USE OF ALTERNATIVE THERAPIES TO REDUCE OPIOID PRESCRIPTIONS. WELLNESS EDUCATION IS BEING IMPROVED THROUGH INITIATIVES SUCH AS, EXPANDING HEALTH TALKS TO EDUCATE STAFF AND COMMUNITY/HEALTH CLASSES; EXPLORING EXPANSION OF SOCIAL SERVICE PROGRAMS; EXPANDING SCHOOL-AGED PROGRAMMING; CREATING AN INVENTORY OF AVAILABLE COMMUNITY WELLNESS RESOURCES; CONTINUING TO OFFER POMERENE EMPLOYEE WELLNESS PROGRAMMING; PARTNER WITH INTERESTED PROGRAMS TO FACILITATE EDUCATION; PARTNER WITH CITY PARKS AND REC DEPARTMENTS TO ENCOURAGE USE OF COMMUNITY WALKING TRAILS AND PARTICIPATION IN LEAGUES; EXPAND KINETICS TO 24/7 AVAILABILITY. MOBILE HEALTH/TELEHEALTH IS BEING ADDRESSED BY EXPLORING AND EXPANDING TELEMEDICINE AND TELEHEALTH SERVICES WHEN POSSIBLE; EXPLORING/INVESTING IN ALTERNATIVE TECHNOLOGIES SUCH AS FIXED WIRELESS, SATELLITE, OR MOBILE BROADBAND TO DELIVER RURAL HIGH-SPEED INTERNET WITHOUT REQUIRING EXTENSIVE CABLE OR FIBER INSTALLATION; PROMOTING TELEHEALTH SERVICES AS AN ALTERNATIVE TO PATIENT'S TRAVELING FOR CARE; ASKING COUNTY TO IMPROVE WI-FI CONNECTIVITY; ASKING COUNTY TO PROVIDE SUBSIDIES OR GRANTS FOR RURAL COMMUNITY ANCHOR INSTITUTIONS SUCH AS SCHOOLS, LIBRARIES, HEALTH CENTERS, AND PUBLIC SAFETY AGENCIES. POMERENE HOSPITAL: SCHEDULE H, PART V, LINE 7A:HTTPS://WWW.POMERENEHOSPITAL.ORG/COMMUNITY-CARE9CC3B603 POMERENE HOSPITAL: SCHEDULE H, PART V, LINE 10:HTTPS://WWW.POMERENEHOSPITAL.ORG/COMMUNITY-CARE9CC3B603 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 (STRATA). 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 RECEIVABLES 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 THIRD PARTY 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, 2024, AND 2023 ALLOWANCE FOR DOUBTFUL ACCOUNTS OF APPROXIMATELY $1,618,000 AND $1,858,000, RESPECTIVELY, RELATES TO RESERVES FOR SELF-PAY BALANCES.THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON A PERCENTAGE OF SELF-PAY ACCOUNTS RECEIVABLE ON DECEMBER 31, 2024 AND 2023. THE ORGANIZATION'S SELF-PAY WRITE-OFFS INCREASED $658,645 FROM $1,983,239 FOR 2023 TO $2,641,884 FOR 2024. THE ORGANIZATION HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2024 OR 2023. 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 10 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 12/31/24 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 (2020) THE POPULATION OF HOLMES COUNTY IS APPROXIMATELY 44,223. POPULATION AND DEMOGRAPHIC CHARACTERISTICS OF HOLMES COUNTY ARE: FEMALE (50%)/MALE (50%); MEDIAN AGE OF 32.5 (UNDER 18 (30%), 18-64 (56%) AND 65+ (14%)) WHICH IS LESS THAN THE OHIO AVERAGE OF 39.9; CULTURAL DIVERSITY NEARLY 50/50 BETWEEN ENGLISH AND ANABAPTIST/AMISH; RACE AND ETHNICITY PRIMARILY WHITE (98%) FOLLOWED BY BLACK/AFRICAN AMERICAN (0.2%), AMERICAN INDIAN (0.1%), ASIAN (0.2%), HISPANIC (1.1%) AND TWO OR MORE RACES (1.2%); EDUCATION DISTRIBUTION OF NO DEGREE (43%), HIGH SCHOOL (33%), SOME COLLEGE (9%), BACHELORS (7%), POST GRADUATE (4%); MEDIAN HOUSEHOLD INCOME OF $74,774 (PER CAPITA INCOME $29,238) WITH 8.8% OF THE POPULATION LIVING IN POVERTY; PERSONS WITHOUT HEALTH INSURANCE 42.3%; AND, MORE THAN 37.4% 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 CURRENTLY HAS TWO RURAL HEALTHCARE CLINICS (RHC) ONE IN LOUDONVILLE AND ONE IN POMERENE FAMILY CARE 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 2024 ALL 12 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 ONE HUNDRED (100) 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 66% OF ITS ANNUAL EBITDA OF $3.9 MILLION ($2.6 MILLION) IN CAPITAL IMPROVEMENTS SUCH AS PATIENT CARE (51.5%), INFORMATION TECHNOLOGY (28.3%), FACILITY (20.2%), POMERENE PROVIDED APPROXIMATELY $2.945 MILLION IN UNCOMPENSATED CARE FOR HOLMES COUNTY AND THE SURROUNDING COMMUNITIES IT SERVES. POMERENE DONATED $59,547.41 TO LOCAL COMMUNITY AGENCIES AND CHARITABLE ORGANIZATIONS. 0 THE HOLMES CO AGRICULTURAL SOCIETY INC PO BOX 376 MILLERSBURG OH 44654 346570421 501(C)(3) 6000 0 TO SUPPORT HOLMES COUNTY FAIR 1 0 X X X X 0 0 0 0 0 0 0 0 0 DR MICHAEL T SCHELL GENERAL SURGEON 464735 0 0 0 20000 0 13800 0 0 0 498535 0 0 0 EUGENE R KOSER ANESTHESIOLOGIST 427823 0 15000 0 7692 0 13800 0 0 0 464315 0 0 0 LEON MILLER GENERAL SURGEON 374464 0 8750 0 15000 0 13566 0 0 0 411780 0 0 0 JASON JUSTUS CEO 318912 0 27360 0 12712 0 10350 0 34100 0 403434 0 0 0 DURRELL R BEACHY CRNA 322580 0 0 0 0 0 12325 0 0 0 334905 0 0 0 BRITTON HOSTETLER CRNA 302565 0 0 0 0 0 11683 0 0 0 314248 0 0 0 TIA CERNAVA CFO 200992 0 12515 0 7380 0 6537 0 21679 0 249103 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 4,040,141. MANAGEMENT AND GENERAL EXPENSES 1,235,172. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,275,313. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,483,087. MANAGEMENT AND GENERAL EXPENSES 1,760,316. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,243,403. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATE -7,888,181. FORM 990, PART XII, LINE 2C: THE FINANCE MANAGER, STAFF ACCOUNTANT, AND FINANCIAL ANALYST PROVIDE REQUESTED DATA TO THE AUDITORS. THE AUDITOR'S FINDINGS ARE REVIEWED AND PRESENTED TO THE CFO FOR APPROVAL. 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 1 POMERENE HEALTH FOUNDATION Q 1282116 BOOK VALUE HEALTH PROFESSIONALS OF HOLMES COUNTY R 6606303 BOOK VALUE POMERENE HEALTH FOUNDATION R 1281878 BOOK VALUE