2019-11-13T09:58:06-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2018-01-01 311072406 PIKE HEALTH SERVICES INC PIKE 7409472186 100 DAWN LANE WAVERLY OH 45690 LISA CARLSON CFO 7409472186 2019-11-06 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-05 67.59.56.31 2019-11-06 13:17:45 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 80CA77797C66AE2A599D9FD8132D56C67F638322 2018 2020-03-31 21:24:44Z ADENA PIKE MEDICAL CENTER DAVE ZANNI 100 DAWN LANE WAVERLY OH 45690 17946029 0 X WWW.ADENA.ORG X 1983 OH PIKE HEALTH SERVICES, INC. IS HIGH QUALITY, COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. 9 8 130 26 0 0 10977 17357 15456262 17723468 44785 2708 90073 202496 15602097 17946029 0 0 0 0 8533779 8996333 0 0 0 9411461 9915821 17945240 18912154 -2343143 -966125 14784509 15792103 761970 3181004 14022539 12611099 PIKE HEALTH SERVICES, INC. IS HIGH QUALITY, COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. 0 0 13340666 0 17849526 PIKE HEALTH SERVICES, INC. IS A 25- BED CRITICAL ACCESS HOSPITAL AND PHYSICIAN PRACTICE LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. IN 2018, PIKE HEALTH SERVICES, INC. HAD 480 INPATIENT DISCHARGES AND 11,104 EMERGENCY ROOM PATIENTS. DURING THE YEAR, PIKE HEALTH SERVICES, INC PARTICIPATED IN HEALTH FAIRS OFFERING SCREENING AND EDUCATION FOR DIABETES, CHOLESTEROL AND ARTHRITIS FOR BOTH ADULTS AND CHILDREN. 13340666 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 130 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X SHARON WISECUP VP SYSTEM FINANCE 7407794478 272 HOSPITAL ROAD CHILLICOTHE OH 456019031 ANTHONY FISH TRUSTEE/CHAIR 2.00 0.00 X X 0 0 0 VAL FRANCIS TRUSTEE/VICE CHAIR 2.00 0.00 X X 0 0 0 PAUL ADKINS TRUSTEE 2.00 0.00 X 0 0 0 JOSH REMY TRUSTEE 2.00 0.00 X 0 0 0 CONNIE SHELLEY TRUSTEE 2.00 0.00 X 0 0 0 JUDY SCHMITT TRUSTEE 2.00 0.00 X 0 0 0 TONY DIXON TRUSTEE 2.00 0.00 X 0 0 0 DAVID KESSLER CHIEF OF MEDICAL STAFF 0.00 50.00 X 0 332882 3762 RENEA GREGORY TRUSTEE 2.00 0.00 X 0 0 0 LISA CARLSON AHS CFO 1.00 50.00 X 0 650185 244021 JEFF GRAHAM AHS CEO 1.00 50.00 X 0 805474 414173 DAVE ZANNI CEO 50.00 0.00 X 208258 0 81472 KATHI EDRINGTON AHS COO 1.00 50.00 X 0 482178 225704 PAUL MONTAVON PHARMACIST 45.00 0.00 X 0 114430 18706 CAROLANN NOVISKY PHARMACIST 45.00 0.00 X 0 103836 18600 ELEANOR BOLNER DEPT MGR 45.00 0.00 X 0 110956 43605 KELLEY MURPHY DEPT MGR 45.00 0.00 X 0 112598 22824 CATHERINE FARINET FORMER DIRECTOR 0.00 50.00 X 0 209669 24805 MARK SHUTER FORMER AHS CEO 0.00 0.00 X 0 564496 0 JOHN FORTNEY FORMER AHS CEO 1.00 50.00 X 0 713277 231524 208258 4199981 1329196 3 1 1 0 PREMIER PHYSICIAN SERVICES 332 CONGRESS PARK DRIVE DAYTON OH 45459 ER COVERAGE 1206023 NTHRIVE INC 200 NORTH POINT CENTER E ALPHARETTA GA 30022 REVENUE CYCLE MANAGEMENT 280794 CAPTIVE RADIOLOGY 6273 FRANK AVENUE NW NORTH CANTON OH 44720 MRI SERVICES 156330 3 13860 3497 17357 NET PATIENT SVC REV 622110 17723468 17723468 17723468 2708 2708 10357 0 10357 10357 10357 EHR IMPLEMENTATION 622110 126058 126058 CAFETERIA REVENUE 722514 49856 49856 16225 16225 192139 17946029 17849526 0 79146 X 594130 594130 6325828 5529325 796503 1591897 1287100 304797 484478 386676 97802 3109550 2501473 608077 302269 64898 237371 442226 11415 430811 48150 27146 21004 1026223 433411 592812 68044 38105 29939 CORPORATE OVERHEAD ALLO 2308918 543363 1765555 MEDICAL SUPPLIES 1266506 1183861 82645 BAD DEBT EXPENSE 1044523 1044523 FRANCHISE FEES 299412 289370 10042 18912154 13340666 5571488 0 3727478 2058012 2057943 2030030 6129 650963 246176 291768 15293086 6344756 7858855 8948330 887928 1813000 14784509 15792103 761970 1184598 0 1996406 761970 3181004 X 14012878 12611099 9661 0 14022539 12611099 14784509 15792103 X -966125 -445314 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 651 651 0 PART II-B, LINE 1: THE OHIO HOSPITAL ASSOCIATION DOES LOBBYING ON BEHALF OF HOSPITAL RELATED CAUSES. THIS ACTIVITY IS PAID FOR THROUGH DUES PAID TO THE OHIO HOSPITAL ASSOCIATION. 350000 350000 7076585 1831554 5245031 7556970 4332514 3224456 309531 180688 128843 8948330 GROUND LEASE 1813000 1813000 COST REPORT SETTLEMENTS PAYABLE 1996406 1996406 1 1 X 1 X 1 X 1 1 1 0 1 1 428975 1327219 0 0.00000 5060275 2087585 2972690 0.16640 5489250 3414804 2972690 0.16640 8796 8796 0.00050 1228869 1228869 0.06880 1237665 1237665 0.06930 6726915 3414804 4210355 0.23570 0 1044523 9599231 9899880 -300649 X 1 1 1 1 PIKE HEALTH SERVICES INC 100 DAWN LANE WAVERLY OH 45690 WWW.ADENA.ORG ST. REG. NUM. 1299 X X X X PIKE HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X ADENA.ORG/INSIDE/PAGE.DT/CHNA X X 1 16 1 HTTPS://WWW.ADENA.ORG/INSIDE/PAGE.DT/CHNA 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.ADENA.ORG/INSIDE/PAGE.DT/FINANCIAL-AID X HTTP://WWW.ADENA.ORG/INSIDE/PAGE.DT/FINANCIAL-AID X HTTP://WWW.ADENA.ORG/INSIDE/PAGE.DT/FINANCIAL-AID X X X X X X 1 X 0 X X X X X 1 X 0 0 PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 5: ADENA PIKE MEDICAL CENTER CAPTURED THE BROAD INTERESTS OF THE COMMUNITY FOR THE CHNA THROUGH TWO METHODS: SURVEY AND INTERVIEWS. A HEALTH NEEDS SURVEY WAS WIDELY DISTRIBUTED TO THE PIKE COUNTY COMMUNITY THROUGH PAPER AND WEB FORM. IN ADDITION TO THE SURVEYS, INTERVIEWS WITH LOCAL COMMUNITY LEADERS, INCLUDING CIVIC, PUBLIC HEALTH AND EMERGENCY RESPONSE WERE REQUESTED AND/OR CONDUCTED TO GAIN FURTHER KNOWLEDGE OF SURVEY TOPICS. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 7D: HARD COPIES OF THE CHNA REPORT WERE PRINTED AND SENT TO COMMUNITY LEADERS AND AGENCIES. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 11: OBESITYADVOCACYARMC CONTRIBUTES THE TIME OF TWO EMPLOYEES WHO DEDICATED A TOTAL OF 2 HOURS PER MONTH TO PARTICIPATING IN COMMITTEE MEETINGS AND COORDINATING PROJECTS FOR THE PIKE COUNTY HEALTH COALITION.ARMC DEPLOYED REGIONAL PUBLIC SERVICE ANNOUNCEMENTS VIA LOCAL RADIO AND SOCIAL MEDIA FOCUSED ON NUTRITION AND FITNESS EDUCATION AND AWARENESS.EDUCATIONAPMC CONTRIBUTED THE TIME OF TWO EMPLOYEES FOR A TOTAL OF FOUR HOURS TO THE HEART HEALTH PROGRAM COORDINATED BY THE PIKE COUNTY OSU EXTENSION.ARMC AND APMC COORDINATED A REGIONAL DIABETES AWARENESS EXPO DELIVERED AT THE JACKSON COUNTY YMCA IN MARCH 2017 WHERE A TOTAL OF 75 PARTICIPANTS WERE PROVIDED FOUR HOURS OF EDUCATION ON DIABETES MANAGEMENT, INCLUDING MEDICATION, NUTRITION, COOKING, AND FITNESS.PROGRAMMINGADENA HEALTH SYSTEM COORDINATED A HEALTHY KIDS EVENT AT THE PIKE COUNTY FAIR WHERE A TOTAL OF 150 CHILDREN WERE PROVIDED 45 MINUTES OF HEALTHY COOKING INSTRUCTION FOLLOWED BY THIRTY MINUTES OF NUTRITION, FITNESS AND WELLBEING EDUCATION. FINANCIAL SUPPORTADENA HEALTH SYSTEM PARTNERED WITH THE PIKE COUNTY OSU EXTENSION TO FUND THE FOOD RX AND FRUIT & VEGGIE PERKS PROGRAM WHICH PROVIDED 25 INDIVIDUAL ADENA PATIENTS AND COMMUNITY SNAP BENEFICIARIES A TOTAL OF $250 OF FRESH FRUITS AND VEGETABLES.RESPIRATORYADVOCACYAPMC CONTRIBUTED THE TIME OF ONE EMPLOYEE WHO DEDICATED A TOTAL OF 4 HOURS TO PARTICIPATING IN COMMITTEE MEETINGS AND COORDINATING PROJECTS FOR PIKE COUNTY SMOKING CESSATION COALITION.PROGRAMMINGADENA HEALTH SYSTEM COORDINATED THE ADENA QUIT CLINIC WHICH PROVIDED A TOTAL OF 19 PATIENTS (INCLUDING THOSE FROM PIKE COUNTY) TOBACCO CESSATION COUNSELING, SUPPORT AND NICOTINE REPLACEMENT EDUCATION BY ADENA PHARMACISTS. THE ADENA CANCER CENTER PROVIDED A TOTAL OF 787 PATIENTS FROM THE REGION INCLUDING PIKE, HIGHLAND AND ROSS COUNTIES WITH FREE LUNG CANCER SCREENINGS IN 2017 WHICH RESULTED IN 7 POSITIVE CANCER RESULTS.FINANCIAL SUPPORTADENA HEALTH SYSTEM PROVIDED $15,000 IN SUPPORT FOR RELAY FOR LIFE WHICH ENGAGED THE ROSS, PIKE AND HIGHLAND COMMUNITIES IN CANCER AWARENESS (INCLUDING LUNG CANCER) AND FUNDRAISING FOR RESEARCH.MENTAL HEALTHADVOCACYARMC DEPLOYED PUBLIC SERVICE ANNOUNCEMENTS VIA LOCAL RADIO AND SOCIAL MEDIA FOCUSED ON MENTAL HEALTH AWARENESS.PROGRAMMINGTHE ADENA HEALTH SYSTEM HOUSES A VICTIM'S ADVOCATE TEAM IN THE ARMC EMERGENCY DEPARTMENT WHICH PROVIDED 81 VICTIMS (INCLUDING THOSE FROM PIKE COUNTY) OF SEXUAL ASSAULT (ADULT AND PEDIATRIC), DOMESTIC VIOLENCE, CHILD ABUSE, ELDER ABUSE, HUMAN TRAFFICKING AND HATE CRIMES WITH MENTAL HEALTH REFERRAL, SAFETY NET AND SUPPORT SERVICES FREE OF CHARGE, VALUED AT VALUED AT $205,000. INFANT MORTALITY/CHILD SAFETYADVOCACYARMC DEPLOYED PUBLIC SERVICE ANNOUNCEMENTS ACROSS THE HEALTH SYSTEM AND CLINICS FOCUSED ON SAFE SLEEP AWARENESS.PROGRAMMINGTHE ADENA CENTERING PREGNANCY PROGRAM PROVIDED A TOTAL OF 25 NUMBER HIGH-RISK PREGNANCY PATIENTS (INCLUDING THOSE FROM PIKE COUNTY) WITH PREGNANCY EDUCATION AND SUPPORT DURING A TOTAL 7 ONGOING MONTHLY CLASSES. FINANCIAL SERVICESADENA HEALTH SYSTEM PROVIDED A TOTAL OF 8 CRIBS AND 1212 SLEEP SACKS FOR SOME OF THE 947 BABIES BORN AT THE ADENA WOMEN'S AND CHILDREN'S CENTER IN 2017. PATIENTS COME FROM MULTIPLE COUNTIES INCLUDING ROSS, PIKE AND HIGHLAND.SUMMARY MAINTENANCE OF RANKING FROM 88 TO 88 IN HEALTH OUTCOMES IN 2017. IMPROVEMENT OF RANKING FROM 88 TO 86 IN HEALTH FACTORS IN 2017.ADDITIONAL INITIATIVES AND RESOURCESRESIDENCY CLINICTHE ADENA FAMILY MEDICINE - RESIDENCY OPERATED A CLINIC IN 2018 PROVIDING AFFORDABLE, QUALITY HEALTH CARE FOR RESIDENTS OF ADENA HEALTH SYSTEMS PRIMARY SERVICE REGION INCLUDING PIKE, HIGHLAND AND ROSS COUNTIES. THE CLINIC PAIRED ACCESSIBLE PRIMARY CARE MEDICAL SERVICES PROVIDED BY PHYSICIAN INTERNS AND RESIDENTS OF ADENA'S GRADUATE MEDICAL EDUCATION PROGRAM, FAMILY AND INTERNAL MEDICINE PRECEPTORS AND A CERTIFIED NURSE PRACTITIONER ALSO PROVIDING SERVICES TO PATIENTS IN THE CLINIC. A TOTAL OF 2,502 PATIENTS, MOSTLY FROM SEVEN COUNTIES (ROSS, FAYETTE, VINTON, PICKAWAY, PIKE, HIGHLAND AND JACKSON) MADE A TOTAL OF 7,787 VISITS TO THE RESIDENCY CLINIC IN 2018.FOR MORE INFORMATION, GO TO: HTTP://WWW.ADENA.ORG/LOCATIONS/DEPARTMENT.DT/RESIDENCY-CLINICADENA SPORTS MEDICINE ATHLETIC TRAINING PROGRAMTHE ADENA HEALTH SYSTEM PROVIDED MORE THAN $591,285 IN ATHLETIC INJURY PREVENTION, DIAGNOSIS, AND EVALUATION SERVICES TO 15 LOCAL PUBLIC HIGH SCHOOLS WITHIN THE SERVICE REGION IN 2018. A TOTAL OF 12 ATHLETIC TRAINERS WORK WITHIN THE SCHOOL'S ATHLETIC DEPARTMENTS AND FOCUS ON EDUCATING STUDENTS, PARENTS AND COACHES ON SPORTS MEDICINE TOPICS, INCLUDING CONCUSSION IDENTIFICATION AND TREATMENT. THE STAFF IS ALSO READILY AVAILABLE AT ATHLETIC EVENTS AND PROVIDES YEARLY SPORTS PHYSICALS TO MORE THAN 1,200 STUDENTS IN PIKE, ROSS, AND JACKSON COUNTIES. COMMUNITY COLLABORATIONSORAL HEALTH INITIATIVETHE ADENA PIKE MEDICAL CENTER PARTNERED WITH THE PIKE COUNTY ROTARY TO PROVIDE A TOTAL OF 600 PIKE COUNTY ELEMENTARY STUDENTS WITH TOOTHBRUSHES AND TOOTHPASTE ($1,404) AS PART OF A COUNTY ORAL HEALTH INITIATIVE. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 16J: WWW.ADENA.ORG/FILES/RESOURCES/ADENAFINAIDFORMFINAL.PDF 1 1 - ADENA FAMILY MEDICINE - PIKETON 100 INDIAN RIDGE DRIVE PIKETON OH 45661 PHYSICIAN OFFICES PART I, LINE 6A: ADENA HEALTH SYSTEM EIN: 31-4379443 PART I, LINE 7: THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $1,044,523 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. PART III, LINE 2: THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS WITH THE COST TO CHARGE RATIO AGREED. PART III, LINE 4: WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA PIKE MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS ESTABLISHED BASED ON EXPECTED PAYMENT RATES FROM PAYORS UTILIZING CURRENT REIMBURSEMENT METHODOLOGIES AND PAYMENT RATES. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM 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 IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE." PART III, LINE 8: THE ADENA HEALTH SYSTEM SERVICE AREA IS A RURAL 13 COUNTY AREA IN SOUTHERN OHIO. ADENA HEALTH SYSTEM HAS EVALUATED THE COMMUNITY HEALTH NEEDS AND HAS IMPORTANT PROGRAMS AND SERVICES THAT ARE DESIGNED TO MEET THE NEEDS OF ADENA'S BROAD SERVICE AREA. HOWEVER, ONE OF THE MOST SIGNIFICANT HEALTH NEEDS MET BY ADENA IS THE IDENTIFICATION OF PHYSICIAN AND ADVANCED PRACTICE PROVIDERS FOR EACH SPECIALTY OF CARE. ADENA RECRUITS, SUPPORTS, AND PROVIDES THE INFRASTRUCTURE FOR PROVIDERS IN SPECIALTIES RANGING FROM PRIMARY CARE TO INTERVENTIONAL CARDIOLOGY. IN ADENA'S RURAL, APPALACHIAN SERVICE AREA, PHYSICIAN AND OTHER KEY CLINICAL AND SUPPORT STAFF ARE DIFFICULT TO RECRUIT AND RETAIN WHICH ELEVATES THE MARKET SALARY FOR SPECIALIZED STAFF. THE MEDICARE TWO PERCENT SEQUESTRATION IS ALSO A COMPONENT OF THE SHORTFALL CALCULATION. BASED ON THESE ISSUES, WE BELIEVE SERVICE TO OUR MEDICARE POPULATION, THAT RESULTED IN A MEDICARE SHORTFALL OF $300,649 IS A COMMUNITY BENEFIT. ALSO, THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6.PRIOR YEAR SETTLEMENTS FOR MEDICARE-RELATED SERVICES THAT WERE BOOKED IN THE CURRENT TAX YEAR ARE ALSO INCLUDED IN THE CURRENT TAX YEAR CALCULATION. PART III, LINE 9B: IF THE RESPONSIBLE INDIVIDUAL HAS NOT SUBMITTED A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE OR HAS NOT PAID-IN-FULL, THREE SEPARATE STATEMENTS ARE SENT OUT FOR THE COLLECTION OF SELF-PAY ACCOUNTS. THE FINAL STATEMENT SENT WILL INFORM THE INDIVIDUAL OF POSSIBLE EXTRAORDINARY COLLECTION ACTIONS (ECA) TO BE TAKEN IF FINANCIAL ASSISTANCE IS NOT APPLIED FOR OR THE ACCOUNT IS NOT PAID IN FULL. AFTER THE FINAL STATEMENT AND BEFORE ECAS ARE TAKEN, REASONABLE EFFORTS ARE MADE TO ORALLY CONTACT THE INDIVIDUAL AS A FINAL NOTICE. COLLECTION AGENCIES ARE THEN INFORMED AND ARE AUTHORIZED TO REPORT UNPAID ACCOUNTS TO CREDIT AGENCIES AND TAKE LEGAL ACTION TO RECOVER OUTSTANDING AMOUNTS DUE. PATIENTS WHO CANNOT PAY CHARGES IN FULL MAY ALSO BE OFFERED A PAYMENT PLAN THAT IS CONSISTENT WITH PIKE HEALTH SERVICES INC.'S CUSTOMER SERVICE PROCEDURES. PART VI, LINE 3: THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. A CONTRACTED VENDOR SUPPLIES STAFF AT THE CASHIER AREA TO EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE. 7. LASTLY, WE UTILIZE A "HINDSIGHT" VENDOR THAT SCREENS ALL BAD DEBT ACCOUNTS, AFTER THE YEAR-END, AGAINST THE STATE MEDICAID ELIGIBILITY AND FEDERAL POVERTY GUIDELINES TO ATTEMPT ONE LAST EFFORT TO OBTAIN FINANCIAL ASSISTANCE FOR INDIVIDUALS. PART VI, LINE 4: PIKE COUNTY, HOME OF THE ADENA PIKE MEDICAL CENTER (APMC), IS LOCATED IN SOUTH CENTRAL OHIO. IT IS PART OF THE 2ND CONGRESSIONAL DISTRICT AND IS ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT CONTAINS THE POPULATION PATTERNS AND DISTINCT ECONOMIC CONDITIONS INHERENT OF THIS REGION OF THE U.S AND FACES SIMILAR CHALLENGES IN DIVERSIFYING ITS ECONOMY TO IMPROVE THE LIVES OF ITS 28,160 RESIDENTS.THERE ARE 10,816 HOUSEHOLDS IN PIKE COUNTY. THE AVERAGE HOUSEHOLD SIZE IS 2.61 PEOPLE, COMPARABLE WITH THE REST OF THE 12 COUNTY SERVICE REGION AND OHIO. THE AVERAGE FAMILY SIZE IS AS WELL WITH 3.11 PEOPLE.MORE THAN 22% OF THE ADULTS IN PIKE COUNTY HAVE NOT GRADUATED FROM HIGH SCHOOL. THIS PERCENTAGE IS HIGHER THAN THE AVERAGES FOR THE REGION (18.9%), OHIO (12.2%) AND THE NATION (14.6%). LESS THAN 12% HAVE A COLLEGE DEGREE. MORE THAN 12% OF THE POPULATION OF PIKE COUNTY IS ESTIMATED TO BE FUNCTIONALLY ILLITERATE, OR LACKING THE READING AND WRITING SKILLS SUFFICIENT FOR ORDINARY PRACTICAL NEEDS. THE UNEMPLOYMENT RATE IN PIKE COUNTY (10.7%) IS CONSIDERABLY HIGHER THAN THE REGIONAL (6.8%), STATE (6%) AND U.S. (7.7%) AVERAGES. IN ADDITION, MORE THAN 44.5% OF THE POPULATION IS NOT IN THE WORKFORCE. THIS IS HIGHER THAN THE STATE (35.4%) AND NATIONAL AVERAGES (35.2%). THE TOP FIVE EMPLOYMENT INDUSTRIES IN PIKE COUNTY ARE MANAGEMENT/BUSINESS/SCIENCE (28.9%), SERVICE (21.5%) SALES (23%), PRODUCTION/TRANSPORTATION SERVICES (19.2%), SALES (18.2%), AND NATURAL RESOURCES/CONSTRUCTION/MAINTENANCE. PIKE COUNTY HAS A GREATER PERCENTAGE OF PEOPLE EMPLOYED IN PRODUCTION, TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS (19.2%) THAN THE REGIONAL, STATE AND NATIONAL AVERAGES. THE PER CAPITA MEDIAN AND MEAN HOUSEHOLD INCOMES IN PIKE COUNTY OHIO ARE MUCH LOWER THAN THE STATE AND U.S. AVERAGES. POVERTY RATES ARE ALSO HIGHER THAN REGIONAL, STATE AND NATIONAL AVERAGES. ACCESS TO EMPLOYMENT IN PIKE COUNTY IS ALSO LOWER THAN OTHER COUNTIES IN THE REGION.PIKE COUNTY AND ITS ENTIRE SURROUNDING SERVICE REGION HAVE A HIGHER PREVALENCE OF DISABILITY THAN THE REST OF OHIO. SEVEN OF THE 12 COUNTIES IN THE SERVICE REGION, INCLUDING PIKE COUNTY, HAVE DISABILITY PREVALENCE RATES OF 16.7% - 22%. PART VI, LINE 5: ADENA PIKE MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A LOCAL BOARD. THE 2018 BOARD OF TRUSTEES OF ADENA PIKE MEDICAL CENTER WAS COMPRISED OF NINE MEMBERS. ONE OF THE BOARD MEMBERS IS AN EMPLOYEE OF ADENA HEALTH SYSTEM. ALL BOARD MEMBERS RESIDE IN THE HOSPITAL'S SERVICE AREA. PART VI, LINE 6: FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WELLSTON, HILLSBORO, WASHINGTON COURT HOUSE AND WAVERLY, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE, HILLSBORO, AND WAVERLY. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN). THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 DAVID KESSLER CHIEF OF MEDICAL STAFF 0 276332 0 0 0 56550 0 0 0 3762 0 336644 0 0 LISA CARLSON AHS CFO 0 435512 0 162254 0 52419 0 226070 0 17951 0 894206 0 98279 JEFF GRAHAM AHS CEO 0 686122 0 50254 0 69098 0 390377 0 23796 0 1219647 0 50254 DAVE ZANNI CEO 166434 0 21691 0 20133 0 67615 0 13857 0 289730 0 21691 0 KATHI EDRINGTON AHS COO 0 439335 0 0 0 42843 0 212447 0 13257 0 707882 0 0 ELEANOR BOLNER DEPT MGR 0 101986 0 8839 0 131 0 21579 0 22026 0 154561 0 8839 CATHERINE FARINET FORMER DIRECTOR 0 201266 0 0 0 8403 0 0 0 24805 0 234474 0 0 MARK SHUTER FORMER AHS CEO 0 0 0 0 0 564496 0 0 0 0 0 564496 0 0 JOHN FORTNEY FORMER AHS CEO 0 431702 0 112213 0 169362 0 208519 0 23005 0 944801 0 112213 PART I, LINE 1A DAVE ZANNI HAS MEMBERSHIP IN ROTARY. PURPOSE IS TO ENHANCE PIKE'S ENGAGEMENT IN THE ACTIVITES OF WAVERLY AND SURROUNDING COMMUNITIES. DAVE ZANNI IS REIMBURSED FOR HIS ROTARY CLUB DUES. THIS IS NOT TREATED AS TAXABLE COMPENSATION. PART I, LINE 3 THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2018. PART I, LINES 4A-B MARK SHUTER RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $564,496. THE ORGANIZATION HAS A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED PAYMENT FROM THE SERP IN 2018: JOHN FORTNEY $56,712 SERP ACCRUAL JEFF GRAHAM $74,108 SERP ACCRUAL LISA CARLSON $53,956 SERP ACCRUAL KATHI EDRINGTON $44,195 SERP ACCRUAL INCLUDED IN PART II, COLUMN (C) ARE AMOUNTS CREDITED TO THE EXECUTIVE UNDER THE SECTION 457(F) DEFERRED COMPENSATION PLAN. THESE AMOUNTS WERE CREDITED TO AN ACCOUNT FOR THE EXECUTIVE IN PRIOR YEARS. PLEASE NOTE THAT IN PRIOR PERIOD(S) AMOUNTS CREDITED TO THE EXECUTIVE'S ACCOUNT HAVE NOT BEEN DISCLOSED IN PART II, COLUMN (C). FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PIKE HEALTH SERVICES IS ADENA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF THE ORGANIZATION NOMINATES TRUSTEES, AND ADENA HEALTH SYSTEM, AS THE SOLE MEMBER OF THE ORGANIZATION, ELECTS THE TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNANCE DECISIONS ARE RESERVED FOR ADENA HEALTH SYSTEM AS THE SOLE MEMBER OF THE ORGANIZATION, SUCH AS THE ELECTION OF MEMBERS OF THE BOARD OF TRUSTEES OF THE ORGANIZATION, APPROVAL OF STRATEGIC PLANS OF THE ORGANIZATION, AND APPROVAL OF AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND CODE OF REGULATIONS. ADENA HEALTH SYSTEM CAN ACT ON THESE RIGHTS BY A VOTE AT ANY MEETING, AN ACTION WITHOUT A MEETING, OR THROUGH OTHER AUTHORIZED MEANS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS REVIEWED AT A BOARD MEETING, AND COPIES OF THE FORM 990 WERE PROVIDED TO THE BOD MEMBERS. ADDITIONALLY, COPIES OF THE 990 WERE MADE AVAILABLE IN THE ADMINISTRATION OFFICE UNTIL THE NOVEMBER 15 FILING DATE. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. ALL CONFLICTS ARE REVIEWED, AND THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. FRONT LINE SUPERVISORS UP THROUGH THE CEO AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2018. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 20,004. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,004. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,919,320. MANAGEMENT AND GENERAL EXPENSES 341,353. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,260,673. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 582,153. MANAGEMENT AND GENERAL EXPENSES 246,720. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 828,873. FORM 990, PART XI, LINE 9: TRANSFER (TO) FROM RELATED ORGANIZATION -441,817. NET ASSETS RELEASED FROM RESTRICTION -3,497. FORM 990, PART XII, LINE 2C: THE ADENA HEALTH SYSTEM'S AUDIT COMMITTEE ENGAGES THE INDEPENDENT AUDIT FIRM FOR THE AUDIT, REVIEWS RESULTS, AND REPORTS TO THE BOARD. ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. PIKE HEALTH SERVICES IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. FORM 990, PART V, LINE 1 A RELATED ORGANIZATION, ADENA HEALTH SYSTEM, ISSUES THE 1099S AND W-2S. GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD OH 45123 310993422 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 ADENA HEALTH FOUNDATION 242 HOSPITAL ROAD CHILLICOTHE OH 45601 753008742 FUNDRAISING OH 501(C)(3) 12A ADENA HEALTH SYSTEM 1 SOUTHERN OHIO HEALTHCARE NETWORK 550 MIRABEAU ST GREENFIELD OH 45123 261566590 FIBEROPTIC NETWORK GRANTS OH 501(C)(3) 12A ADENA HEALTH SYSTEM 1 ADENA HEALTH SYSTEM 242 HOSPITAL ROAD CHILLICOTHE OH 45601 314379443 HOSPITAL OH 501(C)(3) 3 N/A 0 ADENA CARE 272 HOSPITAL ROAD CHILLICOTHE OH 45601 453980850 SEE SCHEDULE R, PART VII OH N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 ADENA HEALTH SYSTEM R 441817 BOOK VALUE SCHEDULE R, PART IV, COLUMN (B) THE PRIMARY ACTIVITY OF ADENA CARE IS TO DEVELOP STRATEGIC RELATIONSHIPS TO THE SERVICE AREAS MAJOR EMPLOYERS THROUGH HEALTH MANAGEMENT AND WELLNESS SERVICES.