2025-11-17T13:50:34-06:00 2024-12-31 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2024-01-01 341623770 JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL JOIN 4193943387 200 ST CLAIR STREET ST MARYS OH 45885 TRICIA A POHL CFO 4193943387 2025-11-14 1 1 AMY CIMINELLO P00796388 6148493000 2025-11-14 2024 2025-03-06 01:10:19Z GRAND LAKE HEALTH SYSTEM TRICIA POHL 200 ST CLAIR STREET ST MARYS OH 45885 108203030 0 X WWW.GRANDLAKEHEALTH.ORG X 1989 OH SEE SCHEDULE O FOR THE MISSION STATEMENT 9 8 838 60 11225 18237 1542114 867808 99620274 104795277 808832 994483 887961 1033565 102859181 107691133 75400 82900 0 0 36376772 39186294 0 0 161937 60018456 60859074 96470628 100128268 6388553 7562865 85266230 87877038 28026690 31544789 57239540 56332249 X THE MISSION OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG.VISION: TO BE: THE REGION'S LEADER AND PREFERRED CHOICE FOR HEALTHCARE; THE MOST DESIRED PLACE FOR EMPLOYMENT; THE RECOGNIZED SOURCE FOR HEALTH AND WELLNESS; AND THE COORDINATOR OF PATIENT SERVICES THAT EXCEED THE SCOPE OF OUR HEALTH SYSTEM.VALUES: COMPASSION - TO SERVE WITH DIGNITY, CONCERN, TRUST AND KINDNESS RESPECT - FOR OUR PATIENTS, FAMILIES, COMMUNITIES AND EACH OTHER STEWARDSHIP - MAKING THE BEST USE OF OUR HUMAN AND ECONOMIC RESOURCES SERVICE EXCELLENCE - ANTICIPATING CUSTOMER NEEDS, CONTINUOUSLY IMPROVING AND CONSISTENTLY EXCEEDING EXPECTATIONS COLLABORATION - TO WORK IN PARTNERSHIP, INTERNALLY AND EXTERNALLY, TO BETTER SERVE OUR COMMUNITIES WORKFORCE - TO VALUE AND RESPECT THE TALENTED, COMMITTED AND DIVERSE PEOPLE WHO MAKE UP OUR HEALTH SYSTEM 0 0 81025894 82900 104950340 GRAND LAKE HEALTH SYSTEM AND AFFILIATED HEALTH CENTERS ARE ORGANIZED AS A CHARITABLE, NON-PROFIT COMMUNITY HOSPITAL OFFERING A WIDE RANGE OF PRIMARY, ACUTE AND REHABILITATIVE SERVICES TO THE RESIDENTS OF THE GRAND LAKE REGION.THE ANCHOR OF GRAND LAKE HEALTH SYSTEM IS JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL (JTDMH) IN ST. MARYS OHIO. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL OPENED ITS DOORS ON MAY 5, 1953 AND TODAY AS THE GRAND LAKE HEALTH SYSTEM, HAS GROWN TO A STATE-OF-THE-ART COMMUNITY HOSPITAL INCLUDING OVER 800 MEDICAL PROFESSIONALS, 200 + PHYSICIANS AND OVER 20 AFFILIATES.JTDMH IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL-TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND MANUFACTURING. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDES A POPULATION OF 24,700 WITH THE ADJACENT COMMUNITIES OF CELINA (ZIP CODE POPULATION OF 19,945) AND WAPAKONETA (POPULATION 17,974) ALSO BEING SERVED BY THE HOSPITAL. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTDMH'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 62,619 WITH 20% IN THE MEDICARE AGE GROUP (65+).JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A FULL RANGE OF ACUTE AND OUTPATIENT SERVICES INCLUDING A 24-HOUR EMERGENCY ROOM AND OBSTETRICAL SERVICE. MAJOR SERVICES INCLUDE SURGICAL; MEDICAL; SKILLED NURSING UNIT; INPATIENT REHABILITATION UNIT; GERIATRIC PSYCHIATRIC UNIT; ICU/CCU; DIAGNOSTIC RADIOLOGY INCLUDING CT, MRI AND 3D MAMMOGRAPHY; PHYSICAL THERAPY; OCCUPATIONAL MEDICINE; CARDIAC SERVICES; URGENT CARE; HOME HEALTH SERVICES; HOSPICE; WOUND CARE; HEARTBURN CENTER AND VEIN CLINIC SERVICES.THE GRAND LAKE SYSTEM COMMUNITY OUTREACH DEPARTMENT OFFERS A VARIETY OF OUTREACH PROGRAMS THAT PROMOTE GOOD HEALTH AMONG ALL AREA CITIZENS NOT JUST PATIENTS. THE GOAL IS TO EDUCATE PEOPLE SO THEY GAIN THE SKILLS AND KNOWLEDGE TO KEEP THEMSELVES AND THOSE AROUND THEM HEALTHY. MANY OF THE CLASSES, SERVICES, AND PROGRAMS HAVE EVOLVED FROM A SUGGESTION BY A HEALTHCARE PROVIDER OR LOCAL RESIDENT. THE OUTREACH DEPARTMENT OFFERS HUNDREDS OF PROGRAMS A YEAR RANGING FROM BLOOD PRESSURE SCREENINGS, SUPPORT GROUPS, SCHOOL PROGRAMS, AND COMMUNITY HEALTH FAIRS TO NAME A FEW. DURING 2024, JTDMH PROVIDED SERVICES TO THE FOLLOWING, BY CATEGORY:ACUTE PATIENTS ADMITTED: 1,631SNF PATIENTS ADMITTED: 103GERIATRIC PSYCH PATIENTS ADMITTED: 216BIRTHS: 291OUTPATIENT VISITS: 77,710 E.R. VISITS: 12,019HOME HEALTH VISITS: 3,899OCCUPATIONAL HEALTH VISITS: 10,605URGENT CARE VISITS: 6,146JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL AND GRAND LAKE HEALTH SYSTEM IS THE HUB OF THE LOCAL HEALTH CARE DELIVERY SYSTEM IN ST. MARYS AND SURROUNDING COMMUNITIES. THE NON-PROFIT COMMUNITY HOSPITAL ALSO HAS A MAJOR ECONOMIC IMPACT ON THE LOCAL COMMUNITY BY PROVIDING EMPLOYMENT TO APPROXIMATELY 700 INDIVIDUALS. THE GRAND LAKE HEALTH SYSTEM INCLUDES PHYSICIAN PRACTICES AND FACILITIES IN CELINA, ST. MARYS, WAPAKONETA, AND MINSTER. IN 2024, THESE PRACTICES HAD 98,836 PATIENT VISITS.GRAND LAKE AFFILIATES INCLUDE: AUGLAIZE + MERCER GENERAL & BARIATRIC SURGERY AUGLAIZE + MERCER GENERAL SURGERY CIAO MED SPA CLEAR PASSAGE GERIATRIC PSYCHIATRIC CENTER GRAND LAKE FAMILY PRACTICE & PEDIATRICS GRAND LAKE FOOT & ANKLE CENTER GRAND LAKE HEARTBURN CENTER GRAND LAKE HOME HEALTH GRAND LAKE HOSPICE GRAND LAKE NEUROLOGICAL CENTER GRAND LAKE OB/GYN GRAND LAKE OCCUPATIONAL MEDICINE GRAND LAKE PEDIATRICS GRAND LAKE PRIMARY CARE AT ST. MARYS GRAND LAKE REHAB & WELLNESS CENTER GRAND LAKE SLEEP CENTER GRAND LAKE UROLOGY JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL JTDMH INPATIENT REHAB UNIT JTDMH TRANSITIONAL CARE UNIT KEMMLER ORTHOPAEDIC MARIA STEIN FAMILY PRACTICE MIAMI & ERIE FAMILY PRACTICE & PEDIATRICS MOR REHAB NEW DAY PAIN MANAGEMENT CENTER URGENT CARE AT JTDMH VANAN ENT & SINUS CENTER WAPAKONETA PRIMARY CAREWE HAVE INVESTED SIGNIFICANTLY IN THE BUILDING DURING THE PAST TEN YEARS INCLUDING COMPLETING A NEW WOMEN'S CENTER, LABORATORY, WOUND CARE CENTER WITH TWO HYPERBARIC CHAMBERS, A NEUROLOGY CENTER, SLEEP CENTER, MIAMI & ERIE MEDICAL CENTER IN MINSTER, AND A NEW OUTPATIENT CENTER RENOVATION. IN CONJUNCTION WITH PREMIER HEALTH, GRAND LAKE HEALTH SYSTEM ENTERED INTO A TEN-YEAR NAMING RIGHTS PARTNERSHIP WITH THE AUGLAIZE MERCER FAMILY YMCA LOCATED IN MINSTER & CELINA. THIS PARTNERSHIP FOCUSES ON MEETING THE NEEDS OF THOSE SERVED BY EXTENDING THE MUTUAL MISSION TO BUILD HEALTHY COMMUNITIES.JTDMH RECEIVED THE FOLLOWING CERTIFICATIONS AND WAS THE RECIPIENT OF THE FOLLOWING AWARDS IN THE PAST THREE YEARS. ACUTE CARE 2023 DNV HEART FAILURE CERTIFICATION 2024 DNV HEART FAILURE CERTIFICATIONBIRTHING CENTER 2022 OHIO FIRST STEPS FOR HEALTHY BABIES, FOUR STAR AWARD 2023 BLUE DISTINCTION CENTER + FOR MATERNITY CARE 2024 OHIO FIRST STEPS FOR HEALTHY BABIES, FOUR STAR AWARD 2024 FIRST STEPS FOR HEALTHY BABIES BRONZE LEVEL FATHER/PARTNER ENGAGEMENT AWARD 2024 GOLD SAFE SLEEP CERTIFICATIONCARDIAC REHAB 2023 AACVPR CARDIAC REACCREDITATIONCHAMBER AWARDS 2023 NON PROFIT ORGANIZATION OF THE YEARCOMMUNITY OUTREACH AWARDS 2023 AWARDED WAPAKONETA AREA COMMUNITY FOUNDATION GRANT FOR 2023 GRAND HEALTH CHALLENGE 2024 AWARDED WAPAKONETA AREA COMMUNITY FOUNDATION GRANT FOR 2024 GRAND HEALTH CHALLENGEDIABETIC EDUCATION & CLINICAL NUTRITION2023-2027 OUTPATIENT DIABETES SELF-MANAGEMENT EDUCATION PROGRAM, CERTIFICATE OF RECOGNITION FOR MEETING NATIONAL STANDARDS, FROM AMERICAN DIABETES ASSOCIATION (CONTINUED RECOGNITION SINCE 2008) 2019-2024 CDC FULL RECOGNITION FOR DIABETES PREVENTION PROGRAM EMERGENCY DEPARTMENT 2022 DNV ACUTE STROKE READY CERTIFICATION 2023 DNV ACUTE STROKE READY CERTIFICATION 2023 WOMEN'S CHOICE AWARD BEST HOSPITAL FOR EMERGENCY CARE Q12023, Q22023 & Q32023 PREMIER HEALTH DOOR TO NEEDLE CHALLENGE 2024 DNV ACUTE STROKE READY CERTIFICATION 2024 WOMEN'S CHOICE AWARD BEST HOSPITAL FOR EMERGENCY CARE INPATIENT PSYCHIATRIC CENTER 2022 HORIZON HEALTH CLINICAL PROGRAM OF THE YEAR 2023 REBRANDED AND CHANGED NAME TO INPATIENT PSYCHIATRIC SERVICES 2024 HORIZON HEALTH CLINICAL EXCELLENCE AWARDHOME HEALTH & HOSPICE AWARDS 2022 CMS COMPARE QUALITY REFRESH REPORT FOR GRAND LAKE HOSPICE 5 STARS 2023 NATIONAL BEST PRACTICE AGENCY BY WELLSKY 2024 NATIONAL BEST PRACTICE AGENCY BY WELLSKYMEDICAL IMAGING 2022-2025 ACR REACCREDITATION IN MRI 2022-2025 ACR REACCREDITATION IN CT 2024-2028 ACR REACCREDITATION FOR 3D MAMMOGRAPHY MEDICARE 5 STAR RATED HOSPITAL2022 MEDICARE 5 STAR RATED HOSPITAL2023 MEDICARE 5 STAR RATED HOSPITALNEW VISION MEDICAL LABORATORY 2021-2023 RECERTIFICATION BY ACCREDITATION COMMISSION FOR HEALTH CARE (ACHC) 2023-2025 RECERTIFICATION BY ACHCOHIO DEPARTMENT OF HEALTH - HEALTHY WORKSITE AWARDS 2022 HEALTHY WORKSITE PLATINUM AWARD 2023 HEALTHY WORKSITE PLATINUM AWARD 2024 HEALTHY WORKSITE GOLD AWARDQUALITY 2023 WOMEN'S CHOICE AWARD BEST HOSPITAL FOR PATIENT SAFETY 2024 WOMEN'S CHOICE AWARD BEST HOSPITAL FOR PATIENT SAFETYSURGERY CENTER 2022 ROBOTIC- SURGERY PROGRAMTRANSITIONAL CARE UNIT 2022 5-STAR MEDICARE COMPARE FACILITY 2023 5-STAR MEDICARE COMPARE FACILITY 2024 4-STAR MEDICARE COMPARE FACILITY WOUND CARE CENTER 2022 ROBERT A WARRINER III, CLINICAL EXCELLENCE AWARD 2022 CENTER OF DISTINCTION AWARD 2023 ROBERT A WARRINER III, MD CENTER OF EXCELLENCE AWARD 2023 CENTER OF DISTINCTION AWARD 2024 ROBERT A WARRINER III, CLINICAL EXCELLENCE AWARD 2024 CENTER OF DISTINCTION AWARDWELCOMED THE FOLLOWING PROVIDERS IN 2024:KEVIN JACKSON, PA-CKATHLEEN HEITKAMP, APRN/CNPKATHRYN BRUNS, APRN/CNPJESSICA WUEBKER, APRN/CNP 81025894 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 140 0 1 838 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X TRICIA A POHL 4193943387 200 ST CLAIR ST ST MARYS OH 45885 JEFFREY SQUIRE CHAIR 2.00 0.00 X X 0 0 0 RANDALL NIEKAMP VICE CHAIR 1.50 0.00 X X 0 0 0 CLAUDIA COE DIRECTOR 1.00 0.00 X 0 0 0 KEN FOX DIRECTOR 1.00 0.00 X 4200 0 0 ISSAC HOYING DIRECTOR 1.00 0.00 X 0 0 0 CHRISTOPHER STUCKE DIRECTOR 1.00 44.00 X 0 498163 57922 CHRIS SCHROER DIRECTOR 1.00 0.00 X 0 0 0 WALLY WAGNER DIRECTOR 1.00 0.00 X 0 0 0 BRIAN SCHLOSSER DIRECTOR 1.00 0.00 X 0 0 0 CYNTHIA BERNING PRESIDENT 24.00 21.00 X 350045 156384 39576 TRICIA POHL TREASURER 38.00 7.00 X 227871 0 57617 LESLIE WOBLER SECRETARY 30.00 10.00 X 70286 0 35782 LANA HINDERS CHIEF CLINICAL OFFICER 45.00 0.00 X 208711 0 55771 TYLER KROEGER VP OF OPERATIONS 45.00 0.00 X 177810 0 39309 HOLLY JACOMET VP OF QUALITY & PHYS. PRACTICES 22.50 22.50 X 180457 0 4795 SHELLY RUPPERT ED OF HUMAN RESOURCES 40.00 0.00 X 176526 0 52411 AMY DIRKSEN ED OF SPECIALTY CARE SERVICES 40.00 0.00 X 155019 0 49490 LESIA ARNETT ED DEVELOPMENT, MARKETING 40.00 0.00 X 152222 0 37915 LORI MILLER CHIEF OF INFORMATION SERVICES 40.00 0.00 X 143642 0 46204 SARA MOSLER PHARMACIST 40.00 0.00 X 130368 0 46972 KEVIN HARLAN FORMER PRESIDENT 40.00 0.00 X 234664 0 0 2211821 654547 523764 19 1 1 0 EMERGENCY PHYSICIANS OF NW OHIO PO BOX 351357 TOLEDO OH 43635 MEDICAL SERVICES 3936518 THERAPY SOLUTIONS 120 W MAIN ST VAN WERT OH 45891 MEDICAL SERVICES 2616925 NEW VISION MEDICAL LABORATORIES INC 680 S FOURTH STREET LOUISVILLE KY 63150 MEDICAL SERVICES 2452360 FEP ACUTE 22029 N 51ST ST PHOENIX AZ 85054 MEDICAL SERVICES 1187003 QUALIVIS LLC PO BOX 123847 DALLAS TX 75312 MEDICAL SERVICES 1149375 29 401331 466477 867808 NET PATIENT REVENUE 621400 104677068 104677068 PASSTHROUGH INCOME 621400 118209 118209 104795277 981648 981648 935986 507161 428825 428825 -13404 442229 17571 4736 12835 12835 12835 CAFETERIA AND VENDING SALES 722514 446118 446118 HPSA INCENTIVES 621400 56047 56047 OUTREACH 621400 55435 55435 47140 15484 24629 7027 604740 107691133 104922243 11225 1889857 X 82900 82900 2008314 2008314 23037024 19516697 3421159 99168 1060995 898234 158271 4490 10955154 8706311 2205262 43581 2124807 1660583 455923 8301 114222 114222 144020 144020 68898 68898 27267095 23244491 4018335 4269 231597 19756 211841 3557226 2074675 1481294 1257 8062660 4160447 3902213 141741 130958 9912 871 647531 579766 67765 449901 449901 4093783 3602529 491254 -390685 -390685 MEDICAL SUPPLIES 11193043 11186548 6495 BAD DEBT EXPENSE 5135706 5135706 PHYSICIAN RECRUITMENT 48108 48108 AWARDS & RECOGNITION 22770 22770 71458 26293 45165 100128268 81025894 18940437 161937 355882 344569 16992626 19004050 15762956 16491239 1494730 1497138 2252750 1745824 105685614 78029550 28348038 27656064 15068508 16349760 2766361 3190053 2224379 1598341 85266230 87877038 7266867 6901868 2051282 7953014 6496557 5836302 12211984 10853605 28026690 31544789 X 57239540 56332249 57239540 56332249 85266230 87877038 X 7562865 1069572 -9539728 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 1238 1238 0 PART II-B, LINE 1: LINE 1(G): EXECUTIVE OFFICERS OF JTD MEMORIAL HOSPITAL PLACED CALLS WITH THEIR LEGISLATORS TO HELP EDUCATE THE LEGISLATORS ON VARIOUS HEALTH CARE RELATED ISSUES. LINE 1(I): THE HOSPITAL PAID DUES TO OHA, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 216352 250 22337 8324 230614 184631 10017 24204 2500 216352 166975 41309 -18361 5292 184631 62756 100100 4119 166975 63135 100 5916 6395 62756 0.00000 1.00000 0.00000 0 1 1 1962914 1962914 65378535 48789767 16588768 37821812 29239783 8582029 522353 522353 27656064 PROFESSIONAL LIABILITY 8269833 LEASE LIABILITY 1469537 OTHER LONG TERM LIABILITIES 829149 COST REPORT SETTLEMENT PAYABLE 285086 10853605 PART V, LINE 4: JTD HOSPITAL FOUNDATION, A RELATED ORGANIZATION, HOLDS THE NED & FERN JOHNS INPATIENT PSYCHIATRIC ENDOWMENT FUND AND THE HEINRICH FAMILY ENDOWMENT FUND. THE NED & FERN JOHNS INPATIENT PSYCHIATRIC ENDOWMENT FUND THE INTENTION OF THIS FUND IS TO SUPPORT SPECIALIZED SERVICES TO THE INPATIENT PSYCHIATRIC CENTER. THIS ENDOWMENT FUND MAY BE UTILIZED TO SUPPORT SPECIALIZED SERVICES INCLUDING BUT NOT LIMITED TO MUSIC THERAPY, ART THERAPY, EDUCATION FOR PATIENTS, FAMILIES, AND THE COMMUNITY, ONGOING EDUCATIONAL NEEDS OF THE INPATIENT PSYCHIATRIC STAFF RELATED TO THE TYPE OF CARE, PROVIDED ON THIS UNIT, AND SUPPLIES SPECIFIC FOR INPATIENT PSYCH PATIENTS SUCH AS WEIGHTED BLANKETS, SENSORY BOXES, FIDGET BOARDS, OR OTHER ACTIVITIES THAT PROVIDE A SAFE SUPPORTIVE ENVIRONMENT AIMED AT HELPING PATIENTS ACHIEVE THEIR OPTIMAL LEVEL OF FUNCTIONING. THE HEINRICH FAMILY ENDOWMENT FUND THE HEINRICH FAMILY ENDOWMENT FUND HAS BEEN ESTABLISHED TO PROVIDE FUTURE INCOME TO SUPPORT JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S EFFORTS TO MEET THE HEALTH CARE NEEDS OF OUR SURROUNDING COMMUNITIES. THE REQUEST FOR A GRANT MUST BE FOR AN ITEM OR SERVICE THAT WILL BENEFIT THE SAFETY, CARE, AND/OR COMFORT OF PATIENTS BEING CARED FOR BY JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. REQUESTS FOR FUNDS MAY ALSO BE REQUESTED TO SUPPORT A COMMUNITY PARTNERSHIP INITIATIVE THAT RELATES TO A NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. 1 1 X 1 X 120.000000000000 1 X 1 1 0 1 1 330 215475 215475 0.00230 8805 9252931 5272134 3980797 0.04190 9135 9468406 5272134 4196272 0.04420 68 33194 1026004 7918 1018086 0.01070 5 18 109390 109390 0.00120 1 0 67798 67798 0.00070 0 0 3 472 113520 113520 0.00120 77 33684 1316712 7918 1308794 0.01380 77 42819 10785118 5280052 5505066 0.05800 0 0 1 0 641 641 0.00000 9 2322 52981 1365 51616 0.00050 2 0 1431 1431 0.00000 0 0 0 0 7 1331 10104 10104 0.00010 3 337 66024 66024 0.00070 0 0 22 3990 131181 1365 129816 0.00130 0 5135706 5681 13376880 20300656 -6923776 X 1 1 1 1 JTD MEMORIAL HOSPITAL 200 SAINT CLAIR STREET ST MARYS OH 45885 WWW.GRANDLAKEHEALTH.ORG STATE REG. NO. 1111 X X X INPATIENT REHAB UNIT, TRANSITIONAL CARE UNIT, GERIATRIC PSYCH UNIT JTD MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V, PAGE 8 X 1 22 0 1 0 1 X 120.000000000000 200.000000000000 X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 1 X 0 X X X 1 X 0 0 JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: JTD MEMORIAL HOSPITAL CREATED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT MET ON JUNE 23, 2022. PARTICIPANTS INCLUDED THE AUGLAIZE COUNTY HEALTH DEPARTMENT, THE MERCER COUNTY HEALTH DEPARTMENT, THE AUGLAIZE COUNTY COUNCIL ON AGING, ST. MARY'S CITY SCHOOLS, UNITED WAY, AND THE FOLLOWING GROUPS FROM JTD MEMORIAL HOSPITAL:- PATIENT CARE SERVICES- HOSPITAL FOUNDATION- GRAND LAKE HOME HEALTH/HOSPICE- EMPLOYED PHYSICIAN PRACTICES- COMMUNITY OUTREACH- ADMINISTRATIONPARTICIPANTS WERE PROVIDED A REPORT COMPILED BY AN INDEPENDENT CONSULTANT, WHICH DREW DATA FROM VARIOUS WEB SOURCES WITH BOTH AUGLAIZE AND MERCER COUNTY HEALTH INDICATORS AND HEALTH STATUS PROFILES FROM 2022. THERE WERE FIVE MAIN SOURCES FOR THIS DATA: OHIO DEPARTMENT OF DEVELOPMENT COUNTY PROFILES; OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE; COUNTY HEALTH RANKINGS AND ROADMAPS 2022; AUGLAIZE COUNTY COMMUNITY HEALTH ASSESSMENT 2021; AND GRAND LAKE HEALTH SYSTEM/JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL COMMUNITY HEALTH ASSESSMENT 2019. PARTICIPANTS REVIEWED ALL DATA AND INFORMATION TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. PARTICIPANTS IDENTIFIED THE HEALTH NEEDS OF THE COMMUNITY BY CONSIDERING THOSE REQUISITES FOR THE IMPROVEMENT OR MAINTENANCE OF HEALTH STATUS IN THE COMMUNITY USING ALL FACTS AND CIRCUMSTANCES PRESENTED. PARTICIPANTS CONSIDERED THE SEVERITY OF EACH NEED, EFFECTIVENESS OF INTERVENTION, HEALTH DISPARITIES ASSOCIATED WITH THE NEED, AND IMPORTANCE THE COMMUNITY PLACES ON ADDRESSING THE NEED. JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: AUGLAIZE COUNTY HEALTH DEPARTMENT, MERCER COUNTY HEALTH DEPARTMENT, AUGLAIZE COUNTY COUNCIL ON AGING, ST. MARY'S CITY SCHOOLS, UNITED WAY JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL, CONDUCTED AND ADOPTED ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2022 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY:- SOCIAL DETERMINANTS OF HEALTH- ACCESS TO CARE- HEALTH BEHAVIORS TO ADDRESS OBESITY, HEART DISEASE, AND STROKE- MENTAL HEALTH AND ADDICTIONTHE 2022 CHNA WAS APPROVED BY THE BOARD ON DECEMBER 21ST, 2022. THE CORRESPONDING IMPLEMENTATION STRATEGY WAS ALSO APPROVED BY THE BOARD ON DECEMBER 21ST, 2022 AND IS EFFECTIVE FOR 2023-2025. THE FOLLOWING ACTIONS WERE TAKEN DURING THE 2023 TAXABLE YEAR ASSOCIATED WITH THE 2022 CHNA.SIGNIFICANT HEALTH NEED 1: SOCIAL DETERMINATES OF HEALTH (SDOH)-MAINTAIN GRAND LAKE RESOURCE GUIDE WITH LINKS TO SUPPORT HOUSING, TRANSPORTATION, AND NUTRITIONAL NEEDS: THE GUIDE IS UPDATED YEARLY AND IS AVAILABLE ON THE GLHS WEBSITE AS WELL AS DISTRIBUTED TO VARIOUS AREA AGENCIES. PROVIDE WELCOME PACKETS TO COMMUNITY MEMBERS IMPROVING ACCESS TO SERVICES.-IMPLEMENTED SCREENING OF INPATIENTS AND PHYSICIAN PRACTICE PATIENTS FOR SDOH: BEGAN SCREENING INPATIENTS MAY 3, 2023. GRAND LAKE PHYSICIAN PRACTICES (GLPP) BEGAN SCREENING PATIENTS IN JUNE 2022. SCREENING OF PSYCHIATRIC INPATIENTS BEGAN IN DECEMBER 2023.-RISK STRATIFICATION OF GLPP PATIENTS: A HEALTH EQUITY SUBCOMMITTEE WAS ESTABLISHED IN NOVEMBER 2023. EDUCATION WAS PROVIDED TO STAFF REGARDING PROVIDING CULTURALLY APPROPRIATE CARE.SIGNIFICANT HEALTH NEED 2: ACCESS TO CARE-PROVIDE HEALTH EDUCATION THROUGH HEALTH FAIRS, COUNTY FAIRS, SCHOOLS, AND EMPLOYERS: 227 COMMUNITY EDUCATION EVENTS WERE HELD IN 2024. 120 COMMUNITY OUTREACH SERVICE EVENTS. 46 SPEAKER EVENTS. THE EVENTS WERE ABLE TO IMPACT 7,294 PARTICIPANTS.-EDUCATE THE COMMUNITY ON GRAND LAKE OFFERINGS THROUGH SPEAKING ENGAGEMENTS, EVENTS, WEBSITE, AND SOCIAL MEDIA OUTLETS: CONTINUED WCSM RADIO INTERVIEWS PROVIDING AWARENESS MONTH INFORMATION AND HOSPITAL UPDATES. SOCIAL MEDIA CHANNELS PROVIDED EDUCATION AND INFORMATION VIDEOS AND POSTS OF NATIONAL AWARENESS MONTHS.-COLLABORATIVE EFFORTS TO IMPROVE VOLUME OF WELL CHILD VISITS: CHILD WELLNESS HEALTH FAIR HELD ON AUGUST 17, 2024 AT THE AUGLAIZE COUNTY FAIRGROUNDS WHERE OVER 100 CHILDREN WERE SCREENED. BEGAN WORKING WITH THE OHIO DEPARTMENT OF HEALTH FOR IMPLEMENTATION OF VACCINES FOR CHILDREN PROGRAM.SIGNIFICANT HEALTH NEED 3: HEALTH BEHAVIORS-CONTINUE THE GRAND HEALTH CHALLENGE TO PROMOTE POSITIVE CHOICES IN FOOD AND EXERCISE: 158 INDIVIDUALS PARTICIPATED IN THE CHALLENGE FROM JANUARY TO OCTOBER 2024 LOSING A TOTAL OF 826 POUNDS. A TOTAL OF 53,315 POUNDS HAS BEEN LOST BY PEOPLE WHO PARTICIPATED IN THE CHALLENGE OVER THE LAST 18 YEARS.-OFFER INTENSIVE CARDIAC REHABILITATION PROGRAM TO PROMOTE DIET, EXERCISE, AND MINDFULNESS OF A HEALTHY LIFESTYLE.-OFFER DIABETES AND PRE-DIABETES INTERVENTIONS AND SUPPORT: 14 PARTICIPANTS IN THE PREDIABETES CLASS IN 2024. 249 CLIENTS PARTICIPATED IN THE DSME PROGRAM IN 2024.SIGNIFICANT HEALTH NEED 4: MENTAL HEALTH AND ADDICTION-CONTINUE PARTNERING WITH COLEMAN BEHAVIORAL HEALTH TO PROVIDE PEER COUNSELING IN THE ED AND INCREASE ACCESS TO MENTAL HEALTH SERVICES.-CONTINUE PARTNERING WITH HORIZON HEALTH FOR INPATIENT GERIATRIC PSYCHIATRY PROGRAM REFERRALS. IN 2024, 216 PATIENTS WERE SERVED IN OUR INPATIENT PSYCHIATRIC UNIT.-SCREEN FOR ALCOHOL AND SUBSTANCE ABUSE IN ED AND REFER TO PROGRAMS AS APPROPRIATE. PART V, LINE 7A HTTPS://GRANDLAKEHEALTH.ORG/PATIENTS-VISITORS/GENERAL-INFORMATION/ PARY V, LINE 16A, FAP HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE PART V, LINE 16B, FAP APPLICATION HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 20D JTDMH DOES NOT HAVE PRESUMPTIVE ELIGIBILITY DETERMINATIONS, AT THIS POINT IN TIME. AN INDIVIDUAL'S ELIGIBILITY IS ONLY DETERMINED AFTER AN APPLICATION HAS BEEN COMPLETED AND SUBMITTED. FINANCIAL ASSISTANCE COUNSELORS ARE TRAINED TO EDUCATE CANDIDATES IN HOW TO COMPLETE THE APPLICATION, AND WORK WITH CANDIDATES THROUGHOUT THE APPROVAL PROCESS. EVERY EFFORT IS MADE TO IDENTIFY POTENTIAL CANDIDATES AND ASSIST POTENTIAL CANDIDATES IN COMPLETING THE APPLICATION. 5 1 - URGENT CARE AT JTDMH 200 ST CLAIR STREET ST MARYS OH 45885 URGENT CARE 2 - GRAND LAKE HOME HEALTH 1122 EAST SPRING STREET ST MARYS OH 45885 HOME HEALTH 3 - GRAND LAKE HOSPICE 1122 EAST SPRING STREET ST MARYS OH 45885 HOSPICE 4 - GRAND LAKE OCCUPATIONAL MEDICINE 200 ST CLAIR STREET ST MARYS OH 45885 OCCUPATIONAL MEDICINE 5 - CELINA PRO HEALTH DIAGNOSTIC CENTER 801 PRO DRIVE CELINA OH 45822 DIAGNOSTIC CENTER PART I, LINE 7: THE HOSPITAL USED THE MEDICARE COST REPORT AS THEIR BASIS FOR CALCULATING THE AMOUNTS REPORTED IN LINE 7A & 7B. ON THE COST REPORT, IT FIRST ALLOCATES OVERHEAD DEPARTMENTS VIA A COST STEP DOWN METHODOLOGY AND THEN CALCULATES A COST TO CHARGE RATIO. FOR LINES 7E, 7F, 7G & 7I ACTUAL COSTS WERE USED. PART I, LN 7 COL(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 $5,135,706. PART II, COMMUNITY BUILDING ACTIVITIES: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY BUILDING ACTIVITIES IN 2024 RANGING FROM PARTICIPATION IN COMMUNITY BOARDS, COMMITTEES AND CLUBS THAT WERE ENGAGED IN IMPROVING THE OVERALL COMMUNITY INCLUDING THE COMMUNITY'S HEALTH/MEDICAL NEEDS TO OFFERING BABYSITTING TRAINING CLASSES TO ASSURE THE CHILDREN OF THE COMMUNITY ARE WELL CARED FOR IN THEIR PARENT'S ABSENCE. OTHER EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO PARTICIPATING IN WORKFORCE DEVELOPMENT OF HEALTH CARE CAREERS THROUGH JOB SHADOWING AND SEMINARS. PART III, LINE 2: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL RECORDS GROSS BAD DEBT EXPENSE WHEN AN ACCOUNT IS DEEMED UNCOLLECTIBLE AT THE VALUE OF CHARGES. IF IT BECOMES NECESSARY TO ESTIMATE BAD DEBT EXPENSE, ESTIMATES ARE DONE BASED UPON HISTORIC RELATIONSHIPS BETWEEN CHARGES AND BAD DEBT. PART III, LINE 3: THE HOSPITAL ESTIMATES THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY BASED UPON A HISTORIC REVIEW OF THE APPLICABLE BAD DEBT ACCOUNTS. EVERY EFFORT IS MADE TO IDENTIFY THESE ACCOUNTS PRIOR TO BEING WRITTEN OFF AS UNCOLLECTIBLE, INCLUDING MULTIPLE EFFORTS TO CONTACT THE PATIENT. AS SOON AS THESE ACCOUNTS ARE DEEMED UNCOLLECTIBLE, ALL COLLECTION WORK AND ACTIVITY IS IMMEDIATELY CEASED. THESE ACCOUNTS ARE THEN TREATED THE SAME AS ANY OTHER ACCOUNT QUALIFYING FOR FINANCIAL ASSISTANCE. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLES ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE 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 HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES REMAINING AFTER THIRD-PARTY COVERAGE FOR A PORTION OF THE BILL), THE HOSPITAL 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 HOSPITAL USED A COST STEP DOWN METHODOLOGY FROM THE MEDICARE COST REPORT TO CALCULATE THE AMOUNTS REPORTED IN LINE 6. THE COST OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2024 WAS $20,300,656 THE PAYMENTS RELATED TO THESE SERVICES WERE $13,376,880. LEAVING A MEDICARE SHORTFALL OF $6,923,776 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH JTD MEMORIAL HOSPITAL'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. PART III, LINE 9B: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL FOLLOWS THE SAME COLLECTION PRACTICES NO MATTER THE TYPE OF PATIENT. ALL PATIENTS ARE TREATED EQUALLY. COLLECTION PRACTICES ARE NOT PURSUED FOR PATIENTS THAT THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE/CHARITY CARE. PART VI, LINE 2: N/A - ALL NEEDS WERE ASSESSED WHILE CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: PATIENTS ARE INFORMED ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH SIGNS POSTED AT REGISTRATION, IN ER/WAITING ROOMS, ON THE WEBSITE, THROUGH INFORMATION INCLUDED IN THE PATIENT HANDBOOK, THROUGH INFORMATION PRINTED ON THE REVERSE SIDE OF THE STATEMENTS THEY RECEIVE FOR SERVICES, AND IS AVAILABLE UPON REQUEST. PART VI, LINE 4: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL-TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND SMALL MANUFACTURING JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDE A POPULATION OF 24,700. THE ADJACENT COMMUNITY OF CELINA (ZIP CODE POPULATION OF 19,945) IS ALSO SERVED BY THE HOSPITAL. THE HOSPITAL ALSO PROVIDES SERVICES TO THE WAPAKONETA COMMUNITY (POPULATION 17,974) ALTHOUGH THE TRADITIONAL SERVICE PATTERNS SEND THAT COMMUNITY'S PATIENTS TO LIMA. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTDMH'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 62,619 WITH 20% IN THE MEDICARE AGE GROUP (65+). PART VI, LINE 5: JTD MEMORIAL HOSPITAL/GRAND LAKE HEALTH COMMUNITY OUTREACHPART OF THE HOSPITAL'S PHILOSOPHY HAS BEEN TO PROMOTE THE HEALTH AND WELLNESS OF COMMUNITY MEMBERS. THE HOSPITAL HAS A HISTORY OF REACHING OUT TO THE COMMUNITY TO PROMOTE WELLNESS AND PREVENTIVE MEDICINE AND HAS AN OFFICE THAT IS DEDICATED TO COORDINATING HEALTHCARE, OUTREACH, AND EDUCATION.FOLLOWING IS A LISTING OF THE WIDE VARIETY OF OUTREACH PROGRAMS THAT ARE SPONSORED BY GRAND LAKE HEALTH SYSTEM.- MONTHLY BLOOD PRESSURE CHECKS - AUGLAIZE COUNTY COUNCIL ON AGING - MONTHLY WELLNESS EDUCATION AND BLOOD PRESSURE SCREENINGS - BREASTFEEDING CLASSES- CHILDBIRTH CLASSES - CALL A NURSE- CPR & FA CLASSES - DIABETIC SUPPORT GROUP- HEALING MEMORIES AND GRIEF SUPPORT - PARKINSON'S SUPPORT GROUP- COMMUNITY HEALTH FAIRS/ROTARY BLOOD TEST CLINICS- SCHOOL HEALTH FAIRS- MAKE BELIEVE HOSPITAL (KINDERGARTEN PROGRAM TO ALLEVIATE FEARS OF HOSPITAL)- NEW BREMEN SENIOR CITIZEN PROGRAM- FREE PROSTATE SCREENING- SPEAKERS BUREAU- BABYSITTING 101 CLASS- WOMEN'S WALK FOR WELLNESS- COORDINATION OF THE UNITED WAY CAMPAIGN FOR THE HOSPITAL- ROAD TO FITNESS PROGRAM (12 MONTHS)- DRUG TAKEBACK PROGRAM- PRE-DIABETES CLASSES (ADVANCED LIFE BALANCED CLASS)- YMCA BLOOD PRESSURE SCREENINGS- STROKE SUPPORT GROUP- HONORING ANGELS SUPPORT GROUP (FOR FAMILIES THAT HAVE HAD MISCARRIAGES AS WELL AS LOSING A CHILD DURING THE FIRST YEAR OF LIFE)- MAN TO MAN PROSTATE SUPPORT GROUP- SENIOR SUPPER HOUR- SENIORCISE- AMERICAN SIGN LANGUAGE CLASSES- FREE MONTHLY WELLNESS EDUCATION & SCREENING IN ADDITION, WE SUPPORT THE WELLNESS OF THE COMMUNITY BY PARTICIPATING IN EVENTS HOSTED AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. FOLLOWING IS A LIST OF TOPICS THAT ARE COVERED:- NUTRITION- HEART EDUCATION- SKIN CANCER- OSTEOPOROSIS SCREEN- BREAST CANCER AWARENESS- CHOLESTEROL AWARENESS- ASSESSMENT OF DIABETES- ALCOHOL EDUCATION- COLORECTAL CANCER EDUCATION- ASTHMA EDUCATION- PERIPHERAL SCREENING- SLEEP APNEA INFORMATION- STROKE EDUCATIONWE ALSO PARTNER WITH ONE LOCAL RADIO STATION PROVIDING MONTHLY INTERVIEWS ON A WIDE VARIETY OF HEALTHCARE TOPICS.SINCE 2007, WE HAVE SPONSORED A WEIGHT LOSS/WELLNESS PROGRAM, ENTITLED, "THE GRAND HEALTH CHALLENGE." IN THE PAST 18 YEARS, THIS PROGRAM HAS SERVED 6,794 RESIDENTS OF BOTH MERCER AND AUGLAIZE COUNTIES, LOSING MORE THAN 53,000 LBS. 1 ST MARYS COMMUNITY FOUNDATION 146 E SPRING ST ST MARYS OH 45885 237372270 501(C)(3) 30000 0 ST MARYS ATHLETIC COMPLEX AUGLAIZE-MERCER COUNTY YMCA 7590 STATE ROUTE 703 CELINA OH 45822 341371829 501(C)(3) 25000 0 YMCA ANNUAL FUND DRIVE DONATION JTD FOUNDATION 200 ST CLAIR STREET ST MARYS OH 45822 341623769 501(C)(3) 25000 0 GLHS VOLUNTEERS DONATION TO SUPPORT THE FOUNDATION 3 0 PART I, LINE 2: THE HOSPITAL MAKES GRANTS TO COMMUNITY ORGANIZATIONS. GRANTS ARE MONITORED THROUGH DIRECT INVOLVEMENT AND CONTACT WITH THE ORGANIZATION OR EVENT IN WHICH THE GRANT WAS GIVEN. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 CHRISTOPHER STUCKE DIRECTOR 0 490563 0 7600 0 0 0 23000 0 34922 0 556085 0 0 CYNTHIA BERNING PRESIDENT 321251 139384 28794 17000 0 0 6000 0 33576 0 389621 156384 0 0 TRICIA POHL TREASURER 220871 0 7000 0 0 0 24191 0 33426 0 285488 0 0 0 LANA HINDERS CHIEF CLINICAL OFFICER 202711 0 6000 0 0 0 22413 0 33358 0 264482 0 0 0 KEVIN HARLAN FORMER PRESIDENT 0 0 0 0 234664 0 0 0 0 0 234664 0 234664 0 SHELLY RUPPERT ED OF HUMAN RESOURCES 173526 0 3000 0 0 0 19154 0 33257 0 228937 0 0 0 TYLER KROEGER VP OF OPERATIONS 171810 0 6000 0 0 0 6000 0 33309 0 217119 0 0 0 AMY DIRKSEN ED OF SPECIALTY CARE SERVICES 155019 0 0 0 0 0 16292 0 33198 0 204509 0 0 0 LESIA ARNETT ED DEVELOPMENT, MARKETING 149222 0 3000 0 0 0 4694 0 33221 0 190137 0 0 0 LORI MILLER CHIEF OF INFORMATION SERVICES 143642 0 0 0 0 0 13026 0 33178 0 189846 0 0 0 HOLLY JACOMET VP OF QUALITY & PHYS. PRACTICES 174457 0 6000 0 0 0 3720 0 1075 0 185252 0 0 0 SARA MOSLER PHARMACIST 130368 0 0 0 0 0 13835 0 33137 0 177340 0 0 0 PART I, LINE 1A JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A PORTION OF YMCA DUES TO THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES; HOWEVER, THIS IS AN EMPLOYEE BENEFIT AVAILABLE TO ALL ELIGIBLE EMPLOYEES OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL TO PROMOTE COMMUNITY WELLNESS (ONE OF THE PEOPLE LISTED IN PART VII, SECTION A, LINE 1A RECEIVED THIS BENEFIT). THE YMCA DUES WERE NOT INCLUDED IN THE RECIPIENT'S COMPENSATION. PART I, LINE 4B KEVIN HARLAN, THE FORMER PRESIDENT, HAS RECEIVED A PAYOUT FROM THE NON QUALIFIED RETIREMENT PLAN OF $234,664 IN THE CURRENT YEAR DUE TO HIS DEPARTURE FROM JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. THE PLAN IS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH INCLUDES AN INCENTIVE BONUS COMPONENT, MAINTAINED BY A RELATED ORGANIZATION FOR KEY EMPLOYEES OF THE RELATED ORGANIZATION. THE VESTING SCHEDULE FOR EACH PARTICIPANT IS DETERMINED BY THE TERMS OF THEIR INDIVIDUAL EMPLOYMENT CONTRACTS. THERE ARE CERTAIN CIRCUMSTANCES WHERE A PARTICIPANT WILL FORFEIT ANY AND ALL OF THE COMPANY CONTRIBUTIONS MADE INTO THE PLAN INCLUDING ENGAGING IN ACTIVITIES WHICH ARE DEEMED TO BE SIGNIFICANTLY COMPETITIVE WITH THE COMPANY WITHIN A 50 MILE RADIUS OF ANY EXISTING OFFICE, IF IT IS DEEMED THE PARTICIPANT ACTED IN A DISHONEST WAY, BREACHES HIS OR HER FIDUCIARY OBLIGATIONS, CONVICTED OF A FELONY INVOLVING SIGNIFICANT MORAL TURPITUDE, OR OTHER ACTS WHICH WOULD CAUSE THE COMPANY SUBSTANTIAL HARM. PART I, LINE 7 EMPLOYEE'S BONUSES ARE DETERMINED AT THE DISCRETION OF THE PRESIDENT. A HOSPITAL FACILITIES REVENUE IMPROVEMENT BONDS SERIES 2012 341623770 2012-12-14 8500000 ASU BUILDING PROJECT AND CAPITAL EQUIPMENT 0 0 0 B HOSPITAL FACILITIES REVENUE IMPROVEMENT BONDS SERIES 2024 341623770 2024-12-26 6000000 OUTPATIENT RENOVATION PROJECT, OTHER BUILDING IMPROVEMENTS, & CAPITAL EQUIP. 0 0 0 A 8500000 8500000 0 0 0 1 B 6000000 6000000 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 A 0 B 0 FORM 990, PART I, LINE 1 MISSION STATEMENT THE MISSION OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE BOARD-DESIGNATED COMMITTEE FOR THEIR REVIEW PRIOR TO FILING. THE BOARD-DESIGNATED COMMITTEE WILL REPORT THEIR REVIEW AND APPROVAL OF FORM 990 TO THE FULL BOARD OF DIRECTORS. A PAPER COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL BOARD MEMBERS FOR THEIR INDEPENDENT REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS, OFFICERS, AND MANAGERS OF GRAND LAKE HEALTH SYSTEM. ANNUALLY, THESE INDIVIDUALS, AS WELL AS, NEW BOARD MEMBERS WHEN THEY FIRST JOIN, PROVIDE THE PRESIDENT OF THE CORPORATION AN UPDATED LISTING OF ALL BUSINESSES OR OTHER ORGANIZATIONS OF WHICH HE OR SHE IS A TRUSTEE, OFFICER, DIRECTOR, MEMBER, PARTNER, OWNER, GENERAL MANAGER, SUBSTANTIAL SHAREHOLDER, EMPLOYEE OR FOR WHICH HE OR SHE ACTS AS AN AGENT. WHEN A CONFLICT OF INTEREST IS IDENTIFIED THE DETERMINATION IS MADE AND DISCUSSED OPENLY AT THE BOARD LEVEL. THE INDIVIDUAL IS THEN PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS. FORM 990, PART VI, SECTION B, LINE 15 THE SALARY AMOUNT FOR THE PRESIDENT IS REVIEWED AND APPROVED BY THE BOARD EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE USES THE OHIO HOSPITAL ASSOCIATION'S ANNUAL CHIEF EXECUTIVE OFFICER COMPENSATION SURVEY AS THE PRIMARY BENCHMARKING RESOURCE. ADDITIONALLY, THEY MAY PERIODICALLY UTILIZE OTHER BENCHMARKING RESOURCES SUCH AS FORM 990S FILED BY OTHER HOSPITALS AND SURVEYS PREPARED BY THIRD PARTY INDEPENDENT COMPENSATION CONSULTANTS SUCH AS GALLAGHER. THE BOARD EXECUTIVE COMMITTEE DETERMINES THE PRESIDENT'S SALARY UTILIZING THIS BENCHMARKING AS WELL AS INPUT FROM THE BOARD OF DIRECTORS. THE BOARD CHAIR COMMUNICATES ANY SALARY CHANGES TO THE DIRECTOR OF FINANCIAL SERVICES VIA MEMO AFTER BOARD APPROVAL IS RECEIVED. SALARY AMOUNTS FOR OFFICERS AND OTHER KEY EMPLOYEES ARE REVIEWED AND APPROVED BY THE PRESIDENT. THE PRESIDENT REFERENCES THE OHA COMPENSATION SALARY SURVEY. THE PRESIDENT IS APPROVED BY THE BOARD OF DIRECTORS TO PERFORM THIS PROCESS. FURTHERMORE, THE PRESIDENT IS COMPLETELY INDEPENDENT FROM ALL OFFICERS AND KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN DECEMBER 2024. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G HOSPITAL CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 12,921,074. MANAGEMENT AND GENERAL EXPENSES 2,379,852. FUNDRAISING EXPENSES 4,269. TOTAL EXPENSES 15,305,195. CONTRACTED PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 8,588,179. MANAGEMENT AND GENERAL EXPENSES 1,608,963. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,197,142. FAMILY PRACTICE PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,735,238. MANAGEMENT AND GENERAL EXPENSES 29,520. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,764,758. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTION IN JTD FAMILY PRACTICE, INC. -9,930,158. DIFFERENCE BETWEEN BOOK AND TAX PASS THROUGH INCOME 390,430. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. JTD HOSPITAL FOUNDATION 200 ST CLAIR STREET ST MARYS OH 45885 341623769 TO RAISE FUNDS FOR JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. OH 501(C)(3) LINE 7 JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL 1 JTDMH PAIN MANAGEMENT LLC 200 ST CLAIR ST ST MARYS OH 45885 465353958 PAIN MANAGEMENT SERVICES OH JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL RELATED 28711 230262 0 1 0.51000 JTDM FAMILY PRACTICE LLC 200 ST CLAIR STREET ST MARYS OH 45885 341689161 PHYSICIANS PROVIDING MEDICAL SERVICES OH JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL C -9187862 9296795 1.00000 1 1 1 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 JTD HOSPITAL FOUNDATION C 426331 CASH TRANSACTION JTD HOSPITAL FOUNDATION R 97218 CASH TRANSACTION JTDM FAMILY PRACTICE LLC A 840392 CASH TRANSACTION JTDM FAMILY PRACTICE LLC B 7219500 CASH TRANSACTION JTDM FAMILY PRACTICE LLC O 1773681 CASH TRANSACTION JTDM FAMILY PRACTICE LLC P 1255008 CASH TRANSACTION JTDM FAMILY PRACTICE LLC Q 7717723 CASH TRANSACTION JTDMH PAIN MANAGEMENT LLC J 90057 AMOUNT INVOICED JTDMH PAIN MANAGEMENT LLC F 117449 CASH TRANSACTION