2018-11-15T14:26:14-06:00 2017-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE STE 4200 INDIANAPOLIS IN 46204 990 2017-01-01 344446484 DEFIANCE HOSPITAL INC DEFI 4197834493 1200 RALSTON AVE DEFIANCE OH 435122495 MICHAEL P BROWNING TREASURER 4197834493 2018-11-15 1 SAMANTHA BOKORI P01057347 3174648600 47.44.8.66 2018-11-15 10:38:16 CS P 76FF2A6BB2396675DA7FC3BECCB7F23E28595D91 D6063055A6803F1C5210E032C865658A36853698 2017 2019-02-21 02:37:17Z PROMEDICA DEFIANCE REGIONAL HOSPITAL MICHAEL P BROWNING 100 MADISON AVE TOLEDO OH 43604 465342353 0 X WWW.PROMEDICA.ORG X 1953 OH DEFIANCE HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL THAT PROVIDES HEALTHCARE SERVICES TO THE GENERAL PUBLIC, INCLUDING THE SURROUNDING COMMUNITIES OF DEFIANCE, PAULDING, HENRY, PUTNAM, WILLIAMS AND FULTON COUNTIES IN OHIO. 17 10 400 147 0 0 272443 643363 56998354 64143871 5587350 26338757 303384 644248 63161531 91770239 1510938 5457261 0 0 25793080 23003270 0 0 0 30515776 33777770 57819794 62238301 5341737 29531938 255979458 292242951 45059507 46691229 210919951 245551722 X OUR MISSION IS TO BE THE LEADER IN PROVIDING QUALITY HEALTHCARE SERVICES THAT MEET THE NEEDS AND EXCEED THE EXPECTATIONS OF OUR CUSTOMERS. 0 0 45631556 5457261 64069126 DEFIANCE HOSPITAL, INC. IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. - SEE SCHEDULE O. 4013016 CONSISTENT WITH OUR MISSION, DEFIANCE HOSPITAL, INC. PROVIDES A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO PATIENTS WITH LIMITED OR NO ABILITY TO PAY. - SEE SCHEDULE O. 5175 CONSISTENT WITH OUR MISSION, DEFIANCE HOSPITAL, INC. PROVIDES COMMUNITY BENEFIT INCLUDING CASH AND IN-KIND CONTRIBUTIONS. - SEE SCHEDULE O. 49649747 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 39 0 1 400 1 0 0 0 0 0 0 0 0 0 0 X 17 10 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 X STANTON E RISSER 5675853618 100 MADISON AVE TOLEDO OH 43604 AMER ARSHAD MD TRUSTEE 1.00 41.00 X 0 580135 40825 ANDREW D SHINDLER TRUSTEE 1.00 1.00 X 0 0 0 DARRIN M ARQUETTE PRES, EX OFFICIO (THRU 1/30/17) 1.00 45.00 X X 0 335318 46341 DEANNE S HELD TRUSTEE 1.00 1.00 X 0 0 0 IAN A WEBER TRUSTEE 1.00 1.00 X 0 0 0 JEFFREY C KUHN SECRETARY, TRUSTEE 1.00 51.50 X X 0 616424 244159 JORDAN W STUCKEY MD TRUSTEE 1.00 41.00 X 0 513492 31197 KAREN L STRAUSS TRUSTEE 1.00 41.00 X 0 556542 216101 KEVIN C WEBB PHD EX OFFICIO 1.00 52.50 X 0 655627 240675 LAURA W KLINE TRUSTEE 1.00 1.00 X 0 0 0 MARK A KLEIN CHAIRPERSON 1.00 2.00 X X 0 0 0 MICHAEL S OSBORNE EX OFFICIO 1.00 1.00 X 0 0 0 NEERAJ K KANWAL MD INTERIM PRESIDENT, EX OFFICIO 40.00 2.50 X X 0 377036 56450 RICHANNE C MANKEY EDD MSED BA TRUSTEE 1.00 1.00 X 0 0 0 RICHARD E WEAVER TRUSTEE 1.00 1.00 X 0 0 0 ROSEMARY K REITER MD TRUSTEE 1.00 41.00 X 0 367302 42318 SONJA J DELANEY TRUSTEE 1.00 1.00 X 0 0 0 STEVEN VANDEMARK TRUSTEE 1.00 1.00 X 0 0 0 THERESA C LAWRENCE TRUSTEE 1.00 1.00 X 0 0 0 WILLIAM J SMALL TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL P BROWNING TREASURER 0.50 50.50 X 0 697115 246414 RANDALL OOSTRA PHS PRES & CEO, EX OFFICIO 0.50 54.50 X 0 1749816 483218 GARY W AKENBERGER SR. VP DIAG, FACILITIES & SEC 0.50 44.00 X 0 379804 91320 SANDY GANG VP, PATIENT CARE, DEFIANCE 40.00 0.00 X 0 151716 34846 SCOTT FOUGHT VP, FINANCE, ACUTE CARE OPS 0.50 44.50 X 0 281158 46283 CHRISTINE HOFFMAN PHARMACIST 40.00 0.00 X 115357 0 21775 KARA BALASH PHARMACIST 40.00 0.00 X 113639 0 22661 TRINA BUETTNER DIRECTOR, PHARMACY 40.00 0.00 X 125292 0 13809 ALAN M SATTLER FORMER OFFICER 0.00 40.00 X 0 389038 80933 GARY M CATES FORMER OFFICER 0.00 41.00 X 0 346626 72340 JULIE K YAROCH DO FORMER OFFICER 0.00 41.00 X 0 297010 44109 KATHLEEN S HANLEY FORMER OFFICER 0.00 0.00 X 0 571790 1351 354288 8865949 2077125 3 1 1 0 LATHROP COMPANY 28 N ST CLAIRE ST SUITE 200 TOLEDO OH 43604 GENERAL CONTRACTOR 8624472 OMNI HEALTH SERVICES LTD 14848 ROACHTON RD PERRYSBURG OH 44094 MEDICAL SERVICES 1512406 MCDONALD'S DESIGN & BUILD INC 101 CLINTON ST SUITE 2200 DEFIANCE OH 43512 GENERAL CONTRACTOR 679580 MBA ARCHITECTS & PLANNERS LLC 114 LOUISIANA AVE PERRYSBURG OH 43551 ARCHITECT SERVICES 647802 TOLEDO PAIN SERVICES 7053 W CENTRAL AVE TOLEDO OH 43617 MEDICAL SERVICES 360000 10 637263 6100 643363 NET PATIENT SERVICES 622110 63503581 63503581 AFFIL. ORG. RENT REV. 531120 640290 640290 64143871 4489568 4489568 25282 39479 -14197 -14197 -14197 395314015 67809 373514875 17760 21799140 50049 21849189 50049 21799140 EHR INCENTIVE 900099 356676 356676 CAFETERIA 722514 142949 142949 ANCILLARY PRODUCTS 900009 75319 75319 83501 83501 658445 91770239 64069126 0 27057750 X 5457261 5457261 18213397 14990433 3222964 880497 720603 159894 2568122 2101763 466359 1341254 1098678 242576 58657 58657 57169 57169 75927 75927 4465 4465 745364 745364 6824640 4758034 2066606 105467 72529 32938 455277 300343 154934 1362394 1114989 247405 1076111 350901 725210 130468 92631 37837 1712944 1712944 4785117 3942345 842772 527004 431302 95702 MEDICAL SUPPLIES 4267874 4170736 97138 INTERCOMPANY SERVICES 4226025 3068946 1157079 DRUGS 3714819 3696123 18696 PROVIDER TAXES 1148335 1148335 2499713 362194 2137519 62238301 49649747 12588554 0 5405823 167871 426285 193073 8350111 9508161 646159 735819 215647 145090 90626389 56398354 26334921 34228035 210394502 243107326 283197 61187 3922813 4096389 255979458 292242951 3187819 5126262 357505 240948 41514183 41324019 45059507 46691229 X 208268726 243368730 2482998 2014765 168227 168227 210919951 245551722 255979458 292242951 X 29531938 5555240 -455407 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4465 4465 0 PART II-B, LINE 1: DEFIANCE HOSPITAL, INC. PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION - A PORTION OF WHICH IS ALLOCABLE TO LOBBYING BY THE ASSOCIATIONS. 168227 168227 168227 168227 166227 2000 168227 166227 166227 166227 166227 1.00000 0 1 1 3320790 3320790 53205417 40189667 13015750 450290 372073 78217 17562428 12487927 5074501 16087464 3348687 12738777 34228035 DUE TO AFFILIATES 1094586 ESTIMATED THIRD PARTY SETTLEMENTS PAYABLE 3387264 INTERCOMPANY DEBT TO THE TOLEDO HOSPITAL 36372721 INTEREST RATE SWAP 450636 ASBESTOS REMEDIATION 18812 41324019 PART V, LINE 4: THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT DEFIANCE HOSPITAL, INC. CONSISTENT WITH DONOR INTENT. 1 1 X 1 X 1 X 1 1 0 1 1 174204 174204 0.00280 11664991 7826664 3838327 0.06170 750 265 485 0.00000 11839945 7826929 4013016 0.06450 5175 5175 0.00010 5175 5175 0.00010 11845120 7826929 4018191 0.06460 1 4375401 354865 14425716 14902387 -476671 X 1 1 1 1 DEFIANCE HOSPITAL INC 1200 RALSTON AVENUE DEFIANCE OH 435122495 WWW.PROMEDICA.ORG 1160 X X X X DEFIANCE HOSPITAL INC 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X HTTPS://WWW.PROMEDICA.ORG/PAGES/ABOUT-US/DEFAULT.ASPX X 1 16 0 1 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 DEFIANCE HOSPITAL, INC. PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. FOLLOWING THE FORMAL COUNTY HEALTH ASSESSMENT SURVEY PROCESSES, DEFIANCE COUNTY CONDUCTED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) PROCESS TO DEVELOP A COUNTY STRATEGIC PLAN, UTILIZING THE MAPP PROCESS THAT INCLUDES FOUR ASSESSMENTS: COMMUNITY THEMES & STRENGTHS, FORCES OF CHANGE, THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT AND THE COMMUNITY HEALTH STATUS ASSESSMENT. THESE FOUR ASSESSMENTS WERE USED BY THE RESPECTIVE COUNTY CHIP COMMITTEES TO PRIORITIZE SPECIFIC HEALTH ISSUES AND POPULATION GROUPS WHICH ARE THE FOUNDATION OF THE PLAN. A RESOURCE ASSESSMENT AND GAP ANALYSIS WAS PART OF THIS FORMAL PROCESS. THE FINAL CHIP PLANS WERE APPROVED BY THE RESPECTIVE COUNTY CHIP STRATEGIC PLANNING COMMITTEES. THE HOSPITAL THEN UTILIZED THESE DATA AND PLANS TO DEVELOP THE HOSPITAL'S CHNA AND IMPLEMENTATION PLAN. FEEDBACK FROM THE LOCAL HEALTH DEPARTMENT WAS REQUESTED AFTER THE HOSPITAL PLAN WAS DRAFTED. PERSONS WHO REPRESENTED THE DEFIANCE COUNTY COMMUNITY THROUGH THESE PROCESSES INCLUDED: CITY OF DEFIANCE, COMMUNITY MEMORIAL HOSPITAL, DEFIANCE AREA FOUNDATION, DEFIANCE AREA YMCA, DEFIANCE CITY SCHOOLS, DEFIANCE COUNTY COMMISSIONERS, DEFIANCE COUNTY GENERAL HEALTH DISTRICT, DEFIANCE COUNTY HELP ME GROW - EARLY INTERVENTION, DEFIANCE COUNTY JUVENILE COURT, DEFIANCE COUNTY, OHIO STATE UNIVERSITY EXTENSION OFFICE, DEFIANCE DEVELOPMENT AND VISITORS BUREAU, FAMILY AND CHILDREN FIRST COUNCIL, FOUR COUNTY ADAMHS (ALCOHOL, DRUG ADDICTION AND MENTAL HEALTH SERVICES) BOARD, FOUR COUNTY FAMILY CENTER, HICKSVILLE VILLAGE, MERCY DEFIANCE HOSPITAL, MINISTERIAL ASSOCIATION, NORTHWESTERN OHIO COMMUNITY ACTION COMMISSION, PROMEDICA DEFIANCE REGIONAL HOSPITAL, RECOVERY SERVICES OF NORTHWEST OHIO, AND UNITED WAY OF DEFIANCE COUNTY. DEFIANCE HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY CONDUCTED ITS 2016 CHNA WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO. DEFIANCE HOSPITAL, INC. PART V, SECTION B, LINE 11: DEFIANCE HOSPITAL, INC. CONDUCTED AND ADOPTED ITS SECOND COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2016 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY:- OBESITY- MENTAL HEALTH - SUBSTANCE ABUSE- INJURY PREVENTIONTHIS CHNA WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2016; THEREFORE, THESE HEALTH NEEDS WILL BE ADDRESSED OVER THE THREE TAX YEARS, 2017-2019.DEFIANCE HOSPITAL, INC. DOES NOT INTEND TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT GIVEN THAT SOME OF THE IDENTIFIED HEALTH NEEDS ARE EITHER BEING ADDRESSED DURING PHYSICIAN VISITS, GO BEYOND THE SCOPE OF THE HOSPITAL, OR ARE BEING ADDRESSED BY, OR WITH, OTHER ORGANIZATIONS IN THE COMMUNITY. TO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOST IMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OF RESOURCES, MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITY ORGANIZATIONS AND COALITIONS.THE 2016 SIGNIFICANT HEALTH NEEDS IDENTIFIED, BUT SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS 2016 IMPLEMENTATION PLAN INCLUDE: HEALTH CARE ACCESS, CARDIOVASCULAR HEALTH, CANCER, DIABETES, ARTHRITIS, ASTHMA, TOBACCO USE, WOMEN'S HEALTH, MEN'S HEALTH, PREVENTIVE MEDICINE (EXCEPT FALL PREVENTION), ADULT SEXUAL BEHAVIOR, INFANT MORTALITY, QUALITY OF LIFE, SOCIAL ISSUES, ORAL HEALTH, YOUTH WEIGHT, YOUTH TOBACCO USE, YOUTH SEXUAL BEHAVIOR, YOUTH MENTAL HEALTH, YOUTH SAFETY, YOUTH VIOLENCE, CHILD HEALTH AND FUNCTIONAL STATUS, CHILD HEALTH INSURANCE, CHILD HEALTH ACCESS, CHILD HEALTH UTILIZATION, EARLY CHILDHOOD, MIDDLE CHILDHOOD, FAMILY FUNCTIONING, NEIGHBORHOODS, COMMUNITY CHARACTERISTICS, AND PARENT HEATH.DEFIANCE HOSPITAL, INC. DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2017 WITH RESPECT TO ITS MOST RECENTLY CHNA CONDUCTED IN 2016:HEALTH NEED IDENTIFIED: OBESITYSTRATEGY #1 - IMPLEMENT OHA HEALTHY HOSPITALS INITIATIVE (2017-2019). HOSPITAL WILL JOIN GOOD4YOU EDUCATIONAL WEBINARS HOSTED BY OHA AND HCNO (2017). DEFIANCE HOSPITAL, INC. WILL IMPLEMENT THE GOOD4YOU INITIATIVE IN CAFETERIAS, VENDING MACHINES, MEETINGS, AND WITH OUTSIDE VENDORS (2018). HOSPITAL WILL HELP INTRODUCE THE PROGRAM INTO OTHER AREAS OF THE COMMUNITY (2019).ACTIONS TAKEN:- THE SODEXO "MINDFUL OFFERINGS" (I.E. HEALTHY OFFERINGS) PROGRAM WAS IMPLEMENTED INSTEAD OF THE OHA (OHIO HOSPITAL ASSOCIATION) HEALTHY OHIO GOOD4YOU PROGRAM. THE PROGRAM WAS IMPLEMENTED WITHIN THE HOSPITAL WITH 30% MINDFUL OFFERINGS IMPLEMENTED IN THE CAFETERIA, 75% IN HOSPITAL VENDING MACHINES, AND 75% IN HOSPITAL MEETING CATERING. STRATEGY #2 - INCREASE NUTRITION/PHYSICAL EDUCATION MATERIALS BEING OFFERED TO PATIENTS BY PRIMARY CARE OFFICES. WORK WITH PRIMARY CARE PHYSICIAN OFFICES TO ASSESS WHAT INFORMATION AND/OR MATERIALS THEY ARE LACKING TO PROVIDE BETTER RESOURCES FOR OVERWEIGHT AND OBESE PATIENTS (2017). ACTIONS TAKEN:- ELEVEN (11) PHYSICIAN OFFICES WERE INVOLVED IN PATIENT NUTRITION/PHYSICAL EDUCATION IN 2017. THE CLINICAL DIETICIAN MET WITH THE INTERNAL MEDICINE AND FAMILY PRACTICE OFFICES TO PERFORM AN ASSESSMENT OF THEIR NEEDS. IT WAS DETERMINED THAT WITH THE IMPLEMENTATION OF THE EPIC ELECTRONIC MEDICAL RECORD SYSTEM THEY HAD ADEQUATE EDUCATION MATERIAL AVAILABLE AND WOULD USE THE DIETICIAN AS A RESOURCE, IF NEEDED. THE PCP'S ROUTINELY REFER TO THE CLINICAL DIETICIAN AND CERTIFIED DIABETES EDUCATOR.HEALTH NEED IDENTIFIED: MENTAL HEALTHSTRATEGY #1 - WORK WITH PRIMARY CARE PHYSICIAN OFFICES TO PROVIDE AND EDUCATE ON THE INFORMATION, RESOURCES AND/OR MATERIALS AVAILABLE FOR MENTAL HEALTH SERVICES. ACTIONS TAKEN:- ELEVEN (11) PRIMARY CARE PHYSICIAN OFFICES WERE PROVIDED WITH RESOURCES FOR MENTAL HEALTH AS PART OF THE IMPLEMENTATION OF PHQ2 (PATIENT HEALTH QUESTIONNAIRE) QUESTIONS WITH ALL PATIENTS SEEN IN PRIMARY CARE PHYSICIAN OFFICES, TO LINK PATIENTS TO NEEDED RESOURCES IF THEY SCREEN POSITIVE.STRATEGY #2 - IMPROVE ACCESS TO MENTAL HEALTH SERVICES BY EXPANDING THE PARTIAL HOSPITALIZATION PROGRAM IN ORDER TO SUPPLEMENT INPATIENT SERVICES WITH AN OUTPATIENT PROGRAM. ACTIONS TAKEN:- THE PARTIAL HOSPITALIZATION PROGRAM IMPLEMENTED IN 2017 SERVED 65 PATIENTS FOR A TOTAL OF 584 VISITS IN 2017, THAT INCREASED THE ACCESS FOR THIS TYPE OF CARE.STRATEGY #3 - UNMASKING MENTAL HEALTH INITIATIVE WILL SEEK TO RAISE $100,000 WHICH WILL BE DIRECTLY USED TO INCREASE MENTAL HEALTH SERVICES SUCH AS A TELEMEDICINE PROGRAM AIMED AT IMPROVING ACCESS FOR YOUTH SERVICES. ACTIONS TAKEN:- APPROXIMATELY $100,000 WAS SECURED FOR DEFIANCE HOSPITAL, INC. THROUGH UNMASKING MENTAL HEALTH, AND $10,000 WAS PROVIDED FOR THE DEFIANCE DRUG FREE COALITION. AN UNKNOWN NUMBER OF YOUTH WERE SERVED BY THIS COMMUNITY PROGRAM IN 2017. HEALTH NEED IDENTIFIED: SUBSTANCE ABUSESTRATEGY #1 - INCREASE THE NUMBER OF HEALTH CARE PROVIDERS SCREENING FOR ALCOHOL AND DRUG ABUSE. ACTIONS TAKEN:- BEGINNING IN 2017 ALL EMERGENCY CENTER PATIENTS OVER THE AGE OF 10 ARE SCREENED USING THE JOHNS HOPKINS "CAGE" ("CUT DOWN, ANNOYED, GUILTY AND EYE-OPENER") SUBSTANCE ABUSE ASSESSMENT TOOL INCREASING THE NUMBER OF PROVIDERS SCREENING FOR ALCOHOL AND DRUG ABUSE AT THE HOSPITAL.STRATEGY #2 - INTRODUCE A SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT MODEL TO PHYSICIANS' OFFICES AND HOSPITAL EMERGENCY DEPARTMENTS - PILOT IN ONE PRIMARY CARE PHYSICIAN OFFICE AND HOSPITAL EMERGENCY DEPARTMENT (STATED AS A GOAL IN 2018.) ACTIONS TAKEN:- BEGINNING IN 2017 ALL EMERGENCY CENTER PATIENTS OVER THE AGE OF 10 ARE SCREENED USING THE JOHNS HOPKINS "CAGE" ("CUT DOWN, ANNOYED, GUILTY AND EYE-OPENER") SUBSTANCE ABUSE ASSESSMENT TOOL, IF INDICATED PATIENTS ARE PRESENTED WITH TREATMENT OPTIONS AVAILABLE WITHIN THE LOCAL COMMUNITY THAT THEY MAY PURSUE. THE HOSPITAL IS REQUESTING TO INCORPORATE THE SAME "CAGE" QUESTIONS INTO THE SOCIAL DETERMINENTS OF HEALTH SCREENING OF ALL PRIMARY CARE PATIENTS.STRATEGY #3 - INCREASE THE NUMBER OF PRIMARY CARE OFFICES USING THE MODEL.ACTIONS TAKEN:- SEVEN PRIMARY CARE PHYSICIAN OFFICES SCREENED PATIENTS FOR DRUG AND ALCOHOL ABUSE.HEALTH NEED IDENTIFIED: INJURY PREVENTIONSTRATEGY #1 - INCREASE THE USE OF SAFE SLEEP PRACTICES. PARTICIPATE IN OHA'S SAFE SLEEP IS GOOD4BABY INITIATIVE. ACTIONS TAKEN:- 483 PARENTS WERE EDUCATED ON SAFE SLEEP PRACTICES THROUGH DEFIANCE HOSPITAL, INC. PROGRAMS IN 2017.STRATEGY #2 - IMPLEMENT THE STEADI (STOPPING ELDERLY ACCIDENTS, DEATHS AND INJURIES) PROGRAM - RESEARCH STEADI PROGRAM IN 2017. (FUTURE YEAR STRATEGIES: IMPLEMENT THE STEADI ASSESSMENTS AND EDUCATION IN AT LEAST ONE PRIMARY CARE PHYSICIAN OFFICE - 2018. IMPLEMENT THE STEADI ASSESSMENTS AND EDUCATION IN AT LEAST THREE ADDITIONAL PRIMARY CARE PHYSICIAN OFFICES - 2019) FALLS ARE THE LEADING CAUSE OF FATAL INJURY AMONG OLDER ADULTS. ACTIONS TAKEN:- THE DEFIANCE HOSPITAL, INC. EMERGENCY CENTER HAS IMPLEMENTED A FALL PREVENTION PROGRAM WHICH SCREENS ALL PATIENTS OVER THE AGE OF 65 AND PRESENTS THEM WITH EDUCATION ON FALL PREVENTION AND ALSO ALERTS THEIR PRIMARY CARE PROVIDER IF INCREASED FALL RISK IS IDENTIFIED SO THEY MAY ADDRESS WITH THE PATIENT AND DETERMINE NEEDS SPECIFIC TO THE PATIENT. (THIS SCREENING PROGRAM WAS IN LIEU OF IMPLEMENTING THE STEADI PROGRAM).- FALL RISK IS ASSESSED ANNUALLY FOR ALL MEDICARE PATIENTS AT PRIMARY CARE PROVIDER OFFICES.- DEFIANCE HOSPITAL, INC. HELD A CHILD SAFETY DAY WITH AREAS OF FOCUS BEING CAR SEAT SAFETY AND BIKE SAFETY. 112 TOTAL BIKE HELMETS WERE DISTRIBUTED TO DECREASE THE CHANCE OF SERIOUS HEAD INJURY IN CASE OF A FALL. DEFIANCE HOSPITAL, INC.: PART V, SECTION B, LINE 16A: THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/PAGES/PATIENT-RESOURCES/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/DEFAULT.ASPXDEFIANCE HOSPITAL, INC.:PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/PAGES/PATIENT-RESOURCES/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/DEFAULT.ASPXDEFIANCE HOSPITAL, INC.:PART V, SECTION B, LINE 16C: A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/PAGES/PATIENT-RESOURCES/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/DEFAULT.ASPX 3 1 - PROMEDICA DEFIANCE HOSP - WOUND CARE 1250 RALSTON AVE SUITE 106 DEFIANCE OH 435125310 WOUND CARE 2 - PROMEDICA PHYSICIANS DEFIANCE ORTHO 1250 RALSTON AVE SUITE 102 DEFIANCE OH 435125308 RADIOLOGY 3 - PROMEDICA DEFIANCE HOSP - AUDIOLOGY 1018 RALSTON AVE DEFIANCE OH 435121396 AUDIOLOGY PART I, LINE 3C: IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY USES RESIDENCY STATUS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 6A: DEFIANCE HOSPITAL, INC. REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE PROMEDICA HEALTH SYSTEM, INC. ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: DEFIANCE HOSPITAL, INC. CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. OTHER BENEFITS AMOUNTS REPORTED ON LINE 7 WERE CALCULATED USING COSTS CHARGED DIRECTLY TO THE INDIVIDUAL PROGRAMS VIA THE FINANCIAL ACCOUNTING SYSTEM. AN INDIRECT COST ALLOCATION FACTOR FOR SHARED SERVICES IS ALSO CALCULATED AND INCLUDED IN APPLICABLE PROGRAMS LISTED IN OTHER BENEFITS. PART III, LINE 2: DEFIANCE HOSPITAL, INC.'S ANALYSIS AND ASSESSMENT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED BAD DEBT EXPENSE USES A RECEIPTS "LOOK-BACK" METHOD UTILIZING HISTORICAL PAYMENT DATA ON ACCOUNTS, INCLUDING CONTRACTUAL ADJUSTMENTS FOR PAYER DISCOUNTS, AS WELL AS PATIENT PAYMENTS, SUCH AS CO-PAYS AND DEDUCTIBLES, TO ESTABLISH ANTICIPATED COLLECTABILITY RATES FOR ACCOUNTS RECEIVABLE WITHIN EACH PAYER CATEGORY. PART III, LINE 3: DEFIANCE HOSPITAL, INC. ESTIMATED THE POSSIBLE AMOUNT OF FINANCIAL ASSISTANCE WITHIN BAD DEBT EXPENSE BY REVIEWING ACCOUNTS THAT WERE INTERNALLY CODED AS HAVING BEEN PROVIDED A FINANCIAL ASSISTANCE APPLICATION, BUT THAT WAS NOT ADEQUATELY COMPLETED BY THE PATIENT OR GUARANTOR, IN WHICH THE ACCOUNT WAS SUBSEQUENTLY WRITTEN OFF TO BAD DEBT. PART III, LINE 4: PROVISION FOR BAD DEBTS AND ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ARE DISCUSSED ON PAGES 12 AND 13 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL REPORT WITH SUPPLEMENTAL INFORMATION. PART III, LINE 8: MEDICARE SHORTFALL, WHICH IS THE EXCESS OF COSTS TO TREAT MEDICARE PATIENTS OVER THE REIMBURSEMENT RECEIVED FROM THE FEDERAL GOVERNMENT, SHOULD BE TREATED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - THE MEDICARE SHORTFALL REPRESENTS THE RELIEF OF A FINANCIAL BURDEN THAT WOULD OTHERWISE BE BORNE BY A GOVERNMENT PROGRAM.- THE MEDICARE SHORTFALL REPRESENTS A SOCIETAL BENEFIT INSOFAR AS MANY OF THE PROGRAMS AND SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY, IF THE DECISION TO PROVIDE SUCH SERVICES WAS MADE ON A FINANCIAL BASIS.- MEDICARE IS A SOCIETAL BENEFIT, PROVIDED BY THE FEDERAL GOVERNMENT, FOR THOSE WHO WOULD OTHERWISE BE UNINSURED AFTER AGING OUT OF TRADITIONAL MEANS OF HEALTH INSURANCE, SUCH AS INSURANCE PROVIDED BY AN EMPLOYER.- MEDICARE IS NOT A TRUE MARKET PAYER, AS COMPARED TO COMMERCIAL PAYERS, WHEREBY REIMBURSEMENT RATES CAN BE NEGOTIATED AND ADJUSTED IN ORDER TO REDUCE INCURRED LOSSES.DEFIANCE HOSPITAL, INC. USED THE MEDICARE ALLOWABLE COSTS PER ITS 2017 AS-FILED MEDICARE COST REPORTS, LESS ANY ADJUSTMENTS FOR SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION, IF APPLICABLE. ALLOWABLE COSTS ARE CALCULATED BY ALLOCATING TOTAL FACILITY COSTS TO REVENUE GENERATING UNITS WITHIN THE HOSPITAL. THE MEDICARE COST REPORT DOES NOT REFLECT ALL OF THE COSTS ASSOCIATED WITH MEDICARE PROGRAMS. PART III, LINE 9B: FINANCIAL ASSISTANCE DISCOUNTS ARE GRANTED FOR MEDICALLY NECESSARY SERVICES WHEN IT IS DETERMINED THAT THE PATIENT AND FAMILY INCOME MEETS THE CRITERIA ESTABLISHED. PATIENTS WHO HAVE INSURANCE COVERAGE OR WHO ARE ENTITLED TO GOVERNMENTAL ASSISTANCE ARE IDENTIFIED IN ORDER FOR REIMBURSEMENT TO BE OBTAINED. ALL PATIENTS WITH SELF-PAY BALANCES AFTER INSURANCE MAY OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS IF THEY PROVIDE APPROPRIATE DOCUMENTATION THAT THEY SATISFY THE INCOME GUIDELINES. VERIFICATION OF FINANCIAL ASSISTANCE IS PURSUED THROUGHOUT THE INTERNAL COLLECTION PROCESS UNTIL ALL OPTIONS HAVE BEEN EXHAUSTED. ALL PATIENTS, THAT HAVE A SELF-PAY BALANCE, INCLUDING PATIENTS THAT MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, RECEIVE BILLING STATEMENTS AND PAYMENT REMINDERS. THESE STATEMENTS INFORM ALL PATIENTS OF THE OPPORTUNITY TO SEEK A FINANCIAL ASSISTANCE ADJUSTMENT FOR MEDICALLY NECESSARY SERVICES, THE ELIGIBILITY CRITERIA, AND THE METHOD TO APPLY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN COMPLETED AND/OR REQUESTED INCOME VERIFICATION HAS NOT BEEN RECEIVED FROM A PATIENT WHO COULD POTENTIALLY QUALIFY, THE PATIENT WILL CONTINUE TO RECEIVE BILLING STATEMENTS THROUGH THE NORMAL COLLECTION PROCESS. IF A PATIENT DOES NOT HAVE INSURANCE, A PRESUMPTIVE CHARITY DETERMINATION (WHICH USES PUBLICLY AVAILABLE DATA SUCH AS DEMOGRAPHIC INFORMATION, CREDIT HISTORY, ETC.) MAY BE MADE TO ASSIST WITH QUALIFYING FOR FINANCIAL ASSISTANCE. ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, AN ADJUSTMENT IS PROCESSED. THE PATIENT ACCOUNT ANALYST WILL DETERMINE PATIENT ELIGIBILITY AND CALCULATE THE ADJUSTMENT BASED ON POLICY GUIDELINES. AN ADJUSTMENT FORM IS PREPARED AND APPROVED PER POLICY. UNINSURED PATIENTS MAY BE REQUIRED TO COMPLETE AN APPLICATION AND PROVIDE REQUIRED DOCUMENTATION, INCLUDING ANY DOCUMENTATION REQUIRED TO DETERMINE ELIGIBILITY. UNINSURED PATIENTS ARE NOTIFIED IN WRITING WHETHER OR NOT THEY QUALIFY FOR ANY FINANCIAL ASSISTANCE ADJUSTMENT FOR WHICH THEY HAVE SUBMITTED AN APPLICATION, AND OF ANY REMAINING BALANCE OWED. THE ADJUSTMENT IS THEN APPLIED TO THE PATIENT'S ACCOUNT.PATIENTS MAY BE OFFERED PAYMENT PLANS WHEN APPROPRIATE BASED ON DOCUMENTED FINANCIAL NEED AND CIRCUMSTANCES. LONGER PAYMENT PLANS MAY BE OFFERED ON AN EXCEPTION BASIS FOR CASES WITH UNUSUALLY HIGH BALANCES OR SPECIAL CIRCUMSTANCES DEMONSTRATING AN INABILITY TO PAY. ONCE THE INTERNAL COLLECTION PROCESS HAS BEEN COMPLETED, PATIENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY IF THE PATIENT HAS NOT CONTACTED US REGARDING THEIR DESIRE TO APPLY FOR FINANCIAL ASSISTANCE, SENT IN A FINANCIAL ASSISTANCE APPLICATION, RESPONDED TO REQUESTS FOR ADDITIONAL INFORMATION, OR WE ARE UNABLE TO MAKE A PRESUMPTIVE CHARITY DETERMINATION. IT IS THE EXPECTATION OF THE EXTERNAL COLLECTION AGENCY AS THEY WORK ACCOUNTS TO OFFER FINANCIAL ASSISTANCE WHEN APPLICABLE. THROUGHOUT THE COLLECTION PROCESS, THE COLLECTION AGENCY WILL INFORM UNINSURED PATIENTS OF THE CRITERIA TO OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS BASED ON FAMILY INCOME AND FAMILY SIZE, AND WILL FORWARD APPLICATIONS FOR PATIENTS WHO SUBMIT THE REQUIRED DOCUMENTATION TO THE CENTRAL BUSINESS OFFICE FOR PROCESSING. PART VI, LINE 2: PROMEDICA HEALTH SYSTEM AND HOSPITALS DEMONSTRATE A COMMITMENT TO THE COMMUNITIES IT SERVES AND THEREFORE, BELIEVES IT IS CRITICAL TO UNDERSTAND THE HEALTH CARE NEEDS OF ITS PRIMARY SERVICE AREA. TO THAT END, PROMEDICA HOSPITALS CONDUCT NEEDS ASSESSMENTS IN ITS PRIMARY SERVICE AREAS USING A VARIETY OF METHODOLOGIES TO ASSESS EACH COUNTY'S HEALTH CARE DATA, IDENTIFY GAPS IN HEALTH CARE INITIATIVES, AND MAKE RECOMMENDATIONS FOR THE BETTERMENT OF THE GENERAL COMMUNITY HEALTH. ANALYSIS OF PUBLISHED COUNTY HEALTH DATA, INTERVIEWS WITH KEY STAKEHOLDERS, AND REVIEW OF HISTORICAL AND EXISTING PROMEDICA COMMUNITY ASSESSMENTS ARE ALL MEANS BY WHICH RECOMMENDATIONS FOR THE PROMEDICA COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLANS ARE DEVELOPED. INFORMATION IS REVIEWED AND APPROVED BY HOSPITAL GOVERNANCE LEADERSHIP TO ASSURE THAT PLANS ARE DEVELOPED TO MEET THE NEEDS OF THE COMMUNITY. PUBLISHED COUNTY HEALTH DATACOUNTY HEALTH DATA WERE OBTAINED FROM SEVERAL SOURCES, INCLUDING THE OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE, THE MICHIGAN DEPARTMENT OF HEALTH, AND FORMAL COUNTY ASSESSMENTS CONDUCTED WITHIN THE INDIVIDUAL COUNTIES. ALTHOUGH MOST COUNTIES CONDUCTING A FORMAL ASSESSMENT UTILIZE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) QUESTIONNAIRE DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AS THE BASIS OF THE COUNTY QUESTIONNAIRE, COUNTY COMMITTEES TYPICALLY ADD AND/OR CHANGE QUESTIONS TO MEET THE COUNTY'S PERCEIVED NEEDS. PROMEDICA'S COMMUNITY GOALS ARE SET BASED ON THESE DATA.PROMEDICA COMMUNITY HEALTH PLANOVERALL, EMPHASIS IS PLACED ON CLINICAL PROGRAMS FOCUSED ON LEADING CAUSES OF DEATH: CHRONIC DISEASES, MENTAL HEALTH, AND HUNGER/OBESITY DUE TO THE LARGE NUMBERS OF INDIVIDUALS AFFECTED BY THESE DISEASES. THE PRIMARY FOCUS FOR COMMUNITY HEALTH ACTIVITIES ARE RELATED TO EDUCATION, SCREENING, AND PREVENTION OF CHRONIC DISEASES, MENTAL HEALTH ISSUES, AND HUNGER/OBESITY; AND IMPROVING RELATED CONDITIONS THAT RESULT IN HIGH MORBIDITY AND MORTALITY IN OUR COMMUNITIES, WITH SPECIAL EMPHASIS PLACED ON SERVING UNDERSERVED POPULATIONS. AS A SYSTEM, WE ARE ALSO COMMITTED TO WORKING BEYOND OUR FOUR WALLS, ON THE SOCIAL AND ECONOMIC ISSUES THAT IMPACT HEALTH. IN ADDITION, PROMEDICA STRATEGIC PLANNING CONTINUES TO DEVELOP PATIENT-CENTERED, INTEGRATED CLINICAL SERVICE LINES INCLUDING CANCER, CARDIOVASCULAR, BEHAVIORAL HEALTH, SOCIAL DETERMINANTS OF HEALTH, AND MATERNAL FETAL MEDICINE. PART VI, LINE 3: THE OPPORTUNITY FOR FINANCIAL ASSISTANCE ADJUSTMENTS IS COMMUNICATED TO PATIENTS AT PROMEDICA HEALTH SYSTEM HOSPITALS THROUGH THE FOLLOWING METHODS:A. DURING THE PRE-REGISTRATION PROCESS FOR SCHEDULED INPATIENTS AND HIGH-DOLLAR OUTPATIENT CASES, THE CENTRALIZED PRE-REGISTRATION STAFF WILL NOTIFY A PATIENT FINANCIAL ADVOCATE TO CONTACT THE PATIENT PRIOR TO SERVICE TO DISCUSS POTENTIAL ELIGIBILITY FOR GOVERNMENT PROGRAMS AND FINANCIAL ASSISTANCE. THE PRE-SERVICE FUNCTION INCLUDES ACCOUNT REGISTRATION, INSURANCE VERIFICATION, PRE-CERTIFICATION AND FINANCIAL COUNSELING.B. ADMITTING LOCATIONS WILL HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE WHEN REGISTERED AS UNINSURED. AT ADMITTING, UNINSURED PATIENTS ARE INFORMED OF THE OPPORTUNITY TO SEEK FINANCIAL ASSISTANCE. C. PATIENT FINANCIAL ADVOCATES ARE AVAILABLE AT THE HOSPITALS TO ASSIST UNINSURED PATIENTS IN COMPLETING THE FORMS. PATIENT FINANCIAL ADVOCATES ATTEMPT TO MEET WITH IN-HOUSE PATIENTS TO ASSESS ELIGIBILITY AND TO ASSIST WITH APPLICATION FOR GOVERNMENT ASSISTANCE PROGRAMS, TO EXPLAIN PATIENT LIABILITY FOR CHARGES, TO PROVIDE AN ESTIMATE OF CHARGES WHEN FEASIBLE, TO EXPLAIN THE OPPORTUNITY FOR FINANCIAL ASSISTANCE, INCLUDING THE CRITERIA AND THE METHOD FOR APPLYING, AND TO EXPLAIN PAYMENT OPTIONS.D. A MESSAGE IS PRINTED ON THE PATIENT BILLING STATEMENTS TO NOTIFY THE UNINSURED PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE, TO EXPLAIN THE ELIGIBILITY CRITERIA, AND TO DESCRIBE THE METHOD TO APPLY.E. A SUMMARY OF THE POLICY FOR UNINSURED PATIENTS IS INCLUDED IN THE STATEMENTS OF UNINSURED PATIENT, AVAILABLE VIA THE PROMEDICA WEB SITE, AVAILABLE AT HOSPITAL REGISTRATION LOCATIONS, OR BY CALLING THE PROMEDICA CUSTOMER SERVICE DEPARTMENT. BUSINESS OFFICE PERSONNEL ALSO NOTIFY UNINSURED PATIENTS OF THE FINANCIAL ADJUSTMENT POLICY THROUGH THE CUSTOMER SERVICE AND COLLECTION DEPARTMENTS. PART VI, LINE 4: DEFIANCE HOSPITAL, INC., LOCATED IN DEFIANCE, OHIO, SERVES AN AREA PRIMARILY AROUND DEFIANCE COUNTY AND HAS A SERVICE AREA POPULATION OF APPROXIMATELY 116,000. APPROXIMATELY, 19% OF THE SERVICE AREA IS AGE 65 OR OVER; 39% IS BETWEEN AGE 35 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $53,000; 55% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER; 47% OF HOUSEHOLDS HAVE AN INCOME OF $50,000 OR LESS. DEFIANCE COUNTY HAS A POPULATION OF APPROXIMATELY 39,000 WITH APPROXIMATELY 5% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 22% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 17% OF DEFIANCE COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE FOR DEFIANCE COUNTY IN 2017 WAS 4.9%. THE LEADING CAUSES OF DEATH IN DEFIANCE COUNTY, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, LUNG DISEASE, STROKE, DIABETES, CANCER, ALZHEIMER'S AND UNINTENTIONAL INJURIES/ACCIDENTS. ACCORDING TO THE 2017 COUNTY HEALTH RANKINGS, DEFIANCE COUNTY RANKED 20 OF 88 COUNTIES FOR HEALTH OUTCOMES, 24 OF 88 FOR LENGTH OF LIFE, AND 18 OF 88 FOR QUALITY OF LIFE. THERE ARE SEVEN HOSPITALS WITHIN A 30-MILE RADIUS OF DEFIANCE HOSPITAL, INC.: MERCY HOSPITAL OF DEFIANCE, COMMUNITY HOSPITALS AND WELLNESS CENTERS (BRYAN), PAULDING COUNTY HOSPITAL, HENRY COUNTY HOSPITAL, COMMUNITY MEMORIAL HOSPITAL, FULTON COUNTY HEALTH CENTER, AND COMMUNITY HOSPITALS AND WELLNESS CENTERS (MONTPELIER). PART VI, LINE 5: DEFIANCE HOSPITAL, INC. IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC. WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. - IN 2017, THERE WERE 450 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), INCLUDING ITS SUBSIDIARIES. OF THESE, 99% LIVED WITHIN PROMEDICA'S 27-COUNTY SERVICE AREA, WITH THE MAJORITY RESIDING WITHIN METRO TOLEDO WHERE PROMEDICA'S ADULT AND PEDIATRIC TERTIARY HOSPITALS (THE TOLEDO HOSPITAL AND TOLEDO CHILDREN'S HOSPITAL) ARE LOCATED. TRUSTEE REPRESENTATION IS COMPRISED OF DIVERSE MEMBERS, INCLUDING 75 PHYSICIANS, FROM NORTHWEST OHIO AND SOUTHEAST MICHIGAN. ADDITIONALLY, PROMEDICA BOARD MEMBERS INCLUDED 151 WOMEN AND 58 RACIAL/ETHNIC MINORITIES.- BOARD MEMBERS ARE NOT COMPENSATED BY PROMEDICA FOR THEIR SERVICE TO OUR HOSPITALS AND OTHER BUSINESS UNITS; THEIR DONATION OF TIME AND EXPERTISE, INCLUDING ATTENDING BOARD MEETINGS, RETREATS AND OTHER ACTIVITIES, ARE PERFORMED ON A VOLUNTEER BASIS. - PROMEDICA'S MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITIES WHICH PROMEDICA SERVES. QUALIFICATION MAY VARY BY HOSPITAL, BUT ANY PHYSICIAN WHO MEETS THOSE QUALIFICATIONS MAY BE GRANTED PRIVILEGES.- IN 2017, PROMEDICA INVESTED SIGNIFICANT TIME AND FINANCIAL RESOURCES TO COMPLETING THE ROLL OUT OF ITS ELECTRONIC HEALTH RECORD (EHR), EPIC. GO-LIVES TOOK PLACE IN MAY AT PROMEDICA BIXBY AND HERRICK, MONROE REGIONAL, AND MEMORIAL HOSPITALS, AS WELL AS THE 30 PROMEDICA PHYSICIANS OFFICES THAT SUPPORT THESE FACILITIES IN MICHIGAN AND FREMONT. THE FINAL GO-LIVES WERE FOLLOWED IN THE FALL WITH A SYSTEM-WIDE UPGRADE TO THE LATEST OPERATING PLATFORM FOR EPIC, FURTHER ENABLING ONE PATIENT, ONE RECORD, AND ONE BILL FOR PATIENTS REGARDLESS OF SERVICE PROVIDED OR THE LOCATION OF SERVICE ACROSS PROMEDICA.- PROMEDICA PROVIDED NEARLY 18,000 HEALTH SCREENINGS TO COMMUNITY MEMBERS THROUGHOUT 2017, INCLUDING BLOOD PRESSURE, BLOOD GLUCOSE AND BODY MASS INDEX SCREENINGS AT NUMEROUS HEALTH FAIRS AND SPORTING EVENTS. ADDITIONALLY, FREE SCREENING MAMMOGRAMS, AS WELL AS SKIN CANCER AND LUNG CANCER SCREENINGS AND COLORECTAL CANCER EDUCATION WERE PROVIDED FOR EARLY DETECTION. PROSTATE CANCER SCREENING EDUCATION AND NUTRITIONAL PROGRAMS WERE DEVELOPED TO KEEP PEOPLE HEALTHY.- PROMEDICA'S FOUNDATION RAISES FUNDS FOR PHILANTHROPY IN SUPPORT OF PROMEDICA'S MISSION TO IMPROVE HEALTH AND WELL-BEING. ANNUAL DONOR PROGRAMS, CAPITAL CAMPAIGNS, PLANNED GIVING, AND EVENT FUNDRAISING ACTIVITIES ARE CONDUCTED TO RAISE FUNDS THAT SUPPORT PATIENTS AND FAMILIES, AS WELL AS LOCAL COMMUNITIES, THROUGH HEALTH-RELATED PROGRAMS, SERVICES, EQUIPMENT, AND FACILITY CONSTRUCTION/RENOVATION THAT HAVE BEEN IDENTIFIED, IN PART, THROUGH A COMMUNITY NEEDS ASSESSMENT. PART VI, LINE 6: PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A MISSION-BASED, LOCALLY OWNED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT WAS FORMED IN TOLEDO, OHIO IN 1986. IN 2017 PROMEDICA WAS COMPRISED OF MORE THAN 17,000 EMPLOYEES, APPROXIMATELY 2,500 VOLUNTEERS AND MORE THAN 2,000 HEALTHCARE PROVIDERS, INCLUDING APPROXIMATELY 900 PROVIDERS EMPLOYED BY PROMEDICA PHYSICIAN GROUP, WHO HAVE JOINED TOGETHER TO FORM A NETWORK ACROSS 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN. AS AN INTEGRATED DELIVERY SYSTEM, PROMEDICA PROVIDERS SHARE RESOURCES SUCH AS ADVANCED TECHNOLOGY, QUALITY STANDARDS, SAFETY PRACTICES, MEDICAL EXPERTISE, AND SPECIALTY SERVICES TO HELP ENSURE AREA RESIDENTS HAVE READY ACCESS TO HIGH-QUALITY CARE IN THE MOST APPROPRIATE SETTING IN ORDER TO PROVIDE COST-EFFICIENT SERVICES. - PROMEDICA MEMBERS INCLUDE: THE TOLEDO HOSPITAL D/B/A PROMEDICA TOLEDO HOSPITAL; PROMEDICA TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF PROMEDICA TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL; FLOWER HOSPITAL D/B/A PROMEDICA FLOWER HOSPITAL; BAY PARK COMMUNITY HOSPITAL D/B/A PROMEDICA BAY PARK HOSPITAL; EMMA L. BIXBY MEDICAL CENTER D/B/A PROMEDICA BIXBY HOSPITAL; HERRICK MEMORIAL HOSPITAL, INC. D/B/A PROMEDICA HERRICK HOSPITAL; FOSTORIA HOSPITAL ASSOCIATION D/B/A PROMEDICA FOSTORIA COMMUNITY HOSPITAL; DEFIANCE HOSPITAL, INC. D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL; MERCY MEMORIAL HOSPITAL CORPORATION D/B/A PROMEDICA MONROE REGIONAL HOSPITAL; MEMORIAL HOSPITAL D/B/A PROMEDICA MEMORIAL HOSPITAL; PROMEDICA INSURANCE CORPORATION; PROMEDICA PHYSICIAN GROUP, A NETWORK OF SYSTEM-EMPLOYED PHYSICIANS AND ADVANCED PRACTICE PROVIDERS; AND PROMEDICA CONTINUING CARE SERVICES CORPORATION, WITH SERVICES SUCH AS SENIOR CARE, HOSPICE, REHABILITATION SERVICES, AND HOME CARE.- IN 2017, PROMEDICA MANAGED APPROXIMATELY 4.1 MILLION PATIENT ENCOUNTERS AND CONTRIBUTED A TOTAL COMMUNITY BENEFIT OF OVER $191 MILLION, WHICH INCLUDED FREE HEALTH SCREENINGS AND PARTICIPATION IN PUBLIC HEALTH FAIRS TO MEDICAL LECTURES AT AREA SENIOR CENTERS AND NUTRITION EDUCATION IN ELEMENTARY SCHOOLS, PLUS MUCH MORE. - PROMEDICA CONTINUES TO OPERATE TWO FOOD CLINICS - ONE AT THE PROMEDICA HEALTH AND WELLNESS CENTER AND THE OTHER AT PROMEDICA'S CENTER FOR HEALTH SERVICES - TO SERVE PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND HAVE A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. PATIENTS ARE ABLE TO RECEIVE FOOD FOR THEM AND THEIR FAMILY FROM THIS LOCATION OR THE ORIGINAL FOOD PHARMACY LOCATED AT PROMEDICA'S CENTER FOR HEALTH SERVICES. AS PART OF THE PROGRAM, EACH PATIENT RECEIVES TWO TO THREE DAYS OF SUPPLEMENTAL FOOD FOR THEIR FAMILY. THROUGH DECEMBER 2017, THERE WERE MORE THAN 9,700 VISITS TO THE FOOD CLINIC, IMPACTING MORE THAN 3,200 UNIQUE HOUSEHOLDS. THIS TRANSLATES TO ABOUT 74,520 DAYS' WORTH OF FOOD PROVIDED TO PATIENTS AND FAMILIES, THE EQUIVALENT OF 223,560 MEALS. - PROMEDICA EBEID INSTITUTE'S MARKET ON THE GREEN PROVIDES BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD, AND A FINANCIAL OPPORTUNITY CENTER TO PROVIDE FINANCIAL COUNSELING FOR RESIDENTS.- IN 2017, PROMEDICA ESTABLISHED THE EBEID PROMISE, A 10-YEAR, $50 MILLION COMMUNITY REVITALIZATION INITIATIVE THANKS TO A GENEROUS $28.5 MILLION GIFT FROM THE FAMILY OF PHILANTHROPIST AND FORMER BOARD MEMBER RUSSELL J. EBEID. THE EBEID PROMISE WILL EXPAND THE SCOPE AND PURPOSE OF THE EBEID INSTITUTE WITH A KEY FOCUS ON THE SOCIAL DETERMINANTS OF HEALTH - HEALTH, NUTRITION, EDUCATION, JOB CREATION, AND FAMILY STABILITY. THIS LONG-TERM INVESTMENT WILL START WITH THE UPTOWN TOLEDO NEIGHBORHOOD AND BE EXPANDED TO TOLEDO'S MONROE STREET CORRIDOR, NEAR PROMEDICA TOLEDO HOSPITAL. PLANS INCLUDE REPLICATING THIS CONCEPT IN COMMUNITIES ACROSS PROMEDICA'S SERVICE AREA IN COMING YEARS.- WITH REGARD TO HEALTH PROFESSIONS EDUCATION, BIWEEKLY, MONTHLY AND ANNUAL PROGRAMS WERE OFFERED THROUGHOUT 2017 FOR CONTINUING MEDICAL EDUCATION CREDIT. MORE THAN 1,500 CREDIT HOURS OF PHYSICIAN EDUCATION WERE OFFERED TO EMPLOYED PROMEDICA PHYSICIANS AND MEDICAL STAFF MEMBERS AS WELL AS NURSES AND OTHER ALLIED HEALTH PROFESSIONALS. 1 PROMEDICA FOUNDATION 444 N SUMMIT STREET TOLEDO OH 43604 341517672 501(C)(3) 124261 OPERATING GRANT PROMEDICA PHYSICIAN GROUP 100 MADISON AVE TOLEDO OH 43604 341899439 501(C)(3) 3333000 OPERATING GRANT PROMEDICA HEALTH SYSTEM INC 100 MADISON AVE TOLEDO OH 43604 341517671 501(C)(3) 2000000 OPERATING GRANT 3 0 PART I, LINE 2: AS AN AFFILIATE OF PROMEDICA HEALTH SYSTEM, INC. (PHS), CORPORATE TREASURY, WITH THE APPROVAL AND OVERSIGHT OF THE FINANCE COMMITTEE, ENSURES THAT FUNDS ARE DISTRIBUTED APPROPRIATELY ACCORDING TO PHS'S STRATEGIC BUSINESS PLAN AND CONSISTENT WITH CORPORATE TREASURY POLICIES AND PROCEDURES. X 1 1 1 1 0 0 0 0 0 0 0 AMER ARSHAD MD TRUSTEE 0 447736 0 130857 0 1542 0 7273 0 33552 0 620960 0 0 DARRIN M ARQUETTE PRES, EX OFFICIO (THRU 1/30/17) 0 215123 0 92356 0 27839 0 20942 0 25399 0 381659 0 0 JEFFREY C KUHN SECRETARY, TRUSTEE 0 479712 0 108013 0 28699 0 229520 0 14639 0 860583 0 0 JORDAN W STUCKEY MD TRUSTEE 0 495912 0 0 0 17580 0 8100 0 23097 0 544689 0 0 KAREN L STRAUSS TRUSTEE 0 432060 0 113052 0 11430 0 198042 0 18059 0 772643 0 0 KEVIN C WEBB PHD EX OFFICIO 0 510025 0 135703 0 9899 0 226149 0 14526 0 896302 0 0 NEERAJ K KANWAL MD INTERIM PRESIDENT, EX OFFICIO 0 324821 0 48616 0 3599 0 31366 0 25084 0 433486 0 0 ROSEMARY K REITER MD TRUSTEE 0 333422 0 32679 0 1201 0 8100 0 34218 0 409620 0 0 MICHAEL P BROWNING TREASURER 0 586938 0 70000 0 40177 0 222483 0 23931 0 943529 0 0 RANDALL OOSTRA PHS PRES & CEO, EX OFFICIO 0 1086659 0 577159 0 85998 0 468579 0 14639 0 2233034 0 159048 GARY W AKENBERGER SR. VP DIAG, FACILITIES & SEC 0 322399 0 48208 0 9197 0 71258 0 20062 0 471124 0 0 SANDY GANG VP, PATIENT CARE, DEFIANCE 0 123244 0 12265 0 16207 0 18325 0 16521 0 186562 0 0 SCOTT FOUGHT VP, FINANCE, ACUTE CARE OPS 0 258000 0 21808 0 1350 0 23604 0 22679 0 327441 0 0 ALAN M SATTLER FORMER OFFICER 0 381523 0 0 0 7515 0 54182 0 26751 0 469971 0 0 GARY M CATES FORMER OFFICER 0 273531 0 63876 0 9219 0 58874 0 13466 0 418966 0 0 JULIE K YAROCH DO FORMER OFFICER 0 251052 0 45000 0 958 0 20931 0 23178 0 341119 0 0 KATHLEEN S HANLEY FORMER OFFICER 0 0 0 0 0 571790 0 0 0 1351 0 573141 0 258776 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS 3 HIGHEST COMPENSATED EMPLOYEES INCLUDED IN TAXABLE COMPENSATION PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF DEFIANCE HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A: UNDER A VOLUNTARY TERMINATION AGREEMENT ENTERED INTO BY THE EMPLOYEE AND THE ORGANIZATION OR UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM PROMEDICA. SEVERANCE PAYMENTS WERE MADE DURING THE YEAR TO THE FOLLOWING LISTED PERSONS IN PART VII: KATHLEEN S. HANLEY $258,776 PART I, LINE 4B: ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. IN ADDITION, THE ORGANIZATION PROVIDES A SPLIT-DOLLAR LIFE INSURANCE PLAN TO ITS CHIEF EXECUTIVE OFFICER FROM WHICH NO CASH PAYMENTS WERE MADE DURING THE YEAR. FORM 990, PART IV, LINE 24A: DEFIANCE HOSPITAL, INC. IS A HEALTH FACILITY THAT IS A SUBSIDIARY OF PROMEDICA HEALTH SYSTEM, INC. (PHS). DEFIANCE HOSPITAL, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE TO THE TOLEDO HOSPITAL, WHICH IS ALSO A SUBSIDIARY OF PHS. THE NOTE PAYABLE REPRESENTS DEFIANCE HOSPITAL, INC.'S PORTION OF TAXABLE AND TAX-EXEMPT BONDS ISSUED BY PROMEDICA HEALTHCARE OBLIGATED GROUP. FORM 990, PART VI, SECTION A, LINE 2 MARK A. KLEIN AND LAURA W. KLINE HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF DEFIANCE HOSPITAL, INC. OR IS THE SOLE MEMBER OF THE SOLE MEMBER OF DEFIANCE HOSPITAL, INC. AS THE MEMBER, PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF DEFIANCE HOSPITAL, INC., AND (B) APPROVE THE NOMINEES TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES, A MAJORITY OF WHOM ARE NOMINATED BY DEFIANCE HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION. FORM 990, PART VI, SECTION B, LINE 11B UNDER THE GUIDANCE OF PROMEDICA HEALTH SYSTEM, INC.'S (PHS) TAX CONSULTANTS, FORM 990S ARE PREPARED BY THE RESPECTIVE ACCOUNTING DEPARTMENT OF EACH AFFILIATE AND REVIEWED BY THE AFFILIATE'S FINANCE LEADERSHIP. AFTER AFFILIATE'S FINANCE LEADERSHIP APPROVAL, COPIES OF THE FORM 990 FOR PHS AND THEIR SUBSIDIARIES ARE PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES AND ARE REVIEWED AND SIGNED BY A PRINCIPAL OFFICER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER SOC SURVEY WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER SOC SURVEYS ARE REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER SOC SURVEYS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED, AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO COMPLETE THE SURVEY OR THE SUBMISSION OF A FALSE OR INCOMPLETE SURVEY, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S SURVEY RESULTS OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL SALARIED EMPLOYEES AND SPECIFICALLY IDENTIFIED HOURLY EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, THE CHIEF HUMAN RESOURCE OFFICER, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PHYSICIANS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PHYSICIAN CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER FOR PROMEDICA PHYSICIAN GROUP (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PHYSICIAN CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PHYSICIANS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PHYSICIAN STANDARD OF CONDUCT AND THE PHYSICIAN CERTIFICATION STATEMENT WHICH THE NEW PHYSICIAN IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, CHIEF OPERATING OFFICER OR THEIR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE V.P., AUDIT & COMPLIANCE. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL BY THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER. RESULTS OF THE EMPLOYED PHYSICIAN AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. ANY ITEMS THAT MEET CRITERIA FOR PUBLIC DISCLOSURE WILL BE COMMUNICATED TO THE APPROPRIATE PHYSICIAN BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE IN ADVANCE OF THE POSTING. THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE WILL PROVIDE THE PHYSICIAN-INDUSTRY RELATIONSHIP DISCLOSURES TO THE APPLICABLE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. THE PUBLIC DISCLOSURE WILL BE POSTED ON THE PROMEDICA HEALTH SYSTEM, INC. WEBSITE (HTTPS://WWW.PROMEDICA.ORG/PAGES/ABOUT-US/INDUSTRY-RELATIONSHIPS.ASPX) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. FORM 990, PART VI, SECTION B, LINE 15 DEFIANCE HOSPITAL, INC.'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF DEFIANCE HOSPITAL, INC.'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES GENERAL: PROGRAM SERVICE EXPENSES 327,290. MANAGEMENT AND GENERAL EXPENSES 1,304,571. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,631,861. PURCHASED SERVICES NON PHYSICIAN: PROGRAM SERVICE EXPENSES 357,025. MANAGEMENT AND GENERAL EXPENSES 14,118. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 371,143. PURCHASED SERVICES PHYSICIANS: PROGRAM SERVICE EXPENSES 3,139,517. MANAGEMENT AND GENERAL EXPENSES 8,300. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,147,817. PURCHASED SERVICES OTHER: PROGRAM SERVICE EXPENSES 242,762. MANAGEMENT AND GENERAL EXPENSES 509,721. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 752,483. PURCHASED SERVICES TEMP AGENCY: PROGRAM SERVICE EXPENSES 108,219. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,219. ALLOCATED COSTS: PROGRAM SERVICE EXPENSES 583,221. MANAGEMENT AND GENERAL EXPENSES 229,896. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 813,117. FORM 990, PART XI, LINE 9: BENEFICIAL INTEREST IN FOUNDATION -455,407. FORM 990, PART III, LINE 4: PROMEDICA HEALTH SYSTEM, INC. - PROGRAM SERVICE ACCOMPLISHMENTS ESTABLISHED IN 1986, PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A MISSION-BASED, LOCALLY OWNED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 28 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN AND IS ONE OF THE REGION'S LEADING HEALTHCARE PROVIDERS. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST IN CUTTING-EDGE TECHNOLOGY, INNOVATIVE PROGRAMS AND FAMILY-CENTERED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF A PATIENT'S ABILITY TO PAY. BASED ON NEEDS THAT WE HAVE ASSESSED WITHIN THE COMMUNITIES WE SERVE, PROMEDICA LAUNCHED NEW SERVICES AND PROGRAMS IN 2017 TO HELP MEET THE GROWING DEMANDS OF LOCAL CONSUMERS ACROSS ALL SPECTRUMS OF LIFE, INCLUDING THOSE INDIVIDUALS WHO ARE OFTEN THE MOST VULNERABLE WHEN IT COMES TO HEALTH CARE: THE ELDERLY, POOR AND UNDERSERVED. PROMEDICA'S MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. THIS IS REFLECTED IN OUR FOUR CORE VALUES, INCLUDING: COMPASSION - WE TREAT OUR PATIENTS AND EACH OTHER WITH RESPECT, INTEGRITY AND DIGNITY; INNOVATION - WE CONTINUALLY SEARCH TO FIND A BETTER WAY FORWARD; TEAMWORK - WE PARTNER WITH OTHERS BECAUSE WE ARE BETTER TOGETHER THAN APART; AND EXCELLENCE - WE STRIVE TO BE THE BEST IN ALL WE DO. PROMEDICA AND ITS AFFILIATES COMPRISE 220 SITES, MORE THAN 2,000 PHYSICIANS AND APPROXIMATELY 17,000 EMPLOYEES AND VOLUNTEERS. DURING 2017, PROMEDICA DISCHARGED 66,395 INPATIENTS AND SERVED 1,195,393 OUTPATIENTS, WHILE HANDLING 286,408 EMERGENCY VISITS SYSTEM-WIDE AS WELL AS 77,180 URGENT CARE VISITS AND MORE THAN 800 VIRTUAL VISITS THROUGH PROMEDICA ONDEMAND. AMONG THE REGION'S LARGEST EMPLOYERS, PROMEDICA PLAYS A SIGNIFICANT ROLE IN ECONOMIC DEVELOPMENT AND STABILITY IN OUR REGION. DURING 2017, FOR EVERY ONE DOLLAR OF REVENUE, ANOTHER 27 CENTS WAS CREATED IN OUR SERVICE-AREA ECONOMY, WITH A TOTAL ECONOMIC OUTPUT OF $4.0 BILLION. WE ALSO CREATE A DIRECT ECONOMIC IMPACT WITH OUR REVENUE, PAYROLL AND EMPLOYMENT. ADDITIONALLY, SPENDING ON SERVICES AND MATERIALS WITH VENDORS IN OUR REGION CREATES AN INDIRECT ECONOMIC BENEFIT. OUR PHYSICIANS AND PROVIDERS, LEADERSHIP TEAM MEMBERS, PHYSICIANS AND RESIDENTS, AND EMPLOYEES INDIVIDUALLY CONTRIBUTE PERSONAL RESOURCES TO THE COMMUNITY IN NUMEROUS WAYS - SUCH AS THROUGH TUTORING ELEMENTARY STUDENTS IN READING AND OTHER LIFE SKILLS, PROVIDING MONTHLY HEALTH LECTURES AT LOCAL SENIOR CENTERS, GENEROUSLY CONTRIBUTING TO COMMUNITY FUNDRAISING CAMPAIGNS SUCH AS UNITED WAY, PARTICIPATING IN MEDICAL MISSIONS, SERVING ON LOCAL NOT-FOR-PROFIT BOARDS, AND DONATING NONPERISHABLE FOODS AND CLOTHING ITEMS TO NUMEROUS LOCAL COMMUNITY ORGANIZATIONS AND CHURCHES - UNDERSCORING A KEY BENEFIT OF PROMEDICA BEING LOCALLY OWNED AND OPERATED. PROMEDICA'S MEMBER AND AFFILIATE HOSPITALS INCLUDE: THE TOLEDO HOSPITAL; TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF THE TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL (A DIVISION OF THE TOLEDO HOSPITAL); FLOWER HOSPITAL; FOSTORIA HOSPITAL ASSOCIATION; DEFIANCE HOSPITAL, INC.; BAY PARK COMMUNITY HOSPITAL; HERRICK MEMORIAL HOSPITAL, INC.; EMMA L. BIXBY MEDICAL CENTER; MEMORIAL HOSPITAL; AND MERCY MEMORIAL HOSPITAL CORPORATION. IN 2017 PROMEDICA ALSO PROVIDED INTEGRATED SERVICES, COMPRISED OF: - PROMEDICA CONTINUING CARE SERVICES CORPORATION, PROVIDING REHABILITATION, HOSPICE, HOME CARE, AMBULATORY AND SENIOR SERVICES, COMMUNITY HEALTH, MEDICAL TRANSPORTATION SERVICES, AND CARE COORDINATION. - PROMEDICA PHYSICIAN GROUP (PROMEDICA PHYSICIANS), WITH APPROXIMATELY 900 HEALTHCARE PROVIDERS, INCLUDING PRIMARY CARE, OBSTETRICS AND SPECIALTY PHYSICIANS, AS WELL AS ADVANCED PRACTICE PROVIDERS. TOGETHER, THIS GROUP HELPS PROMEDICA BROADEN THE CARE WE OFFER TO AREA RESIDENTS, INCLUDING IN SMALLER, OUTLYING COMMUNITIES. - PROMEDICA INSURANCE CORPORATION, THE LARGEST HEALTH MAINTENANCE ORGANIZATION PHYSICALLY LOCATED IN NORTHWEST OHIO. IN 2017, PARAMOUNT ADVANTAGE PROVIDED MEDICAID COVERAGE TO MORE THAN 238,000 MEMBERS ACROSS ALL OF OHIO'S 88 COUNTIES. - PROMEDICA INDEMNITY CORPORATION, PROVIDING MEDICAL PROFESSIONAL AND COMPREHENSIVE GENERAL LIABILITY COVERAGE FOR PROMEDICA, INCLUDING IN OUTLYING AREAS WHERE PRIMARY-CARE PHYSICIAN RECRUITMENT IS DIFFICULT. - TWELVE CONTROLLED FOUNDATIONS THAT SERVE AS FUNDRAISING ENTITIES FOR THEIR RESPECTIVE HOSPITALS/BUSINESS UNITS AND FACILITIES, SUCH AS THE EBEID HOSPICE RESIDENCE ON THE PROMEDICA FLOWER HOSPITAL CAMPUS AND THE MARY ELLEN FALZONE DIABETES CENTER ON THE CAMPUS OF PROMEDICA TOLEDO HOSPITAL. PROMEDICA'S SPECIALIZED CARE INCLUDES ONCOLOGY, ORTHOPAEDICS, HEART AND VASCULAR, NEUROLOGY, REHABILITATIVE, AND BEHAVIORAL MEDICINE, AS WELL AS WOMEN'S AND PEDIATRIC CARE. A FUNDAMENTAL PART OF OUR MISSION IS THAT OUR SERVICES ARE TAILORED TO THE NEEDS OF OUR COMMUNITIES AND THEY ARE AVAILABLE TO EVERYONE IN OUR COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION TO BEING A STRONG ADVOCATE FOR THE HEALTH AND WELL-BEING OF OTHERS, PROMEDICA PROVIDES AND PROMOTES COMMUNITY WELLNESS, COLLABORATING WITH APPROXIMATELY 300 NONPROFIT AGENCIES AND ORGANIZATIONS ACROSS OUR REGION IN 2017 THAT HAD VALUES AND MISSIONS SIMILAR TO OUR OWN. PROMEDICA IS CONTINUALLY IMPROVING ITS SERVICES, FACILITIES, TECHNOLOGIES, AND OUTREACH EFFORTS TO MEET THE EVER-CHANGING NEEDS OF ITS DIVERSE POPULATIONS. IN DIRECT RESPONSE TO COMMUNITY NEEDS, A FEW EXAMPLES FROM 2017 INCLUDE THE FOLLOWING: - IN 2017, PROMEDICA ESTABLISHED THE EBEID PROMISE, A 10-YEAR, $50 MILLION COMMUNITY REVITALIZATION INITIATIVE THANKS TO A GENEROUS $28.5 MILLION GIFT FROM THE FAMILY OF PHILANTHROPIST AND FORMER BOARD MEMBER RUSSELL J. EBEID. THE EBEID PROMISE WILL EXPAND THE SCOPE AND PURPOSE OF THE EBEID INSTITUTE WITH A KEY FOCUS ON THE SOCIAL DETERMINANTS OF HEALTH - HEALTH, NUTRITION, EDUCATION, JOB CREATION, AND FAMILY STABILITY. THIS LONG-TERM INVESTMENT WILL START WITH THE UPTOWN TOLEDO NEIGHBORHOOD AND BE EXPANDED TO TOLEDO'S MONROE STREET CORRIDOR, NEAR PROMEDICA TOLEDO HOSPITAL. PLANS INCLUDE REPLICATING THIS CONCEPT IN COMMUNITIES ACROSS PROMEDICA'S SERVICE AREA IN COMING YEARS. - PROMEDICA ALSO ESTABLISHED A NATIONAL RESEARCH CENTER DEVOTED TO STUDYING THE IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON INDIVIDUALS AND COMMUNITIES. THE CENTER IS BEING DEVELOPED IN COOPERATION WITH THE UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE AND LIFE SCIENCES. IT WILL BE ONE OF THE FIRST OF ITS KIND IN THE NATION AND USES A MULTIDISCIPLINARY APPROACH TO UNDERSTAND AND PROPOSE SOLUTIONS TO ADDRESS THE CONDITIONS IN WHICH PEOPLE ARE BORN, LIVE, WORK AND AGE THAT AFFECT THEIR HEALTH AND WELL-BEING. - THREE PROMEDICA HOSPITALS RECEIVED A 5-STAR RATING FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) IN ITS MOST RECENT COMPARISON OF ACUTE CARE QUALITY. THE THREE HOSPITALS ARE PROMEDICA BAY PARK, MEMORIAL AND TOLEDO HOSPITALS. THE CMS STAR RATING SYSTEM IS A WAY OF SUMMARIZING AND COMPARING HOSPITALS ACROSS THE NATION BASED ON A STANDARDIZED SET OF METRICS AND DEFINITIONS. THE STAR RATING EXAMINES MORE THAN 50 INPATIENT AND OUTPATIENT MEASURES THAT INDICATE GOOD PATIENT OUTCOMES SUCH AS 30-DAY MORTALITY (HEART ATTACK, HEART FAILURE, PNEUMONIA), 30-DAY READMISSIONS, INPATIENT SATISFACTION, HOSPITAL ACQUIRED INFECTIONS, AND MORE. - PROMEDICA CONTINUES TO EMPHASIZE A CULTURE OF SAFETY ACROSS ITS HOSPITALS AND OUTPATIENT SERVICES. THE YEAR-END SERIOUS SAFETY EVENT RATE (SSER) WAS 0.65, REFLECTING A 20% DECREASE IN SERIOUS SAFETY EVENTS. - IN 2017, PROMEDICA OPENED ITS NEW HEADQUARTERS IN DOWNTOWN TOLEDO, OHIO, BRINGING NEARLY 1,000 EMPLOYEES TO THE AREA AND SUPPORTING DOWNTOWN REVITALIZATION AND ECONOMIC GROWTH. - IN 2017, PROMEDICA WELCOMED 130 RESIDENTS/FELLOWS AND 460 MEDICAL STUDENTS FROM THE UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE AND LIFE SCIENCES AS PART OF THE ACADEMIC AFFILIATION CREATED IN 2015. THE COLLABORATION IS HELPING TO ADVANCE MEDICAL EDUCATION AND CLINICAL RESEARCH IN NORTHWEST OHIO, BUILDING A LEGACY MODEL OF HEALTH CARE THAT WILL BENEFIT COMMUNITY MEMBERS ACROSS THE REGION FOR GENERATIONS TO COME. - PROMEDICA BROKE GROUND FOR ITS NEW LENAWEE COUNTY HOSPITAL IN MICHIGAN, TO BE NAMED THE PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL. THE HICKMAN FAMILY GIFT IS THE LARGEST DONATION IN THE HISTORY OF PROMEDICA AND WILL ALLOW FOR THE CONSOLIDATION OF THE PROMEDICA BIXBY AND HERRICK HOSPITALS INTO ONE LOCATION TO BETTER SERVE THE LENAWEE COUNTY COMMUNITY. - PROMEDICA COMPLETED THE ROLL OUT OF ITS NEW ELECTRONIC HEALTH RECORD (EHR), EPIC, IN 2017 AND UPGRADED THE ENTIRE SYSTEM TO THE MOST RECENT VERSION OF EPIC. THE UPGRADED VERSION ALLOWS PROMEDICA TO TAKE ADVANTAGE OF SOME OF THE MANY ENHANCEMENTS THAT EPIC HAS MADE TO ITS SOFTWARE BASED ON INPUT FROM CUSTOMERS. EPIC FURTHER ENABLES ONE PATIENT, ONE RECORD, AND ONE BILL FOR PATIENTS REGARDLESS OF SERVICE PROVIDED OR THE LOCATION OF SERVICE ACROSS PROMEDICA. - PARAMOUNT IMPLEMENTED THE FINAL PHASE OF ITS NEW TRUCARE CARE MANAGEMENT SYSTEM. THE TRUCARE SYSTEM MOVES PARAMOUNT TO A STATE-OF-THE-ART CARE MANAGEMENT SYSTEM AND PROVIDES MANY OPERATIONAL EFFICIENCIES THAT ALLOW PARAMOUNT TO MEET THE RIGOROUS CARE MANAGEMENT DEMANDS THAT ARE REQUIRED TO SERVE THE MEDICAID POPULATION IN OHIO. - PROMEDICA PHYSICIANS LAUNCHED A NEW EDUCATION PROGRAM INTENDED TO HELP BRING AN END TO OHIO'S OPIOID EPIDEMIC. TO DO THIS, PROMEDICA PARTNERED WITH THE OHIO STATE MEDICAL ASSOCIATION TO OFFER SMART RX - SAFE MEDICINE AND RESPONSIBLE TREATMENT PROGRAM. SMART RX IS AN HOUR-LONG ONLINE TRAINING PROGRAM AND PUBLIC AWARENESS CAMPAIGN THAT BRINGS MEDICAL PROFESSIONALS UP-TO-DATE ON OHIO'S OPIOID PRESCRIBING RULES AND REGULATIONS AS WELL AS BEST PRACTICES FOR TREATING PAIN, AND TIPS FOR PATIENTS ON HOW TO APPROPRIATELY HANDLE AND DISPOSE OF POTENTIALLY ADDICTIVE PRESCRIPTION MEDICINES. - PROMEDICA OPENED FOUR ADDITIONAL URGENT CARE CENTERS IN THE METRO-TOLEDO AREA, TO SERVE PATIENTS WHO HAVE MEDICAL CONCERNS THAT DO NOT REQUIRE AN EMERGENCY CENTER. A TOTAL OF NINE URGENT CARE CENTERS ARE NOW OPEN 8 A.M. TO 8 P.M., 365 DAYS PER YEAR, AND ARE STAFFED BY HIGHLY-TRAINED CERTIFIED NURSE PRACTITIONERS. - PROMEDICA OPENED A NEW SPECIALTY PHARMACY TO AID PATIENTS WHO ARE LIVING WITH CHRONIC AND COMPLEX HEALTH CONDITIONS AND NEED SPECIALIZED THERAPIES OR PERSONALIZED CARE. THE PHARMACY PROVIDES DISPENSING FOR SPECIALTY MEDICATIONS USED TO TREAT CHRONIC HEALTH CONDITIONS, INCLUDING CYSTIC FIBROSIS, ULCERATIVE COLITIS AND CHRON'S DISEASE, HEPATITIS C, MULTIPLE SCLEROSIS, AUTOIMMUNE DISEASE, CANCER, AND MUCH MORE. THE NEW PHARMACY IS ABLE TO SHIP MEDICATIONS DIRECTLY TO THE PATIENT FOR IMPROVED ACCESS TO CARE. - PROMEDICA PARTICIPATED IN DOZENS OF COMMUNITY HEALTH FAIRS ACROSS THE REGION THAT INCLUDED FREE PUBLIC SCREENINGS FOR HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, BODY MASS INDEX AND BONE DENSITY. - PROMEDICA CANCER INSTITUTE'S (PCI) COMMUNITY OUTREACH INCLUDED CANCER SCREENINGS AND EDUCATION TO THE MOST VULNERABLE IN OUR COMMUNITY. FREE SCREENING MAMMOGRAMS AS WELL AS LUNG CANCER SCREENINGS WERE PROVIDED FOR EARLY DETECTION. COLORECTAL CANCER EDUCATION AND NUTRITIONAL PROGRAMS WERE DEVELOPED TO KEEP PEOPLE HEALTHY, WHILE SUN SAFETY EDUCATION WAS PROVIDED TO ELEMENTARY SCHOOL CHILDREN TO HELP PREVENT FUTURE CASES OF SKIN CANCER. PCI ALSO HOSTED ANNUAL CANCER SURVIVOR CELEBRATIONS FOR SURVIVORS, FRIENDS AND CAREGIVERS ACROSS THE REGION AND SPONSORED COMMUNITY EVENTS INCLUDING THE ANNUAL NW OHIO SUSAN G. KOMEN, RACE FOR THE CURE AND AMERICAN CANCER SOCIETY RELAY FOR LIFE IN LUCAS COUNTY. - PROMEDICA CONTINUES TO OPERATE TWO FOOD CLINICS - ONE AT THE PROMEDICA HEALTH AND WELLNESS CENTER AND THE OTHER AT PROMEDICA'S CENTER FOR HEALTH SERVICES - TO SERVE PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND HAVE A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. PATIENTS ARE ABLE TO RECEIVE FOOD FOR THEM AND THEIR FAMILY FROM THIS LOCATION OR THE ORIGINAL FOOD PHARMACY LOCATED AT PROMEDICA'S CENTER FOR HEALTH SERVICES. AS PART OF THE PROGRAM, EACH PATIENT RECEIVES TWO TO THREE DAYS OF SUPPLEMENTAL FOOD FOR THEIR FAMILY. THROUGH DECEMBER 2017, THERE HAVE BEEN MORE THAN 9,700 VISITS TO THE FOOD CLINIC, IMPACTING MORE THAN 3,200 UNIQUE HOUSEHOLDS. THIS TRANSLATES TO ABOUT 74,520 DAYS' WORTH OF FOOD PROVIDED TO PATIENTS AND FAMILIES, THE EQUIVALENT OF 223,560 MEALS. - PROMEDICA ALSO OFFERS ITS PRESCRIPTION FOR HEALTH PROGRAM IN THE ADRIAN, MICHIGAN, COMMUNITY. THROUGH THIS PROGRAM, PROMEDICA PROVIDERS ARE ABLE TO WRITE A PRESCRIPTION FOR FOOD FOR ELIGIBLE PATIENTS, WHICH ALLOWS THE INDIVIDUAL TO REDEEM TOKENS FOR THE PURCHASE OF FRESH FRUITS AND VEGETABLES AT THE ADRIAN FARMERS MARKET. THE PROGRAM IS DESIGNED FOR PATIENTS AGE 55 AND OLDER, OR LESS THAN 55 YEARS WITH CHILDREN LIVING IN THE HOUSEHOLD, WHO HAVE A DIAGNOSIS OF HIGH CHOLESTEROL, HIGH BLOOD PRESSURE, OBESITY, PREDIABETES OR DIABETES. - PROMEDICA'S FINANCIAL OPPORTUNITY CENTER (FOC), PROVIDED EDUCATION AND COUNSELING TO NEARLY 1,000 INDIVIDUALS. HOUSED IN THE EBEID INSTITUTE, FOC HELPS INDIVIDUALS NEEDING INCOME SUPPORT (PUBLIC BENEFITS) AND EMPLOYMENT COACHING AND COUNSELING, AS WELL AS FREE TAX PREPARATION THROUGH THE OHIO BENEFIT BANK. FOC ALSO OFFERS A DIGITAL LITERACY SERIES TO ASSIST INDIVIDUALS WISHING TO IMPROVE THEIR COMPUTER LITERACY AND SKILLS TO BE MORE MARKETABLE TO PROSPECTIVE EMPLOYERS. - IN 2017, PROMEDICA PRIMARY CARE PROVIDERS BEGAN SCREENING PATIENTS FOR SOCIAL DETERMINANTS OF HEALTH BY ASKING QUESTIONS RELATED TO EDUCATION, EMPLOYMENT, FOOD SECURITY, HOUSING, TRANSPORTATION, AND VIOLENCE. PATIENTS WHO SCREEN POSITIVE FOR ANY OF THE FACTORS ARE CONNECTED TO NECESSARY COMMUNITY PROGRAMS AND RESOURCES FOR ASSISTANCE. - PROMEDICA TOLEDO HOSPITAL BECAME THE FIRST HOSPITAL IN OHIO TO ACQUIRE SYNAPTIVE MEDICAL'S BRIGHTMATTER TECHNOLOGY, WHICH COMBINES ADVANCED IMAGING, PLANNING, NAVIGATION AND ROBOTIC VISUALIZATION WITH A DIGITAL MICROSCOPE FOR COMPLEX BRAIN TUMOR AND SPINAL SURGERY. THE NEW TECHNOLOGY ALLOWS FOR BETTER SURGICAL ERGONOMICS, FACILITATES COLLABORATION AMONG OPERATING ROOM STAFF, AND CONSUMES LESS SURGICAL TIME, ALL FACTORS THAT COULD LEAD TO IMPROVED PATIENT OUTCOMES. - PROMEDICA'S SUMMER YOUTH EMPLOYMENT PROGRAM PARTNERED 40 CENTRAL-CITY TEENS AGES 16 - 19 WITH MENTORS IN DEPARTMENTS SUCH AS HUMAN RESOURCES, RADIOLOGY, DIETARY, AND INFORMATION TECHNOLOGY TO LEARN SKILLS INCLUDING CUSTOMER SERVICE, PUNCTUALITY AND BEING ACCOUNTABLE TO OTHERS. - PROMEDICA INNOVATION'S BUSINESS INCUBATOR ALLOWS CLIENT COMPANIES IN THE HEALTHCARE FIELD TO ACCELERATE DEVELOPMENT AND COMMERCIALIZATION OF MEDICAL DEVICES AND HEALTH INFORMATION TECHNOLOGY TO IMPROVE PATIENT CARE LOCALLY AND NATIONALLY. - ADDITIONALLY, IN 2017, PROMEDICA INNOVATIONS FORMED A COLLABORATIVE ORGANIZATION CALLED NEXTTECH WITH THE UNIVERSITY OF TOLEDO, BOWLING GREEN STATE UNIVERSITY, AND MERCY HEALTH. NEXTTECH RECEIVED THE OHIO THIRD FRONTIER GRANT OF $8.7 MILLION TO SERVE AS THE ENTREPRENEURIAL SERVICES PROVIDER (ESP) FOR 18 COUNTIES IN NORTHWEST OHIO. THE ESP OFFERS A NETWORK OF ENTREPRENEURIAL SERVICES AND CAPITAL TO ACCELERATE THE GROWTH OF EARLY STAGE OHIO TECHNOLOGY COMPANIES. IN 2017, PROMEDICA CONTRIBUTED $191,681,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE. THESE NUMBERS NOT ONLY INDICATE PROMEDICA'S LONG-STANDING COMMITMENT TO THE COMMUNITY, BUT ALSO FULFILL OUR NOT-FOR-PROFIT STATUS BY IMPROVING THE HEALTH AND WELL-BEING OF RESIDENTS IN THE COMMUNITIES WE SERVE. SPECIFICALLY, THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, CASH AND IN-KIND CONTRIBUTIONS, AND OTHER COMMUNITY BENEFIT OPERATIONS, PROMEDICA CONTRIBUTED $50,124,000 IN 2017. THESE PROGRAMS INCLUDED FREE COMMUNITY HEALTH SCREENINGS, SUCH AS DIABETES TESTING, BLOOD PRESSURE, BONE DENSITY, BODY MASS, AND CANCER CHECKUPS; MAMMOGRAM SCREENINGS FOR LOW-INCOME AND UNINSURED WOMEN; CHILDHOOD IMMUNIZATIONS; REDUCED-COST SCHOOL-ATHLETIC PHYSICALS; FIRST-AID COVERAGE AT COMMUNITY EVENTS; VOLUNTEER ELEMENTARY SCHOOL MENTORS; PUBLIC HEALTH EDUCATION LECTURES AND SEMINARS; A CHILDHOOD OBESITY PROGRAM; AND MANY OTHER COMMUNITY-BASED INITIATIVES. PROMEDICA ALSO CONTRIBUTED $11,054,000 IN FINANCIAL ASSISTANCE FOR PATIENTS WHO DID NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR HOSPITAL SERVICES. THIS AMOUNT REPRESENTS THE COST TO PROVIDE SERVICE AND DOES NOT INCLUDE THE COSTS FOR ACCOUNTS THAT ARE WRITTEN OFF TO BAD DEBT FOR PATIENTS WHO DO NOT PAY THEIR BILLS. IN ADDITION, PROMEDICA'S COST OF BAD DEBT FOR 2017 WAS $28,737,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $191,681,000 NOTED ABOVE. FURTHER, PROMEDICA CONTINUES TO BE A LEADING PARTICIPANT IN THE LUCAS COUNTY CARENET INITIATIVE - A COLLABORATIVE EFFORT AMONG PROMEDICA, MERCY HEALTH PARTNERS, THE UNIVERSITY OF TOLEDO MEDICAL CENTER, THE CITY OF TOLEDO, AND OTHERS. CARENET WAS CREATED TO PROVIDE FREE OR LOWER-COST HEALTH CARE FOR LOW-INCOME LUCAS COUNTY RESIDENTS. ESTABLISHED IN 2003, CARENET BRIDGES THE GAP BETWEEN ADULTS WITHOUT HEALTH INSURANCE AND NEEDED HEALTHCARE SERVICES. WHILE SOME INDIVIDUALS MAY QUALIFY FOR GOVERNMENTAL INSURANCE PROGRAMS SUCH AS MEDICAID, OTHERS DO NOT; IT IS FOR THESE INDIVIDUALS THAT CARENET WAS ESTABLISHED. ADDITIONALLY DURING 2017, PROMEDICA PROVIDED $130,504,000 OF COMMUNITY BENEFIT THROUGH THE COST - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. PROMEDICA'S TOTAL COST - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS DURING 2017 WAS $139,149,000 AND IS NOT REFLECTED IN THE COMMUNITY BENEFIT AMOUNT OF $191,681,000 NOTED ABOVE. INDEED, PROMEDICA GOES BEYOND INDUSTRY STANDARDS IN MEETING THE GOAL OF PROVIDING CARE TO EVERYONE, REGARDLESS OF THEIR ABILITY TO PAY. WE PROVIDE HOSPITAL CARE FREE-OF-CHARGE TO ALL FAMILIES WITHOUT INSURANCE WITH INCOMES AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. IN ADDITION TO FREE CARE FOR THOSE FAMILIES UNDER THIS FEDERAL POVERTY LEVEL, PROMEDICA HOSPITALS PROVIDE SIGNIFICANT DISCOUNTS TO FAMILIES WITH INCOMES OF UP TO 400% OF THE FEDERAL POVERTY LEVEL. IN MANY SITUATIONS, OTHER FUNDING SOURCES ARE SECURED AND ACCOMMODATIONS MADE. PROMEDICA'S POLICIES ARE POSTED AND AVAILABLE IN WRITING IN ALL PROMEDICA FACILITIES. ALSO, FINANCIAL ADVOCATES ARE AVAILABLE TO HELP PATIENTS BY EXPLAINING OUR FREE CARE AND DISCOUNT PROGRAMS, AND TO ASSIST WITH THE PAPERWORK NECESSARY TO QUALIFY FOR GOVERNMENT FUNDING. PATIENT BILLS PROVIDE CLEAR EXPLANATIONS, QUALIFICATIONS AND REMINDERS OF THESE PROGRAMS. IN SUMMARY, PROMEDICA DEMONSTRATES ITS MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. AND, WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL CLASSES, HEALTH FAIRS AND OTHER ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. DEFIANCE HOSPITAL, INC. - PROGRAM SERVICE ACCOMPLISHMENTS DEFIANCE HOSPITAL, INC. (D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL) IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 28 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN, AND IS ONE OF THE REGION'S LEADING HEALTHCARE PROVIDERS. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS, AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. PROMEDICA DEFIANCE REGIONAL HOSPITAL (DRH) IS A 51-BED, CRITICAL ACCESS, GENERAL ACUTE CARE HOSPITAL IN DEFIANCE, OHIO THAT INCLUDES A 10-BED, DISTINCT PSYCHIATRIC UNIT. THE 200,000-SQUARE-FOOT FACILITY PROVIDES HEALTHCARE SERVICES TO RESIDENTS IN THE OHIO COUNTIES OF DEFIANCE, PAULDING, HENRY, FULTON, PUTNAM, AND WILLIAMS. IN 2017 DRH RECEIVED A FOUR-STAR RATING FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) HOSPITAL COMPARE RANKINGS. THE RATING PLACES DRH IN THE TOP 15TH PERCENTILE NATIONWIDE FOR OVERALL HOSPITAL QUALITY. DRH OFFERS A BROAD SPECTRUM OF SERVICES TO MEET THE COMMUNITY'S IDENTIFIED HEALTHCARE NEEDS, INCLUDING FULL-SERVICE EMERGENCY CENTER AND TRAUMA SERVICES, SURGICAL SERVICES, HEALTH EDUCATION PROGRAMMING, THE COPING CENTER FOR PATIENTS WITH MENTAL HEALTH ISSUES, ADVANCED DIAGNOSTICS, WOMEN'S SERVICES, AND A SLEEP DISORDERS CENTER. AS A TESTAMENT TO OUR COMMITMENT TO PROVIDE HIGH-QUALITY CARE TO AREA RESIDENTS, DRH ALSO OFFERS AN EXPANDED VISITING PHYSICIAN CLINIC INCLUDING UROLOGY AND OTHER SPECIALTIES AND SUBSPECIALTIES. AS A COMMUNITY-BASED HOSPITAL, DRH HOSTS VARIOUS SUPPORT GROUPS AND COMMUNITY OUTREACH ACTIVITIES TO PROMOTE HEALTH AND WELLNESS, INCLUDING VARIOUS PROGRAMS FOR NEW MOTHERS AND FAMILIES THROUGHOUT THE YEAR. IN ADDITION, NUMEROUS PRIMARY CARE AND SPECIALTY PHYSICIANS ARE LOCATED IN OUR MEDICAL OFFICE BUILDING, AS WELL AS IN THE MEDICAL OFFICE IN THE NORTH POINTE COMMONS PLAZA. DRH IS ACCREDITED BY THE JOINT COMMISSION AND ALSO HAS EARNED LEVEL III TRAUMA CENTER VERIFICATION, SLEEP MEDICINE ACCREDITATION, A LEVEL I OBSTETRICS AND NEWBORN NURSERY UNIT, AND LABORATORY ACCREDITATION BY THE COMMISSION ON LABORATORY ACCREDITATION OF THE COLLEGE OF AMERICAN PATHOLOGISTS. DRH'S CHARGE IS TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE INDIVIDUALS WHOM WE SERVE THROUGH PREVENTION, EDUCATION AND QUALITY CARE. IN 2017, DRH SERVED 2,386 INPATIENTS AND 74,355 OUTPATIENTS. ADDITIONALLY, 14,062 INDIVIDUALS SOUGHT EMERGENCY CARE AT DRH. THE HOSPITAL CONTRIBUTED $4,018,000 IN COMMUNITY BENEFIT IN 2017 THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE. THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES, CASH AND IN-KIND CONTRIBUTIONS, AND OTHER COMMUNITY BENEFIT OPERATIONS, DRH CONTRIBUTED $5,000 TO THE COMMUNITY DURING 2017. INCLUDED IN THIS AMOUNT ARE PROGRAMS AND SERVICES SUCH AS: - COMMUNITY HEALTH EDUCATION THROUGH NUMEROUS HEALTH PROMOTIONS AND WELLNESS PROGRAMS; - A DISCOUNTED MAMMOGRAM PROGRAM FOR UNINSURED AND UNDERINSURED WOMEN IN THE DEFIANCE AREA; - HEALTH SCREENINGS, INCLUDING BLOOD PRESSURE, HEARING, SKIN CANCER, BONE DENSITY, AND BODY FAT; - JOBCARE, DRH'S OCCUPATIONAL HEALTH PROGRAM, WHICH WORKS CLOSELY WITH AREA EMPLOYERS TO PLAN AND COORDINATE HEALTH SERVICES THAT MEET EMPLOYEES' NEEDS. DRH ALSO PROVIDED FINANCIAL ASSISTANCE TO THE COMMUNITY THROUGHOUT 2017, OF WHICH $174,000 REPRESENTED UNCOMPENSATED AMOUNTS FOR TREATMENT OF PATIENTS WHO DID NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR HOSPITAL SERVICES. FINANCIAL ASSISTANCE REPRESENTS THE COST TO PROVIDE SERVICE AND DOES NOT INCLUDE THE COSTS FOR ACCOUNTS WRITTEN OFF TO BAD DEBT FOR PATIENTS WHO DO NOT PAY THEIR BILLS. DRH'S COST OF BAD DEBT FOR 2017 WAS $1,250,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $4,018,000 NOTED ABOVE. FURTHER, DRH PROVIDED $3,839,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. ALSO IN 2017, THE TOTAL COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS WAS $897,000 AND IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $4,018,000 NOTED ABOVE. DURING 2017, DRH EXPENDED $11,471,000 IN NET PAYROLL, PROVIDING 347 FULL-TIME JOBS. A TOTAL OF $699,000 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES. IN SUMMARY, DRH DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. AND, WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL CLASSES, HEALTH FAIRS AND OTHER OUTREACH ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. COMMUNITY BENEFIT DEFINITIONS PROMEDICA HEALTH SYSTEM, INC. AND ITS SUBSIDIARIES (PROMEDICA) PREPARES ITS COMMUNITY BENEFIT REPORTS CONSISTENT WITH GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES AND CONSISTENT WITH FORM 990, SCHEDULE H, HOSPITALS, REPORTING. COMMUNITY BENEFITS ARE PROGRAMS AND ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. COMMUNITY BENEFITS REPORTED BY PROMEDICA RESPOND TO IDENTIFIED COMMUNITY NEEDS AND MEET AT LEAST ONE OF THE FOLLOWING CRITERIA: - IMPROVE ACCESS TO HEALTHCARE SERVICE. - ENHANCE THE HEALTH OF THE COMMUNITY. - ADVANCE HEALTHCARE KNOWLEDGE. - RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS. FINANCIAL ASSISTANCE CONSISTENT WITH ITS MISSION, PROMEDICA PROVIDES A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO PATIENTS WITH LIMITED OR NO ABILITY TO PAY THEIR BILL. PROMEDICA HOSPITALS PROVIDE FREE CARE TO THOSE UNINSURED PATIENTS WITH INCOMES UP TO 200% OF THE FEDERAL POVERTY LEVEL. SIGNIFICANT DISCOUNTS ARE ALSO PROVIDED ON A SLIDING SCALE TO UNINSURED PATIENTS UP TO 400% OF THE FEDERAL POVERTY LEVEL. FINANCIAL ASSISTANCE IS REPORTED IN THE FORM OF COST TO PROVIDE SERVICES AND HAS BEEN REDUCED TO REFLECT REIMBURSEMENT RECEIVED FROM STATE PROGRAMS DESIGNED TO RELIEVE THE BURDEN OF PROVIDING FINANCIAL ASSISTANCE. THE COST OF FINANCIAL ASSISTANCE DOES NOT INCLUDE THE COSTS FOR ACCOUNTS THAT ARE WRITTEN OFF TO BAD DEBT FOR PATIENTS THAT DO NOT PAY THEIR BILL. GOVERNMENT-SPONSORED HEALTH CARE GOVERNMENT-SPONSORED HEALTH CARE INCLUDE SERVICES THAT ARE REIMBURSED OR PARTIALLY REIMBURSED THROUGH GOVERNMENT MEANS-TESTED PROGRAMS SUCH AS MEDICAID. PROMEDICA INCLUDES THE UNPAID COSTS OF THESE PUBLIC PROGRAMS TO THE EXTENT THAT PAYMENTS RECEIVED ARE LESS THAN THE COSTS OF PROVIDING SERVICES. THE UNPAID COSTS OF TREATING MEDICARE PATIENTS IS REPORTED SEPARATELY AND IS NOT INCLUDED IN PROMEDICA'S COMMUNITY BENEFIT REPORT. ADDITIONALLY, THE COST OF FINANCIAL ASSISTANCE HAS BEEN ELIMINATED FROM ANY AMOUNTS REPORTED IN THIS CATEGORY. COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE ACTIVITIES CARRIED OUT FOR THE EXPRESS PURPOSE OF IMPROVING COMMUNITY HEALTH. THESE ACTIVITIES GENERALLY DO NOT GENERATE INPATIENT OR OUTPATIENT BILLS AS THEY EXTEND BEYOND PATIENT CARE ACTIVITIES AND ARE SUBSIDIZED BY PROMEDICA. COMMUNITY BENEFIT OPERATIONS INCLUDE COSTS ASSOCIATED WITH DEDICATED STAFF, COMMUNITY HEALTH NEED AND/OR ASSESSMENT, AND OTHER COSTS ASSOCIATED WITH COMMUNITY BENEFIT PLANNING AND ADMINISTRATION. HEALTH PROFESSIONS EDUCATION HEALTH PROFESSIONS EDUCATION INCLUDE COSTS FOR ALL EDUCATIONAL PROGRAMS PROMEDICA IS INVOLVED WITH, THE PROVISION OF A CLINICAL SETTING FOR TRAINING FOR HEALTHCARE STUDENTS OUTSIDE THE ORGANIZATION, AND FUNDING FOR HEALTHCARE EDUCATION. SUBSIDIZED HEALTH SERVICES SUBSIDIZED HEALTH SERVICES ARE SERVICES PROVIDED TO THE COMMUNITY DESPITE A FINANCIAL LOSS. THESE SERVICES GENERATE A BILL FOR REIMBURSEMENT, AND INCLUDE CLINICAL PATIENT CARE SERVICES THAT ARE PROVIDED BECAUSE THEY ARE NEEDED IN THE COMMUNITY AND OTHER PROVIDERS ARE UNWILLING, OR UNABLE, TO PROVIDE THE SERVICES, OR THE SERVICES OTHERWISE WOULD NOT BE AVAILABLE TO MEET COMMUNITY NEEDS. RESEARCH RESEARCH ACTIVITIES INCLUDE CLINICAL AND COMMUNITY HEALTH RESEARCH, AS WELL AS STUDIES ON HEALTHCARE DELIVERY. THE AMOUNT REPORTED FOR PROMEDICA IS REDUCED BY ANY EXTERNAL SUBSIDIES, SUCH AS GRANTS. CASH AND IN-KIND CONTRIBUTIONS CASH AND IN-KIND CONTRIBUTIONS INCLUDE FUNDS AND IN-KIND SERVICES DONATED TO COMMUNITY ORGANIZATIONS AND THE COMMUNITY AT LARGE. IN-KIND SERVICES INCLUDE HOURS DONATED BY STAFF FOR COMMUNITY NEEDS WHILE ON WORK TIME; AS WELL AS DONATIONS OF FOOD, EQUIPMENT AND SUPPLIES. 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