2018-05-15T09:17:21-05:00 2017-06-30 990 2016-07-01 342032340 DILEY RIDGE MEDICAL CENTER DILE 6148387911 6150 E BROAD STREET NO WD381N COLUMBUS OH 432131574 PAUL MORRIS VICE PRESIDENT AND CFO 6145464292 2018-05-15 2016 2022-09-23 18:48:47Z EDWARD LAMB 6150 E BROAD STREET NO WD381N COLUMBUS OH 432131574 29785718 0 X WWW.DILEYRIDGEMEDICALCENTER.COM X 2003 OH TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES. 7 4 145 10 0 0 4898 3956 26875042 27297137 -541605 1607407 2491878 869289 28830213 29777789 7592 3998 0 0 5915031 5869686 0 0 0 8896208 9872652 14818831 15746336 14011382 14031453 54297014 54375338 15352739 12082365 38944275 42292973 X TO PROVIDE HEALTH CARE THE WAY IT SHOULD BE. 0 0 12873912 3998 27964017 AN AFFILIATION OF MOUNT CARMEL AND FAIRFIELD MEDICAL CENTER, DILEY RIDGE MEDICAL CENTER (DILEY RIDGE) IS A STATE-OF-THE-ART MEDICAL COMPLEX IN CANAL WINCHESTER, OH, THAT PROVIDES EMERGENCY, INPATIENT AND DIAGNOSTIC SERVICES. THE COMPLEX INCLUDES A 35,000 SQUARE-FOOT FREE-STANDING EMERGENCY AND DIAGNOSTIC CENTER, AND A 50,000 SQUARE-FOOT MEDICAL OFFICE BUILDING. IN FISCAL 2017, DILEY RIDGE PROVIDED MEDICAL CARE FOR 17,077 OUTPATIENT VISITS AND 34,357 EMERGENCY ROOM VISITS. ITS 24-HOUR EMERGENCY CENTER IS LICENSED FOR 10 ACUTE CARE BEDS FOR PATIENTS WHO REQUIRE OBSERVATION AND MONITORING.DILEY RIDGE SERVES PATIENTS THROUGHOUT THE NORTHERN FAIRFIELD COUNTY, INCLUDING THE COMMUNITIES OF PICKERINGTON, GROVEPORT, CANAL WINCHESTER, CARROLL, BALTIMORE AND VIOLET TOWNSHIP. PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS AND AWARDS: WWW.DILEYRIDGEMEDICALCENTER.COM 12873912 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 34 0 1 145 1 0 0 0 0 0 0 0 0 0 0 X 7 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X PAUL MORRIS 6145464619 6150 EAST BROAD STREET COLUMBUS OH 43213 SKY GETTYS DIRECTOR; CHAIR; TREASURER 2.00 0.00 X X 0 0 0 C BRETT JUSTICE DIRECTOR; V CHAIR; VP STRATEGY 2.00 48.00 X X 0 270203 36211 DENISE BAUER DIRECTOR; SECRETARY 2.00 0.00 X X 0 0 0 MELISSA FLEMING DIRECTOR; MCHS ASSOCIATE COUNSEL 2.00 48.00 X 0 204670 33009 HELEN HARDING DIRECTOR 2.00 0.00 X 0 0 0 MARK MATTHEWS DIRECTOR THROUGH 10/16 2.00 0.00 X 0 0 0 BHAVESH PATEL MD DIRECTOR 2.00 0.00 X 0 0 0 MICHAEL WILKINS DIRECTOR, PRES & CEO MC EAST 2.00 53.00 X 0 429411 75685 AIMEE MILLIGAN PRESIDENT AND CEO 55.00 0.00 X 96018 0 12916 EDWARD LAMB MOUNT CARMEL HEALTH SYS CEO AT 11/16 2.00 53.00 X 0 150607 21835 DANIEL POWELL MOUNT CARMEL HEALTH SYS INTERIM CFO 2.00 53.00 X 0 243692 10302 KEITH COLEMAN FORMER OFFICER 0.00 0.00 X 0 568940 212188 RICHARD O'CONNELL FORMER KE;TRINITY EVP EAST THR 11/16 0.00 50.00 X 0 1545409 47362 JACQUELINE PRIMEAU FORMER OFFICER; TRINITY VP M&A 0.00 50.00 X 0 294379 30587 MONICA TREINISH FORMER OFFICER;DIR PATIENT CARE SVCS 50.00 0.00 X 128484 0 9532 CLAUS VON ZYCHLIN FORMER OFFICER; CONSULTANT 0.00 50.00 X 0 966101 787668 JODI WILSON FORMER OFF; VP PATIENT CARE SVCS/CNO 0.00 50.00 X 0 219810 18570 224502 4893222 1295865 1 1 1 0 AVI FOODSYSTEMS INC 2590 ELM RD NE WARREN OH 44483 NUTRITION SERVICES 314903 HOLOGIC INC 250 CAMPUS DR MARLBOROUGH MA 01752 MAMMOGRAPHY SERVICES 248555 COLUMBUS INPATIENT CARE SERVIC 793 W STATE ST 3N09 COLUMBUS OH 43222 INPATIENT HEALTH CARE SERVICES 206385 XANITOS INC 75 REMITTANCE DR DEPT 6529 CHICAGO IL 60675 ENVIRONMENTAL SERVICES 181410 COMO LANDSCAPING 8670 HILL RD SOUTH PICKERINGTON OH 43147 LANDSCAPING SERVICES 115207 5 3956 3956 NET PATIENT SERVICE REVENUE 622110 27297137 27297137 27297137 495094 495094 124990 0 124990 124990 124990 1042992 77250 0 7929 1042992 69321 1112313 1112313 MEDICARE/MEDICAID HIT 622110 663524 663524 CAFETERIA REVENUE 722514 77419 77419 OTHER OPERATING REVENUE 622110 3356 3356 744299 29777789 27964017 0 1809816 3998 3998 108934 108934 138016 138016 4536557 3819692 716865 132693 114713 17980 633569 516255 117314 319917 255934 63983 1395677 27914 1367763 1528 1528 1280657 1202425 78232 142323 131129 11194 173493 89148 84345 6000 5528 472 511515 471282 40233 5722 5272 450 6984 6435 549 287887 287887 897582 826984 70598 231448 213244 18204 BAD DEBT EXPENSE 3099729 3099729 MEDICAL SUPPLIES EXP 971500 971500 EQUIPMENT MAINTENANCE 422876 389615 33261 HOSPITAL PROVIDER TAX 405906 405906 31825 29322 2503 15746336 12873912 2872424 0 750 750 32063922 33005475 3566606 3440857 148783 131699 25999 33852 27465767 9711335 18245107 17754432 245847 8273 54297014 54375338 2154362 1328492 13124903 10740817 73474 13056 15352739 12082365 X 38944275 42292973 38944275 42292973 54297014 54375338 X 14031453 1817245 -12500000 X X 0 1 X 1 0 X 0 0 0 0 0 1 1976 0 0 0 1976 0 PART II-B, LINE 1: DILEY RIDGE MEDICAL CENTER HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO A REGIONAL HEALTH CARE ORGANIZATION, WHERE THE ORGANIZATION HAS PROVIDED DILEY RIDGE MEDICAL CENTER WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. 2240420 2240420 18538367 4122453 14415914 6686980 5588882 1098098 17754432 ASSET RETIREMENT OBLIGATION FIN 47 12666 INTERCOMPANY ACCOUNTS PAYABLE 390 13056 1 1 X 1 X 1 X 1 1 0 1 1 502864 502864 0.03980 4023257 2741744 1281513 0.10130 4526121 2741744 1784377 0.14110 1 193 8407 8407 0.00070 1 193 8407 8407 0.00070 1 193 4534528 2741744 1792784 0.14180 1 3099729 0 1420592 1242927 177665 X 1 1 1 1 DILEY RIDGE MEDICAL CENTER 7911 DILEY ROAD CANAL WINCHESTER OH 43110 WWW.DILEYRIDGEMEDICALCENTER.COM REGISTRATION #1494 X X X DIAGNOSTIC SERVICES DILEY RIDGE MEDICAL CENTER 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X SEE SCHEDULE H, PART V, SECTION C X WWW.MOUNTCARMELHEALTH.COM/COMMUNITY-BENEFIT X X 1 15 1 SEE SCHEDULE H, PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X WWW.MOUNTCARMELHEALTH.COM/FINANCIALASSISTANCE X WWW.MOUNTCARMELHEALTH.COM/FINANCIALASSISTANCE X WWW.MOUNTCARMELHEALTH.COM/FINANCIALASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 DILEY RIDGE MEDICAL CENTER PART V, SECTION B, LINE 5: THE FRANKLIN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS A COLLABORATIVE PROJECT, CONDUCTED BY A STEERING COMMITTEE COMPRISED OF THE FOLLOWING ORGANIZATIONS AND LED BY CENTRAL OHIO HOSPITAL COUNCIL: NATIONWIDE CHILDREN'S HOSPITAL, OHIOHEALTH, WEXNER MEDICAL CENTER AT THE OHIO STATE UNIVERSITY, MOUNT CARMEL EAST (MC EAST), MOUNT CARMEL WEST (MC WEST), MOUNT CARMEL ST ANN'S (MC ST. ANN'S), AND MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL (MC NEW ALBANY); COLUMBUS AND FRANKLIN COUNTY PUBLIC HEALTH (WITH SPECIAL KNOWLEDGE OF AND EXPERTISE IN PUBLIC HEALTH); UNITED WAY OF CENTRAL OHIO AND PRIMARYONE HEALTH (REPRESENTING LOW INCOME, MEDICALLY UNDERSERVED, AND MINORITY POPULATIONS); CENTRAL OHIO AREA AGENCY ON AGING AND OHIO DEPARTMENT OF AGING (REPRESENTING THE SENIOR POPULATION); HEALTHCARE FOR THE HOMELESS (REPRESENTING THE HOMELESS POPULATION); OHIO DEPARTMENT OF HEALTH, OHIO DISABILITY AND HEALTH PROGRAM (REPRESENTING THOSE WITH DISABILITIES). THE STEERING COMMITTEE BEGAN CONDUCTING WORK SESSIONS IN JUNE 2014 AND MET PERIODICALLY UNTIL THE RELEASE OF THE CHNA ON JUNE 8, 2016. AN OVERVIEW OF THESE MEETINGS WAS SHARED WITH COMMUNITY MEMBERS AND INPUT AND ADVICE WAS SOLICITED AT BOTH THE COMMUNITY ADVISORY MEETINGS AND COMMUNITY HEALTH PLANNING SESSIONS.THE FAIRFIELD COUNTY CHNA WAS CONDUCTED IN 2016 AND SUPPORTS THE FINDINGS IN THE FRANKLIN COUNTY CHNA. MASS MAILINGS OF SURVEYS WERE DISTRIBUTED TO A SAMPLE OF FAIRFIELD COUNTY RESIDENTS REPRESENTATIVE OF THE COMMUNITY. A COMMITTEE LED BY THE HOSPITAL COUNCIL OF NORTHWEST OHIO COMPILED AND PRIORITIZED THE INFORMATION. FACILITIES REPRESENTED WERE DILEY RIDGE MEDICAL CENTER (DILEY RIDGE) AND FAIRFIELD MEDICAL CENTER AND THE FOLLOWING ORGANIZATIONS: FAIRFIELD COMMUNITY HEALTH CENTER (REPRESENTING THE LOW INCOME, MEDICALLY UNDERSERVED INDIVIDUALS); FAIRFIELD COUNTY FAMILY ADULT AND CHILDREN FIRST COUNCIL, FAIRFIELD COUNTY INJURY PREVENTION PROGRAM (REPRESENTING CHILDREN, HIGH-RISK YOUTH, AND PARENTS); HEAD START/FAIRFIELD COUNTY COMMUNITY ACTION (REPRESENTING LOW-INCOME FAMILIES); SOUTHEASTERN OHIO CENTER FOR INDEPENDENT LIVING (REPRESENTING INDIVIDUALS WITH DISABILITIES AND THEIR FAMILIES); FAIRFIELD DEPARTMENT OF HEALTH (SPECIAL KNOWLEDGE OF AND EXPERTISE IN PUBLIC HEALTH); UNITED WAY OF FAIRFIELD COUNTY (REPRESENTING LOW INCOME, MEDICALLY UNDERSERVED, AND MINORITY POPULATIONS); BLOOM CARROLL DISTRICT SCHOOLS (REPRESENTING CHILDREN AND THEIR FAMILIES); AND FAIRFIELD COUNTY ADAMH BOARD (REPRESENTING MENTAL HEALTH AND ADDICTION SERVICES); AND FAIRFIELD COUNTY COMMISSIONERS OFFICE (SPECIAL KNOWLEDGE OF COMMUNITY NEEDS). OVERVIEW OF THESE MEETINGS WAS SHARED WITH COMMUNITY MEMBERS AND INPUT AND ADVICE SOLICITED AT COMMUNITY ADVISORY MEETINGS AND COMMUNITY HEALTH PLANNING SESSIONS. DILEY RIDGE MEDICAL CENTER PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITIES WHO PARTICIPATED IN THE FRANKLIN COUNTY CHNA WERE NATIONWIDE CHILDREN'S HOSPITAL, OHIOHEALTH, WEXNER MEDICAL CENTER AT THE OHIO STATE UNIVERSITY, MC EAST, MC WEST, MC ST. ANN'S AND MC NEW ALBANY.THE HOSPITAL FACILITIES WHO PARTICIPATED IN THE FAIRFIELD COUNTY CHNA WERE DILEY RIDGE AND FAIRFIELD MEDICAL CENTER. DILEY RIDGE MEDICAL CENTER PART V, SECTION B, LINE 6B: THE COLLABORATIVE ORGANIZATIONS INVOLVED IN THE FRANKLIN COUNTY CHNA INCLUDED: CENTRAL OHIO AREA AGENCY ON AGING, CENTRAL OHIO TRAUMA CENTER, COLUMBUS PUBLIC HEALTH, FRANKLIN COUNTY PUBLIC HEALTH, UNITED WAY OF CENTRAL OHIO, CENTRAL OHIO HOSPITAL COUNCIL, PRIMARYONE HEALTH, HEALTHCARE FOR THE HOMELESS, OHIO DEPARTMENT OF AGING, OHIO DEPARTMENT OF HEALTH OHIO DISABILITY AND HEALTH PROGRAM, THE OHIO STATE UNIVERSITY COLLEGE OF PUBLIC HEALTH, AND THE CENTER FOR PUBLIC HEALTH PRACTICE. DILEY RIDGE MEDICAL CENTER PART V, SECTION B, LINE 7D: THE CHNA FOR FRANKLIN COUNTY WAS PRESENTED TO THE PUBLIC IN AN OPEN FORUM HELD ON JUNE 8, 2016 AT THE BOAT HOUSE AT CONFLUENCE PARK WHERE COPIES WERE SHARED WITH THE PUBLIC AND LEADERS OF COMMUNITY ORGANIZATIONS. MOUNT CARMEL HAS MADE THE DOCUMENT AVAILABLE TO THE COMMUNITY AT WWW.MOUNTCARMELHEALTH.COM AND WWW.CENTRALOHIOHOSPITALS.ORG/CHNA.HTML, WHERE INDIVIDUALS CAN READ ELECTRONICALLY, DOWNLOAD, OR PRINT A COPY. PRINT COPIES CAN BE REQUESTED BY CONTACTING THE HOSPITAL BY PHONE OR EMAIL. DILEY RIDGE HAS MADE THE CHNA FOR FAIRFIELD COUNTY AVAILABLE AT WWW.DILEYRIDGEMEDICALCENTER.COM/COMMUNITY-HEALTH-ASSESSMENTS AND AT WWW.HCNO.ORG/COMMUNITY-SERVICES/COMMUNITY-HEALTH-ASSESSMENTS/, WHERE INDIVIDUALS CAN READ ELECTRONICALLY, DOWNLOAD, OR PRINT A COPY. PRINT COPIES CAN BE REQUESTED BY CONTACTING THE HOSPITAL BY PHONE OR EMAIL.LINE 7A - DILEY RIDGE CHNA URL: WWW.DILEYRIDGEMEDICALCENTER.COM/COMMUNITY-HEALTH-ASSESSMENTSLINE 10A - DILEY RIDGE IMPLEMENTATION STRATEGY URL: WWW.DILEYRIDGEMEDICALCENTER.COM/COMMUNITY-HEALTH-ASSESSMENTSPART V LINE 9:AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC. DILEY RIDGE MEDICAL CENTER PART V, SECTION B, LINE 11: ACCESS TO CARE, MENTAL HEALTH AND ADDICTION, AND CHRONIC CONDITIONS WERE IDENTIFIED NEEDS THAT HAVE BEEN ADDRESSED BY DILEY RIDGE. DILEY RIDGE WAS ABLE TO PROVIDE MANY SERVICES TO THE COMMUNITY THROUGH ITS PARTNERSHIPS. PARTNERING WITH THE JERRY GARVER YMCA IN CANAL WINCHESTER ALLOWED DILEY RIDGE STAFF TO BRING SERVICES DIRECTLY TO THE COMMUNITY BY PROVIDING BLOOD PRESSURE SCREENINGS AND EDUCATION FOR OVER 145 COMMUNITY MEMBERS. DILEY RIDGE PROVIDED CLERICAL AND CLINICAL SUPPORT FOR STUDENTS AT PICKERINGTON HIGH SCHOOLS IN CONJUNCTION WITH TYLER'S LIGHT. TYLER'S LIGHT OFFERS A VOLUNTARY PROGRAM FOR HIGH SCHOOL STUDENTS WHO PLEDGE TO BE DRUG FREE AND SUBMIT TO INITIAL AND RANDOM DRUG TESTS. DILEY RIDGE ASSISTED IN DRUG TAKE BACK DAY, COLLECTING 129 POUNDS OF UNUSED PRESCRIPTIONS.LIMITED RESOURCES AND SCOPE OF PRACTICE WERE REASONS DILEY RIDGE DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS 2016 CHNA. THE FOLLOWING NEEDS ARE NOT BEING ADDRESSED BY DILEY RIDGE, BUT ARE BEING ADDRESSED BY OTHER MOUNT CARMEL HEALTH SYSTEM FACILITIES OR COLLABORATIVE PARTNERS: OBESITY IS BEING ADDRESSED AT MC EAST, MC WEST, MC ST. ANN'S, AND COMMUNITY PARTNERS LISTED ON PAGE 11 OF THE FRANKLIN COUNTY CHNA. INFANT MORTALITY IS BEING ADDRESSED BY MC EAST, MC ST. ANN'S, AND COMMUNITY RESOURCES LISTED ON PAGE 13 OF THE FRANKLIN COUNTY CHNA. INFECTIOUS DISEASE IS BEING ADDRESSED BY MC WEST, MC ST. ANN'S, MC NEW ALBANY, AND COMMUNITY RESOURCES LISTED ON PAGE 26 OF THE FRANKLIN COUNTY CHNA. DILEY RIDGE MEDICAL CENTER PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: DILEY RIDGE REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, DILEY RIDGE INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE AS WELL AS MOUNT CARMEL HEALTH SYSTEM'S WEBSITE (WWW.MOUNTCARMELHEALTH.COM). DILEY RIDGE ALSO SUBMITS THE COMMUNITY HEALTH NEEDS ASSESSMENT AND PLAN WITH THE OHIO DEPARTMENT OF HEALTH EVERY THIRD YEAR IN ACCORDANCE WITH STATE OF OHIO REQUIREMENTS. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $3,099,729, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: DILEY RIDGE USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, DILEY RIDGE IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, DILEY RIDGE IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: DILEY RIDGE IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE."PART III, LINE 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE TWO PERCENT SEQUESTRATION REDUCTION. PART III, LINE 8: DILEY RIDGE DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - DILEY RIDGE ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE- DILEY RIDGE IS COMMITTED TO:-PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES-CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES-ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE -BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, DILEY RIDGE HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: -PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS-MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS-OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS-IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER-IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSDILEY RIDGE COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UNTIL ONE YEAR AFTER THE FIRST BILLING STATEMENT TO THE PATIENT. DILEY RIDGE OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. DILEY RIDGE HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. DILEY RIDGE MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATION - DILEY RIDGE IS LOCATED IN A RAPIDLY GROWING PORTION OF NORTHERN FAIRFIELD COUNTY. FAIRFIELD COUNTY HAD A POPULATION OF 152,597 IN 2016, ACCORDING TO OHIO COUNTY PROFILES PREPARED BY THE OHIO OFFICE OF RESEARCH. THE POPULATION IS 89% WHITE, 6% AFRICAN AMERICAN AND 2.2% TWO OR MORE RACES. THE MEDIAN HOUSEHOLD INCOME IS $60,567. MOST OF THE ADULTS ARE HIGH SCHOOL GRADUATES (92%) AND 26% HAVE A BACHELOR DEGREE OR HIGHER. IN FAIRFIELD COUNTY, 15.8% OF FAMILIES LIVE 125% BELOW THE FEDERAL POVERTY LEVEL. THE COMMUNITY NEED INDEX FOR FAIRFIELD COUNTY, WHERE DILEY RIDGE IS LOCATED, IS A WEIGHTED AVERAGE OF 2.4 ON A SCALE OF 1-5, WITH 1 BEING AN AREA OF LOW NEED AND 5 AN AREA WITH THE HIGHEST LEVEL OF NEED.DILEY RIDGE ALSO SERVES PATIENTS FROM THE ADJACENT FRANKLIN COUNTY. BY 2020, CENTRAL OHIO'S POPULATION IS EXPECTED TO EXPERIENCE A HIGH GROWTH RATE (18%) IN ADULTS AGE 55 AND OLDER AND A SLIGHT DECLINE IN ADULTS BETWEEN THE AGES OF 18 AND 34. IN 2016, APPROXIMATELY 38% OF THE POPULATION OVER AGE 25 HELD A BACHELOR'S OR HIGHER DEGREE, FIVE AND A HALF PERCENTAGE POINTS HIGHER THAN THE NATIONAL AVERAGE. CENTRAL OHIO FEATURES A DIVERSE EMPLOYER BASE, INCLUDING MANUFACTURING, TRADE, EDUCATION, SERVICE, FINANCE AND AGRICULTURE. THE OHIO UNEMPLOYMENT RATE WAS 5.4% IN AUGUST 2017, WHILE THE AUGUST 2017 UNEMPLOYMENT RATES FOR FRANKLIN COUNTY WAS 4.3% AND 4.4% FOR FAIRFIELD COUNTY. THE LEADING INDUSTRIES IN FAIRFIELD COUNTY ARE FINANCIAL SERVICES, INFORMATION SERVICES, CONSTRUCTION, EDUCATION AND HEALTH SERVICES. THERE IS ONE OTHER ADULT HOSPITAL SYSTEM IN THE AREA AND ONE INCOME-BASED CLINIC. PART VI, LINE 5: OTHER INFORMATION - DILEY RIDGE CONTRIBUTED TO THE ECONOMIC AND CIVIC HEALTH OF THE SURROUNDING COMMUNITY BY SERVING ON AND LENDING THEIR EXPERTISE TO SEVERAL CHAMBERS OF COMMERCE AND OTHER CIVIC ORGANIZATIONS, BOTH IN THE CITY OF CANAL WINCHESTER AND IN SURROUNDING SUBURBS. DILEY RIDGE LEADERS HAVE IDENTIFIED COMMUNITY NEEDS THROUGH THEIR SERVICE ON VARIOUS COMMUNITY BOARDS AND ADVISORY GROUPS. LEADERS ADVOCATED ON HEALTH ISSUES IN THE AREA AND OFFERED FINANCIAL SUPPORT FOR COMMUNITY HEALTH EVENTS AND PROGRAMS.DILEY RIDGE LEADERSHIP MEMBERS SERVE ON A NUMBER OF BOARDS FOR COMMUNITY AGENCIES AND SERVICE ORGANIZATIONS INCLUDING: THE NEW HORIZONS YOUTH & FAMILY SERVICES BOARD OF DIRECTORS, CENTRAL OHIO TRAUMA SYSTEM BOARD OF DIRECTORS, VIOLET TOWNSHIP PORT AUTHORITY, CANAL WINCHESTER ROTARY, AND THE PICKERINGTON FOOD BANK FUND RAISING COMMITTEE. DILEY RIDGE LEADERSHIP HOLDS REGULAR MEETINGS WITH LOCAL EMERGENCY MEDICAL SERVICE PROVIDERS TO DISCUSS HOW THE MEDICAL CENTER CAN BEST MEET THE NEEDS OF THE COMMUNITY. DILEY RIDGE MAINTAINS AN OPEN MEDICAL STAFF - MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS. ALL SURPLUS REVENUES ARE REINVESTED INTO SUPPORTING THE HOSPITAL'S HEALTH CARE MINISTRY. THE NEARLY 50,000-SQUARE-FOOT MEDICAL OFFICE BUILDING IS HOME TO BOTH PRIMARY CARE AND SPECIALTY PHYSICIANS, AND IS SEAMLESSLY INTEGRATED AND CONNECTED TO THE EMERGENCY CENTER BY AN ENCLOSED WALKWAY. THE BUILDING ALSO INCLUDES A NATIONWIDE CHILDREN'S HOSPITAL CLOSE TO HOME CENTER, PROVIDING PEDIATRIC URGENT CARE, LABORATORY AND RADIOLOGY SERVICES. PART VI, LINE 6: DILEY RIDGE MEDICAL CENTER IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - SPECIFIC COMMUNITY HEALTH AND WELL-BEING GOALS. IN FISCAL YEAR 2017, GOALS INCLUDED 1) PARTICIPATING IN LOCAL COALITION AND ADVOCACY EFFORTS AIMED AT CURBING TOBACCO USE AND PREVENTING OBESITY, 2) ASSESSING CAPACITY TO IDENTIFY AND SUPPORT INDIVIDUALS THAT ARE HOUSING INSECURE AND ACKNOWLEDGING OTHER BARRIERS INDIVIDUALS HAVE ACCESSING HEALTH CARE AND 3) EXPANDING ACCESS AND DELIVERY OF DIABETES PREVENTION PROGRAM. TRINITY HEALTH ACKNOWLEDGES THE IMPACT SOCIAL DETERMINANTS SUCH AS ADEQUATE HOUSING, SAFETY, ACCESS TO FOOD, EDUCATION, INCOME, AND HEALTH COVERAGE HAVE ON THE HEALTH OF THE COMMUNITY. IN FISCAL YEAR 2016, TRINITY HEALTH LAUNCHED THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), AWARDING EIGHT COMMUNITIES FUNDING TO IMPROVE THE HEALTH AND WELL-BEING OF THEIR COMMUNITIES IN PARTNERSHIP WITH THE LOCAL TRINITY HEALTH MEMBER HOSPITAL. THE AWARDED COMMUNITIES FOCUS ON POLICY, SYSTEM, AND ENVIRONMENTAL CHANGES THAT SPECIFICALLY IMPACT COMMUNITY IDENTIFIED NEEDS AND THAT WILL REDUCE CHILDHOOD OBESITY AND YOUTH TOBACCO USE. IN FISCAL YEAR 2017, TRINITY HEALTH INVESTED $2.7 MILLION IN TCI.AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO OUR COMMUNITIES THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND VULNERABLE, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND DEVELOPING PROGRAMS AND POLICIES TO SPECIFICALLY SUPPORT VULNERABLE POPULATIONS. ANNUALLY, THE ORGANIZATION INVESTS OVER $1.1 BILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING THE SPECIFIC NEEDS OF EACH COMMUNITY.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI LINE 7: OH X X 1 1 0 0 0 0 0 0 0 C BRETT JUSTICE DIRECTOR; V CHAIR; VP STRATEGY 0 232334 0 17870 0 19999 0 16726 0 19485 0 306414 0 0 MELISSA FLEMING DIRECTOR; MCHS ASSOCIATE COUNSEL 0 189977 0 14286 0 407 0 13186 0 19823 0 237679 0 0 MICHAEL WILKINS DIRECTOR, PRES & CEO MC EAST 0 324794 0 55076 0 49541 0 59126 0 16559 0 505096 0 0 EDWARD LAMB MOUNT CARMEL HEALTH SYS CEO AT 11/16 0 91169 0 50000 0 9438 0 20552 0 1283 0 172442 0 0 DANIEL POWELL MOUNT CARMEL HEALTH SYS INTERIM CFO 0 243692 0 0 0 0 0 10302 0 0 0 253994 0 0 KEITH COLEMAN FORMER OFFICER 0 183776 0 89583 0 295581 0 191498 0 20690 0 781128 0 0 RICHARD O'CONNELL FORMER KE;TRINITY EVP EAST THR 11/16 0 878773 0 258051 0 408585 0 11925 0 35437 0 1592771 0 112018 JACQUELINE PRIMEAU FORMER OFFICER; TRINITY VP M&A 0 271215 0 20510 0 2654 0 15900 0 14687 0 324966 0 0 MONICA TREINISH FORMER OFFICER;DIR PATIENT CARE SVCS 107770 0 20714 0 0 0 6570 0 2962 0 138016 0 0 0 CLAUS VON ZYCHLIN FORMER OFFICER; CONSULTANT 0 425410 0 196060 0 344631 0 755351 0 32317 0 1753769 0 0 JODI WILSON FORMER OFF; VP PATIENT CARE SVCS/CNO 0 202981 0 15621 0 1208 0 10276 0 8294 0 238380 0 0 PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2016. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEITH COLEMAN - $239,563 CLAUS VON ZYCHLIN - $179,938 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNTS, WHICH WERE UNPAID AS OF 12/31/16: KEITH COLEMAN - $189,998 (PAID IN 2017) CLAUS VON ZYCHLIN - $743,426 ($615,576 PAID IN 2017 AND $127,850 TO BE PAID IN 2018) THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2016. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2016, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2016. THE FOLLOWING PAYOUTS FOR 2016 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEITH COLEMAN - $51,124 RICHARD O'CONNELL - $221,949 CLAUS VON ZYCHLIN - $143,771 THE FOLLOWING ACCRUALS FOR 2016 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: EDWARD LAMB - $20,417 MICHAEL WILKINS - $47,628 THE FOLLOWING IS A PARTICIPANT IN A TRINITY HEALTH RESTORATION OR RETENTION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($265,000 FOR 2016). THE FOLLOWING PAYOUT FOR 2016 FOR THESE PLANS IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: RICHARD O'CONNELL - $121,018 COLUMN (F) OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. FORM 990, PART VI, SECTION A, LINE 6 DILEY RIDGE MEDICAL CENTER (DILEY RIDGE) IS A MEMBERSHIP CORPORATION WITH TWO MEMBERS: MOUNT CARMEL HEALTH SYSTEM WITH A 70% MEMBERSHIP INTEREST, AND FAIRFIELD MEDICAL CENTER WITH A 30% MEMBERSHIP INTEREST. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A THE TWO MEMBERS OF DILEY RIDGE HAVE THE RIGHT TO ELECT THE BOARD OF DIRECTORS. MOUNT CARMEL HEALTH SYSTEM HAS THE RIGHT TO APPOINT FOUR DIRECTORS, AND FAIRFIELD MEDICAL CENTER HAS THE RIGHT TO APPOINT TWO DIRECTORS. TWO DIRECTORS ARE APPOINTED ON AN EX OFFICIO BASIS AND ARE NOT ENTITLED TO VOTE: THE FIRST BEING THE CURRENT PRESIDENT OF DILEY RIDGE, THE SECOND BEING THE CURRENT CHIEF OF STAFF OF THE MEDICAL STAFF OF DILEY RIDGE. FORM 990, PART VI, SECTION A, LINE 7B SUBJECT TO A MEMBERS AGREEMENT AND THE CODE OF REGULATIONS, THE MEMBERS MUST APPROVE ANY CHANGES IN GOVERNING DOCUMENTS, THE ADMISSION OF ADDITIONAL MEMBERS, THE APPOINTMENT OR REMOVAL OF THE PRESIDENT OR CEO OF DILEY RIDGE MEDICAL CENTER, ANY CHANGE IN THE NAME OF THE CORPORATION OR CHANGE IN THE HOSPITAL NAME IT OPERATES, DISSOLUTION OR LIQUIDATION OF THE CORPORATION, AND THE SALE OR TRANSFER OF A MEMBER INTEREST. MOUNT CARMEL HEALTH SYSTEM MAY EXCLUSIVELY INITIATE OR IMPLEMENT THE FOLLOWING ACTIONS: THE INCURRENCE OF LONG OR SHORT TERM DEBT IN EXCESS OF ESTABLISHED LIMITS, PURCHASE, SALE, LEASE OR DISPOSITION OF REAL PROPERTY, APPROVAL OF ANNUAL CAPITAL PLAN, OPERATING BUDGET AND DISTRIBUTION PLAN OF THE CORPORATION, AND APPOINTMENT AND REMOVAL OF THE INDEPENDENT AUDITOR. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR DILEY RIDGE IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM WERE REVIEWED AT THE BOARD OF DIRECTORS MEETING ON MARCH 21, 2018. EACH MEMBER OF THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C DILEY RIDGE HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF DILEY RIDGE MEDICAL CENTER, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF DILEY RIDGE AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF DILEY RIDGE (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO DILEY RIDGE OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF DILEY RIDGE (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF DILEY RIDGE. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15A QUESTION 15A IS ANSWERED "YES" BECAUSE THE COMPENSATION OF THE CEO OF DILEY RIDGE IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. IN ESTABLISHING CEO COMPENSATION, THE BOARD OF DIRECTORS OF DILEY RIDGE UTILIZES COMPARABLE MARKET DATA PROVIDED BY THE HUMAN RESOURCES DEPARTMENT OF MOUNT CARMEL HEALTH SYSTEM IN ITS EVALUATION AND DETERMINATION OF COMPENSATION. THIS PROCESS IS PERFORMED ANNUALLY. QUESTION 15B IS ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF DILEY RIDGE IS ESTABLISHED BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING THESE EXECUTIVES' COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THESE EXECUTIVES OF DILEY RIDGE ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 DILEY RIDGE IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, DILEY RIDGE INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE AS WELL AS MOUNT CARMEL HEALTH SYSTEM'S WEBSITE (WWW.MOUNTCARMELHEALTH.COM). FORM 990, PART XI, LINE 9: DISTRIBUTION TO MEMBER HOSPITALS -12,500,000. FORM 990, PART XII, LINE 2: DILEY RIDGE MEDICAL CENTER'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY17 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BETHLEHEM HAVEN OF PITTSBURGH 905 WATSON STREET PITTSBURGH PA 15219 251436685 HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 BRIGHTSIDE INC 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA ST COHOES NY 12047 141701597 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 CARING PARTNERS HOME HEALTH INC 1200 EARHART RD ANN ARBOR MI 48105 201681131 HOME HEALTH SERVICES MI 501(C)(3) LINE 10 GLACIER HILLS INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 HEALTH CARE SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA MI 48152 GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM VT 501(C)(3) LINE 1 N/A 0 COLUMBUS ACQUISITION CORP 111 CENTRAL AVENUE NEWARK NJ 07102 262616342 INACTIVE ENTITY NJ 501(C)(3) LINE 10 SAINT MICHAEL'S MEDICAL CENTER 1 CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY MI 48098 383320699 HOSPICE SERVICES MI 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES 1 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HEALTH CARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 0 DUBUQUE MERCY HEALTH FOUNDATION 250 MERCY DRIVE DUBUQUE IA 52001 262227941 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 EAST NORRITON PHYSICIANS SERVICES INC ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 232515999 HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC 1 EMBRACING AGE INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT NY 13214 461051881 PACE PROGRAM NY 501(C)(3) LINE 10 ST JOSEPH'S HEALTH INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 FARREN CARE CENTER INC 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042501711 LONG TERM CARE MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL 1 GLACIER HILLS FOUNDATION 1200 EARHART RD ANN ARBOR MI 48105 208072723 FOUNDATION MI 501(C)(3) LINE 12A, I GLACIER HILLS INC 1 GLACIER HILLS INC 1200 EARHART RD ANN ARBOR MI 48105 381891500 SENIOR LIVING COMMUNITY MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 GLEN EDDY INC 1 GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 20555 VICTOR PARKWAY LIVONIA MI 48152 421253527 HEALTH CARE 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