2016-11-15T13:38:42-06:00 2015-12-31 351178661 Blue & Co LLC 8800 Lyra Drive Suite 450 Columbus OH 43240 990 2015-01-01 344429514 Van Wert County Hospital Association VANW 4192388609 1250 South Washington Street Van Wert OH 45891 MICHAEL T HOLLIDAY VICE PRESIDENT 4192388609 2016-11-09 1 Nancy Kirchner P00386751 6148852583 2016-11-09 2015 2017-02-10 21:41:12Z MICHAEL T HOLLIDAY 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 50230595 0 X www.vanwerthospital.org X 1905 OH PROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTINGS AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER. 14 12 584 186 0 0 220147 212580 43984724 43787453 4195933 3495908 2744069 2722457 51144873 50218398 0 0 0 0 19216428 21761966 0 0 0 25185001 27445846 44401429 49207812 6743444 1010586 97529892 94520077 11899484 12429789 85630408 82090288 X Van Wert County Hospital will meet the community health care needs by continually endeavoring to improve the quality of patient care we provide within our resource capabilities. Programs and services sponsored by the Van Wert County Hospital will serve as an access point to health care within our community. We accept responsibility for providing community leadership. Van Wert County Hospital assures that health care services provided are available to all members of the communities we serve regardless of race, creed, sex, national origin, or ability to pay, while at the same time respecting both the rights and responsibilities of our patients. 0 0 5298765 7755095 Inpatient Patient Care Services 19808255 24179462 Outpatient Patient Care Services 9760805 6413356 Emergency Room Patient Care Services 6158537 6158537 41026362 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 82 0 584 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X Michael Holliday 4192388609 1250 South Washington Street Van Wert OH 45891 MARK MINICK CEO 40.00 X 541105 0 19868 Jennifer Hohman MD Physician 40.00 X 200715 0 23946 Jon Bagley Trustee 2.00 X 0 0 0 Barb Kohnen Chairperson 2.00 X X 0 0 0 Andy Czajkowski Trustee 2.00 X 0 0 0 Eric Jelinger MD Trustee 2.00 X 0 0 0 Todd Wolfrum Trustee 2.00 X 0 0 0 Aaron Mechling Trustee 2.00 X 0 0 0 Mike Keysor Trustee 2.00 X 0 0 0 Gary Clay Vice Chairperson 2.00 X X 0 0 0 Bashar Hamdi MD Trustee 2.00 X 0 0 0 Tim Jurczyk Secretary 2.00 X X 0 0 0 Chuck Koch Trustee 2.00 X 0 0 0 Thomas Conte MD Physician 40.00 X 280092 0 20904 Charles Hoehn MD Physician 40.00 X 255488 0 17842 Scott Jarvis MD Physician 40.00 X 194690 0 15554 Michael Holliday VP Fiscal & Admin Services 40.00 X 234314 0 8480 Jerry Sell MD Physician 40.00 X 399984 0 1992 Jocelyn Wray MD Physician 40.00 X 155316 0 23853 Jianming Han MD Physician 40.00 X 178741 0 18344 2440445 0 150783 10 0 1 0 THERAPY SOLUTIONS 120 W MAIN STREET VAN WERT OH 45891 PHYSICAL THERAPY SERVICES 1673170 siemens medical solutions usa 51 valley stream parkway malvern PA 19355 information systems 611901 PHOENIX PHYSICIANS 3114 CROADSDAILE DRIVE SUITE 200 DURHAM NC 27705 ER PHYSICIAN SERVICES 581089 Weigand Construction 7808 Honeywell Ft Wayne IN 46825 Construction Services 504638 West Central Ohio Hospital Consortium 4197 Fulton Rd Suite C Canton OH 44718 MRI Services 407173 14 212580 212580 PATIENT SERVICE REVENUE 900099 43787453 43787453 43787453 139030 139030 3356878 0 3356878 3356878 3356878 23933 12197 11736 11736 Misc 900099 2322182 2322182 nutrition 900099 254842 254842 Wellness Programs 900099 131208 131208 2489 2489 2710721 50218398 46495685 0 3510133 X 15343081 11660742 3682339 6418885 4878353 1540532 669690 669690 12646921 12646921 20548 18082 2466 5364864 4077297 1287567 380441 311962 68479 51378 15413 35965 130669 99308 31361 2119558 1610864 508694 142937 131502 11435 miscellaneous 4219217 3206605 1012612 Bad Debt Expense 1699623 1699623 49207812 41026362 8181450 0 1904 38474 967624 3113902 24493 8978 3923975 5046337 693878 595115 630307 554708 63298266 46301109 17185471 16997157 67639650 62437367 6462590 5728039 97529892 94520077 6370701 7418631 4436983 4011451 1002270 874234 89530 125473 11899484 12429789 X 81995205 78313766 188997 153717 3446206 3622805 85630408 82090288 97529892 94520077 1010586 -4550706 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1441 1441 0 Part II-B, Line 1: 3.6% of dues paid to the ohio hospital association that is used for political purposes. 8378579 176554 -84547 160748 44818 8265020 8263214 44140 302638 187515 43898 8378579 7628802 1365 781521 111189 37285 8263214 6717856 86376 1031004 172628 33806 7628802 6894036 690 55154 205252 26772 6717856 0.56000 0.44000 0 0 943059 943059 29515751 22978675 6537076 32713495 23322434 9391061 125961 125961 16997157 debt issuance cost, net 38432 investment in joint ventures 912448 other assets 1590466 ASSETS WHOSE USE IS LIMITED 2908419 Estimated Third-Party Settlements 278274 5728039 interest rate swap 33036 ESTIMATED LIABILITY CLAIMS 54005 DEBT ISSUANCE COST 38432 125473 X Part V, Line 4: THE INVESTMENT INCOME GENERATED BY THE ENDOWMENT FUNDS DISTRIBUTED TO THE HOSPITAL IS ABLE TO BE USED FOR GENERAL OPERATING AND CAPITAL EQUIPMENT NEEDS. Part X, Line 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2015 AND 2014, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. X GOLF OUTING 23933 23933 1250 3146 7801 23933 23933 1250 3146 7801 12197 11736 1 1 1 X 1 X 1 1 0 1 1 441 51028 51028 0.00100 11955 7136941 2600344 4536597 0.09220 264 237861 102418 135443 0.00280 12660 7425830 2702762 4723068 0.09600 1693 73457 4380 69077 0.00140 35 30 83 0 83 0.00000 20213 0 20213 0.00040 1758 93753 4380 89373 0.00180 14418 7519583 2707142 4812441 0.09780 1 1699623 15689579 25522513 -9832934 X 1 1 1 Van Wert Medical Services Medical Professional Services 1.00000 2 Sarah Jane Living Center Long Term Alzheimer's Care 0.50000 3 Home Health Care Solutions Home Healthcare Services 0.50000 4 Therapy Solutions Physical Therapy Solutions 0.50000 5 Community Care Systems Managed Care Contracting 0.50000 0.50000 6 DELPHOS REAL ESTATE LLC REAL ESTATE 0.50000 7 CONVOY HEALTH FACILITIES LLC HEALTH FACILITY 0.50000 8 WEST CENTRAL OHIO HOSPITAL CONSORTIUM LTD HEALTHCARE FACILITIES 0.33330 9 NEW VISION MEDICAL LABORATORIES LLC MEDICAL LABORATORIES 0.20000 1 1 VAN WERT COUNTY HOSPITAL 1250 washington street van wert OH 45891 X X X THE VAN WERT COUNTY HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 13 1 0 1 1 X http://www.vanwerthospital.org X 1 13 1 http://www.vanwerthospital.org 0 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X 1 X http://vanwerthospital.org/patients/patient-financial-services X http://vanwerthospital.org/patients/printable-forms 1 0 X X X X 1 X 0 0 THE VAN WERT COUNTY HOSPITAL ASSOCIATION Part V, Section B, Line 5: The project was conducted as a joint effort including the Center for Social Research at Indiana University-Purdue University Fort Wayne(IPFW), the Van Wert County Health Department, Van Wert County Hospital, Van Wert County Family and Childrens First Council, Family Healthcare of Northwest Ohio, Village of Ohio City, Van Wert City Schools, Crestview Local Schools, and Lincolnview Local Schools. The Center for Social Research utilized the Total Design Method research methodology, which is a methodology consisting of a mailed survey approach that resulted in a 40.31% response rate. The Van Wert County Health Collaborative was formed to review, plan and implement strategies to address the community health needs identified as a result of the assessment. This Collaborative consisted of 47 community leaders representing 38 community agencies. Throughout the process, the National Association of City County Health Officer's strategic planning tool, Mobilizing for Action through Planning and Partnerships was used. THE VAN WERT COUNTY HOSPITAL ASSOCIATION Part V, Section B, Line 6b: The Center for Social Research at Indiana University, Purdue University Fort Wayne (IPFW) and the Van Wert County Health Department. THE VAN WERT COUNTY HOSPITAL ASSOCIATION Part V, Section B, Line 11: Adult Keys Issues not selected: Access to Care--data supporting concern is lacking, outside scope of collaborative, too costly to address. Mental Health--managed by Westwood Behavioral Health and primary care docs, ties in to substance abuse efforts in plan. Chronic Disease--will be impacted by action plan steps towards obesity. Homelessness and unemployment--lack opf concrete data, Local One Stop agency deals with unemployment, otherwise not in our scope. Cardiovascular Disease--will be impacted by action plan steps towards obesity. Domestic Violence--addressed by Westwood Behavioral Health and courts. Youth Issues not selected--Mental Health--community partnerships already in place with mental health agency, health department, and schools. Parenting/Brken Family--Schools working with Lima agency for screening and assistance. Bullying--many programs in place locally to address through grants, behavioral health agency,and schools. Teen Parenting--local progams already exist. Poverty/Hunger--local programs already exist. Driving Safety--lack of data to act upon. Booster Seat Use--health department and hospital provide safety checks and reduced cost car seats. Access to Dental--current moble dental unit comes to Family Health Care Clinic infrequently, Family Health Care Clinic looking for funding to address issue, hospital considering how it may join to provide assistance with this issue over it's next planning cycle. 2 1 - SARAH JANE LIVING CENTER 328 W 2ND ST DELPHOS OH 45833 LONG TERM ALZHEIMERS CARE 2 - VANCREST OF CONVOY 510 TULLY DR CONVOY OH 45832 LONG TERM NURSING CARE Part I, Line 3c: THE ORGANIZATION USED THE FPG TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. Part I, Line 7: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. Part I, Ln 7 Col(f): The Association provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Association does not pursue collection of amounts determined to qualify as charity, such amounts are not reported as revenue. Bad debts are shown as an expense valued as revenue not received and written off as revenue. Management estimates an allowance for doutful accounts based upon factors unique to the Association's operations. Part II, Community Building Activities: THE COUMADIN THERAPY CLINIC IS SLATED TO BE OPERATTIONAL DECEMBER 1 HELPING PATIENTS Manage THE MEDICATION AND UNDERLYING CONDITIONS THEY HAVE. DENTAL CARE FOR THE UNINSURED AND UNDERINSURED IS A MAJOR NEED IN THE COMMUNITY. THE HOSPITAL IS DEVELOPING A DENTAL CLINIC TO MEET THESE NEEDS AND ALLOW paTIENTS TO RECEIVE APPROPRIATE TREATMENt IN AN APPROPRIATE CARE SETTING. CURRENTLY, MANY OF THESE PATIENTS SEEK TREATMENT FOR THEIR CONDITIONS THROUGH THE EMERGENCY ROOM.THE HOSPITAL ALSO PARTICIPATES IN INITIATIVES WITH OTHER PROVIDERS AND AFFILIATES IN PROVISION OF SERVICES AND/OR DONATIONS. THE PROVISIONS OF LOW COST HEALTH SCREENING SERVICES IN COLLABORATION WITH OTHER ORGANIZATIONS HELP US IDENTIFY CONDITIONS ON A PROACTIVE BASIS TO BETTER IMPROVE OUR CITIZEN'S HEALTH OR MANAGEMENT OF CHRONIC DISEASES. THE CO-ORDINATION OF CARE THROUGH OUR HOME HEALTH REHABILITATIVE AND LONG TERM CARE PROVIDERS SERVE TO BETTER MEET THE NEEDS OF OUR PATIENTS AND POPULATION. OUR REGIONAL LABORATORY INITIATIVE HAS SHORTENED TURNAROUND TIME FOR TESTS AND HAS LOWERED COST TO OUR PATIENTS. THE HOSPITAL ALSO PARTICIPATES IN ECONOMIC DEVELOPMENT EFFORTS THROUGH ITS MEMBERSHIP IN THE CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS. Part III, Line 4: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. Part III, Line 8: THE ORGANIZATION DOES NOT CONSIDER THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. Part III, Line 9b: FOLLOWING THE GUIDELINES AND PROCESSES AS INDICATED IN QUESTION 3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE, THE ORGANIZATION APPROPRIATELY IDENTIFIES ACCOUNTS AS TO THE TYPE OF ASSISTANCE QUALIFIED FOR. THE AMOUNTS ELIGIBLE FOR ASSISTANCE ARE WRITTEN OFF TO THE APPROPRIATE PROGRAM AND COLLECTION ACTIVITY CEASES IN REGARD TO THOSE AMOUNTS. THE GOAL OF THE ORGANIZATION'S POLICIES IS TO INDENTIY ACCOUNTS ELIGIBLE FOR ASSISTANCE AND BRING THE ACCOUNT TO AN APPROPRIATE CONCLUSION AS EARLY IN THE BILLING CYCLE AS POSSIBLE. Part VI, Line 2: THE ORGANIZATION USES A VARIETY OF METHODS TO ASSESS HEALTH CARE NEEDS. DATA PROVIDED BY THE STATE OF OHIO IS USED TO DETERMINE EPIDEMIOLOGIES RELATED TO CHRONIC CONDITIONS AND CANCER REGISTRIES PROVIDING PREVALENCE. INTERNAL DATA IS ALSO USED AS WELL AS INPUT FROM OTHER PROVIDERS. THE HOSPITAL ALSO USES PATIENT ORIGIN DATA PROVIDED BY THE OHIO HOSPITAL ASSOCIATION TO DETERMINE CURRENT TREATMENT PATTERNS AND DIAGNOSIS FOR CURRENT RESIDENTS BEING TREATED IN VAN WERT COUNTY HOSPITAL AND OTHER SURROUNDING PROVIDERS. THE HOSPITAL ALSO SPONSORS A NUMBER OF HEALTH FAIRS/ASSESSMENTS TO BOTH ADULT AND PEDIATRIC POPULATIONS OF VAN WERT THAT IS ALSO EXAMINED FOR FREQUENCY AND NEEDS. A NUMBER OF STAFF AS WELL AS BOARD OF TRUSTEES MEMBERS ALSO SERVED ON COMMUNITY HEALTH PROVIDER BOARDS AND PROVIDE INPUT TO THE PLANNING PROCESS.THE HOSPITAL PARTICIPATED IN A Community-WIDE HEALTH CARE NEEDS ASSESSMENT PROJECT WITH COLLABORATING AGENCIES WITHIN THE AREA. AS A RESULT OF THIS EFFORT, OBESITY AND SUBSTANCE ABUSE ARE THE NEEDS IDENTIFIED BY THE COALITION THAT WILL HAVE THE FOCUS OF ATTENTION OF PROGRAMS AND SERVICES TO IMPROVE THE COMMUNITY IN THESE AREAS. THE HOSPITAL IS ALSO SUBSCRIBED TO A NUMBER OF BENCHMARKING ORGANIZATIONS THAT PROVIDE BEST OF INDUSTRY APPLICATIONS TO ASSESS METHODOLOGIES FOR TREATING OUR RESIDENTS. Part VI, Line 3: Patient education of eligibility for assistance begins at the patient access to care areas. Informational signage is posted in all patient access areas identifying financial assistance programs and instructions of how to seek out these programs. Similar information is also found in patient informational brochures provided to patients prior to the rendering of care based upon the type of care being provided. Also, available at all patient access points are the patient financial assistance brochure.Patient registration staff at all patient access points are trained in the patient financial assistance programs available at the hospital. They become a valuable resource to patients directing them to the programs they may qualify for and the process with which to seek the appropriate assistance.The hospital utilizes the hospital website as an on-line and technologically current source of financial assistance information for patients that prefer finding educational information in this format. Financial assistance programs, policies, eligibility criteria, and on-line applications for the various programs are available.Patient billing statements provide another avenue for educating patients as to financial assistance programs available and how to contact the hospital to determine eligibility. This information is located on the back of each billing statement received by the patient.The existence of a financial counselor in the patient accounting function is another mechanism utilized in educating patients regarding financial assistance available for hospital services. All uninsured or self-pay potential accounts are identified to the financial counselor upon patient registration. Patients may be contacted upon completion of services. All patients that were not contacted upon completion of services receive a financial assistance application through the mail that includes information regarding all financial assistance programs. The counselor provides follow-up and assistance to identify the patient with the appropriate financial assistance program. Part VI, Line 4: Van Wert County Hospital is located in the rural county of Van Wert, Ohio that boarders the Indiana state line along Allen County Indiana. Our primary service area comprises Van Wert and some portions of Paulding, Putnam and Mercer Counties. Ohio numerically this breaks down to approximately 50,000 residents in our primary market area. The hospital is located within the city of Van Wert, which possesses a population of 10,700. Our population is predominantly white (97.1%) with Hispanic (1.9%) a mix of minorities comprise the remainder. Van Wert is rural in nature with employment not only in agricultural services but also in the manufacturing and service sector. Our county has seen increased unemployment due to the loss of manufacturing jobs related to the auto sector. The unemployment rate and the Affordable Care Act has increased the number of citizens covered under the Medicaid program and qualifying for the hospital's charity care program as well as increasing Bad Debt ( 4.6% of the population is below FPG). Like many Midwest communities the region is experiencing aging populations of 19.6% over 65 and 28.9% 45-64 according to the 2010 census. The hospital also has facilities in the communities of Convoy and Delphos providing long term care to these groups. Behavioral risk factors include (Behavioral Risk Survey) smoking (19.8%), alcohol abuse (16%) and obesity at (36.3%) these behavioral risk factors influence the incidence of chronic diseases we treat. Part VI, Line 5: The Van Wert County Hospital Association Board of Trustees is comprised of volunteers from our community. The majority of these members live and work within the community and are involved with other non-profit agencies. Senior leadership also lives in the primary service area. This "spirit" of community based healthcare resides in our Board of Trustees and is further evidenced by our open medical staff. The accommodation of specialty services not currently present in our area being provided through a Specialty Clinic of the hospital which include Neurology, Neurosurgery, Immunology, and ENT services. The hospital associated personnel also sit on other community based governance boards (United Way, American Red Cross, Chamber of Commerce, Wright State University Regional Campus, Public Access television, American Cancer Society & Van Wert Economic Development to name a few). Through physician recruitment we have brought in a number of new specialties including obstetrics and additional laparoscopic surgical procedures. We also provide a loan forgiveness program for residents interested in becoming physicians and returning to our area. Our Wellness Center provides health, education, and social programs for targeted populations. We have joined a Regional Stroke Network as well as participating in a number of patient and educational support groups (Better Breathers, Stroke Support Group, Better Parenting). The hospital also participates in health professions educational programs. A number of our physicians provide training for senior medical students through the Lima Area Health Education Committee. A number of nursing educational program use our hospital to do their clinical rotations. The hospital on average spends in excess of 1 million dollars in new diagnostic technologies and other health related equipment to better diagnose and treat our clients. 1 X X X X X X 0 1 0 0 0 0 0 0 0 MARK MINICK CEO 541105 0 0 0 0 0 0 0 19868 0 560973 0 0 0 Jennifer Hohman MD Physician 200715 0 0 0 0 0 0 0 23946 0 224661 0 0 0 Thomas Conte MD Physician 280092 0 0 0 0 0 0 0 20904 0 300996 0 0 0 Charles Hoehn MD Physician 255488 0 0 0 0 0 0 0 17842 0 273330 0 0 0 Scott Jarvis MD Physician 194690 0 0 0 0 0 0 0 15554 0 210244 0 0 0 Michael Holliday VP Fiscal & Admin Services 234314 0 0 0 0 0 0 0 8480 0 242794 0 0 0 Jerry Sell MD Physician 399984 0 0 0 0 0 0 0 1992 0 401976 0 0 0 Jocelyn Wray MD Physician 155316 0 0 0 0 0 0 0 23853 0 179169 0 0 0 Jianming Han MD Physician 178741 0 0 0 0 0 0 0 18344 0 197085 0 0 0 Part I, Line 4b MARK MINICK - SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN - ACTUARIAL DETERMINED CATCH UP ANNUAL FUNDING FOR PLAN BENEFIT UNDER TERMS OF INCENTIVE AGREEMENT - $0 A county of van wert ohio 2009-10-29 10755255 finance acquisition, construction, & equipping of hospital facilities 0 0 0 A 10755255 57604 10697651 2010 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 1 First Financial Bank 4.800000000000 0 0 0 0 0 A 0 Aaron Mechling Hospital Board of Trustee Member and Partner in Kaiser Mechling Group Hospital maintains investment account with Kaiser Mechling Group as represe 0 Jon Bagley Hospital Board of Trustee Member and Operations Officer for Joint Venture P Hospital and Vancrest Health System are involved in several joint venture c 0 Form 990, Part VI, Section A, line 6 ANY PERSON, AGE 18 OR OLDER AND RESIDING IN VAN WERT COUNTY HOSPITAL'S GEOGRAPHIC SERVICE AREA, WHO SHALL HAVE CONTRIBUTED THE SUM OF ONE DOLLAR OR MORE TO THE ASSOCIATION DURING THE CALENDAR YEAR, SHALL BE A MEMBER. A CONTRBUTION OF TWENTY-FIVE DOLLARS AT ANY TIME SHALL CONSTITUTE A LIFE MEMBERSHIP. Form 990, Part VI, Section A, line 7a THE BOARD OF TRUSTEES SHALL BE ELECTED BY THE MEMBERS OF THE ASSOCIATION AT THE REGULAR ANNUAL MEETING. ONE SHALL BE APPOINTED BY THE VAN WERT COUNTY board of commissioners. Form 990, Part VI, Section A, line 7b SUBJECT TO THE ARTICLES OF INCORPORATION AND THIS CODE OF REGULATIONS, EACH MEMBER OF THE ASSOCIATION IN GOOD STANDING SHALL BE QUALIFIED TO VOTE ON ANY ISSUES THAT MAY PROPERLY COME BEFORE ANY MEETING OF THE MEMBERS OF THE ASSOCIATION. Form 990, Part VI, Section B, line 11 THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. The audit committee reviews and approves the 990. It is then presented to the full board during a regularly scheduled board meeting. Form 990, Part VI, Section B, line 12c The written conflict of interest policy is regularly and consistently monitored by the Chairperson of the Board of Trustees and the President & CEO. The scope of this policy includes all staff and Board of Trustees members. A conflict of interest questionnaire is completed on an annual basis and reviewed by the Executive Committee. Any issues that arise are addressed with the individual at that point. Any issues that arise thoughout the year are dealt with as necessary. This may involve declaring the conflict of interest and abstaining from discussion or a vote on specific topics. This could also take the form of recusing oneself from part or a whole meeting as necessary and required depending upon the topic for discusion and/or action. Form 990, Part VI, Section B, line 15 The compensation committee contracts with an outside, independent firm to provide a compensation study and evaluation. THE COMMITTEE THEN USES THE RESULTS OF THE STUDY IN CONSULTATION WITH THE COMPENSATION FIRM AND THEN COMPENSATION PHILOSOPHY POLICY TO MAKE COMPENSATION DECISIONS. the last compensation review was performed in july, 2012. Form 990, Part VI, Section C, line 19 There is an annual report prepared that includes a statement of operations. Form 990, Part IX, line 11g purchased services: Program service expenses 12,646,921. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,646,921. 990T in the past the organization has filed a 990-T, however, this organization is no longer required to file that form as it has no unrelated business income to report. Van Wert Medical Services 140 Fox Road Van Wert OH 45891 202812541 Medical Professional Services OH 0 1831460 Wholly Owned SARAH JANE LIVING CENTER 1250 S Washington St van wert OH 45891 311684009 Long Term Alzheimers Care OH N/A RELATED 64982 150132 0 0 0.50000 Home Health Care Solutions 1250 S Washington St van wert OH 45891 200330544 Home Health Care solutions OH N/A RELATED 107254 176141 0 0 0.50000 Therapy Solutions 1250 S Washington St van wert OH 45891 201417403 Physical Therapy Services OH N/A RELATED 89703 452500 0 0 0.50000 Community Care Systems Inc 1250 S Washington St van wert OH 45891 341783212 HEALTHCARE MANAGEMENT SERVICES OH N/A C 5676 0.50000 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0