2016-11-12T00:24:23-06:00 2015-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE STE 4200 INDIANAPOLIS IN 462045108 990 2015-01-01 382796005 EMMA L BIXBY MEDICAL CENTER EMMA 5172650133 818 RIVERSIDE AVE ADRIAN MI 492211488 MICHAEL P BROWNING TREASURER 5172650133 2016-11-12 1 SHAWNA M JIMENEZ P01222873 3174648600 2015 2017-02-10 21:41:12Z PROMEDICA BIXBY HOSPITAL MICHAEL P BROWNING 1801 RICHARDS ROAD TOLEDO OH 43607 135828628 0 X WWW.PROMEDICA.ORG X 1989 MI EMMA L. BIXBY MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT PROVIDES HEALTHCARE SERVICES PRIMARILY TO INDIVIDUALS OF LENAWEE COUNTY. 19 14 790 150 0 0 347775 576749 76689998 79644931 2513312 2325883 1857045 1465860 81408130 84013423 3228227 1797355 0 0 39726463 41180024 0 0 0 35692427 36429203 78647117 79406582 2761013 4606841 122711993 123948879 26275825 25885847 96436168 98063032 X EMMA L. BIXBY MEDICAL CENTER IS DEDICATED TO IMPROVING HUMAN LIFE AND DEVOTED TO THE PATIENTS AND FAMILIES WE SERVE THROUGH INNOVATIVE CARE, SUPERIOR QUALITY AND PREMIER CUSTOMER SERVICE. 0 0 64502356 1797355 80241637 EMMA L. BIXBY MEDICAL CENTER IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. - SEE SCHEDULE O. 4822236 CONSISTENT WITH OUR MISSION, EMMA L. BIXBY MEDICAL CENTER PROVIDES A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO PATIENTS WITH LIMITED OR NO ABILITY TO PAY. - SEE SCHEDULE O. 57126 CONSISTENT WITH OUR MISSION, EMMA L. BIXBY MEDICAL CENTER PROVIDES A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT INCLUDING COMMUNITY HEALTH IMPROVEMENT SERVICES AND HEALTH PROFESSIONS EDUCATION. - SEE SCHEDULE O. 69381718 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 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 1 1 1 1 0 0 1 79 0 1 790 1 0 0 0 0 0 0 0 0 0 0 X 19 14 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 1 0 X BRIAN HANSEN 4198918505 5901 MONCLOVA RD MAUMEE OH 43537 ABDUL G ARSHAD MD FACS TRUSTEE 1.00 41.00 X 0 365876 30370 STACEY L BOCK TRUSTEE 1.00 41.00 X 0 206864 29996 MARCY L BROWN EX OFFICIO 1.00 1.00 X 0 0 0 CARLTON L COOK MD TRUSTEE 1.00 1.00 X 0 0 0 PATRICK D FARVER TRUSTEE 1.00 1.00 X 0 0 0 L CHARLES FORCE TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL R HERR DVM TRUSTEE 1.00 1.00 X 0 0 0 JEFFREY A KUHMAN TRUSTEE 1.00 1.00 X 0 0 0 ANDRES LOPEZ TRUSTEE 1.00 1.00 X 0 0 0 BARBARA A MITZEL TRUSTEE 1.00 1.00 X 0 0 0 SAMANTHA M MUCHA MD TRUSTEE 1.00 41.00 X 0 542988 29411 WILLIAM B NOE TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL R OLSAVER TRUSTEE 1.00 1.00 X 0 0 0 JAMES D PHILP TRUSTEE 1.00 1.00 X 0 0 0 ALAN H SNIDER DO TRUSTEE 1.00 1.00 X 0 0 0 ROBERT L VOGEL TRUSTEE 1.00 1.00 X 0 0 0 PAUL R WALKER MD TRUSTEE 1.00 1.00 X 0 0 0 KEVIN C WEBB PHD EX OFFICIO 1.00 52.00 X 0 658740 115301 KATHLEEN S WESTFALL TRUSTEE 1.00 1.00 X 0 0 0 TIMOTHY J JAKACKI PRESIDENT, EX OFFICIO (THRU 8/15) 40.00 1.00 X X 0 405745 300645 JULIE K YAROCH DO PRESIDENT, EX OFFICIO 40.00 3.00 X X 0 224191 34283 EMORY M SCHMIDT CHAIRPERSON 1.00 9.00 X X 0 0 0 ALAN M SATTLER TREASURER 0.50 51.50 X 0 588758 120076 JEFFREY C KUHN SECRETARY 0.50 51.50 X 0 592348 112234 GARY AKENBERGER SR. VP FINANCE, PHS 0.50 45.00 X 0 415589 89075 KATHRYN GREENLEE VP CLINICAL SERVICES, LHA 40.00 0.50 X 0 175716 45457 MARY ABRAHAM PHARMACIST 40.00 0.00 X 117520 0 31970 JENNIFER FOSS MANAGER, PHARMACY 40.00 0.00 X 121490 0 7698 MATTHEW HAMMOND ASSOCIATE VP, OPERATIONS 40.00 0.00 X 122134 0 17551 RENEE LUKAS COORD., CLINICAL PHARMACY 40.00 0.00 X 113079 0 9274 MELISSA THOMPSON PHARMACIST 40.00 0.00 X 111921 0 13140 KATHLEEN S HANLEY FORMER OFFICER 0.00 41.00 X 0 696193 166986 586144 4873008 1153467 7 1 1 0 BIXBY ANESTHESIA ASSOCIATES PC 102 E MAUMEE ST ADRIAN MI 49221 ANESTHESIA SERVICES 1129000 HMP OF LUCAS COUNTY 5410 MARYLAND WAY SUITE 300 BRENTWOOD TN 37027 HOSPITALIST SERVICES 1081728 MARK LEVINE MD 200 CURTIS RD 2ND FLOOR ADRIAN MI 49221 PHYSICIAN SERVICES 683573 WSB REHABILITATION SERVICE 510 W MAIN ST CANFIELD OH 44406 THERAPY SERVICES 513108 OMNI HEALTH SERVICES LTD 1650 EBER RD HOLLAND OH 43528 PHYSICIAN SERVICES 439000 13 127451 436398 12900 576749 NET PATIENT SERVICES 622110 76997847 76997847 RESIDENT SERVICES FEES 623110 2258275 2258275 AFFIL. ORG. RENT REV. 531120 388809 388809 79644931 803903 803903 45289 45289 199390 189507 9883 9883 9883 53106678 41000 51621289 4409 1485389 36591 1521980 1521980 EHR INCENTIVE 900099 888003 888003 DIETARY AND CAFETERIA 722514 285283 285283 SCHOOL PHYSICALS 900099 97512 97512 139890 139890 1410688 84013423 80241637 0 3195037 1797355 1797355 31482046 27704200 3777846 1008155 887176 120979 5960199 5244975 715224 2729624 2402069 327555 134544 134544 95795 95795 12946 12946 268168 268168 6521530 6128282 393248 200331 8013 192318 892861 687503 205358 2359353 2359353 2330426 2260513 69913 180547 86663 93884 436560 436560 4121507 3668141 453366 1232960 1097334 135626 MEDICAL SUPPLIES 6997295 6997295 DRUGS 4814627 4814627 INTERCOMPANY SERVICES 3805342 3386754 418588 FOOD 554381 510031 44350 1470030 1264227 205803 79406582 69381718 10024864 0 12544914 13038385 10781200 10463000 1132175 955681 425913 457530 101224945 76209033 24869773 25015912 61959428 66339047 4153304 1383790 6845286 6295534 122711993 123948879 7212643 6471859 19063182 19413988 26275825 25885847 X 91445790 93096551 3562072 3579701 1428306 1386780 96436168 98063032 122711993 123948879 X 4606841 -2990125 10148 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12946 12946 0 PART II-B, LINE 1: EMMA L. BIXBY MEDICAL CENTER PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE MICHIGAN HOSPITAL ASSOCIATION - A PORTION OF WHICH IS ALLOCABLE TO LOBBYING BY THE ASSOCIATIONS. 1428306 -41526 1386780 1436934 -8628 1428306 1391000 26281 19653 1436934 1391000 1391000 1391000 1391000 0.36050 0.63950 0 1 1 955610 955610 26219090 17773419 8445671 322248 304495 17753 3359293 3190475 168818 70368704 54940644 15428060 25015912 DUE FROM AFFILIATES 1277629 BENEFICIAL INTEREST IN FOUNDATION 4892615 DEFERRED COSTS 109186 OTHER RECEIVABLES 16104 6295534 DUE TO AFFILIATES 2478241 ASBESTOS REMEDIATION 1479690 ESTIMATED THIRD PARTY SETTLEMENTS PAYABLE 4325859 INTERCOMPANY DEBT TO THE TOLEDO HOSPITAL 11130198 19413988 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT EMMA L. BIXBY MEDICAL CENTER CONSISTENT WITH DONOR INTENT. PART X, LINE 2: EMMA L. BIXBY MEDICAL CENTER IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES (PHS). THE FOLLOWING REFLECTS PHS'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740. EXCEPT AS NOTED BELOW, PHS DID NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, A TAXABLE SUBSIDIARY OF PHS RECOGNIZED A LIABILITY FOR UNCERTAIN TAX POSITIONS OF $0 AND $9,027,000, RESPECTIVELY. EMMA L. BIXBY MEDICAL CENTER DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. 1 1 X 1 X 1 X 1 1 1 0 1 1 821410 821410 0.01020 17150066 13151125 3998941 0.04970 6790 4905 1885 0.00000 17978266 13156030 4822236 0.05990 13344 13344 0.00020 43782 43782 0.00050 57126 57126 0.00070 18035392 13156030 4879362 0.06060 1 4321316 608260 23267386 26749653 -3482267 X 1 1 1 BIXBY MEDICAL OFFICE LIMITED PARTNERSHIP FACILITY LEASING 0.64600 0.19870 2 LENAWEE PHYSICIAN HOSPITAL ORGANIZATION LLC PHYSICIAN MGMT. SERVICES 0.50000 0.01490 0.48020 3 HERRICK MEMORIAL OFFICE PLAZA CONDO ASSOCIATION FACILITY SUPPORT 0.71800 0.28200 1 1 EMMA L BIXBY MEDICAL CENTER 818 RIVERSIDE AVE ADRIAN MI 49221 WWW.PROMEDICA.ORG 1060000004 X X X EMMA L BIXBY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X WWW.PROMEDICA.ORG/CHNA X 1 13 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 X X X 1 X 0 X X X X X 1 X 0 0 EMMA L. BIXBY MEDICAL CENTER PART V, SECTION B, LINE 5: EMMA L. BIXBY MEDICAL CENTER (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 OR EXPERTISE IN PUBLIC HEALTH. THESE PERSONS INCLUDED STAFF OF LENAWEE COUNTY HEALTH DEPARTMENT, LENAWEE UNITED WAY, AND VARIOUS, LOCAL HOSPITAL STAFF INVOLVED IN COMMUNITY HEALTH PROGRAMMING. THE HOSPITAL FACILITY CONSULTED WITH THESE PERSONS THROUGH MEETINGS AND ALSO VIA EMAIL CORRESPONDENCE.ADDITIONALLY, THE HOSPITAL FACILITY CONSULTED WITH OTHER ORGANIZATIONS AND OTHER GROUPS IN CONDUCTING ITS MOST RECENT CHNA. THESE CONSULTING INDIVIDUALS REPRESENTED THE FOLLOWING ORGANIZATIONS:- PROMEDICA HERRICK HOSPITAL- LENAWEE UNITED WAY - LENAWEE COUNTY HEALTH DEPARTMENT- COMMUNITIES IN SCHOOLS- CATHOLIC CHARITIES- YMCA OF LENAWEE COUNTY- GOODWILL INDUSTRIES OF SOUTHEASTERN MICHIGAN- LENAWEE EMERGENCY AND AFFORDABLE HOUSING CORPORATION (LEAHC)- LENAWEE GREAT START- LENAWEE COUNTY MENTAL HEALTH ASSOCIATION- FAMILY COUNSELING AND CHILDREN'S SERVICES EMMA L. BIXBY MEDICAL CENTER PART V, SECTION B, LINE 11: EMMA L. BIXBY MEDICAL CENTER WILL SPECIFICALLY IMPLEMENT PROGRAMS TO ADDRESS THE FOLLOWING HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - CANCER- CARDIOVASCULAR HEALTH- MARIJUANA AND OTHER DRUG USEACTIONS TAKEN DURING 2015 TO ADDRESS THE ABOVE IDENTIFIED NEEDS ARE INCLUDED BELOW:HEALTH NEED IDENTIFIED: CANCERSTRATEGY #1 - GRANDPARENT CARDS FROM THE AMERICAN CANCER SOCIETY TO BE DISTRIBUTED TO CHILDREN, ASKING THEM TO REMIND THEIR GRANDPARENTS TO GET COLONOSCOPIES. ACTIONS TAKEN:- GRANDPARENT CARDS WERE NOT RECEIVED FROM THE AMERICAN CANCER SOCIETY AND THEREFORE NOT AVAILABLE FOR DISTRIBUTION.STRATEGY #2 - ANNUALLY PROVIDE A FREE SKIN CANCER SCREENING, DEPENDENT UPON AVAILABILITY OF DERMATOLOGIST COMMITMENT. ACTIONS TAKEN:- PROVIDED ANNUAL FREE SKIN CANCER SCREENING. THE NUMBER OF RESIDENTS PARTICIPATING IN PREVENTIVE SCREENINGS WAS 60.STRATEGY #3 - MONTHLY MAN TO MAN MEETINGS, A PROSTATE CANCER EDUCATION AND SUPPORT PROGRAM. ACTIONS TAKEN:- HELD MONTHLY MAN TO MAN MEETINGS, A PROSTATE CANCER EDUCATION AND SUPPORT PROGRAM. NUMBER OF RESIDENTS PARTICIPATING IN SUPPORT PROGRAMS WAS 133.STRATEGY #4 - PARTICIPATION IN COMMUNITY EVENTS, INCLUDING RELAY FOR LIFE, RALLY FOR THE CURE, PROJECT CONNECT, WELLNESS FAIR, AND THE WOMEN'S HEALTH EVENT. ACTIONS TAKEN:- PARTICIPATED IN COMMUNITY EVENTS, INCLUDING RELAY FOR LIFE, RALLY FOR THE CURE, PROJECT CONNECT, WELLNESS FAIR, AND THE WOMEN'S HEALTH EVENT. NUMBER OF RESIDENTS PARTICIPATING IN THESE COMMUNITY EVENTS WAS 918.STRATEGY #5 - PARTICIPATION IN THE LOOK GOOD, FEEL BETTER PROGRAM, IN COLLABORATION WITH THE AMERICAN CANCER SOCIETY (ACS). (THIS STRATEGY WILL BE MAINTAINED AS LONG AS FUNDING AND ADVERTISING IS AVAILABLE FROM ACS.)ACTIONS TAKEN:- PARTICIPATED IN THE LOOK GOOD, FEEL BETTER PROGRAM, IN COLLABORATION WITH THE AMERICAN CANCER SOCIETY. THE NUMBER OF RESIDENTS PARTICIPATING IN THESE QUARTERLY EVENTS WAS 8. HEALTH NEED IDENTIFIED: CARDIOVASCULAR HEALTHSTRATEGY #1 - MONTHLY GLUCOSE SCREENINGS/EDUCATION EVENTS TO BE HELD. ACTIONS TAKEN: - THE NUMBER OF RESIDENTS RECEIVING GLUCOSE SCREENING STICKS WAS 244. 100 OF THESE WERE AT THE "ALL ABOUT WOMEN" EVENT AND AN ESTIMATED 144 WERE AT SENIOR FAIRS HELD IN ADRIAN AND ADVERTISED IN THE LENAWEE COUNTY PAPER AND ON THE LOCAL NEWS BROADCAST IN BOTH ADRIAN AND TECUMSEH.STRATEGY #2 - SEMIANNUAL BLOOD PRESSURE SCREENINGS/EDUCATION TO BE HELD AT COMMUNITY EVENTS. ACTIONS TAKEN: - THE NUMBER OF RESIDENTS PARTICIPATING IN BLOOD PRESSURE SCREENING EDUCATION EVENTS WAS 105.STRATEGY #3 - SEMIANNUAL CARDIAC REHABILITATION EDUCATION AT COMMUNITY EVENTS. ACTIONS TAKEN:- THE NUMBER OF EDUCATIONAL OPPORTUNITIES HELD IN THE COMMUNITY REGARDING CARDIOVASCULAR REHABILITATION TOTALED 4 EVENTS HELD IN LENAWEE COUNTY. HEALTH NEED IDENTIFIED: MARIJUANA AND OTHER DRUG USESTRATEGY #1 - HOST A DRUG ENFORCEMENT AGENCY DRUG TAKE BACK DAY ANNUALLY.ACTIONS TAKEN:- TWO (2) DRUG ENFORCEMENT AGENCY DRUG TAKE BACK DAYS WITH 439 POUNDS OF PRESCRIPTION DRUGS AND 646 GALLONS OF SHARPS DISPOSED OF LEGALLY AND RESPONSIBLY. STRATEGY #2 - PROVIDE PRESCRIPTION DRUG MISUSE EDUCATION AT A COMMUNITY EVENT TWICE PER YEAR. ACTIONS TAKEN: - PROVIDED PRESCRIPTION DRUG MISUSE EDUCATION AT TWO (2) COMMUNITY EVENTS. THE NUMBER OF PARTICIPANTS AT THE TWO EDUCATION EVENTS WAS NOT TRACKED; HOWEVER, APPROXIMATELY 9,600 NARCOTIC TABLETS WERE COLLECTED AT BOTH EVENTS, ONE HELD IN MAY 2015 AND ONE IN SEPTEMBER 2015.EMMA L. BIXBY MEDICAL CENTER DID NOT ADDRESS ALL OF THE SPECIFIC NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AS THESE AREAS EITHER ARE ADDRESSED DURING PHYSICIAN VISITS, GO BEYOND THE SCOPE OF THE HOSPITAL, OR ARE BEING ADDRESSED BY, OR WITH, OTHER ORGANIZATIONS IN THE COMMUNITY. ALTHOUGH PROMEDICA PHYSICIANS AND OTHER PROGRAMS ADDRESS THE HEALTH NEEDS OF PATIENTS AS NEEDED, THE NEEDS SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS PLAN, INCLUDE (*INDICATES PROMEDICA PARTICIPATES IN COMMUNITY OUTREACH PROGRAMS ADDRESSING THESE ISSUES):- HEALTH STATUS - ADDRESSED AT PHYSICIAN VISITS; LENAWEE HEALTH NETWORK*- HEALTH CARE COVERAGE - PARAMOUNT HEALTH CARE*- HEALTH CARE ACCESS - LENAWEE COUNTY HEALTH DEPARTMENT- CANCER - ADDRESSED AT PHYSICIAN VISITS; AMERICAN CANCER SOCIETY RELAY FOR LIFE*- ASTHMA - ADDRESSED AT PHYSICIAN VISITS- WEIGHT STATUS - ADDRESSED AT PHYSICIAN VISITS; LENAWEE HEALTH NETWORK*- TOBACCO USE - ADDRESSED AT PHYSICIAN VISITS; PROMEDICA TOBACCO TREATMENT CENTERS; LENAWEE COUNTY HEALTH DEPARTMENT TOBACCO REDUCTION COALITION- ALCOHOL CONSUMPTION- SUBSTANCE/DRUG USE - ADDRESSED AT PHYSICIAN VISITS; LENAWEE HEALTH NETWORK*; LENAWEE COUNTY HEALTH DEPARTMENT SUBSTANCE ABUSE PREVENTION COALITION- WOMEN'S HEALTH - ADDRESSED AT PHYSICIAN VISITS; WIC NUTRITION; BREASTFEEDING EDUCATION*; BREAST AND CERVICAL CARE PROJECT*; LENAWEE COUNTY HEALTH DEPARTMENT MATERNAL INFANT HEALTH PROGRAM- MEN'S HEALTH - ADDRESSED AT PHYSICIAN VISITS- MENTAL HEALTH - ADDRESSED AT PHYSICIAN VISITS- PREVENTIVE MEDICINE AND HEALTH SCREENINGS - PROMEDICA FLU CLINICS; ADDRESSED AT PHYSICIAN VISITS- SEXUAL BEHAVIOR AND PREGNANCY OUTCOMES - ADDRESSED AT PHYSICIAN VISITS; LENAWEE COUNTY HEALTH DEPARTMENT HIV/AIDS TESTING AND FAMILY PLANNING CLINIC- PERCEIVED QUALITY OF LIFE - THE LENAWEE COMMUNITY FOUNDATION- SOCIAL CONTEXT AND SAFETY- MENTAL HEALTH AND SUICIDE - ADDRESSED AT PHYSICIAN VISITS, YELLOW RIBBON TRAINING FOR TEENS; PARENT MANAGEMENT TRAINING - OREGON MODEL; - ORAL HEALTH - PARENTING - LENAWEE COMMUNITY MENTAL HEALTH AUTHORITY - PARENTING SKILL BUILDING FOR PARENTS WITH MENTAL ILLNESS (OR CHILD WITH SEVERE EMOTIONAL DISTUBANCE); LENAWEE GREAT START PARENT COALITION* - YOUTH INITIATIVES - LENAWEE COMMUNITY FOUNDATION - LENAWEE YOUTH COUNCIL; YOUTH LEADERSHIP SUMMER DAY CAMP; IMAGINATION LIBRARY (FREE BOOKS); WEEKEND SNACK SACKS*; LENAWEE COLLEGE ACCESS NETWORK; BOYS & GIRLS CLUBS TRIPLE PLAYTO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESSALL OF THE NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOSTIMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OFRESOURCES MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITYORGANIZATIONS AND COALITIONS. EMMA L. BIXBY MEDICAL CENTER PART V, SECTION B, LINE 16I: THE HOSPITAL FACILITY WAS IN THE PROCESS OF REVISING ITS FINANCIAL ASSISTANCE POLICY DURING TAX YEAR 2015 AND UPDATING ITS PROCEDURES. AS OF APRIL 2016, THE HOSPITAL FACILITY'S POLICIES AND PROCEDURES WERE REVISED TO INCLUDE THE FOLLOWING MEASURES TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY: - THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/FINANCIALASSISTANCE- THE FAP WAS WIDELY AVAILABLE UPON REQUEST AND WITHOUT CHARGE (IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL)- NOTICE OF AVAILABILITY OF THE FAP WAS CONSPICUOUSLY DISPLAYED THROUGHOUT THE HOSPITAL FACILITY. EMMA L. BIXBY MEDICAL CENTER PART V, SECTION B, LINE 20E: 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 IN ORDER TO ASSIST WITH QUALIFYING FOR FINANCIAL ASSISTANCE. EMMA L. BIXBY MEDICAL CENTER PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED THE LOOK-BACK METHOD WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE LOOK-BACK METHOD IS BASED ON PAST CLAIMS PAID IN FULL TO THE HOSPITAL BY MEDICARE-FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL FACILITY OVER A SPECIFIED 12-MONTH PERIOD, DIVIDED BY THE GROSS CHARGES FOR THOSE CLAIMS. EMMA L. BIXBY MEDICAL CENTER: PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/FINANCIALASSISTANCEEMMA L. BIXBY MEDICAL CENTER:PART V, SECTION B, LINE 16C: A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/FINANCIALASSISTANCE EMMA L. BIXBY MEDICAL CENTER: PART V, SECTION B, LINE 20B: A PATIENT FINANCIAL ADVOCATE (PFA) ISASSIGNED TO EACH PATIENT WHO HAS BEEN ADMITTED TO THE HOSPITAL FACILITY TO NOTIFY THE INDIVIDUAL OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE. 11 1 - HICKMAN CANCER CTR 777 KIMOLE LANE SUITE 130 ADRIAN MI 49221 CANCER CARE 2 - WOLF CREEK 901 KIMOLE LANE ADRIAN MI 49221 LAB 3 - SPORTSCARE AT ADRIAN 1136 COUNTRY CLUB RD SUITE A ADRIAN MI 49221 PHYSICAL THERAPY 4 - BLISSFIELD HEALTH CTR 157 WEST BROOKE LANE BLISSFIELD MI 49228 LAB 5 - PROMEDICA HUDSON HEALTH CTR 458 CROSS STREET HUDSON MI 49247 LAB 6 - MONROE CANCER CENTER 800 STEWART RD MONROE MI 48162 CANCER SUPPORT 7 - TOTAL REHAB AT ONSTED 400 N MAIN STREET SUITE B ONSTED MI 49265 PHYSICAL THERAPY 8 - PROMEDICA RADIOLOGY 770 RIVERSIDE AVE ADRIAN MI 49221 RADIOLOGY 9 - PROMEDICA HUDSON HEALTH CTR 458 CROSS STREET HUDSON MI 49247 RADIOLOGY 10 - BLISSFIELD HEALTH CTR 157 WEST BROOKE LANE BLISSFIELD MI 49228 RADIOLOGY 11 - PROMEDICA OCCUHEALTH 1801 W MAUMEE ST STE 140 ADRIAN MI 49221 OCCUPATIONAL MEDICINE PART I, LINE 6A: EMMA L. BIXBY MEDICAL CENTER REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE PROMEDICA HEALTH SYSTEM, INC. ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: EMMA L. BIXBY MEDICAL CENTER 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: EMMA L. BIXBY MEDICAL CENTER'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: EMMA L. BIXBY MEDICAL CENTER 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 15 AND 16 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS. 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.EMMA L. BIXBY MEDICAL CENTER USED THE MEDICARE ALLOWABLE COSTS PER ITS 2015 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 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. IN ADDITION, PROMEDICA STRATEGIC PLANNING CONTINUES TO DEVELOP PATIENT-CENTERED, INTEGRATED CLINICAL SERVICE LINES INCLUDING CANCER, CARDIOVASCULAR, ORTHOPAEDICS 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: EMMA L. BIXBY MEDICAL CENTER, LOCATED IN ADRIAN, MI, SERVES AN AREA PRIMARILY AROUND LENAWEE COUNTY WITH A POPULATION OF APPROXIMATELY 91,000. APPROXIMATELY, 17% OF THE SERVICE AREA IS AGE 65 OR OVER; 40% IS BETWEEN AGE 35 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $47,000; 48% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER; 53% OF HOUSEHOLDS HAVE AN INCOME OF $50,000 OR LESS. LENAWEE COUNTY HAS A POPULATION OF APPROXIMATELY 90,000 WITH APPROXIMATELY 14% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 16% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 16% OF LENAWEE COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE AT THE END OF 2015 FOR LENAWEE COUNTY WAS 8.8%. THE LEADING CAUSES OF DEATH IN THE SERVICE AREA, BASED ON AGE ADJUSTED MORTALITY RATES ARE LUNG DISEASE, DIABETES, CANCER, AND HEART DISEASE. ACCORDING TO THE 2015 COUNTY HEALTH RANKINGS, LENAWEE COUNTY RANKED 24 OF 83 COUNTIES FOR HEALTH OUTCOMES, 23 OF 83 FOR MORTALITY, AND 12 OF 83 FOR MORBIDITY. THERE ARE FIFTEEN HOSPITALS WITHIN A SIX COUNTY AREA AROUND ADRIAN, HERRICK MEMORIAL HOSPITAL, INC., HILLSDALE COMMUNITY HEALTH CENTER, UNIVERSITY OF MICHIGAN, ALLEGIANCE HEALTH, FULTON COUNTY HEALTH CENTER, COMMUNITY HOSPITALS AND WELLNESS CENTERS - ARCHBOLD, FLOWER HOSPITAL, ST. ANNE MERCY HOSPITAL, THE TOLEDO HOSPITAL, ST. VINCENT MERCY MEDICAL CENTER, ST. CHARLES MERCY HOSPITAL, BAY PARK COMMUNITY HOSPITAL, UNIVERSITY OF TOLEDO MEDICAL CENTER, ST. LUKE'S HOSPITAL AND MERCY MEMORIAL HOSPITAL-MONROE. PART VI, LINE 5: EMMA L. BIXBY MEDICAL CENTER IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC. WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. - IN 2015, THERE WERE MORE THAN 500 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), INCLUDING ITS SUBSIDIARIES. OF THESE, 100% 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 80 PHYSICIANS, FROM NORTHWEST OHIO AND SOUTHEAST MICHIGAN. ADDITIONALLY, PROMEDICA BOARD MEMBERS INCLUDED 189 WOMEN AND 77 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. IN 2015, PROMEDICA BOARD MEMBERS GAVE MORE THAN 28,000 HOURS IN SERVICE TO THE ORGANIZATION, WHICH EQUATES TO AN ESTIMATED CONTRIBUTION OF MORE THAN $3 MILLION TO OUR COMMUNITIES.- 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.- A NEW FOOD PHARMACY PILOT LAUNCHED, SERVING PATIENTS AT THE ADULT MEDICINE CLINIC AT PROMEDICA'S CENTER FOR HEALTH SERVICES (CHS) AND THE WW KNIGHT FAMILY MEDICINE PRACTICE. THE PROGRAM REFERS PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY TO RECEIVE FOOD FOR THEMSELVES AND THEIR FAMILY FROM THE FOOD PHARMACY LOCATED ON THE FIRST FLOOR OF CHS. EACH PATIENT RECEIVES TWO TO THREE DAYS OF SUPPLEMENTAL FOOD FOR THEIR FAMILY. STARTING IN APRIL THROUGH DECEMBER 2015, APPROXIMATELY 1,400 REFERRALS WERE MADE TO THE FOOD PHARMACY, PROVIDING SUPPLEMENTAL FOOD TO MORE THAN 1,800 HOUSEHOLDS. - PROMEDICA OPENED THE EBEID INSTITUTE'S NEW MARKET ON THE GREEN TO PROVIDE BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. - PROMEDICA PROVIDED NEARLY 7,500 HEALTH SCREENINGS TO COMMUNITY MEMBERS THROUGHOUT 2015, 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. 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 2015, PROMEDICA WAS COMPRISED OF MORE THAN 17,000 EMPLOYEES, APPROXIMATELY 2,700 VOLUNTEERS AND MORE THAN 2,300 HEALTHCARE PROVIDERS, INCLUDING NEARLY 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; ST. LUKE'S HOSPITAL D/B/A PROMEDICA ST. LUKE'S 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, AND HOME CARE.- IN 2015, PROMEDICA MANAGED 4.7 MILLION PATIENT ENCOUNTERS AND CONTRIBUTED A TOTAL COMMUNITY BENEFIT OF NEARLY $199 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. - IN ADDITION, THE PROMEDICA ADVOCACY FUND ASSISTED LOCAL NONPROFIT AGENCIES WITH SIMILAR MISSIONS THROUGH GRANTS TOTALING NEARLY $315,000. AS IN PRIOR YEARS, EMPHASIS WAS PLACED ON ORGANIZATIONS WORKING TO PROVIDE BASIC NEEDS SERVICES SUCH AS CLOTHING, SHELTER AND FOOD AS THESE ARE TIED CLOSELY TO PROMEDICA'S MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITIES IT SERVES.- WITH REGARD TO HEALTH PROFESSIONS EDUCATION, BIWEEKLY, MONTHLY AND ANNUAL PROGRAMS WERE OFFERED THROUGHOUT 2015 FOR CONTINUING MEDICAL EDUCATION CREDIT. APPROXIMATELY 1,800 CREDIT HOURS OF PHYSICIAN EDUCATION WERE OFFERED. THERE WERE APPROXIMATELY 7,100 PHYSICIANS WHO PARTICIPATED IN EDUCATIONAL PROGRAMS, AND APPROXIMATELY 8,600 NON-PHYSICIANS (I.E., ALLIED HEALTH PROFESSIONALS).- PROMEDICA'S FOUNDATION RAISES FUNDS FOR PHILANTHROPY IN SUPPORT OF PROMEDICA'S MISSION TO IMPROVE HEALTH AND WELL-BEING. PROMEDICA FOUNDATION IS A SEPARATE PHILANTHROPIC ENTITY, AND 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. 1 PROMEDICA FOUNDATION 2042 N COVE BLVD TOLEDO OH 43606 311517672 501(C)(3) 254188 OPERATING GRANT PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 5855 MONROE ST SYLVANIA OH 43560 341880767 501(C)(3) 1008500 OPERATING GRANT MERCY MEMORIAL HOSPITAL CORPORATION 718 N MACOMB MONROE MI 48162 381984289 501(C)(3) 528000 OPERATING GRANT LENAWEE UNITED WAY 4224 W MAUMEE ADRIAN MI 49221 391598949 501(C)(3) 5000 CHARITABLE DONATION 4 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. 1 1 0 0 0 0 1 1 0 ABDUL G ARSHAD MD FACS TRUSTEE 0 258278 0 82896 0 24702 0 7364 0 23006 0 396246 0 0 STACEY L BOCK TRUSTEE 0 169805 0 34503 0 2556 0 10613 0 19383 0 236860 0 0 SAMANTHA M MUCHA MD TRUSTEE 0 540820 0 0 0 2168 0 7950 0 21461 0 572399 0 0 KEVIN C WEBB PHD EX OFFICIO 0 446920 0 200389 0 11431 0 101135 0 14166 0 774041 0 0 TIMOTHY J JAKACKI PRESIDENT, EX OFFICIO (THRU 8/15) 0 132603 0 134027 0 139115 0 280369 0 20276 0 706390 0 0 JULIE K YAROCH DO PRESIDENT, EX OFFICIO 0 223364 0 0 0 827 0 15799 0 18484 0 258474 0 0 ALAN M SATTLER TREASURER 0 405315 0 154161 0 29282 0 97575 0 22501 0 708834 0 0 JEFFREY C KUHN SECRETARY 0 396043 0 169512 0 26793 0 100167 0 12067 0 704582 0 0 GARY AKENBERGER SR. VP FINANCE, PHS 0 291582 0 84049 0 39958 0 67444 0 21631 0 504664 0 0 KATHRYN GREENLEE VP CLINICAL SERVICES, LHA 0 138462 0 31874 0 5380 0 30876 0 14581 0 221173 0 0 KATHLEEN S HANLEY FORMER OFFICER 0 456423 0 197040 0 42730 0 149277 0 17709 0 863179 0 0 PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF EMMA L. BIXBY MEDICAL CENTER, 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: TIMOTHY J. JAKACKI $93,632 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. PART I, LINE 6: CERTAIN LISTED PERSONS RECEIVED INCENTIVES BASED ON INDIVIDUAL PRODUCTIVITY NET EARNINGS. PART I, LINE 7: A HIGHEST COMPENSATED EMPLOYEE RECEIVED A DISCRETIONARY BONUS BASED ON EXCEPTIONAL PERFORMANCE. FORM 990, PART VI, SECTION A, LINE 6 AS A MICHIGAN 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 EMMA L. BIXBY MEDICAL CENTER. AS THE MEMBER, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF EMMA L. BIXBY MEDICAL CENTER, AND (B) FILL ANY VACANCY ON THE BOARD OF TRUSTEES. 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 11 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 CERTIFICATION STATEMENT WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER CERTIFICATION STATEMENTS ARE COMPILED AND 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 CERTIFICATION STATEMENTS (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 FILE THE CERTIFICATION STATEMENT, OR THE FILING OF A FALSE OR INCOMPLETE CERTIFICATION STATEMENT, 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 CERTIFICATION STATEMENT 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, 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 PPG PHYSICIAN WEBSITE (I.E., WWW.PPGDOCS.ORG) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. FORM 990, PART VI, SECTION B, LINE 15 EMMA L. BIXBY MEDICAL CENTER'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF EMMA L. BIXBY MEDICAL CENTER'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 XI, LINE 9: PENSION/POST-RETIREMENT EXPENSE ADJUSTMENT 34,045. BENEFICIAL INTEREST IN FOUNDATION -23,897. FORM 990, PART IV, LINE 24A: EMMA L. BIXBY MEDICAL CENTER IS A HEALTH FACILITY THAT IS A SUBSIDIARY OF PROMEDICA HEALTH SYSTEM, INC. (PHS). EMMA L. BIXBY MEDICAL CENTER HOLDS AN INTERCOMPANY NOTE PAYABLE TO THE TOLEDO HOSPITAL, WHICH IS ALSO A SUBSIDIARY OF PHS. THE NOTE PAYABLE REPRESENTS EMMA L. BIXBY MEDICAL CENTER'S PORTION OF TAXABLE AND TAX-EXEMPT BONDS ISSUED BY PROMEDICA HEALTHCARE OBLIGATED GROUP. FORM 990, PART VI, SECTION B, LINE 16B: JOINT VENTURE OPERATING AGREEMENTS INVOLVING PROMEDICA HEALTH SYSTEM, INC. OR ITS SUBSIDIARIES (COLLECTIVELY, PHS) INCLUDE PROVISIONS TO PROTECT PHS'S TAX EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. PHS CONTINUALLY ENSURES THAT ITS TAX EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL PHS JOINT VENTURES. 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 27 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 2015 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 332 SITES, MORE THAN 2,300 PHYSICIANS AND APPROXIMATELY 17,000 EMPLOYEES AND VOLUNTEERS. DURING 2015, PROMEDICA DISCHARGED 82,132 INPATIENTS AND SERVED MORE THAN 1,535,310 OUTPATIENTS, WHILE HANDLING 350,316 EMERGENCY VISITS SYSTEM-WIDE. AMONG THE REGION'S LARGEST EMPLOYERS, PROMEDICA PLAYS A SIGNIFICANT ROLE IN ECONOMIC DEVELOPMENT AND STABILITY IN OUR REGION. DURING 2015, FOR EVERY ONE DOLLAR OF REVENUE, ANOTHER 43 CENTS WAS CREATED IN OUR SERVICE-AREA ECONOMY, WITH A TOTAL ECONOMIC OUTPUT OF $4.5 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 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 GOODS TO NUMEROUS LOCAL FOOD PANTRIES 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; MERCY MEMORIAL HOSPITAL CORPORATION, AND ST. LUKE'S HOSPITAL. IN 2015, 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 NEARLY 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 2015, PARAMOUNT ADVANTAGE PROVIDED MEDICAID COVERAGE TO MORE THAN 227,000 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 FLOWER HOSPITAL CAMPUS AND THE MARY ELLEN FALZONE DIABETES CENTER ON THE CAMPUS OF THE 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 MORE THAN 300 NONPROFIT AGENCIES AND ORGANIZATIONS ACROSS OUR REGION IN 2015 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 2015 INCLUDE THE FOLLOWING: - MERCY MEMORIAL HOSPITAL CORPORATION, IN MONROE, MICHIGAN, BECAME A MEMBER OF PROMEDICA EFFECTIVE JAN. 1, 2015. BY SHARING RESOURCES AND CLINICAL EXPERTISE, THIS NEW PARTNERSHIP HELPS BROADEN THE DEPTH AND BREADTH OF OUR SERVICES FOR RESIDENTS OF SOUTHEASTERN MICHIGAN. - PROMEDICA, ALONG WITH FIVE OTHER OHIO HOSPITALS, ESTABLISHED THE MIDWEST HEALTH COLLABORATIVE (MHC) TO IMPROVE THE VALUE OF HEALTHCARE SERVICES THROUGHOUT THE STATE. WHILE REMAINING INDEPENDENT, THESE SIX HEALTHCARE ORGANIZATIONS ARE WORKING TOGETHER TO ASSESS THE FEASIBILITY OF CREATING A STATEWIDE PROVIDER NETWORK, EXCHANGE BEST PRACTICES, SHARE RESOURCES, REDUCE COSTS, DEVELOP INNOVATIVE WAYS TO DELIVER HEALTH CARE ACROSS LARGE POPULATIONS, AND REDUCE CARE VARIATION. - IN 2015, PROMEDICA FINALIZED A COMPREHENSIVE AGREEMENT WITH THE UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE AND LIFE SCIENCES TO FORM AN ACADEMIC AFFILIATION WITH THE PURPOSE OF ADVANCING MEDICAL EDUCATION AND CLINICAL RESEARCH IN NORTHWEST OHIO. THE AFFILIATION WILL BUILD A LEGACY MODEL OF HEALTH CARE THAT WILL BENEFIT COMMUNITY MEMBERS ACROSS THE REGION FOR GENERATIONS TO COME. - PROMEDICA OPENED ITS FIRST URGENT CARE CENTERS IN OREGON AND PERRYSBURG, OHIO, TO SERVE PATIENTS WHO HAVE MEDICAL CONCERNS THAT DO NOT REQUIRE AN EMERGENCY CENTER. THE URGENT CARE CENTERS ARE OPEN 10 A.M. TO 10 P.M., 365 DAYS PER YEAR, AND ARE STAFFED BY HIGHLY-TRAINED CERTIFIED NURSE PRACTITIONERS. - PROMEDICA'S SUMMER YOUTH EMPLOYMENT PROGRAM PARTNERED 77 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. - AS CHILDHOOD OBESITY CONTINUES TO BE AN IMPORTANT ISSUE IN OUR COMMUNITIES, BAY PARK COMMUNITY HOSPITAL BEGAN PILOTING A NEW HEALTH AND NUTRITION PROGRAM TO CHILDREN IN GRADES 2 - 5 IN ITS SERVICE AREA. THE PROGRAM FEATURES A BOARD GAME DEVELOPED BY PROMEDICA CALLED NUTREXITY, WHICH OFFERS A FUN WAY FOR KIDS TO LEARN ABOUT HEALTH, INCLUDING GOOD NUTRITION, EXERCISE ESSENTIALS, AND THE IMPORTANCE OF GIVING BACK TO THE COMMUNITY. - PROMEDICA PHYSICIANS EXPANDED CARE TO BETTER COVER LOCAL AND RURAL COMMUNITIES, ADDING MORE THAN 100 NEW PRIMARY CARE PHYSICIANS, SPECIALISTS AND ADVANCED PRACTICE PROVIDERS IN 2015. - PROMEDICA PARTICIPATED IN DOZENS OF COMMUNITY HEALTH FAIRS THAT INCLUDED APPROXIMATELY 7,500 FREE PUBLIC SCREENINGS FOR HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, BODY MASS INDEX AND BONE DENSITY. - AS PART OF ITS HUNGER-FREE INITIATIVE, PROMEDICA CONTINUED TO IMPLEMENT A FOOD RECLAMATION PROGRAM. MORE THAN 160,000 POUNDS OF FOOD HAVE BEEN RECLAIMED FROM PARTNERS SUCH AS HOLLYWOOD CASINO, THE TOLEDO HOSPITAL, FLOWER HOSPITAL, FIFTH THIRD FIELD, AND OWENS COMMUNITY COLLEGE SINCE THE PROGRAM STARTED IN 2013. - PROMEDICA'S COME TO THE TABLE HUNGER SUMMIT TOOK PLACE IN ALBUQUERQUE, NEW MEXICO IN JUNE AS PART OF PROMEDICA'S EFFORTS TO RAISE AWARENESS OF HUNGER AS A HEALTH ISSUE. PRESENTED BY PROMEDICA, THE ALLIANCE TO END HUNGER, AND PRESBYTERIAN HEALTHCARE SERVICES, THE SUMMIT FEATURED PERSPECTIVES FROM AN ARRAY OF EXPERTS, INCLUDING A KEYNOTE ADDRESS BY AUDREY ROWE, ADMINISTRATOR FOR THE FOOD AND NUTRITION SERVICE AT THE U.S. DEPARTMENT OF AGRICULTURE. - 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 SKIN CANCER AND LUNG CANCER SCREENINGS WERE PROVIDED FOR EARLY DETECTION. PROSTATE CANCER SCREENING EDUCATION AND NUTRITIONAL PROGRAMS WERE DEVELOPED TO KEEP PEOPLE HEALTHY, AND A COLORECTAL CANCER EDUCATION EVENT TOOK PLACE AT HUNTINGTON CENTER. 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. - A NEW FOOD PHARMACY PILOT LAUNCHED, SERVING PATIENTS AT THE ADULT MEDICINE CLINIC AT PROMEDICA'S CENTER FOR HEALTH SERVICES (CHS) AND THE WW KNIGHT FAMILY MEDICINE PRACTICE. THE PROGRAM REFERS PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY TO RECEIVE FOOD FOR THEM AND THEIR FAMILY FROM THE FOOD PHARMACY LOCATED AT CHS. EACH PATIENT RECEIVES TWO TO THREE DAYS OF SUPPLEMENTAL FOOD FOR THEIR FAMILY. STARTING IN APRIL THROUGH DECEMBER 2015, APPROXIMATELY 1,400 REFERRALS WERE MADE TO THE FOOD PHARMACY, PROVIDING SUPPLEMENTAL FOOD TO MORE THAN 1,800 HOUSEHOLDS. - THROUGH ITS ADVOCACY FUND, PROMEDICA CONTINUED TO SUPPORT LOCAL COMMUNITY ORGANIZATIONS THAT PROVIDE ASSISTANCE TO THOSE IN NEED WITH BASIC NECESSITIES THAT DIRECTLY IMPACT INDIVIDUALS' HEALTH AND WELL-BEING. THIS SUPPORT AMOUNTED TO GRANTS TOTALING MORE THAN $315,000 IN 2015. - PROMEDICA AND THE AARP FOUNDATION (AARP'S AFFILIATED CHARITY) JOINED TOGETHER AS FOUNDING MEMBERS OF THE NEW NOT-FOR-PROFIT ORGANIZATION THE ROOT CAUSE COALITION. THE COALITION IS FOCUSED ON ADDRESSING HUNGER AS A PUBLIC HEALTH ISSUE AND OTHER SOCIAL DETERMINANTS OF HEALTH. - TO HELP MEET THE NEED FOR ADDITIONAL SCHOOL NURSES IN THE TOLEDO PUBLIC SCHOOL SYSTEM (TPS), PROMEDICA BEGAN FUNDING NINE ADDITIONAL SCHOOL NURSES, ENABLING ALL TPS ELEMENTARY SCHOOLS TO HAVE A FULL-TIME SCHOOL NURSE. STUDIES HAVE SHOWN THAT FULL-TIME NURSES IN PUBLIC SCHOOLS CAN HAVE A POSITIVE IMPACT ON HEALTH AND STRONG ACADEMIC OUTCOMES. OVER THE NEXT THREE YEARS, PROMEDICA AND TPS WILL TRACK AND EVALUATE STUDENT HEALTH STATISTICS TO DEVELOP A SUSTAINABILITY PLAN AND SUPPORT ONGOING FUNDING FOR THE PROGRAM. - PROMEDICA OPENED THE EBEID INSTITUTE'S NEW MARKET ON THE GREEN TO PROVIDE BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. THE INSTITUTE WAS MADE POSSIBLE THROUGH A GENEROUS DONATION FROM PROMEDICA BOARD MEMBER RUSSELL EBEID. - AFTER MORE THAN A YEAR OF PLANNING, BUILDING, TESTING AND TRAINING, PROMEDICA'S NEW ELECTRONIC HEALTH RECORD (EHR), EPIC, WENT LIVE WITH A SUCCESSFUL PILOT OF 20 PROMEDICA PHYSICIANS AND PROVIDERS. FOLLOWING EPIC'S METHODOLOGY, ADDITIONAL GO-LIVES ARE SCHEDULED THROUGH 2016 AND 2017 TO BRING ALL PROVIDERS, HOSPITALS AND SERVICES ON BOARD. THE NEW PLATFORM WILL FURTHER ENABLE ONE PATIENT, ONE RECORD, AND ONE BILL FOR PATIENTS REGARDLESS OF SERVICE PROVIDED OR THE LOCATION OF SERVICE ACROSS PROMEDICA. - TOLEDO AND TOLEDO CHILDREN'S HOSPITALS OPENED A NEW SURGERY SUITE TO INCREASE EFFICIENCY AND PROVIDE A BETTER EXPERIENCE FOR PATIENTS AND FAMILIES. IT INCLUDES 10 REPLACEMENT OPERATING ROOMS, LARGER PRE-OP AND RECOVERY AREAS, A NEW PEDIATRIC RECOVERY AREA, AND A NEW TEXT ALERT SYSTEM FOR WAITING FAMILIES. - IN COLLABORATION WITH HCR MANORCARE, THE NEW HEARTLAND AT PROMEDICA SKILLED NURSING AND REHABILITATION FACILITY OPENED ON THE CAMPUS OF FLOWER HOSPITAL. IT PROVIDES MEDICALLY COMPLEX AND INTENSIVE REHABILITATION SERVICES FOR SHORT-TERM PATIENTS TRANSITIONING BETWEEN HOSPITAL CARE AND HOME. - FLOWER HOSPITAL RADIOLOGY INSTALLED A NEW MRI SCANNER THAT PROVIDES INCREASED IMAGE RESOLUTION, RESULTING IN EXCELLENT IMAGE QUALITY AND PROVIDING PATIENTS WITH MORE ROOM DURING THE IMAGING PROCESS. ADDITIONALLY IT CAN ACCOMMODATE PATIENTS WEIGHING UP TO 550 LBS. (250 KG) AND ITS SHORT, WIDE BORE DESIGN HELPS REDUCE PATIENT ANXIETY AND INCREASES PATIENT COMFORT. - PROMEDICA DESIGNATED CLEVELAND CLINIC LABORATORIES (CCL) AS ITS NEW PRIMARY REFERENCE LAB, ALLOWING CCL TO PERFORM THE 1% OF HIGHLY SPECIALIZED LABORATORY TESTING THAT CANNOT BE PERFORMED BY PROMEDICA LABS. CCL IS ONE OF THE TOP SIX PRIMARY REFERENCE LABORATORIES IN THE COUNTRY, PROVIDING HIGH-QUALITY, STATE-OF-THE-ART DIAGNOSTIC SERVICES TO PHYSICIANS AND HEALTHCARE FACILITIES NATIONWIDE. THE NEW COLLABORATION OFFERS EFFICIENT, COST EFFECTIVE AND COORDINATED CARE ACROSS THE REGION FOR OUR PATIENTS. - ST. LUKE'S HOSPITAL ACHIEVED NICHE (NURSES IMPROVING CARE FOR HEALTH SYSTEM ELDERS) DESIGNATION. NICHE IS A NATIONAL, NURSING-DRIVEN PROGRAM DESIGNED TO HELP HOSPITALS AND HEALTHCARE ORGANIZATIONS IMPROVE THE CARE PROVIDED TO OLDER ADULTS. - THE HICKMAN CANCER CENTER AT FLOWER HOSPITAL WAS EXPANDED TO A TOTAL OF 32 TREATMENT BAYS, INCLUDING FOUR BEDS TO INCREASE PATIENT COMFORT DURING TREATMENT AND TWO ADDITIONAL EXAM ROOMS TO IMPROVE PATIENT FLOW AT THE CENTER. - PROMEDICA, IN PARTNERSHIP WITH HARBOR, A REGIONAL BEHAVIORAL HEALTH AGENCY, IMPLEMENTED A TELEPSYCH PROGRAM TO ASSIST IN CARING FOR INPATIENTS AT BOTH THE EMMA L. BIXBY MEDICAL CENTER AND HERRICK HOSPITAL CAMPUSES AS WELL AS IN BOTH OUTPATIENT MENTAL HEALTH FACILITIES. - POSITIONED TO BE A REGIONAL LEADER IN RESEARCH AND INNOVATIONS, PROMEDICA PARTICIPATED IN MORE THAN 160 INDUSTRY-SPONSORED CLINICAL RESEARCH TRIALS AS WELL AS MORE THAN 60 INTERNAL RESEARCH PROJECTS CONDUCTED BY PHYSICIANS, NURSES AND ALLIED HEALTH PROFESSIONALS. ADDITIONALLY, PROMEDICA'S MEDICAL TECHNOLOGY 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. IN 2015, PROMEDICA CONTRIBUTED $198,749,000 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, RESEARCH, CASH AND IN-KIND CONTRIBUTIONS, AND OTHER COMMUNITY BENEFIT OPERATIONS, PROMEDICA CONTRIBUTED $60,815,000 IN 2015. 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 $18,122,000 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 2015 WAS $21,472,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $198,749,000 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 2015, PROMEDICA PROVIDED $119,812,000 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 2015 WAS $111,127,000 AND IS NOT REFLECTED IN THE COMMUNITY BENEFIT AMOUNT OF $198,749,000 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. EMMA L. BIXBY MEDICAL CENTER - PROGRAM SERVICE ACCOMPLISHMENTS FOUNDED IN 1911, EMMA L. BIXBY MEDICAL CENTER (D/B/A PROMEDICA BIXBY HOSPITAL) CONTINUES TO MEET THE HEALTHCARE NEEDS OF ADRIAN, MICHIGAN AND SURROUNDING SOUTHEAST MICHIGAN COMMUNITIES AS THE LARGEST ACUTE CARE FACILITY IN LENAWEE COUNTY. IT 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 27 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 HEALTH CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. PROMEDICA BIXBY HOSPITAL (BH) IS AN 88-BED, FULL-SERVICE, ACUTE CARE HOSPITAL STAFFED BY MORE THAN 120 ACTIVE PHYSICIANS WORKING TO MEET IDENTIFIED NEEDS OF THE COMMUNITY. OFFERING MYRIAD INPATIENT AND OUTPATIENT SERVICES, ITS STAFF OF PROFESSIONALS OFFER CARE IN GENERAL SURGERY, CARDIOLOGY, OBSTETRICS/GYNECOLOGY, NEUROLOGY, BEHAVIORAL MEDICINE, ONCOLOGY, ORTHOPAEDICS, PULMONOLOGY, PEDIATRICS, FAMILY MEDICINE, PAIN MANAGEMENT, WOUND CARE, AND CRITICAL CARE. BH ALSO OFFERS EMERGENCY MEDICINE SERVICES AND IS ACCREDITED AS A PRIMARY STROKE CARE CENTER BY HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). THE HOSPITAL ALSO IS A NICHE (NURSES IMPROVING CARE FOR HEALTHSYSTEM ELDERS) DESIGNATED HOSPITAL, A NATIONAL NURSE-DRIVEN PROGRAM DESIGNED TO HELP HOSPITALS IMPROVE THE CARE OF OLDER ADULTS. IN 2015, BH SERVED 4,286 INPATIENTS; 107,692 OUTPATIENTS; AND 33,072 EMERGENCY CENTER PATIENTS. BH PROVIDES INPATIENT AND OUTPATIENT SERVICES WITH STATE-OF-THE-ART TECHNOLOGY AND STRIVES TO OFFER EXCEPTIONAL CARE TO BEST RESPOND TO COMMUNITY NEED. THIS IS REFLECTED IN THE PROGRAMS AND SERVICES OFFERED, SUCH AS HICKMAN CANCER CENTER. AS PART OF THE PROMEDICA CANCER INSTITUTE, HICKMAN CANCER CENTER OFFERS DIAGNOSTIC SERVICES, AS WELL AS RADIATION AND MEDICAL ONCOLOGY TREATMENT FOR HUNDREDS OF NEW PATIENTS ANNUALLY. AS A MEMBER OF THE TOLEDO COMMUNITY HOSPITAL ONCOLOGY PROGRAM, HICKMAN CANCER CENTER OFFERS PATIENTS THE OPPORTUNITY TO PARTICIPATE IN NATIONAL CANCER TRIALS. FURTHER, BH'S CARDIAC REHABILITATION PROGRAM IS CERTIFIED BY THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION. IN 2015, BH PARTNERED WITH THE LENAWEE COUNTY INTERMEDIATE SCHOOL DISTRICT TO PROVIDE NINE INTERNSHIPS EACH SCHOOL YEAR TO STUDENTS WITH DISABILITIES THROUGH PROJECT SEARCH. THE PROGRAM OFFERS THE STUDENTS AN OPPORTUNITY TO LEARN SKILLS THAT WILL ASSIST THEM IN FINDING LONG-TERM EMPLOYMENT WITHIN THE COMMUNITY UPON GRADUATION. THE HOSPITAL CONTRIBUTED $4,879,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE IN 2015. THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, AND OTHER COMMUNITY BENEFIT OPERATIONS, BH CONTRIBUTED $57,000 TO THE COMMUNITY DURING 2015. THE FOLLOWING ARE EXAMPLES OF SUCH CONTRIBUTIONS: - SUPPORT OF THE LENAWEE HEALTH NETWORK VEGGIE MOBILE, WHICH BRINGS FRESH PRODUCE TO THE LENAWEE COUNTY COMMUNITY. - SUPPORT GROUPS FOR INDIVIDUALS WITH CHRONIC DISEASES, FOCUSED ON PATIENTS' EMOTIONAL, PHYSIOLOGICAL AND PSYCHOLOGICAL NEEDS; - ANNUAL CANCER SURVIVORSHIP PROGRAM FOR CANCER SURVIVORS AND THEIR FAMILIES, FRIENDS AND CAREGIVERS TO SHARE STORIES OF INSPIRATION AND HOPE. - CHILDHOOD AND ADULT IMMUNIZATIONS, ASTHMA CARE, AND INDIGENT AND SENIOR HEALTH FAIRS FOR THE UNDERPRIVILEGED AND LOCAL COMMUNITY AT LARGE; - COMMUNITY HEALTH AND WELLNESS SERVICES, WHICH INCLUDED TOBACCO CESSATION PROGRAMS, NUTRITION AND FITNESS CLASSES, PRENATAL AND FAMILY PLANNING CLASSES, AND CPR TRAINING; AND - FREE BLOOD PRESSURE, BODY MASS INDEX (BMI), CHOLESTEROL, CANCER, AND DIABETES SCREENINGS FOR AREA RESIDENTS, INCLUDING AT LOCAL SENIOR CENTERS. BH PROVIDED A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO THE COMMUNITY DURING 2015, OF WHICH $821,000 REPRESENTED UNCOMPENSATED AMOUNTS FOR TREATMENT TO THOSE 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. BH'S COST OF BAD DEBT FOR 2015 WAS $863,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $4,879,000 NOTED ABOVE. FURTHER, BH PROVIDED $4,001,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. ALSO IN 2015, THE TOTAL COST - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS WAS $3,933,000 AND IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $4,879,000 NOTED ABOVE. BH PROVIDED 650 JOBS THROUGH DIRECT EMPLOYMENT IN 2015, EXPENDING $22,000,000 IN NET PAYROLL. A TOTAL OF $1,039,000 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES. IN SUMMARY, BH 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 USING REPORTING 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 FEDERAL, STATE AND LOCAL 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 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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