2015-11-16T15:23:09-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-01-01 311072406 PIKE HEALTH SERVICES INC PIKE 7409472186 100 DAWN LANE WAVERLY OH 45690 ROBERT M ROSENBERGER CFO 7409472186 2015-11-16 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-04-25 22:37:26Z ADENA PIKE MEDICAL CENTER ROBERT M ROSENBERGER 100 DAWN LANE WAVERLY OH 45690 19598199 0 X ADENA.ORG X 1983 OH PIKE HEALTH SERVICES, INC. IS HIGH QUALITY; COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. 9 8 192 30 0 0 23797 10000 18824677 18223759 -161780 42399 1175136 1307943 19861830 19584101 12720 11000 0 0 10558576 9523382 0 0 0 13366526 12184613 23937822 21718995 -4075992 -2134894 14931356 15899206 1074831 1153571 13856525 14745635 PIKE HEALTH SERVICES, INC. IS HIGH QUALITY; COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. 0 0 17475424 11000 19401836 PIKE HEALTH SERVICES, INC. IS A 25- BED CRITICAL ACCESS HOSPITAL AND PHYSICIAN PRACTICE LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. INCLUDED IN THE BED COUNT ARE 21 ACUTE BEDS AND 4 INTENSIVE CARE BEDS WITH AUTHORIZATION FOR SWING BEDS ON AN AS NEEDED BASIS. IN 2014, PIKE HEALTH SERVICES, INC. HAD 581 INPATIENT ADMISSIONS, 35,945 OUTPATIENT VISITS, AND 13,508 VISITS TO THE EMERGENCY DEPARTMENT. ADENA PIKE COMMUNITY HOSPITAL PROVIDED CHARITY CARE TO THE COMMUNITY IN THE AMOUNT OF $1,333,397. DURING THE YEAR, PIKE HEALTH SERVICES , INC PARTICIPATED IN HEALTH FAIRS OFFERING SCREENING AND EDUCATION FOR DIABETES, CHOLESTEROL AND ARTHRITIS FOR BOTH ADULTS AND CHILDREN. 17475424 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 192 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X ROBERT M ROSENBERGER CFO 7407797582 272 HOSPITAL ROAD CHILLICOTHE OH 456019031 ANTHONY FISH CHAIRMAN 2.00 0.00 X X 0 0 0 MARGARET FOILL TREASURER 2.00 0.00 X X 0 0 0 VAL FRANCIS VICE CHAIRMAN 2.00 0.00 X X 0 0 0 LINDA SHOEMAKER SECRETARY 2.00 0.00 X X 0 0 0 PAUL ADKINS TRUSTEE 2.00 0.00 X 0 0 0 TODD BURKITT TRUSTEE 2.00 0.00 X 0 0 0 EUGGLE ROBERTSON TRUSTEE 2.00 0.00 X 0 0 0 DAVID KESSLER CHIEF OF MEDICAL STAFF 2.00 0.00 X 315009 0 0 CONNIE SHELLEY TRUSTEE 2.00 0.00 X 0 0 0 DAVE ZANNI CEO 50.00 0.00 X 128828 0 31429 SHARON NOVAK VP FINANCE/CFO (JAN-MARCH) 50.00 0.00 X 103442 0 9942 LAURA IRELAND EMPLOYEE 40.00 0.00 X 100755 0 34573 DAN RASE EMPLOYEE 40.00 0.00 X 100198 0 17611 JOHN CRAWFORD DOCTOR 40.00 0.00 X 131071 0 22312 ELLIS FRAZIER DOCTOR 40.00 0.00 X 167285 0 12131 CHERYL SMITH PHARMACIST 40.00 0.00 X 135250 0 12255 CATHERINE FARINET FORMER CHIEF OF MEDICAL STAFF 50.00 0.00 X 197894 0 18870 CRAIG SOLLE FORMER PRESIDENT AND CEO 50.00 0.00 X 159171 0 26242 1538903 0 185365 10 1 1 0 PREMIER HEALTH CARE SERVICES INC 332 CONGRESS PARK DRIVE DAYTON OH 45459 HOSPITALIST & ER COVERAGE 609879 PRECYSE SOLUTIONS LLC DEPT 1736 PO BOX 11407 BIRMINGHAM AL 35246 TRANSCRIPTION & CODING 504981 2 10000 10000 NET PATIENT SVC REV 622110 18223759 18223759 18223759 10166 0 10166 10166 10166 46200 3801 42399 42399 42399 25371 10297 15074 15074 EHR IMPLEMENTATION 622110 1178077 1178077 CAFETERIA REVENUE 722514 25703 25703 COUNTY TAX LEVY 900099 19460 19460 59463 59463 1282703 19584101 19401836 0 172265 8000 8000 3000 3000 588648 316967 271681 6620920 5836356 784564 1807681 1732295 75386 506133 418263 87870 1537610 1371179 166431 969535 843239 126296 793375 714038 79337 31527 25784 5743 997935 897828 100107 CORPORATE OVERHEAD ALLO 4776132 2229976 2546156 BAD DEBT EXPENSE 1634512 1634512 MEDICAL SUPPLIES 1443987 1443987 21718995 17475424 4243571 0 1448975 3006208 94659 45815 2528428 3107401 11215 170716 339597 306807 1471081 2012285 9440186 3185991 6622359 6254195 2415042 995779 14931356 15899206 1073924 1153571 907 0 1074831 1153571 X 13856525 14745635 13856525 14745635 14931356 15899206 X -2134894 11 3023993 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 568 568 0 PART II-B, LINE 1: THE OHIO HOSPITAL ASSOCIATION DOES LOBBYING ON BEHALF OF HOSPITAL RELATED CAUSES. THIS ACTIVITY IS PAID FOR THROUGH DUES PAID TO THE OHIO HOSPITAL ASSOCIATION. 350000 350000 5055955 569440 4486515 3775277 2543181 1232096 258954 73370 185584 6254195 GROUND LEASE 2276817 COST REPORT SETTLEMENT RECEIVABLE/(PAYABLE) -1281038 995779 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED AS OF DECEMBER 31, 2014 AND 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANGEMENT BELIEVES THAT IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2011. FESTIVAL OF TREES 25371 25371 952 1111 3982 4252 25371 25371 952 1111 3982 4252 10297 15074 1 1 X 1 X 1 X 1 1 1 0 1 1 1001923 2131766 -1129843 0.00000 6281540 2809889 3471651 0.17290 7283463 4941655 2341808 0.17290 23746 23746 0.00120 23746 23746 0.00120 7307209 4941655 2365554 0.17410 0 1634512 81726 6335273 6426525 -91252 X 1 1 1 1 PIKE HEALTH SERVICES INC 100 DAWN LANE WAVERLY OH 45690 WWW.ADENA.ORG ST. REG. NUM. 1299 X X X X PIKE HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X ADENA.ORG/INSIDE/PAGE.DT/CHNA X X 1 13 0 1 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X X X 1 X 0 X X X 1 X 0 0 PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 5: ADENA PIKE MEDICAL CENTER CAPTURED THE BROAD INTERESTS OF THE COMMUNITY FOR THE CHNA THROUGH TWO METHODS: SURVEY AND INTERVIEWS. A HEALTH NEEDS SURVEY WAS WIDELY DISTRIBUTED TO THE PIKE COUNTY COMMUNITY THROUGH PAPER AND WEB FORM. IN ADDITION TO THE SURVEYS, INTERVIEWS WITH LOCAL COMMUNITY LEADERS, INCLUDING CIVIC, PUBLIC HEALTH AND EMERGENCY RESPONSE WERE REQUESTED AND/OR CONDUCTED TO GAIN FURTHER KNOWLEDGE OF SURVEY TOPICS. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 6A: THE CHNA FOR ADENA PIKE MEDICAL CENTER WAS CONDUCTED IN COLLABORATION WITH WITH TWO OTHER HOSPITAL FACILITIES THAT ARE PART OF THE ADENA HEALTH SYSTEM: ADENA REGIONAL MEDICAL CENTER AND ADENA GREENFIELD MEDICAL CENTER. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 7D: HARD COPIES OF THE CHNA REPORT WERE PRINTED AND SENT TO COMMUNITY LEADERS AND AGENCIES. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 11: OBESITY-EMPLOYEE HEALTH INITIATIVES:IN 2014, ADENA HEALTH SYSTEM RESTRUCTURED ITS INTERNAL HEALTH & WELLNESS TEAM TO CREATE AN EVIDENCE-BASED HEALTH AND WELLNESS PLATFORM BY DEVELOPING AND REFINING PROGRAMS FOR HEALTH SYSTEM EMPLOYEES (RESIDENTS OF THE SERVICE REGION) THAT COULD BE IMPLEMENTED ON A LARGER SCALE IN THE COMMUNITY.THE TEAM SUCCESSFULLY CREATED A MODEL BUILT AROUND THREE COMPONENTS PROVEN TO DRIVE IMPROVED INDIVIDUAL HEALTH AND WELLNESS: MOVEMENT, NUTRITION AND WELLBEING. THE TEAM COORDINATED PROGRAMMING WITHIN THESE THREE AREAS BASED OUT OF THE ADENA REGIONAL MEDICAL CENTER CAMPUS. PROGRAMS INCLUDED A CAMPUS BASED WALKING PROGRAM, WEIGHT WATCHERS AT WORK, AND STRESS MANAGEMENT CLASSES - IN ADDITION TO ESTABLISHED OFFERINGS INCLUDING FAMILY FIT AND ADENA FIT. THE PROGRAMS IMPLEMENTED AT THE PIKE MEDICAL CENTER CAMPUS INCLUDE THE WALKING PROGRAM AND THE ADENA FIT PROGRAMS. EMPLOYEES AT THE PIKE LOCATION ARE ENCOURAGED TO ENGAGE IN THE REMAINDER OF THE PROGRAMS AT ADENA REGIONAL MEDICAL CENTER. A COMMUNICATION PLAN WAS BUILT AROUND THE PROGRAMMING TO ENSURE EFFECTIVE COMMUNICATION TO EMPLOYEES. IN ADDITION, A COMPETITIVE CHALLENGE FOR EMPLOYEES, MOVE MORE ADENA, WAS ALSO COORDINATED TO ENCOURAGE 90 MINUTES OF ACTIVITY PER WEEK, AS WELL AS A VENUE TO MARKET OTHER EMPLOYEE HEALTH AND WELLNESS OFFERINGS. THE TEAM SUCCESSFULLY ENGAGED MORE THAN 35% OF THE TOTAL EMPLOYEE POPULATION THROUGH THESE INITIATIVES IN 2014.OBESITY-COMMUNITY PROGRAMMING:AHS COMMUNITY HEALTH ADVANCEMENT COLLABORATED WITH A VARIETY OF COMMUNITY PARTNERS TO COORDINATE AND DELIVER COMMUNITY PROGRAMS AIMED AT PROMOTING MOVEMENT AND NUTRITION. PROGRAMS BASED OR FACILITATED THROUGH THE PIKE MEDICAL CENTER INCLUDED:THE CYCLEMANIA EVENT AT THE PIKE COUNTY FAIR, WHICH IS AN ANNUAL BIKE RACE. MORE THAN 125 CHILDREN PARTICIPATED IN THE RACE THAT OFFERS A FREE T-SHIRT, BIKE HELMET, AND SAFETY INFORMATION. WINNERS OF THE RACES ALSO RECEIVE A NEW BICYCLE.SPONSORSHIP AND PARTICIPATION IN THE HEALTHY KIDS' EVENT AT THE PIKE YMCA AND PIKE COUNTY PUBLIC LIBRARY. WITH MORE THAN 800 IN ATTENDANCE, THIS EVENT PROVIDED ENTERTAINMENT, INFUSED EDUCATION ON HEALTHY LIVING AND AN EASTER EGG HUNT.OBESITY-REGIONAL INITIATIVES:THE COMMUNITY HEALTH ADVANCEMENT OFFICE WAS RESTRUCTURED IN 2014. THE DIRECTOR FOR THE OFFICE IMMEDIATELY STARTED WITH COORDINATION OF THE EMPLOYEE HEALTH & WELLNESS COMMITTEE WHICH COMPLETED AND BEGAN EXECUTION OF ITS PLAN IN AUGUST. IN ADDITION, A CORPORATE EVENTS COORDINATOR WAS ADDED TO SUPPORT THE DIRECTOR, FACILITATE EVENT SET-UP AND DELIVERY, AS WELL AS ALIGN HEALTH AND WELLNESS PROGRAMMING WITH COMMUNITY EVENTS. A COMMUNITY HEALTH FOCUS AND MESSAGE, "MOVE MORE, EAT BETTER" WAS FINALIZED AND SET FOR IMPLEMENTATION IN 2015.MENTAL & BEHAVIORAL HEALTH-ADVOCACY:AS ONE OF 3 HEALTH SYSTEM PARTICIPANTS IN THE STRONG START OHIO PROJECT (FROM THE GOVERNOR'S OFFICE OF HEALTH TRANSFORMATION) AHS BEGAN DELIVERING PRENATAL CARE TO PREGNANT WOMEN WITH ADDICTION ISSUES USING A CENTERINGPREGNANCY MODEL AT THE ADENA REGIONAL MEDICAL CENTER CAMPUS. THIS PROJECT PROVIDED A MONTHLY OPPORTUNITY TO INFORM THE STATE OF OHIO ABOUT BARRIERS TO ACHIEVING POSITIVE BIRTH OUTCOMES, INCLUDING ACCESS TO LONGER-TERM ADDICTION TREATMENT IN SOUTHERN OHIO. APPROXIMATELY 10% OF THE 77 WOMEN SERVED THROUGH THE PROGRAM IN 2014 WERE FROM PIKE COUNTY OHIO.THE AHS DIRECTOR OF COMMUNITY HEALTH ADVANCEMENT ALSO SERVED ON THE SOUTHEAST OHIO MEDICAID EXPANSION COMMITTEE, TO PARTICIPATE IN EFFORTS TO EXPAND MEDICAID COVERAGE TO THE REGION'S RESIDENTS. THIS GROUP ALSO INFORMS STATE GOVERNMENT ON THE NEED AND BENEFIT OF AFFORDABLE HEALTH CARE IN SOUTHERN OHIO.MENTAL & BEHAVIORAL HEALTH-REFERRAL SOURCES:AHS CONTINUED TO OPERATE THE REGION'S ONLY ACUTE INPATIENT, PSYCHIATRIC UNIT FOR INSURED, UNINSURED AND UNDER INSURED PATIENTS IN 2014 AT THE ADENA REGIONAL MEDICAL CENTER. AHS WOMEN'S & CHILDREN'S, PRIMARY CARE AND PAIN MANAGEMENT SERVICE LINES MADE REFERRALS FOR PATIENTS NEEDING MENTAL AND BEHAVIORAL HEALTH SERVICES IN PIKE COUNTY TO THE ADENA COUNSELING CENTER, PAINT VALLEY MENTAL HEALTH CENTER, ADENA WOMEN'S AND CHILDREN'S CENTERINGPREGNANCY PROGRAM, AND THE PIKE COUNTY RECOVERY COUNCIL.MENTAL & BEHAVIORAL HEALTH-CESSATION RESOURCES:AHS SERVED A TOTAL OF 25 WOMEN, 7 FROM PIKE COUNTY, ADDICTED TO OPIATES AS PART OF ITS CENTERINGPREGNANCY PROGRAM IN 2014. IN ADDITION, A WORK TEAM WAS CONVENED TO REVIEW COMMUNITY NEED, DEMAND AND OPPORTUNITIES FOR EXPANSION OF CURRENT AHS MENTAL AND BEHAVIORAL HEALTH OPPORTUNITIES.MENTAL & BEHAVIORAL HEALTH-SCREENING:IN 2014, EACH AHS IMPLEMENTED A SCREENING POLICY TO IDENTIFY POSSIBLE MENTAL AND BEHAVIORAL ISSUES WITH PATIENTS PRESENTING IN THE EMERGENCY ROOMS OF ADENA HEALTH SYSTEM HOSPITALS.SMOKING-CESSATION RESOURCES:ALONG WITH PROVIDER SMOKING CESSATION COUNSELING PROVIDED TO PATIENTS SELF-IDENTIFIED AS SMOKERS, AHS HAS CONVENED A WORK TEAM TO IDENTIFY ADDITIONAL OPPORTUNITIES TO IDENTIFY AND PROVIDE INTERVENTION TO CURRENT SMOKERS WHO ARE PATIENTS OF PIKE COUNTY AHS PROVIDERS.SMOKING-SCREENING:AHS CANCER CENTER PROVIDED 194 PATIENTS WITH FREE LUNG SCREENINGS IN 2014, WITH 13 PATIENTS WHO WERE IDENTIFIED WITH EARLY STAGE LUNG CANCER.NEEDS THAT CANNOT BE ADDRESSED:UNINTENTIONAL INJURIES, IN GENERAL, WERE NOT ADDRESSED AS PART OF THE IMPLEMENTATION PLAN. THE PRIMARY CAUSE OF UNINTENTIONAL INJURIES IN PIKE COUNTY IS AUTOMOTIVE ACCIDENTS. AHS/APMC DOES NOT HAVE THE CAPABILITIES OR RESOURCES AT THIS TIME TO DELIVER A DRIVER SAFETY CAMPAIGN. A PROGRAM IS CURRENTLY WELL COORDINATED BY THE OHIO STATE HIGHWAY PATROL AND LOCAL LAW ENFORCEMENT.A SECOND CAUSE OF UNINTENTIONAL INJURY DEATHS ARE RELATED TO DRUG OVERDOSES. AHS HAS IDENTIFIED STRATEGIES TO ADVOCATE AND SUPPORT BEHAVIORAL HEALTH EFFORTS AS PART OF ITS IMPLEMENTATION STRATEGY LISTED ABOVE. COORDINATION OF CESSATION RESOURCES AND REGIONAL PARTNERSHIPS TO ADVOCATE FOR EXPANDED ADDICTION SERVICES IN THE PLAN SHOULD BE NOTED, AS DRUG RELATED DEATHS WILL BE INDIRECTLY IMPACTED AS PART OF THESE EFFORTS.ADDITIONAL INITIATIVES AND RESOURCES:ADENA SPORTS MEDICINE-ATHLETIC TRAINING PROGRAM:THE ADENA HEALTH SYSTEM PROVIDED 10 LOCAL PUBLIC HIGH SCHOOLS WITHIN THE SERVICE REGION WITH ATHLETIC INJURY PREVENTION, DIAGNOSIS, AND EVALUATION SERVICES. A TOTAL OF 8 ATHLETIC TRAINERS WORK WITHIN THE SCHOOL'S ATHLETIC DEPARTMENTS AND FOCUS ON EDUCATING STUDENTS, PARENTS AND COACHES ON SPORTS MEDICINE TOPICS, INCLUDING CONCUSSION IDENTIFICATION AND TREATMENT. THE STAFF IS ALSO READILY AVAILABLE AT ATHLETIC EVENTS AND PROVIDES YEARLY SPORTS PHYSICALS TO MORE THAN 1,200 STUDENTS IN PIKE, ROSS, AND JACKSON COUNTIES IN 2014. COMMUNITY HEALTH PROGRAMS: AHS/ARMC OFFERED INFORMATION AT 5 COMMUNITY HEALTH PROGRAMS AND EVENTS IN LOCATIONS THROUGHOUT THE YEAR TO HELP THE COMMUNITY LEAD HEALTHIER LIVES THROUGH WELLNESS EDUCATION AND THE PREVENTION OF ILLNESS AND INJURY. TOPICS INCLUDED, BUT WERE NOT LIMITED TO THE FOLLOWING: HIV; CANCER; DIABETES; HEART DISEASE; BONE AND JOINT CARE; CHILDBIRTH; MULTIPLE SCLEROSIS; STROKE; AND WELLNESS.COMMUNITY EVENTS: AHS/APMC ALSO PARTICIPATED IN 3 HEALTH FAIRS/COMMUNITY EVENTS AND SENIOR HEALTH FAIRS IN PIKE COUNTY ORGANIZED BY OTHER COMMUNITY ORGANIZATIONS IN 2014, INCLUDING THE LOCAL COMMUNITY COLLEGES, LOCAL PUBLIC SCHOOLS, SENIOR ASSOCIATIONS AND COMMUNITY ORGANIZATIONS. AT THE GENERAL HEALTH FAIRS/COMMUNITY EVENTS, ADENA PROVIDED BLOOD PRESSURE CHECKS, DIABETES INFORMATION, BONE DENSITY SCREENINGS, AND PEDIATRIC CONNECTIONS/INFORMATION. THERE IS NO INVASIVE TESTING - E.G., BLOOD SUGAR, CHOLESTEROL, HIV TESTING, ETC. - AT ANY OF THESE EVENTS. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 20E: PATIENTS HAVE 120 DAYS FROM THE TIME THEIR ACCOUNT GOES TO "SELF-PAY" TO PAY IN FULL OR MAKE PAYMENT ARRANGEMENTS. ON THE 121ST DAY, THEY ARE SENT TO A COLLECTION AGENCY WHO WILL DO CREDIT REPORTING. COLLECTION AGENCIES REQUIRE ADENA MANAGEMENT APPROVAL TO PURSUE LEGAL ACTION. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 22D: THE PATIENT IS INITIALLY CHARGED REGULAR HOSPITAL RATES FOR SERVICES PERFORMED. THE PATIENT THEN COMPLETES AN APPLICATION FOR FINANCIAL AID FORM AND RETURNS IT TO THE FINANCIAL COUNSELORS, EMPLOYED BY AN OUTSIDE AGENCY. HCAP/CHARITY ADJUSTMENTS ARE ADMINISTERED BASED ON PROOF OF INCOME AND THE TABLES OF THE FEDERAL POVERTY LIMITS (FPL) AND THE MAXIMUM AMOUNT CHARGED IS CALCULATED IN THE FOLLOWING MANNER: 1. 100% WRITE-OFF AND HCAP ELIGIBLE - LESS THAN OR EQUAL TO 200% FPL 2. 60% WRITE-OFF - BETWEEN 201% - 400% OF FPL. MANAGEMENT DECIDED TO LIMIT THE DISCOUNT TO THOSE UNDER THE 400% FPL, BASED ON MANAGEMENT'S EXPERIENCE AT OTHER INSTITUTIONS ALONG WITH A CURSORY REVIEW OF HOSPITALS IN THE LOCAL MARKET. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 16B WEBSITE: WWW.ADENA.ORG/FILES/RESOURCES/ADENAFINAIDFORMFINAL.PDF PART I, LINE 6A: ADENA HEALTH SYSTEM EIN: 31-4379443 PART I, LINE 7: THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $1,634,512 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. PART III, LINE 2: THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS. PART III, LINE 3: IN DETERMINING THE APPROPRIATE AMOUNT TO BE RECORDED ON PART III, LINE 3, ALL SELF PAY CLAIMS ARE TURNED OVER TO A COLLECTION VENDOR. THE VENDOR DETERMINES IF THE CLAIM IS CHARITY AFTER THE PATIENT SUPPLIES APPROPRIATE DOCUMENTATION. HOWEVER, THE HOSPITAL HAD AN OUTSIDE CREDIT AGENCY REVIEW TWO MONTHS OF BAD DEBT TRANSACTIONS AND DETERMINED THAT 49% OF THE AMOUNT BOOKED AS BAD DEBT EXPENSE RELATED TO UNCOMPENSATED CHARITY CARE. THE HOSPITAL RECLASSED $1,399,113 FROM BAD DEBT EXPENSE TO CHARITY CARE. BAD DEBT EXPENSE BEFORE THIS RECLASS WAS $3,033,625 LEAVING $1,634,512 AS BAD DEBT EXPENSE. BASED ON THIS ANALYSIS AND RECLASS, THE HOSPITAL ESTIMATES THAT 5% OF THE BAD DEBT EXPENSE REPORTED IN PART III LINE 2 ARE AMOUNTS THAT WOULD BE ATTRIBUTABLE TO PATIENTS UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA PIKE MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS ESTABLISHED BASED ON EXPECTED PAYMENT RATES FROM PAYORS UTILIZING CURRENT REIMBURSEMENT METHODOLOGIES AND PAYMENT RATES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE." PART III, LINE 8: OUR SERVICE AREA IS A RURAL 13 COUNTY AREA IN SOUTHERN OHIO. THE POPULATION IS AN AGING POPULATION WHICH RESULTS IN MEDICARE AS OUR LARGEST PAYOR GROUP. IN ADDITION, THE ECONOMIC CONDITIONS THAT RESULT FROM APPALACHIAN DESIGNATION CREATE A RECRUITING ISSUE. TO COMBAT THE ISSUE, WE ARE FORCED TO NOT ONLY EMPLOY PHYSICIANS BUT MUST PAY A PREMIUM TO GET THEM TO AGREE TO SERVE THE AREA'S RESIDENTS. BASED ON THESE ISSUES, WE BELIEVE SERVICE TO OUR MEDICARE POPULATION, THAT RESULTED IN A MEDICARE SHORTFALL OF $91,252, IS A COMMUNITY BENEFIT. ALSO, THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6. PART III, LINE 9B: THERE ARE TWO TIERS: 100% CHARITY FOR UP TO OR EQUAL TO 200% OF FEDERAL POVERTY LEVELS AND 60% FOR 201%-400% OF FEDERAL POVERTY LEVELS. PART VI, LINE 2: IN 2014, AHS'S COMMUNITY BUILDING ACTIVITIES PROMOTED ECONOMIC DEVELOPMENT IN DOWNTOWN CHILLICOTHE. THE HEALTH SYSTEM IS HELPING FUND A HISTORIC BUILDING REHABILITATION PROJECT WHICH WILL IN TURN HELP REVITALIZE THE DOWNTOWN CHILLICOTHE BUSINESS DISTRICT AS WELL AS PROMOTE JOB GROWTH. THE BUILDING WILL ALSO PROVIDE HOUSING FOR ADENA PHYSICIAN RESIDENTS AND MEDICAL STUDENTS WHICH ENABLES THE HEALTH SYSTEM TO INCREASE PROVIDER ACCESS WITHIN THE REGION. PART VI, LINE 3: THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. A CONTRACTED VENDOR SUPPLIES STAFF AT THE CASHIER AREA TO EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE. 7. LASTLY, WE UTILIZE A "HINDSIGHT" VENDOR THAT SCREENS ALL BAD DEBT ACCOUNTS, AFTER THE YEAR-END, AGAINST THE STATE MEDICAID ELIGIBILITY AND FEDERAL POVERTY GUIDELINES TO ATTEMPT ONE LAST EFFORT TO OBTAIN FINANCIAL ASSISTANCE FOR INDIVIDUALS. PART VI, LINE 4: PIKE COUNTY, HOME OF THE ADENA PIKE MEDICAL CENTER (APMC), IS LOCATED IN SOUTH CENTRAL OHIO IN THE 2ND CONGRESSIONAL DISTRICT AND IS ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT CONTAINS THE POPULATION PATTERNS AND DISTINCT ECONOMIC CONDITIONS INHERENT OF THIS REGION OF THE U.S AND FACES SIMILAR CHALLENGES IN DIVERSIFYING ITS ECONOMY TO IMPROVE THE LIVES OF ITS 26,066 RESIDENTS.THE TOTAL POPULATION OF PIKE COUNTY OHIO IS 28,685. IT REPRESENTS 5.6% OF THE TOTAL POPULATION OF THE TOTAL ADENA HEALTH SYSTEM SERVICE REGION. THE COUNTY, AS WELL AS THE REMAINDER OF THE 12 COUNTY SERVICE REGION, HAS SIMILAR DEMOGRAPHICS AS THE STATE OF OHIO AND U.S. OVER 57% OF THE POPULATION IS BETWEEN THE AGES OF 20 AND 64 AND 14.5% OF THE POPULATION IS OVER THE AGE OF 65. LESS THAN 4% OF THE POPULATION IS A RACE OR ETHNICITY OTHER THAN WHITE.THERE ARE 10,816 HOUSEHOLDS IN PIKE COUNTY. THE AVERAGE HOUSEHOLD SIZE IS 2.61 PEOPLE, COMPARABLE WITH THE REST OF THE 12 COUNTY SERVICE REGION AND OHIO. THE AVERAGE FAMILY SIZE IS AS WELL WITH 3.11 PEOPLE.APPROXIMATELY 22% OF THE ADULTS IN PIKE COUNTY HAVE NOT GRADUATED FROM HIGH SCHOOL. THIS PERCENTAGE IS HIGHER THAN THE AVERAGES FOR THE REGION (18.9%), OHIO (12.2%) AND THE NATION (14.6%). MORE THAN 11% OF THE POPULATION OF PIKE COUNTY IS ESTIMATED TO BE FUNCTIONALLY ILLITERATE, OR LACKING THE READING AND WRITING SKILLS SUFFICIENT FOR ORDINARY PRACTICAL NEEDS. THE UNEMPLOYMENT RATE IN PIKE COUNTY (10.7%) IS CONSIDERABLY HIGHER THAN THE REGIONAL (6.8%), STATE (6%) AND U.S. (7.7%) AVERAGES. IN ADDITION, MORE THAN 44.5% OF THE POPULATION IS NOT IN THE WORKFORCE. THIS IS HIGHER THAN THE STATE (35.4%) AND NATIONAL AVERAGES (35.2%). THE TOP FIVE EMPLOYMENT INDUSTRIES IN PIKE COUNTY ARE MANAGEMENT/BUSINESS/SCIENCE (28.9%), SERVICE (21.5%) SALES (23%), PRODUCTION/TRANSPORTATION SERVICES (19.2%), SALES (18.2%), AND NATURAL RESOURCES/CONSTRUCTION/MAINTENANCE. PIKE COUNTY HAS A GREATER PERCENTAGE OF PEOPLE EMPLOYED IN PRODUCTION, TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS (19.2%) THAN THE REGIONAL, STATE AND NATIONAL AVERAGES. THE PER CAPITA MEDIAN AND MEAN HOUSEHOLD INCOMES IN PIKE COUNTY OHIO ARE MUCH LOWER THAN THE STATE AND U.S. AVERAGES. POVERTY RATES ARE ALSO HIGHER THAN REGIONAL, STATE AND NATIONAL AVERAGES. ACCESS TO EMPLOYMENT IN PIKE COUNTY IS ALSO LOWER THAN OTHER COUNTIES IN THE REGION.THERE ARE 7,697 CIVILIAN VETERANS LIVING IN PIKE COUNTY, ACCOUNTING FOR ALMOST 10% OF THE REGION'S POPULATION. THE TOTAL CIVILIAN VETERANS WITHIN THE ADENA HEALTH SYSTEM 12-COUNTY SERVICE REGION REPRESENT 5% OF OHIO'S TOTAL CIVILIAN VETERAN POPULATION.PIKE COUNTY AND ITS ENTIRE SURROUNDING SERVICE REGION HAVE A HIGHER PREVALENCE OF DISABILITY THAN THE REST OF OHIO. SEVEN OF THE 12 COUNTIES IN THE SERVICE REGION, INCLUDING PIKE COUNTY, HAVE DISABILITY PREVALENCE RATES OF 16.7% - 22%. PART VI, LINE 5: ADENA PIKE MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A VARIETY OF MEANS, INCLUDING BOARD MEMBERS, ADMINISTRATIONS, EMPLOYEES AND VOLUNTEERS. THE 2014 BOARD OF TRUSTEES OF ADENA PIKE MEDICAL CENTER WAS COMPRISED OF 9 MEMBERS. NONE OF THE BOARD MEMBERS ARE EMPLOYEES OF ADENA HEALTH SYSTEM. ALL OR 100% OF THE BOARD MEMBERS RESIDE IN PIKE COUNTY OHIO. PART VI, LINE 6: FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WASHINGTON COURT HOUSE AND WAVERLY, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE AND WAVERLY. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN), A PARTNERSHIP OF THE REGION'S THREE LARGEST HEALTHCARE PROVIDERS -- ADENA, O'BLENESS HEALTH SYSTEM AND HOLZER CONSOLIDATED HEALTH SYSTEMS. THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. 0 HOPE CLINIC OF PIKE COUNTY PO BOX 101 WAVERLY OH 45690 263193098 501(C)(3) 8000 PROVIDE MEDICAL CARE 1 0 X 1 1 1 0 0 0 0 0 0 0 0 DAVID KESSLER CHIEF OF MEDICAL STAFF 314112 0 150 0 747 0 0 0 1958 0 316967 0 0 0 DAVE ZANNI CEO 124802 0 50 0 3976 0 11871 0 20439 0 161138 0 0 0 JOHN CRAWFORD DOCTOR 130208 0 150 0 713 0 0 0 23605 0 154676 0 0 0 ELLIS FRAZIER DOCTOR 165787 0 0 0 1498 0 0 0 13561 0 180846 0 0 0 CATHERINE FARINET FORMER CHIEF OF MEDICAL STAFF 197165 0 0 0 729 0 0 0 20791 0 218685 0 0 0 CRAIG SOLLE FORMER PRESIDENT AND CEO 124685 0 150 0 34336 0 11153 0 15822 0 186146 0 0 0 PART I, LINE 1A DAVE ZANNI IS REIMBURSED FOR HIS ROTARY CLUB DUES. THIS IS TREATED AS TAXABLE COMPENSATION. PART I, LINE 3 THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2014. PART I, LINE 4A LINE 4A: TWO EMPLOYEES THAT WERE PREVIOUSLY LISTED IN PART VII, SECTION A, LINE 1A RECEIVED SEVERANCE IN 2014. - CRAIG SOLLE REPORTED SEVERANCE COMPENSATION OF $33,811 IN 2014. - SHARON NOVAK REPORTED SEVERANCE COMPENSATION OF $71,168 IN 2014. THEY ARE RECEIVING 12 MONTHS OF SEVERANCE AND THEN A 6 MONTH BRIDGE IF NOT EMPLOYED. AT ANY TIME AFTER THE INTIAL 12 MONTHS, AHS WOULD REDUCE PAY IF EMPLOYED AT A LESSER RATE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PIKE HEALTH SERVICES, INC. IS ADENA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A PIKE HEALTH SYSTEM, INC. ELECTS AND APPOINTS MEMBERS TO THE GOVERNING BODY SUBJECT TO THE APPROVAL OF ADENA HEALTH SYSTEM, THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNING DECISIONS ARE SUBJECT TO THE APPROVAL OF ADENA HEALTH SYSTEM, THE SOLE MEMBER OF PIKE HEALTH SERVICES, INC. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS REVIEWED AT A BOARD MEETING AND COPIES OF THE FORM 990 WERE PROVIDED TO THE BOD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM, PIKE HEALTH SERVICES, INC.'S SOLE MEMBER, ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. ALL ADENA HEALTH SYSTEM WORKFORCE MEMBERS AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE TOP MANAGEMENT OFFICIAL AT ADENA PIKE MEDICAL CENTER HAS HIS COMPENSATION REVIEWED ANNUALLY BY ADENA HEALTH SYSTEM, A RELATED PARTY. THE SYSTEM UTILIZES A SEPARATE TPA MANAGEMENT COMPENSATION CONSULTING FIRM THAT USES SEVERAL AVAILABLE MARKET STUDIES FOR APPLICABLE POSITIONS IN COMPARABLE MARKETS. THIS PROCESS WAS LAST UNDERTAKEN IN 2014. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER FROM RELATED ORGANIZATION 3,023,993. FORM 990, PART XII, LINE 2C: ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. PIKE HEALTH SERVICES, INC. IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD OH 45123 310993422 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 ADENA HEALTH FOUNDATION 242 HOSPITAL ROAD CHILLICOTHE OH 45601 753008742 FUNDRAISING OH 501(C)(3) 11A ADENA HEALTH SYSTEM 1 SOUTHERN OHIO HEALTHCARE NETWORK 550 MIRABEAU ST GREENFIELD OH 45123 261566590 FIBEROPTIC NETWORK GRANTS OH 501(C)(3) 11A ADENA HEALTH SYSTEM 1 ADENA HEALTH SYSTEM 242 HOSPITAL ROAD CHILLICOTHE OH 45601 314379443 HOSPITAL OH 501(C)(3) 3 N/A 0 ADENA CARE 272 HOSPITAL ROAD CHILLICOTHE OH 45601 453980850 PROVIDE EMPLOYEE HEALTH INSURANCE OH N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 ADENA HEALTH SYSTEM S 3023993 BOOK VALUE ADENA HEALTH SYSTEM O 9440623 TIMESHEET ALLOCATION