2014-11-13T13:28:47-06:00 2013-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE STE 2000 INDIANAPOLIS IN 462045108 990 2013-01-01 344428794 FLOWER HOSPITAL FLOW 4198241819 5200 HARROUN RD SYLVANIA OH 43560 NEERAJ K KANWAL MD PRESIDENT 4198241819 2014-11-13 1 SAMANTHA BOKORI P01057347 3174648600 2014-10-27 2013 2015-11-30 17:44:51Z PROMEDICA FLOWER HOSPITAL NEERAJ K KANWAL MD 5200 HARROUN RD SYLVANIA OH 43560 586288848 0 X WWW.PROMEDICA.ORG X 1907 OH FLOWER HOSPITAL IS AN ACUTE CARE FACILITY AND REFERRAL CENTER, PROVIDING INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO THE GENERAL PUBLIC OF NORTHWEST OHIO AND SOUTHEAST MICHIGAN. 23 19 1782 226 0 0 1543551 1483576 217385540 207974023 18583402 17170500 6650375 8521075 244162868 235149174 15964961 17084844 0 0 91696052 102308599 0 0 0 99161395 98505388 206822408 217898831 37340460 17250343 497855756 564506781 70318171 72437878 427537585 492068903 X AS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC., WE ARE A VALUABLE COMMUNITY RESOURCE PROVIDING COMPREHENSIVE HEALTH SERVICES WITH EXPERTISE AND COMPASSION, AND IMPROVING THE HEALTH OF THOSE WE SERVE THROUGH PREVENTION, EDUCATION AND SUPERIOR SERVICE. 0 0 166486722 17084844 206343917 FLOWER HOSPITAL IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. - SEE SCHEDULE O. 9108534 CONSISTENT WITH OUR MISSION, FLOWER HOSPITAL PROVIDES A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO PATIENTS WITH LIMITED OR NO ABILITY TO PAY. - SEE SCHEDULE O. 8942039 3458308 CONSISTENT WITH OUR MISSION, FLOWER HOSPITAL PROVIDES A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT INCLUDING COMMUNITY HEALTH IMPROVEMENT SERVICES, SUBSIDIZED HEALTH SERVICES, HEALTH PROFESSIONS EDUCATION, RESEARCH, AND CASH AND IN-KIND CONTRIBUTIONS. - SEE SCHEDULE O. 184537295 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 1 1 1 0 0 0 0 0 1 1 1 0 0 1 113 0 1 1782 1 0 0 0 0 0 0 0 0 0 0 X 23 19 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 1 0 OH X BRIAN HANSEN 4198918505 5901 MONCLOVA RD MAUMEE OH 43537 MARY M ARQUETTE TRUSTEE 1.00 0.00 X 0 0 0 RICHARD W BALHOFF TRUSTEE 1.00 0.00 X 0 0 0 MARK S BARNES TRUSTEE 1.00 0.00 X 0 0 0 JOHN H BOGGS TRUSTEE 1.00 0.00 X 0 0 0 RICHARD J BRUNNER TRUSTEE 1.00 0.00 X 0 0 0 BETH ANN CARR EX OFFICIO 1.00 0.00 X 0 0 0 JAMES R FINDLAY SR TRUSTEE 1.00 0.00 X 0 0 0 KATHLEEN L FISCHER TRUSTEE 1.00 0.00 X 0 0 0 DAVID W GREENBERG TRUSTEE 1.00 0.00 X 0 0 0 ROBERT E HEISLER TRUSTEE 1.00 0.00 X 0 0 0 JENNIFER M KRANZ TRUSTEE 1.00 0.00 X 0 0 0 DAVID J LIVINGSTON PHD TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL D MCPHEE MD TRUSTEE 1.00 40.00 X 0 396285 42579 BOYD R MONTGOMERY TRUSTEE 1.00 0.00 X 0 479 0 HENRY H NADDAF MD TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM C NOWICKI TRUSTEE 1.00 0.00 X 0 0 0 JAMES E RAVAS TRUSTEE 1.00 0.00 X 0 0 0 JASON M ROBERTSON TRUSTEE 1.00 0.00 X 0 0 0 KESARI B SARIKONDA MD TRUSTEE 1.00 0.00 X 43877 10874 0 JAMES R SAUTTER TRUSTEE 1.00 0.00 X 0 0 0 AGHA SHAHID MD TRUSTEE 1.00 0.00 X 0 0 0 JOSEPH F STOCKDALE TRUSTEE 1.00 0.00 X 0 0 0 KEITH A WALKER TRUSTEE 1.00 0.00 X 0 0 0 AUDREY M WARRICK TRUSTEE 1.00 0.00 X 0 0 0 DOUGLAS J WELCH TRUSTEE 1.00 0.00 X 0 0 0 ALAN M SATTLER PRESIDENT, EX OFFICIO 1.00 44.00 X X 0 368665 70139 JAMES D ARMSTRONG CHAIRPERSON 1.00 1.00 X X 0 0 0 KATHLEEN S HANLEY TREASURER 0.50 51.50 X 0 700133 104802 JEFFREY C KUHN SECRETARY 0.50 51.00 X 0 521270 73952 DARRIN ARQUETTE VP, FH 40.00 0.00 X 0 169779 37716 SCOTT FOUGHT VP, FINANCE 0.50 40.50 X 0 160361 36807 MAURINE WEIS VP PATIENT CARE, FH 40.00 0.00 X 0 180415 32774 JAMES BURNS SENIOR MEDICAL PHYSICIST 40.00 0.00 X 209591 0 56343 QIN-SHENG CHEN SENIOR MEDICAL PHYSICIST 40.00 0.00 X 238898 0 32489 JEANINE HUTTNER PROGRAM DIR. PRACTICE RESIDENCY 40.00 0.00 X 237143 0 56471 DAVID WALLER AVP PHARMACY 40.00 0.00 X 172480 0 40296 JOHN ZONA ASSOC. DIR. PRACTICE RESIDENCY 40.00 0.00 X 198512 10680 48521 KEVIN C WEBB PHD FORMER OFFICER 0.00 45.00 X 0 483405 52701 GARY AKENBERGER FORMER KEY EMPLOYEE 0.00 44.50 X 0 336133 72295 PAMELA JENSEN FORMER KEY EMPLOYEE 0.00 40.00 X 0 249044 39044 RANDALL SCHIMMOELLER FORMER KEY EMPLOYEE 0.00 42.00 X 0 295577 35607 1100501 3883100 832536 33 1 1 0 RUDOLPH LIBBE INC 6494 LATCHA RD WALBRIDGE OH 434659738 CONSTRUCTION SERVICES 3778185 SPIEKER CO 8350 FREMONT PIKE PERRYSBURG OH 43551 CONSTRUCTION SERVICES 1392987 TOLEDO CLINIC INC 4235 SECOR RD TOLEDO OH 43623 PHYSICIAN SERVCES 961756 LATHROP COMPANY INC 460 WEST DUSSEL DRIVE MAUMEE OH 435374205 CONSTRUCTION SERVICES 487135 HKS INC 1919 MCKINNEY AVE DALLAS TX 75201 ARCHITECTURAL DESIGN 408979 25 1298186 74310 111080 1483576 NET PATIENT SERVICES 622110 207372201 207372201 AFFIL. ORG. RENT. REV. 531120 601822 601822 207974023 6935147 6935147 332648 0 332648 332648 332648 361071691 66200 350663858 238680 10407833 -172480 10235353 10235353 306778 237136 69642 69642 PHARMACY/DRUGS 446110 3985716 3985716 EHR INCENTIVE 900099 2430024 2430024 CAFETERIA/DIETARY 722514 1068774 1068774 634271 634271 8118785 235149174 209802225 0 23863373 17084844 17084844 43877 13877 30000 81822520 65213336 16609184 3038681 2182522 856159 12030046 9443069 2586977 5373475 4294499 1078976 316218 316218 211063 211063 18584 18584 1347455 1347455 13392882 10440096 2952786 511127 450749 60378 2279825 1419182 860643 3348369 3013532 334837 3797718 3341036 456682 392535 177717 214818 1266845 1266845 12411881 8295474 4116407 1979771 1781794 197977 DRUGS 26337816 26337816 0 0 MEDICAL SUPPLIES 15969250 15958177 11073 0 INTERCOMPANY SERVICES 7279675 7247540 32135 0 FOOD 2421239 2421239 0 0 5223135 4153951 1069184 217898831 184537295 33361536 0 7419769 8643666 28082919 28868517 3882599 3806947 1228541 1125203 188604416 131956575 54652521 56647841 364862829 422727013 335667 412785 37390911 42274809 497855756 564506781 16802993 15927888 53515178 56509990 70318171 72437878 X 393308048 451952544 16922726 20682909 17306811 19433450 427537585 492068903 497855756 564506781 X 17250343 41340121 5940854 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18584 18584 0 PART II-B, LINE 1: FLOWER HOSPITAL PAYS DUES TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION - A PORTION OF WHICH IS ALLOCABLE TO LOBBYING BY THE ASSOCIATIONS. 17306811 2126639 19433450 16469781 837030 17306811 15594725 1700000 -824944 16469781 14808234 786491 15594725 12547509 2260725 14808234 1.00000 1 1 1 521173 521173 64321843 46192289 18129554 382713 382713 0 938924 593787 345137 122439763 84787786 37651977 56647841 DEFERRED COSTS 318025 DUE FROM AFFILIATES 537403 GRANT/RESEARCH FUNDS 115102 BENEFICIAL INTEREST IN FOUNDATION 40001257 OTHER RECEIVABLES 1303022 42274809 DUE TO AFFILIATES 11049078 ESTIMATED THIRD PARTY SETTLEMENTS PAYABLE 5922012 INTEREST RATE SWAP 340242 INTERCOMPANY DEBT TO THE TOLEDO HOSPITAL 36607215 ASBESTOS REMEDIATION 1603812 MALPRACTICE TAIL LIABILITY 987631 56509990 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT FLOWER HOSPITAL CONSISTENT WITH DONOR INTENT. PART X, LINE 2: FLOWER HOSPITAL 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, 2013 AND 2012. FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012, A TAXABLE SUBSIDIARY OF PHS RECOGNIZED A LIABILITY FOR UNCERTAIN TAX POSITIONS OF $1,059,000 AND $1,552,000, RESPECTIVELY. THE SUBSIDIARY RECOGNIZED A CREDIT FOR INTEREST AND PENALTIES WITHIN THE INCOME TAX EXPENSE LINE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS RELATED TO UNRECOGNIZED TAX BENEFITS OF $20,000 AND $117,000 AS OF DECEMBER 31, 2013 AND 2012, RESPECTIVELY. FLOWER HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2013 AND 2012. 1 1 X 1 X 1 X 1 1 0 1 1 5674866 5674866 0.02600 24020677 20641416 3379261 0.01550 61001 6594 54407 0.00020 29756544 20648010 9108534 0.04170 548082 548082 0.00250 6302020 2788807 3513213 0.01610 1975364 579431 1395933 0.00640 108878 90070 18808 0.00010 7695 7695 0.00000 8942039 3458308 5483731 0.02510 38698583 24106318 14592265 0.06680 1 10554993 488441 45389852 51066309 -5676457 X 1 1 1 PROMEDICA CARDIOVASCULAR CO-MANAGEMENT CO LLC PHYSICIAN SERVICES 0.05450 0.01360 0.55680 2 PROMEDICA ORTHOPEDIC CO-MANAGEMENT CO LLC PHYSICIAN SERVICES 0.10640 0.28720 3 PROMEDICA SURGICAL SERVICES CO-MANAGEMENT CO LLC PHYSICIAN SERVICES 0.13210 0.30190 1 1 FLOWER HOSPITAL 5200 HARROUN RD SYLVANIA OH 43560 WWW.PROMEDICA.ORG 1227 X X X X FLOWER HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X WWW.PROMEDICA.ORG/CHNA X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X 1 1 X X X 1 0 X X X X 1 X 0 0 FLOWER HOSPITAL PART V, SECTION B, LINE 3: FLOWER HOSPITAL (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 LUCAS COUNTY, 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:- AMERICAN CANCER SOCIETY - EXCHANGE CLUB - FAMILY & CHILDREN FIRST COUNCIL - LUCAS COUNTY EDUCATIONAL SERVICE CENTER - LUCAS COUNTY HELP ME GROW- LUCAS COUNTY JUVENILE COURT - MENTAL HEALTH AND RECOVERY SERVICES BOARD OF LUCAS COUNTY- MERCY HEALTH PARTNERS - PARISH NURSE ASSOCIATION - SUSAN G. KOMEN BREAST CANCER FOUNDATION - TOLEDO COMMUNITY FOUNDATION - TOLEDO-LUCAS COUNTY HEALTH DEPARTMENT - SYLVANIA SCHOOLS - UNITED WAY OF GREATER TOLEDO- UNIVERSITY OF TOLEDO - UNIVERSITY OF TOLEDO MEDICAL CENTER- YMCA FLOWER HOSPITAL PART V, SECTION B, LINE 7: FLOWER HOSPITAL WILL SPECIFICALLY IMPLEMENT PROGRAMS TO ADDRESS THE FOLLOWING HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - CANCER SCREENINGS - SKIN, BREAST AND COLORECTAL- MENTAL HEALTH - DEPRESSION/ANXIETY AND DRUG/ALCOHOL USE- CARDIOVASCULAR HEALTH - STROKE- OBESITY/HUNGER INITIATIVES- ALZHEIMER'S DISEASEFLOWER HOSPITAL 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 HAS, OR PARTICIPATES IN, COMMUNITY OUTREACH PROGRAMS ADDRESSING THESE ISSUES):- HEALTH STATUS - ADDRESSED AT PHYSICIAN VISITS; MINORITY HEALTH COALITION*, HEALTHY LUCAS COUNTY*- HEALTH CARE COVERAGE - TOLEDO LUCAS COUNTY CARENET*; PARAMOUNT HEALTH CARE*- HEALTH CARE ACCESS - TOLEDO LUCAS COUNTY CARENET*; - CARDIOVASCULAR HEALTH - PROMEDICA HEART & VASCULAR INSTITUTE; PROMEDICA WELLNESS; AMERICAN HEART ASSOCIATION*; SYLVANIA EXPO*; BEDFORD BUSINESS ASSOCIATION*; COMMUNITY STROKE WORKSHOP*; WESTGATE CHAPEL WORKSHOP*; SENIOR SAFETY DAY AT TOLEDO POLICE DEPARTMENT*- DIABETES - PROMEDICA DIABETES EDUCATION- ASTHMA - ADDRESSED AT PHYSICIAN VISITS- ALCOHOL USE - ADDRESSED AT PHYSICIAN VISITS- SUBSTANCE ABUSE - ADDRESSED AT PHYSICIAN VISITS- WOMEN'S HEALTH - ADDRESSED AT PHYSICIAN VISITS; NORTHWEST OHIO KOMEN*- MEN'S HEALTH - ADDRESSED AT PHYSICIAN VISITS; AFRICAN AMERICAN MALE WELLNESS WALK*- MENTAL HEALTH - ADDRESSED AT PHYSICIAN VISITS; PROMEDICA DEPRESSION SCREENINGS; NATIONAL ALLIANCE ON MENTAL ILLNESS; UNIVERSITY CHURCH HEALTH FAIR*; ELEANOR KAHLE SENIOR CENTER*; SUICIDE COALITION WORKSHOP*; RADIO PROGRAM ON SENIOR SENSE*; CHRYSLER EMPLOYEE HEALTH FAIR*; EPWORTH UNITED METHODIST CHURCH PRESENTATION*- PREVENTIVE SCREENINGS AND IMMUNIZATIONS - ADDRESSED AT PHYSICIAN VISITS; KOMEN*; TOLEDO LUCAS COUNTY MINORITY HEALTH COALITION*- SEXUAL BEHAVIOR - ADDRESSED AT PHYSICIAN VISITS- PERCEIVED QUALITY OF LIFE - YOUTH SAFETY - PROMEDICA SAFE KIDS- YOUTH VIOLENCE - PROMEDICA TEEN PEP- YOUTH PERCEPTIONS - ORAL HEALTH - DENTAL CENTER OF NORTHWEST OHIO*; TOLEDO LUCAS COUNTY HEALTH DEPARTMENT- EARLY CHILDHOOD (0-5 YEARS) ISSUES - LUCAS COUNTY EARLY CHILDHOOD COMMITTEE- MIDDLE CHILDHOOD (6-11 YEARS) ISSUES - PUBLIC AND PAROCHIAL SCHOOLS- FAMILY FUNCTIONING - NEIGHBORHOOD AND COMMUNITY CHARACTERISTICS - LIVEWELL TOLEDO*- PARENTAL HEALTHTO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOST IMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OF RESOURCES MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITY ORGANIZATIONS AND COALITIONS. 6 FLOWER HOSP TOTAL REHAB 5150 HARROUN RD SYLVANIA OH 43560 PHYSICAL THERAPY TOTAL REHAB AT BEDFORD 2000 W DEAN RD TEMPERANCE MI 48182 PHYSICAL THERAPY FAMILY PHYSICIAN ASSOCIATION 5300 HARROUN RD SUITE 304 SYLVANIA OH 43560 FAMILY MEDICINE CENTER TOTAL REHAB AT SPRING MEADOWS 6855 SPRING VALLEY DR SUITE 155 HOLLAND OH 43528 PHYSICAL THERAPY SPORTSCARE AT PROFESSIONAL PARK 4848 HOLLAND-SYLVANIA RD SUITE 202 SYLVANIA OH 43560 PHYSICAL THERAPY PROMEDICA HEARING CENTER 5300 HARROUN RD SUITE 218 SYLVANIA OH 43560 AUDIOLOGY PART I, LINE 6A: FLOWER HOSPITAL REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE PROMEDICA HEALTH SYSTEM, INC. ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: FLOWER HOSPITAL 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: FLOWER HOSPITAL'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: FLOWER HOSPITAL ESTIMATED THE POSSIBLE AMOUNT OF CHARITY CARE 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 HEALTHCARE OBLIGATED GROUP COMBINED 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, MANDATED BY THE FEDERAL GOVERNMENT, FOR THOSE WHO WOULD OTHERWISE BE UNINSURED AFTER AGING OUT OF TRADITIONAL MEANS OF HEALTH INSURANCE, SUCH AS THAT 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.FLOWER HOSPITAL USED THE MEDICARE ALLOWABLE COSTS PER ITS 2013 AS-FILED MEDICARE COST REPORTS, LESS ANY ADJUSTMENTS FOR SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION, IF NECESSARY. 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, SUCH AS SERVICES AND CLINICS. 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. 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 COMPLETE, 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, OR RESPONDED TO REQUESTS FOR ADDITIONAL INFORMATION. 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: HEART DISEASE, CANCERS, AND STROKE, 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 CARDIOVASCULAR DISEASE, CANCERS AND 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 NEUROLOGY. PART VI, LINE 3: THE OPPORTUNITY FOR FINANCIAL ASSISTANCE ADJUSTMENTS IS COMMUNICATED TO PATIENTS AT ALL 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. ALL ADMITTING LOCATIONS WILL HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE. 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: FLOWER HOSPITAL, LOCATED IN SYLVANIA, OHIO, SERVES AN AREA PRIMARILY AROUND LUCAS COUNTY WITH A POPULATION OF APPROXIMATELY 619,000. APPROXIMATELY, 15% OF THE SERVICE AREA IS AGE 65 OR OVER; 39% IS BETWEEN AGE 35 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $43,000; 43% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER; 59% OF HOUSEHOLDS HAVE AN INCOME OF $50,000 OR LESS. LUCAS COUNTY HAS A POPULATION OF APPROXIMATELY 438,000 WITH APPROXIMATELY 11% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 26% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 15% OF LUCAS COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE FOR LUCAS COUNTY IN 2013 WAS 8.0%. THE LEADING CAUSES OF DEATH IN THE SERVICE AREA, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, STROKE, DIABETES, CANCER, ALZHEIMER'S, LUNG DISEASE, AND UNINTENTIONAL INJURIES/ACCIDENTS. ACCORDING TO 2014 COUNTY HEALTH RANKINGS, LUCAS COUNTY RANKED 68 OF 88 COUNTIES FOR HEALTH OUTCOMES, 59 OF 88 FOR MORTALITY, AND 71 OF 88 FOR MORBIDITY. THERE ARE FOURTEEN HOSPITALS WITHIN A SIX COUNTY AREA AROUND SYLVANIA, HERRICK MEMORIAL HOSPITAL, INC., EMMA L. BIXBY MEDICAL CENTER, FULTON COUNTY HEALTH CENTER, COMMUNITY HOSPITALS AND WELLNESS CENTERS - ARCHBOLD, THE TOLEDO HOSPITAL, ST. ANNE MERCY HOSPITAL, ST. VINCENT MERCY MEDICAL CENTER, ST. CHARLES MERCY HOSPITAL, BAY PARK COMMUNITY HOSPITAL, UNIVERSITY OF TOLEDO MEDICAL CENTER, ST. LUKE'S HOSPITAL, MERCY MEMORIAL-MONROE, WOOD COUNTY HOSPITAL, AND HENRY COUNTY HOSPITAL. PART VI, LINE 5: IN 2013, THERE WERE 453 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA). 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 67 PHYSICIANS, FROM NORTHWEST OHIO AND SOUTHEAST MICHIGAN; ALL TRUSTEES RESIDE WITHIN PROMEDICA'S SERVICE REGION IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN. - 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 2013, PROMEDICA BOARD MEMBERS GAVE APPROXIMATELY 13,590 HOURS IN SERVICE TO THE ORGANIZATION, WHICH EQUATES TO AN ESTIMATED CONTRIBUTION OF MORE THAN $975,000 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.- PROMEDICA PHYSICIANS, WHICH CONSISTS OF APPROXIMATELY 550 PHYSICIANS AND MIDLEVEL PROVIDERS, INTRODUCED ITS NEW PATIENT PORTAL AT ALL PRIMARY CARE AND SPECIALIST PRACTICES. THE PORTAL IS A FREE AND SECURE PLATFORM FOR PATIENTS TO SCHEDULE APPOINTMENTS, MONITOR HEALTH RECORDS AND OBTAIN CERTAIN LAB TEST RESULTS FROM THE CONVENIENCE OF THEIR PERSONAL COMPUTER. - THROUGH PROMEDICA'S ACADEMIC RELATIONSHIP WITH THE UNIVERSITY OF TOLEDO (UT), THE ACADEMIC HEALTH CENTER'S BIOREPOSITORY COLLECTED NEARLY 200 BLOOD AND TISSUE SAMPLES DONATED BY PATIENTS TO ADVANCE RESEARCH IN AREAS OF NEW TREATMENTS, PREVENTION AND CURES FOR CANCER, DIABETES, ALZHEIMER'S DISEASE AND OTHER MEDICAL CONDITIONS. - THE PROMEDICA ADVOCACY FUND PROVIDED GRANTS TOTALING NEARLY $400,000 TO MORE THAN A DOZEN NONPROFIT ORGANIZATIONS, HELPING THEM PROVIDE FOOD, CLOTHING AND SHELTER TO AT-RISK INDIVIDUALS IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN.- BASED ON RESULTS FROM ITS COMMUNITY HEALTH ASSESSMENTS, PROMEDICA ADVOCACY SPONSORED A SERIES OF PUBLIC SERVICE ANNOUNCEMENTS RELATED TO TOBACCO USE AND SMOKING CESSATION. LOCAL DENTIST LAUREN CZERNIAK, PROMEDICA RESPIRATORY THERAPIST AND TOBACCO TREATMENT SPECIALIST LINDA MORRIS, AND NICK VITUCCI, HEAD COACH OF THE TOLEDO WALLEYE HOCKEY TEAM, COVERED VARIOUS TOPICS RELATED TO SMOKING AND TOBACCO USE. THE SPOTS AIRED OVER SEVERAL MONTHS ON MULTIPLE BUCKEYE CABLE-TV CHANNELS DURING THE FIRST HALF OF 2013.- CONTINUING ITS INITIATIVE TO FIGHT CHILDHOOD OBESITY, PROMEDICA LAUNCHED A PILOT PROGRAM FOR CHILDREN AND ADOLESCENTS WITH A BODY MASS INDEX (BMI) THAT CLASSIFIES THEM AS OBESE. FAMILIES BEGAN MEETING QUARTERLY OVER A 12-MONTH PERIOD WITH A DIETITIAN IN A PHYSICIAN'S OFFICE OR OUTPATIENT CLINIC TO RECEIVE NUTRITION COUNSELING AND ASK QUESTIONS. EACH CHILD'S BMI AND RESPONSES TO A HEALTH QUESTIONNAIRE WILL BE COMPARED BEFORE, DURING AND AFTER THE 12-MONTH PERIOD TO DETERMINE THE PROGRAM'S EFFECTIVENESS.- AS PART OF ITS HUNGER-FREE INITIATIVE, PROMEDICA ESTABLISHED A FOOD RECLAMATION PROGRAM IN PARTNERSHIP WITH HOLLYWOOD CASINO (ROSSFORD, OHIO), AS WELL AS PROMEDICA FLOWER AND TOLEDO HOSPITALS, WHICH PROVIDED MORE THAN 70,000 POUNDS OF REPACKAGED, UNSERVED FOOD TO COMMUNITY FEEDING SITES.- PROMEDICA BEGAN CONSTRUCTION OF THE 55,000 SQUARE FOOT MARY ELLEN FALZONE DIABETES CENTER, WHICH WILL BRING DIABETES PROGRAMS, SERVICES AND PHYSICIANS TOGETHER, PROVIDING COORDINATED CARE IN ONE CONVENIENT LOCATION TO SERVE COMMUNITY MEMBERS LEARNING TO MANAGE THEIR DIABETES.- PROMEDICA CONTINUING CARE SERVICES CORPORATION, THROUGH PROMEDICA HOME CARE, IN PARTNERSHIP WITH PARAMOUNT, BEGAN OFFERING TELEHEALTH MONITORING SERVICES TO ELIGIBLE HOME-CARE PATIENTS TO HELP REDUCE HOSPITAL READMISSIONS BY CAREFUL DAILY MONITORING OF VITAL STATISTICS, NUTRITION AND MEDICATION ADHERENCE.- PROMEDICA ALSO OFFERED FREE VASCULAR SCREENINGS FOR OLDER ADULTS THROUGH JOBST VASCULAR CENTER TO AID IN THE DETECTION OF VASCULAR DISEASE, WHICH MAY LEAD TO STROKE OR PERIPHERAL ARTERIAL DISEASE. APPROXIMATELY 8,000 ADDITIONAL HEALTH SCREENINGS WERE PROVIDED TO COMMUNITY MEMBERS THROUGHOUT 2013, INCLUDING BLOOD PRESSURE, BLOOD GLUCOSE AND BODY MASS INDEX SCREENINGS AT NUMEROUS HEALTH FAIRS AND SPORTING EVENTS. ADDITIONALLY, THE PROMEDICA CANCER INSTITUTE OFFERED FREE SKIN CANCER AND PROSTATE CANCER SCREENINGS FOR THE GENERAL PUBLIC AT PROMEDICA HOSPITALS. 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 2013, PROMEDICA WAS COMPRISED OF NEARLY 15,000 EMPLOYEES, APPROXIMATELY 2,200 VOLUNTEERS AND MORE THAN 1,800 HEALTHCARE PROVIDERS, INCLUDING MORE THAN 550 PROVIDERS EMPLOYED BY PROMEDICA PHYSICIANS, 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; TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART 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; ST. LUKE'S HOSPITAL D/B/A PROMEDICA ST. LUKE'S HOSPITAL; PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL; PROMEDICA INSURANCE CORPORATION; PROMEDICA PHYSICIANS, A NETWORK OF SYSTEM-EMPLOYED PHYSICIANS AND MIDLEVEL PROVIDERS; PROMEDICA CONTINUING CARE SERVICES, WITH SERVICES SUCH AS SENIOR CARE, HOSPICE, REHABILITATION, AND HOME CARE; AND THE ACADEMIC HEALTH CENTER CORPORATION, WITH MEDICAL RESIDENCY PROGRAMS IN FAMILY MEDICINE, SPORTS CARE, VASCULAR SURGERY, AND PHARMACOLOGY.- IN 2013, PROMEDICA MANAGED MORE THAN 4 MILLION PATIENT ENCOUNTERS AND CONTRIBUTED A TOTAL COMMUNITY BENEFIT OF NEARLY $130 MILLION, WHICH INCLUDED FREE HEALTH SCREENINGS AND PUBLIC HEALTH FAIRS TO MEDICAL LECTURES AT AREA SENIOR CENTERS AND IN ELEMENTARY SCHOOLS, PLUS MUCH MORE.- IN ADDITION, THE PROMEDICA ADVOCACY FUND ASSISTED LOCAL NONPROFIT AGENCIES WITH SIMILAR MISSIONS THROUGH DONATIONS TOTALING NEARLY $400,000. AS IN PRIOR YEARS, EMPHASIS WAS PLACED ON ORGANIZATIONS WORKING TO ENSURE BASIC NEEDS 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, MONTHLY, BIWEEKLY AND ANNUAL PROGRAMS WERE OFFERED THROUGHOUT 2013 FOR CONTINUING MEDICAL EDUCATION CREDIT. MORE THAN 1,570 CREDIT HOURS OF PHYSICIAN EDUCATION WERE OFFERED. THERE WERE APPROXIMATELY 6,600 PHYSICIANS WHO PARTICIPATED IN EDUCATIONAL PROGRAMS, AND NEARLY 11,000 NON-PHYSICIANS (I.E., ALLIED HEALTH PROFESSIONALS).- PROMEDICA LAUNCHED ITS HEALTH CONNECT WEBSITE TO HELP PROVIDE HEALTH AND WELLNESS INFORMATION, NEWS AND COMMUNITY PROGRAMS AND SERVICES, AND INTERESTING HEALTH RELATED GUIDELINES TO COMMUNITY MEMBERS IN A CONVERSATIONAL, INTERACTIVE AND ENGAGING FORMAT. - PROMEDICA'S FOUNDATIONS RAISED NEARLY $8 MILLION FOR PHILANTHROPY IN SUPPORT OF THE SYSTEM'S MISSION TO IMPROVE HEALTH AND WELL-BEING. ALL OF PROMEDICA'S FOUNDATIONS ARE SEPARATE ORGANIZATIONS, AND ANNUAL DONOR PROGRAMS, CAPITAL CAMPAIGNS, PLANNED GIVING, AND EVENT FUNDRAISING ACTIVITIES ARE CONDUCTED TO RAISE FUNDS THAT SUPPORT THEIR RESPECTIVE PATIENTS AND FAMILIES, AS WELL AS THE LOCAL COMMUNITY, THROUGH HEALTH-RELATED PROGRAMS, SERVICES, EQUIPMENT, AND FACILITY CONSTRUCTION/RENOVATION THAT HAVE BEEN IDENTIFIED, IN PART, THROUGH A COMMUNITY NEEDS ASSESSMENT. - IN 2013, PROMEDICA FURTHER ENHANCED ITS RELATIONSHIP WITH THE CLEVELAND CLINIC BY SIGNING A MEMORANDUM OF UNDERSTANDING TO DEVELOP A HEALTH SYSTEM AFFILIATION THAT WILL ALLOW THE TWO ORGANIZATIONS TO CREATE A CLINICALLY ALIGNED NETWORK FOCUSED ON PROVIDING HIGH-QUALITY, COST-EFFECTIVE AND TECHNOLOGICALLY ADVANCED CLINICAL SERVICES IN THEIR RESPECTIVE COMMUNITIES. 1 PROMEDICA HEALTH SYSTEM INC 1801 RICHARDS ROAD TOLEDO OH 43607 341517671 501(C)(3) 6875000 OPERATING GRANT PROMEDICA PHYSICIAN GROUP 5855 MONROE STREET SYLVANIA OH 43560 341899439 501(C)(3) 6125000 OPERATING GRANT PROMEDICA CONTINUING CARE SERVICES CORPORATION 5855 MONROE STREET SYLVANIA OH 43560 374492440 501(C)(3) 3575000 OPERATING GRANT PROMEDICA FOUNDATION 2142 NORTH COVE BLVD TOLEDO OH 43606 341517672 501(C)(3) 487309 OPERATING GRANT LOURDES UNIVERSITY 6832 COVENT BLVD SYLVANIA OH 43560 341226547 501(C)(3) 22535 ACADEMIC PROGRAM DONATION 5 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. 0 1 0 0 0 0 0 0 0 MICHAEL D MCPHEE MD TRUSTEE 0 379421 0 0 0 16864 0 17000 0 25579 0 438864 0 0 ALAN M SATTLER PRESIDENT, EX OFFICIO 0 254760 0 75691 0 38214 0 47884 0 22255 0 438804 0 0 KATHLEEN S HANLEY TREASURER 0 460254 0 196212 0 43667 0 89856 0 14946 0 804935 0 0 JEFFREY C KUHN SECRETARY 0 355991 0 144956 0 20323 0 52946 0 21006 0 595222 0 0 DARRIN ARQUETTE VP, FH 0 123784 0 38161 0 7834 0 17370 0 20346 0 207495 0 10577 SCOTT FOUGHT VP, FINANCE 0 148267 0 3000 0 9094 0 18851 0 17956 0 197168 0 0 MAURINE WEIS VP PATIENT CARE, FH 0 144210 0 30594 0 5611 0 14803 0 17971 0 213189 0 0 JAMES BURNS SENIOR MEDICAL PHYSICIST 198336 0 500 0 10755 0 37324 0 19019 0 265934 0 0 0 QIN-SHENG CHEN SENIOR MEDICAL PHYSICIST 233316 0 500 0 5082 0 16868 0 15621 0 271387 0 0 0 JEANINE HUTTNER PROGRAM DIR. PRACTICE RESIDENCY 225709 0 10000 0 1434 0 35590 0 20881 0 293614 0 0 0 DAVID WALLER AVP PHARMACY 164727 0 500 0 7253 0 29883 0 10413 0 212776 0 0 0 JOHN ZONA ASSOC. DIR. PRACTICE RESIDENCY 191905 10680 5000 0 1607 0 24506 0 24015 0 247033 10680 0 0 KEVIN C WEBB PHD FORMER OFFICER 0 375870 0 97758 0 9777 0 40158 0 12543 0 536106 0 0 GARY AKENBERGER FORMER KEY EMPLOYEE 0 224600 0 79130 0 32403 0 49671 0 22624 0 408428 0 0 PAMELA JENSEN FORMER KEY EMPLOYEE 0 179183 0 65981 0 3880 0 23883 0 15161 0 288088 0 25115 RANDALL SCHIMMOELLER FORMER KEY EMPLOYEE 0 208818 0 62744 0 24015 0 22966 0 12641 0 331184 0 0 PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF FLOWER HOSPITAL, 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 4B ALL EMPLOYEES AND AMOUNTS LISTED ARE VOLUNTARY DEFERRALS OR COMPANY CONTRIBUTIONS TO VARIOUS NON-QUALIFIED 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. NO PAYMENTS WERE MADE TO LISTED PERSONS IN PART VII UNDER THE VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE YEAR. SEE PART V SEE PART V 151256 SEE PART V 0 SEE PART V SEE PART V 961756 SEE PART V 0 SEE PART V SEE PART V 27605 SEE PART V 0 SEE PART V SEE PART V 30000 SEE PART V 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: AGHA SHAHID, MD, INC.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:AGHA SHAHID, MD (TRUSTEE) IS GREATER THAN 35% OWNER OF AGHA SHAHID, MD, INC.(C) AMOUNT OF TRANSACTION: $151,256(D) DESCRIPTION OF TRANSACTION: PSYCHIATRIC SERVICES; CHIEF OF STAFF RESPONSIBILITIES.(E) SHARING OF ORGANIZATION REVENUES? = NO SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: TOLEDO CLINIC, INC.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:HENRY H. NADDAF, MD (TRUSTEE) IS AN OFFICER OF TOLEDO CLINIC, INC.(C) AMOUNT OF TRANSACTION: $961,756(D) DESCRIPTION OF TRANSACTION: PHYSICIAN SERVICES(E) SHARING OF ORGANIZATION REVENUES? = NO SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: MATTHEW WAGNER(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:MATTHEW WAGNER IS A FAMILY MEMBER OF MAURINE WEIS (KEY EMPLOYEE).(C) AMOUNT OF TRANSACTION: $27,605(D) DESCRIPTION OF TRANSACTION: EMPLOYMENT(E) SHARING OF ORGANIZATION REVENUES? = NO SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: KESARI B. SARIKONDA, MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:KESARI B. SARIKONDA, MD IS A BOARD MEMBER OF FLOWER HOSPITAL.(C) AMOUNT OF TRANSACTION: $30,000(D) DESCRIPTION OF TRANSACTION: FLOWER HOSPITAL IS IN A JOINT VENTURE WITH KESARI B. SARIKONDA, MD AND OTHERS.(E) SHARING OF ORGANIZATION REVENUES? = NO FORM 990, PART VI, SECTION A, LINE 6 AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF FLOWER HOSPITAL. AS THE MEMBER, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF FLOWER HOSPITAL, 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 THE RESPECTIVE COMPANY'S PRESIDENT 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 ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL SALARIED EMPLOYEES ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE WITHIN 30 DAYS OF NOTIFICATION. 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, COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT, AND A LIST OF ALL NEW EMPLOYEES HIRED DURING THE PREVIOUS 12 MONTHS. 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. FORM 990, PART VI, SECTION B, LINE 15 FLOWER HOSPITAL'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF FLOWER HOSPITAL'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: BENEFICIAL INTEREST IN FOUNDATIONS 5,940,854. FORM 990, PART IV, LINE 24A: FLOWER HOSPITAL IS A HEALTH FACILITY THAT IS A SUBSIDIARY OF PROMEDICA HEALTH SYSTEM, INC. (PHS). FLOWER HOSPITAL HOLDS AN INTERCOMPANY NOTE PAYABLE TO THE TOLEDO HOSPITAL, WHICH IS ALSO A SUBSIDIARY OF PHS. THE NOTE PAYABLE REPRESENTS FLOWER HOSPITAL'S PORTION OF 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. AND SUBSIDIARIES (PHS) INCLUDE PROVISIONS TO PROTECT PHS' 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 - STATEMENT OF 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 2013 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 320 SITES, MORE THAN 1,800 PHYSICIANS AND APPROXIMATELY 15,000 EMPLOYEES AND VOLUNTEERS. DURING 2013, PROMEDICA DISCHARGED 69,357 INPATIENTS AND SERVED MORE THAN 1,394,807 OUTPATIENTS, WHILE HANDLING 269,606 EMERGENCY VISITS SYSTEM-WIDE. AMONG THE REGION'S LARGEST EMPLOYERS, PROMEDICA PLAYS A SIGNIFICANT ROLE IN ECONOMIC DEVELOPMENT AND STABILITY IN OUR REGION. DURING 2013, FOR EVERY ONE DOLLAR OF REVENUE, ANOTHER 33 CENTS WAS CREATED IN OUR SERVICE-AREA ECONOMY, WITH A TOTAL ECONOMIC OUTPUT OF $3.01 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. ADDITIONALLY, OUR PHYSICIANS, LEADERSHIP TEAM MEMBERS AND EMPLOYEES INDIVIDUALLY CONTRIBUTE PERSONAL RESOURCES TO THE COMMUNITY IN NUMEROUS WAYS - SUCH AS THROUGH TUTORING ELEMENTARY STUDENTS IN READING, 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); FLOWER HOSPITAL; FOSTORIA HOSPITAL ASSOCIATION; DEFIANCE HOSPITAL, INC.; BAY PARK COMMUNITY HOSPITAL; HERRICK MEMORIAL HOSPITAL, INC.; EMMA L. BIXBY MEDICAL CENTER; PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL (A DIVISION OF THE TOLEDO HOSPITAL); AND ST. LUKE'S HOSPITAL. IN 2013, 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 MORE THAN 550 HEALTHCARE PROVIDERS, INCLUDING PRIMARY CARE, OBSTETRICS AND SPECIALTY PHYSICIANS, AS WELL AS ADVANCED PRACTICE PROVIDERS; THEY HELP PROMEDICA TO BROADEN THE CARE WE OFFER AREA RESIDENTS, INCLUDING IN SMALLER, OUTLYING COMMUNITIES. - PROMEDICA INSURANCE CORPORATION, THE LARGEST HEALTH MAINTENANCE ORGANIZATION PHYSICALLY LOCATED IN NORTHWEST OHIO. IN 2013, PARAMOUNT ADVANTAGE BEGAN PROVIDING MEDICAID COVERAGE IN ALL OF OHIO'S 88 COUNTIES. TO SUPPORT THESE EFFORTS PARAMOUNT OPENED FIELD OFFICES IN CLEVELAND, COLUMBUS AND THE CINCINNATI/DAYTON AREA. - ACADEMIC HEALTH CENTER CORPORATION, AN ACADEMIC RELATIONSHIP BETWEEN PROMEDICA AND THE UNIVERSITY OF TOLEDO, CONTINUED TO PROMOTE RESEARCH AND EDUCATION THROUGHOUT THE REGION. PROMEDICA HAS ADDITIONAL ACADEMIC RELATIONSHIPS WITH NUMEROUS OTHER INSTITUTIONS INCLUDING THE UNIVERSITY OF MICHIGAN, MICHIGAN STATE UNIVERSITY, AND THE WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE. - 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. 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 LOCAL NONPROFIT AGENCIES AND ORGANIZATIONS IN 2013 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 2013 INCLUDE THE FOLLOWING: - PROMEDICA SPONSORED A SCHOOL-BASED FOOD DRIVE CHALLENGE AS PART OF ITS COME TO THE TABLE INITIATIVE. SCHOOLS RAISED MORE THAN 17,000 POUNDS OF NON-PERISHABLE FOOD ITEMS FOR COMMUNITY FOOD PROGRAMS ACROSS PROMEDICA'S SERVICE AREA. - PROMEDICA'S SUMMER YOUTH EMPLOYMENT PROGRAM PARTNERED 70 CENTRAL-CITY TEENS AGES 16 19 WITH MENTORS IN DEPARTMENTS SUCH AS HUMAN RESOURCES, RADIOLOGY, DIETARY, AND INFORMATION TECHNOLOGY TO LEARN SKILLS INCLUDING CUSTOMER SERVICE, PUNCTUALITY AND BEING ACCOUNTABLE TO OTHERS. - PROMEDICA SYSTEM GRANTS SUBMITTED AN APPLICATION FOR $24 MILLION OVER THREE YEARS TO THE CMS HEALTH CARE INNOVATION AWARDS, ROUND 2. THE PROPOSED POPULATION HEALTH MODEL INTEGRATES EVIDENCE-BASED CLINICAL PROGRAMS AND COMMUNITY SERVICES INCLUDING EDUCATION AND OUTREACH, WELLNESS AND PREVENTION, SOCIAL SUPPORT SERVICES, CASE AND DISEASE MANAGEMENT, HOME CARE COORDINATION AND TELEMEDICINE, CLINICAL PHARMACY - MEDICATION ADHERENCE, AND CARE NAVIGATION AS MEANS FOR IMPROVING COMMUNITY HEALTH AND WELL-BEING. - PROMEDICA FURTHER ENHANCED ITS RELATIONSHIP WITH CLEVELAND CLINIC IN 2013, SIGNING A MEMORANDUM OF UNDERSTANDING TO DEVELOP A HEALTH SYSTEM AFFILIATION THAT WILL ALLOW THE TWO ORGANIZATIONS TO CREATE A CLINICALLY ALIGNED NETWORK FOCUSED ON PROVIDING HIGH-QUALITY, COST-EFFECTIVE AND TECHNOLOGICALLY ADVANCED CLINICAL SERVICES. - PROMEDICA CONTINUED ITS INITIATIVE TO FIGHT OBESITY BY INTRODUCING A PILOT PROGRAM FOR CHILDREN AND ADOLESCENTS WITH A BODY MASS INDEX (BMI) THAT CLASSIFIES THEM AS OBESE. FAMILIES MEET QUARTERLY OVER A 12-MONTH PERIOD WITH A DIETITIAN IN A PHYSICIAN'S OFFICE OR OUTPATIENT CLINIC TO RECEIVE NUTRITION COUNSELING AND ASK QUESTIONS. EACH CHILD'S BMI AND RESPONSES TO A HEALTH QUESTIONNAIRE WILL BE COMPARED BEFORE, DURING AND AFTER THE 12-MONTH PERIOD TO DETERMINE THE PROGRAM'S EFFECTIVENESS. - COORDINATED THROUGH OUR ADVOCACY DEPARTMENT, PROMEDICA CONTINUED TO PROVIDE HEALTH AND NUTRITION EDUCATION TO ELEMENTARY SCHOOL CHILDREN IN GRADES 1 - 6. THE HEALTHY KIDS CONVERSATION MAP(R) PROGRAM IS DESIGNED TO EMPOWER STUDENTS AND THEIR PARENTS/GUARDIANS TO MAKE HEALTHY CHOICES ABOUT FOOD AND EXERCISE. - PROMEDICA PHYSICIANS EXPANDED CARE TO BETTER COVER LOCAL AND RURAL COMMUNITIES, ADDING 88 NEW PRIMARY CARE PHYSICIANS AND SPECIALISTS IN 2013. - PROMEDICA PARTICIPATED IN DOZENS OF COMMUNITY HEALTH FAIRS THAT INCLUDED APPROXIMATELY 8,000 FREE PUBLIC SCREENINGS FOR HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, BODY MASS INDEX AND BONE DENSITY. - AS PART OF ITS HUNGER-FREE INITIATIVE, PROMEDICA ESTABLISHED A FOOD RECLAMATION PROGRAM IN PARTNERSHIP WITH HOLLYWOOD CASINO (ROSSFORD, OHIO), AS WELL AS THE TOLEDO AND FLOWER HOSPITALS, PROVIDING MORE THAN 70,000 POUNDS OF REPACKAGED, UN-SERVED FOOD TO COMMUNITY FEEDING SITES. - PROMEDICA CANCER INSTITUTE'S COMMUNITY OUTREACH INCLUDED SCREENINGS FOR SKIN AND PROSTATE CANCERS, THE FOURTH ANNUAL SURVIVOR CELEBRATION FOR CANCER SURVIVORS, FRIENDS AND CAREGIVERS, AND SPONSORSHIP OF THE ANNUAL SUSAN G. KOMEN RACE(R) FOR THE CURE IN SUPPORT OF BREAST CANCER RESEARCH. - 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 NEARLY $400,000 IN 2013. - PROMEDICA BEGAN CONSTRUCTION OF THE 55,000 SQUARE FOOT MARY ELLEN FALZONE DIABETES CENTER. OPENING IN 2014, THE FACILITY IS NAMED FOR A YOUNG GIRL WHO DIED FROM JUVENILE DIABETES BEFORE HER FAMILY EVEN KNEW SHE HAD THE DISEASE. LOCATED ON THE CAMPUS OF THE TOLEDO HOSPITAL, IT WILL BRING DIABETES PROGRAMS, SERVICES AND PHYSICIANS TOGETHER IN ONE CONVENIENT LOCATION TO SERVE ALL COMMUNITY MEMBERS WORKING TO MANAGE THEIR DIABETES. - FLOWER HOSPITAL BEGAN RENOVATIONS TO ADD PRIVATE PATIENT ROOMS FOR INPATIENTS AND EXPAND ITS PSYCHIATRIC CARE UNIT. - PROMEDICA CONTINUING CARE SERVICES CORPORATION, IN PARTNERSHIP WITH PARAMOUNT INSURANCE, BEGAN OFFERING TELEHEALTH MONITORING SERVICES TO ELIGIBLE HOME-CARE PATIENTS TO REDUCE HOSPITAL READMISSIONS BY CAREFUL DAILY MONITORING OF VITAL STATISTICS, NUTRITION AND MEDICATION ADHERENCE. - WITH OTHER COMMUNITY PARTNERS, PROMEDICA INTRODUCED THE WITNESS TO HUNGER PHOTO EXHIBIT AT THE TOLEDO MUSEUM OF ART. PHOTOS WERE TAKEN BY INDIVIDUALS FACING HUNGER IN THEIR DAILY LIVES TO DEMONSTRATE ITS IMPACT ON FAMILIES, CHILDREN AND OLDER ADULTS IN OUR COMMUNITY. - BAY PARK COMMUNITY HOSPITAL, EMMA L. BIXBY MEDICAL CENTER, FLOWER HOSPITAL, ST. LUKE'S HOSPITAL, THE TOLEDO HOSPITAL, TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF THE TOLEDO HOSPITAL), AND WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL (A DIVISION OF THE TOLEDO HOSPITAL) SUCCESSFULLY COMPLETED THE 90-DAY REPORTING PERIOD TO VERIFY ADOPTION OF ELECTRONIC HEALTH RECORDS (EHRS). BESIDES IMPROVING BOTH CARE AND CARE COORDINATION, EHRS ARE EXPECTED TO ENSURE ADEQUATE PRIVACY AND SECURITY FOR PERSONAL HEALTH INFORMATION. THEY ALSO AIM TO REDUCE HEALTH DISPARITIES AND IMPROVE POPULATION AND PUBLIC HEALTH. - PROMEDICA PHYSICIANS INTRODUCED ITS NEW PROMEDICA PATIENT PORTAL AT ALL PRIMARY CARE AND SPECIALIST PRACTICES. THE PATIENT PORTAL IS A FREE AND SECURE PLATFORM FOR PATIENTS TO SCHEDULE APPOINTMENTS, MONITOR HEALTH RECORDS, AND OBTAIN CERTAIN LAB TEST RESULTS FROM THE CONVENIENCE OF THEIR OWN HOME COMPUTER. - PROMEDICA PHYSICIANS OPENED PROMEDICA AFTERHOURS IN PERRYSBURG, PROVIDING RESIDENTS WITH DIAGNOSIS AND TREATMENT FOR NON-EMERGENCY MEDICAL ISSUES AS WELL AS PRESCRIPTION SERVICES. PROVIDING NEW OPTIONS FOR MEDICAL CARE WHEN PHYSICIAN OFFICES NORMALLY ARE CLOSED, AFTERHOURS IS STAFFED BY PROMEDICA PHYSICIANS CERTIFIED NURSE PRACTITIONERS AND IS OPEN NIGHTS, WEEKENDS AND HOLIDAYS 365 DAYS A YEAR. - PROMEDICA EMPLOYEES PLEDGED MORE THAN $500,000 TO THE UNITED WAY CAMPAIGN IN 2013, SUPPORTING NUMEROUS COMMUNITY PROGRAMS AND SERVICES ACROSS NORTHWEST OHIO AND SOUTHEAST MICHIGAN. - PROMEDICA COLLABORATED WITH TOLEDO PUBLIC SCHOOLS' TOLEDO EARLY COLLEGE HIGH SCHOOL (TECHS) TO DEVELOP CURRICULUM FOR STUDENTS INTERESTED IN HEALTHCARE CAREERS AS PART OF THE STEMM (SCIENCE, TECHNOLOGY, ENGINEERING, MATHEMATICS, AND MEDICINE) PROGRAM. IN 2013, PROMEDICA CONTRIBUTED $129,920,000 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, COMMUNITY BUILDING ACTIVITIES, AND OTHER COMMUNITY BENEFIT OPERATIONS, PROMEDICA CONTRIBUTED $45,598,000 IN 2013. 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; COLLEGE SCHOLARSHIPS FOR STUDENTS ENTERING HEALTHCARE CAREERS; AND MANY OTHER COMMUNITY-BASED INITIATIVES. PROMEDICA ALSO CONTRIBUTED $30,212,000 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 2013 WAS $27,571,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $129,920,000 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 2013, PROMEDICA PROVIDED $54,110,000 OF COMMUNITY BENEFIT THROUGH THE COST - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID PATIENTS. PROMEDICA'S TOTAL COST - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS DURING 2013 WAS $93,196,000 AND IS NOT REFLECTED IN THE COMMUNITY BENEFIT AMOUNT OF $129,920,000 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. FLOWER HOSPITAL - PROGRAM SERVICE ACCOMPLISHMENTS FLOWER HOSPITAL (D/B/A PROMEDICA FLOWER HOSPITAL) IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 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 CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. A 311-BED FACILITY IN SYLVANIA, OHIO, PROMEDICA FLOWER HOSPITAL (FH) HAS 1,469 EMPLOYEES WHO PROVIDE EXTENSIVE HEALTHCARE SERVICES SUCH AS EMERGENCY MEDICINE; INPATIENT REHABILITATION; SURGICAL SERVICES; CARDIAC AND PULMONARY REHABILITATION; INPATIENT ADULT PSYCHIATRIC CARE; LABOR AND DELIVERY; INPATIENT AND OUTPATIENT ONCOLOGY SERVICES; AND A FULL RANGE OF DIAGNOSTIC, LABORATORY AND RADIOLOGY SERVICES. THE FH CAMPUS ALSO IS HOME TO SENIOR AND ASSISTED-LIVING FACILITIES, INCLUDING LAKE PARK, THE GOERLICH CENTER AND EBEID HOSPICE RESIDENCE. ADDITIONAL SERVICES ARE OFFERED THROUGH TERTIARY CARE BY THE TOLEDO HOSPITAL AND TOLEDO CHILDREN'S HOSPITAL. STRIVING TO IMPROVE PATIENT CARE AND CLINICAL EXCELLENCE, FH IS CERTIFIED AS A PRIMARY STROKE CENTER BY THE JOINT COMMISSION. ADDITIONALLY, IN 2013 FH RECEIVED THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES (R) STROKE GOLD PLUS PERFORMANCE ACHIEVEMENT AWARD FOR DEMONSTRATING A COMMITMENT TO IMPROVED CARE FOR STROKE PATIENTS. FH ALSO OPENED ITS NEW INTENSIVE CARE UNIT/INTERMEDIATE CRITICAL CARE UNIT ON THE RENOVATED 4TH FLOOR. THE UNIT CONSISTS OF FOUR ICU ROOMS AND 16 INTERMEDIATE CRITICAL CARE ROOMS, PROVIDING A TOTAL OF 20 ADDITIONAL PRIVATE ROOMS TO HELP PATIENTS HEAL IN A QUIETER, PATIENT-CENTERED ENVIRONMENT. FH SERVED 11,233 INPATIENTS AND 168,853 OUTPATIENTS IN 2013. FURTHER, 33,074 INDIVIDUALS SOUGHT EMERGENCY CARE AT FH. THE HOSPITAL CONTRIBUTED $14,592,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE. THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH ACTIVITIES, CASH AND IN-KIND CONTRIBUTIONS, AND OTHER COMMUNITY BENEFIT OPERATIONS, FH CONTRIBUTED $5,484,000 TO THE COMMUNITY DURING 2013. INCLUDED IN THIS AMOUNT ARE ACTIVITIES AND PROGRAMS SUCH AS: - A VARIETY OF MEDICAL SEMINARS PROVIDED FOR FH'S FAMILY MEDICINE RESIDENTS, AS WELL AS FOR THE COMMUNITY; - VARIOUS HEALTH SCREENINGS AT THE HOSPITAL AND ACROSS THE COMMUNITY, INCLUDING BLOOD PRESSURE, BLOOD GLUCOSE AND SKIN CANCER SCREENINGS; - DONATIONS TO NONPROFIT ORGANIZATIONS AND EVENT SPONSORSHIP GRANTS TO COMMUNITY ACTIVITIES THROUGHOUT SYLVANIA AND THE SURROUNDING AREA; - SPONSORSHIP OF SIX AMERICAN RED CROSS BLOOD DRIVES ON CAMPUS THROUGHOUT THE YEAR TO ASSIST WITH COMMUNITY AND PATIENT BLOOD NEEDS; - A SURVIVORSHIP PROGRAM AND SURVIVOR CENTER THROUGH THE HICKMAN CANCER CENTER AT FH FOR CANCER SURVIVORS, WHICH HELPS PROMOTE FOLLOW-UP CARE AND COMPLIANCE WITH ONGOING SURVEILLANCE, AS WELL AS CANCER SUPPORT GROUPS; - SUPPORT GROUPS FOR PATIENTS AND COMMUNITY MEMBERS UNDERGOING CANCER TREATMENT OR FACED WITH FEEDING DISORDERS; - FREE, PUBLIC ACCESS TO FH'S EXTENSIVE MEDICAL LIBRARY; AND - A BREAST CARE CENTER PROGRAM THAT ROUTINELY ASSISTS WOMEN WHO ARE UNINSURED AND UNDERINSURED, TO HELP ENSURE MAMMOGRAMS AND BREAST CANCER EDUCATION ARE AVAILABLE TO ALL INDIVIDUALS NEEDING CARE. FH PROVIDED A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO THE COMMUNITY DURING 2013, OF WHICH $5,675,000 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. FH'S COST OF BAD DEBT FOR 2013 WAS $2,244,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $14,592,000 NOTED ABOVE. FURTHER, FH PROVIDED $3,433,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID PATIENTS. ALSO IN 2013, THE TOTAL COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS WAS $14,102,000 AND IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $14,592,000 NOTED ABOVE. DURING 2013, FH EXPENDED $51,137,000 IN NET PAYROLL, PROVIDING 1,469 JOBS IN NORTHWEST OHIO. A TOTAL OF $3,082,000 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES. IN SUMMARY, FH 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 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 (THE SYSTEM) 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 THE SYSTEM RESPOND TO AN IDENTIFIED COMMUNITY NEED AND MEET AT LEAST ONE OF THE FOLLOWING CRITERIA: - IMPROVE ACCESS TO HEALTHCARE SERVICE. - ENHANCE THE HEALTH OF THE COMMUNITY. - ADVANCE MEDICAL OR HEALTHCARE KNOWLEDGE. - RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS. FINANCIAL ASSISTANCE CONSISTENT WITH ITS MISSION, THE SYSTEM 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. THE SYSTEM 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 THE SYSTEM'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 THE SYSTEM. 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 INTERNSHIPS AND RESIDENCY EDUCATION, THE PROVISION OF A CLINICAL SETTING FOR UNDERGRADUATE/VOCATIONAL TRAINING FOR STUDENTS OUTSIDE THE ORGANIZATION, AND FUNDING FOR EDUCATION THAT IS LINKED TO COMMUNITY SERVICES AND HEALTH IMPROVEMENT. 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 PATIENT DEMAND. RESEARCH RESEARCH ACTIVITIES INCLUDE CLINICAL AND COMMUNITY HEALTH RESEARCH, AS WELL AS STUDIES ON HEALTHCARE DELIVERY. THE AMOUNT REPORTED FOR THE SYSTEM 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/OR THE COMMUNITY AT LARGE. IN-KIND SERVICES INCLUDE HOURS DONATED BY STAFF TO THE COMMUNITY WHILE ON WORK TIME; AS WELL AS DONATION OF FOOD, EQUIPMENT AND SUPPLIES. 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