ADENA HEALTH SYSTEM: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: ADENA HEALTH SYSTEM (EIN 31-4379443)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-11-15
IRS object ID: 201233209349303753
Schema version: 2011v1.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule G
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-15T10:42:14-07:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	314379443	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ADENA HEALTH SYSTEM	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	ADEN	NameControl
Phone	7407794478	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	272 HOSPITAL ROAD	AddressLine1
City	CHILLICOTHE	City
State	OH	State
ZIP Code	456019031	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Keith T Coleman	Name
Title	CFO	Title
Phone	7407794273	Phone
Date Signed	2012-11-15	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Mark Shuter	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	272 Hospital Road	AddressLine1
City	Chillicothe	City
State	OH	State
ZIP Code	45601	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	379585231	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.ADENA.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1895	YearFormation
State Legal Domicile	OH	StateLegalDomicile
Activity Or Mission Description	"To Heal, To Educate, To Care". The Organization is a regional healthcare system with 1 hospital and several ambulatory centers, in addition to multiple physician practices. AHS offers a wide scope of diagnostic and rehabilitative services both for inpatients and outpatients, including comprehensive cardiology and cancer care.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	2194	TotalNbrEmployees
Total Nbr Volunteers	369	TotalNbrVolunteers
Total Gross UBI	11689	TotalGrossUBI
Net Unrelated Business Txbl Income	-7278	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	13748492	ContributionsGrantsPriorYear
Contributions Grants Current Year	4108646	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	360483761	ProgramServiceRevenuePriorYear
Program Service Revenue CY	366151182	ProgramServiceRevenueCY
Investment Income Prior Year	3840247	InvestmentIncomePriorYear
Investment Income Current Year	5646835	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1862741	OtherRevenuePriorYear
Other Revenue Current Year	1874178	OtherRevenueCurrentYear
Total Revenue Prior Year	379935241	TotalRevenuePriorYear
Total Revenue Current Year	377780841	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	126002	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	97223	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	187026318	SalariesEtcPriorYear
Salaries Etc Current Year	194995529	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	167743075	OtherExpensePriorYear
Other Expenses Current Year	184979996	OtherExpensesCurrentYear
Total Expenses Prior Year	354895395	TotalExpensesPriorYear
Total Expenses Current Year	380072748	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	25039846	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-2291907	RevenuesLessExpensesCY
Total Assets BOY	419282931	TotalAssetsBOY
Total Assets EOY	410696244	TotalAssetsEOY
Total Liabilities BOY	227217017	TotalLiabilitiesBOY
Total Liabilities EOY	227847622	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	192065914	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	182848622	NetAssetsOrFundBalancesEOY
Mission Description	"To Heal, To Educate, To Care" is the mission of Adena Health System. Adena Health System is a regional healthcare system providing a wide scope of services to a 13 county area in south-central Ohio.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	309026614	Expense
Grants	97223	Grants
Revenue	355752489	Revenue
Description	Health Care Programs, General/Other: Routine hospital services - Room and board testing and monitoring by various ancillary specialties, physical therapy and surgical services. There were 14,464 inpatients and 911,771 outpatients treated in 2011.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	4901053	Expense
Grants	0	Grants
Revenue	5638728	Revenue
Description	Emergency Services - Treatment of emergency accident and illness as well as less urgent conditions in the absence of a family physician. The number of visits in 2011 was 53,870.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	4081483	Expense
Grants	0	Grants
Revenue	4759965	Revenue
Description	The Hospice and Home Health departments provide medical care, medications, home health needs, bereavement counseling prescriptions, food and shelter to patients. There were 12,357 Hospice patient days in 2011.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	0	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	0	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	0	TotalOfOtherProgramServiceRev
Total Program Service Expense	318009150	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	1	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	1	InvestTaxExemptBonds
Escrow Account	1	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	1	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	125	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	2194	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	Dawn Bennett Johnson Int Controller	NamePerson
Telephone Number	7407794200	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	272 HOSPITAL ROAD	AddressLine1
City	CHILLICOTHE	City
State	OH	State
ZIP Code	456019031	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (38 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Deborah Barrington
Director/Chairman	2	X	0	0	0
Jack Berno
Employed M.D.	40	X	294408	0	12540
Steve Burkhardt
Director/Treasurer	2	X	0	0	0
Doug Folzenlogen
Employed M.D.	40	X	424165	0	17916
James Grove
Director	2	X	0	0	0
Chad Harris
Director	2	X	0	0	0
Ralph D'Antoni
Director	2	X	0	0	0
Mike Lilly
Director/Secretary	2	X	0	0	0
Gary Evans
Director	2	X	0	0	0
Mathew Schmidt
Director	2	X	0	0	0
Allen Shaw
Employed M.D.	40	X	222526	0	9864
Dave Strickland
Director/Vice Chairman	2	X	0	0	0
Tom White
Director	2	X	0	0	0
Noble Yoshida
Director	2	X	0	0	0
Keith Coleman
Chief Financial Officer	40		329191	0	44649	X
Mark Shuter
Chief Executive Officer	40		725632	0	44702	X
Karen Bolton
General Counsel	40		235228	0	30503		X
John Fortney
Chief Medical Officer	40		365412	0	21816		X
Jeff Graham
Chief Operating Officer	40		258796	0	38750		X
Denise Minor
Chief Nursing Officer	40		181872	0	28540		X
Barbara Purdom
Chief Operating Officer	40		152790	0	35844		X
Patricia Roam
Corporate Compliance Officer	40		155264	0	22990		X
Faitha Shelton
System Director Practice Operations	40		204185	0	40935		X
Elisabeth Williams
Chief Strategy Officer	40		217602	0	20065		X
Jack Baker
Employed M.D.	40		598284	0	17916		X
Wayne Coats
Employed M.D.	40		390471	0	17916		X
Martha Livingston
Chief Business Development Officer	40		150735	0	20993		X
Michele Federer
Employed M.D.	40		434472	0	5754		X
Satish Jetty
Employed M.D.	40		423608	0	17916		X
Mark Moffitt
Chief Information Officer	40		194741	0	14133		X
Eric Perdue
Chief Human Resources Officer	40		152791	0	12607		X
Kirk Tucker
Employed M.D.	40		266823	0	17916		X
Anthony Freeman
Employed M.D.	40		938441	0	17896		X
Rob Bradley
Employed M.D.	40		897642	0	24066			X
Brian Cohen
Employed M.D.	40		2587948	0	18691			X
James Fleming
Employed M.D.	40		896961	0	25466			X
Thomas Lewis
Employed M.D.	40		987347	0	24066			X
Kort Gronbach
Employed M.D.	40		838216	0	21916			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	13525551	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	626366	TotalOtherCompensation
Number Individuals GT100 K	221	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Kings Medical Company
PO Box 72483	Cleveland	OH	44192	MRI Services	2495475
Tatum LLC
PO BOX 847872	Dallas	TX	752847872	Staffing Services	2304309
The Pendleton Group Inc
200 Chartwell Pt Road	Seneca	SC	29672	Consulting	1199419
Premier Health Care Services Inc
332 Congress Park Drive	Dayton	OH	45459	ER coverage, house coverage	996324
Medical Doctor Associates
PO Box 277185	Atlanta	GA	303847185	Medical Staffing Services	554357

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	17	NumberOfContractorsGT100K
Federated Campaigns	0	FederatedCampaigns
Membership Dues	65445	MembershipDues
Fundraising Events	3000	FundraisingEvents
Related Organizations	3202905	RelatedOrganizations
Government Grants	253338	GovernmentGrants
All Other Contributions	583958	AllOtherContributions
Noncash Contributions	0	NoncashContributions
Total Contributions	4108646	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	Net Patient Service Revenue	Description
Business Code	622110	BusinessCode
Total Revenue Column	366151182	TotalRevenueColumn
Related Or Exempt Function Income	366151182	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	366151182	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	5782844	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$5,782,844	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	94150	Real
Personal	0	Personal

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	94150	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	94150	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$94,150	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	1443089	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	1579098	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	-136009	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-136009	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	-$136,009	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	79520	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	3000	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	99496	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	-19976	TotalRevenueColumn
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	-$19,976	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	147932	GrossSalesOfInventory
Cost Of Goods Sold	125796	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	22136	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$22,136	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue	ExclusionExclusionAmount
Food & Nutrition	622110	1246679	0	0	$1,246,679
Consulting Fees	622110	135984	135984	0	$0
All Other Revenue	622110	395205	0	11689	$383,516

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	1777868	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	377780841	TotalRevenueColumn
Related Or Exempt Function Income	366287166	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	11689	UnrelatedBusinessRevenue
Exclusion	$7,373,340	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	97223	Total
Program Services	97223	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	8026932	Total
Program Services	4410494	ProgramServices
Management And General	3616438	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	147470030	Total
Program Services	131828677	ProgramServices
Management And General	15641353	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	8354135	Total
Program Services	6482809	ProgramServices
Management And General	1871326	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	22175516	Total
Program Services	19086603	ProgramServices
Management And General	3088913	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	8968916	Total
Program Services	7691914	ProgramServices
Management And General	1277002	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	29383186	Total
Program Services	21877063	ProgramServices
Management And General	7506123	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	807060	Total
Management And General	807060	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	120000	Total
Management And General	120000	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	1722	Total
Management And General	1722	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1762453	Total
Program Services	13865	ProgramServices
Management And General	1748588	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	381935	Total
Program Services	284893	ProgramServices
Management And General	97042	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	142407	Total
Program Services	17385	ProgramServices
Management And General	125022	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	4111963	Total
Program Services	1915865	ProgramServices
Management And General	2196098	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	1848656	Total
Program Services	1227805	ProgramServices
Management And General	620851	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	9019457	Total
Program Services	6999099	ProgramServices
Management And General	2020358	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	18417236	Total
Program Services	11194064	ProgramServices
Management And General	7223172	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	2575008	Total
Program Services	2454503	ProgramServices
Management And General	120505	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Operating Supplies	59821112	59499211	321901
Provision for Bad Debt	32710711	32710711	0
Repair, Maintenance & Rental	17025563	6125529	10900034
Taxes	2760090	0	2760090

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	4091437	Total
Program Services	4091437	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	380072748	Total
Program Services	318009150	ProgramServices
Management And General	62063598	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	11632	BOY
EOY	10848	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	77635482	BOY
EOY	75912428	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	4565558	BOY
EOY	4554026	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	47965899	BOY
EOY	44303899	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	6449362	BOY
EOY	5582037	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	2951771	BOY
EOY	3046536	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	342858768	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	186859504	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	143789834	BOY
EOY	155999264	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	127550069	BOY
EOY	114131981	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	8363324	BOY
EOY	7155225	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	419282931	BOY
EOY	410696244	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	30848157	BOY
EOY	32054059	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	179713947	BOY
EOY	178919218	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	0	BOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	16654913	BOY
EOY	16874345	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	227217017	BOY
EOY	227847622	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	191651223	BOY
EOY	182286137	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	414691	BOY
EOY	562485	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	192065914	BOY
EOY	182848622	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	419282931	BOY
EOY	410696244	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	-2291907	ReconcilationRevenueExpenses
Reconcilation Other Changes	-6925385	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$1,722	OtherActivitiesAmount
Total Lobbying Expenditures IIB	1722	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	SchC_P2B_S00_L01	Identifier
Return Reference	Schedule C, Part II-B, Line 1	ReturnReference
Explanation	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.	Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	979299	BeginningOfYearBalance
Contributions	48900	Contributions
Investment Earnings Or Losses	30021	InvestmentEarningsOrLosses
Grants Or Scholarships	7757	GrantsOrScholarships
Other Expenditures	0	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	1050463	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	859540	BeginningOfYearBalance
Contributions	50593	Contributions
Investment Earnings Or Losses	101333	InvestmentEarningsOrLosses
Grants Or Scholarships	32167	GrantsOrScholarships
Other Expenditures	0	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	979299	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	762259	BeginningOfYearBalance
Contributions	170668	Contributions
Investment Earnings Or Losses	85016	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	158403	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	859540	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	615256	BeginningOfYearBalance
Contributions	263999	Contributions
Investment Earnings Or Losses	641	InvestmentEarningsOrLosses
Grants Or Scholarships	18520	GrantsOrScholarships
Other Expenditures	99117	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	762259	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	1	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	1	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	1	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	2393357	OtherCostOrOtherBasis
Book Value	2393357	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	147803589	OtherCostOrOtherBasis
Depreciation	51828712	Depreciation
Book Value	95974877	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	10308569	OtherCostOrOtherBasis
Depreciation	10021569	Depreciation
Book Value	287000	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	154582477	OtherCostOrOtherBasis
Depreciation	120424628	Depreciation
Book Value	34157849	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	27770776	OtherCostOrOtherBasis
Depreciation	4584595	Depreciation
Book Value	23186181	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	155999264	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
Defined Benefit Plan Liability	$9,630,427
Accrued Malpractice Insurance Long-term	$7,243,918

Field	Value	IRS element (for citing)
Total Of Amounts	16874345	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	SchD_P05_S00_L04	Identifier
Return Reference	Schedule D, Part V, Line 4	ReturnReference
Explanation	Adena Health Foundation Endowment Funds are used to provide scholarships and offset operating expenses of PACCAR Medical Education Center.	Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	Charity Ball	NameOfEvent1
Gross Receipts Event1	15787	GrossReceiptsEvent1
Charitable Contributions Event1	3000	CharitableContributionsEvent1
Gross Revenue Event1	12787	GrossRevenueEvent1
Cash Prizes Event1	0	CashPrizesEvent1
Non Cash Prizes Event1	0	NonCashPrizesEvent1
Rent Facility Costs Event1	1325	RentFacilityCostsEvent1
Food And Beverage Event1	1898	FoodAndBeverageEvent1
Entertainment Event1	0	EntertainmentEvent1
Other Direct Expenses Event1	30413	OtherDirectExpensesEvent1
Name Of Event2	Plant Sale	NameOfEvent2
Gross Receipts Event2	66733	GrossReceiptsEvent2
Charitable Contributions Event2	0	CharitableContributionsEvent2
Gross Revenue Event2	66733	GrossRevenueEvent2
Cash Prizes Event2	0	CashPrizesEvent2
Non Cash Prizes Event2	0	NonCashPrizesEvent2
Rent Facility Costs Event2	0	RentFacilityCostsEvent2
Food And Beverage Event2	0	FoodAndBeverageEvent2
Entertainment Event2	0	EntertainmentEvent2
Other Direct Expenses Event2	65860	OtherDirectExpensesEvent2
Total Number Of Other Events	0	TotalNumberOfOtherEvents
Gross Receipts Total	82520	GrossReceiptsTotal
Charitable Contributions Total	3000	CharitableContributionsTotal
Gross Revenue Total Events	79520	GrossRevenueTotalEvents
Cash Prizes Total Events	0	CashPrizesTotalEvents
Non Cash Prizes Total Events	0	NonCashPrizesTotalEvents
Rent Facility Costs Total Events	1325	RentFacilityCostsTotalEvents
Food And Beverage Total Events	1898	FoodAndBeverageTotalEvents
Entertainment Total Events	0	EntertainmentTotalEvents
Other Direct Expenses Total Events	96273	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	99496	DirectExpenseSummaryEvents
Net Income Summary	-19976	NetIncomeSummary

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	20418512	TotalCommunityBenefitExpense
Direct Offsetting Revenue	4761170	DirectOffsettingRevenue
Net Community Benefit Expense	15657342	NetCommunityBenefitExpense
Percent Of Total Expense	0.045	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	68156834	TotalCommunityBenefitExpense
Direct Offsetting Revenue	40022850	DirectOffsettingRevenue
Net Community Benefit Expense	28133984	NetCommunityBenefitExpense
Percent Of Total Expense	0.0808	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	88575346	TotalCommunityBenefitExpense
Direct Offsetting Revenue	44784020	DirectOffsettingRevenue
Net Community Benefit Expense	43791326	NetCommunityBenefitExpense
Percent Of Total Expense	0.1258	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	880827	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	880827	NetCommunityBenefitExpense
Percent Of Total Expense	0.0025	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	98723	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	98723	NetCommunityBenefitExpense
Percent Of Total Expense	0.0003	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	979550	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	979550	NetCommunityBenefitExpense
Percent Of Total Expense	0.0028	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	89554896	TotalCommunityBenefitExpense
Direct Offsetting Revenue	44784020	DirectOffsettingRevenue
Net Community Benefit Expense	44770876	NetCommunityBenefitExpense
Percent Of Total Expense	0.1286	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$32,710,711	BadDebtExpenseAmount
Amount Attributable To	1635536	AmountAttributableTo
Amount Reimbursed By Medicare	67477769	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	59421722	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	8056047	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Adena Regional Medical Center	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	272 Hospital Rd	AddressLine1
City	Chillicothe	City
State	OH	State
ZIP Code	45601	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Adena Regional Medical Center	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	100	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	400	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
State Regulation	X	StateRegulation
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	0	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Notified All Patients	X	NotifiedAllPatients
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	15	NumberOfOtherFacilities

Other Facilities OtherFacilities (15 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
Adena Health Pavilion
4437 State Route 159	Chillicothe	OH	45601	Physician Offices
Adena Medical Office Building
4439 State Route 159	Chillicothe	OH	45601	Physician Offices
Adena Urgent Care
55 Centennial Blvd	Chillicothe	OH	45601	Ambulatory Care Center
Adena Health Center - Waverly
12340 State Route 104	Waverly	OH	45690	Ambulatory Care Center
Adena Health Center - Jackson
1000 Veterans Drive	Jackson	OH	45640	Ambulatory Care Center
Adena Home Care Services
111 W Water Street	Chillicothe	OH	45601	Home Health Care and Hospice
Adena Rehabilitation and Wellness Center
445 Shawnee Lane	Chillicothe	OH	45601	Outpatient Rehabilitation Center
Adena Family Medicine - Oak Hill
315 Washington Street	Oak Hill	OH	45656	Physician Offices
Adena Pickaway-Ross Family Physicians
100 N Walnut Street	Chillicothe	OH	45601	Physician Offices
Adena Family Medicine - Circleville
798 N Court Street	Circleville	OH	43113	Physician Offices
Adena Counseling Center
445 Shawnee Lane	Chillicothe	OH	45601	Mental Health Counseling
Adena Family Medicine of Chillicothe
626 Central Center	Chillicothe	OH	45601	Physician Offices
Adena Ross Urology
8 Medical Drive	Chillicothe	OH	45601	Physician Offices
Adena Family Medicine - Greenfield
536 Mirabeau Street	Greenfield	OH	45123	Physician Offices
Adena Family Medicine - Washington CH
308 Highland Avenue Suite C	Washington Court House	OH	43160	Physician Offices

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchH_P01_S00_L03c	Schedule H, Part I, Line 3c	We have inserted the wording from our 2011 audited consolidated financial statements that deals with charity care. "The System provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the System does not pursue collection of amounts determined to qualify as charity care, they are not reported as net patient revenue. Charity care is determined based on established policies, using patient income and assets to determine payment liability. The amount reflects the cost of free or discounted health services, net of contributions and other revenues received, as direct assistance for the provision of charity care."
SchH_P01_S00_L06a	Schedule H, Part I, Line 6a	Annually, Adena Health System provides a Community Benefit Report to the community of Chillicothe listing all system services and accomplishments including community benefit services.
SchH_P01_S00_L07	Schedule H, 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.
SchH_P01_S00_L072f	Schedule H, Part I, Line 7, Column f	Bad debt expense of $32,710,711 was deducted from total operating expenses when calculating the percentages in this column.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	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 believes that 5% of the bad debt expense in Part III, Line 2 are amounts that would be attributable to patients under the hospital's financial assistance policy. The 5% is only a rough estimate at this time. The system is reviewing options to better estimate this for 2012 activity. We do not have separate financial statements for Adena Health System. It is included in the consolidated statements. The billing for Adena Health System is centralized and billing and collection procedures are uniform between the two hospitals in the 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."
SchH_P03_S0B_L08	Schedule H, Part III, Section B, Line 8	The Medicare Advantage plan incurred a shortfall of $8,693,699 in 2011. Our service area is a very rural 13 county area in southern Ohio. The population is an aging population which results in Medicare as our largest payer group. In addition, the economic conditions that result from Appalachian designation create a recruiting issue. To combat this 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 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.
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	The system's collection based bad debt policy clearly states "if agencies identify accounts that qualify for charity care or financial assistance, they are to cease further collection activities and return accounts to Adena Health System for disposition.
SchH_P05_S0B_L19	Schedule H, Part V, Section B, Line 19	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. HCAP/charity adjustments are administered based on proof of income and the tables of the Federal Poverty Limits (FPL) in the following manner: 1. 100% write-off and HCAP eligible - less than 100% FPL 2. 90% write-off - between 101 - 150% of FPL 3. 75% write-off - between 151 - 250% of FPL 4. 50% write-off - between 251 - 350% FPL 5. 25% write-off between 351 - 400% FPL 6. 0% write-off - greater than 400% 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.
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	A recent study with the Ohio State University's College of Public Health's Center for Public Health Practice reflects the community health status of Adena Health System's service region. In addition, a study by Ohio University's Voinovich School of Leadership and Public Affairs developed a snapshot assessment of the communities served by Adena Health System. Adena also measures the needs of communities and populations based on applications it receives from area nonprofit organizations, including schools. The study's common findings show that those living in Adena's service region are among Ohio's most vulnerable populations. Our community faces unique health risks and barriers as a result of social status, human capital, social capital and risk. Many require special services and/or enhanced outreach. A serious threat to the overall health of people in Adena's service area is obesity. The majority of people in our service region are overweight or obese. Overweight and obese people are at a higher risk of developing conditions such as diabetes, hypertension and high cholesterol, among other conditions that lead to chronic disease. Children are at similar risk for health problems when overweight or obese, which could have a long term impact on their lives. The incidence of diabetes, cancer and heart disease are prominent in Adena's patient population. Mortality studies comparing Adena's service region to U.S., Ohio and peer county rates show death rates from cardiovascular disease and cancer are of concern. County Health Rankings data indicates that six of eight counties in the Adena service region rank in the bottom 25 percent in health outcomes. The majority of our community outreach efforts are focused on educating our patients on the importance of better healthcare, positive lifestyle decisions and disease prevention - and guiding them on their healthcare journey.
SchH_P06_S00_L03	Schedule H, 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% 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.
SchH_P06_S00_L04	Schedule H, Part VI, Line 4	Adena Health System serves the needs of more than 500,000 people in 13 counties in south-central Ohio.The following details the number of people in the Adena service region group by vulnerabilities 16.7% No high school diploma 12.2% Unemployed 3.1% Work disabled 6.1% Major depression 6.5% Recent drug user More than 18 percent of those living in Adena's service area live under poverty level averages, which range from 14.2 percent to 22.9 percent. The poverty rate for all of Ohio is 15.1 percent. A high proportion of Adena patients have no or limited health insurance coverage, these include: 9.6% Uninsured 16.6% Medicare beneficiaries 24.7% Medicaid beneficiaries Data shows that nearly 10 percent of Adena service region residents are uninsured. While slightly below the state average of 13 percent, this percentage may increase due to the economic climate and unemployment rates. Eight counties included in the report have been designated as Medically Underserved Areas and/or populations. These shortages may result in a lack of both preventive care and treatment services - factors that may contribute to the region's morbidity and mortality rates.
SchH_P06_S00_L05	Schedule H, Part VI, Line 5	Adena Health System serves nearly a half-million patients in Ohio's Appalachian region. Many people in the region struggle with obesity, diabetes and heart disease. In addition, poverty levels in the region are among the highest in the state. Many of our patients are in need financially and in terms of health coverage. Adena and its employees recognize the value of our healthcare services for those our communities, in addition to the variety of needs many of our patients have. To meet those needs, Adena and its employees participated in the following activities and services to enhance the health and well-being of the patients we serve. Hope Clinic: About 18 percent of Ross County residents, or nearly one-in-five, have no form of health insurance. To ensure access to health care, the Hope Clinic of Ross County was in development in 2011 (opening in January 2012). Adena was involved in the planning and preparation. Once open, Adena physicians and nurses will volunteer their time at the Clinic, providing free health care to those needing it the most. Adena (PACCAR) Medical Education Center: Basic First Aid and CPR courses provided to organizations within the region served by Adena Health System. The courses help educate the public about what they can do when faced with a medical emergency, until professional help arrives. Among those who have taken advantage of the courses are area organizations including: Big Brothers and Big Sisters, Kenworth Trucking, McDonald's Restaurants, Ross County Engineer's Office, Ross County Health Department and Southern Ohio Eye Surgery Center. In addition to First Aid and CPR courses, Adena's community course offerings include Advanced Cardiac Life Support and a Neonatal Resuscitation Program. Athletic Trainers: To ensure the safety and health of local teen athletes, Adena provides athletic trainers free-of-charge to seven high schools in four counties in its service region. Adena sports medicine physicians are available on Saturday morning's to evaluate local athletes' injuries. The Health System's athletic trainers also provide community educational programs, including rehabilitation and nutrition education, CPR classes and school sports physicals. In addition, our trainers provide free services at community events including: Gus Macker 3-on-3 tournament, OHSAA Baseball All-star tournament, and various other events. Employees Giving Back: Coats for Kids: For the fourth year, Adena employees raised hundreds of coats for children from low-income homes throughout our service region. More than 300 new or gently used coats were donated in 2011. Food Pantry Assistance: Adena's Strategy Division packed 700 bags of groceries (4,900 cans) at the Good Samaritan Food Pantry, as a way of helping the less fortunate in the area during Thanksgiving. The unemployment rate for the region is higher than average and the food pantry is crucial in feeding many families. Pediatric Auction: Staff of Adena Pediatrics held an in-house charity auction with proceeds going to needy children in the community. More than $1,600 was raised and donated to 15 children who were identified by the Salvation Army as having significant need. Raising Awareness of Sexual Violence: Adena partnered with the Ross County Sexual Assault Response Team to host "Take a Walk in Her Shoes" event to raise money and awareness to the problem of sexual violence in the region. $2,000 was raised to train volunteer sexual assault victim advocates. Free Mammograms: Hundreds of uninsured and underinsured women in Adena's service region received mammograms as part of the "A Promise to Keep" program. The Health System applied for grant funding to help cover some cost of the program, which is vital in finding breast cancer early. Women in Appalachia are typically diagnosed in more advanced stages of the disease, due to lack of insurance or education on the importance of mammography. Kid Shape: Obesity is a major health concern in Adena's service area. To help children and their families learn about eating healthy and lose weight, Adena dieticians teach the eight-week Kid Shape course. The Adena Health Foundation covers 2/3 of the cost of the program to ensure participation is not costly. Eighty-seven percent of KidShape participants lose weight and 80% of participants keep the weight off after two years. Adena Weigh: To combat obesity in our community, Adena sponsors a weight loss and lifestyle coaching program with a registered dietitian to improve the health of our patients and staff. A registered dietitian assesses the client's diet quality and makes recommendations for health improvement and weight loss. Patients learn their body mass index, waist circumference, health risks based on your eating habits, diet improvement and determine a weight loss goal. Donation to Open Community Pool: When the City of Chillicothe did not have the funds to open the community swimming pool, Adena stepped up with a $20,000 donation. Many in the community do not have the means to air condition their homes, and the pool serves as a way for families to stay cool in the hot weather, as well as offers the health benefits involved in swimming and being active. Community Education: Adena personnel participate in numerous health screenings and health education events to promote better health and lifestyle choices to those living in our service area. These include visits to schools, senior center, community organizations, and more. Healthcare Career Event: Adena hosts a healthcare career night for students in grades 7 through 12. At the event, colleges and universities present information about careers in healthcare and the curriculum available for students. Information presented in breakout sessions include: EMS, Medical Assistant, Medical Office, Medical Therapies, Non-Direct Patient Care, Nursing, Physician, Physician Assistant, Pharmacy, Radiology, Respiratory and Simulation - Virtual Hospital.
SchH_P06_S00_L06	Schedule H, 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 two hospitals and six regional clinics, with a total of 286 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. Adena Greenfield Medical Center: A critical access hospital and 25-bed inpatient facility in Greenfield, OH features an emergency department, inpatient rehabilitation unit and medical/surgical, diagnostic and treatment services, as well as family practice and specialty physicians, directly benefiting Highland County and 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 orthopaedics, 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'Blenness 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.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Method Of ValuationMethodOfValuation	Purpose Of GrantPurposeOfGrant
City of Chillicothe
35 S Paint Street	Chillicothe	OH	45601	316400221	501(c)(3)	20100	Book	Sponsorship of the community pool and DARE Run
Adena Mansion & Gardens Society
848 Adena Road	Chillicothe	OH	45601	271330314	501(c)(3)	10000	Book	Sponsorship to help manage the Adena historical mansion.
Chillicothe Education Foundation
45 East Main Street	Chillicothe	OH	45601	311480939	501(c)(3)	9000	Book	Sponsorship of the "Leader-in-Me" program for the Chillicothe City Schools.
South Central Ohio Big Brothers and Big Sisters
173 West Second Street	Chillicothe	OH	45601	310968026	501(c(3)	5207	Book	Sponsorship of community based program for volunteer mentors.

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	4	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	SchI_P01_S00_L02	Identifier
Return Reference	Schedule I, Part I, Line 2	ReturnReference
Explanation	Each grantee is required to submit 2 progress reports and a final report with an accounting for the use of funds. In addition to progress reports, Community Health staff visit each grantee at least twice during the project period. Summary reports are prepared for the for the Health System's Board of Trustees.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Payments	X	IdemnificationGrossUpPayments
Club Dues Or Fees	X	ClubDuesOrFees
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Compensation Committee	X	CompensationCommittee
Compensation Survey	X	CompensationSurvey
Severance Payment	1	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	1	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (27 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Jack Berno
292617	0	0	0	1791	0	0	0	14161	0	308569	0	0	0
Doug Folzenlogen
406788	0	9286	0	8091	0	0	0	19553	0	443718	0	0	0
Allen Shaw
221974	0	0	0	552	0	0	0	11070	0	233596	0	0	0
Mark Shuter
662349	0	31951	0	31332	0	24895	0	21537	0	772064	0	0	0
Keith Coleman
303600	0	22409	0	3182	0	24084	0	22295	0	375570	0	0	0
Jack Baker
597167	0	0	0	1117	0	0	0	19646	0	617930	0	0	0
Karen Bolton
203812	0	22207	0	9209	0	16700	0	15321	0	267249	0	0	0
Wayne Coats
382575	0	0	0	7896	0	0	0	19595	0	410066	0	0	0
Michele Federer
417675	0	0	0	16797	0	0	0	7433	0	441905	0	0	0
John Fortney
327547	0	21679	0	16186	0	0	0	23546	0	388958	0	0	0
Jeff Graham
235879	0	20096	0	2821	0	20497	0	19965	0	299258	0	0	0
Satish Jetty
400691	0	20096	0	2821	0	0	0	19581	0	443189	0	0	0
Denise Minor
167143	0	12440	0	2289	0	8625	0	21191	0	211688	0		0
Mark Moffitt
154547	0	0	0	40194	0	9287	0	5528	0	209556	0		0
Eric Perdue
146088	0	6591	0	112	0	11307	0	2311	0	166409	0	0	0
Barbara Purdom
124134	0	17322	0	11334	0	11391	0	26161	0	190342	0	0	0
Patricia Roam
130145	0	14566	0	10553	0	12100	0	11877	0	179241	0	0	0
Faitha Shelton
193609	0	10320	0	256	0	17691	0	24676	0	246552	0		0
Kirk Tucker
266594	0	0	0	229	0	0	0	19595	0	286418	0	0	0
Elisabeth Williams
12088	0	0	0	205514	0	0	0	20279	0	237881	0		0
Martha Livingston
139393	0	10844	0	498	0	8781	0	13234	0	172750	0	0	0
Brian Cohen
2570488	0	0	0	17460	0	0	0	20421	0	2608369	0	0	0
Thomas Lewis
963790	0	4359	0	19198	0	0	0	25796	0	1013143	0	0	0
Rob Bradley
880800	0	0	0	16842	0	0	0	25796	0	923438	0	0	0
James Fleming
886571	0	0	0	10390	0	0	0	25796	0	922757	0	0	0
Kort Gronbach
821265	0	0	0	16951	0	0	0	23646	0	861862	0		0
Anthony Freeman
928336	0	0	0	10105	0	0	0	19575	0	958016	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchJ_P01_S00_L01a	Schedule J, Part I, Line 1a	Adena Health System provides for a membership to the local Country Club for all Officers and Key Employees. This benefit is taxed.
SchJ_P01_S00_L04	Schedule J, Part I, Line 4	Elisabeth Williams was terminated as Chief Strategy Officer for Adena Health System in January 2011 and is being paid severance bi-weekly for 18 months.
SchJ_P01_S00_L06	Schedule J, Part I, Line 6	The Adena Health System Management Incentive Plan was established to communicate strategic performance priorities to the management team and to encourage the highest level of performance in the delivery of health care services. The Incentive Award is funded by an Incentive Pool based upon Margin Percentage recommended by Management and approved by the Executive Compensation Committee. The Incentive Pool shall be based upon the percentage of "salary at risk" and number of participants for each eligibility level. Prior to the beginning of each Plan Year, organizational goals shall be developed to support and further the accomplishments of the System's mission, strategic plan, financial goals and business outcomes. At the end of each Plan Year, Management, with the support of the CFO and CHRO shall submit a report summarizing the performance level of the System and the recommended funding level for the Incentive Pool. This proposal is approved by the Executive Compensation Committee.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEIN	CUSIP NumberCUSIPNumber	Date IssuedDateIssued	Issue PriceIssuePrice	Description Of PurposeDescriptionOfPurpose	DefeasedDefeased	On Behalf Of IssuerOnBehalfOfIssuer	Pool FinancingPoolFinancing
County of Ross Ohio
316400085	778260EX3	2008-09-17	141346983	Current refunding of 2001 and 2006 issues	0	0	0
County of Ross Ohio
316400085		2010-09-15	29985000	Infusion Center and Interventional Radiology	0	0	0

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetired	Amount Bond DefeasedAmountBondDefeased	Total ProceedsTotalProceeds	Amount In Reserve FundAmountInReserveFund	Capitalized InterestCapitalizedInterest	Refunding EscrowRefundingEscrow	Issuance Costs From ProceedsIssuanceCostsFromProceeds	Credit EnhancementCreditEnhancement	Working Capital ExpendituresWorkingCapitalExpenditures	Capital ExpendituresCapitalExpenditures	Other Spent ProceedsOtherSpentProceeds	Amount UnspentAmountUnspent	Year Of Subst CompletionYearOfSubstCompletion	Current RefundingCurrentRefunding	Advance RefundingAdvanceRefunding	Final Allocation MadeFinalAllocationMade	Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
1420000	0	196850065	10920538	0	0	1366439	487668	0	55557232	0	0	2010	1	0	1	1
0	0	30070554	0	0	0	411604	0	0	18554400	0	11104550	2012	0	0	0	1

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedProperty	Any Lease ArrangementsAnyLeaseArrangements	Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty	Any Research AgreementsAnyResearchAgreements	Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers	Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI	Total Private Business UseTotalPrivateBusinessUse	Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
0	1	0	0	0	0	0	1
0	0	0	0	0	0	0	1

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiled	Variable Rate IssueVariableRateIssue	Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds	Gross Proceeds Invested In GICGrossProceedsInvestedInGIC	Term Of GICTermOfGIC	Regulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied	Gross Proceeds InvestedGrossProceedsInvested	Exception To RebateExceptionToRebate
Bayerische Landesbank
0	0	0	1	3	1	0	0
(no name)
0	1	0	0			0	0

Form990 Schedule K Part VI Form990ScheduleKPartVI (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchK_P02_S00_L03	Schedule K, Part II, Line 3	Represents original issue plus unspent proceeds from issue 2006 plus investment earning through December 2011. This is for the 2008 issue.
SchK_P02_S00_L06	Schedule K, Part II, Line 6	2001 and 2006 issues were refunded on October 29, 2008. Included $116,560,000 of principal and $149,427 of interest. This is for the 2008 issue.
SchK_P02_S00_L11	Schedule K, Part II, Line 11	$11,750,000 of issue was used to pay off qualified hedged related to the 2001 and 2006 bonds. This is for the 2008 issue.
SchK_P03_S00_L02	Schedule K, Part III, Line 2	Adena Health System leases approximately 300 square feet to a for profit company that operates a coffee kioske. This is considered deminimus space and so 0% was put in Line 4 of Part III. This is for the 2008 issue.
SchK_P04_S00_L04a	Schedule K, Part IV, Line 4a	Proceeds invested in GIC from 2006 issue - Unused portion transfers to 2008 issue. The GIC matured in July 2009; this was 36 months after the date of issue. This is for the 2008 issue.
SchK_P05_S00_L00	Schedule K, Part V	While no formal written policy or procedures were in place in 2011, our bond counsel was routinely involved in decisions related to our bonds. In addition, in 2012, we have engaged our bond counsel to help us prepare the necessary written procedures. This is for the 2008 and 2010 issues.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (9 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
Horizon Telcom Inc
Business vendor of AHS	931628	Payment for telephone service	0
Robin Berno
Spouse of Dir. Jack Berno	97275	Employee Compensation	0
Kristin Davis
Daught. of COO J.Graham	23963	Employee compensation	0
Dean Kuchta
Spouse of K.E Karen Bolton	84575	Employee compensation	0
Tracy Coats
Spouse of K.E Lloyd Coats	7560	Employee Compensation	0
Lois Jetty
Spouse of K.E. Satish Jetty	192475	Employee Compensation	0
Michele Perdue
Spouse of K.E Eric Perdue	60804	Employee compensation	0
Jennifer Strickland
Spouse of B.M. David Strickland	28382	Employee Compensation	0
Jennifer White
Daugh in-law of B.M Tom White	100971	Employee compensation	0

Form990 Schedule L Part V Form990ScheduleLPartV

Field	Value	IRS element (for citing)
Identifier	SchL_P04_S00_L00	Identifier
Return Reference	Schedule L, Part IV	ReturnReference
Explanation	Steve Burkhardt the Treasurer of Horizon Telcom, Inc. regularly abstains from voting and removes himself from discussions concerning Horizon Telcom, Inc.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
F990_P06_S0A_L06	Form 990, Part VI, Section A, Line 6	The organization is composed of 9 member churches. All of the churches are in the Chillicothe, Ohio area.
F990_P06_S0A_L07a	Form 990, Part VI, Section A, Line 7a	The corporate member churches may only elect one person per church to act as their Trustee.The Trustee at Large get appointed as follows. Section 3.03 of the code of Regulations of AHS - "The Board shall elect six (6) at-large Trustee positions. Two of these positions shall be filled with physicians who are members of the active Medical Staff recommended by the Medical Staff in accordance with the Medical Staff bylaws.When a vacancy occurs among the four (4) at large Trustees, with the exception of members eligible for reappointment, the Trustee Committee shall nominate to the board a candidate for the vacant position."
F990_P06_S0A_L07b	Form 990, Part VI, Section A, Line 7b	Section 2.04 Rights of the Corporate Members: (a). The right to elect nine trustees of the Corporation as specified in these Bylaws. (b) The right to approve any lease, sale exchange, transfer,or other disposition of all or substantially all of the assets of the Corporation. (c). The right to approve any proposed merger or consolidation of the Corporation. (d).The right to approve any proposed dissolution of the Corporation. (e).The right to approve any proposed change to the fundemental purpose of the corporation as stated in Section 1.01. (f).The right to approve any proposed amendments to the Code of Regulations.
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	The 990 was reviewed with the trustees at a board meeting prior to filing. Each board member was provided with a copy of the 990.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	The Corporate Compliance Office of Adena Health System annually coordinates the distribution and return of the conflict of interest statements. The Corporate Compliance Officer 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. Conflict Board members abstain from voting on the particular items.All Adena Health System employees and board members are subject to the Conflict of Interest policy.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	Compensation is determined through market surveys on all executives (including CEO). The market surveys are conducted by a 3rd party- Mercer. Mercer makes recommendations to the Executive Compensation Committee which is a subcommittee of the board. The CEO is not present for the CEO recommendation for integrity purposes. The Executive Compensation Committee approves the salary and all aspects of compensation. The Chief Human Resources Officer works with the Human Resources department to implement any changes. The CEO contract is a 8 year contract. The Committee reviews and approves all aspects of the contract which must be approved and signed by all parties prior to processing the changes.The process was last undertaken in March 20, 2012.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	The organization prepares an annual report to the public which includes its statement of revenues and expenses. Additionally, its governing documents and conflict of interest policy is available upon request. The financial statements are not available.
F990_P11_S00_L05	Form 990, Part XI, Line 5	1. Change in unrealized investment not included in audited financial statements ($4,261,231). 2. Pension-related Changes Other Than Net Periodic Cost ($2,658,994). 3. Women's Board/VAC net revenue of ($5,160) is included in the 990 return.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (4 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Total IncomeTotalIncome	EOY AssetsEOYAssets	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Address Line2AddressUS/AddressLine2
Adena Medical Group LLC
Dept L637	Columbus	OH	43260	271370967	Healthcare providers	OH	-28933900	6311092	Adena Health System
Adena Hospice LLC
Adena Health System Sole MBR	Chillicothe	OH	45601	275340755	Healthcare provider	OH	17307	1071178	Adena Health System	272 Hospital Road
Adena Home Infusion DME and Respiratory LLC
Adena Health System Sole MBR	Chillicothe	OH	45601	273752854	Healthcare provider	OH	212477	1304690	Adena Health System
Adena Home Health LLC
Adena Health System Sole MBR	Chillicothe	OH	45601	273752730	Healthcare provider	OH	-366138	2645869	Adena Health System

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
Greenfield Area Medical Center
550 Mirabeau St	Greenfield	OH	45123	310993422	Hospital	OH	501(c((3)	3	Adena Health System	1
Adena Health Foundation
272 Hospital Road	Chillicothe	OH	45601	753008742	Fundraising	OH	501(c)(3)	11a	Adena Health System	1
Southern Ohio Healthcare Network
272 Hospital Road	Chillicothe	OH	45601	261566590	Fiberoptic Network Grants	OH	501(c)(3)	11a	Adena Health System	1

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	Adena Care	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	272 Hospital Road	AddressLine1
City	Chillicothe	City
State	OH	State
ZIP Code	45601	ZIPCode

Field	Value	IRS element (for citing)
EIN	453980850	EIN
Primary Activity	Provide employee health insurance to organizations	PrimaryActivity
Legal Domicile State	OH	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	Adena Health System	BusinessNameLine1

Field	Value	IRS element (for citing)
Type Of Entity	C	TypeOfEntity
Share Of Total Income	0	ShareOfTotalIncome
Share Of EOY Assets	0	ShareOfEOYAssets
Percentage Ownership	1	PercentageOwnership

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	0	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
Greenfield Area Medical Center
c	3202905	Book Value
Adena Health Foundation
c	698275	Book Value
Adena Health Foundation
o	342315	Book Value
Southern Ohio Healthcare Network
o	366047	Book Value