COMMUNITY HOSPITALS AND WELLNESS CENTERS: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY HOSPITALS AND WELLNESS CENTERS (EIN 34-1048666)
Tax period: 2010-10-01 to 2011-09-30
Filed: 2012-08-10
IRS object ID: 201242239349301059
Schema version: 2010v3.4
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 H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-08-10T10:52:44-05:00	Timestamp
Tax Period End Date	2011-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	PLANTE & MORAN PLLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	65 EAST STATE ST STE 600	AddressLine1
City	COLUMBUS	City
State	OH	State
ZIP Code	43215	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	341048666	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITALS & WELLNESS CENTERS	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	COMM	NameControl
Phone	4196361131	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	433 W HIGH STREET	AddressLine1
City	BRYAN	City
State	OH	State
ZIP Code	43506	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	CHAD D TINKEL	Name
Title	CFO	Title
Phone	4196361131	Phone
Date Signed	2012-05-01	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	BERNIE OSTROWSKI	Name
Phone	6148493000	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	PHILIP ENNEN	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	433 W HIGH STREET	AddressLine1
City	BRYAN	City
State	OH	State
ZIP Code	43506	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	78241948	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.CHWCHOSPITAL.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1969	YearFormation
State Legal Domicile	OH	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE QUALITY PATIENT CARE AT EVERY POINT OF SERVICE; TO RESPECT THE DIGNITY AND UNIQUENESS OF ALL PATIENTS; TO PROMOTE SAFE MEDICAL PRACTICES; TO ENCOURAGE MEDICAL RESEARCH; TO PERMIT ACCESS TO ALL SEEKING HEALTHCARE; AND TO MAINTAIN FISCAL SOUNDNESS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	7	NbrIndependentVotingMembers
Total Nbr Employees	821	TotalNbrEmployees
Total Nbr Volunteers	89	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1123659	ContributionsGrantsPriorYear
Contributions Grants Current Year	30524	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	74779970	ProgramServiceRevenuePriorYear
Program Service Revenue CY	76342979	ProgramServiceRevenueCY
Investment Income Prior Year	727125	InvestmentIncomePriorYear
Investment Income Current Year	794546	InvestmentIncomeCurrentYear
Other Revenue Prior Year	447951	OtherRevenuePriorYear
Other Revenue Current Year	728417	OtherRevenueCurrentYear
Total Revenue Prior Year	77078705	TotalRevenuePriorYear
Total Revenue Current Year	77896466	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	114429	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	315777	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	44010495	SalariesEtcPriorYear
Salaries Etc Current Year	38781948	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	33325778	OtherExpensePriorYear
Other Expenses Current Year	33814506	OtherExpensesCurrentYear
Total Expenses Prior Year	77450702	TotalExpensesPriorYear
Total Expenses Current Year	72912231	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-371997	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	4984235	RevenuesLessExpensesCY
Total Assets BOY	151452576	TotalAssetsBOY
Total Assets EOY	154388057	TotalAssetsEOY
Total Liabilities BOY	91343806	TotalLiabilitiesBOY
Total Liabilities EOY	89658090	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	60108770	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	64729967	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROVIDE QUALITY PATIENT CARE AT EVERY POINT OF SERVICE; TO RESPECT THE DIGNITY AND UNIQUENESS OF ALL PATIENTS; TO PROMOTE SAFE MEDICAL PRACTICES; TO ENCOURAGE MEDICAL RESEARCH; TO PERMIT ACCESS TO ALL SEEKING HEALTHCARE; AND TO MAINTAIN FISCAL SOUNDNESS.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	1	SignificantChange
Expense	59887929	Expense
Grants	315777	Grants
Revenue	76388344	Revenue
Description	SEE SCHEDULE OCOMMUNITY HOSPITALS AND WELLNESS CENTERS PROVIDED SERVICES TO APPROXIMATELY 2,800 INPATIENTS AND APPROXIMATELY 46,000 OUTPATIENTS DURING THIS FISCAL YEAR. THE HOSPITAL UTILIZES A BOARD APPROVED CHARITABLE CARE PROGRAM THAT MEASURES INDIVIDUAL AND FAMILY NEEDS BASED ON FEDERAL POVERTY GUIDELINES. THE PROGRAM IS APPLIED UNIFORMLY ACROSS ALL LEVELS OF HOSPITAL SERVICES. THE PROGRAM EXTENDS BEYOND THE FEDERAL POVERTY DEFINITIONS TO ALLOW THE HOSPITAL TO PROVIDE FREE AND/OR SUBSIDIZED CARE FOR PERSONS FALLING WITHIN AND BEYOND THE FEDERAL GUIDELINES. THIS PROGRAM PROVIDED ASSISTANCE TO APPROXIMATELY 3,970 ACCOUNTS DURING THIS FISCAL YEAR.IN ADDITION, THE HOSPITAL PROVIDES THE FOLLOWING:COMMUNITY EDUCATION:ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS) COURSES FOR PHYSICIANS, FOR OUR COUNTY EMS PROVIDERS, AND FOR EMPLOYEES OF OTHER HOSPITALS AT NO CHARGE.CPR COURSES TO AREA LIFEGUARDS AND COACHES AT NO CHARGE. PROVIDE CPR EQUIPMENT TO AREA SCHOOLS TO ALLOW THEM TO PROVIDE TRAINING. CHILDBIRTH EDUCATION CLASSES (INCLUDING PREPARED CHILDBIRTH, BABY CARE, SIBLING READINESS, AND BREAST FEEDING) AT NO CHARGE.HOSPITAL REPRESENTATIVES GAVE OVER 50 COMMUNITY PRESENTATIONS ON A VARIETY OF HEALTH CARE TOPICS.PHARMACY REPRESENTATIVES VISITED AREA PRESCHOOLS AND KINDERGARTENS AND PROVIDED 35 POISON PREVENTION PROGRAMS TO APPROXIMATELY 499 CHILDREN. HOSPITAL STAFF TIME WAS APPROXIMATELY 62 HOURS AMONGST SIX STAFF.PHARMACY PRECEPTOR STUDENTS WERE MADE AVAILABLE TO VISIT AREA SENIOR CENTERS AND EDUCATE SENIORS ON MEDICATION USE.OFFERED SPEAKERS FOR SMOKING CESSATION PROGRAMS.HOST CAREER DAY FOR LOCAL SCHOOLS EDUCATING STUDENTS ON OPPORTUNITIES IN HEALTH CARE PROFESSIONS.PROVIDE A FIELD PLACEMENT SETTING FOR SOCIAL WORK STUDENTS FROM AREA UNIVERSITIES. LACTATION CONSULTANT PROVIDED FOLLOW UP AND HOME VISITS WHEN NEEDED AT NO CHARGE.COUNSELING SERVICES AT NO CHARGE PROVIDED STRESS MANAGEMENT PRESENTATIONS FOR AREA BUSINESSES, PROVIDED DE-ESCALATION TRAINING FOR AREA COMMUNITY MENTAL HEALTH AGENCIES, AND OFFERED CRISIS STABILIZATION TO AREA SCHOOLS AFTER SUICIDE.OFFERED A DIABETIC SUPPORT GROUP THAT PROVIDES FREE MONTHLY MEETINGS TO APPROXIMATELY 20 PEOPLE OFFERING PROFESSIONAL SPEAKERS SHARING THEIR AREA OF EXPERTISE.OFFERED NUTRITION PRESENTATIONS TO VARIOUS COMMUNITY GROUPS.COMMUNITY SUPPORT:CONTINUED OUR SOCIAL SERVICES PROGRAM THAT ASSISTS INDIVIDUALS IN OBTAINING MEDICATIONS WHEN PERSONAL FUNDS ARE NOT AVAILABLE.PROVIDED HEALTH INFORMATION AND HOSPITAL STAFF TO SUPPORT AREA INDUSTRIES EMPLOYEE HEALTH FAIRS. CONTINUED OUR SOCIAL SERVICES PROGRAM THAT ASSISTED INDIVIDUALS IN COMPLETING THEIR OWN ADVANCED DIRECTIVES (E.G. LIVING WILL AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE).CONTINUED OUR SOCIAL SERVICES PROGRAM FOR A GRIEF SUPPORT GROUP FOR THE COMMUNITY.PROVIDED FREE INDIVIDUAL COUNSELING SERVICES TO 25 INDIVIDUALS FROM THE COMMUNITY.OFFERED A SATURDAY SPORTS INJURY ASSESSMENT CLINIC AND PROVIDE THE CLINIC ASSESSMENT FREE OF CHARGE TO AT LEAST 75 AREA HIGH SCHOOL ATHLETES.PROVIDED FREE BLOOD PRESSURE CHECKS THROUGH OUR EMERGENCY AND CARDIOPULMONARY DEPARTMENTS.PROVIDED 9,551 MEALS ON WHEELS FOR HOMEBOUND PEOPLE AT NO CHARGE. IN OUR WILLIAMS COUNTY AREA PROGRAM THIS INCLUDES PROVIDING STAFF AND VEHICLES TO DELIVER THE MEALS TO HOMES.PROVIDED RENT-FREE LIVING SPACE IN BRYAN, OHIO TO UT STUDENTS ASSOCIATED WITH BAHEC, TOTAL ANNUAL RELIEF TO 45 UT STUDENTS WAS $6,650.THE HOSPITAL COORDINATES OUTPATIENT SERVICES FOR CLIENTS OF THE LOCAL COMPASSION MEDICAL CLINIC, WHICH IS A NON-PROFIT CLINIC SERVING UNDER INSURED AND UNINSURED RESIDENTS OF WILLIAMS COUNTY.PAID UNITED COLLECTION AGENCY $35 PER UNRESPONSIVE ACCOUNT THAT THEY WERE ABLE TO REGISTER WITH HCAP OR MEDICAID. PAID UNITED COLLECTION AGENCY $1,000 PER MONTH TO IDENTIFY UNRESPONSIVE ACCOUNTS AS POSSIBLE CHARITABLE CARE RECIPIENTS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY. PROVIDED HEALTH INFORMATION AND HOSPITAL STAFF TO PROVIDE BLOOD PRESSURE AND BMI CHECKS FOR THE COUNTY HEALTH DEPARTMENT'S HEART HEALTH WALK/RUN AND FOR THE COUNTY FAIR.THE CARDIOPULMONARY REHABILITATION DEPARTMENT CONDUCTED 30 FITNESS ASSESSMENTS ON MEMBERS OF THE BRYAN FIRE DEPARTMENT AT NO CHARGE.PROVIDED FREE LUNCHES TO AREA TEACHERS AND STUDENTS TO RECOGNIZE STUDENTS OF THE MONTH TOTAL COSTS $800.PROVIDED FREE LABORATORY TESTING (977 BLOOD PROFILES, 300 PSA TESTS, AND 275 HEMOGLOBIN A1C) FOR THE BI-ANNUAL HEALTH AWARENESS COMMUNITY EVENT. PROVIDED BASIC SUPPLIES AND MEDICATIONS FOR VARIOUS MISSION TRIPS CONDUCTED BY EMPLOYEES AND MEDICAL STAFF.	Description
Total Program Service Expense	59887929	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	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	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	1	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	1	InvestTaxExemptBonds
Escrow Account	0	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	0	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	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	28	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	821	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
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	10	NbrVotingGoverningBodyMembers
Number Independent Voting Members	7	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	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
States Where Copy Of Return Is Filed	OH	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

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

Field	Value	IRS element (for citing)
Telephone Number	4196361131	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	433 W HIGH STREET	AddressLine1
City	BRYAN	City
State	OH	State
ZIP Code	43506	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
JIM WYSE
DIRECTOR	1.00	X	0	0	0
ROGER L SANEHOLTZ OD
DIRECTOR	1.00	X	0	0	0
KATRINA P HESTER
VICE CHAIRMAN/TREASURER	1.00	X	0	0	0	X
CHRISTOPHER CULLIS
DIRECTOR	1.00	X	0	0	0
ALBERT H HORN
DIRECTOR	1.00	X	0	0	0
JAMES A RUPP
CHAIRMAN	1.00	X	0	0	0	X
BRUCE SPANGLER
DIRECTOR	1.00	X	0	0	0
DIANE CONRAD MD
CHIEF STAFF	1.00	X	0	0	0
KEVIN KOLOVICH MD
VICE CHIEF STAFF	1.00	X	0	0	0
PHILIP L ENNEN
PRESIDENT/SECRETARY, CEO	40.00	X	459337	0	34972	X
C NICHOLAS WALZ
VP/CMO	40.00		249593	0	21535	X
JANICE A DAVID
VP PATIENT CARE	40.00		270886	0	38917	X
GREGORY E SLATTERY
VP/CIO	40.00		317730	0	34941	X
MICHAEL CULLER
VP/COO	40.00		188022	0	36232	X
CHAD D TINKEL
VP/CFO	40.00		206106	0	28841	X
SHANNON KEIL
PATHOLOGIST	40.00		351142	0	20400		X
SCOTT FREDERICK
INTERNAL MEDICINE	40.00		355846	0	32875		X
LARRY SIMON
CRNA ANESTHESIOLOGY	40.00		240873	0	18396		X
CRAIG BUELL
DIRECTOR OF PHARMACY	40.00		186285	0	18396		X
MARILYN NUSSBAUMER
SUPERVISOR CATH LAB	40.00		162441	0	18396		X
RUSTY BRUNICARDI
FORMER PRESIDENT	1.00		254121	0	0			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	3242382	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	303901	TotalOtherCompensation
Number Individuals GT100 K	34	NumberIndividualsGT100K
Formers Listed	1	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
AMERISOURCE BERGEN
1300 MORRIS DRIVE	CHESTERBROOK	PA	19087	PHARMACEUTICAL SERVICES	2017345
VARIAN MEDICAL SYSTEMS
1678 SOUTH 2350 WEST	SALT LAKE CITY	UT	84104	MEDICAL MANUFACTURER	1454348
SENECA MEDICAL
85 SHAFFER PARK DRIVE	TIFFIN	OH	44883	MEDICAL DISTRIBUTOR	1445183
BOSTON SCIENTIFIC
ONE BOSTON SCIENTIFIC PLACE	NATICK	MA	01760	MEDICAL MANUFACTURER	1047638
ZIMMER
1800 WEST CENTER STREET	WARSAW	IN	46581	HEALTHCARE PROVIDER	950595

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	18	NumberOfContractorsGT100K
All Other Contributions	30524	AllOtherContributions
Total Contributions	30524	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUES	621400	76169817	76169817
DISCOUNTS EARNED	621400	160011	160011
MEDICAL RECORD FEES	621400	13151	13151

Field	Value	IRS element (for citing)
Total Program Service Revenue	76342979	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	676859	TotalRevenueColumn
Exclusion	$676,859	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	217299	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	198565	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	18734	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	18734	TotalRevenueColumn
Exclusion	$18,734	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	9974	Securities
Other	254630	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	146917	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	9974	Securities
Other	107713	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	117687	TotalRevenueColumn
Exclusion	$117,687	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
CAFETERIA/VENDING	621400	342702	$342,702
INSURANCE REFUNDS	999999	236861	$236,861
CSV OF SERP	621400	81195	$81,195

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	48925	TotalRevenueColumn
Related Or Exempt Function Income	45365	RelatedOrExemptFunctionIncome
Exclusion	$3,560	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	709683	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	77896466	TotalRevenueColumn
Related Or Exempt Function Income	76388344	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$1,477,598	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	4000	Total
Program Services	4000	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	311777	Total
Program Services	311777	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1613638	Total
Management And General	1613638	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	28703814	Total
Program Services	23542868	ProgramServices
Management And General	5160946	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	6263412	Total
Program Services	5137251	ProgramServices
Management And General	1126161	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	2201084	Total
Program Services	1805329	ProgramServices
Management And General	395755	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	48876	Total
Management And General	48876	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	161345	Total
Management And General	161345	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	3469091	Total
Program Services	2051620	ProgramServices
Management And General	1417471	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	102204	Total
Program Services	83828	ProgramServices
Management And General	18376	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	13384571	Total
Program Services	12909419	ProgramServices
Management And General	475152	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	4312326	Total
Program Services	3536970	ProgramServices
Management And General	775356	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	120251	Total
Program Services	98630	ProgramServices
Management And General	21621	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	39946	Total
Program Services	32764	ProgramServices
Management And General	7182	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	2015429	Total
Program Services	1653055	ProgramServices
Management And General	362374	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	7387405	Total
Program Services	6059150	ProgramServices
Management And General	1328255	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	586545	Total
Program Services	481084	ProgramServices
Management And General	105461	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT EXPENSE	1163746	1163746
OHIO FRANCHISE FEE	564507	564507
AGENCY FEES	170784	170784
JOINT COMMISSION	40400	40400
SALES & USE TAX	35221	28888	6333

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	211859	Total
Program Services	211859	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	72912231	Total
Program Services	59887929	ProgramServices
Management And General	13024302	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	2964132	BOY
EOY	3207974	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	18196139	BOY
EOY	25686150	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	70000	BOY
EOY	40000	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	9588571	BOY
EOY	9565612	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1191830	BOY
EOY	1159889	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	960183	BOY
EOY	883882	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	151841968	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	54557810	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	88689814	BOY
EOY	97284158	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	28101617	BOY
EOY	15104281	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	174523	BOY
EOY	263242	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1515767	BOY
EOY	1192869	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	151452576	BOY
EOY	154388057	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	7236374	BOY
EOY	5835702	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	45000000	BOY
EOY	44305000	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	30249718	BOY
EOY	31376219	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	8857714	BOY
EOY	8141169	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	91343806	BOY
EOY	89658090	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	60108770	BOY
EOY	64729967	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	60108770	BOY
EOY	64729967	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	151452576	BOY
EOY	154388057	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	4984235	ReconcilationRevenueExpenses
Reconcilation Other Changes	-363038	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
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	1	DirectContactLegislators
Direct Contact Legislators	$10,383	DirectContactLegislatorsAmount
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$2,115	OtherActivitiesAmount
Total Lobbying Expenditures IIB	12498	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES:	PART II-B, LINE 1I:	A PORTION OF OHA DUES RELATE TO LOBBYING FEES.
PART IV, SUPPLEMENTAL INFORMATION:		PART II-B, LINE 1(G): SENT LETTERS TO TWO UNITED STATES SENATORS AND A MEMBER OF THE HOUSE OF REPRESENTATIVES REGARDING THE EXTENSION OF TOPS (TRANSITION OUTPATIENT PAYMENTS) FOR 2012.

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	138612	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	3071458	OtherCostOrOtherBasis
Book Value	3210070	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	95769923	OtherCostOrOtherBasis
Depreciation	16840506	Depreciation
Book Value	78929417	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	4307451	InvestmentCostOrOtherBasis
Depreciation	2656844	Depreciation
Book Value	1650607	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	48112702	OtherCostOrOtherBasis
Depreciation	34923372	Depreciation
Book Value	13189330	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	441822	OtherCostOrOtherBasis
Depreciation	137088	Depreciation
Book Value	304734	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	97284158	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescription	AmountAmount
SETTLEMENTS PAYABLE UNDER THIRD PARTY REIMBURSEMENT CONTRACTS	$3,616,018
DEFERRED COMPENSATION	$393,727
CONSTRUCTION AND RETAINAGE PAYABLE	$1,275,309
INTEREST RATE SWAP	$2,856,115

Field	Value	IRS element (for citing)
Total Of Amounts	8141169	TotalOfAmounts

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
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent300	X	Pcent300
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	2683590	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1808675	DirectOffsettingRevenue
Net Community Benefit Expense	874915	NetCommunityBenefitExpense
Percent Of Total Expense	0.01220	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	7497611	TotalCommunityBenefitExpense
Direct Offsetting Revenue	3659315	DirectOffsettingRevenue
Net Community Benefit Expense	3838296	NetCommunityBenefitExpense
Percent Of Total Expense	0.05350	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10181201	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5467990	DirectOffsettingRevenue
Net Community Benefit Expense	4713211	NetCommunityBenefitExpense
Percent Of Total Expense	0.06570	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	17	NumberOfActivitiesOrPrograms
Persons Served	1000	PersonsServed
Total Community Benefit Expense	132657	TotalCommunityBenefitExpense
Net Community Benefit Expense	132657	NetCommunityBenefitExpense
Percent Of Total Expense	0.00180	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	13	NumberOfActivitiesOrPrograms
Persons Served	600	PersonsServed
Total Community Benefit Expense	110000	TotalCommunityBenefitExpense
Net Community Benefit Expense	110000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00150	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	45000	TotalCommunityBenefitExpense
Net Community Benefit Expense	45000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00060	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	30	NumberOfActivitiesOrPrograms
Persons Served	1600	PersonsServed
Total Community Benefit Expense	287657	TotalCommunityBenefitExpense
Net Community Benefit Expense	287657	NetCommunityBenefitExpense
Percent Of Total Expense	0.00390	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	30	NumberOfActivitiesOrPrograms
Persons Served	1600	PersonsServed
Total Community Benefit Expense	10468858	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5467990	DirectOffsettingRevenue
Net Community Benefit Expense	5000868	NetCommunityBenefitExpense
Percent Of Total Expense	0.06960	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$1,309,303	BadDebtExpenseAmount
Amount Attributable To	130930	AmountAttributableTo
Amount Reimbursed By Medicare	22496431	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	28777855	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-6281424	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	2	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumber	Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital	General Medical And SurgicalGeneralMedicalAndSurgical	Er24 HoursEr24Hours	Critical Access HospitalCriticalAccessHospital
BRYAN HOSPITAL
1	433 WEST HIGH STREET	BRYAN	OH	43506	X	X	X
MONTPELIER HOSPITAL
3	909 EAST SNYDER AVENUE	MONTPELIER	OH	43543	X		X	X

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumber	CHNA ConductedCHNAConducted	Community DemographicsCommunityDemographics	Existing ResourcesExistingResources	How Data ObtainedHowDataObtained	Community Health NeedsCommunityHealthNeeds	Other Health IssuesOtherHealthIssues	Identifying ProcessIdentifyingProcess	Consulting ProcessConsultingProcess	Information GapsInformationGaps	OtherOther	Needs Assessment ConductedNeedsAssessmentConducted	Take Into AccountTakeIntoAccount	Other FacilitiesOtherFacilities	CHNA Widely AvailableCHNAWidelyAvailable	On RequestOnRequest	Other MethodOtherMethod	Adopt Implement StrategyAdoptImplementStrategy	Develop Community PlanDevelopCommunityPlan	Adopt BudgetAdoptBudget	Prioritize Health NeedsPrioritizeHealthNeeds	Prioritize ServicesPrioritizeServices	Other Needs AddressedOtherNeedsAddressed	All Needs AddressedAllNeedsAddressed	Eligibility Criteria ExplainedEligibilityCriteriaExplained	Uses FPG FreeUsesFPGFree	FPG Free PercentFPGFreePercent	Uses FPG DiscountedUsesFPGDiscounted	FPG Discount PercentFPGDiscountPercent	Explains BasisExplainsBasis	Income LevelIncomeLevel	Asset LevelAssetLevel	Medical IndigencyMedicalIndigency	Explains Application MethodExplainsApplicationMethod	Includes Publicity MeasuresIncludesPublicityMeasures	Posted On WebsitePostedOnWebsite	Attached To InvoicesAttachedToInvoices	Provided On AdmissionProvidedOnAdmission	Available On RequestAvailableOnRequest	Actions On NonpaymentActionsOnNonpayment	Permit Report To Credit AgencyPermitReportToCreditAgency	Permit LawsuitPermitLawsuit	Collection ActivitiesCollectionActivities	Report To Credit AgencyReportToCreditAgency	LawsuitLawsuit	Notify Upon AdmissionNotifyUponAdmission	Notify Before DischargeNotifyBeforeDischarge	Notified All PatientsNotifiedAllPatients	Documented DeterminationDocumentedDetermination	Other Actions TakenOtherActionsTaken	Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy	Used Other MethodUsedOtherMethod	Amounts Generally BilledAmountsGenerallyBilled	Gross ChargesGrossCharges
BRYAN HOSPITAL
1	1	X	X	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	0	1	1	200.000000000000	1	300.000000000000	1	X	X	X	1	1	X	X	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	1
MONTPELIER HOSPITAL
2	1	X	X	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	0	1	1	200.000000000000	1	300.000000000000	1	X	X	X	1	1	X	X	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	1

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	3	NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
ARCHBOLD MEDICAL CENTER
121 WESTFIELD DR	ARCHBOLD	OH	43502	OP SURGERY CENTER, OP RADIOLOGY, OP LAB, OP THERAPIES, AND MOB
RADIATION ONCOLOGY CENTER
524 WEST HIGH ST	BRYAN	OH	43506	RADIATION ONCOLOGY
WAUSEON INTERNAL MEDICINE CLINIC
447 NORTH SHOOP AVE	WAUSEON	OH	43567	PHYSICIAN OFFICE

Form990 Schedule H Part VI Form990ScheduleHPartVI (33 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
PART I, LINE 3C: NOT APPLICABLE
PART I, LINE 6A: NOT APPLICABLE
PART I, LINE 7: CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO (54%) WHICH WAS DERIVED FROM WORKSHEET 2.
PART I, LINE 7G: NOT APPLICABLE
PART I, L7 COL(F): THE PERCENTAGE CALCULATED ON LINE 7F IS BASED ON TOTAL EXPENSES FROM FORM 990, PART IX, LESS BAD DEBTS IN THE AMOUNT OF $1,163,746.
PART II: NOT APPLICABLE
PART III, LINE 4: BAD DEBT AT COST WAS CALCULATED USING A COST TO CHARGE RATIO. CHWC USES AN ESTIMATE OF 10% OF TOTAL BAD DEBT EXPENSE AT COST IN ORDER TO CALCULATE THE AMOUNT RECORDED AS BAD DEBT THAT WOULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. NONE OF THE BAD DEBT EXPENSE IS TREATED AS A COMMUNITY BENEFIT.FOOTNOTE TO FINANCIAL STATEMENTS: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8: MEDICARE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO BASED ON METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. NONE OF THE SHORTFALL IS TREATED AS A COMMUNITY BENEFIT.
PART III, LINE 9B: ALL SELF-PAY BALANCES ARE BILLED ON STATEMENTS AT THIRTY DAY INTERVALS. THE PATIENT REP WILL SET UP MONTHLY PAYMENTS ACCORDING TO THE FOLLOWING GUIDELINES: THE GUARANTOR IS ASKED TO PAY IN FULL. IF PAYMENT IN FULL IS NOT POSSIBLE, THE GUARANTOR IS ASKED TO MAKE MONTHLY PAYMENTS TO PAY THE ACCOUNT IN FULL WITHIN 18 MONTHS, WITH A MINIMUM PAYMENT OF $50 PER MONTH. IF THE GUARANTOR IS NOT ABLE TO AGREE TO THESE ARRANGEMENTS, HE/SHE IS ASKED TO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE.IF NO PAYMENT IS RECEIVED OR ARRANGEMENT ESTABLISHED WITHIN 60 DAYS OF THE INITIAL STATEMENT, A "PAST DUE LETTER" IS SENT TO THE GUARANTOR WITH A REQUEST TO PAY IN FULL OR CONTACT PATIENT ACCOUNTS WITHIN 30 DAYS. IF THE GUARANTOR DOES NOT RESPOND BY THE DUE DATE ON THIS LETTER OR ACCEPTABLE PAYMENTS HAVE NOT BEEN ESTABLISHED, THE VISIT IS REVIEWED BY THE PATIENT ACCOUNTS DIRECTOR TO DETERMINE ELIGIBILITY FOR BAD DEBT AND COLLECTION AGENCY PROCESSING."PRIOR TO SENDING THE ACCOUNT TO COLLECTION, THE PATIENT ACCOUNTS DIRECTOR SENDS THE ACCOUNTS TO "I-SOLUTIONS" TO REVIEW ACCOUNTS FOR COLLECTABILITY. IF ANY ACCOUNT IS DETERMINED THROUGH THIS PROCESS TO BE ELIGIBLE FOR CHARITY, THE ACCOUNT WILL RECEIVE A 100% CHARITY WRITE OFF. ANY ACCOUNT ON THE REPORT THAT LISTS A MAXIMUM PAYMENT AMOUNT THAT IS LESS THAN THE ACCOUNT BALANCE AND THAT FALLS IN THE "BD" OR "LOW" PROPENSITY TO PAY CATEGORY WILL RECEIVE A CHARITY ADJUSTMENT THAT REDUCES THE BALANCE ON THE ACCOUNT TO THE I-SOLUTIONS CALCULATED MAXIMUM PAYMENT AMOUNT. BEGINNING OCTOBER 1, 2008, ACCOUNTS WITH NO LISTED PROPENSITY TO PAY AND A MAXIMUM PAYMENT LESS THAN THE CHARGES WILL ALSO RECEIVE THE SAME CHARITY DISCOUNT. THE BALANCE EQUAL TO THE MAXIMUM PAYMENT AMOUNT IS THEN ADJUSTED TO BAD DEBT AND SENT TO COLLECTION ALONG WITH ALL OTHER ACCOUNTS ELIGIBLE FOR BAD DEBT WRITE OFF.THE HOSPITAL HAS ADDED A STATEMENT TO THE ADMISSION FORM AUTHORIZING THE HOSPITAL TO REVIEW THE GUARANTOR'S CREDIT INFORMATION. IF THIS IS NOT SIGNED BY THE PATIENT, THE ACCOUNT WILL NOT BE SENT TO I-SOLUTIONS FOR COLLECTABILITY REVIEW. IT WILL BE FORWARDED DIRECTLY TO THE COLLECTION AGENCY.ACCOUNTS LISTED IN BAD DEBT ARE NOT CONSIDERED TO BE ACTIVE ACCOUNTS ON THE HOSPITAL SYSTEM. THE COLLECTION AGENCY MAKES ARRANGEMENTS FOR PAYMENTS AND MONITORS THE PAYMENTS. THE HOSPITAL CAN ACCEPT DIRECT PAYMENTS ON THE ACCOUNTS, BUT THE GUARANTOR SHOULD BE ENCOURAGED TO MAKE PAYMENT DIRECT TO THE COLLECTION AGENCY. A REPORT OF PAYMENTS MADE DIRECT TO THE HOSPITAL IS FAXED TO THE COLLECTION AGENCY EVERY MONDAY THRU FRIDAY. THE PATIENT ACCOUNTS DIRECTOR AUTHORIZES THE COLLECTION AGENCY TO FILE A LEGAL SUIT IN ORDER TO OBTAIN PAYMENT WHEN THE GUARANTOR IS UNCOOPERATIVE.IF AN ACCOUNT SENT TO COLLECTION IS LATER DETERMINED TO QUALIFY FOR CHARITY CARE, COLLECTION EFFORTS STOP ON THE APPROVED AMOUNT.
MEDICARE REVENUE RECEIVED AS REPORTED ON LN 5: $22,496,431PLUS MEDICARE MANAGED CARE REVENUE: $5,324,684TOTAL MEDICARE REVENUE: $27,821,115MEDICARE ALLOWABLE COSTS OF CARE AS REPORTED ON LN 6: $28,777,855PLUS MEDICARE MANAGED CARE COSTS: $6,811,183TOTAL MEDICARE COSTS: $35,589,038 TOTAL MEDICARE SHORTFALL: -$7,767,923	RECONCILIATION OF MEDICARE REVENUES & COSTS NOT REPORTED IN COST REPORT	PART III, LINES 5-6:
PART V, SECTION B, LINE 1J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH.	BRYAN HOSPITAL
PART V, SECTION B, LINE 1J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH.	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 3: THE CENTER FOR URBAN AND PUBLIC AFFAIRS (CUPA) AT WRIGHT STATE UNIVERSITY (WSU) CONDUCTED A COMMUNITY HEALTH ASSESSMENT FOR THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT (WCCHD), CHWC BRYAN AND CHWC MONTPELIER HOSPITALS. THE SURVEY WAS BASED UPON THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) CONDUCTED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), AS WELL AS HEALTH ASSESSMENTS CONDUCTED BY NEIGHBORING COUNTIES.THE PURPOSE OF THE HEALTH NEEDS ASSESSMENT IS TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS, ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH, MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS AND PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH.	BRYAN HOSPITAL
PART V, SECTION B, LINE 3: THE CENTER FOR URBAN AND PUBLIC AFFAIRS (CUPA) AT WRIGHT STATE UNIVERSITY (WSU) CONDUCTED A COMMUNITY HEALTH ASSESSMENT FOR THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT (WCCHD), CHWC BRYAN AND CHWC MONTPELIER HOSPITALS. THE SURVEY WAS BASED UPON THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) CONDUCTED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), AS WELL AS HEALTH ASSESSMENTS CONDUCTED BY NEIGHBORING COUNTIES.THE PURPOSE OF THE HEALTH NEEDS ASSESSMENT IS TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS, ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH, MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS AND PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH.	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 4: MONTPELIER HOSPITAL	BRYAN HOSPITAL
PART V, SECTION B, LINE 4: BRYAN HOSPITAL	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 5C: THE NEEDS ASSESSMENT WAS A COMBINED ASSESSMENT WITH THE WILLIAMS COUNTY OHIO PUBLIC HEALTH DEPARTMENT AND MIDWEST COMMUNITY HEALTH ASSOCIATES MEDICAL GROUP. ALL THREE ENTITIES MADE THE REPORT WIDELY AVAILABLE IN THEIR ORGANIZATIONS. THE PUBLIC HEALTH DEPARTMENT MADE PRESENTATIONS TO COMMUNITY GROUPS AND ORGANIZATIONS.	BRYAN HOSPITAL
PART V, SECTION B, LINE 5C: THE NEEDS ASSESSMENT WAS A COMBINED ASSESSMENT WITH THE WILLIAMS COUNTY OHIO PUBLIC HEALTH DEPARTMENT AND MIDWEST COMMUNITY HEALTH ASSOCIATES MEDICAL GROUP. ALL THREE ENTITIES MADE THE REPORT WIDELY AVAILABLE IN THEIR ORGANIZATIONS. THE PUBLIC HEALTH DEPARTMENT MADE PRESENTATIONS TO COMMUNITY GROUPS AND ORGANIZATIONS.	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 6I: THE SURVEY IDENTIFIED 3 SPECIFIC HEALTH NEED ISSUES: FIRST, WILLIAMS COUNTY ADULTS (11.4 PERCENT) WERE SIGNIFICANTLY MORE LIKELY THAN ADULTS NATIONALLY (8.4 PERCENT) TO INDICATE THAT THEY HAVE DIABETES. THE HOSPITAL (IN COLLABORATION WITH WILLIAMS COUNTY PUBLIC HEALTH AND THE LOCAL MEDICAL GROUP) DETERMINED TO COMMIT RESOURCES TO THIS ISSUE BY DESIGNING AND IMPLEMENTING A HEALTH AND WELLNESS ASSESSMENT THAT WOULD TARGET RISK FOR DIABETES. THE COLLABORATIVE GROUP USED 2011 TO CREATE THE DESIGN FOR A SIMPLE WELLNESS ASSESSMENT THAT WOULD LEAD TO TARGETED ONE ON ONE COACHING BASED ON THE ASSESSMENT OUTCOMES. THE GROUP PLANS TO IMPLEMENT ASSESSMENTS IN 2012.SECOND, ONLY 33.3 PERCENT OF ADULTS IN WILLIAMS COUNTY SAID THEY HAVE RECEIVED THE FLU SHOT IN THE PAST 12 MONTHS. SLIGHTLY OVER HALF (59.3 PERCENT) OF THE ADULTS AGED 65 OR OLDER HAVE RECEIVED THE VACCINATION, WHICH IS MUCH LOWER THAN THE STATE (67.4 PERCENT) AND NATIONAL (70.1 PERCENT) PERCENTAGES. THE HOSPITAL DETERMINED TO TAKE A MORE AGGRESSIVE APPROACH WITH ITS OWN EMPLOYEE WORKFORCE DURING THE 2011/2012 FLU SEASON. WE SET A GOAL OF 75% OF STAFF RECEIVING THE VACCINATION AND ACHIEVED 71%. FOR THE 2012/2013 FLU SEASON WE ARE CONSIDERING A MANDATED FLU SHOT POLICY.THIRD, TWO-THIRDS OF WILLIAMS COUNTY RESPONDENTS (67.0 PERCENT) ARE CLASSIFIED AS OVERWEIGHT OR OBESE. THIS RESPONSE IS SLIGHTLY HIGHER THAN THE STATE (66.6 PERCENT) AND SIGNIFICANTLY HIGHER THAN THE NATION (63.1 PERCENT). THE HOSPITAL (IN COLLABORATION WITH WILLIAMS COUNTY PUBLIC HEALTH AND THE LOCAL MEDICAL GROUP) DETERMINED TO COMMIT RESOURCES TO THIS ISSUE BY DESIGNING AND IMPLEMENTING A HEALTH AND WELLNESS ASSESSMENT THAT WOULD TARGET RISK FOR OBESITY. THE COLLABORATIVE GROUP USED 2011 TO CREATE THE DESIGN FOR A SIMPLE WELLNESS ASSESSMENT THAT WOULD LEAD TO TARGETED ONE ON ONE COACHING BASED ON THE ASSESSMENT OUTCOMES. WE ARE USING THE MEASUREMENT OF BODY MASS INDEX (BMI) TO ASSESS AN INDIVIDUAL'S CURRENT OBESITY STATUS AND RISK FOR WEIGHT CONTROL. THE GROUP PLANS TO IMPLEMENT ASSESSMENTS IN 2012.	BRYAN HOSPITAL
PART V, SECTION B, LINE 6I: THE SURVEY IDENTIFIED 3 SPECIFIC HEALTH NEED ISSUES: FIRST, WILLIAMS COUNTY ADULTS (11.4 PERCENT) WERE SIGNIFICANTLY MORE LIKELY THAN ADULTS NATIONALLY (8.4 PERCENT) TO INDICATE THAT THEY HAVE DIABETES. THE HOSPITAL (IN COLLABORATION WITH WILLIAMS COUNTY PUBLIC HEALTH AND THE LOCAL MEDICAL GROUP) DETERMINED TO COMMIT RESOURCES TO THIS ISSUE BY DESIGNING AND IMPLEMENTING A HEALTH AND WELLNESS ASSESSMENT THAT WOULD TARGET RISK FOR DIABETES. THE COLLABORATIVE GROUP USED 2011 TO CREATE THE DESIGN FOR A SIMPLE WELLNESS ASSESSMENT THAT WOULD LEAD TO TARGETED ONE ON ONE COACHING BASED ON THE ASSESSMENT OUTCOMES. THE GROUP PLANS TO IMPLEMENT ASSESSMENTS IN 2012.SECOND, ONLY 33.3 PERCENT OF ADULTS IN WILLIAMS COUNTY SAID THEY HAVE RECEIVED THE FLU SHOT IN THE PAST 12 MONTHS. SLIGHTLY OVER HALF (59.3 PERCENT) OF THE ADULTS AGED 65 OR OLDER HAVE RECEIVED THE VACCINATION, WHICH IS MUCH LOWER THAN THE STATE (67.4 PERCENT) AND NATIONAL (70.1 PERCENT) PERCENTAGES. THE HOSPITAL DETERMINED TO TAKE A MORE AGGRESSIVE APPROACH WITH ITS OWN EMPLOYEE WORKFORCE DURING THE 2011/2012 FLU SEASON. WE SET A GOAL OF 75% OF STAFF RECEIVING THE VACCINATION AND ACHIEVED 71%. FOR THE 2012/2013 FLU SEASON WE ARE CONSIDERING A MANDATED FLU SHOT POLICY.THIRD, TWO-THIRDS OF WILLIAMS COUNTY RESPONDENTS (67.0 PERCENT) ARE CLASSIFIED AS OVERWEIGHT OR OBESE. THIS RESPONSE IS SLIGHTLY HIGHER THAN THE STATE (66.6 PERCENT) AND SIGNIFICANTLY HIGHER THAN THE NATION (63.1 PERCENT). THE HOSPITAL (IN COLLABORATION WITH WILLIAMS COUNTY PUBLIC HEALTH AND THE LOCAL MEDICAL GROUP) DETERMINED TO COMMIT RESOURCES TO THIS ISSUE BY DESIGNING AND IMPLEMENTING A HEALTH AND WELLNESS ASSESSMENT THAT WOULD TARGET RISK FOR OBESITY. THE COLLABORATIVE GROUP USED 2011 TO CREATE THE DESIGN FOR A SIMPLE WELLNESS ASSESSMENT THAT WOULD LEAD TO TARGETED ONE ON ONE COACHING BASED ON THE ASSESSMENT OUTCOMES. WE ARE USING THE MEASUREMENT OF BODY MASS INDEX (BMI) TO ASSESS AN INDIVIDUAL'S CURRENT OBESITY STATUS AND RISK FOR WEIGHT CONTROL. THE GROUP PLANS TO IMPLEMENT ASSESSMENTS IN 2012.	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 7: FIRST, THE PERCENTAGE OF WILLIAMS COUNTY WOMEN OVER THE AGE OF 40 (65.3 PERCENT) WHO HAVE HAD A MAMMOGRAM IS SIGNIFICANTLY LOWER THAN THE STATE (75.8 PERCENT) AND NATION (76.0 PERCENT). THE HOSPITAL ELECTED NOT TO PURSUE THIS NEED AS THE HOSPITAL DOES NOT PROVIDE DIAGNOSTIC MAMMOGRAPHY SCREENING. THE PHYSICIAN MEDICAL GROUP IS ATTEMPTING TO ADDRESS THIS NEED BY SEEKING A GRANT FROM THE SUSAN G. KOMEN FOUNDATION TO CREATE MORE ACCESS TO DIAGNOSTIC MAMMOGRAPHY SCREENING.SECOND, WILLIAMS COUNTY RESIDENTS 50 AND OLDER (53.1 PERCENT) ARE OBTAINING SIGMOIDOSCOPY OR COLONOSCOPY EXAMS AT A RATE SIGNIFICANTLY LOWER THAN THE STATE (60.8 PERCENT) AND NATION (62.2 PERCENT). THE HOSPITAL DID NOT HAVE RESOURCES IN 2011 TO ADDRESS THIS COMMUNITY NEED. THE HOSPITAL HAS STRUGGLED FINANCIALLY SINCE THE 2008 RECESSION AND DETERMINED TO COMMIT OUR LIMITED RESOURCES FIRST TO THE ISSUES OF DIABETES AND OBESITY.	BRYAN HOSPITAL
PART V, SECTION B, LINE 7: FIRST, THE PERCENTAGE OF WILLIAMS COUNTY WOMEN OVER THE AGE OF 40 (65.3 PERCENT) WHO HAVE HAD A MAMMOGRAM IS SIGNIFICANTLY LOWER THAN THE STATE (75.8 PERCENT) AND NATION (76.0 PERCENT). THE HOSPITAL ELECTED NOT TO PURSUE THIS NEED AS THE HOSPITAL DOES NOT PROVIDE DIAGNOSTIC MAMMOGRAPHY SCREENING. THE PHYSICIAN MEDICAL GROUP IS ATTEMPTING TO ADDRESS THIS NEED BY SEEKING A GRANT FROM THE SUSAN G. KOMEN FOUNDATION TO CREATE MORE ACCESS TO DIAGNOSTIC MAMMOGRAPHY SCREENING.SECOND, WILLIAMS COUNTY RESIDENTS 50 AND OLDER (53.1 PERCENT) ARE OBTAINING SIGMOIDOSCOPY OR COLONOSCOPY EXAMS AT A RATE SIGNIFICANTLY LOWER THAN THE STATE (60.8 PERCENT) AND NATION (62.2 PERCENT). THE HOSPITAL DID NOT HAVE RESOURCES IN 2011 TO ADDRESS THIS COMMUNITY NEED. THE HOSPITAL HAS STRUGGLED FINANCIALLY SINCE THE 2008 RECESSION AND DETERMINED TO COMMIT OUR LIMITED RESOURCES FIRST TO THE ISSUES OF DIABETES AND OBESITY.	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 17E: PAID UNITED COLLECTION AGENCY $1,000 PER MONTH TO IDENTIFY UNRESPONSIVE ACCOUNTS AS POSSIBLE CHARITABLE CARE RECIPIENTS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY.	BRYAN HOSPITAL
PART V, SECTION B, LINE 17E: PAID UNITED COLLECTION AGENCY $1,000 PER MONTH TO IDENTIFY UNRESPONSIVE ACCOUNTS AS POSSIBLE CHARITABLE CARE RECIPIENTS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY.	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 19D: OFFERED PROMPT PAY DISCOUNT THAT IS EQUAL TO THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE.	BRYAN HOSPITAL
PART V, SECTION B, LINE 19D: OFFERED PROMPT PAY DISCOUNT THAT IS EQUAL TO THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE.	MONTPELIER HOSPITAL
PART V, SECTION B, LINE 21: A PATIENT WITHOUT INSURANCE THAT DID NOT PROMPTLY PAY WOULD PAY 100% OF THE GROSS CHARGE.	BRYAN HOSPITAL
PART V, SECTION B, LINE 21: A PATIENT WITHOUT INSURANCE THAT DID NOT PROMPTLY PAY WOULD PAY 100% OF THE GROSS CHARGE.	MONTPELIER HOSPITAL
PART VI, LINE 2: THE NEEDS ASSESSMENT WAS A COMBINED ASSESSMENT WITH THE WILLIAMS COUNTY OHIO PUBLIC HEALTH DEPARTMENT AND MIDWEST COMMUNITY HEALTH ASSOCIATES MEDICAL GROUP. ALL THREE ENTITIES MADE THE REPORT WIDELY AVAILABLE IN THEIR ORGANIZATIONS. THE PUBLIC HEALTH DEPARTMENT MADE PRESENTATIONS TO COMMUNITY GROUPS AND ORGANIZATIONS.
PART VI, LINE 3: AT THE TIME OF REGISTRATION, FORMS ARE GIVEN TO ALL PATIENTS WITH NO INSURANCE, EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAM. ALSO, SOCIAL WORKERS HAVE THESE FORMS TO GIVE TO PATIENTS THEY ARE WORKING WITH. THEY ARE ALSO GIVEN TO PATIENTS WITH INSURANCE WHEN REQUESTED.FOR ALL PATIENTS WITH NO THIRD PARTY COVERAGE, OR MEDICARE PATIENTS WITH NO SUPPLEMENT INSURANCE, A LETTER WILL BE SENT AT THE TIME THE ACCOUNT IS FINAL BILLED IF PRIOR ARRANGEMENTS HAVE NOT BEEN MADE. THE LETTER EXPLAINS THE HOSPITAL CARE ASSURANCE PROGRAM THROUGH THE STATE OF OHIO AND THE HOSPITAL CHARITABLE CARE PROGRAM. ENCLOSED WITH THE LETTER IS A COPY OF THE FINANCIAL APPLICATION, A COPY OF THE PATIENT'S SUMMARIZED BILL AND A BUSINESS CARD WITH THE NAME AND PHONE NUMBER OF THE PATIENT REPRESENTATIVE RESPONSIBLE FOR THE PATIENT'S ACCOUNT. THIS PACKET MAY ALSO BE SENT TO ANY GUARANTOR WITH A BALANCE AFTER INSURANCE THAT HE/SHE IS NOT ABLE TO PAY ACCORDING TO THE HOSPITAL GUIDELINES.DEPENDING ON THE PATIENT TYPE, SOCIAL SERVICES PATIENTS ARE MADE AWARE OF FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN THEIR DISCHARGE MATERIALS AS PART OF THE PACKET OF INFORMATION THEY RECEIVE. GOVERNMENT OR COMMERCIAL PATIENTS ARE NOT MADE AWARE IN THEIR DISCHARGE MATERIALS AS IT IS NOT INCLUDED IN THEIR DISCHARGE PACKET. HOWEVER, THE PATIENT ACCOUNT WOULD BE BROUGHT UP AGAIN IF THERE WAS A PATIENT RESPONSIBILITY PORTION AFTER THE PRIMARY CARE PROVIDER WAS BILLED.
PART VI, LINE 4: HOSPITALS ARE LOCATED IN BRYAN AND MONTPELIER, OHIO, IN ADDITION TO A MEDICAL CENTER LOCATED IN ARCHBOLD. ALSO, THERE ARE PHYSICIANS OFFICES LOCATED IN WAUSEON, OHIO. APPROXIMATELY 16.0% OF THE POPULATION IS 65 YEARS OR OLDER AND 11.8% IS BELOW POVERTY LEVEL.
PART VI, LINE 6: COMMUNITY HOSPITALS AND WELLNESS CENTERS PROVIDED SERVICES TO APPROXIMATELY 2,800 INPATIENTS AND APPROXIMATELY 46,000 OUTPATIENTS DURING THIS FISCAL YEAR. THE HOSPITAL UTILIZES A BOARD APPROVED CHARITABLE CARE PROGRAM THAT MEASURES INDIVIDUAL AND FAMILY NEEDS BASED ON FEDERAL POVERTY GUIDELINES. THE PROGRAM IS APPLIED UNIFORMLY ACROSS ALL LEVELS OF HOSPITAL SERVICES. THE PROGRAM EXTENDS BEYOND THE FEDERAL POVERTY DEFINITIONS TO ALLOW THE HOSPITAL TO PROVIDE FREE AND/OR SUBSIDIZED CARE FOR PERSONS FALLING WITHIN AND BEYOND THE FEDERAL GUIDELINES. THIS PROGRAM PROVIDED ASSISTANCE TO APPROXIMATELY 3,970 ACCOUNTS DURING THIS FISCAL YEAR.IN ADDITION THE HOSPITAL PROVIDES THE FOLLOWING:COMMUNITY EDUCATION:- ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS) COURSES FOR PHYSICIANS, FOR OUR COUNTY EMS PROVIDERS, AND FOR EMPLOYEES OF OTHER HOSPITALS AT NO CHARGE.- CPR COURSES TO AREA LIFEGUARDS AND COACHES AT NO CHARGE. PROVIDE CPR EQUIPMENT TO AREA SCHOOLS TO ALLOW THEM TO PROVIDE TRAINING. - CHILDBIRTH EDUCATION CLASSES (INCLUDING PREPARED CHILDBIRTH, BABY CARE, SIBLING READINESS, AND BREAST FEEDING) AT NO CHARGE.- HOSPITAL REPRESENTATIVES GAVE OVER 50 COMMUNITY PRESENTATIONS ON A VARIETY OF HEALTH CARE TOPICS.- PHARMACY REPRESENTATIVES VISITED AREA PRESCHOOLS AND KINDERGARTENS AND PROVIDED 35 POISON PREVENTION PROGRAMS TO APPROXIMATELY 499 CHILDREN. HOSPITAL STAFF TIME WAS APPROXIMATELY 62 HOURS AMONGST NINE STAFF. - PHARMACY PRECEPTOR STUDENTS WERE MADE AVAILABLE TO VISIT AREA SENIOR CENTERS AND EDUCATE SENIORS ON MEDICATION USE.- OFFERED SPEAKERS FOR SMOKING CESSATION PROGRAMS.- HOST CAREER DAY FOR LOCAL SCHOOLS EDUCATING STUDENTS ON OPPORTUNITIES IN HEALTH CARE PROFESSION. - PROVIDE A FIELD PLACEMENT SETTING FOR SOCIAL WORK STUDENTS FROM AREA UNIVERSITIES. - LACTATION CONSULTANT PROVIDED FOLLOW UP AND HOME VISITS WHEN NEEDED AT NO CHARGE.- COUNSELING SERVICES AT NO CHARGE PROVIDED STRESS MANAGEMENT PRESENTATIONS FOR AREA BUSINESSES, PROVIDED DE-ESCALATION TRAINING FOR AREA COMMUNITY MENTAL HEALTH AGENCIES, AND OFFERED CRISIS STABILIZATION TO AREA SCHOOLS AFTER SUICIDE.- OFFERED A DIABETIC SUPPORT GROUP THAT PROVIDES FREE MONTHLY MEETINGS TO APPROXIMATELY 20 PEOPLE OFFERING PROFESSIONAL SPEAKERS SHARING THEIR AREA OF EXPERTISE.- OFFERED NUTRITION PRESENTATIONS TO VARIOUS COMMUNITY GROUPS.COMMUNITY SUPPORT:- CONTINUED OUR SOCIAL SERVICES PROGRAM THAT ASSISTS INDIVIDUALS IN OBTAINING MEDICATIONS WHEN PERSONAL FUNDS ARE NOT AVAILABLE.- PROVIDED HEALTH INFORMATION AND HOSPITAL STAFF TO SUPPORT AREA INDUSTRIES EMPLOYEE HEALTH FAIRS. - CONTINUED OUR SOCIAL SERVICES PROGRAM THAT ASSISTED INDIVIDUALS IN COMPLETING THEIR OWN ADVANCED DIRECTIVES (E.G. LIVING WILL AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE).- CONTINUED OUR SOCIAL SERVICES PROGRAM FOR A GRIEF SUPPORT GROUP FOR THE COMMUNITY.- PROVIDED FREE COUNSELING SERVICES TO 25 INDIVIDUALS FROM THE COMMUNITY.- OFFERED A SATURDAY SPORTS INJURY ASSESSMENT CLINIC AND PROVIDE THE CLINIC ASSESSMENT FREE OF CHARGE TO AT LEAST 75 AREA HIGH SCHOOL ATHLETES.- PROVIDED FREE BLOOD PRESSURE CHECKS THROUGH OUR EMERGENCY AND CARDIOPULMONARY DEPARTMENTS.- PROVIDED 9,551 MEALS ON WHEELS FOR HOMEBOUND PEOPLE AT NO CHARGE. IN OUR BRYAN AREA PROGRAM THIS INCLUDES PROVIDING STAFF AND VEHICLES TO DELIVER THE MEALS TO HOMES.- PROVIDED RENT-FREE LIVING SPACE IN BRYAN, OHIO TO UT STUDENTS ASSOCIATED WITH BAHEC, TOTAL ANNUAL RELIEF TO 45 UT STUDENTS WAS $6650.- THE HOSPITAL COORDINATES OUTPATIENT SERVICES FOR CLIENTS OF THE LOCAL COMPASSION MEDICAL CLINIC, WHICH IS A NON-PROFIT CLINIC SERVING UNDERINSURED AND UNINSURED RESIDENTS OF WILLIAMS COUNTY.- PAID UNITED COLLECTION AGENCY $35 PER UNRESPONSIVE ACCOUNT THAT THEY WERE ABLE TO REGISTER WITH HCAP OR MEDICAID. - PAID UNITED COLLECTION AGENCY $1,000 PER MONTH TO IDENTIFY UNRESPONSIVE ACCOUNTS AS POSSIBLE CHARITABLE CARE RECIPIENTS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY. - PROVIDED HEALTH INFORMATION AND HOSPITAL STAFF TO PROVIDE BLOOD PRESSURE AND BMI CHECKS FOR THE COUNTY HEALTH DEPARTMENTS HEART HEALTH WALK/RUN.- THE CARDIOPULMONARY REHABILITATION DEPARTMENT CONDUCTED 30 FITNESS ASSESSMENTS ON MEMBERS OF THE BRYAN FIRE DEPARTMENT AT NO CHARGE. - PROVIDED FREE LUNCHES TO AREA TEACHERS AND STUDENTS TO RECOGNIZE "STUDENTS OF THE MONTH" TOTAL COSTS $800.- PROVIDED FREE LABORATORY TESTING (977 BLOOD PROFILES, 300 PSA TESTS, AND 275 HEMOGLOBIN A1C) FOR THE BI-ANNUAL HEALTH AWARENESS COMMUNITY EVENT. - PROVIDED BASIC SUPPLIES AND MEDICATIONS FOR VARIOUS MISSION TRIPS CONDUCTED BY EMPLOYEES AND MEDICAL STAFF.
PART VI, LINE 7: NOT APPLICABLE

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained
Total Nbr Of501 C3 And Govt Grants	0	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)

Type Of GrantTypeOfGrant	Number Of RecipientsNumberOfRecipients	Amount Of Cash GrantAmountOfCashGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance
HEALTH SERVICE FUND, FINANCIAL ASSISTANCE TO STUDENTS	55	305127
RENT-FREE LIVING TO COLLEGE STUDENTS	45		6650	FMV	RENT-FREE LIVING PROVIDED TO UNIVERSITY OF TOLEDO STUDENTS.

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	OTHER INFORMATION:	Identifier
Return Reference	PART IV:	ReturnReference
Explanation	PART III, FINANCIAL ASSISTANCE TO STUDENTS: SCHOLARSHIPS ARE AWARDED TO STUDENTS PURSUING CERTAIN DEGREE PROGRAMS, OR FOR PAYING BACK LOANS FROM THOSE PROGRAMS. RECIPIENTS ARE DETERMINED BASED ON REVIEW OF APPLICATIONS BY THE PRESIDENT AND CEO.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	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	0	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 (12 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
PHILIP L ENNEN
373516	0	0	0	85821	0	0	0	34972	0	494309	0	85821	0
C NICHOLAS WALZ
249593	0	0	0	0	0	0	0	21535	0	271128	0	0	0
JANICE A DAVID
184993	0	0	0	85893	0	0	0	38917	0	309803	0	85893	0
GREGORY E SLATTERY
231880	0	0	0	85850	0	0	0	34941	0	352671	0	85850	0
MICHAEL CULLER
188022	0	0	0	0	0	0	0	36232	0	224254	0	0	0
CHAD D TINKEL
206106	0	0	0	0	0	0	0	28841	0	234947	0	0	0
SHANNON KEIL
351142	0	0	0	0	0	0	0	20400	0	371542	0	0	0
SCOTT FREDERICK
269223	0	0	0	86623	0	0	0	32875	0	388721	0	86623	0
LARRY SIMON
240873	0	0	0	0	0	0	0	18396	0	259269	0	0	0
CRAIG BUELL
186285	0	0	0	0	0	0	0	18396	0	204681	0	0	0
MARILYN NUSSBAUMER
162441	0	0	0	0	0	0	0	18396	0	180837	0	0	0
RUSTY BRUNICARDI
254121	0	0	0	0	0	0	0	0	0	254121	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Return Reference	PART I, LINE 4B	ReturnReference
Explanation	THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457F RETIREMENT PLAN: VESTED DISTRIBUTIONS PHILIP ENNEN $85,821 JANICE DAVID $85,893 GREGORY SLATTERY $85,850 MICHAEL CULLER $ 0 CHAD TINKEL $ 0 SCOTT FREDERICK $86,623 NO CONTRIBUTIONS WERE MADE TO THE 457F PLANS DURING THE CALENDAR YEAR. DURING 2010, PHILIP ENNEN, JANICE DAVID, GREGORY SLATTERY, AND SCOTT FREDERICK RECEIVED A VESTED 457F DISTRIBUTION AS NOTED ABOVE. THESE AMOUNTS HAVE BEEN PROPERLY INCLUDED IN OFFICERS' COMPENSATION ON SCHEDULE J, PART II, COLUMN B(III). THE HOSPITAL HAS A SUPPLEMENTAL EXECUTIVE RETENTION PLAN FOR THESE EXECUTIVES UNDER IRC SECTION 457(F). THE AMOUNTS DEFERRED UNDER THIS PLAN WILL BE TAXABLE TO THE EXECUTIVE WHEN VESTED AND THERE IS NO LONGER A SUBSTANTIAL RISK OF FORFEITURE. IN ORDER TO HAVE THE RIGHT TO FUTURE PAYMENT OF ANY EMPLOYER DEFERRAL, THE EXECUTIVE WILL HAVE TO REMAIN IN SERVICE UNTIL THE ACCOUNT BECOMES VESTED AS PROVIDED IN THE PLAN DOCUMENT.	Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEIN	Date IssuedDateIssued	Issue PriceIssuePrice	Description Of PurposeDescriptionOfPurpose	DefeasedDefeased	On Behalf Of IssuerOnBehalfOfIssuer	Pool FinancingPoolFinancing	CUSIP NumberCUSIPNumber
COUNTY OF WILLIAMS OH
346401595	2005-09-07	9447848	CURRENTLY REFUND TAXABLE LOANS	0	0	0
CITY OF BRYAN OH
346400228	2008-07-01	10000000	SEE PART V	0	0	0
COUNTY OF WILLIAMS OH
346401595	2008-07-17	45000000	SEE PART V	0	0	0	96948QAA3
VILLAGE OF ARCHBOLD OH
646400063	2008-08-20	10000000	SEE PART V	0	0	0

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceeds	Refunding EscrowRefundingEscrow	Issuance Costs From ProceedsIssuanceCostsFromProceeds	Capital ExpendituresCapitalExpenditures	Year Of Subst CompletionYearOfSubstCompletion	Current RefundingCurrentRefunding	Final Allocation MadeFinalAllocationMade	Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind	Credit EnhancementCreditEnhancement	Amount UnspentAmountUnspent
9447848	9392848	55000	9392848	2011	1	1	1
10208153			10208153	2011	0	1	1
47467738		303337	45157323	2011	0	0	1	316607	1690471
10208153			10208153		0	1	1

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty	Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged	Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
1	1	1
1	1	1
1	1	1
1	1	1

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiled	Variable Rate IssueVariableRateIssue	Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds	Gross Proceeds Invested In GICGrossProceedsInvestedInGIC	Gross Proceeds InvestedGrossProceedsInvested	Exception To RebateExceptionToRebate	Term Of HedgeTermOfHedge	Superintegrated HedgeSuperintegratedHedge	Hedge TerminatedHedgeTerminated
(no name)
0	1	0	0	0	1
(no name)
0	1	0	0	0	0
FIFTH THIRD BANK
0	1	1	0	1	0	9.500000000000	0	0
(no name)
0	1	0	0	0	0

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

IdentifierIdentifier

ExplanationExplanation

SCHEDULE K SUPPLENTAL INFORMATION

PART I, ISSUE B, COLUMN F: CONSTRUCTION, EQUIPPING, EXPANSION, IMPROVEMENT, INSTALLATION, AND SUBSTANTIAL RENOVATION OF THE ORGANIZATION'S CAMPUS. PART I, ISSUE C, COLUMN F: ACQUISITION, CONSTRUCTION, FURNISHING, AND EQUIPPING OF NEW FACILITIES AND ADDITIONS AND IMPROVEMENTS TO THE ORGANIZATION'S CAMPUS. PART I, ISSUE D, COLUMN F: CONSTRUCTION, EQUIPPING, EXPANSION, IMPROVEMENT, INSTALLATION, AND SUBSTANTIAL RENOVATION OF THE ORGANIZATION'S CAMPUS.

PART II, ISSUE B, LINE 3: TOTAL PROCEEDS OF ISSUE ARE $10,208,153, WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART II, ISSUE C, LINE 3: TOTAL PROCEEDS OF ISSUE ARE $47,467,738, WHICH ARE SALE PROCEEDS OF $45,000,000 PLUS INVESTMENT EARNINGS OF $2,467,738. PART II, ISSUE D, LINE 3: TOTAL PROCEEDS OF ISSUE ARE $10,208,153, WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART II, ISSUE A, LINE 6: THE ESCROW WAS SPENT ON THE DAY OF CLOSING OF THE 2005 ISSUE. PART IV, ISSUES B AND D, LINE 6: THE ORGANIZATION IS WORKING WITH A REBATE ANALYST TO DETERMINE IF THE BOND ISSUES QUALIFIED FOR AN EXCEPTION TO REBATE.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
MIDWEST COMMUNITY HEALTH ASSOCIATES
SEE SCH L, PART V	83527	MCHA RENTS SPACE FROM COMMUNITY HOSPITALS & WELLNESS CENTERS.	0
MIDWEST COMMUNITY HEALTH ASSOCIATES
SEE SCH L, PART V	610786	MCHA PROVIDES MEDICAL SERVICES TO COMMUNITY HOSPITALS & WELLNESS CENTERS.	0

Form990 Schedule L Part V Form990ScheduleLPartV

Field	Value	IRS element (for citing)
Identifier	FORM 990, SCHEDULE L, PART IV, COLUMN B	Identifier
Explanation	DR. KOLOVICH AND DR. CONRAD ARE BOTH VOTING MEMBERS OF CHWC. DR. KOLOVICH IS A VOTING MEMBER OF MCHA AND DR. CONRAD IS A MEDICAL DIRECTOR OF MCHA.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
CHANGES IN PROGRAM SERVICES	FORM 990, PART III, LINE 3	COMMUNITY HOSPITALS & WELLNESS CENTERS CLOSED THE IP AND ED AT THEIR ARCHBOLD FACILITY IN SEPTEMBER 2010.
FORM 990, PART VI, SECTION A, LINE 2		KEVIN KOLOVICH AND DIANE CONRAD HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11		PRIOR TO FILING, FORM 990 IS PROVIDED TO THE BOARD, AND A SUMMARY OF THE DISCLOSURES AND CHANGES TO THE FORM IS PRESENTED BY THE CFO AT A MONTHLY BOARD MEETING. IF A BOARD MEMBER IS NOT IN ATTENDANCE FOR THIS PRESENTATION, THAT INDIVIDUAL WILL RECEIVE A COPY OF FORM 990 AT A LATER DATE, PRIOR TO FILING.
	FORM 990, PART VI, SECTION B, LINE 12C	OFFICERS AND VOTING MEMBERS OF THE BOARD ARE COVERED BY THE CONFLICT OF INTEREST POLICY. CONFLICTS OF INTEREST ARE REVIEWED ON A CASE BY CASE BASIS. IF A TRANSACTION ARISES THAT WOULD RESULT IN A CONFLICT, THE INTERESTED INDIVIDUAL SIGNS A CONFLICT OF INTEREST STATEMENT NOTING THAT THEY ARE NOT INDEPENDENT WITH RESPECT TO THE TRANSACTION, AND THEY ABSTAIN FROM VOTING ON THAT MATTER. THE POLICY IS MONITORED BY ALL BOARD MEMBERS AND OFFICERS. THE POLICY IS REVIEWED WITH ANY NEW BOARD MEMBERS OR OFFICERS.
	FORM 990, PART VI, SECTION B, LINE 15	THE CEO'S AND VICE PRESIDENTS' COMPENSATION IS REVIEWED ANNUALLY AND APPROVED BY THE COMPENSATION COMMITTEE. THE DECISIONS REGARDING COMPENSATION ARE DOCUMENTED IN THE MINUTES FROM THE COMPENSATION COMMITTEE MEETINGS. OHA SURVEY DATA IS USED FOR COMPARABILITY PURPOSES. THE PROCESS WAS LAST UNDERTAKEN IN NOVEMBER OF 2010 AND JANUARY OF 2011.
	FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:	FORM 990, PART XI, LINE 5:	NET UNREALIZED LOSSES ON INVESTMENTS: -249,793. CHANGE IN FAIR VALUE OF INTEREST SWAP AGREEMENTS -113,245. TOTAL TO FORM 990, PART XI, LINE 5: -363,038.
	FORM 990, PART XII, LINE 2C	THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

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

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	433 WEST HIGH STREET	AddressLine1
City	BRYAN	City
State	OH	State
ZIP Code	43506	ZIPCode

Field	Value	IRS element (for citing)
EIN	341596175	EIN
Primary Activities	ASSIST COMMUNITY HOSPITALS AND WELLNESS CENTERS WITH FUNDRAISING	PrimaryActivities
Legal Domicile State	OH	LegalDomicileState
Exempt Code Section	501(C)(3)	ExemptCodeSection
Public Charity Status	11A	PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITALS AND WELLNESS CENTERS	BusinessNameLine1

Field	Value	IRS element (for citing)
Controlled Org	1	ControlledOrg

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	0	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	1	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg