2023-11-15T14:35:49-06:00 2022-12-31 FORVIS LLP 312 WALNUT STREET SUITE 3000 CINCINNATI OH 45202 990 2022-01-01 344429514 VAN WERT COUNTY HOSPITAL ASSOCIATION % FINANCE VANW 4192388609 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 EDGAR SILALAHI CFO 4192388870 2023-11-15 true MICHAEL P BROWNING 999009999 Aaron Hershberger P00961884 5136218300 2 2022 2023-04-26 12:10:37Z VAN WERT HEALTH STEPHEN E MARKOVICH MD 3430 OHIOHEALTH PARKWAY COLUMBUS OH 43202 69233483 false X WWW.VANWERTHEALTH.ORG X 1905 OH TO BE THE BEST COMMUNITY HOSPITAL. 12 10 340 3 0 0 1931580 907571 75077047 63975297 848389 823002 2190009 2882056 80047025 68587926 0 0 0 0 36901750 36639018 0 0 0 50445982 47574324 87347732 84213342 -7300707 -15625416 120811656 102449309 67085268 67413405 53726388 35035904 X MISSION: TO BE THE BEST COMMUNITY HOSPITAL. OUR VISION: TO BE THE FIRST CHOICE FOR HEALTHCARE WITHIN OUR REGION. WE STRIVE TO PROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTINGS AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER. VAN WERT HEALTH WILL MEET THE COMMUNITY HEALTH CARE NEEDS BY CONTINUALLY ENDEAVORING TO IMPROVE THE QUALITY OF PATIENT CARE WE PROVIDE WITHIN OUR RESOURCE CAPABILITIES. PROGRAMS AND SERVICES SPONSORED BY VAN WERT HEALTH WILL SERVE AS AN ACCESS POINT TO HEALTH CARE WITHIN OUR COMMUNITY. WE ACCEPT RESPONSIBILITY FOR PROVIDING COMMUNITY LEADERSHIP. VAN WERT HEALTH ASSURES THAT HEALTH CARE SERVICES PROVIDED ARE AVAILABLE TO ALL MEMEBER OF THE COMMUNITIES WE SERVE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, OR ABILITY TO PAY, WHILE AT THE SAME TIME RESPECTING BOTH RIGHTS AND RESPONSIBILITIES OF OUR PATIENTS. false false 66982966 66293671 INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES 66982966 true true false true false false false false false true true false false true true true false true false false false false false false false false true true false false true true false false false false false false false true false false false false false false true true true false false false true 188 0 true 340 true false false false false false false false false false false false false X 12 10 false false false false true true true true true false false false true true true true true true true true true X FINANCE 6145444350 3430 OHIOHEALTH PARKWAY COLUMBUS OH 43202 Dr Scott Shie Physician 40.0 0.0 X 957748 0 65201 Dr Nicholai Kiehl Physician 40.0 0.0 X 958313 0 59597 Dr M Nizar Orfahli Physician 40.0 0.0 X 517585 0 64119 James Pope CEO - TERM ENDED 40.0 2.0 X X 474344 0 50920 Dr Charles Hoehn Physician 40.0 0.0 X 462049 0 58013 Dr Jeremy Stoller Physician 40.0 0.0 X 453053 0 52383 Thomas Conte MD Chief of Staff 40.0 2.0 X X 439775 0 61991 Edgar Silalahi CFO 40.0 0.0 X 224317 0 46423 Jon Bagley Interm CEO 40.0 2.0 X X 200013 0 12014 Paula Stabler CNO/COO 40.0 0.0 X 187400 0 14415 Leslie Beining Asst CNO 40.0 0.0 X 87538 0 6697 Elizabeth Neuschwanger CNO/COO 40.0 0.0 X 41914 0 7252 Aaron Baker Secretary 2.0 0.0 X X 0 0 0 Ben Faurote Trustee 2.0 0.0 X 0 0 0 Adam Houg MD Trustee 2.0 0.0 X 0 0 0 Eric Jelinger Md Trustee 2.0 2.0 X 0 0 0 Tim Jurzyk Past Chairperson 2.0 0.0 X 0 0 0 Mike Keysor Chairperson 2.0 0.0 X X 0 0 0 Barb Kohnen Trustee 2.0 0.0 X 0 0 0 Jeff Snyder Trustee 2.0 0.0 X 0 0 0 Tom Turnwald Vice-Chairperson 2.0 0.0 X X 0 0 0 Todd Wolfrum Trustee 2.0 0.0 X 0 0 0 5004049 0 499025 43 false true false Quorum Health Resources LLC 1573 Mallory Lane Suite 200 BRENTWOOD TN 37027 REV CYCLE 2964749 Therapy Solutions LLC 120 West Main Street VAN WERT OH 45891 Rehabilitation 2495727 Cardinal Health Pharmacy 71 MIL Acres Drive COLUMBUS OH 43218 PHARMACY 1586717 New Vision Medical Labs Inc 750 West High Street Suite 400 LIMA OH 45801 LABORATORY 1374100 Medline Industries Dept CH 1400 PALATINE IL 60055 Healthcare Supplies 1342328 54 796746 110825 907571 PATIENT SERVICE REVENUE 900099 63975297 63975297 63975297 295026 295026 0 0 1112841 645557 467284 0 467284 467284 527976 527976 527976 527976 0 0 0 0 0 0 0 0 0 RHC Income 900099 1070206 1070206 Cafeteria/Vending Services 900099 96398 96398 ALL OTHER MISC REVENUE 900099 1248168 1248168 2414772 68587926 66293671 1386684 0 0 0 0 1855013 1437911 417102 0 27033682 20955126 6078556 418687 324545 94142 5585595 4329667 1255928 1746041 1353442 392599 0 323988 251139 72849 100810 78143 22667 0 0 20628 15990 4638 21069505 16332001 4737504 0 221607 171778 49829 1394056 1080601 313455 1401930 1086704 315226 0 1182540 916644 265896 248874 192914 55960 0 0 4101595 3179346 922249 0 6831112 5295128 1535984 805341 624259 181082 Taxes 1745042 1352667 392375 Nutritional Services 115669 115669 0 Medical Supplies 6538991 6538991 0 Bad Debt 928558 928558 0 544078 421742 122336 84213342 66982966 17230376 0 527410 1924819 0 0 0 0 12716334 10907566 0 0 0 0 0 0 577828 404018 893264 998615 129637485 65338316 72984311 64299169 16908420 7263482 0 0 0 0 0 0 16204089 16651640 120811656 102449309 5602605 7638528 11863 0 0 0 59070521 58154273 0 0 0 0 2400279 46338 0 0 0 1574266 67085268 67413405 X 49208519 30988588 4517869 4047316 53726388 35035904 120811656 102449309 -15625416 -3065068 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1025 1025 false PART II-B, LINE 1: PERCENTAGE OF DUES PAID TO THE AMERICAN MEDICAL ASSOCIATION THAT IS USED FOR POLITICAL PURPOSES. 4517869 -456771 13782 4047316 4484658 4484658 9388032 304675 311613 5519662 4484658 9053290 714479 285100 94637 9388032 8958410 274201 105932 73389 9053290 1.00000 false false 5224695 5224695 71722843 64231234 7491609 52664019 1107082 51556937 25928 25928 64299169 INVESTMENT IN JOINT VENTURES 651510 ASSETS WHOSE USE IS LIMITED 8971908 OTHER ASSETS 7028222 16651640 0 LEASE LIABILITY 1574266 1574266 SCHEDULE D, PART V, LINE 4 THE INVESTMENT INCOME GENERATED BY THE ENDOWMENT FUNDS DISTRIBUTED TO THE HOSPITAL IS ABLE TO BE USED FOR GENERAL OPERATING AND CAPITAL EQUIPMENT NEEDS. true true X true X true X true true false true true 2094798 1947112 147686 0.00180 12466744 7397436 5069308 0.06090 14561542 9344548 5216994 0.06270 28603 2690 25913 0.00030 16204 16204 0.00020 44807 2690 42117 0.00050 14606349 9347238 5259111 0.06320 true 928558 21241402 10411795 10829607 X true true COMMUNITY CARE SYSTE MANAGED CARE CONTRACTING 0.5 0.5 1 1 VAN WERT COUNTY HOSPITAL ASSOCIATION 1250 S WASHINGTON ST VAN WERT OH 45891 VANWERTHEALTH.ORG/1287 X X X VAN WERT COUNTY HOSPITAL ASSOCIATION false false true X X X X X X X X X 21 true false true true X SEE PART V, SECTION C X true 21 true SEE PART V, SECTION C false true X 100 200. X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 IN CONDUCTING ITS MOST RECENT CHNA, VAN WERT COUNTY HOSPITAL ASSOCIATION OBTAINED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH VIA INTERVIEWS AND SURVEYS OF COMMUNITY LEADERS, REPRESENTATIVES, AND MEMBERS. PART V, SECTION B, LINE 6B VAN WERT COUNTY HOSPITAL ASSOCIATION'S CHNA WAS CONDUCTED WITH THE FOLLOWING ORGANIZATIONS: VAN WERT COUNTY GENERAL HEALTH DISTRICT CRESTVIEW LOCAL SCHOOLS LINCOLNVIEW LOCAL SCHOOLS VAN WERT CITY SCHOOLS WESTWOOD BEHAVIORAL HEALTH CENTER VAN WERT HEALTH NORTHWESTERN OHIO COMMUNITY ACTION COMMISSION FAMILY HEALTH CARE OF NORTHWEST OHIO VAN WERT COUNTY FAMILY & CHILDREN FIRST VAN WERT COUNTY COUNCIL ON AGING YWCA OF VAN WERT COUNTY VAN WERT COUNTY DEPARTMENT OF JOB & FAMILY SERVICES UNITED WAY OF VAN WERT COUNTY MAIN STREET VAN WERT VAN WERT COUNTY ECONOMIC DEVELOPMENT TRI COUNTY ADAMHS BOARD SCHEDULE H, PART V, SECTION B, LINE 11 THE THREE PRIORITY HEALTH NEEDS THAT WILL BE ADDRESSED IN THE 2022-2024 IMPLEMENTATION STRATEGY ARE: - PRIORITY AREA 1: NUTRITION & PHYSICAL ACTIVITY - PRIORITY AREA 2: ACCESS TO CARE - PRIORITY AREA 3: MENTAL HEALTH & ADDICTION PRIORITY AREA 1: NUTRITION & PHYSICAL ACTIVITY STRATEGY 1: INCREASE YOUTH FRUIT CONSUMPTION. (SHIP INDICATOR HB3: YOUTH FRUIT CONSUMPTION). STRATEGY 2: INCREASE YOUTH VEGETABLE CONSUMPTION. (SHIP INDICATOR HB4: YOUTH VEGETABLE CONSUMPTION) STRATEGY 3: INCREASE PHYSICAL ACTIVITY OF CHILDREN. (SHIP INDICATOR HB5: CHILD PHYSICAL ACTIVITY) ACTION STEP(S): - ANNUAL PARTNERSHIP FOR THE MARKET AT THE WASS FARMERS' MARKET TO INCREASE ACCESS TO FRESH PRODUCE. - COMMUNITY WELLNESS EDUCATION AND RESOURCES FOR FAMILIES THAT INCLUDE: + KIDS' HEALTH FAIRS AT AREA SCHOOLS + IT'S A GIRL THING EVENT + BACK TO SCHOOL EVENT + PLACE BIKE RACKS AND WATER STATIONS THROUGHOUT THE COMMUNITY WHERE THERE ARE CURRENTLY NONE (EX. DOWNTOWN AREA) + A HEALTHY LIVING SOCIAL MEDIA CAMPAIGN. PRIORITY AREA 2: ACCESS TO CARE STRATEGY 1: INCREASE HEALTH INSURANCE COVERAGE FOR UNINSURANCE ADULTS. (SHIP INDICATOR AC1: UNINSURED ADULTS) STRATEGY 2: INCREASE HEALTH INSURANCE COVERAGE FOR UNINSURED CHILDREN. (SHIP INDICATOR AC2: UNINSURED CHILDREN) ACTION STEP(S): - INCREASE AWARENESS OF SOCIAL SERVICES. - IMPLEMENT INITIATIVE TO DRIVE COMMUNITY WIDE NETWORKING AMONG ORGANIZATIONS AND PROVIDERS IN VAN WERT HEALTH SERVICE AREA. - WORK WITH HEALTH COLLABORATIVE TO BUILD CULTURAL COMPETENCY FOR SPANISH SPEAKING POPULATION. - BUILD NETWORK OF PROVIDERS THAT SERVE SPANISH SPEAKING POPULATION. - INCREASE ELIGIBILITY SOCIAL ASSISTANCE PROGRAMS OF THE HISPANIC/SPANISH SPEAKING POPULATION. STRATEGY 3: DECREASE NUMBER OF PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS. (SHIP INDICATOR AC3: PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS) STRATEGY 4: DECREASE NUMBER OF MENTAL HEALTH PROFESSIONAL SHORTAGE AREAS. (SHIP INDICATOR AC4: MENTAL HEALTH PROFESSIONAL SHORTAGE AREAS) ACTION STEP(S): - PROVIDE UP TO 6 RENEWABLE HIGH SCHOOL SCHOLARSHIPS FOR THOSE PURSUING STUDIES IN HEALTH AND HUMAN SERVICES. - PROVIDE MEDICAL SCHOLARSHIPS. - CONDUCT ONGOING PHYSICIAN RECRUITMENT AND PARTNERSHIPS TO PROVIDE LOCAL ACCESS TO SPECIALTIES. - INCREASE INTEGRATED MENTAL HEALTH SERVICES IN SCHOOLS. STRATEGY 5: DECREASE UNMET NEED FOR MENTAL HEALTH CARE FOR YOUTH DEPRESSION. (SHIP INDICATOR AC5: YOUTH DEPRESSION TREATMENT FOR UNMET NEED) STRATEGY 6: DECREASE UNMET NEED FOR MENTAL HEALTH CARE FOR MENTAL HEALTH CARE FOR ADULTS. (SHIP INDICATOR AC6: ADULT MENTAL HEALTH CARE UNMET NEED) ACTION STEP(S): - INCREASE AWARENESS AND UTILIZATION OF GETLOCALHELPNOW APP. - INCREASE INTEGRATED MENTAL HEALTH SERVICES IN SCHOOLS. - UPDATE TREATMENT REFERRAL PATHWAYS FOR LOCAL PHYSICIANS AND ORGANIZATIONS. - INVESTIGATE EMR INTEGRATION BETWEEN MENTAL HEALTH AND HEALTHCARE. - INCREASE NUMBER OF ADULTS TRAINED IN YOUTH MENTAL HEALTH FIRST AID. PRIORITY AREA 3: MENTAL HEALTH & ADDICTION STRATEGY 1: DECREASE YOUTH DEPRESSION. (SHIP INDICATOR MHA1: YOUTH DEPRESSION) STRATEGY 2: DECREASE ADULT DEPRESSION. (SHIP INDICATOR MHA2: ADULT DEPRESSION) ACTION STEP(S): - INCREASE AWARENESS AND UTILIZATION OF GETLOCALHELPNOW APP. - INCREASE INTEGRATED MENTAL HEALTH SERVICES IN SCHOOLS. - UPDATE TREATMENT REFERRAL PATHWAYS FOR LOCAL PHYSICIANS AND ORGANIZATIONS. - INVESTIGATE EMR INTEGRATION BETWEEN MENTAL HEALTH AND HEALTHCARE. - COMMUNITY WELLNESS EDUCATION AND RESOURCES FOR FAMILIES THAT INCLUDE: + KIDS' HEALTH FAIRS AT AREA SCHOOLS + IT'S A GIRL THING EVENT + A HEALTHY LIVING SOCIAL MEDIA CAMPAIGN - PROVIDE YOUTH MENTAL HEALTH FIRST AID COURSES IN THE COMMUNITY AND SCHOOLS. - PROVIDE MENTAL HEALTH FIRST AID COURSES IN THE COMMUNITY. STRATEGY 3: DECREASE YOUTH SUICIDE DEATHS. (SHIP INDICATOR MHA3: YOUTH SUICIDE DEATHS) STRATEGY 4: DECREASE ADULT SUICIDE DEATHS. (SHIP INDICATOR MHA4: ADULT SUICIDE DEATHS) ACTION STEP(S): - INCREASE AWARENESS AND UTILIZATION OF GETLOCALHELPNOW APP. - INCREASE INTEGRATED MENTAL HEALTH SERVICES IN SCHOOLS. - UPDATE TREATMENT REFERRAL PATHWAYS FOR LOCAL PHYSICIANS AND ORGANIZATIONS. - INVESTIGATE EMR INTEGRATION BETWEEN MENTAL HEALTH AND HEALTHCARE. - COMMUNITY WELLNESS EDUCATION AND RESOURCES FOR FAMILIES THAT INCLUDE: + KIDS' HEALTH FAIRS AT AREA SCHOOLS + IT'S A GIRL THING EVENT + A HEALTHY LIVING SOCIAL MEDIA CAMPAIGN - PROVIDE YOUTH MENTAL HEALTH FIRST AID COURSES IN THE COMMUNITY AND SCHOOLS. - PROVIDE MENTAL HEALTH FIRST AID COURSES IN THE COMMUNITY. STRATEGY 5: DECREASE YOUTH ALCOHOL USE. (SHIP INDICATOR MHA5: YOUTH ALCOHOL USE) STRATEGY 6: DECREASE YOUTH MARIJUANA USE. (SHIP INDICATOR MHA6: YOUTH MARIJUANA USE) STRATEGY 7: DECREASE UNINTENTIONAL DRUG OVERDOSE DEATHS. (SHIP INDICATOR MHA7: UNINTENTIONAL DRUG OVERDOSE DEATHS) ACTION STEP(S): - INCREASE AWARENESS AND UTILIZATION OF GETLOCALHELPNOW APP. - INCREASE INTEGRATED MENTAL HEALTH SERVICES IN SCHOOLS. - UPDATE TREATMENT REFERRAL PATHWAYS FOR LOCAL PHYSICIANS AND ORGANIZATIONS. - INVESTIGATE EMR INTEGRATION BETWEEN MENTAL HEALTH AND HEALTHCARE. - COMMUNITY WELLNESS EDUCATION AND RESOURCES FOR FAMILIES THAT INCLUDE: + KIDS' HEALTH FAIRS AT AREA SCHOOLS + IT'S A GIRL THING EVENT + A HEALTHY LIVING SOCIAL MEDIA CAMPAIGN - PROVIDE YOUTH MENTAL HEALTH FIRST AID COURSES IN THE COMMUNITY AND SCHOOLS. - PROVIDE MENTAL HEALTH FIRST AID COURSES IN THE COMMUNITY. TAKING EXISTING ORGANIZATIONAL AND COMMUNITY-BASED RESOURCES INTO CONSIDERATION, VAN WERT COUNTY HOSPITAL ASSOCIATION IS CHOOSING NOT TO ADDRESS CHRONIC DISEASES, TOBACCO AND NICOTINE USE, AND VARIOUS COMMUNITY CONDITIONS/SOCIAL DETERMINANTS OF HEALTH AS IDENTIFIED IN THE CHNA. HOWEVER, HEALTH NEEDS SUCH AS VARIOUS CHRONIC DISEASES ARE INDIRECTLY ADDRESSED BY ACTION STEPS FOR THE 3 PRIORITY FACTORS FOCUSED ON BY THE HOSPITAL. WE ARE ALSO CHOOSING NOT TO ADDRESS COVID-19, MATERNAL AND INFANT HEALTH ISSUES, PREVENTATIVE PRACTICES, AND HIV/AIDS TESTING BECAUSE THOSE HEALTH NEEDS WERE PRIORITIZED EXTREMELY LOW BY THE COMMUNITY IN ALL PRIMARY DATA COLLECTION METHODS. VAN WERT COUNTY HOSPITAL ASSOCIATION CANNOT ADDRESS ALL THE HEALTH NEEDS IN THE COMMUNITY AND MUST FOCUS ON AREAS WHERE WE HAVE THE GREATEST POTENTIAL FOR IMPACT AND THAT ALSO ALIGN WITH OUR MISSION AND PREVENT DUPLICATION OF EFFORT. COMMUNITY PARTNERSHIPS MAY SUPPORT OTHER INITIATIVES THAT THE HOSPITAL CANNOT INDEPENDENTLY LEAD IN ORDER TO ADDRESS THE OTHER HEALTH NEEDS IDENTIFIED IN THE 2021 CHNA. PART V, SECTION B, LINE 13H VAN WERT HEALTH UTILIZES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PATIENTS WITH A HOUSEHOLD INCOME LESS THAN 100% OF FPG WHO ARE INELIGIBLE FOR MEDICAID QUALIFY FOR THE HCAP (HEALTH CARE ASSURANCE PROGRAM) WHICH IS A STATE AND FEDERAL PROGRAM ADMINISTERED BY THE OHIO DEPARTMENT OF HEALTH. VAN WERT HEALTH'S HOPE PROGRAM OFFERS FINANCIAL ASSISTANCE TO PATIENT WHO ARE ABOVE 100% OF THE FPG. THOSE WHOSE INCOMES ARE LESS THAN 200% FPG QUALIFY FOR A 60% DISCOUNT WHILE THOSE WHOSE INCOMES ARE LESS THAN 300% OF THE FPG ARE OFFERED A 40% DISCOUNT. HOPE DISCOUNTS ARE ABOVE AND BEYOND 501R DISCOUNTS FOR SELF-PAY PATIENTS. PART V, SECTION B, LINE 16J EVERY PATIENT STATEMENT SENT BY THE ORGANIZATION INCLUDES INFORMATION ABOUT FA / FAP ALONG WITH A FULL APPLICATION FOR THE FAP. SCHEDULE H, PART V, LINE 7A: VANWERTHEALTH.ORG SCHEDULE H, PART V, LINE 10A VANWERTHEALTH.ORG SCHEDULE H, PART V, LINE 16A, B & C VANWERTHEALTH.ORG 6 VAN WERT HEALTH-HEALTH CENTER 140 FOX ROAD VAN WERT OH 45891 PHYS. MEDICAL OFFICE BLDG. VAN WERT HEALTH-ROCKFORD FAMILY MEDICINE 506 S MAIN ST ROCKFORD OH 45882 PHYSICIAN OFFICE VAN WERT HEALTH-OTTOVILLE FAMILY MED 290 E 3RD ST OTTOVILLE OH 45876 PHYSICIAN OFFICE VAN WERT HEALTH PEDIATRIC THERAPY OFFICE 1182 PROFESSIONAL DR VAN WERT OH 45891 PEDIATRIC P.T./HB NON-EXEMPT VAN WERT HEALTH NORTH 214 TOWNE CENTER BLVD VAN WERT OH 45891 PHYSICIAN BASED AMBULATORY CEN VAN WERT HEALTH OBGYN PAULDING 1035 WEST WAYNE ST PAULDING OH 45879 PHYSICIAN OFFICE PART I, LINE 3C VAN WERT HEALTH UTILIZES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PATIENTS WITH A HOUSEHOLD INCOME LESS THAN 100% OF FPG WHO ARE INELIGIBLE FOR MEDICAID QUALIFY FOR THE HCAP (HEALTH CARE ASSURANCE PROGRAM) WHICH IS A STATE AND FEDERAL PROGRAM ADMINISTERE BY THE OHIO DEPARTMENT OF HEALTH. VAN WERT HEALTH'S HOPE PROGRAM OFFERS FINANCIAL ASSISTANCE TO PATIENT WHO ARE ABOVE 100% OF THE FPG. THOSE WHOSE INCOMES ARE LESS THAN 200% FPG QUALIFY FOR A 60% DISCOUNT WHILE THOSE WHOSE INCOMES ARE LESS THAN 300% OF THE FPG ARE OFFERED A 40% DISCOUNT. HOPE DISCOUNTS ARE ABOVE AND BEYOND 501R DISCOUNTS FOR SELF-PAY PATIENTS.VAN WERT HEALTH ALSO USES THE FOLLOWING CRITERIA IN ADDITION TO FPG TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY: MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. PART I, LINE 7 THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. PART I, LN 7 COL(F) $5,433,353 IN BAD DEBT EXPENSE WAS EXCLUDED FROM FORM 990, PART IX TOTAL EXPENSES IN COMPUTING THE PERCENTAGES REPORTED IN COLUMN F. PART III, LINE 2 BAD DEBT IS ACCOUNTED FOR AFTER ALL DISCOUNTS FOR 501R AND FINANCIAL ASSISTANCE ARE APPLIED. VAN WERT HEALTH UTILIZES A RESERVE MODEL FOR ACTIVE A/R TO ESTIMATE BAD DEBT EXPENSE, THIS MODEL IS ADJUSTED MONTHLY TO ACCOUNT FOR FLUCTUATIONS IN THE A/R AGE AND BALANCES. AFTER 4 STATEMENTS CYCLES OVER 120 DAYS ANY REMAINING SELF-PAY BALANCE IS SUBMITTED TO A COLLECTION AGENCY. AT THIS POINT THE WRITE-OFF WOULD BE EXPENSED AND THE RESERVE MODEL ON THE A/R WOULD REFLECT AN OFFSETTING CREDIT TO EXPENSE FOR ANY AMOUNT THAT HAD BEEN PREVIOUSLY RESERVED. PART III, LINE 3 THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. VAN WERT HEALTH DOES NOT ATTRIBUTE ANY BAD DEBT EXPENSE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP), THEREFORE NO PORTION OF BAD DEBT ATTRIBUTABLE TO FAP-ELIGIBLE INDIVIDUALS IS CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 4 SEE FOOTNOTE 1, PAGE 13 UNDER 'PATIENT SERVICE REVENUE' IN THE NOTES TO CONSOLIDATED FINANCIAL STATEMENTS. PART III, LINE 8 THE ORGANIZATION DOES NOT CONSIDER THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. PART III, LINE 9B FOLLOWING THE GUIDELINES AND PROCESSES AS INDICATED IN QUESTION 3, PATIENT EDUCATION REGARDING ELIGIBILITY FOR ASSISTANCE, THE ORGANIZATION APPROPRIATELY IDENTIFIES ACCOUNTS AS TO THE TYPE OF ASSISTANCE QUALIFIED FOR. THE AMOUNTS ELIGIBLE FOR ASSISTANCE ARE WRITTEN OFF TO THE APPROPRIATE PROGRAM AND COLLECTION ACTIVITY CEASES IN REGARD TO THOSE AMOUNTS. THE GOAL OF THE ORGANIZATION'S POLICIES IS TO INDENTIY ACCOUNTS ELIGIBLE FOR ASSISTANCE AND BRING THE ACCOUNT TO AN APPROPRIATE CONCLUSION AS EARLY IN THE BILLING CYCLE AS POSSIBLE. PART VI, LINE 2 THE ORGANIZATION USES A VARIETY OF METHODS TO ASSESS HEALTH CARE NEEDS. DATA PROVIDED BY THE STATE OF OHIO IS USED TO DETERMINE EPIDEMIOLOGY'S RELATED TO CHRONIC CONDITIONS AND CANCER REGISTRIES PROVIDING PREVALENCE. INTERNAL DATA IS ALSO USED AS WELL AS INPUT FROM OTHER PROVIDERS. THE HOSPITAL ALSO USES PATIENT ORIGIN DATA PROVIDED BY THE OHIO HOSPITAL ASSOCIATION TO DETERMINE CURRENT TREATMENT PATTERNS AND DIAGNOSIS FOR CURRENT RESIDENTS BEING TREATED BY VAN WERT HEALTH AND OTHER SURROUNDING PROVIDERS. THE HOSPITAL ALSO SPONSORS A NUMBER OF HEALTH FAIRS/ASSESSMENTS TO BOTH ADULT AND PEDIATRIC POPULATIONS OF VAN WERT THAT ARE ALSO EXAMINED FOR FREQUENCY AND NEEDS. A NUMBER OF STAFF AS WELL AS BOARD OF TRUSTEES MEMBERS ALSO SERVED ON COMMUNITY HEALTH PROVIDER BOARDS AND PROVIDE INPUT TO THE PLANNING PROCESS. THE HOSPITAL PARTICIPATED IN A COMMUNITY-WIDE HEALTH CARE NEEDS ASSESSMENT PROJECT WITH COLLABORATING AGENCIES WITHIN THE AREA. AS A RESULT OF THIS EFFORT, NUTRITION AND PHYSICAL ACTIVITY, ACCESS TO CARE, MENTAL HEALTH AND ADDICTION ARE THE NEEDS IDENTIFIED BY THE COALITION THAT WILL BE THE FOCUS OF THE HEALTH IMPROVEMENT PLAN DEVELOPED BY THE COALITION. THE HOSPITAL IS ALSO SUBSCRIBED TO A NUMBER OF BENCHMARKING ORGANIZATIONS THAT PROVIDE BEST OF INDUSTRY APPLICATIONS TO ASSESS METHODOLOGIES FOR TREATING OUR RESIDENTS. PART VI, LINE 3 PATIENT EDUCATION REGARDING THEIR ELIGIBILITY FOR ASSISTANCE BEGINS AT THE PATIENT ACCESS TO CARE AREAS. INFORMATIONAL SIGNAGE IS POSTED IN ALL PATIENT ACCESS AREAS IDENTIFYING FINANCIAL ASSISTANCE PROGRAMS AND INSTRUCTIONS ON HOW TO SEEK OUT THESE PROGRAMS. SIMILAR INFORMATION IS ALSO FOUND IN PATIENT INFORMATIONAL BROCHURES PROVIDED TO PATIENTS PRIOR TO THE RENDERING OF CARE BASED UPON THE TYPE OF CARE BEING PROVIDED. ALSO, AVAILABLE AT ALL PATIENT ACCESS POINTS ARE THE PATIENT FINANCIAL ASSISTANCE BROCHURES. PATIENT REGISTRATION STAFF AT ALL PATIENT ACCESS POINTS ARE TRAINED IN THE PATIENT FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AT THE HOSPITAL. THEY BECOME A VALUABLE RESOURCE TO PATIENTS DIRECTING THEM TO THE PROGRAMS THEY MAY QUALIFY FOR AND THE PROCESS WITH WHICH TO SEEK THE APPROPRIATE ASSISTANCE. THE HOSPITAL UTILIZES THE HOSPITAL WEBSITE AS AN ON-LINE AND TECHNOLOGICALLY CURRENT SOURCE OF FINANCIAL ASSISTANCE INFORMATION FOR PATIENTS THAT PREFER FINDING EDUCATIONAL INFORMATION IN THIS FORMAT. FINANCIAL ASSISTANCE PROGRAMS, POLICIES, ELIGIBILITY CRITERIA, AND ON-LINE APPLICATIONS FOR THE VARIOUS PROGRAMS ARE AVAILABLE. PATIENT BILLING STATEMENTS PROVIDE ANOTHER AVENUE FOR EDUCATING PATIENTS AS TO FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AND HOW TO CONTACT THE HOSPITAL TO DETERMINE ELIGIBILITY. THIS INFORMATION IS LOCATED ON THE BACK OF EACH BILLING STATEMENT RECEIVED BY THE PATIENT. THE EXISTENCE OF A FINANCIAL COUNSELOR IN THE PATIENT FINANCIAL SERVICES DEPARTMENT IS ANOTHER MECHANISM UTILIZED IN EDUCATING PATIENTS REGARDING FINANCIAL ASSISTANCE AVAILABLE FOR HOSPITAL SERVICES. ALL UNINSURED OR SELF-PAY POTENTIAL ACCOUNTS ARE IDENTIFIED TO THE FINANCIAL COUNSELOR UPON PATIENT REGISTRATION. PATIENTS MAY BE CONTACTED UPON COMPLETION OF SERVICES. ALL PATIENTS THAT WERE NOT CONTACTED UPON COMPLETION OF SERVICES RECEIVE A FINANCIAL ASSISTANCE APPLICATION THROUGH THE MAIL THAT INCLUDES INFORMATION REGARDING ALL FINANCIAL ASSISTANCE PROGRAMS. THE COUNSELOR PROVIDES FOLLOW-UP AND ASSISTANCE TO IDENTIFY THE PATIENT WITH THE APPROPRIATE FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4 VAN WERT COUNTY HOSPITAL ASSOCIATION DBA VAN WERT HEALTH IS LOCATED IN THE RURAL COUNTY OF VAN WERT, OHIO THAT BORDERS THE INDIANA STATE LINE ALONG ALLEN COUNTY INDIANA. OUR PRIMARY SERVICE AREA COMPRISES VAN WERT AND SOME PORTIONS OF PAULDING, PUTNAM AND MERCER COUNTIES. NUMERICALLY THIS BREAKS DOWN TO APPROXIMATELY 50,000 RESIDENTS IN OUR PRIMARY MARKET AREA. THE HOSPITAL IS LOCATED WITHIN THE CITY OF VAN WERT, WHICH POSSESSES A POPULATION OF 10,700. OUR POPULATION IS PREDOMINANTLY WHITE (93.7%) WITH HISPANIC (3.5%). A MIX OF MINORITIES COMPRISE THE REMAINDER. VAN WERT IS RURAL IN NATURE WITH EMPLOYMENT NOT ONLY IN AGRICULTURAL SERVICES BUT ALSO IN THE MANUFACTURING AND SERVICE SECTOR. THE UNEMPLOYMENT RATE IN VAN WERT COUNTY HAS BEEN STEADILY DROPPING FROM A HIGH OF > 15% IN 2008-2010 TO A CURRENT LEVEL AROUND 3%. HOWEVER, 11.4% OF THE POPULATION IS CONSIDERED TO BE LIVING IN POVERTY AND CONTRIBUTES TO INCREASING NUMBERS OF CITIZENS COVERED UNDER THE MEDICAID PROGRAM AND QUALIFYING FOR THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS INCREASING BAD DEBT. LIKE MANY MIDWEST COMMUNITIES THE REGION HAS EXPERIENCED AN AGING POPULATION WITH 19.0% OVER 65 AND 27.8% 45 -64 ESTIMATED FOR 2018 BY THE OHIO OFFICE FOR RESEARCH. PART VI, LINE 5 THE VAN WERT COUNTY HOSPITAL ASSOCIATION BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS FROM OUR COMMUNITY. THE MAJORITY OF THESE MEMBERS LIVE AND WORK WITHIN THE COMMUNITY AND ARE INVOLVED WITH OTHER NON-PROFIT AGENCIES. SENIOR LEADERSHIP ALSO LIVES IN THE PRIMARY SERVICE AREA. THIS "SPIRIT" OF COMMUNITY BASED HEALTHCARE RESIDES IN OUR BOARD OF TRUSTEES AND IS FURTHER EVIDENCED BY OUR OPEN MEDICAL STAFF. THE ACCOMMODATION OF SPECIALTY SERVICES NOT CURRENTLY PRESENT IN OUR AREA BEING PROVIDED THROUGH A SPECIALTY CLINIC OF THE HOSPITAL WHICH INCLUDE NEUROLOGY, NEUROSURGERY, IMMUNOLOGY, AND ENT SERVICES. THE HOSPITAL ASSOCIATED PERSONNEL ALSO SIT ON OTHER COMMUNITY BASED GOVERNANCE BOARDS (UNITED WAY, AMERICAN RED CROSS, CHAMBER OF COMMERCE, WRIGHT STATE UNIVERSITY REGIONAL CAMPUS, PUBLIC ACCESS TELEVISION, AMERICAN CANCER SOCIETY & VAN WERT ECONOMIC DEVELOPMENT TO NAME A FEW) THROUGH PHYSICIAN RECRUITMENT WE HAVE BROUGHT IN A NUMBER OF NEW SPECIALTIES INCLUDING OBSTETRICS, PULMONOLOGY/CRITICAL CARE AND ADDITIONAL LAPAROSCOPIC SURGICAL PROCEDURES. WE ALSO PROVIDE A LOAN FORGIVENESS PROGRAM FOR RESIDENTS INTERESTED IN BECOMING PHYSICIANS AND RETURNING TO OUR AREA. OUR WELLNESS CENTER PROVIDES HEALTH, EDUCATION, AND SOCIAL PROGRAMS FOR TARGETED POPULATIONS. WE HAVE JOINED A REGIONAL STROKE NETWORK AS WELL AS PARTICIPATING IN A NUMBER OF PATIENT AND EDUCATIONAL SUPPORT GROUPS (BETTER BREATHERS, STROKE SUPPORT GROUP, BETTER PARENTING). THE HOSPITAL ALSO PARTICIPATES IN HEALTH PROFESSIONS EDUCATIONAL PROGRAMS. A NUMBER OF OUR PHYSICIANS PROVIDE TRAINING FOR SENIOR MEDICAL STUDENTS THROUGH THE LIMA AREA HEALTH EDUCATION COMMITTEE. A NUMBER OF NURSING EDUCATIONAL PROGRAM USE OUR HOSPITAL TO DO THEIR CLINICAL ROTATIONS. OUR REHAB SERVICES DEPARTMENT ROUTINELY HOSTS STUDENTS FROM THE UNIVERSITY OF FINDLAY, HUNTINGTON COLLEGE, RHODES STATE COLLEGE, UNIVERSITY OF ST. FRANCIS, THE OHIO STATE UNIVERSITY, THE UNIVERSITY OF CINCINNATI, THE UNIVERSITY OF DAYTON, TRINE UNIVERSITY, UTMC AND WESTERN MICHIGAN WHO ARE PURSUING CAREERS IN THERAPY. THE HOSPITAL ON AVERAGE SPENDS IN EXCESS OF 1 MILLION DOLLARS IN NEW DIAGNOSTIC TECHNOLOGIES AND OTHER HEALTH RELATED EQUIPMENT TO BETTER DIAGNOSE AND TREAT OUR CLIENTS. THE HOSPITAL IS CURRENTLY UNDERGOING A NEARLY FORTY MILLION DOLLAR EXPANSION IN ORDER TO BETTER MEET THE NEEDS OF OUR COMMUNITY. THE EXPANSION PROVIDES ALL NEW INPATIENT SPACE FOR ACUTE CARE AND OBSTETRICS. IT WILL ALSO HOUSE A BRAND-NEW SURGICAL SERVICES AREA WITH INCREASED CAPACITY, PRIVATE PRE/POST-OP ROOMS AND CAPACITY FOR ROBOTIC SURGERY. THIS WILL ALLOW PATIENTS WHO ROUTINELY LEAVE THE AREA FOR PORTIONS OF THEIR CARE TO OBTAIN THEIR CARE LOCALLY. VAN WERT HEALTH SUPPORTS NUMEROUS ORGANIZATIONS VIA SPONSORSHIP THROUGHOUT THE COMMUNITY SOME OF THESE INCLUDE THE YWCA SILVER SNEAKERS PROGRAM, THE COMMUNITY FARMER'S MARKET, LIVE HEALTH VAN WERT & THE COUNTY HEALTH COLLABORATIVE, DARE, JUNIOR ACHIEVEMENT, COUNCIL ON AGING, CAMP CLAY, SAFETY COUNCIL WELLNESS AND THE NISWONGER PERFORMING ARTS CONCERT SERIES. VAN WERT HEALTH PROVIDES NUMEROUS SPONSORSHIPS FOR LOCAL SCHOOLS. VAN WERT HEALTH PRESENTS OR PARTICIPATES IN NUMEROUS HEALTH FAIRS THROUGHOUT THE YEAR INCLUDING THE ANNUAL CHILDREN'S HEALTH FAIR, ANNUAL WOMEN'S HEALTH EVENT, ANNUAL CAR SEAT CLINIC AND AN ANNUAL VETERAN'S DAY EVENT. VAN WERT HEALTH STAFF PRESENT AT VARIOUS EVENTS AND SPEAKERS BUREAUS THROUGHOUT THE YEAR INCLUDING THE SILVER SNEAKERS PROGRAM, THE SAFETY COUNCIL AND VARIOUS CAREER FAIRS FOR YOUNG STUDENTS ON THE BENEFITS OF A CAREER IN HEALTH CARE. SUPPORT FOR THE LOCAL BUSINESS DEVELOPMENT COALITION TO PROMOTE GROWTH IN THE OVERALL VAN WERT COMMUNITY. X true true X X X X X false false false false false false false false false James Pope CEO - TERM ENDED 471152 0 0 0 3192 0 27603 0 23317 0 525264 0 Edgar Silalahi CFO 222086 0 625 0 1606 0 26020 0 20403 0 270740 0 Thomas Conte MD Chief of Staff 417568 0 11924 0 10283 0 31500 0 30491 0 501766 0 Dr Scott Shie Physician 789781 0 166527 0 1440 0 41000 0 24201 0 1022949 0 Dr Nicholai Kiehl Physician 790346 0 166527 0 1440 0 35500 0 24097 0 1017910 0 Dr M Nizar Orfahli Physician 424442 0 81875 0 11268 0 47500 0 16619 0 581704 0 Dr Jeremy Stoller Physician 431062 0 20625 0 1366 0 35500 0 16883 0 505436 0 Dr Charles Hoehn Physician 315000 0 145731 0 1318 0 41000 0 17013 0 520062 0 Jon Bagley Interm CEO 199388 0 625 0 0 0 0 0 12014 0 212027 0 Paula Stabler CNO/COO 186249 0 625 0 526 0 2084 0 12331 0 201815 0 PART I, LINE 1A TRAVEL FOR COMPANIONS WAS PROVIDED FOR JAMES POPE. THE AMOUNT PROVIDED WAS NOT TREATED AS TAXABLE COMPENSATION BECAUSE THERE WAS A BUSINESS PURPOSE FOR THE COMPANION TRAVEL. A COUNTY OF VAN WERT OH 310308605 921297AA5 2020-03-01 61290000 REVENUE REFUNDING AND IMPROVEMENT A 9728003 0 36376499 4741918 5147455 0 1645468 0 0 10389830 2772 0 2020 true false true true A false false false false 0.00000 0.00000 0.00000 false false false true A true false false false false false 0 0 false true A true OHIO MEDICAL IMAGING ASSOCIATES SEE PART V 798000 RADIOLOGY SERVICES true SCHEDULE L, PART IV, COLUMN (B) BOARD MEMBER OWNER OF ENTITY (ERIC JELLINGER) FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS ANY PERSON, AGE 18 OR OLDER AND RESIDING IN VAN WERT COUNTY HOSPITAL'S GEOGRAPHIC SERVICE AREA, WHO SHALL HAVE CONTRIBUTED THE SUM OF ONE DOLLAR OR MORE TO THE ASSOCIATION DURING THE CALENDAR YEAR, SHALL BE A MEMBER. A CONTRIBUTION OF TWENTY FIVE DOLLARS AT ANY TIME SHALL CONSTITUTE A LIFE MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A PERSONS AND RIGHTS THE BOARD OF TRUSTEES SHALL BE ELECTED BY THE MEMBERS OF THE ASSOCIATION AT THE REGULAR ANNUAL MEETING. ONE SHALL BE APPOINTED BY THE VAN WERT COUNTY BOARD OF COMMISSIONERS. FORM 990, PART VI, SECTION A, LINE 7B PERSONS, DECISIONS, AND VOTING RIGHTS SUBJECT TO THE ARTICLES OF INCORPORATION AND THIS CODE OF REGULATIONS, EACH MEMBER OF THE ASSOCIATION IN GOOD STANDING SHALL BE QUALIFIED TO VOTE ON ANY ISSUES THAT MAY PROPERLY COME BEFORE ANY MEETING OF THE MEMBERS OF THE ASSOCIATION. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990 THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S MANAGEMENT PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PRACTICE FOR MONITORING COMPLIANCE THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED BY THE CHAIRPERSON OF THE BOARD OF TRUSTEES AND THE PRESIDENT AND CEO. THE SCOPE OF THIS POLICY INCLUDES ALL STAFF AND BOARD OF TRUSTEES MEMBERS. A CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED ON AN ANNUAL BASIS AND REVIEWED BY THE EXECUTIVE COMMITTEE. ANY ISSUES THAT ARISE ARE ADDRESSED WITH THE INDIVIDUAL AT THAT POINT. ANY ISSUES THAT ARISE THOUGHOUT THE YEAR ARE DEALT WITH AS NECESSARY. THIS MAY INVOLVE DECLARING THE CONFLICT OF INTEREST AND ABSTAINING FROM DISCUSSION OR A VOTE ON SPECIFIC TOPICS. THIS COULD ALSO TAKE THE FORM OF RECUSING ONESELF FROM PART OR A WHOLE MEETING AS NECESSARY AND REQUIRED DEPENDING UPON THE TOPIC FOR DISCUSION AND/OR ACTION. FORM 990, PART VI, SECTION B, LINE 15A & 15B COMPENSATION REVIEW THE COMPENSATION COMMITTEE CONTRACTS WITH AN OUTSIDE, INDEPENDENT FIRM TO PROVIDE A COMPENSATION STUDY AND EVALUATION. THE COMMITTEE THEN USES THE RESULTS OF THE STUDY IN CONSULTATION WITH THE COMPENSATION FIRM AND THEN COMPENSATION PHILOSOPHY POLICY TO MAKE COMPENSATION DECISIONS. THE LAST COMPENSATION REVIEW WAS PERFORMED IN 2019. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS AN ATTACHMENT TO FORM 990 AT WWW.GUIDESTAR.ORG OR UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:21069505 VAN WERT MEDICAL SERVICES 140 FOX ROAD VAN WERT OH 45891 202812541 MEDICAL SVCS OH 9122191 1700465 VAN WERT VAN WERT COUNTY HOSP PAIN MGMT 1250 S WASHINGTON ST VAN WERT OH 45891 810822738 PAIN MANAGEMENT OH VAN WERT HOSP RELATED 411486 82720 false false 0.51000 COMMUNITY CARE SYSTEMS INC 1250 S WASHINGTON ST VAN WERT OH 45891 341783212 HEALTHCARE MGMT OH NA C false true true false false false false false false false true false false false false false true false false false