2024-05-10T12:05:44-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 4334 MUNSON STREET SUITE 200 CANTON OH 44718 990 2022-07-01 340714479 GRACE HOSPITAL GRAC 4402043500 2307 W 14TH STREET 2 CLEVELAND OH 441133698 MICHELLE HENNIS INTERIM PRESIDENT & CEO 2164563896 2024-05-09 1 MICHELLE HENNIS 999009999 1 JENNIFER COLEMAN P00743188 3304972000 2024-05-09 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MICHELLE HENNIS 2307 W 14TH STREET 2 CLEVELAND OH 441133698 7498952 0 X WWW.GRACEHOSPITAL.ORG X 1910 OH TO PROVIDE SPECIALIZED HEALTH CARE SERVICES FOR THOSE COPING WITH CATASTROPHIC ILLNESS AND INJURY. 10 10 120 11 0 0 710090 503226 8622977 6939702 68142 30587 64539 25437 9465748 7498952 0 0 0 0 3607316 3541720 0 0 0 5807030 5048803 9414346 8590523 51402 -1091571 17886128 17226445 2072513 2219465 15813615 15006980 X TO SERVE AS A CENTER FOR EXCELLENCE IN THE PROVISION OF SPECIALIZED HEALTH CARE SERVICES AND COMFORT FOR PATIENTS AND FAMILIES COPING WITH CATASTROPHIC ILLNESS AND INJURY. 0 0 5799696 6939702 GRACE HOSPITAL IS A NON-FOR-PROFIT, LONG-TERM ACUTE CARE HOSPITAL LOCATED IN CLEVELAND, OHIO DEDICATED TO PROVIDING PERSONALIZED CARE TO MEET THE NEEDS OF PATIENTS COPING WITH CATASTROPHIC OR CHRONIC INJURY OR ILLNESS REQUIRING EXTENDED HOSPITALIZATION. THE HOSPITAL WAS FOUNDED IN 1910 BY A GROUP OF PHYSICIANS WHO WERE COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITY. GRACE HOSPITAL HAS CONTINUOUSLY PROVIDED SERVICES FOR ITS PATIENTS. IN 1995, GRACE HOSPITAL EARNED APPROVAL TO BECOME THE FIRST CERTIFIED LONG-TERM ACUTE CARE HOSPITAL IN BOTH THE CITY OF CLEVELAND AND CUYAHOGA COUNTY. THE HOSPITAL PRESENTLY SPONSORS SEVERAL INPATIENT SERVICES INCLUDING COMPLEX MEDICAL, PULMONARY, REHABILITATION, VENTILATOR WEANING, LEFT VENTRICAL ASSIST DEVICE, TRANSPLANT SUPPORT, WOUND CARE, AND NEUROLOGICAL REHABILITATION PROGRAMS. THESE SERVICES ARE PROVIDED AT INPATIENT SATELLITES LOCATED WITHIN SOUTH POINTE AND BEDFORD HOSPITALS. GRACE HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED HEALTHCARE CHARACTERIZED BY QUALITY, ACCESSIBILITY, EFFICIENCY, AND COST EFFECTIVENESS. THE HOSPITAL IS SENSITIVE TO AGE, CULTURAL, AND ECONOMIC VARIATIONS, AND IS CONTINUOUSLY ASSESSED AND IMPROVED THROUGH A QUALITY MANAGEMENT PROGRAM. GRACE VOLUNTARILY MAINTAINS A CHARITY CARE POLICY THAT PROVIDES CARE TO INDIVIDUALS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL IS ALSO COMMITTED TO EMPLOYING INDIVIDUALS TO MATCH CULTURAL DIVERSITY OF ITS PATIENT POPULATION. SEVERAL JOB POSTINGS IN THE HOSPITAL REQUIRE EMPLOYEES TO BE BILINGUAL IN EITHER SPANISH OR OTHER LANGUAGES. GRACE HOSPITAL IS INVOLVED IN MANY COMMUNITY ACTIVITIES, INCLUDING HEALTH FAIRS, SPECIAL HEALTH-RELATED PRESENTATIONS, AND SPONSORSHIPS IN HEALTHCARE EDUCATION. IN ADDITION, THE HOSPITAL SPONSORS MEETINGS FOR MANY NON-PROFIT COMMUNITY ORGANIZATIONS. THE BOARD OF DIRECTORS, MEDICAL STAFF, AND MANAGEMENT OF GRACE HOSPITAL ARE COMMITTED TO THE PROVISION OF QUALITY SPECIALTY HEALTHCARE SERVICES, AS A LONG-TERM HOSPITAL, AND FULFILLING A LEADERSHIP ROLE IN THE COMMUNITY. DESPITE CHALLENGING ECONOMIC TIMES, GRACE HOSPITAL HAS SUCCESSFULLY CONTINUED ITS ROLE OF COMMUNITY SERVICE AS ORIGINALLY ENVISIONED BY ITS FOUNDERS. 5799696 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 46 0 120 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X X MICHELLE HENNIS 2164563896 2307 W 14TH STREET NO2 CLEVELAND OH 44111 WILLARD E BARTEL CHAIRPERSON 1.00 1.00 X X 0 0 0 ROBERT A GREVEY VICE CHAIRPERSON 1.00 1.00 X X 0 0 0 JEFFREY L CLOSE TREASURER 1.00 1.00 X X 0 0 0 REV JOSEPH D MCNULTY SECRETARY 1.00 1.00 X X 0 0 0 GERALD L JEPPE DIRECTOR 1.00 1.00 X 0 0 0 NIZAR Z NADER MD FORMER PRESIDENT OF MEDICAL STAFF 1.00 1.00 X 72000 0 0 RICHARD J RYMOND DIRECTOR 1.00 1.00 X 0 0 0 PAUL C VENIZELOS MD DIRECTOR 1.00 1.00 X 0 0 0 BASEL ALTAQI MD DIRECTOR 1.00 1.00 X 0 0 0 THOMAS COOK DIRECTOR 1.00 1.00 X 0 0 0 DEACON CHRISTOPHER DEPENTI DIRECTOR 1.00 1.00 X 0 0 0 MICHELLE HENNIS INTERIM PRESIDENT AND CEO 40.00 1.00 X 164442 0 10396 236442 0 10396 1 0 1 0 TREMONT MEDICAL DEVELOPMENT CORPORATION 2307 WEST 14TH STREET CLEVELAND OH 44113 CONSULTING SERVICES 150000 MAXIM HEALTHCARE SERVICES HOLDINGS 7227 LEE DEFOREST DRIVE COLUMBIA MD 21045 STAFFING SERVICES 140943 3 503226 503226 PATIENT SERVICE REVENU 624100 5718605 5718605 OTHER PROGRAM SERVICE 624100 586506 586506 SPECIALTY HOSPITAL OF 624100 569042 569042 GRACE FOUNDATION MGMT 624100 65549 65549 6939702 30287 30287 14437 0 14437 14437 14437 300 0 300 300 300 PARKING FEES 900099 11000 11000 11000 7498952 6939702 0 56024 X 246838 72000 174838 2815469 2183060 632409 203559 138352 65207 275854 178378 97476 34263 34263 35514 35514 2475055 1241463 1233592 8023 4024 3999 651904 326989 324915 28809 14450 14359 68700 53452 15248 356333 307510 48823 171664 169131 2533 MEDICAL SUPPLIES 689775 689775 NON-MEDICAL SUPPLIES 267401 255245 12156 EQUIPMENT RENTAL & MAIN 176574 88568 88006 BAD DEBT EXPENSE 40580 40580 44208 36719 7489 8590523 5799696 2790827 0 556795 134708 1983046 1694356 1009857 1170020 202616 172119 132436 269485 12176997 10967593 1521035 1209404 11383837 11673917 1096506 902436 17886128 17226445 1487011 1593598 581827 466050 3675 159817 2072513 2219465 X 4429777 3333063 11383838 11673917 15813615 15006980 17886128 17226445 X -1091571 284936 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32151 32151 6214231 5309801 904430 145197 145197 0 5785418 5512595 272823 1209404 BENEFICIAL INTEREST IN PERPETUAL TRUSTS 11673917 C 11673917 DUE FROM RELATED ORGANIZATIONS 902436 902436 EST SETTLEMENTS TO THIRD-PARTIES 34476 CAPITAL LEASE OBLIGATIONS 125341 159817 1 1 X 1 X 1 X 1 0 0 2404100 1881537 522563 0.06110 2404100 1881537 522563 0.06110 2404100 1881537 522563 0.06110 1 40580 93094 2317750 2314886 2864 X 1 1 1 1 GRACE HOSPITAL 7007 POWERS BLVD FLOOR 3 PARMA OH 44129 WWW.GRACEHOSPITAL.ORG 1147 X LONG TERM ACUTE CARE GRACE HOSPITAL 1 0 0 1 X X X X X X 22 1 0 0 1 X WWW.GRACEHOSPITAL.ORG X 1 22 0 1 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X WWW.GRACEHOSPITAL.ORG/BILLING.HTML X WWW.GRACEHOSPITAL.ORG/BILLING.HTML X WWW.GRACEHOSPITAL.ORG/BILLING.HTML X X X X X X X 1 X 0 X X X X 0 X X X 0 0 GRACE HOSPITAL PART V, SECTION B, LINE 5: IN COORDINATION WITH COUNTY PARTNERS AND STAKEHOLDERS, THE CUYAHOGA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY THE CUYAHOGA COUNTY CHNA STEERING COMMITTEE AND INCLUDED THE COLLECTION AND ANALYSIS OF BOTH QUANTITATIVE AND QUIALITATIVE DATA. SECONDARY DATA WAS ANALYZED OVER 200 COMMUNITY INDICATORS, SPANNING AT LEAST 24 TOPICS IN THE AREAS OF HEALTH AND QUALITY OF LIFE. DATA WAS ALSO COLLECTED IN INTERVIEWS OF 32 KEY INFORMANTS WITH KEY COMMUNITY PARTNERS AND THREE COMMUNITY FOCUS GROUPS WITH CUYAHOGA COUNTY RESIDENTS. GRACE HOSPITAL PART V, SECTION B, LINE 11: THE CUYAHOGA COUNTY CHNA IDENTIFIED THREE PRIORITY HEALTH NEEDS: 1. BEHAVIORAL HEALTH (MENTAL HEALTH & DRUG USE/MISUSE); 2. ACCESSIBLE AND AFFORDABLE HEALTHCARE; 3. COMMUNITY CONDITIONS (ACCESS TO HEALTHY FOOD & COMMUNITY SAFETY). AS A LONG TERM ACUTE CARE HOSPITAL, GRACE HOSPITAL CHOSE TO ADDRESS THE PRIORITIZED HEALTH NEED OF ACCESSIBLE AND AFFORDABLE HEALTHCARE. A COMMON THEME IN THE 2022 CUYAHOGA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WAS THE EFFECT OF COVID-19 ON THE CONCERNS OF ASTHMA AND OTHER RESPIRATORY ILLNESSES. AS A LTACH WITH AN AVERAGE LENGTH OF STAY OF APPROXIMATELY 25 DAYS, GRACE HAS THE OPPORTUNITY TO ADDRESS THE CRITICAL NEEDS OF RESPIRATORY PATIENTS AT A MORE AFFORDABLE COST. VENTILATOR WEANING AND RESULTS:GRACE HOSPITAL ADMITS PULMONARY PATIENTS DIRECTLY FROM ACUTE CARE HOSPITAL INTENSIVE CARE UNITS, BUT STILL REQUIRES ONGOING ACUTE MEDICAL AND NURSING CARE. ON AVERAGE, OUR PATIENT SPENDS ABOUT 25 DAYS IN OUR INPATIENT PULMONARY PROGRAM. PATIENTS TYPICALLY HAVE RESPIRATORY COMPLICATIONS RESULTING FROM NEUROLOGICAL DISORDER INCLUDING MUSCULAR DYUSTROPHY AND POST-POLIO SYNDROME; ARE CURRENTLY ON A MECHANICAL VENTILATOR AND ARE CANDIDATE FOR VENTILATOR WEANING; HAVE RESPIRATORY COMPLICATIONS RESULTING FROM SPINAL CORD INJURY; HAVE DIFFICULTY MANAGING THEIR DIAGNOSES OF COPD, EMPHYSEMA, CHRONIC BRONCHITIS, LUNG DISEASE AND OTHER PULMONARY CONDITIONS. GRACE HOSPITAL'S VENTILATOR WEANING PROGRAM IS DESIGNED TO HELP PATIENTS WHO HAVE BEEN DEPENDENT ON A VENTILATOR, LEARN HOW TO BREATHE ON THEIR OWN AGAIN. THE PROGRAM USES THE LATEST RESEARCH AND TECHNOLOGIES, TOGETHER WITH MULTI-DISCIPLINARY TEAM APPROACH, TO HELP PATIENTS SUCCESSFULLY TRANSITION FROM BEING ON A VENTILATOR TO BREATHING INDEPENDENCE. UPON ARRIVAL TO OUR HOSPITAL'S VENTILATOR WEANING RATES HAVE BEEN ABOVE 50% FOR PAST FIVE YEARS.SOME PATIENTS - THOSE WITH SPINAL CORD INJURIES OR NEUROMUSCULAR DISEASE, FOR EXAMPLE - MAY BE UNABLE TO BE WEANED FROM THE VENTILATOR. WHEN THAT IS THE CASE, GRACE HOSPITAL WORKS WITH THE FAMILY TO DETERMINE THE BEST COURSE OF CARE AFTER DISCHARGE FROM THE HOSPITAL. LFTHE PATIENT WILL BE CARED FOR AT HOME, GRACE HOSPITAL WILL TRAIN PATIENT AND HIS OR HER FAMILY IN "TRACH" CARE, SUCTION, HOME VENTILATOR OPERATION AND EMERGENCY CARE, ALSO SELECT HOME HEALTH COMPANY, CHECK THE ENVIRONMENT AND ASSIST IN MAKING SURE THE VENTILATOR IS PROPERLY PLACED FOR PATIENT SAFETY AND COMFORT. GRACE HOSPITAL PART V, SECTION B, LINE 13H: THE FOLLOWING STRUCTURE WILL BE UTILIZED TO DETERMINE THE AMOUNT OF FREE CARE TO BE PROVIDED: HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE LIVING IN THE HOUSEHOLD WILL BE THE TWO MAJOR CRITERIA USED TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FREE CARE. EXTENUATING CIRCUMSTANCES SHOULD BE NOTED AND MAY INCLUDE INFORMATION SUPPLIED TO SUPPORT EXCEPTIONAL SCENARIOS INCLUDING A TERMINAL ILLNESS, DEATH OF A SPOUSE, OR CATASTROPHIC PROBLEMS. GRACE HOSPITAL PART V, SECTION B, LINE 16J: THE POLICY IS ATTACHED TO BILLING INVOICES. GRACE HOSPITAL PART V, SECTION B, LINE 21D: GRACE HOSPITAL OPERATES TWO LONG TERM ACUTE CARE (LTAC) FACILITIES. BOTH UNITS ARE WITHIN UNIVERSITY HOSPITAL. PART I, LINE 3C: THE FOLLOWING STRUCTURE WILL BE UTILIZED TO DETERMINE THE AMOUNT OF FREE CARE TO BE PROVIDED: HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE LIVING IN THE HOUSEHOLD WILL BE THE TWO MAJOR CRITERIA USED TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FREE CARE. EXTENUATING CIRCUMSTANCES SHOULD BE NOTED AND MAY INCLUDE INFORMATION SUPPLIED TO SUPPORT EXCEPTIONAL SCENARIOS INCLUDING A TERMINAL ILLNESS, DEATH OF A SPOUSE, OR CATASTROPHIC PROBLEMS. PART I, LINE 6A: N/A PART I, LINE 7: THE AMOUNTS REPORTED ON LINE B WERE GENERATED FROM THE MEDICAID COST REPORT FILED FOR FISCAL YEAR 2023 AND THE HOSPITAL'S ACCOUNTING SYSTEM.ACUTE CARE HOSPITAL SERVICES RENDERED TO MEDICAID PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC AND OTHER FACTORS. CAPITAL COSTS FOR MEDICAID INPATIENT SERVICES ARE REIMBURSED BASED ON A COST REIMBURSEMENT METHODOLOGY. THE HOSPITAL IS REIMBURSED FOR COST REIMBURSABLE ITEMS AT A TENTATIVE RATE WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS AND AUDITS THEREOF BY THE FISCAL INTERMEDIARY. PART I, LINE 7G: N/A PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 40,580. PART II, COMMUNITY BUILDING ACTIVITIES: N/A PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 REPRESENTS THE PROVISION FOR DOUBTFUL ACCOUNTS REPORTED ON THE JUNE 30, 2023 AUDITED FINANCIAL STATEMENTS, PLUS BAD DEBT RECOVERIES, WHICH WERE NETTED AGAINST BAD DEBT EXPENSE AS STATED IN NOTE 2 TO THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 3: THE AMOUNT REPORTED ON LINE 3 REPRESENTS CHARGES WRITTEN OFF FOR SELF-PAY INDIVIDUALS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY BUT FOR WHOM INSUFFICIENT INFORMATION WAS OBTAINED TO DETERMINE THEIR ELIGIBILITY. THIS AMOUNT WAS DETERMINED BASED ON REVIEW OF BAD DEBT WRITE-OFFS DURING THE YEAR. PART III, LINE 4: PLEASE SEE NOTE 2, "PATIENT SERVICE REVENUE," ON PAGES 13-15 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE AMOUNTS REPORTED WERE GENERATED FROM THE MEDICARE COST REPORT FILED FOR FISCAL YEAR 2023. INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES PER DISCHARGE. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. INPATIENT NONACUTE CARE SERVICES RELATED TO MEDICARE BENEFICIARIES ARE PAID BASED ON A COST REIMBURSEMENT METHODOLOGY. THE HOSPITAL IS REIMBURSED FOR COST REIMBURSABLE ITEMS AT TENTATIVE RATES WITH FINAL SETTLEMENT AFTER SUBMISSION OF ANNUAL COST REPORTS AND AUDITS THEREOF BY THE MEDICARE FISCAL INTERMEDIARY. PART III, LINE 9B: FREE CARE WILL BE EXTENDED TO THOSE WHO QUALIFY FOR THESE REASONS: THE PATIENT IS UNINSURED, THE PATIENT IS NOT ELIGIBLE FOR MEDICAID OR PENDING MEDICAID APPROVAL, THE PATIENT IS DETERMINED TO BE UNABLE TO PAY FOR SERVICES PROVIDED, THE PATIENT IS UNABLE TO ACCEPT AN INSTALLMENT PAYMENT ARRANGEMENT, THE PATIENT IS BELOW 200% OF THE FEDERAL POVERTY GUIDELINES, AND THE PATIENT IS A HARDSHIP CASE AS DESIGNATED BY THE PHYSICIAN AND GRACE HOSPITAL. THE PATIENT WILL NEED TO COMPLETE A CHARITY CARE FORM AND RETURN TO GRACE HOSPITAL FOR DETERMINATION OF FREE CARE. GRACE HOSPITAL STAFF OR ITS BILLING REPRESENTATIVES WILL HELP THE PATIENT COMPLETE THE FORM ON REQUEST. ULTIMATELY, IT IS THE PATIENT'S RESPONSIBILITY TO COMPLETE THE FORM. HE/SHE WILL CONTINUE TO BE FULLY RESPONSIBLE FOR THE BILL UNTIL A DETERMINATION IS MADE. DOCUMENTED PROOF OF INCOME IS REQUIRED. PART VI, LINE 2: THE HOSPITAL PRESENTLY SPONSORS SEVERAL INPATIENT SERVICES INCLUDING COMPLEX MEDICAL, PULMONARY, REHABILITATION, VENTILATOR WEANING, LEFT VENTRICLE ASSIST DEVICE, TRANSPLANT SUPPORT, WOUND CARE, AND NEUROLOGICAL REHABILITATION PROGRAMS. THESE SERVICES ARE PROVIDED AT INPATIENT SATELLITES LOCATED WITHIN BEDFORD AND SOUTH POINTE HOSPITALS. GRACE HOSPITAL IS COMMITTED TO PROVIDING PERSONALIZED HEALTHCARE CHARACTERIZED BY QUALITY, ACCESSIBILITY, EFFICIENCY, AND COST EFFECTIVENESS. THE HOSPITAL IS SENSITIVE TO AGE, CULTURAL, AND ECONOMIC VARIATIONS, AND IS CONTINUOUSLY ASSESSED AND IMPROVED THROUGH A QUALITY MANAGEMENT PROGRAM. GRACE VOLUNTARILY MAINTAINS A CHARITY CARE POLICY THAT PROVIDES CARE TO INDIVIDUALS REGARDLESS OF ABILITY TO PAY. THE HOSPITAL IS ALSO COMMITTED TO EMPLOYING INDIVIDUALS TO MATCH CULTURAL DIVERSITY OF ITS PATIENT POPULATION. GRACE HOSPITAL IS INVOLVED IN MANY COMMUNITY ACTIVITIES, INCLUDING SPECIAL HEALTH-RELATED PRESENTATIONS AND EMPLOYEES WHO SERVE ON THE BOARDS OF OTHER HEALTHCARE AGENCIES. THE BOARD OF DIRECTORS, MEDICAL STAFF, AND MANAGEMENT OF GRACE HOSPITAL ARE COMMITTED TO THE PROVISION OF QUALITY SPECIALTY HEALTHCARE SERVICES AS A LONG-TERM HOSPITAL, AND FULFILLING A LEADERSHIP ROLE IN THE COMMUNITY. DESPITE CHALLENGING ECONOMIC TIMES, GRACE HOSPITAL HAS SUCCESSFULLY CONTINUED ITS ROLE OF COMMUNITY SERVICE AS ORIGINALLY ENVISIONED BY ITS FOUNDERS. PART VI, LINE 3: INFORMATION ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS DESCRIBED ON THE PATIENT'S BILL. THE PATIENT WILL NEED TO COMPLETE A CHARITY CARE FORM AND RETURN TO GRACE FOR DETERMINATION OF FREE CARE. GRACE STAFF OR ITS BILLING REPRESENTATIVES WILL HELP THE PATIENT COMPLETE THE FORM ON REQUEST. PART VI, LINE 4: GRACE HOSPITAL IS A LONG-TERM ACUTE CARE HOSPITAL (LTACH) DEDICATED TO PROVIDING HIGH QUALITY PRIMARY AND SECONDARY HEALTH CARE SERVICES TO MEET THE NEEDS OF LOCAL COMMUNITIES OF NORTHEAST OHIO. PART VI, LINE 5: GRACE HOSPITAL AND THE GRACE FOUNDATION FOR HEALTH, WELLNESS & EDUCATION PROMOTES HEALTH, WELLNESS AND ECONOMIC DEVELOPMENT IN THE TREMONT, OHIO AREA. THIS IS THE GEOGRAPHIC AREA THE HOSPITAL HAS HISTORICALLY SERVED. THE FACILITY ON WEST 14TH STREET PROVIDES CORPORATE SERVICES, SUPPORT SERVICES, AND PHARMACY SERVICES. PART VI, LINE 6: N/A PART VI, LINE 7 N/A X 0 0 0 0 0 0 0 0 0 MICHELLE HENNIS INTERIM PRESIDENT AND CEO 164442 0 0 0 0 0 0 0 10396 0 174838 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF GRACE HOSPITAL IS THE GRACE FOUNDATION FOR HEALTH, WELLNESS & EDUCATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF GRACE HOSPITAL CONSISTS OF THE INDIVIDUALS ELECTED TO THE BOARD OF DIRECTORS OF THE GRACE FOUNDATION FOR HEALTH, WELLNESS & EDUCATION, THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE APPROVAL OF THE SOLE MEMBER: (A) AMENDMENT OR RESTATEMENT OF THE ARTICLES OR CODE OF REGULATIONS; (B) MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION; (C) SALE, LEASE, DISPOSITION, PLEDGE, GIFT OR ENCUMBRANCE OF ANY INTEREST IN REAL OR PERSONAL PROPERTY, EXCEPT IN ACCORDANCE WITH THE ESTABLISHED POLICIES FOR SUCH MATTERS APPROVED FROM TIME TO TIME IN ADVANCE BY THE MEMBER; (D) AGGREGATE BORROWING FOR ANY ONE YEAR PERIOD IN EXCESS OF $250,000; (E) THE FORMULATION OF AN INITIAL OR ANY CHANGE IN ANY SUBSEQUENT, FORMAL OR INFORMAL STATEMENT OF GRACE HOSPITAL'S PURPOSES OR OBJECTIVES; (F) THE APPROVAL OR ADOPTION OF THE ANNUAL AND ANY SPECIAL OPERATING AND CAPITAL BUDGETS; (G) ANY EXPENDITURE OF A NATURE THAT WAS NOT ANTICIPATED OR REFLECTED IN A BUDGET APPROVED IN ADVANCE OF SUCH EXPENDITURE BY THE MEMBER AND ANY EXPENDITURE THAT EITHER SINGLY OR WHEN AGGREGATED WITH ALL OTHER SIMILAR AMOUNTS THROUGHOUT THE FISCAL YEAR EXCEEDS 10 PERCENT OF THE AMOUNT BUDGETED FOR SUCH EXPENDITURE OR CLASS OF EXPENDITURES PURSUANT TO A BUDGET APPROVED IN ADVANCE OF SUCH EXPENDITURE BY THE MEMBER; (H) ANY EXPENDITURE OF THE PRINCIPAL OF OR INCOME FROM ANY FUND OR FUNDS IN ANY MANNER THAT IS INCONSISTENT WITH ANY RESTRICTIONS IMPOSED ON SUCH FUND OR FUNDS BY DONORS, BY THE MEMBER, OR BY THE BOARD OF DIRECTORS; (I) ANY ARRANGEMENT OR THE TERMINATION OF ANY SUCH ARRANGEMENT WITH ANY BANK, TRUST COMPANY, BROKERAGE FIRM, INVESTMENT ADVISOR OR SIMILAR INSTITUTION TO MANAGE THE ASSETS AND INVESTMENT OF THE ASSETS OF GRACE HOSPITAL; AND (J) THE APPOINTMENT OF AN INDEPENDENT AUDITOR. FORM 990, PART VI, SECTION B, LINE 11B THE HOSPITAL CONTRACTED WITH AN OUTSIDE ACCOUNTING FIRM FOR THE PREPARATION OF THE FORM 990. THE HOSPITAL PROVIDED MATERIAL BASED ON REQUESTS FROM THE ACCOUNTING FIRM. MOST OF THE INFORMATION WAS PROVIDED BY THE DIRECTOR OF FINANCE. THE FINAL FORM WAS REVIEWED BY THE DIRECTOR OF FINANCE AND THE CEO. A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLICES TO DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS, AND ANY MEDICAL STAFF MEMBERS WITH ADMINISTRATIVE RESPONSIBILITIES. ANY INDIVIDUAL WHO HAS AN INTEREST, DIRECT OR INDIRECT, IN A CONTRACT OR OTHER TRANSACTION THAT IS PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF, IS REQUIRED TO GIVE PROMPT, FULL AND FRANK DISCLOSURE OF THEIR INTEREST PRIOR TO THE BODY'S ACTING ON SUCH CONTRACT OR TRANSACTION. THE CONTRACT OR TRANSACTION WILL BE AUTHORIZED, APPROVED OR RATIFIED ONLY UPON A FAVORABLE VOTE OF AT LEAST TWO-THIRDS OF DIRECTORS PRESENT. THE INTERESTED PERSON MAY NOT VOTE ON, USE THEIR PERSONAL INFLUENCE ON, NOR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION OR TO RESPOND TO QUESTIONS) IN THE DISCUSSIONS REGARDING THE CONTRACT OR TRANSACTION. THE BOARD MEMBERS COMPLETED CONFLICT OF INTEREST STATEMENTS IN OCTOBER 2019. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CEO IS DETERMINED BY THE BOARD OF DIRECTORS. THE CEO RECEIVES SALARY COMPARABILITY INFORMATION FROM MODERN HEALTHCARE AND CLEVELAND MAGAZINE. SINCE GRACE IS A SMALL HOSPITAL, THE SALARIES IN EFFECT AT GRACE ARE ALWAYS BELOW THE OTHER HOSPITALS IN THE AREA. SALARY ADJUSTMENTS ARE RECEIVED WHEN THE HOSPITAL PROVIDES A COST OF LIVING ADJUSTMENT TO ALL STAFF OR WHEN THERE IS A CHANGE IN THE EMPLOYEE'S RESPONSIBILITIES. 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. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROFESSIONAL CA: PROGRAM SERVICE EXPENSES 1,241,463. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,241,463. PURCHASED SERVICES: NON-DIRECT PROF: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,233,592. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,233,592. FORM 990, PART XI, LINE 9: CHANGES IN VALUE OF BENEFICIAL INTEREST IN PERPETUAL TRUSTS 284,936. THE GRACE FOUNDATION FOR HEALTH WELLNESS & EDUCATION 2307 WEST 14TH STREET CLEVELAND OH 44114 273418360 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12C, III-FI N/A 0 SPECIALTY HOSPITAL OF LORAIN 254 CLEVELAND AVENUE AMHERST OH 44001 341902731 HOSPITAL OH 501(C)(3) LINE 3 N/A 0 THE GRACE CENTER PROPERTY LLC 2307 WEST 14TH STREET CLEVELAND OH 44113 473431477 REAL ESTATE OH N/A 0 0 GRACE CENTER PROPERTY HOLDING LLC 2307 WEST 14TH STREET CLEVELAND OH 44113 473494723 HOLDING COMPANY OH N/A C 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0