2024-11-12T09:54:32-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 203376102 PARAMOUNT ADVANTAGE PARA 4192525772 300 MADISON AVE 270 TOLEDO OH 43604 TERRENCE METZGER CFO 4192525772 2024-11-07 1 0 AMY CIMINELLO P00796388 3122071040 2024-11-07 2023 2024-10-15 13:58:12Z TERRENCE METZGER 300 MADISON AVE 270 TOLEDO OH 43604 206482616 0 X WWW.PARAMOUNTHEALTHCARE.COM X 2005 OH PARAMOUNT ADVANTAGE (THE "COMPANY OR PA), A NONPROFIT CORPORATION, -SEE SCHEDULE O. X 3 2 0 2 0 0 0 0 212348020 8725914 47317022 73409841 0 0 259665042 82135755 0 0 0 0 38217771 10143330 0 0 0 130035829 2321402 168253600 12464732 91411442 69671023 207974426 62299248 117224964 33899351 90749462 28399897 X OUR MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE. 0 1 8713502 8725914 PARAMOUNT ADVANTAGE - PROGRAM SERVICE ACCOMPLISHMENTSPARAMOUNT ADVANTAGE IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA OFFERS COMPREHENSIVE HEALTH SERVICES INCLUDING MEDICAL, SURGICAL, PSYCHIATRIC, REHABILITATIVE, SKILLED NURSING, HOME HEALTH, AND HOSPICE SERVICES IN 28 STATES ACROSS THE COUNTRY AND IS ONE OF THE NATION'S LEADING HEALTH SYSTEMS. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS, AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. PARAMOUNT ADVANTAGE AND PROMEDICA HAVE ESTABLISHED AND PROMOTED THE FOLLOWING KEY VALUES THROUGHOUT THE ORGANIZATIONS:- COMPASSION WE TREAT PEOPLE WITH DIGNITY AND RESPECT; - INNOVATION WE CONTINUALLY SEARCH TO FIND A BETTER WAY FORWARD; - TEAMWORK WE PARTNER WITH OTHERS BECAUSE WE ARE BETTER TOGETHER THAN APART; - EXCELLENCE WE STRIVE TO BE THE BEST IN ALL WE DO;- LEARNING WE USE THE LESSONS WE LEARN TO IMPROVE OUR MEMBERS' LIVESPARAMOUNT ADVANTAGE IS A MEDICAID MANAGED CARE PLAN (MCP) CONTRACTED THROUGH THE OHIO DEPARTMENT OF MEDICAID (ODM) THAT PROVIDES HEALTH CARE SERVICES TO MORE THAN 255,000 OHIO RESIDENTS IN 54 COUNTIES ELIGIBLE FOR AGED, BLIND OR DISABLED, COVERED FAMILIES AND CHILDREN, OR ADULT EXTENSION MEDICAID BENEFITS VIA A STATEWIDE HEALTH MAINTENANCE ORGANIZATION (HMO) PLATFORM. TO THIS END, ALL MEMBERS SELECT A PRIMARY CARE PHYSICIAN (PCP) AT THE TIME OF ENROLLMENT AND ARE ENCOURAGED TO ESTABLISH A RELATIONSHIP WITH THE PHYSICIAN AS SOON AS POSSIBLE. IF MEMBERS DO NOT CHOOSE A PCP, THEN THEY ARE ASSIGNED ONE. THE MEMBER IS INSTRUCTED TO CONTACT HIS/HER PCP WHENEVER MEDICAL OR BEHAVIORAL HEALTH CARE IS NEEDED. THUS, THE PCP IS INFORMED ABOUT HIS/HER PATIENT'S NEEDS AND CAN MAKE INFORMED, APPROPRIATE DECISIONS REGARDING TREATMENT.CARE MANAGEMENT PROGRAMS SUCH AS DISEASE MANAGEMENT, UTILIZATION MANAGEMENT AND CASE MANAGEMENT PROVIDE MEMBERS EDUCATION ABOUT THEIR CONDITION, ENSURE THEY HAVE ACCESS TO APPROPRIATE CARE, AND ASSIST IN HELPING HIGH RISK MEMBERS MANAGE AND NAVIGATE THEIR CARE IN A SUPPORTIVE, COST EFFECTIVE ENVIRONMENT. ADDITIONALLY, PARAMOUNT ADVANTAGE MEDICAID EARNED A 4 OUT OF 5 RATING IN THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE'S (NCQA) MEDICAID HEALTH INSURANCE PLAN RATINGS FOR 2019-2020. THIS WAS THE HIGHEST OF ALL FIVE MEDICAID MANAGED CARE PLANS IN OHIO. NCQA ACCREDITS AND CERTIFIED A WIDE RANGE OF HEALTHCARE ORGANIZATIONS AND MANAGES THE EVOLUTION OF HEDIS, THE PERFORMANCE MEASUREMENT TOOL USED BY MORE THAN 90% OF THE NATION'S HEALTH PLANS. IT RATES EACH HEALTH PLAN ON DOZENS OF QUALITY MEASURES RELATED TO CONSUMER SATISFACTION, PREVENTION AND TREATMENT.PARAMOUNT ADVANTAGE MEMBERS HAVE ACCESS TO A MOBILE APPLICATION, MEMBER NEWSLETTERS, SOCIAL SERVICES REFERRALS, AND THE ABILITY TO SPEAK WITH THE SAME CUSTOMER SERVICE REPRESENTATIVE WHEN CALLING IN FOR SERVICES. MEMBER MATERIALS ARE PROVIDED IN FOUR LANGUAGES AND TRANSLATION SERVICES ARE PROVIDED IN VIRTUALLY ANY LANGUAGE. FOR MEMBERS AND NON-MEMBERS, AN ON-LINE COMMUNITY RESOURCE GUIDE IS AVAILABLE TO INFORM ABOUT HEALTH AND WELL-BEING SERVICES OFFERED IN THEIR COMMUNITIES. THESE SERVICES ARE ALL DESIGNED TO ENSURE OHIO'S MOST VULNERABLE RESIDENTS RECEIVE APPROPRIATE, COORDINATED CARE. PARAMOUNT ADVANTAGE MEMBER WELLNESS PROGRAMS INCLUDE INCENTIVES DESIGNED TO ENSURE SAFER PREGNANCIES AND DELIVERIES FOR MOTHERS AS WELL AS SCREENING, DIAGNOSIS AND TREATMENT SERVICES FOR ADULTS AND CHILDREN. HEALTHCHECK, AN EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT BENEFIT FOR CHILDREN, ALONG WITH A 24-HOUR NURSING HOTLINE, PROVIDE A BROAD RANGE OF NO-COST PREVENTIVE CARE SERVICES.AS PART OF PROMEDICA, PARAMOUNT ADVANTAGE DEMONSTRATES ITS MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. OUR MISSION IS TO IMPROVE YOUR HEALTH AND WELL-BEING. 8713502 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TERRENCE METZGER 4192525772 100 MADISON AVE TOLEDO OH 43604 X MARK WAGONER BOARD CHAIRPERSON 1.00 1.00 X X 0 0 0 LORI JOHNSTON PRESIDENT 1.00 44.00 X X 0 1099311 2315 ELAINE CANNING TRUSTEE 1.00 1.00 X 0 0 0 LOUIS ROBICHAUX TREASURER/CFO - PART YEAR 1.00 54.00 X 0 0 0 TERRENCE METZGER TREASURER/CFO 1.00 54.00 X 0 1055090 4079 STEVE SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 1.00 54.00 X 0 1407180 6028 ARTURO POLIZZI PRESIDENT AND CEO 1.00 54.00 X 0 2121593 5857 STEVEN M CAVANAUGH TREASURER, CFO - FORMER 0.00 0.00 X 0 1335180 5657 JEFFREY C KUHN SECRETARY, CHIEF LEGAL OFFICER - FORMER 0.00 0.00 X 0 748426 30922 GARY AKENBERGER SR VP FINANCE - FORMER 0.00 0.00 X 0 528647 43532 0 8295427 98390 0 1 1 0 0 NET PATIENT SERVICES 524114 8725914 8725914 8725914 2360640 2360640 122831037 72565025 124346861 0 -1515824 72565025 71049201 71049201 82135755 8725914 0 73409841 10123651 6793670 3329981 19679 7896 11783 29000 29000 152686 152686 41692 41692 186088 186088 BAD DEBT EXPENSE 1911686 1911686 SUPPLIES 172 172 UTILITIES 78 78 12464732 8713502 3751230 0 127094087 57737020 64686254 0 12796587 1178934 3397498 3383294 207974426 62299248 20009126 2723114 97215838 31176237 117224964 33899351 X 90749462 28399897 90749462 28399897 207974426 62299248 X 69671023 -1367249 1911686 -132565025 X X 0 1 X 1 1 1 X 1493079936 1534627805 1568084578 212348020 8725914 4816866253 1493079936 1534627805 1568084578 212348020 8725914 4816866253 0 0 0 4816866253 4351146 5673300 4437144 4417124 2360640 21239354 4351146 5673300 4437144 4417124 2360640 21239354 1497431082 1540301105 1572521722 216765144 11086554 4838105607 0.99560 0.99610 0.00440 0.00390 X 0 CERTIFICATE OF DEPOSIT 3383294 3383294 ACCRUED CLAIMS 1018003 DUE TO AFFILIATES 26209446 AGGREGATE HEALTH POLICY RESERVES 3948788 31176237 81820014 0 81820014 152686 163055 315741 82135755 12148991 0 12148991 152686 163055 315741 12464732 PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSES OF EXPENSE PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSES OF EXPENSE 1 1 0 0 0 0 0 0 0 ARTURO POLIZZI PRESIDENT AND CEO 0 1315647 0 789979 0 15967 0 0 0 5857 0 2127450 0 0 STEVE SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 0 625095 0 774925 0 7160 0 0 0 6028 0 1413208 0 0 STEVEN M CAVANAUGH TREASURER, CFO - FORMER 0 0 0 0 0 1335180 0 0 0 5657 0 1340837 0 0 LORI JOHNSTON PRESIDENT 0 848251 0 244897 0 6163 0 0 0 2315 0 1101626 0 0 TERRENCE METZGER TREASURER/CFO 0 480090 0 575000 0 0 0 0 0 4079 0 1059169 0 0 JEFFREY C KUHN SECRETARY, CHIEF LEGAL OFFICER - FOR 0 26526 0 0 0 721900 0 26526 0 4396 0 779348 0 0 GARY AKENBERGER SR VP FINANCE - FORMER 0 246095 0 83570 0 198982 0 36639 0 6893 0 572179 0 0 PART I, LINE 3 A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, INC., USES AN INDEPENDENT CONSULTANT, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVES. PART I, LINES 4A-B ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. STEVEN CAVANAUGH RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $1,335,180 DURING 2023. JEFFERY KUHN RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $721,900 DURING 2023. MATTHEW KANG RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $583,664 DURING 2023. GARY AKENBERGER RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, THE TOLEDO HOSPITAL, IN THE AMOUNT OF $195,150 DURING 2023. OHIO MEDICAID CONTRACT 2023-06-01 72565025 GAAP 311440175 COMMUNITY INSURANCE COMPANY 4361 IRWIN SIMPSON ROAD MASON OH 45040 0 0 0 0 FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: IS A WHOLLY OWNED SUBSIDIARY OF PROMEDICA INSURANCE CORPORATION (PIC), WHICH IS A WHOLLY OWNED SUBSIDIARY OF PROMEDICA HEALTH SYSTEM (PHS). THE COMPANY WAS INCORPORATED IN THE STATE OF OHIO ON AUGUST 10, 2005, WITH OPERATIONS COMMENCING ON DECEMBER 1, 2005. THE COMPANY WAS ESTABLISHED TO SEPARATE THE OHIO MEDICAID BUSINESS OF PARAMOUNT CARE, INC. (PCI) AS A SEPARATE LEGAL ENTITY AS A RESULT OF CHANGES IN OHIO'S MEDICAID PROGRAM. THE COMPANY IS LICENSED AS A HEALTH INSURING CORPORATION IN THE STATE OF OHIO AND IS SUBJECT TO REGULATORY OVERSIGHT BY THE OHIO DEPARTMENT OF INSURANCE (ODI). IN 2015, THE COMPANY SUBMITTED AN APPLICATION TO BECOME FEDERALLY TAX-EXEMPT EFFECTIVE OCTOBER 1, 2015. THE STATUS WAS APPROVED ON MARCH 9, 2016. PA WAS NOT AWARDED A NEXT GENERATION OHIO MEDICAID CONTRACT FOR THE PLAN YEARS 2022-2027 BY THE OHIO DEPARTMENT OF MEDICAID. AS A RESULT, PA ENTERED INTO AN ASSET PURCHASE AGREEMENT WITH COMMUNITY INSURANCE COMPANY D/B/A ANTHEM BLUE CROSS BLUE SHIELD OF OHIO (ANTHEM), WHEREBY PA SOLD CERTAIN ASSETS, PRIMARILY ITS OHIO MEDICAID CONTRACT, AS WELL AS ITS OHIO MEDICAID ENROLLMENT. THE NOVATION OF THE OHIO MEDICAID CONTRACT OCCURRED ON FEBRUARY 11, 2022, AT WHICH POINT ANTHEM PAID THE COMPANY $50,000,000. IN ADDITION, A CONTINGENCY PAYMENT OF $325 PER MEMBER WAS MADE FROM ANTHEM TO PA FOR EACH MEMBER THAT WAS RETAINED BY ANTHEM AS OF MAY 1, 2023. GROSS PROCEEDS WERE RECEIVED IN JUNE 2023 OF $72,565,025 FOR THE CONTINGENCY PAYMENT. IN CONJUNCTION WITH THIS AGREEMENT, THE PARTIES ALSO ENTERED INTO A TRANSITION SERVICES AGREEMENT UNDER WHICH PA PROVIDED ALL SERVICES UNDER THE PREVIOUS OHIO MEDICAID CONTRACT - ON BEHALF OF ANTHEM - UNTIL THE NEXT GENERATION PROGRAM BECAME EFFECTIVE ON FEBRUARY 1, 2023; PA RECEIVED AN ADMINISTRATIVE FEE FROM ANTHEM FOR THESE SERVICES THROUGH THAT TRANSITION DATE. IN 2023 AND 2022, PA EARNED $10,187,918 AND $111,748,935, RESPECTIVELY, FOR THESE SERVICES, WHICH ARE NETTED AGAINST ADMINISTRATIVE EXPENSES ON THE STATUTORY STATEMENT OF REVENUE AND EXPENSES. IN ADDITION, EFFECTIVE AFTER THE NEXT GENERATION GO-LIVE IN FEBRUARY 2023, PA BEGAN TO PROVIDE CERTAIN DATA MIGRATION AND RUN-OUT SERVICES, WHICH WILL CONTINUE FOR A PERIOD OF 17 MONTHS. DURING 2023, PA EARNED $4,151,967 FOR THESE SERVICES, WHICH ARE NETTED AGAINST ADMINISTRATIVE EXPENSES ON THE STATUTORY STATEMENT OF REVENUE AND EXPENSES. ANTHEM WILL ALSO PAY A MONTHLY ADMINISTRATIVE FEE TO PHS AND PA FOR THE PROVISION OF POPULATION HEALTH MANAGEMENT AND CARE MANAGEMENT SERVICES UNDER A RISK PARTICIPATION AGREEMENT. AS OF DECEMBER 31, 2023 AND 2022, THE COMPANY OWED $762,480 AND $57,882,774, RESPECTIVELY, TO ANTHEM IN CONJUNCTION WITH THE ARRANGEMENTS DESCRIBED ABOVE. FORM 990, PART III, LINE 3 PARAMOUNT ADVANTAGE (THE "COMPANY OR PA), A NONPROFIT CORPORATION, IS A WHOLLY OWNED SUBSIDIARY OF PROMEDICA INSURANCE CORPORATION (PIC), WHICH IS A WHOLLY OWNED SUBSIDIARY OF PROMEDICA HEALTH SYSTEM (PHS). THE COMPANY WAS INCORPORATED IN THE STATE OF OHIO ON AUGUST 10, 2005, WITH OPERATIONS COMMENCING ON DECEMBER 1, 2005. THE COMPANY WAS ESTABLISHED TO SEPARATE THE OHIO MEDICAID BUSINESS OF PARAMOUNT CARE, INC. (PCI) AS A SEPARATE LEGAL ENTITY AS A RESULT OF CHANGES IN OHIO'S MEDICAID PROGRAM. THE COMPANY IS LICENSED AS A HEALTH INSURING CORPORATION IN THE STATE OF OHIO AND IS SUBJECT TO REGULATORY OVERSIGHT BY THE OHIO DEPARTMENT OF INSURANCE (ODI). IN 2015, THE COMPANY SUBMITTED AN APPLICATION TO BECOME FEDERALLY TAX-EXEMPT EFFECTIVE OCTOBER 1, 2015. THE STATUS WAS APPROVED ON MARCH 9, 2016. PA WAS NOT AWARDED A NEXT GENERATION OHIO MEDICAID CONTRACT FOR THE PLAN YEARS 2022-2027 BY THE OHIO DEPARTMENT OF MEDICAID. AS A RESULT, PA ENTERED INTO AN ASSET PURCHASE AGREEMENT WITH COMMUNITY INSURANCE COMPANY D/B/A ANTHEM BLUE CROSS BLUE SHIELD OF OHIO (ANTHEM), WHEREBY PA SOLD CERTAIN ASSETS, PRIMARILY ITS OHIO MEDICAID CONTRACT, AS WELL AS ITS OHIO MEDICAID ENROLLMENT. THE NOVATION OF THE OHIO MEDICAID CONTRACT OCCURRED ON FEBRUARY 11, 2022, AT WHICH POINT ANTHEM PAID THE COMPANY $50,000,000. IN ADDITION, A CONTINGENCY PAYMENT OF $325 PER MEMBER WAS MADE FROM ANTHEM TO PA FOR EACH MEMBER THAT WAS RETAINED BY ANTHEM AS OF MAY 1, 2023. GROSS PROCEEDS WERE RECEIVED IN JUNE 2023 OF $72,565,025 FOR THE CONTINGENCY PAYMENT. IN CONJUNCTION WITH THIS AGREEMENT, THE PARTIES ALSO ENTERED INTO A TRANSITION SERVICES AGREEMENT UNDER WHICH PA PROVIDED ALL SERVICES UNDER THE PREVIOUS OHIO MEDICAID CONTRACT - ON BEHALF OF ANTHEM - UNTIL THE NEXT GENERATION PROGRAM BECAME EFFECTIVE ON FEBRUARY 1, 2023; PA RECEIVED AN ADMINISTRATIVE FEE FROM ANTHEM FOR THESE SERVICES THROUGH THAT TRANSITION DATE. IN 2023 AND 2022, PA EARNED $10,187,918 AND $111,748,935, RESPECTIVELY, FOR THESE SERVICES, WHICH ARE NETTED AGAINST ADMINISTRATIVE EXPENSES ON THE STATUTORY STATEMENT OF REVENUE AND EXPENSES. IN ADDITION, EFFECTIVE AFTER THE NEXT GENERATION GO-LIVE IN FEBRUARY 2023, PA BEGAN TO PROVIDE CERTAIN DATA MIGRATION AND RUN-OUT SERVICES, WHICH WILL CONTINUE FOR A PERIOD OF 17 MONTHS. DURING 2023, PA EARNED $4,151,967 FOR THESE SERVICES, WHICH ARE NETTED AGAINST ADMINISTRATIVE EXPENSES ON THE STATUTORY STATEMENT OF REVENUE AND EXPENSES. ANTHEM WILL ALSO PAY A MONTHLY ADMINISTRATIVE FEE TO PHS AND PA FOR THE PROVISION OF POPULATION HEALTH MANAGEMENT AND CARE MANAGEMENT SERVICES UNDER A RISK PARTICIPATION AGREEMENT. AS OF DECEMBER 31, 2023 AND 2022, THE COMPANY OWED $762,480 AND $57,882,774, RESPECTIVELY, TO ANTHEM IN CONJUNCTION WITH THE ARRANGEMENTS DESCRIBED ABOVE. PART V, LINE 1A THE PROMEDICA HEALTH SYSTEM PROCESSES ALL ACCOUNTS PAYABLE THROUGH ONE PAY COMPANY. ALL 1099 FORMS FOR PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES ARE FILED UNDER PROMEDICA HEALTH SYSTEM, INC. FEIN 34-1517671. FORM 990, PART VI, SECTION A, LINE 6 AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF PROMEDICA INSURANCE CORPORATION, WHICH IS THE SOLE MEMBER OF PARAMOUNT ADVANTAGE. PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF PARAMOUNT ADVANTAGE, AND (B) FILL ANY VACANCY OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED BY MANAGEMENT BEFORE BEING PROVIDED TO THE BOARD OF TRUSTEES PRIOR TO FILING. ANY COMMENTS OR QUESTIONS FROM THE BOARD ARE REVIEWED AND INCORPORATED INTO THE RETURN IF APPROPRIATE. FINAL RETURNS ARE PROVIDED TO A PRINCIPAL OFFICER FOR SIGNATURE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER SOC SURVEY WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER SOC SURVEYS ARE REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER SOC SURVEYS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED, AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO COMPLETE THE SURVEY OR THE SUBMISSION OF A FALSE OR INCOMPLETE SURVEY, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S SURVEY RESULTS OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PROVIDERS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL BONUS-ELIGIBLE SENIOR LEADERSHIP AND SPECIFICALLY IDENTIFIED ADDITIONAL EMPLOYEES, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PROVIDERS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, THE CHIEF HUMAN RESOURCE OFFICER, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. ADDITIONALLY, AS PART OF THE ANNUAL MANDATORY COMPLIANCE TRAINING ASSIGNED TO ALL PROMEDICA EMPLOYEES, EACH EMPLOYEE IS REQUIRED TO ELECTRONICALLY ACKNOWLEDGE THAT THEY HAVE RECEIVED A COPY OF THE PROMEDICA STANDARDS OF CONDUCT, THAT THEY UNDERSTAND HOW THE STANDARDS APPLY TO THEM, ACKNOWLEDGE THEIR OBLIGATION TO FOLLOW THEM, THEIR OBLIGATION TO REPORT VIOLATIONS OF THE STANDARDS OR REQUESTS THAT WOULD RESULT IN VIOLATIONS OF THE STANDARDS TO APPROPRIATE COMPANY OFFICERS AND THAT THEY HAVE REPORTED ALL VIOLATIONS KNOWN TO THEM AS REQUIRED BY THE STANDARDS. IN ADDITION THE ATTESTATION STATES ANY CONFLICTS OF INTEREST OR OTHER MATTERS FOR WHICH THE STANDARDS REQUIRE WRITTEN DISCLOSURE TO THE COMPANY HAVE BEEN SO DISCLOSED BY THE EMPLOYEE AND THEY UNDERSTAND AND ACKNOWLEDGE THAT TO THE EXTENT THEY ARE AN AT-WILL EMPLOYEE, THE STANDARDS DO NOT AFFECT THE AT-WILL NATURE OF MY EMPLOYMENT RELATIONSHIP WITH THE COMPANY. EMPLOYED PROVIDERS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PROVIDERS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PROVIDER CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER FOR PROMEDICA PHYSICIAN GROUP, INC. (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE OFFICE OF THE PROMEDICA HEALTH SYSTEM, INC. ("PHS") V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PROVIDER CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE PHS AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PROVIDERS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PROVIDER STANDARD OF CONDUCT AND THE PROVIDER CERTIFICATION STATEMENT WHICH THE NEW PROVIDER IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, OR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE PHS V.P., AUDIT & COMPLIANCE. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL BY THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER. RESULTS OF THE EMPLOYED PROVIDER AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. ANY ITEMS THAT MEET CRITERIA FOR PUBLIC DISCLOSURE WILL BE COMMUNICATED TO THE IDENTIFIED PROVIDER BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, OR DESIGNEE, IN ADVANCE OF THE POSTING. THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, OR DESIGNEE, WILL PROVIDE THE PROVIDER-INDUSTRY RELATIONSHIP DISCLOSURES TO THE APPLICABLE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. THE PUBLIC DISCLOSURE WILL BE POSTED ON THE PHS WEBSITE (HTTPS://WWW.PROMEDICA.ORG/PAGES/ABOUT-US/INDUSTRY-RELATIONSHIPS.ASPX) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. FORM 990, PART VI, SECTION B, LINE 15 PARAMOUNT ADVANTAGE'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF PROMEDICA FOUNDATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. PART VII, SECTION B PROMEDICA HEALTH SYSTEM PROCESSES ALL ACCOUNTS PAYABLE THROUGH ONE PAY COMPANY, PROMEDICA HEALTH SYSTEM, INC. THE INDEPENDENT CONTRACTORS OVER $100,000 WILL BE LISTED ON THE 990 FILED FOR PROMEDICA HEALTH SYSTEM, INC. FEIN 34-1517671. FORM 990, PART VII, SECTION A LOUIS ROBICHAUX IS EMPLOYED BY A MANAGEMENT AGENCY THAT IS UNDER A CONTRACT TO PROVIDE MANAGEMENT SERVICES TO PROMEDICA HEALTH SERVICES. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATES -132,565,025. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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