2025-10-14T14:49:06-05:00 2024-12-31 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2024-01-01 344446484 DEFIANCE HOSPITAL INC DEFI 4192525772 100 MADISON AVE ATTN TAX DEPARTM TOLEDO OH 43604 TERRENCE METZGER CFO 4192525772 2025-10-13 1 1 AMY CIMINELLO P00796388 6148493000 2025-10-09 2024 2025-03-06 01:10:19Z PROMEDICA DEFIANCE REGIONAL HOSPITAL TERRENCE METZGER 100 MADISON AVE ATTN TAX DEPARTMENT TOLEDO OH 43604 103937496 0 X WWW.PROMEDICA.ORG X 1953 OH DEFIANCE HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL THAT PROVIDES HEALTHCARE SERVICES TO THE GENERAL PUBLIC, INCLUDING THE SURROUNDING COMMUNITIES OF DEFIANCE, PAULDING, HENRY, PUTNAM, WILLIAMS, AND FULTON COUNTIES IN OHIO. 18 13 441 119 41971 0 1027914 103048 88588328 103745201 12336 12826 30969 76421 89659547 103937496 0 0 0 0 23605616 24818051 0 0 0 47352802 44790397 70958418 69608448 18701129 34329048 42855228 46643100 21214421 12251163 21640807 34391937 X OUR MISSION IS TO BE THE LEADER IN PROVIDING QUALITY HEALTHCARE SERVICES THAT MEET THE NEEDS AND EXCEED THE EXPECTATIONS OF OUR CUSTOMERS 0 0 53367675 103745201 DEFIANCE HOSPITAL, INC. (D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL) IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 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. PROMEDICA DEFIANCE REGIONAL HOSPITAL (DRH) IS A 25-BED, CRITICAL ACCESS, GENERAL ACUTE CARE HOSPITAL IN DEFIANCE, OHIO THAT INCLUDES A 10-BED, DISTINCT BEHAVIORAL HEALTH UNIT. THE 200,000-SQUARE-FOOT FACILITY PROVIDES HEALTHCARE SERVICES TO RESIDENTS IN THE OHIO COUNTIES OF DEFIANCE, PAULDING, HENRY, FULTON, PUTNAM, AND WILLIAMS. IN 2024, DRH RECEIVED THE OUTSTANDING PATIENT EXPERIENCE AWARD FROM HEALTHGRADES FOR ITS COMMITMENT TO PROVIDING EXCEPTIONAL CARE AND ENSURING POSITIVE EXPERIENCE FOR PATIENTS. BLUE DISTINCTION CENTERS FOR MATERNITY CARE 2024 PROGRAM. THE CHARTIS CENTER FOR RURAL HEALTH, THE AWARD HONORS TOP QUARTILE PERFORMANCE AMONG RURAL HOSPITALS IN PATIENT PERSPECTIVE.DRH OFFERS A BROAD SPECTRUM OF SERVICES TO MEET THE COMMUNITY'S IDENTIFIED HEALTHCARE NEEDS, INCLUDING FULL-SERVICE EMERGENCY CENTER AND LEVEL III TRAUMA CENTER, SURGICAL SERVICES, HEALTH EDUCATION PROGRAMMING, THE COPING CENTER FOR PATIENTS WITH MENTAL HEALTH ISSUES, ADVANCED DIAGNOSTICS, WOMEN'S SERVICES, AND A SLEEP DISORDERS CENTER. AS A TESTAMENT TO OUR COMMITMENT TO PROVIDE HIGH-QUALITY CARE TO AREA RESIDENTS, DRH ALSO OFFERS AN EXPANDED VISITING PHYSICIAN CLINIC INCLUDING UROLOGY AND OTHER SPECIALTIES AND SUBSPECIALTIES. A MEDICAL OFFICE BUILDING ON THE CAMPUS INCLUDES FIVE CLINICAL SUITES FOR SPECIALTIES SUCH AS ORTHOPAEDICS, REHABILITATION SERVICES, OPHTHALMOLOGY, AND BEHAVIORAL HEALTH SERVICES AS WELL AS NUMEROUS PRIMARY CARE PROVIDERS.AS A COMMUNITY-BASED HOSPITAL, DRH HOSTS VARIOUS SUPPORT GROUPS AND COMMUNITY OUTREACH ACTIVITIES TO PROMOTE HEALTH AND WELLNESS, INCLUDING MEDICATION DISPOSAL, HEALTH SCREENINGS, ADDRESSING FOOD INSECURITY, AND MATERNAL AND INFANT HEALTH CLASSES. DRH IS ACCREDITED BY THE JOINT COMMISSION AND HAS EARNED IN ACUTE CARE, CARDIAC CATHETERIZATION LAB, CARDIAC SURGERY, CT SCANNER, EAR/NOSE/THROAT SURGERY, EEG/EKG/EMG LAB, GASTROENTEROLOGY, GYNECOLOGICAL SURGERY, INTERVENTIONAL RADIOLOGY, LABOR & DELIVERY, MRI, MAMMOGRAPHY, MEDICAL/SURGICAL UNIT, MEDICAL ICU, NUCLEAR MEDICINE, OPHTHALMOLOGY, ORTHOPEDIC SURGERY, OUTPATIENT CLINICS, PSYCHIATRIC UNIT, SLEEP LAB, AND VASCULAR SURGERY. DRH'S CHARGE IS TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE INDIVIDUALS WHOM WE SERVE THROUGH PREVENTION, EDUCATION AND QUALITY CARE. AS PART OF PROMEDICA'S COMMITMENT TO ADDRESSING THE COMMUNITY'S HEALTH NEEDS, DEFIANCE REGIONAL HOSPITAL IS AN ACTIVE PARTNER OF THE PROMOTING OVERALL WELLNESS AND EMPOWERING RESIDENTS (POWER)DEFIANCE COALITION. THE HOSPITAL PARTICIPATES AND PROVIDES FINANCIAL CONTRIBUTIONS TO THE CONDUCTING OF THE COUNTY HEALTH ASSESSMENT, DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH IMPROVEMENT PLAN. IN 2024, DRH SERVED 1,602 INPATIENTS AND 94,160 OUTPATIENTS. ADDITIONALLY, 12,695 INDIVIDUALS SOUGHT EMERGENCY CARE AT DRH. THE HOSPITAL CONTRIBUTED $13,155,000 IN COMMUNITY BENEFIT IN 2024 THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE . THROUGH COMMUNITY HEALTH SERVICES, SUBSIDIZED HEALTH SERVICES, CASH AND IN-KIND CONTRIBUTIONS, AND COMMUNITY BENEFIT OPERATIONS, DRH CONTRIBUTED $731,000 TO THE COMMUNITY DURING 2024 . INCLUDED IN THIS AMOUNT ARE PROGRAMS AND SERVICES SUCH AS: COMMUNITY HEALTH EDUCATION THROUGH NUMEROUS HEALTH PROMOTIONS AND WELLNESS PROGRAMS; TOBACCO AND NICOTINE CESSATION EDUCATION, HEART DISEASE AND BLOOD PRESSURE SELF-MONITORING, MEALS AT DISCHARGE FOR PATIENTS SCREENING POSITIVE FOR FOOD INSECURITY, TRAUMA INFORMED CARE AND MENTAL HEALTH FIRST AID AWARENESS, EDUCATION ON FALL AND INJURY PREVENTION, SAFE SLEEP AND MATERNAL AND INFANT HEALTH EDUCATION TO THE COMMUNITY. DRH ALSO PROVIDED FINANCIAL ASSISTANCE TO THE COMMUNITY THROUGHOUT 2024, OF WHICH $3,851,000 REPRESENTED UNCOMPENSATED AMOUNTS FOR TREATMENT OF PATIENTS WHO DID NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR HOSPITAL SERVICES. FINANCIAL ASSISTANCE REPRESENTS THE COST TO PROVIDE SERVICE AND DOES NOT INCLUDE THE COSTS FOR ACCOUNTS WRITTEN OFF TO BAD DEBT FOR PATIENTS WHO DO NOT PAY THEIR BILLS. DRH'S COST OF BAD DEBT FOR 2024 WAS $5,214,000 . THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $13,155,000 NOTED ABOVE. FURTHER, DRH PROVIDED $1,236,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. DURING 2024, DRH EXPENDED $23,393,000 IN TOTAL PAYROLL , PROVIDING 262 FULL-TIME JOBS . A TOTAL OF $1,425,000 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES . IN SUMMARY, DRH DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. AND WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL CLASSES, HEALTH FAIRS AND OTHER OUTREACH ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE. 53367675 1 1 0 1 0 0 0 0 0 1 1 0 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 1 0 0 0 0 0 0 1 1 0 0 0 1 X 0 0 441 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 13 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 KEN BOROFF TRUSTEE 1.00 0.00 X 0 0 0 JENNIFER BOYD TRUSTEE - PART YEAR 1.00 0.00 X 0 0 0 KEITH BURMEISTER PRESIDENT 1.00 44.00 X X 0 352108 7820 DAWN BUSKEY TRUSTEE/CHIEF ACUTE CARE OFFICER 1.00 44.00 X 0 1340164 14772 GARY CATES TRUSTEE/CPO - PART YEAR 1.00 44.00 X 0 686162 5907 FLOYD CHASSE TRUSTEE/CHIEF OF HUMAN RESOURCES 1.00 44.00 X 0 615987 7820 CYNTHIA ENSIGN TRUSTEE 1.00 0.00 X 0 0 0 JONATHAN GATHMAN TRUSTEE 1.00 0.00 X 0 0 0 KATIE GROFF TRUSTEE 1.00 0.00 X 0 0 0 JASON HOEFFEL TRUSTEE 1.00 0.00 X 0 0 0 CRYSTAL HORNISH TRUSTEE 1.00 0.00 X 0 0 0 AMANDA KISSNER CHAIRPERSON 1.00 16.00 X X 0 0 0 LAURA KLINE TRUSTEE 1.00 0.00 X 0 0 0 JOSHUA LUCAS TRUSTEE 1.00 0.00 X 0 0 0 KAY SMITH TRUSTEE/VP OF PROVIDER OPERATIONS 1.00 44.00 X 0 284048 2305 MICHELLE STAHL TRUSTEE 1.00 0.00 X 0 0 0 SUE STAUSBAUGH TRUSTEE 1.00 0.00 X 0 0 0 JORDAN STUCKEY TRUSTEE/PHYSICIAN 1.00 44.00 X 0 553035 14405 SAMUEL SWITZER TRUSTEE 1.00 0.00 X 0 0 0 JAMES WILLIAMS TRUSTEE 1.00 1.00 X 0 0 0 TERRENCE METZGER TREASURER/CFO 1.00 54.00 X 0 1209318 6610 STEPHEN SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 1.00 54.00 X 0 1180376 6038 ARTURO POLIZZI CEO 1.00 54.00 X 0 3119320 14012 TRINA BUETTNER DIRECTOR OF PHARMACY SERVICES 45.00 0.00 X 172930 0 6574 SARA SCHUETTE DIRECTOR OF REHABILITATION 45.00 0.00 X 145628 0 7476 JACK POLING DIRECTOR OF NURSING SERVICES - ACUTE CARE 45.00 0.00 X 144442 0 3510 MARY FLORY DIRECTOR OF SURGICAL SERVICES 45.00 0.00 X 140134 0 6887 CHRISTINE HOFFMAN STAFF PHARMACIST DRH 45.00 0.00 X 137802 0 4343 740936 9340518 108479 17 0 1 0 0 103048 103048 NET PATIENT SERVICES 900099 102870699 102870699 AFFIL. ORG. RENT REV. 531120 874502 874502 103745201 11401 11401 33524 0 33524 33524 33524 1425 0 1425 1425 1425 HEALTH SPA REVENUE 456199 41971 41971 AUXILIARY INCOME 909999 926 926 42897 103937496 103745201 41971 47276 X 20127572 16846766 3280806 3265532 2733248 532284 1424947 1192680 232267 1629 1629 78220 78220 7431 7431 7223568 7223568 24750 3465 21285 1422119 199097 1223022 7332 5352 1980 1842193 589502 1252691 34929 4890 30039 2656 2656 2055310 1808673 246637 INTERCOMPANY SERVICES 10325853 1445619 8880234 DRUGS 7494354 7494354 MEDICAL SUPPLIES 6179909 6179909 PROVISION FOR BAD DEBT 5218152 5218152 2871992 2419744 452248 69608448 53367675 16240773 0 2934062 3780279 208402 0 13068184 12831525 964309 1350553 185423 842082 99377897 76442514 22837407 22935383 109040 0 2548401 4903278 42855228 46643100 5363387 6340869 15851034 5910294 21214421 12251163 X 21472580 34223710 168227 168227 21640807 34391937 42855228 46643100 X 34329048 -21577918 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7431 7431 0 PART II-B, LINE 1: DEFIANCE HOSPITAL, INC. PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, A PORTION OF WHICH IS ALLOCABLE TO LOBBYING BY THE ORGANIZATION. 168227 168227 168227 168227 168227 168227 168227 168227 168227 168227 0.00000 1.00000 0.00000 0 1 1 2832983 2832983 69206648 53408756 15797892 328240 328240 0 20832511 18274686 2557825 6177515 4430832 1746683 22935383 BENEFICIAL INTEREST IN FOUNDATION 4222753 OTHER RECEIVABLE 7534 THIRD PARTY RECEIVABLE 483963 DUE FROM AFFILIATE 92190 RIGHT OF USE ASSET LEASE 96838 4903278 ESTIMATED THIRD PARTY SETTLEMENTS PAYABLE 5813500 ASSET REMEDIATION OBLIGATION 24141 OPERATING LEASE LIABILITY 72653 5910294 PART V, LINE 4: THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT DEFIANCE HOSPITAL, INC. CONSISTENT WITH DONOR INTENT. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 0 763607 763607 0.01190 11661010 12896911 0 0.00000 12424617 12896911 763607 0.01190 35 2142 14600 14600 0.00020 471426 471426 0.00730 0 219647 183591 36056 0.00060 24951 24951 0.00040 35 2142 730624 183591 547033 0.00850 35 2142 13155241 13080502 1310640 0.02040 1 5218152 128765 13230196 12892665 337531 X 1 1 1 1 DEFIANCE HOSPITAL INC 1200 RALSTON AVENUE DEFIANCE OH 43512 WWW.PROMEDICA.ORG 1160 X X X X DEFIANCE HOSPITAL INC 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 600.000000000000 X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 DEFIANCE HOSPITAL, INC. PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. FOLLOWING THE FORMAL COUNTY ASSESSMENT SURVEY PROCESS, PROMEDICA DEFIANCE REGIONAL HOSPITAL STAFF JOINED POWER DEFIANCE, COMPRISED OF MULTIPLE COMMUNITY ORGANIZATIONS, TO COLLABORATE, DEVELOP AND IMPLEMENT A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR DEFIANCE COUNTY. A GAP ANALYSIS AND RESOURCE ASSESSMENT WERE CONDUCTED AS PART OF THIS PROCESS.IN 2022, PROMEDICA DEFIANCE REGIONAL HOSPITAL CONVENED A CHNA COMMITTEE TO REVIEW THE MOST RECENT DEFIANCE COUNTY CHA AND CHIP, WITH GAP AND RESOURCE ASSESSMENTS. THE COMMITTEE THEN SELECTED AND PRIORITIZED KEY INDICATORS FOR THE DEFINED COMMUNITY AND DEVELOPED AN IMPLEMENTATION PLAN TO ADDRESS THESE PRIORITY HEALTH NEEDS IN THE COMMUNITY OVER THE NEXT THREE YEARS, TAKING INTO ACCOUNT THE NEEDS OF MINORITY AND/OR UNDERSERVED POPULATIONS. THE HOSPITAL RECEIVED FEEDBACK ON THE CHNA PLAN FROM THE DEFIANCE COUNTY HEALTH DISTRICT, TO CONFIRM THESE NEEDS FROM A PUBLIC HEALTH EXPERT PERSPECTIVE.THE POWER DEFIANCE COUNTY STRATEGIC CHIP PROCESS INCLUDED INPUT FROM ORGANIZATIONS AND PERSONS WHO REPRESENT THE COMMUNITY. COLLABORATING ORGANIZATIONS INCLUDED:AYERSVILLE LOCAL SCHOOLS, CITY OF DEFIANCE, COMMUNITY MEMORIAL HOSPITAL, CREDIT ADJUSTMENTS INC., DEFIANCE AREA FOUNDATION, DEFIANCE AREA YMCA, DEFIANCE CITY SCHOOLS, DEFIANCE COUNTY COMMISSIONERS, DEFIANCE COUNTY DRUG FREE COALITION, DEFIANCE COUNTY GENERAL HEALTH DISTRICT, DEFIANCE COUNTY JUVENILE COURT, DEFIANCE COUNTY OHIO STATE UNIVERSITY EXTENSION OFFICE, DEFIANCE COUNTY PUBLIC LIBRARY SYSTEM, DEFIANCE DEVELOPMENT AND VISITORS BUREAU, DEFIANCE 2100, FAIRVIEW SCHOOL DISTRICT, FAMILY AND CHILDREN FIRST COUNCIL, FOUR COUNTY ADAMHS BOARD, HICKSVILLE SCHOOLS, HICKSVILLE VILLAGE, MAUMEE VALLEY GUIDANCE CENTER, MERCY HEALTH, DEFIANCE MINISTERIAL ASSOCIATION, NORTHEASTERN LOCAL SCHOOLS, NORTHWESTERN OHIO COMMUNITY ACTION COMMISSION, PROMEDICA DEFIANCE REGIONAL HOSPITAL, RECOVERY SERVICES OF NORTHWEST OHIO, UNITED WAY OF DEFIANCE COUNTY DEFIANCE HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY CONDUCTED ITS 2022 CHNA WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO DEFIANCE HOSPITAL, INC. PART V, SECTION B, LINE 11: DEFIANCE HOSPITAL, INC. CONDUCTED AND ADOPTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2022 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - CHRONIC CONDITIONS RESPIRATORY HEALTH- BEHAVIORAL HEALTH - HEALTHY AGING FALL AND INJURY PREVENTION- SOCIAL DETERMINANTS OF HEALTH FOOD INSECURITY- HEALTHY BEHAVIORS WOMEN'S AND INFANT HEALTHTHIS CHNA WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2022, THEREFORE, THESE HEALTH NEEDS WILL BE ADDRESSED OVER THE THREE TAX YEARS, 2023-2025. DEFIANCE HOSPITAL, INC. DOES NOT INTEND TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT GIVEN THAT SOME OF THE IDENTIFIED HEALTH NEEDS ARE EITHER BEING ADDRESSED DURING PHYSICIAN VISITS, GO BEYOND THE SCOPE OF THE HOSPITAL, OR ARE BEING ADDRESSED BY, OR WITH, OTHER ORGANIZATIONS IN THE COMMUNITY. TO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOST IMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OF RESOURCES, MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITY ORGANIZATIONS AND COALITIONS. THE 2022 SIGNIFICANT HEALTH NEEDS IDENTIFIED, BUT SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS 2022 IMPLEMENTATION PLAN INCLUDE: COMMUNITY CONDITIONS AND HEALTH POLICIES, AFFORDABLE HOUSING DEVELOPMENT AND PRESERVATION, EARLY CHILDHOOD HOME VISITING PROGRAMS, COMPLETE STREETS AND STREETSCAPE DESIGNS, PUBLIC TRANSPORTATION SYSTEMS, WORKFORCE SHORTAGES. DEFIANCE HOSPITAL, INC. TOOK THE FOLLOWING ACTIONS DURING TAX YEAR 2024 WITH RESPECT TO ITS MOST RECENT CHNA, CONDUCTED IN 2022: HEALTH NEED IDENTIFIED: CHRONIC CONDITIONS: RESPIRATORY HEALTH STRATEGY #1 PROVIDE EDUCATION AND RESOURCES RELATED TO TOBACCO/VAPING CESSATIONACTIONS TAKEN: - 35 FLYERS AND RESOURCES RELATED TO TOBACCO OR VAPING CESSATION WERE DISTRIBUTED IN 2024. - 9 EDUCATIONAL MESSAGES ABOUT RESPIRATORY HEALTH WERE POSTED TO THE HOSPITAL'S FACEBOOK PAGE WITH 2,200 PEOPLE FOLLOWING IN 2024. STRATEGY #2 PROVIDE EDUCATION AND RESOURCES RELATED TO HEART DISEASE PREVENTION.ACTIONS TAKEN: - 40 HEART DISEASE PREVENTION EDUCATION MATERIALS WERE DISTRIBUTED IN 2024. STRATEGY #3 BLOOD PRESSURE SCREENING & SELF-MONITORINGACTIONS TAKEN: - 35 COMMUNITY MEMBERS RECEIVED BLOOD PRESSURE SCREENINGS IN 2024. HEALTH NEED IDENTIFIED: BEHAVIORAL HEALTH STRATEGY #1 OFFER HOUSING RESOURCES TO COPING CENTER PATIENTS IDENTIFIED AS HAVING A NEED ON SOCIAL RISK ASSESSMENT. ACTIONS TAKEN:- 17 HOUSING RESOURCES WERE PROVIDED TO PATIENTS IN THE COPING CENTER IN 2024.STRATEGY #2 OFFER MEDSAFE BLUE BOX MEDICATION DISPOSAL STATION IN EMERGENCY DEPARTMENT FOR RESPONSIBLE DISPOSAL FOR THE COMMUNITY. ACTIONS TAKEN:- HOSPITAL MEDSAFE DISPOSAL WAS FILLED AND EMPTIED TWO (2) TIMES IN 2024 TO COLLECT AND DISPOSE OF UNUSED MEDICATIONS RESPONSIBLY. STRATEGY #3 PROVIDE EDUCATION AND RESOURCES RELATED TO MENTAL HEALTH FIRST AID TRAINING (MHFA). ACTIONS TAKEN:- 34 RESOURCES ABOUT MENTAL HEALTH FIRST AID TRAININGS WERE DISTRIBUTED IN 2024. - 11 EDUCATIONAL MESSAGES ABOUT MENTAL HEALTH WERE POSTED ON THE HOSPITAL'S FACEBOOK PAGE WITH 2,200 PEOPLE FOLLOWING IN 2024. STRATEGY #4 PROVIDE EDUCATION AND RESOURCES RELATED TO TRAUMA INFORMED CARE (TIC). ACTIONS TAKEN:- 41 EDUCATIONAL RESOURCES PERTAINING TO TRAUMA INFORMED CARE WERE DISTRIBUTED IN 2024. - 3 EDUCATIONAL MESSAGES ABOUT TRAUMA AND INJURY PREVENTION WERE POSTED TO THE HOSPITAL'S FACEBOOK PAGE WITH 1,900 PEOPLE FOLLOWING IN 2024. HEALTH NEED IDENTIFIED: HEALTHY AGING FALLS AND INJURY PREVENTION STRATEGY #1 PROVIDE EDUCATION AN RESOURCES RELATED TO HOME FITNESS VIDEO EDUCATION, INCLUDING TAI CHI TO IMPROVE BALANCE ACTIONS TAKEN:- 37 EDUCATIONAL RESOURCES WERE DISTRIBUTED TO COMMUNITY MEMBERS ABOUT IMPROVE BALANCE AND FALL PREVENTION. - 13 EDUCATIONAL MESSAGES ABOUT PHYSICAL ACTIVITY AND HEALTHY LIFESTYLES WERE POSTED TO THE HOSPITAL'S FACEBOOK PAGE WITH 2,200 PEOPLE FOLLOWING IN 2024. HEALTH NEED IDENTIFIED: SOCIAL DETERMINANTS OF HEALTH FOOD INSECURITY STRATEGY #1 COMPLETE INPATIENT SDOH SCREENINGS AND USING IMPROVED PROCESS, OFFER FOOD AT DISCAHRGE TO PATIENTS WHO SCREEN FOR FOOD INSECURITY, INCLUDING COMMUNITY RESOURCE LISTING. ACTIONS TAKEN:- 1257 PATIENTS SCREENED POSITIVE FOR FOOD INSECURITY IN 2024. - 68 PATIENTS ACCEPTED FOOD AT DISCHARGE WITH A COMMUNITY RESOURCE LISTING.STRATEGY #2 DISTRIBUTE COMMUNITY FOOD RESOURCE LISTING IN HOSPITAL WAITING AREAS AND TO OTHER COMMUNITY AGENCIES. ACTIONS TAKEN:- 49 COMMUNITY RESOURCE LISTINGS WERE DISTRIBUTED IN HOSPITAL WAITING AREAS AND TO COMMUNITY ORGANIZATIONS IN 2024. HEALTH NEED IDENTIFIED: WOMEN'S AND INFANT HEALTH STRATEGY #1 PROVIDE SAFE SLEEP EDUCATIONAL HANDOUTS TO COMMUINTY GROUPS, TO INCLUDE ALL AGES OF CAREGIVERS ACTIONS TAKEN:- 44 SAFE SLEEP EDUCATIONAL HANDOUTS WERE DISTRIBUTED IN THE COMMUNITY. STRATEGY #2 PROVIDE NO COST MATERNAL HEALTH CLASSES, INCLUDING SAFE SLEEP EDUCATION, OPEN TO THE PUBLIC. ACTIONS TAKEN:- 39 COMMUNITY MEMBERS PARTICIPATED IN MATERNAL HEALTH CLASSES IN 2024. PART V, SECTION B, LINE 7A THE 2022 CHNA CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ABOUT-PROMEDICA/COMMUNITY PART V, SECTION B, LINE 10A THE 2023-2025 CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ABOUT-PROMEDICA/COMMUNITY PART V, SECTION B, LINE 16A: THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C: A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE 3 1 - DEFIANCE REGIONAL PAIN MANAGEMENT 1250 RALSTON AVE STE 203 DEFIANCE OH 43512 PAIN CLINIC 2 - PROMEDICA DEFIANCE HOSPITAL - TOTAL REHA 1252 RALSTON AVE STE 301 DEFIANCE OH 43512 TOTAL REHAB 3 - PROMEDICA DEFIANCE HOSPITAL - JOBST MEDI 1252 RALSTON AVE STE 401 DEFIANCE OH 43512 JOBST MTM PART I, LINE 3C: IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY USES INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY STATUS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: DEFIANCE HOSPITAL, INC. CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. OTHER BENEFITS AMOUNTS REPORTED ON LINE 7 WERE CALCULATED USING COSTS CHARGED DIRECTLY TO THE INDIVIDUAL PROGRAMS VIA THE FINANCIAL ACCOUNTING SYSTEM. AN INDIRECT COST ALLOCATION FACTOR FOR SHARED SERVICES IS ALSO CALCULATED AND INCLUDED IN APPLICABLE PROGRAMS LISTED IN OTHER BENEFITS. 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 $ 5,218,152. PART III, LINE 2: DEFIANCE HOSPITAL, INC.'S ANALYSIS AND ASSESSMENT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED BAD DEBT EXPENSE USES A RECEIPTS "LOOK-BACK" METHOD UTILIZING HISTORICAL PAYMENT DATA ON ACCOUNTS, INCLUDING CONTRACTUAL ADJUSTMENTS FOR PAYER DISCOUNTS, AS WELL AS PATIENT PAYMENTS, SUCH AS CO-PAYS AND DEDUCTIBLES, TO ESTABLISH ANTICIPATED COLLECTABILITY RATES FOR ACCOUNTS RECEIVABLE WITHIN EACH PAYER CATEGORY. PART III, LINE 3: DEFIANCE HOSPITAL, INC. ESTIMATED THE POSSIBLE AMOUNT OF FINANCIAL ASSISTANCE WITHIN BAD DEBT EXPENSE BY REVIEWING ACCOUNTS THAT WERE INTERNALLY CODED AS HAVING BEEN PROVIDED A FINANCIAL ASSISTANCE APPLICATION, BUT THAT WAS NOT ADEQUATELY COMPLETED BY THE PATIENT OR GUARANTOR, IN WHICH THE ACCOUNT WAS SUBSEQUENTLY WRITTEN OFF TO BAD DEBT. PART III, LINE 4: PROVISION FOR BAD DEBTS AND ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ARE DISCUSSED ON PAGE 15 AND 16 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL REPORT WITH SUPPLEMENTAL INFORMATION. PART III, LINE 8: MEDICARE SHORTFALL, WHICH IS THE EXCESS OF COSTS TO TREAT MEDICARE PATIENTS OVER THE REIMBURSEMENT RECEIVED FROM THE FEDERAL GOVERNMENT, SHOULD BE TREATED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - THE MEDICARE SHORTFALL REPRESENTS THE RELIEF OF A FINANCIAL BURDEN THAT WOULD OTHERWISE BE BORNE BY A GOVERNMENT PROGRAM. - THE MEDICARE SHORTFALL REPRESENTS A SOCIETAL BENEFIT INSOFAR AS MANY OF THE PROGRAMS AND SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY, IF THE DECISION TO PROVIDE SUCH SERVICES WAS MADE ON A FINANCIAL BASIS. - MEDICARE IS A SOCIETAL BENEFIT, PROVIDED BY THE FEDERAL GOVERNMENT, FOR THOSE WHO WOULD OTHERWISE BE UNINSURED AFTER AGING OUT OF TRADITIONAL MEANS OF HEALTH INSURANCE, SUCH AS INSURANCE PROVIDED BY AN EMPLOYER. - MEDICARE IS NOT A TRUE MARKET PAYER, AS COMPARED TO COMMERCIAL PAYERS, WHEREBY REIMBURSEMENT RATES CAN BE NEGOTIATED AND ADJUSTED IN ORDER TO REDUCE INCURRED LOSSES.DEFIANCE HOSPITAL, INC. USED THE MEDICARE ALLOWABLE COSTS PER ITS 2024 AS-FILED MEDICARE COST REPORTS, LESS ANY ADJUSTMENTS FOR SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION, IF APPLICABLE. ALLOWABLE COSTS ARE CALCULATED BY ALLOCATING TOTAL FACILITY COSTS TO REVENUE GENERATING UNITS WITHIN THE HOSPITAL. THE MEDICARE COST REPORT DOES NOT REFLECT ALL OF THE COSTS ASSOCIATED WITH MEDICARE PROGRAMS. PART III, LINE 9B: FINANCIAL ASSISTANCE DISCOUNTS ARE GRANTED FOR MEDICALLY NECESSARY SERVICES WHEN IT IS DETERMINED THAT THE PATIENT AND FAMILY INCOME MEETS THE CRITERIA ESTABLISHED. PATIENTS WHO HAVE INSURANCE COVERAGE OR WHO ARE ENTITLED TO GOVERNMENTAL ASSISTANCE ARE IDENTIFIED IN ORDER FOR REIMBURSEMENT TO BE OBTAINED. ALL PATIENTS WITH SELF-PAY BALANCES AFTER INSURANCE MAY OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS IF THEY PROVIDE APPROPRIATE DOCUMENTATION THAT THEY SATISFY THE INCOME GUIDELINES. VERIFICATION OF FINANCIAL ASSISTANCE IS PURSUED THROUGHOUT THE INTERNAL COLLECTION PROCESS UNTIL ALL OPTIONS HAVE BEEN EXHAUSTED. ALL PATIENTS, THAT HAVE A SELF-PAY BALANCE, INCLUDING PATIENTS THAT MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, RECEIVE BILLING STATEMENTS AND PAYMENT REMINDERS. THESE STATEMENTS INFORM ALL PATIENTS OF THE OPPORTUNITY TO SEEK A FINANCIAL ASSISTANCE ADJUSTMENT FOR MEDICALLY NECESSARY SERVICES, THE ELIGIBILITY CRITERIA, AND THE METHOD TO APPLY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN COMPLETED AND/OR REQUESTED INCOME VERIFICATION HAS NOT BEEN RECEIVED FROM A PATIENT WHO COULD POTENTIALLY QUALIFY, THE PATIENT WILL CONTINUE TO RECEIVE BILLING STATEMENTS THROUGH THE NORMAL COLLECTION PROCESS. IF A PATIENT DOES NOT HAVE INSURANCE, A PRESUMPTIVE CHARITY DETERMINATION (WHICH USES PUBLICLY AVAILABLE DATA SUCH AS DEMOGRAPHIC INFORMATION, CREDIT HISTORY, ETC.) MAY BE MADE TO ASSIST WITH QUALIFYING FOR FINANCIAL ASSISTANCE. ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, AN ADJUSTMENT IS PROCESSED. THE PATIENT ACCOUNT ANALYST WILL DETERMINE PATIENT ELIGIBILITY AND CALCULATE THE ADJUSTMENT BASED ON POLICY GUIDELINES. AN ADJUSTMENT FORM IS PREPARED AND APPROVED PER POLICY. UNINSURED PATIENTS MAY BE REQUIRED TO COMPLETE AN APPLICATION AND PROVIDE REQUIRED DOCUMENTATION, INCLUDING ANY DOCUMENTATION REQUIRED TO DETERMINE ELIGIBILITY. UNINSURED PATIENTS ARE NOTIFIED IN WRITING WHETHER OR NOT THEY QUALIFY FOR ANY FINANCIAL ASSISTANCE ADJUSTMENT FOR WHICH THEY HAVE SUBMITTED AN APPLICATION, AND OF ANY REMAINING BALANCE OWED. THE ADJUSTMENT IS THEN APPLIED TO THE PATIENT'S ACCOUNT.PATIENTS MAY BE OFFERED PAYMENT PLANS WHEN APPROPRIATE BASED ON DOCUMENTED FINANCIAL NEED AND CIRCUMSTANCES. LONGER PAYMENT PLANS MAY BE OFFERED ON AN EXCEPTION BASIS FOR CASES WITH UNUSUALLY HIGH BALANCES OR SPECIAL CIRCUMSTANCES DEMONSTRATING AN INABILITY TO PAY. ONCE THE INTERNAL COLLECTION PROCESS HAS BEEN COMPLETED, PATIENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY IF THE PATIENT HAS NOT CONTACTED US REGARDING THEIR DESIRE TO APPLY FOR FINANCIAL ASSISTANCE, SENT IN A FINANCIAL ASSISTANCE APPLICATION, RESPONDED TO REQUESTS FOR ADDITIONAL INFORMATION, OR WE ARE UNABLE TO MAKE A PRESUMPTIVE CHARITY DETERMINATION. IT IS THE EXPECTATION OF THE EXTERNAL COLLECTION AGENCY AS THEY WORK ACCOUNTS TO OFFER FINANCIAL ASSISTANCE WHEN APPLICABLE. THROUGHOUT THE COLLECTION PROCESS, THE COLLECTION AGENCY WILL INFORM UNINSURED PATIENTS OF THE CRITERIA TO OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS BASED ON FAMILY INCOME AND FAMILY SIZE, AND WILL FORWARD APPLICATIONS FOR PATIENTS WHO SUBMIT THE REQUIRED DOCUMENTATION TO THE CENTRAL BUSINESS OFFICE FOR PROCESSING. PART VI, LINE 2: PROMEDICA HEALTH SYSTEM AND HOSPITALS DEMONSTRATE A COMMITMENT TO THE COMMUNITIES IT SERVES AND THEREFORE, BELIEVES IT IS CRITICAL TO UNDERSTAND THE HEALTH CARE NEEDS OF ITS PRIMARY SERVICE AREA. TO THAT END, PROMEDICA HOSPITALS CONDUCT NEEDS ASSESSMENTS IN ITS PRIMARY SERVICE AREAS USING A VARIETY OF METHODOLOGIES TO ASSESS EACH COUNTY'S HEALTH CARE DATA, IDENTIFY GAPS IN HEALTH CARE INITIATIVES, AND MAKE RECOMMENDATIONS FOR THE BETTERMENT OF THE GENERAL COMMUNITY HEALTH. ANALYSIS OF PUBLISHED COUNTY HEALTH DATA, INTERVIEWS WITH KEY STAKEHOLDERS, AND REVIEW OF HISTORICAL AND EXISTING PROMEDICA COMMUNITY ASSESSMENTS ARE ALL MEANS BY WHICH RECOMMENDATIONS FOR THE PROMEDICA COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLANS ARE DEVELOPED. INFORMATION IS REVIEWED AND APPROVED BY HOSPITAL GOVERNANCE LEADERSHIP TO ASSURE THAT PLANS ARE DEVELOPED TO MEET THE NEEDS OF THE COMMUNITY. PUBLISHED COUNTY HEALTH DATACOUNTY HEALTH DATA WERE OBTAINED FROM SEVERAL SOURCES, INCLUDING THE OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE, THE MICHIGAN DEPARTMENT OF HEALTH, AND FORMAL COUNTY ASSESSMENTS CONDUCTED WITHIN THE INDIVIDUAL COUNTIES. ALTHOUGH MOST COUNTIES CONDUCTING A FORMAL ASSESSMENT UTILIZE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) QUESTIONNAIRE DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AS THE BASIS OF THE COUNTY QUESTIONNAIRE, COUNTY COMMITTEES TYPICALLY ADD AND/OR CHANGE QUESTIONS TO MEET THE COUNTY'S PERCEIVED NEEDS. PROMEDICA'S COMMUNITY GOALS ARE SET BASED ON THIS DATA.PROMEDICA COMMUNITY HEALTH PLANOVERALL, EMPHASIS IS PLACED ON CLINICAL PROGRAMS FOCUSED ON LEADING CAUSES OF DEATH: CHRONIC DISEASES, MENTAL HEALTH, AND HUNGER/OBESITY DUE TO THE LARGE NUMBERS OF INDIVIDUALS AFFECTED BY THESE DISEASES. THE PRIMARY FOCUS FOR COMMUNITY HEALTH ACTIVITIES ARE RELATED TO EDUCATION, SCREENING, AND PREVENTION OF CHRONIC DISEASES, MENTAL HEALTH ISSUES, AND HUNGER/OBESITY; AND IMPROVING RELATED CONDITIONS THAT RESULT IN HIGH MORBIDITY AND MORTALITY IN OUR COMMUNITIES, WITH SPECIAL EMPHASIS PLACED ON SERVING UNDERSERVED POPULATIONS. AS A SYSTEM, WE ARE ALSO COMMITTED TO WORKING BEYOND OUR FOUR WALLS, ON THE SOCIAL AND ECONOMIC ISSUES THAT IMPACT HEALTH. IN ADDITION, PROMEDICA STRATEGIC PLANNING CONTINUES TO DEVELOP PATIENT-CENTERED, INTEGRATED CLINICAL SERVICE LINES INCLUDING CANCER, CARDIOVASCULAR, BEHAVIORAL HEALTH, SOCIAL DETERMINANTS OF HEALTH, AND MATERNAL FETAL MEDICINE. PART VI, LINE 3: THE OPPORTUNITY FOR FINANCIAL ASSISTANCE ADJUSTMENTS IS COMMUNICATED TO PATIENTS AT PROMEDICA HEALTH SYSTEM HOSPITALS THROUGH THE FOLLOWING METHODS:A. DURING THE PRE-REGISTRATION PROCESS FOR SCHEDULED INPATIENTS AND HIGH-DOLLAR OUTPATIENT CASES, THE CENTRALIZED PRE-REGISTRATION STAFF WILL NOTIFY A PATIENT FINANCIAL ADVOCATE TO CONTACT THE PATIENT PRIOR TO SERVICE TO DISCUSS POTENTIAL ELIGIBILITY FOR GOVERNMENT PROGRAMS AND FINANCIAL ASSISTANCE. THE PRE-SERVICE FUNCTION INCLUDES ACCOUNT REGISTRATION, INSURANCE VERIFICATION, PRE-CERTIFICATION AND FINANCIAL COUNSELING.B. ADMITTING LOCATIONS WILL HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE WHEN REGISTERED AS UNINSURED. AT ADMITTING, UNINSURED PATIENTS ARE INFORMED OF THE OPPORTUNITY TO SEEK FINANCIAL ASSISTANCE. C. PATIENT FINANCIAL ADVOCATES ARE AVAILABLE AT THE HOSPITALS TO ASSIST UNINSURED PATIENTS IN COMPLETING THE FORMS. PATIENT FINANCIAL ADVOCATES ATTEMPT TO MEET WITH IN-HOUSE PATIENTS TO ASSESS ELIGIBILITY AND TO ASSIST WITH APPLICATION FOR GOVERNMENT ASSISTANCE PROGRAMS, TO EXPLAIN PATIENT LIABILITY FOR CHARGES, TO PROVIDE AN ESTIMATE OF CHARGES WHEN FEASIBLE, TO EXPLAIN THE OPPORTUNITY FOR FINANCIAL ASSISTANCE, INCLUDING THE CRITERIA AND THE METHOD FOR APPLYING, AND TO EXPLAIN PAYMENT OPTIONS.D. A MESSAGE IS PRINTED ON THE PATIENT BILLING STATEMENTS TO NOTIFY THE UNINSURED PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE, TO EXPLAIN THE ELIGIBILITY CRITERIA, AND TO DESCRIBE THE METHOD TO APPLY.E. A SUMMARY OF THE POLICY FOR UNINSURED PATIENTS IS INCLUDED IN THE STATEMENTS OF UNINSURED PATIENT, AVAILABLE VIA THE PROMEDICA WEB SITE, AVAILABLE AT HOSPITAL REGISTRATION LOCATIONS, OR BY CALLING THE PROMEDICA CUSTOMER SERVICE DEPARTMENT. BUSINESS OFFICE PERSONNEL ALSO NOTIFY UNINSURED PATIENTS OF THE FINANCIAL ADJUSTMENT POLICY THROUGH THE CUSTOMER SERVICE AND COLLECTION DEPARTMENTS. PART VI, LINE 4: DEFIANCE HOSPITAL, INC., LOCATED IN DEFIANCE, OHIO, SERVES AN AREA PRIMARILY AROUND DEFIANCE COUNTY. APPROXIMATELY, 19% OF THE SERVICE AREA IS AGE 65 OR OVER; 58% IS BETWEEN AGE 18 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $67,000; 92% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER. DEFIANCE COUNTY HAS A POPULATION OF APPROXIMATELY 38,000 WITH APPROXIMATELY 8% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 23% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 8% OF DEFIANCE COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE FOR DEFIANCE COUNTY IN 2024 WAS 3.9%. THE LEADING CAUSES OF DEATH IN DEFIANCE COUNTY, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, CANCER, COVID, UNINTENTIONAL INJURIES/ACCIDENTS, LUNG DISEASE, DIABETES AND ALZHEIMER'S. THERE ARE SEVEN HOSPITALS WITHIN A 30-MILE RADIUS OF DEFIANCE HOSPITAL, INC.: MERCY HOSPITAL OF DEFIANCE, COMMUNITY HOSPITALS AND WELLNESS CENTERS (BRYAN), PAULDING COUNTY HOSPITAL, HENRY COUNTY HOSPITAL, COMMUNITY MEMORIAL HOSPITAL, FULTON COUNTY HEALTH CENTER, AND COMMUNITY HOSPITALS, AND WELLNESS CENTERS (MONTPELIER). PART VI, LINE 5: DEFIANCE HOSPITAL, INC. IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC., WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. IN 2024:- THERE WERE APPROXIMATELY 300 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), SERVING ON MORE THAN 25 DIFFERENT BOARDS, COMMITTEES, COUNCILS AND FOUNDATIONS. OF THOSE BOARD MEMBERS, MOST LIVE WITHIN PROMEDICA'S OHIO AND MICHIGAN ACUTE CARE SERVICE AREA, WITH THE MAJORITY RESIDING WITHIN THE GREATER TOLEDO AREA WHERE PROMEDICA'S ADULT AND PEDIATRIC TERTIARY HOSPITALS (THE TOLEDO HOSPITAL AND TOLEDO CHILDREN'S HOSPITAL) ARE LOCATED. - PROMEDICA NON-PARENT BOARD MEMBERS' DONATION OF TIME AND EXPERTISE, INCLUDING ATTENDING BOARD MEETINGS, RETREATS AND OTHER ACTIVITIES, WERE PERFORMED ON A VOLUNTEER BASIS. - PROMEDICA'S MEDICAL STAFF PRIVILEGES WERE EXTENDED TO ALL QUALIFIED PHYSICIANS AT OUR METRO TOLEDO AND REGIONAL HOSPITALS. QUALIFICATION MAY VARY BY HOSPITAL, BUT ANY PHYSICIAN WHO MET THOSE QUALIFICATIONS WAS GRANTED PRIVILEGES, UPON THEIR REQUEST.- AS PART OF PROMEDICA'S ELECTRONIC HEALTH RECORD (EHR) JOURNEY, THE INFORMATION TECHNOLOGY SERVICES TEAM COMPLETED TWO SYSTEM-WIDE UPGRADES TO THE EPIC PLATFORM. THE UPGRADES ALLOW PROMEDICA TO TAKE ADVANTAGE OF SOME OF THE MANY ENHANCEMENTS THAT EPIC HAS MADE TO ITS SOFTWARE BASED ON USER INPUT.- PROMEDICA PRIMARY CARE PROVIDERS CONTINUED SCREENING PATIENTS FOR RISK FACTORS OF SOCIAL DETERMINANTS OF HEALTH BY ASKING QUESTIONS RELATED TO EDUCATION, EMPLOYMENT, FOOD SECURITY, HOUSING, TRANSPORTATION, AND VIOLENCE. PATIENTS WHO SCREENED POSITIVE FOR ANY OF THE FACTORS WERE CONNECTED TO COMMUNITY PROGRAMS AND RESOURCES FOR ASSISTANCE.- PROMEDICA CANCER INSTITUTE (PCI) COMPLETED LUNG CANCER SCREENINGS, SCREENING MAMMOGRAMS AND SCREENING COLONOSCOPIES. ADDITIONALLY, PCI CONTINUES TO BE INSTRUMENTAL IN HELPING PROMEDICA IMPLEMENT MONOCLONAL ANTIBODY TREATMENT AT ITS INFUSION CENTERS FOR COVID-19 PATIENTS TO IMPROVE SYMPTOM MANAGEMENT. - PROMEDICA SENIOR CARE SKILLED NURSING FACILITIES AND HOME HEALTH AND HOSPICE AGENCIES PROVIDE UNIQUE SERVICES TO VETERANS, HOLIDAY SUPPORT, SUPPORT GROUPS, AND WORKSHOPS TO ANYONE IN THE COMMUNITY WHO NEEDS ADDITIONAL HELP TO GET THROUGH THE LOSS OF A LOVED ONE. PATIENTS AND RESIDENTS' WISHES ARE GRANTED THROUGH THE ORGANIZATION'S HEART'S DESIRE PROGRAM. THROUGH GRANTS FROM THE HOSPICE MEMORIAL FUND, GRIEF CAMPS FOR CHILDREN AND ADULTS ARE OFFERED AS WELL AS EDUCATIONAL SESSIONS AND LIFE CELEBRATION EVENTS. THE FUND ALSO PROVIDES STABILIZING RESOURCES FOR HOSPICE PATIENTS AND FAMILIES IN FINANCIAL DISTRESS DUE TO THE LACK OF OR REDUCTION IN INCOME FROM TERMINAL ILLNESS OR DISEASE.- PROMEDICA CONTINUES TO EXPAND ITS OPTIONS FOR HOSPITAL-LEVEL CARE IN THE COMFORT OF A PATIENT'S HOME. PROMEDICA ACUTE CARE AT HOME COMBINES PROMEDICA'S EXTENSIVE NETWORK OF IN-HOME CARE PROVIDERS WITH A SOPHISTICATED TECHNOLOGY PLATFORM TO DELIVER SEAMLESS AND EFFECTIVE CARE AT HOME FOR PATIENTS WITH SELECT CHRONIC CONDITIONS OR DIAGNOSES SUCH AS HEART FAILURE, PNEUMONIA OR COPD. RECENTLY, PROMEDICA ACUTE CARE AT HOME EXPANDED ITS SERVICES TO INCLUDE CARE FOR SELECT ONCOLOGY PATIENTS BY COLLABORATING THE PROMEDICA CANCER CENTER. THE CARE TEAM CONSISTS OF PHYSICIANS, NURSE PRACTITIONERS, REGISTERED NURSES, AND MAY INCLUDE OTHER HEALTHCARE PROFESSIONALS, SUCH AS PHYSICAL OR OCCUPATIONAL THERAPISTS, AS NEEDED. PART VI, LINE 6: PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A NATIONWIDE, MISSION-BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT WAS FORMED IN TOLEDO, OHIO IN 1986. IN 2024 PROMEDICA WAS COMPRISED OF MORE THAN 45,000 EMPLOYEES, NEARLY 850 VOLUNTEERS AND MORE THAN 2,100 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS INCLUDING APPROXIMATELY 1,200 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS EMPLOYED BY PROMEDICA PHYSICIAN GROUP (PPG) WHO FORM A PROVIDER NETWORK ACROSS 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN. AS AN INTEGRATED DELIVERY SYSTEM, PROMEDICA PROVIDERS SHARE RESOURCES SUCH AS ADVANCED TECHNOLOGY, QUALITY STANDARDS, SAFETY PRACTICES, MEDICAL EXPERTISE, AND SPECIALTY SERVICES TO ENSURE COMMUNITY MEMBERS HAVE READY ACCESS TO HIGH-QUALITY CARE IN THE MOST APPROPRIATE SETTING IN ORDER TO PROVIDE COST-EFFICIENT SERVICES. IN 2024: - PROMEDICA MEMBERS AND AFFILIATE HOSPITALS INCLUDED: THE TOLEDO HOSPITAL D/B/A PROMEDICA TOLEDO HOSPITAL; PROMEDICA TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF PROMEDICA TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL; FLOWER HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL D/B/A PROMEDICA FLOWER HOSPITAL; BAY PARK COMMUNITY HOSPITAL (D/B/A PROMEDICA BAY PARK HOSPITAL); EMMA L. BIXBY MEDICAL CENTER (D/B/A PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL); FOSTORIA HOSPITAL ASSOCIATION (D/B/A PROMEDICA FOSTORIA COMMUNITY HOSPITAL); DEFIANCE HOSPITAL, INC. (D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL); MERCY MEMORIAL HOSPITAL CORPORATION (D/B/A PROMEDICA MONROE REGIONAL HOSPITAL); MEMORIAL HOSPITAL (D/B/A PROMEDICA MEMORIAL HOSPITAL); AND COMMUNITY HEALTH CENTER OF BRANCH COUNTY (D/B/A PROMEDICA COLDWATER REGIONAL HOSPITAL). PROMEDICA ALSO INCLUDES PROMEDICA INSURANCE CORPORATION; PROMEDICA PHYSICIAN GROUP; AND PROMEDICA CONTINUING CARE SERVICES CORPORATION AS WELL AS HUNDREDS OF SKILLED NURSING AND REHABILITATION CENTERS, ASSISTED LIVING FACILITIES AND MEMORY CARE COMMUNITIES, ALL UNDER THE PROMEDICA SENIOR CARE/HCR MANORCARE UMBRELLA.- PROMEDICA CONTINUED TO OPERATE THREE COMMUNITY FOOD CLINICS, LOCATED AT PROMEDICA BAY PARK HOSPITAL, THE PROMEDICA HEALTH AND WELLNESS CENTER AND PROMEDICA'S CENTER FOR HEALTH SERVICES, TO SERVE PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND HAVE A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. PATIENTS ARE ABLE TO RECEIVE FOOD FOR THEMSELVES AND THEIR FAMILY FROM ONE OF THESE FOOD CLINICS. AS PART OF THE PROGRAM, PATIENTS CAN RECEIVE TWO TO THREE DAYS OF SUPPLEMENTAL FOOD. - FOR ITS MICHIGAN PATIENTS, PROMEDICA PARTNERED WITH THE SOUTH MICHIGAN FOOD BANK TO DISTRIBUTE FOOD RESOURCES TO PROMEDICA PHYSICIANS GROUP OFFICES FOR PATIENTS SCREENING POSITIVE FOR FOOD INSECURITY. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PROVIDE THE $5 VOUCHERS AT DISCHARGE SO PATIENTS CAN REDEEM FRESH PRODUCE FROM THE VEGGIE MOBILE THAT IS SOURCED FROM PROMEDICA FARMS, LOCAL GROWERS, AND A WHOLESALER. - PROMEDICA EBEID INSTITUTE'S MARKET ON THE GREEN PROVIDED BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES AND A FINANCIAL OPPORTUNITY CENTER TO PROVIDE FINANCIAL COUNSELING FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. ADDITIONALLY, TWO NEW FINANCIAL OPPORTUNITY CENTERS (FOC) WERE OPENED IN FREMONT AND DEFIANCE, OHIO. MUCH LIKE THE FOC LOCATED IN UPTOWN TOLEDO, THE NEW LOCATIONS OFFER SERVICES AND ASSIST LOW TO MODERATE-INCOME FAMILIES WITH SECURING LIVING WAGE JOBS, BUILDING CREDIT, REDUCING DEBT, AND GAINING WEALTH. THE FOC ALSO HELPS INDIVIDUALS NEEDING INCOME SUPPORT (PUBLIC BENEFITS) AND EMPLOYMENT COACHING AND COUNSELING AS WELL AS FREE TAX PREPARATION. 1 1 0 0 0 0 0 0 0 ARTURO POLIZZI CEO 0 1585940 0 1530880 0 2500 0 0 0 14012 0 3133332 0 0 DAWN BUSKEY TRUSTEE/CHIEF ACUTE CARE OFFICER 0 645947 0 692842 0 1375 0 0 0 14772 0 1354936 0 0 TERRENCE METZGER TREASURER/CFO 0 771258 0 438060 0 0 0 0 0 6610 0 1215928 0 0 STEPHEN SADOWSKI SECRETARY/CHIEF LEGAL OFFICER 0 618697 0 561679 0 0 0 0 0 6038 0 1186414 0 0 GARY CATES TRUSTEE/CPO - PART YEAR 0 132351 0 241996 0 311815 0 0 0 5907 0 692069 0 0 FLOYD CHASSE TRUSTEE/CHIEF OF HUMAN RESOURCES 0 490731 0 124597 0 659 0 0 0 7820 0 623807 0 0 JORDAN STUCKEY TRUSTEE/PHYSICIAN 0 519425 0 32500 0 1110 0 0 0 14405 0 567440 0 0 KEITH BURMEISTER PRESIDENT 0 257381 0 91163 0 3564 0 0 0 7820 0 359928 0 0 KAY SMITH TRUSTEE/VP OF PROVIDER OPERATIONS 0 207070 0 71831 0 5147 0 0 0 2305 0 286353 0 0 TRINA BUETTNER DIRECTOR OF PHARMACY SERVICES 145228 0 27702 0 0 0 0 0 6574 0 179504 0 0 0 SARA SCHUETTE DIRECTOR OF REHABILITATION 121700 0 23628 0 300 0 0 0 7476 0 153104 0 0 0 PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF DEFIANCE HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE 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. -GARY CATES RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $311,289 DURING 2024. AMANDA STUCKEY FAMILY MEMBER OF J. STUCKEY (BOARD MEMBER) 40371 EMPLOYED BY DEFIANCE HOSPITAL 0 KRISTY HOEFFEL FAMILY MEMBER OF J. HOEFFEL (BOARD MEMBER) 35808 EMPLOYED BY DEFIANCE HOSPITAL 0 FORM 990, PART IV, LINE 24A: DEFIANCE HOSPITAL, INC. IS A HEALTH FACILITY THAT IS A SUBSIDIARY OF PROMEDICA HEALTH SYSTEM, INC. (PHS). DEFIANCE HOSPITAL, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE TO THE TOLEDO HOSPITAL, WHICH IS ALSO A SUBSIDIARY OF PHS. THE NOTE PAYABLE REPRESENTS DEFIANCE HOSPITAL, INC.'S PORTION OF TAXABLE AND TAX-EXEMPT BONDS ISSUED BY PROMEDICA HEALTHCARE OBLIGATED GROUP. 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 DEFIANCE HOSPITAL, INC. AS THE MEMBER, PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF DEFIANCE HOSPITAL, INC., AND (B) APPROVE THE NOMINEES TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES, A MAJORITY OF WHOM ARE NOMINATED BY DEFIANCE HOSPITAL, INC. 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 STATEMENT OF CONFLICT (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 DEFIANCE HOSPITAL, INC.'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF DEFIANCE HOSPITAL, INC.'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 IX, LINE 11G PHYSICIAN AND MEDICAL STAFFING FEES: PROGRAM SERVICE EXPENSES 2,668,025. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,668,025. TEMP AGENCY FEES: PROGRAM SERVICE EXPENSES 898,747. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 898,747. PURCHASED SERVICES - OTHER FEES: PROGRAM SERVICE EXPENSES 2,304,878. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,304,878. SERVICE CONTRACT FEES: PROGRAM SERVICE EXPENSES 832,328. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 832,328. DISASTER RECOVERY: PROGRAM SERVICE EXPENSES 514,612. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 514,612. MEDICAL TRANSPORT: PROGRAM SERVICE EXPENSES 4,978. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,978. FORM 990, PART XI, LINE 9: TRANSFER BETWEEN AFFILIATES -21,577,918. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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