2025-11-17T13:04:26-06:00 2024-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2024-01-01 344427944 THE SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION SHEL 9374982311 915 WEST MICHIGAN STREET SIDNEY OH 453652491 JULIE COVAULT COO 9374982311 2025-11-17 1 1 EMILIE M KNIERIEM CPA P01330194 3176334705 2025-11-17 2024 2025-03-06 01:10:19Z WILSON MEMORIAL HOSPITAL JULIE COVAULT 915 WEST MICHIGAN STREET SIDNEY OH 453652491 139018344 0 X WWW.WILSONHEALTH.ORG X 1920 OH TO MAINTAIN A PATIENT-CENTERED ENVIRONMENT THAT ENCOURAGES AND SUPPORTS INNOVATION AND TEAMWORK IN ACHIEVING EXCELLENCE. TO MAXIMIZE CUSTOMER SATISFACTION BY MEETING THE HIGHEST STANDARDS OF VALUE, SERVICE, AND PERFORMANCE. TO PROVIDE COMMUNITY LEADERSHIP BY ASSURING ACCESS TO THE HIGHEST QUALITY, COMPREHENSIVE HEALTH CARE SERVICES. 16 14 979 62 0 0 537512 354718 106328722 115981491 5632087 5556582 8707183 6773172 121205504 128665963 0 0 0 0 60285966 61586771 0 0 0 61321628 67365187 121607594 128951958 -402090 -285995 151879962 156348091 13761606 14156231 138118356 142191860 X TO MAINTAIN A PATIENT-CENTERED ENVIRONMENT THAT ENCOURAGES AND SUPPORTS INNOVATION AND TEAMWORK IN ACHIEVING EXCELLENCE. TO MAXIMIZE CUSTOMER SATISFACTION BY MEETING THE HIGHEST STANDARDS OF VALUE, SERVICE, AND PERFORMANCE. TO PROVIDE COMMUNITY LEADERSHIP BY ASSURING ACCESS TO THE HIGHEST QUALITY, COMPREHENSIVE HEALTH CARE SERVICES. 0 0 106856444 120433082 HEALTH CARE SERVICES RELATED TO IMPROVING THE HEALTH OF THE COMMUNITY FOR BOTH INPATIENT AND OUTPATIENT PROGRAMS.INPATIENT HEALTHCARE SERVICES - THERE WERE 2,910 ADMISSIONS TO THE HOSPITAL IN 2024, REPRESENTING 6,551 PATIENT DAYS OF CARE. THERE WERE 375 INPATIENT SURGERIES PERFORMED DURING 2024. OUTPATIENT HEALTHCARE SERVICES - THERE WERE 100,016 OUTPATIENT REGISTRATIONS RECORDED IN 2024. SAME DAY SURGERY - THERE WERE 3,590 OUTPATIENT SURGERIES PERFORMED AT THE HOSPITAL IN 2024. EMERGENCY SERVICES - 18,573; HOME HEALTH VISITS - 17,465; HOSPICE - 8,034; OCCUPATIONAL HEALTH VISITS - 16,632; WILSON HEALTH MEDICAL GROUP OFFICE VISITS - 128,952 106856444 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 67 0 1 979 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X PEGGY PUTHOFF 9374985431 915 WEST MICHIGAN STREET SIDNEY OH 453652491 JANICE BENANZER CHAIR 1.00 0.00 X X 0 0 0 TOM MILLIGAN VICE-CHAIR 1.00 0.00 X X 0 0 0 JACKIE DAVIS TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 JOHN DEEDS TRUSTEE 1.00 0.00 X 0 0 0 MARIAN SPICER TRUSTEE 1.00 1.00 X 0 0 0 ANDY COUNTS TRUSTEE 1.00 0.00 X 0 0 0 CHARLES EDELEN TRUSTEE 1.00 0.00 X 0 0 0 PAUL DENTINGER TRUSTEE 1.00 0.00 X 0 0 0 SHELLY GASSON TRUSTEE 1.00 0.00 X 0 0 0 GARY HEITMEYER TRUSTEE 1.00 0.00 X 0 0 0 RUDY KEISTER TRUSTEE 1.00 0.00 X 0 0 0 DR ERIC PRENGER TRUSTEE 40.00 0.00 X 300383 0 45066 JASON STIVER TRUSTEE 1.00 0.00 X 0 0 0 DR MATTHEW VASKO TRUSTEE 40.00 0.00 X 335222 0 48666 DR FRED HAUSSMAN TRUSTEE PARTIAL TERM 1.00 0.00 X 0 0 0 DEVON BEER TRUSTEE PARTIAL TERM 1.00 0.00 X 0 0 0 MARK KLOSTERMAN CEO 40.00 1.00 X X 621885 0 54920 JULIE COVAULT COO 40.00 0.00 X 458555 0 54415 MELISSA TALLMADGE CHIEF NURSING OFFICER 40.00 0.00 X 185673 0 4912 MICHAEL J VIETTI PHYSICIAN 40.00 0.00 X 681243 0 52421 ANDREW DAVID MCDONALD PHYSICIAN 40.00 0.00 X 542471 0 51721 DANIEL JOHN DILWORTH PHYSICIAN 40.00 0.00 X 502445 0 49427 KRISTI L PEDLER PHYSICIAN 40.00 0.00 X 494133 0 15137 ROSEMARY MCCARTHY PHYSICIAN 40.00 0.00 X 493285 0 45097 4615295 0 421782 104 0 1 0 CENTRAL ANESTHESIA STAFFING 2243 BRIXTON ROAD COLUMBUS OH 43221 MEDICAL SERVICES 3323415 CPS REHABILITATION SERVICES LLC 655 METRO PLACE SOUTH STE 450 DUBLIN OH 43017 MEDICAL SERVICES 2136927 CARDIOSOLUTION LLC 4675 CORNELL RD CINCINNATI OH 45241 MEDICAL SERVICES 1857172 OSU PHYSICIANS INC 700 ACKERMAN ROAD STE 6000 COLUMBUS OH 43202 MEDICAL SERVICES 1026666 WILSON SLEEP LLC 915 W MICHIGAN ST SIDNEY OH 45431 MEDICAL SERVICES 768535 12 354718 354718 NET PATIENT REVENUE 623990 115981491 115981491 115981491 4840446 4840446 755632 129098 626534 626534 626534 10939419 10223283 716136 716136 716136 MISCELLANEOUS 900099 3296566 2101261 1195305 INVESTMENT IN JOINT VENTURES 900099 2350330 2350330 DIETARY 900099 499742 499742 6146638 128665963 120433082 0 7878163 X 2109699 1784927 324772 47233114 39961944 7271170 2196373 1788848 407525 6633703 5402857 1230846 3413882 2780456 633426 125000 101015 23985 66142 53451 12691 99750 80610 19140 37496727 30301924 7194803 431324 341945 89379 1301895 1280569 21326 298462 236615 61847 1485777 1177894 307883 193166 153138 40028 287447 227882 59565 15094 15094 6418050 3536233 2881817 1503586 1192013 311573 MEDICAL AND OTHER SUPPL 12849512 12639032 210480 FRANCHISE FEE 2644575 2096566 548009 DUES AND SUBSCRIPTIONS 811700 643500 168200 DIETARY 622176 493249 128927 714804 566682 148122 128951958 106856444 22095514 0 4829365 8477359 349138 350261 13180420 12908978 1448222 1550526 1719697 1767517 148299257 105919669 43310523 42379588 60519974 61966081 6351115 4864398 20171508 22083383 151879962 156348091 11270765 12369808 1820329 615281 670512 1171142 13761606 14156231 X 122457843 124079507 15660513 18112353 138118356 142191860 151879962 156348091 X -285995 4472585 -113086 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4720 4720 0 PART II-B, LINE 1: INDIRECT THROUGH PAYMENTS TO OHA AND GREATER DAYTON AREA HOSPITAL ASSOCIATION MEMBER DUES. THE PERCENTAGE OF OHA DUES USED FOR LOBBYING PURPOSES WAS 3.7% AND GDAHA WAS 10%. 306862 17195 12872 311185 301311 17815 12264 306862 306430 6626 11745 301311 273646 43861 11077 306430 255507 18139 273646 0.30594 0.69406 0 1 1 2579065 2579065 79926819 51640281 28286538 63571459 54279388 9292071 2221914 2221914 42379588 INTEREST IN FOUNDATION'S NET ASSETS 18112353 ACCRUED INTEREST 1000 DEPOSITS 913593 OTHER ASSETS 2371658 RIGHT OF USE ASSETS 575779 ESTIMATED THIRD-PARTY SETTLEMENTS 109000 22083383 LEASE OBLIGATIONS 1171142 1171142 X PART V, LINE 4: THE ENDOWMENT FUNDS WERE ESTABLISHED FOR A VARIETY OF PURPOSES. THE HOSPITAL HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO BALANCE THE MISSION OF BUILDING CAPITAL FOR FUTURE USE WITH THE CORRESPONDING OBLIGATION TO SUPPORT CURRENT AND FUTURE NEEDS OF THE HOSPITAL. THE ENDOWMENT FUNDS CONSIST OF FOUR SEPARATE FUNDS, INCLUDING THE MARY KEISER HOSPICE FUND, THE RUTH HEALTH AND EQUIPMENT FUND, THE ROSS HOME HEALTH CARE AND HOSPICE FUND, AND THE CRIMM FUND FOR SURGICAL EQUIPMENT. PART X, LINE 2: THE HOSPITAL, FOUNDATION, AND WHMG ARE TAX-EXEMPT HOSPITALS AS DEFINED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. SLEEP LAB, LLC AND WOSC ARE LIMITED LIABILITY CORPORATIONS AND, AS SUCH, PASS THEIR INCOME TO ITS MEMBERS. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE FOR THESE ENTITIES IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL, FOUNDATION, SLEEP LAB, LLC, WHMG, AND WOSC HAVE FILED THEIR APPLICABLE FEDERAL AND STATE INCOME TAX RETURNS FOR PERIODS THROUGH DECEMBER 31, 2023. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2024 AND 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 6236000 0 0 0 0 0 0 6236000 0 6236000 0 0 0 0 0 0 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 979530 334187 645343 0.00500 17135440 14209345 2926095 0.02270 18114970 14543532 3571438 0.02770 18114970 14543532 3571438 0.02770 1 9331201 16670772 22582065 -5911293 X 1 1 1 WILSON SLEEP LLC SLEEP STUDIES 0.60000 0.40000 2 HEALTH PARTNERS LTD PROVIDING OCCUPATIONAL HEALTH SERVICES TO HONDA 0.33330 1 1 SHELBY COUNTY MEMORIAL HOSPITAL ASSOC 915 W MICHIGAN STREET SIDNEY OH 45365 HTTPS://WWW.WILSONHEALTH.ORG/ 1268LH X X X THE SHELBY COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X WWW.WILSONHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X HTTP://SHELBYCOUNTYHEALTHDEPT.ORG 1 24 1 WWW.WILSONHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 125.000000000000 400.000000000000 X 1 1 X X X 1 X SEE PART V PAGE 8 X SEE PART V PAGE 8 X SEE PART V PAGE 8 X X X X X X 1 X 0 X X X X X 1 X 0 1 THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: TWENTY-NINE HOSPITALS CAME TOGETHER TO CONDUCT A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR SOUTHWEST OHIO, ORGANIZED BY THE HOSPITAL COUNCIL OF NORTHWEST OHIO AND THE GREATER DAYTON AREA HOSPITAL ASSOCIATION IN DAYTON, OHIO. THE HOSPITAL COUNCIL ASSEMBLED A HIGHLY QUALIFIED TEAM WHICH INCLUDED MEMBERS FROM NINE LOCAL COUNTY HEALTH DEPARTMENTS. THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE 29 HOSPITALS SERVED OVER 11 COUNTIES IN OHIO. FOR THIS CYCLE, 9 LOCAL HEALTH DEPARTMENTS ALSO COLLABORATED TO SHAPE THE PROCESS AND SHARE DATA. CONSISTENT SOURCES OF COMPARABLE DATA WERE AVAILABLE ONLY AT THE STATE AND COUNTY LEVEL, AND THEREFORE EACH PARTICIPATING HOSPITAL IDENTIFIED WHICH COUNTIES CONTAINED THEIR SERVICES AREAS. RESULTS IN THE CHNA REPORT INCLUDE DATA FROM A STRUCTURED SURVEY, QUALITATIVE DATA FROM MULTIPLE FOCUS GROUPS, AN ANALYSIS OF AVAILABLE SECONDARY DATA, AND FINDINGS FROM HEALTH DEPARTMENTS. THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: FOR THIS CYCLE, 9 LOCAL HEALTH DEPARTMENTS ALSO COLLABORATED TO SHAPE THE PROCESS AND SHARE DATA. THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: DRUG DETOX--COMMUNITY NEEDS ADDRESSED: SUBSTANCE ABUSE, MENTAL HEALTH, AND ACCESS TO CARE.GOAL: TO INCREASE THE RESOURCES AVAILABLE FOR PEOPLE SUFFERING FROM ADDICTION, ESPECIALLY OPIOID.STRATEGY/ACTION: CREATE A PARTNERSHIP TO DEVELOP AN INPATIENT DETOX PROGRAM.BACKGROUND: AS WITH MANY COMMUNITIES IN SOUTHWEST OHIO, SHELBY COUNTY IS EXPERIENCING AN INCREASE IN DRUG OVERDOSE DEATHS. OTHER RISKY BEHAVIORS ARE ALSO INCREASING, WITH A RESULTANT RISE IN THE RATES OF SEXUALLY TRANSMITTED DISEASES. IT WAS A TOP CONCERN EXPRESSED AT THE COMMUNITY MEETING, IN RESIDENT SURVEYS, BY NONPROFIT AGENCIES, AND BY THE SIDNEY-SHELBY COUNTY HEALTH DEPARTMENT. THE MEETING PARTICIPANTS AND THE HEALTH DEPARTMENT SPECIFICALLY MENTIONED THE CRISIS OF OPIOID ADDICTION.TELEHEALTH--COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE AND CHRONIC DISEASE.GOAL: TO INCREASE ACCESS TO PRIMARY CARE.STRATEGY/ACTION: IMPLEMENT TELEHEALTH SERVICES ACCESSIBLE TO PATIENTS THROUGHOUT THE WILSON HEALTH HEALTHCARE SYSTEMBACKGROUND: TELEHEALTH IS AN IMPORTANT RESOURCE IN A COUNTY THAT IS 51 % RURAL. RATES OF BREAST, LUNG CANCER, AND OVERALL CANCER ARE HIGHER HERE THAN FOR THE UNITED STATES OR THE STATE OF OHIO. THERE ARE ALSO FEWER PRIMARY CARE PROVIDERS PER CAPITA. ACCESS TO CARE WAS A PRIORITY AT THE COMMUNITY MEETINGS, IN AGENCY SURVEYS, AND FROM THE LOCAL HEALTH DEPARTMENT.COMMUNITY BASED HEALTH CLINICS--COMMUNITY NEEDS ADDRESSED: PREVENTION AND CARDIOVASCULAR HEALTH.GOAL: TO INCREASE ACCESS TO PRIMARY CARE.STRATEGY/ACTION: CREATED 2 COMMUNITY-BASED CLINICS, WITH THE COLLABORATION OF LOCAL EMPLOYERS, TO ESTABLISH ON-SITE AND/OR NEAR-SITE FOR MORE RESIDENTS TO ACCESS.BACKGROUND: THERE ARE FEWER PRIMARY CARE PROVIDERS PER CAPITA IN SHELBY COUNTY THAN IN OHIO OR THE UNITED STATES. ACCESS TO CARE WAS A PRIORITY AT THE COMMUNITY MEETINGS, IN AGENCY SURVEYS, AND FROM THE LOCAL HEALTH DEPARTMENT. RATES OF BREAST, LUNG CANCER, AND OVERALL CANCER ARE HIGHER HERE THAN FOR THE UNITED STATES OR THE STATE OF OHIO. LUNG CANCER AND HEART DISEASE ARE THE LEADING CAUSES OF DEATH.CHRONIC DISEASE MANAGEMENT & PREVENTION--COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE, PREVENTION AND CARDIOVASCULAR HEALTH.GOAL: INCREASE KNOWLEDGE ABOUT CHRONIC DISEASES IN GENERAL, INCLUDING PREVENTION AND DISEASE MANAGEMENT.STRATEGY/ACTION: COMMUNITY ENGAGEMENT TO PROVIDE EDUCATION, SCREENING, AND SUPPORT TO PREVENT AND/OR MANAGE CHRONIC DISEASES.BACKGROUND: ACCESS TO CARE WAS A PRIORITY AT THE COMMUNITY MEETINGS, IN AGENCY SURVEYS, AND FROM THE LOCAL HEALTH DEPARTMENT. RATES OF BREAST, LUNG CANCER, AND OVERALL CANCER ARE HIGHER HERE THAN FOR THE UNITED STATES OR THE STATE OF OHIO. LUNG CANCER AND HEART DISEASE ARE THE LEADING CAUSES OF DEATH. IN ADDITION, THE PERCENTAGE OF THE POPULATION AGE 65 AND OLDER IS INCREASING AND EXCEEDS THE STATE PERCENTAGE.3-D MAMMOGRAPHY SCREENING--COMMUNITY NEEDS ADDRESSED: ACCESS TO CARE, PREVENTION.GOAL: TO INCREASE THE NUMBER OF WOMEN WHO RECEIVE 3-D MAMMOGRAMS.STRATEGY/ACTION: CONTINUE AND EXPAND SCREENING FOR BREAST CANCER WITH 3-D MAMMOGRAPHY.BACKGROUND: 3-D MAMMOGRAPHY HAS THE FOLLOWING ADVANTAGES: EARLY DETECTION OF BREAST CANCER IN THE ABSENCE OF ANY SIGNS OR SYMPTOMS; LESS NEED FOR FOLLOW-UP IMAGING; IDENTIFIES MORE CANCERS; AND IMPROVES DETECTION OF CANCER IN DENSE BREAST TISSUE.SAFE SLEEP--COMMUNITY NEEDS ADDRESSED: MATERNAL HEALTHGOAL: TO EMPHASIZE THE IMPORTANCE OF SAFE SLEEP EDUCATION AND TO DISSEMINATE IT EFFECTIVELY THROUGHOUT OUR COMMUNITIES.STRATEGY/ACTION: PROVIDE SAFE SLEEP EDUCATION TO FAMILIES/CAREGIVERS OF INFANT < 1 YEAR; IDENTIFY FAMILIES NEEDING A SAFE SLEEP SPACE AND PROVIDE RESOURCES.BACKGROUND: SIDS IS THE LEADING CAUSE OF DEATH AMONG BABIES BETWEEN 1 MONTH AND 1 YEAR OF AGE. THIS PROGRAM FOCUSES ON ACTIONS PARENTS AND CAREGIVERS CAN TAKE TO HELP BABIES SLEEP SAFELY AND TO REDUCE THE RISK OF SUDDEN INFANT DEATH SYNDROME (SIDS) AND OTHER SLEEPRELATED CAUSES OF INFANT DEATH.BABY & ME TOBACCO FREE--COMMUNITY NEEDS ADDRESSED: MATERNAL HEALTH, LUNG/RESPIRATORY HEALTHGOAL: SUPPORT PREGNANT WOMEN TO QUIT USING TOBACCO AND VAPING PRODUCTS.STRATEGY/ACTION: EMPLOY A FULL TIME CERTIFIED TOBACCO TREATMENT PROFESSIONAL TO PROVIDE FREE SMOKING AND VAPING CESSATION EDUCATION AND SUPPORT FOR WOMEN WHO ARE PREGNANT OR UP TO ONE YEAR POST-PARTUM. BACKGROUND: TOBACCO USE IS A RISK FACTOR FOR POOR BIRTH OUTCOMES AND INFANT HEALTH. THIS PROGRAM WAS DESIGNED TO PROVIDE FREE TOBACCO AND VAPING CESSATION SUPPORT FOR WOMEN WHO ARE PREGNANT OR UP TO ONE YEAR POST-PARTUM. WOMEN WHO COMPLETE THE SERIES OF SEVEN CLASSES RECEIVE INCENTIVES TO SUPPORT THEIR BABIES THROUGHOUT THE COURSE SUCH AS DIAPERS AND WIPES. THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: SIGNS AT REGISTRATION AS WELL AS INFORMATION ADDED TO THE FRONT OF THE STATEMENT TO MAKE THOSE UTILIZING SERVICES AWARE. THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 20E: NOTIFIED PATIENTS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION.NOTIFIED PATIENTS OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE. THE SHELBY COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE GROSS AMOUNT AND A DISCOUNT IS APPLIED FOR THOSE THAT QUALIFY. WILSON HEALTH LIMITS THE AMOUNTS CHARGED FOR EMERGENCY AND MEDICALLY NECESSARY SERVICES PROVIDED TO INDIVIDUALS ELIGIBLE FOR ASSISTANCE UNDER THIS POLICY TO NOT MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE FOR SUCH CARE. THE AGB IS DERIVED BY DIVIDING (1) THE SUM OF ALL CLAIMS FOR MEDICALLY NECESSARY SERVICES PROVIDED AT WILSON HEALTH AND PAID DURING THE RELEVANT PERIOD BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYERS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBLES, BY (2) THE CHARGES SET FORTH IN THE WILSON HEALTH CHARGEMASTER AT THE TIME THE SERVICES ARE RENDERED. WILSON HEALTH-SPECIFIC AGB PERCENTAGE SHALL BE CALCULATED ANNUALLY FOR A TWELVE (12) MONTH PERIOD FROM JANUARY 1 TO DECEMBER 31 AND ALLOWS 120 DAYS FOR SUCH CALCULATION TO BE MADE AND UPDATED IN THE FAP. THE CALCULATION OF THE HOSPITAL-SPECIFIC AGB PERCENTAGE SHALL COMPLY WITH THE "LOOK-BACK METHOD" DESCRIBED IN THE IRS REGULATION 501(R)-5(B)(1)(B). THE SHELBY COUNTY MEMORIAL HOSPITAL: SCHEDULE H, PART V, LINE 22:IN FULFILLING WILSON MEMORIAL HOSPITAL'S MISSION, WE RECOGNIZE THAT WE WILL NOT RECEIVE PAYMENT FROM CERTAIN INDIVIDUALS FOR CARE THAT HAS BEEN RENDERED, AND A CERTAIN DEGREE OF JUDGMENT WILL BE REQUIRED IN DETERMINING CHARITY CARE LEVELS OF THE PATIENTS.POLICYWILSON MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT ENTITY ESTABLISHED TO MEET THE HEALTH CARE NEEDS OF ALL CITIZENS OF SIDNEY AND SURROUNDING COMMUNITIES. WILSON MEMORIAL HOSPITAL WILL PROVIDE CHARITABLE CARE FOR THOSE INDIVIDUALS WHO CAN DEMONSTRATE THE INABILITY TO PAY BASED ON THEIR FINANCIAL STATUS AS IT RELATES TO HOSPITAL AND FEDERAL POVERTY LEVEL GUIDELINES.RESPONSIBILITYTHE HOSPITAL HAS A LEGAL AND MORAL OBLIGATION TO PROVIDE EMERGENCY, TRAUMA AND OBSTETRICAL CARE BEFORE DETERMINING THE SOURCE OF PAYMENT.ELIGIBILITY REQUIREMENTSI. ALL WILSON MEMORIAL HOSPITAL PATIENTS WHO ARE UNABLE TO PAY FOR HOSPITAL SERVICES WILL BE ELIGIBLE TO APPLY FOR CHARITY ASSISTANCE.II. CHARITY ASSISTANCE MAY BE APPROVED ON TOTAL OR PARTIAL PATIENT RESPONSIBILITY. DOLLAR AMOUNTS ARE BASED ON FINANCIAL INFORMATION SUPPLIED BY THE PATIENT.III. PATIENTS WILL BE ELIGIBLE FOR TOTAL CHARITY ASSISTANCE IF:A. THE PATIENT IS INELIGIBLE FOR PUBLIC ASSISTANCE (MEDICAID, GENERAL ASSISTANCE, ETC.).B. THE PATIENT COMPLETES A FINANCIAL STATEMENT INDICATING CURRENT EARNINGS, EXPENSES AND PERSONAL/FAMILY INFORMATION. WE WILL ACCEPT THE PATIENT'S DECLARATION OF INCOME.C. THE PATIENTS AND/OR FAMILY INCOME DOES NOT EXCEED 1.25 TIMES THE POVERTY GUIDELINES AS ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.IV. PATIENTS WILL BE ELIGIBLE FOR PARTIAL CHARITY ASSISTANCE IF:A. THE PATIENT IS INELIGIBLE FOR PUBLIC ASSISTANCE (MEDICAID, GENERAL ASSISTANCE, ETC.) EITHER OR PARTIAL COVERAGE.B. THE PATIENT COMPLETES A FINANCIAL STATEMENT INDICATING CURRENT EARNINGS, EXPENSES AND PERSONAL/FAMILY INFORMATION. WE WILL ACCEPT THE PATIENT'S DECLARATION OF INCOME.C. THE PATIENTS AND/OR FAMILY INCOME DOES NOT EXCEED FOUR TIMES THE POVERTY GUIDELINES AS ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.D. THE PATIENT AND/OR FAMILY INCOME EXCEEDS FOUR TIMES THE INCOME POVERTY/GUIDELINES, DETERMINATION OF ELIGIBILITY AND AMOUNT OF CHARITY CARE WILL BE BASED ON FINANCIAL STATEMENT FROM PATIENT ON AN ACCOUNT BY ACCOUNT BASIS.V. PATIENTS MAY NOT BE ELIGIBLE FOR CHARITY CARE ASSISTANCE IF THE PROCEDURE PROVIDED IS ELECTIVE. EACH INSTANCE WILL BE REVIEWED ON A CASE BY CASE BASIS WITH MEDICAL STAFF AND MANAGEMENT INPUT. THE SHELBY COUNTY MEMORIAL HOSPITAL: SCHEDULE H, PART V, LINE 16A: HTTPS://WWW.WILSONHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16B: HTTPS://WWW.WILSONHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCESCHEDULE H, PART V, LINE 16C: HTTPS://WWW.WILSONHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE 12 1 - WILSON HOME HEALTH AND HOSPICE 1081 FAIRINGTON STREET SIDNEY OH 45365 HOME HEALTH 2 - WILSON HEALTH MEDICAL GROUP 823 MICHIGAN STREET SIDNEY OH 45365 FAMILY MEDICINE 3 - WILSON HEALTH MEDICAL GROUP 1205 FAIRINGTON DRIVE SIDNEY OH 45365 FAMILY MEDICINE 4 - WILSON HEALTH MEDICAL GROUP 750 FOURTH AVENUE SIDNEY OH 45365 FAMILY MEDICINE 5 - WILSON HEALTH MEDICAL GROUP 661 VANDEMARK ROAD SIDNEY OH 45365 INTERNAL MEDICINE 6 - WILSON HEALTH MEDICAL GROUP 104 DIAMOND DRIVE ANNA OH 45302 FAMILY MEDICINE 7 - WILSON HEALTH MEDICAL GROUP 111 EAST LYNN STREET BOTKINS OH 45306 FAMILY MEDICINE 8 - WILSON HEALTH MEDICAL GROUP 11531 STATE ROUTE 66 FT LORAMIE OH 45845 FAMILY MEDICINE 9 - WILSON HEALTH MEDICAL GROUP 602 W PIKE STREET JACKSON CENTER OH 45334 FAMILY MEDICINE 10 - WILSON HEALTH MEDICAL GROUP 326 N MAIN STREET EAGLE PLAZA STE 300 MINSTER OH 45865 FAMILY MEDICINE 11 - WILSON HEALTH MEDICAL GROUP 1255 E ASH STREET PIQUA OH 45356 FAMILY MEDICINE, OBGYN, INTERNAL MEDICINE 12 - WILSON HEALTH MEDICAL GROUP 1930 PRIME COURT STE 105 TROY OH 45373 OBSTETRICS & GYNECOLOGY PART I, LINE 3C: IN ADDITION TO THE FPG, THE ORGANIZATION CONSIDERS MEDICAL INDIGENCY WHEN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY. PART I, LINE 7: THE SHELBY COUNTY MEMORIAL HOSPITAL 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. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE HOSPITAL'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 3: THE SHELBY COUNTY MEMORIAL HOSPITAL DOES NOT ATTRIBUTE ANY BAD DEBT EXPENSE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP), THEREFORE NO PORTION OF BAD DEBT ATTRIBUTABLE TO FAP-ELIGIBLE INDIVIDUALS IS CONSIDERED A COMMUNITY BENEFIT." PART III, LINE 4: FOR FOOTNOTE, SEE PAGE 14 OF THE 12/31/24 AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE ELDERLY ARE OFTEN AN UNDERSERVED POPULATION THAT EXPERIENCE ISSUES REGARDING ACCESS TO HEALTHCARE SERVICES. MEDICARE IS OUR LARGEST PAYER, AND HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY HAVE A SURPLUS OR DEFICIT FROM PROVIDING THESE SERVICES. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A COMMUNITY BENEFIT. IF TAX EXEMPT HOSPITALS DID NOT PROVIDE MEDICARE SERVICES, THE FEDERAL GOVERNMENT WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE MEDICARE ELIGIBLE. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 12/31/24 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: IN ORDER FOR THE HOSPITAL TO CONTINUE OPERATING EFFICIENTLY, THE FOLLOWING COLLECTION POLICY HAS BEEN ADOPTED.A. EACH PATIENT/GUARANTOR IS INDIVIDUALLY RESPONSIBLE FOR PAYMENT OF ALL CHARGES UNLESS HIS/HER THIRD-PARTY PAYER HAS A CONTRACT WITH THE HOSPITAL.B. THE HOSPITAL WILL ACCEPT ASSIGNMENT OF HEALTH INSURANCE BENEFITS FOR MEDICARE, MEDICAID, TRICARE, AND OTHERS PER INDIVIDUAL CONTRACT.1. DEDUCTIBLE, CO-INSURANCE, OR NON-COVERED SERVICES ARE PAYABLE AT THE TIME OF SERVICE UNLESS FINANCIAL ARRANGEMENTS HAVE BEEN MADE WITH THE FINANCIAL ADVISOR.2. ANY BALANCE AFTER THE APPLICATION OF HEALTH INSURANCE PAYMENTS TO THE PATIENT'S ACCOUNT IS TO BE PAID WITHIN THIRTY (30) DAYS FOLLOWING NOTIFICATION. IF PAID WITHIN 30 DAYS OF RECEIPT OF FIRST STATEMENT, PATIENT IS ELIGIBLE FOR A 10% DISCOUNT ON THE BALANCE OF THE BILL.3. THE HOSPITAL WILL ACCEPT MASTER CARD, VISA, AND DISCOVER CHARGE CARDS FOR PAYMENTS ON PATIENT ACCOUNTS.4. PAYMENTS OR ARRANGEMENT FOR PAYMENT PLANS ARE TO COMMENCE WITHIN THIRTY (30) DAYS OF BILL DATE. 5. PATIENTS ARE ASKED TO "PAY IN FULL" HOWEVER, IF THE PATIENT/GUARANTOR INDICATES AN INABILITY TO MAKE PAYMENT IN FULL, THE PATIENT/GUARANTOR WILL BE GIVEN THE OPTION TO ESTABLISH A CONTRACT ACCOUNT WITH WILSON MEMORIAL HOSPITAL.A MONTHLY CONTRACT ACCOUNT CAN BE ESTABLISHED. THE MONTHLY AGREEMENT MUST BE SET UP SO THAT THE ENTIRE AMOUNT WILL BE PAID OFF IN TWELVE MONTHS, UNLESS OTHERWISE APPROVED BY DIRECTOR OF PATIENT FINANCIAL SERVICES. NO MONTHLY PAYMENT WILL BE LESS THAN $25.00.IF THE PATIENT OR ANY FAMILY MEMBER OF THE RESPONSIBLE PARTY OR GUARANTOR'S FAMILY IS CURRENTLY PAYING ON A BILL AND HAS NEED OF THE HOSPITAL'S SERVICES AGAIN, THE PAYMENT MUST THEN BE ADJUSTED UPWARDS TO REFLECT THE NEXT BALANCE DUE.WILSON MEMORIAL HOSPITAL EMPLOYEES, ALONG WITH THEIR SPOUSE AND CHILDREN UNDER THE AGE OF EIGHTEEN, WHO INDICATE DIFFICULTY IN MEETING PAYMENT OBLIGATIONS ON THEIR ACCOUNT ARE GIVEN THE OPTION TO MAKE MONTHLY PAYMENTS, OR HAVE PAYMENTS DEDUCTED FROM THEIR PAY CHECK. (PAYROLL DEDUCTION PROGRAM).PAYMENT ON THE ACCOUNTS NOT RECEIVED ACCORDING TO THE ABOVE PROVISION WILL BE SUBJECT TO BECOMING A "DELINQUENT ACCOUNT". ACTIONS TAKEN BY THE HOSPITAL TOWARD SUCH ACCOUNTS WILL BE AT THE HOSPITAL'S DISCRETION.THE HOSPITAL RETAINS THE RIGHT TO REFER THE PATIENT'S DELINQUENT ACCOUNTS TO A PROFESSIONAL COLLECTION AGENCY.THE FIRST STATEMENT A PATIENT RECEIVES WILL BE SENT OUT BY WILSON HOSPITAL. IF WITHIN 30 DAYS THERE HAS BEEN NO PAYMENT ON THE ACCOUNT, IT WILL BE SENT TO OUR EARLY OUT PROGRAM. THEY WILL ACT AS A WILSON MEMORIAL FINANCIAL ADVISOR AND RECEIVE A PERCENTAGE OF THE ACCOUNT IF ANY PAYMENT IS MADE TO THEM. IF THE EARLY OUT AGENCY CANNOT COLLECT ON THE ACCOUNTS, THEY ARE SENT BACK TO THE HOSPITAL TO BE SENT TO COLLECTION AGENCIES.DIRECTOR OF PATIENT FINANCIAL SERVICES MUST APPROVE ALL ACCOUNTS SENT TO THE COLLECTION AGENCY AND MUST APPROVE ANY LEGAL ACTION THAT IS SUGGESTED BY THE COLLECTION AGENCY.WILSON MEMORIAL HOSPITAL IS REQUIRED BY LAW TO GIVE "FREE CARE" TO THOSE PERSONS WHO ARE ELIGIBLE BASED ON STATE STATUTES. WILSON MEMORIAL HOSPITAL HAS A CHARITY CARE POLICY FOR THOSE ELIGIBLE WHO CANNOT AFFORD TO PAY FOR CARE. THE CURRENT FEDERAL POVERTY INCOME GUIDELINES WILL BE USED TO DETERMINE ELIGIBILITY OF THE PATIENT.ANY HOSPITAL SERVICES RESULTING FROM AN ACCIDENT OR OTHER CAUSES INVOLVING A DISPUTE AS TO LIABILITY BETWEEN THE PATIENT AND OTHERS, DOES NOT INVOLVE THE HOSPITAL. THE HOSPITAL WILL EXPECT PAYMENT IN THE SAME MANNER AS ALL OTHER SERVICES. THE HOSPITAL WILL ACCEPT A LETTER OF PROTECTION FOR A DURATION OF 90 DAYS. AFTER 90 DAYS THE HOSPITAL WILL ACTIVELY PURSUE THE PATIENT OR GUARANTOR FOR PAYMENT OF RENDERED SERVICES.EXCEPTIONS TO THE ABOVE ITEMS CAN BE MADE WITH THE APPROVAL OF THE DIRECTOR OF PATIENT FINANCIAL SERVICES. ALL UNUSUAL ARRANGEMENTS AND CIRCUMSTANCES ARE REVIEWED AND APPROVED BY THE VICE PRESIDENT OF FINANCE. PART VI, LINE 2: THE ANNUAL STRATEGIC PLANNING PROCESS UTILIZES MARKET DATA WHICH SHOWS SERVICES THAT SHELBY COUNTY RESIDENTS LEAVE TO OBTAIN ELSEWHERE. INPUT IS PROVIDED BY COMMUNITY MEMBERS WHO SIT ON HOSPITAL BOARD. PART VI, LINE 3: INCOME ELIGIBILITY GUIDELINES ARE CONSPICUOUSLY POSTED AT ALL REGISTRATION POINTS. IN ADDITION, THE GUIDELINES ARE PRINTED ON PATIENT STATEMENTS AND BILLS. THE HOSPITAL EMPLOYS FINANCIAL COUNSELORS WHO MEET PERSONALLY AND BY PHONE WITH PATIENTS TO ASSIST THEM IN COMPLETING FORMS TO DETERMINE THE EXTENT OF THEIR ELIGIBILITY FOR ANY FINANCIAL ASSISTANCE. PART VI, LINE 4: THE PRIMARY SERVICE AREA IS SHELBY AND SURROUNDING COUNTIES. WITH THE EXCEPTION OF MIAMI COUNTY TO THE SOUTH, ALL OF THE SERVICE AREA IS CONSIDERED RURAL. SHELBY COUNTY IS A RURAL NON-APPALACHIAN COUNTY WITH A POPULATION OF 47,671. SHELBY COUNTY HAD APPROXIMATELY 115.9 RESIDENTS PER SQUARE MILE. 23.9% OF THE POPULATION IS BELOW THE AGE OF 18, AND 19.8% OF THE POPULATION IS 65 AND OLDER. THE PERCENTAGE OF CHILDREN IN POVERTY IS 16%. THE POPULATION IS MADE UP OF 92.2% WHITE, 1.8% AFRICAN AMERICAN, 0.6% AMERICAN INDIAN OR ALASKA NATIVE, 1.1% OTHER RACE AND 1.7% HISPANIC INDIVIDUALS. PART VI, LINE 5: THE SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION'S BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS FROM OUR COMMUNITY. THE MAJORITY OF OUR BOARD MEMBERS LIVE AND WORK WITHIN THE COMMUNITY AND ARE ACTIVELY INVOLVED WITH OTHER NON-PROFIT AGENCIES. THE MAJORITY OF OUR SENIOR MANAGERS AND STAFF ALSO LIVE IN OUR PRIMARY SERVICE AREA AND MANY SIT ON OTHER COMMUNITY BASED GOVERNANCE BOARDS. THE "SPIRIT" OF COMMUNITY BASED HEALTHCARE RESIDES IN OUR BOARD OF TRUSTEES AND HOSPITAL STAFF AND IS FURTHER EVIDENCED BY OUR OPEN MEDICAL STAFF. X X X 0 0 0 0 0 0 0 0 0 MICHAEL J VIETTI PHYSICIAN 486422 0 186457 0 8364 0 15525 0 36896 0 733664 0 0 0 MARK KLOSTERMAN CEO 460242 0 147850 0 13793 0 20100 0 34820 0 676805 0 0 0 ANDREW DAVID MCDONALD PHYSICIAN 443159 0 58045 0 41267 0 15525 0 36196 0 594192 0 0 0 DANIEL JOHN DILWORTH PHYSICIAN 461400 0 32100 0 8945 0 15525 0 33902 0 551872 0 0 0 ROSEMARY MCCARTHY PHYSICIAN 287964 0 164127 0 41194 0 13545 0 31552 0 538382 0 0 0 JULIE COVAULT COO 360320 0 75450 0 22785 0 20700 0 33715 0 512970 0 0 0 KRISTI L PEDLER PHYSICIAN 280000 0 198355 0 15778 0 12645 0 2492 0 509270 0 0 0 DR MATTHEW VASKO TRUSTEE 250733 0 47239 0 37250 0 13514 0 35152 0 383888 0 0 0 DR ERIC PRENGER TRUSTEE 208096 0 84732 0 7555 0 10090 0 34976 0 345449 0 0 0 MELISSA TALLMADGE CHIEF NURSING OFFICER 185467 0 0 0 206 0 1881 0 3031 0 190585 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WILL BE REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD, EITHER THROUGH THE ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY GOVERNING BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS PERSONAL INFLUENCE ON THE MATTER, AND THE PERSON SHALL NOT BE COUNTED IN DETERMINING THE QUORUM OF THE MEETING. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. FORM 990, PART VI, SECTION B, LINE 15 FOR DETERMINING COMPENSATION FOR THE CEO, THE HR COMMITTEE OF THE BOARD CONDUCTS AN ANNUAL EVALUATION PROCESS INVOLVING INPUT FROM BOARD MEMBER, SENIOR MANAGERS AND MEDICAL STAFF. COMPENSATION IS BENCHMARKED WITH SURVEYS FROM LIKE SIZED HEALTHCARE ORGANIZATIONS. THE BOARD OF TRUSTEES APPROVES THE CEO COMPENSATION PACKAGE ANNUALLY. FOR DETERMINING COPMENSATION FOR OTHER OFFICERS OR KEY EMPLOYEES, THE HOSPITAL USES BENCHMARK COMPENSATION DATA IN ADDITION TO CONSULTING WITH THE EXECUTIVE RECRUITER/RECRUITING FIRM. WHILE THE HR DEPARTMENT PARTICIPATES AND HELPS COORDINATE EFFORTS FOR EXECUTIVE LEADERSHIP RECRUITING, THIS PROCESS IS OUTSOURCED TO AN EXECUTIVE RECRUITING FIRM, AND THE HOSPITAL COLLABORATES WITH THIS FIRM ON COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 22,365,226. MANAGEMENT AND GENERAL EXPENSES 5,310,336. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,675,562. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,936,698. MANAGEMENT AND GENERAL EXPENSES 1,884,467. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,821,165. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATE -113,086. FORM 990, PART XII, LINE 2C: THE COMMITTEE THAT ASSUMES RESPONSIBLITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE CURRENT TAX YEAR. WILSON CARE LLC 915 W MICHIGAN STREET SIDNEY OH 45365 341734715 PHYSICIAN OFFICES OH 17248441 2486045 WILSON MEMORIAL HOSPITAL WILSON MEMORIAL HOSPITAL FOUNDATION 915 WEST MICHIGAN STREET SIDNEY OH 45365 521771615 SUPPORTING HOSPITAL ACTIVITIES OH 501(C)(3) LINE 12A, I N/A 1 WILSON SLEEP LLC 915 WEST MICHIGAN STREET SIDNEY OH 45365 202272183 SLEEP LAB STUDIES OH SHELBY COUNTY MEMORIAL HOSPITAL RELATED 167170 64370 0 0 0.60000 VALLEY REGIONAL SURGERY CENTER 915 WEST MICHIGAN STREET SIDNEY OH 45365 621621627 SURGICAL SERVICES OH SHELBY COUNTY MEMORIAL HOSPITAL RELATED 13545 304806 0 0 0.51000 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1 1 VALLEY REGIONAL SURGERY CENTER J 142233 BOOK VALUE WILSON MEMORIAL HOSPITAL FOUNDATION R 113086 BOOK VALUE WILSON MEMORIAL HOSPITAL FOUNDATION C 354718 BOOK VALUE WILSON SLEEP LLC A 24895 BOOK VALUE WILSON SLEEP LLC O 367229 BOOK VALUE WILSON SLEEP LLC Q 50945 BOOK VALUE