2023-10-27T09:55:04-05:00 2022-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2022-01-01 341407259 MARY RUTAN HOSPITAL MARY 9375924015 205 PALMER AVE BELLEFONTAINE OH 43311 THOMAS DENBOW VP OF FINANCE 9375924015 2023-10-26 1 THOMAS DENBOW 999009999 0 AMY CIMINELLO P00796388 6148493000 2023-10-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHAD ROSS 205 PALMER AVE BELLEFONTAINE OH 43311 172969504 0 X WWW.MARYRUTAN.ORG X 1919 OH SEE SCHEDULE O 14 13 915 85 0 0 2784073 564973 125751368 120391908 4997669 3033802 0 0 133533110 123990683 0 0 0 0 77651922 81852650 0 0 0 50357180 48750952 128009102 130603602 5524008 -6612919 173968937 153810343 40822972 38755076 133145965 115055267 X TO CREATE PHILANTHROPIC RELATIONSHIPS TO SUPPORT PATIENT CARE SERVICES, MEDICAL SCHOLARSHIPS, MEDICAL EQUIPMENT, AND CAPITAL DEVELOPMENT WHILE PROMOTING HEALTH AND WELLNESS THROUGH EDUCATIONAL PROGRAMS AND SERVICES TO THE COMMUNITY IN WHICH WE SERVE. 0 0 4627751 0 24030174 EMERGENCY DEPARTMENT - THE HOSPITAL MAINTAINS AN EMERGENCY DEPARTMENT, WHICH IS AVAILABLE TO THE PUBLIC REGARDLESS OF THEIR ABILITY TO PAY. IN 2022, 16,558 PATIENTS WERE TREATED. 2845604 0 11480896 PHARMACY - THE PHARMACY DEPARTMENT DISPENSED 228,449 MEDICATIONS TO PATIENTS. 5292996 0 56352282 OPERATING ROOM - THE HOSPITAL PERFORMED APPROXIMATELY 2,703 SURGERIES IN 2022. 103264452 0 28528556 MARY RUTAN HOSPITAL OPERATES A NONPROFIT HOSPITAL IN BELLEFONTAINE, OHIO. THE HOSPITAL PROVIDES MEDICALLY NECESSARY SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. IN ASSESSING A PATIENT'S ABILITY TO PAY, THE HOSPITAL USES GENERALLY RECOGNIZED POVERTY INCOME LEVELS OF THE COMMUNITY IT SERVES. IN 2022, MARY RUTAN HOSPITAL PROVIDED $570K IN CHARITY CARE. IN ADDITION, THE HOSPITAL PROVIDES MANY SERVICES AND PROGRAMS THAT BENEFIT ITS PATIENTS AND COMMUNITY MEMBERS. THESE SERVICES INCLUDE PASTORAL CARE, COMMUNITY HEALTH SCREENINGS, HEALTH FAIRS, HEALTH EDUCATION PROGRAMS AND PUBLICATIONS. 103264452 0 28528556 116030803 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 112 0 1 915 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 X THOMAS DENBOW 9375924015 205 PALMER AVE BELLEFONTAINE OH 43311 X SCOTT SHELLHAAS CHAIR (JAN-APR) / BOARD MEMBER (MAY-DEC) 1.50 0.75 X X 0 0 0 JOAN HAUSHALTER VICE CHAIR (JAN-APR) / CHAIR (MAY-DEC) 1.25 2.25 X X 0 0 0 RICK HATCHER BOARD MEMBER 0.75 0.75 X 0 0 0 SCOTT ABRAHAM BOARD MEMBER 0.75 0.75 X 0 0 0 PAUL BENEDETTI BOARD MEMBER 0.75 0.75 X 0 0 0 DOUG CHAMBERLAIN BOARD MEMBER 0.75 1.50 X 0 0 0 RICK GILDOW BOARD MEMBER (JAN-APR) / VICE CHAIR (MAY-DEC) 0.75 0.75 X 0 0 0 JEFF HOLYCROSS BOARD MEMBER 0.75 0.75 X 0 0 0 NANCY KNIGHT BOARD MEMBER 0.75 1.75 X 0 0 0 DARIN OLSON BOARD MEMBER 0.75 0.75 X 0 0 0 JOENEE PURCELL BOARD MEMBER 0.75 1.50 X 0 0 0 JACK RESER BOARD MEMBER 0.75 0.75 X 0 0 0 DR MATT VERBSKY BOARD MEMBER 0.75 0.75 X 0 0 0 THOMAS SIMON BOARD MEMBER 1.25 1.00 X 0 0 0 CHAD ROSS PRESIDENT 44.50 1.50 X 0 400395 113992 STEVEN BROWN VICE PRESIDENT/CFO 44.50 1.50 X 0 307954 78025 TAMARA GUMP COO (LOGAN VIEW INC) 0.00 40.00 X 0 155001 46752 WENDY RODENBERGER VICE PRESIDENT 40.00 0.00 X 200666 0 59797 ROGER AMIGO PHYSICIAN 40.00 0.00 X 607197 0 54498 NICHOLAS PETERS PHYSICIAN 40.00 0.00 X 553106 0 35426 CLIFTON HOOD MEDICAL STAFF DIRECTOR 40.00 0.00 X 487280 0 44733 KIMBERLY KLAPCHAR PHYSICIAN 40.00 0.00 X 453399 0 33705 GREGG FULMER PHYSICIAN 40.00 0.00 X 433429 0 52124 2735077 863350 519052 100 0 1 0 NORTHWEST THERAPY SERVICE 2200 TIMBER TRAIL BELLEFONTAINE OH 43311 PHYSICAL THERAPY SERVICE 4024680 CARDIO SOLUTIONS 4675 CORNELL RD CINCINNATI OH 45241 CONTRACT CARDIO NURSING 3402919 TRUSTAFF TRAVEL NURSES PO BOX 63-8231 CINCINNATI OH 45263 CONTRACT NURSING 1723737 MIDOHIO REHABILITATION SPECIALIST LLC 515 HUNTERS RUN BLUFFTON OH 45817 OCCUPATIONAL THERAPY SERVICE 1165211 CLOUDWAVE 100 CROWLEY DR MARLBOROUGH OH 01752 IT SERVICES 747782 24 564973 564973 PATIENT SERVICES 621110 102503796 102503796 PHARMACY 621110 2589221 2589221 PEDIATRICS CLINIC 621110 2000723 2000723 OB/GYN CLINIC 621110 1685461 1685461 ANESTHESIA 621110 1305638 1305638 10307069 10307069 120391908 1308206 1308206 50704417 48861939 116882 1842478 -116882 1725596 1725596 123990683 120391908 0 3033802 X 2065691 1797249 268442 62648649 53771933 8876716 2897079 2425513 471566 10956795 10450542 506253 3284436 2770429 514007 295534 295534 157000 157000 13629677 12983421 646256 64465 61409 3056 1059309 691541 367768 1687038 1581280 105758 152401 145175 7226 507132 507132 5695479 4211088 1484391 2041112 1944332 96780 MEDICAL SUPPLIES 16300258 15539986 760272 BAD DEBT EXPENSE 3494864 3494864 OHIO HOSPITAL FRANCHISE 2957775 2957775 HCAP FUNDING EXP 421867 421867 287041 275267 11774 130603602 116030803 14572799 0 4460 4610 21445928 10364922 13948692 13944410 1103601 1111575 9292218 10003079 125042352 61364239 55578712 63678113 72513283 54509453 82043 194181 173968937 153810343 18117846 15320824 14813658 13753152 7891468 9681100 40822972 38755076 X 133145965 115055267 133145965 115055267 173968937 153810343 X -6612919 -13057609 1579830 X X 0 1 X 1 1 1 X 1 9152 9152 0 PART II-B, LINE 1: 5.5% PERCENT OF DUES TO THE OHIO HOSPITAL ASSOCIATION AND 27.29% OF THE AMERICAN HOSPITAL ASSOCIATION DUES WERE ALLOCATED TO LOBBYING ACTIVITIES BY THAT ORGANIZATION. 5322402 5322402 54542273 17382878 37159395 4083685 1125127 2958558 57092813 40661961 16430852 4001179 2194273 1806906 63678113 UNPAID INSURANCE CLAIMS 2484316 COST REPORT SETTLEMENT PAYABLE 428105 FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 13984 INTERCOMPANY PAYABLE 517524 LEASE LIABILITIES 1641570 INSURANCE PLAN PAYABLE 4595601 9681100 X 107714525 -13057609 -3218549 -16276158 123990683 0 123990683 127108738 0 127108738 3494864 3494864 130603602 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE -3,494,864. CHANGE IN FMV OF INTEREST RATE SWAP AGREEMENT 276,315. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF BAD DEBT EXPENSE 3,494,864. 1 1 X 1 X 125.000000000000 1 X 1 1 0 1 1 1826429 3113118 0 0.00000 20297094 10630634 9666460 0.07600 22123523 13743752 9666460 0.07600 15 110488 470420 0 470420 0.00370 3 11 86851 0 86851 0.00070 1 247 242190 0 242190 0.00190 4 8905 289779 0 289779 0.00230 23 119651 1089240 1089240 0.00860 23 119651 23212763 13743752 10755700 0.08460 1 1000 2019 2019 0.00000 1 50 13574 13574 0.00010 1 2588 50951 50951 0.00040 1 210 210 0.00000 1 102 3866 3866 0.00000 1 3002 5809 5809 0.00000 1 2607 2607 0.00000 1 1087 1087 0.00000 8 6742 80123 80123 0.00050 0 3494864 24446 13930318 20019778 -6089460 X 1 1 1 1 MARY RUTAN HOSPITAL 205 PALMER AVE BELLEFONTAINE OH 43311 X X X MARY RUTAN HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 0 1 1 X HTTP://WWW.MARYRUTAN.ORG/NEEDS-ASSESSMENT.ASPX X WWW.LOGANHEALTH.ORG X X 1 21 1 HTTPS://FOUNDATION.MARYRUTAN.ORG/NEEDS-ASSESSMENT/ 0 1 X 125.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.MARYRUTAN.ORG/PATIENTS-AND-VISITORS/BILLING-INFORMATION/FINANCI X HTTPS://WWW.MARYRUTAN.ORG/PATIENTS-AND-VISITORS/BILLING-INFORMATION/FINANCI X HTTPS://WWW.MARYRUTAN.ORG/PATIENTS-AND-VISITORS/BILLING-INFORMATION/FINANCI X X X X X 1 X 0 X X X X 1 X 0 1 MARY RUTAN HOSPITAL PART V, SECTION B, LINE 5: MARY RUTAN HOSPITAL WAS A LEAD ORGANIZATION IN FACILITING AND FUNDING THE COMMUNITIES' FOURTH FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT IN 2020; PARTNERING WITH THE LOGAN COUNTY HEALTH DISTRICT, MENTAL HEALTH DRUG AND ALCOHOL BOARD OF LOGAN AND CHAMPAIGN COUNTIES, THE UNITED WAY OF LOGAN COUNTY AND COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY. THIS COLLABORATION ALLOWED COMMUITY PARTNERS TO COME TOGETHETR IN A UNIFIED FRONT TO CREATE A COMPREHENSIVE ASSESSMENT AND PLAN TO ASSIST ALL AGENCIES AND ORGANIZATIONS TO IMPACT THE HEALTH, SAFETY AND WELL-BEING OF THE COMMUNITY AND RESIDENTS OF LOGAN COUNTY.A RANDOM SURVEY WAS COMPLETED VIA A PAPER AND ELECTRONIC SURVEY DOCUMENT TO NUMEROUS RESIDENTS OF LOGAN COUNTY TO GATHER INFORMATION ABOUT HEALTHCARE, QUALITY OF LIFE, WELLNESS, ENVIRONMENT, SAFETY, PARENTING, AND SOCIAL DEMOGRAPHICS. 554 LOGAN COUNTY RESIDENTS RESPONDED TO THE ANONYMOUS SURVEY. IN ADDITION, THREE COMMUNITY FOCUS GROUPS TARGETED AT THE LOW RESPONSE POPULATIONS OF YOUNG ADULT, BLACK AND HISPANIC COMMUNITIES WERE HELD TO DISCUSS NEEDS, ACCESS TO AVAILABLE HEALTH CARE PROGRAMS, AND PRIORITIES. ALSO, ONE ON ONE INTERVIEWS WITH 12 KEY INFORMANTS IN THE COMMUNITY AS WELL AS THE GATHERING OF NUMEROUS SECONDARY DATA SOURCES TO FURTHER VALIDATE AND IDENTIFY AREAS OF CONCERN AND NEED WERE A PART OF THIS COMPREHENSIVE NEEDS ASSESSMENT PROCESS. HEALTH AND HUMAN SERVICE PROVIDERS AND PROFESSIONALS FROM ACROSS THE COUNTY CAME TOGETHER FOR THE PURPOSE OF THIS SURVEY. THESE COMMUNITY PARTNERS INCLUDED PROFESSIONALS IN THE AREAS OF HOSPITAL ADMINISTRATION, PUBLIC HEALTH, MENTAL HEALTH, FQHC, HEALTH AND HUMAN SERVICES, INDUSTRY, COUNSELING, EDUCATION, CHILDREN'S DEVELOPMENT, AGING, LAW ENFORCEMENT, AND LOCAL GOVERNMENT. MARY RUTAN HOSPITAL AND EACH PARTICIPATING ORGANIZATION WILL UTILIZE THIS INFORMATION ACCORDING TO COMMUNITY NEEDS AND THEIR OWN UNIQUE STRENGTHS. EFFORTS ARE BEING COORDINATED ACROSS THE COUNTY TO HELP ENSURE ADEQUATE AVAILABILITY OF NEEDED SERVICES AND EFFORTS TO IMPROVE AT RISK FINDINGS. FIVE ACTIVE COALITIONS ARE WORKING COLLABORATIVELY TO ADDRESS THESE ISSUES. THOSE COALITIONS INCLUDE: HEALTHY LIVING COALITION, COALITION FOR ONGOING RECOVERY EFFORTS, MENTAL HEALTH & SUICIDE COALITION, HOUSING AND HOMELESSNESS COALTION, WORKFORCE DEVELOPMENT COMMITTEE AND THE LOGAN COUNTY COALITION ADVISORY BOARD THAT PROVIDES OVERSIGHT AND DIRECTION FOR THE COALITIONS. THE COMPLETE ACTION PLAN, INCLUDING NEEDS IDENTIFIED, STRATEGIES FOR ADDRESSING THOSE NEEDS, ACTIVITIES UNDERTAKEN, AND MEASUREMENT OF OUTCOMES, CAN BE VIEWED AND/OR DOWNLOADED FROM THE HOSPITAL WEBSITE AT WWW.MARYRUTAN.ORG. THESE SAME COMMUNITY PARTNERS CAME TOGETHER FOR THE CREATION, FACILITATION, AND IMPLEMENTATION OF THE CURRENT YEAR NEEDS ASSESSMENT. IN ADDITION, A COMMUNITY CALL TO ACTION MEETING WAS HELD ON FEBRUARY 9, 2021, WHERE 56 COMMUNITY MEMBERS CAME TOGETHER VIRTUALLY TO REVIEW AND PRIORITIZE AREAS OF RISK AND NEED. MARY RUTAN HOSPITAL PART V, SECTION B, LINE 6B: MARY RUTAN FOUNDATION, LOGAN COUNTY HEALTH DISTRICT, UNITED WAY OF LOGAN COUNTY, MENTAL HEALTH, DRUG AND ALCOHOL SERVICES BOARD OF LOGAN AND CHAMPAIGN COUNTIES, COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY ACTED AS THE LEAD ORGANIZATION AND FUNDING PARTNERS FOR THE ASSESSMENT. OTHERS INVOLVED IN THE PROCESS INCLUDE: LOGAN COUNTY CHILDREN'S SERVICES, LOGAN COUNTY BOARD OF DEVELOPMENTAL DISABILIITIES, LOGAN COUNTY COMMISSIONERS, LOGAN COUNTY FAMILY COURT, LOGAN COUNTY JOB & FAMILY SERVICES, LOGAN COUNTY SHERIFF'S DEPARTMENT, BELLEFONTAINE CITY POLICE DEPARMENT, AREA EMS, COUNCIL OF RUAL SERVICES, LOGAN COUNTY EDUCATIONAL SERVICES CENTER, INDIAN LAKE LOCAL SCHOOLS AND THE LOGAN COUNTY FAITH COALITION. MARY RUTAN HOSPITAL PART V, SECTION B, LINE 7D: AREA MEDIA COMMUNICATION IN PRINT AND RADIO, ELECTRONIC COMMUNICATION AND SOCIAL MEDIA. MARY RUTAN HOSPITAL PART V, SECTION B, LINE 11: AN INTERNAL WORKGROUP REVIEWED THE FINDINGS OF THE 2020 LOGAN COUNTY CHNA AND STATE OF OHIO HEALTH IMPROVEMENT PLAN(SHIP) AND SELECTED THE PRIORITY AREAS OF MENTAL HEALTH, SUBSTANCE ABUSE, OBESITY & CHRONIC DISEASE. AS A PART OF THE CREATION OF THE HEALTH IMPROVEMENT PLAN THE GROUP IDENTIFIED PRIORITY HEALTH OUTCOMES AND PRIORITY FACTORS ALIGNING WITH LOGAN COUNTY AND THE OHIO DEPARTMENT OF HEALTH AND WHENEVER POSSIBLE. WHERE GREATER NEEDS WERE IDENTIFIED- PRIORITY POPULATIONS FOR OBJECTIVES AND SELECT STRATEGIES LIKELY TO REDUCE DISPARITIES AND INEQUITIES WERE INCLUDED. A COPY CAN BE ACCESSED AT WWW.MARYRUTAN.ORG. TWO NEEDS WERE IDENDTIFIED BY THE 2020 COMMUNITY HEALTH RISK AND NEEDS ASSESSMENT, BUT WERE NOT ADDRESSED BY THE MRH HEALTH IMPROVEMENT PLAN AT THIS TIME: WORKFORCE DEVELOPMENT AND HOUSING AND HOMELESSNESS. WHILE WE WILL FOCUS THE MAJORITY OF OUR EFFORTS ON THE IDENTIFIED HEALTH NEEDS, WE WILL SUPPORT COMMUNITY EFFORTS IN THESE AREAS THROUGH PARTICIPATION AND FINANCIAL SUPPORT TO THE LOGAN COUNTY CHAMBER OF COMMERCE, WORKFORCE DEVELOPMENT COMMITTEE AND THE HOUSING AND HOMELESSNESS COALITION. THESE TOPICS ARE NOT ADDRESSED IN MARY RUTAN HOSPITAL'S PLAN OF ACTION DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE PRIORITY HEALTH NEEDS SPECIFICALLY IDENTIFIED. MARY RUTAN HOSPITAL PART V, SECTION B, LINE 13H: MARY RUTAN ALSO HAS A CATASTROPHIC CHARITY POLICY IN PLACE FOR PATIENTS WHO DO NOT QUALIFY FOR OTHER PROGRAMS, WHO HAVE AN ACCUMULATED BALANCE ABOVE $50,000, AND WHOSE INCOME IN BETWEEN 200 AND 400% OF THE FPL. THIS IS A PARTIAL DISCOUNT DEPENDENT UPON % OF FPL, RANGING FROM 50% DISCOUNT TO 90% DISCOUNT. MARY RUTAN HOSPITAL PART V, SECTION B, LINE 15E: PATIENTS CAN COMPLETE A DIGITAL VERSION OF THE FAP APPLICATION ONLINE, WHICH IS IDENTICAL TO THE PAPER FORM AND USED FOR PROCESSING, THOUGH THEY STILL WOULD ULTIMATELY HAVE TO SIGN OFF ON A PRINTED COPY. MARY RUTAN HOSPITAL PART V, SECTION B, LINE 24: AS STATED IN THE FAP, THE FAP APPLIES TO ONLY SERVICES THAT ARE URGENT AND MEDICALLY NECESSARY. NON-FAP ELIGIBLE PATIENTS RECEIVING MEDICALLY NECESSARY SERVICES, SUCH AS OUT OF STATE PATIENTS, RECEIVE AT LEAST A NOMINAL DISCOUNT FROM CHARGE. ELECTIVE SERVICES ARE EXCLUDED FROM THE FAP AS THOSE ARE NOT DEEMED URGENT OR MEDICALLY NECESSARY. RETAIL SERVICES, SUCH AS OUR DIRECT ACCESS LAB, ARE EXEMPT FROM OUR ASSISTANCE PROGRAM AS THEY ARE CONSIDERED NEITHER URGENT NOR MEDICALLY NECESSARY BY THE NATURE OF THEIR RETAIL STATUS (RETAIL IN THIS CASE MEANING NOT SUBMITTED TO THIRD PARTY PAYERS AND THAT THEY ALLOW PATIENTS TO SELF-ORDER/SELF-REFER). PRICES FOR THESE SERVICES ARE LOW, FIXED (NON-NEGOTIATED WITH PAYERS), AND ARE STANDARDIZED REGARDLESS OF SETTING OR INSURANCE STATUS. AN INDIVIDUAL WHO MIGHT OTHERWISE QUALIFY FOR FAP COULD THEREFORE RECEIVE THESE ELECTIVE SERVICES AND PAY THE GROSS CHARGE AMOUNT DUE TO THE EXCLUSION OF THESE ELECTIVE SERVICES, DESPITE BEING OTHERWISE ELIGIBLE UNDER THE FAP. PART V, SECTION B, LINE 16I THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY WERE NOT TRANSLATED FOR OTHER FOREIGN SPEAKING POPULATIONS BECAUSE NONE OF THE FOREIGN SPEAKING POPULATIONS IN THE COMMUNITY EXCEEDED FIVE PERCENT OF THE COMMUNITY IN WHICH THE MARY RUTAN HOSPITAL SERVES. PART I, LINE 7: THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO REPORT FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID AS COMMUNITY BENEFITS. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE RELATED TO PATIENT CARE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), (BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN) IS $3,494,864. PART II, COMMUNITY BUILDING ACTIVITIES: MARY RUTAN HOSPITAL AND FOUNDATION ARE COMMITTED TO PROVIDING PROFESSIONAL ASSISTANCE TO THE LOGAN COUNTY COMMUNITY THROUGH THE VOLUNTEERING OF TIME AND RESOURCES FOR ECONOMIC DEVELOPMENT TO THE LOGAN COUNTY CHAMBER OF COMMERCE, THE LOGAN COUNTY COMMUNITY IMPROVEMENT CORPORATION, INDIAN LAKE CHAMBER OF COMMERCE AND THE LOGAN COUNTY WORKFORCE DEVELOPMENT AND HOUSING AND HOMELESSNESS COALTIONS. IN ADDITION, ADMINISTRATIVE TEAM MEMBERS VOLUNTEER PROFESSIONAL SERVICES AND RESOURCES TO THE UNITED WAY OF LOGAN COUNTY, LOGAN COUNTY HEALTH DISTRICT, LOGAN COUNTY MENTAL HEALTH BOARD, LOGAN COUNTY COALITION OF ONGOING RECOVERY EFFORTS, LOGAN COUNTY FAMILY AND CHILDREN FIRST COUNCIL, LOGAN COUNTY HEALTHY LIVING COALITION, LOGAN COUNTY TRANSPORTATION ADVISORY GROUP, LOGAN COUNTY SUICIDE COALITION, LOGAN COUNTY COALITION ADVISORY BOARD (CAB), PROMOTING AND ESTABLISHING HEALTH, WELLNESS AND NUTRITIONAL SERVICES FOR THOSE IN NEED IN AND AT-RISK AREAS OF THE COMMUNITY. PART III, LINE 2: BAD DEBT IS PRESENTED AT GROSS CHARGES. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD 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 COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 3: THE ESTIMATE OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS BASED ON AN ESTIMATED PERCENTAGE OF BAD DEBT WRITE OFFS. THE PERCENTAGE IS DERIVED FROM A HISTORICAL REVIEW OF PATIENTS THAT QUALIFIED FOR CHARITY AFTER THEY WERE PLACED IN COLLECTIONS. PART III, LINE 4: BAD DEBT FOOTNOTE: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE 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 IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. ADDITIONAL INFORMATION: THE HOSPITAL GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE COMPOSITION OF NET RECEIVABLES FROM PATIENTS AND THIRD-PARTY PAYORS WAS AS FOLLOWS IN 2022: 18% MEDICARE, 70% COMMERCIAL INSURANCE AND HMOS, 8% MEDICAID, AND 4% SELF-PAY. PART III, LINE 8: MEDICARE COSTS HAVE BEEN PULLED FROM THE 2022 MEDICARE COST REPORT, UTILIZING A COST TO CHARGE RATIO. BASED ON 2022 US CENSUS BUREAU ESTIMATES, 19.1% OF THE LOGAN COUNTY, OHIO POPULATION IS OVER AGE 65. SERVICES PROVIDED TO MEDICARE PATIENTS ACCOUNTED FOR APPROXIMATELY 41.0% OF PATIENT SERVICE REVENUE IN 2022. WE HAVE INCLUDED MEDICARE SHORTFALLS IN OUR 2022 COMMUNITY BENEFIT REPORT. THE ONGOING CARE OF OUR AGING POPULATION CERTAINLY MEETS A SIGNIFICANT NEED OF THE COMMUNITY. EQUIVALENT HOSPITAL-BASED CARE IS NOT AVAILABLE FROM ANY OTHER LOCAL SOURCE. PROVIDING EFFICIENT, COST EFFECTIVE CARE IS ALWAYS A GOAL, BUT SHORTFALLS CAN AND DO OCCUR. THOSE SHORTFALLS ARE ABSORBED BY THE HOSPITAL AND ARE CONSIDERED TO BE A COST OF OUR MISSION TO ACCEPT RESPONSIBILITY FOR MEETING THE HEALTHCARE NEEDS OF OUR COMMUNITY. PART III, LINE 9B: MARY RUTAN HOSPITAL COMPLIES WITH THE FAIR DEBT COLLECTION PRACTICES ACT AT ALL TIMES. A SELF-PAY ACCOUNT IS MANAGED BY A DEDICATED TEAM AT THE TIME PATIENT LIABILITY IS DETERMINED POST-SERVICE. THE TYPICAL PROCESS IS A SERIES OF LETTERS AND PHONE CALLS. THE TIMELINESS AND STEPS ARE OUTLINED IN MARY RUTAN HOSPITAL'S BAD DEBT & COLLECTIONS POLICY (WHICH IS POSTED IN FULL ONLINE FOR PATIENT REVIEW, ALONG WITH A PLAIN LANGUAGE SUMMARY). IF THERE IS NO RESPONSE TO THE TEAM'S STATEMENTS AND CALLS, THEN THE ACCOUNT IS PULLED FOR REVIEW, REVIEWED TO VALIDATE THAT THE BALANCES ARE CORRECT, WRITTEN OFF TO BAD DEBT, AND SENT TO A COLLECTION AGENCY. WHEN A PATIENT HAS INITIATED THE CHARITY APPLICATION PROCESS AND HAS APPLIED FOR ONE OF OUR PROGRAMS, THAT PATIENT REMAINS IN THAT STATUS WITHOUT ANY COLLECTION EFFORTS OF ANY KIND UNTIL FINAL ELIGIBILITY FOR ASSISTANCE CAN BE DETERMINED. APPLICABLE ASSISTANCE/DISCOUNTS ARE APPLIED TO THE ACCOUNT BALANCE IF QUALIFIED. PATIENTS WHO DO NOT QUALIFY ARE NOTIFIED AND NORMAL COLLECTION EFFORTS BEGIN/RESUME AT THAT TIME. PART VI, LINE 2: SECONDARY DATA SOURCES HAVE BEEN IDENITIFIED AND ARE REVIEWED ANNUALLY, ALLOWING MRH AND COMMUNITY COALITIONS TO MONITOR AND ADJUST STRATEGIES IN IDENTIFIED AREAS OF RISK AND NEED AS HIGHLIGHTED IN CHA/CHIP. COLLABORATION WITH LOCAL HUMAN SERVICE ORGANIZATIONS IS KEY IN IDENTIFYING NEEDS ON AN ONGOING BASIS. MARY RUTAN HOSPITAL AND MARY RUTAN FOUNDATION PROGRAMS ARE TARGETED TOWARD SPECIFIC POPULATIONS IN NEED, AS WELL AS DESIGNATED AT-RISK AREAS. GENERAL HEALTH AND WELLNESS PROMOTIONS EDUCATE THE COMMUNITY ABOUT PREVENTATIVE MEASURES AGAINST CHRONIC ILLNESSES. HEALTH AND WELLNESS EDUCATION, AS WELL AS FREE SCREENING, ARE PROVIDED MONTHLY AT SUBSIDIZED SENIOR HOUSING UNITS AND AT FOOD PANTRIES. OTHER EXAMPLES INCLUDE POWER-UP 4 FITNESS, FIELD TO FORK AND BILLY BONES, WHICH ARE PROGRAMS EDUCATING STUDENTS ON THE IMPORTANCE OF EXERCISE AND PROPER NUTRITION IN THE FIGHT AGAINST CHILDHOOD OBESITY. THIS PROGRAM IS DONE IN COLLABORATION WITH ALL AREA SCHOOLS. IN ADDITION, MARY RUTAN HOSPITAL UTILIZES THE ROBERT WOOD JOHNSON FOUNDATION AND THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE COUNTY HEALTH RANKINGS REPORT. MARY RUTAN HOSPITAL FACILITATES CREATING A HEALTHIER ME AND MATTER OF BALANCE COURSES TARGETED FOR THE ADULT POPULATION ADDRESSING PROPER NUTRITION, DIET AND EXERCISE. PARENTING CLASSES WERE IMPLEMENTED IN 2022 TO ADDRESS CONCERNS OF MALTREATMENT OF YOUTH IN LOGAN COUNTY. MARY RUTAN HOSPITAL LEADS OTHER COMMUNITY PARTNERS ON THE HEALTHY LIVING COALITION REVIEWING AT-RISK AREAS IN THE COMMUNITY AND ESTABLISHING EDUCATIONAL PROGRAMS AND RESOURCES TO ADDRESS THOSE NEEDS. MARY RUTAN HOSPITAL ALSO SERVICES AS AN ACTIVE MEMBER OF THE LOGAN COUNTY FAMILY AND CHILDREN FIRST COUNCIL TO PROVIDE ORGANIZATION UPDATES REGARDING ONGOING PROJECTS AND TO DISCUSS AND IDENTIFY COMMUNITY NEEDS. THIS COUNCIL IS COMPRISED OF SENIOR LEADERS OF THE HOSPITAL, HEALTH DEPARTMENT, CHILDREN'S SERVICES, JOB AND FAMILY SERVICES, AND MENTAL HEALTH BOARD AS WELL AS OTHER HEALTH AND HUMAN SERVICE AGENCIES, LAW ENFORCEMENT, AND AREA SCHOOL DISTRICTS. MARY RUTAN HOSPITAL IS ALSO AN ACTIVE MEMBER OF THE LOGAN COUNTY COALITION FOR ONGOING RECOVERY EFFORTS - IMPLEMENTING PROGRAMS AND SERVICES TO COMBAT SUBSTANCE ABUSE ISSUES IN LOGAN COUNTY. IN ADDITION, MARY RUTAN HOSPITAL SENIOR LEADERSHIP SERVES ON THE LOGAN COUNTY COALITION ADVISORY BOARD CREATED TO ASSIST AND BE A RESOURCE FOR AT RISK FINDINGS OF THE NEEDS ASSESSMENT OF OBESITY, CHRONIC DISEASE, DRUG ABUSE, MENTAL HEALTH, ACCESS TO SERVICES, HOUSING AND HOMELESSNESS AND WORKFORCE DEVELOPMENT. PART VI, LINE 3: A VARIETY OF MEANS IS USED TO PROVIDE INFORMATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO ALL PATIENTS. NOTICES ARE POSTED AT ALL POINTS OF REGISTRATION, IN OUR CLINICS, AND IN OUR OFF-SITE BUSINESS OFFICE LOCATION. HANDOUTS AND APPLICATIONS FOR HCAP/CHARITY CARE ARE ALSO AVAILABLE AT REGISTRATION. FINANCIAL ASSISTANCE INFORMATION IS INCLUDED IN PATIENT BILLING BROCHURES, ON THE MARY RUTAN HOSPITAL WEBSITE, ON BILLING STATEMENTS, AND IN A SEPARATE LETTER INCLUDED WITH ALL SELF-PAY ACCOUNT BILLING STATEMENTS. MARY RUTAN HOSPITAL REPRESENTATIVES ALSO ATTEMPT TO EDUCATE PATIENTS PRIOR TO AND CONCURRENT WITH SERVICE ABOUT OUR ASSISTANCE PROGRAMS. PART VI, LINE 4: MARY RUTAN HOSPITAL'S PRIMARY SERVICE AREA IS RURAL LOGAN COUNTY. ALTHOUGH MARY RUTAN HOSPITAL DOES SERVE SOME INDIVIDUALS FROM ADJOINING COUNTIES (INCLUDING HARDIN, CHAMPAIGN, SHELBY AND UNION), INPATIENT VOLUMES EQUAL 24% AND OUTPATIENT SERVICE VOLUMES EQUAL 56% OF LOGAN COUNTY RESDENTS. THE LOGAN COUNTY POPULATION IS APPROXIMATELY 46,040 AND BASED ON 2022 US CENSUS BUREAU ESTIMATES, MEDIAN HOUSEHOLD INCOME IS $64,196. AN ESTIMATED 6.4% OF THE COUNTY POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. PART VI, LINE 5: THE HOSPITAL FAMILY INCLUDES PARENT CORPORATION, MARY RUTAN HEALTH ASSOCIATION, AND SUBSIDIARIES MARY RUTAN HOSPITAL, MARY RUTAN FOUNDATION, LOGAN VIEW, INC., AND LOGAN COUNTY CANCER SOCIETY. THERE IS A COORDINATED EFFORT TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY. DOLLARS ARE BUDGETED ANNUALLY THROUGH MARY RUTAN FOUNDATION TO SUPPORT COMMUNITY HEALTH ACTIVITIES ORGANIZED AND SPONSORED BY MARY RUTAN FOUNDATION. THE GOVERNING BODIES OF EACH CORPORATION ARE MADE UP OF RESIDENTS OF OUR COMMUNITY WHO ARE FAMILIAR WITH THE HEALTH AND WELLNESS ISSUES FACING LOGAN COUNTY AND THE SURROUNDING AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. IN ADDITION, ANNUALLY MARY RUTAN FOUNDATION AWARDS COMMUNITY HEALTH AND WELLNESS GRANTS TO AREA SCHOOLS, SOCIAL SERVICE AND NOT FOR PROFIT ORGANIZATIONS FOCUSED ON THE AREAS OF RISK AND NEED IDENTIFIED IN THE COMMUNITY TO EXPAND OUTREACH EFFORTS PAST THE PROGRAMS AND SERVICES PROVIDED BY THE HOSPITAL AND FOUNDATION. DUE TO LACK OF FUNDING BY AREA SCHOOLS AND INABILITY TO EMPLOYEE ATHLETIC TRAINERS, MARY RUTAN HOSPITAL FUNDS AND PROVIDES ATHLETIC TRAINERS AT EACH AREA HIGH SCHOOL FOR THE HEALTH, WELLBEING AND SAFETY OF AREA STUDENT ATHLETES. PART VI, LINE 6: MARY RUTAN HEALTH ASSOCIATION IS THE PARENT CORPORATION. THE HEALTH ASSOCIATION PROVIDES MANAGEMENT SERVICES TO THE HOSPITAL, FOUNDATION, LOGAN COUNTY CANCER SOCIETY AND LOGAN VIEW, LLC AND PARTICIPATES IN VARIOUS HEALTH FAIRS AND SCREENINGS THROUGHOUT THE COMMUNITY EACH YEAR. MARY RUTAN FOUNDATION'S MISSION IS TO CREATE PHILANTHROPIC RELATIONSHIPS TO SUPPORT PATIENT CARE SERVICES, AWARD MEDICAL SCHOLARSHIPS, PURCHASE NEEDED MEDICAL EQUIPMENT AND DEVELOP CAPITAL, WHILE PROMOTING HEALTH AND WELLNESS THROUGH EDUCATIONAL PROGRAMS AND SERVICES. LOGAN COUNTY CANCER SOCIETY PROVIDES FINANCIAL ASSISTANCE TO RESIDENTS OF LOGAN COUNTY WHO HAVE CANCER OR CANCER RELATED ILLNESSES, WHILE PROMOTING EDUCATION IN AWARENESS AND THE DETECTION AND TREATMENT OF CANCER. OPERATION AND FACILITATION OF ALL SERVICES PROVIDED BY THE LOGAN COUNTY CANCER SOCIETY ARE PROVIDED BY EMPLOYEES OF MARY RUTAN HOSPITAL AND MARY RUTAN HEALTH ASSOCIATION AND NO SALARIES OR BENEFITS ARE CHARGED TO THE ORGANIZATION FOR THIS SERVICE. PART VI, LINE 7 THE OHIO DEPARTMENT OF HEALTH - FILED LOGAN COUNTY CHA AND MARY RUTAN HEALTH IMPROVEMENT PLAN WITH THE STATE ALIGNING WORK WITH STATE PRIORITY AREAS. 0 0 0 0 0 0 0 1 0 ROGER AMIGO PHYSICIAN 536353 0 69554 0 1290 0 18000 0 36498 0 661695 0 0 0 NICHOLAS PETERS PHYSICIAN 524998 0 27808 0 300 0 18000 0 17426 0 588532 0 0 0 CLIFTON HOOD MEDICAL STAFF DIRECTOR 371458 0 112012 0 3810 0 18000 0 26733 0 532013 0 0 0 CHAD ROSS PRESIDENT 0 352675 0 47030 0 690 0 81708 0 32284 0 514387 0 0 KIMBERLY KLAPCHAR PHYSICIAN 374013 0 79146 0 240 0 18000 0 15705 0 487104 0 0 0 GREGG FULMER PHYSICIAN 279870 0 152869 0 690 0 18000 0 34124 0 485553 0 0 0 STEVEN BROWN VICE PRESIDENT/CFO 0 273859 0 32115 0 1980 0 43813 0 34212 0 385979 0 0 WENDY RODENBERGER VICE PRESIDENT 173538 0 26921 0 207 0 25121 0 34676 0 260463 0 0 0 TAMARA GUMP COO (LOGAN VIEW INC) 0 139818 0 13392 0 1791 0 14944 0 31808 0 201753 0 0 PART I, LINE 3 THE RELATED ORGANIZATION, MARY RUTAN HEALTH ASSOCIATION, DETERMINES EXECUTIVE COMPENSATION BASED ON USE OF A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINE 7 ADDITIONAL NON-FIXED PAYMENTS TO PHYSICIANS ARE AWARDED BY THE COMPENSATION COMMITTEE BASED UPON RELATIVE VALUE UNITS (RVU), ANY EXTRA CALL TIME TAKEN AND OVERALL QUALITY STANDARDS/MERIT. ADDITIONAL NON-FIXED PAYMENTS TO EXECUTIVES AND OTHER STAFF MEMBERS ARE AWARDED BY THE COMPENSATION COMMITTEE BASED UPON MERIT AND INDIVIDUAL DEPARTMENT GOALS COMPARED TO THE OVERALL GOALS OF THE HOSPITAL. A CITY OF BELLEFONTAINE OHIO 346400091 2012-09-13 9125000 SEE SCH K PART IV 0 0 0 B CITY OF BELLEFONTAINE OHIO 346400091 2012-09-13 10000000 SEE SCH K PART IV 0 0 0 C CITY OF BELLEFONTAINE OHIO 346400091 2017-12-20 11000000 SEE SCH K PART IV 0 0 0 A 6425000 9125000 9125000 2009 1 0 1 1 B 7537797 10000000 125322 9874678 2013 0 0 1 1 C 1048491 11000000 11000000 2017 1 0 1 1 A 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 DEUTSCHE BANK 13.200000000000 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART I, LINE A, COLUMN (F): CURRENTLY REFUND THE CITY OF BELLEFONTAINE, OHIO ADJUSTABLE RATE DEMAND HOSPITAL FACILITIES REVENUE REFUNDING AND IMPROVEMENT BONDS, SERIES 2005 (MARY RUTAN HOSPITAL PROJECT) ISSUED SEPTEMBER 29, 2005. PART I, LINE B, COLUMN (F) FINANCE (I) THE ACQUISITION OF A CANCER TREATMENT CENTER, (II) THE ACQUISITION OF A BUILDING FOR HOSPITAL ADMINISTRATIVE PURPOSES AND (III) THE ACQUISITION, CONSTRUCTION AND EQUIPPING OF OTHER CAPITAL BUDGET ITEMS. PART I, LINE C, COLUMN (F): CONSTRUCTION AND EQUIPPING OF NEW HEALTH CENTER BUILDING PART II, LINE 3, COLUMN B THE $10,000,000 CITY OF BELLEFONTAINE, OHIO HOSPITAL FACILITIES REVENUE BONDS, SERIES 2012B (MARY RUTAN HOSPITAL PROJECT) WERE ISSUED AS DRAW DOWN BONDS, PERMITTING MARY RUTAN HOSPITAL TO DRAW DOWN THE BONDS A MAXIMUM OF TWELVE TIMES, IN MINIMUM AMOUNTS OF $100,000 EACH. AS OF DECEMBER 31, 2014, THE END OF MARY RUTAN HOSPITAL'S FISCAL YEAR, $6,841,987 OF PROCEEDS HAD BEEN DRAWN DOWN. PART III, LINE 9; PART IV, LINE 7 AND PART V (COLUMNS A, B AND C FOR ALL) MARY RUTAN HOSPITAL INTENDS TO ENGAGE BOND COUNSEL TO DRAFT WRITTEN PROCEDURES COVERING POST-ISSUANCE COMPLIANCE. HILL HAMILTON INC THOMAS SIMON THOMAS SIMON, BOARD MEMBER OF MARY RUTAN HOSPITAL 2194184 PROVIDES BUSINESS AND MAL-PRACTICE INSURANCE POLICIES TO MARY RUTAN HOSPITAL AND MARY RUTAN HEALTH ASSOCIATION. ALL PAYMENTS ARE MADE BY MARY RUTAN HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS MARY RUTAN HEALTH ASSOCIATION OF LOGAN COUNTY, AN OHIO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, MARY RUTAN HEALTH ASSOCIATION OF LOGAN COUNTY MAY PARTICIPATE IN THE ELECTION OF THE ORGANIZATION'S TRUSTEES. THE MEMBER SHALL EXERCISE ITS RIGHT TO VOTE AT ANY MEETING OR TO CONSENT TO ANY ACTION WITHOUT A MEETING THROUGH ITS CHAIRMAN, VICE CHAIRMAN, TREASURER, SECRETARY OR PRESIDENT UNLESS BEFORE SUCH VOTE IS TAKEN OR CONSENT IS GIVEN THE BOARD OF TRUSTEES OF THE MEMBER PROVIDES A CERTIFIED COPY OF A RESOLUTION STATING THAT SUCH AUTHORITY IS VESTED ON SOME OTHER OFFICER OR PERSON. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER SHALL EXERCISE ITS RIGHT TO VOTE AT ANY MEETING OR TO CONSENT TO ANY ACTION WITHOUT A MEETING THROUGH ITS CHAIRMAN, VICE CHAIRMAN, TREASURER, SECRETARY OR PRESIDENT UNLESS BEFORE SUCH VOTE IS TAKEN OR CONSENT IS GIVEN THE BOARD OF TRUSTEES OF THE MEMBER PROVIDES A CERTIFIED COPY OF A RESOLUTION STATING THAT SUCH AUTHORITY IS VESTED ON SOME OTHER OFFICER OF PERSON. AN ANNUAL MEETING OF THE MEMBER IS HELD FOR THE ELECTION OF TRUSTEES, FOR THE CONSIDERATION OF REPORTS AND FOR SUCH OTHER BUSINESS. IN ADDITION, THE FOLLOWING MATTERS ARE AUTHORIZED ONLY AFTER AUTHORIZATION BY THE BOARD OF TRUSTEES AND UPON APPROVAL BY THE MEMBER: 1. REMOVAL OF TRUSTEE; 2. AMENDMENT OF THE CORPORATE REGULATIONS; 3. THE PURCHASE, SALE OR ENCUMBRANCE OF REAL PROPERTY, OR OF SUBSTANTIALLY ALL OF THE PERSONAL PROPERTY, OF THE CORPORATION; 4. MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION OR LEGAL ENTITY; 5. ANY CHANGES TO THE ARTICLES OF INCORPORATION; 6. ADOPTION OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGET; 7. EXPENDITURES FOR (A) NON-BUDGETED ITEMS IN EXCESS OF $250,000; (B) ITEMS WHICH ARE INCUDED IN THE CORPORATION'S ANNUAL BUDGET BUT EXCEED THE BUDGETED AMOUNT BY $250,000 OR MORE, AND (C) EXECUTIVE COMPENSATION; 8. EXECUTION OF ANY CONTRACT WITH A TERM IN EXCESS OF ONE YEAR AND REPRESENTING AN EXPENDITURE OF MORE THAN $500,000; 9. APPROVE THE SELECTION OF THE CEO OF THE CORPORATION; 10. APPOINTMENT OF THE CORPORATION'S AUDITORS; 11. ADOPTION OF THE CORPORATION'S LONG RANGE PLANS AND MANAGEMENT OBJECTIVES; 12. ADOPTION OF THE MEDICAL STAFF BY-LAWS; 13. ANY OTHER MATTERS REQUIRED BY LAW TO BE SUBMITTED TO THE MEMBER OR WHICH THE BOARD DETERMINES BY RESOLUTION TO SUBMIT. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CFO, CEO, AND MEMBERS OF THE AUDIT COMMITTEE PRIOR TO FILING. THE BOARD RECEIVES A COPY BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND OFFICERS OF THE CORPORATION SHALL DISCLOSE TO THE BOARD ANY SITUATION WHEREIN THE DIRECTOR OR OFFICER HAS A CONFLICTING INTEREST OR DUALITY OF INTEREST THAT COULD POSSIBLY CAUSE THAT PERSON TO ACT IN OTHER THAN THE BEST INTEREST OF THE CORPORATION. OFFICERS AND DIRECTORS MUST COMPLETE AN ANNUAL STATEMENT OF CONFLICTS OF INTEREST. THE RESPONSES TO THE CONFLICT OF INTEREST ARE REVIEWED AND DETERMINED IF ADDITIONAL DISCLOSURE IS NECESSARY OR IF THE ANSWERS NEED TO BE REVIEWED BY LEGAL COUNSEL. ANY MEMBER OF THE BOARD HAVING A KNOWN DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD MAKE A DISCLOSURE OF SUCH CONFLICT TO THE OTHER TRUSTEES. SUCH PERSON SHALL NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, BUT SUCH PERSON MAY BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. THE MINUTES OF THE MEETING SHOULD REFLECT THE MAKING OF THE DISCLOSURE, AND ABSTENTION FROM VOTING AND THE QUORUM SITUATION. IN ADDITION, ANY OFFICER OF THE CORPORATION HAVING A KNOWN DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER BEFORE SUCH OFFICER FOR ADMINISTRATIVE ACTION SHALL REPORT THE CONFLICT TO THE PRESIDENT OR, IN THE CASE OF THE PRESIDENT, TO THE CHAIR. SUCH OFFICER SHALL ABSTAIN FROM TAKING ANY ADMINISTRATIVE ACTION ON SUCH MATTER. THE CONFLICT OF INTEREST POLICY IS BASED ON THE IRS MODEL. FORM 990, PART VI, SECTION B, LINE 15B MARY RUTAN HOSPITAL'S EXECUTIVE COMPENSATION PHILOSOPHY COVERS THE FOLLOWING GROUPS OF EXECUTIVES: PRESIDENT AND CHIEF EXECUTIVE OFFICER; CHIEF FINANCIAL OFFICER; ASSOCIATION, HOSPITAL, AND SELECT SUBSIDIARY VICE PRESIDENTS AND ADMINISTRATORS. IN DETERMINING THE APPROPRIATE LEVEL OF COMPENSATION WITHIN THE OVERALL STRATEGY, MARY RUTAN WILL CONSIDER SUCH FACTORS AS: TOTAL INCUMBENT RESPONSIBILITIES AND SCOPE OF THE POSITION HELD BY THE INDIVIDUAL; INCUMBENT'S LENGTH OF SERVICE IN THE INDUSTRY, LENGTH OF SERVICE WITH THE HOSPITAL, AND YEARS IN CURRENT POSITION; THE HOSPITAL'S FINANCIAL AND NON-FINANCIAL PERFORMANCE OVER A RELEVANT TIME PERIOD; AND ADDITIONAL ACTIVITIES PERFORMED BY THE INCUMBENT FROM THE POSITION RESPONSIBILITIES IDENTIFIED, BUT HAVING A DIRECT OR INDIRECT IMPACT ON BUSINESS (MULTIPLE JOB RESPONSIBILITIES, SPECIAL PROJECTS, SPECIFIC INDUSTRY EXPERTISE/EXPERIENCE, ETC.). THE REVIEW INCLUDES PERIODIC USE OF AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION STUDIES AND SURVEYS, AND APPROVAL BY THE EXECUTIVE COMMITTEE AND BOARD. VOTING MEMBERS OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE CORPORATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. THE COMPENSATION REVIEW FOR THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES WAS LAST CONDUCTED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE DOCUMENTS ARE ONLY MADE AVAILABLE AT THE WRITTEN REQUEST OF THE INTERESTED PARTY. PART VII AND PART IX THE SALARIES AND WAGES FOR THE OFFICERS AND HIGHEST COMPENSATED EMPLOYEES ON MARY RUTAN HEALTH ASSOCIATION, A RELATED ORGANIZATION, ARE INITIALLY PAID OUT OF MARY RUTAN HEALTH ASSOCIATION BUT AN ENTRY IS MADE TO ALLOCATE THE SALARY AND WAGE EXPESNES TO MARY RUTAN HOSPITAL (WHERE THE MAJORITY OF THE TIME IS SPENT). THEREFORE, THE OFFICERS VICKIE CRUMLEY, AMANDA GOBLE AND STEVE BROWN WILL BE SHOWN AS BEING PAID BY A RELATED ORGANIZATION ON PART VII, BUT THEIR OFFICER COMPENSATION WILL BE INCLUDED ON PART IX, LINE 5 OF THE MARY RUTAN HOSPITAL RETURN. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,830,500. MANAGEMENT AND GENERAL EXPENSES 190,665. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,021,165. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 5,053,353. MANAGEMENT AND GENERAL EXPENSES 251,533. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,304,886. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,099,568. MANAGEMENT AND GENERAL EXPENSES 204,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,303,626. FORM 990, PART XI, LINE 9: TRANSFER FROM MARY RUTAN FOUNDATION 1,303,515. CHANGE IN FMV OF INTEREST RATE SWAP AGREEMENT 276,315. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART I, LINE 1: THOSE DIRECTING MARY RUTAN HOSPITAL, A NOT-FOR-PROFIT, NON-GOVERNMENTAL HOSPITAL, ACCEPT RESPONSIBILITY FOR MEETING HEALTH CARE NEEDS OF THE COMMUNITY AND INSURING: A. THE DELIVERY OF SAFE, EFFICIENT AND ECONOMICAL HEALTH CARE WITHIN THE BOUNDS OF SOUND FINANCIAL AND DEBT SERVICE MANAGEMENT; B. A STRONG COMPETITIVE POSTURE WITHIN ITS SELECTED AREAS OF HEALTH SERVICES THROUGH EFFECTIVE BUDGETING, FORECASTING, AND MANAGEMENT; C. FIRM ESTABLISHMENT OF MARY RUTAN HOSPITAL AS A LEADER IN HEALTH CARE, SERVING RESIDENTS OF LOGAN COUNTY, OHIO, AND SURROUNDING AREAS WITH HIGH QUALITY ACUTE CARE, EMERGENCY CARE, AMBULATORY CARE AND CONSUMER HEALTH EDUCATION CONSISTENT WITH COMMUNITY NEEDS AND STAFF UTILIZATION; D. THAT THE HOSPITAL'S POSITION IN THE COMMUNITY WILL BE ENHANCED THROUGH STRONG INTERNAL MANAGEMENT, WELL-TRAINED HEALTH PROFESSIONALS WHO MAINTAIN CURRENT STANDARDS OF PRACTICE AND AGGRESSIVE AND CREATIVE EVALUATION OF SERVICES, TRENDS AND COMMUNITY NEEDS. E. THAT PATIENT EDUCATION IS PLANNED AND PROVIDED TO PROMOTE AND MAINTAIN HEALTH. MARY RUTAN HEALTH ASSOCIATION 205 PALMER AVE BELLEFONTAINE OH 43311 346544675 HEALTHCARE OH 501(C)(3) 9 N/A 0 MARY RUTAN FOUNDATION 205 PALMER AVE BELLEFONTAINE OH 43311 341407262 CHARITABLE FOUNDATION OH 501(C)(3) 11B MARY RUTAN HEALTH ASSOCIATION 1 LOGAN COUNTY CANCER SOCIETY INC 205 PALMER AVE BELLEFONTAINE OH 43311 237105514 SUPPORT FOR CANCER PATIENTS OH 501(C)(3) 7 MARY RUTAN FOUNDATION 1 LOGAN VIEW LLC 205 PALMER AVE BELLEFONTAINE OH 43311 311101004 HOME MEDICAL EQUIPMENT OH N/A C 1 1 0 1 0 1 0 0 0 0 0 0 1 1 1 1 0 1 0 1 MARY RUTAN HEALTH ASSOCIATION N 1335706 MANAGEMENT AGREEMENT MARY RUTAN HEALTH ASSOCIATION Q 148733 TOTAL CHECKS FROM MRH LOGAN VIEW LLC L 859798 AMOUNT PAID TO LV MARY RUTAN FOUNDATION S 1303515 EQUITY TRANSFER