2021-05-13T10:06:59-05:00 2020-06-30 861065772 DELOITTE TAX LLP 250 EAST FIFTH STREET SUITE 1900 CINCINNATI OH 45202 990 2019-07-01 310537122 BETHESDA HOSPITAL INC BETH 5135696575 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 MICHAEL CROFTON VP FINANCE 5135696577 2021-05-13 1 ALICIA JANISCH P00741382 5137847100 2019 2022-09-23 18:48:47Z MARK CLEMENT 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 767389500 0 X WWW.TRIHEALTH.COM X 1896 OH TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. 13 8 3909 535 1370794 0 945906 3371557 611708927 617830484 13407331 15871786 21801506 49213144 647863670 686286971 315064 707533 0 0 274943724 299136295 0 0 0 275251997 346756562 550510785 646600390 97352885 39686581 1076223195 1219368332 504942942 682046006 571280253 537322326 TO IMPROVE THE HEALTH STATUS OF THE PEOPLE WE SERVE. THIS IS ACCOMPLISHED BY PROVIDING A FULL RANGE OF HEALTH RELATED SERVICES INCLUDING PREVENTION, WELLNESS AND EDUCATION. 0 0 504405250 707533 663713681 SEE SCHEDULE H 504405250 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 417 0 1 3909 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 8 1 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 1 1 X MICHAEL CROFTON - VP FINANCE 5135696577 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 SR SALLY DUFFY SECRETARY 1.00 3.00 X X 0 0 0 CRAIG EISENTROUT MD TRUSTEE (END 6/20) 1.00 60.00 X 0 304084 51011 RALPH MICHAEL CHAIR 1.00 3.00 X X 0 0 0 ROBERT COLLINS MD TRUSTEE 1.00 3.00 X 0 127616 0 MARK CLEMENT PRESIDENT/CEO 15.00 45.00 X X 0 1481585 346875 PHILLIP CASTELLINI TRUSTEE 1.00 3.00 X 0 0 0 KATHY KELLY TRUSTEE (START 7/19) 1.00 3.00 X 0 0 0 THEODORE TORBECK TREASURER 1.00 3.00 X X 0 0 0 PHILIP FOSTER TRUSTEE 1.00 3.00 X 0 0 0 SCOTT FRIEDSTROM MD MED STAFF PRES-(END 12/19) 1.00 3.00 X 0 628253 88603 PHILLIP OBLINGER MD MED STAFF PRES-(END 12/19) 1.00 3.00 X 45000 83751 0 QUINT STUDER TRUSTEE 1.00 3.00 X 0 0 0 RANCE DUKE TRUSTEE (START 7/19) 1.00 3.00 X 0 0 0 DANNY FISCHER MD MED STAFF PRES-(START 1/20) 1.00 3.00 X 12000 0 0 KURT KNOCHEL MD MED STAFF PRES-(START 1/20) 1.00 3.00 X 0 68056 0 ANDREW DEVOE ASST. TREASURER/CFO 15.00 45.00 X 0 737448 176417 STEVE GRACEY ASST. SECRETARY/SVP LEGAL 15.00 45.00 X 0 534649 141312 STEFANIE NEWMAN VP-CNO BETHESDA (END 9/19) 60.00 0.00 X 0 527004 69717 DAVID COOK CHIEF HR OFFICER 15.00 45.00 X 0 475894 104412 LONDON QUICCI PRESIDENT-BETHESDA NORTH 60.00 0.00 X 0 392928 81172 KEVIN JOSEPH MD CHIEF MEDICAL OFFICER 15.00 45.00 X 0 692349 157176 JENNY SKINNER CNE-TRIHEALTH 15.00 45.00 X 0 384395 126252 ROB CERCEK EVP POP HEALTH (END 10/19) 15.00 45.00 X 0 643972 129240 MICHAEL EVERETT PRESIDENT-BETHESDA BUTLER 30.00 30.00 X 0 172152 23213 JOHN WARD SVP-BETHESDA REGION 60.00 0.00 X 0 530464 157847 MICHAEL HOLBERT MD PHYSICIAN 60.00 0.00 X 266080 91782 44302 RICHARD OKRAGLY MD PHYSICIAN 60.00 0.00 X 245642 0 52429 SAKUNTHALA NATARAJAN MD PHYSICIAN 60.00 0.00 X 236539 0 47089 ROBERT KUNKEL MD PHYSICIAN 60.00 0.00 X 284145 0 50450 SCOTT WOODS MD PHYSICIAN 60.00 0.00 X 252098 0 59143 MICHAEL CROFTON FORMER OFFICER 0.00 60.00 X 0 366377 113843 WILLIAM GRONEMAN FORMER KEY EMPLOYEE 0.00 40.00 X 0 418772 141038 GAIL DONOVAN FORMER KEY EMPLOYEE 0.00 0.00 X 0 903818 199356 JASON NIEHAUS FORMER KEY EMPLOYEE 0.00 0.00 X 0 325708 11983 MARY IRVIN FORMER KEY EMPLOYEE 0.00 0.00 X 0 190256 11541 1341504 10081313 2384421 256 1 1 0 PREFERRED LAB PARTNERS LLC 1 MEDICAL VILLAGE DRIVE SUITE B EDGEWOOD KY 41017 LABORATORY 13696411 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 CLINICAL MAINTENANCE 6452100 AMERICAN NURSING CARE INC 1700 EDISON DRIVE SUITE 300 MILFORD OH 45150 NURSE STAFFING 4897740 TRI-STATE HEALTHCARE LAUNDRY 551 S LOOP ROAD EDGEWOOD KY 41017 LAUNDRY 1674048 DAVITA 2000 16TH ST DENVER CO 80202 DIALYSIS SERVICES 1454809 59 2861970 80397 429190 3371557 PATIENT REVENUE 621990 602072091 601495819 576272 AFFILIATED ORG. RENTAL 532000 8403546 8403546 JOA REVENUE 900099 5849676 5849676 HATTON RESEARCH 900099 608883 608883 SENIOR HEALTH SERVICES 900099 339992 339992 556296 -238226 794522 617830484 2584011 2584011 950705 0 950705 950705 950705 93425864 98525 80236614 0 13189250 98525 13287775 13287775 1098847 865915 232932 232932 PHARMACY 621990 31720870 31720870 CARES ACT FUNDING 900099 13457424 13457424 CAFETERIA 900099 2379242 2379242 471971 471971 48029507 686286971 653939341 1370794 27605279 707533 707533 4228278 4228278 1365265 1365265 231033406 179435497 51597909 15857023 11146643 4710380 29569799 20202620 9367179 17082524 12888443 4194081 16298332 16298332 3338289 3338289 394638 394638 735264 735264 36387876 22718877 13668999 8567832 93746 8474086 10333736 4912959 5420777 10846007 1581033 9264974 16829789 14384494 2445295 545481 198088 347393 471174 347036 124138 13584970 13333353 251617 51993278 32594674 19398604 3126640 3126640 MEDICAL/DIETARY SUPPLY 150673526 148812121 1861405 OHIO HOSPITAL FEE 11965126 11965126 EQUIPMENT & REPAIRS 8866043 8801465 64578 DUES AND SUBSCRIPTIONS 286092 286092 1512469 570478 941991 646600390 504405250 142195140 0 60922 74345 72547523 66763771 11908303 11979659 1319725 713773 897717763 440557903 382315960 457159860 297537350 339322584 57926230 55702395 184511909 191277602 37702879 33773623 30392394 62600720 1076223195 1219368332 57717358 68822855 34821 125782 404764402 552391459 24970149 8044046 17456212 52661864 504942942 682046006 X 548440383 506704095 22839870 30618231 571280253 537322326 1076223195 1219368332 X 39686581 6117518 -79762026 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 15577 15577 0 PART II-B, LINE 1: 1I) DURING THE TAX YEAR, BETHESDA HOSPITAL, INC. ("HOSPITAL") PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS, A PORTION ($970) OF WHICH RELATED TO LOBBYING ACTIVITIES. IN ADDITION, TRIHEALTH, INC., A RELATED ORGANIZATION OF HOSPITAL, WHICH PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO HOSPITAL, PAID ANNUAL MEMBERSHIP DUES TO VARIOUS NATIONAL, STATE AND LOCAL ORGANIZATIONS A PORTION OF WHICH RELATED TO LOBBYING ACTIVITIES. A PORTION OF THE AFOREMENTIONED ADMINISTRATIVE SUPPORT SERVICES ARE ALLOCATED TO HOSPITAL AND $14,607 OF THE AMOUNT SHOWN ON LINE 1I REPRESENTS HOSPITAL'S SHARE OF THESE LOBBYING EXPENSES. 3720610 375 93665 72493 3742157 3726463 324903 17126 347882 3720610 3736434 225 101344 111540 3726463 3493840 242594 3736434 3624135 250 -58206 72339 3493840 0.94570 0.05430 0 1 1 4480479 4480479 538622561 193624234 344998327 3529170 2170311 1358859 299256279 240996060 58260219 51829274 3767298 48061976 457159860 INVESTMENT IN JOINT VENTURES 191277602 C 191277602 DUE FROM RELATED ORGANIZATIONS 52078774 RIGHT OF USE ASSET - OPERATING LEASE 6646179 INVESTMENT IN OUTSIDE ENTITIES 3203813 MISCELLANEOUS ASSETS 671954 62600720 THIRD PARTY SETTLEMENTS 2011714 ACCRUED EIB 4274007 MALPRACTICE INSURANCE/WORKERS COMP LIABILITY 5218089 DUE TO RELATED ORGANIZATIONS 39565904 MISCELLANEOUS 1592150 52661864 X PART V, LINE 4: INVESTMENT PROCEEDS FROM ENDOWMENT FUNDS ARE USED TO SUPPORT BETHESDA HOSPITAL, INC. PROGRAMS. PART X, LINE 2: THE FINANCIAL STATEMENTS OF BETHESDA HOSPITAL, INC. ARE AUDITED AS PART OF TRIHEALTH AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED COMBINED FINANCIAL STATEMENTS OF TRIHEALTH THAT REPORTS ITS AND ITS SUBSIDIARIES AND AFFILIATES LIABILITY, IF APPLICABLE, FOR UNCERTAIN TAX POSITIONS UNDER ASC 740-10-25: TRIHEALTH COMPLETED AN ANALYSIS OF UNCERTAIN TAX POSITIONS AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS AT JUNE 30, 2020 OR 2019. IN ADDITION, THE FINANCIAL STATEMENTS OF BETHESDA HOSPITAL, INC. ARE AUDITED AS PART OF ITS PARENT, BETHESDA, INC. FOLLOWING IS THE TEXT OF THE FOOTNOTE TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF BETHESDA, INC. ("COMPANY") THAT REPORTS ITS AND ITS SUBSIDIARIES LIABILITY, IF APPLICABLE, FOR UNCERTAIN TAX POSITIONS UNDER ASC 740-10-25: THE COMPANY COMPLETED AN ANALYSIS OF UNCERTAIN TAX POSITIONS AND DETERMINED NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2020 OR 2019. 1 1 X 1 X 1 X 1 1 0 1 1 8404459 6390157 2014302 0.00310 90009024 57547429 32461595 0.05020 98413483 63937586 34475897 0.05330 905900 174694 731206 0.00110 11327857 9000063 2327794 0.00360 156950 0 156950 0.00020 1806203 0 1806203 0.00280 281695 0 281695 0.00040 14478605 9174757 5303848 0.00810 112892088 73112343 39779745 0.06140 65928 0 65928 0.00010 65928 65928 0.00010 0 46716359 0 116842194 133440058 -16597864 X 1 1 2 1 BETHESDA NORTH HOSPITAL 10500 MONTGOMERY ROAD CINCINNATI OH 45242 WWW.TRIHEALTH.COM 1024 X X X X X 2 BETHESDA BUTLER HOSPITAL 3125 HAMILTON-MASON ROAD HAMILTON OH 45011 WWW.TRIHEALTH.COM 1457 X X X BETHESDA NORTH HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/ X 1 18 1 HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/ 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 BETHESDA BUTLER HOSPITAL 2 0 0 1 X X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/ X 1 18 1 HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/ 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X HTTP://WWW.TRIHEALTH.COM/TOOLS/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 5: PRIMARY DATA SOURCES ALMOST 1,300 PEOPLE HAD AN OPPORTUNITY TO IDENTIFY AND PRIORITIZE HEALTH AND HEALTH-RELATED ISSUES AT A MEETING OR BY SURVEY. TWENTY-THREE (23) COUNTY- OR DISTRICT-LEVEL PUBLIC HEALTH DEPARTMENTS RESPONDED BY SURVEY, AND THE CHNA TEAM ALSO RECEIVED SURVEY RESPONSES FROM 5 CITY-LEVEL HEALTH DEPARTMENTS. NINETY-SIX NONPROFIT ORGANIZATIONS COMPLETED SURVEYS, AND THEY SERVED RESIDENTS IN EVERY COUNTY. TOTAL RESPONSE FAR EXCEEDED THE LEVEL OF RESPONSE EXPERIENCED THREE YEARS EARLIER FOR THE 2016 CHNAS IN CINCINNATI AND DAYTON. PRIMARY DATA WAS OBTAINED, WITH A UNIFORM SET OF QUESTIONS, VIA THE FOLLOWING: * THERE WERE 42 MEETINGS, HELD IN 23 COUNTIES DURING MAY THROUGH JULY 2018, WHICH ATTRACTED 463 REPRESENTATIVES OF COMMUNITY ORGANIZATIONS, THE GENERAL PUBLIC, AND/OR MEMBERS OF MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS TO IDENTIFY BARRIERS TO CARE, GIVE INPUT FOR CURRENT NEEDS ASSESSMENT, PRIORITIZE ISSUES, AND IDENTIFY RESOURCES TO ADDRESS HEALTH AND HEALTH-RELATED ISSUES. * ONLINE SURVEYS OF INDIVIDUALS (828), AGENCIES (96), AND PUBLIC HEALTH DEPARTMENTS (28) THROUGHOUT THE REGION FROM JUNE THROUGH AUGUST 2018. * THE REPORTING HOSPITAL DID NOT RECEIVE WRITTEN COMMENTS FROM THE PUBLIC REGARDING THE 2016 CHNA OR ITS RELATED IMPLEMENTATION STRATEGY. COMMUNITY MEETINGSOUTREACH ANY INDIVIDUAL OR AGENCY REPRESENTATIVE WHO GAVE THEIR ADDRESS DURING THE 2013 OR 2016 CHNA PROCESS WAS ADDED TO AN INVITE LIST, AND THE HEALTH COLLABORATIVE (THC) MAILED THEM AN INVITATION TO THE MEETING SCHEDULED IN THEIR COUNTY. THE CONSULTANTS ADDED NONPROFIT ORGANIZATIONS IN EACH COUNTY THAT HAD EITHER A PHONE NUMBER, STREET ADDRESS, OR EMAIL. THC SENT 544 EMAILS AND 376 LETTERS BY FIRST-CLASS MAIL. THE CONSULTANTS MADE PHONE CALLS TO AGENCIES THAT HAD NOT PREVIOUSLY ATTENDED A CHNA MEETING AS WELL AS TO STRATEGIC ORGANIZATIONS THAT SERVE VULNERABLE POPULATIONS AND/OR HAVE A BROAD REACH, E.G., UNITED WAY. THEY FOLLOWED UP WITH EMAILS. THC SENT FLYERS TO HOSPITALS AND TO MEETING HOST SITES FOR POSTING AND DISTRIBUTION. THE CONSULTANTS ALSO POSTED UPCOMING MEETINGS EVERY TWO WEEKS IN THE INTERACT FOR HEALTH E-NEWSLETTER: HEALTH WATCH, WHICH IS EMAILED ACROSS 20 COUNTIES. THE CONSULTANTS SENT FLYERS TO PUBLIC HEALTH DEPARTMENTS TO POST AND DISTRIBUTE. SOME HEALTH DEPARTMENTS PUBLICIZED MEETINGS ON THEIR SOCIAL MEDIA PAGES AND HELD ADDITIONAL MEETINGS. THERE WAS A 229% INCREASE IN MEETING ATTENDANCE, FROM 202 FOR THE 2016 CYCLE TO 463 FOR THE 2019 CYCLE. APPENDIX 1 OF THE CHNA, WHICH IS POSTED TO TRIHEALTH'S WEBSITE, INCLUDES A LIST OF MEETING ATTENDEES AND THE ORGANIZATIONS EACH REPRESENTS.PURPOSE OF MEETINGS THE PURPOSE OF THE MEETINGS WAS TO SOLICIT PUBLIC INPUT. THE DESIRE WAS TO ATTRACT INDIVIDUALS OR NONPROFIT ORGANIZATIONS WITH EXPERIENCE OR KNOWLEDGE TO SHARE, ESPECIALLY ON EMERGING ISSUES NOT CAPTURED BY THE SECONDARY DATA AND FROM THE PERSPECTIVES OF MEDICALLY UNDERSERVED, MINORITY, AND/OR LOW-INCOME POPULATIONS. THE OBJECTIVES WERE TO: * SHARE COUNTY-LEVEL HIGHLIGHTS FROM THE SECONDARY DATA (AND CITY-LEVEL FOR CINCINNATI HEALTH DEPARTMENT MEETINGS) * GATHER DIVERSE PEOPLE TO SHARE THEIR IDEAS -- GENERAL PUBLIC AND COMMUNITY LEADERS * RECEIVE INPUT FROM AGENCIES THAT REPRESENT VULNERABLE POPULATIONS * HEAR CONCERNS AND QUESTIONS ABOUT EXISTING HEALTH/HEALTH-RELATED ISSUES * OBTAIN INFORMATION ABOUT FINANCIAL AND NON-FINANCIAL BARRIERS TO HEALTH CARE * IDENTIFY RESOURCES AVAILABLE LOCALLY TO ADDRESS ISSUES * OBTAIN INSIGHT INTO LOCAL CONDITIONS FROM LOCAL PEOPLE * DISCOVER HEALTH AND HEALTH-RELATED PRIORITIES OF ATTENDEES MEETING FACILITATION A GROUP OF 2-3 CONSULTANTS WENT TO EACH MEETING, DEPENDING ON THE NUMBER OF RSVPS. EACH MEETING FOLLOWED THE SAME FORMAT AND AGENDA. REFRESHMENTS WERE SERVED, AND NAMETAGS WERE USED TO GENERATE A WELCOMING ATMOSPHERE. LOCATIONS WERE SELECTED FOR CONVENIENCE, ACCESS, AND TRUSTED REPUTATION IN THE COMMUNITY. THE FACILITATOR FIRST SHARED GENERAL TRISTATE AND STATE-SPECIFIC HEALTH AND HEALTH-RELATED DATA TO PROVIDE CONTEXT. THE SURVEY QUESTIONS WERE USED, BUT THE FIRST QUESTION ABOUT MOST SERIOUS HEALTH ISSUES WAS ASKED SEPARATELY. THIS TECHNIQUE WAS INTENDED TO CAPTURE FIRST THOUGHTS WITHOUT AN OPPORTUNITY TO BE INFLUENCED BY THE MORE SPECIFIC COUNTY-LEVEL DATA OR BY OTHER ATTENDEES. AFTER THE FIRST QUESTION, THE CONSULTANTS (A MEETING FACILITATOR AND AT LEAST ONE SCRIBE) SHARED A PROFILE OF THE COUNTY, INCLUDING A SUMMARY OF SECONDARY DATA. THE MEETINGS LASTED 90 MINUTES, OF WHICH 60 MINUTES WAS DEVOTED TO THE GROUP'S BRAINSTORMING. AT THE END, EACH PERSON WAS GIVEN 3 COLORED DOTS. THEY PLACED THE DOTS NEXT TO ISSUES THEY PRIORITIZED AS MOST IMPORTANT HEALTH CONDITIONS OR NEEDS OF THE COMMUNITY. THE AGENDA HANDOUT CONTAINED LINKS TO THE SURVEYS. SURVEYS THE CONSULTANTS DEVELOPED THREE TYPES OF SURVEYS: INDIVIDUAL CONSUMER; AGENCY; AND HEALTH DEPARTMENT. THE QUESTIONS REMAINED THE SAME FOR EACH SURVEY. THE AGENCY SURVEYS WERE PUSHED OUT VIA EMAIL AS WELL AS THE LINK WAS SHARED AT THE COMMUNITY MEETINGS. THE HEALTH DEPARTMENT VERSION ALSO REQUESTED THE QUALIFICATIONS OF THE RESPONDENTS. AS REQUIRED BY THE IRS, THE INDIVIDUAL CONSUMER SURVEY WAS ALSO TRANSLATED INTO SPANISH AND ADAPTED FOR MOBILE APPLICATION AT COMMUNITY EVENTS. THE CONSULTANTS USED SURVEYMONKEY TO COLLECT RESPONSES, TABULATE DATA, INTERPRET AND ANALYZE RESULTS, AND CREATE CATEGORIES TO TRACK KEY WORDS AND PHRASES. PAPER COPIES (TRANSLATED) WERE USED WITH SPANISH-SPEAKING FAMILIES, REFUGEES FROM RWANDA, AND AT TREATMENT FACILITIES. BOTH TRIHEALTH OUTREACH MINISTRIES AND SANTA MARIA COMMUNITY SERVICES PROVIDED THE ANSWERS ALREADY TRANSLATED INTO ENGLISH FOR THE CONSULTANTS. A TOTAL OF 113 IMMIGRANT SURVEYS WERE COMPLETED AND RETURNED. SEE APPENDIX 2 FOR THE SURVEY RESPONDENTS WHO IDENTIFIED THEMSELVES. APPENDIX 3 OF THE CHNA, WHICH IS POSTED TO TRIHEALTH'S WEBSITE, HAS A LIST OF HEALTH DEPARTMENT RESPONDENTS WITH THEIR QUALIFICATIONS.SECONDARY DATA SOURCES DATA COLLECTION COUNTY HEALTH RANKINGS (CHR) FORMED THE FOUNDATION FOR DATA COLLECTION WITH ITS COUNTY-LEVEL FOCUS ON HEALTH OUTCOMES, HEALTH FACTORS, HEALTH BEHAVIORS, QUALITY OF LIFE, CLINICAL CARE, PHYSICAL ENVIRONMENT, AND SOCIOECONOMIC FACTORS. ADDITIONAL SOURCES SUPPLEMENTED THE CHR DATA. PUBLICLY AVAILABLE HEALTH STATISTICS AND DEMOGRAPHICS WERE OBTAINED AT THE STATE AND COUNTY LEVEL. THE EPIDEMIOLOGISTS FOR PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY (PHDMC) VOLUNTEERED TO COLLECT DATA FOR THE STATE OF OHIO AND ITS COUNTIES. THEY INCLUDED DATA THROUGH 2016. OHIO'S 2017 DATA WAS NOT AVAILABLE IN TIME FOR THIS REPORT. THE NUMBER OF DATA MEASURES INCREASED BY 33%, FROM 106 IN 2016 TO 142 IN 2019. DATA SOURCES THE STANDARDS FOR RESEARCHING AND INCLUDING DATA WERE: * COMPARABLE (MEASURES WITH BENCHMARKS SUCH AS HEALTHY PEOPLE 2020 OR STATE/NATIONAL RATES) * COUNTY-LEVEL DATA (ZIP CODE LEVEL PREFERRED BUT RARE) * FOCUS ON HEALTH OUTCOME DATA (PREFERRED OVER SUBJECTIVE SURVEY DATA WHEN BOTH WERE AVAILABLE) * REPRODUCIBLE (NEW UPDATE AVAILABLE WITHIN THREE YEARS OR AT 3-YEAR INTERVALS VS. ONE-TIME) * REPUTABLE SOURCE * TREND DATA AVAILABLE (MORE THAN ONE DATA POINT; 3-5 YEARS PREFERRED) THE CHR WAS AN EXCELLENT STARTING POINT, BUT THE CONSULTANTS DISCOVERED ADDITIONAL SOURCES WITH MORE RECENT DATA AS WELL AS INDICATORS FOR MEASURES NOT COLLECTED BY CHR. THE PREVALENCE OF CERTAIN CANCERS, THE RAPID INCREASE OF HEROIN OVERDOSE DEATHS IN THE REGION, AND ADDITIONAL MORTALITY DATA ARE EXAMPLES OF SUPPLEMENTAL DATA. MANY EXCELLENT SOURCES OF INFORMATION DID NOT HAVE A BREAKDOWN BELOW THE STATE LEVEL OR DID NOT INCLUDE THE ENTIRE REGION. THE CONSULTANTS CONTACTED STATE HEALTH DEPARTMENTS, LOCAL HEALTH DEPARTMENTS, AND LOCAL EXPERTS. THE BIGGEST CHANGE FROM THE PRIOR CYCLE IS THAT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES NO LONGER MAINTAINS THE HEALTH INDICATORS WAREHOUSE AS AN ONLINE SOURCE, AND IT HAD PROVIDED DATA FOR EIGHT KEY MEASURES. PHDMC EPIDEMIOLOGISTS CONSULTED THE OHIO DATA FOR DATA RANGES ENDING WITH 2016 AND ONE PERIOD PRIOR. DUE TO CHARACTER LIMITATION IN THE SOFTWARE, THESE DATA SOURCES COULD NOT BE INCLUDED IN THIS EXPLANATION. HOWEVER, THE DATA SOURCES AND DATES CAN BE FOUND ON PAGES 12 AND 13 OF THE CHNA POSTED ON TRIHEALTH'S WEBSITE. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 5: PRIMARY DATA SOURCES ALMOST 1,300 PEOPLE HAD AN OPPORTUNITY TO IDENTIFY AND PRIORITIZE HEALTH AND HEALTH-RELATED ISSUES AT A MEETING OR BY SURVEY. TWENTY-THREE (23) COUNTY- OR DISTRICT-LEVEL PUBLIC HEALTH DEPARTMENTS RESPONDED BY SURVEY, AND THE CHNA TEAM ALSO RECEIVED SURVEY RESPONSES FROM 5 CITY-LEVEL HEALTH DEPARTMENTS. NINETY-SIX NONPROFIT ORGANIZATIONS COMPLETED SURVEYS, AND THEY SERVED RESIDENTS IN EVERY COUNTY. TOTAL RESPONSE FAR EXCEEDED THE LEVEL OF RESPONSE EXPERIENCED THREE YEARS EARLIER FOR THE 2016 CHNAS IN CINCINNATI AND DAYTON. PRIMARY DATA WAS OBTAINED, WITH A UNIFORM SET OF QUESTIONS, VIA THE FOLLOWING: * THERE WERE 42 MEETINGS, HELD IN 23 COUNTIES DURING MAY THROUGH JULY 2018, WHICH ATTRACTED 463 REPRESENTATIVES OF COMMUNITY ORGANIZATIONS, THE GENERAL PUBLIC, AND/OR MEMBERS OF MEDICALLY UNDERSERVED AND VULNERABLE POPULATIONS TO IDENTIFY BARRIERS TO CARE, GIVE INPUT FOR CURRENT NEEDS ASSESSMENT, PRIORITIZE ISSUES, AND IDENTIFY RESOURCES TO ADDRESS HEALTH AND HEALTH-RELATED ISSUES. * ONLINE SURVEYS OF INDIVIDUALS (828), AGENCIES (96), AND PUBLIC HEALTH DEPARTMENTS (28) THROUGHOUT THE REGION FROM JUNE THROUGH AUGUST 2018. * THE REPORTING HOSPITAL DID NOT RECEIVE WRITTEN COMMENTS FROM THE PUBLIC REGARDING THE 2016 CHNA OR ITS RELATED IMPLEMENTATION STRATEGY. COMMUNITY MEETINGSOUTREACH ANY INDIVIDUAL OR AGENCY REPRESENTATIVE WHO GAVE THEIR ADDRESS DURING THE 2013 OR 2016 CHNA PROCESS WAS ADDED TO AN INVITE LIST, AND THE HEALTH COLLABORATIVE (THC) MAILED THEM AN INVITATION TO THE MEETING SCHEDULED IN THEIR COUNTY. THE CONSULTANTS ADDED NONPROFIT ORGANIZATIONS IN EACH COUNTY THAT HAD EITHER A PHONE NUMBER, STREET ADDRESS, OR EMAIL. THC SENT 544 EMAILS AND 376 LETTERS BY FIRST-CLASS MAIL. THE CONSULTANTS MADE PHONE CALLS TO AGENCIES THAT HAD NOT PREVIOUSLY ATTENDED A CHNA MEETING AS WELL AS TO STRATEGIC ORGANIZATIONS THAT SERVE VULNERABLE POPULATIONS AND/OR HAVE A BROAD REACH, E.G., UNITED WAY. THEY FOLLOWED UP WITH EMAILS. THC SENT FLYERS TO HOSPITALS AND TO MEETING HOST SITES FOR POSTING AND DISTRIBUTION. THE CONSULTANTS ALSO POSTED UPCOMING MEETINGS EVERY TWO WEEKS IN THE INTERACT FOR HEALTH E-NEWSLETTER: HEALTH WATCH, WHICH IS EMAILED ACROSS 20 COUNTIES. THE CONSULTANTS SENT FLYERS TO PUBLIC HEALTH DEPARTMENTS TO POST AND DISTRIBUTE. SOME HEALTH DEPARTMENTS PUBLICIZED MEETINGS ON THEIR SOCIAL MEDIA PAGES AND HELD ADDITIONAL MEETINGS. THERE WAS A 229% INCREASE IN MEETING ATTENDANCE, FROM 202 FOR THE 2016 CYCLE TO 463 FOR THE 2019 CYCLE. APPENDIX 1 OF THE CHNA, WHICH IS POSTED TO TRIHEALTH'S WEBSITE, INCLUDES A LIST OF MEETING ATTENDEES AND THE ORGANIZATIONS EACH REPRESENTS.PURPOSE OF MEETINGS THE PURPOSE OF THE MEETINGS WAS TO SOLICIT PUBLIC INPUT. THE DESIRE WAS TO ATTRACT INDIVIDUALS OR NONPROFIT ORGANIZATIONS WITH EXPERIENCE OR KNOWLEDGE TO SHARE, ESPECIALLY ON EMERGING ISSUES NOT CAPTURED BY THE SECONDARY DATA AND FROM THE PERSPECTIVES OF MEDICALLY UNDERSERVED, MINORITY, AND/OR LOW-INCOME POPULATIONS. THE OBJECTIVES WERE TO: * SHARE COUNTY-LEVEL HIGHLIGHTS FROM THE SECONDARY DATA (AND CITY-LEVEL FOR CINCINNATI HEALTH DEPARTMENT MEETINGS) * GATHER DIVERSE PEOPLE TO SHARE THEIR IDEAS -- GENERAL PUBLIC AND COMMUNITY LEADERS * RECEIVE INPUT FROM AGENCIES THAT REPRESENT VULNERABLE POPULATIONS * HEAR CONCERNS AND QUESTIONS ABOUT EXISTING HEALTH/HEALTH-RELATED ISSUES * OBTAIN INFORMATION ABOUT FINANCIAL AND NON-FINANCIAL BARRIERS TO HEALTH CARE * IDENTIFY RESOURCES AVAILABLE LOCALLY TO ADDRESS ISSUES * OBTAIN INSIGHT INTO LOCAL CONDITIONS FROM LOCAL PEOPLE * DISCOVER HEALTH AND HEALTH-RELATED PRIORITIES OF ATTENDEES MEETING FACILITATION A GROUP OF 2-3 CONSULTANTS WENT TO EACH MEETING, DEPENDING ON THE NUMBER OF RSVPS. EACH MEETING FOLLOWED THE SAME FORMAT AND AGENDA. REFRESHMENTS WERE SERVED, AND NAMETAGS WERE USED TO GENERATE A WELCOMING ATMOSPHERE. LOCATIONS WERE SELECTED FOR CONVENIENCE, ACCESS, AND TRUSTED REPUTATION IN THE COMMUNITY. THE FACILITATOR FIRST SHARED GENERAL TRISTATE AND STATE-SPECIFIC HEALTH AND HEALTH-RELATED DATA TO PROVIDE CONTEXT. THE SURVEY QUESTIONS WERE USED, BUT THE FIRST QUESTION ABOUT MOST SERIOUS HEALTH ISSUES WAS ASKED SEPARATELY. THIS TECHNIQUE WAS INTENDED TO CAPTURE FIRST THOUGHTS WITHOUT AN OPPORTUNITY TO BE INFLUENCED BY THE MORE SPECIFIC COUNTY-LEVEL DATA OR BY OTHER ATTENDEES. AFTER THE FIRST QUESTION, THE CONSULTANTS (A MEETING FACILITATOR AND AT LEAST ONE SCRIBE) SHARED A PROFILE OF THE COUNTY, INCLUDING A SUMMARY OF SECONDARY DATA. THE MEETINGS LASTED 90 MINUTES, OF WHICH 60 MINUTES WAS DEVOTED TO THE GROUP'S BRAINSTORMING. AT THE END, EACH PERSON WAS GIVEN 3 COLORED DOTS. THEY PLACED THE DOTS NEXT TO ISSUES THEY PRIORITIZED AS MOST IMPORTANT HEALTH CONDITIONS OR NEEDS OF THE COMMUNITY. THE AGENDA HANDOUT CONTAINED LINKS TO THE SURVEYS. SURVEYS THE CONSULTANTS DEVELOPED THREE TYPES OF SURVEYS: INDIVIDUAL CONSUMER; AGENCY; AND HEALTH DEPARTMENT. THE QUESTIONS REMAINED THE SAME FOR EACH SURVEY. THE AGENCY SURVEYS WERE PUSHED OUT VIA EMAIL AS WELL AS THE LINK WAS SHARED AT THE COMMUNITY MEETINGS. THE HEALTH DEPARTMENT VERSION ALSO REQUESTED THE QUALIFICATIONS OF THE RESPONDENTS. AS REQUIRED BY THE IRS, THE INDIVIDUAL CONSUMER SURVEY WAS ALSO TRANSLATED INTO SPANISH AND ADAPTED FOR MOBILE APPLICATION AT COMMUNITY EVENTS. THE CONSULTANTS USED SURVEYMONKEY TO COLLECT RESPONSES, TABULATE DATA, INTERPRET AND ANALYZE RESULTS, AND CREATE CATEGORIES TO TRACK KEY WORDS AND PHRASES. PAPER COPIES (TRANSLATED) WERE USED WITH SPANISH-SPEAKING FAMILIES, REFUGEES FROM RWANDA, AND AT TREATMENT FACILITIES. BOTH TRIHEALTH OUTREACH MINISTRIES AND SANTA MARIA COMMUNITY SERVICES PROVIDED THE ANSWERS ALREADY TRANSLATED INTO ENGLISH FOR THE CONSULTANTS. A TOTAL OF 113 IMMIGRANT SURVEYS WERE COMPLETED AND RETURNED. SEE APPENDIX 2 FOR THE SURVEY RESPONDENTS WHO IDENTIFIED THEMSELVES. APPENDIX 3 OF THE CHNA, WHICH IS POSTED TO TRIHEALTH'S WEBSITE, HAS A LIST OF HEALTH DEPARTMENT RESPONDENTS WITH THEIR QUALIFICATIONS.SECONDARY DATA SOURCES DATA COLLECTION COUNTY HEALTH RANKINGS (CHR) FORMED THE FOUNDATION FOR DATA COLLECTION WITH ITS COUNTY-LEVEL FOCUS ON HEALTH OUTCOMES, HEALTH FACTORS, HEALTH BEHAVIORS, QUALITY OF LIFE, CLINICAL CARE, PHYSICAL ENVIRONMENT, AND SOCIOECONOMIC FACTORS. ADDITIONAL SOURCES SUPPLEMENTED THE CHR DATA. PUBLICLY AVAILABLE HEALTH STATISTICS AND DEMOGRAPHICS WERE OBTAINED AT THE STATE AND COUNTY LEVEL. THE EPIDEMIOLOGISTS FOR PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY (PHDMC) VOLUNTEERED TO COLLECT DATA FOR THE STATE OF OHIO AND ITS COUNTIES. THEY INCLUDED DATA THROUGH 2016. OHIO'S 2017 DATA WAS NOT AVAILABLE IN TIME FOR THIS REPORT. THE NUMBER OF DATA MEASURES INCREASED BY 33%, FROM 106 IN 2016 TO 142 IN 2019. DATA SOURCES THE STANDARDS FOR RESEARCHING AND INCLUDING DATA WERE: * COMPARABLE (MEASURES WITH BENCHMARKS SUCH AS HEALTHY PEOPLE 2020 OR STATE/NATIONAL RATES) * COUNTY-LEVEL DATA (ZIP CODE LEVEL PREFERRED BUT RARE) * FOCUS ON HEALTH OUTCOME DATA (PREFERRED OVER SUBJECTIVE SURVEY DATA WHEN BOTH WERE AVAILABLE) * REPRODUCIBLE (NEW UPDATE AVAILABLE WITHIN THREE YEARS OR AT 3-YEAR INTERVALS VS. ONE-TIME) * REPUTABLE SOURCE * TREND DATA AVAILABLE (MORE THAN ONE DATA POINT; 3-5 YEARS PREFERRED) THE CHR WAS AN EXCELLENT STARTING POINT, BUT THE CONSULTANTS DISCOVERED ADDITIONAL SOURCES WITH MORE RECENT DATA AS WELL AS INDICATORS FOR MEASURES NOT COLLECTED BY CHR. THE PREVALENCE OF CERTAIN CANCERS, THE RAPID INCREASE OF HEROIN OVERDOSE DEATHS IN THE REGION, AND ADDITIONAL MORTALITY DATA ARE EXAMPLES OF SUPPLEMENTAL DATA. MANY EXCELLENT SOURCES OF INFORMATION DID NOT HAVE A BREAKDOWN BELOW THE STATE LEVEL OR DID NOT INCLUDE THE ENTIRE REGION. THE CONSULTANTS CONTACTED STATE HEALTH DEPARTMENTS, LOCAL HEALTH DEPARTMENTS, AND LOCAL EXPERTS. THE BIGGEST CHANGE FROM THE PRIOR CYCLE IS THAT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES NO LONGER MAINTAINS THE HEALTH INDICATORS WAREHOUSE AS AN ONLINE SOURCE, AND IT HAD PROVIDED DATA FOR EIGHT KEY MEASURES. PHDMC EPIDEMIOLOGISTS CONSULTED THE OHIO DATA FOR DATA RANGES ENDING WITH 2016 AND ONE PERIOD PRIOR. DUE TO CHARACTER LIMITATION IN THE SOFTWARE, THESE DATA SOURCES COULD NOT BE INCLUDED IN THIS EXPLANATION. HOWEVER, THE DATA SOURCES AND DATES CAN BE FOUND ON PAGES 12 AND 13 OF THE CHNA POSTED ON TRIHEALTH'S WEBSITE. BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 6A: * THE CHRIST HOSPITAL HEALTH NETWORK, * CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER, * CLINTON MEMORIAL HOSPITAL,* HIGHPOINT HEALTH, * KETTERING HEALTH NETWORK (FORT HAMILTON HOSPITAL, GRANDVIEW MEDICAL CENTER, GREENE MEMORIAL HOSPITAL, KETTERING BEHAVIORAL MEDICINE CENTER, KETTERING MEDICAL CENTER, SOIN MEDICAL CENTER, SOUTHVIEW MEDICAL CENTER, SYCAMORE MEDICAL CENTER)* LINDNER CENTER OF HOPE* MERCY HEALTH-CINCINNATI REGION (MERCY HEALTH-ANDERSON HOSPITAL, MERCY HEALTH-CLERMONT HOSPITAL, MERCY HEALTH-FAIRFIELD HOSPITAL, MERCY HEALTH-WEST HOSPITAL, THE JEWISH HOSPITAL)* MERCY HEALTH-SPRINGFIELD REGION (MERCY HEALTH-URBANA HOSPITAL, SPRINGFIELD REGIONAL MEDICAL CENTER)* PREMIER HEALTH (ATRIUM MEDICAL CENTER, MIAMI VALLEY HOSPITAL NORTH, MIAMI VALLEY HOSPITAL SOUTH, UPPER VALLEY MEDICAL CENTER)* TRIHEALTH (BETHESDA BUTLER HOSPITAL, BETHESDA NORTH HOSPITAL, GOOD SAMARITAN HOSPITAL, MCCULLOUGH-HYDE MEMORIAL HOSPITAL, TRIHEALTH EVENDALE HOSPITAL)* UC HEALTH (DANIEL DRAKE CENTER FOR POST-ACUTE CARE, UNIVERSITY OF CINCINNATI MEDICAL CENTER, WEST CHESTER HOSPITAL)* WILSON HEALTH* WAYNE HEALTHCARE BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 6A: * THE CHRIST HOSPITAL HEALTH NETWORK, * CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER, * CLINTON MEMORIAL HOSPITAL,* HIGHPOINT HEALTH, * KETTERING HEALTH NETWORK (FORT HAMILTON HOSPITAL, GRANDVIEW MEDICAL CENTER, GREENE MEMORIAL HOSPITAL, KETTERING BEHAVIORAL MEDICINE CENTER, KETTERING MEDICAL CENTER, SOIN MEDICAL CENTER, SOUTHVIEW MEDICAL CENTER, SYCAMORE MEDICAL CENTER)* LINDNER CENTER OF HOPE* MERCY HEALTH-CINCINNATI REGION (MERCY HEALTH-ANDERSON HOSPITAL, MERCY HEALTH-CLERMONT HOSPITAL, MERCY HEALTH-FAIRFIELD HOSPITAL, MERCY HEALTH-WEST HOSPITAL, THE JEWISH HOSPITAL)* MERCY HEALTH-SPRINGFIELD REGION (MERCY HEALTH-URBANA HOSPITAL, SPRINGFIELD REGIONAL MEDICAL CENTER)* PREMIER HEALTH (ATRIUM MEDICAL CENTER, MIAMI VALLEY HOSPITAL NORTH, MIAMI VALLEY HOSPITAL SOUTH, UPPER VALLEY MEDICAL CENTER)* TRIHEALTH (BETHESDA BUTLER HOSPITAL, BETHESDA NORTH HOSPITAL, GOOD SAMARITAN HOSPITAL, MCCULLOUGH-HYDE MEMORIAL HOSPITAL, TRIHEALTH EVENDALE HOSPITAL)* UC HEALTH (DANIEL DRAKE CENTER FOR POST-ACUTE CARE, UNIVERSITY OF CINCINNATI MEDICAL CENTER, WEST CHESTER HOSPITAL)* WILSON HEALTH* WAYNE HEALTHCARE BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 6B: * THE HEALTH COLLABORATIVE* GREATER DAYTON AREA HOSPITAL ASSOCIATION* ADAMS COUNTY HEALTH DEPARTMENT* BROWN COUNTY HEALTH DEPARTMENT* BUTLER COUNTY HEALTH DEPARTMENT* CHAMPAIGN-URBANA COUNTY HEALTH DEPARTMENT* CINCINNATI HEALTH DEPARTMENT* CITY OF HAMILTON HEALTH DEPARTMENT* CLARK COUNTY COMBINED HEALTH DEPARTMENT* CLERMONT COUNTY PUBLIC HEALTH* CLINTON COUNTY HEALTH DEPARTMENT* DARKE COUNTY GENERAL HEALTH DISTRICT* FAYETTE COUNTY PUBLIC HEALTH* GREENE COUNTY PUBLIC HEALTH* HAMILTON COUNTY PUBLIC HEALTH* HIGHLAND COUNTY HEALTH DEPARTMENT* MIAMI COUNTY PUBLIC HEALTH* MIDDLETOWN CITY HEALTH DISTRICT* NORWOOD HEALTH DEPARTMENT* PIQUA CITY HEALTH DEPARTMENT* PREBLE COUNTY PUBLIC HEALTH* PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY* SIDNEY SHELBY COUNTY HEALTH DEPARTMENT* SPRINGFIELD HEALTH DEPARTMENT* WARREN COUNTY COMBINED HEALTH DISTRICT* NORTHERN KENTUCKY HEALTH DEPARTMENT BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 6B: * THE HEALTH COLLABORATIVE* GREATER DAYTON AREA HOSPITAL ASSOCIATION* ADAMS COUNTY HEALTH DEPARTMENT* BROWN COUNTY HEALTH DEPARTMENT* BUTLER COUNTY HEALTH DEPARTMENT* CHAMPAIGN-URBANA COUNTY HEALTH DEPARTMENT* CINCINNATI HEALTH DEPARTMENT* CITY OF HAMILTON HEALTH DEPARTMENT* CLARK COUNTY COMBINED HEALTH DEPARTMENT* CLERMONT COUNTY PUBLIC HEALTH* CLINTON COUNTY HEALTH DEPARTMENT* DARKE COUNTY GENERAL HEALTH DISTRICT* FAYETTE COUNTY PUBLIC HEALTH* GREENE COUNTY PUBLIC HEALTH* HAMILTON COUNTY PUBLIC HEALTH* HIGHLAND COUNTY HEALTH DEPARTMENT* MIAMI COUNTY PUBLIC HEALTH* MIDDLETOWN CITY HEALTH DISTRICT* NORWOOD HEALTH DEPARTMENT* PIQUA CITY HEALTH DEPARTMENT* PREBLE COUNTY PUBLIC HEALTH* PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY* SIDNEY SHELBY COUNTY HEALTH DEPARTMENT* SPRINGFIELD HEALTH DEPARTMENT* WARREN COUNTY COMBINED HEALTH DISTRICT* NORTHERN KENTUCKY HEALTH DEPARTMENT BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 7D: COPY AVAILABLE WITHOUT CHARGE.PLEASE CONTACT TRIHEALTH MISSION AND CULTURE, 625 EDEN PARK DRIVE, 9TH FLOOR, CINCINNATI, OHIO 45202 BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 7D: COPY AVAILABLE WITHOUT CHARGEPLEASE CONTACT TRIHEALTH MISSION AND CULTURE, 625 EDEN PARK DRIVE, 9TH FLOOR, CINCINNATI, OHIO 45202 BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 11: DUE TO THE PROXIMITY OF TRIHEALTH EVENDALE HOSPITAL (TEH) AND BETHESDA NORTH HOSPITAL (BNH) (LESS THAN 5 MILES) AS WELL AS TEH BEING ONLY A SURGERY CENTER, THESE TWO HOSPITALS WILL WORK TOGETHER IN ADDRESSING THE SIGNIFICANT NEEDS OF THE AREA WITH BNH BEING THE LEADER AS IT IS ONE OF THE FLAGSHIP HOSPITALS OF THE TRIHEALTH SYSTEM.1) SUBSTANCE ABUSE/MENTAL HEALTH - IN RESPONSE TO THE ESCALATING OPIOID ADDICTION EPIDEMIC IN THE MARKET SERVED, A RELATED HOSPITAL, GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO (GSH) AND THE TRIHEALTH SYSTEM ENGAGED THE COMMUNITY IN AN ORGANIZED AND FOCUSED SET OF TACTICS TO ADDRESS THIS. SINCE OCTOBER 2017, THE TRIHEALTH OPIATE STEERING COMMITTEE AND THE GSH OPIATE PILOT CONTINUES TO FOCUS ON FIVE KEY AREAS: PREVENTION, TREATMENT, FUNDING, COMMUNITY PARTNERSHIPS AND TEAM MEMBER SUPPORT. THE FOCUS ON KEY AREAS HAS HELPED BUILD THE INFRASTRUCTURE NECESSARY TO PROVIDE TREATMENT NOT ONLY AT GSH BUT TO EXPAND KEY INITIATIVES TO OTHER TRIHEALTH HOSPITALS. PREVENTION* NARCAN DISTRIBUTION: NARCAN SERVES TO BLOCK THE EFFECTS OF OPIOIDS IN CASE OF AN ACCIDENTAL OVERDOSE. NARCAN WILL CONTINUE TO BE PROVIDED TO ALL ER PATIENTS WHO NEED IT WITHOUT COST TO THE PATIENT, AND GSH WILL CONTINUE ITS EDUCATION OF FIRST RESPONDERS AS NEW INFORMATION ARISES AND NEW RESPONDERS ARE TRAINED. TREATMENT * SUBSTANCE USE TREATMENT COORDINATORS (SUTC): BY JULY 2019, TRIHEALTH WILL HAVE A RESPONSE TO A GRANT PROPOSAL IT SUBMITTED TO BETHESDA FOUNDATION TO EXPAND THE SUTC ROLE TO BETHESDA NORTH HOSPITAL AS A PLATFORM FOR UTILIZING TELEHEALTH FOR FURTHER EXPANSION TO BETHESDA ARROW SPRINGS AMBULATORY CENTER AND MCCULLOUGH HYDE MEMORIAL HOSPITAL. SUTC HAS SPECIFIC SUBSTANCE USE TRAINING, CERTIFICATION AND EXPERIENCE IN SUBSTANCE USE DISORDERS (ALCOHOL, OPIATES ETC.). THE ROLE OF THE SUTC IS TO ENGAGE, ASSESS AND PROVIDE AN APPOINTMENT TO A TREATMENT PROGRAM WITHIN 24-48 HOURS AFTER DISCHARGE. * IN COLLABORATION WITH COMMUNITY PARTNERS BNH/TEH WILL CONTINUE TO TEST THE EFFICACY OF THIS ROLE AND EFFECTIVENESS AT MEETING THESE TARGETS. * IF THE PEER RECOVERY SPECIALIST IDENTIFIED IN THE GOOD SAMARITAN HOSPITAL PROGRESS REPORT RE: 2016 PRIORITIES IS EFFECTIVE IN REACHING OUT TO PATIENTS THAT MIGHT OTHERWISE BE RELUCTANT TO ENTER INTO RECOVERY, THIS FUNCTION WILL BE EVALUATED FOR EXPANSION TO OTHER TRIHEALTH ERS. * TRACKING OUTCOMES: THE TASK FORCE WILL BE MONITORING AN OPIOID DASHBOARD TO TRACK OUTCOMES SUCH AS UTILIZATION OF SUBSTANCE USE WITHDRAWAL MANAGEMENT ORDER SETS, BUPRENORPHINE INDUCTION (MEDICATION USED TO TREAT OPIATE ADDICTION), NARCAN DISPENSING ETC. THIS ALLOWS US TO MONITOR THE EFFECTIVENESS OF OUR INITIATIVES.2). INFANT MORTALITY - BNH PROVIDES OBSTETRIC ("OB") AND GYNECOLOGICAL SERVICES TO ALL COMERS VIA ITS OB CLINICS. THE OB CLINICS HAVE ADOPTED AN INNOVATIVE WOMAN CENTERED MEDICAL HOME MODEL MEANT TO REINFORCE COMPLIANCE WITH PREGNANT PATIENT OFFICE VISITS AND FOLLOW UP CARE. TRIHEALTH PROVIDES A BREASTFEEDING SUPPORT LINE FREE TO THE COMMUNITY, WHICH INCLUDES THE BNH/TEH SERVICE AREA.BNH AND TEH, THROUGH TRIHEALTH, WILL ALSO CONTINUE ITS LONG-TIME PARTNERSHIP WITH AND FUNDING OF SEVERAL ORGANIZATIONS (PROVIDING FUNDING AND HUMAN/CLINICAL RESOURCES) THAT TARGET INFANT MORTALITY AND CHILD HEALTH CONCERNS, INCLUDING; * CRADLE CINCINNATI - AN ORGANIZATION AIMED AT REDUCING INFANT MORTALITY THROUGH EDUCATION AND AWARENESS. CRADLE CINCINNATI'S GOALS ARE TO PREVENT PREMATURE BIRTHS, REDUCING TOBACCO USE AND SUBSTANCE ABUSE, AND PROMOTING SAFE SLEEP FOR BABIES THROUGH THREE APPROACHES: COMMUNICATIONS, MEDICAL, AND COMMUNITY. * HEALTHY BEGINNINGS, WHICH PROVIDES COMPREHENSIVE PRE-NATAL CARE TO THE UNDERSERVED. * HEALTHY MOMS AND BABES, WHICH PROVIDES HOME SERVICES FOR BOTH PRE-NATAL AND POST-DELIVERY SUPPORT FOR UNDERSERVED POPULATIONS. * TRIHEALTH'S THINK FIRST FOR YOUR BABY IS AN INJURY PREVENTION PROGRAM WITH A GOAL TO REDUCE UNINTENTIONAL INJURIES IN INFANTS UNDER THE AGE OF ONE YEAR THROUGH PRENATAL EDUCATION AND POST-PARTUM FOLLOW-UP. * OTHER PARTNERS INCLUDE MARCH OF DIMES AND SWEET CHEEKS DIAPER BANK. FINALLY, BNH AND TEH, THROUGH TRIHEALTH, WILL ALSO PROVIDE FINANCIAL SUPPORT TO OTHER ORGANIZATIONS THAT FOCUS RESOURCES ON INFANT MORTALITY AND MATERNAL HEALTH: * URBAN HEALTH PROJECT (OFFICE SPACE) * OB CLINICS * OB WOMAN CENTERED MEDICAL HOME MODEL * FUNDING FOR CRADLE CINCINNATI NEIGHBORHOOD BASED WOMAN CENTERED MEDICAL HOME * GOOD SAMARITAN FREE HEALTH CLINIC * HEALTHY BEGINNINGS * HEALTHY MOMS AND BABES * THINK FIRST FOR YOUR BABY * START STRONG * MARCH OF DIMES * SWEET CHEEKS DIAPER BANK3. CANCER - BNH, TEH AND TRIHEALTH CANCER INSTITUTE WILL CONTINUE THE TARGETED (MELANOMA, LUNG) FREE SCREENINGS AND FOLLOW UPS. THERE IS A MOBILE MAMMOGRAPHY UNIT THAT WILL CONTINUE TO DO SCREENING IN HIGH NEED AREAS WITHIN HAMILTON COUNTY E.G. AVONDALE, AND THE CITY OF HAMILTON IN BUTLER COUNTY. PATIENTS WITH POSITIVE RESULTS IDENTIFIED AT THE GOOD SAMARITAN FREE HEALTH CENTER WILL CONTINUE TO BE REFERRED TO BNH CLINIC PROVIDERS AND OBTAIN COVERAGE FROM STATE FUNDED BREAST AND CERVICAL CANCER PREVENTION (BCCP) FUNDING. BNH AND TEH THROUGH TRIHEALTH JUST BEGAN A PARTNERSHIP WITH THE ERICA HOLLOMAN FOUNDATION TO SCREEN PRIMARILY AFRICAN AMERICAN WOMEN AT RISK FOR A SPECIFIC KIND OF BREAST CANCER. BNH'S AND TEH'S FOCUS ON PREVENTION WILL CONTINUE TO DEMONSTRATE ITS COMMITMENT VIA IN KIND AND FINANCIAL SUPPORT OF OHIO CANCER RESEARCH, WHICH IS AN INDEPENDENT, STATEWIDE, NONPROFIT ORGANIZATION DEDICATED TO THE CURE AND PREVENTION OF THE MANY FORMS OF CANCER AND THE REDUCTION OF ITS DEBILITATING EFFECTS THROUGH AGGRESSIVE BASIC SEED MONEY RESEARCH, CANCER INFORMATION, AND AWARENESS. THE HOSPITALS PLAN TO CONTINUE FINANCIAL SUPPORT TO THE AMERICAN CANCER SOCIETY AND AMERICAN LUNG ASSOCIATION. 4. ACCESS TO CARE - THIS PRIORITY APPLIES ONLY TO BNH DUE TO THE NATURE OF TEH. CURRENTLY, BNH PROVIDES TRANSPORTATION FOR NEEDY PATIENTS WITH BUS TOKENS AND PAID UBER RIDES. GSH/TRIHEALTH WILL SEEK NEW PARTNERS AND IDENTIFY OTHER AVENUES TO EXPAND THIS TYPE OF SERVICE. IT IS NOT SOMETHING THAT HAS A NATURAL CONNECTION TO A HOSPITAL OR HEALTH SYSTEM LIKE THE OTHER THREE PRIORITIES. IF SPECIFIC ACTIONS THAT ARE WITHIN BNH AREAS OF EXPERTISE ARE NOT FOUND, BNH AND TEH WILL FOCUS ON 1-3 ABOVE. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 11: 1. SUBSTANCE ABUSE/MENTAL HEALTH - IN RESPONSE TO THE ESCALATING OPIOID ADDICTION EPIDEMIC IN THE MARKET SERVED, A RELATED HOSPITAL, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO (GSH) AND THE TRIHEALTH SYSTEM ENGAGED THE COMMUNITY IN AN ORGANIZED AND FOCUSED SET OF TACTICS TO ADDRESS THIS. SINCE OCTOBER 2017, THE TRIHEALTH OPIATE STEERING COMMITTEE AND THE GSH OPIATE PILOT CONTINUES TO FOCUS ON FIVE KEY AREAS: PREVENTION, TREATMENT, FUNDING, COMMUNITY PARTNERSHIPS AND TEAM MEMBER SUPPORT. THE FOCUS ON KEY AREAS HAS HELPED BUILD THE INFRASTRUCTURE NECESSARY TO PROVIDE TREATMENT NOT ONLY AT GSH BUT TO EXPAND KEY INITIATIVES TO OTHER TRIHEALTH HOSPITALS, INCLUDING BETHESDA BUTLER HOSPITAL (BBH). PREVENTION * NARCAN DISTRIBUTION: NARCAN SERVES TO BLOCK THE EFFECTS OF OPIOIDS IN CASE OF AN ACCIDENTAL OVERDOSE. NARCAN WILL CONTINUE TO BE PROVIDED TO ALL ER PATIENTS WHO NEED IT WITHOUT COST TO THE PATIENT, AND BBH WILL CONTINUE ITS EDUCATION OF FIRST RESPONDERS AS NEW INFORMATION ARISES AND NEW RESPONDERS ARE TRAINED. TREATMENT * SUBSTANCE USE TREATMENT COORDINATORS (SUTC): IN DECEMBER 2018, TRIHEALTH EXPANDED THE ROLE OF THE SUBSTANCE USE TREATMENT COORDINATOR ("SUTC") TO BBH THROUGH A STATE GRANT. THE ROLE OF THE SUTC IS TO ENGAGE, ASSESS AND PROVIDE AN APPOINTMENT TO A TREATMENT PROGRAM WITHIN 24-48 HOURS AFTER DISCHARGE. IN COLLABORATION WITH COMMUNITY PARTNERS SUCH AS THE ADDICTION SERVICES COUNCIL, BRIGHTVIEW, TALBERT HOUSE ENGAGEMENT CENTER, TRIHEALTH AND BBH WILL CONTINUE TO TEST THE EFFICACY OF THIS ROLE AND EFFECTIVENESS AT MEETING THESE TARGETS. *BY JULY 2019, TRIHEALTH WILL HAVE A RESPONSE TO A GRANT PROPOSAL IT SUBMITTED TO BETHESDA FOUNDATION TO EXPAND THE SUTC ROLE TO BETHESDA NORTH HOSPITAL AS A PLATFORM FOR UTILIZING TELEHEALTH FOR FURTHER EXPANSION TO ARROW SPRINGS AND MCCULLOUGH HYDE MEMORIAL HOSPITAL (MHMH), A RELATED HOSPITAL. MHMH ALSO SERVES THE BUTLER COUNTY POPULATION. * IF THE PEER RECOVERY SPECIALIST IDENTIFIED IN THE PROGRESS REPORT RE: 2016 PRIORITIES IS EFFECTIVE IN REACHING OUT TO PATIENTS THAT MIGHT OTHERWISE BE RELUCTANT TO ENTER INTO RECOVERY, THIS FUNCTION WILL BE EVALUATED FOR EXPANSION TO BBH. * TRACKING OUTCOMES: THE TASK FORCE WILL BE MONITORING AN OPIOID DASHBOARD TO TRACK OUTCOMES SUCH AS UTILIZATION OF SUBSTANCE USE WITHDRAWAL MANAGEMENT ORDER SETS, BUPRENORPHINE INDUCTION (MEDICATION USED TO TREAT OPIATE ADDICTION), NARCAN DISPENSING ETC. THIS ALLOWS US TO MONITOR THE EFFECTIVENESS OF OUR INITIATIVES. BBH PARTICIPATES IN THE TRIHEALTH BEHAVIORAL HEALTH INTAKE, DESIGNED TO GET PATIENTS TO PROPER TREATMENT SETTINGS AND LOCATIONS EARLY ONCE THEY ARE IN ONE OF THE TRIHEALTH EMERGENCY DEPARTMENTS. EXPANDED TO 24 HR/7-DAY OPERATION * RESPONSIVE TO ALL EMERGENCY DEPARTMENTS WITHIN TRIHEALTH BBH THROUGH TRIHEALTH ALSO PLANS TO CONTINUE ITS SUPPORT FOR: * URBAN HEALTH PROJECT * UNITED WAY, WHICH FUNDS A NUMBER OF AGENCIES THAT AIM TO GET SUBSTANCE ABUSERS BACK ON THEIR FEET IN SOCIETY * NAMI SOUTHWEST OHIO * CAT FEST, HOSTED BY THE CENTER FOR ADDICTION TREATMENT (MAJOR SPONSOR ALCOHOL AND DRUG ADDICTION PROGRAM) 2. INFANT MORTALITY - BBH PARTNERS DIRECTLY WITH AN AREA FEDERALLY QUALIFIED HEALTH CENTER ("FQHC") CALLED PRIMARY HEALTH SOLUTIONS ON A PROGRAM CALLED PRIM (PARTNERSHIP TO REDUCE INFANT MORTALITY), OBTAINING AN OBSTETRICIAN/GYNECOLOGIST FOR PATIENTS THAT SHOW UP IN BBH'S EMERGENCY DEPARTMENT PREGNANT AND WITHOUT PRENATAL CARE. IN PARTNERSHIP WITH MIAMI UNIVERSITY SCHOOL OF NURSING, BBH WILL CONTINUE SCREENING OF ER PATIENTS FOR UNDERLYING SOCIAL DETERMINANTS OF HEALTH ISSUES AND REFER THEM TO PRIMARY HEALTH SOLUTIONS AND/OR COMMUNITY AGENCIES THAT CAN HELP WITH THE UNDERLYING SOCIAL ISSUES. FINALLY, BBH THROUGH TRIHEALTH ALSO PROVIDES FINANCIAL SUPPORT TO OTHER ORGANIZATIONS THAT FOCUS RESOURCES ON INFANT MORTALITY AND MATERNAL HEALTH: * GOOD SAMARITAN FREE HEALTH CLINIC * MARCH OF DIMES * SWEET CHEEKS DIAPER BANK 3. CANCER - BBH AND TRIHEALTH CANCER INSTITUTE WILL CONTINUE THE TARGETED (MELANOMA, LUNG) FREE SCREENINGS AND FOLLOW UPS. THERE IS A MOBILE MAMMOGRAPHY UNIT THAT WILL CONTINUE TO DO SCREENING IN HIGH NEED AREAS WITHIN THE CITY OF HAMILTON IN BUTLER COUNTY. BBH'S AND TRIHEALTH'S FOCUS ON PREVENTION WILL CONTINUE TO DEMONSTRATE ITS COMMITMENT VIA IN KIND AND FINANCIAL SUPPORT OF OHIO CANCER RESEARCH, WHICH IS AN INDEPENDENT, STATEWIDE, NONPROFIT ORGANIZATION DEDICATED TO THE CURE AND PREVENTION OF THE MANY FORMS OF CANCER AND THE REDUCTION OF ITS DEBILITATING EFFECTS THROUGH AGGRESSIVE BASIC SEED MONEY RESEARCH, CANCER INFORMATION, AND AWARENESS. THE HOSPITAL PLANS TO CONTINUE FINANCIAL SUPPORT TO THE AMERICAN CANCER SOCIETY AND AMERICAN LUNG ASSOCIATION. 4. ACCESS TO CARE - CURRENTLY, BBH PROVIDES TRANSPORTATION FOR NEEDY PATIENTS WITH BUS TOKENS AND PAID UBER RIDES. BBH/TRIHEALTH WILL SEEK NEW PARTNERS AND IDENTIFY OTHER AVENUES TO EXPAND THIS TYPE OF SERVICE. IT IS NOT SOMETHING THAT HAS A NATURAL CONNECTION TO A HOSPITAL OR HEALTH SYSTEM LIKE THE OTHER THREE PRIORITIES. IF SPECIFIC ACTIONS THAT ARE WITHIN BBH AREAS OF EXPERTISE ARE NOT FOUND, BBH WILL FOCUS ON 1-3 ABOVE, PARTICULARLY ON SUBSTANCE ABUSE. BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE TO PART I, LINE 3C. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE TO PART I, LINE 3C. BETHESDA NORTH HOSPITAL PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE TO PART I, LINE 3C. BETHESDA BUTLER HOSPITAL PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE TO PART I, LINE 3C. 22 1 - BETHESDA MEDICAL CENTER-ARROW SPRINGS 100 ARROW SPRINGS BLVD LEBANON OH 45036 24-HOUR EMERGENCY ROOM AND COMPREHENSIVE OUTPATIENT SERVICES 2 - BETHESDA OBGYN CENTER RESIDENT CLINIC 10495 MONTGOMERY ROAD CINCINNATI OH 45242 WOMEN'S HEALTH 3 - BNH AMBULATORY TREATMENT CENTER 10506 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT INFUSION AND CHEMOTHERAPY TREATMENT 4 - TRIHEALTH SLEEP MEDICINE 10475 MONTGOMERY ROAD CINCINNATI OH 45242 SLEEP CENTER 5 - B NORTH MINIMALLY INVASIVE SURGERY CTR 10506 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT SURGICAL CENTER 6 - BETHESDA NORTH OUTPATIENT IMAGING CTR 10494 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT IMAGING AND COMPREHENSIVE BREAST CARE CENTER 7 - BETHESDA HAND REHABILITATION 10700 MONTGOMERY ROAD CINCINNATI OH 45242 PHYSICAL THERAPY 8 - BETHESDA HAND REHABILITATION 538 OAK STREET CINCINNATI OH 45206 PHYSICAL THERAPY 9 - BETHESDA LOVELAND PHYSICAL THERAPY 10675 LOVELAND-MADERIA ROAD LOVELAND OH 45140 PHYSICAL THERAPY 10 - BETHESDA FAMILY PRACTICE CENTER 1775 LEXINGTON AVE CINCINNATI OH 45212 FAMILY MEDICINE CLINIC 11 - BETHESDA ALCOHOLDRUG TREATMENT 4410 CARVER WOODS DRIVE CINCINNATI OH 45242 OUTPATIENT ALCOHOL AND DRUG TREATMENT 12 - BETHESDA BUTLER PHYSICAL THERAPY 3035 HAMILTON-MASON ROAD HAMILTON OH 45011 PHYSICAL THERAPY 13 - BETHESDA BUTLER IMAGING CENTER 3075 HAMILTON-MASON ROAD HAMILTON OH 45011 MEDICAL IMAGING 14 - TRIHEALTH SLEEP MEDICINE 3055 HAMILTON-MASON ROAD HAMILTON OH 45011 SLEEP MEDICINE CENTER 15 - BETHESDA SURGERY CENTER 10615 MONTGOMERY ROAD 300 CINCINNATI OH 45242 OUTPATIENT SURGICAL CENTER 16 - BETHESDA MONTGOMERY CARDIAC TESTING 10525 MONTGOMERY ROAD CINCINNATI OH 45242 OUTPATIENT CARDIAC TESTING 17 - BETHESDA MONTGOMERY SLEEP CENTER 10535 MONTGOMERY ROAD CINCINNATI OH 45242 SLEEP CENTER 18 - BETHESDA MRI KENWOOD 8311 MOTGOMERY ROAD CINCINNATI OH 45236 MEDICAL IMAGING 19 - BETHESDA MRI WEST CHESTER 4900 WUNNENBERG WAY WEST CHESTER OH 45069 MEDICAL IMAGING 20 - MEDICENTER RADIATION THERAPY 10550 MONTGOMERY ROAD CINCINNATI OH 45242 RADIATION THERAPY 21 - TRIHEALTH KENWOOD 8240 NORTHCREEK DRIVE CINCINNATI OH 45236 INTEGRATED OUTPATIENT CENTER 22 - THOMAS COMPREHENSIVE CARE CENTER 10506A MONTGOMERY RD CINCINNATI OH 45242 SPECIALTY SERVICES PART I, LINE 3C: BETHESDA HOSPITAL, INC. UTILIZES THE FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING CHARITY CARE ELIGIBILITY. SEE THE RESPONSES TO PART I, LINES 3A AND 3B.AN INDIVIDUAL'S INCOME UNDER FPG IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR CHARITY CARE. ADDITIONALLY, AN INDIVIDUAL'S INCOME IN RELATION TO HIS/HER MEDICAL EXPENSES IS ALSO TAKEN INTO ACCOUNT AND SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. PART I, LINE 6A: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. THE COMMUNITY BENEFIT PROVIDED BY BETHESDA HOSPITAL, INC. IS TRACKED ON A STANDALONE BASIS; HOWEVER, ITS COMMUNITY BENEFIT IS REPORTED IN A REPORT PREPARED BY TRIHEALTH IN COMBINATION WITH ITS RELATED HOSPITALS - THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, MCCULLOUGH-HYDE MEMORIAL HOSPITAL AND TRIHEALTH HOSPITAL, INC. PART I, LINE 7: FOR THE AMOUNTS REPORTED AT COST, IN PART I, LINE 7, BETHESDA HOSPITAL, INC. UTILIZED WORKSHEET 2 - RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H, TO CALCULATE THE COST-TO-CHARGE RATIO. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES COMMUNITY BENEFIT AMOUNT REPORTED IN PART I, LINE 7(G) DOES NOT INCLUDE COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25. IT IS PRESENTED ON FORM 990, PART VIII, LINE 2 AS A DEDUCTION FROM PATIENT SERVICE REVENUE WHICH CORRESPONDS TO ITS FINANCIAL STATEMENT PRESENTATION. SEE RESPONSE TO PART III, LINE 4. THEREFORE, NO ADJUSTMENT TO TOTAL EXPENSES SHOWN ON FORM 990, PART IX, LINE 25 IS NECESSARY. PART II, COMMUNITY BUILDING ACTIVITIES: BETHESDA HOSPITAL, INC. PROVIDED CASH DONATIONS TO VARIOUS CHARITABLE ORGANIZATIONS WITHIN THE COMMUNITY TO ADDRESS HOMELESSNESS, TO INCREASE EDUCATIONAL OPPORTUNITIES AND TO BUILD AN ECONOMIC INFRASTRUCTURE. PART III, LINE 2: SEE PART VI RESPONSE TO PART III, LINE 4. PART III, LINE 3: SEE PART VI RESPONSE TO PART III, LINE 4. PART III, LINE 4: BETHESDA HOSPITAL, INC.'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF THE TRIHEALTH AUDIT REPORT.PATIENT SERVICE REVENUE AND OTHER OPERATING REVENUE (PART OF FOOTNOTE B - PAGES 20-23)PLEASE NOTE THAT UNDER ACCOUNTING STANDARDS UPDATE NO. 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606), WHICH TRIHEALTH ADOPTED DURING THE FISCAL YEAR, BAD DEBT IS CONSIDERED AN "IMPLICIT PRICE CONCESSION AND IS NOT DISTINGUISHED FROM A CONTRACTUAL ADJUSTMENT UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND THEREFORE THERE IS NO LONGER A SPECIFIC DISCLOSURE FOR BAD DEBT IN THE CURRENT YEAR AUDIT REPORT.AS FOR THE AMOUNT OF BAD DEBT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, BETHESDA HOSPITAL, INC. DOES NOT REPORT ACTUAL BAD DEBT EXPENSE AS COMMUNITY BENEFIT. IF UPON FURTHER RESEARCH, IT IS ULTIMATELY DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER TRIHEALTH'S CHARITY CARE POLICY, THOSE COSTS WOULD BE RECLASSIFIED, AS APPROPRIATE, TO COMMUNITY BENEFIT AT THAT TIME.PLEASE NOTE THAT BAD DEBT EXPENSE IS NOT DETERMINED UNTIL AFTER ALL DISCOUNTS AND ANY ASSOCIATED PAYMENTS ARE TAKEN INTO ACCOUNT. IF ANY PAYMENTS ARE RECEIVED AFTER A PATIENT ACCOUNT IS DETERMINED TO BE BAD DEBT, THE ACCOUNT WILL BE ADJUSTED ACCORDINGLY AT THAT TIME. PART III, LINE 8: BETHESDA HOSPITAL, INC. USES THE "STEPDOWN METHODOLOGY" IN DETERMINING THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THIS METHOD OF COST FINDING PROVIDES FOR THE ALLOCATION OF THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS WHICH UTILIZE SUCH SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. BETHESDA HOSPITAL, INC. DID NOT REPORT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT IN PART III, LINE 7 OF THIS SCHEDULE. PART III, LINE 9B: AS OF THE FILING OF THIS RETURN, BETHESDA HOSPITAL, INC., AS PART OF TRIHEALTH, INC., MAINTAINS A WRITTEN DEBT COLLECTION POLICY. TRIHEALTH, INC., WHO PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS, WILL NOT INITIATE COLLECTION PRACTICES ON PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BEFORE COLLECTION ACTIONS ARE TAKEN, TRIHEALTH, INC. WILL MAKE REASONABLE EFFORTS, GENERALLY AS EARLY IN THE BILLING PROCESS AS POSSIBLE, TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. AFTER SUCH EFFORTS HAVE BEEN MADE AND A BALANCE REMAINS THAT IS THE RESPONSIBILITY OF THE PATIENT OR GUARANTOR, TRIHEALTH, INC. MAY PURSUE, IN ITS SOLE DISCRETION, WHATEVER ACTIONS IT MAY BE ENTITLED TO TAKE UNDER LAW. PART VI, LINE 2: IN 1896, BETHESDA HOSPITAL, INC. ("BETHESDA") BEGAN AS A HOME VISITING MINISTRY OF THE METHODIST DEACONESSES TO SERVE THE HEALTH NEEDS OF THE GERMAN IMMIGRANTS LIVING IN CINCINNATI. NOW THAT MINISTRY, ONCE LED BY DEACONESS LOUISE GOLDER AND HER BROTHER REV. CHRISTIAN GOLDER, HAS GROWN INTO SEVERAL HEALTH SERVICES FOR GREATER CINCINNATI. IN 1995, BETHESDA, INC. AND GOOD SAMARITAN HOSPITAL FORMED A PARTNERSHIP TO CREATE A LOCAL HEALTH SYSTEM: TRIHEALTH, INC. ("TRIHEALTH"). THE MISSION OF TRIHEALTH IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY THROUGH A FULL RANGE OF HEALTH RELATED SERVICES-PREVENTION, WELLNESS AND EDUCATION AND THUS EXEMPLIFY THE FOUNDING SPIRIT OF THE BETHESDA DEACONESSES.THE SERVICES DESCRIBED BELOW, AND OTHERS NOT LISTED, PROMOTE COMMUNITY HEALTH IN ACUTE ILLNESS, IN MANAGEMENT OF CHRONIC DISEASE, AND IN EDUCATION AND PREVENTION MEASURES. PROGRAMS SEEK TO REDUCE THE BURDENS ON THE GOVERNMENT. FOR EXAMPLE, IF BETHESDA DID NOT ADDRESS THE ROOT CAUSES OF LOW BIRTH WEIGHT AND PREMATURITY, THE BURDEN TO GOVERNMENT MEDICAL PROGRAMS SUCH AS MEDICAID WOULD BE EVEN GREATER. CHNAAS A FOLLOW UP TO THE 2016 CHNA, TRIHEALTH, INC. AND ITS HOSPITALS JOINED THIRTY-ONE (31) OTHER HOSPITALS IN THE GREATER CINCINNATI-DAYTON REGION TO SPONSOR AND FUND A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT ENTITLED "SW OHIO, N KENTUCKY, SE INDIANA COMMUNITY HEALTH NEEDS ASSESSMENT REPORT 2019". THE COMPREHENSIVE CHNA SPANS TWENTY-FIVE (25) COUNTIES. THE REGIONAL CHNA REPORT COVERS GREATER DAYTON AND GREATER CINCINNATI, WHICH INCLUDES NORTHERN KENTUCKY AND SOUTHEASTERN INDIANA. THE 2019 CHNA REPORT SHARES DATA FOR THE WHOLE REGION AS WELL AS DETAILED COUNTY-LEVEL DATA. IT ALSO ADDED THE VOICE OF THE SOUTHWEST OHIO MEMBERS OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS. DEVELOPING A BROAD CHNA HELPS FULFILL THE STATE OF OHIO'S REQUIREMENT MANDATING THAT HEALTH DEPARTMENTS AND HOSPITALS ALIGN THEIR ASSESSMENTS.FROM THIS LARGER REPORT, TRIHEALTH DEVELOPED A CHNA AND ASSOCIATED IMPLEMENTATION STRATEGY FOR EACH OF ITS FACILITIES BASED ON THE COUNTY BREAKDOWN AND DISCUSSION WITH TRIHEALTH LEADERS WITH EXPERTISE IN THE AREAS WHICH NEED TO BE ADDRESSED.PROGRAM SERVICE ACCOMPLISHMENTSFREE AND DISCOUNTED SERVICES ARE PROVIDED FOR THOSE UNABLE TO PAY AND MEETING ELIGIBILITY CRITERIA. THROUGH THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP), BETHESDA SERVES PATIENTS MEETING CRITERIA SET FORTH BY THE OHIO DEPARTMENT OF JOBS AND FAMILY SERVICES. BETHESDA POLICY IS TO PROVIDE CHARITY CARE ON A SLIDING SCALE DISCOUNTING WHEN THE FAMILY INCOME IS UP TO 300 PERCENT OF THE ANNUALLY ESTABLISHED FEDERAL POVERTY GUIDELINE. IT OFFERS AN UNINSURED DISCOUNT FOR MEDICALLY NECESSARY SERVICES FOR THOSE WHO HAVE NO INSURANCE AND WHO DO NOT QUALIFY FOR OTHER FINANCIAL ASSISTANCE OPTIONS. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION WHICH IS AVAILABLE ON TRIHEALTH'S WEBSITE AND BROCHURES ABOUT FINANCIAL ASSISTANCE ARE VISIBLE AND AVAILABLE IN HOSPITAL REGISTRATION AND ADMITTING AREAS.DURING THE YEAR, BETHESDA PROVIDED COMMUNITY BENEFIT (INCLUDING UNCOMPENSATED CARE) AS SHOWN ON PART I, LINE 7A. THE AMOUNT OF BENEFIT FOR BOTH TRADITIONAL CHARITY CARE AND FOR THE UNPAID COST OF MEDICAID IS ONE MANIFESTATION OF THE RISING RATES OF PERSONS WITHOUT HEALTH INSURANCE. THE MEDICAID PUBLIC PROGRAM REIMBURSES HOSPITALS FOR SERVICES BUT PAYMENTS MAY NOT ALWAYS COVER THE TOTAL COST OF CARE AND MEDICATIONS. THE UNPAID COST OF MEDICARE IS NOT INCLUDED IN TOTAL COMMUNITY BENEFIT. BETHESDA IS COMMITTED TO FULFILLING THE MISSION OF COMPASSION TO THE VULNERABLE MEMBERS OF THE COMMUNITIES THEY SERVE.BETHESDA PARTICIPATES IN THE REGIONAL TRAUMA SYSTEM THUS PROVIDING THE COMMUNITY WITH ACCESS TO TRAUMA CARE. THE TWO EMERGENCY ROOMS OF BETHESDA PROVIDE 24-HOUR EMERGENCY CARE TO COMMUNITY MEMBERS LIVING IN THE NORTHEAST CORRIDOR OF CINCINNATI AS WELL AS WARREN, BUTLER, AND CLERMONT COUNTIES. BETHESDA IS A LEVEL III TRAUMA CENTER AS VERIFIED BY THE COMMITTEE ON TRAUMA OF THE AMERICAN COLLEGE OF SURGEONS. ONE EXAMPLE OF ONGOING EFFORTS BY BETHESDA TO IMPROVE THE HEALTH OF THE BROADER COMMUNITY ARE PROGRAMS TO ADDRESS THE IDENTIFIED HEALTH NEED OF DIABETES. DIABETES EDUCATORS EXTEND THE EDUCATION TO THE COMMUNITY BY PROVIDING CLASSES TO A DIVERSE POPULATION, FROM AREA INDUSTRIES AND FIREHOUSE GROUPS TO RETIREMENT CENTERS. A DIABETES SUPPORT GROUP MEETS FOR CONTINUED EDUCATION IN CHRONIC DISEASE MANAGEMENT. THOUGH HEALTHY WOMEN HEALTHY LIVES WAS INSTITUTED IN JULY 2007 BY GOOD SAMARITAN HOSPITAL WOMEN'S SERVICES TO IMPROVE THE HEALTH OF THE GREATER CINCINNATI COMMUNITY, IT IS NOW FISCALLY SUPPORTED BY BETHESDA HOSPITAL AS WELL, MAKING IT A TRIHEALTH SYSTEM PROGRAM. HEALTHY WOMEN HEALTHY LIVES IS AN APPROACH BASED ON THE PREMISE THAT PREVENTION, EARLY DETECTION, TREATMENT AND ACCESS TO HEALTH CARE SERVICES IMPROVE INDIVIDUAL AND COMMUNITY HEALTH OUTCOMES. THE FOCUS IS ON HEALTH RISKS ASSOCIATED WITH THE ONSET OF MENOPAUSE. WELL ORGANIZED SCREENING AND EDUCATION EVENTS BRING THE SERVICES TO AT RISK POPULATIONS OF AFRICAN AMERICAN, APPALACHIAN, HISPANIC, UNINSURED AND UNDERINSURED WOMEN FORTY YEARS OF AGE OR OLDER. SCREENING INCLUDES OSTEOPOROSIS, MAMMOGRAPHY, CHOLESTEROL, HYPERTENSION, AND OBESITY. EVERY WOMAN RECEIVES A NURSE CONSULTATION, A COPY OF THEIR RESULTS AND A WRITTEN PRIMARY CARE REFERRAL. WOMEN WITH ABNORMAL RESULTS ARE CONTACTED AND ASSISTED IN ACCESSING PRIMARY CARE. IN ADDITION, WOMEN NEEDING PREGNANCY AND GYNECOLOGIC CARE CAN ACCESS THIS SERVICE AT THE OB/GYN CENTER AT BETHESDA NORTH HOSPITAL. CARE IS PROVIDED BY THE MEDICAL RESIDENTS IN OBSTETRICS AND GYNECOLOGY, SUPERVISED BY FACULTY PHYSICIANS. FINANCIAL COUNSELORS AND CARE COORDINATORS ASSIST IN FINDING APPROPRIATE COVERAGE, PAYMENT PLANS AND FINANCIAL AID. AS MANY OF THE WOMEN SERVED BY THE OB/GYN CENTER AT BETHESDA NORTH HOSPITAL HAVE LIMITED PROFICIENCY IN ENGLISH, QUALIFIED BILINGUAL STAFF ASSIST IN LANGUAGE INTERPRETATION. THE TRIHEALTH THINK FIRST PROGRAM IS AN ESTABLISHED BETHESDA SERVICE FOCUSED ON INJURY PREVENTION. THE THINK FIRST PROGRAM STAFF WORKS WITH COMMUNITY PARTNERS TO PROVIDE INJURY PREVENTION PROGRAMS AND COMMUNITY AWARENESS EVENTS. COLLABORATING WITH THE EDUCATORS, THE MEDIA, CIVIC CLUBS AND CORPORATIONS, THINK FIRST TEACHES INJURY PREVENTION TO ALL AGE GROUPS. BETHESDA, WITH OTHER ORGANIZATIONS, PROVIDE SUPPORT TO THE RESPITE CENTER, SERVING THE ADULT HOMELESS OF CINCINNATI. THE RESPITE CENTER, WITH 14 BEDS AND 24 HOUR COVERAGE, PROVIDES FREE MEDICAL SERVICES AND ACCOMMODATIONS FOR HOMELESS PERSONS NEEDING SOME MEDICAL OVERSIGHT. RESPITE HELPS PEOPLE WITHOUT HOMES TOWARD INDEPENDENT LIVING IN PERMANENT HOUSING. BETHESDA CONTINUES A COMMITMENT TO EDUCATING THE NEXT GENERATION OF HEALTH CARE PROVIDERS--PHYSICIANS AND ALLIED HEALTH PROFESSIONALS. COST IN EXCESS OF GOVERNMENTAL SUPPORT FOR MEDICAL EDUCATION PROGRAMS AS SHOWN ON PART I, LINE 7H.THE BETHESDA PARAMEDIC TRAINING PROGRAM IS A HOSPITAL-BASED PROGRAM ACCREDITED BY THE OHIO DEPARTMENT OF TRANSPORTATION. THROUGH THIS TRAINING PROGRAM, CERTIFIED EMERGENCY MEDICAL TECHNICIANS CAN ADVANCE TO THE PARAMEDIC LEVEL. EDUCATION IS COMPRISED OF DIDACTIC SESSIONS, WITH LAB, FIELD, AND HOSPITAL CLINICAL ROTATIONS. BETHESDA, AS A PART OF TRIHEALTH, COLLABORATES WITH LOCAL AND REGIONAL COLLEGES, UNIVERSITIES AND TRAINING CENTERS TO PROVIDE MENTORING, INTERNSHIPS, CLERKSHIPS, SUPERVISED EDUCATION AND CLINICAL ROTATIONS TO STUDENTS IN HEALTH FIELDS. THESE PARTNERSHIPS HELP STUDENTS LEARN ABOUT AND PREPARE FOR PROFESSIONS IN NURSE PRACTITIONER, RESPIRATORY THERAPY, RADIOLOGY TECHNOLOGY, STERILE PROCESSING, PHLEBOTOMY, MEDICAL LABORATORY, PHARMACY, SPEECH, AUDIOLOGY, PHYSICAL THERAPY, AND OCCUPATIONAL THERAPY. IN CONCLUSION, ASIDE FROM THE CHARITY CARE AND UNPAID COST OF MEDICARE PROGRAMS, BETHESDA PROVIDES THE COMMUNITY WITH HEALTH CARE SERVICES AND PROGRAMS, MEDICAL EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS FOR THE POOR AND THE BROADER COMMUNITY. THIS COMMITMENT TO COMMUNITY HEALTH REVEALS BETHESDA'S FOUNDING SPIRIT OF CONCERN FOR THE VULNERABLE. IT ALSO REFLECTS THE ONGOING, TANGIBLE EFFORTS AND CONTRIBUTIONS OF COUNTLESS EMPLOYEES, PHYSICIANS AND LEADERS LIVING THE CORE VALUES OF STEWARDSHIP AND RESPONSE TO COMMUNITY NEEDS. PART VI, LINE 3: TRIHEALTH, INC. PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS INCLUDING BETHESDA HOSPITAL, INC. BROCHURES/APPLICATIONS, PROVIDED IN MULTIPLE LANGUAGES, ARE VISIBLE AND AVAILABLE IN THE REGISTRATION AND ADMITTING AREAS OF ALL TRIHEALTH AFFILIATED HOSPITALS. IN ADDITION, THE APPLICATION IS PRINTED ON THE REVERSE SIDE OF A PATIENT'S BILL WITH INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION AS WELL AS HOW TO RETURN IT. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. FINALLY, TRIHEALTH INC.'S WEBSITE CONTAINS INFORMATION REGARDING ITS CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS WITH DIRECTIONS ON HOW TO CONTACT THE APPROPRIATE PERSONNEL TO INITIATE AN APPLICATION OR ASK QUESTIONS ABOUT THE PROCESS. PART VI, LINE 4: WITH ONE HOSPITAL LOCATED IN MONTGOMERY, OHIO, A SUBURB OF CINCINNATI, AND ONE LOCATED NEAR HAMILTON, OHIO, BETHESDA HOSPITAL, INC. AND THE TRIHEALTH SYSTEM SERVE PRIMARILY HAMILTON, BUTLER, WARREN AND CLERMONT COUNTIES IN OHIO AS WELL AS SOME PERSONS FROM INDIANA AND KENTUCKY. BETHESDA NORTH HOSPITALHAMILTON COUNTY IS THE MOST POPULATED COUNTY IN THE REGION AND IS HOME TO THE LARGEST CITY, CINCINNATI. THE ESTIMATED POPULATION OF THE COUNTY IS 820,000 WITH APPROXIMATELY 15.5% IN POVERTY AND APPROXIMATELY 7% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. BUTLER COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $52,500 WITH 90% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (36% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 15% OF THE POPULATION IS 65 YEARS AND OLDER, 65% IS WHITE, 27% IS AFRICAN-AMERICAN, 4% IS HISPANIC, 3% ASIAN AND 1% OTHER.CLERMONT COUNTY IS A LARGE COUNTY WHICH WAS ONCE MOSTLY RURAL BUT HAS BECOME MORE SUBURBAN AND IS ONE OF OHIO'S APPALACHIAN COUNTIES. THE ESTIMATED POPULATION OF THE COUNTY IS 205,000 WITH APPROXIMATELY 8.5% IN POVERTY AND APPROXIMATELY 6% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. CLERMONT COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $64,000 WITH 90% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (28% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 16% OF THE POPULATION IS 65 YEARS AND OLDER, 93% IS WHITE, 2% IS AFRICAN-AMERICAN, 2% IS HISPANIC, 1.5% ASIAN AND 1.5% OTHER.WARREN COUNTY IS ONE OF THE FASTEST GROWING COUNTIES IN OHIO, BOTH IN RESIDENTIAL AND COMMERCIAL GROWTH. THE ESTIMATED POPULATION OF THE COUNTY IS 232,000 WITH APPROXIMATELY 5% IN POVERTY AND APPROXIMATELY 5% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. CLERMONT COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $79,500 WITH 93% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (42% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 3.5%. APPROXIMATELY 15% OF THE POPULATION IS 65 YEARS AND OLDER, 86% IS WHITE, 6% ASIAN, 4% IS AFRICAN-AMERICAN, 3% IS HISPANIC, AND 1% OTHER.BETHESDA BUTLERBUTLER COUNTY IS ONE OF THE MOST POPULATED COUNTIES IN THE REGION AND INCLUDES THE CITIES OF HAMILTON, MIDDLETOWN AND OXFORD. MANY OF THE CITIES IN THE COUNTY ARE EXPERIENCING GROWTH, AND ONLY ABOUT 9% IS CONSIDERED RURAL. THE ESTIMATED POPULATION OF THE COUNTY IS 385,000 WITH APPROXIMATELY 12.5% IN POVERTY AND APPROXIMATELY 7% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. BUTLER COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $62,000 WITH 90% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (30% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 15% OF THE POPULATION IS 65 YEARS AND OLDER, 80% IS WHITE, 9% IS AFRICAN-AMERICAN, 5% IS HISPANIC, 4% ASIAN AND 2% OTHER. PART VI, LINE 5: BETHESDA HOSPITAL, INC. IS COMPRISED OF VARIOUS MEDICAL SERVICES INCLUDING BETHESDA NORTH HOSPITAL ("NORTH"), BETHESDA MEDICAL CENTER AT ARROW SPRINGS ("ARROW SPRINGS") AND BETHESDA BUTLER HOSPITAL ("HOSPITAL"). ITS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. NORTH IS A 458-BED ACUTE TERTIARY TEACHING HOSPITAL. NORTH PROVIDES A 24-HOUR EMERGENCY DEPARTMENT, INTENSIVE CARE UNITS AND A LEVEL II SPECIAL CARE NURSERY. SERVICES ARE OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. IN ADDITION, NORTH HAS AN OPEN MEDICAL STAFF AND A HISTORY OF TRAINING AND EDUCATING MEDICAL RESIDENTS AND HEALTH CARE PROFESSIONALS. FINALLY IN CONCERT WITH THE HATTON INSTITUTE AT THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, AN AFFILIATED HOSPITAL, NORTH CONDUCTS MEDICAL AND SCIENTIFIC RESEARCH PROGRAMS INCLUDING STUDIES THAT ARE NOT COMMERCIALLY SPONSORED. NORTH PARTICIPATES IN MEDICARE AND MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS, AND HAS AN ACTIVE CHARITY CARE PROGRAM.ARROW SPRINGS COMPRISES A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT, PRIMARY CARE AND SPECIALIST PHYSICIANS, DIAGNOSTIC SERVICES, OCCUPATIONAL MEDICINE, PHYSICAL THERAPY AND A PHARMACY. IT PROVIDES THE SAME HIGH-QUALITY, PATIENT-CENTERED CARE AND SERVICES THAT IS PROVIDED BY NORTH. BUTLER IS AN OVER 50-BED SURGICAL HOSPITAL LOCATED NEAR HAMILTON, OHIO. IT PROVIDES EVERYTHING FROM SURGERY, CARDIOLOGY AND IMAGING TO PHYSICAL THERAPY AND SLEEP STUDIES. WITH EIGHT OPERATING ROOMS, THREE ENDOSCOPY SUITES, TWO PROCEDURE ROOMS AND A FULL-SERVICE 24-HOUR EMERGENCY DEPARTMENT, THE HOSPITAL IS COMPLEMENTED BY ADDITIONAL SERVICES AND PHYSICIAN OFFICES FOR PRIMARY CARE, PEDIATRICS AND SPECIALTY CARE ON CAMPUS.THE BETHESDA HOSPITAL, INC. SERVICES DESCRIBED ABOVE, AND OTHERS NOT LISTED, PROMOTE COMMUNITY HEALTH IN ACUTE ILLNESS, IN MANAGEMENT OF CHRONIC DISEASE, AND IN EDUCATION AND PREVENTION MEASURES WHICH SEEK TO REDUCE THE BURDENS ON THE GOVERNMENT.SEE RESPONSE TO PART VI, LINE 2 FOR ADDITIONAL INFORMATION. PART VI, LINE 6: IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH IN ORDER TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.THROUGH FIVE (5) HOSPITALS, FIVE (5) AMBULATORY LOCATIONS AND OVER 125 SITES OF CARE (EMPLOYING OVER 600 PHYSICIANS INCLUDING RESIDENTS), TRIHEALTH PROVIDES A WIDE RANGE OF CLINICAL, EDUCATIONAL, PREVENTIVE AND SOCIAL PROGRAMS. TRIHEALTH'S NON-HOSPITAL SERVICES INCLUDE PHYSICIAN PRACTICE MANAGEMENT, FITNESS CENTERS AND FITNESS CENTER MANAGEMENT, OCCUPATIONAL HEALTH CENTERS, HOME HEALTH AND HOSPICE CARE.HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/ 1 UPTOWN CONSORTIUM INC 619 OAK STREET SUITE 1100 CINCINNATI OH 45206 200688727 501(C)(3) 185310 GENERAL PURPOSES UNITED WAY 2400 READING ROAD CINCINNATI OH 45202 310537502 501(C)(3) 77932 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 63900 SPONSORSHIP LEGAL AID SOCIETY OF CINCINNATI 215 EAST NINTH STREET SUITE 200 CINCINNATI OH 45202 310536673 501(C)(3) 57510 M-HELP PROGRAM FUNDING HEALTHY MOMS & BABES INC 2270 BANNING ROAD NO 200 CINCINNATI OH 45239 311155292 501(C)(3) 53676 GENERAL SUPPORT GREATER CINCINNATI FOUNDATION 720 E PETE ROSE WAY SUITE 120 CINCINNATI OH 45202 310669700 501(C)(3) 51120 PROJECT LIFT FUNDING FREESTORE FOODBANK INC 1141 CENTRAL PARKWAY CINCINNATI OH 45202 237122205 501(C)(3) 37851 SPONSORSHIP AMERICAN CANCER SOCIETY INC 250 WILLIAMS STREET NW SUITE 400 ATLANTA GA 30303 131788491 501(C)(3) 24793 SPONSORSHIP CENTER FOR RESPITE CARE INC PO BOX 141301 CINCINNATI OH 45250 202544994 501(C)(3) 20448 GENERAL SUPPORT SWEET CHEEKS DIAPER BANK 1615 REPUBLIC STREET CINCINNATI OH 45202 475175383 501(C)(3) 20448 SPONSORSHIP JDRF INTERNATIONAL 200 VESEY STREET 28TH FLOOR NEW YORK NY 10281 231907729 501(C)(3) 15336 SPONSORSHIP KAREN WELLINGTON MEMORIAL FOUNDATION FOR LIVING W BREAST CANCER 312 WALNUT ST NO 1800 CINCINNATI OH 45202 263768567 501(C)(3) 12780 SPONSORSHIP OVARIAN CANCER ALLIANCE OF GREATER CINCINNATI 4918 COOPER ROAD CINCINNATI OH 45242 311287785 501(C)(3) 10224 SPONSORSHIP FRIARS CLUB INC 4300 VINE STREET CINCINNATI OH 45217 310537485 501(C)(3) 10224 PROGRAM SUPPORT NAMI OF SOUTHWEST OHIO 4055 EXECUTIVE PARK DRIVE SUITE 450 450 CINCINNATI OH 45241 310998076 501(C)(3) 10224 SPONSORSHIP LEUKEMIA & LYMPHOMA SOCIETY INC 3 INTERNATIONAL DRIVE RYE BROOK NY 10573 135644916 501(C)(3) 7668 SPONSORSHIP EPISCOPAL RETIREMENT HOMES INC 3870 VIRGINA AVE CINCINNATI OH 45227 310554071 501(C)(3) 5112 SPONSORSHIP MARCH OF DIMES 10806 KENWOOD ROAD CINCINNATI OH 45242 131846366 501(C)(3) 5112 SPONSORSHIP INTERFAITH HOSPITALITY NETWORK OF GREATER CINCINNATI 990 NASSAU STREET CINCINNATI OH 45206 311335474 501(C)(3) 5112 DIRECT SERVICES TO HOMELESS FAMILIES OHIO CANCER RESEARCH ASSOCIATES 85 EAST GAY STREET SUITE 700 COLUMBUS OH 43215 311038309 501(C)(3) 5112 SPONSORSHIP DOWN SYNDROME ASSOCIATION OF GREATER CINCINNATI 4623 WESLEY AVENUE CINCINNATI OH 45212 311051378 501(C)(3) 5112 SPONSORSHIP TENDER MERCIES INC 27 WEST 12TH STREET CINCINNATI OH 45202 311137270 501(C)(3) 5112 GENERAL SUPPORT 22 0 PART I, LINE 2: BETHESDA HOSPITAL, INC. ("HOSPITAL") PROVIDES GRANTS TO OTHER ORGANIZATIONS DIRECTLY ON A VERY LIMITED BASIS. IN THOSE INSTANCES, THE DEPARTMENT GRANTING THE FUNDS IS RESPONSIBLE FOR OBTAINING AND STORING ALL NECESSARY INFORMATION FROM THE OTHER ORGANIZATION RELATIVE TO HOW THE FUNDS WILL BE SPENT. GENERALLY, GRANTS ARE PROVIDED, ON BEHALF OF HOSPITAL THROUGH TRIHEALTH, INC. ("TRIHEALTH"), A SUPPORTING ORGANIZATION OF HOSPITAL, WHICH PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO HOSPITAL. AS SUCH, TRIHEALTH IS RESPONSIBLE FOR MONITORING THE USE OF HOW THE FUNDS WILL BE SPENT. 1 1 0 0 0 0 0 0 0 CRAIG EISENTROUT MD TRUSTEE (END 6/20) 0 299737 0 0 0 4347 0 25410 0 25601 0 355095 0 0 MARK CLEMENT PRESIDENT/CEO 0 1158232 0 264531 0 58822 0 329321 0 17554 0 1828460 0 0 SCOTT FRIEDSTROM MD MED STAFF PRES-(END 12/19) 0 543036 0 31795 0 53422 0 55677 0 32926 0 716856 0 0 ANDREW DEVOE ASST. TREASURER/CFO 0 579546 0 140404 0 17498 0 144652 0 31765 0 913865 0 0 STEVE GRACEY ASST. SECRETARY/SVP LEGAL 0 429210 0 86917 0 18522 0 109962 0 31350 0 675961 0 0 STEFANIE NEWMAN VP-CNO BETHESDA (END 9/19) 0 153704 0 80594 0 292706 0 49037 0 20680 0 596721 0 0 DAVID COOK CHIEF HR OFFICER 0 391458 0 81103 0 3333 0 79254 0 25158 0 580306 0 0 LONDON QUICCI PRESIDENT-BETHESDA NORTH 0 339189 0 51838 0 1901 0 69781 0 11391 0 474100 0 0 KEVIN JOSEPH MD CHIEF MEDICAL OFFICER 0 535110 0 124151 0 33088 0 125353 0 31823 0 849525 0 0 JENNY SKINNER CNE-TRIHEALTH 0 309470 0 58382 0 16543 0 108609 0 17643 0 510647 0 0 ROB CERCEK EVP POP HEALTH (END 10/19) 0 455459 0 118061 0 70452 0 106374 0 22866 0 773212 0 0 MICHAEL EVERETT PRESIDENT-BETHESDA BUTLER 0 142071 0 20000 0 10081 0 11129 0 12084 0 195365 0 0 JOHN WARD SVP-BETHESDA REGION 0 416123 0 84343 0 29998 0 131884 0 25963 0 688311 0 0 MICHAEL HOLBERT MD PHYSICIAN 265050 91539 0 0 1030 243 35067 0 6900 2335 308047 94117 0 0 RICHARD OKRAGLY MD PHYSICIAN 232403 0 3695 0 9544 0 21621 0 30808 0 298071 0 0 0 SAKUNTHALA NATARAJAN MD PHYSICIAN 203453 0 29691 0 3395 0 46199 0 890 0 283628 0 0 0 ROBERT KUNKEL MD PHYSICIAN 251512 0 18982 0 13651 0 32045 0 18405 0 334595 0 0 0 SCOTT WOODS MD PHYSICIAN 235993 0 4896 0 11209 0 32156 0 26987 0 311241 0 0 0 MICHAEL CROFTON FORMER OFFICER 0 312830 0 47263 0 6284 0 88322 0 25521 0 480220 0 0 WILLIAM GRONEMAN FORMER KEY EMPLOYEE 0 305676 0 39310 0 73786 0 114176 0 26862 0 559810 0 27729 GAIL DONOVAN FORMER KEY EMPLOYEE 0 740011 0 155885 0 7922 0 189660 0 9696 0 1103174 0 0 JASON NIEHAUS FORMER KEY EMPLOYEE 0 0 0 0 0 325708 0 0 0 11983 0 337691 0 0 MARY IRVIN FORMER KEY EMPLOYEE 0 13497 0 38113 0 138646 0 9902 0 1639 0 201797 0 0 PART I, LINES 4A-B ELIGIBLE EXECUTIVES (GENERALLY VICE PRESIDENTS AND ABOVE) PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUAL(S) LISTED IN SCHEDULE J, PART II, RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WHICH WAS TREATED AS TAXABLE COMPENSATION BY TRIHEALTH, INC.: WILLIAM GRONEMAN - $27,729 PART I, LINE 3: TRIHEALTH, INC., A RELATED ORGANIZATION OF BETHESDA HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINE 4A: THE REPORTABLE INDIVIDUALS OF BETHESDA HOSPITAL, INC. ARE PAID BY TRIHEALTH, INC., A RELATED ORGANIZATION, RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). TRIHEALTH, INC. HAS A STANDARD EMPLOYEE SEVERANCE PACKAGE. GENERAL SEVERANCE PAY IS BASED ON LENGTH OF SERVICE. IN ADDITION, NOTICE PAY, IF APPLICABLE UNDER TRIHEALTH, INC. POLICY, MAY BE ADDED TO THE SEVERANCE PACKAGE AND THE AMOUNT OF NOTICE PAY WILL BE DETERMINED BY HUMAN RESOURCES IN ACCORDANCE WITH TRIHEALTH, INC. POLICY. PAYMENTS OF SEVERANCE ARE CONDITIONED UPON SIGNING A SEPARATION AND RELEASE AGREEMENT. DURING THE 2019 CALENDAR YEAR, THE FOLLOWING REPORTABLE INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM TRIHEALTH, INC.: STEFANIE NEWMAN - $254,509 JASON NIEHAUS - $262,423 A COUNTY OF HAMILTON OHIO 316000063 407272V59 2017-04-12 316011223 BUILDINGS AND STRUCTURES 0 0 0 B COUNTY OF HAMILTON OHIO 316000063 000000000 2017-04-19 100000000 BUILDINGS AND STRUCTURES 0 0 0 C COUNTY OF HAMILTON OHIO 316000063 000000000 2020-05-14 148454656 BUILDINGS, STRUCTURES & REFUND OF TAXABLE & TAX-EXEMPT BONDS ISSUED 9/29/15 0 0 0 A 1170000 318770291 3974594 314505586 290111 0 0 0 1 B 11270000 102490423 345003 90049192 12096228 0 0 0 1 C 148460751 1811516 9434692 36938431 100276112 1 1 0 1 A 0 1 1 1 0 0.01510 0.01510 0 0 1 B 0 1 1 1 0 0.01970 0.01970 0 0 1 C 0 0 0 0 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 1 1 B 0 1 0 0 1 0 0 1 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 PART II, LINE 3, COLUMN A, COLUMN B AND COLUMN C TOTAL PROCEEDS SHOWN ARE NOT IDENTICAL TO THE ISSUE PRICE LISTED IN PART I, COLUMN (E) DUE TO THE INVESTMENT EARNINGS. PART II, LINE 11, COLUMN C THE AMOUNT SHOWN HERE CONSISTS OF $36,646,925 SPENT TO RETIRE PRINCIPAL AND INTEREST OF PRIOR BONDS, PLUS $291,506 FOR A SWAP TERMINATION FEE PAID WITH RESPECT TO THE RETIRED TAX-EXEMPT DEBT. THE REFUNDING CONSISTED OF PRIOR TAX-EXEMPT BONDS ($9,324,915) AND PRIOR TAXABLE BONDS ($27,322,010) OF MCCULLOUGH-HYDE MEMORIAL HOSPITAL, A RELATED IRC SECTION 501(C)(3) ORGANIZATION OF BETHESDA HOSPITAL, INC. PART IV, LINE 6, COLUMNS A AND B SUCH AMOUNTS WERE APPROPRIATELY YIELD RESTRICTED. FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS, DIRECTORS AND TRUSTEES OF BETHESDA HOSPITAL, INC. LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARDS OF TRIHEALTH, INC., TRIHEALTH HOSPITAL, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, ALL AFFILIATED ENTITIES OF BETHESDA HOSPITAL, INC. MICHAEL EVERETT, KEVIN JOSEPH, MD, MARK CLEMENT, ROB CERCEK, JOHN WARD AND STEVE GRACEY HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE MCCULLOUGH-HYDE MEMORIAL HOSPITAL, AN AFFILIATED ENTITY OF BETHESDA HOSPITAL, INC. KATHY KELLY, RANCE DUKE, CRAIG EISENTROUT, MD, DANNY FISCHER, MD, PHILLIP OBLINGER, MD, BOB COLLINS, MD AND QUINT STUDER HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA, INC., THE SINGLE CORPORATE MEMBER OF BETHESDA HOSPITAL, INC. MARK CLEMENT AND CRAIG EISENTROUT, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF BETHESDA FOUNDATION, INC., A RELATED ENTITY OF BETHESDA HOSPITAL, INC. MARK CLEMENT, JENNY SKINNER AND SR. SALLY DUFFY HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON THE BOARD OF THE GOOD SAMARITAN COLLEGE OF NURSING AND HEALTH SCIENCE, A RELATED ENTITY. MARK CLEMENT, ANDREW DEVOE, ROB CERCEK, STEVE GRACEY, JENNIFER SKINNER, DAVID COOK, LONDON QUICCI, CRAIG EISENTROUT, MD, STEFANIE NEWMAN, PHILLIP OBLINGER, MD, SCOTT FRIEDSTROM, MD, MICHAEL EVERETT AND KEVIN JOSEPH, MD HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED ENTITY BOARDS OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES AS WELL AS BEING EMPLOYED BY TRIHEALTH, INC. FORM 990, PART VI, SECTION A, LINE 4 THE CODE OF REGULATIONS BETHESDA HOSPITAL, INC. HAVE BEEN UPDATED TO PERMIT EACH SPONSORING ORGANIZATION TO HAVE A TRUSTEE SERVE AN UNLIMITED NUMBER OF TERMS. FORM 990, PART VI, SECTION A, LINE 6 BETHESDA HOSPITAL, INC. HAS TWO CORPORATE MEMBERS - BETHESDA, INC. (VOTING MEMBER) AND TRIHEALTH, INC. (NON-VOTING MEMBER). FORM 990, PART VI, SECTION A, LINE 7A BETHESDA, INC. HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF BETHESDA HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B BETHESDA, INC. MUST APPROVE CERTAIN FINANCIAL TRANSACTIONS, AMENDMENTS TO BETHESDA HOSPITAL, INC.'S GOVERNING DOCUMENTS AND THOSE MATTERS RESERVED BY OHIO LAW. FORM 990, PART VI, SECTION B, LINE 11B MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF THIS FORM 990 PRIOR TO FILING AFTER REVIEW BY THE FINANCE AND AUDIT COMMITTEE OF THE BOARD, ALONG WITH THE COMMITTEE'S SUMMARY OF THE FORM 990. HOWEVER, FOR THE PROTECTION OF DONOR PRIVACY, SCHEDULE B - SCHEDULE OF CONTRIBUTORS WAS REMOVED FROM THE COPY PROVIDED TO THE BOARD. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURN MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH NON-SUBSTANTIVE CHANGES ARE NOT SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE CERTAIN FINANCIAL INTERESTS AND FIDUCIARY RELATIONSHIPS. THE EXECUTIVE COMMITTEE AND CORPORATE COUNSEL REVIEW RESPONSES, CONDUCT FURTHER INVESTIGATION (IF NECESSARY), AND DETERMINE WHEN A CONFLICT EXISTS WITH RESPECT TO A CERTAIN TRANSACTION. IF A CONFLICT EXISTS, THE TRANSACTION IS NOT TO BE ENTERED INTO UNLESS ALTERNATIVES ARE FULLY INVESTIGATED, AND IN THEIR ABSENCE, THE BOARD, WITHOUT THE PARTICIPATION OF THE INTERESTED MEMBER(S), DETERMINES THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. PLANS TO MANAGE THE CONFLICT DURING THE RELATIONSHIP ARE IMPLEMENTED. ALL DISCUSSIONS ARE APPROPRIATELY DOCUMENTED. ALL DIRECTORS AND MANAGERS, WHICH INCLUDE OFFICERS AND KEY EMPLOYEES, ARE REQUIRED TO ANNUALLY DISCLOSE ANY CIRCUMSTANCES, INCLUDING FAMILY AND BUSINESS RELATIONSHIPS, THAT MAY CREATE A CONFLICT OF INTEREST FOR THE ORGANIZATION. THESE RESPONSES ARE REVIEWED AND ACTED UPON BY A CONFLICT OF INTEREST COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 BETHESDA HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CONTRIBUTED CAPITAL TO PARENT -10,000,000. LOSS ON UNCONSOLIDATED ORGANIZATIONS -86,429,922. CHANGE IN PENSION PLAN/SERP FUNDED STATUS 3,963,662. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS HELD AT FOUNDATION 744,831. INSURANCE RATE VALUATION CORRECTION 3,007,109. REMOVAL OF PRIOR YEAR INVESTMENT LAG AMOUNT -3,984,714. NET SPECIAL FUNDS ACTIVITY 13,056,457. MISCELLANEOUS -119,449. FORM 990, PART I, LINE 6 DURING THE TAX YEAR, BETHESDA HOSPITAL, INC. WAS ASSISTED BY 535 VOLUNTEERS WHO DONATED APPROXIMATELY 56,000 HOURS. UNFORTUNATELY, THE COVID-19 PANDEMIC LIMITED THE IMPACT OF THESE INDIVIDUALS FROM MARCH THROUGH JUNE DUE TO THE SUSPENSION OF VOLUNTEER ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF TRUSTEES OF BETHESDA HOSPITAL, INC. ("THE CORPORATION"), ESTABLISHED AN EXECUTIVE COMMITTEE WHICH MAY EXERCISE SUCH POWER AND AUTHORITY OF THE BOARD OF TRUSTEES IN INTERVALS BETWEEN MEETINGS OF THE BOARD AS AUTHORIZED BY THE BOARD. THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT & CEO, THE SECRETARY AND TWO OTHER BOARD MEMBERS ALL IN ACCORDANCE WITH THE NETWORK AFFILIATION AGREEMENT. FORM 990, PART XII, LINE 2C THE FINANCIAL STATEMENTS OF BETHESDA HOSPITAL, INC. ("HOSPITAL") ARE AUDITED AS PART OF TRIHEALTH, INC. AND ITS SUBSIDIARIES AND AFFILIATES ("TRIHEALTH"). TRIHEALTH HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES AND AFFILIATES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. IN ADDITION, HOSPITAL'S FINANCIAL STATEMENTS ARE AUDITED WITH BETHESDA, INC., THE PARENT ORGANIZATION OF HOSPITAL. BETHESDA, INC. HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF BOTH ITS AND ITS SUBSIDIARIES FINANCIAL STATEMENTS AS WELL AS THE SELECTION OF THE INDEPENDENT AUDITOR. DURING THE TAX YEAR, THERE WAS NOT A CHANGE IN THE PROCESS OF AUDIT OVERSIGHT AND/OR SELECTION OF AN INDEPENDENT AUDITOR BY EITHER TRIHEALTH OR BETHESDA, INC. FORM 990, PART VI, SECTION B, LINE 16B DURING THE YEAR, BETHESDA HOSPITAL, INC. PARTICIPATED IN A JOINT VENTURE WITH ONE OR MORE TAXABLE PERSONS AND/OR ORGANIZATIONS. AS OF THE END OF THE FISCAL YEAR, BETHESDA HOSPITAL, INC. HAD NOT ADOPTED A WRITTEN POLICY OR PROCEDURE THAT REQUIRES THE ORGANIZATION TO NEGOTIATE, IN ITS TRANSACTIONS AND ARRANGEMENTS WITH OTHER MEMBERS OF THE VENTURE OR ARRANGEMENT, SUCH TERMS AND SAFEGUARDS AS ARE ADEQUATE TO ENSURE THAT THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED. HOWEVER, ALL JOINT VENTURES, WHEN ENTERED INTO, HAVE OUTSIDE LEGAL COUNSEL REVIEW OF THE OPERATING AGREEMENT OR OTHER ORGANIZATIONAL DOCUMENTS TO ENSURE THAT THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED PRIOR TO THE COMMENCEMENT OF THE JOINT VENTURE. ONCE THE JOINT VENTURE COMMENCES, BETHESDA HOSPITAL, INC. PERSONNEL MONITORS ITS ACTIVITIES TO ENSURE THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED. FORM 990, PART VII, SECTION A - AVERAGE HOURS PER WEEK THE OFFICERS AND DIRECTORS FOR BETHESDA HOSPITAL, INC. THAT SHOW AT LEAST 60 HOURS PER WEEK PROVIDE SERVICES TO TRIHEALTH, INC. (A RELATED ORGANIZATION WHO PAID THE INDIVIDUALS) AND ITS SUBSIDIARIES/AFFILIATES ("TRIHEALTH") AS AN ENTIRE SYSTEM. HOURS WORKED, INCLUDING THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION, ARE NOT TRACKED ON AN ENTITY BY ENTITY BASIS, THUS THE AVERAGE HOURS PER WEEK DISCLOSED ARE ESTIMATES TO SHOW THAT THE TIME SPENT BY THESE INDIVIDUALS RELATE TO THEM FULFILLING THEIR DUTIES AS FULL-TIME, 60 HOURS-PER-WEEK EMPLOYEES OF TRIHEALTH VERSUS THEIR DUTIES AS OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION. IN ADDITION, THE COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS IN FULFILLMENT OF THEIR DUTIES AS EMPLOYEES OF TRIHEALTH. DIRECTORS (AS NOTED WITH A "MED STAFF PRES" REFERENCE) FOR BETHESDA HOSPITAL, INC. SERVE ON THE BOARD IN THEIR CAPACITY AS MEDICAL STAFF PRESIDENT FOR EITHER BETHESDA HOSPITAL, INC. OR THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO. IN ADDITION, THESE INDIVIDUALS PROVIDE SERVICES AS EMPLOYEES OF VARIOUS RELATED ENTITIES FOR WHICH THEY RECEIVE COMPENSATION. NONE OF THE COMPENSATION SHOWN IS FOR SERVING AS A DIRECTOR. 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