2021-11-12T15:07:42-06:00 2020-12-31 990 2020-01-01 825373223 HCR MANORCARE INC HCRM 4192525772 PO BOX 10086 ATTN TAX-5 TOLEDO OH 436990086 STEVEN M CAVANAUGH TREASURER 4192525772 2021-11-12 0 STEVEN CAVANAUGH 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEVEN M CAVANAUGH 100 MADISON AVE TOLEDO OH 43604 2863981761 0 X WWW.PROMEDICASENIORCARE.ORG X 2018 OH HCR MANORCARE, INC.'S POST-ACUTE DIVISION WILL SUPPORT HEALTH SYSTEMS, ACUTE CARE PROVIDERS, HEALTH PLANS AND COMMUNITY ORGANIZATIONS BY PROVIDING ACCESS TO A VARIETY OFPOST-HOSPITAL CARE SERVICES IN THE COMMUNITIES WE SERVE. 8 5 48547 3094 10447540 216468 0 193380822 2963072815 2620308994 2531327 -2704444 39769006 43385583 3005373148 2854370955 58944 45275 0 0 1780175953 1661230524 0 0 0 1205109175 1207313321 2985344072 2868589120 20029076 -14218165 4492041234 4332496062 2847728806 3120347682 1644312428 1212148380 X OUR MISSION IS TO IMPROVE YOUR HEALTH AND WELL-BEING 0 0 2000658625 35275 1731819910 SKILLED NURSING AND REHABILITATION SERVICES:HCR MANORCARE, INC.'S SKILLED NURSING AND REHABILITATION CENTERSPROVIDE SHORT-TERM REHABILITATION AND SKILLED NURSING SERVICES FOR THOSE PATIENTS TRANSITIONING BETWEEN HOSPITAL AND HOME. AN INTERDISCIPLINARY TEAM APPROACH HELPS ENSURE THE PATIENT AND THEIR FAMILY ARE READY FOR A SAFE AND HEALTHY RETURN HOME. THE CENTERS ALSO PROVIDE LONG-TERM RESIDENTIAL CARE DESIGNED TO PROVIDE ASSISTANCE TO THOSE WHO ARE NO LONGER ABLE TO CARE FOR THEMSELVES DUE TO PHYSICAL LIMITATIONS, CHRONIC CONDITIONS OR CHANGES IN MENTAL CAPACITY. - SEE SCHEDULE O. 540170349 10000 674686693 HOME HEALTH AND HOSPICE SERVICES:HCR MANORCARE, INC.'S HOME CARE SERVICES ARE DESIGNED TO HELP MEDICALLYABLE PATIENTS CONTINUE TO STRENGTHEN AND INCREASE THEIR ABILITY TO CAREFOR THEMSELVES ONCE THEY RETURN HOME FROM A HOSPITAL STAY. SERVICESSUCH AS WOUND CARE, INFUSION THERAPY, REHABILITATION SERVICES ANDEDUCATIONAL INFORMATION CAN BE PROVIDED IN THE COMFORTS OF ONE'S HOME.HCR MANORCARE, INC.'S HOSPICE SERVICES FOCUS ON THE PHYSICAL, SPIRITUALAND PSYCHOSOCIAL NEEDS OF INDIVIDUALS IN THE LAST STAGE OF THEIR LIVES.HOSPICE SERVICES ARE PROVIDED IN PEOPLE'S HOMES AND IN SKILLED NURSINGAND ASSISTED LIVING CENTERS. PALLIATIVE AND CLINICAL CARE, EDUCATION,COUNSELING AND OTHER RESOURCES TAKE INTO CONSIDERATION THE PATIENTS 210991531 178524703 HCR MANORCARE, INC.'S ARDEN COURTS MEMORY CARE COMMUNITIES PROVIDERESIDENTIAL SECURED LIVING SERVICES FOR THOSE LIVING WITH ALZHEIMER'SOR RELATED DEMENTIA. ARDEN COURTS ARE DESIGNED TO SUPPORT THE HIGHESTPRACTICABLE LEVEL OF ENGAGEMENT AND FUNCTION. FAMILIES AND COMMUNITYCAREGIVERS ARE SUPPORTED THROUGH SPECIAL EDUCATIONAL EVENTS AND SUPPORTGROUPS. 8280670 64729863 8280670 64729863 2760101175 1 1 0 1 0 0 0 0 1 0 1 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 4536 0 1 48547 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 0 CA IN MI PA VI X ROBERT SHARON 5675855652 100 MADISON AVE TOLEDO OH 43604 RANDALL OOSTRA PHS PRES. & CEO, EX OFFICIO 1.00 55.00 X X 0 3971638 136986 STEVEN M CAVANAUGH TREASURER 1.00 55.00 X 0 2048174 105065 KAREN STRAUSS CHIEF OPERATING OFFICER 0.00 40.00 X 0 1485878 49891 JEFFREY C KUHN SECRETARY 1.00 55.00 X 0 1123411 62157 DAVID PARKER PRES., EX OFFICIO 1.00 44.00 X X 0 859031 64425 MATTHEW KANG CFO 1.00 40.00 X 0 720559 41724 SUSAN MOREY SVP OPERATIONS (SKILLED NURSING AND REHABILITATION 0.00 40.00 X 0 552636 37106 MICHAEL REED SVP OPERATIONS (ASSISTED LIVING, HOME HEALTH & HOS 1.00 40.00 X 0 540518 40814 JON GAUDINO DIRECTOR MEDICAL SUPPORT SERVICE 40.00 0.00 X 266499 0 15475 DOUGLAS MOCK AVP ASSISTANT GENERAL MANAGER 40.00 0.00 X 273216 0 2297 VICTORIA STROM DIRECTOR MARKET DEVELOPMENT 40.00 0.00 X 263250 0 6582 PETER ALLEGRETTI GENERAL MANAGER 40.00 0.00 X 257878 0 10149 NICOLE PADMORE DIVISION MEDICAL DIR-MED SERVICES 40.00 0.00 X 257970 0 0 STEPHEN H STAELIN CHAIRMAN 1.00 2.00 X X 0 0 0 JAMES F WHITE JR TRUSTEE 1.00 2.00 X 0 0 0 MICHAEL M HYLANT TRUSTEE 1.00 0.00 X 0 0 0 ROBERT W LACLAIR EX OFFICIO 1.00 4.00 X 0 0 0 SHANKHA MITRA TRUSTEE 1.00 1.00 X 0 0 0 TODD W FISTER TRUSTEE 1.00 0.00 X 0 0 0 1318813 11301845 572671 1029 0 1 0 SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 FOOD SERVICE 48362020 HOSPICELINK 2145 HIGHLAND AVE S SUITE 110 BIRMINGHAM AL 35205 EQUIPMENT RENTAL 22495193 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR SUITE 300 BENSALEM PA 19178 HOUSEKEEPING SERVICES 11547883 LEADERSTAT 1322B MANNING PKWY POWELL OH 43065 PURCHASED SERVICES, MEDICAL STAFF 8471210 SNAPMEDTECH INC 675 PONCE DE LEON AVE NE SUITE 850 ATLANTA GA 30308 PURCHASED SERVICES, MEDICAL STAFF 7676156 817 199028 193181794 193380822 SKILLED NURSING 623110 1733768539 1731819910 1948629 HOME HEALTH & HOSPICE 621610 674686693 674686693 ASSISTED LIVING 623312 184545401 178524703 6020698 REHABILITATION 621340 4569815 2310070 2259745 22738546 22738546 2620308994 817651 817651 3024985 3063726 3061212 6549594 -36227 -3485868 -3522095 -3485868 -36227 JOINT VENTURE INCOME 900099 43225369 43006901 218468 160214 160214 43385583 2854370955 2649761169 10447540 781424 45275 45275 1418768252 1367749144 51019108 10628036 10063881 564155 123711942 115719485 7992457 108122294 104738424 3383870 3890043 3890043 3707996 3707996 582309 582309 32094 32094 257234304 250141484 7092820 10423973 9340301 1083672 1776807 1078504 698303 9485410 4670894 4814516 308133513 306379864 1753649 29387545 25868954 3518591 69211839 69211839 40189370 31575666 8613704 70166575 70166575 PROVIDER TAX 115907625 115907625 MEDICAL SUPPLIES 88634288 88634288 DRUGS 79222108 79222108 STATE UBI TAX 12000 12000 119315522 109574864 9740658 2868589120 2760101175 108487945 0 114618329 77857363 317244444 276780730 18191417 13991802 221061596 67920282 147387333 153141314 43846803 535217672 523610889 3244069399 3210910840 71465837 76203124 4492041234 4332496062 773059023 978832949 6480466 12469947 83491 83491 2068105826 2128961295 2847728806 3120347682 X 1644312428 1212148380 1644312428 1212148380 4492041234 4332496062 X -14218165 437727 6571 -418390181 X X 0 1 X 1 1 0 X 193380822 193380822 1292273739 2930598682 2610079922 6832952343 1292273739 2930598682 2803460744 7026333165 0 0 0 7026333165 4038175 2458999 817651 7314825 4038175 2458999 817651 7314825 273468 439087 216468 929023 32645120 39512706 43167115 115324941 1329230502 2973009474 2847661978 7149901954 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER OPERATING REV - 2018 AMOUNT: $ 16,643,135. JOINT VENTURE INCOME - 2018 AMOUNT: $ 15,760,959. 2019 AMOUNT: $ 33,694,304. 2020 AMOUNT: $ 43,006,901. ALL OTHER REVENUE - 2018 AMOUNT: $ 241,026. 2019 AMOUNT: $ 5,818,402. 2020 AMOUNT: $ 160,214. PART III, SHORT YEAR EXPLANATION: HCR MANORCARE, INC. WAS RECOGNIZED AS A 501(C)(3) TAX-EXEMPT ORGANIZATION AS OF APRIL 20, 2018. AS A RESULT, TAX YEAR 2018 WAS A SHORT YEAR COVERING THE PERIOD FROM APRIL 20, 2018 THROUGH DECEMBER 31, 2018. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 47324 0 0 1 534985 582309 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: HCR MANORCARE, INC. PAID FEES TO THE FOLLOWING COMPANIES: FORBES TATE PARTNERS, LLC, BALLARD PARTNERS, INC. AND GOVERNMENTAL POLICY GROUP INC. A PORTION OF THESE FEES ARE ALLOCABLE TO LOBBYING. HCR MANORCARE, INC. PAYS DUES TO THE FOLLOWING ORGANIZATIONS- A PORTION OF WHICH IS ALLOCABLE TO LOBBYING: CALIFORNIA ASSOCIATION OF HEALTH FACILITIES COLORADO HEALTH CARE ASSOCIATION DELAWARE HEALTH CARE FACILITIES ASSOCIATION FLORIDA ASSISTED LIVING ASSOCIATION FLORIDA HEALTH CARE ASSOCIATION GEORGIA HEALTH CARE ASSOCIATION IOWA HEALTH CARE ASSOCIATION ILLINOIS HEALTH CARE ASSOCIATION INDIANA HEALTH CARE ASSOCIATION HEALTH FACILITIES ASSOCIATION OF MARYLAND (HFAM) HEALTH CARE ASSOCIATION OF MICHIGAN (HCAM) HEALTH CARE ASSOCIATION OF NEW JERSEY OHIO HEALTH CARE ASSOCIATION PENNSYLVANIA HEALTH CARE ASSOCIATION SOUTH CAROLINA HEALTH CARE ASSOCIATION VIRGINIA HEALTH CARE ASSOCIATION WISCONSIN HEALTH CARE ASSOCIATION HOSPICE ACTION NETWORK (HAN) 0 1 X 1530000 1530000 36476917 4838346 31638571 48562974 10976870 37586104 103651542 52105066 51546476 30840163 30840163 153141314 WELL PM PROPERTIES, LLC 496645688 C HEARTLAND HEALTHCARE SERVICES, LLC 26965201 C 523610889 PENSION PLAN LIABILITY 437210 DUE TO AFFILIATES 29190066 LONG TERM LEASE AND OTHER ACCRUED LIABILITIES 2099334019 2128961295 PART IV, LINE 2B: THIS ENTITY HAS CUSTODIAL ACCOUNTS USED TO HOLD THE PORTION OF RESIDENTS' PAYMENTS ORIGINATING FROM SSI OR SIMILAR THAT RELATE TO PERSONAL NEEDS. THE ASSETS ARE BOOKED AS RESTRICTED CASH WITH AN OFFSETTING LIABILITY. 1 UNITED WAY OF GREATER TOLEDO 424 JACKSON STREET TOLEDO OH 43604 344427947 501(C)(3) 35108 CHARITABLE DONATION WISCONSIN HOSPICE AND PALLIATIVE CARE ASSOCIATION INC PO BOX 424 OXFORD WI 53952 833382962 501(C)(3) 10000 CHARITABLE DONATION 2 0 X X 0 0 0 1 0 0 0 0 0 0 0 RANDALL OOSTRA PHS PRES. & CEO, EX OFFICIO 0 1973076 0 1805059 0 193503 0 117599 0 19387 0 4108624 0 0 STEVEN M CAVANAUGH TREASURER 0 1330912 0 710821 0 6441 0 82144 0 22921 0 2153239 0 0 KAREN STRAUSS CHIEF OPERATING OFFICER 0 1005788 0 466613 0 13477 0 22418 0 27473 0 1535769 0 0 JEFFREY C KUHN SECRETARY 0 716660 0 391346 0 15405 0 44915 0 17242 0 1185568 0 0 DAVID PARKER PRES., EX OFFICIO 0 682589 0 175361 0 1081 0 33745 0 30680 0 923456 0 0 MATTHEW KANG CFO 0 567352 0 149936 0 3271 0 18186 0 23538 0 762283 0 0 SUSAN MOREY SVP OPERATIONS (SKILLED NURSING AND 0 435120 0 114763 0 2753 0 22231 0 14875 0 589742 0 0 MICHAEL REED SVP OPERATIONS (ASSISTED LIVING, HOM 0 432360 0 103871 0 4287 0 13622 0 27192 0 581332 0 0 JON GAUDINO DIRECTOR MEDICAL SUPPORT SERVICE 266099 0 400 0 0 0 0 0 15475 0 281974 0 0 0 DOUGLAS MOCK AVP ASSISTANT GENERAL MANAGER 231592 0 41624 0 0 0 0 0 2297 0 275513 0 0 0 VICTORIA STROM DIRECTOR MARKET DEVELOPMENT 211356 0 51894 0 0 0 0 0 6582 0 269832 0 0 0 PETER ALLEGRETTI GENERAL MANAGER 183107 0 74771 0 0 0 0 0 10149 0 268027 0 0 0 NICOLE PADMORE DIVISION MEDICAL DIR-MED SERVICES 234231 0 23739 0 0 0 0 0 0 0 257970 0 0 0 PART I, LINE 1A CHARTER TRAVEL: 2 OFFICERS- NOT INCLUDED IN TAXABLE COMPENSATION TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: 2 HIGHEST COMPENSATED EMPLOYEES - INCLUDED IN TAXABLE COMPENSATION PART I, LINE 1B PAYMENTS FOR TAX INDEMNIFICATION AND GROSS-UP HAD POLICIES IN PLACE AND ALL PROPER PROTOCOLS WERE FOLLOWED DURING 2020. DUE TO EXTENUATING CIRCUMSTANCES RELATED TO THE COVID-19 PANDEMIC THAT LIMITED FLIGHT SCHEDULES AND ABILITY TO TRAVEL, CHARTERED FLIGHT SERVICES WERE UTILIZED WHEN NECESSARY AS THE ONLY FEASIBLE TRAVEL SOLUTION DURING TAX YEAR 2020. THIS WAS NECESSARY IN ORDER TO ENABLE EXECUTIVES TO BE ABLE TO CONTINUE TO CONDUCT BUSINESS WHEN COMMERCIAL FLIGHTS WERE NOT AVAILABLE TO MEET SCHEDULED MEETINGS AND DUE TO SCHEDULE CONSTRAINTS. DURING 2020 THERE WAS NOT A POLICY GOVERNING THIS TYPE OF TRAVEL IN PLACE AS IT WAS NOT FORESEEN IT WOULD BE NECESSARY. CURRENTLY A POLICY IS BEING DRAFTED TO ENSURE PROPER COMPLIANCE AND GOVERNANCE OF THESE EXPENDITURES IN THE FUTURE. PART I, LINE 3 PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF HCR MANORCARE INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. SCHEDULE J, SUPPLEMENTAL INFORMATION: IN ADDITION, THE ORGANIZATION PROVIDES A SPLIT-DOLLAR LIFE INSURANCE PLAN TO ITS CHIEF EXECUTIVE OFFICER FROM WHICH NO CASH PAYMENTS WERE MADE DURING THE YEAR. FORM 990, PART III, LINE 4: HCR MANORCARE'S SKILLED NURSING FACILITIES (SNF), THE MAJORITY OF WHICH DO BUSINESS UNDER THE TRADE NAMES "HEARTLAND AND "MANORCARE HEALTH SERVICES," PROVIDE SKILLED NURSING AND REHABILITATION SERVICES DURING RECOVERY AFTER A HOSPITALIZATION STAY. HCR MANORCARE IS THE POST-ACUTE DIVISION OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION FOCUSED ON THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA IS THE COUNTRY'S 15TH LARGEST HEALTHCARE PROVIDER. THE COMPANY'S STEWARDSHIP OF RESOURCES HAS ENABLED WISE INVESTMENT IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING. HCR MANORCARE OPERATES 172 SKILLED NURSING WHERE NURSES AND PHYSICIANS WORK COLLABORATIVELY TO MANAGE COMPLEX MEDICAL CONDITIONS, PROVIDING CARDIOLOGY, NEUROLOGY, ONCOLOGY, PULMONARY, ORTHOPAEDIC, AND WOUND CARE SERVICES. REHABILITATION SERVICES PROVIDE PATIENTS WITH THE TOOLS THEY NEED TO FUNCTION AT THEIR HIGHEST POTENTIAL. THESE SERVICES INCLUDE PHYSICAL AND OCCUPATIONAL THERAPIES, AS WELL AS SPEECH AND LANGUAGE PATHOLOGY. HCR MANORCARE FACILITIES PROVIDE LONG-TERM CARE ASSISTANCE 24 HOURS A DAY TO THOSE WHO MEET THE SKILLED NURSING REQUIREMENTS AND CANNOT LIVE INDEPENDENTLY. ADDITIONAL SERVICES SUCH AS PALLIATIVE AND HOSPICE CARE CAN ALSO BE PROVIDED IN THE SKILLED NURSING SETTING. IN 2020, HCR MANORCARE'S SNFS PROVIDED OVER 5,243,261 CARE DAYS TO ITS PATIENTS AND RESIDENTS. IN 2020, HCR MANORCARE'S SNFS EXPENDED 695,580,000 IN NET PAYROLL, PROVIDING 35,516 JOBS IN 25 STATES. A TOTAL OF $31,193,000 WAS WITHHELD IN EMPLOYEE STATE AND LOCAL TAXES. IN 2020, HCR MANORCARE SUPPORTED EDUCATION, HEALTH AND WELLNESS EVENTS, DONATING OVER 45,000. HCR MANORCARE INC.'S SKILLED NURSING AND REHABILITATION CENTERS, PRIMARILY OPERATING UNDER THE BRAND NAMES HEARTLAND, MANORCARE AND PROMEDICA, DEMONSTRATE PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL ELIGIBLE PATIENTS REGARDLESS OF THEIR RACE, CREED, NATIONAL ORIGIN, DISABILITY OR AGE. THE CENTERS PROVIDE PATIENTS WITH HOME ASSESSMENTS AND COMMUNITY RESOURCES FOR A SAFE AND HEALTHY TRANSITION HOME. THE CENTERS GRANT PATIENTS AND RESIDENTS THEIR WISHES THROUGH THE ORGANIZATION'S HEARTS' DESIRE PROGRAM. SINCE VISITATION WAS PROHIBITED DURING THE MAJORITY OF 2020, MANY OF THESE WISHES WERE DONE VIRTUALLY THROUGH THE USE OF HUNDREDS OF IPADS THAT WERE ACQUIRED TO KEEP RESIDENTS AND PATIENTS ENGAGED WITH THE OUTSIDE COMMUNITY. IN 2020, THE ORGANIZATION CONTINUED TO OFFER COMMUNITY HEALTH RELATED EDUCATIONAL EVENTS SUCH AS REDUCING STRESS AND HEALTH AND WELLNESS THROUGH VIRTUAL AND ONLINE EDUCATION. FACILITIES HOSTED DRIVES TO COLLECT DONATIONS SUCH AS PPE AND FOOD FOR NON-PROFIT ORGANIZATIONS. THROUGHOUT THE PANDEMIC, THE SKILLED NURSING FACILITIES WERE PROACTIVE IN PROTECTING AND ENGAGING PATIENTS WITH THE CREATION OF AIRBORNE ISOLATION UNITS WITHIN THE CENTERS, SOCIALLY DISTANCED ACTIVITIES AND VIRTUAL VISITS WITH FAMILY, COMMUNITY ENTERTAINMENT AND PET THERAPY. THE SKILLED NURSING CENTERS PROVIDED MORE 128 COMMUNITY-BASED HEALTH CARE PROFESSIONALS WITH CONTINUING EDUCATION CREDITS THROUGH THE OFFERING OF EIGHT COURSES. THIS WAS LIMITED DUE TO PANDEMIC RESTRICTIONS AND HEALTH CARE PROVIDERS LIMITED AVAILABILITY. IN SUMMARY, HCR MANORCARE'S SKILLED NURSING FACILITIES (SNF), HOME HEALTH AND HOSPICE SERVICES (HHH), AND ASSISTED LIVING FACILITIES (ALF) CONTRIBUTED $61,911,000 IN COMMUNITY BENEFIT EXPENDITURES, ALL OF WHICH WAS ATTRIBUTED TO THE COSTSNOT REIMBURSED BY THE GOVERNMENTFOR TREATING MEDICAID PATIENTS. IN ADDITION, HCR MANORCARE'S COST OF BAD DEBT FOR 2020 WAS $20,795,000, THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $61,911,000. THESE NUMBERS NOT ONLY INDICATE HCR MANORCARE'S COMMITMENT TO THE COMMUNITY, BUT ALSO FULFILL OUR NOT-FOR-PROFIT STATUS BY PROVIDING ACCESS TO A VARIETY OF POST-HOSPITAL CARE SERVICES IN THE COMMUNITIES WE SERVE. FORM 990, PART III, LINE 4: HCR MANORCARE'S HOME HEALTH AND HOSPICE SERVICES (HHH), THE MAJORITY OF WHICH DO BUSINESS AS HEARTLAND HOME HEALTH CARE AND HEARTLAND HOSPICE CARE, PROVIDE NURSING, REHABILITATION, SOCIAL SERVICES, PALLIATIVE CARE, BEREAVEMENT AND PATIENT AND FAMILY COUNSELING SERVICES FOR PATIENTS RECOVERING FROM A HOSPITAL STAY OR DIAGNOSED WITH A TERMINAL ILLNESS. HCR MANORCARE IS THE POST-ACUTE DIVISION OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION FOCUSED ON THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA IS THE COUNTRY'S 15TH LARGEST HEALTHCARE PROVIDER. THE COMPANY'S STEWARDSHIP OF RESOURCES HAS ENABLED WISE INVESTMENT IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING. HCR MANORCARE OPERATES 135 HOME HEALTH AND HOSPICE AGENCIES ACROSS THE COUNTRY. HOME HEALTH CAREGIVERS PROVIDE NURSING AND REHABILITATION SERVICES TO PATIENTS AT HOME AND IN SKILLED NURSING OR ASSISTED LIVING FACILITIES. HOME HEALTH CARE SERVICES ARE DESIGNED TO ASSIST THOSE INDIVIDUALS WHO WISH TO STAY AT HOME OR IN ANOTHER RESIDENTIAL SETTING BUT STILL REQUIRE SOME DEGREE OF MEDICAL CARE OR ASSISTANCE WITH DAILY ACTIVITIES, AS WELL AS PATIENTS WHO CONTINUE TO REQUIRE SERVICES AFTER HAVING BEEN DISCHARGED FROM A HIGHER ACUITY SETTING. NURSES AND THERAPISTS PROVIDE SERVICES SUCH AS WOUND CARE, INFUSION THERAPY, REHABILITATION, AND ASSIST PATIENTS WITH DAILY ACTIVITIES. HOSPICE SERVICES ARE DESIGNED TO PROVIDE A BROAD RANGE OF SERVICES TO PATIENTS NEARING THE END OF LIFE. HOSPICE SERVICES CAN INCLUDE PAIN AND SYMPTOM MANAGEMENT, SKILLED NURSING CARE, PHYSICIAN SERVICES, HOME HEALTH AIDE, PATIENT COUNSELING AND FAMILY BEREAVEMENT COUNSELING. SERVICES ARE PROVIDED BY AN INTERDISCIPLINARY TEAM CONSISTING OF NURSES, SOCIAL WORKERS, SPIRITUAL CARE COORDINATORS, BEREAVEMENT COORDINATORS AND NURSE PRACTITIONERS. IN 2020, HCR MANORCARE'S HOSPICE CARE PROVIDED 35,000 STARTS OF CARE TO ITS PATIENTS. IN 2020, HCR MANORCARE'S HOME HEALTH CARE PROVIDED 260,745 TOTAL VISITS TO ITS PATIENTS. IN 2020, HCR MANORCARE'S HHHS EXPENDED $228,168,000 IN NET PAYROLL, PROVIDING 7,918 JOBS IN 24 STATES. A TOTAL OF $11,864,000 WAS WITHHELD IN EMPLOYEE STATE AND LOCAL TAXES. HCR MANORCARE, INC.'S HOME HEALTH AND HOSPICE AGENCIES, PRIMARILY OPERATING UNDER THE BRAND NAMES HEARTLAND AND PROMEDICA, DEMONSTRATE PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY CARE AND SUPPORT TO ALL ELIGIBLE PATIENTS AND FAMILIES REGARDLESS OF THEIR RACE, CREED, NATIONAL ORIGIN, DISABILITY OR AGE. THE HOSPICE AGENCIES PREPARE PATIENTS AND THEIR FAMILY MEMBERS FOR END OF LIFE AND PROVIDE BEREAVEMENT COUNSELING AND FOLLOW-UP TO FAMILIES A YEAR AFTER THE PATIENT PASSES. THE AGENCIES ALSO PROVIDE UNIQUE SERVICES TO VETERANS, HOLIDAY SUPPORT, SUPPORT GROUPS, AND WORKSHOPS TO ANYONE IN THE COMMUNITY WHO NEEDS ADDITIONAL HELP TO GET THROUGH THE LOSS OF A LOVED ONE. PATIENTS' WISHES ARE GRANTED THROUGH THE ORGANIZATIONS HEART'S DESIRE PROGRAM. SINCE VISITATION WAS PROHIBITED DURING MOST OF THE YEAR, MANY OF THESE WISHES WERE DONE VIRTUALLY THROUGH THE USE OF HUNDREDS OF IPADS THAT WERE ACQUIRED TO KEEP PATIENTS AND THEIR FAMILIES ENGAGED WITH THE COMMUNITY. THROUGH GRANTS FROM THE HOSPICE MEMORIAL FUND, GRIEF CAMPS FOR CHILDREN AND ADULTS ARE NORMALLY OFFERED AS WELL AS EDUCATIONAL SESSIONS AND LIFE CELEBRATION EVENTS. MANY OF THESE WERE CANCELLED OR HOSTED VIRTUALLY DUE TO THE PANDEMIC. THE FUND ALSO PROVIDES STABILIZING RESOURCES FOR HOSPICE PATIENTS AND FAMILIES IN FINANCIAL DISTRESS DUE TO THE LACK OF OR REDUCTION IN INCOME FROM TERMINAL ILLNESS OR DISEASE. FORM 990, PART III, LINE 4: HCR MANORCARE'S ASSISTED LIVING FACILITIES (ALF), THE MAJORITY OF WHICH DO BUSINESS UNDER THE TRADE NAME ARDEN COURTS, PROVIDE ASSISTED LIVING SERVICES FOR THOSE WHO ARE LIVING WITH A DEMENTIA DIAGNOSIS OR REQUIRE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. HCR MANORCARE IS THE POST-ACUTE DIVISION OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION FOCUSED ON THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA IS THE COUNTRY'S 15TH LARGEST HEALTHCARE PROVIDER. THE COMPANY'S STEWARDSHIP OF RESOURCES HAS ENABLED WISE INVESTMENT IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING. HCR MANORCARE OPERATES 55 ASSISTED LIVING WITH THE MAJORITY OF THE COMMUNITIES DESIGNED SPECIFICALLY FOR THOSE LIVING WITH ALZHEIMER'S OR RELATED DEMENTIA. ASSISTED LIVING COMMUNITIES PROVIDE ASSISTANCE WITH DRESSING, BATHING, MEAL PREPARATION AND MEDICATIONS IN A HOMELIKE SETTING. PROGRAMMING ACTIVITIES ARE DESIGNED SPECIFICALLY FOR THE INDIVIDUAL RESIDENT'S NEEDS AND ABILITIES. ADDITIONAL SERVICES SUCH AS PALLIATIVE AND HOSPICE CARE CAN ALSO BE PROVIDED IN THE ASSISTED LIVING SETTING. IN 2020, HCR MANORCARE'S ALFS PROVIDED 963,886 DAYS OF CARE TO ITS RESIDENTS. IN 2020, HCR MANORCARE'S ALFS EXPENDED 68,386,000 IN NET PAYROLL, PROVIDING 5,113 JOBS IN 24 STATES. A TOTAL OF $2,428,000 WAS WITHHELD IN EMPLOYEE STATE AND LOCAL TAXES. HCR MANORCARE, INC.'S ASSISTED LIVING FACILITIES, PRIMARILY OPERATING UNDER THE BRAND NAME ARDEN COURTS MEMORY CARE COMMUNITIES, DEMONSTRATE PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY CARE AND ENGAGEMENT TO ALL ELIGIBLE RESIDENTS REGARDLESS OF THEIR RACE, CREED, NATIONAL ORIGIN, DISABILITY OR AGE. THE COMMUNITIES PROVIDE RESIDENTS WITH A PLACE TO PARTICIPATE AND THRIVE IN MEANINGFUL ACTIVITIES AND LIVE IN A SAFE ENVIRONMENT. DURING THE PANDEMIC, THE ASSISTED LIVING MODEL WAS TRANSITIONED FROM A SOCIAL MODEL TO A MORE MEDICAL MODEL TO ENSURE RESIDENT SAFETY AND ENGAGEMENT. THE FACILITIES WERE PROACTIVE IN PROTECTING AND ENGAGING RESIDENTS WITH THE CREATION OF AIRBORNE ISOLATION UNITS WITHIN THE CENTERS, SOCIALLY DISTANCED ACTIVITIES AND VIRTUAL VISITS WITH FAMILY, COMMUNITY ENTERTAINMENT, AND PET THERAPY. THE FACILITIES CONTINUED TO PROVIDE FAMILY AND COMMUNITY RESOURCES TO HELP COPE AND LIVE WITH SOMEONE WITH A DEMENTIA DIAGNOSIS. BECAUSE OF THE PANDEMIC, THESE EVENTS WERE MOVED TO AN ONLINE FORMAT AND WERE ABLE TO REACH A GREATER AUDIENCE. IN 2020, THE ORGANIZATION OFFERED MORE THAN 12 WEBINARS WITH AN AVERAGE OF 561 REGISTRATIONS AND 311 ATTENDEES PER EVENT; MORE THAN 146 MEMORY CARE CAFES AND SUPPORT GROUPS AND HOSTED 120 COMMUNITY FOCUSED EVENTS. INTERNAL, LOCAL AND NATIONALLY KNOWN SPEAKERS WERE USED TO PROVIDE THESE FREE SERVICES TO COMMUNITIES. THE FACILITIES ALSO GRANT RESIDENTS THEIR WISHES THROUGH THE ORGANIZATION'S HEARTS' DESIRE PROGRAM. SINCE VISITATION WAS PROHIBITED DURING THE MAJORITY OF THE YEAR, MANY OF THESE WISHES WERE DONE VIRTUALLY THROUGH THE USE OF HUNDREDS OF IPADS THAT WERE ACQUIRED TO KEEP RESIDENTS ENGAGED WITH THE OUTSIDE COMMUNITY. THE ASSISTED LIVING COMMUNITIES PROVIDED MORE THAN 66 COMMUNITY-BASED HEALTH CARE PROFESSIONALS WITH CONTINUING EDUCATION CREDITS THROUGH THE OFFERING OF SIX COURSES. THIS WAS LIMITED DUE TO PANDEMIC RESTRICTIONS AND HEALTH CARE PROVIDERS LIMITED AVAILABILITY. FORM 990, PART IV, LINE 24A HCR MANORCARE, INC. IS A SUBSIDIARY OF PROMEDICA HEALTH SYSTEM, INC. (PHS). HCR MANORCARE, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE TO THE TOLEDO HOSPITAL, WHICH IS ALSO A SUBSIDIARY OF PHS. THE NOTE PAYABLE REPRESENTS HCR MANORCARE, INC.'S PORTION OF TAXABLE AND TAX-EXEMPT BONDS ISSUED BY PROMEDICA HEALTHCARE OBLIGATED GROUP. FORM 990, PART VI, SECTION A, LINE 6 AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF HCR MANORCARE, INC. AS THE MEMBER, PHS HAS THE RIGHT TO (A) ELECT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF HCR MANORCARE, INC.; AND (B) FILL ANY VACANCY ON THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 RETURNS OF PROMEDICA HEALTH SYSTEM, INC. (PHS) AND ITS SUBSIDIARIES ARE PREPARED BY THE PHS TAX DEPARTMENT WITH THE ASSISTANCE OF FINANCE. THE RETURNS ARE REVIEWED BY THE AVP OF TAX BEFORE BEING PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES PRIOR TO FILING. ANY COMMENTS OR QUESTIONS FROM THE BOARD ARE REVIEWED AND INCORPORATED INTO THE RETURN IF APPROPRIATE. FINAL RETURNS ARE PROVIDED TO A PRINCIPAL OFFICER FOR SIGNATURE PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER SOC SURVEY WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER SOC SURVEYS ARE REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER SOC SURVEYS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED, AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO COMPLETE THE SURVEY OR THE SUBMISSION OF A FALSE OR INCOMPLETE SURVEY, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S SURVEY RESULTS OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL BONUS-ELIGIBLE SENIOR LEADERSHIP AND SPECIFICALLY IDENTIFIED ADDITIONAL EMPLOYEES, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, THE CHIEF HUMAN RESOURCE OFFICER, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. ADDITIONALLY, AS PART OF THE ANNUAL MANDATORY COMPLIANCE TRAINING ASSIGNED TO ALL PROMEDICA EMPLOYEES, EACH EMPLOYEE IS REQUIRED TO ELECTRONICALLY ACKNOWLEDGE THAT THEY HAVE RECEIVED A COPY OF THE PROMEDICA STANDARDS OF CONDUCT, THAT THEY UNDERSTAND HOW THE STANDARDS APPLY TO THEM, ACKNOWLEDGE THEIR OBLIGATION TO FOLLOW THEM, THEIR OBLIGATION TO REPORT VIOLATIONS OF THE STANDARDS OR REQUESTS THAT WOULD RESULT IN VIOLATIONS OF THE STANDARDS TO APPROPRIATE COMPANY OFFICERS AND THAT THEY HAVE REPORTED ALL VIOLATIONS KNOWN TO THEM AS REQUIRED BY THE STANDARDS. IN ADDITION THE ATTESTATION STATES ANY CONFLICTS OF INTEREST OR OTHER MATTERS FOR WHICH THE STANDARDS REQUIRE WRITTEN DISCLOSURE TO THE COMPANY HAVE BEEN SO DISCLOSED BY THE EMPLOYEE AND THEY UNDERSTAND AND ACKNOWLEDGE THAT TO THE EXTENT THEY ARE AN AT-WILL EMPLOYEE, THE STANDARDS DO NOT AFFECT THE AT-WILL NATURE OF MY EMPLOYMENT RELATIONSHIP WITH THE COMPANY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF HCR MANORCARE, INC.'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS WAS DETERMINED BY A COMPENSATION COMMITTEE OF PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: NET TRANSFER FROM RELATED ENTITIES -267,887,995. LOSS FROM DISCONTINUED OPERATIONS -708,678. NET TRANSFER OF ASSETS FROM PROMEDICA CONTINUING CARE SERVICES CORPORATION 3,778,265. NET TRANSFER FROM PROMEDICA CONTINUUM SERVICES 7,429,210. NET TRANSFER OF ASSETS FROM EMMA L. BIXBY MEDICAL CENTER 5,650,865. TRANSFER OF SECURITIES TO TOLEDO HOSPITAL -50,710,848. TRANSFER OF CASH TO TOLEDO HOSPITAL -115,941,000. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR FORM 990, PART XII, LINE 3B THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT YET BEEN COMPLETED. PLANS HAVE BEEN MADE TO HAVE THE REQUIRED SINGLE AUDIT COMPLETED BY THE EXTENDED DUE DATE AS ESTABLISHED IN OMB M-20-26. 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