2018-11-13T15:45:40-06:00 2017-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2017-01-01 341623770 JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL JOIN 4193943387 200 ST CLAIR STREET ST MARYS OH 45885 JEFFREY W VOSSLER CFO 4193943387 2018-11-12 1 BERNIE OSTROWSKI P00366367 6148493000 2018-11-12 67.59.56.30 2018-11-12 12:15:56 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 591040A78CBC3F75C461B288E321443036B4F4D8 2017 2019-02-21 02:37:17Z GRAND LAKE HEALTH SYSTEM KEVIN HARLAN 200 ST CLAIR STREET ST MARYS OH 45885 77339157 0 X WWW.GRANDLAKEHEALTH.ORG X 1989 OH TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG. 9 7 674 148 47554 17257 481258 338872 73890404 75232028 194046 544848 600319 759086 75166027 76874834 114383 64523 0 0 29209665 30609702 30000 29996 177840 39764841 40653454 69118889 71357675 6047138 5517159 72272389 71601089 18816436 18343551 53455953 53257538 X TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG.VISION:TO BE:-THE REGION'S LEADER AND PREFERRED CHOICE FOR HEALTHCARE;-THE MOST DESIRED PLACE FOR EMPLOYMENT;-THE RECOGNIZED SOURCE FOR HEALTH AND WELLNESS; AND-THE COORDINATOR OF PATIENT SERVICES THAT EXCEED THE SCOPE OF OUR HEALTH SYSTEM.VALUES:COMPASSION - TO SERVE WITH DIGNITY, CONCERN, TRUST AND KINDNESSRESPECT - FOR OUR PATIENTS, FAMILIES, COMMUNITIES AND EACH OTHERSTEWARDSHIP - MAKING THE BEST USE OF OUR HUMAN AND ECONOMIC RESOURCESSERVICE EXCELLENCE - ANTICIPATING CUSTOMER NEEDS, CONTINUOUSLY IMPROVING AND CONSISTENTLY EXCEEDING EXPECTATIONSCOLLABORATION - TO WORK IN PARTNERSHIP, INTERNALLY AND EXTERNALLY, TO BETTER SERVE OUR COMMUNITIESWORKFORCE - TO VALUE AND RESPECT THE TALENTED, COMMITTED AND DIVERSE PEOPLE WHO MAKE UP OUR HEALTH SYSTEM 0 0 58928190 64523 75367193 JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND SMALL MANUFACTURING. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDES A POPULATION OF 24,632. THE ADJACENT COMMUNITY OF CELINA (ZIP CODE POPULATION OF 19,621) IS ALSO SERVED BY THE HOSPITAL. THE HOSPITAL ALSO PROVIDES SERVICES TO THE WAPAKONETA COMMUNITY (POPULATION 18,258) ALTHOUGH THE TRADITIONAL SERVICE PATTERNS SEND THAT COMMUNITY'S PATIENTS TO LIMA. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTDMH'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 62,511 WITH 15% IN THE MEDICARE AGE GROUP (65+).JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A FULL RANGE OF ACUTE AND OUTPATIENT SERVICES INCLUDING A 24-HOUR EMERGENCY ROOM AND OBSTETRICAL SERVICE. MAJOR SERVICES INCLUDE SURGICAL; MEDICAL; SKILLED NURSING UNIT; ICU/CCU; DIAGNOSTIC RADIOLOGY INCLUDING CT AND MRI; PHYSICAL THERAPY; OCCUPATIONAL MEDICINE; CARDIAC SERVICES, URGENT CARE, HOME HEALTH SERVICES, HOSPICE, WOUND CARE AND VEIN CLINIC SERVICES.DURING 2017, JTDMH PROVIDED SERVICES TO THE FOLLOWING BY CATEGORY:ACUTE PATIENTS ADMITTED: 1,717SNF PATIENTS ADMITTED: 200BIRTHS: 332OUTPATIENT VISITS: 72,017E.R. VISITS: 13,592HOME HEALTH VISITS: 7,393OCCUPATIONAL HEALTH VISITS: 12,447URGENT CARE: 7,912JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL AND GRAND LAKE HEALTH SYSTEM IS THE HUB OF THE LOCAL HEALTH CARE DELIVERY SYSTEM IN ST. MARYS AND SURROUNDING COMMUNITIES. THE NON-PROFIT COMMUNITY HOSPITAL ALSO HAS A MAJOR ECONOMIC IMPACT ON THE LOCAL COMMUNITY BY PROVIDING EMPLOYMENT TO OVER 600 INDIVIDUALS. THE GRAND LAKE HEALTH SYSTEM INCLUDES PHYSICIAN PRACTICES AND FACILITIES IN CELINA, ST. MARYS, WAPAKONETA, AND MINSTER. IN 2017, THESE PRACTICES HAD OVER 63,199 PATIENT VISITS.GRAND LAKE HEALTH SYSTEMGRAND LAKE HEALTH SYSTEM AND AFFILIATED HEALTH CENTERS ARE ORGANIZED AS A CHARITABLE, NON-PROFIT COMMUNITY HOSPITAL OFFERING A WIDE RANGE OF PRIMARY, ACUTE AND REHABILITATIVE SERVICES TO THE RESIDENTS OF THE GRAND LAKE REGION.THE ANCHOR OF GRAND LAKE HEALTH SYSTEM IS JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IN ST. MARYS OHIO. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL OPENED ITS DOORS ON MAY 5, 1953 AND TODAY AS THE GRAND LAKE HEALTH SYSTEM, HAS GROWN TO A STATE-OF-THE-ART COMMUNITY HOSPITAL INCLUDING OVER 800 MEDICAL PROFESSIONALS, 200 + PHYSICIANS AND 16 AFFILIATES.THE GRAND LAKE HEALTH SYSTEM PROVIDES A WIDE RANGE OF SERVICES INCLUDING THE FOLLOWING CENTERS OF EXCELLENCE: EMERGENCY CARDIAC CARE HOME HEALTH BIRTHING CENTER TRANSITIONAL CARE INPATIENT REHABILITATION SURGICAL SERVICES OUTPATIENT SERVICES URGENT CARE WOMEN'S IMAGING WOUND CAREGRAND LAKE AFFILIATES INCLUDE: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL GRAND LAKE FAMILY PRACTICE & PEDIATRICS AT THE CELINA MEDICAL CENTER WAPAKONETA PRIMARY CARE AT THE WAPAKONETA MEDICAL CENTER GRAND LAKE HOME HEALTH GRAND LAKE HOSPICE GRAND LAKE PRIMARY CARE AT ST. MARYS GRAND LAKE OB/GYN GRAND LAKE OCCUPATIONAL MEDICINE MIAMI & ERIE FAMILY PRACTICE & PEDIATRICS GRAND LAKE SLEEP CENTER NEW DAY PAIN MANAGEMENT CENTER GRAND LAKE NEUROLOGICAL CENTER VANAN ENT & SINUS CENTER JTDMH TRANSITIONAL CARE UNIT JTDMH INPATIENT REHAB UNIT JAMES REICHERT, D.O. GENERAL & BARIATRIC SURGERY URGENT CARE AT JTDMH AUGLAIZE MERCER UROLOGY CLEAR PASSAGE GERIATRIC PSYCHIATRIC CENTER CANCER CENTER OF NORTHWEST OHIO WEST CENTRAL OHIO REGIONAL HEALTHCARE ALLIANCE GRAND LAKE PEDIATRICSGRAND LAKE HEALTH SYSTEM IS THE RECIPIENT OF MANY DISTINGUISHED QUALITY AWARDS.MEDICARE 2017 5-STAR RATING, HOSPITAL COMPARE CONSUMER-ORIENTED WEBSITEBIRTHING CENTER2015 OHIO FIRST STEPS FOR HEALTHY BABIES, ONE STAR AWARD2015 ANTHEM BLUE DISTINCTION CENTER FOR MATERNITY CAREEMERGENCY DEPARTMENT 2015 DNV ACUTE STROKE READY CERTIFICATION 2015 WOMEN'S CHOICE AWARD FOR EMERGENCY DEPARTMENT 2016 WOMEN'S CHOICE AWARD FOR EMERGENCY DEPARTMENT 2017 WOMEN'S CHOICE AWARD FOR EMERGENCY DEPARTMENTTRANSITIONAL CARE UNIT PERFECT SURVEY AWARD PRESENTED BY THE OHIO ACADEMY NURSING HOMES 2011 RECOGNIZED BY OHIO HEALTH CARE ASSOCIATION FOR DEFICIENCY FREE SURVEY 2010RANKED 4TH IN THE STATE OF OHIO IN PATIENT SATISFACTION SURVEY CONDUCTED BY THE DEPARTMENT OF AGING - 2011RANKED 5 STAR IN "NURSING HOME COMPARE" CMS. 2010-2012 FOR OVERALL RATING, HEALTH INSPECTIONS, AND STAFFING STATE OF OHIO PATIENT SATISFACTION SURVEY, TOP 20 2013 2014 RECOGNITION FOR INPATIENT SERVICES TCU DEFICIENCY FREE SURVEY TCU 5-STAR RATINGWOUND CARE CENTER 2015 HEALOGICS CENTER OF DISTINCTION AWARD 2015 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARD 2016 HEALOGICS CENTER OF DISTINCTION AWARD 2016 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARD 2017 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARDCARDIAC CARE FIVE-STAR RECIPIENT FOR TREATMENT OF HEART FAILURE FOR 9 YEARS IN A ROW (2005-2013)ORTHOPEDIC CARE FIVE-STAR RECIPIENT FOR HIP FRACTURE TREATMENT FOR 3 YEARS IN A ROW (2011-2013)PULMONARY CARE RECIPIENT OF THE HEALTHGRADES PULMONARY CARE EXCELLENCE AWARD IN 2013 RANKED IN THE TOP 10% IN THE NATION FOR OVERALL PULMONARY SERVICES IN 2013 FIVE-STAR RECIPIENT FOR OVERALL PULMONARY SERVICES FOR 2 YEARS IN A ROW (2012-2013) FIVE-STAR RECIPIENT FOR TREATMENT OF PNEUMONIA FOR 7 YEARS IN A ROW (2007-2013)GENERAL SURGERY RECIPIENT OF THE HEALTHGRADES GASTROINTESTINAL CARE EXCELLENCE AWARD IN 2013 RECIPIENT OF THE HEALTHGRADES GENERAL SURGERY EXCELLENCE AWARD IN 2013 RANKED IN THE TOP 10% IN THE NATION FOR OVERALL GI SERVICES IN 2013 RANKED IN THE TOP 10% IN THE NATION FOR GENERAL SURGERY IN 2013 RANKED #8 IN OHIO FOR GI SERVICES IN 2013 RANKED #4 IN OHIO FOR GENERAL SURGERY IN 2013 RANKED IN THE TOP 10 IN OHIO FOR GI SERVICES IN 2013 (RANKED 8 IN 2013) RANKED IN THE TOP 5 IN OHIO FOR GENERAL SURGERY IN 2013 (RANKED 4 IN 2013) FIVE-STAR RECIPIENT FOR CHOLECYSTECTOMY IN 2013CRITICAL CARE FIVE-STAR RECIPIENT FOR TREATMENT OF RESPIRATORY FAILURE FOR 5 YEARS IN A ROW (2009-2013)HOME HEALTH & HOSPICE AWARDS2011 OUTSTANDING HOME HEALTH AIDE AWARD, WEST CENTRAL OHIO HOME HEALTH ORGANIZATION 2012 COMMUNITY SERVICE AWARD, OTTERBEIN (HOSPICE) 2012 PRESIDENT'S AWARD FOR CUSTOMER SATISFACTION 2012 HOME CARE ELITE AWARD 2012 HOME CARE ELITE TOP 500 AGENCIES NATIONWIDE 2013 HOME CARE ELITE 2013 DAILY POINT OF LIGHT AWARD FOR HOSPICE VOLUNTEERS 2013 LEVEL ONE FOR "WE HONOR VETERANS" PROGRAM 2014 HOME CARE ELITE 2015 HOME CARE ELITE AWARD OF EXCELLENCE 2017 CERTIFIED HOSPICE AND PALLIATIVE NURSE (CHPN) JANE STEINEMANN 2017 CAHPS HOSPICE SURVEY, SCORES SIGNIFICANTLY EXCEED NATIONAL AVERAGEINFORMATION SYSTEMS HEALTH CARE'S MOST WIRED 2013 MOST IMPROVED HEALTH CARE'S MOST WIRED 2014 MOST IMPROVED HEALTH CARE'S MOST WIRED 2015 MOST IMPROVED HEALTH CARE'S MOST WIRED 2016 - SMALL & RURAL HEALTH CARE'S MOST WIRED 2017 58928190 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 145 0 1 674 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 1 0 X JEFFREY W VOSSLER 4193943387 200 ST CLAIR ST ST MARYS OH 45885 CHRIS SCHROER DIRECTOR 1.00 0.00 X 0 0 0 RAJENDRA KAKARLA MD DIRECTOR 1.00 0.00 X 203652 0 0 SUSAN INGRAHAM DIRECTOR - PART YEAR 1.00 0.00 X 0 0 0 CLAUDIA COE DIRECTOR (SEPTEMBER-PRESENT) 1.00 0.00 X 0 0 0 ANITA GREEN DIRECTOR 1.00 0.00 X 0 0 0 JEREMIE KOENIG DIRECTOR 1.00 0.00 X 0 0 0 SEETARAM RAVIPATI MD DIRECTOR 1.00 0.00 X 2400 0 0 ROBIN BRANDT DIRECTOR 1.00 0.00 X 0 0 0 DALE LUEBKE CHAIRMAN 2.00 0.00 X X 0 0 0 KRAIG NOBLE VICE CHAIR 1.50 0.00 X X 0 0 0 KEVIN HARLAN PRESIDENT 26.50 13.50 X 386773 188367 86351 JEFFREY VOSSLER TREASURER 35.00 5.00 X 230618 0 35861 JILL DICKMAN SECRETARY 35.00 5.00 X 80930 0 35251 DEB MCKEE VP OF PATIENT CARE SERVICE 40.00 0.00 X 207930 0 49571 ART SWAIN VP OF SUPPORT SERVICES 40.00 0.00 X 184050 0 46712 LANA HINDERS DIRECTOR OF EMERGENCY AND AMBULATORY CARE 40.00 0.00 X 116793 0 39081 TYLER KROEGER DIRECTOR OF PHARMACY 40.00 0.00 X 117679 0 29211 CINDY BERNING EXECUTIVE DIRECTOR SYSTEM ENGINEERING AND PROCESS 40.00 0.00 X 138630 0 16377 JILL ENGEL DIRECTOR OF INPATIENT SERVICES 40.00 0.00 X 119678 0 39500 LINDA HAINES EXECUTIVE DIRECTOR 40.00 0.00 X 115092 0 38979 1904225 188367 416894 14 0 1 0 JTDM FAMILY PRACTICE INC 200 SAINT CLAIR ST ST MARYS OH 45885 MEDICAL SERVICES 7420260 EMERGENCY PROFESSIONAL SVCS PO BOX 634850 CINCINNATI OH 452634850 MEDICAL SERVICES 2914728 NEW VISION MEDICAL LABORATORIES INC 750 W HIGH STREET LIMA OH 45801 MEDICAL SERVICES 1580093 WEIGANDT DEVELOPMENT 90 N MAIN STREET MINSTER OH 45865 CONSTRUCTION SERVICES 1306615 THERAPY SOLUTIONS 120 W MAIN STREET VAN WERT OH 45891 MEDICAL SERVICES 1266046 22 303913 34959 31401 338872 NET PATIENT REVENUE 622110 75286565 75286565 PASSTHROUGH INCOME 622110 -54537 -54537 75232028 556974 556974 621156 2004 381397 0 239759 2004 241763 23316 218447 70800 82926 -12126 -12126 -12126 CAFETERIA AND VENDING SALES 722514 345953 345953 COMMUNITY OUTREACH 622110 53718 53718 ELECTRONIC HEALTH RECORD INCENTIV 622110 43946 43946 73706 37501 24238 11967 517323 76874834 75367193 47554 1121215 X 64523 64523 1507071 1507071 18853866 16751742 1987224 114900 1135263 977586 157677 7489003 5994265 1494738 1624499 1283354 332355 8790 167303 167303 121060 121060 29996 29996 50430 50430 17654197 15272385 2381812 483360 28672 434436 20252 2356567 1794525 560550 1492 4537385 3270652 1266733 156258 135237 21021 364617 350377 14240 179543 179543 4322930 3933866 389064 754973 754973 MEDICAL SUPPLIES 6279477 6270893 8584 BAD DEBT EXPENSE 2771600 2771600 PHYSICIAN RECRUITMENT 371192 371192 COMMUNITY OUTREACH 17852 15766 2086 64710 12747 49553 2410 71357675 58928190 12251645 177840 2740 2840 7210630 8572498 13236671 10730490 1006872 1100362 986532 801392 91271882 54685911 34783061 36585971 12526426 12007444 1187267 1149062 1332190 651030 72272389 71601089 7809014 8354243 4802564 3589744 2142852 3268316 4062006 3131248 18816436 18343551 X 53455953 53257538 53455953 53257538 72272389 71601089 X 5517159 820955 -6536529 X X 0 1 X 1 0 X 0 0 0 0 0 0 1 0 1 1179 1179 0 PART II-B, LINE 1: LINE 1(G): EXECUTIVE OFFICERS OF JTD MEMORIAL HOSPITAL PLACED CALLS WITH THEIR LEGISLATORS TO HELP EDUCATE THE LEGISLATORS ON VARIOUS HEALTH CARE RELATED ISSUES. LINE 1(I): THE HOSPITAL PAID DUES TO OHA, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 1732459 1732459 53508767 33858756 19650011 34586286 20827155 13759131 1444370 1444370 36585971 PROFESSIONAL LIABILITY 1362808 OTHER LONG TERM LIABILITIES 1307504 COST REPORT SETTLEMENT PAYABLE 460936 3131248 X X 1 BUTLER CONSULTING INC 270 S BROADMOOR BLVD SPRINGFIELD OH 45504 GRANT WRITER 0 1000 29996 1000 1000 29996 1000 OH 1 1 X 1 X 120.000000000000 1 X 1 1 0 1 1 3105 390025 0 390025 0.00570 10974 10417295 6326540 4090755 0.05960 14079 10807320 6326540 4480780 0.06530 57 38604 377776 11204 366572 0.00530 5 9 38694 0 38694 0.00060 2 0 57884 0 57884 0.00080 0 0 0 0 3 50 74960 0 74960 0.00110 67 38663 549314 11204 538110 0.00780 67 52742 11356634 6337744 5018890 0.07310 7 15913 17753 630 17123 0.00020 2 0 8110 8110 0.00010 2 0 1298 1298 0.00000 3 392 7764 7764 0.00010 14 16305 34925 630 34295 0.00040 0 2771600 16874 12087306 16857583 -4770277 X 1 1 1 1 JTD MEMORIAL HOSPITAL 200 SAINT CLAIR STREET ST MARYS OH 45885 WWW.GRANDLAKEHEALTH.ORG STATE REG. NO. 1111 X X X INPATIENT REHAB UNIT, TRANSITIONAL CARE UNIT JTD MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X HTTPS://WWW.GRANDLAKEHEALTH.ORG/NEWS-AND-EVENTS/COMMUNITY-HEALTH-ASSESSMENT X 1 16 0 1 0 1 X 120.000000000000 200.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X 1 X 0 0 JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: JTD MEMORIAL HOSPITAL CREATED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT MET ON OCTOBER 25, 2016. PARTICIPANTS INCLUDED THE AUGLAIZE COUNTY HEALTH DEPARTMENT, THE MERCER COUNTY HEALTH DEPARTMENT, THE AUGLAIZE COUNTY COUNCIL ON AGING, AND THE FOLLOWING GROUPS FROM JTD MEMORIAL HOSPITAL:-PATIENT CARE SERVICES-HOSPITAL FOUNDATION AND GRAND LAKE HOME HEALTH/HOSPICE-EMPLOYED PHYSICIAN PRACTICES-COMMUNITY OUTREACH-ADMINISTRATIONPARTICIPANTS WERE PROVIDED A REPORT COMPILED BY AN INDEPENDENT CONSULTANT, WHICH DREW DATA FROM VARIOUS WEB SOURCES WITH BOTH AUGLAIZE AND MERCER COUNTY HEALTH INDICATORS AND HEALTH STATUS PROFILES FROM 2016. THERE WERE THREE MAIN SOURCES FOR THIS DATA - INSTITUTE FOR PEOPLE, PLACE AND POSSIBILITY (IP3) COMMUNITY COMMONS, UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE SCHOOL OF MEDICINE AND PUBLIC HEALTH'S COUNTY HEALTH RANKINGS, AND GRAND LAKE HEALTH SYSTEM/JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL COMMUNITY HEALTH ASSESSMENT 2013. PARTICIPANTS REVIEWED ALL DATA AND INFORMATION IDENTIFIED IN THE CHNA IN ORDER TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. PARTICIPANTS IDENTIFIED THE HEALTH NEEDS OF THE COMMUNITY BY CONSIDERING THOSE REQUISITES FOR THE IMPROVEMENT OR MAINTENANCE OF HEALTH STATUS IN THE COMMUNITY USING ALL FACTS AND CIRCUMSTANCES PRESENTED. PARTICIPANTS CONSIDERED THE SEVERITY OF EACH NEED, EFFECTIVENESS OF INTERVENTION, HEALTH DISPARITIES ASSOCIATED WITH THE NEED, AND IMPORTANCE THE COMMUNITY PLACES ON ADDRESSING THE NEED. JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: AUGLAIZE COUNTY HEALTH DEPARTMENT, MERCER COUNTY HEALTH DEPARTMENT, AUGLAIZE COUNTY COUNCIL ON AGING JTD MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE FOLLOWING ACTIONS THAT WERE TAKEN DURING THE 2017 TAX YEAR ARE ASSOCIATED WITH THE 2016 CHNA:SIGNIFICANT HEALTH NEED 1: MENTAL HEALTH - COLEMAN BEHAVIORAL HEALTH PARTNERSHIP: ONGOING INTEGRATION OF COLEMAN STAFF INTO THE GRAND LAKE PHYSICIAN PRACTICES THAT BEGAN IN 2014 CONTINUED THROUGH 2017. COLEMAN REFERRALS FROM THE ED INCREASED BY 12% AND INDIVIDUAL COUNSELING SESSIONS INCREASED BY 58.3% FROM 2016 TO 2017. - HORIZON HEALTH PARTNERSHIP: JTDMH OPENED AN INPATIENT GERO-PSYCH UNIT IN COLLABORATION WITH HORIZON HEALTH, WITH CMS CERTIFICATION EFFECTIVE JANUARY 1, 2018. - TELE MENTAL HEALTH PILOT: PILOT PROGRAM LED BY A CONSORTIUM MEMBER HOSPITAL TO ASSESS BEHAVIORAL HEALTH ED PATIENTS VIA TELEMEDICINE DEVICE HAS BEEN SUCCESSFUL AT A PEER HOSPITAL; INCORPORATION AT JTDMH IS BEING EXPLORED. SIGNIFICANT HEALTH NEED 2: OBESITY - HEALTH SMART: CONTINUED TO SPONSOR HEALTH SMART PROGRAM IN CONJUNCTION WITH THE EMPLOYER-SPONSORED HEALTH PLAN WITH IMPROVED BIOMETRICS NOTED DURING 2017 IN MULTIPLE CATEGORIES FOR THOSE JTDMH EMPLOYEES AND THEIR SPOUSES AND DEPENDENTS WHO PARTICIPATE. - GRAND HEALTH CHALLENGE: 11TH ANNUAL GRAND HEALTH CHALLENGE WAS HELD JANUARY THRU MAY 2017 IN WHICH 537 PARTICIPANTS LOST 3,409.1 POUNDS.SIGNIFICANT HEALTH NEED 3: RISKY BEHAVIORS - SUPPORT FOR HEROIN ADDICTS DRUG TRIAL: THE MEDICATION ASSISTED TREATMENT PROGRAM (MATS) CONTINUED THROUGH 2017 WITH A 63% SUCCESS RATE REPORTED. 29 OUT OF 46 CLIENTS WERE SUCCESSFUL, DEFINED AS NO VIOLATIONS WITHIN THE PAST YEAR. A T-CAP GRANT (TARGETED COMMUNITY ALTERNATIVES TO PRISON) WAS RECEIVED BY THE PROGRAM IN 2017 TO ALLOW IT TO CONTINUE FROM JUNE 2017-2019. - SMOKING CESSATION PROGRAM: SMOKING CESSATION PROGRAM FOR JTDMH/GLHS EMPLOYEES AND DEPENDENTS BEING INVESTIGATED. THE JTDMH OUTREACH SUPPORT SPECIALIST HAS OBTAINED CERTIFICATION AS A SMOKING CESSATION INSTRUCTOR TO ASSIST WITH THIS INITIATIVE.SIGNIFICANT HEALTH NEED 4: ACCESS TO CARE - JTDMH/GLHS PRIMARY CARE SERVICES EDUCATION: COLLABORATED WITH AUGLAIZE COUNTY HEALTH DEPARTMENT IN DISTRIBUTION OF COMPREHENSIVE AUGLAIZE COUNTY PRIMARY CARE PROVIDER LISTINGS, WITH LOCATION, CONTACT INFO, OFFICE HOURS, AND MEDICAID ACCEPTANCE TO PARENTS OF YOUNG CHILDREN AT IMMUNIZATION APPOINTMENTS. - PROMOTION OF JTDMH/GLHS SERVICES VIA WEBSITE AND SOCIAL MEDIA OUTLETS: TRACKING OF PAGE VIEWS AND SOCIAL MEDIA SESSIONS BEGAN IN COLLABORATION WITH JTDMH'S MARKETING FIRM TO ASSIST IN ASSESSING COMMUNITY REACH OF SERVICES PROMOTION. SIGNIFICANT HEALTH NEED 5: EDUCATION/PREVENTION/HEALTH PROMOTION - HEALTH SCREENINGS AT COMMUNITY FUNCTIONS: COMMUNITY OUTREACH EFFORTS TO INCREASE BLOOD PRESSURE SCREENINGS WITHIN THE COMMUNITY RESULTED IN A 16.5% INCREASE IN SCREENING PARTICIPATION FROM 2016 TO 2017. IN ADDITION, OSTEOPOROSIS SCREENINGS INCREASED 57.9% OVER THE SAME TIMEFRAME. - COLORECTAL SCREENINGS: COMMUNITY OUTREACH EFFORTS IN 2017 RESULTED IN A 10% INCREASE IN COLORECTAL SCREENING KIT DISTRIBUTION OVER 2015. 5 1 - URGENT CARE AT JTDMH 200 ST CLAIR STREET ST MARYS OH 45885 URGENT CARE 2 - GRAND LAKE HOME HEALTH 1122 EAST SPRING STREET ST MARYS OH 45885 HOME HEALTH 3 - GRAND LAKE HOSPICE 1122 EAST SPRING STREET ST MARYS OH 45885 HOSPICE 5 - GRAND LAKE OCCUPATIONAL MEDICINE 200 ST CLAIR STREET ST MARYS OH 45885 OCCUPATIONAL MEDICINE 6 - CELINA PRO HEALTH DIAGNOSTIC CENTER 801 PRO DRIVE CELINA OH 45822 DIAGNOSTIC CENTER PART I, LINE 7: THE HOSPITAL USED THE MEDICARE COST REPORT AS THEIR BASIS FOR CALCULATING THE AMOUNTS REPORTED IN LINE 7A & 7B. ON THE COST REPORT, IT FIRST ALLOCATES OVERHEAD DEPARTMENTS VIA A COST STEP DOWN METHODOLOGY AND THEN CALCULATES A COST TO CHARGE RATIO. FOR LINES 7E, 7F,7G & 7I ACTUAL COSTS WERE USED. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,771,600. PART II, COMMUNITY BUILDING ACTIVITIES: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY BUILDING ACTIVITIES IN 2017 RANGING FROM PARTICIPATION IN COMMUNITY BOARDS, COMMITTEES AND CLUBS THAT WERE ENGAGED IN IMPROVING THE OVERALL COMMUNITY INCLUDING THE COMMUNITY'S HEALTH/MEDICAL NEEDS TO OFFERING BABYSITTING TRAINING CLASSES TO ASSURE THE CHILDREN OF THE COMMUNITY ARE WELL CARED FOR IN THEIR PARENT'S ABSENCE. OTHER EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO PARTICIPATING IN WORKFORCE DEVELOPMENT OF HEALTH CARE CAREERS THROUGH JOB SHADOWING AND SEMINARS AND ACTIVE PARTICIPATION IN THE COMMITTEE THAT IS WORKING TO RESTORE CLEAN AND HEALTHY WATER TO THE COMMUNITIES LARGEST RECREATION RESOURCE, GRAND LAKE ST. MARYS. PART III, LINE 2: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL RECORDS BAD DEBT EXPENSE WHEN AN ACCOUNT IS DEEMED UNCOLLECTIBLE AT THE VALUE OF CHARGES. IF IT BECOMES NECESSARY TO ESTIMATE BAD DEBT EXPENSE, ESTIMATES ARE DONE BASED UPON HISTORIC RELATIONSHIPS BETWEEN CHARGES AND BAD DEBT. PART III, LINE 3: THE HOSPITAL ESTIMATES THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY BASED UPON A HISTORIC REVIEW OF THE APPLICABLE BAD DEBT ACCOUNTS. EVERY EFFORT IS MADE TO IDENTIFY THESE ACCOUNTS PRIOR TO BEING WRITTEN OFF AS UNCOLLECTIBLE, INCLUDING MULTIPLE EFFORTS TO CONTACT THE PATIENT. AS SOON AS THESE ACCOUNTS ARE DEEMED UNCOLLECTIBLE, ALL COLLECTION WORK AND ACTIVITY IS IMMEDIATELY CEASED. THESE ACCOUNTS ARE THEN TREATED THE SAME AS ANY OTHER ACCOUNT QUALIFYING FOR FINANCIAL ASSISTANCE. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: THE HOSPITAL USED A COST STEP DOWN METHODOLOGY FROM THE MEDICARE COST REPORT TO CALCULATE THE AMOUNTS REPORTED IN LINE 6. THE COST OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2017 WAS $16,857,583. THE PAYMENTS RELATED TO THESE SERVICES WERE $12,087,306. LEAVING A MEDICARE SHORTFALL OF $4,770,277 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH JTD MEMORIAL HOSPITAL'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. PART III, LINE 9B: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL FOLLOWS THE SAME COLLECTION PRACTICES NO MATTER THE TYPE OF PATIENT. ALL PATIENTS ARE TREATED EQUALLY. COLLECTION PRACTICES ARE NOT PURSUED FOR PATIENTS THAT THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE/CHARITY CARE. PART VI, LINE 2: N/A - ALL NEEDS WERE ASSESSED WHILE CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: PATIENTS ARE INFORMED ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH SIGNS POSTED AT REGISTRATION, IN ER/WAITING ROOMS, ON THE WEBSITE, THROUGH INFORMATION INCLUDED IN THE PATIENT HANDBOOK, THROUGH INFORMATION PRINTED ON THE REVERSE SIDE OF THE STATEMENTS THEY RECEIVE FOR SERVICES, AND IS AVAILABLE UPON REQUEST. PART VI, LINE 4: JTD MEMORIAL HOSPITAL IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND SMALL MANUFACTURING. JTD MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDES A POPULATION OF 24,632. THE ADJACENT COMMUNITY OF CELINA (ZIP CODE POPULATION OF 19,621) IS ALSO SERVED BY THE HOSPITAL. THE HOSPITAL ALSO PROVIDES SERVICES TO THE WAPAKONETA COMMUNITY (POPULATION 18,258) ALTHOUGH THE TRADITIONAL SERVICE PATTERNS SEND THAT COMMUNITY'S PATIENTS TO LIMA. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTD MEMORIAL HOSPITAL'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 62,511 WITH 15% IN THE MEDICARE AGE GROUP (65+). PART VI, LINE 5: JTD MEMORIAL HOSPITAL/GRAND LAKE HEALTH COMMUNITY OUTREACH PART OF THE HOSPITAL'S PHILOSOPHY HAS BEEN TO PROMOTE THE HEALTH AND WELLNESS OF COMMUNITY MEMBERS. THE HOSPITAL HAS A HISTORY OF REACHING OUT TO THE COMMUNITY TO PROMOTE WELLNESS AND PREVENTIVE MEDICINE AND HAS AN OFFICE THAT IS DEDICATED TO COORDINATING COMMUNITY HEALTHCARE, OUTREACH, AND EDUCATION.FOLLOWING IS A LISTING OF THE WIDE VARIETY OF OUTREACH PROGRAMS THAT ARE SPONSORED BY GRAND LAKE HEALTH SYSTEM. - MONTHLY BLOOD PRESSURE CHECKS (4 SITES) - BREASTFEEDING CLASSES - CHILDBIRTH CLASSES - CALL A NURSE - CPR CLASSES - DIABETIC SUPPORT GROUP - HEALING MEMORIES SUPPORT GROUP - STROKE SUPPORT GROUP - PARKINSON'S SUPPORT GROUP - COMMUNITY HEALTH FAIRS/ROTARY BLOOD TEST CLINICS - SCHOOL HEALTH FAIRS - MAKE BELIEVE HOSPITAL (KINDERGARTEN PROGRAM TO ALLEVIATE FEARS OF HOSPITAL)] - NEW BREMEN SENIOR CITIZEN PROGRAM - FREE PROSTATE SCREENING - SENIOR SUPPER HOUR - SENIORCISE - AMERICAN SIGN LANGUAGE CLASSES (I & II) - SPEAKERS BUREAU - SUPERSITTERS CLASSES - FREE MONTHLY WELLNESS EDUCATION & SCREENING (WRIGHT STATE, AGAPE, WAGNERS IGA) - WOMEN'S WALK FOR WELLNESS - COORDINATION OF THE UNITED WAY CAMPAIGN FOR THE HOSPITAL - ROAD TO FITNESS PROGRAM (12 MONTHS) - MAN TO MAN PROSTATE SUPPORT GROUP - DRUG TAKEBACK PROGRAM - PRE-DIABETES CLASSESIN ADDITION, WE SUPPORT THE WELLNESS OF THE COMMUNITY BY PARTICIPATING IN EVENTS HOSTED AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. FOLLOWING IS A LIST OF TOPICS THAT ARE COVERED: - NUTRITION - HEART EDUCATION - SKIN CANCER - OSTEOPOROSIS SCREEN - BREAST CANCER AWARENESS - CHOLESTEROL AWARENESS - ASSESSMENT OF DIABETES - ALCOHOL EDUCATON - COLORECTAL CANCER EDUCATION - ASTHMA EDUCATION - PERIPHERAL SCREENING - SLEEP APNEA INFORMATION - STROKE EDUCATIONWE ALSO PARTNER WITH TWO LOCAL RADIO STATIONS PROVIDING MONTHLY INTERVIEWS ON A WIDE VARIETY OF HEALTHCARE TOPICS.SINCE 2007, WE HAVE SPONSORED A WEIGHT LOSS/WELLNESS PROGRAM, ENTITLED, "THE GRAND HEALTH CHALLENGE." IN THE PAST 12 YEARS, THIS PROGRAM HAS SERVED ALMOST 4,848 RESIDENTS OF BOTH MERCER AND AUGLAIZE COUNTIES, LOSING ALMOST 43,597.30 LBS. WE ARE AGAIN IN THE PLANNING STAGE FOR OUR 13TH YEAR, 2019. 1 AUGLAIZE-MERCER COUNTY YMCA 7590 STATE ROUTE 703 CELINA OH 45822 341371829 501(C)(3) 21500 GENERAL SUPPORT TO PROMOTE HEALTHY LIVING WITHIN THE COMMUNITY, HEALTHY KIDS DAY SPONSORSHIP WAPAKONETA FAMILY YMCA 1100 DEFIANCE STREET WAPAKONETA OH 45895 311568315 501(C)(3) 19368 WALKING PROGRAM AND SAFE KIDS-SAFE POOLS INITIATIVE 2 0 PART I, LINE 2: THE HOSPITAL MAKES GRANTS TO COMMUNITY ORGANIZATIONS. GRANTS ARE MONITORED THROUGH DIRECT INVOLVEMENT AND CONTACT WITH THE ORGANIZATION OR EVENT IN WHICH THE GRANT WAS GIVEN. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 RAJENDRA KAKARLA MD DIRECTOR 0 0 0 0 203652 0 0 0 0 0 203652 0 0 0 KEVIN HARLAN PRESIDENT 386773 126689 0 0 0 61678 28335 41921 14990 1105 430098 231393 0 39530 JEFFREY VOSSLER TREASURER 221798 0 8820 0 0 0 24207 0 11654 0 266479 0 0 0 DEB MCKEE VP OF PATIENT CARE SERVICE 199110 0 8820 0 0 0 21929 0 27642 0 257501 0 0 0 ART SWAIN VP OF SUPPORT SERVICES 176330 0 7720 0 0 0 19254 0 27458 0 230762 0 0 0 LANA HINDERS DIRECTOR OF EMERGENCY AND AMBULATORY 116793 0 0 0 0 0 12068 0 27013 0 155874 0 0 0 CINDY BERNING EXECUTIVE DIRECTOR SYSTEM ENGINEERIN 130910 0 7720 0 0 0 5400 0 10977 0 155007 0 0 0 JILL ENGEL DIRECTOR OF INPATIENT SERVICES 119678 0 0 0 0 0 12445 0 27055 0 159178 0 0 0 LINDA HAINES EXECUTIVE DIRECTOR 108472 0 6620 0 0 0 12008 0 26971 0 154071 0 0 0 PART I, LINE 1A JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A PORTION OF YMCA DUES TO THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES; HOWEVER, THIS IS AN EMPLOYEE BENEFIT AVAILABLE TO ALL ELIGIBLE EMPLOYEES OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL TO PROMOTE COMMUNITY WELLNESS (2 OF THE PEOPLE LISTED IN PART VII, SECTION A, LINE 1A RECEIVED THIS BENEFIT). THE YMCA DUES WERE NOT INCLUDED IN THE RECIPIENT'S COMPENSATION. PART I, LINE 4B LINE 4B: KEVIN HARLAN CONTRIBUTED $13,000 INTO THE PLAN IN 2017 AND THE HOSPITAL MADE A $41,921 CONTRIBUTION INTO THE PLAN DURING 2017. THIS AMOUNT HAS NOT YET VESTED. IN ADDITION, A PREVIOUS CONTRIBUTION TO THE PLAN OF $39,530 VESTED DURING 2017 IN THE AMOUNT OF $48,678. THE VESTED CONTRIBUTION IS REPORTED ON SCHEDULE J, PART II, COLUMN B(III). THE PLAN IS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN MAINTAINED BY A RELATED ORGANIZATION FOR KEY EMPLOYEES OF THE RELATED ORGANIZATION. THERE IS AN INCENTIVE BONUS PLAN AND A PRODUCTION COMPENSATION PLAN. VESTING HAPPENS OVER A 3 OR A 5 YEAR TIME FRAME DEPENDING IF THE CONTRIBUTION WAS MADE TO THE INCENTIVE BONUS PLAN OR THE PRODUCTION COMPENSATION PLAN. THERE ARE CERTAIN CIRCUMSTANCES WHERE A PARTICIPANT WILL FORFEIT ANY AND ALL OF THE COMPANY CONTRIBUTIONS MADE INTO THE PLAN INCLUDING ENGAGING IN ACTIVITIES WHICH ARE DEEMED TO BE SIGNIFICANTLY COMPETITIVE WITH THE COMPANY WITHIN A 50 MILE RADIUS OF ANY EXISTING OFFICE, IF IT IS DEEMED THE PARTICIPANT ACTED IN A DISHONEST WAY, BREACHES HIS OR HER FIDUCIARY OBLIGATIONS, CONVICTED OF A FELONY INVOLVING SIGNIFICANT MORAL TURPITUDE, OR OTHER ACTS WHICH WOULD CAUSE THE COMPANY SUBSTANTIAL HARM. PART I, LINE 7 EMPLOYEE'S BONUSES ARE DETERMINED AT THE DISCRETION OF THE CEO. A HOSPITAL FACILITIES REVENUE IMPROVEMENT BONDS SERIES 2012 341623770 2012-12-14 8500000 ASU BUILDING PROJECT AND CAPITAL EQUIPMENT 0 0 0 A 8500000 8500000 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 0 A 0 X MEDICAL EQUIPMENT 6 31398 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 A DIRECTOR WORKS AT MINSTER BANK, WHILE ANOTHER DIRECTOR IS SERVING ON MINSTER BANK'S BOARD. TWO DIRECTORS ALSO BOTH SERVE ON ELM GROVE CEMETERY'S BOARD. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE BOARD-DESIGNATED COMMITTEE FOR THEIR REVIEW PRIOR TO FILING. THE BOARD-DESIGNATED COMMITTEE WILL REPORT THEIR REVIEW AND APPROVAL OF FORM 990 TO THE FULL BOARD OF DIRECTORS. A PAPER COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS FOR THEIR INDEPENDENT REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS, OFFICERS, AND MANAGERS OF GRAND LAKE HEALTH SYSTEM. ANNUALLY THESE INDIVIDUALS, AS WELL AS NEW BOARD MEMBERS WHEN THEY FIRST JOIN, PROVIDE THE PRESIDENT OF THE CORPORATION AN UPDATED LISTING OF ALL BUSINESSES OR OTHER ORGANIZATIONS OF WHICH HE OR SHE IS A TRUSTEE, OFFICER, DIRECTOR, MEMBER, PARTNER, OWNER, GENERAL MANAGER, SUBSTANTIAL SHAREHOLDER, EMPLOYEE OR FOR WHICH HE OR SHE ACTS AS AN AGENT. WHEN A CONFLICT OF INTEREST IS IDENTIFIED THE DETERMINATION IS MADE AND DISCUSSED OPENLY AT THE BOARD LEVEL. THE INDIVIDUAL IS THEN PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS. FORM 990, PART VI, SECTION B, LINE 15A THE SALARY AMOUNT FOR THE PRESIDENT IS REVIEWED AND APPROVED BY JTDMH'S BOARD EXECUTIVE COMMITTEE. THE EXEC COMMITTEE USES THE OHIO HOSPITAL ASSOCIATION'S ANNUAL CHIEF EXECUTIVE OFFICER COMPENSATION SURVEY, INTEGRATED HEALTHCARE STRATEGIES (AN INDEPENDENT COMPENSATION CONSULTANT), ANNUAL NATIONAL HEALTHCARE LEADERSHIP COMPENSATION SURVEY, OTHER 990'S FILED BY OTHER HOSPITALS AND INPUT FROM THE BOARD OF TRUSTEES AND BOARD EXEC COMMITTEE TO DETERMINE THE PRESIDENT'S SALARY. THE BOARD CHAIR SIGNS THE CHANGE OF PAY FORM AS WELL AS WRITES A MEMO TO THE DIRECTOR OF FINANCIAL SERVICES. DOCUMENTATION REGARDING THE PRESIDENT'S SALARY AND RECORD KEEPING REGARDING DELIBERATIONS IS KEPT BY THE BOARD EXEC COMMITTEE. SALARY AMOUNTS FOR OFFICERS AND OTHER KEY EMPLOYEES ARE REVIEWED AND APPROVED BY THE PRESIDENT. THE PRESIDENT REFERENCES THE OHA COMPENSATION SALARY SURVEY. THE PRESIDENT IS APPROVED BY THE BOARD OF DIRECTORS TO PERFORM THIS PROCESS. FURTHERMORE, THE PRESIDENT IS COMPLETELY INDEPENDENT FROM ALL OFFICERS AND KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN DECEMBER 2017. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 8,680,430. MANAGEMENT AND GENERAL EXPENSES 1,657,999. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,338,429. OTHER CONTRACTED PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,910,315. MANAGEMENT AND GENERAL EXPENSES 545,493. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,455,808. FAMILY PRACTICE PHYSICIAL FEES: PROGRAM SERVICE EXPENSES 1,681,640. MANAGEMENT AND GENERAL EXPENSES 178,320. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,859,960. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTION IN JTD FAMILY PRACTICE, INC. -6,552,860. DIFFERENCE BETWEEN BOOK AND TAX PASS THROUGH INCOME 16,331. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. JTD HOSPITAL FOUNDATION 200 ST CLAIR STREET ST MARYS OH 45885 341623769 TO RAISE FUNDS FOR JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. OH 501(C)(3) LINE 7 JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL 1 JTDMH PAIN MANAGEMENT LLC 200 ST CLAIR ST ST MARYS OH 45885 465353958 PAIN MANAGEMENT SERVICES OH JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL RELATED -4738 189437 0 1 0.51000 JTDM FAMILY PRACTICE LLC 200 ST CLAIR STREET ST MARYS OH 45885 341689161 PHYSICIANS PROVIDING MEDICAL SERVICES OH JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL C 1.00000 1 1 1 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 JTDM FAMILY PRACTICE LLC A 413601 CASH TRANSACTION JTDM FAMILY PRACTICE LLC B 5165000 CASH TRANSACTION JTDM FAMILY PRACTICE LLC O 3917532 CASH TRANSACTION JTDM FAMILY PRACTICE LLC Q 1269053 CASH TRANSACTION JTD HOSPITAL FOUNDATION C 303913 CASH TRANSACTION JDTMH PAIN MANAGEMENT LLC J 62854 AMOUNT INVOICED