2017-11-14T13:24:17-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 250 S High St Suite 100 Columbus OH 43215 990 2016-01-01 314379443 ADENA HEALTH SYSTEM ADEN 7407794478 272 HOSPITAL RD CHILLICOTHE OH 45601 LISA CARLSON CFO 7407794478 2017-11-08 1 Bernie Ostrowski P00366367 6148493000 2017-11-08 67.59.56.32 2017-11-08 13:34:24 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7BCF9D38B0E592211C041BCD1ADDE56655A5E8DF 2016 2017-02-10 21:41:12Z ADENA REGIONAL MEDICAL CENTER LISA CARLSON 272 HOSPITAL RD CHILLICOTHE OH 45601 422937856 0 X WWW.ADENA.ORG X 1895 OH "TO CARE, TO HEAL, TO EDUCATE." THE REPORTING ORGANIZATION IS A REGIONAL HEALTHCARE SYSTEM WITH ONE HOSPITAL AND SEVERAL AMBULATORY CENTERS, IN ADDITION TO MULTIPLE PHYSICIAN PRACTICES. AHS OFFERS A WIDE SCOPE OF DIAGNOSTIC AND REHABILITATIVE SERVICES BOTH FOR INPATIENTS AND OUTPATIENTS, INCLUDING COMPREHENSIVE CARDIOLOGY AND CANCER CARE. FURTHERMORE, AHS IS THE SOLE MEMBER OF TWO CRITICAL ACCESS HOSPITALS, ADENA PIKE MEDICAL CENTER AND ADENA GREENFIELD MEDICAL CENTER, THAT FILE SEPARATELY. 14 12 3159 200 0 0 619395 788168 422296219 408415410 3405739 2180196 11675562 11554082 437996915 422937856 496434 562077 0 0 231139642 229977764 0 0 0 194336482 183278092 425972558 413817933 12024357 9119923 474400163 485156474 230428958 228637469 243971205 256519005 TO CARE, TO HEAL, TO EDUCATE. 0 0 388425310 562077 414153188 HEALTH CARE PROGRAMS, GENERAL/OTHER: ROUTINE HOSPITAL SERVICES. ADENA REGIONAL MEDICAL CENTER PROVIDED CARE FOR 9,859 INPATIENTS AND TREATED 47,799 EMERGENCY VISITS IN 2016. EMERGENCY SERVICES - TREATMENT OF EMERGENCY ACCIDENT AND ILLNESS AS WELL AS LESS URGENT CONDITIONS IN THE ABSENCE OF A FAMILY PHYSICIAN. THERE WERE 77,064 EMERGENT AND URGENT VISITS IN 2016. PHYSICIAN OFFICES: THERE WERE 396,455 PHYSICIAN OFFICE VISITS IN 2016. 388425310 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 1 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 230 0 1 3159 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X SHARON WISECUP VP SYSTEM FINANCE 7407794478 272 HOSPITAL ROAD CHILLICOTHE OH 456019031 STEVEN BURKHARDT TRUSTEE/CHAIRMAN 2.00 0.00 X X 0 0 0 VIRGINIA WETTERSTEN TRUSTEE/VICE CHAIR 2.00 0.00 X X 0 0 0 TOM WHITE TRUSTEE/SECRETARY 2.00 0.00 X X 0 0 0 JOSEPH SULZER TRUSTEE/TREASURER 2.00 0.00 X X 0 0 0 MIKE LILLY TRUSTEE 2.00 2.00 X 0 0 0 DAVE STRICKLAND TRUSTEE 2.00 0.00 X 0 0 0 RALPH D'ANTONI TRUSTEE 2.00 0.00 X 0 0 0 JERRY PHILLIPS TRUSTEE 2.00 0.00 X 0 0 0 WILBUR SEVER JAN-SEPT TRUSTEE/EMPLOYED M.D. 50.00 0.00 X 699685 0 29821 GAIL TAYLOR TRUSTEE 2.00 0.00 X 0 0 0 JOE WATSON TRUSTEE 2.00 0.00 X 0 0 0 NOBLE YOSHIDA TRUSTEE 2.00 0.00 X 0 0 0 HAVAL SAADLLA JAN-SEPT TRUSTEE 50.00 0.00 X 1161321 0 30331 BARTOW HENSHAW TRUSTEE 2.00 0.00 X 0 0 0 WILLIAM STRAUCH SEPT-DEC TRUSTEE 2.00 0.00 X 513381 0 28299 REGGINA YANDILA SEPT-DEC TRUSTEE 2.00 0.00 X 264703 0 29387 ROBERT ROSENBERGER CHIEF FINANCIAL OFFICER (JAN-OCT) 46.00 4.00 X 368157 0 37792 MARK SHUTER CHIEF EXECUTIVE OFFICER (JAN-OCT) 46.00 4.00 X 810195 0 31755 LISA CARLSON CFO 40.00 0.00 X 0 0 0 JAY JUSTICE INTERIM CHRO (FEB-OCT) 40.00 0.00 X 229508 0 3152 JOHN FORTNEY INTERIM CEO 46.00 4.00 X 439134 0 30401 ERIC CECAVA CHIEF OPERATING OFFICER 45.00 0.00 X 389007 0 30971 MARTHA LIVINGSTON CHIEF BUSINESS DEVLOPMENT 45.00 0.00 X 267753 0 22997 ERIC PERDUE CHIEF HUMAN RESOURCES 45.00 0.00 X 221076 0 532 TIM CAHILL GENERAL COUNSEL 50.00 0.00 X 287342 0 40305 BRIAN COHEN EMPLOYED M.D. 50.00 0.00 X 2826193 0 29831 THOMAS LEWIS EMPLOYED M.D. 50.00 0.00 X 852766 0 30333 NEIL GHANY EMPLOYED M.D. 50.00 0.00 X 931788 0 34989 JAMES MANAZER EMPLOYED M.D. 50.00 0.00 X 900711 0 30031 KELLY GALLINA EMPLOYED M.D. 50.00 0.00 X 844803 0 12178 12007523 0 453105 17 0 1 0 APOGEE MEDICAL MANAGEMENT 2525 E CAMELBACK RD PHOENIX AZ 85016 HOSPITALIST STAFF 6055551 CAPTIVE RADIOLOGY 6273 FRANK AVENUE NW NORTH CANTON OH 44720 MRI SERVICES 2936780 PRECYSE SOLUTIONS LLC PO BOX 11407 BIRMINGHAM AL 35246 TRANSCRIPTION & CODING 2620298 STRATEGIC SOURCING INC 3938 N HAMPTON DR POWELL OH 43065 IT CONSULTING 1692777 ECONOMY LINEN & TOWEL SERVICE 5087 HOWARD ST ZANESVILLE OH 43701 LINEN SERVICE 1164549 6 444744 30647 312777 788168 NET PATIENT SVC REV 622110 408415410 408415410 408415410 1983509 1983509 318303 0 318303 318303 318303 196687 0 196687 196687 196687 FOOD & NUTRITION 722514 1872015 1872015 EHR IMPLEMENTATION 622110 1800009 1800009 CONSULTING FEES 900099 924117 924117 6639638 1141637 5498001 11235779 422937856 414153188 0 7996500 X 562077 562077 5967005 5591090 375915 179631102 170349440 9281662 33757022 31369358 2387664 10622635 9953420 669215 27315 27315 1266645 1266645 102007 102007 63449492 54875835 8573657 5407355 5087897 319458 8060611 7552811 507800 2429679 2009348 420331 8256724 7736559 520165 21002938 19680183 1322755 2218100 2218100 MEDICAL SUPPLIES 64731586 64662320 69266 BAD DEBT EXPENSE 13488176 13488176 OVERHEAD ALLOCATION -7162536 -6711304 -451232 413817933 388425310 25392623 0 11558 11658 38845736 74914778 10064834 5215234 70844246 52869504 29367 8989 5226267 5640546 5324627 11210480 384051993 249011201 140284819 135040792 178112976 188239938 25655733 12004555 474400163 485156474 48599526 51452745 163805430 158764005 500000 500000 17524002 17920719 230428958 228637469 X 242393189 254709236 1578016 1809769 243971205 256519005 474400163 485156474 X 9119923 8462817 -5034940 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 3132 3132 0 Part II-B, Line 1: THE OHIO HOSPITAL ASSOCIATION DOES LOBBYING ON BEHALF OF HOSPITAL RELATED CAUSES. THIS ACTIVITY IS PAID FOR THROUGH DUES PAID TO THE OHIO HOSPITAL ASSOCIATION. 1321696 -43583 54095 500 1331708 1305508 44539 -6351 22000 1321696 1219218 34077 52213 1305508 1149935 -2887 77350 5180 1219218 1050463 22085 89484 12097 1149935 1.00000 0.00000 0.00000 0 0 2648975 2648975 175160468 89092701 86067767 196439616 154082966 42356650 9802934 5835534 3967400 135040792 ACCRUED MALPRACTICE INSURANCE - LT 9087619 DEFERRED COMPENSATION LIABILITY 8539274 INTERCOMPANY PAYABLE 293826 17920719 Part V, Line 4: ADENA HEALTH FOUNDATION ENDOWMENT FUNDS ARE USED TO PROVIDE SCHOLARSHIPS AND PURCHASE CAPITAL FOR ADENA HEALTH SYSTEM. THESE FUNDS ARE HELD BY ADENA HEALTH SYSTEM AND ARE ADMINISTERED BY ADENA HEALTH FOUNDATION. 1 1 X 1 X 1 X 1 1 1 0 1 1 8778161 8256270 521891 0.00130 81576163 51445405 30130758 0.07530 90354324 59701675 30652649 0.07660 652428 652428 0.00160 875269 875269 0.00220 1527697 1527697 0.00380 91882021 59701675 32180346 0.08040 17603 17603 0.00000 77500 77500 0.00020 95103 95103 0.00020 0 13488176 0 76030420 70546292 5484128 X 0 1 1 ADENA REGIONAL MEDICAL CENTER 272 HOSPITAL RD CHILLICOTHE OH 45601 WWW.ADENA.ORG ST. REG. NUM. 1029 X X X ADENA REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X www.adena.org/inside/page.dT/CHNA X http://rosscountyhealth.org/healthassessment.pdf X X 1 16 1 HTTP://WWW.ADENA.ORG/FILES/RESOURCES/ROSS-IS-2016.DOCX 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X http://www.adena.org/inside/page.dT/financial-aid X www.adena.org/files/resources/adenafinaidformfinal.pdf X X X X 1 X 0 X X X 1 X 1 0 ADENA REGIONAL MEDICAL CENTER Part V, Section B, Line 5: ADENA REGIONAL MEDICAL CENTER CAPTURED THE BROAD INTERESTS OF THE COMMUNITY FOR THE CHNA THROUGH TWO METHODS: SURVEY AND INTERVIEWS. A HEALTH NEEDS SURVEY WAS WIDELY DISTRIBUTED TO THE ROSS COUNTY COMMUNITY THROUGH PAPER AND WEB FORM. IN ADDITION TO THE SURVEYS, INTERVIEWS WITH LOCAL COMMUNITY LEADERS, INCLUDING CIVIC, PUBLIC HEALTH AND EMERGENCY RESPONSE WERE REQUESTED AND/OR CONDUCTED TO GAIN FURTHER KNOWLEDGE OF SURVEY TOPICS. ADENA REGIONAL MEDICAL CENTER Part V, Section B, Line 6b: THE CHNA FOR ADENA REGIONAL MEDICAL CENTER WAS CONDUCTED IN COLLABORATION WITH THE FOLLOWING ORGANIZATIONS: ADENA HEALTH SYSTEM, CHILLICOTHE CITY SCHOOLS, CHILLICOTHE GAZETTE, HOPE CLINIC OF ROSS COUNTY, HOPEWELL HEALTH CENTER, OHIO DEPARTMENT OF JOB AND FAMILY SERVICES, OHIO STATE UNIVERSITY EXTENSION, OHIO UNIVERSITY CHILLCOTHE, PACCAR, PAINT VALLEY ADAMH BOARD, RECOVERY COUNCIL, ROSS COUNTY CHILD PROTECTION CENTER, ROSS COUNTY HEALTH DISTRICT, ROSS COUNTY YMCA, SCIOTO PAINT VALLEY MENTAL HEALTH CENTER, UNION-SCIOTO SCHOOL DISTRICT, UNITED WAY OF ROSS COUNTY, AND VETERANS ADMINISTRATION HOSPITAL. ADENA REGIONAL MEDICAL CENTER Part V, Section B, Line 7d: HARD COPIES OF THE CHNA REPORT WERE PRINTED AND SENT TO COMMUNITY LEADERS AND AGENCIES. ADENA REGIONAL MEDICAL CENTER Part V, Section B, Line 11: OBESITY-EMPLOYEE HEALTH INITIATIVES: IN 2016, AHS CONTINUED ITS INTERNAL EFFORTS AROUND EMPLOYEE HEALTH AND WELLNESS BY EXPANDING AND IMPLEMENTING EVIDENCE-BASED HEALTH AND WELLNESS PROGRAMMING BUILT ON THREE DIFFERENT PILLARS MOVEMENT, NUTRITION AND WELL-BEING. SOME PROGRAMMING WAS ALSO EXPANDED INTO THE GREATER ROSS COUNTY COMMUNITY.THE TEAM CONTINUED THE CAMPUS BASED WALKING PROGRAM, WEIGHT WATCHERS AT WORK, ADENA FIT, AND STRESS MANAGEMENT CLASSES. THE COMMUNICATION PLAN DEVELOPED IN 2014 WAS CONTINUED, REPRESENTATIVES FROM THE ORGANIZATION'S HEALTH & WELLNESS COMMITTEE ROUNDED TO DEPARTMENTAL MEETINGS. THE MOVE MORE CHALLENGE WAS KICKED OFF AGAIN IN MAY OF 2016 WITH MORE THAN 500 ADENA EMPLOYEES PARTICIPATING.IMPROVEMENT OF HEALTHIER OPTIONS IN THE ADENA REGIONAL MEDICAL CENTER CAFETERIA WAS ALSO CONTINUED. THE OVERALL FRUIT AND VEGETABLE CONSUMPTION CONTINUED TO INCREASE AND HEALTHIER OPTIONS WERE ADDED TO THE MENU. ALL OF THE HEALTH & WELLNESS PROGRAMMING AGAIN ENGAGED MORE THAN 35% OF THE TOTAL EMPLOYEE POPULATION THROUGH THESE INITIATIVES IN 2016. OBESITY-COMMUNITY PROGRAMMING:AHS COMMUNITY HEALTH ADVANCEMENT CONTINUED COLLABORATION WITH MORE THAN A DOZEN OF COMMUNITY PARTNERS TO COORDINATE AND DELIVER COMMUNITY PROGRAMS AIMED AT PROMOTING MOVEMENT AND NUTRITION. PROGRAMS INCLUDED:SPONSORSHIP AND PARTICIPATION IN THE HEALTHY KIDS' EVENT AT THE ROSS COUNTY FAIR WITH CHILLICOTHE GAZETTE, HEALTHY START FOR KIDS, YMCA AND ROSS COUNTY PUBLIC LIBRARY. SPONSORSHIP OF THE ROSS COUNTY PUBLIC LIBRARY'S HEALTHY KIDS PORTION OF THE BOOKWORM PROGRAM. THE MOVE MORE CHALLENGE WALK WITH A DOC PROGRAMOBESITY-REGIONAL INITIATIVES:THE COMMUNITY HEALTH FOCUS AND MESSAGE, "MOVE MORE, EAT WELL" WAS FINALIZED AND IMPLEMENTED IN 2015 AND CONTINUED DURING 2016. BANNERS FOR MORE THAN 35 COMMUNITY AND REGIONAL EVENTS (COUNTY FAIRS, FESTIVALS, SENIOR HEALTH FAIRS, EMPLOYEE HEALTH FAIRS AND HEALTH EXPOS) WERE DISPLAYED THROUGHOUT SIX COUNTIES (FAYETTE, ROSS, HIGHLAND, PIKE, JACKSON, AND PICKAWAY) AS WELL BROCHURES AND EDUCATIONAL INFORMATION ON PHYSICAL ACTIVITY AND NUTRITION WERE DISTRIBUTED. A SOCIAL MEDIA CAMPAIGN ON THE BENEFITS TO PROPER NUTRITION AND FITNESS WERE ALSO POSTED ON FACEBOOK THROUGHOUT THE YEAR. THERE WERE ALSO THREE ONE HOUR RADIO PROGRAMS FEATURING ADENA PHYSICIANS AND REPRESENTATIVES FOCUSED ON HEALTHY LIFESTYLE CHOICES INCLUDING MOVEMENT AND NUTRITION. MENTAL & BEHAVIORAL HEALTH-ADVOCACY:AHS CONTINUED ITS SUPPORT OF MULTIPLE COMMUNITY PARTNERS IN 2016 TO ADVOCATE FOR EXPANDED ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES. ONE PHYSICIAN, ONE COMMUNITY HEALTH REPRESENTATIVE AND ONE SOCIAL WORKER PARTICIPATED ON THE ROSS COUNTY HEROIN PARTNERSHIP ADVISORY COUNCIL AND ASSISTED WITH FACILITATING AND DEVELOPING A COMMUNITY-WIDE STRATEGIC PLAN AROUND THE HEROIN EPIDEMIC. AHS CONTINUED DELIVERY OF PRENATAL CARE TO HIGH-RISK PREGNANT WOMEN, INCLUDING THOSE WITH ADDICTION ISSUES USING A CENTERINGPREGNANCY MODEL AT THE ADENA REGIONAL MEDICAL CENTER CAMPUS. ANOTHER 150 WOMEN WERE SERVED IN 2016 WITH THOSE PARTICIPATING IN THE PROGRAM ACHIEVING BETTER BIRTH OUTCOMES OVERALL THAN THOSE WHO OPTED NOT TO PARTICIPATE. REIMBURSEMENT FROM OHIO MEDICAID CONTINUED FOR THIS PROGRAM IN 2016.THE AHS DIRECTOR OF COMMUNITY HEALTH ADVANCEMENT CONTINUED PARTICIPATING IN THE SOUTHEAST OHIO MEDICAID EXPANSION COMMITTEE, AROUND EFFORTS TO EXPAND MEDICAID COVERAGE TO THE REGION'S RESIDENTS. THIS GROUP ALSO INFORMS STATE GOVERNMENT ON THE NEED AND BENEFIT OF AFFORDABLE HEALTH CARE IN SOUTHERN OHIO.MENTAL & BEHAVIORAL HEALTH-REFERRAL RESOURCES:AHS CONTINUED TO OPERATE THE REGION'S ONLY ACUTE INPATIENT, PSYCHIATRIC UNIT FOR INSURED, UNINSURED AND UNDER INSURED PATIENTS IN 2016 AT THE ADENA REGIONAL MEDICAL CENTER. AHS WOMEN'S & CHILDREN'S, PRIMARY CARE AND PAIN MANAGEMENT SERVICE LINES MADE REFERRALS FOR PATIENTS NEEDING MENTAL AND BEHAVIORAL HEALTH SERVICES IN ROSS COUNTY TO THE ADENA COUNSELING CENTER, PAINT VALLEY MENTAL HEALTH CENTER, ADENA WOMEN'S AND CHILDREN'S CENTERINGPREGNANCY PROGRAM, THE ROSS COUNTY HEALTH DEPARTMENT'S VIVITROL PROGRAM.MENTAL & BEHAVIORAL HEALTH-CESSATION RESOURCES:AHS SERVED MORE THAN 75 WOMEN ADDICTED TO OPIATES AS PART OF ITS BABY CENTERED RECOVERY PROGRAM IN 2016 FROM MULTIPLE COUNTIES, INCLUDING ROSS COUNTY. THE WORK TEAM CONTINUED EFFORTS TOWARDS ACHIEVING CENTERING HEALTHCARE INSTITUTE ACCREDITATION, AS WELL AS WORKING ON DEVELOPING RELATIONSHIPS WITH SOBER LIVING AND SUPPORT PROGRAMS SUCH AS STEPPING STONES AND COMPASS COMMUNITY HEALTH TO ASSIST WITH EXPANDING DRUG ADDICTION SUPPORT SERVICES, INCLUDING HOUSING, IN ROSS COUNTY. MENTAL & BEHAVIORAL HEALTH-SCREENING:IN 2016, AHS CONTINUED ITS SCREENING POLICY TO IDENTIFY POSSIBLE MENTAL AND BEHAVIORAL ISSUES WITH PATIENTS PRESENTING IN THE EMERGENCY ROOMS OF ADENA HEALTH SYSTEM HOSPITALS.SMOKING-CESSATION RESOURCES:THE ADENA QUIT CLINIC CONTINUED WITH PACCAR/KENWORTH TRUCKING COMPANY IN 2016. ANOTHER 35 PARTICIPANTS WERE SERVED AS PART OF THE PROGRAM THAT UTILIZES PHARMACISTS, TRAINED IN THE US PUBLIC HEALTH SERVICES' 5 A'S METHODOLOGY, TO ASSIST TOBACCO USERS IN CESSATION. THE PROGRAM WAS EXPANDED TO ADENA EMPLOYEES IN 2016. SMOKING-SCREENING:AHS CANCER CENTER PROVIDED FREE LUNCH CANCER SCREENINGS FOR OVER 700 PATIENTS FROM MULTIPLE COUNTIES INCLUDING ROSS COUNTY IN 2016, WITH MULTIPLE TYPES OF CANCER AND HEART RELATED ISSUES BEING DETECTED EARLY.ADDITIONAL INITIATIVES AND RESOURCES:UNINTENTIONAL INJURIESIN 2016, ADENA HEALTH SYSTEM AT THE ADENA REGIONAL MEDICAL CENTER TOOK OVER OPERATION OF THE ROSS COUNTY SAFE COMMUNITIES PROGRAM FROM THE ROSS COUNTY HEALTH DISTRICT. TWO ADENA EMPLOYEES COORDINATE THE PROGRAM WHERE OUTREACH AT LOCAL COMMUNITY EVENTS AND A SOCIAL MEDIA CAMPAIGN PROMOTE A VARIETY OF ROAD SAFETY ISSUES, INCLUDING: 1.) SEAT BELT USAGE 2.) SOBER DRIVING 3.) DISTRACTED DRIVING AND 4.) MOTORCYCLE AWARENESS. THE TEAM ATTENDED MORE THAN A DOZEN ROSS COUNTY EVENTS, INCLUDING HIGH SCHOOL FOOTBALL GAMES, FAIRS, AND FESTIVALS TO PROMOTE SAFE DRIVING. THE PRIMARY CAUSE OF UNINTENTIONAL INJURIES IN ROSS COUNTY IN 2016 BECAME DRUG OVERDOSE DEATHS SURPASSING AUTOMOTIVE ACCIDENTS. AHS/AGMC AVERAGED MORE THAN 3 OVERDOSES PER MONTH IN ITS EMERGENCY DEPARTMENT WHERE NARCAN WAS PROVIDED. IN ADDITION, THE ED ADDED INFORMATION PACKETS TO BE PROVIDED TO INDIVIDUALS AND FAMILIES WITH ADDICTION ISSUES CONTAINING RESOURCES FOR TREATMENT AND SUPPORT. ADENA FAMILY MEDICINE-RESIDENCY CLINIC:THE ADENA FAMILY MEDICINE - RESIDENCY CLINIC OPERATED A HOSPITAL CLINIC IN 2016 PROVIDING AFFORDABLE, QUALITY HEALTH CARE. THE CLINIC PAIRED ACCESSIBLE PRIMARY CARE MEDICAL SERVICES PROVIDED BY PHYSICIAN INTERNS AND RESIDENTS OF ADENA'S GRADUATE MEDICAL EDUCATION PROGRAM, FAMILY AND INTERNAL MEDICINE PRECEPTORS AND A CERTIFIED NURSE PRACTITIONER ALSO PROVIDING SERVICES TO PATIENTS IN THE CLINIC. A TOTAL OF 1,437 PATIENTS, MOSTLY FROM SEVEN COUNTIES (ROSS, FAYETTE, VINTON, PICKAWAY, PIKE, HIGHLAND AND JACKSON) MADE A TOTAL OF 4,022 VISITS TO THE RESIDENCY CLINIC IN 2016.ADENA SPORTS MEDICINE-ATHLETIC TRAINING PROGRAMTHE ADENA HEALTH SYSTEM PROVIDED ATHLETIC INJURY PREVENTION, DIAGNOSIS, AND EVALUATION SERVICES TO 10 LOCAL PUBLIC HIGH SCHOOLS WITHIN THE SERVICE REGION.COMMUNITY COLLABORATIONS:PARTNERS FOR A HEALTHIER ROSS COUNTYTHE COALITION ENGAGED ANOTHER 19 AGENCIES TO JOIN THE COALITION WHICH BEGAN PLANNING FOR ROSS COUNTY'S FIRST COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). HOPE CLINICTHIS CLINIC PROVIDES FREE MEDICAL CARE TO THOSE WITHOUT HEALTH INSURANCE COVERAGE, INCLUDING MEDICAL, DENTAL AND VISION CARE.GREATER CHILLICOTHE-ROSS STEERING COMMITTEEIN 2016, ADENA HEALTH SYSTEM COLLABORATED WITH THE ROSS COUNTY CHAMBER OF COMMERCE TO COORDINATE AND CONVENE A COMMUNITY STEERING COMMITTEE FOCUSED ON CREATING A COMMUNITY DEVELOPMENT PLAN FOR ROSS COUNTY. A TOTAL OF 12 LOCAL GOVERNMENT, CIVIC AND BUSINESS LEADERS CONVENED TO IDENTIFY STRATEGIC PRIORITIES FOR THE COMMUNITY AND ASSIST IN ALLOCATING RESOURCES TO SUPPORT INITIATIVES BUILT AROUND THESE STRATEGIC PRIORITIES. ADENA REGIONAL MEDICAL CENTER Part V, Section B, Line 16j: www.adena.org/files/resources/adenafinaidformfinal.pdf ADENA REGIONAL MEDICAL CENTER Part V, Section B, Line 20e: PATIENTS HAVE 120 DAYS FROM THE TIME THEIR ACCOUNT GOES TO "SELF-PAY" TO PAY IN FULL OR MAKE PAYMENT ARRANGEMENTS. ON THE 121ST DAY, THEY ARE SENT TO A COLLECTION AGENCY. COLLECTION AGENCIES REQUIRE ADENA MANAGEMENT APPROVAL TO PURSUE LEGAL ACTION. SELF-PAY PATIENTS HAVE TO ASK FOR A QUESTIONNAIRE AT REGISTRATION ASKING IF THEY WOULD LIKE TO BE SCREENED FOR FINANCIAL ASSISTANCE. IF SO, THEY ARE GIVEN A FAP AT THAT TIME. ADENA REGIONAL MEDICAL CENTER Part V, Section B, Line 23: IN 2016, PATIENTS WOULD CALL IN AND REQUEST THE AGB AT WHICH POINT IT WOULD BE APPLIED. AS A RESULT, A SERIES OF PATIENTS WERE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED. THIS IS A PROCESS THAT HAS SINCE BEEN CORRECTED, APPLYING THE AGB TO ALL PATIENTS ELIGIBLE UNDER THE FAP. MEASURES ARE NOW BEING TAKEN TO APPLY REFUNDS TO ANY PATIENTS WHO HAVE BEEN ADVERSELY AFFECTED. PART V, SECTION B, LINE 20A A PLAIN LANGUAGE SUMMARY OF THE FAP IS NOT CURRENTLY ATTACHED, HOWEVER, THIS WILL BE COMPLETED BY NOVEMBER 15, 2017. 17 1 - ADENA HEALTH PAVILION 4437 STATE ROUTE 159 CHILLICOTHE OH 45601 PHYSICIAN OFFICES, OUTPATIENT SURGERY CENTER 2 - ADENA MEDICAL OFFICE BUILDING 4439 STATE ROUTE 159 CHILLICOTHE OH 45601 PHYSICIAN OFFICES 3 - ADENA HEALTH CENTER - WAVERLY 12340 STATE ROUTE 104 WAVERLY OH 45690 AMBULATORY CARE CENTER 4 - ADENA URGENT CARE 55 CENTENNIAL BLVD CHILLICOTHE OH 45601 AMBULATORY CARE CENTER 5 - ADENA HOME CARE SERVICES 111 W WATER STREET CHILLICOTHE OH 45601 HOME HEALTH CARE AND HOSPICE 6 - ADENA HEALTH CENTER - JACKSON 1000 VETERANS DRIVE JACKSON OH 45640 AMBULATORY CARE CENTER 7 - ADENA REHABILITATION AND WELLNESS CENTER 445 SHAWNEE LANE CHILLICOTHE OH 45601 OUTPATIENT REHABILITATION CENTER 8 - ADENA FAMILY MEDICINE - OAK HILL 315 WASHINGTON STREET OAK HILL OH 45656 PHYSICIAN OFFICES 9 - ADENA PICKAWAY-ROSS FAMILY PHYSICIANS 100 N WALNUT STREET CHILLICOTHE OH 45601 PHYSICIAN OFFICES 10 - ADENA FAMILY MEDICINE - CIRCLEVILLE 798 N COURT STREET CIRCLEVILLE OH 43113 PHYSICIAN OFFICES 11 - ADENA COUNSELING CENTER 445 SHAWNEE LANE CHILLICOTHE OH 45601 MENTAL HEALTH COUNSELING 12 - ADENA FAMILY MEDICINE OF CHILLICOTHE 626 CENTRAL CENTER CHILLICOTHE OH 45601 PHYSICIAN OFFICES 13 - ADENA ROSS UROLOGY 8 MEDICAL DRIVE CHILLICOTHE OH 45601 PHYSICIAN OFFICES 14 - ADENA FAMILY MEDICINE - GREENFIELD 536 MIRABEAU STREET GREENFIELD OH 45123 PHYSICIAN OFFICES 15 - ADENA FAMILY MEDICINE - WASHINGTON CH 308 HIGHLAND AVENUE SUITE C WASHINGTON COURT HOU OH 43160 PHYSICIAN OFFICES 16 - ADENA FAMILY MEDICINE - WELLSTON 118 SOUTH NEW YORK AVE SUITE A WELLSTON OH 45692 NURSE PRACTITIONER CLINIC 17 - ADENA FAMILY MEDICINE - HILLSBORO 160 ROBERTS LANE HILLSBORO OH 45133 URGENT CARE AND FAMILY PRACTICE Part I, Line 7: THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E & 7F. Part I, Ln 7 Col(f): BAD DEBT EXPENSE OF $13,488,176 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. Part II, Community Building Activities: ADENA HEALTH SYSTEM SUPPORTS COMMUNITY BUILDING ACTIVITIES BY PROVIDING GRANTS TO THE FOLLOWING ORGANIZATIONS:CHILLICOTHE CAVALIER CLUB- GRANT PROVIDED TO INSTALL A SCOREBOARDUNITED WAY OF ROSS COUNTY- GRANT PROVIDED TO SUPPORT RELAY FOR LIFEMIGHTY CHILDREN'S MUSEUM- GRANT PROVIDED TO BUILD A CHILDREN'S MUSEUM TO ENCOURAGE LEARNING AND CREATIVITYROSS COUNTY AGRICULTURAL SOCIETY- GRANT PROVIDED TO SUPPORT FREE RIDE DAY AT THE ROSS COUNTY FAIR AND TO PROVIDE A STAGE FOR THE HEALTHY KIDS EVENTLITTLE BLESSINGS- GRANT PROVIDED TO KNIT HATS FOR NEWBORNSOHIO UNIVERSITY FOUNDATION- CAPITAL CAMPAIGN FOR OHIO UNIVERSITYROSS COUNTY CHILD PROTECTION CENTER- GRANT PROVIDED TO SUPPORT ADVOCATES FOR CHILDREN OF ABUSE AND NEGLECT Part III, Line 2: THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS MINUS THE PRESUMPTIVE CHARITY AMOUNT THAT WAS RECLASSED TO SCHEDULE H, PART I, LINE 7A. Part III, Line 3: THE HOSPITAL DEVELOPED, WITH THE HELP OF AN OUTSIDE VENDOR, A NEW PRESUMPTIVE CHARITY POLICY. THE HOSPITAL SENDS A QUARTERLY FILE OF ALL SELF-PAY BALANCES TO THE VENDOR. AFTER THE VENDOR PERFORMS THE CREDIT ANALYSIS, THE VENDOR CATEGORIZES THE CLAIMS INTO THREE CATEGORIES, A CATEGORY THAT WOULD NOT BE ELIGIBLE FOR CHARITY BASED ON THE HOSPITALS CHARITY POLICY, A GROUP THAT WOULD BE ELIGIBLE FOR A 60% CHARITY WRITEOFF, AND A THIRD CATEGORY THAT WOULD BE ELIGIBLE FOR A 100% WRITE OFF. AFTER THE VENDOR RETURNS THIS DATA, A REPORT OF RECEIPTS ON THESE SELF PAY BALANCES IS RUN; THE PAYMENTS RECEIVED SINCE THE FILE WAS SENT TO THE VENDOR IS USED TO REDUCE THE POTENTIAL PRESUMPTIVE CHARITY. THE REMAINING AMOUNT IS USED AS OUR PRESUMPTIVE CHARITY FOR SCHEDULE H, PART III, LINE 3. Part III, Line 4: WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR ADENA REGIONAL MEDICAL CENTER. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS ESTABLISHED BASED ON EXPECTED PAYMENT RATES FROM PAYORS UTILIZING CURRENT REIMBURSEMENT METHODOLOGIES AND PAYMENT RATES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM 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 MEDICARE ADVANTAGE PLAN AND THE PHYSICIAN MEDICARE ADVANTAGE PLAN INCURRED A SHORTFALL OF <$15,925,627> IN 2016. THIS SHORTFALL COMBINED WITH THE LONGFALL FROM TRADITIONAL MEDICARE SOURCES OF $5,484,128 RESULTS IN A NET MEDICARE SHORTFALL OF <$10,441,499>.THE ADENA HEALTH SYSTEM SERVICE AREA IS A RURAL 13 COUNTY AREA IN SOUTHERN OHIO. ADENA HEALTH SYSTEM HAS EVALUATED THE COMMUNITY HEALTH NEEDS AND HAS IMPORTANT PROGRAMS AND SERVICES THAT ARE DESIGNED TO MEET THE NEEDS OF ADENA'S BROAD SERVICE AREA. HOWEVER, ONE OF THE MOST SIGNIFICANT HEALTH NEEDS MET BY ADENA IS THE IDENTIFICATION OF PHYSICIAN AND ADVANCED PRACTICE PROVIDERS FOR EACH SPECIALTY OF CARE. ADENA RECRUITS, SUPPORTS, AND PROVIDES THE INFRASTRUCTURE FOR PROVIDERS IN SPECIALTIES RANGING FROM PRIMARY CARE TO INTERVENTIONAL CARDIOLOGY. IN ADENA'S RURAL, APPALACHIAN SERVICE AREA, PHYSICIAN AND OTHER KEY CLINICAL AND SUPPORT STAFF ARE DIFFICULT TO RECRUIT AND RETAIN WHICH ELEVATES THE MARKET SALARY FOR SPECIALIZED STAFF. THE MEDICARE TWO PERCENT SEQUESTRATION IS ALSO A COMPONENT OF THE SHORTFALL CALCULATION. BASED ON THESE ISSUES, WE BELIEVE SERVICE TO OUR MEDICARE POPULATION IS A COMMUNITY BENEFIT. ALSO, THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6. Part III, Line 9b: ADENA HEALTH SYSTEM HAD A DEBT COLLECTION POLICY, HOWEVER, THIS WAS NOT WRITTEN UNTIL TAX YEAR 2017. Part VI, Line 3: THE AVAILABILITY OF FINANCIAL ASSISTANCE IS COMMUNICATED IN THE FOLLOWING MANNER: 1. STATEMENTS FROM ADENA AS WELL AS COLLECTION VENDORS EXPLAIN AND LIST THE 100% AND 60% ASSISTANCE GUIDELINES ON THE BACKSIDE OF THE STATEMENT. 2. THERE IS SIGNAGE EXPLAINING THE PROGRAM AT ALL THE REGISTRATION AREAS. 3. STAFF AT THE CASHIER AREA EXPLAIN OPTIONS AVAILABLE TO THE PATIENT. 4. WE SEND AN APPLICATION WITH THE SELF-PAY DISCOUNT LETTERS IN CASE THE PATIENT/GUARANTOR CAN'T SET UP A PAYMENT PLAN. 5. THE CUSTOMER SERVICE STAFF IS EDUCATED ON ALL THE OPTIONS AND CAN EXPLAIN THE PROGRAMS WHEN PATIENTS CALL. 6. OUR PHYSICIAN OFFICES, AS WELL AS COLLECTION VENDORS HAVE FINANCIAL AID APPLICATIONS AVAILABLE. 7. LASTLY, WE DO A CREDIT SCORING IN ORDER TO DETERMINE "PRESUMPTIVE CHARITY." IN 2015, ALL SELF-PAY PATIENTS WERE SCORED. Part VI, Line 4: ROSS COUNTY, HOME TO ADENA REGIONAL MEDICAL CENTER, IS LOCATED IN SOUTH CENTRAL OHIO. IT IS PART OF 2 CONGRESSIONAL DISTRICTS (2ND AND THE 15TH) AND ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT CONTAINS THE POPULATION PATTERNS AND DISTINCT ECONOMIC CONDITIONS INHERENT OF THIS REGION OF THE U.S AND FACES SIMILAR CHALLENGES TO IMPROVE THE LIVES OF ITS 77,000 RESIDENTS. THESE INCLUDE LOW EDUCATIONAL ATTAINMENT PERCENTAGES AND HIGH RATES OF UNEMPLOYMENT AND POVERTY. THE TOTAL POPULATION OF ROSS COUNTY REPRESENTS 15% OF THE TOTAL ADENA HEALTH SYSTEM SERVICE REGION AND IS THE PRIMARY PLACE OF RESIDENCE FOR 80% OF THE PATIENTS IT SERVES. THE COUNTY, AS WELL AS THE REMAINDER OF THE 12 COUNTY SERVICE REGION, HAS SIMILAR DEMOGRAPHICS AS THE STATE OF OHIO AND U.S. OVER 64% OF THE POPULATION IS BETWEEN THE AGES OF 19 AND 64 AND 13% OF THE POPULATION IS OVER THE AGE OF 65. THE MAJORITY OF THE POPULATION IS WHITE WITH AFRICAN AMERICANS MAKING UP THE MAJORITY OF THE REGION'S MINORITY POPULATION.THE 28,269 HOUSEHOLDS IN ROSS COUNTY REPRESENT 14.7% OF THE HOUSEHOLDS IN ADENA HEALTH SYSTEM'S 12-COUNTY SERVICE REGION. THE AVERAGE HOUSEHOLD SIZE IS 2.54 PEOPLE, COMPARABLE WITH THE REST OF OHIO AND THE U.S. THE AVERAGE FAMILY SIZE IS AS WELL WITH 3.05 PEOPLE. A LITTLE MORE THAN 50% OF THE POPULATION IS NOW MARRIED WHICH IS COMPARABLE WITH OHIO AND NATIONAL AVERAGES. MORE THAN 14% ARE DIVORCED WHICH IS NOTICEABLY HIGHER THAN BOTH THE STATE AND NATIONAL AVERAGES. MORE THAN 15% OF THE ADULTS IN ROSS COUNTY HAVE NOT GRADUATED FROM HIGH SCHOOL. THIS PERCENTAGE IS HIGHER THAN BOTH THE OHIO (12.2%) AND NATIONAL (14.6%) AVERAGES, BUT IS LOWER THAN THE AVERAGE FOR THE 12-COUNTY SERVICE REGION (18.9%). MORE THAN 10% OF THE POPULATION OF ROSS COUNTY IS ESTIMATED TO BE FUNCTIONALLY ILLITERATE, OR LACKING THE READING AND WRITING SKILLS SUFFICIENT FOR ORDINARY PRACTICAL NEEDS.THE UNEMPLOYMENT RATE IN ROSS COUNTY (4.8%) IS COMPARABLE TO THE U.S. AVERAGE. IN ADDITION, MORE THAN 45% OF THE POPULATION IS NOT IN THE WORKFORCE. THIS IS HIGHER THAN THE STATE AND NATIONAL AVERAGES. THE TOP FIVE EMPLOYMENT INDUSTRIES IN ROSS COUNTY ARE MANAGEMENT/PROFESSIONAL OCCUPATIONS, EDUCATION/HEALTHCARE SERVICES, SALES, PRODUCTION/TRANSPORTATION SERVICES, AND SERVICE OCCUPATIONS. ROSS COUNTY HAS MORE PEOPLE EMPLOYED IN PRODUCTION, TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS THAN THE REGIONAL, STATE AND NATIONAL AVERAGES. THE COUNTY HAS ABOUT HALF AS MANY PROFESSIONAL, SCIENTIFIC AND MANAGEMENT SERVICES PROFESSIONALS AS OHIO AND THE U.S.THE PER CAPITA, MEDIAN AND MEAN HOUSEHOLD INCOMES IN ROSS COUNTY OHIO ARE MUCH LOWER THAN THE STATE AND U.S. AVERAGES, BUT HIGHER THAN REGIONAL AVERAGE. POVERTY RATES ARE ALSO HIGHER THAN STATE AND NATIONAL AVERAGES BUT LOWER THAN THE REST OF THE REGION. ACCESS TO EMPLOYMENT IN ROSS COUNTY IS HIGHER THAN OTHER COUNTIES IN THE REGION.THERE ARE 6,348 CIVILIAN VETERANS LIVING IN ROSS COUNTY, ACCOUNTING FOR ALMOST 8% OF THE REGION'S POPULATION. THE TOTAL CIVILIAN VETERANS WITHIN THE ADENA HEALTH SYSTEM 12-COUNTY SERVICE REGION REPRESENT 5% OF OHIO'S TOTAL CIVILIAN VETERAN POPULATION. ROSS COUNTY ALSO HAS A VETERAN'S ADMINISTRATION HOSPITAL LOCATED 4.5 MILES FROM ADENA REGIONAL MEDICAL CENTER.ROSS COUNTY AND ITS ENTIRE SURROUNDING SERVICE REGION HAVE A HIGHER PREVALENCE OF DISABILITY THAN THE REST OF OHIO. SEVEN OF THE 12 COUNTIES IN THE SERVICE REGION HAVE DISABILITY PREVALENCE RATES OF 16.7% - 22%. ROSS COUNTY'S PREVALENCE RATE IS 13.5%. Part VI, Line 5: ADENA REGIONAL MEDICAL CENTER WORKS TO PROMOTE THE HEALTH OF ITS COMMUNITY THROUGH A VARIETY OF MEANS, INCLUDING BOARD MEMBERS, ADMINISTRATIONS, EMPLOYEES AND VOLUNTEERS. THE 2016 BOARD OF TRUSTEES OF ADENA HEALTH SYSTEM WAS COMPRISED OF 15 MEMBERS. ONE OF THE BOARD MEMBERS WAS AN EMPLOYEE OF ADENA HEALTH SYSTEM AT THE END OF THE YEAR. ALL BUT ONE MEMBER OF THE BOARD MEMBERS RESIDE IN ROSS COUNTY OHIO. Part VI, Line 6: FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WASHINGTON COURT HOUSE, WAVERLY, HILLSBORO, AND WELLSTON, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE, WAVERLY, AND HILLSBORO. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN), A COLLABORATION OF THE REGION'S THREE LARGEST HEALTHCARE PROVIDERS. THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. 1 ADENA HEALTH FOUNDATION 272 HOSPITAL ROAD CHILLICOTHE OH 45601 753008742 501(C)(3) 466974 PAYMENT OF ORGANIZATION EXPENSES CHILLICOTHE CAVALIER CLUB 2710 S BRIDGE ST CHILLICOTHE OH 45601 311324783 501(C)(3) 15000 SCOREBOARD INSTALLMENT UNITED WAY ROSS COUNTY 69 E WATER ST CHILLICOTHE OH 45601 314389671 501(C)(3) 20000 RELAY FOR LIFE MIGHTY CHILDRENS MUSEUM PO BOX 503 CHILLICOTHE OH 45601 473052995 501(C)(3) 21000 RAISING FUNDS TO BUILD A CHILDREN'S MUSEUM TO ENCOURAGE LEARNING AND CREATIV ROSS COUNTY AGRICULTURAL SOCIETY 207 S QUARRY BAINBRIDGE OH 45612 316050864 501(C)(3) 6500 FREE RIDE DAY AT THE ROSS COUNTY FAIR AND STAGE FOR HEALTHY KIDS EVENT LITTLE BLESSINGS INC 5095 DRY RUN RD CHILLICOTHE OH 45601 811865841 501(C)(3) 5000 TO KNIT HATS FOR NEWBORNS OHIO UNIVERSITY FOUNDATION 104 MCGUFFEY HALL ATHENS OH 45701 316402113 501(C)(3) 10000 CAPITAL CAMPAIGN FOR OHIO UNIVERSITY- CHILLICOTHE ROSS COUNTY CHILD PROTECTION CENTER 138 MARIETTA RD CHILLICOTHE OH 45601 311579825 501(C)(3) 17603 ADVOCATES FOR CHILDREN OF ABUSE AND NEGLECT 8 0 Part I, Line 2: DECISIONS TO DONATE TO COMMUNITY PROJECTS ARE BROUGHT TO CEO FOR APPROVAL FROM MEMBERS OF SENIOR LEADERSHIP AND/OR THE STRATEGY DEPARTMENT. FOR EACH GRANT THERE IS AN AGREEMENT SIGNED BY ADENA AND THE ORGANIZATION RECEIVING THE DONATION THAT CONFIRMS FUNDS ARE BEING USED FOR THE INTENDED PURPOSE. A BLANKET AMOUNT IS BUDGETED FOR THE FISCAL YEAR AND CONSIDERED AS EACH REQUEST IS MADE. X X X 1 1 X X X X 1 0 0 0 0 0 0 0 0 WILBUR SEVER JAN-SEPT TRUSTEE/EMPLOYED M.D. 672779 0 0 0 26906 0 0 0 29821 0 729506 0 0 0 HAVAL SAADLLA JAN-SEPT TRUSTEE 1109058 0 42153 0 10110 0 0 0 30331 0 1191652 0 0 0 WILLIAM STRAUCH SEPT-DEC TRUSTEE 502600 0 2015 0 8766 0 0 0 28299 0 541680 0 0 0 REGGINA YANDILA SEPT-DEC TRUSTEE 224022 0 32625 0 8056 0 0 0 29387 0 294090 0 0 0 ROBERT ROSENBERGER CHIEF FINANCIAL OFFICER (JAN-OCT) 338255 0 0 0 29902 0 9811 0 27982 0 405950 0 0 0 MARK SHUTER CHIEF EXECUTIVE OFFICER (JAN-OCT) 552477 0 0 0 257718 0 7950 0 23805 0 841950 0 0 0 JAY JUSTICE INTERIM CHRO (FEB-OCT) 229508 0 0 0 0 0 346 0 2806 0 232660 0 0 0 JOHN FORTNEY INTERIM CEO 399200 0 0 0 39934 0 7950 0 22451 0 469535 0 0 0 ERIC CECAVA CHIEF OPERATING OFFICER 365003 0 0 0 24004 0 6105 0 24866 0 419978 0 0 0 MARTHA LIVINGSTON CHIEF BUSINESS DEVLOPMENT 248985 0 100 0 18668 0 7247 0 15749 0 290749 0 0 0 ERIC PERDUE CHIEF HUMAN RESOURCES 22811 0 0 0 198265 0 449 0 83 0 221608 0 0 0 TIM CAHILL GENERAL COUNSEL 269952 0 0 0 17390 0 6432 0 33873 0 327647 0 0 0 BRIAN COHEN EMPLOYED M.D. 2797583 0 500 0 28110 0 0 0 29831 0 2856024 0 0 0 THOMAS LEWIS EMPLOYED M.D. 843700 0 0 0 9066 0 0 0 30333 0 883099 0 0 0 NEIL GHANY EMPLOYED M.D. 903178 0 500 0 28110 0 0 0 34989 0 966777 0 0 0 JAMES MANAZER EMPLOYED M.D. 865481 0 8365 0 26865 0 0 0 30031 0 930742 0 0 0 KELLY GALLINA EMPLOYED M.D. 844803 0 0 0 0 0 0 0 12178 0 856981 0 0 0 Part I, Line 1a ADENA HEALTH SYSTEM PROVIDES FOR A MEMBERSHIP TO THE LOCAL COUNTRY CLUB FOR ALL OFFICERS AND KEY EMPLOYEES. THIS BENEFIT IS GROSSED UP AND TAXED AND RECEIVED BY FOUR OF THE OFFICERS AND KEY EMPLOYEES. ADENA HEALTH SYSTEM PROVIDED A HOUSING ALLOWANCE TO ROBERT ROSENBERGER FOR TEN MONTHS IN THE AMOUNT OF $9,500. THIS BENEFIT HAS NOT BEEN TREATED AS TAXABLE COMPENSATION. Part I, Line 4a MARK SHUTER RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $72,692. ERIC PERDUE RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $178,198. A COUNTY OF ROSS OHIO 316400085 778260EX3 2008-09-17 141346983 CURRENT REFUNDING OF 2001 AND 2006 ISSUES 0 0 0 B COUNTY OF ROSS OHIO 316400085 2010-09-15 29985000 INFUSION CENTER AND INTERVENTIONAL RADIOLOGY 0 0 0 A 12395000 196860219 10920528 1366439 487668 184085584 2010 1 0 1 1 B 4132640 30087491 411604 29675887 2012 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 0 0 0.00700 0.00700 0 0 1 A 0 0 0 1 0 0 1 BAYERISCHE LANDESBANK 3.000000000000 1 0 0 B 0 0 0 0 0 0 0 0 0 A 1 B 1 Date Rebate Computation Performed Issuer Name: COUNTY OF ROSS OHIO Date the Rebate Computation was Performed: 01/01/2013 SCHEDULE K, PART II, LINE 6 2001 AND 2006 ISSUES WERE REFUNDED ON OCTOBER 29, 2008. INCLUDED $116,560,000 OF PRINCIPAL AND $149,427 OF INTEREST. THIS IS FOR THE 2008 ISSUE. SCHEDULE K, PART II, LINE 11 $11,750,000 OF ISSUE WAS USED TO PAY OFF QUALIFIED HEDGED RELATED TO THE 2001 AND 2006 BONDS. THIS IS FOR THE 2008 ISSUE. SCHEDULE K, PART III, LINE 2 ADENA HEALTH SYSTEM LEASES APPROXIMATELY 300 SQUARE FEET TO A FOR PROFIT COMPANY THAT OPERATES A COFFEE KIOSK. THIS IS CONSIDERED DEMINIMUS SPACE AND SO 0% WAS PUT IN LINE 4 OF PART III. THIS IS FOR THE 2008 ISSUE. THE LEASE CEASED IN FALL OF 2012. SCHEDULE K, PART IV, LINE 4A PROCEEDS INVESTED IN GIC FROM 2006 ISSUE - UNUSED PORTION TRANSFERS TO 2008 ISSUE. THE GIC MATURED IN JULY 2009; THIS WAS 36 MONTHS AFTER THE DATE OF ISSUE. THIS IS FOR THE 2008 ISSUE. SCHEDULE K, PART IV, LINE 2C THE DATE THE LAST REBATE COMPUTATION WAS PERFORMED IS OCTOBER 31, 2013. JOHN FORTNEY PHYSICIAN STUDENT LOANS X 11214 8989 0 1 1 8989 ROBIN BERNO SPOUSE OF DIRECTOR JACK BERNO 124888 EMPLOYEE COMPENSATION 0 JENNIFER WHITE DAUGHTER-IN-LAW OF BOARD DIRECTOR TOM WHITE 100720 EMPLOYEE COMPENSATION 0 JENNIFER STRICKLAND RELATIVE OF CHAIR DAVID STRICKLAND 30614 EMPLOYEE COMPENSATION 0 MICHELLE PERDUE SPOUSE OF KEY EMPLOYEE ERIC PERDUE 69766 EMPLOYEE COMPENSATION 0 TARA D'ANTONI DAUGHTER-IN-LAW OF BOARD DIRECTOR RALPH D'ANTONI 25059 EMPLOYEE COMPENSATION 0 MARIA SMITH SISTER OF BOARD DIRECTOR JOE WATSON 110302 EMPLOYEE COMPENSATION 0 Form 990, Part VI, Section A, line 3 ADENA HEALTH SYSTEM PAID AN EXECUTIVE CONSULTING SERVICES FIRM, TATUM, FOR CFO DUTIES. LISA CARLSON WAS PAID $56,100 FROM TATUM FOR HER ROLE AS CHIEF FINANCIAL OFFICER. Form 990, Part VI, Section A, line 6 THE ORGANIZATION IS COMPOSED OF 9 MEMBER CHURCHES. ALL OF THE CHURCHES ARE IN THE CHILLICOTHE, OHIO AREA. 1. FIRST PRESBYTERIAN CHURCH 2. SALEM COMMUNITY CHURCH 3. ORCHARD HILL UNITED CHURCH OF CHRIST 4. TABERNACLE BAPTIST CHURCH 5. ST. MARY'S CATHOLIC CHURCH 6. TRINITY UNITED METHODIST CHURCH 7. ST. PAUL'S EPISCOPAL CHURCH 8. WALNUT STREET UNITED METHODIST CHURCH 9. ST. PETER'S CATHOLIC CHURCH Form 990, Part VI, Section A, line 7a THE CORPORATE MEMBER CHURCHES MAY ONLY ELECT ONE PERSON PER CHURCH TO ACT AS THEIR TRUSTEE. THE TRUSTEES AT LARGE GET APPOINTED AS FOLLOWS. SECTION 3.03 OF THE CODE OF REGULATIONS OF AHS - "THE BOARD SHALL ELECT SIX (6) AT-LARGE TRUSTEE POSITIONS. TWO OF THESE POSITIONS SHALL BE FILLED WITH PHYSICIANS WHO ARE MEMBERS OF THE ACTIVE MEDICAL STAFF RECOMMENDED BY THE MEDICAL STAFF IN ACCORDANCE WITH THE MEDICAL STAFF BYLAWS. WHEN A VACANCY OCCURS AMONG THE FOUR (4) AT LARGE TRUSTEES, WITH THE EXCEPTION OF MEMBERS ELIGIBLE FOR REAPPOINTMENT, THE TRUSTEE COMMITTEE SHALL NOMINATE TO THE BOARD A CANDIDATE FOR THE VACANT POSITION." Form 990, Part VI, Section A, line 7b SECTION 2.04 RIGHTS OF THE CORPORATE MEMBERS: (A) THE RIGHT TO ELECT NINE TRUSTEES OF THE CORPORATION AS SPECIFIED IN THESE BYLAWS. (B) THE RIGHT TO APPROVE ANY LEASE, SALE EXCHANGE, TRANSFER, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION. (C) THE RIGHT TO APPROVE ANY PROPOSED MERGER OR CONSOLIDATION OF THE CORPORATION. (D) THE RIGHT TO APPROVE ANY PROPOSED DISSOLUTION OF THE CORPORATION. (E) THE RIGHT TO APPROVE ANY PROPOSED CHANGE TO THE FUNDAMENTAL PURPOSE OF THE CORPORATION AS STATED IN SECTION 1.01. (F) THE RIGHT TO APPROVE ANY PROPOSED AMENDMENTS TO THE CODE OF REGULATIONS. Form 990, Part VI, Section B, line 11b THE 990 WAS REVIEWED AT A BOARD MEETING, AND COPIES OF THE FORM 990 WERE PROVIDED TO THE BOD MEMBERS. ADDITIONALLY, COPIES OF THE 990 WERE MADE AVAILABLE ON THE HOSPITAL'S BOARD PORTAL AND IN ADMINISTRATION OFFICE UNTIL THE NOVEMBER 15 FILING DATE. Form 990, Part VI, Section B, line 12c THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. ALL CONFLICTS ARE REVIEWED, AND THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. FRONT LINE SUPERVISORS UP THROUGH THE CEO, ADVANCED PRACTICE CLINICIANS, AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS RETAINS MERCER, AN INDEPENDENT COMPENSATION CONSULTANT, TO EVALUATE THE TOTAL COMPENSATION FOR ALL DISQUALIFIED PERSONS. MERCER UTILIZES THE COMPENSATION PHILOSOPHY TO CONDUCT THE EVALUATION. EACH POSITION IS COMPARED TO PEER DATA OF ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY. THE DATA ANALYSIS COVERS CASH COMPENSATION (BASE SALARY), TOTAL CASH COMPENSATION (BASE SALARY AND INCENTIVES, BOTH PAID AND OPPORTUNITY), AND TOTAL COMPENSATION (BASE SALARY, INCENTIVES AND ALL BENEFITS). THE EXECUTIVE COMPENSATION COMMITTEE MEETS WITH MERCER REGULARLY TO REVIEW AND MONITOR ALL TOTAL COMPENSATION FOR THE DISQUALIFIED PERSONS. COMPENSATION WAS LAST REVIEWED IN 2016. Form 990, Part VI, Section C, line 19 THE ORGANIZATION PREPARES AN ANNUAL REPORT TO THE PUBLIC WHICH INCLUDES ITS STATEMENT OF REVENUES AND EXPENSES. ADDITIONALLY, ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE AVAILABLE ON GUIDESTAR.ORG AS PART OF THE ANNUAL FORM 990 FILING. Form 990, Part IX, line 11g MEDICAL PROFESSIONAL FEES: Program service expenses 2,602,483. Management and general expenses -555,697. Fundraising expenses 0. Total expenses 2,046,786. PURCHASED SERVICES: Program service expenses 34,732,495. Management and general expenses 8,289,402. Fundraising expenses 0. Total expenses 43,021,897. FACILITY MAINTENANCE: Program service expenses 17,540,857. Management and general expenses 839,952. Fundraising expenses 0. Total expenses 18,380,809. Form 990, Part XI, line 9: TRANSFERS (TO) FROM AFFILIATED ORGANIZATION -8,713,894. PENSION RELATED CHANGES OTHER THAN NET PERIODIC COSTS 1,913,600. intercompany receipts eliminated in consolidation 54,237. COURT DIALYSIS K-1 ACTIVITY - BOOK TO TAX DIFFERENCE 674. TEMPORARILY RESTRICTED EXPENDITURES -111,671. NET ASSETS RELEASED FROM RESTRICTION FOR PURCHASE OF CAPITAL ASSETS 2,266,858. CONTRIBUTIONS RECLASSED OUT OF NET ASSETS -444,744. Form 990, Part XII, Line 2c: THE AUDIT COMMITTEE ENGAGES THE INDEPENDENT AUDIT FIRM FOR THE AUDIT, REVIEWS RESULTS, AND REPORTS TO THE BOARD. ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. ADENA HEALTH FOUNDATION IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. ADENA MEDICAL GROUP LLC DEPT L637 COLUMBUS OH 43260 271370967 HEALTHCARE PROVIDERS OH 65313939 5523640 ADENA HEALTH SYSTEM ADENA HOSPICE LLC 272 HOSPITAL ROAD CHILLICOTHE OH 45601 275340755 HEALTHCARE PROVIDERS OH 2022574 261040 ADENA HEALTH SYSTEM ADENA HOME HEALTH 272 HOSPITAL ROAD CHILLICOTHE OH 45601 273752730 HEALTHCARE PROVIDERS OH 3000904 288558 ADENA HEALTH SYSTEM ADENA HOME INFUSIONHOME RESPIRATORY 272 HOSPITAL ROAD CHILLICOTHE OH 45601 273752854 HEALTHCARE PROVIDERS OH 2133126 940773 ADENA HEALTH SYSTEM ADENA PHARMACY 272 HOSPITAL ROAD CHILLICOTHE OH 45601 451138187 HEALTHCARE PROVIDERS OH 5297469 704567 ADENA HEALTH SYSTEM GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD OH 45123 310993422 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 ADENA HEALTH FOUNDATION 272 HOSPITAL ROAD CHILLICOTHE OH 45601 753008742 FUNDRAISING OH 501(C)(3) 11A ADENA HEALTH SYSTEM 1 SOUTHERN OHIO HEALTHCARE NETWORK 272 HOSPITAL ROAD CHILLICOTHE OH 45601 261566590 FIBEROPTIC NETWORK GRANTS OH 501(C)(3) 11A ADENA HEALTH SYSTEM 1 PIKE HEALTH SERVICES INC 100 DAWN LANE WAVERLY OH 45690 311072406 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 ADENA CARE 272 HOSPITAL ROAD CHILLICOTHE OH 45601 453980850 SEE SCHEDULE R, PART VII OH ADENA HEALTH SYSTEM C 976441 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 GREENFIELD AREA MEDICAL CENTER R 1318574 BOOK VALUE PIKE HEALTH SERVICES S 250028 BOOK VALUE SOUTHERN OHIO HEALTHCARE NETWORK S 3869897 BOOK VALUE ADENA HEALTH FOUNDATION R 114283 BOOK VALUE SCHEDULE R, PART IV, COLUMN (B) THE PRIMARY ACTIVITY OF ADENA CARE IS TO DEVELOP STRATEGIC RELATIONSHIPS TO THE SERVICE AREAS MAJOR EMPLOYERS THROUGH HEALTH MANAGEMENT AND WELLNESS SERVICES.