2017-11-14T08:57:18-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 250 S High St Suite 100 Columbus OH 43215 990 2016-01-01 311480941 GENESIS HEALTHCARE SYSTEM GENE 7404545000 2951 MAPLE AVENUE ZANESVILLE OH 43701 PAUL MASTERSON CFO 7404545000 2017-11-13 1 Bernie Ostrowski P00366367 6148493000 2017-11-12 67.59.56.33 2017-11-13 09:28:24 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CDA108602048A852A3C7A9C68094104E2D92ED46 2016 2017-02-10 21:41:12Z MATTHEW PERRY 2951 MAPLE AVENUE ZANESVILLE OH 43701 409968196 0 3727 X WWW.GENESISHCS.ORG X 1997 OH IN 1997, GOOD SAMARITAN MEDICAL CENTER AND BETHESDA HOSPITAL ASSOCIATION, A TAX-EXEMPT COMMUNITY HOSPITAL ALSO LOCATED IN ZANESVILLE, AFFILIATED TO FORM GENESIS HEALTHCARE SYSTEM. GENESIS HAS BEEN GRANTED 501C3 STATUS AS A HOSPITAL. ALL HOSPITAL OPERATIONS AND ASSETS OF GOOD SAMARITAN MEDICAL CENTER WERE TRANSFERRED TO GENESIS WITH THE EXCEPTION OF CERTAIN INVESTMENTS. GOOD SAMARITAN MEDICAL CENTER WILL CONTINUE TO HAVE CONTROL OVER CERTAIN INVESTMENTS WHICH ARE BEING USED BY THE GENESIS HEALTHCARE SYSTEM IN FULFILLING ITS TAX-EXEMPT PURPOSE. 17 14 3215 369 2630470 -21879 204558 371813 354489598 387260718 7558357 3925547 13606907 16178704 375859420 407736782 0 92394 0 0 162730988 164875549 0 0 0 182836903 195063330 345567891 360031273 30291529 47705509 531322335 542563079 383169806 385731853 148152529 156831226 X TO PROVIDE COMPASSIONATE, QUALITY HEALTH CARE 0 0 203631273 92394 168507650 GENESIS PROVIDES ACUTE CARE SERVICES INCLUDING MEDICAL, SURGICAL, OBSTETRICAL, PEDIATRIC AND CRITICAL CARE. TOTAL DISCHARGES FROM MEDICAL/SURGICAL UNITS DURING 2016 WERE 7,298. TOTAL OBSTETRIC DISCHARGES EQUALED 1,559 WITH 1,557 TOTAL BIRTHS AND PEDIATRIC DISCHARGES EQUALED 187. THERE WERE 400 CRITICAL CARE DISCHARGES, 1,335 CARDIOVASCULAR DISCHARGES, 576 ONCOLOGY DISCHARGES AND 926 ORTHOPEDIC DISCHARGES.GENESIS PROVIDES A WIDE RANGE OF DIAGNOSTIC AND SUPPORT SERVICES FOR INPATIENTS AND OUTPATIENTS. THESE SERVICES ARE COMPRISED OF LABORATORY, IMAGING SERVICES, CARDIAC, AND PHARMACY. LABORATORY SERVICES INCLUDE CHEMISTRY, PATHOLOGY, MICROBIOLOGY, HEMATOLOGY, AND CYTOLOGY FOR TOTAL VOLUMES IN 2016 OF 1,609,927. IMAGING SERVICES INCLUDES RADIOLOGY, NUCLEAR MEDICINE, MRI, ULTRASOUND, CT SCAN, AND PET SCAN WITH TOTAL VOLUMES OF 174,569. 40455359 0 126546727 HEART & VASCULAR SERVICES: THE GENESIS HEART & VASCULAR TEAM PROVIDES CARDIAC, THORACIC, AND VASCULAR SERVICES. HEART TREATMENTS INCLUDE INTERVENTIONAL CARDIOLOGY SUCH AS BALLOON ANGIOPLASTY AND STENTING, ELECTROPHYSIOLOGY TO TREAT ABNORMAL HEART RHYTHMS AND OPEN-HEART SURGERY SUCH AS CORONARY ARTERY BYPASS GRAFTING (CABG) AND VALVE REPAIR AND REPLACEMENT. OTHER SERVICES PROVIDED ARE MEDICAL MANAGEMENT BY OUR CARDIOLOGISTS, AN ANTICOAGULATION CLINIC AND A CARDIAC REHABILITATION PROGRAM. GENESIS HOSPITAL HAS RECEIVED CHEST PAIN CENTER ACCREDITATION, HEART FAILURE ACCREDITATION & ATRIAL FIBRILLATION CERTIFICATION FROM THE SOCIETY OF CARDIOVASCULAR PATIENT CARE. THE TOTAL NUMBER OF HEART & VASCULAR CASES TREATED IN 2016 WERE 2,477. 17255666 0 53976733 RESPIRATORY SERVICES - GENESIS RESPIRATORY & LUNG PROVIDES SERVICES FOR A VARIETY OF LUNG CONDITIONS AND DISEASES INCLUDING LUNG SURGERIES AND RESPIRATORY THERAPY. OUR TEAM, INCLUDING BOARD-CERTIFIED PULMONOLOGISTS, PROVIDE CARE AND TREATMENT FOR PATIENTS WITH PNEUMONIA, LUNG CANCER, BLACK LUNG DISEASE, RESPIRATORY FAILURE, COLLAPSED LUNG, AND OTHER PLEURAL DISEASES. THE TOTAL NUMBER OF RESPIRATORY CASES TREATED IN 2016 WERE 1,952. 14459673 0 45230702 ORTHOPEDIC SERVICES - THE GENESIS ORTHOPEDIC TEAM PROVIDES ALL THE CARE NEEDED FOR MUSCULOSKELETAL SURGERY, FROM IMAGING TESTS TO REHABILITATION. PATIENTS BENEFIT FROM BOARD-CERTIFIED ORTHOPEDIC SURGEONS AND SPECIALLY TRAINED SURGICAL NURSING STAFF. BESIDES GENERAL ORTHOPEDIC SURGERIES, GENESIS OFFERS: KNEE SURGERY, INCLUDING ACL RECONSTRUCTION, KNEE REPLACEMENT, AND MENISCECTOMY AND MENISCUS REPAIR; SHOULDER SURGERY INCLUDING REPLACEMENTS AND ROTATOR CUFF REPAIR; PARTIAL OR TOTAL HIP REPLACEMENT; AND HAND SURGERY INCLUDING CARPAL AND CUBITAL TUNNEL RELEASE. PATIENTS SCHEDULED FOR A HIP OR KNEE REPLACEMENT ARE ABLE TO TAKE PART IN A PREOPERATIVE CLASS THAT EXPLAINS HOW TO PREPARE FOR SURGERY AND HOW TO ENHANCE THEIR RECOVERY. THE TOTAL NUMBER OF ORTHOPEDIC CASES TREATED IN 2016 WERE 1,117. IN 2014, THE NEW GENESIS BEHAVIORAL HEALTH CENTER OPENED BRINGING TOGETHER ALL GENESIS BEHAVIOR HEALTH SERVICES IN ONE LOCATION. THE PREMIER FACILITY IS THE ONLY COMPREHENSIVE BEHAVIORAL HEALTH CENTER IN SOUTHEASTERN OHIO AND OFFERS INPATIENT AND OUTPATIENT ADULT, ADOLESCENT, AND CHILD PSYCHIATRIC CARE; SUBSTANCE ABUSE SUPPORT AND RECOVERY PROGRAMS; PARTIAL HOSPITALIZATION; AND ANGER MANAGEMENT. INPATIENT & PARTIAL HOSPITALIZATION CARE IS PROVIDED IN THREE DISTINCT AREAS; A PRIVATE, SECURE ADULT UNIT; A CLOSED INTENSIVE PSYCHIATRIC UNIT, AND A PEDIATRIC/ ADOLESCENT UNIT. ALONG WITH PRIVATE ROOMS THE NEW CENTER PROVIDES OPEN, QUIET SPACES WITH NATURAL LIGHTING AND EXERCISE EQUIPMENT. THE GENESIS BEHAVIORAL HEALTH TEAM OF PSYCHIATRISTS, PSYCHOLOGISTS, CERTIFIED COUNSELORS, THERAPISTS, NURSES AND SUPPORT STAFF ARE HIGHLY TRAINED AND WORK CLOSELY WITH OTHER COMMUNITY BASED HEALTH AGENCIES TO COORDINATE SERVICES. MISCELLANEOUS PROGRAMS INCLUDE SUBSTANCE ABUSE, SUICIDE AND DATE VIOLENCE PREVENTION AND GRIEF COUNSELING TO AREA SCHOOLS AND CONDUCTING CLASSES ON DEALING WITH DIVORCE REQUIRED FOR FAMILIES GOING THROUGH THIS PROCESS BY THE MUSKINGUM COUNTY COURT SYSTEM. PEOPLE OF ALL AGES AND FROM 33 COUNTIES COME TO GENESIS FOR BEHAVIORAL HEALTH CARE. TOTAL INPATIENTS TREATED IN 2016 WERE 1,601. 14459673 0 45230702 275801971 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 299 0 1 3215 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 17 14 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X MARTI NASH 7404545000 2951 MAPLE AVENUE ZANESVILLE OH 43701 JODY BALLAS EX-OFFICIO 2.62 0.00 X 0 0 0 JERRY NOLDER TREASURER 2.31 0.00 X X 0 0 0 MARK MOYER TRUSTEE 1.85 0.00 X 0 0 0 SR LAURA WOLF EX-OFFICIO 1.69 0.00 X 0 0 0 RANDY COCHRANE CHAIR 2.62 0.24 X X 0 0 0 JAMES MCDONALD TRUSTEE 1.15 0.24 X 0 0 0 ERIN REMSTER MD TRUSTEE 40.00 0.00 X 0 295062 17213 JOHN DITTOE TRUSTEE 1.15 0.00 X 0 0 0 SR MARY ANN NUGENT TRUSTEE 1.15 0.00 X 0 0 0 WILLIAM SHADE MD VICE CHAIR 2.85 0.00 X X 0 1600 0 JOANN BUTCHER EX-OFFICIO 1.62 0.00 X 0 0 0 COLBY GRAHAM TRUSTEE 1.15 0.00 X 0 0 0 PATRICK NASH SECRETARY 2.08 0.04 X X 0 0 0 SHIRLEY VAN WYE TRUSTEE 2.08 0.43 X 0 0 0 TOD KLOTZBACH TRUSTEE 1.15 0.00 X 0 0 0 DANIEL MCGINTY EX-OFFICIO 1.69 0.04 X 0 0 0 JOHN ZIMMERMAN MD TRUSTEE 39.85 0.15 X 0 482593 31838 MATTHEW PERRY PRESIDENT & CEO 39.08 0.92 X 673143 0 100768 PAUL MASTERSON CHIEF FINANCIAL OFFICER 39.12 0.88 X 407281 0 66040 EDMUND ROMITO CHIEF INFORMATION OFFICER 40.00 0.00 X 337719 0 34902 ALAN BURNS CHIEF DEVELOPMENT OFFICER 39.85 0.15 X 368688 0 57582 DANIEL SCHEERER MD CHIEF MEDICAL AFFAIRS OFFICER 40.00 0.00 X 391782 0 63598 ABBY NGUYEN CHIEF NURSING OFFICER 39.81 0.19 X 259690 0 27839 DIANNA LEVECK CHIEF HUMAN RESOURCES OFFICER 40.00 0.00 X 281286 0 21032 WENDY CEDOZ CHIEF LEGAL OFFICER 40.00 0.00 X 285835 0 28561 SLOAN ALBERT CHIEF PHYSICIAN NETWORK OFFICER 40.00 0.00 X 372225 0 21601 SHAWN ROARK CHIEF TRANSF/POP HEALTH OFFICER 40.00 0.00 X 305862 0 17989 CHARLES ADAMS JR DIRECTOR 40.00 0.00 X 153969 0 17808 SHARON PARKER DIRECTOR OF CANCER SERVICE 40.00 0.00 X 159501 0 19206 LES BOYER DIRECTOR 40.00 0.00 X 149803 0 21236 CHERYL JORGE DIRECTOR 40.00 0.00 X 161870 0 18904 GREGORY HAMILTON DIRECTOR 40.00 0.00 X 148856 0 23348 4457510 779255 589465 56 0 1 0 PRECYSE SOLUTIONS LLC 1275 DRUMMERS LN SUITE 200 WAYNE PA 190871571 HEALTH INFORMATION MANAGEMENT 5603409 ZANESVILLE ANESTHESIA PHYSICIANS INC 37 S SEVENTH ST ZANESVILLE OH 43701 MEDICAL SERVICES 4212958 CARDIAC ANESTHESIA ASSOC 800 FOREST AVE ZANESVILLE OH 43701 MEDICAL SERVICES 1710000 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 84127 LABWORK 1059245 DIVERSIFIED CLINICAL SERVICES 28525 NETWORK PLACE CHICAGO IL 606731285 MEDICAL PERSONNEL SERVICES 913874 42 113211 258602 371813 NET PATIENT SERVICES 621110 386963746 386963746 PASSTHROUGH INCOME 621110 296972 296972 387260718 4859461 4859461 1400199 1297500 102699 102699 102699 933914 -933914 -933914 -933914 CAFETERIA SALES 621110 2917285 96965 2820320 OCCUPATIONAL HEALTH 621110 1278021 1278021 EHR TECHNOLOGY INCOME 621110 1198334 1198334 10682365 4422040 2533505 3726820 16076005 407736782 394261812 2630470 10472687 92394 92394 1247233 1247233 119703338 88620309 31083029 4894208 3585979 1308229 30437528 22301533 8135995 8593242 6296256 2296986 722652 722652 428751 428751 154630 154630 32493527 17624460 14869067 489916 489916 10472028 5034722 5437306 7783150 1453212 6329938 11062203 6681171 4381032 503615 203040 300575 14921222 14921222 21716519 17633794 4082725 283620 275571 8049 MEDICAL SUPPLIES 72335487 71567685 767802 BAD DEBT EXPENSE 14462071 14462071 LAB REFERENCE FEES 1592079 1588267 3812 PHYSICIAN RECRUITMENT 774662 774662 4867198 2195707 2671491 360031273 275801971 84229302 0 2771751 3865531 6303262 10305181 7083 2083 64163472 71240238 5566927 5753526 6335414 6539873 475063051 165224080 316929775 309838971 76303329 83537936 10935680 9247024 6109176 6109176 35896466 36123540 531322335 542563079 38014307 40430754 5510444 4736012 291245952 287707200 9900000 10825000 38499103 42032887 383169806 385731853 X 148152529 156831226 148152529 156831226 531322335 542563079 X 47705509 1277397 -40304209 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 158780 0 1 21613 180393 0 Part II-B, Line 1: GENESIS HEALTHCARE SYSTEM PAYS MEMBERSHIP DUES TO THE FOLLOWING ORGANIZATIONS. A PORTION OF THE DUES ARE RELATED TO LOBBYING ACTIVITIES. AMERICAN HOSPITAL ASSOCIATION - FSCC SHARE (AHA): 21.78% OF $56,117 ($12,222) OHIO HOSPITAL ASSOCIATION - FSCC SHARE (OHA): 3.5% OF $77,721 ($2,720) AMERICAN SOCIETY HEALTHCARE ENGINEERING (ASHE/AHA): 21.78% OF $450 ($98) AMERICAN SOCIETY HEALTHCARE HR ADMIN (ASHHRA/AHA): 21.78% OF $160 ($35) AMERICAN SOCIETY HEALTHCARE RISK MGMT (ASHRM/AHA): 21.78% OF $159 ($35) SOC FOR HEALTHCARE STRATEGY & MARKET DEVELOPMENT (SHSMD/AHA): 21.78% OF $235 ($51) CATHOLIC CONFERENCE OF OHIO: 3.5% OF $3,262 ($114) CATHOLIC HEALTH ASSOC (FSCC SHARE): 3.11% OF $7,898 ($246) ACADEMY OF NUTRITION & DIETETICS (AND): 14.0% OF $234 ($33) AMERICAN ACADEMY OF SLEEP MEDICINE (AASM): 2.0% OF $1,100 ($22) AMERICAN BAR ASSOC (ABA): 2.5% OF $219 ($5) AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION (AHIMA): 5.0% OF $350 ($18) AMERICAN HEART ASSOC (AHA): 6.0% OF $260 ($16) AMERICAN MEDICAL GROUP ASSOCIATION (AMGA): 20.0% OF $9,750 ($1,950) AMERICAN SOCIETY HEALTH-SYSTEM PHARMACISTS (ASHP): 40.0% OF $109 ($43) AMERICAN SPEECH & HEARING ASSOCIATION (ASHA): 4.0% OF $900 ($36) ASSOCIATION OF COMMUNITY CANCER CENTERS (ACCC): 3.0% OF $1,150 ($35) COLLEGE OF HEALTHCARE INFO MGMT EXECUTIVES (CHIME): 8.0% OF $375 ($30) HEALTHCARE INFORMATION & MANAGEMENT SYSTEMS SOCIETY (HIMSS): 2.87% OF $2,813 ($81) MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA): 23.0% OF $779 ($179) OHIO STATE BAR ASSOCIATION (OBA): 5.0% OF $305 ($15) SOCIETY OF DIAGNOSTIC MEDICAL SONOGRAPHY (SDMS): 4.0% OF $160 ($6) SOCIETY OF THORACIC SURGEONS (STS): 18.0% OF $8,250 ($1,485) SOCIETY OF VASCULAR ULTRASOUND (SVU): 20.0% OF $145 ($29) TRAUMA CENTER ASSOCIATION OF AMERICA (TCAA): 29.0% OF $1,667 ($483) ZANESVILLE - MUSKINGUM CO. CHAMBER OF COMMERCE: 10.0% OF $5,833 ($583) ZANESVILLE - MUSKINGUM CO. CHAMBER OF COMMERCE: 10.0% OF $4,590 ($459) OHIO HOSPICE AND PALLIATIVE CARE ORGANIZATION DBA MIDWEST CARE ALLIANCE (OHPCO): 7.3% OF 8,000 ($584) GENESIS HEALTHCARE SYSTEM PAID SECOND CAPITAL CONSULTING, LLC $158,780 IN 2016 FOR ADVOCACY AND OUTREACH CONSULTING SERVICES. THESE SERVICES ASSIST GENESIS IN ENGAGING, EDUCATING AND COMMUNICATING WITH PUBLIC POLICY MAKERS REGARDING PENDING LEGISLATION OR PROPOSED REGULATIONS AND ASSIST ELECTED OFFICIALS IN UNDERSTANDING THE IMPACT THESE REGULATIONS HAVE ON GENESIS'S ABILITY TO DELIVER COST EFFECTIVE, QUALITY CARE FOR PATIENTS IN SOUTHEAST OHIO. GENESIS WORKS PRIMARILY THROUGH NATIONAL AND STATE HOSPITAL ASSOCIATIONS, IN WHICH GENESIS HAS MEMBERSHIP, TO UNDERSTAND POTENTIAL POLICIES WHICH COULD NEGATIVELY AFFECT THEIR ABILITY TO WORK WITH THE LOCAL MEDICAL COMMUNITY TO MEET THE HEALTHCARE NEEDS OF THE REGION. SOME ISSUES OF INTEREST INCLUDE THE 340B PROGRAM, MEDICAID REGULATIONS AND INFRASTRUCTURE IMPROVEMENTS AT THE LOCAL LEVEL TO ENHANCE ACCESS TO THE HOSPITAL FOR EMERGENCY VEHICLES, PATIENTS AND FAMILIES, WHILE MINIMIZING TRAFFIC CONGESTION THROUGHOUT THE BUSY COMMERCIAL CORRIDOR IN ZANESVILLE. 8108904 8108904 222168695 16924704 205243991 5101243 2425836 2675407 226213415 144617224 81596191 13470794 1256316 12214478 309838971 UNAMORTIZED BOND ISSUE COSTS 4362683 INVESTMENTS IN RELATED AND OTHER HEALTHCARE ORGANIZATIONS 4272056 ASSETS LIMITED AS TO USE 27488801 36123540 ACCRUED MINIMUM PENSION LIABILITY 40731184 ACCRUED PROFESSIONAL LIABILITY 1301703 42032887 X Part X, Line 2: THE SYSTEM AND ITS SUBSIDIARIES ARE TAX-EXEMPT ORGANIZATIONS, EXCEPT FOR CARELIFE; ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND TO RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. 1 1 X 1 X 1 X 1 1 0 1 1 4684352 11452439 0 0.00000 75982804 57606437 18376367 0.05320 80667156 69058876 18376367 0.05320 52 77482 1359030 57781 1301249 0.00380 12 3220 1267877 0 1267877 0.00370 1607242 1472497 134745 0.00040 11 1341 38518 0 38518 0.00010 75 82043 4272667 1530278 2742389 0.00800 75 82043 84939823 70589154 21118756 0.06120 0 14462073 197265 105377213 108636239 -3259026 X 1 1 1 2 GENESIS HOSPITAL 2951 MAPLE AVE ZANESVILLE OH 43701 X X X ACUTE CARE HOSPITAL GENESIS HOSPITAL 2 0 0 1 X X X X X X X X X 15 1 1 0 1 X WWW.GENESISHCS.ORG/ABOUT-US/COMMUNITY X 1 16 1 WWW.GENESISHCS.ORG/ABOUT-US/COMMUNITY 0 1 X 100.000000000000 300.000000000000 X X 1 1 X X X 1 X http://www.genesishcs.org/app/files/public/2726/Financial-Assistance-Self-P X http://www.genesishcs.org/app/files/public/2660/Fin-Assist-Form-Rev.pdf X http://www.genesishcs.org/app/files/public/2546/Fin-Asst-Summary.pdf X X X X 1 X 0 X X X X 1 X 0 0 GENESIS HOSPITAL Part V, Section B, Line 5: A COMMUNITY HEALTH SURVEY WAS CONDUCTED. THE SURVEY GATHERED THE COMMUNITY INPUT ON THEIR PRIORITIES FOR CHRONIC CONDITIONS, RISK FACTORS FOR DISEASE, MOTHERS AND CHILDREN AND ACCESS TO CARE. THE SURVEY WAS COLLECTED ON THE GENESIS WEBSITE IN SEPTEMBER OF 2015 AND USED FACEBOOK, TWITTER, AND THE ZANESVILLE TIMES RECORDER TO PUBLICIZE THE COMMUNITY HEALTH NEEDS SURVEY. 67 COMPLETED SURVEYS WERE COLLECTED FROM THE GENESIS WEBSITE AND FROM INDIVIDUALS WAITING FOR SERVICES AT THE GENESIS HOSPITAL. ALL SIX COUNTIES WERE REPRESENTED IN THE SURVEY. TWO STUDENTS FROM MUSKINGUM UNIVERSITY AND KEY PARTNERS SUCH AS MUSKINGUM VALLEY HEALTH CENTER, THE VETERAN'S CLINIC, SALVATION ARMY, CHRIST'S TABLE, AND UNITED WAY COLLECTED SURVEYS FROM LOCATIONS SERVICING THE UNDERSERVED POPULATION. SIXTY-THREE PERSONS COMPLETED THE SURVEY IN THE UNDERSERVED LOCATIONS. A TOTAL OF 130 SURVEYS WERE COLLECTED.58 KEY INFORMANT SURVEYS WERE COLLECTED IN THE COMMUNITY AND CONTAINED CATEGORIES FOR BEHAVIORAL RISKS, MOMS AND BABIES, MORTALITY RATES AND POVERTY. SPECIAL CARE WAS USED TO IDENTIFY KEY INFORMANTS WITH KNOWLEDGE OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS. IN ADDITION, WE HAVE IDENTIFIED THE KEY INFORMANTS SPECIFICALLY AS: (1) PERSONS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH; (2) REPRESENTATIVES FROM GOVERNMENT OR PUBLIC HEALTH DEPARTMENTS; AND (3) LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE NEEDS. ALL SIX COUNTIES WERE REPRESENTED IN THE KEY INFORMANT SURVEY.IN ADDITION TO USING COUNTY BASED NEEDS ASSESSMENTS, DUE TO THE LARGE COMMUNITY DEFINED IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT, SPECIAL CARE WAS TAKEN TO INCORPORATE THE VIEWS OF KEY INFORMANTS FROM EACH COUNTY. BELOW ARE EXAMPLES OF THE AGENCIES AND GROUPS COMPLETING THE KEY INFORMANT SURVEYS.COSHOCTON:GENESIS HEALTHCARE SYSTEMCOSHOCTON COUNTY HEALTH DEPARTMENTCOSHOCTON JOB AND FAMILY SERVICESCOSHOCTON UNITED WAYMUSKINGUM VALLEY HEALTH CENTERCOSHOCTON BEHAVIORAL HEALTH CHOICESMUSKINGUM:GENESIS HEALTHCARE SYSTEMTHE CARR CENTERQUALITY CARE PARTNERSZANESVILLE-MUSKINGUM COUNTY HEALTH DEPARTMENTHEART BEATSBIG BROTHERS BIG SISTERSMUSKINGUM COUNTY COMMUNITY FOUNDATIONMUSKINGUM RECREATION CENTERMUSKINGUM COUNTY PORT AUTHORITYSALVATION ARMYBETHEL MISSIONFIRST UNITED METHODIST CHURCHMUSKINGUM VALLEY HEALTH CENTERAMERICAN CANCER SOCIETYWICGUERNSEY:GENESIS HEALTHCARE SYSTEMAMERICAN CANCER SOCIETYMUSKINGUM VALLEY HEALTH CENTERMORGAN:GENESIS HEALTHCARE SYSTEMMORGAN LOCAL SCHOOLSMUSKINGUM VALLEY HEALTH CENTERBUCKEYE HILLSSALVATION ARMYNOBLE:GENESIS HEALTHCARE SYSTEMBUCKEYE HILLS-HOCKING VALLEY REGIONAL DEVELOPMENT DISTRICTCARESOURCEAMERICAN CANCER SOCIETYPERRY:GENESIS HEALTHCARE SYSTEMPERRY COUNTY HEALTH DEPARTMENTNORTHERN LOCAL SCHOOLSHELP ME GROWHOPEWELL HEALTH CENTERCROOKSVILLE SCHOOL NURSESALVATION ARMY GENESIS HOSPITAL Part V, Section B, Line 6a: THE CHNA WAS CONDUCTED SIMULTANEOUSLY FOR BOTH GENESIS HOSPITAL AND GOOD SAMARITAN HOSPITAL. GENESIS HOSPITAL Part V, Section B, Line 7d: THE CHNA REPORT IS AVAILABLE ON OUR WEBSITE AT HTTP://GENESISHCS.ORG, UNDER THE TAB "ABOUT US" AT THE BOTTOM OF THE FRONT PAGE, AND THEN UNDER THE "CARING FOR OUR COMMUNITY" TAB. THE REPORT WAS SHARED WITH COMMUNITY PARTNERS AND COPIES ARE AVAILABLE FOR FREE UPON REQUEST. GENESIS HOSPITAL Part V, Section B, Line 11: THE COMMUNITY BENEFIT 2016-2018 IMPLEMENTATION STRATEGY IS A WRITTEN PLAN THAT ADDRESSES EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2015 CHNA. THE PLAN HAS BEEN TAILORED TO THE SERVICE LINES OF GENESIS, TAKING INTO ACCOUNT SPECIFIC PROGRAMS, RESOURCES AND PRIORITIES. THE IMPLEMENTATION STRATEGY PLANNING GROUPS INCLUDED TWO THAT HAD REPRESENTATION ACROSS SERVICE LINES AND INCLUDED COMMUNITY AGENCIES: (1) THE ADDICTION REDUCTION PLANNING GROUP AND (2) THE OBESITY REDUCTION PLANNING GROUP. OTHER GENESIS PLANNING GROUPS INCLUDED: GENESIS BEHAVIORAL HEALTH, CANCER SERVICES, HEART AND VASCULAR SERVICES, TRAUMA SERVICES, NEUROSCIENCE SERVICES, WOMEN'S AND CHILDREN'S SERVICES, POPULATION HEALTH AND WELLNESS, PULMONARY ADMINISTRATION, EDUCATIONAL SERVICES, MEDICAL STAFF SERVICES, GENESIS HOSPICE AND PALLIATIVE CARE/CAREGIVERS, MARKETING AND PUBLIC RELATIONS, MISSION, NURSELINE, SPIRITUAL CARE, PATIENT EDUCATION AND VOLUNTEER SERVICES.GIVEN THE EVER CHANGING LANDSCAPE OF HEALTHCARE, THE INITIATIVES IN THIS IMPLEMENTATION STRATEGY MAY CHANGE AND NEW ONES MAY BE ADDED OR OTHERS ELIMINATED BASED ON THE COMMUNITY NEEDS DURING THE 2016-2018 PERIOD. THESE CHANGES WILL BE NOTED EACH YEAR IN THE ANNUAL EVALUATION REPORT.THE COMMUNITY BENEFIT 2016-2018 IMPLEMENTATION STRATEGY OUTCOMES ARE TRACKED QUARTERLY AND ANNUALLY THROUGH THE COMMUNITY BENEFIT'S DATA SYSTEM KNOWN AS THE COMMUNITY BENEFIT INVENTORY OF SOCIAL ACCOUNTABILITY (CBISA). THE INITIAL PROPOSED OUTCOMES IN THE TABLES BELOW WILL BE USED AS A BASELINE FOR PERFORMANCE FOR EACH YEAR AND USED TO GUIDE THE EVALUATION PROCESS AND FUTURE INITIATIVE DEVELOPMENT. THE INITIATIVES AND ANTICIPATED OUTCOMES INCLUDED IN THIS DOCUMENT WILL BE EVALUATED AGAINST THE DATA COLLECTED FOR THE IDENTIFIED MEASURES THROUGH CBISA. THE FOCUS AREA LEADERS WILL ENSURE THAT THE OUTCOMES FOR EACH INITIATIVE ARE REPORTED IN CBISA THROUGH THE COMMUNITY BENEFIT PROGRAM AND SUMMARY REPORTS WILL BE ASSESSED QUARTERLY BY THE GENESIS COMMUNITY BENEFIT COMMITTEE. THE DOCUMENT '2016 EVALUATION OF PROGRESS COMMUNITY BENEFIT 2016-2018 IMPLEMENTATION STRATEGY' WAS APPROVED BY THE GENESIS QUALITY COMMITTEE AND THE BOARD OF DIRECTORS IN APRIL OF 2017. IT OUTLINES THE 2016 OUTCOMES FOR EACH INITIATIVE. THE EVALUATION REPORT WAS POSTED ON THE GENESIS WEBSITE MAY 2017.THE CHNA IDENTIFIED TOP PRIORITY CHRONIC CONDITIONS, RELATED RISK FACTORS, ISSUES FOR MOTHERS AND CHILDREN AND ACCESS TO CARE ISSUES. THE COMMUNITY BENEFIT 2016-2018 IMPLEMENTATION STRATEGY FOCUSES ON ALL THE MAJOR AREAS OF NEED EXCEPT ACCESS TO CARE (CHNA PAGES 27-29). ACCESS TO CARE IS A FOCUS OF THE GENESIS STRATEGIC PLAN AND INITIATIVES ARE IMPLEMENTED THROUGH ADMINISTRATION, SERVICE LINE DIRECTORS, FINANCIAL ASSISTANCE, AND TRANSFORMATIONAL CARE DEPARTMENTS. THE TOP HEALTH PRIORITIES FROM THE CHNA, WHICH ARE THE FOCUS OF THE 2016-2018 COMMUNITY BENEFIT IMPLEMENTATION STRATEGY, ARE LISTED BELOW ACCOMPANIED BY THE REFERENCE PAGE WHERE THAT PRIORITY AREA IS LOCATED IN THE CHNA DOCUMENT.THE TOP PRIORITY CHRONIC CONDITIONS IDENTIFIED ARE AS FOLLOWS:1. CANCER (CHNA PAGE 14); PRIORITY RISK FACTOR: TOBACCO USE (CHNA PAGE 15)2. MENTAL HEALTH ISSUES (CHNA PAGE 16); PRIORITY RISK FACTORS: DRUG ADDICTIONS (CHNA PAGE 17) AND ALCOHOL OVERUSE (CHNA PAGE 18)3. DIABETES (CHNA PAGE 18)4. HEART DISEASE (CHNA PAGE 19); PRIORITY RISK FACTORS: OBESITY (CHNA PAGE 20), UNHEALTHY EATING (CHNA PAGE 20), AND PHYSICAL INACTIVITY (CHNA PAGE 21)5. CHRONIC BREATHING PROBLEMS (CHNA PAGE 21)6. JOINT & BACK PAIN (CHNA PAGE 22)7. STROKE (CHNA PAGE 23); PRIORITY RISK FACTOR: HIGH BLOOD PRESSURE (CHNA PAGE 23)THE TOP PRIORITY HEALTH ISSUES FOR MOTHERS AND CHILDREN INCLUDE:1. PREGNANT AND USING TOBACCO (CHNA PAGE 24)2. PREGNANT AND USING ALCOHOL (CHNA PAGE 24)3. PREGNANT AND USING DRUGS (CHNA PAGE 24)4. CHILDREN OVERWEIGHT (CHNA PAGE 25)5. SUPPORT FOR DRUG ADDICTED BABIES (CHNA PAGE 25)6. CHILDREN WITH DISABILITIES (CHNA PAGE 26)AS PLANNING GROUPS FORMED TO DESIGN THE COMMUNITY BENEFIT 2016-2018 IMPLEMENTATION STRATEGY, TWO CROSS AGENCY/CROSS SERVICE LINES PLANNING GROUPS EVOLVED. ONE GROUP FOCUSED ON ADDICTIONS REDUCTION AND BECAME THE ADDICTIONS REDUCTION PLANNING GROUP WHICH INCLUDED ADDICTIONS TO TOBACCO, ALCOHOL AND DRUGS AND INCLUDED ADDICTED MOTHERS AND BABIES. ANOTHER GROUP FORMED TO FOCUS ON ADULT AND CHILDREN OBESITY REDUCTION AND BECAME THE OBESITY REDUCTION PLANNING GROUP. THE OTHER TOP PRIORITY CHRONIC CONDITIONS AND ISSUES FOR MOTHERS AND CHILDREN TOPICS WERE DESIGNED BY THE RELATED SERVICE LINE STAFF LISTED IN THE INTRODUCTION IN THE IMPLEMENTATION STRATEGY SECTION. 15 1 - HOSPICE & PALLIATIVE CARE 713 FOREST AVENUE ZANESVILLE OH 43701 HOSPICE & PALLIATIVE CARE CENTER 2 - CTR FOR OUTPATIENT & OCCUPATIONAL REHAB 740 ADAIR AVENUE ZANESVILLE OH 43701 OUTPATIENT REHAB SERVICES 3 - HEALTHPLEX 2800 MAPLE AVENUE ZANESVILLE OH 43701 OUTPATIENT LAB/IMAGING/URGENT CARE; PEDIATRIC REHAB 4 - GENESIS PHYSICIAN'S PAVILION 945 BETHESDA DRIVE ZANESVILLE OH 43701 OUTPATIENT CARDIAC REHAB SERVICES; WOUND CARE CENTER 5 - GENESIS BEHAVIORAL HEALTH 2991 MAPLE AVENUE ZANESVILLE OH 43701 MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT 6 - GENESIS INTERVENTIONAL PAIN MGT CLINIC 2945 MAPLE AVENUE ZANESVILLE OH 43701 PAIN MEDICINE SPECIALIZATION;IMAGING TECHNIQUES;SOLUTIONS TO PAIN MANAGEMENT 7 - GENESIS SLEEP DISORDERS CENTER 840 BETHESDA DRIVE ZANESVILLE OH 43701 DIAGNOSIS AND TREATMENT OF SLEEP DISORDERS 8 - GENESIS RHEUMATOLOGY CARE CENTER 2525 MAPLE AVENUE ZANESVILLE OH 43701 EDUCATION AND OUTPATIENT RHEUMATOLOGY SERVICES 9 - GENESIS FIRST CARE - SOUTH 23 NORTH MAYSVILLE PIKE ZANESVILLE OH 43701 URGENT CARE 10 - CAMBRIDGE HEALTH CENTER 61353 SOUTHGATE PARKWAR CAMBRIDGE OH 43725 IMAGING SERVICES/LAB SERVICE/WOUND MANAGEMENT 11 - GENESIS CANCER CENTER 2951 MAPLE AVENUE ZANESVILLE OH 43701 CANCER & PALLATIVE CARE/WOMEN'S BOUTIQUE 12 - GENESIS HEALTHCARE CENTER - NEW CONCORD 1 EAST MAIN STREET NEW CONCORD OH 43762 LAB SERVICES 13 - GENESIS HEALTH CENTER - PERRY COUNTY 301 DR MIKE CLOUSE DRIVE SOMERSET OH 43783 DIAGNOSITC HEALTHCARE SERVICES/PHYSICAL & OCCUPATIONAL THERAPY 14 - GENESIS SURGERY CENTER 2907 MAPLE AVENUE ZANESVILLE OH 43701 OUTPATIENT SURGERY 15 - GENESIS NEW LEXINGTON DRAW CENTER 445 WEST BROADWAY NEW LEXINGTON OH 43764 LAB SERVICES Part I, Line 7: COSTS OF CHARITY CARE AND COMMUNITY BENEFIT ACTIVITIES WERE CALCULATED USING THE HOSPITAL'S COST ACCOUNTING SYSTEM.PART I, LINE 7, COLUMN (F): PERCENTAGE OF TOTAL EXPENSES WAS CALCULATED BASED ON TOTAL EXPENSES LESS BAD DEBT EXPENSE AS REPORTED ON FORM 990, PART IX. Part II, Community Building Activities: GENESIS HAS AN ACTIVE PRESENCE ON MANY COMMITTEES INVOLVED IN FINDING LOW COST SOLUTIONS TO PHYSICAL AND MENTAL HEALTH ISSUES PREVALENT IN OUR COMMUNITIES, WITH PARTICULAR FOCUS ON SERVING LOW-INCOME, UNINSURED OR OTHERWISE UNDERSERVED. GENESIS NURSES, THERAPISTS, DIABETES COUNSELORS, ADMINISTRATORS AND OTHER PROFESSIONALS PARTICIPATE IN COMMUNITY COALITIONS AND PREVENTION PROGRAMS, PRIMARILY WITH A FOCUS ON DIABETES, DOMESTIC VIOLENCE, FAMILY SERVICES, WELLNESS INITIATIVES AND MENTAL HEALTH. THESE ACTIVITIES ARE ALL CAPTURED IN COMMUNITY BENEFIT. COMMUNITY BENEFIT BUILDING ACTIVITIES ARE NOT PART OF THE DOCUMENTATION FOR COMMUNITY BENEFIT TO DATE FOR GENESIS. Part III, Line 2: BAD DEBT IS CALCULATED USING GROSS CHARGES. Part III, Line 3: THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE WAS ESTIMATED BASED UPON BAD DEBT A/R RECLASSIFIED IN 2016 TO CHARITY WITH DISCHARGE DATES OF 2015 AND PRIOR. Part III, Line 4: THE FINANCIAL STATEMENT FOOTNOTE RELATED TO BAD DEBT IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENT FOOTNOTE 1 "NATURE OF BUSINESS AND SIGNIFICANT ACCOUNTING POLICIES" GROUPED WITH ACCOUNTS RECEIVABLE ON PAGE 8. Part III, Line 8: CALCULATION WAS BASED ON THE MEDICARE COST TO CHARGE RATIO. Part III, Line 9b: ALL PATIENTS ARE OFFERED A PLAIN LANGUAGE SUMMARY (PLS) OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE FROM THE HOSPITAL. AT LEAST THREE SEPARATE COMMUNICATIONS WILL BE MAILED TO THE LAST KNOWN ADDRESS OF THE RESPONSIBLE PARTY ALSO CONTAINING THE PLS. AT LEAST 60 DAYS WILL LAPSE BETWEEN THE FIRST AND THIRD REQUIRED COMMUNICATION. DETAILED ITEMIZED STATEMENTS WILL BE MADE AVAILABLE UPON REQUEST EXCEPT WHERE PROHIBITED BY STATE OR FEDERAL REGULATIONS. ACCOUNTS WITH ZERO BALANCES WILL NOT RECEIVE THREE SEPARATE COMMUNICATIONS; HOWEVER, THESE ACCOUNT HOLDERS MAY ALSO BE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE. ALL RESPONSIBLE PARTIES WILL RECEIVE WRITTEN NOTIFICATION REGARDING EXTRAORDINARY COLLECTION ACTIONS (ECA) THAT MAY COMMENCE IF ACTION IS NOT TAKEN. THIRTY DAYS WILL LAPSE BETWEEN ISSUANCE OF NOTIFICATION AND COMMENCEMENT OF ECA. ACTION TAKEN BY THE RESPONSIBLE PARTY CONSTITUTES MAKING PAYMENT ARRANGEMENTS FOR THE AMOUNT DUE OR COMPLETING A FINANCIAL ASSISTANCE APPLICATION. ACCOUNTS GO TO FULL COLLECTION AFTER DAY 120 IF NO PRIOR ARRANGEMENTS HAVE BEEN MADE. COLLECTION AGENCIES ARE INSTRUCTED TO MAKE PHONE CALLS AND SEND LETTERS. IF THEY CANNOT RESOLVE THE BALANCE, OR HAVE NOT BEEN ABLE TO MAKE PAYMENT ARRANGEMENTS, THE ACCOUNT IS SENT BACK TO GENESIS AS NON-COLLECTIBLE IN 18 MONTHS. Part VI, Line 2: GENESIS HEALTHCARE SYSTEM, AS A NOT-FOR-PROFIT HEALTH CARE SYSTEM, IS DEDICATED TO MEETING THE HEALTH NEEDS OF OUR COMMUNITIES, REGARDLESS OF ONE'S ABILITY TO PAY. WE ENCOURAGE AND SUPPORT COLLABORATION WITH OTHER COMMUNITY PARTNERS TO IDENTIFY, RESPOND TO AND STRIVE TO IMPROVE THE HEALTH-RELATED NEEDS OF THE POOR, THE UNDERSERVED, AND THE COMMUNITY AT LARGE. WE PLEDGE ALL AVAILABLE FINANCIAL RESOURCES - AFTER OUR OPERATING EXPENSES ARE MET - TO RESPOND TO THE COMMUNITY'S HEALTH NEEDS WITH SERVICE INITIATIVES, FINANCIAL AND PROFESSIONAL SUPPORT, AND EDUCATION AND WELLNESS PROGRAMS.THE COMMUNITY BENEFIT COMMITTEE COLLABORATES WITH GENESIS ADMINISTRATION AND DEPARTMENTS AND WITH COMMUNITY AGENCIES IN OUR DEFINED GEOGRAPHIC MARKET, INCLUDING BUT NOT LIMITED TO THE PUBLIC HEALTH DEPARTMENTS, MUSKINGUM VALLEY HEALTH CENTERS, AND THE UNITED WAY, TO ASSESS COMMUNITY HEALTH NEEDS AND STRENGTHS; DEVELOP A COMMUNITY BENEFIT PLAN WITH STRATEGIC GOALS AND INTERVENTIONS; MONITOR IMPLEMENTATION OF COMMUNITY BENEFIT ACTIVITIES; EVALUATE COMMUNITY BENEFIT ACTIVITIES; ADVOCATE FOR THE COMMUNITY BENEFIT PROGRAMS; AND ASSIST IN TELLING THE GENESIS HOSPITAL COMMUNITY BENEFIT STORY. Part VI, Line 3: GENESIS HAS SIGNAGE STRATEGICALLY LOCATED IN THE FACILITY (REGISTRATION AREAS AND CASHIER AREAS) ADVISING OF FREE CARE. BILLING STATEMENTS ALSO CONTAIN THIS INFORMATION ALONG WITH A CHARITY CARE APPLICATION PRINTED ON THE REVERSE SIDE OF THE BILL. THE INFORMATION IS ALSO AVAILABLE ON OUR WEBSITE. WE HAVE RESOURCE COUNSELORS THAT WORK IN THE EMERGENCY DEPARTMENT TO SCREEN PATIENTS FOR CHARITY ASSISTANCE AND LOOK FOR POTENTIAL MEDICAID QUALIFIERS. FOR INPATIENTS, WE ALSO HAVE A THIRD PARTY THAT SCREENS SELF-PAYS, UNDERINSURED AND MEDICARE ONLY PATIENTS FOR MEDICAID AND/OR CHARITY. SELF-PAY, MEDICARE ONLY AND UNINSURED INPATIENTS ARE SCREENED FOR MEDICAID AND/OR CHARITY. Part VI, Line 4: OUR GEOGRAPHIC MARKET AREA IS A SIX-COUNTY RURAL REGION OF SOUTHEAST OHIO, INCLUDING MUSKINGUM, MORGAN, PERRY, COSHOCTON, GUERNSEY AND NOBLE COUNTIES. TOTAL MARKET AREA POPULATION IS APPROXIMATELY 226,800, WITH MUSKINGUM COUNTY (86,100) REPRESENTING THE LARGEST COUNTY. MEDIAN HOUSEHOLD INCOME LEVELS RANGE FROM $7,400 TO $12,400 LOWER THAN THE STATE MEDIAN HOUSEHOLD INCOME AND $11,900 TO $16,800 LOWER THAN THE NATIONAL MEDIAN HOUSEHOLD INCOME. PEOPLE LIVING BELOW POVERTY LEVEL RANGES FROM 15.0% TO 19.0% IN THE REGION VERSUS 14.8% FOR STATE AND 13.5% FOR NATION. Part VI, Line 5: ONGOING COMMUNITY HEALTH EDUCATION IS PROVIDED THROUGH REGULARLY SCHEDULED HEALTH AND WELLNESS PROGRAMS PRESENTED BY GENESIS STAFF AND AFFILIATED PHYSICIANS. PREVENTATIVE HEALTH SCREENINGS ARE ALSO ROUTINELY SCHEDULED. INDIVIDUALS AT RISK ARE ENCOURAGED TO SEE A PHYSICIAN AND PROVIDED ASSISTANCE WITH PHYSICIAN ACCESS AS NEEDED. PROGRAM TOPICS ARE BASED ON COMMUNITY NEED AS DETERMINED BY FEEDBACK FROM PARTICIPANTS, THE COMMUNITY BENEIFIT COMMITTEE AND INTERNAL CLINICAL GROUPS. GENESIS ALSO REGULARLY PROVIDES HEALTH AND WELLNESS EDUCATION THROUGH COMMUNITY-BASED HEALTH FAIRS HELD THROUGHOUT THE COMMUNITY. CLINICAL EXPERIENCES ARE OFFERED FOR HEALTHCARE STUDENTS AS WELL AS TRAINING OPPORTUNITIES FOR HEALTHCARE PROFESSIONALS. Part VI, Line 6: THE GENESIS ORGANIZATION AND IT'S AFFILIATES ARE REACHING OUT TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH VARIOUS PROGRAMS, MANY BASED ON PREVENTION. THESE FREE PROGRAMS INCLUDE FALL-RISK ASSESSMENTS, THINKFIRST INJURY PREVENTION FOR CHILDREN AND YOUNG ADULTS, AND IMPACT (IMMEDIATE POST-CONCUSSION ASSESSMENT AND COGNITIVE TESTING). AS A PART OF THESE PROGRAMS, GENESIS COMMUNITY AMBULANCE SERVICE (CAS) PARTICIPATES IN PRESENTATIONS THAT SIMULATE DISTRACTED DRIVING ACCIDENTS TO SCHOOLS AND ORGANIZATIONS. CAS ALSO PROMOTES THE WELL-BEING OF THE COMMUNITY THROUGH STANDBYS AT LOCAL EVENTS, PARAMEDIC ASSIST, AMBULANCE TOURS AND EFFORTS TO INCREASE PUBLIC AWARENESS OF EMERGENCY MEDICAL SERVICE AND 9-1-1 BEFORE AN EMERGENCY OCCURS. IN ADDITION, GENESIS PROVIDES NUMEROUS HEALTH SCREENINGS THROUGH OUR AFFILIATED PHARMACIES, PARTICIPATES IN COMMUNITY-BASED HEALTH FAIRS, OFFERS REGULAR EDUCATION PROGRAMS ON A VARIETY OF HEALTH TOPICS, AND COOPERATES WITH OUR IN-HOME CARE AFFILIATES TO GENERATEA BETTER QUALITY OF LIFE FOR AREA RESIDENTS WHO MAY OTHERWISE REQUIRE NURSING HOME CARE.System member organizations routinely participate with the hospital in providing health and wellness programs and screenings. Specifically, the retail pharmacy offers ongoing screenings through a well-established wellness program and serves as the hospital's screening partner for community-based initiatives. 1 UNITED WAY OF MPM COUNTIES 526 PUTNAM AVENUE ZANESVILLE OH 43701 314379456 501(C)(3) 40000 GRANTS WERE PAID TO ASSIST IN COMMUNITY IMPACTGRANTS WERE PAID TO ASSIST IN PROVIDING ASSISTANCE FOR COMMUNITY IMPACT PROJECTS GENESIS HEALTHCARE FOUNDATION 1135 MAPLE AVENUE ZANESVILLE OH 43701 311629304 501(C)(3) 13894 GRANT PAID TO FUND GENESIS FOUNDATION CAPITAL CAMPAIGN AMERICAN HEART ASSOCIATION PO BOX 4002907 DES MOINES IA 50340 135613797 501(C)(3) 17000 HEARTCHASE SPONSORSHIP AGREEMENT AMERICAN CANCER SOCIETY 5555 FRANTZ ROAD DUBLIN OH 43017 131788491 501(C)(3) 6500 COUNTY SPONSOR FOUNDATION FOR APPALACHIAN OHIO PO BOX 456 NELSONVILLE OH 45764 311620483 501(C)(3) 5000 COMMUNITY FOUNDATINO FOR PERRY CO ENDOW 200 MUSKINGUM VALLEY HEALTH CENTER 716 ADAIR AVENUE ZANESVILLE OH 43701 208814374 501(C)(3) 10000 PATIENT CARE CHARITABLE FUND 5 0 Part I, Line 2: THE UNITED WAY DONATION IS MONITORED THROUGH "METRICS AND DATA" REPORTED TO GHCS AND GHCS APPOINTS ONE "AT-LARGE MEMBER" ANNUALLY TO SERVE ON THE COMMUNITY IMPACT BOARD. THE AMERICAN HEART ASSOCIATION GRANT IS PART OF A 3 YR COMMITMENT FROM 2016-2018 FOR A TOTAL CONTRIBUTION OF $51,000. THIS COMMITMENT WAS AUTHORIZED BY OUR CEO THROUGH A SIGNED AGREEMENT AND IS TO BENEFIT THE LOCAL HEART CHASE PROGRAM OF WHICH GENESIS IS A SPONSOR AND PARTICIPANT. THE AMERICAN CANCER SOCIETY GRANT IS A SPONSORSHIP OF LOCAL ACS EVENTS IN AREA COUNTIES SERVED BY GENESIS. GENESIS ENCOURAGES COMMUNITY AND EMPLOYEE PARTICIPATION IN THESE EVENTS. THE FOUNDATION FOR APPALACHIAN OHIO GRANT IS PART OF GENESIS'S INVESTMENT IN PERRY COUNTY, ONE OF THE SURROUNDING COUNTIES THAT GENESIS SERVES. OUR CEO AND OTHER STAFF MEMBERS ALSO COMMIT TIME AND ENERGY WORKING IN COLLABORATION WITH THE FOUNDATION TO PROMOTE GOOD HEALTH AND WELL-BEING FOR AREA RESIDENTS. THE CONTRIBUTION TO THE MUSKINGUM VALLEY HEALTH CENTER PATIENT CARE CHARITABLE FUND IS JUST ONE OF THE MANY WAYS THAT GENESIS WORKS WITH MVHC TO PROVIDE ACCESS TO PRIMARY AND PREVENTIVE CARE SERVICES FOR UNINSURED AND UNDERINSURED RESIDENTS. OUR CHIEF PHYSICIAN NETWORK OFFICER SERVED ON THE MVHC BOARD DURING 2016. SHE, AS WELL AS SEVERAL PHYSICIANS AND TECHNICAL STAFF MEMBERS, WORKS CLOSELY WITH MVHC TO HELP MEET THE HEALTH NEEDS OF MUSKINGUM COUNTY. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 ERIN REMSTER MD TRUSTEE 0 249692 0 45370 0 0 0 2650 0 14563 0 312275 0 0 JOHN ZIMMERMAN MD TRUSTEE 0 344757 0 137836 0 0 0 7050 0 24788 0 514431 0 0 MATTHEW PERRY PRESIDENT & CEO 673143 0 0 0 0 0 83270 0 17498 0 773911 0 0 0 PAUL MASTERSON CHIEF FINANCIAL OFFICER 407081 0 200 0 0 0 47384 0 18656 0 473321 0 0 0 EDMUND ROMITO CHIEF INFORMATION OFFICER 337719 0 0 0 0 0 31002 0 3900 0 372621 0 0 0 ALAN BURNS CHIEF DEVELOPMENT OFFICER 368688 0 0 0 0 0 42867 0 14715 0 426270 0 0 0 DANIEL SCHEERER MD CHIEF MEDICAL AFFAIRS OFFICER 321480 0 70302 0 0 0 46885 0 16713 0 455380 0 0 0 ABBY NGUYEN CHIEF NURSING OFFICER 259690 0 0 0 0 0 6590 0 21249 0 287529 0 0 0 DIANNA LEVECK CHIEF HUMAN RESOURCES OFFICER 281286 0 0 0 0 0 6617 0 14415 0 302318 0 0 0 WENDY CEDOZ CHIEF LEGAL OFFICER 285835 0 0 0 0 0 1962 0 26599 0 314396 0 0 0 SLOAN ALBERT CHIEF PHYSICIAN NETWORK OFFICER 372225 0 0 0 0 0 2479 0 19122 0 393826 0 0 0 SHAWN ROARK CHIEF TRANSF/POP HEALTH OFFICER 305862 0 0 0 0 0 638 0 17351 0 323851 0 0 0 CHARLES ADAMS JR DIRECTOR 127125 0 26844 0 0 0 2578 0 15230 0 171777 0 0 0 SHARON PARKER DIRECTOR OF CANCER SERVICE 143292 0 16209 0 0 0 3900 0 15306 0 178707 0 0 0 LES BOYER DIRECTOR 149777 0 26 0 0 0 1408 0 19828 0 171039 0 0 0 CHERYL JORGE DIRECTOR 134844 0 27026 0 0 0 4138 0 14766 0 180774 0 0 0 GREGORY HAMILTON DIRECTOR 147416 0 1440 0 0 0 4559 0 18789 0 172204 0 0 0 Part I, Line 1a THE ORGANIZATION PAYS COUNTRY CLUB DUES AND RELATED BUSINESS EXPENSES FOR TEN MEMBERS OF LEADERSHIP. PERSONAL USAGE IS PAID BY THE INDIVIDUAL AND THE PERCENTAGE OF DUES RELATED TO PERSONAL USAGE ARE ADDED TO THE INDIVIDUALS W-2. Part I, Line 4b LINE 4B: A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS SET UP TO PROVIDE ADDITIONAL DEFERRED RETIREMENT INCOME TO THE GENESIS HEALTH CARE SYSTEM SENIOR LEADERSHIP TEAM MEMBERS. THIS PLAN IS FUNDED BY GENESIS AND VESTS WITH SERVICE. GENESIS HEALTHCARE SYSTEM MADE CONTRIBUTIONS TO NONQUALIFIED RETIREMENT PLANS FOR THE FOLLOWING INDIVIDUALS: MATTHEW PERRY: $77,970 PAUL MASTERSON: $26,000 ALAN BURNS: $22,750 EDMUND ROMITO: $21,125 DANIEL SCHEERER, MD: $40,560 A MUSKINGUM COUNTY OHIO 316400080 2013-05-09 294645952 SEE PART VI 0 0 0 A 294645952 18306939 12464619 46879891 4794175 47125926 324552 62751 2015 1 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 PART II, LINE 6 $46,879,891 WAS SPENT ON THE ISSUE DATE OF THE SERIES 2013 BONDS TO CURRENTLY REFUND A TAXABLE LOAN. THEREFORE, AS OF 12/31/2016, THERE ARE $0 PROCEEDS IN REFUNDING ESCROW. PART I, LINE A(F) (i) Currently refund a taxable loan for certain hospital revenue bonds; and (ii) finance certain capital improvement projects for hospital facilities SOUTHEAST OHIO MEDICAL INSURANCE COMPANY LTD BOARD MEMBER, JOHN ZIMMERMAN, M.D., IS A BOARD MEMBER WITH SOMIC 1965714 ACCRUED INSURANCE PREMIUMS 0 Form 990, Part VI, Section A, line 3 THE HIM DEPARTMENT WAS OUTSOURCED INCLUDING A DIRECTOR AND A MANAGER. A FIXED MONTHLY FEE IS PAID WHICH INCLUDES ALL PERSONNEL SALARY, WAGE AND BENEFIT COSTS, AND IS BASED ON ANNUAL VOLUMES OF MEDICAL RECORDS PROCESSED. FOR 2016, THE TOTAL FEE WAS $370,597. Form 990, Part VI, Section A, line 6 FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC., AND BETHESDA CARE SYSTEM (OR THEIR RESPECTIVE SUCCESSORS AN ASSIGNS) ARE THE MEMBERS OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7a THE MEMBERS OF THE FILING ORGANIZATION, HAVE THE RIGHT TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY, WHETHER PERIODICALLY, OR AS VACANCIES ARISE, OR OTHERWISE. Form 990, Part VI, Section A, line 7b THE MEMBERS OF THE FILING ORGANIZATION, HAVE THE RIGHT TO APPROVE OR RATIFY DECISIONS OF THE ORGANIZATION'S GOVERNING BODY SUCH AS APPROVAL OF THE GOVERNING'S BODY'S DECISION TO DISSOLVE THE ORGANIZATION. Form 990, Part VI, Section B, line 11b THE 990 IS REVIEWED IN ITS ENTIRETY BY THE CFO. AN OVERVIEW OF THE 990 IS REVIEWED WITH THE EXECUTIVE COMMITTEE. Form 990, Part VI, Section B, line 12c THE CONFLICT OF INTEREST POLICY STATES THAT BOARD MEMBERS AND OFFICERS HAVE A DUTY TO GOVERN HONESTLY AND ECONOMICALLY. ALL POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO THE BOARD OF DIRECTORS AND THE BOARD WILL DETERMINE IF A CONFLICT EXISTS AND APPROPRIATE PROCEDURES TO MITIGATE THE SITUATION, SUCH AS ALTERNATIVE TRANSACTIONS AND PARTICIPATION AND VOTING RESTRICTIONS. THE COMPLIANCE OFFICER MONITORS AND ENFORCES THESE POLICIES. ALL OFFICERS AND DIRECTORS REVIEW AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. Form 990, Part VI, Section B, line 15 THE COMPENSATION OF THE CEO IS MANAGED THROUGH A THIRD PARTY THAT IS A NATIONALLY RECOGNIZED FIRM SPECIALIZING IN COMPENSATION BENCHMARKING AND ANALYSIS. THE FIRM IS RECOGNIZED FOR THEIR EXPERTISE IN EVALUATING TOTAL COMPENSATION AT THE EXECUTIVE LEVEL. THIS FIRM PRESENTS THEIR RECOMMENDATIONS AND ANALYSIS TO THE COMPENSATION COMMITTEE, WHICH IS MADE UP OF INDEPENDENT MEMBERS OF THE GENESIS BOARD OF DIRECTORS. THE COMMITTEE IS RESPONSIBLE FOR MAKING A RECOMMENDATION TO THE BOARD OF DIRECTORS REGARDING THE EXECUTIVE COMPENSATION POLICY AND SPECIFIC COMPONENTS OF THE TOTAL COMPENSATION OF THE CEO. THE CEO IS ACTIVELY INVOLVED IN THE REVIEW, ANALYSIS AND RECOMMENDATION RELATED TO THE TOTAL COMPENSATION FOR THE REMAINING MEMBERS OF THE SENIOR LEADERSHIP TEAM. THE CEO DETERMINES THE COMPENSATION OF THE SENIOR LEADERSHIP TEAM MEMBERS WITHIN THE PARAMETERS ESTABLISHED BY THE COMPENSATION COMMITTEE. THIS COMPENSATION PROCESS WAS LAST COMPLETED IN 2016. Form 990, Part VI, Section C, line 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, line 9: GAIN IN FAIR VALUE OF PERPETUAL TRUST -1,977,947. PLEDGE RECEIVABLE FROM RELATED PARTY -37,143,783. RESERVE FOR COSHOCTON COUNTY MEMORIAL -1,222,479. CONTRIBUTED CAPITAL 40,000. FORM 990, PART XII, LINE 2C: The finance committee oversees the audit of the financial statements and is involved in the selection of the independent accountant which completes the audit. This process has not changed from the prior year. FORM 990, PAGE 1, LINE H(D): THIS IS THE PARENT RETURN FOR A GROUP: GENESIS HEALTHCARE SYSTEM GROUP RETURN, EIN: 31-1773259 PART VI, SECTION B, LINE 16B: ALTHOUGH THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY REGARDING JOINT VENTURES, LEGAL COUNSEL EVALUATES EACH PROPOSED VENTURE IN ADVANCE AND THE BOARD MUST APPROVE. THE GUIDELINES FOR EACH JOINT VENTURE ARE CLEARLY ARTICULATED IN EACH OF THE OPERATING AGREEMENTS OR RELATED GOVERNANCE DOCUMENTS. CURRENTLY GENESIS HEALTHCARE SYSTEM IS INVOLVED IN ONE JOINT VENTURE. FORM 990, PART IV, LINE 12B: GENESIS HEALTHCARE SYSTEM IS INCLUDED IN AUDITED CONSOLIDATED FINANCIAL STATEMENTS. OHIO INTEGREATED CARE PROVIDERS (OICP) IS A WHOLLY-OWNED DISREGARDED ENTITY UNDER GENESIS HEALTHCARE SYSTEM AND IS INCLUDED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. 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