2016-05-16T14:17:20-05:00 2015-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-07-01 311724085 HOLZER MEDICAL CENTER - JACKSON HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 DAN JANICAK CFO 7404465060 2016-05-13 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-12-15 16:53:06Z CHRISTOPHER MEYER 100 JACKSON PIKE GALLIPOLIS OH 45631 32719135 0 X WWW.HOLZER.ORG X 2000 OH TO ENHANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE. 10 9 313 2 1402 -541 0 0 30916497 32517774 13401 5511 248369 195850 31178267 32719135 0 0 0 0 12593894 11031915 0 0 0 18476610 16715444 31070504 27747359 107763 4971776 27190100 30093829 48223102 46162697 -21033002 -16068868 X TO ENHANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE 0 0 26704882 0 32604244 THE HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO CERTAIN ESTABLISHED POLICIES OF THE HOSPITAL. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL COMPARES INCURRED CHARGES WITH GENERALLY RECOGNIZED POVERTY INCOME LEVELS AND THE PATIENT'S FINANCIAL RESOURCES. BECAUSE THE HOSPITAL DOES NOT EXPECT TO RECEIVE PAYMENT FOR AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUES.CONSISTENT WITH ITS MISSION, THE HOSPITAL PROVIDES COMMUNITY SERVICES INTENDED TO BENEFIT THE UNDERSERVED AND ENHANCE THE HEALTH STATUS OF THE COMMUNITY. THE HOSPITAL OPERATES A 24 HOUR PER DAY, 7 DAY PER WEEK EMERGENCY ROOM PROVIDING CARE TO ALL PATIENTS. CONTINUING EDUCATION, CERTIFICATION PROGRAMS AND INFORMATIONAL SEMINARS ARE CONDUCTED FOR BOTH HOSPITAL AND MEDICAL STAFF. HEALTH FAIRS FOR THE COMMUNITY ARE CONDUCTED AT NO CHARGE. HOSPITAL STAFF ALSO RESPONDS TO REQUESTS FROM EMPLOYERS AND COMMUNITY GROUPS, ALONG WITH SENIOR CITIZENS CENTERS, FOR SCREENINGS AND INFORMATIONAL PROGRAMS.THE HOSPITAL'S MEETING ROOMS ARE MADE AVAILABLE TO ORGANIZATIONS AT NO CHARGE FOR HEALTH-RELATED PROGRAMMING AND MEETINGS. ADDITIONALLY, CIVIC AND PROFESSIONAL ORGANIZATIONS ARE INVITED TO THE HOSPITAL REGULARLY FOR PROGRAMS THAT ARE EDUCATIONAL AND INFORMATIONAL ON HEALTH CARE SERVICES AS DEVELOPED.SPEAKERS FROM THE HOSPITAL STAFF ARE AVAILABLE AND RESPOND TO SPEAKING INVITATIONS FOR GROUPS AND ORGANIZATIONS IN THE HOSPITAL'S SERVICE AREA. THE HOSPITAL OFFERS MANY SERVICES TO THE COMMUNITY AT NOMINAL OR NO CHARGE, INCLUDING BLOOD PRESSURE AND BLOOD SUGAR SCREENINGS, CHOLESTEROL CHECKS, PULSE OXIMETRY, PROSTRATE CHECKS AND BONE DENSITY. ASSISTANCE IS ALSO PROVIDED TO SENIOR CITIZENS AND OTHER PATIENTS AND THEIR FAMILIES WITH THE SUBMISSIONS OF FORMS FOR INSURANCE, FINANCIAL COUNSELING, AND APPLICATION TO THE MEDICARE AND MEDICAID PROGRAMS FOR HEALTH SERVICE COVERAGE. COSTS ASSOCIATED WITH THESE PROGRAMS ARE INCLUDED IN THE HOSPITAL'S EXPENSES. 26704882 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 313 1 1 1 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X DAN JANICAK CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 STEVE CHAPMAN CHAIRMAN 1.00 2.00 X X 0 18000 0 DANNY HOLSCHUH VICE CHAIRMAN 1.00 3.00 X X 0 18000 0 GARY ROACH SECRETARY 1.00 3.00 X X 0 18000 0 LARRY KIDD TREASURER 1.00 3.00 X X 0 18000 0 ALAN STOCKMEISTER VICE CHAIRMAN THROUGH 12/31/14 1.00 3.00 X X 0 12000 0 BOB GRILLO TRUSTEE 1.00 2.00 X 0 18000 0 THOMAS TOPE TRUSTEE 1.00 1.00 X 0 0 0 BRENT SAUNDERS TRUSTEE 1.00 39.00 X 0 400203 27975 BRAD MUNN TRUSTEE 1.00 2.00 X 0 18000 0 PAUL REED TRUSTEE 1.00 3.00 X 0 18000 0 NIRMAL DUTTA MD TRUSTEE 1.00 0.00 X 0 0 0 CHRISTOPHER MEYER CEO - HHS 1.00 39.00 X 0 420724 0 DAN JANICAK CFO - HHS 1.00 39.00 X 0 0 0 WAYNE MUNRO CEO - HHS THROUGH 12/31/14 1.00 39.00 X 0 590452 0 RHONDA L DAILEY VP PATIENT CARE 40.00 0.00 X 175405 0 12947 SAMIA Y KANOOZ PHYSICIAN 40.00 0.00 X 200222 0 7860 PAUL J ESSMAN DENTIST 40.00 0.00 X 159416 0 11627 HERMAN D CRABTREE JR PHARMACIST 40.00 0.00 X 136313 0 5108 AMANDA L FORCHE DENTIST 40.00 0.00 X 130114 0 4189 PATRICIA J HIGHTOWER DIRECTOR - ED 40.00 0.00 X 107661 0 15725 KENNETH G PAYNE CFO - HHS THROUGH 3/31/14 0.00 1.00 X 0 346237 27676 909131 1895616 113107 6 1 1 0 HEALOGICS WOUND CARE & HYPERBARIC SERVIC PO BOX 551187 JACKSONVILLE FL 32255 CONTRACT LABOR/MEDICAL SPECIALISTS 431559 JOY BENNETT 999 RIDGEWOOD DR POINT PLEASANT WV 25550 CRNA 249490 DAVID B GRIMM 1506 CHERRY RIDGE RD THURMAN OH 45685 CRNA 249299 LYNDA J FRALEY 39225 TR 247 POMEROY OH 45769 CRNA 223049 VIRTUAL RADIOLOGIC CORPORATION 11995 SINGLETREE LANE SUITE 500 MINNEAPOLIS MN 55344 IMAGE READERS 147046 5 NET PATIENT SERVICES 622110 31128013 31128013 HCAP 622110 1389761 1389761 32517774 5511 5511 77811 0 77811 77811 77811 CAFETERIA SALES 900099 109380 1402 107978 MEDICAL RECORD FEES 900099 8630 8630 PURCHASE DISCOUNTS 900099 29 29 118039 32719135 32604244 1402 113489 8171902 7438355 733547 2202286 2019325 182961 657727 657727 162990 144944 18046 -1980 -1980 1460093 1401143 58950 529285 496919 32366 434526 428421 6105 773861 773861 80868 73199 7669 1858515 1858515 2602281 2602281 276308 276308 MEDICAL SUPPLIES 4854882 4854882 BAD DEBT EXPENSE 3175259 3175259 FRANCHISE FEE 506808 506808 1748 -3065 4813 27747359 26704882 1042477 0 1151 1151 3518179 5501934 3324807 3455833 397426 381748 704169 452996 -9290 -6492 49820465 34626171 17294998 15194294 334860 335362 1623800 4777003 27190100 30093829 5402996 4900988 28604127 28604127 1240858 1302766 12975121 11354816 48223102 46162697 X -21041762 -16076746 8760 7878 -21033002 -16068868 27190100 30093829 X 4971776 -7642 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 661 661 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION RELATES TO LOBBYING. 1633793 1633793 18822068 10962731 7859337 26449643 21539505 4910138 2914961 2123935 791026 15194294 OTHER ASSETS 1319369 MEDICARE SETTLEMENTS 155619 RELATED PARTY RECEIVABLE 3302015 4777003 RELATED PARTY PAYABLE 11354816 11354816 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND 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. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF JUNE 30, 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE SYSTEM FILES FEDERAL AND STATE TAX RETURNS AND BELIEVES IT IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE FISCAL YEAR 2012. 1 1 X 1 X 1 X 1 1 1 0 0 467684 1388297 -920613 0.00000 6629519 5095080 1534439 0.06240 7097203 6483377 613826 0.06240 7097203 6483377 613826 0.06240 0 3175259 158763 11260452 10816189 444263 X 1 1 1 1 HOLZER MEDICAL CENTER - JACKSON 500 BURLINGTON ROAD JACKSON OH 45640 X X X X HOLZER MEDICAL CENTER- JACKSON 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X HTTP://WWW.HOLZER.ORG/HEALTH-WELLNESS/CHNA/ X 1 13 1 HTTP://WWW.HOLZER.ORG/APP/FILES/PUBLIC/258/CHNA-IMPLEMENTATION-PLAN-2013-14 0 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTP://WWW.HOLZER.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/PAY-MY-BI X HTTP://WWW.HOLZER.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/PAY-MY-BI X X X X X 1 0 X X X X 1 X 0 0 HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 5: THE COMMUNITY NEEDS ASSESSMENT TEAM SURVEYED KEY COMMUNITY PARTNERS, INCLUDING REPRESENTATIVES OF THE LOCAL CITY/COUNTY HEALTH DEPARTMENT, COMMUNITY OUTREACH GROUPS, AND OTHER FOCUS GROUPS TO SUPPLEMENT THE FINDINGS OF THE ASSESSMENT. HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 6A: HOLZER HOSPITAL FOUNDATION (HOLZER MEDICAL CENTER) HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 11: HOLZER MEDICAL CENTER JACKSON DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA BECAUSE OF LIMITED FINANCIAL RESOURCES. AN IMPLEMENTATION PLAN WILL BE ROLLED OUT OVER THE NEXT THREE YEARS. THE IMPLEMENTATION STRATEGY WAS ADOPTED JUNE 2013.HTTP://WWW.HOLZER.ORG/APP/FILES/PUBLIC/258/CHNA-IMPLEMENTATION-PLAN-2013-14 PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.HOLZER.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/PAY-MY-BI HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.HOLZER.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/PAY-MY-BI PART I, LINE 7: EXPENSES WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2. PART I, LINE 7, COLUMN (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 $ 3,175,259. PART III, LINE 4: BAD DEBT WAS RECORDED AT GROSS CHARGES ONCE AN ACCOUNT HAD BEEN THROUGH MULTIPLE ATTEMPTS FOR PAYMENT. IT WAS THEN SUBMITTED FOR COLLECTIONS, LESS ANY AMOUNTS THAT MAY HAVE BEEN PAID THROUGH INSURANCE OR PRIVATE PAYMENTS. BAD DEBT WAS CALCULATED ON AUDITED FINANCIAL STATEMENT BALANCES. NONE OF THE BAD DEBT IS TREATED AS COMMUNITY BENEFIT. 5% OF THE BAD DEBT IS ESTIMATED AS LIKELY ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE. IF IT IS UNCLEAR WHETHER AN ACCOUNT MAY QUALIFY AS CHARITY, IT IS FIRST ASSUMED TO BE CHARITY, NOT BAD DEBT, UNTIL ADDITIONAL INFORMATION SHOWS OTHERWISE.FOOTNOTE FROM FINANCIAL STATEMENTS: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE 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 AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: MEDICARE COSTS AS REPORTED IN THE MEDICARE COST REPORT WERE CALCULATED USING A COST-TO-CHARGE RATIO METHODOLOGY AS REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. PART III, LINE 9B: FOUR PATIENT STATEMENTS ARE SENT TO NON-MEDICARE ACCOUNTS. FIVE PATIENT STATEMENTS ARE SENT TO MEDICARE ACCOUNTS. IF NO PATIENT PAYMENT RESPONSE, ACCOUNTS ARE SELECTED AND PROCESSED TO BAD DEBT. THIS POLICY APPLIES TO PATIENTS WHO QUALIFY UNDER THE CHARITY CARE/FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: NEEDS ARE ASSESSED THROUGH COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: NOTICES ARE POSTED THAT SPECIFY THE RIGHTS OF THESE INDIVIDUALS TO RECEIVE WITHOUT CHARGE BASIC, MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES. THE POSTINGS ARE PRINTED IN ENGLISH AND SPANISH AND ARE LOCATED IN ADMISSIONS AREAS, THE BUSINESS OFFICE, AND THE EMERGENCY DEPARTMENT. PATIENT STATEMENTS CONTAIN FEDERAL POVERTY GUIDELINES, AN EXPLANATION OF WHAT SERVICES MAY QUALIFY FOR FREE CARE, AND INFORMATION ON HOW TO APPLY. THE ORGANIZATION ALSO EMPLOYS FINANCIAL ADVOCATES AND BENEFIT ELIGIBILITY COORDINATORS TO ASSIST IN THE INFORMATION/EDUCATION PROCESS. PART VI, LINE 4: HOLZER MEDICAL CENTER - JACKSON IS LOCATED ON APPROXIMATELY 11 ACRES OF A 77-ACRE TRACT OF LAND FACING US 32 APPROXIMATELY ONE MILE SOUTH OF THE INTERSECTION OF US 32 AND US 35 NEAR THE CITY OF JACKSON, OHIO. THE INTERSECTION OF THESE TWO US HIGHWAYS IS A CENTRAL HUB OF THE HIGHWAY SYSTEM IN SOUTHEASTERN OHIO. THE PRIMARY SERVICE AREA FOR HOLZER MEDICAL CENTER - JACKSON IS JACKSON COUNTY, OHIO. THE SECONDARY SERVICE AREA INCLUDES PORTIONS OF PIKE, GALLIA, VINTON, SCIOTO, LAWRENCE, ROSS AND ATHENS COUNTIES IN OHIO. PART VI, LINE 5: HOLZER MEDICAL CENTER-JACKSON BELIEVES THAT EDUCATIONAL AND PREVENTATIVE SERVICES ARE IMPERITIVE TO IMPROVING THE HEALTH OF OUR COMMUNITY. AS SUCH, THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT AT HOLZER MEDICAL CENTER-JACKSON ORGANIZES AND PROVIDES HEALTH SCREENING THROUGHOUT THE YEAR AT OUR CAMPUS, AT VARIOUS FAIRS AND FESTIVALS IN THE COMMUNITY, AT OUR LOCAL SCHOOLS AND ALSO AT AREA BUSINESSES. NO-COST HEALTH SCREENINGS INCLUDE: BLOOD PRESSURE, GLUCOSE, CHOLESTEROL, HEMOGLOBIN, BONE DENSITY AND BODY COMPOSITION SCREENING AND PULMONARY FUNCTION TESTING. SOME OF OUR LARGER COMMUNITY EVENTS INCLUDE: THE JACKSON COUNTY APPLE FESTIVAL, JACKSON COUNTY FAIR, GENERAL MILLS EMPLOYEE HEALTH FAIR, ANNUAL BREAST CANCER AWARENESS HEALTH FAIR AND THE ANNUAL COMMUNITY HEART HEALTH FAIR. HOLZER MEDICAL CENTER-JACKSON ALSO HOSTS MONTHLY DIABETES EDUCATION MEETINGS AND FREE HEART SAVER CPR CLASSES ARE OFFERED TO VARIOUS GROUPS AND COMMUNITY MEMBERS. IN ADDITION TO PROVIDING HEALTH SCREENINGS IN THE COMMUNITY, THE COMMUNITY HEALTH AND WELLNESS STAFF ORGANIZE AND PRESENT EDUCATIONAL PRESENTATIONS ON A VARIETY OF HEALTH AND WELLNESS TOPICS FOR CIVIC GROUPS, SENIOR CITIZENS, BUSINESS GROUPS AND CHURCH ORGANIZATIONS. PART VI, LINE 6: HOLZER MEDICAL CENTER AND HOLZER MEDICAL CENTER-JACKSON COMPRISE THE TWO HOSPITALS IN THE SYSTEM, WITH HOLZER MEDICAL CENTER-JACKSON ACCOUNTING FOR 18% OF HOSPITAL ADMISSIONS. HOLZER MEDICAL CENTER IS LOCATED IN GALLIA COUNTY AND HOLZER MEDICAL CENTER-JACKSON IS LOCATED IN JACKSON COUNTY. ALL HEALTH SCREENING AND PATIENT EDUCATION IS PROVIDED BY STAFF IN AREAS WITHIN OUR PRIMARY SERVICE AREA WHICH INCLUDES GALLIA, JACKSON AND MEIGS COUNTIES IN OHIO AND MASON COUNTY, WEST VIRGINIA AS WELL AS SOME SERVICES PROVIDED IN OUR SECONDARY SERVICE AREA. 1 0 0 0 0 0 0 0 0 BRENT SAUNDERS TRUSTEE 0 400203 0 0 0 0 0 27975 0 0 0 428178 0 0 CHRISTOPHER MEYER CEO - HHS 0 420724 0 0 0 0 0 0 0 0 0 420724 0 0 WAYNE MUNRO CEO - HHS THROUGH 12/31/14 0 590452 0 0 0 0 0 0 0 0 0 590452 0 0 RHONDA L DAILEY VP PATIENT CARE 175405 0 0 0 0 0 12947 0 0 0 188352 0 0 0 SAMIA Y KANOOZ PHYSICIAN 200222 0 0 0 0 0 7860 0 0 0 208082 0 0 0 PAUL J ESSMAN DENTIST 159416 0 0 0 0 0 11627 0 0 0 171043 0 0 0 KENNETH G PAYNE CFO - HHS THROUGH 3/31/14 0 143218 0 0 0 203019 0 24115 0 3561 0 373913 0 0 PART I, LINE 3 COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION, HOLZER HEALTH SYSTEM, AND INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A DURING THE CALENDAR YEAR 2014, FORMER OFFICER KENNETH G. PAYNE RECEIVED A LUMP SUM OF $203,019 OF SEVERANCE PAY. FORM 990, PART VI, SECTION A, LINE 6 HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B HOLZER MEDICAL CENTER - JACKSON'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY HOLZER HEALTH SYSTEM'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE CONTROLLER AND THE CFO OF HOLZER HEALTH SYSTEM REVIEW FORM 990. A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING MARCH 2015. 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 VII, SECTION A: HOLZER HEALTH SYSTEM PAYS BERKELEY RESEARCH GROUP, LLC FOR CFO SERVICES BY DAN JANICAK. THE CONTRACT WITH THE MANAGEMENT COMPANY IS $35,000 PER MONTH STARTING MAY 2014. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATE -6,760. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -882. FORM 990, PART XII, LINE 2C: THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. HOLZER HEALTH SYSTEM 100 JACKSON PIKE GALLIPOLIS OH 45631 311156690 MANAGEMENT SERVICES OH 501(C)(3) LINE 11A, I N/A 0 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 9 HOLZER HEALTH SYSTEM 0 HOLZER FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 7 HOLZER HEALTH SYSTEM 0 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 0 HOLZER VANGUARD INC AND AFFILIATES 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 0 0