2016-02-03T15:25:12-06:00 2014-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2013-07-01 314379491 HOLZER HOSPITAL FOUNDATION HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 DAN JANICAK CFO 7404465060 2016-02-03 1 BERNIE OSTROWSKI P00366367 6148493000 2013 2016-04-25 22:37:26Z X SEE SCHEDULE O WAYNE MUNRO MD 100 JACKSON PIKE GALLIPOLIS OH 45631 154388987 0 X WWW.HOLZER.ORG X 1910 OH TO ENCOURAGE WELLNESS AND STRIVE TO IMPROVE THE HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. 16 2 1486 30 28748 -9078 268158 1525 136283240 152937374 124722 106574 4069534 1300114 140745654 154345587 21526 0 0 0 48069567 58799734 0 0 0 80560216 72237211 128651309 131036945 12094345 23308642 104179192 105476713 33305526 43128746 70873666 62347967 X TO ADVANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE 0 0 107073164 0 153012433 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. THE HOSPITAL OPERATES HOLZER HOSPICE.CONTINUING EDUCATION, CERTIFICATION PROGRAMS, AND INFORMATIONAL SEMINARS ARE CONDUCTED FOR BOTH HOSPITAL AND MEDICAL STAFF. HEALTH FAIRS ARE CONDUCTED AT NO CHARGE. ADDITIONALLY, THE HOSPITAL'S MOBILE UNIT IS TAKEN TO COMMUNITY EVENTS TO PERFORM FREE SCREENINGS, AND DISPENSE EDUCATIONAL MATERIALS. HOSPITAL STAFF ALSO RESPONDS TO REQUESTS FROM EMPLOYERS AND COMMUNITY GROUPS, ALONG WITH SENIOR CITIZEN CENTERS, FOR SCREENINGS AND INFORMATIONAL PROGRAMS. EDUCATIONAL SUPPORT GROUPS, SUCH AS DIABETES AND CANCER, AND AN EDUCATIONAL GROUP MEETING FOR STROKES, ARE SPONSORED BY THE HOSPITAL. 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, HEMOGLOBIN, PULSE OXIMETRY, PROSTATE CHECKS, BONE DENSITY, AND TUMOR REGISTRY. THE PEDIATRIC UNIT WORKS IN CONJUNCTION WITH THE GALLIA COUNTY HEALTH DEPARTMENT IN PROMOTING FREE IMMUNIZATIONS. THE HOSPITAL ALSO PROVIDES EDUCATIONAL PROGRAMS AND SCREENINGS, AND DISCOUNTS AT THE HOSPITAL'S GIFT SHOP, CAFETERIA, AND PHARMACY IN CONJUNCTION WITH ITS MAXWELL 50 PROGRAM. 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. 107073164 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 1 1 0 0 1 49 0 1 1486 0 0 0 0 0 0 1 1 0 0 0 0 X 16 2 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X DAN JANICAK CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 THOMAS TOPE TRUSTEE 1.00 0.00 X 0 0 0 ALAN STOCKMEISTER VICE CHAIR 1.00 3.00 X X 0 18000 0 SUZANNE MIZE MD TRUSTEE 1.00 0.00 X 0 0 0 BRENT SAUNDERS CHAIRMAN OF HHS BOARD 1.00 39.00 X X 239077 187231 40567 STEVE CHAPMAN CPA CHAIRMAN 1.00 3.00 X X 0 18000 0 LARRY KIDD TREASURER 1.00 3.00 X X 0 18000 0 DANNY HOLSCHUH TRUSTEE 1.00 2.00 X 0 18000 0 PAUL REED TRUSTEE 1.00 3.00 X 0 18000 0 GARY ROACH SECRETARY 1.00 3.00 X X 0 18000 0 BASHAR ATAI MD TRUSTEE 1.00 0.00 X 0 323483 0 WAYNE MUNRO MD CEO- HHS 36.00 4.00 X X 0 609876 0 KENNETH G PAYNE CFO- HHS 7/1/13-3/31/14 36.00 4.00 X X 167706 167192 37712 LOIS BOSLEY TRUSTEE 39.00 1.00 X 0 155776 0 BOB GRILLO TRUSTEE 1.00 2.00 X 0 18000 0 RENUKA KANDULA TRUSTEE 1.00 39.00 X 0 416570 0 CHRISTOPHER MEYER MD TRUSTEE 1.00 39.00 X 0 442488 0 GREG MICKUNAS TRUSTEE 1.00 39.00 X 0 383105 0 BRAD MUNN TRUSTEE 1.00 2.00 X 0 18000 0 RYAN SMITH TRUSTEE 1.00 2.00 X 0 0 0 RODNEY STOUT MD TRUSTEE 1.00 39.00 X 0 189948 0 DR JON SULLIVAN TRUSTEE 1.00 39.00 X 0 306986 0 ARTURO ROA TRUSTEE 1.00 39.00 X 0 938047 0 JARED SHEETS TRUSTEE 1.00 39.00 X 0 265616 0 PATRICK CONNORS TRUSTEE 36.00 4.00 X 0 345991 0 JOHN CUNNINGHAM TRUSTEE 36.00 4.00 X 0 295572 0 JIM PHILLIPPE TRUSTEE 36.00 4.00 X 169057 144462 31300 DAN JANICAK CFO- HHS 4/1/14-CURRENT 36.00 4.00 X 0 0 0 BARBARA CAMPFIELD TRUSTEE 36.00 4.00 X 0 0 0 SHANE E EPHLIN PHARMACIST 40.00 0.00 X 152303 0 35647 ELAINE K BROWN PHARMACIST 40.00 0.00 X 150246 0 12996 JILL D STRAUCH PHARMACIST 40.00 0.00 X 148425 0 18935 CHARLES T MEADOWS PHARMACIST 40.00 0.00 X 146388 0 14639 TERRY J SPURLIN PHARMACIST 40.00 0.00 X 141972 0 23545 1315174 5316343 215341 26 0 1 0 ALTERNATE SOLUTIONS HEALTHCARE SYSTEM 1251 EAST DOROTHY LANE KETTERING OH 45419 HOME CARE MANAGEMENT 791637 GEIGER BROTHERS PO BOX 469 JACKSON OH 45640 CONTRACTORS 737012 TRIDENT 1022 MAIN STREET DUNEDIN FL 34698 CATH LAB OUTSIDE SERVICES 384117 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 19182 COMPLIANCE SERVICES 373485 RADON MEDICAL IMAGING CORPORATION WV 3254 US ROUTE 60 E ONA WV 25545 MEDICAL IMAGING 287262 13 1525 1525 NET PATIENT SERVICES 622110 151043276 151043276 HCAP 622110 1649118 1649118 LIFELINE INCOME 622110 244980 244980 152937374 73172 73172 111585 43400 68185 68185 68185 31902 1500 0 0 31902 1500 33402 33402 CAFETERIA SALES 722320 880979 28748 852231 LAUNDRY INCOME 812300 159784 159784 GIFT SHOP SALES 900099 116107 116107 75059 75059 1231929 154345587 153012433 28748 1302881 X 43311498 34172772 9138726 2712694 2140316 572378 8854374 6986101 1868273 3921168 3093802 827366 167500 167500 12462 12462 227620 227620 16584681 7352731 9231950 5681412 5496880 184532 1436197 1126840 309357 1994461 1795015 199446 703227 551752 151475 558559 502703 55856 9365688 8429119 936569 802710 722439 80271 MEDICAL SUPPLIES 21197540 21197540 BAD DEBTS 9395485 9395485 HOLZER CARDIAC LLC 2319635 2319635 FRANCHISE FEE 1602851 1602851 187183 187183 131036945 107073164 23963781 0 105776 125090 10640195 12111736 15712402 22163367 8985606 -570415 2312009 6971519 1333199 824932 176926763 136713511 35284791 40213252 7082210 7120700 22723004 16516532 104179192 105476713 20903246 29084402 2016233 2016233 8600626 11662424 1785421 365687 33305526 43128746 X 70792234 62293987 81432 53980 70873666 62347967 104179192 105476713 X 23308642 78503 -31912844 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1186 1186 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION RELATES TO LOBBYING. 451456 451456 40029356 28074664 11954692 132776698 105427648 27349050 3669253 3211199 458054 40213252 OTHER ASSETS 1347176 RELATED PARTY RECEIVABLES 15169356 16516532 COST REPORT SETTLEMENTS 296726 RELATED PARTY PAYABLE 68961 365687 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, 2014, 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 2011. 1 1 X 1 X 1 X 1 1 1 0 0 2759914 1649118 1110796 0.00910 23135493 18630200 4505293 0.03700 25895407 20279318 5616089 0.04610 25895407 20279318 5616089 0.04610 0 9395485 469774 40744542 44597146 -3852604 X 1 1 1 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 X X X HOLZER HOSPITAL FOUNDATION 1 1 X X X X X X X X X 13 1 1 1 X HTTP://WWW.HOLZER.ORG/CHNA/ X X X X X X 0 0 1 1 100.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 HOLZER HOSPITAL FOUNDATION PART V, SECTION B, LINE 3: 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 HOSPITAL FOUNDATION PART V, SECTION B, LINE 4: HOLZER MEDICAL CENTER JACKSON HOLZER HOSPITAL FOUNDATION PART V, SECTION B, LINE 7: HOLZER HOSPITAL FOUNDATION DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA BECAUSE OF LIMITED FINANCIAL RESOURCES. THE IMPLEMENTATION STRATEGY IS POSTED ON THE ORGANIZATION'S WEBSITE: HTTP://WWW.HOLZER.ORG/CHNA/ 3 PHYSICIAN'S OFFICE - DR TIMOTHY DAMRON 2881 SR 160 GALLIPOLIS OH 45631 GENERAL MEDICAL AND SURGICAL PHYSICIAN'S OFFICE - DR LINDA ALSTON 2881 SR 160 GALLIPOLIS OH 45631 GENERAL MEDICAL AND SURGICAL MEDICAL PLAZA 100 JACKSON PIKE GALLIPOLIS OH 45631 GENERAL MEDICAL AND SURGICAL PART I, LINE 7: EXPENSES WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2. PART I, LN 7 COL(F): BAD DEBT OF $9,395,485 FROM PART IX OF FORM 990 WAS EXCLUDED FROM THE TOTAL EXPENSES IN THIS CALCULATION. 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 AT COST WAS CALCULATED BASED ON THE AUDITED FINANCIAL STATEMENTS BALANCE. NONE OF THE BAD DEBT AT COST 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. MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. 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: THE PRIMARY SERVICE AREA FOR HOLZER HOSPITAL FOUNDATION IS COMPRISED OF THE FOUR-COUNTRY AREA OF GALLIA, JACKSON, AND MEIGS COUNTIES IN OHIO, AND MASON COUNTY IN WEST VIRGINIA. THE SECONDARY SERVICE AREA INCLUDES PARTS OF VINTON, LAWRENCE, ATHENS, AND SCIOTO COUNTIES IN OHIO, AND JACKSON COUNTY IN WEST VIRGINIA. PART VI, LINE 5: HOLZER MEDICAL CENTER 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 ORGANIZES AND PROVIDES HEALTH SCREENINGS 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, BONE DENSITY AND BODY COMPOSITION SCREENINGS. SOME OF OUR LARGER COMMUNITY EVENTS INCLUDE: GALLIA COUNTY FAIR, MEIGS COUNTY FAIR, MASON COUNTY FAIR, BUCKEYE RURAL ELECTRIC EMPLOYEE HEALTH FAIR, BUCKEYE RURAL ELECTRIC ANNUAL MEETING AND HOLZER CENTER FOR CANCER FAIR. HOLZER MEDICAL CENTER ALSO HOSTS A MONTHLY DIABETES EDUCATION MEETING, MS SUPPORT GROUP, CANCER SUPPORT GROUP AND PROVIDES HEALTH SCREENING TO SENIOR CITIZENS IN OUR SERVICE AREA AND SPEAKERS THROUGHOUT THE YEAR TO DISCUSS VARIOUS MEDICAL TOPICS TO COMMUNITY GROUPS. ALONG WITH THESE NO-COST SCREENINGS, THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT PROVIDES EDUCATIONAL INFORMATION TO LOCAL ORGANIZATIONS TO PROMOTE HEALTH AND WELLNESS FOR THEIR EMPLOYEES. PART VI, LINE 6: HOLZER MEDICAL CENTER AND HOLZER MEDICAL CENTER-JACKSON COMPRISE THE TWO HOSPITALS IN THE SYSTEM, WITH HOLZER MEDICAL CENTER ACCOUNTING FOR 82% OF HOSPITAL ADMISSIONS. HOLZER MEDICAL CENTER IS LOCATED IN GALLIA COUNTY AND HOLZER MEDICAL CENTER-JACKSON IS LOCATED IN JACKSON COUNTY. ALL HEALTH SCREENINGS 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. 0 0 0 0 0 0 0 0 0 BRENT SAUNDERS CHAIRMAN OF HHS BOARD 239077 187231 0 0 0 0 21844 18723 0 0 260921 205954 0 0 BASHAR ATAI MD TRUSTEE 0 323483 0 0 0 0 0 0 0 0 0 323483 0 0 WAYNE MUNRO MD CEO- HHS 0 609876 0 0 0 0 0 0 0 0 0 609876 0 0 KENNETH G PAYNE CFO- HHS 7/1/13-3/31/14 167706 167192 0 0 0 0 16719 16719 0 4274 184425 188185 0 0 LOIS BOSLEY TRUSTEE 0 155776 0 0 0 0 0 0 0 0 0 155776 0 0 RENUKA KANDULA TRUSTEE 0 416570 0 0 0 0 0 0 0 0 0 416570 0 0 CHRISTOPHER MEYER MD TRUSTEE 0 442488 0 0 0 0 0 0 0 0 0 442488 0 0 GREG MICKUNAS TRUSTEE 0 383105 0 0 0 0 0 0 0 0 0 383105 0 0 RODNEY STOUT MD TRUSTEE 0 189948 0 0 0 0 0 0 0 0 0 189948 0 0 DR JON SULLIVAN TRUSTEE 0 306986 0 0 0 0 0 0 0 0 0 306986 0 0 ARTURO ROA TRUSTEE 0 938047 0 0 0 0 0 0 0 0 0 938047 0 0 JARED SHEETS TRUSTEE 0 265616 0 0 0 0 0 0 0 0 0 265616 0 0 PATRICK CONNORS TRUSTEE 0 345991 0 0 0 0 0 0 0 0 0 345991 0 0 JOHN CUNNINGHAM TRUSTEE 0 295572 0 0 0 0 0 0 0 0 0 295572 0 0 JIM PHILLIPPE TRUSTEE 169057 144462 0 0 0 0 16854 14446 0 0 185911 158908 0 0 SHANE E EPHLIN PHARMACIST 152303 0 0 0 0 0 15230 0 20417 0 187950 0 0 0 ELAINE K BROWN PHARMACIST 150246 0 0 0 0 0 8722 0 4274 0 163242 0 0 0 JILL D STRAUCH PHARMACIST 148425 0 0 0 0 0 18935 0 0 0 167360 0 0 0 CHARLES T MEADOWS PHARMACIST 146388 0 0 0 0 0 14639 0 0 0 161027 0 0 0 TERRY J SPURLIN PHARMACIST 141972 0 0 0 0 0 14197 0 9348 0 165517 0 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, A WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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 HOSPITAL FOUNDATION 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 2014. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL DEPARTMENTAL CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,682,855. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,682,855. ADMINISTRATIVE AND PATIENT RECORDS/CARE CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 566,304. MANAGEMENT AND GENERAL EXPENSES 9,231,950. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,798,254. PHARMACY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 478,303. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 478,303. LABORATORY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,625,269. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,625,269. FORM 990, PART XI, LINE 9: INTERCOMPNAY TRANS (RENT,SVCS,FEES) PART IX NOT RECORDED ON FINANCIAL -31,885,392. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -27,452. FORM 990, PART XI, LINE 2C: THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PAGE 1, PART C: DOING BUSINESS AS: HOLZER MEDICAL CENTER HOLZER MEDICAL CENTER - GALLIPOLIS EXPLANATION OF CHANGES - REASON FOR FILING AMENDED RETURN: THE 2013 FORM 990 WAS ORIGINALLY FILED BY ATTACHING THE AUDITED FINANCIAL STATEMENTS FOR THE FYE 6-30-13 BECAUSE ISSUANCE OF THE AUDITED FINANCIAL STATEMENTS FOR FYE 6-30-14 DID NOT OCCUR UNTIL AFTER THE EXTENDED FILING DUE DATE. THE 2013 FORM 990 IS BEING AMENDED TO INCLUDE A COPY OF THE FINALIZED AUDITED FINANCIAL STATEMENTS FOR FYE 6-30-14. NO CHANGES HAVE BEEN TO THE FINANCIAL STATEMENTS THAT WOULD REQUIRE ADJUSTMENTS TO BE MADE TO ANY PARTS OF THE FORM 990 OR ITS RELATED SCHEDULES. HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 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 1 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 1 HOLZER VANGUARD 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH N/A C 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 0 1 HOLZER HEALTH SYSTEM K 6655400 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM J 108176 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM L 40630125 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM N 3256609 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM Q 1737640 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM P 532989 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM R 131746 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM J 427312 ACCRUAL TRANSACTION