2015-11-11T14:29:48-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-01-01 311480941 GENESIS HEALTHCARE SYSTEM GENE 7404545000 2951 MAPLE AVENUE ZANESVILLE OH 43701 PAUL MASTERSON CFO 7404545000 2015-11-09 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-02-25 16:41:14Z MATTHEW PERRY 2951 MAPLE AVENUE ZANESVILLE OH 43701 372943982 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. 16 11 3210 421 805387 -183264 370113 430648 338078219 351432224 6550579 6490416 14167794 13692700 359166705 372045988 110000 40000 0 0 156097798 156741016 0 0 0 183236127 176700456 339443925 333481472 19722780 38564516 542428772 547383164 379542394 391911824 162886378 155471340 X TO PROMOTE CHARITABLE SUPPORT FOR GENESIS HEALTHCARE SYSTEM AS WE SHARE ITS MISSION TO PROVIDE COMPASSIONATE, QUALITY HEALTHCARE. 0 0 175521152 40000 141696674 GENESIS PROVIDES ACUTE CARE SERVICES INCLUDING MEDICAL, SURGICAL, OBSTETRICAL, PEDIATRIC AND CRITICAL CARE. THE MEDICAL/SURGICAL UNITS ARE STAFFED AT BOTH CAMPUSES FOR A COMBINED TOTAL OF 136 BEDS. TOTAL PATIENTS DISCHARGED FROM THESE UNITS IN 2014 WERE 7,838. OBSTETRICS STAFFS A TOTAL OF 24 BEDS AT THE BETHESDA CAMPUS AND DISCHARGED 1,551 PATIENTS FOR A TOTAL OF 1,527 BIRTHS. THE PEDIATRIC UNIT IS LOCATED AT THE BETHESDA CAMPUS WITH 4 BEDS AND HAD 277 DISCHARGES IN 2014. THERE ARE 21 CRITICAL CARE BEDS BETWEEN THE TWO CAMPUSES AND DISCHARGED 371 PATIENTS DURING THE YEAR AND 25 CARDIOVASCULAR BEDS IN A UNIT LOCATED ON THE GOOD SAMARITAN CAMPUS WITH 1,424 DISCHARGES IN 2014. THERE IS ALSO A CANCER UNIT ON THE GOOD SAMARITAN CAMPUS WITH 15 BEDS AND 834 DISCHARGES IN 2014 AND AN ORTHOPAEDIC UNIT WITH 6 BEDS AND 559 DISCHARGES IN 2014.GENESIS PROVIDES A WIDE RANGE OF DIAGNOSTIC AND SUPPORT SERVICES ON BOTH CAMPUSES 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 2014 OF 1,455,221. IMAGING SERVICES INCLUDES RADIOLOGY, NUCLEAR MEDICINE, MRI, ULTRASOUND, CT SCAN, AND PET SCAN WITH TOTAL VOLUMES OF 166,300. PHARMACY PRESCRIPTIONS TOTALED 7,743,381. 39969631 0 117178630 CARDIAC SERVICES - GENESIS PROVIDES CARDIAC, THORACIC, AND VASCULAR SERVICES INCLUDING AN OPEN-HEART SURGERY PROGRAM. THE MOST COMMON OPEN-HEART SURGERY PERFORMED AT GENESIS IS CORONARY ARTERY BYPASS GRAFTING. HOWEVER, OUR BOARD-CERTIFIED SURGEONS PERFORM SEVERAL HEART, LUNG AND VASCULAR SURGICAL PROCEDURES. GENESIS IS SOUTHEASTERN OHIO'S ONLY ACCREDITED CHEST PAIN CENTER ENCOMPASSING NOT ONLY SURGERY BUT ALSO INTERVENTIONAL CARDIOLOGY, ELECTROPHYSIOLOGY, DIAGNOSTIC SERVICES, AND HEART AND VASCULAR REHABILITATION. THE TOTAL NUMBER OF CARDIAC CASES TREATED IN 2014 WERE 2,609. 18005901 0 52787747 RESPIRATORY SERVICES - GENESIS TREATS A LARGE VOLUME OF RESPIRATORY CASES ON INPATIENT BASIS. THIS INCLUDES PATIENTS WITH CHRONIC LUNG DISEASE AS WELL AS PNEUMONIA PATIENTS. THE TOTAL NUMBER OF INPATIENT RESPIRATORY CASES TREATED IN 2014 WERE 2,152. 15437855 0 45259030 ORTHOPEDIC SERVICES - THE GENESIS ORTHOPEDIC DEDICATED TEAM OFFERS SERVICES RANGING FROM DIAGNOSTIC IMAGING SERVICES TO TOTAL JOINT REPLACEMENT BY PROVIDING STELLAR SURGICAL PROCEDURES, PAIN MANAGEMENT, A PHYSICAL REHABILITATION PROGRAM AND SPORTS MEDICINE SERVICES. THE MOST COMMON ORTHOPEDIC SURGERIES PERFORMED AT GENESIS ARE HIP AND KNEE REPLACEMENTS, ARTHROSCOPIC SURGERY AND ACL SURGERY AS WELL AS ROTATOR CUFF AND CARPAL TUNNEL. IN 2014, A NEW ORTHOPEDIC PROGRAM WAS STARTED TO ENSURE EMERGENCY ORTHOPEDIC CARE IS AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. THE TOTAL NUMBER OF ORTHOPEDIC INPATIENT CASES TREATED IN 2014 WERE 1,160.GRANTS WERE PAID TO GENESIS HEALTHCARE FOUNDATION TO HELP FURTHER THE RELATED TAX-EXEMPT ORGANIZATION'S PURPOSE. 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 2014 WERE 1,623. 15437855 0 45259030 248934539 1 1 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 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 318 0 1 3210 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 16 11 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 OH X MARTI NASH 7404545000 2951 MAPLE AVENUE ZANESVILLE OH 43701 WALTER OFFINGER VICE CHAIR 2.50 0.00 X X 0 0 0 JODY BALLAS CHAIR 3.60 0.00 X X 0 0 0 JERRY NOLDER TREASURER 3.20 0.00 X X 0 0 0 MARK MOYER TRUSTEE 2.80 0.00 X 0 0 0 SR LAURA WOLF EX-OFFICIO 2.70 0.20 X 0 0 0 RANDY COCHRANE SECRETARY 2.10 0.40 X X 0 0 0 THOMAS DIEHL MD TRUSTEE 3.10 36.90 X 0 423534 21096 ROBERT KESSLER TRUSTEE 3.30 0.00 X 0 0 0 JAMES MCDONALD EX-OFFICIO 2.70 0.40 X 0 0 0 ERIN WELCH TRUSTEE 1.20 0.00 X 0 0 0 WALTER WIELKIEWICZ MD TRUSTEE 1.60 38.40 X 0 213281 35137 MAX CROWN TRUSTEE 1.20 0.00 X 0 0 0 SHANE BACKUS MD TRUSTEE 2.10 0.00 X 0 0 0 JOHN DITTOE TREASURER 1.60 0.00 X 0 0 0 SR MARY ANN NUGENT TRUSTEE 1.60 0.20 X 0 0 0 WILLIAM SHADE MD TRUSTEE 2.80 0.00 X 0 0 0 MATTHEW PERRY PRESIDENT & CEO 37.70 2.30 X 642047 0 95667 PAUL MASTERSON CHIEF FINANCIAL OFFICER 37.60 2.40 X 371959 0 62896 EDMOND ROMITO CHIEF INFOR OFFICER 40.00 0.00 X 281478 0 116170 ALAN BURNS CHIEF DEVELOPMENT OFFICER 39.90 0.10 X 320973 0 43703 REGINA PENNINGTON CHIEF QUALITY OFFICER 39.90 0.10 X 218211 0 35076 DANIEL SCHEERER MD CHIEF MEDICAL AFFAIRS OFFI 40.00 0.00 X 381132 0 207175 ABBY NGUYEN DIRECTOR OF NURSING AND CL 39.50 0.50 X 223507 0 28412 DIANNA LEVECK DIRECTOR OF HUMAN RESOURCE 40.00 0.00 X 227657 0 22056 WENDY CEDOZ CHIEF LEGAL OFFICER 40.00 0.00 X 221654 0 23672 CHARLES ADAMS JR DIRECTOR OF LEAN SIGMA 40.00 0.00 X 154741 0 16546 RAY RYMAN CLINICAL PHARMACIST 40.00 0.00 X 138079 0 18945 GREGORY PETE HAMILTON DIRECTOR OF PHARMACY SERVI 40.00 0.00 X 136534 0 28554 SHARON PARKER DIRECTOR OF CANCER SERVICE 40.00 0.00 X 147964 0 18618 LES BOYER DIRECTOR 40.00 0.00 X 146587 0 16958 RICHARD HELSPER CHIEF OPER OFFICER 40.00 0.00 X 233572 0 1166 KAREN GREEN FORMER EMPLOYEE 40.00 0.00 X 138930 0 4358 3985025 636815 796205 54 1 1 0 DMK DEVELOPMENT GROUP LLC 9200 SHELBYVILLE ROAD LOUISVILLE KY 40222 REAL ESTATE DEVELOPERS 4526092 ZANESVILLE ANESTHESIA PHYSICIANS INC 37 S SEVENTH ST ZANESVILLE OH 43701 MEDICAL SERVICES 4147236 ADVIZEX TECHNOLOGIES LLC 860 BETHESDA DR ZANESVILLE OH 43701 MEDICAL SERVICES 3827840 CARDIAC ANESTHESIA ASSOC 800 FOREST AVE ZANESVILLE OH 43701 MEDICAL SERVICES 1642441 BRICKER & ECKLER LLP 500 CHIPETA WAY SALT LAKE CITY UT 84108 MEDICAL SERVICES 950428 45 311972 118676 430648 NET PATIENT SERVICES 621110 350764778 350764778 PASSTHROUGH INCOME 621110 667446 667446 351432224 5705886 5705886 910300 897994 12306 12306 12306 784530 0 784530 784530 784530 CAFETERIA SALES 621110 3227709 98260 3129449 EHR TECHNOLOGY INCOME 621110 2065998 2065998 OCCUPATIONAL HEALTH 621110 1460701 1460701 6925986 1950852 707127 4268007 13680394 372045988 356922081 805387 13887872 40000 40000 117474357 81466650 36007707 5859979 4063805 1796174 24983347 17325565 7657782 8423333 5841451 2581882 1921688 1428458 493230 991111 200 990911 487858 487858 29077359 14638655 14438704 192342 192342 11262737 5095647 6167090 6741831 1082594 5659237 5171248 3454394 1716854 762243 254443 507800 2456134 2456134 22146644 20005846 2140798 -1053727 -1073946 20219 MEDICAL SUPPLIES 64871402 64871402 BAD DEBT EXPENSE 19112330 19112330 PHYSICIAN RECRUITMENT 2828946 2828946 LAB REFERENCE FEES 1299092 1299092 8431218 4550531 3880687 333481472 248934539 84546933 0 6647860 5078691 5111085 19706108 856733 12083 59913257 64611351 5138075 5570466 10874232 6574865 495485727 228514714 145724442 266971013 78459192 75979914 13443621 10007852 1703129 6109176 214557146 86761645 542428772 547383164 42006589 45571099 6865423 6027933 301754826 301145952 28915556 39166840 379542394 391911824 X 162886378 155471340 162886378 155471340 542428772 547383164 X 38564516 -1921756 -44057798 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 161182 0 1 26596 187778 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. FSCC HEALTHCARE MINISTRY (FOR CHA): 2.98% OF $15,196 ($453) CATHOLIC CONFERENCE OF OHIO: 3.4% OF $2,060 ($70) OHIO HOSPITAL ASSOCIATION - FSCC SHARE (OHA): 3.4% OF $72,437 ($2,463) AMERICAN HOSPITAL ASSOCIATION - FSCC SHARE (AHA): 22.8% OF $52,087 ($11,876) AMERICAN ACADEMY OF SLEEP MEDICINE (AASM): 2.0% OF $1,350 ($27) AMERICAN COLLEGE OF RADIATION ONCOLOGY (ACRO): 2.0% OF $530 ($11) AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION (AHIMA): 5.0% OF $710 ($36) AMERICAN HOSPITAL ASSOCIATION (AHA): 22.8% OF $400 ($91) AMERICAN ORGANIZATION OF NURSE EXECUTIVE (AONE): 10.0% OF $220 ($22) ASSOCIATION OF COMMUNITY CANCER CENTERS (ACCC): 3.0% OF $1,150 ($35) CLINICAL LABORATORY MANAGEMENT ASSOCIATION (CLMA): 15.0% OF $195 ($29) HEALTHCARE INFORMATION & MANAGEMENT SYSTEMS SOCIETY (HIMSS): 4.01% OF $3,175 ($127) MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA): 20.0% OF $1,140 ($228) NATIONAL QUALITY FORUM: 7.71% OF $3,938 ($304) SOCIETY OF DIAGNOSTIC MEDICAL SONOGRAPHY (SDMS): 12.5% OF $160 ($20) SOCIETY FOR HUMAN RESOURCE MANAGEMENT (SHRM): 6.0% OF $190 ($11) SOCIETY OF THORACIC SURGEONS (STS): 20.0% OF $3,200 ($640) SOCIETY OF VASCULAR ULTRASOUND (SVU): 20.0% OF $290 ($58) TRAUMA CENTER ASSOCIATION OF AMERICA (TCAA): 29.0% OF $2,000 ($580) ZANESVILLE - MUSKINGUM CO. CHAMBER OF COMMERCE: 10.0% OF $4,500 ($450) ZANESVILLE - MUSKINGUM CO. CHAMBER OF COMMERCE: 10.0% OF $2,083 ($208) COALITION TO PROTECT AMERICA'S HEALTH CARE (FSCC SHARE): 100.0% OF $8,000 ($8,000) NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION (NHPCO): 6.5% OF $6,498 ($422) OHIO HOSPICE AND PALLIATIVE CARE ORGANIZATION DBA MIDWEST CARE ALLIANCE: 6.7% OF 6,500 ($436) GENESIS HEALTHCARE SYSTEM PAID SECOND CAPITAL CONSULTING, LLC $161,182 IN 2014 FOR SERVICES RELATED TO GOVERNMENT RELATIONS INCLUDING OUTREACH AND ADVOCACY PRIMARILY AT THE STATE AND LOCAL LEVELS. ISSUES AT THE LOCAL LEVEL INCLUDED WORKING WITH CITY OFFICIALS REGARDING THE HOSPITAL CONSOLIDATION PROJECT AND PASSAGE OF A CITY ORDINANCE FOR WATER TAP FEES AND TRANSPORTATION INGRESS AND EGRESS FOR PATIENTS, FAMILIES, AND THE PUBLIC RELATED TO A SECOND ENTRANCE TO THE BETHESDA CAMPUS. STATE ISSUES INCLUDED MAINTAINING MEDICAID EXPANSION, TRANSPORTATION FUNDING AND MONITORING OF GENERAL HEALTHCARE RELATED ISSUES. FEDERALLY, THE ORGANIZATION WORKED PRIMARILY THROUGH NATIONAL HEALTHCARE ASSOCIATIONS IN WHICH IT MAINTAINED MEMBERSHIP AND COMMUNICATED WITH LOCAL CONGRESSIONAL DELEGATION REGARDING ISSUES OF PHARMACEUTICAL ACCESS FOR INDIGENT PATIENTS (340B PROGRAM) RAC AUDIT, APPEAL DELAYS AND SGR REFORM (DOC FIX). 7904309 7904309 53290265 45848356 7441909 4088831 1756652 2332179 426407737 177531379 248876358 3794585 3378327 416258 266971013 UNAMORTIZED BOND ISSUE COSTS 4640368 INVESTMENTS IN RELATED AND OTHER HEALTHCARE ORGANIZATIONS 4352134 ASSETS LIMITED AS TO USE 77769143 86761645 ACCRUED MINIMUM PENSION LIABILITY 37759145 ACCRUED PROFESSIONAL LIABILITY 1407695 39166840 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 TAX AUTHORITIES. MANAGEMENT HAS ANAYLZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014 AND 2013, 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 CURRENLTY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES THAT IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO FISCAL YEAR 2011. 1 1 X 1 X 1 X 1 1 0 1 1 0 0 8994987 8626077 368910 0.00120 0 0 71196349 55979324 15217025 0.04840 0 0 0 0 80191336 64605401 15585935 0.04960 10 22561 826970 29142 797828 0.00250 1 178 14306 0 14306 0.00000 0 0 952337 847243 105094 0.00030 0 0 0 0 0 0 0 0 11 22739 1793613 876385 917228 0.00280 11 22739 81984949 65481786 16503163 0.05240 0 19112330 2022132 95468273 93852694 1615579 X 1 1 2 1 GOOD SAMARITAN HOSPITAL 800 FOREST AVE ZANESVILLE OH 43701 X X X ACUTE CARE HOSPITAL 2 BETHESDA HOSPITAL 2951 MAPLE AVE ZANESVILLE OH 43701 X X X ACUTE CARE HOSPITAL GOOD SAMARITAN HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X HTTP://WWW.GENESISHCS.ORG 1 13 1 HTTP://WWW.GENESISHCS.ORG/ABOUT-US/NOT-FOR-PROFIT-STATUS/COMMUNITY-HEALTH-N 0 0 1 X 100.000000000000 300.000000000000 X X 1 1 X X X 1 X X X X X 1 X 0 X X 1 X 0 0 BETHESDA HOSPITAL 2 0 0 1 X X X X X X X X X 13 1 1 0 1 X HTTP://WWW.GENESISHCS.ORG 1 13 1 HTTP://WWW.GENESISHCS.ORG/ABOUT-US/NOT-FOR-PROFIT-STATUS/COMMUNITY-HEALTH-N 0 0 1 X 100.000000000000 300.000000000000 X X 1 1 X X X 1 X X X X X 1 X 0 X X 1 X 0 0 GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 11: DURING 2014, THE GOOD SAMARITAN HOSPITAL MADE SIGNIFICANT PROGRESS IN MEETING THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA. OF THE 13 NEEDS IDENTIFIED, CARDIAC DISEASE, SUBSTANCE ABUSE, TOBACCO USE, AND OBESITY RATE RANKED THE HIGHEST. TO ADDRESS THESE NEEDS, AN INCREASED NUMBER OF CARDIOVASCULAR SCREENING EVENTS AND COMMUNITY BASED EDUCATION PROJECTS WERE PERFORMED AND AED EQUIPMENT AND TRAINING DONATED. BEHAVIORAL HEALTH STAFF WORKED WITH VARIOUS AREA COALITIONS TO REDUCE SUBSTANCE ABUSE AND A GRANT FOR A RESIDENTIAL FACILITY FOR SUBSTANCE ABUSE RECOVERY FOR MEN WAS OBTAINED. A TOBACCO TASK FORCE THAT INCLUDES THE ZANESVILLE MUSKINGUM COUNTY HEALTH DEPARTMENT WAS DEVELOPED ALONG WITH TASK FORCE SUBGROUPS, THE TOBACCO FREE CAMPUS AND INPATIENT TOBACCO USE. A GENESIS TOBACCO TREATMENT PROGRAM OPENED JULY 1, 2014 TO THE ENTIRE COMMUNITY. GENESIS ALSO JOINED FORCES WITH THE HEALTH DEPARTMENT TO CREATE AN OBESITY TASK FORCE AND PROVIDED PROGRAMS TO THE COMMUNITY SUCH AS SHAPING FUTURES, FOCUSED ON ENGAGING YOUTH AND GRIP (GENESIS RISK INTERVENTION PROGRAM) WHICH FOCUSES ON HEALTHY LIFESTYLE CHANGES THROUGH DIET AND EXERCISE, AS WELL AS CONTRIBUTING TO THE CARE AND MAINTENANCE OF A COMMUNITY GARDEN THROUGH BOTH FINANCIAL ASSISTANCE AND PERSONNEL TIME.PROGRESS WAS ALSO REPORTED IN MEETING THE OTHER NEEDS IDENTIFIED IN THE ASSESSMENT EXCEPT FOR THAT RELATED TO SEPTICEMIA. THE PROJECT TO CARRYOUT THE IMPLEMENTATION STRATEGY FOR THIS HEALTH NEED WAS TEMPORARILY PLACED ON HOLD UNTIL A PHYSICIAN CHAMPION COULD BE IDENTIFIED. BETHESDA HOSPITAL PART V, SECTION B, LINE 11: DURING 2014, BETHESDA HOSPITAL MADE SIGNIFICANT PROGRESS IN MEETING THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2013 CHNA. OF THE 13 NEEDS IDENTIFIED, CARDIAC DISEASE, SUBSTANCE ABUSE, TOBACCO USE, AND OBESITY RATE RANKED THE HIGHEST. TO ADDRESS THESE NEEDS, AN INCREASED NUMBER OF CARDIOVASCULAR SCREENING EVENTS AND COMMUNITY BASED EDUCATION PROJECTS WERE PERFORMED AND AED EQUIPMENT AND TRAINING DONATED. BEHAVIORAL HEALTH STAFF WORKED WITH VARIOUS AREA COALITIONS TO REDUCE SUBSTANCE ABUSE AND A GRANT FOR A RESIDENTIAL FACILITY FOR SUBSTANCE ABUSE RECOVERY FOR MEN WAS OBTAINED. A TOBACCO TASK FORCE THAT INCLUDES THE ZANESVILLE MUSKINGUM COUNTY HEALTH DEPARTMENT WAS DEVELOPED ALONG WITH TASK FORCE SUBGROUPS, THE TOBACCO FREE CAMPUS AND INPATIENT TOBACCO USE. A GENESIS TOBACCO TREATMENT PROGRAM OPENED JULY 1, 2014 TO THE ENTIRE COMMUNITY. GENESIS ALSO JOINED FORCES WITH THE HEALTH DEPARTMENT TO CREATE AN OBESITY TASK FORCE AND PROVIDED PROGRAMS TO THE COMMUNITY SUCH AS SHAPING FUTURES, FOCUSED ON ENGAGING YOUTH AND GRIP (GENESIS RISK INTERVENTION PROGRAM) WHICH FOCUSES ON HEALTHY LIFESTYLE CHANGES THROUGH DIET AND EXERCISE, AS WELL AS CONTRIBUTING TO THE CARE AND MAINTENANCE OF A COMMUNITY GARDEN THROUGH BOTH FINANCIAL ASSISTANCE AND PERSONNEL TIME.PROGRESS WAS ALSO REPORTED IN MEETING THE OTHER NEEDS IDENTIFIED IN THE ASSESSMENT EXCEPT FOR THAT RELATED TO SEPTICEMIA. THE PROJECT TO CARRYOUT THE IMPLEMENTATION STRATEGY FOR THIS HEALTH NEED WAS TEMPORARILY PLACED ON HOLD UNTIL A PHYSICIAN CHAMPION COULD BE IDENTIFIED. GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 22D: FAP PATIENTS ARE PROVIDED A MINIMUM DISCOUNT OF 40%. THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. BETHESDA HOSPITAL PART V, SECTION B, LINE 22D: FAP PATIENTS ARE PROVIDED A MINIMUM DISCOUNT OF 40%. THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.GENESISHCS.ORG/PATIENTS-VISITORS/YOUR-GENESIS-BILL/ BETHESDA HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.GENESISHCS.ORG/PATIENTS-VISITORS/YOUR-GENESIS-BILL/ 9 HOSPICE & PALLIATIVE CARE 713 FOREST AVENUE ZANESVILLE OH 43701 HOSPICE & PALLIATIVE CARE CENTER RADIATION ONCOLOGY 817 FOREST AVENUE ZANESVILLE OH 43701 OUTPATIENT RADIATION TREATMENT CENTER CTR FOR OUTPATIENT & OCCUPATIONAL REHAB 740 ADAIR AVENUE ZANESVILLE OH 43701 OUTPATIENT REHAB SERVICES HEALTHPLEX 2800 MAPLE AVENUE ZANESVILLE OH 43701 OUTPATIENT LAB/IMAGING/URGENT CARE; COMPLIMENTARY MEDICINE; PEDIATRIC REHAB BETHESDA PHYSICIAN'S PAVILION 945 BETHESDA DRIVE ZANESVILLE OH 43701 OUTPATIENT CARDIAC REHAB SERVICES; WOUND CARE CENTER GENESIS BEHAVIORAL HEALTH 2991 MAPLE AVENUE ZANESVILLE OH 43701 MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT GENESIS INTERVENTIONAL PAIN MGT CLINIC 2945 MAPLE AVENUE ZANESVILLE OH 43701 PAIN MEDICINE SPECIALIZATION;IMAGING TECHNIQUES;SOLUTIONS TO PAIN MANAGEMENT GENESIS SLEEP DISORDERS CENTER 840 BETHESDA DRIVE ZANESVILLE OH 43701 DIAGNOSIS AND TREATMENT OF SLEEP DISORDERS GENESIS RHEUMATOLOGY CARE CENTER 2525 MAPLE AVENUE ZANESVILLE OH 43701 EDUCATION AND OUTPATIENT RHEUMATOLOGY 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 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 $ 19,112,330. 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 AND WELLNESS INITIATIVES. PART III, LINE 4: THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE WAS ESTIMATED BASED UPON BAD DEBT A/R RECLASSIFIED IN 2014 TO CHARITY WITH DISCHARGE DATES OF 2013 AND PRIOR. BAD DEBT COST IS CALCULATED USING GROSS CHARGES. 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: SELF-PAY ACCOUNTS RECEIVE ONE STATEMENT BEFORE GOING TO PRE-COLLECTION (APPROXIMATELY 30 DAYS). ALL ACCOUNTS ARE ELECTRONICALLY SCREENED FOR FAP ONCE AT PRE-COLLECT STATUS AND ADJUSTMENTS ARE POSTED ELECTRONICALLY BACK IN EPIC. ACCOUNTS STAY IN PRE-COLLECT FOR 90 DAYS UNLESS ACCOUNT HAS BEEN PAID OR REGULAR PAYMENT ARRANGEMENTS ARE ESTABLISHED. ACCOUNTS GO TO FULL COLLECTION AFTER DAY 120 IF NO PRIOR ARRANGEMENTS HAVE BEEN MADE. EACH OF THE COLLECTION AGENCIES IS INSTRUCTED TO MAKE PHONE CALLS AND SEND LETTERS. IF THEY CANNOT RESOLVE THE BALANCE, OR HAVE NOT BEEN ABLE TO MAKE PAYMENT ARRANGEMENTS, IT IS SENT BACK TO GENESIS AS NON-COLLECTIBLE IN 180 DAYS.COLLECTION PRACTICES DO NOT APPLY TO ACCOUNT BALANCES KNOWN TO QUALIFY FOR CHARITY. 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 DEPARTMENT, 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 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. 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 227,000, WITH MUSKINGUM COUNTY (85,000) REPRESENTING THE LARGEST COUNTY. MEDIAN HOUSEHOLD INCOME LEVELS RANGE FROM $7,000 TO $10,500 LOWER THAN THE STATE MEDIAN HOUSEHOLD INCOME AND $11,500 TO $15,000 LOWER THAN THE NATIONAL MEDIAN HOUSEHOLD INCOME. PEOPLE LIVING BELOW POVERTY LEVEL RANGES FROM 15.2% TO 20.3% IN THE REGION VERSUS 15.8% FOR STATE AND 15.4% 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, A COMMUNITY ADVISORY GROUP AND INTERNAL CLINICAL GROUP. GENESIS ALSO REGULARLY PROVIDES HEALTH AND WELLNESS EDUCATION THROUGH COMMUNITY-BASED HEALTH FAIRS HELD THROUGHOUT THE COMMUNITY. 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 3 0 PART I, LINE 2: THE UNITED WAY DONATION IS MONITORED THROUGH "METRICS AND DATA" REPORTED TO GHCS AND GHCD APPOINTS ONE "AT-LARGE MEMBER" ANNUALLY TO SERVE ON THE COMMUNITY IMPACT BOARD. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 THOMAS DIEHL MD TRUSTEE 0 302220 0 121314 0 0 0 5830 0 15266 0 444630 0 0 WALTER WIELKIEWICZ MD TRUSTEE 0 170446 0 42835 0 0 0 18500 0 16637 0 248418 0 0 MATTHEW PERRY PRESIDENT & CEO 642021 0 26 0 0 0 76634 0 19033 0 737714 0 0 0 PAUL MASTERSON CHIEF FINANCIAL OFFICER 371933 0 26 0 0 0 43568 0 19328 0 434855 0 0 0 EDMOND ROMITO CHIEF INFOR OFFICER 281452 0 26 0 0 0 99494 0 16676 0 397648 0 0 0 ALAN BURNS CHIEF DEVELOPMENT OFFICER 320947 0 26 0 0 0 28559 0 15144 0 364676 0 0 0 REGINA PENNINGTON CHIEF QUALITY OFFICER 218185 0 26 0 0 0 14248 0 20828 0 253287 0 0 0 DANIEL SCHEERER MD CHIEF MEDICAL AFFAIRS OFFI 280795 0 100337 0 0 0 190528 0 16647 0 588307 0 0 0 ABBY NGUYEN DIRECTOR OF NURSING AND CL 223481 0 26 0 0 0 6749 0 21663 0 251919 0 0 0 DIANNA LEVECK DIRECTOR OF HUMAN RESOURCE 227631 0 26 0 0 0 6851 0 15205 0 249713 0 0 0 WENDY CEDOZ CHIEF LEGAL OFFICER 221628 0 26 0 0 0 0 0 23672 0 245326 0 0 0 CHARLES ADAMS JR DIRECTOR OF LEAN SIGMA 129715 0 25026 0 0 0 1466 0 15080 0 171287 0 0 0 RAY RYMAN CLINICAL PHARMACIST 138053 0 26 0 0 0 2964 0 15981 0 157024 0 0 0 GREGORY PETE HAMILTON DIRECTOR OF PHARMACY SERVI 136508 0 26 0 0 0 8740 0 19814 0 165088 0 0 0 SHARON PARKER DIRECTOR OF CANCER SERVICE 147938 0 26 0 0 0 3900 0 14718 0 166582 0 0 0 LES BOYER DIRECTOR 146561 0 26 0 0 0 410 0 16548 0 163545 0 0 0 RICHARD HELSPER CHIEF OPER OFFICER 233572 0 0 0 0 0 0 0 1166 0 234738 0 0 0 KAREN GREEN FORMER EMPLOYEE 138930 0 0 0 0 0 3359 0 999 0 143288 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS COUNTRY CLUB DUES AND RELATED BUSINESS EXPENSES FOR SEVEN 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 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, $71,434 PAUL MASTERSON, $23,606 ALAN BURNS, $18,064 REGINA PENNINGTON, $14,248 EDMUND ROMITO, $91,694 DANIEL SCHEERER, MD, $186,766 A MUSKINGUM COUNTY OHIO 316400080 2013-05-09 294645952 SEE PART VI 0 0 0 A 294645952 18223718 27292801 46879891 4794175 198078495 108964 47131371 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 12/31/2014, 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 JOK COMPANY INC BOARD MEMBER, ROBERT KESSLER, IS A PARTNER OF JOK COMPANY, INC. 294334 LEASE PAYMENTS ON OFFICE SPACE 0 KESSLER SIGN COMPANY BOARD MEMBER, ROBERT KESSLER, IS A PARTNER OF KESSLER SIGN COMPANY, INC. 114343 LEASED SIGNAGE AND ADVERTISING SERVICES 0 RADIOLOGY ASSOCIATION OF SEO BOARD MEMBER, SHANE BACKUS, M.D., IS A PARTNER IN RADIOLOGY ASSOC. OF SEO 840381 PROFESSIONAL FEES AND PURCHASED SERVICES FROM GHCS & GMG, LLC 0 ZANDEX HEALTHCARE CORP BOARD MEMBER, WILLIAM SHADE M.D., IS A MEDICAL DIR. OF ZANDEX HEALTHCARE 267728 RENT AND PURCHASED SERVICES FROM GHCS & AFFILIATES 0 QUALITY CARE PARTNERS BOARD MEMBER, WILLIAM SHADE M.D., IS A PHYSICIAN OF QUALITY CARE PARTNERS 5151399 HEALTH INSURANCE AND ADMINISTRATIVE EXPENSES FOR GHCS, MEMBER FEES FOR GMG AND MANAGEMENT FEES FOR OICP 0 FORM 990, PART VI, SECTION A, LINE 3 THE MANAGEMENT OF PHYSICIAN OFFICE SPACE (PROPERTY MANAGEMENT) IS OUTSOURCED AND THE MANAGER REPORTS TO A VP OF THE HOSPITAL. THE LABOR BILLED WAS $47,868 AND THE MANAGEMENT FEE WAS $43,174. THE MANAGEMENT OF FOOD & NUTRITION AND PLANT OPERATION IS ALSO OUTSOURCED. THE DIRECTORS OF THESE AREAS ALSO REPORT TO A VP OF THE HOSPITAL. THERE WERE 3 MANAGERS PROVIDED AND 1 DIETICIAN. LABOR BILLED WAS $333,303 AND THE MANAGEMENT FEE WAS $66,348. THE MANAGEMENT OF ENVIRONMENTAL SERVICES & PATIENT TRANSPORT/SERVICE RESPONSE CENTER ARE ALSO OUTSOURCED. THE ENVIRONMENTAL SERVICES CONSISTED OF 2 MANAGERS. THE LABOR BILLED WAS $332,368 AND THE MANAGEMENT FEE WAS 37,114. FOR THE TRANSPORT SERVICES, THERE WERE 3 MANAGERS PROVIDED. THE LABOR BILLED WAS $190,519 AND THE MANAGEMENT FEE WAS $30,604. 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 11 THE 990 IS REVIEWED IN ITS ENTIRETY BY THE CFO. AN OVERVIEW OF THE 990 IS REVIEWED WITH THE EXECUTIVE COMMITTEE PRIOR TO FILING THE RETURN. 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 2014. 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: LOSS IN FAIR VALUE OF PERPETUAL TRUST -9,360,805. PLEDGE RECEIVABLE FROM RELATED PARTY -28,020,130. OHIO INTEGRATED CARE PROVIDERS, LLC -145,196. RESERVE FOR COSHOCTON COUNTY MEMORIAL -6,531,667. 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 VENTURE IN ADVANCE AND THE BOARD MUST APPROVE. CURRENTLY GENESIS HEALTHCARE SYSTEM IS INVOLVED IN ONE JOINT VENTURE, OF WHICH IT OWNS 50%. 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. ZANESVILLE SURGERY CENTER 2907 BELL STREET ZANESVILLE OH 43701 311620813 SURGICAL CENTER OH 0 0 GENESIS HEALTHCARE SYSTEM OHIO INTEGRATED CARE PROVIDERS LLC 2951 MAPLE AVE ZANSVILLE OH 43701 461795662 CLINICAL INTEGRATION OH -145196 34477 GENESIS HEALTHCARE SYSTEM GENESIS HEALTHCARE FOUNDATION 2951 MAPLE AVENUE ZANESVILLE OH 43701 311629304 FUNDRAISING FOR GHS OH 501(C)(3) 3 GENESIS HEALTHCARE SYSTEM 1 GOOD SAMARITAN MEDICAL CENTER FOUNDATION 2951 MAPLE AVENUE ZANESVILLE OH 43701 310969646 FUNDRAISING FOR GHS OH 501(C)(3) 3 GENESIS HEALTHCARE FOUNDATION 1 BETHESDA HOSPITAL FOUNDATION 2951 MAPLE AVENUE ZANESVILLE OH 43701 310885513 FUNDRAISING FOR GHS OH 501(C)(3) 3 GENESIS HEALTHCARE FOUNDATION 1 FRANCISCAN SISTERS OF CHRISTIAN CHARITY 2951 MAPLE AVENUE ZANESVILLE OH 43701 391530622 SPONSOR OF GHS WI 501(C)(3) 7 N/A 0 GOOD SAMARITAN MEDICAL CENTER 2951 MAPLE AVENUE ZANESVILLE OH 43701 314379479 MAINTAINS REAL ESTATE TITLE FOR HOSPITAL OH 501(C)(3) 3 GENESIS HEALTHCARE SYSTEM 1 BETHESDA CARE SYSTEM 2951 MAPLE AVENUE ZANESVILLE OH 43701 311067174 SPONSOR OF GHS OH 501(C)(3) 9 GENESIS HEALTHCARE SYSTEM 1 BETHESDA HOSPITAL ASSOCIATION 2951 MAPLE AVENUE ZANESVILLE OH 43701 314380038 MAINTAINS REAL ESTATE TITLE FOR HOSPITAL OH 501(C)(3) 11C GENESIS HEALTHCARE SYSTEM 1 ALTERNACARE 2951 MAPLE AVENUE ZANESVILLE OH 43701 311487187 STERILIZATIONS OH 501(C)(3) 3 BETHESDA CARE SYSTEM 1 CARESERVE 2951 MAPLE AVENUE ZANESVILLE OH 43701 311099924 FORMERLY OPERATED 2 NURSING HOMES THAT WERE SOLD PRIOR TO 2012 OH 501(C)(3) 3 GENESIS HEALTHCARE SYSTEM 1 COMMUNITY AMBULANCE SERVICE 2951 MAPLE AVENUE ZANESVILLE OH 43701 341773323 AMBULANCE SERVICE OH 501(C)(3) 9 GENESIS HEALTHCARE SYSTEM 1 GENESIS CAREGIVERS 2951 MAPLE AVENUE ZANESVILLE OH 43701 311282152 2 NURSING HOMES & HOME CARE SERVICES OH 501(C)(3) 3 CARESERVE 1 BETHESDA HOSPITALITY SHOP 2951 MAPLE AVENUE ZANESVILLE OH 43701 316050713 GIFT SHOP OH 501(C)(3) 3 GENESIS HEALTHCARE SYSTEM 1 GENESIS PROFESSIONAL CORPORATION 2951 MAPLE AVENUE ZANESVILLE OH 43701 311599754 PHYSICIAN PRACTICES OH 501(C)(3) 3 GENESIS HEALTHCARE SYSTEM 1 CARELIFE LLC 2951 MAPLE AVENUE ZANESVILLE OH 43701 311128717 PHYSICIAN SERVICES, CHILDCARE SERVICES, PHARMACY, DME OH GENESIS HEALTHCARE SYSTEM C -31834597 25834453 1.00000 1 SOUTHEAST OHIO MEDICAL INSURANCE COMPANY FIRST CARIBBEAN HOUSE GEORGE TOWN CAYMAN ISLANDS CJ 980436356 CAPTIVE INSURANCE COMPANY CJ GENESIS HEALTHCARE SYSTEM C 17734540 1.00000 1 0 0 1 1 1 0 0 0 0 1 1 1 1 0 1 1 1 1 1 CARELIFE LLC O 2915453 ACCRUAL TRANSACTION CARELIFE LLC S 862340 ACCRUAL TRANSACTION CARELIFE LLC R 164640 ACCRUAL TRANSACTION GENESIS HEALTHCARE SYSTEM GROUP Q 368977 ACCRUAL TRANSACTION COMMUNITY AMBULANCE SERVICE M 981029 ACCRUAL TRANSACTION GENESIS HEALTHCARE SYSTEM GROUP S 3211783 ACCRUAL TRANSACTION GOOD SAMARITAN MEDICAL CENTER S 840000 ACCRUAL TRANSACTION BETHESDA HOSPITAL ASSOCIATION D 69217 LOAN AGREEMENT