2014-05-15T12:50:30-05:00 2013-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2012-07-01 314379491 HOLZER HOSPITAL FOUNDATION HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 DAN JANICAK 7404465060 2014-05-14 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2015-11-30 17:44:51Z SEE SCHEDULE O WAYNE MUNRO MD 100 JACKSON PIKE GALLIPOLIS OH 45631 141346324 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 1304 38 0 0 137421 268158 117432970 136283240 94314 124722 1537482 4069534 119202187 140745654 57600 21526 0 0 51087561 48069567 0 0 0 68076089 80560216 119221250 128651309 -19063 12094345 87492950 104179192 25396143 33305526 62096807 70873666 X TO ADVANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE 0 0 111171644 21526 138830715 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. 111171644 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 52 0 1 1304 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 INTERIM CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 THOMAS TOPE 1.00 4.00 X 0 0 0 ALAN STOCKMEISTER 1.00 3.00 X X 0 0 0 SUZANNE MIZE MD 1.00 0.00 X 0 0 0 BRENT SAUNDERS 1.00 4.00 X X 449307 0 24624 STEVE CHAPMAN 1.00 3.00 X X 0 0 0 LARRY KIDD 1.00 3.00 X X 0 0 0 DANNY HOLSCHUH 1.00 0.00 X 0 0 0 PAUL REED 1.00 3.00 X 0 0 0 GARY ROACH 1.00 3.00 X X 0 0 0 BASHAR ATAI MD 1.00 0.00 X 0 0 0 WAYNE MUNRO MD 36.00 4.00 X 0 650407 0 KENNETH G PAYNE 36.00 4.00 X 333236 0 33188 JOHN H ALLEN JR 40.00 0.00 X 292753 0 25508 JAMES PHILLIPPE II 40.00 0.00 X 319856 0 21623 TERRY J SPURLIN 40.00 0.00 X 158822 0 35878 ELAINE K BROWN 40.00 0.00 X 151559 0 15873 LISA B HALLEY 40.00 0.00 X 150000 0 20695 CHARLES T MEADOWS 40.00 0.00 X 149813 0 16486 SHANE E EPHLIN 40.00 0.00 X 149603 0 35048 2154949 650407 228923 28 0 1 0 HOLZER CLINIC 90 JACKSON PIKE GALLIPOLIS OH 45631 PHYSICIANS 24902338 GEIGER BROTHERS PO BOX 469 JACKSON OH 45640 CONTRACTORS 2708112 PLANTE AND MORAN 16060 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 ACCOUNTANTS 597970 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 19182 COMPLIANCE SERVICE 469348 ALTERNATE SOLUTIONS HEALTHCARE SYSTEM 1251 EAST DOROTHY LANE KETTERING OH 45419 HOME CARE MGMT 309562 14 20386 148711 99061 268158 NET PATIENT SERVICES 622110 134938173 134938173 HCAP 622110 1077199 1077199 LIFELINE INCOME 622110 267868 267868 136283240 85871 85871 162556 43400 119156 119156 119156 525000 34500 520649 0 4351 34500 38851 38851 18065 20386 36621 -18556 -18556 EHR IMPLEMENTATION 622110 1709070 1709070 CAFETERIA SALES 722320 1086290 1086290 LAUNDRY INCOME 812300 163172 163172 1010402 838405 171997 3968934 140745654 138830715 0 1646781 X 19526 19526 2000 2000 36583036 28864015 7719021 2993811 2362117 631694 5250235 4142435 1107800 3242485 2558321 684164 751573 751573 276275 276275 271418 271418 29898287 25954647 3943640 129 129 3546499 3431309 115190 3000032 2353825 646207 1720478 1548430 172048 730614 573240 157374 843256 758930 84326 8545995 7691396 854599 643360 579024 64336 MEDICAL SUPPLIES 18729255 18729255 BAD DEBTS 6473675 6473675 HOLZER CARDIAC LLC 3180971 3180971 FRANCHISE FEE 1544353 1544353 404046 404046 128651309 111171644 17479665 0 85864 105776 9099566 10640195 11665131 15712402 0 920399 8985606 2214919 2312009 1244411 1333199 158855075 123570284 31454222 35284791 7012508 7082210 23795930 22723004 87492950 104179192 16836674 20903246 -19017 2016233 2016233 4707498 8600626 1854755 1785421 25396143 33305526 X 61910407 70792234 186400 81432 62096807 70873666 87492950 104179192 X 12094345 114200 -3431686 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1168 1168 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION RELATES TO LOBBYING. 451456 451456 36227462 27099189 9128273 114840783 93331202 21509581 7335374 3139893 4195481 35284791 OTHER ASSETS 1389884 RELATED PARTY RECEIVABLES 21333120 22723004 COST REPORT SETTLEMENTS 296726 RELATED PARTY PAYABLE 1488695 1785421 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 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 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 2010. GOLF OUTING 38451 20386 18065 36621 38451 20386 18065 36621 36621 -18556 1 1 X 1 X 1 X 1 1 1 0 0 3309538 1895999 1413539 0.01160 17202127 11362093 5840034 0.04780 20511665 13258092 7253573 0.05940 20511665 13258092 7253573 0.05940 0 6473675 323684 40271361 44260284 -3988923 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 12 1 1 1 X 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 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, L7 COL(F): BAD DEBT OF $6,473,675 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. NONE OF THE 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. 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. AN IMPLEMENTATION PLAN WILL BE ROLLED OUT OVER THE NEXT THREE YEARS. THE IMPLEMENTATION STRATEGY WAS ADOPTED JUNE 2013.HTTP://WWW.HOLZER.ORG/GEDOWNLOAD!/HOLZER-CHNA-IMPLEMENTATIONSTRATEGY_SIGNED_2014.PDF?ITEM_ID=9024001&VERSION_ID=9024002 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. 1 HOLZER FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 501(C)(3) 19526 N/A N/A GENERAL SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION MAY PROVIDE FUNDS TO RELATED, EXEMPT ORGANIZATIONS. 0 1 0 0 0 0 0 0 0 BRENT SAUNDERS 401833 0 47474 0 0 0 19626 0 4998 0 473931 0 0 0 WAYNE MUNRO MD 0 631333 0 19074 0 0 0 0 0 0 0 650407 0 0 KENNETH G PAYNE 306796 0 26440 0 0 0 18549 0 14639 0 366424 0 0 0 JOHN H ALLEN JR 208371 0 84382 0 0 0 15495 0 10013 0 318261 0 0 0 JAMES PHILLIPPE II 311999 0 7525 0 332 0 11528 0 10095 0 341479 0 0 0 TERRY J SPURLIN 158822 0 0 0 0 0 15882 0 19996 0 194700 0 0 0 ELAINE K BROWN 151559 0 0 0 0 0 6465 0 9408 0 167432 0 0 0 LISA B HALLEY 150000 0 0 0 0 0 15898 0 4797 0 170695 0 0 0 CHARLES T MEADOWS 149813 0 0 0 0 0 14981 0 1505 0 166299 0 0 0 SHANE E EPHLIN 149603 0 0 0 0 0 14960 0 20088 0 184651 0 0 0 PART I, LINE 4B 457(F)- SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE BRENT SAUNDERS $49,510 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION 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 CONSOLIDATED HEALTH SYSTEMS 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 CONSOLIDATED HEALTH SYSTEM'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE CONTROLLER AND THE CFO OF HOLZER CONSOLIDATED HEALTH SYSTEMS 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 CONSOLIDATED 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 2012. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023, 990, AND 990-T ARE AVAILABLE TO THE PUBLIC UPON REQUEST. 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. OTHER FEES FORM 990, PART IX, LINE 11G MISC CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 438,813. MANAGEMENT AND GENERAL EXPENSES 174,263. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 613,076. MEDICAL DEPARTMENT CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 23,252,899. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,252,899. ADMINISTRATIVE AND PATIENT RECORDS/CARE CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 911,138. MANAGEMENT AND GENERAL EXPENSES 3,769,377. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,680,515. PHARMACY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 31,075. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,075. LABORATORY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,320,722. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,320,722. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: INTERCOMPANY TRANS (RENT,SVCS,FEES) PART IX NOT RECORDED ON FINANCIAL -3,356,295. INTERCOMPANY GRANTS TO/FROM HOLZER FOUNDATION -75,391. 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 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER CONSOLIDATED HEALTH SYSTEMS 1 HOLZER FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 7 HOLZER CONSOLIDATED HEALTH SYSTEMS 1 HOLZER CONSOLIDATED HEALTH SYSTEMS 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 CONSOLIDATED HEALTH SYSTEMS 1 HOLZER VANGUARD 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH N/A C 1 0 1 1 0 0 0 0 0 0 1 1 0 1 0 0 1 0 0 1 HOLZER FOUNDATION C 148711 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM J 363636 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM K 108176 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM M 4197738 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM P 3968885 ACCRUAL TRANSACTION HOLZER HEALTH SYSTEM S 3170651 ACCRUAL TRANSACTION