2013-05-07T07:46:23-05:00 2012-06-30 351178661 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2011-07-01 344440884 WOOD COUNTY HOSPITAL ASSOCIATION WOOD 4193548900 950 W WOOSTER STREET BOWLING GREEN OH 43402 KAROL D BORTEL 4193548900 2013-05-06 1 STEPHEN A SHERIDAN P00028551 6148852583 2013-05-06 2011 2016-03-07 17:11:31Z KAROL D BORTEL 950 W WOOSTER STREET BOWLING GREEN OH 43402 93512042 0 X WWW.WOODCOUNTYHOSPITAL.ORG X 1951 OH THE WOOD COUNTY HOSPITAL BOARD OF TRUSTEE, EMPLOYEES, MEDICAL STAFF, AND VOLUNTEERS ARE DEDICATED TO PROVIDING THE HIGHEST QUALITY PREVENTIVE, RESTORATIVE, EDUCATIONAL, AND REHABILITATIVE HEALTH CARE SERVICE TO ALL. 11 10 767 300 3437 0 709362 1287105 88674980 87599330 775237 913517 2210328 2402308 92369907 92202260 0 0 0 0 44967858 47214883 0 0 0 42873286 44604762 87841144 91819645 4528763 382615 181693796 180469324 59887632 67631592 121806164 112837732 X WOOD COUNTY HOSPITAL'S MISSION IS TO PROVIDE THE HIGHEST QUALITY PREVENTATIVE, RESTORATIVE, EDUCATIONAL AND REHABILITATION HEALTH CARE SERVICES TO ALL. INPATIENT ACUTE CARE AND ANCILLARY SERVICES ARE AVAILABLE TO SERVE BOTH TRADITIONAL INPATIENTS AND AMBULATORY PATIENTS. EMERGENCY SERVICES ARE PROVIDED 24 HOURS A DAY, SEVEN DAYS A WEEK. DURING FISCAL YEAR 2012, 26,048 INDIVIDUALS RECEIVED TREATMENT IN THE EMERGENCY DEPARTMENT. MEDICAL CARE IS PROVIDED REGARDLESS OF THE PATIENT'S ABILITY TO PAY. DURING THE FISCAL YEAR, $70,639,504 WAS THE VALUE OF SERVICES PROVIDED WHERE THE HOSPITAL DID NOT RECEIVE FULL PAYMENT. OF THIS, $4,217,487 WAS CHARITY CARE. 0 0 71457816 89359709 WOOD COUNTY HOSPITAL PROVIDED HEALTH CARE SERVICES TO 3,442 INPATIENTS, 326 NEWBORNS, AND 91,134 OUTPATIENTS DURING FISCAL YEAR ENDING 6/30/12. WOOD COUNTY HOSPITAL PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF OUR HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS ARE FINANCIALLY ABLE TO PURCHASE NECESSARY MEDICAL CARE. THEREFORE, IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, WOOD COUNTY HOSPITAL PROVIDED CHARITY CARE VALUED AT $4,217,487. 71457816 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 103 0 1 767 1 1 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 1 1 0 OH X KAROL D BORTEL 4193548900 950 W WOOSTER ST BOWLING GREEN OH 434022699 STANLEY KORDUCKI 40.00 X X 187180 0 40593 KAREN APPLE 1.50 X 0 0 0 DIANE HUFFMAN 1.50 X 0 0 0 JAMES F CARTER 1.50 X 0 0 0 DANELDA DREWES 1.50 X X 0 0 0 GAYLYN FINN 1.50 X X 0 0 0 RODNEY ROGERS 1.50 X 0 0 0 DR E J KUEBECK 1.50 X X 0 0 0 MICHAEL MARSH 1.50 X 0 0 0 DR THOMAS WOJCIECHOWSKI 1.50 X 0 0 0 WILLIAM CULBERTSON 1.50 X 0 0 0 KAROL BORTEL 40.00 X 88569 0 21494 CAROLE MATTHEWS 40.00 X 113552 0 15508 BRUCE KIACZ 40.00 X 111076 0 5872 WILLIAM KIDD 40.00 X 105088 0 5527 JOANNE WHITE 40.00 X 105641 0 3130 711106 0 92124 10 0 1 0 MAXIT HEALTHCARE HOLDINGS INC 705 E MAIN STREET WESTFIELD IN 46074 CERNER CONSULTANTS 470979 TECHNICORE CLINICAL ENGINEERING PO BOX 1210 FINDLAY OH 45839 SERVICE AGREEMENTS 346631 SCOTT J DEERING MD 1605 GLENEAGLES DRIVE BOWLING GREEN OH 43402 PHYSICIAN RECRUITMENT 142899 3 7798 1031246 248061 1287105 PATIENT SERVICE REVENU 900099 87599330 87599330 87599330 900525 900525 741693 0 741693 741693 738256 3437 1290774 32000 1223929 85853 66845 -53853 12992 12992 MEALS 900099 496651 496651 MISCELLANEOUS 900099 382411 382411 LEASED EMPLOYEES 900099 238641 238641 542912 368092 174820 1660615 92202260 89326730 3437 1584988 35450017 26587513 8862504 2315542 1736657 578885 7218474 5413856 1804618 2230850 1673138 557712 4303 4303 83276 83276 6464855 6464855 655074 655074 284278 284278 126389 126389 1855253 1855253 58838 24124 34714 67464 45876 21588 657138 657138 6897624 6897624 105976 105976 MEDICAL AND OTHER SUPPL 13562853 10443397 3119456 BAD DEBT 5125205 5125205 EQUIPMENT RENTAL AND MA 2738944 2026819 712125 MISCELLANEOUS 2168201 2168201 3749091 2069088 1680003 91819645 71457816 20361829 0 157521 1325150 28721401 20052995 10324816 14054557 220186 234068 75704 1739177 1702283 983097 1168585 131690638 61589949 66942336 70100689 40689161 43394454 1950295 29135104 29191541 181693796 180469324 6304334 5654954 45978740 44790962 52401 7552157 17185676 59887632 67631592 X 92875695 83698394 26889605 27189043 2040864 1950295 121806164 112837732 181693796 180469324 X 382615 -9351047 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 775340 775340 20257984 9430864 10827120 94631423 52159085 42472338 16025891 16025891 70100689 INTEREST IN WOOD COUNTY HOSPITAL FOUNDATION 27189043 INVESTMENT IN JOINT VENTURES 1076834 OTHER ASSETS 355034 ESTIMATED THIRD PARTY SETTLEMENTS 17741 BOND ISSUANCE COSTS, NET 552889 29191541 PENSION LIABILITY 13528150 INTEREST RATE SWAP 3657526 17185676 ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ASSOCIATION AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF JUNE 30, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ASSOCIATION HAS FILED ITS FEDERAL AND STATE INCOME TAX RETURNS FOR PERIODS THROUGH JUNE 30, 2011 AND IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. HOWEVER, AS OF THE DATE THE FINANCIAL STATEMENTS WERE AVAILABLE TO BE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). 1 1 1 X 1 X 1 1 1 0 1 1 72 12884548 12884548 0.14030 8997957 5249396 3748561 0.04080 72 21882505 5249396 16633109 0.18110 9597 217959 113531 104428 0.00110 102 12063 12063 0.00010 152 3736 3736 0.00000 247412 30330 30330 0.00030 257263 264088 113531 150557 0.00150 72 257263 22146593 5362927 16783666 0.18260 40000 25 784 784 0.00000 70056 10890 10890 0.00010 110081 11674 11674 0.00010 1 10570130 14298860 -3728730 X 1 1 1 1 WOOD COUNTY HOSPITAL ASSOCIATION

1037 CONNEAUT AVE BOWLING GREEN OH 43402

X WOOD COUNTY HOSPITAL ASSOCIATION 1 1 1 100.000000000000 1 200.000000000000 1 X X 1 1 X X X X X 1 X X X 1 X X X X X X 1 X 0 1 3 WOOD COUNTY HOSPITAL REHABILITATION CENT

1037 CONNEAUT AVE BOWLING GREEN OH 43402

PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY WOOD COUNTY WOUND HEALING CENTER

1037 CONNEAUT AVE BOWLING GREEN OH 43402

WOUND HEALING TREATMENT CENTER WOOD COUNTY HOSPITAL BLOOD DRAW STATION

1039 HASKINS ROAD BOWLING GREEN OH 43402

LAB PART I LINE 7 WOOD COUNTY HOSPITALSELECTED CATEGORIES DETAIL FOR PERIOD FROM 7/1/2011 THROUGH 6/30/2012 EXPENSES OFFSETS BENEFIT PERSONS BE HEALTHY NOW WOOD COUNTY WELLNESS (8200) 2,704 0 2,704 195 BREAST CANCER AND CERVICAL CANCER PRESENTATION DEVLAC HALL WELLNESS (8200) 181 0 181 26 BRIEF OUTPATIENT MEETINGS NUTRITION SERVICES/DIABETES PROGRAM NUTRITION SERVICES (4) 3,051 0 3,051 446 COMMUNITY HEALTH EDUCATION WELLNESS (8200) 4,387 50 4,337 479 DIABETES AWARENESS MONTH DIETARY/NUTRITION SERVICES (8050) 500 0 500 300 DIABETES HEALTH FAIR NUTRITION SERVICES DIETARY/NUTRITION SERVICES (8050) 5,818 0 5,818 80 DIABETES INTEREST GROUP NUTRITION SERVICES/DIABETES ED. PROGRAM DIETARY/NUTRITION SERVICES (8050) 1,423 0 1,423 140 EDUCATIONAL PHONE CALLS NUTRITION SERVICES/DIABETES EDUCATION PR DIETARY/NUTRITION SERVICES (8050) 1,136 0 1,136 223 FITNESS ASSESSMENT, EVALUATION AND PHYSICAL ACTIVITY PLAN WELLNESS (8200) 109 0 109 1 GO RED FOR WOMEN WELLNESS (8200) 311 0 311 75 HEALTH FAIR WELLNESS (8200) 801 0 801 417 HEALTH MATTERS LECTURE SERIES WELLNESS (8200) 554 0 554 134 HIGH SCHOOL PHYSICALS (WELLNESS'S PORTION OF THE EVENTS) WELLNESS (8200) 1,721 0 1,721 304 LOOK GOOD FEEL BETTER AMERICAN CANCER SOCIETY PROGRAM WELLNESS (8200) 342 0 342 16 MEDICATION SAFETY REVIEW EVENT PHARMACY (7070) 0 0 0 30 NATIONAL NUTRITION MONTH NUTRITION SERVICES (4) 204 0 204 300 OB MOM AND BABY REST TENT OB (6100) 0 0 0 187 POSITIVELY PINK WELLNESS (8200) 18,042 0 18,042 446 PRENATAL EDUCATION AND SUPPORT OB (6100) 0 0 0 839 PROSTATE SCREENINGS WELLNESS (8200) 1,440 0 1,440 63 SPEAKERS BUREAU WELLNESS (8200) 111 0 111 18 WOOD COUNTY FAIR WELLNESS (8200) 6,204 0 6,204 492 *** COMMUNITY HEALTH EDUCATION 49,039 50 48,989 5,211 COMMUNITY BASED CLINICAL SERVICES (A2) BG CHAMBER OF COMMERCE BLOOD ANALYSIS DAY LABORATORY (7010) 4,938 0 4,938 217 FARM BUREAU SCREENING WELLNESS (8200) 23,424 9,361 14,063 101 HEALTH SCREENING WELLNESS (8200) 3,130 0 3,130 529 PEMBERVILLE FREE FAIR HEALTH SCREENINGS WELLNESS (8200) 1,198 0 1,198 517 *** COMMUNITY BASED CLINICAL SERVICES 32,690 9,361 23,329 1,364 HEALTH CARE SUPPORT SERVICES (A3) BARIATRIC INFORMATION SESSIONS AND SUPPORT GROUPS NUTRITION SERVICES (4) 374 0 374 738 LIFELINE PROGRAM LIFELINE (8210) 34,754 84,120 (49,366) 334 PATIENT TOBACCO CESSATION WELLNESS (8200) 666 0 666 120 *** HEALTH CARE SUPPORT SERVICES 35,794 84,120 (48,326) 1,192 CHILDREN'S HEALTH AND SAFETY (A4) ATHLETIC TRAINING FOR LOCAL HIGH SCHOOLS REHABILITATION SVCS (7091) 85,665 20,000 65,665 500 FITNESS IS FUN WELLNESS (8200) 418 0 418 118 HIGH FIVE PROGRAM WELLNESS (8200) 2,577 0 2,577 1,010 HIGH SCHOOL PHYSICALS REHABILITATION SVCS (7091) 8,354 0 8,354 UNKNOWN KIDS HEALTH AND SAFETY FAIR WELLNESS (8200) 3,034 0 3,034 UNKNOWN OBB OB (6100) 0 0 0 22 STUFFEE WELLNESS (8200) 388 0 388 180 *** CHILDREN'S HEALTH AND SAFETY 100,436 20,000 80,436 1,830 **** COMMUNITY HEALTH IMPROVEMENT SERVICES 217,959 113,531 104,428 9,597 HEALTH PROFESSIONS EDUCATION (B) NURSES/NURSING STUDENTS (B2) CLINICAL EDUCATION FOR NURSING STUDENTS NURSING EDUCATION (6010) 0 0 0 93 *** NURSES/NURSING STUDENTS 0 0 0 93 OTHER HEALTH PROFESSIONAL EDUCATION (B3) BGSU DIETETIC INTERNS DIETARY/NUTRITION SERVICES (8050) 5,432 0 5,432 6 DISCHARGE PLANNING INTERNSHIP DISCHARGE PLANNING (6015) 5,555 0 5,555 2 *** OTHER HEALTH PROFESSIONAL EDUCATION 10,987 0 10,987 8 SCHOLARSHIPS/FUNDING FOR PROFESSIONAL EDUCATION (B4) WOOD COUNTY HOSPITAL SCHOLARSHIP PROGRAM HUMAN RESOURCES (8223) 500 0 500 1 *** SCHOLARSHIPS/FUNDING FOR PROFESSIONAL EDUCATI 500 0 500 1 OTHER (B5) ADVISORY FOR BGSU COLLEGE OF FAMILY AND CONSUMER SCIENCES NUTRITION SERVICES (4) 576 0 576 UNKNOWN *** OTHER 576 0 576 0 **** HEALTH PROFESSIONS EDUCATION 12,063 0 12,063 102 SUBSIDIZED HEALTH SERVICES (C) EMERGENCY AND TRAUMA SERVICES (C1) E.M.S, OUTREACH EMERGENCY DEPARTMENT (6230) 0 0 0 25 PARAMEDIC INTERCEPTS EMERGENCY DEPARTMENT (6230) 0 0 0 1 *** EMERGENCY AND TRAUMA SERVICES 0 0 0 26 HOSPITAL OUTPATIENT SERVICES (C3) DIABETES EDUCATION FOLLOW UP PHONE CALLS (NON BILLABLE) DIETARY/NUTRITION SERVICES (8050) 3,736 0 3,736 126 *** HOSPITAL OUTPATIENT SERVICES 3,736 0 3,736 126 **** SUBSIDIZED HEALTH SERVICES 3,736 0 3,736 152 FINANCIAL AND IN KIND CONTRIBUTIONS (E) CASH DONATIONS (E1) ACT BG DIETARY/NUTRITION SERVICES (8050) 160 0 160 300 AMERICAN CANCER SOCIETY MARKETING (8216) 11,410 0 11,410 1,000 AMERICAN RED CROSS FIRE & ICE RED CROSS FUND RAISER MARKETING (8216) 1,000 0 1,000 UNKNOWN BIG BROTHERS BIG SISTERS MARKETING (8216) 300 0 300 100 BLACK SWAMP ARTS FESTIVAL MARKETING (8216) 250 0 250 5,000 BLACK SWAMP PLAYERS MARKETING (8216) 130 0 130 UNKNOWN BOWLING GREEN CHAMBER OF COMMERCE MARKETING (8216) 4,000 0 4,000 UNKNOWN BOWLING GREEN COMMUNITY FOUNDATION MARKETING (8216) 2,500 0 2,500 UNKNOWN BOWLING GREEN HIGH SCHOOL SPORTS BOOSTERS MARKETING (8216) 200 0 200 UNKNOWN BOWLING GREEN KIWANIS SPONSORSHIP MARKETING (8216) 120 0 120 UNKNOWN BOWLING GREEN PARKS AND RECREATION MARKETING (8216) 295 0 295 UNKNOWN DOWNTOWN BOWLING GREEN MARKETING (8216) 795 0 795 10,000 EDUCATIONAL MARKETING GROUP MARKETING (8216) 510 0 510 500 GRAND RAPIDS APPLEBUTTER FEST MARKETING (8216) 3,500 0 3,500 5,000 PREVENTION PARTNERS MARKETING (8216) 150 0 150 UNKNOWN UNITED WAY MARKETING (8216) 1,500 0 1,500 200 *** CASH DONATIONS 26,820 0 26,820 22,100 GRANTS (E2) SAFE SITTER SCHOLARSHIP WELLNESS (8200) 146 0 146 2 *** GRANTS 146 0 146 2 IN KIND DONATIONS (E3) BOWLING GREEN KIWANIS HUMAN RESOURCES (8223) 50 0 50 UNKNOWN HAITI MISSION TRIP MATERIALS MANAGEMENT (7250) 938 0 938 UNKNOWN NATIONAL TRACTOR PULLS EMERGENCY DEPARTMENT (6230) 0 0 0 61,000 VILLAGE OF WAYNE, BREAST CANCER RUN, EMS STAND BY UNKNOWN (0) 0 0 0 100 WHEELED MEALS NUTRITION SERVICES/DIABETES EDUCATION PROGRAM DIETARY/NUTRITION SERVICES (8050) 2,376 0 2,376 152,510 WOOD COUNTY FAIR EMERGENCY MEDICAL COVERAGE EMERGENCY DEPARTMENT (6230) 0 0 0 11,700 *** IN KIND DONATIONS 3,364 0 3,364 225,310 **** FINANCIAL AND IN KIND CONTRIBUTIONS 30,330 0 30,330 247,412 COMMUNITY BUILDING ACTIVITIES (F) COMMUNITY SUPPORT (F3) BOWLING GREEN TRAFFIC ADVISORY COUNCIL MARKETING (8216) 0 0 0 40,000 *** COMMUNITY SUPPORT 0 0 0 40,000 LEADERSHIP DEV/TRAINING FOR COMMUNITY MEMBERS (F5) WOOD COUNTY HOSPITAL BUSINESS ADVISORY LUNCHEON READYWORKS (7097) 784 0 784 25 *** LEADERSHIP DEV/TRAINING FOR COMMUNITY MEMBERS 784 0 784 25 COMMUNITY HEALTH IMPROVEMENT ADVOCACY (F7) HOSPITAL COUNCIL OF NW OHIO UNKNOWN (0) 10,181 0 10,181 UNKNOWN WALK FROM OBESITY WELLNESS (8200) 619 0 619 56 WOOD COUNTY HEALTH DISTRICT LICENSING COUNCIL DIETARY/NUTRITION SERVICES (8050) 90 0 90 70,000 *** COMMUNITY HEALTH IMPROVEMENT ADVOCACY 10,890 0 10,890 70,056 **** COMMUNITY BUILDING ACTIVITIES 11,674 0 11,674 110,081 NUMBER OF PROGRAMS 72 GRAND TOTALS 275,762 113,531 162,231 367,344 PART III, LINE 9B: IT IS OUR POLICY TO PROCESS CHARITY APPLICATIONS WHEN WE KNOW THE PATIENT IS ELIGIBLE, AND NOT TO PURSUE A FORM OF PAYMENT ONCE WE HAVE THE ELIGIBILTIY CONFIRMED. WOOD COUNTY HOSPITAL ASSOCIATION PART V, SECTION B, LINE 21: SELF PAY PATIENTS ARE BILLED ACCORDING TO THE FEE SCHEDULE HOWEVER, BASED ON INCOME THE SLIDING FEE SCHEDULE IS APPLIED. SELF PAY PATIENTS GENERALLY RECEIVE A DISCOUNT OF NOT LESS THAN 20%. PART VI, LINE 2: NEEDS ASSESSMENT PREPARED BY THE WOOD COUNTY HEALTH PARTNERS. PART VI, LINE 3: THROUGH FINANCIAL COUNSELOR AND WEBSITE - ALSO, THE BACKSIDE OF PATIENT STATEMENTS INCLUDES A CHARITY APPLICATION TO WHICH THE PATIENTS ARE DIRECTED FROM THE FRONT OF THE STATEMENT. PART VI, LINE 4: THE COMMUNITY THAT IS SERVED BY WOOD COUNTY HOSPITAL IS DEFINED AS WOOD COUNTY SOUTH OF STATE ROUTE 582 AND CONTIGUOUS AREAS TO THE EAST, SOUTH AND WEST OF THE COUNTY LINES. THE ESTIMATED POPULATION OF THE HOSPITAL'S PRIMARY SERVICE AREA CENTERS ON 22 ZIP CODES. THIS CONSTITUTES APPROXIMATELY 80% OF THE INPATIENT DISCHARGES FROM THE HOSPITAL; WITH 20% FALLING OUTSIDE THE DEFINED SERVICE AREA. THE POPULATION IS ESTIMATED TO BE 76,615, BASED ON THE 2010 CENSUS. IT IS EXPECTED TO EXPERIENCE A VERY MODEST GROWTH RATE OF 0.5% OVER THE NEXT FIVE YEARS. PART VI, LINE 5: COMMUNITY PARTNERS: WOOD COUNTY HEALTH PARTNERSWOOD COUNTY HOSPITAL IS COMMITTED TO THE COMMUNITY IT SERVES BY PROVIDING EXCELLENT HEALTHCARE SERVICES INCLUDING MEDICAL CARE, EDUCATION, COMMUNITY SUPPORT, AND WORKING WITH LIKE-MINDED ORGANIZATIONS, AGENCIES, AND INSTITUTIONS TO MAKE A DIFFERENCE. THIS GROUP, WOOD COUNTY HEALTH PARTNERS, HAVE WORKED TOGETHER OVER THE PAST TWELVE YEARS TO COMPLETE THREE COMMUNITY HEALTH ASSESSMENTS. THE CURRENT ASSESSMENT, COMPLETED IN SEPTEMBER 2012, WAS JOINTLY FUNDED BY WOOD COUNTY HOSPITAL AND WOOD COUNTY HEALTH DISTRICT AND ALSO INCLUDED IN-KIND SUPPORT FROM THE REMAINING PARTNERS. REPORTS FILED WITH STATES PART VI, LINE 7 OH X 0 0 X X X X 0 0 0 0 0 0 0 0 0 STANLEY KORDUCKI 187180 0 0 0 0 0 0 0 40593 0 227773 0 227773 0 PART I, LINE 1A FITNESS FACILITY BENEFIT: ACCORDING TO THE ECONOMIC BENEFITS OF REGULAR EXERCISE, RESEARCHERS HAVE FOUND THAT THE RETURN ON INVESTMENT AMONG COMPANIES THAT OFFER WELLNESS BENEFITS RANGES FROM $1.49 TO $13 FOR EVERY DOLLAR INVESTED. WELLNESS-ORIENTED SERVICES IN BOTH A FITNESS FACILITY AND THE WORKPLACE PROGRAMS WE OFFER THROUGH WELLNESS ARE PROVEN TO HELP ADDRESS OUR HEALTH GOALS, REDUCE THE IMPACT OF OBESITY RATES, AND IMPROVE BUSINESS PROFITABILITY. WOOD COUNTY HOSPITAL INVESTS IN EMPLOYEE HEALTH BY PAYING A FIXED AMOUNT OF $62.50 TO ALL EMPLOYEES, INCLUDING EXECUTIVES, WHO JOIN A FITNESS FACILITY WHERE THEY CAN WORK OUT. WOOD COUNTY HOSPITAL, LIKE OTHER EMPLOYERS, ARE AWARE THAT A FITNESS BENEFIT REDUCES EMPLOYEE HEALTH CARE EXPENSES, LOWERS RATES OF ABSENTEEISM, REDUCES DISABILITY AND WORKERS' COMPENSATION CLAIMS AND HELPS TO ATTRACT AND RETAIN TALENTED EMPLOYEES. STUDIES SHOW THAT EMPLOYEES WHO EXERCISE AT LEAST ONCE A WEEK, REGARDLESS OF THEIR WEIGHT, HAVE LOWER HEALTH CARE COSTS THAN THEIR SEDENTARY CO-WORKERS. ONE STUDY, IN FACT, SHOWED THAT ACTIVE EMPLOYEES TAKE 27 PERCENT FEWER SICK DAYS AND REPORT 14 TO 25 PERCENT FEWER DISABILITY DAYS THAN INACTIVE EMPLOYEES. WHILE ONLY 16% OF THE AMERICAN POPULATION CURRENTLY BELONGS TO A HEALTH CLUB, MEMBERSHIP HAS INCREASED MORE THAN 10% OVER THE PAST THREE YEARS TO OVER 50.2 MILLION MEMBERS, DESPITE THE POOR ECONOMY. WITH AN IMPROVED ECONOMIC OUTLOOK, CLUBS ACROSS THE COUNTRY ARE GEARING UP FOR MORE DEMAND THAN THEY'VE SEEN IN YEARS. SO THAT IS THE REASON WHY WE SUBSIDIZE EMPLOYEES JOINING A FITNESS FACILITY. SUPPLEMENTAL INFORMATION PART III 2011 W2 COMPENSATION FOR STANLEY KORDUCKI WAS REPORTED IN 2010 DUE TO FISCAL YEAR VS CALENDAR YEAR REPORTING. WOOD COUNTY 344601607 978303AV7 2008-02-28 45525000 NEW BED TOWER, SURGERY, ETC. 0 0 0 45525000 206890 25000 1 0 0 1 0 0 0 0 1 0 1 1 JP MORGAN CHASE 10.000000000000 0 0 0 0 0 DR VEGA PHYSICIAN RECRUITMENT X 20438 19410 0 1 1 DR T JANTZ PHYSICIAN RECRUITMENT X 33142 26514 0 1 1 DR LANE PHYSICIAN RECRUITMENT X 459306 153000 0 1 1 DR BELL HOME DOWNPAYMENT LOAN X 44541 35144 0 1 1 234068 FORM 990, PART VI, SECTION B, LINE 11 THE DRAFT 990 IS PREPARED AND MEMBERS NOTIFIED THAT IT IS AVAILABLE FOR REVIEW & COMMENT. ANY QUESTIONS ARE DISCUSSED AND HANDLED AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 12C EVERY 2 YEARS ALL BOARD MEMBERS AND VICE PRESIDENTS ARE ASKED TO SIGN A CONFLICT OF INTEREST DISCLOSURE. THESE DOCUMENTS ARE RETAINED IN ADMINISTRATION. ANY IDENTIFIED CONFLICTS ARE ADDRESSED BY THE BOARD OR CEO AS APPROPRIATE. ACTION TAKEN WOULD BE CONTINGENT UPON THE TYPE OF CONFLICT RANGING FROM DISCLOSURE ONLY TO ABSTAINING FROM VOTES OR DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, AN EVALUATION IS SENT TO BOARD MEMBERS AND KEY EMPLOYEES. THE BOARD COMPENSATION COMMITTEE MEETS TO REVIEW INPUT FROM THOSE QUERIED. COMPARATIVE WAGE DATA IS OBTAINED FROM OHA AND OTHER INDUSTRY REPORTING SERVICES. THE COMPENSATION COMMITTEE MAKES A RECOMMENDATION TO THE BOARD AND A VOTE IS TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN UNRESTRICTED NET ASSETS -9,559,916. CHANGE IN INTEREST IN NET ASSETS OF WOOD COUNTY FOUNDATION 299,438. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST -90,569. TOTAL TO FORM 990, PART XI, LINE 5: -9,351,047. WOOD HEALTH COMPANY 950 W WOOSTER STREET BOWLING GREEN OH 43402 810616720 FAMILY HEALTH AND SPECIALIZED CARE OH 7212432 2447554 WOOD COUNTY HOSPITAL WHC MEDICAL SERVICES 950 W WOOSTER STREET BOWLING GREEN OH 43402 050623391 FAMILY HEALTH AND SPECIALIZED CARE OH 0 120276 WOOD COUNTY HOSPITAL WOOD COUNTY WOMEN'S CARE 755 HASKING ROAD BOWLING GREEN OH 43402 810565899 WOMEN'S HEALTH CARE OH 1698060 1062134 WOOD COUNTY HOSPITAL WOOD COUNTY HOSPITAL FOUNDATION 950 W WOOSTER ST BOWLING GREEN OH 43402 341546464 TO OBTAIN CHARITABLE CONTRIBUTIONS, MANAGE THOSE GIFTS & DISBURSE THEM OH 501(C)(3) LINE 11A, I N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0