2013-11-14T18:05:25-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-01-01 311072406 PIKE HEALTH SERVICES INC PIKE 7409472186 100 DAWN LANE WAVERLY OH 45690 CRAIG E SOLLE 7409472186 2013-11-07 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-02-25 16:41:14Z PIKE COMMUNITY HOSPITAL CRAIG E SOLLE 100 DAWN LANE WAVERLY OH 45690 21885412 0 X ADENA.ORG X 1983 OH PIKE HEALTH SERVICES, INC. IS HIGH QUALITY; COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. 9 8 271 67 0 0 73327 38278 21456193 20840203 1549 1325 999065 991157 22530134 21870963 3350 3000 0 0 11869383 10932075 0 0 0 11421614 10637182 23294347 21572257 -764213 298706 12322628 15732254 9950904 9872430 2371724 5859824 X PIKE HEALTH SERVICES, INC. IS HIGH QUALITY; COMPASSIONATE HEALTHCARE; ACCESSIBLE TO THE COMMUNITY; COMMITTED TO EXCELLENCE; RESPECTFUL OF EACH INDIVIDUAL; AND FOUNDED ON SERVICE TO OTHERS. 0 0 18777363 3000 20840203 SEE SCHEDULE OPIKE HEALTH SERVICES, INC. IS A 25-BED CRITICAL ACCESS HOSPITAL AND PHYSICIAN PRACTICE LOCATED IN THE STATE OF OHIO IN PIKE COUNTY. INCLUDED IN THE BED COUNT ARE 21 ACUTE BEDS AND 4 INTENSIVE CARE BEDS WITH AUTHORIZATION FOR SWING BEDS ON AN AS NEEDED BASIS. IN 2012, PIKE HEALTH SERVICES, INC. HAD 602 INPATIENT ADMISSIONS, 302 SURGERY CASES (INCLUDING AMBULATORY), AND 13,648 VISITS TO THE EMERGENCY DEPARTMENT. ADENA PIKE COMMUNITY HOSPITAL PROVIDED CHARITY CARE TO THE COMMUNITY IN THE AMOUNT OF $4,417,653, INCLUDING 11.9% SELF PAY PATIENTS, WHO HAVE NO INSURANCE.PIKE HEALTH SERVICES, INC'S COMMUNITY OUTREACH ACTIVITY HAS SERVED 570 CITIZENS IN VARIOUS PROGRAMS THROUGHOUT PIKE COUNTY. DURING THE YEAR, THEY PARTICIPATED IN 9 HEALTH FAIRS OFFERING SCREENING AND EDUCATION FOR DIABETES, CHOLESTEROL AND ARTHRITIS FOR BOTH ADULTS AND CHILDREN. ADDITIONALLY, THEY SUPPORT THE YOUNG RESIDENTS OF THE COUNTY IN VARIOUS PROGRAMS INCLUDING HEAD START AND CHILD SAFETY PRESENTATIONS. 18777363 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 74 0 1 271 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X SHARON NOVAK 7409476306 100 DAWN LANE WAVERLY OH 45690 PAUL ADKINS 2.00 0.00 X 0 0 0 TODD BURKITT 2.00 0.00 X 0 0 0 CATHERINE FARINET 50.00 0.00 X 50890 185569 11333 ANTHONY FISH 2.00 0.00 X X 0 0 0 MARGARET FOILL 2.00 0.00 X X 0 0 0 VAL FRANCIS 2.00 0.00 X X 0 0 0 RON HINES 2.00 0.00 X 0 0 0 CONNIE SHELLEY 2.00 0.00 X 0 0 0 LINDA SHOEMAKER 2.00 0.00 X X 0 0 0 MELBY WILLIAMS 2.00 0.00 X X 0 0 0 SHARON NOVAK 50.00 0.00 X 15064 78873 13676 CRAIG SOLLE 50.00 0.00 X 22213 128482 23574 CINDY INGRAM 50.00 0.00 X 42425 165108 19585 DAVID KESSLER 50.00 0.00 X 43136 179636 0 ELLIS FRAZIER 50.00 0.00 X 34045 126736 5607 JOHN CRAWFORD 50.00 0.00 X 35165 112176 15991 CHERYL SMITH 50.00 0.00 X 21160 90744 2346 264098 1067324 92112 0 0 1 0 PREMIER HEALTH CARE SERVICES INC 221 CONGRESS PARK DRIVE DAYTON OH 45456 EMERGENCY DEPT PHYSICIANS 640000 M MODAL SERVICES LTD PO BOX 102467 ATLANTA GA 30368 TRANSCRIPTION 240842 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER DR CHICAGO IL 60693 LAB SERVICES 201762 WISE MEDICAL STAFFING 432 MAGAZINE ST TUPELO MO 38804 CONTRACT NURSING SERVICES 171036 SIEMENS MEDICAL SOLUTION 51 VALLEY STREAM PARKWAY MALVERN PA 19355 SERVICE CONTRACT 152530 8 38278 38278 NET PATIENT SVC REV 622110 20840203 20840203 20840203 10060 0 10060 10060 10060 1325 0 1325 1325 1325 34601 14449 20152 20152 COUNTY TAX LEVY 622110 922592 922592 CAFETERIA REVENUE 622110 38353 38353 960945 21870963 20840203 0 992482 3000 3000 529674 529674 7489607 6343575 1146032 2351897 2253815 98082 560897 463520 97377 2081 2081 101192 101192 1588722 1281142 307580 1508001 1260124 247877 786394 707755 78639 24698 16164 8534 326674 294007 32667 1447033 1301874 145159 BAD DEBT EXPENSE 3438201 3438201 MEDICAL SUPPLIES 1414186 1414186 21572257 18777363 2794894 0 167282 1237644 93545 98511 2094661 2197152 18710 0 32446 255839 233139 151323 597208 8982138 1264257 7293655 7717881 1258687 0 166824 822102 3618273 12322628 15732254 3906272 1761207 4790000 0 0 33920 1254632 8077303 9950904 9872430 X 2371724 5859824 2371724 5859824 12322628 15732254 X 298706 32065 3157329 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 761 761 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: OHIO HOSPITAL ASSOCIATION STRATEGIC ISSUES 350000 350000 4847110 186612 4660498 3526075 1056065 2470010 258953 21580 237373 7717881 OTHER RECEIVABLES 2263889 COST REPORT SETTLEMENT RECEIVABLE 1354384 3618273 CAPITAL LEASE OBLIGATION 15621 DUE TO/FROM ADENA HEALTH SYSTEM 8061682 8077303 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 IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED AS OF DECEMBER 31, 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 CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANGEMENT BELIEVES THAT IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2009. FESTIVAL OF TREES 34601 34601 4842 9607 34601 34601 4842 9607 14449 20152 1 1 X 1 X 1 X 1 1 1 0 1 1 2204819 923177 1281642 0.07070 4849342 3244465 1604877 0.08850 7054161 4167642 2886519 0.15920 7 570 9625 140 9485 0.00050 7 570 9625 140 9485 0.00050 7 570 7063786 4167782 2896004 0.15970 4 1500 1500 4 1500 1500 3438201 2796127 6906037 6717912 188125 X 1 1 1 1 PIKE HEALTH SERVICES INC

100 DAWN LANE WAVERLY OH 45690

X X X X PIKE HEALTH SERVICES INC 1 1 1 100.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 PART I, LINE 6A: ADENA HEALTH SYSTEM EIN: 31-4379443 PART I, LINE 7: THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CONVERT CHARGES TO COSTS IN LINE 7A AND 7B. ACTUAL COSTS WERE USED IN LINE 7E. PART I, L7 COL(F): BAD DEBT EXPENSE OF $3,438,201 WAS DEDUCTED FROM TOTAL OPERATING EXPENSES WHEN CALCULATING THE PERCENTAGES IN THIS COLUMN. PART II: THE COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE POPULATION OF PIKE COUNTY BY EDUCATING FOR A HEALTHIER LIFESTYLE, SCREENING THE GENERAL PUBLIC FOR MAJOR HEALTH RISKS. ONGOING EDUCATION IN FIRST AID AND CPR IS GIVEN THROUGHOUT THE COMMUNITY. PART III, LINE 4: PART III, LINE 2THE BAD DEBT EXPENSE LISTED ON PART III, LINE 2 IS DERIVED FROM THE FINANCIAL STATEMENTS. PART III, LINE 3THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FAP LISTED ON PART III, LINE 3 IS DERIVED FROM THE HCAP REPORT. THE AMOUNT IS DETERMINED BY ANALYZING THE BAD DEBTS THAT WERE DENIED BY THE HCAP PROGRAM BECAUSE OF PATIENTS POTENTIALLY BEING ELIGIBLE UNDER PIKE HEALTH SERVICES, INC'S FAP.PART III, LINE 4 WE DO NOT HAVE SEPARATE FINANCIAL STATEMENTS FOR PIKE HEALTH SERVICES, INC. IT IS INCLUDED IN THE CONSOLIDATED STATEMENTS OF ADENA HEALTH SYSTEM. THE FOOTNOTE IN OUR FINANCIAL STATEMENTS INCLUDES THE FOLLOWING ABOUT OUR BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLES. "AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF 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 ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS ESTABLISHED BASED ON EXPECTED PAYMENT RATES FROM PAYORS UTILIZING CURRENT REIMBURSEMENT METHODOLOGIES AND PAYMENT RATES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE." PART III, LINE 8: THE HOSPITAL USED THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT WHEN DETERMINING THE AMOUNT ON PART III - LINE 6. PART III, LINE 9B: ALL NON INSURED PATIENTS MUST COMPLETE APPLICATIONS FOR FINANCIAL ASSISTANCE. IF THEY DO NOT, THEY WILL ALL BE TREATED EQUALLY PER THE COLLECTION POLICY. IF THE PATIENT COMPLETES THE APPLICATION AND QUALIFIES, THE ACCOUNT WILL BE ADJUSTED PER THE POLICY. PIKE HEALTH SERVICES, INC. PART V, SECTION B, LINE 20D: THE HOSPITAL HAS A NONDISCRIMINATORY POLICY RELATED TO EMERGENCY MEDICAL CARE. ALL PATIENTS ARE TREATED BEFORE EMERGENCY MEDICAL CARE BEFORE PAYMENT IS DISCUSSED.THE MAXIMUM AMOUNT CHARGED TO THOSE PATIENTS THAT ARE FAP ELIGIBLE IS CALCULATED AS FOLLOWS: IF PATIENT'S INCOME LEVEL IS 100% OF FPG (FEDERAL POVERTY GUIDELINES)OR LESS THEN 100% DISCOUNT IS APPLIED AND THE DISCOUNTED AMOUNT IS WRITTEN OFF TO CHARITY CARE. THE REMAINING DISCOUNTS ARE CALCULATED ON A SLIDING SCALE DIRECTLY RELATED TO THE PATIENTS INCOME LEVEL AS COMPARED TO FPG. FOR EXAMPLE, IF THE PATIENT'S INCOME LEVEL IS 140% OF FPG THEN 60% DISCOUNT IS APPLIED. IF THE PATIENT'S INCOME LEVEL IS 180% OF FPG THEN 20% DISCOUNT IS APPLIED. PART VI, LINE 2: MANY PROGRAMS ARE IN AFFECT INVOLVING PATIENT SCREENING TO COVER THE HEALTH CARE NEEDS OF THE COMMUNITY INCLUDING THE RISKS THAT HAVE BEEN IDENTIFIED IN THE NEEDS ASSESSMENT. PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY IS POSTED AT ALL PATIENT ENTRANCES, IN WAITING ROOMS, IN THE ADMISSION'S OFFICE, IN TREATMENT ROOMS, ON THE HOSPITAL'S WEBSITE, AND IS AVAILABLE UPON REQUEST. THE POLICY IS ALSO PROVIDED TO PATIENTS UPON ADMISSION. BROCHURES ARE AVAILABLE THROUGHOUT THE HOSPITAL AND PHYSICIAN OFFICES. AWARENESS OF THE ASSISTANCE PROGRAMS ARE PROMOTED THROUGH THE MANY HEALTH FAIRS AND SCREENING THROUGHOUT AREA. PART VI, LINE 4: PIKE COUNTY IS LOCATED IN THE APPALACHIAN REGION OF THE US WITH A POPULATION OF 28,700. THE MEDIUM INCOME IS $31,649, WITH 15.10% OF THE POPULATION LIVING BELOW THE POVERTY LEVEL. OVER 10% OF THE POPULATION IS OVER 65 YEARS OF AGE. PART VI, LINE 5: MEDICAL AND HOSPITAL STAFF ARE ACTIVE PARTICIPANTS ON NUMEROUS BOARDS THROUGHOUT THE AREA AND REGION IN AN EFFORT TO PROMOTE COMMUNITY HEALTH AND HEALTHIER LIFESTYLES. SCHEDULE H, PART VI, LINE 6 FOUNDED IN 1895, ADENA HEALTH SYSTEM IS AN INDEPENDENT, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN CHILLICOTHE, OH. THE HEALTH SYSTEM INCLUDES THREE HOSPITALS AND SIX REGIONAL CLINICS, WITH A TOTAL OF 311 BEDS. ADENA SERVES THE NEEDS OF NEARLY 500,000 PEOPLE IN 13 COUNTIES, LIVING IN OHIO'S APPALACHIAN REGION. OUR FACILITIES INCLUDE: ADENA REGIONAL MEDICAL CENTER: A 261-BED INPATIENT HOSPITAL IN CHILLICOTHE, OH FEATURING AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND TREATMENT SERVICES, ADVANCED SURGICAL SUITES, INTENSIVE/CARDIAC CARE, MEDICAL OFFICE BUILDING AND THE ADENA HEALTH PAVILION, WHICH INCLUDES OUTPATIENT SURGERY, PHYSICIAN OFFICES AND THE ADENA SLEEP CENTER. IN 2011, ADENA INVESTED $21 MILLION IN THE CONSTRUCTION OF A 35,000 SQUARE-FOOT CANCER CENTER TO PROVIDE PATIENTS WITH ACCESS TO CANCER DIAGNOSIS AND TREATMENT AT A FACILITY NEAR THEIR HOMES. THE CANCER CENTER OPENED IN JANUARY 2012. GREENFIELD AREA MEDICAL CENTER AND PIKE HEALTH SERVICES, INC.: BOTH ARE CRITICAL ACCESS HOSPITALS, EACH WITH A 25-BED INPATIENT FACILITY IN GREENFIELD, OH AND WAVERLY, OH, RESPECTIVELY. EACH FEATURES AN EMERGENCY DEPARTMENT, INPATIENT CARE INCLUDING REHABILITATION AND MEDICAL/SURGICAL, DIAGNOSTIC AND TREATMENT SERVICES, AS WELL AS FAMILY PRACTICE AND SPECIALTY PHYSICIANS. THESE TWO HOSPITALS DIRECTLY BENEFIT HIGHLAND COUNTY (GREENFIELD AREA MEDICAL CENTER) AND PIKE COUNTY (PIKE HEALTH SERVICES, INC.) AS WELL AS SURROUNDING COMMUNITIES. ADENA HEALTH CENTERS: LOCATED IN CHILLICOTHE AND WITH REGIONAL SITES IN CIRCLEVILLE, JACKSON, OAK HILL, WASHINGTON COURT HOUSE AND WAVERLY, OH. OUR HEALTH CENTERS INCLUDE PHYSICIAN OFFICES, DIAGNOSTIC AND TREATMENT SERVICES, PHYSICAL, OCCUPATION AND SPEECH THERAPIES. URGENT CARE SERVICES ARE OFFERED IN CHILLICOTHE AND WAVERLY. ADENA HOME CARE AND HOSPICE: PROVIDES HIGHLY PERSONALIZED, QUALITY CARE TO PATIENTS OF FOUR SERVICE LINES -- HOME HEALTH, HOSPICE, HOME RESPIRATORY AND HOME INFUSION. ADENA REHABILITATION AND WELLNESS CENTER: PROVIDES PHYSICAL, OCCUPATIONAL, MASSAGE AND INDUSTRIAL REHABILITATION, AS WELL AS ORTHOPEDICS, SPORTS MEDICINE, WOMEN'S HEALTH, VESTIBULAR, FIBROMYALGIA AND CHRONIC PAIN PROGRAMS, AS WELL AS INDUSTRIAL AND SPECIALIZED HAND PROGRAMS. ADENA COUNSELING CENTER: PROVIDES A WIDE RANGE OF OUTPATIENT COUNSELING SERVICES, INCLUDING GROUP, INDIVIDUAL AND FAMILY COUNSELING. A VARIETY OF SUPPORT GROUPS ALSO MEET AT THE CENTER. OFF-CAMPUS PHYSICIAN OFFICES: A NUMBER OF PHYSICIAN OFFICES ARE LOCATED THROUGHOUT THE REGION SERVED BY ADENA. THESE INCLUDE OFFICES FOR FAMILY PHYSICIANS, ENDOCRINOLOGISTS, GERONTOLOGISTS AND UROLOGISTS. TELEMEDICINE: IN 2011, THE HEALTH SYSTEM CONTINUED ITS AFFILIATION WITH THE SOUTHERN OHIO HEALTH CARE NETWORK (SOHCN), A PARTNERSHIP OF THE REGION'S THREE LARGEST HEALTHCARE PROVIDERS -- ADENA, O'BLENESS HEALTH SYSTEM AND HOLZER CONSOLIDATED HEALTH SYSTEMS. THIS PARTNERSHIP HAS RESULTED IN THE CONSTRUCTION OF AN EXPANSIVE FIBER OPTIC BROADBAND TELECOMMUNICATIONS NETWORK TO SERVE THE HEALTHCARE AND EDUCATIONAL NEEDS OF PEOPLE LIVING IN OHIO'S APPALACHIAN REGION. THROUGH THIS TECHNOLOGY, TELEMEDICINE IS ENABLING PATIENTS TO BE ON ADENA'S CAMPUS, BUT TREATED BY PHYSICIANS OUTSIDE THE REGION. ADENA HAS TELEMEDICINE RELATIONSHIPS WITH OHIO STATE UNIVERSITY MEDICAL CENTER, RIVERSIDE METHODIST HOSPITAL, AND NATIONWIDE CHILDREN'S HOSPITAL IN COLUMBUS. X X X X 0 0 0 0 0 0 0 0 0 CATHERINE FARINET 50890 185171 0 0 0 398 0 0 0 13853 50890 199422 0 0 CRAIG SOLLE 22213 128114 0 0 0 368 0 8464 0 17065 22213 154011 0 0 CINDY INGRAM 42425 164977 0 0 0 131 0 162 0 19423 42425 184693 0 0 DAVID KESSLER 43136 179257 0 0 0 379 0 0 0 0 43136 179636 0 0 ELLIS FRAZIER 34045 126268 0 0 0 468 0 0 0 5607 34045 132343 0 0 JOHN CRAWFORD 35165 111871 0 0 0 305 0 0 0 15991 35165 128167 0 0 PART I, LINE 3 PIKE HEALTH SERVICES, INC. WAS ACQUIRED DURING 2012 BY ADENA HEALTH SYSTEM. THE METHODS DISCLOSED ON SCHEDULE J, PART I, LINE 3 DIRECTLY RELATE TO THE METHODS USED BY PIKE HEALTH SERVICES, INC. TO DETERMINE TOP MANAGEMENT OFFICIAL'S COMPENSATION BEFORE THE ACQUISITION. POST ACQUISITION, THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IS REVIEWED ON A BI-ANNUAL BASIS IN CONJUNCTION WITH OTHER MANAGEMENT POSITIONS BY THE HUMAN RESOURCE DEPARTMENT OF ADENA HEALTH SYSTEM, A RELATED ENTITY, WHICH IS RESPONSIBLE FOR EMPLOYEE COMPENSATION. IN ADDITION TO AN THE USE OF AN INDEPENDENT CONSULTANT, VARIOUS MARKET SURVEYS ARE USED AS APPROPRIATE FOR THE APPLICABLE POSITIONS AND RECOMMENDATIONS FOR SALARY SCALE CHANGES ARE APPROVED BY THE HUMAN RESOURCES COMMITTEE OF THE ADENA HEALTH SYSTEM BOARD OF DIRECTORS, A RELATED ENTITY. SPECIFIC WAGE INCREASES FOR INDIVIDUALS ARE BASED ON THE EMPLOYEE MEETING AGREED UPON DEVELOPMENTAL AND PERFORMANCE-BASED GOALS FOR THE FISCAL YEAR. THE PROCESS WAS LAST UNDERTAKEN DURING 2012 AND ALSO IN APRIL/JUNE 2013. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S GOVERNING DOCUMENTS HAVE BEEN UPDATED TO ALIGN WITH THE GOVERNING DOCUMENTS OF ADENA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PIKE HEALTH SERVICES, INC. IS ADENA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A PIKE HEALTH SYSTEM, INC. ELECTS AND APPOINTS MEMBERS TO THE GOVERNING BODY SUBJECT TO THE APPROVAL ADENA HEALTH SYSTEM, THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNING DECISIONS ARE SUBJECT TO THE APPROVAL OF ADENA HEALTH SYSTEM, THE SOLE MEMBER OF PIKE HEALTH SERVICES, INC. FORM 990, PART VI, SECTION B, LINE 11 THE CEO OR VICE PRESIDENT OF FINANCE REVIEWS THE FORM 990 AND THE BOARD WILL BE PRESENTED WITH A COPY OF THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICE OF ADENA HEALTH SYSTEM, PIKE HEALTH SERVICES, INC.'S SOLE MEMBER, ANNUALLY COORDINATES THE DISTRIBUTION AND RETURN OF THE CONFLICT OF INTEREST STATEMENTS. THE CORPORATE COMPLIANCE OFFICE IS RESPONSIBLE FOR REVIEWING THE RESPONSES AND COMMUNICATING ANY EXTRA STEPS THAT NEED TO TAKE PLACE REGARDING ANY OF THE RESPONSES. AT EVERY BOARD MEETING AND COMMITTEE OF THE BOARD, THE AGENDA ITEM OF CONFLICT OF INTEREST IS INCLUDED AND CALLED OUT. CONFLICTED BOARD MEMBERS ABSTAIN FROM VOTING ON THE PARTICULAR ITEMS. ANY MEMBER ABSTAINING FROM VOTING IS DOCUMENTED IN THE MINUTES. ALL ADENA HEALTH SYSTEM WORKFORCE MEMBERS AND BOARD MEMBERS ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE TOP MANAGEMENT OFFICIAL AT PIKE HEALTH SERVICES, INC., ALONG WITH ANY KEY EMPLOYEES HAVE THEIR COMPENSATION REVIEWED ON A BI-ANNUAL BASIS IN CONJUNCTION WITH OTHER MANAGEMENT POSITIONS BY THE HUMAN RESOURCE DEPARTMENT RESPONSIBLE FOR EMPLOYEE COMPENSATION. VARIOUS MARKET SURVEYS ARE USED AS APPROPRIATE FOR THE APPLICABLE POSITIONS AND RECOMMENDATIONS FOR SALARY SCALE CHANGES ARE APPROVED BY THE HUMAN RESOURCES COMMITTEE OF THE ADENA HEALTH SYSTEM BOARD OF DIRECTORS, A RELATED ENTITY. SPECIFIC WAGE INCREASES FOR INDIVIDUALS ARE BASED ON THE EMPLOYEE MEETING AGREED UPON DEVELOPMENTAL AND PERFORMANCE-BASED GOALS FOR THE FISCAL YEAR. THE PROCESS WAS LAST UNDERTAKEN DURING 2012 AND ALSO IN APRIL/JUNE 2013. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: REDUCTION IN INHERENT CONTRIBUTION FROM PIKE FOR BEG. UNRSCT NET ASSETS -2,371,724. ADJUSTMENT TO REDUCTION IN INHERENT CONTRIBUTION FOR 2 MONTHS OF ACTIVITY 350,087. INHERENT CONTRIBUTION FROM ACQUISITION OF PIKE HEALTH SERVICES INC 5,178,966. FORM 990, PART XII, LINE 2C: ADENA HEALTH SYSTEM'S BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. PIKE HEALTH SERVICES, INC. IS PART OF ADENA HEALTH SYSTEM'S CONSOLIDATED AUDIT. GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD OH 45123 310993422 HOSPITAL OH 501(C)(3) 3 ADENA HEALTH SYSTEM 1 ADENA HEALTH FOUNDATION 242 HOSPITAL ROAD CHILLICOTHE OH 45601 753008742 FUNDRAISING OH 501(C)(3) 11A ADENA HEALTH SYSTEM 1 SOUTHERN OHIO HEALTHCARE NETWORK 550 MIRABEAU ST GREENFIELD OH 45123 261566590 FIBEROPTIC NETWORK GRANTS OH 501(C)(3) 11A ADENA HEALTH SYSTEM 1 ADENA HEALTH SYSTEM 242 HOSPITAL ROAD CHILLICOTHE OH 45601 314379443 HOSPITAL OH 501(C)(3) 3 N/A 0 ADENA CARE 272 HOSPITAL ROAD CHILLICOTHE OH 45601 453980850 PROVIDE EMPLOYEE HEALTH INSURANCE OH N/A C 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 ADENA HEALTH SYSTEM C 5178966 BOOK VALUE ADENA HEALTH SYSTEM O 9979354 TIME SHEET ALLOCATION