2011-08-11T12:00:15-05:00 2010-12-31 CROWE HORWATH LLP 3815 River Crossing Parkway Suite 300 Indianapolis IN 462400977 990 2010-01-01 344428598 WAYNE HOSPITAL COMPANY WAYN 9375481141 835 SWEITZER STREET GREENVILLE OH 45331 WAYNE DESCHAMBEAU 2011-08-10 true 3175698989 2010 2016-02-24 21:20:13Z WAYNE HEALTHCARE WAYNE DESCHAMBEAU PRES & CEO 835 SWEITZER STREET GREENVILLE OH 45331 157017343 false X WWW.WAYNEHEALTHCARE.COM X 1922 OH THE MISSION OF WAYNE HOSPITAL CORPORATION IS TO PROVIDE OUTPATIENT AND INPATIENT SERVICES TO THOSE IN NEED REGARDLESS OF THEIR ABILITIY TO PAY. SCHEDULE H PROVIDES INFORMATION ABOUT WAYNE HOSPITAL CORPORATION PROVIDING CARE REGARDLESS OF PATIENT'S ABILITY TO PAY. 13 10 679 118 0 0 388223 132889 55176785 58117193 1274615 6110235 431411 395113 57271034 64755430 32000 136318 0 0 25904080 29023602 0 0 114512 27975776 29525342 53911856 58685262 3359178 6070168 134188715 117124174 56178959 39101379 78009756 78022795 X THE MISSION OF WAYNE HOSPITAL CORPORATION IS TO PROVIDE OUTPATIENT AND INPATIENT SERVICES AT A LEVEL TO RANK PROMINENTLY ON A REGIONAL AND NATIONAL BASIS FOR QUALITY OF CARE, PATIENT SATISFACTION AND SPIRITUALITY SUPPORT. THE HOSPITAL COLLABORATES WITH OTHER HEALTH CARE PROVIDERS TO DEVELOP NEW AND/OR IMPROVED SERVICES FOR RESIDENTS OF DARKE COUNTY, OHIO. (CONTINUED ON SCHEDULE O). false 48368201 104318 58000286 AS A FULL-SERVICE PRIMARY CARE FACILITY, WAYNE HOSPITAL OFFERS PHYSICIANS AND THEIR PATIENTS ACCESS TO A VARIETY OF INPATIENT AND OUTPATIENT SERVICES INCLUDING: EMERGENCY, RADIOLOGY, MATERNITY/SPECIAL BEGINNINGS, SURGERY, HEART HEALTH, CANCER CARE, REHABILITATION SERVICES, LABORATORY, CHRONIC DIALYSIS CENTER, AMBULATORY CARE, OUTPATIENT REHABILITATION, DIABETES EDUCATION PROGRAM, SLEEP CARE SERVICES, AND ENTEROSTOMAL THERAPY. THE HOSPITAL HAD APPROXIMATELY 2,545 ADMISSIONS AND 88,798 OUTPATIENT VISITS IN 2010. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. IN ADDITION TO THE FINANCIAL ASSISTANCE PROVIDED, WAYNE HOSPITAL ALSO IS PROACTIVE IN SUPPORTING COMMUNITY WELLNESS THROUGH HEALTH SCREENINGS, EDUCATION, AND HEALTH MANAGEMENT. 202297 32000 18364 WAYNE HOSPITAL HAS MANY ADDITIONAL PROGRAMS. ONE ADDITIONAL PROGRAM IS THE COUNTY HEALTH FAIR IN WHICH EMPLOYEES FROM THE HOSPITAL PROVIDE OVER 120 HOURS OF TIME TO HELP WITH HEALTH SCREENINGS AND PROVIDE EDUCATIONAL INFORMATION TO THE COMMUNITY. ANOTHER PROGRAM IS THE VARIOUS DIABETES SEMINARS AND CLASSES HELD AT WAYNE HOSPITAL WHICH PROVIDE INFORMATION TO THE PUBLIC ON DIABETES AWARENESS, OFFER THE COMMUNITY HEALTH SCREENINGS FOR DIABETES, AND EDUCATE THOSE WITH DIABETES ABOUT MANAGING THE DISEASE. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT OVER 285 HOURS OF TIME ON THE DIABETES SEMINARS AND CLASSES AND THE HOSPITAL HAS CONTRIBUTED $730 OF SUPPLIES TO THE PROGRAM. AN ADDITIONAL PROGRAM OF WAYNE HOSPITAL IS THE CANCER AWARENESS, PREVENTION, AND SCREENING PROGRAM IN WHICH THE HOSPITAL OFFERS SEMINARS AND CLASSES TO THE COMMUNITY IN ORDER TO PROMOTE AWARENESS, TEACH WAYS OF PREVENTION, AND OFFER HEALTH SCREENINGS TO THE COMMUNITY. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT OVER 115 HOURS OF TIME ON THE CANCER AWARENESS SEMINARS. 48570498 true true false true false false false false true true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 69 0 true 679 true false false false false false false false false false false X 13 10 false false false false false false false true true false true true true true true true true true true false false X WAYNE DESCHAMBEAU 9375475722 835 SWEITZER STREET GREENVILLE OH 45331 DAN FRANZ 1 X 0 0 0 BRAD BIXLER 1 X X 0 0 0 PHILLIP GARBIG 1 X X 0 0 0 PHILIP DUBBS 1 X 0 0 0 THOMAS BROWN MD 1 X 0 0 0 ROXANNE CECH MD 1 X 0 0 0 CINDY SCOTT 1 X 0 0 0 JOHN SWALLOW 1 X X 0 0 0 LARRY ROLL 1 X 0 0 0 LUCILLE HOSFELD 1 X 0 0 0 WILLIAM JOHNSTON 1 X 0 0 0 MIKE GRAY 1 X 0 0 0 JAMES APPLEMAN MD 1 X 0 0 0 WAYNE DESCHAMBEAU 40 X 232914 0 36043 DENNIS LOCKARD 40 X 152438 0 25258 PETER LACHIEWICZ 40 X 519439 0 47007 PATRICK KARR 40 X 499901 0 46781 DANIEL MCKELLAR 40 X 565058 0 20206 JOHN A DUTRO 40 X 347615 0 29976 DAVID M WARE 40 X 309331 0 28971 2626696 0 234242 15 false true false MESSER CONSTRUCTION CO 4801 HEMPSTEAD DR DAYTON OH 45429 CONTRACTOR SERVICES 4860924 CPSI PO BOX 850309 MOBILE AL 366850309 SOFTWARE AND CLINICAL PROVIDER 552209 NORTH DAYTON PATHOLOGISTS 2222 PHILADELPHIA DR DAYTON OH 45406 PATHOLOGY CONSULTING SERVICES 466263 MANAGECAST TECHNOLOGIES PO BOX 778 BATAVIA OH 45103 IT CONSULTING SERVICES 448520 WEST CENTRAL OHIO HOSPITAL CONS PO BOX 35381 CANTON OH 44735 MRI SERVICES 393283 22 3000 129889 132889 PATIENT SERVICE REVENUE 57782601 57782601 RENTAL INCOME 334592 334592 0 0 0 0 58117193 1209074 1209074 0 0 0 0 0 97162073 1001 92207272 54641 4954801 -53640 4901161 4901161 0 0 27640 27640 27640 FOOD SALES 131424 131424 REBATE REVENUE 82371 82371 HOUSEKEEPING 79608 79608 74070 74070 0 0 367473 64755430 58018650 0 6603891 134318 134318 2000 2000 0 0 446654 446654 0 22368972 20185790 2183182 517338 466847 50491 4043498 3612224 431274 1647140 1449483 197657 0 153694 28370 125324 212040 212040 0 0 1798220 1798220 5854689 4208329 1646360 127484 1166 33962 92356 507896 323716 177305 6875 216676 59328 157348 0 1836173 1318362 517811 54039 26626 27413 0 36163 30376 5787 935298 935298 0 4686239 4019275 666964 709143 490808 218335 SUPPLIES 5896670 5803944 77572 15154 BAD DEBT 6371998 6371998 MISCELLANEOUS 128920 37538 91255 127 0 0 0 0 58685262 48570498 10000252 114512 0 2100195 11965119 12331990 4344609 5926618 7144613 82731 38115 886706 1273400 867388 503849 94243482 36598830 48058158 57644652 61191609 32343498 123166 133355 0 2620154 1732964 134188715 117124174 5211874 5973244 46865000 30000000 4102085 3128135 56178959 39101379 X 77833720 77845708 163116 164167 12920 12920 78009756 78022795 134188715 117124174 X 6070168 -6057129 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 false false false false false false false false true 1141 1141 false 0 Description of other lobbying activities Schedule C, Part II-B, Line 1i WAYNE HOSPITAL COMPANY PAYS DUES TO THE OHIO HOSPITAL ASSOCIATION. A PORTION OF THOSE DUES ($1,141) IS SPENT ON LOBBYING. 195314 0 3051 2000 0 0 196365 236705 0 6844 2000 46235 0 195314 236705 0 0 0 0 0 236705 0.0982 0.0658 0.836 false false 1957475 1957475 65741650 22751428 42990222 2848221 1202724 1645497 23415108 12644678 10770430 281028 281028 57644652 0 ESTIMATED THIRD PARTY SETTLEMENTS 433970 INTEREST RATE SWAP LIABILITY 2675594 ESTIMATED ASSET RETIREMENT OBLIGATION 18571 3128135 64755430 58685262 6070168 -2990345 -3066784 -6057129 13039 58873263 -2990345 108810 -2881535 61754798 3000632 3000632 64755430 58860224 174962 174962 58685262 0 0 58685262 Intended uses of endowment funds Schedule D, Part V, Line 4 ENDOWMENT FUNDS ARE SPECIFICALLY SET ASIDE FOR CLINICALLY RELATED SCHOLARSHIPS GRANTED TO STUDENTS GOING INTO A HEALTH RELATED FIELD OF STUDY AND FOR INDIGENT CARE. FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A). U.S. GAAP REQUIRES THAT A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. DUE TO ITS TAX-EXEMPT STATUS, THE HOSPITAL IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE HOSPITAL'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF OHIO FOR THE LAST THREE YEARS. THE HOSPITAL DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. THE HOSPITAL RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE HOSPITAL DID NOT HAVE ANY AMOUNTS RECORDED FOR INTEREST AND PENALTIES AT DECEMBER 31, 2010 AND 2009. Other changes in net assets Schedule D, Part XI, Line 8 CHANGE IN INTEREST OF RELATED ENTITIES - 55170; CHANGE IN VALUE OF INTEREST RATE SWAP - -121322; LOSS ON DISPOSITION OF DEFERRED FINANCING COSTS - -3000632; Other revenues in audited financial statements not in form 990 Schedule D, Part XII, Line 2d CHANGE IN INTEREST OF RELATED ENTITIES - 55170; LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT - 53640; Other revenues in form 990 not in audited financial statements Schedule D, Part XII, Line 4b LOSS ON DISPOSITION OF DEFERRED FINANCING COSTS - 3000632; Other expenses in audited financial statements not in form 990 Schedule D, Part XIII, Line 2d CHANGE IN VALUE OF INTEREST RATE SWAP - 121322; LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT - 53640; true true X true X true X true false false 2106046 0 2106046 0.0403 1299184 0 1299184 0.0248 1612619 0 1612619 0.0308 0 0 5017849 0 5017849 0.0959 19708 224 19484 0.0004 0 0 0 0.000 0 0 0 0.000 0 0 0.000 150589 18140 132449 0.0025 0 0 170297 18364 151933 0.0029 0 0 5188146 18364 5169782 0.0988 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 30000 30000 0.0005 0 0.000 0 0 30000 0 30000 0.0005 false 2990144 0 53059000 44608398 8450602 X true false WEST CENTRAL OHIO HOSPITAL CONSORTIUM LTD PARTNERSHIP FOR MOBILE MRI UNIT 0.3333 0 0 1 1 WAYNE HOSPITAL COMPANY

835 SWEITZER STREET GREENVILLE OH 45331

X X X X 1 WAYNE HOSPITAL COMPANY PROFESSIONAL SERVICES LLC

835 SWEITZER STREET GREENVILLE OH 45331

PHYSICIAN PROFESSIONAL SERVICES ORGANIZATION Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 6,371,998 Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 A COST-TO-CHARGE RATIO WAS USED FOR THE FIGURES REPORTED IN THE TABLE AND WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. Community Building Activities Schedule H, Part II WAYNE HOSPITAL COMPANY GRANTED $30,000 TO THE EDISON FOUNDATION, WHICH SUPPORTS EDISON COMMUNITY COLLEGE. THE GRANT WAS INTENDED TO BE USED FOR A NEW FACILITY ON THE CAMPUS OF EDISON COMMUNITY COLLEGE FOR HEALTHCARE EDUCATION. IN ADDITION TO THE GRANT TO THE EDISON FOUNDATION, WAYNE HOSPITAL COMPANY ALLOWS CLINICALS TO BE COMPLETED AT THE WAYNE HOSPITAL FACILITY SO THAT STUDENTS OF EDISON COMMUNITY COLLEGE CAN EARN REGISTERED NURSING DEGREES. WAYNE HOSPITAL'S CONTINUOUS SUPPORT OF HEALTHCARE EDUCATION PROMOTES HEALTH WITHIN THE COMMUNITY IT SERVES. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE BAD DEBT EXPENSE IN SCHEDULE H, PART III, LINE 2 IS DETERMINED USING THE COST TO CHARGE RATIO. THE WAYNE HOSPITAL COMPANY FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE DESCRIBING THE BAD DEBT EXPENSE. THE FINANCIAL STATEMENTS ACCOUNT FOR BAD DEBT BY CALCULATING THE CHARGES TO REVENUE THAT WERE WRITTEN OFF AS UNCOLLECTIBLE. THE HOSPITAL HAS AN EFFICIENT AND EFFECTIVE PROCEDURE IN PLACE TO IDENTIFY ALL PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE MEDICARE ALLOWABLE COSTS ARE DETERMINED USING THE COST TO CHARGE RATIO. Other collection actions permitted Schedule H, Part V Section B, Line 15e (1) WAYNE HOSPITAL COMPANY - WAGE GARNISHMENT; Other collection actions Schedule H, Part V Section B, Line 16e (1) WAYNE HOSPITAL COMPANY - WAGE GARNISHMENT; Other actions taken before collection actions Schedule H, Part V Section B, Line 17e (1) WAYNE HOSPITAL COMPANY - WAYNE HEALTHCARE SENDS OUT 3 STATEMENTS AND 2 PRECOLLECT LETTERS PRIOR TO TURNING OVER A PATIENT TO AN AGENCY.; Means used to determine amounts billed Schedule H, Part V Section B, Line 19d (1) WAYNE HOSPITAL COMPANY - WAYNE HEALTHCARE PROVIDES A 25% DISCOUNT TO PATIENTS WHO DID NOT HAVE INSURANCE COVERAGE DURING CARE. ADDITIONALLY, PATIENTS HAVE THE ABILITY TO APPLY FOR CHARITY CARE, FINANCIAL ASSISTANCE, AND MAKE PAYMENT ARRANGEMENTS.; Gross Charges for Medical Care Schedule H, Part V Section B, Line 21 (1) WAYNE HOSPITAL COMPANY - EACH PATIENT IS CHARGED THE SAME RATE OF GROSS CHARGES REGARDLESS OF THE TYPE OF COVERAGE, IF ANY, THAT THE PATIENT HAS.; Needs assessment. Schedule H, Part VI, Line 2 THE ORGANIZATION ASSESES THE NEEDS OF THE COMMUNITY BY REACHING OUT TO LOCAL ORGANIZATIONS TO SURVEY THE HEALTH NEEDS OF THEIR EMPLOYEES. ADDITIONALLY THE HOSPITAL ASSESSES THE TRENDS OF INPATIENT ADMISSIONS TO DETERMINE WHAT THE CURRENT NEEDS ARE AND WHAT ADDITIONAL PROGRAMMING MAY BEENFIT THE NEEDS OF THE COMMUNITY. WAYNE HOSPITAL COMPANY IS WORKING WITH DARKE COUNTY HEALTH DEPARTMENT TO COMPLETE A NEEDS ASSESSMENT IN 2011 AND 2012. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 WAYNE HOSPITAL PROVIDES PAMPHLETS TO PATIENTS THAT DESCRIBE THE FINANCIAL ASSISTANCE POLICIES. THERE IS SIGNAGE UP THROUGHOUT THE KEY PATIENT AREAS IN THE HOSPITAL ALONG WITH FINANCIAL ASSISTANCE APPLICATIONS. THE HOSPITAL'S WEBSITE HAS THE FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO THE PATIENTS. WAYNE HOSPITAL SENDS A FINANCIAL COUNSELOR TO SPEAK WITH OUR INPATIENTS THAT MAY BE ELIGIBLE FOR ASSISTANCE. FINALLY, WAYNE HOSPITAL PUTS THE FINANCIAL ASSISTANCE APPLICATION DIRECTLY ON THE BACK OF ALL PATIENT STATEMENTS SO THAT THE PATIENT HAS IMMEDIATE ACCESS TO THE APPLICATION. Community information. Schedule H, Part VI, Line 4 WAYNE HOSPITAL SERVES THE DARKE COUNTY COMMUNITY. DARKE COUNTY IS MAINLY A RURAL FARMING COMMUNITY WITH A POPULATION OF OVER 50,000. APPROXIMATELY 10% OF THE COUNTY INCOME LEVEL IS UNDER THE FEDERAL POVERTY GUIDELINES AND 12.7% OF THE REVENUES FOR THE HOSPITAL WERE MEDICAID PATIENTS IN 2010. THE COUNTY UNEMPLOYMENT RATE IN 2010 WAS 9.1%. WAYNE HOSPITAL IS THE ONLY HOSPITAL WITHIN THE COUNTY AND THERE IS A FEDERALLY QUALIFIED HEALTH CENTER THAT SERVES THE COUNTY AND THEREFORE PROVIDES A SIGNIFICANT AMOUNT OF REFERRALS TO THE FACILITY. Promotion of community health Schedule H, Part VI, Line 5 WAYNE HOSPITAL'S GOVERNING BODY IS COMPRISED OF LOCAL COMMUNITY AND COUNTY RESIDENTS WHO HAVE A VESTED INTEREST IN THE VIABILITY OF THE FACILITY. THE MEMBERS ARE ATTORNEYS, BANK EXECUTIVES, SCHOOL OFFICIALS, RETIRED BUSINESS OWNERS, AND OTHER LOCAL MEDICAL PROFESSIONALS. WAYNE HOSPITAL EXTENDS STAFF PRIVILEGES NOT ONLY TO OUR EMPLOYED PHYSICIANS, BUT TO THE COMMUNITY'S MEDICAL PROFESSIONALS AS WELL IN ORDER TO KEEP AS MUCH OF OUR PATIENT POTENTIAL AT THE FACILITY AS POSSIBLE. WAYNE HOSPITAL COMPLETED ITS MAJOR CONSTRUCTION PROJECT IN 2010 TO EXPAND OUR EMERGENCY DEPARTMENT, OPERATING AND PRE/POST CARE AREAS, RADIOLOGY AND CARDIOPULMONARY DEPARTMENTS, AND A NEW STATE OF THE ART ICU. THERE WAS A GREAT NEED TO EXPAND THE SPACE FOR THESE SERVICES TO IMPROVE PATIENT CARE AND PATIENT PRIVACY. IN ADDITION, WAYNE HOSPITAL IS OFFERING NEW SERVICES FOR OUR CANCER PATIENTS AND LOOKING TO EXPAND THESE IN 2010 AND BEYOND. true THE EDISON FOUNDATION 1973 EDISON DR PIQUA OH 45356 311379781 501(C)(3) 30000 0 N/A N/A BUILD NEW FACILITY VERSAILLES AREA HISTORICAL SOCIETY PO BOX 54 VERSAILLES OH 45380 270896150 501(C)(3) 104318 BOOK VALUE BUILDING AND LAND USE OF BUILDING AND LAND 2 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE GRANT FUNDS PAID TO THE EDISON FOUNDATION WERE INTENDED TO BE USED FOR A NEW FACILITY FOR HEALTHCARE EDUCATION. THE ORGANIZATION CONFIRMED THAT THE FUNDS WILL BE USED FOR THIS PURPOSE IN A LETTER TO WAYNE HOSPITAL AS A RECEIPT FOR THEIR CONTRIBUTION. THE LAND AND BUILDING WERE GRANTED TO VERSAILLES AREA HISTORICAL SOCIETY BY MEANS OF A WARRANTY DEED. IF THE HISTORICAL SOCIETY DOES NOT USE THE BUILDING AND LAND IN ACCORDANCE WITH THEIR CHARITABLE PURPOSE, WAYNE HOSPITAL HAS THE OPTION OF BUYING BACK THE LAND AND BUILDING FOR $1 PURSUANT TO THE DEED. X true true X X X X false false false true false false false false false WAYNE DESCHAMBEAU 205414 0 27500 0 0 0 14440 0 21603 0 268957 0 0 0 DENNIS LOCKARD 144898 0 0 0 7540 0 4280 0 20978 0 177696 0 0 0 PETER LACHIEWICZ 403754 0 115685 0 0 0 24080 0 22927 0 566446 0 0 0 PATRICK KARR 354960 0 144941 0 0 0 24080 0 22701 0 546682 0 0 0 DANIEL MCKELLAR 350068 0 214990 0 0 0 7580 0 12626 0 585264 0 0 0 JOHN A DUTRO 303357 0 44258 0 0 0 7580 0 22396 0 377591 0 0 0 DAVID M WARE 250014 0 59317 0 0 0 7580 0 21391 0 338302 0 0 0 Housing allowance or residence for personal use Schedule J, Part I, Line 1a WAYNE HOSPITAL PROVIDES A HOUSE THAT IS OWNED BY THE HOSPITAL FOR USE BY THE CFO. THE HOUSE IS LOCATED RIGHT NEXT TO THE HOSPITAL AND WILL EVENTUALLY BE TORN DOWN AND TURNED INTO PARKING SPACE. THIS WAS TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUAL. Compensation contingent on revenues of the organization Schedule J, Part I, Line 5a THE ORGANIZATION PAYS THE PHYSICIAN STAFF BONUSES BASED ON THE REVENUES OF THE ORGANIZATION. BONUS AMOUNTS ARE DEPENDENT UPON THE REVENUE GENERATED BY THE LLC ATTRIBUTED TO THE PHYSICIANS. COUNTY OF DARKE OHIO 346400036 2010-11-01 30000000 CURRENTLY REFUND PORTION OF 11/1/2007 BONDS false false false 0 0 30000000 0 0 0 0 0 0 0 0 0 2010 true false true true false false false false true 0.000 0.000 0.000 true false true false 0.0 false 0.0 false true ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 (CONTINUED FROM PART III) THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SCHEDULE H PROVIDES INFORMATION ABOUT WAYNE HOSPITAL CORPORATION PROVIDING CARE REGARDLESS OF PATIENT'S ABILITY TO PAY. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b A COPY OF THE DRAFT OF THE FORM 990 IS SENT TO EACH VOTING MEMBER OF THE GOVERNING BODY PRIOR TO THE BOARD MEETING IN WHICH THE CONTROLLER PRESENTS THE MAJOR ITEMS RELATING TO THE FORM 990. AFTER THE PRESENTATION, THE BOARD HAS THE OPPORTUNITY TO ASK QUESTIONS AND THEN VOTES TO APPROVE THE FILING OF THE FORM 990. Conflict of interest policy Form 990, Part VI, Section B, Line 12c THE CONFLICT OF INTEREST POLICY IS SIGNED ANNUALLY BY ALL MANAGEMENT, SENIOR MANAGEMENT, OFFICERS, DIRECTORS, AND KEY EMPLOYEES. AFTER THE SIGNED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED, THEY ARE REVIEWED BY THE CONTROLLER. ANY CONFLICTS OF INTEREST THAT ARE DISCLOSED ARE DISCUSSED WITH THE BOARD CHAIR, WHO ENSURES THAT THE INTERESTED PERSON ABSTAINS FROM VOTING ON MATTERS RELATED TO THE CONFLICT OF INTEREST. Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE EXECUTIVE BOARD REVIEWS AND DETERMINES THE COMPENSATION FOR THE CEO. THEY USE COMPENSATION SURVEYS CONDUCTED BY AN INDEPENDENT CONSULTING COMPANY IN THEIR DECISION MAKING PROCESS. THE DELIBERATION AND DISCUSSION REGARDING THE CEO'S COMPENSATION IS INCLUDED IN THE BOARD MINUTES. THIS PROCESS IS COMPLETED FOR WAYNE DESCHAMBEAU, CEO AND WAS LAST UNDERTAKEN IN 2010. Public Disclosure 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 changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -2990345; CHANGE IN VALUE OF INTEREST RATE SWAP - -121322; CHANGE IN INTEREST OF RELATED ENTITIES - 55170; LOSS ON DISPOSITION OF DEFERRED FINANCING COSTS - -3000632; WAYNE HOSPITAL COMPANY PROFESSIONAL SERVICES LLC 835 SWEITZER STREET GREENVILLE OH 45331 270581440 PROFESSIONAL MEDICAL SERVICES OH -2171023 -1564155 NA THE WAYNE HOSPITAL FOUNDATION INC 835 SWEITZER STREET GREENVILLE OH 45331 260380696 FUNDRAISING OH 501(C)(3) 11 - Type I NA HEALTHWAY INC 835 SWEITZER STREET GREENVILLE OH 45331 311497938 PROVIDER NETWORK OH NA C CORPORATION 662 26911 1 false false true false false false false false false false true true true true false true false false