2011-11-14T15:07:05-06:00 2010-12-31 BLUE & CO LLC 8800 LYRA DRIVE SUITE 450 COLUMBUS OH 43240 990 2010-01-01 344429514 VAN WERT COUNTY HOSPITAL ASSOCIATION VANW 4192388609 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 MICHAEL T HOLLIDAY 4192388609 2011-11-14 1 NANCY KIRCHNER 6148852583 2010 2016-02-24 21:20:13Z MICHAEL T HOLLIDAY 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 53325759 0 X WWW.VANWERTHOSPITAL.ORG X 1905 OH PROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTINGS AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER. 12 11 468 242 242697 2200 313784 1068464 47707763 48131111 -430220 2473578 1439145 1486982 49030472 53160135 0 0 0 0 19695523 22135169 133939 4109 4109 25177783 26343417 45007245 48482695 4023227 4677440 68883484 73725020 16818183 14805096 52065301 58919924 PROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTING AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER. 0 0 36875375 48624179 PROVIDE INPATIENT PATIENT CARE SERVICES, OUTPATIENT CARE SERVICES, AND EMERGENCY CARE SERVICES. 36875375 1 1 0 1 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 468 0 1 468 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X MICHAEL HOLLIDAY 4192388609 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 MARK J MINICK 40.00 X X X 772753 0 15677 ANDY CZAJKOWSKI 2.00 X 0 0 0 GEORGE M BROOKS 2.00 X 0 0 0 ERIC JELINGER MD 2.00 X 0 0 0 JON BAGLEY 2.00 X X 0 0 0 BILL LUDWIG 2.00 X 0 0 0 JON A RHOADES 2.00 X 0 0 0 JOEL D KNERR MD 2.00 X X 0 0 0 BARB KOHNEN 2.00 X X 0 0 0 GARY ADAMS 2.00 X 0 0 0 AARON MECHLING 2.00 X 0 0 0 JOCELYN WRAY MD 2.00 X 0 0 0 MICHAEL HOLLIDAY 40.00 X X 184393 0 11270 CRAIG HANSON MD 40.00 X X 343342 0 10585 THOMAS CONTE MD 40.00 X X 427848 0 12492 MUHAMMED AL-FAWAKHIRI MD 40.00 X 174920 0 10208 SHANEETA JOHNSON MD 40.00 X X 296111 0 2686 SCOTT JARVIS MD 40.00 X X 262904 0 8335 DOUGLAS MOORE MD 40.00 X X 241596 0 7343 THOMAS LAUTZENHEISER MD 40.00 X 164871 0 9029 2868738 0 87625 9 0 1 0 WEIGAND CONSTRUCTION 7808 HONEYWELL DRIVE FORT WAYNE IN 46825 CONSTRUCTION & CONSTRUCTION MANAGEMENT 2993854 THERAPY SOLUTIONS 120 W MAIN STREET VAN WERT OH 45891 PHYSICAL THERAPY SERVICES 1249360 CLINICAL COLLEAGUES 613 TATEM AVE COLLINGSWOOD NJ 08108 ANESTHESIA PROFESSIONAL SERVICES 1023219 MORRISON MANAGEMENT SPECIALISTS 39395 W 12 MILE RED SUITE 101 FARMINGTON HILLS MI 48331 FOOD SERVICE MANAGMENT 570294 SIEMENS MEDICAL SOLUTIONS USA 51 VALLEY STREAM PARKWAY MALVERN PA 19355 INFORMATION SYSTEMS 545555 18 775098 293366 1068464 NET PATIENT SERVICE RE 900099 48131111 48131111 48131111 219207 219207 979106 979106 979106 242697 736409 2397826 9436 152891 2397826 -143455 2254371 2254371 27541 12733 14808 14808 CAFETERIA/CATERING 900099 272230 272230 WELLNESS INCOME 900099 139406 139406 MISCELLANEOUS INCOME 900099 81432 81432 493068 53160135 48624179 242697 3224795 2822363 2822363 12738604 9426567 3312037 448885 332175 116710 5130089 3796266 1333823 995228 736469 258759 481052 481052 95258 14289 80969 606339 606339 4109 4109 7244055 7244055 339808 299031 40777 545555 354611 190944 1976596 1620809 355787 93336 28001 65335 417434 354819 62615 2351719 1740272 611447 428581 317150 111431 MEDICAL & OTHER SUPPLIE 6047217 4474941 1572276 BAD DEBT EXPENSE 2955167 2955167 MISCELLANEOUS 2327930 2327930 NUTRITIONAL SERVICES 288385 213405 74980 BIO-MED ENGINEERING 144985 144985 48482695 36875375 11603211 4109 1556478 783812 443413 6143864 5601265 671307 712411 946537 512376 56397718 35505901 17319355 20891817 39329284 38735005 2473246 6488334 68883484 73725020 4161134 4224168 9400693 7597814 2841673 2113615 414683 869499 16818183 14805096 X 47307208 54475361 1474078 1131000 3284015 3313563 52065301 58919924 68883484 73725020 X 4677440 2177183 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3892 3892 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION IS USED FOR POLITICAL PURPOSES. 6496893 29533 612733 -217775 -27348 7384282 5715171 2535 1004939 -202203 -23549 6496893 5998772 63420 -1216525 -207220 -27917 4610531 0.52500 0.47500 0.00000 0 0 27966499 35505901 -7539402 735249 735249 27362686 27362686 333284 333284 20891817 DEBT ISSUANCE COST, NET 56350 INVESTMENT IN JOINT VENTURE 617511 OTHER ASSETS 1044640 UNCONDITIONAL PROMISES TO GIVE 872933 ASSETS WHOSE USE IS LIMITED 3896900 6488334 THIRD PARTY SETTLEMENTS 454639 INTEREST RATE SWAP 154739 ESTIMATED LIABILITY CLAIMS 51000 PENSION LIABILITY 209121 869499 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INVESTMENT INCOME GENERATED BY THE ENDOWMENT FUNDS DISTRIBUTED TO THE HOSPITAL IS ABLE TO BE USED FOR GENERAL OPERATING AND CAPITAL EQUIPMENT NEEDS. VAN WERT COMMUNITY HOSPITAL GOLF OU 27541 27541 608 4482 7643 27541 27541 608 4482 7643 12733 14808 1 1 1 X 1 X 1 1 1 0 1 1 1121 205069 205069 0.00420 14700 6058114 2770195 3287919 0.06780 1034 446205 273073 173132 0.00360 16855 6709388 3043268 3666120 0.07560 3545 126159 1170 124989 0.00260 395 12580 12580 0.00030 6911 1005497 825752 179745 0.00370 157 34407 34407 0.00070 11008 1178643 826922 351721 0.00730 27863 7888031 3870190 4017841 0.08290 57 67583 67583 0.00140 57 67583 67583 0.00140 0 1477315 29546 14420347 16578400 -2158053 X 1 1 1 VAN WERT MEDICAL SERVICES MEDICAL PROFESSIONAL SERVICES 1.00000 2 SARAH JANE LIVING CENTER LONG TERM ALZHEIMER'S CARE 0.50000 3 HOME HEALTH CARE SOLUTIONS HOME HEALTHCARE SERVICES 0.50000 4 THERAPY SOLUTIONS PHYSICAL THERAPY SOLUTIONS 0.50000 5 COMMUNITY CARE SYSTEMS MANAGED CARE CONTRACTING 0.50000 0.50000 4 1 VAN WERT COUNTY HOSPITAL

1250 WASHINGTON STREET VAN WERT OH 45891

X X X DISPROPORTIONATED SHARE HOSPITAL 2 VAN WERT HEALTH CENTER

140 FOX ROAD VAN WERT OH 45891

OUTPATIENT DIAGNOSIS 3 SARAH JANE LIVING CENTER

328 W 2ND ST DELPHOS OH 45833

LONG TERM ALZHEIMERS CARE 4 VANCREST OF CONVOY

510 TULLY DR CONVOY OH 45832

LONG TERM NURSING CARE THE VAN WERT COUNTY HOSPITAL ASSOCIATION 1 PART I, LINE 3C: THE ORGANIZATION USED THE FPG TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. PART I, LINE 7: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. PART II: THE HOSPITAL ENGAGES IN A NUMBER OF HEALTH COALITION INITIATIVES TO IMPROVE HEALTH STATUS OF OUR POPULATION. THE HOSPITAL PROVIDED A STARTUP GRANT & ONGOING SUPPORT FOR THE FAMILY HEALTH CARE OF NORTHWEST OHIO, A FQHC CURRENTLY WITH LOOK-ALIKE STATUS. FAMILY HEALTH CARE OF NORTHWEST OHIO IS CURRENTLY SERVING RESIDENTS OF VAN WERT, PAULDING & MERCER COUNTIES. THROUGH THE HOSPITAL'S HELP OF PROVIDING PRIMARY CARE PHYSICIANS AND FUNDING, THIS CLINIC SERVES AS A SAFETY NET PROVIDER TO CITIZENS THAT CURRENTLY HAD NO PRIMARY CARE PHYSICIAN OR ACCESS TO PRIMARY CARE SERVICES. IN 2009, THE HOSPITAL UNDERTOOK AN EXPANSION OF OUR EMERGENCY SERVICES DEPARTMENT, BECAUSE OF INCREASING VISITS DUE TO ECONOMIC, BEHAVIORAL, AND AGING POPULATION THE HOSPITAL EXPERIENCED INCREASING VOLUMES. IN PARTNERSHIP WITH OUR COMMUNITY THROUGH A CAPITAL RAISING CAMPAIGN CONSTRUCTION IS UNDERWAY. THIS STATE-OF THE-ART FACILITY WILL BETTER SERVE OUR POPULATION WITH EXPANDED TREATMENT AREAS (12,000 SQ. FT.) AND NEW TECHNOLOGY. THIS EXPANSION HAS ALSO PROVIDED ENHANCED OUR DISASTER RESPONSE CAPABILITIES. THE SIZE OF THE PROJECT ALSO INCLUDES MANY ECONOMIC BENEFITS FOR OUR COMMUNITY BEYOND THE CONSTRUCTION PHASE. THE HOSPITAL ALSO PARTICIPATES IN INITIATIVES WITH OTHER PROVIDERS AND AFFILIATES IN PROVISION OF SERVICES AND/OR DONATIONS. THE PROVISIONS OF LOW COST HEALTH SCREENING SERVICES IN COLLABORATION WITH OTHER ORGANIZATIONS HELP US IDENTIFY CONDITIONS ON A PROACTIVE BASIS TO BETTER IMPROVE OUR CITIZEN'S HEALTH OR MANAGEMENT OF CHRONIC DISEASES. THE CO-ORDINATION OF CARE THROUGH OUR HOME HEALTH REHABILITATIVE AND LONG TERM CARE PROVIDERS SERVE TO BETTER MEET THE NEEDS OF OUR PATIENTS AND POPULATION. OUR REGIONAL LABORATORY INITIATIVE HAS SHORTENED TURNAROUND TIME FOR TESTS AND HAS LOWERED COST TO OUR PATIENTS. THE HOSPITAL ALSO PARTICIPATES IN ECONOMIC DEVELOPMENT EFFORTS THROUGH ITS MEMBERSHIP IN THE CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS. PART III, LINE 4: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLIAM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT. PART III, LINE 8: THE ORGANIZATION DOES NOT CONSIDER THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. PART III, LINE 9B: FOLLOWING THE GUIDELINES AND PROCESSES AS INDICATED IN QUESTION 3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE, THE ORGANIZATION APPROPRIATELY IDENTIFIES ACCOUNTS AS TO THE TYPE OF ASSISTANCE QUALIFIED FOR. THE AMOUNTS ELIGIBLE FOR ASSISTANCE ARE WRITTEN OFF TO THE APPROPRIATE PROGRAM AND COLLECTION ACTIVITY CEASES IN REGARD TO THOSE AMOUNTS. THE GOAL OF THE ORGANIZATION'S POLICIES IS TO INDENTIY ACCOUNTS ELIGIBLE FOR ASSISTANCE AND BRING THE ACCOUNT TO AN APPROPRIATE CONCLUSION AS EARLY IN THE BILLING CYCLE AS POSSIBLE. PART VI, LINE 2: THE ORGANIZATION USES A VARIETY OF METHODS TO ASSESS HEALTH CARE NEEDS. DATA PROVIDED BY THE STATE OF OHIO IS USED TO DETERMINE EPIDEMIOLOGIES RELATED TO CHRONIC CONDITIONS AND CANCER REGISTRIES PROVIDING PREVALENCE. INTERNAL DATA IS ALSO USED AS WELL AS INPUT FROM OTHER PROVIDERS. THE HOSPITAL ALSO USES PATIENT ORIGIN DATA PROVIDED BY THE OHIO HOSPITAL ASSOCIATION TO DETERMINE CURRENT TREATMENT PATTERNS AND DIAGNOSIS FOR CURRENT RESIDENTS BEING TREATED IN VAN WERT COUNTY HOSPITAL AND OTHER SURROUNDING PROVIDERS. THE HOSPITAL ALSO SPONSORS A NUMBER OF HEALTH FAIRS/ASSESSMENTS TO BOTH ADULT AND PEDIATRIC POPULATIONS OF VAN WERT THAT IS ALSO EXAMINED FOR FREQUENCY AND NEEDS. A NUMBER OF STAFF AS WELL AS BOARD OF TRUSTEES MEMBERS ALSO SERVED ON COMMUNITY HEALTH PROVIDER BOARDS AND PROVIDE INPUT TO THE PLANNING PROCESS.THE HOSPITAL IS ALSO SUBSCRIBED TO A NUMBER OF BENCHMARKING ORGANIZATIONS THAT PROVIDE BEST OF INDUSTRY APPLICATIONS TO ASSESS METHODOLOGIES FOR TREATING OUR RESIDENTS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE BEGINS AT THE PATIENT ACCESS TO CARE AREAS. INFORMATIONAL SIGNAGE IS POSTED IN ALL PATIENT ACCESS AREAS IDENTIFYING FINANCIAL ASSISTANCE PROGRAMS AND INSTRUCTIONS OF HOW TO SEEK OUT THESE PROGRAMS. SIMILAR INFORMATION IS ALSO FOUND IN PATIENT INFORMATIONAL BROCHURES PROVIDED TO PATIENTS PRIOR TO THE RENDERING OF CARE BASED UPON THE TYPE OF CARE BEING PROVIDED. ALSO, AVAILABLE AT ALL PATIENT ACCESS POINTS ARE THE PATIENT FINANCIAL ASSISTANCE BROCHURE.PATIENT REGISTRATION STAFF AT ALL PATIENT ACCESS POINTS ARE TRAINED IN THE PATIENT FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AT THE HOSPITAL. THEY BECOME A VALUABLE RESOURCE TO PATIENTS DIRECTING THEM TO THE PROGRAMS THEY MAY QUALIFY FOR AND THE PROCESS WITH WHICH TO SEEK THE APPROPRIATE ASSISTANCE.THE HOSPITAL UTILIZES THE HOSPITAL WEBSITE AS AN ON-LINE AND TECHNOLOGICALLY CURRENT SOURCE OF FINANCIAL ASSISTANCE INFORMATION FOR PATIENTS THAT PREFER FINDING EDUCATIONAL INFORMATION IN THIS FORMAT. FINANCIAL ASSISTANCE PROGRAMS, POLICIES, ELIGIBILITY CRITERIA, AND ON-LINE APPLICATIONS FOR THE VARIOUS PROGRAMS ARE AVAILABLE.PATIENT BILLING STATEMENTS PROVIDE ANOTHER AVENUE FOR EDUCATING PATIENTS AS TO FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AND HOW TO CONTACT THE HOSPITAL TO DETERMINE ELIGIBILITY. THIS INFORMATION IS LOCATED ON THE BACK OF EACH BILLING STATEMENT RECEIVED BY THE PATIENT.THE EXISTENCE OF A FINANCIAL COUNSELOR IN THE PATIENT ACCOUNTING FUNCTION IS ANOTHER MECHANISM UTILIZED IN EDUCATING PATIENTS REGARDING FINANCIAL ASSISTANCE AVAILABLE FOR HOSPITAL SERVICES. ALL UNINSURED OR SELF-PAY POTENTIAL ACCOUNTS ARE IDENTIFIED TO THE FINANCIAL COUNSELOR UPON PATIENT REGISTRATION. PATIENTS MAY BE CONTACTED UPON COMPLETION OF SERVICES. ALL PATIENTS THAT WERE NOT CONTACTED UPON COMPLETION OF SERVICES RECEIVE A FINANCIAL ASSISTANCE APPLICATION THROUGH THE MAIL THAT INCLUDES INFORMATION REGARDING ALL FINANCIAL ASSISTANCE PROGRAMS. THE COUNSELOR PROVIDES FOLLOW-UP AND ASSISTANCE TO IDENTIFY THE PATIENT WITH THE APPROPRIATE FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: VAN WERT COUNTY HOSPITAL IS LOCATED IN THE RURAL COUNTY OF VAN WERT, OHIO THAT BOARDERS THE INDIANA STATE LINE ALONG ALLEN COUNTY INDIANA. OUR PRIMARY SERVICE AREA COMPRISES VAN WERT AND SOME PORTIONS OF PAULDING, PUTNAM AND MERCER COUNTIES. OHIO NUMERICALLY THIS BREAKS DOWN TO APPROXIMATELY 50,000 RESIDENTS IN OUR PRIMARY MARKET AREA. THE HOSPITAL IS LOCATED WITHIN THE CITY OF VAN WERT, WHICH POSSESSES A POPULATION OF 10,700. OUR POPULATION IS PREDOMINANTLY WHITE (97.1%) WITH HISPANIC (1.9%) A MIX OF MINORITIES COMPRISE THE REMAINDER. VAN WERT IS RURAL IN NATURE WITH EMPLOYMENT NOT ONLY IN AGRICULTURAL SERVICES BUT ALSO IN THE MANUFACTURING AND SERVICE SECTOR. OUR COUNTY HAS SEEN INCREASED UNEMPLOYMENT DUE TO THE LOSS OF MANUFACTURING JOBS RELATED TO THE AUTO SECTOR. THE UNEMPLOYMENT RATE IN 2009 WAS IN EXCESS OF 13%. THIS SITUATION HAS ALSO INCREASED THE NUMBER OF CITIZENS COVERED UNDER THE MEDICAID PROGRAM AND QUALIFYING FOR THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS INCREASING BAD DEBT (IN 2000 4.2% OF THE POPULATION WAS BELOW FPG). LIKE MANY MIDWEST COMMUNITIES THE REGION IS EXPERIENCING AGING POPULATIONS OF 18.3% OVER 65 AND 27.2% 45-64 ACCORDING TO THE 2000 CENSUS. THE HOSPITAL ALSO HAS FACILITIES IN THE COMMUNITIES OF CONVOY AND DELPHOS PROVIDING LONG TERM CARE TO THESE GROUPS. BEHAVIORAL RISK FACTORS INCLUDE (2002 OHIO BEHAVIORAL RISK SURVEY) SMOKING (19.3%), ALCOHOL ABUSE (14%) AND OBESITY AT (34.1%) THESE BEHAVIORAL RISK FACTORS INFLUENCE THE INCIDENCE OF CHRONIC DISEASES WE TREAT. PART VI, LINE 6: THE VAN WERT COUNTY HOSPITAL ASSOCIATION BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS FROM OUR COMMUNITY. THE MAJORITY OF THESE MEMBERS LIVE AND WORK WITHIN THE COMMUNITY AND ARE INVOLVED WITH OTHER NON-PROFIT AGENCIES. SENIOR LEADERSHIP ALSO LIVES IN THE PRIMARY SERVICE AREA. THIS "SPIRIT" OF COMMUNITY BASED HEALTHCARE RESIDES IN OUR BOARD OF TRUSTEES AND IS FURTHER EVIDENCED BY OUR OPEN MEDICAL STAFF. THE ACCOMMODATION OF SPECIALTY SERVICES NOT CURRENTLY PRESENT IN OUR AREA BEING PROVIDED THROUGH A SPECIALTY CLINIC OF THE HOSPITAL WHICH INCLUDE NEUROLOGY, NEUROSURGERY, IMMUNOLOGY, AND ENT SERVICES. THE HOSPITAL ASSOCIATED PERSONNEL ALSO SIT ON OTHER COMMUNITY BASED GOVERNANCE BOARDS (UNITED WAY, AMERICAN RED CROSS, CHAMBER OF COMMERCE, WRIGHT STATE UNIVERSITY REGIONAL CAMPUS, PUBLIC ACCESS TELEVISION, AMERICAN CANCER SOCIETY & VAN WERT ECONOMIC DEVELOPMENT TO NAME A FEW). THROUGH PHYSICIAN RECRUITMENT WE HAVE BROUGHT IN A NUMBER OF NEW SPECIALTIES INCLUDING BARIATRIC AND ADDITIONAL LAPAROSCOPIC SURGICAL PROCEDURES. WE ALSO PROVIDE A LOAN FORGIVENESS PROGRAM FOR RESIDENTS INTERESTED IN BECOMING PHYSICIANS AND RETURNING TO OUR AREA. OUR WELLNESS CENTER PROVIDES HEALTH, EDUCATION, AND SOCIAL PROGRAMS FOR TARGETED POPULATIONS. WE HAVE JOINED A REGIONAL STROKE NETWORK AS WELL AS PARTICIPATING IN A NUMBER OF PATIENT AND EDUCATIONAL SUPPORT GROUPS (BETTER BREATHERS, STROKE SUPPORT GROUP, BETTER PARENTING). THE HOSPITAL ALSO PARTICIPATES IN HEALTH PROFESSIONS EDUCATIONAL PROGRAMS. A NUMBER OF OUR PHYSICIANS PROVIDE TRAINING FOR SENIOR MEDICAL STUDENTS THROUGH THE LIMA AREA HEALTH EDUCATION COMMITTEE. A NUMBER OF NURSING EDUCATIONAL PROGRAM USE OUR HOSPITAL TO DO THEIR CLINICAL ROTATIONS. THE HOSPITAL ON AVERAGE SPENDS IN EXCESS OF 1 MILLION DOLLARS IN NEW DIAGNOSTIC TECHNOLOGIES AND OTHER HEALTH RELATED EQUIPMENT TO BETTER DIAGNOSE AND TREAT OUR CLIENTS. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 MARK J MINICK 408170 0 215727 0 148856 0 7350 0 8327 0 788430 0 0 0 MICHAEL HOLLIDAY 145418 0 0 0 38975 0 4362 0 6908 0 195663 0 0 0 CRAIG HANSON MD 143378 0 0 0 199964 0 3688 0 6897 0 353927 0 0 0 THOMAS CONTE MD 384470 0 0 0 43378 0 7350 0 5142 0 440340 0 0 0 MUHAMMED AL-FAWAKHIRI MD 131733 0 0 0 43187 0 3374 0 6834 0 185128 0 0 0 SHANEETA JOHNSON MD 270333 0 0 0 25778 0 0 0 2686 0 298797 0 0 0 SCOTT JARVIS MD 182483 0 0 0 80421 0 7350 0 985 0 271239 0 0 0 DOUGLAS MOORE MD 225945 0 0 0 15651 0 0 0 7343 0 248939 0 0 0 THOMAS LAUTZENHEISER MD 164171 0 0 0 700 0 5076 0 3953 0 173900 0 0 0 COUNTY OF VAN WERT OHIO 346401507 1920-10-29 10755255 FINANCE ACQUISITION, CONSTRUCTION, & EQUIPPING OF HOSPITAL FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GEORGE BROOKS BOARD MEMBER & NORTHWEST OH PRESIDENT OF FIRST FINANCIAL BANK FIRST FINANCIAL BANK HOLDS A PORTION OF HOSPITAL INVESTMENTS AND HOSPITAL LONG TERM DEBT. 0 ERIC JELINGER MD BOARD MEMBER & PRINCIPAL WITH PRINCIPAL WEST OHIO X-RAY WEST OHIO X-RAY CONTRACTS FOR INDEPENDENT PROVISION OF HOSPITAL RADIOLOGY SERVICES 0 JON BAGLEY BOARD MEMBER & PRINCIPAL WITH VANCREST LTD VANCREST LTD IS A JOINT VENTURE PARTNER WITHT THE HOSPITAL INVOLVING NURSING HOME FACILITIES, HOME CARE, AND THERAPY SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE REVIEWS AND APPROVES THE 990. IT IS THEN PRESENTED TO THE FULL BOARD DURING A REGULARLY SCHEDULED BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST QUESTIONNARE IS COMPLETED ON AN ANNUAL BASIS AND REVIEWED BY THE EXECUTIVE COMMITTEE. ANY ISSUES THAT ARISE ARE ADDRESSED WITH THE INDIVIDUAL AT THAT POINT. ANY ISSUES THAT ARISE THROUGHOUT THE YEAR ARE DEALT WITH AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE CONTRACTS WITH AN OUTSIDE, INDEPENDENT FIRM TO PROVIDE A COMPENSATION STUDY AND EVALUATION. THIS STUDY IS USED TO MAKE COMPENSATION DECISIONS. FORM 990, PART VI, SECTION C, LINE 19 THERE IS AN ANNUAL REPORT PREPARED THAT INCLUDES A STATEMENT OF OPERATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,188,264. CHANGE IN RESTRICTED NET ASSETS THE PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. VAN WERT MEDICAL SERVICES 140 FOX RD VAN WERT OH 45891 202812541 MEDICAL PROFESSIONAL SERVICES OH VAN WERT COUNTY HOSPITAL ASSOCIATION SARAH JANE LIVING CENTER 1250 S WASHINGTON ST VAN WERT OH 45891 311684009 LONG TERM ALZHEIMERS CARE OH ALZHEIMERS CARE 0 0 HOME HEALTH CARE SOLUTIONS 1250 S WASHINGTON ST VAN WERT OH 45891 200330544 HOME HEALTH CARE SERVICES OH HOME CARE 0 0 THERAPY SOLUTIONS 1250 S WASHINGTON ST VAN WERT OH 45891 201417403 PHYSICAL THERAPY SERVICES OH THERAPY CARE 0 0 COMMUNITY CARE SYSTEMS INC 1250 S WASHINGTON ST VAN WERT OH 45891 341783212 HEALTHCARE MANAGEMENT SERVICES OH C 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0