2026-05-14T11:11:05-05:00 2025-06-30 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2024-07-01 311724085 HOLZER MEDICAL CENTER - JACKSON HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 TROY MILLER CFO 7404465060 2026-05-11 1 1 AMY CIMINELLO P00796388 6148493000 2026-05-05 2024 2025-03-06 01:10:19Z RODNEY STOUT 100 JACKSON PIKE GALLIPOLIS OH 45631 35157095 0 X WWW.HOLZER.ORG X 2000 OH TO ENHANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE. 7 1 257 5 0 0 910249 346 32374141 34926107 13760 16151 179603 189781 33477753 35132385 0 0 0 0 11910178 13215051 0 0 0 13239260 13660226 25149438 26875277 8328315 8257108 34135872 25904121 42621196 28132412 -8485324 -2228291 X FRIENDLY VISITS, EXCELLENT CARE; EVERY PATIENT, EVERY TIME. 0 0 25591140 0 34995031 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. CONTINUING EDUCATION, CERTIFICATION PROGRAMS AND INFORMATIONAL SEMINARS ARE CONDUCTED FOR BOTH HOSPITAL AND MEDICAL STAFF. HEALTH FAIRS FOR THE COMMUNITY ARE CONDUCTED AT NO CHARGE. HOSPITAL STAFF ALSO RESPONDS TO REQUESTS FROM EMPLOYERS AND COMMUNITY GROUPS, ALONG WITH SENIOR CITIZENS CENTERS, FOR SCREENINGS AND INFORMATIONAL PROGRAMS.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, PULSE OXIMETRY, PROSTRATE CHECKS AND BONE DENSITY. 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. 25591140 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 1 257 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 1 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TROY MILLER 7404465000 100 JACKSON PIKE GALLIPOLIS OH 45631 BRENT SAUNDERS TRUSTEE 1.00 49.00 X 0 112850 992 TOM WISEMAN VICE CHAIR 1.00 3.00 X X 0 24000 0 LARRY KIDD CHAIRMAN 1.00 3.00 X X 0 24000 0 GARY ROACH TRUSTEE 1.00 49.00 X 0 202833 3121 BOB GRILLO SECRETARY 1.00 3.00 X X 0 24000 0 PAUL REED TREASURER 1.00 3.00 X X 0 24000 0 CLAYTON NEWMAN TRUSTEE 1.00 3.00 X 0 0 0 BRAD MUNN TRUSTEE - PART YEAR 1.00 0.00 X 0 0 0 RODNEY STOUT CEO - HHS 1.00 49.00 X 0 637605 10755 MICHAEL HAYNES CFO - HHS 1.00 49.00 X 0 399506 7990 DR ZACHARY BOSLEY PHYSICIAN 50.00 0.00 X 314056 0 5860 DR MATTHEW COMEAU PHYSICIAN 50.00 0.00 X 374292 0 6542 HERMAN CRABTREE JR PHARMACIST 50.00 0.00 X 173998 0 4961 DR JENNIFER CALAFATO PHYSICIAN 50.00 0.00 X 305676 0 4888 DR HANNAH DAVIDSON PHYSICIAN 50.00 0.00 X 208616 0 3653 1376638 1448794 48762 14 0 1 0 QUALIVIS 200 CENTERPOINT ROAD SUITE 2360 COLUMBIA SC 29210 STAFFING SERVICES 568619 HEALOGICS WOUND CARE & HYPERBARIC SERVIC 28525 NETWORK PLACE CHICAGO IL 60673 WOUND CARE & HBOT SERVICES 319588 2 346 346 NET PATIENT SERVICES 622110 34087101 34087101 HCAP 622110 839006 839006 34926107 15049 15049 93634 24710 68924 68924 68924 1102 0 1102 1102 1102 CAFETERIA SALES 900099 120857 120857 120857 35132385 34995031 0 137008 9367721 8720011 647710 102576 95510 7066 3001443 2794688 206755 743311 692108 51203 87744 87744 2369667 2348891 20776 458551 456473 2078 134184 119064 15120 705892 605709 100183 160706 121646 39060 469991 437616 32375 792257 737682 54575 194113 186809 7304 BAD DEBT EXPENSE 4158823 4158823 MEDICAL SUPPLIES 2772210 2761717 10493 FRANCHISE FEE 894642 894642 FOOD 255462 253767 1695 205984 205984 26875277 25591140 1284137 0 1426 1526 15019298 9128739 4729085 4291612 1449438 379616 387162 359103 96610 116614 54265180 46491012 7838382 7774168 369265 378263 4245206 3474480 34135872 25904121 3121049 3454704 24814335 23677639 14685812 1000069 42621196 28132412 X -8488677 -2231569 3353 3278 -8485324 -2228291 34135872 25904121 X 8257108 -2000075 X X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 2414 2414 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION ARE CONSIDERED LOBBYING ACTIVITIES. IN TOTAL $9,446 WERE PAID TO AHA OF WHICH $2,414 ARE CONSIDERED LOBBYING ACTIVITIES. 1633793 1633793 19504415 14761177 4743238 30143011 28874408 1268603 2983961 2855427 128534 7774168 OTHER ASSETS 3349 RELATED PARTY RECEIVABLE 3471131 3474480 RELATED PARTY PAYABLE 1000069 1000069 1 1 X 1 X 1 X 1 1 1 0 1 1 927410 383845 543565 0.02390 5407142 5647028 0 0.00000 6334552 6030873 543565 0.02390 6334552 6030873 543565 0.02390 0 4158823 207941 7251843 7450968 -199125 X 1 1 1 1 HOLZER MEDICAL CENTER - JACKSON 500 BURLINGTON ROAD JACKSON OH 45640 X X X X X HOLZER MEDICAL CENTER- JACKSON 1 0 0 1 X X X X X X X X X 25 1 1 1 1 X HTTPS://TINYURL.COM/58R65BU2 X 1 22 1 HTTPS://TINYURL.COM/58R65BU2 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://TINYURL.COM/29U8XBFK X HTTPS://TINYURL.COM/29U8XBFK X HTTPS://TINYURL.COM/29U8XBFK X X X X X 1 X 0 X X X 1 X 0 0 HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT COORDINATOR WORKED WITH AN OUTSIDE VENDOR TO IDENTIFY KEY INFORMANTS (SCHOOLS, LOCAL HEALTH DEPARTMENTS, COMMUNITY OUTREACH GROUPS AND OTHERS) THROUGHOUT THE COMMUNITY/SERVICE AREA AND CONDUCTED INTERVIEWS TO IDENTIFY PRIORITY NEEDS. HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 6A: HOLZER HOSPITAL FOUNDATION (HOLZER MEDICAL CENTER)ADENA HEALTH SYSTEM HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 6B: GALLIA COUNTY HEALTH DISTRICTJACKSON COUNTY HEALTH DEPARTMENTMEIGS COUNTY HEALTH DEPARTMENTVINTON COUNTY HEALTH DEPARTMENTMASON COUNTY HEALTH DEPARTMENTGALLIPOLIS CITY SCHOOLS/GALLIA COUNTY SCHOOLSAREA AGENCY ON AGINGATHENS COUNTY HEALTH DEPARTMENTUNIVERSITY OF RIO GRANDEOHIO UNIVERSITYOHIOHEALTH HOLZER MEDICAL CENTER- JACKSON PART V, SECTION B, LINE 11: HOLZER MEDICAL CENTER JACKSON DID NOT ADDRESS ALL OF THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA BECAUSE OF LIMITED FINANCIAL RESOURCES. THE IMPLEMENTATION PLAN IDENTIFIED HEALTH INITIATIVES THAT ARE POSTED ON THE ORGANIZATION'S WEBSITE. PART V, SECTION B, LINE 20C HOLZER PROCESSES ALL COMPLETE FAP APPLICATIONS BUT DOES NOT PROCESS INCOMPLETE APPLICATIONS. THEY REACH OUT TO INDIVIDUALS WHO DO NOT COMPLETE THE FAP APPLICATION WITH ADDITIONAL INFORMATION LETTERS ON HOW TO COMPLETE AND GIVE THEM 30 DAYS TO COMPLETE THE APPLICATION BEFORE SENDING A FAILURE TO PROVIDE ADDITIONAL INFORMATION LETTER. PART I, LINE 7: EXPENSES WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4,158,823. 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 WAS CALCULATED ON AUDITED FINANCIAL STATEMENT BALANCES. NONE OF THE BAD DEBT 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 BAD DEBT UNTIL ADDITIONAL INFORMATION SHOWS OTHERWISE. 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. PART III, LINE 9B: FOUR PATIENT STATEMENTS ARE SENT TO MEDICARE AND NON-MEDICARE ACCOUNTS EACH TOTALING 120 DAYS. IF NO PATIENT PAYMENT RESPONSE, ACCOUNTS ARE SELECTED AND PROCESSED TO BAD DEBT. PART VI, LINE 2: NEEDS ARE ASSESSED THROUGH COMMUNITY HEALTH NEEDS ASSESSMENT. 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: HOLZER MEDICAL CENTER - JACKSON IS LOCATED ON APPROXIMATELY 11 ACRES OF A 77-ACRE TRACT OF LAND FACING US 32 APPROXIMATELY ONE MILE SOUTH OF THE INTERSECTION OF US 32 AND US 35 NEAR THE CITY OF JACKSON, OHIO. THE INTERSECTION OF THESE TWO US HIGHWAYS IS A CENTRAL HUB OF THE HIGHWAY SYSTEM IN SOUTHEASTERN OHIO. THE PRIMARY SERVICE AREA FOR HOLZER MEDICAL CENTER - JACKSON IS JACKSON COUNTY, OHIO. THE SECONDARY SERVICE AREA INCLUDES PORTIONS OF PIKE, GALLIA, VINTON, SCIOTO, LAWRENCE, ROSS AND ATHENS COUNTIES IN OHIO. PART VI, LINE 5: HOLZER MEDICAL CENTER-JACKSON BELIEVES THAT EDUCATIONAL AND PREVENTATIVE SERVICES ARE IMPERATIVE TO IMPROVING THE HEALTH OF OUR COMMUNITY. AS SUCH, THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT AT HOLZER MEDICAL CENTER-JACKSON ORGANIZES AND PROVIDES HEALTH SCREENING 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 SCREENING. SOME OF OUR LARGER COMMUNITY EVENTS INCLUDE: THE JACKSON COUNTY APPLE FESTIVAL, JACKSON COUNTY FAIR, GENERAL MILLS EMPLOYEE HEALTH FAIR, ANNUAL BREAST CANCER AWARENESS HEALTH FAIR AND THE ANNUAL COMMUNITY HEART HEALTH FAIR. HOLZER MEDICAL CENTER-JACKSON ALSO HOSTS MONTHLY DIABETES EDUCATION MEETINGS AND FREE HEART SAVER CPR CLASSES ARE OFFERED TO VARIOUS GROUPS AND COMMUNITY MEMBERS. PART VI, LINE 6: HOLZER MEDICAL CENTER AND HOLZER MEDICAL CENTER-JACKSON COMPRISE THE TWO HOSPITALS IN THE SYSTEM, WITH HOLZER MEDICAL CENTER-JACKSON ACCOUNTING FOR 10% OF HOSPITAL ADMISSIONS. HOLZER MEDICAL CENTER IS LOCATED IN GALLIA COUNTY AND HOLZER MEDICAL CENTER-JACKSON IS LOCATED IN JACKSON COUNTY. ALL HEALTH SCREENING 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. 0 0 0 0 0 0 0 0 0 RODNEY STOUT CEO - HHS 0 637605 0 0 0 0 0 10755 0 0 0 648360 0 0 MICHAEL HAYNES CFO - HHS 0 399506 0 0 0 0 0 7990 0 0 0 407496 0 0 DR MATTHEW COMEAU PHYSICIAN 374292 0 0 0 0 0 6542 0 0 0 380834 0 0 0 DR ZACHARY BOSLEY PHYSICIAN 314056 0 0 0 0 0 5860 0 0 0 319916 0 0 0 DR JENNIFER CALAFATO PHYSICIAN 305676 0 0 0 0 0 4888 0 0 0 310564 0 0 0 DR HANNAH DAVIDSON PHYSICIAN 208616 0 0 0 0 0 3653 0 0 0 212269 0 0 0 GARY ROACH TRUSTEE 0 202833 0 0 0 0 0 3121 0 0 0 205954 0 0 HERMAN CRABTREE JR PHARMACIST 173998 0 0 0 0 0 3480 0 1481 0 178959 0 0 0 PART I, LINE 3 COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION, HOLZER HEALTH SYSTEM, 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 HEALTH SYSTEM IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B HOLZER MEDICAL CENTER - JACKSON'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY HOLZER HEALTH SYSTEM'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER AND THE CFO OF HOLZER HEALTH SYSTEM 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 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 2021. 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. FORM 990, PART XI, LINE 9: TRANSFER TO/FROM AFFILIATES -2,000,000. NET ASSETS RELEASED FROM RESTRICTION -75. FORM 990, PART XII, LINE 2C: THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART II: TROY MILLER IS AN AUTHORIZED SIGNER OF FORM 990S. HE WAS APPOINTED INTERIM CFO IN SEPTEMBER 2025, AND LATER NAMED AS THE PERMANENT CFO. HOLZER HEALTH SYSTEM 100 JACKSON PIKE GALLIPOLIS OH 45631 311156690 MANAGEMENT SERVICES OH 501(C)(3) LINE 12A, I N/A 0 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER HERITAGE FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 10 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC AND AFFILIATES 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH N/A C 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 0