2024-11-08T16:59:55-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST STE 100 COLUMBUS OH 43215 990 2023-10-01 341048666 COMMUNITY HOSPITALS AND WELLNESS CENTERS COMM 2603738429 433 W HIGH ST BRYAN OH 435061690 STANTON RISSER PH ACFO 2602669380 2024-11-08 1 1 AMY CIMINELLO P00796388 6148493000 2023 2024-10-15 13:58:12Z GREG JOHNSON 1450 PRODUCTION RD FORT WAYNE IN 468081167 25364531 0 X WWW.PARKVIEW.COM X 1969 OH IMPROVE HEALTH & PROVIDE QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 13 8 837 8 -32287 0 2495258 12976 111982510 24695855 1225556 478388 2122535 145841 117825859 25333060 0 0 0 0 65719401 11056770 0 0 0 56657412 9456620 122376813 20513390 -4550954 4819670 137389135 119525040 44756074 53988345 92633061 65536695 X COMMUNITY HOSPITALS AND WELLNESS CENTERS WORKS TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND PROVIDES QUALITY HEALTH SERVICES TO ALL WHO ENTRUST THEIR CARE TO US. 0 0 19883023 24739033 EFFECTIVE OCTOBER 1, 2023, COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC), ALONG WITH ITS TEAM OF CO-WORKERS, PHYSICIANS, AND ADVANCED PRACTICE PROVIDERS, OFFICIALLY AFFILIATED WITH PARKVIEW HEALTH SYSTEM, INC. CHWC IS BASED IN BRYAN, OHIO AND HAS TWO HOSPITALS IN WILLIAMS COUNTY AND AN OUTPATIENT CENTER IN FULTON COUNTY. UPON AFFILIATION, CHWC DESIGNATED THESE THREE FACILITIES AS PARKVIEW BRYAN HOSPITAL, PARKVIEW MONTPELIER HOSPITAL AND PARKVIEW ARCHBOLD. FEATURED SERVICES:PARKVIEW BRYAN HOSPITAL, A 98-BED CHARITABLE, NOT-FOR-PROFIT, COMMUNITY-OWNED HOSPITAL, PROVIDES COMPREHENSIVE, PATIENT-CENTERED(SEE SCHEDULE O FOR CONTINUATION)HEALTHCARE INCLUDING A REGIONAL INTERVENTIONAL CARDIOLOGY PROGRAM, FAMILY BIRTHING CENTER, RADIATION ONCOLOGY, EMERGENCY MEDICINE, SURGICAL SERVICES, AND INPATIENT AND OUTPATIENT SPECIALTY SERVICES. PARKVIEW MONTPELIER HOSPITAL, A 25-BED CHARITABLE, NOT-FOR-PROFIT, CRITICAL ACCESS HOSPITAL, PROVIDES HEALTHCARE SERVICES INCLUDING EMERGENCY MEDICINE, LAB AND DIAGNOSTIC IMAGING, REHABILITATION AND THERAPY SERVICES, AND SLEEP LAB.LOCATED IN FULTON COUNTY, PARKVIEW ARCHBOLD WITH NO INPATIENT BEDS, OPERATES FOUR SURGICAL SUITES, PHYSICIAN CLINICS AND PROVIDES A BROAD RANGE OF OUTPATIENT SERVICES. COMMUNITY BENEFIT:CHWC'S COMMITMENT TO IMPROVING HEALTH AND INSPIRING WELL-BEING EXTENDS BEYOND THE HOSPITAL WALLS AND THROUGHOUT NORTHWEST OHIO. CHWC COLLABORATES WITH A HOST OF AREA ORGANIZATIONS WHO SHARE CHWC'S MISSION AND VALUES. CHWC STRATEGICALLY INVESTS IN INITIATIVES THAT ADDRESS THE GREATEST COMMUNITY HEALTH NEEDS OUTLINED BY THE MOST RECENT TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). BASED ON THE 2022 CHNA RESULTS, THE TOP HEALTH CONCERNS FOR WILLIAMS COUNTY, OHIO ARE ACCESS TO CARE, HEALTH BEHAVIORS, MENTAL HEALTH AND ADDICTION. BASED UPON THESE RESULTS, CHWC, ALONG WITH CRITICAL AREA HEALTH PARTNERS CREATE A COMMUNITY HEALTH IMPROVEMENT PLAN THAT SERVES AS AN IN-DEPTH PLAN DEFINING HOW TO ADDRESS EACH IDENTIFIED HEALTH NEED. FINANCIAL ASSISTANCE:CHWC IS COMMITTED TO MAKING HEALTHCARE ACCESSIBLE TO THOSE WHO NEED IT, REGARDLESS OF THEIR HEALTH STATUS OR ABILITY TO PAY. WITH FINANCIAL ASSISTANCE, PATIENTS CAN RECEIVE THE PARKVIEW CARE THEY EXPECT - NO MATTER WHAT MEDICAL OBSTACLES THEY MIGHT FACE. FINANCIAL ASSISTANCE SERVICES INCLUDE: 1) USING FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES, INCLUDING CHARITABLE CARE AND FINANCIAL ASSISTANCE POLICIES AND A STANDARD APPLICATION PROCESS; 2) PROVIDING EXTENDED PAYMENT PLAN OPTIONS; AND 3) PROVIDING EMERGENCY CARE, REGARDLESS OF ABILITY TO PAY.AWARDS/RECOGNITION:AWARD: IN OCTOBER 2023, PARKVIEW BRYAN HOSPITAL WAS RECOGNIZED BY THE THE CHARTIS CENTER FOR OUTSTANDING RURAL HEALTHCARE. 19883023 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 44 0 1 837 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 8 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X STANTON RISSER 2602669380 1450 PRODUCTION RD FORT WAYNE IN 468081167 CHAD TINKEL DIRECTOR/CHWC PRESIDENT 39.00 1.00 X X 900726 0 90243 STEVE BUMB DIRECTOR/CHWC CHIEF OF STAFF 39.00 1.00 X 385889 0 50293 CAROLYN SHARROCK-DORSTEN DIRECTOR/MCHA PHYSICIAN 1.00 39.00 X 0 355933 71761 KATRINA HESTER DIRECTOR 1.00 1.00 X 0 0 0 CHRISTOPHER KANNEL DIRECTOR/CHAIR 1.00 1.00 X X 0 0 0 CINDY REED DIRECTOR 1.00 1.00 X 0 0 0 RUSS DAVIES DIRECTOR 1.00 1.00 X 0 0 0 ALLYN LUCE DIRECTOR 1.00 1.00 X 0 0 0 LARS ELLAR DIRECTOR/TREASURER 1.00 1.00 X X 0 0 0 ELENA WEST DIRECTOR/VICE CHAIR 1.00 1.00 X X 0 0 0 JIM WATKINS DIRECTOR/SECRETARY 1.00 1.00 X X 0 0 0 GREG JOHNSON DIRECTOR/REGIONAL MARKET PRESIDENT 1.00 39.00 X X 0 888491 189006 RICHARD CHURCH DIRECTOR/PH CHIEF GWTH STR OFFICER 1.00 39.00 X 0 630011 189714 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 1.00 39.00 X 0 2165508 277888 ELIZABETH GRIMES CHWC VP PAT CARE SVCS 40.00 0.00 X 258320 0 49731 ANCEL PATRICK CHWC VP OPERATIONS 40.00 0.00 X 320548 0 47554 DAMODER KESIREDDY CHWC PHYSICIAN 40.00 0.00 X 794562 0 36300 JOSE PARODI CHWC PHYSICIAN 40.00 0.00 X 567787 0 27541 DAVID COOLEY CHWC PHYSICIAN 40.00 0.00 X 872279 0 54221 JODI TINKEL CHWC PHYSICIAN 40.00 0.00 X 622487 0 16086 KHALID MINHAS CHWC PHYSICIAN 40.00 0.00 X 758265 0 42887 CHRISTA POMEROY FORMER OFFICER/PH DIRECTOR TREASURY 40.00 0.00 X 267525 0 37020 PHILIP ENNEN FORMER OFFICER 0.00 0.00 X 366527 0 0 MICHAEL CULLER FORMER OFFICER 0.00 0.00 X 123976 0 0 JANICE DAVID FORMER KEY EMPLOYEE/CURRENT MCHA PSA 40.00 0.00 X 535854 0 21242 6774745 4039943 1201487 52 1 1 0 CLINICAL COLLEAGUES INC PO BOX 824246 PHILADELPHIA PA 19182 ANESTHESIOLOGISTS 739319 FORT WAYNE RADIOLOGY ASSN LLC 3707 NEW VISION DR FORT WAYNE IN 46845 RADIOLOGY SERVICES 559479 PARKVIEW HOSPITAL INC 11109 PARKVIEW PLAZA DR FORT WAYNE IN 46845 LABORATORY SERVICES 374564 SPECTRUM MEDICAL PHYSICS INC 803 W MARKET ST LIMA OH 45805 PHYSICS & DOSIMETRY SERVICES 106825 WILLIAMS EMERGENCY GROUP LLC PO BOX 677979 DALLAS TX 75267 PHYSICIAN SERVICES 106802 5 11976 1000 12976 NET PATIENT SERVICE 622110 23695590 23695590 CHWC PAIN MGMT LLC 621990 867743 867743 INTERUNIT RENT 531120 61441 61441 CHWPM BILLINGS 561000 54416 54416 MASSAGE THERAPY CLINIC 621990 16665 16665 24695855 478388 478388 74649 31471 43178 43178 43178 CAFETERIA 722514 134950 134950 LOSS FROM VANTAGE HEALTHCARE 900099 -32287 -32287 102663 25333060 24739033 -32287 613338 X 298619 298619 215586 144289 71297 7329813 7329813 3212752 3212752 3104257 2961201 143056 288401 259721 28680 686985 672499 14486 5378 4891 487 1800 1250 550 3199 3199 1010682 1010682 52100 21354 30746 MEDICAL SUPPLIES 3381132 3381132 FRANCHISE FEES & TAXES 625904 625904 HCAP ASSESSMENT FEES 121300 121300 TUITION & CERTIFICATION 113871 113871 61611 22364 39247 20513390 19883023 630367 0 6078501 3445 32679900 17936683 12791586 1928686 2246106 1092619 1020409 34780426 1078677 67371036 33701749 31767191 34047426 587358 655168 10627061 2379251 137389135 119525040 8147919 2982254 24171619 0 11243690 0 1192846 51006091 44756074 53988345 X 92633061 65536695 137389135 119525040 X 4819670 1937776 -33853812 X 0 1 X 1 1 1 X 2340000 1350000 3690000 24903653 546435 24357218 6006773 532242 5474531 180000 180000 33701749 DUE TO/FROM INTERUNIT 50840517 EST. MEDICARE/MEDICAID SETTLEMENTS 165574 51006091 X PART X, LINE 2: PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): INCOME TAXES: THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE CORPORATION AND CERTAIN AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CERTAIN SUBSIDIARIES OF THE CORPORATION ARE TAXABLE ENTITIES, THE TAX EXPENSE AND LIABILITIES OF WHICH ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES EACH FILE A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH SYSTEMS INCLUDE SUCH MATTERS AS THE TAX-EXEMPT STATUS OF EACH ENTITY, THE CONTINUED TAX-EXEMPT STATUS OF BONDS, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME, AND VARIOUS POSITIONS RELATING TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (REPORTED ON FORM 990T). AS OF DECEMBER 31, 2023 AND 2022, THERE ARE NO UNRECOGNIZED TAX BENEFITS RESULTING FROM UNCERTAIN TAX POSITIONS. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 AND 990T FILED BY THE CORPORATION AND ITS TAX-EXEMPT AFFILIATED ENTITIES ARE GENERALLY NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR 2019 AND PRIOR. 1 1 X 1 X 1 X 1 0 0 135643 135643 0.00660 3998750 2319837 1678913 0.08180 4134393 2319837 1814556 0.08840 22288 22288 0.00110 19341 19341 0.00090 41629 41629 0.00200 4176022 2319837 1856185 0.09040 1 0 0 6135374 7453007 -1317633 X 1 1 2 1 PARKVIEW BRYAN HOSPITAL 433 W HIGH ST BRAYN OH 435061690 X X X 2 PARKVIEW MONTPELIER HOSPITAL 909 E SNYDER AVE MONTPELIER OH 435431251 X X X SWING BEDS PARKVIEW BRYAN HOSPITAL 1 0 0 1 X X X X X X X X X X 22 1 1 1 1 X HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X HTTPS://WWW.WILLIAMSCOUNTYHEALTH.ORG X X 1 23 1 HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS 0 1 X 200.000000000000 300.000000000000 X X X X X X X 1 1 X X X 1 X HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/ X HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/ X HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/ X X X X X X 1 X 0 X X X X X 1 X 0 0 PARKVIEW MONTPELIER HOSPITAL 2 0 0 1 X X X X X X X X X X 22 1 1 1 1 X HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS X HTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/ X X 1 23 1 HTTPS://WWW.PARKVIEW.COM/LOCALHEALTHNEEDS 0 1 X 200.000000000000 300.000000000000 X X X X X X X 1 1 X X X 1 X HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/ X HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/ X HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/ X X X X X X 1 X 0 X X X X X 1 X 0 0 PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS.- TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH. PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS.- TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH. PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:THE WILLIAMS COUNTY HEALTH PARTNERS HAS BEEN CONDUCTING COMMUNITY HEALTH ASSESSMENTS SINCE 2006 FOR THE PURPOSE OF MEASURING COMMUNITY HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT (CHA) WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND AN ELECTRONIC SURVEY OF ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THEIR CHA DATA TO NATIONAL, STATE, AND LOCAL HEALTH TRENDS. COMMUNITY STAKEHOLDERS WERE ACTIVELY ENGAGED IN THE EARLY PHASES OF CHA PLANNING AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO (HCNO), A NEUTRAL, REGIONAL, NONPROFIT HOSPITAL ASSOCIATION, TO FACILITATE THE CHA AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP).THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT, ALONG WITH COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC), THEN INVITED VARIOUS COMMUNITY STAKEHOLDERS TO PARTICIPATE IN THE COMMUNITY HEALTH IMPROVEMENT PROCESS. DATA FROM THE MOST RECENT CHA WERE CAREFULLY CONSIDERED AND CATEGORIZED INTO COMMUNITY PRIORITIES WITH ACCOMPANYING STRATEGIES. THIS WAS DONE USING THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS'(NACCHO) NATIONAL FRAMEWORK: MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). OVER THE NEXT THREE YEARS, THESE PRIORITIES AND STRATEGIES WILL BE IMPLEMENTED AT THE COUNTY-LEVEL WITH THE HOPE TO IMPROVE POPULATION HEALTH AND CREATE LASTING, SUSTAINABLE CHANGE. IT IS THE HOPE OF THE WILLIAMS COUNTY PARTNERS HEALTH PARTNERS THAT EACH AGENCY IN THE COUNTY WILL TIE THEIR INTERNAL STRATEGIC PLAN TO AT LEAST ONE STRATEGY IN THE CHIP.THE CHIP WAS PLANNED BY VARIOUS AGENCIES AND SERVICE-PROVIDERS WITHIN WILLIAMS COUNTY. FROM OCTOBER 2022 TO JANUARY 2023, THE WILLIAMS COUNTYHEALTH PARTNERS REVIEWED MANY DATA SOURCES CONCERNING THE HEALTH ANDSOCIAL CHALLENGES THAT WILLIAMS COUNTY RESIDENTS ARE FACING. THEY DETERMINED PRIORITY ISSUES WHICH, IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES; DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES; EXAMINED BEST PRACTICES AND SOLUTIONS; AND DETERMINED SPECIFIC STRATEGIES TO ADDRESS IDENTIFIED PRIORITY ISSUES. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEDICATION TO THIS PROCESS: WILLIAMS COUNTY HEALTH PARTNERS; ALICIA GRAHAM, SHALOM COUNSELING & MEDIATION CENTER; ALLYN LUCE, ALTENLOH, BRINCK & CO.; AMY KIRBY, UNITED WAY OF WILLIAMS COUNTY; ASHLEY EPLING, WILLIAMS COUNTY ECONOMIC; DEVELOPMENT CORPORATION (WEDCO); BECKY KIMBLE, THE ABILITY CENTER; BECKY MCGUIRE, OHIO STATE UNIVERSITY EXTENSION OFFICE; BETHANY COUTZ, EDUCATING COMMUNITIES ON HEALTHY OPPORTUNITIES (ECHO) COALITION; BETHANY SHIRKEY, FOUR COUNTY ALCOHOL, DRUG ADDICTION AND MENTAL HEALTH SERVICES (ADAMHS) BOARD; BOBBI CASE, COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC); CHASITY YODER, UNITED WAY OF WILLIAMS COUNTY; CHRIS KANNEL, VILLAGE OF MONTPELIER; DEANNA CUSTAR, WILLIAMS COUNTY BOARD OF HEALTH; DONNA SPROW, WILLIAMS COUNTY DEPARTMENT OF AGING; GENE MCBRIDE, PIONEER AREA MINISTERIAL ASSOCIATION; JENNI MCKARNS, WILLIAMS COUNTY COMMUNITY GARDENING ASSOCIATION (WCCGA); JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD); JIM WYSE, MILLCREEK-WEST UNITY LOCAL SCHOOLS; KAREN VONDEYLEN, MAUMEE VALLEY GUIDANCE CENTER; KATIE BROWN, WCHD; KEIRA CHRISTMAN, WEDCO; KERMIT RIEHLE, EDGERTON SCHOOLS; KIM LAMMERS, MAUMEE VALLEY PLANNING ORGANIZATION; MELISSA EWERS, VILLAGE OF MONTPELIER; MICHELLE KANNEL, MONTPELIER SCHOOLS; NATHAN HOFFER, WCHD; RACHEL AESCHLIMAN, WCHD; RACHEL BLANTON, SARAH'S FRIENDS; RUTH PECK, RECOVERY SERVICES OF NORTHWEST OHIO; SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP; SARAH VASHAW, BRYAN CITY SCHOOLS; SHEANA BEHRINGER, NOCAC; SUSAN SHEETS, WILLIAMS COUNTY JUVENILE COURTS; TAMMY RIEGSECKER, WCHD; TODD ROTH, WILLIAMS COUNTY ENGINEER'S OFFICE; AND VICTORIA SMITH, WCHD.PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE CHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEE WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TOCOLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FORADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARETRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE ANDNATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITYAREA.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ONA CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES AREPROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 5: DESCRIBE HOW THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, AND IDENTIFY THE PERSONS THE HOSPITAL FACILITY CONSULTED:THE WILLIAMS COUNTY HEALTH PARTNERS HAS BEEN CONDUCTING COMMUNITY HEALTH ASSESSMENTS SINCE 2006 FOR THE PURPOSE OF MEASURING COMMUNITY HEALTH STATUS. THE MOST RECENT WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT (CHA) WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN SURVEY OF ADULTS AND AN ELECTRONIC SURVEY OF ADOLESCENTS WITHIN WILLIAMS COUNTY. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) AND YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). THIS HAS ALLOWED WILLIAMS COUNTY TO COMPARE THEIR CHA DATA TO NATIONAL, STATE, AND LOCAL HEALTH TRENDS. COMMUNITY STAKEHOLDERS WERE ACTIVELY ENGAGED IN THE EARLY PHASES OF CHA PLANNING AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE PROJECT. THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT CONTRACTED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO (HCNO), A NEUTRAL, REGIONAL, NONPROFIT HOSPITAL ASSOCIATION, TO FACILITATE THE CHA AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP).THE WILLIAMS COUNTY COMBINED HEALTH DISTRICT, ALONG WITH COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC), THEN INVITED VARIOUS COMMUNITY STAKEHOLDERS TO PARTICIPATE IN THE COMMUNITY HEALTH IMPROVEMENT PROCESS. DATA FROM THE MOST RECENT CHA WERE CAREFULLY CONSIDERED AND CATEGORIZED INTO COMMUNITY PRIORITIES WITH ACCOMPANYING STRATEGIES. THIS WAS DONE USING THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS'(NACCHO) NATIONAL FRAMEWORK: MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). OVER THE NEXT THREE YEARS, THESE PRIORITIES AND STRATEGIES WILL BE IMPLEMENTED AT THE COUNTY-LEVEL WITH THE HOPE TO IMPROVE POPULATION HEALTH AND CREATE LASTING, SUSTAINABLE CHANGE. IT IS THE HOPE OF THE WILLIAMS COUNTY PARTNERS HEALTH PARTNERS THAT EACH AGENCY IN THE COUNTY WILL TIE THEIR INTERNAL STRATEGIC PLAN TO AT LEAST ONE STRATEGY IN THE CHIP.THE CHIP WAS PLANNED BY VARIOUS AGENCIES AND SERVICE-PROVIDERS WITHIN WILLIAMS COUNTY. FROM OCTOBER 2022 TO JANUARY 2023, THE WILLIAMS COUNTYHEALTH PARTNERS REVIEWED MANY DATA SOURCES CONCERNING THE HEALTH ANDSOCIAL CHALLENGES THAT WILLIAMS COUNTY RESIDENTS ARE FACING. THEY DETERMINED PRIORITY ISSUES WHICH, IF ADDRESSED, COULD IMPROVE FUTURE OUTCOMES; DETERMINED GAPS IN CURRENT PROGRAMMING AND POLICIES; EXAMINED BEST PRACTICES AND SOLUTIONS; AND DETERMINED SPECIFIC STRATEGIES TO ADDRESS IDENTIFIED PRIORITY ISSUES. WE WOULD LIKE TO RECOGNIZE THESE INDIVIDUALS AND THANK THEM FOR THEIR DEDICATION TO THIS PROCESS: WILLIAMS COUNTY HEALTH PARTNERS; ALICIA GRAHAM, SHALOM COUNSELING & MEDIATION CENTER; ALLYN LUCE, ALTENLOH, BRINCK & CO.; AMY KIRBY, UNITED WAY OF WILLIAMS COUNTY; ASHLEY EPLING, WILLIAMS COUNTY ECONOMIC; DEVELOPMENT CORPORATION (WEDCO); BECKY KIMBLE, THE ABILITY CENTER; BECKY MCGUIRE, OHIO STATE UNIVERSITY EXTENSION OFFICE; BETHANY COUTZ, EDUCATING COMMUNITIES ON HEALTHY OPPORTUNITIES (ECHO) COALITION; BETHANY SHIRKEY, FOUR COUNTY ALCOHOL, DRUG ADDICTION AND MENTAL HEALTH SERVICES (ADAMHS) BOARD; BOBBI CASE, COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC); CHASITY YODER, UNITED WAY OF WILLIAMS COUNTY; CHRIS KANNEL, VILLAGE OF MONTPELIER; DEANNA CUSTAR, WILLIAMS COUNTY BOARD OF HEALTH; DONNA SPROW, WILLIAMS COUNTY DEPARTMENT OF AGING; GENE MCBRIDE, PIONEER AREA MINISTERIAL ASSOCIATION; JENNI MCKARNS, WILLIAMS COUNTY COMMUNITY GARDENING ASSOCIATION (WCCGA); JIM WATKINS, WILLIAMS COUNTY HEALTH DEPARTMENT (WCHD); JIM WYSE, MILLCREEK-WEST UNITY LOCAL SCHOOLS; KAREN VONDEYLEN, MAUMEE VALLEY GUIDANCE CENTER; KATIE BROWN, WCHD; KEIRA CHRISTMAN, WEDCO; KERMIT RIEHLE, EDGERTON SCHOOLS; KIM LAMMERS, MAUMEE VALLEY PLANNING ORGANIZATION; MELISSA EWERS, VILLAGE OF MONTPELIER; MICHELLE KANNEL, MONTPELIER SCHOOLS; NATHAN HOFFER, WCHD; RACHEL AESCHLIMAN, WCHD; RACHEL BLANTON, SARAH'S FRIENDS; RUTH PECK, RECOVERY SERVICES OF NORTHWEST OHIO; SALLY TAYLOR, PARKVIEW PHYSICIANS GROUP; SARAH VASHAW, BRYAN CITY SCHOOLS; SHEANA BEHRINGER, NOCAC; SUSAN SHEETS, WILLIAMS COUNTY JUVENILE COURTS; TAMMY RIEGSECKER, WCHD; TODD ROTH, WILLIAMS COUNTY ENGINEER'S OFFICE; AND VICTORIA SMITH, WCHD.PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE CHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEE WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TOCOLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FORADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARETRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE ANDNATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITYAREA.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ONA CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES AREPROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:PARKVIEW MONTPELIER HOSPITAL PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:PARKVIEW BRYAN HOSPITAL PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:WILLIAMS COUNTY HEALTH DEPARTMENT PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY'S CHNA WAS ALSO CONDUCTED WITH THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:WILLIAMS COUNTY HEALTH DEPARTMENT PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 7D: THE 2022 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE AT THE FOLLOWING WEBSITES:WILLIAMS COUNTY HEALTH DISTRICTHTTPS://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2024/05/2022-WILLIAMS-CHA-9-16-22-FINAL.PDFHOSPITAL COUNCIL OF NORTHWEST OHIOHTTPS://WWW.HCNO.ORG/WP-CONTENT/UPLOADS/2022/10/2022-WILLIAMS-CHA-9-16-22-F.PDF PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 7D: THE 2022 WILLIAMS COUNTY HEALTH ASSESSMENT IS AVAILABLE AT THE FOLLOWING WEBSITES:WILLIAMS COUNTY HEALTH DEPARTMENTHTTPS://WWW.WILLIAMSCOUNTYHEALTH.ORG/WP-CONTENT/UPLOADS/2024/05/2022-WILLIAMS-CHA-9-16-22-FINAL.PDFHOSPITAL COUNCIL OF NORTHWEST OHIOHTTPS://WWW.HCNO.ORG/WP-CONTENT/UPLOADS/2022/10/2022-WILLIAMS-CHA-9-16-22-F.PDF PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 11: DESCRIBE HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED:THE STRATEGIC PLAN OF ACTION IS TO ADDRESS THREE PRIORITIES 1) ACCESS TO CARE, 2) HEALTH BEHAVIORS, 3) MENTAL HEALTH AND ADDICTION. ALL PRIORITIES HAVE SPECIFIC STRATEGIES AND ACTION STEPS OUTLINED IN THE CHIP.PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE CHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEE WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. INDICATORS HAVE ALREADY BEEN DEFINED THROUGHOUT THIS REPORT AND ARE IDENTIFIED WITH THE ICON.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 11: DESCRIBE HOW THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY SUCH NEEDS THAT ARE NOT BEING ADDRESSED TOGETHER WITH THE REASONS WHY SUCH NEEDS ARE NOT BEING ADDRESSED:THE STRATEGIC PLAN OF ACTION IS TO ADDRESS THREE PRIORITIES 1) ACCESS TO CARE, 2) HEALTH BEHAVIORS, 3) MENTAL HEALTH AND ADDICTION. ALL PRIORITIES HAVE SPECIFIC STRATEGIES AND ACTION STEPS OUTLINED ON PAGES 38-50 IN THE CHIP.PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE SHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS NEEDED BASIS. THE FULL COMMITTEE WILL MEET QUARTERLY OR AS NEEDED TO REPORT OUT PROGRESS. THE COMMITTEE WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE COMMITTEE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY.WILLIAMS COUNTY WILL CONTINUE FACILITATING CHA EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS. PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN WILLIAMS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. INDICATORS HAVE ALREADY BEEN DEFINED THROUGHOUT THIS REPORT AND ARE IDENTIFIED WITH THE ICON.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE CHIP COMMITTEE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY).FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 13B: ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS.PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT. THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THIS FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE.IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE.SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT.THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCAIL PROGRAM AND THE APPLICATION PROCESS. COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY ARE DISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREECLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 13B: ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS.PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT. THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THIS FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE.IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE.SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT.THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCIAL PROGRAM AND THE APPLICATION PROCESS. COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY ARE DISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREE CLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. PARKVIEW BRYAN HOSPITAL PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS, IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY. PARKVIEW MONTPELIER HOSPITAL PART V, SECTION B, LINE 20E: VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE 'SELF PAY/COLLECTION POLICY'. I-SOLUTIONS IS AN ELECTRONIC SCREENING PROCESS THAT PROVIDES A SCORE RELATING TO THE PATIENT'S ABILITY TO PAY.PRESUMPTIVE ELIGIBILITY IS DETERMINED IMMEDIATELY PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. PATIENTS RECEIVING A FINANCIAL DISCOUNT FROM THE I-SOLUTIONS PROCESS MAY ALSO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR A HIGHER DISCOUNT, AS LONG AS THE APPLICATION IS COMPLETED WITHIN 240 DAYS OF THE 1ST STATEMENT DATE. THE PATIENT DOES NOT RECEIVE NOTIFICATION OF THE CHARITY DISCOUNT APPLIED BASED ON PRESUMPTIVE ELIGIBILITY AS THE ACCOUNT HAS ALREADY MET THE HOSPITAL GUIDELINES FOR PLACEMENT WITH A COLLECTION AGENCY AND IS IMMEDIATELY FORWARDED TO THE AGENCY FOR COLLECTION OF THE REMAINING BALANCE. THE COLLECTION AGENCY WILL ENCOURAGE COMPLETION OF A FINANCIAL APPLICATION, IF THEY DETERMINE THE PATIENT IS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, REGARDLESS, IF THE ACCOUNT HAS ALREADY RECEIVED A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY. PARKVIEW BRYAN HOSPITAL - PART V, LINES 16A, 16B AND 16C: HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE PARKVIEW MONTEPELIER HOSPITAL - PART V, LINES 16A, 16B AND 16C: HTTPS://WWW.PARKVIEW.COM/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE 2 1 - PARKVIEW ARCHBOLD 121 WESTFIELD DR ARCHBOLD OH 43502 OP SURGERY CENTER, OP RADIOLOGY, OP LAB, OP THERAPIES AND MOB 2 - RADIATION ONCOLOGY CENTER 524 WEST HIGH ST BRYAN OH 43506 RADIATION ONCOLOGY PART I, LINE 7: PART I, LINE 7ATHE FINANCIAL ASSISTANCE COST REPORTED ON LINE 7A IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE FINANCIAL ASSISTANCE CHARGES FOREGONE ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF SERVICES RENDERED.PART I, LINE 7BCOMMUNITY HOSPITALS AND WELLNESS CENTERS ACCEPTS ALL MEDICAID, MEDICAID MANAGED CARE, AND OUT-OF-STATE MEDICAID PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS. INTERNAL REVENUE SERVICE (IRS) REVENUE RULING 69-545 IMPLIES THAT TREATING MEDICAID PATIENTS IS A COMMUNITY BENEFIT. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICAID, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE UNREIMBURSED MEDICAID COST REPORTED ON LINE 7B IS CALCULATED UNDER THE COST TO CHARGE RATIO METHODOLOGY. UNDER THIS METHOD, THE MEDICAID CHARGES ARE MULTIPLIED BY THE RATIO OF COST TO CHARGES TO DETERMINE THE COST OF MEDICAID SERVICES RENDERED. THEN, THE COST OF MEDICAID SERVICES RENDERED IS DEDUCTED FROM THE REIMBURSEMENT RECEIVED FOR MEDICAID PATIENTS TO ARRIVE AT A GAIN/(LOSS) RELATIVE TO THESE PATIENTS.PART I, LINE 7EAMOUNTS PRESENTED ARE BASED ON ACTUAL SPEND FOR THOSE SERVICES AND BENEFITS PROVIDED DEEMED TO IMPROVE THE HEALTH OF THE COMMUNITIES IN WHICH WE SERVE AND CONFORM WITH THE MISSION OF OUR EXEMPT PURPOSE.PART I, LINE 7IIN KEEPING WITH OUR MISSION AND COMMITMENT TO THE COMMUNITIES IN WHICH WE SERVE, COMMUNITY HOSPITALS AND WELLNESS CENTERS CONTINUES ITS TRADITION OF CONTRIBUTING TO NUMEROUS ORGANIZATIONS ON BOTH AN AS-NEEDED BASIS AND NEGOTIATED BASIS. AMOUNTS PRESENTED REPRESENT ACTUAL SPEND TO ORGANIZATIONS THROUGHOUT OUR COMMUNITIES. PART III, LINE 2: FOR FINANCIAL STATEMENT PURPOSES, THE ORGANIZATION HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. PART III, LINE 4: BAD DEBT EXPENSE - PARKVIEW HEALTH SYSTEM, INC. AND SUBSIDIARIES - NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTSTEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE OR THE PAGE NUMBER ON WHICH THIS FOOTNOTE IS CONTAINED IN THE ATTACHED FINANCIAL STATEMENTS:PAGES 13 AND 24 - 27 OF ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTSCOMMUNITY HOSPITALS AND WELLNESS CENTERS BELIEVES THERE ARE SEVERAL REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. FIRST, WHILE COMMUNITY HEALTH AND WELLNESS CENTERS ACCEPTS ALL MEDICARE PATIENTS, NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. SECOND, BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. THIRD, IRS REVENUE RULING 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 9B: THE FOLLOWING COLLECTION PRACTICES ARE CONSISTENT WITH ALL PATIENTS:STATEMENT CYCLE:THE FIRST STATEMENT MAILED TO THE PATIENT/GUARANTOR IS A STATEMENT SUMMARIZING THE CHARGES AND INSURANCE PAYMENTS, IF APPLICABLE. THIS STATEMENT IS MAILED TO THE GUARANTOR THE DAY AFTER THE ACCOUNT IS FINAL BILLED IN THE HOSPITAL SYSTEM, OR THE DAY FOLLOWING RECEIPT AND SETTLEMENT OF INSURANCE PAYMENT, IF APPLICABLE. IF INSURANCE HAS PENDED PROCESSING OF A CLAIM, HOLDING FOR REQUESTED INFORMATION FROM THE POLICY HOLDER, THE BILLER CALLS THE GUARANTOR OF THE ACCOUNT, IF UNABLE TO REACH THEM A LETTER IS SENT TO THE PATIENT/GUARANTOR ASKING THEM TO PROVIDE THE INSURANCE WITH THE REQUESTED INFORMATION AND NOTIFY THE PATIENT ACCOUNTS OFFICE WHEN IT IS COMPLETED. IF THE PATIENT DOES NOT RESPOND TO THE LETTER BY THE DUE DATE, THE ACCOUNT WILL BE CHANGED TO SELF-PAY PRIOR TO INSURANCE PAYMENT, AND THE PATIENT WILL BEGIN RECEIVING STATEMENTS. FOLLOWING THE INITIAL SUMMARY STATEMENT, A GUARANTOR STATEMENT IS MAILED TO THE GUARANTOR THE FIRST WEEK OF EACH MONTH, UNTIL THE ACCOUNT IS SETTLED IN FULL, OR REFERRED TO AN OUTSIDE AGENCY FOR COLLECTIONS. THE GUARANTOR STATEMENT LISTS ALL ACCOUNTS WITH AN OUTSTANDING PATIENT BALANCE, EXCLUDING BAD DEBT ACCOUNTS THAT ARE PROCESSING WITH A COLLECTION AGENCY. ACCOUNTS PROCESSING WITH INSURANCE WILL NOT BE INCLUDED ON PATIENT/GUARANTOR STATEMENTS, UNTIL THERE IS A PATIENT BALANCE DUE ON THE ACCOUNT.PHONE CALLS:CHWC WILL ATTEMPT TO MAKE A PHONE CALL TO ALL PATIENTS WITH NO INSURANCE APPROXIMATELY 2 WEEKS AFTER THE DATE OF SERVICE, AT THAT TIME WE OFFER ASSISTANCE WITH MEDICAID ENROLLMENT, FINANCIAL ASSISTANCE INCLUDING HOSPITAL PROGRAM AND HCAP OR SETTING UP PAYMENT ARRANGEMENTS. THIS PHONE CALL WILL BE DOCUMENTED ON THE ACCOUNT NOTES.PAYMENT ARRANGEMENT GUIDELINES:THE PATIENT STATEMENT INCLUDES CONTACT INFORMATION FOR THE PATIENT ACCOUNTS BILLING OFFICE. PATIENT REPRESENTATIVES ARE AVAILABLE TO SET UP PAYMENT ARRANGEMENTS WITH THE GUARANTOR. WHEN A GUARANTOR CALLS TO SET UP PAYMENT ARRANGEMENTS, THE GUARANTOR IS ASKED TO PAY IN FULL, AND OFFERED THE OPTION OF A 15% PROMPT PAY DISCOUNT IF PAID IN FULL WITHIN 30 DAYS OF THE FIRST STATEMENT DATE. REQUESTS FOR DISCOUNTS EXCEEDING 15% ARE TO BE APPROVED BY THE PRESIDENT/CEO OR CFO. IF PAYMENT IN FULL IS NOT POSSIBLE, THE GUARANTOR IS ASKED TO MAKE MONTHLY PAYMENTS TO PAY THE ACCOUNT IN FULL WITHIN 18 MONTHS, AND WITH A MINIMUM PAYMENT OF $50.00 PER MONTH. EXCEPTIONS CAN BE MADE TO THESE PAYMENT GUIDELINES TO ALLOW A SMALLER PAYMENT OR EXTENDED TIME TO PAY OFF THE BILL, IF DETERMINATION IS MADE THAT THE GUARANTOR IS MAKING EVERY EFFORT TO PAY AND AGREES TO INCREASE PAYMENTS IN THE FUTURE, IF THE FINANCIAL CIRCUMSTANCES CHANGE. THE GUARANTOR MAY BE ASKED TO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, IF HE/SHE IS NOT ABLE TO MAKE ACCEPTABLE PAYMENT ARRANGEMENTS. (SEE FINANCIAL ASSISTANCE POLICY).FINAL NOTICE:IF NO PAYMENT IS RECEIVED OR PAYMENT ARRANGEMENT ESTABLISHED BY DAY 63 FROM THE INITIAL STATEMENT DATE, A "PAST DUE LETTER" IS SENT TO THE GUARANTOR OF PARAGON ACCOUNTS WITH A REQUEST TO PAY IN FULL OR CONTACTPATIENT ACCOUNTS WITHIN 30 DAYS. THE PAST DUE LETTER WILL INCLUDE THE 'PLAIN LANGUAGE SUMMARY". THE PAST DUE LETTER WILL INFORM THE PATIENT THAT THE ACCOUNT WILL BE CONSIDERED FOR COLLECTIONS IF THERE IS NO RESPONSE WITHIN 30 DAYS AND WILL ALSO LIST THE ECA'S (SEE ECA BELOW) THAT MAY BE INITIATED IF THE GUARANTOR DOES NOT RESPOND. IF THERE IS NO RESPONSE BY THE 38TH DAY FOLLOWING THE DATE OF THE 'PAST DUE LETTER OR ACCEPTABLE PAYMENTS HAVE NOT BEEN ESTABLISHED, THE ACCOUNT IS REVIEWED BY THE PATIENT REPRESENTATIVE TO DETERMINE ELIGIBILITY FOR BAD DEBT AND COLLECTION AGENCY PROCESSING. IF THE PATIENT HAD PREVIOUSLY ESTABLISHED A PAYMENT ARRANGEMENT BUT DID NOT FOLLOW THROUGH WITH TIMELY PAYMENTS, A PHONE CALL TO THE PATIENT WILL BE MADE TO RE-ESTABLISH THE PAYMENT ARRANGEMENT. IF THE PATIENT IS NOT ABLE TO BE REACHED AFTER A MINIMUM OFTWO ATTEMPTS, OR IS NOT COOPERATIVE, THE ACCOUNT WILL BE CONSIDERED FOR BAD DEBT/COLLECTIONS DURING THE NEXT TRANSFER OF ACCOUNTS.INVALID ADDRESS OR CONTACT INFORMATION:IF A PATIENT STATEMENT IS RETURNED FOR AN INVALID ADDRESS, THE PATIENT WILL BE CONTACTED BY PHONE TO OBTAIN CORRECT BILLING INFORMATION. IF THERE IS NO VALID PHONE CONTACT, OR THE PATIENT DOESN'T RESPOND TO A PHONE CALL, THE ACCOUNT MAY BE SENT TO THE COLLECTION AGENCY PRIOR TO SENDING A FINAL "PAST DUE LETTER". THE AGENCY WILL ATTEMPT TO LOCATE A VALID ADDRESS FOR THE GUARANTOR. THE AGENCY WILL NOTIFY THE HOSPITAL IF A VALID ADDRESS IS OBTAINED. IF THE PATIENT DOES NOT COOPERATE WITH THE COLLECTION AGENCY REGARDING PAYMENT OR COMPLETION OF A FINANCIAL APPLICATION, THE AGENCY WILL CONTACT THE HOSPITAL SO THAT A FINAL 'PAST DUE LETTER' CAN BE SENT. IF THERE IS NO RESPONSE TO THE PAST DUE LETTER, THE COLLECTION AGENCY MAY CONTINUE WITH APPROPRIATE ECA'S 240 DAYS FROM THE ORIGINAL STATEMENT DATE. THE HOSPITAL AND AGENCY WILL WORK TOGETHER TO ASSURE THE AGENCY HAS THE APPROPRIATE 1ST STATEMENT DATE SINCE THE ACCOUNTS MAY BE INITIALLY SENT TO THE AGENCY PRIOR TO THE NORMAL MINIMUM OF DAY 100.PRESUMPTIVE ELIGIBILITY:AFTER THE SECONDARY COLLECTION AGENCY HAS DETERMINED AN ACCOUNT TO BE UNCOLLECTIBLE, THE ACCOUNT IS SENT TO "I-SOLUTIONS" TO REVIEW AND DETERMINE CHARITY ELIGIBILITY. ANY ACCOUNTS THAT LIST ON THE I-SOLUTIONS REPORT AS "YES" UNDER THE CHARITY COLUMN WILL RECEIVE A CHARITY DISCOUNT EQUAL TO THE "W/O AMOUNT" LISTED ON THE REPORT. ACCOUNTS THAT CONTAIN A POSITIVE "W/O AMOUNT AND FALL IN THE "BD OR "LOW" PROPENSITY TO PAY CATEGORY, AND ACCOUNTS WITH NO LISTED PROPENSITY TO PAY BUT A POSITIVE "W/O AMOUNT" WILL ALSO RECEIVE A CHARITY DISCOUNT EQUAL TO THE "W/O AMOUNT" LISTED ON THE REPORT. VISITS WITH A PROPENSITY TO PAY "NMD" (NEED MORE DATA) DO NOT RECEIVE A CHARITY ADJUSTMENT.THE ADMISSION AUTHORIZATION FORM INCLUDES A STATEMENT AUTHORIZING THE HOSPITAL TO REVIEW THE GUARANTOR'S CREDIT INFORMATION. IF THIS IS NOT SIGNED BY THE PATIENT OR HIS/HER REPRESENTATIVE, THE VISIT WILL NOT BE SENT TO I-SOLUTIONS FOR REVIEW.ACCOUNTS RECEIVING A DISCOUNT BASED ON PRESUMPTIVE ELIGIBILITY ARE ELIGIBLE TO APPLY FOR AN ADDITIONAL DISCOUNT IF A FINANCIAL APPLICATION IS COMPLETED WITHIN 240 DAYS FROM THE 1ST STATEMENT DATE. PART VI, LINE 2: DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, IN ADDITION TO ANY CHNAS REPORTED IN PART V, SECTION B. WILLIAMS COUNTY PARTNERS FOR HEALTH COMMITTEE PRESENTS THE 2022 WILLIAMS COUNTY COMMUNITY HEALTH ASSESSMENT. THE DATA CONTAINED IN THIS REPORT IS A SCIENTIFICALLY VALID SAMPLING CONDUCTED EVERY THREE YEARS IN THE COMMUNITY TO BETTER IDENTIFY AND UNDERSTAND HEALTH ISSUES FACING WILLIAMS COUNTY RESIDENTS. THROUGH A COMBINED EFFORT BY THE WILLIAMS COUNTY HEALTH DEPARTMENT, COMMUNITY HOSPITALS AND WELLNESS CENTERS BRYAN AND MONTPELIER, AND THE MANY ORGANIZATIONS LISTED IN THIS PUBLICATION, WE ARE ABLE TO PROVIDE VALUABLE INFORMATION BOTH TO INDIVIDUAL RESIDENTS AND ORGANIZATIONS IN THE COMMUNITY. IN THE PAST, THIS INFORMATION HAS HELPED TO EDUCATE CITIZENS ABOUT THEIR COMMUNITY AND WE HOPE YOU FIND THE NEW REPORT HELPFUL IN THAT REGARD. IN THE 2022 REPORT YOU WILL FIND THAT IN MANY WAYS THE HEALTH OF OUR COMMUNITY IS VERY GOOD AND RANKS HIGHER THAN BOTH THE NATION AND STATE AVERAGES. IN OTHER AREAS, YOU WILL FIND WE STILL HAVE CHALLENGES THAT NEED TO BE ADDRESSED FOR THE BETTERMENT OF OUR COMMUNITY. WHETHER YOU USE THIS INFORMATION TO APPLY FOR GRANTS OR JUST BECOME MORE INFORMED WE HOPE THAT YOU FIND THIS REPORT USEFUL FOR YOUR PURPOSES. PART VI, LINE 3: DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.ALL PATIENTS REGISTERING FOR EMERGENCY OR MEDICALLY NECESSARY CARE WILL BE OFFERED A FINANCIAL APPLICATION AND "PLAIN LANGUAGE SUMMARY" AT THE TIME OF REGISTRATION. CHWC WILL ALSO FOLLOW UP WITH UNINSURED PATIENTS WITHIN 3 TO 4 WEEKS OF SERVICE, IF A FINANCIAL APPLICATION IS NOT RECEIVED OR MEDICAID APPLICATION IS NOT COMPLETED BY THAT DATE. FOLLOW UP CONSISTS OF A PHONE CALL TO OFFER THE PATIENT ASSISTANCE WITH THE MEDICAID APPLICATION AND DISCUSS FINANCIAL ASSISTANCE OPTIONS.PATIENT BILLING STATEMENTS INCLUDE ON THE BACK SIDE, INFORMATION ON THE HCAP AND HOSPITAL FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CURRENT POVERTY LEVELS, AS REQUIRED BY HCAP POLICY. THE OPTIONS FOR REQUESTING A FINANCIAL APPLICATION ARE ALSO LISTED ON THE STATEMENT. REFERENCE TO THE FINANCIAL ASSISTANCE INFORMATION WILL BE CLEARLY NOTED ON THE FRONT SIDE OF THE STATEMENT.THE PLAIN LANGUAGE SUMMARY, FINANCIAL APPLICATION, BILLING AND COLLECTIONS POLICY, AND THE FINANCIAL ASSISTANCE POLICY ARE DISPLAYED ON THE HOSPITAL WEBSITE.IN COMPLIANCE WITH THE 5-PERCENT/1000 PERSON THRESHOLD UNDER THE HHS GUIDANCE SAFE HARBOR AND 501R REGULATIONS, THE SPANISH VERSION OF THE FAP, FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY IS ALSO AVAILABLE AT ALL HOSPITAL LOCATIONS AND ON THE HOSPITAL WEBSITE.SIGNAGE IS POSTED AT ALL 3 HOSPITAL BUILDINGS IN CUSTOMER AREAS INCLUDING ADMISSIONS OFFICE, BILLING OFFICE, CASHIER AREA AND EMERGENCY DEPARTMENT.THE SIGNAGE WILL PROVIDE INFORMATION ON THE HOSPITAL FINANCIAL PROGRAM AND THE APPLICATION PROCESS. COPIES OF THE FINANCIAL APPLICATION AND PLAIN LANGUAGE SUMMARY AREDISTRIBUTED TO THE COMPASSION CLINIC IN WILLIAMS COUNTY. THIS IS A 'FREECLINIC AND PATIENTS ARE ENCOURAGED TO COMPLETE THE APPLICATION IF THEY NEED FOLLOW UP SERVICES AT THE HOSPITAL. PART VI, LINE 4: DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES.ACCORDING TO THE UNITED STATES CENSUS BUREAU'S 2022 AMERICAN COMMUNITY SURVEY (ACS) 5-YEAR ESTIMATES, COMMUNITY HOSPITALS AND WELLNESS CENTERS (CHWC) SERVES A RURAL POPULATION OF 37,102 IN WILLIAMS COUNTY. WHEN DELVING INTO THE SOCIO-ECONOMIC FABRIC OF THE COUNTY, THE U.S. CENSUS BUREAU'S ACS REPORTS THAT THE MEDIAN HOUSEHOLD INCOME STANDS AT $60,632, WHILE 11.2% OF HOUSEHOLDS HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL (2018-2022). A TESTAMENT TO THE COMMUNITY'S COMMITMENT TO HEALTH, AROUND 94.6% OF THE COUNTY'S RESIDENTS ARE COVERED BY HEALTH INSURANCE, WITH MEDICAID EXTENDING ITS COVERAGE TO 18.1% OF THE INSURED POPULATION ACCORDING TO THE U.S. CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY DATABASE (2022).HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA), AN AGENCY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, DEVELOPS SHORTAGE DESIGNATION CRITERIA INTENDED TO IDENTIFY A GEOGRAPHIC AREA, POPULATION GROUP OR FACILITY AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OR A MEDICALLY UNDERSERVED AREA OR POPULATION (MUA/P). EACH HPSA DESIGNATION IS GIVEN A SCORE (RANGING FROM 0 TO 26) THAT EXPRESSES THE PRIORITY LEVEL FOR CLINICIAN ASSIGNMENT. MEANING, THE HIGHER THE HPSA SCORE, THE HIGHER THE PRIORITY. HRSA HAS DESIGNATED/IDENTIFIED THE FOLLOWING MEDICALLY UNDERSERVED AREAS/POPULATIONS AND HEALTH PROFESSIONAL SHORTAGE AREAS:WILLIAMS COUNTY:1) DISCIPLINE: PRIMARY CAREHPSA ID: 139999392BSERVICE AREA NAME: HEALTH PARTNERS OF WESTERN OHIODESIGNATION TYPE: FEDERALLY QUALIFIED HEALTH CENTERHPSA SCORE: 21 STATUS: DESIGNATEDRURAL STATUS: NON-RURAL2) DISCIPLINE: PRIMARY CAREHPSA ID: 1396199989SERVICE AREA NAME: EDGERTON FAMILY HEALTH CENTERDESIGNATION TYPE: RURAL HEALTH CLINICHPSA SCORE: 14STATUS: DESIGNATEDRURAL STATUS: RURAL3) DISCIPLINE: MENTAL HEALTH HSPA ID: 7393813179HPSA NAME: LI-DEFIANCE/FULTON/HENRY/WILLIAMS COUNTIESDESIGNATION TYPE: LOW INCOME POPULATION HPSACOUNTY NAME: DEFIANCE, FULTON, HENRY, AND WILLIAMS COUNTYHPSA SCORE:16 STATUS: DESIGNATEDRURAL STATUS: PARTIALLY RURAL4) DISCIPLINE: MENTAL HEALTHHSPA ID: 7395863055HPSA NAME: EDGERTON FAMILY HEALTH CENTERDESIGNATION TYPE: RURAL HEALTH CLINICCOUNTY NAME: WILLIAMS COUNTYHPSA SCORE:167STATUS: DESIGNATEDRURAL STATUS: RURAL PART VI, LINE 5: PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (E.G. OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS, ETC.).THE MAJORITY OF THE COMMUNITY HOSPITALS AND WELLNESS CENTERS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PEOPLE THROUGHOUT THE COMMUNITY CAN COUNT ON COMMUNITY HOSPITALS AND WELLNESS CENTERS TO BE STANDING BY WITH EMERGENCY CARE 24 HOURS A DAY, 365 DAYS A YEAR. THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD-CERTIFIED PHYSICIANS AND A NURSING STAFF THAT IS TRAINED AND CERTIFIED IN EMERGENCY CARE. THE HOSPITAL PROVIDES THE HIGHEST QUALITY OF CARE IN THE MOST EFFICIENT MANNER POSSIBLE. WE TAKE INTO CONSIDERATION COMMUNITY FEEDBACK ON SERVICES THEY WOULD LIKE PROVIDED LOCALLY AND ASSESS IF WE CAN PROVIDE THEM WITH THE UPMOST QUALITY AND EFFICIENCY. PART VI, LINE 6: IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.EFFECTIVE OCTOBER 1, 2023, COMMUNITY HOSPITALS AND WELLNESS CENTERS, ALONG WITH ITS TEAM OF CO-WORKERS, PHYSICIANS, AND ADVANCED PRACTICE PROVIDERS, OFFICIALLY AFFILIATED WITH PARKVIEW HEALTH SYSTEM, INC., A HEALTHCARE SYSTEM SERVING NORTHEAST INDIANA AND NORTHWEST OHIO THROUGH ITS HOSPITALS AND PHYSICIAN CLINICS. COMMUNITY HOSPITALS AND WELLNESS CENTERS IS BASED IN BRYAN, OHIO AND HAS TWO HOSPITALS IN WILLIAMS COUNTY AND AN OUTPATIENT CENTER IN FULTON COUNTY. UPON AFFILIATION, COMMUNITY HOSPITALS AND WELLNESS CENTERS DESIGNATED THESE THREE FACILITIES AS PARKVIEW BRYAN HOSPITAL, PARKVIEW MONTPELIER HOSPITAL AND PARKVIEW ARCHBOLD. ADDITIONALLY, PARKVIEW HEALTH SYSTEM, INC. INCLUDES THE NOT-FOR-PROFIT HOSPITALS OF PARKVIEW HOSPITAL, INC.; COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.; COMMUNITY HOSPITAL OF NOBLE COUNTY, INC.; DEKALB MEMORIAL HOSPITAL, INC.; HUNTINGTON MEMORIAL HOSPITAL, INC.; PARK CENTER, INC.; PARKVIEW WABASH HOSPITAL, INC.; WHITLEY MEMORIAL HOSPITAL, INC.; AS WELL AS 60 PERCENT OWNERSHIP IN THE JOINT VENTURE OF ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC.EACH HOSPITAL ENTITY ENGAGES IN COMMUNITY OUTREACH ACTIVITIES CUSTOMIZED TO MEET THE UNIQUE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. AFFILIATE HOSPITALS ALSO WORK TOGETHER AND SHARE PROGRAMMING AND MESSAGING WHERE COMMON COMMUNITY HEALTH ISSUES ARE IDENTIFIED. PARKVIEW HEALTH SYSTEM, INC. ENGAGES WITH A BOARD OF DIRECTORS AND AFFILIATE HOSPITALS EACH HAVE A LOCAL BOARD OF DIRECTORS. MOST OF THE BOARD OF DIRECTORS SHALL ALWAYS BE INDEPENDENT AS DEFINED BY THE INTERNAL REVENUE SERVICE (IRS). PARKVIEW CONTRIBUTES TO THE OVERALL SUCCESS OF THE REGION THROUGH SIGNIFICANT INVOLVEMENT IN THE COMMUNITIES WE SERVE. BY DEVELOPING VARIOUS PARTNERSHIPS AND ALIGNMENTS WITH DIFFERENT SECTORS AND ORGANIZATIONS, PARKVIEW HELPS TO BENEFIT THE ECONOMY, QUALITY OF LIFE AND HEALTH/WELL-BEING ACROSS THE REGION. WITH A CONSISTENT FOCUS ON OUR MISSION AND VISION, WE WORK TO PROVIDE THE BEST CARE TO EVERY PERSON, EVERY DAY WITHIN OUR FACILITIES WHILE SERVING AS GOOD STEWARDS OF SURPLUS FUNDS TO POSITIVELY IMPACT COMMUNITY HEALTH STATUS. X X X X X 0 1 0 0 0 0 0 1 0 JEANNE' WICKENS PH CHIEF FINANCIAL OFFICER 0 834975 0 187034 0 1143499 0 239228 0 38660 0 2443396 0 1107767 GREG JOHNSON DIRECTOR/REGIONAL MARKET PRESIDENT 0 681591 0 112796 0 94104 0 155300 0 33706 0 1077497 0 84817 CHAD TINKEL DIRECTOR/CHWC PRESIDENT 347866 0 244487 0 308373 0 63794 0 26449 0 990969 0 278519 0 DAVID COOLEY CHWC PHYSICIAN 704973 0 143920 0 23386 0 34324 0 19897 0 926500 0 0 0 DAMODER KESIREDDY CHWC PHYSICIAN 590859 0 183879 0 19824 0 36300 0 0 0 830862 0 0 0 RICHARD CHURCH DIRECTOR/PH CHIEF GWTH STR OFFICER 0 517021 0 71738 0 41252 0 143100 0 46614 0 819725 0 0 KHALID MINHAS CHWC PHYSICIAN 668685 0 64050 0 25530 0 12950 0 29937 0 801152 0 18750 0 JODI TINKEL CHWC PHYSICIAN 617689 0 4050 0 748 0 11951 0 4135 0 638573 0 0 0 JOSE PARODI CHWC PHYSICIAN 493266 0 46950 0 27571 0 1734 0 25807 0 595328 0 18750 0 JANICE DAVID FORMER KEY EMPLOYEE/CURRENT MCHA PSA 5913 0 162726 0 367215 0 20424 0 818 0 557096 0 382083 0 STEVE BUMB DIRECTOR/CHWC CHIEF OF STAFF 343862 0 40450 0 1577 0 21998 0 28295 0 436182 0 0 0 CAROLYN SHARROCK-DORSTEN DIRECTOR/MCHA PHYSICIAN 0 302136 0 48029 0 5768 0 36300 0 35461 0 427694 0 0 ANCEL PATRICK CHWC VP OPERATIONS 196526 0 0 0 124022 0 22376 0 25178 0 368102 0 84086 0 PHILIP ENNEN FORMER OFFICER 0 0 0 0 366527 0 0 0 0 0 366527 0 366527 0 ELIZABETH GRIMES CHWC VP PAT CARE SVCS 168523 0 0 0 89797 0 25600 0 24131 0 308051 0 49506 0 CHRISTA POMEROY FORMER OFFICER/PH DIRECTOR TREASURY 207232 0 12500 0 47793 0 8618 0 28402 0 304545 0 31411 0 MICHAEL CULLER FORMER OFFICER 0 0 0 0 123976 0 0 0 0 0 123976 0 123976 0 PART I, LINE 3 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF COMMUNITY HOSPITALS AND WELLNESS CENTERS' CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKIEW HEALTH SYSTEM, INC. INDEPENDENT COMPENSATION CONSULTANT FORM 990 OF OTHER ORGANIZATIONS COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE OF RELATED ORGANIZATION PARKVIEW HEALTH SYSTEM, INC. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS THE FOLLOWING INDIVIDUALS PARTICIPATE IN SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS. BENEFITS EARNED UNDER THE PLANS WILL FUND THE EMPLOYEES' EVENTUAL RETIREMENT BENEFIT. THESE BENEFITS ARE PROVIDED IN EXCHANGE FOR THE EMPLOYEES' YEARS OF SERVICE TO THE ORGANIZATION AND THE AMOUNT OF THE BENEFITS MAY VARY FROM YEAR TO YEAR. THE FOLLOWING INDIVIDUALS VESTED IN A PORTION OF THEIR DEFERRED COMPENSATION PLANS, WHICH IS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS AT THE TIME OF VESTING. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III): MICHAEL CULLER $123,976; JANICE DAVID $382,083; PHILIP ENNEN $366,527; ELIZABETH GRIMES $49,506; GREG JOHNSON $84,817; KHALID MINHAS $18,750; JOSE PARODI $18,750; ANCEL PATRICK $84,086; CHRISTA POMEROY $31,411; CHAD TINKEL $278,519; JEANNE' WICKENS $1,101,767 AMOUNTS LISTED ABOVE THAT HAVE BEEN REPORTED AS DEFERRED COMPENSATION ON PRIOR FORM 990 OF THE ORGANIZATION OR RELATED ORGANIZATIONS WILL ALSO BE REFLECTED IN SCHEDULE J, PART II, COLUMN (F). FOR EXAMPLE, THE AMOUNT OF $1,107,767 REPORTED AS REQUIRED FOR JEANNE' WICKENS WAS A RESULT OF THE VESTING OF SUCH AMOUNT UNDER THE TERMS OF THE RESPECTIVE PLANS. HOWEVER, THESE AMOUNTS WERE PREVIOUSLY REPORTED IN JEANNE' WICKENS' DEFERRED COMPENSATION FROM PRIOR YEARS AS THE AMOUNTS WERE DEFERRED UNDER THE PLANS. AS SUCH, THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN (F) IS AN INDICATION OF AMOUNTS THAT HAVE BEEN REPORTED TWICE, ONCE AS A DEFERRAL AND ONCE AS VESTED. THE FOLLOWING INDIVIDUALS HAVE AN AMOUNT INCLUDED IN SCHEDULE J, PART II, COLUMN (C) FOR AN AMOUNT EARNED BUT NOT YET VESTED UNDER ONE OF PARKVIEW'S DEFERRED COMPENSATION PLANS. THE AMOUNTS ARE AT RISK AND WILL NOT BE PAID UNLESS AND UNTIL EACH EMPLOYEE HAS PROVIDED SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. BENEFITS UNDER THE PLANS VEST AT THE TIME SET FORTH IN THE PLAN DOCUMENTS AND ARE FORFEITED IF THE EMPLOYEES TERMINATE EMPLOYMENT BEFORE SATISFYING THOSE PLAN CONDITIONS. DEFERRALS REPORTED IN SCHEDULE J, PART II, COLUMN (C) INCLUDE: RICHARD CHURCH $136,500; GREG JOHNSON $119,000; CHAD TINKEL $15,217; JEANNE' WICKENS $216,128 PART I, LINE 7 THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP) ARE ANNUAL INCENTIVE PROGRAMS. THE COMPENSATION COMMITTEE OF RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., REVIEWS AND APPROVES THE PLAN DOCUMENTS FOR MICP AND PICP. AT CONCLUSION OF THE PLAN YEAR, THE PARKVIEW HEALTH SYSTEM, INC. EXECUTIVE COMMITTEE APPROVES FINAL PAYMENT. JODI TINKEL FAMILY MEMBER OF DIRECTOR/OFFICER CHAD TINKEL 638573 EMPLOYEE JODI TINKEL RECEIVED COMPENSATION (INCLUDING TAXABLE AND NONTAXABLE FRINGE BENEFITS TREATED AS COMPENSATION) FROM PARKVIEW HEALTH SYSTEM, INC. (10/1/2023 THROUGH 12/31/2023) AND COMMUNITY HOSPITALS AND WELLNESS CENTERS (1/1/2023 THROUGH 9/30/2023). 0 FORM 990, PART V, LINES 1A AND 2A: PARKVIEW HEALTH SYSTEM, INC. (PH), EIN 35-1972384, IS THE COMMON PAYING AGENT FOR THE FILING ORGANIZATION, COMMUNITY HOSPITALS AND WELLNESS CENTERS, EIN 34-1048666. THEREFORE, ALL APPLICABLE IRS TAX FILINGS, INCLUDING FORMS 1099, 1096, W-2 AND W-3 ARE REPORTED AND FILED BY PH. THE TOTAL NUMBER REPORTED IN BOX 3 OF FORM 1096 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2023 WAS 704. THE TOTAL NUMBER OF EMPLOYEES REPORTED ON FORM W-3 AND FILED BY THE COMMON PAYING AGENT, PH, FOR THE YEAR ENDED DECEMBER 31, 2023 WAS 18,435. FOR PURPOSES OF COMPLETING FORM 990, PART V, LINE 1A AND 2A, THE NUMBER REPORTED FOR THE COMMUNITY HOSPITALS AND WELLNESS CENTERS WAS 13 AND 570 RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE PRESIDENT OF THE CORPORATION, THE CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER OR HIS/HER DESIGNEE, THE CURRENT PRESIDENT OF THE MEDICAL STAFF AND SUCH OTHER PERSONS AS IDENTIFIED BY THE CHAIR OF THE BOARD, EACH OF WHOM SHALL BE ENTITLED TO VOTE. IN NO EVENT SHALL THE MEMBERS OF THE EXECUTIVE COMMITTEE EXCEED EIGHT (8) PEOPLE. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION IN ANY MATTER WHEN THE BOARD IS NOT IN SESSION, REPORTING TO THE BOARD FOR ITS RATIFICATION OF ITS ACTION. THE CHAIR OF THE BOARD SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. MEETINGS OF THE EXECUTIVE COMMITTEE MAY BE CALLED BY THE CHAIR OR BY THREE (3) MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 OFFICER JEANNE' WICKENS AND DIRECTOR RICHARD CHURCH HAVE A BUSINESS RELATIONSHIP AS DIRECTORS ON THE BOARD OF A RELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 4 THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF COMMUNITY HOSPITALS AND WELLNESS CENTERS: PARKVIEW HEALTH SYSTEM, INC. WAS ADDED AS THE SOLE CORPORATE MEMBER. THE RESERVED POWERS OF THE CORPORATE MEMBER ARE LISTED ON THE FORM 990, SCHEDULE O UNDER THE SECTION OF FORM 990, PART VI, SECTION A, LINE 7A. THE COMPOSITION OF THE BOARD WAS INCREASED FROM NOT LESS THAN EIGHT BUT NO MORE THAN ELEVEN TO NOT LESS THAN NINE BUT NO MORE THAN 14. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION. PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384 IS THE SOLE MEMBER OF COMMUNITY HOSPITALS AND WELLNESS CENTERS WITH CERTAIN RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER, PARKVIEW HEALTH SYSTEM, INC. EIN 35-1972384, SHALL HAVE THE FOLLOWING RESERVED POWERS: (I) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD SUBJECT TO THE COMPOSITION REQUIREMENTS REGARDING COMMUNITY AND PHYSICIAN REPRESENTATION SET FORTH IN ARTICLE V, SECTION 2; (II) APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR AND VICE CHAIR OF THE BOARD AND THE PRESIDENT OF THE CORPORATION; PROVIDED, HOWEVER, THAT THE CHAIR SHALL BE A COMMUNITY DIRECTOR; (III) APPROVE AND/OR REQUIRE THE ADOPTION OF AMENDMENTS TO THE ARTICLES OF INCORPORATION OR CODE OF REGULATIONS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; PROVIDED, THAT NO AMENDMENT TO THE CORPORATION'S ARTICLES OR CODE OF REGULATIONS THAT MODIFIES THE TERMS AND CONDITIONS PERTAINING TO THE COMPOSITION OR STRUCTURE OF THE CORPORATION'S BOARD SET FORTH IN ARTICLE V, SECTIONS 2 AND 3 OF THIS CODE OF REGULATIONS (THE "BOARD PROVISIONS") MAY BE ADOPTED BY THE CORPORATE MEMBER DURING THE THREE (3) YEAR PERIOD COMMENCING ON THE DATE OF ADOPTION (THE "RESTRICTION PERIOD"); PROVIDED, HOWEVER, THAT THE CORPORATE MEMBER MAY AMEND THE BOARD PROVISIONS DURING THE RESTRICTION PERIOD IF, AND ONLY TO THE EXTENT THAT, THE CORPORATE MEMBER REASONABLY DETERMINES SUCH AMENDMENT (I) IS IN CONJUNCTION WITH A CHANGE OF CONTROL OR CHANGE OF OWNERSHIP OF THE CORPORATE MEMBER OR COMMUNITY HOSPITALS AND WELLNESS CENTERS, AND (II) AMENDS THE COMPOSITION AND/OR STRUCTURE OF THE BOARD SO THAT THE SAME IS SUBSTANTIALLY SIMILAR TO THE COMPOSITION AND/OR STRUCTURE OF THE BOARDS OF THE CORPORATE MEMBER'S OTHER SUBSIDIARY HOSPITALS; (IV) APPROVE AND/OR REQUIRE THE ESTABLISHMENT, ACQUISITION, DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, AFFILIATION OR CORPORATE REORGANIZATION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (V) APPROVE AND ADOPT THE STRATEGIC PLAN AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (VI) APPROVE AND/OR REQUIRE THE INCURRENCE OF ANY DEBT, INCLUDING THE ISSUANCE OF ANY BONDS, PROPOSED BY THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VII) APPROVE AND/OR REQUIRE THE APPROVAL OF CONTRACTS OR LOANS OBLIGATING THE CORPORATION TO EXPEND OR REPAY AN AMOUNT IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (VIII) APPROVE AND/OR REQUIRE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, TRANSFER, ENCUMBRANCE OR OTHER DISPOSITION OF PROPERTY AND ASSETS OF THE CORPORATION IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; (IX) APPROVE AND ADOPT THE CAPITAL BUDGET, OPERATING BUDGET, FINANCIAL PLANS AND ANY AMENDMENTS THERETO FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (X) APPROVE AND/OR REQUIRE THE ADOPTION OF A MANAGED CARE POLICY FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION, INCLUDING NETWORK PARTICIPATION, PARTICIPATION IN ANY MANAGED CARE AGREEMENT AND PARTICIPATION IN ANY OTHER HEALTH CARE SERVICE ARRANGEMENTS; (XI) APPOINT AND REMOVE AUDITORS, ATTORNEYS AND OTHER PROFESSIONAL ADVISORS FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XII) DEVELOP, APPROVE AND/OR REQUIRE THE ADOPTION OF MEDICAL STAFF QUALITY ASSURANCE STANDARDS, UTILIZATION REVIEW STANDARDS, CRITERIA, POLICIES AND PROCEDURES FOR THE CORPORATION AND ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION; (XIII) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION TO CHANGE THE CORPORATION FROM A GENERAL, ACUTE CARE COMMUNITY HOSPITAL OR TO CLOSE THE CORPORATION'S CURRENT LOCATION; (XIV) APPROVE EACH ANNUAL LIST OF PROPOSED DONORS AND AMOUNTS OF DONATIONS OR GRANTS NOT INCLUDED IN THE ANNUAL BUDGET, AND MAKE PROPOSALS TO DEVIATE THEREFROM THROUGHOUT EACH YEAR IN EXCESS OF LIMITS SPECIFIED IN THE POLICY OF THE CORPORATE MEMBER; AND (XV) APPROVE AND/OR REQUIRE THE ADOPTION OF ANY ACTION THAT IS INCONSISTENT WITH THE POLICY OF THE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B SEE SCHEDULE O EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION B, LINE 11B PURSUANT TO PARKVIEW HEALTH SYSTEM INC.'S BYLAWS, THE SYSTEM COMPLIANCE AND AUDIT COMMITTEE MAY ACT ON BEHALF OF THE CORPORATION TO PROVIDE REVIEW OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS' FORM 990 FILINGS. COMMUNITY HOSPITALS AND WELLNESS CENTERS IS A SUBSIDIARY CORPORATION OF PARKVIEW HEALTH SYSTEM, INC. AN ELECTRONIC COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY AND THE SYSTEM COMPLIANCE AND AUDIT COMMITTEE, PRIOR TO FILING WITH THE IRS. ON OCTOBER 24, 2024, THE SYSTEM COMPLINACE AND AUDIT COMMITTEE REVIEWED THE FORM 990 AS ULTIMATELY FILED WITH THE IRS. THIS REVIEW INCLUDED A PRESENTATION BY THE ORGANIZATION'S TAX PREPARER TO HIGHLIGHT THE SIGNIFICANT AREAS ON THE FORM 990 AND SUPPLEMENTAL SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C AS DESCRIBED IN ARTICLE IX SECTION 6, OF THE PARKVIEW HEALTH SYSTEM, INC. (PH) BYLAWS, PH ADOPTED PH'S COMPLIANCE POLICY FOR THE ORGANIZATION AND ITS NOT-FOR-PROFIT RELATED ORGANIZATIONS (AND AS LIKEWISE NOTED IN THEIR BYLAWS) WHEN ADDRESSING CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THIS COMPLIANCE POLICY (COMPLIANCE POLICY #14) REQUIRES THAT EACH BOARD MEMBER, BOARD COMMITTEE MEMBER, AND KEY MANAGEMENT PERSONNEL MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. THIS INFORMATION IS PROVIDED TO THE CHAIRMAN OF THE BOARD (FOR BOARD AND BOARD COMMITTEE MEMBERS) AND TO SENIOR MANAGEMENT (FOR KEY MANAGEMENT PERSONNEL). IN ADDITION, AS TO THE CONDUCT OF BOARD MEETINGS, THE FOLLOWING PROCESS IS FOLLOWED: "WHENEVER A PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE IS CONSIDERING A TRANSACTION OR ARRANGEMENT WITH AN ORGANIZATION, ENTITY OR INDIVIDUAL IN WHICH A PERSON COVERED BY THIS POLICY HAS A FINANCIAL OR CONFLICTING INTEREST, THE FOLLOWING SHALL OCCUR: 1. THE INTERESTED PERSON MUST DISCLOSE THE FINANCIAL OR CONFLICTING INTEREST AND ALL MATERIAL FACTS TO THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE; 2. THE INTERESTED PERSON WITH THAT FINANCIAL OR CONFLICTING INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING REGARDING THE TRANSACTION OR ARRANGEMENT HOWEVER, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE FINANCIAL OR CONFLICTING INTEREST; AND 3. THE PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE MUST APPROVE THE TRANSACTION OR ARRANGEMENT BY A MAJORITY VOTE OF THE BOARD MEMBERS PRESENT AT A MEETING THAT HAS A QUORUM, NOT INCLUDING THE VOTE OF THE INTERESTED PERSON. THE INTERESTED PERSON MAY NOT VOTE ON THE MATTER. A. UPON THE REQUEST OF PH OR PH AFFILIATE BOARD OR BOARD COMMITTEE, THE MATTER MAY BE DELEGATED TO THE PH COMPLIANCE AND AUDIT COMMITTEE FOR EVALUATION, RECOMMENDATION AND/OR DETERMINATION. 4. WHENEVER A FINANCIAL OR CONFLICTING INTEREST IS ADDRESSED BY A PH OR PH AFFILIATE BOARD, NOTICE SHALL BE GIVEN TO THE PH COMPLIANCE OFFICER / GENERAL COUNSEL." FORM 990, PART VI, SECTION B, LINE 15 RELATED ORGANIZATION, PARKVIEW HEALTH SYSTEM, INC., HAS A PROCESS IN PLACE FOR REVIEWING AND APPROVING COMPENSATION OF THE CEO & EVP LEVEL EXECUTIVES. THE PROCESS INCLUDES CONSULTATIONS WITH AN INDEPENDENT COMPENSATION ADVISOR AND THE REVIEW OF APPROPRIATE COMPARABILITY DATA; REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE GOVERNING BODY CONSISTING OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE COMPENSATION; AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. IN 2023, THE COMPENSATION COMMITTEE OF PARKVIEW HEALTH SYSTEM, INC. REVIEWED AND APPROVED ALL CEO & EVP LEVEL COMPENSATION, BENEFITS, AND PERQUISITES FOR THE 2023 COMPENSATION PACKAGE, PURSUANT TO THE PARKVIEW HEALTH BYLAWS. IN ADDITION, AGGREGATE INFORMATION ON ALL OTHER EXECUTIVE ROLES (OUTSIDE OF THE CEO & EVPS) IS SHARED. THE COMPENSATION PACKAGE OF THE CEO AND EVPS WAS APPROVED BY A MAJORITY OF INDEPENDENT COMPENSATION COMMITTEE MEMBERS. ADDITIONALLY, THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE PLAN DOCUMENTS FOR THE MANAGEMENT INCENTIVE COMPENSATION PLAN (MICP) AND THE PHYSICIAN AND PROVIDER INCENTIVE COMPENSATION PLAN (PICP). THE BOARD OF PARKVIEW HEALTH SYSTEM, INC. APPROVES ANY CHANGES IN COMPENSATION FOR THE CEO. PARKVIEW'S INDEPENDENT CONSULTANT PREPARES A SUMMARY OF THE EXECUTIVE COMPENSATION PROCESS USING DATA FROM MULTIPLE PUBLISHED SURVEYS PREPARED BY INDEPENDENT FIRMS FOR POSITIONS THAT ARE FUNCTIONALLY COMPARABLE IN SIMILAR-SIZED HEALTH SYSTEMS AND HOSPITAL ORGANIZATIONS ON BOTH A REGIONAL AND NATIONAL BASIS. THE INDEPENDENT CONSULTANT PROVIDES A STATEMENT OF REASONABLENESS OF THE COMPENSATION PROVIDED TO THE CEO AND EVP LEVEL EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 1,153,414. MANAGEMENT AND GENERAL EXPENSES 124,583. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,277,997. MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,326,398. MANAGEMENT AND GENERAL EXPENSES 15,708. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,342,106. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 481,389. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 481,389. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,765. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,765. FORM 990, PART IX, LINES 5-10: PARKVIEW HEALTH SYSTEM, INC., EIN 35-1972384, SERVES AS THE COMMON PAYING AGENT FOR ALL TAX-EXEMPT ORGANIZATIONS OF THE SYSTEM. SALARIES AND WAGES OF EMPLOYEES WORKING FOR THESE ORGANIZATIONS ARE CHARGED DIRECTLY TO THE ORGANIZATIONS IN WHICH THEY WORK. THE ACTUAL EXPENSES FOR PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS ARE REFLECTED ON THE BOOKS OF PARKVIEW HEALTH SYSTEM, INC. FOR FINANCIAL REPORTING PURPOSES. TO ACCOUNT FOR BENEFIT COSTS ON THE BOOKS OF THE OTHER TAX EXEMPT ORGANIZATIONS, AN ALLOCATION METHODOLOGY IS UTILIZED TO CHARGE THESE ORGANIZATIONS WITH AN ESTIMATE OF THE OVERALL COSTS, REFERRED TO AS A "BENEFIT ALLOCATION" FROM PARKVIEW HEALTH SYSTEM, INC. THE ALLOCATION DOES NOT DISTINGUISH BETWEEN THE COSTS OF THE VARIOUS COMPONENTS (I.E. PAYROLL TAXES, EMPLOYEE BENEFITS, AND PENSION PLAN CONTRIBUTIONS). THEREFORE, FOR PURPOSES OF THE FORM 990, PART IX, THE TOTAL BENEFIT ALLOCATION FOR THE EMPLOYEES' SALARIES AND WAGES REPORTED ON LINE 7 IS REFLECTED ON LINE 9 AND NOT ALLOCATED BETWEEN LINES 8 OR 10. FOR PURPOSES OF THE FORM 990, PART IX, LINES 5 AND 6 REFLECT COMPENSATION AND BENEFIT AMOUNTS REPORTED IN PART VII. FORM 990, PART XI, LINE 9: AFFILIATION OF CHWC AT FAIR VALUE -32,706,994. ASSET TRANSFERS/ADJUSTMENTS 48,511. EQUITIZE CHWC PAIN MANAGEMENT LLC -559,873. BOOK TO TAX DIFFERENCE VANTAGE HEALTHCARE OF OHIO LLC 32,287. BOOK TO TAX DIFFERENCE CHWC PAIN MGMT LLC -867,743. RELEASE INTERCOMPANY RECEIVABLE 200,000. 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