TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) CATHERINE R KNIPP...................................................................... EX OFFICIO	1.00 ................. 0.00	X		0	0	0
(2) CHARLES F HEID...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	323	0
(3) DARYL L KNIPP...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(4) DENNIS S NEWMAN...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(5) HOLLY L BRISTOLL...................................................................... TRUSTEE	1.00 ................. 42.00	X		0	384,538	89,558
(6) IRACEMA AREVALO MD...................................................................... TRUSTEE	1.00 ................. 40.00	X		0	272,635	29,602
(7) JENNIFER G HOHMAN MD...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(8) JONATHAN DILLER MD...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(9) JUDITH M REINO...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(10) KENNETH A MYERS...................................................................... CHAIRPERSON	1.00 ................. 1.00	X	X	0	0	0
(11) KEVIN C WEBB PHD...................................................................... TRUSTEE	1.00 ................. 52.00	X		0	658,740	115,301
(12) MICHAEL M WALERYSZAK...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(13) PAMELA M JENSEN...................................................................... PRESIDENT, EX OFFICIO	40.00 ................. 1.00	X	X	0	281,184	63,692
(14) STEVEN A RUSHER DPM...................................................................... TRUSTEE	1.00 ................. 0.00	X		7,083	0	0
(15) THOMAS F DEWEY JR...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(16) TOM H HOFFMAN...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(17) TY N TRACY DC...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) WILSON E FORNEY IV........................................................................ TRUSTEE	1.00 .......................0.00	X					0	0	0
(19) ALAN M SATTLER........................................................................ TREASURER	0.50 .......................51.50		X				0	588,758	120,076
(20) JEFFREY C KUHN........................................................................ SECRETARY	0.50 .......................51.50		X				0	592,348	112,234
(21) GARY AKENBERGER........................................................................ SR. VP FINANCE, PHS	0.50 .......................45.00			X			0	415,589	89,075
(22) KARLA FALLS........................................................................ VP OPERATIONS, MH	40.00 .......................0.00			X			0	185,715	176,468
(23) MATTHEW GOETZ........................................................................ PHARMACIST	40.00 .......................0.00				X		111,213	0	6,364
(24) NATHAN PERKINS........................................................................ DIRECTOR	40.00 .......................0.00				X		100,180	0	11,158
(25) PATRICIA BEASCHLER........................................................................ PHARMACIST	40.00 .......................0.00				X		113,387	0	11,207
(26) RANDAL KOCH........................................................................ DIRECTOR, PHARMACY	40.00 .......................0.00				X		134,340	0	13,076
(27) DAVID BREWER........................................................................ FORMER OFFICER	40.00 .......................0.00					X	0	117,450	42,199
(28) KATHLEEN S HANLEY........................................................................ FORMER OFFICER	0.00 .......................41.00					X	0	696,193	166,986
(29) JILL TROSIN........................................................................ FORMER KEY EMPLOYEE	0.00 .......................40.00					X	0	197,471	21,762

(A) Name and business address	(B) Description of services	(C) Compensation
PT SERVICES INC 2550 S STATE RT 100 TIFFIN,OH44883	PHYSICAL THERAPY SERVICES	4,743,136
AA BOOS & SONS INC 2015 PICKLE RD OREGON,OH43616	GENERAL CONSTRUCTION	1,416,799
OMNI HEALTH SERVICES LTD 1650 EBER RD HOLLAND,OH43528	PHYSICIAN SERVICES	568,000
CLEVELAND CLINIC PO BOX 931720 CLEVELEND,OH441931211	LAB SERVICES	461,709
TOLEDO PAIN SERVICES 7053 W CENTRAL AVE TOLEDO,OH43617	MEDICAL SERVICES	386,592
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 12

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization MEMORIAL HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization MEMORIAL HOSPITAL		Employer identification number 34-4430849

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization MEMORIAL HOSPITAL			Employer identification number 34-4430849
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

6,172

Total. Add lines 1c through 1i ....................................................................................................

6,172

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	MEMORIAL HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION - A PORTION OF WHICH IS ALLOCABLE TO LOBBYING BY THE ASSOCIATIONS.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	1,125,672	0
b	Contributions ...	10,184	1,094,539
c	Net investment earnings, gains, and losses	-13,648	31,133
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	792,008
f	Administrative expenses ....
g	End of year balance ......	330,200	1,125,672

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

Yes

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	1,136,120		1,136,120
b	Buildings	23,766,808	2,418,156	21,348,652
c	Leasehold improvements	9,257	2,462	6,795
d	Equipment ...	14,412	3,970	10,442
e	Other ...	21,812,265	5,167,155	16,645,110
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				39,147,119

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DUE FROM AFFILIATES				180,277
(2) BENEFICIAL INTEREST IN FOUNDATION				6,828,647
(3) OTHER RECEIVABLES				195,036
(4) BOND ISSUANCE COSTS				762,278
(5) ESTIMATED THIRD PARTY RECEIVABLE				2,624,293
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				10,590,531

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
DUE TO AFFILIATES	2,024,545
ESTIMATED THIRD PARTY SETTLEMENTS PAYABLE	1,816,329
ASBESTOS REMEDIATION	2,189,895
INTERCOMPANY DEBT TO THE TOLEDO HOSPITAL	20,048,893
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	26,079,662
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART V, LINE 4:

THE ENDOWMENT FUNDS ARE INVESTED TO GENERATE INCOME TO BE USED TO SUPPORT MEMORIAL HOSPITAL CONSISTENT WITH DONOR INTENT.

PART X, LINE 2:

MEMORIAL HOSPITAL IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES (PHS). THE FOLLOWING REFLECTS PHS'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER ASC 740. EXCEPT AS NOTED BELOW, PHS DID NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014. FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014, A TAXABLE SUBSIDIARY OF PHS RECOGNIZED A LIABILITY FOR UNCERTAIN TAX POSITIONS OF $0 AND $9,027,000, RESPECTIVELY. MEMORIAL HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2015 AND 2014.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .
b	Medicaid (from Worksheet 3, column a) . . . . .	9,745,192	5,546,416	4,198,776	7.400 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	2,386	1,300	1,086	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	9,747,578	5,547,716	4,199,862	7.400 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	133,544		133,544	0.240 %
f	Health professions education (from Worksheet 5) . . .	376,452		376,452	0.660 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	509,996		509,996	0.900 %
k	Total. Add lines 7d and 7j .	10,257,574	5,547,716	4,709,858	8.300 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	5,231	5,231	0.010 %
8	Workforce development
9	Other
10	Total	5,231	5,231	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,717,792

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

11,283

Provide in Part VI the text 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.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

9,161,229

Enter Medicare allowable costs of care relating to payments on line 5.....

13,993,432

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-4,832,203

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 COOPERATIVE CARE	PHYSICIAN ORGANIZATION	50.000 %	1.890 %	48.110 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	MEMORIAL HOSPITAL 715 SOUTH TAFT AVE FREMONT,OH43420 WWW.PROMEDICA.ORG 1263	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.PROMEDICA.ORG/CHNA

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C 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.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
MEMORIAL HOSPITAL	PART V, SECTION B, LINE 5: MEMORIAL HOSPITAL ("THE HOSPITAL FACILITY") TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH. THESE PERSONS INCLUDED AMERICAN CANCER SOCIETY, CITY OF FREMONT ECONOMIC DEVELOPMENT, CITY OF WOODVILLE, COMMUNITY HEALTH SERVICES, EASTER SEALS, FAMILY & CHILDREN FIRST COUNCIL, FIRELANDS COUNSELING AND RECOVERY SERVICES, LOCAL PHYSICIANS, LOCAL LONG-TERM CARE FACILITIES, SANDUSKY COUNTY EDUCATIONAL SERVICE CENTER, SANDUSKY COUNTY HELP ME GROW, SANDUSKY COUNTY BOARD OF DEVELOPMENTAL DISABILITIES, SANDUSKY COUNTY JUVENILE COURT, SANDUSKY COUNTY PARK DISTRICT, SANDUSKY COUNTY EMERGENCY MEDICAL SERVICES, MENTAL HEALTH AND RECOVERY SERVICES BOARD OF SANDUSKY COUNTY, THE BELLEVUE HOSPITAL, SANDUSKY COUNTY COMMUNITIES FOUNDATION, SANDUSKY COUNTY CHAMBER OF COMMERCE, SANDUSKY COUNTY ECONOMIC DEVELOPMENT CORPORATION, SANDUSKY COUNTY HEALTH DEPARTMENT, FREMONT CITY SCHOOLS, TERRA STATE COMMUNITY COLLEGE, PATHSTONE, UNITED WAY OF SANDUSKY COUNTY, VANGUARD SENTINEL ADULT CAREER TECHNOLOGY CENTER, VICTORY CHRISTIAN FELLOWSHIP CHURCH, WSOS, AND YMCA OF SANDUSKY COUNTY. THE HOSPITAL FACILITY CONSULTED WITH THESE PERSONS THROUGH MEETINGS AND ALSO VIA EMAIL CORRESPONDENCE.MEMORIAL HOSPITAL SHARED THE HOSPITAL'S CHNA STRATEGIC PLAN WITH A SENIOR FOCUS GROUP (PRIMARILY SENIOR VOLUNTEERS AT MEMORIAL HOSPITAL) TO GAIN THEIR FEEDBACK ABOUT THE PLAN. ALSO, STEPHANIE BROWN, SANDUSKY COUNTY HEALTH COMMISSIONER, AND CATHY GLASSFORD, SANDUSKY COUNTY HEALTH PARTNERS, PROVIDED FEEDBACK ON THE HOSPITAL'S STRATEGIC PRIORITIES AND PLANS, SUPPORTING THESE ACTIONS FOR THE HOSPITAL COMMUNITY.
MEMORIAL HOSPITAL	PART V, SECTION B, LINE 16I: THE HOSPITAL FACILITY WAS IN THE PROCESS OF REVISING ITS FINANCIAL ASSISTANCE POLICY DURING TAX YEAR 2015 AND UPDATING ITS PROCEDURES. AS OF APRIL 2016, THE HOSPITAL FACILITY'S POLICIES AND PROCEDURES WERE REVISED TO INCLUDE THE FOLLOWING MEASURES TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY:- THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:WWW.PROMEDICA.ORG/FINANCIALASSISTANCE- THE FAP WAS WIDELY AVAILABLE UPON REQUEST AND WITHOUT CHARGE (IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL)- NOTICE OF AVAILABILITY OF THE FAP WAS CONSPICUOUSLY DISPLAYEDTHROUGHOUT THE HOSPITAL FACILITY.
MEMORIAL HOSPITAL	PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED THE LOOK-BACK METHOD WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE LOOK-BACK METHOD IS BASED ON PAST CLAIMS PAID IN FULL TO THE HOSPITAL BY MEDICARE-FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL FACILITY OVER A SPECIFIED 12-MONTH PERIOD, DIVIDED BY THE GROSS CHARGES FOR THOSE CLAIMS.
MEMORIAL HOSPITAL:	PART V, SECTION B, LINE 11: MEMORIAL HOSPITAL CONDUCTED AND ADOPTED ITS SECOND COMMUNITY HEALTH NEEDS ASSESSMENT DURING TAX YEAR 2015 AND INTENDS TO ADDRESS THE FOLLOWING IDENTIFIED SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY:- CANCER - INCREASE ACCESS, EDUCATION, AND SCREENING- RISKY BEHAVIOR IN YOUTH - REDUCE TEEN PREGNANCY AND SEXUALLY TRANSMITTED DISEASE- OBESITY - MENTAL HEALTH - DEPRESSION SCREENINGS AND SUICIDE PREVENTIONNO ACTIONS WERE TAKEN DURING TAX YEAR 2015 TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH MEMORIAL HOSPITAL'S MOST RECENTLY CONDUCTED CHNA. THE SECOND CHNA WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2015; THEREFORE, THESE HEALTH NEEDS WILL BE ADDRESSED OVER THE NEXT 3 TAX YEARS.MEMORIAL HOSPITAL DOES NOT INTEND TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT GIVEN THAT SOME OF THE IDENTIFIED HEALTH NEEDS ARE EITHER BEING ADDRESSED DURING PHYSICIAN VISITS, GO BEYOND THE SCOPE OF THE HOSPITAL, OR ARE BEING ADDRESSED BY, OR WITH, OTHER ORGANIZATIONS IN THE COMMUNITY. TO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOST IMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OF RESOURCES, MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITY ORGANIZATIONS AND COALITIONS.ALTHOUGH PROMEDICA PHYSICIANS AND OTHER PROGRAMS ADDRESS THE HEALTH NEEDS OF PATIENTS AS NEEDED, THE HEALTH NEEDS SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS PLAN, INCLUDE:- ADULT ALCOHOL ABUSE- ADULT MARIJUANA OTHER DRUGS- ADULT MINORITY HEALTH- ADULT SEXUAL BEHAVIOR- ADULT TOBACCO- ADULT WEIGHT CONTROL- ARTHRITIS - ASTHMA - CARDIOVASCULAR- CHILDREN'S HEALTH FUNCTIONAL STATUS- CHILDREN'S HEALTH INSURANCE ACCESS UTILIZATION- DIABETES- FAMILY FUNCTIONING NEIGHBORHOOD COMMUNITY- HEALTH CARE ACCESS - HEALTH COVERAGE- HEALTH PERCEPTIONS- ORAL HEALTH- PARENT HEALTH- PREVENTIVE MEDICINE- QUALITY OF LIFE - WOMEN'S HEALTH- YOUTH ALCOHOL- YOUTH MARIJUANA OTHER DRUGS- YOUTH MENTAL HEALTH- YOUTH PERCEPTIONS- YOUTH SAFETY- YOUTH TOBACCO- YOUTH VIOLENCE ISSUES- YOUTH WEIGHT STATUSMEMORIAL HOSPITAL DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2015 WITH RESPECT TO ITS PREVIOUSLY CONDUCTED CHNA:HEALTH NEED IDENTIFIED: OBESITY/HUNGER/WELLNESS INITIATIVESSTRATEGY #1 - "WALK WITH A DOC" PROGRAM.ACTIONS TAKEN:- PROGRAM RENAMED "HIKE FOR YOUR HEALTH" WHERE HEALTHCARE PROVIDERS LED WALKS FOR JUNE THROUGH AUGUST WITH AN ESTIMATED 6 PARTICIPANTS PER WALK.STRATEGY #2 - CONTINUE REPLACING MEMORIAL HOSPITAL VENDING MACHINES WITH HEALTHY VENDING.ACTIONS TAKEN:- 100% HEALTHY OFFERINGS IN FROZEN VENDING MACHINES AND 50% IN SNACK VENDING.STRATEGY #3 - PROVIDE A FARMER'S MARKET AT MEMORIAL HOSPITAL BIWEEKLY JUNE THROUGH SEPTEMBER.ACTIONS TAKEN:- PROVIDED A FARMER'S MARKET AT MEMORIAL HOSPITAL BIWEEKLY JUNE THROUGH SEPTEMBER. NUMBER OF FARMER'S MARKETS OFFERED IN 2015 WAS 10. ATTENDED COMMUNITY FARMER'S MARKET JUNE THROUGH OCTOBER AND OFFERED HEALTH EDUCATION MATERIAL TO ESTIMATED 7,000 COMMUNITY MEMBERS.STRATEGY #4 - OFFER HEALTHY, HOT ENTREE CHOICES IN THE HOSPITAL CAFETERIA DAILY (CAFE CUISINE).ACTIONS TAKEN:- OFFERED HEALTHY, HOT ENTREE CHOICES IN THE HOSPITAL CAFETERIA DAILY (CAFE CUISINE). GRAB AND GO INCREASED VARIETY BY 25% MINDFUL (HEALTHIER) CHOICES. HEALTHY ACTION STATION OFFERED 3 TIMES PER WEEK INCREASED SALES BY 20% OF THESE OFFERINGS. REMOVED ALL FRIED FOODS AND SUGAR BASED BEVERAGES.STRATEGY #5 - PROVIDE COMMUNITY NUTRITION EDUCATION AT LOCAL GROCERY STORES AT LEAST ONE TIME PER QUARTER.ACTIONS TAKEN:- MEMORIAL STAFF PROVIDED COMMUNITY NUTRITION EDUCATION AT FOUR LOCAL GROCERY STORE TOURS. TOTAL EDUCATION PROVIDED TO 40 COMMUNITY MEMBERS.STRATEGY #6 - PARTNER WITH SANDUSKY COUNTY SCHOOLS TO ACHIEVE THEIR OBESITY/HUNGER GOALS.ACTIONS TAKEN:- IMPLEMENTED NUTREXITY AND NUTRITIONAL CONVERSATION MAPS TO 8 ELEMENTARY SCHOOLS AND CAMP FEARLESS (HOSPICE CAMP FOR CHILDREN WHO HAVE EXPERIENCED LOSS). PARTICIPATED IN THE ANNUAL FAMILY FEST WITH NUTRITIONAL WELLNESS GAME WITH OVER 150 PARTICIPANTS. STRATEGY #7 - PARTNER WITH FREMONT CITY SCHOOLS ON ACHIEVING THEIR GOALS IN REGARDS TO THE SUMMER MEAL PROGRAM.ACTIONS TAKEN:- "PURPLE PRIDE" COLLABORATION RESULTING IN DELIVERING DAILY LUNCHES AND RECREATIONAL EXERCISE DAILY DURING THE SUMMER BREAK JUNE THROUGH AUGUST. STRATEGY #8 - EXPAND SUMMER CAMPS FOCUSING ON NUTRITION, ACTIVITIES AND SELF-ESTEEM FOR YOUTH OF THE COMMUNITY. ACTIONS TAKEN:- 200 CHILDREN PARTICIPATED IN SUMMER CAMPS FOCUSING ON NUTRITION, ACTIVITIES AND SELF-ESTEEM FOR YOUTH OF THE COMMUNITY. STRATEGY #9 - EXPAND HEALTHY COOKING NIGHTS.ACTIONS TAKEN:- EXPANDED HEALTHY COOKING NIGHTS - PROVIDED 3 HEALTHY COOKING CLASSES WITH 40 PARTICIPANTS TOTAL.STRATEGY #10 - CONTINUE PARTICIPATION IN THE COMMUNITY'S GARDEN PROJECT.ACTIONS TAKEN:- CONTINUED PARTICIPATION IN THE COMMUNITY'S GARDEN PROJECT. A HOSPITAL GARDEN PLOT WAS INITIATED AND TENDED BY VOLUNTEERS. PRODUCE WAS HARVESTED AND DELIVERED TO THE LIBERTY CENTER HOMELESS SHELTER AS WELL AS USED IN HEALTHY COOKING CLASSES.HEALTH NEED IDENTIFIED: CANCER SCREENINGS - LUNG, BREAST, COLORECTAL AND PROSTATESTRATEGY #1 - TO ANNUALLY PROVIDE EDUCATION AND RESOURCE INFORMATION ON LUNG, BREAST, COLORECTAL AND PROSTATE CANCER. ACTIONS TAKEN:- RELAY FOR LIFE - PARTICIPATED TO RAISE FUNDS FOR SANDUSKY COUNTY RELAY FOR LIFE AND PROVIDED A TABLE WITH EDUCATIONAL CANCER MATERIALS AT THIS EVENT. SEVENTEEN TEAM MEMBERS PARTICIPATED AND RAISED OVER $11,200.- HEALTHLINK NEWSLETTER HIGHLIGHTED BREAST CANCER IN OCTOBER AND LUNG CANCER IN NOVEMBER. - PROVIDED 28 LUNG SCREENINGS FOR EARLY DETECTION IN HIGH RISK PATIENTS WITH ONE (1) POSITIVE FINDING.- PROVIDED EDUCATIONAL TALKS AND RESOURCES AS FOLLOWS: OAK HARBOR SENIOR CENTER, DANBURY SENIOR CENTER, PT CLINTON SENIOR CENTER AND ELMORE SENIOR CENTER PROVIDING INFO ON BREAST CANCER TO 70 SENIORS.- MEMORIAL HOSPITAL'S FAMILY FEST PROVIDED A TABLE WITH EDUCATIONAL INFORMATION ON SMOKING AND THE RELATIONSHIP TO CANCER AND OVERALL HEALTH. APPROXIMATELY 1,500 ATTENDED THE FAMILY FEST AND RECEIVED EDUCATIONAL MATERIALS.- USED APPROVED AND GRANT FUNDED RESOURCES FROM SUSAN G. KOMEN TO PROVIDE BREAST EXAMS AND MAMMOGRAMS. NUMBER OF MAMMOGRAMS PROVIDED WAS 22.- MAINTAINED WIGS PROGRAM TO FIT CANCER PATIENTS. FITTED 4 PATIENTS.- CONTINUED TO OFFER CANCER RELATED SUPPORT GROUPS SUCH AS MEN'S PROSTATE GROUP AND LOOK GOOD FEEL BETTER PROGRAM.- PARTICIPATED IN SANDUSKY COUNTY'S CANCER COALITION.- STAR PROGRAM IMPLEMENTED WITH 2 PHYSICAL MEDICINE EMPLOYEES CERTIFIED.- CONTINUED SUPPORT OF THE AMERICAN CANCER SOCIETY THROUGH EVENT SPONSORSHIP AND BOARD PARTICIPATION.HEALTH NEED IDENTIFIED: MENTAL HEALTH - DEPRESSION/ANXIETY/SUICIDE AND BINGE DRINKINGSTRATEGY #1 - INCREASE HOSPITAL-WIDE PARTICIPATION IN RED RIBBON WEEK.ACTIONS TAKEN:- TABLE WITH INFORMATIONAL MATERIALS AND PLEDGES TO REMAIN DRUG FREE WAS DISPLAYED DURING RED RIBBON WEEK. 45 YOUTH AND 30 ADULT PLEDGES WERE SECURED. PARTICIPATED IN THE RED RIBBON 'SPOOKTACULAR' EVENT WITH 455 REGISTERED ATTENDEES.STRATEGY #2 - CONTINUE EFFORTS AT MEMORIAL HOSPITAL FAMILY FEST TO EDUCATE ATTENDEES ON ALCOHOL/BINGE DRINKING ISSUES.ACTIONS TAKEN:- CONTINUED EFFORTS AT MEMORIAL HOSPITAL FAMILY FEST TO EDUCATE ATTENDEES ON SUBSTANCE USE AND TEENS/TIPS FOR PARENTS. SELF ESTEEM ACTIVITY WAS ALSO PROVIDED TO SEVERAL HUNDRED YOUTH AND PARENTS PARTICIPATING.STRATEGY #3 - CONTINUE COLLABORATIVE EFFORTS WITH COMMUNITY TEAM TO ADDRESS ALCOHOL ABUSE. ACTIONS TAKEN: - ATTENDED MEETING OF MENTAL HEALTH COALITION THAT HAS MERGED MEETINGS WITH PREVENTION PARTNERSHIP.STRATEGY #4 - PARTICIPATE IN NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) WALK TO RAISE FUNDS TO SUPPORT RELATED COMMUNITY PROGRAMS.ACTIONS TAKEN:- PARTICIPATED IN NAMI WALK TO RAISE FUNDS TO SUPPORT RELATED COMMUNITYPROGRAMS. NUMBER OF PARTICIPANTS IN NAMI WALK WAS 47 WITH $941 IN PLEDGES WHICH DESIGNATED OUR TEAM AS ONE OF THE HONOR TEAMS OF THE DAY.STRATEGY #5 - PARTICIPATE IN THREE DEPRESSION SCREENINGS.ACTIONS TAKEN:- PARTICIPATED IN NATIONAL DEPRESSION SCREEN IN OCTOBER WITH 47 COMPLETED SCREENS. PARTICIPATED IN HOSPITAL DEPRESSION SCREEN EVENT IN NOVEMBER AND HAD CLINICIANS AVAILABLE FOR 4 HOURS TO CONDUCT SCREENS. CONDUCTED SCREEN AS PART OF SENIOR EVENT HELD IN MAY WITH 316 SENIORS IN ATTENDANCE. PRESENTED ON STRESS AND SIGNS OF DEPRESSION AT GOLDEN THREADS MEETING TO 25 PARTICIPANTS.STRATEGY #6 - CONTINUE TO DEVELOP, IMPLEMENT AND DISTRIBUTE COMMUNITY MENTAL HEALTH RESOURCES. ACTIONS TAKEN:- PARTICIPATED IN SANDUSKY COUNTY RESOURCE FAIR WHICH WAS A JOINT VENTURE WITH SCHOOLS. MENTAL HEALTH LITERATURE WAS DISTRIBUTED.- DEVELOPED MENTAL HEALTH RESOURCES BASED ON INPUT FROM COMMUNITY TEAM AND RESOURCES WERE HANDED OUT AT COMMUNITY EVENTS THROUGHOUT THE YEAR.HEALTH NEED IDENTIFIED: RISKY BEHAVIOR IN YOUTH - TEEN PREGNANCY AND PRESCRIPTION DRUG MISUSESTRATEGY #1 - CONTINUE MEMORIAL HOSPITAL'S I
ACTIONS TAKEN:	- CONTINUED MEMORIAL INVOLVEMENT WITH SANDUSKY COUNTY HEALTH DEPARTMENT'S PREVENTION PARTNERSHIP. HOSPITAL PRESIDENT SITS ON THE COUNCIL AND ATTENDS MEETINGS. STRATEGY #2 - CONTINUE EXPANSION OF HIV SCREENINGS IN SANDUSKY COUNTY. ACTIONS TAKEN:- PARTNERED WITH THE SANDUSKY COUNTY HEALTH DEPARTMENT TO EXPAND HIV TESTING IN THE COMMUNITY AND PROVIDED INFORMATION REGARDING ACCESS TO FREE HIV SCREENINGS TO PATIENTS UTILIZING OUR EMERGENCY DEPARTMENT. STRATEGY #3 - CONTINUE MEMORIAL HOSPITAL STAFF INVOLVEMENT AND SUPPORT IN THE FAMILY AND CHILDREN FIRST COUNCIL.ACTIONS TAKEN:- AS PART OF THIS EFFORT, DR. RIEMAN CONTACTED THE JUVENILE DETENTION CENTER AND GATHERED INFORMATION FOR POSSIBLE GAME LISTING DRUGS AND THEIR IMMEDIATE AFFECTS AND LONG TERM AFFECTS.STRATEGY #4 - CONTINUE MEMORIAL HOSPITAL STAFF INVOLVEMENT AND SUPPORT OF RED RIBBON WEEK.ACTIONS TAKEN:- EDUCATIONAL MATERIAL ON DISPLAY IN LOBBY DURING RED RIBBON WEEK. RECEIVED 30 ADULT AND 54 YOUTH PLEDGES FOR LIVING ALCOHOL AND DRUG FREE.STRATEGY #5 - EXPAND YOUTH MENTORING IN SANDUSKY COUNTY.ACTIONS TAKEN:- PROVIDED A SPEAKER FOR THE SANDUSKY COUNTY POSITIVE PEOPLE MEETING IN MARCH TO PROMOTE MENTORING FOR AT RISK YOUTH. PROVIDED SEVERAL MENTORS FOR AT RISK YOUTH THROUGH SANDUSKY COUNTY POSITIVE PEOPLE PROGRAM.STRATEGY #6 - CONTINUE TO EXPAND OUTREACH WITH THE SANDUSKY COUNTY HEALTH DEPARTMENT'S ASSET DEVELOPMENT PROGRAM WITHIN THE SANDUSKY COUNTY SCHOOLS. ACTIONS TAKEN:- PARTNERED WITH THE SANDUSKY COUNTY HEALTH DEPARTMENT TO EXPAND THE ASSET DEVELOPMENT PROGRAM WITHIN THE SANDUSKY COUNTY SCHOOLS. DR. AREVALO CONTINUES TO BUILD A WORKING RELATIONSHIP WITH THE SANDUSKY COUNTY HEALTH DEPARTMENT.STRATEGY #7 - CONTINUE TO ASSIST SANDUSKY COUNTY SCHOOLS TO ACHIEVE THEIR STRATEGIC GOALS IN RELATION TO RISKY BEHAVIOR IN YOUTH. ACTIONS TAKEN:- THE DIRECTOR OF PHYSICAL MEDICINE MET WITH THE FREMONT MIDDLE SCHOOL PRINCIPAL AND HIGH SCHOOL INTERVENTIONIST TO DETERMINE NEEDS AND OTHER KEY STAFF WHO MIGHT CONTRIBUTE TO THE NEEDS OF THE STUDENTS. CONTACT MADE WITH THE DIRECTOR OF CURRICULUM, ASSESSMENT AND STAFF DEVELOPMENT ALONG WITH DIRECTOR OF STUDENT SERVICES TO ACCESS WHERE WE MAY PARTNER FOR FUTURE NEEDS. SCHOOLS DID NOT REPLY. STRATEGY #8 - HOST A CME (EDUCATIONAL SESSIONS) AT MEMORIAL HOSPITAL FOCUSING ON MISUSE OF PRESCRIPTION DRUGS. ACTIONS TAKEN:- EXPANDED AWARENESS OF MISUSE OF PRESCRIPTION DRUGS WITH A CME PROVIDED IN OCTOBER.STRATEGY #9 - CONTINUE TO IMPLEMENT/MONITOR MEMORIAL MEDICAL STAFF'S REGISTRATION IN THE OHIO AUTOMATED RX REPORTING SYSTEM (OARRS).ACTIONS TAKEN:- HOSTED EDUCATIONAL SESSIONS FOCUSING ON PRESCRIPTION DRUG ABUSE. HEALTH DEPARTMENT SPOKE AT MEDICAL STAFF QUARTERLY MEETING UPDATING ON OARRS REGULATIONS AND REQUIREMENTS. 44 PHYSICIANS REGISTERED IN OARRS BY APRIL.
MEMORIAL HOSPITAL:	PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/FINANCIALASSISTANCEMEMORIAL HOSPITAL:PART V, SECTION B, LINE 16C: A PLAIN LANGUAGE SUMMARY OF THE FAP WASWIDELY AVAILABLE AT THE FOLLOWING URL: WWW.PROMEDICA.ORG/FINANCIALASSISTANCEMEMORIAL HOSPITAL:PART V, SECTION B, LINE 20B: A PATIENT FINANCIAL ADVOCATE (PFA) IS ASSIGNED TO EACH PATIENT WHO HAS BEEN ADMITTED TO THE HOSPITAL FACILITY TO NOTIFY THE INDIVIDUAL OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE.

Schedule H (Form 990) 2015

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address		Type of Facility (describe)
1	1 - HERBERT-PERNA CTR FOR PHYSICAL HEALTH 710 CLEVELAND AVENUE FREMONT,OH43420	OCCUPATIONAL MEDICINE
2	2 - HAYES AVENUE LAB 2575 HAYES AVENUE SUITE 2 FREMONT,OH43420	LAB
3	3 - CLYDE PT OT ST 507 MCPHERSON HWY CLYDE,OH43410	PHYSICAL/OCCUPATIONAL THERAPY
4	4 - GIBSONBURG PT OT ST 116 S MAIN STREET GIBSONBURG,OH43431	PHYSICAL/OCCUPATIONAL THERAPY
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. 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.
3	Patient education of eligibility for assistance. 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.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. 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.).
6	Affiliated health care system. 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.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 6A:	MEMORIAL HOSPITAL REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE PROMEDICA HEALTH SYSTEM, INC. ANNUAL COMMUNITY BENEFIT REPORT.
PART I, LINE 7:	MEMORIAL HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. OTHER BENEFITS AMOUNTS REPORTED ON LINE 7 WERE CALCULATED USING COSTS CHARGED DIRECTLY TO THE INDIVIDUAL PROGRAMS VIA THE FINANCIAL ACCOUNTING SYSTEM. AN INDIRECT COST ALLOCATION FACTOR FOR SHARED SERVICES IS ALSO CALCULATED AND INCLUDED IN APPLICABLE PROGRAMS LISTED IN OTHER BENEFITS.
PART II, COMMUNITY BUILDING ACTIVITIES:	MEMORIAL HOSPITAL PROMOTED THE HEALTH OF ITS COMMUNITY BY SUPPORTING VARIOUS ACTIVITIES THAT ENGAGE IN COMMUNITY BUILDING ACTIVITIES.
PART III, LINE 2:	MEMORIAL HOSPITAL'S ANALYSIS AND ASSESSMENT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED BAD DEBT EXPENSE USES A RECEIPTS "LOOK-BACK" METHOD UTILIZING HISTORICAL PAYMENT DATA ON ACCOUNTS, INCLUDING CONTRACTUAL ADJUSTMENTS FOR PAYER DISCOUNTS, AS WELL AS PATIENT PAYMENTS, SUCH AS CO-PAYS AND DEDUCTIBLES, TO ESTABLISH ANTICIPATED COLLECTABILITY RATES FOR ACCOUNTS RECEIVABLE WITHIN EACH PAYER CATEGORY.
PART III, LINE 3:	MEMORIAL HOSPITAL ESTIMATED THE POSSIBLE AMOUNT OF FINANCIAL ASSISTANCE WITHIN BAD DEBT USING THE RATIO OF FINANCIAL ASSISTANCE AS COMPARED TO GROSS CHARGES.
PART III, LINE 4:	PROVISION FOR BAD DEBTS AND ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ARE DISCUSSED ON PAGES 15 AND 16 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS.
PART III, LINE 8:	MEDICARE SHORTFALL, WHICH IS THE EXCESS OF COSTS TO TREAT MEDICARE PATIENTS OVER THE REIMBURSEMENT RECEIVED FROM THE FEDERAL GOVERNMENT, SHOULD BE TREATED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS:- THE MEDICARE SHORTFALL REPRESENTS THE RELIEF OF A FINANCIAL BURDEN THAT WOULD OTHERWISE BE BORNE BY A GOVERNMENT PROGRAM.- THE MEDICARE SHORTFALL REPRESENTS A SOCIETAL BENEFIT INSOFAR AS MANY OF THE PROGRAMS AND SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY, IF THE DECISION TO PROVIDE SUCH SERVICES WAS MADE ON A FINANCIAL BASIS.- MEDICARE IS A SOCIETAL BENEFIT, PROVIDED BY THE FEDERAL GOVERNMENT, FOR THOSE WHO WOULD OTHERWISE BE UNINSURED AFTER AGING OUT OF TRADITIONAL MEANS OF HEALTH INSURANCE, SUCH AS INSURANCE PROVIDED BY AN EMPLOYER.- MEDICARE IS NOT A TRUE MARKET PAYER, AS COMPARED TO COMMERCIAL PAYERS, WHEREBY REIMBURSEMENT RATES CAN BE NEGOTIATED AND ADJUSTED IN ORDER TO REDUCE INCURRED LOSSES.MEMORIAL HOSPITAL USED THE MEDICARE ALLOWABLE COSTS PER ITS 2015 AS-FILED MEDICARE COST REPORTS, LESS ANY ADJUSTMENTS FOR SUBSIDIZED HEALTH SERVICES AND HEALTH PROFESSIONS EDUCATION, IF APPLICABLE. ALLOWABLE COSTS ARE CALCULATED BY ALLOCATING TOTAL FACILITY COSTS TO REVENUE GENERATING UNITS WITHIN THE HOSPITAL. THE MEDICARE COST REPORT DOES NOT REFLECT ALL OF THE COSTS ASSOCIATED WITH MEDICARE PROGRAMS.
PART III, LINE 9B:	FINANCIAL ASSISTANCE DISCOUNTS ARE GRANTED FOR MEDICALLY NECESSARY SERVICES WHEN IT IS DETERMINED THAT THE PATIENT AND FAMILY INCOME MEETS THE CRITERIA ESTABLISHED. PATIENTS WHO HAVE INSURANCE COVERAGE OR WHO ARE ENTITLED TO GOVERNMENTAL ASSISTANCE ARE IDENTIFIED IN ORDER FOR REIMBURSEMENT TO BE OBTAINED. ALL PATIENTS WITH SELF-PAY BALANCES AFTER INSURANCE MAY OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS IF THEY PROVIDE APPROPRIATE DOCUMENTATION THAT THEY SATISFY THE INCOME GUIDELINES. VERIFICATION OF FINANCIAL ASSISTANCE IS PURSUED THROUGHOUT THE INTERNAL COLLECTION PROCESS UNTIL ALL OPTIONS HAVE BEEN EXHAUSTED. ALL PATIENTS, THAT HAVE A SELF-PAY BALANCE, INCLUDING PATIENTS THAT MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, RECEIVE BILLING STATEMENTS AND PAYMENT REMINDERS. THESE STATEMENTS INFORM ALL PATIENTS OF THE OPPORTUNITY TO SEEK A FINANCIAL ASSISTANCE ADJUSTMENT FOR MEDICALLY NECESSARY SERVICES, THE ELIGIBILITY CRITERIA, AND THE METHOD TO APPLY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN COMPLETED AND/OR REQUESTED INCOME VERIFICATION HAS NOT BEEN RECEIVED FROM A PATIENT WHO COULD POTENTIALLY QUALIFY, THE PATIENT WILL CONTINUE TO RECEIVE BILLING STATEMENTS THROUGH THE NORMAL COLLECTION PROCESS.ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, AN ADJUSTMENT IS PROCESSED. THE PATIENT ACCOUNT ANALYST WILL DETERMINE PATIENT ELIGIBILITY AND CALCULATE THE ADJUSTMENT BASED ON POLICY GUIDELINES. AN ADJUSTMENT FORM IS PREPARED AND APPROVED PER POLICY. UNINSURED PATIENTS MAY BE REQUIRED TO COMPLETE AN APPLICATION AND PROVIDE REQUIRED DOCUMENTATION, INCLUDING ANY DOCUMENTATION REQUIRED TO DETERMINE ELIGIBILITY. UNINSURED PATIENTS ARE NOTIFIED IN WRITING WHETHER OR NOT THEY QUALIFY FOR ANY FINANCIAL ASSISTANCE ADJUSTMENT FOR WHICH THEY HAVE SUBMITTED AN APPLICATION, AND OF ANY REMAINING BALANCE OWED. THE ADJUSTMENT IS THEN APPLIED TO THE PATIENT'S ACCOUNT.PATIENTS MAY BE OFFERED PAYMENT PLANS WHEN APPROPRIATE BASED ON DOCUMENTED FINANCIAL NEED AND CIRCUMSTANCES. LONGER PAYMENT PLANS MAY BE OFFERED ON AN EXCEPTION BASIS FOR CASES WITH UNUSUALLY HIGH BALANCES OR SPECIAL CIRCUMSTANCES DEMONSTRATING AN INABILITY TO PAY. ONCE THE INTERNAL COLLECTION PROCESS HAS BEEN COMPLETED, PATIENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY IF THE PATIENT HAS NOT CONTACTED US REGARDING THEIR DESIRE TO APPLY FOR FINANCIAL ASSISTANCE, SENT IN A FINANCIAL ASSISTANCE APPLICATION, OR RESPONDED TO REQUESTS FOR ADDITIONAL INFORMATION. IT IS THE EXPECTATION OF THE EXTERNAL COLLECTION AGENCY AS THEY WORK ACCOUNTS TO OFFER FINANCIAL ASSISTANCE WHEN APPLICABLE. THROUGHOUT THE COLLECTION PROCESS, THE COLLECTION AGENCY WILL INFORM UNINSURED PATIENTS OF THE CRITERIA TO OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS BASED ON FAMILY INCOME AND FAMILY SIZE, AND WILL FORWARD APPLICATIONS FOR PATIENTS WHO SUBMIT THE REQUIRED DOCUMENTATION.
PART VI, LINE 2:	PROMEDICA HEALTH SYSTEM AND HOSPITALS DEMONSTRATE A COMMITMENT TO THE COMMUNITIES IT SERVES AND THEREFORE, BELIEVES IT IS CRITICAL TO UNDERSTAND THE HEALTH CARE NEEDS OF ITS PRIMARY SERVICE AREA. TO THAT END, PROMEDICA HOSPITALS CONDUCT NEEDS ASSESSMENTS IN ITS PRIMARY SERVICE AREAS USING A VARIETY OF METHODOLOGIES TO ASSESS EACH COUNTY'S HEALTH CARE DATA, IDENTIFY GAPS IN HEALTH CARE INITIATIVES, AND MAKE RECOMMENDATIONS FOR THE BETTERMENT OF THE GENERAL COMMUNITY HEALTH. ANALYSIS OF PUBLISHED COUNTY HEALTH DATA, INTERVIEWS WITH KEY STAKEHOLDERS, AND REVIEW OF HISTORICAL AND EXISTING PROMEDICA COMMUNITY ASSESSMENTS ARE ALL MEANS BY WHICH RECOMMENDATIONS FOR THE PROMEDICA COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLANS ARE DEVELOPED. INFORMATION IS REVIEWED AND APPROVED BY HOSPITAL GOVERNANCE LEADERSHIP TO ASSURE THAT PLANS ARE DEVELOPED TO MEET THE NEEDS OF THE COMMUNITY. PUBLISHED COUNTY HEALTH DATACOUNTY HEALTH DATA WERE OBTAINED FROM SEVERAL SOURCES, INCLUDING THE OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE, THE MICHIGAN DEPARTMENT OF HEALTH, AND FORMAL COUNTY ASSESSMENTS CONDUCTED WITHIN THE INDIVIDUAL COUNTIES. ALTHOUGH MOST COUNTIES CONDUCTING A FORMAL ASSESSMENT UTILIZE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) QUESTIONNAIRE DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AS THE BASIS OF THE COUNTY QUESTIONNAIRE, COUNTY COMMITTEES TYPICALLY ADD AND/OR CHANGE QUESTIONS TO MEET THE COUNTY'S PERCEIVED NEEDS. PROMEDICA'S COMMUNITY GOALS ARE SET BASED ON THESE DATA.PROMEDICA COMMUNITY HEALTH PLANOVERALL, EMPHASIS IS PLACED ON CLINICAL PROGRAMS FOCUSED ON LEADING CAUSES OF DEATH, CHRONIC DISEASES, MENTAL HEALTH, AND HUNGER/OBESITY DUE TO THE LARGE NUMBERS OF INDIVIDUALS AFFECTED BY THESE DISEASES. THE PRIMARY FOCUS FOR COMMUNITY HEALTH ACTIVITIES ARE RELATED TO EDUCATION, SCREENING, AND PREVENTION OF CHRONIC DISEASES, MENTAL HEALTH ISSUES, AND HUNGER/OBESITY; AND IMPROVING RELATED CONDITIONS THAT RESULT IN HIGH MORBIDITY AND MORTALITY IN OUR COMMUNITIES, WITH SPECIAL EMPHASIS PLACED ON SERVING UNDERSERVED POPULATIONS. IN ADDITION, PROMEDICA STRATEGIC PLANNING CONTINUES TO DEVELOP PATIENT-CENTERED, INTEGRATED CLINICAL SERVICE LINES INCLUDING CANCER, CARDIOVASCULAR, ORTHOPAEDICS AND MATERNAL FETAL MEDICINE.
PART VI, LINE 3:	THE OPPORTUNITY FOR FINANCIAL ASSISTANCE ADJUSTMENTS IS COMMUNICATED TO PATIENTS AT PROMEDICA HEALTH SYSTEM HOSPITALS THROUGH THE FOLLOWING METHODS:A. DURING THE PRE-REGISTRATION PROCESS FOR SCHEDULED INPATIENTS AND HIGH-DOLLAR OUTPATIENT CASES, THE CENTRALIZED PRE-REGISTRATION STAFF WILL NOTIFY A PATIENT FINANCIAL ADVOCATE TO CONTACT THE PATIENT PRIOR TO SERVICE TO DISCUSS POTENTIAL ELIGIBILITY FOR GOVERNMENT PROGRAMS AND FINANCIAL ASSISTANCE. THE PRE-SERVICE FUNCTION INCLUDES ACCOUNT REGISTRATION, INSURANCE VERIFICATION, PRE-CERTIFICATION AND FINANCIAL COUNSELING.B. ADMITTING LOCATIONS WILL HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE WHEN REGISTERED AS UNINSURED. AT ADMITTING, UNINSURED PATIENTS ARE INFORMED OF THE OPPORTUNITY TO SEEK FINANCIAL ASSISTANCE. C. PATIENT FINANCIAL ADVOCATES ARE AVAILABLE AT THE HOSPITALS TO ASSIST UNINSURED PATIENTS IN COMPLETING THE FORMS. PATIENT FINANCIAL ADVOCATES ATTEMPT TO MEET WITH IN-HOUSE PATIENTS TO ASSESS ELIGIBILITY AND TO ASSIST WITH APPLICATION FOR GOVERNMENT ASSISTANCE PROGRAMS, TO EXPLAIN PATIENT LIABILITY FOR CHARGES, TO PROVIDE AN ESTIMATE OF CHARGES WHEN FEASIBLE, TO EXPLAIN THE OPPORTUNITY FOR FINANCIAL ASSISTANCE, INCLUDING THE CRITERIA AND THE METHOD FOR APPLYING, AND TO EXPLAIN PAYMENT OPTIONS.D. A MESSAGE IS PRINTED ON THE PATIENT BILLING STATEMENTS TO NOTIFY THE UNINSURED PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE, TO EXPLAIN THE ELIGIBILITY CRITERIA, AND TO DESCRIBE THE METHOD TO APPLY.E. A SUMMARY OF THE POLICY FOR UNINSURED PATIENTS IS INCLUDED IN THE STATEMENTS OF UNINSURED PATIENT, AVAILABLE VIA THE PROMEDICA WEB SITE, AVAILABLE AT HOSPITAL REGISTRATION LOCATIONS, OR BY CALLING THE PROMEDICA CUSTOMER SERVICE DEPARTMENT. BUSINESS OFFICE PERSONNEL ALSO NOTIFY UNINSURED PATIENTS OF THE FINANCIAL ADJUSTMENT POLICY THROUGH THE CUSTOMER SERVICE AND COLLECTION DEPARTMENTS.
PART VI, LINE 4:	MEMORIAL HOSPITAL, LOCATED IN FREMONT, OHIO, SERVES AN AREA PRIMARILY AROUND SANDUSKY AND SENECA COUNTIES WITH A POPULATION OF APPROXIMATELY 83,000. APPROXIMATELY, 18% OF THE SERVICE AREA IS AGE 65 OR OVER; 39% IS BETWEEN AGE 35 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $47,000; 53% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER; 53% OF HOUSEHOLDS HAVE AN INCOME OF $50,000 OR LESS. SANDUSKY COUNTY HAS A POPULATION OF APPROXIMATELY 60,000 WITH APPROXIMATELY 6% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 23% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 17% OF SANDUSKY COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE FOR SANDUSKY COUNTY IN 2015 WAS 7.3%. THE LEADING CAUSES OF DEATH IN THE SERVICE AREA, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, LUNG DISEASE, DIABETES, CANCER, AND UNINTENTIONAL INJURIES/ACCIDENTS. ACCORDING TO 2015 COUNTY HEALTH RANKINGS, SANDUSKY COUNTY RANKED 39 OF 88 COUNTIES FOR HEALTH OUTCOMES, 34 OF 88 FOR MORTALITY, AND 49 OF 88 FOR MORBIDITY. SENECA COUNTY HAS A POPULATION OF APPROXIMATELY 56,000 WITH APPROXIMATELY 6% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 23% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 16% OF SENECA COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE FOR SENECA COUNTY IN 2015 WAS 7.3%. ACCORDING TO 2015 COUNTY HEALTH RANKINGS, SENECA COUNTY RANKED 29 OF 88 COUNTIES FOR HEALTH OUTCOMES, 42 OF 88 FOR MORTALITY, AND 19 OF 88 FOR MORBIDITY. THERE ARE SEVEN HOSPITALS WITHIN A SIX COUNTY AREA AROUND FREMONT, BELLEVUE HOSPITAL, H.B. MAGRUDER MEMORIAL HOSPITAL, MERCY HOSPITAL, WOOD COUNTY HOSPITAL, FIRELANDS REGIONAL MEDICAL CENTER, FISHER-TITUS MEDICAL CENTER, AND MERCY HOSPITAL OF WILLARD.
PART VI, LINE 5:	MEMORIAL HOSPITAL IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC. WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. - IN 2015, THERE WERE MORE THAN 500 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), INCLUDING ITS SUBSIDIARIES. OF THESE, 100% LIVED WITHIN PROMEDICA'S 27-COUNTY SERVICE AREA, WITH THE MAJORITY RESIDING WITHIN METRO TOLEDO WHERE PROMEDICA'S ADULT AND PEDIATRIC TERTIARY HOSPITALS (THE TOLEDO HOSPITAL AND TOLEDO CHILDREN'S HOSPITAL) ARE LOCATED. TRUSTEE REPRESENTATION IS COMPRISED OF DIVERSE MEMBERS, INCLUDING 80 PHYSICIANS, FROM NORTHWEST OHIO AND SOUTHEAST MICHIGAN. ADDITIONALLY, PROMEDICA BOARD MEMBERS INCLUDED 189 WOMEN AND 77 RACIAL/ETHNIC MINORITIES.- BOARD MEMBERS ARE NOT COMPENSATED BY PROMEDICA FOR THEIR SERVICE TO OUR HOSPITALS AND OTHER BUSINESS UNITS; THEIR DONATION OF TIME AND EXPERTISE, INCLUDING ATTENDING BOARD MEETINGS, RETREATS AND OTHER ACTIVITIES, ARE PERFORMED ON A VOLUNTEER BASIS. IN 2015, PROMEDICA BOARD MEMBERS GAVE MORE THAN 28,000 HOURS IN SERVICE TO THE ORGANIZATION, WHICH EQUATES TO AN ESTIMATED CONTRIBUTION OF MORE THAN $3 MILLION TO OUR COMMUNITIES.- PROMEDICA'S MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITIES WHICH PROMEDICA SERVES. QUALIFICATION MAY VARY BY HOSPITAL, BUT ANY PHYSICIAN WHO MEETS THOSE QUALIFICATIONS MAY BE GRANTED PRIVILEGES.- A NEW FOOD PHARMACY PILOT LAUNCHED, SERVING PATIENTS AT THE ADULT MEDICINE CLINIC AT PROMEDICA'S CENTER FOR HEALTH SERVICES (CHS) AND THE WW KNIGHT FAMILY MEDICINE PRACTICE. THE PROGRAM REFERS PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY TO RECEIVE FOOD FOR THEMSELVES AND THEIR FAMILY FROM THE FOOD PHARMACY LOCATED ON THE FIRST FLOOR OF CHS. EACH PATIENT RECEIVES TWO TO THREE DAYS OF SUPPLEMENTAL FOOD FOR THEIR FAMILY. STARTING IN APRIL THROUGH DECEMBER 2015, APPROXIMATELY 1,400 REFERRALS WERE MADE TO THE FOOD PHARMACY, PROVIDING SUPPLEMENTAL FOOD TO MORE THAN 1,800 HOUSEHOLDS. - PROMEDICA OPENED THE EBEID INSTITUTE'S NEW MARKET ON THE GREEN TO PROVIDE BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. - PROMEDICA PROVIDED NEARLY 7,500 HEALTH SCREENINGS TO COMMUNITY MEMBERS THROUGHOUT 2015, INCLUDING BLOOD PRESSURE, BLOOD GLUCOSE AND BODY MASS INDEX SCREENINGS AT NUMEROUS HEALTH FAIRS AND SPORTING EVENTS. ADDITIONALLY, FREE SCREENING MAMMOGRAMS, AS WELL AS SKIN CANCER AND LUNG CANCER SCREENINGS AND COLORECTAL CANCER EDUCATION WERE PROVIDED FOR EARLY DETECTION. PROSTATE CANCER SCREENING EDUCATION AND NUTRITIONAL PROGRAMS WERE DEVELOPED TO KEEP PEOPLE HEALTHY.
PART VI, LINE 6:	PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A MISSION-BASED, LOCALLY OWNED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT WAS FORMED IN TOLEDO, OHIO IN 1986. IN 2015, PROMEDICA WAS COMPRISED OF MORE THAN 17,000 EMPLOYEES, APPROXIMATELY 2,700 VOLUNTEERS AND MORE THAN 2,300 HEALTHCARE PROVIDERS - INCLUDING NEARLY 900 PROVIDERS EMPLOYED BY PROMEDICA PHYSICIAN GROUP - WHO HAVE JOINED TOGETHER TO FORM A NETWORK ACROSS 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN. AS AN INTEGRATED DELIVERY SYSTEM, PROMEDICA PROVIDERS SHARE RESOURCES SUCH AS ADVANCED TECHNOLOGY, QUALITY STANDARDS, SAFETY PRACTICES, MEDICAL EXPERTISE, AND SPECIALTY SERVICES TO HELP ENSURE AREA RESIDENTS HAVE READY ACCESS TO HIGH-QUALITY CARE IN THE MOST APPROPRIATE SETTING IN ORDER TO PROVIDE COST-EFFICIENT SERVICES. - PROMEDICA MEMBERS INCLUDE: THE TOLEDO HOSPITAL D/B/A PROMEDICA TOLEDO HOSPITAL; PROMEDICA TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF PROMEDICA TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL; FLOWER HOSPITAL D/B/A PROMEDICA FLOWER HOSPITAL; BAY PARK COMMUNITY HOSPITAL D/B/A PROMEDICA BAY PARK HOSPITAL; EMMA L. BIXBY MEDICAL CENTER D/B/A PROMEDICA BIXBY HOSPITAL; HERRICK MEMORIAL HOSPITAL, INC. D/B/A PROMEDICA HERRICK HOSPITAL; FOSTORIA HOSPITAL ASSOCIATION D/B/A PROMEDICA FOSTORIA COMMUNITY HOSPITAL; DEFIANCE HOSPITAL, INC. D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL; MERCY MEMORIAL HOSPITAL CORPORATION D/B/A PROMEDICA MONROE REGIONAL HOSPITAL; ST. LUKE'S HOSPITAL D/B/A PROMEDICA ST. LUKE'S HOSPITAL; MEMORIAL HOSPITAL D/B/A PROMEDICA MEMORIAL HOSPITAL; PROMEDICA INSURANCE CORPORATION; PROMEDICA PHYSICIAN GROUP, A NETWORK OF SYSTEM-EMPLOYED PHYSICIANS AND ADVANCED PRACTICE PROVIDERS; AND PROMEDICA CONTINUING CARE SERVICES CORPORATION, WITH SERVICES SUCH AS SENIOR CARE, HOSPICE, REHABILITATION, AND HOME CARE.- IN 2015, PROMEDICA MANAGED 4.7 MILLION PATIENT ENCOUNTERS AND CONTRIBUTED A TOTAL COMMUNITY BENEFIT OF NEARLY $199 MILLION, WHICH INCLUDED FREE HEALTH SCREENINGS AND PARTICIPATION IN PUBLIC HEALTH FAIRS TO MEDICAL LECTURES AT AREA SENIOR CENTERS AND NUTRITION EDUCATION IN ELEMENTARY SCHOOLS, PLUS MUCH MORE. - IN ADDITION, THE PROMEDICA ADVOCACY FUND ASSISTED LOCAL NONPROFIT AGENCIES WITH SIMILAR MISSIONS THROUGH GRANTS TOTALING NEARLY $315,000. AS IN PRIOR YEARS, EMPHASIS WAS PLACED ON ORGANIZATIONS WORKING TO PROVIDE BASIC NEEDS SERVICES SUCH AS CLOTHING, SHELTER AND FOOD AS THESE ARE TIED CLOSELY TO PROMEDICA'S MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITIES IT SERVES.- WITH REGARD TO HEALTH PROFESSIONS EDUCATION, BIWEEKLY, MONTHLY AND ANNUAL PROGRAMS WERE OFFERED THROUGHOUT 2015 FOR CONTINUING MEDICAL EDUCATION CREDIT. APPROXIMATELY 1,800 CREDIT HOURS OF PHYSICIAN EDUCATION WERE OFFERED. THERE WERE APPROXIMATELY 7,100 PHYSICIANS WHO PARTICIPATED IN EDUCATIONAL PROGRAMS, AND APPROXIMATELY 8,600 NON-PHYSICIANS (I.E., ALLIED HEALTH PROFESSIONALS).- PROMEDICA'S FOUNDATION RAISES FUNDS FOR PHILANTHROPY IN SUPPORT OF PROMEDICA'S MISSION TO IMPROVE HEALTH AND WELL-BEING. PROMEDICA FOUNDATION IS A SEPARATE PHILANTHROPIC ENTITY, AND ANNUAL DONOR PROGRAMS, CAPITAL CAMPAIGNS, PLANNED GIVING, AND EVENT FUNDRAISING ACTIVITIES ARE CONDUCTED TO RAISE FUNDS THAT SUPPORT PATIENTS AND FAMILIES, AS WELL AS LOCAL COMMUNITIES, THROUGH HEALTH-RELATED PROGRAMS, SERVICES, EQUIPMENT, AND FACILITY CONSTRUCTION/RENOVATION THAT HAVE BEEN IDENTIFIED, IN PART, THROUGH A COMMUNITY NEEDS ASSESSMENT.

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
MEMORIAL HOSPITAL

Employer identification number
34-4430849

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) PROMEDICA FOUNDATION 2142 N COVE BLVD TOLEDO,OH43606	34-1517672	501(C)(3)	317,429	OPERATING GRANT
(2) SANDUSKY COUNTY ECONOMIC DEVELOPMENT CORPORATION 2511 COUNTRYSIDE DR SUITE C FREMONT,OH43420	34-1424666	501(C)(3)	10,000	CHARITABLE DONATION
(3) WSOS COMMUNITY 109 S FRONT STREET FREMONT,OH43420	34-0975934	501(C)(3)	16,596	CHARITABLE DONATION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	AS AN AFFILIATE OF PROMEDICA HEALTH SYSTEM, INC. (PHS), CORPORATE TREASURY, WITH THE APPROVAL AND OVERSIGHT OF THE FINANCE COMMITTEE, ENSURES THAT FUNDS ARE DISTRIBUTED APPROPRIATELY ACCORDING TO PHS'S STRATEGIC BUSINESS PLAN AND CONSISTENT WITH CORPORATE TREASURY POLICIES AND PROCEDURES.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1HOLLY L BRISTOLLTRUSTEE	(i) (ii)	0 ------------- 264,499	0 ------------- 96,238	0 ------------- 23,801	0 ------------- 69,800	0 ------------- 19,758	0 ------------- 474,096	0 ------------- 0
2IRACEMA AREVALO MDTRUSTEE	(i) (ii)	0 ------------- 255,382	0 ------------- 0	0 ------------- 17,253	0 ------------- 6,508	0 ------------- 23,094	0 ------------- 302,237	0 ------------- 0
3KEVIN C WEBB PHDTRUSTEE	(i) (ii)	0 ------------- 446,920	0 ------------- 200,389	0 ------------- 11,431	0 ------------- 101,135	0 ------------- 14,166	0 ------------- 774,041	0 ------------- 0
4PAMELA M JENSENPRESIDENT, EX OFFICIO	(i) (ii)	0 ------------- 221,829	0 ------------- 56,031	0 ------------- 3,324	0 ------------- 48,779	0 ------------- 14,913	0 ------------- 344,876	0 ------------- 0
5ALAN M SATTLERTREASURER	(i) (ii)	0 ------------- 405,315	0 ------------- 154,161	0 ------------- 29,282	0 ------------- 97,575	0 ------------- 22,501	0 ------------- 708,834	0 ------------- 0
6JEFFREY C KUHNSECRETARY	(i) (ii)	0 ------------- 396,043	0 ------------- 169,512	0 ------------- 26,793	0 ------------- 100,167	0 ------------- 12,067	0 ------------- 704,582	0 ------------- 0
7GARY AKENBERGERSR. VP FINANCE, PHS	(i) (ii)	0 ------------- 291,582	0 ------------- 84,049	0 ------------- 39,958	0 ------------- 67,444	0 ------------- 21,631	0 ------------- 504,664	0 ------------- 0
8KARLA FALLSVP OPERATIONS, MH	(i) (ii)	0 ------------- 148,585	0 ------------- 34,021	0 ------------- 3,109	0 ------------- 162,939	0 ------------- 13,529	0 ------------- 362,183	0 ------------- 0
9DAVID BREWERFORMER OFFICER	(i) (ii)	0 ------------- 112,625	0 ------------- 250	0 ------------- 4,575	0 ------------- 20,741	0 ------------- 21,458	0 ------------- 159,649	0 ------------- 0
10KATHLEEN S HANLEYFORMER OFFICER	(i) (ii)	0 ------------- 456,423	0 ------------- 197,040	0 ------------- 42,730	0 ------------- 149,277	0 ------------- 17,709	0 ------------- 863,179	0 ------------- 0
11JILL TROSINFORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 158,851	0 ------------- 35,895	0 ------------- 2,725	0 ------------- 14,894	0 ------------- 6,868	0 ------------- 219,233	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 3

PROMEDICA HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION OF MEMORIAL HOSPITAL, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE

PART I, LINE 4B

ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	HOLLY L. BRISTOLL AND CHARLES F. HEID HAVE A FAMILY RELATIONSHIP. CATHERINE R. KNIPP AND DARYL L. KNIPP HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6	AS AN OHIO NON-PROFIT ORGANIZATION, THIS CORPORATION HAS A CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	PROMEDICA HEALTH SYSTEM, INC. (PHS) IS THE PARENT CORPORATION AND SOLE MEMBER OF MEMORIAL HOSPITAL. AS THE SOLE MEMBER, PHS HAS THE RIGHT TO (A) NOMINATE AND ELECT A MINORITY OF THE MEMBERS AND REMOVE (WITH CAUSE) THE MEMBERS OF THE BOARD OF TRUSTEES OF MEMORIAL HOSPITAL, AND (B) APPROVE THE NOMINEES TO FILL ANY VACANCIES ON THE BOARD OF TRUSTEES, A MAJORITY OF WHOM ARE NOMINATED BY MEMORIAL HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7B	WHILE THE BOARD OF TRUSTEES OF EACH BUSINESS UNIT IS GRANTED CERTAIN POWERS WITH RESPECT TO SUCH BUSINESS UNIT'S OPERATIONS, AS THE MEMBER, PROMEDICA HEALTH SYSTEM, INC. RETAINS APPROVAL RIGHTS WITH RESPECT TO CERTAIN CORPORATE ACTIONS SUCH AS (I) ADOPTION OF THE BUSINESS UNIT'S STRATEGIC PLANS AND FINANCIAL PLANS, (II) EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (III) EXPENDITURES FOR ITEMS WHICH ARE INCLUDED IN THE BUSINESS UNIT'S ANNUAL BUDGETS BUT WHICH EXCEED THE BUDGETED AMOUNT BY AN AMOUNT IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER, (IV) INCURRENCE, ASSUMPTION OR GUARANTEE OF ANY INDEBTEDNESS, (V) SALE, LEASE OR OTHER DISPOSITION OF REAL PROPERTY OR ASSETS WITH A VALUE IN EXCESS OF CERTAIN DOLLAR LIMITS SET FROM TIME TO TIME BY THE MEMBER AND (VI) ANY MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR LIQUIDATION.
FORM 990, PART VI, SECTION B, LINE 11	UNDER THE GUIDANCE OF PROMEDICA HEALTH SYSTEM, INC.'S (PHS) TAX CONSULTANTS, FORM 990S ARE PREPARED BY THE RESPECTIVE ACCOUNTING DEPARTMENT OF EACH AFFILIATE AND REVIEWED BY THE AFFILIATE'S FINANCE LEADERSHIP. AFTER AFFILIATE'S FINANCE LEADERSHIP APPROVAL, COPIES OF THE FORM 990 FOR PHS AND THEIR SUBSIDIARIES ARE PROVIDED TO THE RESPECTIVE COMPANY'S BOARD OF TRUSTEES AND ARE REVIEWED AND SIGNED BY A PRINCIPAL OFFICER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	PROMEDICA HEALTH SYSTEM, INC. AND AFFILIATES (PHS) HAVE STANDARDS OF CONDUCT THAT APPLY TO ALL PHS BOARD MEMBERS AND EMPLOYEES. BOARD MEMBERS AND EMPLOYEES ARE EXPECTED TO CERTIFY THEIR COMPLIANCE WITH THE APPLICABLE STANDARDS PRIOR TO ELECTION/APPOINTMENT OR PRIOR TO BEGINNING EMPLOYMENT. BOARD MEMBERS ANNUALLY (OR IMMEDIATELY IF NEW POTENTIAL CONFLICTS OF INTEREST ARISE), ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE BOARD MEMBER CERTIFICATION STATEMENT WITHIN 30 DAYS OF DISSEMINATION. BOARD MEMBER CERTIFICATION STATEMENTS ARE COMPILED AND REVIEWED BY THE V.P., AUDIT & COMPLIANCE/CHIEF COMPLIANCE OFFICER (CCO). SUMMARIZED INFORMATION IS FORWARDED FOR REVIEW TO THE CHIEF FINANCIAL OFFICER, GENERAL COUNSEL, BUSINESS UNIT PRESIDENTS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (PRESIDENT/CEO), BASED UPON THEIR RESPECTIVE KNOWLEDGE OF THE BOARD MEMBERS. THE PURPOSE OF THIS REVIEW IS TO BOTH INFORM MANAGEMENT OF THE DISCLOSED CONFLICTS AND TO ALLOW THEM TO IDENTIFY TO THE V.P., AUDIT & COMPLIANCE, ANY POTENTIAL UNDISCLOSED CONFLICTS. THE AUDIT & COMPLIANCE DEPARTMENT THEN CONDUCTS AN AUDIT OF ALL BOARD MEMBER CERTIFICATION STATEMENTS (ALONG WITH ANY RELATIONSHIPS NOTED THROUGH THE ABOVE REVIEW) TO IDENTIFY ANY POSITIONAL CONFLICTS OF INTEREST AND TO TEST MATERIAL TRANSACTIONS WITH BOARD MEMBERS/THEIR AFFILIATES FOR FAIR MARKET VALUE. THE RESULTS OF THE AUDIT ARE REPORTED DIRECTLY TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE WITH A COPY TO THE PRESIDENT/CEO. THE REPORT INCLUDES A SUMMARY OF THE AUDIT PROCEDURES PERFORMED, ANY SIGNIFICANT CONCERNS IDENTIFIED AND THEIR RESOLUTION. ANY UNRESOLVED CONFLICTS ARE ADDRESSED BY THE AUDIT COMMITTEE WITH RECOMMENDATIONS TO THE FULL BOARD AS NEEDED. FAILURE TO FILE THE CERTIFICATION STATEMENT, OR THE FILING OF A FALSE OR INCOMPLETE CERTIFICATION STATEMENT, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE BOARD MEMBER'S CERTIFICATION STATEMENT OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION BY THE BOARD OF TRUSTEES UP TO AND INCLUDING REMOVAL FROM THE BOARD/COMMITTEE/COUNCIL. EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL SALARIED EMPLOYEES AND SPECIFICALLY IDENTIFIED HOURLY EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC EMPLOYEE CERTIFICATION QUESTIONNAIRE BY AN ESTABLISHED DEADLINE THAT IS COMMUNICATED TO THE EMPLOYEE. THE HUMAN RESOURCES DEPARTMENT ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND PROVIDES NOTIFICATION TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL EMPLOYEE CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT. ALL NEW EMPLOYEES, EXCLUDING EMPLOYED PHYSICIANS, ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYEE STANDARD OF CONDUCT AND THE EMPLOYEE CERTIFICATION STATEMENT WHICH THE NEW EMPLOYEE IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. THE AUDIT & COMPLIANCE DEPARTMENT HAS ACCESS TO A REPORT THAT IDENTIFIES ALL NEW HIRES. A SAMPLE OF EMPLOYEES IS IDENTIFIED AND AN AUDIT IS CONDUCTED TO ENSURE THAT REQUIRED DOCUMENTATION IS ON FILE. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE V.P., AUDIT & COMPLIANCE AND IF NECESSARY DISCUSSED WITH THE BUSINESS UNIT PRESIDENT IN WHICH THE EMPLOYEE WORKS, AND GENERAL COUNSEL. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL OF THE PHS PRESIDENT/CEO. RESULTS OF THE EMPLOYEE PROCESS AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. FAILURE TO COMPLETE THE CERTIFICATION QUESTIONNAIRE, OR THE COMPLETION OF A FALSE OR INCOMPLETE CERTIFICATION QUESTIONNAIRE, OR FAILURE TO DISCLOSE IMMEDIATELY ANY NEW CONFLICTS OF INTEREST THAT MAY ARISE, OR FAILURE TO COOPERATE WITHOUT CONDITION, HONESTLY AND COMPLETELY WITH ANY INVESTIGATION OR REVIEW OF THE EMPLOYEE'S CERTIFICATION QUESTIONNAIRE OR HIS/HER ACTIONS OR CIRCUMSTANCES SHALL BE GROUNDS FOR SANCTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. EMPLOYED PHYSICIANS ANNUALLY (OR IMMEDIATELY IF NEW CONFLICTS OF INTEREST ARISE), ALL EMPLOYED PHYSICIANS ARE REQUIRED TO COMPLETE AND SUBMIT AN ELECTRONIC PHYSICIAN CERTIFICATION QUESTIONNAIRE BY THE ESTABLISHED AND COMMUNICATED DEADLINE. THE OFFICE OF THE PRESIDENT/CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER FOR PROMEDICA PHYSICIAN GROUP (PPG) ENSURES THAT ALL QUESTIONNAIRES, WHICH ARE STORED ELECTRONICALLY, ARE COMPLETED AND REVIEWED AND ENSURES NOTIFICATION IS PROVIDED TO THE V.P., AUDIT & COMPLIANCE OF THE NUMBER OF ANNUAL PHYSICIAN CERTIFICATION QUESTIONNAIRES SENT AND RECEIVED AND ALSO ENSURES COPIES OF ANY QUESTIONNAIRES CONTAINING DISCLOSURES THAT WARRANT FURTHER REVIEW BY THE AUDIT & COMPLIANCE DEPARTMENT ARE FORWARDED ACCORDINGLY. ALL NEW EMPLOYED PHYSICIANS ARE PROVIDED EITHER AN ELECTRONIC OR PAPER COPY OF THE EMPLOYED PHYSICIAN STANDARD OF CONDUCT AND THE PHYSICIAN CERTIFICATION STATEMENT WHICH THE NEW PHYSICIAN IS REQUIRED TO COMPLETE PRIOR TO BEGINNING EMPLOYMENT. IDENTIFIED CONFLICTS ARE INITIALLY REVIEWED BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER, CHIEF OPERATING OFFICER OR THEIR DESIGNEE, AND IF APPROPRIATE, ARE SUBSEQUENTLY REPORTED TO THE OFFICE OF THE V.P., AUDIT & COMPLIANCE. IF THE CONFLICT IS CONSIDERED A SIGNIFICANT EXPOSURE RISK FOR PHS, A RECOMMENDATION WILL BE PREPARED FOR FINAL APPROVAL BY THE PHS PRESIDENT/CHIEF EXECUTIVE OFFICER. RESULTS OF THE EMPLOYED PHYSICIAN AUDIT ARE INCLUDED IN THE ABOVE REPORT TO THE CHAIR OF THE AUDIT & COMPLIANCE COMMITTEE. ANY ITEMS THAT MEET CRITERIA FOR PUBLIC DISCLOSURE WILL BE COMMUNICATED TO THE APPROPRIATE PHYSICIAN BY THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE IN ADVANCE OF THE POSTING. THE PPG PRESIDENT/CHIEF MEDICAL OFFICER OR DESIGNEE WILL PROVIDE THE PHYSICIAN-INDUSTRY RELATIONSHIP DISCLOSURES TO THE APPLICABLE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE. THE PUBLIC DISCLOSURE WILL BE POSTED ON THE PPG PHYSICIAN WEBSITE (I.E., WWW.PPGDOCS.ORG) DATABASE BY THE PHS MARKETING/COMMUNICATIONS REPRESENTATIVE.
FORM 990, PART VI, SECTION B, LINE 15	MEMORIAL HOSPITAL'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE COMPENSATED BY PROMEDICA HEALTH SYSTEM, INC. (PHS), A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION DETERMINATIONS OF MEMORIAL HOSPITAL'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE MADE BY A COMPENSATION COMMITTEE OF PHS. EACH YEAR INDEPENDENT CONSULTANTS CONDUCT AN ANNUAL SURVEY AND RECOMMEND EXECUTIVE PAYROLL BASE SALARY RANGES BASED UPON THE MARKET. THE DATA IS REVIEWED AND APPROVED BY THE PROMEDICA HEALTH SYSTEM COMPENSATION COMMITTEE EVERY OCTOBER. SALARY ADJUSTMENTS ARE DETERMINED AT THE DECEMBER MEETING OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES OTHER FORMS OF COMPENSATION BASED UPON THE PRIOR YEAR PERFORMANCE AT THE JANUARY MEETING EACH YEAR.
FORM 990, PART VI, SECTION C, LINE 19	PROMEDICA HEALTH SYSTEM, INC. AND SUBSIDIARIES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART IX, LINE 11G	OTHER GENERAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 473,998. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 473,998. NON PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 3,933,794. MANAGEMENT AND GENERAL EXPENSES 560,930. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,494,724. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 1,288,388. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,288,388.
FORM 990, PART XI, LINE 9:	BENEFICIAL INTEREST IN FOUNDATIONS 2,295,665.
FORM 990, PART IV, LINE 24A:	MEMORIAL HOSPITAL IS A HEALTH FACILITY THAT IS A SUBSIDIARY OF PROMEDICA HEALTH SYSTEM, INC. (PHS). MEMORIAL HOSPITAL HOLDS AN INTERCOMPANY NOTE PAYABLE TO THE TOLEDO HOSPITAL, WHICH IS ALSO A SUBSIDIARY OF PHS. THE NOTE PAYABLE REPRESENTS MEMORIAL HOSPITAL'S PORTION OF TAXABLE AND TAX-EXEMPT BONDS ISSUED BY PROMEDICA HEALTHCARE OBLIGATED GROUP.
FORM 990, PART VI, SECTION B, LINE 16B:	JOINT VENTURE OPERATING AGREEMENTS INVOLVING PROMEDICA HEALTH SYSTEM, INC. OR ITS SUBSIDIARIES (COLLECTIVELY, PHS) INCLUDE PROVISIONS TO PROTECT PHS'S TAX EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. PHS CONTINUALLY ENSURES THAT ITS TAX EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL PHS JOINT VENTURES.
FORM 990, PART III, LINE 4:	PROMEDICA HEALTH SYSTEM, INC. - PROGRAM SERVICE ACCOMPLISHMENTS ESTABLISHED IN 1986, PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A MISSION-BASED, LOCALLY OWNED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN AND IS ONE OF THE REGION'S LEADING HEALTHCARE PROVIDERS. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST IN CUTTING-EDGE TECHNOLOGY, INNOVATIVE PROGRAMS AND FAMILY-CENTERED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF A PATIENT'S ABILITY TO PAY. BASED ON NEEDS THAT WE HAVE ASSESSED WITHIN THE COMMUNITIES WE SERVE, PROMEDICA LAUNCHED NEW SERVICES AND PROGRAMS IN 2015 TO HELP MEET THE GROWING DEMANDS OF LOCAL CONSUMERS ACROSS ALL SPECTRUMS OF LIFE, INCLUDING THOSE INDIVIDUALS WHO ARE OFTEN THE MOST VULNERABLE WHEN IT COMES TO HEALTH CARE: THE ELDERLY, POOR AND UNDERSERVED. PROMEDICA'S MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF THOSE WE SERVE. THIS IS REFLECTED IN OUR FOUR CORE VALUES, INCLUDING: COMPASSION - WE TREAT OUR PATIENTS AND EACH OTHER WITH RESPECT, INTEGRITY AND DIGNITY; INNOVATION - WE CONTINUALLY SEARCH TO FIND A BETTER WAY FORWARD; TEAMWORK - WE PARTNER WITH OTHERS BECAUSE WE ARE BETTER TOGETHER THAN APART; AND EXCELLENCE - WE STRIVE TO BE THE BEST IN ALL WE DO. PROMEDICA AND ITS AFFILIATES COMPRISE 332 SITES, MORE THAN 2,300 PHYSICIANS AND APPROXIMATELY 17,000 EMPLOYEES AND VOLUNTEERS. DURING 2015, PROMEDICA DISCHARGED 82,132 INPATIENTS AND SERVED MORE THAN 1,535,310 OUTPATIENTS, WHILE HANDLING 350,316 EMERGENCY VISITS SYSTEM-WIDE. AMONG THE REGION'S LARGEST EMPLOYERS, PROMEDICA PLAYS A SIGNIFICANT ROLE IN ECONOMIC DEVELOPMENT AND STABILITY IN OUR REGION. DURING 2015, FOR EVERY ONE DOLLAR OF REVENUE, ANOTHER 43 CENTS WAS CREATED IN OUR SERVICE-AREA ECONOMY, WITH A TOTAL ECONOMIC OUTPUT OF $4.5 BILLION. WE ALSO CREATE A DIRECT ECONOMIC IMPACT WITH OUR REVENUE, PAYROLL AND EMPLOYMENT. ADDITIONALLY, SPENDING ON SERVICES AND MATERIALS WITH VENDORS IN OUR REGION CREATES AN INDIRECT ECONOMIC BENEFIT. OUR PHYSICIANS AND PROVIDERS, LEADERSHIP TEAM MEMBERS AND EMPLOYEES INDIVIDUALLY CONTRIBUTE PERSONAL RESOURCES TO THE COMMUNITY IN NUMEROUS WAYS - SUCH AS THROUGH TUTORING ELEMENTARY STUDENTS IN READING AND OTHER LIFE SKILLS, PROVIDING MONTHLY HEALTH LECTURES AT LOCAL SENIOR CENTERS, GENEROUSLY CONTRIBUTING TO COMMUNITY FUNDRAISING CAMPAIGNS SUCH AS UNITED WAY, PARTICIPATING IN MEDICAL MISSIONS, SERVING ON LOCAL NOT-FOR-PROFIT BOARDS, AND DONATING NONPERISHABLE GOODS TO NUMEROUS LOCAL FOOD PANTRIES AND CHURCHES - UNDERSCORING A KEY BENEFIT OF PROMEDICA BEING LOCALLY OWNED AND OPERATED. PROMEDICA'S MEMBER AND AFFILIATE HOSPITALS INCLUDE: THE TOLEDO HOSPITAL; TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF THE TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL (A DIVISION OF THE TOLEDO HOSPITAL); FLOWER HOSPITAL; FOSTORIA HOSPITAL ASSOCIATION; DEFIANCE HOSPITAL, INC.; BAY PARK COMMUNITY HOSPITAL; HERRICK MEMORIAL HOSPITAL, INC.; EMMA L. BIXBY MEDICAL CENTER; MEMORIAL HOSPITAL; MERCY MEMORIAL HOSPITAL CORPORATION, AND ST. LUKE'S HOSPITAL. IN 2015, PROMEDICA ALSO PROVIDED INTEGRATED SERVICES, COMPRISED OF: - PROMEDICA CONTINUING CARE SERVICES CORPORATION, PROVIDING REHABILITATION, HOSPICE, HOME CARE, AMBULATORY AND SENIOR SERVICES, COMMUNITY HEALTH, MEDICAL TRANSPORTATION SERVICES, AND CARE COORDINATION. - PROMEDICA PHYSICIAN GROUP (PROMEDICA PHYSICIANS), WITH NEARLY 900 HEALTHCARE PROVIDERS, INCLUDING PRIMARY CARE, OBSTETRICS AND SPECIALTY PHYSICIANS, AS WELL AS ADVANCED PRACTICE PROVIDERS. TOGETHER, THIS GROUP HELPS PROMEDICA BROADEN THE CARE WE OFFER TO AREA RESIDENTS, INCLUDING IN SMALLER, OUTLYING COMMUNITIES. - PROMEDICA INSURANCE CORPORATION, THE LARGEST HEALTH MAINTENANCE ORGANIZATION PHYSICALLY LOCATED IN NORTHWEST OHIO. IN 2015, PARAMOUNT ADVANTAGE PROVIDED MEDICAID COVERAGE TO MORE THAN 227,000 MEMBERS ACROSS ALL OF OHIO'S 88 COUNTIES. - PROMEDICA INDEMNITY CORPORATION, PROVIDING MEDICAL PROFESSIONAL AND COMPREHENSIVE GENERAL LIABILITY COVERAGE FOR PROMEDICA, INCLUDING IN OUTLYING AREAS WHERE PRIMARY-CARE PHYSICIAN RECRUITMENT IS DIFFICULT. - TWELVE CONTROLLED FOUNDATIONS THAT SERVE AS FUNDRAISING ENTITIES FOR THEIR RESPECTIVE HOSPITALS/BUSINESS UNITS AND FACILITIES, SUCH AS THE EBEID HOSPICE RESIDENCE ON THE FLOWER HOSPITAL CAMPUS AND THE MARY ELLEN FALZONE DIABETES CENTER ON THE CAMPUS OF THE TOLEDO HOSPITAL. PROMEDICA'S SPECIALIZED CARE INCLUDES ONCOLOGY, ORTHOPAEDICS, HEART AND VASCULAR, NEUROLOGY, REHABILITATIVE, AND BEHAVIORAL MEDICINE, AS WELL AS WOMEN'S AND PEDIATRIC CARE. A FUNDAMENTAL PART OF OUR MISSION IS THAT OUR SERVICES ARE TAILORED TO THE NEEDS OF OUR COMMUNITIES AND THEY ARE AVAILABLE TO EVERYONE IN OUR COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION TO BEING A STRONG ADVOCATE FOR THE HEALTH AND WELL-BEING OF OTHERS, PROMEDICA PROVIDES AND PROMOTES COMMUNITY WELLNESS, COLLABORATING WITH MORE THAN 300 NONPROFIT AGENCIES AND ORGANIZATIONS ACROSS OUR REGION IN 2015 THAT HAD VALUES AND MISSIONS SIMILAR TO OUR OWN. PROMEDICA IS CONTINUALLY IMPROVING ITS SERVICES, FACILITIES, TECHNOLOGIES, AND OUTREACH EFFORTS TO MEET THE EVER-CHANGING NEEDS OF ITS DIVERSE POPULATIONS. IN DIRECT RESPONSE TO COMMUNITY NEEDS, A FEW EXAMPLES FROM 2015 INCLUDE THE FOLLOWING: - MERCY MEMORIAL HOSPITAL CORPORATION, IN MONROE, MICHIGAN, BECAME A MEMBER OF PROMEDICA EFFECTIVE JAN. 1, 2015. BY SHARING RESOURCES AND CLINICAL EXPERTISE, THIS NEW PARTNERSHIP HELPS BROADEN THE DEPTH AND BREADTH OF OUR SERVICES FOR RESIDENTS OF SOUTHEASTERN MICHIGAN. - PROMEDICA, ALONG WITH FIVE OTHER OHIO HOSPITALS, ESTABLISHED THE MIDWEST HEALTH COLLABORATIVE (MHC) TO IMPROVE THE VALUE OF HEALTHCARE SERVICES THROUGHOUT THE STATE. WHILE REMAINING INDEPENDENT, THESE SIX HEALTHCARE ORGANIZATIONS ARE WORKING TOGETHER TO ASSESS THE FEASIBILITY OF CREATING A STATEWIDE PROVIDER NETWORK, EXCHANGE BEST PRACTICES, SHARE RESOURCES, REDUCE COSTS, DEVELOP INNOVATIVE WAYS TO DELIVER HEALTH CARE ACROSS LARGE POPULATIONS, AND REDUCE CARE VARIATION. - IN 2015, PROMEDICA FINALIZED A COMPREHENSIVE AGREEMENT WITH THE UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE AND LIFE SCIENCES TO FORM AN ACADEMIC AFFILIATION WITH THE PURPOSE OF ADVANCING MEDICAL EDUCATION AND CLINICAL RESEARCH IN NORTHWEST OHIO. THE AFFILIATION WILL BUILD A LEGACY MODEL OF HEALTH CARE THAT WILL BENEFIT COMMUNITY MEMBERS ACROSS THE REGION FOR GENERATIONS TO COME. - PROMEDICA OPENED ITS FIRST URGENT CARE CENTERS IN OREGON AND PERRYSBURG, OHIO, TO SERVE PATIENTS WHO HAVE MEDICAL CONCERNS THAT DO NOT REQUIRE AN EMERGENCY CENTER. THE URGENT CARE CENTERS ARE OPEN 10 A.M. TO 10 P.M., 365 DAYS PER YEAR, AND ARE STAFFED BY HIGHLY-TRAINED CERTIFIED NURSE PRACTITIONERS. - PROMEDICA'S SUMMER YOUTH EMPLOYMENT PROGRAM PARTNERED 77 CENTRAL-CITY TEENS AGES 16 - 19 WITH MENTORS IN DEPARTMENTS SUCH AS HUMAN RESOURCES, RADIOLOGY, DIETARY, AND INFORMATION TECHNOLOGY TO LEARN SKILLS INCLUDING CUSTOMER SERVICE, PUNCTUALITY AND BEING ACCOUNTABLE TO OTHERS. - AS CHILDHOOD OBESITY CONTINUES TO BE AN IMPORTANT ISSUE IN OUR COMMUNITIES, BAY PARK COMMUNITY HOSPITAL BEGAN PILOTING A NEW HEALTH AND NUTRITION PROGRAM TO CHILDREN IN GRADES 2 - 5 IN ITS SERVICE AREA. THE PROGRAM FEATURES A BOARD GAME DEVELOPED BY PROMEDICA CALLED NUTREXITY, WHICH OFFERS A FUN WAY FOR KIDS TO LEARN ABOUT HEALTH, INCLUDING GOOD NUTRITION, EXERCISE ESSENTIALS, AND THE IMPORTANCE OF GIVING BACK TO THE COMMUNITY. - PROMEDICA PHYSICIANS EXPANDED CARE TO BETTER COVER LOCAL AND RURAL COMMUNITIES, ADDING MORE THAN 100 NEW PRIMARY CARE PHYSICIANS, SPECIALISTS AND ADVANCED PRACTICE PROVIDERS IN 2015. - PROMEDICA PARTICIPATED IN DOZENS OF COMMUNITY HEALTH FAIRS THAT INCLUDED APPROXIMATELY 7,500 FREE PUBLIC SCREENINGS FOR HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, BODY MASS INDEX AND BONE DENSITY. - AS PART OF ITS HUNGER-FREE INITIATIVE, PROMEDICA CONTINUED TO IMPLEMENT A FOOD RECLAMATION PROGRAM. MORE THAN 160,000 POUNDS OF FOOD HAVE BEEN RECLAIMED FROM PARTNERS SUCH AS HOLLYWOOD CASINO, THE TOLEDO HOSPITAL, FLOWER HOSPITAL, FIFTH THIRD FIELD, AND OWENS COMMUNITY COLLEGE SINCE THE PROGRAM STARTED IN 2013. - PROMEDICA'S COME TO THE TABLE HUNGER SUMMIT TOOK PLACE IN ALBUQUERQUE, NEW MEXICO IN JUNE AS PART OF PROMEDICA'S EFFORTS TO RAISE AWARENESS OF HUNGER AS A HEALTH ISSUE. PRESENTED BY PROMEDICA, THE ALLIANCE TO END HUNGER, AND PRESBYTERIAN HEALTHCARE SERVICES, THE SUMMIT FEATURED PERSPECTIVES FROM AN ARRAY OF EXPERTS, INCLUDING A KEYNOTE ADDRESS BY AUDREY ROWE, ADMINISTRATOR FOR THE FOOD AND NUTRITION SERVICE AT THE U.S. DEPARTMENT OF AGRICULTURE.
- PROMEDICA CANCER INSTITUTE'S (PCI) COMMUNITY OUTREACH INCLUDED	CANCER SCREENINGS AND EDUCATION TO THE MOST VULNERABLE IN OUR COMMUNITY. FREE SCREENING MAMMOGRAMS, AS WELL AS SKIN CANCER AND LUNG CANCER SCREENINGS WERE PROVIDED FOR EARLY DETECTION. PROSTATE CANCER SCREENING EDUCATION AND NUTRITIONAL PROGRAMS WERE DEVELOPED TO KEEP PEOPLE HEALTHY, AND A COLORECTAL CANCER EDUCATION EVENT TOOK PLACE AT HUNTINGTON CENTER. PCI ALSO HOSTED ANNUAL CANCER SURVIVOR CELEBRATIONS FOR SURVIVORS, FRIENDS AND CAREGIVERS ACROSS THE REGION AND SPONSORED COMMUNITY EVENTS INCLUDING THE ANNUAL NW OHIO SUSAN G. KOMEN, RACE FOR THE CURE AND AMERICAN CANCER SOCIETY RELAY FOR LIFE IN LUCAS COUNTY. - A NEW FOOD PHARMACY PILOT LAUNCHED, SERVING PATIENTS AT THE ADULT MEDICINE CLINIC AT PROMEDICA'S CENTER FOR HEALTH SERVICES (CHS) AND THE WW KNIGHT FAMILY MEDICINE PRACTICE. THE PROGRAM REFERS PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY TO RECEIVE FOOD FOR THEM AND THEIR FAMILY FROM THE FOOD PHARMACY LOCATED AT CHS. EACH PATIENT RECEIVES TWO TO THREE DAYS OF SUPPLEMENTAL FOOD FOR THEIR FAMILY. STARTING IN APRIL THROUGH DECEMBER 2015, APPROXIMATELY 1,400 REFERRALS WERE MADE TO THE FOOD PHARMACY, PROVIDING SUPPLEMENTAL FOOD TO MORE THAN 1,800 HOUSEHOLDS. - THROUGH ITS ADVOCACY FUND, PROMEDICA CONTINUED TO SUPPORT LOCAL COMMUNITY ORGANIZATIONS THAT PROVIDE ASSISTANCE TO THOSE IN NEED WITH BASIC NECESSITIES THAT DIRECTLY IMPACT INDIVIDUALS' HEALTH AND WELL-BEING. THIS SUPPORT AMOUNTED TO GRANTS TOTALING MORE THAN $315,000 IN 2015. - PROMEDICA AND THE AARP FOUNDATION (AARP'S AFFILIATED CHARITY) JOINED TOGETHER AS FOUNDING MEMBERS OF THE NEW NOT-FOR-PROFIT ORGANIZATION THE ROOT CAUSE COALITION. THE COALITION IS FOCUSED ON ADDRESSING HUNGER AS A PUBLIC HEALTH ISSUE AND OTHER SOCIAL DETERMINANTS OF HEALTH. - TO HELP MEET THE NEED FOR ADDITIONAL SCHOOL NURSES IN THE TOLEDO PUBLIC SCHOOL SYSTEM (TPS), PROMEDICA BEGAN FUNDING NINE ADDITIONAL SCHOOL NURSES, ENABLING ALL TPS ELEMENTARY SCHOOLS TO HAVE A FULL-TIME SCHOOL NURSE. STUDIES HAVE SHOWN THAT FULL-TIME NURSES IN PUBLIC SCHOOLS CAN HAVE A POSITIVE IMPACT ON HEALTH AND STRONG ACADEMIC OUTCOMES. OVER THE NEXT THREE YEARS, PROMEDICA AND TPS WILL TRACK AND EVALUATE STUDENT HEALTH STATISTICS TO DEVELOP A SUSTAINABILITY PLAN AND SUPPORT ONGOING FUNDING FOR THE PROGRAM. - PROMEDICA OPENED THE EBEID INSTITUTE'S NEW MARKET ON THE GREEN TO PROVIDE BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. THE INSTITUTE WAS MADE POSSIBLE THROUGH A GENEROUS DONATION FROM PROMEDICA BOARD MEMBER RUSSELL EBEID. - AFTER MORE THAN A YEAR OF PLANNING, BUILDING, TESTING AND TRAINING, PROMEDICA'S NEW ELECTRONIC HEALTH RECORD (EHR), EPIC, WENT LIVE WITH A SUCCESSFUL PILOT OF 20 PROMEDICA PHYSICIANS AND PROVIDERS. FOLLOWING EPIC'S METHODOLOGY, ADDITIONAL GO-LIVES ARE SCHEDULED THROUGH 2016 AND 2017 TO BRING ALL PROVIDERS, HOSPITALS AND SERVICES ON BOARD. THE NEW PLATFORM WILL FURTHER ENABLE ONE PATIENT, ONE RECORD, AND ONE BILL FOR PATIENTS REGARDLESS OF SERVICE PROVIDED OR THE LOCATION OF SERVICE ACROSS PROMEDICA. - TOLEDO AND TOLEDO CHILDREN'S HOSPITALS OPENED A NEW SURGERY SUITE TO INCREASE EFFICIENCY AND PROVIDE A BETTER EXPERIENCE FOR PATIENTS AND FAMILIES. IT INCLUDES 10 REPLACEMENT OPERATING ROOMS, LARGER PRE-OP AND RECOVERY AREAS, A NEW PEDIATRIC RECOVERY AREA, AND A NEW TEXT ALERT SYSTEM FOR WAITING FAMILIES. - IN COLLABORATION WITH HCR MANORCARE, THE NEW HEARTLAND AT PROMEDICA SKILLED NURSING AND REHABILITATION FACILITY OPENED ON THE CAMPUS OF FLOWER HOSPITAL. IT PROVIDES MEDICALLY COMPLEX AND INTENSIVE REHABILITATION SERVICES FOR SHORT-TERM PATIENTS TRANSITIONING BETWEEN HOSPITAL CARE AND HOME. - FLOWER HOSPITAL RADIOLOGY INSTALLED A NEW MRI SCANNER THAT PROVIDES INCREASED IMAGE RESOLUTION, RESULTING IN EXCELLENT IMAGE QUALITY AND PROVIDING PATIENTS WITH MORE ROOM DURING THE IMAGING PROCESS. ADDITIONALLY IT CAN ACCOMMODATE PATIENTS WEIGHING UP TO 550 LBS. (250 KG) AND ITS SHORT, WIDE BORE DESIGN HELPS REDUCE PATIENT ANXIETY AND INCREASES PATIENT COMFORT. - PROMEDICA DESIGNATED CLEVELAND CLINIC LABORATORIES (CCL) AS ITS NEW PRIMARY REFERENCE LAB, ALLOWING CCL TO PERFORM THE 1% OF HIGHLY SPECIALIZED LABORATORY TESTING THAT CANNOT BE PERFORMED BY PROMEDICA LABS. CCL IS ONE OF THE TOP SIX PRIMARY REFERENCE LABORATORIES IN THE COUNTRY, PROVIDING HIGH-QUALITY, STATE-OF-THE-ART DIAGNOSTIC SERVICES TO PHYSICIANS AND HEALTHCARE FACILITIES NATIONWIDE. THE NEW COLLABORATION OFFERS EFFICIENT, COST EFFECTIVE AND COORDINATED CARE ACROSS THE REGION FOR OUR PATIENTS. - ST. LUKE'S HOSPITAL ACHIEVED NICHE (NURSES IMPROVING CARE FOR HEALTH SYSTEM ELDERS) DESIGNATION. NICHE IS A NATIONAL, NURSING-DRIVEN PROGRAM DESIGNED TO HELP HOSPITALS AND HEALTHCARE ORGANIZATIONS IMPROVE THE CARE PROVIDED TO OLDER ADULTS. - THE HICKMAN CANCER CENTER AT FLOWER HOSPITAL WAS EXPANDED TO A TOTAL OF 32 TREATMENT BAYS, INCLUDING FOUR BEDS TO INCREASE PATIENT COMFORT DURING TREATMENT AND TWO ADDITIONAL EXAM ROOMS TO IMPROVE PATIENT FLOW AT THE CENTER. - PROMEDICA, IN PARTNERSHIP WITH HARBOR, A REGIONAL BEHAVIORAL HEALTH AGENCY, IMPLEMENTED A TELEPSYCH PROGRAM TO ASSIST IN CARING FOR INPATIENTS AT BOTH THE EMMA L. BIXBY MEDICAL CENTER AND HERRICK HOSPITAL CAMPUSES AS WELL AS IN BOTH OUTPATIENT MENTAL HEALTH FACILITIES. - POSITIONED TO BE A REGIONAL LEADER IN RESEARCH AND INNOVATIONS, PROMEDICA PARTICIPATED IN MORE THAN 160 INDUSTRY-SPONSORED CLINICAL RESEARCH TRIALS AS WELL AS MORE THAN 60 INTERNAL RESEARCH PROJECTS CONDUCTED BY PHYSICIANS, NURSES AND ALLIED HEALTH PROFESSIONALS. ADDITIONALLY, PROMEDICA'S MEDICAL TECHNOLOGY BUSINESS INCUBATOR ALLOWS CLIENT COMPANIES IN THE HEALTHCARE FIELD TO ACCELERATE DEVELOPMENT AND COMMERCIALIZATION OF MEDICAL DEVICES AND HEALTH INFORMATION TECHNOLOGY TO IMPROVE PATIENT CARE LOCALLY AND NATIONALLY. IN 2015, PROMEDICA CONTRIBUTED $198,749,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, FINANCIAL ASSISTANCE AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE. THESE NUMBERS NOT ONLY INDICATE PROMEDICA'S LONG-STANDING COMMITMENT TO THE COMMUNITY, BUT ALSO FULFILL OUR NOT-FOR-PROFIT STATUS BY IMPROVING THE HEALTH AND WELL-BEING OF RESIDENTS IN THE COMMUNITIES WE SERVE. SPECIFICALLY, THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, CASH AND IN-KIND CONTRIBUTIONS, AND OTHER COMMUNITY BENEFIT OPERATIONS, PROMEDICA CONTRIBUTED $60,815,000 IN 2015. THESE PROGRAMS INCLUDED FREE COMMUNITY HEALTH SCREENINGS, SUCH AS DIABETES TESTING, BLOOD PRESSURE, BONE DENSITY, BODY MASS, AND CANCER CHECKUPS; MAMMOGRAM SCREENINGS FOR LOW-INCOME AND UNINSURED WOMEN; CHILDHOOD IMMUNIZATIONS; REDUCED-COST SCHOOL-ATHLETIC PHYSICALS; FIRST-AID COVERAGE AT COMMUNITY EVENTS; VOLUNTEER ELEMENTARY SCHOOL MENTORS; PUBLIC HEALTH EDUCATION LECTURES AND SEMINARS; A CHILDHOOD OBESITY PROGRAM; AND MANY OTHER COMMUNITY-BASED INITIATIVES. PROMEDICA ALSO CONTRIBUTED $18,122,000 IN FINANCIAL ASSISTANCE FOR PATIENTS WHO DID NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR HOSPITAL SERVICES. THIS AMOUNT REPRESENTS THE COST TO PROVIDE SERVICE AND DOES NOT INCLUDE THE COSTS FOR ACCOUNTS THAT ARE WRITTEN OFF TO BAD DEBT FOR PATIENTS WHO DO NOT PAY THEIR BILLS. IN ADDITION, PROMEDICA'S COST OF BAD DEBT FOR 2015 WAS $21,472,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $198,749,000 NOTED ABOVE. FURTHER, PROMEDICA CONTINUES TO BE A LEADING PARTICIPANT IN THE LUCAS COUNTY CARENET INITIATIVE - A COLLABORATIVE EFFORT AMONG PROMEDICA, MERCY HEALTH PARTNERS, THE UNIVERSITY OF TOLEDO MEDICAL CENTER, THE CITY OF TOLEDO, AND OTHERS. CARENET WAS CREATED TO PROVIDE FREE OR LOWER-COST HEALTH CARE FOR LOW-INCOME LUCAS COUNTY RESIDENTS. ESTABLISHED IN 2003, CARENET BRIDGES THE GAP BETWEEN ADULTS WITHOUT HEALTH INSURANCE AND NEEDED HEALTHCARE SERVICES. WHILE SOME INDIVIDUALS MAY QUALIFY FOR GOVERNMENTAL INSURANCE PROGRAMS SUCH AS MEDICAID, OTHERS DO NOT; IT IS FOR THESE INDIVIDUALS THAT CARENET WAS ESTABLISHED. ADDITIONALLY DURING 2015, PROMEDICA PROVIDED $119,812,000 OF COMMUNITY BENEFIT THROUGH THE COST - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID AND OTHER MEANS-TESTED PATIENTS. PROMEDICA'S TOTAL COST - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS DURING 2015 WAS $111,127,000 AND IS NOT REFLECTED IN THE COMMUNITY BENEFIT AMOUNT OF $198,749,000 NOTED ABOVE. INDEED, PROMEDICA GOES BEYOND INDUSTRY STANDARDS IN MEETING THE GOAL OF PROVIDING CARE TO EVERYONE, REGARDLESS OF THEIR ABILITY TO PAY. WE PROVIDE HOSPITAL CARE FREE-OF-CHARGE TO ALL FAMILIES WITHOUT INSURANCE WITH INCOMES AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. IN ADDITION TO FREE CARE FOR THOSE FAMILIES UNDER THIS FEDERAL POVERTY LEVEL, PROMEDICA HOSPITALS PROVIDE SIGNIFICANT DISCOUNTS TO FAMILIES WITH INCOMES OF UP TO 400% OF THE FEDERAL POVERTY LEVEL.
IN MANY SITUATIONS, OTHER FUNDING SOURCES ARE SECURED AND	ACCOMMODATIONS MADE. PROMEDICA'S POLICIES ARE POSTED AND AVAILABLE IN WRITING IN ALL PROMEDICA FACILITIES. ALSO, FINANCIAL ADVOCATES ARE AVAILABLE TO HELP PATIENTS BY EXPLAINING OUR FREE CARE AND DISCOUNT PROGRAMS, AND TO ASSIST WITH THE PAPERWORK NECESSARY TO QUALIFY FOR GOVERNMENT FUNDING. PATIENT BILLS PROVIDE CLEAR EXPLANATIONS, QUALIFICATIONS AND REMINDERS OF THESE PROGRAMS. IN SUMMARY, PROMEDICA DEMONSTRATES ITS MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. AND, WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL CLASSES, HEALTH FAIRS AND OTHER ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE.
MEMORIAL HOSPITAL - PROGRAM SERVICE ACCOMPLISHMENTS	MEMORIAL HOSPITAL (D/B/A PROMEDICA MEMORIAL HOSPITAL) IS A MEMBER OF PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), A MISSION-BASED, LOCALLY OWNED, NONPROFIT HEALTHCARE ORGANIZATION HIGHLY FOCUSED ON ACHIEVING CORE VALUES. HEADQUARTERED IN TOLEDO, OHIO, PROMEDICA SERVES 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN, AND IS ONE OF THE REGION'S LEADING HEALTHCARE PROVIDERS. OUR STEWARDSHIP OF RESOURCES HAS ENABLED US TO WISELY INVEST IN PATIENT-CENTERED CARE, ADVANCED TECHNOLOGY, INNOVATIVE PROGRAMS, AND FAMILY-ORIENTED FACILITIES THAT HELP TO ENSURE PATIENTS AND AREA RESIDENTS HAVE EQUAL ACCESS TO HIGH-QUALITY, SAFE CARE IN THE MOST APPROPRIATE SETTING, REGARDLESS OF PATIENTS' ABILITY TO PAY. A 100 BED HOSPITAL IN FREMONT, OHIO, PROMEDICA MEMORIAL HOSPITAL (MH) PROVIDES EXTENSIVE HEALTHCARE SERVICES SUCH AS EMERGENCY MEDICINE; SURGICAL SERVICES; OUTPATIENT PHYSICAL REHABILITATION; HEART, VASCULAR AND PULMONARY CARE; LABOR AND DELIVERY; MENTAL HEALTH SERVICES; AND A FULL RANGE OF LABORATORY AND RADIOLOGY SERVICES. MH SERVED 1,703 INPATIENTS AND 58,306 OUTPATIENTS IN 2015. FURTHER, 24,109 INDIVIDUALS SOUGHT EMERGENCY CARE AT MH. THE HOSPITAL CONTRIBUTED $4,710,000 IN COMMUNITY BENEFIT THROUGH COMMUNITY BENEFIT EXPENDITURES, AND GOVERNMENT-SPONSORED, MEANS-TESTED HEALTH CARE. THROUGH COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, AND OTHER COMMUNITY BENEFIT OPERATIONS, MH CONTRIBUTED $510,000 TO THE COMMUNITY DURING 2015. INCLUDED IN THIS FIGURE ARE PROGRAMS AND EVENTS SUCH AS: - SUMMER CAMPS FOCUSING ON NUTRITION, ACTIVITIES AND SELF-ESTEEM FOR YOUTH OF THE COMMUNITY. - STAFF INVOLVEMENT AND SUPPORT OF RED RIBBON WEEK. - YOUTH MENTORING PROGRAMS IN SANDUSKY COUNTY. - HEALTH SCREENINGS FOR BLOOD PRESSURE, BLOOD SUGAR AND CHOLESTEROL AT LOCAL FAIRS AND COMMUNITY EVENTS, AS WELL AS FIRST AID COVERAGE FOR SPECIAL EVENTS. - SCREENINGS FOR SKIN AND BREAST CANCER. - PARTICIPATION IN THE NATIONAL ALLIANCE ON MENTAL ILLNESS WALK TO RAISE FUNDS TO SUPPORT MENTAL HEALTH COMMUNITY PROGRAMS. - PROVIDE EDUCATIONAL TALKS AND RESOURCES RELATED TO CANCER AT DANBURY AND ELMORE SENIOR CENTERS. - USE APPROVED AND FUNDED RESOURCES FROM SUSAN G. KOMEN TO PROVIDE BREAST EXAMS AND MAMMOGRAMS. MH PROVIDED $4,200,000 OF COMMUNITY BENEFIT THROUGH COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICAID PATIENTS. COMMUNITY BENEFIT DOES NOT INCLUDE THE COSTS FOR ACCOUNTS WRITTEN OFF TO BAD DEBT FOR PATIENTS WHO DO NOT PAY THEIR BILLS. MH'S COST OF BAD DEBT FOR 2015 WAS $545,000. THIS AMOUNT IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $4,710,000 NOTED ABOVE. ALSO IN 2015, THE TOTAL COSTS - NOT REIMBURSED BY THE GOVERNMENT - FOR TREATING MEDICARE PATIENTS WAS $7,052,000 AND IS NOT INCLUDED IN THE COMMUNITY BENEFIT AMOUNT OF $4,710,000 NOTED ABOVE. DURING 2015, MH EXPENDED $12,455,000 IN NET PAYROLL, PROVIDING 381 JOBS IN NORTHWEST OHIO. A TOTAL OF $761,000 WAS WITHHELD FROM HOSPITAL EMPLOYEES IN STATE AND LOCAL TAXES. IN SUMMARY, MH DEMONSTRATES PROMEDICA'S MISSION AND CORE VALUES BY PROVIDING HIGH-QUALITY HEALTH CARE TO ALL PATIENTS, REGARDLESS OF THEIR RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, OR AGE. AND, WE RECOGNIZE THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL CARE. THEREFORE, WE PROVIDE THESE HEALTHCARE SERVICES; RECRUIT AND TRAIN HEALTHCARE PROFESSIONALS TO SERVE THE BROADER COMMUNITY; PROVIDE APPROPRIATE FINANCIAL ASSISTANCE; OFFER SERVICES AND CONTRIBUTIONS TO OTHER NONPROFIT ORGANIZATIONS THAT ALLOW THEM TO PROVIDE KEY SERVICES TO THEIR CONSTITUENTS; AND PRESENT FREE EDUCATIONAL CLASSES, HEALTH FAIRS AND OTHER ACTIVITIES TO OUR LOCAL COMMUNITY TO HELP ENSURE ALL MEMBERS HAVE EQUAL ACCESS TO CARE.
COMMUNITY BENEFIT DEFINITIONS	PROMEDICA HEALTH SYSTEM, INC. AND ITS SUBSIDIARIES (PROMEDICA) PREPARES ITS COMMUNITY BENEFIT REPORTS USING REPORTING GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES AND CONSISTENT WITH FORM 990, SCHEDULE H, HOSPITALS, REPORTING. COMMUNITY BENEFITS ARE PROGRAMS AND ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. COMMUNITY BENEFITS REPORTED BY PROMEDICA RESPOND TO IDENTIFIED COMMUNITY NEEDS AND MEET AT LEAST ONE OF THE FOLLOWING CRITERIA: - IMPROVE ACCESS TO HEALTHCARE SERVICE. - ENHANCE THE HEALTH OF THE COMMUNITY. - ADVANCE HEALTHCARE KNOWLEDGE. - RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS. FINANCIAL ASSISTANCE CONSISTENT WITH ITS MISSION, PROMEDICA PROVIDES A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO PATIENTS WITH LIMITED OR NO ABILITY TO PAY THEIR BILL. PROMEDICA HOSPITALS PROVIDE FREE CARE TO THOSE UNINSURED PATIENTS WITH INCOMES UP TO 200% OF THE FEDERAL POVERTY LEVEL. SIGNIFICANT DISCOUNTS ARE ALSO PROVIDED ON A SLIDING SCALE TO UNINSURED PATIENTS UP TO 400% OF THE FEDERAL POVERTY LEVEL. FINANCIAL ASSISTANCE IS REPORTED IN THE FORM OF COST TO PROVIDE SERVICES AND HAS BEEN REDUCED TO REFLECT REIMBURSEMENT RECEIVED FROM STATE PROGRAMS DESIGNED TO RELIEVE THE BURDEN OF PROVIDING FINANCIAL ASSISTANCE. THE COST OF FINANCIAL ASSISTANCE DOES NOT INCLUDE THE COSTS FOR ACCOUNTS THAT ARE WRITTEN OFF TO BAD DEBT FOR PATIENTS THAT DO NOT PAY THEIR BILL. GOVERNMENT-SPONSORED HEALTH CARE GOVERNMENT-SPONSORED HEALTH CARE INCLUDE SERVICES THAT ARE REIMBURSED OR PARTIALLY REIMBURSED THROUGH FEDERAL, STATE AND LOCAL MEANS-TESTED PROGRAMS SUCH AS MEDICAID. PROMEDICA INCLUDES THE UNPAID COSTS OF THESE PUBLIC PROGRAMS TO THE EXTENT THAT PAYMENTS RECEIVED ARE LESS THAN THE COSTS OF PROVIDING SERVICES. THE UNPAID COSTS OF TREATING MEDICARE PATIENTS IS REPORTED SEPARATELY AND IS NOT INCLUDED IN PROMEDICA'S COMMUNITY BENEFIT REPORT. ADDITIONALLY, THE COST OF FINANCIAL ASSISTANCE HAS BEEN ELIMINATED FROM ANY AMOUNTS REPORTED IN THIS CATEGORY. COMMUNITY HEALTH IMPROVEMENT SERVICES & COMMUNITY BENEFIT OPERATIONS COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE ACTIVITIES CARRIED OUT FOR THE EXPRESS PURPOSE OF IMPROVING COMMUNITY HEALTH. THESE ACTIVITIES DO NOT GENERATE INPATIENT OR OUTPATIENT BILLS AS THEY EXTEND BEYOND PATIENT CARE ACTIVITIES AND ARE SUBSIDIZED BY PROMEDICA. COMMUNITY BENEFIT OPERATIONS INCLUDE COSTS ASSOCIATED WITH DEDICATED STAFF, COMMUNITY HEALTH NEED AND/OR ASSESSMENT, AND OTHER COSTS ASSOCIATED WITH COMMUNITY BENEFIT PLANNING AND ADMINISTRATION. HEALTH PROFESSIONS EDUCATION HEALTH PROFESSIONS EDUCATION INCLUDE COSTS FOR ALL EDUCATIONAL PROGRAMS PROMEDICA IS INVOLVED WITH, THE PROVISION OF A CLINICAL SETTING FOR TRAINING FOR HEALTHCARE STUDENTS OUTSIDE THE ORGANIZATION, AND FUNDING FOR HEALTHCARE EDUCATION. SUBSIDIZED HEALTH SERVICES SUBSIDIZED HEALTH SERVICES ARE SERVICES PROVIDED TO THE COMMUNITY DESPITE A FINANCIAL LOSS. THESE SERVICES GENERATE A BILL FOR REIMBURSEMENT, AND INCLUDE CLINICAL PATIENT CARE SERVICES THAT ARE PROVIDED BECAUSE THEY ARE NEEDED IN THE COMMUNITY AND OTHER PROVIDERS ARE UNWILLING, OR UNABLE, TO PROVIDE THE SERVICES, OR THE SERVICES OTHERWISE WOULD NOT BE AVAILABLE TO MEET COMMUNITY NEEDS. RESEARCH RESEARCH ACTIVITIES INCLUDE CLINICAL AND COMMUNITY HEALTH RESEARCH, AS WELL AS STUDIES ON HEALTHCARE DELIVERY. THE AMOUNT REPORTED FOR PROMEDICA IS REDUCED BY ANY EXTERNAL SUBSIDIES, SUCH AS GRANTS. CASH AND IN-KIND CONTRIBUTIONS CASH AND IN-KIND CONTRIBUTIONS INCLUDE FUNDS AND IN-KIND SERVICES DONATED TO COMMUNITY ORGANIZATIONS AND THE COMMUNITY AT LARGE. IN-KIND SERVICES INCLUDE HOURS DONATED BY STAFF FOR COMMUNITY NEEDS WHILE ON WORK TIME; AS WELL AS DONATIONS OF FOOD, EQUIPMENT AND SUPPLIES.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL

Employer identification number

34-4430849

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) COBRA VENTURES LLC 5901 MONCLOVA RD MAUMEE,OH43537 20-4671613	LAND LEASING	OH	5,510	94,354	ST LUKE'S HOSPITAL FOUNDATION
(2) MIDWEST CARDIOVASCULAR CONSULTANTS LLC 5855 MONROE ST SYLVANIA,OH43560 61-1448753	EMPLOYS PHYSICIANS	OH	0	535,504	PROMEDICA PHYSICIAN GROUP
(3) PROMEDICA CENTRAL PHYSICIANS LLC 5855 MONROE ST SYLVANIA,OH43560 34-1881137	EMPLOYS PHYSICIANS	OH	231,170,716	291,204,025	PROMEDICA PHYSICIAN GROUP
(4) PROMEDICA EAST PHYSICIANS LLC 5855 MONROE ST SYLVANIA,OH43560 34-1881145	EMPLOYS PHYSICIANS	OH	7,735,386	-1,576,704	PROMEDICA PHYSICIAN GROUP
(5) PROMEDICA WEST PHYSICIANS LLC 5855 MONROE ST SYLVANIA,OH43560 34-1893773	EMPLOYS PHYSICIANS	OH	15,982,568	-8,068,901	PROMEDICA PHYSICIAN GROUP
(6) PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS LLC 5855 MONROE ST SYLVANIA,OH43560 26-3888045	EMPLOYS PHYSICIANS	OH	30,141,070	-56,519,329	PROMEDICA PHYSICIAN GROUP
(7) PROMEDICA CARDIOTHORACIC PHYSICIANS LLC 5855 MONROE ST SYLVANIA,OH43560 27-0978204	EMPLOYS PHYSICIANS	OH	5,936,506	-9,670,745	PROMEDICA PHYSICIAN GROUP
(8) WELLCARE PHYSICIANS LLC 5901 MONCLOVA RD MAUMEE,OH43537 61-1528443	EMPLOYS PHYSICIANS	OH	16,368,856	8,878,730	PROMEDICA PHYSICIAN GROUP
(9) THE PHARMACY COUNTER LLC 5855 MONROE ST SYLVANIA,OH43560 27-1325141	MEDICAL EQUIPMENT & PHARMACY	OH	60,641,144	17,065,865	PROMEDICA PHYSICIAN GROUP
(10) WOLF CREEK ASSOCIATES LLC 901 KIMOLE LN ADRIAN,MI49221 38-3164818	FACILITY LEASING	MI	131,432	1,308,580	EMMA L BIXBY MEDICAL CENTER
(11) PROMEDICA MONROE CARDIOLOGY PLLC 5855 MONROE ST SYLVANIA,OH43560 27-2920342	EMPLOYS PHYSICIANS	MI	2,425,382	-3,059,070	PROMEDICA PHYSICIAN GROUP
(12) ERIE WEST HOSPICE & PALLIATIVE CARE LLC 5855 MONROE ST SYLVANIA,OH43560 20-5752995	PROVIDES HOSPICE CARE	OH	4,709,330	7,039,875	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES
(13) PROMEDICA ANESTHESIA CONSULTANTS LLC 5855 MONROE ST SYLVANIA,OH43560 45-3251737	EMPLOYS PHYSICIANS	OH	30,303,052	-44,305,935	PROMEDICA PHYSICIAN GROUP
(14) PROMEDICA PHYSICIANS MANAGEMENT SERVICES LLC 5855 MONROE ST SYLVANIA,OH43560 45-3230331	PRACTICE MANAGEMENT	OH	0	-2,356,472	PROMEDICA PHYSICIAN GROUP
(15) PROMEDICA SURGICAL SERVICES LLC 5855 MONROE ST SYLVANIA,OH43560	EMPLOYS PHYSICIANS	OH	0	0	PROMEDICA PHYSICIAN GROUP
(16) MISSION POINTE GOLF COURSE LLC 2142 NORTH COVE TOLEDO,OH43606	GOLF COURSE	OH	0	391,382	PROMEDICA FOUNDATION
(17) PROMEDICA INNOVATIONS LLC 1801 RICHARDS RD TOLEDO,OH43607	INVESTMENT COMPANY	OH	0	0	PROMEDICA HEALTH SYSTEM INC
(18) PROMEDICA GENITO-URINARY SURGEONS LLC 5855 MONROE ST SYLVANIA,OH43560 46-1120436	EMPLOYS PHYSICIANS	OH	11,558,436	-14,936,580	PROMEDICA PHYSICIAN GROUP
(19) PROMEDICA MONROE PHYSICIANS PLLC 5855 MONROE ST SYLVANIA,OH43560 46-1111822	EMPLOYS PHYSICIANS	MI	27,275	-757,452	PROMEDICA PHYSICIAN GROUP
(20) PROMEDICA MULTI-SPECIALTY PHYSICIANS LLC 5855 MONROE ST SYLVANIA,OH43560 45-4976786	EMPLOYS PHYSICIANS	OH	0	159,481	PROMEDICA PHYSICIAN GROUP
(21) PROMEDICA HOSPITALISTS LLC 5855 MONROE ST SYLVANIA,OH43560	EMPLOYS PHYSICIANS	OH	0	0	PROMEDICA PHYSICIAN GROUP
(22) PROMEDICA HOSPITALISTS PLLC 5855 MONROE ST SYLVANIA,OH43560	EMPLOYS PHYSICIANS	MI	0	0	PROMEDICA PHYSICIAN GROUP
(23) MEMORIAL ANESTHESIA LTD 715 SOUTH TAFT AVE FREMONT,OH43420 20-5763680	EMPLOYS PHYSICIANS	OH	0	0	PROMEDICA PHYSICIAN GROUP
(24) MEMORIAL PROFESSIONAL SERVICES LTD 715 SOUTH TAFT AVE FREMONT,OH43420 27-3763993	EMPLOYS PHYSICIANS	OH	10,132,691	-381,185	PROMEDICA PHYSICIAN GROUP
(25) PHS VENTURES LLC 1801 RICHARDS RD TOLEDO,OH43607 34-1880473	HEALTH CARE MANAGEMENT SERVICES	DE	0	0	PROMEDICA HEALTH SYSTEM INC

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)BAY PARK COMMUNITY HOSPITAL 2801 BAY PARK DR OREGON,OH43616 34-1883132	HOSPITAL	OH	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(2)CARE ENTERPRISES INC 5901 MONCLOVA RD MAUMEE,OH43537 34-1366709	FACILITY LEASING	OH	501(C)(3)	11B, II	PROMEDICA HEALTH SYSTEM INC	Yes
(3)DEFIANCE HOSPITAL AUXILIARY 1200 RALSTON DEFIANCE,OH43512 51-0173779	HOSPITAL / FOUNDATION SUPPORT	OH	501(C)(3)	11D, III-O	DEFIANCE HOSPITAL INC	Yes
(4)DEFIANCE HOSPITAL INC 1200 RALSTON DEFIANCE,OH43512 34-4446484	HOSPITAL	OH	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(5)EMMA L BIXBY MEDICAL CENTER 818 RIVERSIDE AVE ADRIAN,MI49221 38-2796005	HOSPITAL	MI	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(6)EMMA L BIXBY MEDICAL CENTER AUXILIARY 818 RIVERSIDE AVE ADRIAN,MI49221 38-2149602	HOSPITAL / FOUNDATION SUPPORT	MI	501(C)(3)	11B, II	EMMA L BIXBY MEDICAL CENTER	Yes
(7)FLOWER HOSPITAL 5200 HARROUN RD SYLVANIA,OH43560 34-4428794	HOSPITAL	OH	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(8)FOSTORIA HOSPITAL ASSOCIATION 501 VAN BUREN STREET FOSTORIA,OH44830 34-0898745	HOSPITAL	OH	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(9)FOSTORIA HOSPITAL AUXILIARY PO BOX 907 FOSTORIA,OH44830 34-6517634	HOSPITAL / FOUNDATION SUPPORT	OH	501(C)(3)	11A, I	FOSTORIA HOSPITAL ASSOCIATION	Yes
(10)HERRICK MEDICAL CENTER AUXILIARY 500 E POTTAWATAMIE ST TECUMSEH,MI49286 38-3076105	HOSPITAL / FOUNDATION SUPPORT	MI	501(C)(3)	11B, II	HERRICK MEMORIAL HOSPITAL INC	Yes
(11)HERRICK MEMORIAL HOSPITAL INC 500 E POTTAWATAMIE ST TECUMSEH,MI49286 38-3049015	HOSPITAL	MI	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(12)LENAWEE LONG TERM CARE 700 LAKESHIRE TR ADRIAN,MI49221 38-2879330	LONG TERM CARE	MI	501(C)(3)	9	EMMA L BIXBY MEDICAL CENTER	Yes
(13)PROMEDICA CONTINUING CARE SERVICES CORP 5855 MONROE ST SYLVANIA,OH43560 34-4492440	LONG TERM AND HOME HEALTH CARE	OH	501(C)(3)	9	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES	Yes
(14)PROMEDICA COURIER SERVICES INC 3170 W CENTRAL AVE TOLEDO,OH43606 26-0324790	COURIER SERVICE	OH	501(C)(3)	11B, II	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES	Yes
(15)PROMEDICA HEALTH SYSTEM INC 1801 RICHARDS RD TOLEDO,OH43607 34-1517671	PARENT COMPANY OF HEALTH SYSTEM	OH	501(C)(3)	11B, II	N/A		No
(16)PROMEDICA INDEMNITY CORP ONE CHURCH ST 5TH FLOOR BURLINGTON,VT05401 34-1931936	PROFESSIONAL & GENERAL LIABILITY	VT	501(C)(3)	11B, II	PROMEDICA HEALTH SYSTEM INC	Yes
(17)PROMEDICA PHYSICIANS AND CONTINUUM SERVICES 5855 MONROE ST SYLVANIA,OH43560 34-1880767	PHYSICIAN MANAGEMENT SERVICES	OH	501(C)(3)	11B, II	PROMEDICA HEALTH SYSTEM INC	Yes
(18)PROMEDICA PHYSICIAN GROUP 5855 MONROE ST SYLVANIA,OH43560 34-1899439	PHYSICIAN HEALTH CARE SERVICES	OH	501(C)(3)	9	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES	Yes
(19)ST LUKE'S HOSPITAL 5901 MONCLOVA RD MAUMEE,OH43537 34-4428232	HOSPITAL	OH	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(20)ST LUKE'S HOSPITAL FOUNDATION 5901 MONCLOVA RD MAUMEE,OH43537 34-1292849	FOUNDATION	OH	501(C)(3)	11B, II	PROMEDICA HEALTH SYSTEM INC	Yes
(21)PROMEDICA FOUNDATION 2142 N COVE BLVD TOLEDO,OH43606 34-1517672	FOUNDATION	OH	501(C)(3)	11B, II	PROMEDICA HEALTH SYSTEM INC	Yes
(22)THE TOLEDO HOSPITAL 2142 N COVE BLVD TOLEDO,OH43606 34-4428256	HOSPITAL	OH	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(23)TOLEDO DISTRICT NURSE ASSOCIATION 1946 N 13TH STREET TOLEDO,OH43624 34-4427949	SKILLED HOME CARE	OH	501(C)(3)	9	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES	Yes
(24)VISITING NURSE HOSPICE AND HEALTH CARE 5855 MONROE ST SYLVANIA,OH43560 34-1831624	HOSPICE HOME CARE	OH	501(C)(3)	9	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES	Yes
(25)KAITLYN'S COTTAGE INC 1260 RALSTON AVE DEFIANCE,OH43512 45-4781053	RESPITE CARE	OH	501(C)(3)	9	DEFIANCE HOSPITAL INC	Yes
(26)MONROE CANCER CENTER 800 STEWART RD MONROE,MI48162 27-1302183	CANCER CENTER	MI	501(C)(3)	9	MERCY MEMORIAL HOSPITAL CORPORATION	Yes
(27)MONROE COMMUNITY HEALTH SERVICES 718 N MACOMB MONROE,MI48162 38-2934134	LONG TERM CARE	MI	501(C)(3)	9	MERCY MEMORIAL HOSPITAL CORPORATION	Yes
(28)MERCY MEMORIAL HOSPITAL CORPORATION 718 N MACOMB MONROE,MI48162 38-1984289	HOSPITAL	MI	501(C)(3)	3	PROMEDICA HEALTH SYSTEM INC	Yes
(29)PARAMOUNT ADVANTAGE 1901 INDIAN WOOD CIR MAUMEE,OH43537 20-3376102	HEALTH INSURANCE	OH	501(C)(3)	9	PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) BIXBY MEDICAL OFFICE LIMITED PARTNERSHIP 818 RIVERSIDE AVE ADRIAN,MI49221 38-2972398	FACILITY LEASING	MI	EMMA L BIXBY MEDICAL CENTER	RELATED	36,791	1,173,776		No		Yes		64.600 %
(2) REYNOLDS RD SURGICAL CENTER LLC 2865 N REYNOLDS RD TOLEDO,OH43615 31-1569454	FREESTANDING AMBULATORY SURGICAL CENTER	OH	THE TOLEDO HOSPITAL	RELATED	726,688	2,333,126		No			No	65.040 %
(3) WATERVILLE MEDICAL CENTER LLC 5901 MONCLOVA RD MAUMEE,OH43537 32-0160784	FACILITY LEASING	OH	CARE ENTERPRISES INC	RELATED	32,184	753,658		No			No	70.000 %
(4) NORTHWEST OHIO DEDICATED BREAST MRI LLC 5901 MONCLOVA RD MAUMEE,OH43537 26-0679898	MEDICAL DIAGNOSTICS	OH	THE TOLEDO HOSPITAL	RELATED	211,264	449,126		No			No	50.000 %
(5) WEST CENTRAL SURGICAL CENTER LLC 7055 W CENTRAL TOLEDO,OH43617 20-0088459	AMBULATORY SURGICAL CENTER	OH	THE TOLEDO HOSPITAL	RELATED	298,291	2,912,457		No		Yes		50.000 %
(6) OHIO CARE AMBULATORY SURGICAL CENTER LLC 5959 MONCLOVA RD MAUMEE,OH43537 34-1863472	AMBULATORY SURGICAL CENTER	OH	ST LUKE'S HOSPITAL	RELATED	73,215	1,293,530		No			No	54.680 %
(7) LENAWEE PHYSICIAN HOSPITAL ORGANIZATION LLC 818 RIVERSIDE AVE ADRIAN,MI49221 38-3605511	PHYSICIAN MANAGEMENT SERVICES	MI	EMMA L BIXBY MEDICAL CENTER	RELATED	-23,464	253,470		No		Yes		50.000 %
(8) PROMEDICA SURGICAL SERVICES CO-MANAGEMENT CO LLC 5901 MONCLOVA RD MAUMEE,OH43537 46-1989695	PHYSICIAN MANAGEMENT SERVICES	OH	PROMEDICA HEALTH SYSTEM INC	RELATED	743,257	816,423		No			No	51.920 %
(9) EAST-WEST HOLDINGS LTD 715 SOUTH TAFT AVE FREMONT,OH43420 20-4066818	REAL ESTATE	OH	MEMORIAL HOSPITAL	RELATED	6,016	306,259		No			No	50.000 %
(10) SURGICAL INSTITUTE OF MONROE LLC 1051 S TELEGRAPH RD MONROE,MI48161 27-0843485	AMBULATORY SURGICAL CENTER	MI	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES	RELATED	4,044	3,684,750		No			No	54.000 %
(11) PROMEDICA MASTER TENANT LLC 1801 RICHARDS RD TOLEDO,OH43607 47-5288490	REAL ESTATE	OH	PROMEDICA MANAGER MEMBER LLC	RELATED		103,328		No		Yes		1.000 %
(12) PROMEDICA DOWNTOWN CAMPUS LANDLORD LLC 1801 RICHARDS RD TOLEDO,OH43607 47-3163945	REAL ESTATE	OH	PROMEDICA MANAGER MEMBER LLC	RELATED		22,771,216		No		Yes		90.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) CARE HOLDINGS 5901 MONCLOVA RD MAUMEE,OH43537 34-1796790	HOLDING COMPANY	OH	PROMEDICA HEALTH SYSTEM INC	C			100.000 %	Yes
(2) HERRICK MEMORIAL DEVELOPMENT CORP 500 E POTTAWATAMIE TR ADRIAN,MI49221 38-3146907	FACILITY LEASING	MI	EMMA L BIXBY MEDICAL CENTER	C	906	964,439	100.000 %	Yes
(3) LHA PHYSICIAN SERVICES CORPORATION 818 RIVERSIDE AVE ADRIAN,MI49221 61-1451576	PHYSICIAN BILLING	MI	EMMA L BIXBY MEDICAL CENTER	C	-44,391		100.000 %	Yes
(4) PHYSICIANS ADVANTAGE MSO 5901 MONCLOVA RD MAUMEE,OH43537 06-1811760	PHYSICIAN MANAGEMENT SERVICES	OH	PROMEDICA HEALTH SYSTEM INC	C			100.000 %	Yes
(5) PROMEDICA CENTRAL CORPORATION OF MICHIGAN 5855 MONROE ST SYLVANIA,OH43560 38-3322278	PHYSICIAN HEALTH CARE SERVICES	OH	PROMEDICA PHYSICIAN GROUP	C	-1,047,084	3,582,068	100.000 %	Yes
(6) PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES 1901 INDIAN WOOD CIR MAUMEE,OH43537 34-1570675	HEALTH CARE INSURANCE	OH	PROMEDICA HEALTH SYSTEM INC	C	76,588,676	344,035,035	100.000 %	Yes
(7) PROMEDICA NORTH PHYSICIAN CORPORATION 5855 MONROE ST SYLVANIA,OH43560 38-3482148	PHYSICIAN HEALTH CARE SERVICES	OH	PROMEDICA PHYSICIAN GROUP	C		203,340	100.000 %	Yes
(8) PROMEDICA RETAIL GROUP INC 3890 MONROE ST TOLEDO,OH43606 34-1159928	FLORIST	OH	PROMEDICA PHYSICIANS AND CONTINUUM SERVICES	C	485	1,016,984	100.000 %	Yes
(9) HERRICK MEMORIAL OFFICE PLAZA CONDOMINIUM ASSOCIATION 818 RIVERSIDE AVE ADRIAN,MI49221 38-3639616	FACILITY MANAGEMENT	MI	HERRICK MEMORIAL DEVELOPMENT CORP	C	45	55,879	71.800 %	Yes
(10) PROMEDICA HEALTH NETWORK INC 1801 RICHARDS RD TOLEDO,OH43607 47-4006496	PHYSICIAN MANAGEMENT SERVICES	OH	PROMEDICA HEALTH SYSTEM INC	C			100.000 %	Yes
(11) MONROE HEALTH VENTURES 718 N MACOMB MONROE,MI48164 38-2704426	PHARMACY	MI	MERCY MEMORIAL HOSPITAL CORPORATION	C			100.000 %	Yes
(12) PROMEDICA MANAGER MEMBER LLC 1801 RICHARDS RD TOLEDO,OH43607 47-5168737	REAL ESTATE	OH	PROMEDICA HEALTH SYSTEM INC	C		9,536,974	100.000 %	Yes

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

Yes

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) PROMEDICA FOUNDATION	B	317,429	FMV
(2) PROMEDICA FOUNDATION	C	274,876	FMV
(3) PROMEDICA PHYSICIAN GROUP	G	293,574	FMV
(4) PROMEDICA PHYSICIAN GROUP	J	123,195	FMV
(5) THE TOLEDO HOSPITAL	P	279,427	FMV
(6) PROMEDICA HEALTH SYSTEM INC	P	6,126,310	FMV
(7) PROMEDICA PHYSICIAN GROUP	P	5,327,586	FMV
(8) PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES	P	160,586	FMV
(9) PROMEDICA COURIER SERVICES INC	P	62,329	FMV

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: MEMORIAL HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY AND SURROUNDING AREAS REGARDLESS OF THE PATIENT'S ABILITY TO PAY. SERVICES INCLUDE INPATIENT ROUTINE, INPATIENT ANCILLARY, AND OUTPATIENT CARE. OUR MISSION IS TO CONTINUALLY IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE INDIVIDUALS AND FAMILIES IN THE COMMUNITIES WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	18
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	500
6	Total number of volunteers (estimate if necessary) .............	6	252
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	15,504,406	342,376
9	Program service revenue (Part VIII, line 2g) .........	64,142,663	53,300,156
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-206,746	676,347
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,873,385	1,088,501
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	81,313,708	55,407,380
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	138,302	344,025
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	32,228,926	25,090,511
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	32,367,291	31,188,890
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	64,734,519	56,623,426
19	Revenue less expenses. Subtract line 18 from line 12.......	16,579,189	-1,216,046
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	82,765,686	88,593,330
21	Total liabilities (Part X, line 26).............	35,472,191	40,971,360
22	Net assets or fund balances. Subtract line 21 from line 20.....	47,293,495	47,621,970

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 42,951,807 including grants of $ 344,025 ) (Revenue $ 53,508,176 )
	MEMORIAL HOSPITAL IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. - SEE SCHEDULE O.

4b	(Code: ) (Expenses $ 4,199,862 including grants of $ ) (Revenue $ )
	CONSISTENT WITH OUR MISSION, MEMORIAL HOSPITAL PROVIDES A SIGNIFICANT AMOUNT OF FINANCIAL ASSISTANCE TO PATIENTS WITH LIMITED OR NO ABILITY TO PAY. - SEE SCHEDULE O.

4c	(Code: ) (Expenses $ 509,996 including grants of $ ) (Revenue $ )
	CONSISTENT WITH OUR MISSION, MEMORIAL HOSPITAL PROVIDES A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT INCLUDING COMMUNITY HEALTH IMPROVEMENT SERVICES AND HEALTH PROFESSIONS EDUCATION. - SEE SCHEDULE O.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses47,661,665

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	466,203	4,390,944	1,068,758

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	274,876
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	67,500

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		342,376

			Business Code
2a	NET PATIENT SERVICES	622110	53,153,252	53,153,252
b	AFFIL. ORG. RENT REV.	531120	146,904		146,904
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			53,300,156

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			401,308			401,308
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		160,544
b	Less: rental expenses		175,258
c	Rental income or (loss)		-14,714
d	Net rental income or (loss)......			-14,714			-14,714
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	207,432	7,632,970
b	Less: cost or other basis and sales expenses	160,107	7,405,256
c	Gain or (loss)	47,325	227,714
d	Net gain or (loss).....			275,039			275,039
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a		11,356
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			11,356			11,356
Business Code			Miscellaneous Revenue
11a	EHR INCENTIVE		900099	350,254	350,254
b	CAFETERIA/DIETARY		722514	264,598			264,598
c	MEDICAL RECORDS		900099	4,670	4,670
d	All other revenue ....			472,337			472,337
e	Total. Add lines 11a–11d ......			1,091,859
12	Total revenue. See Instructions......			55,407,380	53,508,176	0	1,556,828

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	344,025	344,025
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	7,083		7,083
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	19,794,793	15,882,929	3,911,864
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	325,305	180,436	144,869
9	Other employee benefits .......	3,281,230	2,728,164	553,066
10	Payroll taxes ...........	1,682,100	1,329,466	352,634
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	172,294		172,294
c	Accounting ...........	49,519		49,519
d	Lobbying ...........	6,172		6,172
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	109,090		109,090
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	6,257,110	5,222,182	1,034,928
12	Advertising and promotion ....	209,509	140,001	69,508
13	Office expenses .......	594,787	377,569	217,218
14	Information technology ......	1,174,023	1,056,621	117,402
15	Royalties ..
16	Occupancy ...........	2,040,252	1,811,337	228,915
17	Travel ............	167,474	108,338	59,136
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	664,034	664,034
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,660,723	3,657,180	1,003,543
23	Insurance ...	114,513	97,533	16,980
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	INTERCOMPANY SERVICES	5,641,563	5,077,407	564,156
b	MEDICAL SUPPLIES	4,549,154	4,549,154
c	DRUGS	1,777,455	1,777,455
d	LICENSE AND FEES	1,050,856	1,050,856
e	All other expenses	1,950,362	1,606,978	343,384
25	Total functional expenses. Add lines 1 through 24e	56,623,426	47,661,665	8,961,761	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			1,838,572	1	2,950,685
2	Savings and temporary cash investments .........			4,134,893	2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			8,649,948	4	10,819,859
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			572,841	8	731,668
9	Prepaid expenses and deferred charges ......			2,053,981	9	392,650
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	46,738,862
b	Less: accumulated depreciation	10b	7,591,743	34,002,228	10c	39,147,119
11	Investments—publicly traded securities .			23,917,760	11	23,654,557
12	Investments—other securities. See Part IV, line 11 .....			312,847	12	306,261
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			7,282,616	15	10,590,531
16	Total assets. Add lines 1 through 15 (must equal line 34)...			82,765,686	16	88,593,330

17	Accounts payable and accrued expenses .....	4,566,902	17	7,679,940
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	19,840,000	20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	6,548,582	23	7,211,758
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	4,516,707	25	26,079,662
26	Total liabilities. Add lines 17 through 25..	35,472,191	26	40,971,360

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	42,760,513	27	40,793,323
28	Temporarily restricted net assets ...........	4,202,782	28	6,498,447
29	Permanently restricted net assets	330,200	29	330,200
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	47,293,495	33	47,621,970
34	Total liabilities and net assets/fund balances ........	82,765,686	34	88,593,330