TY 2014 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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) PHILIP L ENNEN........................................................................ PRESIDENT/SECRETARY, CEO	40.00 .......................0.50	X	X			403,047	34,900
(2) KATRINA P HESTER........................................................................ CHAIRMAN	0.10 .......................0.10	X	X			0	0
(3) CHRISTOPHER CULLIS........................................................................ VICE CHAIRMAN/TREASURER	0.10 .......................0.10	X	X			0	0
(4) JIM WYSE........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(5) JAMES RUPP........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(6) BRUCE SPANGLER........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(7) KEVIN KOLOVICH MD........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(8) GLEN SEAMAN MD........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(9) CHRISTOPHER KANNEL........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(10) LARRY DEWIRE........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(11) DAVID SWANSON........................................................................ DIRECTOR	0.10 .......................0.10	X				0	0
(12) GREGORY E SLATTERY........................................................................ VP/CIO	40.00 .......................0.00		X			268,135	34,900
(13) MICHAEL CULLER........................................................................ VP/COO	40.00 .......................0.00		X			198,728	34,900
(14) CHAD D TINKEL........................................................................ VP/CFO	40.00 .......................0.50		X			245,660	35,740
(15) JANICE DAVID........................................................................ VP PATIENT CARE	40.00 .......................0.00			X		241,633	17,800
(16) SHANNON KEIL........................................................................ PATHOLOGY PHYISICAN	40.00 .......................0.00				X	274,997	24,900
(17) LARRY SIMON........................................................................ CRNA	40.00 .......................0.00				X	202,212	24,900

(A) Name and business address	(B) Description of services	(C) Compensation
EMCARE PHYSICIAN SERVICES 350 WEST CEDAR STREET FOURTH FLOOR PENSACOLA,FL32502	ER PHYSICIAN SERVICES	1,950,499
AMERISOURCE BERGEN 1300 MORRIS DRIVE CHESTERBROOK,PA19087	PHARMACEUTICAL SUPPLIES	1,632,469
SENECA MEDICAL 85 SHAFFER PARK DRIVE TIFFIN,OH44883	MEDICAL SUPPLIES	1,314,542
BIOMET 56 E BELL DR WARSAW,IN46582	MEDICAL DEVICES	1,073,285
BOSTON SCIENTIFIC ONE BOSTON SCIENTIFIC PLACE NATICK,MA01760	MEDICAL DEVICES	991,007
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 44

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	1,225,591		1,225,591
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 ....	29,126,896	21,764,178	7,362,718
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	763,476	550,375	213,101
9	Other employee benefits .......	5,908,319	4,163,963	1,744,356
10	Payroll taxes ...........	2,170,804	1,576,725	594,079
11	Fees for services (non-employees):
a	Management ......	6,345,195	5,396,538	948,657
b	Legal .........	444,233		444,233
c	Accounting ...........	134,260		134,260
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....
12	Advertising and promotion ....	328,133	328,133
13	Office expenses .......	2,819,493	764,509	2,054,984
14	Information technology ......	341,615		341,615
15	Royalties ..
16	Occupancy ...........	1,420,835	688,237	732,598
17	Travel ............	116,000	65,064	50,936
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	167,617	46,478	121,139
20	Interest ...........	1,712,351	852,830	859,521
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	5,879,013	2,261,346	3,617,667
23	Insurance ..............	490,043	374,960	115,083
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	BILLABLE/NONBILLABLE SU	8,076,455	8,076,455
b	REPAIRS AND MAINTENANCE	3,396,109	2,171,352	1,224,757
c	BAD DEBT EXPENSE	1,889,419	1,889,419
d	TAXES	1,359,052	1,276,510	82,542
e	All other expenses	-700,077	-684,582	-15,495
25	Total functional expenses. Add lines 1 through 24e	73,414,832	51,562,490	21,852,342	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).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	4,707,765	1	3,496,119
2	Savings and temporary cash investments .........	24,717,913	2	31,713,588
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	7,845,324	4	8,469,949
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 ..............	1,084,198	8	1,244,414
9	Prepaid expenses and deferred charges ..........	1,826,531	9	1,815,870
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	160,375,875
b	Less: accumulated depreciation .....	10b	80,144,075	84,560,995	10c	80,231,800
11	Investments—publicly traded securities ..........	22,499,036	11	23,942,752
12	Investments—other securities. See Part IV, line 11 .....	735,853	12	671,738
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	1,619,020	15	2,600,481
16	Total assets. Add lines 1 through 15 (must equal line 34)......	149,596,635	16	154,186,711
	17	Accounts payable and accrued expenses .........	6,963,075	17	6,811,151
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	42,025,000	20	41,195,000
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 ..	23,099,758	23	21,213,600
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....................	4,272,273	25	7,244,351
26	Total liabilities. Add lines 17 through 25.........	76,360,106	26	76,464,102
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	73,236,529	27	77,722,609
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	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 ...........	73,236,529	33	77,722,609
34	Total liabilities and net assets/fund balances ........	149,596,635	34	154,186,711

- 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.
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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

2014

Open to Public
Inspection

Name of the organization

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

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.)

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 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. 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—2013. 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—2014. 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—2013. 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) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. 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—2013. 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) 2014

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 (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) 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 IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

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

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 9(a)) 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 9(a)) 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 IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b 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

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

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

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, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) 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) 2014

Page 6

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

1. 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
7	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) 2014

Page 7

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 2014 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-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

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) 2014

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

2014

Open to Public
Inspection

If the organization answered "Yes" to 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" to 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" to 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

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

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-.

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

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) 2011	(b) 2012	(c) 2013	(d) 2014	(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) 2014

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 to 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

1,496

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

1,496

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:	PART OF OHA DUES ARE ATTRIBUTED TO LOBBYING, TOTAL DUES WERE $41,565 OF WHICH 3.6% WERE CONTRIBUTED TO LOBBYING.

Schedule C (Form 990 or 990EZ) 2014

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," to 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

2014

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to 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" to 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, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, 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" to 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 in 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 in 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) 2014

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" to 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

If "Yes," explain the arrangement in Part XIII and complete the following table:


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" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

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

Temporarily restricted endowment SchDMd Bullet

The percentages in 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)

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

3a(ii)

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

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' to 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 .................	830,800	2,124,658		2,955,458
b	Buildings ................		96,155,148	25,967,146	70,188,002
c	Leasehold improvements ............	6,320,727		3,771,513	2,549,214
d	Equipment ................		54,641,366	50,188,661	4,452,705
e	Other .................		303,176	216,755	86,421
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					80,231,800

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to 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
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to 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









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes
DEFERRED COMPENSATION		406,218
SETTLEMENTS PAYABLE UNDER THIRD PARTY REIMBURSEMENT CONTRACTS		5,394,197
INTEREST RATE SWAP		1,443,936






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		7,244,351
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) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to 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' to 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 X, LINE 2:	ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND TO RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2015 AND 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES THAT IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO FISCAL YEAR 2012.

Return Reference

Explanation

PART X, LINE 2:

ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND TO RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2015 AND 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES THAT IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO FISCAL YEAR 2012.

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to 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

2014

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

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? ..........

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

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) ..	3,152,838	3,220,843	-68,005	0 %
b	Medicaid (from Worksheet 3, column a) ....	10,173,725	4,725,614	5,448,111	7.580 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	0	0
d	Total Financial Assistance and Means-Tested Government Programs .	13,326,563	7,946,457	5,380,106	7.580 %
Other Benefits		221,931	5,700	216,231	0.300 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	221,931	5,700	216,231	0.300 %
f	Health professions education (from Worksheet 5) ..
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 ..	221,931	5,700	216,231	0.300 %
k	Total. Add lines 7d and 7j .	13,548,494	7,952,157	5,596,337	7.880 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(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
8	Workforce development
9	Other
10	Total

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. ......

1,889,419

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. ......

188,942

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).....

21,080,214

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

25,405,056

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

-4,324,842

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 %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

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?2 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	BRYAN HOSPITAL 433 WEST HIGH STREET BRYAN,OH43506	X	X		X
2	MONTPELIER HOSPITAL 909 EAST SNYDER AVENUE MONTPELIER,OH43543	X		X	X

Schedule H (Form 990) 2014

Page

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)

	BRYAN 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 12

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

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

Yes

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. ............................

Yes

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): HTTP://WWW.CHWCHOSPITAL.ORG/COMMUNITYBENEFITS.ASP.

Other website (list url): HTTP://WWW.CHWCHOSPITAL.ORG/WP-CONTENT/UPLOADS/2014/08/BRYAN-HOSPITAL-CHA-

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 12

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

Yes

If "Yes" (list url): HTTP://WWW.CHWCHOSPITAL.ORG/COMMUNITYBENEFITS.ASP.

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

10b

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

12b

If "Yes" to 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) 2014

Page

Part VFacility Information (continued)

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

Yes

Financial Assistance Policy (FAP)

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 300.000000000000%

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): HTTPS://WWW.CHWCHOSPITAL.ORG/PATIENT-SERVICES/CHWC-FINANCIAL-ASSISTANCE/

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.CHWCHOSPITAL.ORG/PATIENT-SERVICES/CHWC-FINANCIAL-ASSISTANCE/

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) 2014

Page

Part VFacility Information (continued)

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

Yes

Did the hospital facility or other authorized third 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 18. (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) 2014

Page

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)

	MONTPELIER 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?.......................

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 12

Yes

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

Yes

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. ............................

Yes

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): HTTP://WWW.CHWCHOSPITAL.ORG/COMMUNITYBENEFITS.ASP.

Other website (list url): HTTP://WWW.CHWCHOSPITAL.ORG/WP-CONTENT/UPLOADS/2014/08/MONTPELIER-HOSPITAL

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 12

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

Yes

If "Yes" (list url): HTTP://WWW.CHWCHOSPITAL.ORG/COMMUNITYBENEFITS.ASP.

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

10b

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

12b

If "Yes" to 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) 2014

Page

Part VFacility Information (continued)

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

Yes

Financial Assistance Policy (FAP)

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 300.000000000000%

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

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): HTTPS://WWW.CHWCHOSPITAL.ORG/PATIENT-SERVICES/CHWC-FINANCIAL-ASSISTANCE/

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.CHWCHOSPITAL.ORG/PATIENT-SERVICES/CHWC-FINANCIAL-ASSISTANCE/

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

Yes

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) 2014

Page

Part VFacility Information (continued)

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

Yes

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 18. (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

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)

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) 2014

Page

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
BRYAN HOSPITAL	PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 3J: THE OVERALL GOAL OF THE NEEDS ASSESSMENT WAS TO PERFORM A COMMUNITY HEALTH ASSESSMENT THAT WILL LEAD TO IMPROVED QUALITY OF PUBLIC AND PRIVATE HEALTH SERVICES. IN ADDITION, THE HEALTH ASSESSMENT CAN BE USED FOR A VARIETY OF PURPOSES SUCH AS THE FOLLOWING:- TO ASSESS THE DISTRIBUTION OF DISEASE AND BEHAVIORAL RISK FACTORS.- TO ASSESS BROAD COMMUNITY HEALTH ISSUES AND TO SHAPE A BROADER DEFINITION OF COMMUNITY HEALTH.- TO MONITOR THE IMPACT OF COMMUNITY HEALTH ACTION PLANS AND TRENDS IN BEHAVIORAL RISK MODIFICATIONS. - TO PROVIDE A VEHICLE TO DISCUSS WAYS TO IMPROVE COMMUNITY HEALTH. THE STUDY CAN ASSIST STAKEHOLDERS WORKING COLLABORATIVELY IN THE COMMUNITY TO ADDRESS ISSUES THAT AFFECT HEALTH.THE COMMUNITY HEALTH ASSESSMENT WILL CONTINUE TO BE REPEATED EVERY THREE YEARS TO DETERMINE IF ACTIONS TAKEN BY COMMUNITIES ARE IMPACTING THE BEHAVIORS THAT LEAD TO POOR HEALTH.
BRYAN HOSPITAL	PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT STRATEGIC PLANNING PROCESS WAS FACILITATED BY BRITNEY WARD, MPH, DIRECTOR OF COMMUNITY HEALTH IMPROVEMENT, FROM THE HOSPITAL COUNCIL OF NORTHWEST OHIO. THE COMMITTEE MET ON A QUARTERLY BASIS SINCE THE ORIGINAL CHNA WAS COMPLETED IN 2013.COMMITTEE MEMBERS:- AMERICAN CANCER SOCIETY - AMY BOEHM, JESSICA WEST- BOARD OF DEVELOPMENTAL DISABILITIES - DEBRA GUILFORD, DENNIS MYERS- BRYAN CITY SCHOOLS - DIANA SAVAGE- CLERGY - DAVID TILLY- COMMUNITY HEALTH & WELLNESS CENTERS - JAN DAVID, TAMMY DEGRYSE, PHIL ENNEN, MIKE FREEMAN, JESSICA REITZEL, JEANETTE ROBERTS, LINDA TRAUSCH- FOUR COUNTY ADAMHS BOARD - LES MCCASLIN- JOB & FAMILY SERVICES - PAMELA JOHNSON- NORTH CENTRAL SCHOOLS - KEN BOYER- PARKVIEW PHYSICIANS GROUP - KRYSTAL MILLER, SALLY TAYLOR- SAFE SCHOOLS HEALTHY STUDENTS - RON RITTICHIER- WILLIAMS COUNTY HEALTH DEPARTMENT - EMILY GOLIAS, MEGAN RILEY, BETH SCHWEITZER, BECKI SNYDER, JIM WATKINS- WILLIAMS COUNTY SHERIFF - STEVE TOWNS- UNITED WAY - BILL PEPPLE- YMCA - ROB IMBER
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT STRATEGIC PLANNING PROCESS WAS FACILITATED BY BRITNEY WARD, MPH, DIRECTOR OF COMMUNITY HEALTH IMPROVEMENT, FROM THE HOSPITAL COUNCIL OF NORTHWEST OHIO. THE COMMITTEE MET ON A QUARTERLY BASIS SINCE THE ORIGINAL CHNA WAS COMPLETED IN 2013.COMMITTEE MEMBERS:- AMERICAN CANCER SOCIETY - AMY BOEHM, JESSICA WEST- BOARD OF DEVELOPMENTAL DISABILITIES - DEBRA GUILFORD, DENNIS MYERS- BRYAN CITY SCHOOLS - DIANA SAVAGE- CLERGY - DAVID TILLY- COMMUNITY HEALTH & WELLNESS CENTERS - JAN DAVID, TAMMY DEGRYSE, PHIL ENNEN, MIKE FREEMAN, JESSICA REITZEL, JEANETTE ROBERTS, LINDA TRAUSCH- FOUR COUNTY ADAMHS BOARD - LES MCCASLIN- JOB & FAMILY SERVICES - PAMELA JOHNSON- NORTH CENTRAL SCHOOLS - KEN BOYER- PARKVIEW PHYSICIANS GROUP - KRYSTAL MILLER, SALLY TAYLOR- SAFE SCHOOLS HEALTHY STUDENTS - RON RITTICHIER- WILLIAMS COUNTY HEALTH DEPARTMENT - EMILY GOLIAS, MEGAN RILEY, BETH SCHWEITZER, BECKI SNYDER, JIM WATKINS- WILLIAMS COUNTY SHERIFF - STEVE TOWNS- UNITED WAY - BILL PEPPLE- YMCA - ROB IMBER
BRYAN HOSPITAL	PART V, SECTION B, LINE 6A: MONTPELIER HOSPITAL
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 6A: BRYAN HOSPITAL
BRYAN HOSPITAL	PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 6B: WILLIAMS COUNTY HEALTH DEPARTMENT
BRYAN HOSPITAL	PART V, SECTION B, LINE 7D: THE ASSESSMENT IS AVAILABLE ON THE FOLLOWING ADDITIONAL WEBSITES: WILLIAMS COUNTY GENERAL HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WILLIAMSCOUNTYFINALHEALTHASSESSMENT.PDFHOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/PDF/COUNTIES/WILLIAMSCOUNTY2013HEALTHASSESSMENT.PDFALSO, CDS WITH A DIGITAL COPY OF THE FULL REPORT WERE GIVEN TO ALL KEY LEADERS AT COMMUNITY EVENT AND THESE ARE NOW MADE AVAILABLE TO ANYONE WHO MAY REQUEST THEM.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 7D: THE ASSESSMENT IS AVAILABLE ON THE FOLLOWING ADDITIONAL WEBSITES: WILLIAMS COUNTY GENERAL HEALTH DISTRICTHTTP://WWW.WILLIAMSCOUNTYHEALTH.ORG/WILLIAMSCOUNTYFINALHEALTHASSESSMENT.PDFHOSPITAL COUNCIL OF NORTHWEST OHIOHTTP://WWW.HCNO.ORG/PDF/COUNTIES/WILLIAMSCOUNTY2013HEALTHASSESSMENT.PDFALSO, CDS WITH A DIGITAL COPY OF THE FULL REPORT WERE GIVEN TO ALL KEY LEADERS AT COMMUNITY EVENT AND THESE ARE NOW MADE AVAILABLE TO ANYONE WHO MAY REQUEST THEM.
BRYAN HOSPITAL	PART V, SECTION B, LINE 11: RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE NEEDS IDENTIFIED THROUGH THE HEALTH ASSESSMENT. OF THE PRIORITY NEEDS IDENTIFIED BY THE COMMUNITY PLANNING PROCESS, THE HOSPITAL IS NOT DIRECTLY ADDRESSING THE ISSUES OF YOUTH AND ADULT OBESITY RELATED BEHAVIORS AND PREVENTIVE HEALTH. THIS IS BECAUSE MANY COMMUNITY AGENCIES ACROSS WILLIAMS COUNTY ARE ADDRESSING THESE ISSUES THROUGH THE FOLLOWING ACTION STEPS: BRYAN CITY SCHOOLS ARE GOING TO ORGANIZE A MEETING WITH ALL WILLIAMS COUNTY SCHOOL DISTRICT SUPERINTENDENTS TO OFFER SUPPORT, SERVICES, AND COORDINATE EFFORTS TO INCREASE SCHOOL NUTRITION. WILLIAMS COUNTY HEALTH DEPARTMENT IS GOING TO RESEARCH THE AWARENESS CAMPAIGN WE CAN! PROGRAM AND CREATE A COMMUNITY CALENDAR/GUIDE AND WELLNESS BLOG WITH THE MOST UP-TO-DATE INFORMATION REGARDING NUTRITION AND EXERCISE PROGRAMS AND OPPORTUNITIES IN WILLIAMS COUNTY. THE WILLIAMS COUNTY CITY HEALTH DEPARTMENT WILL ALSO INCORPORATE VARIOUS SECTORS OF THE COMMUNITY INTO THE COMMUNITY-WIDE PLAN (SUCH AS COMMUNITY ORGANIZATIONS, CHURCHES, POLITICAL OFFICIALS, LAW ENFORCEMENT, SCHOOLS, MEDIA, ETC.) THE PARKVIEW PHYSICIANS GROUP WILL WORK WITH PRIMARY CARE PHYSICIAN OFFICES TO ASSESS WHAT INFORMATION AND/OR MATERIALS THEY ARE LACKING TO PROVIDE BETTER CARE FOR OVERWEIGHT AND OBESE PATIENTS. THEY WILL ALSO COLLECT BASELINE DATA ON BUSINESSES AND ORGANIZATIONS OFFERING WELLNESS AND INSURANCE INCENTIVE PROGRAMS TO EMPLOYEES. THEY ARE GOING TO PROVIDE SECTORS WITH WAYS TO SUPPORT THE CAMPAIGN: POSTING OR HANDING OUT FLYERS, OFFERING THEIR FACILITY AS A FLU CLINIC SITE, OFFER FREE VACCINES TO EMPLOYEES, ETC.) PARKVIEW PHYSICIANS GROUP IS GOING TO COMPLETE A BASELINE SURVEY WITH PHYSICIAN'S OFFICES TO DETERMINE WHICH SCREENINGS THEY ARE RECOMMENDING.COMMUNITY MEMBER, SISTER RITA WILL OBTAIN BASELINE DATA REGARDING WHICH CITIES/TOWNS, SCHOOL DISTRICTS, CHURCHES, AND ORGANIZATIONS CURRENTLY HAVE COMMUNITY GARDENS AND/OR FARMER'S MARKETS. PARKVIEW PHYSICIAN GROUP WILL ENLIST PRIMARY CARE AND OB/GYN AND FAMILY PHYSICIAN OFFICES TO EDUCATE WOMEN OF CHILDBEARING AGE ON USING PRENATAL VITAMINS AND FOLIC ACID BEFORE GETTING PREGNANT, AND SEND EDUCATION ON PREGNANCY DO'S AND DON'TS WHEN PATIENT CALLS IN TO CONFIRM A PREGNANCY. THE IMPLEMENTATION STRATEGY IS POSTED ON THE HOSPITAL'S WEBSITE AT HTTP://WWW.CHWCHOSPITAL.ORG/COMMUNITYBENEFITS.ASP.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 11: RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE NEEDS IDENTIFIED THROUGH THE HEALTH ASSESSMENT. OF THE PRIORITY NEEDS IDENTIFIED BY THE COMMUNITY PLANNING PROCESS, THE HOSPITAL IS NOT DIRECTLY ADDRESSING THE ISSUES OF YOUTH AND ADULT OBESITY RELATED BEHAVIORS AND PREVENTIVE HEALTH. THIS IS BECAUSE MANY COMMUNITY AGENCIES ACROSS WILLIAMS COUNTY ARE ADDRESSING THESE ISSUES THROUGH THE FOLLOWING ACTION STEPS: BRYAN CITY SCHOOLS ARE GOING TO ORGANIZE A MEETING WITH ALL WILLIAMS COUNTY SCHOOL DISTRICT SUPERINTENDENTS TO OFFER SUPPORT, SERVICES, AND COORDINATE EFFORTS TO INCREASE SCHOOL NUTRITION. WILLIAMS COUNTY HEALTH DEPARTMENT IS GOING TO RESEARCH THE AWARENESS CAMPAIGN WE CAN! PROGRAM AND CREATE A COMMUNITY CALENDAR/GUIDE AND WELLNESS BLOG WITH THE MOST UP-TO-DATE INFORMATION REGARDING NUTRITION AND EXERCISE PROGRAMS AND OPPORTUNITIES IN WILLIAMS COUNTY. THE WILLIAMS COUNTY CITY HEALTH DEPARTMENT WILL ALSO INCORPORATE VARIOUS SECTORS OF THE COMMUNITY INTO THE COMMUNITY-WIDE PLAN (SUCH AS COMMUNITY ORGANIZATIONS, CHURCHES, POLITICAL OFFICIALS, LAW ENFORCEMENT, SCHOOLS, MEDIA, ETC.) THE PARKVIEW PHYSICIANS GROUP WILL WORK WITH PRIMARY CARE PHYSICIAN OFFICES TO ASSESS WHAT INFORMATION AND/OR MATERIALS THEY ARE LACKING TO PROVIDE BETTER CARE FOR OVERWEIGHT AND OBESE PATIENTS. THEY WILL ALSO COLLECT BASELINE DATA ON BUSINESSES AND ORGANIZATIONS OFFERING WELLNESS AND INSURANCE INCENTIVE PROGRAMS TO EMPLOYEES. THEY ARE GOING TO PROVIDE SECTORS WITH WAYS TO SUPPORT THE CAMPAIGN: POSTING OR HANDING OUT FLYERS, OFFERING THEIR FACILITY AS A FLU CLINIC SITE, OFFER FREE VACCINES TO EMPLOYEES, ETC.) PARKVIEW PHYSICIANS GROUP IS GOING TO COMPLETE A BASELINE SURVEY WITH PHYSICIAN'S OFFICES TO DETERMINE WHICH SCREENINGS THEY ARE RECOMMENDING.COMMUNITY MEMBER, SISTER RITA WILL OBTAIN BASELINE DATA REGARDING WHICH CITIES/TOWNS, SCHOOL DISTRICTS, CHURCHES, AND ORGANIZATIONS CURRENTLY HAVE COMMUNITY GARDENS AND/OR FARMER'S MARKETS. PARKVIEW PHYSICIAN GROUP WILL ENLIST PRIMARY CARE AND OB/GYN AND FAMILY PHYSICIAN OFFICES TO EDUCATE WOMEN OF CHILDBEARING AGE ON USING PRENATAL VITAMINS AND FOLIC ACID BEFORE GETTING PREGNANT, AND SEND EDUCATION ON PREGNANCY DO'S AND DON'TS WHEN PATIENT CALLS IN TO CONFIRM A PREGNANCY. THE IMPLEMENTATION STRATEGY IS POSTED ON THE HOSPITAL'S WEBSITE AT HTTP://WWW.CHWCHOSPITAL.ORG/COMMUNITYBENEFITS.ASP.
BRYAN HOSPITAL	PART V, SECTION B, LINE 20E: PAID UNITED COLLECTION AGENCY $1,000 PER MONTH TO IDENTIFY UNRESPONSIVE ACCOUNTS AS POSSIBLE CHARITABLE CARE RECIPIENTS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 20E: PAID UNITED COLLECTION AGENCY $1,000 PER MONTH TO IDENTIFY UNRESPONSIVE ACCOUNTS AS POSSIBLE CHARITABLE CARE RECIPIENTS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY.
BRYAN HOSPITAL	PART V, SECTION B, LINE 22D: FINANCIAL APPLICATIONS NOT MEETING ELIGIBILITY FOR HCAP WILL BE REVIEWED BY THE PATIENT ACCOUNTS DIRECTOR, ALONG WITH ASSISTANCE FROM SOCIAL WORKERS, HOSPITAL PATIENT REPRESENTATIVES, AND THE PATIENT ACCOUNTS CLERK, TO DETERMINE THE APPROPRIATE LEVEL OF CHARITABLE DISCOUNT THAT CAN BE APPLIED TO THE VISITS. THE FOLLOWING CRITERIA ARE USED TO DETERMINE ELIGIBILITY FOR THE HOSPITAL CHARITABLE ASSISTANCE PROGRAM. 1. THE INCOME AND SLIDING DISCOUNT LEVELS ARE BASED ON THE MOST RECENT FEDERAL POVERTY INCOME GUIDELINES. 2. CURRENT GROSS INCOME IS USED TO DETERMINE THE LEVEL OF DISCOUNT, AND INCOME FOR THE MONTHS PRIOR TO SERVICE CAN BE USED TO SUPPORT ANY ADDITIONAL DISCOUNTS THAT MAY BE APPROPRIATE THROUGH THE EXCEPTIONS PROCESS. THE PT ACCTS DIRECTOR MAY ALSO USE BANK BALANCES AND OTHER WRITTEN DOCUMENTATION ABOUT THE FAMILY'S FINANCIAL SITUATION TO REQUEST A HIGHER DISCOUNT THROUGH THE EXCEPTIONS PROCESS.3. ANY PROOF OF INCOME PROVIDED WITH THE APPLICATION IS REVIEWED TO VERIFY ACCURACY WITH THE WRITTEN INFORMATION ON THE APPLICATION. PROOF OF INCOME IS NOT REQUIRED FOR THE HOSPITAL CHARITABLE ASSISTANCE PROGRAM BUT IS USUALLY PROVIDED TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR HCAP.4. THE FAMILY SIZE DETERMINATION VARIES FOR THE HCAP PROGRAM. STEP-CHILDREN AND STEP-PARENTS, IN RELATIONSHIP TO THE PATIENT ARE INCLUDED IF THEY RESIDE IN THE SAME HOME. ALSO, CHILDREN OVER 18 ARE INCLUDED IN FAMILY SIZE, IF THE CHILD IS STILL SUPPORTED BY THE PARENT (CHILD IS STILL A STUDENT)5. CHILD SUPPORT PAID IS SUBTRACTED FROM GROSS INCOME TO DETERMINE THE APPROPRIATE INCOME LEVEL, WHEN THE CHILD IS NOT INCLUDED WITH THE FAMILY SIZE. CHILD SUPPORT RECEIVED IS ADDED TO THE GROSS INCOME WHEN THE CHILD IS INCLUDED WITH THE FAMILY SIZE. IF A CHILD IS THE PATIENT AND IS IN A FAMILY WITH SPLIT CUSTODY, WITH NO CHILD SUPPORT PAID BY EITHER PARENT, AND THE PARENT RESPONSIBLE FOR PAYING THE MEDICAL BILLS APPLIES FOR FINANCIAL ASSISTANCE, THE CHILD IS COUNTED AS HALF WHEN DETERMINING THE FAMILY SIZE. A DISCOUNT LEVEL HALF WAY BETWEEN THE INCOME LEVEL FOR THE FAMILY SIZE INCLUDING THE CHILD, AND THE INCOME LEVEL FOR THE FAMILY SIZE EXCLUDING THE CHILD, IS FIGURED AND USED TO DETERMINE THE CHARITY LEVEL. ADD THE 2 DISCOUNT LEVELS TOGETHER AND DIVIDE BY 2 TO DETERMINE THE AMOUNT THAT IS HALF WAY BETWEEN THE 2 FIGURES. IF THERE IS AN EVEN NUMBER OF CHILDREN IN THE FAMILY, COUNT HALF OF THE CHILDREN TO FIGURE FAMILY SIZE, WHEN THERE IS SPLIT CUSTODY, AND ONE PARENT IS RESPONSIBLE FOR PAYING THE MEDICAL BILLS. WHEN A CHILD IS THE PATIENT AND IS IN A FAMILY WITH SPLIT CUSTODY WITH NO CHILD SUPPORT PAID, AND BOTH PARENTS ARE RESPONSIBLE FOR PAYING THE MEDICAL BILL, BOTH BIOLOGICAL PARENTS INCOME SHOULD BE OBTAINED AND THE FAMILY SIZE WILL INCLUDE THE CHILD, BOTH BIOLOGICAL PARENTS AND ANY OTHER BIOLOGICAL OR ADOPTED SIBLINGS TO THE PATIENT. 6. THE PATIENT'S CHECKING AND SAVINGS ACCOUNT BALANCES (OR PARENTS IF THE PATIENT IS A MINOR) ARE REVIEWED TO DETERMINE IF RESOURCES ARE AVAILABLE TO PAY ON THE OUTSTANDING BALANCES. A GENERAL GUIDELINE IS FOLLOWED TO DETERMINE A REDUCTION IN THE DISCOUNT LEVEL BASED ON THE PATIENT'S CHECKING AND SAVINGS ACCOUNT BALANCES. IF 50% OF THE SAVINGS AND CHECKING ACCOUNT BALANCE IS EQUAL TO OR GREATER THAN THE OUTSTANDING ACCOUNT BALANCE, THE PERCENT OF DISCOUNT DETERMINED BY THE INCOME MAY BE REDUCED BY ONE LEVEL, UNLESS THE PATIENT ACCOUNTS DIRECTOR, CEO OR CFO DETERMINE OTHER CIRCUMSTANCES ALLOW THE FULL DISCOUNT WITH NO REDUCTION.LETTERS ARE SENT TO ALL GUARANTORS THAT APPLY FOR THE CHARITABLE ASSISTANCE PROGRAM, INCLUDING THOSE WHO DO NOT QUALIFY FOR A DISCOUNT. THE DISCOUNT WILL BE APPLIED TO ALL OPEN VISITS AT THE TIME THE APPLICATION IS RECEIVED, EXCLUDING BAD DEBT VISITS, UNLESS AUTHORIZED BY ADMINISTRATION. THE APPLICATION MAY ALSO BE USED FOR ADDITIONAL NEW ACCOUNTS FOR UP TO 90 DAYS FROM THE PREVIOUS APPLICATION DATE. THE TOTAL AMOUNT AND TOTAL NUMBER OF VISITS RECEIVING A CHARITY ADJUSTMENT FOR THE MONTH ARE PROVIDED ON A MONTHLY SUMMARY REPORT FOR THE BOARD OF DIRECTORS, ALONG WITH ANY VISITS FOR WHICH THE DIRECTOR IS REQUESTING APPROVAL FOR ADDITIONAL DISCOUNTS THROUGH THE EXCEPTIONS PROCESS. ON THE EXCEPTIONS REPORT, THE PATIENT ACCOUNTS DIRECTOR PROVIDES A BRIEF SUMMARY OF THE REASONS WHY THE GUARANTOR HAS EXTENUATING CIRCUMSTANCES TO QUALIFY FOR A HIGHER DISCOUNT THAN DETERMINED THROUGH THE NORMAL REVIEW PROCESS. THE DISCOUNT IS APPLIED AND THE LETTER IS SENT TO THE GUARANTOR AFTER THE CEO OR CFO SENDS A WRITTEN APPROVAL FOLLOWING THE BOARD MEETING.THE HOSPITAL PRESIDENT/CEO OR VP OF FINANCE MAY ALSO DETERMINE A VISIT TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, BASED ON INFORMATION THEY HAVE RECEIVED FROM THE PATIENT. THE PRESIDENT/CEO OR VP OF FINANCE WILL PROVIDE WRITTEN NOTICE TO THE PATIENT ACCOUNTS DIRECTOR TO APPLY THE DISCOUNT.BEGINNING IN JUNE 2008, VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE "SELF-PAY/COLLECTION POLICY." FOR THOSE WHO ARE NOT FAP-ELIGIBLE, THERE IS A PROMPT PAY DISCOUNT THAT IS EQUAL TO THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE.
MONTPELIER HOSPITAL	PART V, SECTION B, LINE 22D: FINANCIAL APPLICATIONS NOT MEETING ELIGIBILITY FOR HCAP WILL BE REVIEWED BY THE PATIENT ACCOUNTS DIRECTOR, ALONG WITH ASSISTANCE FROM SOCIAL WORKERS, HOSPITAL PATIENT REPRESENTATIVES, AND THE PATIENT ACCOUNTS CLERK, TO DETERMINE THE APPROPRIATE LEVEL OF CHARITABLE DISCOUNT THAT CAN BE APPLIED TO THE VISITS. THE FOLLOWING CRITERIA ARE USED TO DETERMINE ELIGIBILITY FOR THE HOSPITAL CHARITABLE ASSISTANCE PROGRAM. 1. THE INCOME AND SLIDING DISCOUNT LEVELS ARE BASED ON THE MOST RECENT FEDERAL POVERTY INCOME GUIDELINES. 2. CURRENT GROSS INCOME IS USED TO DETERMINE THE LEVEL OF DISCOUNT, AND INCOME FOR THE MONTHS PRIOR TO SERVICE CAN BE USED TO SUPPORT ANY ADDITIONAL DISCOUNTS THAT MAY BE APPROPRIATE THROUGH THE EXCEPTIONS PROCESS. THE PT ACCTS DIRECTOR MAY ALSO USE BANK BALANCES AND OTHER WRITTEN DOCUMENTATION ABOUT THE FAMILY'S FINANCIAL SITUATION TO REQUEST A HIGHER DISCOUNT THROUGH THE EXCEPTIONS PROCESS.3. ANY PROOF OF INCOME PROVIDED WITH THE APPLICATION IS REVIEWED TO VERIFY ACCURACY WITH THE WRITTEN INFORMATION ON THE APPLICATION. PROOF OF INCOME IS NOT REQUIRED FOR THE HOSPITAL CHARITABLE ASSISTANCE PROGRAM BUT IS USUALLY PROVIDED TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR HCAP.4. THE FAMILY SIZE DETERMINATION VARIES FOR THE HCAP PROGRAM. STEP-CHILDREN AND STEP-PARENTS, IN RELATIONSHIP TO THE PATIENT ARE INCLUDED IF THEY RESIDE IN THE SAME HOME. ALSO, CHILDREN OVER 18 ARE INCLUDED IN FAMILY SIZE, IF THE CHILD IS STILL SUPPORTED BY THE PARENT (CHILD IS STILL A STUDENT)5. CHILD SUPPORT PAID IS SUBTRACTED FROM GROSS INCOME TO DETERMINE THE APPROPRIATE INCOME LEVEL, WHEN THE CHILD IS NOT INCLUDED WITH THE FAMILY SIZE. CHILD SUPPORT RECEIVED IS ADDED TO THE GROSS INCOME WHEN THE CHILD IS INCLUDED WITH THE FAMILY SIZE. IF A CHILD IS THE PATIENT AND IS IN A FAMILY WITH SPLIT CUSTODY, WITH NO CHILD SUPPORT PAID BY EITHER PARENT, AND THE PARENT RESPONSIBLE FOR PAYING THE MEDICAL BILLS APPLIES FOR FINANCIAL ASSISTANCE, THE CHILD IS COUNTED AS HALF WHEN DETERMINING THE FAMILY SIZE. A DISCOUNT LEVEL HALF WAY BETWEEN THE INCOME LEVEL FOR THE FAMILY SIZE INCLUDING THE CHILD, AND THE INCOME LEVEL FOR THE FAMILY SIZE EXCLUDING THE CHILD, IS FIGURED AND USED TO DETERMINE THE CHARITY LEVEL. ADD THE 2 DISCOUNT LEVELS TOGETHER AND DIVIDE BY 2 TO DETERMINE THE AMOUNT THAT IS HALF WAY BETWEEN THE 2 FIGURES. IF THERE IS AN EVEN NUMBER OF CHILDREN IN THE FAMILY, COUNT HALF OF THE CHILDREN TO FIGURE FAMILY SIZE, WHEN THERE IS SPLIT CUSTODY, AND ONE PARENT IS RESPONSIBLE FOR PAYING THE MEDICAL BILLS. WHEN A CHILD IS THE PATIENT AND IS IN A FAMILY WITH SPLIT CUSTODY WITH NO CHILD SUPPORT PAID, AND BOTH PARENTS ARE RESPONSIBLE FOR PAYING THE MEDICAL BILL, BOTH BIOLOGICAL PARENTS INCOME SHOULD BE OBTAINED AND THE FAMILY SIZE WILL INCLUDE THE CHILD, BOTH BIOLOGICAL PARENTS AND ANY OTHER BIOLOGICAL OR ADOPTED SIBLINGS TO THE PATIENT. 6. THE PATIENT'S CHECKING AND SAVINGS ACCOUNT BALANCES (OR PARENTS IF THE PATIENT IS A MINOR) ARE REVIEWED TO DETERMINE IF RESOURCES ARE AVAILABLE TO PAY ON THE OUTSTANDING BALANCES. A GENERAL GUIDELINE IS FOLLOWED TO DETERMINE A REDUCTION IN THE DISCOUNT LEVEL BASED ON THE PATIENT'S CHECKING AND SAVINGS ACCOUNT BALANCES. IF 50% OF THE SAVINGS AND CHECKING ACCOUNT BALANCE IS EQUAL TO OR GREATER THAN THE OUTSTANDING ACCOUNT BALANCE, THE PERCENT OF DISCOUNT DETERMINED BY THE INCOME MAY BE REDUCED BY ONE LEVEL, UNLESS THE PATIENT ACCOUNTS DIRECTOR, CEO OR CFO DETERMINE OTHER CIRCUMSTANCES ALLOW THE FULL DISCOUNT WITH NO REDUCTION.LETTERS ARE SENT TO ALL GUARANTORS THAT APPLY FOR THE CHARITABLE ASSISTANCE PROGRAM, INCLUDING THOSE WHO DO NOT QUALIFY FOR A DISCOUNT. THE DISCOUNT WILL BE APPLIED TO ALL OPEN VISITS AT THE TIME THE APPLICATION IS RECEIVED, EXCLUDING BAD DEBT VISITS, UNLESS AUTHORIZED BY ADMINISTRATION. THE APPLICATION MAY ALSO BE USED FOR ADDITIONAL NEW ACCOUNTS FOR UP TO 90 DAYS FROM THE PREVIOUS APPLICATION DATE. THE TOTAL AMOUNT AND TOTAL NUMBER OF VISITS RECEIVING A CHARITY ADJUSTMENT FOR THE MONTH ARE PROVIDED ON A MONTHLY SUMMARY REPORT FOR THE BOARD OF DIRECTORS, ALONG WITH ANY VISITS FOR WHICH THE DIRECTOR IS REQUESTING APPROVAL FOR ADDITIONAL DISCOUNTS THROUGH THE EXCEPTIONS PROCESS. ON THE EXCEPTIONS REPORT, THE PATIENT ACCOUNTS DIRECTOR PROVIDES A BRIEF SUMMARY OF THE REASONS WHY THE GUARANTOR HAS EXTENUATING CIRCUMSTANCES TO QUALIFY FOR A HIGHER DISCOUNT THAN DETERMINED THROUGH THE NORMAL REVIEW PROCESS. THE DISCOUNT IS APPLIED AND THE LETTER IS SENT TO THE GUARANTOR AFTER THE CEO OR CFO SENDS A WRITTEN APPROVAL FOLLOWING THE BOARD MEETING.THE HOSPITAL PRESIDENT/CEO OR VP OF FINANCE MAY ALSO DETERMINE A VISIT TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, BASED ON INFORMATION THEY HAVE RECEIVED FROM THE PATIENT. THE PRESIDENT/CEO OR VP OF FINANCE WILL PROVIDE WRITTEN NOTICE TO THE PATIENT ACCOUNTS DIRECTOR TO APPLY THE DISCOUNT.BEGINNING IN JUNE 2008, VISITS DETERMINED TO BE CHARITY ELIGIBLE THROUGH THE I-SOLUTIONS PROGRAM, WILL RECEIVE CHARITY DISCOUNTS ACCORDING TO THE "SELF-PAY/COLLECTION POLICY." FOR THOSE WHO ARE NOT FAP-ELIGIBLE, THERE IS A PROMPT PAY DISCOUNT THAT IS EQUAL TO THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
BRYAN HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:	HTTPS://WWW.CHWCHOSPITAL.ORG/PATIENT-SERVICES/CHWC-FINANCIAL-ASSISTANCE/
MONTPELIER HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:	HTTPS://WWW.CHWCHOSPITAL.ORG/PATIENT-SERVICES/CHWC-FINANCIAL-ASSISTANCE/

Schedule H (Form 990) 2014

Page

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?3
Name and address		Type of Facility (describe)
1	ARCHBOLD MEDICAL CENTER 121 WESTFIELD DR ARCHBOLD,OH43502	OP SURGERY CENTER, OP RADIOLOGY, OP LAB, OP THERAPIES, AND MOB
2	RADIATION ONCOLOGY CENTER 524 WEST HIGH ST BRYAN,OH43506	RADIATION ONCOLOGY
3	WAUSEON INTERNAL MEDICINE CLINIC 447 NORTH SHOOP AVE WAUSEON,OH43567	PHYSICIAN OFFICE
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

Page

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 3C:	NOT APPLICABLE
PART I, LINE 6A:	NOT APPLICABLE
PART I, LINE 7:	CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO (51%) WHICH WAS DERIVED FROM WORKSHEET 2.
PART I, LINE 7G:	NOT APPLICABLE
PART I, LN 7 COL(F):	THE PERCENTAGE CALCULATED ON LINE 7F IS BASED ON TOTAL EXPENSES FROM FORM 990, PART IX, LESS BAD DEBTS IN THE AMOUNT OF $1,889,419.
PART I, LINE 7E:	THE PHARMACY DEPARTMENT HOLDS COMMUNITY MEDICATION RECONCILIATION DAYS. COLLECTED AND DISSEMINATED INFORMATION REGARDING AVAILABLE MEDICARE ADVANTAGE PLANS FOR WILLIAMS COUNTY RESIDENCE AT THE BRYAN SENIOR CENTER AND THE WILLIAMS COUNTY FAIR. BRYAN HOSPITAL HOSTED AND PRESENTED A PROGRAM TO RAISE AWARENESS AND PROVIDE EDUCATION REGARDING THE IMPORTANT CAUSE OF ORGAN, EYE AND TISSUE DONATIONS. ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND PEDIATRIC ADVANCED LIFE SUPPORT (PALS) COURSES FOR PHYSICIANS, FOR OUR COUNTY EMS PROVIDERS, AND FOR EMPLOYEES OF OTHER HOSPITALS AT NO CHARGE. CPR COURSES TO AREA LIFEGUARDS AND COACHES AT NO CHARGE. PROVIDE CPR EQUIPMENT TO AREA SCHOOLS TO ALLOW THEM TO PROVIDE TRAINING. CHILDBIRTH EDUCATION CLASSES (INCLUDING PREPARED CHILDBIRTH, BABY CARE, SIBLING READINESS, AND BREAST FEEDING) AT NO CHARGE. HOSPITAL REPRESENTATIVES GAVE OVER 50 COMMUNITY PRESENTATIONS ON A VARIETY OF HEALTH CARE TOPICS. PHARMACY REPRESENTATIVES VISITED AREA PRESCHOOLS AND KINDERGARTENS AND PROVIDED 32 POISON PREVENTION PROGRAMS TO APPROXIMATELY 456 CHILDREN. PHARMACY PRECEPTOR STUDENTS WERE MADE AVAILABLE TO VISIT AREA SENIOR CENTERS AND EDUCATE SENIORS ON MEDICATION USE. OFFERED SPEAKERS FOR SMOKING CESSATION PROGRAMS. NURSING PROVIDE HAND HYGIENE PROGRAMS TO 50 KIDS. HOST CAREER DAY FOR LOCAL SCHOOLS EDUCATING STUDENTS ON OPPORTUNITIES IN HEALTH CARE PROFESSIONS. PROVIDE A FIELD PLACEMENT SETTING FOR SOCIAL WORK STUDENTS FROM AREA UNIVERSITIES. LACTATION CONSULTANT PROVIDED FOLLOW UP AND HOME VISITS WHEN NEEDED AT NO CHARGE. COUNSELING SERVICES AT NO CHARGE PROVIDED STRESS MANAGEMENT PRESENTATIONS FOR AREA BUSINESSES, AND PROVIDED DE-ESCALATION TRAINING FOR AREA COMMUNITY MENTAL HEALTH AGENCIES. OFFERED A DIABETIC SUPPORT GROUP THAT PROVIDES FREE MONTHLY MEETINGS TO APPROXIMATELY 10 PEOPLE. OFFERED NUTRITION PRESENTATIONS TO VARIOUS COMMUNITY GROUPS.COMMUNITY SUPPORT: CONTINUED OUR SOCIAL SERVICES PROGRAM THAT ASSISTS INDIVIDUALS IN OBTAINING MEDICATIONS WHEN PERSONAL FUNDS ARE NOT AVAILABLE. PROVIDED HEALTH INFORMATION AND HOSPITAL STAFF TO SUPPORT AREA INDUSTRIES EMPLOYEE HEALTH FAIRS. CONTINUED OUR SOCIAL SERVICES PROGRAM THAT ASSISTED INDIVIDUALS IN COMPLETING THEIR OWN ADVANCED DIRECTIVES (E.G. LIVING WILL AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE). CONTINUED OUR SOCIAL SERVICES PROGRAM FOR A GRIEF SUPPORT GROUP FOR THE COMMUNITY. OFFER STROKE SUPPORT GROUP THAT MEETS ON A MONTHLY BASIS. OFFER A LOW VISION SUPPORT GROUP THAT MEETS ON A MONTHLY BASIS. OFFERED A SATURDAY SPORTS INJURY ASSESSMENT CLINIC AND PROVIDE THE CLINIC ASSESSMENT FREE OF CHARGE TO AT LEAST 60 AREA HIGH SCHOOL ATHLETES. PROVIDED FREE BLOODPRESSURE CHECKS THROUGH OUR EMERGENCY AND CARDIOPULMONARY DEPARTMENTS. PROVIDED 9,561 MEALS ON WHEELS FOR HOMEBOUND PEOPLE AT A FREE WILL DONATION. IN OUR WILLIAMS COUNTY AREA PROGRAM THIS INCLUDES PROVIDING STAFF AND VEHICLES TO DELIVER THE MEALS TO HOMES. PROVIDED RENT-FREE LIVING SPACE IN BRYAN, OHIO TO UT STUDENTS ASSOCIATED WITH BAHEC, TOTAL ANNUAL RELIEF TO 27 UT STUDENTS WAS $18,600. THE HOSPITAL COORDINATES OUTPATIENT SERVICES FOR CLIENTS OF THE LOCAL COMPASSION MEDICAL CLINIC, WHICH IS A NON-PROFIT CLINIC SERVING UNDER INSURED AND UNINSURED RESIDENTS OF WILLIAMS COUNTY. PAID UNITED COLLECTION AGENCY $35 PER UNRESPONSIVE ACCOUNT THAT THEY WERE ABLE TO REGISTER WITH HCAP OR MEDICAID. PAID UNITED COLLECTION AGENCY $1,000 PER MONTH TO IDENTIFY UNRESPONSIVE ACCOUNTS AS POSSIBLE CHARITABLE CARE RECIPIENTS BEFORE SENDING THE ACCOUNT TO A COLLECTION AGENCY. PROVIDED HEALTHINFORMATION AND HOSPITAL STAFF TO PROVIDE BLOOD PRESSURE AND BMI CHECKS FOR THE COUNTY HEALTH DEPARTMENT'S HEART HEALTH WALK/RUN AND FOR THE COUNTY FAIR. THE CARDIOPULMONARY REHABILITATION DEPARTMENT CONDUCTED 22 FITNESS ASSESSMENTS ON MEMBERS OF THE BRYAN FIRE DEPARTMENT AT NO CHARGE. PROVIDED FREE LUNCHES TO AREA TEACHERS AND STUDENTS TO RECOGNIZE STUDENTS OF THE MONTH TOTAL COSTS $800. PROVIDED BASIC SUPPLIES AND MEDICATIONS FOR VARIOUS MISSION TRIPS CONDUCTED BY EMPLOYEES AND MEDICAL STAFF. MAINTAIN AND SUSTAIN A DIABETIC SUPPORT GROUP THAT MEETS ON A MONTHLY BASIS AT THE HOSPITAL. PROVIDE FREE PATIENT NAVIGATOR PROGRAM, WHICH PROVIDES ASSISTANCE AND SUPPORT TO WOMEN IN TWO DISTINCT AREAS: WOMEN WHO ARE DIAGNOSED WITH BREAST CANCER AND WOMEN WHO ARE PREGNANT. PAID $5,000 TO HELP FUND THE CENTRAL OHIO POISON CENTER, WHICH 46 CALLS WERE PLACED FROM OUR COMMUNITY. HELPED FUND THE PURCHASE OF BOVIE MEDICAL CORPORATION AARON 1250-G AND SUPPORT MATERIALS FOR OUR SISTER HOSPITAL IN ADAMA, ETHIOPIA OUR COSTS WERE $8,000.
PART II, COMMUNITY BUILDING ACTIVITIES:	NOT APPLICABLE
PART III, LINE 2:	BAD DEBT WAS CALCULATED USING AUDITED FINANCIALS.
PART III, LINE 3:	ESTIMATE OF 10% OF TOTAL BAD DEBT EXPENSE IN ORDER TO CALCULATE THE AMOUNT RECORDED AS BAD DEBT THAT WOULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. NONE OF THE BAD DEBT EXPENSE IS TREATED AS A COMMUNITY BENEFIT.
PART III, LINE 4:	ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES THRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUAL DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISIONS FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	MEDICARE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO BASED ON METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. THE SHORTFALL IS CONSIDERED COMMUNITY BENEFIT DUE TO THE ELDERLY POPULATION IN THE HOSPITAL'S SERVICE AREA.
PART III, LINE 9B:	ALL SELF-PAY BALANCES ARE BILLED ON STATEMENTS AT THIRTY DAY INTERVALS. THE PATIENT REP WILL SET UP MONTHLY PAYMENTS ACCORDING TO THE FOLLOWING GUIDELINES:THE GUARANTOR IS ASKED TO PAY IN FULL. IF PAYMENT IN FULL IS NOT POSSIBLE, THE GUARANTOR IS ASKED TO MAKE MONTHLY PAYMENTS TO PAY THE ACCOUNT IN FULL WITHIN 18 MONTHS, WITH A MINIMUM PAYMENT OF $50 PER MONTH. IF THE GUARANTOR IS NOT ABLE TO AGREE TO THESE ARRANGEMENTS, HE/SHE IS ASKED TO COMPLETE A FINANCIAL APPLICATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF NO PAYMENT IS RECEIVED OR ARRANGEMENT ESTABLISHED WITHIN 60 DAYS OF THE INITIAL STATEMENT, A "PAST DUE LETTER" IS SENT TO THE GUARANTOR WITH A REQUEST TO PAY IN FULL OR CONTACT PATIENT ACCOUNTS WITHIN 30 DAYS. IF THE GUARANTOR DOES NOT RESPOND BY THE DUE DATE ON THIS LETTER OR ACCEPTABLE PAYMENTS HAVE NOT BEEN ESTABLISHED, THE VISIT IS REVIEWED BY THE PATIENT ACCOUNTS DIRECTOR TO DETERMINE ELIGIBILITY FOR BAD DEBT AND COLLECTION AGENCY PROCESSING. PRIOR TO SENDING THE ACCOUNT TO COLLECTION, THE PATIENT ACCOUNTS DIRECTOR SENDS THE ACCOUNTS TO "I-SOLUTIONS" TO REVIEW ACCOUNTS FOR COLLECTABILITY. IF ANY ACCOUNT IS DETERMINED THROUGH THIS PROCESS TO BE ELIGIBLE FOR CHARITY, THE ACCOUNT WILL RECEIVE A 100% CHARITY WRITE OFF. ANY ACCOUNT ON THE REPORT THAT LISTS A MAXIMUM PAYMENT AMOUNT THAT IS LESS THAN THE ACCOUNT BALANCE AND THAT FALLS IN THE "BD OR "LOW" PROPENSITY TO PAY CATEGORY WILL RECEIVE A CHARITY ADJUSTMENT THAT REDUCES THE BALANCE ON THE ACCOUNT TO THE I-SOLUTIONS CALCULATED MAXIMUM PAYMENT AMOUNT. BEGINNING OCTOBER 1, 2008, ACCOUNTS WITH NO LISTED PROPENSITY TO PAY AND A MAXIMUM PAYMENT LESS THAN THE CHARGES WILL ALSO RECEIVE THE SAME CHARITY DISCOUNT. THE BALANCE EQUAL TO THE MAXIMUM PAYMENT AMOUNT IS THEN ADJUSTED TO BAD DEBT AND SENT TO COLLECTION ALONG WITH ALL OTHER ACCOUNTS ELIGIBLE FOR BAD DEBT WRITE OFF. THE HOSPITAL HAS ADDED A STATEMENT TO THE ADMISSION FORM AUTHORIZING THE HOSPITAL TO REVIEW THE GUARANTOR'S CREDIT INFORMATION. IF THIS IS NOT SIGNED BY THE PATIENT, THE ACCOUNT WILL NOT BE SENT TO I-SOLUTIONS FOR COLLECTABILITY REVIEW. IT WILL BE FORWARDED DIRECTLY TO THE COLLECTION AGENCY. ACCOUNTS LISTED IN BAD DEBT ARE NOT CONSIDERED TO BE ACTIVE ACCOUNTS ON THE HOSPITAL SYSTEM. THE COLLECTION AGENCY MAKES ARRANGEMENTS FOR PAYMENTS AND MONITORS THE PAYMENTS. THE HOSPITAL CAN ACCEPT DIRECT PAYMENTS ON THE ACCOUNTS, BUT THE GUARANTOR SHOULD BE ENCOURAGED TO MAKE PAYMENT DIRECT TO THE COLLECTION AGENCY. A REPORT OF PAYMENTS MADE DIRECT TO THE HOSPITAL IS FAXED TO THE COLLECTION AGENCY EVERY MONDAY THRU FRIDAY. THE PATIENT ACCOUNTS DIRECTOR AUTHORIZES THE COLLECTION AGENCY TO FILE A LEGAL SUIT IN ORDER TO OBTAIN PAYMENT WHEN THE GUARANTOR IS UNCOOPERATIVE. IF AN ACCOUNT SENT TO COLLECTION IS LATER DETERMINED TO QUALIFY FOR CHARITY CARE, COLLECTION EFFORTS STOP ON THE APPROVED AMOUNT.
PART VI, LINE 2:	THE NEEDS ASSESSMENT WAS A COMBINED ASSESSMENT WITH THE WILLIAMS COUNTY OHIO PUBLIC HEALTH DEPARTMENT AND MIDWEST COMMUNITY HEALTH ASSOCIATES MEDICAL GROUP. ALL THREE ENTITIES MADE THE REPORT WIDELY AVAILABLE IN THEIR ORGANIZATIONS. THE PUBLIC HEALTH DEPARTMENT MADE PRESENTATIONS TO COMMUNITY GROUPS AND ORGANIZATIONS.
PART VI, LINE 3:	AT THE TIME OF REGISTRATION, FORMS ARE GIVEN TO ALL PATIENTS WITH NO INSURANCE, EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAM. ALSO, SOCIAL WORKERS HAVE THESE FORMS TO GIVE TO PATIENTS THEY ARE WORKING WITH. THEY ARE ALSO GIVEN TO PATIENTS WITH INSURANCE WHEN REQUESTED.FOR ALL PATIENTS WITH NO THIRD PARTY COVERAGE, OR MEDICARE PATIENTS WITH NO SUPPLEMENT INSURANCE, A LETTER WILL BE SENT AT THE TIME THE ACCOUNT IS FINAL BILLED IF PRIOR ARRANGEMENTS HAVE NOT BEEN MADE. THE LETTER EXPLAINS THE HOSPITAL CARE ASSURANCE PROGRAM THROUGH THE STATE OF OHIO AND THE HOSPITAL CHARITABLE CARE PROGRAM. ENCLOSED WITH THE LETTER IS A COPY OF THE FINANCIAL APPLICATION, A COPY OF THE PATIENT'S SUMMARIZED BILL AND A BUSINESS CARD WITH THE NAME AND PHONE NUMBER OF THE PATIENT REPRESENTATIVE RESPONSIBLE FOR THE PATIENT'S ACCOUNT. THIS PACKET MAY ALSO BE SENT TO ANY GUARANTOR WITH A BALANCE AFTER INSURANCE THAT HE/SHE IS NOT ABLE TO PAY ACCORDING TO THE HOSPITAL GUIDELINES.DEPENDING ON THE PATIENT TYPE, SOCIAL SERVICES PATIENTS ARE MADE AWARE OF FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN THEIR DISCHARGE MATERIALS AS PART OF THE PACKET OF INFORMATION THEY RECEIVE. GOVERNMENT OR COMMERCIAL PATIENTS ARE NOT MADE AWARE IN THEIR DISCHARGE MATERIALS AS IT IS NOT INCLUDED IN THEIR DISCHARGE PACKET. HOWEVER, THE PATIENT ACCOUNT WOULD BE BROUGHT UP AGAIN IF THERE WAS A PATIENT RESPONSIBILITY PORTION AFTER THE PRIMARY CARE PROVIDER WAS BILLED.
PART VI, LINE 4:	HOSPITALS ARE LOCATED IN BRYAN AND MONTPELIER, OHIO, IN ADDITION TO A MEDICAL CENTER LOCATED IN ARCHBOLD. APPROXIMATELY 16.8% OF THE POPULATION IS 65 YEARS OR OLDER, 18.3% IS BELOW POVERTY LEVEL, AND 11.6% ARE WITHOUT HEALTH INSURANCE UNDER AGE 65.
PART VI, LINE 5:	TEN OUT OF 11 OF THE ORGANIZATION'S BOARD RESIDES IN THE ORGANIZATION'S PRIMARY SERVICE AREA, WITH NONE BEING EMPLOYEES, INDEPENDENT CONTRACTORS OR RELATED TO THE MANAGEMENT TEAM AND ONLY TWO BEING ON THE MEDICAL STAFF. TEN OF THE ELEVEN BOARD MEMBERS ARE VOLUNTEER POSITIONS WITH NO PAY.
PART VI, LINE 6:	NOT APPLICABLE

Schedule H (Form 990) 2014

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" to 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

2014

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

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 in 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 in 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 in 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," to line 5a or 5b, describe in Part III.

For persons listed in 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," to line 6a or 6b, describe in Part III.

For persons listed in 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 in 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" to 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) 2014

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 in 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 in 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)
1PHILIP L ENNENPRESIDENT/SECRETARY, CEO	(i) (ii)	345,643 ............................... 0	10,000 ............................... 0	47,404 ............................... 0	10,000 ............................... 0	24,900 ............................... 0	437,947 ............................... 0	0 ............................... 0
2GREGORY E SLATTERYVP/CIO	(i) (ii)	221,573 ............................... 0	0 ............................... 0	46,562 ............................... 0	10,000 ............................... 0	24,900 ............................... 0	303,035 ............................... 0	0 ............................... 0
3MICHAEL CULLERVP/COO	(i) (ii)	192,088 ............................... 0	0 ............................... 0	6,640 ............................... 0	10,000 ............................... 0	24,900 ............................... 0	233,628 ............................... 0	0 ............................... 0
4CHAD D TINKELVP/CFO	(i) (ii)	211,300 ............................... 0	0 ............................... 0	34,360 ............................... 0	10,000 ............................... 0	25,740 ............................... 0	281,400 ............................... 0	0 ............................... 0
5JANICE DAVIDVP PATIENT CARE	(i) (ii)	174,960 ............................... 0	0 ............................... 0	66,673 ............................... 0	10,000 ............................... 0	7,800 ............................... 0	259,433 ............................... 0	0 ............................... 0
6SHANNON KEILPATHOLOGY PHYISICAN	(i) (ii)	274,997 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	24,900 ............................... 0	299,897 ............................... 0	0 ............................... 0
7LARRY SIMONCRNA	(i) (ii)	202,212 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	24,900 ............................... 0	227,112 ............................... 0	0 ............................... 0
8CRAIG BUELLDIRECTOR OF PHARMACY	(i) (ii)	133,994 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	25,740 ............................... 0	159,734 ............................... 0	0 ............................... 0
9MARILYN NUSSBAUMERDIRECTOR CATH LAB	(i) (ii)	151,576 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	7,800 ............................... 0	159,376 ............................... 0	0 ............................... 0

Schedule J (Form 990) 2014

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 4B

THE FOLLOWING INDVIDUALS PARTICIPATED IN A 457(B) RETIREMENT PLAN: PHILIP ENNEN, JANICE DAVID, GREGORY SLATTERY, CHAD TINKEL, AND MIKE CULLER. A $10,000 CONTRIBUTION WAS MADE TO 457(B) PLAN. THESE AMOUNTS HAVE BEEN PROPERLY INCLUDED IN OFFICERS' COMPENSATION ON SCHEDULE J, PART II, COLUMN B(III). THE HOSPITAL HAS A SUPPLEMENTAL EXECUTIVE RETENTION PLAN FOR THESE EXECUTIVES UNDER IRC SECTION 457(B). THE AMOUNTS DEFERRED UNDER THIS PLAN WILL BE TAXABLE TO THE EXECUTIVE WHEN VESTED AND THERE IS NO LONGER A SUBSTANTIAL RISK OF FORFEITURE. IN ORDER TO HAVE THE RIGHT TO FUTURE PAYMENT OF ANY EMPLOYER DEFERRAL, THE EXECUTIVE WILL HAVE TO REMAIN IN SERVICE UNTIL THE ACCOUNT BECOMES VESTED AS PROVIDED IN THE PLAN DOCUMENT.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number
34-1048666

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	CITY OF BRYAN OH	34-6400228		07-01-2008	10,000,000	SEE PART VI		X		X		X
B	COUNTY OF WILLIAMS OH	34-6401595	96948QAA3	07-17-2008	45,000,000	SEE PART VI		X		X		X
C	VILLAGE OF ARCHBOLD OH	34-6400063		08-20-2008	10,000,000	SEE PART VI		X		X		X
D	COUNTY OF WILLIAMS OH	34-6401595		09-26-2012	2,905,428	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	1,281,982		3,805,000		1,295,810		1,321,827
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	10,208,153		47,692,402		10,208,153		2,905,428
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	303,337		303,337
8 Credit enhancement from proceeds . . . . . . . . . . .	316,607		316,607
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	10,208,153		47,072,458		10,208,153		2,905,428
11 Other spent proceeds . . . . . . . . . . . . . .
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .	2011		2011		2011		2005
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X		X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X	X			X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2014

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	1.240 %		1.240 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .
6 Total of lines 4 and 5 . . . . . . . . . . . . .	1.240 %		1.240 %
7 Does the bond issue meet the private security or payment test? . . . . .		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .	X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .		X		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X		X	X
b Exception to rebate? . . . . . . . .	X			X	X		X
c No rebate due? . . . . . . . .	X		X		X			X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .		X	X		X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X			X		X
b Name of provider . . . . . . . . .	FIFTH THIRD BANK		FIFTH THIRD BANK
c Term of hedge . . . . . . . . . .	9.500000000000		9.500000000000
d Was the hedge superintegrated? . . . .		X		X
e Was the hedge terminated? . . . . . .		X		X

Schedule K (Form 990) 2014

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X	X			X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

SCHEDULE K SUPPLENTAL INFORMATION

PART I, ISSUE A, COLUMN F: CONSTRUCTION, EQUIPPING, EXPANSION, IMPROVEMENT, INSTALLATION, AND SUBSTANTIAL RENOVATION OF THE ORGANIZATION'S CAMPUS. PART I, ISSUE B, COLUMN F: ACQUISITION, CONSTRUCTION, FURNISHING, AND EQUIPPING OF NEW FACILITIES AND ADDITIONS AND IMPROVEMENTS TO THE ORGANIZATION'S CAMPUS. PART I, ISSUE C, COLUMN F: CONSTRUCTION, EQUIPPING, EXPANSION, IMPROVEMENT, INSTALLATION, AND SUBSTANTIAL RENOVATION OF THE ORGANIZATION'S CAMPUS. PART I, ISSUE D, COLUMN F: CURRENTLY REFUND SERIES 2005 BONDS WHICH PROCEEDS CURRENTLY REFUNDED TAXABLE LOANS USED FOR CONSTRUCTING OR EQUIPPING SEVERAL HOSPITALS.

FORM 990, SCHEDULE K, PART II

PART II, ISSUE A, LINE 3: TOTAL PROCEEDS OF ISSUE ARE $10,208,153, WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART II, ISSUE B, LINE 3: TOTAL PROCEEDS OF ISSUE ARE $47,692,402, WHICH ARE SALE PROCEEDS OF $45,000,000 PLUS INVESTMENT EARNINGS OF $2,692,402. PART II, ISSUE C, LINE 3: TOTAL PROCEEDS OF ISSUE ARE $10,208,153, WHICH ARE SALE PROCEEDS OF $10,000,000 PLUS INVESTMENT EARNINGS OF $208,153. PART II, ISSUE D, LINE 6: THE ESCROW WAS SPENT ON THE DAY OF CLOSING OF THE 2012 ISSUE.

Schedule K (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2014

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) PPG OHIOMIDWEST COMMUNITY HEALTH ASSOCIATES	SEE SCH L, PART V	1,354,370	PPG OHIO/MCHA PROVIDES MEDICAL SERVICES TO COMMUNITY HOSPITALS & WELLNESS CENTERS.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
FORM 990, SCHEDULE L, PART IV, COLUMN B:	DR. KOLOVICH AND DR. SEAMAN ARE BOTH VOTING MEMBERS OF CHWC AND VOTING MEMBERS OF PPG OHIO/MCHA.

Schedule L (Form 990 or 990-EZ) 2014

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

2014

Open to Public
Inspection

Name of the organization

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	DRS. KOLOVICH AND SEAMAN HAVE A BUSINESS RELATIONSHIP WITH THE PHYSICIAN GROUP MCHA/PPG-OH. CHRISTOPHER CULLIS IS THE OWNER/EDITOR OF THE LOCAL NEWSPAPER AND THUS HAS BUSINESS RELATIONSHIPS WITH THE ORGANIZATION AND OTHER TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 11	PRIOR TO FILING, FORM 990 IS PROVIDED TO THE BOARD, AND A SUMMARY OF THE DISCLOSURES ARE PRESENTED BY THE PLANTE MORAN AT A MONTHLY BOARD MEETING. IF A BOARD MEMBER IS NOT IN ATTENDANCE FOR THIS PRESENTATION, THAT INDIVIDUAL WILL RECEIVE A COPY OF FORM 990 AT A LATER DATE, PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	OFFICERS AND VOTING MEMBERS OF THE BOARD ARE COVERED BY THE CONFLICT OF INTEREST POLICY. CONFLICTS OF INTEREST ARE REVIEWED ON A CASE BY CASE BASIS. IF A TRANSACTION ARISES THAT WOULD RESULT IN A CONFLICT, THE INTERESTED INDIVIDUAL SIGNS A CONFLICT OF INTEREST STATEMENT NOTING THAT THEY ARE NOT INDEPENDENT WITH RESPECT TO THE TRANSACTION, AND THEY ABSTAIN FROM VOTING ON THAT MATTER. THE POLICY IS MONITORED BY ALL BOARD MEMBERS AND OFFICERS. THE POLICY IS REVIEWED WITH ANY NEW BOARD MEMBERS OR OFFICERS.
FORM 990, PART VI, SECTION B, LINE 15	THE CEO'S AND VICE PRESIDENT'S COMPENSATION ARE REVIEWED ANNUALLY AND APPROVED BY THE COMPENSATION COMMITTEE. THE DECISIONS REGARDING COMPENSATION ARE DOCUMENTED IN THE MINUTES FROM THE COMPENSATION COMMITTEE MEETINGS. OHA SURVEY DATA IS USED FOR COMPARABILITY PURPOSES. SIMILAR HOSPITALS' 990'S ARE REVIEWED FOR COMPARABILITY PURPOSES. THE PROCESS WAS LAST UNDERTAKEN OCTOBER 2015 FOR THE VICE PRESIDENTS AND DECEMBER 2015 FOR THE PRESIDENT.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 24E:	AMOUNT REPORTED INCLUDES REIMBURSEMENT OF EXPENSES FROM CHWC PAIN MANAGEMENT, LLC.
FORM 990, PART XI, LINE 9:	CHANGE IN FAIR VALUE OF INTEREST SWAP AGREEMENTS 333,912. FLOW THROUGH LOSS FROM VANTAGE HEALTHCARE OF OHIO LLC 829.
FORM 990, PART XII, LINE 2C:	THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

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

2014

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITALS & WELLNESS CENTERS

Employer identification number

34-1048666

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

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) SHARE FOUNDATION 433 WEST HIGH STREET BRYAN,OH43506 34-1596175	ASSIST COMMUNITY HOSPITALS AND WELLNESS CENTERS WITH FUNDRAISING	OH	501(C)(3)	11A	COMMUNITY HOSPITALS AND WELLNESS CENTERS	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2014

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) COMMUNITY HOSPITALS & WELLNESS CENTERS PAIN MANAGEMENT LLC 433 WEST HIGH STREET BRYAN,OH43506 46-1084537	MEDICAL SERVICES	OH	COMMUNITY HOSPITALS & WELLNESS CENTERS	RELATED	984,849	454,438		No		Yes		51.000 %

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	(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

Schedule R (Form 990) 2014

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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) . . . . . . . . . . . . . . . . . . . . .

Yes

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

Yes

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

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) CHWC PAIN MANAGEMENT LLC	Q	680,041	ACCRUAL TRANSACTION

Schedule R (Form 990) 2014

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) 2014

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) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE QUALITY PATIENT CARE AT EVERY POINT OF SERVICE; TO RESPECT THE DIGNITY AND UNIQUENESS OF ALL PATIENTS; TO PROMOTE SAFE MEDICAL PRACTICES; TO ENCOURAGE MEDICAL RESEARCH; TO PERMIT ACCESS TO ALL SEEKING HEALTHCARE; AND TO MAINTAIN FISCAL SOUNDNESS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	791
6	Total number of volunteers (estimate if necessary) .............	6	90
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-829
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-829

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	17,218	62,035
9	Program service revenue (Part VIII, line 2g) .........	75,752,631	75,434,529
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	763,961	1,035,677
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	801,689	688,886
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	77,335,499	77,221,127
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	40,434,701	39,195,086
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)....	35,289,583	34,219,746
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	75,724,284	73,414,832
19	Revenue less expenses. Subtract line 18 from line 12.......	1,611,215	3,806,295
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	149,596,635	154,186,711
21	Total liabilities (Part X, line 26).............	76,360,106	76,464,102
22	Net assets or fund balances. Subtract line 21 from line 20.....	73,236,529	77,722,609

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 11,171,011 including grants of $ 0 ) (Revenue $ 10,903,994 )
	INPATIENT CARE: BRYAN HOSPITAL MEDICAL & SURGICAL UNIT HAS 54 BEDS AND PROVIDE CARE FOR 812 INPATIENTS AND 321 OBSERVATION PATIENTS; BRYAN HOSPITAL PEDIATRIC UNIT HAS 6 BEDS AND PROVIDE CARE FOR 22 INPATIENTS AND 39 OBSERVATION PATIENTS; BRYAN HOSPITAL INTENSIVE CARE UNIT AND TELEMETRY UNIT HAS 16 BEDS AND PROVIDE CARE FOR 796 INPATIENTS AND 437 OBSERVATION PATIENTS; BRYAN HOSPITAL OBSTETRICS HAS 9 BEDS AND PROVIDED CARE FOR 310 INPATIENTS. MONTPELIER HOSPITAL HAS 25 BEDS AND PROVIDED CARE TO 343 INPATIENTS.

4b	(Code: ) (Expenses $ 10,043,196 including grants of $ 0 ) (Revenue $ 11,496,062 )
	SURGERY CARE: BRYAN SURGERY HAS 6 OPERATING ROOMS THAT DID 1,806 GENERAL SURGERY CASES, 2,303 PAIN MANAGEMENT CASES, 698 ORTHOPEDIC CASES, 599 OPHTHALMOLOGY CASES, 466 GYNECOLOGY CASES, 90 ENT CASES, AND 234 UROLOGY CASES. ARCHBOLD SURGERY HAS 4 OPERATING ROOMS THAT DID 291 ORTHOPEDIC CASES, 115 GENERAL SURGERY CASES, AND 156 UROLOGY CASES.

4c	(Code: ) (Expenses $ 4,284,968 including grants of $ 0 ) (Revenue $ 3,926,127 )
	EMERGENCY ROOM CARE: BRYAN ED CARED FOR 13,954 PATIENTS WITH 1090 BEING ADMITTED; MONTPELIER ED CARED FOR 4,486 PATIENTS WITH 10 BEING ADMITTED.

	(Code: ) (Expenses $ 26,063,315 including grants of $ 0 ) (Revenue $ 49,108,346 )
	COMMUNITY HOSPITALS AND WELLNESS CENTERS PROVIDED SERVICES TO APPROXIMATELY 2,500 INPATIENTS, APPROXIMATELY 1,150 OBSERVATION PATIENTS, AND APPROXIMATELY 18,500 EMERGENCY DEPARTMENT PATIENTS DURING THIS FISCAL YEAR. THE HOSPITAL UTILIZES A BOARD APPROVED CHARITABLE CARE PROGRAM THAT MEASURES INDIVIDUAL AND FAMILY NEEDS BASED ON FEDERAL POVERTY GUIDELINES. THE PROGRAM IS APPLIED UNIFORMLY ACROSS ALL LEVELS OF HOSPITAL SERVICES. THE PROGRAM EXTENDS BEYOND THE FEDERAL POVERTY DEFINITIONS TO ALLOW THE HOSPITAL TO PROVIDE FREE AND/OR SUBSIDIZED CARE FOR PERSONS FALLING WITHIN AND BEYOND THE FEDERAL GUIDELINES. THIS PROGRAM PROVIDED ASSISTANCE TO APPROXIMATELY 5,050 ACCOUNTS DURING THIS FISCAL YEAR.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 26,063,315 including grants of $ 0 ) (Revenue $ 49,108,346 )
4e	Total program service expenses51,562,490

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,239,627	0	267,320

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) CRAIG BUELL........................................................................ DIRECTOR OF PHARMACY	40.00 .......................0.00	X	133,994	0	25,740
(19) MARILYN NUSSBAUMER........................................................................ DIRECTOR CATH LAB	40.00 .......................0.00	X	151,576	0	7,800
(20) GARY D BROWN........................................................................ ASST DIRECTOR PHARMACY	40.00 .......................0.00	X	119,645	0	25,740

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		62,035

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			62,035
			Business Code
2a	NET PATIENT REVENUES		621400	75,434,529	75,434,529
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			75,434,529
3	Investment income (including dividends, interest, and other similar amounts).......			1,086,861			1,086,861
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	360,277
b	Less: rental expenses	326,016
c	Rental income or (loss)	34,261
d	Net rental income or (loss).......			34,261			34,261
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		124,610
b	Less: cost or other basis and sales expenses		175,794
c	Gain or (loss)		-51,184
d	Net gain or (loss)..........			-51,184			-51,184
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
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	CAFETERIA/VENDING		621400	655,454			655,454
b	LOSS FROM VANTAGE HEALTHCARE		621400	-829		-829
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			654,625
12	Total revenue. See Instructions......			77,221,127	75,434,529	-829	1,725,392


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			4,707,765	1	3,496,119
2	Savings and temporary cash investments .........			24,717,913	2	31,713,588
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			7,845,324	4	8,469,949
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 ..............			1,084,198	8	1,244,414
9	Prepaid expenses and deferred charges ..........			1,826,531	9	1,815,870
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	160,375,875
b	Less: accumulated depreciation .....	10b	80,144,075	84,560,995	10c	80,231,800
11	Investments—publicly traded securities ..........			22,499,036	11	23,942,752
12	Investments—other securities. See Part IV, line 11 .....			735,853	12	671,738
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,619,020	15	2,600,481
16	Total assets. Add lines 1 through 15 (must equal line 34)......			149,596,635	16	154,186,711
17	Accounts payable and accrued expenses .........			6,963,075	17	6,811,151
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			42,025,000	20	41,195,000
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 ..			23,099,758	23	21,213,600
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....................			4,272,273	25	7,244,351
26	Total liabilities. Add lines 17 through 25.........			76,360,106	26	76,464,102
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			73,236,529	27	77,722,609
28	Temporarily restricted net assets ...........				28
29	Permanently restricted net assets ...........				29
	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 ...........			73,236,529	33	77,722,609
34	Total liabilities and net assets/fund balances ........			149,596,635	34	154,186,711