TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) LUCILLE HOSFELD CHAIRMAN	1.0 .................	X	X	0	0
(2) MIKE GRAY VICE PRESIDENT	1.0 .................	X	X	0	0
(3) C WILLIAM JOHNSTON SECRETARY / TREASURER	1.0 .................	X	X	0	0
(4) LARRY ROLL PAST CHAIRMAN	1.0 .................	X	X	0	0
(5) PHIL DUBBS PAST CHAIRMAN (THRU MARCH 2015)	1.0 .................	X		0	0
(6) JOHN WARNER BOARD MEMBER	1.0 .................	X		0	0
(7) PHILLIP GARBIG BOARD MEMBER (THRU MARCH 2015)	1.0 .................	X		0	0
(8) CINDY SCOTT BOARD MEMBER	1.0 .................	X		0	0
(9) ERIC EVERMAN BOARD MEMBER	1.0 .................	X		0	0
(10) JENNIFER RAWLINS MD BOARD MEMBER (THRU NOVEMBER 2015)	1.0 .................	X		0	0
(11) TRAVIS FLIEHMAN BOARD MEMBER (AS OF APRIL 2015)	1.0 .................	X		0	0
(12) ANNA HATIC DO BOARD MEMBER (AS OF NOVEMBER 2015)	1.0 .................	X		0	0
(13) JOHN DUTRO MD BOARD MEMBER / SURGEON	40.0 .................	X		369,879	35,546
(14) DON MILLER BOARD MEMBER (AS OF APRIL 2015)	1.0 .................	X		0	0
(15) WAYNE DESCHAMBEAU CEO	40.0 .................		X	309,196	35,009
(16) DENNIS LOCKARD CFO (THRU JULY 2015)	40.0 .................		X	129,274	21,509
(17) JENNIFER WILLIAMS INTERIM CFO/ (CFO AS OF DECEMBER 2015)	40.0 .................		X	99,779	17,691

(A) Name and business address	(B) Description of services	(C) Compensation
KETTERING ANESTHESIA ASSOC 3500 PENTAGON BLVD SUITE 200 BEAVERCREEK,OH45431	ANESTHESIA SERVICES	1,039,400
PREMIER PHYSICIAN SERVICES INC PO BOX 634850 CINCINNATI,OH45263	HOSPITALISTS	491,618
CHRIST HOSPITAL PO BOX 635899 CINCINNATI,OH452635899	ULTRASOUND SERVICES	395,206
LAB CORP OF AMERICA PO BOX 12140 BURLINGTON,NC272162140	LAB TESTING SERVICES	325,442
SLEEP CARE INC PO BOX 418 WORTHINGTON,OH43085	SLEEP TESTING SERVICES	320,980
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 30

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

Attach to Form 990 or Form 990-EZ.
right arrow

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

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

Section A. Public Support

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

Section B. Total Support

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

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

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

Section A. Public Support

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

Section B. Total Support

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

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

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

Section A. All Supporting Organizations

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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

11a

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

11b

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

11c

Section B. Type I Supporting Organizations

Yes

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

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

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

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

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

Yes

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

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

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

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

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

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

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

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

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2015

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

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

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

Name of organization Wayne Hospital Company

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

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

Page 3

Name of organization Wayne Hospital Company		Employer identification number 34-4428598

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

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

Page 4


Name of organization Wayne Hospital Company			Employer identification number 34-4428598
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

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

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

4,733

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

4,733

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
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	WAYNE HOSPITAL COMPANY PAYS DUES TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE THESE DUES, $4,733 WAS SPENT ON LOBBYING
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	WAYNE HOSPITAL COMPANY PAYS DUES TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE THESE DUES, $4,733 WAS SPENT ON LOBBYING

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

Part I

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

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....	201,920	201,841	194,461	197,906	196,365
b	Contributions ...		0	9,303	0	0
c	Net investment earnings, gains, and losses	99	79	77	555	1,541
d	Grants or scholarships ...		0	2,000	4,000	0
e	Other expenditures for facilities and programs ...		0	0	0	0
f	Administrative expenses ....		0	0	0	0
g	End of year balance ......	202,019	201,920	201,841	194,461	197,906

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

Board designated or quasi-endowment SchDMd Bullet

3.84 %

Permanent endowment SchDMd Bullet

2.57 %

Temporarily restricted endowment SchDMd Bullet

93.59 %

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

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

Yes

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

3a(i)

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

3a(ii)

If "Yes" on 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' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

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

1a	Land ...	1,776,661		1,776,661
b	Buildings	67,674,261	35,970,485	31,703,776
c	Leasehold improvements	3,625,979	1,997,834	1,628,145
d	Equipment ...	30,715,569	23,099,681	7,615,888
e	Other ...	32,809	0	32,809
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				42,757,279

Schedule D (Form 990) 2015

Page 3

Part VII

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

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

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
INTEREST RATE SWAP LIABILITY	3,876,348
ESTIMATED THIRD PARTY SETTLEMENTS	105,063
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	3,981,411
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	53,866,964
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-3,021,129
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-4,126,678
e	Add lines 2a through 2d .....................			2e	-7,147,807
3	Subtract line 2e from line 1..................			3	61,014,771
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	434,089
b	Other (Describe in Part XIII.) ...........	4b	-343,601
c	Add lines 4a and 4b....................			4c	90,488
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	61,105,259

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	54,230,288
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	343,601
e	Add lines 2a through 2d....................			2e	343,601
3	Subtract line 2e from line 1...................			3	53,886,687
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	434,089
b	Other (Describe in Part XIII.) ............	4b	4,232,866
c	Add lines 4a and 4b.....................			4c	4,666,955
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	58,553,642

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
Schedule D, Part V, Line 4 Intended uses of endowment funds	ENDOWMENT FUNDS ARE SPECIFICALLY SET ASIDE FOR CLINICALLY RELATED SCHOLARSHIPS GRANTED TO STUDENTS GOING INTO A HEALTH RELATED FIELD OF STUDY AND FOR INDIGENT CARE.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A). U.S. GAAP requires that a tax position is recognized as a benefit only if it is "more likely than not" that the tax position would be sustained in a tax examination, with a tax examination being presumed to occur. The amount recognized is the largest amount of tax benefit that is greater than 50% likely of being realized on examination. For tax positions not meeting the "more likely than not" test, no tax benefit is recorded. Due to its tax-exempt status, the Hospital is not subject to U.S. Federal income tax or state income tax. The Hospital's Form 990 has not been subject to examination by the Internal Revenue Service or the state of Ohio for the last three years. The Hospital does not expect the total amount of unrecognized tax benefits to significantly change in the next 12 months. The Hospital recognizes interest and/or penalties related to income tax matters in income tax expense. The Hospital did not have any amounts recorded for interest and penalties at December 31, 2015 and 2014.
Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990	BAD DEBT - -4119337 CHANGE IN INTEREST OF RELATED PARTIES - -7341
Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements	GAIN ON DISPOSAL OF FIXED ASSETS - 1127 RENTAL EXPENSES - -344728
Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990	GAIN ON DISPOSAL OF FIXED ASSETS - -1127 RENTAL EXPENSE INCLUDED IN REVENUE - 344728
Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements	CHANGE IN VALUE OF INTEREST RATE SWAP - 113529 BAD DEBT - 4119337

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

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? . . . . . .

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .			1,033,585		1,033,585	1.90 %
b	Medicaid (from Worksheet 3, column a) . . . . .			10,416,883	4,857,098	5,559,785	10.21 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			752,411		752,411	1.38 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	12,202,879	4,857,098	7,345,781	13.49 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			76,116	14,545	61,571	0.11 %
f	Health professions education (from Worksheet 5) . . .					0	0 %
g	Subsidized health services (from Worksheet 6) . . . .					0	0 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			50,407		50,407	0.09 %
j	Total. Other Benefits . .	0	0	126,523	14,545	111,978	0.21 %
k	Total. Add lines 7d and 7j .	0	0	12,329,402	4,871,643	7,457,759	13.70 %

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

Schedule H (Form 990) 2015

Page

Part II

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

		(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					0	0 %
2	Economic development					0	0 %
3	Community support	4		7,100		7,100	0.01 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building					0	0 %
7	Community health improvement advocacy					0	0 %
8	Workforce development					0	0 %
9	Other					0	0 %
10	Total	4	0	7,100	0	7,100	0.01 %

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? ..........................

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

4,119,337

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. ......

28,542

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).....

17,803,629

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

24,692,787

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

-6,889,158

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) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Wayne Hospital Company 835 Sweitzer Street Greenville,OH45331 WWW.WAYNEHEALTHCARE.ORG Ohio Department of Health 1159AHR	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Wayne Hospital Company
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

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

Yes

6 a

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

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

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.waynehealthcare.org/our-community/community-health/community-health

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

If "Yes" (list url): http://www.waynehealthcare.org/our-community-health/community-health

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

12b

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

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Wayne Hospital Company
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.0% and FPG family income limit for eligibility for discounted care of 200.0%

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):

http://www.waynehealthcare.org/media/file/FAA%20POSTED%20%20LETTER%202015.pdf

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

www.waynehealthcare.org/media/file/2015_hcap_application_revised.pdf

A plain language summary of the FAP was widely available on a website (list url):
http://www.waynehealthcare.org/media/file/FAA%20POSTED%20%20LETTER%202015.pdf

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

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

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

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

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

Other (describe in Section C)

Billing and Collections

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Wayne Hospital Company
Name of hospital facility or letter of facility reporting group

Yes

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - OHIO DEPARTMENT OF HEALTH. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 5 Facility , 2	Facility , 2 - CENTER FOR DISEASE CONTROL AND PREVENTION. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 5 Facility , 3	Facility , 3 - OHIO DEPARTMENT OF JOB AND FAMILY SERVICES. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 5 Facility , 4	Facility , 4 - OHIO DEPARTMENT OF PUBLIC SAFETY. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death
Schedule H, Part V, Section B, Line 5 Facility , 5	Facility , 5 - OHIO MENTAL HEALTH AND ADDICTION SERVICES. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 5 Facility , 6	Facility , 6 - HEALTH RESOURCES AND SERIVES ASSOCIATION. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 5 Facility , 7	Facility , 7 - OHIO DEVELOPMENT SERVICES AGENCY. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 5 Facility , 8	Facility , 8 - GRACE RESURRECTION COMMUNITY CENTER. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 5 Facility , 9	Facility , 9 - ROBERT WOOD JOHNSON FOUNDATION. This effort has included: a demographic analysis; a survey of 418 adult residents selected at random; focus group sessions with uninsured persons, low-income persons, and minority groups convened by the Darke County Department of Job and Family Services and Grace Resurrection Community Center; a focus group with school nurses; as well as analysis of data from the Ohio Department of Health, Ohio Department of Job and Family Services, the Center for Disease Control and Prevention, the Bureau of the Census' American Community Survey, the Ohio Department of Public Safety, the Ohio Development Service Agency, the Health Resources and Services Association, the Ohio Mental Health and Addiction Services and the Robert Wood Johnson Foundation. The study addresses secondary data for maternal and infant health data, clinical and preventive services, diseases, hospital and emergency discharge data, and leading causes of death.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - DARKE COUNTY HEALTH DEPARTMENT. Diane Barga ,Program Coordinator Family Consumer Science, Darke County Health Department ,barga.8@osu.edu
Schedule H, Part V, Section B, Line 6b Facility , 2	Facility , 2 - DARKE COUNTY HEALTH DEPARTMENT. Jennifer Barga ,Director of Nursing, Darke County Health Department ,Jennifer.Barga@odh.ohio.gov
Schedule H, Part V, Section B, Line 6b Facility , 3	Facility , 3 - VERSAILLES HEALTH CARE CENTER. Shannon Condon ,Facility Rehab Director, Versailles Health Care Center ,scondon@covenantcare.com
Schedule H, Part V, Section B, Line 6b Facility , 4	Facility , 4 - DARK COUNTY COMMISSONER'S OFFICE. John Cook ,Business Administrator, Darke County Commissioner's Office,jcook@co.darke.oh.us
Schedule H, Part V, Section B, Line 6b Facility , 5	Facility , 5 - DARKE COUNTY CHAMBER OF COMMERCE. Sharon Deschambeau ,President, Chamber of Commerce ,sharond@darkecountyohio.com
Schedule H, Part V, Section B, Line 6b Facility , 6	Facility , 6 - DARKE COUNTY. Denise Dillman ,Wellness ,ddillman@co.darke.oh.us
Schedule H, Part V, Section B, Line 6b Facility , 7	Facility , 7 - CUPA. Jane Dockery ,Associate Director, CUPA ,jane.dockery@wright.edu
Schedule H, Part V, Section B, Line 6b Facility , 8	Facility , 8 - VERSAILLES HEALTH CARE CENTER. Kristy Earick ,Administrator, Versailles Health Care Center ,KEarick@covenantcare.com
Schedule H, Part V, Section B, Line 6b Facility , 9	Facility , 9 - GRACE RESURRECTION COMMUNITY CENTER. Sharon Fellers ,Executive Director, Grace Resurrection Community Center ,sharonf@grccenter.org
Schedule H, Part V, Section B, Line 6b Facility , 10	Facility , 10 - FAMILY HEALTH. Dr. Michael Fourman ,Director of Dental Services, Family Health ,mfourman@familyhealth.cc
Schedule H, Part V, Section B, Line 6b Facility , 11	Facility , 11 - DARKE COUNTY SCHOOLS. Mike Gray ,Superintendent, Darke County Schools ,dk_supt@mdeca.org
Schedule H, Part V, Section B, Line 6b Facility , 12	Facility , 12 - TRI-COUNTY BOARD OF RECOVERY AND MENTAL SERVICES. Kelly Harrison ,Prevention Specialist ,kharrison@dcrs.info
Schedule H, Part V, Section B, Line 6b Facility , 13	Facility , 13 - DARKE COUNTY UNITED WAY. Lauren Henry ,Executive Director, Darke County United Way ,Lauren@darkecountyunitedway.org
Schedule H, Part V, Section B, Line 6b Facility , 14	Facility , 14 - DARKE COUNTY HEALTH DEPARTMENT. Terrence Holman ,Health Commissioner, Darke County Health Department ,terrence.holman@odh.ohio.gov
Schedule H, Part V, Section B, Line 6b Facility , 15	Facility , 15 - DARKE COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES. Diane Lee ,Transportation Coordinator ,Diann.Lee@jfs.ohio.gov
Schedule H, Part V, Section B, Line 6b Facility , 16	Facility , 16 - TRI-COUNTY BOARD OF RECOVERY AND MENTAL SERVICES. Jodi Long ,Director, Clinical Services & Evaluation ,longj@tcbmds.org
Schedule H, Part V, Section B, Line 6b Facility , 17	Facility , 17 - TRI-COUNTY BOARD OF RECOVERY AND MENTAL SERVICES. Mark McDaniel ,Executive Director, Tri-County Board of Recovery and Mental Health Services ,mcdanielm@tcbmds.org
Schedule H, Part V, Section B, Line 6b Facility , 18	Facility , 18 - DARKE COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES. Tiffany Thomas ,Eligibility Referral Supervisor, Darke County Department of Job & Family Services ,Tiffany.Thomas@jfs.ohio.gov
Schedule H, Part V, Section B, Line 6b Facility , 19	Facility , 19 - COUNCIL ON RURAL SERVICES. Jeff Vaughn ,ACES Coordinator, Council on Rural Services ,jvaughn@councilonruralservices.org
Schedule H, Part V, Section B, Line 6b Facility , 20	Facility , 20 - BRETHERN RETIREMENT COMMUNTY. John Warner ,President & CEO, Brethren Retirement Community ,John.Warner@bhrc.org
Schedule H, Part V, Section B, Line 6b Facility , 21	Facility , 21 - DARKE COUNTY HEALTH DEPARTMENT. Dennis Wein ,Public Health Nurse, Darke County Health Department ,dennis.wein@odh.ohio.gov
Schedule H, Part V, Section B, Line 6b Facility , 22	Facility , 22 - DARKE COUNTY PARK DISTRICT. Erica Wentworth ,Naturalist, Darke County Park District ,EWentworth@darkecountyparks.org
Schedule H, Part V, Section B, Line 6b Facility , 23	Facility , 23 - FAMILY HEALTH. Laurie White ,Director of Behavioral Health and Wellness Services, Family Health ,LWhite@familyhealth.cc
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - WAYNE HOSPITAL COMPANY. Darke County Community Health Needs Assessment (CHNA) 2015 Wayne HealthCare partnered with the Darke County Health Department, Tri-county Board of Mental Health, Job & Family Services, the Darke County Chamber of Commerce, and Family Health to prepare the 2015-2017 Community Health Needs Assessment (CHNA) with Wright State University serving as the data, research, and facilitation consultant. The 2015 Wayne Healthcare Implementation Strategy focuses on the health priorities discovered during the assessment process that were identified as the most serious threats to the health of the Darke County community. Using the data gathered during the CHNA, three health priorities were identified for the service area: chronic disease prevention & education; coordinated care & coordinated management; and mental health & substance abuse. Wayne HealthCare will focus on addressing the chronic disease & education and coordinated care & coordinated management priorities; the Coalition for a Health Darke County will be the lead agent in addressing mental health & substance abuse. Additionally, Wayne HealthCare is a partner on select aspects of the effort to address mental health & substance abuse, which is primarily being addressed by the Coalition for a Healthy Darke County. In support of the 2015 Community Health Needs Assessment and ongoing community benefit initiatives, Wayne HealthCare will implement the following strategies to impact and measure community health improvement. Priority: Chronic Disease Prevention & Education Goal: Improve opportunities for chronic disease risk management and support chronic disease prevention and education programming. * Objective 1: By December 2017, increase the number of partners providing health education and promotion services by 2 new partners. * Objective 2: By December 2017, increase participation in risk factor management programs and activities. * Objective 3: By December 2017, increase participation of adults in support groups and counseling programs for those affected by chronic disease. Priority: Coordinated Care & Coordinated Management Goal: Improve access to care and optimize health care resources by coordinating patient care with all healthcare providers in the community. * Objective: To reduce hospital readmission and deliver better health outcomes via coordinated care and coordinated management regarding Chronic Obstructive Pulmonary Disease and Congestive Heart Failure by December 2017. o Strategy 1: By December 2017, develop a mechanism to enable care coordination across multiple agencies by using the Darke County Adult Collaborative Care Release form. o Strategy 2: Identify patients at high risk for readmission and ensure that they get appropriate follow-up care beginning with a pilot demonstration project of a coordination of care data platform to enable connectivity and collaboration across health care and human services organizations. Priority: Mental Health and Substance Abuse Goal: Expand assistance and support of the Coalition for a Healthy Darke County to improve access to mental healthcare and substance abuse services. * Objective: By December 2017, increase utilization and awareness of mental health & substance abuse services to enhance the health and wellbeing of individuals, organizations, and workplaces in Darke County. o Strategy 1: Strengthen the collaborative partnership with the Coalition for a Healthy Darke County to improve access to mental health and substance abuse services in the community by 2017. For more information on how Wayne HealthCare is addressing health priorities in our community, visit http://www.waynehealthcare.org/media/file/Implementation%20Strategy%20for%20WHC_2015-17.pdf

Schedule H (Form 990) 2015

Page 8

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?1
Name and address		Type of Facility (describe)
1	WAYNE HOSPITAL COMPANY PROFESSIONAL SERVICES LLC 835 SWEITZER STREET GREENVILLE,OH45331	PHYSICIAN PROFESSIONAL SERVICES ORGANIZATION
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	4119337
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	A COST-TO-CHARGE RATIO WAS USED FOR THE FIGURES REPORTED IN THE TABLE AND WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.
Schedule H, Part II Community Building Activities	WAYNE HEALTHCARE CONTRIBUTED $3,000 TO EDISON COMMUNITY COLLEGE FOUNDATION TO SUPPORT THE NURSING STUDENTS GOING THROUGH THE PROGRAM TO EARN AN RN DEGREE. WAYNE HEALTHCARE ALLOWS THOSE STUDENTS TO COMPLETE THE REQUIRED CLINCIAL EDUCATION ONSITE WITH INTENT THAT SOME OF THE STUDENTS WILL BE INTERESTED IN WORKING FOR WAYNE HEALTHCARE UPON GRADUATION. WAYNE HEALTHCARE DONATED $1,100 TO UNITED WAY AND DARKE COUNTY CHAMBER TO HELP WITH FAMILIES IN NEED IN THE COMMUNITY. WAYNE HEALTHCARE DONATED $3,000 TO MAIN STREET GREENVILLE TO HELP SPONSOR FAMILY ACTIVITIES.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The estimated amount of the organization's bad debt expense that may be attributable to patients eligible under the organization's financial assistance policy was estimated by applying the percentage of patient accounts reactivated and qualified for charity over the total patient accounts written off and then multiplying that percentage by the bad debt expense identified as charity care in the future.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	The provision for bad debts is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in healthcare coverage, and other collection indicators. Accounts receivable are written off and charged to the provision for bad debts after collection efforts have been made in accordance with the Hospital's policies. Recoveries are treated as a reduction to the provision for bad debts. Accounts receivable are reduced by an allowance for doubtful accounts. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by major payor category. Income from incentive payments is subject to retrospective adjustment as the incentive payments are calculated using Medicare cost report data that is subject to audit.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	The Medicare allowable costs are determined using the internal cost accounting system. Wayne HealthCare has a large percentage of Medicare patients in the community it serves and as reported the shortfalls often arise from payments that are less than the cost to provide the care or services. As provided in IRS Revenue Ruling 69-545, the community benefit standard for nonprofit hospitals states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	Patients known to qualify for charity care or financial assistance are not sent to a collection agency. The organization repeatedly offers patients access to financial help during their hospital stays and after, as well as with each billing notice. Bills are sent to a collection agency as a last resort and only: when patients have the ability to pay some portion of their healthcare expenses but refuse to do so; when patients refuse to work with the organization to determine if they qualify for free or discounted care via federal, state, local or hospital assistance programs; when the organization is unable to locate the patient or person responsible for the bill.
Schedule H, Part V, Section B, Line 16a FAP website	- Wayne Hospital Company: Line 16a URL: http://www.waynehealthcare.org/media/file/FAA%20POSTED%20%20LETTER%202015.pdf;
Schedule H, Part V, Section B, Line 16b FAP Application website	- Wayne Hospital Company: Line 16b URL: www.waynehealthcare.org/media/file/2015_hcap_application_revised.pdf;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- Wayne Hospital Company: Line 16c URL: http://www.waynehealthcare.org/media/file/FAA%20POSTED%20%20LETTER%202015.pdf;
Schedule H, Part VI, Line 2 Needs assessment	THE ORGANIZATION ASSESES THE NEEDS OF THE COMMUNITY BY REACHING OUT TO LOCAL ORGANIZATIONS TO SURVEY THE HEALTH NEEDS OF THEIR EMPLOYEES. ADDITIONALLY THE HOSPITAL ASSESSES THE TRENDS OF INPATIENT ADMISSIONS TO DETERMINE WHAT THE CURRENT NEEDS ARE AND WHAT ADDITIONAL PROGRAMMING MAY BENEFIT THE NEEDS OF THE COMMUNITY. WAYNE HOSPITAL COMPANY WORKED IN CONJUNCTION WITH THE CENTER FOR URBAN AND PUBLIC AFFAIRS AT WRIGHT STATE UNIVERSITY FOR THE DARKE COUNTY HEALTH DEPARTMENT TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	WAYNE HOSPITAL PROVIDES PAMPHLETS TO PATIENTS THAT DESCRIBE THE FINANCIAL ASSISTANCE POLICIES. THERE IS SIGNAGE UP THROUGHOUT THE KEY PATIENT AREAS IN THE HOSPITAL ALONG WITH FINANCIAL ASSISTANCE APPLICATIONS. THE HOSPITAL'S WEBSITE HAS THE FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO THE PATIENTS. WAYNE HOSPITAL SENDS A FINANCIAL COUNSELOR TO SPEAK WITH OUR INPATIENTS AS WELL AS EMERGENCY DEPARTMENT PATIENTS THAT MAY BE ELIGIBLE FOR ASSISTANCE. FINALLY, WAYNE HOSPITAL PUTS THE FINANCIAL ASSISTANCE APPLICATION DIRECTLY ON THE BACK OF ALL PATIENT STATEMENTS SO THAT THE PATIENT HAS IMMEDIATE ACCESS TO THE APPLICATION.
Schedule H, Part VI, Line 4 Community information	WAYNE HOSPITAL SERVES THE DARKE COUNTY COMMUNITY. DARKE COUNTY IS MAINLY A RURAL FARMING COMMUNITY WITH A POPULATION OF OVER 52,000. APPROXIMATELY 12.2% OF THE COUNTY INCOME LEVEL IS UNDER THE FEDERAL POVERTY GUIDELINES AND 3.7% OF THE REVENUES FOR THE HOSPITAL WERE MEDICAID PATIENTS IN 2015. THE COUNTY UNEMPLOYMENT RATE IN 2015 WAS 4.2%. WAYNE HOSPITAL IS THE ONLY HOSPITAL WITHIN THE COUNTY AND THERE IS A FEDERALLY QUALIFIED HEALTH CENTER THAT SERVES THE COUNTY AND THEREFORE PROVIDES A SIGNIFICANT AMOUNT OF REFERRALS TO THE FACILITY.
Schedule H, Part VI, Line 5 Promotion of community health	WAYNE HOSPITAL'S GOVERNING BODY IS COMPRISED OF LOCAL COMMUNITY AND COUNTY RESIDENTS WHO HAVE A VESTED INTEREST IN THE VIABILITY OF THE FACILITY. THE MEMBERS ARE ATTORNEYS, BANK EXECUTIVES, SCHOOL OFFICIALS, RETIRED BUSINESS OWNERS, AND OTHER LOCAL MEDICAL PROFESSIONALS. WAYNE HOSPITAL EXTENDS STAFF PRIVILEGES NOT ONLY TO OUR EMPLOYED PHYSICIANS, BUT TO THE COMMUNITY'S MEDICAL PROFESSIONALS AS WELL IN ORDER TO KEEP AS MUCH OF OUR PATIENT POTENTIAL AT THE FACILITY AS POSSIBLE. The Lifestyle Enhancement Center expanded chronic disease management programs to include Cardiac Rehabilitation and Congestive Heart Failure Clinic. Current existing programs include Diabetes Education Programs, Smoking Cessation and Pulmonary Rehabilitation. The Group Lifestyle Balance Program expanded from Wayne HealthCare employees to inviting the public to participate. Approximately 33 people participated in the program.
Schedule H, Part VI, Line 7 State filing of community benefit report	OH

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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? ..

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

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

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

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

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

Yes

Any related organization?

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

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

The organization?

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

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

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

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JOHN DUTRO MD BOARD MEMBER / SURGEON	(i) (ii)	361,777 ------------- 0	8,102 ------------- 0	0 ------------- 0	7,580 ------------- 0	27,966 ------------- 0	405,425 ------------- 0	0 ------------- 0
2WAYNE DESCHAMBEAU CEO	(i) (ii)	269,696 ------------- 0	33,500 ------------- 0	6,000 ------------- 0	7,580 ------------- 0	27,429 ------------- 0	344,205 ------------- 0	0 ------------- 0
3DENNIS LOCKARD CFO (THRU JULY 2015)	(i) (ii)	110,543 ------------- 0	14,402 ------------- 0	4,329 ------------- 0	5,417 ------------- 0	16,092 ------------- 0	150,783 ------------- 0	0 ------------- 0
4PETER LACHIEWICZ OB/GYN	(i) (ii)	452,177 ------------- 0	36,910 ------------- 0	0 ------------- 0	7,580 ------------- 0	28,114 ------------- 0	524,781 ------------- 0	0 ------------- 0
5PATRICK KARR OB/GYN	(i) (ii)	436,857 ------------- 0	64,624 ------------- 0	0 ------------- 0	7,580 ------------- 0	27,210 ------------- 0	536,271 ------------- 0	0 ------------- 0
6DANIEL MCKELLAR SURGEON	(i) (ii)	454,260 ------------- 0	20,000 ------------- 0	0 ------------- 0	7,580 ------------- 0	26,743 ------------- 0	508,583 ------------- 0	0 ------------- 0
7DAVID M WARE SURGEON	(i) (ii)	491,922 ------------- 0	5,697 ------------- 0	0 ------------- 0	7,580 ------------- 0	27,966 ------------- 0	533,165 ------------- 0	0 ------------- 0
8JEROME M LEAHEY FAMILY PRACTICE	(i) (ii)	127,436 ------------- 0	0 ------------- 0	0 ------------- 0	4,280 ------------- 0	25,055 ------------- 0	156,771 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
Schedule J, Part I, Line 1a Housing allowance or residence for personal use	WAYNE HOSPITAL PROVIDES A HOUSE THAT IS OWNED BY THE HOSPITAL FOR USE BY THE CFO. THE HOUSE IS LOCATED RIGHT NEXT TO THE HOSPITAL AND WILL EVENTUALLY BE TORN DOWN AND TURNED INTO PARKING SPACE. THIS WAS TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUAL. THE CEO RECEIVES A CAR ALLOWANCE WHICH IS TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUAL.
Schedule J, Part I, Line 5a Compensation contigent on revenues of the organization	THE ORGANIZATION PAYS THE PHYSICIAN STAFF BONUSES BASED ON THE REVENUES OF THE ORGANIZATION. BONUS AMOUNTS ARE DEPENDENT UPON THE REVENUE GENERATED BY THE LLC ATTRIBUTED TO THE PHYSICIANS.

Schedule J (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- 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

2015

Open to Public
Inspection

Name of the organization
Wayne Hospital Company

Employer identification number
34-4428598

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	County Of Darke Ohio	34-6400036		11-01-2010	30,000,000	Refund portion of 11/1/2007 bonds		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0
2 Amount of bonds legally defeased ..............	0
3 Total proceeds of issue ..................	30,000,000
4 Gross proceeds in reserve funds .............	0
5 Capitalized interest from proceeds .............	0
6 Proceeds in refunding escrows ...............	0
7 Issuance costs from proceeds ...............	0
8 Credit enhancement from proceeds .............	0
9 Working capital expenditures from proceeds .............	0
10 Capital expenditures from proceeds .............	0
11 Other spent proceeds .............	30,000,000
12 Other unspent proceeds .............	0
13 Year of substantial completion .............	2010
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X
15 Were the bonds issued as part of an advance refunding issue? .....		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X

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

Cat. No. 50193E

Schedule K (Form 990) 2015

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
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?
c Are there any research agreements that may result in private business use of bond-financed property? .............		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 ....	0 %
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 .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		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
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

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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......
b Exception to rebate? ........
c No rebate due? .........	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
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2015

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
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
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

Part VI

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

Return Reference	Explanation
Schedule K, Part IV, Line 2c ISSUER NAME: COUNTY OF DARKE, OHIO: NO REBATE DUE	THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON REBATE NOT REQUIRED DUE TO PROCEEDS NOT BEING INVESTED.

Schedule K (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

Return Reference	Explanation
Form 990, Part III, Line 1 ORGANIZATION'S MISSION	(CONTINUED FROM PART III) THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SCHEDULE H PROVIDES INFORMATION ABOUT WAYNE HOSPITAL CORPORATION PROVIDING CARE REGARDLESS OF PATIENT'S ABILITY TO PAY.
Form 990, Part III, Line 4b PROGRAM SERVICE ACCOMPLISHMENTS	(CONTINUED FROM PART III, LINE 4B) ANOTHER PROGRAM INVOLVES CONDUCTING VARIOUS DIABETES SEMINARS AND CLASSES HELD AT WAYNE HOSPITAL WHICH PROVIDE INFORMATION TO THE PUBLIC ON DIABETES AWARENESS, OFFER THE COMMUNITY HEALTH SCREENINGS FOR DIABETES, AND EDUCATE THOSE WITH DIABETES ABOUT MANAGING THE DISEASE. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT OVER 250 HOURS OF TIME ON THE DIABETES SEMINARS AND CLASSES AND THE HOSPITAL HAS CONTRIBUTED MATERIALS AND SUPPLIES TO THE PROGRAM. AN ADDITIONAL PROGRAM OF WAYNE HOSPITAL IS THE CANCER AWARENESS, PREVENTION, SCREENING AND TREATMENT PROGRAM IN WHICH THE HOSPITAL OFFERS DIAGNOSTIC AND THERAPEUTIC SERVICES IN ADDITION TO SEMINARS AND CLASSES TO THE COMMUNITY IN ORDER TO PROMOTE AWARENESS, TEACH WAYS OF PREVENTION, AND OFFER HEALTH SCREENINGS TO THE COMMUNITY. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT OVER 142.5 HOURS OF TIME ON THE CANCER AWARENESS SEMINARS. WAYNE HOSPITAL ALSO PROVIDED AWARENESS, PREVENTION, SCREENING OF BLOOD PRESSURE CLINIC. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT 11 HOURS OF TIME ON THE CLINIC. CHILD BIRTHING CLASSES, BREASTFEEDING CLASSES AND CHILD SIBLING CLASSES WERE OFFERED TO THE COMMUNITY. THE EMPLOYEES OF WAYNE HOSPITAL HAVE SPENT 216 HOURS OF TIME ON THE CHILD BIRTHING CLASSES.
Form 990, Part VI, Line 15b PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS	THE COMPENSATION FOR OTHER OFFICERS IS DETERMINED BY THE CEO USING MARKET STUDIES PROVIDED BY HUMAN RESOURCES, EVALUATIONS, AND PERFORMANCE. THE CEO DETERMINES THE APPROPRIATE COMPENSATION. THIS PROCESS WAS COMPLETED FOR THE CFO AND WAS LAST UNDERTAKEN IN 2015.
Form 990, Part VI, Line 1a Delegate broad authority to a committee	Section 2. Executive Committee. The Executive Committee shall consist of the Chairman, Vice Chairman, Secretary/Treasurer and two additional members of the Board of Trustees. Duties. The Executive Committee shall have power to transact all regular business of the Hospital during the period between the meetings of the board of Trustees, subject to any prior limitation imposed by the Board of Trustees and with the understanding that all matters of major importance shall be referred to the Board of Trustees. Minutes of the executive committee meetings shall be submitted to the Board and its actions shall be subject to approval or disapproval at the next regular Board meeting.
Form 990, Part VI, Line 6 Classes of members or stockholders	Wayne Hospital Company has members of the Corporation and consists of only one class of members. Any natural person of legal age or any organization, including corporations, partnerships, associations or similar entities ("Organization") may become a Member of the Corporation provided, in the case of a natural person, such person maintains a personal residence in Darke County, Ohio or is an employee of Wayne Hospital at the time he becomes a Member and, in the case of an Organization, the Organization maintains an office or other facility in Darke County. The membership of an Organization shall terminate if it ceases to have an office or other facility in Darke County.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	Any person desiring to become a Member may do so by contributing at least One Hundred Dollars to the Corporation in one lump sum payment for the general unrestricted use of the Corporation and shall be admitted as a Member unless it is determined by the Board of Trustees that such person does not meet certain qualifications set forth by the Articles of incorporation. No person shall be issued more than one membership, or entitled to direct that a membership shall be issued to another person or persons, regardless of the amount or number of contributions made by such person, except that in the event a husband and wife jointly contribute at one time Two Hundred Dollars or more, then each of them shall be admitted as Members. No membership may be transferred to another person or Organization, except in the case of an Organization, a membership may be transferred to a successor Organization that has an office or other facility in Darke County. Each Member which is not a natural person shall from time to time appoint an individual (a "Primary Representative") to represent such Member in the Corporation, to cast votes on behalf of such Member and to receive correspondence from the Corporation.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	Each Member of record in the membership book of the Corporation on the record date for a meeting of Members shall be entitled to one vote on each matter properly submitted to the Members for their vote. Members may vote at meeting either in person or by proxy. The membership book of the Corporation shall be reviewed on an annual basis to assure that the names of Members who have ceased to be Members are deleted and the names of persons who have become Members since the last annual review were properly recorded. The major item for vote by the Members each year is the Board of Trustee elections.
Form 990, Part VI, Line 11b Review of form 990 by governing body	A copy of the draft of the Form 990 is sent to each voting member of the governing body prior to the Board Meeting in which the Controller presents the major items relating to the Form 990. After the presentation, the Board has the opportunity to ask questions and then votes to approve the filing of the Form 990.
Form 990, Part VI, Line 12c Conflict of interest policy	The conflict of interest policy is signed annually by all management, senior management, officers, directors, and key employees. After the signed conflict of interest statements are submitted, they are reviewed by the Controller. Any conflicts of interest that are disclosed are discussed with the board chair, which ensures that the interested person abstains from voting on matters related to the conflict of interest.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	The executive board reviews and determines the compensation for the CEO. They use compensation surveys conducted by independent consulting companies in their decision making process. The VP of Human Resources compiles the survey information and provides to the Chairman of the Board independently of the CEO's influence. This process is completed for Wayne Deschambeau, CEO and was last undertaken in 2015.
Form 990, Part VI, Line 19 Required documents available to the public	The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	- Total Revenue: 72722, Related or Exempt Function Revenue: 72722, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees	Agency Employees - Total Expense: 3311217, Program Service Expense: 3172111, Management and General Expenses: 139106, Fundraising Expenses: ; Data Processing - Total Expense: 365353, Program Service Expense: 256255, Management and General Expenses: 109098, Fundraising Expenses: ; Consulting - Total Expense: 1794767, Program Service Expense: 1734767, Management and General Expenses: 60000, Fundraising Expenses: ; Collection Fees - Total Expense: 845598, Program Service Expense: , Management and General Expenses: 845598, Fundraising Expenses: ; Purchased Services - Total Expense: 879579, Program Service Expense: , Management and General Expenses: 879579, Fundraising Expenses: ; ICD-10 Services - Total Expense: 189, Program Service Expense: , Management and General Expenses: 189, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN VALUE OF INTEREST RATE SWAP - 113529; CHANGE IN VALUE IN RELATED ENTITIES - -7341;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wayne Hospital Company

Employer identification number

34-4428598

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) WAYNE HOSPITAL COMPANY PROFESSIONAL SERVICES LLC 835 SWEITZER STREET GREENVILLE,OH45331 27-0581440	PROFESSIONAL MEDICAL SERVICES	OH	-2,181,762	404,649	WAYNE HEALTHCARE

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)THE WAYNE HOSPITAL FOUNDATION INC 835 SWEITZER STREET GREENVILLE,OH45331 26-0380696	FUNDRAISING	OH	501(c)(3	Type I	WAYNE HEALTHCARE	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(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 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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) HEALTHWAY INC 835 SWEITZER STREET GREENVILLE,OH45331 31-1497938	PROVIDER NETWORK	OH	WAYNE HEALTHCARE	C Corporation		28,001	100 %	Yes

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

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

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

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

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

Yes

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

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

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

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

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

Yes

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

Yes

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

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	39,344	345,104
9	Program service revenue (Part VIII, line 2g) .........	56,807,146	57,250,307
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	7,457,942	3,091,312
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	574,281	418,536
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	64,878,713	61,105,259
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	18,370	30,745
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)	28,451,129	28,563,482
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)....	31,336,297	29,959,415
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	59,805,796	58,553,642
19	Revenue less expenses. Subtract line 18 from line 12.......	5,072,917	2,551,617
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	125,390,526	123,801,268
21	Total liabilities (Part X, line 26).............	37,674,365	36,448,431
22	Net assets or fund balances. Subtract line 21 from line 20.....	87,716,161	87,352,837

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 48,519,978 including grants of $ 30,745 ) (Revenue $ 57,478,748 )
	AS A FULL-SERVICE PRIMARY CARE FACILITY, WAYNE HOSPITAL OFFERS PHYSICIANS AND THEIR PATIENTS ACCESS TO A VARIETY OF INPATIENT AND OUTPATIENT SERVICES INCLUDING: EMERGENCY, RADIOLOGY, MATERNITY/SPECIAL BEGINNINGS, SURGERY, HEART HEALTH, CANCER CARE, REHABILITATION SERVICES, LABORATORY, CHRONIC DIALYSIS CENTER, AMBULATORY CARE, OUTPATIENT REHABILITATION, DIABETES EDUCATION PROGRAM, SLEEP CARE SERVICES, AND ENTEROSTOMAL THERAPY. THE HOSPITAL HAD APPROXIMATELY 2,167 ADMISSIONS AND 81,051 OUTPATIENT VISITS IN 2015. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY AT NO CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. IN ADDITION TO THE FINANCIAL ASSISTANCE PROVIDED, WAYNE HOSPITAL ALSO IS PROACTIVE IN SUPPORTING COMMUNITY WELLNESS THROUGH HEALTH SCREENINGS, EDUCATION, AND HEALTH MANAGEMENT.

4b	(Code: ) (Expenses $ 140,315 including grants of $ ) (Revenue $ 14,545 )
	WAYNE HOSPITAL HAS MANY ADDITIONAL PROGRAMS. ADDITIONAL PROGRAMS INCLUDE THE COUNTY AND CORPORATE HEALTH FAIRS IN WHICH EMPLOYEES FROM THE HOSPITAL PROVIDE OVER 155 HOURS OF TIME TO HELP WITH HEALTH SCREENINGS AND PROVIDE EDUCATIONAL INFORMATION TO THE COMMUNITY. IN ADDITION TO THE COUNTY AND CORPORATE HEALTH FAIRS, WAYNE HOSPITAL ALSO CONTRIBUTES 200 HOURS TO THE YOUTH HEALTH FAIR, WHICH IS A HEALTH FAIR GEARED TO ALL THE FIFTH GRADERS IN DARKE COUNTY. OVER 400 STUDENTS WERE IN ATTENDANCE. (CONTINUED ON SCHEDULE O)

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses48,660,293

(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) PETER LACHIEWICZ OB/GYN	40.0 .......................	X	489,087	0	35,694
(19) PATRICK KARR OB/GYN	40.0 .......................	X	501,481	0	34,790
(20) DANIEL MCKELLAR SURGEON	40.0 .......................	X	474,260	0	34,323
(21) DAVID M WARE SURGEON	40.0 .......................	X	497,619	0	35,546
(22) JEROME M LEAHEY FAMILY PRACTICE	40.0 .......................	X	127,436	0	29,335

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,998,011	0	279,443

1	Briefly describe the organization’s mission or most significant activities: The mission of Wayne Hospital Corporation is to provide quality care and promote wellness, regardless of ability to pay.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	576
6	Total number of volunteers (estimate if necessary) .............	6	115
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

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 above		1f	345,104

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		345,104

			Business Code
2a	NET PATIENT SERVICE REVENUE	621110	57,224,435	57,224,435
b	MEANINGFUL USE INCENTIVE PAYMENTS	621110	25,872	25,872
c
d
e
f	All other program service revenue.			0	0	0	0
g Total.Add lines 2a–2f.....			57,250,307

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			1,749,622			1,749,622
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents	750	345,663
b	Less: rental expenses		344,728
c	Rental income or (loss)	750	935
d	Net rental income or (loss)......			1,685			1,685
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	2,501	36,842,619
b	Less: cost or other basis and sales expenses	1,374	35,502,056
c	Gain or (loss)	1,127	1,340,563
d	Net gain or (loss).....			1,341,690			1,341,690
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		7,086
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			7,086			7,086
Business Code			Miscellaneous Revenue
11a	FOOD SALES		722210	166,779			166,779
b	HOUSEKEEPING		812900	28,199	28,199
c	REBATE REVENUE		900099	142,065	142,065
d	All other revenue ....			72,722	72,722	0	0
e	Total. Add lines 11a–11d ......			409,765
12	Total revenue. See Instructions......			61,105,259	57,493,293	0	3,266,862

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	30,745	30,745
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	612,458		612,458
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0	0	0
7	Other salaries and wages	19,769,174	17,417,902	2,351,272
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	566,845	496,476	70,369
9	Other employee benefits .......	6,077,431	5,322,974	754,457
10	Payroll taxes ...........	1,537,574	1,313,993	223,581
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	127,316		127,316
c	Accounting ...........	94,012		94,012
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	446,352		446,352
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	7,196,703	5,163,133	2,033,570	0
12	Advertising and promotion ....	196,101	180,899	15,202
13	Office expenses .......	103,692	62,869	40,823
14	Information technology ......	316,817	115,237	201,580
15	Royalties ..
16	Occupancy ...........	1,654,797	1,654,797	0
17	Travel ............	69,540	41,036	28,504
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	49,679	30,990	18,689
20	Interest ...........	1,219,554		1,219,554
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	5,423,228	5,043,602	379,626
23	Insurance ...	554,820	304,318	250,502
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	BAD DEBT	4,119,337	4,119,337
b	MEDICAL SUPPLIES	5,662,816	5,654,840	7,976
c	MAINTENANCE AGREEMENTS	1,494,456	899,268	595,188
d	DIETARY	325,552	285,711	39,841
e	All other expenses	904,643	522,166	382,477	0
25	Total functional expenses. Add lines 1 through 24e	58,553,642	48,660,293	9,893,349	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,413,807	1	6,843,920
2	Savings and temporary cash investments .........			5,691,580	2	6,773,466
3	Pledges and grants receivable, net ......			6,372	3	3,938
4	Accounts receivable, net .............			5,804,067	4	5,935,069
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
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
				0	6
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			1,294,183	8	1,420,774
9	Prepaid expenses and deferred charges ......			730,793	9	723,946
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	103,825,279
b	Less: accumulated depreciation	10b	61,068,000	46,907,157	10c	42,757,279
11	Investments—publicly traded securities .			55,048,438	11	54,102,436
12	Investments—other securities. See Part IV, line 11 .....			1,778,704	12	2,652,393
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			2,715,425	15	2,588,047
16	Total assets. Add lines 1 through 15 (must equal line 34)...			125,390,526	16	123,801,268

17	Accounts payable and accrued expenses .....	5,846,002	17	5,555,353
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	27,579,584	20	26,911,667
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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..	0	22
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	4,248,779	25	3,981,411
26	Total liabilities. Add lines 17 through 25..	37,674,365	26	36,448,431

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	87,531,615	27	86,868,192
28	Temporarily restricted net assets ...........	171,626	28	471,725
29	Permanently restricted net assets	12,920	29	12,920
	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 .....	0	30	0
31	Paid-in or capital surplus, or land, building or equipment fund ...	0	31	0
32	Retained earnings, endowment, accumulated income, or other funds	0	32	0
33	Total net assets or fund balances ...........	87,716,161	33	87,352,837
34	Total liabilities and net assets/fund balances ........	125,390,526	34	123,801,268