TY 2019 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) ERIC EVERMAN VICE CHAIR	1.0 .................	X	X	0	0
(2) JOHN DUTRO MD CHAIR/SURGEON	40.0 .................	X	X	194,323	14,308
(3) JOHN WARNER PAST CHAIR (PARTIAL YEAR)/BOARD MEMBER	1.0 ................. 1.0	X	X	0	0
(4) TODD DURHAM SEC/TREASURER	1.0 .................	X	X	0	0
(5) TRAVIS FLIEHMAN PAST CHAIR	1.0 ................. 1.0	X	X	0	0
(6) ANNA HATIC DO BOARD MEMBER	1.0 .................	X		0	0
(7) CAROLINE SCHMIDT BOARD MEMBER	1.0 .................	X		0	0
(8) DAN WATREN BOARD MEMBER	1.0 .................	X		0	0
(9) DON MILLER BOARD MEMBER	1.0 .................	X		0	0
(10) GEOFF WALKER BOARD MEMBER	1.0 .................	X		0	0
(11) M LYNNE HAWLEY MD BOARD MEMBER	1.0 .................	X		0	0
(12) MARY GARMAN BOARD MEMBER	1.0 .................	X		0	0
(13) MIKE GRAY BOARD MEMBER	1.0 .................	X		0	0
(14) MIKE MAIBERGER BOARD MEMBER (PARTIAL YEAR)	1.0 .................	X		0	0
(15) SUSAN SHIELDS BOARD MEMBER	1.0 .................	X		0	0
(16) TIM SNIDER BOARD MEMBER	1.0 .................	X		0	0
(17) JENNIFER WILLIAMS CFO	39.0 ................. 1.0		X	179,934	26,919

(A) Name and business address	(B) Description of services	(C) Compensation
SHOOK CONSTRUCTION CO 2000 W DOROTHY LANE MORAINE,OH45439	CONSTRUCTION CONTRACTOR	4,182,687
HORIZON HEALTH PO BOX 840839 DALLAS,TX752840839	SENIOR BEHAVIORAL HEALTH SERVICES	1,728,293
TRINITY 827 YARD ST COLUMBUS,OH43212	ARCHITECT SERVICES	1,694,854
KETTERING ANESTHESIA ASSOC 3500 PENTAGON BLVD SUITE 200 BEAVERCREEK,OH45431	ANESTHESIA SERVICES	1,474,640
HOSPITAL CARE GROUP PC 6435 W JEFFERSON BLVD PMB 109 FORT WAYNE,IN46804	HOSPITALISTS	1,271,032
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 29

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- 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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Wayne Hospital Company

Part I Contributors	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

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) (2019)

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(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

5,864

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

5,864

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 THESE DUES, $5,864 WAS SPENT ON LOBBYING.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- 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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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 ....	202,019	202,019	202,019	202,019	201,920
b	Contributions ...			0	0	0
c	Net investment earnings, gains, and losses	4,114		0	0	99
d	Grants or scholarships ...	29,113		0	0	0
e	Other expenditures for facilities and programs ...	164,099		0	0	0
f	Administrative expenses ....			0	0	0
g	End of year balance ......	12,921	202,019	202,019	202,019	202,019

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

4.68 %

Term endowment SchDMd Bullet

95.32 %

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 .....	2,056,184		2,056,184
b	Buildings ....	71,063,036	46,751,115	24,311,921
c	Leasehold improvements	2,940,812	2,192,793	748,019
d	Equipment ....	35,779,823	28,386,922	7,392,901
e	Other .....	13,761,215		13,761,215
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				48,270,240

Schedule D (Form 990) 2019

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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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)INSURANCE RECOVERY RECEIVABLE				38,488
(2)ACCOUNTS RECEIVABLE- OTHER				16,332
(3)DUE FROM CARE ASSURANCE
(4)ACCRUED INTEREST RECEIVABLE				37,664
(5)HOSPITALIST INCOME GUARANTEE - CURRENT PORTION				945,423
(6)HOSPITALIST INCOME GUARANTEE - LT PORTION
(7)TRUSTEE HELD ASSETS				35,842,566
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				36,880,473

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
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	3,682,347
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) 2019

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	78,426,571
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	5,160,992
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	94,724
e	Add lines 2a through 2d .....................			2e	5,255,716
3	Subtract line 2e from line 1..................			3	73,170,855
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	300,225
b	Other (Describe in Part XIII.) ...........	4b	-340,043
c	Add lines 4a and 4b....................			4c	-39,818
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	73,131,037

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	67,789,611
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	889,027
e	Add lines 2a through 2d....................			2e	889,027
3	Subtract line 2e from line 1...................			3	66,900,584
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	300,225
b	Other (Describe in Part XIII.) ............	4b	0
c	Add lines 4a and 4b.....................			4c	300,225
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	67,200,809

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 Internal Revenue Service has ruled the Hospital and Foundation are tax-exempt organizations as defined under Section 501(c)(3) of the Internal Revenue Code and are exempt from income taxes on related income pursuant to Section 501(a). WHC Professional Services, LLC. is a limited liability corporation and as such passes income to the members. Accordingly, no provision for income taxes has been made for this entity in the consolidated financial statements. The Hospital, Foundation, and WHC Professional Services, LLC. have filed their applicable federal and state income tax returns for periods through December 31, 2018. These income tax returns are generally open to examination by the relevant taxing authorities for a period of three years from the later of the dates the return was filed or its due date (including approved extensions). Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken and recognize a tax liability if an uncertain position has been taken that more likely than not would not be sustained upon examination by various federal and state taxing authorities. Management has analyzed the tax positions taken by these entities, and has concluded that as of December 31, 2019 and 2018, there are no uncertain positions taken or expected to be taken that would require recognition of a liability or disclosure in the accompanying consolidated financial statements. The entities are subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress.
Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990	CHANGE IN INTEREST OF RELATED PARTIES - 94724
Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements	RENTAL EXPENSES INCLUDED IN REVENUE - -387081 CONTRIBUTIONS NETTED WITH EXPENSES - 44572 HRSA EXPENSE INCLUDED IN REVENUE - 2466
Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990	RENTAL EXPENSES INCLUDED IN REVENUE - 387081 HRSA EXPENSE INCLUDED IN REVENUE - -2466 CHANGE IN VALUE OF INTEREST RATE SWAP - 548984 CONTRIBUTIONS NETTED WITH EXPENSES - -44572

Schedule D (Form 990) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- 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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

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) . . .			608,163	0	608,163	1.00 %
b	Medicaid (from Worksheet 3, column a) . . . . .			13,129,411	5,042,713	8,086,698	13.35 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			907,083		907,083	1.50 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	14,644,657	5,042,713	9,601,944	15.85 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			90,956	12,450	78,506	0.13 %
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) . . . .			117,192		117,192	0.19 %
j	Total. Other Benefits . .	0	0	208,148	12,450	195,698	0.32 %
k	Total. Add lines 7d and 7j .	0	0	14,852,805	5,055,163	9,797,642	16.18 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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	1		5,000		5,000	0.01 %
3	Community support	10		100,450		100,450	0.17 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building	1		5,000		5,000	0.01 %
7	Community health improvement advocacy					0	0 %
8	Workforce development					0	0 %
9	Other					0	0 %
10	Total	12	0	110,450	0	110,450	0.18 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

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. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

21,721,486

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

18,030,154

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

3,691,332

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) 2019

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?1Name, 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) 2019

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): https://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 18

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

Yes

If "Yes" (list url): https://www.waynehealthcare.org/our-community/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) 2019

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)

Was widely publicized 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):

www.waynehealthcare.org/visitors-and-patients/patient-information/financial-assistance

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

www.waynehealthcare.org/visitors-and-patients/patient-information/financial-assistance

A plain language summary of the FAP was widely available on a website (list url):
www.waynehealthcare.org/visitors-and-patients/patient-information/financial-assistance

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

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

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

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	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 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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

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

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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 3E	The significant health needs of the community are identified and prioritized through the CHNA.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - WAYNE HOSPITAL COMPANY. The following organizations and other groups consulted with Wayne HealthCare while conducting its most recent CHNA: - Greater Dayton Area Hospital Association - The Southwest District of the Association of Ohio Health Commissioners - Ohio Department of Health - Center for Disease Control and Prevention - Ohio Department of Job and Family Services This effort included: 42 community meetings that attracted 440 (unduplicated) participants; 715 Individual Consumer Surveys (includes 223 Mobile Surveys); 96 Agency Surveys; 74 Latino Consumer Surveys; 39 Surveys from refugees from Rwanda; 29 Health Department Surveys; as well as analysis of secondary data from the local and state level. The study addresses secondary data for maternal and infant health, clinical and preventive services, hospital data, and leading causes of death. Secondary data sources included: - AIDSvu - https://aidsvu.org/ - American Community Survey (5-year estimate 2012-2016) - Business Analyst, Delorme map data, ESRI, U.S. Census provided by RWJF 2018 County Health Rankings - Cancer Incidence: Ohio Department of Health, Ohio Cancer Incidence Surveillance System, 2014- 2015 - Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System - Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. 500 Cities Project Data 2016 - Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER Online Database, Underlying Causes of Death and Multiple Causes of Death - Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention - Centers for Disease Control and Prevention's national HIV surveillance program - Comprehensive Housing Affordability Strategy (CHAS) data - County Health Rankings 2018 - American Community Survey, 5-year estimates - County Health Rankings 2018 - Area Health Resource File/American Medical Association - County Health Rankings 2018 - Area Health Resource File/National Provider Identification File - County Health Rankings 2018 - Behavioral Risk Factor Surveillance System - County Health Rankings 2018 - Bureau of Labor Statistics - County Health Rankings 2018 - Centers for Disease Control and Prevention Diabetes Interactive Atlas - County Health Rankings 2018 - National Highway Traffic Safety Administration, Fatality Analysis Reporting System - County Health Rankings 2018 - National Center for Education Statistics - County Health Rankings 2018 - National Center for Health Statistics - County Health Rankings 2018 - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB prevention - County Health Rankings 2018 - Small Area Income and Poverty Estimates - County Health Rankings 2018 - U.S. Census Bureau's Small Area Health Insurance - Dartmouth Atlas of Healthcare. Accessed on 2/6/18 at www.countyhealthrankings.org/explore-health-rankings/rankings-data-documentation - Data USA (Cincinnati) - Access to Care - ED Facts provided by RWJF 2018 County Health Rankings - Environmental Protection Agency. Air Quality System Monitoring Data. State Air Monitoring Data. Annual PM 2.5 Level (Monitor only). Accessed from Environmental Public Health Tracking Network: https://ephtracking.cdc.gov/ accessed on 03/01/2018 - Environmental Public Health Tracking Network - Federal Bureau of Investigation (FBI), Uniform Crime Reporting (UCR), Crime in the United States. Available at: https://crime-data-explorer.fr.cloud.gov/ - Feeding America, Map the Meal Gap, Accessed March 9, 2018 - Greater Cincinnati Community Health Status Survey - www.governing.com/gov-data/health/county-suicide-death-rates-map.html - Indiana State Health Department - Kentucky Cancer Registry - Kentucky State Health Department - http://kentuckyhealthfacts.org/ - Measure of America - National Center for Health Statistics - https://data.cdc.gov/ - National Center for Health Statistics - Mortality Files - National Center for Health Statistics - Natality files - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention - Northern Kentucky Health District - Ohio Department of Health, Death Certificates - Ohio Department of Health, HIV/AIDS Surveillance Program. Data reported through 6/30/17 - Ohio Department of Health, STD Surveillance Program. Data reported through 5/7/2017 - Ohio Department of Health: Center for Public Health Statistics and Informantics. Ohio Public Health Information Warehouse - Ohio Emergency Medical Services; Naloxone Administration by Ohio EMS Providers, accessed at https://www.ems.ohio.gov/index.aspx#gsc.tab=0 - Population: Bridged-Race County Population data from National Center for Health Statistics (NCHS), Ohio Department of Health, 2014-2015 - PreventionFIRST! Student Drug Use Survey, through 2017 - Safe Drinking Water Information System - U.S. Census Bureau, 2012-2016 American Community Survey 5-Year Estimates - U.S. Census Bureau, County Business Patterns - U.S. Census Population Estimates - Uniform Crime Reporting - FBI - USDA Food Environment Atlas To ensure broad representation but also inclusion of vulnerable populations, the CHNA Team and its partners did the following: - Marketing the community meetings through hospitals, health departments, and community-based nonprofit organizations with follow-up email and phone calls to nonprofit agencies that had not been engaged in past CHNA meetings. - Addressed two meetings of grantees for Interact for Health's Thriving Community initiative to publicize the meetings and share the link to the online survey. - Solicited input in smaller focus group settings for people who were African-American; Latino; elderly; identifying as belonging within the LBGTQ+ community; or members of Cincinnati's Creating Healthy Communities initiative - and asked them to share the survey link with friends, family, and colleagues. - Engaged native speakers who were health and outreach workers to conduct one-on-one surveys with Latinos and refugees from the conflict in Rwanda. - Sent college student interns to community events and festivals, which attracted the general public as well as those which targeted specific populations, such as Cincy Cinco, Asian Food Fest, and Juneteenth (among others) - they conducted the surveys on mobile tablets with drop-down menus. - People Working Cooperatively also administered mobile surveys in low-income homes, for elderly and disabled residents, where their nonprofit was making repairs and/or accessibility modifications. - Medical offices shared surveys with patients who were minorities or receiving substance abuse treatment.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - LIST OF ALL HOSPITAL FACILITIES WITH WHICH WE COLLABORATED:. The Christ Hospital Health Network Cincinnati Children's Hospital Medical Center Clinton Memorial Hospital Highpoint Health Kettering Health Network Fort Hamilton Hospital Grandview Medical Center Greene Memorial Hospital Kettering Behavioral Medicine Center Kettering Medical Center Soin Medical Center Southview Medical Center Sycamore Medical Center Lindner Center of HOPE McCullough Hyde Memorial Hospital Mercy Health \| Cincinnati Region Mercy Health - Anderson Hospital Mercy Health - Clermont Hospital Mercy Health - Fairfield Hospital Mercy Health - West Hospital The Jewish Hospital - Mercy Health Mercy Health \| Springfield Region Mercy Health - Urbana Hospital Springfield Regional Medical Center Premier Health Atrium Medical Center Miami Valley Hospital Miami Valley Hospital North Miami Valley Hospital South Upper Valley Medical Center TriHealth Bethesda Butler Hospital Bethesda North Hospital Good Samaritan Hospital TriHealth Evendale Hospital UC Health Daniel Drake Center for Post-Acute Care University of Cincinnati Medical Center West Chester Hospital Wayne HealthCare Wilson Health
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - WAYNE HOSPITAL COMPANY. - BRETHERN RETIREMENT COMMUNTY - COUNCIL ON RURAL SERVICES - DARKE COUNTY - DARKE COUNTY CHAMBER OF COMMERCE - DARKE COUNTY COMMISSONER'S OFFICE - DARKE COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES - DARKE COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES - DARKE COUNTY HEALTH DEPARTMENT - DARKE COUNTY HEALTH DEPARTMENT - DARKE COUNTY HEALTH DEPARTMENT - DARKE COUNTY PARK DISTRICT - DARKE COUNTY SCHOOLS - DARKE COUNTY UNITED WAY - FAMILY HEALTH - GRACE RESURRECTION COMMUNITY CENTER - GREATER DAYTON AREA HOSPITAL ASSOCIATION - THE HEALTH COLLABORATIVE - THE SOUTHWEST DISTRICT OF THE ASSOCIATION OF OHIO HEALTH COMMISSIONERS - TRI-COUNTY BOARD OF RECOVERY AND MENTAL SERVICES - TRI-COUNTY BOARD OF RECOVERY AND MENTAL SERVICES
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - WAYNE HOSPITAL COMPANY. Wayne HealthCare partnered with the Greater Dayton Area Hospital Association, the Southwest District of the Association of Ohio Health Commissioners, Ohio Department of Health, 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 2019-2021 Community Health Needs Assessment (CHNA) with Gwen Finegan serving as the lead consultant. Her role involved responsibility for the following activities: Day-to-day management of operations; Identifying and vetting data resources; Liaison with THC and GDAHA; Regular reporting to THC; Liaison with community organizations; Liaison with Southwest Association of Ohio Health Commissioners; Process design and implementation (including but not limited to timeline creation; creation of materials; creation of survey questions; meeting design; and overall approach and methodology); Quality control and oversight; Supervision of subcontractors; Support for hospital and public health representatives (including presentation at meetings, webinar training, communication by phone and email, facilitation of specific requests, and sharing best practice resources); Selection of data and creation of tables for mapping; Creation of regional data tables; Research for causes of death; Designing and formatting final report; Writing final report A community health needs assessment engages community members and partners to collect and analyze health-related data from many sources. The 2019-21 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 & health education/promotion; access to care; and mental health. In support of the 2019-21 Community Health Needs Assessment and ongoing community benefit initiatives, Wayne HealthCare will implement the following strategies to impact and measure community health improvement. Chronic Disease Prevention & Health Education/Promotion Implementation Strategies Goal: Improve opportunities for chronic disease prevention by supporting education and programming that focuses on risk factor management. Objective 1: By December 2021, increase opportunities for health education/promotion and prevention programs outside of the traditional healthcare setting. Activity 1: Inventory existing partnerships with organizations that do not directly provide healthcare services. Activity 2: Partner with local businesses, human service organizations, libraries, and other entities that may not traditionally offer health education and prevention programs to meet people where they are by going to them with prevention-focused programming and educational opportunities. Activity 3: Increase marketing of behavior change and risk factor management programs and availability of health education activities, such as the Healthy Living Series, Cardiopulmonary rehabilitation, and clinical exercise program, to organizations in the community. Objective 2: By December 2021, increase participation in primary and secondary prevention programs and activities. Activity 1: Increase participation in the Healthy Living Series Program (Prevent T2), which meets the guidelines for the National Diabetes Prevention Program and is approved by the Centers for Medicare and Medicaid Services. Strategy 1: Provide enrollment and retention support for the National Diabetes Prevention Program through a grant from the Ohio Department of Health (ODH). The grant will cover the cost to participate in the program for those who meet grant requirements. Strategy 2: Increase awareness of the program by using the new wellness digital platform to educate individuals in the community the lifestyle skills the program teaches. Strategy 3: Partner with providers and community organizations to inform individuals in the community that Medicare will cover the cost of the program when they meet requirements to participate. Strategy 4: Expand grant eligibility standards to reach more low-income participants. Activity 2: Increase participation in primary and secondary prevention programs in the Lifestyle Enhancement Center. Strategy 1: Expand opportunities for community to participate in clinical exercise program, with a renewed focus on weight management. Strategy 2: Improve marketing aimed at the general community and providers regarding opportunities for cardiopulmonary rehabilitation. Strategy 3: Increase retention rate of patients transitioning to maintenance phase of cardiopulmonary rehabilitation. Activity 3: Expand availability of cancer-focused primary and secondary prevention programs. Strategy 1: Initiate Survivor's Strength clinical exercise secondary prevention program. Strategy 2: Expand marketing of tobacco cessation programs currently available to the public in the Lifestyle Enhancement Center. Activity 4: Implement wellness portal to increase access to information on age-appropriate preventive screening, health education materials, and promote opportunities for engagement in primary and secondary prevention. Priority: Mental Health Goal: Improve opportunities for geriatric behavioral health management and support through patient screening and community education opportunities. Objective 1: By December 2021, implement geriatric depression and geriatric anxiety screenings on all patients to the inpatient Senior Behavioral Health unit. Activity 1: Implement Geriatric Depression Scale screening on all patients admitted to the Senior Behavioral Health unit completed at the time of admission and the time of discharge. Activity 2: Implement Geriatric Anxiety Scale screening on all patients admitted to the Senior Behavioral Health unit completed at the time of admission and the time of discharge. Objective 2: By December 2021, increase community education programming based on the data gathered through the geriatric screening tools. Activity 1: Analyze data geriatric anxiety and depression screening results on patients admitted to the Senior Behavioral Health unit. Activity 2: Increase the number of community partners, skilled facilities, and other geriatric health and wellness providers reached through outreach meetings, community activities, and other networking events, to promote and share the findings of the data collected. Activity 3: Actively promote the online mental health screening tool provided by the Tri-County Board of Recovery and Mental Health Services during community outreach events. Activity 4: Partner with more organization to provide information on geriatric mental health and wellness at community events and health fairs. Objective 3: By December 2021, expand education opportunities among staff and volunteers for identifying mental health issues. Activity 1: Expand opportunities for education on suicidal risk assessments and risk for self-harm assessment for all hospital personnel. Activity 2: Improve competencies for nursing personnel regarding assessment of the psychiatric mental health patient. Priority: Access to Care Goal: Improve access to clinical care in Darke County. Objective 1: By December 2021, leverage Wayne HealthCare Professional Services LLC to increase primary care access in Darke County. Activity 1: Continually assess needs and meet identified needs with appropriate service lines and personnel. Activity 2: Increase primary care opportunities within Wayne HealthCare Professional Services LLC. Activity 3: Increase marketing of current primary care providers and Walk-in Care. Objective 2: By December 2021, streamline processes to increase reach of OB/GYN services, with a focus on engagement in prenatal care. Activity 1: Market availability of OB/GYN services. Activity 2: Increase health education regarding prenatal care, targeting vulnerable populations For more information on how Wayne HealthCare is addressing health priorities in our community, visit www.waynehealthcare.org/media/file/Implementation_Strategy%202019_2021_Final.pdf

Schedule H (Form 990) 2019

Page 9

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) 2019

Page 10

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 V, Section B, Line 3 Line 3i Supplemental Information	THE HOSPITAL PARTICIPATED IN THE PREPARATION OF A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT THAT COVERED 35 HOSPITALS AND 28 LOCAL HEALTH DEPARTMENTS. IN ADDITION TO THE COLLABORATIVE EFFORT, THE HOSPITAL COMPLETED AN EVALUATION OF THE IMPACT OF ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED ITS PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT. THIS EVALUATION WAS COMPLETED SUBSEQUENT TO THE END OF THE TAX YEAR AND HAS BEEN APPROVED BY THE GOVERNING BODY.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	6635106
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	IN ORDER TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE FOR LINE 7, A COST-TO-CHARGE RATIO WAS USED. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES AS PROVIDED WITHIN THE IRS INSTRUCTIONS FOR COMPLETION OF SCHEDULE H.
Schedule H, Part II Community Building Activities	WAYNE HEALTHCARE CONTRIBUTED $5,000 TO PARTNERING FOR PROGRESS WHICH IS A COLLABORATIVE ECONOMIC DEVELOPMENT EFFORT PROVIDING COMPREHENSIVE SUPPORT TO THE DARKE COUNTY BUSINESS COMMUNITY. WAYNE HEALTHCARE CONTRIBUTED $2,500 TO EDISON COMMUNITY STATE COLLEGE FOUNDATION TO SUPPORT THE NURSING STUDENTS IN THE PROGRAM TO EARN AN RN DEGREE. WAYNE HEALTHCARE CONTRIBUTED $3,500 TO DARKE COUNTY WELLNESS CHALLENGE TO PROMOTE COMMUNITY HEALTH THROUGHOUT A MULTITUDE OF RUNNING/WALKING EVENTS IN DARKE COUNTY. WAYNE HEALTHCARE CONTRIBUTED $2,500 TO THE YMCA OF DARKE COUNTY FOR THEIR ANNUAL CAMPAIGN THAT ASSISTS FAMILIES TO SUBSIDIZE THEIR MEMBERSHIP FEES, ENABLING THEM TO RECEIVE DISCOUNTED CHILDCARE, TAKE SWIM LESSONS, PARTICIPATE IN GROUP EXERCISE CLASSES AND USE THE YMCA FACILITY FOR FAMILY ACTIVITIES. WAYNE HEALTHCARE CONTRIBUTED $4,500 TO YOLO OF DARKE COUNTY, INC. TO SUPPORT BRINGING TOGETHER HIGH ENERGY INDIVIDUALS WITH A GOAL OF LIVING LIFE TO THE FULLEST AND GIVING BACK TO THE COMMUNITY. WAYNE HEALTHCARE CONTRIBUTED $1,100 TO BIG BROTHERS BIS SISTERS OF SHELBY AND DARKE COUNTY TO HELP SPONSOR FAMILY ACTIVITIES. WAYNE HEALTHCARE CONTRIBUTED $3,150 TO DARKE COUNTY UNITED WAY TO HELP ASSESS AND ADDRESS HEALTH AND HUMAN SERVICE NEEDS IN OUR COMMUNITY. WAYNE HEALTHCARE CONTRIBUTED $5,000 TO COALITION FOR HEALTHY DARKE COUNTY TO HELP SUPPORT THE CREATION OF A HEALTHY, VIBRANT, SAFE AND SECURE COMMUNITY. WAYNE HEALTHCARE CONTRIBUTED $75,000 TO THE CITY OF GREENVILLE SOUTH PARK PROJECT TO HELP SUPPORT FAMILY ACTIVITIES . WAYNE HEALTHCARE CONTRIBUTED $1,200 TO DARKE COUNTY CENTER FOR THE ARTS TO PROVIDE A POSITIVE IMPACT ON THE QUALITY OF LIFE IN OUR COMMUNITY. WAYNE HEALTHCARE CONTRIBUTED $2,000 TO THE DARKE COUNTY AGRICULTURAL SOCIETY FOR THE JUNIOR FAIR RENOVATION CAMPAIGN. WAYNE HEALTHCARE CONTRIBUTED $5,000 TO BRETHREN RETIREMENT COMMUNITY FOR THEIR ANNUAL CAPITAL CAMPAIGN.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	FOR FINANCIAL STATEMENT PURPOSES, Wayne Hospital Company HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). Implicit price concessions includes BAD DEBTS. Therefore, Bad debts ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 and bad debt expense is not separately reported as an expense on IRS Form 990, Part IX. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT attributable to patients eligible under Norton Hospital's financial assistance policy ON A GROSS BASIS.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	On January 1, 2019, the Hospital adopted Financial Accounting Standards Board (FASB) Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers (Topic 606), herby referred to as "ASC 606". ASC 606 outlines a single comprehensive model for recognizing revenue as performance obligations, defined in a contract with a customer as goods or services transferred to the customer in exchange for consideration, are satisfied. The standard also requires expanded disclosures regarding the Hospital's revenue recognition policies and significant judgements employed in the determination of revenue. The Hospital applied the modified retrospective approach to all contracts when adopting ASC 606. As a result, upon the Hospital's adoption of ASC 606, the majority of what was previously classified as the provision for bad debts in the consolidated statement of operations and changes in net assets is now reflected as implicit price concessions (as defined in ASC 606) and therefore is included as a reduction to patient care service revenues in 2019. For periods prior to the adoption of ASC 606, the provision for bad debts was presented consistent with the previous revenue recognition standards that required such provision to be presented separately as a component of new operating revenues. Additionally, upon adoption of ASC 606, the allowance for doubtful accounts of approximately $4,126,000 as of December 31, 2018 was reclassified as a component of patient accounts receivable. Other than these changes, the adoption of ASC 606 did not have a material impact on the 2019 financial statements and the Hospital does not expect it to have a material impact on its results of operations on a prospective basis. As part of the adoption of ASC 606, the Hospital elected two of the available practical expedients provided for in the standard. First, the Hospital does not adjust the transaction price for any financing components as those were deemed insignificant. Additionally, the Hospital expenses all incremental customer contract acquisition costs as incurred because such costs are not material and would be amortized over a period of less than one year.
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, which incorporates the cost to charge ratio. Wayne HealthCare has a large percentage of Medicare patients in the community it serves and shortfalls may arise when payments received 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: www.waynehealthcare.org/visitors-and-patients/patient-information/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website	- Wayne Hospital Company: Line 16b URL: www.waynehealthcare.org/visitors-and-patients/patient-information/financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- Wayne Hospital Company: Line 16c URL: www.waynehealthcare.org/visitors-and-patients/patient-information/financial-assistance;
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 GREATER DAYTON AREA HOSPITAL ASSOCIATION, WITH GWEN FINEGAN SERVING AS THE LEAD CONSULTANT, AND 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 51,300. APPROXIMATELY 9.5% OF THE COUNTY INCOME LEVEL IS UNDER THE FEDERAL POVERTY GUIDELINES AND 28.4% OF THE REVENUES FOR THE HOSPITAL WERE MEDICAID PATIENTS IN 2019. THE COUNTY UNEMPLOYMENT RATE IN 2018 WAS 3.5%. 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. A MAJORITY OF THESE INDIVIDUALS ARE NEITHER EMPLOYEE'S OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. 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. OVER 140 PEOPLE PARTICIPATED IN THE PROGRAMS FOR TOBACCO CESSATION, CARDIAC DISEASE, HEART FAILURE, CARDIAC & PULMONARY REHAB . THE HEALTHY MOMENTS PROGRAM IS AVAILABLE TO THE EMPLOYEES AND THE PUBLIC IS INVITED. IN 2019 170 PARTICIPANTS ATTENDED THE HEALTHY MOMENTS SESSIONS.
Schedule H, Part VI, Line 7 State filing of community benefit report	OH

Schedule H (Form 990) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Wayne Hospital Company

Employer identification number
34-4428598

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) CITY OF GREENVILLE 100 PUBLIC SQUARE GREENVILLE,OH45331	34-6400593	CITY OF GREENVILLE	75,400	PROGRAM SUPPORT
(2) BRETHREN RETIREMENT COMMUNITY 750 CHESTNUT STREET GREENVILLE,OH45331	34-4431168	501(C)3	6,500	GENERAL SUPPORT
(3) Loyal Order of the Moose 1200 Sweitzer St Greenville,OH45331	34-4292710	501(c)(8)	8,000	GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

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

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

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

Part IV

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

Return Reference

Explanation

Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.

Wayne HealthCare provides grant support to perpetuate and advance the highest quality of health care services at Wayne HealthCare and the surrounding communities along with providing funds to other organizations that will improve the health of the community. Wayne HealthCare's Senior Leadership team reviews and approves all grants and other assistance provided to organizations and individuals to ensure that grants are used for proper purposes and are not otherwise diverted from the intended use. If the Hospital receives a large request mid year that has not been budgeted the request is taken to the Board for review and approval.

Schedule I (Form 990) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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 nonfixed
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) 2019

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 CHAIR/SURGEON	(i) (ii)	188,073 ------------- 0	6,250 ------------- 0	0 ------------- 0	2,372 ------------- 0	11,936 ------------- 0	208,631 ------------- 0	0 ------------- 0
2JENNIFER WILLIAMS CFO	(i) (ii)	158,423 ------------- 0	21,511 ------------- 0	0 ------------- 0	5,640 ------------- 0	21,279 ------------- 0	206,853 ------------- 0	0 ------------- 0
3WAYNE DESCHAMBEAU CEO	(i) (ii)	313,178 ------------- 0	62,588 ------------- 0	5,000 ------------- 0	8,480 ------------- 0	21,862 ------------- 0	411,108 ------------- 0	0 ------------- 0
4SHELTON MONGER CIO	(i) (ii)	149,607 ------------- 0	20,222 ------------- 0	0 ------------- 0	5,193 ------------- 0	962 ------------- 0	175,984 ------------- 0	0 ------------- 0
5PEGGY SCHULTZ VP HUMAN RESOURCES	(i) (ii)	145,963 ------------- 0	20,170 ------------- 0	0 ------------- 0	5,257 ------------- 0	9,742 ------------- 0	181,132 ------------- 0	0 ------------- 0
6KIMBERLEE FREEMAN VP OF PATIENT CARE/CNO	(i) (ii)	154,947 ------------- 0	21,923 ------------- 0	0 ------------- 0	5,612 ------------- 0	21,852 ------------- 0	204,334 ------------- 0	0 ------------- 0
7PETER LACHIEWICZ OB/GYN	(i) (ii)	420,654 ------------- 0	44,831 ------------- 0	0 ------------- 0	8,480 ------------- 0	12,028 ------------- 0	485,993 ------------- 0	0 ------------- 0
8PATRICK KARR OB/GYN	(i) (ii)	400,516 ------------- 0	41,196 ------------- 0	0 ------------- 0	8,480 ------------- 0	21,965 ------------- 0	472,157 ------------- 0	0 ------------- 0
9STEPHANIE BUCHANAN SURGEON	(i) (ii)	388,038 ------------- 0	13,333 ------------- 0	0 ------------- 0	8,480 ------------- 0	12,011 ------------- 0	421,862 ------------- 0	0 ------------- 0
10KARA SCHULTZ SURGEON	(i) (ii)	346,060 ------------- 0	15,968 ------------- 0	0 ------------- 0	8,480 ------------- 0	202 ------------- 0	370,710 ------------- 0	0 ------------- 0
11ALISHA REISS SURGEON	(i) (ii)	436,034 ------------- 0	369 ------------- 0	0 ------------- 0	8,480 ------------- 0	21,947 ------------- 0	466,830 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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 5a Compensation contingent 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) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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	34-6400361	237242AS1	09-12-2019	27,449,851	SEE PART VI		X		X		X
B	COUNTY OF DARKE OHIO	34-6400361	000000000	09-12-2019	39,414,756	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0		0
2 Amount of bonds legally defeased ..............	0		0
3 Total proceeds of issue ..................	27,597,609		39,414,756
4 Gross proceeds in reserve funds .............	1,102,240		0
5 Capitalized interest from proceeds .............	0		0
6 Proceeds in refunding escrows ...............	0		0
7 Issuance costs from proceeds ...............	225,000		565,661
8 Credit enhancement from proceeds .............	0		0
9 Working capital expenditures from proceeds .............	0		0
10 Capital expenditures from proceeds .............	1,044,509		618,497
11 Other spent proceeds .............	0		24,102,135
12 Other unspent proceeds .............	25,225,860		14,128,463
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........		X	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........		X		X
16 Has the final allocation of proceeds been made? ..........		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part Ⅲ

Private Business Use

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

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

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		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 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

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

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

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

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference	Explanation
Schedule K, Part I, Column (f) BOND ISSUES LINE A	THE SERIES 2019A BONDS WERE ISSUED TO PROVIDE THE FUNDS WHICH WILL BE USED TO (I) PROVIDE A PORTION OF THE MONIES NECESSARY TO FINANCE CERTAIN CAPITAL IMPROVEMENT PROJECTS CONSISTING OF THE ACQUISITION, CONSTRUCTION, FURNISHING AND EQUIPPING OF ADDITIONS AND IMPROVEMENTS TO "HOSPITAL FACILITIES" AS THE TERM IS DEFINED IN SECTION 140.01 OF THE OHIO REVISED CODE; (II) FUND A DEBT SERVICE RESERVE FUND FOR THE SERIES 2019A BONDS, (III) PAY INTEREST ON A PORTION OF THE SERIES 2019A BONDS; AND (IV) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2019A BONDS.
Schedule K, Part I, Column (f) BOND ISSUES LINE B	THE SERIES 2019BC BONDS WERE ISSUED TO (I) FINANCE THE COSTS OF ACQUIRING, CONSTRUCTING, EQUIPPING, INSTALLING AND IMPROVING "HOSPITAL FACILITIES" AS THE TERM IS DEFINED IN SECTION 140.01 OF THE OHIO REVISED CODE; (II) CURRENTLY REFUND THE OUTSTANDING PRINCIPAL AMOUNT OF THE COUNTY'S ADJUSTABLE RATE DEMAND HOSPITAL FACILITIES REFUNDING REVENUE BONDS, SERIES 2010 (WAYNE HOSPITAL) DATED NOVEMBER 1, 2010 ISSUED IN THE ORIGINAL PRINCIPAL AMOUNT OF $30,000,000, WHICH FINANCED AND REFINANCED THE COSTS OF EQUIPPING, INSTALLING AND IMPROVING HOSPITAL FACILITIES; AND (III) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2019BC BONDS.
Schedule K, Part II, Line 3 BOND ISSUES COLUMN A	TOTAL PROCEEDS OF THE ISSUE 27,597,609, WHICH ARE TOTAL PROCEEDS OF 27,449,851 PLUS INTEREST EARNINGS OF 147,758.
Schedule K, Part II, Line 11 BOND ISSUES COLUMN B	Related to the current refunding of the Series 2010 Bonds described above.
Schedule K, Part II, Line 12 BOND ISSUES COLUMN B	Relates to the remaining amount of undrawn bond proceeds.

Schedule K (Form 990) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

- 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

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 79 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 160 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 77 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 57 HOURS OF TIME ON THE CHILD BIRTHING CLASSES.
Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES	THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED BY THE CEO USING MARKET STUDIES PROVIDED BY HUMAN RESOURCES, EVALUATION, AND PERFORMANCE. THE CEO DETERMINES THE APPROPRIATE COMPENSATION. THIS PROCESS WAS COMPLETED FOR THE CFO AND KEY EMPLOYEES AND WAS LAST UNDERTAKEN IN 2019.
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. The Corporate Member shall have the right to appoint up to two (2) representatives from the Directors appointed by it (or their designees) to be member(s) of the Executive Committee; provided that any such Director (or their designee) is either a senior Premier Health Partners clinical or management employee. To the extent a Director's designee is appointed by the Corporate Member to serve on the Executive Committee, such designee shall be considered an ex-officio Director, with vote, for the purposes of his/her service on the Executive Committee only. 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 4 Significant changes to organizational documents	During the tax year, the organization's By-Laws were amended to change the qualifications of appointment and/or privileges of the governing body's voting members.
Form 990, Part VI, Line 6 Classes of members or stockholders	The Corporation shall have two (2) Members as follows: (1) those persons, corporations, associations or other entities who shall have been members as set forth in the register of membership book of the Corporation as of April 1, 2017 (the "Individual Members") and those additional Individual Members admitted as Members to the Corporation in accordance with Section 1.2 hereof shall collectively hold a 66.7% (two-thirds) percentage interest in the Corporation; and (3) Premier Health Partners (the "Corporate Member") shall hold a 33.3% (one-third) percentage interest in the Corporation.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	THE BOARD SHALL CONSIST OF EIGHTEEN (18) DIRECTORS ELECTED BY THE MEMBERS AS FOLLOWS: (1) TWELVE (12) DIRECTORS SHALL BE ELECTED BY THE INDIVIDUAL MEMBERS AND SIX (6) DIRECTORS SHALL BE APPOINTED BY THE CORPORATE MEMBER. EXCEPT AS OTHERWISE PROVIDED IN THIS CODE OF REGULATIONS OR BY THE ARTICLES OF INCORPORATION, THE ACT OF THE MAJORITY OF THE DIRECTORS, EXCLUDING NONVOTING, EX OFFICIO DIRECTORS PRESENT AT ANY MEETING OF THE BOARD AT WHICH A QUORUM IS PRESENT SHALL BE THE ACT OF THE BOARD. DIRECTORS MAY NOT VOTE BY PROXY. FOR THE PURPOSES OF VOTING ON ANY MATTER BEFORE THE BOARD, EACH DIRECTOR ELECTED BY THE INDIVIDUAL MEMBERS SHALL HAVE ONE (1) VOTE AND THE DIRECTORS APPOINTED BY THE CORPORATE MEMBER SHALL COLLECTIVELY HAVE THE RIGHT TO EXERCISE A TOTAL OF SIX (6) VOTES ON ANY MATTER BEFORE THE BOARD, SUCH THAT THE DIRECTORS ELECTED BY THE INDIVIDUAL MEMBERS SHALL HAVE THE AUTHORITY TO EXERCISE TWO-THIRDS OF THE VOTING POWER OF THE BOARD AND THE CORPORATE MEMBER'S APPOINTED DIRECTORS SHALL HAVE THE AUTHORITY TO COLLECTIVELY EXERCISE ONE-THIRD OF THE VOTING POWER OF THE BOARD. THE VOTING RIGHTS OF THE CORPORATE MEMBER'S APPOINTED DIRECTORS AT ANY BOARD MEETING SHALL BE DETERMINED BY DIVING SIX (6) BY THE NUMBER OF CORPORATE MEMBER'S DIRECTORS IN ATTENDANCE AT SUCH MEETING. THE CORPORATE MEMBER SHALL UNDERTAKE GOOD FAITH EFFORTS TO ENSURE THAT THREE (3) OF ITS SIX (6) APPOINTED DIRECTORS ATTEND BOARD MEETINGS, IN WHICH EVENT, EACH SUCH DIRECTOR SHALL HAVE THE RIGHT TO EXERCISE TWO (2) VOTES. DUE TO UNFORESEEN OR UNEXPECTED CIRCUMSTANCES, THERE MAY BE OCCASIONS WHERE LESS THAN THREE (3) OF THE CORPORATE MEMBER'S APPOINTED DIRECTORS WILL BE ABLE TO ATTEND A BOARD MEETING, IN WHICH CASE, THE CORPORATE MEMBER'S APPOINTED DIRECTOR(S) IN ATTENDANCE SHALL HAVE THE VOTING RIGHTS AS DETERMINED PURSUANT TO THE FORMULA SET FORTH ABOVE.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	THE CORPORATE MEMBER SHALL HAVE RESERVED POWERS OVER SIGNIFICANT GOVERNANCE TRANSACTIONS, SUCH AS THE FOLLOWING: MATERIAL CHANGES TO THE CORPORATION'S ARTICLES OF INCORPORATION AND/OR CODE OF REGULATIONS; DISTRIBUTION OR TRANSFER OF ASSETS; MATERIAL CHANGES IN THE OPERATIONS, PURPOSE OR STATUS OF THE HOSPITAL, OR AS AN ORGANIZATION EXEMPT FROM TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE; MERGER, CONSOLIDATION, SALE, DISSOLUTION OR ANY OTHER COMBINATION; AND SIGNIFICANT BORROWING AND CAPITAL EXPENDITURES (AS MORE FULLY DESCRIBED IN SECTION 1.14 OF THE CODE OF REGULATIONS.)
Form 990, Part VI, Line 11b Review of form 990 by governing body	The Form 990 is reviewed and approved by the CFO. Due to the timing of the organizations governing body meeting schedule the Finance Committee then reviews the Form 990 in detail and approves. The Finance Committee then reports to the full governing body at a board meeting. During the board meeting any questions or discussions related to the Form 990 are addressed.
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 CFO. Any conflicts of interest that are disclosed and 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 2019.
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: 108307, Related or Exempt Function Revenue: 108307, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 5 JOHN DUTRO, SEC/TREAS/SURGEON	JOHN DUTRO IS AN OFFICER OF THE BOARD IN HIS CAPACITY AS THE SECRETARY AND TREASURER. HE IS NOT COMPENSATED FOR HIS SERVICES RENDERED TO THE BOARD AS AN OFFICER. IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS, PART IX, LINE 5 REPORTS DR. DUTRO'S COMPENSATION FOR SERVICES RENDERED AS A SURGEON OF THE ORGANIZATION.
Form 990, Part IX, Line 11g Other Fees	Agency Employees - Total Expense: 8324892, Program Service Expense: 8103569, Management and General Expenses: 221323, Fundraising Expenses: ; Data Processing - Total Expense: 299257, Program Service Expense: 202711, Management and General Expenses: 96546, Fundraising Expenses: ; Consulting - Total Expense: 2269123, Program Service Expense: 2209057, Management and General Expenses: 60066, Fundraising Expenses: ; Collection Fees - Total Expense: 912132, Program Service Expense: , Management and General Expenses: 912132, Fundraising Expenses: ; Purchased Services - Total Expense: 831824, Program Service Expense: 102421, Management and General Expenses: 729403, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN VALUE OF INTEREST RATE SWAP - -548984; CHANGE IN VALUE IN RELATED ENTITIES - 94724;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	19010655
Software Version:	2019v5.0

1	Briefly describe the organization’s mission or most significant activities: The mission of Wayne Hospital Company is providing quality care and promoting wellness close to home.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	617
6	Total number of volunteers (estimate if necessary) .............	6	105
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	123,442
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	49,247

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	51,729	28,201
9	Program service revenue (Part VIII, line 2g) .........	63,235,701	66,115,391
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,690,814	6,495,267
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	464,763	492,178
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	70,443,007	73,131,037
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	47,520	142,855
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	31,484,138	34,262,895
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	33,866,491	32,795,059
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	65,398,149	67,200,809
19	Revenue less expenses. Subtract line 18 from line 12.......	5,044,858	5,930,228
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	147,002,030	186,619,457
21	Total liabilities (Part X, line 26).............	36,855,422	65,835,889
22	Net assets or fund balances. Subtract line 21 from line 20.....	110,146,608	120,783,568

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 55,524,684 including grants of $ 142,855 ) (Revenue $ 66,432,039 )
	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, SENIOR BEHAVIORAL HEALTH, 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 1,940 ADMISSIONS AND 74,784 OUTPATIENT VISITS IN 2019. 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 $ 318,598 including grants of $ 0 ) (Revenue $ 12,450 )
	WAYNE HOSPITAL HAS MANY ADDITIONAL PROGRAMS. ADDITIONAL PROGRAMS INCLUDE THE COUNTY AND CORPORATE HEALTH FAIRS IN WHICH EMPLOYEES FROM THE HOSPITAL PROVIDE 994 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 38 HOURS TO THE YOUTH HEALTH FAIR, WHICH IS A HEALTH FAIR GEARED TO ALL THE FIFTH GRADERS IN DARKE COUNTY. 259 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 expenses55,843,282

(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) WAYNE DESCHAMBEAU CEO	39.0 .......................1.0	X			380,766	0	30,342
(19) KIMBERLEE FREEMAN VP OF PATIENT CARE/CNO	40.0 .......................		X		176,870	0	27,464
(20) PEGGY SCHULTZ VP HUMAN RESOURCES	40.0 .......................		X		166,133	0	14,999
(21) SHELTON MONGER CIO	40.0 .......................		X		169,829	0	6,155
(22) ALISHA REISS SURGEON	40.0 .......................			X	436,403	0	30,427
(23) KARA SCHULTZ SURGEON	40.0 .......................			X	362,028	0	8,682
(24) PATRICK KARR OB/GYN	40.0 .......................			X	441,712	0	30,445
(25) PETER LACHIEWICZ OB/GYN	40.0 .......................			X	465,485	0	20,508
(26) STEPHANIE BUCHANAN SURGEON	40.0 .......................			X	401,371	0	20,491

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,374,854	0	230,740

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	15,201
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	13,000

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		28,201

		Business Code
2a	NET PATIENT SERVICE REVENUE	621110	66,098,391	66,098,391
b	MEANINGFUL USE INCENTIVE PAYMENTS	621110	17,000	17,000
c
d
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		66,115,391

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,430,975		123,442	2,307,533
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		324,809	6a
b	Less: rental expenses		387,081	6b
c	Rental income or (loss)	0	-62,272	6c
d	Net rental income or (loss).......			-62,272			-62,272
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	1,200	18,508,465	7a
b	Less: cost or other basis and sales expenses	117	14,445,256	7b
c	Gain or (loss)	1,083	4,063,209	7c
d	Net gain or (loss).........			4,064,292			4,064,292
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	FOOD SALES		722210	225,352			225,352
b	HOUSEKEEPING		812900	10,143	10,143
c	REBATE REVENUE		900099	210,648	210,648
d	All other revenue ....			108,307	108,307	0	0
e	Total. Add lines 11a–11d ......			554,450
12	Total revenue. See instructions.....			73,131,037	66,444,489	123,442	6,534,905

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	142,855	142,855
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	826,592	208,631	617,961
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	22,084,131	19,358,380	2,725,751
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	673,135	590,053	83,082
9	Other employee benefits .......	8,939,610	7,836,232	1,103,378
10	Payroll taxes ...........	1,739,427	1,485,566	253,861
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	90,275		90,275
c	Accounting ...........	52,000		52,000
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	300,225		300,225
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	12,637,228	10,617,758	2,019,470	0
12	Advertising and promotion ....	486,483	436,174	50,309
13	Office expenses .......	100,548	54,846	45,702
14	Information technology ......	485,020	180,124	304,896
15	Royalties ..
16	Occupancy ...........	1,219,594	989,115	230,479
17	Travel ............	92,760	41,776	50,984
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	122,486	100,516	21,970
20	Interest ...........	1,035,611	403,888	631,723
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	5,053,716	3,770,072	1,283,644
23	Insurance ...	466,082	240,781	225,301
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	MEDICAL SUPPLIES	7,727,538	7,717,740	9,798
b	MAINTENANCE AGREEMENTS	1,538,130	898,820	639,310
c	DIETARY	355,104	311,710	43,394
d
e	All other expenses	1,032,259	458,245	574,014	0
25	Total functional expenses. Add lines 1 through 24e	67,200,809	55,843,282	11,357,527	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 ........			2,689,270	1	6,127,013
2	Savings and temporary cash investments .........			20,670,864	2	20,331,981
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			6,177,555	4	6,992,162
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			117,567	7	205,064
8	Inventories for sale or use ............			1,411,695	8	1,478,448
9	Prepaid expenses and deferred charges ......			944,659	9	925,418
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	125,601,070
b	Less: accumulated depreciation	10b	77,330,830	39,299,531	10c	48,270,240
11	Investments—publicly traded securities .			64,382,227	11	57,455,045
12	Investments—other securities. See Part IV, line 11 .....			7,839,989	12	7,953,613
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14	0
15	Other assets. See Part IV, line 11 ...........			3,468,673	15	36,880,473
16	Total assets. Add lines 1 through 15 (must equal line 33)...			147,002,030	16	186,619,457

17	Accounts payable and accrued expenses .....	6,725,573	17	10,191,011
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	24,405,535	20	51,672,646
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	832,082	24	289,885
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	4,892,232	25	3,682,347
26	Total liabilities. Add lines 17 through 25..	36,855,422	26	65,835,889

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	109,870,663	27	120,707,286
28	Net assets with donor restrictions ...........	275,945	28	76,282
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	110,146,608	32	120,783,568
33	Total liabilities and net assets/fund balances ........	147,002,030	33	186,619,457

(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	-2,246,650	834,839	WAYNE HEALTHCARE

(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

(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

(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