TY 2021 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/1099-NEC)
(1) KRISTY RITCHIE MD...................................................................... TRUSTEE	50.00 ................. 0.00	X		621,898	35,385
(2) ERIN REMSTER DO...................................................................... TRUSTEE	50.00 ................. 0.00	X		315,682	22,770
(3) WILLIAM SHADE MD...................................................................... TRUSTEE	50.00 ................. 0.00	X		306,801	8,837
(4) TOD KLOTZBACH...................................................................... TREASURER	1.27 ................. 0.16	X	X	0	0
(5) PATRICK NASH...................................................................... EX-OFFICIO	1.38 ................. 0.16	X	X	0	0
(6) JAMES MCDONALD...................................................................... VICE CHAIR	1.38 ................. 0.16	X	X	0	0
(7) JIM NICHOLSON...................................................................... SECRETARY	1.38 ................. 0.12	X	X	0	0
(8) JONATHAN TONGSON MD...................................................................... TRUSTEE	50.00 ................. 0.00	X		0	0
(9) RANDY COCHRANE...................................................................... TRUSTEE	1.38 ................. 0.16	X		0	0
(10) JOANN BUTCHER...................................................................... TRUSTEE	1.27 ................. 0.18	X		0	0
(11) JOHN DITTOE...................................................................... TRUSTEE	1.27 ................. 0.00	X		0	0
(12) COLBY GRAHAM...................................................................... TRUSTEE	1.04 ................. 0.00	X		0	0
(13) SUSAN HOLDREN...................................................................... TRUSTEE	1.38 ................. 0.16	X		0	0
(14) MATT ABBOTT...................................................................... TRUSTEE	1.27 ................. 0.08	X		0	0
(15) SHIRLEY VAN WYE...................................................................... TRUSTEE	1.15 ................. 0.05	X		0	0
(16) SCOTT MCCONNAHA...................................................................... TRUSTEE	1.38 ................. 0.00	X		0	0
(17) LORI LOWE...................................................................... TRUSTEE	1.15 ................. 0.00	X		0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) MATTHEW PERRY........................................................................ PRESIDENT/CEO	48.89 .......................1.11	X			994,131	32,081
(19) SCOTT WEGNER MD........................................................................ CHIEF CLINICAL OFFICER	50.00 .......................0.00		X		720,427	139,799
(20) SHARON PARKER........................................................................ CHIEF OPERATION OFFICER	49.85 .......................0.15		X		536,973	272,347
(21) EDMUND ROMITO........................................................................ CHIEF INFORMATION OFFICER	50.00 .......................0.00		X		502,752	141,957
(22) DIANNA LEVECK........................................................................ CHIEF HUMAN RESOURCES OFFICER	49.85 .......................0.15		X		541,708	77,554
(23) MICHAEL NORMAN........................................................................ CHIEF FINANCIAL OFFICER	48.93 .......................1.07		X		564,107	36,218
(24) DANIEL SCHEERER MD........................................................................ CHIEF MEDICAL AFFAIRS OFFICER	50.00 .......................0.00		X		367,875	183,077
(25) WENDY CEDOZ........................................................................ CHIEF LEGAL OFFICER	50.00 .......................0.00		X		455,564	64,732
(26) CHRISTOPHER SCHOELLES........................................................................ CHIEF OPERATION OFFICER	50.00 .......................0.00		X		441,848	25,820
(27) SHON BENDER........................................................................ CHIEF NURSING OFFICER	50.00 .......................0.00		X		394,173	10,413
(28) LINDA SUPPLEE........................................................................ DIRECTOR/CPHO	50.00 .......................0.00		X		256,441	4,737
(29) GREG MATONAK........................................................................ DIRECTOR/FACILITY PLANNING & SUPPORT	50.00 .......................0.00			X	218,293	25,191
(30) LES BOYER........................................................................ DIRECTOR/TECHNICAL SERVICES	50.00 .......................0.00			X	199,822	32,190
(31) RHONDA ANDREWS........................................................................ STAFF	50.00 .......................0.00			X	203,916	19,022
(32) CHARLES ADAMS JR........................................................................ DIRECTOR/LEAN SIX SIGMA	50.00 .......................0.00			X	193,707	23,925
(33) TISHA VAUGHAN........................................................................ STAFF	50.00 .......................0.00			X	198,552	14,850

(A) Name and business address	(B) Description of services	(C) Compensation
CENTRAL OHIO HOSPITALISTS INC 3525 OLENTANGY RIVER RD SUITE 4330 COLUMBUS,OH43214	MEDICAL SERVICES	7,310,093
ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY,UT84127	MEDICAL SERVICES	1,867,627
P&W ARCHITECTS LLP 11275 S SAM HOUSTON PKY W SUITE 200 HOUSTON,TX77031	PROFESSIONAL SERVICES	1,404,178
ADVIZEX TECHNOLOGIES 6480 ROCKSIDE WOODS BLVD 190 INDEPENDENCE,OH44131	TECHNOLOGY SERVICES	1,271,406
APG ARCHITECTS 3808 JAMES COURT STE ONE ZANESVILLE,OH43701	PROFESSIONAL SERVICES	1,271,179
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 53

- TIN:

SCHEDULE A
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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

Did one or more disqualified persons (as defined on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2021

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization GENESIS HEALTHCARE SYSTEM

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) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization GENESIS HEALTHCARE SYSTEM		Employer identification number 31-1480941

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization GENESIS HEALTHCARE SYSTEM			Employer identification number 31-1480941
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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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

Yes

158,358

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

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

Yes

10,292

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

168,650

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1:	GENESIS HEALTHCARE SYSTEM PAYS MEMBERSHIP DUES AND A PORTION OF THOSE DUES ARE RELATED TO LOBBYING: OHIO HOSPITAL ASSOCIATION - FSCC SHARE (OHA): 4.60% OF $92,610 ($4,260) CATHOLIC CONFERENCE OF OHIO: 4.30% OF $2,100 ($90) CATHOLIC HEALTH ASSOC (FSCC SHARE): 3.83% OF $97,294 ($3,726) AMERICAN MEDICAL GROUP ASSOCIATION (AMGA): 10.00% OF $11,250 ($1,125) HEALTHCARE INFORMATION & MGMT SYSTEMS SOCIETY (MIMSS): 1.87% OF $3,375 ($63) TRAUMA CENTER ASSOCIATION OF AMERICA (TCAA): 14.00% OF $2,000 ($280) AMERICAN SOCIETY FOR HEALTH CARE ENGINEERING, AMERICAN (ASHI): 22.73% OF $475 ($108) OHIO HOSPICE AND PALLIATIVE CARE ORGANIZATION DBA MIDWEST CARE ALLIANCE (OHPCO): 3.00% OF $800 ($24) OHIO HOSPICE AND PALLIATIVE CARE ORGANIZATION DBA MIDWEST CARE ALLIANCE (OHPCO): 7.70% OF $8,000 ($616) GENESIS HEALTHCARE SYSTEM PAID SECOND CAPITAL CONSULTING, LLC $158,358 IN 2021 FOR ADVOCACY AND OUTREACH CONSULTING SERVICES. SECOND CAPITAL CONSULTING, LLC HAS PROVIDED ADVOCACY AND OUTREACH CONSULTING SERVICES TO GENESIS HEALTHCARE SYSTEM SINCE 2013. THESE SERVICES ASSIST THE SYSTEM TO ENGAGE, EDUCATE AND COMMUNICATE WITH PUBLIC POLICY MAKERS REGARDING PENDING LEGISLATION OR PROPOSED REGULATIONS, AS WELL AS, ASSIST ELECTED OFFICIALS IN UNDERSTANDING THE IMPACT OF LEGISLATION ON GHCS'S ABILITY TO DELIVER COST EFFECTIVE, QUALITY CARE FOR PATIENTS IN SOUTHEAST OHIO. GENESIS WORKS PRIMARILY THROUGH NATIONAL AND STATE HOSPITAL ASSOCIATIONS, IN WHICH GENESIS HAS MEMBERSHIP, TO UNDERSTAND POTENTIAL POLICIES WHICH COULD NEGATIVELY AFFECT THEIR ABILITY TO WORK WITH THE LOCAL MEDICAL COMMUNITY TO MEET THE HEALTHCARE NEEDS OF THE REGION. SOME ISSUES OF INTEREST INCLUDE THE 340B PROGRAM, MEDICARE & MEDICAID BUDGET DECISIONS AND REGULATIONS, AND INFRASTRUCTURE IMPROVEMENTS AT THE LOCAL LEVEL THAT ENHANCE ACCESS TO THE HOSPITAL. IN FACT, A DIRECT ACCESS LANE OPENED THIS YEAR FOR EMERGENCY VEHICLES, SPEEDING THE TIME CRITICAL TO PATIENTS IN ARRIVING FOR EMERGENCY CARE.

Return Reference

Explanation

PART II-B, LINE 1:

GENESIS HEALTHCARE SYSTEM PAYS MEMBERSHIP DUES AND A PORTION OF THOSE DUES ARE RELATED TO LOBBYING: OHIO HOSPITAL ASSOCIATION - FSCC SHARE (OHA): 4.60% OF $92,610 ($4,260) CATHOLIC CONFERENCE OF OHIO: 4.30% OF $2,100 ($90) CATHOLIC HEALTH ASSOC (FSCC SHARE): 3.83% OF $97,294 ($3,726) AMERICAN MEDICAL GROUP ASSOCIATION (AMGA): 10.00% OF $11,250 ($1,125) HEALTHCARE INFORMATION & MGMT SYSTEMS SOCIETY (MIMSS): 1.87% OF $3,375 ($63) TRAUMA CENTER ASSOCIATION OF AMERICA (TCAA): 14.00% OF $2,000 ($280) AMERICAN SOCIETY FOR HEALTH CARE ENGINEERING, AMERICAN (ASHI): 22.73% OF $475 ($108) OHIO HOSPICE AND PALLIATIVE CARE ORGANIZATION DBA MIDWEST CARE ALLIANCE (OHPCO): 3.00% OF $800 ($24) OHIO HOSPICE AND PALLIATIVE CARE ORGANIZATION DBA MIDWEST CARE ALLIANCE (OHPCO): 7.70% OF $8,000 ($616) GENESIS HEALTHCARE SYSTEM PAID SECOND CAPITAL CONSULTING, LLC $158,358 IN 2021 FOR ADVOCACY AND OUTREACH CONSULTING SERVICES. SECOND CAPITAL CONSULTING, LLC HAS PROVIDED ADVOCACY AND OUTREACH CONSULTING SERVICES TO GENESIS HEALTHCARE SYSTEM SINCE 2013. THESE SERVICES ASSIST THE SYSTEM TO ENGAGE, EDUCATE AND COMMUNICATE WITH PUBLIC POLICY MAKERS REGARDING PENDING LEGISLATION OR PROPOSED REGULATIONS, AS WELL AS, ASSIST ELECTED OFFICIALS IN UNDERSTANDING THE IMPACT OF LEGISLATION ON GHCS'S ABILITY TO DELIVER COST EFFECTIVE, QUALITY CARE FOR PATIENTS IN SOUTHEAST OHIO. GENESIS WORKS PRIMARILY THROUGH NATIONAL AND STATE HOSPITAL ASSOCIATIONS, IN WHICH GENESIS HAS MEMBERSHIP, TO UNDERSTAND POTENTIAL POLICIES WHICH COULD NEGATIVELY AFFECT THEIR ABILITY TO WORK WITH THE LOCAL MEDICAL COMMUNITY TO MEET THE HEALTHCARE NEEDS OF THE REGION. SOME ISSUES OF INTEREST INCLUDE THE 340B PROGRAM, MEDICARE & MEDICAID BUDGET DECISIONS AND REGULATIONS, AND INFRASTRUCTURE IMPROVEMENTS AT THE LOCAL LEVEL THAT ENHANCE ACCESS TO THE HOSPITAL. IN FACT, A DIRECT ACCESS LANE OPENED THIS YEAR FOR EMERGENCY VEHICLES, SPEEDING THE TIME CRITICAL TO PATIENTS IN ARRIVING FOR EMERGENCY CARE.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

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) 2021

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(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 .....	10,624,782		10,624,782
b	Buildings ....	232,413,412	37,719,631	194,693,781
c	Leasehold improvements	7,168,637	3,343,426	3,825,211
d	Equipment ....	275,246,481	198,718,739	76,527,742
e	Other .....	13,063,078	2,307,891	10,755,187
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				296,426,703

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

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

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value
(1)INVESTMENTS IN RELATED AND OTHER HEALTHCARE ORGANIZATIONS				70,687,016
(2)ASSETS LIMITED AS TO USE				27,886,767
(3)RIGHT OF USE LEASE ASSETS				21,087,195
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				119,660,978

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.)	40,217,676
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) 2021

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

PART X, LINE 2:

THE SYSTEM AND ITS SUBSIDIARIES ARE TAX-EXEMPT ORGANIZATIONS, EXCEPT FOR CARELIFE; ACCORDINGLY, NO TAX PROVISION IS REFLECTED IN THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND TO RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

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) . . .			2,089,113	1,017,351	1,071,762	0.220 %
b	Medicaid (from Worksheet 3, column a) . . . . .			98,889,757	88,052,589	10,837,168	2.220 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			100,978,870	89,069,940	11,908,930	2.440 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	42	72,903	1,993,456	53,453	1,940,003	0.400 %
f	Health professions education (from Worksheet 5) . . .	6	2,359	1,185,995	0	1,185,995	0.240 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	5	371	9,220	0	9,220	0 %
j	Total. Other Benefits . .	53	75,633	3,188,671	53,453	3,135,218	0.640 %
k	Total. Add lines 7d and 7j .	53	75,633	104,167,541	89,123,393	15,044,148	3.080 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

20,676,788

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).....

119,796,767

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

122,338,488

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

-2,541,721

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) 2021

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)					Other (describe)
1	GENESIS HOSPITAL 2951 MAPLE AVE ZANESVILLE,OH43701	X	X	X	ACUTE CARE HOSPITAL

Schedule H (Form 990) 2021

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)

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

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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 21

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

Yes

6 a

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

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

Yes

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

Yes

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

Hospital facility’s website (list url): HTTPS://GENESISHCS.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

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 21

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

Yes

If "Yes" (list url): HTTPS://GENESISHCS.ORG/COMMUNITY-BENEFIT-IMPLEMENTATION-STRATEGY

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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):

HTTPS://WWW.GENESISHCS.ORG/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE

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

HTTPS://WWW.GENESISHCS.ORG/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.GENESISHCS.ORG/PATIENTS/BILLING-INSURANCE/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) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	GENESIS HOSPITAL
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) 2021

Page 7

Part VFacility Information (continued)

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

	GENESIS HOSPITAL
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) 2021

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
GENESIS HOSPITAL	PART V, SECTION B, LINE 5: A PARTNERSHIP WAS DEVELOPED TO DO A COMBINED HEALTH DEPARTMENTS AND GENESIS CHNA. THE GENESIS SERVICE AREA (GSA) COUNTY HEALTH DEPARTMENTS AND OHIO UNIVERSITY COLLABORATED TO DESIGN A MECHANISM TO COMPLETE THE 2021 CHNA. THIS PARTNERSHIP BECAME THE SOUTHEASTERN OHIO HEALTH IMPROVEMENT COLLABORATIVE (SOHIC) AND IS MADE UP OF COSHOCTON CITY AND COUNTY HEALTH DEPARTMENTS, GENESIS, MORGAN COUNTY HEALTH DEPARTMENT, NOBLE COUNTY HEALTH DEPARTMENT, PERRY COUNTY HEALTH DEPARTMENT, ZANESVILLE-MUSKINGUM COUNTY HEALTH DEPARTMENT, OHIO ALLIANCE FOR POPULATION HEALTH, OHIO UNIVERSITY'S (OU) COLLEGE OF HEALTH SCIENCES AND PROFESSIONS, AND THE OU'S VOINOVICH SCHOOL OF LEADERSHIP AND PUBLIC SERVICE. SOHIC CONTRACTED WITH THE NORTHWEST HOSPITAL COUNCIL OF OHIO TO DESIGN THE ASSESSMENT TOOLS, ADD RELEVANT SECONDARY AND MORTALITY DATA, AND DEVELOP THE REPORTS. THE INFORMATION CONTAINED IN THE 2021 CHNA REPORT ARE BASED UPON DATA OBTAINED FROM RESPONSES TO WRITTEN COMMUNITY HEALTH SURVEYS (CHS) THAT WERE COLLECTED FROM APRIL THROUGH MAY 2021. THE CHS FOCUSED ON ADULTS AGES 19 AND OLDER. IN ORDER TO MAINTAIN COMPLETE OBJECTIVITY THROUGHOUT THE SURVEY PROCESS, THE COLLABORATIVE ENGAGED THE SERVICES OF THE HOSPITAL COUNCIL OF NORTHWEST OHIO AND OHIO UNIVERSITY TO ADMINISTER THE SURVEYS AND COMPILE THE RESULTS. SURVEYS WERE ALSO CONDUCTED WITH KEY LEADERS FROM THE GSA COUNTIES. THESE SURVEYS WERE INCLUDED IN THE ANALYSIS OF THIS REPORT AND INFORMED PRIORITIZATION OF ALL THE RESULTS TO IDENTIFY THE TOP HEALTH NEEDS OF OUR COMMUNITIES. GENESIS COMMUNITY BENEFIT STEERING COMMITTEE PRIORITIZED THE INFORMATION AND DETERMINED SIX TOP HEALTH NEEDS: MENTAL HEALTH ISSUES, HEART DISEASE, CANCER, STROKE, DIABETES, AND SOCIAL DETERMINANTS OF HEALTH.PROCESS AND METHODS FOR ENGAGING COMMUNITY: MULTIPLE SECTORS, INCLUDING THE GENERAL PUBLIC, WERE ASKED THROUGH EMAIL LIST SERVS, SOCIAL MEDIA, AND PUBLIC NOTICES TO PARTICIPATE IN THE PROCESS, INCLUDING DEFINING THE SCOPE OF THE PROJECT, CHOOSING QUESTIONS FOR THE CHS, REVIEWING INITIAL DATA, PLANNING A COMMUNITY RELEASE, AND IDENTIFYING AND PRIORITIZING NEEDS. SOHIC WORKED TOGETHER TO CREATE ONE COMPREHENSIVE CHNA, WITH MORE THAN 88 COMMUNITY MEMBERS ATTENDING THE COUNTIES' RELEASE OF THE REPORT AND PROVIDING FEEDBACK ON THE KEY ISSUES FOR THE GSA.PRIMARY DATA COLLECTION METHODS:THE FINDINGS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT ARE BASED ON SELF-ADMINISTERED CHS USING A STRUCTURED QUESTIONNAIRE. THE QUESTIONS WERE MODELED AFTER THE SURVEY INSTRUMENTS USED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) FOR THEIR NATIONAL AND STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS). THE HCNO ASSISTED WITH CHS DEVELOPMENT, GUIDED THE HEALTH ASSESSMENT PROCESS, AND INTEGRATED SOURCES OF PRIMARY AND SECONDARY DATA INTO THE FINAL REPORT. OU SOUGHT INSTITUTIONAL REVIEW BOARD (IRB) APPROVAL FOR THE CHS, ADMINISTERED THE CHS, AND COLLECTED THE DATA.THIS CHS COMPLETION PROCESS WAS CROSS-SECTIONAL IN NATURE AND INCLUDED A WRITTEN CHS OF ADULTS WITHIN COSHOCTON, MORGAN, MUSKINGUM, NOBLE, AND PERRY COUNTIES. FROM THE BEGINNING, COMMUNITY LEADERS AND MEMBERS WERE ACTIVELY ENGAGED IN THE CHS PLANNING PROCESS AND HELPED DEFINE THE CONTENT, SCOPE, AND SEQUENCE OF THE CHS. ACTIVE ENGAGEMENT OF COMMUNITY MEMBERS THROUGHOUT THE CHNA PLANNING PROCESS IS REGARDED AS AN IMPORTANT STEP IN COMPLETING A VALID CHNA.ONE ADULT CHS INSTRUMENT WAS DESIGNED FOR THE CHNA. AS A FIRST STEP IN THE DESIGN PROCESS, HEALTH EDUCATION RESEARCHERS FROM THE UNIVERSITY OF TOLEDO AND STAFF MEMBERS FROM HCNO MET TO DISCUSS POTENTIAL SOURCES OF VALID AND RELIABLE CHS ITEMS THAT WOULD BE APPROPRIATE TO ASSESS THE HEALTH STATUS AND HEALTH NEEDS OF ADULTS. THE INVESTIGATORS DECIDED TO DERIVE THE MAJORITY OF THE ADULT SURVEY ITEMS FROM THE BRFSS. THIS DECISION WAS BASED ON BEING ABLE TO COMPARE LOCAL DATA WITH STATE AND NATIONAL DATA. THE PROJECT COORDINATOR FROM HCNO CONDUCTED A MEETING WITH SOHIC. DURING THIS MEETING, HCNO AND SOHIC REVIEWED AND DISCUSSED BANKS OF POTENTIAL SURVEY QUESTIONS FROM THE BRFSS. BASED ON INPUT FROM SOHIC, THE PROJECT COORDINATOR COMPOSED A DRAFT ADULT CHS CONTAINING 110 ITEMS. IRB APPROVAL WAS GRANTED TO OU BY OU'S SOCIAL AND BEHAVIORAL IRB.THE SAMPLING FRAME FOR THE ADULT CHS CONSISTED OF ADULTS AGES 19 AND OLDER LIVING IN COSHOCTON, MORGAN, MUSKINGUM, NOBLE, AND PERRY COUNTIES. SEE BELOW FOR THE ESTIMATED NUMBER OF PEOPLE AGES 19 AND OLDER LIVING IN EACH COUNTY. THE HCNO STAFF ANALYSTS CONDUCTED A POWER ANALYSIS TO DETERMINE WHAT SAMPLE SIZE WAS NEEDED TO ENSURE A 95% CONFIDENCE LEVEL WITH A CORRESPONDING MARGIN OF ERROR OF 6% (I.E., THERE CAN BE 95% ASSURANCE THAT THE "TRUE" POPULATION RESPONSES ARE WITHIN A 6% MARGIN OF ERROR OF THE CHS FINDINGS)THE RANDOM SAMPLE OF MAILING ADDRESSES OF ADULTS FROM COSHOCTON, MORGAN, MUSKINGUM, NOBLE, AND PERRY COUNTIES WAS OBTAINED FROM MELISSA DATA CORPORATION IN RANCHO SANTA MARGARITA, CALIFORNIA. CHS WERE MAILED IN EARLY APRIL 2021 AND RETURNED THROUGH MID-MAY 2021.PRIOR TO MAILING THE CHS, OU MAILED AN ADVANCE LETTER TO 2,000 ADULTS IN EACH COUNTY (COSHOCTON, MORGAN, MUSKINGUM, NOBLE, AND PERRY). THIS ADVANCE LETTER WAS PRINTED ON SOHIC STATIONERY AND SIGNED ON BEHALF OF THE GROUP BY THE CO-CHAIRS LINDA SUPPLEE OF GENESIS AND ANGELA DEROLPH OF THE PERRY COUNTY HEALTH DEPARTMENT. THE LETTER INTRODUCED THE CHNA PROJECT AND INFORMED READERS THAT THEY MAY BE RANDOMLY SELECTED TO RECEIVE THE CHS. THE LETTER ALSO EXPLAINED THAT THE RESPONDENTS' CONFIDENTIALITY WOULD BE PROTECTED, AND IT ENCOURAGED THE READERS TO COMPLETE AND RETURN THE CHS PROMPTLY IF THEY WERE SELECTED. LETTERS RETURNED AS UNDELIVERABLE WERE NOT REPLACED WITH ANOTHER POTENTIAL RESPONDENT TO RECEIVE THE CHS. LASTLY, IT IS IMPORTANT TO NOTE THAT THE ADVANCE WAVE LETTER STATED THAT IF THE RECIPIENT WAS SELECTED TO RECEIVE THE CHS, THEY WOULD RECEIVE A $2 BILL AS A THANK YOU FOR THEIR TIME TO COMPLETE THE CHS. AFTER SENDING THE LETTER, OU ENCOUNTERED PROBLEMS WITH THIS RECRUITMENT STRATEGY DUE TO INSTITUTIONAL RULES ABOUT EXCHANGING MONEY. A GIFT CARD DRAWING REPLACED THE $2 BILL INCENTIVE THAT WAS ORIGINALLY NOTED. THE LETTER INCLUDED ADDITIONAL INFORMATION REGARDING THE DRAWING WITH INFORMATION ON HOW TO ENTER BY FILLING OUT A POSTAGE-PAID CARD THAT WAS INCLUDED IN THE MAILING. INDIVIDUALS RECEIVING THE CHS AND POST CARD WERE ASKED TO PROVIDE EITHER THEIR PHONE NUMBER OR EMAIL ADDRESS AND INSTRUCTED TO MAIL THE POSTAGE PAID, POST CARD SEPARATELY FROM THEIR CHS. THIRTEEN WEEKS FOLLOWING THE ADVANCE LETTER, AN ADDITIONAL MAILING WAS ADMINISTERED. THE MAILING INCLUDED A PERSONALIZED, HAND SIGNED COVER LETTER (ON SOHIC STATIONERY) DESCRIBING THE PURPOSE OF THE CHS AND THE CHANCES OF WINNING A GIFT CARD, THE QUESTIONNAIRE, A SELF-ADDRESSED STAMPED RETURN ENVELOPE, AND A POSTCARD TO ENTER THE DRAWING FOR A $100 OR $25 GIFT CARD. THE MAILING MATERIALS WERE INCLUDED IN A LARGE COLORED ENVELOPE. A TOTAL OF 3,000 CHS PER COUNTY WERE SENT OUT BY OU. HSAS RETURNED AS UNDELIVERABLE WERE NOT REPLACED WITH ANOTHER POTENTIAL RESPONDENT.INDIVIDUAL CHS RESPONSES WERE ANONYMOUS. ONLY GROUP DATA WAS AVAILABLE. ALL DATA WAS ANALYZED BY HEALTH EDUCATION RESEARCHERS AT THE UNIVERSITY OF TOLEDO USING STATISTICAL PRODUCT AND SERVICE SOLUTIONS 26.0 (SPSS). CROSSTABS WERE USED TO CALCULATE DESCRIPTIVE STATISTICS FOR THE DATA PRESENTED IN THIS REPORT. TO BE REPRESENTATIVE OF EACH COUNTY, THE ADULT CHS DATA COLLECTED WAS WEIGHTED BY AGE, GENDER, RACE, AND INCOME USING CENSUS DATA.DATA FROM SAMPLE SURVEYS HAVE THE POTENTIAL FOR BIAS IF THERE ARE DIFFERENT RATES OF RESPONSE FOR DIFFERENT SEGMENTS OF THE POPULATION. IN OTHER WORDS, SOME SUBGROUPS OF THE POPULATION MAY BE MORE REPRESENTED IN THE COMPLETED SURVEYS THAN THEY ARE IN THE POPULATION FROM WHICH THOSE SURVEYS ARE SAMPLED. IF A SAMPLE HAS 25% OF ITS RESPONDENTS BEING MALE AND 75% BEING FEMALE, THEN THE SAMPLE IS BIASED TOWARDS THE VIEWS OF FEMALES (IF FEMALES RESPOND DIFFERENTLY THAN MALES). THIS SAME PHENOMENON HOLDS TRUE FOR ANY POSSIBLE CHARACTERISTIC THAT MAY ALTER HOW AN INDIVIDUAL RESPONDS TO THE SURVEY ITEMS. IN SOME CASES, THE PROCEDURES OF THE SURVEY METHODS MAY PURPOSEFULLY OVER-SAMPLE A SEGMENT OF THE POPULATION IN ORDER TO GAIN AN APPROPRIATE NUMBER OF RESPONSES FROM THAT SUBGROUP FOR APPROPRIATE DATA ANALYSIS WHEN INVESTIGATING THEM SEPARATELY (THIS IS OFTEN DONE FOR MINORITY GROUPS). WHETHER THE OVER-SAMPLING IS DONE INADVERTENTLY OR PURPOSEFULLY, THE DATA NEEDS TO BE WEIGHTED SO THAT THE PROPORTIONED CHARACTERISTICS OF THE SAMPLE ACCURATELY REFLECT THE PROPORTIONED CHARACTERISTICS OF THE POPULATION. IN THE 2021 COSHOCTON, MORGAN, MUSKINGUM, NOBLE, AND PERRY SURVEYS, A WEIGHTING WAS APPLIED PRIOR TO THE ANALYSIS THAT WEIGHTED THE SURVEY RESPONDENTS TO REFLECT THE ACTUAL DISTRIBUTION OF EACH COUNTY BASED ON AGE, SEX, RACE, AND INCOME.
GENESIS HOSPITAL	PART V, SECTION B, LINE 6B: THE SOUTHEAST OHIO HEALTH IMPROVEMENT COLLABORATIVE (SOHIC) COMMISSIONED AND FUNDED THE COMMUNITY HEALTH NEEDS ASSESSMENT: COSHOCTON CITY HEALTH DEPARTMENT COSHOCTON COUNTY HEALTH DEPARTMENT GENESIS HEALTHCARE SYSTEM MORGAN COUNTY HEALTH DEPARTMENT NOBLE COUNTY HEALTH DEPARTMENT OHIO ALLIANCE FOR POPULATION HEALTH OHIO UNIVERSITY'S (OU) COLLEGE OF HEALTH SCIENCES AND PROFESSIONS OU'S VOINOVICH SCHOOL OF LEADERSHIP AND PUBLIC SERVICE PERRY COUNTY HEALTH DEPARTMENT ZANESVILLE/MUSKINGUM COUNTY HEALTH DEPARTMENT
GENESIS HOSPITAL	PART V, SECTION B, LINE 7D: THE CHNA REPORT IS AVAILABLE ON OUR WEBSITE AT HTTP://GENESISHCS.ORG, AT THE BOTTOM OF THE FRONT PAGE. THE REPORT WAS SHARED WITH COMMUNITY PARTNERS AND COPIES ARE AVAILABLE FOR FREE UPON REQUEST.
GENESIS HOSPITAL	PART V, SECTION B, LINE 11: THIS IMPLEMENTATION STRATEGY (IS) OUTLINES THE GENESIS SERVICE LINE'S PLANS TO ADDRESS THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE 2021 CHNA. SERVICE LINES CONSIDERED SPECIFIC PROGRAMS, RESOURCES, AND PRIORITIES FOR THE COMMUNITY WHEN DEVELOPING THIS STRATEGY. SERVICE LINES INVOLVED IN THE DESIGN INCLUDE: BEHAVIORAL HEALTH CANCER SERVICES DIABETES & NUTRITION SERVICES EDUCATIONAL SERVICES EMERGENCY SERVICES HEART & VASCULAR SERVICES HOSPICE & PALLIATIVE CARE MARKETING & PUBLIC RELATIONS MISSION NURSELINE ORTHOPEDIC CENTER PATIENT EXPERIENCE PERRY COUNTY EMERGENCY DEPARTMENT POPULATION HEALTH PULMONARY SERVICES REHABILITATION & AMBULATORY SERVICES SPIRITUAL CARE TRAUMA SERVICES, VOLUNTEER SERVICES WOMEN'S & CHILDREN'S SERVICE SIX TOP COMMUNITY HEALTH PRIORITIES WERE IDENTIFIED AND WILL BE OF PRIMARY FOCUS:1. MENTAL HEALTH ISSUES2. HEART DISEASE3. CANCER4. STROKE5. DIABETES6. SOCIAL DETERMINANTS OF HEALTHFOR THOSE NEEDS NOT CAPTURED IN THE TOP SIX PRIORITY FOCUS AREAS, THERE ARE ADDITIONAL COMMUNITY BENEFIT INITIATIVES THAT WILL BE PROVIDED FOR THE OTHER AREAS OF NEEDS. THOSE ADDITIONAL INITIATIVES ARE DEFINED IN THE IMPLEMENTATION STRATEGY. EDUCATIONAL SERVICES EMERGENCY SERVICES HOSPICE & PALLIATIVE CARE MARKETING & PUBLIC RELATIONS MISSION NURSELINE ORTHOPEDIC CENTER PATIENT EXPERIENCE PERRY COUNTY EMERGENCY DEPARTMENT PULMONARY SERVICES REHABILITATION & AMBULATORY SERVICES SPIRITUAL CARE TRAUMA SERVICES, VOLUNTEER SERVICES WOMEN'S & CHILDREN'S SERVICE
SCHEDULE H, PART V, LINE 5 CON'T:	MULTIPLE SETS OF WEIGHTINGS WERE CREATED AND USED IN THE STATISTICAL SOFTWARE PACKAGE (SPSS 26.0) WHEN CALCULATING FREQUENCIES. FOR ANALYSES DONE FOR THE ENTIRE SAMPLE AND ANALYSES DONE BASED ON SUBGROUPS OTHER THAN AGE, RACE, SEX, OR INCOME THE WEIGHTINGS THAT WERE CALCULATED BASED ON THE PRODUCT OF THE FOUR WEIGHTING VARIABLES (AGE, RACE, SEX, INCOME) FOR EACH INDIVIDUAL. WHEN ANALYSES WERE DONE COMPARING GROUPS WITHIN ONE OF THE FOUR WEIGHTING VARIABLES (E.G., SMOKING STATUS BY RACE/ETHNICITY), THAT SPECIFIC VARIABLE WAS NOT USED IN THE WEIGHTING SCORE THAT WAS APPLIED IN THE SOFTWARE PACKAGE. IN THE EXAMPLE SMOKING STATUS BY RACE, THE WEIGHTING SCORE THAT WAS APPLIED DURING ANALYSIS INCLUDED ONLY AGE, SEX, AND INCOME. THUS, A TOTAL OF EIGHT WEIGHTING SCORES FOR EACH INDIVIDUAL WERE CREATED AND APPLIED DEPENDING ON THE ANALYSIS CONDUCTED.

Schedule H (Form 990) 2021

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?22
Name and address		Type of Facility (describe)
1	1 - HEALTHPLEX 2800 MAPLE AVENUE ZANESVILLE,OH43701	OUTPATIENT LAB/ IMAGING, PEDIATRIC REHAB
2	2 - MEDICAL ARTS BUILDING (MAB) II 751 FOREST AVENUE ZANESVILLE,OH43701	OUTPATINT DIAGNOSTIC
3	3 - MOB II 955 BETHESDA DR ZANESVILLE,OH43701	OUTPATIENT DIAGNOSTIC & EDUCATION
4	4 - GENESIS PHYISCIAN'S PAVILION 945 BETHESDA DR ZANESVILLE,OH43701	OUTPAIENT CARDOAC REHAB SERVICES; WOUND CARE CENTER
5	5 - GENESIS BEHAVIORAL HEALTH 2991 MAPLE AVE ZANESVILLE,OH43701	MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT
6	6 - SARAP CANCER CENTER 2951 MAPLE AVE ZANESVILLE,OH43701	CANCER & PALLATIVE CARE/ WOMEN'S BOUTIQUE
7	7 - GENESIS SURGERY CENTER 2907 MAPLE AVE ZANESVILLE,OH43701	OUTPATIENT SURGERY
8	8 - GENESIS ORTHOPEDIC CENTER 2904 BELL STREET ZANESVILLE,OH43701	OUTPATIENT ORTHODIC AND SPORTMEDICINE DIAGNOTICS
9	9 - GENESIS OUTPATIENT REHAB 3297 NAOKE AVE ZANESVILLE,OH43701	OUTPATIENT REHAB AND IMAGING
10	10 - GENESIS VEIN CENTER 930 BETHESDA DR ZANESVILLE,OH43701	DIAGNOSTIC AND TREATMENT OF OUTPATIENT VEIN DISORDERS
11	11 - GENESIS INTERVENTIONAL PAIN MGMT CLINIC 2945 MAPLE AVE ZANESVILLE,OH43701	PAIN MEDICINE SPECIALIZATION; IMAGING TECHNIQUES; SOLUTIONS TO PAIN
12	12 - CAMBRIDGE HEALTH CENTER 61353 SOUTHGATE PARKWAY CAMBRIDGE,OH43725	IMAGING SERVICES/ LAB SERVICE/ WOUND MANAGEMENT
13	13 - GENESIS SLEEP DISORDERS CENTER 840 BETHESDA DR ZANESVILLE,OH43701	DIAGNOSTICS AND TREATMENT OF SLEEP DISORDERS
14	14 - GENESIS HEALTH CENTER - PERRY COUNTY 301 DR MIKE CLOUSE DR SOMERSET,OH43783	DIAGNOSITIC HEALTHCARE SERVICES/ PHYSICAL & OCCUPATIONAL THERAPY
15	15 - GENEIS ENDOCRINOLOGY 860 BETHESDA DR ZANESVILLE,OH43701	EDUCATION AND OUTPATIENT ENDOCRINOLOGY SERVICES
16	16 - GENESIS HEALTHCARE CENTER - NEW CONCORD 1 EAST MAIN STREET NEW CONCORD,OH43762	LAB SERVICES
17	17 - HOSPICE & PALLIATIVE CARE 713 FOREST AVE ZANESVILLE,OH43701	HOSPICE & PALLIATIVE CARE CENTER
18	18 - GENESIS NEW LEXINGTON DRAW CENTER 401 LINCOLN PARK DR NEW LEXINGTON,OH43764	LAB SERVICES
19	19 - GENEIS RHEUMAOLOGY CARE CENTER 2525 MAPLE AVE ZANESVILLE,OH43701	EDUCATION AND OUTPATIENT RHEUMATOLOGY SERVICE
20	20 - GENESIS SPECIALY CENTER 1452 CLARK ST CAMBRIDGE,OH43725	LAB SERVICES
21	21 - IMAGING MVHC PUTNAM 915 PUTNAM AVE ZANESVILLE,OH43701	LAB SERVICES
22	22 - IMAGING MVHC MALTA 859 S MAIN ST STE 146 MALTA,OH43758	LAB SERVICES

Schedule H (Form 990) 2021

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
PART I, LINE 7:	COSTS OF CHARITY CARE AND COMMUNITY BENEFIT ACTIVITIES WERE CALCULATED USING THE HOSPITAL'S COST ACCOUNTING SYSTEM.PART I, LINE 7, COLUMN (F): PERCENTAGE OF TOTAL EXPENSES WAS CALCULATED BASED ON TOTAL EXPENSES LESS BAD DEBT EXPENSE AS REPORTED ON FORM 990, PART IX.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 20,676,788.
PART II, COMMUNITY BUILDING ACTIVITIES:	GENESIS HAS AN ACTIVE PRESENCE ON MANY COMMITTEES INVOLVED IN FINDING LOW COST SOLUTIONS TO PHYSICAL AND MENTAL HEALTH ISSUES PREVALENT IN OUR COMMUNITIES, WITH PARTICULAR FOCUS ON SERVING LOW-INCOME, UNINSURED OR OTHERWISE UNDERSERVED. THESE ACTIVITIES ARE CAPTURED IN CBISA AS IN-KIND CONTRIBUTIONS BY THE SERVICE LINES UNDER COMMUNITY HEALTH IMPROVEMENT ACTIVITIES. COMMUNITY BUILDING ACTIVITIES ARE CURRENTLY NOT PART OF THE DOCUMENTATION FOR COMMUNITY BENEFIT.
PART III, LINE 2:	BAD DEBT IS CALCULATED USING GROSS CHARGES.
PART III, LINE 3:	NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE.
PART III, LINE 4:	THE FINANCIAL STATEMENT FOOTNOTE RELATED TO BAD DEBT IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENT FOOTNOTE 1 "NATURE OF BUSINESS AND SIGNIFICANT ACCOUNTING POLICIES" GROUPED WITH ACCOUNTS RECEIVABLE ON PAGE 9.
PART III, LINE 8:	THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDES (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
PART III, LINE 9B:	ALL PATIENTS ARE OFFERED A PLAIN LANGUAGE SUMMARY (PLS) OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE FROM THE HOSPITAL. AT LEAST THREE SEPARATE COMMUNICATIONS WILL BE MAILED TO THE LAST KNOWN ADDRESS OF THE RESPONSIBLE PARTY ALSO CONTAINING THE PLS. AT LEAST 60 DAYS WILL LAPSE BETWEEN THE FIRST AND THIRD REQUIRED COMMUNICATION. DETAILED ITEMIZED STATEMENTS WILL BE MADE AVAILABLE UPON REQUEST EXCEPT WHERE PROHIBITED BY STATE OR FEDERAL REGULATIONS. ACCOUNTS WITH ZERO BALANCES WILL NOT RECEIVE THREE SEPARATE COMMUNICATIONS; HOWEVER, THESE ACCOUNT HOLDERS MAY ALSO BE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE. ALL RESPONSIBLE PARTIES WILL RECEIVE WRITTEN NOTIFICATION REGARDING EXTRAORDINARY COLLECTION ACTIONS (ECA) THAT MAY COMMENCE IF ACTION IS NOT TAKEN. THIRTY DAYS WILL LAPSE BETWEEN ISSUANCE OF NOTIFICATION AND COMMENCEMENT OF ECA. ACTION TAKEN BY THE RESPONSIBLE PARTY CONSTITUTES MAKING PAYMENT ARRANGEMENTS FOR THE AMOUNT DUE OR COMPLETING A FINANCIAL ASSISTANCE APPLICATION. ACCOUNTS GO TO FULL COLLECTION AFTER DAY 120 IF NO PRIOR ARRANGEMENTS HAVE BEEN MADE. COLLECTION AGENCIES ARE INSTRUCTED TO MAKE PHONE CALLS AND SEND LETTERS. IF THEY CANNOT RESOLVE THE BALANCE, OR HAVE NOT BEEN ABLE TO MAKE PAYMENT ARRANGEMENTS, THE ACCOUNT IS SENT BACK TO GENESIS AS NON-COLLECTIBLE IN 18 MONTHS.
PART VI, LINE 2:	GENESIS HEALTHCARE SYSTEM, AS A NOT-FOR-PROFIT HEALTH CARE SYSTEM, IS DEDICATED TO MEETING THE HEALTH NEEDS OF OUR COMMUNITIES, REGARDLESS OF ONE'S ABILITY TO PAY. WE ENCOURAGE AND SUPPORT COLLABORATION WITH OTHER COMMUNITY PARTNERS TO IDENTIFY, RESPOND TO AND STRIVE TO IMPROVE THE HEALTH-RELATED NEEDS OF THE POOR, THE UNDERSERVED, AND THE COMMUNITY AT LARGE. WE PLEDGE ALL AVAILABLE FINANCIAL RESOURCES - AFTER OUR OPERATING EXPENSES ARE MET - TO RESPOND TO THE COMMUNITY'S HEALTH NEEDS WITH SERVICE INITIATIVES, FINANCIAL AND PROFESSIONAL SUPPORT, AND EDUCATION AND WELLNESS PROGRAMS.THE COMMUNITY BENEFIT COMMITTEE COLLABORATES WITH GENESIS ADMINISTRATION AND DEPARTMENTS AND WITH COMMUNITY AGENCIES IN OUR DEFINED GEOGRAPHIC MARKET, INCLUDING BUT NOT LIMITED TO THE PUBLIC HEALTH DEPARTMENTS, MUSKINGUM VALLEY HEALTH CENTERS, AND THE UNITED WAY, TO ASSESS COMMUNITY HEALTH NEEDS AND STRENGTHS; DEVELOP A COMMUNITY BENEFIT PLAN WITH STRATEGIC GOALS AND INTERVENTIONS; MONITOR IMPLEMENTATION OF COMMUNITY BENEFIT ACTIVITIES; EVALUATE COMMUNITY BENEFIT ACTIVITIES; ADVOCATE FOR THE COMMUNITY BENEFIT PROGRAMS; AND ASSIST IN TELLING THE GENESIS HOSPITAL COMMUNITY BENEFIT STORY.
PART VI, LINE 3:	GENESIS HAS SIGNAGE STRATEGICALLY LOCATED IN THE FACILITY (REGISTRATION AREAS AND CASHIER AREAS) ADVISING OF FREE CARE. BILLING STATEMENTS ALSO CONTAIN THIS INFORMATION ALONG WITH A CHARITY CARE APPLICATION PRINTED ON THE REVERSE SIDE OF THE BILL. THE INFORMATION IS ALSO AVAILABLE ON OUR WEBSITE. WE HAVE REGISTRATION STAFF THAT WORK IN THE EMERGENCY DEPARTMENT TO SCREEN PATIENTS FOR POTENTIAL MEDICAID QUALIFIERS IF THE PATIENT ALLOWS. FOR INPATIENTS, WE HAVE RESOURCE COUNSELING STAFF THAT SCREEN SELF-PAY, UNDERINSURED AND MEDICARE ONLY PATIENTS FOR MEDICAID AND/OR CHARITY.
PART VI, LINE 4:	OUR GEOGRAPHIC MARKET AREA IS A SIX-COUNTY RURAL REGION OF SOUTHEAST OHIO, INCLUDING MUSKINGUM, MORGAN, PERRY, COSHOCTON, GUERNSEY AND NOBLE COUNTIES. IN 2019, TOTAL MARKET AREA POPULATION WAS APPROXIMATELY 226,453, WITH MUSKINGUM COUNTY (86,131) REPRESENTING THE LARGEST COUNTY. MEDIAN HOUSEHOLD INCOME LEVELS RANGE FROM $46,883 TO $52,105 WHICH IS PREDOMINATELY LOWER THAN THE STATE MEDIAN HOUSEHOLD INCOME OF $58,704 AND EVEN LOWER THAN THE NATIONAL MEDIAN HOUSEHOLD INCOME OF $65,712. 17.8 % PEOPLE LIVING BELOW POVERTY LEVEL IN THE REGION VERSES 14.5% FOR THE STATE AND 13% FOR THE NATION. IN 2019, CHILDREN IN POVERTY RANGE FROM 16% TO 22.2% IN OUR REGION COMPARED TO 18% FOR THE STATE OF OHIO.
PART VI, LINE 5:	ONGOING COMMUNITY HEALTH EDUCATION IS PROVIDED THROUGH REGULARLY SCHEDULED HEALTH AND WELLNESS PROGRAMS PRESENTED BY GENESIS STAFF AND AFFILIATED PHYSICIANS. PREVENTATIVE HEALTH SCREENINGS ARE PROVIDED FOR PULSE OX AND I.M.P.A.C.T (IMMEDIATE POST-CONCUSSION ASSESSMENT AND COGNITIVE TESTING). PROGRAM TOPICS ARE BASED ON COMMUNITY NEED AS DETERMINED BY FEEDBACK FROM PARTICIPANTS, THE COMMUNITY BENEIFIT COMMITTEE AND SERVICE LINE LEADERS. GENESIS ALSO REGULARLY PROVIDES HEALTH AND WELLNESS PROMOTION THROUGH COMMUNITY-BASED HEALTH FAIRS AND EVENTS HELD THROUGHOUT THE COMMUNITY. CLINICAL EXPERIENCES ARE OFFERED FOR HEALTHCARE STUDENTS AS WELL AS TRAINING OPPORTUNITIES FOR HEALTHCARE PROFESSIONALS.GENESIS COMMUNITY AMBULANCE SERVICE BEGAN GIVING PATIENTS WHO WERE IN NEED OF TRANSPORATION FREE RIDES HOME IN 2021 AS WELL, BECAUSE MANY LOCAL TRANSPORATION AGENCIES (BUSSES, TAXIS) WOULD NOT GIVE RIDES TO PATIENTS WHO MAY HAVE BEEN EXPOSED TO COVID-19, OR TESTED POSITIVE, DURING THEIR HOSPITAL STAY. IN 2022 GENESIS HEALTHCARE SYSTEM BEGAN REIMBURSING THE COSTS OF THESE RIDES, THOUGH THEY BEGAN IN 2021. ACCESS TO TRANSPORATION CONTINUES TO BE A GREAT NEED IN THE GENESIS SERVICE AREA.
PART VI, LINE 6:	GENESIS HOSPITAL AND ITS AFFILIATES ARE REACHING OUT TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH COMMUNITY INITIATIVES, MANY BASED ON PREVENTION. SOME EXAMPLES INCLUDE:- PROVIDING CLINICAL EXPERIENCES FOR NURSING, MEDICAL, AND OTHER HEALTH PROFESSIONAL STUDENTS - COMMUNITY HEALTH EDUCATION/HEALTH PROMOTION INITIATIVES ON VARIOUS HEALTH TOPICS - PROVIDE HEALTHCARE SUPPORT SERVICES SUCH AS NURSELINE- SUBSIDIZED HEALTH SERVICES SUCH AS THE VACCINATIONS FOR COVID-19 AND MEDICAL CLINICS FOR COVID POSITIVE MEMBERS- SUPPORT GROUPS ARE AVAILABLE FOR VARIOUS HEALTH CONDITIONS

Schedule H (Form 990) 2021

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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

2021

Open to Public
Inspection

Name of the organization
GENESIS HEALTHCARE SYSTEM

Employer identification number
31-1480941

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(h) Purpose of grant or assistance
(1) UNITED WAY OF MPM COUNTIES 526 PUTNAM AVENUE ZANESVILLE,OH43701	31-4379456	501(C)(3)	20,000	0		CORPORATE DONATION FOR PLEDGE CAMPAIGN
(2) CENTRAL AMERICAN MEDICAL OUTREACH 322 WESTWOOD AVENUE ORVILLE,OH44667	34-1740695	501(C)(3)	0	180,007	COST	DONATION OF SUPPLIES
(3) MUSKINGUM COUNTY COMMUNITY FOUNDATION 534 PUTNAM AVENUE ZANESVILLE,OH43701	31-1147022	501(C)(3)	10,000	0		GROUNDHOG DAY CELEBRATION
(4) GENESIS HEALTHCARE FOUNDATION 1135 MAPLE AVENUE ZANESVILLE,OH43701	31-1629034	501(C)(3)	45,000	0		DONATION FOR AT RISK COMPENSATION

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) 2021

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
PART I, LINE 2:	DONATIONS ARE GRANTED TO 501(C)(3) OR RELATED GENESIS HEALTHCARE SYSTEM ORGANIZATIONS. RECIPIENTS ARE REVIEWED AND GRANTS ARE MONITORED WHEN AWARDED FOR PROPER USAGE.

Schedule I (Form 990) 2021

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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

2021

Open to Public Inspection

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

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 .....

Yes

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

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1MATTHEW PERRY PRESIDENT/CEO	(i) (ii)	845,973 ------------- 0	148,158 ------------- 0	0 ------------- 0	3,907 ------------- 0	28,174 ------------- 0	1,026,212 ------------- 0	0 ------------- 0
2SCOTT WEGNER MD CHIEF CLINICAL OFFICER	(i) (ii)	593,168 ------------- 0	127,259 ------------- 0	0 ------------- 0	5,406 ------------- 0	134,393 ------------- 0	860,226 ------------- 0	0 ------------- 0
3SHARON PARKER CHIEF OPERATION OFFICER	(i) (ii)	437,492 ------------- 0	99,481 ------------- 0	0 ------------- 0	254,522 ------------- 0	17,825 ------------- 0	809,320 ------------- 0	0 ------------- 0
4KRISTY RITCHIE MD TRUSTEE	(i) (ii)	0 ------------- 355,004	0 ------------- 266,894	0 ------------- 0	0 ------------- 5,572	0 ------------- 29,813	0 ------------- 657,283	0 ------------- 0
5EDMUND ROMITO CHIEF INFORMATION OFFICER	(i) (ii)	408,126 ------------- 0	94,626 ------------- 0	0 ------------- 0	120,178 ------------- 0	21,779 ------------- 0	644,709 ------------- 0	0 ------------- 0
6DIANNA LEVECK CHIEF HUMAN RESOURCES OFFICER	(i) (ii)	440,289 ------------- 0	101,419 ------------- 0	0 ------------- 0	54,395 ------------- 0	23,159 ------------- 0	619,262 ------------- 0	0 ------------- 0
7MICHAEL NORMAN CHIEF FINANCIAL OFFICER	(i) (ii)	459,776 ------------- 0	104,331 ------------- 0	0 ------------- 0	7,061 ------------- 0	29,157 ------------- 0	600,325 ------------- 0	0 ------------- 0
8DANIEL SCHEERER MD CHIEF MEDICAL AFFAIRS OFFICER	(i) (ii)	280,527 ------------- 0	87,348 ------------- 0	0 ------------- 0	172,133 ------------- 0	10,944 ------------- 0	550,952 ------------- 0	0 ------------- 0
9WENDY CEDOZ CHIEF LEGAL OFFICER	(i) (ii)	370,643 ------------- 0	84,921 ------------- 0	0 ------------- 0	44,777 ------------- 0	19,955 ------------- 0	520,296 ------------- 0	0 ------------- 0
10CHRISTOPHER SCHOELLES CHIEF OPERATION OFFICER	(i) (ii)	359,355 ------------- 0	82,493 ------------- 0	0 ------------- 0	4,385 ------------- 0	21,435 ------------- 0	467,668 ------------- 0	0 ------------- 0
11SHON BENDER CHIEF NURSING OFFICER	(i) (ii)	321,384 ------------- 0	72,789 ------------- 0	0 ------------- 0	7,385 ------------- 0	3,028 ------------- 0	404,586 ------------- 0	0 ------------- 0
12ERIN REMSTER DO TRUSTEE	(i) (ii)	0 ------------- 300,682	0 ------------- 15,000	0 ------------- 0	0 ------------- 4,801	0 ------------- 17,969	0 ------------- 338,452	0 ------------- 0
13WILLIAM SHADE MD TRUSTEE	(i) (ii)	0 ------------- 306,801	0 ------------- 0	0 ------------- 0	0 ------------- 5,981	0 ------------- 2,856	0 ------------- 315,638	0 ------------- 0
14LINDA SUPPLEE DIRECTOR/CPHO	(i) (ii)	216,500 ------------- 0	39,941 ------------- 0	0 ------------- 0	2,179 ------------- 0	2,558 ------------- 0	261,178 ------------- 0	0 ------------- 0
15GREG MATONAK DIRECTOR/FACILITY PLANNING & SUPPORT	(i) (ii)	200,701 ------------- 0	17,592 ------------- 0	0 ------------- 0	1,962 ------------- 0	23,229 ------------- 0	243,484 ------------- 0	0 ------------- 0
16LES BOYER DIRECTOR/TECHNICAL SERVICES	(i) (ii)	186,333 ------------- 0	13,489 ------------- 0	0 ------------- 0	3,937 ------------- 0	28,253 ------------- 0	232,012 ------------- 0	0 ------------- 0
17RHONDA ANDREWS STAFF	(i) (ii)	132,036 ------------- 0	71,880 ------------- 0	0 ------------- 0	1,309 ------------- 0	17,713 ------------- 0	222,938 ------------- 0	0 ------------- 0
18CHARLES ADAMS JR DIRECTOR/LEAN SIX SIGMA	(i) (ii)	152,345 ------------- 0	41,362 ------------- 0	0 ------------- 0	4,745 ------------- 0	19,180 ------------- 0	217,632 ------------- 0	0 ------------- 0
19TISHA VAUGHAN STAFF	(i) (ii)	133,722 ------------- 0	64,830 ------------- 0	0 ------------- 0	5,215 ------------- 0	9,635 ------------- 0	213,402 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
PART I, LINE 1A	THE ORGANIZATION PAYS COUNTRY CLUB DUES AND RELATED BUSINESS EXPENSES FOR MEMBERS OF SENIOR LEADERSHIP. PERSONAL USAGE IS PAID BY THE INDIVIDUAL AND THE PERCENTAGE OF DUES RELATED TO PERSONAL USAGE ARE ADDED TO THE INDIVIDUALS W-2.
PART I, LINE 7	BOARD REVIEWS BONUSES BASED ON PERFORMANCE.
PART I, LINE 4B:	A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS SET UP TO PROVIDE ADDITIONAL DEFERRED RETIREMENT INCOME TO THE GENESIS HEALTH CARE SYSTEM SENIOR LEADERSHIP TEAM MEMBERS. THIS PLAN IS FUNDED BY GENESIS AND VESTS WITH SERVICE. GENESIS HEALTHCARE SYSTEM MADE CONTRIBUTIONS TO NONQUALIFIED RETIREMENT PLANS FOR THE FOLLOWING INDIVIDUALS: WENDY CEDOZ: $22,7506 DIANNA LEVECK: $27,170 EDMUND ROMITO: $38,025 DANIEL SCHEERER, MD: $148,134 SHARON PARKER: $232,351

Schedule J (Form 990) 2021

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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

2021

Open to Public
Inspection

Name of the organization
GENESIS HEALTHCARE SYSTEM

Employer identification number
31-1480941

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 MUSKINGUM OHIO	31-6400080	628077CK3	05-09-2013	295,000,000	ACQUIRING, CONSTRUCTING, RENOVATING, INSTALLING AND EQUIPPING HOSP FAC.		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	12,470,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	294,645,952
4 Gross proceeds in reserve funds .............	28,217,261
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2016
	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 2020, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

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

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference	Explanation

Schedule K (Form 990) 2021

Additional Data

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Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

Part I

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

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

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

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

Part II

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

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






Total ............... $

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JONATHAN TONGSON	DR. TONGSON SERVES ON THE BOARD OF GHCS	250,000	SERVICES PROVIDED BY PREFERRED ASSOCIATES OF PATHOLOGY, WHICH DR TONGSON IS A OWNER OF.		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990) 2021

Additional Data

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SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC., AND BETHESDA CARE SYSTEM (OR THEIR RESPECTIVE SUCCESSORS AN ASSIGNS) ARE THE MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBERS OF THE FILING ORGANIZATION, HAVE THE RIGHT TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY, WHETHER PERIODICALLY, OR AS VACANCIES ARISE, OR OTHERWISE.
FORM 990, PART VI, SECTION A, LINE 7B	THE MEMBERS OF THE FILING ORGANIZATION, HAVE THE RIGHT TO APPROVE OR RATIFY DECISIONS OF THE ORGANIZATION'S GOVERNING BODY SUCH AS APPROVAL OF THE GOVERNING'S BODY'S DECISION TO DISSOLVE THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11B	THE 990 IS REVIEWED IN ITS ENTIRETY BY THE CFO.
FORM 990, PART VI, SECTION B, LINE 12C	THE CONFLICT OF INTEREST POLICY STATES THAT BOARD MEMBERS AND OFFICERS HAVE A DUTY TO GOVERN HONESTLY AND ECONOMICALLY. ALL POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO THE BOARD OF DIRECTORS AND THE BOARD WILL DETERMINE IF A CONFLICT EXISTS AND APPROPRIATE PROCEDURES TO MITIGATE THE SITUATION, SUCH AS ALTERNATIVE TRANSACTIONS AND PARTICIPATION AND VOTING RESTRICTIONS. THE COMPLIANCE OFFICER MONITORS AND ENFORCES THESE POLICIES. ALL OFFICERS AND DIRECTORS REVIEW AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15	THE COMPENSATION OF THE CEO IS MANAGED THROUGH A THIRD PARTY THAT IS A NATIONALLY RECOGNIZED FIRM SPECIALIZING IN COMPENSATION BENCHMARKING AND ANALYSIS. THE FIRM IS RECOGNIZED FOR THEIR EXPERTISE IN EVALUATING TOTAL COMPENSATION AT THE EXECUTIVE LEVEL. THIS FIRM PRESENTS THEIR RECOMMENDATIONS AND ANALYSIS TO THE COMPENSATION COMMITTEE, WHICH IS MADE UP OF INDEPENDENT MEMBERS OF THE GENESIS BOARD OF DIRECTORS. THE COMMITTEE IS RESPONSIBLE FOR MAKING A RECOMMENDATION TO THE BOARD OF DIRECTORS REGARDING THE EXECUTIVE COMPENSATION POLICY AND SPECIFIC COMPONENTS OF THE TOTAL COMPENSATION OF THE CEO. THE CEO IS ACTIVELY INVOLVED IN THE REVIEW, ANALYSIS AND RECOMMENDATION RELATED TO THE TOTAL COMPENSATION FOR THE REMAINING MEMBERS OF THE SENIOR LEADERSHIP TEAM. THE CEO DETERMINES THE COMPENSATION OF THE SENIOR LEADERSHIP TEAM MEMBERS WITHIN THE PARAMETERS ESTABLISHED BY THE COMPENSATION COMMITTEE. THIS COMPENSATION PROCESS WAS LAST COMPLETED IN 2020.
FORM 990, PART VI, SECTION C, LINE 19	THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 30,199,540. MANAGEMENT AND GENERAL EXPENSES 13,484,953. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,684,493. MEDICAL AND PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 8,900,664. MANAGEMENT AND GENERAL EXPENSES 1,796,850. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,697,514. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 50,910. MANAGEMENT AND GENERAL EXPENSES 1,604,661. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,655,571. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 821. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 821. BILLING AND COLLECTION FEES: PROGRAM SERVICE EXPENSES 128. MANAGEMENT AND GENERAL EXPENSES 2,643,115. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,643,243. INPATIENT TRANSPORT: PROGRAM SERVICE EXPENSES 116,526. MANAGEMENT AND GENERAL EXPENSES 1,425,269. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,541,795. RELATED ORGANIZATION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,032,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,032,800. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,732,066. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,732,066. COURIER SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 698,150. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 698,150. MARKETING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 57,425. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,425.
FORM 990, PART XI, LINE 9:	TRANSFERS TO/FROM AFFILIATES -55,264,482. CHANGE IN PENSION DUE TO SETTLEMENTS 2,511,085.
FORM 990, PART XII, LINE 2C:	THE FINANCE COMMITTEE OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN THE SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PAGE 1, LINE H(D):	THIS IS THE PARENT RETURN FOR A GROUP: GENESIS HEALTHCARE SYSTEM GROUP RETURN, EIN: 31-1773259

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

GENESIS HEALTHCARE SYSTEM

Employer identification number

31-1480941

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)GENESIS HEALTHCARE FOUNDATION 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-1629304	FUNDRAISING FOR GHS	OH	501(C)(3)	3	GENESIS HEALTHCARE SYSTEM	Yes
(2)GOOD SAMARITAN MEDICAL CENTER FOUNDATION 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-0969646	FUNDRAISING FOR GHS	OH	501(C)(3)	3	GENESIS HEALTHCARE FOUNDATION	Yes
(3)BETHESDA HOSPITAL FOUNDATION 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-0885513	FUNDRAISING FOR GHS	OH	501(C)(3)	3	GENESIS HEALTHCARE FOUNDATION	Yes
(4)FRANCISCAN SISTERS OF CHRISTIAN CHARITY 1415 SOUTH RAPIDS ROAD MANITOWOC,WI542209302 39-1530622	SPONSOR OF GHS	WI	501(C)(3)	7	N/A		No
(5)GOOD SAMARITAN MEDICAL CENTER 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-4379479	MAINTAINS REAL ESTATE TITLE FOR HOSPITAL	OH	501(C)(3)	3	GENESIS HEALTHCARE SYSTEM	Yes
(6)BETHESDA CARE SYSTEM 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-1067174	SPONSOR OF GHS	OH	501(C)(3)	9	GENESIS HEALTHCARE SYSTEM	Yes
(7)BETHESDA HOSPITAL ASSOCIATION 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-4380038	MAINTAINS REAL ESTATE TITLE FOR HOSPITAL	OH	501(C)(3)	LINE 12B, II	GENESIS HEALTHCARE SYSTEM	Yes
(8)ALTERNACARE 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-1487187	STERILIZATIONS	OH	501(C)(3)	3	BETHESDA CARE SYSTEM	Yes
(9)CARESERVE 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-1099924	FORMERLY OPERATED 2 NURSING HOMES THAT WERE SOLD PRIOR TO 2012	OH	501(C)(3)	3	GENESIS HEALTHCARE SYSTEM	Yes
(10)COMMUNITY AMBULANCE SERVICE 2951 MAPLE AVENUE ZANESVILLE,OH43701 34-1773323	AMBULANCE SERVICE	OH	501(C)(3)	LINE 11	GENESIS HEALTHCARE SYSTEM	Yes
(11)GENESIS CAREGIVERS 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-1282152	HOME CARE SERVICES	OH	501(C)(3)	3	CARESERVE	Yes
(12)BETHESDA HOSPITALITY SHOP 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-6050713	GIFT SHOP	OH	501(C)(3)	3	GENESIS HEALTHCARE SYSTEM	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) CARELIFE LLC 2951 MAPLE AVENUE ZANESVILLE,OH43701 31-1128717	PHYSICIAN SERVICES, CHILDCARE SERVICES, PHARMACY, DME	OH	GENESIS HEALTHCARE SYSTEM	C	-59,528,754	56,702,926	100.000 %	Yes
(2) SOUTHEAST OHIO MEDICAL INSURANCE COMPANY FIRST CARIBBEAN HOUSE GEORGE TOWN,CAYMAN ISLANDS CJ 98-0436356	CAPTIVE INSURANCE COMPANY	CJ	GENESIS HEALTHCARE SYSTEM	C		17,887,728	100.000 %	Yes

Schedule R (Form 990) 2021

Page 3

Part V

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

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

Yes

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

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

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

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

Yes

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

Yes

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CARELIFE LLC	R	57,646,261	ACCRUAL TRANSACTION
(2) COMMUNITY AMBULANCE SERVICE	S	1,758,197	ACCRUAL TRANSACTION
(3) GENESIS HEALTHCARE FOUNDATION	C	623,581	ACCRUAL TRANSACTION

Schedule R (Form 990) 2021

Page 4

Part VI

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

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

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: IN 1997, GOOD SAMARITAN MEDICAL CENTER AND BETHESDA HOSPITAL ASSOCIATION, A TAX-EXEMPT COMMUNITY HOSPITAL ALSO LOCATED IN ZANESVILLE, AFFILIATED TO FORM GENESIS HEALTHCARE SYSTEM. GENESIS HAS BEEN GRANTED 501C3 STATUS AS A HOSPITAL. ALL HOSPITAL OPERATIONS AND ASSETS OF GOOD SAMARITAN MEDICAL CENTER WERE TRANSFERRED TO GENESIS WITH THE EXCEPTION OF CERTAIN INVESTMENTS. GOOD SAMARITAN MEDICAL CENTER WILL CONTINUE TO HAVE CONTROL OVER CERTAIN INVESTMENTS WHICH ARE BEING USED BY THE GENESIS HEALTHCARE SYSTEM IN FULFILLING ITS TAX-EXEMPT PURPOSE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	3,734
6	Total number of volunteers (estimate if necessary) .............	6	309
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	242,771
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	36,640,849	15,705,413
9	Program service revenue (Part VIII, line 2g) .........	455,530,661	541,202,025
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,373,276	9,176,282
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	26,952,885	24,854,617
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	527,497,671	590,938,337
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	322,389	260,007
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	187,475,317	207,305,750
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	262,928,052	300,871,388
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	450,725,758	508,437,145
19	Revenue less expenses. Subtract line 18 from line 12.......	76,771,913	82,501,192
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	697,051,307	667,796,820
21	Total liabilities (Part X, line 26).............	481,340,257	416,135,555
22	Net assets or fund balances. Subtract line 21 from line 20.....	215,711,050	251,661,265

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 311,356,515 including grants of $ 260,007 ) (Revenue $ 558,682,519 )
	GENESIS PROVIDES ACUTE CARE SERVICES INCLUDING MEDICAL, SURGICAL, OBSTETRICAL, PEDIATRIC AND CRITICAL CARE. GENESIS PROVIDES A WIDE RANGE OF DIAGNOSTIC AND SUPPORT SERVICES FOR INPATIENTS AND OUTPATIENTS. THESE SERVICES ARE COMPRISED OF LABORATORY, IMAGING SERVICES, CARDIAC, AND PHARMACY. LABORATORY SERVICES INCLUDE CHEMISTRY, PATHOLOGY, MICROBIOLOGY, HEMATOLOGY, CYTOLOGY, AND PHLEBOTOMY. IMAGING SERVICES INCLUDES RADIOLOGY, NUCLEAR MEDICINE, MRI, ULTRASOUND, CT SCAN, PET SCAN, MAMMOGRAPHY AND BONE DENSITY SCANNING.GENESIS HEART & VASCULAR SERVICES PROVIDE NEEDED HEART CARE FROM PREVENTION TO REHABILITATION. OUR BOARD-CERTIFIED SPECIALISTS INCLUDE CARDIOLOGISTS, CARDIOTHORACIC VASCULAR SURGEONS, ELECTROPHYSIOLOGISTS, INTERVENTIONAL CARDIOLOGISTS, CARDIAC ANESTHESIOLOGISTS AND CARDIAC REHAB SPECIALISTS. THE CARDIOTHORACIC AND VASCULAR SURGICAL TEAMS PERFORM A WIDE VARIETY OF COMPLEX AND HIGH-RISK CARDIAC, THORACIC AND VASCULAR PROCEDURES INCLUDING OPEN HEART SURGERY. OUR CARDIAC TEAM TAKES OUR PATIENTS FROM EVALUATION AND DIAGNOSIS THROUGH LIFESTYLE CHANGES AND TREATMENTS. ALSO INCLUDED IN OUR CARDIAC SERVICES ARE OUR CLINICS AND SPECIALTY PROGRAMS. THESE INCLUDE AN ANTICOAGULATION CLINIC, A CONGESTIVE HEART FAILURE CLINIC, A DEVICE CLINIC, A VEIN CLINIC AND A CARDIAC REHABILITATION PROGRAM. GENESIS IS AN ACCREDITED CHEST PAIN CENTER WITH PCI, AN ACCREDITED ECHOCARDIOGRAPHY FACILITY. RESPIRATORY SERVICES - GENESIS RESPIRATORY & LUNG PROVIDES SERVICES FOR A VARIETY OF LUNG CONDITIONS AND DISEASES INCLUDING LUNG SURGERIES AND RESPIRATORY THERAPY. OUR TEAM, INCLUDING BOARD-CERTIFIED PULMONOLOGISTS, PROVIDE CARE AND TREATMENT FOR PATIENTS WITH PNEUMONIA, LUNG CANCER, BLACK LUNG DISEASE, RESPIRATORY FAILURE, COLLAPSED LUNG, AND OTHER PLEURAL DISEASES. THE GENESIS ORTHOPEDIC TEAM OF BOARD-CERTIFIED SURGEONS, SPECIALLY TRAINED NURSES, AND REHABILITATION THERAPISTS WORK TOGETHER TO DIAGNOSE AND TREAT THE MUSCULOSKELETAL ISSUES OF OUR PATIENTS. SERVICES RANGE FROM ADVANCED IMAGING TESTING THROUGH TO REHABILITATION. SURGICAL SURGERIES INCLUDE NUMEROUS PROCEDURES INCLUDING REPLACEMENT OF THE HIP, KNEE, OR SHOULDER AS WELL AS VARIOUS SURGERIES INVOLVING THE HAND. THE SPECIALIZED REHABILITATION PROGRAM SPEEDS RECOVERY AFTER A SERIOUS INJURY OR SURGERY RELATED TO A BONE, JOINT, LIGAMENT, TENDON OR MUSCLE. IN ADDITION TO PHYSICAL AND OCCUPATIONAL THERAPY, GENESIS ALSO PROVIDES AMPUTEE AND PROSTHETICS THERAPY AND TRAINING.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses311,356,515

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,790,289	1,244,381	1,170,905

1a	Federated campaigns..		1a	9,000
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	623,581
e	Government grants (contributions)		1e	15,072,832

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

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

h Total. Add lines 1a-1f.......		15,705,413

		Business Code
2a	NET PATIENT SERVICES	621110	541,202,025	541,202,025
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		541,202,025

3 Investment income (including dividends, interest, and othersimilar amounts) ......			8,769,249			8,769,249
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,585,457	6a
b	Less: rental expenses		1,245,901	6b
c	Rental income or (loss)		339,556	6c
d	Net rental income or (loss).......			339,556	339,556
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	407,033		7a
b	Less: cost or other basis and sales expenses	0		7b
c	Gain or (loss)	407,033		7c
d	Net gain or (loss).........			407,033			407,033
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	CAFETERIA SALES		621110	2,786,710			2,786,710
b	340B DISPENSING		621110	1,096,801	1,096,801
c	LABORATORY		621110	17,000	17,000
d	All other revenue ....			20,614,550	16,027,137	242,771	4,344,642
e	Total. Add lines 11a–11d ......			24,515,061
12	Total revenue. See instructions.....			590,938,337	558,682,519	242,771	16,307,634

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	260,007	260,007
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 ...........	7,894,202		7,894,202
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........	158,007,773	105,675,036	52,332,737
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,918,347	180,326	3,738,021
9	Other employee benefits .......	25,894,457	563,158	25,331,299
10	Payroll taxes ...........	11,590,971	8,229,441	3,361,530
11	Fees for services (non-employees):
a	Management ......	73,974	24,468	49,506
b	Legal .........	549,712		549,712
c	Accounting ...........	11,863,070		11,863,070
d	Lobbying ...........	158,358		158,358
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	64,743,878	39,267,768	25,476,110
12	Advertising and promotion ....	941,729	279,699	662,030
13	Office expenses .......	8,069,756	3,043,651	5,026,105
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	10,918,548	1,435,078	9,483,470
17	Travel ............	475,789	175,120	300,669
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	4,516	160	4,356
20	Interest ...........	16,093,997	1,576,950	14,517,047
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	20,268,129	7,110,484	13,157,645
23	Insurance ...	-213,481	3,384	-216,865
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	128,443,951	119,089,366	9,354,585
b	BAD DEBT EXPENSE	20,676,788	20,676,788
c	DUES/LICENSES/SUBSCRIPT	12,334,435	1,388,008	10,946,427
d	EMPLOYEE RECOGNITION	2,519,847	2,367,701	152,146
e	All other expenses	2,948,392	9,922	2,938,470
25	Total functional expenses. Add lines 1 through 24e	508,437,145	311,356,515	197,080,630	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 ........			16,816,468	1	6,814,175
2	Savings and temporary cash investments .........			116,600,134	2	3,866,299
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			69,139,538	4	66,933,025
5	Loans and other receivables from 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 .......
					5
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) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			9,963,877	8	9,519,127
9	Prepaid expenses and deferred charges ......			11,353,314	9	16,194,049
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	538,516,390
b	Less: accumulated depreciation	10b	242,089,687	283,934,043	10c	296,426,703
11	Investments—publicly traded securities .			121,487,554	11	135,829,831
12	Investments—other securities. See Part IV, line 11 .....			9,114,220	12	8,271,183
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			4,281,450	14	4,281,450
15	Other assets. See Part IV, line 11 ...........			54,360,709	15	119,660,978
16	Total assets. Add lines 1 through 15 (must equal line 33)...			697,051,307	16	667,796,820

17	Accounts payable and accrued expenses .....	108,116,570	17	108,051,371
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	267,717,550	20	263,276,508
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 .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	4,365,000	23	4,590,000
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	101,141,137	25	40,217,676
26	Total liabilities. Add lines 17 through 25..	481,340,257	26	416,135,555

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	215,711,050	27	251,661,265
28	Net assets with donor restrictions ...........		28
	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 ...........	215,711,050	32	251,661,265
33	Total liabilities and net assets/fund balances ........	697,051,307	33	667,796,820