Lenawee Long Term Care

“As a michigan non-profit organization, this corporation has a corporate member.”

“Promedica health system, inc. (phs) is the parent corporation and sole member of emma l. Bixby medical center which is the sole member of lenawee long term care. Phs has the right to (a) elect a majority of the members and approve all of the members, and remove any member of the board of trustees of lenawee long term care, and (b) fill and/or approve any nomination to fill any vacancy on the board of trustees.”

“While the board of trustees of each business unit is granted certain powers with respect to such business unit's operations, as the member, promedica health system, inc. Retains approval rights with respect to certain corporate actions such as (i) adoption of the business unit's strategic plans and financial plans, (ii) expenditures for non-budgeted items in excess of certain dollar limits set from time to time by the member, (iii) expenditures for items which are included in the business unit's annual budgets but which exceed the budgeted amount by an amount in excess of certain dollar limits set from time to time by the member, (iv) incurrence, assumption or guarantee of any indebtedness, (v) sale, lease or other disposition of real property or assets with a value in excess of certain dollar limits set from time to time by the member and (vi) any merger, consolidation, reorganization, dissolution or liquidation.”

“Under the guidance of promedica health system, inc.'s (phs) tax consultants, form 990s are prepared by the respective accounting department of each affiliate and reviewed by the affiliate's finance leadership. After affiliate's finance leadership approval, copies of the form 990 for phs and their subsidiaries are provided to the respective company's board of trustees and are reviewed and signed by a principal officer prior to filing with the internal revenue service.”

“Promedica health system, inc. And affiliates (phs) have standards of conduct that apply to all phs board members and employees. Board members and employees are expected to certify their compliance with the applicable standards prior to election/appointment or prior to beginning employment. Board members annually (or immediately if new potential conflicts of interest arise), all board members are required to complete and return the board member soc survey within 30 days of dissemination. Board member soc surveys are reviewed by the v.p., audit & compliance/chief compliance officer (cco). Summarized information is forwarded for review to the chief financial officer, general counsel, business unit presidents and the president and chief executive officer (president/ceo), based upon their respective knowledge of the board members. The purpose of this review is to both inform management of the disclosed conflicts and to allow them to identify to the v.p., audit & compliance, any potential undisclosed conflicts. The audit & compliance department then conducts an audit of all board member soc surveys (along with any relationships noted through the above review) to identify any positional conflicts of interest and to test material transactions with board members/their affiliates for fair market value. The results of the audit are reported directly to the chair of the audit & compliance committee with a copy to the president/ceo. The report includes a summary of the audit procedures performed, any significant concerns identified, and their resolution. Any unresolved conflicts are addressed by the audit committee with recommendations to the full board as needed. Failure to complete the survey or the submission of a false or incomplete survey, or failure to disclose immediately any new conflicts of interest that may arise, or failure to cooperate without condition, honestly and completely with any investigation or review of the board member's survey results or his/her actions or circumstances shall be grounds for sanction by the board of trustees up to and including removal from the board/committee/council. Employees, excluding employed physicians annually (or immediately if new conflicts of interest arise), all salaried employees and specifically identified hourly employees, excluding employed physicians, are required to complete and submit an electronic employee certification questionnaire by an established deadline that is communicated to the employee. The human resources department ensures that all questionnaires, which are stored electronically, are completed and provides notification to the v.p., audit & compliance of the number of annual employee certification questionnaires sent and received and copies of any questionnaires containing disclosures that warrant further review by the audit & compliance department. All new employees, excluding employed physicians, are provided either an electronic or paper copy of the employee standard of conduct and the employee certification statement which the new employee is required to complete prior to beginning employment. The audit & compliance department has access to a report that identifies all new hires. A sample of employees is identified and an audit is conducted to ensure that required documentation is on file. Identified conflicts are initially reviewed by the v.p., audit & compliance and if necessary discussed with the business unit president in which the employee works, the chief human resource officer, and general counsel. If the conflict is considered a significant exposure risk for phs, a recommendation will be prepared for final approval of the phs president/ceo. Results of the employee process audit are included in the above report to the chair of the audit & compliance committee. Failure to complete the certification questionnaire, or the completion of a false or incomplete certification questionnaire, or failure to disclose immediately any new conflicts of interest that may ar”

“Lenawee long term care's top management official and other officers are compensated by promedica health system, inc. (phs), a related tax-exempt organization. Compensation determinations of lenawee long term care's top management official and other officers are made by a compensation committee of phs. Each year independent consultants conduct an annual survey and recommend executive payroll base salary ranges based upon the market. The data is reviewed and approved by the promedica health system compensation committee every october. Salary adjustments are determined at the december meeting of the compensation committee. The compensation committee approves other forms of compensation based upon the prior year performance at the january meeting each year.”

“Promedica health system, inc. And subsidiaries provide any document open to public inspection upon request.”

“Lenawee long term care is a health facility that is a subsidiary of promedica health system, inc. (phs). Lenawee long term care holds an intercompany note payable to the toledo hospital, which is also a subsidiary of phs. The note payable represents lenawee long term care's portion of taxable and tax-exempt bonds issued by promedica healthcare obligated group.”

“Promedica health system, inc. - program service accomplishments established in 1986, promedica health system, inc. (promedica) is a mission-based, locally owned, not-for-profit healthcare organization highly focused on achieving core values. Headquartered in toledo, ohio, promedica serves 28 counties in northwest ohio and southeast michigan and is one of the region's leading healthcare providers. Our stewardship of resources has enabled us to wisely invest in cutting-edge technology, innovative programs and family-centered facilities that help to ensure patients and area residents have equal access to high-quality, safe care in the most appropriate setting, regardless of a patient's ability to pay. Based on needs that we have assessed within the communities we serve, promedica launched new services and programs in 2017 to help meet the growing demands of local consumers across all spectrums of life, including those individuals who are often the most vulnerable when it comes to health care: the elderly, poor and underserved. Promedica's mission is to improve the health and well-being of those we serve. This is reflected in our four core values, including: compassion - we treat our patients and each other with respect, integrity and dignity; innovation - we continually search to find a better way forward; teamwork - we partner with others because we are better together than apart; and excellence - we strive to be the best in all we do. Promedica and its affiliates comprise 220 sites, more than 2,000 physicians and approximately 17,000 employees and volunteers. During 2017, promedica discharged 66,395 inpatients and served 1,195,393 outpatients, while handling 286,408 emergency visits system-wide as well as 77,180 urgent care visits and more than 800 virtual visits through promedica ondemand. Among the region's largest employers, promedica plays a significant role in economic development and stability in our region. During 2017, for every one dollar of revenue, another 27 cents was created in our service-area economy, with a total economic output of $4.0 billion. We also create a direct economic impact with our revenue, payroll and employment. Additionally, spending on services and materials with vendors in our region creates an indirect economic benefit. Our physicians and providers, leadership team members, physicians and residents, and employees individually contribute personal resources to the community in numerous ways - such as through tutoring elementary students in reading and other life skills, providing monthly health lectures at local senior centers, generously contributing to community fundraising campaigns such as united way, participating in medical missions, serving on local not-for-profit boards, and donating nonperishable foods and clothing items to numerous local community organizations and churches - underscoring a key benefit of promedica being locally owned and operated. Promedica's member and affiliate hospitals include: the toledo hospital; toledo children's hospital (operating as part of the toledo hospital); promedica wildwood orthopaedic and spine hospital (a division of the toledo hospital); flower hospital; fostoria hospital association; defiance hospital, inc.; bay park community hospital; herrick memorial hospital, inc.; emma l. Bixby medical center; memorial hospital; and mercy memorial hospital corporation. In 2017 promedica also provided integrated services, comprised of: - promedica continuing care services corporation, providing rehabilitation, hospice, home care, ambulatory and senior services, community health, medical transportation services, and care coordination. - promedica physician group (promedica physicians), with approximately 900 healthcare providers, including primary care, obstetrics and specialty physicians, as well as advanced practice providers. Together, this group helps promedica broaden the care we offer to area residents, including in smaller, outlying communities. - promedi”

“(ehr), epic, in 2017 and upgraded the entire system to the most recent version of epic. The upgraded version allows promedica to take advantage of some of the many enhancements that epic has made to its software based on input from customers. Epic further enables one patient, one record, and one bill for patients regardless of service provided or the location of service across promedica. - paramount implemented the final phase of its new trucare care management system. The trucare system moves paramount to a state-of-the-art care management system and provides many operational efficiencies that allow paramount to meet the rigorous care management demands that are required to serve the medicaid population in ohio. - promedica physicians launched a new education program intended to help bring an end to ohio's opioid epidemic. To do this, promedica partnered with the ohio state medical association to offer smart rx - safe medicine and responsible treatment program. Smart rx is an hour-long online training program and public awareness campaign that brings medical professionals up-to-date on ohio's opioid prescribing rules and regulations as well as best practices for treating pain, and tips for patients on how to appropriately handle and dispose of potentially addictive prescription medicines. - promedica opened four additional urgent care centers in the metro-toledo area, to serve patients who have medical concerns that do not require an emergency center. A total of nine urgent care centers are now open 8 a.m. To 8 p.m., 365 days per year, and are staffed by highly-trained certified nurse practitioners. - promedica opened a new specialty pharmacy to aid patients who are living with chronic and complex health conditions and need specialized therapies or personalized care. The pharmacy provides dispensing for specialty medications used to treat chronic health conditions, including cystic fibrosis, ulcerative colitis and chron's disease, hepatitis c, multiple sclerosis, autoimmune disease, cancer, and much more. The new pharmacy is able to ship medications directly to the patient for improved access to care. - promedica participated in dozens of community health fairs across the region that included free public screenings for high blood pressure, high cholesterol, body mass index and bone density. - promedica cancer institute's (pci) community outreach included cancer screenings and education to the most vulnerable in our community. Free screening mammograms as well as lung cancer screenings were provided for early detection. Colorectal cancer education and nutritional programs were developed to keep people healthy, while sun safety education was provided to elementary school children to help prevent future cases of skin cancer. Pci also hosted annual cancer survivor celebrations for survivors, friends and caregivers across the region and sponsored community events including the annual nw ohio susan g. Komen, race for the cure and american cancer society relay for life in lucas county. - promedica continues to operate two food clinics - one at the promedica health and wellness center and the other at promedica's center for health services - to serve patients who screen positive for food insecurity and have a referral from their primary care provider. Patients are able to receive food for them and their family from this location or the original food pharmacy located at promedica's center for health services. As part of the program, each patient receives two to three days of supplemental food for their family. Through december 2017, there have been more than 9,700 visits to the food clinic, impacting more than 3,200 unique households. This translates to about 74,520 days' worth of food provided to patients and families, the equivalent of 223,560 meals. - promedica also offers its prescription for health program in the adrian, michigan, community. Through this program, promedica providers are able to write a prescription for food for e”

“Patients who did not have the financial resources to pay for hospital services. This amount represents the cost to provide service and does not include the costs for accounts that are written off to bad debt for patients who do not pay their bills. In addition, promedica's cost of bad debt for 2017 was $28,737,000. This amount is not included in the community benefit amount of $191,681,000 noted above. Further, promedica continues to be a leading participant in the lucas county carenet initiative - a collaborative effort among promedica, mercy health partners, the university of toledo medical center, the city of toledo, and others. Carenet was created to provide free or lower-cost health care for low-income lucas county residents. Established in 2003, carenet bridges the gap between adults without health insurance and needed healthcare services. While some individuals may qualify for governmental insurance programs such as medicaid, others do not; it is for these individuals that carenet was established. Additionally during 2017, promedica provided $130,504,000 of community benefit through the cost - not reimbursed by the government - for treating medicaid and other means-tested patients. Promedica's total cost - not reimbursed by the government - for treating medicare patients during 2017 was $139,149,000 and is not reflected in the community benefit amount of $191,681,000 noted above. Indeed, promedica goes beyond industry standards in meeting the goal of providing care to everyone, regardless of their ability to pay. We provide hospital care free-of-charge to all families without insurance with incomes at or below 200% of the federal poverty level. In addition to free care for those families under this federal poverty level, promedica hospitals provide significant discounts to families with incomes of up to 400% of the federal poverty level. In many situations, other funding sources are secured and accommodations made. Promedica's policies are posted and available in writing in all promedica facilities. Also, financial advocates are available to help patients by explaining our free care and discount programs, and to assist with the paperwork necessary to qualify for government funding. Patient bills provide clear explanations, qualifications and reminders of these programs. In summary, promedica demonstrates its mission and core values by providing high-quality health care to all patients, regardless of their race, creed, sex, national origin, disability, or age. And, we recognize that not all individuals possess the ability to purchase essential medical care. Therefore, we provide these healthcare services; recruit and train healthcare professionals to serve the broader community; provide appropriate financial assistance; offer services and contributions to other nonprofit organizations that allow them to provide key services to their constituents; and present free educational classes, health fairs and other activities to our local community to help ensure all members have equal access to care.”

“Lenawee long term care (lltc, d/b/a provincial house of adrian) a 117-bed nursing home facility located in adrian, michigan. Lltc is part of promedica health system, inc. (promedica), a mission-based, locally owned, nonprofit healthcare organization highly focused on achieving core values. Headquartered in toledo, ohio, promedica serves 28 counties in northwest ohio and southeast michigan, and is one of the region's leading healthcare providers. Our stewardship of resources has enabled us to wisely invest in patient-centered care, advanced technology, innovative programs, and family-oriented facilities that help to ensure patients and area residents have equal access to high-quality, safe care in the most appropriate setting, regardless of patients' ability to pay. Lltc is a long-term care facility designed to provide assistance to individuals who no longer are able to care for themselves because of physical limitations, chronic conditions, disabilities, or other changes in personal health. Its staff provides skilled nursing services to long-term care residents as well as patients who require post-hospital care so they may return to a home setting. Rehabilitation services include cardiac and stroke rehabilitation, treatment for orthopaedic conditions such as hip fractures or joint replacement, lymphedema treatment and more. Long-term residents are able to enjoy special events such as cookouts, holiday celebrations, picnics, trips to local restaurants, and sightseeing tours. In 2017, provincial house received the governor's award of excellence from mpro, a michigan-based nonprofit committed to healthcare quality improvement. In 2017, lltc provided a total of 39,872 long-term care days to its residents. Twenty-six volunteers donated more than 1050 hours of assistance to care for these individuals. Lltc contributed $1,202,000 in community benefit in 2017, all of which was attributed to the costs - not reimbursed by the government - for treating medicaid patients. Lltc's cost of bad debt for 2017 was $249,000. This amount is not included in the community benefit amount of $1,202,000 noted above. During 2017, lltc expended $4,421,000 in net payroll, providing 142 jobs in southeast michigan. A total of $197,000 was withheld in employee state and local taxes. Lltc demonstrates promedica's mission and core values by providing high-quality health care to all patients, regardless of their race, creed, sex, national origin, disability, or age. And, we recognize that not all individuals possess the ability to purchase essential medical care. Therefore, promedica provides these healthcare services; recruits and trains healthcare professionals to serve the broader community; provides appropriate financial assistance; offers services and contributions to other nonprofit organizations that allow them to provide key services to their constituents; and presents free educational classes, health fairs and other activities to our local community to help ensure all members have equal access to care.”

“Promedica health system, inc. And its subsidiaries (promedica) prepares its community benefit reports consistent with guidelines published by the catholic health association of the united states and consistent with form 990, schedule h, hospitals, reporting. Community benefits are programs and activities that provide treatment and/or promote health and healing as a response to identified community needs. Community benefits reported by promedica respond to identified community needs and meet at least one of the following criteria: - improve access to healthcare service. - enhance the health of the community. - advance healthcare knowledge. - relieve or reduce the burden of government or other community efforts. Financial assistance consistent with its mission, promedica provides a significant amount of financial assistance to patients with limited or no ability to pay their bill. Promedica hospitals provide free care to those uninsured patients with incomes up to 200% of the federal poverty level. Significant discounts are also provided on a sliding scale to uninsured patients up to 400% of the federal poverty level. Financial assistance is reported in the form of cost to provide services and has been reduced to reflect reimbursement received from state programs designed to relieve the burden of providing financial assistance. The cost of financial assistance does not include the costs for accounts that are written off to bad debt for patients that do not pay their bill. Government-sponsored health care government-sponsored health care include services that are reimbursed or partially reimbursed through government means-tested programs such as medicaid. Promedica includes the unpaid costs of these public programs to the extent that payments received are less than the costs of providing services. The unpaid costs of treating medicare patients is reported separately and is not included in promedica's community benefit report. Additionally, the cost of financial assistance has been eliminated from any amounts reported in this category. Community health improvement services & community benefit operations community health improvement services include activities carried out for the express purpose of improving community health. These activities generally do not generate inpatient or outpatient bills as they extend beyond patient care activities and are subsidized by promedica. Community benefit operations include costs associated with dedicated staff, community health need and/or assessment, and other costs associated with community benefit planning and administration. Health professions education health professions education include costs for all educational programs promedica is involved with, the provision of a clinical setting for training for healthcare students outside the organization, and funding for healthcare education. Subsidized health services subsidized health services are services provided to the community despite a financial loss. These services generate a bill for reimbursement, and include clinical patient care services that are provided because they are needed in the community and other providers are unwilling, or unable, to provide the services, or the services otherwise would not be available to meet community needs. Research research activities include clinical and community health research, as well as studies on healthcare delivery. The amount reported for promedica is reduced by any external subsidies, such as grants. Cash and in-kind contributions cash and in-kind contributions include funds and in-kind services donated to community organizations and the community at large. In-kind services include hours donated by staff for community needs while on work time; as well as donations of food, equipment and supplies.”