| FORM 990, PART VI, SECTION A, LINE 3 |
EFFECTIVE NOVEMBER 1, 2019, CONSOLIDATED HEALTH SERVICES, INC, D/B/A CHI HEALTH AT HOME (CHAH) WAS GIVEN THE AUTHORITY AND RESPONSIBILITY TO CONDUCT, SUPERVISE, AND MANAGE THE DAY-TO-DAY OPERATIONS OF PATHWAYS HOME HEALTH AND HOSPICE (PHHH), INCLUDING BUT NOT LIMITED TO SUPERVISION, DIRECTION AND MANAGEMENT OF PHHS' EMPLOYEES OR CONTRACTORS, AND TO PERFORM ALL OF THE MANAGEMENT SERVICES NECESSARY FOR THE BUSINESS OPERATIONS OF PHHH, INCLUDING, BUT NOT LIMITED TO, BILLING, SCHEDULING OF VISITS, COLLECTION OF REVENUES, ACCOUNTS PAYABLE, DISBURSEMENT OF FUNDS, COORDINATION WITH THIRD-PARTY PAYERS, OBTAINING SUPPLIES, EQUIPMENT, AND SERVICES, NEGOTIATING MANAGED CARE AGREEMENTS, STRATEGIC PLANNING, OVERSIGHT OF RELEASE OF INFORMATION AND HEALTH INFORMATION MANAGEMENT SERVICES, PROVIDING ADMINISTRATIVE SUPPORT TO PHHH, OPERATING AND MAINTAINING INFORMATION SYSTEMS, AND PROVIDING SUCH OTHER SERVICES AS ARE REQUIRED FOR THE EFFICIENT OPERATION OF PHHH. THROUGH THIS MANAGEMENT AGREEMENT, DANIEL S. DIETZ-CEO, AND WILLIAM S. HERDTNER-CFO, OFFICERS OF CHAH, WHOM SERVE IN THEIR RESPECTIVE ROLES FOR PHHH, ARE COMPENSATED BY CHAH. THE PORTION OF THEIR COMPENSATION RELATED TO THEIR SERVICES PROVIDED TO PHHH FOR THE FISCAL YEAR ENDED JUNE 30, 2021 WERE AS FOLLOWS: DANIEL S. DIETZ-$127,386, WILLIAM S. HERDTNER $60,931. |
| FORM 990, PART VI, SECTION A, LINE 6 |
THE ORGANIZATION HAS TWO MEMBERS; EL CAMINO HOSPITAL AND DIGNITY HEALTH, DBA SEQUOIA HOSPITAL; BOTH ARE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATIONS AND EXEMPT UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| FORM 990, PART VI, SECTION A, LINE 7A |
EACH OF THE MEMBER HOSPITALS HAS THE RIGHT TO VOTE FOR ONE HALF OF THE CORPORATION'S DIRECTORS. AN ADDITIONAL MEMBER SHALL BE APPOINTED BY A MAJORITY VOTE OF THE CORPORATIONS ELECTED AND SERVING DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B |
THE MEMBER HOSPITALS HAVE RESERVED POWERS, INCLUDING THE POWER TO APPROVE CHANGES IN THE ORGANIZATIONAL DOCUMENTS AND PURPOSES, THE DISPOSITION OF ALL OR SUBSTANTIALLY ALL ASSETS, MERGER OR OTHER REORGANIZATION, EXTRAORDINARY EXPENDITURES, AND DEBT INCURRENCE. |
| FORM 990, PART VI, SECTION B, LINE 11B |
OUR PROCESS IS, UPON COMPLETION OF THE DRAFT COPY, THE 990 IS REVIEWED IN DETAIL BY A COMMITTEE OF THE BOARD ALONG WITH THE ORGANIZATION'S CEO, CFO, AND TAX AUDIT FIRM. THE DRAFT COPY IS PROVIDED TO THE COMMITTEE IN PAPER FORM. THE 990 IS REVIEWED PRIOR TO FILING. THE 990 IS MADE AVAILABLE TO BOARD MEMBERS FOR FINAL REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C |
CONFLICT OF INTEREST POLICY APPLIES TO BOARD MEMBERS AND EXECUTIVE STAFF. THE POLICY IS REVIEWED ANNUALLY. IN THE CASE OF A POTENTIAL OR ACTUAL CONFLICT, THE MEMBER WOULD RECUSE HIMSELF/HERSELF FROM MANAGEMENT DECISIONS RELATED TO THAT CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 |
NO OFFICERS, DIRECTORS OR TRUSTEES RECEIVED COMPENSATION FROM THE ORGANIZATION. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS OR TRUSTEES BY MANAGEMENT COMPANY WAS SET BY THE MANAGEMENT COMPANY'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 |
THE AUDITED FINANCIAL STATEMENTS AND WRITTEN CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST; THE PUBLIC CAN COME IN AND REVIEW A COPY OF THE DOCUMENTS; HOWEVER IN SOME CASES WE WILL PROVIDE A BOUND COPY OR EMAIL THEM A PDF COPY. UPON REQUEST, AND IN PERSON, THE PUBLIC CAN COME IN AND REVIEW A COPY OF THE ORGANIZATION'S 990 AND GOVERNING DOCUMENTS. |
| FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC |
W. SCOTT HERDTNER - 1700 EDISON DR., MILFORD, OH 45150. DANIEL S. DIETZ - 1700 EDISON DR., MILFORD, OH 45150. |
| FORM 990, PART IX, LINE 11G |
OTHER DIRECTOR FEES FOR SERVICE (NON EMPLOYEES): PROGRAM SERVICE EXPENSES 3,037,856. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,037,856. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,617,980. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 37,677. TOTAL EXPENSES 2,655,657. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 991,640. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 991,640. MEDICAL PROFESSIONALS: PROGRAM SERVICE EXPENSES 490,096. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 490,096. |
Attach to Form 990 or 990-EZ.