Hospitals are invited to nominate those who have made noteworthy contributions to health care in Ohio.

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1 1. Health Care Leadership Awards - Overview Each year, OHA honors outstanding individuals and organizations whose achievements have enhanced and brought honor to Ohio hospitals. These awards reflect excellent personal or organizational accomplishments within the Ohio hospital community. Hospitals are invited to nominate those who have made noteworthy contributions to health care in Ohio. LEADERSHIP AWARDS (full descriptions on Page 2) Donald R. Newkirk Award James R. Castle Distinguished Service Award Dr. Eli Crew Community Service Excellence Award COMPLETION & ACCURACY Please ensure the information provided in the nomination is complete and accurate. This information will be used on the OHA website and social media, and in the recognition dinner program, slide show and statewide press release. CONTACTS The nominator and primary contact person will receive information related to the nominee and the 2018 OHA Recognition Dinner. DEADLINE Nominations will be accepted until 11:59 p.m. on Feb. 2, PHOTOGRAPH A photograph of the nominee is required. Please one head shot of the nominee to communications@ohiohospitals.org by Feb. 2. RECOGNITION Award recipients will be honored at the OHA Recognition Dinner on Tuesday, June 5 during OHA s Annual Meeting in Columbus. QUESTIONS Please contact Jennica Norris or Katelyn Bowling with any questions. 1

2 2. Health Care Leadership Awards - Descriptions Donald R. Newkirk Award Honors an individual who has made a significant lifetime contribution to the health care field in Ohio. Presented to an individual with multiple years of health care service who has made a significant impact in his or her hospital, the local community and across the state of Ohio. This is the association s highest award and bears the name of the individual who led OHA for 27 years. Eligibility: Nominees should be the president or CEO of an OHA member organization, either past or present. James R. Castle Distinguished Service Award Honors an individual whose professional attainments embody qualities of an outstanding leader or mentor for service to the health care community, or other special achievement. Presented to an individual who has made a significant impact in his or her hospital, local community or region of the state. This award commemorates James Castle, who served as OHA s president and CEO for 23 years, from 1989 through Eligibility: Nominees should be the president, CEO or other senior executive of an OHA member organization, either past or present. Dr. Eli Crew Community Service Excellence Award Recognizes an individual or organization who serves as a friend to hospitals or health systems and whose support of the health care industry reflects the public interest. Dr. Eli R. Crew, was one of the strongest hospital advocates of an Ohio-based organization. In 1915, he invited Ohio hospital administrators to an organizational meeting at Cedar Point in Sandusky where OHA was founded. Eligibility: Nominees can be hospital/health system board members or other volunteers, medical staff members, community leaders or others in the public or private sector. 2

3 3. Health Care Leadership Awards - Select Award * 1. Please select the award for which you are making a nomination. An individual may be nominated for only one of the following awards: Donald R. Newkirk Award James R. Castle Distinguished Service Award Dr. Eli Crew Community Service Excellence Award 3

4 4. Nominee Information * 2. Provide basic contact information for the nominee. Nominee name Credentials (specify RN, M.D., etc.) Nominee title Department/unit (write out abbreviations) Health system Hospital mailing address Hospital mailing address 2 city state zip code Nominee phone number Nominee * 3. Please indicate the nominee's length of service in health care and at your facility. Years of service at the hospital/organization Total years of service in health care 4

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6 5. Nominator Information * 4. Please enter contact information for the nominator. The nominator will receive information related to the nominee and the 2018 OHA Recognition Dinner. Nominator name Credentials (specify RN, LPN, etc.) Nominator title Hospital Health system Hospital mailing address Hospital mailing address 2 Hospital city Hospital state Hospital zip code Nominator phone number Nominator 6

7 6. Additional Contact Information 5. If an individual other than the nominator should receive information related to the nominee and OHA Recognition Dinner, include their contact information below. Contact name Credentials (specify RN, LPN, etc.) Contact title Health system/organization mailing address mailing address 2 city state zip code Contact phone number Contact 7

8 7. Summary (125 word maximum) * 6. Include a summary of approximately 125 words summarizing the nomination. The summary will be used on OHA's website and social media, as well as in several publications. 8

9 8. Nomination * 7. Submit a nomination of approximately 1,000 words describing how your hospital s nominee embodies the qualities of the selected award as described on page 2. 9

10 9. Photographs one color, digital photograph of the nominee to Include the name of the hospital and nominee in the body of the . * 8. My hospital agrees to send a photo of the nominee to communications@ohiohospitals.org by Feb. 2. I agree 10