2023-11-13T17:20:46-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2022-01-01 344428218 FIRELANDS REGIONAL MEDICAL CENTER FIRE 4195577400 1111 HAYES AVE SANDUSKY OH 448703323 KEVIN RILEY CHIEF FINANCIAL OFFICER 4195577400 2023-11-13 1 KEVIN RILEY 999009999 1 AMY CIMINELLO P00796388 6148493000 2023-11-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KEVIN RILEY 1111 HAYES AVE SANDUSKY OH 44870 348467775 0 X WWW.FIRELANDS.COM X 1919 OH OUR MISSION IS TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR PHYSICIANS, THEIR PATIENTS, OUR VOLUNTEERS AND EMPLOYEES AS WE STRIVE TOGETHER TO IMPROVE THE HEALTH AND WELL BEING OF THOSE WE SERVE. 41 35 2337 147 324489 323489 11427325 11487850 255257874 242389392 26975670 10600785 15705402 18333980 309366271 282812007 912697 36365 0 0 131283041 144321308 0 0 527739 134934328 141613664 267130066 285971337 42236205 -3159330 572183649 491649591 271407046 225564564 300776603 266085027 X OUR MISSION IS TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR PHYSICIANS, THEIR PATIENTS, OUR VOLUNTEERS AND EMPLOYEES AS WE STRIVE TOGETHER TO IMPROVE THE HEALTH AND WELL BEING OF THOSE WE SERVE. 0 0 214511367 36365 242389392 FIRELANDS REGIONAL MEDICAL CENTER IS A 287-BED FACILITY SERVING THE GREATER ERIE COUNTY REGION WITH HIGH-QUALITY HEALTHCARE SERVICES DESIGNED TO HELP THE PEOPLE IN OUR COMMUNITIES LIVE HEALTHIER, HAPPIER LIVES. AS A NON-PROFIT ORGANIZATION, FIRELANDS IS COMMITTED TO ITS MISSION TO: "PROVIDE EXCELLENT HEALTHCARE, PROMOTE COMMUNITY WELLNESS, AND IMPROVE THE LIVES WE SERVE." FIRELANDS IS DEDICATED TO PROVIDING CARE TO ALL THOSE IN THE COMMUNITY REGARDLESS OF ABILITY TO PAY.FIRELANDS REGIONAL MEDICAL CENTER IS A RESULT OF COMBINING THREE ORIGINAL HOSPITALS: GOOD SAMARITAN HOSPITAL AND MEMORIAL HOSPITAL IN 1985 AND THEN MERGING WITH PROVIDENCE HOSPITAL IN 2001. FIRELANDS REGIONAL MEDICAL CENTER TODAY CARRIES ON THE PROUD TRADITION OF DELIVERING A FULL-RANGE OF ALLOPATHIC AND OSTEOPATHIC MEDICAL SERVICES TO NEARLY 300,000 RESIDENTS IN A FIVE-COUNTY AREA. AS THE LARGEST YEAR-ROUND EMPLOYER IN ERIE COUNTY, FIRELANDS REGIONAL MEDICAL CENTER PLAYS AN IMPORTANT ROLE IN THE LOCAL COMMUNITY. WITH OVER 2,000 INDIVIDUALS EMPLOYED IN THE HEALTH SYSTEM IN 2022, $1.94 MILLION WAS PAID IN CITY AND SCHOOL PAYROLL TAXES IN 2022, AND $15.6 MILLION OF GOODS AND SERVICES WERE PURCHASED FROM BUSINESSES IN FIRELANDS' SERVICE AREA.IN TERMS OF HEALTHCARE SERVICES PROVIDED IN 2022, INPATIENT CARE WAS GIVEN TO 7,608 INDIVIDUALS, AND THE HOSPITAL PROVIDED CARE THROUGH 235,190 OUTPATIENT VISITS. THERE WERE 42,261 PERSONS TREATED IN THE EMERGENCY ROOM AND URGENT CARE, PROVIDING MULTIPLE LEVELS OF EMERGENCY AND URGENT CARE SERVICES FOR MAJOR AND MINOR INJURIES AND ILLNESSES. FIRELANDS HAD 684 BIRTHS IN 2022.CONSISTENT WITH OUR COMMITMENT TO PROVIDE CARE TO ALL, REGARDLESS OF ABILITY TO PAY, FIRELANDS GAVE BACK TO THE COMMUNITY OVER $41.13 MILLION OF SERVICES IN FREE OR DISCOUNTED PROGRAMS OR SERVICES. ADDITIONAL CHARITY CARE WAS PROVIDED BY INDEPENDENT PHYSICIANS WHO ARE ON THE MEDICAL STAFF OF FIRELANDS. SPECIFICALLY, IN TERMS OF FREE OR DISCOUNTED CARE PROVIDED, FIRELANDS SERVED THE FOLLOWING NUMBER OF PERSONS WITHIN EACH CATEGORY, AMOUNTING TO SIGNIFICANT DOLLARS INVESTED IN THE COMMUNITY FOR WHICH FIRELANDS DID NOT RECEIVE COMPENSATION:PERSONS SERVED -- CATEGORY -- COST OF PROVIDING CARE34,327 -- COSTS OF SERVICES NOT OVERED BY MEDICAID -- $7,174,22713,501 -- COMMUNITY HEALTH IMPROVEMENT -- $294,434124 -- HEALTH PROFESSIONS EDUCATION -- $3,791,9387,894 -- FINANCIAL ASSISTANCE AT COST -- $1,190,3180 -- IN-KIND DONATIONS -- $24,376FIRELANDS' COMMUNITY OUTREACH DEPARTMENT IS DEDICATED TO PROVIDING SCREENINGS, COMMUNITY EDUCATION PROGRAMS AND PREVENTIVE SERVICES ALL DESIGNED TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE SERVICES ARE PROVIDED AT FREE OR DISCOUNTED RATES. FIRELANDS ALSO WORKS IN CONJUNCTION WITH OTHER HEALTHCARE FACILITIES TO BRING SPECIALIZED PEDIATRIC CLINICS TO THE AREA, SUCH AS CARDIOLOGY, GASTROENTEROLOGY, NEUROLOGY, ORTHOPEDIC, AND PULMONARY.FIRELANDS HAS SEEN SIGNIFICANT GROWTH IN BRINGING ADVANCED PROCEDURES TO THE LOCAL COMMUNITY SO THAT PERSONS RESIDING IN THE FIVE-COUNTY AREA CAN STAY CLOSER TO HOME FOR ADVANCED CARE SUCH AS HEART SURGERY, SPINE SURGERY, VASCULAR SURGERY AND ADVANCED CARE IN MEDICAL ONCOLOGY AND RADIATION ONCOLOGY SERVICES. IN 2022, FIRELANDS WELCOMED SIX NEW PHYSICIANS SPECIALIZING IN THE AREAS OF CARDIOLOGY, FAMILY MEDICINE, GASTROENTEROLOGY, NEUROSURGERY, PHYSICAL MEDICINE, AND REHABILITATION. 214511367 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 1 0 1 242 0 1 2337 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 41 35 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 OH X JACKIE SPRINGER CONTROLLER 4195575544 1111 HAYES AVE SANDUSKY OH 448703323 THOMAS WILLIAMSON MD DIRECTOR/PHYSICIAN 1.00 40.00 X 0 355902 52395 KARL OBERER DO DIRECTOR/PHYSICIAN 1.00 40.00 X 0 263760 55230 STEVEN BENEDICT MD DIRECTOR 1.00 0.00 X 45508 0 0 PATRICK MCGUINNMD DIRECTOR 1.00 0.00 X 28516 0 0 FREDRIC ITZKOWITZ DO DIRECTOR 1.00 0.00 X 24245 0 0 BRADLEY MITCHEL DIRECTOR 1.00 0.00 X 2005 0 0 CARLOS LOWELL DO DIRECTOR 1.00 0.00 X 1110 0 0 JOHN O BACON DIRECTOR 1.00 2.00 X 0 0 0 LEON J WIEBER DIRECTOR 1.00 1.00 X 0 0 0 TIMOTHY MAYLES DIRECTOR 1.00 0.00 X 0 0 0 MARY JANE HILL DIRECTOR 1.00 1.00 X 0 0 0 EUGENE SANDERS DIRECTOR 1.00 0.00 X 0 0 0 WENDY SCHMIEDL DIRECTOR 1.00 0.00 X 0 0 0 SHELLY CHESBRO DIRECTOR 1.00 0.00 X 0 0 0 GREGORY GRAVES DIRECTOR 1.00 0.00 X 0 0 0 ROGER M GUNDLACH CHAIR 2.00 2.00 X X 0 0 0 JOHN HOTY DIRECTOR 1.00 0.00 X 0 0 0 BRYAN KASPER DIRECTOR 1.00 2.00 X 0 0 0 THEODORE A KASTOR DIRECTOR 1.00 1.00 X 0 0 0 DANIEL KELLER DIRECTOR 1.00 1.00 X 0 0 0 RICHARD R KELLER MD DIRECTOR 1.00 1.00 X 0 0 0 STEVE LICHTCSIEN DIRECTOR 1.00 1.00 X 0 0 0 DUFFIELD E MILKIE DIRECTOR 1.00 0.00 X 0 0 0 ALLEN R NICKLES DIRECTOR 1.00 1.00 X 0 0 0 JAMES E PRESTON DO DIRECTOR 1.00 0.00 X 0 0 0 PAULA J RENGEL DIRECTOR 1.00 2.00 X 0 0 0 JAMES V STOUFFER JR DIRECTOR 1.00 1.00 X 0 0 0 CURTIS JOHNSON JR DIRECTOR 1.00 0.00 X 0 0 0 JAMES HART DIRECTOR 1.00 1.00 X 0 0 0 JAMES O WIBLE DIRECTOR 1.00 2.00 X 0 0 0 JAMES SCHERGER DIRECTOR 1.00 0.00 X 0 0 0 CHRISSY WOSTMAN DIRECTOR 1.00 0.00 X 0 0 0 LUVADA WILSON DIRECTOR 1.00 1.00 X 0 0 0 LEE A ALEXAKOS DIRECTOR 1.00 1.00 X 0 0 0 DARLENE CROOKS DIRECTOR 1.00 0.00 X 0 0 0 JANICE W WARNER DIRECTOR 1.00 0.00 X 0 0 0 MATTHEW KOSIOR DIRECTOR 1.00 0.00 X 0 0 0 JUSTIN HARRIS DIRECTOR 1.00 0.00 X 0 0 0 NAOMI TWINE DIRECTOR 1.00 0.00 X 0 0 0 JEREMY NORMINGTON-SLAY PRESIDENT & CEO 40.00 2.00 X 903755 0 178402 ROBERT M MOORE VP LEGAL/SECRETARY (NON-VOTING) 40.00 2.00 X 444017 0 126485 KEVIN RILEY CHIEF FINANCIAL, TREASURER (NON-VOTING) 40.00 2.00 X 21163 0 4188 JAMES MILLER VICE CHAIR 2.00 1.00 X 0 0 0 SCOTT M CAMPBELL MD VP & CHIEF MEDICAL OFFICER 40.00 0.00 X 580018 0 42833 MARCUS ADEYEMI PHYSICIAN 40.00 0.00 X 490918 0 55517 ANUPAM JHA PHYSICIAN 40.00 0.00 X 434324 0 28535 DENISE PARRISH VP & CHIEF NURSING OFFICER 40.00 0.00 X 336166 0 84969 JAMES SPICER VP OPERATIONS 40.00 0.00 X 331281 0 14915 DANIEL J MONCHER EXEC VP/CFO/TREASURER (NON-VOTING) FORMER 40.00 2.00 X 626026 0 36309 4269052 619662 679778 10 1 1 0 PREMIER ANESTHESIA PO BOX 638144 CINCINNATI OH 45263 ANESTHESIA SERVICES 2875239 BRIDGE HOMECARE PARTNERS 5335 FAR HILLS AVE DAYTON OH 45429 HOME HEALTH 1360000 H-FIVE CONSULTING LLC 23 OVERBROOK DR BINGHAMPTON NY 13901 CONSULTING SERVICES 1305756 WADSWORTH SERVICE INC 1500 MICHAEL OWENS WAY PERRYSBURG OH 43551 CONSTRUCTION SERVICES 1125194 UNIVERSITY HOSPITALS PO BOX 78000 DEPT 781887 DETROIT MI 482781887 PHYSICIAN STAFF 930017 103 46862 43164 9293449 2104375 11487850 NET PATIENT SERVICE REVENUE 623000 238432180 238432180 SCHOOL OF NURSING 611600 556538 556538 PROGRAM SERVICE INVESTMENTS 525990 -1729 -1729 3402403 3402403 242389392 8891212 8891212 63675615 3598697 63051442 2513297 624173 1085400 1709573 1709573 271495 46862 91029 180466 180466 EMPLOYEE PHARMACY 456110 12812359 12812359 OFFICE RENTS 531190 2427813 2427813 DIETARY SERVICES 722514 843384 843384 2069958 324489 1745469 18153514 282812007 242389392 324489 28610276 X 19365 19365 17000 17000 5467108 3391700 2075408 100018200 73020059 26788736 209405 20233424 14808105 5384248 41071 11199618 8157628 3018874 23116 7402958 5372693 2015473 14792 2671103 770376 1900727 397856 397856 253926 253926 1205568 1205568 29556588 20208664 9342388 5536 766427 1887 574243 190297 59418941 54543963 4852555 22423 6435382 6435382 6222109 1493470 4728639 622911 448436 173929 546 49326 49326 3773653 3773653 16666988 16666988 2271542 898126 1373416 FRANCHISE TAX 7421642 7421642 AFFILIATION FEES 735655 728816 6839 3144047 2768796 361537 13714 285971337 214511367 70932231 527739 10724 10624 28445289 26256766 70005 49570 36850843 30173175 5907955 6086888 8614040 13305561 383720061 218366951 176634081 165353110 306556325 243317352 4780811 5236258 4313576 1860287 572183649 491649591 101856864 51370170 139547526 134685768 30002656 39508626 271407046 225564564 X 281135096 250643253 19641507 15441774 300776603 266085027 572183649 491649591 X -3159330 -23712359 -7819887 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3778 3778 0 PART II-B, LINE 1: OHIO HOSPITAL ASSOCIATION ANNUAL DUES OF WHICH 5.5% IS RELATED TO LOBBYING ACTIVITIES 0 18066638 -2956325 882155 89261 14138897 16884280 2048359 762850 103151 18066638 15226787 2498063 745247 95323 16884280 13792827 2310248 798502 87786 15226787 16316411 -1099381 1330271 93932 13792827 1.00000 1 0 13618776 13618776 187535598 86789421 100746177 3071078 1261912 1809166 164307605 126851034 37456571 15187004 3464584 11722420 165353110 CAPITAL LEASE 7004259 SELF-INSURANCE RESERVE 8960000 ACCRUED POST-RETIREMENT & PENSION 20463422 DEFERRED INCOME GUARANTEE 2905804 DUE TO RELATED PARTIES 175141 39508626 X PART V, LINE 4: ENDOWMENT FUND EXPENDITURES FOR FACILITIES AND PROGRAMS ARE USED TO PROMOTE PHYSICAL AND MENTAL WELL-BEING IN THE COMMUNITY. PART X, LINE 2: FINANCIAL STATEMENTS FOR FIRELANDS REGIONAL MEDICAL CENTER ARE PART OF THE CONSOLIDATED AND AUDITED FINANCIAL STATEMENTS OF FIRELANDS REGIONAL HEALTH SYSTEM. CADDYSHACK OPEN 318357 46862 271495 500 3202 14796 34709 29531 8291 0 318357 46862 271495 500 3202 14796 34709 29531 8291 91029 180466 1 1 1 X 1 X 302.000000000000 1 1 1 0 1 1 3211152 2020834 1190318 0.00420 38504264 31330037 7174227 0.02510 41715416 33350871 8364545 0.02930 348945 54511 294434 0.00100 6825158 3033220 3791938 0.01330 24376 24376 0.00010 7198479 3087731 4110748 0.01440 48913895 36438602 12475293 0.04370 1 5000 5000 0.00000 1 23969 763532 158941 604591 0.00210 2 23969 768532 158941 609591 0.00210 1 2602256 358240 98710838 124237242 -25526404 X 1 1 1 NORTHERN OHIO SURGICAL PROPERTIES PROPERTY OWNERSHIP/MANAGEMENT 0.50000 0.30730 2 ERIE SHORES SURGERY CENTER OWNERSHIP OF AMBULATORY SURGICAL CENTER 0.56730 0.26730 3 BBD PROFESSIONAL PROPERTY MANAGEMENT PROPERTY OWNERSHIP/MANAGEMENT 0.25000 0.75000 1 1 FIRELANDS REGIONAL MEDICAL CENTER 1111 HAYES AVENUE SANDUSKY OH 44870 WWW.FIRELANDS.COM STATE REG. #1164 X X X X FIRELANDS REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X X 22 1 0 1 1 X WWW.FIRELANDS.COM X ERIECOHEALTHOHIO.COM X 1 22 0 1 0 1 X 200.000000000000 302.000000000000 X 1 1 X X X X 1 X WWW.FIRELANDS.COM X WWW.FIRELANDS.COM X WWW.FIRELANDS.COM X X X X X X X 1 X 0 X X X X 1 X 0 0 FIRELANDS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3J: OTHER TOPICS THAT THE CHNA REPORT ADDRESSED INCLUDE SOCIAL DETERMINANTS, PERSONAL HEALTH STATUS, ACCESS TO HEALTH CARE, MENTAL HEALTH, ORAL HEALTH, SMOKING/TOBACCO USE, ALCOHOL AND SUBSTANCE ABUSE, MATERNAL/INFANT/CHILD HEALTH, HEALTHY LIVING, COMMUNICABLE DISEASES, VACCINATIONS AND PREVENTION SERVICES, CHRONIC DISEASE MANAGEMENT, TRANSPORTATION, HOUSING, ENVIRONMENTAL QUALITY, SAFETY/INJURY/VIOLENCE, AND REPRODUCTIVE/SEXUAL HEALTH. FIRELANDS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: THE CHNA REPORT WAS FUNDED BY THE ERIE COUNTY HEALTH DEPARTMENT BOARD OF HEALTH, THE ERIE COUNTY COMMUNITY HEALTH CENTER BOARD OF DIRECTORS, FIRELANDS HEALTH - FIRELANDS REGIONAL MEDICAL CENTER, AND THE SANDUSKY ARTISANS RECOVERY COMMUNITY CENTER. PROJECT MANAGEMENT AND REPORT DEVELOPMENT WAS PROVIDED BY THE CENTER FOR MARKETING AND OPINION RESEARCH. FIRELANDS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE CHNA IDENTIFIED TOP PRIORITY HEALTH NEEDS IN OUR REGION BASED ON SURVEY DATA, HEALTH DATA, AND DEMOGRAPHIC DATA. THOSE PRIORITY NEEDS INCLUDE ACCESS TO HEALTH CARE, ALCOHOL & SUBSTANCE ABUSE, CHANGING DEMOGRAPHICS AND SOCIAL DETERMINANTS OF HEALTH, MENTAL HEALTH, AND OBESITY & HEALTHY LIFESTYLE CHOICES. FIRELANDS REGIONAL MEDICAL CENTER INCLUDED PLANS TO ADDRESS EACH OF THESE NEEDS IN THE CHNA IMPLEMENTATION PLAN ATTACHED TO THIS RETURN. FIRELANDS REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16J: FIRELANDS REGIONAL MEDICAL CENTER UTILIZES NEWSLETTERS AND BILLBOARDS AND HAS FINANCIAL SERVICES STAFF ATTEND APPROXIMATELY TEN MARKETING EVENTS EACH CALENDAR YEAR AS ADDITIONAL METHODS OF PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINE 20A FIRELANDS REGIONAL MEDICAL CENTER PROVIDES A WRITTEN NOTICE ABOUT UPCOMING ECAS AND NOTIFIES THE RECIPIENT ABOUT WHERE THEY CAN FIND A PLAIN LANGUAGE SUMMARY OF THE FAP AT LEAST 30 DAYS BEFORE INITIATING THOSE ECAS. 24 1 - FIRELANDS REGIONAL MEDICAL CENTER OUTPAT 904 PIERCE ST SANDUSKY OH 44870 OUTPATIENT DIALYSIS 2 - FIRELANDS REGIONAL MEDICAL CENTER OP THE 1912 HAYES AVE SANDUSKY OH 44870 OP THERAPIES & SLEEP LAB 3 - FIRELANDS REGIONAL MEDICAL CENTER HOME H 5420 MILAN ROAD SANDUSKY OH 44870 HOME HEALTH AGENCY 4 - FIRELANDS REGIONAL MEDICAL CENTER OUTPAT 290 PROGRESS DR SUITE A BELLEVUE OH 44811 OUTPATIENT DIALYSIS 5 - FIRELANDS REGIONAL MEDICAL CENTER OP IMA 2500 W STRUB RD SANDUSKY OH 44870 OP IMAGING CENTER 6 - FIRELANDS COUNSELING & RECOVERY SERVICES 1925 HAYES AVE SANDUSKY OH 44870 OP MENTAL HEALTH & CD 7 - FIRELANDS COUNSELING & RECOVERY SERVICES 292 BENEDICT AVE NORWALK OH 44857 OP MENTAL HEALTH & CD 8 - FIRELANDS COUNSELING & RECOVERY SERVICES 290 PROGRESS DR SUITE B BELLEVUE OH 44811 OP MENTAL HEALTH & CD 9 - FIRELANDS COUNSELING & RECOVERY SERVICES 76 ASHWOOD RD TIFFIN OH 44883 OP MENTAL HEALTH & CD 10 - FIRELANDS COUNSELING & RECOVERY SERVICES 675 BARSTON RD FREMONT OH 43420 OP MENTAL HEALTH & CD 11 - FIRELANDS COUNSELING & RECOVERY SERVICES 6150 PARK SQUARE DRIVE LORAIN OH 44053 OP MENTAL HEALTH & CD 12 - FIRELANDS COUNSELING & RECOVERY SERVICES 335 BUCKEYE BLVD PORT CLINTON OH 43452 OP MENTAL HEALTH & CD 13 - FIRELANDS REGIONAL MEDICAL CENTER OP PHY 348 MILAN AVE 2 NORWALK OH 44857 OP PHYSICAL THERAPY 14 - FIRELANDS COUNSELING & RECOVERY SERVICES 122 WEST CENTER ST FOSTORIA OH 44830 OP MENTAL HEALTH & CD 15 - FIRELANDS REGIONAL MEDICAL CENTER OP PHY 2012 CLEVELAND RD W HURON OH 44839 OP PHYSICAL THERAPY 16 - FIRELANDS REGIONAL MEDICAL CENTER OP PHY 101 S WASHINGTON ST CASTALIA OH 44824 OP PHYSICAL THERAPY 17 - FIRELANDS COUNSELING & RECOVERY SERVICES 97 HOUPT DR UPPER SANDUSKY OH 43351 OP MENTAL HEALTH & CD 18 - FIRELANDS REGIONAL MEDICAL CENTER OP IMA 1470 W MCPHERSON HWY CLYDE OH 43410 OP IMAGING CENTER 19 - FIRELANDS REGIONAL MEDICAL CENTER OP IMA 1401 BONE CREEK DRIVE SANDUSKY OH 44870 OP IMAGING & PHYSICAL THERAPY 20 - FIRELANDS REGIONAL MEDICAL CENTER OP WOU 615 FULTON ST PORT CLINTON OH 43452 OP WOUND CARE 21 - FIRELANDS OP PHYS THER DIAG READIOLOGY 3960 E HARBOR ROAD PORT CLINTON OH 43452 OP PHYSICAL THERAPY, IMAGING, AND LAB 22 - FIRELANDS REGIONAL MEDICAL CENTER OP PHY 2801 CLEVELAND ROAD SANDUSKY OH 44870 OP PHYSICAL & SPEECH THERAPY 23 - FIRELANDS REGIONAL MEDICAL CENTER OP RAD 2520 COLUMBUS AVE SUITE C SANDUSKY OH 44870 OP IMAGING CENTER 24 - FIRELANDS REGIONAL MEDICAL CENTER OP LAB 2520 COLUMBUS AVE SUITE D SANDUSKY OH 44870 OP LAB PART I, LINE 3C: FIRELANDS REGIONAL MEDICAL CENTER DOES USE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. PART I, LINE 6A: FIRELANDS REGIONAL MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT. PART I, LINE 7: TO DERIVE COSTS OF CHARITY CARE AND OTHER COMMUNITY BENEFITS, A COMBINATION OF COST ACCOUNTING SYSTEM AND COST-TO-CHARGE RATIOS WAS USED. THE LATTER WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. OUR COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT TYPES AND PAYER SOURCES. PART II, COMMUNITY BUILDING ACTIVITIES: SEE NARRATIVE UNDER PART VI, LINE 5 PART III, LINE 2: THE RATIO DERIVED ON WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES WAS APPLIED TO THE ORGANIZATION'S BAD DEBT PROVISION IN ORDER TO COMPUTE BAD DEBT EXPENSE. PART III, LINE 3: FOR ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS FINANCIAL POLICY, FIRELANDS REGIONAL MEDICAL CENTER UTILIZED A COMBINATION OF HISTORICAL PATIENT VISIT AND THIRD-PARTY DATA BASED ON ESTIMATED FAMILY SIZE, INCOME, AND OTHER DEMOGRAPHICS. ALL ACCOUNTS PLACED INTO BAD DEBT DURING THE YEAR WITH NO PAYMENT ACTIVITY WERE SCORED BASED ON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, AND ALL WHO MET THE INCOME CRITERIA BASED ON FAMILY SIZE WERE ASSUMED TO BE ELIGIBLE FOR CHARITY AND THUS TREATABLE AS COMMUNITY BENEFIT. PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THAT THEY ARE DETERMINED TO BE UNCOLLECTIBLE.AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYERS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYERS. PART III, LINE 8: FIRELANDS REGIONAL MEDICAL CENTER'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE MEDICARE COSTS REFLECTED IN PART III, LINE 6. THE ORGANIZATION BELIEVES THAT ALL OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE THESE SERVICES ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND PROMOTE THE WELL-BEING OF THE COMMUNITY. FURTHERMORE, IT RELIEVES THE BURDEN ON LOCAL GOVERNMENTS. PART III, LINE 9B: WHEN A PATIENT IS UNINSURED OR INSURANCE PAYMENTS HAVE BEEN RECEIVED AND APPLIED, THEY ARE CLASSIFIED AS SELF PAY. OVER A 90-DAY PERIOD EACH PATIENT RECEIVES A MINIMUM OF 2 BALANCE-DUE STATEMENTS AND 1 FINAL STATEMENT. DURING THAT PERIOD THE PATIENT HAS THE OPPORTUNITY TO PAY THE ACCOUNT IN FULL, SET UP PAYMENT ARRANGEMENTS, OR APPLY FOR FINANCIAL AID. IN THE EVENT THE PATIENT DOES NOT PAY THE ACCOUNT IN FULL, SET UP PAYMENT ARRANGEMENTS, APPLY FOR FINANCIAL AID, OR MAKE AN EFFORT TO CONTACT THE FACILITY WITH SPECIAL CIRCUMSTANCES CONCERNING THE UNPAID BALANCE, THE ACCOUNT IS PLACED IN BAD DEBT COLLECTION AT OR ABOUT 120 DAYS FROM THE FIRST STATEMENT OR LAST PAYMENT. SHOULD AN ACCOUNT BE PLACED IN COLLECTION, THE PATIENT HAS AN ADDITIONAL OPPORTUNITY TO APPLY FOR FINANCIAL AID, SET UP PAYMENT ARRANGEMENTS, OR SUPPLY ADDITIONAL INFORMATION RELATED TO THE ACCOUNT. IF ANY OF THESE EVENTS OCCUR, THE COLLECTION ACCOUNT IS EITHER PLACED ON HOLD, BILLED TO INSURANCE, UPDATED WITH THE PAYMENT ARRANGEMENT, OR TAKEN OUT OF BAD DEBT AND ADJUSTED ACCORDING TO FINANCIAL AID GUIDELINES. PRIOR TO PLACING AN ACCOUNT IN BAD DEBT, THE ACCOUNT IS SCREENED BY SELF PAY COMPASS, A SOFTWARE APPLICATION THAT SCORES THE PATIENT'S INCOME BASED ON SEVERAL FINANCIAL RESOURCE DATABASES. THE APPLICATION IDENTIFIES ALL ACCOUNTS THAT MEET THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY GUIDELINES BASED ON INCOME. ACCOUNTS THAT MEET 100% OF FPL ARE WRITTEN OFF TO PRESUMPTIVE CHARITY AND NOT PLACED IN BAD DEBT COLLECTION. PART VI, LINE 2: FIRELANDS REGIONAL MEDICAL CENTER USES SEVERAL RESOURCES TO DETERMINE THE HEALTHCARE NEEDS OF THE COMMUNITY IT WHICH IT SERVES. IT WORKS IN CONJUNCTION WITH THE LOCAL HEALTH DEPARTMENT AND HELPS TO FUND A COMMUNITY NEEDS ASSESSMENT, WHICH IS DONE EVERY FEW YEARS. RESULTS OF THE ASSESSMENT ARE ANALYZED AND USED TO DETERMINE THE NEED FOR NEW PROGRAMS, SERVICES, EDUCATIONAL PROGRAMS, AND ACCESS NEEDS. THE MEDICAL CENTER ALSO COMMISSIONS A PHYSICIAN STUDY EVERY FEW YEARS TO DETERMINE THE TYPES AND NUMBERS OF PHYSICIANS NEEDED TO ADEQUATELY MEET THE NEEDS OF THE COMMUNITY. ADDITIONALLY, EVERY THREE YEARS A COMMUNITY RESEARCH STUDY IS PERFORMED WHICH ASKS LOCAL RESIDENTS FOR THEIR PERCEPTIONS OF HEALTHCARE SERVICES IN THE AREA AND DETERMINES IF ADDITIONAL SERVICES ARE NEEDED. SECONDARY DATA OF THE REGION IS ANALYZED ANNUALLY TO DETERMINE UTILIZATION OF SPECIFIC SERVICES, OUTMIGRATION OF LOCAL RESIDENTS TO RECEIVE SERVICES, ETC. PROJECTED UTILIZATION STUDIES ENSURE THAT ANY NEW PROGRAMS OR SERVICES EXPLORED MEET THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: HOSPITAL CARE ASSURANCE PROGRAM SIGNS ARE POSTED IN ALL REGISTRATION AND EMERGENCY AREAS. BILLING AND FINANCIAL ASSISTANCE BROCHURES ARE AVAILABLE WITH INSTRUCTIONS ON WHOM TO CONTACT AND HOW TO APPLY FOR SERVICES. FINANCIAL ASSISTANCE GUIDELINES AND APPLICATIONS ARE ALSO AVAILABLE ON OUR WEBSITE (WWW.FIRELANDS.COM). EVERY PATIENT STATEMENT CONTAINS CHARITY GUIDELINES AND AN APPLICATION. SELF-PAY INPATIENTS ARE SEEN ON-SITE BY A CONTRACTED AGENCY THAT DISCUSSES AND ASSISTS PATIENTS WITH APPLICATIONS FOR MEDICAID OR DISABILITY. THESE PATIENTS ARE ALSO SCREENED BY A FINANCIAL COUNSELOR WHO EXPLAINS THE HOSPITAL'S CHARITY PROCESS, ASSISTS WITH THE APPLICATION, AND/OR SUPPLIES THEM WITH A CONTACT IF QUESTIONS SHOULD ARISE AFTER DISCHARGE. SELF-PAY INPATIENTS ARE MONITORED DAILY TO IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR MEDICAID AND HAVE NO PRIOR INSURANCE COVERAGE. ALL SELF-PAY ACCOUNTS WITH A BALANCE OF $1,500 OR MORE ARE SCREENED BY A THIRD PARTY AND A MEDICAID APPLICATION IS STARTED FOR THOSE THAT MEET ELIGIBILITY GUIDELINES. DURING THE SCHEDULING PROCESS, IF A PATIENT STATES THEY HAVE NO INSURANCE OR ARE CONCERNED ABOUT THEIR FINANCIAL LIABILITY, THE PATIENT CALL IS FORWARDED TO A FINANCIAL COUNSELOR WHO WILL EXPLAIN OUR CHARITY PROGRAM AND OFFER TO ASSIST WITH AND/OR MAIL THE FINANCIAL ASSISTANCE APPLICATION. REGISTRATION STAFF SUPPLIES THE PATIENT WITH A BROCHURE AND APPLICATION IF A FINANCIAL COUNSELOR IS NOT AVAILABLE UPON DISCHARGE. FINANCIAL COUNSELING STAFF IS AVAILABLE MONDAY - FRIDAY 8:00 AM TO 4:30 PM. A PATIENT NAVIGATOR IS ALSO AVAILABLE IN THE CANCER CENTER TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH CHARITY CARE AND MEDICAID APPLICATIONS, AS WELL AS PHARMACY VENDOR PROGRAMS FOR ONCOLOGY DRUGS. PART VI, LINE 4: FIRELANDS REGIONAL MEDICAL CENTER SERVES A FIVE-COUNTY AREA OF APPROXIMATELY 290,000 RESIDENTS. THE PRIMARY SERVICE AREA IS ERIE COUNTY, WHICH HAS A POPULATION OF ABOUT 75,000 PERSONS AND IS LOCATED ON THE SOUTHERN SHORE OF LAKE ERIE, HALFWAY BETWEEN CLEVELAND, OH AND TOLEDO, OH. BASED UPON THE LATEST CENSUS DATA, THE MAJORITY OF THE POPULATION'S RACE IS CAUCASION, WITH 18% MINORITY; 93.3% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION OR AT LEAST SOME COLLEGE. THE COUNTY'S MEDIAN AGE IS 46 AND THE MEDIAN HOUSEHOLD INCOME IS $69,296. APPROXIMATELY 69% OF THE COUNTY'S RESIDENTS OWN THEIR HOME, WITH THE MEDIAN HOME VALUE OF $173,200. SECONDARY SERVICE AREAS CONSIST OF THE CONTIGUOUS COUNTIES OF OTTAWA, HURON, AND SANDUSKY WHICH HAVE A COMBINED POPULATION OF APPROXIMATEY 158,000 INDIVIDUALS. FIRELANDS COUNSELING & RECOVERY SERVICES REACHES EVEN FURTHER, SERVING 7 SURROUNDING COUNTIES INCLUDING THE COUNTIES ERIE, HURON, LORAIN, OTTAWA, SANDUSKY, SENECA, AND WYANDOT. HOME HEALTH SERVICES PROVIDED BY THE MEDICAL CENTER COVERS 13 COUNTIES. DEMOGRAOPHICS OF THESE COUNTIES ARE SIMILAR TO THE PRIMARY AREA OF ERIE COUNTY. PART VI, LINE 5: PART VI LINE 5, FIRELANDS REGIONAL MEDICAL CENTER ESTABLISHED THE FIRELANDS GARDEN DISTRICT PLAN IN 2007 WITH THE GOAL OF ENHANCING AND REVITALIZING THE MEDICAL CENTER'S NEIGHBORHOOD IN TERMS OF ATTRACTIVENESS, SAFETY, AND APPEAL. THIS REVITALIZATION IS ACCOMPLISHED THROUGH A PROGRAM PROVIDING FIRELANDS EMPLOYEES THE RESOURCES NEEDED TO MAKE A DOWN PAYMENT FOR THE PURCHASE OR RESTORATION OF HOMES FOR OCCUPANCY.FIRELANDS PARTICIPATES IN THE NORTHWEST OHIO PUBLIC INFORMATION OFFICER COMMITTEE TO BRING ADDITIONAL SKILLS TO THE AREA REGARDING DISASTER READINESS. IN ADDITION TO MEETING THE REQUIRED INCIDENT COMMAND TRAINING COURSES, THE MEDICAL CENTER HAS GONE ABOVE AND BEYOND BY ATTENDING REGIONAL MEETINGS, COMPLETING CRISIS AND EMERGENCY RISK COMMUNICATION TRAINING, PUBLIC INFORMATION OFFICER TRAINING THROUGH THE OHIO EMERGENCY MANAGEMENT AGENCY AND THE DEPARTMENT OF HOMELAND SECURITY, AS WELL AS INCORPORATING SOCIAL MEDIA IN ITS CRISIS COMMUNICATION METHODS.MANAGEMENT STAFF OF FIRELANDS REGIONAL MEDICAL CENTER IS ENCOURAGED TO PARTICIPATE IN LOCAL AND REGIONAL BOARDS AND ACTIVITIES THAT IMPROVE THE LOCAL COMMUNITY. ADVOCACY INCLUDES SUCH ACTIVITIES AS FINANCIAL SUPPORT TO A LOCAL CLINIC THAT SERVES UNINSURED AND UNDERINSURED PATIENTS ALONG WITH EFFORTS TO ORGANIZE A FEDERALLY QUALIFIED HEALTH CENTER FOR THE COMMUNITY, AND BOARD LEVEL WORK FOR COMMUNITY HEALTH EDUCATION ENTITIES AND AREA NON-PROFIT ORGANIZATIONS THAT WORK TO IMPROVE THE HEALTH OF THE COMMUNITY. 1 EDUCATION PAYMENT PROGRAM SCHOLARSHIPS 15 17000 N/A N/A PART II LINE 1: TO BE ELIGIBLE FOR THE EDUCATION PAYMENT PROGRAM SCHOLARSHIPS, A CANDIDATE MUST BE A QUALIFIED FAMILY MEMBER OF A CURRENT ACTIVE EMPLOYEE AND BE SPONSORED BY THEIR FIRELANDS-EMPLOYED FAMILY MEMBER, BE A HIGH SCHOOL GRADUATE (OR EQUIVALENT) OR A HIGH SCHOOL SENIOR PLANNING TO BEGIN OR CONTINUE COURSE WORK AT AN ACCREDITED EDUCATIONAL INSTITUTION WITHIN ONE YEAR OF SUBMITTING A PROGRAM APPLICATION AND HAVE A CUMULATIVE ACADEMIC AVERAGE OF "C OR BETTER. AWARD RECIPIENTS ARE SELECTED BASED ON APPLICATION, PAST ACADEMIC PERFORMANCE, FIELD OF STUDY, EDUCATIONAL INSTITUTION, ECONOMIC NEED, AND AVAILABILITY OF FUNDS. THIS PROGRAM IS ADMINISTERED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, AGE, ANCESTRY, NATIONAL ORIGIN, OR DISABILITY. FUNDS ARE PAID DIRECTLY TO THE SCHOOL ON BEHALF OF THE RECIPIENT. X X X X X 1 1 0 0 0 1 0 0 0 JEREMY NORMINGTON-SLAY PRESIDENT & CEO 672498 0 229647 0 1610 0 121586 0 56816 0 1082157 0 0 0 DANIEL J MONCHER EXEC VP/CFO/TREASURER (NON-VOTING) F 172843 0 130659 0 322524 0 652 0 35657 0 662335 0 0 0 SCOTT M CAMPBELL MD VP & CHIEF MEDICAL OFFICER 464954 0 111942 0 3122 0 23028 0 19805 0 622851 0 0 0 ROBERT M MOORE VP LEGAL/SECRETARY (NON-VOTING) 339848 0 98948 0 5221 0 90000 0 36485 0 570502 0 0 0 MARCUS ADEYEMI PHYSICIAN 361883 0 128549 0 486 0 12200 0 43317 0 546435 0 0 0 ANUPAM JHA PHYSICIAN 429256 0 0 0 5068 0 12200 0 16335 0 462859 0 0 0 DENISE PARRISH VP & CHIEF NURSING OFFICER 258258 0 75866 0 2042 0 39268 0 45701 0 421135 0 0 0 THOMAS WILLIAMSON MD DIRECTOR/PHYSICIAN 0 330810 0 13635 0 11457 0 12200 0 40195 0 408297 0 0 JAMES SPICER VP OPERATIONS 279246 0 50695 0 1340 0 0 0 14915 0 346196 0 0 0 KARL OBERER DO DIRECTOR/PHYSICIAN 0 234768 0 26062 0 2930 0 10723 0 44507 0 318990 0 0 PART I, LINES 4A-B SEVERENCE WAS PAID TO DANIEL MONCHER, FORMER EXECUTIVE VP & CFO, IN THE AMOUNT OF $318,434. PART I LINE 4B NORTH COAST PROFESSIONAL COMPANY, A RELATED PARTY, CONTRIBUTED TO A 409A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN ON THE BEHALF OF JEREMY NORMINGTON-SLAY, PRESIDENT, IN THE AMOUNT $109,386. NORTH COAST PROFESSIONAL COMPANY, A RELATED PARTY, CONTRIBUTED TO A 409A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN ON THE BEHALF OF SCOTT CAMPBELL, CHIEF MEDICAL OFFICER, IN THE AMOUNT OF $10,828. NORTH COAST PROFESSIONAL COMPANY, A RELATED PARTY, CONTRIBUTED TO A 409A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN ON THE BEHALF OF DENISE PARRISH, CHIEF NURSING OFFICER, IN THE AMOUNT OF $28,737 PART I LINE 6A BONUS COMPENSATION IS BASED ON A SUCCESS SHARING PLAN MEASURED BY PATIENT SATISFACTION, QUALITY/ACCREDITATION, FINANCIAL PERFORMANCE, AND EMPLOYEE ENGAGEMENT A COUNTY OF ERIE OHIO 346400428 29514PAV4 2016-08-15 62145000 SEE PART VI 0 0 0 B COUNTY OF ERIE OHIO 346400428 29514PAW2 2016-08-15 15000000 SEE PART VI 0 0 0 C COUNTY OF ERIE OHIO 346400428 29514PBD3 2016-03-31 39880000 SEE PART VI 0 0 0 D COUNTY OF ERIE OHIO 346400428 000000000 2017-07-11 13968800 SEE PART VI 0 0 0 A 1605000 62152439 62152439 2008 1 0 1 1 B 15000000 15000000 2008 1 0 1 1 C 2800000 39880000 39880000 2013 1 0 1 1 D 4411200 13968800 13968800 2017 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 1 0 0 0 0 1 B 0 0 1 1 0 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K SUPPLENTAL INFORMATION PART I LINE A, COLUMN (F): CURRENTLY REFUND THE COUNTY OF ERIE, OHIO HOSPITAL FACILITIES REVENUE BONDS, SERIES 2006A (FIRELANDS REGIONAL MEDICAL CENTER PROJECT) ISSUED JUNE 1, 2006, WHICH WERE PREVIOUSLY DEEMED REISSUED ON AUGUST 6, 2014, AS A RESULT OF A DEEMED REISSUANCE OF SUCH BONDS ON AUGUST 15, 2016. PART I LINE B, COLUMN (F): CURRENTLY REFUND THE COUNTY OF ERIE, OHIO HOSPITAL FACILITIES REVENUE BONDS, SERIES 2006B (FIRELANDS REGIONAL MEDICAL CENTER PROJECT) ISSUED JUNE 1, 2006, WHICH WERE PREVIOUSLY DEEMED REISSUED ON AUGUST 6, 2014, AS A RESULT OF A DEEMED REISSUANCE OF SUCH BONDS ON AUGUST 15, 2016. PART I LINE C, COLUMN (F): CURRENTLY REFUND THE COUNTY OF ERIE, OHIO HOSPITAL FACILITIES REVENUE AND REVENUE REFUNDING BONDS, SERIES 2012A/B (FIRELANDS REGIONAL MEDICAL CENTER) ISSUED AUGUST 15, 2012, WHICH WERE PREVIOUSLY DEEMED REISSUED ON AUG 6, 2014 AND MARCH 31, 2016, AS A RESULT OF A DEEMED REISSUANCE OF SUCH BONDS ON NOV. 5, 2021. PART I LINE D, COLUMN (F): CURRENTLY REFUND THE COUNTY OF ERIE, OHIO HOSPITAL FACILITIES REVENUE AND REVENUE REFUDING BONDS, SERIES 2017 (FIRELANDS REGIONAL MEDICAL CENTER PROJECT), ISSUED JULY 11, 2017 AND WHICH WERE DEEMED REISSUED ON APRIL 15, 2020. PART II LINE 3, COLUMN A TOTAL PROCEEDS OF THE ISSUE ARE COMPRISED OF $62,145,000 SALE PROCEEDS AND $7,439 OF INVESTMENT PROCEEDS. PART IV LINE 2C, COLUMN A: ARBITRAGE REBATE CALCULATION REPORTS WERE PREPARED ON: JUNE 15, 2011 FOR THE COMPUTATION PERIOD JUNE 1, 2006 TO JUNE 1, 2011; FEBRUARY 17, 2015 FOR THE COMPUTATION PERIOD JUNE 1, 2006 TO AUGUST 6, 2014; AND JUNE 19, 2016 FOR THE COMPUTATION PERIOD AUGUST 6, 2014 TO AUGUST 6, 2019. EACH REPORT INDICATED THAT THERE WAS NO NET REBATE LIABILITY. PART IV LINE 2C, COLUMN B: ARBITRAGE REBATE CALCULATION REPORTS WERE PREPARED ON: JUNE 15, 2011 FOR THE COMPUTATION PERIOD JUNE 1, 2006 TO JUNE 1,2011; MAY 26, 2016 FOR THE COMPUTATION PERIOD JUNE 1, 2006 TO JUNE 1, 2016. EASH REPORT INDICATED THAT THERE WAS NO NET REBATE LIABILITY. PART I LINE A, COLUMN (F): (I) ACQUIRE, CONSTRUCT, RENOVATE, INSTALL AND EQUIP HOSPITAL FACILITIES; AND (II) PAY COSTS OF ISSUANCE. PART II LINE 3, COLUMN A: TOTAL PROCEEDS OF THE ISSUE ARE COMPRISED OF $10,000,000 SALE PROCEEDS AND $108,088 OF INVESTMENT PROCEEDS A COUNTY OF ERIE OHIO 346400428 000000000 2019-12-23 10000000 SEE PART VI 0 0 0 A 1605000 10108088 54600 10053488 2021 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 CLARITY CARE LLC BUSINESS ENTITY 575200 NEUROLOGY COVERAGE COMPENSATION 0 BRITTANY MONCHER FAMILY MEMBER 45788 EMPLOYMENT 0 ALICE SPRINGER FAMILY MEMBER 108849 EMPLOYMENT 0 PART IV LINE 1 BOARD MEMBER STEVEN BENEDICT FULLY OWNS CLARITY CARE LLC. PART IV LINE 2 BRITTANY MONCHER IS THE DAUGHER-IN-LAW OF DANIEL MONCHER, FORMER TREASURER AND EXECUTIVE VICE PRESIDENT FINANCE. SHE IS EMPLOYED BY FIRELANDS REGIONAL MEDICAL CENTER AS A NURSE PART IV LINE 3 ALICE SPRINGER IS THE SPOUSE OF NON-VOTING BOARD MEMBER J. WILIAM SPRINGER. SHE IS EMPLOYED BY FIRELANDS REGIONAL MEDICAL CENTER AS DIRECTOR OF DEVELOPMENT. FORM 990, PART VI, SECTION B, LINE 11B THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE HAS BEEN DELEGATED THE AUTHORITY BY THE FIRELANDS REGIONAL HEALTH SYSTEM BOARD OF DIRECTORS TO REVIEW AND APPROVE ALL FORM 990'S FOR ALL COMPANIES IN THE SYSTEM. THE FINAL VERSION OF THE RESPECTIVE FORM 990 IS MADE AVAILABLE TO THE CHAIR OF THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE FOR REVIEW AND APPROVAL PRIOR TO THE FORM 990 BEING SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C FIRELANDS REGIONAL MEDICAL CENTER AUDIT AND CORPORATE COMPLIANCE COMMITTE ANNUALLY REVIEWS ALL CONFLICT OF INTEREST STATEMENTS TO ASSURE PERSONS IDENTIFIED IN THE CONFLICT OF INTEREST POLICY ARE IN COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION IS DELEGATED BY THE BOARD OF DIRECTORS TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE APPOINTS A COMPENSATION SUB-COMMITTEE WHICH UTILIZES AN INDEPENDENT THIRD PARTY TO EVALUATE THE APPROPRIATE PAY RANGE FOR THE CEO AND OTHER KEY MANAGEMENT POSITIONS AT LIKE-SIZED AND SIMILAR HOSPITALS IN THE SAME GEOGRAPHIC REGION. THE SUB-COMMITTEE MAKES A RECOMMENDATION TO THE EXECUTIVE COMMITTEE BASED ON THEIR RESEARCH AND FINDINGS. THE EXECUTIVE COMMITTEE APPROVES THE ANNUAL SALARIES OF THE CEO AND ALL VICE PRESIDENTS. THIS PROCESS IS COMPLETED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS OF THE ORGANIZATION ARE MADE AVAILABLE VIA A QUARTERLY "REPORT TO BOND HOLDERS" WHICH IS SENT TO ANY CONSTITUANTS, BOND HOLDERS OR INTERESTED PARTIES WHO REQUEST TO BE ON THE DISTRIBUTION LIST. QUARTERLY REPORTS AND THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ARE ALSO POSTED TIMELY AT HTTP://WWW.MSRB.ORG/ UTILIZING THE EMMA SYSTEM. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC BY SPECIAL REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,755,355. MANAGEMENT AND GENERAL EXPENSES 6,328,084. FUNDRAISING EXPENSES 5,536. TOTAL EXPENSES 13,088,975. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 10,081,680. MANAGEMENT AND GENERAL EXPENSES 2,414,056. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,495,736. PURCHASED MAINTENANCE: PROGRAM SERVICE EXPENSES 2,292,617. MANAGEMENT AND GENERAL EXPENSES 187,219. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,479,836. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,079,012. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,079,012. COLLECTION AGENCY FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 413,029. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 413,029. FORM 990, PART XI, LINE 9: SCHOOL OF NURSING FUNDING -36,581. PENSION ADJUSTMENTS 5,580,941. NET TRANSFER (TO)/FROM AFFILIATES -13,439,863. RECLASS CONTRIBUTIONS 399,105. PARTNERSHIP INCOME/(LOSS) RELATED TO SCHEDULE K-1S -324,489. RECLASS SCHOLARSHIPS 1,000. FORM 990, PART XII, LINE 2: FINANCIAL STATEMENTS FOR FIRELANDS REGIONAL MEDICAL CENTER ARE AUDITED BY PLANTE MORAN, PLLC AS PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF FIRELANDS REGIONAL HEALTH SYSTEM. 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