2022-11-14T12:58:23-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2021-01-01 341425870 LAKE HOSPITAL SYSTEM INC LAKE 4403541991 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 ROBERT TRACZ SENIOR VP & CFO 4403541991 2022-11-11 1 ROBERT TRACZ 999009999 AMY CIMINELLO P00796388 6148493000 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z LAKE HEALTH ROBERT TRACZ 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 944998078 0 X WWW.UHHOSPITALS.ORG X 1983 OH TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS OF LAKE COUNTY AND NEIGHBORING COMMUNITIES IN PARTNERSHIP WITH THOSE WHO SHARE A COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION, AND SUPERIOR QUALITY. 11 11 3320 450 1803494 0 12062589 15516333 346342471 385477854 26041896 36603703 26655602 37861849 411102558 475459739 158900 0 0 0 153691022 165947185 0 0 0 247620636 268232969 401470558 434180154 9632000 41279585 660977812 631158601 413098945 121765594 247878867 509393007 X IT IS THE MISSION OF LAKE HOSPITAL SYSTEM TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS OF LAKE COUNTY AND NEIGHBORING COMMUNITIES IN PARTNERSHIP WITH THOSE WHO SHARE A COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION, AND SUPERIOR QUALITY. 0 0 359562227 418863977 LAKE HOSPITAL SYSTEM, INC., IS A 120-YEAR-OLD HEALTH CARE INSTITUTION THAT HAS PRIMARILY SERVED THE HEALTH CARE NEEDS OF RESIDENTS IN LAKE COUNTY AND THE SURROUNDING COMMUNITIES SINCE 1902. LAKE HEALTH HAS HAD A LONG-STANDING TRADITION OF PROVIDING SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT WE SERVE. WE HAVE BEEN GUIDED BY OUR MISSION TO PROVIDE LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY AND OUR CORE VALUES - RESPECT, INNOVATION, TEAMWORK, STEWARDSHIP, AND INTEGRITY. WE HAVE BEEN GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES. THE HIGH PRIORITY AREAS INCLUDE COVID 19, DIABETES, CHRONIC DISEASE, BEHAVIORAL HEALTH, AND ACCESS TO CARE. IN APRIL 2021, LAKE HEALTH JOINED UNIVERSITY HOSPITALS. AS SUCH, LAKE HEALTH'S TAX ID REMAINS THE SAME, AND IT FILES ITS TAX RETURN INDEPENDENTLY FROM UH.LAKE HEALTH IS COMPRISED OF 11 FACILITIES IN LAKE, GEAUGA, AND CUYAHOGA COUNTIES, AND WHICH INCLUDE THE FOLLOWING:1. TRIPOINT MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)2. LAKE WEST MEDICAL CENTER (FULL-SERVICE, ACUTE CARE HOSPITAL)3. BEACHWOOD MEDICAL CENTER (FULL-SERVICE ACUTE CARE HOSPITAL)4. MENTOR HEALTH CENTER (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, OUTPATIENT SURGERY, CANCER SERVICES)5. BRUNNER, SANDEN DEITRICK WELLNESS CENTER (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY, OCCUPATIONAL HEALTH SERVICES AND A MEDICALLY BASED FITNESS CENTER)6. MADISON HEALTH CENTER (OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES, PHYSICAL THERAPY)7. WILLOWICK HEALTH CENTER (URGENT CARE, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)8. CHARDON HEALTH CENTER (, OUTPATIENT LAB AND DIAGNOSTICS, PHYSICIAN OFFICES)9. PERRICO HEALTH CENTER (PHYSICIAN OFFICES, PHYSICAL THERAPY, OUTPATIENT LAB AND DIAGNOSTICS)10. LAKE SOM HEALTH CENTER (PHYSICIAN OFFICES, LAB, AND DIAGNOSTICS)11. LAKE CONTINUING CARE CENTER (COMPREHENSIVE, INPATIENT REHABILITATION; GERIATRIC PSYCHIATRY)ACCESSIBILITY IS KEY TO OUR MISSION. WE HAVE CONTRACTED WITH MOST INSURANCE PROVIDERS TO ENSURE A VAST ARRAY OF PRIMARY CARE PHYSICIANS AND SPECIALISTS. LAKE HEALTH ALSO OPERATES THREE FULL-SERVICE EMERGENCY DEPARTMENTS INCLUDING: TRIPOINT MEDICAL CENTER IN CONCORD TOWNSHIP, LAKE WEST MEDICAL CENTER IN WILLOUGHBY AND BEACHWOOD MEDICAL CENTER IN BEACHWOOD. THESE EMERGENCY DEPARTMENTS ARE OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY.OUR GROWTH AS A HOSPITAL SYSTEM REFLECTS THE MANY WAYS WE ARE BUILDING ON OUR MISSION AND HOW WE ASPIRE TO BE MORE THAN YOUR TYPICAL COMMUNITY HOSPITAL. WE WANT OUR PATIENTS TO RECEIVE SUPERIOR PATIENT CARE WITHOUT HAVING TO LEAVE THE COMMUNITY, AND THAT'S WHY WE ARE COMMITTED TO BRINGING THE BEST RESOURCES TOGETHER TO PROVIDE AN EXPANDED LEVEL OF COMMUNITY CARE.LAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. IN FACT, TAKING HEALTH EDUCATION PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. IN 2021, WE CONTINUED OUR MISSION OF HELPING TO CARE AND EDUCATE OUR COMMUNITIES REGARDING COVID-19. WE ALSO PUT A FOCUS ON HELPING PATIENTS FEEL COMFORTABLE TO RETURN FOR HEALTH CARE IN OUR COMMUNITIES AND PROVIDING ADDITIONAL ACCESS FOR PATIENTS.IN 2021, LAKE HEALTH PROVIDED APPROXIMATELY $450,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION, WHICH CONTINUED TO FOCUS ON LAKE HEALTH CONTRIBUTED APPROXIMATELY $8.5 MILLION IN 2021 IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW.COMMUNITY PROGRAMS AND EVENTS:LAKE HEALTH CONTINUED TO BE AN ANCHOR INSTITUTE IN COMMUNITY BY SUPPORTING OVER 50 LOCAL ORGANIZATION WITH AN EMPHASIS ON SUPPORTING ORGANIZATIONS THAT ALIGNED WITH PROVIDING SUPPORT AS IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT. INCLUDING, LAKE COUNTY FREE MEDICAL CLINIC, LAKE COUNTY COUNCIL ON AGING, AND FORBES HOUSE. WE ALSO CONTINUED TO PROVIDING COMMUNITY PROGRAMS INCLUDING: INFANT AND CHILDBIRTH PROGRAMS INCLUDING CHILDBIRTH PREPARATION, INFANT CARE, BREASTFEEDINGPROGRAM, SIBLING PROGRAM, INFANT AND CHILD CPR, AND CAR SEAT CHECKS.SUPPORT GROUPS, INCLUDING BREASTFEEDING, BREAST CANCER, DIABETES, STROKE, AND AMPUTEE UNITED WAY DAY OF CARING AND HARVEST FOR HUNGERSCHOOL PARTNERSHIPSBREAST HEALTH FOR HISPANIC WOMENINTEGRATIVE HEALTH AND WELLNESS 359562227 1 1 0 1 0 0 1 0 0 1 1 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 134 0 1 3320 1 1 1 1 CJ 0 0 0 0 0 0 0 0 1 0 X 11 11 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X ROBERT TRACZ 4403541984 3605 WARRENSVILLE CTR RD MSC 9155 SHAKER HEIGHTS OH 44122 THOMAS P JUBECK CHAIR 5.00 0.00 X X 0 0 0 BRETT HIMES VICE CHAIR 5.00 0.00 X X 0 0 0 DAWN GUBANC-ANDERSON SECRETARY 2.00 0.00 X X 0 0 0 ADAM SANDEN TREASURER 2.00 0.00 X X 0 0 0 MICHAEL E MAYHER TRUSTEE 2.00 0.00 X 0 0 0 RAYMOND PAGANINI TRUSTEE 1.00 0.00 X 0 0 0 CHETAN PATEL MD TRUSTEE 1.00 0.00 X 0 0 0 DAVID ROLLINS MD TRUSTEE 1.00 0.00 X 0 0 0 RAYMOND SINES TRUSTEE 1.00 0.00 X 0 0 0 DAVID STEIGER MD TRUSTEE 1.00 0.00 X 0 0 0 KEITH ZIEGLER TRUSTEE 1.00 0.00 X 0 0 0 CYNTHIA MOORE-HARDY PRESIDENT AND CEO 55.00 10.00 X 3284651 0 18431 ROBERT TRACZ SR. VP/CFO 50.00 10.00 X 694972 0 26066 JOHN BANIEWICZ MD SR VP, MEDICAL AFFAIRS 45.00 10.00 X 694597 0 23813 RICHARD D CICERO SR VP, MARKETING & BUSINESS 45.00 10.00 X 444530 0 23201 ADETINUKE TADESE CHIEF MEDICAL INFORMATICS OFFICER 40.00 5.00 X 348804 0 31219 BILL OSTERMAN VP, ACUTE CARE SERVICES 40.00 0.00 X 281475 0 8163 MICHELE PIRC PRIMARY NURSE PRACTITIONER 40.00 0.00 X 280248 0 0 DAVID HERMAN VP, FINANCE 40.00 10.00 X 271483 0 27923 JOYCE A TAYLOR VP, QUALITY SERVICES, CQO 40.00 0.00 X 251540 0 11603 JERROLD PETERS VP, CIO 40.00 5.00 X 235631 0 11672 CYNTHIA J RACER VP, CLINICAL SERVICES 40.00 0.00 X 230078 0 19626 7018009 0 201717 122 0 1 0 MAXIM HEALTHCARE SERVICES INC 25000 COUNTRY CLUB BLVD SUITE 200 NORTH OLMSTED OH 44070 MEDICAL STAFFING 10251055 COMMUNITY HOSPITALISTS LLC 30680 BAINBRIDGE ROAD SOLON OH 44139 HOSPITAL MEDICAL STAFFING COVERAGE AND M 7307983 CROTHALL HEALTHCARE INC 13028 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING SERVICES 4276605 SODEXO INC AND AFFILIATES PO BOX 360170 PITTSBURG PA 152516170 NUTRITION SERVICES OPERATIONS 3310761 PHILIPS MEDICAL SYSTEMS 595 MINER RD CLEVELAND OH 44143 SERVICE AGREEMENTS: INSPECTIONS, MAINTEN 2692718 210 591848 14328711 595774 16488 15516333 PATIENT CARE 621110 385477854 385477854 385477854 4339469 4339469 300 300 2569663 0 2569663 2569663 42723 2526940 493620586 8181687 461924421 7613918 31696165 567769 32263934 32263934 SALES AND SERVICES 621110 17585467 16778742 661433 145292 PURCHASE DISCOUNTS 621110 7165941 7165941 CMS INCENTIVE PAYMENTS 621110 5073893 5073893 5466885 4367547 1099338 35292186 475459739 418863977 1803494 39275935 X 7042282 7042282 134080863 114589740 19491123 2181778 1771569 410209 13127088 10658986 2468102 9515174 7726169 1789005 2054385 1529292 525093 353976 35398 318578 89000 89000 1193698 1193698 83479356 78177965 5301391 2273893 320545 1953348 3988029 2125647 1862382 14376135 215642 14160493 12437248 10571661 1865587 307359 306313 1046 17960 2694 15266 3545835 3500787 45048 19911631 5512532 14399099 6096319 5339185 757134 MEDICAL SUPPLIES 71190582 71190582 BAD DEBT 35625368 35625368 HOSPITAL FRANCHISE FEE 10053078 10053078 MEMBERSHIP DUES 1239117 309074 930043 434180154 359562227 74617927 0 13258149 27770102 38112459 42521682 6527097 6280323 21044664 11756580 201903409 14306826 195766389 187596583 275224064 274056047 16519042 94525948 81177284 660977812 631158601 53168378 41974398 195490 1266241 206205555 0 153529522 78524955 413098945 121765594 X 247878867 509393007 247878867 509393007 660977812 631158601 X 41279585 -21068425 241302980 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19839 19839 0 PART II-B, LINE 1: LINE 1I: MEMBERSHIP DUES PAID TO HOSPITAL INDUSTRY ASSOCIATIONS AND ORGANIZATIONS, THE PERCENTAGE OF WHICH IS REPORTED UNDER IRS RULES AS LOBBYING EXPENSE. X 1 1507.00 0 0 0 1 1 0.00 0 7186654 474754 582521 89913 336209 7817807 6503815 1793553 402960 73639 1440035 7186654 6272122 541913 606520 87443 829297 6503815 6834614 829389 -207803 26377 1157701 6272122 6265843 1432011 434510 30544 1267206 6834614 0.00000 0.47350 0.52650 0 1 1 21980000 21980000 110691805 3122326 107569479 61579919 10468774 51111145 7651685 715726 6935959 187596583 DEFERRED COMPENSATION 2045450 FINANCE RIGHT OF USE ASSETS NET 77344 INVESTMENTS IN AFFILIATES 29801603 OPERATING RIGHT OF USE ASSETS 49252887 81177284 THIRD PARTY SETTLEMENTS 6630447 DEFERRED COMPENSATION 2525337 LEASE OBLIGATION 49318121 MARKETING LIABILITY 10000 PAYER ADVANCES 20041050 78524955 PART V, LINE 4: LAKE HEALTH'S ENDOWMENT FUNDS WITH DONOR RESTRICTIONS ARE HELD BY THE LAKE HOSPITAL FOUNDATION, INC. DBA LAKE HEALTH FOUNDATION (THE "FOUNDATION"), A RELATED ORGANIZATION. THE FOUNDATION'S MISSION IS TO SECURE FINANCIAL AND NON-FINANCIAL SUPPORT FOR USE IN REALIZING LAKE HEALTH'S VISION OF PROVIDING HEALTH CARE FOR THE COMMUNITY. THE FOUNDATION'S SOLE MEMBER IS LAKE HEALTH. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES PROGRAM-RELATED INVESTMENTS 20353 CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICES MANAGEMENT FEES RELATED TO LHS ASSURANCE, LTD. 115635 0 0 0 0 0 0 135988 0 135988 0 0 1 0 0 0 PART III ACCOUNTING METHOD: 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 1083757 1083757 0.00270 67196273 50047013 17149260 0.04300 68280030 50047013 18233017 0.04570 443453 443453 0.00110 2332501 2244000 88501 0.00020 8493588 8493588 0.02130 11269542 2244000 9025542 0.02260 79549572 52291013 27258559 0.06830 120588 120588 0.00030 120588 120588 0.00030 1 35625368 0 61097345 77335563 -16238218 X 1 1 1 MENTOR SURGERY CENTER LLC OUTPATIENT SURGICAL CENTER 0.42860 0.00000 0.57140 2 LAKE WEST MEDICAL SPECIALISTS MEDICAL OFFICE BUILDING 0.12000 0.00000 0.88000 3 CONCORD MEDICAL CAMPUS PHYSICIAN BUILDING LLC MEDICAL OFFICE BUILDING 0.51470 0.00000 0.48530 4 MENTOR MEDICAL CAMPUS PHYSICIAN BUILDING LLC MEDICAL OFFICE BUILDING 0.45650 0.00000 0.54350 5 LAKE PHO INC PHYSICIAN SERVICES 0.50000 0.00000 0.50000 6 LAKE WILLOUGHBY PROPERTIES LLC MEDICAL OFFICE BUILDING 0.35000 0.00000 0.65000 7 NEW MANNA CLG LLC MEDICAL OFFICE BUILDING 0.51000 0.00000 0.25000 2 1 WEST MEDICAL CENTER 36000 EUCLID AVENUE WILLOUGHBY OH 44094 WWW.LAKEHEALTH.ORG X X X 2 TRIPOINT MEDICAL CENTER 7590 AUBURN ROAD CONCORD OH 44077 WWW.LAKEHEALTH.ORG X X X WEST MEDICAL CENTER 1 0 0 1 X X X X X X X X X 19 1 1 0 1 X HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT X 1 20 1 HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION X X X X X X 1 X 0 X X X X 1 X 0 0 TRIPOINT MEDICAL CENTER 2 0 0 1 X X X X X X X X X 19 1 1 0 1 X HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT X 1 20 1 HTTPS://LAKEHEALTH.ORG/ABOUT/HEALTH-NEEDS-ASSESSMENT 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION/FINANCIAL-AID X HTTPS://LAKEHEALTH.ORG/PATIENTS/FINANCIAL-INFORMATION X X X X X X 1 X 0 X X X X 1 X 0 0 WEST MEDICAL CENTER PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP ("DHG") AND ARTOWER ADVISORY SERVICES, LLC ("ARTOWER"). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 5: LAKE HEALTH IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING A NEEDS ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY LAKE HEALTH'S SENIOR LEADERSHIP TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT COMPILED USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP ("DHG") AND ARTOWER ADVISORY SERVICES, LLC ("ARTOWER"). THE COLLECTIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA")TEAM REVIEWED SEVERAL SOURCES OF QUANTITATIVE HEALTH, AS WELL AS SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO LAKE HEALTH'S SERVICE AREA. LAKE HEALTH ALSO TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, PUBLIC HEALTH AGENCIES, AND LOCAL ORGANIZATIONS IN IDENTIFYING AND ADDRESSING THE NEEDS OF THE COMMUNITY. WEST MEDICAL CENTER PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 6A: AS ALLOWED BY IRS GUIDELINES, LAKE HEALTH DECIDED TO PRODUCE A JOINT CHNA REPORT FOR ITS TWO LAKE COUNTY HOSPITALS, WEST MEDICAL CENTER AND TRIPOINT MEDICAL CENTER. GUIDELINES STATE THAT COLLABORATING FACILITIES MUST DEFINE THEIR COMMUNITIES TO BE THE SAME AND CONDUCT A JOINT CHNA PROCESS. WEST MEDICAL CENTER PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 11: IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, LAKE HEALTH WILL FOCUS ON THOSE MOST WITHIN ITS IMMEDIATE ABILITY TO INFLUENCE. WEST MEDICAL CENTER PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION. TRIPOINT MEDICAL CENTER PART V, SECTION B, LINE 15E: THE CONTACT INFORMATION FOR SOURCES OF ASSISTANCE WITH FAP APPLICATIONS IS ON THE LAKE HEALTH WEBSITE BUT NOT CURRENTLY ON THE FAP OR FAP APPLICATION. PART V, SECTION B, LINE 22D UNINSURED PATIENTS WHO DO NOT QUALIFY FOR LAKE HEALTH'S FINANCIAL ASSISTANCE PROGRAM ARE BILLED FOR GROSS CHARGES AND ARE OFFERED A 30% PROMPT PAY DISCOUNT IF PAYMENT IS RECEIVED WITHIN 30 DAYS OF THE FIRST PATIENT STATEMENT OR A PAYMENT PLAN IS AGREED UPON. THEMAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. 50 1 - UH MENTOR HEALTH CENTER 9485 MENTOR AVENUE SUITE 101 MENTOR OH 44060 GENERAL MEDICAL & SURGICAL OUTPATIENT 2 - UH MADISON HEALTH CENTER 6270 NORTH RIDGE RD MADISON OH 44057 GENERAL MEDICAL & EMERGENCY DEPARTMENT 3 - UH LHPG LAKE COUNTY FAMILY PRACTICE 9500 MENTOR AVENUE SUITE 100 MENTOR OH 44060 PHYSICIAN OFFICE 4 - UH WILLOWICK HEALTH CENTER 29804 LAKESHORE BLVD WILLOWICK OH 44095 URGENT CARE CENTER 5 - UH LHPG PHYSICIANS PERRICO HEALTH CENTER 4176 STATE ROUTE 306 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 6 - UH DIAGNOSTICS PERRICO HEALTH CENTER 4176 STATE ROUTE 306 WILLOUGHBY OH 44094 DIAGNOSTIC CENTER 7 - UH LHPG MENTOR IMED 9485 MENTOR AVENUE SUITE 210 MENTOR OH 44060 PHYSICIAN OFFICE 8 - UH LHPG MENTOR PEDIATRICS 9485 MENTOR AVENUE SUITE 101 MENTOR OH 44060 PHYSICIAN OFFICE 9 - UH LHPG NORTH COAST FAMILY PRACTICE 7580 AUBURN RD SUITE 202 CONCORD OH 44077 PHYSICIAN OFFICE 10 - UH CHARDON HEALTH CENTER 510 FIFTH AVENUE CHARDON OH 44024 URGENT CARE CENTER 11 - UH LHPG MADISON FAMILY PRACTICE 6270 NORTH RIDGE RD MADISON OH 44057 PHYSICIAN OFFICE 12 - UH LHPG WILLOUGHBY IMED 36100 EUCLID AVENUE SUITE 240 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 13 - UH LHPG WILLOUGHBY PEDIATRICS 36100 EUCLID AVENUE SUITE 300 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 14 - UH LHPG CHARDON FAMILY PRACTICE 510 FIFTH AVENUE SUITE 130 CHARDON OH 44024 PHYSICIAN OFFICE 15 - UH LHPG MENTOR FAMILY PRACTICE 8655 MARKET STREET MENTOR OH 44060 PHYSICIAN OFFICE 16 - UH LHPG MADISON PEDIATRICS 6270 NORTH RIDGE RD MADISON OH 44057 PHYSICIAN OFFICE 17 - UH LHPG MENTOR GENERAL SURGERY 9500 MENTOR AVENUE SUITE 300 MENTOR OH 44060 PHYSICIAN OFFICE 18 - UH LHPG WILLOWICK FAMILY PRACTICE 29804 LAKESHORE BLVD WILLOWICK OH 44095 PHYSICIAN OFFICE 19 - UH LHPG PLASTIC SURGERY 36060 EUCLID AVENUE SUITE 204 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 20 - UH LHPG SOM GENERAL SURGERY 2105 SOM CENTER ROAD SUITE 107 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 21 - UH LHPG CHARDON PEDIATRICS 510 FIFTH AVENUE CHARDON OH 44024 PHYSICIAN OFFICE 22 - UH LAKE SOM HEALTH CENTER WELLNESS & REHAB 5105 SOM CENTER ROAD WILLOUGHBY OH 44094 REHABILITATION CLINIC 23 - UH LHPG CARDIO ELECTROPHYSIOLOGY 36100 EUCLID AVENUE SUITE 400 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 24 - UH LHPG WEST IMED 36100 EUCLID AVENUE SUITE 210 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 25 - UH LHPG ORTHOPEDIC SURGERY 36060 EUCLID AVENUE SUITE 203 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 26 - UH LHPG MENTOR OBGYN 9485 MENTOR AVENUE SUITE 202 MENTOR OH 44060 PHYSICIAN OFFICE 27 - UH LHPG SPORTS MEDICINE & REHAB 36060 EUCLID AVENUE SUITE 105 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 28 - UH LHPG INTEGRATIVE MEDICINE 8655 MARKET STREET MENTOR OH 44060 PHYSICIAN OFFICE 29 - UH LHPG PHYSICIANS MENTOR MEDICAL PHYSICIA 9485 MENTOR AVENUE SUITES 200 203 MENTOR OH 44060 PHYSICIAN OFFICE 30 - UH LHPG OBGYN WILLOUGHBY 5105 SOM CENTER ROAD SUITE 201 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 31 - UH CHARDON HEALTH CENTER RADIOLOGY 510 FIFTH AVE SUITE 110 CHARDON OH 44024 PHYSICIAN OFFICE 32 - UH LHPG BARIATRIC SURGERY 36100 EUCLID AVENUE SUITE 170 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 33 - UH LABORATORY LAKE AMBULATORY BLDG 9500 MENTOR AVE SUITE 220 MENTOR OH 44060 DIAGNOSTIC CENTER 34 - UH LAKE WEST MEDICAL CENTER REFERENCE LAB 36100 EUCLID AVE SUITE 190 WILLOUGHBY OH 44094 DIAGNOSTIC CENTER 35 - UH LHPG NORTHEAST OHIO HEART ASSOCIATES 36100 EUCLID AVENUE SUITE 120 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 36 - UH LHPG SPORTS MEDICINE 8655 MARKET STREET MENTOR OH 44060 PHYSICIAN OFFICE 37 - UH IMED NP BEACON HEALTH 36100 EUCLID AVENUE SUITE 120 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 38 - UH LHPG OPHTHALMOLOGY ASSOCIATES 36100 EUCLID AVE SUITE 450 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 39 - UH LHPG NORTHEAST OHIO HEART ASSOCIATES 7580 AUBURN ROAD SUITE 106 CONCORD OH 44077 PHYSICIAN OFFICE 40 - UH BRUNNER SANDEN DEITRICK WELLNESS CENTER 8655 MARKET STREET MENTOR OH 44060 MEDICAL FITNESS CENTER 41 - UH LHPG ARTHRITIS ASSOCIATES 5105 SOM CENTER ROAD SUITE 200 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 42 - UH LHPG OHIO HAND AND SHOULDER CENTER 13170 RAVENNA ROAD CHARDON OH 44024 PHYSICIAN OFFICE 43 - UH LAKE CONTINUING CARE CENTER 10977 CAPITAL PARKWAY CONCORD OH 44077 REHABILITATION AND PSYCHIATRIC DEPARTMENTS 44 - UH LHPG MIDDLEFIELD FAMILY PRACTICE 16030 EAST HIGH STREET MIDDLEFIELD OH 44062 PHYSICIAN OFFICE 45 - UH LHPG HACKETT MEDICAL GROUP 8300 TYLER BOULEVARD SUITE 300 MENTOR OH 44060 PHYSICIAN OFFICE 46 - UH WELLNESS CLINIC AT MHS 8655 MARKET STREET MENTOR OH 44060 WALK IN CLINIC 47 - UH LHPG PAIN MANAGEMENT 5105 SOM CENTER ROAD SUITE 202 WILLOUGHBY OH 44094 PHYSICIAN OFFICE 48 - UH LHPG PAIN MANAGEMENT 9485 MENTOR AVE SUITE 103 MENTOR OH 44060 PHYSICIAN OFFICE 49 - UH LHPG MENTOR ENDOCRINOLOGY 8300 TYLER BOULEVARD SUITE 102 MENTOR OH 44060 PHYSICIAN OFFICE 50 - UH URGENT CARE BRUNNER SANDEN DEITRICK WEL 8655 MARKET STREET MENTOR OH 44060 URGENT CARE CENTER PART I, LINE 3C: OHIO HOSPITAL CARE ASSURANCE PROGRAM (HCAP)AS A PARTICIPANT IN THE HCAP PROGRAM, LAKE HEALTH OFFERS EMERGENCY AND OTHER MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES FREE OF CHARGE IF YOU ARE A RESIDENT OF OHIO AND EITHER (1) YOU ARE CURRENTLY AN ELIGIBLE RECIPIENT OF THE GENERAL ASSISTANCE OR THE DISABILITY ASSISTANCE PROGRAMS OR (2) YOUR INCOME IS AT OR BELOW 100% OF THE FEDERAL POVERTY GUIDELINES (FPG).LAKE HEALTH ASSISTIN ADDITION TO HCAP, LAKE HEALTH HAS A FINANCIAL ASSISTANCE POLICY CALLED LAKE HEALTH ASSIST. THIS PROVIDES FINANCIAL ASSISTANCE FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE DISCOUNTED FROM OUR NORMAL CHARGES IF YOU ARE AN UNINSURED OHIO RESIDENT AND YOUR INCOME DOES NOT EXCEED FOUR TIMES THE FEDERAL POVERTY GUIDELINES (FPG). ALL APPLICANTS WILL BE SCREENED FOR MEDICAID COVERAGE AND MUST COOPERATE WITH THE MEDICAID REPRESENTATIVES TO BE ELIGIBLE FOR ASSISTANCE UNDER OUR FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO NON-OHIO RESIDENTS, INDIVIDUALS WITH INSURANCE, MEDICAID, OR MEDICAID PE. IF YOU ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER OUR FINANCIAL ASSISTANCE POLICY, YOU WILL RECEIVE FREE OR OTHER DISCOUNTED ASSISTANCE ACCORDING TO THE SCALE. PAYMENT OF THE FULL BALANCE IS NOT REQUIRED PRIOR TO RECEIVING THE DISCOUNT; AFTER A FINANCIAL ASSISTANCE DISCOUNT IS APPLIED, THE REMAINING BALANCE WILL BE BILLED TO THE PATIENT. PART I, LINE 6A: COMMUNITY BENEFIT REPORT IS PREPARED BY UH LAKE HEALTH MARKETING AND FINANCE DEPARTMENT. PART I, LINE 7: A COST-TO-CHARGE RATIO IS USED. THIS RATIO TAKES THE TOTAL COSTS, INCLUDING ALLOCATED COSTS FROM OVERHEAD DEPARTMENTS, OF PROVIDING PATIENT CARE DIVIDED BY TOTAL GROSS REVENUE. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE VARIOUS FREE COMMUNITY SCREENING EVENTS FOR HEALTH CONDITIONS SUCH AS BLOOD PRESSURE, CHOLESTEROL, BONE DENSITY, PROSTATE CANCER, SKIN CANCER, HEART DISEASE AND OBESITY. PART I, LN 7 COL(F): AN ESTIMATED PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED THAT RESULTS IN NET PATIENT SERVICE REVENUE BEING REPORTED AT THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE ESTIMATION OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED PRIMARILY ON THE TYPE AND AGE OF THE PATIENT ACCOUNTS RECEIVABLE AND THE EFFECTIVENESS OF COLLECTION EFFORTS. THE POLICY IS TO RESERVE A PORTION OF ALL SELF-PAY RECEIVABLES, INCLUDING AMOUNTS DUE FROM THE UNINSURED AND AMOUNTS RELATED TO CO-PAYMENTS AND DEDUCTIBLES, AS THESE CHARGES ARE RECORDED. PATIENT ACCOUNTS RECEIVABLE BALANCES AND THE EFFECTIVENESS OF THE RESERVE POLICIES ARE REVIEWED ON A MONTHLY BASIS, AND VARIOUS ANALYTICS SUPPORT THE BASIS FOR THE ESTIMATES. ROUTINE HINDSIGHT PROCEDURES ARE PERFORMED TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE TO DETERMINE THE REASONABLENESS OF THE PROCESS FOR ESTIMATING THE ALLOWANCE FOR BAD DEBT. CHARITY CARE AND OTHER COMMUNITY BENEFITS AS A PERCENTAGE OF EXPENSE IS CALCULATED USING TOTAL EXPENSES FROM FORM 990, PART IX LESS BAD DEBT EXPENSE OF $35,625,368 FROM PART IX. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIESLAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. TAKING HEALTH EDUCATION PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO THE LAKE HEALTH MISSION. IN 2021, LAKE HEALTH CONTINUED TO PROVIDE EDUCATION AND ASSISTANCE WITH THE COVID-19 CRISIS EXPANDED TO INCLUDE CHRONIC DISEASES AND ACCESS TO HEALTH CARE. IN 2021, LAKE HEALTH PROVIDED APPROXIMATELY $450,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION. LAKE HEALTH ALSO CONTRIBUTED OVER $8.5 MILLION IN CASH AND IN-KIND DONATIONS TO CIVIC AND COMMUNITY PROGRAMS AND PARTNERSHIPS WITH A HEALTH AND WELLNESS FOCUS. COALITION BUILDING LAKE HEALTH IS COMMITTED TO BRINGING THE BEST RESOURCES TOGETHER TO PROVIDE AN EXPANDED LEVEL OF COMMUNITY CARE, WHICH IS WHY IT IS INVOLVED IN MANY COMMUNITY COALITIONS AND PARTNERSHIPS TO IMPROVE THE HEALTH OF INDIVIDUALS IN THE SERVICE AREA.AS PART OF ITS MISSION, LAKE HEALTH HAS A LONG HISTORY OF PARTNERING WITH OTHERS IN THE COMMUNITY WHO SHARE OUR VALUES OF PROVIDING LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY. THESE PARTNERSHIPS PROVED TO BE INVALUABLE DURING THIS CHALLENGING TIME. OUR PARTNERSHIP WITH THE LAKE COUNTY ALCOHOL, DRUG ADDICTION, AND MENTAL HEALTH SERVICES (ADAMHS) BOARD ALLOWED US TO PROVIDE IMMEDIATE SUPPORT TO OUR TEAM MEMBERS COPING WITH THE STRESS OF THE PANDEMIC, ALONG WITH LAKE HEALTH'S BEHAVIORAL HEALTH AND CRISIS INTERVENTION TEAM. WE ALSO CONTINUE TO OPERATE A SENIOR CARE POST-ACUTE CARE NETWORK IN COORDINATION WITH OUR LONG TERM CARE INSTITUTES. THE NETWORK HELPS US TO PROVIDE A MEDICAL DIRECTOR ON SITE IN ORDER TO HELP BETTER COORDINATE CARE AND KEEP MORE SENIORS OUT OF THE ACUTE HOSPITAL SETTING BY BRINGING CARE ON SITE. WE ALSO CONTINUE TO PARTNER WITH OUR LOCAL SCHOOLS BY OPENING ON SITE SCHOOL CLINICS. THOSE CLINICS INCLUDE: LAKELAND COMMUNITY COLLEGE, MENTOR SCHOOL DISTRICT CARDINAL CLINIC AND THE WILLOUGHBY-EASTLAKE SCHOOL DISTRICT WELLNESS CLINIC. PART III, LINE 2: BAD DEBT IS ESTIMATED USING A HINDSIGHT ANALYSIS ON PREVIOUS YEARS ACCOUNTS RECEIVABLE. THOSE PERCENTAGES ARE THEN APPLIED TO CURRENT YEAR ACCOUNTS RECEIVABLE BY PAYOR TO ESTIMATE THE AMOUNT OF UNCOLLECTIBLE. ANYTHING OVER 365 DAYS IS FULLY RESERVED. PART III, LINE 3: THERE IS NO ESTIMATE OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FOR PATIENTS WHO QUALIFY, THOSE PATIENTS ARE DEEMED TO BE UNABLE TO PAY AND ARE THEREFORE WRITTEN OFF TO CHARITY RATHER THAN BAD DEBT. PART III, LINE 4: PAGE 11 OF ATTACHED AUDITED FINANCIAL STATEMENTS, NOTE 2(G) - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES, NET PATIENT SERVICE REVENUE ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 8: BASED ON A COST TO CHARGE RATIO DETERMINED IN ACCORDANCE WITH MEDICARE COST REPORT REQUIREMENTS, THE COSTS OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2021 WAS $61,097,345 THE PAYMENTS RELATED TO THESE SERVICES WERE $77,335,563 LEAVING A MEDICARE SHORTFALL OF $16,238,218 FOR THE YEAR.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: PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS: PATIENTS WHO DO NOT HAVE THE MEANS TO PAY FOR SERVICES PROVIDED AT LAKE HOSPITAL SYSTEM REQUEST TO BE CONSIDERED UNDER THE UNINSURED/UNCOMPENSATED CHARITY CARE GUIDELINES. THESE GUIDELINES DEFINE LAKE HOSPITAL SYSTEM'S COMMITMENT TO PROVIDING CARE TO PATIENTS WHO ARE IN THE GREATEST FINANCIAL NEED. PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE, OR WHOSE OUT OF POCKET RESPONSIBILITY IS SUBSTANTIAL AFTER INSURANCE COVERAGE, OR WHOSE INCOME LEVEL IS AT OR BELOW 250% OF THE FEDERAL INCOME POVERTY GUIDELINES, ARE ELIGIBLE TO APPLY FOR UNINSURED CHARITY CARE ASSISTANCE.THE UNINSURED/UNCOMPENSATED CHARITY CARE PROGRAM DOES NOT RELIEVE NOR FORGIVE POINT-OF-SERVICE COPAYMENTS THAT THE PATIENT MAY BE REQUIRED TO PAY UNDER THE TERMS OF THEIR INSURANCE BENEFIT PLAN. PER VISIT COPAYMENTS WILL BE COLLECTED AT THE POINT OF SERVICE IN COMPLIANCE WITH THE INSURANCE BENEFIT TERMS.PROCEDURE ELIGIBILITY FOR LAKE'S UNINSURED/UNCOMPENSATED CARE IS DETERMINED BY THE FOLLOWING TWO-PART TEST. THE LAKE HOSPITAL SYSTEMS UNINSURED/UNCOMPENSATED CARE PROGRAM REQUIRES PATIENTS TO MEET AT LEAST ONE CONDITION IN BOTH PART ONE AND PART TWO:PART ONE: INSURANCE TEST 1. PATIENT DOES NOT HAVE GOVERNMENTAL OR PRIVATE INSURANCE COVERAGE; OR2. PATIENT'S INSURANCE DOES NOT COVER THE MEDICALLY NECESSARY SERVICE; OR3. PATIENT'S INSURANCE BENEFITS ARE EXHAUSTED (I.E. LIFETIME RESERVE DAYS, MEDICARE); OR4. PATIENT HAS OR WILL OBTAIN MEDICALLY NECESSARY SERVICES FROM THE HOSPITAL FOR WHICH THEY DO NOT HAVE THE FINANCIAL MEANS TO PAY; OR5. PATIENT IS RESPONSIBLE FOR CO-PAYMENTS AND DEDUCTIBLES, CARRIES NO SECONDARY INSURANCE COVERAGE AND ONLY SOURCE OF INCOME IS SOCIAL SECURITY.PART TWO: INCOME TEST (RELATIVE TO LAKE HOSPITAL CHARGES)1. FAMILY INCOME IS COMPARED TO THE FEDERAL POVERTY INCOME GUIDELINES (FAMILY INCLUDES PATIENT, PATIENT'S SPOUSE, AND ALL OF THE PATIENT'S CHILDREN, NATURAL OR ADOPTIVE, UNDER THE AGE OF EIGHTEEN WHO LIVE IN THE HOME). THE SCHEDULE SHOWN BELOW WILL BE USED TO COMPARE FAMILY INCOME TO A SLIDING SCALE BASED UPON THE FEDERAL POVERTY INCOME GUIDELINES. IFFAMILY INCOME IS AT OR BELOW THE DESIGNATED THRESHOLD, THE PATIENT IS ELIGIBLE FOR THE PERCENT CHARITY DISCOUNT ASSOCIATED WITH THAT LEVEL OF INCOME; OR2. THE RELATIONSHIP BETWEEN THE PATIENT'S MEDICAL BILLS, FAMILY INCOME AND FAMILY ASSETS (INCLUDING, BUT NOT LIMITED TO SUCH ITEMS AS BANK ACCOUNTS, TRUSTS, PROPERTY, HOME EQUITY, ESTATE OR INVESTMENTS) INDICATES THAT THE PURSUIT OF PAYMENT WOULD ADVERSELY AFFECT THE WELL BEING OF THE PATIENT AND FAMILY MEMBERS, AND WHERE THE PAYMENT OF LAKE HOSPITAL'S BILL WOULD RESULT IN UNDUE HARDSHIP; OR3. PATIENT'S FAMILY INCOME EXCEEDS 250% OF THE FEDERAL INCOME POVERTY GUIDELINES, HOWEVER PATIENT HAS SUPPLIED INFORMATION TO SUPPORT EXCEPTIONAL LIVING CIRCUMSTANCES (I.E. TERMINAL ILLNESS, EXCESSIVE MEDICAL BILLS AND/OR MEDICATIONS, ETC.) OR 100% OF INCURRED CHARGES GREATER THAN 25% OF ANNUAL FAMILY INCOME (INCLUDING BANK ACCOUNTS, TRUSTS AND INVESTMENTS, BUT EXCLUDING PRIMARY RESIDENCE). BEFORE UNINSURED/UNCOMPENSATED CARE CAN BE AWARDED, THE FOLLOWING CONDITIONS MUST BE MET:1. IF LAKE HOSPITAL DETERMINES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR MEDICAL ASSISTANCE, THE PATIENT MUST COOPERATE WITH LAKE HOSPITAL'S EFFORTS TO ESTABLISH ELIGIBILITY FOR GOVERNMENT ASSISTANCE PROGRAMS.2. IF LAKE HOSPITAL AWARDS UNINSURED/UNCOMPENSATED CARE, IT WILL ONLY COVER THE SERVICES PROVIDED UNDER THE ACCOUNT NUMBER(S) SHOWN ON THE ACCOMPANYING APPLICATION.3. PROOF OF INCOME AND FINANCIAL DOCUMENTATION WILL BE REQUESTED. (SEE HOSPITAL CARE ASSURANCE POLICY.) PART VI, LINE 2: LAKE HEALTH HAS HAD A LONG-STANDING TRADITION OF PROVIDING SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. WE ARE GUIDED BY OUR MISSION TO PROVIDE LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY, AND OUR CORE VALUES - RESPECT, INNOVATION, TEAMWORK, STEWARDSHIP AND INTEGRITY. THE SYSTEM HAS MADE SIGNIFICANT STRATEGIC ADVANCEMENTS IN SERVING THE RESIDENTS OF LAKE COUNTY AND SURROUNDING COMMUNITIES, RANGING FROM A CLINICAL INTEGRATION INITIATIVE TO INVESTMENTS IN NEW FACILITIES AND PROVIDER-CENTERED TECHNOLOGIES. RATHER THAN FOCUSING ON EPISODES OF CARE, THE SYSTEM AND ITS PHYSICIAN PARTNERS PROVIDE A LIFETIME OF HEALTH AND WELLNESS, EMBRACING A PHILOSOPHY OF PATIENT AND FAMILY-CENTERED CARE. THE SYSTEM AND ITS PHYSICIAN PARTNERS CONTINUE TO MOVE FORWARD IN FURTHER DEVELOPING A STRATEGIC PLAN THAT INCLUDES A FOCUS ON VALUE-BASED PURCHASING AND EVOLVING CARE MODELS.GUIDED BY A COLLABORATIVE HEALTH NEEDS ASSESSMENT CONDUCTED IN COOPERATION WITH THE LAKE COUNTY GENERAL HEALTH DISTRICT, LAKE HEALTH HAS DEVELOPED PROGRAMS, SERVICES AND PARTNERSHIPS TO ADDRESS THE MOST PRESSING HEALTH ISSUES IN OUR SERVICE AREAS AND THE SURROUNDING COMMUNITIES. THE HIGH PRIORITY AREAS INCLUDE ACCESS TO CARE, ALCOHOL ABUSE, DIABETES, DRUG OVERDOSE DEATHS, HEART DISEASE, HIGH BLOOD PRESSURE, LIMITED ACCESS TO HEALTHY FOODS, MENTAL HEALTH, AND OBESITY. LAKE HEALTH AND ITS PARTNERS ARE COMMITTED TO OFFERING THE BEST RESOURCES TO PROVIDE AN EXPANDED LEVEL OF CARE TO MEET THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: 1. SIGNAGE POSTED AT FACILITY ACCESS POINTS FOR PATIENTS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE.2. CHARITY/HCAP APPLICATION FORMS GIVEN TO SELF-PAY PATIENTS AT TIME OF REGISTRATION. EXPLANATION OF ASSISTANCE PROVIDED TO COMPLETE APPLICATION IF NEEDED.3. UNINSURED INPATIENTS ARE VISITED BEDSIDE TO ASSIST WITH THE COMPLETION OF THE CHARITY/HCAP APPLICATION AND TO PROVIDE APPLICATION ASSISTANCE WITH OTHER PROGRAMS SUCH AS MEDICAID, FOOD STAMPS, ETC.4. UNINSURED PATIENTS WHO RECEIVE OUTPATIENT SERVICES ARE CONTACTED BY PHONE TO ASSIST WITH THE CHARITY/HCAP APPLICATION AND OTHER PROGRAMS LISTED ABOVE.5. CHARITY/HCAP APPLICATION APPEARS ON THE BACK OF ALL PATIENT STATEMENTS.6. CHARITY/HCAP APPLICATION APPEARS ON LAKE HEALTH WEBSITE. PART VI, LINE 4: LAKE HEALTH'S PRIMARY SERVICE AREA IS LAKE COUNTY (POPULATION ABOUT 233,000) AND SELECTED ZIP CODES IN ITS SECONDARY SERVICE AREAS (CUYAHOGA, ASHTABULA AND GEAUGA COUNTIES WITH A POPULATION IN THE DEFINED ZIP CODES) OF 124,000. (POPULATION FIGURES ARE AS OF 2020.) PART VI, LINE 5: PRIOR TO 1985, UH LAKE HEALTH'S FACILITIES WERE PUBLICLY OPERATED AS LAKE COUNTY MEMORIAL HOSPITALS. HOWEVER, IN 1985 THE BOARD OF COUNTY COMMISSIONERS AND HOSPITAL TRUSTEES AGREED TO PRIVATIZE THE HOSPITAL TO ENSURE THE VIABILITY OF A TECHNOLOGICALLY PROGRESSIVE HOSPITAL SYSTEM FOR LAKE COUNTY RESIDENTS. COUNTY COMMISSIONERS SERVE AS MEMBERS OF THE LAKE HOSPITAL CORPORATION AND, AS SUCH, APPOINT THE COMMUNITY LEADERS WHO SERVE ON THE SYSTEM'S GOVERNING BOARD.ON APRIL 16, 2021, UNIVERSITY HOSPITALS HEALTH SYSTEM (UHHS) BECAME THE SOLE CORPORATE MEMBER OF LAKE HEALTH SYSTEM, INC. THROUGH A MEMBERSHIP SUBSTITUTION. UHHS IS THE PARENT OF VARIOUS CORPORATIONS INVOLVED IN THE DELIVERY OF HEALTHCARE SERVICES, INCLUDING A NETWORK OF PHYSICIANS, OUTPATIENT CENTERS, HOSPITALS, WELLNESS, OCCUPATIONAL HEALTH, SKILLED NURSING, ELDER HEALTH, REHABILITATION, AND HOME CARE SERVICES THAT OPERATE IN THE NORTHEAST OHIO REGION. LAKE HEALTH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. OVER 550 PHYSICIANS COMPRISE LAKE HEALTH'S MEDICAL STAFF.LAKE HEALTH'S COMMITMENT TO THE COMMUNITY IS READILY APPARENT IN THE BOARD OF TRUSTEES, WHICH IS COMPRISED SOLELY OF COMMUNITY MEMBERS, APPOINTED BY THE COUNTY COMMISSIONERS. ALL PROCEEDS ARE REINVESTED IN CAPITAL OR OTHER PROGRAMS AND SERVICES DESIGNED TO MEET THE COMMUNITIES WE SERVE.LAKE HEALTH PROVIDES SERVICES AND PROGRAMS BASED ON THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. IN FACT, TAKING HEALTH PROGRAMS AND SCREENINGS TO WHERE PEOPLE LIVE, WORK AND PLAY IS FUNDAMENTAL TO OUR MISSION. IN 2016, WE PROVIDED OVER $600,000 IN COMMUNITY BENEFIT THROUGH HEALTH EDUCATION PROGRAMS, EXCLUDING BLOOD DRIVES. DURING THESE COMMUNITY EVENTS AND HEALTH FAIRS, WE PERFORMED OVER 11,600 BLOOD PRESSURE CHECKS, CHOLESTEROL SCREENINGS, GLUCOSE, HEEL SCREENINGS, SKIN CANCER SCREENINGS AND PROSTATE CANCER SCREENINGS FOR FREE OR AT LOW COST. LAKE HEALTH'S COMMITMENT TO HEALTH IMPROVEMENT SERVICES THAT PROVIDE A DEMONSTRATED COMMUNITY BENEFIT CAN BE BROADLY CATEGORIZED INTO THREE AREAS: COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, AND CASH AND IN-KIND GIFTS. SOME OF THE PROGRAMS AND EVENTS ARE HIGHLIGHTED BELOW.COMMUNITY HEALTH EDUCATIONLAKE HEALTH HAS AN EXTENSIVE COMMUNITY HEALTH PROGRAM THAT PROVIDES HEALTH SCREENINGS, PHYSICIAN LECTURES, SELF-HELP, AND EXERCISE PROGRAMS IN MULTIPLE COMMUNITY LOCATIONS THROUGHOUT LAKE COUNTY AND SURROUNDING AREAS. OUR SUPPORT GROUPS HELP MEET EDUCATIONAL AND EMOTIONAL NEEDS RELATED TO A VARIETY OF CONDITIONS. WE ALSO PARTNER WITH MANY LOCAL ORGANIZATIONS, INCLUDING THE UNITED WAY, THE AMERICAN RED CROSS, THE AMERICAN HEART ASSOCIATION, THE ARTHRITIS FOUNDATION, THE ALZHEIMER'S ASSOCIATION, THE LAKE COUNTY YMCA, LAKE COUNTY GENERAL HEALTH DISTRICT, AND THE LAKE METROPARKS TO INCREASE AWARENESS OF HEALTH ISSUES IN THE COMMUNITY. THESE PROGRAMS AND SERVICES INCLUDE:A. COMMUNITY CALENDARS AND NEWSLETTERS THE BEST OF HEALTH MAGAZINE, MAILED QUARTERLY TO ABOUT 150,000 HOUSEHOLDS CALENDAR OF EVENTS IN THE NEWS-HERALD, TEN TIMES PER YEAR HEALTH TALKS IN THE NEWS-HERALD (WEEKLY)B. EDUCATION ON SPECIFIC DISEASE CONDITIONS SENIOR CONNECTION LUNCH AND LEARNS COMMUNITY HEALTH LECTURE SERIES ARTHRITIS EXPO STRESS MANAGEMENT BREAST HEALTH FOR HISPANIC WOMENC. HEALTH PROMOTION AND WELLNESS PROGRAMS BE FIT FOR LIFEE. EDUCATION TO THE PUBLIC ABOUT HEALTH ISSUES INFORMATION THROUGH MEDIA RELEASES WEBSITE SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+)F. SCHOOL HEALTH EDUCATION PROGRAMS HEART SMART KIDS ASSEMBLYG. DIGITAL CONSUMER HEALTH INFORMATION BABY AND TODDLER E-NEWSLETTER REGARDING HEALTH E-NEWSLETTER CONSTANT CONTACT E-BLASTS SOCIAL MEDIA (FACEBOOK, TWITTER, GOOGLE+) WEBSITE VIDEOSH. SOCIAL MEDIA CONSUMER HEALTH INFORMATION FACEBOOK POSTS AND REMINDERS TWITTER POSTS AND REMINDERS GOOGLE+ VIDEOSI. SELF-HELP WELLNESS WORKSHOP MINDFULNESS RETREATONE OF THE MANY WAYS LAKE HEALTH IS BUILDING THE COMMUNITY IS THROUGH STRONG PARTNERSHIPS WITH OTHERS WHO SHARE OUR COMMITMENT TO LOCAL ACCESS, HEALING WITH COMPASSION AND SUPERIOR QUALITY. LAKE HEALTH JOINED FORCES WITH LAKE METROPARKS, LAKE COUNTY YMCA AND THE LAKE COUNTY HEALTH DISTRICT TO LAUNCH BE FIT FOR LIFE. THE ANNUAL MINDFULNESS RETREAT PROVIDES A DAYLONG EVENT THAT PROVIDES RELAXATION AND THE OPPORTUNITY TO PAUSE, REFLECT AND HEAL. PART VI, LINE 6: IN 2021, UNIVERSITY HOSPITALS BECAME THE SOLE MEMBER OF LAKE HOSPITAL SYSTEM. AS SUCH, LAKE HOSPITAL SYSTEM'S TAX ID REMAINS THE SAME, AND FILES ITS TAX RETURN INDEPENDENTLY FROM UNIVERSITY HOSPITALS. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 CYNTHIA MOORE-HARDY PRESIDENT AND CEO 1000062 0 2204523 0 80066 0 6359 0 12072 0 3303082 0 0 0 ROBERT TRACZ SR. VP/CFO 469898 0 154125 0 70949 0 6390 0 19676 0 721038 0 0 0 JOHN BANIEWICZ MD SR VP, MEDICAL AFFAIRS 543713 0 131400 0 19484 0 6000 0 17813 0 718410 0 0 0 RICHARD D CICERO SR VP, MARKETING & BUSINESS 316489 0 105300 0 22741 0 5525 0 17676 0 467731 0 0 0 ADETINUKE TADESE CHIEF MEDICAL INFORMATICS OFFICER 305357 0 41850 0 1597 0 0 0 31219 0 380023 0 0 0 DAVID HERMAN VP, FINANCE 215397 0 50175 0 5911 0 0 0 27923 0 299406 0 0 0 BILL OSTERMAN VP, ACUTE CARE SERVICES 223777 0 51750 0 5948 0 0 0 8163 0 289638 0 0 0 MICHELE PIRC PRIMARY NURSE PRACTITIONER 164524 0 109230 0 6494 0 0 0 0 0 280248 0 0 0 JOYCE A TAYLOR VP, QUALITY SERVICES, CQO 204529 0 37800 0 9211 0 0 0 11603 0 263143 0 0 0 CYNTHIA J RACER VP, CLINICAL SERVICES 160987 0 34200 0 34891 0 0 0 19626 0 249704 0 0 0 JERROLD PETERS VP, CIO 185916 0 40500 0 9215 0 0 0 11672 0 247303 0 0 0 PART I, LINE 1A CYNTHIA MOORE-HARDY, RECEIVED THE FOLLOWING TAXABLE BENEFIT IN 2021: SOCIAL CLUB DUES OF $12,230 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) NON-QUALIFIED DEFERRED COMPENSATION ARRANGEMENT : CYNTHIA MOORE-HARDY : $80,850 PART I, LINE 7 DISCRETIONARY BONUS MAY BE AWARDED BASED ON PERFORMANCE. THOSE BONUSES ARE DETERMINED BY THE STRATEGIC LEADERSHIP TEAM. THE FOLLOWING INDIVDUALS RECEIVED THESE BONUSES: - CYNTHIA MOORE-HARDY: $272,869 RETENTION BONUS; $1,931,654 INCENTIVE BONUS - ROBERT TRACZ: $154,125 RETENTION BONUS - JOHN BANIEWICZ MD: $131,400 RETENTION BONUS - RICHARD CICERO: $105,300 RETENTION BONUS - ADETINUKE TADESE: $41,850 RETENTION BONUS - WILLIAM OSTERMAN: $51,750 RETENTION BONUS - DAVID HERMAN: $50,175 RETENTION BONUS - JOYCE TAYLOR: $37,800 RETENTION BONUS - JERROLD PETERS: $40,500 RETENTION BONUS - CYNTHIA RACER: $34,200 RETENTION BONUS MATT J CICERO FAMILY MEMBER OF KEY EMPLOYEE, RICHARD D. CICERO 98721 SEE PART V 0 ABIGAIL CICERO FAMILY MEMBER OF KEY EMPLOYEE, RICHARD D. CICERO 94332 SEE PART V 0 ANNE-MARIE TRACZ FAMILY MEMBER OF OFFICER, ROBERT TRACZ 11274 SEE PART V 0 PART IV, COLUMN D MATT J. CICERO, WHO HAS A FAMILY RELATIONSHIP WITH RICHARD D. CICERO, SERVED AS A HOSPITAL EMPLOYEE DURING 2021 AND RECEIVED COMPENSATION.ABIGAIL CICERO, WHO HAS A FAMILY RELATIONSHIP WITH RICHARD D. CICERO, SERVED AS A HOSPITAL EMPLOYEE DURING 2021 AND RECEIVED COMPENSATION.ANNE-MARIE TRACZ, WHO HAS A FAMILY RELATIONSHIP WITH ROBERT TRACZ, SERVED AS A HOSPITAL EMPLOYEE DURING 2021 AND RECEIVED COMPENSATION. FORM 990, PART VI, SECTION A, LINE 4 UNIVERSITY HOSPITALS HEALTH SYSTEM (UNIVERSITY HOSPITALS) BECAME THE SOLE MEMBER OF LAKE HOSPITAL SYSTEM IN 2021. FORM 990, PART VI, SECTION A, LINE 6 UNIVERSITY HOSPITALS IS THE MEMBER OF LAKE HOSPITAL SYSTEM, INC DBA LAKE HEALTH FORM 990, PART VI, SECTION A, LINE 7A UNIVERSITY HOSPITALS HAS THE RIGHT TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B UNIVERSITY HOSPITALS HAS THE RIGHT TO MAKE GOVERNANCE DECISIONS SUCH AS APPROVAL OF THE GOVERNING BODY'S ELECTION OR REMOVAL OF MEMBERS OF THE GOVERNING BODY, OR APPROVAL OF THE GOVERNING BODY'S DECISION TO DISSOLVE THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS FOLLOWED BEFORE FILING THE LAKE HEALTH FORM 990 INCLUDES A DETAILED REVIEW COMPLETED BY AN INDEPENDENT OUTSIDE CPA FIRM, PRESENTATION TO AND REVIEW BY THE LAKE HEALTH CFO, CEO, AND THE DIRECTOR OF TAX FOR UNIVERSITY HOSPITALS HEALTH SYSTEM. A DRAFT IS PRESENTED FOR REVIEW BY THE LAKE HEALTH FINANCE COMMITTEE, AND PRESENTATION TO THE LAKE HEALTH BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE LAKE HOSPITAL SYSTEM, INC. BOARD OF TRUSTEES COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY, WHICH IS REVIEWED BY THE LHS CFO AND A DIRECTOR OF THE BOARD OF TRUSTEES. BOARD MEMBERS WILL EXCUSE THEMSELVES FROM THE BOARD MEETING WHEN A TOPIC OF POTENTIAL CONFLICT IS PRESENTED AND RETURN TO THE MEETING FOLLOWING THE COMPLETION OF DISCUSSION, MOTION, AND VOTE. COMPLIANCE WITH THE LHS CONFLICT OF INTEREST POLICY MONITORED AND ENFORCED BY THE BOARD CHAIR, COMMITTEE CHAIRS, AND THE DIRECTOR RESPONSIBLE FOR BOARD OF TRUSTEE MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE LAKE HOSPITAL SYSTEM, INC. CEO, OTHER OFFICERS, AND KEY EMPLOYEES INCLUDES MARKET RESEARCH, REVIEW, AND ASSESSMENT BY AN INDEPENDENT CONSULTING FIRM TO MAKE A RECOMMENDATION TO THE LHS BOARD OF DIRECTORS. THE BOARD REVIEWS THE REPORT PROVIDED IN CONJUNCTION WITH PERFORMANCE ASSESSMENTS, AND UTILIZES THIS INFORMATION TO DETERMINE COMPENSATION LEVEL. A COMPENSATION REVIEW WAS CONDUCTED BY THE COMPENSATION AREA OF THE HUMAN RESOURCE DEPARTMENT OF UNIVERSITY HOSPITALS HEALTH SYSTEM IN 2021. FORM 990, PART VI, SECTION C, LINE 19 LAKE HOSPITAL SYSTEM, INC. MAKES ITS FORM 990, FORM 990-T, AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST, FOR THE SAME PERIOD OF TIME AS SET FORTH IN THE INTERNAL REVENUE CODE SECTION 6104(D), AND ANNUAL FINANCIAL INFORMATION WITH THE ATTORNEY GENERAL OF THE STATE OF OHIO. GOVERNING DOCUMENTS FOR LAKE HOSPITAL SYSTEM, INC. ARE AVAILABLE THROUGH THE WEBSITE OF THE OHIO SECRETARY OF STATE. FORM 990, PART IX, LINE 11G OUTSOURCED SERVICES: PROGRAM SERVICE EXPENSES 12,079,638. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,079,638. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 14,711,243. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,711,243. CONSULTING: PROGRAM SERVICE EXPENSES 220,979. MANAGEMENT AND GENERAL EXPENSES 2,910,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,131,946. MAINTENANCE & REPAIR: PROGRAM SERVICE EXPENSES 2,993,819. MANAGEMENT AND GENERAL EXPENSES 2,390,424. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,384,243. DATA PROCESSING & COLLECTION: PROGRAM SERVICE EXPENSES 3,245,464. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,245,464. MISCELLANEOUS OTHER: PROGRAM SERVICE EXPENSES 460,926. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 460,926. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 44,465,896. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,465,896. FORM 990, PART XI, LINE 9: NET GAIN FROM AFFILIATED ENTITIES 37,259. DERIVATIVE INSTRUMENTS LOSS 4,606,294. UNDERWRITING SUPPORT OF FOUNDATION -2,298,702. NEW MANNA K-1 ALLOCATION -1,099,338. DONATED CAPITAL FROM FOUNDATION 16,488. UH MEMBER SUBSTITUTION AND FV ADJUSTMENTS TRANSACTIONS 240,040,979. FORM 990, PART XII, LINE 2C: UNIVERSITY HOSPITALS' BOARD OF DIRECTORS OVERSEES THE AUDIT PROCESS AND APPROVES THE INDEPENDENT AUDIT FIRM. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. 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