2022-11-14T22:18:55-06:00 2021-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST STE 200 INDIANAPOLIS IN 46204 990 2021-01-01 344430716 FISHER-TITUS MEDICAL CENTER FISH 4196688101 272 BENEDICT AVENUE NORWALK OH 448572374 SCOTT ENDSLEY CHIEF FINANCIAL OFFICER 4196688101 2022-11-14 1 SCOTT ENDSLEY 999009999 NATHAN A RODGERS CPA P01568275 3172757444 2022-11-12 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z BRENT W BURKEY MD 272 BENEDICT AVENUE NORWALK OH 448572374 203387465 0 X WWW.FISHER-TITUS.ORG X 1911 OH PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER, WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. 12 8 1089 93 922546 130741 137226 216858 152142479 165654357 2280199 6349179 885397 763214 155445301 172983608 138720 142747 0 0 62814146 75510269 0 0 0 69837282 77245630 132790148 152898646 22655153 20084962 230784511 249539511 62925345 62882671 167859166 186656840 X PROVIDE QUALITY HEALTHCARE IN A COST EFFECTIVE MANNER, WHILE RESPECTING THE DIGNITY AND UNIQUENESS OF EACH INDIVIDUAL WE SERVE. 0 0 121350533 142747 157464469 SEE SCHEDULE O 3941570 0 7267342 SEE SCHEDULE O 125292103 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 136 0 1 1089 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 OH X DAVID V WILSON MBACMA 4196688101 272 BENEDICT AVENUE NORWALK OH 448572374 DENNIS DOUGHTY CHAIRMAN 15.00 3.00 X X 0 0 0 PERRY DRYDEN VICE CHAIRMAN 10.00 2.00 X X 0 0 0 DENNIS C CAMP TREASURER 12.00 2.00 X X 0 0 0 JULIE S ROBERTS DDS SECRETARY 7.00 2.00 X X 0 0 0 JOHN K HUGHES MD DIRECTOR 4.00 42.00 X 0 286891 67898 SUSAN S HAZEL DIRECTOR 4.00 2.00 X 0 0 0 JONATHAN D ZAHLER DO DIRECTOR 4.00 2.00 X 0 0 0 JEFFREY C HUBER DIRECTOR 4.00 3.00 X 0 0 0 MARK E CORIELL DIRECTOR 4.00 2.00 X 0 0 0 JOHN A LENDRUM DIRECTOR 4.00 2.00 X 0 0 0 BRENT BURKEY PRESIDENT/CEO 50.50 14.50 X X 607585 0 55039 MARC D DOLCE DIRECTOR - BEGAN AUG 2022 4.00 2.00 X 0 0 0 SCOTT E ENDSLEY CHIEF FINANCIAL OFFICER 52.00 8.00 X 296704 0 41537 MATTHEW MATTNER CHIEF OPERATIONS OFFICER 43.50 6.50 X 321105 0 68791 MIRIAM BATKE CHIEF HUMAN RESOURCE OFFIC 37.00 8.00 X 234573 0 34623 KATIE CHIEDA CHIEF NURSING OFFICER 45.00 0.00 X 249691 0 65471 GARY MOORMAN CHIEF MEDICAL OFFICER 45.00 0.00 X 417192 0 35627 LINDA STEVENSON CHIEF INFORMATION OFFICER 37.00 8.00 X 227938 0 51239 SUZANNE FARMER CHIEF ADMINISTRATIVE OFFIC 37.00 5.00 X 256755 0 32714 SHARON HARWOOD CHIEF COMPLIANCE OFFICER 40.00 2.00 X 221913 0 42277 JASON FRONEK SR DIRECTOR INFORMATION SE 33.00 7.00 X 158292 0 41280 2991748 286891 536496 28 0 1 0 CERNER CORPORATION 2800 ROCKCREEK PATHWAY KANSAS CITY MO 64117 HEALTHCARE INFORMATION TECHNOLOGY 3491793 METROHEALTH SYSTEMS PO BOX 73122 CLEVELAND OH 441931861 SPINE CENTER PROFESSIONAL FEE & TRAUMA P 3067867 MCR GROUP LLC PO BOX 51325 KNOXVILLE TN 37950 MEDICARE DEPENDENT CONSULTANTS 2389356 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 272162140 BLOOD ADMINISTRATION; LAB TESTING 1314377 NOMS HEALTHCARE 2500 W STRUB ROAD SANDUSKY OH 44870 PROFESSIONAL FEES - ORTHOPEDIC 920313 20 216858 38148 216858 HOSPITAL NET PATIENT SERVICES 623000 156794847 156794847 NURSING HOME & ASSISTED LIVING RE 623000 7267342 7267342 MEDICAL LABORATORY 621500 848721 848721 340B PHARMACY REVENUE 446110 669622 669622 NCCN CREDENTIALING REVENUE 518210 71175 71175 2650 2650 165654357 2365752 2365752 34 34 33489339 897911 29507539 896318 3981800 1593 3983393 3983393 CAFETERIA SALES 722210 420766 420766 HOSPITAL AUXILARY SALES 453220 222379 222379 MISC. OTHER HOSPITAL REVENUE 900099 120069 120069 763214 172983608 164731811 922546 7112393 X 142747 142747 2996583 1679742 1316841 57291539 47277455 10014084 1915291 1580515 334776 9203200 7594558 1608642 4103656 3386371 717285 351290 263468 87822 138332 69166 69166 144776 144776 24395351 20291724 4103627 341307 341202 105 4184786 2520671 1664115 7898625 3554564 4344061 3809598 2618830 1190768 130642 107996 22646 276687 97652 179035 860952 776844 84108 6952535 6402447 550088 1271210 929154 342056 MEDICAL SUPPLIES 22701978 22443557 258421 OHIO HOSPITAL TAX & SNF 2653297 2653297 0 DUES & SUBSCRIPTIONS 195326 31225 164101 UBI INCOME TAX -9792 -9792 0 948730 538710 410020 152898646 125292103 27606543 0 5375 5640 27672848 27094557 15777340 19327987 160000 240000 54679 0 3394186 2637257 1952704 2568032 228956111 115149668 107083745 113806443 70068948 78180333 673303 0 471508 699354 3469875 4979908 230784511 249539511 21720789 25245026 32893 13117 22115248 19163130 3625570 3473313 15430845 14988085 62925345 62882671 X 167841188 186639340 17978 17500 167859166 186656840 230784511 249539511 X 20084962 -407572 -879716 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 0 1 10372 10372 0 PART II-B, LINE 1: EXECUTIVE MEMBERS OF THE ORGANIZATION, ON AN OCCASIONAL BASIS, MAY WRITE OR SPEAK TO LEGISLATIVE MEMBERS CONCERNING PROPOSED LEGISLATION THAT MIGHT IMPACT THE LOCAL DELIVERY OF HEALTHCARE SERVICES. THE MEDICAL CENTER HAS MEMBERSHIPS IN VARIOUS HEALTHCARE RELATED ASSOCIATIONS, WHICH PROVIDE STATE AND NATIONAL LEADERSHIP ON LEGAL, REGULATORY, QUALITY AND ACCREDITATION ISSUES. AS A PART OF THAT LEADERSHIP ROLE, THESE ORGANIZATIONS DO CONTACT LEGISLATORS TO EXPRESS THEIR ASSOCIATION'S POSITIONS ON MATTERS IMPORTANT TO THEIR MEMBERSHIP. THE FOLLOWING ORGANIZATIONS LISTED BELOW SHOW THE PERCENTAGE OF THE DUES THAT REFLECT LOBBYING AS DETERMINED BY THE IRS: OHIO HEALTH CARE ASSOCIATION - 19.64% OF DUES; OHIO HOSPITAL ASSOCIATION - 6.2% OF DUES AND AMERICAN HOSPITAL ASSOCIATION - 26.47% OF DUES. 2022355 2022355 153381651 68128299 85253352 62287500 42372781 19914719 11264605 4648588 6616017 113806443 CAPITAL LEASE OBLIGATIONS 3479256 OPERATING LEASE OBLIGATIONS 760523 REFUNDABLE ADVANCE OBLIGATIONS 6144089 DUE TO AFFILIATED ENTITIES 4604217 14988085 X 174495190 -407572 2286309 1878737 172616453 367155 367155 172983608 155174748 2518036 2518036 152656712 241934 241934 152898646 PART X, LINE 2: MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FISHER-TITUS MEDICAL CENTER INDIVIDUAL ACCRUED UNCERTAIN TAX POSITION WAS $0.00. PART XI, LINE 2D - OTHER ADJUSTMENTS: TRANSFERS TO VARIOUS AFFILIATED ENTITIES -1,916,424. PROFIT SHARING RELATED TO THE PAIN MANAGEMENT JOINT VENTURE 128,339. CHANGE IN INTEREST SWAP VALUE 130,434. HEALTH PROMOTION OF NORWALK REVENUE 689,554. FISHER-TITUS PAIN MANAGEMENT LLC REVENUE 2,967,548. ADJUSTMENT TO FASB #158 CHANGE IN PENSION LIABILITY 24,822. NET PERIODIC PENSION & POSTRETIREMENT BENEFIT COST 262,036. PART XI, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXILIARY REVENUE 222,379. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 144,776. PART XII, LINE 2D - OTHER ADJUSTMENTS: FISHER-TITUS PAIN MANAGEMENT LLC EXPENSES 2,154,892. HEALTH PROMOTIONS OF NORWALK EXPENSES 363,144. PART XII, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL AUXILIARY EXPENSES 97,158. HOSPITAL EXPENSE ADJUSTMENTS TO REVENUES 144,776. 1 1 X 1 X 1 X 1 1 0 1 1 1 893 494602 509245 0 0.00000 1 18533228 20193302 0 0.00000 2 893 19027830 20702547 0 0.00000 5 60086 85350 85350 0.00060 1 4 7425 7425 0.00000 1 405972 326944 79028 0.00050 5 174740 8580 166160 0.00110 12 60090 673487 335524 337963 0.00220 14 60983 19701317 21038071 337963 0.00220 1 6863425 1715856 33479211 35241494 -1762283 X 1 1 1 FISHER-TITUS PAIN MANAGEMENT LLC PAIN MANAGEMENT 0.51000 0.49000 1 1 FISHER-TITUS MEMORIAL HOSPITAL 272 BENEDICT AVENUE NORWALK OH 44857 HTTPS://WWW.FISHER-TITUS.ORG X X X FISHER-TITUS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 1 1 1 X SEE PART V SUPPLEMENTAL FACILITY INFO X SEE PART V SUPPLEMENTAL FACILITY INFO X 1 20 1 SEE PART V SUPPLEMENTAL FACILITY INFO 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X WWW.FISHERTITUS.ORG/FINANCIAL-SERVICES X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 1 X 0 X X X 1 X 0 0 FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL PARTICIPATED IN A COMMUNITY WIDE HEALTH NEEDS ASSESSMENT IN CONJUNCTION WITH HURON COUNTY PUBLIC HEALTH AND A THIRD-PARTY CONSULTANT TO REVIEW AND DRAFT THE QUESTIONS. IN JULY-2019, 24 COMMUNITY LEADERS, STAKEHOLDERS AND EMPLOYEES FROM PARTICIPATING ORGANIZATIONS GATHERED TO DISCUSS THEIR PERSPECTIVES ON EMERGING HEALTH ISSUES IN HURON COUNTY. INPUT WAS TAKEN FROM REPRESENTATIVES WITH BROAD INTEREST IN THE COMMUNITY AS WELL AS THE PUBLIC HEALTH DEPARTMENT AND THOSE AGENCIES WITH KNOWLEDGE, INFORMATION, OR EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY AS WELL AS MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND THOSE WITH CHRONIC HEALTH NEEDS. THE CHNA PROCESS STARTED WITH THE RESULTS GIVEN TO THE WORK GROUPS, THEN THROUGH THE MAPP PROCESS BY MEETINGS, FOCUS GROUPS AND SURVEYS FROM REPRESENTATIVES OF THE LOCAL COMMUNITY, THE RESULTS WERE ANALYZED, BY REPRESENTATIVES FROM HURON COUNTY PUBLIC HEALTH WHO MET WITH KEY INFORMANTS SUCH AS JUDGES, PHYSICIANS, AND LEADERS/EMPLOYEES OF SOCIAL ORGANIZATIONS THROUGHOUT HURON COUNTY. ADDITIONAL DETAILS CAN BE FOUND ON OUR WEBSITE: HTTPS://WWW.FISHERTITUS.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT-SUPPORT/HEALTH-NEEDS-ASSESSMENT FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: MERCY HEALTH-WILLARD HOSPITAL FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: MEMBERS OF THE HURON COUNTY HEALTH PARTNERS (THE GROUP WHO WORKED ON THE CHNA) HURON COUNTY PUBLIC HEALTH, FIRELANDS COUNSELING AND RECOVERY SERVICES, HURON COUNTY MENTAL HEALTH AND ADDICTION SERVICES, HURON COUNTY CLERK OF COURTS, HURON COUNTY EMT, HURON COUNTY FAMILY AND CHILDREN FIRST COUNCIL, HURON COUNTY JOB AND FAMILY SERVICES, HURON COUNTY SHERIFF'S OFFICE, HURON COUNTY VICTIMS ASSISTANCE PROGRAM, HURON COUNTY WIC, NATIONAL ALLIANCE ON MENTAL ILLNESS HURON COUNTY, BELLEVUE CITY SCHOOLS, MONROEVILLE LOCAL SCHOOLS, NEW LONDON LOCAL SCHOOLS, NORWALK CATHOLIC SCHOOLS, NORWALK CITY SCHOOLS, PLYMOUTH-SHILOH LOCAL SCHOOL DISTRICT, SOUTH CENTRAL LOCAL SCHOOLS, WESTERN RESERVE LOCAL SCHOOLS, WILLARD CITY SCHOOLS, NORWALK ECONOMIC DEVELOPMENT CORPORATION, NORWALK UNITED FUND, OHIO STATE HIGHWAY PATROL-NORWALK POST. FISHER-TITUS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PRIORITIZED HEALTH NEEDS FROM THE MOST RECENT CHNA DONE IN 2020 AND ADOPTED IN 2020 ARE: PHYSICAL HEALTH-PROMOTE HEALTH AND REDUCE CHRONIC DISEASE BY PARTNERING WITH LOCAL SCHOOLS, SUPPORTING LOCAL PROGRAMS THAT ARE PROVIDING HEALTHY MEALS TO CHILDREN, SUPPORTING COMMUNITY BASED PHYSICAL ACTIVITY PROGRAMS, WORKING WITH EMPLOYERS TO EDUCATE EMPLOYEES, PROVIDED WEIGHT LOSS EDUCATION. INCREASING PUBLIC KNOWLEDGE ON DIABETES, CARDIOVASCULAR AND PULMONARY DISEASES. HEALTH SCREENINGS AND WORKING WITH PHYSICIAN OFFICES FOR THOSE ENROLLED IN MEDICARE TO INCREASE THE NUMBER OF WELLNESS VISITS AND CHRONIC CARE MANAGEMENT. ALSO WORKING WITH LOCAL SCHOOLS TO PROVIDE SEXUAL HEALTH PROGRAMS. MENTAL HEALTH AND ADDICTION- COLLABORATING ON PROJECTS WITH OTHER MENTAL HEALTH AGENCIES. COLLABORATING WITH OTHER LOCAL AGENCIES ON OPIOID THRESHOLD ALERT, SUPPORTING LOCAL AGENCIES TO GET ADDICTED INDIVIDUALS INTO APPROPRIATE FACILITIES FOR TREATMENT. ACCESS TO CARE- INCREASE COMPLIANCE WITH MEDICATION THROUGH PROGRAMS THAT ADDRESS BARRIERS FOR ACCESSING MEDICATIONS. INCREASING PUBLIC KNOWLEDGE OF IMPORTANCE OF SCREENING MAMMOGRAMS AND REMOVING BARRIERS TO GETTING MAMMOGRAMS. ADD SERVICES AND PROVIDERS BASED ON COMMUNITY HEALTH AND WELLNESS NEEDS, TAKING INTO CONSIDERATION THE VOLUME OF PATIENTS INCLUDING EXPANDING TELEHEALTH CAPABILITIES. WE ACKNOWLEDGE THE IMPORTANCE OF THESE SIGNIFICANT HEALTH NEEDS BUT ARE UNABLE TO ADDRESS THE FOLLOWING DUE TO LIMITED FINANCIAL RESOURCES. THE AREAS NOT ADDRESSED ARE ORAL HEALTH AND TRANSPORTATION. FISHER-TITUS MEDICAL CENTER: FORM 990, SCHEDULE H, PART V, LINE 7A, CHNA URL: HTTPS://WWW.FISHERTITUS.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT-SUPPORT/HEALTH-NEEDS-ASSESSMENT/ FISHER-TITUS MEDICAL CENTER: FORM 990, SCHEDULE H, PART V, LINE 10A, IMPLEMENTATION STRATEGY URL:HTTPS://WWW.FISHERTITUS.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT-SUPPORT/HEALTH-NEEDS-ASSESSMENT/ FISHER-TITUS MEDICAL CENTER: FORM 990, SCHEDULE H, PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.FISHERTITUS.ORG/PATIENTS-GUESTS/BILLING-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE/ FISHER-TITUS MEDICAL CENTER: FORM 990, SCHEDULE H, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.FISHERTITUS.ORG/PATIENTS-GUESTS/BILLING-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE/ 2 1 - NORWALK MEMORIAL HOME 272 BENEDICT AVENUE NORWALK OH 44857 INTERMEDIATE & SKILLED NURSING FACILITY 2 - THE CARRIAGE HOUSE OF FISHER-TITUS 175 SHADY LANE DRIVE NORWALK OH 44857 ASSISTED LIVING FACILITY PART I, LINE 3C: ALONG WITH THE FEDERAL POVERTY GUIDELINES, FISHER-TITUS USES MEDICAL INDIGENCY AND UNDERINSURANCE STATUS TO HELP DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. PART I, LINE 7: THE COSTING METHODOLOGY USED FOR THE CHARITY CARE SEGMENT OF THE LINE 7 TABLE WAS THE IRS WORKSHEET 1, "CHARITY CARE AT COSTS" IN THE INSTRUCTIONS. COST TO CHARGE RATIOS WERE CARRIED OVER FROM THE IRS WORKSHEET 2 AS A BASIS TO ESTIMATE EXPENSES AND WAS APPLIED TO THE GROSS PATIENT CHARIY CARE CHARGES RECORDED IN 2021. THE COSTING METHODOLOGY USED FOR THE UNREIMBURSED MEDICAID SEGMENT ON THE LINE 7 TABLE WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICAID COST REPORT DATA. THE COSTING METHODOLOGY USED FOR THE "OTHER BENEFITS" SEGMENT OF THE LINE 7 TABLE WERE CALCULATED USING A COMBINATION OF DIRECT COSTS AND OUR COST ACCOUNTING SYSTEM WHICH TAKES INTO CONSIDERATION ALL PATIENT TYPES AND SEGMENTS. PART II, COMMUNITY BUILDING ACTIVITIES: IN 2021, FISHER-TITUS'S COMMUNITY BUILDING ACTIVITIES BENEFITS PROVIDED $2.1 MILLION TO SUPPORT PROGRAMS THAT IMPACTED THE OVERALL HEALTH OF OUR COMMUNITIES AND THE QUALITY OF LIFE OF OUR RESIDENTS. WHILE HOSPITAL-BASED MEDICAL SERVICES ARE THE MOST OBVIOUS WAY WE HELP, FTMC FULFILLS THE HEALTH-CARE NEEDS OF OUR AREA WITH COMMUNITY HEALTH SCREENINGS, EDUCATION CLASSES, PATIENT ASSISTANCE PROGRAMS AND SUPPORT OF HEALTH-RELATED ACTIVITIES. FTMC EMPLOYEES SERVE ON COMMUNITY AND CIVIC BOARDS, HEALTH-ORIENTED ORGANIZATIONS AND ARE INVOLVED IN ECONOMIC DEVELOPMENT ACTIVITIES THROUGHOUT THE COUNTY. FTMC ALSO WORKS WITH SCHOOLS; WORK SITES AND SAFETY NET PROVIDERS TO PROMOTE HEALTH AND WELLNESS AND PREVENT DISEASE. FISHER-TITUS IS A LEADER IN ENVIRONMENTAL STEWARDSHIP, HAVING EARNED NUMEROUS STATE AND NATIONAL AWARDS. PART III, LINE 2: THE COSTING METHODOLOGY USED FOR COMPLETING THE SCHEDULE H PART III, LINE 2 IS DERIVED FROM THE BAD DEBT EXPENSE INCLUDED IN THE AUDITED FINANCIAL STATEMENTS ADJUSTED BY THE AMOUNT OF THE WRITE-OFFS OF THE ACCOUNTS THAT WENT TO BAD DEBT. PART III, LINE 3: AS A TAX-EXEMPT HOSPITAL, NOT-FOR-PROFIT ORGANIZATION WE MUST PROVIDE NECESSARY MEDICAL CARE TO ALL, REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES PROVIDED. MAKING QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS, QUALIFIES BAD DEBT AS COMMUNITY BENEFIT. THE IDENTIFICATION OF PATIENTS ELIGIBLE FOR CHARITY CARE IS SOLEY BASED ON THE COOPERATION OF THE PATIENT TO PROVIDE THE ORGANIZATION ENOUGH FAMILY AND FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY TO MATCH OUR PROGRAMS. HISTORICALLY, IN ADDITION TO THE INTERNALLY IDENTIFIED CHARITY, 10-13% OF THE ACCOUNT BALANCES TURNED TO COLLECTION WERE SUBSEQUENTLY IDENTIFIED BY THE AGENCY AS CHARITY AND RETURNED. THIS CHARITY IS RECORDED ONLY WHEN IT HAS BEEN IDENTIFIED THROUGH VERIFICATION OF INABILITY TO PAY. WE DO BELIEVE THERE IS A SECOND, RELATIVELY EQUAL SEGMENT OF THE BAD DEBT THAT WOULD QUALIFY FOR CHARITY. PATIENTS WITH POOR CREDIT RATINGS AND MULTIPLE CREDITORS MAKING COLLECTION EFFORT FINDS LITTLE VALUE IN COMPLETING THE CHARITY APPLICATION PROCESS TO ONLY ELIMINATE ONE CREDITOR AND HAVE NO IMPROVEMENT TO THEIR FINANCIAL STATUS. WE ESTIMATE THAT UNDER THE CURRENT ECONOMIC CONDITIONS UNIDENTIFIED CHARITY IN BAD DEBT EXPENSE IS ESTIMATED TO BE AN ADDITIONAL $1,715,856 OR 25% OF BAD DEBT. SINCE THIS CALCULATION IS ON AN ACCRUAL BASIS, WE BELIEVE ESTIMATING 10% FOR CHARITY TO BE IDENTIFIED IN FUTURE YEARS AND AN ADDITIONAL 15% FOR BALANCES NEVER IDENTIFIED AS CHARITY IS A VERY CONSERVATIVE AND REASONABLE ESTIMATE OF THIS CHARITY CARE VALUE. PART III, LINE 4: THE FOOTNOTE THAT DISCUSSES BAD DEBT EXPENSE TREATMENT IN THE AUDIT FINANCIAL STATEMENTS IS ON PAGE 14. PART III, LINE 8: FISHER-TITUS MEDICAL CENTER'S MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO EXTRACTED FROM THE MEDICARE COST REPORT DATA. THE MEDICAL CENTER BELIEVES THAT ALL OF THE $1,762,283 SHORTFALL SHOULD BE CONSIDERED AS COMMUNITY BENEFIT, BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT MEDICALLY NECESSARY CARE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY. THIS YEAR, MEDICARE ACCOUNTED FOR 48.2% OF HOSPITAL REVENUES AND THESE MEDICARE BENEFICIARIES WERE PROVIDED CARE IN SPITE OF THIS SHORTFALL. CARING FOR THE MEDICARE BENEFICIARIES RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE TRUE COST FOR THEIR CARE AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. TAX EXEMPT HOSPITALS ARE ALSO EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE MEDICAL CENTER IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. PART III, LINE 9B: THE CHARITY POLICY IS A SUBSET OF THE OVERALL COLLECTION POLICY. WHEN PATIENTS ARE IDENTIFIED AS QUALIFYING FOR ANY OF THE CHARITY CATEGORIES WE SEARCH ACCOUNTS RECEIVABLE AND ACCOUNTS PLACED WITH COLLECTION AGENCIES AND PACKAGE THEM WITH THE APPLICATION. CHARITY INFORMATION IS SHARED WITH OUR RELATED ORGANIZATIONS AND FORMS THE BASIS FOR THEIR CHARITY ADJUSTMENTS. IN ADDITION WITH PATIENT APPROVAL, WE MAY CONTACT LOCAL PHYSICIAN PRACTICES WITH THE INFORMATION AS MANY WILL ADJUST THEIR BALANCES BASED UPON THE INFORMATION PROVIDED. PART VI, LINE 2: USING A SEVERITY AND SIZE COMPARISON INFORMATION THE HOSPITAL ALSO COMPARED DATA FROM HEALTHY PEOPLE 2020 AND OHIO 2020-2022 STATE IMPROVEMENT PLAN, HOSPITAL ADMISSIONS, LOCAL HEALTH CARE PROVIDER OFFICE VISITS AS WELL AS UNDERSERVED, LOW INCOME AGENCIES ALONG WITH THE CHNA. PART VI, LINE 3: PATIENTS ARE INTERVIEWED AFTER REGISTRATION TO ASSIST THEM IN DETERMINING EACH PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AVAILABLE INTERNALLY AND EXTERNALLY. FTMC HAS BILINGUAL SIGNAGE POSTED IN THE ADMITTING/REGISTRATION AREAS, BILLING OFFICE AND FINANCIAL COUNSELING OFFICES, AND IN THE INPATIENT GUIDES IN THE PATIENT ROOMS. THE FTMC WEBSITE HAS A SECTION ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND CONTACT INFORMATION. A MESSAGE ABOUT FINANCIAL ASSISTANCE AND CHARITY CARE ALSO IS INCLUDED ON THE BILLS THAT ARE SENT TO THE PATIENTS. MANY MATERIALS ARE BILINGUAL AND INTERPRETATION SERVICES ARE AVAILABLE. OUR SOCIAL SERVICES DEPARTMENT REGULARLY REFERS PATIENTS IN NEED TO OUR FINANCIAL COUNSELORS FOR ASSISTANCE. WE ALSO TAKE REFERRALS FROM THE LOCAL COUNTY HUMAN SERVICES AGENCIES, VICTIMS OF VIOLENT CRIMES, LOCAL HEALTH DEPARTMENTS, LOCAL LAW ENFORCEMENT AGENCIES, CHURCHES, ETC. FTMC IS VERY PROACTIVE IN TAKING THE MESSAGE TO OUR COMMUNITY. BROCHURES ARE AVAILABLE AT COMMUNITY OUTREACH EVENTS HELD IN THE HOSPITAL AND AT OUTSIDE COMMUNITY EVENTS. FTMC COMMUNICATES THE INFORMATION ABOUT CHARITY CARE PROGRAMS THROUGH ITS COMMUNITY NEWSLETTER AND LOCAL NEWS MEDIA. PART VI, LINE 4: THE FISHER-TITUS MEDICAL CENTER PROVIDES COMPREHENSIVE STATE-OF-THE ART HEALTH CARE SERVICES TO THE RESIDENTS OF HURON AND ERIE AS WELL AS PORTIONS OF OTHER CONTIGUOUS COUNTIES WITH THE LATEST MEDICAL ADVANCEMENTS. FISHER-TITUS'S PRIMARY AREA IS THE GREATER HURON COUNTY AREA IN NORTH CENTRAL OHIO, WHICH IS HOME TO AROUND 58,400 RESIDENTS. FISHERS-TITUS'S 50 ACRE CAMPUS IS IN THE COUNTY SEAT OF NORWALK, WHICH IS THE LARGEST CITY IN THE COUNTY WITH OVER 16,800 RESIDENTS. FISHERS-TITUS HAS NUMEROUS MEDICAL OFFICES LOCATED THROUGHOUT THE COUNTY TO PROVIDE EASY ACCESS TO PHYSICIANS FOR COMMUNITY RESIDENTS. HURON COUNTY HAD THE 21ST HIGHEST LEVEL OF UNEMPLOYMENT WITH AN AVERAGE OF 5.8% IN 2021. THE LARGEST PERCENTAGE OF RESIDENTS ARE CHILDREN UNDER 18 WITH THOSE INDIVIDUALS 65 AND OLDER MAKING UP 18.1% OF THE POPULATION. 89.6% OF THE RESIDENTS ARE CAUCASIAN WITH 7.0% OF THE POPULATION BEING HISPANIC OR LATINO (OF ANY RACE). IN 2020, MEDIAN HOUSEHOLD INCOME WAS $55,041 COMPARED TO OHIO'S MEDIAN HOUSEHOLD INCOME OF $58,116. IN 2020, 12.0% OF INDIVIDUALS WERE LIVING IN POVERTY WITH THOSE UNDER THE AGE OF 18 LIVING IN POVERTY ESTIMATED TO BE 16.0%. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED PERSONS. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE MEDICAL CENTER IN THEIR OVERSIGHT ROLE. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP. FTMC'S MEDICAL STAFF IS OPEN AND PRIVILEGES ARE GRANTED TO ALL QUALIFIED PHYSICIANS WHO APPLY AND MEET THE STANDARDS OF THE MEDICAL CENTER PRIVILEGING PROCESS. THE MEDICAL CENTER UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND TO EXPAND ACCESS POINTS OF CARE TO PATIENTS THROUGHOUT THE COMMUNITY INCLUDING, BUT NOT LIMITED TO THE FOLLOWING:1. EDUCATIONAL PROGRAMS THAT PROVIDE CLASSES AND INFORMATION ON TOBACCO CESSATION, HEALTHY AGING, CHILDBIRTH, INFANT CARE, EARLY PREGNANCY AND MORE.2. FREE MAMOGRAMS TO QUALIFYING INDIVIDUALS, FREE OR LOW-COST SCREENINGS FOR HEART DISEASE, BREAST, PROSTATE, SKIN AND COLORECTAL CANCER AS WELL AS OSTEOPOROSIS ASSESSMENTS. 1 FISHER TITUS FOUNDATION 272 BENEDICT AVE NORWALK OH 44857 341476934 501(C)(3) 27747 0 FMV CONTRIBUTION PLEDGE TO HELP PURCHASE STEMI & CRASH CARTS NORWALK ATHLETIC BOOSTER 27 WELTON AVENUE NORWALK OH 44857 341354358 501(C)(3) 20000 0 FMV CONTRIBUTION TOWARDS NORWALK MIDDLE SCHOOL TENNIS COURTS RESTORE NORWALK PO BOX 271 NORWALK OH 44857 822398024 501(C)(3) 10000 0 FMV CONSTRIBUTION TOWARDS SPLASH PAD IN CITY OF NORWALK NORWALK ECONOMIC DEVELOPMENT CORP 10 1/2 WEST MAIN STREET NORWALK OH 44857 341787391 501(C)(3) 10000 0 FMV CONTRIBUTION TO THE NORWALK ECONOMIC DEVELOPMENT TO HELP THE LOCAL COMMUNITY VILLAGE OF WAKEMAN 59 HYDE STREET WAKEMAN OH 44889 15000 0 FMV COMMUNITY SUPPORT FOR WELLNESS & FITNESS ACTIVITIES AT RED CAP PARK NORWALK AREA UNITED FUND PO BOX 134 2 EAST SEMINARY STREET NORWALK OH 44857 340906312 501(C)(3) 10000 0 FMV CONTRIBUTE TO THE UNITED WAY CAMPAIGN TO HELP THE LOCAL COMMUNITY CITY OF NORWALK - PARKS & RECREATION 100 REPUBLIC STREET NORWALK OH 44857 50000 0 FMV CONTRIBUTION TOWARDS NORWALK ALL-ABILITIES PARK 5 2 PART I, LINE 2: THE MEDICAL CENTER REVIEWS EACH GRANT OR DONATION REQUEST BEFORE THE GRANT OR DONATION IS MADE. X X X X X X 0 1 0 0 0 0 0 0 0 BRENT BURKEY PRESIDENT/CEO 447203 0 112775 0 47607 0 54770 0 269 0 662624 0 43307 0 GARY MOORMAN CHIEF MEDICAL OFFICER 352868 0 61750 0 2574 0 11600 0 24027 0 452819 0 0 0 MATTHEW MATTNER CHIEF OPERATIONS OFFICER 252975 0 46250 0 21880 0 39102 0 29689 0 389896 0 0 0 JOHN K HUGHES MD DIRECTOR 0 234222 0 708 0 51961 0 38100 0 29798 0 354789 0 0 SCOTT E ENDSLEY CHIEF FINANCIAL OFFICER 231153 0 35000 0 30551 0 32860 0 8677 0 338241 0 0 0 KATIE CHIEDA CHIEF NURSING OFFICER 193443 0 54286 0 1962 0 30975 0 34496 0 315162 0 0 0 SUZANNE FARMER CHIEF ADMINISTRATIVE OFFIC 209558 0 45176 0 2021 0 31486 0 1228 0 289469 0 0 0 LINDA STEVENSON CHIEF INFORMATION OFFICER 190298 0 35750 0 1890 0 27362 0 23877 0 279177 0 0 0 MIRIAM BATKE CHIEF HUMAN RESOURCE OFFIC 223062 0 10457 0 1054 0 24382 0 10241 0 269196 0 0 0 SHARON HARWOOD CHIEF COMPLIANCE OFFICER 168085 0 32500 0 21328 0 26741 0 15536 0 264190 0 0 0 JASON FRONEK SR DIRECTOR INFORMATION SE 147741 0 9300 0 1251 0 6784 0 34496 0 199572 0 0 0 PART I, LINE 4B PART I LINE 4B & PART II, LINE 1 -INCLUDED IN DR. BURKEY'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $54,770 REPORTED IN COLUMN C IS $9,906 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $44,864 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 5 - INCLUDED IN MR. ENDSLEY'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $32,860 REPORTED IN COLUMN C IS $8,768 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $24,092 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 6 - INCLUDED IN MS. CHIEDA'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $30,975 REPORTED IN COLUMN C IS $10,401 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $20,574 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AND ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 4 -INCLUDED IN DR. HUGHES'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $38,100 REPORTED IN COLUMN C IS $11,600 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $26,500 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 3 - INCLUDED IN MR. MATTNER'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $39,102 REPORTED IN COLUMN C IS $11,600 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $27,502 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AND ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 10 -INCLUDED IN MS. HARWOOD'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $26,741 REPORTED IN COLUMN C IS $7,569 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $19,172 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AND ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 8 - INCLUDED IN MS. STEVENSON'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $27,362 REPORTED IN COLUMN C IS $7,547 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $19,814 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AND ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 9 - INCLUDED IN MS. BATKE'S TOTAL CONTRIBUTIONS TO DEFERRED COMPENSATION OF $24,382 REPORTED IN COLUMN C IS $4,840 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $19,542 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AND ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. PART I LINE 4B & PART II, LINE 7 - INCLUDED IN MS. FARMERS'S TOTAL CONTRIBUTION TO DEFERRED COMPENSATION OF $31,486 REPORTED IN COLUMN C IS $10,287 OF VESTED DEFERRED WAGES AND QUALIFIED RETIREMENT PLAN CONTRIBUTIONS AND $21,199 FOR THE CURRENT YEAR ACCRUAL OF A NON-VESTED, NON-QUALIFIED RETIREMENT PLAN. THIS PLAN PROVIDES AN ADDITIONAL BENEFIT BASED ON YEARS OF ELIGIBLE SERVICE AND VESTED STATUS AND REMAINS SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. PART 1 LINE 3: RESPONSIBILTY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE PERSONNEL COMMITTEE OF THE FISHER-TITUS HEALTH BOARD. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDENT CONSULTANT REPORTS TO THE PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP AND TRENDS IN PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE THEN PROVIDED TO EACH OF THE DIRECTORS OF THE FISHER-TITUS HEALTH BOARD. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED BY THE PERSONNEL COMMITTEE AND THEN BY THE FISHER-TITUS HEALTH BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE SUCH ACTION IS TAKEN REFLECT SUCH ACTION. THIS IS DONE ANNUALLY AND WAS LAST DONE IN MARCH 2021. A COUNTY OF HURON OHIO 346400672 2015-04-01 9420000 SEE PART VI BELOW 0 0 0 B COUNTY OF HURON OHIO 346400672 2017-08-15 17825000 SEE PART VI BELOW 0 0 0 A 9420000 50000 9370000 2015 1 0 1 1 B 17825500 239217 6645200 10941083 2017 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 0 0 1 1 PNC 6.800000000000 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 0 B 0 PART I, LINE A: SERIES 2015A BONDS - PURPOSE WAS TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 2003A BONDS. PART 1, LINE B: SERIES 2017A BONDS - PURPOSE WAS TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 2007A BONDS AND ACQUIRE ADDITIONAL HOSPITAL EQUIPMENT. PART II, LINE 11, COLUMN A: INCLUDED IN COLUMN A $9,370,000 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 2003A BONDS. PART II, LINE 11, COLUMN B: INCLUDED IN COLUMN B $10,941,083 OF THE PROCEEDS WERE USED TO REFUND THE HOSPITAL'S COUNTY OF HURON REVENUE BONDS, SERIES 2007A BONDS. BRENT BURKEY PRESIDENT SEE PART V X 240000 240000 0 1 1 240000 BATTLES INSURANCE AGENCY PERRY DRYDEN, BOARD MEMBER IS PRESIDENT OF BATTLES INSURANCE AGENCY AND 50% 1202891 VENDOR 0 PART IV: PART IV, LINE 5 - PERRY DRYDEN, BOARD MEMBER IS PRESIDENT OF BATTLES INSURANCE AGENCY AND 50% OWNER. PART IV: PART II LINE 1 - THE LOAN REPRESENTS THE VALUE OF THE PURCHASE OF A SPLIT-DOLLOAR LIFE INSURANCE POLICY TO SUPPLEMENT RETIREMENT INCOME AND RETURN PREMIUMS TO THE ORGANIZATION BASED ON THE AGREEMENT. X AUDIOLOGY EQUIPMENT 1 38148 FMV 0 0 0 PART I, COLUMN (B): THE AMOUNT IS THE NUMBER OF CONTRIBUTORS. FORM 990, PART III, LINE 4A: FISHER-TITUS MEDICAL CENTER (FTMC) IS AN INDEPENDENT NON-PROFIT COMMUNITY HEALTHCARE ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPOSED OF AREA RESIDENTS INCLUDING BUSINESS AND COMMUNITY LEADERS, PHYSICIANS AND OTHER INTERESTED INDIVIDUALS. FTMC IS COMPOSED OF THE FOLLOWING FIVE OPERATING DIVISIONS: FISHER-TITUS MEMORIAL HOSPITAL THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO THE RESIDENTS OF HURON, ERIE AND THE ADJACENT COUNTIES OF SANDUSKY, CRAWFORD, LORAIN, ASHLAND AND RICHLAND. IN 2021, THE HOSPITAL PROVIDED 13,218 DAYS OF INPATIENT CARE TO 3,801 PATIENTS. THE HOSPITAL HAD 130,721 OUTPATIENT AND 25,073 EMERGENCY ROOM VISITS DURING THE YEAR. THE NORWALK MEMORIAL HOME THE NORWALK MEMORIAL HOME PROVIDES SKILLED AND LONG-TERM CARE IN ITS TRANSITIONAL AND EXTENDED CARE UNITS. DURING 2021, THE HOME SERVED 313 RESIDENTS AND PROVIDED 18,796 DAYS OF CARE. THE HOME HEALTH CENTER HOME HEALTH AGENCY THE HOME HEALTH CENTER PROVIDED 12,133 HOME VISITS TO 307 DIFFERENT PATIENTS IN 2021. THE CARRIAGE HOUSE OF FISHER-TITUS OPENED IN 1998, THE CARRIAGE HOUSE IS A 48-UNIT ASSISTED LIVING FACILITY, WHICH PROVIDED 10,957 DAYS OF ASSISTED LIVING CARE TO 36 RESIDENTS IN 2021. FACILITY AND PROGRAM EXPANSIONS IN JANUARY, NORTH CENTRAL EMS OWNED BY FISHER-TITUS HEALTH PARTNERED WITH METROHEALTH TO LAUNCH A NEW EMERGENCY TRIAGE, TREAT, AND TRANSPORT OR ET3 MODEL PROGRAM. THE ET3 MODEL IS A VOLUNTARY, FIVE-YEAR PAYMENT MODEL THAT WILL PROVIDE GREATER FLEXIBILITY TO AMBULANCE CARE TEAMS TO ADDRESS THE EMERGENCY HEALTH CARE NEEDS OF PATIENTS FOLLOWING A 911 CALL. THIS MODEL ALLOWS NORTH CENTRAL EMS FLEXIBILITY WHEN ASSESSING 911 CALLS UPON ARRIVAL BASED ON PATIENT NEED. IN ADDITION TO TREATING ON SCENE OR TRANSPORTING TO A LOCAL EMERGENCY ROOM, OUR EMS CREWS CAN TRANSPORT TO OTHER DESTINATIONS SUCH AS A PRIMARY CARE OFFICE OR CONVENIENT CARE, BASED ON PATIENT NEED. IN MARCH, FISHER-TITUS BROKE GROUND ON THEIR NEW BUSINESS OPERATIONS CENTER ACROSS FROM THE MEDICAL CENTER. THE RENOVATED BUILDING IS OWNED AND MANAGED BY FISHER-TITUS WITH OVER 7,000 SQUARE FEET RESERVED FOR VARIOUS BUSINESS OPERATIONS DEPARTMENTS. IN ADDITION, OVER 8,000 SQUARE FEET IS RESERVED FOR FAMILY HEALTH SERVICES, A FEDERALLY QUALIFIED HEALTH CENTER, TO PROVIDE BEHAVIORAL HEALTH, PRIMARY CARE, AND DENTISTRY SERVICES TO HURON COUNTY, REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE NEW FACILITY WAS OPENED IN JULY. IN MAY, THE CARRIAGE HOUSE OF FISHER-TITUS LAUNCHED SHORT-TERM AND TRIAL LIVING OPTIONS FOR SENIORS. THESE OPTIONS ALLOW SENIORS AND FAMILIES TO SEE WHAT LIVING AT THE CARRIAGE HOUSE IS LIKE. IN JUNE, THE FISHER-TITUS PAIN MANAGEMENT CENTER INTRODUCES THREE NEW STATE-OF-THE-ART PROCEDURES: MILD, STIMWAVE, AND PLATELET-RICH PLASMA (PRP) TREATMENT. MILD IS AN OUTPATIENT PROCEDURE THAT CAN HELP PATIENTS DIAGNOSED WITH LUMBAR SPINAL STENOSIS (LSS) TO EXPERIENCE LESS PAIN AND INCREASED MOBILITY. STIMWAVE IS AN OUTPATIENT PROCEDURE THAT USES STIMULATION TO REPROGRAM A PATIENT'S NERVE CELLS TO REPLACE THE PAINFUL SIGNALS TO THE BRAIN. PRP TREATMENT, IS A FORM OF REGENERATIVE MEDICINE THAT CAN IMPROVE THE BODY'S ABILITY TO HEAL ITSELF BY AMPLIFYING THE NATURAL GROWTH FACTORS YOUR BODY USES TO HEAL TISSUE. EDUCATION AND RESEARCH - TO ENSURE THAT WE HAVE THE QUALITY WORKFORCE WE NEED TO CARE FOR OUR COMMUNITY IN THE FUTURE, WE ARE COMMITTED TO THE EDUCATION OF CURRENT AND FUTURE CAREGIVERS, AND WE WORK WITH EHOVE CAREER CENTER, ASHLAND UNIVERSITY, BOWLING GREEN STATE UNIVERSITY FIRELANDS CAMPUS, LORAIN COUNTY COMMUNITY COLLEGE, NORTH CENTRAL STATE COLLEGE, TERRA COMMUNITY COLLEGE, OHIO UNIVERSITY AND MORE TO PROVIDE INTERNSHIPS, INSTRUCTORS, CLASSROOM SPACE, AND CLINICAL TRAINING. WE ARE PLEASED TO BE ABLE TO OFFER A COMPREHENSIVE LEARNING EXPERIENCE UTILIZING OUR STATE-OF-THE-ART FACILITIES AND ADVANCED TECHNOLOGY. EXCELLENT PHYSICIANS: THE MEDICAL STAFF IS COMPOSED OF BOTH INDEPENDENT PRACTITIONERS AS WELL AS PHYSICIANS AND PROVIDERS EMPLOYED BY FISHER-TITUS UNDER THE NAME FISHER-TITUS MEDICAL CARE. OVERALL, THE MEDICAL STAFF INCLUDES 266 PHYSICIANS AND ALLIED HEALTH PROFESSIONALS, REPRESENTING 37 MEDICAL SPECIALTIES. THE MEDICAL CARE EMPLOYED GROUP INCLUDES PRACTITIONERS REPRESENTING PRIMARY CARE, PEDIATRICS, DIGESTIVE HEALTH, UROLOGY, BEHAVIORAL HEALTH, PULMONOLOGY, CARDIOLOGY, AND VASCULAR CARE. IN 2021, 1 FAMILY MEDICINE, 1 UROLOGY, AND 1 PEDIATRICS PROVIDER JOINED THE GROUP. AWARDS AND ACCREDITATIONS - THROUGHOUT THE YEARS FISHER-TITUS HAS BEEN HIGHLY SUCCESSFUL IN MEETING THE CHALLENGES OF AN INCREASINGLY COMPLEX HEALTH-CARE INDUSTRY AND HAS PROVIDED EXCEPTIONAL SERVICE QUALITY TO MEMBERS OF THE SURROUNDING COMMUNITIES. THE MEDICAL CENTER IS ACCREDITED BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP), WITH ITS LAST THREE-YEAR SURVEY OCCURRING IN 2021. FISHER-TITUS ALSO IS A LEVEL 3 TRAUMA CENTER, HFAP PRIMARY STROKE CENTER, A LEVEL 2 ADULT CARDIAC CATHETERIZATION LABORATORY, AND HAS ALSO BEEN ACCREDITED BY THE COMMISSION ON CANCER SINCE 1989. THE MEDICAL CENTER'S FOCUS ON QUALITY CARE AND EXCEPTIONAL SERVICE IS EVIDENCED BY THE MANY HOSPITAL AND DEPARTMENTAL ACCREDITATIONS, AWARDS, AND RECOGNITIONS RECEIVED IN 2021: FISHER-TITUS WAS NAMED TO NEWSWEEK'S 2021 LIST OF BEST MATERNITY CARE HOSPITALS, ONLY ONE OF 217 FACILITIES NATIONWIDE. THIS WAS THE SECOND YEAR IN A ROW THEY RECEIVED THIS RECOGNITION. THE DISTINCTION RECOGNIZES FACILITIES THAT HAVE EXCELLED IN PROVIDING CARE TO MOTHERS, NEWBORNS AND THEIR FAMILIES, AS VERIFIED BY THE 2020 LEAPFROG HOSPITAL SURVEY. BEST MATERNITY CARE HOSPITALS IS PART OF NEWSWEEK, POWERED BY DATA FROM THE LEAPFROG GROUP. IN MARCH, FISHER-TITUS WAS RECOGNIZED AS A 2021 TOP 100 RURAL & COMMUNITY HOSPITAL. COMPILED BY THE CHARTIS CENTER FOR RURAL HEALTH, THIS 11TH ANNUAL RECOGNITION PROGRAM HONORS OUTSTANDING PERFORMANCE AMONG THE NATION'S RURAL HOSPITALS BASED ON THE RESULTS OF THE HOSPITAL STRENGTH INDEX. IN 2021, FISHER-TITUS EARNED AN "A" FOR THE SPRING AND FALL LEAPFROG HOSPITAL SAFETY GRADES. THIS ALSO LEAD TO THEM EARNING A STRAIGHT A DESIGNATION FOR HAVING "A" RATINGS SINCE FALL 2019. THE LEAPFROG GROUP, AN INDEPENDENT NATIONAL WATCHDOG ORGANIZATION, ASSIGNS AN "A," "B," "C," "D, OR "F" GRADE TO GENERAL HOSPITALS ACROSS THE COUNTRY BASED ON OVER 30 NATIONAL PERFORMANCE MEASURES REFLECTING ERRORS, INJURIES, ACCIDENTS, AND INFECTIONS, AS WELL AS SYSTEMS HOSPITALS HAVE IN PLACE TO PREVENT HARM. ALSO FROM LEAPFROG IN 2021, FISHER-TITUS WAS NAMED A TOP RURAL HOSPITAL NATIONALLY ONLY ONE OF TWO IN THE STATE OF OHIO. THE LEAPFROG TOP HOSPITAL AWARD IS WIDELY ACKNOWLEDGED AS ONE OF THE MOST COMPETITIVE AWARDS AMERICAN HOSPITALS CAN RECEIVE. THE TOP HOSPITAL DESIGNATION IS BESTOWED BY THE LEAPFROG GROUP, A NATIONAL WATCHDOG ORGANIZATION OF EMPLOYERS AND OTHER PURCHASERS RECOGNIZED AS THE TOUGHEST STANDARD-SETTERS FOR HEALTH CARE SAFETY AND QUALITY. IN SEPTEMBER, FISHER-TITUS AND NORTH CENTRAL EMS RECEIVED THE AMERICAN HEART ASSOCIATION'S MISSION: LIFELINE EMS BRONZE RECEIVING ACHIEVEMENT AWARD FOR IMPLEMENTING SPECIFIC QUALITY IMPROVEMENT MEASURES TO TREAT PATIENTS WHO SUFFER SEVERE HEART ATTACKS. THE AMERICAN HEART ASSOCIATION'S MISSION: LIFELINE PROGRAM HELPS REDUCE BARRIERS TO PROMPT TREATMENT FOR HEART ATTACKS STARTING FROM WHEN 9-1-1 IS CALLED, TO EMS TRANSPORT, AND CONTINUING THROUGH HOSPITAL TREATMENT AND DISCHARGE. OPTIMAL CARE FOR HEART ATTACK PATIENTS TAKES COORDINATION BETWEEN THE INDIVIDUAL HOSPITAL, EMS, AND HEALTH CARE SYSTEM. IN ADDITION, THE MEDICAL CENTER MAINTAINS THE FOLLOWING ONGOING ACCREDITATIONS: COMMISSION ON CANCER ACCREDITATION, ONCOLOGY, LABORATORY, PHARMACY DEPARTMENTS. FISHER-TITUS ENDOSCOPY CENTER, AMERICAN SOCIETY OF GASTROINTESTINAL ENDOSCOPY (ASGE) RECOGNITION FOR COMMITMENT TO PATIENT SAFETY AND QUALITY IN ENDOSCOPY SERVICES. CARDIOVASCULAR CATH LAB, OHIO DEPARTMENT OF HEALTH FISHER-TITUS SLEEP CENTER, ACCREDITATION COMMISSION FOR HEALTH CARE (ACHC) OHIO DEPARTMENT OF HEALTH MAMMOGRAPHY QUALITY STANDARDS AMERICAN COLLEGE OF RADIOLOGY, MAMMOGRAPHY OHIO DEPARTMENT OF HEALTH, RADIOLOGY NORWALK MEMORIAL HOME AND CARRIAGE HOUSE ASSISTED LIVING, OHIO DEPARTMENT OF HEALTH HOME HEALTH DEPARTMENT, OHIO DEPARTMENT OF HEALTH NUCLEAR MEDICINE, OHIO DEPARTMENT OF HEALTH INTERSOCIETY COMMISSION FOR THE ACCREDITATION OF VASCULAR LAB, ULTRASOUND COLLEGE OF PATHOLOGISTS (CAP) ACCREDITATION DEPT. OF PATHOLOGY & LABORATORY SERVICES & BLOOD GAS LAB COLLEGE OF PATHOLOGISTS (CAP) PULMONARY MEDICINE AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION FOR MAGNETIC RESONANCE IMAGING AMERICAN DIABETES ASSOCIATION EDUCATION RECOGNITION CERTIFICATE INTERSOCIETAL ACCREDITATION COMMISSION (IAC) ECHO MATERNITY, OHIO DEPARTMENT OF HEALTH SURVEY FORM 990, PART III, LINE 4B: COMMUNITY HEALTH AND OUTREACH PROGRAMS: FISHER-TITUS MEDICAL CENTER'S COMMUNITY BENEFITS EXTEND OUTSIDE OUR WALLS TO FAMILIES, BUSINESS, SCHOOLS, CHURCHES AND NEIGHBORHOODS THROUGH OUTREACH PROGRAMS AND OTHER COORDINATED CARE ACTIVITIES THAT MAKE OUR COMMUNITIES HEALTHIER PLACES TO LIVE, WORK AND WORSHIP. OUR GOAL IS TO HELP ALL RESIDENTS EQUALLY ACCESS THE CARE THEY NEED AND HELP THEM LEARN TO MANAGE THEIR CONDITIONS AND LIVE HEALTHIER, SAFER LIVES. IN 2020 A NEW HURON COUNTY HEALTH NEEDS ASSESSMENT WAS COMPLETED AND PUBLISHED. FISHER-TITUS WAS A LEADER IN THE PROCESS AND PARTNERED WITH HEALTH-RELATED AND CIVIC ORGANIZATIONS THROUGHOUT THE COUNTY TO BOTH FUND THE PROJECT AND ASSIST IN THE ASSESSMENT PROCESS. FROM THAT REPORT, THE BOARD OF DIRECTORS OF FISHER-TITUS MEDICAL CENTER DETERMINED THAT CERTAIN HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT SHOULD BE ADDRESSED AS THE HIGHEST PRIORITY THROUGH AN IMPLEMENTATION STRATEGY. THE PRIORITIES INCLUDE SUPPORTING INITIATIVES GEARED TO HEALTHY WEIGHT; IMPROVING ACCESS TO MENTAL HEALTH SERVICES; REDUCING SUBSTANCE ABUSED THROUGH PREVENTION, SCREENING, AND TREATMENT; IMPROVING ACCESS TO CARE; AND IMPROVING THE PUBLIC HEALTH INFRASTRUCTURE. FISHER-TITUS SUPPORTS OTHER AREA NON-PROFIT COMMUNITY ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICE AND EMPLOYEE VOLUNTEERISM. MANY OF OUR COMMUNITY BENEFIT PROGRAMS ARE ORGANIZED TO WORK COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS. IN 2021, WE OFFERED COMMUNITY HEALTH EDUCATION PROGRAMS, INCLUDING SCHOOL-BASED PROGRAMS, SUPPORT GROUPS, COMMUNITY-BASED HEALTH FAIRS AND SCREENINGS, AND WALKING AND FITNESS PROGRAMS THAT IMPACTED OUR RESIDENTS THROUGH 60,090 ENCOUNTERS. AUXILIARY AND VOLUNTEER SERVICE: - DURING 2021, OUR 82 CARING VOLUNTEERS DONATED 4,964 HOURS OF AUXILIARY AND VOLUNTEER SERVICES TO THE MEDICAL CENTER. THE VOLUNTEER PROGRAM WAS SUSPENDED IN MID-MARCH 2020 DUE TO COVID. SOME VOLUNTEERS RETURNED THROUGHOUT 2021. VOLUNTEERS PROVIDE A VARIETY OF SERVICES INCLUDING HELPING FAMILY MEMBERS, PROVIDING TRANSPORTATION, ASSISTING AT COMMUNITY HEALTH PROGRAMS, DELIVERING REFRESHMENTS, MAIL AND FLOWERS TO HOSPITAL PATIENTS AND RESIDENTS OF THE NORWALK MEMORIAL HOME PLUS ESCORTING PATIENTS THROUGHOUT THE BUILDING. THEY ALSO PERFORM CLERICAL DUTIES, STAFF THE MEDICAL CENTER'S GIFT SHOP, AND ORGANIZE SEVERAL FUND-RAISING EVENTS THROUGHOUT THE YEAR. VOLUNTEER "AMBASSADORS" HAVE INSTRUCTED PATIENTS SINCE APRIL 2010 ON THE USE OF THE TELEVISION/COMPUTER SCREENS LOCATED IN EACH PATIENT ROOM. VOLUNTEERS WORKING IN THIS CAPACITY ARE AT FISHER-TITUS MEDICAL CENTER SEVEN DAYS PER WEEK EACH MORNING FOR 2 HOURS. AMONG THE ITEMS PATIENTS ARE INSTRUCTED ON ARE HOW TO ACCESS THE DAY'S MENU, MEDICAL INFORMATION PERTAINING TO THE PERSON'S HEALTH PROBLEMS, ACCESSING THE INTERNET, PLAYING GAMES, OBTAINING THE NAMES OF CAREGIVERS AS THEY ENTER THE PATIENT'S ROOM, CHOOSING MOVIES, ETC. THE PATIENT THEN MAY USE A REMOTE CONTROL OR A WIRELESS KEYBOARD TO ACCESS THIS INFORMATION. INFORMATION SERVICES PROVIDES ALL COMPUTER TRAINING FOR VOLUNTEERS THAT WORK IN THIS CAPACITY. COMMUNITY HEALTH IMPROVEMENT SERVICES: NUMEROUS HEALTH SCREENINGS ARE OFFERED THROUGHOUT THE YEAR AT THE MEDICAL CENTER AND AT VARIOUS COMMUNITY LOCATIONS AND EVENTS THROUGHOUT OUR SERVICE AREA. THESE PROGRAMS INCLUDE SCREENING FOR BLOOD GLUCOSE, CHOLESTEROL LEVELS, SKIN CANCER, PROSTATE CANCER, OSTEOPOROSIS AND SCREENING MAMMOGRAMS. IN ADDITION, THE MEDICAL CENTER SPONSORS NUMEROUS SUPPORT GROUPS TO PROVIDE EDUCATION, CARE AND EMOTIONAL SUPPORT TO INDIVIDUALS AND FAMILIES AFFECTED BY DISABILITIES AND CHRONIC MEDICAL CONDITIONS. FTMC'S HEALTH MINISTRY PROGRAM, FORMED IN 2000, HAS BEEN A VERY EFFECTIVE GRASSROOTS INITIATIVE TO GATHER INFORMATION AND PROVIDE HEALTH PROGRAMS THROUGHOUT HURON COUNTY. CURRENTLY 50 AREA CONGREGATIONS ARE MEMBERS OF THE FTMC HEALTH MINISTRY PROGRAM WHICH PROVIDES HEALTH AND WELLNESS INFORMATION AND PROGRAMS IN AREA CHURCHES. THE MEDICAL CENTER IN PARTNERSHIP WITH ITS PHYSICIANS AND OTHER COMMUNITY ORGANIZATIONS PROVIDES PUBLIC FORUMS AND EDUCATIONAL SESSIONS ON A VARIETY OF TOPICS, WHICH ARE SOMETIMES HELD IN TANDEM WITH THE HEALTH SCREENINGS PROVIDED. WE ALSO PROVIDE NUMEROUS HEALTH FAIRS DURING THE YEAR IN SEVERAL LOCATIONS THROUGHOUT THE COUNTY AND SURROUNDING COMMUNITIES IN OUR SERVICE AREA. THESE COMMUNITY HEALTH IMPROVEMENT SERVICES BENEFITED 60,086 PEOPLE IN 2021 AT A COST OF $85,350. PROFESSIONAL MEDICAL EDUCATION: THE MEDICAL CENTER SUPPORTS AND STAFFS SEVERAL CLASSES FOR HEALTH PROFESSIONALS INCLUDING HEALTHCARE PROVIDER CPR, ADVANCED CARDIAC LIFE SUPPORT, BASIC LIFE SUPPORT INSTRUCTOR COURSE AND PEDIATRIC ADVANCE LIFE SUPPORT. IN ADDITION, FTMC SUPPORTS STUDENTS SHADOWING EMPLOYEES TO LEARN MORE ABOUT THEIR CHOSEN CAREER PATH. THE TOTAL COST OF PROFESSIONAL MEDICAL EDUCATION PROVIDED TO 4 PARTICIPANTS WAS $7,425. SUBSIDIZED HEALTH SERVICES: THE MEDICAL CENTER SUBSIDIZES CERTAIN HEALTH SERVICES AND PROCESSES TO ADDRESS SPECIFIC HEALTH ISSUES IN THE COMMUNITY, PROVIDE CARE TO THE UNDERSERVED, OR ENHANCE THE OVERALL QUALITY OF HEALTHCARE WITHIN THE COMMUNITY. THE COST ASSOCIATED WITH THE HEALTH SERVICES IN 2021 WAS $79,028. DONATIONS AND COMMUNITY SUPPORT: THE MEDICAL CENTER MAKES CASH AND NON-CASH CONTRIBUTIONS ANNUALLY TO LOCAL NON-PROFIT ORGANIZATIONS THAT BENEFIT THE HEALTH AND DEVELOPMENT OF OUR LOCAL COMMUNITY AND ITS RESIDENTS. IN ADDITION, THE MEDICAL CENTER SUPPORTS AREA SCHOOLS BY AWARDING SPECIAL HEALTH EDUCATION GRANTS TO SCHOOL DISTRICTS IN OUR SERVICE TERRITORY TO FUND INNOVATIVE PROGRAMS IN THE AREAS OF SCIENCE, MATH, HEALTH AND HEALTH RELATED EDUCATION. THE TOTAL COST OF THESE DONATIONS AND SUPPORT IN 2021 WAS $166,160. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF FISHER-TITUS MEDICAL CENTER IS THE PARENT COMPANY FISHER-TITUS HEALTH, AN OHIO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL BE COMPOSED OF THOSE INDIVIDUALS WHO ARE VOTING DIRECTORS OF THE MEMBER AT ANY TIME, AS DETERMINED UNDER THE CODE OF REGULATIONS OF THE MEMBER (FISHER-TITUS HEALTH). FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBER (FISHER-TITUS HEALTH): A) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION AND THE CODE OF REGULATIONS; B) TO APPROVE ANY MERGER OF THE CORPORATION OR ANY SALE OF SUBSTANTIALLY ALL OF ITS ASSETS; TO DISSOLVE OR TERMINATE THE EXISTENCE OF THE CORPORATION AND TO DETERMINE THE DISTRIBUTION OF ASSETS UPON SUCH TERMINATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS OF THE FISHER-TITUS MEDICAL CENTER DELEGATED THE RESPONSIBILITY FOR THE REVIEW OF THE MEDICAL CENTER'S FORM 990, PLUS ALL REQUIRED SCHEDULES AND ATTACHMENTS, TO THE FISHER-TITUS AUDIT COMMITTEE. THE MEMBERS OF THIS COMMITTEE HAVE A STRONG BACKGROUND IN ACCOUNTING, LEGAL, FINANCE, AND BUSINESS AND HAVE THE TECHNICAL EXPERTISE TO PERFORM A SUBSTANTIVE REVIEW. THE AUDIT COMMITTEE REVIEWED THE MEDICAL CENTER'S FORM 990 PRIOR TO FILING AND REPORTED TO THE MEDICAL CENTER'S BOARD OF DIRECTORS REGARDING THE RESULTS OF THEIR REVIEW. IN ADDITION, EACH MEMBER OF THE MEDICAL CENTER'S BOARD OF DIRECTORS HAD ACCESS TO A COPY OF THE FORM 990 FOR VIEWING PRIOR TO FILING VIA A SECURE INTERNET WEBSITE AND A PAPER COPY WAS AVAILABLE FOR REVIEW AT THE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C ALL OF OUR AFFILIATED CORPORATE BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT UPON JOINING THE BOARD AND ANNUALLY THROUGHOUT THEIR TENURE. THESE ARE RETAINED BY ADMINISTRATION. AREAS OF CONFLICT ARE REVIEWED AND ADDRESSED AS NECESSARY TO THE TRANSACTIONS OF THE BOARD. IF AN AREA OF CONFLICT ARISES, BOARD MEMBERS ARE EXCUSED AND PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DISCUSSIONS REGARDING THE AREA OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 RESPONSIBILITY FOR DETERMINING AND RECOMMENDING EXECUTIVE COMPENSATION RESTS WITH THE PERSONNEL COMMITTEE OF THE FISHER-TITUS HEALTH BOARD. THE COMMITTEE RETAINS AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO HELP ESTABLISH CASH COMPENSATION TARGET RANGES AND IDENTIFY REASONABLE AND CUSTOMARY BENEFIT PROGRAMS FOR EXECUTIVES. THE INDEPENDENT CONSULTANT REPORTS TO THE PERSONNEL COMMITTEE ON RELEVANT PEER GROUPS, CASH COMPENSATION REPORTED IN AVAILABLE SALARY SURVEYS FOR THE PEER GROUP, AND TRENDS IN BENEFITS AND PERQUISITE PROGRAMS CUSTOMARILY AVAILABLE AMONG THE PEER GROUP FOR EXECUTIVES. RECOMMENDATIONS BY THE CONSULTANT ARE PRESENTED TO THE PERSONNEL COMMITTEE WHICH PREPARES MINUTES OF ITS DELIBERATIONS REGARDING EXECUTIVE COMPENSATION INCLUDING RECOMMENDATIONS THAT ARE PROVIDED TO EACH OF THE DIRECTORS OF FISHER-TITUS HEALTH. THE RECOMMENDATIONS TO BE ACTED ON MUST BE APPROVED FIRST BY THE JOINT PERSONNEL COMMITTEE AND THEN BY THE FISHER-TITUS HEALTH'S BOARD OF DIRECTORS. THE MINUTES OF EACH BOARD MEETING WHERE ACTION IS TAKEN REFLECT SUCH ACTION. THE PROCESS IS PERFORMED ANNUALLY IN THE SPRING AND WAS LAST DONE IN MARCH 2021. FORM 990, PART VI, SECTION C, LINE 19 WE ISSUE AN ANNUAL REPORT TO THE COMMUNITY THAT IS PLACED IN THE LOCAL NEWSPAPER AND ON OUR WEBSITE THAT PROVIDES OUR OPERATING FINANCIAL STATEMENT, COMMUNITY BENEFIT FIGURES BROKEN DOWN BY CHARITY CARE & FINANCIAL ASSISTANCE, UNPAID COSTS OF MEDICAID, COMMUNITY HEALTH & OUTREACH PROGRAMS, DONATIONS & COMMUNITY SUPPORT, SUBSIDIZED HEALTH SERVICES & PROFESSIONAL MEDICAL EDUCATION, & UNPAID COSTS OF MEDICARE & BAD DEBT. AS REQUIRED, WE OFFER A TIMELY RESPONSE TO WRITTEN REQUESTS FOR COPIES OF THE 990S AS WELL AS HAVING THE 990S AVAILABLE UPON THE PREMISES FOR THE PUBLIC TO REVIEW AND ON THE GUIDESTAR INTERNET WEBSITE. ADDITIONALLY, OUR CONFLICT OF INTEREST POLICY, CODE OF REGULATIONS, AND GOVERNING DOCUMENTS ARE ALSO AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION A, LINE 1B: INFORMATION RELATING TO FAMILY MEMBERS OF SOME OF THE ORGANIZATION'S GOVERNING BODY COMPENSATED BY THE ORGANIZATION OR INVOLVED IN BUSINESS TRANSACTIONS WITH THE ORGANIZATION IS INCLUDED IN PART IV OF SCHEDULE L, TRANSACTIONS WITH INTERESTED PERSONS. HOWEVER, MEMBERS OF THE ORGANIZATION'S GOVERNING BODY ARE PROMINENT CITIZENS IN THE COMMUNITIES SERVED BY THE ORGANIZATION FOR PURPOSES OF SATISFYING THE COMMUNITY BENEFIT STANDARD ESTABLISHED BY REVENUE RULING 69-545, 1969-2 C.B. 117. FORM 990, PART IX, LINE 11G HEALTHCARE PROVIDERS: PROGRAM SERVICE EXPENSES 4,365,047. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,365,047. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 15,926,677. MANAGEMENT AND GENERAL EXPENSES 4,103,627. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,030,304. FORM 990, PART XI, LINE 9: FASB #158 ADJUSTMENT (CHANGE IN PENSION LIABILTIY) 24,822. PROFIT SHARING RELATED TO PAIN MANAGEMENT 128,339. INTER-SYSTEM TRANSFER OF FUNDS BETWEEN AFFLIATED 501(C)(3) ORGANIZATIONS -1,916,424. CHANGE IN BOND INTEREST SWAP VALUE 130,434. PAIN MANAGMENT JOINT VENTURE DIVIDEND PAYMENTS TO FISHER-TITUS 491,077. NET PERIODIC PENSION & POSTRETIREMENT BENEFIT COST 262,036. 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