2019-11-13T17:46:50-06:00 2018-12-31 910189318 MOSS ADAMS LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2018-01-01 340714583 CITY HOSPITAL ASSOCIATION CITY 3303857200 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 MIKE HEATHER CFO 3303857200 2019-11-09 1 LAUREN A HAVERLOCK P00545829 3104770450 2019-11-09 23.242.64.125 2019-11-09 14:59:09 PS P E99E84FB72D0C5700B098457E985E881114703D2 7D0D6C7A6A5655B0595BBDB8C4257A6B648F0CEB 2018 2020-04-17 16:48:07Z EAST LIVERPOOL CITY HOSPITAL KEITH RICHARDSON 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 75542057 0 X WWW.ELCH.ORG X 1905 OH TO CHAMPION THE QUALITY OF LIFE AND PROVIDE EXCELLENT CARE FOR ALL THAT WE SERVE; BASED SOLELY ON OUR BELIEF IN THE SACRED VALUE OF HUMAN LIFE. 8 6 679 58 0 0 17560 0 82891296 75252346 196093 1855 107858 287856 83212807 75542057 2500 45033 0 0 30059386 31588756 0 0 0 41153438 38179662 71215324 69813451 11997483 5728606 56691528 80715274 13492661 12292922 43198867 68422352 X THE ORGANIZATION PROVIDES HIGH QUALITY, COMPASSIONATE HEALTH CARE SERVICES WITHIN THE AVAILABLE RESOURCES. HEALTHCARE SERVICES WILL BE PROVIDED TO PREVENT ILLNESS, RELIEVE SUFFERING, AID IN HEALTH RESTORATION AND TO PROMOTE WELLNESS. THE ORGANIZATION PROVIDES SERVICES TO ANY PERSON, WITHOUT DISCRIMINATION. 1 0 51526324 45033 75331936 THE ORGANIZATION PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE ORGANIZATION, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO AFFORD ESSENTIAL MEDICAL SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE ORGANIZATION'S COMMITMENT TO SERVE ALL MEMBERS OF THE ORGANIZATIONS COMMUNITY WITH FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COSTS, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY HAVE BEEN CONSIDERED WHERE WHERE THE NEED AND AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THE ORGANIZATION PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE ORGANIZATOIN CONSIDERS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION IN THE ENTIRE COMMUNITY. THE ORGANIZATION IS LOCATED IN EAST LIVERPOOL, OHIO AND SERVICES THE SURROUNDING COMMUNITIES; STAFFING 152 BEDS FOR ACUTE CARE, INTENSIVE CARE, NURSERY, AND SKILLED NURSING IN THE MEDICALLY UNDESERVED AREA. DURING 2017, THE ORGANIZATION PROVIDED NUMEROUS BENEFITS TO THE SURROUNDING COMMUNITY, INCLUDING FINANCIAL SUPPORT THROUGH THE COMMUNITY BENEFIT INITIATIVE PROGRAM. COMMUNITY EDUCATION AND WELLNESS PROGRAMS - THE ORGANIZATION OFFERED THE FOLLOWING TO THE COMMUNITY FREE OR AT A NOMINAL CHARGE:HEALTH FAIRSCPR CLASSESCHILDBIRTH CLASSESGARFIELD ELEMENTARY WELLNESS PROGRAMCOVER THE UNINSURED PROGRAMHEARTSAVER FIRST AID CLASSESADVANCE CARDIAC LIFE SUPPORTHEALTHCARE PROVIDE RECERTIFICATIONBREAST FEEDING SUPPORTPASTORAL OUTREACH PROGRAMSDIABETES EDUCATIONARTHRITIS AQUATICS CLASSESSMOKING CESSATION CLASSESBASICS IN BABYSITTING CLASSESAUTISM SUPPORT GROUPCONDUCTED HOSPITAL TOURS FOR AREA SCHOOLS AND COMMUNITY GROUPS SERVED AS AN OBSERVATION SITE FOR THE HIGH SCHOOL FOR HEALTHPROFESSIONS DEVELOPED BY THE PUBLIC SCHOOLS HOSTED SEVERAL SHADOW STUDENTS FROM AREA SCHOOLS SERVED AS HOST SITE FOR OHIO HIGHER EDUCATION TELECOMMUNICATION SYSTEMOPERATED A PHYSICIAN REFERRAL LINE FREE TO THE COMMUNITY HOSTED PROGRAMS FOR STUDENT NURSES AND RADIOLOGY TECHNICIANS IN TRAININGPROVIDED FOOD TO NEEDY FAMILIES FOR THANKSGIVING, AND GIFTS TO NEEDY CHILDREN FOR CHRISTMAS TO THE SALVATION ARMY DAY OF CARING, DAY OF GIVING PROGRAM - MONEY AND FOOD DRIVE 1556340 205188 THE PODIATRY PROGRAM STARTED JULY 2018 WITH 12 D.P.M.'S. THERE ARE FOUR IN THEIR FIRST YEAR, FOUR IN THEIR SECOND YEAR AND FOUR IN THEIR FOURTH YEAR. 53082664 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 75 0 1 679 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X MELISSA BRACONE 3303863096 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 KEITH RICHARDSON CEO (REGIONAL) AND SECRETARY 40.00 0.30 X X 345480 0 27067 GREGORY BRICKER DIRECTOR 1.00 0.00 X 0 0 0 DAVID HAMILTON TREASURER 1.00 0.00 X X 0 0 0 TAMMIE MCINTOSH CHAIRMAN 1.00 0.00 X 0 0 0 MARK MANGANO DIRECTOR 1.00 0.00 X 0 0 0 GRETCHEN NICKELL DO DIRECTOR 1.00 40.00 X 0 119000 0 ROBERT O'HARA DIRECTOR 1.00 0.00 X 0 0 0 JOSEPH SHEMASEK PAST CHAIRMAN 1.00 0.30 X 0 0 0 MIKE SARIAN PRESIDENT 1.00 10.00 X 0 0 0 WILLIAM FOWLER CFO (REGIONAL) 40.00 1.00 X 125957 0 11542 MIKE HEATHER CFO 1.00 10.00 X 0 0 0 JAYNE ROSE C.N.O. 40.00 0.00 X 156399 0 18030 NICHOLAS PETRUSKA II PHARMACIST 40.00 0.00 X 124135 0 15094 MICHAEL DALEY PHARMACIST 40.00 0.00 X 116544 0 21870 WILLIAM SMITH DIRECTOR OF PHARMACY 40.00 0.00 X 134816 0 21870 SANDRA HALSTEAD DIRECTOR OF SURGERY 40.00 0.00 X 113378 0 21870 1116709 119000 137343 13 0 1 0 PRIME HEALTHCARE MANAGEMENT II 3300 E GUASTI ROAD 3RD FLOOR ONTARIO CA 91761 MANAGEMENT 4002135 HOSPITAL BUSINESS SOLUTIONS 3300 E GUASTI ROAD 3RD FLOOR ONTARIO CA 91761 BUSINESS OFFICE SERVICES 1562484 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 1347968 OHIO VALLEY ANESTHETISTS LLC 425 WEST 5TH STREET EAST LIVERPOOL OH 43920 ANESTHESIA 1027000 MEDLINE THREE LAKES DRIVE NORTHFIELD IL 60093 MEDICAL SUPPLIES 976587 2 NET PATIENT REVENUE 621500 75252346 75252346 75252346 1855 1855 CAFETERIA/VENDING 900099 57370 57370 HEALTH EDUCATION 900099 15457 15457 LEGAL FEE REIMBURSEMENT 900099 3078 3078 211951 211951 287856 75542057 75537124 0 4933 X 45033 45033 540247 304609 235638 23860870 14316522 9544348 323480 323480 5082403 5082403 1781756 1300681 481075 4002135 4002135 114948 114948 10415800 9746103 669697 127120 109323 17797 138652 93943 44709 110559 66335 44224 113923 97974 15949 312690 312690 2729016 2729016 248456 248456 BAD DEBT EXPENSE 9672962 9672962 MEDICAL SUPPLIES 5935012 5341511 593501 REPAIRS AND MAINTENANCE 1519895 911937 607958 TAXES AND LICENSES 459227 459227 2279267 1920459 358808 69813451 53082664 16730787 0 6787360 8595934 2021131 11289141 9315081 477259 823866 272412 648352 16236261 7945132 8723842 8291129 145005 2037883 1343222 1240556 25632156 49762473 56691528 80715274 5195252 5219741 213091 95254 8084318 6977927 13492661 12292922 X 43198867 68422352 43198867 68422352 56691528 80715274 5728606 388586 19106293 0 X X 0 1 X 1 0 X 0 0 0 0 0 1 1326 0 0 0 1326 0 PART II-B, LINE 1: AMOUNT REPORTED IN PART II-B, LINE 1F REPRESENTS PORTION OF DUES PAID TO TRADE ASSOCATIONS THAT IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 918703 918703 6012698 3844767 2167931 253305 75000 178305 7525561 3613641 3911920 1525994 411724 1114270 8291129 DUE FROM COSHOCTON REGIONAL 25526 DUE FROM PRIME HEALTHCARE MANAGEMENT 114753 DUE FROM KEENAN 1518718 DUE FROM EAST LIVERPOOL MEDICAL GROUP 31701555 DUE FROM OHIO VALLEY HOME HEALTH 1594588 DUE FROM OHIO VALLEY HOME CARE 151980 DUE FROM FOUNDATION 14655353 49762473 CAPITAL LEASES 1009036 DUE TO AFFILIATES 2967472 IBNR 795881 OTHER CURRENT LIABILITIES 1345 INTEREST RATE SWAP 2204193 6977927 X PART X, LINE 2: THE LITERATURE RELATED TO UNCERTAIN TAX POSITIONS PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR ACCOUNTING FOR UNCERTAIN TAX POSITIONS AND ALSO PROVIDES GUIDANCE ON VARIOUS RELATED MATTERS SUCH AS DE-RECOGNITION, INTEREST, PENALTIES AND DISCLOSURES REQUIRED. THE COMPANY DOES NOT HAVE ANY ENTITY-LEVEL UNCERTAIN TAX POSITIONS. 1 1 1 X 350.000000000000 1 X 450.000000000000 1 1 0 0 1005224 692138 313086 0.00450 12075229 4874946 7200283 0.10310 13080453 5567084 7513369 0.10760 1389918 879107 510811 0.00730 20538 20538 0.00030 1410456 879107 531349 0.00760 14490909 6446191 8044718 0.11520 1 9672963 4159374 17473009 16958844 514165 X 1 1 1 1 EAST LIVERPOOL CITY HOSPITAL 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 WWW.ELCH.ORG 11418 X X EAST LIVERPOOL CITY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE PART V, PAGE 8 X 1 16 1 SEE PART V, PAGE 8 0 1 X 350.000000000000 450.000000000000 X X X X X 1 1 X X X 1 X SEE SUPPLEMENTAL INFO X SEE SUPPLEMENTAL INFO X SEE SUPPLEMENTAL INFO X X X X X X 1 X 0 X X X X 1 X 0 0 EAST LIVERPOOL CITY HOSPITAL PART V, SECTION B, LINE 5: PRIMARY QUALITATIVE DATA TO REFLECT INPUT FROM THE BROAD COMMUNITY AND VULNERABLE POPULATIONS WAS COLLECTED SPECIFICALLY FOR THIS ASSESSMENT AND INCLUDED A TOTAL OF SEVENTEEN IN-DEPTH STAKEHOLDER INTERVIEWS, FOUR FOCUS GROUPS REFLECTING 49 PARTICIPANTS, AND 417 SURVEYS COMPLETED BY INDIVIDUALS REPRESENTING DIVERSE CONSTITUENT GROUPS. IN ADDITION TO GATHERING INPUT FROM FOCUS GROUPS AND STAKEHOLDER INTERVIEWS, INPUT AND GUIDANCE ALSO CAME FROM THE COMMUNITY REPRESENTATIVES, WHO SERVED ON THE COLUMBIANA COUNTY HEALTH PARTNERS STEERING COMMITTEE. SEVENTEEN STAKEHOLDER INTERVIEWS WERE CONDUCTED FROM JANUARY 21-APRIL 16, 2016 BY MEMBERS OF THE STEERING COMMITTEE. STAKEHOLDERS INTERVIEWED INCLUDED INDIVIDUALS WITH EXPRETISE IN THE FOLLOWING DISCIPLINES AND/OR ORGANIZATIONAL AFFILIATIONS.STAKEHOLDERS INTERVIEWED:- SCHOOL DISTRICTS- CASE MANAGEMENT AT EACH HOSPITAL- CATHOLIC CHARITIES- JUVENILE JUSTICE SYSTEM- LOCAL GOVERNMENT / COUNTY COMMISSIONERS- COMMUNITY RESOURCE CENTER- HEALTH AND HUMAN SERVICE PROVIDERS- FOOD PANTRY- MENTAL HEALTH AND RECOVERY- YOUTH SERVICES- VISITING NURSES ASSOCIATION- FAITH-BASED ORGANIZATIONS PROVIDING ASSISTANCE- HISPANIC COMMUNITY EAST LIVERPOOL CITY HOSPITAL PART V, SECTION B, LINE 6A: PARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE: COLUMBIANA COUNTY EDUCATIONAL SERVICE CENTER, COLUMBIANA COUNTY GENERAL HEALTH DISTRICT, COLUMBIANA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD, COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, EAST LIVERPOOL CITY HEALTH DEPARTMENT, EAST LIVERPOOL CITY HOSPITAL, RIVER VALLEY PHYSICIANS, SALEM CITY HEALTH DEPARTMENT, AND SALEM REGIONAL MEDICAL CENTER. EAST LIVERPOOL CITY HOSPITAL PART V, SECTION B, LINE 6B: PARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE: COLUMBIANA COUNTY EDUCATIONAL SERVICE CENTER, COLUMBIANA COUNTY GENERAL HEALTH DISTRICT, COLUMBIANA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD, COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, EAST LIVERPOOL CITY HEALTH DEPARTMENT, EAST LIVERPOOL CITY HOSPITAL, RIVER VALLEY PHYSICIANS, SALEM CITY HEALTH DEPARTMENT, AND SALEM REGIONAL MEDICAL CENTER. EAST LIVERPOOL CITY HOSPITAL PART V, SECTION B, LINE 11: EAST LIVERPOOL CITY HOSPITAL, SALEM REGIONAL CENTER AND THE COLUMBIANA COUNTY GENERAL HEALTH DISTRICTS HAVE BEEN COLLABORATING ON THEIR COUNTY-WIDE CHNA PLANNING EFFORTS SINCE 2013, AND HAVE ADDRESSED AT LEAST TWO OF OHIO'S HEALTH PRIORITIES IN EACH PLANNING CYCLE. IN ADDITION, THE LOCAL HEALTH DEPARTMENTS AND HOSPITALS HAVE ALIGNED WITH A THREE-YEAR TIMELINE FOR CONDUCTING ASSESSMENTS AND PLANNING, BEGINNING IN 2013 AND CONTINUING INTO THE 2016 CHNA PLANNING CYCLE.COLUMBIANA COUNTY'S EXISTING POPULATION HEALTH PLANNING INFRASTRUCTURE WILL CONTINUE TO COLLABORATE ON THE DEVELOPMENT OF FUTURE STRATEGIES TO BE DETERMINED BY THE COLUMBIANA HEALTH PARTNERS AS A RESULT OF THIS CHNA, INCLUDING IDENTIFYING ENHANCED OPPORTUNITIES TO:- DETERMINE PRIORITIES, OBJECTIVES, IMPLEMENTATION, STRATEGIES, ONGOING EVALUATION AND A COMMUNICATION PLAN- STANDARDIZE ASSESSMENT TIMELINES AND PROVIDE AN INTEGRATED DEFITION OF COMMUNITY- EFFICIENTLY COLLECT AND SHARE POPULATION-LEVEL AND CLINICAL DATA- PURSUE COLLABORATE PARTNERSHIPS FOR IMPLEMENTING EVIDENCE-BASED, COMMUNITY HEALTH IMPROVEMENT ACTIVITIES- DEFINE STANDARDS FOR TRACKING PROGRESS AND EVALUATING THE IMPACT OF IMPLEMENTED ACTIVITIESDURING THE MAY 2, 2016 COLUMBIANA COUNTY HEALTH PARTNERS' CHNA WORK GROUP MEETING, THE PARTICIPANTS AGREED THAT THE 2016 CHNA INITIATIVES SHOULD FOCUS ON THREE MAJOR PRIORITY CATEGORIES AS SELECTED FROM THE PRIORITIZATION SURVEY'S 52 OPTIONS. THESE WERE SORTED AND RANKED BY THE PRIORITIZATION CRITERIA OF MAGNITUDE AND IMPACT. THE THREE MAJOR PRIORITY CATEGORIES SELECTED INCLUDE: OBESITY, MENTAL HEALTH/SUBSTANCE ABUSE, AND TOBACCO USE/CANCER PREVENTION. SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A CHNA REPORT AND IMPELEMENTATION PLAN ARE AVAILABLE ON THE HOSPITAL FACILITY'S WEBSITE:HTTP://WWW.ELCH.ORG/ABOUT-US/COMMUNITY-HEALTH.ASPX SCHEDULE H, PART V, SECTION B, LINE 16 THE FAP, FAP APPLICATION, AND FAP PLAIN LANGUAGE SUMMARY CAN BE FOUND HERE:HTTP://WWW.ELCH.ORG/PATIENTS-VISITORS/INSURANCE-FINANCIAL-INFO.ASPX PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS FROM THE 2018 MEDICARE COST REPORT. PART III, LINE 8: THE HOSPITAL CONTENDS THAT THE ENTIRE AMOUNT OF THE MEDICARE SURPLUS SHOULD ALSO BE CONSIDERED AS A COMMUNITY BENEFIT. THE REASON FOR THIS IS THAT THE MEDICARE RATES ARE SET UNILATERALLY BY THE FEDERAL GOVERNMENT AND THE HOSPITAL AGREES TO SERVICE THESE PATIENTS AT THESE RATES AS PART OF OUR MISSION AND SERVICE TO THE COMMUNITY.THE COST INCLUDED ON LINE 6 COMES FROM THE MEDICARE COST REPORT WHICH THE FEDERAL GOVERNMENT HAS SET UP AS THEIR WAY TO CAPTURE AND SEGREGATE THE COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS. PART III, LINE 9B: THE HOSPITAL PRACTICE IS THAT UPON VERIFICATION THAT A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, THE HOSPITAL DISCONTINUES COLLECTION EFFORTS AND MAKES THE APPROPRIATE ADJUSTMENT TO THE PATIENT'S ACCOUNT BASED UPON THE PATIENT'S INDIVIDUAL CIRCUMSTANCES. SCHEDULE H, PART III, SECTION A, LINE 4 THE COMPANY'S PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE COMPANY ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCES FOR BOTH CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THESE ALLOWANCES. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE COMPANY RECORDS A PROVISION FOR DOUBTFUL ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY REPSONSIBLE. THE DIFFERENCE BETWEEN EXPECTED RATES (OR DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART VI, LINE 2 ONGOING EFFORTS AND EVALUATION OF MANAGEMENT, STAFF, PHYSICIANS WITH FEEDBACK FROM PATIENTS AND COMMUNITY. DEMOGRAPHIC RESEARCH AND STUDIES ALSO UTILIZED TO DETERMINE TYPE AND QUANTITY OF SERVICES NEEDED BY SPECIALTY TO BEST SERVE OUR COMMUNITY. SCHEDULE H, PART VI, LINE 3 INFORMATION REGARDING FINANCIAL ASSISTANCE AND CHARITY CARE IS MADE AVAILABLE AT TIME OF REGISTRATION, ON THE HOSPITAL'S WEBSITE, AND ON PATIENT STATEMENTS. APPLICATIONS ARE ALSO MADE AVAILABLE TO PATIENTS AT TIME OF REGISTRATION IF APPROPRIATE.IN ORDER TO ENSURE THAT PATIENTS ARE AWARE OF THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY, THE HOSPITAL WIDELY DESSEMINATES THE EXISTENCE AND TERMS OF THIS POLICY THROUGHOUT ITS SERVICE AREA. IN ADDITION TO OTHER APPOPRIATE EFFORTS TO INFORM THE COMMUNITY ABOUT THE POLICY IN A WAY TARGETED TO REACH COMMUNITY MEMBERS MOST LIKELY TO NEED FINANCIAL ASSISTANCE, THE FOLLOWING ACTIONS ARE TAKEN:A. WRITTEN NOTICE TO ALL PATIENTSEACH PATIENT WHO IS SEEN, WHETHER ADMITTED OR NOT, SHALL RECEIVE THE PLAIN LANGUAGE SUMMARY. THE NOTICE SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.B. POSTING OF NOTICESTHE FINANCIAL ASSISTANCE POLICY SHALL BE CLEARLY AND CONSPICUOUSLY POSTED IN LOCATIONS THAT ARE VISIBLE TO THE PATIENTS IN THE FOLLOWING AREAS: (1) EMERGENCY DEPARTMENT; (2) BILLING OFFICE; (3) ADMISSIONS OFFICE; AND (4) OTHER OUTPATIENT SETTINGS. THE NOTICE SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.C. NOTICE TO ACCOMPANY BILLING STATEMENTSEVERY POST-DISCHARGE STATEMENT SHALL INCLUDE A COPY OF THE NOTICE. EACH BILL THAT IS SENT TO A PATIENT WHO HAS NOT PROVIDED PROOF OF COVERAGE BY A THIRD PARTY AT THE TIME CARE IS PROVIDED OR UPON DISCHARGE MUST INCLUDE A STATEMENT OF CHARGES FOR SERVICES RENDERED BY THE HOSPITAL. THESE NOTICES SHALL BE PROVIDED IN NON-ENLGISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.D. AVAILABILITY OF FINANCIAL ASSISTANCE DOCUMENTSTHE HOSPITAL SHALL POST A COPY OF THIS POLICY, THE PLAIN LANGUAGE SUMMARY AND THE FINANCIAL ASSISTANCE APPLICATION ON ITS WEBSITE AND MAKE ALL SUCH DOCUMENTS AVAILABLE FOR FREE DOWNLOAD. SUCH DOCUMENTS SHALL BE AVAILABLE IN THE EMERGENCY ROOM AND ADMISSIONS OFFICE AND BY MAIL UPON REQUEST. THE DOCUMENTS SHALL BE PROVIDED IN NON-ENLGISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.E. ACCESSIBILITY TO LIMITED ENGLISH PROFICIENT INDIVIDUALSTHE HOSPITAL SHALL MAKE TRANSLATIONS OF THIS POLICY, THE PLAIN LANGUAGE SUMMARY, AND THE FINANCIAL ASSISTANCE APPLICATION AVAILABLE IN ANY LANGUAGE THAT IS THE PRIMARY LANGUAGE OF THE LESSER OF ONE THOUSAND (1,000) INDIVIDUALS OR FIVE PERCENT (5%) OF THE POPULATION OF THE COMMUNITIES SERVED BY THE HOSPITAL. SCHEDULE H, PART VI, LINE 4 COLUMBIANA COUNTY, OHIO COLUMBIANA COUNTY IS LOCATED IN NORTHEASTERN OHIO AND IS ONE OF OHIO'S 32 APPALACHIAN COUNTIES. IT IS BORDERED ON THE NORTH BY MAHONING COUNTY; ON THE EAST BY PENNSYLVANNIA; ON THE SOUTH BY THE OHIO RIVER AND WEST VIRGINIA; AND ON THE WEST BY JEFFERSON, CARROLL AND STARK COUNTIES. OVER HALF OF THE COUNY'S TOTAL POPULATION OF 105,686 LIVES IN UNINCORPORATED RURAL AREAS, WITH VILLAGES AND TOWNS SOME DISTANCE APART.THE COUNTY HAS TWO MAJOR GEOGRAPHIC CONCENTRATIONS OF DEVELOPMENT AND POPULATION. THE NORTHERN CORRIDOR BETWEEN THE CITIES OF SALEM AND EAST PALESTINE, (INCLUDING THE VILLAGES OF WASHINTONVILLE, LEETONIA, COLUMBIANA AND NEW WATERFORD AND THE FOUR TOWNSHIPS OF PERRY, SALEM, FAIRFIELD AND UNITY); EXTEND ALONG A 20-MILE DISTANCE BORDERING MAHONING COUNTY TO THE NORTH, AND CONTAIN ALMOST 48% OF THE COUNTY'S POPULATION. THE SOUTHERN CORRIDOR EXTENDS FOR ABOUT 10 MILES FROM THE VILLAGE OF WELLSVILLE TO EAST LIVERPOOL, (INCLUDING ST. CLAIR TOWNSHIP) AND CONTAINS 11% OF THE COUNTY'S TOTAL POPULATION.EAST LIVERPOOL CITY HOSPITAL IS THE ONLY HOSPITAL WITHIN 20 MILES OF THE CITY. THE HOSPITAL SERVES PATIENTS WITHIN A 10-15 MILE RADIUS INCLUDING PATIENTS FROM NEIGHBORING PENNSYLVANIA AND WEST VIRGINIA. MOST RESIDENTS HAVE LIVED HERE ALL THEIR LIVES AND THE COMMUNITY IS COMPRISED OF A SIGNIFICANT BIAS OF SENIOR CITIZENS. SCHEDULE H, PART VI, LINE 5 EAST LIVERPOOL CITY HOSPITAL HAS AN OPEN MEDICAL STAFF, A COMMUNITY BOARD OF TRUSTEES AND IS EXTREMELY GENEROUS WITH FUNDING COMMUNITY CHARITIES AND DONATING EMPLOYEE TIME TO SERVE THE GENERAL POPULATION OF THE AREA SERVED. THIS INCLUDES PARTICIPATING IN COMMUNITY HEALTH FAIRS, SCHOOL PROGRAMS, AND FREE PUBLIC SPEAKING REGARDING TOPICS RECOGNIZED AS IMPLEMENTATION PRIORITIES IN THE 2016 CHNA. ELCH OFFERS FREE SMOKING CESSATION, DIABETES EDUCATION, AND HEALTH NUTRITION TO ALL COMMUNITY MEMBERS.PERCENT OF TOTAL EXPENSEBAD DEBT EXPENSE OF $9,672,963 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEMCITY HOSPITAL ASSOCIATION IS A SUBSIDIARY OF PRIME HEALTHCARE FOUNDATION, INC. (PHF). PHF AND ITS SUBSIDIARIES ARE THEIR OWN HEALTH SYSTEM MANAGED BY PRIME HEALTHCARE MANAGEMENT II, INC. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT THIS IS NOT APPLICABLE TO CITY HOSPITAL ASSOCIATION. 0 THE EAST LIVERPOOL COMMUNITY PARTNERSHIP FOR REVITALIZATION PO BOX 252 EAST LIVERPOOL OH 43920 474229560 501(C)(3) 15000 TITLE SPONSOR FOR JAZZ AND BBQ FESTIVAL 1 X X 1 1 0 0 0 0 0 0 0 1 0 KEITH RICHARDSON CEO (REGIONAL) AND SECRETARY 310240 0 35240 0 0 0 0 0 27067 0 372547 0 0 0 JAYNE ROSE C.N.O. 145000 0 11399 0 0 0 0 0 18030 0 174429 0 0 0 WILLIAM SMITH DIRECTOR OF PHARMACY 134816 0 0 0 0 0 0 0 21870 0 156686 0 0 0 PART I, LINE 1A CITY HOSPITAL ASSOCIATION ALLOWS COMPANION TRAVEL BY EXECUTIVES ONLY WHEN IT SERVCES A JUSTIFIED BUSINESS PURPOSE. IF IT IS LATER DETERMINED THAT THERE WAS NOT A JUSTIFIED BUSINESS PERPOSE, THIS WILL RESULT IN TAXABLE COMPENSATION TO THE EXECUTIVE IN QUESTION. CITY HOSPITAL ASSOCIATION PROVIDES A MEMBERSHIP TO AN AREA SOCIAL CLUB IN ORDER FOR EXECUTIVES TO CONDUCT HOSPITAL BUSINESS. ANY PERSONAL USE BY THE EXECUTIVES IS INCLUDED IN THAT EXECUTIVE'S TAXABLE WAGES. PART I, LINE 3 A RELATED ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY OFFICER COMPENSATION IS ESTABLISHED BY PRIME HEALTHCARE MANAGEMENT II, INC. IN ACCORDANCE WITH A MANAGEMENT AGREEMENT. WRITTEN EMPLOYMENT CONTRACTS ARE FORWARDED TO THE FACILITY ONCE EXECUTED. COMPENSATION SURVEY OR STUDIES ARE UTILIZED. PRIME HEALTHCARE MANAGEMENT II INC SEE PART V 4002135 MANAGEMENT FEE 1 HOSPITAL BUSINESS SOLUTIONS INC SEE PART V 1562484 BUSINESS OFFICE SERVICES 1 PART IV, LINES (1) AND (2), COLUMN (B) ENTITY IS INDIRECTLY, CONSTRUCTIVELY OWNED MORE THAN 35% BY AN OFFICER OF THE ORGANIZATION. FORM 990, PART III, LINE 2 PODIATRIC RESIDENCY PROGRAM FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION IS BEING MANAGED BY PRIME HEALTHCARE MANAGEMENT II, INC., AN AFFILIATE OF PRIME HEALTHCARE FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 6 SOLE CORPORATE CONTROLLING MEMBERSHIP OF THE HOSPITAL WAS TRANSFERRED TO PRIME HEALTHCARE FOUNDATION, INC. (PHF). FORM 990, PART VI, SECTION A, LINE 7A PRIME HEALTHCARE FOUNDATION, INC. (PHF) HAS THE POWER TO APPOINT THE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B PRIME HEALTHCARE FOUNDATION, INC. (PHF), THE SOLE CORPORATE MEMBER, HOLDS CERTAIN RESERVED POWERS AS SET FORTH IN THE ARTICLES OF INCORPORATION. PHF HAS THE POWER TO APPOINT THE BOARD MEMBERS AND APPROVE ANY AMENDMENTS OF THE ORGANIZATION'S ARTICLES OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORMS ARE REVIEWED BY THE ORGANIZATION'S CFO AND OUTSIDE COUNSEL PRIOR TO FILING AND THEN THE RETURNS ARE PROVIDED TO THE BOARD FOR THEIR REVIEW CONTEMPORANEOUSLY WITH THEIR FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE REVIEW OF QUESTIONNAIRES THAT OFFICERS, DIRECTORS, AND KEY EMPLOYEES COMPLETE ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 A RELATED ORGANIZATOIN USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY OFFICER COMPENSATION IS ESTABLISHED BY PRIME HEALTHCARE MANAGEMENT II, INC. IN ACCORDANCE WITH A MANAGEMENT AGREEMENT. WRITTEN EMPLOYMENT CONTRACTS ARE FORWARDED TO THE FACILITY ONCE EXECUTED. COMPENSATION SURVEY OF STUDIES ARE UTILIZED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,684,831. MANAGEMENT AND GENERAL EXPENSES 669,697. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,354,528. MEDICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 864,081. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 864,081. COLLECTION FEES: PROGRAM SERVICE EXPENSES 62,490. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,490. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,134,701. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,134,701. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT MAKE ANY CHANGES TO EITHER IT'S OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR. PRIME HEALTHCARE FOUNDATION INC 3300 E GUASTI ROAD SUITE 300 ONTARIO CA 91761 208065139 HOSPITAL/MGMT DE 501(C)(3) LINE 3 N/A 0 OHIO VALLEY HOME HEALTH SERVICES 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 341014198 HEALTHCARE OH 501(C)(3) LINE 10 PHF-EAST LIV 0 KNAPP MEDICAL CENTER 1401 E 8TH STREET-PO BOX 1110 WESLACO TX 78596 741393060 HOSPITAL TX 501(C)(3) LINE 3 PHF 0 MID-VALLEY PHYSICIANS ASSOCIATION 1401 E 8TH STREET WESLACO TX 78596 742755150 SUPPORT TX 501(C)(3) LINE 11 KMC 0 KNAPP MEDICAL GROUP 1401 E 8TH STREET WESLACO TX 78596 271619835 HEALTHCARE TX 501(C)(3) LINE 3 KMC 0 CALIFORNIA UNIVERSITY OF SCIENCE AND MEDICINE 3300 E GUASTI ROAD SUITE 300 ONTARIO CA 91761 464141445 EDUCATION CA 501(C)(3) LINE 2 PHF 0 MISSION HOSPITAL INC 900 SOUTH BRYAN ROAD MISSION TX 78572 742206635 HOSPITAL TX 501(C)(3) LINE 3 PHF-MISSION 0 MISSION HOSPITAL FOUNDATION 900 SOUTH BRYAN ROAD MISSION TX 78572 542076455 SUPPORT TX 501(C)(3) LINE 11 MISSION HOSP 0 MISSION DOCTORS GROUP 906 SOUTH BRYAN ROAD SUITE 209 MISSION TX 78572 742798500 HEALTHCARE TX 501(C)(3) LINE 3 MISSION HOSP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0